Promene u hematološkim i parametrima hemostaze u toku infekcije SARS-CoV-2

Hematološki parametri su se pokazali korisnim za stratifikaciju i prognozu toka bolesti kod pacijenata obolelih od COVID-19. Limfopenija je prepoznatljiv znak SARS-CoV-2 infekcije i prisutna je u različitom stepenu kod skoro svih pacijenata. Postoje i indikacije da je stepen smanjenja broja limfocita povezan sa težinom bolesti. Takođe, pokazan je i značaj niskog broja eozinofilnih leukocita, koji u kombinaciji sa limfopenijom kod pacijenata sa simptomi- ma predstavlja snažan indikator infekcije. Povišen broj neutrofilnih leukocita ukazuje na loš ishod, a u kombinaciji sa niskim brojem limfocita, kada je povišen indeks neutrofilni leukociti / limfociti, može da se koristi kao marker nepovoljne prognoze bolesti. Koagulopatija je ključna karakteristika SARS-CoV-2 infekcije. Najčešće se manifestuje pro-trombotskim stanjem sa povećanom incidencom venskih i arterijskih tromboza. Povišene vrednosti D-dimera su pove- zane sa nepovoljnom progresijom bolesti. Pored toga, koagulopatija može da se manifestuje i produženim protrombinskim i parcijalnim tromboplastinskim vremenom, kao i povišenom koncentarcijom fibrinogena koja je posledica prisutne inflamacije. Kod osoba kod kojih dođe do razvoja diseminovane intravaskularne koagulacije može doći do pada koncentracije fibri- nogena i trombocitopenije. Takođe, trombocitopenija je još jedan pokazatelj nepovoljnog is- hoda bolesti.Predavanje je održano na Simpozijumu COVID-19 infekcija – dijagnostički i prognostički biohemijski parametri u Beogradu pod pokroviteljstvom Ministarstva zdravlja Republike Srbije, Projekat „Hitan odgovor Republike Srbije na COVID-19”

Uloga hormona tiroidne žlezde u proceni preživljavanja bolesnika u odeljenjima intenzivne nege

