Environmental and climate changes are a threat for the survival of global ecosystems and biodiver... more Environmental and climate changes are a threat for the survival of global ecosystems and biodiversity. Climate changes can alter rainfall, influence crop fields, affect human health, cause changes to forests and other ecosystems, and impact energy supply. Paleoclimatic research, even not completely analogue, can illustrate how temperatures, precipitation patterns, cryospheric extent, and biospheric adaptations are affected by greenhouse gas emissions. It is the opportunity to observe Earth s system respond to high carbon dioxide, and paleoreconstructions can help us learn how resilient ecosystems become in a time of change. Investigation of small mammal fossils is very useful for Pleistocene terrestrial environment reconstructions. The methods include: Bioclimatic analysis and actualistic methods. Serbia within the Balkan Peninsula, is an interesting place to study the transition between the Late Pleistocene and Holocene and contribute to the knowledge about the formation of the current biodiversity in central Balkan. In the future, Serbia is expected to be especially affected by climate change. Understanding the response of natural systems to changing climate is important for sustainability, and can guide society in adaptation and mitigation, in order to improve present and future resilience of the country.
Even though industrial development has brought vast improvements to our daily lives, it carries w... more Even though industrial development has brought vast improvements to our daily lives, it carries with it negative effects such as adverse health outcomes caused by PM2.5 and other pollutants. The negative externalities and external costs might occur when property rights are not properly defined, which means that if no one holds a property right on the atmosphere and the quality of air, there is no appropriate mechanism to prevent a further expansion of negative effects. An economic burden of pollution related to premature morbidity and mortality in individual countries can account for 5–14% of GDP (World Bank, 2021). In 2019, the worldwide health cost of mortality and morbidity caused by exposure to PM2.5 concentration was $8.1 trillion, which is equivalent to 6.1 percent of the global gross domestic product (GDP) (World Bank estimate). Policymakers require evidence-based results that clearly show the impact that air pollution has on the economy and society, in order to be able to establish the proper regulations and ensure their successful implementation. The purpose of this long term study is to provide methods for assessing the negative effects of PM2.5 concentration on PM2.5-related mortality using panel data structure and demonstrate how socio-economic factors affect this relation. This study employed advanced econometric techniques to analyse the long-term impact of PM2.5 on human health, while controlling for socio economic indicators. This study has demonstrated significant effects of socio-economic, health risk and system and governance variables on the relation between PM2.5 concentration and PM2.5-related mortality.
Over the past decades, technological and economic growth has significantly contributed to the imp... more Over the past decades, technological and economic growth has significantly contributed to the improvement of the health care system through increased investment in technological research, training and the application of new technologies in health care. There is evidence that rapid technological and economic growth, contributing to the improvement of the health care system, also leads to a reduction in mortality rates, as well as to a longer life expectancy, which indirectly affects human activity in scientific and political spheres. At the same time, there is evidence that 2.5-micron particles (PM2.5 particles), as a result of industrial development and increased car use, have a negative impact on health outcomes around the world. This paper analyses the impact of increased concentration of PM2.5 particles in the air on economic and technological development, in order to explore whether there is an interdependent relationship between them. The paper aims to clarify the long-term eff...
The purpose of this study was to assess the effect of levocetirizine (xyzal) on salivary gland fu... more The purpose of this study was to assess the effect of levocetirizine (xyzal) on salivary gland function in patients with allergic rhinitis using technetium-99m pertechnetate ( 99m Tc-P) salivary gland scintigraphy. The study population consisted of 67 patients with allergic rhinitis and 31 ...
Environmental and social responsibility of companies • The panel data regression model and panel ... more Environmental and social responsibility of companies • The panel data regression model and panel data analysis • Motives for implementing an environmental friendly strategy within the firm • Business-innovative strategies to address social and environmental responsibility • "Going green" policy of the firms
Environmental and social responsibility of companies • The panel data regression model and panel ... more Environmental and social responsibility of companies • The panel data regression model and panel data analysis • Motives for implementing an environmental friendly strategy within the firm • Business-innovative strategies to address social and environmental responsibility • "Going green" policy of the firms
Organizational culture and organizational structure have a correlated interrelationship. Structur... more Organizational culture and organizational structure have a correlated interrelationship. Structure determines the behaviors, attitudes, dispositions and ethics that create the work culture. In this paper, the authors analyze the interrelationship between the organizational structure and culture in the mining companies in Eastern Serbia. Investigation was conducted in two companies, with 138 participants in the survey. The research was conducted at the beginning of 2016. The questionnaires included 50 questions concerning the organizational structure and culture, and were anonymous. The results confirmed a significant correlation between the organizational structure and culture in the investigated organizations.
