During the current pandemic, we witnessed a rise of post-intubation tracheal stenosis (PITS) in patients intubated due to COVID-19. We prospectively analyzed data from patients referred to our institution during the last 18 months for severe symptomatic post-intubation upper airway complications. Interdisciplinary bronchoscopic and/or surgical management was offered. Twenty-three patients with PITS and/or tracheoesophageal fistulae were included. They had undergone 31.85 (±22.7) days of ICU hospitalization and 17.35 (±7.4) days of intubation. Tracheal stenoses were mostly complex, located in the subglottic or mid-tracheal area. A total of 83% of patients had fracture and distortion of the tracheal wall. Fifteen patients were initially treated with rigid bronchoscopic modalities and/or stent placement and eight patients with tracheal resection-anastomosis. Post-treatment relapse in two of the bronchoscopically treated patients required surgery, while two of the surgically treated patients required rigid bronchoscopy and stent placement. Transient, non-life-threatening post-treatment complications developed in 60% of patients and were all managed successfully. The histopathology of the resected tracheal specimens didn’t reveal specific alterations in comparison to pre-COVID-era PITS cases. Prolonged intubation, pronation maneuvers, oversized tubes or cuffs, and patient- or disease-specific factors may be pathogenically implicated. An increase of post-COVID PITS is anticipated. Careful prevention, early detection and effective management of these iatrogenic complications are warranted.

Background: COVID-19 clinical presentation is usually non-specific and includes commonly encountered symptoms like fever, cough, nausea, and vomiting. It has been reported that COVID-19 patients can potentially transmit the disease to others before developing symptoms. Thus, extensive surveillance and screening of individuals at risk of the disease is required to limit SARS-COV-2 spread. The COVID-19 respiratory triage score has been used for patient screening. We aimed to determine its diagnostic performance characteristics, which have not been adequately studied before.Methodology: This is a retrospective observational study involving all patients screened for COVID-19 at a tertiary care facility. Patients were tested using nasopharyngeal swab for SARS-COV-2 PCR. The Saudi CDC COVID-19 respiratory triage score was measured for all subjects. The sensitivity, specificity, positive predictive value, and negative predicted value of COVID-19 respiratory triage score were measured with reference to SARS-COV-2 PCR test. Multivariate regression analysis was done to identify factors that can predict a positive SARS-COV-2 PCR test.Result: A total of 1,435 subjects were included. The COVID-19 respiratory triage score provided a marginal diagnostic performance with a receiver-operating characteristics (ROC) area under the curve value of 0.60 (95% CI: 0.57–0.64). A triage score of 5 provided the best cut-off value for the combined sensitivity and specificity. Clinical characteristics that independently predicted positive COVID-19 PCR test include male sex (adjusted OR: 1.47; p = 0.034), healthcare workers and their family members (adjusted OR: 1.99; 95%; p = 0.016), fever (adjusted OR: 2.98; p < 0.001), and moderate disease severity (adjusted OR: 5; p < 0.001).Conclusion: The current COVID-19 respiratory triage score has marginal diagnostic performance characteristics. Its performance can improve by including additional predictors to the respiratory symptoms in order to avoid missing COVID-19 patients with atypical presentation and to limit unnecessary SARS-COV-2 PCR testing.

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BACKGROUND: Cancer patients are particularly vulnerable during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to evaluate clinical characteristics and mortality among cancer patients with COVID-19. METHODS: This retrospective, observational cohort study included 53 patients with a malignancy and reverse-transcription polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus-2 infection in a tertiary care center in Mecca, Saudi Arabia, from March 14, 2020, to October 29, 2020. Clinical, laboratory, and radiological data were collected from institutional electronic records and analyzed. RESULTS: Overall, 53 patients (62% male) were enrolled. The mean age of the patients was 54.9 ± 19.0 years, with 76% aged <65 years. The most common symptoms were fever (66%), dry cough (40%), and dyspnea (36%). Most infections (89%) were community acquired. Hematological malignancies (36%) were the most common cancer type. The most common solid tumors were breast cancer (23%) and colon cancer (9%). Just over half (51%) had a stage 4 tumor, and 30% of the patients had received chemotherapy within 2 weeks before the onset of COVID-19 symptoms. Initial chest radiographs showed pneumonia in 43% of patients; 38%, 9%, and 6% required oxygen support, intensive care unit admission, and invasive mechanical ventilation, respectively. The most common complication was secondary bacterial infection (13.2%). The all-cause mortality rate was 17%. In the multivariable logistic regression, dyspnea, leukocytosis, use of systemic steroids, and secondary bacterial infection were found to be risk factors for death. CONCLUSION: Hospitalized cancer patients with COVID-19 have a high mortality rate. Our study finds a correlation between multiple independent risk factors and mortality. Patients with dyspnea, leukocytosis, systemic steroid use, or secondary bacterial infection require more care, attention, and possibly more aggressive treatment.