Ovaj rad istražuje faktore i odrednice upravljanja rizikom alternativnih investicija. Alternativne investicije imaju velik i rastuci ulagacki potencijal u današnjem okruženju, što predstavlja važna ...istraživacka pitanja. Motivi ulaganja u alternativne fondove su ponajprije vezani uz vece stope povrata od drugih kategorija ulaganja kao i zbog diversifi kacije ulaganja. Integracija alternativnih fondova u fi nancijskom sustavu je važna u znanstvenom i aplikativnom smislu. U radu se razraduju bitne odrednice rizika kod alternativnih fondova te mogucnosti za upravljanje tim rizicima. Analiza je obuhvatila važne pokazatelje rizika i njegova potencijala u kategorijama alternativnih investicija. Izloženo u radu daje poseban doprinos u nedovoljno poznatom i istraženom porucuju alternativnih investicija, posebno u kontekstu fi nancijskih tržišta u razvoju. Alternativne investicije u razvijenim fi nancijskim tržištima postaju standardom, što implicira potrebu za vecim poznavanjem bitnih odrednica rizika koje su podložne promjenama u suvremenom ekonomskom okruženju.
Background and Objectives: Treatment of advanced lung cancer (LC) has become increasingly personalized over the past decade due to an improved understanding of tumor molecular biology and antitumor ...immunity. The main task of a pulmonologist oncologist is to establish a tumor diagnosis and, ideally, to confirm the stage of the disease with the least invasive technique possible. Materials and Methods: The paper will summarize published reviews and original papers, as well as published clinical studies and case reports, which studied the role and compared the methods of invasive pulmonology diagnostics to obtain adequate tumor tissue samples for molecular analysis, thereby determining the most effective molecular treatments. Results: Bronchoscopy is often recommended as the initial diagnostic procedure for LC. If the tumor is endoscopically visible, the biopsy sample is susceptible to molecular testing, the same as tumor tissue samples obtained from surgical resection and mediastinoscopy. The use of new sampling methods, such as cryobiopsy for peripheral tumor lesions or cytoblock obtained by ultrasound-guided transbronchial needle aspiration (TBNA), enables obtaining adequate small biopsies and cytological samples for molecular testing, which have until recently been considered unsuitable for this type of analysis. During LC patients’ treatment, resistance occurs due to changes in the mutational tumor status or pathohistological tumor type. Therefore, the repeated taking of liquid biopsies for molecular analysis or rebiopsy of tumor tissue for new pathohistological and molecular profiling has recently been mandated. Conclusions: In thoracic oncology, preference should be given to the least invasive diagnostic procedure providing a sample for histology rather than for cytology. However, there is increasing evidence that, when properly processed, cytology samples can be sufficient for both the cancer diagnosis and molecular analyses. A good knowledge of diagnostic procedures is essential for LC diagnosing and treatment in the personalized therapy era.
Introduction. Lymphangioleiomyomatosis and pulmonary Langerhans cell histiocytosis are the most common pulmonary cystic diseases. Although they differ in pathogenesis, they share several features. ...The aim of this paper is to present the similarities and differences between these diseases, as well as to describe two cases from our practice. Outlines of cases. The patient with lymphangioleiomyomatosis (43 years old) had pulmonary changes detected during a regular examination within the underlying disease ? tuberous sclerosis. Four years after starting therapy with everolimus, she was still respiratory asymptomatic, a slight radiological deterioration of cystic changes was registered, the diffusion capacity was declining (by 12%). The second patient (23 years old) was admitted due to bilateral radiological lung changes and symptoms in the form of dry cough, quick fatigue, and chest pain. Pathohistological examination of the transbronchial biopsy showed numerous large-core histiocytes, immunohistochemically positive for CD1a and S100, so it was concluded that it was Langerhans cell histiocytosis. Cessation of smoking was advised. The follow-up examinations showed withdrawal of symptoms and an orderly finding of lung function, chest high-resolution computed tomography indicated slight regression of changes. In the meantime, the patient gave birth to a healthy child, the pregnancy and prenatal period were uneventful. Conclusion. These diseases are extremely rare and in cooperation with other specialties should be distinguished from diseases that mimic lung cysts.
