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клица\u003C/a\u003E\u003C/b\u003E.\u003C/div\u003E\u003C/div\u003E\u003C/div\u003E\u003C/div\u003E\u003C/div\u003E\u003C/div\u003E\u003C/div\u003E\u003C/div\u003E\u003C/div\u003E";}}());</script></div> </div> <div class="vector-column-start"> <div class="vector-main-menu-container"> <div id="mw-navigation"> <nav id="mw-panel" class="vector-main-menu-landmark" aria-label="Сајт"> <div id="vector-main-menu-pinned-container" class="vector-pinned-container"> </div> </nav> </div> </div> <div class="vector-sticky-pinned-container"> <nav id="mw-panel-toc" aria-label="Садржај" data-event-name="ui.sidebar-toc" class="mw-table-of-contents-container vector-toc-landmark"> <div id="vector-toc-pinned-container" class="vector-pinned-container"> <div id="vector-toc" class="vector-toc vector-pinnable-element"> <div class="vector-pinnable-header vector-toc-pinnable-header vector-pinnable-header-pinned" data-feature-name="toc-pinned" data-pinnable-element-id="vector-toc" > <h2 class="vector-pinnable-header-label">Садржај</h2> <button class="vector-pinnable-header-toggle-button vector-pinnable-header-pin-button" data-event-name="pinnable-header.vector-toc.pin">помери на страну</button> <button class="vector-pinnable-header-toggle-button vector-pinnable-header-unpin-button" data-event-name="pinnable-header.vector-toc.unpin">сакриј</button> </div> <ul class="vector-toc-contents" id="mw-panel-toc-list"> <li id="toc-mw-content-text" class="vector-toc-list-item vector-toc-level-1"> <a href="#" class="vector-toc-link"> <div class="vector-toc-text">Почетак</div> </a> </li> <li id="toc-Osnovne_informacije" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Osnovne_informacije"> <div class="vector-toc-text"> <span class="vector-toc-numb">1</span> <span>Osnovne informacije</span> </div> </a> <ul id="toc-Osnovne_informacije-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Patogeneza" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Patogeneza"> <div class="vector-toc-text"> <span class="vector-toc-numb">2</span> <span>Patogeneza</span> </div> </a> <ul id="toc-Patogeneza-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Klinička_slika" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Klinička_slika"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Klinička slika</span> </div> </a> <ul id="toc-Klinička_slika-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Dijagnostički_testovi_za_kardiovaskularnu_autonomnu_neuropatiju_[2]" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Dijagnostički_testovi_za_kardiovaskularnu_autonomnu_neuropatiju_[2]"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Dijagnostički testovi za kardiovaskularnu autonomnu neuropatiju <sup><span>[</span>2<span>]</span></sup></span> </div> </a> <ul id="toc-Dijagnostički_testovi_za_kardiovaskularnu_autonomnu_neuropatiju_[2]-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Diferencijalna_dijagnoza_[2]" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Diferencijalna_dijagnoza_[2]"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Diferencijalna dijagnoza <sup><span>[</span>2<span>]</span></sup></span> </div> </a> <ul id="toc-Diferencijalna_dijagnoza_[2]-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Terapija" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Terapija"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Terapija</span> </div> </a> <ul id="toc-Terapija-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Izvori" 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dir="ltr"><figure typeof="mw:File/Thumb"><a href="/wiki/%D0%94%D0%B0%D1%82%D0%BE%D1%82%D0%B5%D0%BA%D0%B0:Glucose_metabolism.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/95/Glucose_metabolism.svg/300px-Glucose_metabolism.svg.png" decoding="async" width="300" height="233" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/95/Glucose_metabolism.svg/450px-Glucose_metabolism.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/95/Glucose_metabolism.svg/600px-Glucose_metabolism.svg.png 2x" data-file-width="1390" data-file-height="1080" /></a><figcaption>Metabolizam glukoze </figcaption></figure> <p><b>Dijabetesna autonomna neuropatija</b> (akronim <b>DAN</b> od engl. reči <b>D</b>iabetic <b>a</b>utonomic <b>n</b>europathy) je najmanje prepoznata i shvaćena komplikacija šečerne bolesti, uprkos značajnom uticaju na preživljavanje i kvalitet života kod ljudi sa dijabetesom. Komplikacija može da zahvati bilo koji organ u telu, smanji sposobnost bolesnika za sprovođenje aktivnosti dnevnog i kvalitet života i poveća rizik od smrti.