Sarcoidosis significantly reduces patients' health status, both independently and also due to increased BMI. Reduction in BMI may contribute to improved spirometry results and health status of patients with sarcoidosis.

In Serbia there is a high prevalence of respiratory symptoms, asthma and chronic bronchitis smoking addiction.

Summary: Recently published data indicate that vitamin D abnormalities are common in sarcoidosis patients. The purpose of this study was to compare serum vitamin 25(OH)D levels among sarcoidosis patients with different clinical courses of the disease. The study also included the first observations on cognitive functions (i.e. depression and fatigue syndrome) in relation to vitamin D deficiency in sarcoidosis patients. At the Biochemical Laboratory of the Clinical Center of Serbia, Belgrade, vitamin D25(OH)D was measured using the Elecsys ® Vitamin D total test. A total of 226 patients with biopsy-positive sarcoidosis were analyzed. The average median value of serum vitamin D was 9.47 mg/L, suggesting severe deficiency. Statistically significant correlation was found in patients with chronic disease and low levels of serum vitamin 25(OH)D (Chi-Square=6.044; df=2; p=0.014). The patient group with vitamin D serum levels higher than 20 mg/L showed higher levels of the mean forced vi tal capacity (FVC) by 380 mL, and forced expiratory volume in one second (FEV1) by 220 mL, when compared to the patient group with lower serum vitamin D. A statistically significant role was established for serum vitamin 25(OH)D levels as the predictor of fatigue (R 2 =0.878; p=0.038 (b=0.216)) and depression in patients with sarcoidosis (R 2 =0.80; p=0.000 (b=0.391)). The insufficiency of 25(OH)D seems to be an important factor in predicting the course of chronic disease, significant lung function impairments and cognitive failures such as fatigue and depression. The fact that the majo rity of the analyzed sarcoidosis patients had totally deficient serum 25(OH)D levels made this finding even more notable. Keywords: vitamin D, deficiency, sarcoidosisKratak sadr`aj: Nedavno objavljena istra`ivanja kod obole lih od sarkoidoze govore o ~estim abnormalnim vrednostima vitamina D. Cilj ove studije bio je da se uporedi nivo vita mina 25(OH)D kod obolelih od sarkoidoze sa razli~itim klini~kim tokom bolesti. Tako|e, ova studija predstavlja prva za pa `anja o vezi izme|u kognitivnih funkcija (odnosno ose}a ja depresije i zamora) i deficita vitamina D kod obolelih od sarko idoze. U Biohemijskoj laboratoriji Klini~kog centra Srbije vitamin D -25(OH)D meren je kori{}enjem testa Elec sys ® Vitamin D. Analizirano je 226 bolesnika sa sarkoidozom potvr|enom biopsijom. Prose~na srednja vrednost vitamina D u serumu bila je 9,47 mg/L, {to ukazuje na ozbiljan nedostatak. Statisti~ki zna~ajna korelacija na |e na je kod pa cije nata sa hroni~nom formom bolesti i niskim nivoom vitamina 25(OH)D u serumu (Xi-kvad rat=6,044; df=2; p=0,014). Grupa pacijenata sa nivoom vitamina D u serumu ve}im od 20 mg/L pokazuje ve}i nivo srednjeg for siranog vitalnog kapaciteta (FVC) za 380 mL i forsiranog ekspi ratornog volumena u prvoj sekundi (FEV1) za 220 mL u od nosu na grupu pacijenata sa ni`im nivoom D vitamina. Utvr|eno je da nivo vitamina 25(OH)D u serumu ima stati sti~ki zna~ajnu ulogu kao prediktor zamora i depresije kod obolelih od sarkoidoze. Insuficijencija 25(OH)D ...

Subacute invasive pulmonary aspergillosis (IPA) represents a form of chronic pulmonary aspergillosis which affects immunocompetent individuals or mildly immunocompromised persons with underlying pulmonary disease. Pneumothorax can be a rare complication of subacute IPA due to a leakage of air from an air-filled lung cavitation into the pleural space. Herein, we report rare and unusual case of pneumothorax in a patient with pulmonary cavity infection. A 40-year-old woman was admitted to thoracic surgery due to complete pneumothorax of the left lung. She was active smoker with untreated chronic obstructive pulmonary disease (COPD). After thoracic drainage multiple cavity forms in the both lungs were noticed. Galactomannan antigen was positive in bronchoalveolar lavage as well as culture of Aspergillus fumigatus. Antifungal treatment by voriconazole was started and continued during 6 months with a favorable outcome. This case highlights that subacute IPA is a diagnose that should be considered in patients with end-stage COPD, low body mass index, or patient who developed pneumothorax. The results of our case show that voriconazole is a safe and effective treatment as primary or salvage therapy in subacute forms of IPA, irrespective of the immunological status of the patients.

SummaryBackgroundAn increased homocysteine (Hcy) concentration may represent a metabolic marker of folate and vitamin B12 deficiency, both significant public health problems. For different reasons, patients with chronic obstructive pulmonary disease (COPD) are prone to these deficiencies. The study evaluates the reliability of Hcy concentration in predicting folate or vitamin B12 deficiency in these patients.MethodsA group of 50 COPD patients (28 males/22 females, age (χ̄±SD=49.0±14.5) years was enrolled. A chemiluminescent microparticle immunoassay was applied for homocysteine, folate and vitamin B12 concentration. Kolmogorov-Smirnov, Mann-Whitney U and χ2 tests, Spearman’s correlation and ROC analysis were included in the statistical analysis, with the level of significance set at 0.05.ResultsAverage (SD) concentrations of folate and vitamin B12 were 4.13 (2.16) μg/L and 463.6 (271.0) ng/L, whereas only vitamin B12 correlated with the Hcy level (P=−0.310 (R=0.029)). Gender related differences were not significant and only a borderline significant correlation between age and folate was confirmed (R=0.279 (P=0.047)). The incidence of folate and vitamin B12 deficiency differed significantly (P=0.000 and P<0.000 for folate and vitamin B12 respectively), depending on the cutoff used for classification (4.4, 6.6 and 8.0 μg/L – folate; 203 and 473 ng/L – vitamin B12). ROC analyses failed to show any significance of hyperhomocysteinemia as a predictor of folate or vitamin B12 deficiency.ConclusionReliability of the Hcy concentration as a biomarker of folate or vitamin B12 depletion in COPD patients is not satisfactory, so their deficiency cannot be predicted by the occurrence of HHcy.