Background/Aim. Patients in intensive care units (ICUs) often exhibit disturbances in the concentration of thyroid hormones (THs), even if they had no previous thyroid disorders. The aim of the study was to determine whether there is a correlation between THs and the survival rate in the ICU and whether these hormones have predictive capability for mortality rate assessment. Methods. The study included 41 patients (23 women and 18 men) divided into two groups: survivors (70.7%) and non-survivors (29.3%). In peripheral blood samples taken within the first 24 hrs after ICU admission, TH levels were measured: triiodothyronine (T3), thyroxine (T4), free T3 (FT3), free T4 (FT4), and thyroid stimulating hormone (TSH), as well as procalcitonin (PCT). The Sequential Organ Failure Assessment Score (SOFAS) was calculated for each patient. Results. A statistically significant difference between the study groups (survivor vs. non-survivor patients, p < 0.05) was found for PCT, SOFAS, T3, T4, and FT4. The area under the receiver operating characteristic (ROC) curve (AUC) – (AUROC) for the SOFAS was 0.991 [95% confidence interval (CI): 0.898–1.000, p < 0.001], for T3 was 0.727 (95% CI: 0.566–0.854, p = 0.0097), for T4 was 0.793 (95% CI: 0.638–0.903, p = 0.0008), for FT3 was 0.707 (95% CI: 0.544–0.8389, p = 0.0299), and for FT4 was 0.795 (95% CI: 0.640–0.904, p = 0.0005). Compared to other parameters, T3 had higher sensitivity (91.67%), FT4 had higher specificity (93.10%), while SOFAS had both the highest sensitivity (91.67%) and specificity (96.55%) in relation to all other tested parameters. Multiple linear regression analysis showed that FT4 and T4 were significant predictors of survival time (β = -0.362, p = 0.012 and β = -0.356, p = 0.014, respectively). Conclusion. Among all examined THs, only FT4 and T4 showed strong predictive potential for assessing mortality in ICU patients. This study has highlighted the significance of assessing THs levels in critically ill patients. This is crucial because it opens the possibility of implementing specific therapies to rectify issues stemming from hormonal deficiencies.Uvod/Cilj. Bolesnici u odeljenjima intenzivne nege (OIN) često imaju poremećaj u koncentraciji tiroidnih hormona (TH), čak i u slučajevima kada nisu prethodno imali poremećaj funkcije tiroidne žlezde. Cilj rada bio je da se utvrdi da li postoji korelacija između TH i stepena preživljavanja u OIN, kao i da li ovi hormoni imaju prediktivni značaj u proceni smrtnosti bolesnika. Metode. U studiji je učestvovalo 41 bolesnika (23 žene i 18 muškaraca) koji su bili podeljeni u dve grupe: grupu preživelih (70.7%) i grupu preminulih (29.3%). U uzorcima periferne krvi koji su uzimani u toku prv a 24 sata od prijema u OIN određivani su nivoi TH: trijodtironin (T3), tiroksin (T4), slobodan T3 (free T3 – FT3), slobodan T4 (FT4) i tiroid-stimulirajući hormon (TSH), kao i prokalcitonin (PCT). Za svakog bolesnika izračunat je Sequential Organ Failure Assessment Score (SOFAS). Rezultati. Statistički značajna razlika između ispitivanih grupa (preživeli vs. preminuli, p < 0,05) utvrđena je za parametre SOFAS, T3, T4 i FT4. Površina ispod receiver operating characteristic (ROC) krive [area under the ROC curve (AUC) – (AUROC)] iznosila je za SOFAS 0,991 [95% confidence interval (CI): 0,898–1,000, p < 0,001], za T3 0,727 (95% CI:0,566–0,854, p = 0,0097), za T4 0,793 (95% CI: 0,638– 0,903, p = 0,0008), za FT3 0,707 (95% CI: 0,544–0,8389, p = 0,0299) i za FT4 0,795 (95% CI: 0,640–0,904, p = 0,0005). U poređenju sa ostalim parametrima, T3 je imao višu osetljivost (91,67%), FT4 višu specifičnost (93,10%), dok je SOFAS imao istovremeno i najvišu osetljivost (91,67%) i specifičnost (96,55%) u odnosu na sve druge ispitivane parametre. Primenom multiple linearne regresione analize utvrđeno je da su FT4 i T4 bili značajni prediktori vremena preživljavanja bolesnika (β = -0,362, p = 0,012 i β = -0,356, p = 0,014, redom). Zaključak. Među svim ispitanim TH, pokazano je da FT4 i T4 imaju snažan prediktivni potencijal za procenu smrtnosti bolesnika u OIN. Ovom studijom je istaknut značaj određivanja nivoa TH kod kritično obolelih, što je ključno jer otvara mogućnost primene specifičnh terapija koje bi korigovale poremećaje nastale zbog deficita hormona

Factor analysis and association of lipid, inflammatory, cardiac and renal biomarkers with creactive protein in cardiovascular risk categorization

