TUMOR MARKER CA 125 IN THE DIAGNOSIS OF ACTIVE PULMONARY TUBERCULOSIS – A STUDY OF ADULTS IN MOSTAR, B&H

Background: Tumor marker CA 125 is found in normal mesothelial lung cells and normal bronchial epithelial cells. If destruction of these cells occurs due to inflammation or tumour, CA 125 will be released, and increased in the serum. Subjects and Methods: From November 2008 to May 2009 a study analysing CA 125 levels in serum samples from patients who are hospitalized at the Pulmology Department of University Hospital Mostar. Standard laboratory tests, X-ray, sputum examination to BK, and tumour marker CA 125 were performed in all patients. Patients were divided into 5 groups. Comparing clinical and laboratory findings of patients and statistical processing of collected data, conclusions were drown about the role of tumor markers Ca 125 in the diagnosis of pulmonary tuberculosis. Results: This analysis is performed on 220 patients, forty with pulmonary tuberculosis. Of the total number of patients included, there is 60% of the negative findings of tumor marker Ca 125 which is statistically significant (P<0.05). Further analysis of Ca 125 shows that there is 75% of positive findings in active pulmonary tuberculosis, which is a statistically significant difference (P=0.002). Within the group of patients with lung carcinoma, half of the patients showed positive finding of tumor marker CA 125. Statistical analysis showed that sensitivity of CA 125 was 75%, specificity was (68%) and positive predictive value was 12% in patients with active tuberculosis. Conclusions: The result of this study showed that the increase in serum tumor marker CA 125 is present in active pulmonary tuberculosis as well as in patients with lung cancer

Management and outcomes in critically ill nonagenarian versus octogenarian patients.

BACKGROUND: Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. METHODS: We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80-89.9 years) and nonagenarian (> 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. RESULTS: The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 + 5 vs. 7 + 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90-1.74; p = 0.19)). CONCLUSION: After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered- together with illness severity and pre-existing functional capacity - to effectively guide triage decisions. TRIAL REGISTRATION: NCT03134807 and NCT03370692

Implementation of the Discussion Methods in Croatian Language Teaching from 1st to 4th Grade

Hrvatski jezik najvažniji je predmet u učenju i podučavanju. Cijela komunikacija provodi se upravo na materinskome jeziku. Uz roditelje, upravo učitelji imaju najvažniju ulogu pri poticanju komunikacije među učenicima. Školstvo se i dalje većinski temelji na tradicionalnom načinu podučavanja stoga je potrebno nastavu okrenuti suvremenim metodama. Učitelji moraju koristiti metode koje će potaknuti učenike da razvijaju svoje potencijale. Postepeno, kroz različite korake, učitelj treba buditi kreativnost učenika, poticati ih na komunikaciju te na oblikovanje i izražavanje vlastitog mišljenja. Razvijanjem komunikacijskih kompetencija poučava se učenike kako koristiti jezična znanja u stvarnoj komunikaciji. Iz tog razloga učenike se treba izlagati govornim situacijama kako bi primijenili naučeno znanje. Upravo je to podloga izražavanja vlastitog mišljenja kako bi se uz poticaj učitelja razvilo kritičko mišljenje. Ono podrazumijeva otkrivanje i rješavanje problema putem kritičkog promišljanja, sučeljavanja s tuđim mišljenjima kako bi se donijela utemeljena odluka. Cilj je da učenik u sigurnoj okolini bez ustručavanja izražava svoje mišljenje i što je važnije da potkrijepi svoje mišljenje činjenicama. U radu se nude četiri prijedloga koja se mogu koristiti u praktičnoj provedbi od prvog do četvrtog razreda u svim predmetnim područjima. Cilj rada je ukazati na važnost učitelja u oblikovanju kritičkog mišljenja u učenika od prvog do četvrtog razreda i pokazati načine kako različite oblike rasprave ukomponirati u nastavne sate Hrvatskog jezika. Upravo na tim temeljima, učenici će kroz ostatak osnovnoškolskog i srednjoškolskog obrazovanja usavršiti različite oblike usmene i pisane rasprave.Croatian is the most important subject in learning and teaching. All communication is carried out in the mother tongue. Along with parents, it is teachers who play the most important role in encouraging communication among students. Education is still mostly based on the traditional way of teaching, so it is necessary to turn teaching to modern methods. Teachers must use methods that will encourage students to develop their potential. Through various steps, the teacher should awaken the creativity of students, encourage them to communicate and to shape and express their own opinions. By developing communication competencies, students are taught how to use language skills in real communication. For this reason, students need to be exposed to speaking situations in order to apply the learned knowledge. This is the basis for expressing one's own opinion in order to develop critical thinking with the encouragement of the teacher. It involves discovering and solving problems through critical thinking, confronting other people's opinions in order to make a decision. The goal is for the student to express his / her opinion in a safe environment without hesitation and, more importantly, to substantiate his / her opinion with facts. Thesis offers four proposals that can be used in the practical implementation of the first to fourth grade in all subject areas. Thesis goal is to point out the importance of teachers in shaping critical thinking in students from first to fourth grade and to show ways how to incorporate different forms of discussion into Croatian language classes. It is on these foundations that students will perfect various forms of oral and written discussion through the rest of primary and secondary education

