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Introduction/Objective. Cardiovascular disease is one of the most common comorbidities among subjects with chronic obstructive pulmonary disease (COPD). The aim of this study is to evaluate electrocardiogram (ECG) parameters and mortality predictors in COPD patients. Methods. A total of 835 consecutive patients were included. The patients were classified to suffer from COPD if the forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) was < 70% in three consecutive postbronchodilator measurements. The following ECG changes were observed: axis, P wave, low ORS complex, transitional zone, left bundle branch block (LBBB), right bundle branch block (RBBB), incomplete RBBB, S1S2S3 configuration, negative T in V1–V3. The patients were followed up for mortality over a five-year period. Results. Both survivors and non-survivors were of similar age, sex, and COPD status. FVC and FEV1, as well as Global Initiative for Chronic Obstructive Lung Disease stadiums were significantly higher in the survivor group (p < 0.016, p < 0.001, p < 0.001, respectively). Normal axis was in significantly higher percentage in non-survived patients (p = 0.020). RBBB and incomplete RBBB are more frequent findings in patients who died (p < 0.001, p < 0.05, respectively). LBBB, S1S2S3 configuration is in significantly higher percentage present in non-survivors (p < 0.016, p < 0.001, respectively). In the multivariable logistic model, patients with LBBB have two times higher chance of mortality compared to patients without LBBB. In contrast, patients with RBBB have 1.6 times lower chance of having death outcome. Conclusion. The main ECG predictors of COPD patients’ five-year mortality are LBBB and RBBB, but according to statistical model, ECG should be further explored and possibly obligatory involved in a routine clinical practice as an easy and low-cost screening method.

Introduction: Morbid obesity is associated with a number of ventilatory and cardiovascular disorders and increased risk for cardiovascular diseases, which can be improved by weight loss. Cardiopulmonary testing (CPET) is proposed for the objective evaluation of the effects of bariatric surgery in morbid obese patients. Aim: To evaluate the change of CPET and hemodynamic parameters in patients treated with bariatric surgery. Methods: We performed CPET in 250 morbid obese patients during for the preoperative assessment. We analyzed 50 patients (37 women, mean age 38±10 years) before and 6 months after bariatric surgery. All patients underwent CPET (treadmill, Bruce protocol) with expiratory gas analyses. Results: The mean weight before treatment was 126.69 ±19.21kg, and BMI was 43.8 ± 5.4 kg/m2. Averaged body weight reduction was -29, 6 kg, and BMI -10 kg/m2 after 6 months follow-up, with significant difference in comparison to baseline values (43.8±5, 4 vs 33.9±14, 3; p

Background: Until now, a proper biomarker(s) to evaluate sarcoidosis activity has not been recognized. The aims of this study were to evaluate the sensitivity and specificity of the two biomarkers of sarcoidosis activity already in use (serum angiotensin converting enzyme - ACE and serum chitotriosidase) in a population of 430 sarcoidosis patients. The activities of these markers were also analyzed in a group of 264 healthy controls. Methods: Four hundred and thirty biopsy positive sarcoidosis patients were divided into groups with active and inactive disease, and groups with acute or chronic disease. In a subgroup of 55 sarcoidosis patients, activity was also assessed by F-18 fluorodeoxyglucose positron emission tomography (18F-FDG-PET) scanning. Both serum chitotriosidase and ACE levels showed non-normal distribution, so nonparametric tests were used in statistical analysis. Results: Serum chitotriosidase activities were almost 6 times higher in patients with active sarcoidosis than in healthy controls and inactive disease. A serum chitotriosidase value of 100 nmol/mL/h had the sensitivity of 82.5% and specificity of 70.0%. A serum ACE activity cutoff value of 32.0 U/L had the sensitivity of 66.0% and the specificity of 54%. A statistically significant correlation was obtained between the focal granulomatous activity detected on 18F-FDG PET/CT and serum chitotriosidase levels, but no such correlation was found with ACE. The levels of serum chitotriosidase activity significantly correlated with the disease duration (P< 0.0001). Also, serum chitotriosidase significantly correlated with clinical outcome status (COS) categories (p = 0.272, P = 0.001). Conclusions: Serum chitotriosidase proved to be a reliable biomarker of sarcoidosis activity and disease chronicity.

