ABSTRACT
The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has triggered a global health pandemic that led to substantial morbidity and mortality worldwide. The virus has been known to predominantly cause severe hypoxemic respiratory failure but there have been multiple reports of extra-pulmonary manifestations. Additionally, there has been increasing evidence of COVID-19 hyper-coagulability. Herein, we present a case of a 49-year-old male with a past medical history of diet controlled type II diabetes mellitus and recently diagnosed COVID-19 who presented to the emergency department with a chief complaint of nausea and vomiting. Our patient was found to have a thrombus-like appearing 1.9 cm × 1.2 cm well-circumscribed mass, attached to the greater curvature of the ascending aorta, superior to the right coronary cusp of the aortic valve almost three weeks after his initial diagnosis of COVID-19 virus.
ABSTRACT
The rapid emergence of coronavirus disease 2019 (COVID-19) has become the biggest healthcare crisis of the last century, resulting in thousands of deaths worldwide. There have been studies that evaluated the role of angiotensin-converting enzyme (ACE) inhibitors (ACEi) and angiotensin receptor blockers (ARBs) in treating patients with COVID-19. However, the prior use of diuretics and their effect on mortality in this setting remains unknown. The aim of the study was to evaluate the effect of diuretics in patients admitted with COVID-19. The current study was conducted between March 15, 2020, and April 30, 2020, during the COVID-19 pandemic in three different hospitals in Northern New Jersey, USA. The primary outcome was survival or in-hospital mortality from COVID-19 from the day of admission. The secondary outcome was severe or non-severe illness from COVID-19. This retrospective study included a total of 313 patients with a median age of 61.3 ± 14.6 years. There was a total of 68 patients taking diuretics at home and 245 patients who were not taking diuretics. There was a total of 39 (57.35%) deaths in patients taking diuretics as compared to 93 (37.96%) deaths in patients not taking diuretics (p-value 0.0042). Also, 54 (79.41%) patients who took diuretics had severe COVID-19 illness as compared to 116 (47.35%) who did not take diuretics (p-value <.0001). However, after adjusting for the confounding factors, there was no difference in mortality or severity of illness in COVID-19 patients taking diuretics at the time of admission. In conclusion, there was no effect of the baseline use of diuretics in the prognosis of COVID-19.
ABSTRACT
Background: The limited data available so far has shown a high mortality rate among COVID-19 patients admitted to the ICU. Possible risk factors for poor outcomes in this type of patients need to be analyzed so we can identify strategies to reduce mortality. Objective: Characterized the COVID-19 experience in Community hospital ICU. Methods: Single center retrospective cohort study involving all adult patients admitted to the ICU with severe COVID-19 infection. Results: 132 patients were admitted to ICU during the study period. There was a preponderance for males and the most common ethnicity was Hispanic. The overall mortality was 69%, and mortality after intubation was 76%. In the multivariable analysis older Age (OR = 15.7), Obesity (OR = 2.92) and Mechanical Ventilation (OR = 12.0) were found to be a significant independent risk factor for increased mortality. Conclusion: Our study confirms the high mortality rate in patients critically ill with COVID-19 requiring ICU care especially among older age group, mechanically ventilated and obese patients. Overall outcomes are comparable to larger tertiary care centers. Our findings highlight the need to plan for optimal resource allocation and tailoring therapies to target the disease so as to improve outcomes.