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Introduction. Modification of tryptophan metabolism during the progression of chronic kidney disease may have significant pathophysiological consequences. The aim of this study was to investigate the status of metabolic products of tryptophan, indoxyl sulfate and kynurenine in different stages of chronic kidney disease. Material and Methods. In all participants included in the cross-sectional study (n = 66) with previously diagnosed chronic kidney disease, the parameters of renal function were measured: glomerular filtration rate using radionuclide plasma clearance with 99mTc-labelled diethylene triamine penta-acetate and effective renal plasma flow using 131Ilabeled orthoiodohippuric acid. Plasma concentrations of indoxyl sulfate and kynurenine were measured by high-performance liquid chromatography. Results. A significant difference was observed in the concentrations of both metabolites between the observed groups (Group II – measured glomerular filtration rate - 15 - 60 ml/min/1.73 m²; n = 36 vs. Group I measured glomerular filtration rate > 60 l/ min/1.73 m²; n = 26): indoxyl sulfate 1.07 ± 0.89 vs. 2.44 ± 4.05 μg/ ml, p < 0.001; kynurenine 3.15 ± 0.22 vs. 3.21 ± 0.17 μg/ml, p < 0.05. The correlation was statistically significant between glomerular filtration rate and kynurenine – r = -0.38, p = 0.001 and indoxyl sulfate – r = 0.56, p ≤ 0.001; effective plasma renal flow and kynurenine – r = -0.33, p < 0.05 and indoxyl sulfate – r = 0.46, p ≤ 0.001. Conclusion. There is a significant difference in the plasma concentrations of indoxyl sulfate and kynurenine in the group of patients with glomerular filtration rate of 15 - 60 ml/min/1.73 m² compared to patients with glomerular filtration rate > 60 ml/min/1.73 m². In patients with chronic kidney disease, plasma concentrations of both metabolites of tryptophan are inversely correlated with the glomerular filtration rate and effective plasma renal flow. [ABSTRACT FROM AUTHOR]

Zinc plays an essential role in many enzymatic systems, cell division processes, DNA - protein synthesis, in immune system functioning, in metabolism regulation of carbohydrates, lipids and proteins: it also has anti-inflammatory and antioxidant effects. There are very few studies which have explored zinc status in general population, so the objective of this study was to examine the zinc status in general adult population in northern Serbia (Province of Vojvodina). 5025 examinees older than 18 years of age have been included in this research (4214 males and 811 females). Anthropometric measurements have been taken from all examinees (body weight and height, body mass index, waist circumference), systolic and diastolic blood pressure; laboratory parameters have been taken by the standard laboratory methods (complete blood count test, total cholesterol, triglycerides, HDL - cholesterol, glucose, creatinine) while the serum concentration od Zn has been measured by the atomic absorption spectrometry. The results of our study indicate that the presence of low serum zinc concentrations was in 2.28% of males and 3.82% of females. The majority of examinees, both males and females, have had the serum zinc concentrations within the reference range (males: 95.02%, females: 94.7%). High serum zinc concentration has been present in 2.7% of examined males and in 1.48% females. It has been determined, by the analysis of examined parameters, that there is statistically positive correlation between zinc level and the red blood cell count and the hemoglobin level. However, the result of regression analysis showed that low serum zinc concentration had no role in anemia prediction. The results of the study showed that the zinc status in Vojvodina in the majority of males and females is satisfactory, regarding the fact that the low serum zinc concentrations prevalence in male population is 2.28% and in female population 3.82%. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the importance of serum concentration of magnesium (Mg) in the first trimester of pregnancy for predicting pre-eclampsia (PE).Methods: This prospective study included 403 pregnant women over 18, with singleton pregnancy (from 11 to 14 weeks of pregnancy). The subjects were divided into a group who subsequently developed PE (PEKT) (n = 61), and a group of healthy pregnancies with no complications and with normal outcomes (TNT) (n = 342). In the first trimester, urea, creatinine, uric acid, Mg, free beta subunit of human chorionic gonadotrophin, plasma protein A related to pregnancy, and C-reactive protein were determined. We followed all subjects until the end of pregnancy.Results: Serum Mg is significantly lower in PEKT than in TNT group (p < 0.001). The serum first trimester Mg level cutoff at ≤0.81 mmol/L had a sensitivity of 77.0% and specificity of 71.6% for the detection of women with PEKT. The level of serum Mg has the strongest significant positive correlation (p < 0.05) with the week of gestational outcomes (R = 0.442), weight (R = 0.416), and Apgar score (R = 0.343) of the newborns, and the strongest significant negative correlation with the number of miscarriages (R = -0.413), serum creatinine (R = -0.471), and the number of pregnancies (R = -0.326). The week of gestational outcome is predicted with the greatest reliability by the serum Mg.Conclusions: Serum Mg level during the first trimester of pregnancy is a significant prediction tool for PE and could also play an important role in predicting the week of gestational outcome and birth weight of newborns. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) is one of the most significant global health problems accompanied by numerous complicatons, with constant increase in the number of affected people. This number is much higher in early phases of disease and patients are mostly asymptomatic, so early detection of CKD is crucial. The aim was examination of the prevalence of CKD in the general population of males in Vojvodina, based on estimated glomerular filtration rate (eGFR) and urine albumin/creatinine ratio (ACR), and exploring the determinants and awareness of CKD. Methods: This cross-sectional study included 3060 male examinees from the general population, over 18 years of age, whose eGFR and ACR were calculated, first morning urine specimen examined, arterial blood pressure measured and body mass index calculated. Standard biochemistry methods determined creatinine, urea, uric acid and glucose serum concentrations as well as albumin and creatinine urine levels. Results: Prevalence of CKD in the adult male population is 7.9%, highest in men over 65 years of age (46.7%), while in the other age groups it is 3.6 - 12.6 %. The largest number of examinees with a positive CKD marker suffer from arterial hypertension (HTA) and diabetes mellitus (DM). Only 1.3% of examinees with eGFR<60 ml/min/1.73 m² and/or ACR ≥ 3 mg/mmol had been aware of positive CKD biomarkers. Conclusions: Obtained results show the prevalence of CKD in adult males is 7.9%, HTA and DM are the most important CKD risk factors and the level of CKD awareness is extremely low (1.3%) indicating the necessity for introduction of early stage disease recognition measures, including raising CKD awareness. [ABSTRACT FROM AUTHOR]

