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Currently in Croatia, there are 275 severe asthma patients treated with biological therapy. Most of them (201) are receiving anti-IL5 therapy. To assess the outcomes of the most used biological therapy in severe asthma patients in Croatia, we conducted a real-life study, including 41 patients receiving anti-IL5 therapy at Clinical Center for Lung Diseases Jordanovac. Although our data offers some insight into biological therapeutics outcomes, we need a larger group of patients to make more precise conclusions.

During the COVID-19 pandemic, much effort has been made to investigate SARS-CoV-2–specific antibodies as possible therapeutic agents. During that challenging time we are dealing with a new and insufficiently know pathogen, when reagents, standards and methodologies for antibody characterization are lacking, and are developed in parallel with therapy, making it difficult to properly asses and compare the results of convalescent plasma usage within the individual trials. At present, no conclusions can be drawn due to the lack of standardization in antibody assessments. Here we describe an approach of establishing antibody characterization in emergent times which would, if followed, enable comparison of results from different studies. We established an assay of wild-type SARS-CoV-2 neutralization, as the most relevant for antibody protectivity. To ensure the maximal reproducibility, we used a banking system of its biological components - a challenge virus, cells and an anti-SARS-CoV-2 antibody in-house standard, calibrated to the First WHO International Standard immediately upon its availability. Consequently, all collected serological data were retrospectively expressed in an internationally comparable way. The neutralizing antibodies (NAbs) among convalescents ranged from 4 to 2869 IUmL-1, being in significant positive correlation to the disease severity. NAbs decline in convalescents was on average 1.4-fold in a one-month period. Heat-inactivation of sera samples resulted in a 2.3-fold decrease of NAb titres in comparison to the native sera, implying significant complement activating properties of SARS-CoV-2 specific antibodies. The monitoring of NAb titres in the sera of immunocompromised COVID- 19 patients that lacked their own antibodies evidenced the successful transfusion of antibodies by the COVID-19 convalescent plasma units with NAb titres of 35 IUmL-1 or higher. Results have been published in Ravlić, Hećimović et al. Front. Immun. 2022 ; 13:816159. https://doi.org/10.3389/fimmu.2022.816159

In 2020, a worldwide spread of SARS-CoV-2 caused the global COVID-19 pandemic. Experience from previous outbreaks with other coronaviruses showed that convalescent sera contained neutralizing antibodies (NAbs) against the virus and that their use was beneficial to the treated patients. Although convalescent plasma therapy was considered generally beneficial, the scientific medical community lacks definitive proof of its efficacy coming from carefully designed clinical trials. The reasons for this can be found in its short-term usage only during epidemics caused by a new and insufficiently know pathogen, in a period when pathogen specific therapy and vaccines are lacking. During this period, methods for plasma neutralization potency determination are usually lacking or if they exist, they are neither standardized nor validated. All this results in the variability within different individual trials. Here we describe an approach of establishing antibody characterisation in emergent times which would, if followed, enable comparison of results from different studies. We established an assay of wild-type SARS-CoV-2 neutralisation, as the most relevant for antibody protectivity. To ensure the maximal reproducibility, we used a banking system of its biological components - a challenge virus, cells and an anti-SARS-CoV-2 antibody in-house standard, calibrated to the First WHO International Standard immediately upon its availability. Consequently, all collected serological data were retrospectively expressed in an internationally comparable way. The neutralising antibodies (NAbs) among convalescents ranged from 4 to 2869 IUmL-1, being in significant positive correlation to the disease severity. NAbs decline in convalescents was on average 1.4-fold in a one-month period. Heat-inactivation of sera samples resulted in a 2.3-fold decrease of NAb titres in comparison to the native sera, implying significant complement activating properties of SARS-CoV-2 specific antibodies. The monitoring of NAb titres in the sera of immunocompromised COVID-19 patients that lacked their own antibodies evidenced the successful transfusion of antibodies by the COVID-19 convalescent plasma units with NAb titres of 35 IUmL-1 or higher.

