Rare benign lung tumours presenting with high clinical suspicion for malignancy: a case series and review of the literature

Introduction. Incidentally discovered lung nodules can be worrisome for both the patient and their physicians. Although 95% of solitary lung nodules are benign, it is important to distinguish which nodules have high clinical suspicion for malignancy. Existing clinical guidelines do not apply to patients with signs and symptoms related to the lesion and with an increased baseline risk of lung cancer or metastasis. This paper highlights the vital role of pathohistological analysis and immunohistochemistry in the definitive diagnosis of such incidentally discovered lung nodules. Material and methods. The three cases presented were selected based on their similar clinical presentations. A review of the literature was performed using the online database PubMed, for articles published in the period between January of 1973 to February of 2023 using the following medical subject headlines: “primary alveolar adenoma,” “alveolar adenoma,” “primary pulmonary meningioma,” “pulmonary meningioma,” and “pulmonary benign metastasizing leiomyoma.” Results (Case Series). The case series consists of three incidentally discovered lung nodule(s). Although they presented with high clinical suspicion for malignancy, detailed workup confirmed the diagnosis of three rare benign lung tumours: primary alveolar adenoma, primary pulmonary meningioma, and benign metastasizing leiomyoma. Conclusions. Clinical suspicion for malignancy in the presented cases arose from previous and current medical history of malignancy, family history of malignancy, and/or specific radiographic findings. This paper highlights the need for a multidisciplinary approach in the management of incidentally discovered pulmonary nodules. Excisional biopsy and pathohistological analysis remain the gold standard in confirming the presence of a pathologic process and determining the nature of the disease. Common features of the diagnostic algorithm utilized among the three cases include multi-slice computerized tomography, excisional biopsy via atypical wedge resection (if the nodule is peripherally located), and lastly, pathomorphological analysis using haematoxylin and eosin staining and immunohistochemistry

Novi podaci o incidenciji dijabetesa tipa 1 u Crnoj Gori: bolest počinje u mlađoj životnoj dobi

In the last several decades, a great number of studies have pointed to a dramatic increase of type 1 diabetes mellitus (T1DM) incidence in the whole world, especially in younger age groups. Therefore, the aim of the study was to assess changes in the age distribution at onset of T1DM in Montenegro children aged <15 years during a 15-year period (1997-2011) and analyze the seasonal pattern. Primary case ascertainment was from diabetes register, secondary and tertiary independent data sources were hospital case records and register of children receiving free test stripes in pharmacy. Standardized incidence rates were calculated using the Poisson regression. Case ascertainment was 100% complete using the capture-recapture method. The mean age-standardized incidence was 18.6/100,000 (95% CI: 13.0-24.1) from 2007 to 2011 compared with 13.4/100,000 95% CI, 11.5-15.5) from 1997 to 2006. The incidence of T1DM increased predominantly in younger age groups. Relative increase of incidence per 5-year period was largest in boys aged 0-4 and 5-9 years: 64.7% (95% CI: 20.6-10.7; p=0.004) and 52.8% (95% CI: 16.9-88.8; p=0.004), respectively. Seasonality in monthly case counts of T1DM was apparent. The greatest number of cases were diagnosed during autumn and winter months. In conclusion, the onset of T1DM was found to occur at an ever younger age in Montenegro children. Our results indicated a seasonal pattern of the disease onset.Posljednjih desetljeća velik broj istraživanja ukazuje na dramatičan porast incidencije dijabetesa tipa 1 u cijelom svijetu, naročito u mlađim dobnim skupinama. Cilj ovoga istraživanja bio je obnoviti podatke iz prethodne studije, istražiti promjene u dobi pojavljivanja dijabetesa kod djece u dobi od 0 do 14 godina (1997.-2011.) i analizirati sezonski obrazac pojave bolesti. Kao prvi izvor poslužili su podaci iz registra oboljelih od šećerne bolesti, a kao drugi i treći izvor korištena su bolnička otpusna pisma i registar djece koja primaju besplatno test trake u ljekarnama. Za izračun standardizirane incidencije korišten je Poissonov regresijski model. Upotrebom metode capture-recapture pouzdanost podataka procijenjena je na 100%. Standardizirana incidencija za dobnu skupinu 0-14 godina bila je 18,6/100.000 (95% CI: 13,0-24,1) od 2007. do 2011. godine u usporedbi s incidencijom od 13,4/100.000 95% CI, 11,5-15,5) od 1997. do 2006. godine. Incidencija dijabetesa tipa 1 rasla je pretežito u mlađim dobnim skupinama. Relativno povećanje incidencije u petogodišnjem razdoblju bilo je najveće kod dječaka dobnih skupina 0-4 i 5-9 godina: 64,7% (95% CI: 20,6-10,7; p=0,004) odnosno 52,8% (95% CI: 16,9-88,8; p=0,004). Izražen je sezonski obrazac, tj. bolest se najčešće dijagnosticira u jesenjim i zimskim mjesecima. U zaključku, dijabetes tipa 1 u Crnoj Gori dijagnosticira se kod djece sve mlađe dobi. Naši rezultati ukazuju na sezonski obrazac pojave bolesti

