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Hymenoptera venom allergy (HVA) is an anaphylactic reaction that occurs after the sting of Hymenoptera insects: honeybee (Apis mellifera), wasp (Vespula vulgaris) or hornet (Vespa crabo). Hymenoptera insects can cause IgE-mediated hypersensitivity reactions in insect-sensitized patients, ranging from local to severe systemic reactions and even fatal anaphylaxis. Systemic allergic reactions (SAR) after Hymenoptera insect stings have been reported in up to 7.5% of adults and up to 3.4% of children. They can be limited to the skin or cause severe reactions such as dizziness, dyspnea, nausea, and loss of consciousness, shock, cardiac or respiratory arrest. Patients with HVA are advised to carry an emergency kit consisting of an epinephrine auto-injector (AAI), H1-antihistamines and corticosteroids depending on the severity of the previous SAR. The only treatment that can potentially prevent SAR is immunotherapy with the appropriate venom (VIT). Venom immunotherapy (VIT) has been reported to be effective in 77%-84% of patients treated with bee venom and in 91%-96% of patients treated with wasp venom. The latest European Academy of Allergy and Clinical Immunology (EAACI) guidelines provide evidence-based recommendations for the use of VIT. It is recommended in children and adults who are hypersensitive to the venom because it leads to a significant improvement in quality of life-compared to wearing an adrenaline auto-injector. By receiving increasing doses of venom over 3 to 5 years, VIT leads to a change in the immune response and tolerance to the respective venom. Molecular diagnostics, which uses recombinant allergens, enables detection of true sensitization and thus improves the selection of appropriate venom for long-term VIT. This review aims to provide information on immunotherapy recommendations, as well as risk factors for SAR during and after VIT.

Higher education institutions are considered as the main bearers of socio-economic development of society in general. Having in mind that quality is considered as an important part of institution's responsibility as well as its' sustainability, it is necessary to provide a holistic approach that would cover all processes in the institution and offer students and other stakeholders the expected standards of professional and competent functioning in all aspects of life and work. On that basis, every higher education institution tend to design and implement scientific research and professional work in various fields, and to promote and nurture creative and critical thinking values, academic integrity and professional ethics. Dedicated to this mission, many of them attempt to establish themselves as reputable HEI's in the country and the region committed to the standards of the European educational space, endeavoring to develop science, academic community, local and regional social community. Vision of many faculties is oriented toward becoming recognizable in the international academic community by constantly striving to meet as higher as possible educational, scientific and academic community standards, but also, in accordance to their original principles and actions, to contribute to the development a culture of quality in the society. Therefore, the quality management of a higher education institution is a process that continuously and systematically follows-up over a long-time period whether the established system of quality assurance, monitoring and control is effective and adjusted to proclaimed European standards. Purpose of this presentation is to gain insight into to current developmental state of quality management in HEI's in relation to the proclaimed standards.

Good menstrual hygiene management in schools means that schoolgirls have access to adequate school toilets that meet criteria for basic sanitation and hygiene service, but also that they have basic knowledge about menstrual hygiene. The aim of this work is to assess sanitation and hygiene conditions for adequate menstrual hygiene management in rural schools in the Šumadija and Pomoravlje districts. The study was conducted on the territory of the rural areas of Šumadija and Pomoravlje districts in 2016. It encompassed 238 schools, of which 108 in Šumadija and 130 in Pomoravlje district. To assess sanitation and hygiene conditions for adequate menstrual hygiene management, a questionnaire was created, with questions related to: existence of toilets at schools and whether they are functional, accessible, single-sex, and ensure privacy, to provision of soap and toilet paper, handwashing facilities, bins with a lid in toilet cubicles for schoolgirls, and to provision of menstrual hygiene education. This research showed that a high percentage of school toilets in rural areas meet the basic service criteria (more than 90% for sanitation and about 85% for hygiene) in respect of toilet type and whether toilets are single-sex, usable, and with functional handwashing facilities. However, the obstacles to reaching the criteria for advanced service level are the insufficient provision of facilities for the disposal of menstrual products in toilet cubicles (76.9%), as well as the absence of menstrual hygiene education in 50% of schools. The research indicated the need to improve sanitation and hygiene conditions in order to reach advanced service level that would include better menstrual hygiene management in rural schools in Serbia. Also, a continued research should be focused on the role of social and economic aspects concerning schoolgirls and their families in the attainment of adequate menstrual hygiene.