Even though industrial development has brought vast improvements to our daily lives, it carries w... more Even though industrial development has brought vast improvements to our daily lives, it carries with it negative effects such as adverse health outcomes caused by PM2.5 and other pollutants. The negative externalities and external costs might occur when property rights are not properly defined, which means that if no one holds a property right on the atmosphere and the quality of air, there is no appropriate mechanism to prevent a further expansion of negative effects. An economic burden of pollution related to premature morbidity and mortality in individual countries can account for 5–14% of GDP (World Bank, 2021). In 2019, the worldwide health cost of mortality and morbidity caused by exposure to PM2.5 concentration was $8.1 trillion, which is equivalent to 6.1 percent of the global gross domestic product (GDP) (World Bank estimate). Policymakers require evidence-based results that clearly show the impact that air pollution has on the economy and society, in order to be able to establish the proper regulations and ensure their successful implementation. The purpose of this long term study is to provide methods for assessing the negative effects of PM2.5 concentration on PM2.5-related mortality using panel data structure and demonstrate how socio-economic factors affect this relation. This study employed advanced econometric techniques to analyse the long-term impact of PM2.5 on human health, while controlling for socio economic indicators. This study has demonstrated significant effects of socio-economic, health risk and system and governance variables on the relation between PM2.5 concentration and PM2.5-related mortality.
Over the past decades, technological and economic growth has significantly contributed to the imp... more Over the past decades, technological and economic growth has significantly contributed to the improvement of the health care system through increased investment in technological research, training and the application of new technologies in health care. There is evidence that rapid technological and economic growth, contributing to the improvement of the health care system, also leads to a reduction in mortality rates, as well as to a longer life expectancy, which indirectly affects human activity in scientific and political spheres. At the same time, there is evidence that 2.5-micron particles (PM2.5 particles), as a result of industrial development and increased car use, have a negative impact on health outcomes around the world. This paper analyses the impact of increased concentration of PM2.5 particles in the air on economic and technological development, in order to explore whether there is an interdependent relationship between them. The paper aims to clarify the long-term effect of PM2.5 on health outcomes, control of technological and economic growth, as well as other important factors, based on the analysis of given panel data and the application of modern econometric methods. Accordingly, the purpose of this paper is to provide information on the negative impact of PM2.5 particles on human health, as an indirect impact on the development of new materials and technologies, taking into account socioeconomic factors at the global level.
Graves' disease is an autoimmune disease wich etiology that is not completely understood. Num... more Graves' disease is an autoimmune disease wich etiology that is not completely understood. Numerous experimental investigations and clinical observations have primarily elucidated the role of the humoral stimulatory factors in the disease (LATS, TSI, etc). These autoantibodies (TRAb) react with TSH receptor and produce postreceptor stimulatory effects, that lead to hyperfunction of the thyroid. It is thus understandable why sensitive and specific techniques such as radioreceptor assays, cAMP generated in thyrocytes, etc. detect high levels of these autoantibodies in more than 85%, in patients with untreated Graves' disease 1-3 . The incidence and serum level of TRAb decrease during thyrosupressive therapy 4,5 , and are almost always negative in stable remission 6,7 . Transplacental passage of TRAb from mother to foetus, results in genesis of neonatal hyperthyroidism 8 . This model for the role of TRAb in autoimmune hyperthyroidism is partly complicated by the fact that not al...
