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Introduction/Objective. Chronic obstructive pulmonary disease (COPD) is a primary lung disease. Today, pulmonary rehabilitation (PR) is the basis for non-pharmacological treatment of these patients, with numerous confirmed effects on the most significant symptoms of the disease and the quality of life (QoL). The aim of this study was to determine the relationship between certain risk factors and the outcome of PR, as well as to determine the percentage of respondents who had a positive outcome of PR. Methods. The study included 500 patients with COPD, determined according to the Global Initiative for Chronic Obstructive Lung Disease guidelines, all stages (I–IV), in the stable phase of the disease, who completed the outpatient PR program. Disease stage, comorbidities, forced expiratory volume in the first second, six-minute walk test (6MWT), COPD Assessment Test (CAT), and Medical Research Council dyspnea scale, body mass index, airflow obstruction, dyspnea and exercise capacity (BODE) index, were measured before and after the program. The last four parameters have been observed as risk factors that affect the outcome of PR, but also as parameters by which we monitor the outcome of PR. Results. A successful outcome of PR was achieved by as many as 452 (90.4%) patients. The following were determined as independent predictors of a positive outcome of PR: lower number of comorbidities, absence of heart failure, higher BMI, and CAT ≥ 10. Conclusions. PR in our group of patients leads to statistically significant improvements in most of the examined subjective and objective parameters, in patients in all stages of the disease.

Introduction. Over the last few months the coronavirus disease 2019 (COVID-19) pandemic has created overwhelming challenges for physicians around the world. While much has been described in the literature about lung infiltrates and respiratory failure associated with infection of coronavirus 2 (SARSCoV- 2), pneumothorax is reported as a rare (a rate of 1%) but a life-threatening complication of COVID-19 pneumonia. Late bilateral spontaneous pneumothorax has been described in few cases. The aim of the report is to consider pneumothorax as a possible complication of COVID-19 pneumonia, which is also one of the causes of respiratory deterioration and potentially fatal outcome in these patients. Case outline. This article describes the clinical course of the patient who tested positive for SARS-CoV-2 on reverse-transcriptase polymerase chain reaction (RT-PCR) testing of nasopharyngeal and oropharyngeal swab specimens and who presented with COVID-19 pneumonia complicated by bilateral, spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema. He had no underlying lung disease nor risk factors for pneumothorax, except administered non-invasive ventilation/continuous positive airway pressure during first hospitalization. The patient was successfully treated with surgical (chest drainage, thoracoscopy and pleural abrasion) and non-surgical methods (by application of drugs and other supportive therapies). Conclusion. This review demonstrates that the possibility of a late pneumothorax should be kept in mind in patients with, or recovering from, COVID-19 disease with progressive dyspnea. The timely diagnosis and management of pneumothorax will reduce COVID-19 associated mortality.

Background/Aim. The influenza virus is often the cause of exacerbations among chronic obstructive pulmonary disease (COPD) patients, especially during the winter season. However, vaccination rates are still below recommended even in developed countries. The aim of the study was to determine the rates and examine the effectiveness of immunization against seasonal influenza in preventing exacerbations among COPD patients in Serbia. Methods. The prospective cohort study of stable COPD outpatients was conducted over three years (between October 1, 2014, and September 30, 2017) at the Polyclinic Department of Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia. The rates and effects of seasonal flu vaccination on COPD exacerbation rates were evaluated using univariate and multivariate logistic regression analysis, taking into account comorbidity, age, and body mass index (BMI). Results. The study included 840 patients. The flu vaccination rate was 37.1%. Exacerbations occurred more frequently in unvaccinated patients [176 (31.9%) vs. 375 (68.1%), p = 0.043]. In elderly vaccinated patients (≥ 65 years) there were fewer exacerbations compared to unvaccinated patients [89 (56.0%) vs. 188 (69.4%), p = 0.005]. Lower frequency of exacerbations was also observed in vaccinated patients with comorbidities [165 (61.1%) vs. 327 (69.4%), p = 0.021] and low BMI [27 (64.3%) vs. 78 (83.9%), p = 0.011]. Multivariate logistic regression analysis identified BMI < 21 kg/m2 [relative risk (RR): 0.490; 95% confidence interval (CI): 0.318–0.758; p = 0.001] and heart failure (RR: 2.734; 95% CI: 1.121–6.669; p = 0.027) as independent predictors of COPD exacerbations. Conclusion. Immunization for seasonal influenza in Serbia is below recommended rates. Flu vaccination was associated with a significant reduction in COPD exacerbation rates, particularly in elderly patients and patients with heart failure and low BMI.

