Wearing surgical face mask has no significant impact on auscultation assessment.

Objective: During the COVID-19 pandemic, universal mask-wearing became one of the main public health interventions. Because of this, most physical examinations, including lung auscultation, were done while patients were wearing surgical face masks. The aim of this study was to investigate whether mask wearing has an impact on pulmonologist assessment during auscultation of the lungs. Methods: This was a repeated measures crossover design study. Three pulmonologists were instructed to auscultate patients with previously verified prolonged expiration, wheezing, or crackles while patients were wearing or not wearing masks (physician and patients were separated by an opaque barrier). As a measure of pulmonologists' agreement in the assessment of lung sounds, we used Fleiss kappa (K). Results: There was no significant difference in agreement on physician assessment of lung sounds in all three categories (normal lung sound, duration of expiration, and adventitious lung sound) whether the patient was wearing a mask or not, but there were significant differences among pulmonologists when it came to agreement of lung sound assessment. Conclusion: Clinicians and health professionals are safer from respiratory infections when they are wearing masks, and patients should be encouraged to wear masks because our research proved no significant difference in agreement on pulmonologists' assessment of auscultated lung sounds whether or not patients wore masks.

Corrigendum to: Post-treatment neutrophil to lymphocyte ratio as a prognostic tool in patients treated with tocilizumab for severe COVID-19 pneumonia - a single center experience.

[This corrects the article DOI: 10.11613/BM.2023.020704.].

SUCCESSFULLY TREATED ACUTE INTERSTITIAL PNEUMONIA.

Acute interstitial pneumonia (AIP) is a rare idiopathic interstitial pneumonia with histology finding of diffuse alveolar damage (DAD). It is characterized by progressive hypoxic respiratory failure, high mortality rate, and absence of guidelines for its treatment. Here we present a case of a 64-year-old woman with progressive dyspnea, acute respiratory failure, diffuse bilateral reticulonodular opacities on standard chest radiograph, diffuse ground-glass opacities on computed tomography, and biopsy proven DAD. Diagnosis of AIP was established after extensive work-up that excluded the known risk factors for acute respiratory distress syndrome. Oxygen therapy and high-dose parenteral corticosteroids led to gradual improvement and resulted in complete respiratory recovery. Since there are no existing guidelines for treating AIP, more case reports and case series if not randomized control trials are warranted in order to define the most effective therapeutic modality.

Left ventricular diastolic function in diabetes mellitus type 2 patients: correlation with heart rate and its variability.

AIMS: To assess the prevalence of left ventricular diastolic dysfunction in a population of patients with type 2 diabetes mellitus; to determine correlation of diastolic dysfunction with heart rate and its variability. METHODS: The study included 202 patients with type 2 diabetes mellitus. Echocardiography was performed with special reference to diastolic function, and heart rate variability was analysed using standard deviation of normal RR intervals, root mean square of successive differences and percentage of successive R-R intervals greater than 50 ms (pNN 50 %) in a 24-h electrocardiogram recording. RESULTS: Diastolic dysfunction is present in 79 % of type 2 diabetes mellitus patients: grade 1 in 52 %, grade 2 in 26 % and grade 3 in 1 % of patients. The subjects with grade 1 diastolic dysfunction had a statistically significantly higher heart rate variability compared with those with grade 2 diastolic dysfunction (LSD, post hoc test, p = 0.001). In the group with diastolic dysfunction, grade 2 reduced heart rate variability was recorded in 83 % of patients (37 and 7 % for grade 1 and normal diastolic function). An increase in the severity of diastolic dysfunction was associated with decreased heart rate variability and increased heart rate. CONCLUSION: Progression of diastolic dysfunction is associated with a significantly greater prevalence of reduced heart rate variability, which is accompanied by increased heart rate.

P2RY12 gene polymorphisms and effect of clopidogrel on platelet aggregation.

Objective of this study was to assess platelet response to clopidogrel and its association with certain single nucleotide polymorphisms (SNPs) of the P2RY12 gene. Several studies have shown that patients with poor in vitro response to clopidogrel have worse outcomes after coronary interventions. Pharmacological response to clopidogrel is mediated by the P2Y12 platelet receptor, therefore, SNPs of the P2RY12 gene may account for some of the observed variability in the cardiovascular risk. Fifty patients with stable coronary heart disease, undergoing percutaneous coronary intervention were included in this study. Response to clopidogrel was analysed using light transmitted aggregometry before, and 5 days after the initation of therapy. SNPs analysed: c.-15+742C > T, c.-180+2739T > C and c.18C > T. A higher proportion of non-responders to clopidogrel were noted in carriers of 18C > T[T/T] (p = 0.05), and lower prevalence in carriers of 742C > T[T/T] (p = 0.05). Participants with 742C > T[T/T] had significantly higher change in aggregation compared to other 742C > T variants ([C/C] = 20.5 +/- 21.9%; [C/T] = 20.0 +/- 31.2%; [T/T] = 48.6 +/- 21.3%; p = 0.03). Those carrying 18C > T[T/T] had smaller change in aggregation (7.6 +/- 15.0%) compared to other variants, but the difference was not statistically significant (p = 0.15). Analysis of variance showed 18C > T[T/T] was a statistically significant predictor of poor response to antiaggregation therapy, independent from other clinical and demographic variables. There was no relation between poor response to clopidogrel and any other genetic variant. Our results suggest that 18C > T SNP of the P2RY12 gene may be an independent predictor of pharmacological response to clopidogrel. Larger prospective studies are needed to confirm this link and assess its possible clinical consequences.

