Comparison of Jaffe Method and Enzymatic Method at Measuring Serum Creatinine Level, Creatinine Clearance and Estimated Glomerular Filtration Rate.

Background: Correct measuring of blood and urine creatinine level is necessary for identification and tracking of chronic kidney disease (CKD). Objective: The aim of this study is a comparison of Jaffe and enzymatic methods for measuring creatinine in serum and in urine, in order to determine whether there are any statistical significant differences between them, and whether they are reflected on creatinine clearance calculation and estimated glomerular filtration rate (eGFR). Methods: Creatinine in serum and urine was measured for the group of patients (N=60; female=34, male=26) from 24 to 69 years of age by using Jaffe's method on Dimension RxL biochemical analyzer, and enzymatic method on integrated biochemical and immunochemical analyzer Architect ci8200, and obtained levels are used for creatinine clearance calculation and eGFR. Results: The methods correlate well, both in measuring serum creatinine (r 1 = 0.990) and in measuring urine creatinine (r 2 =0.974). There are no statistically significant differences between them (p=0.57). Measuring creatinine using different methods showed no statistically significant differences in the calculated clearances (p=0.93), they significantly correlate (r=0.9722). eGFR, using the MDRD and CKD-EPI formulas, were not statistically significantly different, regardless of the used method. Conclusion: Apart from significant correlations between the used methods, the results of using the Jaffe and enzymatic methods showed no significant differences at measuring serum creatinine level, or creatinine clearance and glomerular filtration rate.

Risk factors associated with the development of secondary hyperparathyroidism in dialysis patients.

Aim To determine risk factors associated with the development and severity of secondary hyperparathyroidism in dialysis patients. Methods A cross-sectional study at the Clinical Centre of the University of Tuzla (March 2022) included 104 adult patients (males 51.9%, females 48.1%) with chronic kidney diseases under dialysis treatment. Based on parathyroid hormone (PTH) values, patients were divided into two groups: study group (45/104, PTH >792pg/mL) and control group (59/104, PTH 176-792 pg/ mL). The analysis aimed to resolve whether there was a connection between the duration of dialysis, the type of therapy treatment administered, the underlying kidney disease, and the presence of comorbidities with the values of PTH, and a wide spectrum of monitored laboratory parameters. Results The most common causes of chronic renal failure were undefined kidney diseases (32.7%), followed by diabetic nephropathy (18.3%) and chronic glomerulonephritis (16.3%). In the examined biochemical parameters, a significant difference was found in mean values of alkaline phosphatase (p<0.001). The correlation was proved between the duration of dialysis (p=0.028), the values of phosphorus (p=0.031), and alkaline phosphatase (p<0.001) with absolute values of PTH. The most common present comorbidity was hypertension (78.8%), followed by cardiovascular diseases (40.4%) and diabetes (22.1%). Conclusion A number of factors contribute to the development and severity of SHPT. Modulation of therapy and better control of risk parameters can prolong and reduce the frequency of SHPT in dialysis patients, as well as the occurrence of comorbidities.

Early predictors of severity and mortality in COVID-19 hospitalized patients.

Aim To identify laboratory tests for early detection and the development of more severe illness and death in COVID-19 hospitalized patients. Methods A prospective study was done on 66 hospitalized COVID-19 patients (males: 54.5%; mean age 70.1 ± 9.6 years) who were stratified into: moderate (n=36; 54.5%), severe (n=12; 18.2%), and critically ill (n=18; 27.3%). Besides clinical findings, a wide spectrum of laboratory parameters was monitored at admission and control during the first seven days of hospitalization and used to predict progression from non-severe to severe illness and to predict the final outcome. Results Critically ill patients showed a higher control value of white blood cell count, C-reactive protein, lactate dehydrogenase, ferritin, but lower lymphocyte count and O2 saturation. Patients with fatal outcome (23; 34.85%) showed a higher control value of neutrophil, lactate dehydrogenase, ferritin, and lower lymphocyte and O2 saturation. Progression from moderate to severe or critical illness was predicted by increasing lactate dehydrogenase (95% CI 0.5803 to 0.8397;p=0.003729), increase in ferritin (95% CI 0.5288 to 0.8221;p=0.03248), and by drop in O2 saturation (95% CI 0.5498 to 0.8179;p=0.01168). A fatal outcome was predicted by increase in ferritin (95% CI 0.5059 to 0.8195;p=0.04985), as well as by drop in O2 saturation (95% CI 0.5916 to 0.8803; p=0.001861). Conclusion Increase in ferritin, and drop in O2 saturation could be the most important prognostic parameters for the development of more severe clinical illness and death in COVID-19 hospitalized patients.

