BACKGROUND Both phases of euthyroid sick syndrome (ESS) are associated with worse prognosis in septic shock patients. Although there are still no indications for supplementation therapy, there is no evidence that both phases (initial and prolonged) are adaptive or that only prolonged is maladaptive and requires supplementation. AIM To analyze clinical, hemodynamic and laboratory differences in two groups of septic shock patients with ESS. METHODS A total of 47 septic shock patients with ESS were divided according to values of their thyroid hormones into low T3 and low T3T4 groups. The analysis included demographic data, mortality scores, intensive care unit stay, mechanical ventilation length and 28-day survival and laboratory with hemodynamics. RESULTS The Simplified Acute Physiology Score II score (P = 0.029), dobutamine (P = 0.003) and epinephrine requirement (P = 0.000) and the incidence of renal failure and multiple organ failure (MOF) (P = 0.000) were significantly higher for the low T3T4. Hypoalbuminemia (P = 0.047), neutrophilia (P = 0.038), lymphopenia (P = 0.013) and lactatemia (P = 0.013) were more pronounced on T2 for the low T3T4 group compared to the low T3 group. Diastolic blood pressure at T0 (P = 0.017) and T1 (P = 0.007), as well as mean arterial pressure at T0 (P = 0.037) and T2 (P = 0.033) was higher for the low T3 group. CONCLUSION The low T3T4 population is associated with higher frequency of renal insufficiency and MOF, with worse laboratory and hemodynamic parameters. These findings suggest potentially maladaptive changes in the chronic phase of septic shock.

Background: Autoimmune limbic encephalitis (ALE) is an inflammatory brain process involving a group of diseases with antibodies against neuronal synaptic and cellular antigens. Diagnosis is based on clinical examination, neurological functional tests, cerebrospinal fluid analysis, immunological testing, and radiological findings. Objective: This case report aims to present the case of a 68-year-old patient initially hospitalized for intermittent neurological deficits in the form of cognitive disorders of consciousness, which was initially declared as dementia without physical neurological deficit. Case presentation: Initial brain MRI (SIEMENS Magnetom Avanto, 1.5 T, Erlangen, Germany) showed changes differentially diagnosed characterised as glial neoplasm of mixed-grade astrocytoma or inflammatory process of unilateral autoimmune encephalitis. Since the neurosurgical opinion suggested a higher-grade glioma with proposed surgical treatment, the patient was referred for repeated MRI with MR spectroscopy in order to exhaust all diagnostic possibilities before surgery. MRI with MR spectroscopy (SIEMENS Magnetom Lumina, 3 T, Erlangen, Germany) revealed radiologically altered findings, in the right hippocampus and parahippocampal gyrus, which primarily corresponded to changes due to unilateral autoimmune encephalitis,due to its morphology characteristics and spectroscopy profile, making the primary glial neoplasm of lower grade less likely. Since the neurological mosaic IIFT result showed a positive LGI1 antibody finding, therapy for autoimmune encephalitis was initiated, leading to significant improvement in cognitive functions and the return of short-term memory. Conclusion: Although the detection of antibodies against onconeural, cellular, and synaptic proteins represents a significant advancement in diagnosing autoimmune limbic encephalitis, the role of conventional diagnostic tools such as MRI, EEG, and cerebrospinal fluid analysis should not be overlooked, where the application of new functional imaging techniques such as MR spectroscopy can be beneficial and should be considered.

