Latest news with #rheumatology
Medscape
2 days ago
- General
- Medscape
5 Things You Need to Know When Treating Gout
Welcome to Rheum With a Viewpoint . My name is Dr Arinola Dada, and I've been practicing rheumatology for 20 years. Let's talk about five things you need to know when you're treating patients with gout. 1. Your patients have been taking anti-inflammatory medications when you were not looking. It's possible that your patients may have some kidney damage, so when they call you on Saturday night to report an acute attack of gout and your first instinct is to order indomethacin, take a pause and consider trying something else. My go-to medication is prednisone. 2. How much prednisone should you give your patient? The secret in the world of rheumatology is to go slow. You can start with 40 mg/d of prednisone for 4 days, then taper down to 30 mg/d for 4 days, then 20 mg/d for 4 days, and continue to reduce in that fashion. That secret sauce is going to help you treat your patient's acute gout. 3. When should you start allopurinol? You should not start allopurinol during an acute attack. Remember, allopurinol does not treat acute attacks. Allopurinol is there to help lower uric acid levels in the blood. It's useful for prevention and management, but you want to start allopurinol after an acute attack of gout has settled. If the patient is already on allopurinol, they can continue taking their medication without adjusting the dose. Simply treat the acute attack. 4. Women tend to get tophi in their fingers. You may want to look closely if you have a female patient with suspected gout. Patients report that this acute pain feels like somebody smashed their finger with a hammer. That kind of complaint would give you insight that your female patient may actually be experiencing gout in her DIP joints or inside her Heberden nodes. 5. Remember that when patients have tophi, they may not be able to feel it. Talk to your local radiologist to see if you can order a dual-energy CT (DECT) scan. It really helps differentiate between gout and pseudogout.
Medscape
6 days ago
- General
- Medscape
Skill Checkup: A Man With Plaque Psoriasis and Joint Pain
A 46-year-old White man with a 10-year history of moderate to severe plaque psoriasis presents with worsening joint symptoms. He has been treated with topical steroids for the past 2 years but reports that his psoriasis flare-ups have become more frequent and more severe over the past 6 months. Over the past 3 months, he has developed progressive joint pain, swelling, and stiffness primarily affecting the distal interphalangeal (DIP) joints of his hands. He notes that the stiffness is worst in the morning, lasting more than an hour, but improves with activity. He denies having recent trauma, fever, or infectious symptoms. On physical exam, there is visible swelling of several fingers and toes (described as "sausage digits," consistent with dactylitis) and nail pitting. No tenderness or decreased range of motion is noted in the axial skeleton. Laboratory results show an elevated C-reactive protein level and erythrocyte sedimentation rate, but rheumatoid factor (RF) and antinuclear antibody are negative. This patient's psoriasis history, DIP joint involvement, dactylitis, and nail pitting are characteristic of psoriatic arthritis (PsA). The presence of active psoriasis and nail changes strongly points to PsA as the most likely cause of this patient's joint disease as well. In contrast, rheumatoid arthritis (RA) typically causes a symmetric polyarthritis of the hands that favors the proximal joints (metacarpophalangeal and proximal interphalangeal joints), while DIP joints are usually not involved. Positive RF or anti–citrullinated peptide (anti-CCP) antibodies are seen in most cases; the patient's asymmetric DIP joint arthritis and negative RF make RA unlikely. Osteoarthritis (OA) can affect DIP joints, but it is a noninflammatory degenerative arthritis that usually presents at an older age with brief morning stiffness and pain that worsens with activity, often with bony enlargements (Heberden's nodes) rather than diffuse swelling; unlike PsA, OA does not often cause intense inflammation, dactylitis, or nail pitting. OA DIP joint changes are usually due to osteophytes ("bone spurs") without the psoriatic nail lesions. Reactive arthritis (ReA) is a seronegative spondyloarthritis like PsA and can cause asymmetric oligoarthritis with enthesitis/dactylitis; however, ReA is usually triggered by a recent infection and often involves the lower extremities (knees, ankles, and toes) with extra-articular features like urethritis or conjunctivitis, which are not seen here. PsA classically produces erosive changes with new bone formation on radiographs. In advanced disease, DIP joints can erode into a pencil-in-cup deformity, where the phalanx tapers and "cups" into an eroded adjacent bone. Though this can occur in other inflammatory diseases, it is most commonly associated with PsA. Such combined erosive and proliferative bone changes are highly suggestive of PsA and are not typically seen in