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Vesna Radović

Recommendations for Use of Free Light Chain Assay in Monoclonal Gammopathies

The serum immunoglobulin free light chain assay measures levels of free κ and λ immunoglobulin light chains. There are three major indications for the free light chain assay in the evaluation and management of multiple myeloma and related plasma cell disorders. In the context of screening, the serum free light chain assay in combination with serum protein electrophoresis and immunofixation yields high sensitivity, and negates the need for 24-hour urine studies for diagnoses other than light chain amyloidosis. Second, the baseline free light chains measurement is of major prognostic value in virtually every plasma cell disorder. Third, the free light chain assay allows for quantitative monitoring of patients with oligosecretory plasma cell disorders, including AL, oligosecretory myeloma, and nearly twothirds of patients who had previously been deemed to have non-secretory myeloma. In AL patients, serial free light chains measurements outperform protein electrophoresis and immunofixation. In oligosecretory myeloma patients, although not formally validated, serial free light chains measurements reduce the need for frequent bone marrow biopsies. In contrast, there are no data to support using free light chain assay in place of 24-hour urine electrophoresis for monitoring or for serial measurements in plasma cell disorders with measurable disease by serum or urine electrophoresis.

Open access

Marijana Dajak

Preporuke za Primenu Tumorskih Markera Kod Monoklonskih Gamapatija

Monoklonske gamapatije čine grupu poremećaja koji se karakterišu klonskom proliferacijom plazma ćelija. M protein je tumorski marker specifičan za monoklonske gamapatije jer odražava klonsku produkciju imunoglobulina. Monoklonske gamapatije uključuju: multipli mijelom, Waldenström-ovu makroglobulinemiju (WM), nesekretorni mijelom, prikriveni (smoldering) multipli mijelom, monoklonsku gamapatiju od neodređenog značaja (MGUS, Monoclonal gammopathy of undetermined significance), primarnu sistemsku amiloidozu i bolest teških lanaca. Dijagnoza multiplog mijeloma je zasnovana na detekciji M proteina u serumu i/ili urinu, infiltraciji plazma ćelija u koštanoj srži i litičkim koštanim lezijama na radiografiji skeleta. Prema NACB (National Academy of Clinical Biochemistry) preporukama, tumorski markeri za dijagnozu, screening, identifikaciju klonaliteta, praćenje bolesti i prognostičku evaluaciju kod monoklonskih gamapatija su: elektroforeza proteina u serumu i/ili urinu, imunofiksacija u serumu i/ili urinu, slobodni laki lanci (SLL) u serumu i/ili urinu, viskoznost seruma i β2-mikroglobulin. Imunofiksacija se koristi za identifikaciju klonaliteta (tipa) M proteina primećenog na elektroforezi i kada postoji sumnja bez obzira na normalan proteinski elektroforetogram. Posebno je korisna za prepoznavanje i razlikovanje biklonskih ili triklonskih gamapatija. Viskoznost seruma trebalo bi određivati ako pacijent ima znake i simptome sindroma hiperviskoznosti. WM je najčeŠći uzrok hiperviskoznosti, ali se takođe može pojaviti i kod pacijenata sa velikim nivoima monoklonskog IgA ili IgG. Automatizovana imunoodređivanja SLL u serumu su osetljivija od tradicionalne elektroforetske metode i imunofiksacije za detekciju mijeloma monoklonskih lakih lanaca, nesekretornog mijeloma i AL amiloidoze. Osim toga, odnos SLL u serumu je nezavisan faktor rizika za nastanak maligne progresije kod pacijenata sa MGUS. Određivanje SLL u serumu i elektroforeze proteina seruma kao testova prve linije za razmatranje prisustva mogućih poremećaja B ćelija daje dodatnu dijagnostičku informaciju.

Open access

Fimka Tozija and Nikola Jankulovski

Abstract

The aim of this paper was to present the strategic approach applied for improvement of quality in emergency medical services (EMS) in the Republic of Macedonia. This approach was accomplished through three stages: (I) assessment and recommendations for policies; (II) development of innovative evidence-based programmes; and (III) policy implementation. Strategic assessment of EMS was performed by applying WHO standard methodology. A survey was conducted in 2006/2007 on the national level in fifteen general hospitals, four university hospitals, and sixteen pre-hospital EMS. The overall evaluation was based on a hospital emergency department (ED) questionnaire, information on the general characteristics of the pre-hospital dispatch centre, review of ED medical records, and the patient questionnaire. The key findings of the assessment showed that EMS required extensive changes and improvements. Pre-hospital EMS was not well-developed and utilised. Hospital EDs were not organised as separate divisions ran by a head medical doctor. The diagnostic and treatment capacities were insufficient or outdated. Most of the surveyed hospitals were capable of providing essential diagnostic tests in 24 h or less. There was no follow-up of the EMS patients or an appropriate link between the hospital EDs and primary health care facilities. The main findings of the assessment, recommendations, and proposals for action served as the basis for new policies and integrated into Macedonia’s official strategy for emergency medical services 2009-2017.

