RESUMO
Objective: To describe the clinical characteristics and outcomes of two waves of the COVID-19 pandemic. Methods: A de-identified dataset of patients with COVID-19 admitted to our community hospital in Evanston, Illinois, from March 1, 2020 to February 28, 2021 was retrospectively reviewed. Patients from the first wave were identified as those admitted during the initial peak of admissions observed at our hospital between March 1, 2020 and September 3, 2020. The second wave was defined as those admitted during the second peak of admissions observed between October 1, 2020 and February 28, 2021. Results: In total, 671 patients were included. Of these, 399 (59.46%) were identified as patients from the first wave and 272 (40.54%) as patients from the second wave. Significantly more patients received steroids (86.4% vs 47.9%, p < 0.001), remdesivir (59.6% vs 9.5%, p < 0.001), humidified high-flow nasal cannula (18% vs 6.5%, p < 0.001), and noninvasive ventilation (11.8% vs 3.3%, p < 0.001) during the second wave. Patients from the first wave had a greater hazard for death compared with patients from the second wave (hazard ratio [HR] 1.62, 95% CI 1.08-2.43; p = 0.019). Conclusion: Among patients hospitalized with COVID-19 in our community hospital, there was a decrease in case-fatality rate in the second surge of the COVID-19 pandemic compared with the first wave.
Assuntos
Glicemia/metabolismo , Serviços Médicos de Emergência/estatística & dados numéricos , Acidente Vascular Cerebral/sangue , Procedimentos Desnecessários , Adulto , Idoso , Idoso de 80 Anos ou mais , Glucose/uso terapêutico , Humanos , Hipoglicemia/complicações , Hipoglicemia/diagnóstico , Hipoglicemia/terapia , Hipoglicemiantes , Pessoa de Meia-Idade , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia , Resultado do TratamentoRESUMO
Umbilical hernias are a common complication of persistent ascites. Spontaneous rupture of these hernias is a less common complication. We report a case of spontaneous evisceration through an umbilical hernia in a cirrhotic patient with chronic ascites. Definitive surgical repair of the evisceration was not possible secondary to persistent ascites that was refractory to paracentesis and diuresis. Transjugular intrahepatic portocaval shunt (TIPS) placement was ultimately performed in an attempt to eliminate the ascites fluid. This case demonstrates a rare, but life-threatening complication of abdominal ascites that may be prevented by aggressive medical and surgical management.
