Diabetic Foot – An Emerging Pandemic Introduction Diabetic foot as defined by the World Health Organization is, ‘The foot of a diabetic patient that has the potential risk of pathologic consequences, including infection, ulceration, and/ or destruction of deep tissues associated with neurologic abnormalities, various degrees of peripheral vascular disease, and/or metabolic complications of diabetes in the lower limb’.
Case Reports Thrombosis or clotting of blood in major vessels, particularly in the aorta, is very rare in neonates. We present an extremely small to date neonate who was diagnosed with descending aorta thrombosis at 72 hours of life without any identifiable risk factors for the same. This baby boy was born at Sri Ramakrishna Hospital at 35 weeks of gestation with severe intrauterine growth restriction with a birth weight of 1045 grams. The mother had previous 2 abortions with severe preeclampsia in this pregnancy for which she was on oral medications. She did not have any history of photosensitivity, rash or arthralgia. It was a nonconsanguineous marriage without family history suggestive of any premature thrombotic events. The baby vigorous at birth and was well for first 72 hours except for transient tachypnea of newborn (mild respiratory distress). No umbilical arterial or venous catheterization was done.
Case Reports A 32-year-old lady who was 28 weeks pregnant was referred from a Hospital at Ottanchathram on 23/10/16 with a history of watery per vaginal loss for the past 2 days. This was her second pregnancy and she had an Emergency Caesarean section during the first time. She had Type 2 diabetes and was on treatment. Her pregnancy was largely uneventful except for one episode of mild per vaginal spotting during the second trimester. On Examination, the vitals were stable, no contractions were palpable and Per speculum examination revealed clear fluid loss from the cervix confirming Preterm Prelabor rupture of membranes. Blood investigations revealed a raised white cell count and CRP with suboptimally controlled diabetes. An Ultrasound scan revealed a single live foetus in breech presentation with a reduced Amniotic fluid index of 1.3 and normal Umbilical and Middle cerebral artery Dopplers. She was commenced on Erythromycin 500mg BD, Levemir 6 units BD, Homolog 7 units TDS and given 2 doses of Betamethasone 12mg, 24 hrs apart. She was counselled about the potential risks of prematurity by the neonatologist. She was closely monitored with regular blood tests, vaginal swabs and Ultrasound scans. The Maternal and Foetal conditions were stable for 2 weeks. On 8/11/2016 at 30+2 weeks, she developed contractions. She was commenced on Magnesium sulphate infusion for Foetal neuroprotection as per the NICE recommendations. As her contractions progressed, a decision was made to deliver her. An Emergency Caesarean section was done in view of previous Caesarean with a breech presentation and an alive female baby was delivered in good condition at 2:43 pm. The baby weighed 1302 Gms and APGARS were 7 at 1 and 9 at 5.