Abstract Objectives To develop two ethical checklists to evaluate (i) management of ethical concerns in research projects and (ii) awareness of ethical conduct of healthcare laboratory professionals. Methods Comprehensive discussion among the members of IFCC Task Force on Ethics based on pertinent literature. Results This Checklist for Clinical Research Projects should be useful to evaluate research proposals from an ethical perspective before submitting it to an IRB or its equivalent, thereby diminishing rejection rates and resulting in more time-effective projects. The checklist designed to evaluate the ethical conduct in laboratory medicine could be useful for self evaluation (internal audits) and for certification/accreditation processes performed by third parties. Conclusions These checklists are simple but powerful tools useful to guide professionals to adhere to ethical principles in their practice, especially in developing countries where accredited ethics committees may be difficult to find.

ntroduction: The thyroid hormone secretion disorders may be hyperthyroidism (reduced TSH levels and increased levels of FT3 and FT4) and subclinical hyperthyroidism (decreased concentration of TSH with normal FT3 and FT4).Aim: To investigate levels of thyroid hormones (TSH, FT3, and FT4) in patients with hyperthyroidism or subclinical hyperthyroidism treated at Tuzla Blue Clinic.Materials and methods:The study included 120 patients divided into three groups: a control group, groups with respondents who have hyperthyroidism, and a group of patients with subclinical hyperthyroidism. The concentrations of the hormones TSH, FT3, and FT4 were analyzed. The determination was carried out on the device IMMULITE 1 Siemens using the immunochemistry method. Results:TSH between our group investigated the existence of significant statistical differences between the control group and the group with hyperthyroidism (p<0.0001) and between the control group and the group withsubclinical hyperthyroidism (p=0.0001), and the parameter FT3 showed that a statistically significant difference exists between the control group and the group with hyperthyroidism (p<0.0001), and between patients with hyperthyroidism andsubclinical hyperthyroidism (p<0.0001). For FT4, we found a statistically significant difference between the control group and the group with hyperthyroidism (p<0.0001) and between groups with hyperthyroidism and subclinical hyperthyroidism (p <0.0001).Conclusions: The concentration of TSH is reduced in both hyperthyroidism and subclinical hyperthyroidism. The serum concentrations of FT3 and FT4 are elevated in hyperthyroidism, while in subclinical hyperthyroidism, the serum concentrations of FT3 and FT4 stand in the reference area.Keywords:Thyrotropin, thyroxine, TSH, FT3, FT4, hyperthyroidism

Uvod: Biotin, vitamin H ili vitamin B7, je topiv u vodi i neophodan je za reakcije karboksilacije, glukoneogenezu i metabolizam aminokiselina. Preporučena doza za odrasle je 0,03-0,06 mg/dan. Terapija visokim dozama biotina medicinski je indicirana za urođene pogreške metabolizma (nedostatak biotinidaze) i određene oblike alopecije, obično u dozama 5-10 mg/dan. U kliničkom ispitivanju je primjena biotina u dozi od 300 mg/dan kao tretman za progresivnu multiplu sklerozu. Materijal i metode: Streptavidin i manjim dijelom avidin nekovalentno se vežu za biotin s posebno jakim afinitetom, a trajnost te interakcije iskorištava se u laboratorijskim tehnikama kao što su western blot, protočna citometrija, imunohistokemija i imunohemijski testovi. Prema trenutačnim istraživanjima, poznato je da biotin uzrokuje interferencije u imunohemijskim testovima. Biotin ima sposobnost vezanja na različite molekule (biotinilacija) uz minimalne promjene u funkcionalnih ili antigenskih svojstava. Interferencije sa biotinom uključuju brojne imunohemijske testove kao što su proteini i steroidni hormoni, tumorski markeri, mikronutrijenti i lijekovi. Rezultati: Biotin može lažno povećati ili smanjiti rezultate u kompetitivnome i nekompetitivnome “sendvič” imunohemijskom testu. Niža povećanja vrijednosti obično se čine manje značajnima u usporedbi s visokim odstupanjima kod povišenih koncentracija biotina, ali mogu biti od terapijske i dijagnostičke važnosti. Osobito za procjenu hormona štitnjače (T3, T4, fT3, fT4), steroidnih hormona (kortizol, progesteron, testosteron i estradiol) kao i vitamina B12 i folne kiseline u slučaju postojeće interferencije biotina teško će se razlikovati deficit, referentna vrijednost odnosno povećanje. Interferencija sa biotinom mogla bi se ukloniti sa serijskim razblaženjem uzorka, ponavljanjem analize na drugoj metodi koja ne koristi biotin, utvrđivanjem koncentracije biotina i uklanjanjem biotina prije nego što se uzorak testira. Zaključak: Preporuka je da pacijent prestane sa terapijom biotina 3 dana prije uzorkovanja krvi odnosno 14 dana ako se koriste visoke doze biotina.

