ASSESSMENT OF THE INSTRUMENTAL ACTIVITIES OF DAILY LIVING IN MILD COGNITIVE IMPAIRMENT AND DEMENTIA DUE TO ALZHEIMER'S DISEASE: DIAGNOSTIC ACCURACY OF THE SERBIAN VERSION OF THE AMSTERDAM IADL QUESTIONNAIRE

To establish a diagnosis of dementia, it is necessary, in addition to cognitive impairment, to prove the existence of a disorder of instrumental activities of daily living (IADL). The Amsterdam IADL Questionnaire is a reliable instrument translated into different languages. This study aims to assess the diagnostic accuracy of the Serbian version of the Amsterdam IADL Questionnaire. The study  included 75 patients with mild cognitive impairment (MCI) and dementia due to Alzheimer's disease. The questionnaire was scored using the weighted average (WA) and item response theory (IRT) scoring method. Diagnostic accuracy was examined using receiver–operating characteristic (ROC) curves. The area under the curves (AUC) was calculated with 95% confidence intervals (CI). The correlation between IRT and WA scores was strong and significant (r=-0.980, p<0.001). The AUC for the IRT scores of A-IADL-Q  was 0.832 (95% CI: 0.729 to 0.909), while the AUC for the WA scores of A-IADL-Q was 0.848 (95% CI: 0.746 to 0.920). Both were significantly different from the AUC of 0.5 (p<0.001). There  was no significant difference between the AUCs of IRT and WA scoring  (z=1.157; p=0.247). Cutoffs and the highest combination of sensitivity and specificity for the IRT (sensitivity 0.767; specificity 0. 844) and WA (sensitivity 0.744; specificity 0. 844) scores of A-IADL-Q  were calculated. We have shown that A-IADL-Q has moderate diagnostic accuracy in differentiating dementia and MCI. This instrument can be used in combination with cognitive measures to diagnose dementia in its early stages

Dijagnostički značaj određivanja proteina u cerebrospinalnoj tečnosti kod diferencijalne dijagnostike oboljenja CNS-a

The differential diagnosis between inflammatory and noninflammatory diseases of CNS includes CSF quantitative measurements of immunoglobulin and albumin concentrations and their comparison to the serum. For that purpose we estimated the concentrations of albumin and immunoglobulin G both in CSF and serum of patients with inflammatory and noninflammatory diseases of CNS. Parallely, these parameters were determined in the control group composed of patients having the values of investigated parameters within reference ranges. The obtained data were statistically evaluated by nonparametric Mann-Whitney test. The values of calculated CSF/albumin ratio have shown significant differences between the both patient groups and the control one (p lt 0.001). It proves that in each examined group the blood brain barrier is damaged. For the assessment of intrathecal IgG synthesis we have calculated both IgG/albumin index and Schuller index. The comparison of the values obtained for patients with noninflammatory diseases to the control one, revealed no statistically significant differences (p > 0.05). On the contrary, significant difference have been observed between the group with inflammatory diseases and the control (p lt 0.05), proving the existence of IgG intrathecal synthesis. Values of both indexes were much higher in patients with inflammatory than noninflamatory diseases, meaning that they can be used in differential diagnosis.Diferencijalna dijagnoza inflamatornih i neinflamatornih oboljenja CNS-a, obuhvata kvantitativno određivanje koncentracija imunoglobulina i albumina, kao i njihovo poređenje sa serumom. Koncentracije albumina i imunoglobulina G određene su u cerebrospinalnoj tečnosti (CST) u serumu pacijenata sa inflamatornim i neinflamatornim oboljenjima CNS-a. Ovi parametri određeni su i u kontrolnoj grupi, sačinjenoj od pacijenata kod kojih su ispitivani parametri bili u granicama referentnih vrednosti. Dobijeni rezultati statistički su obrađeni neparametarskim Mann-Whitney testom. Izračunate vrednosti CSF/albumin pokazale su statistički značajne razlike između obe grupe pacijenata i kontrolne grupe (p lt 0,001). Ovo dokazuje da je kod obe grupe pacijenata krvno moždana barijera oštećena. Za procenu intratekalne sinteze IgG izračunati su Ig/albumin indeks i Schuller-ov index. Poređenjem vrednosti za pacijente sa nezapaljenskim oboljenjima i kontrolne grupe nisu nađene značajne razlike (p > 0,05). Suprotno, statistički značajne razlike uočene su između grupe sa inflamatornim oboljenjima i kontrolne grupe (p lt 0,05), što ukazuje na postojanje intratekalne sinteze IgG-a. Vrednosti izračunatih indeksa za zapaljenske procese bile su značajno više u odnosu na nezapaljenska oboljenja (p lt 0,05), što se može iskoristiti za diferencijalnu dijagnozu ovih oboljenja

Oksidativni stres u akutnoj blast povredi pluća je nezavisan od enzimske sinteze azot-monoksida

