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Introduction: Pneumonia is one of the most common diseases in modern medicine. It is an inflammation of the lung parenchyma caused by various agents or noxae. It is present equally in both sexes but does occur more commonly in people who are older, immunocompromised or have comorbidities (COPD, heart or kidney diseases). The most common causing microorganisms are Streptococcus pneumoniae, Haemophilus influenzea, Moraxella catarrhalis and Mycoplasma pneumoniae. Treatment decisions are based on physical examination results, lab analyses, sputum analysis, CURB65 and PSI scores. The patient is then treated as an in-patient or an out-patient. Treatment can be pharmacological or non-pharmacological. Patients are treated pharmacologically with combined antibiotic therapy according to antibiogram results or, more commonly, empirically. Since a high mortality rate from pneumonia persists worldwide, adequate and timely treatment of these patients is of the utmost importance.

Bronchiectasis is a chronic lung disease characterized by an abnormal dilation of the bronchial lumen caused by weakening or destruction of the muscle or elastic components of the bronchial wall, decreased mucous clearance and frequent infections of the respiratory tract. The golden standard for bronchiectasis diagnosis is high-resolution computed tomography (HRCT) of the chest. Inflammation holds a central role in the development of structural lung changes, as well as airway and lung parenchyma damage. Infection and colonization of the respiratory tract contribute to increased inflammation and further damage to the lung. Upon entry into the respiratory tract, the pathogens activate epithelial cells, macrophages and dendritic cells. Activated inflammatory cells secrete chemical mediators which activate the immune response and thus allow the phagocytosis of pathogens. Early diagnosis, appropriate treatment and interruption of the vicious circle between infection and inflammation in patients suffering from bronchiectasis, prevent the development of structural changes to the airways.

Introduction/Objective Postmortem examination has a significant role in evaluating the quality of health care. The objective of the paper is to analyze the cause of death as determined by postmortem examination in patients who had undergone emergency hospitalization and had subsequently died within 24h, as well as the factors that contributed to the fatal outcome and correlation with available clinical data. Methods the analysis included autopsy reports and protocols, as well as clinical data from medical records and autopsy referrals during the three year period (2018-2020) for patients who had undergone a postmortem examination at the Insitute of Pathology, Medical Faculty, University of Belgrade. The correlation between the clinical diagnosis and postmortem findings was evaluated using Goldman criteria. Results the patients analysed were predominantly male (52/90; 58%). Women were statistically significantly older than men (p=0.024). The most common clinical diagnosis was cardiovascular disease (32.2%). The majority of the patients reported experiencing the first symptoms a few hours before seeking medical help (80%). The majority of the patients were being treated for chronic disease (80%) before hospitalization. The immediate cause of death determined by postmortem examination was most commonly heart failure (38/90, 42.2%). The most common clinically unrecognised causes of death include: bronchopneumonia (8/90), myocarditis (3/90), acute ischemic lesion/acute myocardial infarction (3/90) and bowel infarction (3/90). Conclusion the correlation between clinical and postmortem findings is very important because it enables the discovery of diagnostic and treatment errors and promotes new knowledge crucial for medical advancement.

Introduction/aim Clinical signs and symptoms of pulmonary embolism (PE) are non-specific, which is why it is commonly not diagnosed on time or sometimes not diagnosed at all. We are presenting a case of pulmonary embolism manifesting with syncope as a dominant symptom. Case report A 74-year-old female patient was hospitalized at the Clinic for Pulmonary Diseases with PE manifested with syncope. At admission, she was afebrile, tachypneic, with normal cardiac function and normal blood tension. Upon auscultation, breathing was muffled with late inspiration crackles above the base of the left lung. There were no other significant findings. The chest X-ray recorded at admission showed a non-homogenous shadow towards the base of the left lung and minimal pleural effusion. The ECG and echocardiography findings were normal. Partial respiratory insufficiency was verified by the acid-base balance analysis. Inflammatory markers were significantly elevated, with erythrocyte sedimentation rate of 30mm/h, fibrinogen of 8.62g/l and D-dimer of 18.6mg/l. Anticardiolipin IgG and IgM antibodies were negative, as well as beta-2 GPI IgG and IgM antibodies. An MDCT lung angiography was performed because of the elevated values of D-dimer and tachypnea, which showed multiple emboli of various sizes in the distal part of the right pulmonary artery and all lobar branches, as well as an embolus in the lobar branch for the lower lobe of the left lung. After a neurology consult, a head CT was ordered because the patient had suffered from loss of consciousness, but there were no pathological densities in the brain. Colour Doppler Ultrasonography of the blood vessels in the lower extremities showed organized thrombosis of the left femoral vein. A vascular surgeon was consulted and he prescribed anticoagulant therapy and an elastic compressive stocking, with control Colour Doppler Ultrasonography to be performed in six months. Conclusion Although syncope is an easily detectable symptom, it is still an unregulated crossroad of many an internal and neurological disease.

