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Introduction. Diabetes mellitus is a common metabolic disorder with more than 1.7% of the world population. Diabetes mellitus affects 3% of Serbian population. Stroke is one of the major macrovascular complications of Diabetes mellitus. Aim. Determining what additional intervention, care and treatment of diabetic patients with stroke needs, when comparing patients with stroke who have other risk factors. Material and Methods. The research was conducted in the Specialized Hospital "Sveti Sava", at the Intensive Care B, during the period from the 1 November 2019 th to the 31 December 2019. Total number of patients was 40. Subjects were divided into two equal groups of 20 patients: the first group the experimental group with diabetic patients with acute stroke, and the second group the control, with patients with acute stroke who have other risk factors. The study was based on general standards of nursing interventions, and advanced standards in the care and treatment of diabetic patients with stroke were used. Results. According to "Nursing activities score" of basic nursing interventions: continuous monitoring was present in 13 (65%) patients in the experimental group whereas the control group had 5 (25%) patients. Monitoring of vital parameters and the number of nursing interventions were much higher in the experimental group. Conclusions. Using the common standards of nursing interventions in the care and treatment of diabetic patients with acute stroke is not enough. Their demands are highlighted and they require a longer time and the increased number of nurses for the implementation of the plan of care and treatment for these patients. Patients with stroke are complex and prone to numerous complications and serious approach to each patient individually is needed.

The aim of this study was to analyze the prevalence of Helicobacter pylori infection and gastroduodenal lesions in Montenegrin patients with chronic kidney disease on hemodialysis. The study included 55 hemodialysis patients with dyspeptic symptoms and 50 control subjects with normal kidney function who had also dyspepsia. After dyspepsia assessment by an interview, all subjects underwent gastroduodenoscopy and histopathological analysis of biopsy specimens, taken from the corpus and antrum of the stomach. Helicobacter pylori was confirmed in 50.9% of corpus mucosa i.e. 60.6% of antrum mucosa of maintenance hemodialysis patients. There were no significantly differences in endoscopic findings of the stomach and bacterial presence between the two study groups of participants (p = 0.451), while duodenal lesions were prevalent in control subjects (p < 0.001). The atrophy of corpus mucosa was more common in hemodialysis patients (p = 0.007), especially in those who have been on hemodialysis for a longer time (p < 0.001) and had lower pH (p = 0.011). The prevalence of Helicobacter pylori infection shown an inverse relationship with dialysis duration. Contrary, a positive relationship between Helicobacter pylori and the concentration of bicarbonate was demonstrated (p = 0.031). The prevalence of Helicobacter pylori and atrophic mucosal changes in Montenegrin hemodialysis patients depends on dialysis duration and acid-base balance.

Background: The aim of this study was to identify the risk factors associated with falling in post stroke patients. Methods: This retrospective case-control study included 561 neurology patients hospitalized for a stroke and divided into two groups: falling patients and non-falling patients. They referred to the Special Hospital for Cerebrovascular Diseases "Sveti Sava" in Belgrade, Serbia, from 2018- 2019. Logistic regression analysis was applied to examine socio-economic factors associated with predictors of unmet healthcare needs. Results: A significant difference was seen in the length of hospitalization of falling patients compared to the non-falling (P

PURPOSE The main purpose of this study was to analyze the characteristics of dyspepsia and contributing factors in Montenegrin maintenance hemodialysis patients. METHODS The study included 43 patients undergoing hemodialysis with symptoms of dyspepsia and 40 control dyspeptic subjects with preserved kidney function. All subjects underwent an interview about dyspeptic symptoms, physical and biochemical examination, and upper gastrointestinal endoscopy with pathohistological analysis of biopsy specimens. RESULTS Early satiety, bloating and heartburn were the most common symptoms in hemodialysis patients but without significant difference in frequency in relation to controls. Chronic kidney disease patients had statistically lower concentration of total proteins and albumin (p

Background: Patients with oncological diseases often have mental disorders in the form of comorbidity. The aim of this study was to research the association of cancer with the presence of symptoms of depression and anxiety in primary health care patients. Methods: This prospective observational study done in 2020 included adult users of health care at the Health Center Trstenik, Central Serbia, aged 19 and over, both sexes, with a diagnosis of oncological disease. A research instrument to assess depressive symptoms is used PHQ-9 (The Patient Health Questionnaire) questionnaire, derived from PRIME MD- and (The Primary Care Evaluation of Mental Disorders), and the Beck Anxiety Scale (BAI) to register the presence of certain anxiety symptoms. Results: The largest percentage of patients had symptoms of mild (27.2%) or moderate depression (22%), while 18% reported symptoms of major depression. The level of depression was higher in older subjects, in the presence of chronic diseases with greater limitations of activity and the presence of difficulties in performing daily activities, with a more pronounced effect of pain on activity, the presence of stress. All subjects were characterized as persons with severe anxiety (score 26-63). The level of anxiety was higher in older respondents, in the presence of long-term illness, with greater limitations of activities and difficulties in performing daily activities, with a more pronounced influence of pain on performing activities and the influence of the media. Conclusion: Caring for the mental health of cancer patients must occupy a significant part of each country's national health policy.

