Podiatry Commons^™

Enterococcus Faecium: Evolution, Adaptation, Pathogenesis And Emerging Therapeutics, Yahan Wei, Dennise Palacios Araya, Kelli L. Palmer

School of Podiatric Medicine Publications

The opportunistic pathogen Enterococcus faecium colonizes humans and a wide range of animals, endures numerous stresses, resists antibiotic treatment and stubbornly persists in clinical environments. The widespread application of antibiotics in hospitals and agriculture has contributed to the emergence of vancomycin-resistant E. faecium, which causes many hospital-acquired infections. In this Review, we explore recent discoveries about the evolutionary history, the environmental adaptation and the colonization and dissemination mechanisms of E. faecium and vancomycin-resistant E. faecium. These studies provide critical insights necessary for developing novel preventive and therapeutic approaches against vancomycin-resistant E. faecium and also reveal the intricate interrelationships …

Management Of Group B Streptococcus Necrotizing Fasciitis Secondary To Puncture Wound In Diabetic Patient Using Xenograft* Therapy, Nikita V. Gambhir, Heather V. Tran, Stephanie N. Campbell

School of Podiatric Medicine Publications

Necrotizing soft tissue infection (NSTI) is a rapidly progressive skin and soft tissue infection that primarily affects deeper layers of adipose tissue, fascia and muscle. Once a patient becomes symptomatic, the disease typically progresses within hours. The standard treatment consists of broad-spectrum IV antibiotics, serial debridement and supportive care. However, long-term goals should include prevention of atherosclerotic disease, cardiovascular and cerebrovascular events, and ultimately, a reduction in mortality rates. Following debridement for NSTI, it is not uncommon for patients to require multiple surgeries and secondary wound healing given the extent of soft tissue loss.

Use Of A Borate-Based Bioactive Glass Matrix On Infected, Exposed Hardware, Stephanie N. Campbell, Cyaandi Dove, Connor V. Krolikowski

School of Podiatric Medicine Publications

A dreaded complication of implanting surgical hardware is a wound dehiscence resulting in hardware exposure; which places the wound at risk for infection and biofilm formation. Once established, biofilms are difficult to eradicate, with a high rate of recurrence even after surgical debridement. As such, there exists a significant need for novel technologies that can help us expedite healing in wounds with exposed hardware. Here we evaluate a borate-based bioactive glass matrix* in this challenging setting.

Shooter’S Abscess: Foot Infections In People Who Inject Drugs, Amanda L. Killeen, Randi Heming, Peter A. Crisologo, Michael C. Siah, Lawrence A. Lavery

School of Podiatric Medicine Publications

Musculoskeletal infections are common among people who inject drugs. Little is known about the prevalence and characteristics of skin and soft-tissue infections in this patient population, especially in the lower extremity. The aim of this study is to describe the clinical characteristics, bacterial pathogens, and clinical outcomes in adults with foot infections due to intravenous drug use. Nine patients for whom the podiatric service was consulted for lower-extremity abscess secondary to intravenous drug use were included in this study. Most infections (66.7%) were located on the dorsal foot. Two of the abscesses (22.2%) resulted in amputation, with one toe amputation …

Effects Of Supervised Exercise Therapy On Muscle Function During Walking In Patients With Peripheral Artery Disease, Cody P. Anderson, Iraklis Pipinos, Jason M. Johanning, Sara A. Myers, Hafizur Rahman

School of Podiatric Medicine Publications

Background: Although supervised exercise therapy (SET) is a primary treatment for peripheral artery disease (PAD), the current literature is limited regarding the mechanisms contributing to increased walking distances, including how lower extremity muscle function is altered after SET. This study aimed to investigate the effects of SET on lower extremity muscle function during walking in patients with PAD. Methods: Twelve patients with PAD participated in a 6-month SET program consisting of three weekly exercise sessions (a total of 72 sessions) and adhered to the American College of Sports Medicine’s (ACSM) recommendations. Each session started with a 5 min warm-up of …

Prevention Of Amputation By Minimally Invasive Surgery In A Diabetic Patient With Osteomyelitis And Peripheral Vascular Disease With A History Of Previous Amputations, Orlexia Thomas Dpm, Francois M. Lokenye Dpm, Lady Poaula Dejesus Dpm, Facfas, Facpm, Dwsp

Posters

This study aims to demonstrate the efficacy of minimally invasive surgical interventions in preventing foot amputation and promoting wound healing in a diabetic patient with osteomyelitis and peripheral vascular disease, compounded by a history of ray resection.

