Corticosteroid therapy in patients with MERS was not associated with a difference in mortality after adjustment for time-varying confounders but was associated with delayed MERS coronavirus RNA clearance. These findings highlight the challenges and importance of adjusting for baseline and time-varying confounders when estimating clinical effects of treatments using observational studies.

Introduction The emergence of the Severe Acute Respiratory Syndrome Coroanvirus 2 (SARS-CoV-2) had raised possibilities of coinfection with the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in countries were these two viruses were reported. In this study, we describe the clinical presentation and demographics of eight patients who were coinfected with SARS-CoV-2 and MERS-CoV. Materials and Methods This is a case series of hospitalized patients admitted to Saudi intensive care units (ICUs). We collected demographics, underlying conditions, presenting symptoms and clinical outcome from the patients’ medical records. Results During the study period from March 14, 2020 to October 19, 2020, there was a total of 67 SARS-CoV-2 ICU admitted patients who underwent simultaneous SARS-CoV-2 and MERS-CoV testing. Of those patients, 8 (12%) tested positive for both SARS-CoV-2 and MERS-CoV. There were 6 (75%) males, the mean age + SD was 44.4 + 11.8 years, and 7 (87.5%) were obese. Of the patients, 7 (87.5%) were non-smokers, 1 (12.5%) had diabetes mellitus, 1 (12.5%) had heart failure, and 1 (12.5%) had been on anti-platelet therapy. The mean hospital length of stay (LOS) was 21.1 + 11.6 days and the average ICU LOS was 10.9 + 6.03 days. All patients received supportive therapy and all were treated with corticosteroid. Of all the patients, 4 (50%) were discharged home and 3 (37.5%) died. Conclusion This case series is an important addition to the medical knowledge as it showed the interaction of the coinfection of SARS-CoV-2 and MERS-CoV.

Background Dedicated neurocritical care units have dramatically improved the management and outcome following brain injury worldwide. Aim This is the first study in the Middle East to evaluate the clinical impact of a neurocritical care unit (NCCU) launched within the diverse clinical setting of a polyvalent intensive care unit (ICU). Design and Methods A retrospective before and after cohort study comparing the outcomes of neurologically injured patients. Group one met criteria for NCCU admission but were admitted to the general ICU as the NCCU was not yet operational (group 1). Group two were subsequently admitted thereafter to the NCCU once it had opened (group 2). The primary outcome was all-cause ICU and hospital mortality. Secondary outcomes were ICU length of stay (LOS), predictors of ICU and hospital discharge, ICU discharge Glasgow Coma Scale (GCS), frequency of tracheostomies, ICP monitoring, and operative interventions. Results Admission to NCCU was a significant predictor of increased hospital discharge with an odds ratio of 2.3 (95% CI: 1.3–4.1; p=0.005). Group 2 (n = 208 patients) compared to Group 1 (n = 364 patients) had a significantly lower ICU LOS (15 versus 21.4 days). Group 2 also had lower ICU and hospital mortality rates (5.3% versus 10.2% and 9.1% versus 19.5%, respectively; all p < 0.05). Group 2 patients had higher discharge GCS and underwent fewer tracheostomies but more interventional procedures (all p < 0.05). Conclusion Admission to NCCU, within a polyvalent Middle Eastern ICU, was associated with significantly decreased mortality and increased hospital discharge.