<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>Ova komplikacija šećerne bolesti ostaje često dugo neprepoznata. Terapija je simptomatska, a rana detekcija i kontrola šećerne bolesti, kao i koegzistirajućih riziko-faktora za nastanak neuropatije, može sprečiti, usporiti ili odložiti nastanak <a href="/wiki/%D0%94%D0%B8%D1%98%D0%B0%D0%B1%D0%B5%D1%82%D0%B5%D1%81%D0%BD%D0%B0_%D0%BD%D0%B5%D1%84%D1%80%D0%BE%D0%BF%D0%B0%D1%82%D0%B8%D1%98%D0%B0" title="Дијабетесна нефропатија">dijabetesne neuropatije</a>, uključujući i dijabetesnu autonomnu neuropatiju.<sup id="cite_ref-1._2-0" class="reference"><a href="#cite_note-1.-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Osnovne_informacije">Osnovne informacije</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Dijabetesna_autonomna_neuropatija&veaction=edit&section=1" title="Уредите одељак „Osnovne informacije”" class="mw-editsection-visualeditor"><span>уреди</span></a><span class="mw-editsection-divider"> | </span><a href="/w/index.php?title=Dijabetesna_autonomna_neuropatija&action=edit&section=1" title="Уреди извор одељка: Osnovne informacije"><span>уреди извор</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Najvažniji faktori koji uzrokuju dijabetesnu autonomnu neuropatiju su: </p> <ul><li>loša kontrola glikemije,</li> <li>dugo trajanje šećerne bolesti,</li> <li>poznije godine života,</li> <li>ženski pol i</li> <li>viši indeks telesne mase.</li></ul> <p>Mortalitet u roku od 5 do 10 godina od postavljene dijagnoze dijabetesne autonomne neuropatije je visok i kreće se od 25% do 50% kod bolesnik, koji umirer sa znacima simptomatske autonomne disfunkcijom.<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Petogodišnja smrtnost kod bolesnika je tri puta viša nego kod pacijenata bez autonomnog poremećaja.<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> Vodeći uzroci smrti kod bolesnika sa simptomatskom ili asimptomatskom autonomnom neuropatijom su srčane bolesti i nefropatija. </p><p>Autonomna neuropatija je takođe važan faktor rizika za cerebrovaskularni inzult.<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Patogeneza">Patogeneza</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Dijabetesna_autonomna_neuropatija&veaction=edit&section=2" title="Уредите одељак „Patogeneza”" class="mw-editsection-visualeditor"><span>уреди</span></a><span class="mw-editsection-divider"> | </span><a href="/w/index.php?title=Dijabetesna_autonomna_neuropatija&action=edit&section=2" title="Уреди извор одељка: Patogeneza"><span>уреди извор</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Dijabetesna neuropatije uključuju brojne etiološke faktore uključujući: </p> <ul><li>metabolički inzult nervnih vlakana,</li> <li>neurovaskularnu insuficijenciju,</li> <li>autoimuno oštećenje i</li> <li>deficijenciju neurohumoralnog faktora rasta.</li></ul> <p>Hiperglikemična aktivacija puteva poliola dovodi do akumulacije sorbitola i potencijalne promene odnosa NAD i NADH, što može uzrokovati direktno oštećenje neurona i/ili opadanje kapilarne cirkulacije u nervu. Aktivacija protein kinaze C indukuje vazokonstrikciju i redukuje neuronalni kapilarni protok.<sup id="cite_ref-1._2-1" class="reference"><a href="#cite_note-1.-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>Porast oksidativnog stresa sa porastom produkcije slobodnih radikala uzrokuje oštećenje endotela kapilara i redukuje bioraspoloživost azot oksida (NO). Ekscesivna produkcija NO može dovesti do formiranja peroksinitrita i oštetiti endotel i neurone - to je proces poznat pod nazivom nitrozativni stres.<sup id="cite_ref-1._2-2" class="reference"><a href="#cite_note-1.-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>Pored navedenog u patogenezi dijabetesne autonomne neuropatije važnu ulogu imaju imuni mehanizmi: </p> <ul><li>smanjenje neurotropnog faktora rasta,</li> <li>deficijencija esencijalnih masnih kiselina.</li></ul> <p>Rezultat ovih multifaktorskih procesa može biti ćelijska nekroza i aktivacija gena uključenih u neuronalno oštećenje.<sup id="cite_ref-1._2-3" class="reference"><a href="#cite_note-1.-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Klinička_slika"><span id="Klini.C4.8Dka_slika"></span>Klinička slika</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Dijabetesna_autonomna_neuropatija&veaction=edit&section=3" title="Уредите одељак „Klinička slika”" class="mw-editsection-visualeditor"><span>уреди</span></a><span class="mw-editsection-divider"> | </span><a href="/w/index.php?title=Dijabetesna_autonomna_neuropatija&action=edit&section=3" title="Уреди извор одељка: Klinička slika"><span>уреди извор</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Ratvijeni klinički simptomi autonomne neuropatije u osnovi se ne javljaju dugo nakon pojave šećerne bolesti, ali se zato subklinička autonomna disfunkcija, javiti unutar jedne godine od dijagnoze šećerne bolesti tipa 2 i unutar dve godine kod tipa 1 dijabetesa.<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p> <table class="wikitable"> <tbody><tr> <td><b>Kardiovaskularne</b></td> <td> <ul><li>Tahikadija, intolerancija fizičkog napora — rani je znak.