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| 1 | Management of critically ill patients with diabetes显示文摘Disorders of glucose homeostasis, such as stress-induced hypoglycemia and hyperglycemia, are common complications in patients in the intensive care unit. Patients with preexisting diabetes mellitus(DM) are more susceptible to hyperglycemia, as well as a higher risk from glucose overcorrection, that may results in severe hypoglycemia. In critically ill patients with DM, it is recommended to maintain a blood glucose range between 140-180 mg/d L. In neurological patients and surgical patients, tighter glycemic control(i.e., 110-140 mg/d) is recommended if hypoglycemia can be properly avoided. There is limited evidence that shows that critically ill diabetic patients with a glycosylated hemoglobin levels above 7% may benefit from looser glycemic control, in order to reduce the risk of hypoglycemia and significant glycemic variability. | Livier Josefina Silva-Perez Mario Alberto Benitez-Lopez Joseph Varon Salim Surani | 2017 | World Journal of Diabetes2017，8，3： | 10 |
| 2 | Pulmonary complications of hepatic diseases显示文摘Severe chronic liver disease(CLD) may result from portal hypertension, hepatocellular failure or the combination of both. Some of these patients may develop pulmonary complications independent from any pulmonary pathology that they may have. Among them the hepatopulmonary syndrome(HPS), portopulmonary hypertension(PPH) and hepatic hydrothorax(HH) are described in detail in this literature review. HPS is encountered in approximately 15% to 30% of the patients and its presence is associated with increase in mortality and also requires liver transplantation in many cases. PPH has been reported among 4%-8% of the patient with CLD who have undergone liver transplantation. The HH is another entity, which has the prevalence rate of 5% to 6% and is associated in the absence of cardiopulmonary disease. These clinical syndromes occur in similar pathophysiologic environments. Most treatment modalities work as temporizing measures. The ultimate treatment of choice is liver transplant. This clinical review provides basic concepts; pathophysiology and clinical presentation that will allow the clinician to better understand these potentially life-threatening complications. This article will review up-to-date information on the pathophysiology, clinical features and the treatment of the pulmonary complications among liver disease patients. | Salim R Surani Yamely Mendez Humayun Anjum Joseph Varon | 2016 | World Journal of Gastroenterology2016，22，26： | 3 |
| 3 | Management of hypertensive crises in the elderly显示文摘高血压的危机比 180/120 mmHg 高是血压的举起。这些能迫切或突现,取决于结束机关损坏的存在。高血压的危机的临床的演讲在老病人是相当可变的,并且临床医生们必须怀疑非特定的症状。在 pathophysiological 的过细的知识在他们改变的老病人需要的设法的高血压的危机,药理学选择,使用的药的 pharmacokinetics,他们的副作用,和他们和另外的药的相互作用。Clevidipine, nicardipine, labetalol, esmolol,和 fenoldopam 在比较喜欢的选择在之中由于他们的功效和 tolerability 老。除非没有可得到的另外的选择, Nitroprusside, hydralazine,和 nifedipine 应该被避免,由于复杂并发症和无法预言的回答的高风险。 | Abbas Alshami Carlos Romero America Avila Joseph Varon | 2018 | Journal of Geriatric Cardiology2018，15，7： | 3 |
| 4 | When a liver transplant recipient goes back to alcohol abuse: Should we be more selective?显示文摘Alcoholic liver disease(ALD) is one of the most common indications for liver transplantation(LT). However, it has always remained as a complicated topic from both medical and ethical grounds, as it is seen for many a 'self-inflicted disease'. Over the years, the survival rate of transplanted patients has significantly improved. The allocation system and the inclusion criteria for LT has also undergone some modifications. Early LT for acute alcoholic hepatitis has been subject to recent clinical studies with encouraging results in highly selected patients. We have learned from studies the importance of a multidisciplinary evaluation of candidates for LT. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Risk factors for relapse include the presence of anxiety or depressive disorder, short duration of sobriety pre-LT and lack of social support. The identification of risk factors and the strengthen of social support system may decrease relapse among these patients. Family counseling of candidates is highly encouraged to prevent relapse to alcohol. Relapse has been associated with different histopathological changes, graft damage, graft loss and even decrease in survival among some studies. Therefore, each patient should be carefully selected and priority is to continue to lean on patients with high probability of success. The ethical issue remains as to the patient returning to drinking after the LT, hindering the way for other patients who could have received the same organ. | Monica Leon Joseph Varon Salim Surani | 2016 | World Journal of Gastroenterology2016，22，20： | 2 |
