613 Elizabeth St 605
Corpus Christi TX 78404
Medical School: Other - 1996
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: Yes
Participates In EHR: No
License #: L1317
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Dr. Christopher Fernandez is associated with these group practices
|HCPCS Code||Description||Average Price||Average Price
Allowed By Medicare
|HCPCS Code:00566||Description:Anesth cabg w/o pump||Average Price:$3,572.91||Average Price Allowed
|HCPCS Code:00562||Description:Anesth hrt surg w/pmp age 1+||Average Price:$3,411.33||Average Price Allowed
|HCPCS Code:93503||Description:Insert/place heart catheter||Average Price:$860.00||Average Price Allowed
|HCPCS Code:01936||Description:Anesth perc img tx sp proc||Average Price:$628.46||Average Price Allowed
|HCPCS Code:36620||Description:Insertion catheter artery||Average Price:$258.00||Average Price Allowed
|HCPCS Code:76937||Description:Us guide vascular access||Average Price:$172.00||Average Price Allowed
HCPCS Code Definitions
- Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes
- Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure)
- Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); percutaneous
Medical Malpractice Cases
Medical Board Sanctions
Physical Medicine And Rehabilitation
*These referrals represent the top 10 that Dr. Fernandez has made to other doctors
Revisiting the 'Gadgil effect': do interguild fungal interactions control carbon cycling in forest soils? - The New phytologist
I. II. III. IV. V. VI. VII. VIII. References SUMMARY: In forest ecosystems, ectomycorrhizal and saprotrophic fungi play a central role in the breakdown of soil organic matter (SOM). Competition between these two fungal guilds has long been hypothesized to lead to suppression of decomposition rates, a phenomenon known as the 'Gadgil effect'. In this review, we examine the documentation, generality, and potential mechanisms involved in the 'Gadgil effect'. We find that the influence of ectomycorrhizal fungi on litter and SOM decomposition is much more variable than previously recognized. To explain the inconsistency in size and direction of the 'Gadgil effect', we argue that a better understanding of underlying mechanisms is required. We discuss the strengths and weaknesses of each of the primary mechanisms proposed to date and how using different experimental methods (trenching, girdling, microcosms), as well as considering different temporal and spatial scales, could influence the conclusions drawn about this phenomenon. Finally, we suggest that combining new research tools such as high-throughput sequencing with experiments utilizing natural environmental gradients will significantly deepen our understanding of the 'Gadgil effect' and its consequences on forest soil carbon and nutrient cycling.Â© 2015 The Authors. New Phytologist Â© 2015 New Phytologist Trust.
Low high-sensitivity troponin I and zero coronary artery calcium score identifies coronary CT angiography candidates in whom further testing could be avoided. - Academic radiology
Pilot study to determine whether among subjects receiving coronary computed tomography angiography (CTA), the combination of high-sensitivity troponin I (hsTnI) and coronary artery calcium score (CACS) identifies a low-risk population in whom CTA might be avoided.A cross-sectional study of 314 symptomatic patients receiving CTA as part of their acute coronary syndrome evaluation was conducted. hsTnI was measured with Abbott Laboratories' hsTnI assay. CACSs were calculated via the Agatston method. Patients were followed for at least 30Â days after discharge for the occurrence of major adverse cardiac events (MACEs; all-cause mortality, acute coronary syndrome, and revascularization).Of 314 subjects studied, 213 (67.8%) had no coronary artery stenosis, and 67 (21.3%), 28 (8.9%), and 6 (1.9%) had maximal coronary artery stenosis of 1%-49%, 50%-69%, and 70% or greater, respectively. All MACEs occurred during index hospitalization and include one myocardial infarction and four revascularizations. Sixty-two percent (189/307) of subjects had zero CACS, and 24% (76/314) of subjects had undetected hsTnI. No subjects with undetectable hsTnI or zero CACS had an MACE. A strategy of avoiding further testing in subjects with undetectable initial hsTnI, performing CACS on subjects with detectable initial hsTnI but nonincreased hsTnI (less than 99th percentile), and obtaining CTA in subjects with Agatston greater than 0 will have a negative predictive value of 100.0% (95% confidence interval, 98.2%-100.0%). This strategy will avoid CTA in 63% (198/314) of subjects.In this pilot study, the addition of CACS to hsTnI improves the identification of low-risk subjects in whom CTA might be avoided.Copyright Â© 2015 AUR. Published by Elsevier Inc. All rights reserved.
