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Midfoot Charcot Neuroarthropathy in Patients With Diabetes

Katherine M. Raspovic, Kimberlee B. Hobizal, Bedda L. Rosario, Dane K. Wukich
2015 Foot & Ankle Specialist  
Introduction-Charcot neuroarthropathy (CN) and diabetic foot ulceration (DFU) are serious complications of diabetes mellitus (DM) that can result in infection, hospitalization, amputation, and have been shown to negatively affect quality of life (QOL). To the best of our knowledge, there are no studies in the literature that have specifically compared QOL in patients with diabetic CN without DFU to a group of patients with diabetic CN and concurrent DFU. The aim of this study was to compare
more » ... -reported assessments of QOL in patients with CN to a group of patients with CN and concomitant midfoot ulceration. Materials and Methods-We compared a group of 35 diabetic patients with midfoot CN and no ulcer to a group of 22 diabetic patients with midfoot CN and concurrent DFU. Self-reported outcome was assessed using the Medical Outcome Study Short Form 36 (SF-36) health survey and Foot and Ankle Ability Measure (FAAM). Results-No significant differences were found when comparing the 2 groups utilizing the SF-36 and FAAM with the exception that CN patients without foot ulcers had lower mean scores on the Bodily Pain Subscale. Both groups demonstrated negative impact on physical QOL and lower extremity function to a greater degree than mental QOL. Conclusion- The presence of ulceration does not appear to significantly impact QOL in patients with CN when compared to patients with CN without ulceration. Levels of Evidence-Prognostic, Level III: Case control Keywords Charcot neuroarthropathy; diabetic foot ulcer; quality of life; SF-36 For reprints and permissions queries, please visit SAGE's Web site at
doi:10.1177/1938640015585957 pmid:25956872 pmcid:PMC5663468 fatcat:jeivq3f2bbfrlo372hm2qfiblm

Outcomes of Osteomyelitis in Patients Hospitalized With Diabetic Foot Infections

Dane K. Wukich, Kimberlee B. Hobizal, Tresa L. Sambenedetto, Kristin Kirby, Bedda L. Rosario
2016 Foot & ankle international  
Background-This study was conducted to evaluate the outcomes of patients with diabetic foot osteomyelitis (DFO) compared to diabetic foot soft tissue infections (STIs). Methods-229 patients who were hospitalized with foot infections were retrospectively reviewed, identifying 155 patients with DFO and 74 patients with STI. Primary outcomes evaluated were the rates of amputations and length of hospital stay. DFO was confirmed by the presence of positive bone culture and/or histopathology.
more » ... Patients with DFO had a 5.6 times higher likelihood of overall amputation (P < .0001), a 3.4 times higher likelihood of major amputation (P = .027) and a 4.2 times higher likelihood of minor amputation (P < .0001) compared to patients without DFO. Major amputation was performed in 16.7% patients diagnosed with DFO and 5.3% of patients diagnosed with STI. Patients with DFO complicated by Charcot neuroarthropathy had a 7 times higher likelihood of undergoing major amputation (odds ratio 6.78, 95% confidence interval 2.70-17.01, P < .0001). The mean hospital stay was 7 days in DFO and 6 days in patients with DFI (P = .0082). Patients with DFO had a higher erythrocyte sedimentation rate (85 vs 71, P = .02) than patients with STI, however the differences in C-reactive protein (13.4 vs 11.8, P = .29) were not significantly different. Conclusion-In this study of moderate and severe DFIs, the presence of osteomyelitis resulted in a higher likelihood of amputation and longer hospital stay. Readers should recognize that the findings of this study may not be applicable to less severe cases of DFO that can be effectively managed in an outpatient setting. Reprints and permissions: Corresponding Level of Evidence-Level III, retrospective comparative case series.
doi:10.1177/1071100716664364 pmid:27553085 pmcid:PMC5672907 fatcat:eoc7c4bus5c2zgixngx2noii6e

Sleep disturbance and cardiometabolic risk factors in early pregnancy: a preliminary study