Introduction Alpha-1 antitrypsin deficiency is one of the most widespread genetic disorders. However, due to its autosomal codominant inheritance, clinical manifestations occur only in individuals who have two faulty alleles ; the predominant variant with expression is PiZZ. (1, 2) The most successful treatment today is replacement therapy with a human alpha1- proteinase inhibitor. (3) The purpose of this study was to evaluate the effect of the drug in patients who have the aforementioned disorder. Methods This is a retrospective, observational, noncomparative case study. The inclusion criteria for augmentation therapy are proven low levels of A1AT, a genetic variant of PiZZ, and progressive lung disease with FEV1 80% or lower. The outcome measure was to record the deterioration of pulmonary function. The progression of their disease has been continuously monitored by lung function tests (spirometry and CO diffusion) at least once every 6 months. Results Over the last 15 years, there have been 29 patients that were on therapy with a human alpha1- proteinase inhibitor. 22 of them are male (76%) and 7 female. The mean age at the time of diagnosis was 46, 75 years and more than half (55%) are between 40 and 50 years old. The vast majority of patients (93%) are smokers (or ex- smokers) that have on average 23, 56 pack years. Nearly all patients received their therapy in a two-week regimen. Out of 29 patients that have been on augmentation therapy, 19 were continuously monitored over at least 5 years. Over this 5-year period, we observed that those subjects who received treatment had no further significant deterioration in FVC, FEV1, or DLCO. Average FVC at the beginning was 64, 5%, FEV1 35, 26% and DLCO 42, 63% while after 5 years these values were 60, 63%, 30, 42% and 41, 72%, respectively. The differences between their first findings and those after 5 years were -4, 68 for ΔFVC, -4, 53 for ΔFEV1 and ΔDLCO is -1, 95. None of the subjects had significant side effects that would require discontinuing the drug. Conclusion Given all the above, we can affirm that a human alpha1- proteinase inhibitor seems to be a safe drug that is effective in slowing the decline of pulmonary function and reducing the number of exacerbations.

Lung transplantation is a therapeutic option for the treatment of advanced lung disease. The risk of pulmonary infections is increased in lung transplant recipients. We report a case of a pulmonary coinfection with Mycobacterium tuberculosis and Nocardia species in a lung transplant recipient., Transplantacija pluća jedna je od terapijskih opcija kod liječenja uznapredovale plućne bolesti. Primatelji presađenih pluća imaju povećani rizik za nastanak plućnih infekcija. U radu prikazujemo slučaj koinfekcije pluća kod bolesnika s transplantiranim plućima, čiji su uzročnici Mycobacterium tuberculosis i Nocardia species.

This presentation highlights the need to develop a set of minimum standards for monitoring. This would ensure a meaningful comparison of the Article 17 reporting results between EU member states.

INTRODUCTION Cannabis is the most frequently used drug in the world, and smoking is the fastest way to produce psychoactive effects. Cannabinoids are lipid soluble, which results in a rapid systemic absorption via respiratory and gastrointestinal tract. The deleterious impact of cannabis on the lungs is well-known, and the additives, such as silicon dioxide, which are used in the drug processing, can pose an additional health risk. Deep cannabis inhalation, and breath holding are especially dangerous. The side effects of marijuana smoking, among others, are a barotrauma of the lung, pneumomediastinum, pneumothorax, subcutaneous emphysema, alveolar haemorrhage, intravascular haemolysis, along with acute respiratory distress syndrome, which sometimes have a lethal outcome. Also, adverse cardiac events (myocardial infarction) were reported. This is the direct consequence of high temperatures and toxic active compounds, such as acids, produced during cannabis smoking. The result is inflammatory edema, damaged alveolar- capillary basement membrane, coagulopathy, and increased alveolar permeability. CASE REPORT A 36-year old man was hospitalized due to hemoptysis. He used to be addicted to opiates eleven years ago, has untreated hepatitis C, and frequent superficial thrombophlebitides, is a year-long tobacco smoker (pack-years 30), and has occasionally been smoking marijuana for the past 20 years. The last time he smoked marijuana, was two weeks prior to the onset of hemoptysis. He started feeling dyspnea a year ago, with sporadic wheezing, and coughing, but this was his first time having blood in the sputum. He also felt chest discomfort. Renal and liver function, coagulation studies and electrolytes were normal. A computed tomography pulmonary angiogram showed an inhomogeneous ground glass infiltrate anterobasally in the upper lung lobe, without any sign of pulmonary embolism. A fiber optic bronchoscopy showed normal airways with traces of blood. Cytologic work-up of the acquired materials showed no abnormalities, and no infection was proven. Gradually, on conservative therapy, the hemoptysis stopped, and the patient's clinical condition improved. CONCLUSION Illegal cannabis use is prevalent among young people. Although psychiatric disorders are the most common result of marijuana abuse, respiratory complications have been coming into focus due to some rare but life-threatening repercussions, such as hemoptysis. Here we want to emphasise that physicians should exhibit a high level of awareness when treating young patients with alveolar hemorrhage, and take drug abuse into consideration. A lot more effort should be put into educating people about the dangers of marijuana smoking, since complications may arise even in recreational smokers.

