Ectopic thyroid tissue is a rare pathological finding bellow the diaphragm and extremely rare finding is ectopic thyroid tissue in the adrenal gland. Thyroid tissue can be located anywhere along the way of embryological migration pathway of thyroglossal duct. In most cases of ectopic thyroid tissue, it is located in the neck. Pathohistologically ectopic thyroid tissue in all cases was formed of follicular cells that expressed TTF-1, Thyroglobulin, PAX8, and cytokeratin 7, and there was lack expression of calretinin. In the literature we found 15 such cases. Women are much more affected than men (14:1), and it usually presents in the fifth decade (mean age 49). In all cases it was composed of normal follicular cells, and C cells were not found. Review of the literature reveals that adrenal ectopic thyroid tissue is almost always cystic, and has distinctive pathologic features. The most important thing is that ectopic thyroid tissue must be distinguished from metastatic deposits from thyroid gland carcinoma.

Introduction: Cardiovascular diseases (CVD) are leading factor in global mortality and morbidity. It is the cause of 1/3 of total annual mortality, while coronary heart disease (CHD), as one of the CVD entities, is responsible for 85% of deaths worldwide. The aim of the study is to show the importance of the first phase of cardiac rehabilitation (CR) in patients who are going on cardiac surgery, as well as the impact on respiratory function, the occurrence of pulmonary complications and the length of hospitalization. Methods: A sample of 18 patients was included in the randomized observer study. First phase of CR was carried out according to a predefined protocol. We used arterial blood gases (ABG) to evaluate the respiratory function, "two-minute walk test" (2MWT) to assess the functional capacity Data taken from medical documentation are the duration of mechanical ventilation (MV), the length of stay in the ICU, occurrence of the postoperative pulmonary complications and duration of total hospitalization. Results: The test sample consisted of 12 men (60.58 ± 8.33) and 6 women (66.00 ± 6.51). The mean value of CR was 6.15 ± 3.98 days and MV 19,67±11,23 hours. There were no pulmonary complications in 61,11% patients. Using ABG, a statistically significant difference was found in PO2 after extubating and at the last day in ICU (p = 0.01). 2MWT preoperatively significantly correlated with the examined on the last day of hospitalization (r = 0.648 p-value <0.001) well as the length of postoperative hospitalization and duration of mechanical ventilation (r = 0.708 p-value <0.001). Conclusion: The study showed that first phase of cardiac rehabilitation may positively affect the improvement of functional capacity.

Introduction: The most common causes of renal artery disease are stenosis, as a consequence of atherosclerosis and fibromuscular dysplasia. Computed tomographic (CT) angiography is a non-invasive method, which enables visualization of vascular structures and walls of blood vessels, as well as morphology of the renal parenchyma. Objective: To determine the importance of CT angiography in detecting the cause and degree of renal arterial disease. Methods: A total of 45 patients were included in the cross-sectional study conducted from March 2017 to March 2019 in the KBC DR Dragiša Mišović-Dedinje, Belgrade, Serbia. Criteria for inclusion were suspicion of secondary arterial hypertension, patients in preparation for kidney transplantation and in the follow-up period after transplantation, as well as patients with suspected traumatic lesions. We analyzed the causes of the disease, the morphology of the blood vessel wall, the percentage of stenosis, and the renal parenchyma. Results: The most common causes of renal arterial disease are atherosclerosis, which was found in 33 (73%) patients, renal artery aneurysm was found in 5 (11%) subjects, fibromuscular dysplasia in 4 (8.9%) and trauma in 1 (2) , 3%) of the patient. There were 10 (22.2%) patients with a significant (average 80 ± 14.5%) degree of stenosis. The sensitivity of CT angiography in the detection of atherosclerotic changes in the renal arteries was 87.9%, while the sensitivity of CT angiography in the detection of fibromuscular dysplasia was 75%. A statistically significant correlation was found between atherosclerotic stenosis of the renal arteries and a positive CTA finding (p = 0.0002). Conclusion: CT angiography is an important method of visualization and quantification of pathological changes in the renal arteries.

Introduction: Puberty is a juvenile developmental period accompanied by intensive growth and acquisition of reproductive ability. The onset of puberty is influenced by many factors: genetics, neuropeptides and glycoproteins, gonadotropins, sex hormones and the child's nutrition status. Premature puberty is defined as the appearance of secondary sexual characteristics in girls before the age of 8, and in boys before the age of 9. The aim of this paper is to analyze the published results on the importance and influence of factors such as birth weight, current weight and BMI on the development of premature puberty. Results: Eating disorders caused by eating high-calorie foods lead a child to obesity, which is accompanied by premature puberty. On the other hand, conditions characterized by reduced nutrition may be accompanied by delayed puberty. According to the results of this study, children with more pronounced manifestations of precocious puberty had a significantly lower birth weight Discussion: Birth weight of less than 2500g, as well as newborns' SGA (small for gestational age), are directly related to earlier pubertal maturation. Five decades ago, Frich et al. found that reaching a body weight of 48 kg in girls is a "critical mass" for development of menarche. Conclusion: The occurrence of secondary sexual characteristics is more frequent in children with increased body weight and correlates inversely with the child's birthweight.

