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CORD-19:cbab61c03b58e81082109fa56830f400890485fc JSONTXT 9 Projects

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T1 0-140 Sentence denotes Clinical characteristics and outcome of ICU admitted MERS corona virus infected patients Egyptian Journal of Chest Diseases and Tuberculosis
T2 142-150 Sentence denotes Abstract
T3 151-263 Sentence denotes Middle East Respiratory Syndrome (MERS) is a novel respiratory illness firstly reported in Saudi Arabia in 2012.
T4 264-336 Sentence denotes It is caused by a new corona virus, called MERS corona virus (MERS-CoV).
T5 337-420 Sentence denotes Most people who have MERS-CoV infection developed severe acute respiratory illness.
T6 421-437 Sentence denotes Aim of the work:
T7 438-595 Sentence denotes This work is done to determine the clinical characteristics and the outcome of intensive care unit (ICU) admitted patients with confirmed MERS-CoV infection.
T8 596-617 Sentence denotes Patients and methods:
T9 618-725 Sentence denotes This study included 32 laboratory confirmed MERS corona virus infected patients who were admitted into ICU.
T10 726-780 Sentence denotes It included 20 (62.50%) males and 12 (37.50%) females.
T11 781-818 Sentence denotes The mean age was 43.99 ± 13.03 years.
T12 819-1010 Sentence denotes Diagnosis was done by real-time reverse transcription polymerase chain reaction (rRT-PCR) test for corona virus on throat swab, sputum, tracheal aspirate, or bronchoalveolar lavage specimens.
T13 1011-1095 Sentence denotes Clinical characteristics, co-morbidities and outcome were reported for all subjects.
T14 1096-1104 Sentence denotes Results:
T15 1105-1413 Sentence denotes The main symptoms among the included patients were: fever (96.87%), cough (93.75%), dyspnea (90.62%), sore throat (75%), runny nose (75%), sputum (50%), headache (43.75%), myalgia (40.62%), chest pain (37.50%), hemoptysis (37.50%), nausea and vomiting (34.37%), abdominal pain (21.87%) and diarrhea (15.62%).
T16 1414-1507 Sentence denotes The presence of abdominal symptoms is significantly (P < 0.05) associated with bad prognosis.
T17 1508-1604 Sentence denotes Out of the included 32 patients, 18 patients (56.25%) survived and 14 patients (43.75%) expired.
T18 1605-1812 Sentence denotes There was a statistically significant difference in the duration of symptoms before hospitalization, mechanical ventilation and ICU and total hospital stay between the expired group and survivors (P < 0.01).
T19 1813-1944 Sentence denotes Current smoking and smoking severity were statistically significantly (P < 0.01) higher in the expired group compared to survivors.
T20 1945-2072 Sentence denotes Also, there was a statistically (P < 0.05) significant positive correlation between mortality and smoking severity (r = 0.640).
T21 2073-2470 Sentence denotes Most of the expired patients presented with bilateral pulmonary infiltrates or unilateral infiltrates, but most of the survivors presented with normal This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). radiology or increased bronchovascular markings, and this difference in the results was statistically highly significant (P < 0.01).
T22 2471-2739 Sentence denotes There were statistically highly significant (P < 0.01) differences in the mean values of APACHE II score (21.11 ± 3.70 vs 24.21 ± 3.82), SOFA score (5.83 ± 2.64 vs 8.85 ± 2.17) and CPIS (7.55 ± 1.14 vs 8.64 ± 1.39) between the expired group and survivors respectively.
T23 2740-2960 Sentence denotes Also, there was a statistically significant decrease in PH, PaO 2 , O 2 saturation and HCO 3 (P < 0.05) among the expired group in comparison with the survivors, but no statistical difference regarding PaCO 2 (P > 0.05).
T24 2961-3294 Sentence denotes There was a statistically significant positive correlation between mortality and old age (r = 0.633), obesity (r = 0.712), diabetes mellitus (r = 0.685), renal failure (r = 0.705), chronic heart diseases (0.591), COPD (r = 0.523), malignancy (r = 0.692), kidney transplantation (r = 0.644) and liver cirrhosis (r = 0.525) (P < 0.05).
T25 3295-3427 Sentence denotes There was a statistically (P < 0.05) positive correlation between the number of associated co-morbidities and mortality (r = 0.735).