RA (which shows only erosions with osteopenia) . Positive anti-CCP antibody more strongly supports RA rather than PsA, as PsA is usually seronegative for RA markers, such as the RF and anti-CCP antibodies. Uric acid crystals in joint fluid would more likely indicate gout, not PsA. While patients with PsA have been shown to experience a higher risk for gout, the presentation in this case (chronic DIP joint arthritis with nail changes) is not consistent with it. HLA-B27 antigen is associated with PsA in those who have axial (spinal) involvement, but it is less common patients with PsA and without spine disease. The patient has no axial symptoms, so HLA-B27 testing would be of limited value. Moreover, HLA-B27 is not required to diagnose PsA. The Classification of PsA (CASPAR) criteria is the internationally accepted standard for classifying PsA. It requires the presence of inflammatory arthritis (joints, spine, or entheses) plus a total of at least 3 points from features including: Current psoriasis (2 points) or personal/family history of psoriasis (1 point); psoriatic nail changes (pitting or onycholysis, 1 point); dactylitis (swelling of an entire digit, 1 point); negative RF (1 point); and juxta-articular new bone formation on radiography (1 point). PsA is diagnosed using the CASPAR criteria in patients with inflammatory arthritis who score at least 3 points, with the criteria demonstrating high specificity and sensitivity and serving as the preferred diagnostic tool once other differentials are excluded. This patient meets the CASPAR criteria as he has inflammatory arthritis with psoriasis, nail pitting, and dactylitis and is RF-negative. The American College of Rheumatology and European League Against Rheumatism (ACR/EULAR) criteria are typically used for RA, not PsA, and emphasize symmetric joint involvement and RA-specific antibodies (RF/anti-CCP) and do not apply here. The modified New York criteria are used to classify ankylosing spondylitis, focusing on axial skeletal findings (eg, sacroiliitis on radiography and low back pain), which are not the primary issue in this patient. The Jones Criteria are designed for acute rheumatic fever diagnosis and are unrelated to PsA. The patient is diagnosed with moderate to severe PsA, and given his dactylitis, arthritis, and skin involvement, he is given methotrexate as initial therapy owing to cost-effectiveness; however, he returns to his next appointment, and his PsA remains active. In a patient with moderate to severe PsA that is inadequately controlled on a conventional synthetic DMARD (methotrexate), experts recommend escalating to a biologic DMARD. Tumor necrosis factor (TNF) inhibitors (such as adalimumab, etanercept, or infliximab) are a proven biologic choice for PsA, effective for both joint and skin symptoms. The latest Group for Research and Assessment of Psoriasis and PsA (GRAPPA), ACR, and EULAR guidelines endorse using a TNF inhibitor (or another biologic/targeted therapy) once conventional DMARD therapy fails to achieve remission. In this case, adding a TNF inhibitor is appropriate to control joint inflammation and prevent further damage while also improving psoriasis. Switching to another conventional DMARD (like sulfasalazine or leflunomide) is generally less effective in patients with moderate to severe disease; this method is typically more effective in mild to moderate cases. Oral corticosteroid are generally not recommended for routine PsA management, as they might worsen disease. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help symptomatically, but they are most appropriate in mild PsA, not moderate to severe disease. This patient has active polyarthritis and progressive symptoms, requiring disease-modifying therapy, and using NSAIDs without advancing systemic treatment would allow ongoing joint damage. An oral phosphodiesterase 4 (PDE-4) inhibitor can be used as an alternative for patients who prefer an oral medication and want to avoid injections. Further, current GRAPPA guidelines and ACR guidelines include PDE-4 inhibitors among the recommended treatment options for active PsA. The potency of PDE-4 inhibitors (such as apremilast) are likely not as strong as Janus kinase inhibitors in moderate to severe cases of PsA. However, the latter needs to be weighed carefully against PDE-4 inhibitors due to higher risks for infection among other long-term side effects. In moderate to severe cases of PsA, 5-aminosalicylic acid derivatives, such as sulfasalazine, are typically not very effective; they are reserved for add-on therapy in case of mild disease activity. Calcineurin inhibitor can help severe psoriatic skin lesions, but they are not a preferred therapy for PsA joint manifestations. Antimalarial drugs can be considered when previous DMARDs use is ineffective or if joint inflammation remains a significant concern, but they are not typically recommended in PsA as they might lead to psoriasis flare-ups. Editor's Note: Skill Checkups are wholly fictional or fictionalized clinical scenarios intended to provide evidence-based educational takeaways.
