Twin to twin transfusion syndrome (TTTTS) accounts for approximately 10% of monochorionic twin pregnancies and, if left untreated, is associated with high morbidity and mortality rate. A net transfusion of blood flow from one fetus (donor twin) to the other (recipient twin) via placental vascular anastomoses has been supposed as the major etiology of TTTTS. The donor twin becomes hypovolemic and oliguria, oligohydramnios, and a variable degree of growth restriction develop, whereas the recipient twin manifests polyuria, polyhydramnios, and hydrops in response to hypervolemia. TTTTS can be treated by either serial amniocentesis or selective fetoscopic laser coagulation of the communicating vessels. The rationale for removal of large volumes of amniotic fluid is to prevent preterm delivery secondary to polyhydramnios and to improve fetal circulation by reducing pressure on the chorionic plate. On the other hand, the goal of laser therapy is to occlude vascular anastomoses, thereby interrupting intertwin blood exchange. Although laser treatment is associated with increased survival rate and reduced neurologic complications, compared with amnioreduction, it requires highly specialized centers, whereas serial amniocentesis has the advantage of being performed worldwide. Therefore, the optimal treatment for pregnancies complicated with TTTTS is still controversial.

The number of elderly with chronic kidney disease (CKD) is constantly increasing worldwide, and irregular screening of CKD leads to disease discovering usually in advanced stages. The aim of the study was to examine the presence of CKD biomarkers in the elderly primary care patients, and to analyze whether the presence of diabetes and hypertension in elderly increases the risk for microalbuminuria and reduction of glomerular filtration rate (GFR). Cross-sectional study included 90 patients older than 65 years of age who are registered in the Family medicine teaching centre of Health centre Bijeljina. Patients were divided into three groups: first consisted of 30 patients who had neither hypertension nor diabetes nor other chronic disease, second of 30 patients with type 2 diabetes mellitus and third of 30 patients with arterial hypertension. Data on patients were obtained by interview, analysis of medical records and physical examinations. Serum and urine creatinine, proteinuria, microalbuminuria (MAU, turbidimetry), and urinary sediment were analyzed. Biomarkers of chronic kidney disease (GFR <60 mL / min / 1.73m2, proteinuria and mikroalbuminurija<MAU) were found in 20 (22.2%) patients. Among them, 14 had normal GFR and MAU (12) or MAU and proteinuria (2), whereas 6 had GFR <60 mL / min / 1.73m2 of which 3 had proteinuria and / or MAU. The group with diabetes had significantly more MAU compared to the other two groups, while the groups with diabetes and hypertension had slightly more proteinuria and erythrocyturia than control group. Hypertension and diabetes in the elderly may result in development of CKD biomarkers, so prevention and regular screening of CKD in the patients with these two diseases are necessary.

Among the many antibiotics that treat infections of the respiratory system, the most common and with a large role are penicillins, cephalosporins, and macrolides. Acute otitis media is rapidly formed otitis media, with the duration of the inflammatory process to 3 weeks. As a rule, there is a nasal-pharyngeal route, and causes are viruses, bacteria and / or a viral / bacterial coinfection. To determine the effectiveness of amoxicillin, amoxicillin with clavulanate, ceftriaxone and azithromycin in children aged 0 to 14 years, depending on the number of repeat episodes. 120 patients with acute inflammation of the middle ear, treated in the cabinet of Otorhinolaryngology of Health Center of Gracanica. Diagnosis of the patients was placed and confirmed on the basis of physical examination, laboratory and microbiological analysis and tympanometry findings. 120 children aged 0-14 years. 52 (43.33%) male and 68 (56.67%) female. In 37 (30.83%) an episode of OMA, in 41 (34.86%) two episodes, in 29 (24.16%) three, in 13 (10.83%) cases more than three episodes in the past year. In 23 (19.16%) two epizide acute inflammation shorter than two months, in 11 (9.16%) children 3 episodes in 6 months, and in 13 (10.83%) children four episodes OMA for a period of one year . Causes: Streptococcus pneumoniae (37.64%), Haemophilus inphluenzae (14.11%), Moraxella catarrhalis (12.94%) and Pseudomonas (12.94%), Staphylococcus aureus (4.70%), Escherichia coli (4.70%) and Streptococcus pyogenes (3.52%). Amoxicillin (90 mg / kg bw) and amoxicillin + clavulanate (90 mg / kg bw), azithromycin (5-10 mg / kg bw), ceftriaxone (50mg / kg). Based on our research, we came to the data that is generally consistent with the WHO recommendations for the treatment of OMA in children.

