Risk factors for brain metastases in surgically staged IIIA non-small cell lung cancer patients treated with surgery, radiotherapy and chemotherapy

mortality among patients with carcinomas. The aim of this study was to point out risk factors for brain metastases (BM) appearance in patients with IIIA (N2) stage of nonsmall cell lung cancer (NSCLC) treated with three-modal therapy. Methods. We analyzed data obtained from 107 patients with IIIA (N2) stage of NSCLC treated surgically with neoadjuvant therapy. The frequency of brain metastases was examined regarding age, sex, histological type and the size of tumor, nodal status, the sequence of radiotherapy and chemotherapy application and the type of chemotherapy. Results. Two and 3-year incidence rates of BM were 35% and 46%, respectively. Forty-six percent of the patients recurred in the brain as their first failure in the period of three years. Histologically, the patients with nonsquamous cell lung carcinoma had significantly higher frequency of metastases in the brain compared with the group of squamous cell lung carcinoma (46%: 30%; p = 0.021). Examining treatment-related parameters, treatment with taxane-platinum containing regimens was associated with a lower risk of brain metastases, than platinum-etoposide chemotherapy regimens (31%: 52%; p = 0.011). Preoperative radiotherapy, with or without postoperative treatment, showed lower rate of metastases in the brain compared with postoperative radiotherapy treatment only (33%: 48%; p = 0.035). Conclusion. Brain metastases are often site of recurrence in patients with NSCLC (IIIA-N2). Autonomous risk factors for brain metastases in this group of patients are non-squamous NSCLC, N1-N2 nodal status, postoperative radiotherapy without preoperative radiotherapy

Pneumothorax in a patient with pneumonia caused by SARS-CoV-2: A case report

Introduction. The coronavirus disease 2019 (COVID-19) is an acute infectious multisystem disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), man-ifested by acute respiratory symptoms. The novel coronavirus pneumonia (NCP) is the most common serious clinical mani-festation of SARS-CoV-2 infection. In the severe NCP, the sys-temic manifestations of the disease were also demonstrated, and one of the rare complications, first described in Wuhan (China), is pneumothorax. Case report. A 65-year-old female was admitted to the Clinic for Pulmonology with a high fever, shortness of breath, sore throat, and general weakness that started five days before. Laboratory findings revealed lympho-penia, elevated values of inflammatory markers, and liver le-sion. A chest X-ray (CXR) demonstrated diffusely accentuated interstitial pattern and reduced parenchymal transparency, left perihilar. Positive SARS-CoV-2 in a nasopharyngeal swab sam-ple was detected in the real-time reverse transcription-polymerase chain reaction (RT-PCR), confirming the diagnosis of NCP. Immediately, nasal oxygen therapy with a flow rate of 8 L/min, with chloroquine phosphate, antibiotics, and symp-tomatic treatment, was initiated. On the 8th day, her condition suddenly deteriorated, and she developed severe hypoxemia. A repeated CXR showed complete left-sided pneumotho-rax. Thoracic drainage was successfully performed with com-plete reexpansion of the lungs the very next day. The patient was released from the hospital in good general condition with normal arterial blood gases. Conclusion. Pneumothorax may develop as a complication in patients with pneumonia caused by SARS-CoV-2, without previous pulmonary comorbidities, due to alveolar damage. Acute deterioration with rapid oxygen desaturation in these patients should raise the suspicion of pneumothorax. Early diagnosis and prompt treatment are nec-essary to reduce mortality

INCUBATORS AS A DEVELOPMENT MODEL FOR SMALL AND MEDIUM-SIZED COMPANIES

There is no doubt in the world today whether or not to support the founding and development of small and medium-sized companies. They have become an objective reality in all modern economies of the world. State, governmental institutions and non-governmental organizations in many developing countries completely support small-scale industry and entrepreneurship. Transitional countries are also trying to achieve a quick development of small and medium-sized companies. The results are significant but not sufficient, since the process of privatization and transition to the principles of marketeconomy are still incomplete. Innovations within the educational system that are beneficial for small-scale industry and entrepreneurship, the increase in numbers of entrepreneurs, as well as the significant support and specific help from the international community in relation to the development of entrepreneurship in the Republika Srpska, are positive and encourageing facts. In order to realize business enterprise when it comes to the development of small business, the modern practice has developed a business incubator system that enables the organization of own buisnesses with support from governmental organs, financial and educational institutions and donors. Incubators make it possible to start the work of several small businesses under one roof. Clusters are a new specific model for developing small and medium-sized companies