U kliničkoj praksi koristi se nekoliko skorova za procenu rizika od pojave različitih oblika kardiovaskularnih bolesti (KVB) koji se zasnivaju na multivarijabilnim regresionim jednačinama izvedenim iz rezultata praćenja različitih kohortnih grupa. Na osnovu prisustva tradicionalnih faktora rizika [hiperholesterolemija, hipertenzija, pol, starost, porodična istorija KVB, dijabetes i pušenje] definisanim algoritmima se izračunava apsolutni 10-godišnji rizik za koronarnu bolest srca (KBS) na osnovu Framingamskog rizik skora (FRS), 10-godišnji rizik od svih oblika KVB – tzv. „globalni KVB rizik“ (globalni FRS), kao i dugoročni (30-godišnji) rizik za KVB. Ateroskleroza je bolest uslovljena brojnim faktorima koju prati hronična inflamacija niskog intenziteta i dislipidemija. Zahvaljujući velikom broju postojećih dokaza da C-reaktivni protein (CRP) snažno i nezavisno predviđa pojavu kardiovaskularnih komplikacija, primena CRP-a u kliničkoj praksi definisana je od strane nekoliko organizacija. Za proces ateroskleroze karakteristična je hronična inflamacija gde su koncentracije CRP-a u cirkulaciji niže od granice detekcije konvencionalnih testova. Određivanje tako niskih nivoa CRP-a zahteva testove sa većom analitičkom osetljivošću, koji se označavaju kao visoko osetljivi (highsensitivity, hs), a na ovaj način određena koncentracija CRP-a kao „visoko osetljivi CRP“ (hsCRP). Takođe, postoje podaci i o drugim faktorima koji doprinose održavanju inflamacije ili odražavaju intenzitet aterosklerotskih procesa i koji bi mogli da identifikuju doprinos kardiovaskularnom riziku koji ne potiče od tradicionalnih faktora rizika, kao što su mokraćna kiselina, jačina glomerularne filtracije procenjena na osnovu koncentracije kreatinina ili cistatina C (eGFR), amino-terminalni pro-natriuretički peptid tipa B (NT-proBNP), srčani troponin (cTn). Cilj rada bio je da se ispita da li postoji povezanost između hsCRP-a, ustanovljenog biomarkera proaterogenog metaboličkog stanja, i drugih biomarkera inflamacije [serumski amiloid A (SAA), fibrinogen, α1-kiseli glikoprotein (A1AGP), haptoglobin, C3 i C4 komponente komplementa), metabolizma lipida [ukupan, HDL, non-HDL i LDL holesterol, trigliceridi, apolipoprotein A-I (apo A-I), apolipoprotein B (apo B), lipoprotein (a) (Lp(a))], bubrežne [kreatinin, cistatin C (Cys-C), procenjena jačina glomerularne filtracije (eGFR)] i srčane funkcije (NT-proBNP, cTnT), koji bi mogli da unaprede procenu kardiovaskularnog rizika u primarnoj prevenciji. Ispitane su i analitičke karakteristike i klinička efikasnost metode visoke osetljivosti koja se koristila za određivanje hsCRP-a. Faktorskom analizom ispitana je priroda uticaja svakog pojedinačnog biomarkera na kardiovaskularni rizik i eventualna povezanost sa vrednostima hsCRP-a, grupisanje ispitivanih biomarkera povezanih sa aterosklerozom i inflamacijom slabog intenziteta, kao i povezanost dobijenih faktora sa vrednostima hsCRP, kategorizacijom 10-godišnjeg rizika na osnovu FRS i globalnog FRS, kao i sa klasifikacijom 30-godišnjeg rizika...Several risk score algorithms for cardiovascular risk assessment based on multivariable regression equations derived from different cohorts are being used in clinical practice. According to presence of traditional risk factors [hypercholesterolemia, hypertension, gender, age, family history of premature cardiovascular disease (CVD), diabetes and cigarette smoking], absolute 10-year risk for coronary heart disease (CHD) according to Framingham risk score (FRS), 10-year risk for cardiovascular disease in general – „global CVD risk“ using global FRS, and long term (30-year) CVD risk are being calculated. Atherosclerosis is a disease conditioned with multiple factors followed by chronic low-grade inflammation and dyslipidemia. Thanks to substantial evidence that C-reactive protein (CRP) strongly and independently predicts cardiovascular complications, the use of CRP in clinical practice is recommended by several institutions. Atherosclerosis process is characterized with chronic inflammation where circulating CRP concentrations are lower than limit of detection of conventional assays. For measuring such low CRP levels high-sensitivity (hsCRP) assays have been developed. Also, there are evidence of other factors, contributing to and maintaining the intensity of atherosclerotic processes, which might identify cardiovascular risk contribution not originated from traditional risk factors. These are uric acid, estimated glomerular filtration rate (eGFR) based on creatinine or cystatin C, amino-terminal pro- B-type natriuretic peptide (NT-proBNP), cardiac troponin (cTn). The aim of this study was to examine whether there is association between hsCRP, as the established marker of proaterogenic metabolic state, and other biomarkers of inflammation [serum amyloid A (SAA), fibrinogen, α1-acid glycoprotein (A1AGP), haptoglobin, C3 and C4 complement components), lipid metabolism [total, HDL, non- HDL and LDL cholesterol, triglycerides, apolipoprotein A-I (apo A-I), apolipoprotein B (apo B), lipoprotein (a) (Lp(a))], renal [creatinine, cystatin C (Cys-S), estimated glomerular filtration rate (eGFR)] and cardiac function (NT-proBNP, cTnT), which might promote cardiovascular risk assessment in primary prevention. The analytical performance and clinical efficacy of high sensitivity method used for CRP determination were also evaluated. Using factor analysis, the nature of influence of every single examined biomarker on cardiovascular risk and their possible connection to hsCRP values, also clustering of examined biomarkers associated with atherosclerosis and low-grade inflammation, as well as relations of identified factors with hsCRP values, 10-year risk categorization based on FRS and global FRS, and 30-year risk classification, were analyzed. The examined population were 242 healthy volunteers, 100 men and 142 women, 20–80 years old. They were free of diabetes mellitus and of any known cardiac, renal, hepatic and rheumatic disease, and were not taking any prescribed medication. Information about their age, smoking habits, body weight and height, physical activity, family history of CVD, aspirin intake and, in case of women, if they were taking any oral contraceptives, were obtained through questionnaire. Blood pressure was measured prior to venipuncture..

