Background: We aimed to examine the role played by the COVID-19 infection in patients' death and to determine the proportion of patients for whom it was a major contributor to death. Methods:We included patients ≥50 years old who were hospitalized with COVID-19 infection and died between March 1, 2020 and September 30, 2020 in a tertiary medical center. We considered COVID-19 infection to be a major cause for death if the patient had well-controlled medical conditions and death was improbable without coronavirus infection, and a minor cause for death if the patient had serious illnesses and had an indication for palliative care.Results: Among 243 patients, median age was 80 (interquartile intervals: 72-86) and 40% were female. One in two had moderate or severe frailty and 41% had dementia.Nearly 60% of the patients were classified as having advanced, serious illnesses present prior to the hospitalization, with death being expected within 12 months, and among this group 39% were full code at admission. In the remaining 40% of patients, deaths were classified as unexpected based on patients' prior conditions, suggesting that COVID-19 infection complications were the primary contributor to death.Conclusions: For slightly less than half (40%) of patients who died of complications of COVID-19, death was an unexpected event. Among the 60% of patients for whom death was not a surprise, our findings identify opportunities to improve endof-life discussions and implement shared decision-making in high-risk patients early on or prior to hospitalization. BACKGROUNDAs of October 2021, more than 660,000 people in the United States have died from complications related to COVID-19. 1 In one metaanalysis, global mortality for hospitalized patients was estimated at 17% in patients not admitted to the intensive care unit and 40% in studies of critically ill patients. 2 Factors associated with mortality include older age, chronic medical conditions (e.g., diabetes mellitus, chronic lung diseases, obesity or hypertension), 3 and frailty. 4 Although it is likely that many patients who die with COVID-19 were low-risk prior to contracting the illness, the number that come from lower risk groups is unknown. In fact, some lay outlets and even scientific papers have argued that almost no low-risk patients die of COVID. 5,6

No abstract

Sirolimus is an immunosuppressant frequently prescribed to prevent graft-vs-host disease in renal transplant patients. Pericardial effusion is recognized as a rare and potentially lethal side effect of this medication. Hemopericardium, specifically, is an even rarer complication that has yet to be reported in the literature. We report the first case of sirolimus-induced hemopericardium in a renal transplant patient.

No abstract