DIABETES COMPLICATIONS: THE DIABETIC FOOT

The diabetic foot occurs due to decreased blood supply to lower limbs due to accelerated arterial hardening also called atherosclerosis, nerve damage which leads to decreased sensation in foot, tight fitting shoes etc. Since there is poor blood and nerve supply, even a small trauma or infection can cause a very serious damage which can lead to even amputation of limbs. Below is a video of diabetic foot in an uncontrolled diabetic patient.

Treatment includes antibiotics, daily dressing of the wound with vitE, trental ointments (which increase blood flow in lower limbs) can be used. 

Surgical management includes debridement of the infected area and then dressing and antibiotics. If that doesnt help then amputation is the last resort.

DIABETES MELLITUS

Diabetes mellitus is a group of metabolic disease in which patient cant utilize glucose present in the body either due to decreased insulin or due to insulin resistance in body. There are basically two types of diabetes:

• Diabetes Mellitus Type I: It occurs due to destruction of insulin producing cells ( beta-cells) in the islet of Langerhans of pancreas. This occurs due to some autoimmune disorders, pancreatitis, infections. Destruction of beta-cells leads to decreased production of insulin. Insulin is required by muscle cells to draw the sugar in blood into themselves. But in absence of insulin they cant do it and sugar remains circulating in blood leading to a rise in blood sugar level i.e. Diabetes.

• Diabetes Mellitus Type II: This type usually occurs in obese people in whom resistance to insulin developes. So there is insulin but muscle cant use them for glucose uptake as insulin cant attach to its receptors because the receptors becomes defective. Pancreas tries to overcome to this situation by producing increased amount of insulin, which leads to increased weight in turn. But after some period of time the pancreas gets exhausted of overwork and the insulin levels start to decline.

Symptoms: The patient usually feels lethargic, due to decreased amount of glucose in muscle. Thirst, Polyuria occur when kidneys no longer can retain the sugar lost in urine leading to increased osmotic outflow. Increased appetite is also a symptom.

Usually in type I diabetes the symptoms lead to diagnosis at once but there is no hidden disease while in type II patient develops symptoms very late and is diagnosed late or accidentally during regular check up.

Treatment:

Type I can be treated by using insulin, combination of insulins.

Type II: Here diet and lifestyle modification along with oral hypogycemics like metformin is prescribed. Exercise usually helps to decrease the insulin resistance. But after a few years when beta cell get exhausted of producing excess insulin, recombinant  insulin injections are required.

WHAT IS STUDENTS ELBOW

Olecranon bursitis also known as student elbow is a condition in which there is pain, redness, swelling around the olecranon due to inflammation of the elbow bursa. The bursa is located on the extensor surface near the extreme proximal end of ulna.

CAUSES: It is usually caused by trauma to to the elbow like a hard blow to the elbow or repeated minor injuries to the elbow for example while studying. Due to the injury the bursa starts producing larger amount of fluid than normal exceeding the normal rate and gets accumulated in the bursa leading to swelling and pain.

Infection of bursa is also one of the cause.

TREATMENT: Usually the 1st treatment is rest and avoiding further injuries to the elbow.

Aspiration of the fluid and injecting steroid into the bursa to reduce inflammation is also one of the practices.

Antibiotics can be prescribed if inection is suspected.

Surgical resection of bursa can also be done if medical management fails.

Here is a video by Dr Vikram Singh Yadav of aspiration and steroid injection into the bursa.

PERCUTANEOUS NEPHROSTOMY VIDEO

Here is a video showing how PCN is done. Dr Vikram has explained it in the video very well. 

Indications for PCN are:

• Pelvi-Ureteric Junction Obstruction
• Renal abscesses, urinomas
• PUJ obstruction secondary to stone
• Urine diversion in obstruction during pregnancy
• Treatment regarding any fistulas due to iatrogenic or traumatic injuries, malignant or inflammatory fistulas.

Contra-Indications include:

• Bleeding diathesis
• Unco-operative patient
• Severe hyperkalemia (>7) -- Do dialysis first then the procedure

Urethral Stricture

It is abnormal narrowing of urethra due to trauma, STDs or urethritis.