Background:Biomarkers are commonly used to estimate the presence of subclinical cardiovascular disease (CVD) in patients with essential arterial hypertension (HT). In addition to known association between cystatin C and glomerular filtration rate (GFR), elucidating the association between cystatin C and vascular biomarkers (intima-media thickness of common carotid arteries (CCIMT), carotid plaque and renal artery resistance index (RRI)) in patients with unresponsive hypertensive phenotype could be of significant clinical interest. Methods:Participants (n = 200, median age 58 (52–64) years, 49% female) under treatment with antihypertensive drugs were stratified into two subgroups based on their blood pressure level as having responsive hypertension (RHT – compliant and responsive to treatment,n = 100), or nonresponsive (URHT – compliant but nonresponsive to treatment,n = 100). GFR was measured by isotopic (slope-intercept) method (99m Tc diethylene triamine penta-acetic acid – mGFR). Results:The URHT group had significantly higher median cystatin C serum concentration (p = 0.02) and CCIMT (p = 0.00) compared to the RHT group, with no significant difference in RRI (p = 0.51) and mGFR among subgroups [69.9 ± 28.2 vs 76.74 ± 23.61 ml/min/1.73m2,p = 0.27]. In the URHT group, cystatin C was found to be associated with CCIMT (p = 0.02), hsCRP (p = 0.01) and duration of HT (p = 0.02), independently of mGFR and age. Independent predictors of URHT phenotype were CCIMT (p= 0.02) and hsCRP (p= 0.04). Conclusion:In addition to GFR, cystatin C serum concentration is positively and independently associated with CCIMT in patient with URHT phenotype and subclinical CVD. Prospective larger studies should further investigate the clinical importance of this relationship. [ABSTRACT FROM PUBLISHER]

Introduction. The existence of proteinuria may be overlooked by applying the test strips. The aim of this study has been to determine the discrepancy between the findings of proteinuria detected by test strips when compared to the results of its testing with the sulfosali- cylic acid. Material and Methods. The study sample consisted of 1106 subjects, who were divided into the proteinuria positive (test strips showed the presence of isolated proteinuria), and proteinuria negative group (microscopic examination revealed the presence of >10 fresh red blood cells/pL, and/or >1 dysmorphic erythrocyte/pL, and/or >10 leukocytes/pL, and/or> 1 cylinder, and/or >1 nonsquamous epithelial cells/pL, and/or >100 bacteria/pL). Both groups had the urine tested with sulfosalicylic acid. The chemical and microscopic examination of the urine was done by the analyzer LabUMat-UriSed. Results. Proteinuria was confirmed with the sulfosalicylic acid test in 96.5% of subjects from group 1 and in 85.3% of subjects from group 2. Among the patients with the negative finding of proteinuria on the test strip and with the positive sulfosalicylic acid test there was a significantly higher number of those with pathological findings of erythrocytes, leukocytes, bacteria and cylinders in the urine when compared to those of the same group with negative sulfosalicylic acid test. Conclusion. Sulfosalicylic acid test should be performed in cases of pathological microscopic findings in the urine in case of the presence of >10 fresh erythrocytes/pL and/or >1 dysmorphic eryth- rocyte/pL and/or >10 leukocytes/pL and/or >1 cylinder (except hyaline) and/or >1 nonsquamous epithelial cells/pL and/or >100 bacteria/ pL even if the test strip examination is negative for proteinuria. [ABSTRACT FROM AUTHOR]

Introduction. Cystatin C is one of biomarkers that meet the conditions necessary for an endogenous substance to be a marker of the glomerular filtration rate. Cystatin C - Properties. Cystatin C is produced in the nucleated cells in a constant amount, and its serum concentration does not depend on muscle mass and protein intake. The catabolism of cystatin C is mostly done in the kidneys. Determination of Cystatin C Level. Cystatin C may be determined in the serum, plasma, capillary blood and urine. The laboratory methods which are mainly used to determine its level are nephelometric and turbidimetric immunoassays. Cystatin C as a Marker of Glomerular Filtration Rate. Cystatin C is superior to creatinine as a marker of kidney function, especially in the early stages of chronic kidney disease. Several formulas are available for calculating the glomerular filtration rate from serum cystatin C. Cystatin C in Various Physiological/Pathophysiological Conditions. The level of cystatin C should be interpreted carefully because there are factors that can affect its level regardless of the renal function (thyroid dysfunction, glucocorticoids use, malignancies etc.). Higher cystatin C concentrations in general population are associated with an increased cardiovascular risk, as well as with preeclampsia in pregnant women. Conclusion. The significant advantages of cystatin C as a kidney function marker are its use in the creatinine "blind" area, in pediatric and the elderly population. In addition, cystatin C could be used as a marker for cardiovascular risk assessment, in predicting and detecting preeclampsia, in patients with malignant diseases, etc. [ABSTRACT FROM AUTHOR]