Does The Use Of Dacc-Coated Dressings Improve Clinical Outcomes For Hard To Heal Wounds: A Systematic Review, Saskia Schwarzer, Jose Luis Lazaro-Martinez, Amanda L. Killeen, Paulo Alves, Andrea Gledhill, Erik Nygren, Lawrence A. Lavery, Matthew Malone

School of Podiatric Medicine Publications

Reports of overuse and antimicrobial resistance have fuelled some clinicians to adopt alternative wound dressings termed to be non-medicated or non-antimicrobials, which still claim antimicrobial or antibacterial activity. In this PROSPERO-registered systematic review, we evaluated the in vivo clinical evidence for the effectiveness of DACC-coated dressings in chronic, hard to heal wound-related outcomes. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Framework was adopted as the template in constructing this systematic review. The PICO format (Population [or patients], Intervention, Comparison [control], Outcome/s) was used to identify key clinical questions in determining patient outcomes under two domains (infection control and …

Navigating The Uncommon: Providencia Rettgeri In Diabetic Foot Ulcers, Nikita Gambhir, Heather V. Tran, Stephanie N. Campbell, Mihir Panchal

School of Podiatric Medicine Publications

A case study presents with a rare microorganism, Providencia rettgeri, as a pathogen identified in a non-healing diabetic foot ulcer with osteomyelitis. P. rettgeri remains an emerging pathogen with documented drug-resistant hospital associated infections. Given the rarity of this organism in such wounds and its intrinsic resistance to multiple antibiotics, this study aims to understand the pathogen’s role in diabetic foot infections and improve clinical management practices.

Providencia has been classified as Critical Priority 1 on World Health Organization’s global priority pathogen list for the need of new antibiotics, highlighting its international significance. P. rettgeri tends to grow in nosocomial …

Effect Of A Potent Nitrogenous Bisphosphonate On Cell Viability In Diabetic Conditions: An In Vitro Study On Human Fibroblasts And Pre-Osteoblasts, Denae Cantu, Bryan Liu, Deborah Rocha Seixas, Claudia Biguetti

School of Podiatric Medicine - Student Research

Introduction Zoledronate (Zol) is a nitrogenous bisphosphonate (nBP) used to treat osteoporosis, bone metastases, and Charcot foot. Despite its efficacy in preventing fractures, concerns exist about its side effects on mesenchyme-origin cells and impaired wound healing. We hypothesize that Zol may impair the responses of human fibroblasts (hF) and pre-osteoblasts (MC3T3), potentially compromising tissue healing in the lower extremities of patients with diabetes.

Methodology: MC3T3 cells and hF were cultured in 96-well plates at a density of 2.5 x 10³ cells for 48 and 72 hours, respectively. Cells were subjected to normal glucose, high glucose, and high oxidative stress conditions …

From Crisis To Closure: Use Of Kerecis© Omega3 And Negative Pressure Wound Therapy In Treating Necrotizing Soft Tissue Infection, Nikita Gambhir, Heather V. Tran, Stephanie N. Campbell, Mihir Panchal

School of Podiatric Medicine Publications

The aim of this case study was to evaluate the effectiveness of Kerecis© Omega3 MariGen Micro for the treatment of a necrotizing soft tissue infection (NSTI) in a diabetic patient, including wound healing progress and closure outcomes post-application.

The application of acellular dermal micromatrix allograft in conjunction with NPWT and STSG, facilitated significant wound healing in a patient with NSTI, without amputation. This case highlights the unique properties of Kerecis Omega3, a fish-derived skin substitute rich in omega-3 fatty acids, significantly contributed to tissue regeneration and wound healing, even in a high-risk patient with multiple comorbidities, including diabetes and obesity. …

Trajectories Of Diabetes-Related Sequelae For Identifying Transition Probabilities, And Optimal Timepoints For Prevention Of Ulceration, Infection, And Amputation, Daniel C. Jupiter, Yuanyi Zhang, Naohiro Shibuya

School of Podiatric Medicine Publications

To reduce diabetes-related complications and to avoid futile procedures, foot and ankle surgeons need to understand the relative timings of catastrophic events, their incidence, and probabilities of transitions between disease states in diabetes in different patient populations. For this study, we tracked medical events (including an initial diagnosis of diabetes, ulcer, wound care, osteomyelitis, amputation, and reamputation, in order of severity) and the time between each such event in patients with diabetes, stratifying by sex, race, and ethnicity. We found that the longest average duration between the different lower extremity states was a diagnosis of diabetes to the occurrence of …

Return To Play Time After Achilles Tendon Rupture In Professional Soccer Players, Oyinkansola Mudasiru, Amanda Killeen

School of Podiatric Medicine - Student Research

Introduction: Achilles tendon ruptures are severe injuries that drastically affect the careers of athletes. These ruptures typically occur during matches, often due to dorsiflexion of the ankle during passes or when tackling. Professional athletes tend to have surgical repair quickly with the goal of returning to their sport as fast as possible.