Small airways in asthma

© 2016, Serbian Medical Society. All rights reserved. Asthma is a chronic inflammatory lung disease characterized by reversible obstruction of airways and bronchial hyperresponsiveness. In recent years there has been a growing interest in the role of the small airways in asthma and there is increasing evidence that they contribute significantly to the clinical expression of asthma. Numerous studies have shown that inflammation is present in the small airways of patients with asthma and that it may be more intense than that found in the large airways, particularly in severe asthma, nocturnal asthma, coexisting asthma and obesity and asthma in smokers. Currently there is no accepted single lung function parameter to detect small airways dysfunction. Recent data show that impulse oscillometry is a promising diagnostic tool to assess the involvement of the small airways. The use of corticosteroids in extrafine formulation, whether alone or in fixed combinations with long-acting b2 agonists, improves drug distribution throughout the bronchial tree, enhancing the therapeutic effect with lower doses of drugs

Hypogonadism in chronic obstructive pulmonary disease (COPD) - risk factors

© 2019 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved. Bacground/Aim. Chronic obstructive pulmonary disease (COPD) is the leading cause of morbidity and mortality in pulmonary pathology. However, apart from its own pulmonary manifestations, this disease is also characterized by systemic effects, including hypogonadism which is described especially in the group of men with COPD. The aim of this study was to evaluate risk factors for hypogonadism in men with COPD. Methods. The study included 96 male patients with COPD in stable phase of the disease. All patients were checked for concentration of free testosterone in serum, markers of systemic inflammation, tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and C reactive protein (CRP), pulmonary function test, gas exchange parameters, a 6-minute walk test (6MWT), nutritional status and condition of skeletal muscle (midthigh muscle cross-sectional area - MTCSA using computed tomography). Results. Decreased value of free testosterone was found in 37.5% of the patients. In the group with hypogonadism (free testosterone < 4.5 pg/mL), we found significantly increased serum concentration of TNF-α (5.88 ± 3.21 vs. 3.16 ± 2.53 pg/mL; p < 0.05), significantly lower MTSCA (68.2 ± 18.72 vs. 91.1 ± 21.4 cm2; p < 0.05) and the 6MWT (268.33 ± 32.35 vs. 334.25 ± 43.25 m; p < 0.05). Lung function, gas exchange markers and body mass index (BMI) were similar in both groups. The multivariate regression analysis singled out serum value of TNF-α as an independent predictor of serum concentrations of free testosterone (B = -0.157; 95% confidence interval: -0.262-0.053). Conclusion. In our analysis we found that TNF-α as a marker of systemic inflammation is an independent predictor of the presence of hypogonadism in the patients with COPD. Our results indicate that hypogonadism predisposes to skeletal muscle wasting and exercise intolerance in male COPD patients

Unusual Respiratory Manifestations of Ankylosing Spondylitis – A Case Report

A male patient, 54 years old, was initially admitted to the hospital because of fatigue he felt during the last month and swelling of the lower legs. Upon hospital admittance, gas exchange analysis showed global respiratory failure: pO2=6.1 kPa, pCO2=10.9 kPa, pH=7.35, A-a gradient = 1.0. Due to the existence of hypercapnia and decompensated respiratory acidosis, the patient was connected to a device for non-invasive mechanical ventilation. Reduced chest mobility was noticed, and the respiratory index value was decreased. Radiographs of the chest and thoracic and lumbo-sacral spine showed marked changes on the spine attributable to ankylosing spondylitis (AS). Radiographs of the sacroiliac joints showed reduced sacroiliac joint intraarticular space with signs of subchondral sclerosis. The diagnosis of AS was set on the basis of New York Criteria (bilateral sacroiliitis, grade 3) and clinical criteria (back pain, lumbar spine limitation and chest expansion limitation). HLA typing (HLA B27 +) confirmed the diagnosis of AS. Pulmonary function test proved severe restrictive syndrome. Polysomnography verified the existence of severe obstructive sleep apnoea (AHI =73). This was a patient with newly diagnosed AS, with consequent severe restrictive syndrome and global respiratory failure with severe obstructive sleep apnoea. Thee patient was discharged from the hospital with a NIV (global respiratory failure) device for home use during the night