Lung trauma has been considered to be one of the vital injuries induced by explosion-generated blast overpressure. Conflicting evidence exists as to whether nitric oxide plays a crucial role in acute lung injury induced by blast. Data presented in this study demonstrate that local exposure of midthoracic region to moderate-level blast overpressure significantly enhanced lipid peroxidation product malondialdehyde and superoxide anion generation in rabbit's lungs 30 minutes after exposure, whereas the activities of antioxidant enzymes (superoxide dismutase, glutathione peroxidase) activity showed parallel increase. NG-nitro-L-arginine methyl ester, a non-specific inhibitor of nitric oxide synthase (NOS), had no effects on the measured parameters suggesting that oxidative stress induced by blast exposure might be independent from NOS.Smatra se da je povreda pluća jedna od najvažnijih povreda do kojih dolazi delovanjem blast talasa generisanog na mestu eksplozije. Do danas ne postoji definitivan stav da li azot-monoksid ima bitnu ulogu u akutnoj blast povredi pluća. Rezultati ove studije pokazuju da lokalno delovanje blast nadpritiska srednje jačine na središnji deo toraksa dovodi do povećanog stvaranja malondialdehida, produkta lipidne peroksidacije kao i povećanog generisanja superoksidnog anjona, 30 minuta posle traume. Istovremeno, dolazi do smanjenja aktivnosti antioksidativnih enzima (superoksid-dizmutaze i glutation-peroksidaze) u plućnom tkivu kunića. NG-nitro-L-arginin-metil estar (L-NAME), nespecifični inhibitor enzima azot-monoksid sintaze (NOS) nije imao efekta na određivane parametere, što ukazuje daje oskidativni stres indukovan blast povredom verovatno nezavisan od aktivnosti enzima NOS

Antioksidativni status i kliničko-patološki parametri kod obolelih od Parkinsonove bolesti

Backgroun / Aim. Constant production of free radicals and antioxidants (AO) in the cell is a part of normal cellular function. Their imbalance might take a part in pathophysiology of many diseases, including Parkinson’s disease (PD). Evaluation of the disease status, prooxidant-antioxidant balance (PAB) and antioxidants are being widely estimated. The aim of this study was to examine potential interaction between several AO variables (GSH, SOD, CAT and PAB) and clinicopathological features of patients with PD, particularly Hoehn and Yahr (H&Y) stage. Methods. A multivariate analysis of variance (MANOVA) was conducted to test the hypothesis of the mean differences between clinicopathological characteristics (gender, age at examination, duration of the disease, and H&Y stage) and AO variables, compared with age/sex matched healthy controls. The study included 91 patients with idiopatic PD patients and 20 healthy controls. Results. The multivariate effect size was estimated at 0.269, p <0.001, implying that 27.0% of the variance of the dependent variables was accounted for H&Y stage. Univariate tests showed that there were significant differences (p <0.001) across the H&Y stage on all AO variables. The H&Y stage remained significant predictor after controlling for the second variable, the disease duration (p <0.001, η2 = 0.249), and there were still significant differences across the H&Y stage on all variables, with effect size ( η2) ranging from 0.132, p =0.011 (lnGSH) to the still high values of 0.535 (lnPAB), 0.627 (lnSOD) and 0.964 (lnCAT). Conclusion. The results indicate that higher level of oxidative stress in blood of PD patients is possibly related to PD stage. Along with reduction of SOD and GSH level, CAT activity was elevated in comparison to healthy subjects. Furthermore, Pwas shifted toward oxidative stress

Prooxidant-antioxidant balance, hsTnI and hsCRP: mortality prediction in haemodialysis patients, two-year follow-up

Oxidative stress and inflammation are highly intertwined pathophysiological processes. We analyzed the markers of these processes and high-sensitive troponin I (hsTnI) for mortality prediction in patients on haemodialysis. This study enrolled a total of 62 patients on regular haemodialysis. The patients were monitored for two years, and the observed outcomes were all-cause and cardiovascular mortality. Blood samples were taken before one dialysis session for analysis of the baseline concentrations of prooxidant-antioxidant balance (PAB), total antioxidant status (TAS), total oxidative status (TOS), hsTnI, hsCRP and resistin. The overall all-cause mortality was 37.1% and CVD mortality 16.1%. By univariate and multivariate logistic regression, our findings suggest that good predictors of all-cause mortality include hsCRP and PAB (p lt .05) and of CVD mortality hsCRP (p lt .05) and hsTnI (p lt .001). To evaluate the relationship between the combined parameter measurements and all-cause/CVD mortality risk, patients were divided into three groups according to their PAB, hsCRP and hsTnI concentrations. The cutoffs for hsCRP and hsTnI and the median for PAB were used. Kaplan-Meier survival curves pointed out that the highest mortality risk of all-cause mortality was in the group with hsCRP levels above the cutoff and PAB levels above the median (p lt .001). The highest risk of CVD mortality was found in the group with hsCRP and hsTnI levels above the cutoff levels (p =.001). Our data suggest that hsCRP and PAB are very good predictors of all-cause mortality. For CVD complications and mortality prediction in HD patients, the most sensitive parameters appear to be hsTnI and hsCRP

