Introduction: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a common cause of hospitalization, while the empirical use of antibiotics increases the need for reliable biomarkers. The aim of this study was to evaluate the diagnostic and prognostic value of procalcitonin (PCT) and C-reactive protein (CRP) in bacterial exacerbations. Methods: This retrospective study included 50 patients hospitalized due to AECOPD during the period from August to December 2025. PCT and CRP levels, as well as clinical outcomes including the need for mechanical ventilation and mortality, were analyzed. Results: Bacterial etiology was confirmed in 82% of patients, with significantly higher PCT and CRP levels (p < 0.001). PCT ≥ 0.25 ng/mL was associated with a greater need for NIV (35.3% vs. 6.1%; p = 0.013) and a trend toward higher mortality. ROC analysis demonstrated better prognostic value of PCT for in-hospital mortality (AUC 0.80) compared to CRP (AUC 0.75). Discussion: PCT and CRP play an important role in the triage of patients with AECOPD. CRP demonstrates good sensitivity, whereas PCT is a more specific marker of bacterial infection and a more accurate prognostic indicator. Conclusion: Procalcitonin and CRP are useful biomarkers in the evaluation of AECOPD, with PCT showing greater specificity and better prognostic value.

Background:  Tuberculosis (TB) poses a substantial risk as an opportunistic infection in individuals who have received solid organ transplants, particularly in those with liver transplants compounded by inflammatory bowel disease. Managing TB in this group is particularly challenging due to possible drug interactions and the heightened risk of liver toxicity. Case study: We present a 35-year-old male liver transplant recipient with Crohn’s disease, who developed pulmonary TB despite prior prophylaxis and immunosuppression. The first anti-TB treatment was modified and dose-reduced due to the patient's immunocompromised status. This regimen failed, with recurrent positive sputum cultures. Upon retreatment with a full-dose triple regimen excluding pyrazinamide, the patient responded well with full recovery and no adverse hepatic or Crohn’s-related events. Conclusion: This case illustrates the challenges of treating TB in liver transplant patients with Crohn’s disease, emphasizing the delicate balance between achieving therapeutic effectiveness and minimizing hepatotoxicity. In carefully selected patients, administering a complete tuberculosis treatment protocol without pyrazinamide can provide a safe and effective therapeutic outcome.

Introduction: The mechanisms of pulmonary embolism in patients with metabolic syndrome has not been fully investigated. The aim of the study was to determine the connection between metabolic syndrome and pulmonary embolism and to evaluate the values of the glucolipid profile in patients with pulmonary embolism in metabolic syndrome. Methods: A cohort study included 305 patients with pulmonary embolism, divided into two groups: the first group with metabolic syndrome (n=165) and the control group without metabolic syndrome (n=140). The data was collected from May 2019 to May 2023. Demographic, anthropometric and laboratory parameters (glucose, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides) were analyzed in all patients with confirmed pulmonary embolism. Results: Patients with pulmonary embolism in metabolic syndrome had statistically significantly higher values of glucose, total cholesterol, LDL cholesterol, triglycerides and lower values of HDL cholesterol compared to patients with pulmonary embolism without metabolic syndrome (p<0.05). Discussion: The results of our research indicate a strong need for a broad evaluation of metabolic abnormalities with special highlight on comorbidities and the need for a multidisciplinary approach to patients with metabolic syndrome. Assessing the risk of pulmonary embolism should become imperative in the treatment of patients with metabolic syndrome. Conclusion: Metabolic syndrome may play a key role in the pathogenesis of pulmonary embolism and may be a link between venous thrombosis, atherosclerosis and pulmonary embolism. Due to the complex relationship between hyperglycemia, dyslipidemia and pulmonary embolism, additional research is necessary to answer the question why people with metabolic syndrome have a higher risk of pulmonary embolism, as well as to determine appropriate preventive strategies.

