Person:
Tardaguila García, Aroa

First Name

Aroa

Last Name

Tardaguila García

URI

https://hdl.handle.net/20.500.14352/81034

Affiliation

Universidad Complutense de Madrid

Faculty / Institute

Enfermería, Fisioterapia y Podología

Department

Enfermería

Area

Enfermería

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Now showing 1 - 10 of 22

Variables That Could Influence Healing Time in Patients with Diabetic Foot Osteomyelitis
(Journal of Clinical Medicine, 2023) Tardaguila García, Aroa; Álvaro Afonso, Francisco Javier; García Madrid, Marta; López Moral, Mateo; Sanz Corbalán, Irene; Lázaro Martínez, José Luis
Aim: 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.
Medical Versus Surgical Treatment for the Management of Diabetic Foot Osteomyelitis: A Systematic Review
(Journal of Clinical Medicine, 2021) Tardaguila García, Aroa; Sanz Corbalán, Irene; García Alamino, Josep M.; Ahluwalia, Raju; Uccioli, Luigi; Lázaro Martínez, José Luis
A 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.
Correlation between Empirical Antibiotic Therapy and Bone Culture Results in Patients with Osteomyelitis
(Adv Skin Wound Care, 2019) Tardaguila García, Aroa; Lázaro Martínez, José Luis; Sanz Corbalán, Irene; García Álvarez, Yolanda; Álvaro Afonso, Francisco Javier; García Morales, Esther Alicia
Objective: To analyze the correlation between empirical antibiotic therapies prescribed in primary care centers by general practitioners and the microbiology results of bone culture in patients with diabetic foot-related osteomyelitis. Methods: This observational study involved 80 patients with diabetic foot ulcers and clinically suspected osteomyelitis. The patients were taking antibiotics prescribed by general practitioners to treat diabetic foot infections. Bone samples were taken from every patient for microbiology analysis in a specialized diabetic foot unit. Main outcome measure: The sensitivity of the bone cultures to antibiotics was compared with the patient's previous antibiotic therapy, and antibiotic and bacterial resistance were analyzed. Main results: The bone cultures from only 16 patients (22.3%) showed sensitivity to the antibiotics that the patient had been prescribed. Fifty-six patients (77.8%) displayed bacterial resistance to the antibiotic that they were taking. Conclusions: Awareness and implementation of international antibiotic stewardship guidelines are poor in primary care centers. It is important to establish strategies that foster a better understanding of treatment management standards and ensure the proper implementation of guidelines.
A non‐invasive method for diagnosing plantar warts caused by human papillomavirus (HPV)
(Journal of Medical Virology, 2021) García Oreja, Sara; Álvaro Afonso, Francisco Javier; Sevillano Fernández, David; Tardaguila García, Aroa; López Moral, Mateo; Lázaro Martínez, José Luis
The methods that are used for the diagnostic confirmation of human papillomavirus (HPV) include excisional biopsy and histopathological studies or polymerase chain reaction (PCR). They are invasive, laborious, and subject to ethical restrictions due to the benign nature of these warts. This study aims to analyse the accuracy of noninvasive swab samples to diagnose plantar warts. Fifty plantar warts were included in the study. Skin swabs and hyperkeratosis skin scales were collected from each wart. Multiplex PCR was performed to detect and type the HPVs. The prevalence of HPV in this study was 90% when the sample was obtained using the wart scraping method and 94% when it was obtained using swabs and the new method. In 45 of the 45 positive samples (sensitivity: 100%), the result between the wart scab and wart swab were almost identical. The genotyping result was identical in all 46 patients who had a positive result using both methods. The swab method appears to be a simple and accurate technique to diagnose plantar warts due to HPV. It is a noninvasive technique that could be performed even by inexperienced professionals and in patients with pain or a fear of needles.
Complications associated with the approach to metatarsal head resection in diabetic foot osteomyelitis
(International Wound Journal, 2018) Tardaguila García, Aroa; Sanz Corbalán, Irene; Molines Barroso, Raúl Juan; Álvaro Afonso, Francisco Javier; García Álvarez, Yolanda; Lázaro Martínez, José Luis
The aim of this study was to evaluate the recovery time and the development of complications in the dorsal and plantar approach to metatarsal head resections (MHR) in patients with diabetic foot ulcers complicated by osteomyelitis. A retrospective study was carried out involving 108 patients who underwent MHRs for the treatment of diabetic foot osteomyelitis. Two cohorts were defined: dorsal approach with incision closed with sutures and plantar approach with ulcer healed using conservative treatment. The main outcomes were the weeks until healing and complications related to the approaches. Fifty-three patients (49.1%) underwent a plantar approach and 55 (50.9%) a dorsal approach. Both approaches rendered similar healing times. However, the patients undergoing a dorsal approach developed more post-surgical complications than patients treated through a plantar approach. The dorsal approach intervention was performed on smaller and shallower ulcers; however, more complications developed at follow up using this approach than through a plantar approach for MHR complicated with osteomyelitis.
Analysis of Plantar Pressure Pattern after Metatarsal Head Resection. Can Plantar Pressure Predict Diabetic Foot Reulceration?
(Journal of Clinical Medicine, 2021) García Madrid, Marta; García Álvarez, Yolanda; Álvaro Afonso, Francisco Javier; García Morales, Esther Alicia; Tardaguila García, Aroa; Lázaro Martínez, José Luis
To 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.