Introduction Dynamic contour tonometry (DCT) is a contact, non-applanation method for measuring intraocular pressure (IOP). Objektive The study aimed at evaluating the impact of central corneal thickness (CCT) on values of IOP measured using two methods: Goldmann applanation tonometry (GAT) and DCT. Methods The study included 150 patients (300 eyes) with the diagnosis of open-angle glaucoma (54 males) and mean age of 59.39± 13.12 years. IOP was measured using two methods: GAT and DCT. CCT was measured (ultrasound pachymetry). DCT introduced a new value - the ocular pulse amplitude (OPA). Results The IOP measured with the GAT was lower compared to the IOP measured with DCT (17.71±3.35mmHg vs 19.80± 3.67mmHg). There was a significant positive correlation between IOP measured with GAT and IOP measured with DCT (r= 0.867, p< 0.01). In all patients, there was a significant positive correlation between CCT and IOP measured with GAT (r=0.198, p< 0.01), as well as between CCT and IOP measured with DCT (r=0.180, p< 0.05). With every 10mm of change in CCT, the change of IOP measured with GAT was 0.3mmHg, while the average change of IOP measured with DCT was 0.4 mmHg. There was a significant positive correlation between CCT and OPA (r=0.204, p< 0.01). There was also a significant positive correlation between OPA and IOP measured with GAT (r= 0.393, p< 0.01) and between OPA and IOP measured with DCT (r= 0.452, p< 0.01). Conclusion IOP measured with GAT was lower than IOP measured with DCT. CCT had impact on both methods: GAT and DCT. The impact of CCT on IOP (DCT) was lower compared to the impact of CCT on IOP(GAT).

Tonometry is a method for measuring intraocular pressure (IOP). Goldmann applanation tonometry (GAT) represents a golden standard for measuring IOP. The measurement is conducted by measuring the force needed to straighten out a certain area of the cornea. Errors do occur when using the GAT method: inadequate shape and arrangement of fluorescent pictures, bulbar pressure, wrong calibration, astigmatism, corneal pathology (edema, distortion, central corneal thickness), body posture, obesity, the Valsalva maneuver. Modifications of Goldmann's applanation tonometry are methods by Dreger, Perkins and Halberg. Alternative ways to measure IOP are: the digital method and the impression method using Schiotz tonometer. The dynamic contact tonometry(DCT, PASCAL) uses contact, but is a non-applanation method of measuring IOP. It is based on the matching shapes of the head of the tonometer and the cornea, enabling the head of the tonometer to take on the role of the bulbar sheath. Therefore, it directly measures the force transferred onto the bulbar sheath, which is the result of IOP. DCT is an ophthalmology device available commercially since 2004 that measures IOP directly by measuring dynamic pulsatile fluctuations in IOP using a piezoelectric sensor embedded into the tip that touches the cornea. Other tonometry methods are: a) pneumotonometry, b) Ocular Blood flow (OBF), c) non contact tonometry: Grolman's air tonometer, Air-puff tonometer, Ocular Response Analyser (ORA), d) Mackay-Marg electric tonometer, Tono-Pen, Proview Phosphene tonometer, Rebound tonometar. Goldmann applanation tonometry continues to be the golden standard in measuring IOP. It is exact, but not too precise. If more precise measurements are needed other methods of measuring IOP are available.