Bruxism is a parafunctional activity of the masticatory system, which is characterized by clenching or scraping of teeth. This condition is often accompanied by a change in the shape and size of the teeth, as well as the function of the stomatognathic system. Bruxism can occur during sleep and in the waking state. The etiology is multifactorial and all causes can be divided into peripheral and central. The clinical signs and symptoms of bruxism are primarily characterized by temporomandibular disorders, the appearance of bruxofacets and changes in the hard dental tissues, supporting apparatus of the teeth and masticatory muscles, as well as headaches. The diagnosis of bruxism is made on the basis of anamnesis and clinical signs and symptoms, while electromyography and polysomnographic analysis are used in scientific researches. Therapy is aimed at controlling etiological factors and reducing symptoms. Occlusal splints are the most commonly used in the treatment of bruxism. Medications are used in situations when other methods, including psychotherapy, do not give positive results. Given the multifactorial etiology, the therapeutic approach must be multidisciplinary. The approach to the patient must be individual in order to treat as effectively as possible.

The new pandemic, caused by the corona viral disease 2019 (Covid-19), has brought with it a series of restrictive measures that have drastically altered people's way of life and which restrict freedom of movement, behavior and social engagement. At the time of pandemia, almost all aspects of each individual lifestyle have been impaired, especially in members of vulnerable groups, particularly women in postpartum women. Acute psychological reactions to a pandemia may include insomnia, fear of infection, anxiety, frustration, panic attacks, loneliness, but also depressive episodes. Non-psychotic postpartum mood and anxiety disorders can occur as an inability to adapt to stressful life situations. A comprehensive understanding of the impact of the pandemia on the mental health of women in the postpartum period is needed, in order to devise adequate approaches to recovery from such a major disaster as the Covid-19 pandemic.

Introduction: Postpartum depression negatively affects a woman's quality of life and the development of a relationship with her child, which can have far-reaching consequences on the cognitive, behavioral and emotional development of the child. Etiology includes genetic predisposition, sudden hormonal changes, and sociodemographic factors. Case report: A 28-year-old patient, married, mother of a one-month-old boy. She graduated from the High school of economics, unemployed. She appears in the family medicine clinic due to chronic fatigue and bad mood, at the insistence of her husband, who thinks that she needs professional help. She grew up in a harmonious family. He gets along well with his wife, there are no existential problems. It denies previous illnesses. Neat appearance, inconspicuous posture and behavior, psychomotor diskette slowed down, more sparse spontaneous verbalization, slightly compromised volitional instinctual dynamisms, lowered basic mood. In the laboratory findings, hypothyroidism with elevated thyroid peroxidase antibody and antithyreoglobulin antibodies is detected. The thyroid ultrasound verifies the right lobe of 46x14x15mm, the left lobe of 48x13x12mm, inhomogeneous and easily hypoechoic structure. The Edinburgh Postnatal Depression Scale indicates the presence of depression (total score 18). The patient is referred for a consultative examination by a psychiatrist and a nuclear medicine specialist. Psychiatrist indicates the introduction of Sertralin 50 mg tablets (1x1/2 for the first seven days, then 1x1) and Bromasepam tablets 1,5 mg (2x1/2), nuclear specialist Levotiroskin sodium tablets 50 mcg (1x1/2 for 5 days and 1x1 for 2 days). After six months, withdrawal of the symptoms of the disease and exclusion of therapy by a psychiatrist. Conclusion: Autoimmune thyroid disease is a significant and often unrecognized cause of postpartum depression. Early detection and timely therapeutic intervention of these have a significant role in the prevention and successful treatment of postpartum depression.

