Critically ill patients with diabetes and Middle East respiratory syndrome:a multi-center observational study

Background: Diabetes is a risk factor for infection with coronaviruses. This study describes the demographic, clinical data, and outcomes of critically ill patients with diabetes and Middle East Respiratory Syndrome (MERS).Methods: This retrospective cohort study was conducted at 14 hospitals in Saudi Arabia (September 2012–January 2018). We compared the demographic characteristics, underlying medical conditions, presenting symptoms andsigns, management and clinical course, and outcomes of critically ill patients with MERS who had diabetes compared to those with no diabetes. Multivariable logistic regression analysis was performed to determine ifdiabetes was an independent predictor of 90-day mortality.Results: Of the 350 critically ill patients with MERS, 171 (48.9%) had diabetes. Patients with diabetes were more likely to be older, and have comorbid conditions, compared to patients with no diabetes. They were more likely topresent with respiratory failure requiring intubation, vasopressors, and corticosteroids. The median time to clearance of MERS-CoV RNA was similar (23 days (Q1, Q3: 17, 36) in patients with diabetes and 21.0 days (Q1, Q3: 10, 33) in patients with no diabetes). Mortality at 90 days was higher in patients with diabetes (78.9% versus 54.7%, p <0.0001). Multivariable regression analysis showed that diabetes was an independent risk factor for 90-day mortality(odds ratio, 2.09; 95% confidence interval, 1.18–3.72).Conclusions: Half of the critically ill patients with MERS have diabetes; which is associated with more severe disease. Diabetes is an independent predictor of mortality among critically patients with MERS

Critically ill patients with diabetes and Middle East respiratory syndrome:a multi-center observational study

Background: Diabetes is a risk factor for infection with coronaviruses. This study describes the demographic, clinical data, and outcomes of critically ill patients with diabetes and Middle East Respiratory Syndrome (MERS).Methods: This retrospective cohort study was conducted at 14 hospitals in Saudi Arabia (September 2012–January 2018). We compared the demographic characteristics, underlying medical conditions, presenting symptoms andsigns, management and clinical course, and outcomes of critically ill patients with MERS who had diabetes compared to those with no diabetes. Multivariable logistic regression analysis was performed to determine ifdiabetes was an independent predictor of 90-day mortality.Results: Of the 350 critically ill patients with MERS, 171 (48.9%) had diabetes. Patients with diabetes were more likely to be older, and have comorbid conditions, compared to patients with no diabetes. They were more likely topresent with respiratory failure requiring intubation, vasopressors, and corticosteroids. The median time to clearance of MERS-CoV RNA was similar (23 days (Q1, Q3: 17, 36) in patients with diabetes and 21.0 days (Q1, Q3: 10, 33) in patients with no diabetes). Mortality at 90 days was higher in patients with diabetes (78.9% versus 54.7%, p <0.0001). Multivariable regression analysis showed that diabetes was an independent risk factor for 90-day mortality(odds ratio, 2.09; 95% confidence interval, 1.18–3.72).Conclusions: Half of the critically ill patients with MERS have diabetes; which is associated with more severe disease. Diabetes is an independent predictor of mortality among critically patients with MERS

Lithofacies Attributes of a Transgressive Carbonate System : The Middle Eocence Seeb Formation, Al Khoud Area, Muscat, Oman

The Seeb Formation (Middle Eocene) is an about 600 m thick transgressive carbonate succession deposited in the Batina and Muscat coastal region of Oman. The formation consists of five informal, but distinct units, and their stacking architecture suggests a deepening-upward, shallow marine depositional setting. Unit I is characterized by cross-bedded, sandy, bioclastic packstones to grainstones deposited in a high energy beach-to-intertidal environment. Unit II consists of indistinctly bedded, nodular, bioclastic (mainly larger foraminifera) packstones and wackestones deposited in a logoonal lagoonal environment. Unit III is defined by medium to thickly bedded, bioclastic packestones to grainstones and subordinate, laterally confined conglomerates. Prominent sedimentary structures in Unit III include hummocky and swaly cross-stratificiation, erosional surfaces, dewatering-induced deformations and laterally amalgamating beds. This unit represents sub-tidal sand shoals deposited in a storm-dominated shelf (between the fair-weather wave-base and storm-base). Unit IV is extensively burrowed, nodular, bioclastic wackestone to rudstone which is similar to Unit II in many aspects. Unit IV was deposited on the basinward side of the Unit III sand shoals below the reach of the storm-generated waves and currents. The uppermost Unit V is characterized by poorly-cemented bioclastic (large foraminiferal) rudstones with clay and silt-size quartz matrix. Bioclasts are generally intact with no apparent reworking. Deposition of Unit V is also envisaged as a low-energy, outershelf environment