T26 3428-3440 Sentence denotes Conclusions:
T27 3441-3538 Sentence denotes Most MERS corona patients present with fever, cough, dyspnea, sore throat, runny nose and sputum.
T28 3539-3601 Sentence denotes The presence of abdominal symptoms may indicate bad prognosis.
T29 3602-3876 Sentence denotes Prolonged duration of symptoms before patients' hospitalization, prolonged duration of mechanical ventilation and hospital stay, bilateral radiological pulmonary infiltrates, and hypoxemic respiratory failure were found to be strong predictors of mortality in such patients.
T30 3877-4184 Sentence denotes Also, old age, current smoking, smoking severity, presence of associated co-morbidities like obesity, diabetes mellitus, chronic heart diseases, COPD, malignancy, renal failure, renal transplantation and liver cirrhosis are associated with a poor outcome of ICU admitted MERS corona virus infected patients.
T31 4186-4271 Sentence denotes Organization reported the first case of pneumonia caused by MERS-CoV in Saudi Arabia.
T32 4272-4354 Sentence denotes All cases of MERS have been linked to countries in and near the Arabian Peninsula.
T33 4355-4479 Sentence denotes This virus has spread from ill people to others through close contact, such as caring for or living with an infected person.
T34 4480-4536 Sentence denotes Also, contact with the camels may be a potential source.
T35 4537-4609 Sentence denotes However, there is no evidence of sustained spread in community settings.
T36 4610-4682 Sentence denotes Most MERS patients developed a severe acute respiratory illness [1, 2] .
T37 4683-4818 Sentence denotes This work is done to determine the clinical characteristics and the outcome of ICU admitted patients with confirmed MERS-CoV infection.
T38 4819-4917 Sentence denotes This study included 32 laboratory confirmed MERS corona virus patients who were admitted into ICU.
T39 4918-4973 Sentence denotes Consent was taken from the patients or their relatives.
T40 4974-5010 Sentence denotes All studied cases were subjected to:
T41 5011-5036 Sentence denotes (1) Full medical history.
T42 5037-5071 Sentence denotes (2) Thorough clinical examination.
T43 5072-5284 Sentence denotes (3) Calculation of body mass index (BMI): a BMI of >30 is considered obese according to WHO [3] . (4) Routine laboratory investigations (complete blood count, kidney and liver functions, and blood sugar testing).
T44 5285-6042 Sentence denotes (5) Radiological assessment: chest X-ray (posteroanterior and lateral views) and computed tomography (CT). (6) Arterial blood gases, including; PH, PaO 2 , SaO 2 , PaCO 2 and HCO 3 . (7) Acute Physiology and Chronic Health Evaluation II (APACHE II) score, the Sequential Organ Failure Assessment score (SOFA) and the Clinical Pulmonary Infection Score (CPIS). (8) Throat swab (Eurotubo, Deltalab, 08191 Rubı´, Barcelona, Spain), sputum, tracheal aspirate or bronchoalveolar lavage specimens were taken and stored at 28°C, and transported within 72 h to the reference laboratories, where they were subjected to real-time reverse-tran scriptase-polymerase-chain-reaction (rRT-PCR) assays to test for MERS-CoV (Altona Diagnostics GmbH, 22767 Hamburg, Germany).
T45 6043-6160 Sentence denotes For all patients, the results of rRT-PCR tests were confirmed by measuring cyclethreshold values for viral load [4] .
T46 6161-6307 Sentence denotes The statistical analysis was performed with the Statistical Package for the Social Sciences, version 16 for Windows (SPSS Inc., Chicago, IL, USA).
T47 6308-6356 Sentence denotes Chi-square test was used to measure association.
T48 6357-6416 Sentence denotes Pearson's correlation test was used to measure correlation.
T49 6417-6478 Sentence denotes Values of P < 0.05 were considered statistically significant.
T50 6479-6547 Sentence denotes In this study, there were 20 (62.50%) males and 12 (37.50%) females.
T51 6548-6585 Sentence denotes The mean age was 43.99 ± 13.03 years.
