Background The rapid spread of the coronavirus disease 2019 (COVID-19) epidemic has significantly impacted global health. So far, the evidence regarding the risk factors that predict the outcomes of COVID-19 patients is limited. In this study, we identified several risk factors that are associated with increased mortality in COVID-19 patients. Methods We performed a retrospective review of electronic medical records of the patients admitted with an initial diagnosis of COVID-19. We extracted several patient variables (including demographics, lab results, and pre-existing conditions) and examined for their association with increased mortality. Results Of the 487 people included in the study, 340 survived and 147 expired. Significant differences existed in demographics and underlying comorbidities between the two groups. A higher proportion of patients were age 65 and older (87.76% vs 53.24%, p < 0.001), and were predominantly male (63.27% vs 52.94%, p = 0.0351). Multivariate analysis showed five variables to be the predictors for mortality: age ≥65 [OR = 3.87, 95% CI (2.01, 7.46), p < 0.001], initial presentation with dyspnea [OR = 1.71, 95% CI (1.03, 2.82), p = 0.037], history of cardiomyopathy [OR = 3.33, 95% CI (1.07, 10.41), p < 0.038], positive initial chest imaging findings [OR = 2.24, CI (1.26, 3.97), p = 0.006], and acute kidney injury (AKI) [OR = 3.33 CI (2.10, 5.28), P < 0.001]. Conclusion Identifying COVID-19 patients with these characteristics may help guide the management and improve mortality.

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Objective/purpose: To report a case of etomidate induced seizure in a patient that received 0.15 mg/kg of etomidate for a procedural sedation which resolved without intervention. Summary: A 68-year-old woman presented to the emergency department with a dislocated shoulder. Etomidate was given to the patient for procedural sedation to allow the physician to reduce the shoulder dislocation. Upon administration of the medication, the patient began seizing; this lasted for about 2 minutes. No medications were needed for cessation of the seizure. Conclusion: A causality assessment determined that the adverse effect of the epileptogenic action in etomidate was possible. Limited data is available in regard to the incidence rate of this adverse effect.

Objectives: Pegfilgrastim is a granulocyte colony-stimulating factor (G-CSF) used as primary prophylaxis in patients receiving myelosuppressive chemotherapy regimens that have greater than 20% risk of developing febrile neutropenia (FN). Historically, pegfilgrastim has been administered 24 to 72 hours after chemotherapy, necessitating a return to clinic to receive the provider-administered injection. An alternative option is the pegfilgrastim on-body injector (OBI). With the OBI device, patients have their pegfilgrastim administered 27 hours after receiving chemotherapy while remaining at home, avoiding an additional clinic appointment. Concerns with pegfilgrastim OBI include lack of experience with the device in both the patient and provider, device-related failures, and the success of delivery. This study evaluates pegfilgrastim OBI failure rates through associated patient outcomes among cancer patients receiving chemotherapy requiring G-CSF. Methods: A retrospective electronic chart review was conducted of adult patients with cancer who received chemotherapy and pegfilgrastim OBI from July 1, 2016, to July 31, 2018. The primary objective of this study was the incidence of FN in patients receiving pegfilgrastim OBI. Results: There were no reported cases of hospitalization due to FN in patients who received pegfilgrastim OBI. Dose delays and dosage modifications were not observed in our review. The OBI device failure rate was found to be low (1.92%). Conclusion: The low device failure rate from this study suggests that the OBI is a viable option for administration of pegfilgrastim in patients receiving chemotherapy requiring G-CSF.

OBJECTIVE: To provide a focused review of the literature related to the association between exposure to Z-drugs and the risk of falls, especially in the older population.<br/> DATA SOURCES: A literature search was conducted using Medline, PsychInfo, and the Cochrane Library database for all clinical trials, case series, and case reports published in English up to May 2020. The search terms used consisted of each Z-drug, including "zolpidem," "zopiclone," "eszopiclone," and "zaleplon," matched with "falls."<br/> STUDY SELECTION: The search yielded 295 studies. After review of abstracts, content and references were reviewed, and duplicates removed, a total of 9 articles met inclusion of exposure to at least 1 Z-drug and a primary outcome of falls.<br/> DATA EXTRACTION: The American Geriatrics Society 2019 Beers Criteria Update for Potentially Inappropriate Medication Use in Older Adults recommends to avoid using nonbenzodiazepine hypnotics in this patient population because of the risk of adverse events.<br/> DATA SYNTHESIS: A majority of the literature suggests an increased risk of falls with exposure to Z-drug use, especially zolpidem. Eight trials examined falls as a primary outcome in non-elderly (n=3) and elderly (n=5) patients in different settings, mostly in an inpatient setting (nursing facility or acute care hospital).<br/> CONCLUSION: Exposure to Z-drugs, especially zolpidem, should be evaluated and counseled on continuously as these medications put patients at an increased risk for falls and other complications.