Background: Conflicting data exist on traditional lipid profiles in patients with Alzheimer’s disease (AD) and vascular dementia (VD), whereas scarce number of studies evaluated non-traditional lipid profiles in patients with AD and VD. Studies have shown that ethnic background may affect lipid profile. Objective: The aim of the present study was to conduct comparative assessment of traditional and non-traditional lipid profiles in Bosnian patients with AD and VD. Methods: A controlled, cross-sectional study was performed with 66 patients with AD, 50 patients with VD, and 60 control subjects. The Montreal Cognitive Assessment (MoCA) test was used for an evaluation of the global cognitive function. The Hachinski ischemic score was used to distinguish patients with VD from those with AD. Plasma total cholesterol (TC), high-density lipoprotein -cholesterol (HDL-C), and triglycerides (TG) levels were determined using standard enzymatic colorimetric techniques, whereas the Friedewald formula was used to calculate low-density lipoprotein-cholesterol (LDL-C) levels. The non-traditional lipid indices such as TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C ratio were separately calculated. The differences between the groups were analyzed with ANOVA followed by the Tuckey posthoc test or with the Kruskal Wallis test followed by the Mann-Whitney test. Results: Results of the present study have shown that patients in AD group had significantly lower level of TC, TG, LDL-C, VLDL-C, Non-HDL-C and significantly lower atherogenic index compared to the control group (CG) and compared to the VD patients. Significant difference in values of TG and VLDL-C was observed between VD and the CG, whereas no significant difference in values of TC, LDL-C, atherogenic index and Non-HDL-C was observed between these two groups. Our results have also shown that TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C ratios were significantly lower in AD patients compared to the VD and CG. Moreover, TG/HDL-C ratio was significantly lower in VD compared to the CG. However, a significant difference in TC/HDL-C and LDL-C/HDL-C was not observed between VD and the CG. Conclusion: Based on the results of the present study it can be deduced that there is a difference in traditional and non-traditional lipid profiles between AD and VD patients of Bosnian descent. Obtained results suggest that lipids are decreased in AD and in VD to a certain extent. However, since there is an inconsistence in literature whether there is an association between cholesterol and cognition, large prospective studies are required to elucidate this controversy.

Background: Lipids and lipoproteins are significantly involved in maintaining structural and functional components of the human brain and neurons, but their role in the development of Alzheimer’s disease (AD) and vascular dementia (VD) remains unclear. Objective: The aim of the present study was to explore the differences in the standard and novel lipid profile parameters in patients with AD and VD, stratified by the degree of cognitive impairment (CI). Methods: Present study included 66 patients with AD, 50 patients with VD, and 60 control subjects. For an evaluation of the global cognitive function the Montreal Cognitive Assessment (MoCA) test was used. In order to distinguish patients with VD from those with AD the Hachinski ischemic score was used. Plasma total cholesterol (TC), high-density lipoprotein -cholesterol (HDL-C), and triglycerides (TG) levels were determined using standard enzymatic colorimetric techniques, whereas the Friedewald formula was used to calculate low-density lipoprotein-cholesterol (LDL-C) levels. The non-traditional lipid indices such as TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C ratio were separately calculated. The differences between the groups were analyzed with the Kruskal Wallis test followed by the Mann-Whitney test or with ANOVA followed by the Tuckey posthoc test. Results: Results of the conducted study have found that the patients in AD group with moderate CI and patients in AD group with severe CI exhibited significantly lower levels of serum TC, TG, LDL-C, VLDL-C, Non- HDL-C, atherogenic index, TG/HDL-C, TC/HDL-C and LDL-C/HDL-C compared to cognitively normal control subjects. Moreover, patients in VD group with severe and moderate CI had significantly lower level of TG compared to control group of subjects. Our results have also shown that patients in AD group with moderate CI had significantly lower level of TC, TG, LDL-C, Non-HDL-C, atherogenic index, TG/HDL-C, TC/HDL-C compared to VD patients with moderate CI. In addition, patients in AD group with severe CI had significantly lower level of TC, LDL-C, Non-HDL-C and TC/HDL-C compared to VD patients with severe CI. Conclusion: The results of this study have shown dysregulation of lipid metabolism in AD and VD patients with different degree of CI. In both moderate and in severe CI, patients with AD had lower levels of majority of standard and novel lipid parameters compared to patients with VD. Further larger prospective studies are required to elucidate the accuracy of standard and novel lipid parameters in the assessment of different degree of CI in AD and VD.