Redefining fine roots improves understanding of below-ground contributions to terrestrial biosphere processes. - The New phytologist
Fine roots acquire essential soil resources and mediate biogeochemical cycling in terrestrial ecosystems. Estimates of carbon and nutrient allocation to build and maintain these structures remain uncertain because of the challenges of consistently measuring and interpreting fine-root systems. Traditionally, fine roots have been defined as all roots â‰¤ 2 mm in diameter, yet it is now recognized that this approach fails to capture the diversity of form and function observed among fine-root orders. Here, we demonstrate how order-based and functional classification frameworks improve our understanding of dynamic root processes in ecosystems dominated by perennial plants. In these frameworks, fine roots are either separated into individual root orders or functionally defined into a shorter-lived absorptive pool and a longer-lived transport fine-root pool. Using these frameworks, we estimate that fine-root production and turnover represent 22% of terrestrial net primary production globally - a c. 30% reduction from previous estimates assuming a single fine-root pool. Future work developing tools to rapidly differentiate functional fine-root classes, explicit incorporation of mycorrhizal fungi into fine-root studies, and wider adoption of a two-pool approach to model fine roots provide opportunities to better understand below-ground processes in the terrestrial biosphere.Â© 2015 The Authors. New Phytologist Â© 2015 New Phytologist Trust.
Rendezvous technique for the treatment of complete common bile duct transection after multiple hepatobiliary surgeries. - Journal of laparoendoscopic & advanced surgical techniques. Part A
Common bile duct (CBD) injury during surgical procedures is a serious complication. Partial injury can usually be managed by a combination of percutaneous and/or endoscopic techniques. However, the management of complete transection of the CBD is very challenging. There are small case series of nonsurgical management of complete CBD transection during laparoscopic cholecystectomy. In this particular case, a 55-year-old female patient had multiple operations because of malignant pheochromocytoma with liver metastases. She developed a complete CBD transection during right hepatectomy. A biloma was managed with image-guided percutaneous drainage. However, both attempts of percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP) for CBD stent were unsuccessful, as the native CBD was partially resected during the injury. A rendezvous procedure, in which a guidewire was placed through the distal CBD and into a biloma by ERCP and subsequently snared with PTC, allowed for a biliary-duodenal catheter to be placed successfully and achieve continuity of the patient's biliary tree.
Troponin elevations only detected with a high-sensitivity assay: clinical correlations and prognostic significance. - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
With clinical use of high-sensitivity troponin I (hsTnI), more frequent troponin elevations will occur. However, the burden and implications of these elevations are not well understood. The authors quantified the prevalence of elevated hsTnI in patients presenting with possible acute coronary syndrome (ACS) who do not have elevated troponin with a current generation assay (cardiac troponin I [cTnI]) and determined the association of these newly detected elevations with a composite of all-cause mortality and subsequent cardiac hospitalization.This was a prospective observational study of 808 subjects evaluated for possible ACS and followed for up to 1 year. Troponin values were measured with hsTnI (Abbott Laboratories) and cTnI (Abbott and Beckman Coulter). Cardiac hospitalization was defined as hospitalization for ACS, revascularization, acute heart failure (AHF), or tachy/brady arrhythmia that occurred after the index emergency department (ED) visit or hospital discharge.Forty subjects (5%) were diagnosed with ACS (26 myocardial infarction and 14 unstable angina). On the initial sample, the prevalence of elevated hsTnI among subjects with nonelevated cTnI was 9.2% using a gender-neutral cutoff (95% confidence interval [CI] = 7.1% to 11.4%) and 11.1% using a gender-specific cutoff (95% CI = 8.8% to 13.4%). Adjudicated diagnoses for subjects whose initial samples had elevated hsTnI but nonelevated cTnI (gender-neutral cutoff) were as follows: three (4.6%) ACS, 15 (23.1%) AHF, three (4.6%) volume overload etiology unclear/noncardiac, three (4.6%) cardiac (non-ACS), and 41 (63.1%) other. Of the 65 patients whose initial samples had hsTnI but nonelevated cTnI, eight developed cTnI elevation on subsequent serial sampling. After traditional cardiovascular risk factors and renal function were adjusted for, subjects with elevated initial hsTnI but nonelevated cTnI (initial and serial sampling) had a higher risk of all-cause mortality and subsequent cardiac hospitalization than subjects with both nonelevated hsTnI and nonelevated cTnI (hazard ratio [HR] = 1.91, 95% CI = 1.14 to 3.19).On the initial sample, 9% to 11% of subjects without cTnI elevation had hsTnI elevation. Although the majority of the patients with these newly detected hsTnI elevations did not have ACS, they had a higher risk for all-cause mortality and subsequent cardiac hospitalization.Â© 2014 by the Society for Academic Emergency Medicine.
Total synthesis of a functional designer eukaryotic chromosome. - Science (New York, N.Y.)
