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Introduction. COVID-19 is responsible for the current global pandemic. Globally, over 15 million people are currently infected, and just over 600,000 have died due to being infected. It is known that people with chronic illnesses and compromised immune systems can develop more severe clinical presentation. Tuberculosis (TB) is still one of the biggest epidemiological problems worldwide. Both of these diseases can be misdiagnosed and can manifest in a similar way. We will present a case study of a patient who was initially treated as a COVID-19 infection, with TB being diagnosed later on. The recovery began only after being treated for both diseases simultaneously. Case report. The patient is a 27-year-old male, non-smoker, with no history of any significant diseases. He presented with fever, fatigue and hemoptysis. Computed tomography pulmoangiography had shown massive consolidations and excavations, which could be caused by COVID-19. Despite being treated for COVID-19, there was no clinical improvement. On the follow-up chest X-ray, beside signs of COVID-19, there were also changes that could indicate TB. TB was detected in sputum, using PCR and Mycobacteria Growth Indicator Tube, and only after being treated for both diseases did his condition improve. Conclusion. There are a few reported cases of COVID-19 and TB coinfections, and we believe that there are many more patients with this coinfection being unrecognized

Sarcoidosis afflicts the central nervous system more frequently than previously believed. Neurological symptoms are present in roughly one-half of patients, and depend on the location in the central nervous system. The probability of spontaneous regression is significantly less when compared to other forms of sarcoidosis, which means that the proper diagnosis and treatment is paramount. Even when properly treated, functional defects are not uncommon. Majority of these patients require immunomodulating drugs and continuous follow-up. New immunomodulating drugs, especially biological agents, have shown to be significantly more effective, with fewer side effects, and are important when corticosteroids could not be applied. Less invasive methods, such as cerebrospinal analysis, help greatly in the diagnostics procedure, and require further research and improvement.

Introduction. COVID-19 pneumonia does not have a characteristic course and prognosis. Many facts still remain hidden, mainly why certain patients develop complications with serious tissue damage and whether it causes a permanent organ impairment. If and when will fibrosis develop in COVID-19 pneumonia requires further research, but a link between the amount of tissue afflicted and the development of fibrosis exists. Case outline. A previously healthy, non-smoker, woman with minor symptoms on admission had suddenly developed a serious respiratory insufficiency and whose radiographic finding on computed tomography scan had shown a serious progression with the development of fibrosis in a matter of days. The exact mechanism and correlation of this clinical course remains unknown; however, it is clear that the pulmonary fibrosis is caused by COVID-19 pneumonia. Follow-up computed tomography scan, performed 50 days after initial symptoms, had shown a partial regression of consolidations and post-inflammatory fibrosis. Conclusion. Pulmonary fibrosis is the most severe complication of COVID-19 infection on the respiratory system. Who, when or if a patient will develop any complication is still unclear, as well as whether these changes are reversible? Also, the number of recovered patients who later develop some chronic complications remains to be seen.

Introduction. Orbit is one of the rarer locations for the metastasis of malignant tumors. The symptoms of orbital tumors are nonspecific, but require detail diagnostics. Methods of visualization, such as ultrasound, radiography, computed tomography scan and/or magnetic resonance imaging of the endocranium are a mandatory step in the diagnostics in order to determine not only the spread of the malignancy but also the affliction of the surrounding structures. The orbital manifestations can be the first sign of the malignant disease. Outline of cases. The first case report presents a female patient with ocular symptomatology as a result of a metastasis of previously undiscovered breast cancer, and the second report presents a male patient with undiscovered lung cancer also presenting with ocular symptomatology. Conclusion. An orbital tumor should instigate further diagnostic procedures, as it can be the first sign of a disseminated malignant disease. [Projects of the Serbian Ministry of Education, Science and Technological Development, Grant no.175046 and Grant no.175081]

Severe COVID infection is most often presented as bilateral pneumonia and, according to current knowledge, can be explained by cytokine storm, hypercoagulability and microvascular thromboses. Patients at risk of poor outcome include obese middle-aged men and persons with cardiovascular and pulmonary comorbidities and diabetes. One of specific traits of COVID 19 pneumonias is frequent discrepancy between clinical presentation, radiographic findings and oxygen saturation. Regular monitoring and use of early warning scores improve survival and decrease rates of emergency admissions to intensive care units. Corner-stone of treatment of critically ill patients include oxygen, anti-inflammatory and anticoagulant therapy. Best results are obtained through administering high flow oxygen and non-invasive mechanical ventilation.

