This patient was admitted to the hospital with gangrene of the right great toe due to long-standing diabetes and related complications. He underwent amputation of the right great toe. His treatment included antibiotics, anti-diabetic medications, and wound care. He was discharged after an uneventful recovery with medications and lifestyle counseling to manage his diabetes and prevent further infections or complications.
A 35-year old female patient was admitted to the female medicine ward with complaints of blackish discoloration of left toe, difficulty in walking since 5-6 months, joint pain since 15-20 years. she had a past history of malaria, convulsions and typhoid before 3-4 years.
A 35 year old female patient was admitted to the female medicine ward with complaints of bodyache with weakness, pain in knee joint since 2-3 months, difficulty in walking. she had a past history of TB lymphadenopathy.
A 35-year old female patient was admitted to the female medicine ward with complaints of blackish discoloration of left toe, difficulty in walking since 5-6 months, joint pain since 15-20 years. she had a past history of malaria, convulsions and typhoid before 3-4 years.
A 35 year old female patient was admitted to the female medicine ward with complaints of bodyache with weakness, pain in knee joint since 2-3 months, difficulty in walking. she had a past history of TB lymphadenopathy.
A 45 year old female patient was admitted to the female medicine ward with complaints of severe joint pain in both extremities, difficulty in breathing, weakness, headache and eye pain, chest pain. She is a k/c/o hypertension since 1 year and hypoglycaemia since 1 month.
Danaparoid can interact majorly with drugs such as Warfarin, Hirudins (Bivalirudin, Lepirudin) and Other Anticoagulants like Heparin, Enoxaparin, Dalteparin, Tinzaparin, Fondaparinux, Phenindione, Argatroban, Rivaroxaban, Apixaban and Dabigatran.
The Effect of Long Term Smoking as an Independent Coronary Risk
Factor on Myocardial Perfusion Detected by Thallium 201 or Tc99m Sestamibi Spect Study. Samir Rafla*, Ahmed Ibrahim Abdel-Aaty, Mohammed Ibrahim Lotfy and Riham Gamal
shortage of medications is a problem confronts each hospital among the world, this a presentation gives a brief information about the problem from a humble research. Ahmed Nouri, PharmD
http://www.theheart.org/web_slides/1135309.do
A study on Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients (ADVANCE)
Coversyl Plus and Coversyl Plus HD is Potent ACE Inhibitor of class drugs with Cardiovascular and stroke Protection with significant Mortality & Morbidity reduction in wide class of Patients with Newly Diagnosed Hypertension Patients,CAD Patients,Patients with H/O stroke/TIA ,hypertensive Diabetic Patients and CKD Patients
A 45 year old female patient was admitted to the female medicine ward with complaints of severe joint pain in both extremities, difficulty in breathing, weakness, headache and eye pain, chest pain. She is a k/c/o hypertension since 1 year and hypoglycaemia since 1 month.
Danaparoid can interact majorly with drugs such as Warfarin, Hirudins (Bivalirudin, Lepirudin) and Other Anticoagulants like Heparin, Enoxaparin, Dalteparin, Tinzaparin, Fondaparinux, Phenindione, Argatroban, Rivaroxaban, Apixaban and Dabigatran.
The Effect of Long Term Smoking as an Independent Coronary Risk
Factor on Myocardial Perfusion Detected by Thallium 201 or Tc99m Sestamibi Spect Study. Samir Rafla*, Ahmed Ibrahim Abdel-Aaty, Mohammed Ibrahim Lotfy and Riham Gamal
shortage of medications is a problem confronts each hospital among the world, this a presentation gives a brief information about the problem from a humble research. Ahmed Nouri, PharmD
http://www.theheart.org/web_slides/1135309.do
A study on Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients (ADVANCE)
Coversyl Plus and Coversyl Plus HD is Potent ACE Inhibitor of class drugs with Cardiovascular and stroke Protection with significant Mortality & Morbidity reduction in wide class of Patients with Newly Diagnosed Hypertension Patients,CAD Patients,Patients with H/O stroke/TIA ,hypertensive Diabetic Patients and CKD Patients
Stroke is the 2nd leading death associated disorder. It is also known as cerebrovascular disorder mainly caused by high blood cholesterol levels or rupture of cerebral arteries.
