Changes in respiratory function impairment following the treatment of severe pulmonary tuberculosis – limitations for the underlying COPD detection Milan Radovic,1,2 Lidija Ristic,1,2 Zorica Ciric,1,2 Violeta Dinic-Radovic,3 Ivana Stankovic,1,2 Tatjana Pejcic,1,2 Milan Rancic,1,2 Dragan Bogdanovic4 1Department of Internal Medicine, Faculty of Medicine, University of Nis, 2Clinic for Lung Diseases, 3Clinic for Gastroenterology and Hepatology, Clinical Centre of Nis, 4Public Health Institute Nis, Nis, Republic of Serbia Background: During the treatment phase of active pulmonary tuberculosis (PTB), respiratory function impairment is usually restrictive. This may become obstructive, as a PTB-associated airflow obstruction (AFO) or as a later manifestation of underlying COPD.Purpose: The aim of the study was to examine the potential causes and risks for AFO development in PTB by exploring the aspects of spirometry limitations and clinical implications for the underlying COPD detection, taking into account various confounding factors.Patients and methods: Prospective, nest case–control study on 40 new cases of PTB with initial restrictive respiratory function impairment, diagnosed and treated according to the directly observed treatment short course (DOTS) strategy.Results: From all observed patients, 37.5% of them developed AFO upon the completion of PTB treatment, with significantly increased average of forced vital capacity (%) (P<0.01). Their changes in forced expiratory volume in the first second (%) during the PTB treatment were strongly associated with the air pollution exposure in living (0.474%–20.971% for 95% confidence interval [CI]; P=0.041) and working environments (3.928%–20.379% for 95% CI; P=0.005), initial radiological extent of PTB lesions (0.018%–0.700% for 95% CI; P=0.047), leukocyte count (0.020%–1.328% for 95% CI; P=0.043), and C-reactive protein serum level (0.046%–0.205% for 95% CI; P=0.003) compared to the other patients. The multivariate logistic regression analysis model shows initial radiological extent of pulmonary tuberculosis lesions (OR 1.01–1.05 for 95% CI; P=0.02) and sputum conversion rate on culture (OR 1.02–1.68 for 95% CI; P=0.04) as the most significant predictors for the risk of AFO development.Conclusion: AFO upon PTB treatment is a common manifestation of underlying COPD, which mostly occurs later, during the reparative processes in active PTB, even in the absence of major risk factors, such as cigarette smoking and biomass fuel dust exposure. Initial spirometry testing in patients with active PTB is not a sufficient and accurate approach in the detection of underlying COPD, which may lead to their further potential health deterioration. Keywords: tuberculosis, pulmonary, respiratory function tests, lung diseases, obstructive

During a 36-month period from 1992 to 1994, 33 patients with severe polytrauma acquired in war combat (1 female, 32 male, 38.61 +/- 8.79 years) developed acute renal failure (ARF) which required hemodialysis (HD) treatment. In 12 patients, multiple system organ failure (MSOF) occurred as a complication of either general conditions or septic complications. In 17 patients (51.4%), and in 3 patients with MSOF, recovery of renal function occurred. We compared the outcome of ARF and several predictive scores (APACHE II and ATNISS). The APACHE II score did not correlate with the outcome of ARF, and ATNISS significantly correlated with the outcome of ARF. The maximum value of ATNISS in the patients with lethal outcome was 1.004, and the minimal value with the same outcome was 0.182. Although ATNISS is a very good score of severity, it seems to underestimate very influential factors in patients with severe polytrauma with ARF (MSOF, mechanism of trauma).

Introduction: Cisplatin is one of the most frequently used chemotherapeutics, which is known to cause both tumor and normal lung tissue damage through the generation of free radicals and cells apoptosis/necrosis. Melatonin is a neurohormone that regulates numerous physiological processes in the body both through receptor pathways and by maintaining tissue redox homeostasis.Material and methods: The extent of rat lung damage induced by cisplatin and the effects of melatonin on this process was determined based on the pathohistological changes and biochemical disturbances in tissue lipid peroxidation, protein carbonyl modification and in the activity of xanthine oxidase (XO), caspase-3 and DNases.Results: Histopathological analysis of rat lung tissue obtained from animals that received cisplatin found them to be edematous, with significant deterioration of alveolar epithelium. These morphological changes are accompanied by a significant increase in all studied oxidative stress-related parameters, as well as with the activity of apoptosis-related enzymes. A five-day treatment with melatonin completely prevented a cisplatin-induced increase in oxidative stress-related parameters and in the activity of XO, caspase-3 and alkaline DNase. Also, the histopathological changes observed during microscopic analysis were much less pronounced than in the group that received cisplatin only.Conclusions: These results can potentially be connected with the ability of melatonin to inhibit the activity of XO, caspase-3 and alkaline DNase and/or its ability to scavenge free radicals, thus preventing lung damage induced by cisplatin.

Pulmonary artery sarcomas are rare neoplasms that are often confused with chronic thrombo-embolic disease, as both can have similar clinical and imaging presentation.

The global outbreak of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has prompted significant public health concerns. This study focuses on 442 chronic hemodialysis patients diagnosed with COVID-19, emphasizing the impact of vaccination status on clinical outcomes. The study investigates the correlation between vaccination status and laboratory findings, aiming to identify predictive factors for mortality. Results indicate that vaccination status plays a crucial role in outcomes. Full vaccination, evidenced by two or three doses, is associated with better outcomes, including reduced incidence of bilateral pneumonia and lower risks of complications such as hemorrhage and thrombosis. Laboratory analyses reveal significant differences between vaccinated and unvaccinated patients in parameters like C-reactive protein, ferritin, and white blood cell counts. Univariate and multivariate Cox proportional hazards regression analyses identify several factors influencing mortality, including comorbidities, pneumonia development, and various inflammatory markers. In conclusion among hemodialysis patients affected by COVID-19 infection, vaccination with at least three doses emerges as a protective factor against fatal outcomes. Independent predictors of mortality are CRP levels upon admission, maximum CRP values during the illness and cardiovascular comorbidities. Noteworthy lymphocytopenia during infection exhibits a notable level of specificity and sensitivity in predicting mortality.