Background Recent improvements in the use of wide-spectrum antibiotics for the treatment of life-threatening illnesses have led to an upsurge in fungus infections in critical care units. An invasive fungal illness called Mucormycosis is becoming more common among seriously unwell individuals. Due to its strong invasive power and inherently low susceptibility to antifungal treatments, its prognosis is bleak. Our study aimed to determine the incidence of fungi, especially Mucormycosis, in respiratory intensive care units. Methods Patients hospitalized at Menoufia University Hospitals' general and respiratory intensive care units between June 2021 and June 2022 were included in this study. On Sabouraud dextrose agars, bronchial secretions were cultured and evaluated for fungus susceptibility. Results Regarding mechanical ventilation and APACHE II score, there was a substantial difference between fungus growth and absence of fungus growth. Regarding Fate, the presence of bilateral lung consolidation associated with cavitations on CT chest, and APACHE II score, there was a significant difference between negative and positive Mucormycosis development. The most susceptible antifungal agent was Caspofungin. Conclusion In patients in the pulmonary intensive care unit (ICU) who have a high resistance rate, fungus infections are a big issue. The danger of a fungal infection rises with mechanical ventilation. For quick treatment, isolating and diagnosing the fungus is essential.

Purpose Autoimmune rheumatic diseases (ARD) are groups of diseases that are commonly associated with cardiac and pulmonary manifestations and may affect the morbidity and mortality of the patients. The study aimed to the assessment of cardiopulmonary manifestations and their correlation with the semi-quantitative scoring of high-resolution computed tomography (HRCT) in ARD patients. Methods and patients 30 patients with ARD were included in the study (mean age 42.2 ± 9.76 years) [10 patients were scleroderma (SSc), 10 patients were rheumatoid arthritis (RA), and 10 patients were systemic lupus erythematosus (SLE)]. They all met the diagnostic criteria of the American College of Rheumatology and underwent spirometry, echocardiography, and chest HRCT. The HRCT was assessed by a semi-quantitative score for parenchymal abnormalities. Correlation between HRCT lung scores and: inflammatory markers, lung volumes in spirometry, and echocardiographic indices has been performed. Results The total lung score (TLS) by HRCT was 14.8 ± 8.78 (mean ± SD), ground glass opacity score (GGO) was 7.20 ± 5.79 (mean ± SD) and fibrosis lung score (F) was 7.63 ± 6.05 (mean ± SD). TLS correlated significantly with ESR (r 0.528, p 0.003), CRP (r 0.439, p 0.015), PaO2 (r -0.395, P 0.031) FVC% (r -0.687, p 0.001), and echocardiographic Tricuspid E (r -0.370, p 0.044), Tricuspid E/è (r -0.397,p 0.03), ESPAP (r 0.459,p 0.011), TAPSE (r -0.405, p 0.027), MPI-TDI (r -0.428, p 0.018) and RV Global strain(r -0.567, p 0.001). GGO score correlated significantly with ESR (r 0.597, p 0.001), CRP (r 0.473, p 0.008), FVC% (r -0.558, p 0.001), and RV Global strain(r -0.496, p 0.005). F score correlated significantly with FVC% (r -0.397, p 0.030), Tricuspid E/è (r -0.445, p 0.014), ESPAP (r 0.402, p 0.028), and MPI-TDI (r -0.448, p 0.013). Conclusion The total lung score and GGO score in ARD were found to be consistently significantly correlated with FVC% predicted, PaO2, inflammatory markers, and RV functions. Fibrotic score correlated with ESPAP. Therefore, in a clinical setting, most clinicians who monitor patients suffering from ARD should concern with the applicability of semiquantitative HRCT scoring in clinical practice.

