Parameters in predicting the risk of a prolonged hospital stay in patients with acute exacerbation of chronic obstructive pulmonary disease: a single-centre experience.

Aim To identify clinical and laboratory parameters on admission and/or during a hospital stay that would predict prolonged hospital stay in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A retrospective cross-sectional study was conducted at the Clinic for Pulmonary Diseases and Tuberculosis, Clinical Centre University of Sarajevo for the period 2019-2021 accounting patients admitted due to AECOPD. The need for hospitalization was evaluated according to the current GOLD criteria and certain clinical parameters. Spirometry testing and laboratory analysis were performed for all patients on the day of admission and on the 10th day of hospital stay. Linear regression was used to show the relationship between multiple independent predictor variables and LOS. Results A total of 50 patients were evaluated during their hospital stay due to AECOPD. Median of LOS was 22.02±1.06, with 90% hospital survival rate. Due to AECOPD the median of LOS in the intensive care unit (ICU) was 4±0.68 days with pH<7.35 in 34% of hospitalized patients. According to spirometry classification on the day of admission, 56% of patients were assigned to group 3 and 16% to group 4 with significant improvement identified on spirometry findings on discharge. Platelets on the day of admission were the only statistically significant positive predictors of the length of hospital stay. Conclusion Identifying chronic obstructive pulmonary disease patients at risk of frequent exacerbations and appropriate disease management could reduce the disease burden.

Can neutrophil-to-lymphocyte ratio and proatherogenic risk factors improve the accuracy of pneumonia severity index in the prediction of community acquired pneumonia outcome in healthy individuals?

Aim To investigate infl uence of neutrophil-to-lymphocyte ratio (NLR) and proatherogenic risk factors to improve the accuracy of pneumonia severity index (PSI) in the prediction of community acquired pneumonia (CAP) outcome in healthy individuals. Methods A retrospective observational cross-sectional study conducted at the Clinic for Pulmonary Diseases and Tuberculosis "Podhrastovi", University Clinical Centre Sarajevo, included 83 patients with the diagnosis of CAP during the period March 2019-March 2021. Once diagnosed with CAP, PSI score was calculated and according to its value the need for hospital treatment was identifi ed. Patients were divided in two groups: low risk of CAP (PSI <90), and high risk of CAP (PSI> 90). Results The overall average hospital stay was 22.76±10.154 days. In the patients diagnosed with CAP, a positive correlation was established between the following parameters PSI score and age (r=0.670; p<0.01), C-reactive protein-CRP (rho=0.287; p<0.01), leukocytes (rho=0.406; p<0.01), NLR (rho=0.313; p<0.01) and platelet to lymphocyte ratio (PLR) (0.296; p<0.05). CRP, leukocytes, NLR and PLR were statistically signifi cantly higher in patients with high risk of CAP compared to patients with low risk of CAP. Diastolic blood pressure, lymphocytes, eosinophils were signifi cantly lower in patients with high risk of CAP (p<0.05;) compared to patients with low risk of CAP (p<0.01). The optimal cut-off value of NLR for CAP patients was 3.089 with an estimated area under curve (AUC) of 0.664. Conclusion Proatherogenic parameters such as age, systolic blood pressure and leukocytes in combination with neutrophil-lymphocyte count ratio could improve accuracy of the pneumonia severity index in community acquired pneumonia outcome.

Adjunct corticosteroid treatment in patients with pneumonia: A precision medicine approach.

Pneumonia is the leading infectious cause of death worldwide. While inflammation is critically important in host response to microbial invasion, exaggerated inflammation can damage the lungs, contributing to respiratory failure and mortality. Corticosteroids are effective in reducing inflammation and can also cause immune suppression. Presently, clinicians are unable to reliably distinguish between exaggerated and appropriate immune response and thus cannot rapidly identify patients most likely to benefit from adjunctive corticosteroids. In this review, we propose a biomarker-guided, precision medicine approach to corticosteroid treatment, aimed to give these medications at appropriate dose and time and only to patients who have exaggerated inflammation.

[The effectivness of direct observed treatment short course (DOTS) in tuberculosis treatment]. / Efektivnost direktno opserviranog kratkotrajnog kursa (DOTS) u lijecenju tuberkuloze.

UNLABELLED: In 1994 the National Tuberculosis (TB) Programme of our country adopted direct observed treatment short course (DOTS) as National TB control strategy. After that DOTS has been implemented in different parts of country. OBJECTIVE: to define the effectiveness of DOTS strategy implementation in Sarajevo Canton. PATIENTS AND METHODS: Medical histories and treatment cards of TB smear patients admitted in the University Clinic Sarajevo during 1998 and 1999, as well as Referral Microbiological Laboratory Registers of Federation of Bosnia and Herzegovina were used for the analysis. The control group consisted of patients treated in the area which covers present Sarajevo Canton in the period when DOTS strategy was not used. RESULTS: In 1998 there were 83.6 % new TB cases and 89.5 % in 1999. The smear sputum conversion rate was 89.5 % in 1998 and 93 % in 1999. Smear sputum conversion rates were achieved in the period of 30-45 days after antituberculous treatment onset in 50.0 % patients in 1998 and in 51.7 % in 1999. Chest X-ray partial regression in the initial phase (at the end of second month of treatment) was achieved in the examined groups in higher percentages (70.1 % in 1998 and 77.9 % in 1999.) compared with the control group (44.29 %). It was evident that partial radiographic regression was achieved up to 45 days after treatment onset in the examined group in 42.6 % cases in 1998 and in 61.2 % in 1999. In this period in the control group partial radiographic regression was not achieved at all. Total chest X-ray regression was achieved neither in examined groups nor in control group. CONCLUSION: These data are the results of successfulness of the DOTS treatment.

[Hospital sepsis and aggressive medical interventions]. / Bolnicka sepsa i agresivni medicinski zahvati.

AIM: To find out do the aggressive medical interventions have an effect on appearance of gram positive and gram negative hospital sepsis among 200 patients with positive clinical and laboratorial signs of sepsis and who have proved monomicrobial blood isolates. METHODS: Samples of septic patients were analyzed statistically by using x2 test and coefficient of contingency C. RESULTS: After we put gram negative so as gram positive sepsis to a correlation with the aggressive medical treatments, which proceeded, we got statistically significant results. CONCLUSIONS: Aggressive medical interventions impute hospital sepsis and etiology.

[Periodontal findings in patients addicted to psychoactive drugs]. / Parodontalni nalaz pacijenata ovisnih o psihoaktivnim supstancama.

Psychoactive drug misuse, as bad habit, is local ethiologic factor of periodontal diseases, and it represents the significant socio-medical problem. The aim of study is: to establish the values of plaque and gingival index in psychoactive drug addicts. The study has been carried out in 42 patients. Experimental group consists of psychoactive drug addicts, and control group consists of patients who have not used psychoactive drugs. The plaque and gingival index show significant difference between experimental and control group. Psychoactive drug misuse has the influence to increased adherence of dental plaque and gingival inflammation, and therapeutic approach is at multidisciplinary level.