Antifosfolipidna antitela u zdravih srpskih osoba srednjih godina - preliminarni podaci

Background: The investigation of the prevalence of the IgG and the IgM isotypes of anticardiolipin (aCL) and antib2glycoprotein I (ab2gpI) Abs in healthy Serbian middle-aged subjects was the main goal of our study. In addition, we analyzed the potential associations of above-mentioned Abs with serum proteins and lipids/lipoproteins. Methods: Forty healthy subjects were included in our study. Obesity (BMI 30 kg/m2) was present in 8/40 (20%) subjects. Titers of analyzed Abs were measured by ELISA. Results: The prevalence of IgG and IgM ab2gpI Abs was 5% and 12.5%, respectively, while the prevalence of IgM aCL was 10%. The IgG ab2gpI Abs were significantly different between subjects with normal triglycerides levels and those with hypertriglyceridemia (Mann-Whitney, P = 0.014). The significant difference in hsCRP concentrations was observed between subjects with the increased levels of the IgM isotype of aCL Abs and those with normal IgM aCL values (Mann-Whitney, P = 0.028). Conclusions: Dyslipidemia and BMI ≥30 were associated with aPL Abs and therefore, the correction of BMI and lipid status might be beneficial in reduction or elimination of predisposing factors that might trigger thrombotic events in otherwise healthy middle-aged subjects. Larger national study is necessary to confirm our findings.Uvod: Analiza prevalentnosti IgG i IgM izotipa antikardiolip- inskih (aCL) i anti- b2glikoprotein I (ab2gpI) At kod zdravih sredove~nih stanovnika Srbije je bila glavni cilj na{e studije. Dodatno, analizirali smo potencijalnu povezanost gore- navedenih At sa serumskim proteinima i lipidima/lipopro- teinima. Metode: 40 zdravih ispitanika je bilo uklju~eno u na{u studiju. Gojaznost (BMI ≥ 30 kg/m2) je uo~ena kod 8/40 (20%) osoba. Titri analiziranih antitela su utvr|ivani ELISA testom. Rezultati: Prevalentnost IgG i IgM ab2gpIAt je bila 5% i 12.5%, redom, dok je prevalentnost IgM aCL bila 10%. Nivoi IgG ab2gpI At su se zna~ajno razlikovali izme|u ispi- tanika sa i bez hipertrigliceridemije (Mann-Whitney, P = 0.014). Zna~ajne razlike u hsCRP koncentracijama uo~ene su izme|u osoba sa povi{enim nivoima IgM aCL At i onih sa referentim vrednostima (Mann-Whitney, P = 0,028). Zaklju~ak: Dislipidemija i BMI ≥30 su bili povezani sa aPL At uprkos njihovoj niskoj prevalentnosti, i zato korekcija BMI i lipidnog statusa bi bila korisna u redukciji ili elimi- naciji predispoziraju}ih faktora koji mogu da izazovu trom- boti~ki doga|aj kod ina~e zdravih sredove~nih ispitanika. Obimnije nacionalne studije su neophodne da bi potvrdile na{e nalaze