The radioactive iodine (131I) ablation is a well-accepted treatment modality for differentiated thyroid cancer patients. Unfortunately, the radiation induces the oxidative stress and damages cells and tissues, simultaneously activating the mechanisms of antioxidative defense. Since the mechanisms of those processes are not completely known, we wanted to examine the changes in the most important reactive oxygen species and antioxidative components, as well as their correlation and significance for lipid peroxidation. Our results showed that the level of thiobarbituric acid reactive substances was increased during the first 30 days after the radiotherapy. Among antioxidant components, superoxide dismutase was increased in the 3rd and 30th day; catalase in 7th and reduced glutathione in 3rd and 7th day after the radiotherapy. As regards the prooxidants, the reduction of hydrogen peroxide (H2O2) was recorded in 7th and 30th day, and superoxide anion radical (O×-) was unchanged after the exposure to 131I. These results indicate that differentiated thyroid cancer patients are under constant oxidative stress despite the observed increase in antioxidative and reduction in prooxidative parameters. The understanding of these early processes is important since their progress determines the latter effects of 131I therapy. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. III41007 and Grant no. 175007]

As it is known that genetic polymorphisms of glutathione S-transferases (GST) have been associated with a variety of human diseases including cancer, we have analyzed the impact of GSTT1 and GSTM1 null genotypes on the risk of development of differentiated thyroid cancer (DTC) and cytogenetic changes in peripheral blood lymphocytes of DTC patients before and after radioiodine therapy. The polymorphism of GSTT1 and GSTM1 genes were genotyped using multiplex polymerase chain reaction (PCR) and cytokinesis - block micronucleus (MN) assay to assess cytogenetic changes. GSTT1 and GSTM1 null were predominantly found in patients, but statistical significance was observed only for GSTT1 null. The null genotypes increased risk of development of DTC; GSTT1 null a 4.5 times (p < 0.05), GSTM1 null about 3 times but on the border of statistical significance (p = 0.057), while combination of dual null genotypes almost 7 times (p < 0.05) increased risk. No significant effects of the null genotypes as well as their interactions with potential modifiers of MN (diagnose, age, gender and smoking habits) were observed on both baseline and radioiodine-induced values of MN and cytokinesis block proliferation index (CBPI) in DTC patients. Results suggest that both GSTT1 and GSTM1 null genotypes increased risk for DTC but to a greater extent GSTT1 null. Null genotypes of GSTT1 and GSTM1 did not have potential to influence baseline and radioiodine-induced values of MN and CBPI, so that absence of T1 and M1 isoenzymes did not cause increased mutagen sensitivity of PBLs of DTC patients. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. III41010 and Grant no. ON175103]

As apoptosis and genome instability in children with autoimmune diseases (AIDs) are insufficiently investigated, we aimed to analyse them in peripheral blood lymphocytes (PBLs) of children and adolescents with Hashimoto's thyroiditis (HT), Graves' disease (GD) and type 1 diabetes mellitus (T1DM), including possible factors that could affect their occurrence. The study population included 24 patients and 19 healthy controls. Apoptotic cells were detected using an Annexin V-FITC/7-AAD kit. Genome instability was measured as micronuclei (MNs) frequency using the cytokinesis-block MN assay. In addition, comet assay was performed for determination of genome instability as genome damage index (GDI) in new subpopulation of patients with T1DM. The percentage of apoptotic PBLs in patients with AID was significantly lower than in control subjects. There was a positive correlation between thyroid-stimulating homone (TSH) concentration and the proportion of cells in late stage apoptosis in patients with autoimmune thyroid diseases (AITDs). The MN frequency in patients was significantly higher than in controls. Individuals with HT or T1DM had a significantly higher MN frequency than those with GD. Similarly, the value of GDI in patients with T1DM was significantly higher than in controls. The level of apoptosis was positively correlated with MN frequency as well as with GDI in patients with AID. In conclusion, children with AITD (HT and GD) and T1DM have a significantly lower level of apoptosis in PBLs and significantly higher MN frequency as GDI than healthy subjects. Apoptosis and the level of genome instability in these patients with AID are positively correlated.