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Uzrokovano je smanjenjem simpatičkog i parasimpatičkog odgovora koji normalno povećavaju kardijalni output i preusmeravaju perifernu krvnu cirkulaciju do skeletnih mišića. Takođe zbog smanjenja ejekcione frakcije, sistolne disfunkcije i smanjenja dijastolnog punjenja</li> <li>Kardijalna denervacija, bezbolni infarkt miokarda</li> <li>Ortostatska hipotenzija</li></ul> </td></tr> <tr> <td><b>Gastrointestinalne</b></td> <td> <ul><li>Ezofagealna disfunkcija — poremećaji ezofagealnog motiliteta kao što su disfagija, retrosternalna nalagodnost, žgaravica nisu česti kod dijabetičara.<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup></li> <li>Dijabetesna gastropareza</li> <li>Dijareja — javlaj se 20% bolesnika. Simptomi su intermitentni od nekoliko sati do nekoliko dana. Noćna dijareja i fekalna inkontinencija su česti. Može biti rezultat intestestinalnog ipermotiliteta uzrokovanog smanjenjem simpatičke inhibicije. Hipomotilitet je posledica pankreasne disfunkcije, takođe i steatoreja.<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup></li> <li>Konstipacija — - najčešća komplikacija, javlja se kod skoro 60% dijabetičara. Može biti udružena sa atonijom debelog creva i rektuma i ponekad sa megakolonom. Može se smenjivati sa epizodama dijareje.<sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup></li> <li>Fekalna inkontinencija</li></ul> </td></tr> <tr> <td><b>Genitourinarne</b></td> <td> <ul><li>Erektilna disfunkcija — prevalenca oko 50%.<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup></li> <li>Retrogradna ejakulacija</li> <li>Seksualna disfunkcija kod žena</li> <li>Cistopatija — neurogena bešika - kod 37 do 50%.<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup></li> <li>Neurogena bešika</li></ul> </td></tr> <tr> <td><b>Neurovaskularne</b></td> <td> <ul><li>Poremećaj krvnog protoka u koži</li> <li>Intolerancija toplote</li> <li>Gustatorno znojenje</li> <li>Suva koža</li></ul> </td></tr> <tr> <td><b>Metaboličke</b></td> <td> <ul><li>Nepredvidljive hipoglikemije</li> <li>Sa hipoglikemijom udruženi autonomni poremećaji</li></ul> </td></tr> <tr> <td><b>Pupilarne</b></td> <td> <ul><li>Smanjeni dijametar zenice adaptirane na tamu</li> <li>Argyll –Robertson tip zenice</li></ul> </td></tr></tbody></table> <div class="mw-heading mw-heading2"><h2 id="Dijagnostički_testovi_za_kardiovaskularnu_autonomnu_neuropatiju_[2]"><span id="Dijagnosti.C4.8Dki_testovi_za_kardiovaskularnu_autonomnu_neuropatiju_.5B2.5D"></span>Dijagnostički testovi za kardiovaskularnu autonomnu neuropatiju <sup id="cite_ref-1._2-4" class="reference"><a href="#cite_note-1.-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Dijabetesna_autonomna_neuropatija&veaction=edit&section=4" title="Уредите одељак „Dijagnostički testovi za kardiovaskularnu autonomnu neuropatiju [2]”" class="mw-editsection-visualeditor"><span>уреди</span></a><span class="mw-editsection-divider"> | </span><a href="/w/index.php?title=Dijabetesna_autonomna_neuropatija&action=edit&section=4" title="Уреди извор одељка: Dijagnostički testovi za kardiovaskularnu autonomnu neuropatiju [2]"><span>уреди извор</span></a><span class="mw-editsection-bracket">]</span></span></div> <table class="wikitable"> <tbody><tr> <th>Test</th> <th>Parametri posmatranja </th></tr> <tr> <td><b>Srčana frekvenca u miru</b></td> <td> <ul><li>> 100 otkucaja/min je patološki</li></ul> </td></tr> <tr> <td><b>Varijacija srčane frekvence</b></td> <td> <ul><li>Kada pacijent legne na leđa i diše 6 puta u minuti, razlika u srčanoj frekvenci manje od 10 otkucaja/min je patološka R-R inspiracija/R-R ekspiracija >1,17 - patološki</li></ul> </td></tr> <tr> <td><b>Srčana frekvenca kao odgovor na stajanje</b></td> <td> <ul><li>Tokom stalnog EKG monitoringa, R-R interval se meri između 15 i 30 otkucaja nakon ustajanja. Normalno, tahikardija je praćena refleksnom bradikardijom.</li> <li>0:15 >1.03 je normalno</li></ul> </td></tr> <tr> <td><b>Srčana frekvenca kao odgovor na Valsalva manevar</b></td> <td> <ul><li>Pacijent forsirano izdahne u usni deo manometra, vršeći pritisak od 40 mmHg za 15 sekundi</li> <li>Odnos od najdužeg do najkraćeg R-R intervala manje od 1,2 je patološki</li></ul> </td></tr> <tr> <td><b>Sistolni krvni pritisak - odgovor na stajanje</b></td> <td> <ul><li>Meri se kada pacijent leži i 2 minuta nakon ustajanja</li> <li>Pad od više od 30 mmHg je patološki</li> <li>Pad od 10 do 29 mmHg je granični</li></ul> </td></tr> <tr> <td><b>Dijastolni krvni pritisak - odgovor na izometričke vežbe</b></td> <td> <ul><li>Pacijent stiska rukom dinamometar do maksimuma.</li> <li>Stisak zatim održava na 30% od maksimuma tokom 5 min.