Introduction: Diabetes mellitus type 2 has become a global health-care problem of modern society due to a pronounced increase of prevalence to pandemic proportions and vascular complications. At present, glycated hemoglobin (HbA1c) is widely accepted as a measure of glycemic control in established diabetes. The aim of this study was to analyze the lipid profile in serum of patients with diabetes mellitus type 2, and its relationship with HbA1c levels. Methods: The observational cross-sectional study included 60 diabetic patients, 30 men, and 30 women, age 32–94 years. Patients were assigned into two groups based on HbA1c values; Group 1: HbA1c ≤ 7% (good glycemic control) and Group 2: HbA1c > 7% (poor glycemic control). We analyzed the concentration of glucose, HbA1c, and lipid profile including total cholesterol levels, triglycerides (TAG), low-density lipoproteins (LDL), and high-density lipoproteins (HDL). Results: Significantly lower values of glucose concentration, TAG and the ratio TAG/HDLc were obtained in the group of patients with good glycemic control. (p < 0.0005) Patients with good glycemic control had lower values of Castelli 1 and Castelli 2 index, and atherogenic index of plasma, compared to patients with poor glycemic control, but this difference was not significant. (p > 0.005) Our study revealed a significant positive correlation between HbA1c and triglyceride level (r = 0.375; p = 0.003) and HbA1c and ratio triglyceride/HDLc (r = 0.335; p = 0.009). Conclusion: HbA1c can also be used as a predictor of dyslipidemia in type 2 diabetics in addition to as a glycemic control parameter.

Introduction: Inflammation plays an important role in atherosclerosis which is the primary cause of acute coronary syndrome (ACS) that encompasses acute myocardial infarction (AMI) and unstable angina (UA). Objective: To investigate and characterize white blood cells (WBC) count, differential blood count in peripheral blood and neutrophil to lymphocyte ratio (NLR) in patients by the type of ACS. Patients and methods: The cross-sectional study included 100 patients with ACS (50 males, 50 females), aged 41 to 91 years, classified into two groups: AMI group (n=50) and UA group (n=50). Patients were hospitalized at the Clinic for Heart Diseases, University Clinical Center of Sarajevo. From patients’ medical histories the following data were obtained: WBC, neutrophil, eosinophil and basophil granulocytes count, monocyte and lymphocyte count, levels of high sensitive troponin I (hsTnI), creatine kinase MB (CK-MB) and C-reactive protein (CRP). The results were analyzed using software package SPSS, version 19.0. Results: Average WBC count, neutrophil granulocytes, and monocytes were significantly higher in AMI group than in UA group (p = 0.001, p < 0.0005, p = 0.03, respectively). Eosinophil count was significantly lower in patients with AMI (p = 0.022). NLR was significantly higher in AMI group in relation to patients with UA (p = 0.001). Significantly higher values of hsTnI and CK-MB were established in patients with AMI. NLR correlated significantly positive with the values of hsTnI, CK-MB, CRP, WBC and neutrophil count, and significantly negative with lymphocyte count. Conclusion: Average values of NLR were significantly higher in patients with AMI in relation to patients with UA, indicating the importance of this inflammatory marker in discrimination of clinical forms of ACS. A positive correlation was established between NLR and markers of myocardial necrosis, and between NLR and CRP, indicating the importance of NLR in the assessment of the extent of the myocardial lesion and in inflammation intensity assessment in ACS.