Lithofacies Attributes of a Transgressive Carbonate System : The Middle Eocence Seeb Formation, Al Khoud Area, Muscat, Oman

The Seeb Formation (Middle Eocene) is an about 600 m thick transgressive carbonate succession deposited in the Batina and Muscat coastal region of Oman. The formation consists of five informal, but distinct units, and their stacking architecture suggests a deepening-upward, shallow marine depositional setting. Unit I is characterized by cross-bedded, sandy, bioclastic packstones to grainstones deposited in a high energy beach-to-intertidal environment. Unit II consists of indistinctly bedded, nodular, bioclastic (mainly larger foraminifera) packstones and wackestones deposited in a logoonal lagoonal environment. Unit III is defined by medium to thickly bedded, bioclastic packestones to grainstones and subordinate, laterally confined conglomerates. Prominent sedimentary structures in Unit III include hummocky and swaly cross-stratificiation, erosional surfaces, dewatering-induced deformations and laterally amalgamating beds. This unit represents sub-tidal sand shoals deposited in a storm-dominated shelf (between the fair-weather wave-base and storm-base). Unit IV is extensively burrowed, nodular, bioclastic wackestone to rudstone which is similar to Unit II in many aspects. Unit IV was deposited on the basinward side of the Unit III sand shoals below the reach of the storm-generated waves and currents. The uppermost Unit V is characterized by poorly-cemented bioclastic (large foraminiferal) rudstones with clay and silt-size quartz matrix. Bioclasts are generally intact with no apparent reworking. Deposition of Unit V is also envisaged as a low-energy, outershelf environment

Late Cretaceous Sub-Marine Fan System in Batain Mélange Zone, the Fayah Formation in Northeastern Oman

The Batain coast along the northeastern margin of Oman between Ra’s Al-Hadd and Ra’s Jibsch, is comprised of Permian to Late Cretaceous complex stratigraphy in a tectonically deformed area recording Permian rifting to late Cretaceous Tethys closure events. These rocks are thrust over Mesozoic and older autochthonous sedimentary cover in the form of a major nappe structure known as the Batain Nappe. The uppermost part of the Batain nappe is comprised of isolated outcrops of early Maastrichtian siliciclastic Fayah Formation dominated by gravity flow deposits. The Fayah Formation in the Jabal Fayah area is over four hundred meters thick and comprised of five distinct facies associations; namely, i) coarsening-up sandstone, ii) conglomerate, iii) debris- flow, iv) turbidite, and v) inter-bedded sandstone and shale lithofacies. These lithofacies associations are repeated many times in the section. The sandstone lithofacies association exhibits a coarsening-upward trend making sequences tens of meters thick in various parts of the formation. Waterscape structures are common along with occasional sandstone dykes and convolute bedding, reflecting fluidized conditions of deposition. The conglomerate lithofacies association is comprised of a series of interbedded coarsening-upward pebble to gravel size conglomerates containing chert, limestone, granite and volcanic clasts ranging a few mm to cm in diameter. Occasionally these are interbedded with sandstone lithofacies. The conglomerate lithofacies was deposited by a high-energy channelized flow in a sub-aqueous setting. The debris-flow lithofacies association is a matrix supported chaotic mixture of clay and boulders of granite, limestone and volcanic rocks, some of which are meter-sized in diameter, and possibly derived from the nearby basement rocks such as the Jabal Ja’alan basement rocks. It constitutes the most dominant part of the formation. These sediments were deposited along a slope setting, possibly as olistostrome formed due to submarine slumping and sliding. The turbidite lithofacies association is comprised of monotonous grayish-green to brown coloured clays tens of meters thick interbedded with thin, clean, well-sorted sandstone. The Interbedded sandstone and shale lithofacies association is comprised of a half to one meter thick cross-bedded, burrowed arkosic sandstone and plane laminated shale. The sandstone constitutes about 25% of the association with ripple lamination in the upper part of the unit indicating a fining-upward trend. Dewatering structures are common. This association constitutes the upper 100m of the formation. These sediments were deposited in shallow water conditions by channelized flows. Based on the lithofacies associations described above, especially the dominance of debris-flow units and turbidites, the greater part of the Fayah Formation are interpreted as having been deposited under a sub-marine fan setting. Only the upper part of the formation was deposited in a shallow water setting before the onset of overlying carbonate deposits. The sub-marine fan system was active during the last stages of the Tethys Ocean closure at the time of onset of the Batain nappe

