Presepsin as a Novel Biomarker in predicting In-hospital Mortality in Patients With COVID-19 Pneumonia.

OBJECTIVES: Different biomarkers such as C-reactive protein (CRP), serum ferritin and D-dimer are used in prognostic assessment of patients with COVID-19 pneumonia. Presepsin (PSP) is a soluble CD14 subtype that has recently been proposed as a novel biomarker in patients with sepsis. The aim of the current study was to detect the relation of PSP to the outcome of COVID-19 as well as its relation to other inflammatory biomarkers. METHODS: This multicenter retrospective observational study was conducted in Saudi Arabia and Misr International Hospital, Egypt, from January 2021 to May 2021. Hospitalised patients who had positive throat swab of SARS-CoV-2 and radiological evidence of viral pneumonia (moderate and severe forms) were included in the study. Demographics and clinical features, as well as laboratory parameters, including serum ferritin, CRP, D-dimer and PSP, of enrolled patients were retrospectively collected. Pneumonia severity index (PSI) was used to evaluate the severity of pneumonia. RESULTS: A total of 202 hospitalised patients who were diagnosed with COVID-19 pneumonia and tested positive for SARS-CoV-2 RNA were enrolled in our study. Of 202 hospitalised patients, 67 (33.17%) required intensive care unit (ICU) admission. A total of 176 (87.1%) patients survived and were discharged, whereas 26 (12.9%) patients did not survive. PSP level was found to be significantly elevated in nonsurvivor versus survivor group (median [IQR] 978.5 [755.8-1400] vs 516.5 [343.3-720], P<0.001) as well as in ICU versus non-ICU patients (median [IQR] 800 [631-1200] and 446 [320-626], respectively) (P<0.001). Elevated levels were also found to be associated with increased length of hospital stay. Levels above 775 pg/mL were found to be associated with in-hospital mortality (specificity 80%, sensitivity 73%). CONCLUSION: Elevated PSP levels indicated poor outcomes in hospitalised patients with COVID-19 pneumonia and were associated with in-hospital mortality.

Role of ultrasonography in assessment of anatomic upper airway changes in patients with obstructive sleep apnea.

Instroduction: Obstructive sleep apnea is a common disorder, characterized by recurrent narrowing and closure of the upper airway accompanied by intermittent oxyhemoglobin desaturation and sympathetic activation. Ultrasound imaging of the airways has advantages of being safe, quick, repeatable, portable and widely available. Airway ultrasound can visualize and assess the mouth and tongue, oropharynx, hypopharynx, epiglottis, larynx, vocal cords, cricothyroid membrane, cricoid cartilage, trachea, and cervical esophagus. MATERIAL AND METHODS: This study assessed the role of ultrasonography in detecting the level and degree of obstruction of airway passages in patients with obstructive sleep apnea (OSA) and its relation to OSA severity. It included thirty-three patients diagnosed as OSA, and ten healthy subjects as a control group. All participants were ≥ 18 years and were subjected to full medical history, Epworth sleepiness score (ESS), thorough clinical examination, complete overnight polysomnography and neck ultrasonography. RESULTS: Ultrasonography findings showed a statistically significant increase in lateral parapharyngeal wall thickness (LPWT) (P < 0.001) and a significant increase in distance between lingual arteries (DLA) (P < 0.01) among OSA patients. Moreover, there was a significant statistical decrease in the retropalatal pharynx transverse diameter (RPD) (P < 0.05) in the OSA group compared to those without OSA. LPWT and DLA are parameters that can be used to predict the severity of OSA. Combination of LPWT and RPD can achieve a 100% sensitivity and specificity. CONCLUSIONS: Ultrasound is more objective and convenient than the questionnaire because it doesn't require overnight time consumption. It is also more relevant than pulse oximetry for examining pharyngeal airspace. Also, this study demonstrated that submental ultrasonography is sufficiently sensitive for differentiating OSA severity.

Prognostic value of pro-inflammatory cytokine and pro-angiogenesis factor in differentiating malignant from benign exudative effusion.

BACKGROUND AND AIMS: The precise mechanism of pathogenesis in exudation of effusions is uncertain. Released factors in inflammation and malignancy of pleura are related to incremented permeability of the micro-pleural vessels. Angiopoietins (Ang) take part in development of angiogenesis and pleural inflammation. Interleukin-8 (IL-8) influences proliferation and tumor angiogenesis and it is expressed in cancer. The aims of this study were to investigate the relationship between inflammation, angiogenesis and etiologies of exudative effusions, and to evaluate the diagnostic value in differentiating malignant from benign. METHODS: The study includes 49 pleural fluid (PF) samples. Ang-2 and IL-8 in PF and serum were estimated. RESULTS: Ten patients were transudative and 39 patients were exudative fluid, subdivided into 16 benign and 23 malignant effusion. Ang-2 and IL-8 either fluid level or ratio were in significantly high in exudative more than in transudative fluid (P = 0.002). Ang-2 and IL-8 in PF were in high level than in serum of exudative and transudative. Ang-2 fluid level and ratio were significantly high in benign exudative effusion (P = 0.01, P = 0.05, respectively), while IL-8 level was significantly high in malignant exudative effusion (P = 0.04). Cut-off points for PF Ang-2 and IL-8 in differentiating malignant from benign exudative were 15.67 ng/mL, 325.54 pg/mL, respectively. CONCLUSION: Our results support the evidence that angiogenesis and inflammatory pathways are linked, and that inflammation and vascular permeability of pleura constitutes the pathogenic basis of the majority of exudative effusion.