COVID-19 in Northeast Bosnia and Herzegovina and patient's length of hospitalization.

BACKGROUND: Since the outbreak of COVID-19 pandemic, clinical data from various parts of the world have been reported. Up till now, there has been no clinical data with regards to COVID-19 from Bosnia and Herzegovina (B&H). The aim was to report on the first cohort of patients from B&H and to analyze factors that influence COVID-19 patient's length of hospitalization (LOH). METHODS: This retrospective cohort study was conducted at Tuzla University Clinical Center (UKC), B&H. It involved 25 COVID-19 positive patients that needed hospitalisation between March 28th and April 27th 2020. The LOH was measured from the time of admission to discharge. Factors analyzed induced age, BMI, presence of known comorbidities, serum creatinine and O2 saturation upon admission. RESULTS: The mean age was 52.92 ± 19.15 years and BMI 28.80 ± 4.22. LOH for patients with BMI < 25 was 9 ± SE2.646 days (CI 95% 3.814-14.816) vs 14.182 ± SE .937 (CI 95% 12.346-16.018 p < 0.05; HR 5.148 CI95% 1.217 to 21.772 p = 0.026) for ≥25 BMI. The mean LOH of patients with normal levels of O2 ≥ 95% was 11.667 ± SE1.202 (CI95% 8.261 to 13.739; p = 0.046), while LOH for patients with < 95% was 14.625 ± SE 1.231 CI95% 12.184 to 16.757 p = 0.042; HR 3.732 CI95%1.137-12.251 p = 0.03). Patients without known comorbidities had a mean LOH of 11.700 ± SE1.075 (CI 95% 9.592-13.808), while those with comorbidities had a mean of 14.8 ± 1.303 (CI 95% 12.247-17.353; p = 0.029) with HR2.552. CONCLUSION: LOH varied among COVID-19 patients and was prolonged when analyzed for BMI ≥25, comorbidities, elevated creatinine, and O2 saturation < 95%. Furthermore, risk factors for COVID-19 patients in B&H do not deviate from those reported in other countries.

Concordance of non-invasive serology-based scoring indices and transient elastography for liver fibrosis and cirrhosis in chronic hepatitis C.

Aim To assess concordance of eight frequently used serology-based scoring indices for liver fibrosis and cirrhosis with transient elastography (TE) in chronic hepatitis C (CHC) patients in order to determine serum indices with the highest concordance and clinical usability in clinical practice. Methods In this prospective study, 63 CHC patients were included and TE results were compared with eight non-invasive indices. The diagnostic performance of these tests was assessed using receiver operating characteristic curves with kappa index calculated for the concordance analysis. Results Median age of 63 patients was 54 years (interquartile range: 42 to 63); 27 (42.9%) were females. According to areas under the Receiver Operating Characteristics (AUROC), the best performing serum markers for significant liver fibrosis (METAVIR ≥F2), advanced liver fibrosis (≥F3) and cirrhosis (F4) determined by TE measurements (≥7.1kPa, ≥9.5kPa and ≥12kPa, respectively) were Fibrotest (AUROC=0.727 for ≥F2) and FIB-4 score (AUROC=0.779 for ≥F3 and AUROC=0.889 for F4). Fibrotest cut-off at >0.50 was concordant with TE for presence of significant fibrosis in 30 (out of 45; 66.7%), FIB-4 cut-off at <1.45 was concordant for absence of significant fibrosis in 13 (out of 18; 72.2%) and Goeteborg University Cirrhosis Index (GUCI) cut-off at >1 was concordant for presence of cirrhosis in 16 (out of 22; 72.7%) patients, but not for exclusion of cirrhosis. Conclusion Serology-based scoring indices had moderate overall concordance with TE. We propose that FIB-4 score, Fibrotest and GUCI be used in routine practice to exclude and diagnose significant fibrosis and diagnose cirrhosis, respectively.