Objectives: We hypothesized that cardiac biomarker levels could be elevated in patients with dementia due to high frequency of cardiovascular risk factors in older patients with vascular and neurodegenerative type of this disease. The aim was to determine possible association between cardiac Troponin I (cTnI) blood levels and dementia. Methods: The cross-sectional study included 88 patients, female gender, and mean age 81 years, who were recruited from specialized unit of the Health Care Hospice for persons with disabilities in Sarajevo, Bosnia and Herzegovina. According to the Hachinski ischemic score, 59 patients with dementia were classified in two groups- vascular (VD) and neurodegenerative dementia (ND), while 29, age-matched asymptomatic persons, were used as a control group(CG). The cTnI was measured using ELISA kit Humani Tn-I/TNNI3 (Elabscience Biotechnology Co., Ltd), using immunoanalayzer STAT FAX 2100, USA. Results: The Mini-Mental State Examination (MMSE)score was significantly lower in dementia patients than in control group (p<0.01). No significant difference in cardiac TnI levels was found in Alzheimer’s (AD), vascular dementia (VD)  and control group (AD: Me = 3.41, VD: Me = 3.49, control group: Me=3.57; (p=0.737). Conclusion: The participants’age and comorbidities are probable factors causing no association between dementia and cTnI. It is known that troponins are associated with risk of dementia but cTnI levels are as well under influences of a possible epigenetic modification of cTnI that should be the objects of the future investigation.

Introduction: Serum uric acid (SUA) is the final product of purine metabolism in humans. Aim: The present study aimed to identify a potential association between serum UA and cardiac troponin I (cTnI) levels and to find out whether uric acid could differentiate patients presenting with the acute myocardial infarction (AMI) and unstable angina pectoris (UAP) in hyperuricemic and normouricemic acute coronary syndrome (ACS) patients. Methods: Eighty ACS patients, aged 50-83 years, were enrolled in the study, 40 of them presenting with AMI and 40 with UAP. Frequency of patients with serum uric level over threshold for hyperuricemia was investigated and two groups of patients were formed such as hyperuricemic and normouricemic groups (A and B groups, respectively) independently of type of ACS. Those groups of patients were also subjected to cTnI measurement. Results: Levels of SUA are associated with the type of ACS in the hyperuricemic ACS patients (AMI versus UAP, 499(458-590), 425(400-447) mmol/L, p=0.007, respectively). Uric acid correlated significantly with cTnI, moderate positively in the group A (rho=0.358, p=0.038) and moderate negatively in the group B (r=-0.309, p=0.037) of ACS patients. Multiple logistic regression analysis revealed that cTnI and age were independently associated with the SUA levels in the group A of ACS patients. Conclusions: Serum uric acid differentiates AIM and UAP patients in hyperuricemic group of acute coronary syndrome. Therefore it can be used as nonspecific parameter for evaluation of the myocardial lesion extent only in hyperuricemic ACS patients. This is supported by finding that cTnI along with age predicts SUA level in hyperuricemic ACS patients.

Objectives: We hypothesized that serum heart fatty acid binding protein (HFABP) levels could be affected by hypertension in addition to renal impairment in patients on hemodialysis. The aim was to find out possible association between serum HFABP and hypertension in patients treated by hemodialysis. Methods: The cross-sectional study included 72 patients, both gender, age 18-78 years who were recruited from Clinic for Hemodialysis, University Clinical Center Sarajevo. According to Kidney Disease Outcomes Quality Initiative criteria for hypertension, patients were distributed into 2 groups: normotensive (HD-N) and hypertensive (HD-H) group. The cardiac biomarker HFABP was measured using ELISA kit Human FABP3 (Elabscience Biotechnology Co.,Ltd), on immunoanalyzer STAT FAX 2100, USA. The kidney functional biomarkers were measured spectrophotometrically using automated analyzer. Results: Serum HFABP level was lower in HD-H group (3.02(1.96-4.13) ng/mL) compared to serum HFABP in HD-N group (3.38(1.98-5.37) ng/mL)(p=0.359). Patients in HD-N group were older and treated by hemodialysis for a longer time than those in HD-H group (p<0.001 and p=0.029, respectively). Conclusion: Serum HFABP level in normotensive patients on hemodialysis is not significantly different compared to hypertensive patients suggesting that heart type fatty acid binding protein might not be significantly affected by hypertension in hemodialysis patients. Keywords: HFABP, hemodialysis, blood pressure, cardiovascular risk

