Introduction: One important concern during the management of COVID-19 pneumonia patients with acute hypoxemic respiratory failure is early anticipation of the need for intubation. ROX is an index that can help in identification of patients with low and those with high risk of intubation. So, this study was planned to validate the diagnostic accuracy of the ROX index for prediction of COVID-19 pneumonia outcome (the need for intubation) and, in addition, to underline the significant association of the ROX index with clinical, radiological, demographic data. Material and methods: Sixty-nine RT-PCR positive COVID-19 patients were enrolled. The following data were collected: medical history, clinical classification of COVID-19 infection, the ROX index measured daily and the outcome assessment. Results: All patients with severe COVID-19 infection (100%) were intubated (50% of them on the 3 rd day of admission), but only 38% of patients with moderate COVID-19 infection required intubation (all of them on the 3 rd day of admission). The ROX index on the 1 st day of admission was significantly associated with the presence of comorbidities, COVID-19 clinical classification, CT findings and intubation (p ≤ 0.001 for each of them). Regression analysis showed that sex and ROX.1 are the only significant independent predictors of intubation [AOR (95% CI): 16.9 (2.4-117), 0.77 (0.69-0.86)], respectively. Cut-off point of the ROX index on the 1 st day of admission was ≤ 25.26 (90.2% of sensitivity and 75% of specificity). Conclusions: ROX is a simple noninvasive promising tool for predicting discontinuation of high-flow oxygen therapy and could be used in the assessment of progress and the risk of intubation in COVID-19 patients with pneumonia.

BackgroundBronchoscopic lung volume reduction (BLVR), using biological agents, is one of the new alternatives to lung volume reduction surgery.ObjectivesTo evaluate efficacy and safety of biological BLVR using low cost agents including autologous blood and fibrin glue.MethodsEnrolled patients were divided into two groups: group A (seven patients) in which autologous blood was used and group B (eight patients) in which fibrin glue was used. The agents were injected through a triple lumen balloon catheter via fiberoptic bronchoscope. Changes in high resolution computerized tomography (HRCT) volumetry, pulmonary function tests, symptoms, and exercise capacity were evaluated at 12 weeks postprocedure as well as for complications.ResultsIn group A, at 12 weeks postprocedure, there was significant improvement in the mean value of HRCT volumetry and residual volume/total lung capacity (% predicted) (P-value: <0.001 and 0.038, respectively). In group B, there was significant improvement in the mean value of HRCT volumetry and (residual volume/total lung capacity % predicted) (P-value: 0.005 and 0.004, respectively). All patients tolerated the procedure with no mortality.ConclusionBLVR using autologous blood and locally prepared fibrin glue is a promising method for therapy of advanced emphysema in term of efficacy, safety as well as cost effectiveness.

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Background: Pleural malignancy either primary or due to metastatic involvement can be presented by different macroscopic appearances in thoracoscopic examination of pleural cavity.Purpose: To identify the relationship between thoracoscopic view of different malignant pleural lesions and pathological types of malignancy in malignant pleural effusion.Patients and methods: A retrospective study reviewing medical reports of sixty-nine (69) patients who underwent medical thoracoscopy and were confirmed to be malignant pleural effusion by pleural tissue biopsy as well as macroscopic appearances of malignant pleural lesions were identified.Results: Metastatic adenocarcinoma was the main type of malignancy (46 cases 66.7%), followed by malignant lymphoma (9 cases 13%), malignant mesothelioma (4 cases 5.8%), squamous cell carcinoma (4 cases 5.8%), small cell carcinoma (3 cases 4.3%), sarcoma (2 cases 2.9%) and lastly spindle cell tumor (single case 1.4%). Nodular appearance of malignant pleural lesions was the main thoracoscopic finding (75.45%) followed by masses (50.7%), plaques (20.3%) and lastly adhesions (14.5%) of cases. Nodules represented the main thoracoscopic finding in both metastatic adenocarcinoma and malignant lymphoma (82.6% and 77.78%, respectively) afterward masses (45.65% and 66.67%, respectively). However; masses represented the main thoracoscopic finding (100%) in malignant mesothelioma followed by nodules (50%).Conclusion: Inspecting pleural cavity via medical thoracoscopy and identification of macroscopic appearance of different malignant pleural lesions may give a good prospect about the suspected pathological type of malignancy in malignant pleural effusion.

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