Introduction Although extracorporeal shock wave lithotripsy (ESWL) is minimally invasive and highly efficient for the management of kidney stones, adverse effects have been described. Available indicators of renal function exhibit insufficient sensitivity in acute renal injury (AKI). We aimed to evaluate the severity of the kidney tissue response to ESWL injury by measuring the urinary neutrophil gelatinase-associated lipocalin (uNGAL), which can indicate AKI in its early phase. Material and methods The prospective, controlled study included 62 patients with nephrolithiasis undergoing single ESWL treatment. uNGAL level was measured before the procedure, and 6 h and 12 h after. Results The median uNGAL level increased by 126.0%, 6 h after ESWL (p <0.001). The growth rate continued and 12 h after was higher by 583.7%, compared to the pre-treatment level (p <0.001). The median value of estimated glomerular filtration rate (eGFR) dropped by 15.3% 12 h after the treatment (p <0.001). It increased by 5.0% in the period 7 days to 3 months after (p <0.001) and after 3 months it was lower by 10.1% compared to pre-ESWL values (p <0.001). uNGAL level after 12 h was significantly negatively associated with eGFR, 12 h, 7 days and 3 months after the ESWL. The sensitivity of uNGAL 12 h after ESWL was 60.6%; its specificity was 75.0%, with a positive predictive value of 74.0% and negative predictive value of 61.7%. Conclusions uNGAL appears to be a useful biomarker for the assessment and prediction of AKI. It was noticed that uNGAL had the highest predictive value 12 h after the ESWL treatment.

BACKGROUND Post-traumatic stress disorder (PTSD) is a mental health condition that is triggered by a terrifying event either experiencing it or witnessing it. Although the pathogenesis is still unknown, some researches indicate inflammatory background and liver dysfunction as a part of the disease. We wanted to determine inflammatory markers' levels and investigate the correlation with liver enzymes in PTSD patients. METHODS This cross-sectional study included 60 male subjects aged between 40 - 60 years. Subjects were divided into two groups: a group of veterans with combat exposure and PTSD according to DSM-IV criteria and a control group of healthy subjects without combat exposure. WBC count, leucocytes ratios, levels of inflammatory markers (C reactive protein- CRP, fibrinogen, and erythrocyte sedimentation rateESR), and liver enzymes (aspartate aminotransferase- AST, alanine aminotransferase- ALT, creatine kinase- CK, and gamma-glutamyl transferase- GGT) were determined in all respondents. RESULTS The concentrations of CRP, fibrinogen, ESR, platelet-lymphocyte ratio and monocytelymphocyte ratio in subjects with PTSD were statistically significantly higher than those in the control group. Levels of AST and GGT in PTSD subjects were statistically significantly higher than of those in the control group subjects. Statistically significant positive correlation was found between serum AST and CRP concentration (Rho = 0.416; P = 0.022), as well as GGT and CRP concentration (Rho = 0.395; P = 0.031). CONCLUSIONS Results indicate the relationship between liver pathology and inflammation in the complex pathogenesis of PTSD. These can be used in future researches and development of a new diagnostic approach and treatment that may lead to a longer lifespan of PTSD patients. KEY WORDS PTSD, Inflammation, Liver Enzymes

Abstract Introduction. Present study was performed to verify red blood cell distribution width-to-platelet ratio (RPR) level in rheumatoid arthritis (RA) patients and to examine its correlation with clinical and biochemical indicators of disease activity status. Methods. In this cross-sectional analytical study, 67 patients with RA and 34 age- and gender-matched healthy control subjects were enrolled. Based on the disease activity score 28-ESR (DAS28-ESR), RA patients were divided into subgroups: low disease activity (n = 20), moderate disease activity (n = 22) and high disease activity (n = 25). Laboratory tests included erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) concentration, platelet count (PLT), red blood cells count (RBC), red blood cells distribution width (RDW) and fibrinogen concentration. Statistical analyses were carried out using SPSS 13 software. Statistical significance was set at a p-value less than 0.05. Results. There was statistically significant difference (p = 0.006) between RPR in RA patients with different stages of disease activity, with higher values in patients with low disease activity. The RPR showed statistically significant negative correlations with ESR (rho = –0.309; p = 0.012), CRP (rho = –0.421; p = 0.001), swollen joint count – SJC (rho = –0.368; p = 0.002) and tender joint count – TJC (rho = –0.355; p = 0.003), DAS28-ESR (rho = –0.409; p = 0.001), DAS28-CRP (rho = –0.422; p < 0.0005) and Visual analogue scale – VAS (rho = –0.260; p = 0.033) in RA patients. Conclusion. The present study provided evidence that the lower RPR values in RA patients are significantly associated with the disease activity indicators.

