The influence of oxygenotherapy on the hypercapnia in patients with chronic obstructive pulmonary disease

Background/Aim. Oxygen therapy is a necessary therapeutic method in treatment of severe chronic respiratory failure (CRF), especially in phases of acute worsening. Risks which are to be taken into consideration during this therapy are: unpredictable increase of carbon dioxide in blood, carbonarcosis, respiratory acidosis and coma. The aim of this study was to show the influence of oxygen therapy on changes of arterial blood carbon dioxide partial pressure. Methods. The study included 93 patients in 104 admittances to the hospital due to acute exacerbation of CFR. The majority of the patients (89.4%) had chronic obstructive pulmonary disease (COPD), while other causes of respiratory failure were less common. The effect of oxygenation was controlled through measurement of PaO2 and PaCO2 in arterial blood samples. To analyze the influence of oxygen therapy on levels of carbon dioxide, greatest values of change of PaO2 and PaCO2 values from these measurements, including corresponding PaO2 values from the same blood analysis were taken. Results. The obtained results show that oxygen therapy led to the increase of PaO2 but also to the increase of PaCO2. The average increase of PaO2 for the whole group of patients was 2.42 kPa, and the average increase of PaCO2 was 1.69 kPa. There was no correlation between the initial values of PaO2 and PaCO2 and changes of PaCO2 during the oxygen therapy. Also, no correlation between the produced increase in PaO2 and change in PaCO2 during this therapy was found. Conclusion. Controlled oxygen therapy in patients with severe respiratory failure greatly reduces the risk of unwanted increase of PaCO2, but does not exclude it completely. The initial values of PaO2 and PaCO2 are not reliable parameters which could predict the response to oxygen therapy

Analysis of the CYP2C19 genotype associated with bleeding in Serbian STEMI patients who have undergone primary PCI and treatment with clopidogrel (vol 74, pg 443, 2018)

The correct Author names are shown in this paper

Ektopično lučenje ACTH udruženo s hiperamilazemijom u bolesnika s karcinomom pluća malih stanica: prikaz slučaja

