Objective. To compare frequency of echocardiographic changes in patients with chronic obstructive pulmonary disease (COPD) and non-COPD controls and to assess their relation to the level of airflow limitation. Methods. Study population included 120 subjects divided in two groups. Group 1 included 60 patients with COPD (52 male and 8 female, aged 40 to 80 years) initially diagnosed according to the actual recommendations. Group 2 included 60 subjects in whom COPD was excluded serving as a control. The study protocol consisted of completion of a questionnaire , pulmonary evaluation (dyspnea severity assessment, baseline and post-bronchodilator spirometry, gas analyses, and chest X-ray) and two dimensional (2D) Doppler echocardiography. Results. We found significantly higher mean right ventricle end-diastolic dimension (RVEDd) in COPD patients as compared to its dimension in controls (28.0 ± 4.8 vs. 24.4 ± 4.3; P = 0.0000). Pulmonary hypertension (PH) was more frequent in COPD patients than in controls (28.0 ± 4.8 vs. 24.4 ± 4.3; P = 0.0000) showing linear relationship with severity of airflow limitation. The mean value of left ventricular ejection fraction (LVEF%) was significantly lower in COPD patients than its mean value in controls (57.4 ± 6.9% vs. 64.8 ± 2.7; P = 0.0000) with no correlation with severity of airflow limitation.       Conclusion. Frequency of echocardiographic changes in COPD patients was significantly higher as compared to their frequency in controls in the most cases being significantly associated with severity of airflow limitation. Echocardiography enables early, noninvasive, and accurate diagnosis of cardiac changes in COPD patients giving time for early intervention. Key words: airflow limitation, chronic obstructive pulmonary disease, Doppler echocardiography, pulmonary hypertension, ventricular dysfunction.

AIM: To assess the frequency of carotid artery disease (CAD) and lower extremities artery disease (LEAD) in patients with chronic obstructive pulmonary disease (COPD) and their relation to the severity of airflow limitation and the level of C-reactive protein (CRP). METHODS: We performed a cross-sectional study including 60 patients with COPD (52 male, 8 female), aged 40 to 80 years, initially diagnosed according to the actual criteria. Also, 30 subjects in whom COPD was excluded, matched to COPD patients by sex, age, body mass index and smoking status, served as controls. All study subjects completed questionnaire and underwent pulmonary evaluation (dyspnea severity assessment, baseline and post-bronchodilator spirometry, gas analyses, and chest X-ray), angiological evaluation by Doppler ultrasonography and measurement of serum CRP level. RESULTS: We found a statistically significant difference between the frequency of carotid plaques in COPD patients as compared to their frequency in controls (65% vs 30%; P = 0.002). The mean value of intima-media thickness (IMT) in COPD patients with CAD was significantly higher than its mean value in controls (0.8 ± 0.2 vs. 0.7 ± 0.2; P = 0.049). IMT value in COPD patients with CAD was significantly related to the degree of airflow limitation, i.e. to the degree of FEV1 decline (P = 0.000), as well as to the serum CRP level (P = 0.001). We found a statistically significant difference between the frequency of COPD patients with LEAD as compared to the frequency of LEAD in controls (78.3% vs 43.3%; P = 0.001). According to the Fontaine classification, COPD patients with LEAD were categorized in the stages I, IIA and IIB (53.3%, 30% and 16.7%, respectively), whereas all controls with LEAD were categorized in the Fontaine stage I. Among COPD patients with LEAD there was significant association between disease severity and clinical manifestations due to the vascular changes (P = 0.001) and serum CRP level (P = 0.001). CONCLUSION: Our findings suggest higher prevalence and higher severity of vascular changes in COPD patients as compared to their prevalence and severity in non-COPD subjects. Prevalence and severity of vascular changes in COPD patients were significantly related to the severity of airflow limitation and serum CRP levels.

Introduction: Genetic risk factors that increase venous thromboembolism risk are disorders in the synthesis or activity of coagulation factors. Factor V Leiden, prothrombin (20210-A), antithrombin deficiency, protein C and protein S deficiency, and hyperhomocysteinemia are the most common venous thromboembolism-related gene mutations. When genetic factors are combined with non-provoking risk factors (obesity, psoriasis, smoking and previous venous thromboembolism) the result is increased venous thromboembolism risk for each factor individually. Previous venous thromboembolism is one of the strongest risk factors, even in patients actively treated with anticoagulants. Patients are more likely to have recurrent venous thromboembolism with longer duration. Psoriasis is a complex immune-mediated disease, associated with cardiovascular risk, hypercoagulability markers and elevated homocysteine. Lots of observational reports suggest increased incidence of venous thromboembolic events in patient with psoriasis. Case presentation: We present patient with inherited thrombophilia and chronic diffuse plaque psoriasis complicated with deep venous thrombosis and pulmonary embolism. DNA analysis indicates the presence of homozygosis for Factor V Leiden mutation as well as heterozygosis for Factor XIII V34L, PAI-1 5G/4G and MTHFR A1298C polymorphism. Dermatological anamnesis is positive for plaque psoriasis since 12 years ago. Conclusion: The presentation of this case indicates an association between venous thromboembolism and chronic psoriasis. All patients with recurrent thromboembolism, hereditary thrombophilia, and moderate to severe psoriasis should be considered to be at higher risk for venous thromboembolism and appropriately treated.

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a preventable cause of in-hospital death, and one of the most prevalent vascular diseases. There is a lack of knowledge with regards to contemporary presentation, management, and outcomes of patients with VTE. Many clinically important subgroups (including the elderly, those with recent bleeding, renal insufficiency, disseminated malignancy or pregnant patients) have been under-represented in randomized clinical trials. We still need information from real life data (as example RIETE). The paper presents case series with VTE in special conditions, including cancer associated thrombosis, malignant homeopathies, as well in high risk population.

BACKGROUND: Cellulitis is a common infectious disease with typical feature – the tendency for recurrence. AIM: The aim of the study was to define comorbidities, clinical, and laboratory – biochemical factors associated with longer length of stay (LOS) in patients with recurrent cellulitis in the lower legs. MATERIALS AND METHODS: The study is a retrospective-cohort study conducted at the Department of Dermatovenerology at General Hospital in Skopje, from January 2016 to August 2019. In the study, we included and analyzed only hospitalized patients admitted for recurrent cellulitis on the lower legs. Inclusion in the study recorded the following variables – comorbid conditions in the patients – present in the medical records or obtained from the interview of the patient and initial values of laboratory assays on admission. RESULTS: The study included hospitalized 205 patients, admitted for recurrent cellulitis. The most significant comorbid conditions and laboratory parameters which correlate with increased LOS are as follows: Type 2 diabetes mellitus – insulin dependent (p < 0.001), chronic renal failure (p = 0.003), ischemic heart disease (p = 0.006), peripheral arterial disease (p = 0.007), fever ≥38.0°C (p < 0.001), hypoalbuminemia ˂34 g/L (p < 0.001), elevated value of C-reactive protein >10 mg/L (p < 0.001), and leukocytosis >109 L (p = 0.009). CONCLUSION: Cellulitis is potential medical emergency event. Recurrence is the most significant complication of cellulitis and lower legs cellulitis is associated with a risk for long-term morbidity. The study has identified several independent factors that are significantly associated with an increased LOS. This independent factors present on admission can stratify the patient with the highest risk of mortality, can improve patient care for better outcomes, and decrease the number of relapses and hospital readmissions.