T52 6586-6919 Sentence denotes The main symptoms among the included patients were: fever (96.87%), cough (93.75%), dyspnea (90.62%), sore throat (75%), runny nose (75%), sputum (50%), headache (43.75%), myalgia (40.62%), chest pain (37.50%), hemoptysis (37.50%), nausea and vomiting (34.37%), abdominal pain (28.12%), abdominal pain (21.87%) and diarrhea (15.62%).
T53 6920-7012 Sentence denotes The mean duration of symptoms before seeking medical advice was 5.30 ± 3.25 days (Table 1) .
T54 7013-7089 Sentence denotes The chest radiological findings among the included patients were as follows:
T55 7090-7250 Sentence denotes 8 (25%) normal chest radiology, 5 (15.63%) increased bronchovascular markings, 7 (21.87%) unilateral infiltrates, and 12 (37.50%) diffuse bilateral infiltrates.
T56 7251-7387 Sentence denotes Pneumothorax occurred in 5 (15.63%) ventilated patients, for 3 of them it was unilateral and for other 2 patients bilateral ( Table 1) .
T57 7388-7438 Sentence denotes Regarding the ABGs findings in our study: mean PH:
T58 7439-7464 Sentence denotes 7.26 ± 0.33, mean PaO 2 :
T59 7465-7505 Sentence denotes 64.04 ± 20.50 mmHg, mean O 2 saturation:
T60 7506-7534 Sentence denotes 83.92 ± 17.45, mean PaCO 2 :
T61 7535-7599 Sentence denotes 38.75 ± 4.17 mmHg, and mean HCO 3 19.44 ± 8.5 meq/L ( Table 1 ).
T62 7600-7720 Sentence denotes The mean APACHE II score was 22.46 ± 4.01, the mean SOFA score was 7.15 ± 2.85 and mean CPIS was 8.03 ± 1.35 (Table 1) .
T63 7721-7925 Sentence denotes Regarding the presence of co-morbidity, 21 (65.62%) patients out of the included 32 patients were associated with one or more co-morbidities and 11 (34.38%) patients were without co-morbidity ( Table 2) .
T64 7926-8014 Sentence denotes All patients were admitted in ICU and a mean duration of ICU stay was 11.32 ± 4.50 days.
T65 8015-8152 Sentence denotes Regarding mechanical ventilation need, there were 23 (71.87%) ventilated patients and 9 (28.13%) patients without mechanical ventilation.
T66 8153-8242 Sentence denotes For ventilated patients the mean duration of mechanical ventilation was 6.21 ± 3.76 days.
T67 8243-8302 Sentence denotes The mean total hospital stay was 15 ± 3.6 days ( Table 1) .
T68 8303-8389 Sentence denotes According to the outcome of 32 patients included in this study, there were two groups:
T69 8390-8584 Sentence denotes (1) The survivor group that included 18 patients (56.25%) with a mean age of 37.25 ± 15.50 years. (2) The expired group that included 14 patients (43.75%) with a mean age of 50.47 ± 13.80 years.
T70 8585-8754 Sentence denotes There was a highly statistically significant (P < 0.01) difference between the expired group and the survivors regarding the duration of mechanical ventilation (expired:
T71 8755-8778 Sentence denotes 9.64 ± 2.46, survivors:
T72 8779-8811 Sentence denotes 3.55 ± 2.00), ICU stay (expired:
T73 8812-8836 Sentence denotes 13.98 ± 3.50, survivors:
T74 8837-8883 Sentence denotes 8.66 ± 2.40) and total hospital stay (expired:
T75 8884-8908 Sentence denotes 17.50 ± 2.92, survivors:
T76 8909-8935 Sentence denotes 13.06 ± 2.81) ( Table 2) .
T77 8936-9280 Sentence denotes In this study, in spite of a statistically significant (P < 0.05) increase in occurrence of corona virus infection among males in comparison with females (62.50% males and 37.50% females), there was no statistically significant difference (P > 0.05) in the mortality among them (45% among males and 41.67% among females) (P > 0.05) ( Table 2) .
T78 9281-9416 Sentence denotes Current smoking and smoking severity were statistically significantly (P < 0.01) higher in the expired group compared to the survivors.
T79 9417-9548 Sentence denotes Non smoking and ex smoking were statistically significantly (P < 0.01) higher among survivors in comparison with the expired group.
T80 9549-9688 Sentence denotes Also, there was a statistically (P < 0.05) significant positive correlation between mortality and smoking severity (r = 0.640) ( Table 2) .
