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: The role of oxidative stres in patients with Meniere disease (MD), is still unresearched.

The aim: The aim was to compare serum levels of total and direct bilirubin, albumins, uric acid and creatinine as antioxidative status parameters in patients with MD with healthy controls, and patients with multiple sclerosis (MS).

Methods: We divided patients in three groups - 85 MD patients, 75 healthy controls (HC) and 72 MS patients. Patients with
MD were divided into groups according to sex, age at the time of the disease onset, and number of attacs per year. Severity
of clinical presentation during the attack was assessed by Vertigo Symptom Scale.

Results: The serum levels of all parameters were significantly lower in MD and MS group compared to the healthy control
group (p<0.05). Regarding severity of clinical presentation we found strong correlation (p<0.001) which indicates lower
antioxidant status in patients with severe clinical presentation.

Conclusion: The results of our research showed significantly lower values of all investigated parameters in MD group
related to the healthy controls, which could suggest a potential role of oxidative process in MD patophysiology. 

Chronic obstructive pulmonary disease (COPD) significantly reduces quality of life and is one of the main causes of chronic morbidity and mortality worldwide. Acute exacerbation of COPD (AECOPD) is a life-threatening condition that causes rapid deterioration of respiratory symptoms (worsening of dyspnea, cough and/or abundant sputum production) requiring urgent treatment. This review article examines the evidence underlying supplemental oxygen therapy and ventilator support during exacerbations of COPD. In the introduction, we discuss the epidemiology and pathophysiology of hypercapnic respiratory failure, and then we explain that the key to achieving appropriate levels of oxygenation is using controlled low-flow oxygen therapy. In patients with risk of hypercapnia a target oxygen saturation (SaO ) range of 88%–92% 2 is now generally accepted unless hypercapnia is disproved by gas analysis of arterial blood. However, if the partial pressure of carbon dioxide in arterial blood (PaCO ) is normal, oxygen therapy may target the usual saturation range of 94%–98%. 2 Many COPD patients may have a lower stable SaO , such that chasing this target (94%-98%) is not usually necessary unless 2 the patient is unwell. Further, we review current recommendations for ventilatory support in patients with AEHOBP. Noninvasive ventilation has assumed an important role in managing patients with acute respiratory failure. The use of invasive ventilation is the last remaining option, associated with a poor outcome.

Introduction The testing of stressors and the impact of stress on health and work ability of electricians working in workplaces with a special health risk is very important.

OBJECTIVE is to examine the impact of occupational stress on the ability of electricians to work.

METHODS The research was designed as a cross sectional study and covered 108 respondents, classified into two groups: electricians (52) and control group (56) made up of administrative workers. The survey included the following: Questionnaire on basic sociodemographic indicators of respondents, IRS Questionnaire, Work Ability Index (WAI) Questionnaire, General Health Questionnsire (GHQ), Copenhagen Burnout Inventory (CBI) and Occupational Stress Assessment Questionnaire. Data analysis was performed with SPSS.

RESULTS The frequency of different categories of WAI score is uniform between the tested groups (p = 0.155). Work ability is poor in 11.5%, moderate in 25%, good in 26.90% and excellent in 36.5% of electricians. The frequency of different categories of WAI score is aligned between the tested groups (p = 0.155). By analyzing all components of IRS score, it was found that there is a statistically significant difference in the components between the electricians and the  control group: requirements (p <0.001) and work role (p <0.001); GHQ is higher in electricians, but no statistically significant difference was found (p = 0.082); CBI is statistically significantly higher in electricians (p <0.001) and WAI score is statistically significantly higher in electricians (p = 0.039). In the overall population, the 10 strongest stressors were ranked and statistically significant difference in all stressors (p <0.001) between the electrician and the control group was shown. The values of the stressors are equal in relation to WAI score categories. In the electricians, the strongest stressors are: night work (4.60), hazards (4.58), shift work (4.54), working overtime (4.46), time limit for individual tasks (4.44), fear of injuries (4.42), pressure of time limits for execution of tasks (4.23), work overload (4.22), inadequate work space (4.18) and daily unforeseen situations (4.10). Average value of all stressors among electricians is 2.87 ± 1.10 (Min 1.10, Max 4.60). In the tested population, 14 different stressors have higher values than the average value of all stressors. In the control group, the average value of all stressors is 1.84 ± 0.33 (Min. 1.17, Max 2.69). Correlation analysis has shown that there is a correlation of age with shift work (r = 0.130, p = 0.013) and working overtime (r = -0.220, p <0.001). URS is statistically significantly related to the time limit for individual tasks (r = 0.149, p = 0.005) and pressure of time limits for execution of tasks (r = 0.125, p = 0.017). ERS is statistically significantly related to night work (r = 0.169, p = 0.001), shift work (r = 0.160, p = 0.002), time limit for execution of tasks (r = 0.203, p <0.001) pressure of time limits for execution of tasks (r = 0.194, p <0.001), work overload (r = 0.128, p = 0.017) and inadequate work space (r = 0.122, p = 0.022). The subjective assessment of work ability in relation to physical (p = 0.010) and psychological requirements (p <0.001) is statistically significantly lower in electricians compared to control group. DISCUSSION By analyzing all components of IRS score, it is found that there is a statistically significant difference between the electricians and the control group in the requirements and the working role components. In the overall population, the top 10 stressors were ranked and it was shown that there was a statistically significant difference in all stressors between the electricians and the control group. The average value of all stressors in the electricians is high and a large number (14) of different stressors have higher values than the average value of all the stressors. The subjective assessment of work ability in relation to physical and mental requirements is statistically significantly worse in electricians than in control group. More than half of electricians went on sick leave (mostly short leaves) during the previous year.

