Introduction: Diabetes mellitus, the most frequent endocrinology disease is a predisposing factor for infections. Diabetic patients have 4,4 times greater risk of systemic infection than non diabetics. Aim: a) To determine the prevalence and characteristics of acute infectious diseases in hospitalized diabetics; b) To correlate values of blood glucose levels and HbA1c with acute infections in hospitalized diabetics; c) To identify the etiology of infectious diseases. Material and methods: The study included 450 diabetic patients hospitalized in the 24-month period in the Intensive care unit of the Clinic for Endocrinology, Diabetes and Metabolic Disorders CCUS. In 204 patients (45,3%) there was an acute infectious condition and the following data was registered: a) gender and age; b) basic illness; c) laboratory parameters of inflammation (Le, CRP); d) blood glucose upon admission, parameters of glucoregulation (HbA1c, fructosamine); e) type of infection; f) verification of etiological agent; g) late complications of diabetes; and h) outcome. Results: Out of 204 diabetic patients with infection, there was 35,3% men and 64,7% women. More than half of patients (61%) were in the age group 61-80 years. The most common primary disease was Diabetes mellitus type 2. HbA1c and fructosamine were significantly increased in diabetic patients with acute infection compared to diabetics without acute infection. There is a positive correlation between HbA1c levels and CRP, and blood glucose and CRP in diabetic patients with acute infection. Most frequent infections: urinary tract infection (70,0%), followed by respiratory infections (11,8%), soft tissue infections (10,3%), generalized–bacteremia / sepsis (6,9%). The most common cause of urinary infection and generalized infection was Escherichia colli. The most common bacteria causing soft tissue infections was Staphylococcus aureus. Conclusion: Almost half (45,3%) of hospitalized diabetic patients had acute infectious condition. They present most frequently in women, aged 61-80 years, with Type 2 Diabetes mellitus. HbA1c and fructosamine were significantly increased in diabetic patients with acute infection. There is a positive correlation between the parameters of inflammation and glucoregulation in diabetics with acute infection. Most frequent was a urinary tract infection and the most common causative agent was Escherichia coli. The most common cause of soft tissue infections was Staphylococcus aureus. Out of 21 patients with verified soft tissue infections, 18 of them (85,7%) had confirmed diagnosis of diabetic microangiopathy diabetica. A total of 96,1% of patients fully recovered.

Assessment of the autonomic nervous system function could be of great importance in evaluation of the risk factors of the patients in perioperative period. Surgery and anaesthesia as integral medical procedures aimed as restoring and improving different disorders of homoestasis and physical conditions of subjects with different ailments and functional cardiac reserves have strong influence on haemodynamic function in perioperative period and it is of a great importance to clearly define if an individual patient is at a great risk of autonomic dysfunction in addition to the underlying morbidity, whicht increase the risk of morbidity and mortality in the perioperative period. Clinical tests for evaluation of autonomic nervous dysfunction have not become widely used by clinicians for several reasons. Some of the clinical tests are quite demanding what makes them less possible for performing in patients with poor reserve and more comorbidities and there are also difficulties in interpretation of subjective findings. Monitoring of heart rate variability as a parameter of autonomic nervous system activity has been clearly advocated in the risk assessment and follow up of the patients who develop diabetes mellitus and patients with coronary syndrome [1]. In subjects with diabetes mellitus who could have cardiac autonomic diabetic neuropathy, the quite serious condition of haemodynamic instability could increase the risk of aggravation and complications of the general condition in perioperative period [2]. On the other hand, most subjects with different stages of coronary syndrome have been shown to have different alterations of heart rate variability, and monitoring of heart rate viability in perioperative period could be a part of predicting tools of risk factors for surgery and anaesthesia [3]. The aim of this paper to give a reviewi of the importance of assessment of heart rate variability in relatively healthy subjects and subjects with different comorbid states, focusing on presenting of different findings of linear meaures of the analysis of parameter by means of two different softwares. Figure 1. Tachogram during calm and deep respiration in relatively healthy subject