Background and Objectives: Inadequate treatment of asthma and chronic obstructive pulmonary disease (COPD) might have a negative impact on their progression. Inhalation therapy is the cornerstone of ...pharmacotherapy for these conditions. However, challenges such as low adherence, negative attitudes, and misconceptions about inhaled medications still persist, impeding effective disease management. This study aimed to evaluate adherence, ascertain the level of disease control in asthma and COPD, explore potential misconceptions surrounding inhalation therapy among patients with obstructive lung diseases and the general population in Vojvodina, and evaluate the reliability of newly developed questionnaires employed in the study. Materials and Methods: This cross-sectional study utilized a battery of questionnaires encompassing sociodemographic data, the Asthma Control Test (ACT), the COPD Assessment Test (CAT), along with two novel questionnaires—one for assessing adherence and another for analyzing attitudes toward inhalation therapy. Statistical analyses were conducted using SPSS software, version 25.0. Results: The average ACT score among patients with asthma was 17.31, while it was 19.09 for the CAT questionnaire among COPD patients. The composite score on the newly developed adherence assessment questionnaire was 2.27, exhibiting a reliability coefficient lower than recommended (α = 0.468). Significant statistical differences emerged among sample subgroups regarding attitudes and misconceptions toward inhalation therapy. The reliability coefficient for this questionnaire was deemed satisfactory (α = 0.767). Conclusions: Adherence rates were notably suboptimal in both subgroups of the studied population. The disease control levels were higher among asthma patients, while they exhibited less prevalent misconceptions regarding inhalation therapy compared to COPD patients and the healthy population.
In addition to the detrimental health consequences, the early stages of the COVID-19 pandemic have yielded unforeseen benefits in terms of reducing air pollution emissions. This study investigated ...air pollution changes in Novi Sad, Serbia, during the COVID-19 lockdown (March–June 2020) and their correlation with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) hospitalizations. Using quasi-Poisson generalized linear models (GLM) and distributed lag non-linear models (DLNM), we examined the relationship between the number of AECOPD hospitalizations and the concentrations of selected air pollutants (PM10, PM2.5, SO2, and NO2) from March to June of 2019, 2020, and 2021. During the COVID-19 lockdown, significant reductions in most air pollutant concentrations and the number of AECOPD hospitalizations were observed. However, neither the study year nor its interaction with air pollutant concentration significantly predicted AECOPD hospitalizations (p > 0.05). The 95% confidence intervals of the relative risks for the occurrence of AECOPD hospitalizations at each increase in the examined air pollutant by 10 μg/m3 overlapped across years, suggesting consistent effects of air pollution on the risk of AECOPD hospitalizations pre-pandemic and during lockdown. In conclusion, reduced air pollution emissions during the COVID-19 lockdown did not lead to a statistically significant change in the number of AECOPD hospitalizations.
Chronic obstructive pulmonary disease (COPD) is one of the greatest global public health challenges. Acute exacerbations of COPD lead to the accelerated deterioration of lung function, reduced ...quality of life, a higher number of hospitalizations, and increased mortality. The factor causing the exacerbation is usually an infectious agent, but the impact of environmental factors is being studied more thoroughly. Among them, meteorological factors are the least examined. Multiple studies have shown that lower temperatures during the cold season, as well as sudden temperature changes regardless of the season, have the most significant negative effect on patients with COPD. However, higher temperatures, especially during summer heatwaves, can also cause COPD exacerbation and it is expected that this will be an even more important health problem in the future considering climate changes. The effects of other meteorological factors on acute exacerbation of COPD, such as atmospheric pressure, solar radiation, rainfall, wind speed, and humidity are far less investigated and opposing results have been obtained in different studies. Thus, there is a need for further research in this area that would result in clinical recommendations and public health interventions that could decrease the global burden of COPD.