Case Presentation on Diabetes Mellitus complicationsShivankAgrawal5
This case study on Diabetes Complications presented by Shivank Agrawal (Doctor of Pharmacy ) will help understand about the critical insights regarding treatment of Diabetes, its complications and its management.
Title: Case Study: Management of Diabetic Cellulitis
Introduction:
Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia, leading to various complications including skin infections such as cellulitis. Cellulitis is a bacterial infection affecting the skin and underlying tissues, often exacerbated in diabetic patients due to impaired immune function and compromised blood circulation. This case study focuses on the management of diabetic cellulitis in a patient presenting with typical symptoms.
Treatment Plan:
Antibiotic Therapy: Initiation of empiric antibiotic therapy with oral cephalexin to cover common pathogens such as Staphylococcus aureus and Streptococcus species. The choice of antibiotics was based on local antibiogram data and the patient's clinical response.
Glycemic Control: Optimization of blood glucose levels through insulin therapy to enhance immune function and promote wound healing. Regular monitoring of blood glucose levels was implemented to adjust insulin doses accordingly.
Wound Care: Daily wound cleansing with saline followed by application of topical antimicrobial agents and sterile dressings to prevent secondary infection and promote granulation tissue formation.
Patient Education: Comprehensive education regarding diabetic foot care, including the importance of daily foot inspections, proper footwear, and prompt management of any foot injuries to prevent future complications.
Conclusion:
This case highlights the importance of prompt diagnosis and appropriate management of diabetic cellulitis to prevent complications and improve patient outcomes. A collaborative approach involving pharmacists, physicians, and other healthcare professionals is essential for the comprehensive care of diabetic patients with skin infections. Emphasis on glycemic control and wound care plays a crucial role in preventing recurrent infections and promoting overall health in diabetic individuals.
Role of Clinical Pharmacist in Management of Diabetes Complications.
Pharmacists play a crucial role in the management of diabetes cellulitis, contributing significantly to patient care through their expertise in medication therapy management, patient education, and collaborative healthcare. Their involvement spans various aspects of the management process:
Medication Management:
Antibiotic Selection: Pharmacists assist in choosing appropriate antibiotics based on the patient's clinical presentation, comorbidities, and potential drug interactions.
Dosing and Administration: They ensure proper dosing regimens, considering factors such as renal function and drug allergies, to optimize therapeutic efficacy and minimize adverse effects.
Monitoring: Pharmacists monitor the patient's response to antibiotic therapy, inc
CASE PRESENTATION ON MILD HEPATOMEGALY 54454.pptxkrishna keerthi
Explore this informative Slide share presentation to delve into the intricacies of Hepatomegaly, a condition characterized by an enlarged liver. This comprehensive slide deck covers the causes, symptoms, diagnostic approaches, and management strategies related to Hepatomegaly. Gain valuable insights into liver health, medical imaging, and associated pathologies. Whether you're a healthcare professional or some one curious about liver conditions, this presentation provides a detailed overview to enhance your understanding. Navigate through a visual journey that outlines the diverse symptoms associated with hepatomegaly, enabling a nuanced understanding of clinical presentations. The presentation extends beyond diagnosis to encompass management strategies, emphasizing the importance of a multidisciplinary approach in treating Hepatomegaly.
Prix Galien International 2024 Forum ProgramLevi Shapiro
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
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Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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Anti ulcer drugs and their Advance pharmacology ||
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ASA GUIDELINE
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3. CASE SUMMARY
• A 59 years old male was admitted in KMCH hospital on 23rd October 2018 with
the complaints of discoloration of right great toe (right foot infection).patient has
a past medical history of Diabetes mellitus type 2 and Hypertension for
10years,Acute pancreatitis (treatment since 2011), coronary artery disease on
treatment . Past surgical history of wound debridement right foot (24.8.2009),4th
toe amputation done on (14.9.2009) ,left above knee amputation done on
2010.Past medication includes Tab. GlycometGP2,Tab.Lasix(40mg) and Tab.
Ecospirin (75mg) .Laboratory investigations shows Hb-10.1g/dL, Blood Glucose
Fasting-107mg/dL and Glycosylated HbA1c-6.7% .Urine Analysis shows Presence
of Albumin,Plenty of Pus cells are seen.
