Pathophysiology
According to the World Health Organization "Evidence suggests that podoconiosis is the result of a genetically determined abnormal inflammatory reaction to mineral particles in irritant red clay soils derived from volcanic deposits".The pathophysiology of podoconiosis is a combination of genetic susceptibility, possibly through associations with HLA-DQA1, HLA-DQB1, and HLA-DRB1 variants, and a cumulative exposure to irritant soil. In susceptible individuals, irritant soil particles penetrate the feet and collect in lymphatic vessels. Over time, chronic inflammation within the lymphatic vessels leads to fibrosis and occlusion. Diagnosis
Differential diagnosis
The differential diagnosis for podoconiosis includes other causes of tropical lymphedema, such as filariasis or leprosy, and mycetoma pedis.While filariasis is generally unilateral, podoconiosis affects the legs bilaterally albeit asymmetrically and in an ascending manner. Podoconiosis very rarely affects the groin while filariasis frequently involves the groin: a high ratio of lymphoedema/hydrocele cases in an area suggests podoconiosis as the dominant cause of lymphedema. In some cases, the history and clinical presentation alone are unable to differentiate between the two causes of tropical lymphedema. Local epidemiology can also be a clue to diagnosis, as podoconiosis is typically found in higher altitude areas with volcanic soils while filariasis is common in low-lying areas where mosquitos are prevalent. Blood smears for identification of microfilariae and antigen detection techniques can be helpful in the diagnosis of lymphatic filariasis.Lepromatous lymphedema can also mimic podoconiosis clinically, but the former will have loss of sensation in the toes and feet, thickened nerves, and trophic ulcers. Other causes of lymphedema include Kaposi sarcoma, mycetoma, and elephantiasis nostras verrucosa.
Dapagliflozin/saxagliptin, sold under the brand name Qtern, is a fixed-dose combination anti-diabetic medication used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes. It is a combination of dapagliflozin and saxagliptin. It is taken by mouth.The most common side effects include upper respiratory tract infection (such as nose and throat infections) and, when used with a sulphonylurea, hypoglycaemia (low blood glucose levels).Dapagliflozin/saxagliptin was approved for medical use in the European Union in July 2016, and in the United States in February 2017. Medical uses
In the United States dapagliflozin/saxagliptin is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes.In the European Union it is indicated in adults aged 18 years and older with type 2 diabetes mellitus:

to improve glycemic control when metformin with or without sulphonylurea (SU) and either saxagliptin or dapagliflozin does not provide adequate glycemic control. when already being treated with saxagliptin and dapagliflozin. References
External links
"Dapagliflozin propanediol". Drug Information Portal. U.S. National Library of Medicine. "Saxagliptin". Drug Information Portal. U.S. National Library of Medicine. "Dapagliflozin". MedlinePlus. "Saxagliptin". MedlinePlus.