Histologically confirmed small cell lung cancer associated with Cushing’s syndrome and elevated amylase is rarely described in the literature. We present a case of a 63-year-old patient admitted to cardiology department due to shortness of breath, exhaustion, palpitations and nausea. Elevated values of troponin and electrocardiography suggested that he could have acute coronary syndrome. According to the radiologist’s opinion, plane lung radiography was normal. Elevated level of amylase was found in both serum (3802 U/L, normal range 28-100) and urine (12012 U/L, normal range 0-450 U/L), as well as elevated sodium (156 mmol/L, normal range 137-147 mmol/L), hyperglycemia (12 mmol/L, normal range 3.8-6.1 mmol/L) and lowered serum potassium (1.7 mmol/L, normal range 3.5-5.3 mmol/L). Computerized tomography (CT) of the abdomen revealed a tumor of the left adrenal gland and enlargement of the right adrenal gland with normal structure of the pancreas. During hospitalization, the patient had blood while coughing and CT scan of the lungs showed a tumor 48x38x51 mm in size localized in the laterobasal segment of the left lung with mediastinal lymphadenopathy. He also had bilateral pleural effusions with signs of pulmonary embolism, which explained elevated troponin values. Biopsy confirmed microcellular lung carcinoma and tumor cells were diffusely positive for TT F-1 and focally for CK7, expressing markers of neuroendocrine differentiation (chromogranin +++, synaptophysin +++, NS E ++). Since neuroendocrine tumor was confirmed and the patient had low potassium and high glucose, hypercortisolism was suspected. High morning cortisol (1784 mmol/L, normal range 171-536) and unsuppressed ACTH (214 pg/L, <60), as well as a high level of chromogranin (1339 μg/L, <65) were determined. During hospital stay, the patient developed heart and respiratory failure and died in the second week of hospitalization.Histološki potvrđeni slučajevi karcinoma malih stanica udruženi s Cushingovim sindromom i povišenim vrijednostima amilaze u serumu su jako rijetko opisani u literaturi. Prikazujemo slučaj 63-godišnjeg bolesnika primljenog na odjel kardiologije zbog kratkoće daha, iscrpljenosti, lupanja srca i mučnine. Povišene vrijednosti troponina i elektrokardiogram ukazivali su na mogući akutni koronarni sindrom. Prema mišljenju radiologa i snimaka pluća radiografija je bila normalna. Povišena razina amilaze pronađena je u serumu (3802 U/L, normalni raspon 28-100 U/L) i mokraći (12012 U/L, normalni raspon 0-450 U/L), kao i povišenje natrija (156 mmol/L, normalni raspon 137-147 mmol/L), hiperglikemija (12 mmol/L, normalni raspon 3,8-6,1 mmol/L) i nizak serumski kalij (1,7 mmol/L, normalni raspon 3,5 do 5,3 mmol/L). Kompjutorizirana tomografija (CT) trbuha pokazuje tumor lijeve nadbubrežne žlijezde i proširenja desne nadbubrežne žlijezde s normalnom strukturom gušterače. Tijekom hospitalizacije bolesnik je izbacivao krv dok kašlje i CT pluća pokazuje tumorsku masu veličine 48x38x51 mm, lokaliziranu u laterobazalnom segmentu lijevog pluća s medijastinalnom limfadenopatijom. On je također imao bilateralne pleuralne izljeve sa znakovima plućne embolije, što je bio razlog povišene vrijednosti troponina. Biopsija je potvrdila da se radi o karcinomu pluća malih stanica i tumorske stanice su bile difuzno pozitivne na TT F-1 i fokalno na CK7, izražavajući biljege neuroendokrine diferencijacije (kromogranin +++, sinaptofizin +++, NS E ++). Kako je potrvđen neuroendokrini tumor te kako je bolesnik imao nizak kalij i visoku razinu glukoze, postavljena je sumnja na hiperkortizolizam. To je potvrdio nalaz visoke razine jutarnjeg kortizola (1,784 mmol/L, normalni raspon 171-536) i nesuprimiranog ACTH (214 pg/L, <60), kao i visoka razina kromogranina (1339 μg/L, <65). Tijekom boravka u bolnici u bolesnika se razvila srčana i respiracijska insuficijencija te je preminuo u drugom tjednu hospitalizacije

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

Introduction/Aim. Lung cancer is a leading cause of 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

Analysis of the association of the CYP2C19 variants with the effects of clopidogrel therapy in patients underwent to carotid endarterectomy

Introduction. Despite proven clinical effect of clopidogrel, a considerable number of patients do not have an adequate response to this type of medication. Problems during therapy occur in the form of resistance, which is present in 11% of patients or bleeding that occurs in about 9% of patients. Pharmacogenomics studies demonstrated that variants of the CYP2C19 gene significantly influence the interindividual heterogenity of the clopidogrel response. The American Heart Association, US Food and Drug Administration and the European Medicines Agency, cite the CYP2C19 gene as a significant factor which influences patients response to clopidogrel. Further, it has been shown that the contribution of genetic and non-genetic factors affecting clopidogrel therapy may vary between patients from different populations, which justifies conducting population-specific studies. The aim. The aim of our study was to examine the significance of the CYP2C19*2 and the CYP2C19*17 variants in the individual response to clopidogrel, in Serbian patients. Methods. The study involved 108 patients with carotid artery stenosis who underwent endarterectomy and received clopidogrel for at least 30 days after the intervention. Also, 120 patients with myocardial infarction receiving clopidogrel after PCI (percutaneous coronary intervention) were included. Commercial tests were used for standard laboratory testing. Allelic discrimination was performed after Sanger sequencing. Results were analysed using statistical tests. Results. In patients undergoing endarterectomy CYP2C19*2 carriers had a higher risk for being clopidogrel low-responder in comparison with non-carriers (1.250, 95% CI 1.695–1.658, P<0.01). In the group of patients undergoing PCI, risk for reinfarction in patients who were carriers of CYP2C19*2 was higher compared to patients with wild type genotype (OR 5.355, 95% CI 0.955-31.08; P=0.038). Variant CYP2C19*17 showed no association with variations in response to clopidogrel therapy. Conclusion. The CYP2C19*2 variant shows significant association with a poor response to clopidogrel and it should be considered when planning therapy.XXIII Congress of the Cardiology society of Serbia, October 21-23, 2021, Belgrade, Serbia

