Coronavirus Disease (COVID-19) is caused by the RNA virus SARS-CoV-2. The primary receptor for the virus is most likely Angiotensin-converting enzyme 2 (ACE2), and the virus enters the body by infecting epithelial cells of the respiratory tract. Through the activation of Toll Like Receptors (TLRs), epithelial cells begin to synthesize various biologically active molecules. The pathophysiology of the COVID 19 is primarily attributed to the hyperactivation of host's immune system due to direct damage to the cells, with consequent release of proinflammatory substances, but also due to the activation of the innate immune response through the activation of alveolar macrophages and dendrite cells (DC). A strong proinflammatory reaction causes damage to alveolar epithelial cells and vascular endothelium. Respiratory epithelial cells, alveolar macrophages and DC are likely to be the most important cells involved in the innate immune response to the virus, since prolonged and excessive SARS-CoV-2-induced activation of these cells leads to the secretion of cytokines and chemokines that massively attract leukocytes and monocytes to the lungs and cause lung damage.

Introduction: Children with low body weight for gestational age are five times more likely to die in the neonatal period and 4.7 times more likely to die in the first years of life compared to children born at term. The aim To analyze early adaptation to extrauterine life of low body weight for gestational age. Material and methods: Retrospective study with the observation period January-September 2018. The data were obtained by reviewing the medical histories of newborns. As parameters of early adaptation, we observed the Apgar score in the 1st and 5th minute as well as the presence of polycythemia at birth. Results: Out of a total of 405 newborns, 52 had low body weight for gestational age. Apgar score in the 1st and 5th minute was statistically significantly lower in children small for gestational age compared to children with normal body weight for gestational age (p <0.05). Polycythemia is a mechanism of adaptation statistically significantly more often present in children of small body weight for gestational age (p <0.05). Conclusion: Children of low body weight for gestational age have a lower Apgar score in the first and fifth minutes as well as more frequent polycythemia compared to children with normal body weight and we can take them as good indicators of adaptation to early extrauterine life.

Introduction/Aim: Heat stress represents the important problem in military services. This study investigates the effects of exertional heat stress on complex cognitive functions. Methods: 40 male soldiers performed exertional heat stress test, of which 10 performed the test of the same intensity in cool environment. Cognitive functions were mesured by computerized battery CANTAB, before and immediately after exertional heat stress test. Results: Exertional heat stress led to impairment of some cognitive functions in unacclimatized group: decrease of accuracy in MTS test (from 92,6±4,2% towards 84,5±6,9%, p<0,05) and PSRs (from 85,0±8,0% towards 77,0±9,6%, p<0,05), while similar decreases were recorded in MTS test in passively acclimatized group (from 92,2±5,5% towards 87,7±5,6%, p<0,05) i.e. in PSRs test in actively acclimatized group (from 83,3±6,3% towards 69,4±5,1%, p<0,05). The reaction time was not affected in any group whatsoever. Discussion and conclusion: Exertional heat stress leads to mild impairment of complex cognitive functions, particularly in domain of accuracy. Physical strain itself, however, does not affect cognitive functions. Relatively resistance to heat stress in zoung soldiers may be contributed to their high aerobic level.

Introduction: Sudden cardiac death (SCD) represents the unexpected and sudden death of young apparently healthy people. Alarge number of examined cases referred to professional athletes. There is not enough data in the literature related to those who performed sports in a sporadic and recreational manner. In order to prevent SCD, a screening protocol was determined, in which, an ECG performed at rest plays a important role. Based on the established criteria, changes on the ECG can be treated as normal, borderline and abnormal. An abnormal result indicates a risk of SCD. Objective: The aim of this study was to determine the risk of SCD in students who practice physical activity recreationally. Methods: The research involved 500 students (both sexes) of the 1st and 3rd year of study on the University of Pristina situated in Kosovska Mitrovica. As part of the regular systematic examination, an ECG was performed at rest. The risk of SCD was determined by analyzing the changes on the ECG and grouping them based on screening recommendations. Results: The obtained results show that 44% of students had changes on the ECG and that 8% of students had an abnormal result indicated a possible risk of sudden cardiac death. Conclusion: Therefore, timely recognizing and interpreting ECG changes in accordance with screening recommendations is an imperative for identification and possible prevention of SCD.