It is generaly accepted that the thyrotropin receptor antibody (TRAb) has a stimulating activity ... more It is generaly accepted that the thyrotropin receptor antibody (TRAb) has a stimulating activity and is the major pathogenic factor in Graves' disease (GD). In spite of that, TRAb is not routinely examined in clinical practice. The aim of this article is to briefly review the subject and suggest protocols for the diagnosis, treatment and follow-up of patients with GD based on our own studies and referring especially to TRAb. Clinical symptoms and signs and thyroid hormones may have poor sensitivity or specificity, especially in cases of endocrine ophthalmopathy and subclinical hyperthyroidism. In these cases the TRAb test is 98% sensitive and specific with a diagnostic accuracy of almost 99%. By this test it is possible to differentiate between autoimmune and other forms of thyrotoxicosis such as autonomous hyperthyroidism, destructive thyroiditis, iodine induced hyperthyroidism etc. Antithyroid drugs decrease serum TRAb levels and also induce immune remission. If after treatment TRAb remains increased as in about 30% of our cases, patients will relapse. In pregnant women with GD the follow-up of serum TRAb levels is also important as predictive of immune thyroid disease in the newborn. Data presented in this article confirm that the determination of serum TRAb levels in some rare hyperthyroid disorders, such as associated autoimmune and autonomous forms and in epidemiological studies, is also justified.
Iodine prophylaxis implemented at the territory of former Yugoslavia in 1953, has successfully co... more Iodine prophylaxis implemented at the territory of former Yugoslavia in 1953, has successfully corrected previously existent mild iodine deficiency in East Serbia. Clinical findings (incidence of goiter in school children, ratio of diffuse to focal toxic goiters, uptake of 131I in healthy persons) in subsequent decades were adequate for the areas with corrected iodine deficiency. Iodine content in consume salt was increased from 10mg KI/ kg to 20 mg KI/kg, for the entire territory of Serbia, by federal legislation, in 1993. This report is presenting an occasional investigation of variation in thyroid morbidity and neonatal TSH, in the area of corrected iodine deficiency, in conditions of increasing iodine consumption. Investigated parameters included: neonatal TSH, incidence of autoimmune thyroid diseases (Graves'-Basedow disease, Hashimoto's thyroiditis, primary hypothyroidism), and autonomous thyrotoxicosis (Plummer's disease), incidence of goiter in school children, uptake of 131I in healthy persons, in the period 1978 - 2000. Results have demonstrated that two years following the implementation of increased iodization, findings of neonatal TSH decreased for average 40% and incidence of autoimmune hyperthyroidism increased over 250%. In subsequent two years, both parameters have recovered. Incidence of Hashimoto's thyroiditis, primary hypothyroidism, and autonomous thyrotoxicos (Plummer's disease) incidence of goiter in school children, was unchanged. There is a considerable probability that modification of thyroid morbidity was initiated by increased iodine consumption in the region with previously corrected iodine deficiency, although other factors could not be excluded.
The proportion of free hormones can be estimated in the presence of protein-bound hormones by a v... more The proportion of free hormones can be estimated in the presence of protein-bound hormones by a variety of direct assay approaches or by a two test strategy to calculate a free hormone »index«. The T 4 /TBG ratio, determined from measurements of total thyroxine (TT 4) and thyroxine-binding globulin (TBG) concentrations, is an appropriate index with improved diagnostic accuracy compared with T 4. In this study, we calculated the T 4 /TBG ratio after determining serum TT 4 and TBG by radioimmunoassay (INEP, SCG) in euthyroid persons (n=102), in patients with hypothyrosis (n=33) and hyperthyrosis (n=66), as well as in healthy pregnant women (n=346). The reference range for each group of patients was determined. Values obtained for the T 4 /TBG ratio in healthy subjects varied from 2.1 to 4.4. They were lower in hypothyrosis (0.5 '2.2) and elevated in hyperthyrosis (4.7-13.1). The reference intervals of the T 4 /TBG ratio were also determined for each trimester of pregnancy. A significant correlation was obtained between the values for T 4 /TBG ratio and FT 4 concentration, determined by the two-step radioimmunoassay (CIS-bio international, France), in healthy subjects and patients with thyroid disorders (r=0.93), as well as during pregnancy (0.59). In conclusion, we determined reference intervals for the T 4 /TBG ratio, confirming its practical usefulness in the assessment of thyroid function.
