Browsing by Author "Stjepanovic, Mihailo I. (55052044500)"

Adult Langerhans Cell Histiocytosis (LCH) is a quite rare and tobacco smoking related disease. We report on a case of pulmonary LCH, diagnosed at the Teaching Hospital of Lung Disease, Clinical Centre of Serbia in Belgrade. On admission, a 45-year-old mechanician, smoker (30 pack/years) had severe dyspnea, fatigue and massive pretibial/ ankle oedema due to right-heart failure. Since the age of 19 years, he suffered from recurrent pneumothorax, and the first radiographic changes (bilateral micronodular shadows) were present at the age of 39 together with obstructive disturbance of ventilation and respiratory failure. At the patient's age of 40 years, open lung biopsy led to diagnosis of LCH. Investigation was completed with computed tomography scans, hemodynamic investigation (heart catheterization and pneumoangiography), echocardiography, skeletal scintigraphy, and additional lung function testing. Treatment included methylprednisolon, sildenafil, and diuretics. The patient is being followed up and severe pulmonary arterial hypertension is usually considered a poor prognosis.

Background: Immune dysregulation and associated inefficient anti-viral immunity during Coronavirus Disease 2019 (COVID-19) can cause tissue and organ damage which shares many similarities with pathogenetic processes in systemic autoimmune diseases. In this study, we investigate wide range autoimmune and immunoserological markers in hospitalized patients with COVID-19. Methods: Study included 51 patients with confirmed Severe Acute Respiratory Syndrome Coronavirus 2 infection and hospitalized due to COVID-19 pneumonia. Wide spectrum autoantibodies associated with different autoimmune inflammatory rheumatic diseases were analyzed and correlated with clinical and laboratory features and pneumonia severity. Results: Antinuclear antibodies (ANA) positivity was found in 19.6%, anti-cardiolipin IgG antibodies (aCL IgG) in 15.7%, and anti-cardiolipin IgM antibodies (aCL IgM) in 7.8% of patients. Positive atypical x anti-neutrophil cytoplasmic antibodies (xANCA) were detected in 10.0% (all negative for Proteinase 3 and Myeloperoxidase) and rheumatoid factor was found in 8.2% of patients. None of tested autoantibodies were associated with disease or pneumonia severity, except for aCL IgG being significantly associated with higher pneumonia severity index (p = 0.036). Patients with reduced total serum IgG were more likely to require non-invasive mechanical ventilation (NIMV) (p < 0.0001). Serum concentrations of IgG (p = 0.003) and IgA (p = 0.032) were significantly lower in this group of patients. Higher total serum IgA (p = 0.009) was associated with mortality, with no difference in serum IgG (p = 0.115) or IgM (p = 0.175). Lethal outcome was associated with lower complement C4 (p = 0.013), while there was no difference in complement C3 concentration (p = 0.135). Conclusion: Increased autoimmune responses are present in moderate and severe COVID-19. Severe pneumonia is associated with the presence of aCL IgG, suggesting their role in disease pathogenesis. Evaluation of serum immunoglobulins and complement concentration could help assess the risk of non-invasive mechanical ventilation NIMV and poor outcome. Copyright © 2022 Stjepanovic, Stojanovic, Stankovic, Cvejic, Dimic-Janjic, Popevic, Buha, Belic, Djurdjevic, Stjepanovic, Jovanovic, Stojkovic-Laloševic, Soldatovic, Bonaci-Nikolic and Miskovic.

Introduction: Acute eosinophilic pneumonia (AEP) is idiopathic disease characterized by acute febrile illness, progressive respiratory failure, diffuse pulmonary infiltrates, and pulmonary eosinophilia. The aetiology of AEP is unknown, although several studies have proposed that cigarette smoke is potentially related to the onset of AEP. Herein is a report of a rare case showing the causal association between short-term period of excessive smoking and AEP Case report: A 25-year-old patient was admitted to the ICU (during on-duty hours) as an emergency case due to acute disease occurred a day prior to hospitalisation. His symptoms were febricity, dry cough, excessive fatigue and general weakness. The patient was a non-smoker who had smoked 30 cigarettes a day prior to the onset of the symptoms. At the time of admission, he was voluntary, but somnolent, orientated, febrile, dyspneic, cyanotic, adynamic, and without peripheral lymphadenopathy. Due to both poor oxygenation and the life-threatening condition, the corticosteroid therapy, in addition to the antibiotic therapy were immediately administered to the patient. The eosinophilia was diagnosed based on control tests, such as Le 22.0x10 9, with dominating eosinophilic leucocytes of 12.59 (0-7% reference value) and neutrophils of 86.26 (44-72% reference range), Se 58mm/h, CRP 115, fibrinogen 6.5, while other parametres ranged within the reference scales. Afterwards, eosinophil chamber count of 2300 was found (<350mm 3 reference value). The specific protein value amounted to IgE 255.0 IU/ml (0-100 reference value). The MSCT of the thorax revealed: pneumonic infiltrates of sub-segment type, including associated pleural thickening, observed in the subhilar and bibasal parts, both sides. Moreover, pleural effusion was observed in a minor incisure on the right and in the upper part of a major incisure on the left. Conclusion: The majority of reported cigarette smoking-induced AEP cases are young adults who were first-time smokers. In light of such reports and considering the increase of early cigarette smoking in young adults, it is important that physicians are aware of the possibility of this potentially life-threatening, but fully reversible disease.