Objective: To present a scoping review to identify the return to play (RTP) rates following Achilles tendon rupture and whether these athletes achieve functional outcomes comparable to their pre- operative conditions.

Methods: 2 databases were queried; Google Scholar and PubMed using the search terms "Achilles tendon rupture" AND …

Methicillin-Resistant Staphylococcus Aureus In Diabetic And Non-Diabetic Foot Infections, Lawrence A Lavery, Mario C Reyes, Mehmet Suludere, Bijan Najafi, Matthew Sideman, Michael C Siah, Arthur N Tarricone

Center on Aging Staff Publications

To identify the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection, reinfection and clinical outcomes. Four hundred forty-six patients that were admitted to the hospital with moderate or severe foot infections were retrospectively reviewed. Tissue and bone cultures were obtained from the index hospital admission. Conversion was defined as methicillin susceptible Staphylococcus aureus in the first culture and subsequently MRSA when there was a reinfection. The incidence of MRSA was 7.8% (n = 35), with no significant difference between soft tissue infections (7.7%) and osteomyelitis (8.0%). MRSA incidence was 9.4 times higher in non-diabetics (23.8% vs. 3.2%, p = < 0.01). The incidence of reinfection was 40.8% (n = 182). Conversion to MRSA was seen in 2.2% (n = 4) total, occurring in 5.4%. Non-diabetics were 20.1 times more likely to have MRSA reinfection than people with diabetes (28.6% vs. 1.9%, p <  0.001). MRSA patients had a higher proportion of healed wounds (82.4% vs. 69.3%, p = 0.02). There were no differences in other clinical outcomes in MRSA vs. other infections in reinfection (28.6% vs. 24.3%, p = 0.11), amputation (48.6% vs. 52.0%, p = 0.69) or hospitalization (28.6% vs. 42.6, p = 0.11). The incidence of MRSA for the first infection (7.8%), reinfection (6.0%) and conversion to MRSA (2.2%) was low. MRSA was 9.4 times more common in people without diabetes.

A Systematic Review Of Diabetic Foot Infections: Pathogenesis, Diagnosis, And Management Strategies, Sabyasachi Maity, Noah Leton, Narendra Nayak, Ameet Jha, Nikhilesh Anand, Kamala Thompson, Danielle Boothe, Alexandra Cromer, Yaliana Garcia, Aliyah Al-Islam

School of Medicine Publications

Background: Diabetic foot infection represents a significant complication of diabetes mellitus, contributing substantially to morbidity, mortality, and healthcare expenditure worldwide. Accurate diagnosis relies on a comprehensive assessment integrating clinical evaluation, imaging studies, and microbiological analysis. Management necessitates a multidisciplinary approach, encompassing surgical intervention, antimicrobial therapy, and advanced wound care strategies. Preventive measures are paramount in reducing the incidence and severity, emphasizing patient education, regular foot screenings, and early intervention.

Methods: The researchers performed a systematic review of literature using PUBMED MESH keywords. Additionally, the study was registered in the International Prospective Register of Systematic Reviews at the Center for Reviews …

Evaluating Hmgb1 As A Biomarker For Metabolic Dysregulation And Progression Of Diabetes In A Mexican American Cohort, Peter Elvin, Walid Fakhouri, Craig Hanis, Cláudia Cristina Biguetti

School of Podiatric Medicine - Student Research

Aim/Hypothesis: This study focuses on HMGB1 to evaluate its association with the development and progression of diabetes within a Mexican American cohort of non-diabetic (ND), pre-diabetic (Pre-D), and diabetic (D) individuals.

