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.

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.

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.

Background: The association of pulmonary tuberculosis (PTB) and diabetes mellitus (DM) is very common. Objectives: to find out whether there is a difference in clinical presentation and treatment outcomes of diagnosed PTB in diabetic patients comparing to PTB patients without diabetes mellitus. Methods: Clinical symptoms, radiographic appearance of extensive forms of PTB as well as treatment outcomes of pulmonary tuberculosis were reviewed in 97 diabetic patients and compared to 97 patients affected only by PTB. Results: Cough was the most common symptom in both groups, but with significant difference in the favour of diabetic patients (p Conclusions: More severe clinical presentation and lower TB treatment cure rate were registered in diabetic patients comparing to non-diabetics.

The r enal damage is an emerging complication of excess weight.  Aim of this study was to determine the occurrence of chronic kidney disease (CKD) in subjects depending on their weight and the influence of body mass index (BMI) on glomerular filtration (GF) rate decline in outpatients with hypertension and/or diabetes mellitus type 2. Methods: This observational, cross sectional, pilot study included 200 adult patients suffering from hypertension and/or diabetes mellitus type 2 from March 2012. to March 2013. in the Institute for Occupational Medicine of Canton Sarajevo. Renal function was evaluated by using MDRD equation and measurement of microalbuminuria and proteinuria in 24 - hour urine, using nefelometric method at the Institute of Clinical Biochemistry of the University Clinical Center in Sarajevo K/DOQI classification  was used to define the stages of CKD. Results: Of the total 200 patients (62.5% male; mean age of 52.46 ± 8.2 years) most of them had a BMI of 25 - 30 (n=99; 49.5%). Most patients with a body mass index above 30 suffered from hypertension associated with diabetes mellitus type 2 (n=23; 34.3%,  p<0.05). The average values of BMI were statistically higher in men than in women (29.16±4.4 vs. 27.76±3.7). Early CKD was found in 118 patients (59.0%), mostly those with a BMI above 30 (63.8%). Conclusion: Early detection of CKD in primary care should definitely be a priority, especially in high - risk patients. It is also necessary to increase work on the prevention of obesity in order to prevent disease progression.

Background: Prevalence of pulmonary tuberculosis (PTB) is rather high in diabetic patients. Objectives: to find out whether there is a difference in clinical presentation of PTB in diabetic patients comparing to non-diabetic patients affected by PTB. Methods: The study comprised 194 TB patients divided in two groups, i.e. diabetic patients with established diagnosis of PTB, and the patients affected only by PTB. Clinical symptoms of both groups were reviewed and compared in the time of establishing PTB diagnosis. The frequency of new and relapse pulmonary TB, cavitary and ulcerous PTB were observed. Results: Women are more commonly affected by PTB than men in the diabetic group (p<0.05). Cough was more common in diabetic patients (95.9%) affected by PTB than non-diabetic patients (77.3%), hemoptysis in 29.9% diabetic patients and 13.4% without diabetes. Fever (p<0.001), shortness of breath (p<0.001), chest pain (p<0.0001) and night sweat (p<0.001) were more common in diabetic patients than non-diabetics. The cavitary (p<0.05) and ulcerous PTB (p<0.05) were also more common in diabetic patients. There was no significant difference in new and relapse PTB between two groups. Conclusions: PTB in diabetic patients is more likely to present with more severe clinical presentation, i. e. significantly more symptoms, as well as more cavitary and ulcerous TB lesions. Key words: clinical features, pulmonary tuberculosis, diabetes mellitus.

Background: The association of pulmonary tuberculosis (PTB) and diabetes mellitus (DM) is very common. Aims and objectives: To find out whether there is difference in presentation of radiological images of PTB in diabetic patients comparing to non-diabetic patients affected by PTB. Methods: We screened 97 diabetic patients with established diagnosis of PTB and 97 patients affected by PTB without diabetes mellitus. Chest radiography of both groups were reviewed and compared in the time of establishing PTB diagnosis. Then a partial tuberculous (TB) infiltrate regression on chest radiography after the antituberculous treatment initiation, defined as obvious reducing of infiltrate size, was observed. The time of radiological regression was estimated as the number of days needed for partial radiological regression. Results: On the chest radiography upper lung lobe is involved by TB lesions in 42.2% diabetic and 62.5% non-diabetic patients (p Conclusions: PTB in diabetic patients is more likely to present with atypical radiological images and radiological TB infiltrate regression is prolonged in diabetic patients.

SETTING Emergency rooms. OBJECTIVE To assess quality of care and its determinants for asthma patients before emergency room treatment. DESIGN Consecutive patients with acute severe asthma attending emergency rooms were questioned about the severity of their disease and treatment in the previous 4 weeks. Prescriptions of inhaled corticosteroids were recorded. Other outcomes included self-reported adherence to treatment and loss of work. RESULTS Thirteen centres in 11 countries recruited 1156 patients. Only 36% of patients with persistent asthma had been prescribed an adequate dose of inhaled corticosteroids. This percentage improved in those receiving regular care from the same doctor (OR 2.86, 95%CI 1.38-5.96), and was at least as good for the 10% of patients receiving 'private' health care (OR 3.08, 95%CI 1.69-5.62). Forty-four per cent of patients had health insurance covering some asthma medications. These patients were more likely to be receiving adequate inhaled corticosteroids (OR 1.74, 95%CI 1.17-2.58), and reported better adherence than those without insurance (OR 3.00, 95%CI 1.64-5.50). Of those on adequate inhaled corticosteroids, 18% had lost work in each of the 4 previous weeks compared with 59% among those more than one treatment step below the recommended dose. CONCLUSIONS Access to adequate treatment is critical for better management of asthma.