Background: Endothelin-1 (ET-1) is potent vasoconstrictor peptide which is able to contribute to the functional and structural renal changes. The aim of this study was to investigate the relationship between plasma concentration of ET-1 and indices of renal function in patients with diabetic nephropathy. Methods: We measured plasma ET-1 levels in 99 patients with type 2 diabetes, divided into two groups according to the values of their glomerular filtration rate (GFR): group I (GFR ≥ 60 mL/min/1.73 m2; n = 50), group II (GFR ≥ 60 mL/min/1.73 m2, n = 49), and the control group ( n = 30) with clinically healthy subjects who were matched by age and sex. GFR and effective renal plasma flow (ERPF) were measured by the radioisotopic clearance. Other renal function parameters, such as serum concentrations of cystatin C, urea, creatinine, uric acid, 24-h albuminuria and proteinuria were additionally measured. Results: There were significant differences in plasma concentration of ET-1 among groups I, II and the control group (1.45 vs. 2.40 vs. 0.80 pg/mL, p < 0.001). The correlation between ET-1 and mGFR ( r = −0.52, p < 0.001), ERPF ( r = −0.42, p < 0.001), albuminuria and proteinuria ( r = 0.36, p < 0.001; r = 0.48, p < 0.001) and cystatin C ( r = 0.42, p < 0.001) was significant. In multiple regression analyses, only plasma concentration of ET-1 ( p < 0.001) and duration of hypertension ( p < 0.05) were independently and significantly associated with mGFR. Conclusion: A higher plasma concentration of ET-1 is independently associated with a decreased value of GFR in patients with diabetic nephropathy. [ABSTRACT FROM AUTHOR]

Aim To determine the differences in plasma homocysteine levels between three MTHFR 677 genotype subgroups in patients with thrombosis and in controls, as well as between patients with thrombosis and controls with the same MTHFR 677 genotype. Methods This case-control study was conducted in Clinical Center of Vojvodina, Novi Sad, from June to December 2011. We included 65 patients with either arterial or venous thrombosis (mean age, 40.97 ± 11.38 years) and 65 controls with no history or clinical evidence of any thrombotic event (mean age, 41.23 ± 11.12 years). Patients and controls were age- and sex-matched. Results In comparison with controls, thrombotic patients had significantly higher homocysteine levels (12.81 ± 4.94 μmol/L vs 9.82 ± 3.68 μmol/L; P < 0.001) and significantly higher incidence of hyperhomocysteinemia (55% vs 22%; P < 0.001; odds ratio [OR] = 4.521). There were no significant differences in homocysteine levels between homozygous carriers, heterozygous carriers, and non-carriers of the MTHFR 677 mutation in either thrombotic patients (12.97 ± 5.40 μmol/L vs 12.55 ± 5.71 μmol/L vs 13.27 ± 1.71 μmol/L; P = 0.100) or controls (10.07 ± 2.50 μmol/L vs 10.25 ± 4.84 μmol/L vs 9.20 ± 2.44 μmol/L; P = 0.651). However, in comparison with controls, homozygous carriers in thrombotic patient group did not have significantly higher levels of homocysteine (12.97 ± 5.40 μmol/L vs 10.07 ± 2.50 μmol/L; P = 0.072), but heterozygous carriers (12.55 ± 5.71 μmol/L vs 10.25 ± 4.84 μmol/L; P = 0.020) and non-carriers (13.27 ± 1.71 μmol/L vs 9.20 ± 2.44 μmol/L; P < 0.001) did. There was no significant difference in homocysteine levels between patients with arterial and venous thrombosis (12.76 ± 3.60 μmol/L vs 12.86 ± 5.51 μmol/L; P = 0.990) and between patients with one thrombotic event and those with recurrent thrombotic events (12.14 ± 3.20 μmol/L vs 15.25 ± 8.51 μmol/L; P = 0.254). Conclusion Plasma homocysteine levels have a greater clinical significance in the prevention of thrombosis and managing its complications than MTHFR 677 genotyping. [ABSTRACT FROM AUTHOR]

Background: One of the leading causes of terminal renal failure is diabetic nephropathy. The aim of this study was to determine the relationship between homocysteine levels and the biomarkers of renal function, inflammation and oxidative stress, as well as the incidence of macrovascular complications in patients with diabetic nephropathy. Methods: Sixty-four patients with diabetic nephropathy were included in this study. They were divided according to their homocysteine levels into two groups: hyperhomocysteinemic (HHcy, n=47) and normohomocysteinemic patients (NHCy, n=17). The re sults were compared to a control group (n=20) with normal renal function and without diabetes. Besides homocysteine, cystatine C, creatinine, urea, albuminuria, creatinine clearance, lipid status parameters, apolipoprotein A-I and B, lipo protein (a), CRP, fibrinogen, oxidative LDL were determined using appropriate methods. The incidence of macro vascular diabetic complications was also determined. Results: The results indicate that the level of renal dysfunction is greater in HHcy than in NHcy patients (p<0.05). In HHcy patients levels of oxLDL were also higher compared to NHcy patients (119.3±140.4 vs. 71.4±50.8 ng/mL, disp< 0.05) as well as fibrinogen levels (4.3±1.3 vs. 3.7±0.8 g/L, p<0.05). The in cidence of macrovascular complications is more frequent in HHcy than in NHcy patients (55.3. vs. 35.3 %, p>0.05), and in patients with macroalbuminuria compared to patients with microalbuminuria (65% vs. 39%, p<0.05). Conclusions: It can be concluded that HHcy is significantly present in patients with diabetic nephropathy, especially if there is greater reduction of renal function. Besides that, significantly higher concentrations of inflammatory (fibrinogen) and oxidative stress (oxLDL) markers were present in HHcy patients with diabetic nephropathy compared to NHcy patients.Therefore in diabetic nephropathy patients it is useful to regularly monitor the levels of homocysteine, as well as inflammatory and markers of oxidative stress. [ABSTRACT FROM AUTHOR]