Potrošnja antibiotika u bolnicama i stopa otpornosti bakterija Klebsiella pneumoniae i Escherichia coli u Crnoj Gori

Inappropriate use of antibiotics leads to an increase in antibiotic resistance. Infections caused by antibiotic-resistant gram-negative bacteria are a serious threat to public health. This study aimed to compare data on inpatient antibiotic consumption with antimicrobial resistance (AMR) rate of Klebsiella pneumoniae and Escherichia coli invasive strains in Montenegro and provide targets for improving antibiotic use. We used the national data on antibiotic consumption from 2009 to 2015, Point Prevalence Survey data on inpatient antibiotic consumption from 2015, and national AMR data on 79 Klebsiella pneumoniae and 68 Escherichia coli isolates collected from 8 hospitals from 2016 to 2018. The most commonly used antibiotics were third-generation cephalosporins with a median annual consumption of 0.66 DDD/1000/day. Ceftriaxone was the most frequently prescribed antibiotic in the treatment of community/hospital acquired infections and surgical/medical prophylaxis. The highest resistance rates were recorded for Klebsiella pneumoniae to ceftriaxone, ceftazidime and gentamicin (93.59%, 90.79% and 89.87%, respectively), and Escherichia coli to aminopenicillins, ceftriaxone and ceftazidime (89.06%, 70.15% and 61.54%, respectively). High consumption of broadspectrum antibiotics in Montenegro is accompanied by the high rate of resistance of Klebsiella pneumoniae and Escherichia coli to these agents. Antibiotic misuse demands the introduction of an antimicrobial stewardship program in Montenegrin hospitals.Neodgovarajuća upotreba antibiotika dovodi do povećanja otpornosti na antibiotike. Infekcije uzrokovane gram-negativnim bakterijama otpornima na antibiotike ozbiljna su prijetnja javnom zdravlju. Ovo istraživanje imalo je za cilj usporediti podatke o potrošnji antibiotika u bolnicama sa stopom antimikrobne rezistentnosti (AMR) invazivnih sojeva Klebsiella pneumoniae i Escherichia coli u Crnoj Gori i osigurati ciljeve za poboljšanje upotrebe antibiotika. Rabili smo nacionalne podatke o potrošnji antibiotika od 2009. do 2015. godine, podatke iz studije presjeka o potrošnji antibiotika u bolnicama u 2015. godini i nacionalne podatke AMR za 79 izolata Klebsiella pneumoniae i 68 izolata Escherichia coli prikupljena iz 8 bolnica od 2016. do 2018. godine. Najčešće primijenjeni antibiotici bili su cefalosporini treće generacije s medijanom godišnje potrošnje od 0,66 DDD/1000/dan. Ceftriakson je najčešće propisivani antibiotik u liječenju izvanbolničkih i bolničkih infekcija te u kirurškoj/medicinskoj profilaksi. Stopa otpornosti Klebsiella pneumoniae bila je najviša na ceftriakson, ceftazidim i gentamicin (93,59%, 90,79% odnosno 89,87%), a Escherichia coli na aminopeniciline, ceftriakson i ceftazidim (89,06%, 70,15% odnosno 61,54%). Visoka potrošnja antibiotika širokog spektra u Crnoj Gori praćena je visokom stopom otpornosti Klebsiella pneumoniae i Escherichia coli na njih. Zlouporaba antibiotika zahtijeva uvođenje programa antimikrobnog upravljanja u crnogorskim bolnicama

Lung cancer mortality in Montenegro, 1990 to 2015

Aim To analyze the trend of lung cancer mortality in Montenegro from 1990 to 2015. Methods Data on lung cancer mortality were collected from death certificates obtained from the Statistical Office of Montenegro for the period 1990-2009 and the Institute for Public Health for the period 2010-2015. Population data were obtained from the Statistical Office of Montenegro. Rates were age-standardized to the World Standard Population, and mortality trends were analyzed with the joinpoint regression. Results In 2015, lung cancer accounted for 5.44% of all deaths and 22.92% of all cancer deaths. It was the leading cause of all cancer deaths and the third-leading cause of all deaths. A joinpoint was observed in 2004 in women and in the entire population, and in 2005 in men. The overall mortality rates increased from 1990 to 2004 by an average of 3.91% per year and decreased from 2004 to 2015 by an average of 1.95%; which in the entire observed period resulted in an average increase of 1.3% per year. A particularly strong growth rate was observed in women, even 7.14% in the period from 1990 to 2004. Conclusion The observed increase in lung cancer mortality warrants improved tobacco control