Background Incentive spirometry (IS) is mostly used postoperatively to avoid pulmonary complications, but its effect on COPD patients and its effect on diaphragmatic functions are still not fully studied. The current study aimed to evaluate the value of IS on arterial blood gases, mMRC dyspnea scale, spirometry, and diaphragmatic functions by ultrasound in patients hospitalized for COPD exacerbation. Methods and patients Forty patients (37 males, 3 females) were admitted for COPD exacerbations and divided randomly into 2 groups: Group1 (G1) =20 patients (mean age 60.7±5.99) used incentive spirometry (IS) for 2 months with medical treatment. Group 2 as a control group (G2) = 20 patients (mean age 60.3±6.44) were given medical treatment only. ABG, spirometry, mMRC dyspnea scale, and diaphragmatic ultrasound functions were assessed on admission and after 2 months of treatment in the groups. Results There were statistically significant differences between G1 and G2 after 2 months regarding PaCO2, FEV1/FVC (p=0.001 and 0.042, respectively), and Lt diaphragmatic excursion and diaphragm thickness ratio. There was a statistically significant increase in results of PaO2, PaCO2, FEV1/FVC, PEFR, and all diaphragmatic findings in group I before and after 2 months of IS but no difference in FVC and mMRC dyspnea scale. Conclusion Incentive spirometry in COPD patients seems to improve ABG, and spirometry functions together with improving diaphragmatic functions. Trial registration ClinicalTrials.gov NCT05679609. Retrospectively egistered on 10 January 2023

Purpose: Autoimmune rheumatic diseases (ARD) are groups of diseases that are commonly associated with cardiac and pulmonary manifestations and may affect the morbidity and mortality of the patients. This study aimed to the assessment of cardiopulmonary manifestations and its correlation with the semi-quantitative scoring of high-resolution computed tomography (HRCT) in ARD patients.Methods and patients: The study included 30 patients (mean age 42.2±9.76 years) diagnosed with ARD [10 patients were scleroderma (SSc), 10 patients were rheumatoid arthritis (RA), and 10 patients were systemic lupus erythematosus (SLE)]. All patients fulfilled the diagnostic criteria of the American College of Rheumatology and underwent spirometry, echocardiography, disease activity or disability scores, and chest HRCT. The HRCT was assessed by a semi-quantitative score for parenchymal abnormalities including ground glass opacity (GGO), fibrosis (F), and honeycombing (HC).Results: The total lung score by HRCT was 14.8±8.78 (mean±SD). There were statistically significant positive correlations between ESR (r =0.528, p=0.003), CRP (r=0.439, p =0.015) and ESPAP (r=0.459,p=0.011) and total lung score and significant negative correlation between PaO2 (r=-0.395, P=0.031), FVC% (r=-0.687, p=0.001), Tricuspid E(r= -0.370, p=0.044), Tricuspid E/è (r= -0.397,p=0.03), TAPSE (r= -0.405, p=0.027), MPI-TDI(r= -0.428, p=0.018) and RV Global strain(r= -0.567, p=0.001) and total lung score. There was no significant correlation between the total lung score and any of the disease scores.Conclusion: The semi-quantitative score is a reliable method that correlated with lung and RV functions.

Background It is crucial to differentiate between benign and malignant pleural effusions while making a diagnosis. The purpose of this research was to investigate the diagnostic significance of GSDMD and VEGF in discriminating between different kinds of pleural effusion and their correlation with both progression-free and overall survivals in the malignant type. Methods Ninety-one pleural fluid samples, which were classified as transudates or exudates (tuberculous, para-infectious, or malignant) by pleural fluid classifications, were tested for GSDMD using sandwich ELIZA kits, and 41 of the exudative samples were randomly selected for VEGF testing. Both markers' diagnostic accuracy was assessed. Results The lowest level of GSDMD was associated with the transudate group (mean and SD of 2.35 ± 0.44 ng/mL) and the highest in the malignant effusion group (mean and SD of 4.38 ± 1.67 ng/mL). The specificity and sensitivity of GSDMD in the diagnosis of exudative PE were 97% and 98%, respectively (p = 0.001) with the cutoff point = 2.89). Regarding VEGF, its level was 222.3 ± 53.4 pg/ml for all studied samples where MPE (n = 21) was 261.2 ± 48.2 pg/ ml (mean ± SD), TBPE (n = 7) was 185.4 ± 6.96 pg/ml (mean ± SD), and PIPE (n = 13) was 179.3 ± 13.9 pg/ml (mean ± SD). The diagnostic accuracy of VEGF for the detection of MPE was 90% with a sensitivity of 100% and specificity of 80% and the cutoff point was 191.5 pg/ml. There were highly significant inverse correlations between progression-free survival and both GSDMD (r =− 0.531, p = 0.009) and VEGF (r = − 0.582, p = 0.006) in MPE. Conclusion Pleural effusion GSDMD can be an effective marker for differentiating the different kinds of PE, and VEGF levels can be a useful adjuvant marker in screening out MPE as a possible diagnosis, leading to the proper selection of patients who may benefit from more invasive procedures.

