Joseph Varon - Profile on Academia.edu (original) (raw)

Papers by Joseph Varon

Cureus

Humans maintain core body temperature via a complicated system of physiologic mechanisms that cou... more Humans maintain core body temperature via a complicated system of physiologic mechanisms that counteract heat/cold fluctuations from metabolism, exertion, and the environment. Overextension of these mechanisms or disruption of body temperature homeostasis leads to bodily dysfunction, culminating in a syndrome analogous to exertional heat stroke (EHS). The inability of this thermoregulatory process to maintain the body temperature is caused by either thermal stress or certain drugs. EHS is a syndrome characterized by hyperthermia and the activation of systemic inflammation. Several drug-induced hyperthermic syndromes may resemble EHS and share common mechanisms. The purpose of this article is to review the current literature and compare exertional heat stroke (EHS) to three of the most widely studied drug-induced hyperthermic syndromes: malignant hyperthermia (MH), neuroleptic malignant syndrome (NMS), and serotonin syndrome (SS). Drugs and drug classes that have been implicated in these conditions include amphetamines, diuretics, cocaine, antipsychotics, metoclopramide, selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and many more. Observations suggest that severe or fulminant cases of drug-induced hyperthermia may evolve into an inflammatory syndrome best described as heat stroke. Their underlying mechanisms, symptoms, and treatment approaches will be reviewed to assist in accurate diagnosis, which will impact the management of potentially life-threatening complications.

The objective of this study was to determine the prognostic significance and clinical impact of a... more The objective of this study was to determine the prognostic significance and clinical impact of acute elevation of cardiac troponin I (cTNI) after subarachnoid hemorrhage (SAH); examining in-hospital complications and follow-up assessment as variables.

Handbook of Critical and Intensive Care Medicine, 2021

Trauma is the leading cause of death in persons under age 35 and accounts for 10% of all deaths. ... more Trauma is the leading cause of death in persons under age 35 and accounts for 10% of all deaths. All trauma patients require systemic approach to minimize outcomes. About 140,000 traumatic deaths occur annually. Sepsis, hemorrhage, adult respiratory distress syndrome, and multiple organ system failure are the leading causes of death in trauma patients who survive the initial resuscitation and surgical repair of their injuries. Trauma accounts for approximately 30% of all intensive care unit admissions.

Handbook of Critical and Intensive Care Medicine, 2021

Weaning from mechanical ventilation is defi ned as the transition from the ventilatory dependence... more Weaning from mechanical ventilation is defi ned as the transition from the ventilatory dependence of the patient to a spontaneous breathing status. Recognizing when a patient is ready to be weaned from mechanical ventilation is greatly infl uences the outcome, and may prevent compromising a patient. Weaning indices were developed to help the physician predict the outcome of weaning trials, a common concern in the intensive care unit (ICU) setting. Many physiological mechanisms explain the

Chest, 2020

Sleep disturbances in COPD tend to be underdiagnosed. Patients hospitalized with COPD exacerbatio... more Sleep disturbances in COPD tend to be underdiagnosed. Patients hospitalized with COPD exacerbations may have a high burden of sleep and mental health comorbidity. The purpose of this study was to examine prevalence and characterize the nature and severity of sleep disturbances and depression in patients hospitalized with an acute COPD exacerbation METHODS: Setting was a community hospital. Inclusion criteria were all patients admitted, and being treated for a diagnosis of acute COPD exacerbation. Patients were administered questionnaires on the day of discharge. Instruments used included the Becks Depression Inventory (BDI), the Functional Outcomes of Sleep Questionnaire (FOSQ), The Epworth sleepiness scale (ESS) and the Pittsburgh Sleep quality Index (PSQI). RESULTS: A total of 53 patients, 28M, 25F were included. Mean age was 65 þ/-14 years. An abnormal FOSQ was seen in 64.2%.of the patients. PSQI showed 50.9% of patients had a subjective sleep quality assessment rated "fairly bad" or "very bad". 74.5% had abnormal sleep latency; of which 25.4% were severely abnormal. Sleep duration was actually well preservedonly 15.6% had an estimated sleep duration below 5 hours. Routine use of sedative hypnotics >3/week was seen in 31% of patients. Sleep disturbance on PSQI was described as moderate in 57% but severe only in 3.9% of the patients. Based on ESS of >10, 39.6% of patients had excess daytime sleepiness.Based on BDI scale, 58.5% of the patients had clinical depression; as many as 33.9% of the patients had moderate to severe depression CONCLUSIONS: Patients hospitalized with acute exacerbation of COPD have a significant burden of sleep and mental health morbidity. There is significantly high prevalence of abnormal sleep quality, prolonged sleep latency and sedative hypnotic use. This group also shows excess daytime sleepiness, as well as a clinically significant comorbid depression with a third of the group showing moderate to severe depression. CLINICAL IMPLICATIONS: Specific interventions to improve sleep and mental health of patients may improve functional outcomes and overall quality of life in patients being discharged after a hospitalization with COPD exacerbation.

