EFTA00621679.pdf

11111111111111111 Accession #. Order it: A13123t0035 G8310455 Date Collected: Date Received: 12/30/2013 12/31/2013 Reference GENOVA DIAGNOSTICS Patient: Date of Birth: Jeffrey Epstein 01/20/1953 Dated Report: Telephone: 01/17/2014 5616275816 VIVIVIgdx.net • 800.577.4767 Age: 60 Fax: 5616275895 Sex: Male Ordering Physician: Repriled: The Natural Medicine Clinic Comment: Thomas Rotrano, DC 2401 PGA Blvd Ste 132 Palm Beach Gardens. FL 33410 • IIMIMISO GI Effects f Stool Profiles U.S. ?steal podIng 2000 2200 GI Effects Comprehensive Profile Methodology: DNA Analysis, GCAWS. Microscopic. Colorimetfic. Automated Chemistry. EtA The GI Effects Gastrointestinal Function Profile (2100) and the GI Effects Microbial Ecology Profile (2105) have been replaced by GI Effects Comprehensive Profile (2200) and a new version of the Microbial Ecology Profile (2205), respectively. Updates on the new GI Effects Comprehensive Profile (2200) and Microbial Ecology Profile (2205) include: o The 2200 and 2205 will Include for parasitology, replacing PCR. To enhance clinical utility for our clients, Genova Diagnostics will now offer gold standard technology on its GI Effects Profiles. When multiple stool samples are provided. Genova utilizes a pooled process known as Optimized Parasitology Recovery (OPR). o In order to optimize clinical utility. pathogens (C. difficile, H. pylori, Shiga Toxin E. coll, and Campylobacter app.) will now only be offered as EIA add ons. Clinical utility is best achieved by applying diagnostic assessment for these pathogens within an appropriate clinical differential. o Drug Resistant Genes will be discontinued from reported profiles. Measurement of drug resistant genes indicates presence of DNA for the gene in stool, but does not provide evidence of gene expression. Therefore, no specific treatment indications can be inferred. o PCR will continue to be utilized for assessment of gut microbiota, including predominant and opportunistic bacteria, and yeast/fungi. If you have any questions regarding these important changes. please feel free to contact Client Services at 800-5224762, or contact us online at www.gclx.net. Georgia Lab Lin code 4067-007 Latotalmy Director: Rabat M. David. PhD <MIA IDS 1930255349 Tenting Perfoimed by Genova Diagnostics. Inc. 3425 Corporate Way. Duluth. GA 30096 New Tort Clinical Lab PFI 44578 n orioa Clinical Lab Lin #800008124 Page 1 EFTA00621679  Accession tt. A1312310035 Date Collected: 12130/2013 Order it G8310455 Date Received: 12131/2013 Reference H: Date of Report: 01/17/2014 G E NOVA DIAGNOSTICS' Patient: Date of Birth: Jeffrey Epstein 01/20/1953 Telephone: 5616275816 www.gdx.net • 800.522.4762 Age: 60 Fax: 5616275895 Sex: Male Ordering Physician: Reprinted: The Natural Medicine Clinic Comment: Thomas Rofrano, DC 2401 PGA Blvd Ste 132 Palm Beach Gardens, FL 33410 GI GI Effects Stool Profiles 2200 GI Effects Comprehensive Profile Methodology: DNA Analysis. GOMS.Mtcroscopic. Cotonmetnc. Automated Chermstry, Quintile Ranking 95% Reference Consistency = Results I 1st I 2nd I 3rd I 4th 5th Range Hard/Constipated Predominant Bacteria E+007 Obligate Anaerobes Predominant Bacteria play major roles 1.6 6.7 n health. They provide colonization resistance aganst potentially Bacteroides spp. 6.2 I I I 1 4, pathogenic organisms. aid n digestion 1.5 62 and absorption. produce vitamins and Clostridia spp. 5.3 SCFA's. and stimulate the GI immune 16 62 system. DNA probes allow detection of Prevotella spp. 4.6 multiple species (spp.) within a genus. so the genera that are reported cover 1.6 74 many species. Fusobacteria spp. 5.1 1.6 58 Streptomyces spp. 4.7 Organisms are detected by DNA 1.7 62 analysis. One colony forming unit (CFU) is equivalent to one bacterium. Mycoplasma spp. 3.7 Each genome detected represents one Facultative Anaerobes cell. or one CFU. Results are expressed in scientific notation. so an 1.8 78 organism reported as 2.5 E+007 Lactobacillus spp. 3.8 - 1.2 CFU/gram