CONCLUSION Occupational stress significantly affects work ability of electricians. Values of WAI score are statistically significantly higher in electricians, and values of stressors are equal in relation to WAI score categories. Correlation analysis has shown there is a correlation between age, URS and ERS with individual stressors. 

Introduction: Dementia is a clinical diagnosis based on deficits of intellectual function, usually memory. Primarily neurodegenerative diseases are characterized by progressive neuronal damages and its synapsis. Early-onset Alzheimer disease 18 occurs in someone younger than 65. FDG-PET/CTis a quantitative tomographic technique also calleda biomarker of neuronal activity.

Case outline: A female of 54, mother, 12 years of education, an accountant, was sent to FDG-PET/CT brain scan because of loss of memory, social withdrawal, apathy, behavior changes, troubles with paying bills, speaking difficulties with no structural imaging abnormalities. PET scan reviled glucose hypometabolism in parietal lobes, left posterior cingulum, parietotemporal regions, the left parietooccipital region, left insula and temporal lobes. A male of 43, father, army corporal, 12 years of education, was sent to metabolic hybrid imaging because suspected dementia. He expressed progressive behavior decline, in a year time. The patient wasn't cooperative, could not concentrate and confabulated a lot. Forgetfulness, decline in voluntary dynamics and apathy dominated the clinical presentation. Structural imaging showed supratentorial, right precentral gyri solitary lesion and cortical bilateral hypocampal atrophy. FDG scan reviled distinctively diminished glucose metabolism posteriorly in parietal and temporal lobes, both posterior cingulum. SPM analysis confirmed the visually observed pattern of hypometabolism in both patients.

Conclusion: Depression is an important consideration in the differential diagnosis of AD. Early detection of AD through molecular imaging techniques will assist the choice of medications to slow the progression of the disease and optimize patient care.

Introduction: Asphyxiation by aspiration- inhalation of foreign bodies is a form of violent mechanical asphyxia and can occur at any age, most commonly in children and the elderly. In children up to third age choking is a significant cause of morbidity and mortality. Mortality due to aspiration of foreign bodies is higher in children because of the relatively narrow airways and less developed protective mechanisms. The size, type, shape and place of obstruction with foreign body leads to the diversity of clinical picture.

Case report. We present the case of a 15 month-old girl, who was found by her mother in her house in a village, lying down, cyanotic, collapsed, without breathing. Autopsy showed that the cause of death was acute respiratory obstruction with impacted grains of corn in two places, on the larynx entrance and in the right bronchus.

Conclusion. The diagnosis of death by asphyxiation due to aspiration of foreign bodies is set at autopsy, when the place of airway occlusion is found. If a foreign body was removed during providing assistance, the diagnosis would be made based on medical records or history data of persons who were provided assistance. In cases of sudden deaths of young children, in order to clarify pathophysiological mechanism and mode of death in each case, a pathologist should always keep in mind the possibility of aspiration of foreign bodies, and in accordance with this, carefully apply appropriate autopsy techniques to locate the place of obstruction, with special regard to local finding in airways.

Introduction: Primary mediastinal large B cell lymphoma is a rare highly aggressive form of non-Hodgkin lymphoma and occurs in 5-7% of all diffuse large B lymphoma and 2% of all non-Hodgkin lymphomas. Originates from thymic medullary cells and has its own histogenesis. Typically affects young women in the third and fourth decade of life. Superior vena cava syndrome is present in more than 50% of cases, with swelling of face, hands, deep venous thrombosis, dyspnea, dysphagia, chest pain, headache and cough. Diagnosis is made by histopathological analysis and immunohistochemical surgical biopsy specimens obtained mediastinoscopy. Timely treatment with cycles of monoclonal antibody and chemotherapy is requirement to relapse and stable state.

Case outline: Patient, 37 years old, came for the first time for review at General practice because she has been repeatedly visited emergency service due to coughing, feeling that something is strangling, the lack of air pressure and pain in the head and swelling of face and neck. Started detailed diagnostics. Radiologically determined mediastinal tumor, computed tomography confirmed it and sent to the referral Institute where video-assisted thoracic surgery and patho histology diagnosed PMBCL CSII AM +. Administered six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone therapy protocols submitted by the expected side effects. Control positron emission tomography found that the tumor mass completely withdrawn. In remission for two years, have a good feeling and occurs at regular checkups.

Conclusion: General practice has a big responsibility in recognizing early symptoms of malignant disease that accelerates
the diagnosis and timely start of treatment.

Migratory erythema is the most common manifestation of the first (early) phase of Lyme borreliosis. It is defined as the spreding rash or redness at the site of the tick bite. Although the occurrence of migratory erythema indicates the presence of local infection with pathogenic strains of bacteria from Borrelia burgdorferi sensu lato complex, the exact mechanism by which spirochetes conductspreading in human skin has not been elucidated. This paper will review the literature, initially related to tick-pathogen-host interaction, after which the most common theories of the development of specific morphology of migratory erythema will be presented, as well as differential diagnostic problems that may arise from infection with other pathogens or the development of various allergic and autoimmune conditions.