Status epilepticus (SE) is the state of continuous seizures, whether they are convulsive or non-c... more Status epilepticus (SE) is the state of continuous seizures, whether they are convulsive or non-convulsive, lasting longer than 5 minutes without return to the neurologic baseline between seizures. This neurologic emergency accounts for 20% of emergency department (ED) admissions and requires the clinician's expeditious recognition and prompt management in order to prevent irreversible neurological damage and further complications related to the prolonged hospital stay. This paper reviews the most recent and up-to-date information aimed at caring for these critically ill patients.

Expert Opinion on Investigational Drugs, 2021

The American Journal of Emergency Medicine, 2020

Background. The spread of COVID-19 from Wuhan in China throughout the world has been alarmingly r... more Background. The spread of COVID-19 from Wuhan in China throughout the world has been alarmingly rapid. Epidemiologic techniques succeeded in containing the disease in China, but efforts were not as successful in the rest of the world, particularly the United States where there have been 1,592, 599 cases with 95,863 deaths as of May 25, 2020. Projections are for continued new infections and deaths if no effective treatments can be activated over the next six months. We performed a systematic review to determine the potential time course for development of treatments and vaccines focusing on availability in the last half of 2020. Methods. Our search was performed during the week of May 25, 2020. Publications: We reviewed up to date information from several sources to identify potential treatments for COVID-19: We used the Reagan-Udall Expanded Access Navigator COVID-19 Treatment Hub to track the efforts of companies to develop treatments. We then used the results to search for publica...

Case Reports in Infectious Diseases, 2018

We present the case of a 55-year-old gentleman, with bilateral pulmonary embolism and a large per... more We present the case of a 55-year-old gentleman, with bilateral pulmonary embolism and a large pericardial effusion that lead to a pericardial window with evacuation of creamy pus. Gram stains were negative, with culture growing Capnocytophaga. Pathology revealed acute necrotizing and exudative changes, including frank abscess formation. In developed countries, pericardial abscess and acute pericarditis are uncommon due to availability of broad-spectrum antibiotics. Pericardial abscess due to Capnocytophaga is even more uncommon.

Rhabdomyolysis ranges from an asymptomatic illness with elevation in the creatine kinase level to... more Rhabdomyolysis ranges from an asymptomatic illness with elevation in the creatine kinase level to a life-threatening condition associated with extreme elevations in creatine kinase, electrolyte imbalances, acute renal failure and disseminated intravascular coagulation. Muscular trauma is the most common cause of rhabdomyolysis. Less common causes include muscle enzyme deficiencies, electrolyte abnormalities, infectious causes, drugs, toxins and endocrinopathies. Weakness, myalgia and tea-colored urine are the main clinical manifestations. The most sensitive laboratory finding of muscle injury is an elevated plasma creatine kinase level. The management of patients with rhabdomyolysis includes early vigorous hydration.

Cureus, May 5, 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.

Case reports in critical care, 2016

The most common cause of a pneumoperitoneum is a perforation of a hollow viscus and the treatment... more The most common cause of a pneumoperitoneum is a perforation of a hollow viscus and the treatment is an exploratory laparotomy; nevertheless, not all pneumoperitoneums are due to a perforation and not all of them need surgical intervention. We hereby present a case of pneumoperitoneum due to a diaphragmatic defect, which allowed air from a pneumothorax to escape through the diaphragmatic hernia into the abdominal cavity.

