Joseph Varon - Academia.edu (original) (raw)
Papers by Joseph Varon
Journal of Intensive Care
Background The relationship between computed tomography (CT) and prognosis of patients with COVID... more Background The relationship between computed tomography (CT) and prognosis of patients with COVID-19 pneumonia remains unclear. We hypothesized that the Ichikado CT score, obtained in the first 24 h of hospital admission, is an independent predictor for all-cause mortality during hospitalization in patients with COVID-19 pneumonia. Methods Single-center retrospective cohort study of patients with confirmed COVID-19 pneumonia admitted at our institution between March 20th, 2020 and October 31st, 2020. Patients were enrolled if, within 24 h of admission, a chest CT scan, an arterial blood gas, a complete blood count, and a basic metabolic panel were performed. Two independent radiologists, who were blinded to clinical data, retrospectively evaluated the chest CT scans following a previously described qualitative and quantitative CT scoring system. The primary outcome was all-cause in-hospital mortality or survival to hospital discharge. Secondary outcomes were new requirements for inv...
The year 2004 shook the world with earth-quakes, hurricanes and Tsunamis in a way we would never ... more The year 2004 shook the world with earth-quakes, hurricanes and Tsunamis in a way we would never imagine. Thousands of people died, were in-jured, missing or became homeless. Government agencies, health-care associations and citizens in general take part in planning for emergency pre-paredness and action when a natural disaster strikes a geographical area in such a devastating way. In-ternational humanitarian associations also partici-pate in offering relief to the regions most critically affected. Hospitals and health-care organizations play an important role during these disaster and emergency situations. It is their duty to provide an efficient re-sponse in mass-casualty situations during natural ca-tastrophes. For this reason, hospitals invest substan-tial efforts in developing disaster preparedness plans and training in coordination with public health sys-tems and government agencies. Natural disasters impact a population in vari-ous ways. The victims ’ environment may be sever...
Resuscitation from death is not an every day event; however, it is no longer a rarity. Cardiopulm... more Resuscitation from death is not an every day event; however, it is no longer a rarity. Cardiopulmonary resuscitation (CPR) has, therefore, become a common tool in our management of these critically ill patients. Despite an improved understanding and management of cardiac arrest, and the widespread application of do-not resuscitate (DNR) orders in an attempt to prevent the inappropriate use of CPR, the success rate following in-hospital cardiac arrest has remained unchanged over the last three decades, with return of spontaneous circulation (ROSC) in about 30 % with approximately 15 % of patients being discharged neurologically intact [1-5]. In this issue of Critical Care and Shock, Santos-Llanos and co-workers, in a retrospective one-year record
Posterior reversible encephalopathy syndrome (PRES) is a clinical-neuroradiological entity charac... more Posterior reversible encephalopathy syndrome (PRES) is a clinical-neuroradiological entity characterized by headache, vomiting, altered mental status, blurred vision and seizures as well as images suggesting whitegray matter edema involving in most cases posterior regions of the central nervous system, as demonstrated by magnetic resonance image. The development of PRES is most commonly associated with hypertensive encephalopathy, preeclampsia-eclampsia and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, and immunosuppressive/cytotoxic drugs. While usually reversible, the early recognition and treatment of this syndrome is important to prevent permanent neurological sequelae. The treatment is based in the management or withdrawal of the triggering factor. In this manuscript we will briefly review the pathogenesis, clinical scenario, diagnostic studies and management of PRES.
Life-threatening hyponatremia can occur when sodium concentration falls to 125 mmol/L or less. Sy... more Life-threatening hyponatremia can occur when sodium concentration falls to 125 mmol/L or less. Symptoms usually do not depend on the absolute sodium concentration but on the rate of fall. Estimates of mortality in acute hyponatremia are as high as 50%. Marathon runners are at particular risk of developing a syndrome which consists of severe hyponatremia, pulmonary edema and cerebral edema as originally described by Varon and Ayus. This syndrome, if not managed appropriately has a very high morbidity and mortality.
