Introduction. Hypothyroidism can be accompanied by various neuropsychiatric manifestations ranging from mild depression and anxiety to psychosis. Objective. The study aimed to determine the presence of depression in patients with hypothyroidism (clinical and subclinical). Methods. The survey was conducted over twenty-four months, from 01. 07. 2017. to 01. 07. 2019., at the Health Center Krupa na Uni. The cross-sectional study included 160 persons, two groups of 80 persons each. The first group included those with newly diagnosed hypothyroidism, while the control group consisted of people with neat, thyroid function. In addition to the general questionnaire, the study used Beck's Depression Inventory and laboratory analyzes (enzymatic assays to determine thyroid stimulating hormone and thyroxine). The chi-square test was used in the statistical analysis. Results. The first group consisted of 62 (38.7%) subjects with subclinical hypothyroidism and 18 (11.3%) with clinical hypothyroidism, 51 (63.7%) women and 29 (36.3%) men with a mean age of 52±6.9 years. The control group consisted of 42 (52.5%) women and 38 (47.5%) men, with a mean age of 51±4.3 years. Mild depression was verified in 50 (31.2%), moderately severe in 43 (26.9%), and severe depression in 3 (1.9%). The study found the existence of statistically significantly moderate-severe depression in participants with subclinical hypothyroidism (p<0.05). Conclusion. The results of our study indicate a statistically significantly presence of moderately severe depression in patients with subclinical hypothyroidism. Early detection and adequate therapeutic intervention of thyroid gland disorders in patients with depression. Our findings favor the need for early and routine screening for hypothyroidism and depression.

Introduction. Jarisch-Herxheimer reaction implies trembling, headache, temperature, rash, meningitis, respiratory problems, liver, kidney and heart dysfunction during antibiotic treatment of Lyme disease. Case outline. A 47-year-old patient in May 2016 had circular redness on the thigh, fatigue, myalgia, nausea and headache. Borrelia Burgdorferi IgM antibodies were positive. She took doxycycline 200 mg/day, four weeks. Western blot IgM and IgG were positive as well. Retreated with Azithromycin, 500 mg/day, three weeks. Next year, there was a sleep and memory disorder, fatigue, dizziness, right leg paresthesia and burning in the soles, muscle weakness, decreased sensitivity and right foot hyperreflexia. Electromyography showed axonal degeneration of the peroneus and the tibialis. Pleocytosis (5 leucocytes/mm³) and intrathecal IgG were found. Magnetic resonance of the head in order. Neuroborreliosis was diagnosed and treatment included ceftriaxone, 2 grams/day, three weeks. After the second dose, trembling, myalgia, headache, nausea, flushed nose, dizziness and nausea started. Temperature 37.8°C. No changes on the skin. The antibiotic was not interrupted, symptomatic therapy was administered, and after two days the symptoms stopped. Neurological disorders have not completely disappeared. Titre antibodies still present. Conclusion. Jarisch-Herxheimer reaction occurs in 7.0-30.0% of patients treated for Lyme disease. Causes are multifactorial. Spirochetes release toxins, hypersensitivity is present, phagocytes destroy agents, complements and cytokines are activated. It is often not recognized. Tremor, fever, myalgia and skin rashes are present before the antibiotic, and the worsening is attributed to the underlying disease or allergy. Doctors should expect it during the treatment of spirochete-related diseases and provide appropriate care.

Uvod: Primarni medijastinalni B krupnoćelijski limfom je redak, visoko agresivan oblik non Hodgkinovog limfoma i javlja se u 5-7 % svih difuznih velikoćelijskih B limfoma i 2% svih non Hodgkinovih limfoma. Vodi poreklo od medularnih ćelija timusa i ima sopstvenu histogenezu. Tipično obolevaju mlade žene u trećoj i četvrtoj dekadi života. Sindrom gornje šuplje vene je prisutan u više od 50% slučajeva, sa otokom lica, ruku, dubokim venskim trombozama, dispnejom, disfagijom, bolom u grudima, glavoboljom i kašljem. Dijagnoza se postavlja patohistološkom i imunohistohemjskom analizom hirurškog bioptata dobijenog medijastinoskopijom. Blagovremena terapija ciklusima monoklonskih antitela i polihemioterapijom omogućava stabilan relaps bolesti. Prikaz bolesnika: Pacijentkinja, stara 37 godina, javlja se prvi put na pregled kod svog izabranog lekara jer je već u nekoliko navrata posećivala Službu hitne medicinske pomoći zbog kašlja, osećaja da je nešto davi, nedostatka vazduha, pritiska i bolova u glavi kao i otečenosti vrata i lica. Započeta detaljna dijagnostika. Radiološki utvrđen tumor medijastinuma, kompjuterizovana tomografija potvrdila i poslata na referentni Institut gde je videoasistiranom torakoskopskom hirurgijom i patohistološkom analizom dijagnostikovan PMBCL CSII AM+. Ordinirano šest ciklusa rituksimab, ciklofosfamid, doksorubicin, vinkristin i prednizolon terapijskog protokola koje je podnela sa očekivanim neželjenim dejstvima. Kontrolna pozitronska emisiona tomografija utvrdila da se tumorska masa u potpunosti povukla. U remisiji je dve godine, dobro se oseća i javlja se na redovne kontrolne preglede. Zaključak: Na izabranom lekaru je velika odgovornost u prepoznavanju ranih simptoma maligne bolesti što ubrzava postavljanje konačne dijagnoze i blagovremeni početak lečenja.

Introduction: Stomach cancer is the second in mortality and the fourth most frequent of all cancers in the world. In the recent decades, the number of patients with Signet ring cell carcinoma type has been growing. Unknown etiology with proven risk factors such as smoked and salted foods, smoking, metabolic syndrome, alcohol abuse and Helicobacter pylori infection. Five-year span survival is 20%-40%.

Case outline: Patient, 70 years old, in good health, came to the GP, because of pain she had been feeling in the lower back area for a couple of months. Sometimes she wakes up because of the pain below the chest. Belch, acid, lost three kilograms. Didn't pay any attention to the problem because earlier, due to severe osteoporosis, she had obtained a compression fracture of two vertebrae. Occult bleeding negative. Laboratory normal. Tenderness on palpation of epigastrium, the tumor mass is not palpable. Addressed immediate to esophagogastroduodenoscopy. Diagnosis: Ulcer ventriculi, region antrum. Histopathological findings: Gastric Adenocarcinoma, diffuse type, Signet ring cell. Computed tomography showed locoregional lymphadenopathy so responsible Consilium decided radical surgery and chemotherapy. Despite being treated, the patient pass away two years after the onset of the illness.

Conclusion: Primary health care workers have a big responsibility, because of nonspecific symptoms, in detection of gastric cancer. Good evaluation of patients who should be referred for esophagogastroduodenoscopy is essential. The doctor should keep in mind in the further course of treatment early postoperative complications, Dumping syndrome, appears ventral anastomosis, subocclusive disorders, gallbladders calculus formation, educate patients about nutrition, vitamins, monitor vitamin B12 and iron because patients are prone to vitamin deficiency and pernicious anemia. Psychological support for patients and their families is also very significant, through a concrete doctor-patient relationship.