Yahoo
28-05-2025
- Business
- Yahoo
Sobi to share new clinical data and research at EULAR 2025
STOCKHOLM, May 28, 2025 /PRNewswire/ -- Sobi® (STO: SOBI) will present new clinical data and research outcomes at the annual European Congress of Rheumatology (EULAR 2025) in Barcelona from the 11-14 June 2025. Research will include clinical trial outcomes on the efficacy and safety of Gamifant in the treatment of macrophage activating syndrome, updates on trial details of Vonjo investigating the potential treatment of VEXAS, and an analysis on the management of uncontrolled gout. Sobi will host a symposium on the dermatologic, rheumatologic, and hematologic features of VEXAS syndrome during the congress. The symposium will be chaired by Dr Sophie Georgin-Lavialle MD, PhD from the French National Reference Centre for auto-inflammatory diseases and inflammatory amyloidosis. The symposium will be followed by a panel discussion and Q&A. "We are delighted that our continued advancements in treating rare disease, including those suffering with the most debilitating rheumatology conditions will be presented at this year's EULAR conference. Sobi's presentations will provide insights and treatment options for those working with patients with rheumatological conditions, providing them with the most up-to-date clinical data and approaches," said Lydia Abad-Franch, MD, MBA, Head of Research, Development, and Medical Affairs (RDMA), and Chief Medical Officer at Sobi. "With several poster and oral presentations and a longer form symposium, we are proud to be able to show how research and collaboration can advance clinical practice – and we look forward to meeting and connecting with colleagues in Barcelona," Lydia Abad-Franch concluded. Key data to be presented at EULAR 2025 Gamifant (emapalumab) Efficacy and Safety of emapalumab in Patients with Macrophage Activation Syndrome in Still's disease: Results from a Pooled Analysis of Two Prospective Trials Speaker: Professor Fabrizio De Benedetti (principal investigator of the study) Oral presentation Session title: Clinical Abstract Session: Proceedings in Juvenile Idiopathic Arthritis Session date: Thursday 12 June Session time: 10:30 - 12:00 CEST Presentation time: 10:48 - 10:57 CEST Location: Room 6.1 Exposure-safety analysis from two clinical trials of emapalumab in patients with macrophage activation syndrome in Still's disease Speaker: Professor Fabrizio De Benedetti (principal investigator of the study) Poster presentation Session title: Poster View VI Session date: Friday 13 June Session time: 12:00 – 13:30 CEST Location: Poster Hall NASP (formerly SEL-212) Variations in uncontrolled gout between Rheumatologists and Nephrologists Poster presentation Session title: Poster View VIII Session date: Friday 13 June Session time: 10:15 - 11:45 CEST Location: Poster Hall Vonjo (pacritinib) Development of a Consensus Definition of VEXAS Flare for Use in Clinical Research Poster presentation Session title: Poster View VII Session date: Friday 13 June Session time: 14 :45 - 15 :45 CEST Location: Poster Hall PAXIS: A Randomized, Double-Blind, Placebo-Controlled, Dose Finding Phase 2 Study (Part 1) Followed by an Open-Label Period (Part 2) to Assess the Efficacy and Safety of Pacritinib in Patients with VEXAS Syndrome Poster tour Session Title: Poster Tour II/ Clinical and Basic Poster Tours: Autoinflammatory Diseases including VEXAS Session date: Saturday 14 June Session time: 10:15 -11:45 CEST Presentation time: 10:29 - 10:36 CEST (4 mins + 2 mins Q&A) Location: Poster Tour II Development of a Disease Activity Index for the Assessment of VEXAS Syndrome (VEXAS-DAI) Poster tour Session title: Poster Tour II/ Clinical and Basic Poster Tours: Autoinflammatory Diseases including VEXAS Session date: Saturday 14 June Session time: 10:15 - 11:45 CEST Presentation time: 10:43 - 10:50 CEST (4 mins + 2 mins Q&A) Location: Poster Tour II Medical Symposium An in-depth presentation on VEXAS syndrome: the dermatologic, rheumatologic, and hematologic features of the condition. Followed by a panel discussion and Q&A Symposium title: Putting on your VEXAS goggles: Seeing what's in plain sight Session date: Friday 13 June Session time: 17:30 - 18:30 CEST Location: Fira de Barcelona, Room B4 About Gamifant® (emapalumab) Gamifant® (emapalumab) is indicated for the treatment of adult and paediatric (newborn and older) patients with primary hemophagocytic lymphohistiocytosis (HLH) with refractory, recurrent or progressive disease or intolerance with conventional HLH therapy. About Macrophage activation syndrome (MAS) Macrophage activation syndrome (MAS) is a