Introduction: Cough is frequent symptom in sarcoidosis and there are no specifi c tools for measurement of its severity in Serbia. Aim: the goal of this study was to translate and validate the Serbian version of the Leices-ter Cough Questionnaire (LCQ) in a population of sarcoidosis patients. Methods: After the LCQ forward-backward translation process, in the cross-sectional study in 275 (180 female) sarcoidosis patients Serbian version of the LCQ was administered together with other standardized instruments for measurement of Patient Reported Outcomes (PROs)-symptoms of dyspnea (assessed by MRC and Borg scales) and fatigue (measured by Fatigue Assessment Scale and List of Daily Activities), and patients' health status (assessed by generic tool-15D). Pulmonary function tests (spirometry and diff using capacity for carbon monoxide) were also measured. Results: Serbian LCQ version showed excellent internal consistency (Cronbach's Alpha of its diff erent scores ranged between 0.901 for physical domain and 0.951 for the total score). Concurent validity assessed by correlations of all LCQ scores with other PROs and pulmonary function tests was very good, since all these correlations were statistically signifi cant. Conclusions: Our results confi rmed that the Serbian version of LCQ is a valid instrument to monitor the infl uence of chronic cough on quality of life in sarcoidosis patients.

Matrix metaloproteinases (MMPs) and their specific inhibitors - tissue inhibitors of matrix metalloproteinases (TIMPs) play an important role in pulmonary extracellular matrix destruction. Sarcoidosis is an inflammatory disease affecting multiple organs. It has been reported that MMP-9 and TIMP-1 levels were increased in bronchoalveolar lavage fluid and induced sputum of sarcoidosis patients. The aim of our study was to evaluate MMP-9, TIMP-1 and MMP-9/TIMP-1 complex concentrations and MMP-9/TIMP-1 ratio in sarcoidosis patients, their relationship with inflammatory markers and their ability do predict the existence of disease. We included 101 sarcoidosis patients and 50 healthy subjects. Serum samples were analyzed. Besides routine biochemical parameters, high-sensitive C-reactive protein (hsCRP), serum amyloid A (SAA), MMP-9, TIMP-1 and MMP-9/TIMP-1 complex concentrations were measured. MMP-9 (P

Background: Until now, a proper biomarker(s) to evaluate sarcoidosis activity has not been recognized. The aims of this study were to evaluate the sensitivity and specificity of the two biomarkers of sarcoidosis activity already in use (serum angiotensin converting enzyme - ACE and serum chitotriosidase) in a population of 430 sarcoidosis patients. The activities of these markers were also analyzed in a group of 264 healthy controls. Methods: Four hundred and thirty biopsy positive sarcoidosis patients were divided into groups with active and inactive disease, and groups with acute or chronic disease. In a subgroup of 55 sarcoidosis patients, activity was also assessed by F-18 fluorodeoxyglucose positron emission tomography (18F-FDG-PET) scanning. Both serum chitotriosidase and ACE levels showed non-normal distribution, so nonparametric tests were used in statistical analysis. Results: Serum chitotriosidase activities were almost 6 times higher in patients with active sarcoidosis than in healthy controls and inactive disease. A serum chitotriosidase value of 100 nmol/mL/h had the sensitivity of 82.5% and specificity of 70.0%. A serum ACE activity cutoff value of 32.0 U/L had the sensitivity of 66.0% and the specificity of 54%. A statistically significant correlation was obtained between the focal granulomatous activity detected on 18F-FDG PET/CT and serum chitotriosidase levels, but no such correlation was found with ACE. The levels of serum chitotriosidase activity significantly correlated with the disease duration (P< 0.0001). Also, serum chitotriosidase significantly correlated with clinical outcome status (COS) categories (p = 0.272, P = 0.001). Conclusions: Serum chitotriosidase proved to be a reliable biomarker of sarcoidosis activity and disease chronicity.