Potrošnja antibiotika u bolnicama i stopa otpornosti bakterija Klebsiella pneumoniae i Escherichia coli u Crnoj Gori

Inappropriate use of antibiotics leads to an increase in antibiotic resistance. Infections caused by antibiotic-resistant gram-negative bacteria are a serious threat to public health. This study aimed to compare data on inpatient antibiotic consumption with antimicrobial resistance (AMR) rate of Klebsiella pneumoniae and Escherichia coli invasive strains in Montenegro and provide targets for improving antibiotic use. We used the national data on antibiotic consumption from 2009 to 2015, Point Prevalence Survey data on inpatient antibiotic consumption from 2015, and national AMR data on 79 Klebsiella pneumoniae and 68 Escherichia coli isolates collected from 8 hospitals from 2016 to 2018. The most commonly used antibiotics were third-generation cephalosporins with a median annual consumption of 0.66 DDD/1000/day. Ceftriaxone was the most frequently prescribed antibiotic in the treatment of community/hospital acquired infections and surgical/medical prophylaxis. The highest resistance rates were recorded for Klebsiella pneumoniae to ceftriaxone, ceftazidime and gentamicin (93.59%, 90.79% and 89.87%, respectively), and Escherichia coli to aminopenicillins, ceftriaxone and ceftazidime (89.06%, 70.15% and 61.54%, respectively). High consumption of broadspectrum antibiotics in Montenegro is accompanied by the high rate of resistance of Klebsiella pneumoniae and Escherichia coli to these agents. Antibiotic misuse demands the introduction of an antimicrobial stewardship program in Montenegrin hospitals.Neodgovarajuća upotreba antibiotika dovodi do povećanja otpornosti na antibiotike. Infekcije uzrokovane gram-negativnim bakterijama otpornima na antibiotike ozbiljna su prijetnja javnom zdravlju. Ovo istraživanje imalo je za cilj usporediti podatke o potrošnji antibiotika u bolnicama sa stopom antimikrobne rezistentnosti (AMR) invazivnih sojeva Klebsiella pneumoniae i Escherichia coli u Crnoj Gori i osigurati ciljeve za poboljšanje upotrebe antibiotika. Rabili smo nacionalne podatke o potrošnji antibiotika od 2009. do 2015. godine, podatke iz studije presjeka o potrošnji antibiotika u bolnicama u 2015. godini i nacionalne podatke AMR za 79 izolata Klebsiella pneumoniae i 68 izolata Escherichia coli prikupljena iz 8 bolnica od 2016. do 2018. godine. Najčešće primijenjeni antibiotici bili su cefalosporini treće generacije s medijanom godišnje potrošnje od 0,66 DDD/1000/dan. Ceftriakson je najčešće propisivani antibiotik u liječenju izvanbolničkih i bolničkih infekcija te u kirurškoj/medicinskoj profilaksi. Stopa otpornosti Klebsiella pneumoniae bila je najviša na ceftriakson, ceftazidim i gentamicin (93,59%, 90,79% odnosno 89,87%), a Escherichia coli na aminopeniciline, ceftriakson i ceftazidim (89,06%, 70,15% odnosno 61,54%). Visoka potrošnja antibiotika širokog spektra u Crnoj Gori praćena je visokom stopom otpornosti Klebsiella pneumoniae i Escherichia coli na njih. Zlouporaba antibiotika zahtijeva uvođenje programa antimikrobnog upravljanja u crnogorskim bolnicama

Assessment of Ecological Risk of Heavy Metal Contamination in Coastal Municipalities of Montenegro

Assessment of heavy metal concentrations in the soil samples of urban parks and playgrounds is very important for the evaluation of potential risks for residents, especially children. Until recently, there has been very little data about urban parks pollution in Montenegro. To evaluate the sources of potential contamination and concentration of heavy metals, soil samples from coastal urban parks and kindergartens of Montenegro were collected. Based on the heavy metal concentrations, multivariate analysis combined with geochemical approaches showed that soil samples in coastal areas of Montenegro had mean Pb and Cd concentrations that were over two times higher than the background values, respectively. Based on principal component analysis (PCA), soil pollution with Pb, Cd, Cu, and Zn is contributed by anthropogenic sources. Results for Cr in the surface soils were primarily derived from natural sources. Calculation of different ecological contamination factors showed that Cd is the primary contribution to ecological risk index (RI) origins from anthropogenic, industry, and urbanization sources. This data provides evidence about soil pollution in coastal municipalities of Montenegro. Special attention should be paid to this problem in order to continue further research and to consider possible ways of remediation of the sites where contamination has been observed