Lycopene and Caffeic Acid Phenethyl Ester Affect Caspase-3 Activity, but Do Not Alter the NO Pathway in Lung Tissue Damage Induced by Cisplatin.

INTRODUCTION: Antioxidants such as lycopene (LCP) and caffeic acid phenethyl ester (CAPE) represent ideal molecules for the treatment of different reactive oxygen species (ROS) associated disorders. Cisplatin is a chemotherapeutic agent, causing an increase in ROS and DNA damage, with numerous side effects, which include lung toxicity. In the presents study, we evaluated and mutually compared the potential of LCP and CAPE in preventing cisplatin-induced rat lung damage. METHODS: The study was done using pathohistological analysis and a panel of biochemical parameters that reflect lung oxidative tissue damage, inflammation, and apoptosis. RESULTS: The obtained results suggest that cisplatin (10 mg/kg) causes significant disturbances in the lung tissue morphology, followed by an increase in lipid peroxidization and protein modification. Also, a pronounced inflammatory response and cell apoptosis cascade activation was noted. Both LCP and CAPE were able to mitigate the changes, to a different extent, in oxidative damage and apoptosis progression induced by cisplatin. However, they both had limited effect on inflammation since they only prevented an increase in myeloperoxidase activity but had not been able to prevent the NO generation. CONCLUSION: It is hard to be exact in saying whether LCP or CAPE is better in preventing cis-platin-induced lung damage since they obviously possess different mechanisms of action.

Trends in tuberculosis notification and mortality and factors associated with treatment outcomes in Serbia, 2005 to 2015.

BackgroundPreviously a country with medium tuberculosis (TB) burden, Serbia almost reached a low TB burden during the period 2005 to 2015.AimThe aim of this study was to analyse the trends in notification rates and treatment success rates as well as to identify predictors of treatment outcomes.MethodsWe performed a trend analysis and logistic regression analysis of 17,441 TB cases registered from 2005 to 2015 in all health facilities in Serbia, to identify predictors of treatment success, loss to follow-up and mortality.ResultsFrom 2005 to 2015, TB notification rate and mortality in Serbia decreased but treatment success remained below the global target. Loss to follow-up was associated with retreatment (odds ratio (OR) = 2.38; 95% confidence interval (CI): 2.08-2.77), male sex (OR = 1.57; 95% CI: 1.39-1.79), age younger than 65 years (OR = 1.37; 95% CI: 1.20-1.51), lower education level (OR = 2.57; 95% CI: 1.74-3.80) and pulmonary TB (OR = 1.28; 95% CI: 1.06-1.56). Deaths were more frequent in retreatment cases (OR = 1.39; 95% CI: 1.12-1.61), male patients (OR = 1.34; 95% CI: 1.19-1.52), those 65 years and older (OR = 4.34; 95% CI: 4.00-5.00), those with lower education level (OR = 1.63; 95% CI: 1.14-2.33) and pulmonary TB (OR = 2.24; 95% CI: 1.78-2.83).ConclusionsSpecial interventions should be implemented to address groups at risk of poor treatment outcome.

HIV prevalence, knowledge and self-perceived risk of HIV infection among tuberculosis patients in Serbia.

OBJECTIVE: The aim of the study was to estimate the seroprevalence of HIV infection among TB patients, knowledge, self-perceived risks and testing practices related to HIV. METHODS: We performed cross-sectional study from 10 May to 15 July 2011. Cluster sampling method was used to select 27 hospitals where 289 TB patients were consecutively recruited. Descriptive statistics and multivariable logistic regression methods were used to identify the factors associated with correct comprehensive knowledge of HIV/AIDS. RESULTS: HIV prevalence among TB patients was 0.3%. Only 25.2% of the respondents presented comprehensive correct knowledge of HIV/AIDS. The percentage of correct answers to all questions related to knowledge about HIV/AIDS increases with educational status (χ2 = 5.42; p < 0.05) and decreases with the age of respondents (χ2 = 8.53; p > 0.05). The independent predictors of correct comprehensive knowledge were living without partner (OR = 4.45; CI = 1.59-12.95) and self-awareness of HIV risk (OR = 4.43; CI = 1.20-16.52). CONCLUSION: HIV prevalence among TB patients is higher than among general population in Serbia. The level of comprehensive correct knowledge of HIV/AIDS is low. There is a need for continuous implementation of public health strategy to successfully manage HIV and HIV/TB co-infection in Serbia.