</li> <li>Porast dijastolnog pritiska manje od 16 mmHg u suprotnoj ruci je patološki</li></ul> </td></tr> <tr> <td><b>EKG</b></td> <td> <ul><li>QTc (korigovani QT interval na EKG-u) treba da bude manji od 440 ms</li> <li>Sniženje pika jako niske frekvence kao i pika niske frekvence - simpatička disfunkcija</li> <li>Sniženje pika visoke frekvence - parasimpatička disfunkcija</li> <li>Sniženje odnosa niske frekvence/visoke frekvence - simpatički disbalans</li></ul> </td></tr> <tr> <td><b>Neurovaskularni protok</b></td> <td> <ul><li>Neinvazivno laser Doppler merenje perifernog simpatetičkog odgovora na nocicepciju</li></ul> </td></tr></tbody></table> <div class="mw-heading mw-heading2"><h2 id="Diferencijalna_dijagnoza_[2]"><span id="Diferencijalna_dijagnoza_.5B2.5D"></span>Diferencijalna dijagnoza <sup id="cite_ref-1._2-5" class="reference"><a href="#cite_note-1.-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Dijabetesna_autonomna_neuropatija&veaction=edit&section=5" title="Уредите одељак „Diferencijalna dijagnoza [2]”" class="mw-editsection-visualeditor"><span>уреди</span></a><span class="mw-editsection-divider"> | </span><a href="/w/index.php?title=Dijabetesna_autonomna_neuropatija&action=edit&section=5" title="Уреди извор одељка: Diferencijalna dijagnoza [2]"><span>уреди извор</span></a><span class="mw-editsection-bracket">]</span></span></div> <table class="wikitable"> <tbody><tr> <th>Poremećaj</th> <th>Znaci i siptomi </th></tr> <tr> <td><b>Kardiovaskularni poremećaji</b></td> <td> <ul><li>Idiopatska ortostatska hipotenzija, MSA sa parkinsonizmom, ortostatska</li></ul> <p>tahikardija, hiperadrenergična hipotenzija </p> <ul><li>Shy- Drager sindrom</li> <li>Panhypopituitarizam</li> <li>Feohromocitom</li> <li>Hipovolemija</li> <li>Kongestivna bolest srca</li> <li>Karcinoidni sindrom</li></ul> </td></tr> <tr> <td><b>Gastrointestinalni poremećaji</b></td> <td> <ul><li>Opstrukcije</li> <li>Bezoari</li> <li>Sekretorna dijareja (endokrini tumori)</li> <li>Bilijarne bolesti</li> <li>Psihogeno povraćanje</li> <li>Lekovi</li></ul> </td></tr> <tr> <td><b>Genitourinarni</b></td> <td> <ul><li>Genitalna i pelvična hirurgija</li> <li>Aterosklerotske vaskularne bolesti</li> <li>Lekovi</li> <li>Alkoholni abusus</li></ul> </td></tr> <tr> <td><b>Ostali uzroci neurovaskularne disfunkcije</b></td> <td> <ul><li>Chagas-ova bolest, amiloidoza, arsenik</li></ul> </td></tr> <tr> <td><b>Metabolički</b></td> <td> <ul><li>Ostali uzroci hipoglikemije, intenzivna glikemička kontrola i lekovi koji mogu maskirati hipoglikemiju</li></ul> </td></tr></tbody></table> <div class="mw-heading mw-heading2"><h2 id="Terapija">Terapija</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Dijabetesna_autonomna_neuropatija&veaction=edit&section=6" title="Уредите одељак „Terapija”" class="mw-editsection-visualeditor"><span>уреди</span></a><span class="mw-editsection-divider"> | </span><a href="/w/index.php?title=Dijabetesna_autonomna_neuropatija&action=edit&section=6" title="Уреди извор одељка: Terapija"><span>уреди извор</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Terapija autonomne neuropatije može popraviti simptome gastropareze: </p> <ul><li>izmenama dijetetskog režima</li> <li>primenom prokinetika kao što su metoklopramid ili eritromicin.</li></ul> <p>Terapija erektilne disfunkcije obuhvata primenu inhibitora <a href="/wiki/Fosfodiesteraza" title="Fosfodiesteraza">fosfodiesteraze tip 5</a> (PDE5), primenu prostaglandina intrakorporealno ili intraureteralno, primenu vakuum aparata ili penilnih proteza. Ukoliko nema kontraindikacija PDE5 inhibitor bi trebalo koristiti kao prvu liniju terapije muskaraca sa dijabetesnom erektilnom disfunkcijom. </p><p>pućivanje specijalisti za erektilnu disfunkciju treba razmotriti za eugonadne pacijente koji ne reaguju na PDE5 inhibitore, ili za pacijente kod kojih je primena PDE5 inhibitora kontraindikovana. Kod muškaraca sa dijabetesnom ED koji ne reaguju na PDE5 therapiju trebalo bi ispitati postojanje hipogonadizma. </p><p>Muškarce sa dijabetesom i erektilnom disfunkcijom koji žele potomstvo trebalo bi uputiti stručnjacima koji se bave problemom ejakulatorne disfunkcije. </p> <div class="mw-heading mw-heading2"><h2 id="Izvori">Izvori</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Dijabetesna_autonomna_neuropatija&veaction=edit&section=7" title="Уредите одељак „Izvori”" class="mw-editsection-visualeditor"><span>уреди</span></a><span class="mw-editsection-divider"> | </span><a href="/w/index.php?title=Dijabetesna_autonomna_neuropatija&action=edit&section=7" title="Уреди извор одељка: Izvori"><span>уреди извор</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r28440201">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-1">^</a></b></span> <span class="reference-text">Vinik AI, Mitchell BD, Leicher SB, Wagner AL, O’Brian JT, Georges LP. 