Advanced technical methods are essential for accurate diagnosis of Graves' or Basedow&... more Advanced technical methods are essential for accurate diagnosis of Graves' or Basedow's disease (GD). Inadequate methods may lead to a false diagnostic conclusion. We have analyzed the clinical features and methodology aspects of cases diagnosed as GD with negative findings for TSH receptor autoantibodies. The initial diagnosis was based on clinical findings (patient record, hypermetabolic state, goiter palpation) and laboratory testing (fT4 and TSH). From a total of 255 newly registered patients with GD, fifty-one (20%) were negative in a conventional porcine TBII assay. All fifty-one patients were retested with 131I or 99mTc uptake tests, thyroid scintigraphy, and a second-generation TBII assay. Results disclosed twenty-one cases (8.3%) with diagnosis other than GD: ten cases of autonomous hyperthyroidism (Plummer's disease), seven cases of painless thyroiditis and four cases of euthyroid endocrine ophthalmopathy. All twenty-one patients remained negative in the second-generation TBII assay. Measurement by second-generation TBII assay was performed on the remaining thirty patients initially found negative for TBII. As a result of this reevaluation, only 234 of the original 255 patients had GD. Of those, 231 (204 according to porcine plus 27 according to human TRAb assay) had detectable TBII (98.7%). This investigation stresses the problem of correct diagnosis and the methodological limitations in the assessment of laboratory parameter validity in GD. Based on this work, TSH receptor autoantibody-negative GD is extremely rare.
Estimated 80% of all referrals to Tertiary Care for Thyroid disease in Serbia are deemed unnecess... more Estimated 80% of all referrals to Tertiary Care for Thyroid disease in Serbia are deemed unnecessary or ill-timed by the specialty care providers, and detract from time and effort available to treat the remaining appropriate referrals. Documentation on patient treatment rarely is delivered from Primary Care to the Specialty Care center, necessitating costly duplication of laboratory and radiology testing. Documentation from the Specialty Care center often does not return to the Primary Care center, rendering follow up care more difficult, and denying Primary Care clinicians the opportunity to learn from each case. A deployed web-based electronic consultation system is proposed to alleviate the problems noted above. Appropriate organizational interventions will be designed into the pilot project to overcome inertial resistance to change, monitor utilization, and proactively ensure cost-effective systems implementation. The use of an electronic system will optimize the time a specialist spends with a referred patient, as complete diagnostic workups will have been completed and this needy patient will not be competing for specialist time with inappropriately referred patients. Additionally, modern database information supports detailed data analysis to observe clinical patterns and treatment effectiveness.
Environmental and climate changes are a threat for the survival of global ecosystems and biodiver... more Environmental and climate changes are a threat for the survival of global ecosystems and biodiversity. Climate changes can alter rainfall, influence crop fields, affect human health, cause changes to forests and other ecosystems, and impact energy supply. Paleoclimatic research, even not completely analogue, can illustrate how temperatures, precipitation patterns, cryospheric extent, and biospheric adaptations are affected by greenhouse gas emissions. It is the opportunity to observe Earth s system respond to high carbon dioxide, and paleoreconstructions can help us learn how resilient ecosystems become in a time of change. Investigation of small mammal fossils is very useful for Pleistocene terrestrial environment reconstructions. The methods include: Bioclimatic analysis and actualistic methods. Serbia within the Balkan Peninsula, is an interesting place to study the transition between the Late Pleistocene and Holocene and contribute to the knowledge about the formation of the current biodiversity in central Balkan. In the future, Serbia is expected to be especially affected by climate change. Understanding the response of natural systems to changing climate is important for sustainability, and can guide society in adaptation and mitigation, in order to improve present and future resilience of the country.
Even though industrial development has brought vast improvements to our daily lives, it carries w... more Even though industrial development has brought vast improvements to our daily lives, it carries with it negative effects such as adverse health outcomes caused by PM2.5 and other pollutants. The negative externalities and external costs might occur when property rights are not properly defined, which means that if no one holds a property right on the atmosphere and the quality of air, there is no appropriate mechanism to prevent a further expansion of negative effects. An economic burden of pollution related to premature morbidity and mortality in individual countries can account for 5–14% of GDP (World Bank, 2021). In 2019, the worldwide health cost of mortality and morbidity caused by exposure to PM2.5 concentration was $8.1 trillion, which is equivalent to 6.1 percent of the global gross domestic product (GDP) (World Bank estimate). Policymakers require evidence-based results that clearly show the impact that air pollution has on the economy and society, in order to be able to establish the proper regulations and ensure their successful implementation. The purpose of this long term study is to provide methods for assessing the negative effects of PM2.5 concentration on PM2.5-related mortality using panel data structure and demonstrate how socio-economic factors affect this relation. This study employed advanced econometric techniques to analyse the long-term impact of PM2.5 on human health, while controlling for socio economic indicators. This study has demonstrated significant effects of socio-economic, health risk and system and governance variables on the relation between PM2.5 concentration and PM2.5-related mortality.
