SMOKING BEHAVIORS AND LUNG CANCER EPIDEMIOLOGY: A COHORT STUDY

Background: Lung cancer is the most common cancer in the world. According to the latest available data, in the year 2012 Croatia was among 20 countries with the highest incidence of lung cancer. Although tobacco smoking is a proven cause of lung cancer, recent data show that more than one quarter of adult inhabitants of Croatia are everyday smokers. The purpose of this study was to present epidemiology and treatment modalities of lung cancer in the Department for mediastinal tumors, Clinic for lung diseases Jordanovac, and to make a comparison between the available data from Croatia and the rest of the world. Subjects and methods: The study cohort included 212 newly diagnosed lung cancer patients who had referred to our Department from January 2012 until December 2012. Features such as age, gender, cytology and histology of the tumor, stage at diagnosis and applied therapy were evaluated respectively. Results: Approximately two-thirds of all newly diagnosed lung cancers occurred in men. Out of the study cohort, 12.3% were diagnosed with small cell lung cancer (SCLC) and 87.7% were diagnosed with non-small cell lung cancer (NSCLC). The majority of the patients diagnosed with NSCLC had adenocarcinoma (47.9%), followed by squamous cell carcinoma (33.9%) and large cell carcinoma (15%). Only a small number of patients diagnosed and treated for lung cancer in our Department had never smoked tobacco. The majority of those patients were women and the most common histological type found was adenocarcinoma. Conclusion: The number of patients who had potentially operable disease at presentation was around 10%. That is why, in most cases, therapeutic options were confined to palliative chemotherapy or radiotherapy. Attention should be directed to an early detection of lung cancer patients, which could provide better treatment options and improve overall survival

PHARMACOTHERAPY OF SEVERE ASTHMA

Teška astma javlja se u 5–10% bolesnika s astmom. Točni patofiziološki mehanizmi nisu poznati. Najčešće je karakterizira neutrofilna upala dišnih putova ili odsutnost upalnih promjena uz ubrzano remodeliranje bronha. Klinički se najčešće radi o nealergijskoj astmi kod žena, a prevladavaju fenotip astme kasne pojavnosti i aspirinska astma. Alergijska astma znatno rjeđe pripada skupini teških astma. Iako se većina bolesnika s blagom i srednje teškom astmom može uspješno liječiti kombinacijskom terapijom, bolesnici s teškom astmom trebaju liječenje peroralnim glukokortikoidima. Prije početka liječenja teške astme peroralnim glukokortikoidima treba upotrijebiti najviše doze inhalacijskih glukokortikoida, do 2000 µg beklometazona ili ekvivalenata, uz dodatak beta2-agonista dugog djelovanja, antagonista leukotrijenskih receptora, teofilinskih preparata i antikolinergika dugog djelovanja. Zbog nuspojava oralnih glukokortikoida važna je alternativna terapija teške astme: liječenje omalizumabom, makrolidnim antibioticima, inhibitorima TNF-a, antagonistima citokinskih receptora i bronhalnom termoplastikom. Unatoč znatnom napretku u razumijevanju toga kompleksnog fenotipa liječenje teške astme ostaje vrlo zahtjevno.Severe asthma affects 5–10% of the asthma population. Exact pathophysiology of severe asthma mechanisams is complex and not fully understood. Cellular inflammation of the airways with neutrophils is a characteristic feature and is considered relevant to the pathogenesis of the disease, but all components of the airway wall have been reported to be thickened in severe asthma with or without cellular inflammation. Clinically it usually involves women with severe non-allergic asthma, late onset of asthma patients and aspirin induced asthma. Severe asthma rarely affects allergic asthma patients. Although majority of adults with mild or moderate asthma can be treated by inhaled glucocorticoids either alone or in combination with beta 2 agonists bronchodilators, patients with severe asthma require high doses of inhaled glucocorticoids or continuous oral use of glucocorticoids. Treatment of severe asthma should be started with high doses of inhaled steroids, 2000 µg of beclomethasone or its equivalents in addition to long acting beta 2 agonists, leukotriene receptor antagonists, theophylline and long acting anticholinergic drugs. Due to significant short-term and longterm oral glucocorticoids side effects it is essential to emphasize the importance of alternative therapies in severe asthma: treatment with omalizumab, macrolide antibiotics, tumor necrosis factor alpha inhibitors, cytokine receptors inhibitors and bronchial thermoplasty. Although there is a significant improvement in the treatment of severe asthma, the challenge remains to determine therapeutic strategy for appropriate phenotype in view of the heterogeneity of severe asthma

