Mortality rate of ICU patients with the Middle East Respiratory Syndrome - Coronavirus infection at King Fahad Hospital, Jeddah, Saudi Arabia.

OBJECTIVE: The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is a novel coronavirus circulating in the Arabian Peninsula since September 2012. It leads to significant respiratory disease and among patients with co-morbidities is associated with high mortality. This research studied the mortality rate of MERS-CoV among intensive care unit (ICU) patients and the correlation of mortality with different co-morbidities. METHODS: This was a retrospective observational study conducted at the Intensive Care Unit of the King Fahad Hospital, Jeddah, Saudi Arabia. Data was obtained through patient chart review. RESULTS: The total sample consisted of 52 laboratory-confirmed MERS-CoV infection patients. 39 patients died, with a 75% case-fatality rate. Many patients had underlying co-morbidities, including diabetes mellitus (51.9%), hypertension (46.2%), and chronic renal disease (21.2%). CONCLUSIONS: MERS-CoV ICU mortality remains markedly high due to a combination of factors; the disease process of MERS-CoV leads to multiple organ failure, particularly respiratory and renal failure.

Enantioselective total synthesis and X-ray structures of the tetrahydroprotoberberine alkaloids (-)-(S)-tetrahydropalmatrubine and (-)-(S)-corytenchine.

Enantioselective total syntheses and X-ray structures of both (S)-tetrahydropalmatrubine (2) and (S)-corytenchine (3) are reported for the first time. They were both derived from (S)-N-norlaudanidine, a benzyltetrahydroisoquinoline that was synthesized with high (>95% ee) enantioselectivity using a chiral auxiliary-assisted Bischler-Napieralski cyclization/reduction approach.

[2,2'-Imino-diethano-lato(2-)-κO,N,O'][4-(meth-oxy-carbonyl-meth-yl)phen-yl]boron.

The title compound, C(13)H(18)BNO(4), was readily obtained from the reaction of methyl 4-boronobenzene acetate with ethano-lamine. A combination of inter-molecular N-H⋯O hydrogen bonds and C-H⋯π inter-actions leads to the pairwise association of mol-ecules.

Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus.

BACKGROUND: Middle East respiratory syndrome (MERS) is caused by a coronavirus (MERS-CoV) and is characterized by hypoxemic respiratory failure. The objective of this study is to compare the outcomes of MERS-CoV patients before and after the availability of extracorporeal membrane oxygenation (ECMO) as a rescue therapy in severely hypoxemic patients who failed conventional strategies. METHODS: We collected data retrospectively on MERS-CoV patients with refractory respiratory failure from April 2014 to December 2015 in 5 intensive care units (ICUs) in Saudi Arabia. Patients were classified into two groups: ECMO versus conventional therapy. Our primary outcome was in-hospital mortality; secondary outcomes included ICU and hospital length of stay. RESULTS: Thirty-five patients were included; 17 received ECMO and 18 received conventional therapy. Both groups had similar baseline characteristics. The ECMO group had lower in-hospital mortality (65 vs. 100%, P = 0.02), longer ICU stay (median 25 vs. 8 days, respectively, P < 0.01), and similar hospital stay (median 41 vs. 31 days, P = 0.421). In addition, patients in the ECMO group had better PaO2/FiO2 at days 7 and 14 of admission to the ICU (124 vs. 63, and 138 vs. 36, P < 0.05), and less use of norepinephrine at days 1 and 14 (29 vs. 80%; and 36 vs. 93%, P < 0.05). CONCLUSIONS: ECMO use, as a rescue therapy, was associated with lower mortality in MERS patients with refractory hypoxemia. The results of this, largest to date, support the use of ECMO as a rescue therapy in patients with severe MERS-CoV.

Stroke in CT-scan Department of Khartoum Hospital, Sudan.

Prospective data were collected on consecutive patients admitted to Khartoum Teaching Hospital with a diagnosis of stroke. Risk factors and clinical characteristics were assessed by neurological examination and computed tomography scan. A total of 128 patients were enrolled in the study, of whom 74 (57.8%) were men. The age (mean+/-standard deviation) of the patients was 53+/-18.5 years. Eighty-five (66.4%) and 43 (33.6%) patients had ischaemic and haemorrhagic stroke, respectively. Hypertension, diabetes mellitus, smoking, heart disease and hypercholesterolaemia were the risk factors for stroke. Thus, further studies are needed on stroke. Hypertension should be discovered early and treated effectively.

