Physicians Regional Medical Center

Naples, FL, United States

Physicians Regional Medical Center

Naples, FL, United States
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Rekkerth D.J.,GREER Laboratories Inc | Hadley J.A.,Physicians Regional Medical Center
Allergy, Asthma and Clinical Immunology | Year: 2014

Background: Skin prick/puncture testing (SPT) is widely accepted as a safe, dependable, convenient, and cost-effective procedure to detect allergen-specific IgE sensitivity. It is, however, prone to influence by a variety of factors that may significantly alter test outcomes, affect the accuracy of diagnosis, and the effectiveness of subsequent immunotherapy regimens. Proficiency in SPT administration is a key variable that can be routinely measured and documented to improve the predictive value of allergy skin testing. Methods: Literature surveys were conducted to determine the adherence to repeated calls for development and implementation of proficiency testing standards in the 1990's, the mid-2000's and the 2008 allergy diagnostics practice parameters. Results: Authors publishing clinical research in peer-reviewed journals and conducting workshops at annual scientific meetings have recommended proficiency testing based primarily on its potential to reduce variability, minimize confounding test results, and promote more effective immunotherapeutic treatments. Very few publications of clinical studies, however, appear to report proficiency testing data for SPT performance. Allergen immunotherapy recommendations are updated periodically by the Joint Task Force on Practice Parameters representing the American Academy of Allergy, Asthma and Immunology (AAAAI), the American College of Allergy, Asthma and Immunology (ACAAI), and the Joint Council of Allergy, Asthma and Immunology (JCAAI). Conclusions: Despite consensus that all staff who perform SPT should meet basic quality assurance standards that demonstrate their SPT proficiency, the gap between recommendations and daily practice persists. By embracing standards, the accuracy of SPT and allergy diagnosis can be optimized, ultimately benefiting patients with allergic disease. © 2014 Fatteh et al.


Srinivasan P.,New York Hospital Queens | Brandler M.,New York Hospital Queens | D'Souza A.,SUNY Downstate Medical Center | Millman P.,New York Hospital Queens | Moreau H.,Physicians Regional Medical Center
Journal of Perinatology | Year: 2010

An uncommon clinical entity mimicking necrotizing enterocolitis (NEC) is allergic enterocolitis secondary to cow's milk protein allergy. Although milk protein allergy is the most common food allergy among infants and young children, the incidence and prevalence of this disease entity presenting as enterocolitis in neonates is not well documented. We report this case of milk protein-associated allergic enterocolitis to highlight the unusual recurrent presentation as NEC, (with recurrent pneumatosis, bloody stools) managed successfully with modification of milk formula. © 2010 Nature Publishing Group All rights reserved.


Mellick L.B.,Georgia Regents University | Pleasant M.R.,Physicians Regional Medical Center
Pediatric Emergency Care | Year: 2010

Objective: Bilateral lower cervical paraspinous intramuscular bupivacaine injections have recently been reported as a therapeutic modality for headache pain in adult patients presenting to an emergency department. In this study, we accomplished a retrospective review of all pediatric patients with headaches who were treated with this technique in an emergency department setting over a 16-month period. The therapeutic response of all pediatric patients who received bilateral lower cervical paraspinous intramuscular bupivacaine injections for headache pain is described in this article. Methods: Three separate databases were reviewed to capture all patients younger than 18 years with a diagnosis of headache who received bilateral cervical injections between June 30, 2003, and December 1, 2004, in the Medical College of Georgia and Children's Medical Center emergency departments. Their medical records were retrospectively reviewed to determine their response to this procedure. Results: The headaches of 13 patients younger than 18 years were treated with this procedure. The mean headache severity was 9.15, and the mean duration of headache was 3.16 days. Six (46.2%) of 13 patients had complete relief of their headaches, whereas 5 (38.4%) of 13 patients had partial relief. No significant relief was documented in 2 (15.4%) of 13 patients. A therapeutic response was documented in 11 (84.6%) of 13 of the patients. Conclusions: These retrospective observations suggest that bilateral lower cervical paraspinous intramuscular injections with small amounts of bupivacaine may have a therapeutic role in the management of headache pain in children, and their rate of therapeutic response may be similar to that recently reported for adult headache patients. © 2010 by Lippincott Williams & Wilkins.