SERUM ACTIVITY OF ENZYMES AND BILIRUBIN IN PATIENTS WITH CIRRHOSIS AND LIVER CANCER

Introduction: The most important biochemical reactions of the human organism take place in the liver, and therefore it represents one of the most important organs for life. Parameters that play an important role in the diagnosis and monitoring of patients are the enzymes ALT, AST, GGT, ALP, and bilirubin. Objective: To evaluate the serum activity of enzymes and bilirubin in patients with liver cirrhosis and liver cancer. Materials and methods: The study included 120 patients aged over 50 years. Among them, 40 patients had liver cirrhosis, 40 had cancer and liver metastases, and 40 patients were apparently healthy (control group). The concentrations of AST, ALT, GGT, and ALP were determined on Abbott Architect i2000sr biochemical analyzer and Dimension analyzer. Results: The study showed that the mean values of the studied parameters were significantly higher in subjects with liver cirrhosis and cancer with liver metastases than in the control group. A statistically significant difference (p <0.05) was found in ALP and bilirubin concentrations between the studied groups. In addition, the study revealed a statistically significant difference (p <0.05) in ALT, AST, and GGT activity between subjects with cancer and the control group and subjects with cirrhosis and the control group. Conclusions: The results confirm that the activities of enzymes ALT, AST, GGT, ALP, and bilirubin were increased in subjects with cirrhosis and cancer compared to the control group

SOCIODEMOGRAPHIC CHARACTERISTICS INFLUENCE PAIN PERCEPTION IN NON-SMALL CELL LUNG CANCER PATIENTS

Uvod: Karcinom pluća najčešća je maligna bolest u muškaraca, a u žena se nalazi na trećem mjestu. Nedvojbeno je da oboljeli, uz ostale simptome, trpe bol. Svrha rada: Istraživanje je provedeno kako bi se utvrdilo postoji li utjecaj ­sociodemografskih karakteristika na percepciju boli mjerenoj analogno-vizualnom ljestvicom među oboljelima od karci­noma pluća ne-malih stanica. Metode: Ovo primijenjeno, opservacijsko, unicentrično istraživanje imalo je dva kraka: 1) presječni krak, i 2) prospektivni, kohortni krak. Rezultati: U istraživanje je ukupno uključen 41 bolesnik s medijanom dobi 61 (56–68) godina. Ovo istraživanje pokazalo je da subjektivna percepcija boli jest povezana s dobi i urbaniziranošću ­mjesta boravka te kako su s intenzivnijim subjektivnim osjećajem boli bile povezane mlađa dob (≤ 60 godina vs. > 60 ­godina, p=0,026) i gradska naselja (grad vs. selo, p=0,031). Dob je bila neovisno i statistički značajno povezana i s relativnom promjenom boli nakon terapije (Wald=5,914; ss=1; p=0,015). Zaključci: Koliko dob, spol, način življenja, mjesto stanovanja pa i sam mentalitet mogu utjecati na doživljaj boli vrijedno je uzeti u obzir kako bi se takvim pacijentima omogućila što bolju skrb i kvaliteta života u godinama borbe s malignom bolešću.Background: Lung cancer is the most common malignant disease in men and the third most common in women worldwide. Pain in these patients is a leading and debilitating symptom, among others. Objectives: The aim of this research was to determine the relationship between the sociodemographic characteristics and pain perception, as measured by ­visual analogue scale for pain, in patients with non-small cell lung cancer. Methods: This observational, single centre study ­included both a cross-sectional and prospective cohort design. Results: Forty-one patients with a median age of 61 years (range 56–68) were included. This study showed that subjective perception of pain is related to age and place of residence. Younger patients (≤ 60 years old, p=0.026) and those residing in cities (p=0.031) reported feeling worse pain. Age was independently and statistically associated with the relative relief of pain after analgesic therapy (Wald=5.914; ss=1; p=0.015). Conclusion: Age, lifestyle, place of residence, and mentality should be considered when evaluating pain perception in patients suffering from chronic pain related to malignant disease in order to provide the best possible medical treatment with the goal of improving quality of life

Survival of heart failure patients with reduced and preserved ejection fraction is not different!

Introduction: A progress in the management of cardiovascular disease leads to a decrease in mortality, but heart failure (HF) seems to be an exception. Today, the rate of rehospitalization and mortality after acute heart failure is still very high. Lower ejection fraction (EF) means worse prognosis, but recent studies are reporting that HF patients with preserved EF have no better survival compared to patients with reduced EF1. Goal: to investigate a possible difference in the outcome of HF patients with reduced (HFREF) and preserved ejection fraction (HFPEF). Patients and Methods: In 222 patients hospitalized in acute HF (138 with reduced EF and 74 with preserved EF) were determined routine laboratory test, including BNP. The LVEF cutoff for diagnosing of HFPEF was above 45 %. Patients were followed for the next 18 months for the occurrence of 1. readmission due to repeat decompensation and 2. mortality. Results: BNP at discharge was higher in HFREF compared to HFPEF group [699.3 (271.8-1519.1) pg/ml vs 263.3 (134.4-502.2) pg/ ml, p <0.001]. During 18-month follow-up 129 patients (58.11%) were readmitted due to decompensation, but there was no significant difference between group: in HFREF group was hospitalized 87 (63.04%) patients compared to 42 (50%) patients in HFPEF group (p=0.077). There was no difference in the rate of readmission in 1-month (p=0.7), 6-month (p=0.24), and 12-month follow up (p=0.16) in HFREF vs HFPEF group. In Kaplan-Meier curve there was no significant difference in the mean time of the occurrence of readmission due to decompensation: in HFREF group 2.2 (95% CI=1.58- 2.8) months and in HFPEF group 2.33 (95% CI=1.3-3.4) months (p=0.89) (Figure 1). In HFREF 18-month survival was 43.5% (60/138) and in HFPEF group was 56.0 % (47/84) and the difference was not significant (p=0,096). In the Kaplan-Meier curve, there was no difference in time of survival in 18-month follow-up (p=0.9): mean time of survival in HFREF was 3.8 (95% CI=3.0-4.7) months and in HFPEF 3.75 (95% CI=2.5-5.0) months (Figure 2). There was no difference in mortality in 1-month (p=0.8), 6-month (p=0.16) and 12-month follow up (p=0.08). Conclusion: Rate of rehospitalization due to decompensation and mortality is not different between HFREF and HFPEF group. Preserved EF is not related to better survival in patients with HF

