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Background Arginine vasopressin (AVP), produced by hypothalamic neurons, is released during stress following different stimuli such as hypotension, hypoxia, hyperosmolarity, acidosis, and infections. Measurement of AVP levels has limitations because of its short half-life and instability. Copeptin, the carboxy-terminal part of the precursor (prepro-AVP), is a more stable peptide and mirrors AVP concentrations. Aim The aim of this work was to study the usefulness of plasma copeptin as a predictor of prognosis and outcome of respiratory failure patients admitted in the ICU. Patients and methods This prospective study was carried out on 45 patients (38 patients admitted at Benha University Hospital ICU and Chest Department and seven healthy patients). They were classified into three groups: group A (ICU patients) comprised 30 patients admitted with respiratory failure due to different chest diseases; group B (in-patients) comprised eight patients selected from those hospitalized at Chest Department because of respiratory failure and with no need for ICU admission as a positive control group; and group C comprised seven healthy patients included as a negative control group. All patients were submitted to full clinical history and physical examination at ICU admission, as well as available preadmission clinical data, pulmonary function tests, chest radiography if done, arterial blood gases, ECG, and clinical lab data; blood samples were taken and plasma was separated and copeptin level was measured by sandwich immunoluminometric assay. Results There was a statistically significant difference among studied groups as regards plasma copeptin level, which was higher in ICU patients (group A) than in in-patients (group B) and healthy control patients (group C) (P<0.001). There was a statistically significant correlation between copeptin level and both Glasgow Coma Scale and Acute Physiology and Chronic Health Evaluation II (APACHE II) score (P<0.001). The relation with Glasgow Coma Scale was negative, whereas that with Acute Physiology and Chronic Health Evaluation II score was positive. There was a statistically significant positive correlation between mean copeptin level and patients’ outcome, as its level was markedly higher in nonsurvivors (80.6+31.6) than in survivors (30.5+17.3) (P<0.001), substantiating it as a prognostic marker in critically ill patients. In ICU patients copeptin levels less than 55 pg/ml predict good prognosis and survival among ICU patients, with a sensitivity of 88.2% and a specificity of 84.6%. Conclusion Elevated plasma copeptin levels reflect disease severity and predict short-term mortality. Copeptin concentrations are strongly related to hypoxia, as they increase markedly with low blood oxygen concentration. Elevated plasma copeptin levels predict long hospital and ICU stay. Plasma copeptin levels increased progressively with the development of complications in ICU patients.

Background Empyema thoracis is defined as accumulation of pus in the pleural space. Despite advanced medical diagnostic and therapeutic methods, thoracic empyema remains a common clinical entity and a serious problem all over the world with significant associated morbidity and mortality. Aim The aim of this work was to study the efficacy and safety of medical thoracoscopy (MT) in the management of empyema. Patients and methods This study included 30 inpatients with empyema. Included patients had frank pus on aspiration (turbid purulent fetid fluid) with or without positive Gram stain smear and microbiological culture findings or pH less than 7.20, with signs of sepsis. Patients were managed by MT. MT using rigid thoracoscopy was performed with evacuation of the purulent fluid, visualization of the pleural space, assessment of adhesions and purulent material, forceps adhesiolysis, and irrigation by normal saline with partial debridement of accessible parietal pleural surface. Results The present study included 30 patients with empyema (17 men, 13 women with a mean age of 47.4±14.5 years; range, 18–70 years); 19 (63.3%) patients had free-flowing empyema (by computed tomography/ ultrasonography) and 11 (36.7%) patients had multiloculated empyema. The etiology of empyema included pneumonia (parapneumonic effusion) (33.3%), malignancy (23.3%), tuberculosis (6.7%), lung abscess (6.7%), and no cause was identified in nine patients (spontaneous pleural infection) (30%). MT was considered successful without subsequent interventional procedures in 26 of 30 (86.7%) patients, including all patients with free-flowing empyema (19 patients), 63.6% of patients with multiloculated empyema (seven patients), and four (13.3%) patients required surgical intervention (surgical decortication). No procedure-related mortality or chronic morbidity occurred in this study. Conclusion MT is a simple, safe, minimally invasive, and effective modality in the management of empyema.

Chronic Obstructive Pulmonary Disease (COPD) is currently one of the leading causes of mortality in the globe, according to the World Health Organization. When COPD sufferers have an acute exacerbation, the infectiondetecting hormone procalcitonin (PCT) may be administered (AECOPD). The development of COPD is linked to PCT and other viral inflammatory variables. The goal of this research was to determine the PCT level in patients with COPD. Methods: ELISA was used to monitor PCT levels throughout AECOPD and after the patient was stabilised. Study groups differed significantly in PCT results (P-value 0.001). Stable (2220.9 pg/ml) and exacerbation (2679 pg/ml) groups had higher levels, whereas the control group had considerably lower levels (1696.9 pg/ml). Compared to the control group (2220.9 pg/ml), it was considerably greater in the exacerbation group (2679 pg/ml). Conclusion: In patients with stable COPD and AECOPD, PCT has a negative relationship with severity.

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