Alyssa Haney, Daniel J. Buysse, Bedda L. Rosario, Yi-Fan Chen, Michele L. Okun
2014 Sleep Medicine  
Cardiometabolic (CM) risk factors are linked to increased morbidity. Disturbed sleep is associated with CM risk factors in late pregnancy, but little is known about sleep in early pregnancy and CM risk factors. Diary and actigraphy-assessed sleep information, as well as CM outcomes (blood pressure (BP) and body mass index (BMI)), were collected thrice from pregnant women (N=161) in early pregnancy: T1 (10-12 weeks), T2 (14-16 weeks) and T3 (18-20 weeks). The sleep variables evaluated included
more » ... eep onset latency (SOL), wake after sleep onset (WASO) and total sleep time (TST). Sleep variables were dichotomised using established clinical cut-offs. BMI and BP significantly changed across time. Women with persistent SOL≥20 min had greater BMI than women without persistent SOL≥20 min prior to covariate adjustment at T1 and T2, but at T3 the BMI values converged. Similar results were observed for persistent WASO≥30 min. Persistently long WASO, as measured by actigraphy, was associated with elevated SBP, after controlling for covariates. Consistent with anecdotal evidence, it appears as if a subset of women report substantial difficulty initiating and maintaining sleep during early pregnancy and this may augment the risk of higher BP and BMI. Understanding these relationships is important as CM risk factors are linked to maternal and infant morbidity. Assessing sleep in early pregnancy may bestow time necessary for appropriate intervention.
doi:10.1016/j.sleep.2014.01.003 pmid:24657205 pmcid:PMC4084505 fatcat:323qgjsjs5d6tlcqaadhpko7ma

Liberation From Renal Replacement Therapy After Cadaveric Liver Transplantation

Ibtesam A. Hilmi, Ali Al-Khafaji, Daniela Damian, Bedda L. Rosario-Rivera, Ali Abdullah, John A. Kellum
2016 Transplantation Direct  
4 [3; 5.3] 4.3 [3.4; 5.9] 0.256 Albumin 5% (L) 1.75 [1.4; 2.5] 2 [1; 3] 0.936 Packed red blood cells, units 12 [8.5; 15] 10 [8; 13] 0.477 Fresh-frozen plasma, units 10 [5.5; 14.5] 8.5 [6  ...  0.84 min 30 (88.2%) 27 (93.1%) 0.416 Veno-venous bypass 6 (17.6%) 2 (6.9%) 0.186 Aprotinin 20 (60.6%) 21 (72.4%) 0.239 Methylene blue 4.5 [3.1; 5.7] 4 [3.4; 4.9] 0.582 Crystalloid (L)  ... 
doi:10.1097/txd.0000000000000622 pmid:27826603 pmcid:PMC5096437 fatcat:m4v7hvyctje2tfwaf4b7b37qru

Correlation of SF-36 and SF-12 Component Scores in Patients With Diabetic Foot Disease

Dane K. Wukich, Tresa L. Sambenedetto, Natalie M. Mota, Natalie C. Suder, Bedda L. Rosario
2016 Journal of Foot and Ankle Surgery  
The assessment of patient outcomes is becoming increasingly important in all areas of medicine, including foot and ankle surgery. The Medical Outcomes Study Short Form 36-item (SF-36) is widely used as a generic measure of quality of life; however, patients often find answering 36 questions cumbersome. Consequently, the Short Form 12 (SF-12) was developed. We hypothesized that the agreement between the SF-12 and SF-36 component scores would be substantial in patients with diabetic foot disease.
more » ... We retrospectively reviewed the data from 300 patients with diabetes mellitus (DM) and foot and ankle pathology who completed the SF-36 questionnaire. Of the 300 patients, 155 (51.7%) had problems directly related to complications of DM and 145 (48.3%) had routine foot complaints that were unrelated to complications of DM. The 12 questions of the SF-12 were abstracted from the SF-36. The overall median score for the SF-36 physical component summary was 34.70 compared with the overall SF-12 physical component summary of 36.75 (p = .04). The intraclass correlation coefficient was 0.93688. The overall median score for the SF-36 mental component summary was 52.40 compared with the overall SF-12 mental component summary of 51.25 (p = .34). The intraclass correlation coefficient was 0.95449. Substantial agreement was observed when comparing the component scores of the SF-12 and the SF-36. From our study results of 300 patients with DM, it appears that the SF-36 and SF-12 are comparable outcome instruments for use with patients with diabetic foot disease.
doi:10.1053/j.jfas.2015.12.009 pmid:27052155 pmcid:PMC5664160 fatcat:6ecckunrgzaa3mp2fgjtiqhuni