Short-term, overt hypothyroidism in patients with differentiated thyroid cancer (DTC) before radioiodine (131-I) therapy might be accompanied by a number of metabolic changes, including altered protein and lipid metabolism. Protein concentrations and their relationship to lipids in the serum of DTC patients have not been fully elucidated. The aim of our study was to evaluate the protein and lipid concentrations in 24 DTC patients before and 3 and 7 days after 131-I therapy compared with those of 20 healthy control subjects. After radioiodine therapy, the mean protein concentration (78.71 ± 6.71 g/L vs. 87.16 ± 6.04 g/L; p = 0.003) and cholesterol level (8.12 ± 2.13 mmol/L vs. 8.84 ± 2.09 mmol/L; p = 0.001) were lower 3 days after therapy; this persisted up to 7 days after therapy, whereas triglyceride concentrations were higher 3 days after therapy (2.44 ± 1.07 mmol/L vs. 2.26 ± 1.08 mmol/L; p = 0.041) and returned towards the pretreatment values at 7 days after 131-I therapy. There was an indirect correlation between the protein and triglyceride concentrations 3 days after 131-I therapy in patients over 50 years old (Spearman’s r = - 0.583, p = 0.048) but not in patients under 50 years old (Pearson’s r = - 0.277, p = 0.384). Radioiodine therapy of DTC patients led to decreased serum protein and cholesterol concentrations, accompanied by increased triglyceride levels; these changes were especially evident in older subjects with metastases.

Differentiated thyroid carcinomas (DTCs) present more than 90% of all thyroid tumours and include papillary and follicular carcinomas. Females suffer 2-3 times more often than men. Radiation is considered to be one of the most important etiological factors for the appearance of differentiated thyroid carcinomas, especially papillary carcinomas. DTCs may have a hereditary character in about 3% of cases. Disease usually presents in the form of slow growing thyroid nodules. The diagnostics is based on clinical examination, completed with ultrasonography and fine needle aspiration biopsy with cytological findings. DTCs patients require multidisciplinary therapeutic approach including total or near-total thyreoidectomy with postoperative application of radioactive iodine 131 for ablation of residual tumor as well as normal thyroid tissue. After that, the administration of L-thyroxine is required, at dose which inhibits the secretion of TSH. All patients require continuous monitoring, which also includes the determination of serum concentration of thyroglobulin. The prognosis is generally good, and the ten-year survival rate is over 90%. Recurrence is present in 10-15% of all patients, mainly in the neck, lymph nodes or thyroid region.

Hashimoto thyroiditis (HT) is the most frequent thyroid autoimmune disease, while papillary thyroid cancer (PTC) is one of the most common endocrine malignancies. A few patients with HT also develop PTC. The aim of this study was to analyze cytokine profiles in patients with PTC accompanied with autoimmune HT in comparison with those in patients with PTC alone or HT alone and healthy subjects. Cytokine levels were determined in supernatants obtained from phytohemagglutinin (PHA)-stimulated whole blood cultures in vitro. The concentrations of selected cytokines: Th1-interferon gamma (IFN-γ); Th2-interleukin 4 (IL-4), interleukin 5 (IL-5), interleukin 6 (IL-6), interleukin 10 (IL-10) and interleukin 13 (IL-13); Th9-interleukin 9 (IL-9); and Th17-interleukin 17 (IL-17A) were measured using multiplex cytokine detection systems for human Th1/Th2/Th9/Th17/Th22. We found that PTC patients with HT produced significantly higher concentrations of IL-4, IL-6, IL-9, IL-13 and IFN-γ than PTC patients without HT. In conclusion, autoimmune HT affects the cytokine profile of patients with PTC by stimulating secretion of Th1/Th2/Th9 types of cytokines. Th1/Th2 cytokine ratios in PTC patients with associated autoimmune HT indicate a marked shift toward Th2 immunity.

Cytokines play a key role in the regulation of cells of the immune system and also have been implicated in the pathogenesis of malignant diseases. The aim of this study was to evaluate cytokine profiles in patients with differentiated thyroid cancer (DTC) before and 7 days after radioactive iodine (131-I) therapy. Cytokine levels were determined in supernatants obtained from phytohemagglutinin-stimulated whole blood cultures of 13 patients with DTC and 13 control subjects. The concentrations of selected cytokines: Th1-interferon gamma (IFN-γ), interleukin 2 (IL-2) and tumor necrosis factor alpha (TNF-α); Th2-interleukin 4 (IL-4), interleukin 5 (IL-5), interleukin 13 (IL-13) and interleukin 10 (IL-10); Th9-interleukin-9 (IL-9); and Th17-interleukin 17 (IL-17A) were measured using multiplex cytokine detection systems for Human Th1/Th2/Th9/Th17/Th22. We have shown that peripheral blood cells of DTC patients produce significantly higher concentrations of Th2/Th9 cytokines (IL-5, IL-13 and IL-9) than control subjects. The 131-I therapy led to reduced secretion of Th2 cytokines (IL-4, IL-5 and IL-13). Despite this, the calculated cytokine ratios (Th1/Th2) in DTC patients before and 7 days after 131-I therapy were not different from those in healthy subjects. DTC patients have significantly higher concentrations of Th2/Th9 cytokines (IL-5, IL-13 and IL-9) than control subjects. There is no influence of hypothyroidism or stage of disease on cytokine production in DTC patients before 131-I therapy. The radioactive 131-I therapy leads to reduced secretion of Th2 cytokines (IL-4, IL-5 and IL-13). Additional studies are needed to determine the significance of these findings.