Case report : Severe mitral regurgitation due to rupture of the chordae tendineae and mitral valve pro-lapse (Barlow’s disease), with a left atrial volume of 37.6 mL/m 2 was verified in 43-year old patient. He was admitted for an examination due to frequent palpitations and fast and irregular heartbeats. In the anamnestic data, thrombosis of the veins of the right leg was verified (thrombosis of popliteal, posterior tibial and great saphenous vein during previous years). He carries mutations: heterozygote of factor V Leiden, with MTHFR C677T heterozygote (CT), PAI- 1 heterozygote (4G⁄5G) and MTHFR A1298C heterozygote. The surgical treatment was done, and mechanical valve was implanted. In the follow-ing months, the patient complained on frequent dizziness, with crises of consciousness, and a short-ness of breath. He was not suitable for beta-blocker therapy, as well as propafenone and amiodarone, which had been prescribed in therapy in the meantime. The 24-hour ECG Holter monitoring described various arrhythmias, most of the time AV block of the first degree with PQ interval up to 320 msec, oc-casionally second-degree atrioventricular block Mobitz II, polymorphic ventricular extrasystoles and one attack of non-sustained ventricular tachycardia (6 ventricular extrasystoles in row), with intermit-tent nodal rhythm, junctional tachycardia and atrial flutter with AV ratio 2:1. An electrophysiological study was performed, and the cavotricuspid isthmus (CTI) dependent atrial flutter was verified, and radiofrequent ablation was done. After the procedure patient was in sinus rhythm. During the next follow up visits, the patient was in sinus rhythm, on therapy with a low dose of nebivolol (inability to tolerate beta blockers) and ivabradine, along with vitamin K antagonists. Conclusion

AIM To analyze a change of level of nautriuretic peptide (NT pro- BNP) caused by stress distension of myocardial wall in cases of acute myocardial infarction (AIM), as a possible predictor of early heart failure. METHODS Patients with myocardial infarction were followed up. Standard clinical and laboratory examination, including NT pro- BNP, and other laboratory analyses, were performed on the day of admission, the next day and on the eighth day of hospitalization. Statistical analyses included variance for repeated measurement (ANOVA), factorial multivariate analysis and test of multiple correlations. RESULTS The most important predictors of early heart failure in acute myocardial infarction were age, diastolic blood pressure, creatin kinase (CK) on admission, larger field of infarction zone and so on. Multiple correlations showed statistically significant correlation of age, diastolic pressure and larger zone of myocardial infarction with an increase of NT pro-BNP concentration. The activity of CK on the day after admission was higher than on admission (p=0.02) and myocard-binding CK (CK-MB) the next day after admission was higher than on admission (p=0.016). A statistically significant increase was found on the next day for NT pro-BNP in comparison with the value on admission (p=0.0049), but the level of activity of CK was markedly decreased on the eighth hospital day. CONCLUSION The significant increase of the concentration of NT pro-BNP during myocardial infarction is an important predictor of early heart failure, therefore, in case of a significant increase of NT pro-BNP in the early phase of the infraction a therapy that could prevent clinically relevant heart failure should be administered .

Introduction: According to the World Health Organization estimates annually in the world die due to CVI every sixth women and 10th man. This paper is the research of the correlation between changes in relative air humidity and stroke (CVA) in the Sarajevo Canton. Included are patients who experienced an acute stroke in the Canton of Sarajevo and treated in the pre hospital phase by the staff of the Institute for Emergency Medicine. Days with stroke and those without cases of stroke were compared within three years and meteorological data for those days were obtained by the Weather Bureau of Federation of Bosnia and Herzegovina. Meteorological data include measurements of average humidity every day at 7, 14 and 21 o’clock in three years. Aim: To evaluate the significance of the influence of humidity on the incidence of CVI’s. Show the trend towards CVI in the reporting period and is it correlated with the trend of change in relative humidity in those days. Correlate the incidence of stroke as determined in relation to gender, age and selected climatic parameter. Material and Methods: This article presents a retrospective study. Subjects were patients of Emergency Medical Care Institute in Sarajevo, which in the period from 2004 to 2006 had a CVI. Included are patients who had a working diagnosis of stroke for the first time or as a repeated stroke. Analysis of cases of stroke was carried out by gender, age, days and seasons by descriptive-analytical epidemiological methods. Results: In total were registered 1930 patients during three years period. According to years of research in 2004–635, 2005-616 and 2006 – 679. It was found that when testing the null hypothesis about the effects of humidity in two months with a maximum stroke in the year and days without CVI and relative humidity only in 2005 had a statistically significant effect on the incidence of stroke, while during the other two years of the study there was no impacts. It turned out that the extreme values of relative humidity of the day whether there was a rapid increase or decrees in humidity increases the incidence of stroke in all three years of research. Conclusion: Patients gender had no effect on the incidence of CVI. Seasons had no effect on the incidence of CVI. Most CVI in all three years of research was in relation to the old age and occurred in the older age group 70-79 (41.35%), where it was shown that the age of the patient influences the incidence of CVI. Extremely low relative humidity and extremely high, influence on the increase in the number of CVI. Determined is a slight correlation between the average relative humidity and CVI in single day.