BACKGROUND Cerebrospinal levels of isoprostanes (IsoPs) have been established as biomarkers of oxidative stress in Alzheimer's disease (AD) and vascular dementia (VD). The value of peripheral levels in the diagnostics of these diseases is less conclusive. The aim of this study was to determine serum 8-iso-prostaglandin-F2alpha (8-iso-PGF2α) levels in Bosnian AD and VD patients and to establish whether there is an association between 8-iso-PGF2α serum concentration and cognitive impairment (CI) in patients with dementia. SUBJECTS AND METHODS Serum levels of 8-iso-PGF2α were measured by enzyme immunoassay method in AD (n=30) and VD patients (n=30) and control subjects (CG, n=30). The AD and VD group were further stratified according to the level of CI. RESULTS The serum 8-iso-PGF2α levels were significantly higher in the AD (74.00 pg/mL) and VD groups (38.00 pg/mL) compared to the CG (17.50 pg/mL). A significant difference in serum 8-iso-PGF2α levels between patients with moderate and severe CI was not established in either AD or VD. CONCLUSION Serum 8-iso-PGF2α proved to be a good biomarker in AD and VD, however it cannot be recommended for the differentiation of moderate and severe CI.

Abstract Introduction. Bladder cancer is the most common malignancy involving the urinary system. Recent research tends to emphasize the role of oxidative stress products in the carcinogenesis of bladder cancer. The level of oxidative stress can be measured by assessing the MDA levels. This study aimed to evaluate serum MDA levels in patients with bladder cancer, as well as to determine its potential role as a biomarker in the diagnosis of the disease and progression risk considerations. Methods. The study was designed as a cross-sectional study and included 90 patients, divided into three groups with 30 patients each: Ta, T1and T2–T4 group, based on histopathological findings after transurethral resection of the tumor. The control group included 30 healthy volunteers. MDA level was determined using the spectrophotometric method. Results. Serum MDA level in patients with bladder cancer [0.86 (0.78–1.05) μmol/L] was significantly higher than the serum MDA level in control group [0.70 (0.69–0.72) μmol/L] (p < 0.001). Serum MDA level in Ta group [0.73 (0.70–1.05) μmol/L], T1 group [0.85 (0.80–1.12) μmol/L] and in T2–T4 group [0.91 (0.84–1.04) μmol/L] was significantly higher than the serum MDA level in control group [0.70 (0.69–0.72) μmol/L] (p < 0.01). MDA level in T1 and T2–T4 group was significantly higher than the MDA level in Ta group (p < 0.01). No significant difference was observed in MDA level between T1 and T2–T4 group (p = NS). A statistically significant positive correlation was found between tumor size and serum MDA level in patients with bladder cancer (rho = 0.254 p < 0.01). Conclusions. The results of the present study suggest that MDA serum level might play a significant role as a biomarker in the diagnosis of bladder cancer, as well as in the monitoring of its progression.

Aim To assess triglyceride - to high-density lipoprotein cholesterol (TG/HDL)-C ratio in patients with acute coronary syndrome (ACS) and to verify its association with renal dysfunction. Methods A cross sectional study included 85 ACS patients divided in two groups with (ACS - RD) and without (ACS-nRD) presence of renal dysfunction, and 35 healthy subjects. Blood pressure, blood glucose, C-reactive protein, urea, creatinine, eGFR and serum lipids levels (total cholesterol, triglycerides, LDL-C, HDL-C) was measured in all participants. Based on the values of the measured lipid fractions TG/HDLc ratio was calculated. Results Patients in ACS group had significantly lower HDL-C level (p<0.0005) but significantly higher TG level (p=0.046) and TG/HDL-C ratio (p<0.0005) than controls. There was a significant increase (p<0.0005) in TG/HDL-C ratio in ACS-RD group compared to ACS-nRD group. The ACS-RD group had significantly higher level of TG (p=0.001), serum urea (p=0.02) and creatinine (p<0.0005) compared to the ACS-nRD group. With a cut-off level of 1.135 TG/HDL-C ratio had a sensitivity of 77.6% and a specificity of 62.9% in distinguishing between ACS patients and healthy subjects. With cut-off value of 1.905 TG/HDL-C ratio had a sensitivity of 75.9% and a specificity of 78.6% in distinguishing between ACS patients with and without renal dysfunction. Conclusion This study confirms the reliability of the TG/HDLC ratio as a simple, low cost and useful marker in distinguishing between patients with ACS and healthy subjects and ACS patients with and without renal dysfunction.

Testing strategies can either have a very positive or negative effect on the learning process. The aim of this study was to examine the degree of consistency in evaluating the practicality and logic of questions from a medical school pathophysiology test, between students and family medicine doctors. The study engaged 77 family medicine doctors and 51 students. Ten questions were taken from cardiac pathophysiology and 10 questions from pulmonary pathophysiology, and each question was assessed on the criteria of practicality and logic. A nonparametric Mann-Whitney test was used to test the difference between evaluators. On the criteria of logic, only four out of 20 items were evaluated differently by students in comparison to doctors, two items each from the fields of cardiology and pulmonology. On the criteria of practicality, for six of the 20 items there were statistically significant differences between the students and doctors, with three items each from cardiology and pulmonology. Based on these indicative results, students should be involved in the qualitative assessment of exam questions, which should be performed regularly under a strictly regulated process.

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.