Medical Biochemistry as Subdiscipline of Laboratory Medicine in Serbia

Medical biochemistry is the usual name for clinical biochemistry or clinical chemistry in Serbia, and medical biochemist is the official name for the clinical chemist (or clinical biochemist). This is the largest sub-discipline of the laboratory medicine in Serbia. It includes all aspects of clinical chemistry, and also laboratory hematology with coagulation, immunology, etc. Medical biochemistry laboratories in Serbia and medical biochemists as a profession are part of Health Care System and their activities are regulated through: the Health Care Law and rules issued by the Chamber of Medical Biochemists of Serbia. The first continuous and organized education for Medical Biochemists (Clinical Chemists) in Serbia dates from 1945, when the Department of Medical Biochemistry was established at the Pharmaceutical Faculty in Belgrade. In 1987 at the same Faculty a five years undergraduate study program was established, educating Medical Biochemists under a special program. Since the academic year 2006/2007 the new five year undergraduate (according to Bologna Declaration) and four-year postgraduate program according to EC4 European Syllabus for Postgraduate Training in Clinical Chemistry and Laboratory Medicine has been established. The Ministry of Education and Ministry of Public Health accredited these programs. There are four requirements for practicing medical biochemistry in the Health Care System: University Diploma of the Faculty of Pharmacy (Study of Medical Biochemistry), successful completion of the professional exam at the Ministry of Health after completion of one additional year of obligatory practical training in the medical biochemistry laboratories, membership in the Serbian Chamber of Medical Biochemists and licence for skilled work issued by the Serbian Chamber of Medical Biochemists. In order to present laboratory medical biochemistry practice in Serbia this paper will be focused on the following: Serbian national legislation, healthcare services organization, sub-disciplines of laboratory medicine and medical biochemistry as the most significant, education in medical biochemistry, conditions for professional practice in medical biochemistry, continuous quality improvement, and accreditation. Serbian healthcare is based on fundamental principles of universal health coverage and solidarity between all citizens

Turistički značaj muzeja u Vojvodini

Vojvodina is an area with long and rich cultural tradition. The first museum in Vojvodina was founded in the 19th Serbian century by Matica Srpska, from which the present Museum of Vojvodina emerged. City museums are located in all major cities in Vojvodina, and each of them houses valuable artifacts. Museum visitation is not at a high level and it is necessary to invest a lot of effort and innovation that museums become more interesting than surfing the Internet. One of the good ways that museums become appealing to visitors is the event 'Museum Night'. Museums contribute to tourism value of certain destinations, and owing to tourism, increase the number of visitors, gain popularity and fulfill their cultural and educational function.Vojvodina je prostor sa dugom i bogatom kulturnom tradicijom. Prvi muzej u Vojvodini osnovala je Matica srpska u 19. veku iz koga je nastao današnji Vojvođanski muzej. Gradski muzeji nalaze se u svim većim gradovima u Vojvodini, i svaki od njih poseduje vredne eksponate. Posećenost muzeja nije na zavidnom nivou i potrebno je uložiti dosta truda i inovacija da muzeji postanu zanimljiviji od 'surfovanja' Internetom. Jedan od dobrih načina da muzeji postanu interesantni za posetioce jeste i manifestacija 'Noć muzeja'. Muzeji doprinose turističkoj vrednosti pojedinih mesta, a zahvaljujući turizmu povećavaju broj svojih posetilaca, stiču popularnost i ispunjavaju svoju kulturno-obrazovnu funkciju

Turistički značaj muzeja u Vojvodini

Vojvodina is an area with long and rich cultural tradition. The first museum in Vojvodina was founded in the 19th Serbian century by Matica Srpska, from which the present Museum of Vojvodina emerged. City museums are located in all major cities in Vojvodina, and each of them houses valuable artifacts. Museum visitation is not at a high level and it is necessary to invest a lot of effort and innovation that museums become more interesting than surfing the Internet. One of the good ways that museums become appealing to visitors is the event 'Museum Night'. Museums contribute to tourism value of certain destinations, and owing to tourism, increase the number of visitors, gain popularity and fulfill their cultural and educational function.Vojvodina je prostor sa dugom i bogatom kulturnom tradicijom. Prvi muzej u Vojvodini osnovala je Matica srpska u 19. veku iz koga je nastao današnji Vojvođanski muzej. Gradski muzeji nalaze se u svim većim gradovima u Vojvodini, i svaki od njih poseduje vredne eksponate. Posećenost muzeja nije na zavidnom nivou i potrebno je uložiti dosta truda i inovacija da muzeji postanu zanimljiviji od 'surfovanja' Internetom. Jedan od dobrih načina da muzeji postanu interesantni za posetioce jeste i manifestacija 'Noć muzeja'. Muzeji doprinose turističkoj vrednosti pojedinih mesta, a zahvaljujući turizmu povećavaju broj svojih posetilaca, stiču popularnost i ispunjavaju svoju kulturno-obrazovnu funkciju