Case reports in pulmonology, 2017

Congenital lobar emphysema is an uncommon bronchopulmonary malformation characterized by lobar ov... more Congenital lobar emphysema is an uncommon bronchopulmonary malformation characterized by lobar overinflation and accompanying alveolar septum damage that leads to compression atelectasis of the lung parenchyma and displacement of mediastinal structures, with the resultant ventilation-perfusion mismatch. We present a case of a 33-year-old lady with progressive exertional dyspnea. Chest radiograph findings lead to the suspicion of congenital lobar emphysema, which was then confirmed by a computed tomography (CT) scan. This condition is most commonly identified in newborns, with very few cases being reported in adults. Lobectomy remains the treatment of choice and in general has good outcome.

Respiratory Rate-oxygenation Index Score in Corona Virus Disease 2019 (COVID-19) Patients Undergoing Non-invasive Mechanical Ventilation or High Flow Oxygen Supplementation

World nutrition journal, Oct 31, 2022

it's expected to continue as a common treatment option for these patients. A variety of postopera... more it's expected to continue as a common treatment option for these patients. A variety of postoperative complications have been described, including iatrogenic splenectomy, wound infection, incisional hernia, early and distal bowel obstruction, anastomotic leaks, pulmonary embolism, postoperative respiratory failure and pneumonia. Sudden cardiac death is a dreaded complication in the immediate postoperative period. Death from any cause is reported to be 0.3% for laparoscopic bariatric procedure within the first 30 days, and it rises to 2.1% when performed via laparotomy. Careful consideration of all this variables is key when management patients with extreme obesity in the ICU.

Infectious Diseases

Springer eBooks, 2021

Oxygenation Index, Adjusted Oxygenation Index and Saturation Index in Coronavirus Disease 2019 (COVID-19) Patients

Cureus, Feb 12, 2023

The SARS-CoV-2 virus, which causes Coronavirus-19 infection , frequently elicits the development ... more The SARS-CoV-2 virus, which causes Coronavirus-19 infection , frequently elicits the development of depressed immunity, therefore, opportunistic infections. Opportunistic organisms are commonly present in the human body without causing critical illness. However, they can also lead to pathologic illness when a person is immunocompromised. Aspergillosis is among the many opportunistic infections. Even though this infection primarily involves the respiratory system and is less likely to be found in the gastrointestinal tract, we report a case of a COVID-19 individual that developed massive gastrointestinal bleeding whose condition deteriorated, and the pathological examination revealed gastric aspergillosis. Although not common, gastric aspergillosis should be considered while treating patients with COVID-19 who present gastrointestinal symptoms.

Cureus

Humans maintain core body temperature via a complicated system of physiologic mechanisms that cou... more Humans maintain core body temperature via a complicated system of physiologic mechanisms that counteract heat/cold fluctuations from metabolism, exertion, and the environment. Overextension of these mechanisms or disruption of body temperature homeostasis leads to bodily dysfunction, culminating in a syndrome analogous to exertional heat stroke (EHS). The inability of this thermoregulatory process to maintain the body temperature is caused by either thermal stress or certain drugs. EHS is a syndrome characterized by hyperthermia and the activation of systemic inflammation. Several drug-induced hyperthermic syndromes may resemble EHS and share common mechanisms. The purpose of this article is to review the current literature and compare exertional heat stroke (EHS) to three of the most widely studied drug-induced hyperthermic syndromes: malignant hyperthermia (MH), neuroleptic malignant syndrome (NMS), and serotonin syndrome (SS). Drugs and drug classes that have been implicated in these conditions include amphetamines, diuretics, cocaine, antipsychotics, metoclopramide, selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and many more. Observations suggest that severe or fulminant cases of drug-induced hyperthermia may evolve into an inflammatory syndrome best described as heat stroke. Their underlying mechanisms, symptoms, and treatment approaches will be reviewed to assist in accurate diagnosis, which will impact the management of potentially life-threatening complications.

The objective of this study was to determine the prognostic significance and clinical impact of a... more The objective of this study was to determine the prognostic significance and clinical impact of acute elevation of cardiac troponin I (cTNI) after subarachnoid hemorrhage (SAH); examining in-hospital complications and follow-up assessment as variables.

Handbook of Critical and Intensive Care Medicine, 2021

Trauma is the leading cause of death in persons under age 35 and accounts for 10% of all deaths. ... more Trauma is the leading cause of death in persons under age 35 and accounts for 10% of all deaths. All trauma patients require systemic approach to minimize outcomes. About 140,000 traumatic deaths occur annually. Sepsis, hemorrhage, adult respiratory distress syndrome, and multiple organ system failure are the leading causes of death in trauma patients who survive the initial resuscitation and surgical repair of their injuries. Trauma accounts for approximately 30% of all intensive care unit admissions.