Vitamin D has an important role in numerous physiological functions. Vitamin D receptors are characterized by polymorphisms and presence in different tissues including a number of cells of the immune system. The role of vitamin D as a biological inhibitor of inflammatory hyperactivity is of particular importance. Hypovitaminosis D has been associated with many serious chronic diseases, such as autoimmune, infectious and cardiovascular diseases as well as some types of cancer. Vitamin D has an influence on the immune response to tuberculosis. Calcitriol (1,25-dihydroxycholecalciferol), the major active form of vitamin D, has shown in vitro activity against Mycobacterium tuberculosis. It has been found that susceptibility to chronic mycobacterial infections is strongly correlated with a low vitamin D intake and particular VDR alleles. Vitamin D deficiency might predispose the individuals infected with Mycobacterium tuberculosis to develop tuberculosis. Calcitriol binds to vitamin D receptors and modulates immune responses by regulating the transcription of genes responsive to vitamin D. Faster conversion of sputum mycobacterial culture in patients with pulmonary tuberculosis is associated with being a carrier of the t allele of the TaqI vitamin D receptor polymorphism. On the contrary, slower sputum culture conversion in pulmonary tuberculosis has been found in the carriers of the f allele of the FokI vitamin D receptor polymorphism. The results of in vitro studies, clinical research and population studies indicated that vitamin D deficiency might be a strong risk factor for developing TB. Vitamin D is an inexpensive, easily accessible vitamin, relevant for the prevention of tuberculosis. In addition, vitamin D could contribute to the success of tuberculosis treatment.

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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 vital 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 (R2=0.878; p=0.038 (b=0.216)) and depression in patients with sarcoidosis (R2=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 majority of the analyzed sarcoidosis patients had totally deficient serum 25(OH)D levels made this finding even more notable.

Introduction Potassium iodine (KI) is used as a drug therapy for treating numerous diseases such as small-vessel vasculitis, erythema nodosum, vasculitis nodularis, Sweet's syndrome, tuberculosis and granulomatosis, and for iodized salt. At the same time, KI can be harmful. Iodine intake may increase the frequency of thyroiditis in humans, and may induce the occurrence of experimental thyroiditis (ET) in animals. Investigations on an experimental model for the examination of thyroiditis in Wistar rats have clearly showed morphological changes in the rat thyroid evoked by KI administration. Objective The purpose of this study was to compare the effects of low and high doses of KI on the thyroid gland of Wistar rats and determine the effect on hormone status (T4, T3 and TSH) in this rat strain. Methods Two groups of rats from the Wistar strain were treated with a low iodine dose (225 μg/g BW) and with a high iodine dose (675 μg/g BW) of KI solutions. Untreated nonimmunized animals served as controls. The solution was administrated daily intraperitoneally during the period of 26 consecutive days. Results Monitoring hormone status (TSH, T3 and T4) and morphological changes it was found that therapeutic doses of KI applied in treatment induced the occurrence of experimental thyroiditis (chronic destructive Hashimoto's thyroiditis in humans) and cell necrosis in animals not carrying a genetic susceptibility. Significant inflammatory changes were observed in rats treated with a high iodine dose. Conclusion The early iodine induced cell necrosis and inflammation in the nonimmunized animals without genetic susceptibility is a new experimental model of thyroiditis. .

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Severe COVID infection is most often presented as bilateral pneumonia and, according to current knowledge, can be explained by cytokine storm, hypercoagulability and microvascular thromboses. Patients at risk of poor outcome include obese middle-aged men and persons with cardiovascular and pulmonary comorbidities and diabetes. One of specific traits of COVID 19 pneumonias is frequent discrepancy between clinical presentation, radiographic findings and oxygen saturation. Regular monitoring and use of early warning scores improve survival and decrease rates of emergency admissions to intensive care units. Corner-stone of treatment of critically ill patients include oxygen, anti-inflammatory and anticoagulant therapy. Best results are obtained through administering high flow oxygen and non-invasive mechanical ventilation. [ABSTRACT FROM AUTHOR]