In silico studies and the design of novel agents for the treatment of systemic tuberculosis.

Tuberculosis (TB) is an ancient infectious disease, which re-emerged with the appearance of multidrug-resistant strains and acquired immune deficiency syndrome. Enoyl-acyl-carrier protein reductase (InhA) has emerged as a promising target for the development of anti-tuberculosis therapeutics. This study aims to develop quantitative structure-activity relationship (QSAR) models for a series of arylcarboxamides as InhA inhibitors. The QSAR models were calculated on the basis of optimal molecular descriptors based on the simplified molecular-input line-entry system (SMILES) notation with the Monte Carlo method as a model developer. The molecular docking study was used for the final assessment of the developed QSAR model and designed novel inhibitors. Methods used for the validation indicated that the predictability of the developed model was good. Structural indicators defined as molecular fragments responsible for increases and decreases of the studied activity were defined. The computer-aided design of new compounds as potential InhA inhibitors was presented. The Monte Carlo optimization was capable of being an efficient in silico tool for developing a model of good statistical quality. The predictive potential of the applied approach was tested and the robustness of the model was proven using different methods. The results obtained from molecular docking studies were in excellent correlation with the results from QSAR studies. This study can be useful in the search for novel anti-tuberculosis therapeutics based on InhA inhibition. Communicated by Ramaswamy H. Sarma.

Changes in respiratory function impairment following the treatment of severe pulmonary tuberculosis - limitations for the underlying COPD detection.

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.

ASSESSMENT OF THE ROLE OF PRIMARY HEALTH CARE IN TUBERCULOSIS CONTROL IN SERBIA.

INTRODUCTION: At the onset of the 21st century, tuberculosis is still a public health problem. Due to the implementation of tuberculosis control program in Serbia, there is no fear of an epidemic. Within the reform of the health care system, the service for pulmonary diseases is being restructured, calling for strengthening the role of primary health care. This study was aimed at analyzing the current role of primary health care in tuberculosis control. MATERIAL AND METHODS: A cross-sectional study was conducted between the 12th and 30th September, 2010. For evaluating the current role of primary health care in tuberculosis control, four questionnaires were designed based on the "Performance assessment questionnaire regarding TB control for use in PHC", Journal Brasileiro de Pneumologia, print version ISSN 1806-3713 (vol. 35, no 6, Sao Paulo, June 2009). The following methods were used to analyze the results: descriptive statistical analysis, Student's T-test, Fisher's analysis of variance. The reliability of the results was tested with Cronbach's alpha and factor analysis. The level of significance in all the methods bordered 0.05. RESULTS: Primary health care does not participate in tuberculosis control in line with the possibilities of the existing legal framework. Although the paper proves that tuberculosis notification rate is higher in the areas less covered by the pneumophysiological service, the role of primary health care does not differ from the areas fully covered. CONCLUSION: There is a need for strategic empowerment of the primary health care system to be actively involved in the diagnostics. treatment and follow up of tuberculosis in Serbia.

Pulmonary function parameters as prognostic factors in advanced non-small cell lung cancer.