• Patient was diagnosed with gangrene on right great toe .patient was treated with
surgical procedure called Amputation(removal of an entire affected body part
here its toe) and Drugs used for infection is cephalosporin antibiotics .other drugs
include Inj. Magnex forte(3gm) ,Inj.Cebanex forte (3gm),Tab.Lasix(40mg),
Tab.Glycomet. Gp(2500/2mg),Tab.Isolazine (T.ID)(37.5mg),
Tab.Arkamine(100mg),Tab.Cardivas.CR(20mg),Tab.Ivabrad(5mg)
,Tab.Ecospirin(75mg) ,Inj.Paracetamol(1gm),Inj.Heparin(2500units)
4. PATIENT’S PROFILE
• Patient details:
Name:Mr.R.Jayaraj
Age:59yrs old
Sex:Male
Reg no/Ip no:501226/E67880(8)
Primary Consultant:Thomas K.Abraham
This patient was admitted in KMCH hospital on 23rd October 2018 with
the complaints of Discoloration of right great toe(right foot infection).
5. MULTIPLE MEDICAL CONDITIONS :
Type II Diabetes Mellitus
Gangrene on Right great toe
Diabetic foot infection
MEDICAL HISTORY:
Type II Diabetes Mellitus (since 2008)
Hypertension (for10 yrs)
Acute pancreatitis (treatment since 2011)
Coronary artery disease on treatment.
PERSONAL/FAMILY HISTORY:
Nill
SOCIAL STATUS:
Married
KNOWN DRUG ALLERGIES:
Nil
PRESENT SURGERY DONE
Amputation right great toe(on 24.10.18)
10. LAB INVESTIGATIONS
TEST OBSERVED VALUE NORMAL RANGE
Hb 10.1 12-15g/dL
Tc 6800 4000-11300cells/cumm
Platelet count 295000 150000-450000cells/uL
Urea 62mg/dL 10-50mg/dL
Creatinine 2.8mg/dL 0.7 to 1.2 mg/dL
WBC 6800 4000-11300cells/cumm
eGFR 23ml/min/1.73m2
Serum sodium 137 meq/L 133 to 145meq/L
Potassium 5.4meq/L 3.7 to 5.4 meq/L
11. DIABETIC CHART
• 23/10/18
Blood glucose fasting:107mg/dL
• 24/10/18
Glycosylated HbA1c:6.7%.
As per the WHO statement HbA1c more than 6.5%indicates diabetes.
12. URINE ANALYSIS
MACROSCOPY MICROSCOPY
OBJECTIVE OBSERVATION
Colour straw
Appearance clear
Specific gravity 1.015
Reaction Acidic
Albumin ++
Sugar Not detected
Acetone -ve
Bile salts -ve
Bile pigments -ve
Urobilinogen Slightly increased
OBJECTIVE OBSERVATION
Pus cells plenty
RBC 2-3cell/HPF
Epithelial 2-3cell/HPF
Bacteria Nil
Crystals Nil
Cast Nil
Flagellates Nil
others Nil
14. • As per the physical examination, vitals and lab findings ,the patient’s
health condition is summarized as follows
Diabetic foot infection –gangrene right great toe
severity leads to the surgical procedure - AMPUTATION
Anemia-patient is anemic nature due to diabetes
Elevated levels of albumin shows the presence of complications of
diabetes ,such as diabetic neuropathy and also leads to diabetic
nephropathy .
15.
16. DIABETIC FOOT INFECTION
• DEFINITION:
The American Diabetes Association defines the diabetic foot
as the anatomical area below the malleoli in a person with diabetes
mellitus. The diabetic foot may be defined as a group of syndromes in
which neuropathy, ischaemia and infection lead to tissue breakdown,
resulting in morbidity and possible amputation (World Health
Organization ,1995).2
Gangrene is a form of necrosis of tissue with superadded
putrefaction.Diabetes may unknowingly develop wet gangrene after
experiencing a minor toe or foot injury.
24. REASONABLE OUTCOMES
MORTALITY OUTCOMES:
To avoid diabetes and cardiovascular related PROGRESSION.
MORBIDITY OUTCOMES:
a) DISEASE RELATED
To reduce morbidity resulting from uncontrolled blood glucose,anaemia,bacterial
infection .