Implementation of the Discussion Methods in Croatian Language Teaching from 1st to 4th Grade

Hrvatski jezik najvažniji je predmet u učenju i podučavanju. Cijela komunikacija provodi se upravo na materinskome jeziku. Uz roditelje, upravo učitelji imaju najvažniju ulogu pri poticanju komunikacije među učenicima. Školstvo se i dalje većinski temelji na tradicionalnom načinu podučavanja stoga je potrebno nastavu okrenuti suvremenim metodama. Učitelji moraju koristiti metode koje će potaknuti učenike da razvijaju svoje potencijale. Postepeno, kroz različite korake, učitelj treba buditi kreativnost učenika, poticati ih na komunikaciju te na oblikovanje i izražavanje vlastitog mišljenja. Razvijanjem komunikacijskih kompetencija poučava se učenike kako koristiti jezična znanja u stvarnoj komunikaciji. Iz tog razloga učenike se treba izlagati govornim situacijama kako bi primijenili naučeno znanje. Upravo je to podloga izražavanja vlastitog mišljenja kako bi se uz poticaj učitelja razvilo kritičko mišljenje. Ono podrazumijeva otkrivanje i rješavanje problema putem kritičkog promišljanja, sučeljavanja s tuđim mišljenjima kako bi se donijela utemeljena odluka. Cilj je da učenik u sigurnoj okolini bez ustručavanja izražava svoje mišljenje i što je važnije da potkrijepi svoje mišljenje činjenicama. U radu se nude četiri prijedloga koja se mogu koristiti u praktičnoj provedbi od prvog do četvrtog razreda u svim predmetnim područjima. Cilj rada je ukazati na važnost učitelja u oblikovanju kritičkog mišljenja u učenika od prvog do četvrtog razreda i pokazati načine kako različite oblike rasprave ukomponirati u nastavne sate Hrvatskog jezika. Upravo na tim temeljima, učenici će kroz ostatak osnovnoškolskog i srednjoškolskog obrazovanja usavršiti različite oblike usmene i pisane rasprave.Croatian is the most important subject in learning and teaching. All communication is carried out in the mother tongue. Along with parents, it is teachers who play the most important role in encouraging communication among students. Education is still mostly based on the traditional way of teaching, so it is necessary to turn teaching to modern methods. Teachers must use methods that will encourage students to develop their potential. Through various steps, the teacher should awaken the creativity of students, encourage them to communicate and to shape and express their own opinions. By developing communication competencies, students are taught how to use language skills in real communication. For this reason, students need to be exposed to speaking situations in order to apply the learned knowledge. This is the basis for expressing one's own opinion in order to develop critical thinking with the encouragement of the teacher. It involves discovering and solving problems through critical thinking, confronting other people's opinions in order to make a decision. The goal is for the student to express his / her opinion in a safe environment without hesitation and, more importantly, to substantiate his / her opinion with facts. Thesis offers four proposals that can be used in the practical implementation of the first to fourth grade in all subject areas. Thesis goal is to point out the importance of teachers in shaping critical thinking in students from first to fourth grade and to show ways how to incorporate different forms of discussion into Croatian language classes. It is on these foundations that students will perfect various forms of oral and written discussion through the rest of primary and secondary education

Analysis of serum concentration of TWEAK cytokin and testosterone in patients with severe form of COVID-19

