Introduction: The study of importance of left ventricular contractile reserve presence and changes plasma brain natriuretic peptide levels (BNP) during exercise in patinets with idiopathic dilated cardiomyopathy is very popular today, but these two parametres have rarely been interconnected. The study of response BNP during echocardiography stress tests in patients with idiopathic dilated cardiomyopathy with or without preserved left ventricular contractile reserve. We studied 55 consecutive patients with idiopathic dilated cardiomyopathy (mean age 54.98 ± 9.84, 49 (89.1%) male) treated in the outpatient clinic for heart failure at the Institute of Cardiovascular Diseases "Dedinje". All the patients underwent the echocardiography stress test. Contractile reserve was assessed by measuring of the changes of the left ventricle ejection fraction basally and in the first minute after the strongest stress. Level of BPN was measured at rest, in the first minute and after 20 minutes of maximal exercise stress. Following the kinetics of BNP level during stress testing, we find that in patients with preserved left ventricular contractile reserve BNP level is rising at maximum load achieved (Mediana (IQR) - 59 (22-113) vs. 91 (37-135) vs. 78 (30-159) ng/L, p<0.001), whereas in patients without preserved left ventricular contractile reserve BNP level does not change significantly (Mediana (IQR) – 89 (50-322) vs. 119.5 (61.3-321.8) vs. 136 (72- 281), p=0.102). The increase in BNP in the peak load compared to its value at rest was positively correlated with preserved contractile reserve (r=0.38, p=0.009), better WMSI at rest (r=-0.28, p=0.04), greater difference in the double product (r=0.40, p=0.002), as well as the work accomplished on the test (r = 0.47, p <0.001), and longer duration of the test (r = 0.43, p = 0.001). The increase in BNP during physical exercise in patients with idiopathic dilated cardiomyopathy suggests a preserved contractile reserve of the left ventricle.

Prediktori pobolјšanja kvaliteta života nakon hirurške revskularizacije miokarda su još uvek nepotpuno poznati. Cilj rada je bio da ispita prediktore poboljšanja kvaliteta života šest meseci nakon hirurške revaskularizacije miokarda. Ispitivali smo 208 uzastopnih pacijenata koji su podvrgnuti hirurškoj revaskularizaciji miokarda. Za ispitivanje kvaliteta života korišćen je upitnik Nottingham Health Profile Questionnaire prvi deo. Upitnik se sastoji od 38 pitanja koji su podeljeni u 6 odeljaka: fizička pokretljivost, socijalna izolacija, emocionalne reakcije, energija, bol i san. Upitnik je podeljen svim pacijentima pre i šest meseci nakon operacije. Prosečna starost ispitivanih pacijenata je bila 58,8 ± 8,2 godine, 82% su bili muškarci. Poređenje pre i postoperativnih skorova je pokazalo da se poboljšanje nalazi kod 53,76% bolesnika, pogoršanje kod 12,46%, normalan KŽ pre i posle operacije kod 26,70%, dok je KŽ nakon operacije bez promene kod 7,08% bolesnika. Nezavisni prediktori poboljšanja kod pacijenata nakon operacije su bili: odsustvo prethodnog infarkta miokarda u odeljku fizička pokretljivost (p=0,03; OR=0,59; CI 0,40-0,92), viša CCS klasa angine u odeljcima fizička pokretljivost (p=0,006; OR=2,34; CI 1,46-3,32), energija (p=0,02; OR=1,70; CI 1,29-2,64) i bol (p<0,001; OR=4,64; CI 2,27-7,31), muški pol u odeljku bol (p=0,03; OR=0,45; CI 0,26-0,62) i mlađe starosno doba u odeljku bol (p=0,01; OR=0,69; CI 0,41-0,85). Prediktori poboljšanja kvaliteta života šest meseci nakon hirurške revaskularizacije miokarda su viša CCS klasa angine, odsustvo prethodnog infarkta miokarda, muški pol i mlađe starosno doba.

One of possibilities to estimate size of myocardial injury during the acute myocardial infarction are electrocardiographic changes,
forming of QS formation (ECG signs of scares changes). This investigation which included three groups of patients receiving thrombolytic, nitrates or beta blockers in acute phase of myocardial infarction has aim to analyze 12-chanels electrocardiogram and to establish difference between this therapeutics groups in sum of QRS score, but also to indicateon frequency of periinfarction heart insufficiency in this therapeutics groups, comparing with observed ECG changes. Analysis shows significant differences between groups
in value of QRS score, and also significant lower value of QRS score in patients with acute myocardial infarction treated with thrombolytic therapy. This difference relative to other two groups shows lower level of myocardial injury during acute myocardial infarction in patients treating with thrombolytic therapy. 