Close monitoring for hypoglycemia symptoms such as sweating ,pale skin,dizziness,etc,,.
To control blood pressure without missing dose of antihypertensive agents .
25. • b) DRUG RELATED
To prevent ,manage or minimize drug related morbidity
-Monitoring any side effects or toxicity.
-Monitoring any drug-drug ,drug-disease or drug-food interactions.
BEHAVIOURAL OUTCOMES
• Adhere to medication regimen.
• Obtain annual eye check ups
• Get routine and timely medical examinations and laboratory tests.
• Avoid any stimulants and OTC drugs that may affect blood glucose, and blood circulation.
PHARMACOECONOMIC OUTCOMES
• Keep drug and treatment costs within patients resources .
• Make cost effective and efficient use of health care services.
26. PHARMACIST INTERVENTIONS
The prescribed drugs are rational .
DRUG DUPLICATION:Nil.
DRUG-DRUG INTERACTION CHART :
Drug Interacting
drug
Severity Risk Rectifications
aspirin heparin moderate cause bleed more easily dose adjustment needed according
with the testing of prothrombin
time
cefaperazone
sodium
heparin moderate cause bleed more easily dose adjustment needed
27. DRUG -FOOD INTERACTION
DRUGs INTERACTING FOOD CLINICAL RESULTS
paracetamol alcohol Alcohol Paracetamol Syndrome –
hepatotoxity occur from the
ingestion of therapeutic doses of
paracetamol in moderate to heavy
drinkers of alcohol.
metformin alcohol Slows the action of oral
hypoglycemic agent(8 to 12hrs)
28. DRUG – DISEASE INTERACTION
Drug Disease Clinical result
aspirin anemia GI blood loss, causes damage in
mucosal layer in GI.
CLASS OF DRUGS PRESENT LAB VALUES TARGET VALUE
ANTI ANAEMIC DRUG
Inj.cebanex forte (3gm)
10.1gm/dL 12-15gm/dL
ANTI PLATELET DRUGS
Tab.ecospirin(75mg)
295000cells/microliter >295000cells/microliter
THERAPEUTIC END POINT
29. PATIENT ON DISCHARGE
His post operative recovery was uneventful.he was managed post
operatively with INJ.Heparin ,TAB.Ecospirin ,IV antibiotics and analgesics
and daily dressings done.
MEDICATIONS DOSAGE MORNING AFTERNOON EVENING NIGHT A/B FOOD DURATION
TAB.CIFRAN 500mg 1 0 0 1 A 7DAYS
TAB.CLOPILET A 75mg 1 0 0 0 A 14DAYS
TAB.STILOZ 50mg 1 0 0 1 A 14DAYS
CAP.OMEZ 20mg 1 0 0 1 B 7DAYS
30. PATIENT POST OPERATIVE CONDITION
His post op recovery was uneventful .He was managed post operatively
with Inj.Heparin ,Tab.Ecospirin ,I.V Antibiotics and Analgesics and daily
dressing done.
Discharge –stable condition -27/10/18
Follow up review on 5/11/2018
31. PATIENT COUNSELLING
BASED ON DIET
• Eating an unhealthy diet high in fat will make any existing atherosclerosis worse and increase your risk of
developing gangrene.
• Continuing to eat high-fat foods will cause more fatty plaques to build-up in your arteries. This is because
fatty foods contain cholesterol.
• There are 2 types of fat – saturated and unsaturated. Avoid foods that contain saturated fats because they
increase levels of "bad cholesterol" in your blood.
32. PATIENT EDUCATION
BASED ON LIFESTYLE MODIFICATION
Smoking
Smoking can cause your arteries to become blocked, resulting in a loss of blood supply to your
arms or legs. This is known as peripheral arterial disease (PAD). Which may also cause
gangrene
So that You must give up the smoking to reduce the risk of gangrene
Alcohol
Drinking excessive amounts of alcohol will cause your blood pressure to rise, and also raise the
level of cholesterol in your blood. Which may also block the artery and that may cause
gangrene
Men and women are advised not to drink more than 14 units a week. 14 units is equivalent to
6 pints of average-strength beer or 10 small glasses of low-strength wine.