Uvod: Glavni patofiziološki mehanizam teškog oblika SARS-CoV-2 infekcije je poremećaj imunološkog odgovora s razvojem citokinske oluje posredovane lučenjem brojnih proupalnih citokina. Mnoge studije su pokazale da povišene razine proupalnih citokina pozitivno koreliraju s ishodom bolesnika s teškim oblikom SARS-CoV-2 infekcije. Također, istraživanja su pokazala uzajamni utjecaj COVID-19 i poremećaja sinteze testosterona. Dosad nije istražena uloga citokina TWEAK-a (engl. TNF-like weak inducer of apoptosis) te njegova povezanost s razinom testosterona i smrtnošću bolesnika s teškim oblikom SARSCoV-2 infekcije. Ciljevi istraživanja: Glavni cilj istraživanja bio je usporediti serumske razine TWEAK-a u skupini bolesnika s teškim oblikom SARS-CoV-2 infekcije koji su preživjeli u odnosu na skupinu bolesnika koji su preminuli. Sporedni ciljevi istraživanja su bili ispitati povezanost serumske razine TWEAK-a sa serumskom razinom testosterona te rizikom smrtnosti u bolesnika sa teškim oblikom SARS-CoV-2 infekcije. Ispitanici i metode: U istraživanje je uključeno 66 muškaraca u dobi od 18 do 65 godina s dijagnosticiranim teškim oblikom SARS-CoV-2 infekcije koji su hospitalizirani u Respiracijskom intenzivističkom centru (RIC) u razdoblju od prosinca 2021. do svibnja 2022. godine. Serumske razine testosterona i TWEAK-a su mjerene u tri vremenske točke: prvog, sedmog te četrnaestog dana hospitalizacije u RIC-u. Rezultati: Serumske razine TWEAK-a prvog dana hospitalizacije u RIC-u bile su značajno niže u skupini bolesnika koji su preživjeli u usporedbi s bolesnicima koji su preminuli za vrijeme hospitalizacije (179,3 (86,6-375,5) pg/mL vs. 247,2 (89,7-326,8) pg/mL, P=0,037). Serumska razina TWEAK-a na dan prijemu u RIC pokazala se kao signifikantni prediktor smrtnosti (AUC=0,689, P=0,019) i negativno je korelirala sa serumskom razinom 59 testosterona (r= -0,310, P=0,036). Serumska razina TWEAK-a je značajno i pozitivno korelirala s rezultatima Brixia bodovne ljestvice (r=0,491, P<0,001). Zaključci: Naša studija pokazala je da su serumske razine TWEAK-a u bolesnika s teškim oblikom SARS-CoV-2 infekcije niže u skupini bolesnika koji su preživjeli u usporedbi s bolesnicima koji su preminuli. Serumske razine TWEAK-a na dan prijemu u RIC su se pokazale znakovitim prediktor smrtnosti od teškog oblika SARS-CoV-2 infekcije uz negativnu povezanost sa serumskim razinama testosterona. Dobivenim rezultatima potvrdili smo dokaze o ulozi i povezanosti TWEAK-a i testosterona s kliničkim tijekom i ishodima u bolesnika s teškim oblikom SARS-CoV-2 infekcije.Introduction: The main pathophysiological mechanism of the severe form of SARS-CoV-2 infection is the disruption of the immune response with the development of a cytokine storm mediated by the secretion of numerous pro-inflammatory cytokines. Many studies have shown that elevated levels of pro-inflammatory cytokines positively correlate with the outcome of patients with a severe form of SARS-CoV-2 infection. Also, research has shown the mutual impact of COVID-19 and testosterone synthesis disorders. The role of the cytokine TWEAK (TNF-like weak inducer of apoptosis) and its association with testosterone levels and mortality in patients with a severe form of SARS-CoV-2 infection have not yet been investigated. Research objectives: The main aim of the research was to compare the serum levels of TWEAK in the group of patients with a severe form of SARS-CoV-2 infection who survived compared to the group of patients who died. The secondary objectives of the study were to examine the relationship between the serum level of TWEAK and the serum level of testosterone and the risk of mortality in patients with a severe form of SARS-CoV-2 infection. Subjects and methods: 66 men aged 18 to 65 with a diagnosed severe form of SARS-CoV-2 infection who were hospitalized in the Respiratory Intensive Care Center (RIC) between December 2021 and May 2022 were included in the study. Serum levels of testosterone and TWEAK were measured at three time points: the first, seventh and fourteenth days of hospitalization in the RIC. 62 Results: Serum TWEAK levels on the first day of hospitalization in RIC were significantly lower in the group of patients who survived compared to patients who died during hospitalization (179.3 (86.6-375.5) pg/mL vs. 247.2 (89.7-326.8) pg/mL, P=0.037). The serum level of TWEAK on the day of admission to the RIC proved to be a significant predictor of mortality (AUC=0.689, P=0.019) and was negatively correlated with the serum level of testosterone (r= -0.310, P=0.036). The serum level of TWEAK was significantly and positively correlated with the results of the Brixia score scale (r=0.491, P<0.001). Conclusions: Our study showed that serum levels of TWEAK in patients with severe SARSCoV-2 infection were lower in the group of patients who survived compared to patients who died. Serum levels of TWEAK on the day of admission to the RIC proved to be a significant predictor of mortality from a severe form of SARS-CoV-2 infection with a negative association with serum testosterone levels. With the obtained results, we have confirmed the evidence of the role and association of TWEAK and testosterone with the clinical course and outcomes in patients with a severe form of SARS-CoV-2 infection

