A 45Years old male patient with Decreased sensation of Right foot.

THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT 
CHEIF COMPLAINTS:-
Patient complaint of decreased sensation of Right foot.
Blackish discolouration of right toe since 2 weeks
Bedsore on the back since 1month.
H/O previous amputation of left leg above knee .
HISTORY OF PRESENT ILLNESS :-
Patient was apparently asymptomatic 1month back,then he developed Ulcer over the lower back of body  which is the dependent portion while he was lying in supine position .
It is gradual in onset and progressive in nature.
No H/O of discharge. 
No  H/O of fever. 
L/E of ulcer
A 4×3cm ulcer was present over the coccygeal region. 
Margins are inflamed.
Edges are slopy
Floor is covered with slough.
Base is the bone.
L/E of right leg
Blackish discolouration present over the right great toe extending upto the base of the great toe.
Line of demarcation is Positive. 
Surrounding skin is normal.
HISTORY OF PAST ILLNESS :-
K/C/O DM since 8years .
K/C/O  Chronic hyponatremia since 5months.
H/O acute necrotizing fascits 4months back for which above knee amputation was done followed by skin grafting
K/C/O Hypothyroidism since 1year and is on 25microgm Thyroxine.
Not a K/C/O Hypertension, Tuberculosis, Asthma,epilepsy. 
PREVIOUS TREATMENT HISTORY:-
Blood transfusion-yes
Surgery of left leg 
PERSONAL HISTORY:-
Married 
Occupation- farmer
Appetite-Normal
Diet- nonveg
Bowel- regular
Micturition- normal
No known allergies 
No known habits or Addictions
FAMILY HISTORY:-
no significant family history 
GENERAL EXAMINATION:-
no pallor, cyanosis, icterus, lymphadenopathy, clubbing of fingers or toes, Oedema of feet, malnutrition, dehydration. 
VITALS:-
Temp- afebrile 
Pr- 76/ min
Rr-16/ min
Bp-130/70 mm /Hg
Spo2- 98%
SYSTEMIC EXAMINATION:-
 a)CVS - S1 S2 Positive 
b)Respiratory system  -BAE Positive 
c)Abdomen- soft, non tender
d)CNS
    Level of consciousness- alert
    Speech- normal 
     Signs of meningeal irritation like neck           
      Stiffness, kerning 's sign- no
     Cranial system, motor system, sensory 
     system- normal.
     no cerebral signs
INVESTIGATIONS:-
ECG
Left leg 
Bacterial culture and sensitivity report
Specimen wound swab is sent for culture
Plenty of disintegrated pus cells, plenty of gram negative bacilli few gram Positive cocci in singles are seen
E.coli isolated 
TREATMENT:-
Diabetic diet
T.pan 40mg PO OD
T.HIFENAC-P PO BD
Inj.PIPTAZ 4.5gm IV BD
Tab.BACTRAM DS PO BD
IVF-NS @ 75ml per hour 
T.MVT PO OD
Syp.POTCLDR 15ml PO BD
GRBS monitoring 6th hourly
Inj.HAI subcutaneously







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