is read as 25 milion colony 2.3 76 forming units per gram of feces. Bifidobacter spp. 7.1 I I - 1.8 I 1.7 7.7 Escherichia coli (E. coli) 5.4 Opportunistic Bacteria Expected Value No clinically significant amounts. Opportunistic Bacteria may cause symptoms and be associated with disease. They can affect digestion and absorption. nutrient production. pH and immune state. Antibiotic sensitivity tests will be performed on all opportunistic bacteria found. although clinical history is usually considered to determine treatment since the organisms we not generally considered to be pathogens. Gastronintesinel Effects Interpretation Interpretive Guides are downloadable at: www.qdx.net/lests/interpretive-guides Georgia Lab Lie code #067 4007 Laboratory Director: Robert h1. David. PhD CLIA IDa 1100255349 Testfig Performed by Genova Diagnostics. Inc. 3425 corporate Way. Daub% GA 30096 New York Clinical Lab PFI a4578 Floods Clinical Lab Lie a800008124 Page 2 EFTA00621680  Ordering Physician: Date of Report: 01/17/2014 A1312310035 G ENOVA DIAGNOSTICS' Thomas Rofrano. DC Comment: Reprinted: Jeffrey Epstein www.gdx.net • 800.522.4762 2200 GI Effects Comprehensive Profile Methodology: DNA Analys,s. GC/MS. Microscopic, Colonmetric. Automated Chemistry. EIA Yeast/Fungi Expected Value No clinically significant amounts. Yeast/Fungi Yeast overgrowth has been linked to many chronic conditions. in part because of antigenic responses in some patients to even low rates of yeast growth. Potential symptoms include diarrhea. headache. bloating. atopic dermatitis and fatigue. Positives are reported as +1. +2. +3 or +4 indicating >100. >1000. >10000 or >100000 pg DNA/g. Parasitology Microscopic Exam Results:* Parasitology Parasite Recovery Literature Dientamoeba fragilis: Few Trophozoites suggests that >90% of enteric parasitic infections are detected in a sample from a single stool collection. Increased sensitivity results from the collection of additional specimens on separate days. Parasites have been detected n 20-24% of U.S. patients with mild to moderate GI symptoms. Parasitology EIA Tests: In Range Out of Range Cryptosporidium ( Negative ) Giardia lamblia ( Negative ) E. histolytica/dispar ( Negative ) ( ) Indicates testrig performed by Genova. Inc. 63 Zlicoa St.. Ashevile. NC 28801-1074 A. L. Peace-Brewer. PhD. D(ABMLI). Lab Director • CLIA LC. 03400655571 • Medicare Lic. 034-8475 Adiposity Index Expected Value Firmicutes % 54 <=80 % The Adiposity Index is derived by using DNA probes that detect multiple Bacteroidetes % 46 >= 20 % genera of the phyla Firmicutes and Bacteroidetes. Abnormalities of these phyla may be associated with increased caloric extraction from food. Georgia Lab Lie Code #067-007 Laboratory Director: Robert ht. David. PhD CLIA IDS 1030255349 Testog Performed by Genova Diagnostics. Inc. 3425 Corporate Way. Odell,. GA 30096 New York Clinical Lab PFI a4578 Florida Clinical Lab Lie N8O00O8124 Page 3 EFTA00621681  Ordering Physician: Date of Report: 01/1712014 A1312310035 G E N DIAGNOSTICS' OVA Thomas Rofrano, DC Comment: Reprinted: Jeffrey Epstein • 0114110 www.gdx.net • 800.522.4762 4141414b111 2200 GI Effects Comprehensive Profile Methodology DNA Analysis. GC/MS. Microscopic. Colonmetric. Automated Chemistry. EtA quintile Ranking 95% Roforence Results I 'm I 2nd I 3rd I 4th 5th I Range Beneficial SCFA 53 >- 35 mMig Beneficial SCFA Total SCFA 34 L Short chain fatty acids (SCFA) 5.2 are produced by bacterial fermentation n-Butyrate 3.4 L 3.9 mM/g of dietary polysaccharides and fiber. The product. N-butyrate. is taken up 52 71 and used to sustain the normal activity Acetate % 67 47-77 % of colonic epithieial cells. Butyrate has been shown to lower the risk of colitis 10 25 and colorectal cancer. A healthy n-Butyrate % 10 7-30 % balance of GI microbes depends on 13 25 production of SCFA by one specie to Propionate % 21 10-29 % allow the normal growth of another one al a complex cross-feeding network. 