Current Respiratory Medicine Reviews
Cureus
A fecalith is a mass of an accumulation of hardened fecal matter that is seen in patients with Ch... more A fecalith is a mass of an accumulation of hardened fecal matter that is seen in patients with Chagas disease, Hirschsprung's disease, and inflammatory bowel disease. In this article, we report a case of a 53-year-old female with chronic abdominal pain who was admitted with progressive weight loss, near syncope episode, and serum potassium of 2.6 mg/dL. An abdominal computed tomography (CT) scan revealed a left lower quadrant complex mass measuring 10.3 cm, with asymmetrical wall thickening and inflammatory stranding, nondiscarding the compromise of the small bowel and consequent mild small bowel distention. A fecalith of 10.3 x 10.9 x 8.7 cm was found during an exploratory laparotomy in the small intestine. We report this rare case of distal jejunum fecalith accompanied by chronic pain.
El golpe de calor es una condicion comun que pone en riesgo la vida, donde el deterioro es rapido... more El golpe de calor es una condicion comun que pone en riesgo la vida, donde el deterioro es rapido, caracterizado por una elevacion de la temperatura corporal. Existen el llamado golpe de calor clasico y el golpe de calor asociado al ejercicio. Esto tradicionalmente ocurre en condiciones ambientales de temperatura elevada, sin embargo, se puede presentar en temperaturas bajas de 5 a 9°C. En EU se han contabilizado entre 17.6 y 26.5 casos por cada 100,000 habitantes, registrando aproximadamente 200 casos de muerte por ano. En Mexico, el incremento de las temperaturas en los ultimos anos, ha aumentado los casos sobretodo en Baja California, donde el sexo femenino tiene mayor predisposicion asi como las personas menores a los 19 anos. El diagnostico se sospecha cuando encontramos hipertermia mayor a 40.6 °C acompanada de disfuncion del sistema nervioso central, piel seca y caliente, sudoracion y fatiga extrema, diarrea, nausea y/o vomito, y en general presentan taquicardia e hiperventil...
Current Respiratory Medicine Reviews
Cureus, 2021
Novel coronavirus 2019 (COVID-19) has been one of the largest and most devastating global pandemi... more Novel coronavirus 2019 (COVID-19) has been one of the largest and most devastating global pandemics of our time. There have been several complications of this disease that have also proven to be debilitating and deadly. While primarily affecting the respiratory system, some cases presented with uncommon complications such as pneumopericardium and spontaneous pneumothorax. We present a case of an elderly female diagnosed with COVID-19 found to have both spontaneous pneumothorax and pneumopericardium. She had a complicated hospital course and ultimately succumbed to her illness. While the pathogenesis of these conditions is not yet fully understood, further studies are needed to help clinicians develop treatment and prevention strategies to improve patient outcomes.
Cureus, 2021
The aeromedical transport of critically ill patients has become an integral part of practicing me... more The aeromedical transport of critically ill patients has become an integral part of practicing medicine on a global scale. The development of reliable portable medical equipment allows physicians, emergency medical technicians, and nurses to transport wounded and diseased patients under constant critical care attention. Air transportation involves utilizing a fixed-wing (airplane) or rotor-wing (helicopter) aircraft to accomplish different types of transports ranging from scene responses to international transfers. The proper preparation and management of patients undergoing aeromedical transport require a basic understanding of the physiological changes and unique challenges encountered within the aircraft environment at 8,000 ft above sea level. The purpose of this paper is to review the literature and provide guidelines for approaching the aeromedical transportation of critically ill patients.
Life-threatening hyponatremia can occur when sodium concentration falls to 125 mmol/L or less. Sy... more Life-threatening hyponatremia can occur when sodium concentration falls to 125 mmol/L or less. Symptoms usually do not depend on the absolute sodium concentration but on the rate of fall. Estimates of mortality in acute hyponatremia are as high as 50%. Marathon runners are at particular risk of developing a syndrome which consists of severe hyponatremia, pulmonary edema and cerebral edema as originally described by Varon and Ayus. This syndrome, if not managed appropriately has a very high morbidity and mortality.