Background/Aim. Cardiovascular morbidity and mortality are markedly increased in chronic renal failure (CRF). The aim of this study was to evaluate lipid parameters and bioindices in patients with different stages of CRF. Methods. In 46 hemodialysed (HD), 50 CRF patients with II, III and IV stage of CRF (non-HD) and 48 control subjects triglycerides (TG), total cholesterol (C), HDL-C, urea, creatinine, creatinuria (standard biochemical methods), apolipoprotein (apo) AI, apo B, lipoprotein(a), cystatin C (immunoturbidimetric method) were evaluated, and LDL-C, non-HDL-C, LDLC/ HDL-C, non-HDL-/HDL-C, TG/HDL-C, and new bioindices, LTI (lipid tetrad index), logLTI, LPI (lipid pentad index), logLPI, AIP (atherogenic index of plasma), and creatinine clearance were calculated. Results. There were significant differences in the levels of TG, HDL-C, LDL-C, non- HDL-C, total C and apo A-I between the HD and non-HD patients, and the HD patients and the controls. LTI and LPI were significantly higher in the HD and non-HD patients compared to the controls (p < 0.05), without a good separation by the Box-Whisker plots. The values of TG/HDL-C ratio and AIP were significantly higher in the HD and non- HD-patients compared to the controls (p < 0.05), and significantly higher in the HD compared to non-HD patients (p < 0.05). AIP > 0.11 was found in 71.7% of the HD, 56% of non-HD and 31.3% of the controls. Conclusion. Among lipid parameters and indices, AIP and TG/HDL-C ratio are most suitable for evaluation of lipid disturbances in different stages of CRF. In addition to, non-HDL-/HDL-C, and apoB/A-I ratios, apo A-I, HDL-C and TG are important markers in HD patients. Non-HDL-C is not a suitable marker. LTI and LPI need to be further investigated. [ABSTRACT FROM AUTHOR]

Given that thyroid function influences serum cystatin C and creatinine levels, the question arises as to whether it is possible to accurately estimate glomerular filtration rate (GFR) in patients with thyroid dysfunction. The objective of the study was to determine serum cystatin C and creatinine levels and estimate GFR in patients with thyroid dysfunction. The study included 32 cases with newly diagnosed hyperthyroidism and 27 cases with newly diagnosed hypothyroidism, as well as 20 healthy controls matched for sex and age with the cases. Serum concentrations of thyroid stimulating hormone (TSH), free triiodothyronine (fT3) and free thyroxine (fT4), creatinine and cystatin C were measured in all study subjects. GFR was estimated using the Modification of Diet in Renal Disease (MDRD), the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and cystatin C-based equations. Serum cystitis C levels were significantly higher in hyperthyroid subjects compared to controls (1.32±0.31 vs. 0.89±0.15; p<0.01). Serum keratinize levels were significantly lower in hyperthyroid subjects compared to controls (60.6±10.2 vs. 76.4±8.6; p<0.01), and significantly higher in hypothyroid subjects compared to controls (94.5±13.2 vs. 76.4±8.6; p<0.01). GFR estimated with the MDRD equations was significantly higher in hyperthyroid subjects compared to hypothyroid subjects (101.6±20.7 vs. 64.1±11.6 mol/min/1.73m²; p<0.01). GFR estimated with the equation based on serum cystitis C was significantly lower in hyperthyroid subjects compared to hypothyroid subjects (59.2±22.1 vs. 92.1±16.0 mol/min/ 1.73m²; p<0.01). Although serum cystitis C is regarded a reliable marker of GFR and more sensitive than serum keratinize, it has limitations in patients with thyroid dysfunction, due to significant changes in its serum concentrations regardless of renal function. In patients with thyroid dysfunction GFR should therefore be estimated using the equations based on serum creatinine. [ABSTRACT FROM AUTHOR]

Cardiovascular morbidity and mortality are markedly increased in chronic renal failure patients. Although it cannot be regarded as a cardiovascular disease risk equivalent, kidney dysfunction is considered an independent predictor of increased cardiovascular risk that increases with deteriorating kidney function. The association is a very complex one, and the term cardiorenal syndrome is now widely used. Cardiovascular disease in chronic kidney disease patients usually manifests as ischemic heart disease (in the form of angina, acute coronary syndrome or sudden cardiac death), cerebrovascular disease, peripheral vascular disease, and congestive heart failure. Vascular disease includes atherosclerosis and vascular calcifications, and cardiomyopathy comprises left ventricular hypertrophy, cardiac fibrosis and left ventricular systolic and diastolic dysfunction. In addition to the well-established traditional risk factors such as hypertension, hyperlipidemia, insulin resistance and diabetes mellitus, the association is supported by synergistic action of non-traditional risk factors such as excessive calcium-phosphorus load, hyperparathyroidism, anemia, hemodynamic overload, malnutrition, inflammation, hyperhomocysteinemia, altered nitric oxide synthase and increased oxidative stress. This paper summarizes the current understanding of the significance of specific uremic retention solutes, natriuretic peptides, biochemical markers of disorders in calcium-phosphorus homeostasis, systemic inflammation, oxidative stress, and dyslipidemia. [ABSTRACT FROM AUTHOR]