Over the past decades, technological and economic growth has significantly contributed to the imp... more Over the past decades, technological and economic growth has significantly contributed to the improvement of the health care system through increased investment in technological research, training and the application of new technologies in health care. There is evidence that rapid technological and economic growth, contributing to the improvement of the health care system, also leads to a reduction in mortality rates, as well as to a longer life expectancy, which indirectly affects human activity in scientific and political spheres. At the same time, there is evidence that 2.5-micron particles (PM2.5 particles), as a result of industrial development and increased car use, have a negative impact on health outcomes around the world. This paper analyses the impact of increased concentration of PM2.5 particles in the air on economic and technological development, in order to explore whether there is an interdependent relationship between them. The paper aims to clarify the long-term eff...
The purpose of this study was to assess the effect of levocetirizine (xyzal) on salivary gland fu... more The purpose of this study was to assess the effect of levocetirizine (xyzal) on salivary gland function in patients with allergic rhinitis using technetium-99m pertechnetate ( 99m Tc-P) salivary gland scintigraphy. The study population consisted of 67 patients with allergic rhinitis and 31 ...
Environmental and social responsibility of companies • The panel data regression model and panel ... more Environmental and social responsibility of companies • The panel data regression model and panel data analysis • Motives for implementing an environmental friendly strategy within the firm • Business-innovative strategies to address social and environmental responsibility • "Going green" policy of the firms
Environmental and social responsibility of companies • The panel data regression model and panel ... more Environmental and social responsibility of companies • The panel data regression model and panel data analysis • Motives for implementing an environmental friendly strategy within the firm • Business-innovative strategies to address social and environmental responsibility • "Going green" policy of the firms
Organizational culture and organizational structure have a correlated interrelationship. Structur... more Organizational culture and organizational structure have a correlated interrelationship. Structure determines the behaviors, attitudes, dispositions and ethics that create the work culture. In this paper, the authors analyze the interrelationship between the organizational structure and culture in the mining companies in Eastern Serbia. Investigation was conducted in two companies, with 138 participants in the survey. The research was conducted at the beginning of 2016. The questionnaires included 50 questions concerning the organizational structure and culture, and were anonymous. The results confirmed a significant correlation between the organizational structure and culture in the investigated organizations.
Even though industrial development has brought vast improvements to our daily lives, it carries w... more Even though industrial development has brought vast improvements to our daily lives, it carries with it negative effects such as adverse health outcomes caused by PM2.5 and other pollutants. The negative externalities and external costs might occur when property rights are not properly defined, which means that if no one holds a property right on the atmosphere and the quality of air, there is no appropriate mechanism to prevent a further expansion of negative effects. An economic burden of pollution related to premature morbidity and mortality in individual countries can account for 5–14% of GDP (World Bank, 2021). In 2019, the worldwide health cost of mortality and morbidity caused by exposure to PM2.5 concentration was $8.1 trillion, which is equivalent to 6.1 percent of the global gross domestic product (GDP) (World Bank estimate). Policymakers require evidence-based results that clearly show the impact that air pollution has on the economy and society, in order to be able to establish the proper regulations and ensure their successful implementation. The purpose of this long term study is to provide methods for assessing the negative effects of PM2.5 concentration on PM2.5-related mortality using panel data structure and demonstrate how socio-economic factors affect this relation. This study employed advanced econometric techniques to analyse the long-term impact of PM2.5 on human health, while controlling for socio economic indicators. This study has demonstrated significant effects of socio-economic, health risk and system and governance variables on the relation between PM2.5 concentration and PM2.5-related mortality.