The 2030 Agenda for Sustainable Development is a global strategic framework of seventeen goals to be achieved within a decade. The recent Progress Report shows that Serbia made steps toward reaching targets within the sustainable development goal (SDG) 6 related to the availability and sustainable management of water and sanitation for all. While 82% of the population in urban areas has access to safe drinking water, the country needs to regulate water supply systems and individual water sources in rural areas. Hygienically correct water is a prerequisite for preventing the transmission of fecal-oral diseases. The biggest challenge under the SDG 6 is safe sanitation management, available to 18% of the population. A national on-site study in Serbia identified issues with the containment, emptying, transport, and final disposal of excreta. The key actions must be connecting households to public sewers, regulating management of septic tanks, and investing in environmentally safe wastewater treatment plants. The Progress Report claims that 98% of the population has access to hand-washing facilities with soap and water within the household. This highlights the importance of providing hygienically correct water not only for drinking and sanitation, but for personal hygiene, hand washing, laundry, cleaning, and other household needs. Water, sanitation, and hygiene (WASH) are of prime importance in public institutions. Several studies in Serbia reported inadequate sanitary-hygienic conditions in schools and healthcare facilities in rural areas. WASH in schools and healthcare facilities not only contributes to reducing the spread of infectious diseases but also supports the healthy habits of pupils and patients and promotes the good health of the entire population. We propose the public health system ensure long-term supervision over water supply, sanitation services, and hygiene in households, schools, and healthcare facilities through continuous monitoring programs in line with the indicators and targets of the 2030 Agenda.

Provision of water supply service, through small-scale water supply systems (SSWS), is faced with many challenges in the entire pan-European region. This was the first comprenhensive national study that assessed drinking water quality and sanitary conditions in Serbia. This national survey was undertaken in rural areas of the Republic of Serbia in 2016 and on the basis of the WHO rapid assessment methodology. For the purpose of this study, three Broad Areas (BA) covering 26 districts were created, based on geographical and socio-economic characteristics of the districts: Vojvodina with 7 districts as BA1, West Serbia, Šumadija and Belgrade with 9 districts as BA2 and South and East Serbia and Kosovska Mitrovica with 10 districts as BA3. A total of 1168 piped water supply systems were inspected, sampled and analysed for selected microbiological and physical-chemical parameters. This study summarized the differences in compliance rate for microbiological and each physical-chemical parameter and sanitary scores between Broad Areas. This comparative analysis of small piped drinking water supply systems showed notable, significant differences in drinking water quality and identified sanitary risks between the selected areas.

Provision of safe water, sanitation, and hygiene (WASH) services in health care facilities is a priority at the global, national, and local levels. To inform improvements planning, conditions of WASH, waste management, and environmental cleaning were assessed in 81 facilities in the Autonomous Province of Vojvodina, Serbia, as part of a nationally representative survey in 2019. The survey included on-site checks, structured interviews, and drinking-water quality analysis. WHO/UNICEF indicators for WASH service levels and an advanced service level defined at the national level were applied. The results showed that all investigated facilities provided basic water services; 94% of facilities provided basic hygiene and waste management services; 58 and 2%, respectively, provided basic cleaning and sanitation services. Only 1% of investigated facilities met the basic level for all five WASH dimensions. Advanced service levels were only met for hygiene, waste management, and/or cleaning in 15–38% of facilities. In 33% of health care facilities, drinking-water quality was not in compliance with the national standards. The results revealed that there is a need for increased awareness and efforts to ensure basic provisions for sanitation, environmental cleaning, and drinking-water safety. HIGHLIGHTS The majority of health care facilities (HCFs) in Autonomous Province Vojvodina provide basic services for drinking-water, hygiene, and health care waste management.; Basic provisions for sanitation and environmental cleaning in HCFs emerged as priorities for future action.; There is a need to increase efforts to ensure advanced WASH services (observed in up to 38% of facilities), to strengthen the provision of people-centred, quality health care, and outbreak preparedness.