| 5 | The hemodynamic management of elderly patients with sepsis显示文摘Sepsis is among the most common reason for admission to intensive care units throughout the world. In the US and most Western nations sepsis is largely a disease of the elderly. Management of elderly patients with severe sepsis is challenging. Early recognition of this syndrome, together with the early administration of appropriate antibiotics and cautious fluid resuscitation is the cornerstone of therapy. Echocardiography together with non-invasive or invasive hemodynamic monitoring is recommended in patients who have responded poorly to fluids or have significant underlying cardiac disease. This paper reviews the hemodynamic changes that characterize sepsis, particularly as they apply to elderly patients and provides recommendations for the management of these patients. | Paul E. Marik Joseph Varon | 2007 | Journal of Geriatric Cardiology2007，4，2： | 2 |
| 6 | Correlation between metabolic syndrome and sleep apnea显示文摘The so-called 'metabolic syndrome'(MS),constitutes a cluster of metabolic and cardiovascular abnormalities,including fasting glucose,blood pressure,triglycerides,high density lipoprotein cholesterol(HDL-C),and waist circumference that arise from insulin resistance. Obstructive sleep apnea(OSA) syndrome is characterized by recurrent episodes of partial or complete obstruction of the upper airway,involving cessation or significant decreased airflow,with intermittent hypoxemia,frequent arousals from sleep and recurrent oxyhemoglobin desaturations that interfere with normal sleep patterns generating difficulty falling asleep,unrefreshing sleep and loud snoring. The relation between these two entities is known as 'Syndrome Z',and there is no question about the impact of these risk factors on health and disease. This clinical condition presents a growing epidemic Worldwide,affecting approximately 60% of the general population with both MS and OSA due to the constant increase of body mass index in humans. This article presents evidence-based data that focuses on the direct relationship between MS and OSA. | Alejandro Castaneda Edgar Jauregui-Maldonado Iqbal Ratnani Joseph Varon Salim Surani | 2018 | World Journal of Diabetes2018，9，4： | 2 |
| 7 | Diabetic ketoacidosis: Treatment in the intensive care unit or general medical/surgical ward?显示文摘Diabetic ketoacidosis(DKA) is defined as an acute metabolic disorder, which is characterized by an increased presence of circulating ketones, and the development of ketoacidosis in the presence of hyperglycemia. This syndrome occurs as a result of insulin deficiency. Patients can be dramatically ill, however, with aggressive treatment, most patients recover rapidly. Despite being a low-risk condition, the development of acidosis, is one of the admission criteria to the intensive care unit(ICU) for these patients, in order to provide close monitoring, and recognize complications that could result from the use of aggressive therapy, such as continuous infusions if insulin. In some institutions, DKA is treated in the emergency department and general medical/surgical wards to avoid ICU overcrowding. | Yamely Mendez Salim Surani Joseph Varon | 2017 | World Journal of Diabetes2017，8，2： | 2 |
| 8 | Therapeutic Hypothermia : Past, Present and Future显示文摘 | Joseph Varon Pilar Acosta | 2008 | Chest2008，133，： | 1 |
| 9 | Diagnosis and management of hypertensive crises显示文摘 | Paul E Marik | 2000 | Chest2000，118，1： | 1 |