Open access

Mirjana Đerić, Sunčica Kojić-Damjanov, Velibor Čabarkapa and Nevena Eremić

Biochemical Markers of Atherosclerosis

This paper is a brief review of some lipid parameters and serum markers of inflammation in a view of their predictive relevance for the atherosclerotic disease. A discourse on the importance of measuring different lipids and lipoproteins, concentration of LDL particles and apolipoprotein levels is still underway. Also, the recommendations for apolipoprotein (a), phenotypization and other lipid markers have not yet been established. In recent years the recommendations imply simultaneous measuring of multiple markers and calculating the lipid index values such as lipid tetrad index (LTI), lipid pentad index (LPI) and atherogenic index of plasma (AIP). Several circulating markers of inflammation such as C-reactive protein, serum fibrinogen and elevated leukocyte number, are consistently associated with atherosclerosis. In spite of a lack of evidence on measuring the C-reactive protein in a wide population, the guidelines for its application in diagnostics and therapy of coronary heart disease were developed. Some proinflammatory cytokines, adhesion molecules and markers of leukocyte activation are promising markers, requiring, however, more detailed prospective evaluation. The question to be elucidated is if these inflammatory markers are directly involved in the pathogenic process.

Open access

Jean-Claude Besson, Estelle Augarde and Michael Nasterlack

Worker Protection During Mercury Electrolysis Cell Plant Decommissioning

This article brings information on how to protect worker health during the decommissioning of mercury-based electrolysis facilities. It relies on the Euro Chlor document "Health 2, Code of practice, Control of worker exposure to mercury in the chlor-alkali industry" that provides protection guidelines for both normal production and decommissioning activities, and on hands-on experience gained during chlor-alkali plant decommissioning operations.

Decommissioning and dismantling of mercury-containing chlorine production plants presents challenges to industrial hygiene and health protection that are usually not present during normal operations. These involve meticulous training and enforcement of the appropriate use of personal protective equipment to prevent excessive mercury exposure.

The best practice guidelines and recommendations available from Euro Chlor can help employers and occupational physicians to manage these challenges, as they provide state-of-the-art procedures. Our experience is that rigorous implementation of these procedures and worker training ensured acceptable hygiene at the workplace and prevented mercury-related adverse health effects.

Open access

Sanja Stanković

Preporuke Za Primenu Tumorskih Markera Kod Kancera Pluća

Kancer pluća predstavlja jedan od najozbiljnijih problema moderne onkologije. Uprkos kontinuiranom napretku u dijagnostičkim metodama, kod 50-70% pacijenata s kancerom pluća, bolest se dijagnostikuje u uznapredovalom stadijumu, isključujuci na taj način mogućnost radikalne terapije. Određivanje tumorskih markera kod kancera pluća može biti od pomoći u postavljanju dijagnoze, praćenju pacijenta i terapije, a takođe može da pruži dodatne informacije u prognostičke svrhe. U daljem tekstu opisani su odgovarajući serumski markeri kod dve glavne forme tumora pluća-mikrocelularnog i nemikrocelularnog (SCLC i NSCLC), kao i abnormalne supstance identifikovane u tumorima pluća ili njihovim metastazama, kao što su molekularni markeri, markeri prognoze u primeni neoadjuvantne ili adjuvantne terapije i mikrometastazama koštane srži ili limfnom čvoru.