Several molecules, chemicals and cells are involved in tissue damage during any hypoxic event, su... more Several molecules, chemicals and cells are involved in tissue damage during any hypoxic event, such as a cardiac arrest, a respiratory arrest or a cerebrovascular accident. Among them: calcium, protein kinase enzymes, calcium binding proteins, S-100β protein and adhesion molecules such as intracellular adhesion molecule-1 (ICAM-1) are frequently cited in the literature. Controversy exists as to whether these “hypoxic aggressors” can be modified favorably by the use of therapeutic hypothermia. This review focus on the role of these different molecules, chemicals and cells and the protective effect of therapeutic hypothermia. Case Report
Email : Joseph.Varon@uth.tmc.edu The care of the critically ill patient in the pediatric intensiv... more Email : Joseph.Varon@uth.tmc.edu The care of the critically ill patient in the pediatric intensive care unit (PICU) has remained an important topic for those health care providers dealing with children. The purpose of this article is to introduce to the reader a summary of selected papers which we consider relevant to the care of the pediatric critically ill patient and that were published Review Article Crit Care & Shock (2007) 10 : 117-121
Health care costs represent a large percentage of the gross domestic product all over the world. ... more Health care costs represent a large percentage of the gross domestic product all over the world. According to the National Health Statistics Group, health care expenditure in the United States accounted for as much as 14% of the gross national product in 1992 and it is projected to reach 30% by 2030. The intensive care unit (ICU) represents the hallmark of highly competent modern hospitals, offering highly trained staff and life-saving technology and it is also one of the most expensive units in the hospital. Expenses related to running the ICU have been estimated at approximately 20% of total hospital costs, despite only representing 10% of all hospital beds. Assisted mechanical ventilation particularly affects the high costs in the ICU. Actually, a mere of 1 million persons per year receive mechanical ventilation during their stay in the ICU. A variety of different approaches to stabilize or reduce costs in the ICU have been suggested. Reducing the length of ICU stay, improving th...
A thirty year-old woman with history of end-stage renal disease was admitted to the hospital for ... more A thirty year-old woman with history of end-stage renal disease was admitted to the hospital for a vascular access intervention. Her intraoperative course was complicated by upper airway obstruction with a difficult intubation. During the intubation attempts she developed a cardiopulmonary arrest. Cardiopulmonary resuscitation and advanced life support was given for approximately 25 minutes until ROSC was obtained. Shortly thereafter she was taken to the intensive care unit, where her Glasgow coma score was 4T. A chest x-ray was obtained on arrival to the ICU (Figure 1, Panel A) and depicted pulmonary edema.
The use of therapeutic hypothermia (TH) in clinical medicine is no longer a rarity. Since the mod... more The use of therapeutic hypothermia (TH) in clinical medicine is no longer a rarity. Since the modern inception of this technique by Fay in the 1940s, TH has been used for a variety of clinical scenarios. (1,2) TH has gained significant popularity as a brain-protection strategy in victims of sudden cardiac death in whom return of spontaneous circulation (ROSC) has been obtained with coma. (3) Nonetheless, many trials and case series have shown the advantageous effects of lowering the body’s core temperature in a variety of other clinical conditions including near-drowning, hypoxemic brain injury, traumatic brain injury, traumatic cardiac arrest, stroke, newborn hypoxic-ischemic encephalopathy, hepatic encephalopathy, bacterial meningitis, congestive heart failure, postoperative neonatal tachycardia, and the acute respiratory distress syndrome. (2,3) However, despite the well documented evidence of its therapeutic value, and the ease of implementation, TH is not used as much as the au...