| 10 | Critical care practice in India:Results of the intensive care unit need assessment survey(ININ2018)显示文摘BACKGROUND A diverse country like India may have variable intensive care units(ICUs)practices at state and city levels.AIM To gain insight into clinical services and processes of care in ICUs in India,this would help plan for potential educational and quality improvement interventions.METHODS The Indian ICU needs assessment research group of diverse-skilled individuals was formed.A pan-India survey'Indian National ICU Needs'assessment(ININ 2018-I)was designed on google forms and deployed from July 23rd-August 25th,2018.The survey was sent to select distribution lists of ICU providers from all 29 states and 7 union territories(UTs).In addition to emails and phone calls,social medial applications-WhatsApp™,Facebook™and LinkedIn™were used to remind and motivate providers.By completing and submitting the survey,providers gave their consent for research purposes.This study was deemed eligible for category-2 Institutional Review Board exempt status.RESULTS There were total 134 adult/adult-pediatrics ICU responses from 24(83%out of 29)states,and two(28%out of 7)UTs in 61 cities.They had median(IQR)16(10-25)beds and most,were mixed medical-surgical,111(83%),with 108(81%)being adult-only ICUs.Representative responders were young,median(IQR),38(32-44)years age and majority,n=108(81%)were males.The consultants were,n=101(75%).A total of 77(57%)reported to have 24 h in-house intensivist.A total of 68(51%)ICUs reported to have either 2:1 or 2≥:1 patient:nurse ratio.More than 80%of the ICUs were open,and mixed type.Protocols followed regularly by the ICUs included sepsis care,ventilator-associated pneumonia(83%each);nutrition(82%),deep vein thrombosis prophylaxis(87%),stress ulcer prophylaxis(88%)and glycemic control(92%).Digital infrastructure was found to be poor,with only 46%of the ICUs reporting high-speed internet availability.CONCLUSION In this large,national,semi-structured,need-assessment survey,the need for improved manpower including;in-house intensivists,and decreasing patient-tonurse ratios was evident.Sepsis was the most common diagnosis and quality and research initiatives to decrease sepsis mortality and ICU length of stay could be prioritized.Additionally,subsequent surveys can focus on digital infrastructure for standardized care and efficient resource utilization and enhancing compliance with existing protocols. | Rahul Kashyap Kirtivardhan Vashistha Chetan Saini Taru Dutt Dileep Raman Vikas Bansal Harpreet Singh Geeta Bhandari Nagarajan Ramakrishnan Harshit Seth Divya Sharma Premkumar Seshadri Mradul Kumar Daga Mohan Gurjar Yash Javeri Salim Surani Joseph Varon 无 | 2020 | World Journal of Critical Care Medicine2020，9，2： | 1 |
| 11 | Role of vitamin C in diabetic ketoacidosis:Is it ready for prime time?显示文摘Diabetic ketoacidosis(DKA) is life-threatening acute metabolic complication of diabetes mellitus(DM) that is characterized by acidosis, ketosis, and hyperglycemia, currently affecting mostly patients under 30 years of age with diabetes mellitus type 1. In both, DM and DKA, a pro-inflammatory state exists. This clinical entity occurs as a result of hyperglycemia-induced disturbances, resulting in an increased oxidative metabolism. For the latter reason, the use of vitamin C seems promising in DKA due to its antioxidant role in reducing the superoxide radicals that are consequence of the oxidative stress. This can decrease the proinflammatory state and avoids complications. Vitamin C, or also known as ascorbic acid, has been widely used in several illnesses, such as common cold, tissue healing, fertility, atherosclerosis, cancer prevention, immunity restoration, neuro-degenerative disease and also has been suggested to decrease the risk of DM, and this reason is giving place to believe that vitamin C can have an important role in treating diabetic complications such as DKA. In order to counteract these oxidative disturbances in DKA patients, we analyzed the current data regarding vitamin C and evaluate its role in any type treatment of this complication in the near future. | Sebastian Casillas Alan Pomerantz Salim Surani Joseph Varon | 2018 | World Journal of Diabetes2018，9，12： | 1 |
| 12 | Bench - to - bedside, review : Rhabdomyolysis - an overview for clinicians 显示文摘 | Ana L Huerta - Alardf Joseph Varon Paul E Marik | 2005 | Crit Care2005，9，2： | 1 |
| 13 | Perioperative hypertension man-agement显示文摘 | Joseph Varon and Paul E Marik | 2008 | Vasc Health Risk Manag2008，4，3： | 1 |
| 14 | Diagnosis and management of labile blood pressure during acute cerebrovascular accidents and other hypertensive crises显示文摘 | Joseph Varon | 2007 | American Journal of Emergency Medicine2007，，8： | 1 |
