40 Wright St Wing Memorial Hospital
Palmer MA 01069
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Solid tumors after chronic lymphocytic leukemia patients: Report of six cases and review of the literature. - The Gulf journal of oncology
Malignancies have been reported to occur with increased frequency in chronic lymphocytic Leukemia (CLL) patients. The aim of this study was to describe which second malignancies occur in patients with CLL, whether these malignancies are related to CLL, its treatment, or both. We also attempt to study factors predicting the development of other malignancies.Between 1995 and 2009, six cases of CLL associated with solid tumor were diagnosed in Hematology Department of Military Hospital of Tunis. The diagnosis of CLL was made by immunophenotyping of peripheral blood circulating B cells, and the diagnosis of solid tumors was made by biopsy with anatomopathological exam and immunohistochemical study.The mean age of patients was 71 years. Five patients were male. The CLL was classified Stage A in one case, Stage B in three cases and Stage C in two cases. Two patients had abnormal karyotype. Three patients have not received specific treatment for their CLL. Solid tumors were represented by skin cancer in three cases, lung cancer in two cases and breast cancer in one case. The median time between diagnosis of CLL and that of solid tumor was 53 months.Patients with CLL have an increased risk of developing a second cancer. Awareness of risk factors could permit early detection.
Morphological and molecular identification of free living amoeba isolated from hospital water in Tunisia. - Parasitology research
Free-living amoebae (FLA) are opportunistic and ubiquitous protozoa that are widely found in various environmental sources. They are known to cause serious human infections. The aim of our study was to detect FLA and Acanthamoeba spp. in hospital water circuits. Eighty-four water samples were collected over a period of 4Â months (September-December 2011) from different wards of the Sfax University Hospital (surgical services, intensive care unit, operating theater, and water storage tanks). FLA were detected in 53.5Â % of samples as follows: surgical services (80Â %), operating theater and surgical intensive care unit (13.3Â %), medical intensive care unit (0Â %), water storage tanks (6.6Â %). The predominant morphotype was the acanthopodial (89Â %). The others morphotypes were as follows: monopodial (40Â %), dactylopodial (22Â %), rugosa (62Â %), eruptive (24Â %), fan shaped (18Â %), and polypodial (18Â %). Acanthamoeba was found in 40 samples (47.6Â %). 64.2Â % of isolates were identified as Acanthamoeba spp. by PCR, using primers to amplify a region of 18S rDNA which showed variation in the product length. Sequence analysis of five PCR products identified Acanthamoeba sp. These isolates belong to T4, T10, and T11 genotypes, and to our knowledge this is the first report of the T10 and T11 genotype in Tunisia.The occurrence of potentially pathogenic FLA in the hospital environment may represent a health risk for patients, since these organisms can cause severe opportunistic illness and also can harbor pathogenic agents. Thus, increased awareness regarding these parasites and recognition of their importance, particularly in immunocompromised patients is crucial.
Tinea manuum due to Trichophyton erinacei from Tunisia. - Journal de mycologie meÌdicale
Trichophyton erinacei is a zoonotic fungus affecting hedgehogs. Although several human infections with this organism have been documented in the literature, it has rarely been isolated as a human pathogen. This paper reports on an erythematous lesion spotted on the hand of a 10-year-old girl. Based on the culture of the patient's skin scrapings, the pathogen was mycologically identified as T.Â erinacei, which was further confirmed by sequencing the internal transcribed spacers of the fungal nuclear ribosomal DNA using universal primer ITS1-ITS4. This is the first case of T.Â erinacei in a Tunisian patient. A survey was carried out on the environment of our patient, and the results revealed the presence of hedgehogs with suspect scaly lesions. The same fungus was isolated from the hair and scales of the hedgehog, which was confirmed by PCR sequencing. The frequency of T.Â erinacei has often been underestimated, which is attributed not only to the gaps of knowledge still existing in the current understanding of the dermatophyte but also to differential diagnosis problems. Molecular study offers a simple and rapid tool to identify the source of infection and, hence, avoid the risk of recurrence.Copyright Â© 2015 Elsevier Masson SAS. All rights reserved.
Geotrichum capitatum septicemia: case report and review of the literature. - Mycopathologia
Geotrichum capitatum is an uncommon cause of invasive infections in immunocompromised patients, particularly those with hematological malignancies and severe neutropenia. The aim of this study was to report the cases of invasive geotrichosis in our hospital. It is a retrospective study of invasive geotrichosis diagnosed in the Laboratory of Parasitology-Mycology of the UH Habib Bourguiba, Sfax, from January 2005 to August 2013. Six cases of invasive Geotrichum infections were diagnosed. There were three men and three women. The mean age was 35 years. Five patients have acute myeloid leukemia with a profound neutropenia, and one patient was hospitalized in the intensive care unit for polytraumatism. Clinically, the prolonged fever associated with pulmonary symptoms was the predominant symptom (n = 5). Geotrichum capitatum was isolated in one or more blood culture. Two patients had urinary tract infections documented by multiple urine cultures positive for G. capitatum. Five patients received conventional amphotericin B alone or associated with voriconazole. The outcome was fatal in four cases. Invasive geotrichosis is rare, but particularly fatal in immunocompromised patients. Approximately, 186 cases have been reported in the literature. The prognostic is poor with mortality over 50 %. So, early diagnosis and appropriate management are necessary to improve prognosis.