Handbook of Critical and Intensive Care Medicine, 2021

Weaning from mechanical ventilation is defi ned as the transition from the ventilatory dependence... more Weaning from mechanical ventilation is defi ned as the transition from the ventilatory dependence of the patient to a spontaneous breathing status. Recognizing when a patient is ready to be weaned from mechanical ventilation is greatly infl uences the outcome, and may prevent compromising a patient. Weaning indices were developed to help the physician predict the outcome of weaning trials, a common concern in the intensive care unit (ICU) setting. Many physiological mechanisms explain the

Chest, 2020

Sleep disturbances in COPD tend to be underdiagnosed. Patients hospitalized with COPD exacerbatio... more Sleep disturbances in COPD tend to be underdiagnosed. Patients hospitalized with COPD exacerbations may have a high burden of sleep and mental health comorbidity. The purpose of this study was to examine prevalence and characterize the nature and severity of sleep disturbances and depression in patients hospitalized with an acute COPD exacerbation METHODS: Setting was a community hospital. Inclusion criteria were all patients admitted, and being treated for a diagnosis of acute COPD exacerbation. Patients were administered questionnaires on the day of discharge. Instruments used included the Becks Depression Inventory (BDI), the Functional Outcomes of Sleep Questionnaire (FOSQ), The Epworth sleepiness scale (ESS) and the Pittsburgh Sleep quality Index (PSQI). RESULTS: A total of 53 patients, 28M, 25F were included. Mean age was 65 þ/-14 years. An abnormal FOSQ was seen in 64.2%.of the patients. PSQI showed 50.9% of patients had a subjective sleep quality assessment rated "fairly bad" or "very bad". 74.5% had abnormal sleep latency; of which 25.4% were severely abnormal. Sleep duration was actually well preservedonly 15.6% had an estimated sleep duration below 5 hours. Routine use of sedative hypnotics >3/week was seen in 31% of patients. Sleep disturbance on PSQI was described as moderate in 57% but severe only in 3.9% of the patients. Based on ESS of >10, 39.6% of patients had excess daytime sleepiness.Based on BDI scale, 58.5% of the patients had clinical depression; as many as 33.9% of the patients had moderate to severe depression CONCLUSIONS: Patients hospitalized with acute exacerbation of COPD have a significant burden of sleep and mental health morbidity. There is significantly high prevalence of abnormal sleep quality, prolonged sleep latency and sedative hypnotic use. This group also shows excess daytime sleepiness, as well as a clinically significant comorbid depression with a third of the group showing moderate to severe depression. CLINICAL IMPLICATIONS: Specific interventions to improve sleep and mental health of patients may improve functional outcomes and overall quality of life in patients being discharged after a hospitalization with COPD exacerbation.

Status epilepticus (SE) is the state of continuous seizures, whether they are convulsive or non-c... more Status epilepticus (SE) is the state of continuous seizures, whether they are convulsive or non-convulsive, lasting longer than 5 minutes without return to the neurologic baseline between seizures. This neurologic emergency accounts for 20% of emergency department (ED) admissions and requires the clinician's expeditious recognition and prompt management in order to prevent irreversible neurological damage and further complications related to the prolonged hospital stay. This paper reviews the most recent and up-to-date information aimed at caring for these critically ill patients.

Expert Opinion on Investigational Drugs, 2021

The American Journal of Emergency Medicine, 2020

Background. The spread of COVID-19 from Wuhan in China throughout the world has been alarmingly r... more Background. The spread of COVID-19 from Wuhan in China throughout the world has been alarmingly rapid. Epidemiologic techniques succeeded in containing the disease in China, but efforts were not as successful in the rest of the world, particularly the United States where there have been 1,592, 599 cases with 95,863 deaths as of May 25, 2020. Projections are for continued new infections and deaths if no effective treatments can be activated over the next six months. We performed a systematic review to determine the potential time course for development of treatments and vaccines focusing on availability in the last half of 2020. Methods. Our search was performed during the week of May 25, 2020. Publications: We reviewed up to date information from several sources to identify potential treatments for COVID-19: We used the Reagan-Udall Expanded Access Navigator COVID-19 Treatment Hub to track the efforts of companies to develop treatments. We then used the results to search for publica...

