Post-COVID condition: Pulmonary or systemic, reversible or irreversible?

During the COVID-19 pandemic, many patients were completely recovered, and about 30% of patients had prolonged symptoms, independent from the severity of their clinical picture of the COVID-19. There is no correlation between severe acute COVID and severe post-COVID syndrome. According to the NICE 2020 recommendations, the term long COVID includes symptomatic COVID-19 (period 4-12 weeks after acute disease) and post-COVID-19 syndrome. According to the WHO post-COVID-19 syndrome is a condition in persons with a history of probable or confirmed COVID infection, usually 3 months from the onset of COVID-19, with symptoms lasting at least 2 months, that cannot be explained by an alternative diagnosis. Intolerance to physical exertion, experiencing breathing difficulty and neuropsychiatric disorders are the most common and the longest lasting difficulties. Most common respiratory post-COVID manifestation is persistent dyspnea, while persistent pulmonary fibrosis was extremely rare. In almost half of patients who have had severe COVID pneumonias, there was no absolute correlation between pulmonary function disorders and thoracic CT images, and disorders kept persisting after complete radiographic regression. Dominant manifestation of these disorders is reduced lung diffusion capacity for CO (TLCOc, KCOc), while spirometry values are mostly normal. Pulmonary thromboembolism, myocarditis, anxiety-depressive disorder, forgetfulness and hair loss are some of the serious post-COVID complications. A significant number of patients need physical rehabilitation

The first outbreak of brucellosis in the region of Šabac

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

Association between tobacco smoking and pulmonary tuberculosis

Background/Aim. Numerous studies evaluate the influence of tobacco smoking on the tuberculosis (TB) development, with the results indicating that smoking can be also considered as important risk factor in TB. The aim of this study was to assess the influence of tobacco smoking as the risk factor in the development of TB as well as in its clinical course. Methods. We analyzed data from the medical records of 192 consecutively hospitalized TB patients (124 males and 68 females) in the Institute of Pulmonary Diseases and Tuberculosis, Clinical Center of Serbia, Belgrade in the period from 2005 to 2007. Results. Among the analyzed TB patients there were more smokers (63.5%) than nonsmokers (36.5%). The majority of the smokers (73.8%) belonged to a middle age group (35-54 years) while the majority of nonsmokers (64.3%) were older than 55 years. Sex ratio among the smokers showed the domination of males (80.3%). There were significantly more males in the smoking group and more females in the nonsmoking group (χ2 = 34.402, p < 0.0001). Most smokers (68.9%) smoked more than 20 cigarettes daily. The average index of pack/years among all of the examinated patients was 32.75 ± 18.26. Cavitary pulmonary lesions were more frequently verified in the smokers (64.2%) than in the nonsmokers (35.8%). The sputum acid-fast bacillus smear-positive finding was more frequent in the smokers (78%) than in the nonsmokers (22%). The nonsmoking TB patients had more accompanied immunodeficient diseases (34%) than the smoking ones (19%). Body-mass index was lower in the smokers (21.75) than in the nonsmokers (23.80), although this difference did not reach the statistical significance. Conclusion. There are more smokers than nonsmokers in TB patients. Smokers more frequently have cavitary forms of TB with sputum acid-fast bacillus smear - positive finding than nonsmokers

Mystery called sarcoidosis: Forty-four years follow-up of chronic systemic disease

Introduction. This is a presentation of a 61-year-old female patient. Since 44 years have passed from the onset of her first symptoms until the final diagnosis of sarcoidosis, this was the reason of our decision to publish the case. Case Outline. During the follow-up period of 44 years the patient had ocassional polymorphic complains, such as adynamia, nausea, abdominal pains, myalgia, arthralgia, body weight loss (8-10 kg) etc. The clinical course was predominated by splenomegaly, hepatitis and arthralgia, and later chronic renal failure also developed. Laboratory findings showed elevated markers of acute inflammation and autoantibodies. The patient was hospitalized in different university internal hospitals (gastroenterology, allergology, rheumatology, nephrology and pulmology). Liver biopsy was performed three times, rectum and kidney biopsy once each and finally bronchoscopy and pulmonary biopsy was done. At last, about 40 years from the onset of the first symptoms, in 2006 the diagnosis of lung sarcoidosis was established. Conclusion. The final diagnosis of spleen sarcoidosis was confirmed by pathologically verified sarcoidosis of the lungs. This case is particularly interesting because of the presence of familial sarcoidosis (the patient’s son also had recurrent pulmonary sarcoidosis). [Projekat Ministarstva nauke Republike Srbije, br. 175046

Comparison between Carotid Artery Wall Thickness Measured by Multidetector Row Computed Tomography Angiography and Intimae-Media Thickness Measured by Sonography