Exposing children to environmental pollutants during periods significant for their physiological development can lead to long-lasting health effects, dysfunction, and disease. The aim of this paper was to focus on a relatively scarce ambient AQ monitoring practice at the locations of preschol and school institutions in Serbia, within the local network of AQ monitoring stations. This was a cross-sectional study covering period 2015 to 2020. Measuring points (SO2, NO2, soot, PM10) were in front of kindergardens, primary and secondary schools in urban settlements. Results originate from the continuous public health programme conducted by the Institute of Public Health of Serbia. Only PM10 and B(a)P values at some points have exceeded annual limit values in front of chosen facilities in 2020. In sum, both the absolute number of urban ambient AQ measuring points monitored by the local network of Institutes of Public Health and those in front of the educational facilities have increased in this period: from 73/17 to 172/26. In a percentual view, these facilities are chosen more seldom within this time frame, dropping from 23.29 to 15.12% of all AQ monitoring points. As such facilities are mainly located at important city intersections, in order to assess the exposure to air pollution of vulnerable population groups (children from preschool to adolescence age), there is a need to locate measuring points near them.

Chronic human exposure to water contaminated with hepatotoxic cyanobacterial compounds (cyanotoxins) can lead to an increased incidence of hepatocellular carcinoma or other forms of liver disease. Humans can be exposed to cyanotoxins through ingestion, inhalation and dermal contact, i.e. by using contaminated drinking water, recreational water, water used for hemodialysis or via food. Among hepatotoxic cyanotoxins, cyclic peptides microcystins and nodularin should be emphasized, as well as the tricyclic alkaloid cylindrospermopsin. In addition, the existence of a new hepatotoxic cyanobacterial secondary metabolite, called limnotrixin, has been investigated in recent years. Due to the different chemical structures of these cyanotoxins, mechanisms of their toxic effects also differ. Globally, hepatotoxins are the most common cyanobacterial toxins and, among them, microcystins are the most frequently detected during cyanobacterial blooms and also the most extensively studied. The latter is also the case in the Republic of Serbia, where cases of cyanobacterial blooms in water bodies used for water supply are mostly related to species that are potential microcystin producers (e.g. representatives of the genera Microcystis and Planktothrix). Additionally, microcystins are the only group of hepatotoxic cyanotoxins for which regular monitoring has been established in our country, which primarily refers to the water bodies used as water supply sources. However, since there is an increased frequency of cyanobacterial blooming, both worldwide and in our country, it is very important to monitor potential risks and understand the toxicity and potential carcinogenicity of hepatotoxic products of cyanobacteria, which was the main aim of this study

Student centered learning implies the pedagogical approach based on constructivism and theories related to it, and it is characterized by the methods used to make a student actively contribute the learning process. It is recognized in the mindset and culture of the faculty, and focused on the needs and opinions of students. This paper presents the main elements of this approach in the context of higher education system. It starts with the perspective that placing the student at the center, the "heart" of the educational process, is a response to numerous social challenges and the reform process. The first part of the paper highlights a dichotomy resulting from the need to reconceptualize the traditional educational system in order to respond the needs of the knowledge society. It further points out the particularities and the differences between the teaching paradigm and the learning paradigm and elaborates the (im)possibility of combining them. The second part of the paper is dedicated to the analysis of the possibilities for implementing student-centered approach in higher education institutions and making it an integrative part of their climate and learning culture.

Introduction. The Burnout syndrom is a health issue that greatly disables a person. It includes emotional exhaustion, depersonalization and reduced efficiency in the workplace. So far, this issue has not been addressed where medical staff is concerned. Methods. The Maslach Burnout Inventory - Human Service Survey and Demografic Questionnaire were used. Emotional exhaustion is taken to be the most important aspect of the syndrome. Results. The sample consisted of data acquired from 59 nurses/technicians, out of which 45 were female and 14 male. 12% of them possessed all of the characteristics belonging to the syndrome, 27% of them were overextended (whereby the majority of them were inefficient), while the additional 10% were ineffective. There was a correlation between the chronic disease, on the one hand, and emotional exhaustion (p