Assessment of parameter settings for SPM5 spatial normalization of structural MRI data: Application to type 2 diabetes

Bedda L. Rosario, Scott K. Ziolko, Lisa A. Weissfeld, Julie C. Price
2008 NeuroImage  
Spatial normalization is the process of standardizing images of different subjects into the same anatomical space. The goal of this work was to assess standard and unified methods in SPM5 for the normalization of structural magnetic resonance imaging (MRI) data acquired in mid-life/ elderly subjects with diabetes. In this work, we examined the impact of different parameters (i.e. nonlinear frequency cutoff, nonlinear regularization and nonlinear iterations) on the normalization, in terms of the
more » ... residual variability. Total entropy was used to assess the residual anatomical variability after spatial normalization in a sample of 14 healthy mid-life/elderly control subjects and 24 mid-life/elderly subjects with type 2 diabetes. Spatial normalization was performed using default settings and by varying a single parameter or a combination of parameters. Descriptive statistics and nonparametric tests were used to examine differences in total entropy. Statistical parametric mapping analyses were performed to evaluate the influence of parameter settings on the spatial normalization. Total entropy results and SPM analyses suggest that the best parameters for the spatial normalization of mid-life/elderly image data to the MNI template, when applying the standard approach, correspond to the default cutoff (25 mm), heavy regularization, and the default number of nonlinear iterations (16). On the other hand, when applying the unified approach, the default parameters were the best for spatial normalization of mid-life/elderly image data to the MNI priors. These findings are relevant for studies of structural brain alterations that may occur in normal aging, chronic medical conditions, neuropsychiatric disorders, and neurodegenerative disorders.
doi:10.1016/j.neuroimage.2008.02.004 pmid:18394922 pmcid:PMC2925520 fatcat:3hr4f2dhlzfzjpd44usfodiemu

Successful tactile based visual sensory substitution use functions independently of visual pathway integrity

Vincent K. Lee, Amy C. Nau, Charles Laymon, Kevin C. Chan, Bedda L. Rosario, Chris Fisher
2014 Frontiers in Human Neuroscience  
Lee and Bedda L. Rosario.  ...  Chan: data analysis, manuscript revision and preparation, manuscript proofing; Bedda L.  ... 
doi:10.3389/fnhum.2014.00291 pmid:24860473 pmcid:PMC4026734 fatcat:yk3bxnoyy5ecdev2zss6rhziia

MRI Investigation of New Approach to Improve the Recovery of Myocardial Ischemia Reperfusion Injury by Treatment with Intralipid®

Yijen L. Wu, Li Liu, Fang-Cheng Yeh, Bedda L. Rosario, Chien Ho
2016 World Journal of Cardiovascular Diseases  
Despite advances in revascularization and thrombolytic therapy, the outcome of patients after acute myocardial infarction (MI) could be complicated by ischemia reperfusion injury (IRI) and subsequent ventricular remodeling. Inflammation plays a central role in IRI. Intralipid ® has been shown to reduce infarct size after IRI, but its effects on myocardial inflammation have not been addressed. The goal of this study is to investigate the effects of Intralipid ® on in-situ myocardial inflammation
more » ... and to better characterize its cardio-protective effects. Methods and Results: Cellular MRI was used to evaluate myocardial inflammation of iron-oxide-labeled macrophage infiltration. Cardiac MRI was used to evaluate global and regional ventricular wall motion, as well as myocardial perfusion and infarction in a rat model. Our results show that the Intralipid ® treatment following IRI can preserve global and regional ventricular wall motion, and reduce the infarct size. The Intralipid ® -treated rats exhibit reduced myocardial macrophage infiltration, indicating reduced in-situ myocardial inflammation. Conclusions: Our results indicate that the Intralipid ® treatment can protect the heart against IRI and can specifically reduce in-situ myocardial inflammation. Additional study is needed to assess if treatment using Intralipid ® after LAD occlusion could improve the recovery of patients suffering from a heart attack and also reduce future development of heart failure.
doi:10.4236/wjcd.2016.610041 fatcat:w434feqypndgxo6fj5475tnctm

