[Fever of unknown origin--a case report of brucellar discitis].

INTRODUCTION: Febrile episodes of unknown origin lasting for two weeks require detailed investigation by various medical specialists. Fever of unknown origin is most commonly caused by infections, malignancy, colagenosis and in 5-10% of cases, despite detailed diagnostic assessmnet, the cause remains unknown. In cases of fever of unknown origin, the diagnostic procedures are difficult and complex. CASE REPORT: This is a case report of brucellar discitis in a female patient treated at the Clinic of Endocrinology, Diabetes and Metabolic Diseases with a diagnosis of fever of unknown origin. Her laboratory findings revealed high erythrocyte sedimentation rate, anemia and high gamma globulin fractions. The patient underwent radiology examination and a suspicion of infection was defined, which was later confirmed by additional tests. CONCLUSION: Despite the fact that the diagnostic investigations of patients with fever of unknown origin are complex and time consuming, detection of the cause is of utmost importance and it is a prerequisite for successful therapy.

[The place and role of physical activity in the treatment of obesity].

Treatment of obesity should primarily include diet and physical activity. Increased physical activity increases energy consumption with beneficial effects on the cardiovascular and metabolic-endocrine systems. It is of utmost importance to point out that simultaneous changes in physical activity and diet decrease both the total body fat mass and the viscelar fat. At the same time, protein body structure is maintained and subsequent follow-up of patients showed better results in respect of maintaining the achieved results. In children and adolescents it is possible to achieve weight loss only by increasing physical activity. Physical activity should be performed three times a week, and if metabolic effects are to be achieved, each training should last up to an hour. Highly recommendable are: swimming, cycling and hiking, whereas team sports provide better socialization of obese people.

[Characteristics of arterial hypertension in obesity]. / Karakteristike arterijske hipertenzije u gojaznosti.

INTRODUCTION: Arterial hypertension is the most frequent cardiovascular disease in obese persons, progressing with time to left ventricular hypertension, often associated with dilatation, diastolic disorders, hearth rhythm disturbance, and generalized atherosclerosis. ETIOLOGY: The origin of this disease is related to hemodynamic disturbances (increased blood volume, minute volume, mainly due to increased stroke volume) accompanied with changes of peripheral resistance, which increases in a later phase. However, metabolic factors are presently considered as primarily responsible for appearance of hypertension, which has rightly obtained the attribute of metabolic hypertension. A key role belongs to insulin, in fact, to insulin resistance and hyperinsulinism. TREATMENT: Awareness of the metabolic basis of arterial hypertension in obesity has resulted in a specific approach to its treatment. The primary treatment includes reduction diet, with a drastic reduction of salt intake and with compulsory physical activity, while concerning medications one should consider converting enzyme inhibitors, alpha1 blockers and calcium channel antagonists.

[Development and differentiation of adipose tissue]. / Razvoj i diferencijacija masnog tkiva.

INTRODUCTION: For years adipose tissue has been considered inert, serving only as a depot of energy surplus. However, there have been recent changes, undoubtedly due to advancement of methods for studying the morphology and metabolic activities of adipose tissue (microdialysis and adipose tissue catheterization). In normal-weight subjects, adipose tissue makes 10-12% with males and 15-20% with females. About 80% of adipose tissue is located under the skin, and the rest envelops the internal organs. With humans there are white and brown adipose tissues, which is predominant with infants and small children. HISTOLOGIC CHARACTERISTICS: From a histological point of view, it is a special form of reticular connective tissue, which contains adipocytes with netlike structure. Human adipose tissue has four types of adrenergic receptors with different topographic dispositions, which manifest different metabolic activity of adipocytes of particular body organs. Changes in adipose tissue are associated with the process of adipocyte differentiation. Critical moments for this process are last months of pregnancy, the first six months of infancy and then puberty. However, the differentiation process may also begin during maturity. Namely, as size of adipocytes can increase to a certain limit, this process can be activated after reaching a "critical" adipocyte volume. The differentiation process is affected by a number of hormones (insulin, glucagon, corticosteroids, somatotropin (STH), thyroid gland hormones, prolactin, testosterone), but also by some other substances (fatty acids, prostaglandins, liposoluble vitamins, butyrate, aspirin, indomethacin, metylxanthine, etc.).

[Are drugs necessary in the treatment of obesity?]. / Da li su potrebni lekovi za lecenje gojaznosti?

INTRODUCTION: The main principles of obesity treatment are dietetic nutrition, physical activity and psychotherapy. Drug therapy is adjuvant, time limited and can be applied only with the mentioned therapeutic measures. An ideal antiadipose agent induces a potent decrease of body mass on the account of fat depot, it can be administered for a prolonged time without developing resistance, it should not be accompanied by significant side effects, and it has no negative effects on the obesity-related diseases. ANTI-OBESITY AGENTS: Nowadays, there are mainly two groups of drugs in use, having different mechanisms of action: appetite suppressors and fat resorption inhibitors. From the first group of drugs the most suitable is dexfenfluramine, which is applied in obese nervous and tense subjects and in cases of compulsive food intake whereas fat resorption inhibitors (tetrahydrolipstatin, orlistat) are especially recommended to obese patients with accompanying hyperlipoproteinemia. Insulin-dependent form of diabetes is an indication for administration of drugs from this group. CONCLUSION: Of course, before applying drugs it is necessary to thoroughly consider indications and especially contraindications of their action. In respect to the treatment duration, three-month treatments are mainly recommended. Prolonged courses are acceptable only if well-controlled studies are in question.

Body fat mass in normal weight subjects.

Obesity is characterized by excessive body fat accumulation which may lead to serious health problems and complications. Body mass index is the most optimal parameter to evaluate the level of nutritional status and diagnose obesity. However, modern techniques studying body composition can more accurately determine whether the gain of body weight was on the account of body fat, lean body mass or total body water. If one's body mass index is in the range of normal values but the amount of body fat is above normal range, we talk about sarcopenic obesity. In order to evaluate presence of sarcopenic obesity, a group of 140 normal weight students of the Faculty of Medicine in Novi Sad were measured. Apart from standard anthropometrical parameters the amount of body fat was also determined by using the method of bioelectrical impedance analysis. Sarcopenic obesity was diagnosed in 25.71% of examined students. By using body mass index values this type of obesity cannot be diagnosed, and knowing that a higher amount of body fat in normal weight persons can lead to complications, especially metabolic, it is of great importance to evaluate the amount of body fat accurately.