Poređenje dve metode procene kardiovaskularnog rizika - 'Framingham' rizik skor i 'Score' sistem

Numerous studies have shown that the major risk factors for coronary heart disease (cigarette smoking, hypertension, elevated serum total cholesterol and low-density lipoprotein cholesterol - LDL, low serum high-density lipoprotein cholesterol - HDL, diabetes mellitus and advancing age), are additive in predictive power. Accordingly, the total risk of a person can be estimated by summing up the risk imparted by each of the major risk factors. Using data obtained from population studies, various risk assessment algorithms have been developed. The aim of this study was to compare the two most common risk scores. Risk assessment for determining 10-year risk in 185 healthy, asymptomatic individuals of both sexes, 30-85 years old, was carried out according to both Framingham (FRS) and SCORE risk scoring. The risk factors included in the calculation of 10-year risk are gender, age, total cholesterol, HDL-cholesterol, systolic blood pressure, treatment for hypertension and cigarette smoking. The determinations of total cholesterol and HDL-cholesterol were made in sera collected after a 12h fasting period using an Olympus AU2700 automated analyzer. The Framingham risk score was determined using an electronic calculator - ATP III Risk Estimator, and the risk status according to SCORE was obtained using charts for the 10-year risk in populations at high risk. Among 185 participants, in 152 (82%) 10-year risk for Coronary Heart Disease (CHD) death was lt 10%, 24 (13%) had intermediate and 9 (5%) had high risk (>20%) according to FRS. According to SCORE, 110 (60%) participants had lt 1%, 56 (30%) had 1-5% and 19 (10%) had >5% of 10-year risk for cardiovascular death. Different categories of risk were assigned to ∼30% of individuals according to different risk assessment models. Differences in risk classification when using two different risk assessment algorithms can be explained with several important issues including different endpoints, consideration of interactions and incorporation of antihypertensive use. It is important to note that neither FRS nor SCORE have been appropriately adjusted for our population, according to the national cardiovascular mortality rate.Brojne studije su pokazale aditivnu prediktivnu vrednost glavnih faktora rizika za pojavu koronarne srčane bolesti (pušenje, hipertenzija, povišena koncentracija ukupnog i LDL-holesterola i niska koncentracija HDL-holesterola u serumu, dijabetes i starost). Na osnovu toga, ukupan rizik za jednu osobu može se proceniti sumiranjem rizika koji nosi svaki glavni faktor rizika pojedinačno. Veliki broj algoritama za procenu rizika razvijen je na osnovu podataka dobijenih iz populacionih studija. Cilj ovog rada bio je poređenje dva najčešće korišćena rizik skora. Za 185 zdravih, asimptomatskih osoba oba pola, 30-85 godina starosti, procenjen je rizik od pojave kardiovaskularnih bolesti (KVB) u narednih 10 godina prema "Framingham" (FRS) i SCORE sistemu. Faktori rizika koji su uključeni u izračunavanje 10-godišnjeg rizika su pol starost, ukupan i HDLholesterol, sistolni krvni pritisak, terapija antihipertenzivima i pušenje. Ukupan i HDL-holesterol određivani su u uzorcima seruma, dobijenim posle 12 sati gladovanja, na biohemijskom analizatoru Olympus AU2700. FRS je izračunavan pomoću programa "ATP III Risk Estimator", a SCORE rizik je dobijen pomoću tablica za 10-godišnji rizik za populacije sa visokim rizikom. Od 185 učesnika, kod 152 (82%) 10- godišnji rizik za srčanu smrt bio je lt 10%, 24 (13%) je imalo srednji, a 9 (5%) je imalo visoki rizik (≥20%) na osnovu FRS. Prema SCORE-u, 110 učesnika (60%) imalo je 10- godišnji rizik od kardiovaskularne smrti lt 1%, 56 (30%) je imalo 1-5% rizika, dok je kod 19 osoba (10%) identifikovan visok rizik (≥5%). Oko 30% ispitanika svrstano je u različite kategorije rizika na osnovu različitih modela za procenu rizika. Razlike u klasifikaciji na osnovu kardiovaskularnog rizika, koje se dobijaju korišćenjem dva različita algoritma za procenu rizika, mogu se objasniti time što ovi sistemi koriste različite krajnje ishode bolesti i što se razlikuju po uticaju interakcija i uzimanju u obzir upotrebe antihipertenzivnih lekova. Važno je naglasiti da ni FRS ni SCORE nisu prilagođeni našoj populaciji, na osnovu nacionalne stope mortaliteta od KVB