Case Reports in Infectious Diseases, 2018

We present the case of a 55-year-old gentleman, with bilateral pulmonary embolism and a large per... more We present the case of a 55-year-old gentleman, with bilateral pulmonary embolism and a large pericardial effusion that lead to a pericardial window with evacuation of creamy pus. Gram stains were negative, with culture growing Capnocytophaga. Pathology revealed acute necrotizing and exudative changes, including frank abscess formation. In developed countries, pericardial abscess and acute pericarditis are uncommon due to availability of broad-spectrum antibiotics. Pericardial abscess due to Capnocytophaga is even more uncommon.

Rhabdomyolysis ranges from an asymptomatic illness with elevation in the creatine kinase level to... more Rhabdomyolysis ranges from an asymptomatic illness with elevation in the creatine kinase level to a life-threatening condition associated with extreme elevations in creatine kinase, electrolyte imbalances, acute renal failure and disseminated intravascular coagulation. Muscular trauma is the most common cause of rhabdomyolysis. Less common causes include muscle enzyme deficiencies, electrolyte abnormalities, infectious causes, drugs, toxins and endocrinopathies. Weakness, myalgia and tea-colored urine are the main clinical manifestations. The most sensitive laboratory finding of muscle injury is an elevated plasma creatine kinase level. The management of patients with rhabdomyolysis includes early vigorous hydration.

Cureus, May 5, 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.

Case reports in critical care, 2016

The most common cause of a pneumoperitoneum is a perforation of a hollow viscus and the treatment... more The most common cause of a pneumoperitoneum is a perforation of a hollow viscus and the treatment is an exploratory laparotomy; nevertheless, not all pneumoperitoneums are due to a perforation and not all of them need surgical intervention. We hereby present a case of pneumoperitoneum due to a diaphragmatic defect, which allowed air from a pneumothorax to escape through the diaphragmatic hernia into the abdominal cavity.

Case reports in pulmonology, 2017

Congenital lobar emphysema is an uncommon bronchopulmonary malformation characterized by lobar ov... more Congenital lobar emphysema is an uncommon bronchopulmonary malformation characterized by lobar overinflation and accompanying alveolar septum damage that leads to compression atelectasis of the lung parenchyma and displacement of mediastinal structures, with the resultant ventilation-perfusion mismatch. We present a case of a 33-year-old lady with progressive exertional dyspnea. Chest radiograph findings lead to the suspicion of congenital lobar emphysema, which was then confirmed by a computed tomography (CT) scan. This condition is most commonly identified in newborns, with very few cases being reported in adults. Lobectomy remains the treatment of choice and in general has good outcome.

Respiratory Rate-oxygenation Index Score in Corona Virus Disease 2019 (COVID-19) Patients Undergoing Non-invasive Mechanical Ventilation or High Flow Oxygen Supplementation

World nutrition journal, Oct 31, 2022

it's expected to continue as a common treatment option for these patients. A variety of postopera... more it's expected to continue as a common treatment option for these patients. A variety of postoperative complications have been described, including iatrogenic splenectomy, wound infection, incisional hernia, early and distal bowel obstruction, anastomotic leaks, pulmonary embolism, postoperative respiratory failure and pneumonia. Sudden cardiac death is a dreaded complication in the immediate postoperative period. Death from any cause is reported to be 0.3% for laparoscopic bariatric procedure within the first 30 days, and it rises to 2.1% when performed via laparotomy. Careful consideration of all this variables is key when management patients with extreme obesity in the ICU.

Infectious Diseases

Springer eBooks, 2021

Oxygenation Index, Adjusted Oxygenation Index and Saturation Index in Coronavirus Disease 2019 (COVID-19) Patients

Cureus, Feb 12, 2023

The SARS-CoV-2 virus, which causes Coronavirus-19 infection , frequently elicits the development ... more The SARS-CoV-2 virus, which causes Coronavirus-19 infection , frequently elicits the development of depressed immunity, therefore, opportunistic infections. Opportunistic organisms are commonly present in the human body without causing critical illness. However, they can also lead to pathologic illness when a person is immunocompromised. Aspergillosis is among the many opportunistic infections. Even though this infection primarily involves the respiratory system and is less likely to be found in the gastrointestinal tract, we report a case of a COVID-19 individual that developed massive gastrointestinal bleeding whose condition deteriorated, and the pathological examination revealed gastric aspergillosis. Although not common, gastric aspergillosis should be considered while treating patients with COVID-19 who present gastrointestinal symptoms.