Ornithopod and Sauropod Dinosaur Remains from the Maastrichtian Al-Khod Conglomerate, Sultanate of Oman

Fieldwork in the Upper Cretaceous (Maastrichtian) Al-Khod Conglomerates in the Sultanate of Oman led to the discovery of a large bone fragment tentatively identified as a partial distal left humerus of a sauropod and an ornithopod dorsal vertebra. The very fragmentary state of preservation of the dorsal vertebra makes specific attribution difficult, but it shows remarkable similarities to the rhabdodontid dinosaurs Rhabdodon and Zalmoxes

Critically ill healthcare workers with the middle east respiratory syndrome (MERS): A multicenter study.

BACKGROUND:Middle East Respiratory Syndrome Coronavirus (MERS-CoV) leads to healthcare-associated transmission to patients and healthcare workers with potentially fatal outcomes. AIM:We aimed to describe the clinical course and functional outcomes of critically ill healthcare workers (HCWs) with MERS. METHODS:Data on HCWs was extracted from a multi-center retrospective cohort study on 330 critically ill patients with MERS admitted between (9/2012-9/2015). Baseline demographics, interventions and outcomes were recorded and compared between survivors and non-survivors. Survivors were approached with questionnaires to elucidate their functional outcomes using Karnofsky Performance Status Scale. FINDINGS:Thirty-Two HCWs met the inclusion criteria. Comorbidities were recorded in 34% (11/32) HCW. Death resulted in 8/32 (25%) HCWs including all 5 HCWs with chronic renal impairment at baseline. Non-surviving HCW had lower PaO2/FiO2 ratios 63.5 (57, 116.2) vs 148 (84, 194.3), p = 0.043, and received more ECMO therapy compared to survivors, 9/32 (28%) vs 4/24 (16.7%) respectively (p = 0.02).Thirteen of the surviving (13/24) HCWs responded to the questionnaire. Two HCWs confirmed functional limitations. Median number of days from hospital discharge until the questionnaires were filled was 580 (95% CI 568, 723.5) days. CONCLUSION:Approximately 10% of critically ill patients with MERS were HCWs. Hospital mortality rate was substantial (25%). Patients with chronic renal impairment represented a particularly high-risk group that should receive extra caution during suspected or confirmed MERS cases clinical care assignment and during outbreaks. Long-term repercussions of critical illness due to MERS on HCWs in particular, and patients in general, remain unknown and should be investigated in larger studies

Treatment of Middle East respiratory syndrome with a combination of lopinavir/ritonavir and interferon-β1b (MIRACLE trial): statistical analysis plan for a recursive two-stage group sequential randomized controlled trial

Abstract The MIRACLE trial (MERS-CoV Infection tReated with A Combination of Lopinavir/ritonavir and intErferon-β1b) investigates the efficacy of a combination therapy of lopinavir/ritonavir and recombinant interferon-β1b provided with standard supportive care, compared to placebo provided with standard supportive care, in hospitalized patients with laboratory-confirmed MERS. The MIRACLE trial is designed as a recursive, two-stage, group sequential, multicenter, placebo-controlled, double-blind randomized controlled trial. The aim of this article is to describe the statistical analysis plan for the MIRACLE trial. The primary outcome is 90-day mortality. The primary analysis will follow the intention-to-treat principle. The MIRACLE trial is the first randomized controlled trial for MERS treatment. Trial registration ClinicalTrials.gov, NCT02845843. Registered on 27 July 2016