Person: Lázaro Martínez, José Luis
Universidad Complutense de Madrid
Faculty / Institute
Enfermería, Fisioterapia y Podología
Now showing 1 - 10 of 18
PublicationBacterial Diversity and Antibiotic Resistance in Patients with Diabetic Foot Osteomyelitis(MDPI, 2023-01-19) Álvaro Afonso, Francisco Javier; García Álvarez, Yolanda; Tardáguila García, Aroa; García Madrid, Marta; López Moral, Mateo; Lázaro Martínez, José LuisThis study analysed the bacterial diversity, antibiotic susceptibility, and resistance in patients with complications of diabetic foot osteomyelitis (DFO). A retrospective observational study was carried out between September 2019 and September 2022 and involved 215 outpatients with a diagnosis of DFO at a specialized diabetic foot unit. A total of 204 positive bone cultures were isolated, including 62.7% monomicrobial cultures, and 37.3% were formed with at least two microorganisms. We observed that Proteus spp., Coagulase-negative staphylococci (CoNS), Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Corynebacterium were the most frequently isolated microorganisms and accounted for more than 10% of the DFO cases. With stratification by Grampositive (GP) and Gram-negative (GN) bacteria, we observed that 91.6% of cultures presented at least one GP bacteria species, and 50.4% presented at least one GN bacteria species. The most common GP species were CoNS (29%), S. aureus (25.8%), and Corynebacterium spp. (14%). The most frequent GN species consisted of Proteus spp. (32%), P. aeruginosa (23.3%), and E. coli (17.5%). The main antibiotics with resistance to GP-dominated infections were penicillins without �-lactamase inhibitor, and those in GN-dominated infections were sulfonamides and penicillins without �-lactamase. Significant differences were not observed in mean healing time in DFU with acute osteomyelitis (12.76 weeks (4.50;18)) compared to chronic osteomyelitis (15.31 weeks (7;18.25); p = 0.101) and when comparing cases with soft tissue infection (15.95 (6;20)) and those without such an infection (16.59 (7.25;19.75), p = 0.618). This study shows that when treatment of DFO is based on early surgical treatment, the type of DFO and the presence of soft infection are not associated with different or worse prognoses. PublicationElaboración de material docente virtual para las prácticas de la asignatura de Microbiología del Grado de Podología(2021-06) Alou Cervera, Luis; Sevillano Fernandez, David; González Hidalgo, Natalia; Bas Caro, Pedro; Domínguez Guardiola, Natalia; Álvaro Afonso, Francisco Javier; Molines Barroso, Raúl Juan; Lázaro Martínez, José LuisEl aprendizaje mixto con la incorporación de nuevas tecnologías como vídeos cortos y cuestionarios online ha permitido mejorar el rendimiento, la satisfacción y el compromiso de los estudiantes. El objetivo de este Proyecto de Innovación Docente fue elaborar material docente virtual para las prácticas de la asignatura de Microbiología del Grado de Podología. Al inicio del curso se elaboró un cuestionario para valorar los conocimientos previos en materia de microbiología del alumnado. Posteriormente los alumnos se inscribieron de forma voluntaria a las prácticas de Microbiología eligiendo entre el formato virtual o presencial. El guion teórico de prácticas presenciales se adaptó a un formato virtual incorporando multitud de imágenes y ejemplos prácticos de las pruebas de diagnóstico microbiológico y centrados en dos áreas prioritarias de diagnóstico, las infecciones de pie diabético y las infecciones fúngicas en podología. Posteriormente, realizaron dos casos clínicos prácticos tanto en las prácticas presenciales como en las virtuales. Estos últimos debieron contestar un cuestionario sobre los casos prácticos así como valorar la actividad. Por último, los alumnos respondieron de nuevo al cuestionario de conocimientos planteado al inicio del curso académico. Todo el material fue subido al Campus Virtual para su consulta y resolución. De los 71 alumnos matriculados, 19 (26,8%) eligieron realizar las prácticas en formato virtual y 52 (73,2%) en formato presencial. Tanto las prácticas en formato virtual como presencial mejoraron el rendimiento de los alumnos, observándose un incremento significativo de 1,9 y de 2,0 en la calificación para el grupo de prácticas en formato virtual y presencial, respectivamente. No se observaron diferencias significativas entre ambos formatos (virtual y presencial) en la calificación obtenida después de realizar las prácticas. Se observó un nivel alto de participación de la actividad. Un 71,8% de los alumnos realizaron el cuestionario previo de conocimientos y un 66,2% realizaron el cuestionario de conocimientos después de las prácticas. La participación del alumno que eligió el formato presencial fue superior a la del alumno que