Analysis of serum concentration of TWEAK cytokin and testosterone in patients with severe form of COVID-19

Uvod: Glavni patofiziološki mehanizam teškog oblika SARS-CoV-2 infekcije je poremećaj imunološkog odgovora s razvojem citokinske oluje posredovane lučenjem brojnih proupalnih citokina. Mnoge studije su pokazale da povišene razine proupalnih citokina pozitivno koreliraju s ishodom bolesnika s teškim oblikom SARS-CoV-2 infekcije. Također, istraživanja su pokazala uzajamni utjecaj COVID-19 i poremećaja sinteze testosterona. Dosad nije istražena uloga citokina TWEAK-a (engl. TNF-like weak inducer of apoptosis) te njegova povezanost s razinom testosterona i smrtnošću bolesnika s teškim oblikom SARSCoV-2 infekcije. Ciljevi istraživanja: Glavni cilj istraživanja bio je usporediti serumske razine TWEAK-a u skupini bolesnika s teškim oblikom SARS-CoV-2 infekcije koji su preživjeli u odnosu na skupinu bolesnika koji su preminuli. Sporedni ciljevi istraživanja su bili ispitati povezanost serumske razine TWEAK-a sa serumskom razinom testosterona te rizikom smrtnosti u bolesnika sa teškim oblikom SARS-CoV-2 infekcije. Ispitanici i metode: U istraživanje je uključeno 66 muškaraca u dobi od 18 do 65 godina s dijagnosticiranim teškim oblikom SARS-CoV-2 infekcije koji su hospitalizirani u Respiracijskom intenzivističkom centru (RIC) u razdoblju od prosinca 2021. do svibnja 2022. godine. Serumske razine testosterona i TWEAK-a su mjerene u tri vremenske točke: prvog, sedmog te četrnaestog dana hospitalizacije u RIC-u. Rezultati: Serumske razine TWEAK-a prvog dana hospitalizacije u RIC-u bile su značajno niže u skupini bolesnika koji su preživjeli u usporedbi s bolesnicima koji su preminuli za vrijeme hospitalizacije (179,3 (86,6-375,5) pg/mL vs. 247,2 (89,7-326,8) pg/mL, P=0,037). Serumska razina TWEAK-a na dan prijemu u RIC pokazala se kao signifikantni prediktor smrtnosti (AUC=0,689, P=0,019) i negativno je korelirala sa serumskom razinom 59 testosterona (r= -0,310, P=0,036). Serumska razina TWEAK-a je značajno i pozitivno korelirala s rezultatima Brixia bodovne ljestvice (r=0,491, P<0,001). Zaključci: Naša studija pokazala je da su serumske razine TWEAK-a u bolesnika s teškim oblikom SARS-CoV-2 infekcije niže u skupini bolesnika koji su preživjeli u usporedbi s bolesnicima koji su preminuli. Serumske razine TWEAK-a na dan prijemu u RIC su se pokazale znakovitim prediktor smrtnosti od teškog oblika SARS-CoV-2 infekcije uz negativnu povezanost sa serumskim razinama testosterona. Dobivenim rezultatima potvrdili smo dokaze o ulozi i povezanosti TWEAK-a i testosterona s kliničkim tijekom i ishodima u bolesnika s teškim oblikom SARS-CoV-2 infekcije.Introduction: The main pathophysiological mechanism of the severe form of SARS-CoV-2 infection is the disruption of the immune response with the development of a cytokine storm mediated by the secretion of numerous pro-inflammatory cytokines. Many studies have shown that elevated levels of pro-inflammatory cytokines positively correlate with the outcome of patients with a severe form of SARS-CoV-2 infection. Also, research has shown the mutual impact of COVID-19 and testosterone synthesis disorders. The role of the cytokine TWEAK (TNF-like weak inducer of apoptosis) and its association with testosterone levels and mortality in patients with a severe form of SARS-CoV-2 infection have not yet been investigated. Research objectives: The main aim of the research was to compare the serum levels of TWEAK in the group of patients with a severe form of SARS-CoV-2 infection who survived compared to the group of patients who died. The secondary objectives of the study were to examine the relationship between the serum level of TWEAK and the serum level of testosterone and the risk of mortality in patients with a severe form of SARS-CoV-2 infection. Subjects and methods: 66 men aged 18 to 65 with a diagnosed severe form of SARS-CoV-2 infection who were hospitalized in the Respiratory Intensive Care Center (RIC) between December 2021 and May 2022 were included in the study. Serum levels of testosterone and TWEAK were measured at three time points: the first, seventh and fourteenth days of hospitalization in the RIC. 62 Results: Serum TWEAK levels on the first day of hospitalization in RIC were significantly lower in the group of patients who survived compared to patients who died during hospitalization (179.3 (86.6-375.5) pg/mL vs. 247.2 (89.7-326.8) pg/mL, P=0.037). The serum level of TWEAK on the day of admission to the RIC proved to be a significant predictor of mortality (AUC=0.689, P=0.019) and was negatively correlated with the serum level of testosterone (r= -0.310, P=0.036). The serum level of TWEAK was significantly and positively correlated with the results of the Brixia score scale (r=0.491, P<0.001). Conclusions: Our study showed that serum levels of TWEAK in patients with severe SARSCoV-2 infection were lower in the group of patients who survived compared to patients who died. Serum levels of TWEAK on the day of admission to the RIC proved to be a significant predictor of mortality from a severe form of SARS-CoV-2 infection with a negative association with serum testosterone levels. With the obtained results, we have confirmed the evidence of the role and association of TWEAK and testosterone with the clinical course and outcomes in patients with a severe form of SARS-CoV-2 infection