Uz tradicionalne faktore rizika smatra se da i inflamacija doprinosi nastanku ishemičnog moždanog udara (IMU). U toku inflamacije neutrofilni leukociti se degranulišu, kada može doći do oslobađanja njihovog enzima mijeloperoksidze (MPO) u ekstracelularni prostor. Osim peroksidazme MPO poseduje i hlorinišuću aktivnost kojom stvara hipohlornu kiselinu i dugoživeće oksidanse hloramine. U ovoj studiji je određivana hlorinišuća aktivnost MPO i koncentracija ukupnih hloramina u serumu. U studiju je bilo uključeno 29 pacijenata sa akutnim IMU, starosti 69.0 godina (64.2–78.0), i 25 ispitanika kontrolne grupe bez IMU, starosti 69.0 godina (67.0–72.0). Nađeno je da je u grupi sa IMU broj neutrofilnih leukocita u perifernoj krvi značajno veći od kontrolnih vrednosti (4.56±1.76 vs. 7.74±3.35 × 109/L, u kontrolnoj grupi i kod pacijenata; p<0.05). Takođe je i hlorinišuća aktivnost MPO seruma bila veća u grupi sa IMU (67.2 U/L vs. 92.3 U/L, kod kontrole i kod pacijenata; p<0.05). Iako je koncentracija ukupnih hloramina bila nešto veća kod IMU nego u kontrolnoj grupi, razlika nije bila statistički značajna (p=0.178). Aktivnost MPO je značajno korelirala sa koncentracijom triglicerida (p<0.05). Korelacija između hlorinišuće aktivnosti MPO i ukupnih hloramina nije bila značajna (p=0.402), dok su korelacije MPO aktivnosti i broja neutrofila (p=0.071) odnosno MPO aktivnosti i prisustva aritmije (p=0.094) bile nešto veće. Rezultati ove studije ukazuju da MPO verovatno ima ulogu u patogenezi IMU, što se delimično može zasnivati na hlorinaciji biološki značajnih molekula vaskularnog kompartmana.

Hypertension represents one of the most significant preventable causes of death worldwide, and accordingly the target group for its prevention and early detection primarily refers to young population. Assessment of prevalence of selected risk factors for the development of hypertension among students, and determination of the existence of differences between genders, defined age groups and included faculties. A cross-sectional study was carried out during 2013., at Faculties of Medical Sciences, University of Belgrade. Respondents completed an questionnaire specially designed for the purpose of this study. Categorical data were analyzed using statistical chi-square test of independence. The study included 600 respondents, mainly female (61.2%), with the mean age of 53.1 ± 17.4 years. More than third of the participants (38,6%) reported the genetic predisposition to development of hypertension. Recorded modifiable risk factors were overweight (22,33%), regular extra salt intake (86,3%) and smoking (32,8%). The results of the study indicate presence of reversible risk factors in the observed population. Designing educational programs on chronic diseases during graduate studies is necessary to keep hypertension from developing at older age and mitigate the number of existing risk factors development.

Tests have shown that adipose tissue is very important in the production of chemical substances that have a major impact on atherosclerosis. The basic fat cells adiposity is very active in bio secretion hormones and other substances. Adiposities secrete chemical substances such as leptin, resistin, adiponectin, and others who participate in metabolic processes. One of the most important adipocytokine affecting the formation and the regression of atheromas plaque in the coronary blood vessels are adiponectin and resistin. So our aim was to determine the value of the concentration of adiponectin and resistin on patient with myocardial heart attack and determine their correlation with the control group of healthy subjects. In this study were included 68 subjects, 40 with myocardial heart attacks and 28 control groups of normal healthy. In the group with myocardial 78.6% of respondents were male and 21.4% female. Tests have shown that the concentration of adiponectin in the group with myocardial heart attack was significantly lower than the control group (4.94 to 6.74, p=0.043, p<0.05. In the same study group average value of resistin was significantly higher than in the control group (15.73 to 7.88, p=0.001, p<0.01) (Student's t-test, p = 0.581, p> 0.05). All this indicates that in patients with myocardial heart attack there is a decline in the concentration of adiponectin, which has cardio protective effect. The increase in resistin in myocardial heart attack in directly related to the appearance of athermanous plaques in the coronary blood vessels and has a bad prognostic significance.

