This study aims to determine the incidence and outcome of COVID-19 patients who required positive pressure ventilation (PPV) and subsequently developed pulmonary barotrauma (PBT). Also, to investigate the risk factors and predictors of these complications to better understand the disease pathogenesis. Patients and Methods: This retrospective analysis enrolled all adult COVID-19 patients admitted through the period from October 1, 2020, to December 31, 2020. All patients who received any form of PPV were included. Patients were then divided into two groups based on PBT development, including subcutaneous emphysema, pneumothorax, and pneumomediastinum. Medical records of all patients were reviewed. Patients' demographics, laboratory data on admission, respiratory support modes, surgical interventions, and outcomes were collected and analyzed. Results: In the specified period, 1095 patients were hospitalized due to COVID-19 illness. A total of 239 (21.8%) of all admitted patients received PPV. PBT accounted for 21.3% (51/ 239) of the study cohort. While both groups were equally exposed to the same modes of PPV, receiving invasive ventilation significantly correlated with decreased PBT odds (OR = 0.891; 95% CI, 0.803-0.988; p=0.029). PBT patients were significantly younger (p<0.001). Diabetes mellitus was found to have a protective effect on developing PBT (OR = 0.867; 95% CI, 0.782-0.962), while PO 2 /FIO 2 ratio was inversely associated with higher odds of developing PBT in both univariate and multivariate analyses (p=0.03 and p=0.019, respectively). Conclusion: COVID-19-infected patients are at a higher risk of developing PBT. Invasive positive pressure ventilation was associated with less PBT compared to noninvasive ventilation and delaying intubation does not seem to reduce the risk of pulmonary barotrauma.

Aim: Pneumothorax (PNX), pneumomediastinum (PMD) and subcutaneous emphysema (SCE) are COVID-19 complications related to positive-pressure ventilation. We analyzed the pathophysiology of these complications without ventilation. Patients & methods: Out of 1845 admitted COVID-19 patients, we retrospectively collected data for 15 patients, from a tertiary medical center, from 1 October 2020 to 31 March 2021. Results: Five patients suffered from spontaneous PNX, 8/15 developed PMD and 8/15 developed SCE. The mean BMI was 29.7, as most patients were obese or overweight. Most patients had lymphocytopenia and increased C-reactive protein, ferritin and lactate dehydrogenase levels. Eleven patients succumbed to the disease. Conclusion: Risk factors of spontaneous PNX, PMD and SCE in COVID-19 patients need further investigations by conducting more comprehensive case–control studies.

Background: Thymolipoma is a rare benign thymic tumor that arises in the anterior mediastinum. It presents with non-specific symptoms such as chest pain and dyspnea due to compression of the tumor on surrounding structures. In addition, this tumor is associated with paraneoplastic syndromes, including myasthenia gravis. Such a relationship is still not understood and requires investigation. Objective: Investigate the significance of myasthenia gravis in thymolipoma patients. Methods: We present a series of 16 thymolipoma cases from multiple medical centers. Data extraction included demographic, diagnostic, radiological and laboratory, and clinical outcome variables. We also used the modified Osserman score to assess the severity of myasthenia gravis. Results: Ten patients were males, and six were females; the sample mean age was 39.9 years (SD = 16.7). Upon presentation, 7/16 patients were asymptomatic, 4/16 patients had chest pain, and 2/16 had dyspnea. Seven patients were having myasthenia gravis; they experience generalized weakness (3/7), diplopia (2/7), ptosis (1/7), and bulbar weakness (1/7). Serum acetylcholine receptor antibody (AChRAb) was positive in 4 patients. All patients underwent thymectomy either via sternotomy or thoracotomy. After proper follow-up, only 2/7 of myasthenic patients had a complete remission of symptoms, no tumor recurrence was observed. Conclusion: Although the effect of using steroids in myasthenic patients on thymolipomic transformation still needs confirmation, diagnosis of thymolipoma should be kept in mind in myasthenic patients presenting with relevant symptoms and taking steroids. Furthermore, complete remission of myasthenic symptoms after removal of thymolipoma needs further investigation.

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