T81 9689-10074 Sentence denotes In this study, there were no statistically significant differences between the expired and survivors groups as regards fever, cough, dyspnea, runny nose, sore throat, chest pain, hemoptysis, myalgia or headache (P > 0.05), but there was a statistically significant increase in frequency of nausea, vomiting and diarrhea among the expired group than that among the survivors (P < 0.05).
T82 10075-10264 Sentence denotes Also, there was a statistically significant increase in the duration of the symptoms before the hospitalization among the expired group than that among the survivors (P < 0.05) ( Table 2 ).
T83 10265-10422 Sentence denotes There was a statistically significant (P < 0.05) positive correlation (r = 0.681) between mortality and prolonged duration of illness before hospitalization.
T84 10423-10740 Sentence denotes Our study showed that most of the expired patients presented with bilateral pulmonary infiltrates or unilateral infiltrates, but most of the survivors presented with normal radiology or increased bronchovascular markings, and this difference in the results was statistically highly significant (P < 0.01) ( Table 2) .
T85 10741-10932 Sentence denotes There were statistically highly significant (P < 0.01) differences in the mean values of APACHE II score (21.11 ± 3.70 vs 24.21 ± 3.82), SOFA score (5.83 ± 2.64 vs 8.85 ± 2.17) and Table 2) .
T86 10933-11166 Sentence denotes This study found a statistically significant decrease in PH, PaO 2 , O 2 saturation and HCO 3 (P < 0.05) among the expired group in comparison with the survivors, but no statistical difference regarding PaCO 2 (P > 0.05) ( Table 2) .
T87 11167-11606 Sentence denotes As regards the correlation between mortality and specific co-morbidities, there was a statistically significant positive correlation between mortality and old age (r = 0.633, smoking (r = 0.640), obesity (r = 0.712), diabetes mellitus (r = 0.685), renal failure (r = 0.705), chronic heart diseases (0.591), COPD (r = 0.523), malignancy (r = 0.692), kidney transplantation (r = 0.644) and liver cirrhosis (r = 0.525) (P < 0.05), (Table 3) .
T88 11607-11736 Sentence denotes There was a statistical (P < 0.05) positive correlation between the number of associated comorbidities and mortality (r = 0.735).
T89 11738-11806 Sentence denotes In this study, there were 20 (62.50%) males and 12 (37.50%) females.
T90 11807-12063 Sentence denotes This sex distribution showed a significant (P < 0.05) increase in the occurrence of corona virus infection among males, but there was no statistically significant difference (P > 0.05) in the mortality among them (45% among males and 41.67% among females).
T91 12064-12118 Sentence denotes Our results agree with other workers' results [6, 7] .
T92 12119-12293 Sentence denotes The increased occurrence of corona virus infection among males can be explained by excess movement of the males through community with more exposure to the infected patients.
T93 12294-12554 Sentence denotes In this study, there was high mortality (14 patients (43.75%) out of 32) among corona virus infected patients and there was a statistically significant (P < 0.05) increase in mortality in middle and old aged patients in comparison to young patients (mean ages:
T94 12555-12627 Sentence denotes 50.47 ± 13.80 among the expired group vs 37.25 ± 15.50 among survivors).
T95 12628-12742 Sentence denotes Also, there was a statistically significant (P < 0.05) positive correlation (r = 0.633) between age and mortality.
T96 12743-12829 Sentence denotes Other researchers found similar results [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] .
T97 12830-13040 Sentence denotes This high mortality rate among corona virus infected old patients is explained by the high virulence of the new virus in the absence of previous immunity and already compromised immune system among old peoples.
T98 13041-13204 Sentence denotes The most common symptoms among the included patients were: fever (96.87%), cough (93.75%), dyspnea (90.62%), sore throat (75%), runny nose (75%), and sputum (50%).
T99 13205-13562 Sentence denotes There were statistically significant differences between the expired and survivors groups regards fever, cough, dyspnea, runny nose, sore throat, chest pain, hemoptysis, myalgia or headache (P > 0.05), but the frequency of nausea, vomiting and diarrhea were statistically significant higher among the expired group in comparison to the survivors (P < 0.05).