AIM To analyze the usefulness of specified immunological parameters, proinflammatory IL-1α and profibrogenic, antiinflammatory TGF-β1, along with routinely used laboratory tests, in the differential - diagnostic procedure of chronic hepatitis of infectious and noninfectious etiology. METHODS A total of 150 subjects were divided into two groups, depending on the infectious or noninfectious etiology of liver damage, and the control group. Apart from standard laboratory tests, the analysis included serum levels of cytokines: IL-1α and TGF-β1. RESULTS A high degree of correlation of serum level of IL-1α with viral hepatitis has been found, especially with active replication of genetic material ( HBV-DNA or HCV-RNA-PCR positive), p less 0.01. The highest mean concentration of TGF-β1 was noted in the group of malignant and toxic hepatitis, p less 0.0001. A negative correlation between the concentration of IL-1α and TGF-β1 has been found (-0.18). For IL-1 α significant predictive parameters included a previous infection of hepatitis B, lower serum level of TGFβ, age, use of alcohol, lower MELD and Chilld-Pugh scores. For TGF-β1 significant predictive parameters were age, lower MELD and Child-Pugh scores, history of receiving transfusions, lower serum level of IL-1α, higher serum level of fibrinogen. A predictive model has been delivered MELD = (TGF-β1) x 0,001- (IL-1 α) x 0,085 + CTP x 1,771-2,052; ( ± 2.04, R2=0,61; p less 0,001). CONCLUSION Inflammatory and immune parameters, analyzed together could significantly contribute to the understanding of chronic liver damage and thus differential diagnostic procedure. IL-1α and TGF-β1 are important parameters of inflammatory activity and fibrosis evaluation in chronic liver damage.

Introduction: Life satisfaction involves cognitive component that allows evaluation of the life and accomplishments of life, and emotional component that includes an evaluation of emotions and mood that followed these accomplishments. Goal: To examine the life satisfaction of young people who attend secondary school, examine the level of satisfaction with life according to sex, to academic achievement, the presence of siblings and to examine the relationship between levels of life satisfaction and risk-taking behaviors. Results and Discussion: The results showed that there was no relationship between life satisfaction and preferences of delinquency, as well as life satisfaction and achieved academic success. The results confirmed the relationship between life satisfaction and sex as well as the relationship between life satisfaction and the presence of siblings in the family.

Introduction: The intention of this work is to research whether the link between the barometer pressure and the cerebrovascular insult (CVI) exists. The stroke is the first cause of non-traumatic disability and third illness by mortality in the majority of available relevant literature. Goals: Goal of the sudy was to research all the cases of the patients who suffered from the acute stroke in the Canton of Sarajevo and those who were treated in the pre-hospital phase by Emergency Medical Institute staff and their working diagnosis was established as CVI ac. Material and methods: The criteria in the research were established for inclusion and exclusion of cases. The days with and without CVI cases were compared with the meteorological data obtained from the Hydro-meteorological Institute of Federation of Bosnia and Herzegovina . Since the approval was requested and obtained from the Hydro-meteorological Institute, all the meteorological data could be compared. The meteorological data comprise the barometer pressure measuring every day at 7 h, 14 h and 21 h. Results and discussion: In the retrospective study, there will be followed, during three years (2004, 2005 and 2006), the cases of the patients who suffered from the stroke, and, the emergency medical care was offered to them by the side of the Emergency Medical Institute of Canton of Sarajevo staff. All the cases in the Canton of Sarajevo were followed regardless of the place of incidence: whether the help was offered in Institute’s outpatient departments, patient’s flat or at public place. Due to the extensiveness of data (in the analysis comprising three years, there was the total of 1930 cases), the test of normal distribution was used. Since it was about the pre-hospital research, the acute stroke was looked at generally without division by types. The certain diagnostics by types can only be established in the hospital. Conclusion: The results in the research indicate that the extreme values of barometer pressure, regardless of their being increased ones or decreased ones, influence the increase of CVI incidence, while by comparing the average values in the days with CVI and without CVI, they did not have any influence on the CVI incidence.