Background There is no clear evidence whether pirfenidone has a benefit in patients with probable or possible UIP, i.e. when idiopathic pulmonary fibrosis (IPF) is diagnosed with a lower degree of diagnostic certainty. We report on outcomes of treatment with pirfenidone in IPF patients diagnosed with various degrees of certainty. Methods and findings We followed patients in the multi-national European MultiPartner IPF Registry (EMPIRE) first seen between 2015 and 2018. Patients were assessed with HRCT, histopathology and received a multi-disciplinary team (MDT) IPF diagnosis. Endpoints of interest were overall survival (OS), progression-free survival (PFS) and lung function decline. Results A total of 1626 patients were analysed, treated with either pirfenidone (N = 808) or receiving no antifibrotic treatment (N = 818). When patients treated with pirfenidone were compared to patients not receiving antifibrotic treatment, OS (one-, two- and three-year probability of survival 0.871 vs 0.798; 0.728 vs 0.632; 0.579 vs 0.556, P = 0.002), and PFS (one-, two- and three-year probability of survival 0.597 vs 0.536; 0.309 vs 0.281; 0.158 vs 0.148, P = 0.043) was higher, and FVC decline smaller (-0.073 l/yr vs -0.169 l/yr, P = 0.017). The benefit of pirfenidone on OS and PFS was also seen in patients with probable or possible IPF. Conclusions This EMPIRE analysis confirms the favourable outcomes observed for pirfenidone treatment in patients with definitive IPF and indicates benefits also for patients with probable or possible IPF., F. Hofmann-La Roche; Boehringer Ingelheim, This study was supported by F. Hofmann-La Roche. The EMPIRE registry is supported by Boehringer Ingelheim and F. Hofmann-La Roche. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Turbulent environment, crisis, globalization, rapid technical and technological progress, constant changes require new creative ideas from SME, new knowledge and constant innovation. SME should learn to live with constant changes. Knowledge is the driving force of any innovative venture.Isak Adizes points out: "On one occasion, I asked Ferdinand Porsche (the son of a founder of a car company) if he had two choices ahead of you: to lose all your people or to lose all your machines from which to give up before? He answered the machine! Why? What is easier to replace machines or people? Well machines of course. People have become the most valuable assets of SME because they have knowledge .. The recovery, development and competitiveness of SME depends on the ability and speed of using new knowledge and technologies (innovation capabilities). According to the European Commission, the creation, use and commercialization of new knowledge and technologies are essential for achieving competitiveness. The knowledge base encourages the development of innovations. Innovations as the most important source of change occupy a central place in the knowledge economy. Innovative SME are those who have implemented a one innovation. According to the OECD, a knowledge-based economy is an economy based on the creation, use and dissemination of knowledge and information. The innovative SME are the driving force for knowledge-based economy, they are the most efficient, most dynamic and flexible part of the economy and contribute to increasing the overall competitiveness of the Serbian economy. The paper presents the concept of innovative SME, development conditions and limitations. The importance that innovative SME have for the development of the SME sector in Serbia, as well as the creation of a competitive economy. The importance of the knowledge and innovation relation in innovative SME is also shown, as a key factor in the change and development of the economy as a whole.We given guidelines for improvement and further development of innovative SME in Serbia.

112 215 199 M20 M22 The Vardar-Tethyan mega-suture between the Eurasian and Adria (Gondwana) margins comprises remnants of oceanic lithosphere of Neotethys and distal parts of the adjacent continental margins including unconformable Late Cretaceous sedimentary cover and Cenozoic igneous rocks of post-obduction age. This study provides kinematic constraints for displacements and rotations affecting the Serbian part of the West Vardar and Jadar-Kopaonik units after the closure of the Neotethyan (= Sava) Ocean. The targets of the paleomagnetic research were Late Cretaceous sediments representing an overstep sequence and a wide variety of Oligocene-Earliest Miocene igneous rocks. The studied 48 sampling points were distributed within two segments of a narrow and 160 km long strip of the Western Vardar zone, namely the wider Rudnik Mts. area to the north and the Kopaonik Mts. area to the south. The results of standard laboratory processing and statistical evaluation suggest that both studied segments of the Western Vardar zone were affected by 30°–46° clockwise vertical-axis rotation which must have taken place after 20 Ma. It is proposed that clockwise vertical-axis rotation documented in the present study on one hand, and the previously documented counterclockwise vertical-axis rotation of Adria, on the other hand are related to large scale extension in the southern Pannonian basin.