Approximately 72 million people in the US experience hypertension. Worldwide, hypertension may af... more Approximately 72 million people in the US experience hypertension. Worldwide, hypertension may affect as many as 1 billion people and be responsible for approximately 7.1 million deaths per year. It is estimated that approximately 1% of patients with hypertension will, at some point, develop a hypertensive crisis. Hypertensive crises are further defined as either hypertensive emergencies or urgencies, depending on the degree of blood pressure elevation and presence of end-organ damage. Immediate reduction in blood pressure is required only in patients with acute end-organ damage (i.e. hypertensive emergency) and requires treatment with a titratable, short-acting, intravenous antihypertensive agent, while severe hypertension without acute end-organ damage (i.e. hypertensive urgency) is usually treated with oral antihypertensive agents. The primary goal of intervention in a hypertensive crisis is to safely reduce blood pressure. The appropriate therapeutic approach of each patient wil...
Coronary artery disease remains a common problem in industrialized countries. Percutaneous corona... more Coronary artery disease remains a common problem in industrialized countries. Percutaneous coronary interventions are usually performed utilizing the femoral approach. Arterial puncture-closing devices have been developed in hope to avoid manual compression and shortening the period of rest. In a recent meta-analysis in the Journal of the American Medical Association these devices have shown only marginal benefits over manual compression. Further, well designed studies are necessary to document the comparative effects of these devices versus manual compression.
Ethambutol is a common component in the treatment of mycobacteria infections worldwide, and is ra... more Ethambutol is a common component in the treatment of mycobacteria infections worldwide, and is rarely associated with nephrotoxicity. We report a patient presenting with acute kidney injury due to ethambutol as well as its management and a comprehensive review of the pertinent literature. From Dorrington Medical Associates, PA, Universidad Autonoma de Baja California, Houston, Texas, USA (Stephanie Pablo), University General Hospital, Houston, Texas, USA (Joseph Gathe), and The University of Texas Health Science Center at Houston, The University of Texas Medical Branch at Galveston, University General Hospital, Houston, Texas, USA (Joseph
Journal of Intensive Care
Background The relationship between computed tomography (CT) and prognosis of patients with COVID... more Background The relationship between computed tomography (CT) and prognosis of patients with COVID-19 pneumonia remains unclear. We hypothesized that the Ichikado CT score, obtained in the first 24 h of hospital admission, is an independent predictor for all-cause mortality during hospitalization in patients with COVID-19 pneumonia. Methods Single-center retrospective cohort study of patients with confirmed COVID-19 pneumonia admitted at our institution between March 20th, 2020 and October 31st, 2020. Patients were enrolled if, within 24 h of admission, a chest CT scan, an arterial blood gas, a complete blood count, and a basic metabolic panel were performed. Two independent radiologists, who were blinded to clinical data, retrospectively evaluated the chest CT scans following a previously described qualitative and quantitative CT scoring system. The primary outcome was all-cause in-hospital mortality or survival to hospital discharge. Secondary outcomes were new requirements for inv...
The year 2004 shook the world with earth-quakes, hurricanes and Tsunamis in a way we would never ... more The year 2004 shook the world with earth-quakes, hurricanes and Tsunamis in a way we would never imagine. Thousands of people died, were in-jured, missing or became homeless. Government agencies, health-care associations and citizens in general take part in planning for emergency pre-paredness and action when a natural disaster strikes a geographical area in such a devastating way. In-ternational humanitarian associations also partici-pate in offering relief to the regions most critically affected. Hospitals and health-care organizations play an important role during these disaster and emergency situations. It is their duty to provide an efficient re-sponse in mass-casualty situations during natural ca-tastrophes. For this reason, hospitals invest substan-tial efforts in developing disaster preparedness plans and training in coordination with public health sys-tems and government agencies. Natural disasters impact a population in vari-ous ways. The victims ’ environment may be sever...