Direct Estimation of Reference Intervals for Thyroid Parameters in the Republic of Srpska

Background: The aim of this study was to determine the reference values for thyrotropin (TSH), thyroid hormones (total and free thyroxine, T4 and fT4; total and free triiodothyronine, T3 and fT3), thyroglobulin (Tg) and thyroid antibodies (thyroid peroxidase, TPOAb and thyroglobulin antibody, TgAb) in the population of the Republic of Srpska. Methods: A total of 250 euthyroid subjects were enrolled in this study. A direct method for choosing reference subjects was used to establish reference intervals. The hormones and thyroid antibodies were measured by an electrochemiluminescence immunoassay method (ECLIA, Roche Diagnostics, Mannheim, Germany). We calculated the re f erence intervals by MedCalc, version 12.1.4.0 (MedCalc software, Belgium) as recommended by the IFCC (CLSI C28-A3). Results: Using guidelines recommended by the National Academy of Clinical Biochemistry (NACB) and based on standard statistical approaches, the reference intervals derived for TSH, fT4, T4, fT3, T3 were 0.75-5.32 mIU/L, 12.29-20.03 pmol/L, 73.49-126,30 nmol/L, 4.11-6.32 pmol/L, 1.15-2.32 nmol/L and for Tg, TPOAb, TgAb were 3.63-26.00 mu g/L, lt 18.02 mIU/L, lt 98.00 mIU/L, respe ctively. We found a significant difference (p lt 0.05) in TSH and fT3 values between different age groups as well as in T4, fT4 and fT3 values between ge nder groups. Conclusions: The established reference values for the population of the Republic of Srpska were significantly different from the values recommended by the manufacturer of reagents (Roche Diagnostics). Our results showed that a laboratory needs to establish its own reference values in order to set up a proper diagnosis, as well as to treat patients successfully

Parametri oksidativnog stresa i antioksidativne zaštite

At present, the mechanisms of many diseases (cardiovascular diseases, cancer diabetes, rheumatoid arthritis, hepatitis, atherosclerosis, haemorrhagic shock, AIDS etc) are explained through interaction of oxidative stress (OS) mediators and antioxidative defence (AOD) sistem factors. It is important to develop new and evaluate existing analytical procedures for determination of OS mediators and methods for evaluation of antioxidative status. More frequent use of these tests will be very useful for evaluating organism status in health and disease, for monitoring the effects of therapies. These tests will be beneficial for judgment if antioxidant supplementation is necessary or therapy with vitamin E or selenium. All cells normally generate superoxide anion radical (O2 -), hydrogen peroxide (H2O2), hydroxyl anion radical (OH -), nitric oxide (NO), peroxynitrite anion (ONOO -). In cellular injury, during hypoxia and following reperfusion, increased amounts of free radicals can generate. This event can aggravate tissue injury. AOD system (albumin, uric acid, glutathione, vitamin E, vitamin C, SOD, GPx catalase, selenium, caeruloplasmin, transferrin) is very important physiological regulator in health and disease.Danas se mehanizmi velikog broja bolesti (kardiovaskularne bolesti, kancer dijabetes, reumatoidni artritis, hepatitis, ateroskleroza, hemoragijski šok AIDS i dr) objašnjavaju interakcijom činilaca oksidativnog stresa (OS) i antioksidativne (AO) zaštite. Zbog toga je značajno razvijati nove i evaluirati postojeće metode za merenje pokazatelja oksidativnog stresa i to slobodnih radikala, njihovih reaktivnih intermedijera i produkata peroksidacije lipida, kao i metode za procenu antioksidativnog statusa organizma. Šira primena ovih testova bi bila značajna za procenu stanja kako već obolelog, tako i zdravog organizma u cilju prevencije potencijalnih bolesti, za praćenje efikasnosti primenjene terapije kao i procene da li je potrebna suplementacija ishrane antioksidansima ili uvođenje terapije vitaminom E ili selenom. U toku normalnog metabolizma u ćeliji se stvaraju superoksidni anjon (O2.-), vodonik peroksid (H2O2), hidroksilni anjon radikal (OH -), azot monoksid (NO), peroksinitritni anjon (ONOO -). U slučaju oštećenja/povrede ćelije, usled hipoksije i posledične reperfuzije dolazi do povećanog stvaranja slobodnih radikala, koji sami ili preko svojih reaktivnih produkata, produbljuju oštećenje tkiva. Sistem AO zaštite organizma (albumin, mokraćna kiselina, glutation; vitamini E i C; enzimi SOD, GPx, katalaza, selen; ceruloplazmin i transferin) je zbog toga značajan fiziološki regulator kako u toku normalnih metaboličkih procesa tako i u patološkim stanjima