Introduction. Emotions are one of the most important psychological processes, with a decisive influence on a person's voice. Faced with the great challenges and changes that primary and secondary socialization agents impose in the process of growing up, children consequently experience a spectrum of various unpleasant feelings: anxiety, fear, anger, frustration and sadness. Due to the fast-paced lifestyle, it often happens that the child ignores unpleasant feelings, which further worsens the condition in which he finds himself. Among other conditions, psychogenic aphonia in children has become more frequent in recent years. The current case report aims to determine the frequency of psychogenic aphonia in children, to identify the most common causes that lead to psychogenic aphonia and highlight the methods of vocal treatment that give the best results during rehabilitation. Case report. The current paper presents the results collected in a two-year period at the Clinic for Ear, Throat and Nose of the Clinical Hospital Center "Zvezdara". In the period from March 2017 to May 2019, psychogenic aphonia was diagnosed in 31 patients, which is an evident increase compared to the previous ten-year period in which psychogenic aphonia was diagnosed in 38 younger patients. Analyzing heteroanamnestic data obtained from parents, the most common answer about the cause of psychogenic aphonia is dissatisfaction with school success. After successful diagnostics by an otorhinolaryngologist, psychiatrist and vocal pathologist, in the process of rehabilitation of psychogenic aphonia, methods of digital manipulation of the larynx, methods of restoring the voice with cough reflex and methods of turning out the feedback system were applied. In this particular case, the method of digital manipulation of the larynx gave the best results. Conclusion. Optimal evaluation of patients with voice disorders requires the joint efforts of experts from different disciplines. Having in mind the tendency of recurrence of psychogenic aphonia, these findings suggest that the integration of the interventions of a vocal pathologist and a psychiatrist could give effective results in the process of rehabilitation voice.

The variety of etiological factors contributing to the development of distal bite various form, as well as the structures that are affected by the disorders determine the deegre of complexity of the malocclusion itself, and thus the choice of therapeutic procedure by which it will be treated. An 11-year-old female patient was diagnosed with this type of malocclusion with a certain degree of presence of other irregularities. After a detailed diagnostic procedure, and determining the type of growth, we approach the therapeutic procedure in two phases. By applying the funcional therapy in the first phase, we correct the vertical growth type, and then in the second phase of therapy using a fixed technique we achieve harmonious intermaxillary relations, an adequate molar and canine Class I relationship as well, thus improving the aesthetics of the patient's face.

Any fracture of the femoral shaft presents a challenge to the orthopedic surgeon. Femoral fractures most often occur within polytrauma, by forces of high intensity as is the case with traffic accidents. There are two methods to treat with internal fracture fixation, intra and extra medullary fixation. Both treatments have their advantages and disadvantages and it is necessary to make a good preoperative plan. We present the case of a 23-year-old man who suffered a femoral shaft fracture as a driver in a car accident. He was initially surgically treated with orthopedic repositioning and internal, extramedullary fixation. After 18 months, bending of the osteosynthetic material and dislocation of the fragments with varus and recurvatum were verified. Oligotrophic pseudoarthrosis was also present. Reintervention and fixation with interlocking nail was performed. The weight bearing is allowed after two weeks. After 3 months, patient has full range of motion and there is no palpatory painful sensitivity. Intramedullary fixation is the method of choice for fractures of the femur, especially when there is no comminution and in cases of open fractures of the first and second degree. Rotation of fragments is locked, physical rehabilitation is faster and there is less risk of mal union.

Hip fractures as well as coxarthrosis are conditions that are becoming more common in everyday orthopedic practice. With the aging of the world's population, there is an increasing need for partial (HA) or total hip arthroplasty (THA). No elective procedure is as important to quality of life as total hip arthroplasty, and partial hip arthroplasty is a method of treatment in elder population who suffered fracture of the femoral neck. There are several hip approaches that can be used for arthroplasty. Hip dislocation is a serious complication after hip arthroplasty and occurs somewhat more frequently when the posterior hip approach is used. The aim of this study is to show that the piriformis sparing technique gives better results in terms of reducing the frequency of dislocations in the early postoperative period (one year). We operated od 249 patients, and after follow-up that lasted from 13 to 22 months we had four dislocations, three in patient with THA(0.021) and one after HA(0.009). Preservation of the piriformis tendon is a minor modification in the operative technique that can lead to a great benefit in the quality of treatment and a reduced risk of complications.

Treatment of humerus fractures is divided into operative and non-operative treatment Fractures of the diaphysis of the humerus heal well. Surgeons today have many opportunities to treat them. The decision on the type of treatment to be applied depends on the location of the fracture, the existence of associated injuries, the age and the general condition of the patient. Non-operative treatment is most often applied, although there are fractures in which surgical intervention is necessary in order to perform healing and prevent complications. Non-operative treatment of fractures of the diaphysis of the humerus gives good results, with little angulation and minimal or no shortening of the arm. Adequate repositioning, appropriate plaster immobilization and regular X-rays heal the fracture within the allotted time. Disciplined early physical therapy in terms of circular movements prevents shoulder contracture and allows later physical therapy to last significantly shorter. Non-operative treatment lasts from 7-11,5 weeks.

The ectopic spleen (ES) is a rare variation occurred depend on the absence or laxity of the suspensory ligaments. The ES is a rarely diagnosed clinical condition. Less than 500 symptomatic patients have been reported. Less than 0.25% of splenectomies are performed on the ES. Patients are usually asymptomatic. It's diagnosed incidentally in general. The incidence is not clear. ES incidence is reported less than 0.5%. However, this rate covers all of the relocations. The spleen can be found anywhere in the abdomen or pelvis, depends on the length of the vascular pedicle. The pelvic ES is a rarely encountered situation. Knowing this anomaly is essential for early diagnosis and prevention serious problems such as torsion, infarction and acute abdomen. A 21 years old female patient with ES was presented on pelvic magnetic resonance imaging.