eligió el formato presencial. El grado de satisfacción de las prácticas en formato virtual fue elevado ya que se obtuvo un valor medio de 4 sobre 5. PublicationEfficacy of cryotherapy for plantar warts: A systematic review and meta‐analysis(Wiley, 2022-04-01) García Oreja, Sara; Álvaro Afonso, Francisco Javier; Tardáguila García, Aroa; López Moral, Mateo; García Madrid, Marta; Lázaro Martínez, José LuisRecent systematic reviews of plantar warts continue to consider cryotherapy as one of the treatments of choice, but this method appears to have lower cure rates than alternative treatments. A systematic review using meta-analyses of the efficacy of cryotherapy in plantar warts treatment was performed. Systematic electronic searches were conducted. The primary endpoint was complete clearance of plantar warts. Risk-of-bias assessment was based on Cochrane Handbook recommendations. Meta-analyses used Review Manager v5.4.1 software. Cryotherapy appears to have lower cure rates than other treatments (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.12–0.78) with substantial heterogeneity (I2 = 80%). A second subgroup analysis had low heterogeneity (I2 = 28.2%). Subgroup analysis showed that plantar wart cure rates were significantly lower with cryotherapy compared to the physical treatment group (OR 0.05, 95% CI 0.01–0.49) with substantial heterogeneity (I2 = 79%), and antiviral, chemotherapy, and retinoid group (OR 0.30, 95% CI 0.14–0.66) without heterogeneity (I2 = 0%). Intralesional versus spray-on cryotherapy appears to be more effective (OR 0.21, 95% CI 0.09–0.48). No difference in efficacy between two rounds of 10-s and four rounds of 5-s freeze–thaw cycles in cryotherapy was found. Evidence of the superiority of antivirals and chemotherapy over cryotherapy in the treatment of plantar warts was found. However, no evidence supports the superiority or inferiority of cryotherapy compared to other treatments. PublicationAnalysis of Plantar Pressure Pattern after Metatarsal Head Resection. Can Plantar Pressure Predict Diabetic Foot Reulceration?(MPDI, 2021-05-24) García Madrid, Marta; García Álvarez, Yolanda; Álvaro Afonso, Francisco Javier; García Morales, Esther Alicia; Tardáguila García, Aroa; Lázaro Martínez, José LuisTo evaluate the metatarsal head that was associated with the highest plantar pressure after metatarsal head resection (MHR) and the relations with reulceration at one year, a prospective was conducted with a total of sixty-five patients with diabetes who suffered from the first MHR and with an inactive ulcer at the moment of inclusion. Peak plantar pressure and pressure time integral were recorded at five specific locations in the forefoot: first, second, third, fourth, and fifth metatarsal heads. The highest value of the four remaining metatarsals was selected. After resection of the first metatarsal head, there is a displacement of the pressure beneath the second metatarsal head (p < 0.001). Following the resection of the minor metatarsal bones, there was a medial displacement of the plantar pressure. In this way, plantar pressure was displaced under the first metatarsal head following resection of the second or third head (p = 0.001) and under the central heads after resection of the fourth or fifth metatarsal head (p < 0.009 and p < 0.001 respectively). During the one-year follow-up, patients who underwent a metatarsal head resection in the first and second metatarsal heads suffered transfer lesion in the location with the highest pressure. Patients who underwent a minor metatarsal head resection (second–fifth metatarsal heads) showed a medial transference of pressure. Additionally, following the resection of the first metatarsal head there was a transference of pressure beneath the second metatarsal head. Increase of pressure was found to be a predictor of reulceration in cases of resection of the first and second metatarsal heads. PublicationDifferences in the Sub-Metatarsal Fat Pad Atrophy Symptoms between Patients with Metatarsal Head Resection and Those without Metatarsal Head Resection: A Cross-Sectional Study(MDPI, 2020-03-14) Molines Barroso, Raúl Juan; García Álvarez, Yolanda; García-Klepzig, José Luis; García Morales, Esther Alicia; Álvaro Afonso, Francisco Javier; Lázaro Martínez, José LuisWe aimed to evaluate the differences in the sub-metatarsal skin and fat pad atrophy between patients at a high risk of ulceration with and without previous metatarsal head resection. A cross-sectional study was performed in a diabetic foot unit involving 19 participants with a history of metatarsal head resection (experimental group) and 19 (control group) without a history of metatarsal head resection but with an ulcer in other locations in the metatarsal head. No participants had active ulcerations at