Summary Background: There is still no reliable, specific biomarker for precision diagnosis and clinical monitoring of systemic lupus erythematosus. The aim of this study was to investigate the importance of the determination of immunofenotypic profiles (T, B lymphocytes and NK cells) and serum cytokine concentrations (IL-17 and IFN-alpha) as potential biomarkers for this disease. Methods: The study included 55 patients with SLE and 25 healthy controls. The proportion of T, B, NK cells were assessed in peripheral blood using flow cytometric assays while the serum cytokine concentration (IL-17 and IFNalpha) was determined by ELISA test. Results: ROC curve analysis showed good accuracy to distinguish between patients and healthy individuals for activated T cells (AUC=0.798; p<0.001), Treg (AUC= 0.651; p=0.036), and memory B cells (AUC=0.285; p=0.002). We found statistically significant difference (p=0.036) in the levels of serum IL-17 between patients with SLE (IL-17=49.27 pg/mL) and controls (IL-17= 28.64 pg/mL). Conclusions: Significant increase in the relative number of Treg lymphocytes, and decrease in memory B cells, as well as decrease level of IL-17, in SLE patients may be implicated in the pathogenesis of the disease. These parameters, as biomarkers, could distinguish SLE patients and no-SLE patients. Monitoring subpopulations of immune cells in peripheral blood using flow cytometry provides insight into abnormal T and B cell function in SLE. Progress in understanding the immunity at SLE, results in concrete benefits for the SLE patients, which include new clinical management and therapeutic strategies.

Objective: Association between neck circumference (NC) and components of metabolic syndrome in different countries and ethnic groups is still insufficiently investigated. The aim of the present study was to assess an impact of gender on NC values and to determine whether NC correlates with standard anthropometric measures and blood pressure values in Bosnian young adults. Material and Methods: Study participants were recruited by the snowball method. NC, Body Mass Index (BMI), Waist circumference (WC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured by trained personnel. Differences between the means were assessed by a Student t-test. Coefficients of correlation were determined by Pearson’s test. This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as: Zaciragic A, Elezovic M, Avdagic N, et al. Relationship between neck circumference, standard anthropometric measures and blood pressure values in Bosnian young adults. Eurasian J Med 2018; DOI: 10.5152/eurasianjmed.2018.18197. ©Copyright 2018 by Atatürk University School of Medicine Available online at www.eajm.org Results: In young men (n =49) value of NC was 37.71±1.79 cm, while in young women (n=62) value of NC was 32.23±1.83 cm (P<0.001). Significant positive correlation in both gender between NC and BMI (r= 0.70; P<0.001 in men and r= 0.53; P<0.001 in women), and between NC and WC (r= 0.48; P<0.001 in men and r= 0.38; P=0.01 in women) was found. Significant correlation of NC with SBP (r=0.08; P=0.57), and with DBP (r=0.20; P=0.17) in young men was not determined. Likewise, in young women significant correlation of NC with SBP (r=0.08; P=0.54), and with DBP (r=0.09; P=0.49) was not observed. Conclusions: Results of the present study suggest possible use of NC measurement as a valid method of obesity assessment in young adults. Lack of an association between NC and blood pressure values requires additional investigation.

BACKGROUND The aim of the present study was to evaluate serum nitric oxide (NO) and C reactive protein (CRP) concentration in veterans with and without PTSD. Furthermore, we aimed to assess whether there is a correlation between serum NO and CRP concentrations in tested groups. SUBJECTS AND METHODS Cross-sectional study included 90 male individuals, with and without experience of direct war combat, divided into three equal groups (n=30): group 1- included war veterans with PTSD, group 2 - included war veterans without PTSD, and control group - 30 apparently healthy volunteers, without experience of direct war combat. The diagnosis of PTSD was assessed according to the guidelines in the 10th revision of the International Classification of Diseases (ICD-10). High-sensitivity CRP was determined by immunonephelometry. The serum NO level was determined by classic colorimetrical Griess reaction. RESULTS Serum CRP concentration in veterans with (3.54±1.19 mg/L) and without PTSD (3.24±2.04 mg/L), was significantly higher (p<0.05) compared to control group (1.26±1.06 mg/L). Serum NO concentration in veterans with (7.64±4.43 μmol/L) and without PTSD (7.12±2.60 μmol/L) was significantly lower (p<0.05) compared to control group (11.26±7.01 μmol/L). Statistically significant correlation between serum NO and CRP concentration was determined in veterans without PTSD (r=-0.473; p<0.01). No correlation was observed between serum NO and CRP concentration in veterans with PTSD (r=0.118; p=0.534) and in control group (r=-0.067; p=0.727). CONCLUSION The present study has showed significant increase of serum CRP and significant decrease of serum NO concentrations in veterans with and without PTSD. Furthermore, statistically significant negative correlation between serum NO and CRP concentration was determined only in veterans without PTSD. Obtained results indicate that the complex mechanism of the pathogenesis of PTSD requires further research.