Introduction Holotranscobalamin contains biologically available cobalamin because only holotranscobalamin promotes the uptake of the cobalamin therein by all cells, via specific receptors. Therefore holotranscobalamin has been proposed as a potentially useful alternative indicator of vitamin B12 status. The aim of the present study was to assess usefulness of holotranscobalamin in the evaluation of vitamin B12 status. Material and methods We examined serum level of holotranscobalamin in 135 subjects divided in four groups according to the serum concentration of vitamin B12: 30 subjects with vitamin B12 <154 pmol/l, 50 subjects with vitamin B12 154-250, 30 subjects with vitamin B12 251-350 pmol/l, 25 subjects with vitamin B12 >350 pm 01/1. Results The results show that in subjects with low vitamin B12 serum level there are those with normal liolotranscobalamin concentration (60%) and that in subjects with normal vitamin B12 there are those with low holotranscobalamin concentration (22%). The obtained results also show positive significant correlation between levels of holotranscobalamin and vitamin B12 (r=0.62, p<0.001). Conclusion We can conclude that biologically active cobalamin, holotranscobalamin, is a useful tool when examining vitamin B12 status especially in subjects with borderline and low vitamin B12 concentrations. Measurements of the serum holotranscobalamin may be superior to total serum cobalamin. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is one of the most common demyelinating diseases of the central nervous system. We aimed to investigate serum and cerebrospinal fluid levels of different laboratory inflammatory biomarkers in patients with MS. Methods: A total of 120 subjects participated in the study, 60 of whom were diagnosed with MS, 30 with the final diagnosis of non-inflammatory diseases of the central nervous system (CNS), and 30 healthy subjects representing the control group. Regarding the progression of radiological findings after 2 years from the initial diagnosis, the MS group was divided into stationary radiological findings (n = 30) and radiologically proven disease progression (n = 30). In all patients, we analyzed levels of laboratory inflammatory biomarkers: C reactive protein (CRP), Neutrophil-to-lymphocyte ratio (NLR), Growth differentiation factor 15 (GDF15) in serum samples, and neurofilaments (NFs) in cerebrospinal fluid (CSF). NFs and GDF15 were analyzed initially, while CRP and NLR values were analyzed initially and after two years. Results: We found statistically lower GDF15 values and initial CRP values in the MS group regarding the group with non-inflammatory diseases of the CNS (p<0.0001). On the other side, we determined a significant elevation of laboratory markers CRP and NLR, initially and after a two-year period, in the MS subgroup with the progression of magnetic resonance imaging (MRI) findings (p<0.0001 and p=0.050, respectively). Also, we found a positive correlation between CRP and NFs (r=0.243, p=0.04), as well as a positive correlation between CRP and GDF15 in patients with MS (r=0.769, p<0.0001). Conclusions: We found a significant elevation of laboratory markers of systemic inflammation, CRF? and NLR in MS patients who developed disease progression based on MRI findings. There is a need for further studies to validate current parameters to be considered as useful markers of MS activity and disability. [ABSTRACT FROM AUTHOR]

Background: Since COVID-19 pandemic is a global crisis, tests with high sensitivity and specificity are crucial for the identification and management of COVID-19 patients. There is an urgent need for low-cost rapid antigen COVID-19 test with a good diagnostic performance. Although various antigen rapid detection tests are widely available, strong evidence of their usefulness in clinical practice are still limited. Therefore, our aim was to evaluate clinical performance of STANDARD Q COVID-19 Ag Test (SD Biosensor, Gyeonggi-do, South Korea). Methods: The performance of the STANDARD Q COVID-19 Ag Test for the detection of SARS-CoV-2 antigen was evaluated in comparison to RT-qPCR results in 120 symptomatic patients (median age 49, IQR 36–70) who presented to health care facility in Novi Sad, Vojvodina, Serbia. Results: Twenty five out of 120 samples have been tested positive using STANDARD Q COVID-19 Ag Test, and all of them were also positive on RT-qPCR. Overall, the STANDARD Q COVID-19 Ag Test showed sensitivity of 58.1% (95% CI 42.1–73.0) but it was higher in the early days of disease, when the highest viral loads were detected. During the first five days after the symptom onset, the sensitivity ranged from 66.7% to 100% and the pooled accuracy and Kappa values were high (0.92 and 0.852). Conclusions: A strong agreement between performance of STANDARD Q COVID-19 Ag Test and RT-qPCR was observed during the first five days of illness, suggesting that this rapid antigenic test can be very useful for COVID-19 diagnosis in the early phase of disease. [ABSTRACT FROM AUTHOR]

Introduction. Microalbuminuria is a very important independent risk factor for the progression of renal diseases as well as diseases of the cardiovascular system. Pathophysiological mechanisms that lead to the development of microalbuminuria in patients with diabetes are complex and they are a result of numerous factors. In the past decade, endothelin- 1, the most potent vasoconstrictor peptide, was identified as an important factor that significantly contributes to the functional and structural renal changes. The objective of this study was to the relationship between plasma concentration of endothelin-1 and urinary albumin excretion in patients with type 2 diabetes mellitus. Material and Methods. There were 76 patients with type 2 diabetes who were divided into those having normoalbuminuria (n=33), microalbuminuria (n=29), and macroalbuminuria (n=14), and 30 healthy controls. Plasma levels of endothelin-1 were measured by enzyme-linked immunosorbent assay. Results. There were significant differences in plasma concentration of endothelin-1 among groups (p˂0.01). The correlation between endothelin-1, albuminuria, proteinuria and glomerular filtration rate was significant. In multiple regression analyses the plasma concentration of endothelin-1 was independently and significantly associated with albuminuria (β=0.01, p=0.009), proteinuria (β=0.02, p<0.001) and glomerular filtration rate (β=-0.01, p=0.0006). Conclusion. Higher plasma concentrations of endothelin-1 are independently associated with the levels of urinary excretion of albumin which may corroborate the hypothesis of a potential role of this peptide in the development of microalbuminuria in diabetic nephropathy. [ABSTRACT FROM AUTHOR]