Gender differences in systemic sclerosis: relationship to clinical features, serologic status and outcomes

Christine Peoples, Thomas A. Medsger, Mary Lucas, Bedda L. Rosario, Carol A. Feghali-Bostwick
2016 Journal of Scleroderma and Related Disorders  
Introduction-There is a strong female preponderance reported in many connective tissue diseases and in almost all systemic sclerosis (SSc) case series. Methods-We compared gender differences in SSc patients in a large single-center cohort, including demographic features, disease subtype, environmental exposures, disease-specific serum autoantibodies, organ system involvement (frequency and severity) and survival. Adjustment for cutaneous subset (diffuse cutaneous [dc] and limited cutaneous [lc]) was performed.
doi:10.5301/jsrd.5000209 pmid:29242839 pmcid:PMC5726425 fatcat:aymujex24bfsbpu5yl33jvnkbi

Use of magnetic resonance imaging in severe pediatric traumatic brain injury: assessment of current practice

Peter A. Ferrazzano, Bedda L. Rosario, Stephen R. Wisniewski, Nadeem I. Shafi, Heather M. Siefkes, Darryl K. Miles, Andrew L. Alexander, Michael J. Bell, _ _
2019 Journal of Neurosurgery: Pediatrics  
OBJECTIVEThere is no consensus on the optimal timing and specific brain MRI sequences in the evaluation and management of severe pediatric traumatic brain injury (TBI), and information on current practices is lacking. The authors performed a survey of MRI practices among sites participating in a multicenter study of severe pediatric TBI to provide information for designing future clinical trials using MRI to assess brain injury after severe pediatric TBI.METHODSInformation on current imaging
more » ... ctices and resources was collected from 27 institutions participating in the Approaches and Decisions after Pediatric TBI Trial. Multiple-choice questions addressed the percentage of patients with TBI who have MRI studies, timing of MRI, MRI sequences used to investigate TBI, as well as the magnetic field strength of MR scanners used at the participating institutions and use of standardized MRI protocols for imaging after severe pediatric TBI.RESULTSOverall, the reported use of MRI in pediatric patients with severe TBI at participating sites was high, with 40% of sites indicating that they obtain MRI studies in > 95% of this patient population. Differences were observed in the frequency of MRI use between US and international sites, with the US sites obtaining MRI in a higher proportion of their pediatric patients with severe TBI (94% of US vs 44% of international sites reported MRI in at least 70% of patients with severe TBI). The reported timing and composition of MRI studies was highly variable across sites. Sixty percent of sites reported typically obtaining an MRI study within the first 7 days postinjury, with the remainder of responses distributed throughout the first 30-day postinjury period. Responses indicated that MRI sequences sensitive for diffuse axonal injury and ischemia are frequently obtained in patients with TBI, whereas perfusion imaging and spectroscopy techniques are less common.CONCLUSIONSResults from this survey suggest that despite the lack of consensus or guidelines, MRI is commonly obtained during the acute clinical setting after severe pediatric TBI. The variation in MRI practices highlights the need for additional studies to determine the utility, optimal timing, and composition of clinical MRI studies after TBI. The information in this survey describes current clinical MRI practices in children with severe TBI and identifies important challenges and objectives that should be considered when designing future studies.
doi:10.3171/2018.10.peds18374 pmid:30738383 pmcid:PMC6687576 fatcat:mscoh5dlevesxapmoayq74dz6a

Exposure to high concentrations of inspired oxygen does not worsen lung injury after cardiac arrest