Rapid advances in DNA synthesis techniques have made it possible to engineer viruses, biochemical pathways and assemble bacterial genomes. Here, we report the synthesis of a functional 272,871-base pair designer eukaryotic chromosome, synIII, which is based on the 316,617-base pair native Saccharomyces cerevisiae chromosome III. Changes to synIII include TAG/TAA stop-codon replacements, deletion of subtelomeric regions, introns, transfer RNAs, transposons, and silent mating loci as well as insertion of loxPsym sites to enable genome scrambling. SynIII is functional in S. cerevisiae. Scrambling of the chromosome in a heterozygous diploid reveals a large increase in a-mater derivatives resulting from loss of the MATÎ± allele on synIII. The complete design and synthesis of synIII establishes S. cerevisiae as the basis for designer eukaryotic genome biology.
Determining place and process: functional traits of ectomycorrhizal fungi that affect both community structure and ecosystem function. - The New phytologist
There is a growing interest amongst community ecologists in functional traits. Response traits determine membership in communities. Effect traits influence ecosystem function. One goal of community ecology is to predict the effect of environmental change on ecosystem function. Environmental change can directly and indirectly affect ecosystem function. Indirect effects are mediated through shifts in community structure. It is difficult to predict how environmental change will affect ecosystem function via the indirect route when the change in effect trait distribution is not predictable from the change in response trait distribution. When response traits function as effect traits, however, it becomes possible to predict the indirect effect of environmental change on ecosystem function. Here we illustrate four examples in which key attributes of ectomycorrhizal fungi function as both response and effect traits. While plant ecologists have discussed response and effect traits in the context of community structuring and ecosystem function, this approach has not been applied to ectomycorrhizal fungi. This is unfortunate because of the large effects of ectomycorrhizal fungi on ecosystem function. We hope to stimulate further research in this area in the hope of better predicting the ecosystem- and landscape-level effects of the fungi as influenced by changing environmental conditions.
The role of chitin in the decomposition of ectomycorrhizal fungal litter. - Ecology
Ectomycorrhizal fungal tissues comprise a significant forest-litter pool. Ectomycorrhizal (EM) fungi may also influence the decomposition of other forest-litter components via competitive interactions with decomposer fungi and by ensheathing fine roots. Because of these direct and indirect effects of ectomycorrhizal fungi, the factors that control the decomposition of EM fungi will strongly control forest-litter decomposition as a whole and, thus, ecosystem nutrient and carbon cycling. Some have suggested that chitin, a component of fungal cell walls, reduces fungal tissue decomposition because it is relatively recalcitrant. We therefore examined the change in chitin concentrations of EM fungal tissues during decomposition. Our results show that chitin is not recalcitrant relative to other compounds in fungal tissues and that its concentration is positively related to the decomposition of fungal tissues. Variation existing among EM fungal isolates in chitin concentration suggests that EM fungal community structure influences C and nutrient cycling.
Can ectomycorrhizal colonization of Pinus resinosa roots affect their decomposition? - The New phytologist
In many forest ecosystems, fine root litter comprises a large pool of organic carbon and nutrients. In temperate climates ectomycorrhizal fungi colonize the roots of many forest plant species. If ectomycorrhizal colonization influenced root decomposition, it could significantly influence carbon sequestration and nutrient cycling. Fungal tissues and fine roots may decompose at different rates and, therefore, ectomycorrhizal colonization may either hasten or retard root decomposition. Unfortunately, no comparisons of the decomposition of roots and ectomycorrhizal fungi have yet been made. Therefore, we compared decomposition of Pinus resinosa fine roots and ectomycorrhizal fungi from a Pinus resinosa plantation. We also compared the decomposition rates of nonmycorrhizal Pinus resinosa fine roots with roots colonized by nine species of ectomycorrhizal fungi. We found that the several tested isolates of ectomycorrhizal fungi decomposed far more rapidly than the fine roots and that ectomycorrhizal colonization either had no significant effect on root decomposition or significantly increased root decomposition depending on the isolate of fungus. We conclude that the composition of an ectomycorrhizal fungal community may affect carbon and nutrient cycling through its influence on root decomposition.Â© 2011 The Authors. New Phytologist Â© 2011 New Phytologist Trust.
Ocular effects of exposure to industrial chemicals: clinical management and proteomic approaches to damage assessment. - Cutaneous and ocular toxicology
Industrial chemicals in a variety of applications are often found in highly populated areas and their presence carries risks. The threat of serious consequences from inadvertent or intentional events involving hazardous chemicals is a possibility. Extremism and/or other illicit activities pose environmental threats from chemical exposures. We present here a review of the threat of ocular injury in small-and large-scale chemical releases and discuss mechanisms of damage and repair to the eyes. The emerging field of proteomics has been described in relation to its potential role in the assessment of ocular changes following chemical exposures and management of ocular trauma.
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613 Elizabeth St 605 Corpus Christi, TX 78404
613 Elizabeth Street Suite 612
1521 S Staples St Suite 700
1521 S Staples St Suites 104, 301 & 304
600 Elizabeth Street
613 Elizabeth St Suite 402
3226 S Alameda St
1521 S Staples St Suite 700