Biohemija i metabolizam vitamina D

Vitamin D is not technically a vitamin, since it is not an essential dietary factor. It is rather a prohormone produced photochemically in the skin from 7-dehydrocholesterol. Vitamin D and its metabolites may be categorized as either cholecalciferols or ergocalciferols. Cholecalciferol (vitamin D3) is the parent compound of the naturally occurring family and is produced in the skin from 7-dehydrocholesterol on exposure to the ultraviolet B portion of sunlight. Vitamin D2 (ergocalciferol), the parent compound of the other family, is manufactured by irradiation of ergosterol produced by yeasts and its potency is less than one-third of vitamin D3's potency. The steps in the vitamin D endocrine system include the following: 1) the photoconversion of 7-dehydrocholesterol to vitamin D3 in the skin or dietary intake of vitamin D3; 2) metabolism of vitamin D3 by the liver to 25-hydroxyvitamin-D3 [25(OH)D3], the major form of vitamin D circulating in the blood compartment; 3) conversion of 25(OH)D3 by the kidney (functioning as an endocrine gland) to the hormone 1,25-dihydroxyvitamin D3 [1,25(OH)2D3 ]; 4) systemic transport of the dihydroxylated metabolite 1,25(OH)2D3 to distal target organs; and 5) binding of 1,25(OH)2D3 to a nuclear receptor (VDR) at target organs, followed by generation of appropriate biological responses. The activation of vitamin D to its hormonal form is mediated by cytochrome P450 enzymes. Six cytochrome P450 (CYP) isoforms have been shown to hydroxylate vitamin D. Four of these, CYP27A1, CYP2R1, CYP3A4 and CYP2J3, are candidates for the enzyme vitamin D 25-hydroxylase that is involved in the first step of activation. The highly regulated, renal enzyme 25-hydroxyvitamin D-1a-hydro xylase contains the component CYP27B1, which completes the activation pathway to the hormonal form 1,25(OH)2D3. A five-step inactivation pathway from 1,25(OH)2D3 to calcitroic acid is attributed to a single multifunctional CYP, CYP24A1, which is transcriptionally induced in vitamin D target cells by the action of 1,25(OH)2D3. An additional key component in the operation of the vitamin D endocrine system is the plasma vitamin D binding protein (DBP), which carries vitamin D3 and its metabolites to their metabolism and target organs. DBP is a specific, high-affinity transport protein. It is synthesized by the liver and circulates in great excess, with fewer than 5% of the binding sites normally occupied. 1,25(OH)2D3, acts as a ligand for a nuclear transcription factor, vitamin D receptor - VDR, which like all other nuclear receptors, regulates gene transcription and cell function. The widespread presence of VDR, and the key activating (1a-hydroxylase, CYP27B1) and inactivating (24-hydroxylase, CYP24A1) enzymes in most mammalian cells means that the cells in these tissues have the potential to produce biological responses, depending on the availability of appropriate amounts of vitamin D3. Thanks to this widespread presence of elements of vitamin D endocrine system, its biological features are being recognized outside bone tissue, i.e. calcium and phosphate metabolism.Vitamin D nije pravi vitamin, odnosno nije esencijalni dijetetski faktor, već je pre prohormon koji nastaje fotohemijskom reakcijom u koži iz 7-dehidroholesterola. Vita min D i njegovi metaboliti mogu da se kategorizuju kao holekalciferoli ili ergokalciferoli. Holekalciferol (vitamin D3) je polazno jedinjenje za familiju koja se nalazi u prirodi i produkuje se u koži iz 7-dehidroholesterola pri izlaganju ultraljubičastom B delu spektra sunčeve svetlosti. Vitamin D2 (ergokalciferol), polazno jedinjenje druge familije, nastaje radijacijom ergosterola koga produkuju kvasci i ima samo jednu trećinu aktivnosti vitamina D3. Faze u endokrinom sistemu vitamina D su: 1) fotokonverzija 7-dehidroholesterola u vitamin D3 u koži ili unos vitamina D3-hranom; 2) metabolizam vitamina D3 u jetri do 25-hidroksivitamina D3 [25(OH)D3], glavnog oblika vitamina D u cirkulaciji; 3) konverzija 25(OH)D3 u bubregu (koji ovde funkcioniše kao endokrina žlezda) do hormona 1,25-dihidroksivitamin D3 [1,25(OH)2D3]; 4) sistemski transport dihidroksi-metabolita do distalnih ciljnih organa; i 5) vezivanje 1,25(OH)2D3 za nuklearni receptor (VDR) u ciljnim organima, što prati odgovarajući biološki odgovor. Aktivacija vitamina D do hormonskog oblika je posredovana citohrom P450 enzimima. Pokazano je da šest izoformi citohroma P450 (CYP) učestvuje u hidroksilaciji vitamina D. Za četiri od njih, CYP27A1, CYP2R1, CYP3A4 i CYP2J3, se pretpostavlja da imaju aktivnost 25-hidroksilaze koja uče s tvuje u prvom koraku aktivacije. Renalni enzim, 25-hidroksivitamin D-1a-hidroksilaza sa strogo regulisanom aktivnošću, predstavlja CYP27B1, koji završava aktivaciju do hormonskog oblika 1,25(OH)2D3. Proces inaktivacije, koji se sastoji iz pet stupnjeva od 1,25(OH)2D3 do kalcitroične kiseline, obavlja jedan multifunkcionalni CYP, CYP24A1, čija je transkripcija indukovana u ciljnim ćelija carbonma dejstva vitamina D posredstvom 1,25(OH)2D3. Dodatna ključna komponenta u dejstvu vitamin D endokrinog sistema je vitamin D vezujući protein u plazmi (DBP), koji transportuje vitamin D3 i njegove metabolite do ciljnih i organa gde se odvija njihov metabolizam. DBP je specifičan transportni protein velikog afiniteta. Sintetiše se u jetri i cirkuliše u velikom višku, sa zasićenjem vezujućih mesta manjim od 5%. 1,25(OH)2D3 deluje kao ligand nuklearnog transkripcionog faktora, VDR, koji reguliše transkripciju gena i funkciju ćelija. široka rasprostranjenost VDR i ključnih enizma aktivacije (1a-hidroksilaza, CYP27B1) i inaktivacije (24-hidroksilaza, CYP24A1) u većini ćelija sisara znači da ćelije u ovim tkivima imaju potencijal za produkovanje bioloških odgovora, zavisno od raspoloživosti dovoljnih ko li čina vitamina D3. Zahvaljujući rasprostranjenosti elemenata endokrinog sistema vitamina D, njegove biološke oso bi ne se prepoznaju i izvan koštanog sistema, odnosno metabolizma kalcijuma i fosfora

Uticaj proizvoda komposta na klijanje semena povrća

The aim of this work is determination of influence of different compost leachates and teas types on vegetables seed germination. Composts used for leachate and tea production were produced of municipal waste (MSW) and waste from tobacco industry (TW). Results achieved with MSW products were comparable to control. Compost products derived from TW showed significant phytotoxicity, which can be correlated with their chemical composition. Leachates from MSW compost lead to the lower germination index in comparison to MSW compost teas, which indicates the possibilites their application.Cilj ovog rada je određivanje uticaja različitih kompostnih čajeva i ekstrakata na klijanje semena povrća. Kompost korišćen za dobijanje ekstrakata i čajeva potiče od komunalnog otpada (MSW) i otpada iz duvanske industrije (TW). Rezultati postignuti sa komposnim produktima MSW su uporedivi sa kontrolom. Kompostni produkti dobijeni od TW pokazuju značajnu fitotoksičnost koja se može dovesti u vezu sa njihovim hemijskim sastavom. Ekstrakti od MSW komposta doveli su do nižeg germinacionog indeksa u poređenju sa čajevima, što ukazuje na mogućnosti njihove primene