Seguimiento a lo largo plazo de marcadores analíticos y radiológicos de los pacientes diabéticos con sospecha clínica de osteomielitis tras el cierre completo de su lesión
(2020) Tardaguila García, Aroa; Lázaro Martínez, José Luis
La osteomielitis de Pie Diabético representa aproximadamente el 50,0% delas infecciones de las úlceras de Pie Diabético, siendo la primera causa de amputación menor y mayor de los pacientes afectados. La amputación mayor en pacientes diabéticos se asocia a elevados costes sociosanitarios ya una tasa de mortalidad a los 2 y 5 años del 48,0% y del 68,0%,respectivamente. En la actualidad, no existe un consenso sobre los criterios diagnósticos de la osteomielitis de Pie Diabético y esto en ocasiones se traduce en un retraso terapéutico. De igual manera, la ausencia de indicadores diagnósticos y evolutivos de la osteomielitis de Pie Diabético no permite evaluar con claridad la ventaja terapéutica del tratamiento quirúrgico frente al médico. Además, aún no se han definido unos criterios claros acerca de la curación de la osteomielitis de Pie Diabético, que permitirían definir indicadores de evolución y resolución basados en marcadores analíticos y radiológicos, facilitando el tratamiento y el seguimiento de esta enfermedad, reduciendo los costes de tratamiento, las amputaciones y las tasas de mortalidad...
Efficacy of cryotherapy for plantar warts: A systematic review and meta‐analysis
(Dermatologic Therapy, 2022) García Oreja, Sara; Álvaro Afonso, Francisco Javier; Tardaguila García, Aroa; López Moral, Mateo; García Madrid, Marta; Lázaro Martínez, José Luis
Recent 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.
Intra-Observer and Inter-Observer Reliability of Ankle Circumference Measurement in Patients with Diabetic Foot: A Prospective Observational Study
(Journal of Clinical Medicine, 2023) Montoro Cremades, David; Tardaguila García, Aroa; Navarro Pérez, David; García Álvarez, Yolanda; López Moral, Mateo; Lázaro Martínez, José Luis
Inflammation, being a typical response to vascular tissue alterations, induces variations in tissue oxygen diffusion pressure. Diabetic microangiopathy, an inflammatory process, is characterized by an increase in vascular flow at rest, reduced venous and arteriolar responses, and increased capillary permeability, resulting in oedema development, decreased transcutaneous oxygen pressure, and increased transcutaneous carbon dioxide pressure. This phenomenon potentially hampers ulcer healing. Although the figure-of-eight method has proven to be a reliable, valid, quick, and efficient test for assessing foot and ankle measurements in patients with oedema and compromised skin integrity, it has not been studied in patients with diabetic foot. The aim of this study was to determine and compare the intra- and inter-observer variabilities of the figure-of-eight method in patients with diabetic foot. A prospective observational and cross-sectional study was undertaken, involving sixty-one subjects from a specialized Diabetic Foot Unit. Three investigators with varying levels of experience independently measured the subjects to assess both intra-observer and inter-observer variability. The evaluation was conducted using the Intraclass Correlation Coefficient (ICC). In the statistical analysis, an ICC of 0.93, adjusted using a 95% confidence interval (CI), was obtained for inter-observer reliability ICC, indicating excellent reliability among observers. Furthermore, an ICC of 0.98 with a 95% CI was obtained for the intra-observer reliability analysis, indicating excellent reliability. The results support using this test during the clinical management of oedema in patients with diabetic foot. The absence of an objective, fast, and readily available diagnostic method for oedema in diabetic foot patients in clinical practice might pose a limitation. Subsequent research should tackle this issue and explore the correlation between ankle perimeter measurements and other clinical outcomes in diabetic foot patients, including wound healing and quality of life.
Microbiological culture combined with PCR for the diagnosis of onychomycosis: Descriptive analysis of 121 patients
(Mycoses, 2023) Navarro Pérez, David; García Oreja, Sara; Tardaguila García, Aroa; León Herce, Diego; Álvaro Afonso, Francisco Javier; Lázaro Martínez, José Luis
Background: Onychomycosis is the most common nail pathology, involving various pathogens such as dermatophytes, moulds and yeasts. Objective: The objective of this study was to observe the prevalence of onychomycosis, analyse the most appropriate diagnostic test, and assess the distribution of pathogens based on age, sex, quarter of the year, duration of symptoms and previous treatment. Methods: Retrospectively, mycological culture and PCR data and results were collected from 121 patients. Results: Of the 121 samples, 57% (69/121) tested positive when both microbiological study techniques were combined. The prevalence of onychomycosis was higher when PCR was performed (52.1%) compared to microbiological culture (33.1%). Among the 81 samples negative by microbiological culture, 31 were positive by PCR. Similarly, of the 58 samples negative by PCR, eight were positive by microbiological culture. Diagnostic accuracy data (with 95% confidence intervals) for PCR, using microbiological culture as the gold standard, were as follows: sensitivity of 0.8, specificity of 0.62, positive predictive value of 0.51 and negative predictive value of 0.86. The most frequently identified pathogen was Trichophyton rubrum, and the hallux nail plate was the most commonly affected location. However, no statistically significant associations were found between sex, age, quarter of the year and affected area with culture and PCR results. Conclusion: Combining microbiological culture and PCR can increase the detection rate of onychomycosis and help avoid false-negative results.