T100 13563-13752 Sentence denotes These findings could be explained by the fact that the presence of nausea, vomiting and diarrhoea leads to dehydration (due to poor oral intake and fluid loss) with its detrimental effects.
T101 13753-13967 Sentence denotes The duration of symptoms before hospitalization, ICU stay, mechanical ventilation and hospital stay in our studied patients were statistically significantly prolonged in the expired group compared to the survivors.
T102 13968-14131 Sentence denotes Also, there was a statistically significant (P < 0.05) positive correlation (r = 0.681) between mortality and prolonged duration of illness before hospitalization.
T103 14132-14191 Sentence denotes Other investigators found similar results [5] [6] [7] [8] .
T104 14192-14443 Sentence denotes These results can be explained by a delay in diagnosis and management of corona infected patients' result in deterioration in their health status with more need for ICU admission, mechanical ventilation, increased total hospital stay and poor outcome.
T105 14444-14687 Sentence denotes Also, Al-Tawfiq et al. [9] found that corona patients in comparison with controls were more likely to be admitted to the intensive care unit (53% vs 20%; OR, 4.65; P = .025) and to have a high mortality rate (76% vs 15%; OR, 18.96; P < 0.001).
T106 14688-14764 Sentence denotes The chest radiological findings among the included patients were as follows:
T107 14765-14925 Sentence denotes 8 (25%) normal chest radiology, 5 (15.63%) increased bronchovascular markings, 7 (21.87%) unilateral infiltrates, and 12 (37.50%) diffuse bilateral infiltrates.
T108 14926-15050 Sentence denotes Pneumothorax occurred in 5 (15.63%) ventilated patients, for 3 of them it was unilateral and for other 2 patients bilateral.
T109 15051-15334 Sentence denotes Most of the expired patients presented with bilateral pulmonary infiltrates or unilateral infiltrates, but most of the survivors presented with normal radiology or increased bronchovascular markings, and this difference in the results was statistically highly significant (P < 0.01).
T110 15335-15425 Sentence denotes Our findings agree with other investigators who detected similar results [7] [8] [9] 15] .
T111 15426-15674 Sentence denotes These extensive radiological shadows are denoting extensive lung pathology with its detrimental effects on pulmonary gas exchange and general condition of the patients with more need for mechanical ventilation and are associated with bad prognosis.
T112 15675-15894 Sentence denotes This study found a statistically significant decrease in PH, PaO 2 , O 2 saturation and HCO 3 (P < 0.05) among the expired group in comparison to the survivors, but no statistical difference regarding PaCO 2 (P > 0.05).
T113 15895-16107 Sentence denotes Our results are in accordance with that of Reyes et al. [16] who reported that one of the independent variables that were associated with high mortality was hypoxemia among SARS patients caused by a corona virus.
T114 16108-16243 Sentence denotes Current smoking and smoking severity were statistically significantly (P < 0.01) higher in the expired group compared to the survivors.
T115 16244-16379 Sentence denotes Non smoking and ex smoking were statistically significantly (P < 0.01) higher among the survivors in comparison with the expired group.
T116 16380-16505 Sentence denotes Also, there was statistically (P < 0.05) significant positive correlation between mortality and smoking severity (r = 0.640).
T117 16506-16721 Sentence denotes These results are in agreement with previous data that showed that smoking is a major determinant of morbidity and mortality in respiratory tract infection, especially in populations that smoke heavily [6] [7] [8] .
T118 16722-16832 Sentence denotes Cigarette smoking is associated with a variety of alterations in cellular and humoral immune system functions.
T119 16833-17132 Sentence denotes These alterations include a decreased level of circulating immunoglobulins, a depression of antibody responses to certain antigens, a decrease in CD4+ lymphocyte counts, an increase in CD8+ lymphocyte counts, depressed phagocyte activity and a decreased release of pro inflammatory cytokines. [17] .
T120 17133-17253 Sentence denotes Smoking increases CD8+ lymphocytes in the cell mediated system and suppresses the host defense against infections [18] .
T121 17254-17366 Sentence denotes There was a statistically significant (P < 0.05) positive correlation between mortality and obesity (r = 0.712).
T122 17367-17528 Sentence denotes Several studies indicate that morbid obesity may be an independent risk factor for complications and mortality from MERS corona virus infection [6] [7] [8] [9] .
