Uvod. Hronični bol u donjem dijelu leđa je sindrom uzrokovan različitim anatomskim i funkcionalnim poremećajima lumbalne kičme i njene okoline koji traje duže od tri mjeseca. Kvalitet života obuhvata subjektivni doživljaj vlastitog stepena funkcionisanja, ali i objektivnu ocjenu zdravstvenog stanja. Cilj rada. Procijeniti uticaj prisustva komorbiditeta na stepen funkcionalne onesposobljenosti kod pacijenata sa hroničnim bolom u donjem dijelu leđa. Metod. Istraživanje je kao studija presjeka obavljeno u Domu zdravlja Krupa na Uni u periodu od 01.10.2016. do 01.09.2017. godine. Uzorak je činilo 115 slučajno odabranih pacijenata, 50 (43,48%) muškaraca i 65 (56,52%) žena, prosječne starosti 46 ± 8,9 godina. Instrument istraživanja bili su upitnici Roland Morris Disability Questionnaire, Fear Avoidance Beliefs, Patient Health Questionnaire, Generalized Anxiety Disorder, Beck's Depression Inventory, kao i posebno kreiran opšti upitnik za potrebe istraživanja. Obrada podataka vršena je standardnim statističkim metodima. Rezultati. Statistički značajno povećanje funkcionalne nesposobnosti potvrđeno je kod sledećih komorbiditeta: hronični gastritis 28.7% (p=0,006), gojaznost (BMI > 25) 65.2% (p=0.007), alkoholizam 10.4% (p=0,004), nodozna struma štittaste žlijezde 6.1% (p=0.006), anksioznost 73.7% (p=0.035) i depresija 37.4% (p=0.042). Zaključak. Rano otkrivanje i odgovarajući pristup praćenja pridruženih bolesti kod osoba sa hroničnim bolom u donjem dijelu leđa u ambulanti porodične medicine, značajno bi smanjili funkcionalnu onesposobljenost, troškove zdravstvene zaštite i gubitak prihoda zbog izgubljene produktivnosti. Ključne riječi: komorbiditet, funkcionalna onesposobljenost, hroničan bol.

Food additive is any substance of known chemical composition that is not normally used as food in itself or is a typical food ingredient, regardless of nutritional value, and is added specifically for technological and organoleptic properties of food in the technological process of production, during preparation, processing, finishing, processing, shaping, packaging, transport and storage, which leads or can be expected to lead to the fact that he or his by-product directly or indirectly becomes an ingredient of that food. Food additives are a necessity in food production technology. Their use causes consumer distrust and controversy among the professional public. The negative attitude of a significant number of consumers due to the lack of awareness of the legislation that precedes the approval of food additives can be removed through open, transparent, independent, responsible / timely communication on risk. On the other hand, research on inadequate labeling, toxicity and the use of illicit food additives requires continuous monitoring, improvement of the control system and elimination of deficiencies. The safe use of food additives is a joint responsibility of the state, producers, distributors, the profession, ie laboratories, but also the consumers themselves.

Uloga hipotiroidizma U nastankU metaboličkog sindroma i hepatične steatoze Uvod: Kontrolisane studije ukazuju da smanjena funkcija štitne žlijezde može predstavljati nezavisni faktor rizika za nastanak elemenata metaboličkog sindroma i hepatične steatoze, koja se smatra jetrenom komponentom metaboličkog sindroma. Cilj: Istraživanje je imalo za cilj ispitati ulogu hipotiroidizma u nastanku metaboličkog sindroma i hepatične steatoze. Metode: Istraživanje je obuhvatilo 27 (54.0%) žena i 23 (46.0%) muškarca prosječne starosti 48 ± 6.9 godina sa verifikovanim hipotiroidizmom i 29 (58.0%) žena i 21(42.0%) muškarca prosječne starosti 45 ± 5.8 godina sa urednom funkcijom štitne žlijezde. Podaci su prikupljeni na osnovu anamneze, fizikalnog pregleda, dostupne medicinske dokumentacije, laboratorijskih analiza i ultrazvučnog pregleda. Rezultati: Hipotiroidizam (otvoreni i subklinički) ima statistički značajnu ulogu u nastanku metaboličkog sindroma i hepatične steatoze (p<0.05). Zaključak: Pravovremena dijagnoza i adekvatan terapijski menadžment poremećaja štitne žlijezde značajno bi smanjili incidencu kardiovaskularnih komplikacija, mogućnost nastanka steatohepatitisa, troškove zdravstvene zaštite i gubitak prihoda zbog izgubljene produktivnosti. Ključne riječi: hipotiroidizam, metabolički, sindrom, hepatična steatoza. Role of hypothyroidism in the onset of metabolic syndrome and hepatic steatosis Introduction: The comorbidity of metabolic syndrome and hypothyroidism results in significant progression of the atherosclerotic process, bearing in mind the overlap of pathogenic mechanisms. Reduced thyroid function is an independent risk factor for liver steatosis, which is considered a hepatic component of metsbolic syndrome. Objective: The study aimed to examine the role of hypothyroidism in the onset of metabolic syndrome and hepatic steatosis.