Aim To investigate total homocysteine (tHcy) serum concentration in patients with probable vascular dementia (VD) and in agematched controls, as well as to determine an association between tHcy serum concentration and cognitive impairment in patients with probable VD. Methods Serum concentration of tHcy was determined by the Fluorescence Polarization Immunoassay on the AxSYM System. Cognitive impairment was tested by the Mini Mental Status Examination (MMSE) score. Body mass index (BMI) was calculated for each subject included in the study. Results Age, systolic, diastolic blood pressure and BMI did not differ significantly between the two groups. Mean serum tHcy concentration in the control group of subjects was 13.35 µmol/L, while in patients with probable VD it was significantly higher, 19.45 µmol/L (p=0.002). A negative but insignificant association between serum tHcy concentration and cognitive impairment in patients with probable VD was found. Conclusion Increased tHcy concentration in patients with probable VD suggests the possible independent role of Hcy in the pathogenesis of VD.

Introduction Leptin is a cytokine-like hormone which has a complex role in inflammation. However, the importance of leptin in the pathogenesis of rheumatoid arthritis (RA) is far from being fully elucidated. The aim of the study was to determine serum leptin levels in RA patients and to evaluate whether there is an association between disease activity, anthropometric indices and leptin levels. Material and methods This hypothesis-generating study included 55 RA patients and 25 matched healthy subjects. The serum leptin concentration was determined by enzyme-linked immunosorbent assay (ELISA). Results Median serum leptin level in RA patients of 27.4 ng/ml (14.5–54.9 ng/ml) was statistically significantly higher (p = 0.03) compared with the median leptin value of 16.3 ng/ml (9.6–38.8 ng/ml) determined in healthy controls. The serum leptin level in the high disease activity group was significantly higher (p < 0.0005) than that in the low disease activity group and in healthy controls. A significant difference (p = 0.001) in serum leptin level was also found when the high disease activity group was compared with the moderate disease activity group. In the RA group a statistically significant positive correlation (rho = 0.390; p = 0.003) was observed between serum leptin level and disease activity score (DAS28). Conclusions The present results show that serum leptin levels are increased and significantly associated with disease activity in patients with RA and may have a valuable role in the inflammatory reactions and pathogenesis of RA.

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

Objectives: The aim was to examine whether plasma coagulation factors activities are increased in patients with diabetes mellitus type 2 (DM2). Also, we aimed to assess whether any association exists between plasma coagulation factors and cardiometabolic risk factors in these patients. Methods: This cross-sectional study included 30 DM2 patients and 30 healthy subjects as control group. Plasma fibrinogen concentration and activities of coagulation factors II, V, VII, IX, X, XI and XII were measured. Results: The activities of coagulation factors IX (145.51±5.27 % of norm; p <0.0005) and XI (136.38±5.08 % of norm; p=0.001) and fibrinogen concentration [10.5 (9.3-13.25) mmol/L; p=0.001] were significantly higher in DM2 patients compared to control (IX - 116.44±3.86 % of norm; XI - 109,27±5,95 % of norm; fibrinogen – 8.8  (7.9-10.2) mmol/L). Plasma activities of factors II, V, VII and X were higher, whereas factor XII activity was lower in diabetic patients than in control subjects, but not statistically significant. A significant positive correlation between fasting blood glucose and factors IX, X and XI, was observed in DM2 patients. In the same group significant positive correlation was determined between factors II, VII, IX, X and triglycerides and between factor II and total cholesterol. Conclusion: Procoagulant state in DM2 as evidenced by enhanced activation of coagulation factors IX and XI and elevated fibrinogen concentration, may contribute to the increased risk of thrombosis and vascular complications in DM2 patients. Furthermore, in the prevention of thrombotic complications in patients with diabetes mellitus it is necessery to keep blood glucose and lipids under control. Key words: coagulation factors, patients with DM2, thrombosis, lipids