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color:#33aa33; margin-left:0.3em">CS1 одржавање: Вишеструка имена: списак аутора (<a href="/wiki/%D0%9A%D0%B0%D1%82%D0%B5%D0%B3%D0%BE%D1%80%D0%B8%D1%98%D0%B0:CS1_%D0%BE%D0%B4%D1%80%D0%B6%D0%B0%D0%B2%D0%B0%D1%9A%D0%B5:_%D0%92%D0%B8%D1%88%D0%B5%D1%81%D1%82%D1%80%D1%83%D0%BA%D0%B0_%D0%B8%D0%BC%D0%B5%D0%BD%D0%B0:_%D1%81%D0%BF%D0%B8%D1%81%D0%B0%D0%BA_%D0%B0%D1%83%D1%82%D0%BE%D1%80%D0%B0" title="Категорија:CS1 одржавање: Вишеструка имена: списак аутора">веза</a>)</span>.</span> </li> <li id="cite_note-9"><span class="mw-cite-backlink"><b><a href="#cite_ref-9">^</a></b></span> <span class="reference-text"><cite class="citation journal">Verne GN; Sninsky CA (1998). <a rel="nofollow" class="external text" href="https://archive.org/details/sim_gastroenterology-clinics-of-north-america_1998-12_27_4/page/861">„Diabetes and the gastrointestinal tract”</a>. <i>Gastroenterol Clin North Am</i>. <b>27</b> (4): 861—874. <a href="/wiki/PMID" title="PMID">PMID</a> <a rel="nofollow" class="external text" href="//www.ncbi.nlm.nih.gov/pubmed/9890116">9890116</a>. <a href="/wiki/Digitalni_identifikator_objekta" title="Digitalni identifikator objekta">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2FS0889-8553%2805%2970035-2">10.1016/S0889-8553(05)70035-2</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fsr.wikipedia.org%3ADijabetesna+autonomna+neuropatija&rft.atitle=Diabetes+and+the+gastrointestinal+tract&rft.au=Sninsky+CA&rft.au=Verne+GN&rft.date=1998&rft.genre=article&rft.issue=4&rft.jtitle=Gastroenterol+Clin+North+Am&rft.pages=861-874&rft.volume=27&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2Fsim_gastroenterology-clinics-of-north-america_1998-12_27_4%2Fpage%2F861&rft_id=info%3Adoi%2F10.1016%2FS0889-8553%2805%2970035-2&rft_id=info%3Apmid%2F9890116&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal" class="Z3988"><span style="display:none;"> </span></span>.</span> </li> <li id="cite_note-10"><span class="mw-cite-backlink"><b><a href="#cite_ref-10">^</a></b></span> <span class="reference-text"><cite class="citation journal">Valdovinos MA, Camilleri M, Zimmerman BR (1993). „Chronic diarrhea in diabetes mellitus: mechanisms and an approach to diagnosis and treatment”. <i>Mayo Clin Proc</i>. <b>687</b> (7): 691—702. <a href="/wiki/PMID" title="PMID">PMID</a> <a rel="nofollow" class="external text" href="//www.ncbi.nlm.nih.gov/pubmed/8350642">8350642</a>. <a href="/wiki/Digitalni_identifikator_objekta" title="Digitalni identifikator objekta">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2FS0025-6196%2812%2960606-5">10.1016/S0025-6196(12)60606-5</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fsr.wikipedia.org%3ADijabetesna+autonomna+neuropatija&rft.atitle=Chronic+diarrhea+in+diabetes+mellitus%3A+mechanisms+and+an+approach+to+diagnosis+and+treatment&rft.au=Valdovinos+MA%2C+Camilleri+M%2C+Zimmerman+BR&rft.date=1993&rft.genre=article&rft.issue=7&rft.jtitle=Mayo+Clin+Proc&rft.pages=691-702&rft.volume=687&rft_id=info%3Adoi%2F10.1016%2FS0025-6196%2812%2960606-5&rft_id=info%3Apmid%2F8350642&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal" class="Z3988"><span style="display:none;"> </span></span><span class="citation-comment" style="display:none; color:#33aa33; margin-left:0.3em">CS1 одржавање: Вишеструка имена: списак аутора (<a href="/wiki/%D0%9A%D0%B0%D1%82%D0%B5%D0%B3%D0%BE%D1%80%D0%B8%D1%98%D0%B0:CS1_%D0%BE%D0%B4%D1%80%D0%B6%D0%B0%D0%B2%D0%B0%D1%9A%D0%B5:_%D0%92%D0%B8%D1%88%D0%B5%D1%81%D1%82%D1%80%D1%83%D0%BA%D0%B0_%D0%B8%D0%BC%D0%B5%D0%BD%D0%B0:_%D1%81%D0%BF%D0%B8%D1%81%D0%B0%D0%BA_%D0%B0%D1%83%D1%82%D0%BE%D1%80%D0%B0" title="Категорија:CS1 одржавање: Вишеструка имена: списак аутора">веза</a>)</span>.</span> </li> <li id="cite_note-11"><span class="mw-cite-backlink"><b><a href="#cite_ref-11">^</a></b></span> <span class="reference-text"><cite class="citation journal">Maleki D, Camilleri M, Burton DD,; et al. (1998). <a rel="nofollow" class="external text" href="https://archive.org/details/sim_digestive-diseases-and-sciences_1998-11_43_11/page/2373">„Pilot study of pathophysiology of constipation among community diabetics”</a>. <i>Dig Dis Sci</i>. <b>43</b> (11): 2373—2378. <a href="/wiki/PMID" title="PMID">PMID</a> <a rel="nofollow" class="external text" href="//www.ncbi.nlm.nih.gov/pubmed/9824121">9824121</a>. <a href="/wiki/Semantic_Scholar" title="Semantic Scholar">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:20897117">20897117</a>. <a href="/wiki/Digitalni_identifikator_objekta" title="Digitalni identifikator