Over the past decades, technological and economic growth has significantly contributed to the imp... more Over the past decades, technological and economic growth has significantly contributed to the improvement of the health care system through increased investment in technological research, training and the application of new technologies in health care. There is evidence that rapid technological and economic growth, contributing to the improvement of the health care system, also leads to a reduction in mortality rates, as well as to a longer life expectancy, which indirectly affects human activity in scientific and political spheres. At the same time, there is evidence that 2.5-micron particles (PM2.5 particles), as a result of industrial development and increased car use, have a negative impact on health outcomes around the world. This paper analyses the impact of increased concentration of PM2.5 particles in the air on economic and technological development, in order to explore whether there is an interdependent relationship between them. The paper aims to clarify the long-term effect of PM2.5 on health outcomes, control of technological and economic growth, as well as other important factors, based on the analysis of given panel data and the application of modern econometric methods. Accordingly, the purpose of this paper is to provide information on the negative impact of PM2.5 particles on human health, as an indirect impact on the development of new materials and technologies, taking into account socioeconomic factors at the global level.
Graves' disease is an autoimmune disease wich etiology that is not completely understood. Num... more Graves' disease is an autoimmune disease wich etiology that is not completely understood. Numerous experimental investigations and clinical observations have primarily elucidated the role of the humoral stimulatory factors in the disease (LATS, TSI, etc). These autoantibodies (TRAb) react with TSH receptor and produce postreceptor stimulatory effects, that lead to hyperfunction of the thyroid. It is thus understandable why sensitive and specific techniques such as radioreceptor assays, cAMP generated in thyrocytes, etc. detect high levels of these autoantibodies in more than 85%, in patients with untreated Graves' disease 1-3 . The incidence and serum level of TRAb decrease during thyrosupressive therapy 4,5 , and are almost always negative in stable remission 6,7 . Transplacental passage of TRAb from mother to foetus, results in genesis of neonatal hyperthyroidism 8 . This model for the role of TRAb in autoimmune hyperthyroidism is partly complicated by the fact that not al...
It is generaly accepted that the thyrotropin receptor antibody (TRAb) has a stimulating activity ... more It is generaly accepted that the thyrotropin receptor antibody (TRAb) has a stimulating activity and is the major pathogenic factor in Graves' disease (GD). In spite of that, TRAb is not routinely examined in clinical practice. The aim of this article is to briefly review the subject and suggest protocols for the diagnosis, treatment and follow-up of patients with GD based on our own studies and referring especially to TRAb. Clinical symptoms and signs and thyroid hormones may have poor sensitivity or specificity, especially in cases of endocrine ophthalmopathy and subclinical hyperthyroidism. In these cases the TRAb test is 98% sensitive and specific with a diagnostic accuracy of almost 99%. By this test it is possible to differentiate between autoimmune and other forms of thyrotoxicosis such as autonomous hyperthyroidism, destructive thyroiditis, iodine induced hyperthyroidism etc. Antithyroid drugs decrease serum TRAb levels and also induce immune remission. If after treatment TRAb remains increased as in about 30% of our cases, patients will relapse. In pregnant women with GD the follow-up of serum TRAb levels is also important as predictive of immune thyroid disease in the newborn. Data presented in this article confirm that the determination of serum TRAb levels in some rare hyperthyroid disorders, such as associated autoimmune and autonomous forms and in epidemiological studies, is also justified.
Iodine prophylaxis implemented at the territory of former Yugoslavia in 1953, has successfully co... more Iodine prophylaxis implemented at the territory of former Yugoslavia in 1953, has successfully corrected previously existent mild iodine deficiency in East Serbia. Clinical findings (incidence of goiter in school children, ratio of diffuse to focal toxic goiters, uptake of 131I in healthy persons) in subsequent decades were adequate for the areas with corrected iodine deficiency. Iodine content in consume salt was increased from 10mg KI/ kg to 20 mg KI/kg, for the entire territory of Serbia, by federal legislation, in 1993. This report is presenting an occasional investigation of variation in thyroid morbidity and neonatal TSH, in the area of corrected iodine deficiency, in conditions of increasing iodine consumption. Investigated parameters included: neonatal TSH, incidence of autoimmune thyroid diseases (Graves'-Basedow disease, Hashimoto's thyroiditis, primary hypothyroidism), and autonomous thyrotoxicosis (Plummer's disease), incidence of goiter in school children, uptake of 131I in healthy persons, in the period 1978 - 2000. Results have demonstrated that two years following the implementation of increased iodization, findings of neonatal TSH decreased for average 40% and incidence of autoimmune hyperthyroidism increased over 250%. In subsequent two years, both parameters have recovered. Incidence of Hashimoto's thyroiditis, primary hypothyroidism, and autonomous thyrotoxicos (Plummer's disease) incidence of goiter in school children, was unchanged. There is a considerable probability that modification of thyroid morbidity was initiated by increased iodine consumption in the region with previously corrected iodine deficiency, although other factors could not be excluded.