Stevens-Johnson syndrome (SJS) is a severe, episodic, acute mucocutaneous reaction that is most often elicited by drugs and occasionally by infections. The drugs commonly implicated as the cause of SJS are anticonvulsants, sulfonamides, non-steroidal anti-inflammatory drugs and antibiotics. Carbamazepine has been commonly implicated in SJS. We report a case of SJS-TEN overlap syndrome developing in patient who was prescribed carbamazeine after epileptic attack during radiotherapy for the purpose of treatment Glioblastoma multiforme, patients underlying disease, whose symptomatology deteriorated patients condition.

Aging of population leads to limitations in functional abilities and in activities of daily living (ADL) which are the essential elements of independent care of oneself. Limitations in performing these activities result in increasing need for assistance and institutionalizing of the elderly. The aim of this study was to investigate the influence of fear of movement, or kinesiophobia, on ADL in elder institutionalized people with chronic pain. The research included 60 individuals older than 65 suffering from chronic musculoskeletal pain, institutionalized in Gerontoloski Centar Nis. The participants` fear of movement was assesed by Tampa Scale of Kinesiophobia, performing ADL was assesed by Katz index and pain intensity was evaluated by Numerical Rating Scale. We found that a large number of participants had high degree of kinesiophobia (63%), as well as that there is statistically significant negative correlation between the values of Katz index and Tampa Scale (r=-0.583, p<0.01). There is no statistically significant negative correlation between the values of Numerical Rating Scale and Katz index (r=0.139, p<0.289). There is no statistically significant positive correlation between the values of Numerical Rating Scale and Tampa Scale (r=0.215, p=0.098). The research showed that kinesiophobia has influence on ADL in elder institutionalized people with chronic pain. Higher degree of fear of movement corresponds to greater dependence of the participants in performing ADL. Pain intensity influenced neither the fear of movement nor the dependence/independence in performing ADL.

Modern aspects of social development brings new concerns that contribute to obesity, as a direct result of the overall abundance. Almost that there is declarative consistent view that obesity, according to its frequency, a global epidemic of the new millennium and that is because of the effect on the overall health of the necessary complementary multidisciplinary approach, because its prevention can prevent and significantly reduce the mortality rate. Technological development, automation in the food production, reduced participation of manual labor and a sedentary lifestyle, obesity causes an increase not only in highly industrialized, but in the less developed countries. Obesity is a direct temptations of modern civilization and a major challenge for a community where food is plentiful. This fact increases the responsibility of each individual and placed before him the obligation to recognize the causes of obesity, so that, by changing their behavior, could reduce the burden involved with obesity.

Meniscus injuries occupy an important place among damages to the knee joint and are crucially important for athlets. Arthroscopy is a method of choice in both diagnostic as well as therapeutic treatment. After the intervention, it is necessary to start physical tretmeant as soon as possible. The study presents the treatment of 14 year old female patient, who started physical therapy five days after the removal of part of the lateral meniscus. Procedures involved electrical and kinesy therapy. Within the kinesy treatment static contractions were included, lymphatic drainage, and also passive exercises in order to increase range of motion. In the end, exercises against resistance were conducted to strengthen the musculature. After one month of therapy the treatment was completed, and patient was advised to continue strengthening the musculature at home. During the last examination the absence of swelling was noted, with painful sensitivity and limited motion in the knee. The MMT score for qvadriceps femoris was 4. The patient was advised to start with the lighter recreative activities. Arthroscopic meniscotomy is relatively rare intervention with adolescents, which was the motive for displaying this case. Applying early rehabilitation is fully exploited regenerative potential of this age and the optimal time for patients to return completely to usual activities.