The available data on the impact of air pollution on acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are inconsistent. We investigated the influence of air pollution on the ...number of severe AECOPD hospitalizations of non-infectious etiology in patients residing in Novi Sad, Serbia. In this time-series, we used a quasi-Poisson generalized linear model in conjunction with distributed lag non-linear models, after controlling for lag days, seasonal and long-term trends, and meteorological factors (air temperature and humidity), to estimate the relative risk (RR) of AECOPD hospitalization for each increase of 10 μg/m3 in the air pollutant concentration. A total of 552 AECOPD hospitalizations were registered during 2017–2022. With each 10 μg/m3 increase in the selected air pollutants’ concentration, the cumulative RR (lags0–7) in single-predictor models for AECOPD admission were 1.52 (95% CI 0.98–2.35) for PM10, 1.44 (95% CI 0.93–2.25) for PM2.5, 1.13 (95% CI 0.87–1.47) for SO2, and 0.99 (95% CI 0.69–1.42) for NO2. Similar results were found in multi-predictor models as well as in group analyses between smokers and non-smokers. In conclusion, no significant associations between exposure to air pollutants and the daily AECOPD admissions were found. There is an obvious need for additional research on the topic.
Introduction. Super obese group of patients with body mass index (BMI) ?
50kg/m2 have higher technical intraoperative problems, higher morbidity and
mortality. Indications for the metabolic procedure ...are widening and
minimally invasive operation dictate both patients and surgeons to face with
previously assumed ?general contraindication? for surgical
bariatric/metabolic procedure. Case outline. We present a super obese
patient with restenosis of the trachea, chronic obstructive pulmonary
disease, sleep apnea and cardiomyopathy with panniculus grade IV, in whom as
a multidisciplinary team we did simultaneously permanent tracheostomy,
laparoscopic sleeve gastrectomy and panniculectomy. Conclusion. Quality of
life after the bariatric operation is a factor which must be leading in
concern how to approach a difficult patient, with operation adaptable to fit
all demands.
nema
(1) Background: home-based spirometry, as a form of telemedicine in pulmonology, was previously successfully implemented in clinical practice in developed countries. However, experiences from ...developing countries are lacking. The aim of this study was to assess the reliability and feasibility of home-based spirometry in patients with interstitial lung diseases from Serbia. (2) Methods: 10 patients were given a personal hand-held spirometer with operating instructions and asked to perform daily domiciliary spirometry for the next 24 weeks. The K-BILD questionnaire was used to assess patients' quality of life, while the questionnaire designed specifically for this study was used to assess their attitudes toward and satisfaction with domiciliary spirometry. (3) Results: there was a significant positive correlation between office- and home-based spirometry at the beginning (r = 0.946;
< 0.001) and end of the study (r = 0.719;
= 0.019). The compliance rate was nearly 70%. The domiciliary spirometry did not affect patients' overall quality of life or anxiety levels, as measured via different domains of the K-BILD. Patients expressed positive experiences and high satisfaction with the home spirometry program. (4) Conclusions: home-based spirometry may represent a reliable form of spirometry, exploited in routine clinical practice; however, additional research in developing countries with a larger sample size is required.
Introduction/Objective. Locally advanced lung cancer is often accompanied by atelectasis of either a part or the entire lung. The aim of this study was to establish the benefits of brachytherapy on ...the patients? quality of life, the length of the progression-free survival (PFS), and the overall survival (OS) as related to the presence or absence of atelectasis after the applied treatment. Methods. The total of 100 patients with locally advanced lung cancer or endobronchial metastasis of other malignancy were treated with the high-dose-rate endobronchial brachytherapy (HDR-EBB) in 2017. For observing the patients? clinical characteristics, the PFS and OS, the patients were classified into four groups according to the presence of atelectasis before and after HDR-EBB. Results. After HDR-EBB alone or combined with other treatment modalities, a statistically significant symptom alleviation was registered for all the symptoms except cough (p < 0.05). The significantly highest PFS value was registered among the patients with atelectasis prior but not after HDR-EBB. The longest survival was registered in the patients who had atelectasis prior to, but not after HDR-EBB, as well as among the patients without atelectasis either before or after EBB. Conclusion. HDR-EBB is an efficient method that improved the quality of life of most patients. There were improved rates of re-aeration after HDR-EBB treatment alone and as a part of combined treatment. Reaeration after EBB is a positive prognostic factor with respect to PFS and OS of these patients.
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