Introduction: Laboratory professionals (LP) are exposed to various hazards in the workplace, whose direct and/or cumulative effects can lead to the development of health disorders of varying severity. Our study aims to assess the level of occupational risk in biomedical laboratories. Subjects and methods: A cross-sectional study was conducted between November 2020 and February 2021. The study included LP of all profiles in Europe, and the territorial affiliation of the respondents formed the basis for the formation of the groups studied. A validated questionnaire used for data collection was distributed online through the networks of professional associations. Based on the type of agent, frequency of exposure, characteristics of the workplace and work process, and individual factors, an occupational risk assessment matrix was created in categories ranging from low to very high. Descriptive and inferential statistical methods with a statistical significance threshold of 5% (p ≤ 0.05) were used for the statistical analysis. Results: Significant differences in risk categorization were found between the groups studied (p < 0.001). Overall, 81.2% of LP in the European Union fall into the medium risk category, while more than half (52.1%) of LP and 1.7% of LP in Bosnia and Herzegovina fall into the high and very high risk categories. Higher education, service longer than 21 years, public sector, and biochemistry laboratory were identified as predictors of high risk, while predictors of very high risk were higher education, service of 21 to 30 years, public sector, and histopathology and molecular laboratories. Conclusions: Lack of equipment, organizational issues and working conditions were identified as weak points that directly correlate with risk levels in biomedical laboratory workplaces. Additional efforts to control exposure in biomedical laboratories are needed to maintain the health of LP.

Aim To investigate the serum value of brain derived neurotrophic factor (BDNF), proteins S-100, NSE, IL-6 in normal pressure patients (NPH) compared to control (healthy) group and also a possible correlation with radiological findings in NPH patients. Methods Study patients were included during the period of 2020- 2022. All NPH patients met the diagnostic criteria for probability of NPH. Control patients group included patients without known brain disorder, without clinical symptoms of NPH. Blood samples were taken before planned surgery for NPH. BDNF serum concentrations were assessed by a sensitive ELISA kit, and serum concentrations of S-100, NSE and IL-6 were assessed by using ECLIA technology for immunoassay detection. Results Among 15 patients who were included, seven NPH patients were compared to eight control patients. Non-significant decrease in BDNF serum concentrations, an increase of protein S-100 serum concentrations, a decrease of NSE serum concentrations, as well as an increase of IL-6 serum concentrations in NPH patients compared to healthy controls was found. Strong positive correlation between BNDF and Evans index was observed (p=0.0295). Conclusion We did not find a significant difference of BDNF, protein S-100, IL-6 and NSE between serum concentration in NPH and healthy patients. More future research is needed to find the role of BDNF in NPH patients.

Abstract Background: Low-grade chronic inflammation is an important feature of chronic kidney disease (CKD). Aim: To determine the values of C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients with different stages of CKD and to examine how they change depending on the progression of renal damage. Materials and methods: A cross-sectional descriptive comparative study included 157 subjects at different stages of CKD which was assessed based on glomerular filtration rate (GFR) calculated according to the MDRD equation. CRP was analyzed by an immunoturbidimetric method. NLR and PLR were calculated by a mathematical calculation after a blood count was performed. Results: The present study showed an increase in serum creatinine, CRP, and NLR values with progression of renal failure. There was a statistically significant difference in the creatinine and CRP concentrations between groups with different stages of CKD (p <0.001 for all comparisons). A significant positive correlation was found between NLR and CRP, while negative, significant correlations were observed between NLR and eGFR as well as between PLR and eGFR. There was a slight increase in PLR value with the progression of renal impairment, but the correlation between PLR and CRP was not significant. Conclusion: These results suggest that NLR, together with CRP, may serve as an indicator of systemic low-grade inflammation progression in patients with CKD. Larger prospective studies are required to observe the possibility of using NLR as a surrogate marker for CRP in patients with CKD.