Cilj rada je prikazati i naglasiti važnost odabira adekvatnog inhalacijskog uređaja za pojedinog bolesnika, kao i edukaciju pravilne inhalacijske tehnike, kako bolesnika, tako i liječnika koji propisuje uređaj. Astma i KOPB su najčešće kronične plućne bolesti koje se, za razliku od drugih kroničnih bolesti, liječe na poseban način- inhalacijom lijeka. Danas na svjetskom tržištu postoji preko 40 različitih inhalacijskih uređaja od kojih se svaki koristi na drugačiji i specifičan način i ponekad je teško odabrati odgovarajući uređaj za bolesnike. Taj izbor ovisi o više čimbenika: mogućnostima samog bolesnika (njegove plućne funkcije, motorike, dobi, mogućnosti shvaćanja tehnike, komorbiditetima kao što je primjerice artritis), dijagnozi i kombinaciji lijekova koje mu trebaju, kao i znanju liječnika da sve te čimbenike prepozna i odabere adekvatan uređaj za bolesnika te mu objasni i pokaže njegovu primjenu. Ovaj rad pokazuje razlike u razumijevanju i odabiru inhalacijskih uređaja specijalizanta pulmologije među kojima je provedena anketa s pitanjima vezanim za karakteristike uređaja prije i nakon vježbi o toj temi. Pitanja koja su bila postavljena u anketi bila su: broj inhalacijskih uređaja u Hrvatskoj, mišljenja o najjednostavnijem uređaju, najvećih problema kod primjene DPI i pMDI uređaja, te odabira uređaja za pojedine skupine bolesnika (mladu bolesnicu s astmom i bolesnika s Parkinsonovom bolesti).

U današnje vrijeme znanstvenici i stručnjaci istražuju prirodu različitim naprednim tehnologijama pomoću kojih nam otkrivaju i približavaju dosad nepoznato. Ova izložba ostvarena je suradnjom Javne ustanove Rezervat Lokrum i Tehničkog muzeja Nikola Tesla s ciljem približavanja svijeta šišmiša i tehnologija koje se koriste za njihovo istraživanje. Otok Lokrum zaštićen je kao poseban rezervat šumske vegetacije prije više od 70 godina zbog jedinstvene šume česvine koju nastanjuju brojne vrste. Putopisci i istraživači posjećivali su Lokrum i bilježili nalaze vrsta. Ipak, podatci o šišmišima bili su skromni sve do 2016. godine kad su istraživači iz Hrvatske i Velike Britanije započeli zajednička istraživanja. Otkrili su ukupno 11 vrsta šišmiša što je velik broj za tako mali otok. Lokrum je izuzetno važno stanište za kolonije dviju vrsta šišmiša — Kolombatovićevog dugoušana i malog potkovnjaka. Istraživanja šišmiša na Lokrumu suvremenim tehnologijama kao što su primjena bat detektora i telemetrije na izložbi su prikazana filmom, pri čemu se čuje i glasanje šišmiša snimljeno pomoću bat detektora. Izložba je postavljena u prostoru Benediktinskog samostana na Lokrumu.

