Sjögren'ssyndrom is autoimmune disorder where cells of immune system afack and destroy eccrine glands which produce tears and spit. We have a patients with following problems: dryness of the bucal lining and conjunctiva, dysphagia of solid food, paint in joints amd muscles, hand sensitivity to coldness.

Diabetes is the most common cause of end-stage renal disease .in United States , Europa and Japan. Approximately 40% of patients with type 1 diabetes and 5-15% of patients with type 2 diabetes eventually develop end-stage renal disease. Risk factors for development of diabetic nephropathy include hyperglycemia, hypertension, positive family history of nephropathy and hypertension, and smoking. Key elements in the primary care of diabetes include glycemic control, blood pressure control, and screening for microalbuminuria. In general, the goal for glycemic control is a blood glucose level as close to normal (HbA C <7%) . Blood pressure control is at least as important as glucose control, especially after the onset of 1 renal damage, and blood pressure should be consistently <130/85. Screening for diabetic nephropathy involves monitoring at least yearly for urinary albumin excretion >30 mg per day. Microalbuminuria is defined as the urinary excretion of 30300 mg of albumin per day. Both glycemic control and rigorous control of blood pressure have significant impact on prevention and progression of diabetic nephropathy. Identification of patients with microalbuminuria selects a population of patients with increased mortality. Microalbuminuria screening should begin at the time of diagnosis. ACE inhibitors should be used when microalbuminuria is present regardless of the presence or absence of hypertension in type 1 diabetes and are widely.
used in normotensive patients with type 2 diabetes, as well.The effect of ACE inhibitors is probably not only via lowered
systemic blood pressure but also via direct effects on intraglomerular hemodynamics. 

In this work we have examined echocardiographic characteristics of left ventricle in patients with acute myocardial infarction (AMI). We used prospective study, during 12 months, and we followed 55 patients with diagnosed non Q AMI. All patients were hospitalized in the Coronary unit. Results: 55 consecutive (40 males middle age 55,4±8,7 and 15 females middle age 57,4±10,3) had non Q AMI. Value of ejection fraction: after 4.day - 50,4±6,2% ,2.weeks - 54,6±5,8%, 4. weeks - 59,3±5,4%. Value of ejection fraction in patients with thrombolytic therapy: 61,6±6,8% vs. 57,3±6,6% p> 0,05;Value of left ventricle fractional shortening: 28,8±2,5% (in patients with thrombolytic therapy 30,3±4,8% vs.27,2±5,9%) Value of end2 2 2 - diastolic volume: after 4.day- 62,5±5,3 ml/m , 2.weeks - 63,1±5,4 ml/m , 4. weeks - 64,4±5,8 ml/m (in patients with throm 2 2 2 bolytic therapy 60,5±9,2 ml/m vs. 67,4±8,4 ml/m ) Value of endsistolic volume: after 4. day - 26,2±2,1 ml/m , 2.weeks2 2 26,8±2,3 ml/m , 4. weeks - 27,6±2,2 ml/m (in patients with thrombolytic therapy 25,6±2,8 ml/m2 vs. 31,7±3,1 ml/m2 p> 0,05). During the in-hospital follow up period, 2(3,6%) patients and during the post-hospital follow up period, 1 (1,9%) patients with non Q AMI had lethal outcome.