Resuscitation from death is not an every day event; however, it is no longer a rarity. Cardiopulm... more Resuscitation from death is not an every day event; however, it is no longer a rarity. Cardiopulmonary resuscitation (CPR) has, therefore, become a common tool in our management of these critically ill patients. Despite an improved understanding and management of cardiac arrest, and the widespread application of do-not resuscitate (DNR) orders in an attempt to prevent the inappropriate use of CPR, the success rate following in-hospital cardiac arrest has remained unchanged over the last three decades, with return of spontaneous circulation (ROSC) in about 30 % with approximately 15 % of patients being discharged neurologically intact [1-5]. In this issue of Critical Care and Shock, Santos-Llanos and co-workers, in a retrospective one-year record
Posterior reversible encephalopathy syndrome (PRES) is a clinical-neuroradiological entity charac... more Posterior reversible encephalopathy syndrome (PRES) is a clinical-neuroradiological entity characterized by headache, vomiting, altered mental status, blurred vision and seizures as well as images suggesting whitegray matter edema involving in most cases posterior regions of the central nervous system, as demonstrated by magnetic resonance image. The development of PRES is most commonly associated with hypertensive encephalopathy, preeclampsia-eclampsia and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, and immunosuppressive/cytotoxic drugs. While usually reversible, the early recognition and treatment of this syndrome is important to prevent permanent neurological sequelae. The treatment is based in the management or withdrawal of the triggering factor. In this manuscript we will briefly review the pathogenesis, clinical scenario, diagnostic studies and management of PRES.
Life-threatening hyponatremia can occur when sodium concentration falls to 125 mmol/L or less. Sy... more Life-threatening hyponatremia can occur when sodium concentration falls to 125 mmol/L or less. Symptoms usually do not depend on the absolute sodium concentration but on the rate of fall. Estimates of mortality in acute hyponatremia are as high as 50%. Marathon runners are at particular risk of developing a syndrome which consists of severe hyponatremia, pulmonary edema and cerebral edema as originally described by Varon and Ayus. This syndrome, if not managed appropriately has a very high morbidity and mortality.
Current Respiratory Medicine Reviews
Cureus
A fecalith is a mass of an accumulation of hardened fecal matter that is seen in patients with Ch... more A fecalith is a mass of an accumulation of hardened fecal matter that is seen in patients with Chagas disease, Hirschsprung's disease, and inflammatory bowel disease. In this article, we report a case of a 53-year-old female with chronic abdominal pain who was admitted with progressive weight loss, near syncope episode, and serum potassium of 2.6 mg/dL. An abdominal computed tomography (CT) scan revealed a left lower quadrant complex mass measuring 10.3 cm, with asymmetrical wall thickening and inflammatory stranding, nondiscarding the compromise of the small bowel and consequent mild small bowel distention. A fecalith of 10.3 x 10.9 x 8.7 cm was found during an exploratory laparotomy in the small intestine. We report this rare case of distal jejunum fecalith accompanied by chronic pain.
El golpe de calor es una condicion comun que pone en riesgo la vida, donde el deterioro es rapido... more El golpe de calor es una condicion comun que pone en riesgo la vida, donde el deterioro es rapido, caracterizado por una elevacion de la temperatura corporal. Existen el llamado golpe de calor clasico y el golpe de calor asociado al ejercicio. Esto tradicionalmente ocurre en condiciones ambientales de temperatura elevada, sin embargo, se puede presentar en temperaturas bajas de 5 a 9°C. En EU se han contabilizado entre 17.6 y 26.5 casos por cada 100,000 habitantes, registrando aproximadamente 200 casos de muerte por ano. En Mexico, el incremento de las temperaturas en los ultimos anos, ha aumentado los casos sobretodo en Baja California, donde el sexo femenino tiene mayor predisposicion asi como las personas menores a los 19 anos. El diagnostico se sospecha cuando encontramos hipertermia mayor a 40.6 °C acompanada de disfuncion del sistema nervioso central, piel seca y caliente, sudoracion y fatiga extrema, diarrea, nausea y/o vomito, y en general presentan taquicardia e hiperventil...
