AIM This study aimed to reveal the prevalence of the insulin resistance (IR) identified by triglyceride glucose index (TyG index) among students of University of Sarajevo. The impact of visceral fat level and waist to hip ratio measures on TyG value in students has been investigated. PATIENTS AND METHODS Study included 160 apparently healthy students, both genders, aged from 19-27 years. Two groups were formed: Group1, TyG <4,49 and Group 2, TyG³4,49. A short interview, questionnaire, anthropometric measures, visceral fat level (VFL), blood pressure and biochemical parameters were applied. The statistical level of significance was P<0,05. RESULTS Forty-five students (28, 1%) were insulin resistant. There was a significant difference in TyG value (P<0,001), [group 1- 4,19 (3,93-4,34 vs. group 2 - 4,59 (4,55-4,74)]. Fasting blood glucose (FBG) and lipid parameters-total cholesterol, triglycerides and very low-density lipoprotein cholesterol (TC, TG and VLDL-C) were significantly higher in group TyG ³4,49 compared to TyG <4,49 group, with exception of HDL-C of LDL-C (P>0.05). Stepwise linear regression analysis showed significant impact of waist to hip ratio on TyG value (P=0,001). CONCLUSION The prevalence of IR measured by TyG in university students was 28,1%. The impact of waist to hip ratio on value of TyG index points on possible application of both parameters in visceral obesity and insulin resistance assessment in apparently healthy individuals.

Background and objective Type 2 diabetes mellitus (T2DM) is a global health issue that has seen a significant increase in prevalence worldwide. Oxidative stress plays a crucial role in the pathogenesis of numerous chronic diseases. Oxidative stress induced by hyperglycemia has a central role in the development of insulin resistance, as well as micro- and macrovascular complications of diabetes mellitus. This study aimed to investigate the influence of the duration of T2DM on blood glucose levels, glycated hemoglobin (HbA1c), renal function parameters, oxidative stress, and von Willebrand factor (vWf) activity in individuals with diabetes. Methodology A total of 135 participants from both genders with T2DM were included in this study. The participants were divided into three groups based on the duration of their disease: up to five years (46 participants), from 6-10 years (49 participants), and over 10 years (40 participants). The investigated parameters were as follows: fasting glucose, two-hour postprandial glucose, HbA1c, total antioxidant capacity (TAC), glomerular filtration rate (GFR), and vWf activity. Statistical analysis was performed using SPSS Statistics (IBM Corp., Armonk, NY). The Kolmogorov-Smirnov test was applied to assess the normality of distribution. Differences between the groups were analyzed using the Kruskal-Wallis test and analysis of variance (ANOVA), with appropriate post-hoc tests. A p-value <0.05 was considered statistically significant. Results The average age of the participants was 60.86 ± 8.87 years, the average weight was 86 ± 14.6 kg, the average height was 168 ± 9.18 cm, the waist circumference was 99 ± 11.4 cm, the systolic blood pressure was 127 ± 15.6 mmHg, and the diastolic blood pressure was 77 ± 6.7 mmHg. The study revealed statistically significant differences between the groups (p<0.05) for the following parameters: two-hour postprandial glucose (p=0.001), HbA1c (p=0.048), GFR (p=0.038), and vWf activity (p=0.006). No statistical significance was found for TAC values (p>0.05). Conclusions Higher levels of vWf activity were found in people who had been treated for type 2 diabetes for more than 10 years. These findings indicate that the level of vWf activity in people with type 2 diabetes 10 years after the onset of the disease can be used as a marker of vascular pathology.

Background: Metabolic syndrome (MetS) denotes a cluster of co-occurring medical conditions associated with regulating hyperglycemia and acute cardiovascular events and complications. The escalating frequency of MetS among individuals afflicted with type 2 diabetes mellitus (T2DM) underscores its burgeoning significance as a critical public health concern and a complex clinical conundrum. Timely identification is imperative to avert the expedited progression of diabetic complications. Objective: To investigate the role of CRP/HDL-C and Monocyte/HDL ratios in predicting MetS in T2DM individuals. Methods: The study was designed as a two-year prospective study and included 80 T2DM patients divided into MetS and non-MetS groups based on MetS development over two years. The patients’ serums were analyzed for complete blood count parameters, lipid profile, and C-reactive protein (CRP). Based on the laboratory test results, Monocyte/HDL-C and CRP/HDL-C ratios were calculated and analyzed. The receiver operating characteristic (ROC) curve and their corresponding areas under the curve (AUC) were used to determine prognostic accuracy. Results: Monocyte/HDL-C ratio and CRP/HDL-C ratio were significantly higher in MetS-T2DM2 than in nonMetS-T2DM (p=0.003 and p=0.029, respectively). The results of ROC curve analysis have shown that the CRP/HDL-C ratio (AUC of 0.695) and Monocytes/HDL-C ratio (AUC of 0.645) can serve as good predictors of MetS in T2DM patients. Conclusion: This study confirms the reliability of the Monocytes/HDL-C and CRP/HDL-C ratios as novel, simple, low-cost, and valuable predictors of MetS development in T2DM.