Implementation of the Discussion Methods in Croatian Language Teaching from 1st to 4th Grade

Hrvatski jezik najvažniji je predmet u učenju i podučavanju. Cijela komunikacija provodi se upravo na materinskome jeziku. Uz roditelje, upravo učitelji imaju najvažniju ulogu pri poticanju komunikacije među učenicima. Školstvo se i dalje većinski temelji na tradicionalnom načinu podučavanja stoga je potrebno nastavu okrenuti suvremenim metodama. Učitelji moraju koristiti metode koje će potaknuti učenike da razvijaju svoje potencijale. Postepeno, kroz različite korake, učitelj treba buditi kreativnost učenika, poticati ih na komunikaciju te na oblikovanje i izražavanje vlastitog mišljenja. Razvijanjem komunikacijskih kompetencija poučava se učenike kako koristiti jezična znanja u stvarnoj komunikaciji. Iz tog razloga učenike se treba izlagati govornim situacijama kako bi primijenili naučeno znanje. Upravo je to podloga izražavanja vlastitog mišljenja kako bi se uz poticaj učitelja razvilo kritičko mišljenje. Ono podrazumijeva otkrivanje i rješavanje problema putem kritičkog promišljanja, sučeljavanja s tuđim mišljenjima kako bi se donijela utemeljena odluka. Cilj je da učenik u sigurnoj okolini bez ustručavanja izražava svoje mišljenje i što je važnije da potkrijepi svoje mišljenje činjenicama. U radu se nude četiri prijedloga koja se mogu koristiti u praktičnoj provedbi od prvog do četvrtog razreda u svim predmetnim područjima. Cilj rada je ukazati na važnost učitelja u oblikovanju kritičkog mišljenja u učenika od prvog do četvrtog razreda i pokazati načine kako različite oblike rasprave ukomponirati u nastavne sate Hrvatskog jezika. Upravo na tim temeljima, učenici će kroz ostatak osnovnoškolskog i srednjoškolskog obrazovanja usavršiti različite oblike usmene i pisane rasprave.Croatian is the most important subject in learning and teaching. All communication is carried out in the mother tongue. Along with parents, it is teachers who play the most important role in encouraging communication among students. Education is still mostly based on the traditional way of teaching, so it is necessary to turn teaching to modern methods. Teachers must use methods that will encourage students to develop their potential. Through various steps, the teacher should awaken the creativity of students, encourage them to communicate and to shape and express their own opinions. By developing communication competencies, students are taught how to use language skills in real communication. For this reason, students need to be exposed to speaking situations in order to apply the learned knowledge. This is the basis for expressing one's own opinion in order to develop critical thinking with the encouragement of the teacher. It involves discovering and solving problems through critical thinking, confronting other people's opinions in order to make a decision. The goal is for the student to express his / her opinion in a safe environment without hesitation and, more importantly, to substantiate his / her opinion with facts. Thesis offers four proposals that can be used in the practical implementation of the first to fourth grade in all subject areas. Thesis goal is to point out the importance of teachers in shaping critical thinking in students from first to fourth grade and to show ways how to incorporate different forms of discussion into Croatian language classes. It is on these foundations that students will perfect various forms of oral and written discussion through the rest of primary and secondary education