1401 W Seminole Blvd
Sanford FL 32771
Medical School: Other - 1981
Accepts Medicare: Yes
Participates In eRX: No
Participates In PQRS: Yes
Participates In EHR: No
License #: ME81598
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Awards & Recognitions
Dr. Jorge Vazquez is associated with these group practices
|HCPCS Code||Description||Average Price||Average Price
Allowed By Medicare
|HCPCS Code:00790||Description:Anesth surg upper abdomen||Average Price:$825.96||Average Price Allowed
|HCPCS Code:00840||Description:Anesth surg lower abdomen||Average Price:$787.16||Average Price Allowed
|HCPCS Code:00810||Description:Anesth low intestine scope||Average Price:$511.68||Average Price Allowed
|HCPCS Code:00740||Description:Anesth upper gi visualize||Average Price:$467.43||Average Price Allowed
|HCPCS Code:36556||Description:Insert non-tunnel cv cath||Average Price:$425.00||Average Price Allowed
|HCPCS Code:00400||Description:Anesth skin ext/per/atrunk||Average Price:$372.43||Average Price Allowed
|HCPCS Code:36620||Description:Insertion catheter artery||Average Price:$220.00||Average Price Allowed
HCPCS Code Definitions
- Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); percutaneous
- Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older
Medical Malpractice Cases
Medical Board Sanctions
Cardiovascular Disease (Cardiology)
Cardiovascular Disease (Cardiology)
*These referrals represent the top 10 that Dr. Vazquez has made to other doctors
Landscape of genomic alterations in cervical carcinomas. - Nature
Cervical cancer is responsible for 10-15% of cancer-related deaths in women worldwide. The aetiological role of infection with high-risk human papilloma viruses (HPVs) in cervical carcinomas is well established. Previous studies have also implicated somatic mutations in PIK3CA, PTEN, TP53, STK11 and KRAS as well as several copy-number alterations in the pathogenesis of cervical carcinomas. Here we report whole-exome sequencing analysis of 115 cervical carcinoma-normal paired samples, transcriptome sequencing of 79 cases and whole-genome sequencing of 14 tumour-normal pairs. Previously unknown somatic mutations in 79 primary squamous cell carcinomas include recurrent E322K substitutions in the MAPK1 gene (8%), inactivating mutations in the HLA-B gene (9%), and mutations in EP300 (16%), FBXW7 (15%), NFE2L2 (4%), TP53 (5%) and ERBB2 (6%). We also observe somatic ELF3 (13%) and CBFB (8%) mutations in 24 adenocarcinomas. Squamous cell carcinomas have higher frequencies of somatic nucleotide substitutions occurring at cytosines preceded by thymines (Tp*C sites) than adenocarcinomas. Gene expression levels at HPV integration sites were statistically significantly higher in tumours with HPV integration compared with expression of the same genes in tumours without viral integration at the same site. These data demonstrate several recurrent genomic alterations in cervical carcinomas that suggest new strategies to combat this disease.
Species distribution and antifungal susceptibility of bloodstream fungal isolates in paediatric patients in Mexico: a nationwide surveillance study. - The Journal of antimicrobial chemotherapy
To establish the species distribution and in vitro susceptibilities of 358 bloodstream fungal isolates from paediatric patients in Mexico.Isolates were collected during a 2 year surveillance programme in 14 medical centres in 10 Mexican states. A molecular approach was used to determine the Candida parapsilosis species complex. In vitro susceptibility to amphotericin B, fluconazole, voriconazole, itraconazole, posaconazole, caspofungin, anidulafungin and micafungin was determined according to CLSI procedures. Species-specific clinical breakpoints for fluconazole, voriconazole and echinocandins were applied.Candida spp. accounted for 98.33% of fungaemias, including 127 Candida albicans isolates, 127 C. parapsilosis complex isolates (121 C. parapsilosis sensu stricto, 4 Candida orthopsilosis and 2 Candida metapsilosis strains) and 72 Candida tropicalis isolates. C. albicans and C. parapsilosis complex were the species predominant in neonates (48 cases each; 41.02%). C. parapsilosis complex was also the predominant species in patients 1 month to <2 years of age (P = 0.007). In contrast, C. albicans was the most frequent species in patients aged 2 to <12 years (P = 0.003). Antifungal resistance was rare among the subset of isolates. Candida glabrata showed the highest resistance rate to amphotericin B (1/9 isolates), fluconazole (1/9 isolates) and itraconazole (2/9 isolates).The species distribution differed with the age of the patients, with C. albicans and C. parapsilosis complex being the most commonly isolated species. C. glabrata showed the highest resistance rate to amphotericin B, fluconazole and itraconazole. This is the first study of fungaemia episodes in Mexican children.