| 15 | Bench-to-bed- side review : Rhabdomyolysis-an overview for clinicians 显示文摘 | Huerta-Alardin AL Joseph Varon J Marik PE | 2005 | Crit Care2005，9，： | 1 |
| 16 | Treatment of acute severe hypertension:current and newer agents显示文摘 | Joseph Varon | 2008 | Drugs2008，68，3： | 1 |
| 17 | Hydrocortisone, ascorbic acid and thiamine for sepsis: Is the jury out?显示文摘Sepsis and septic shock remain a major cause of morbidity and mortality among patients admitted in the intensive care unit.Diabetes is a major risk factor for the development of sepsis.The global mortality of sepsis remains high,despite significant interventions and guidelines.It has been known for decades that patients with sepsis have reduced levels of antioxidants,most notably vitamin C.Furthermore,experimental data has demonstrated multiple beneficial effects of vitamin C in sepsis.In addition,corticosteroids and thiamine may have synergistic biological effects together with vitamin C.Preliminary data suggests that therapy with hydrocortisone,ascorbic acid and thiamine improves the outcome of patients with sepsis with the potential to save millions of lives.However,this intervention has met with much resistance and has not been widely adopted.Ultimately,we await the final jury verdict on this simple,safe and cheap intervention. | Paul Ellis Marik Joseph Varon Salim R Surani | 2020 | World Journal of Diabetes2020，11，4： | 1 |
| 18 | Cardiopulmonary resuscitation in the elderly: a clinical and ethical perspective显示文摘The daily practice of cardiopulmonary resuscitation (CPR) in elderly patients has brought up the attention of outcome research and resource allocation. Determinants to predict survival have been well identified. There has been empirical evidence that CPR is of doubtful utility in the geriatric population, more studies have showed controversial data. Sometimes situations in which CPR needs to be given in the elderly, causes stress to healthcare providers, due to lack of communication of the patient’s wishes and the belief that it will not be successful. It is of importance to state that we have the duty to identify on time the patients that will most likely benefit from CPR, and find out the preferences of the same. Whenever it is possible to institute these guidelines, we will avoid patient suffering. | Ana L. Huerta-Alardín Manuel Guerra-Cantú Joseph Varon | 2007 | Journal of Geriatric Cardiology2007，4，2： | 1 |
| 19 | Gastrointestinal stress ulcer prophylaxis in the intensive care unit,where is the data?显示文摘Stress-induced gastrointestinal ulcers are common among patients admitted to the intensive care unit(ICU).These ulcers impose significant morbidity and mortality,therefore,stress ulcer prophylaxis(SUP) is a common clinical practice among healthcare providers dealing with these critically-ill patients.Several strategies for SUP have been suggested over the past four decades,with acid suppressive therapies being the most commonly used in the ICU.Whether SUP is effective and safe,or not,remains a topic of controversy.The data is still conflicting,and provision of a simple answer is not feasible at the present time.Recently,a large phase IV,multicenter,randomized clinical trial(SUP-ICU),negated the benefits(and harms) of proton pump inhibitors as SUP.This article reviews some of these controversies. | Abbas Alshami Sheily Vianney Barona Joseph Varon Salim Surani | 2019 | World Journal of Meta-Analysis2019，7，3： | 0 |
| 20 | Auscultation transformed:the ingenious invention of the stethoscope by René Théophile Hyacinthe Laennec显示文摘This study delves into the life and significant contributions of René Théophile Hyacinthe Laennec,a prominent French physician of the 19^(th) century,and thoroughly examines his revolutionary creation,the stethoscope.Laennec’s innovative spirit not only revolutionized medical diagnosis during his time but also left a lasting imprint on the broader field of medicine,influencing healthcare for generations.This extensive inquiry covers various aspects,including his historical context,the development of the stethoscope,its profound implications for medical diagnosis,and its enduring impact on the history of medicine. | René Figueroa Joseph Varon | 2024 | History & Philosophy of Medicine2024，6，2： | 0 |
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