Broward Health Medical Center

Fort Lauderdale, FL, United States

Broward Health Medical Center

Fort Lauderdale, FL, United States
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Julian E.,Advanced Dermatology and Cosmetic Surgery | Julian E.,Broward Health Medical Center | Mammino J.,Advanced Dermatology and Cosmetic Surgery
Cutis | Year: 2016

In the sport of fishing, barbed fishhooks often are used for their effectiveness in maintaining the fish on the hook once it is caught. However, if a fishhook is implanted in the skin of a fisherman or fisherwoman, a barb can pose problems in removing the fishhook without exacerbating internal injury, a common fear among outpatient physicians. We describe the case of a patient who presented to the dermatology clinic with a barbed fishhook injury and discuss several simple methods for barbed fishhook removal that can be easily utilized in the outpatient setting. Because failing to treat the patient may lead to further discomfort and increased risk for complications, practitioners should be familiar with the removal methods described here, as they are not time consuming and do not require complex equipment. Furthermore, these techniques may be useful for removal of other foreign bodies embedded in cutaneous tissue (eg, splinters). © 2016 Cutis.


Edgar N.R.,Nova Southeastern University | Saleh D.,Nova Southeastern University | Miller R.A.,Broward Health Medical Center
Journal of Clinical and Aesthetic Dermatology | Year: 2017

Aphthous stomatitis is a painful and often recurrent inflammatory process of the oral mucosa that can appear secondary to various well-defined disease processes. Idiopathic recurrent aphthous stomatitis is referred to as recurrent aphthous stomatitis. The differential diagnosis for recurrent aphthous ulcerations is extensive and ranges from idiopathic benign causes to inherited fever syndromes, to connective tissue disease, or even inflammatory bowel diseases. A thorough history and review of systems can assist the clinician in determining whether it is related to a systemic inflammatory process or truly idiopathic. Management of aphthous stomatitis is challenging. For recurrent aphthous stomatitis or recalcitrant aphthous stomatitis from underlying disease, first-line treatment consists of topical medications with use of systemic medications as necessary. Herein, the authors discuss the differential diagnosis and treatment ladder of aphthous stomatitis as described in the literature.


Nichols A.J.,University of Miami | Allen A.H.,Saint Petersburg General Hospital | Shareef S.,Broward Health Medical Center | Badiavas E.V.,University of Miami | And 2 more authors.
JAMA Dermatology | Year: 2017

IMPORTANCE: Keratinocyte carcinomas (KCs), consisting of squamous cell carcinomas (SCCs) and basal cell carcinomas (BCCs), are the most common human malignant neoplasms. Several risk factors have been implicated in KC development. For some SCCs, particularly those in immunocompromised patients, human papillomavirus (HPV) may be an important factor. OBJECTIVE: To determine whether quadrivalent HPV vaccination would affect the development of KCs in immunocompetent patients with a history of multiple KCs. DESIGN, SETTING, AND PARTICIPANTS: Two patients with a history of multiple KCs - a man in his 70s (patient 1) and a woman in her 80s (patient 2) - were treated in a private dermatology practice. Each patient received 3 doses of the quadrivalent HPV vaccine at 0, 2, and 6 months in 2013, and both patients underwent full-body skin examinations at least every 3 months. Biopsy-proven skin cancers were recorded for 16 months (for patient 1) or 13 months (for patient 2) after the first dose of vaccine and then compared with the number of biopsy-proven skin cancers recorded over a similar period before the first dose of vaccine. The period of observation was from October 18, 2011, to June 21, 2014. MAIN OUTCOMES AND MEASURES: The numbers of new SCCs and BCCs after the first dose of the quadrivalent HPV vaccine. RESULTS: Patient 1 had a mean of 12 new SCCs and 2.25 new BCCs per year before vaccination. After vaccination, he developed 4.44 SCCs and 0 BCCs per year, a 62.5% reduction in SCCs and a 100% reduction in BCCs. Patient 2 had a mean of 5.5 new SCCs and 0.92 new BCCs per year before vaccination. After vaccination, she developed 1.84 SCCs and 0 BCCs per year, a 66.5% reduction in SCCs and a 100% reduction in BCCs. The quadrivalent HPV vaccine was well tolerated by both patients and had no adverse effects. CONCLUSIONS AND RELEVANCE: A reduction of SCCs and BCCs was observed in 2 patients after administration of the quadrivalent HPV vaccine. These findings highlight the possibility that cutaneous SCC development, and perhaps BCC development, may be driven in part by HPV in immunocompetent patients. Human papillomavirus vaccination may represent an efficacious, cost-effective, readily available, and well-tolerated strategy for preventing KCs. © 2017 American Medical Association. All rights reserved.


