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Background: Higher levels of thyroid autoantibodies in follicular fluid (FF) of thyroid autoimmunity (TAI) positive women are strongly correlated with serum levels and may have effect on the post-implantation embryo development. Literature highlights that levothyroxine (LT4) treatment may attenuate the risk of adverse pregnancy outcomes. The aim of the study was to estimate the pregnancy and newborn outcomes in women with FF thyroid autoantibodies undergoing assisted reproductive technology (A RT). Methods: The study population included 24 women with confirmed clinical pregnancy, 8 TAI positive and 16 TAI negative women. LT4 supplementation was applied in 20.8% patients, TAI positive. Results: Pregnancy outcomes were: twin pregnancy rate 4 1 .7 % , early miscarriage rate 8.3% , late miscarriage rate 4.2% , preterm birth rate 16.7% , term birth rate 70.8% , live birth rate 96.0% . There was significant difference in serum and in FF TgAbs (p< 0.001)betw een the groups according to TAI, while serum fT 3 was lower in the group with TAI (p = 0 .0 4 7 ). Serum P 4 was higher in LT4 treated group (p = 0 .0 0 5 ), with TAI, and newborns in this group had higher birth weight (p = 0.001) and height (p = 0 .0 0 8 ). Maternal complications occurred in 23.8% of patients. No congenital malformations in newborns were noted. Conclusions: Thyroid autoantibodies present in FF may have an effect on the post-implantation embryo development, but have no effect on further course of pregnancy. The special benefit of LT4 treatment for successful A R T outcome was demonstrated for newborn anthropometric parameters.

Today, infertility is not only a serious health but also a psycho-social problem, one that is on the rise in the world. Thyroid autoimmunity (TAI) is the most common disease of the thyroid gland in the reproductive period, which can affect spontaneous conception as well as conception through assisted reproduction technology (ART), but also the maintenance of healthy pregnancy. It can also cause numerous maternal and fetal complications. There is a wide array of publications on the topic of the mechanisms of association between TAI and reproduction, with the question of whether thyroid autoantibodies are solely tissue-specific antibodies, whether and when to start levothyroxine treatment, and that we require more fundamental research on the direct effect of thyroid autoantibodies starting from folliculogenesis to embryogenesis and implantation as well as the post-implantation embryo development, but also the composition of the follicular fluid as a microenvironment of enormous importance for the maturation of the oocytes which thyroid autoantibodies reach via the blood-follicle barrier.

Medullary thyroid carcinoma is a form of neuroendocrine tumor that arises from parafollicular C cells which produce calcitonin. In addition to calcitonin, these cells produce smaller amounts of other peptides, including carcinoembryonic antigen (CEA), which is used as a nonspecific tumor marker in the follow-up of patients with this tumor. MTC is a rare thyroid tumor and occurs three times more often in women than in men. It can occur in two forms, sporadic (80%) and familial form (20%). The familial form can occur alone or in association with other endocrine tumors within MEN 2A and MEN 2B syndromes. The sporadic form most often occurs in the fifth and sixth decades of life. The familial form is inherited autosomally dominantly, most often based on a mutation in the RET protooncogene located on chromosome 10. C-cell hyperplasia is considered to be a premalignant lesion, which precedes medullary carcinoma. Medullary carcinoma metastasizes very early. We presented a patient with a sporadic form of MTC which appeared at a typical age. Initial values of both baseline and stimulated calcitonin were not in the range for suspected MCT, but due to persistent increases in calcitonin, with elevated baseline (63 pg / mL) and higher stimulated calcitonin (96 pg / mL), the patient was referred for surgical treatment. Due to the strong correlation of calcitonin values with tumor size, the initial calcitonin values were expected to be low because the tumor was 3 mm in size. The histopathological diagnosis was C-cell hyperplasia. However, due to the fact that nodular C-cell hyperplasia is histopathologically difficult to distinguish from medullary microcarcinoma, based on the persistent increase in calcitonin levels, the patient was likely to already have metastatic disease at the time of thyroidectomy. Definitive diagnosis was made by liver biopsy. Therapy with tyrosine kinase inhibitors was introduced, and calcitonin levels strarted to decrea, but there is an increase in carcinoembryonic antigen, which is a poor prognostic parameter.

Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, is a necrotizing vasculitis of small and medium-sized blood vessels characterized by diffuse inflammation of vascular structures and perivascular and extravascular granulomatosis. In its systemic form, GPA predominantly affects the ear, nose and throat, with lung and kidney involvement with typically rapidly progressive necrotizing glomerulonephritis with extracapillary crescents, while the absence of kidney damage at the time of diagnosis is defined as a limited form of GPA with a more favorable prognosis (1, 2). Antineutrophil cytoplasmic antibodies (c-ANCA) with specificity for proteinase 3 (PR3) represent a biochemical diagnostic criterion. They are detected in 90% of generalized forms and in about 50% of limited forms of granulomatosis with polyangiitis (1, 2). In the absence of treatment, GPA is a disease of progressive evolution. Systemic corticosteroid therapy and immunosuppressive therapy significantly changed the prognostic aspect of the disease. Only a few sporadic observations have been published on endocrine disorders associated with GPA. We present a case of a man, 39 years old, with Wegener's granulomatosis who developed autoimmune thyroiditis 8 years after the initial diagnosis.