Current Respiratory Medicine Reviews
Cureus, 2021
Novel coronavirus 2019 (COVID-19) has been one of the largest and most devastating global pandemi... more Novel coronavirus 2019 (COVID-19) has been one of the largest and most devastating global pandemics of our time. There have been several complications of this disease that have also proven to be debilitating and deadly. While primarily affecting the respiratory system, some cases presented with uncommon complications such as pneumopericardium and spontaneous pneumothorax. We present a case of an elderly female diagnosed with COVID-19 found to have both spontaneous pneumothorax and pneumopericardium. She had a complicated hospital course and ultimately succumbed to her illness. While the pathogenesis of these conditions is not yet fully understood, further studies are needed to help clinicians develop treatment and prevention strategies to improve patient outcomes.
Cureus, 2021
The aeromedical transport of critically ill patients has become an integral part of practicing me... more The aeromedical transport of critically ill patients has become an integral part of practicing medicine on a global scale. The development of reliable portable medical equipment allows physicians, emergency medical technicians, and nurses to transport wounded and diseased patients under constant critical care attention. Air transportation involves utilizing a fixed-wing (airplane) or rotor-wing (helicopter) aircraft to accomplish different types of transports ranging from scene responses to international transfers. The proper preparation and management of patients undergoing aeromedical transport require a basic understanding of the physiological changes and unique challenges encountered within the aircraft environment at 8,000 ft above sea level. The purpose of this paper is to review the literature and provide guidelines for approaching the aeromedical transportation of critically ill patients.
Life-threatening hyponatremia can occur when sodium concentration falls to 125 mmol/L or less. Sy... more Life-threatening hyponatremia can occur when sodium concentration falls to 125 mmol/L or less. Symptoms usually do not depend on the absolute sodium concentration but on the rate of fall. Estimates of mortality in acute hyponatremia are as high as 50%. Marathon runners are at particular risk of developing a syndrome which consists of severe hyponatremia, pulmonary edema and cerebral edema as originally described by Varon and Ayus. This syndrome, if not managed appropriately has a very high morbidity and mortality.
Several molecules, chemicals and cells are involved in tissue damage during any hypoxic event, su... more Several molecules, chemicals and cells are involved in tissue damage during any hypoxic event, such as a cardiac arrest, a respiratory arrest or a cerebrovascular accident. Among them: calcium, protein kinase enzymes, calcium binding proteins, S-100β protein and adhesion molecules such as intracellular adhesion molecule-1 (ICAM-1) are frequently cited in the literature. Controversy exists as to whether these “hypoxic aggressors” can be modified favorably by the use of therapeutic hypothermia. This review focus on the role of these different molecules, chemicals and cells and the protective effect of therapeutic hypothermia. Case Report
Email : Joseph.Varon@uth.tmc.edu The care of the critically ill patient in the pediatric intensiv... more Email : Joseph.Varon@uth.tmc.edu The care of the critically ill patient in the pediatric intensive care unit (PICU) has remained an important topic for those health care providers dealing with children. The purpose of this article is to introduce to the reader a summary of selected papers which we consider relevant to the care of the pediatric critically ill patient and that were published Review Article Crit Care & Shock (2007) 10 : 117-121
Health care costs represent a large percentage of the gross domestic product all over the world. ... more Health care costs represent a large percentage of the gross domestic product all over the world. According to the National Health Statistics Group, health care expenditure in the United States accounted for as much as 14% of the gross national product in 1992 and it is projected to reach 30% by 2030. The intensive care unit (ICU) represents the hallmark of highly competent modern hospitals, offering highly trained staff and life-saving technology and it is also one of the most expensive units in the hospital. Expenses related to running the ICU have been estimated at approximately 20% of total hospital costs, despite only representing 10% of all hospital beds. Assisted mechanical ventilation particularly affects the high costs in the ICU. Actually, a mere of 1 million persons per year receive mechanical ventilation during their stay in the ICU. A variety of different approaches to stabilize or reduce costs in the ICU have been suggested. Reducing the length of ICU stay, improving th...
