Figure 1

dreynoso

Internal Medicine

polymicrobial wound infection in uncontrolled diabetic - note Charcot changes in foot

38 years old, female. The patient has Diabetes Mellitus, Hypertension, and hypertriglyceridemia (879 mg/dL). She sought medical care complaining of blister formation on the plantar region of her feet, which has been progressing with pain. On examination, callus formation and reduced sensation in the lower limbs are observed. The patient uses Metformin 850 mg three times a day and NPH insulin 20 IU in the morning. We suspect that the patient is not adequately adhering to the treatment. What can be done to prevent further alterations in her lower limbs?

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.
A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.
A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.
70 yo WF with 20y hx HTN lost 21 lbs on a semaglutide but still BMI over 30, shows drop in BP when standing, stabilizing at 102-116 systolic, 65-75 diastolic. Discontinued all HTN meds x 30 days and no episodes of HTN. Could a small weight loss like this cause a drop to normal BP? Has anyone heard of a side effect of lowering BP?