Snyder A.,Broward Health Medical Center | Schiechert R.A.,Hollywood Dermatology and Cosmetic Specialists | Zaiac M.N.,Florida International University | Zaiac M.N.,Greater Miami Skin and Laser Center
Journal of Clinical and Aesthetic Dermatology | Year: 2017

A 47-year-old woman presented with hyperpigmented patches on her upper extremities. The patient had begun using a topical estrogen cream in the affected areas prior to noticing the hyperpigmentation. A diagnosis of melasma secondary to topical estrogen cream was made. While systemic hormones are a welldocumented trigger for the development of melasma, this case represents the first report of melasma associated with topical estrogens. Topical estrogens are frequently prescribed to postmenopausal women for skin rejuvenation. Melasma should be discussed as a potential side effect of systemic as well as topical estrogen preparations.


Startzman A.N.,Broward Health Medical Center | Fowler O.,Nova Southeastern University | Carreira D.,Florida Institute of Orthopaedic Surgical Specialists
Orthopedics | Year: 2017

Proximal hamstring tendinosis and partial hamstring origin ruptures are painful conditions of the proximal thigh and hip that may occur in the acute, chronic, or acute on chronic setting. Few publications exist related to their diagnosis and management. This systematic review discusses the incidence, treatment, and prognosis of proximal hamstring tendinosis and partial hamstring ruptures. Conservative treatment measures include nonsteroidal anti-inflammatory drugs, physical therapy, rest, and ice. If these measures fail, platelet-rich plasma or shockwave therapy may be considered. When refractory to conservative management, these injuries may be treated with surgical debridement and hamstring reattachment. Copyright © SLACK Incorporated.


Cahn P.,Fundacion Huesped | Pozniak A.L.,Chelsea and Westminster Hospital NHS Foundation Trust | Mingrone H.,Fundacion IDEAA | Brites C.,Federal University of Bahia | And 15 more authors.
The Lancet | Year: 2013

Background Dolutegravir (GSK1349572), a once-daily HIV integrase inhibitor, has shown potent antiviral response and a favourable safety profile. We evaluated safety, efficacy, and emergent resistance in antiretroviral- experienced, integrase-inhibitor-naive adults with HIV-1 with at least two-class drug resistance. Methods ING111762 (SAILING) is a 48 week, phase 3, randomised, double-blind, active-controlled, non-inferiority study that began in October, 2010. Eligible patients had two consecutive plasma HIV-1 RNA assessments of 400 copies per mL or higher (unless >1000 copies per mL at screening), resistance to two or more classes of antiretroviral drugs, and had one to two fully active drugs for background therapy. Participants were randomly assigned (1:1) to once-daily dolutegravir 50 mg or twice-daily raltegravir 400 mg, with investigator-selected background therapy. Matching placebo was given, and study sites were masked to treatment assignment. The primary endpoint was the proportion of patients with plasma HIV-1 RNA less than 50 copies per mL at week 48, evaluated in all participants randomly assigned to treatment groups who received at least one dose of study drug, excluding participants at one site with violations of good clinical practice. Non-inferiority was prespecified with a 12% margin; if non-inferiority was established, then superiority would be tested per a prespecified sequential testing procedure. A key prespecified secondary endpoint was the proportion of patients with treatment-emergent integrase-inhibitor resistance. The trial is registered at ClinicalTrials.gov, NCT01231516. Findings Analysis included 715 patients (354 dolutegravir; 361 raltegravir). At week 48, 251 (71%) patients on dolutegravir had HIV-1 RNA less than 50 copies per mL versus 230 (64%) patients on raltegravir (adjusted difference 7·4%, 95% CI 0·7 to 14·2); superiority of dolutegravir versus raltegravir was then concluded (p=0·03). Significantly fewer patients had virological failure with treatment-emergent integrase-inhibitor resistance on dolutegravir (four vs 17 patients; adjusted difference -3·7%, 95% CI -6·1 to -1·2; p=0·003). Adverse event frequencies were similar across groups; the most commonly reported events for dolutegravir versus raltegravir were diarrhoea (71 [20%] vs 64 [18%] patients), upper respiratory tract infection (38 [11%] vs 29 [8%]), and headache (33 [9%] vs 31 [9%]). Safety events leading to discontinuation were infrequent in both groups (nine [3%] dolutegravir, 14 [4%] raltegravir). Interpretation Once-daily dolutegravir, in combination with up to two other antiretroviral drugs, is well tolerated with greater virological effect compared with twice-daily raltegravir in this treatment-experienced patient group. Funding ViiV Healthcare. © 2013 Elsevier Ltd.