Background: The aim of the study was to find out what happens to erythrocytes and their forms during life and after death as a result of high water temperature.Methods: Heat stress was used on a rat model.to investigate the effects of different temperature intensities (37°C and 44°C) and exposure time (20 min and until the time of death) on erythrocyte morphology. Total of 23 Wistar rats were divided into two groups: 37°C as control group and 44°C as trial groups. The trial groups were classified into antemortem the exposure time of 20 min and postmortem groups exposure time until fatal outcome. The anaesthetised rats were exposed to preheated water using the water bath. May-Grünwald-Giemsa colouring technique was applied on blood samples taken from the abdominal aorta. Results: Exposure of Wistar rats to water temperature in groups KG37 and G44 led to a significant changes in core temperature. In the control group, the thermoregulatory mechanism established normothermia, and in G44 hyperthermia was detected during 20 minutes of exposure. The frequency of heat stroke in group G44 was 43.8%. Target cells and anulocytes were predominant in antemortem group at 44°C, while anulocytes and spherocytes in postmortem groups 44°C, respectively. Dacryocytes with spherocytes were significantly higher in postmortem group 44°C than in antemortem group 44°C (p=0.002, p=0.017, respectively).Conclusions: Poikilocytosis is associated with the exposure length and temperature intensity. Following a fatal outcome dacryocytes with spherocytes at 44°C were significantly more than in corresponding antemortem groups.

Aim To explore patient's awareness and appliance of the fasting state requirements for blood sampling. Methods This observational survey was performed at the Department of Medical Biochemistry and Immunology Diagnostics, Cantonal Hospital Zenica, from June to July 2019. An anonymous questionnaire was conducted on 200 consecutive outpatients older than 18, who were admitted to the laboratory for routine blood testing. Results A total of 134 (67%) patients were informed that they needed to be at fasting to perform laboratory tests. Patients were mostly informed by a requesting physician or a nurse, 68 (50.8%), and by other patients, members of the family and friends, 58 (43.3%); only seven (5.2%) patients were informed in the laboratory. A total of 75 (37.5%) patients arrived to the laboratory properly prepared. Conclusion Most patients were not well informed about fasting state requirements for blood sampling and consequently they were not adequately prepared for laboratory tests. Laboratory should establish updated fasting recommendations available to patients and healthcare professionals, and conduct continuing education of patients and health care staff.

Aim To present haemoglobin and ferritin parameters in donors to highlight the importance of serum ferritin testing for the purpose of evaluating iron depots in order to make recommendations for preserving a population of blood donors. Method A prospective study was conducted on 80 blood donors divided in two groups: group I (regular donors, n =40) and group II (irregular donors, n=40). Haemoglobin and ferritin were measured twice every 45 days, before two consecutive blood donations. Results By measuring haemoglobin and ferritin values before donation in both groups, a decrease of initial ferritin value in Group I relative to Group II was observed (without statistical significance). A significant decrease was found between repeated measurements for both parameters in both groups, indicating equal intensity of the decline in value regardless of a donor status. Measurement of ferritin before and after donation revealed statistically significant loss of ferritin in all examinees (p=0.011). The decline in haemoglobin after donation, although significant, did not fall below the reference value for donation in either women or men. Conclusion Results indicate the need for periodic monitoring of the plasma value of ferritin in voluntary donors who donate blood more than twice a year and the possible oral supplementation with iron.

Introduction Acute appendicitis (AA) is the most common surgical condition of the abdomen in children. The aim of this study was to analyse the possible use of the neutrophil-to-lymphocyte ratio (NLR) in the diagnosis and prediction of AA complications in children. Material and methods We included 170 AA patients under 15 years of age, who were divided into the following groups: Group 1 – non-operated patients with AA, and Group 2 – patients who underwent appendectomy. Based on pathologic grades of AA, Group 2 was subdivided into: Group A – phlegmonous, Group B – gangrenous, and Group C – perforated AA. NLR was calculated as the absolute neutrophil count divided by the absolute lymphocyte count. Results In Group 2 NLR was significantly higher than in Group 1 (5.5 (1.9–9.9) vs. 2.3 (1.2–3.7); p < 0.001). A significant difference in NLR was found between Group C and Group A (p < 0.001), and as well as between Group B and Group A (p = 0.001). The determined optimal cut-off value of NLR in differentiating Group 1 vs. Group 2 was ≥ 3.48 (p < 0.001). In differentiating Group A from Group C the optimal cut-off value of NLR was ≥ 5.61 (p < 0.001). Furthermore, optimal cut-off value of NLR in differentiating Group A from Group B was ≥ 5.45 (p = 0.001). Conclusions The obtained results suggest that NLR could be used as a simple and reliable test in the diagnosis and prediction of AA complications in children. However, to draw definite conclusions on the predictive power of NLR as a marker of AA large multicentric studies are required.