Oral thromboprophylaxis in pelvic trauma: a standardized protocol. - The Journal of emergency medicine
Thromboprophylaxis for deep vein thrombosis (DVT) after lower-extremity trauma could include rivaroxaban, an oral medication that does not need laboratory monitoring.To assess rivaroxaban's efficacy in preventing DVTs after pelvic trauma compared to its historical incidence.All patients admitted with pelvic fractures in a 12-month period followed a standardized thromboprophylaxis protocol: 1) rivaroxaban 10 mg/day within 24 h of injury or upon hemodynamic stability; 2) pre-operative, post-operative, and 30-day extremity ultrasound; 3) ventilation-perfusion scintigraphy for clinical signs of pulmonary embolus; and 4) a 45-, 90-, and 120-day re-evaluation. Rivaroxaban administration ceased the day of surgery and restarted 12 h post-operatively or upon hemodynamic stability, continuing for 30 days. Excluded patients had severe neurological or hepatosplenic injuries, heparin hypersensitivity, or hemodynamic instability.Of 113 patients assessed, 84 patients (66 males), average age 46.6 years (range 19-69 years), were included. They had isolated pelvic trauma (nÂ = 37), associated lower limb injuries (n = 47), average Injury Severity Score 21.4 (range 16-50), and average Glasgow Coma Scale score 13.6 (range 9-15). Patients receiving thromboprophylaxis soon after their fracture (nÂ = 64) had a lower incidence of DVT than those receiving delayed thromboprophylaxis (n = 20) (p = 0.02). One patient (1.2%) died from a pulmonary embolus; 13 had asymptomatic below-the-knee DVTs. Rivaroxaban did not increase intra- or post-operative bleeding in surgical wounds.DVT incidence after pelvic fractures is reduced by administering antithrombotics within 24 h of injury or, if the patient is hemodynamically unstable, 24 h after stabilization. Rivaroxaban is a safe and effective method of providing this thromboprophylaxis.Copyright Â© 2012 Elsevier Inc. All rights reserved.
Acute meningitis prognosis using cerebrospinal fluid interleukin-6 levels. - The Journal of emergency medicine
Improved diagnostic tests would aid in diagnosing and treating community-acquired meningitis.To analyze the diagnostic value of interleukin-6 (IL-6) in the cerebrospinal fluid (CSF) of patients presenting with symptoms of acute meningitis.In a 6-month prospective, observational, cross-sectional emergency department (ED) study, serum and CSF samples were obtained from all patients with a headache and fever in whom the physician suspected meningitis. Patients were excluded if computed tomography findings contraindicated a lumbar puncture, if they had bleeding disorders, or if their serum indicated bleeding. IL-6 levels were measured and compared in patients with (Group A) and without (Group B) bacterial meningitis.Samples were obtained from 53 patients, of whom 40 were ultimately found to have meningitis. These 40 patients averaged 49.6 Â± 21.9 years, with number of men 18 (45%), hospitalizations 21 (52%), mortality 3 (.07%), and IL-6 average rating 491 (median: 14.5; range 0000-6000). Findings in the two groups were: Group A (with meningitis): n = 13, average IL-6 level: 1495 (median: 604; 25/75 percentiles: 232.5-2030; 95% confidence interval [CI] 371.7-2618.6; range 64-6000). Group B (with aseptic meningitis): n = 27, average IL-6 level: 7.34 (median: 5; 25/75 percentiles: 0.0/15.1; 95% CI 3.94-10.73; range 0-23.6). Mann-Whitney rank sum test: p < 0.0001.In patients with acute bacterial meningitis, CSF cytokine concentrations are elevated. Measuring CSF inflammatory cytokine levels in patients with acute meningitis could be a valuable ED diagnostic tool. Using this tool could improve the prognosis of patients with bacterial meningitis by allowing more rapid initiation of antibiotic treatment.Copyright Â© 2012 Elsevier Inc. All rights reserved.