objekta">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1023%2FA%3A1026657426396">10.1023/A:1026657426396</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fsr.wikipedia.org%3ADijabetesna+autonomna+neuropatija&rft.atitle=Pilot+study+of+pathophysiology+of+constipation+among+community+diabetics&rft.au=Maleki+D%2C+Camilleri+M%2C+Burton+DD%2C&rft.date=1998&rft.genre=article&rft.issue=11&rft.jtitle=Dig+Dis+Sci&rft.pages=2373-2378&rft.volume=43&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A20897117&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2Fsim_digestive-diseases-and-sciences_1998-11_43_11%2Fpage%2F2373&rft_id=info%3Adoi%2F10.1023%2FA%3A1026657426396&rft_id=info%3Apmid%2F9824121&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal" class="Z3988"><span style="display:none;"> </span></span><span class="citation-comment" style="display:none; color:#33aa33; margin-left:0.3em">CS1 одржавање: Вишеструка имена: списак аутора (<a href="/wiki/%D0%9A%D0%B0%D1%82%D0%B5%D0%B3%D0%BE%D1%80%D0%B8%D1%98%D0%B0:CS1_%D0%BE%D0%B4%D1%80%D0%B6%D0%B0%D0%B2%D0%B0%D1%9A%D0%B5:_%D0%92%D0%B8%D1%88%D0%B5%D1%81%D1%82%D1%80%D1%83%D0%BA%D0%B0_%D0%B8%D0%BC%D0%B5%D0%BD%D0%B0:_%D1%81%D0%BF%D0%B8%D1%81%D0%B0%D0%BA_%D0%B0%D1%83%D1%82%D0%BE%D1%80%D0%B0" title="Категорија:CS1 одржавање: Вишеструка имена: списак аутора">веза</a>)</span>.</span> </li> <li id="cite_note-12"><span class="mw-cite-backlink"><b><a href="#cite_ref-12">^</a></b></span> <span class="reference-text"><cite class="citation journal">Joshi N, Caputo GM, Weitekamp MR, Karchmer AW (1999). „Infections in patients with diabetes mellitus”. <i>New England Journal of Medicine</i>. <b>341</b> (25): 1906—1912. <a href="/wiki/PMID" title="PMID">PMID</a> <a rel="nofollow" class="external text" href="//www.ncbi.nlm.nih.gov/pubmed/10601511">10601511</a>. <a href="/wiki/Digitalni_identifikator_objekta" title="Digitalni identifikator objekta">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1056%2FNEJM199912163412507">10.1056/NEJM199912163412507</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fsr.wikipedia.org%3ADijabetesna+autonomna+neuropatija&rft.atitle=Infections+in+patients+with+diabetes+mellitus&rft.au=Joshi+N%2C+Caputo+GM%2C+Weitekamp+MR%2C+Karchmer+AW&rft.date=1999&rft.genre=article&rft.issue=25&rft.jtitle=New+England+Journal+of+Medicine&rft.pages=1906-1912&rft.volume=341&rft_id=info%3Adoi%2F10.1056%2FNEJM199912163412507&rft_id=info%3Apmid%2F10601511&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal" class="Z3988"><span style="display:none;"> </span></span><span class="citation-comment" style="display:none; color:#33aa33; margin-left:0.3em">CS1 одржавање: Вишеструка имена: списак аутора (<a href="/wiki/%D0%9A%D0%B0%D1%82%D0%B5%D0%B3%D0%BE%D1%80%D0%B8%D1%98%D0%B0:CS1_%D0%BE%D0%B4%D1%80%D0%B6%D0%B0%D0%B2%D0%B0%D1%9A%D0%B5:_%D0%92%D0%B8%D1%88%D0%B5%D1%81%D1%82%D1%80%D1%83%D0%BA%D0%B0_%D0%B8%D0%BC%D0%B5%D0%BD%D0%B0:_%D1%81%D0%BF%D0%B8%D1%81%D0%B0%D0%BA_%D0%B0%D1%83%D1%82%D0%BE%D1%80%D0%B0" title="Категорија:CS1 одржавање: Вишеструка имена: списак аутора">веза</a>)</span>.</span> </li> <li id="cite_note-13"><span class="mw-cite-backlink"><b><a href="#cite_ref-13">^</a></b></span> <span class="reference-text"><cite class="citation journal">A randomized controlled trial of topical glycopyrrolate, the first specific treatment for diabetic gustatory sweating (1997). <a rel="nofollow" class="external text" href="https://archive.org/details/sim_diabetologia_1997-03_40_3/page/299">„A randomised controlled trial of topical glycopyrrolate, the first specific treatment for diabetic gustatory sweating”</a>. <i>Diabetologia</i>. <b>40</b> (3): 299—301. <a href="/wiki/PMID" title="PMID">PMID</a> <a rel="nofollow" class="external text" href="//www.ncbi.nlm.nih.gov/pubmed/9084967">9084967</a>. <a href="/wiki/Semantic_Scholar" title="Semantic Scholar">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:34013119">34013119</a>. <a href="/wiki/Digitalni_identifikator_objekta" title="Digitalni identifikator objekta">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2Fs001250050677">10.1007/s001250050677</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fsr.wikipedia.org%3ADijabetesna+autonomna+neuropatija&rft.atitle=A+randomised+controlled+trial+of+topical+glycopyrrolate%2C+the+first+specific+treatment+for+diabetic+gustatory+sweating&rft.au=A+randomized+controlled+trial+of+topical+glycopyrrolate%2C+the+first+specific+treatment+for+diabetic+gustatory+sweating&rft.date=1997&rft.genre=article&rft.issue=3&rft.jtitle=Diabetologia&rft.pages=299-301&rft.volume=40&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A34013119&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2Fsim_diabetologia_1997-03_40_3%2Fpage%2F299&rft_id=info%3Adoi%2F10.1007%2Fs001250050677&rft_id=info%3Apmid%2F9084967&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal" class="Z3988"><span style="display:none;"> </span></span></span> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="Literatura">Literatura</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Dijabetesna_autonomna_neuropatija&veaction=edit&section=8" title="Уредите одељак „Literatura”" class="mw-editsection-visualeditor"><span>уреди</span></a><span