Background: Recurrent and persistent pleural exudates are common in clinical practice, and in a large number of patients, thoracocentesis and blind pleural biopsy procedures do not provide a definitive diagnosis. In the Western world, the majority of these exudates are malignant. Thoracoscopy today remains the gold standard technique in providing diagnosis and management in these cases.Objectives: Diagnostic yield of medical thoracoscopy was evaluated in cases of undiagnosed pleural effusion.Patients and methods: Semi flexible medical thoracoscopy was done for 40 patients in the period between

Background and objective: Many trace elements play important roles in activating or inhibiting enzymatic reactions, by competing with other elements and metalloproteins for binding sites, by affecting the permeability of cell membranes and by other mechanisms. They play important roles in the oxidant/ antioxidant balance. As such, trace elements are thought to be involved directly or indirectly in the pathogenesis of several diseases.The aim of the present study is to investigate the effect trace elements (Se, Mn and Zn) intravenously administered on the period the COPD patients spend on mechanical ventilation. Methods: In a randomized double-blinded controlled trial a set of 120 subjects (40 normal volunteers and 80 COPD) were recruited. Serum concentration levels of Se, Mn and Zn were determined for all enrolled subjects with Inductively Coupled Plasma spectroscopy. COPD patients received intravenous supplementation of the above trace elements and the period the patients spent on mechanical ventilation was determined.Results: There was a significant reduction (P = 0.013) in the period the patients with COPD spent on the mechanical ventilation when received intravenous supplementation (9.4 Ϯ 7.3 days) compared with the COPD patients who received placebo (17.8 Ϯ 7.6 days). Conclusions: Trace element (Se, Mn and Zn) status is altered in critically ill patients with COPD. The supplementation achieved a reduction in the period those patients spent on the mechanical ventilation. A larger multi-centre trial is required to confirm this preventive effect and to explore its applicability to other critical care conditions.

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Background & Aims: In healthcare settings with limited resources, it is crucial to make a plan to prioritize hospital admission for patients affected by COVID-19. So, we tried to develop a novel approach for triaging COVID-19 patients and deciding the priority for hospital admission using Lung Ultrasound. In this study, we aimed to evaluate the efficacy of lung ultrasound in triaging suspected COVID-19 patients and assessment of the severity of COVID-19 pneumonia and its comparison with CT chest as the gold standard. Method: This was a multicenter cross-sectional study enrolled on 243 COVID-19 confirmed patients presented to the emergency department in three major University hospitals in Egypt. Lung ultrasound was done by an experienced emergency physician or chest physician according to the local protocol of each hospital. Demographic, clinical, and laboratory data were collected from each patient. Each patient was subjected to CT chest and lung ultrasound. Results: A total of 243 confirmed COVID-19 patients were enrolled in this study, with a mean age of 46.7+10.4 years. Ground glass opacity (GGO), subpleural consolidation, trans-lobar consolidation, and crazy paving were reported in chest CT scans of 54.3%, 15.2%, 11.1%, and 8.6% of patients, respectively. B-line artifacts were found in 81.1% of COVID-19 patients, which was of confluent pattern in 18.9% of patients. The lung ultrasound findings of 197 patients (81.1%) were completely coincident with those of CT with a Kappa agreement value of 0.77, and this offered a diagnostic sensitivity of 74 %, a diagnostic specificity of 97.9 %, positive predictive value (PPV) of 90.2% and negative predictive value (NPV) of 93.6 % for lung ultrasound in triaging COVID-19 patients. Adding O2 saturation to the findings of lung imaging, the accuracy of evaluation of lung ultrasound to differentiate between severe and non-severe lung diseases showed that ultrasound had 100% sensitivity and specificity. Conclusion: Lung Ultrasound with Oxygen saturation is a very efficient tool for decision-making to prioritize hospital admission for patients affected by COVID-19 in healthcare settings with limited resources.

Objective: To assess cough peak flow in patients with frequent infective exacerbations of COPD. Design: Cross-sectional controlled clinical study. Settings: Pulmonary function laboratory of the Chest Department of Ain Shams University Hospitals, Cairo, Egypt. Patients: Forty male patients with severe COPD; twenty with stable disease and twenty with more than two exacerbations in the last year were included in the study. Interventions: Spirometry and cough peak flows were measured at least six weeks after recovery from their last exacerbation. Results: Both groups were matched as regards demographics and lung functions. There was a statistically significant lower CPF in the frequent exacerbation group. Conclusion: Cough peak flow can guide respiratory physicians in fine tuning the management of patients with severe COPD to their particular needs.