Fungemia caused by Yarrowia lipolytica. - Mycopathologia
Yarrowia lipolytica is weakly pathogenic yeast, which is rarely isolated from the blood. We report unusual cases of Y. lipolytica fungemia occurred between October 2012 and June 2014 in the intensive care unit (ICU) of the UH Habib Bourguiba Sfax. During this period, 55 cases of Y. lipolytica septicemia were diagnosed. There were 44 men and 11 women (sex ratio = 4).The median age was 43 years. The broad-spectrum antibiotics (100 %), the catheterization (96 %), and the prolonged hospitalization in ICU (91 %) were the main risk factors. Patients were hospitalized in ICU, mostly, for polytraumatism (45.4 %), pneumopathy (9 %), and post-operative complications (7 %). Fever unresponsive to broad-spectrum antibacterial therapy was the predominant sign of infection (83.6 %). Y. lipolytica was isolated in one or several blood cultures (14.5 %) and in the catheter tip culture of nine patients (16.3 %).Treatment was based on intravenous amphotericin B (58.2 %), fluconazole (45.4 %) and/or removal catheter (69 %). Apyrexia or blood cultures sterilization was obtained for 34 patients (61.8 %). Y. lipolytica candidemia is an opportunistic and emerging human yeast pathogen. It can reach to the bloodstream of immunocompromised or critically ill patients during hospitalization through intravascular catheterization. Further clinical data need to be evaluated for formulating management strategies of seriously ill patients infected with uncommon fungal agents.
Reliability and validity of a 20-s alternative to the wingate anaerobic test in team sport male athletes. - PloS one
The intent of this study was to evaluate relative and absolute reliability of the 20-s anaerobic test (WAnT20) versus the WAnT30 and to verify how far the various indices of the 30-s Wingate anaerobic test (WAnT30) could be predicted from the WAnT20 data in male athletes. The participants were Exercise Science majors (age: 21.5Â±1.6 yrs, stature: 0.183Â±0.08 m, body mass: 81.2Â±10.9 kg) who participated regularly in team sports. In Phase I, 41 participants performed duplicate WAnT20 and WAnT30 tests to assess reliability. In Phase II, 31 participants performed one trial each of the WAnT20 and WAnT30 to determine the ability of the WAnT20 to predict components of the WAnT30. In Phase III, 31 participants were used to cross-validate the prediction equations developed in Phase II. Respective intra-class correlation coefficients (ICC) for peak power output (PPO) (ICCâ€Š=â€Š0.98 and 0.95) and mean power output (MPO) (ICC 0.98 and 0.90) did not differ significantly between WAnT20 and WAnT30. ICCs for minimal power output (POmin) and fatigue index (FI) were poor for both tests (range 0.53 to 0.76). Standard errors of the means (SEM) for PPO and MPO were less than their smallest worthwhile changes (SWC) in both tests; however, POmin and FI values were "marginal," with SEM values greater than their respective SWCs for both tests values. Stepwise regression analysis showed that MPO had the highest coefficient of predictability (Râ€Š=â€Š0.97), with POmin and FI considerable lower (Râ€Š=â€Š0.71 and 0.41 respectively). Cross-validation showed insignificant bias with limits of agreement of 0.99Â±1.04, 6.5Â±92.7 W, and 1.6Â±9.8% between measured and predicted MPO, POmin, and FI, respectively. WAnT20 offers a reliable and valid test of leg anaerobic power in male athletes and could replace the classic WAnT30.
Epidemiological profile of fungal keratitis in Sfax (Tunisia). - Journal de mycologie mÃ©dicale
Fungal keratitis is responsible for a significant burden of blinding disease in the developing world.The aim of this study was to determine the etiological agents, predisposing factors and therapy of keratomycosis in our region.Retrospective study of 60 patients with clinically and cultured confirmed fungi keratitis, who were attended at department of mycology in Sfax (1995 to 2012).The mean age of patients was 47.2 years (sex ratio: 1.58). At least, one presumed predisposing factor was identified in 83.3% of cases. Corneal traumatism was established as the most common predisposing factor (61.6%) with vegetative matter (42.4%). Patients had corneal ulcer in 40% or abscess in 47.6%. All cases were positive on direct microscopy and 93% of cultures were positive. Filamentous fungi form the major etiologic agents (83%): Fusarium species (49% with F. solani [66%]), Aspergillus sp. (22%), Alternaria (5%), Scedosporium sp. (2%); and non-identified mold in (5%). Yeast were identified in 17% of cases. Topical agents were used in 97% of cases: ketoconazole 2%, amphotericin B (0.5%). Fluconazole per os was administrated for 11% of cases, itraconazole (2 cases) and voriconazole (one case). Keratoplasty was indicated for 27% of cases. The outcome was favorable in 16% of patients. Among the patients, 71% had persistent corneal deposit sequelae. Four patients lost the eyeball.Corneal traumatism was the principal risk factor for fungal keratitis in young and middle-aged farmers. Fusarium solani is the predominant cause in Sfax. Early diagnosis, coupled with appropriate treatment, is crucial for increasing the chance of complete recovery.Copyright Â© 2014 Elsevier Masson SAS. All rights reserved.