AbstractBackgroundMelanoma of unknown primary site (MUP) is not a completely understood entity with nodal metastases as the most common first clinical manifestation. The aim of this multicentric study was to assess frequency and type of oncogenic BRAF/NRAS/KIT mutations in MUP with clinically detected nodal metastases in relation to clinicopathologic features and outcome. Materials and MethodsWe analyzed series of 103 MUP patients (period: 1992–2010) after therapeutic lymphadenectomy (LND): 40 axillary, 47 groin, 16 cervical, none treated with BRAF inhibitors. We performed molecular characterization of BRAF/NRAS/KIT mutational status in nodal metastases using direct sequencing of respective coding sequences. Median follow-up time was 53 months. ResultsBRAF mutations were detected in 55 cases (53 %) (51 V600E, 93 %; 4 others, 7 %), and mutually exclusive NRAS mutations were found in 14 cases (14 %) (7 p.Q61R, 4 p.Q61K, 2 p.Q61H, 1 p.Q13R). We have not detected any mutations in KIT. The 5-year overall survival (OS) was 34 %; median was 24 months. We have not found significant correlation between mutational status (BRAF/NRAS) and OS; however, for BRAF or NRAS mutated melanomas we observed significantly shorter disease-free survival (DFS) when compared with wild-type melanoma patients (p = .04; 5-year DFS, 18 vs 19 vs 31 %, respectively). The most important factor influencing OS was number of metastatic lymph nodes >1 (p = .03).ConclusionsOur large study on molecular characterization of MUP with nodal metastases showed that MUPs had molecular features similar to sporadic non-chronic-sun-damaged melanomas. BRAF/NRAS mutational status had negative impact on DFS in this group of patients. These observations might have potential implication for molecular-targeted therapy in MUPs.

Abstract Background Cerebellar glioblastoma multiforme (GBM) is rare and presents with increased intracranial pressure and cerebellar signs. The recommended treatment is radical resection, if possible, with radiation and chemotherapy. Clinical Presentation A 53-year-old man presented with hypertensive cerebellar bleeding and a 2-day history of severe headaches, nausea, vomiting, gait instability, and elevated blood pressure. Computed tomography (CT) showed a left cerebellar hematoma with no obstruction of cerebrospinal fluid and no hydrocephalus. CT angiography showed no signs of pathologic blood vessels in the posterior cranial fossa. The patient was observed in the hospital and discharged. Subsequent CT showed complete hematoma resorption. Two weeks later, he developed headaches, nausea, and worsening cerebellar symptoms. Magnetic resonance imaging (MRI) showed a 4-cm diameter tumor in the left cerebellar hemisphere where the hemorrhage was located. The tumor was radically resected and diagnosed as GBM. The patient underwent radiation and chemotherapy. At a follow-up of 1.5 years, MRIs showed no tumor recurrence. Conclusion Hypertensive cerebellar hemorrhage may be the first presentation of underlying tumor, specifically GBM. Patients undergoing surgery for cerebellar hemorrhage should have clot specimens sent for histologic examination and have pre- and postcontrast MRIs. Patients not undergoing surgery should have MRIs done after hematoma resolution to rule out underlying tumor.

Aim: To show a case report of mental health consequances of a felow who survived Trauma brain injury (TBI) with commotio cerebri that was not properly diagnosed in the first emergency medical examination and harm that he and his family suffer because of lack of knowledge and ethics of medical, economic and judical authorities. Case report: A twenty-six year old male survived a traffic accident that caused TBI. He was misdiagnosed during the emergency examination. Because of that (and other factors) he has not returned to his previous level of functioning. After he treated in the Department of Psychiatry, he went back to his environment a sick leave council interrupted his sick leave, showing mistrust to him and his condition and towards the discharge diagnoses from the Department of Psychiatry. The council sent him to his job without occupational rehabilitation that was recommended. As he could not work in his full capacity, the authorities from his job discharged him on January 2012. When he was on the trial for getting his compensation because of health damages the insurance health expert denied his sufferings and all mental consequences of the commotio cerebri because it was not diagnosed on the first examination in the evening of the accident. So the destiny of this young fellow is very questionable in perspective because of lack of knowledge and ethics of medical staff who are not responsible regarding Hippocratic oath and of industry management who do not take adequate care about their workers who survive traffic accident on the way back to home from their job and who continually suffer because of health particularly mental health consequences. Conclusion: The TBI is an important health public problem and the hospital must establish a perfect managemet in this patients for avoid Mental Changes of Commotio Cerebri.