Aim To investigate the association between type 2 diabetes mellitus (T2DM) and pulmonary embolism, as well as to determine the prognostic value of troponin, D-dimer, prothrombotic, and proinflammatory markers in patients with T2DM. Methods The retrospective cohort study included 305 patients with pulmonary embolism, divided into two groups: the first group with type 2 diabetes mellitus (n=165) and the control group without type 2 diabetes mellitus (n=140). Data were collected from May 2018 to May 2023. In all patients the following parameters were analysed: anthropometric parameters, laboratory parameters (troponin, D-dimer, CRP, fibrinogen, uric acid, glucose, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides), arterial blood pressure, antiphospholipid antibodies, HOMA-IR index, CT angiography of the pulmonary artery, rate of adverse clinical events in pulmonary embolism (need for inotropic catecholamine support, fibrinolysis, cardiopulmonary resuscitation) and the rate of intrahospital mortality from pulmonary embolism. Results Patients with T2DM had elevated troponin, D-dimer, CRP, uric acid, fibrinogen, HOMA-IR and more severe clinical complications with higher mortality rates within 10 days of hospital admission. Significant predictors of PE in T2DM patients were found. Patients with pulmonary embolism in T2DM had a 4.38 times higher chance of death compared to patients with pulmonary embolism without T2DM. Conclusions Troponin, D-dimer, prothrombotic, and proinflammatory markers have good prognostic value for short-term outcomes in PE among patients with T2DM.

The objective of this paper was to present basic clinical characteristics and outcomes of treating Covid 19 patients during the second wave of the pandemic. In the retrospective study for the period from September 2020 to February 2021 it was analyzed disease history data and radiological lung changes, time from the initial start of the disease until hospitalization, parameters of blood gas analysis, comorbidities, and the outcome. The research covered 409 patients, out of which 263 (64.3%) were males. Average age was 67.07± 12.44 years (min. 20; max. 93). A high comorbidities prevalence (82.9%) was noticed out of which arterial hypertension (69.2%), diabetes mellitus (37.7%) and obesity (24.7%). On the radiological lung scan the most noticed changes were consolidation (46.2%), “ground glass” (41.3%) and interstitial changes (13%). Bilateral lung infiltration was noticed in 91.9% of the patients. Average oxygen saturation was 84.29%±10.28% (min. 35; max. 98; med. 87%). In patients with unilateral lung infiltration, average oxygen saturation was 85.09%±8.60% (med. 89%, min.61% max 98%), while in patients with bilateral lung infiltration average was 84.22%±10.42% (med. 87%, min. 35%, max. 98%). From the total all patients’ death was noticed in 35.7% cases. Morbidity of patients with unilateral lung infiltration was 27.3% and in patients with unilateral infiltration 36.4%. Hospital admission in the first week of the disease indicates the severity of the clinical condition and can be a predictor of poor outcome. Bilateral pulmonary infiltration, obesity and diabetes mellitus are risk factors for high mortality.

Background: The association between diabetes mellitus type 2 (T2DM) and pulmonary embolism (PE) is still unclear. Objective: The aim of this study was to determine the prognostic value of prothrombotic, proinflammatory markers, and troponin for pulmonary embolism and its complications in patients with type 2 diabetes mellitus. Methods: The retrospective cohort study included 294 patients with type 2 diabetes mellitus divided into two groups: (a) the first group with pulmonary embolism (n=165); (b) the control group without pulmonary embolism (n=129). The data were collected from May 2018 to May 2023. In all patients we analyzed: anthropometric parameters, laboratory parameters (troponin, D-dimer, CRP, fibrinogen, uric acid, glucose, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides), arterial blood pressure, antiphospholipid antibodies, HOMA-IR index, CT angiography of the pulmonary artery, rate of adverse clinical events in pulmonary embolism (need for inotropic catecholamine support, fibrinolysis, cardiopulmonary resuscitation) and rate of intrahospital mortality from pulmonary embolism. Results: Troponin levels were significantly higher in the PE group compared to the non-PE group (p = 0.002). D-dimer, CRP, uric acid, fibrinogen and HOMA- IR were significantly elevated in the PE group compared to the non-PE group (p < 0.001). Patients with pulmonary embolism in T2DM proved to have significantly more in-hospital death within 10 days of hospital admission (p<0.001), compared to patients with T2DM, without pulmonary embolism. Conclusion : Prothrombotic, proinflammatory markers, and troponin have good prognostic value for short-term outcomes in PE among patients with T2DM.