Methods: Data from a cohort of 40 individuals, standardized by age (61.76±11.77), BMI (32.52±7.02), and sex (58% male, 42% female) was analyzed. We assessed several immunological markers utilizing ELISA assays from buffy coats. After excluding out of range samples, the remaining 20 individuals displayed statistical significance in HMGB1. Pearson's correlation coefficient examined the relationship between HMGB1 levels and glycemic changes (HOMA-IR, HOMA-B, HOMA-IS², and HbA1c). Statistical significance …

Co-Localization Of Osteoclasts Differentiation Markers In An Implant Model In Diabetic Mice, Diego Adobbati, Deborah Rocha Seixas, Danieli Rodrigues, Claudia C. Biguetti

School of Podiatric Medicine - Student Research

Introduction and Hypothesis: Diabetes can impair implant osseointegration and impact implant functionality. While significant research has focused on osteogenesis during the osseointegration, little attention has been given to pre-osteoclast differentiation. We hypothesize that diabetes increases pre-osteoclast activity potentially leading to implant failure. This study aims to identify and localize osteoclast markers, specifically DC-STAMP (Dendritic Cell-Specific Transmembrane Protein) and NFATc2 (Nuclear Factor of Activated T-cells, cytoplasmic 2), in diabetic (D) and non-diabetic (ND) mice.

Methodology: Twenty-four 16-week-old male 129 Sv mice (12 diabetic and 12 non-diabetic) underwent implantation with a 0.5x1.5 mm commercially pure titanium screw in the right maxillary bone. …

A Microtomographic And Histopathological Evaluation Of Dental Cements As Late-Stage Peri-Implant Complication In A Rat Model, Bhuvana Lakkasetter Chandrashekar, Cláudia Cristina Biguetti, Alexandra Arteaga, Andres J. Miramontes, Evelin Rios, Danieli C. Rodrigues

School of Podiatric Medicine Publications

Cement mediated peri-implantitis accounts for 1.9–75% of dental implant failures associated with peri-implant diseases. This study evaluated the biological impact of dental cements on osseointegrated implants using Lewis rats. Twenty-two rats were distributed into 6 groups: negative control (NC) soft diet (SD), and hard diet (HD); positive control SD and HD (n = 3); Implant + bio-ceramic Cement (BC) SD and HD which included contralateral Sham sites (n = 5). Titanium implants were placed on either side of the maxillae and allowed to heal for 14 days. Later, both sides of experimental groups underwent a re-entry surgery to simulate clinical …

The Effect Of Limb Salvage Efforts In Different Age Groups: Relationships Between Major And Minor Amputations, Wenye Song, Javier La Fontaine, Naohiro Shibuya, John Prochaska, Daniel C. Jupiter

School of Podiatric Medicine Publications

“Limb salvage” efforts, such as performing minor amputations before infections spread proximally from the foot to decrease major lower extremity amputation, are an important part of healthcare today. It is unclear whether these efforts are preventing the number of major amputations and improving patients’ quality of life and the cost-effectiveness of the U.S. healthcare system. Rates of non-traumatic lower extremity amputation (NLEA) among patients with diabetes decreased in the early 2000s but rebounded in the 2010s. We analyzed the proportion of major amputations and differences in amputation rates between age groups in Texas. Patient data was extracted from the Texas …

A Proposed Addition To The Modified Wells Criteria: Exploring Thrombosis In The E-World, Nidhin John, Amanda Kileen

School of Podiatric Medicine - Student Research

The advancement of technology and over-reliance on electronics have led to "e-thrombosis." This review investigates the link between prolonged sedentary behavior due to extensive electronic use and the risk of venous thromboembolism (VTE) and deep vein thrombosis (DVT). The term "e-thrombosis" was introduced in 2003 by Beasley et al., highlighting the risk of immobility associated with electronics. E-thrombosis is particularly relevant post-COVID-19, with increased remote working and online learning. This review evaluates recent studies to determine if e-thrombosis should be considered in updated screening tools like the Wells Score.

A systematic literature review was conducted using PubMed, Direct Science, and …

Case Report Of Surgical Management For Charcot Foot Medial Column Beaming With Stj Arthrodesis, Prachi Patel, Randy Semma

Posters

Medial column beaming is a surgical procedure that involves inserting a metallic beam to the medial column of the foot to treat the Charcot deformity of the foot.

A surgeon will use a large diameter screw to insert a beam into medial column which includes the first metatarsal, medial cuneiform, navicular and talus (fig 3) The beam shares the load of weightbearing with the foot's ligaments and joints, reducing the abnormal loss of structural integrity that can occur in Charcot arthropathy of the foot.

Subtalar joint fusion is often performed concurrently with medial column beaming to enhance the overall stability …