potentially life-threatening complication of Still's disease characterised by interferon-gamma (IFNγ)–driven systemic hyperinflammation. More than one-third of patients inadequately respond to high-dose glucocorticoids. Emapalumab, an anti-IFNγ antibody, demonstrated efficacy and safety in a phase 2 pilot study in patients with MAS in Still's disease and an inadequate response to high-dose glucocorticoids. About NASP, formerly SEL-212 NASP is a novel investigational medicine designed to reduce serum urate (SU) levels in people with uncontrolled gout, potentially reducing harmful tissue urate deposits which when left untreated can lead to debilitating gout flares and joint deformity. NASP is administered every 4-weeks as a sequential, two-component, infusion therapy consisting of tolerogenic nanoencapsulated sirolimus (NAS) which mitigates the formation of anti-drug antibodies (ADAs) and a uricase, pegadricase (P), which reduces serum uric acid. ADAs develop due to unwanted immune responses to biologic medicines, reducing their efficacy and tolerability, which remains an issue across multiple therapeutic modalities and disease states including uncontrolled gout. About VONJO® (pacritinib) VONJO is a kinase inhibitor that is indicated in the US for the treatment of adults with intermediate or high-risk primary or secondary (post-polycythemia vera or post-essential thrombocythemia) myelofibrosis with a platelet count below 50 × 109/L. This indication is approved under accelerated approval based on spleen volume reduction. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial(s). About VEXAS VEXAS syndrome is a disease that causes inflammatory and hematologic (blood) manifestations. The syndrome is caused by mutations in the UBA1 gene of blood cells and acquired later in life. The condition is not genetically inherited. About Sobi Sobi is a global biopharma company unlocking the potential of breakthrough innovations, transforming everyday life for people living with rare diseases. Sobi has approximately 1,900 employees across Europe, North America, the Middle East, Asia and Australia. In 2024, revenue amounted to SEK 26 billion. Sobi's share (STO: SOBI) is listed on Nasdaq Stockholm. More about Sobi at and LinkedIn. Contacts For details on how to contact the Sobi Investor Relations Team, please click here. For Sobi Media contacts, click here. This information was brought to you by Cision The following files are available for download: Sobi share New clinical Data and Research at EULAR 2025 View original content:
Daily Mail
26-05-2025
- Health
- Daily Mail
Fraudster doctor who gave chemo to healthy patients WITHOUT cancer to fund lavish $118m lifestyle learns his fate
A Texas doctor has been sentenced to 10 years in federal prison for orchestrating one of the most egregious medical fraud schemes in modern US history making $118 million in false claims. Jorge Zamora-Quezada, 68, a once-respected rheumatologist, was convicted of diagnosing hundreds of healthy patients with a life-altering disease they never had - all to bankroll his empire of jets, beachfront properties, and European sports cars. Zamora-Quezada's criminal scheme centered around one of deception as set about falsely diagnosing people with rheumatoid arthritis, an incurable autoimmune disease that affects joints but can be treated with various medications and chemotherapy drugs that involve toxins. Armed with falsified test results and fabricated symptoms, he administered toxic treatments, including chemotherapy infusions, steroids, and other aggressive drugs to people who were otherwise young and healthy. 'Dr. Zamora-Quezada funded his luxurious lifestyle for two decades by traumatizing his patients, abusing his employees, lying to insurers, and stealing taxpayer money,' said Matthew R. Galeotti, head of the DOJ's Criminal Division. 'His depraved conduct represents a profound betrayal of trust toward vulnerable patients who depend on care and integrity from their doctors.' The doctor is thought to have particularly made children, the disabled and elderly patients a target. 'Constantly being in bed and being unable to get up from bed alone, and being pumped with medication, I didn't feel like my life had any meaning,' one devastated patient told the court. According to the Department of Justice, patients who should have been thriving were instead left with liver damage, hair loss, strokes, necrosis of the jaw, and chronic pain so severe that some couldn't even lift a spoon or walk unassisted. 