T123 17529-17575 Sentence denotes There are some explanations for these results.
T124 17576-17675 Sentence denotes Obesity can impede pulmonary function (reduced functional residual capacity and expiratory volume).
T125 17676-17851 Sentence denotes A subsequent ventilation-perfusion abnormality may decrease ventilatory reserve and predispose the obese to respiratory failure after even mild pulmonary challenges [19, 20] .
T126 17852-18009 Sentence denotes Obstructive sleep apnea is present in 40% of obese persons and is associated with systemic hypertension, pulmonary hypertension, and cor pulmonale [21, 22] .
T127 18010-18105 Sentence denotes Obese persons are at an increased risk of developing pulmonary emboli and aspiration pneumonia.
T128 18106-18249 Sentence denotes Morbid obesity is associated with complications in the intensive care unit including prolonged stay, prolonged ventilation and death [23, 24] .
T129 18250-18450 Sentence denotes In addition to its effects on pulmonary function, obesity is frequently, but not always associated with diabetes, hypertension, hyperlipidemia, cardiovascular disease and high overall mortality [20] .
T130 18451-18759 Sentence denotes Our work found a statistically significant positive correlation between mortality and diabetes mellitus (r = 0.685), renal failure (r = 0.705), chronic heart diseases (0.591), COPD (r = 0.523), malignancy (r = 0.692), kidney transplantation (r = 0.644) and liver cirrhosis (r = 0.525) (P < 0.05), (Table 3) .
T131 18760-18893 Sentence denotes There was a statistically (P < 0.05) positive correla-tion between the number of associated co-morbidities and mortality (r = 0.735).
T132 18894-18994 Sentence denotes Our results are in accordance with other workers' results [6] [7] [8] [9] [10] [11] [12] [13] [14] .
T133 18995-19199 Sentence denotes Also, Arabi et al. [25] concluded that people with DM, renal failure, and chronic lung disease and immuno-compromised persons are considered to be at a high risk of severe disease from MERS CoV infection.
T134 19200-19512 Sentence denotes Also, our results are in agreement with previous data showing that patients who are immuno-compromised as a result of chronic diseases, malignancy, receiving treatment related to solid organ transplants and DM are at a high risk of respiratory tract infection-related complications including mortality [26, 27] .
T135 19513-19737 Sentence denotes Immuno-compromised patients have an increased attention because of the documentation of prolonged viral shedding in critically ill patients, with the subsequent emergence of resistance to neuraminidase inhibitor drugs [28] .
T136 19738-20088 Sentence denotes Renal failure population has many factors such as overwhelming uremia, neutrophil dysfunction, malnutrition, trace elements' deficiencies, iron overload, impaired glucose metabolism, and hyperparathyroidism, and the use of immunosuppressive drugs to treat and control underlying diseases leads to increased morbidity and mortality of infection [29] .
T137 20089-20603 Sentence denotes Casqueiro et al. [30] concluded that the infectious diseases are more frequent and/or serious in patients with DM, which potentially increases their morbidity and mortality due to many factors as a deficiency of the C4 component in DM, this reduction of C4 is probably associated with polymorphonuclear dysfunction and reduced cytokine response decrease secretion of inflammatory cytokines as interleukin-1 (IL-1) and IL-6 decreased mobilization of polymorphonuclear leukocytes, chemotaxis and phagocytic activity.
T138 20604-20666 Sentence denotes CD4 T-lymphocytes and their response to antigens are impaired.
T139 20667-20764 Sentence denotes Most MERS corona patients present with fever, cough, dyspnea, sore throat, runny nose and sputum.
T140 20765-20827 Sentence denotes The presence of abdominal symptoms may indicate bad prognosis.
T141 20828-21102 Sentence denotes Prolonged duration of symptoms before patients' hospitalization, prolonged duration of mechanical ventilation and hospital stay, bilateral radiological pulmonary infiltrates, and hypoxemic respiratory failure were found to be strong predictors of mortality in such patients.
T142 21103-21406 Sentence denotes Also, old age, current smoking, smoking severity, presence of associated co-morbidities like obesity, diabetes mellitus, chronic heart diseases, COPD, malignancy, renal failure, renal transplantation and liver cirrhosis associated with a poor outcome of ICU admitted MERS corona virus infected patients.