Douglas A.C.,Indiana University | Wippold F.J.,Mallinckrodt Institute of Radiology | Broderick D.F.,Mayo Clinic Jacksonville | Aiken A.H.,Emory Healthcare | And 15 more authors.
Journal of the American College of Radiology | Year: 2014

Most patients presenting with uncomplicated, nontraumatic, primary headache do not require imaging. When history, physical, or neurologic examination elicits "red flags" or critical features of the headache, then further investigation with imaging may be warranted to exclude a secondary cause. Imaging procedures may be diagnostically useful for patients with headaches that are: associated with trauma; new, worse, or abrupt onset; thunderclap; radiating to the neck; due to trigeminal autonomic cephalgia; persistent and positional; and temporal in older individuals. Pregnant patients, immunocompromised individuals, cancer patients, and patients with papilledema or systemic illnesses, including hypercoagulable disorders may benefit from imaging. Unlike most headaches, those associated with cough, exertion, or sexual activity usually require neuroimaging with MRI of the brain with and without contrast to exclude potentially underlying pathology before a primary headache syndrome is diagnosed. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. © 2014 American College of Radiology.


Bowyer H.R.,University of Pittsburgh | Glover M.,Physicians Regional Medical Center
Journal of Neuroscience Nursing | Year: 2010

Guillain-Barre syndrome (GBS) is a syndrome that affects the immune system and attacks the peripheral nervous system. Discussion includes defining GBS as well as its etiology and differential diagnosis. Patients with GBS are not uncommon, and therefore it is important to be educated and to have a more precise understanding. GBS patients need to be treated holistically through emotional and physical support and known effective treatments. Through this article, readers will be able to achieve a thorough understanding of GBS and management options/strategies. Clinical features and manifestation of presenting symptoms will assist in determining initial laboratory studies, imaging, and any other testing that should be performed. Proper and quick diagnosis of GBS will be critical to further optimize treatment options and to decrease the likelihood of further immediate progression. Treatment modalities will be discussed as well as management during the acute hospital course and after discharge from the acute care facility. Discussion will focus on moderate to severe cases and associating treatment plans evaluated from evidence-based practice. Copyright © 2010 American Association of Neuroscience Nurses.


Gulati G.L.,Thomas Jefferson University | Bourne S.,Thomas Jefferson University | Bourne S.,Physicians Regional Medical Center | Jamal S.M.E.,Thomas Jefferson University | And 2 more authors.
Laboratory Medicine | Year: 2011

Objective: This study was undertaken to determine if automated differential leukocyte counts (A-DIFF) can be used in place of manual differential leukocyte counts (M-DIFF) in chronic lymphocytic leukemia (CLL) patients. Methods: Relative and absolute automated lymphocyte counts obtained from 83 specimens from 76 CLL patients were compared with corresponding manual counts obtained by performing differential on albuminized blood smears. Means and correlation coefficients were calculated using Excel software. Results: The mean relative lymphocyte count by automated method was 73.6% as compared to 75.6% by the manual method. The mean absolute lymphocyte count by automated method was 32.1 × 10 3/μL as opposed to 32.9 × 10 3/μL by the manual method. The correlation coefficients were 0.928 and 0.998 for the relative lymphocyte counts and absolute lymphocyte counts, respectively. Conclusion: Automated differential leukocyte counts can be used in place of M-DIFF in CLL.


Ogun S.A.,Olabisi Onabanjo University | Martins S.,University of Porto | Adebayo P.B.,University of Nigeria | Dawodu C.O.,Lagos State University | And 2 more authors.
European Journal of Human Genetics | Year: 2015

Machado-Joseph disease (MJD) has been described in Africans, but no cases have been reported from Nigeria. Current MJD global distribution results from both the ancestral populations-of-origin and the founder effects of mutations, some as a consequence of the Portuguese sea travels in the 15th to 16th century. Two main ancestral haplotypes have been identified: the Machado lineage, which is more recent, predominant in families of Portuguese extraction, and the Joseph lineage, which is much older and worldwide spread, postulated to have an Asian origin. We report a Nigerian family with MJD from Calabar, once settled by Portuguese slave traders, and assessed its mutational origin. The proband was a 33-year-old man with progressive unsteady gait, weakness of all limbs, dysphagia, dysarthria, urinary frequency and diaphoresis. He had end-of-gaze nystagmus, spastic quadriparesis and atrophic small muscles of the hand. He showed fibrillation potentials on EMG, and nerve conduction studies suggested a central axonopathy without demyelination. This family bears the Joseph haplotype, which has a founder effect in the island of Flores, in the Azores (and their descendants in North-America), but is also the most common in non-Portuguese populations worldwide, with an estimated mutation age of around 7000 years. © 2015 Macmillan Publishers Limited All rights reserved.