class="mw-editsection-divider"> | </span><a href="/w/index.php?title=Dijabetesna_autonomna_neuropatija&action=edit&section=8" title="Уреди извор одељка: Literatura"><span>уреди извор</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><cite class="citation journal">Vinik, A. I.; Maser, R. E.; Mitchell, B. D.; Freeman, R. (2003). „Diabetic autonomic neuropathy”. <i>Diabetes Care</i>. <b>26</b> (5): 1553—1579. <a href="/wiki/PMID" title="PMID">PMID</a> <a rel="nofollow" class="external text" href="//www.ncbi.nlm.nih.gov/pubmed/12716821">12716821</a>. <a href="/wiki/Digitalni_identifikator_objekta" title="Digitalni identifikator objekta">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.2337%2Fdiacare.26.5.1553">10.2337/diacare.26.5.1553</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fsr.wikipedia.org%3ADijabetesna+autonomna+neuropatija&rft.atitle=Diabetic+autonomic+neuropathy&rft.au=Freeman%2C+R.&rft.au=Maser%2C+R.+E.&rft.au=Mitchell%2C+B.+D.&rft.aufirst=A.+I.&rft.aulast=Vinik&rft.date=2003&rft.genre=article&rft.issue=5&rft.jtitle=Diabetes+Care&rft.pages=1553-1579&rft.volume=26&rft_id=info%3Adoi%2F10.2337%2Fdiacare.26.5.1553&rft_id=info%3Apmid%2F12716821&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal" class="Z3988"><span style="display:none;"> </span></span>.</li> <li><cite class="citation journal">Maser, Raelene E.; Lenhard, James M.; Decherney, Stephen G. (2000). „Cardiovascular Autonomic Neuropathy”. <i>Endocrinologist</i>. <b>10</b>: 27—33. <a href="/wiki/Digitalni_identifikator_objekta" title="Digitalni identifikator objekta">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1097%2F00019616-200010010-00006">10.1097/00019616-200010010-00006</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fsr.wikipedia.org%3ADijabetesna+autonomna+neuropatija&rft.atitle=Cardiovascular+Autonomic+Neuropathy&rft.au=Decherney%2C+Stephen+G.&rft.au=Lenhard%2C+James+M.&rft.aufirst=Raelene+E.&rft.aulast=Maser&rft.date=2000&rft.genre=article&rft.jtitle=Endocrinologist&rft.pages=27-33&rft.volume=10&rft_id=info%3Adoi%2F10.1097%2F00019616-200010010-00006&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal" class="Z3988"><span style="display:none;"> </span></span>.</li> <li><cite class="citation journal">Ewing, D. J.; Clarke, B. F. (1986). „Diabetic autonomic neuropathy: Present insights and future prospects”. <i>Diabetes Care</i>. <b>9</b> (6): 648—665. <a href="/wiki/PMID" title="PMID">PMID</a> <a rel="nofollow" class="external text" href="//www.ncbi.nlm.nih.gov/pubmed/3100258">3100258</a>. <a href="/wiki/Semantic_Scholar" title="Semantic Scholar">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:1762571">1762571</a>. <a href="/wiki/Digitalni_identifikator_objekta" title="Digitalni identifikator objekta">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.2337%2Fdiacare.9.6.648">10.2337/diacare.9.6.648</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fsr.wikipedia.org%3ADijabetesna+autonomna+neuropatija&rft.atitle=Diabetic+autonomic+neuropathy%3A+Present+insights+and+future+prospects&rft.au=Clarke%2C+B.+F.&rft.aufirst=D.+J.&rft.aulast=Ewing&rft.date=1986&rft.genre=article&rft.issue=6&rft.jtitle=Diabetes+Care&rft.pages=648-665&rft.volume=9&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A1762571&rft_id=info%3Adoi%2F10.2337%2Fdiacare.9.6.648&rft_id=info%3Apmid%2F3100258&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal" class="Z3988"><span style="display:none;"> </span></span></li> <li>Vinik A, Erbas T, Pfeifer M, Feldman M, Feldman E, Stevens M, Russell J. <i>Diabetic autonomic neuropathy.</i> In: Porte D Jr, Sherwin RS, Baron A, eds. Ellenberg & Rifkin’s Diabetes Mellitus. 6th ed. New York, NY: McGraw-Hill. <cite class="citation book">Porte D Jr, Sherwin RS, Baron A, ур. (2003). <i>Ellenberg & Rifkin’s Diabetes Mellitus</i> (6th изд.). New York, NY: McGraw-Hill. стр. 789—804.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fsr.wikipedia.org%3ADijabetesna+autonomna+neuropatija&rft.btitle=Ellenberg+%26+Rifkin%E2%80%99s+Diabetes+Mellitus&rft.date=2003&rft.edition=6th&rft.genre=book&rft.pages=789-804&rft.place=New+York%2C+NY&rft.pub=McGraw-Hill&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook" class="Z3988"><span style="display:none;"> </span></span><span class="citation-comment" style="display:none; color:#33aa33; margin-left:0.3em">CS1 одржавање: Вишеструка имена: списак уредника (<a href="/wiki/%D0%9A%D0%B0%D1%82%D0%B5%D0%B3%D0%BE%D1%80%D0%B8%D1%98%D0%B0:CS1_%D0%BE%D0%B4%D1%80%D0%B6%D0%B0%D0%B2%D0%B0%D1%9A%D0%B5:_%D0%92%D0%B8%D1%88%D0%B5%D1%81%D1%82%D1%80%D1%83%D0%BA%D0%B0_%D0%B8%D0%BC%D0%B5%D0%BD%D0%B0:_%D1%81%D0%BF%D0%B8%D1%81%D0%B0%D0%BA_%D1%83%D1%80%D0%B5%D0%B4%D0%BD%D0%B8%D0%BA%D0%B0" title="Категорија:CS1 одржавање: Вишеструка имена: списак уредника">веза</a>)</span></li></ul> <div class="mw-heading