study inclusion. Sub-metatarsal skin thickness and fat pad thickness in the first and second metatarsals were evaluated by an ultrasound transducer. The experimental group showed sub-metatarsal fat pad atrophy (3.74 ± 1.18 mm and 2.52 ± 1.04 mm for first and second metatarsal, respectively) compared with the control group (5.44 ± 1.12 mm and 4.73 ± 1.59 mm) (p < 0.001, confidence interval: (CI): 0.943–2.457 and p < 0.001, CI: 1.143–3.270 for first and second metatarsal, respectively); however, sub-metatarsal skin thickness was not different between groups (experimental 2.47 ± 0.47 mm vs. control 2.80 ± 0.58 mm (p = 0.063, CI: −0.019–0.672) and 2.24 ± 0.60 mm vs. 2.62 ± 0.50 mm (p = 0.066, CI: −0.027–0.786) for first and second metatarsal, respectively). Patients with previous metatarsal head resection showed sub-metatarsal fat pad atrophy, which could be associated with the risk of reulceration in the metatarsal head. PublicationLong-Term Complications after Surgical or Medical Treatment of Predominantly Forefoot Diabetic Foot Osteomyelitis: 1 Year Follow Up(MPDI, 2021-05-01) Tardáguila García, Aroa; García Álvarez, Yolanda; García Morales, Esther Alicia; López Moral, Mateo; Sanz Corbalán, Irene; Lázaro Martínez, José LuisAim: To compare long-term complications according to the treatment received for management of diabetic foot osteomyelitis (surgical or medical) at 1 year follow up. Design and Participants: A prospective observational study was conducted involving 116 patients with diabetic foot osteomyelitis. The patients received surgical or medical treatment based on the principles described in the literature. To register the development of a complication, both groups of treatments were followed-up 1 year after the ulcer had healed. Results: Ninety-six (82.8%) patients received surgical treatment and 20 (17.2%) medical treatment. No differences were found in the time to healing between both groups of treatment, 15.7 ± 9.2 weeks in the surgical group versus 16.4 ± 12.1 weeks in the medical group; p = 0.103. During follow up, 85 (73.3%) patients developed complications without differences between both groups, 68 (70.8%) in the surgical group versus 17 (85%) in the medical group (p = 0.193). The most common complication in both groups was re-ulceration. We did not observe significant differences comparing complication-free time survival between both treatments (p = 0.665). Conclusion: The onset of complications after healing in patients who suffered from diabetic foot osteomyelitis was not associated with the treatment received. Surgical and medical approaches to the management of diabetic foot osteomyelitis produced similar results in long-term follow up. PublicationPredictive Radiographic Values for Foot Ulceration in Persons with Charcot Foot Divided by Lateral or Medial Midfoot Deformity(MPDI, 2022-01-18) López Moral, Mateo; Molines Barroso, Raúl J.; Sanz Corbalán, Irene; Tardáguila García, Aroa; García-Madrid Martín de Almagro, Marta; Lázaro Martínez, José LuisBackground: To identify differences in radiographic outcomes in weight-bearing lateral X-ray to predict the probability of ulceration in patients with midfoot Charcot neuroarthropathy (CN) differentiated by lateral and medial column deformities. Methods: Thirty-five patients who suffered from CN midfoot deformity participated in this 1 year prospective study in a specialized diabetic foot unit. Lateral talar-first metatarsal angle, calcaneal pitch, and cuboid height were performed by digital radiographs in the weight-bearing lateral view. Patients were followed up for 1 year or until an ulcer ulceration event occurred in the midfoot region. Results: ROC analyses showed that all patients with medial pattern deformity that developed a midfoot ulcer had a lateral talar-first metatarsal angle greater (negative) than −27.5 degrees (°). All patients with lateral pattern deformity that developed a midfoot ulcer had a calcaneal pitch greater (more negative) than −5° and a cuboid height greater (more negative) than −1.5°. Conclusions: Lateral talar-first metatarsal angle was the greatest predictor of midfoot ulceration, with greater than −27.5° measurement correlating with ulceration occurrence in patients with medial deformity. Calcaneal pitch and cuboid height were the greatest predictors of midfoot ulceration with greater than −5 and −1.5°, respectively in patients with CN lateral deformity. PublicationImportance of Footwear Outsole Rigidity in Improving Spatiotemporal Parameters in Patients with Diabetes and Previous Forefoot Ulcerations(MDPI, 2020-03-25) López Moral, Mateo; Molines Barroso, Raúl Juan; Álvaro Afonso, Francisco Javier; Uccioli, Luigi; Senneville, Eric; Lázaro Martínez, José LuisWe aimed to identify if any differences existed in spatiotemporal parameters