Application of music has positive effects on physical, emotional and spiritual well-being, stress reduction, patients' and medical staff mood improvement, making the work environment more pleasant for both patients and staff. The aim of this narrative review is to present facts about perioperative music implementation and effects on patients and medical staff. In highly developed countries, music provided by professionals in the form of music therapy is incorporated in patients' care on the wards or in the recovery room to improve their mood, prevent depression and enable physical rehabilitation and relaxation. Perioperative music application decreases postoperative pain intensity and anxiety level, and increases patient's satisfaction. So far, music therapy application was studied in patients undergoing gynecological procedures, Caesarean section, breast surgery, urological procedures, cardiovascular surgery, abdominal surgery, orthopedic and maxilofacial surgery and different kinds of diagnostic and interventional procedures. Moreover, in real life, music is present on daily bases during performances in the operating rooms all over the world. There is an open question about music's influence on surgical team performance. In the operating room, choice of music and its perception differs depending on professional status and medical specialty. Music can improve surgeons' performance in the operating room. Type of music and its volume needs to be carefully chosen if music is used in the operating room, to prevent distraction of medical staff during performance. In surgical patients, music as nonpharmacological method can be safely used in the perioperative period as adjuvant therapy to pain medications, for anxiety and pain relief.

Providing safe drinking water, sanitation and hygiene (WASH) in health care facilities has a central place in achieving universal and equal access to WASH for all. Well-organized supply of safe drinking water, sanitation and hygiene in health institutions is essential for patient health, quality of care, prevention and control of infections, suppression of antimicrobial resistance and improvement of ecological sustainability of the health system. Improving and maintaining WASH in healthcare institutions is a cornerstone in achieving SDGs, in particular SDG 6: Securing accessibility and sustainable water management and sanitation for all and SDG 3: Providing healthy living and promoting prosperity for all in all ages.

The microbial agents that cause infectious diseases are highly prevalent in health care facilities. Adequate water supply, sanitation and hygiene are the key elements for the provision of basic health services. The consequences of poor sanitary and hygienic conditions and inadequate water supply are numerous in health care facilities. The importance of improving water supply, sanitation and hygiene in health care facilities has been recognized as an international priority and set in the 2030 Agenda for Sustainable Development, particularly through goal 3.8 and 6. The establishment and maintenance of safe water supply and adequate sanitary and hygienic conditions has multiple benefits for health care facilities. It is necessary to introduce and implement risk assessment and risk management approach as effective way of continuously ensuring and maintaining the safety of drinking water quality in health care facilities as recommended by the World Health Organization, in order to reduce the risks associated with inadequate water supply and protect health of patients and staff. Realization of activities on the improvement requires a multidisciplinary approach and good inter-sectoral cooperation at all levels local, national and global.

Speaking about Serbian national epick poems mean testify about them, about their existence, their truth, and the ethics of that show. That ethics is mostly expressed dignity and courage, knightly persistence, divine legitimization and unconditional faith in God. The codex of ethic isn't written the letter, its national collective wisdom expressed in the character of the heroes model who have inconceivable sensibility of God in his acts when death is confirmed by the power of faith. An epic hero of the duel winning, on the field of wisdom and heroism. It is codex of respect and self-respect, codex of honor, dignity and modesty. The codex of ethich has only the best, the best like people, closest to God. Only epic hero can take baptism correctness and truth in feats because of his fight, immediate death is not the final death, but are tran-sformed into the most wonderful sacrifice to God for giving birth to eternal life. The highest virtue epic heroes is a defense of goods. This is the law of life of each hero, what makes a man is called man.This codex of ethics is not a task category, it is a way of growing up and educating. An epic heroes are the holders of manly heroism, evangelic which is deeply rooted in them, and with them the entire Serbian nation.

Correction for ‘Gamma ray assisted modification of carbon quantum dot/polyurethane nanocomposites: structural, mechanical and photocatalytic study’ by Milica Budimir et al., RSC Adv., 2019, 9, 6278–6286.

