Abstract
Background: Recently, an increasing number of resistant-to-terbinafine dermatophytosis cases have been reported. Thus, identifying an alternative antifungal agent that possesses a broad-spectrum activity, including against resistant strains, is needed.
Methods: In this study, we compared the antifungal activity of efinaconazole to fluconazole, itraconazole, and terbinafine against clinical isolates of dermatophyte, Candida, and molds using in vitro assays. The minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of each antifungal was quantified and compared. Both susceptible and resistant clinical isolates of Trichophyton mentagrophytes (n=16), T. rubrum (n=43), T. tonsurans (n=18), T. violaceum (n=4), Candida albicans (n=55), C. auris (n=30), Fusarium sp., Scedosporium sp., and Scopulariopsis sp. (n=15 for each) were tested.
Results: Our data shows that efinaconazole was the most active antifungal, compared to the other agents tested, against dermatophytes with MIC50 and MIC90 (Concentration that inhibited 50% and 90% of strains tested, respectively) values of 0.002 and 0.03 μg/ml, respectively. Fluconazole, itraconazole and terbinafine showed MIC50 and MIC90 values of 1 and 8 μg/ml, 0.03 and 0.25 μg/ml, and 0.031 and 16 μg/ml, respectively. Against Candida isolates, efinaconazole MIC50 and MIC90 values were 0.016 and 0.25 μg/ml, respectively, whereas fluconazole, itraconazole and terbinafine had MIC50 and the MIC90 values of 1 and 16 μg/ml, 0.25 and 0.5 μg/ml, and 2 and 8 μg/ml, respectively. Against various mold species, efinaconazole MIC values ranged from 0.016 and 2 μg/ml, compared to 0.5 to greater than 64 μg/ml for the comparators.
Conclusions: efinaconazole showed superior potent activity against a broad panel of susceptible and resistant dermatophyte, Candida, and mold isolates.
Background: The coronavirus disease of 2019 pandemic impacted all facets of health care in the United States, including the professional training for podiatry residents and students. In March of 2020, the Association of American Medical Colleges recommended pausing then modifying all clinical rotations. The podiatric community followed suit. In-person restrictions, cancellations of clerkships, limited clinical experiences, virtual didactic programs, and reduced surgical cases for students and residency programs occurred for many months during the ongoing pandemic. These adaptations impacted the ability of podiatric students to complete clinical rotations and clerkships, which are pivotal to their academic curriculum and residency program application and selection.
Methods: A survey was conducted by the Council of Teaching Hospitals (COTH) and sent out by the American Association of Colleges of Podiatric Medicine. The 2021 postinterview surveys were sent out to all participants in the 2021 Centralized Application Service for Podiatric Residencies Web application and match cycle, both programs and candidates.
Results: The COTH presents results and comments from the 2021 virtual interview experience and residency match. Data and anecdotal comments from the 2021 postinterview survey conducted by COTH, sent out by American Association of Colleges of Podiatric Medicine, are presented here.
Conclusions: Results from the surveys of program directors and candidates show a preference by both groups for in-person interviews despite the personal time demands and increased costs associated with travel.
The coronavirus disease of 2019 pandemic is driving significant change in the health-care system and disrupting the best practices for diabetic limb preservation, leaving large numbers of patients without care. Patients with diabetes and foot ulcers are at increased risk for infections, hospitalization, amputations, and death. Podiatric care is associated with fewer diabetes-related amputations, emergency room visits, hospitalizations, length-of-stay, and costs. However, podiatrists must mobilize and adopt the new paradigm of shifts away from hospital care to community-based care. Implementing the proposed Pandemic Diabetic Foot Triage System, in-home visits, higher acuity office visits, telemedicine, and remote patient monitoring can help podiatrists manage patients while reducing the coronavirus disease of 2019 risk. The goal of podiatrists during the pandemic is to reduce the burden on the health-care system by keeping diabetic foot and wound patients safe, functional, and at home.