Measuring intrabladder pressure with the head of the bed elevated 30Â°: evidence to support a change in practice. - American journal of critical care : an official publication, American Association of Critical-Care Nurses
A 30Â° head-of-bed elevation is recommended for most critically ill patients. Measuring intrabladder pressure with the patient in this position is controversial.To assess the feasibility of measuring intrabladder pressure with a 30Â° head-of-bed elevation.A prospective, randomized, and experimental study. Patients had intrabladder pressure measured first while positioned supine with a 30Â° head-of-bed elevation and 25 mL of saline instilled into the bladder and again after the patients were randomly repositioned to supine without any head-of-bed elevation (flat) or with a 30Â° head-of-bed elevation while supine or in right lateral or left lateral position with either 25, 50, or 200 mL of saline instilled into the patient's bladder.Intrabladder pressures measured with the patient in all 3 head-of-bed elevated positions were higher than pressures measured with patients supine and flat after instillation of 25 mL of saline into the bladder, but intrabladder pressure did not differ between the 30Â° head-of-bed elevated positions and the supine and flat positions when 50 or 200 mL of saline was instilled into the bladder. Two-way analysis of variance showed a significant interaction between volume of saline instilled (P = .05), patient's position (P = .007), and bladder instill volume and position interaction (P = .004).It is feasible to measure intrabladder pressure with a 30Â° head-of-bed elevation, and that position could be an alternative to supine positioning of patients for measurement of intrabladder pressure.
Reliability of intrabladder pressure measurement in intensive care. - American journal of critical care : an official publication, American Association of Critical-Care Nurses
The reliability of intrabladder pressure measurements obtained in nonsupine patients is unknown.To investigate the reliability of measurements of intrabladder pressure obtained with 30 degrees head-of-bed elevation.With patients supine, 30 degrees head-of-bed elevation, and instillation of 0 and 25 mL physiological saline, intrabladder pressure was measured in 10 patients: twice by one nurse to assess intraobserver reliability and once by a different nurse to assess interobserver reliability. Data were analyzed by using paired t tests, Pearson correlation, and Bland-Altman analysis.For intraobserver reliability, measurements obtained with no instillation (mean difference, -1.8; 95% confidence interval [CI], -4.9 to 1.3; P = .22) and with instillation of 25 mL (mean difference, -0.6; 95% CI, -1.8 to 0.6; P = .28) did not differ significantly. Pearson r values were 0.74 and 0.81, respectively. Estimated Bland-Altman bias and limits of agreements were -1.8 and -10.3 to 6.7 mm Hg and -0.6 and -3.82 to 2.62 mm Hg, respectively. For interobserver reliability, measurements obtained with no instillation (mean difference, 1.0; 95% CI, -2.2 to 4.2; P = .49) and with instillation of 25 mL (mean difference, -0.7; 95% CI, -2.45 to 1.05; P = .39) did not differ significantly. Pearson r values were 0.78 and 0.82, respectively. Estimated Bland-Altman bias and limits of agreement were 1.0 and -7.76 to 9.76 mm Hg and -0.7 and -5.5 to 4.0 mm Hg, respectively.Reliability of intrabladder pressure measurements obtained with 30 degrees head-of-bed elevation is strong.
