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

Intra-aortic balloon pump in patients with cardiogenic shock complicating myocardial infarction: a systematic review and meta-analysis of randomized trials (protocol)

Abstract Background Cardiogenic shock is the leading cause of death in patients with acute myocardial infarction. Despite significant advancements in health technology and research, hospital mortality approaches 50%. The intra-aortic balloon pump is a mechanical hemodynamic assist device that has been used for over 40 years in the management of patients with cardiogenic shock. A recent randomized trial suggests that the use of intra-aortic balloon pumps does not reduce mortality in patients with ischemic cardiogenic shock. Methods We plan to search MEDLINE, EMBASE, and the Cochrane Trial Registry for potentially eligible randomized trials that compare the use of intra-aortic balloon pump with no mechanical device support in patients with cardiogenic shock. No date, language or journal limitations will be applied. Two reviewers will independently screen and identify eligible studies using predefined eligibility criteria. Data abstraction will be done independently and in duplicate. We plan to use RevMan software to generate pooled estimates across included studies, using the previously published method of DerSimonian and Laird. We will report pooled estimates as risk ratios with 95% confidence intervals for binary outcomes, and as mean differences with 95% confidence intervals for continuous outcomes. We will assess the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Discussion The aim of this systematic review and meta-analysis is to summarize the available evidence on the efficacy of the intra-aortic balloon pump in cardiogenic shock. Systematic review registration: PROSPERO CRD42014007056

Effect of Luting Cement Film Thickness on the Pull-Out Bond Strength of Endodontic Post Systems

Optimal bond strength between the prefabricated post/dowel to the surrounding dentin is essential. The present study aimed to analyze and compare the effect of three different cement film thicknesses on the pull-out bond strength of three different prefabricated post systems. Extracted natural teeth (N = 90) with similar root dimensions were acquired. Teeth were mounted in resin blocks, endodontically treated, sectioned at cemento-enamel junction, divided into three groups (A: Parapost Fiber Lux plus; B: 3M ESPE Relyx fiber post; and C: Parapost XP), and stored. Uniform post spaces were prepared for the groups (A and C: Length = 8 mm, Width = 1.5 mm; B: Length = 8 mm, Width = 1.6 mm). Each group (N = 30) was further subdivided into three subgroups (n = 10) based on the size (4, 5, and 6) of the post and cemented with resin cement (MultiLink-N, Ivoclar Vivadent). After thermocycling, the specimens were subjected to a pull-out test using a universal testing machine, and tensile force was recorded (MPa). Digital microscopic evaluations were performed for modes of failure. ANOVA and Tukey-HSD tests were used for statistics. Significant differences were observed for each tested material (p = 0.000). The lowest and highest bond strength values were recorded for Group C (Titanium post) and Group A (000), respectively. Multiple comparisons showed significance (p < 0.05) among all the groups, except for space 1 and space 2 (p = 0.316) for Group A. Most of the failures occurred within the cement-dentin and post-cement interface (Adhesive failures, 73.5%). An increase in the luting cement film thickness results in the decrease in pull-out bond strength of prefabricated posts luted with resin cement, irrespective of the type/material/shape of the post. The serrated fiber posts showed the highest pull-out bond strength compared to the smooth surfaced fiber posts or serrated metal posts. Increased pull-out bond strengths were observed when appropriate post space was created with the same sized drill as the post size