[Isolated central nervous system relapse of diffuse large B-cell lymphoma in the era of immunochemotherapy]. / Izolirani relaps difuznog B-limfoma velikih stanica u CNS u eri imunokemoterapije.

Diffuse large B-cell lymphoma (DLBCL) is the most common histologic subtype of non-Hodgkin's lymphoma. Standard chemotherapy is CHOP regimen (cyclophosphamide, doxorubicin, vincristine and prednisone). Addition of rituximab to standard chemotherapy regimen significantly increased the success of treatment and overall survival in DLBCL patients. The incidence of isolated relapse of lymphoma in the central nervous system (CNS) occurs in 1.2% to 10.4% of patients, and the outcome is almost always fatal. In this paper, we report the clinical course in a patient with advanced large B-cell lymphoma, who had been treated with immunochemotherapy but developed isolated CNS relapse of lymphoma shortly after achieving complete remission. There is still no consensus regarding the administration of prophylaxis for CNS relapse of lymphoma in patients with DLBCL, hence the question when and how to conduct the prophylaxis remains unresolved. The risk of CNS relapse of lymphoma in young patients with a low risk of death is decreased and it is classified as score 0 and 1 according to the International Prognostic Index (IPI), while the risk is increased in patients with score 2 to 5 according to the same classification. The risk of CNS relapse of lymphoma is increased if the disease is found in the head, neck, bone marrow or testicle. According to the results of some studies, the addition of rituximab to standard chemotherapy as well as intrathecal methotrexate CNS prophylaxis or prophylactic head irradiation do not reduce the risk of relapse of lymphoma in the CNS. Some studies suggest that high-dose intravenous methotrexate may help reduce the risk of CNS relapse in high-risk patients, but it needs to be confirmed in future researches.

[Thirty years experience of treatment with peritoneal dialysis in University Hospital "Sveti Duh"]. / 30-godisnje iskustvo lijecenja peritonejskom dijalizom u KB Sveti Duh.

Peritoneal dialysis (PD) is a treatment for patients with severe chronic kidney disease (CKD) which uses the patient's peritoneum as a membrane across which fluids and dissolved substances are exchanged from the blood. Implementation of this method begun in the seventies, with approximately 7000 patients treated in the year 1981. That same year, we started using this method in our center and to date we have a total of 167 patients. Years of experience and improvement of the technique made this method equivalent to hemodialysis and often even a first method of choice when treating patients with CKD. Data from all patients treated in our center were prospectively collected from year 1981 to 2010. A total of 167 patients (83 women and 84 men) between the ages 28 and 79 (median of 59) were treated by this method. The number of patients enrolled in the program of PD decreased from 64 in the first 10 year period (1981-1990) to 40 in the last 10 year period (2001-2010). 30-year average of PD treatment was 34 months (range from 1 to 110 months). Average duration of treatment per patient increased during the years up to 42 months per patient. The most common reason for termination of PD treatment was fatal outcome (48%), failure of peritoneal membrane (35%) and kidney transplantation (2.4%). Overall rate of peritonitis during the observed peritonitis was 1 every 15 months of treatment. Comparing the rates of peritonitis between the first and the last ten year period, a significant decrease from 1 every 10 months to 1 every 39 months was observed. Overall share of patients with diabetes was 19%. The total number of diabetic patients increased during years according to the increasing rates of diabetic patients worldwide. The decrease in number of patients enrolled in the program in our center is probably due to further development of transplantation program and opening of new dialysis centers in Croatia. The decrease of the peritonitis rate and consequent increase of duration of PD treatment per patient is explained by the improvement of techniques, solutions and better education of the patients and medical staff. 30 years of existence the Centre enabled us to gain experience in treating patients with CKD. Along with experience came the improvement of quality of life of our patients. Our goal is to further develop PD as it is the method of choice in terms of better physical and psychical rehabilitation of the patient with CKD waiting for the transplantation treatment.

Secondary hypertension due to isolated interrupted aortic arch in a 60-year-old person--one-year follow up.

Interrupted aortic arch (IAA) is a congenital defect characterized by loss of luminal continuity between the ascending and descending aorta1. It is a rare malformation with an estimated incidence of perinatally diagnosed cases of 3 per million live births3. The condition is considered extremely rare in adults. However, its true prevalence in this population is unknown. We have found 30 case reports of IAA in adults in literature, 5 of whom were older than 50 years. Four of them had type A IAA. Arterial hypertension is a typical co-morbidity. In this report we describe a 60-year-old male patient who had a type A asymptomatic IAA. Although we initially suspected the aortic coarctation, further invasive procedures revealed complete interruption of the aortic arch just distal to the origin of the left subclavian artery. The patient underwent surgical repair, followed by full recovery and near-normalization of blood pressure.