Open access

Snežana Jovičić

Biohemijski Aspekti, Laboratorijska Dijagnoza I Praćenje Povišene Koncentracije Holesterola: Preporuke NCEP ATP III

Treći izveštaj ekspertske grupe o detekciji, evaluaciji i tretmanu povišene koncentracije holesterola u odraslih (Adult Treatment Panel III, ATP III) predstavlja ažuriran klinički vodič Nacionalnog programa edukacije o holesterolu (National Cholesterol Education Program, NCEP), o određivanju holesterola i zbrinjavanju osoba s povišenom koncentracijom holesterola u serumu. Pored toga što preporučuje intenzivan tretman pacijenata sa koronarnom srčanom bolešću (coronary heart disease/CHD), važna karakteristika ATP III je težište na primarnoj prevenciji kod osoba sa više prisutnih faktora rizika. ATP III nastavlja da identifikuje povišene koncentracije LDL holesterola kao primarni cilj terapije za snižavanje holesterola. Osnovni princip prevencije je da se intenzitet terapije prilagođava apsolutnom riziku za CHD svake osobe pojedinačno. Procena rizika podrazumeva određivanje LDL holesterola u sklopu analize lipoproteina i identifikaciju pratećih determinanti rizika (prisustvo ili odsustvo CHD, drugih kliničkih oblika aterosklerotske bolesti i dijabetesa, pušenje, hipertenzija, niska koncentracija HDL holesterola, porodična anamneza prevremene pojave CHD, starost). U kategoriji najvišeg rizika nalaze se osobe sa CHD i CHD ekvivalentima rizika, čiji je apsolutni rizik od pojave srčane smrti ili nefatalnog infarkta miokarda u narednih 10 godina ≥20%. Drugu kategoriju čine osobe sa dva ili više faktora rizika kod kojih je 10-godišnji rizik <20%. Apsolutni rizik se procenjuje na osnovu Framingham rizik skora. U trećoj kategoriji su osobe sa jednim ili nijednim faktorom rizika. Definisane su preporučene koncentracije LDL holesterola za svaku kategoriju i postižu se korekcijom ishrane i/ili farmakoterapijom. Evropske preporuke za prevenciju kardiovaskularne bolesti (cardiovascular disease, CVD) u kliničkoj praksi preporučuju upotrebu SCO-RE (Systematic COronary Risk Evaluation) tablica za procenu rizika za pojavu CVD, koje podrazumevaju apsolutnu verovatnoću za fatalan ishod CVD u toku 10 godina. Cilj ovog rada je predstavljanje delova NCEP ATP III i evropskih preporuka značajnih za njihovu implementaciju u laboratorijsku praksu.

Open access

Ljiljana Kezunović

function tests. European Community for Coal and Steel, Luxembourg. Bull Eur Physiopathol Respir 1983;19:1-95. Pavičić F, Slavković V, Štangl B, Tabori Đ. Preporuke za unifikaciju i standardizaciju testova za ispitivanje ventilacijske sposobnosti pluća [Recommendations for unification and standardization of spirometric tests]. Golnik: 1985. Krstev S. Osnovni principi epdemiologije u izučavanju specifičnih i nespecifičnih profesijskih respiratornih bolesti [Basic epidemiological principles of studying specific and non

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Tadija Đ Đukić and Miloš Pavlović

, B. and J. Elliott (2011), Financial Accounting and Reporting, 14th eddition, Pearson Education Limited, FASB, (2010): Conceptual Framework, Statement of Financial Accounting Concepts No 8, September 2010., glava 1, paragraf 2, str. 1., dostupno na internet strani: http://www.fasb.org/cs/BlobServer?blobcol=urldata&blobtable=MungoBlobs&blobkey=id&blobwhere=1175822892635&blobheader=application%2Fpdf Fond za razvoj ekonomske nauke, 2013, Siva ekonomija u Srbiji: Novi nalazi i preporuke za reformu, dostupno na: http

Open access

Saša Marić, Andrej Razpet, Vera Nikolić, Aleš Snoj and Predrag Simonović

Abstract

The purpose of this study was to assess the genetic diversity of Serbian huchen and provide guidelines for conservation and management. Fourteen huchen individuals were collected from six localities. For all individuals the mitochondrial DNA control region and the NADH1 gene were sequenced, and two microsatellite loci were genotyped. Sequencing of two mtDNA loci showed the presence of the same haplotypes (Hh_CR_1 and Hh_ND1_1) in all investigated specimens and the complete absence of genetic variability at inter- and intra-populational level. However, analyzed individuals from Serbia have the largest number of control region repeats (average 8.7) compared to all other huchen populations from the Danube basin. Microsatellite data show that the most of Serbian huchens were placed in the “eastern” cluster except one individual from the Drina River which clustered with “western” samples, most likely a consequence of stocking. In spite of only two loci used, four unique alleles found in the studied Serbian and Drina basin population indicate that the Danube basin may possess more region specific alleles than previously thought, which could be of great importance for efficient species management in the future.