Acute instable atherosclerotic plate in the basis of the pathophysiology of the acute coronary syndrome and it is divided on two big groups: a) acute coronary syndrome without ST elevation (NONSTEMI) and b) myocardial infarction with ST elevation (STEMI). Clopidogrel belongs to the group of antiaggregation drugs which inhibit ADP receptors and on that way prevent platelets aggregation. The clinical confirmation of the clopidogrel efficiency is confirmed trough 4 big clinical studies: CAPRIE, CURE, COMMIT/CCS 2 and CLARITY-TIMI 28 studies. In CAPRIE study, clopidogrel showed moderate but significant advantage comparing to aspirin in prevention of the secondary ischemic cerebrovascular stroke and myocardial infarction. The results of CURE study showed that doubled combined therapy with clopidogrel and aspirin brought the reduction of the relative risk of cardiovacular events with patients with acute coronary syndrome without ST elevation. The results of this study showed that the group of patients which received clopidogrel beside aspirin and thrombolytic therapy it came to the reduction of the occluded arteries. In COMMIT were also involved the patients with the acute myocardial infarction with ST elevation. Total number of lethal cases of the repeated myocardial infarctions or acute brain stroke was smaller in a group which was receiving clopidogrel beside thrombolytic therapy and aspirine in comparison with the placebo group. The results of CLARITY and COMMIT studies gave us recommendation that patients with acute myocardial infarction with ST elevation which have thrombolytic therapy or percutaneous coronary intervention should receive clopidogrel as well.

In clinical hyperkalemia, correlation between plasma K and the ECG is less reliable. A tall, peaked, symmetrical T wave with a narrow base, the so-called "tented" T wave is the earlinest ECG abnormality, usually best seen in leads II, III, V2, V3, and V4. The tented appearance and the narrow base are probably more characteristic of hyperkalemia than is the amplitude of the T wave. A decrease in amplitude of the R wave, appearance of a prominent S wave, widening of the QRS complex, depression of the ST segment evolve as plasma K approaches 8-9m Eq/liter. With hyperkaliemia, depression of intraventricular conduction is characteristically diffuse and results in prolongation of both the initial and terminal parts of the QRS complex. The resulting pattern may resemble RBBB, LBBB, left anterior or posterior divisional block, or a combination of the four.

Metformin is an anti-hyperglycemic agent used for the treatment of type 2 diabetes mellitus. Biguanides lower blood glucose levels primarily by decreasing the amount of glucose produced by the liver. Metformin also helps to lower blood glucose levels by making muscle tissue more sensitive to insulin so glucose can be absorbe. The purpose of the study was to establish the effect of metformin on insulin secretion in obese patients with newly diagnosed diabetes mellitus type 2. We included 40 patients with Type-2 Diabetes Mellitus, who were treated on Department for Internal Disease in Hospital King Milutin Laplje Selo. Patients included in the study were newly diagnosed with diabetes mellitus type 2, glycemia < 12 mmol/L, and hed the Body Mass Index >30 kg/m2. They were treated with metformin, 1000 mg/day. Insulin sensitivity was determined by HOMA IR, insulin secretion by HOMA, lipid status by spectrophotometry. After six months of treatment blood biochemistry tested again. BMI was also established. Metformin significantly lowered BMI (BMI before therapy 31.02 kg/m2, after treatment 28.7 kg/m2) (both p<0,001 vs baseline) waist circumference mean value 98±0.55 cm-93,12 cm. (p<0,001) During the therapy the glycaemia decreased from 11.7 mmol - 6,78 mmol/l, insulinemia mean value 20.141 mlU/l -13.691, HOMA IR elevated in all patients. Among the cholesterol fractions, most significant results were obtained in LDL cholesterol. Mean LDL cholesterol levels 4.51± 2.02 mmol/L. Mean cholesterol level 6.98±2.31 mmol/L. HDL levels -1.32 mmol/L. Serum triglycerides was (mean) 2.63±1.32mmol/L. After six months therapy Metformin produces beneficial changes in lipid states. Metformin may be the first therapeutic option in the diabetes mellitus type 2 with overweight or obesity. Metformin produces beneficial changes in glycemia control, and moderated in weight, lipids and insulinemia. 