AIM: To investigate the impact of some parameters of lung function (forced expiratory volumen in 1 second - FEV1, forced vital capacity - FVC and ratio FEV1/FVC%) on survival in patients with advanced non-small cell lung cancer (NSCLC). METHODS: It retrospectively analyzed data of 155 patients with NSCLC receiving second-line treatment in the Clinic for Lung Diseases, Clinical Center Nis, Serbia, from October 2009 to December 2012. Fifteen potential prognostic variables were subjected to univariate and multivariate analysis to investigate prognostic impact to survival. RESULTS: Among the total of 155 patients, 124 (80%) were males. The most frequent was squamous carcinoma, 86 (55,5%). Mean FEV1 was 1.89 ± 0.71 L (61.8%), mean FVC 2.95 ± 0.8 L (77.2%) and mean FEV1/FVC% was 63.6%. In a multivariate analysis using Cox regression hazard model (hazard ratio, HR), independent prognostic factors for overall survival (OS) were: FEV1 less than 50% of predicted HR= 4.513, 95% confidence interval (CI): 1.433-14.216 (p=0.010), performance status 2 (HR= 0.090, CI= 0.035-0.230 (p=0.000) and weight loss more than 5 % (HR= 0.162, CI= 0.068-0.382 (p=0.000). CONCLUSION: FEV1 in patients with advanced NSCLC receiving chemotherapy is an important independent factor that can predict survival. There was close relationship between impaired lung function and lung cancer patients survival.

Challenges in the diagnosis and treatment of recurrent non-resolving pneumonia - the case of foreign body aspiration in adult mimicking lung neoplasm.

Foreign-body tracheobronchial aspiration in adults is fairly rare, and it is caused mostly by the failure of airway protective mechanisms. The symptoms of this clinical entity can mimic many other respiratory diseases, such as recurrent or non-resolving pneumonia, asthma, lung neoplasm etc. Flexible bronchoscopy was indicated in this situation, both for diagnostic and therapeutic purposes. We are reporting on a case of a fiftythree- year old women with recurrent, non-resolving pneumonia, recurrent hemoptysis, dyspnea, fiver, chest pain and radiological presentation of middle lobe neoplasm caused by aspirated chicken neck bone.

Pulmonary embolism in chronic hypoxemic patients with and without secondary polycythemia--analysis of risk factors in prospective clinical study.

AIM: Prospectively evaluate the incidence of pulmonary embolism and risk factors for this life-threatening disease on chronic hypoxemic patients treated in intensive respiratory care unit. METHODS: The study enrolled 842 consecutive patients with severe exacerbation of chronic obstructive pulmonary disease or respiratory failure. The initial assessment included clinical history collection, physical examination, hematological and biochemical analysis, gas analysis, chest X ray, 12 lead electrocardiography and determination of value of D-dimer. Of all enrolled patients, 211 met the exclusion criteria. Of 631 included patients, 269 (42.6%) had normal D-dimer. D-dimer level ≥ 500 µg/L was found in 362 (57.5%) patients who were referred to Doppler echocardiography, lower limb color Doppler ultrasonography and thoracic multidetector helical computed tomography. According the value of hematocrit, all patients were divided in two groups: group I (100 patients) with polycythema and group II (262 patients) without polycythemia. RESULTS: The first outcome of the study was the significantly higher incidence of pulmonary embolism in group I of patients than in group II, 39 (39%) and 29 (11.06%), respectively. Patients in group I had significantly worse disturbance of pulmonary function and higher degree of pulmonary hypertension (58.4 ± 3.66 vs. 30.3 ± 9.41). Apart from polycythemia in group I, the most common risk factors were arrhythmia, absolute and varicose veins. CONCLUSION: Polycythemia is a single most significant risk factor for pulmonary embolism in chronic hypoxemic patients. Value of D-dimer ≥ 500 µg /L, as well as presence of comorbidity, particularly vein varicose, in these patients should raise clinical suspicion of PE. Key words: chronic obstructive pulmonary disease, multidetector computed tomography, arrhythmia, varicose veins, pulmonary hypertension.

Nutrition disorder and systemic inflammation in patients with chronic obstructive pulmonary disease.