Introduction: Poor glycemic control, assessed by higher glycated hemoglobin (HbA1c) levels, is associated with greater risk of diabetic complications. Aim: The aim of this study was to assess the association of triglyceride - to - HDL cholesterol (TG/HDL-C) ratio and triglyceride glucose (TyG) index with HbA1c and to evaluate their potential role as predictors of glycemic control in patients with diabetes mellitus type 2 (DM2). Patients and methods: This cross-sectional study was conducted in Health Center Banovici and included a total of 113 patients with DM2 classified according to their HbA1c values in two groups: DM2 HbA1c <7% - DM2 patients with good glycemic control (n=39) and DM2 HbA1c ≥7% - DM2 patients with poor glycemic control (n=74). Anthropometric, biochemical parameters and blood pressure values were measured, while TG/HDL-C ratio and TyG index were calculated. Results: TG/HDL-C ratio and TyG index were significantly higher in DM2 HbA1c≥7% compared to DM2 HbA1c<7% group (p=0.003 and p<0.001; respectively). Both TG/HDL-C ratio and TyG index were positively associated with HbA1c levels (Rho=0.29; p=0.002; Rho=0.37; p<0.001; respectively). In linear regression analysis TG/HDL-C ratio and BMI, and also TyG index and BMI were significantly independently associated with HbA1c even after controlling for age, gender, diabetes duration and smoking. When we stratified patients according to BMI values, independent association between TG/HDL-C ratio and HbA1c remained significant only in normal weight subjects (OR 0.21; 95%CI: 0.05-0.37; β=0.65; p=0.017), while independent association between TyG index and HbA1c remained significant only in overweight and obese subjects (OR 0.063; 95%CI: 0.01- 0.12; β=0.24; p =0.027). Conclusion: TG/HDL-C ratio might be a useful predictor of glycemic control in normal weight, and TyG index in overweight and obese patients with DM2.

Aim To identify rates of most common pre-analytical errors and to document possible (different) error rates between inpatients and outpatients. Methods This retrospective study was conducted at the Department of Medical Biochemistry and Immunology Diagnostics, Cantonal Hospital Zenica, from December 2016 until March 2017. Data on rejected blood samples in the laboratory information system were analysed. Results During the 3-month period 35,343 patient blood samples (25,545 inpatients and 9,798 outpatients) were received in the laboratory. The study identified 602 (1.70%) rejected samples because of pre-analytical errors, mostly due to haemolysis, 292 (48.50%), and clotted samples, 240 (39.87%). The remaining 70 (11.63%) samples were rejected because of inappropriate sample volume, inappropriate container and identification errors (7.81%, 2.16% and 1.66%, respectively). The proportion of inpatient rejected samples was 8.7-fold higher than in the outpatient samples. The proportion of inpatient rejected samples because of haemolysis, clotted samples, inappropriate sample volume and inappropriate containers were higher than in the outpatient samples (20.5-, 12.1-, 2.3- and 1.3-fold higher, respectively); proportion of rejected samples because of identification errors was 8.0-fold higher in the outpatient (collection sites outside the hospital) than in the inpatient samples. Conclusion Higher pre-analytical sample error rates were connected with inpatient samples, while higher identification error rates were connected with outpatient samples. Establishment of periodic stuff training and introduction of information technology could reduce pre-analytical errors.

Aim To investigate the association of parameters of lipid profile and estimated glomerular filtration rate (eGFR) p<60 ml/min/1.73m2 calculated by the Modification of Diet in Renal Disease (MDRD) in non-dialysis kidney patients. Methods The observational, case-control study enrolled patients (n=117) recruited from the Nephrological Counselling Centre of the University Clinical Centre Sarajevo and divided into two groups: group 1 eGFR (15-59 mL/min/1.73 m2 ), and group 2 (control) eGFR ≥ 60 mL/min/1.73 m2 . Concentration of lipids, lipoproteins and apolipoproteins was measured, and atherogenic index of plasma (AIP; log(TG/HDLc)) was calculated. Results High density lipoprotein cholesterol (HDLc) and apolipoprotein E (APOE) concentrations in serum were reduced [(1.02 (0.94-1.29) vs 1.15 (1.1-1.4) mmol/L; p=0.009 and 0.035 (0.026-0.04) vs 0.041 (0.034-0.05) g/L; p=0.002, respectively)], while AIP was higher in group 1 than in group 2 (0.19±0.03 vs 0.09±0.04; p=0.013). Values less than 1.09 mmol/L and 0.038 g/L for HDLc and APOE, or higher than 0.165 for AIP (p< 0.05) were associated with the eGFR below 60 ml/min/1.73 m2. The age [OR = 1.1; 95% CI (1.05-1.17)] and AIP [OR = 8.7; 95% CI (1.18- 65.0)] were independent positive predictors, while APOE was a negative predictor of eGFR reduction rate (OR=0.01; 95% CI (0.001-0.033; p<0.001). Conclusion Changes in parameters such as HDLc, APOE and AIP are associated with CKD. The study results imply the need of the AIP calculation as routine laboratory work due to its role along with the age and APOE in the prediction of renal function decline.