Introduction: Hypersensitivity pneumonitis is a complex pulmonary syndrome mediated by the immune system and caused by inhalation of antigens to which the patient has been previously sensitized. From the clinical point of view hypersensitivity pneumonitis can be divided into acute/subacute, and chronic phenotypes. It is characterized by an insidious onset of cough, dyspnea, fatigue, and weight loss that develop over several weeks to a few months. Case report: A 52-year-old patient came in February 2017 with high temperature, chest tightness, dyspnea, persistent cough, hemoptysis and weight loss of more than 6 kilograms. Radiography and computerized tomography showed poorly defined small diffuse centrilobular bilateral nodules. Inspiratory crackles were detected by physical examination. Routine laboratory tests were regular. Bronchoalveolar lavage fluid analysis and lung biopsies by video-assisted thoracoscopic surgery indicated the presence of diffuse lymphocytic infiltrates and giant cells with non-necrotizing granulomas and cellular bronchiolitis. Hypersensitivity pneumonitis diagnosed. She was given 35 mg deflazacort, bronchodilators to widen the airways and etamsilat pills. We did not identify the causative agents, including home, workplace and recreational environmental factors.Conclusion: Making the correct diagnosis has critical therapeutic and prognostic implications. Patients with hypersensitivity pneumonitis should be referred to expert centers, as the overlap with other forms of interstitial lung disease may be deceiving. The mainstay in managing this illness is to avoid the causative antigen, though complete removal is not always possible.

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.

Introduction: Neuromuscular autoimmune diseases, above all multiple sclerosis, have an increasing prevalence today. They develop with nonspecific symptoms, progress, have consequences on the functioning of the whole organism and are a major cause of disability. Case Report:A70-year old woman with difficulty in walking, cramps and numbness of the limbs seek medical help. The MRI of the brain and the cervical segment shows demyelination changes, typical of the multiple sclerosis, but due to the nonspecific clinical picture and age, the tests are directed to infectious agents, vasculitis. Later, because of swelling of extremities diagnosed the autoimmune polymyositis, but for the treatment is poorly reacted. Conclusion: Due to contradictory findings and a limited number of diagnostic procedures, multiple sclerosis are difficult to diagnose, remains undetectable, progresses and is often fatal, especially in the elderly.

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.

Bronchiolitis is an acute viral disease of lower respitatory pathways in children under 2 years of age. It is manifested by coughing, whistling and refusing food intake. The most common cause of bronchiolitis is a respiratory syncytial virus. Vitamin D is a steroid hormone which is synthesized in the skin after sun exposure or food intake. With discovery of Vitamin D receptors and hydroxylated enzymes in immune cells, a potential role for Vitamin D in maintaining immune homeostasis was seen. It has been established that Vitamin D induces a change of the antimicrobial polypeptide, cathelicidin, which has both antibacterial and antiviral roles.

A case of a patient is shown, who was admitted for neurological exploration, with clinical manifestations of the cerebrovascular accident in the posterior circulation (TIA V-B vascularisation). In accordance with diagnostic protocol, an endocranial CT was performed. The results of the brain CT indicated an existence of an alteration in the right pontocerebellar angle area, which was subsequently diagnosed as a n. vestibularis schwannoma in an NMR examination. After a neurosurgical deliberation, the patient was treated with a gamma knife. After this surgery, which was done in a local anesthesia, the patient's condition was well and he was discharged. Control examinations have shown minor difficulties during the stimulation of the left ear auditive structures. Control examinations involving NMR showed no signs of recidivate focal findings.

Arachnoid cysts are cavities filled with liquor, usually localized on the floor of the middle cranial fossa. Clinically, they are usually asymptomaticand can sometimes be presented with increased intracranial pressure syndrome and epileptic seizures. We present a patient who, after a slight head injury in a accident develops an increased intracranial pressure syndrome followed by an epileptic seizure. Based on the clinical course and diagnostic processing, we want to draw attention doctors who are in a position to inspect these patients that apparently slight head injuries can be complicated and dangerous for the lives of the premorbid intracranial condition of the injured.

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. 

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.