AIM: To detect nutrition disorders (underweight and obesity) in patients with chronic obstructive disease (COPD) and presence of systemic inflammation by determination of inflammatory mediators serum values C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α) and leptin. METHODS: The examination involved 85 patients with COPD. Nutrition categories were defined by body mass index (BMI). Fat free mass (FFM) was evaluated by mid upper-arm circumference (MUAC) and fat mass (FM) by tricipital skin-fold thickness (TFS). Values of TNF-α and leptin were measured by standardized ELISA kits and, CRP by latex turbidimetry. RESULTS: There were 14 (16.5%) underweight patients, 28 (32.9%) normal, 28 (32.9%) pre-obese and 15 (17.6%) obese. Values of MUAC and TSF were significantly different among the nutrition categories (p=0.000). The lowest MUAC and TSF values were in the underweight, and the highest in the obese. There was no significant difference of CRP and TNF-α among nutrition categories. Leptin of the underweight and normal nutrition was significantly different from leptin of the pre-obese and obese (p=0.000). The highest CRP and the lowest TNF-α and leptin were in the underweight patients. The obese had the lowest CRP (although increased as compared to normal values) and the highest leptin, while the pre-obese had the highest TNF-α. CONCLUSION: Two basic nutrition disorders (underweight and obesity) were manifested in COPD patients. The inflammatory profile differs between underweight COPD patients and obese. Probably that happens due to systemic inflammation, and in part due to dysfunction of adipose tissue.

Importance of certain pro-inflammatory indices in patients with liver cirrhosis and bacterial infection on prognosis and course of the disease.

INTRODUCTION: Certain pro-inflammatory indices serum levels, such as leucocytes count and C-reactive protein appears to be a significant and simple clinical tool in prediction of unfavorable course of liver cirrhosis, its complications due to the bacterial infections, length ofhospitalisation and lethal outcome. Cirrhotic patients often have a complications due to bacterial infection, demanding the unexpected need for hospitalization in 30% to 50% of the cases. THE AIM of this study was to assess the impact of pro-inflammatory indices in patients with liver cirrhosis, in relation to bacterial infection and their evaluation as possible prognostic factors on functional liver deterioration, length of hospitalization and lethal outcome. MATERIAL AND METHODS: The research was conducted as a prospective study, on 120 patients with liver cirrhosis, who were in divided into two groups: I-experimental one of 60 patients with bacterial infection and II-control one of 60 patients, with no infectious complications diagnosed end treated in period 2005.-2010. Year. RESULTS: Most of the patients of experimental group were in C stage of disease, compared to those in the control one (p < 0.001). They had also, initially significantly higher increased values of pro-inflammatory indices, which were significantly reduced during the treatment (p < 0.001), with average longer length of hospitalisation and lethal outcome (p < 0.001; p < 0.01). CRP and the Le count values were most significant predictive factors for length of hospitalisation and lethal outcome. DISCUSSION: Pro-inflammatory indices values may predict an unfavorable course and lethal outcome in cirrhotic patients with bacterial infections. Prevention of bacterial infection in those patients improves their long-term survival, achieving the slower course of the underlying disease.

Osteoporosis in patients with chronic obstructive pulmonary disease.

UNLABELLED: One of the extrapulmonary effects of chronic obstructive pulmonary disease (COPD) is osteoporosis. Osteoporosis is characterized by a low bone mineral density (BMD). THE AIM: The aim of this study was to determine relationship between bone mineral density and severity of COPD and body mass index (BMI). PATIENTS AND METHODS: in this study 85 COPD patients were recruited. Diagnosis and severity of COPD was made according to the GOLD guidelines. Height and weight were measured, and BMI was calculated. BMD (at the lumbar spine and at the femoral neck) were performed using Dual energy X-ray absorptiometry (DXA). BMD was expressed in g/cm2 and standardized T-score. RESULTS: The increase of COPD severity leads to the decrease of average values of BMD (femoral neck p = 0.005; lumbar spine p = 0.026), as well as T score (femoral neck p = 0.026; lumbar spine = 0.156). Also, the decrease of BMI leads to the decrease of average values of BMD (femoral neck p = 0.034; lumbar spine p = 0.269) and T score (femoral neck p = 0.001; lumbar spine p = 0.105), as well as to the increase of total osteoporosis (p = 0.009). CONCLUSION: patients with severe COPD and lowe BMI have lower BMD and T score and more frequently have osteoporosis.