The proportion of free hormones can be estimated in the presence of protein-bound hormones by a v... more The proportion of free hormones can be estimated in the presence of protein-bound hormones by a variety of direct assay approaches or by a two test strategy to calculate a free hormone »index«. The T 4 /TBG ratio, determined from measurements of total thyroxine (TT 4) and thyroxine-binding globulin (TBG) concentrations, is an appropriate index with improved diagnostic accuracy compared with T 4. In this study, we calculated the T 4 /TBG ratio after determining serum TT 4 and TBG by radioimmunoassay (INEP, SCG) in euthyroid persons (n=102), in patients with hypothyrosis (n=33) and hyperthyrosis (n=66), as well as in healthy pregnant women (n=346). The reference range for each group of patients was determined. Values obtained for the T 4 /TBG ratio in healthy subjects varied from 2.1 to 4.4. They were lower in hypothyrosis (0.5 '2.2) and elevated in hyperthyrosis (4.7-13.1). The reference intervals of the T 4 /TBG ratio were also determined for each trimester of pregnancy. A significant correlation was obtained between the values for T 4 /TBG ratio and FT 4 concentration, determined by the two-step radioimmunoassay (CIS-bio international, France), in healthy subjects and patients with thyroid disorders (r=0.93), as well as during pregnancy (0.59). In conclusion, we determined reference intervals for the T 4 /TBG ratio, confirming its practical usefulness in the assessment of thyroid function.
Advanced technical methods are essential for accurate diagnosis of Graves' or Basedow&... more Advanced technical methods are essential for accurate diagnosis of Graves' or Basedow's disease (GD). Inadequate methods may lead to a false diagnostic conclusion. We have analyzed the clinical features and methodology aspects of cases diagnosed as GD with negative findings for TSH receptor autoantibodies. The initial diagnosis was based on clinical findings (patient record, hypermetabolic state, goiter palpation) and laboratory testing (fT4 and TSH). From a total of 255 newly registered patients with GD, fifty-one (20%) were negative in a conventional porcine TBII assay. All fifty-one patients were retested with 131I or 99mTc uptake tests, thyroid scintigraphy, and a second-generation TBII assay. Results disclosed twenty-one cases (8.3%) with diagnosis other than GD: ten cases of autonomous hyperthyroidism (Plummer's disease), seven cases of painless thyroiditis and four cases of euthyroid endocrine ophthalmopathy. All twenty-one patients remained negative in the second-generation TBII assay. Measurement by second-generation TBII assay was performed on the remaining thirty patients initially found negative for TBII. As a result of this reevaluation, only 234 of the original 255 patients had GD. Of those, 231 (204 according to porcine plus 27 according to human TRAb assay) had detectable TBII (98.7%). This investigation stresses the problem of correct diagnosis and the methodological limitations in the assessment of laboratory parameter validity in GD. Based on this work, TSH receptor autoantibody-negative GD is extremely rare.
Estimated 80% of all referrals to Tertiary Care for Thyroid disease in Serbia are deemed unnecess... more Estimated 80% of all referrals to Tertiary Care for Thyroid disease in Serbia are deemed unnecessary or ill-timed by the specialty care providers, and detract from time and effort available to treat the remaining appropriate referrals. Documentation on patient treatment rarely is delivered from Primary Care to the Specialty Care center, necessitating costly duplication of laboratory and radiology testing. Documentation from the Specialty Care center often does not return to the Primary Care center, rendering follow up care more difficult, and denying Primary Care clinicians the opportunity to learn from each case. A deployed web-based electronic consultation system is proposed to alleviate the problems noted above. Appropriate organizational interventions will be designed into the pilot project to overcome inertial resistance to change, monitor utilization, and proactively ensure cost-effective systems implementation. The use of an electronic system will optimize the time a specialist spends with a referred patient, as complete diagnostic workups will have been completed and this needy patient will not be competing for specialist time with inappropriately referred patients. Additionally, modern database information supports detailed data analysis to observe clinical patterns and treatment effectiveness.
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Papers by Jane Paunkovic