A thirty year-old woman with history of end-stage renal disease was admitted to the hospital for ... more A thirty year-old woman with history of end-stage renal disease was admitted to the hospital for a vascular access intervention. Her intraoperative course was complicated by upper airway obstruction with a difficult intubation. During the intubation attempts she developed a cardiopulmonary arrest. Cardiopulmonary resuscitation and advanced life support was given for approximately 25 minutes until ROSC was obtained. Shortly thereafter she was taken to the intensive care unit, where her Glasgow coma score was 4T. A chest x-ray was obtained on arrival to the ICU (Figure 1, Panel A) and depicted pulmonary edema.
The use of therapeutic hypothermia (TH) in clinical medicine is no longer a rarity. Since the mod... more The use of therapeutic hypothermia (TH) in clinical medicine is no longer a rarity. Since the modern inception of this technique by Fay in the 1940s, TH has been used for a variety of clinical scenarios. (1,2) TH has gained significant popularity as a brain-protection strategy in victims of sudden cardiac death in whom return of spontaneous circulation (ROSC) has been obtained with coma. (3) Nonetheless, many trials and case series have shown the advantageous effects of lowering the body’s core temperature in a variety of other clinical conditions including near-drowning, hypoxemic brain injury, traumatic brain injury, traumatic cardiac arrest, stroke, newborn hypoxic-ischemic encephalopathy, hepatic encephalopathy, bacterial meningitis, congestive heart failure, postoperative neonatal tachycardia, and the acute respiratory distress syndrome. (2,3) However, despite the well documented evidence of its therapeutic value, and the ease of implementation, TH is not used as much as the au...
Approximately 72 million people in the US experience hypertension. Worldwide, hypertension may af... more Approximately 72 million people in the US experience hypertension. Worldwide, hypertension may affect as many as 1 billion people and be responsible for approximately 7.1 million deaths per year. It is estimated that approximately 1% of patients with hypertension will, at some point, develop a hypertensive crisis. Hypertensive crises are further defined as either hypertensive emergencies or urgencies, depending on the degree of blood pressure elevation and presence of end-organ damage. Immediate reduction in blood pressure is required only in patients with acute end-organ damage (i.e. hypertensive emergency) and requires treatment with a titratable, short-acting, intravenous antihypertensive agent, while severe hypertension without acute end-organ damage (i.e. hypertensive urgency) is usually treated with oral antihypertensive agents. The primary goal of intervention in a hypertensive crisis is to safely reduce blood pressure. The appropriate therapeutic approach of each patient wil...
Coronary artery disease remains a common problem in industrialized countries. Percutaneous corona... more Coronary artery disease remains a common problem in industrialized countries. Percutaneous coronary interventions are usually performed utilizing the femoral approach. Arterial puncture-closing devices have been developed in hope to avoid manual compression and shortening the period of rest. In a recent meta-analysis in the Journal of the American Medical Association these devices have shown only marginal benefits over manual compression. Further, well designed studies are necessary to document the comparative effects of these devices versus manual compression.
Ethambutol is a common component in the treatment of mycobacteria infections worldwide, and is ra... more Ethambutol is a common component in the treatment of mycobacteria infections worldwide, and is rarely associated with nephrotoxicity. We report a patient presenting with acute kidney injury due to ethambutol as well as its management and a comprehensive review of the pertinent literature. From Dorrington Medical Associates, PA, Universidad Autonoma de Baja California, Houston, Texas, USA (Stephanie Pablo), University General Hospital, Houston, Texas, USA (Joseph Gathe), and The University of Texas Health Science Center at Houston, The University of Texas Medical Branch at Galveston, University General Hospital, Houston, Texas, USA (Joseph