Association of biomarkers of inflammation and HLA-DRB1 gene locus with risk of developing rheumatoid arthritis in females.

Rheumatoid arthritis (RA) is an autoimmune disease causing chronic inflammation of the joints. Multiple factors, including HLA-DRB1 gene variants, influence the susceptibility to RA. The HLA-DRB1 gene is part of a family of genes called the human leukocyte antigen (HLA) complex. In this study, we compared the inflammatory biomarkers values, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), between patients with RA and healthy control group of females of the Public Institution Health Centre of Sarajevo Canton. In addition, we estimated the frequencies of the HLA-DRB1 gene variants and their association with the risk for RA development in females. The haematological and biochemical tests were completed on automated analyzers. To assess the association between the HLA-DRB genes and the risk of RA in females, low-resolution genotyping of the HLA-DRB1, DRB3, DRB4, and DRB5 gene loci was performed by the sequence-specific polymerase chain reaction method (PCR-SSP). ESR and CRP were the most sensitive acute-phase reactants in females with RA and there was a correlation between ESR and CRP values in RA patients. There was significantly positive association between of the HLA-DRB1*03, *04, *08, *10, *11, and *14 variants and elevated values of ESR in RA patients, but negative between HLA-DRB1*03, *13 and *15 alleles and elevated CRP values. Furthermore, our results confirm genetic susceptibility to RA in a female population to the members of the HLA-DRB1*04 and *03 allelic groups, the DRB1*04/DRB1*04 and DRB1*03/DRB1*04 genotypes, and the DRB1*04-DRB4* or DRB1*03-DRB3* haplotypes, which, therefore, represent risk factors for the development of this disease. According to our results, the DRB1*01/DRB1*15 and DRB1*07/DRB1*16 genotypes and the HLA-DRB5 gene locus represent a protective factor for RA. The presence of specific HLA-DRB1 gene variants increases the risk of developing RA, while other variants provide protection against disease. Therefore, HLA typing could be helpful in the prediction of RA development and establishing and confirming a definitive diagnosis of autoimmune diseases in some subjects. A strong association with the higher levels of ESR and CRP could be used to establish definitive diagnosis and introduce of early treatment of RA to prevent the occurrence of RA symptoms.

Effectiveness of treating the renal anemia in chronic hemodialyzed patients by epoietin alpha and beta.

INTRODUCTION: Anemia is an early sign of chronic kidney dysfunction, caused by many different factors, but the insufficient erythropoietin synthesis is the crucial factor in its development. OBJECTIVES: The objective of our study was to compare effectiveness of epoietin alpha and beta application in the treatment of renal anemia in chronic hemodialyzed patients. PATIENTS AND METHODS: The group included 60 patients of both sexes, randomly chosen. Criteria for including patients into the study were: older than 18 years, haemodialyzed longer than three months and treated by epoietin beta, stable level of hemoglobin, between 9 and 11 g/dL at least two successive measurements and no malignant disease present. The patients were then randomized into groups: 20 patients were administered epoietin alpha intravenously instead of epoietin beta subcutaneously (experimental group); 20 patients were administered intravenously epoietin beta instead of epoietin beta subcutaneously (control group A), the rest of 20 patients were administered epoietin beta subcutaneously (control group B). All the testees were administered epoietin alpha or beta three times weekly after haemodialysis, intravenously or subcutaneously. RESULTS: Comparison among mean values of hematological and biochemical parameters before starting the treatment by erythropoietin, and third and sixth months after therapy in the studied groups, no significant difference was found (p > 0.05). CONCLUSION: Epoietin alpha and beta showed approximate degree of efficacy in renal anemia treatment of hemodialysis patients. The way of erythropoetin administration did not significantly effect the level of hemoglobin and hematocrit in six months research period.

