Cardiopulmonary disease as sequelae of long-term COVID-19: Current perspectives and challenges.

COVID-19 infection primarily targets the lungs, which in severe cases progresses to cytokine storm, acute respiratory distress syndrome, multiorgan dysfunction, and shock. Survivors are now presenting evidence of cardiopulmonary sequelae such as persistent right ventricular dysfunction, chronic thrombosis, lung fibrosis, and pulmonary hypertension. This review will summarize the current knowledge on long-term cardiopulmonary sequelae of COVID-19 and provide a framework for approaching the diagnosis and management of these entities. We will also identify research priorities to address areas of uncertainty and improve the quality of care provided to these patients.

Identifying Electronic Medication Administration Record (eMAR) Usability Issues from Patient Safety Event Reports.

BACKGROUND: Improving our understanding of the association between medication errors and health information technology (health IT) usability has the potential to reduce errors and improve patient safety. This study used patient safety event reports (PSEs) to investigate the contribution of usability challenges associated with the electronic medication administration record (eMAR) to medication errors. METHODS: Free-text descriptions of 849 medication-related PSEs selected from 2.3 million reports were analyzed. Coders identified the specific health IT components, usability challenge categories, and nuanced usability themes that contributed to each PSE. Thematic analysis was conducted to refine categorizations and identify emerging themes. Final analysis was limited to PSEs involving a contribution from eMAR, either as the point of origin or as a downstream contributor to error. RESULTS: eMAR contributed to 473 PSEs. eMAR was the point of origin for 84 (17.8% of 473) PSEs. Usability challenge categories included Workflow support (n = 52, 11.0%) and Display/Visual clutter (n = 30, 6.3%). eMAR contributed downstream from the point of origin in 389 (82.2% of 473) PSEs, with errors stemming primarily from Pharmacy IT and computerized provider order entry (CPOE). Prominent secondary eMAR-associated usability challenges included Display/Visual clutter (n = 327, 69.1%) and Alerting (n = 32, 6.8%). CONCLUSION: This study identified several eMAR usability challenges, through the analysis of PSEs, that contribute to medication errors. Findings highlight the critical need for improving the eMAR user interface. Improved interface design, better vendor usability testing, eMAR-focused certification testing, consideration of work system factors, and eMAR-focused usability and safety testing by health care facilities can improve eMAR technology and patient safety.

Spectrum Handoff based on Imperfect Channel State Prediction Probabilities with Collision Reduction in Cognitive Radio Ad Hoc Networks.

The spectrum handoff is highly critical as well as challenging in a cognitive radio ad hoc network (CRAHN) due to lack of coordination among secondary users (SUs), which leads to collisions among the SUs and consequently affects the performance of the network in terms of spectrum utilization and throughput. The target channel selection mechanism as part of handoff process can play an enormously significant role in minimizing the collisions among the SUs and improving the performance of a cognitive radio network (CRN). In this paper, an enhanced target channel selection scheme based on imperfect channel state prediction is proposed for the spectrum handoff among the SUs in a CRAHN. The proposed scheme includes an improved frame structure that increases coordination among the SUs in the ad hoc environment and helps in organizing the SUs according to the shortest job first principle during channel access. Unlike the existing prediction-based spectrum handoff techniques, the proposed scheme takes into account the accuracy of channel state prediction; the SUs affected due to false prediction are compensated by allowing them to contend for channel access within the same transmission cycle and thus enabling them to achieve higher throughput. The proposed scheme has been compared with the contemporary spectrum handoff schemes and the results have demonstrated substantial improvement in throughput and extended data delivery time by virtue of the reduced number of collisions.

Analysis of Efficient Spectrum Handoff in a Multi-Class Hybrid Spectrum Access Cognitive Radio Network Using Markov Modelling.