Background: Advanced paternal and/or maternal age is a classic risk factor for Down syndrome. The aim of the study was to investigate the frequency of Down syndrome types in children and its association with maternal and paternal age in Bosnia and Herzegovina. Subjects and Methods: The cross sectional, observational study included 127 children, 49 girls and 78 boys, aged 1-180 months suspected to have Down syndrome, admitted to the Centre for Genetics, Faculty of Medicine University of Sarajevo, for cytogenetic analysis and differential diagnosis of Down syndrome during the period from January 2010 to May 2015. Standard method of 72 hours cultivation of peripheral blood lymphocytes has been applied. The accepted level of statistical significance was p<0.05. Study Results: The most common type of Down syndrome was standard trisomy (86.6%), comparing to translocation and mosaicism (7.1%; 6.3%, respectively). The highest frequency of Down syndrome cases was in mother and father’s group from 30-39 years old (57; 57 children, respectively) compared to mother and father’s groups with younger than 30 (44; 29, respectively) and 40 and older (26; 41, respectively). The significant difference was found in maternal age between translocation and mosaicism groups (p=0.036). Difference between parental years and type of Down syndrome was significant when Standard trisomy 21 and translocation (p=0.045), as well as mosaicism and translocation (p=0.036), were compared. Conclusion: The most common type of Down syndrome was standard trisomy 21, with highest occurrence in parents from 30 to 39 years old. Parents were the youngest in translocation group. Obtained results suggest that multidisciplinary approach to identifying the trigger for trisomy appearance and the influence of maternal age is required.

Objective: Renalase is an enzyme that circulates in the blood and modulates the cardiac function, sympathetic tone and systemic blood pressure. It can be synthesized in the kidneys, liver and cardiomyocytes. The active enzyme degrades circulating catecholamines, causing a significant fall in blood pressure. Changes in renalase concentration in hemodialysis patients may explain the frequent occurrence of hypertension among patients with end-stage kidney disease. The aim of this study was to asses’ serum renalase levels in hemodyalisis patients and apparently healthy subjects, and association of renalase and blood pressure in patients group. Design and method: 160 subjects were recruited in the study: 120 with end-stage renal disease, divided into two groups, according to their blood pressures (normotensive and hypertensive), and 40 apparently healthy individuals matched in age and sex. Blood pressure was measured before and after a hemodialysis session. The target values, according to ESH/ESC guidelines, were lower than 140/90 mmHg before, and 130/90 mmHg after hemodialysis. The blood for the estimating serum renalase concentration was taken before dialysis. Enzyme-linked immunosorbent assay (ELISA) kit with monoclonal antibody specific to renalase, was used. Results: Mean serum renalase levels in normotensive as well as hypertensive hemodialysis patients were significantly higher compared to control group {89.32 (45.77–170.22) and 42.7 (32.79–63.35) &mgr;g/ml, respectively; p < 0.0005}. No significant difference of renalase levels among normotensive and hypertensive patients was noted {64.04 (40.76–173.84) and 91.86 (56.77–149.75.35)&mgr;g/ml; (p > 0.05)}. There was a highly significant difference between systolic and diastolic pressure measured before and after the dialysis in normotensive and hypertensive groups of patients (p < 0.0005). It was noted that there is a significant, negatively directed association between patients’ age at the beginning of dialysis and the duration of hemodialysis. Also, the correlation between blood pressure and renalase activity among normotensive and hypertensive hemodialysis patients was not shown (p > 0.05). Conclusions: Further studies are needed to define the role of renalase and its complex pathophysiological link with blood pressure regulation, kidney function and sympathetic tone. Renalase may become a new therapeutic target that leads to a better prognosis for patients with end-stage kidney disease.