Introduction: Sarcoidosis is a rare multisystem granulomatous disease with unknown etiology. The interplay of vitamin D deficiency and genetic polymorphisms in genes coding for the proteins relevant for metabolism of vitamin D is an important, but unexplored area. The aim of this study was to investigate the association between single nucleotide polymorphisms (SNPs) in CYP2R1 (rs10741657), CYP27B1 (rs10877012), DBP (rs7041; rs4588), and VDR (rs2228570) genes and sarcoidosis, as well as the association between these SNPs and 25(OH)D levels in sarcoidosis patients. Material and methods: For that purpose we genotyped 86 sarcoidosis patients and 50 healthy controls using the PCR-RFLP method. Results: Subjects carrying the CC genotype of CYP27B1 rs10877012 have 10 times lower odds of suffering from sarcoidosis. Moreover, DBP rs4588 AA genotype was shown to be a susceptibility factor, where carriers of this genotype had eight times higher odds for developing sarcoidosis. In addition, the A allele of the DBP gene (rs4588) was associated with lower levels of 25(OH)D in sarcoidosis patients. Conclusions: These results suggest that patients with vitamin D deficiency should be regularly tested for genetic modifiers that are related to sarcoidosis in order to prevent development of serious forms of sarcoidosis. Copyright © 2018 Termedia & Banach

Numerous studies evaluated the influence of inhaled corticosteroids (ICS) on growth and development of asthmatic children. The aim of this study was to estimate the growth in asthmatic children and to examine the influence of continuous administration of ICS within a period of one year on their growth and development in relation to age, gender and the level of asthma control. The study group consisted of 60 boys and 40 girls, aged 7 to 18 years, diagnosed with partly controlled (76 children) and uncontrolled allergic asthma (24 children). Most of children received a moderate ICS doses. Body height increased during the analyzed period, and the increase rate was different depending on the age group. The largest height increase in both genders was seen in patients 7-14 years old and it was statistically significant (p<0.001). In the age over 15 years, in both genders, there were no statistically significant differences in height after three months. Statistical significance existed between start point and the 12th month as well as between 3-12 months (p=0.041 and p=0.031, respectively). Slower growth is explained with a short time difference, having in mind that children of that age are usually growing slower. There was no statistically significant difference in the increase of body height in relation to the level of asthma control. We concluded that prolonged use of the ICS in asthmatic children has a favorable effect on clinical course of disease, while at the same time does not have an adverse effect on children's growth.

Introduction: The most common cause of death in patients with amyotrophic lateral sclerosis (ALS) is respiratory failure, often in the period of 2–5 years, with a small percentage of patients surviving up to 10 years or more. The aim of the study was to evaluate the significance of pulmonary function tests in prediction of mortality and definition of indications for noninvasive mechanical ventilation (NIMV). Material and methods: This retrospective-prospective study was performed at the Clinic of Pulmonology, Clinical Centre of Serbia in the period from January 2015 to December 2017. Patients with diagnosis of ALS established according to El Escorial criteria were included. Results: The study included 76 patients with ALS, 50 (65.85%) with spinal and 26 (34.2%) with bulbar form of disease. Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were higher in spinal form of ALS, and the difference was statistically significant when compared to bulbar form. Form of disease, FVC < 70%, maximum inspiratory pressure (PImax) < 50 and maximum expiratory pressure (PEmax) < 50 were significant factors for survival. The patients with bulbar form of disease had 2.174 (95.0% CI: 1.261–3.747) higher risk for death. Conclusions: Our study points to the significance of timely application and early start of NIMV in patients with ALS as an important approach to defer functional impairment, which would mean that the criteria, in our country, for application of these devices must be changed, not only regarding the value of current functional diagnostic tests used in everyday practice in patients with ALS but also in regard to the introduction of new diagnostic tests, such as sniff nasal inspiratory pressure and/or polysomnographic testing. Copyright © 2019 Termedia & Banach.