Jonathan Elmer, Bo Wang, Samer Melhem, Raghevesh Pullalarevu, Nishit Vaghasia, Jaya Buddineni, Bedda L Rosario, Ankur A Doshi, Clifton W Callaway, Cameron Dezfulian
2015 Critical Care  
Post-cardiac arrest patients are often exposed to 100% oxygen during cardiopulmonary resuscitation and the early post-arrest period. It is unclear whether this contributes to development of pulmonary dysfunction or other patient outcomes. Methods: We performed a retrospective cohort study including post-arrest patients who survived and were mechanically ventilated at least 24 hours after return of spontaneous circulation. Our primary exposure of interest was inspired oxygen, which we
more » ... ized by calculating the area under the curve of the fraction of inspired oxygen (FiO 2 AUC) for each patient over 24 hours. We collected baseline demographic, cardiovascular, pulmonary and cardiac arrest-specific covariates. Our main outcomes were change in the respiratory subscale of the Sequential Organ Failure Assessment score (SOFA-R) and change in dynamic pulmonary compliance from baseline to 48 hours. Secondary outcomes were survival to hospital discharge and Cerebral Performance Category at discharge. Results: We included 170 patients. The first partial pressure of arterial oxygen (PaO2):FiO2 ratio was 241 ± 137, and 85% of patients had pulmonary failure and 55% had cardiovascular failure at presentation. Higher FiO 2 AUC was not associated with change in SOFA-R score or dynamic pulmonary compliance from baseline to 48 hours. However, higher FiO 2 AUC was associated with decreased survival to hospital discharge and worse neurological outcomes. This was driven by a 50% decrease in survival in the highest quartile of FiO 2 AUC compared to other quartiles (odds ratio for survival in the highest quartile compared to the lowest three quartiles 0.32 (95% confidence interval 0.13 to 0.79), P = 0.003). Conclusions: Higher exposure to inhaled oxygen in the first 24 hours after cardiac arrest was not associated with deterioration in gas exchange or pulmonary compliance after cardiac arrest, but was associated with decreased survival and worse neurological outcomes.
doi:10.1186/s13054-015-0824-x pmid:25888131 pmcid:PMC4371614 fatcat:v7xurzdklvgtnd3tbsh222v3fa

Presenting Characteristics Associated With Outcome in Children With Severe Traumatic Brain Injury

Bedda L. Rosario, Christopher M. Horvat, Stephen R. Wisniewski, Michael J. Bell, Ashok Panigrahy, Giulio Zuccoli, Srikala Narayanan, Goundappa K. Balasubramani, Sue R. Beers, P. David Adelson
2018 Pediatric Critical Care Medicine  
Rosario (IQR) or N(%) MortalityOR (95% CI) P GOS-E PedsOR (95% CI) = Glasgow Outcome Scale -Extended Pediatric Revision; BMI = body mass index; GCS = Glasgow Comma Scale; AIS = Abbreviated Injury  ... 
doi:10.1097/pcc.0000000000001676 pmid:30067578 pmcid:PMC6170689 fatcat:rs3nc7vj4bc37nvq4wlmdx33q4

Low-Fidelity Haptic Simulation Versus Mental Imagery Training for Epidural Anesthesia Technical Achievement in Novice Anesthesiology Residents

