Validacija sprske verzije upitnika za procenu hronične opstruktivne bolesti pluća

Uvod/Cilj. Upitnik za procenu hronične opstruktivne bolesti pluća (HOBP) (engl. COPD Assessment Test - CAT) je jednostavan i pouzdan test namenjen za merenje ukupnog zdravstvenog stanja bolesnika sa HOBP i koristan je za upotrebu u svakodnevnoj kliničkoj praksi. Cilj ovog istraživanja bio je da se proceni validnost i opravdanost primene srpske verzije CAT. Metode. U studiji je učestvovalo 140 bolesnika u stabilnom stanju HOBP, ispitivanih u ambulantnim uslovima na Klinici za pulmologiju, Kliničkog centra Srbije u Beogradu i Institutu za plućne bolesti Vojvodine u Sremskoj Kamenici. Tokom prvog pregleda bolesnicima je učinjeno ispitivanje plućne funkcije (spirometrija), popunili su CAT upitnik i mMMR (modified Medical Research Council) skalu za procenu stepena dispneje. Pouzdanost CAT test-retesta je ispitivana kod 20 bolesnika od strane istog istraživača. Rezultati. Pokazali smo da srpska verzija CAT ima visoku internu konzistentnost sa Cronbach-ovim alfa 0.88. Test-retest analiza pokazala je dobru korelaciju između CAT rezultata u dve vremenske tačke (Spearmanov r = 0,681; p < 0,01). CAT je umereno korelirao sa mMRC skalom (r = + 0,57), blago sa forsiranim ekspiratornim volumenom u prvoj sekundi (FEV1), (r -0,214), uz pozitivnu korelaciju sa ukupnim brojem pogoršanja HOBP, ali bez jasne regularnosti sa promenom GOLD (Global Initiative for Chronic Obstructive Lung Disease) stadijuma. Zaključak. Srpska verzija CAT je pokazala visoku internu konzistentnost i test-retest pouzdanost. Ona predstavlja pouzdano, jednostavno i lako sredstvo za upotrebu koje se može koristiti u svakodnevnoj kliničkoj praksi za procenu zdravstvenog stanja kod bolesnika sa HOBP u Srbiji.Background/Aim. The Chronic obstructive pulmonary disease (COPD) Assessment Test (CAT) is a simple and reliable tool designed to measure overall COPD related health status and complement physician assessment in rou-tine clinical practice. Objective of this study was to evaluate the validity of the Serbian version of CAT. Methods. Study included 140 outpatients in the stable COPD, recruited from two centres: Clinic for Pulmonology, Clinical Center of Serbia, Belgrade, and Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica. All patients completed pulmonary function testing – spirometry, the CAT and the modified Medical Research Council (mMRC) dyspnea scale at baseline visit. The CAT test-retest reliability was tested in 20 patients by the same investigator (physician). Results.We demonstrated that Serbian version of CAT had high internal consistency with Cronbach’s alpha 0.88. Test-retest analysis showed good correlation between CAT scores in two time points (Spearman’s ρ = 0.681, p < 0.01). In our study the CAT correlated moderately to mMRC scale (ρ = +0.57), weakly to FEV1 (ρ -0.214), was positively related to number of exacerbations, but did not showed exact regularity with change in the Global Initiative for Chronic Obstructive lung disease (GOLD) stage. Conclusion.The Serbian version of CAT is a reliable, simple and easy-to-use tool that can be used in everyday clinical practice to assess the health status of COPD patients in Serbia

Aortic stenosis: From diagnosis to optimal treatment

Aortic stenosis is the most frequent valvular heart disease. Aortic sclerosis is the first characteristic lesion of the cusps, which is considered today as the process similar to atherosclerosis. Progression of the disease is an active process leading to forming of bone matrix and heavily calcified stiff cusps by inflammatory cells and osteopontin. It is a chronic, progressive disease which can remain asymptomatic for a long time even in the presence of severe aortic stenosis. Proper physical examination remains an essential diagnostic tool in aortic stenosis. Recognition of characteristic systolic murmur draws attention and guides further diagnosis in the right direction. Doppler echocardiography is an ideal tool to confirm diagnosis. It is well known that exercise tests help in stratification risk of asymptomatic aortic stenosis. Serial measurements of brain natriuretic peptide during a follow-up period may help to identify the optimal time for surgery. Heart catheterization is mostly restricted to preoperative evaluation of coronary arteries rather than to evaluation of the valve lesion itself. Currently, there is no ideal medical treatment for slowing down the disease progression. The first results about the effect of ACE inhibitors and statins in aortic sclerosis and stenosis are encouraging, but there is still not enough evidence. Onset symptoms based on current ACC/AHA/ESC recommendations are I class indication for aortic valve replacement. Aortic valve can be replaced with a biological or prosthetic valve. There is a possibility of percutaneous aortic valve implantation and transapical operation for patients that are contraindicated for standard cardiac surgery

Massive right atrial myxoma with dyspnea at rest in an elderly patient: A case report

Introduction. Primary heart tumors are extremely rare and myxoma is the most common type of these tumors. Although intraatrial presentation is a predilection place, right atrial localization is atypical. The symptom triad is characteristic in the clinical presentation of the tumor: embolic complication, intracardiac blood flow obstruction and systemic manifestations like elevated erythrocyte sedimentation rate, fever, anemia, body weight loss. Case report. We presented an elderly female patient with massive myxoma in the right atrium, 77 × 44 mm in diameter, which filled the entire right atrium and spread into the right ventricle, causing the tricuspid valve obstruction and dyspnea. It was visualized by transthoracic echocardiography and small and insignificant pericardial effusion was also seen. After surgical removal of the tumor, the patient remained without any symptoms and pericardial effusion. Conclusion. Tumors of the right heart have to be considered in the differential diagnosis of unexplained dyspnea in elderly patients. Transthoracic echocardiography is certainly necessary and mostly available diagnostic tool that can be of great help in diagnosing heart tumor as well as planning cardiac surgery, as it provides in most cases excellent visualization of the tumor and its relationship with other parts of the heart

Role of natriuretic peptides in the assessment of aortic stenosis severity

Background/Aim. Symptom onset is a critical point in natural course of aortic stenosis and the most important indication for aortic valve replacement. The aim of the study was to evaluate the role of natriuretic peptides level in the assessment of symtomatic status of patients with severe aortic stenosis and the preserved left ventricular systolic function. Methods. In 67 patients with isolated severe aortic stenosis symptomatic status, transthoracic echocardiography, and BNP and NT-proBNP plasma level were assesed. Natriuretic peptides levels were also measured in 36 healthy controls. Results. BNP and NT-proBNP levels were significantly higher in the patients with aortic stenosis compared with the healthy controls. The symptomatic patients had a higher level of natriuretic peptides than the asymptomatic ones (BNP 118 [29-266] vs 79 [44-90] pg/mL, p &lt; 0.001; NT-proBNP 258 [67-520], vs 79 [77- 112] pmol/L, p &lt; 0.0001). Natriuretic peptides levels increased with the severity of NYHA class. NT-proBNP level higher than 122 pmol/L was a cutoff value for detection of symptoms in the patients with severe aortic stenosis. Conclusion. The levels of natriuretic peptides were significantly higher in the patients with symptomatic aortic stenosis, and increased with NYHA class. Measurement of natriuretic peptides levels could be important addition to clinical and echocardiographic assessment in determing optimal timing for valve replacement in aortic stenosis