With its heavily-wooded landscape, three open water bodies, an abundance of natural and artificial (man-made) roosts, as well as the lack of disturbance overnight from human activities such as noise and artificial lighting ; the island of Lokrum is an ideal habitat for a wide range of bat species. Yet prior to 2016 knowledge of bat fauna on the island was limited to one source simply stating that two bat species have nursery colonies in the Benedictine monastery complex. With the planned renovation of the island’s historical buildings, the authorities at the Public Institution “Special Reserve of forest vegetation Island Lokrum” commissioned the Croatian Biospeleological Society (CBSS) to undertake an assessment of the islands bat fauna, with particular reference to the Benedictine monastery complex and Maximillian residence. This would be a requirement of the licensing process during the renovation of the buildings, as bat colonies are protected under both EU and Croatian law. In 2017, the Vincent Wildlife Trust were asked to collaborate on the bat assessment using specialist radio-telemetry techniques. Further work was undertaken in 2019 with the assistance of British ecologists who specialise in mitigating the effects on bats of the renovation of historical buildings. The assessment was conducted using mist- nettings, ultra-sound recordings, infra-red filming, visual and photographic building surveys. These established that 11 of the 34 bat species found in Croatia are present on the Lokrum, which is an extraordinarily high bat biodiversity for an island with a surface area of only 0.7 km2. Radio-telemetry studies of the island’s population of Plecotus kolombatovici, have shown it to have a flexible roosting ecology. In addition to the roosts in the Benedictine monastery complex, Maximillian residence and Fort Royal, day roosts were also found in natural cavities in trees and cracks in caves. The study highlighted the importance of the island’s buildings even to those bats who roosted in natural sites. They were the focus of much overnight bat activity and used as night roosts and for social interaction between the population. The development of a mitigation plan for the Benedictine monastery complex and Maximillian residence focused on three species known to have maternity roosts in the buildings ; Plecotus kolombatovici, Rhinolophus hipposideros and Myotis mystacinus. Two further species, Rhinolophus ferrumequinum and Myotis nattereri, were also accommodated in the plans. Roosting opportunities and the provision of flightpaths through the building have been maintained. A dedicated bat room has been set aside on the ground floor of the monastery. Bat access points, particularly into the roofs of the buildings, have been incorporated in the plans. Finally, provision has been made for bat access into the proposed reconstructed roof in the central room of the monastery complex and over the veranda in the Maximillian residence.

Astma je češča plućna bolest od KOPB-a i najznačajnija kronična bolest djece i mladih.Signifikantan je uzrok morbiditeta te predstavlja financijski teret društvu (izostanak iz škole, izostanak s posla, troškovi zdravstvenog sustava itd).Obzirom na njen kroničan tijek potrebno je neprestano osiguravati podršku bolesnicimada ustraju u liječenju a obzirom na njenu heterogenu narav, suradnju između specijalista i liječnika opće medicine(LOM).Liječnici obiteljske medicine su u većini slučajeva prvi kontakt s oboljelima i njihova uloga je omogućiti brzi put do dijagnoze, implementirati terapiju te prattti tijek bolesti i njene egzacerbaccije.Optimizaciji suradnje specijalista alergologa illi pulmologa sa LOM može pomoći jednostavni postupnik koji daje orjentacijski okvir za podjelu zadataka u zbrinjavanju ove bolesti. Jednu varijantu postupnika koju predlažemo za raspravu prikazuje tablica 1.

Lokrum Island, Dubrovnik, Croatia, is a special reserve of forest vegetation since 1948. The total surface of the island is 0.7 km2, while dense vegetation covers 86% of the island, with the forest and maquis dominated by Quercus ilex and Fraxinus ornus. The island and the seabelt are also a Natura 2000 site. Lokrum Island, as a part of Dubrovnik Old Town, is under the protection of UNESCO as a cultural heritage. The only known data for the bat fauna on the island originate from one source stating that two bat species have nurseries in the Benedictine monastery, without any additional data on dates and numbers of specimens. In June and September 2016 we investigated the bat fauna by placing mist-nets around water bodies, searching overground and underground potential roosting sites and echolocation recording using ultrasound detectors. Overall 7 bat species were mistnetted: Hypsugo savii, Miniopterus schreibersii, Myotis nattereri, M. mystacinus, Pipistrellus kuhlii, P. nathusii and Plecotus kolombatovici. In the Benedictine monastery a nursery colony of Rhinolophus hipposideros was confirmed and one R. ferrumequinum specimen was also recorded. The nursery of Plecotus kolombatovici was also confirmed, although the exact location in the monastery complex was not found. The echolocation recordings revealed 2 more species: Tadarida teniotis and Nyctalus noctula. Preserved forest and vegetation of the island, water reservoirs at three localities, a number of overground roosts and sea caves together with the absence of visitors during the night enables a high biodiversity of bat fauna for such a small island, with 11 of the 34 Croatian- recorded bat species. The results were presented at the International Bat Night in 2016, the first ever for that particular county. Bat research results from 2016, together with additional research planned in 2017, will enable further recommendations and actions for the conservation of the bat fauna through the current development of the Lokrum Island Reserve Management Plan.