Objectives : The objective of the study was to examine influence of various stimuli on the salivary flow rate in students. Methods : This cross sectional study was conducted at the Faculty of Medicine, University of Sarajevo, in 108 randomly included students. Students were divided into four groups: group 1-stimulated with physical activity (n=28), group 2-stimulated with chewing gum mint (n=28), group 3-stimulated with chewing gum strawberry (n=25) and group 4-stimulated with lemon flavored candy (n=27). Unstimulated and stimulated salivary flow rate was determined. Results : Out of 108 students included in the study, 46 were men. Age range was 19-26 years. The flow rate of stimulated salivary flow rate in the study group 1 was lower (0.21 ± 0.04 mL/min) compared to unstimulated one (0.34 ± 0.03 mL/min, (p=0.001). Stimulated salivary flow rates in groups 2, 3 and 4 were higher compared to unstimulated salivary flow rates (p<0.001). Unstimulated salivary flow rate was not associated with gender, daily consumption of cigarettes and chewing gums. There was positive association between unstimulated and stimulated salivary flow rate and negative association between BMI and stimulated salivary flow rate. Conclusion : Various stimuli had different influence on stimulated salivary flow rate, showing decrease by physical activity and increase by chewing gum and candy. The clinical use of candies and sugar free chewing gums can provide relief to patients with xerostomia. In order to clarify negative association between BMI and stimulated salivary flow rate, larger prospective studies with different age groups are needed. Keywords : saliva, stimuli, unstimulated salivary flow rate, stimulated salivary flow rate

Objective: Despite advances in the technology of dialysis, cardiovascular morbidity and mortality in patients with end-stage renal disease (ESRD) who are on hemodialysis therapy are still very high. Recent clinical studies have demonstrated a significant correlation between leptin levels and hypertension, hyperlipidemia, perturbed fibrinolysis and chronic inflammation. The aim of this study was to investigate the significance of changes in serum leptin concentrations and relationship of leptin and traditional cardiovascular risk factors in patients with varying duration of hemodialysis therapy. Design and method: The cross sectional study included 60 patients with end stage renal disease, of both sexes, divided into two equal groups (n = 30) based on the duration of hemodialysis treatment: A group of subjects who are on hemodialysis therapy between three months and five years, and group of subjects who are on hemodialysis therapy five and more than five years. The control group (n = 30) consisted of apparently healthy subjects, with no subjective and objective indicators of chronic renal disease. The serum leptin concentration was determined by enzyme-linked immunosorbent assay (ELISA). Results: Serum leptin levels in patients in Group under 5 years was significantly higher from leptin concentrations in serum of patients in Group eqally and more then 5 years and of serum leptin concentrations in the control group. Statistically significant positive correlation was found between serum leptin levels and body mass index (BMI) in subjects of Group eqally and more then 5 years and in the control group. There was no significant correlation between serum leptin levels and C – reactive protein (CRP) in any of the groups of patients. Results showed that the serum leptin value had a poor diagnostic accuracy in distinguish hemodialysis patients from healthy control, as well as, hemodialysis patients at different length of dialysis therapy. Conclusions: In this population of stable HD patients, obtained results do not support the hypothesis that serum leptin and relationship between leptin and traditional cardiovascular risk factors can be used as an independent marker to distinguish between hemodialysis patients than healthy subjects, nor in differentiating hemodialysis patients at different length of dialysis therapy.