Fatigue is a prominent symptom in a large number of medical conditions, malignant and infectious diseases. Fatigue is also a prominent symptom of sarcoidosis. The occurrence of fatigue in sarcoidosis is well known but exact incidence has not been established and varies from 30-70% of patients depending on age, sex and organ involvement by the granulomatous process. The exact definition of fatigue varies broadly. It can be both physical and mental. The patients describe their sensation of fatigue qualitatively different from that fatigue they experienced before they became sick. Fatigue has a major impact on the quality of life in sarcoidosis. Establishing the extent of fatigue in sarcoidosis provides relevant insight regarding the patient’s quality of life. Unfortunately there is no objective parameter for assessing fatigue in sarcoidosis. Generally, fatigue is detected by means of questionnaires. Regarding the therapy, there is no effective treatment for fatigue in sarcoidosis.

Background/Aim. In Serbia brucellosis is a primary disease of the animals in the southern parts of the country. The aim of this study was to describe the first outbreak of human and animal brucellosis in the region of Šabac, Serbia. Methods. An epidemiological investigation was conducted to identify a source of outbreak and the ways of transmission of brucellosis infection in human population. A descriptive and analytical epidemiological methods (cohort study) were used. Additional data included monthly reports of the infectious diseases from the Institutes of Public Health and data from the Veterinary Specialistic Institute in Šabac. The serological tests for human brucellosis cases were performed in the Laboratory of the Military Medical Academy; laboratory confirmation of animal brucellosis cases was obtained from the reference laboratory of the Faculty of Veterinary Medicine, Belgrade. Results. Twelve cases of brucellosis were recorded from February 9 to September 1, 2004. Total attack rate was 8.1% (7.5% of males, 14.2% of females). Relative risk (RR) of milk consumption was 8.9 (95% confidence interval: 1.63-13.38), and RR for direct contact with animals was 14 (95% confidence interval: 3.5-55.6). The prevalence of seropositive animals in 33 villages of the Mačva region accounted for 0.8%. Regarding animal species, sheep were predominant - 264 (95.7%). Out of a total number of seropositive animals, ELISA results were positive in 228 (88.7%) of them. Conclusion. As contact epidemics generally last longer, it is probable that the implemented measures of outbreak control did reduce the length of their duration.

Introduction Dyspnoea is a characteristic symptom of chronic obstructive pulmonary disease (COPD), which impairs everyday functioning of patients. Objective The aim of our study was to evaluate the relationship between the degree of dyspnoea of COPD patients and their health-related quality of life. Method We measured the degree of dyspnoea and health-related quality of life in 85 COPD outpatients (46 male; mean age was 58 ± 12 years; mean forced expiratory volume in one second (FEV1) was 47.9±18.6% predicted). The degree of dyspnoea was assessed by Baseline Dyspnoea Index (BDI), List of Daily Activities (DAL), Visual Analogue Scale (VAS), Modified MRC Dyspnoea Scale, and Borg Category Scale (BCS). The patients filled two standardized questionnaires for measuring health-related quality of life: the generic one - 15D, and the respiratory specific one - the St George’s Respiratory Questionnaire (SGRQ). Total 15D and SGRQ scores, as well as the scores for individual domains of SGRQ (symptoms, activity and impact scores) for each patient were calculated. In 40 out of 85 patients, the same procedure was repeated at the follow-up, with a mean 4-week interval between the visits. Results There were statistically highly significant correlations (p

Introduction: Asthma is the chronic inflammatory disease of the airways, and the inhalation treatment is the most convenient way to deliver the medication directly to the airways. Objective: The aim of our study was to evaluate the relationship between respiratory symptom scores in asthmatic outpatients and their satisfaction with inhaled asthma medication. Method: In 124 patients, (39 males; mean age 45±18 years; mean forced expiratory volume in one second (FEV1) 71.8±23.4% predicted), respiratory symptoms were determined by 4-item questionnaire for most frequent asthma symptoms - cough, wheezing, dyspnea and chest tightness (all of them graded from 1 - without symptoms, 2 - mild, 3 - moderate, and 4 - severe symptoms), with overall score (from 4 to 16), as well as by scale for assessment of sinonasal symptoms − the 20-item sinonasal outcome test (SNOT-20) (in 65 out of 124 patients). SNOT-20 scores ranged from 0 to 5, where higher score indicated more manifested symptom. Patients’ satisfaction was measured by standardized "Satisfaction with Inhaled Asthma Treatment Questionnaire" (SATQ), which scores were calculated for the overall satisfaction as well as for individual domains (effectiveness of treatment, easy application, medication burden, and side-effects and related worries). The bigger the score the better the satisfaction, and vice versa. Results: The highest degree of correlation with overall satisfaction scores was found (using the Pearson’s coefficient of linear correlation) for the scores of wheezing (r=-0.271; p=0.002). SNOT-20 scores best correlated with side-effects and worries domain scores. Conclusion: The severity of respiratory symptoms in the asthmatics is strongly correlated with satisfaction with inhaled medication. Improving the asthmatic symptoms Results in enhancement of their satisfaction with inhaled medication and compliance.