during gait among different densities of rocker soles in patients with a history of neuropathic ulcerations and the differences in comfort between shoe conditions. This study was a cross-sectional study of 24 patients with diabetes and a history of neuropathic diabetic foot ulcers (DFUs). Spatiotemporal parameters (duration of stance phase (ms), stride length (cm), and step velocity (m/s)) were analyzed in barefoot, semirigid outsole, and rigid outsole footwear conditions. A dynamic pressure measurement system (Footscan® system, RSscan International, Olen, Belgium) was used to assess shoe conditions. We also analyzed differences in comfort between the shoe conditions using a visual analog scale. A Wilcoxon test for paired samples was used to assess gait differences. Result showed that a rigid outsole causes changes in the subphases of the stance phase (p < 0.001; Cohen d = 0.6) compared to a semirigid outsole. Stride length (p < 0.001; Cohen d = 0.66) and step velocity were significantly longer (p < 0.001; Cohen d = 2.03) with the use of rigid outsole footwear. A rigid rocker sole reduces the time of the stance phase, in addition to increasing the stride length and velocity of step in patients with a previous history of DFUs. PublicationMedical Versus Surgical Treatment for the Management of Diabetic Foot Osteomyelitis: A Systematic Review(MPDI, 2021-03-17) Tardáguila García, Aroa; Sanz Corbalán, Irene; García Alamino, Josep M.; Ahluwalia, Raju; Uccioli, Luigi; Lázaro Martínez, José LuisA systematic review and quality assessment was performed to assess the management of diabetic foot osteomyelitis by medical or surgical treatment. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was used. All selected studies were evaluated using the Cochrane Risk of Bias Tool to assess the risk of bias for randomized controlled trials. The literature was revised using PubMed (Medline) and Embase (Elsevier) up to September 2020 to identify clinical trials assessing medical or surgical treatment to manage diabetic foot osteomyelitis. A total of six clinical trials that met our inclusion criteria, with a total of 308 participants. Healing rate, complete closure of the wound, and type of complications were the outcomes evaluated. Risk of bias assessment showed that only two of the six clinical trials included in the systematic review had a low risk of bias. Based on our findings, we believe that the management of diabetic foot osteomyelitis remains challenging. There are few high-quality clinical trials that both stratify clinical presentations and compare these treatments. We conclude that the available evidence is insufficient to identify the best option to cure diabetic foot osteomyelitis. PublicationVariables That Could Influence Healing Time in Patients with Diabetic Foot Osteomyelitis(MDPI, 2023-01-01) Tardáguila García, Aroa; Álvaro Afonso, Francisco Javier; García Madrid, Marta; López Moral, Mateo; Sanz Corbalán, Irene; Lázaro Martínez, José LuisAim: To compare the healing time in patients with diabetic foot osteomyelitis according to the presence or absence of clinical signs of infection, variation of blood parameters, the presence of different radiological signs, and the treatment received for the management of osteomyelitis. Methods: A prospective observational study was carried out in a specialised Diabetic Foot Unit between November 2014 and November 2018. A total of 116 patients with osteomyelitis were included in the study (treated by either a surgical or medical approach). During the baseline visit, we assessed the diagnosis of osteomyelitis, demographic characteristics and medical history, vascular and neurological examination, clinical signs of infection, increased blood parameters, radiological signs of osteomyelitis, and the treatment to manage osteomyelitis. We analysed the association between the presence of clinical signs of infection, variation of blood parameters, presence of radiological signs, and treatment received for management of osteomyelitis with the healing time. Results: The mean time to ulcer healing was 15.8 ± 9.7 weeks. Concerning healing times, we did not find an association with the presence of clinical signs of infection or with the increase in blood parameters, except in the case of eosinophils, which with higher values appear to increase the healing time (U = 66, z = −2.880, p = 0.004). Likewise, no relationship has been found between healing time and the appearance of the different radiological signs of osteomyelitis, nor depending on the treatment administered for the management of osteomyelitis. Conclusion: High levels of eosinophils are associated with a longer healing time of diabetic foot ulcers complicated with osteomyelitis, finding no other factors related to increased healing time.