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. The Republika Srpska does have the capability to accept the model of developing small and medium-sized companies by following the model of clusters

Predviđanje razvoja povrtarstva u Republici Srpskoj (Forecasting of Vegetable Production in Republic of Srpska)

The research object in my work is bassed on forecasting the production parameters about significant types of vegetables in Republic of Srpska regarding to the surface, yield and total production of the following vegetables: beans, cucumber and cabbage and kale.The basis to estimate adequate models with whom have been derived the prediction are the informations (data) of production parameters,mentioned types of vegetables from 1996-2011 year. On the basis of estimated model is derived predicting the values of the parameters observed in 2016. year. The prediction is based on modern quantitative methods, specifically applied the method of time series analysis , and used the appropriate ARIMA models.The form choice of the model is the result of qualitative analysis and statistical criteria. Prediction of the surface shows that there will be changes in the structure of the observed planting vegetables in the Republic of Srpska in 2016. year. The bean surface will be reduced by approximately 600 ha,while the cucumbers ,cabbage and kale surface will be increased for those values. Yields of cucumbers, cabbage and kale in the forecasting period is characterized by stability, as minor fluctuations indicate yields of beans. Tendencies that characterize the area and yield the observed culture is directly reflected in their production. Anticipated production of beans 2016th. The lower will be approximately 500 tons as compared to the 2011th year , a consequence primarily of reducing the area under beans. Stable production during the forecasting period will have cabbage and kale. Anticipated production will be higher for cucumbers for about 1,300 tons at the end of the forecasting period . Results predictions can serve as a basis for qualitative analysis of the production and development of vegetable growing in the Republic of Srpska, as well as for policy and strategy development of vegetable growing in the future and design of agricultural policy measures to encourage the development of production, consumption, processing and export of the observed types of vegetables

Tendencies and prediction of prices of industrial crops In serbia

The research in this paper deals with the prices of the most important industrial crops in Serbia – soybean, sunflower, sugarbeet, rapeseed and tobacco. The main aim of the research was to perform aquantitative analysisto determine the trends in the prices and to predict the trends for the following period. The analysis was based on the average annual prices for the period 2005-2019. The quantitative analysis was performed by using methods of descriptive statistics and the average annual rate of change to discover the trendsfor the analyzed period and to predict the trends for the following five years (2020-2024). The average annual price of soybean was 311.86 EUR/t. The price ranged between 189 and 527 EUR/t. The annual change rate of soybean price in Serbia in the analyzed period was 2.76%. The average annual price of sunflower was 264.78 EUR/t. The price ranged between 163 and 455 EUR/t. The annual change rate of sunflower price in Serbia was 2.13%. The average annual price of sugarbeet was 31.60 EUR/t. The price ranged between 24.36 and 40.31 EUR/t. The annual change rate of sugar beet price was 1.85 %. The average annual price of rapeseed was 299.58 EUR/t. The price ranged between 145 and 447 EUR/t. The annual change rate was 5.84%. The average annual price of tobacco was 1,749 EUR/t. The price ranged between 1,068 and 2,159 EUR/t. The annual change rate of tobacco price in Serbia was 3.90%.The predictions show that the expected prices for the industrial crops in 2024 in Serbia will be as follows: soybean 337, sunflower 266, sugar beet 35.33, rapeseed 425 and tobacco 2,208 EUR/

Price Parities for Vegetables in Serbia - Analysis and Forecasting

The paper analyzes price parities of important vegetable crops in Serbia in relation to wheat, which has always been a point of reference in price formation of other agricultural products. The analysis was carried out by means of descriptive statistics for the period 1994-2017 for the following vegetable crops: potato, bean, tomato, pepper, onion and cabbage. The method used for forecasting of the price parities for the period 2018-2022 is time series analysis, i.e. ARIMA models. The research results showed that the price parities of bean, tomato and pepper will increase: from 9.1 to 12.3 for bean, from 1.9 to 3.5 for tomato and from 2.3 to 3 for pepper. The price parities for potato (1.4) and cabbage (1.4) will remain practically unchanged, while the price parity of onion will decrease to 1.5