Buechel F.F.,UMDNJ New Jersey Medical School | Buechel F.F.,Physicians Regional Medical Center | Helbig T.E.,UMDNJ New Jersey Medical School | Pappas M.J.,NJ Institute of Technology
Journal of ASTM International | Year: 2012

Low-contact-stress rotating-platform knee replacements were the original mobile-bearing knees developed by the senior authors in 1978 to improve fixation and minimize wear, however, 1-2 % experienced "spin-out" and wear resulting in the development of a third generation rotating platform (Buechel- Pappas, or B-P) in 1991. The purpose of this study is to evaluate design modifications incorporated into the B-P device based upon clinical outcomes. Clinical results of the initial 310 cementless B-P rotating platform total knee replacements in 257 patients were analyzed using a strict knee scoring scale. Of that group, 259 total knees in 206 patients were followed for 2-18 years (mean: 7.6 years). The titanium alloy metallic implants had a 10 μm thick titanium nitride (TiN) coating on all bearing and fixation surfaces and sinteredbead porous-coating, pore size of 350 microns, on all fixation surfaces. The rotating-platform bearing allowed 45° of internal and external rotation with further rotation limited by a stop pin on the tibial component to block complete rotary subluxation=dislocation of the bearing in the event of significant flexion instability or rotational trauma. The study showed 86.4 % excellent, 12.3 % good, 0.3 % fair, and 1.0 % poor results using a strict knee scoring scale. Complications requiring revision included tibial component loosening in 2 superobese (BMI >50), osteoarthritic patients (0.6%) and 1 late deep infection (0.3%) in a rheumatoid patient after 3.3 years. There were no cases of bearing wear, subluxation, or dislocation seen. Radiographic analysis, using >2 mm lucency in any implant zone, demonstrated 0 % of radiolucencies around femoral components, 2.6 % around tibial components, and 0 % around patella components. Survivorship, using an end point of revision for wear or component loosening was 99.4 % at the 18-year interval. Copyright © 2012 by ASTM International.


Tressler C.S.,Pfizer | Beatty R.,Physicians Regional Medical Center | Lemp M.A.,Georgetown University
Ocular Surface | Year: 2011

Benzalkonium chloride (BAK) is the principal preservative employed in topical ocular hypotensive medications, although alternative compounds recently have begun to be employed or examined. Individual clinical trials have shown that exposure to BAK concentrations contained in ophthalmic solutions does not produce adverse sequelae in the majority of glaucoma patients, but concerns continue with regard to its long-term use. These concerns have resulted from an extensive research effort, including preclinical studies with in vitro and in vivo models, as well as recent clinical investigations dedicated specifically to this issue. The aim of this systematic literature review of both preclinical and clinical data was to determine the relevance of these findings to clinical practice. Most preclinical studies reported negative effects of BAK exposure, but with few exceptions, BAK concentrations and exposure times greatly exceeded those likely to be experienced by patients, given the normal physiological dilution by the tear film. In addition, consistent evidence of BAK-related toxicity did not emerge from our review of dedicated clinical investigations. Thus, taken together, current evidence supports the safety of BAK for most glaucoma patients, although subpopulations with abnormal tearing may benefit from alternative preservative compoundsor preservative-free formulations. Further studies to identify these populations are needed. ©2011 Ethis Communications, Inc.


Bourne S.,Thomas Jefferson University | Bourne S.,Physicians Regional Medical Center | Ma N.,Thomas Jefferson University | Gulati G.,Thomas Jefferson University | And 2 more authors.
Laboratory Medicine | Year: 2013

Objective: Immature granulocyte (IG) count is the latest addition to the automated leukocyte differential generated by the Sysmex analyzers. The objective of this study was to assess the reliability of the automated IG counts. Methods: Automated IG percentages were compared with the corresponding manual IG percentages of 418 blood specimens. The data were divided into five groups. The difference between individual automated IG percentages and corresponding manual IG percentages was plotted and the number of outliers, based on Rumke's published 95% confidence limits, was determined for each group. Results: Of 418 automated IG percentages, 392 were within 95% confidence limits, with 26 outliers. More than half of the outliers carried also the "blast" flag, prompting a smear review. A significant difference between manual and automated IG percentage was noted when the manual IG count was greater than 10%. Conclusion: Automated and manual IG percentages compared fairly well with each other. We concluded that automated IG counts less than or equal to 10% may be considered reportable without a smear review.

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