Chronic airflow obstruction syndrome due to pulmonary tuberculosis treated with directly observed therapy--a serious changes in lung function.

UNLABELLED: The origin of Chronic airflow obstruction (CAO) syndrome in active Tuberculosis (TB), despite significant similarities with chronic obstructive pulmonary disease (COPD), still remains unknown. The aim of the study was to examine the potential causes and risks for the development of CAO syndrome in new cases of pulmonary TB. DESIGN: Prospective, nest case-control study. PATIENTS: 40 patients with newly detected cavitary pulmonary TB and initial normal respiratory function, diagnosed and treated according to DOTS strategy. MEASUREMENTS AND RESULTS: The average values of Snider's radiological score during TB treatment were significantly reduced (p < 0.001), as well as average values of non-specific systemic serum markers of inflammation. The average values of FEV1 (%), both before, during and at the end of completion of TB treatment were significantly decreased (p < 0.05;). Linear regression analysis confirmed a statistically significant association between changes in the values of FEV1 (%), resulting in TB treatment completion, and the value of Snider's radiological score and the sputum culture conversion rate. From the initial findings of normal pulmonary ventilation tests, upon the completion of TB treatment 35.0% of observed patients developed the CAO syndrome. Logistic regression analysis confirmed a positive familiar burden for COPD, Snider's radiological score at the beginning of TB treatment and sputum conversion rate on culture, as statistically significant predictors, while multivariate logistic regression analysis confirmed Snider's radiological score at the beginning of TB treatment and sputum conversion rate on culture as most significant risk factors for CAO syndrome occurrence and development. CONCLUSION: The CAO syndrome is often a consequence and significant functional impairment of the respiratory system, during the reparative processes in active TB, even in the absence of risk factors for COPD. Only microbiological cure of TB patients with underlying risks for disorders of lung function, is not sufficient and effective approach for prevention of their further potential health deterioration.

[Illness perception in chronic obstructive pulmonary disease].

INTRODUCTION: The aim of the study was to investigate illness perception in patients with chronic obstructive pulmonary disease (COPD), and to explore its relation to socio-demographic and illness/treatment-related characteristics. MATERIAL AND METHODS: 44 consecutive COPD patients answered the general questionnaire (which identified data on gender, age, education, economic status, employment, personal estimate of family relations quality) and IPQ-R (which evaluates the illness perception components). The data were statistically processed using T-test, Mann-Whitney U-test, one way anova, and correlation analysis. RESULTS: COPD patients perceived their illness predominantly negatively. The markers of negative illness perception were female gender: older age, medium economic status, being employed, and high number of hospital treatments. The self report of good family relations was associated with both positive (strong belief in personal control) and negative illness perception (belief in serious consequences). Believing that external causes were predominantly responsible for the illness onset was related to the positive illness representation and to a lower education level. CONCLUSION: Illness perception in COPD patients is negative and associated with certain socio-demographic and illness/treatment-related characteristics; this may have implications for detecting and modifying negative perception patterns in patients at risk.

Tuberculosis in the 21st century--challenges, endeavours and recommendations to doctors.