mw-heading2"><h2 id="Spoljašnje_veze"><span id="Spolja.C5.A1nje_veze"></span>Spoljašnje veze</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Dijabetesna_autonomna_neuropatija&veaction=edit&section=9" title="Уредите одељак „Spoljašnje veze”" class="mw-editsection-visualeditor"><span>уреди</span></a><span class="mw-editsection-divider"> | </span><a href="/w/index.php?title=Dijabetesna_autonomna_neuropatija&action=edit&section=9" title="Уреди извор одељка: Spoljašnje veze"><span>уреди извор</span></a><span class="mw-editsection-bracket">]</span></span></div> <div id="spoiler" style="border-top: 2px solid #3A75C4; border-bottom: 2px solid #3A75C4; background-color:white; padding:1px 0px 2px 3px; font-size: 90%; margin: 2em auto; width: 50%; text-align:center;"><div class="center"><table><tbody><tr><td style="padding-right:10px"><span typeof="mw:File"><a href="/wiki/%D0%94%D0%B0%D1%82%D0%BE%D1%82%D0%B5%D0%BA%D0%B0:Star_of_life.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/a/ae/Star_of_life.svg/60px-Star_of_life.svg.png" decoding="async" width="60" height="58" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/a/ae/Star_of_life.svg/90px-Star_of_life.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/a/ae/Star_of_life.svg/120px-Star_of_life.svg.png 2x" data-file-width="198" data-file-height="192" /></a></span></td><td>Molimo Vas, obratite pažnju na <b><a href="/wiki/%D0%92%D0%B8%D0%BA%D0%B8%D0%BF%D0%B5%D0%B4%D0%B8%D1%98%D0%B0:%D0%9E%D0%B4%D1%80%D0%B8%D1%86%D0%B0%D1%9A%D0%B5_%D0%BE%D0%B4%D0%B3%D0%BE%D0%B2%D0%BE%D1%80%D0%BD%D0%BE%D1%81%D1%82%D0%B8_%D0%B7%D0%B0_%D0%BC%D0%B5%D0%B4%D0%B8%D1%86%D0%B8%D0%BD%D1%81%D0%BA%D0%B5_%D1%81%D0%B0%D0%B4%D1%80%D0%B6%D0%B0%D1%98%D0%B5" title="Википедија:Одрицање одговорности за медицинске садржаје">važno upozorenje</a></b><br />u vezi sa temama iz <b>oblasti medicine (zdravlja)</b>.</td></tr></tbody></table></div></div> <style data-mw-deduplicate="TemplateStyles:r26481770">.mw-parser-output .portal-bar{font-size:88%;font-weight:bold;display:flex;justify-content:center;align-items:baseline}.mw-parser-output .portal-bar-bordered{padding:0 2em;background-color:#fdfdfd;border:1px solid #a2a9b1;clear:both;margin:1em auto 0}.mw-parser-output .portal-bar-related{font-size:100%;justify-content:flex-start}.mw-parser-output .portal-bar-unbordered{padding:0 1.7em;margin-left:0}.mw-parser-output .portal-bar-header{margin:0 1em 0 0.5em;flex:0 0 auto;min-height:24px}.mw-parser-output .portal-bar-content{display:flex;flex-flow:row wrap;flex:0 1 auto;padding:0.15em 0;column-gap:1em;align-items:baseline;margin:0;list-style:none}.mw-parser-output .portal-bar-content-related{margin:0;list-style:none}.mw-parser-output .portal-bar-item{display:inline-block;margin:0.15em 0.2em;min-height:24px;line-height:24px}@media screen and (max-width:768px){.mw-parser-output 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title="Портал:Медицина">Medicina</a></li><li class="portal-bar-item"><span typeof="mw:File"><a href="/wiki/%D0%94%D0%B0%D1%82%D0%BE%D1%82%D0%B5%D0%BA%D0%B0:P_chemistry.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/c/ca/P_chemistry.svg/21px-P_chemistry.svg.png" decoding="async" width="21" height="19" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/ca/P_chemistry.svg/32px-P_chemistry.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/ca/P_chemistry.svg/42px-P_chemistry.svg.png 2x" data-file-width="400" data-file-height="360" /></a></span> <a href="/wiki/%D0%9F%D0%BE%D1%80%D1%82%D0%B0%D0%BB:%D0%A5%D0%B5%D0%BC%D0%B8%D1%98%D0%B0" title="Портал:Хемија">Hemija</a></li></ul></div><style data-mw-deduplicate="TemplateStyles:r25171006">.mw-parser-output .sister-bar{display:flex;justify-content:center;align-items:baseline;font-size:88%;background-color:#fdfdfd;border:1px solid #a2a9b1;clear:both;margin:1em 0 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.portal-bar+style+.sister-bar,.mw-parser-output .sister-bar+.navbox-styles+.navbox,.mw-parser-output .sister-bar+.navbox-styles+.portal-bar{margin-top:-1px}</style><div class="noprint metadata sister-bar" role="navigation" aria-label="sister-projects"><div class="sister-bar-header"><b>Dijabetesna autonomna neuropatija</b> na <a href="/wiki/%D0%92%D0%B8%D0%BA%D0%B8%D0%BF%D0%B5%D0%B4%D0%B8%D1%98%D0%B0:%D0%91%D1%80%D0%B0%D1%82%D1%81%D0%BA%D0%B8_%D0%BF%D1%80%D0%BE%D1%98%D0%B5%D0%BA%D1%82%D0%B8" title="Википедија:Братски пројекти"><span id="sister-projects" style="white-space:nowrap;">srodnim projektima</span></a> Vikipedije:</div><div class="sister-bar-content"><div class="sister-bar-item"><span class="sister-bar-logo"><span typeof="mw:File"><span><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/f/ff/Wikidata-logo.svg/21px-Wikidata-logo.svg.png" decoding="async" width="21" height="12" class="mw-file-element" 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