1.0 36 Valerate % 3.2 0A-4.6 % Inflammation 3.1 Inflammation Lactoforrin 0.5 c- 6.3 ucliml- Lactoforrin. an iron-binding glycoprotein. is released in IBD but not W0Cs Negative Negative-Rare in non-inflammatory IBS. High levels are found in Crohn's. UC or infection. Mucus Negative Negative WBC's we elevated M general inflammaticonnfection. Mucus is often visualized in acute GI inflammation. Immunology 20 144 Immunology Focal sigA 32 5 161 mgrdi High fecal slgA indicates immune system reactions to the presence of antigens from bacteria. yeast or other microbes. Low sigA can result from stress or malnutrition. Georgia Lab Lie Code /1067-007 Latotalmy Director: Rabat M. David. PhD CLIA IDS 1100255349 Testing Performed by Genova Diagnostics. Inc. 3425 Corporate Way. DLgulli. GA 30096 New York Clinical Lab PFI $4578 Florida Clinical Lab Lie #800008124 Page 4 EFTA00621682  Ordering Physician: Date of Report: 01/17/2014 A1312310036 G E NOVA DIAGNOSTICS' Thomas Rofrano, DC Comment: Repnnted: Jeffrey Epstein 41•••• www.gdx.net • 800.522.4762 --•-•4141411 2200 GI Effects Comprehensive Profile Methodology: DNA Analysis. GC/MS. Microscope. Colonmetsic. Automated Chemistry. EtA quintile Ranking 95% Reference Results I 1st I 2nd I 3rd I 4th 5th I Range Additional Tests 5.9 69 Additional Tests pl-I 6.6 I I I I • I 5.7 7.1 pH is influenced by numerous factors. but it is strongly related to the RBCs Negative Negative bacterial release of pH-bwerng organic acids and pH-raising ammonia. Color Brown Positive RBCs can signify GI tract bleeds-Q. Color (other than brown) abnormalities can be due to upper GI bleedng. or bile duct blockage. steatonhea or antibiotic use. Digestion 200 Digestion Elastase 1 236 I I l- > 100 uglg Pancreatic elastase 1 levels below 119 100 are strongly correlated with severe 74 <— 181 mgrdL pancreatic nsufficiency: levels of Triglycerides 100-200 identify moderate pancreatic 4.4 insufficiency. High triglycerkies signify Putrefactive SCFA 1.1 e 7.4 Mid fat maldigestion. Putrefactive SCFA are a result of bacterial fermentation of Vegetable Fibers Rare None-Few undigested protein. High numbers of vegetable fibers indicate maldigestion. Absorption 91 Absorption LCFAs 6.8 <- 15.1 mmot'L High LCFA indicates fat 129 malabsorption due to pancreatic or biliary Total Fat 9.1 <- 18.9 mmotfL insufficiency. or acute bacterial infection that produces intestinal cell destruction. 142 High total fat usually signals Cholesterol <56 <- 191 mg/dL malabsorption. as does elevated fecal cholesterol. *UC = Unable to Calculate REJ' = 'Unable to perform: sample was rejected. Decisions evolving diagnosis and treatment are the responsibility of the clinician. Georgia Lab Lic. Code 4067-007 Lab:watery Director: Robert M. David. PhD WA ID, 1100255349 Testing Performed by Genova Diagnostics. Inc. 3425 Commie way. Caulk GA 30096 New York Clirical Lab PFI 44578 Florida Clinical Lab Lie. M800005124 Page 5 EFTA00621683  IIIIIIIglllllllll Accession g: Order ft: A1312310035 G8310455 Date Colected: Date Received: 12/30:2013 12/31/2013 GENOVA DIAGNOSTICS' Reference g: Patient: Jeffrey Epstein Date of Report: 01/07/2014 nen 01120/1953 www.gdx.net• 800.522.4762 Date of Birth: Telephone: 5616275816 Age: 60 Fax: 5616275895 Ordering Physician: Sex: Male The Natural Medicine Clinic Reprinted: Thomas Rofrano, DC Comment: 2401 PGA Blvd Ste 132 Palm Beach Gardens. FL 33410 • 414141 GI . GI Effects X Stool Profiles ?mai pending ZOOS • 2130 Campylobacter EIA Methodology: EIA Results Expected Value 1. Campylobacter spp. Negative Negative Campylobacter Campylobacterjejuni is the most frequent cause of bacterial-Sidi:Ed diarrhea. While transmission can occur via the fecal-oral mute. infection is primarily associated with the ingestion of contaminated and poorly cooked foods of animal origin. notably. red meat and milk. Decisions evolving diagnosis and treatment are the responsibility of the clinician. Georgia Lab Lie. Code 4067-007 Laboratory Director. Robed U. David. PhD CLIP ICC 1100255349 