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Introduction: The new coronavirus, SARS-CoV-2, provokes infection with different clinical presentation. It involves an asymptomatic condition, mild variants with fever and dry cough to severe pneumonia, adynamia and respiratory failure with lethal outcome. The fibrotic lung tissue after the inflammatory process is a background for development of a secondary pneumothorax. Although it rarely causes lethal outcomes in COVID-19 patients, pneumothorax requires early diagnosis and adequate treatment to prevent any complications and decrease mortality rate. Aim: The aim of this study was to analyse the results of surgical treatment of hospitalized COVID-19 patients with pneumothorax in terms of demographic data, concomitant diseases, complications, and outcome. Materials and methods: Longitudinal prospective study was carried out with 26 patients with pneumothorax as a result of SARS-CoV-2 infection. They were treated at the Intensive Care Unit of the Infectious Disease Clinic and at the Second Clinic of Surgery, St George University Hospital in Plovdiv over a 6-month period from September 2020 to February 2021. Results: Seventeen of the patients were men and nine – women. Twenty-four of all patients underwent thoracentesis and two of them had a video-assisted thoracoscopy. The mean age of the studied patients with pneumothorax and COVID-19 was 66.77±12.61 years, which shows that it is the patients of advanced age with concomitant diseases that are at a higher risk of serious complications and adverse outcome. Of the hospitalized 1245 patients with COVID-19, 385 (30.92%) passed away. Of all hospitalized patients with SARS-CoV-2, 26 (2.08%) developed pneumothorax. Sixteen of them (62%) passed away. The possibility of a lethal outcome for intubated patients increased more than twice. Conclusions: The pneumothorax as a complication of COVID-19 carries high mortality and severely worsens the prognosis for these patients.

INTRODUCTION: Several immunological methods are used to determine the serum antinuclear antibodies (ANA). Indirect immunofl uorescence assay (IFA) with tissue slices or HEp-2 cells is the standard technique considered the gold standard for their screening. Serumfree McCoy-Plovdiv cell line may also be used as substrate for IFA. Another method for detection of total and specifi c ANA is the enzyme-linked immunosorbent assay (ELISA). Immunoblot is also applied in specifi c ANA confi rmation. The AIM of the current study was to determine and propose a justifi ed immunological approach for identifi cation of clinically signifi cant ANA by comparing the screening tests - ANA-IFA on serum-free McCoy-Plovdiv cell substrate with ELISA for total ANA, and confi rmative methods for specifi c ANA-ELISA with immunoblot. MATERIALS AND METHODS: Serum samples from 38 patients screened for total ANA by ELISA (Trinity Biotech, NY, USA) and IFA-ANA with МcCoy-Plovdiv cell line, were included in the study. Positive samples were confi rmed by immunoblot (Orgentec Diagnostika, Germany) and ELISA for specifi city of confi rmed ANA. RESULTS: No significant difference (Р > 0.05) and very good agreement were found between the two screening tests. Very good agreement for specifi c antibodies against SS-A, SS-B, dsDNA, moderate for anti-Sm and anti-Sm/RNP and fair for anti-histone/nucleosomal antibodies was found between confi rmative methods. No agreement was found for anti-Scl-70 antibodies. CONCLUSION: IFA-ANA with serum-free МcCoy-Plovdiv cell line and screening ELISA may be recommended for determination of total ANA, and immunoblot and ELISA - for confi rmation and identifi cation of specifi c ANA.