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The communication potential of virtual technology is widely recognized. Here, we review current problems related to developing, evaluating, or using virtual technology in business communication. Business uses of digital technology are broadly understood, but some of the questions we discussed here raise confusion about virtuality and reality, mental illusions, intransitive condition, and impassable boundaries of virtuality - embodied, sensual, singular subjectivity. Virtual communication is far beyond using computer technology, as we know it today. However, we all should be aware of confusion related to computer-mediated perception. From individual perception, communication sometime moves toward contemplative abstraction, which tends to forget its precondition: the original, mediated perceptual-sensuous immediacy of physical existence in the world. Perception is the unmediated directness, original, non-objected participation of organism in the universe. That is existence in unity with things, coexistence with the world. Original or phenomenological, sensory perception is not seen as a sign that the object emits and which informs us about it, or as structures of our brain centers or translation energy pulses in the respective forms - all these ideas are subsequent, second level or secondary metal structures. Perception is not noticed, but modus vivendi, manner of existence, the direct participation in the universe. This is the metaphysical meaning of perception, which doesn't deny the necessity of action, forces us to treat perceptions as a message, but it is secondary and derived meaning that we cannot legitimately absolutize.

Sarcoidosis affects the central nervous system more frequently than it used to be believed. While the cranial nerves are most frequently affected, neurosarcoidosis can involve other nervous system tissues as well. TREATMENT OF NEUROSARCOIDOSIS: Although a lot of drugs have proved useful in treating neurosarcoidosis, corticosteroids are still the gold standard in treatment of these patients. Therapeutic protocols differ regarding the dose of these drugs. Symptomatic neurosarcoidosis should always be treated with pulse corticosteroid therapy. People with diabetes, high blood pressure, osteoporosis and tuberculosis should be carefully monitored, as they are prone to complications associated with treatment with corticosteroids. In cases when treatment with corticosteroids does not show the desired results or therapy is discontinued due to the development of side effects, there are other pharmacologic options, such as methotrexate, mycophenolate mofetil, cyclophosphamide, chloroquine, azathioprine, thalidomide, and infliximab. It should be noted that the treatment response to the above mentioned regimens, except for infliximab, is relatively slow compared to corticosteroids; therefore, corticosteroids should be taken into account in all states and particularly in the acute phase of the disease.It is the existence of different forms of the disease, lack of local diagnostic criteria and different and non standardized therapy that makes the treatment of this disease difficult. Despite advances in pharmacotherapy and radiological diagnosis, it is necessary to develop better diagnostic strategies in order to set the optimal therapeutic approach.

Sarcoidosis can affect any part of the central nervous system presenting with an extremely diverse clinical picture. Clinical presentations actually depend on the localization ofgranulomas in the central nervous system. Making diagnosis according to the localization and the clinical variations is often a clinical challenge. DIAGNOSIS OF NEUROSARCOIDOSIS: Diagnosis is based on the clinical picture, clinical and radiological findings (magnetic resonance imaging with contrast endocranium), laboratory findings (angio-tenzin-converting enzyme and chitotriosidase in cerebrospinal fluid); however, it is necessary first to exclude all other possible causes of granulomatous inflammation. Recent studies in patients with neurosarcoidosis show a high value of at least one marker of the disease. The safest way and the gold standard in diagnosing this disease would be histopathological confirmation, which is rarely performed due to its invasiveness.New diagnostic methods will contribute to better methods of bypassing invasive procedures, and they will significantly facilitate the diagnosis of neurosarcoidosis, which is a real challenge even for experienced clinicians who deal with this disease.

Diagnosis of Wegener's granulomatosis at the early stage is difficult because of the nonspecific symptoms which mimic other disorders. The aim of this paper is to describe clinical and radiological features of Wegener's granulomatosis (WG) in a Serbian population at initial presentation. A retrospective review of 37 patient's case records was carried out. All those patients were diagnosed with WG and they attended the Institute for lung diseases in Belgrade over the period of 15 years. There were 20 males and 17 females, ranging in age from 18 to 73 years (mean age 46.2 years). The mean period from the onset of the first symptoms to diagnosis of WG was 4.59 +/- 6.15 months. The criteria of American College of Rheumatology were fulfilled in all patients. Twenty-five of 37 patients had systemic, generalized form of WG and while 12 of them had a limited involvement of upper and lower respiratory system. The frequency of different system involvement was: upper respiratory tract 64.8%, lower respiratory tract 100%, kidneys 67.5%, musculoskeletal system 40.5%, skin 27.2%, eyes 8.1%, and nervous system two patients. ANCA (antineutrophil cytoplasmic antibodies) test was positive in 32 ((86.5%) patients, and negative in 5 (13.5%). All patients were ANA negative. Histological evidence of granulomatous vasculitis was obtained in 34 (91.9%), whereas in three patients the diagnosis was based on clinical manifestations and positive c-ANCA test. There are minor variations in our data when compared with those reported in literature.