Testing Performed by Genova Diagnosbes. Inc. 3425 Corporate Way. Duluth. GA 30096 New York Clinical Lab PFI 44578 Florida Clinical Lab Lie M800005124 Page 1 EFTA00621684  Accession A: A1312310035 Date Colected: 12/30:2013 Order A: 68310455 Date Received: 12/31/2013 GENOVA DIAGNOSTICS' Reference if: Patient: Jeffrey Epstein Date of Report: 01/17/2014 earn Date 01Birth: 01/20/1953 Telephone: 5616275816 www.gdx.net• 800.522.4762 Age: 60 Fax: 5616275895 Ordering Physician: Sex: Mate The Natural Medicine Clinic Reprinted: Thomas Rofrano, DC Comment: 2401 PGA Blvd Ste 132 Palm Beach Gardens, FL 33410 411•4141 GI Effects ./x Stool Profiles S paten. v.•mnr 200S 2131 Clostridium difficile EIA Methodology: EIA Results Expectod Value 1. Clostridium difficile Negative Negalivet Clostridium difficile Clostridium difficale is an anaerobic, spore-forming gram-positive bacterium which can be part of the normal intestinal flora. Disrupbon of the normal gut flora via antibiotic use (especially those with broad spectrum activity) may result n overgrowth of Clostridium difficile. Symptoms may range in severity from mild diarrhea to fife-threateni-ig colitis. tIndicates testing performed by Genova. Inc. 63 Zillicoa St.. Asheville. NC 28801-1074 A. L. Peace-Brewer. PhD. D(ABMLI). Lab Director' CLIA Lic. #34D0655571 Medicare Lic. 834-8475 Decisions evolving diagnosis and treatment are the responsibility of the clinician. Georgia Lab Lie. Code /1067-007 Laboratory Director. Robed M. David. PhD CLIA IDa 1100255349 Tesbng Performed by Genova Diagnostics. Inc. 3425 Corporate Way. Duluth. GA 30096 New Vont Clinical Lab PFI S4578 Florida Clinical Lab Lic M00008124 Page 1 EFTA00621685  Accession 4: A1312310035 Date Colected: 12/30:2013 Order N: G8310455 Date Received: 12/31)2013 GENOVA DIAGNOSTICS' Reference 5: Patient: Jeffrey Epstein Date of Report: 01/17)2014 -*NH www.gdx.net• 800.522.4762 Date of Birth: 01120/1953 Telephone: 5616275816 Age: 60 Fax: 5616275895 Ordering Physician: Sex: Male The Natural Medicine Clinic Reprinted: Thomas Rofrano, DC Comment: 2401 PGA Blvd Ste 132 Palm Beach Gardens, FL 33410 . GI Effects GIsix Stool Profiles'steal palling Me 2132 Shiga toxin E. coli EIA Methodology: EM Results Expected Value 1. Shiga toxin E. cell Negalivet Negative Shiga toxin E. cell Shiga toxin-producing Escherichia coil (STEC) is a group of bacterial strains that have been identified as worldwide causes of serious human gastrointestinal disease. The subgroup enterohemorrhagic E. coli includes over 100 different stereotypes. with 0157:H7 being the most significant. as it occurs in over 80% of cases. The pathogen is transmitted primarily by food. in particular dairy and beef cattle. tlndicates testing performed by Genova. Inc. 63 Zillicoa St.. Asheville. NC 28801-1074 A. L. Peace-Brewer. PhD. D(ABMLI). Lab Director' CLIA Lic. 03400655571 Medicare Lic. 534-8475 Decisions iwolving diagnosis and treatment are the responsibility of the clinician. Georgia Lab Lie. Code /1067-007 Laboratory Director. Robed M. David. PhD CLIA IDE 1100255348 Tesbng Performed by Genova Dragnosbes. Inc. 3425 Corporate Way. Duluth. GA 30096 New York Clinical Lab PFI p4578 Florida Clinical Lab Lin N800008124 Page 1 EFTA00621686  II II EMINIIIINIM Accession #: Order #: A1312310035 G8310455 Date Collected: Date Received: 12/30/2013 12/31/2013 G ENOVA DIAGNOSTICS Reference #: Patient: Jeffrey Epstein Date of Report: 01/0872014 ••••• www.gdx.net • 800.522.4762 Date of Birth: 01/20/1953 Telephone: 5616275816 Age: 60 Fax: 5616275895 Ordering Physician: Sex: Male The Natural Medicine Clinic Reprinted: Thomas Rofrano, DC Comment: 2401 PGA Blvd Ste 132 Palm Beach Gardens, FL 33410 • GT • GI Effects t/A4 Stool Profiles 2133 Helicobacter pylon Stool Antigen EIA (HpSA) Methodaiogy EIA Results Expected Value 1. HpSA - H. pylon Negative Negative HpSA (Helicobacter pylori stool antigen) Helicobacter pylori is a bacterium which causes peptic ulcer disease and plays a role in the develo