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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.

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<0.01); lower lung lobe in 14.5% diabetic, and in 4.5% non-diabetic patients (p<0.05). Chest radiography TB infiltrate regression is achieved in 98.9% TB patients without DM compared to diabetic patients (87.5%) (p<0.05). The difference in the average number of days needed for partial radiological regression after the onset of antituberculous treatment is statistically high significant (p<0.001) between two examined groups (57.75 days in diabetic patients and 33.68 days in non-diabetic group). Conclusions: PTB in diabetic patients is more likely to present with atypical radiological images and radiological TB infiltrate regression is prolonged in diabetic patients.