'For most patients, it was obvious that they did not have rheumatoid arthritis,' one stunned rheumatologist testified during the 25-day trial. The diagnosis, in many cases, had been conjured out of thin air. The disgraced doctor would order a number of 'fraudulent, repetitive, and excessive medical procedures on patients in order to increase revenue.' All told, Zamora-Quezada's scheme siphoned more than $28 million from Medicare, Medicaid, TRICARE, and private insurers like Blue Cross Blue Shield. He used the profits to construct a sprawling real estate portfolio spanning the US and Mexico, purchase a million dollar private jet, and drive off in a Maserati GranTurismo, both of which were branded with his initials 'ZQ'. He also owned multiple residential properties, including two penthouses and a condo in Mexico and another condo in Aspen, Colorado. He owned several homes and commercial buildings in Texas, court records show. And while his patients lay in bed, ravaged by unnecessary drugs, Zamora-Quezada referred to himself as 'La Eminencia' - The Eminence -and flew across borders in style. Having been convicted of one count of conspiracy to commit health care fraud, seven counts of health care fraud, and one count of conspiracy to obstruct justice, Zamora-Quezada will now spend the next decade behind bars. He has been ordered to forfeit over $28 million, his jet, his Maserati, and his entire real estate empire consisting of 13 properties. 'Today's sentence is not just a punishment - it's a warning,' Galeotti said. 'Medical professionals who harm Americans for personal enrichment will be aggressively pursued and held accountable.' Zamora-Quezada's victims have come forward during the trial to explain how their former doctor would diagnose them with degenerative diseases that other doctors would later reveal they never had. One of his victims was Maria Zapata, 70, who went to see the doctor years earlier because of a pain in her knee. The doctor told her she had arthritis and gave her injections that would 'strengthen the cartilage' in her knee. Her husband then asked the doctor why he was administering so many injections, but he reassured them the treatment would help. However, there was discoloration on Zapata's leg and other doctors were concerned with the course of the treatment before finally a doctor told Zapata she never even had arthritis. Another patient of Dr Zamora-Quezada, Nora Rodriguez, said that that he yelled at her and threw her out of his office after she questioned his treatment. 'He kept getting upset when I was asking him why I was feeling worse and not getting better,' she said. 'He yelled and told me, ''you are no longer my patient; get out of this office,''' Rodriguez said. Inside his Mission, Texas clinic, Zamora-Quezada ran what prosecutors described as a 'culture of fear.' He hired foreign staffers on temporary visas, who fearing deportation wouldn't question his unethical orders. One former worker told how he threw a paperweight at them after failing to generate enough unnecessary procedures. When insurance companies requested patient files, employees were told to make them 'appear.' When real patients weren't available for records, he used staffers as fake models for ultrasounds. Many records weren't stored in proper facilities but rather dumped in a rundown barn infested in the Rio Grande Valley that was infested with rodents and termites, some covered in animal feces and urine. He threatened employees, abused his status, and manipulated desperate people who had come to him for care. 'He took advantage of the very system he swore to uphold,' prosecutors argued in court. For his victims, many say the damage cannot be undone. Among the most harrowing testimonies came from parents of children subjected to unnecessary treatments. One mother compared her child's experience under Zamora-Quezada's care to that of a science experiment: 'He used my child like a lab rat,' she said, describing endless injections and pills prescribed for a disease that never existed. Others told the court they lived for years under the shadow of a false diagnosis, believing their dreams had been crushed with not much longer left to live. Some described how the devastating diagnosis saw them abandoning plans for college or feeling like they were 'living a life in the body of an elderly person.' Zamora-Quezada's had faced some public scrutiny in the past. In 2006, he was accused of prescribing a drug 'inconsistent with public health and welfare' and of 'billing for treatment that was improper, unreasonable, or medically or clinically unnecessary.' He later settled for a public reprimand by the Texas Medical Board in 2009 and was fined $30,000 but able to continue his practice.