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: Erectile dysfunction is a significant public health problem. It is estimated that more than 50% of men between the ages of 40 and 70 suffer from the same or intermittent illness. Case report: A 45 years old patient was admitted to the family medicine ambulance for erection problems over the previous 6 months He complained on the ubiquitous absence of morning erection, nocturnal erection and spontaneous erection satisfactory for sexual intercourse. Physical examination reveals an enlarged thyroid gland. Ultrasound detected a non-homogeneous, partially calcified, clearly circumscribed nodule 24 x 30 x 22 mm in the right lobe of the thyroid gland. A diagnosis of hypothyroidism was based on thyroid function test. The patient was referred to a nuclear medicine specialist for Fine needle aspiration biopsy. The cytological finding of the bioptate reveals follicular accumulations of macronuclear thyrocytes of hyperchromatic nuclei (TBSRTC IV follicular tumor) and right-sided lobectomy was performed. Levothyroxine therapy was initiated and six months after that erectile function was normalised. Conclusion: Early detection and adequate treatment of hypothyroidism in patients with erectile dysfunction could result in significant improvement in erectile function.

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Brojna pretklinička, molekularna i klinička ispitivanja ukazuju na kauzalnu udruženost dijabetes melitusa tipa 2 (eng. typ 2 diabetes mellitus, T2DM) i poremećaja štitne žlijezde. Prisutsvo dijabetesa pokreće kaskadnu, antihomeostatičnu reakciju koja za posljedicu imao oboljenja štitne žlijezde. Prethodno postojeća bolest štitne žlijezde dodatno narušava metaboličku kontrolu i beta staničnu funkciju dijabetičara. Cilj: Utvrditi postojanje statistički značajno češće prisustvo hipotireoze, tiroidnihnodusa i dobrodiferentovanih karcinoma štitne žlijezde kod pacijenata sa verifikovanim T2DMu odnosu na kontrolnu grupu. Ispitati postojanje statistički značajne povezanosti vrijednosti hemoglobina A1c (HbA1C) sa navedenim oboljenjima štitne žlijezde kod oboljelih od T2DM. Materijal i metode: Istraživanje je kao studija presjeka obavljeno u Domu zdravlja Krupa na Uni u periodu od 01.09.2017. do 01.03.2018. Uzorak je činilo 186 pacijenata, odnosno dvije grupe po 93 pacijenta. U prvoj su bili pacijenti sa djagnozom T2DM u minimalnom trajanju od 5 godina bez verifikovanog poremećaja štitne žlijezde. Kontrolnu grupu su činili pacijenti bez dijabetes mellitusa tipa 2. Podaci su prikupljeni na osnovu anamneze, fizikalnog pregleda, dostupne medicinske dokumentacije, laboratorijskih analiza i ultrazvučnogpregleda. Obrada podataka je vršena standardnim statističkim metodama. Rezultati: Grupa pacijenta sa verifikovanim T2DM imala je statistički značajno češće prisustvo hipotireoze i tireoidnih nodusa u odnosu na kontrolnu grupu (p <0.05). Kada su u pitanju dobrodiferentovani karciomi razlika je bila nesignifikanta (p = 0.15). U grupi ispitanika sa dijagnostifikovanim T2DM, hipotireozom i ultrazvučno verifikovanim nodusima u štitnoj žlijezdi utvrđen je statistički značajno viši HbA1c u odnosu na oboljele od T2DM bez prisutnih oboljenja štitne žlijezde (p< 0.05). Zaključak: Istraživanje je potvrdilo da dijabetes mellitus tip 2 predstavlja značajan faktor rizika za nastanak hipotireoze i tiroidnihnodusa ali ne i dobro diferentovanih karcinoma štitne žlijezde. Navedena oboljenja se češće javijaju kod pacijenata sa lošom regulacijom glikemije (visokim HbA1c).

Polyphenols are compounds that contain in their structure one or more hydroxyl groups attached directly to one or more aromatic hydrocarbons. They represent one of the most numerous and widespread groups of secondary plant metabolites with more than 8000 polyphenolic structures. Polyphenols are antioxidants that reduce endothelial dysfunction and blood pressure, improve the immune defense, alleviate the inflammatory response, block platelet aggregation and oxidation of low-density lipoproteins. Some studies suggest that there is an indirect link between flavonoid intake and myocardial infarction and coronary heart disease. Dark chocolate, nuts, grapes, red wine and the Mediterranean diet (based on fruits and vegetables, fish and olive oil) are rich in polyphenols and are key in preventing cardiovascular disease. Polyphenols prevent neurodegenerative changes associated with cerebral ischemia. Blueberry anthocyanins have antiatherogenic and anti-inflammatory properties so they have a neuroprotective effect. Red wine extract, rich in anthocyanin, reduces injuries caused by cerebral ischemia. Food intake of polyphenols can reduce hypertension, anti-inflammatory and antioxidant effects, as well as increased production of nitric oxide. The importance of black and green tea in lowering blood pressure is especially pointed out. Further research on polyphenols is needed in order to make as clear recommendations as possible for their general preventive use.