Highlights Anakinra averted need for mechanical ventilation in patients with severe COVID-19 pneumonia. Anakinra accelerated weaning off oxygen therapy and hastened transition to room air. Patients treated with anakinra had significant reduction in biomarkers of inflammation. Study results did not demonstrate significant difference in in-hospital mortality. We provided further evidence for the utility of anakinra in severe COVID-19 pneumonia.

Objectives: Pulmonary nocardiosis is a rare opportunistic infection that is often encountered in immunocompromised patients, in particular those with human immunodeficiency virus (HIV) infection and in solid organ transplant recipients. As the number of immunocompromised patients increase, it is expected that the number of patients with pulmonary nocardiosis will increase. The aim of this study is to review the chest HRCT findings of patients with confirmed pulmonary nocardiosis and to review the imaging features of pulmonary nocardiosis in the literature. Methods: We searched the electronic database of the Royal Hospital, Muscat, Oman for patients with a diagnosis of pulmonary nocardiosis between January 2006 and January 2019. Nine patients with pulmonary nocardiosis were identified, but three patients were excluded as no chest HRCT images were available. Patient clinical presentation was recorded and chest HRCT images were retrospectively reviewed. Results: The six patients enrolled in the study were male, aged between 29 and 49 years. Three patients were immunocompromised, two of whom had undergone a renal transplant. The main HRCT findings were cavitary nodules/masses, non-cavitary nodules/masses, septal thickening, centrilobular nodules, ground glass opacities, consolidation, pleural effusion, pleural thickening, enlarged lymph nodes and necrotic lymph nodes. Conclusion: Pulmonary nocardiosis has various findings on chest CT. Most common are pulmonary nodules and masses. Awareness of these findings can help radiologists to suggest the diagnosis in the appropriate clinical settings. Keywords: Nodules; Masses; Lung Infections; Opportunistic Pathogen; Pulmonary Nocardiosis; Computed Tomography.

Objectives: The aim of this study is to assess the correlation between the severity of the initial chest x-ray abnormalities in patients with confirmed diagnosis of coronavirus disease 2019 (COVID-19) and the final outcomes. Methods: Retrospectively, we identified serial chest radiographs of 64 patients (57 men, 7 women, with mean age of 50 years) admitted to the Royal Hospital between March 15, 2020 and May 30, 2020 with confirmed diagnosis of COVID-19. The chest radiographs were examined for presence, extent, distribution and progression pattern of radiological abnormalities. Each lung field was divided into 3 zones on each CXR and a score was allocated for each zone. The scores (0 [normal], 1 [mild] to 4 [severe]) for all six zones per chest radiographic examination were summed to provide a cumulative chest radiographic score (range, 0–24). Results: The initial CXR was abnormal in 60 patients (93.8%). The most common finding was ground glass opacity (58/64, 90.6%), followed by consolidation (50/64, 78.1%). The majority of the patients had bilateral (51/64, 85%), multifocal (57/64 95%) combined central and peripheral (36/64, 60%) lung abnormalities. The median score of initial CXR for deceased patients was significantly higher than those who recovered (17 vs 11 respectively; P = 0.009). Five CXR evolution patterns were identified: type I (initial radiograph deteriorates then improves), type II (fluctuate), type III (static), type IV (progressive deterioration) and type V (progressive improvement). Conclusion: Higher baseline chest radiograph score is associated with higher mortality rate and poor prognosis in those with COVID-19 pneumonia. Keywords: SARS-CoV-2; COVID-19; Chest X-ray; Scoring System; Pneumonia; Prognosis; Outcome; Severity; Consolidation; Ground-glass.