Introduction: Peritoneal dialysis (PD) is an established treatment for patients with end-srage kidney disease. The method was developed as an alternative to hemodialysis (HD) presenting a patient survival rate equivalent to HD and better preservation of residual renal function. Peritoneal dialysis (PD) patients have different peritoneal membrane permeability (transport) characteristics. High peritoneal membrane permeability is associated with increased mortality risk in the patient population. Aim: The aim of this study was to analyze the importance of the peritoneal membrane transport status in patients treated with continuous ambulatory peritoneal dialysis (CAPD). Methods: The study included 60 adult continuous ambulatory peritoneal dialysis (CAPD) patients, 29 male and 31 female, mean age 56.63±15.06 years. All patients treated with conventional glucose- based PD fluids. For the short term (within 3 month after start of PD) and long term (more than 12 months) peritoneal dialysis analysis of peritoneal transport characteristics has been used peritoneal functional test (PFT). With the test, categorisation of patients was possible into high (H), high-average (HA), low average (LA), and low (L) transporters. Results: Dialysate–to plasma ratio (D/P) of creatinine showed significantly increased over time (0.654±0.141 vs... 0.705±0.13, p<0.001). In multivariate analysis age, gender, time on dialysis, comorbid diseases, diabetes mellitus (DM), serum albumin, were considered as independent factors influencing the PFT. The high transporter group had higher D/Pcreat (H 0.84±0.03 vs... LA 0.57±0.05, p<0.001), higher proportion of man (H 100% vs... LA 39.5%, p<0.05), higher proportion of patients with comorbid diseases (H 60% vs... LA 20.9%, p<0.05), lower serum albumin concentration (H 29±6.0 vs... LA 37±5.2, p<0.001), lower D4/D0 glucose ( H 0.23±0.07 vs... LA 0.42±0.14, p<0.001), and lower drained volume (H 600±173 vs... LA 1016±355, p<0.001). Conclusion: The PFT was en easy, inexpensive, reliable test to assess peritoneal transport type and it also provided information about peritoneal clearance of solutes and ultrafiltration. Peritoneal transport type classification was recognized not only as aid for prescription, but also as a prognostic index.

Introduction: Idiopathic Idiopathic membranous nephropathy (iMN) is an immune-complex mediated renal disease which is usually associated with the nephrotic syndrome (NS). The course of the disease is variable. Some patients maintain normal kidney function with or without a spontaneous remission of proteinuria, while others progress to end-stage renal failure or die from complications related to the nephrotic syndrome. Whether or not to treat a patient with idiopathic membranous nephropathy is still controversial. The controversy is mainly related to the toxicity of the therapy and the variable natural course of the disease-spontaneous remission occurs in 40–50% of patients. Aim: The aim of this study was to describe our experience of treatment of an idiopathic membranous nephropathy (iMN), efficacy and complications rate. Case report: Our patient was older, mail gender, in high-risk group with persistent proteinuria 10,68 g/day and stable renal function. We have taken these factors into consideration, along with age and other comorbidities, that may significantly elevate the risk of treatment. We chose to start with early treatment, following the Ponticelli’s group protocol based on high dose corticosteroids (odd months) alternating with clorambucil (even months) for six months. This treatment was accompanied by the steroid side effects, including hyperglycaemia dependance on insulin therapy and pulmonary thromboembolism despite administered prophylactically low molecular weight heparin. The six-month treatment was successfully completed with the reduction of proteinuria to nephritic values 2,86 g/day, despite many complications. Complete remission of the disease with non-significant proteinuria and with stable renal function was achieved in 14 months which has been maintained for 2 years. Conclusion: We suggest that decisions on the timing of start of therapy, whom to treat, best sequence of the use of the various immunosuppressive drugs must be based on an individualized assessment of risks and benefits.