Persistence of otoacoustic emissions in children with auditory neuropathy spectrum disorders.

OBJECTIVES: Many studies confirmed the disappearance of otoacoustic emissions in some of the patients with auditory neuropathy spectrum disorder, yet the data about the incidence rate of such disappearance is scanty or even absent. This study aims to test the persistence of transient evoked otoacoustic emissions in patients with auditory neuropathy spectrum disorder over few years. METHODS: The study group consisted of 77 subjects (31 females and 46 males). Their ages ranged from 4 to 9 years (5.5 ± 1.5). All the subjects were previously diagnosed to have auditory neuropathy spectrum disorder affecting both ears. Transient evoked otoacoustic emissions test results of the recent follow up sessions were compared with their initial diagnostic evaluation sessions done 3-6 years ago (3.7 ± 0.8), in order to test the persistence of the emissions and the reduction of emissions level. RESULTS: The transient evoked otoacoustic emissions level was reduced in the follow up visit compared to the initial study group. The transient evoked otoacoustic emissions level showed insignificant reduction (less than 3dB) in 77.3% of the ears in the study group, and significant reduction (i.e. 3dB or more) in 20.8%, and was absent in 1.9%. The transient evoked otoacoustic emissions level reduction in the different study subgroups was homogenous; gender (males versus females) laterality (right versus left ears) incubated to neonatal intensive care unit versus those non incubated all showed no significant differences in transient evoked otoacoustic emissions level reduction. Moreover, the duration of auditory neuropathy spectrum disorder was not correlated to the degree of transient evoked otoacoustic emissions reduction. Those fitted with hearing aids had more reduction in their transient evoked otoacoustic emissions level compared with those not fitted with hearing aids. CONCLUSIONS: (1) Transient evoked otoacoustic emissions was still detected in 98.1% of patients with auditoryneuropathy spectrum disorder few years after the diagnosis.(2) Those fitted with hearing aids showed the most pronounced reduction in transient evokedotoacoustic emissions level.

Synthesis and antimicrobial activity of novel 5-amino-4-cyano-1H-pyrazole and quinazolin-4(3H)-one derivatives.

New substituted aroylhydrazones (4a-f) were synthesized from the acid hydrazide (3) and the corresponding aldehyde or aldose. 5-Amino-4-cyano-1H-pyrazole derivatives (6a-f) were prepared by the reaction of the aroylhydrazones (4a-f) with malononitrile. The synthesized compounds were tested for antimicrobial activity against various bacteria and fungi and showed moderate to high inhibition activities. Compounds incorporating a sugar moiety as well as a pyrazolyl ring in their structure displayed the highest antimicrobial activity.

Prevalence and risk factors of hearing impairment among primary-school children in Shebin El-kom District, Egypt.

PURPOSE: This study examined the feasibility of screening hearing loss in rural and urban schools in Egypt, and investigated the prevalence and causes of hearing impairment (HI) in Egyptian primary-school students. METHOD: A total of 555 children (6-12 years of age) from a rural and an urban school in the Shebin El-Kom District of Egypt were screened for HI at their schools. A 2-stage screening procedure was used, and positive cases were referred for a diagnostic hearing assessment at a regional medical facility. Risk factors were investigated through a parent questionnaire and an environmental study consisting of noise, ventilation, and crowding measurements at the schools. RESULTS: The screening failure rate was 25.6%, and the prevalence of confirmed HI was 20.9%. The rate of HI did not differ across the schools. Conductive hearing loss of minimal to mild severity was the most common type of HI. The most important predictors for HI were parent suspicion, otitis media, household smoking, low socioeconomic status, and postnatal jaundice. CONCLUSIONS: The prevalence of HI did not differ across settings and was more common than reported in children from developed countries. The screening results also suggest that professionals with limited audiology background can be trained to implement hearing screening programs in Egyptian schools.