Lateral column arthrodesis of the tarsometatarsal joints is a highly controversial topic in foot and ankle surgery, with minimal prospective research and reproducible findings in the current literature. Arthrodesis of the lateral fourth and fifth tarsometatarsal joints, when performed, is most often done secondary to post-traumatic osteoarthritis or Charcot’s neuroarthropathy deformity. This case report focuses on arthrodesis of the lateral column in a patient with post-traumatic osteoarthritis from a previously sustained Lisfranc fracture-dislocation. The patient also experienced a cavus foot deformity that was addressed with a lateral displacement calcaneal osteotomy. Arthrodesis of the fourth and fifth tarsometatarsal joints was found to be successful on this patient, with bony union noted to occur radiographically 12 weeks postoperatively. In addition, the patient experienced significant reduction in her preoperative pain and an ability to return to activities of daily living. Regular visits during an 18-month postoperative period occurred, with the patient continuing to have satisfactory results and a significant reduction in preoperative pain levels. One postoperative complication was encountered 15 months postoperatively: painful hardware, which resulted in the removal of both calcaneal screws and one screw from the fourth tarsometatarsal arthrodesis site. This case report proposes that lateral column arthrodesis may be performed successfully in select patients where other joint-preserving procedures may not be applicable. Herein we outline a suggested surgical technique with hardware that can be used to reproduce these findings and assist surgeons who are unfamiliar with performing this procedure.
Background: We investigated the relationship between ankle radiographic bone morphology and observed fracture type.
Methods: We retrospectively reviewed patients who had visited the emergency department with ankle injuries between June 1, 2012, and July 31, 2018. Patients were treated with open reduction and internal fixation. Patients were grouped by fracture pattern. Group 1 consisted of isolated lateral malleolar fractures, and group 2 comprised bimalleolar fractures. Group 1 was further divided into subgroups A and B based on classification as Weber type B and C fractures, respectively. Four radiographic parameters were measured postoperatively on a standing whole-leg anteroposterior view of the ankle: talocrural angle (TCA), medial malleolar relative length (MMRL), lateral malleolar relative length (LMRL), and distance between the talar dome and distal fibula.
Results: One hundred seventeen patients were included in group 1-A, 89 in group 1-B, and 168 in group 2. The TCA and MMRL were significantly larger in group 2 than in group 1. Lateral to medial malleolar length ratio was also significantly different between the groups. However, there were no significant differences between the groups in terms of LMRL and the distance between the distal fibula tip and talar process. Between subgroups 1-A and 1-B, LMRL (P = .402) and MMRL (P = .592) values were not significantly different. However, there was a significant difference between groups in TCA and the distance between the distal fibula tip and talar process.
Conclusions: The TCA, MMRL, and lateral malleolar length to medial malleolar length ratio were significantly higher in patients with bimalleolar fracture than in patients with isolated lateral malleolar fractures.
Background: Syndesmosis is an important soft-tissue component supporting ankle stability. It is commonly injured along with ankle fractures. Accurate reduction and fixation of syndesmosis is essential to obtain better functional results. Therefore, we aimed to find a practical method using the mortise view of the ankle to determine the optimal syndesmosis fixation angle intraoperatively.
Methods: We randomly selected 200 adults (100 women and 100 men) aged 18 to 60 years. Three-dimensional anatomical models of the tibia and fibula were created. We created a best-fit plane on the articular surface of the medial malleolus and a 90° vertical plane to the medial malleolus plane. We determined two splines on the cortical borders of the tibia and fibula distant from the most superior point of the ankle joint in horizontal view. We created two spheres that fit to the predefined splines. The optimal syndesmosis fixation angle was determined measuring the angle between the line connecting the center points of the spheres and the 90° vertical plane to the medial malleolus plane.
Results: We observed no statistically significant difference in optimal syndesmosis fixation angles between sex groups. The participant mean ± SD age was 47.1 ± 10.5 years. The optimal syndesmosis fixation angle in the mortise view was found to be 21° ± 4.3°.
Conclusions: We determined the optimal syndesmosis fixation angle to be 21° ± 4.3° using the mortise view of the ankle. The surgeon could evaluate the whole articular surface of the ankle joint with the medial and lateral syndesmotic spaces in mortise view accurately, and at the same position syndesmosis fixation could be performed at a mean ± SD angle of 21° ± 4.3°.