Glaucoma is defined as a chronical progressive optical neuropathy with morphological (excavation of the optic nerve head) and functional disturbances (defects in the field of vision). According to the WHO data 60 million people have been diagnozed with glaucoma worldwide, 4 million of whom are blind. Clinical glaucoma is classified as: primary, secondary and congenital. Intraocular pressure (IOP) is the fluid pressure inside the eye. Normal IOP is between 10 and 22 mmHg. It depends on the homeostasis between production and elimination of eye fluid. There are three mechanisms for production of eye fluid: diffusion, ultrafiltration and active secretion. Primary open angle glaucoma or simplex glaucoma develops due to slow clogging of drainage channels in the wall of the angle. Primarily, the normal ability of the eye to eliminate more than 2.2 microliters of fluid per minute is reduced. Risk factors for open angle glaucoma include: raised intraocular pressure, age of the patient, positive family history, race, central cornea thickness, pseudoexfoliation, miopia and vascular factors (local and systemic). Raised intraocular pressure is still considered to be the most important risk factor for glaucoma development.

Diabetes mellitus is one of the most prevalent chronical non-communicable diseases and is a huge public health problem. Diabetic nephropathy is a microvascular complication of both insulin dependant and insulin independent diabetes mellitus and is characterized by persistent proteinuria, accompanied by hypertension and retinopathy, but without urinary tract infection, other kidney disease or heart failure. According to the newest Annual report on dialysis treatment and transplant surgery in Serbia for the year 2015, hypertension and diabetic nephropathy were the most common causes of terminal renal failure (51.5%); the percentage of new diabetic patients was 22.6%. About 2/3 of all patients diagnosed with manifested diabetic nephropathy die of cardiovascular disease even before their kidney disease progresses to the final stage of renal insufficiency. Risk factors for the development of diabetic nephropathy are: gender, age, genetic factors, hyperglicemia, hypertension, dyslipidemia, hypoprotein nutrition and smoking. Diabetic nephropathy shall not develop if there is no hyperglicemia, regardless of genetic predisposition and all other risk factors. The phases of development of diabetic nephropathy are: glomerular hyperfiltration, latent phase, mycroalbuminuria, macroalbuminuria, chronic kidney disease development. The most important measures of prevention for diabetic nephropathy are: maintenance of glicemia and HbA1C < 7.0% as close as possible to the recommended target level ranges, blood pressure reduction and maintenance at the target range of 130/80, blocking the renin angiotensin aldosterone system, stopping smoking, avoiding nephrotoxic agents - NSAID, aminoglycoside antibiotics, radiocontrast media; treatment of hyperlipidemia, physical activity, weight reduction in overweight patients. The Steno 2 study emphasised the importance of a multifactorial approach to the prevention of proteinuria. It is expected that new drugs, that will affect certain growth factors, AGEs or reactive oxygen radicals, vasoactive factors which include endothelial receptor blockers, shall be efficient in the prevention of diabetic nephropathy.

Acute exacerbation(s) of chronic obstructive pulmonary disease (AECOPD) tend to be critical and debilitating events leading to poorer outcomes in relation to chronic obstructive pulmonary disease (COPD) treatment modalities, and contribute to a higher and earlier mortality rate in COPD patients. Besides pro-active preventative measures intended to obviate acquisition of AECOPD, early recovery from severe AECOPD is an important issue in determining the long-term prognosis of patients diagnosed with COPD. Updated GOLD guidelines and recently published American Thoracic Society/European Respiratory Society clinical recommendations emphasize the importance of use of pharmacologic treatment including bronchodilators, systemic steroids and/or antibiotics. As a non-pharmacologic strategy to combat the effects of AECOPD, noninvasive ventilation (NIV) is recommended as the treatment of choice as this therapy is thought to be most effective in reducing intubation risk in patients diagnosed with AECOPD with acute respiratory failure.