Sarcoidosis is a multisystem granulomatous disorder of unknown etiology. Clinical manifestations depend on the disease activity and organ involvement. The actual incidence of myocardial sarcoidosis has never been established. Manifestations range from accidental findings and benign conditions to fatal cardiomyopathies and arrhythmias.Bernstein et al. first described myocardial sarcoidosis in 1929, and Getzen first described a lethal case caused by myocardial sarcoidosis in 1937. A definite histological diagnosis of sarcoidosis is dificult to make, and in some cases treatment should be initiated without histological confirmation. An optimal strategy for establishing diagnosis of myocardial sarcoidosis is not clear. Thallium scintigraphy (with additional use of gallium and technetium) is most often used and investigated 2D echocardiography is less sensitive, but could be an additional tool in diagnostics. New non-invasive techniques, such as magnetic resonance imaging (MRI) and positron emission tomography (PET) can also be applied in diagnostics of this disease. Considering life-threatening potential of myocardial sarcoidosis, prompt and aggressive treatment with corticosteroids and/or inmmunosuppressive drugs is necessary.Recognition of myocardial sarcoidosis and choice of adequate treatment regimen requires maximal involvement and team work of cardiologists and respirator), specialists. This paper also deals with new diagnostic and therapeutic procedures, because early diagnosis and initiation of adequate treatment are the main prognostic factors of myocardial sarcoidosis.

Chemoprophylaxis represents a preventive antituberculotic treatment of persons at singificant risk of developing tuberculosis, in whom active tuberculosis is excluded The decision on treatment is based on detailed history about close contacts, tuberculin skin testing, data on BCG vaccination, and clinical examination. Conclusions are quite different depending on the fact if BCG vaccine is routinely applied (the case in developing countries, due to high tuberculosis incidence) or not--(in developed countries, where negative tuberkulin skin test is a normal finding), and tuberculin-positive persons are considered recently infected and undergo preventive therapy. The population at increased risk of developing tuberculosis includes: close contacts of patients with acive tuberculosis, recent skin test converters or with positive purified protein derivative (PPD) test, HIV-positive persons, those with underlying diseases that increase the risk of tuberculosis (diabetes mellitus, prolonged glucocorticoid therapy, immunosuppressive therapy, terminal renalfailure, kidney transplantation, all disorders associated with malnutrition etc.), those coming from high TB prevalence countries, immigrants, alchocolics, asylants, drug addicts, patients in psychiatric hospitals, etc. Preventive therapy usually lasts for 6 months and consists of isoniazid 5mg/kg daily for adults and 10 mg/kg/daily for children.

Primary pure cell seminoma of the mediastinum is a rare and potentially fatal lesion. Encroachment or invasion of adjacent structures is common, as are distant metastases. We present an unusual case of mediastinal seminoma with directly intracavitary invasion into the right atrium and extension to the left atrium. A 22-year-old male with right side chest pain, progressive cough, dyspnea, fever and right arm swelling lasting about a month is presented. Chest radiography on admission revealed a large mass in the anterior mediastinum. A cardiac ultrasonographic examination showed right atrial compression by the mass, with invasion of the right atrium wall. We also found polyp-like (about 2.5 cm in diameter) masses in left atrium near the area of the right pulmonary veins and a circumferential pericardial effusion. Percutaneous needle biopsy revealed mediastinal seminoma. To our knowledge, no similar case has been previously reported.

Tuberculous lymphadenitis is an uncommon form of extrapulmonary tuberculosis. We report on a case of isolated Cervicomediastinal tuberculous lymphadenitis without parenhimal involvement. A 49-year old woman was hospitalized with a four week history of night sweats and weight loss. Plain chest radiography disclosed mediastinal mass of the right side. Echocardiographic examination revealed a soft tissue mass below the ascending aorta and aortic arch causing moderate narrowing of the right ventricular outflow tract and the main pulmonary artery. Computed tomographic scanning showed soft tissue mass in the middle mediastinum surrounding the great vessels extending posteriorely with moderate compression of trachea. Histological examination of the cervical mass revealed caseating granuloma containing acid-alcohol fast bacillus. Antituberculous chemotherapy was started.