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.

_______ 1 SAŽETAK Uvod/Cilj: Hronični bol u donjem delu leđa često je praćen promenama u trajanju i kvalitetu sna. S druge strane, narušena struktura sna negativno utiče na kvalitet života obolelih. Cilj istraživanja je bio da se ispita da li postoji veza između prisustva poremećaja spavanja i stepena funkcionalne onesposobljenosti kod osoba sa hroničnim bolom u donjem delu leđa. Metode: Studijom preseka obuhvaćeno je 150 osoba sa hroničnim bolom u donjem delu leđa koje su se javile u Dom zdravlja Krupa na Uni u periodu od 01.10.2016. do 01.10. 2018.godine. Pored opšteg upitnika, u istraživanju su korišćeni Upitnik o nesposobnosti po Rolandu Morisu (engl. Roland Morris Disability Questionnaire) i Pitsburčki indeks kvaliteta sna (engl. Pittsburgh Sleep Quality Index). U statističkoj analizi podataka primenjen je hi kvadrat test. Rezultati: Od 150 osoba sa hroničnim bolom u donjem delu leđa 88 (58,7%) su činile žene, a 62 (41,3%) muškarci. Prosečna starost ispitanika je bila 54,0 ± 5,7 godina. Žene su bile statistički značajno starije nego muškarci. Muškarci i žene, kao i osobe uzrasta 40-59 godina i 60-79 godina, sa narušenim kvalitetom sna su značajno češće imali viši stepen funkcionalne onesposobljenosti nego osobe sa nenarušenim kvalitetom sna. Kod najmlađih osoba (20-39 godina) sa niskom funkcionalnom onesposobljenošću 5,3% je imalo narušen kvalitet sna, a 4,3% u uzrastu 40-59 godina i 4,0% u uzrastu 60-79 godina. Među osobama sa višim stepenom funkcionalne onesposobljenosti ni jedna osoba nije imala narušen kvalitet sna u uzrastu 20-39 godina, a sve osobe uzrasta 40-59 i 60-79 godina su imale narušen san. Zaključak: Neophodna su dalja istraživanja o povezanosti kvaliteta sna i stepena funkcionalne onesposobljenosti osoba sa hroničnim bolom u donjem delu leđa. Edukacija o higijeni spavanja, rutinska procena kvaliteta sna i rana terapijska intervencija kod osoba sa hroničnim bolom u donjem delu leđa mogu doprineti smanjivanju funkcionalne onesposobljenosti, kao i troškova zdravstvene zaštite i radnog apsentizma.

Objective. Atrial fibrillation (AF) is the most common arrhythmia in clinical practice affecting 1-2% of the world population. It is characterized by high-frequency atrial excitation, consequent asynchronous contraction, and irregular ventricular excitation. Risk factors and comorbidities predispose to AF by altering the extracellular matrix, altering the function of fibroblasts and fat cells, ion channels, myocytes, the autonomic nervous system, endothelial and vascular changes. The study aimed to identify risk factors and comorbidities that were statistically significantly associated with the onset of AF. Methods. The study was a cross-sectional study conducted at the Krupa Health Center at Uni in the period from 1 November 2017 to 1 January 2019. Data were collected through medical history, physical examination, electrocardiograms, laboratory diagnostics, ultrasound examination and available medical records. Data processing was performed using standard statistical methods. Results. The study included 145 randomly selected patients, 96 (66.2%) women and 49 (33.8%) men., average age 63 ± 9.8 years. AF was more common in women older than 60 years and people consuming alcohol (p<0.05). Comorbidities associated with FA are: left ventricular hypertrophy, mitral regurgitation, hypertension, diabetes, chronic obstructive pulmonary disease, and obesity (p<0.05). Conclusion. Early detection, timely and adequate management of comorbidity and risk factors of FA prevents or slows the progression of AF, raises the quality of life of patients, reduces the costs of health care and work absenteeism.

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.

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.

bulantnog krvnog pritiska, signifikantan porast krvnog pritiska u jutarnjim časovima i tokom intenzivne fizičke aktivnosti. Ultrazvučnim pregledom se nalazi značajno povećanje dimenzija štitne žlijezde u odnosu na ranije nalaze, dok laboratorijska obrada detektuje hipotireozu. Pacijentkinja se upućuju u Zavod za nuklearnu medicinu gdje se indikuje totalna tiroidektomija. Mjesec dana nakon operacije pacijentkinja koristi Levotiroksin natrijum 100 mcg 1x1tokom 6 dana i 1x3/4 sedmi dan, dok je inicijalna antihipertenzivna terapija ograničena na Enalapril 5 mg 1x1. ZAKLJUČAK: Rana detekcija i adekvatna supstituciona terapija Hašimotovog tiroiditisa omogućava normalizaciju ili značajno smanjenje vrijednosti sekundarne hipertenzije, redukuje mogućnost nastanka ireverzibilnih promjena na krvnim sudovima i koegzistirajuće esencijalne hipertenzije. KLJUČNE RIJEČI: Hašimotov tiroiditis, sekundarna hipertenzija.

Introduction. Hashimoto's thyreoiditis has a complex effect on the gastrointestinal tract, which includes hormone receptor alteration, neuromuscular disorders, myopathies caused by intestinal wall infiltration. Case report. A 44-year-old patient appears in the family medicine clinic due to moderate pain in the lower part of the abdomen present for the past three months, which intensifies before defecation and stops immediately after defecation. He has two to four liquid stools daily in which he has not noticed the presence of mucus or blood for the past two months. He negates earlier illnesses as well as diseases relevant to heredity. Physical examination provides a neat finding. Ultrasound examination of the abdomen is within the age range. Thyroid ultrasound identifies the right flap of a 48x24x10 mm diametre with hypoechogenic calcified nodus 14x12 mm in diameter (meets the criteria of the American Thyroid Association for aspiration biopsy), left flap of 44x20x14 mm diameter. The following are the laboratory findings: TSH 7.66 mIU/l, FT4 6.42 pmol/l, TG 5080 ng/ml, calcitonin 8.94 pg/ml, TG-At 24.99 IU/ ml, TPO-At 500 IU/ml. The patient is instructed on a hygienic dietary regimen and includes spasmolytic and antidiarrheal, and referred to a nuclear medicine specialist who performs an aspiration biopsy (TBSRTC IV follicular tumor). The Oncology Consilium indicates surgery (right-sided lobectomy) with extempore verification and further follow-up. Pathohistological examination of the removed right lobe excludes the presence of malignant disease (struma coloides multinodosa glandulae thyroideae). Antidiarrheal therapy is discontinued and replacement therapy is administered (levothyroxine sodium tablets 50 mcg, qd). Subsequent proctosigmoidoscopy shows a neat finding. One year after surgery the patient is in remission of the disease. Conclusion. Diagnostic evaluation of the thyroid gland in patients with irritable colon syndrome significantly improves quality of life, reduces occupational absenteeism and health care costs.