Formation of vascular access in elderly and diabetic patients is burdened with many difficulties. The aim of this study was to determine the factors that older people and patients with diabetes mellitus defined as the population risk for the formation of arteriovenous fistula for hemodialysis. The study was organized as a retrospective study, a subject of interest in people older than 65 years of age and diabetes, which in four years because of the need for further treatment performed arteriovenous fistula. Analyzed the demographic structure of the patient, type of anastomosis, the use of central-venous catheters for hemodialysis, arterial blood pressure and size of the lumen of blood vessels used for anastomosis, intraoperative measured. From the laboratory analysis determined the routine hematological and biochemical parameters. In relation to the positioning of arteriovenous fistula (p=0.033), the placement of catheters for hemodialysis (p=0.0009), preventive form of vascular access (p=0.04) and values of systolic (p=0.0001) and diastolic (p=0.0001) arterial blood pressure, achieved a statistically significant difference. Patients with diabetic nephropathy, compared to the population of elderly, have a significantly higher number of leukocytes (7.5±2.61 vs. 8.5±3.24, p=0.03), fibrinogen level (5.57±2.39 vs. 6.8±1.71, p=0.036), glycemia (5.35±1.24 vs. 7.1±2.28, p<0.0001), cholesterol (3.77±1 , 03 vs. 4.5±1.71, p=0.001), triglycerides (1.59 ±0.62 vs. 1.86±0.76, p=0.009) and LDL-cholesterol (2.13±0.76 vs. 2.42±2.04, p=0.02). Total proteins (64±9.98 vs. 62 ±7.4, p=0.027) and albumin (36±34 vs. 9.55±5.49, p=0.037) were significantly lower values in diabetics. Characteristics of older diabetics and is characterized as a risk population of patients for the creation of arterio-fistula were timely creation and position of arterio fistula, the need for placement of central-venous catheters for hemodialysis and arterial blood pressure.

Doppler ultrasound check-up significantly increases a possibility of initial functioning of arteriovenous fistula. The aim of the study was the preoperative evaluation of vascular system of the extremity for creation of arteriovenous fistula for haemodialysis. The examination was organized at Urology and Nephrology Clinic, Clinical Centre "Kragujevac". The examined subjects were 87 patients, 52 (59,8%) male and 35 (40,2%) female, mean age of 61±11,1 years. There were performed the routine biochemical analyses, demographical structure and clinical characteristics (type of anastomosis, fistula placement, arterial blood pressure, lumen size of the artery and vein, measured intraoperatively by Doppler technique). In 72,1% of patients with functioning fistula there was made a terminal-lateral anastomosis, compared to 57,7% of patients with initial non-functioning fistula, there was found a statistically significant difference between the groups p=0,008. Radiocephalic fistula was created in 62,3% of the examined patients with initial functioning , in patients with non-functioning, the distal fistula was created in 38,5% of the examined patients. Regarding the type of the fistula location there was obtained statistically significant difference; p=0,04. There was found a statistically significant difference between the group of patients with initial functioning of arteriovenous and the group without, concerning the intraoperatively measured lumen of the cephalic vein (2±0,29 vs. 2±0,38 mm); p=0,03 (2,1±0,5 vs. 1,8±0,4); p=0,0009. Statistical significance between the groups was also found in the lumen of the cephalic vein verified by the ultrasound (2,1±0,53 vs. 1,8±0,25 mm); p=0,038. Peak of the systolic speed of the radial, corelated to the group of patients with and the group without initial functioning fistula (50 ± 12,42 vs. 40 ± 6,9 cm/sec); (p=0,0026), has statistically significant value. By the correlation of the group of patients with initial functioning and the group of patients without initial functioning, regarding hemoglobin (97 ± 16,1 vs. 88 ± 18,3 g/l); p=0,006 and the level of urea (22,6 ± 12,7 vs. 23,9 ± 9,8); p=0,02, there was found a statistically significant difference. Color Doppler ultrasound has an important role in preoperative evaluation of blood vessels and it represents a meaningful predictive parameter of functioning of arteriovenous fistula. 

Epstein-Barrov virus (EBV) is a cause of heterophile antibody positive infectious mononucleosis (IM),which is characterized by fever, sore throat, limfadenopatiom and atypical limfocitozom. IM is mainly a self-limited disease. Complications of the central nervous system, hepatitis (which can be fulminant), (splenomegalia, obstruction of the upper respiratory tract with bacterial can sometimes be deadly.

Alpha lipoic acid is the most efficient of all known antioxidants for its lipo and hydrosolubility which enable easy penetrability in cytoplasm making its protection of free reactive radicals, energetic metabolism, regulation of genetic expresion etc. It has wide application in prevention and in therapy of diabetic angiopathy, neuropathy, cardiovascular, cerebrovascular, neurodegenerative disease, lesion, (insufficiency) of liver, HIV, intoxication with hard metals, mycotoxins etc. An important proprety of lipoic acid is its possibility to prevent or remove lesions which are caused by application aminogycosides and haloperidol (ototoxicity, nephrotoxicity) according to its wide application. R isomer of lipoic acid is physiological substance presented in organism which synthesize in in liver enabling its its application in relatively high dose for a longer period of time.