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Purpose: To analyze clinical characteristics of ocular sarcoidosis in a group of biopsy-proven sarcoid patients treated at the single referral center for sarcoidosis in Serbia.Methods: A prospective study carried out on 88 biopsy-proven sarcoid patients between January 2012 and December 2014. All patients underwent complete ophthalmological examination.Results: Ocular sarcoidosis was present in 32 patients (36.4% of all) and included: eyelid skin lesions (2.3%); orbital inflammation (2.3%); conjunctival lesions (7.9%); anterior uveitis (2.3%); intermediate uveitis (1.1%); posterior uveitis (15.9%); panuveitis (5.7%), and neuro-ophthalmologic manifestations (9.1%). Complications included cataract (20.4%); glaucoma (5.7%); cystoid macular edema (3.4%); epiretinal membrane formation (4.5%); macular atrophy (2.3%); and choroidal neovascularization (1.1%). Binocular visual impairment was present in one patient (1.1%), due to complications of posterior uveitis (macular scars).Conclusions: Patients in Serbia demonstrated ocular sarcoidosis as the first most common site of extrapulmonary sarcoid manifestations, with more often neuro-ophthalmologic lesions than in other European populations. [ABSTRACT FROM AUTHOR]

Introduction: Sarcoidosis affects the central nervous system more frequently than it used to be believed. While the cranial nerves are most frequently affected, neurosarcoidosis can involve other nervous system tissues as well. Treatment of Neurosarcoidosis: Although a lot of drugs have proved useful in treating neurosarcoidosis, corticosteroids are still the gold standard in treatment of these patients. Therapeutic protocols differ regarding the dose of these drugs. Symptomatic neurosarcoidosis should always be treated with pulse corticosteroid therapy. People with diabetes, high blood pressure, osteoporosis and tuberculosis should be carefully monitored, as they are prone to complications associated with treatment with corticosteroids. In cases when treatment with corticosteroids does not show the desired results or therapy is discontinued due to the development of side effects, there are other pharmacologic options, such as methotrexate, mycophenolate mofetil, cyclophosphamide, chloroquine, azathioprine, thalidomide, and infliximab. It should be noted that the treatment response to the above mentioned regimens, except for infliximab, is relatively slow compared to corticosteroids; therefore, corticosteroids should be taken into account in all states and particularly in the acute phase of the disease. Conclusion: It is the existence of different forms of the disease, lack of local diagnostic criteria and different and non standardized therapy that makes the treatment of this disease difficult. Despite advances in pharmacotherapy and radiological diagnosis, it is necessary to develop better diagnostic strategies in order to set the optimal therapeutic approach. [ABSTRACT FROM AUTHOR]

Introduction. In diagnostics of neurosarcoidosis, radiological diagnostic procedures are available, non-invasive and they contribute significantly to the diagnosis of this disease. The aim of this paper is to present a brief overview of the radiological diagnostic methods, their application, and their importance in daily clinical work with these patients. Radiological Presentation of Neurosarcoidosis. Magnetic resonance is the method of choice in diagnostics of this disease. Computed tomography can also be helpful in patients with contraindications for magnetic resonance, although it is less precise in assessing the involvement of the periventricular white matter, hypothalamus, and cranial nerves. The number of lesions and the degree of involvement of the parenchyma and leptomeninges are better seen by magnetic resonance than by computed tomography scan. It is important to note that the magnetic resonance imaging may be normal in patients with neurosarcoidosis, especially in patients with cranial neuropathy, or in patients treated with corticosteroids. There is a number of variability in the occurrence of neurosarcoidosis on radiological images. Conclusion. Radiological procedures are on the very top of diagnostic pyramid of this disease due to their availability, non-invasiveness, and precision. [ABSTRACT FROM AUTHOR]

Introduction: Sarcoidosis can affect any part of the central nervous system presenting with an extremely diverse clinical picture. Clinical presentations actually depend on the localization of granulomas in the central nervous system. Making diagnosis according to the localization and the clinical variations is often a clinical challenge. Diagnosis of Neurosarcoidosis. Diagnosis is based on the clinical picture, clinical and radiological findings (magnetic resonance imaging with contrast endocranium), laboratory findings (angio-tenzin-converting enzyme and chitotriosidase in cerebrospinal fluid); however, it is necessary first to exclude all other possible causes of granulomatous inflammation. Recent studies in patients with neurosarcoidosis show a high value of at least one marker of the disease. The safest way and the gold standard in diagnosing this disease would be histopathological confirmation, which is rarely performed due to its invasiveness. Conclusion. New diagnostic methods will contribute to better methods of bypassing invasive procedures, and they will significantly facilitate the diagnosis of neurosarcoidosis, which is a real challenge even for experienced clinicians who deal with this disease. [ABSTRACT FROM AUTHOR]