Introduction. Multiple sclerosis is a chronic, inflammatory disease of the central nervous system characterized by areas with inflammatory changes associated with demyelination. Cholesterol is a significant structural component of the central nervous system incorporated into the myelin sheath. The aim of study was to examine values of lipid status parameters in patients with multiple sclerosis and the correlation between these parameters and the triglyceride glucose index. Material and Methods. A retrospective study included 28 patients with multiple sclerosis. Medical records of the Clinic of Neurology and databases of the Center of Laboratory Medicine, Clinical Center of Vojvodina were analyzed. Based on the obtained data of the glycemic index and lipid profile, triglyceride glucose index was calculated. Results. Borderline elevated values of total cholesterol and low-density cholesterol (5.25 ± 1.08 mmol/L; 3.90 ± 4.54) were found in patients with multiple sclerosis. Linear correlation analysis showed a statistically positive correlation between triglyceride glucose index and total cholesterol (r = 0.572; p = 0.01), low-density cholesterol (r = 0.256; p = 0.05) and low-density cholesterol to high-density cholesterol ratio (r = 0.502); p = 0.01). No statistically significant correlation between triglyceride glucose index and high-density cholesterol was observed. Conclusion. The examined group with multiple sclerosis had borderline elevated values of total cholesterol and low-density cholesterol. There is a significant correlation between the triglyceride glucose index and values of total cholesterol, low-density cholesterol, as well as the low-density cholesterol to high-density cholesterol ratio. [ABSTRACT FROM AUTHOR]

Background: Anemia is a global public health problem of endemic proportions, especially in women, and with serious health consequences. Anemia was defined according to the World Health Organization criteria as hemoglobin concentration <150 g/L for men and <120 g/L for women. The incidence of anemia varies between regions, so the aim of the study was to determine the incidence of anemia in a randomly selected sample of adult working individuals of both sexes, in Vojvodina. Methods: The study included a total of 6087 subjects (4658 men and 1429 non-pregnant women) aged 18-65 years who presented for a regular checkup at the Public Health Institute of Vojvodina. Blood specimen collection was performed by antecubital venipuncture in all subjects. Results: The results showed that the incidence of anemia in adults in Vojvodina was 7.7%, and it was more frequent in women (20%) than in men (5.86%). The most frequent was normocytic anemia, whereas microcytic anemia was less prevalent. Macrocytic anemia was found in only 5.5% of subjects, exclusively in women. The greatest proportion of anemic subjects, regardless of sex, had hemoglobin levels that indicated mild anemia (Hb 100-119 g/L for women, and 100-129 g/L for men). Only 4% of men and 12% of women had Hb levels that indicated the presence of moderate or severe anemia (<100 g/L). Conclusions: Considering the medical, social and economic consequences anemia may produce, identification of risk factors and application of adequate preventive measures should be a public health priority. [ABSTRACT FROM AUTHOR]

Early, rapid and reliable identification of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is crucial for successful control of coronavirus disease 2019 (COVID-19). The quantitative real-time reverse transcription polymerase chain reaction (RT-PCR) assay is considered the gold standard for molecular diagnosis of SARS-CoV-2. The objective of this study was to compare the clinical performances of the three authorized tests -- the Abbott Real Time SARS-CoV-2 (ACOV) assay (Abbott Molecular Inc., North Chicago, IL), GeneFinder™ COVID-19 Plus RealAmp (GeneFinder) Kit (OSANG Healthcare Co., Ltd, Dongan-gu Anyang, Korea) and the Biomerieux ARGENE® SARS-COV-2 R-GENE® real-time detection (ARGENE) kit (bioMerieux SA., Marcyl'Etoile, France) and to determine whether the selection of targeted genes has an impact on test's specificity. In this study, we included 155 nasopharyngeal swabs (NPS) from adult individuals with symptoms or suspected of COVID-19, aged from 17 to 91 years, previously tested by the ACOV and subsequently tested by the GeneFinder and the ARGENE. In this comparative analysis, we found that the GeneFinder assay detected the most cases of COVID-19 infection, followed by the ACOV assay, and then by ARGENE. Positive agreement ranged from 74.74% to 95.41%, with the strongest agreement observed between the GeneFinder and ACOV assays -- 95.41% (95% confidence intervals (CI): 89.37%-98.36%) indicating an excellent agreement between these two tests and the lowest agreement between the GeneFinder and ARGENE assay -- 74.74% (95% CI: 65.08%-81.41%). The negative percent agreement was 100% (GeneFinder/ACOV, GeneFinder/ARGENE and ACOV/ARGENE). Only 3.2% of cases were false-negative using the ACOV test, while 18.0% of samples were false-negative using the ARGENE assay to detect SARS-CoV-2. Combined usage of the Abbott SARS-CoV-2 and the GeneFinder assays can be applied to maximize SARS-CoV-2 detection accuracy. [ABSTRACT FROM AUTHOR]

Background/Aim. Obesity status can be assessed with numerous anthropometric, morphological and functional indices and this study was designed to assess relationship among them. The aim of this study was to investigate associations between anthropometric indices, ultrasonography measurement of visceral and subcutaneous fat tissue thickness and certain proinflammatory adipokines level. Methods. This cross-sectional study comprised a consecutive sample of 60 obese respondents without obesity-related comorbidities, and 20 age-matched healthy normal-weight controls. Anthropometric [body mass index (BMI), waist circumference (WC), neck circumference (NC), body fat, a body shape index (ABSI)], and ultrasonographic indices [thickness of intraabdominal fatt tissue (IAFT), visceral fat (VF), maximum subcutaneous fat (Max SFT), minimal subcutaneous fat (Min SFT)], and serum levels of chemerin and resistin were assessed in all subjects. Results. All anthropometric indices showed statistically significant differences between study groups. The mean IAFT, Max SFT, Min SFT and VF were significantly higher in the obese group compared to controls (p < 0.01, for all). Serum levels of chemerin and resistin correlated positively with BMI, percentage of fat adipose tissue (FAT, %), total FAT (kg), and VF (p < 0.05, for all). Also, we observed significant correlation between resistin and NC (r = 0.23, p = 0.03) and ABSI (r = 0.22, p = 0.04). In multivariable linear regression analysis, chemerin (ß = 0.23; p = 0 .008) a nd r esistin (ß = 0.43; p =0.002) were independently and significantly associated only with VF. Conclusion. Obesity indices, both classical and newer ones, are in positive, statistically significant correlation with the level of proinflammatory cytokines. Ultrasonographically measured VF thickness, independently associated with adipokine levels, may improve assessment of proinflammatory fat tissue characteristics. Further studies are needed to precisely define the use of ultrasonographic fat tissue measurements into clinical practice. [ABSTRACT FROM AUTHOR]