The magnitude of problem with tuberculosis lies in the fact that one third of the world population is infected by Mycobacterium tuberculosis. Even in the 21st century, tuberculosis kills more people than any other infective agent. Definition of case of resistance--the case of resistant tuberculosis is precisely defined by the recommendations of the World Health Organization as primary, initial, acquired multidrug resistant and extensively drug resistant tuberculosis. The development of resistance tuberculosis may result from the administration of mono-therapy or inadequate combinations of anti-tuberculosis drugs. A possible role of doctors in the development of multi drug-resistant tuberculosis is very important. Actually, multi drug-resistant tuberculosis is a direct consequence of mistakes in prescribing chemotherapy, provision of anti-tuberculosis drugs, surveillance of the patient and decision-making regarding further treatment as well as in a wrong way of administration of anti-tuberculosis drugs. The problem of extensively drug-resistant tuberculosis in the world has become very alarming. In South Africa, extensively drug resistant tuberculosis accounts for 24% of all tuberculosis case. It can be concluded that only adequate treatment according to directly supervised short regiment for correctly categorized cases of tuberculosis can stop the escalation of multidrug or extensively drug resistant tuberculosis, which is actually an incurable illness in the 21st century.

[Infective complications in patients with lung cancer].

INTRODUCTION: This study was aimed at analyzing the site, kind and type of infection which develop in patients having lung cancer at hospital treatment. MATERIAL AND METHODS: Clinical data of the patients hospitalized for lung cancer were analyzed at the Clinic for Lung Diseases and Tuberculosis in Knez Selo in the period from January 2002 till December 2007. A great number of patients (1296-75.9%) had non-small cell lung cancer. In 1708 patients with lung cancer, 773 febrile episodes were recorded, i.e. 687 states of infections. RESULTS: Most of the infections were recorded in the tracheobronchial tree (60.9%). The infection was confirmed microbiologically in 38% of infectious states. Predominant Gram positive pathogens were Staphylococcus aureus and Streptococcus, but among Gram negative pathogens there were Escherichia coli and Haemophilus influenzae. DISCUSSION: A significantly better therapy response to antibiotics was found in the group of patients where microbiological agents were isolated (p < 0.05). The predominant site of infection in the patients with lung cancer is the tracheobronchial tree without a significant difference between frequency of Gram positive and Gram negative pathogens.

[Antioxidant enzymes and lipid peroxidation products in patients with pulmonary tuberculosis].

INTRODUCTION: A lot of studies have dealt with the oxidative stress in pulmonary diseases, and some of them with tuberculosis as well. The aim of this study was to examine the antioxidant enzyme level (superoxide dismutase, glutathione peroxidase, catalase) and the lipid peroxidation products in patients with tuberculosis. MATERIAL AND METHODS: Forty patients with tuberculosis were included in the study. The examined parameters were measured before and three weeks after the beginning of the antituberculosis treatment (group I). The control group included 40 healthy persons (group II). RESULTS: The superoxide dismutase level was significantly lower in group I in both measurements (p < 0.001 and p < 0.01) in relation to group II, but there were no significant changes in its level during the therapy. During the treatment, the glutation peroxidase level significantly increased (p < 0.05), and in relation to group II, its level was significantly lower in both measurements in group I (p < 0.001 and p < 0.001). The catalase level significantly increased during the treatment, but there was no significant difference in relation to group II level. There was no significant difference in relation to the lipid peroxidase products between the groups. DISCUSSION: Our study group had reduced antioxidant enzyme level and some of them showed significant improvement during the treatment. The lipid peroxidase product level was stable. CONCLUSION: In patients with tuberculosis the antioxidative status is lower and its level and possible development of the oxidative stress depend on the disease severity.

[Pulmonary embolism in patients with chronic hypoxemia].