Pain treatment in post-traumatic hip fracture in the elderly: regional block vs. systemic non-steroidal analgesics. - International journal of emergency medicine
This prospective, randomized double-blind study, conducted over 19Â months in a tertiary care ED, sought to determine if a fascia-iliaca regional anesthetic block provides better and safer pain relief than does parenteral analgesia.This study also aimed to determine the effectiveness of parenteral NSAID analgesia for acute hip fractures.Patients >65 years old presenting at an adult ED with acute hip fractures were randomized upon presentation to the ED into two groups (A and B) using numbers generated by the EPI-INFOâ„¢ (Atlanta, GA: Centers for Disease Control and Prevention) program. The randomization list was kept by one of the authors who did not interact with the patients. Two groups of patients were to receive either (A) a fascia-iliaca block with bupivacaine and parenteral saline injection, or (B) the same block with saline and an IV NSAID injection. Upon admission to the study, vital signs such as blood pressure, mean blood pressure (MAP), heart rate (HR), respiratory rate (RR) and pain-intensity measurements [using the Visual Analogue Scale (VAS)] were obtained and repeated at 15 min, 2 h and at8 h. The occurrence of complications was registered.One hundred seventy-five patients were randomized, and 21 were excluded from participation. The remaining 154 patients were grouped as: group A (nâ€‰=â€‰62) or group B (nâ€‰=â€‰92). The mean pain level on admission to the ED for all patients, assessed with the VAS, was 8.21â€‰Â±â€‰0.91 (CI 95%: 6.43-9.99); in group A the VAS was 7.6â€‰Â±â€‰0.22 and in group B 8.5â€‰Â±â€‰0.72 (pâ€‰=â€‰0.411). At 15-min evaluation, values were: group A 6.24â€‰Â±â€‰0.17 and group B 2.9â€‰Â±â€‰0.16 (pâ€‰<â€‰0.001). At the 2-h assessment, values were: group A 1.78â€‰Â±â€‰0.11 and group B 2.3â€‰Â±â€‰1.16 (pâ€‰=â€‰0.764). At 8 h the VAS for group A was 2.03â€‰Â±â€‰0.12 and for group B 4.4â€‰Â±â€‰0.91 (pâ€‰=â€‰0.083).THIS STUDY DEMONSTRATES THAT: (1) parenteral NSAIDs are very effective as analgesics after hip fractures in elderly patients, (2) fascia-iliaca regional blocks are nearly as effective for up to about 8 h after administration and (3) regional fascia-iliaca blocks effectively control post-hip fracture pain. (4) Fascia iliaca regional block has a rapid onset.
Lactic dehydrogenase in cerebrospinal fluid may differentiate between structural and non-structural central nervous system lesions in patients with diminished levels of consciousness. - The Journal of emergency medicine
Impaired consciousness without a history of trauma is a common reason for emergency department (ED) visits. Among critically ill patients with a history and physical findings suggestive of a cerebrovascular accident (CVA), it may be difficult to differentiate between a structural and a non-structural cause for their condition.This study was conducted to determine if lactic dehydrogenase (LDH) levels in the cerebrospinal fluid (CSF) of patients with acute non-traumatic neurological disorders could distinguish between structural and non-structural etiologies.Over a 6-month period, CSF specimens were collected from 54 critically ill patients admitted to the ED with impaired consciousness and findings consistent with a CVA. The patients had moderate to severe impairment of consciousness, had a new motor or sensory deficit, or had meningeal signs of recent onset. CSF-LDH levels were analyzed because CSF levels of the enzyme are typically elevated in meningitis, metastatic cancer, and disorders resulting in ischemic necroses. Patients were excluded if a computed tomography scan showed contraindications to performing a lumbar puncture, if they had a coagulopathy, or if the CSF was xanthochromic or produced visible blood sediment after centrifuging. The data were analyzed according to the patients' admission diagnoses-structural vs. non-structural lesion.Of the samples collected from 54 patients, eight were excluded. Among the 46 patients included in the study, the mean age was 56.1 +/- 2.75 years, mean APACHE II score was 20.93 +/- 0.98, Glasgow Coma Scale (GCS) score was 7.15 +/- 0.49, and mortality was 55% (22 patients). The 30 patients with a structural abnormality had a mean age of 56.7 +/- 3.55 years, GCS score of 7.3 +/- 0.61, APACHE II score of 20.2 +/- 1.1, mortality of 43% (13 patients), and CSF-LDH level of 128.8 +/- 24.8 IU/L (95% confidence interval [CI] 78.1-179.6). The 16 patients with a non-structural (metabolic) disturbance had: a mean age of 55.0 +/- 4.42 years, GCS score of 6.87 +/- 0.86, APACHE II score of 22.2 +/- 1.94, mortality of 56% (9 patients), and CSF-LDH level of 29.8 +/- 2.9 IU/L (95% CI 23.6-36.1). Analysis by Student's t-test was p < 0.05. When the diagnostic value of CSF-LDH level was evaluated using a cutoff point of 40 IU/L, the following results were obtained: sensitivity: 86.7%, specificity: 81.3%, pretest likelihood: 65%, positive predictive value: 90%, negative predictive value: 76%, Likelihood Ratio (LR)+: 4.62, LR-: 0.16 (6.25-fold increase).In critically ill patients with acutely altered levels of consciousness but without a history of trauma, a CSF-LDH value < or = 40 IU/L is associated with non-structural pathology.