Unusual respiratory manifestations of ankylosing spondylitis a case report

© 2016, University of Kragujevac, Faculty of Science. All rights reserved. A male patient, 54 years old, was initially admitted to the hospital because of fatigue he felt during the last month and swelling of the lower legs. Upon hospital admittance, gas exchange analysis showed global respiratory failure: pO2=6.1 kPa, pCO2=10.9 kPa, pH=7.35, A-a gradient = 1.0. Due to the existence of hypercapnia and decompensated respiratory acidosis, the patient was connected to a device for non-invasive mechanical ventilation. Reduced chest mobility was noticed, and the respiratory index value was decreased. Radiographs of the chest and thoracic and lumbo-sacral spine showed marked changes on the spine attributable to ankylosing spondylitis (AS). Radiographs of the sacroiliac joints showed reduced sacroiliac joint intraarticular space with signs of subchondral sclerosis. e diagnosis of AS was set on the basis of New York Criteria (bilateral sacroiliitis, grade 3) and clinical criteria (back pain, lumbar spine limitation and chest expansion limitation). HLA typing (HLA B27 +) confirmed the diagnosis of AS. Pulmonary function test proved severe restrictive syndrome. Polysomnography verifi ed the existence of severe obstructive sleep apnoea (AHI =73). is was a patient with newly diagnosed AS, with consequent severe restrictive syndrome and global respiratory failure with severe obstructive sleep apnoea. e patient was discharged from the hospital with a NIV (global respiratory failure) device for home use during the night

Blastic plasmacytoid dendritic cell neoplasm of the uterus

© 2020, Serbia Medical Society. All rights reserved. Introduction Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and very aggressive hematological malignancy derived from precursor of the plasmacytoid dendritic cell. We present a case with cervix uteri involvement without skin lesions, which is, to the best of our knowledge, the first case of BPDCN localized in the cervix. Case outline A 66-year-old previously healthy women initially presented with a four-week history of vaginal bleeding. Gynecologic examination revealed a tumorous bleeding formation on cervix uteri. Except paleness of the skin, physical examination results were normal. Complete blood counts showed anemia and thrombocytopenia. Computed tomography scans showed an expansive tumorous formation at the level of the isthmus and cervix uteri, 60 × 42 mm in size. Cervical biopsy was done and final pathohistological diagnosis was BPDCN. Karyotype analysis results from the bone marrow aspiration specimen demonstrated tetrasomy of chromosome 2 and monosomy of chromosome 16. The patient did not accept treatment and died two months after the initial diagnosis was established. Conclusion Attributes such as aggressive clinical course of BPDCN, demonstrated unusual localization, infrequency, and the absence of consensus about standard treatment options, demand constructive clinical reasoning and tight cooperation between medical professionals of various fields

Assessment of volemia status using ultrasound examination of the inferior vena cava and spectroscopic bioimpedance in hemodialysis patients

Background/Aim. Hypervolemia is an important risk factor for the development of cardiovascular morbidity and mortality in patients treated with regular hemodialysis. There is still no reliable method for assessing the status of volemia in these patients. The aim of the study was to assess the status of volemia in patients treated with regular hemodialysis by measuring the parameters of the inferior vena cava (IVC) and bioimpedance. Methods. The effect of hemodialysis treatment on ultrasound parameters of the IVC, as well as on the parameters measured by bioimpedance, was examined before and after hemodialysis. The values of the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) were measured both before and after hemodialysis. Forty-five patients were involved in this non-interventional cross-section study, including the patients treated with standard bicarbonate dialysis. According to the interdialytic yield, the patients were divided into three groups: I (up to 2,000 mL), II (2,000–3,000 mL), and III (over 3,000 mL). Results. The values of the IVC parameters and the parameters measured with bioimpedance were significantly lower after treatment with hemodialysis (p < 0.005). The third group of patients had a significantly higher total fluid volume in the body compared to the group I, as well as a significantly greater volume of extracellular fluid (p < 0.005). The significantly lower values of NT-proBNP in all groups (p < 0.005) were detected after hemodialysis. After treatment with hemodialysis, a positive correlation was observed between the concentration of NT-proBNP in the serum and the extracellular/intracellular water ratio. However, the correlation between NT-proBNP concentration and total fluid measured by bioimpedance spectroscopy did not reach statistical significance. Conclusion. Measurement of the IVC ultrasound parameters and volemia parameters using bioimpedance significantly contributes to the assessment of the status of volemia. Nevertheless, it cannot be used as a separate parameter, only in combination with all other methods