Biochemical markers of iron status in hemodialysis patients.

INTRODUCTION: Secondary lack of iron in patients on hemodyalisis is the main cause of inadequate answer on therapy of recombinant human erythropoietin (rHuEPO). Therefore, it is very important to follow the status of iron in these patients. OBJECTIVES: The objectives of our study were to define the value of hemoglobin content in reticulocytes as predictor of functional iron deficiency on hemodialyzed treated patients with erythropoietin (rHuEPO) then evaluate the eficiency of using the value of hemoglobin content in reticulocytes in administration of iron HD (Patients on hemodialyzed ). PATIENTS AND METHODS: It is a prospective study which included 53 patients treated on chronical hemodialysis and continuing hospital peritoneal dialysis (CAPD), all patients were given additional iron therapy intravenously in order to keep the level of ferritin between 300 microg/l and 500 microg/ and transferrin saturation over 20%. The patients were both male and female randomly chosen. The following parameters conected to iron deficiency were compared in this study. The study was taken in the period from august to december 2008 at University Clinical Centar Tuzla. RESULTS AND DISCUSSION: The study included patients from chronical HD programme in therapy with rhEPO, iron intravenously, than patients on CAPD also in therapy with rh EPO and intravenously iron and patients on chronical HD with intravenously iron without rh EPO therapy. There wasn't any significant difference between numbers of male and female patients that were examined and in control group. In this study the following parameters conected to iron deficiency were compared. There wasn't any significant difference in values of seruum ferritin, Ret-he and hemoglobin between the examined and control group. Still, it's clear that members of the examined group had higher values of these parameters comparing to the control group. If we would use criterias like the saturation transferrin and the level of ferritin as referent standard we would have 26/53 (49.1%) patients with iron deficiency in the whole sample. CONCLUSION: Following chematological and biochemic parameters in examined patients on HD are giving us essential information for planing and leading an adequate erythropoietin therapy. For the maximum effect of rhEPO therapy, an adequate compensation of iron is necessary.

Disorders of hemostasis in the course and after laparoscopic cholecystectomy.

INTRODUCTION: Hemostasis is a very important mechanism, whose changes can cause different complications. In the course of surgical interventions some changes in the system of coagulation happen. Laparoscopic cholecystectomy is a method of choice in the treatment of gallbladder calculosis. In the course of the procedure, parameters of hemostasis change, which stimulates a possible appearance of thromboembolic complications. The objective of our research was to reveal the changes in the system of coagulation in patients treated by laparoscopic cholecystectomy. EXAMINEES AND METHODS: Total sample involved 60 patients, divided into two groups, who were treated either by classical or laparoscopic method. Parameters of primary and secondary hemostasis were determined for the patients of both groups in Polyclinic for Transfusiology UKC Tuzla, before the operation, in the course, and 24 hours after the operation, and on the 5th day after the surgery. RESULTS: Patients from both groups showed changes in the process of coagulation. The changes were more expressed in the group of patients treated by laparoscopic cholecystectomy. Very important result was the increased value of D-dimer measured on the 5th day after the operation in the patients operated by laparoscopic cholecystectomy, where value was 2.5 times higher in the relation to preoperative value (263.5 microg/l, so it was out of referential value). Increase of fibrinogen in both groups were an important result of this study. DISCUSSION AND CONCLUSION: Results of the study showed changes in the process of coagulation in both groups, and increased fibrinolytic activity of the organism after laparoscopic cholecystectomy (requires a discussion on longer and thorough prophylaxis of tromboembolism).