Pruritus is one of the commonest symptoms of dermatologic appearances in uraemic syndrome and it occurs in 90% of patients on dialysis with different etiology and pathophysiology. The aim of the study was to estimate the frequency of uraemic pruritus and the comparison with clinical and biochemical parameters in 124 patients treated by chronicle haemodialysis at Department of Haemodialysis, Urology and Nephrology Clinic, Clinical Center “Kragujevac”. The routine laboratory analyzes were carried out in examined patients and the concentration of parathyroid hormone was determined. The study was based on data from history of disease and  questionnaire carried out in all patients. Of 124 patients, 65,3% were male and 34,7% were female, mean age of 55,98±12,94 years; the mean time on HD was 55,5 ±50,4 months. 46,8% of examined patients had symptoms of uraemic pruritus. Uraemic syndrome and uraemic complications, manifested by the concentration of urea, 21,57±7,56 vs. 22,93±5,754; p=0,05 and time on dialysis, 67,27±60,07 vs. 43,64±36,84; p=0,02, are the significant parameters of uraemic pruritus. Serum concentration of iron 15,16±8,03 vs. 11,73±6,21; p=0,05 and UIBC 25,12±10,6 vs. 30,45±9,86; p=0,04, as well as hyperglycemia 6,16±2,516 vs. 6,82±2,872; p=0,02 are significantly correlated with uraemic pruritus. There was a statistically significant difference in albumin concentration 35,84±9,09 vs. 37,72± 3,105; p=0,05 but our results were reverse to the data in literature where the reported albumin level was higher in patients with uraemic pruritus. 27,6% of examined patients had itching of all the body what is in correlation with literature. Between the patients with localized itching and patients with generalized itching, there are statistical significance in following: number of erythrocytes 2,4±0,96 vs. 2,7±0,6; p=0,02, concentration of hemoglobin 78,53±31,44 vs. 89,36±19,81; p=0,05, hematocrit 0,23±0,089 vs. 0,26±0,057; p=0,02 and TIBC 29,45±12,01 vs. 34±4,86; p=0,02, as well as concentration of glycemia 5,38±2,52 vs. 6,42±2,12; p=0,01.

Diabetes mellitus is the most frequently chronical disease.In the relation on the degree of affection populations (over 150 000 000 peoples), was able speak about pandemic of this illnesses. In the orgin of insulin-indipendent diabetes mellitus, the primary role has the insuline resistence. Date from literature gives the evidence that the metformin is a drug for insuline resitence. Behaind the rest, has been proved that metformin, decrease risk factors for beginning complications this illnesses

The aim of our work was to inquire characteristics of myocardial infarction in diabetic patients.We questioned
prospectively 441 patients, diagnosed with acute myocardial infarction. Diabetes mellitus (DM) was found in 31,3%
patients. Atrial fibrillation was found in 16,7% patients with DM and 7,3% on patients without DM(p<0,05).Ventricular
arrhythmias gr.III was found in 18,8% patients with DM and 15,8% on patients without DM (p>0,05), gr. IV 24,6% vs.
12,9% (p<0,05) and gr.V 18,1% vs.9,9% (p<0,05). Heart failure (NYHA I) was found in 10,9% patients with DM and
10,6% on patients without DM (p>0,05), heart failure NYHA II 13,8 vs.10,6% (p>0,05), heart failure NYHA III 14,5% vs.
5,6% (p<0,05) and heart failure NYHAIV 10,1 vs. 3,3% (p<0,05).Cardiogenic shock was found in 21,7% patients with DM
and 10,2% on patients without DM (p<0,05). QRS scor was found 8,3+-2,9 in patients with DM and 4,5+-1,5 on patients
without DM (p<0,05). In-hospital mortality was found 20,3% in patients with DM and 8,2% on patients without DM
(p<0,05). Post-hospital mortality was found 10,2% in patients wuth DM and 5,1% on patients without DM (p>0,05).
Myocardial infarction in patients with DM have difficulty clinical flow and higher mortality

Sindrom X or Metabolic Syndrome are both terms used to describe a collection of herth risks contitions that increase your chance os developing heart disease, stroke and diabetes. The condition is aslo known by other names including insulin Resistence syndrome, and Dysmetabolic syndrome. The number of people with Metabolic Syndrome increases with
age, affecting more than 40 percent of people in their 60 s and 70 s. Components of Metabolic Syndrome are: Abdominal obesity, atherogenic dyslipidemia, raised blood pressure, insulin resistance, proinflamate state and prothrombotic state. The
National Cholesterol Education Program 's Adult Treatment Panel III report (ATPIII) identified 6 components of the metabolic syndrome that relevate to CVD. Insulin resistance is present in the majority of people with the matabolic syndrome.
It strongly associates is present with other metabolic risk factors and correlates unuvariately with CVD risk. Patiens with
longstanding insulin resistance frequently manifest glucose intolerance. When glucose intolerance evolves into diabetslevel hyperglicemia, independent risk factor for CVD. When 3 of 5 of the listed caracteristics are present, a diagnosis of metabolic syndrome can be made. The exact cause of Metabolic syndrome is not known. Most reserchers believe it is caused by
a combination of your genetic makeup and lifestyle choices-including the types of food you eat and level of physical activity.