Negative blood culture infective endocarditis in the elderly: long-term follow-up. - Gerontology
Since the appearance of transesophageal echocardiography, the long-term prognosis of patients with negative blood culture infective endocarditis (NBCIE) has been found to be similar to that of patients with positive blood culture infective endocarditis (PBCIE). Nevertheless, the prognostic implications of NBCIE in the elderly (>65 years) has not, to date, been well documented. Our aim was to study the long-term prognosis of elderly patients with NBCIE and compare it with that of elderly patients with PBCIE.Our study group was composed of 60 consecutive patients >65 years old with a diagnosis of IE (confirmed by vegetation analysis or following Duke's criteria). Every patient underwent transthoracic and transesophageal echocardiography. Fifty patients (83.3%) had PBCIE and 10 (16.7%) had NBCIE. All patients were followed up long-term, and the study end point was a composite one of death or need for valvular heart surgery.Mean age was 72.9 +/- 5 years (56.7% male). Similar clinical and echocardiographic characteristics were found in both groups. Global mortality, need for surgery, predisposing factors and infection location were also similar in both groups. In addition, no differences were found in the long-term prognosis (log rank p = 0.29).In our series, the long-term prognosis in elderly patients with IE is independent of the presence of a negative or positive blood culture. Thus, age cannot be considered an independent risk factor of negative outcome in elderly patients with NBCIE.
Single fascia iliaca compartment block for post-hip fracture pain relief. - The Journal of emergency medicine
Hip fractures can cause considerable pain when untreated or under-treated. To enhance pain relief and diminish the risk of delirium from typically administered parenteral analgesics and continued pain, we tested the efficacy of using fascia-iliaca blocks (FICB), administered by one of four attending physicians working in the emergency department (ED), with commonly available ED equipment. After informed consent, a physician administered one FICB to 63 sequential adult ED patients (43 women, 20 men; ages 37-96 years, mean 73.5 years) with radiographically diagnosed hip fractures. Under aseptic conditions, a 21 g, 2-inch IM injection needle was inserted perpendicularly to the skin 1 cm below the juncture of the lateral and medial two-thirds of a line that joins the pubic tubercle to the anterior superior iliac spine. The needle was inserted until a loss of resistance was felt twice (fascia lata and fascia iliaca), at which point 0.3 mL/kg of 0.25 bupivacaine was infused. The physician tested the block's efficacy by assessing sensory loss. Pain assessments were done using a 10-point Likert Visual Analog Scale (VAS) before, and at 15 min, 2 h, and 8 h post-block. Block failure was having the same level of pain as before the block. Oral analgesics were administered as needed. The IRB approved this study. Post-procedure pain was reduced in all patients, but not completely abolished in any. Before the FICB, the pain ranged from 2 to 10 points (average 8.5) using the VAS; at 15 min post-injection, it ranged from 1 to 7 points (average 2.9); at 2 h post-injection, it ranged from 2 to 6 points (average 2.3); at 8 h post-injection, it ranged from 4 to 7 points (average 4.4). Analgesic requests in the first 24 h after admission averaged 1.2 doses (range 1 to 4 doses) of diclofenac 75 mg. There were no systemic complications and only two local hematomas. Resident physicians learned the procedure and could perform it successfully with less than 5 min instruction. Physicians rarely use the FICB in EDs, although the technique is simple to learn and use. This rapid, effective, and safe method of achieving excellent pain control in ED patients with hip fractures can be performed using standard ED equipment.
Map & Directions
1401 W Seminole Blvd Sanford, FL 32771
920 Lexington Green Lane Sanford Primary Care Center
1403 Medical Plaza Dr Ste 108