Grace Lim, Robert G. Krohner, David G. Metro, Bedda L. Rosario, Jong-Hyeon Jeong, Tetsuro Sakai
2016 Anesthesia and Analgesia  
Background-There are many teaching methods for epidural anesthesia skills. Previous work suggests that there is no difference in skill acquisition whether novice learners engage in lowfidelity versus high-fidelity haptic simulation for epidural anesthesia. However, no study has compared the effect of low-fidelity haptic simulation for epidural anesthesia versus mental imagery training in which no physical practice is attempted. We tested the hypothesis that mental imagery training is superior
more » ... low-fidelity haptic simulation training for epidural anesthesia skill acquisition. Methods-Twenty PGY-2 anesthesiology residents were tested at the beginning of the training year. After a didactic lecture on epidural anesthesia, they were randomized into two groups. Group LF had low-fidelity simulation training for epidural anesthesia using a previously described banana simulation technique. Group MI had guided, scripted mental imagery training in which they were initially oriented to the epidural kit components and epidural anesthesia was described in stepwise detail, followed by individual mental rehearsal; no physical practice was undertaken. Each resident then individually performed epidural anesthesia on a partial-human task trainer on three consecutive occasions under the direct observation of skilled evaluators who were blinded to group assignment. Technical achievement was assessed using a modified validated skills checklist. Scores (0-21) and duration to task completion (minutes) were recorded. A linear mixed-effects model analysis was performed to determine differences in scores and duration between groups and over time. Results-There was no statistical difference between the two groups for scores and duration to task completion. Both groups showed similarly significant increases (P = 0.0015) in scores over time ( estimated mean score [standard error]: Group MI: 15.9 [0.55] to 17.4 [0.55] to 18.6 [0.55]; Group LF: 16.2 [0.55] to 17.7 [0.55] to 18.9 [0.55]). Time to complete the procedure decreased similarly and significantly (P = 0.032) for both groups after the first attempt (estimated mean time [standard error]: Group MI: 16.0 [1.04] minutes to 13.7 [1.04] minutes to 13.3 [1.04] minutes; Group LF: 15.8 [1.04] minutes to 13.4 [1.04] minutes to 13.1 [1.04] minutes).
doi:10.1213/ane.0000000000001260 pmid:27007077 pmcid:PMC4840058 fatcat:knyaispqgzd5pbnpzjcheyzvgi

Inter-rater reliability of manual and automated region-of-interest delineation for PiB PET

Bedda L. Rosario, Lisa A. Weissfeld, Charles M. Laymon, Chester A. Mathis, William E. Klunk, Michael D. Berginc, Jeffrey A. James, Jessica A. Hoge, Julie C. Price
2011 NeuroImage  
Previous examination of the default parameters within the SPM Normalize option performed by our group on aging brains indicated that the parameter of importance was the degree of regularization (Rosario  ... 
doi:10.1016/j.neuroimage.2010.12.070 pmid:21195782 pmcid:PMC3057323 fatcat:stnsbpf7yrg25gacn55eggmihy

Tibiotalocalcaneal Arthrodesis Using Retrograde Intramedullary Nail Fixation: Comparison of Patients With and Without Diabetes Mellitus

Dane K. Wukich, Brady R. Mallory, Natalie C. Suder, Bedda L. Rosario
2015 Journal of Foot and Ankle Surgery  
Retrograde intramedullary nailing for tibiotalocalcaneal arthrodesis is a salvage procedure reserved for severe cases of deformity. The aim of the present study was to compare the outcomes of this technique in patients with and without diabetes mellitus (DM). A total of 61 patients with and 56 without DM underwent retrograde intramedullary nailing and had a minimum follow-up period of 12 months. The overall incidence of complication was 45.2%; however, the overall incidence of complications
more » ... een those with and without DM was not significantly different (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.38 to 1.65, p = .54). Patients with DM had a significantly greater rate of superficial infections (OR 8.3, 95% CI 1.01 to 68.67, p = .03). However, no difference was seen in the rate of deep infection (OR 0.90, 95% CI 0.34 to 2.46, p = . 83) or noninfectious complications (OR 0.50, 95% CI 0.23 to 1.13, p = .09). Successful limb salvage was achieved for 96.8% of the patients with DM and 94.7% of those without DM (p = . 66). A femoral head allograft was used in 32 (27.4%) of 117 patients to substitute for an osseous void. Of the 32 patients who required a femoral head allograft, 21 (67.7%) experienced a complication compared with 32 (37.6%) of 85 patients who did not require a femoral head allograft (OR 3.16, 95% CI 1.35 to 7.41, p = .008). The incidence of patient satisfaction was 80% for patients with DM and 72% for those without DM (p = .36). Despite a high incidence of complications, limb salvage was accomplished in approximately 95% of patients with complicated deformities. Four patients (6.56%) with DM experienced a tibia fracture; therefore, we now routinely use a 300-mm-long nail for this reconstruction.
doi:10.1053/j.jfas.2015.02.019 pmid:26015305 pmcid:PMC5664154 fatcat:iiahp56svvd3pl7iuv4nb6trdy
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