Srcanu insuficijenciju (SI) definira se kao sindrom koji se manifestira nemogucnoscu srca da primi ili istisne krv zbog strukturnih ili funkcionalnih srcanih ostecenja (1). Najvažnije klinicke manifestacije sindroma srcane insuficijencije su gusenje s tipicnim nedostatkom zraka ili zamorom (u mirovanju ili prilikom napora) i otok gležnjeva. Dijagnoza srcane insuficijencije se postavlja na osnovi simptoma, klinickih znakova i dodatnih dijagnostickih postupaka. Klinicka sumnja na postojanje srcane insuficijencije mora biti potvrđena određenim ispitivanjima koja se posebno odnose na procjenu srcane funkcije (2). Za dijagnozu srcane insuficijencije koriste se i Framinghamski kriteriji. Da bi se postavila dijagnoza SI na osnovi tih kriterija, neophodno je postojanje najmanje jednog velikog i dvaju malih kriterija (3). Nakon postavljene dijagnoze SI važna je i procjena težine klinicke slike. Simptomi bolesti mogu biti koristeni za klasifikaciju težine srcane insuficijencije i poslužiti kao pokazatelji ucinka terapije. Danas se u svrhu klasifikacije SI koristi revidirana klasifikacija NYHA (New York Heart Association).

Acute pancreatitis is a rare but life-threatening complication in patients with transplanted kidney. The incidence of acute pancreatitis after kidney transplantation ranges from 2% to 7%, with mortality rate between 50 and 100%. We report a case of a female patient aged 46 years, developing an interstitial acute pancreatitis 8 years following a renal transplantation. The specific aethiological factor was not clearly established, although possibility of biliary pancreatitis with spontaneous stone elimination and/or medication-induced pancreatitis remains the strongest. Every patient after renal transplantation with an acute onset of abdominal pain should be promptly evaluated for presence of pancreatitis with a careful application of the most appropriate diagnostic procedure for each individual patient.

razinu stresa na radnom mjestu, liječnici su u opasnosti od pojave sindroma izgaranja na radu. Ovim istraživanjem identificirali smo prediktore sindroma izgaranja iz područja organizacije rada u bolničkih liječnika. Provedena je presječna studija koja je obuhvatila 250 bolničkih liječnika zaposlenih u Univerzitetsko-kliničkom centru u Tuzli. Od ukupno 250, njih 160 (64%) je pristalo na sudjelovanje, a 13 (5%) je dostavilo nepotpune podatke u anketama. Konačan broj ispitanika bio je 147 liječnika, dobi 41.24 ± 8.97(SD) godina (58% žena). Za evaluaciju stresora radnog mjesta upotrijebljen je „upitnik o stresorima na radnom mjestu bolničkih zdravstvenih djelatnika“ koji je kreiran u Školi narodnog zdravlja “Andrija Štampar” u Zagrebu, a za procjenu sindroma izgaranja korišten je „Maslach Burnout Inventory“MBI, preveden na naš jezik. Ova studija pokazala je visoku razinu stresora iz područja loše organizacije rada. Među bolničkim liječnicima zabilježena je visoka razina emocionalne iscrpljenosti (37%), visoka razina depersonalizacije (46%) i niska razina percepcije osobnog dostignuća (50%), a koji se odnose na prisutnost sindroma izgaranja na radu. Glavni prediktor sve tri dimenzije sindroma izgaranja bio je preopterećenost poslom. Dobrom organizacijom posla, kao i kontinuiranim preventivnim intervencijama moglo bi se utjecati na sprečavanje ne samo sindroma izgaranja nego i na pojavu kroničnih obolijevanja liječnika, povezanih sa stresom na radu.