Case Report: Therapeutic and immunomodulatory effects of plasmapheresis in long-haul COVID.

Many patients with COVID-19 experience a range of debilitating symptoms months after being infected, a syndrome termed long-haul COVID. A 68-year-old male presented with lung opacity, fatigue, physical and cognitive weaknesses, loss of smell and lymphocytopenia. After rounds of therapeutic plasma exchange (TPE), the patient returned to normal activities and work. Mechanistically in the patient's peripheral blood mononuclear cells (PBMCs), markers of inflammatory macrophages diminished and markers of lymphocytes, including natural killer (NK) cells and cytotoxic CD8 T-cells, increased. Circulating inflammatory proteins diminished, while positive regulators of tissue repair increased. This case study suggests that TPE has the capacity to treat long-haul COVID.

Targeting pulmonary vascular disease to improve global health: pulmonary vascular disease: the global perspective.

Although there is widespread agreement on the need to address the glaring health-care disparities that exist in underserved countries in the world, there has not been an accepted approach to address these disparities that has proven to be successful. The international agenda has chosen to focus on maternal/fetal needs and infectious disease-based illnesses. However, cardiovascular diseases remain the leading cause of morbidity and mortality in the developing world. Since the adoption of the United Nations Millennium Development Goals in 2000, progress in raising the health-care standard in poorer countries has been slow. As an alternative approach, a global health-care strategy that targets cardiovascular disease may prove successful. The Pulmonary Vascular Research Institute has adopted a ground-up strategy by enlisting physicians from developing countries as partners in a virtual heart and lung institute. Realizing that pulmonary vascular disease is often a manifestation of advanced cardiovascular disease, we need to explore those illnesses that are prevalent in poorer countries where pulmonary hypertension is a resulting problem. Through education, capacity building, research, and clinical trials it should be possible to establish a successful paradigm that addresses the needs of patients and physicians while simultaneously expanding the knowledge and expertise about pulmonary vascular diseases worldwide. Eventually regional centers of excellence will be established worldwide that will serve the populace of both the developing and developed worlds combined.

Practice pattern variability for myocardial revascularization: impact on resource use across 24 centers.

OBJECTIVE: To determine the predictors of hospital length of stay (LOS) after elective uncomplicated coronary artery bypass graft surgery. DESIGN: Retrospective analysis of the EPI-1 database, 1991-1993. SETTING: Multicenter; 24 academic, private, federal, and health maintenance institutions. PARTICIPANTS: Patients undergoing elective CABG surgery (n = 2,417). MEASUREMENTS AND MAIN RESULTS: Using a systematic sampling scheme at each site, each patient was evaluated to identify markers of chronic disease, perioperative test data, treatments, adverse outcomes, and LOS. Institutional differences in the care of patients free of complications were assessed using a multivariate model. LOS was the outcome variable selected to estimate cost. A total of 861 patients (37%) were free of any complication. The mean site LOS ranged from 5.4 to 9.0 days, with half of the 24 centers reporting a hospital LOS routinely >7.1 days. The predominant factor associated with a complication-free LOS was site per se, accounting for 32% of the variability in hospital LOS that could not be explained by any site characteristic (eg, size, geographic location, academic affiliation). Multivariable analysis identified 3 demographic predictors--age >75 years (increasing LOS by 1.3 days), admission from the emergency department (increasing LOS by 0.7 days), and uninsured or Medicaid-insured (increasing LOS by 0.4 days); 2 historical predictors--New York Heart Association class III or IV congestive heart failure (increasing LOS by 0.5 days) and history of arrhythmia (increasing LOS by 0.7 days); and 2 practice patterns--transfusion of blood products (increasing LOS by 0.3 days) and delayed extubation (increasing LOS by 0.5 days). Previous myocardial infarction, diabetes, chronic obstructive pulmonary disease, neurologic disease, and other historical factors were not associated with LOS in patients without a complication. CONCLUSION: A substantial variability in LOS after complication-free coronary artery bypass graft surgery was determined predominantly by site per se, even after adjustment for disease severity, site type or location, and surgical and anesthetic practices. The variability in LOS was likely due to practice style influences and represents an opportunity to decrease waste in the provision of a common and expensive procedure.