Background: Being able to detect an early increase in the inflammatory response might prove to be vital in COVID-19 patients for mitigating its deleterious effects over time.Case: A 52-year-old man, obese, with moderate asthma and hypertension, who suffered COVID-19 with moderate symptoms used a wearable device to record his heart rate variability during his illness. He had a low parasympathetic tone, which decreased every day until it reached almost 2 standard deviations (SD) lower than normal, at the end of the second week. The sympathetic tone grew from more than 3 SD to more than 5 SD.Conclusions: These findings suggest that there might be an alteration in the modulation of the sympathetic and parasympathetic nervous systems, which apparently augments sympathetic tone and decreases parasympathetic tone. Population norms should be studied and published for COVID-19 patients over short-term and 24-h HRV measurements.

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Healthcare has become one of the most important emerging application areas of blockchain technology.[1] Although the use of a cryptographic ledger within Anesthesia Information Management Systems (AIMS) remains uncertain. The need for a truly immutable anesthesia record is yet to be established, given that the current AIMS database systems have reliable audit capabilities. Adoption of AIMS has followed Roger's 1962 formulation of the theory of diffusion of innovation. Between 2018 and 2020, adoption was expected to be the 84% of U.S. academic anesthesiology departments.[2] Larger anesthesiology groups with large caseloads, urban settings, and government affiliated or academic institutions are more likely to adopt and implement AIMS solutions, due to the substantial amount of financial resources and dedicated staff to support both the implementation and maintenance that are required. As health care dollars become more scarce, this is the most frequently cited constraint in the adoption and implementation of AIMS.[3] We propose the use of a blockchain database for saving all incoming data from multiparametric monitors at the operating theatre. We present a proof of concept of the use of this technology for electronic anesthesia records even in the absence of an AIMS at site. In this paper we shall discuss its plausibility as well as its feasibility. The Electronic medical records (EMR) in AIMS might contain errors and artifacts that may (or may not) have to be dealt with. Making them immutable is a scary concept. The use of the blockchain for saving raw data directly from medical monitoring equipment and devices in the operating theatre has to be further investigated.

Background: Although indicators of surgical and medical treatment have been applied to patients with typical dissection (AD) of the descending thoracic aorta, the natural history of descending aortic intramural hematoma (AIH) is not yet clearly known.Objective: The goal of this study was to test the hypothesis that the absence of flow communication through the intimal tear in AIH involving the descending aorta has a different clinical course compared with AD.Methods: We prospectively evaluated clinical and echocardiographic data between AD (76 patients) and AIH (27 patients) of the descending thoracic aorta.Results: Patients had no differences In age, gender, or clinical presentation. The development of pleural effussion or periaortic hematoma was more frequent in patients with AIH than it was in patients with AD. AIH and AD had same predictors of complications at follow-up: aortic diameter (>5 cm) at diagnosis and persistent back pain. Although medical treatment was selected in the same proportion between groups, surgical treatment was more frequently selected in AD (39% vs. 22%, p < 0.01). AD patients who received surgical treatment had higher mortality than those with AIH (36% vs. 17%, p < 0.01). There was no difference in mortality between patients who received medical treatment (15% in AD vs 14% in AIH, p = 0.7). In follow-up imaging studies of 23 patients with AIH,6 patients (25%) showed complete resolution and 6 patients (25%) increased the descending aortic diameter. Typical AD developed in 3 patients (13%). A three-year survival rate did not show significant difference (82 ± 6% in AIH vs 75 ± 7% in AD, p = 0.37).Conclusion: AIH of the descending thoracic aorta have relatively frequent complications at follow-up including dissection and aneurysm formation. Medical treatment with very close imaging follow-up and timed elective surgery in cases with complications allow better management for patients with AIH of the descending thoracic aorta.