Baer II W.H.,MercyHealth ClinXus LLC | Maini A.,Broward Health Medical Center | Jacobs I.,Pfizer
Pharmaceuticals | Year: 2014

Biologics such as rituximab are an important component of oncology treatment strategies, although access to such therapies is challenging in countries with limited resources. This study examined access to rituximab and identified potential barriers to its use in the United States, Mexico, Turkey, Russia, and Brazil. The study also examined whether availability of a biosimilar to rituximab would improve access to, and use of, rituximab. Overall, 450 hematologists and oncologists completed a survey examining their use of rituximab in patients with non-Hodgkin's lymphoma (NHL) and chronic lymphocytic leukemia (CLL). Less than 40% of physicians considered rituximab as easy to access from a cost perspective. Furthermore, many physicians chose not to treat, were unable to treat, or had to modify treatment with rituximab despite guidelines recommending its use in NHL and CLL patients. Insurance coverage, reimbursement, and cost to patient were commonly reported as barriers to the use of rituximab. Across all markets, over half of physicians reported that they would increase use of rituximab if a biosimilar was available. We conclude that rituximab use would increase across all therapy types and markets if a biosimilar was available, although a biosimilar would have the greatest impact in Brazil, Mexico, and Russia. © 2014 by the authors; licensee MDPI, Basel, Switzerland.


Tippets D.M.,Cleveland Clinic | Zaryanov A.V.,Broward Health Medical Center | Vincent Burke W.,Broward Health Medical Center | Patel P.D.,Cleveland Clinic | And 3 more authors.
Journal of Arthroplasty | Year: 2014

Heterotopic ossification (HO) is a complication following total hip arthroplasty (THA) with traditional approaches. The direct anterior approach (DAA) has become a popular approach for THA; however, no study has evaluated HO formation following DAA THA. We examined the incidence of HO in a consecutive series of THA using the DAA in two separate hospitals. Standard preoperative radiographs were examined to determine the type of degenerative arthritis, and follow-up radiographs of at least 6months after surgery were evaluated for the presence and classification of HO. The overall incidence of HO after DAA THA in this study was 98/236, or 41.5%, which falls within the reported range from recent studies involving more traditional approaches to the hip. © 2014 Elsevier Inc.


Hsu A.R.,Rush University Medical Center | Gross C.E.,Rush University Medical Center | Lee S.,Rush University Medical Center | Carreira D.S.,Broward Health Medical Center
Journal of the American Academy of Orthopaedic Surgeons | Year: 2014

Advances in foot and ankle arthroscopy have allowed surgeons to diagnose and treat a broadening array of disorders that were previously limited to open procedures. Arthroscopy of the posterior ankle, subtalar joint, and first metatarsophalangeal joint and tendoscopy can be used to address common foot and ankle ailments, with the potential benefits of decreased pain, fast recovery, and low complication rates. Posterior ankle and subtalar arthroscopy can be used to manage impingement, arthrofibrosis, synovitis, arthritis, fractures, and osteochondral defects. First metatarsophalangeal joint arthroscopy can address osteophytes, chronic synovitis, osteochondral defects, and degenerative joint disease. Tendoscopy is a minimally invasive alternative for evaluation and débridement of the Achilles, posterior tibial, flexor hallucis longus, and peroneal tendons.


Rivera N.T.,Broward Health Medical Center | Bray N.,Broward Health Medical Center | Wang H.,Broward Health Medical Center | Zelnick K.,Broward Health Medical Center | And 2 more authors.
Therapeutic Advances in Cardiovascular Disease | Year: 2014

Infection of implanted cardiac devices has a low rate of occurrence. Fungal infections of such devices represent an atypical phenomenon, associated with high mortality. Both medical and surgical therapies are recommended for a successful outcome.A 60-year-old woman with past medical history of heart failure with reduced ejection fraction, implantable cardioverter-defibrillator (ICD) placement, sarcoidosis and diabetes presented with fevers and atypical pleuritic chest pain. Transthoracic echocardiogram revealed a highly mobile 2.09 cm by 4.49 cm mass associated with the ICD wire. Blood cultures were positive for Candida albicans. The patient underwent sternotomy for removal. The vegetation was 4 cm by 2 cm by 2 cm in size, attached to the right ventricle without interference with the tricuspid valve. The patient was treated with micafungin for 2 weeks and then fluconazole for 6 weeks.In this case report, we describe the rare infection of an ICD lead with C. albicans, in the form of a fungal ball. This is the 18th reported case of Candida device-related endocarditis and the first reported in a woman. Prior case reports have occurred primarily in pacemaker rather than ICD leads. The vegetation size is also one of the largest that has been reported, measuring 4 cm at its greatest length.As Candida device-related endocarditis is so rare, and as fatality occurs in half of cases, clinical management can only be derived from sporadic case reports. Therefore, the course of this patient's disease care will be a useful adjunct to the current literature for determining treatment and prognosis in similar cases. © The Author(s), 2014.

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