Causes:-

• Inflammation or scar tissue formation due surgery, disease or injury
• Pressure from enlarging tumor
• instrumentation of urethra eg. cystoscopy
• STDs
• H/O repeated urethritis

Symptoms:-

• Decreased stream of urine
• Incomplete emptying of bladder with terminal dribling of urine
• Urinary intermittency
• Frequent micturition
• Acute or chronic retention of urine

Complications:-

• Urinary retention
• Bilateral hydronephrosis
• • Urinary infections
  • Urinary calculi

  Diagnosis:-
  
  
  • Urine routine examination with microscopy
  • Urine culture
  • Retrograde Urogram (RGU)
  • Post void residual urine
  • Cystoscopy

  Treatment:-
  
  
  • Instrumentation with bougies or catheter depending on severitySurgery eg urethrostomy or urethroplasty can be done

WHAT ARE SEBACEOUS CYSTS

A sebaceous cyst is closed sac under the skin filled with sebum which in a cheesy or oil like material. These cysts are sometimes called epidermal cysts. They are basically caused by blocked sebaceous gland, trauma, swollen sebaceous glands, excessive amounts of testosterone. Usually they present as painless nodule under the skin, can occur anywhere in the body. If they get infected, redness, pain, warm skin and tenderness appear around the area and cheesy like material may drain from the area.


How To Remove A Sebaceous Cyst by VideojugBeautyandStyle
 
Treatment usually include surgical removal of the cyst. If properly removed along with the wall and sac, cyst will not recur. If it gets infected, the cyst is 1st drained and patient is kept on antibiotic treatment. When infection gets settled the cyst is then excised.

This is a sebaceous cyst excised from back of patient

ASPIRATION OF GANGLION CYST AND INJECTING STEROID INJECTION INTO IT

O.k few days earlier I discussed about ganglion cysts, what are they, their treatment modalities. Here is a video showing how to aspirate and then inject kenacort into the cyst.

1st we clean the area and then apply some local anesthetic. When the area becomes numb we insert a wide bore needle into it and then aspirate the fluid. Then keeping the needle in place we replace the syringe with the kenacort (steroid) loaded syringe and then inject it into the cyst.

What Are Ganglion Cysts

Ganglion cysts are found most commonly at the dorsum of hand near the wrist joint or fingers. The can also be found near other joint. They are hard, somtimes painfull swellings, which on applying pressure move away, the movement is restricted on flexion/ extension of wrist, and on applying light the light is transmitted through the cyst as it contains clear fluid i.e. transillumination is positive.

Cyst usually resolves itself

Treatment options include aspiration and then injection with steroid e.g. triamcinolone (kenakort) or surgical excision. Although there is higher rate of recurrence.

DIABETIC FOOT

Diabetic foot usually occurs in patients with uncontrolled diabetes. It is one of the most serious complications of diabetes mellitus. It usually occurs due to blood supply problems in lower limbs, and peripheral neuropathy both occuring due to high levels of blood sugar. Many patients with ulcer result in lower limp amputation if not treated early with good diabetic controll and antibiotics.

Here is a video of a patient with diabetic foot. He had an unctrolled diabetes for 3-4 yrs.

ACNE VULGARIS

O.k, first of all vulgaris doesnt mean that it is vulgar or dirty, it means most common type e.g. icthyosis vulgaris, acne vulgaris. Acne is a very common problem in world. It is caused as a result of blockages of follicles which are called microcomedone, which later become enlarged and result in comedones if open and milia if closed. The comedones contain sebum and dead skin which can become infected by propionibacterium acne leading to inflammation and pustule ( pimple) formation. Other causes include hormonal changes during puberty, anabolic steroid intake, diet.

Symptoms include comedones, seborrhea, pustules, nodules, scars, pigmentations.

TREATMENT includes ointments like benzoyl peroxide, clyndamycin cream, if they dont help then isotretinoin gel/cream. If all these treatments fail then oral isotretinoin is prescribed which usually given for 4-6 months and can cause long term resolution of symptoms. It is teratogenic ( causes developement problem in fetus) so is contraindicated in pregnancy.


Some other modalities are Dermabrasion, phototherapy, photodynamic therapy, laser.


Home remedies... aloe vera oil, egg oil and tea tree oil.


Also Watch: Blackhead Removal Video Collection by Dr Vikram Singh Yadav