Introduction/Objective. The chronic obstructive pulmonary disease (COPD) exacerbations have a major impact on outcomes of COPD patients. Pulmonary rehabilitation (PR) interrupts the vicious circle caused by exacerbations. It has not been widely implemented as standard of COPD treatment yet. The aim of study was to examine the effectiveness of PR in prevention of exacerbations. Method. The prospective observation study included stable COPD patients between January 2015 and December 2018. The effects of PR on exacerbation rates were evaluated using univariate and multivariate logistic regression analysis, taking into account age, comorbidity, vaccination status (against seasonal flu), body mass index (BMI). Results. Study included 1,674 patients (956 males, age 65.93 Ѓ} 8.45, current or ex-smokers 94.9%; 21 ≥ BMI 1,406 patients, 84%, FEV1 < 80% 1,448 patients, 86.5%). The PR rate was 48.1%. There was significant difference in PR status with respect to age (p = 0.020), comorbidities (p = 0.015), FEV1 (p < 0.001), respiratory symptoms using COPD assessment test (CAT) score (p < 0.001), vaccination against seasonal flu (p < 0.001). Exacerbations occurred more frequently in non-PR patients (415 (51.6%) vs. 641 (73.7%), p < 0.001). In multivariate analysis, PR (RR 0.421; 95% CI (0.307–0.577); p < 0.001) and BMI ≥ 21kg/m2 (RR 0.605; 95% CI (0.380–0.965); p = 0.035) were independent protective factors and CAT score >10 (RR 2.375; 95% CI (1.720–3.280); p < 0.001) and FEV1 < 80% (RR 2.021; 95% CI (1.303–3.134); p = 0.002) were independent risk factors from exacerbations. Conclusion. Patients who successfully completed PR treatment had significantly less frequent exacerbations compared to patients that not pass through PR program.

BACKGROUND: Neck pain (NP) is associated with high disability rates among healthcare workers. OBJECTIVE: To determine the potential risk factors associated with disability due to NP among healthcare staff working in primary care settings. METHODS: This 30-day prospective cross-sectional study involved a survey of 63 healthcare personnel (55 women and 8 men aged 45.30±12.34 years) of two primary healthcare centers in Serbia, who completed a general questionnaire developed for this purpose along with the Neck Disability Index (NDI), whereby the potential predictors of NP-related disability were assessed using the statistical package SPSS ver. 24. RESULTS: Female healthcare workers achieved a higher score on the NDI scale (Me = 8.00, p < 0.05), as did older respondents (r = 0.260, p < 0.05), those with longer work experience (r = 0.323, p < 0.05), and those that wear prescription glasses (Me = 9.00, p < 0.01). Higher NDI scores were also achieved by respondents that suffered from neck pain at the time of the study (Me = 12.50, p < 0.001), especially if they relied on pain medication (Me = 13.00, p < 0.05), and topical analgesic creams (Me = 12.50, p < 0.05) for treating neck pain. CONCLUSION: Female sex, older age, greater work experience, current neck pain, use of pain-relieving medications and creams, and need for prescription glasses to correct vision increase the risk of disability due to pain in the cervical spine among healthcare workers. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Back pain often develops in early childhood and becomes more frequent during adolescence. The aim of this study was to determine potential risk factors and the therapy effects on back pain in children. METHODS: This retrospective study included 96 boys and girls treated for back pain in outpatient and hospital setting in the 1.1.2016–31.12.2016 period at the Institute of Child and Youth Health Care of Vojvodina, Serbia. The influence of sex, age, physical activity and presence of concomitant locomotor system deformities, as well as applied therapies, on the back pain in children was analyzed using SPSS ver. 21. RESULTS: The studied sample comprised of 56.3% girls. The average age of the subjects was 14.64 years, 43 (44.8%) of the children were physically active. In children suffering from back pain, spinal column deformities were also noted, mostly scoliosis (27.1%) and kyphosis (20.8%). Chronic pain was diagnosed in 54 children (56.3%). The average pain intensity, as measured on the VAS, was 5.72 and 0.92 before and after therapy, respectively (p < 0.05). CONCLUSION: Among the analyzed parameters, only lumboishialgia was a significant factor in the onset of back pain, which declined following ergonomic education and physical therapy. [ABSTRACT FROM AUTHOR]

Introduction. Fibrous dysplasia is a noninherited benign skeletal disorder associated with abnormal bone development. Single bone involvement, the monostotic form, accounts for 70 - 80% of cases, while the polyostotic form, with multiple bone involvement, accounts for 20 - 30% of cases. Cystic degeneration and occasional aneurysmal bone cyst formation may be found in fibrous dysplasia lesions, particularly in the costal lesions. Case Report. A 51-year-old man presented with acute shortness of breath after sustaining simple chest wall injury. Chest computed tomography showed multiple massive osteolytic rib lesions, as well as a massive left-sided pleural effusion with compression atelectasis of the lung parenchyma. Osteolytic lesions of the anterior 2nd and 7th thoracic vertebral body were found, along with a well defined osteolytic lesion in the body of the sternum. Video-assisted thoracoscopy of the left pleural space was performed and frozen sections, collected using endoscopic biopsy forceps of the cystic wall and solid parts of the tumors, were sent for ex tempore histopathological analysis. Results showed fibrous dysplasia with suspected malignancy. Talc pleurodesis was performed based on the obtained results. At present, the patient is asymptomatic with his daily routine uninterrupted by his medical condition. Conclusion. Treatment of pleural effusion caused by a cyst rupture of unresectable degenerated polyostotic fibrous dysplasia of the ribs represents a surgical challenge. Surgical drainage of the cysts followed by chemical pleurodesis seems to be a reasonable solution in cases where pulmonary functions are impacted by combined effects of pleural effusion and cystic compression. [ABSTRACT FROM AUTHOR]