Fox News
21-05-2025
- Health
- Fox News
Texas doctor sentenced to 10 years in prison in one of the ‘most significant' cases of patient harm
A Texas-based doctor was sentenced Wednesday to 10 years in prison for healthcare fraud after he carried out what prosecutors said was a nearly two-decade scheme that involved falsely diagnosing thousands of patients with degenerative diseases and profiting handsomely off their treatments. Jorge Zamora-Quezada, a rheumatologist licensed to practice medicine in Texas, Arizona and Massachusetts before being stripped of his licenses in each state, raked in hundreds of millions of dollars for the misdiagnoses and treatment he ordered during his roughly 20 years as a medical practitioner. The treatments included punishing rounds of chemotherapy, intravenous infusions, and a battery of other tests, monthly visits, and regular procedures associated with the treatment of rheumatoid arthritis, a chronic, autoimmune condition for which there is no cure. The sentencing, and his earlier court appearances, played out at times like a study in contrasts. Prosecutors detailed his extravagant lifestyle, including a private jet, 13 properties across the U.S., including in Aspen and various towns in Mexico, and a Maserati – while the health of the patients he defrauded continued to worsen. Prosecutors accused him of taking advantage of vulnerable individuals in Texas, such as teenagers, elderly individuals, and disabled persons, in order to carry out the scheme. Some of them testified at Wednesday's hearing about the ongoing side effects they suffered as a result of the doctor's actions, including receiving chemotherapy or IV infusions they did not need. It's "one of the most egregious" cases of its kind the Justice Department has brought in this space, Matthew Galeotti, head of the Justice Department Criminal Division, told Fox News Digital in a sit-down interview on Wednesday. That's because of "all of the various kinds of misconduct rolled into one," he said, "and because it was pervasive – the scheme lasted more than 18 years." "By the time you're towards the end of the scheme, he knows the consequences some of these things have had on the victims, and he's going forward anyways," he said of the doctor. The Justice Department's Criminal Division has been prosecuting this case for years. Unlike other departments, it is one of the few where career and political staff alike are largely in lockstep, with goals and cases that transcend partisan politics and seek instead to hold criminals like the Texas doctor accountable. Galeotti said he sees the case as emblematic of the Trump administration's goals to vindicate victims and counter wasteful government spending. "Even in cases where you don't see this level of misconduct, where you're not prescribing someone chemotherapy medicine that doesn't need it, which obviously sort of stands out on its own, we still have a problem because you were wasting government funds that should be going to actually benefiting patients," Galeotti said. A separate Justice Department official told Fox News Digital Zamora-Quezada's case was one of the "most significant" instances of patient harm that he had seen in at least a decade. "There was testimony about truly debilitating side effects from the medications, things like strokes, necrosis of the jawbone, really the jawbone melting away, hair loss, liver damage," the official said. The doctor's actions were seen as particularly egregious, in the Justice Department's telling, because they sought to prey on lower-income communities in Texas, targeting teenagers, elderly persons, and disabled individuals. The doctor also operated in areas with less access to medical care and with fewer native English speakers compared to other parts of the state. "Of course, it's always the most twisted when you're benefiting from someone else's misfortune – misfortune you caused – and misfortune you used for your own personal enrichment," Galeotti said. "They're the hallmarks of the worst kind of conduct that you see," Galeotti said. Zamora-Quezada was convicted by a jury in 2020 of seven counts of healthcare fraud, one count of conspiracy to commit healthcare fraud, and one count of obstruction of justice. His attorneys argued that the fraud was not "pervasive" in the way the government made it out to be, according to public court filings. Prosecutors said Zamora-Quezada purchased condominium properties in vacation towns, including in Aspen, San Diego, and Puerto Vallarta, Mexico. They said he commuted to his various doctors' offices in Texas in a Maserati and a private jet, both emblazoned with his initials, "ZQ." His assets were forfeited after he was charged, prosecutors said. Meanwhile, they said, while Zamora-Quezada was living a life of luxury, out of nearly 100,000 Medicare patients he treated, Zamora-Quezada diagnosed 72.9% of them with rheumatoid arthritis. Prosecutors compared that data to seven other Texas rheumatologists, who cumulatively diagnosed 13% of their patients with the same condition. Prosecutors asked for $100 million in restitution, but the judge required him to pay $28 million. Attorneys for Zamora-Quezada did not respond to Fox News Digital's request for comment.
