Introduction:Hyperglycemia is a common complication of critical illness. Patients in intensive care unit with stress hyperglycemia have significantly higher mortality (31%) compared to patients with previously confirmed diabetes (10%) or normoglycemia (11.3%). Stress hyperglycemia is associated with increased risk of critical illness polyneuropathy (CIP) and prolonged mechanical ventilation. Intensive monitoring and insulin therapy according to the protocol are an important part of the treatment of critically ill patients.Objective:To evaluate the incidence of stress hyperglycemia, complications and outcome in critically ill patients in our Medical intensive care unit.Materials and methods:This study included 100 patients hospitalized in Medical intensive care unit during the period January 2014–March 2015 which were divided into three groups: Diabetes mellitus, stress-hyperglycemia and normoglycemia. During the retrospective-prospective observational clinical investigation the following data was obtained: age, gender, SAPS, admission diagnosis, average daily blood glucose, highest blood glucose level, glycemic variability, vasopressor and corticosteroid therapy, days on mechanical ventilation, total days of hospitalization in Medical intensive care unit, and outcome.Results:Patients with DM treated with a continuous insulin infusion did not have significantly more complications than patients with normoglycemia, unlike patients with stress hyperglycemia, which had more severe prognosis. There was a significant difference between the maximum level of blood glucose in recovered and patients with adverse outcome (p = 0.0277). Glycemic variability (difference between max. and min. blood glucose) was the strongest predictor of adverse outcome. The difference in glycemic variability between the stress-hyperglycemia and normoglycemic group was statistically significant (p = 0.0066). There was no statistically significant difference in duration of mechanical ventilation and total days of hospitalization in the intensive care unit between the groups.Conclusion:Understanding of the objectives of glucose regulation and effective glycemic control is essential for the proper optimization of patient outcomes.

Introduction:Thyroid function disorders are common in patients with chronic kidney disease. The aim of this study was to compare thyroid function among patients on chronic hemodialysis (HD) and healthy participants and to assess duration of dialysis on thyroid disorders.Material and methods:Prospective study included 80 participants divided in two groups. Study group included 40 patients on HD who were divided in two subgroups, according to time on dialysis (under and over 72 months). Exclusion critheria were: previous thyroid disorders, systemic illnesses, criticaly ill patients and acute inflamatory diseases. Control group included 40 healthy participants. Blood samples were taken for standard laboratory analysis, total and free thyroid hormone levels.Results:In HD group we found statistycally significant lower mean values of T3 (1,36 ± 0.451, p<0.0001), T4 (80.33 ± 19.167, p= 0.0001), and higher mean values of TSH (3.16 ± 3.168, p= 0.01), higher frequency of low T3 syndrome in 12.5% (n=5) (p=0.01) and subclinical hypothyroidism in 17.5% (n=7) (p=0.021). In the subgroup of patients with time on HD <72 months, significantly, more frequent and low T3 syndrome was found in 19.23% (n = 5) (p = 0.01). In the subgroup of patients with HD >72 months subclinical hypothyroidism was found more frequently in 35.71% (n = 5) (p = 0.04).Conclusion:Thyroid disorders are more common in patients on HD compared to general population. These findings suggest that thyroid function and morphology screening should be performed in HD patients.

ObjectiveThe aim of the study was to describe the prevalence of hyperlactatemia and emphasis on repeated lactate measurements in critically ill patients, and the associated mortality.Materials and methodsThe study included 70 patients admitted in the Medical Intensive Care Unit at the Clinical Center, University of Sarajevo, in a 6-month period (July - December 2015). The following data were obtained: age, gender, reason for admission, Simplified Acute Physiology Score II, Acute Physiology and Chronic Health Evaluation, lactate concentrations upon admission, after 24 and 48 hours, and outcome (discharge from hospital or death).ResultsUpon admission,hyperlactatemia was present in 91.4% patients with a mean concentration of lactate 4.13 ±1.21 mmol/L. Lactate concentration at 48 hours was independently associated within creased in-hospital mortality (P = 0.018).ConclusionPersistent hyperlactatemia is associated with adverse outcome in critically ill patients. Lactate concentration at 48 hours is independently associated within creased in-hospital mortality and it represents a statistically significant predictive marker of fatal outcomes of patients. Blood lactate concentrations > 2.25 mmol/L should be used by clinicians to identify patients at higher risk of death.

T hyroid gland morphology is affected in patients with chronic kidney disease. The aim: The purpose of this study was to compare thyroid gland morphology among patients on chronic hemodialysis (HD) and healthy participants and to assess the duration of dialysis on thyroid disorders. Material and methods: Prospective study included 80 participants divided into two groups. Study group included 40 patients on (HD) who were divided in two subgroups, according to the time spent on dialysis (i.e. under and over 72 months). The exclusion critheria was represented by the previous thyroid disorders and systemic illnesses. The control group included 40 healthy participants. The blood samples were taken for standard laboratory analysis, total and free thyroid hormone levels. Results: Thyroid ultrasound was performed, thyroid wolume was calculated and the echostructure assessed. Mean values of thyroid volume were increased in HD patients (e.g.18,88 ± 3,20 ml, p<0.01). Diffuse goiter was found in 35% (n = 14) patients on HD (p = 0.01). In a subgroup of patients (i.e. with time on HD <72 months), the significant and more frequent was multinodular goiter, in 15.38% (n = 4) (p = 0.03). There was no significant correlation between the time on dialysis , thyroid volume (r=-0.05, NS) and TSH levels (r=0.14, NS). A significant, positive correlation between the thyroid volume and TSH levels was observed in HD group of patients (r=0.24 p<0.05). Conclusion: Thyroid disorders are more common in patients on HD compared to general population. These findings suggest that thyroid morphology screening should be performed in HD patients.

t hyroid disorders are common in chronic kidney disease. The aim of this study was to examine the role of renal anemia on thyroid function, morphology and autoimmunity in clinically euthyroid patients on chronic hemodialysis (HD). Prospective study during 12 months period included 40 stable patients on chronic HD treatment. Patients were divided into two groups according to the serum hemoglobin level (group A Hgb > 125 g / L and group B Hgb <125 g / L). Blood samples were taken for determination total and free thyroid hormones, thyroid antibodies and standard biochemical tests. Thyroid ultrasonography was performed with a 7.5 MHz transducer, 50 mm linear transducer. Thyroid wolume was calculated, echostructure assessed and presence of nodular changes. In group A, was found significantly lower levels of total T3 (1.29 ± 0469 vs. 1.55 ± 0352, p <0.1); higher prevalence of low T3 syndrome (17.24% (n = 5) vs. 0.00 (n = 0), p <0.05); ultrasound findings suggestive for Hashimoto thyroiditis (13.79 (n = 4) vs. 0.00% (n = 0), p <0.05) and multinodular goiter (13.79% (n = 4) vs. 0.00% (n = 0) , p <0.05). We found no statistically significant difference in the mean values of of thyroid antibodies levels, as well as in their percentage representation among groups. Morphological, functional and autoimmune disorders of thyroid gland are more common in patients on HD with Hgb level <125 g / L. These findings suggest a role of renal anemia in the pathogenesis of these, and need for periodical screening of thyroid function, morphology, and titer of thyroid antibodies in patients HD, as well as more effective diagnosis and more aggressive treatment of renal anemia.

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renal transplantation, pregnancy.