INTRODUCTION: The aim of this prospective, originally designed, clinical--diagnostic study including 200 chronic hypoxemic patients was to assess the possibility of implementation of noninvasive diagnostic strategy and to investigate the incidence of pulmonary embolism and parameters of diagnostic accuracy of radiological findings according to Shintz criteria, echocardiography, lung perfusion scanning according to PIOPED criteria. MATERIAL AND METHODS: The study included 200 chronic hypoxemic patients divided into 2 groups, the group I consisting of 42 women and 58 men and the group II consisting of 48 women and 52 men. RESULTS AND CONCLUSION: Out of 200 hypoxemic patients, 49 patients (24.5%) were found to have pulmonary embolism. In the group I of 100 patients (42 women and 58 men) with chronic hypoxemia and secondary erythrocytosis the diagnosis of pulmonary embolism was confirmed in 39%, that being statistically significantly different (p < 0.001) from 100 patients (48 women and 52 men) in the group II with chronic hypoxemia without secondary erythrocytosis, where pulmonary embolism was found in 10% of the patients. The predictive value was positive for direct radiological signs in 92.3% of patients in the group I for PTE, for indirect ones in 74.35%, and in the group II it was positive for direct radiological signs in 60% and for indirect ones in 90%. The predictive value of perfusion scan was positive in 59% of the group I and in only 22% of the group II. The predictive value for high pressure in the pulmonary artery was positive in 93.7% of the group I and in 66.6% of the group II. The following were found to be a variable predictor: hypoxemia, enlargement of the pulmonary artery, peripheral oligemia and elevation of diaphragm. Logistic regression according to backward--conditional method showed that the chronic hypoxemic patients with secondly erythrocytosis, who had radiological sign of peripheral oligemia--Westermark sign, had 2.286 times higher probability of having pulmonary embolism than similar patients without this sign.

[Rare congenital heart disease as a cause of tuberculosis activation].

INTRODUCTION: Patients with congenital cyanotic heart defects and the left-to-right shunt are at a three times higher risk of getting tuberculosis than acyanotic ones. No TB cases have been recorded in adult patients with the right-to-left shunt having cyanosis since their birth. CASE REPORT: A 34-year-old man was referred to our Clinic with the discomforts such as chronic cough, hemoptysis and insomnia. At the admission he was pale, cyanotic, with a partial manifest respiratory insufficiency and characteristic TB pulmonary lesions detected by x-rays and tomography. After the sputum positive TB recidivism had been diagnosed, the antituberculotics treatment was introduced resulting in the successful smear and culture conversion and radiological regression of pulmonary lesions, but associated with non-explicable deterioration of cyanosis and chronic respiratory insufficiency until Doppler-echocardiographic examination verified the presence of tetralogy of Fallot. CONCLUSION: Congenital cyanotic heart defects are extremely rare in adults. Nevertheless, it is necessary to maintain a very high level of clinical suspicion regarding TB activation even in the cases of defects with the right-to-left shunt.

[Bronchoalveolar lavage and pulmonary sarcoidosis].

INTRODUCTION: Bronchoalveolar lavage is a procedure of washing out of the lungs and the lavage fluid may contain different immunophenotypisation cells. Accordingly, the analysis of bronchoalveolar lavage fluid is an important part in diagnosis of interstitial lung diseases. The aim of this study was the examination of cellular composition of the lavage fluid in patients with lung sarcoidosis. MATERIAL AND METHODS This prospective study included 58 patients (30 women, 28 men), average age 42+ 10.32 years, who underwent standard biochemical analysis, lung radiography, lung function, analysis as well as analysis of cellular composition and immunophenotypisation of lavage fluid cells. RESULTS: 43/58 patients had the first radiological stage of sarcoidosis; 8/58 had second and 7/58 had third radiological stage of sarcoidosis. The majority of patients had preserved lung ventilation (71%), changes in small airways and obstructive ventilation disorder was established in 22% patients, and 7% of' patients presented with restrictive ventilation disorder. The pulmonary transfer factor for CO and transfer coefficient were reduced in 40/58 patients (69%), even in those with normal ventilation. The majority of patients 53/58 had hypercellular lavage fluid, 96.55% of patients had lymphocytic alveolitis (x 34%) in regard to relative reduction of alveolar macrophage (x 63%). The immunophenotypisation of lavage fluid done in 25 patients showed the domination of CD4+ lymphocyte (x 54%) and raised ratio CD4+/CD8+. CONCLUSION: Our results show that lymphocytic alveolitis is one of the best criteria in the diagnosis of pulmonary sarcoidosis.