Presentation and outcome of Middle East respiratory syndrome in Saudi intensive care unit patients.

BACKGROUND: Middle East respiratory syndrome coronavirus infection is associated with high mortality rates but limited clinical data have been reported. We describe the clinical features and outcomes of patients admitted to an intensive care unit (ICU) with Middle East respiratory syndrome coronavirus (MERS-CoV) infection. METHODS: Retrospective analysis of data from all adult (>18 years old) patients admitted to our 20-bed mixed ICU with Middle East respiratory syndrome coronavirus infection between October 1, 2012 and May 31, 2014. Diagnosis was confirmed in all patients using real-time reverse transcription polymerase chain reaction on respiratory samples. RESULTS: During the observation period, 31 patients were admitted with MERS-CoV infection (mean age 59 ± 20 years, 22 [71 %] males). Cough and tachypnea were reported in all patients; 22 (77.4 %) patients had bilateral pulmonary infiltrates. Invasive mechanical ventilation was applied in 27 (87.1 %) and vasopressor therapy in 25 (80.6 %) patients during the intensive care unit stay. Twenty-three (74.2 %) patients died in the ICU. Nonsurvivors were older, had greater APACHE II and SOFA scores on admission, and were more likely to have received invasive mechanical ventilation and vasopressor therapy. After adjustment for the severity of illness and the degree of organ dysfunction, the need for vasopressors was an independent risk factor for death in the ICU (odds ratio = 18.33, 95 % confidence interval: 1.11-302.1, P = 0.04). CONCLUSIONS: MERS-CoV infection requiring admission to the ICU is associated with high morbidity and mortality. The need for vasopressor therapy is the main risk factor for death in these patients

Additional file 2: of Presentation and outcome of Middle East respiratory syndrome in Saudi intensive care unit patients

A table presenting the superimposed respiratory tract infections and antibiotic use. (DOCX 28 kb

Evaluation of the Clinical Outcomes of Apixaban Use in Patients with Atrial Fibrillation and Uncontrolled Hypothyroidism: A Real-world Evidence

Introduction Atrial fibrillation (AF) poses a substantial worldwide health concern, significantly increasing the risk of stroke and morbidity. Direct oral anticoagulants (DOACs) such as apixaban are recommended over vitamin K antagonists for the management of AF. However, the impact of thyroid abnormalities on DOACs, specifically apixaban in AF patients remains underexplored. Given the limited data, this study aims to evaluate the effectiveness and safety of apixaban in AF patients with uncontrolled hypothyroidism. Methods This study was a retrospective cohort analysis that categorized patients into two sub-cohorts according to their hypothyroidism status at the time they began apixaban treatment: a control group (without hypothyroidism) and an active group (with uncontrolled hypothyroidism). The primary outcome assessed was the rate of thrombosis events following the initiation of apixaban, while bleeding, stroke, and venous thromboembolism (VTE) events were considered as secondary outcomes. Logistic regression analysis was performed, with a p-value of less than .05 deemed statistically significant. Results Among 292 patients included, 51 had uncontrolled hypothyroidism, and 241 were in the control group. Both groups had a median age of 70 years, with predominantly female patients. Any thrombosis events were higher in the uncontrolled hypothyroidism at crude analysis (17.6% vs 8.4%; p-value = .04); as well as higher odds at regression analysis [aOR: 2.40, 95%CI 0.99-5.83; p-value = .05]. In addition, stroke and major bleeding events were significantly higher in the uncontrolled hypothyroidism group (aOR: 4.26, 95%CI 1.51-12.00; p-value = .006 and aOR: 6.21, 95%CI 1.73-22.19; p-value = .005, respectively). The rate of VTE events and minor bleeding did not differ significantly between the two groups. Conclusions The use of apixaban in patients with AF and uncontrolled hypothyroidism was linked to higher rates of thrombosis and major bleeding compared to those without known hypothyroidism. These findings highlight the need for further research through larger prospective studies in this often-overlooked population