INTRODUCTION: Stress at work is a major problem in the modern world in many areas of work, especially in health care. Occupational burnout of nurses represents a serious problem, not only for themselves. It also affects the quality of the health services provided to patients. OBJECTIVE is to examine the connection between occupational stress and occupational burnout among nurses working in public health institutions. METHODS: An examination was carried out to determine aconnection between occupational burnout and occupational stress among nurses working in the hospital, at the departments of surgery, gynecology and emergency. For the evaluation of professional burnout among nurses, the Maslach Burnout Inventory, MBI-HSS pattern, was used, and Matteson and Ivancevich Questionnaire was used to assess occupational stress. Statistical data processing was done by the SPSS 17 software.RESULTS A total of 60 examinees were included in the study, 20 of them from the Surgery, Gynecology and Emergency department. Of these, 51 (81.7%) arefemale and 9 (18.3%) are male. The average age of nurses is 41.45 years, from which 40.9on Surgery; 41.8 on Emergency; 41.65 on Gynecology, and the average years of serviceare 17.91. Descriptive statistics for the examined variables are shown and it can be seen that there is a low level of occupational stress, i.e. the result is below 21.In the occupational burnout variable, respondents show the medium level of emotional exhaustion (M=24.05), low level depersonalization (M=3.83) and low level of lack of professional achievement subscale (M=38.71). The test results confirm the first hypothesis (H1) that with the increaseof occupational stress levels, the level of occupational burnout among nurses also increases.Occupational stress correlates with occupational burnout (r=0.529, p<0.01), i.e. nurses who have higher results of occupational stress, have more occupational burnout results also. The results of the tests involving correlations between occupational burnout and occupational stress dimensions show that with the increase of occupational stress the dimension of emotional exhaustion also increases (r=0.493, p<0.01), that there is no significant correlation between occupational stress and the dimension of depersonalization, and that the dimension of occupational stress and the dimension of individual realization have significant connection (r=0.393, p=0.01). The results show that there is no statistically significant difference between departments when it comes to occupational burnout, i.e. nurses working in Surgery do not have higher results of occupational burnout than nurses working in Gynecology and Emergency F(0.679) p>0.05, and that there is no statistically significant difference between the departments in terms of occupational stress, i.e. nurses working in Surgery do not have higher occupational stress results than ones working in Gynecology and Emergency department F(0.722) p>0.05. The results do not show significant differences in the level of occupational burnout and occupational stress in relation to nurses' age and years of service. DISCUSSION AND CONCLUSION: The results of the study show that with increased occupationalstressoccupational burnout also increases and that nurses have low levels of occupationalstress, low depresonization, low level of lack of personal achievement and a medium level of emotional exhaustion. There were no significant differences in occupationalburnout and occupationalstress between nurses working in surgery, gynecology and emergency departments. No significant differences in occupationalburnout and occupationalstress were found in relation to the age and years of service of nurses working in the departments of surgery, gynecology and emergency.

The most significant prostate diseases (PD) are benign prostatic hyperplasia (BPH), prostatic intraepithelial neoplasia
(PIN) and prostate cancer (PC). Generally, all PD are rare before the age of 50 with growing number of patients, primarily
with BHP, with each next decade, but about decade later the highest number of PIN and PC began to report. The aim of this
paper is to examine some of clinical, biochemical and histopathological characteristics of BPH, PIN and PC. Our sample
consisted of 169 men. Statisticaly the most common PD was BPH-77.5%, and the rarest PIN-8.3% (p<0.001). The average age of patients was 70.6±7.5 years (51-89) with no significant differences between diagnosis (p=0.415). PIN and PC are more often found in people from urban areas (p=0.004). In the central prostate area BPH is significantly higher in 88.5% (p<0.001). Peripheral parts are significantly more common places of PIN and PC (p<0.001). Median serum PSA values is statistically highest in PC-87.2 ng/ml (12.7-372.5), (p<0,001), especially those with predominantly peripheral parts localization. Gleason score is an important prognostic factor, with average value at PC is 7.32±1.4 (5-10), with a significantly higher values for diffuse PC. BPH is the most common, and PIN rarest PD. All diseases have occurred in people older than 50 years. Usually, BPH is in central and PIN and PC in peripheral prostate parts. PSA values were highest at PC, which is a prove of its importance in malignancy early detection.

Introduction:Although placement of the central venous catheter is a routine procedure carried out by anesthesiologists, it
carries a certain risk of complications. One of the complications is malposition, or inadequate catheter position.

Case report: We present a case of the patient who was admitted to an intensive care unit due to head injury and blood
vomiting. The central venous catheter was inserted through the right internal jugular vein. Due to haemodynamic instability and the need for fluid and blood infusion, a chest x-ray examination was not immediately performed to evaluate the position of the catheter. After the patient was stabilized, the test was performed and revealed that the tip of the catheter was not located in the superior vena cava but in the right subclavian vein.

Conclusion: This case has shown that the misplacement of the central venous catheter tip is not unusual. Once in the venous system, even when it is not located in the superior vena cava, it can be used for initial fluid replacement and drug administration, and after the patient is stabilized, the repositioning or placement of a new catheter should be considered.