Introduction. Recently, there has been a need to use more readily available parameters to assess the severe acute respiratory syndrome coronavirus 2 infection in children. Material and Methods. A single-center retrospective study included 30 children with severe acute respiratory syndrome coronavirus 2 infection who were admitted to the Isolation Department of the Institute for Child and Youth Health Care of Vojvodina from April to September 2020. A complete blood count with differential was performed. Additionally, systemic inflammatory index, neutrophil-lymphocyte ratio and plateletlymphocyte ratio were calculated. For comparison, age- and sex-matched 30 children negative for severe acute respiratory syndrome coronavirus 2 were included in the study. Results. In the period from April to September 2020, 30 laboratory-confirmed cases of coronavirus-19, aged 0 – 17 years, were admitted to the Institute for Child and Youth Health Care of Vojvodina. The age was not a risk factor for the development of coronavirus-19 (p = 0.707; OR: 1.018; 95% CI: 0.927 – 1.119). The comparison of hematological parameters of severe acute respiratory syndrome coronavirus 2 status showed that hemoglobin concentration (p < 0.01) and hematocrit (p < 0.01) were lower, and the percentage of neutrophil granulocytes (p < 0.05) was higher among severe acute respiratory syndrome coronavirus 2 positive children. Furthermore, it was found that some severe acute respiratory syndrome coronavirus 2 positive children had a higher (p < 0.01), while others had a lower (p < 0.01) percentage of lymphocytes. The systemic inflammatory index, the ratio of neutrophils to lymphocytes, and the ratio of platelets to lymphocytes, were not found to be statistically significantly different (p > 0.05). Conclusion. Low hemoglobin and hematocrit levels, a high percentage of neutrophil granulocytes, and a non-physiological percentage of lymphocytes (both, low and high) may have a diagnostic significance in children with severe acute respiratory syndrome coronavirus 2 infection. [ABSTRACT FROM AUTHOR]

Background: Anemia represents a significant cause of maternal and perinatal mortality, as well as child mortality. The aim of the research was to determine the serum concentration of hepcidin in children aged 6 months to 2 years and adolescents aged 11 to 19 years which suffer from iron deficiency anemia and compare it with the serum concentration of hepcidin in the control groups, as well as to determine its connection with the parameters of the iron metabolism. Methods: The research included 173 examinees, 89 of them suffered from iron deficiency anemia and 84 did not suffer from iron deficiency anemia (the latter represented the control group). Blood samples were collected from all study participants. The samples were analyzed for complete blood count and parameters of iron metabolism. ELISA method was used for establishing serum hepcidin levels. Results: The research showed that the concentration of hepcidin is statistically lower in children (4.4 ng/mL) and adolescents (4.1 ng/mL) who suffer from iron deficiency anemia in comparison with the control group (14 ng/mL, 10 ng/mL, respectively). The positive correlation between serum hepcidin level and iron in the serum, ferritin, the mean corpuscular volume and transferrin saturation was confirmed, but the negative one occurred in serum hepcidin level, transferrin and reticulocytes. Conclusions: The age of the examinees does not influence the level of serum hepcidin which makes it a more sensitive indicator of the level of iron in the body. Besides this, serum hepcidin is a reliable biological marker for the assessment of iron deficiency anemia. [ABSTRACT FROM AUTHOR]

Introduction. Endothelium is a dynamic, strategically positioned defensive regulator of vascular homeostasis. Physiology and Pathophysiology of Vascular Endothelium. Endothelial phenotypic modulation involves five basic characteristics: the expression of leukocyte adhesion molecules, the production of cytokines, change in the shape and the permeability of the endothelium, prothrombotic changes and upregulation of autoantigens. Obesity, Metabolic Inflammation and Vascular Endothelium One of the most important pathophysiological manifestations of adiposopathy may be the phenotypic conversion of vascular endothelium. Insulin Resistance and Vascular Endothelium. Under the conditions of insulin resistance and consequent hyperinsulinemia, there is imbalance between the production of endothelial vasoconstrictors and vasodilators, increased expression of adhesion molecules, and platelet hyperreactivity. Hyperglycemia and Vascular Endothelium. Hyperglycemia causes endothelial dysfunction by various mechanisms that involve activation of polyol pathway and production of sorbitol, increased formation of advanced glycation end products, activation of various isoforms of protein kinase C and activation of hexosamine pathway. Dyslipidemia and vascular endothelium. Dyslipidemia takes an important role in a cascade of pathophysiological processes that result in endothelial activation and chronic dysfunction. Conclusion. Hyperglycemia, hyperinsulinemia, insulin resistance, dyslipidemia, visceral obesity and low-grade inflammation are the main factors responsible for development of endothelial dysfunction in type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]

