Lower Extremity Infection

Antibiotics And DFIs: What The Evidence Reveals

February 24, 2014

Given the prevalence of foot infections in patients with diabetes, aggressive and judicious management with antibiotics is crucial.

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‘Skin popping’ of the foot by drug abusers

February 22, 2014

Demographic description of the presentation and treatment of lower extremity skin and soft tissue infections secondary to skin popping in intravenous drug abusers. Pirozzi K1, Van JC1, Pontious J2, Meyr AJ3. J Foot Ankle Surg

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Partial Foot Amputations for Salvage of the Diabetic Lower Extremity

January 1, 2014

Lower extremity infections are a common yet unfortunate complication of diabetes-related ulcers often requiring surgical intervention. The main goals of surgical treatment consist of selecting the appropriate procedure to effectively eradicate nonsalvageable tissue, achieve primary healing, and maximize subsequent dynamic functionality. An overview of each partial foot amputation procedure is discussed with a focus on procedure selection as well as standard and advanced surgical techniques.

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News Story About Pharma Industry Payments – Response

March 13, 2013

I am sorry that it has been so long since I put up a post.  Things have been slightly hectic. Unfortunately, instead of reporting on new infectious disease information, with this entry I find myself responding to a story about my receiving payments to lecture from the pharmaceutical industry.  The story ran today (3/13/13) in the Philadelphia Inquirer and online at www.philly.com .  http://www.philly.com/philly/health/20130312_Philly_foot_doc_among_highest_paid_by_Big_Pharma.html When the original print story was run I had not had a chance to respond to the author, reporter Sam Woods.  I give Mr. Woods credit for updating the online story in response to some of my comments, reproduced below, which I emailed to him this morning.   I feel that the Pharma Industry has done an excellent job in disseminating important information that may otherwise not be available to those of us interested in saving limbs of patients with diabetes.  This is done in an unbiased, government approved and monitored way, under strict federal guidance.  My lectures are randomly, and independently audited for compliance with these guidelines and I have never been found to be deficient.  Here is my response to Mr

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Can Bracing Have An Impact For The Charcot Foot?

February 27, 2013

Although surgical reconstruction can be effective for patients with Charcot, not every patient is an appropriate candidate for surgery. Accordingly, this author explores the potential of employing various forms of bracing, including ankle foot orthoses and patellar tendon bracing, in patients with Charcot foot. read more

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Off-Label Drug Promotion: Coming Soon?

December 18, 2012

The U.S. Second Circuit Court of Appeals recently ruled to prohibit criminal prosecution for truthful off-label promotion of drugs as a First Amendment right

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Off Label Drug Promotion…Coming Soon?

December 12, 2012

(I want to thank my friend and colleague Jeff Karr, DPM ( www.osteomyelitiscenter.com ) for alerting me to this news story.) Just this past week the U.S.

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What’s New & Interesting in the Infectious Diseases Literature – Summer 2012

August 13, 2012

I confess…I have been a bit lackadaisical in my scanning through the journals I receive each month.  This point was driven home to me yesterday when I went to find room on my desk to put some work and realized it was totally covered with stacks of journal back issues I had put aside with all good intentions to eventually read through!  It was time to start clearing my desk with the side benefit of realizing I could probably come up with some interesting articles to blog about.  Well, I did.  In fact, I think I have enough for a few upcoming posts. Those of you who have heard me lecture on MRSA know that I am not a big fan of the use of trimethoprim/sulfamethoxazole for the treatment of even mild outpatient infections.  My main objection has been increased toxicity of this drug vs. other options including; Stevens-Johnson syndrome, renal toxicity, allergies, drug-drug interactions, etc.   However, I have also questioned the evidence supporting its use and have frequently stated that we don’t even know the proper dosing!  Most clinicians use this drug at the “standard” dose of 1 DS tablet bid (160mg/800mg).  However, some authorities have argued that that dose is too low for MRSA and an increased dose of 2 DS tabs bid should be used.  This has always concerned me because of the potential risk for increased adverse events with the higher dose.  A study published in the December 2011 (I told you I was behind on my reading!) Clinical Infectious Diseases by Cadena and colleagues compared the two dosing regimens and found no difference in outcomes with those treated with the higher dose vs.

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Radio Interview About Diabetic Foot Infections and SALSAL

July 17, 2012

This past Sunday, July 15, I had the pleasure of participating in a radio interview on WOKV, Jacksonville, FL, the largest, most listened to talk radio station in Northern Florida. Here is the link to the audiostream: http://wokv.media.streamtheworld.com/audio/save_leg_save_101730761.mp3 The show was hosted by Desmond Bell, DPM.  Des, a former student “done good”, is the Executive Director of the Save a Leg, Save a Life Foundation   http://savealegsavealife.org/ or SALSAL. From its modest beginnings as a way for Des and his wife De Anna, a nurse practitioner and wound specialist, to get local providers in the Jacksonville area up to speed in the area of wound care, SALSAL has grown into a nationwide organization with at least 30 local chapters spread throughout the US.  As I mention in the interview, the scope of the organization did not really hit me until I was giving a dinner lecture to the local chapter in Seattle a few months back and over 70 health care providers of all specialties attended.  I have seen this organization grow from its first small meeting in Jacksonville, where I don’t think there even were 70 attendees, to a significant national “player” in the area of limb salvage.  Congrats to Des and De Anna.

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New 2012 IDSA Diabetic Foot Infection Guidelines

May 22, 2012

As promised, I would post a link to the newly revised, updated IDSA DFI Guidelines as soon as they were available.  Well, I am honored, proud and excited to be able to let my readership know that after about 6 years in writing, multiple levels of peer review and well over 60 individual review comments, that the newly revised guidelines have been posted by IDSA on their website. Here is the link:    http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/2012%20Diabetic%20Foot%20Infections%20Guideline.pdf Those of you familiar with the 2004 document will immediately notice the changes.  All IDSA Guidelines are now standardized to a “question, recommendation, evidence summary” format.  Each committee is assigned to determine which are the most critical questions that need to be answered.  In this case, we came up with 10 questions that cover everything from diagnosis to antibiotics, to osteomyelitis and wound care.  There are 44 evidenced based recommendations that  guide the clinician in the answers to those 10 questions.  The evidence is then summarized and graded by the British Medical Journal “GRADE” system.  This common sense approach matches the strength of the recommendation with the level of the evidence.  This is given in plain English.  For example “Strong, Low” means that there is a strong recommendation but a relatively low level of evidence on which the decision has been based. I hope that you all find the new Guidelines helpful in your management of these patients.  I look forward to your comments

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