Introduction. Pulmonary embolism is a common condition with high morbidity and mortality, particularly if misdiagnosed or untreated. It has non-specific clinical manifestations, often presenting with symptoms similar to other cardiovascular or common respiratory diseases. Dyspnea is the most common symptom. The main goals of pulmonary embolism therapy are to stop blood clots from getting bigger and prevent formation of new clots. The aim of this article was to review the clinical presentation, incidence, diagnostic algorithms and prevention of pulmonary embolism. Management of pulmonary embolism. The management of pulmonary embolism depends on patients' hemodynamic stability (hemodynamically stabile and hemodynamically unstable patients), as well as on specific conditions (population who cannot receive the same therapy as the previously mentioned patients). The management is largely focused on medical therapy of pulmonary embolism, as the first line therapy (emergency) and then on medical options for this disease. Special attention was given to urgent intravenous thrombolytic therapy in hemodynamically unstable patients, considering that these patients are the most vitally compromised, in shock and with high mortality rate. The initial treatment in hemodynamically stable patients consists of low molecular weight heparin and unfractionated heparin, which is later replaced by long term oral anticoagulation therapy. Its duration depends on the nature of the basic disease. Some populations cannot receive any thrombolytic therapy (pregnant women, patients suffering from malignant diseases and heparin-induced thrombocytopenia). These patients may receive low molecular weight heparin, unfractionated heparin and warfarin; patients with malignant diseases receive life-long anticoagulation therapy; argatroban or lepirudin are used in the management of heparin-induced thrombocytopenia. Conclusion. Prevention of pulmonary embolism is lifesaving. It includes prophylactic medical regimens and "mechanical" supportive therapy (elastic graduated compression stockings, inferior vena cava filters). [ABSTRACT FROM AUTHOR]

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Introduction. Primary spontaneous pneumothorax is an infrequent condition which requires emergency medical treatment. Nowadays, due to hiking and tourism, many people reach high altitudes in a hypobaric hypoxia environment. These hypoxic conditions can be tolerated if one is exposed to low oxygen pressure, leading to a sequence of physiological responses. Occasionally, hypoxia causes maladaptive responses which leads to different forms of high altitude diseases. Case Report. We report a case of a 49-year-old man, a former professional athlete, passionate about hiking and still physically active. He was admitted to our Emergency Department with short breath and a chest X-ray revealed a large right sided pneumothorax which was successfully treated with tube drainage. Conclusion. Although primary spontaneous pneumothorax is a rare condition, it should be suspected during physical examination. Therefore, physicians should be prepared to recognize it, especially paying attention to all hikers and high-altitude travelers in order to avoid possible risks for high-altitude sickness. [ABSTRACT FROM AUTHOR]

Introduction. The major oxygen sensors in the human body are peripheral chemoreceptors, also known as interoreceptors- as connected with internal organs, located in the aortic arch and in the body of the common carotid artery. Chemoreceptor function under physiological conditions. Stimulation of peripheral chemoreceptors during enviromental hypoxia causes a reflex-mediated increased ventilation, followed by the increase of the muscle sympatic activity, aiming to maintain tissue oxygen homeostatis, as well as glucosae homeostatis. Besides that, peripheral chemoreceptors interact with central chemoreceptors, responsible for carbon dioxide changes, and they are able to modulate each other. Chemoreceptor function in pathophysiological conditions. Investigations of respiratory function in many pathological processes, such as hypertension, obstructive sleep apnea, congestive heart failure and many other diseases that are presented with enhanced peripheral chemosensitivity and impaired functional sympatholysis ultimately determine the peripheral chemoreceptor role and significance of peripheral chemoreceptors in the process of those pathological conditions development. Considering this, the presumed influence of peripheral chemoreceptors is important in patients having the above mentioned pathology. Conclusion. The importance and the role of peripheral chemoreceptors in the course of the breathing control is still controversial, despite many scientific attempts to solve this problem. The main objective of this review is to give the latest data on the peripheral chemoreceptor role and to highlight the importance of peripheral chemoreceptors for maintaining of oxygen homeostasis in pateints with hypoxia caused by either physiological or pathological conditions. [ABSTRACT FROM AUTHOR]