Introduction: Treatment of acute lymphoblastic leukemia includes the use of high doses of glucocorticoides (prednisone and dexamethasone), which significantly increase the success of therapy due to lymphocytolitic effect. The aim: The aim of the study was to determine tolerability of high doses of prednisone and dexamethasone in children with acute lymphoblastic leukemia and the structure and the intensity of adverse effects, occurred after application of these medicines. Subjects and methods: In a prospective study, we analyzed adverse effects of high doses of glucocorticoides in children suffering acute lymphoblastic leukemia treated in the Institute for Child and Youth Health Care of Vojvodina, since December 2010. until October 2014, were analyzed. This study included 18 patients, aged from 2 to 15 years. Results: Hyperglycemia appeared in 89% of patients treated with prednisone and in 61% of patients treated with dexamethasone. In order to control the high blood glucose level (above 10 mmol /L), in 11% of patients insulin was used. Hypertension appeared in 28% patients treated with prednisone and dexamethasone. Antihypertensives were needed for regulation in 17% patients. Hypopotassemia and hypocalcaemia were significantly more expressed after the use of prednisone in comparison to dexamethasone. In 11% of patients, the treatment with dexamethasone caused depressive behavior, followed by agitation. Conclusion: Adverse effects of dexamethasone and prednisone, administered in high doses in children with ALL were known, expected and reversible. Adverse reactions usually disappeared spontaneously or after short-term symptomatic therapy. [ABSTRACT FROM AUTHOR]

Given its possible protective effect on vascular endothelial function, we hypothesized that the circulating level of insulin-like growth factor 1 (IGF-1) could be associated with biomarkers of endothelial dysfunction and vascular inflammation, i.e., soluble intercellular adhesion molecule 1 (sICAM-1), soluble E-selectin (sE-selectin) and high-sensitivity C-reactive protein (hs-CRP, in non-diabetic obese women. A total of 40 obese women (median age 35 (31-39) years; moderately obese I (n=21) body mass index (BMI) 30.0-34.9 kg/m² and severely obese (n=19) BMI 35.0-39.9 kg/m²) and 40 controls, age-matched healthy nonobese women were included in the study. Anthropometric parameters (BMI, waist circumference, fat adipose tissue percentage - FAT% measured by bioelectrical impedance analysis), serum concentrations of biomarkers (IGF-1, sICAM-1, sE-selectin and hs-CRP) and common carotid artery intima-media thickness Z-score (CCIMT Z-score) were assessed in all subjects. Severely obese subjects had a significantly lower median concentration of IGF-1 compared to moderately obese and nonobese subjects (95 (73.75-109.25) vs. 120 (108.3-141.7) vs. 115.5 (94.1-165.5) mg/mL, P<0.05). In moderately obese subjects, the median concentration of hs-CRP (3.41 (2.3-5.1) vs. 5.9 (3.2-9.57) mg/L, P=0.01) and sICAM-1 (244.5 (192.7-262.2) vs. 325.2 (229.2-339.6) mg/L, P=0.03) were significantly lower compared to severely obese subjects. In regression analysis IGF-1 concentration was independently associated with FAT% (ß=-3.14; P=0.03), hs-CRP (ß=-4.24; P=0.001) and CCIMT Z-score (ß=-19.2; P=0.001). The circulating level of IGF-1 is associated with hs-CRP, but not with sE-selectin and sICAM-1 in non-diabetic obese women. [ABSTRACT FROM AUTHOR]

Introduction. During liver transplantation, continuous laboratory monitoring of complex changes of the hemostatic system is necessary. The aim of this study was to compare two methods of monitoring: standard coagulation tests and rotational thromboelastometry. Material and Methods. The study included 17 patients who had undergone orthotopic liver transplantation in the Clinical Centre of Vojvodina, Serbia in the period from June 2008 to October 2012. The coagulation parameters (platelet count, activated partial thromboplastin time, prothrombin time and fibrinogen level) were compared with the thromboelastometric parameters (coagulation time, clot formation time and maximal clot firmness). Results. The results showed a statistically significant correlation between the platelet count and maximum clot firmness of the intrinsically (r=0.51, p<0.001) and extrinsically activated thromboelastometric assays (r=0.64, p<0.001). The fibrinogen level and maximum clot firmness of the fibrinogen thromboelastometric test correlated significantly as well (r=0.44, p=0.002). No significant correlations were found among the activated partial thromboplastin time, prothrombin time, coagulation time and clot formation time. Conclusion. For an ��������������������������������������������adequate������������������������������������ perioperative monitoring of the dynamic intraoperative hemostatic changes and the optimal use of blood derivatives during liver transplantation, the combined application of standard coagulation tests and rotational thromboelastometry should be considered whenever possible. Key words: Blood Coagulation Tests; Thromboelastography; Liver Transplantation; Hemostasis; Blood Chemical Analysis [ABSTRACT FROM AUTHOR]

Lipids play a pivotal role in the atherogenesis, starting from initial changes. Their predictive value in coronary heart disease and development of novel therapeutic strategies is an increasingly addressed issue nowadays. LDL particles are fundamental, because reduction of LDL-cholesterol was proven to reduce morbidity and mortality associated with atherosclerosis. Besides the regulation of LDL-receptor expression, significant clinical importance is assigned to oxidized LDL (ox-LDL) and small dense LDL (sdLDL) that are generated through intravascular remodelling of triglyceride-rich lipoproteins, while the exact role of anti-oxLDL antibodies in atherosclerosis propagation and their clinical significance still remain unclear. In recent years, however, better understanding of the basic mechanisms involved in atherosclerosis development, as well as in the metabolic fate of lipids and lipoproteins, emphasizes the crucial role of other lipoprotein particles not only in the propagation, but also in the initiation of atherosclerosis and atherothrombosis. [ABSTRACT FROM AUTHOR]