Cognitive radio networks (CRNs) rely on sensing of the licensed spectrum of a primary network to dynamically ascertain underutilized portion of the spectrum, thus affording additional communication opportunities. In a CRN, a single homogeneous spectrum access, such as interweave only deprives the secondary users (SUs) of channel access during handoff, particularly at high primary network traffic. Therefore, providing quality-of-service (QoS) to multi-class SUs with diverse delay requirements during handoff becomes a challenging task. In this paper, we have evolved a Markov-based analytical model to ascertain the gain in non-switching spectrum handoff scheme for multi-class SUs employing hybrid interweave-underlay spectrum access strategy. To satisfy the QoS requirements of the delay-sensitive traffic, we have analyzed the impact of hybrid spectrum access scheme for prioritized multi-class SUs traffic. The results show substantial improvement in spectrum utilization, average system throughput and extended data delivery time compared to conventional CRN using interweave only spectrum access. This demonstrates the suitability of the proposed scheme towards meeting QoS requirements of the delay-sensitive SU traffic while improving the overall performance for delay-tolerant SU traffic as well.

Immunosuppressive agents modulate function, growth, and survival of cardiomyocytes and endothelial cells derived from human embryonic stem cells.

Cardiac cell replacement therapy by using human embryonic stem cell (hESC) derivatives remains a potential approach to regenerate myocardium. The major hurdles to clinical application of this technology are immunogenicity and post-transplantation cell death. Here we examined the effects of calcineurin-targeting immunosuppressants cyclosporine A (CsA) and FK506, as well as rapamycin and a selective inhibitor of calcineurin-binding downstream nuclear factor of activated T-cell (NFAT) transcription factor VIVIT on the proliferative activity, function, and survival of hESC-derived cardiomyocytes (hESC-CM) and endothelial cells (hESC-EC) in culture. As shown by automated microscopy, treatments with CsA, FK506, and rapamycin all decreased proliferation, reducing the percentage of hESC-CM and hESC-EC with the mitotic marker Ki67(+) by as much as 60% and 74%, respectively. Administration of the cell permeable analogue 11R-VIVIT protein did not modulate their proliferative activity. All immunosuppressants reversed the proapoptotic effect of chelerythrine in hESC-CM demonstrating an inhibitory role of calcineurin/NFAT and mammalian target of rapamycin (mTOR) pathways in hESC-CM survival (using apoptotic marker caspase-3), whereas the protection was less obvious in hESC-EC exposed to H2O2. Immunosuppressants did not affect cell viability in hESC-EC. Our results show that immunosuppressants reduce proliferation, while offsetting cell loss to a smaller extent by reduction in apoptosis of hESC-CM. Immunosuppressant therapy would be compatible with stem cell transplantation, but the resulting reduction in graft expansion capabilities would potentially necessitate implantation of increased cell numbers when immunosuppressants are given. The effects of NFAT-binding immunosuppressant molecules, which do not affect hESC-CM proliferation, may point the way forward for new classes of compounds better suited to cell implantation.

Precipitating factors of hepatic encephalopathy: experience at Pakistan Institute of Medical Sciences Islamabad.

BACKGROUND: Hepatic encephalopathy is an extra hepatic complication of impaired liver function and is manifested as neuropsychiatric signs and symptoms associated with acute or chronic liver disease in the absence of other neurological disorders. There are numerous factors of hepatic encephalopathy. The main objective of this study was to analyse the precipitating factors of hepatic encephalopathy in cases seen in Pakistan Institute of Medical Sciences Islamabad. METHODS: Fifty admitted patients with acute or chronic liver diseases complicating to hepatic encephalopathy were probed into for precipitating factors, based on history, clinical examination and laboratory methods from September 2005 to December 2005. The associated biochemical laboratory data analysis and prognostic stratification through Child's Pugh classification was also done. RESULTS: Infection (44%), gastrointestinal bleeding (38%) and constipation (38%), stood out as the most common factors. Usage of drugs with ammonium salts, tranquilizers and large volume paracentesis were least common factors. Most patients were in grade III (52%), and grade IV (22%), of hepatic encephalopathy. Other common associations were ascites (64%), Child's class C (62%), hyponatremia (50%), low haemoglobin (70%), hepatitis C (62%), and high mortality rate (30%). CONCLUSION: Infection, gastrointestinal bleeding and constipation being the most important precipitating factors must be prevented and hospital funds, medicines and human efforts should lay emphasis, on these factors to decrease the incidence of hepatic encephalopathy. This also includes effective control measures against rising cases of hepatitis C, as it is the leading cause of liver cirrhosis in Pakistan.