The increased thickness of the carotid wall >1 mm is a significant predictor of coronary and cerebrovascular diseases. The purpose of our study was to assess the agreement between multidetector row computed tomography angiography (MDCTA) in measuring carotid artery wall thickness (CAWT) and color Doppler ultrasound (CD-US) in measuring intimae-media thickness (IMT). Eighty-nine patients (aged 35–81) were prospectively analyzed using a 64-detector MDCTA and a CD-US scanner. Continuous data were described as the mean value ± standard deviation, and were compared using the Mann–Whitney U test. A p value <0.05 was considered significant. Bland–Altman statistics were employed to measure the agreement between MDCTA and CD-US. CAWT ranged from 0.62 to 1.60 mm, with a mean value of 1.09 mm. IMT ranged from 0.60 to 1.55 mm, with a mean value of 1.06 mm. We observed an excellent agreement between CD-US and MDCTA in the evaluation of the common carotid artery thickness, with a bias between methods of 0.029 mm (which is a highly statistically important difference of absolute values [t = 43.289; p < 0.01] obtained by paired T test), and limits of agreement from 0.04 to 0.104. Pearson correlation coefficient was 0.9997 (95% CI 0.9996–0.9998; p < 0.01). We conclude that there is an excellent correlation between CAWT and IMT measurements obtained with the MDCTA and CD-US

Association between active pulmonary tuberculosis and miRNA-146a: A preliminary study from Serbia

Introduction: Tuberculosis (TB) continues to be a significant public health problem. The role of small non-coding RNAs, such as microRNAs (miRNAs), was investigated extensively in Mycobacterium tuberculosis (MTB) infection as well as in a variety of other pathophysiological processes in recent years. It was found that miRNAs act as regulators of both early reaction to MTB infection and in process of adaptation of the host immune cells during latent course of the disease. Molecule miRNA-146a is expressed exclusively in immune cells and it has the most prominent role in modulation of innate immunity. Methodology: We investigated the level of expression of miRNA-146a using an RT-qPCR technique in peripheral blood mononuclear cells of 44 patients with active pulmonary TB and 17 healthy individuals. We also analyzed the significance of miRNA-146a rs2910164 SNV for expression profile of miRNA-146a, in order to investigate potential usage of miRNA-146a as a biomarker for TB. Results: There was statistically significant decrease of expression of miRNA-146a in TB group compared to control group. When gender cohorts were analyzed, the expression levels in TB male and TB female subgroup were significantly lower than the expression levels in the same gender control subgroups. Conclusions: Our results indicate that miRNA-146a plays a significant role in the pathogenesis of TB, suggesting that miRNA-146a could be used as a biomarker for active pulmonary TB

Kašnjenje zbog bolesnika, zdravstvenog sustava i ukupno kašnjenje u dijagnosticiranju i liječenju tuberkuloze u populaciji Srbije

Currently, topical are studies that examine diff erent reasons for delay of tuberculosis (TB) diagnosis and its impact on disease prognosis. The aim was to examine three time periods associated with treatment delay: patient related, health system related and total delay. This retrospective-prospective study included 100 consecutive patients hospitalized at Department of Pulmonology, Clinical Center of Serbia, in the period from March to December 2015. Study results showed median patient delay to be 92.5 days. Total delay was aff ected by patient related delay. Median healthcare delay was 18.5 days. Patients that reported excessive alcohol consumption were more likely to have prolonged time to seek medical help. Years of alcohol consumption yielded moderate positive correlation with patient related delay (r=0.362, p0.05). Clinical characteristics such as patient TB category and chest radiograph abnormalities were not associated with prolonged patient related delay (p>0.05). Study results point to the importance of health education and/or health intervention in the population group at a high risk of TB.Trenutno su veoma aktualne studije koje istražuju razloge za kašnjenje dijagnosticiranja tuberkuloze (TB) te njihov utjecaj na prognozu bolesti. Cilj je bio ispitati tri razdoblja povezana s kašnjenjem dijagnoze: bolesnikovo, zdravstvenog sustava i ukupno kašnjenje. Ovo retrospektivno-prospektivno istraživanje uključilo je 100 uzastopnih bolesnika s dijagnozom TB i hospitaliziranih u Klinici za pulmologiju Kliničkog centra Srbije između ožujka i prosinca 2015. Studija je pokazala medijan vremena kašnjenja bolesnika od 92,5 dana, što je utjecalo i na ukupno vrijeme kašnjenja. Medijan vremena kašnjenja zdravstvenog sustava bio 18,5 dana. Kod bolesnika koji su prekomjerno konzumirali alkohol bilo je vjerojatnije da će imati produženo vrijeme do traženja liječničke pomoći. Godine konzumiranja alkohola bile su u pozitivnoj i umjerenoj korelaciji s vremenom kašnjenja bolesnika (r=0,362, p0,05). Kategorija bolesnika s TB i nenormalnosti radiograma nisu bile povezane s vremenom kašnjenja bolesnika (p>0,05). Sve ovo ukazuje na važnost zdravstvenog odgoja i/ili zdravstvene intervencije kod stanovništva s visokim rizikom od TB