Objectives: Aim of the present study was to investigate serum concentration of leptin and its association with values of body mass index (BMI), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) in hemodialysis (HD) patients. Methods: This cross-sectional study included 60 HD patients (34 male, 26 female) and 30 age- and sex-matched (4 males, 26 females) apparently healthy subjects. Serum leptin concentration was determined by an enzyme-linked immunosorbent assay (ELISA). Serum CRP concentration was measured by means of particle-enhanced immunonephelometry. ESR value was determined by Western Green method. BMI was calculated as weight (kg) divided by height squared (m2). Results: Results have shown that median serum leptin concentration (30.65 ng/mL; 12.48-86.40 ng/mL) was statistically significantly higher in HD patients compared to median serum leptin concentration (15.75 ng/mL; 9.15-30.65 ng/mL) in the control group of healthy subjects (p<0.05). Likewise, median serum CRP concentration (5.5 mg/L; 1.93-8.9 mg/L) and median ESR value (57.5 mm/h; 40.5-77.0 mm/h) were significantly higher in HD patients compared to median serum CRP concentration (0.8 mg/L; 0.38-1.43 mg/L) (p<0.001) and median ESR value (10.0 mm/h; 6.5-14.0 mm/h) (p<0.001) determined in the control group. Statistically significant positive correlation was found between BMI values and serum leptin concentration in HD patients (rho=0.434; p<0.001). Positive, although not significant, correlation was observed between serum CRP and leptin levels in HD patients (rho=0.171; p>0.05). Negative correlation between ESR values and serum leptin concentrations in HD patients was determined but it was not statistically significant (rho= -0.029; p>0.05). Conclusions: Increased serum concentration of leptin as pro-inflammatory cytokine as well as elevated serum values of CRP and ESR indicate presence of systemic micro inflammation in HD patients. Results of the present study point to possible use of serum leptin concentration as an indicator of nutritional status in HD patients based on observed significant positive correlation between serum leptin concentrations and BMI values. However, absence of significant association between serum leptin and CRP levels as well as between serum leptin concentrations and ESR values in HD patients requires further investigation and clarification.

Objectives : Alternations in adipokines secretion associated with obesity could play an important role in diet-induced diabetes. The aim of our study was to estimate the impact of high-fat diet on serum adiponectin and leptin levels in streptozotocin (STZ) induced type 2 diabetes mellitus (T2DM). Methods : The study included 40 adult male Wistar rats were divided into four groups: Standard food control group (C-Non-HF)(n=10), standard food STZ group (STZ-NonHF)(n=10), high-fat diet control group (C-HF)(n =10) and high-fat diet STZ group (STZ-HF)(n =10). C-NonHF and STZ-NonHF group was fed with regular chow, and other two groups were given high-fat diet for 5 weeks. Type 2 DM was induced by single intra-peritoneal STZ injection (60 mg/kg). All the rats were fasted for 12 hours; when blood samples were taken for the measurement of serum leptin and adiponectin level by ELISA. Results : Mean serum adiponectin level was significantly lower in STZ-HF (1.34±0.57 ng/mL) compared to STZ-NonHF (2.61±0.79 ng/mL), C-NonHF (3.13±0.74 ng/mL) and C-HF group (3.04±0.63 ng/mL) (p<0.01). Mean serum leptin level was significantly higher in STZ-HF (1792.0}1378.8 pg/mL) compared to STZ-NonHF (634.0}149.1 pg/mL), C-NonHF (671.5}164.0 pg/mL) and C-HF group (593.8}200.8 pg/mL) (p<0.05). In STZ-HF group, a significant positive correlation between leptin and glucose level was observed (r=0.71; p=0.048). Conclusion : Our study results show that high fat diet induces an increase in serum leptin and the decrease in adiponectin levels in STZ diabetic rats and suggests that high fat diet impairs glucose control by increasing leptin secretion. Key words: Diabetes mellitus, leptin, adiponectin, obesity

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.

Aim: To investigate the capacity of mean platelet volume (MPV) in detecting CD disease activity and in differentiating CD patients from healthy controls. Methods : MPV values were measured in 30 CD patients and 30 healthy individuals matched for age and gender. Based on the result of Crohn’s Disease Activity Index, CD patients were subdivided into two subgroups: active and inactive phase of disease. MPV was measured by standard methods for all study participants. Results: A significant decrease in MPV was noted in CD patients compared to healthy controls (p=0.002). When active CD patients were compared with inactive CD patients, a  significant decrease in MPV was also found (p=0.031). The overall accuracy of MPV in discriminating CD patients from healthy controls as well as active from inactive CD patients was 66% (cut-off level of 8.83 fL). Significant negative correlation between MPV and platelet count (PLT) (rho= -0.570; p=0.01) and significant positive correlation between MPV and platelet distribution width (PDW) (rho= 0.615; p=0.01) was observed in CD patients. Conclusion: Based on our results that have shown significant difference in MPV that was related to Crohn’s disease activity, we consider that MPV could be added to other serological markers of CD, especially in differentiating the active from the inactive phase of disease. Key words: mean platelet volume, Crohn’s disease, inflammatory bowel disease