Enzymatic activities in different strains isolated from healthy and brittle leaf disease affected date palm leaves: study of amylase production conditions. - Applied biochemistry and biotechnology
The present study aimed to investigate and compare the enzymatic production of endophytic bacteria isolated from healthy and brittle leaf disease affected date palm leaves (pectinase, cellulase, lipase, and amylase). The findings revealed that the enzymatic products from the bacterial isolates of healthy date palm leaves were primarily 33% amylolytic enzyme, 33 % cellulase, 25 % pectinase, and 25 % lipase. The isolates from brittle leaf disease date palm leaves, on the other hand, were noted to produce 16 % amylolytic enzyme, 20 % cellulose, 50 % pectinase, and 50 % lipase. The effects of temperature and pH on amylase, pectinase, and cellulose activities were investigated. The Bacillus subtilis JN934392 strain isolated from healthy date palm leaves produced higher levels of amylase activity at pH 7. A Box Behnken Design (BBD) was employed to optimize amylase extraction. Maximal activity was observed at pH and temperature ranges of pH 6-6.5 and 37-39 Â°C, respectively. Under those conditions, amylase activity was noted to be attained 9.37 U/ml. The results showed that the enzyme was able to maintain more than 50 % of its activity over a temperature range of 50-80 Â°C, with an optimum at 70 Â°C. This bacterial amylase showed high activity compared to other bacteria, which provides support for its promising candidacy for future industrial application.
Micro-fabricated DC comparison calorimeter for RF power measurement. - Sensors (Basel, Switzerland)
Diode detection and bolometric detection have been widely used to measure radio frequency (RF) power. However, flow calorimeters, in particular micro-fabricated flow calorimeters, have been mostly unexplored as power meters. This paper presents the design, micro-fabrication and characterization of a flow calorimeter. This novel device is capable of measuring power from 100 Î¼W to 200 mW. It has a 50-Ohm load that is heated by the RF source, and the heat is transferred to fluid in a microchannel. The temperature change in the fluid is measured by a thermistor that is connected in one leg of a Wheatstone bridge. The output voltage change of the bridge corresponds to the RF power applied to the load. The microfabricated device measures 25.4 mm Ã— 50.8 mm, excluding the power supplies, microcontroller and fluid pump. Experiments demonstrate that the micro-fabricated sensor has a sensitivity up to 22 Ã— 10â»Â³ V/W. The typical resolution of this micro-calorimeter is on the order of 50 Î¼W, and the best resolution is around 10 Î¼W. The effective efficiency is 99.9% from 0âˆ’1 GHz and more than 97.5% at frequencies up to 4 GHz. The measured reflection coefficient of the 50-Ohm load and coplanar wave guide is less than âˆ’25 dB from 0âˆ’2 GHz and less than âˆ’16 dB at 2âˆ’4 GHz.
Changes in genotype and fluconazole susceptibility of isolates from patients with Candida glabrata in Tunisia. - ThÃ©rapie
Candida glabrata has emerged as an opportunistic pathogen of considerable importance in invasive and superficial infections.To analyze the development of fluconazole resistance in patients under treatment through epidemiological survey in our hospital.Twenty two patients (89 clinical strains) were collected. Molecular typing of isolates was performed by polymorphic markers. Analysis of gene expression was realized by reverse transcriptase-real time polymerase chain reactions (RT-qPCR).Genetic analysis showed that 63% persists with apparently unchanged strains (n=14). Among them, four showed fluconazole resistance development. A strain replacement was observed in 6 patients and two patients selected more resistant isolates during the course of treatment. An analysis of Candida glabrata cerebellar degeneration-related protein 1 (CgCDR1), Candida glabrata cerebellar degeneration-related protein 2 (CgCDR2) and Candida glabrata sterol 14 alpha-demetylase Erg 11 (CgERG11) expression revealed an over-expression in 10 resistant isolates.This study demonstrated that C. glabrata strain undergo frequent changes in vivo. The increase in CgCDR1 and CgCDR2 expression was the most mechanism associated with fluconazole resistance.Â© 2014 SociÃ©tÃ© FranÃ§aise de Pharmacologie et de ThÃ©rapeutique.
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