SMOKING BEHAVIORS AND LUNG CANCER EPIDEMIOLOGY: A COHORT STUDY

Background: Lung cancer is the most common cancer in the world. According to the latest available data, in the year 2012 Croatia was among 20 countries with the highest incidence of lung cancer. Although tobacco smoking is a proven cause of lung cancer, recent data show that more than one quarter of adult inhabitants of Croatia are everyday smokers. The purpose of this study was to present epidemiology and treatment modalities of lung cancer in the Department for mediastinal tumors, Clinic for lung diseases Jordanovac, and to make a comparison between the available data from Croatia and the rest of the world. Subjects and methods: The study cohort included 212 newly diagnosed lung cancer patients who had referred to our Department from January 2012 until December 2012. Features such as age, gender, cytology and histology of the tumor, stage at diagnosis and applied therapy were evaluated respectively. Results: Approximately two-thirds of all newly diagnosed lung cancers occurred in men. Out of the study cohort, 12.3% were diagnosed with small cell lung cancer (SCLC) and 87.7% were diagnosed with non-small cell lung cancer (NSCLC). The majority of the patients diagnosed with NSCLC had adenocarcinoma (47.9%), followed by squamous cell carcinoma (33.9%) and large cell carcinoma (15%). Only a small number of patients diagnosed and treated for lung cancer in our Department had never smoked tobacco. The majority of those patients were women and the most common histological type found was adenocarcinoma. Conclusion: The number of patients who had potentially operable disease at presentation was around 10%. That is why, in most cases, therapeutic options were confined to palliative chemotherapy or radiotherapy. Attention should be directed to an early detection of lung cancer patients, which could provide better treatment options and improve overall survival

Sociodemographic characteristics influence pain perception in non-small cell lung cancer patients

Uvod: Karcinom pluća najčešća je maligna bolest u muškaraca, a u žena se nalazi na trećem mjestu. Nedvojbeno je da oboljeli, uz ostale simptome, trpe bol. Svrha rada: Istraživanje je provedeno kako bi se utvrdilo postoji li utjecaj ­sociodemografskih karakteristika na percepciju boli mjerenoj analogno-vizualnom ljestvicom među oboljelima od karci­noma pluća ne-malih stanica. Metode: Ovo primijenjeno, opservacijsko, unicentrično istraživanje imalo je dva kraka: 1) presječni krak, i 2) prospektivni, kohortni krak. Rezultati: U istraživanje je ukupno uključen 41 bolesnik s medijanom dobi 61 (56–68) godina. Ovo istraživanje pokazalo je da subjektivna percepcija boli jest povezana s dobi i urbaniziranošću ­mjesta boravka te kako su s intenzivnijim subjektivnim osjećajem boli bile povezane mlađa dob (≤ 60 godina vs. > 60 ­godina, p=0,026) i gradska naselja (grad vs. selo, p=0,031). Dob je bila neovisno i statistički značajno povezana i s relativnom promjenom boli nakon terapije (Wald=5,914; ss=1; p=0,015). Zaključci: Koliko dob, spol, način življenja, mjesto stanovanja pa i sam mentalitet mogu utjecati na doživljaj boli vrijedno je uzeti u obzir kako bi se takvim pacijentima omogućila što bolju skrb i kvaliteta života u godinama borbe s malignom bolešću.Background: Lung cancer is the most common malignant disease in men and the third most common in women worldwide. Pain in these patients is a leading and debilitating symptom, among others. Objectives: The aim of this research was to determine the relationship between the sociodemographic characteristics and pain perception, as measured by ­visual analogue scale for pain, in patients with non-small cell lung cancer. Methods: This observational, single centre study ­included both a cross-sectional and prospective cohort design. Results: Forty-one patients with a median age of 61 years (range 56–68) were included. This study showed that subjective perception of pain is related to age and place of residence. Younger patients (≤ 60 years old, p=0.026) and those residing in cities (p=0.031) reported feeling worse pain. Age was independently and statistically associated with the relative relief of pain after analgesic therapy (Wald=5.914; ss=1; p=0.015). Conclusion: Age, lifestyle, place of residence, and mentality should be considered when evaluating pain perception in patients suffering from chronic pain related to malignant disease in order to provide the best possible medical treatment with the goal of improving quality of life