ABSTRACT The study aim was to explore the pattern of the changes in haematological and iron status parameters of acute coronary syndrome patients through period 1-7 day of hospital admission in order to define the type of anaemia. Forty-one patients (15 female and 26 male patients, aged 36-81years) of the Clinic for Heart Disease and Rheumatism, University Clinical Center Sarajevo have been included in the cross-sectional study. Haematological and serum iron status parameters have measured on days 1 and 7 of hospital admission. A decrease in haemoglobin levels to <13g/dl in men and <12g/dl in women was notified as anaemia. A significant reduction in red blood cells count, haemoglobin, haematocrit (p<0.01), iron, total iron binding capacity (p<0.05) and significant ferritin elevation (p<0.05) within period the 1-7 day were noted. Percent of anemic patients on day 1 was 17.07 % with increase of number on day 7 (36.36%). Serum ferritin has been elevated with reduction of red blood cells count, mean cell volume, mean corpuscular haemoglobin (p<0.05); haemoglobin, haematocrit (p<0.01) at first 24 hours of admission in anemic versus non-anemic patients. Anemic patients had significantly lower values of percent transferrin saturation (p<0.05), red blood cells count, haemoglobin, haematocrit (p<0.01) compared to non anemic on day 7. A statistically significant negative correlations were obtained between serum iron and C-reactive protein; cardiac troponin I and total iron binding capacity (rho=-0.389, p<0.05; rho=-0.331; p<0.05, respectively). Observed changes in laboratory parameters through period 1-7 day indicate inflammatory type of anaemia in acute coronary syndrome. Key words: anaemia, acute coronary syndrome, haematological, iron status, parameters

The aim of the study was to detect prevalence of MBL2 exon 1 (codons 52, 54 and 57) genetic polymorphism in postmenopausal women in Bosnia and Herzegovina and its possible role as genetic risk factor for susceptibility to occurrence of osteoporosis in this study group. Also, we investigated association between MBL serum concentrations and osteoporosis in postmenopausal women. Genetic codons' variations were determined by PCR-RFLP and MBL in serum was measured by ELISA method in 75 postmenopausal women (37 with osteoporosis and 38 apparently healthy, non-osteoporotic women serving as a control). Serum MBL levels were not significantly different between osteoporosis and control group (492 (37-565.1) and 522.6 (477-559.4) ng/mL respectively, p=0.206). Genotype frequencies were not significantly different (p=0.997) between the studied groups of postmenopausal women. Genotype frequencies A/A, A/0 and 0/0 in osteoporosis group were 0.576; 0.405; 0.018 and in control group 0.562; 0.412; 0.026, respectively. Frequencies of A and 0 allele were 0.78 and 0.22 in osteoporosis and 0.77 and 0.23 in control group. The results do not suggest association of functional polymorphism of MBL2 gene and MBL serum concentration with osteoporosis in postmenopausal females.

Studies that investigated an association between asymmetric dimethylarginine (ADMA) and glycated haemoglobin (HbA1c) in type 2 diabetes mellitus (T2DM) have given discordant results. The aim of this study was to determine and compare serum ADMA concentration in patients with T2DM and healthy controls, and to assess correlation between ADMA and HbA1c in patients with T2DM. Serum ADMA concentration was determined by ELISA method with the use of ADMA ® - ELISA kit (DLD Diagnostics, Hamburg, Germany) and HbA1c levels were determined by an immunoturbidimetric method in 60 patients with T2DM and 60 healthy individuals matched for age and sex. Results have shown that mean serum ADMA concentration was significantly higher in T2DM patients (1.54±0.06 μmol/L) compared to mean serum ADMA concentration (0.62±0.02 μmol/L; p<0.0001) in healthy subjects. A significant, positive, correlation between serum ADMA concentration and HbA1c levels was observed (r=0.494; p<0.01) in T2DM patients. Our results suggest that there is an association between endothelial dysfunction and glycaemic control in type 2 diabetes mellitus. Possible explanation for obtained results may be oxidative stress that is increased in conditions of hyperglycaemia and it also promotes endothelial dysfunction. Larger, longitudinal studies are required that will evaluate relation between metabolic abnormalities and increased ADMA levels in patients with type 2 diabetes mellitus.