Background and Aim: Coronaviruses are dangerous human and animal pathogens. It is characterized by fast spread, starting as an epidemic through China, followed by a worldwide pandemic. This study aimed to determine the prevalence of laboratory proven blood stream bacterial co-infection in hospitalized adult COVID-19 Egyptian patients and to recognize antibiotic susceptibilities of identified pathogens together with evaluation of predictors for case severity.Methods: The study involved 142 adult COVID-19 Egyptian patients. The diagnosis was confirmed by quantitative or real time polymerase chain reaction (PCR) on nasopharyngeal swabs. For each case two blood cultures were taken after ≥ 3 days of hospital admission.Results:About 30% of positive blood cultures showed Gram positive staphylococci while Gram negative bacilli were detected by 70% (Klebsiella ;30%, E.coli ; 20% and Pseudomonas ; 20%).Variable resistance patterns were noticed in all bacterial isolates.Blood stream infections (BSI) were identified in 40 cases (28%). About 70% of them were males. The mean age significantly associated with BSI was 63.5±18.2 years old. Hypertension and diabetes had high significant association with BSI by 55% and 60% respectively. Significantly 68% of mechanically ventilated COVID cases were BSI complicated. Death was the fate of 57.5% of BSI positive COVID cases significantly with low O2 saturation and prolonged hospital stay (21.6±3.52 days). Conclusion:All blood stream bacterial pathogens were multidrug resistant. Infections were detected among old aged, diabetic, hypertensive and mechanically ventilated patients. Prescribing antibiotics in COVID patients should be guided by careful clinical and laboratory assessment to improve their management and outcomes.

Background Inhalation lung injury occurs in almost one-third of all serious burns and is responsible for a considerable proportion of burn patient fatalities each year. History of closed space fire or unconsciousness at the accident site, occurrence of pharyngeal or facial burns, hoarseness, and wheezing, and laboratory tests that include blood gas abnormalities or Carboxyhemoglobin levels in blood ˃ 10% are used to diagnose inhalation lung injury. It is also characterized by radiological findings of alveolar or interstitial edema, atelectasis, and/or consolidations, as well as the presence of erythema with laryngeal or tracheal edema in the bronchoscope. Objectives To study the diagnostic and prognostic efficacy of radiologist score and bronchial wall thickening as radiological CT findings in inhalation lung injury. Methods This prospective case–control study included 48 patients with inhalation lung injury (ILI) as a case group and 10 patients without ILI were selected as the control group, all recruited from the burn and plastic department. Within the first 12 h of suspected ILI, a fiberoptic bronchoscope was done to confirm the diagnosis. An initial chest X-ray was done followed by computed tomography through which the radiologist score (RADS) together with bronchial wall thickening (BWT) was done. Results Duration of ventilation was higher in cases than in controls (8.50 ± 3.94 vs 3.25 ± 0.50). The hospital duration was higher in cases than in controls (13.6 ± 4.68 vs9.50 ± 4.52). The BWT was 2.12 ± 0.66 (mean ± SD) in the ILI group while the control group was 1.32 ± 0.48 (mean ± SD). Correlating between baseline PaO2 and RADS score and BWT, it was found that there was a highly significant negative correlation between PaO2 and RADS score and BWT among inhalation lung injury patients (P value 0.001). The sensitivity of BWT in the detection of the need for mechanical ventilation was 83% at a cut-off point of 1.65. Its specificity was 78% and accuracy 75%. Conclusion CT done within 24 h of burn patients has a good role in the diagnosis and management of ILI from the burn.