Thyroid nodules (TN) are present in about half of the population. About 5% of all nodules are malignant. Image-guided methods for the treatment of TN are becoming a significant alternative to surgery. Percutaneous ethanol ablation (PEA) is effective in the treatment of thyroid cysts, and neck lymph node metastases. Percutaneous laser ablation (PLA) significantly reduces the size of the nodules and improves subjective symptoms. The adverse effects of PEA are rare, transitory, and mild. Radiofrequency ablation (RFA) is effective for nodules of all sizes and compositions. The major complications of RFA are rare and transient. Microwave ablation is also effective in the treatment of thyroid nodules with rare major complications. High-intensity focused ultrasound (HIFU) is a transcutaneous method. It is effective in the treatment of thyroid nodules, and complications are rare. Graves' hyperthyroidism was also treated with HIFU. As thermal ablation (TA ) methods are becoming more popular in 2020, the European Thyroid Association published clinical practice guidelines for the use of image-guided ablation in benign thyroid nodules. A meta-analysis showed that low-risk papillary thyroid microcarcinoma recurrences after TA treatment are rare, as are complications. As the TA methods are acceptable for the treatment of the low-risk papillary thyroid carcinoma European Thyroid Association and Cardiovascular and Interventional Radiological Society of Europe issued clinical practice guidelines for the use of minimally invasive treatments in malignant thyroid lesions. Image-guided treatments for thyroid nodules and cancer are here to stay. Their use will expand and become part of routine clinical practice.

Mercury (Hg) is one of the most important environmental pollutants with endocrine- disrupting properties. There is little data from epidemiological studies describing the dose- response relationship between toxic metal levels and hormone levels. The aim of this study was to use the nearest neighbor matching analysis to determine the difference in Hg concentration in healthy/sick subjects with thyroid disease and to use Benchmark modeling to determine the dose- response relationship between Hg levels in the blood and thyroid-stimulating hormone (TSH) and thyroid hormones in serum. Blood samples were collected and used for Hg measurement using the ICP-MS method, and separated serum was used for hormone analysis. The study showed the existence of a statistically significant difference in Hg levels measured in healthy and sick subjects and the existence of a dose-response relationship between Hg and all measured hormones, with a narrow interval obtained for the Hg-TSH pair. The results of this research support the use of the Benchmark dose approach for the purpose of analyzing data from human studies, and our further research will be focused on examining the impact of low doses on animal models in order to determine more precise effects of low doses on the organism. Živa (Hg) je jedan od najznačajnijih zagađivača životne sredine sa osobinama endokrinog ometača. Malo je podataka iz epidemioloških studija koji opisuju odnos doza-odgovor između nivoa toksičnih metala i nivoa hormona. Cilj ovog rada bio je da primenom nearest neighbor matching analize utvrdi razliku u koncentraciji Hg kod zdravih/obolelih ispitanika od bolesti štitaste žlezde i da primenom Benchmark modelovanja utvrdi odnos doza-odgovor između nivoa Hg u krvi i tireostimulišućeg hormona (TSH) i tiroidnih hormona u serumu. Uzorci krvi su sakupljeni i korišćeni za merenje Hg uz pomoć ICP-MS metode, a izdvojeni serum korišćen je za analizu hormona. Studija je pokazala postojanje statistički značajne razlike u nivoima Hg koji su izmereni kod zdravih i bolesnih ispitanika i postojanje odnosa doza-odgovor između Hg i svih merenih hormona, pri čemu je uzak interval dobijen za Hg-TSH par. Rezultati ovog istraživanja podržavaju upotrebu Benchmark dose pristupa u svrhu analize podataka iz humanih studija, a naša dalja istraživanja će biti usmerena na ispitivanje uticaja niskih doza na životinjskim modelima, u cilju utvrđivanja preciznijih efekata niskih doza na organizam.

Economic growth is a key point of macroeconomic policy and is the subject of constant attention and debate by professional public and policy makers. Theoretical and empirical research indicates differences in the level and direction of determinants’ influence on the growth rate. The main goal of our article is to construct a model of economic growth determinants in South-East European countries. We used an unbalanced panel of 12 selected SEE countries over the period 2006–2019. Our empirical findings have shown that the most robust results can be obtained using a two-step generalized method of moments (GMM) model with dummy variable. In our dynamic model, we found that trade openness and gross fixed capital formation have a positive impact on economic growth, while government expenditures negatively determine economic growth. Gross fixed capital formation has the greatest positive impact on economic growth, while government expenditure has the greatest negative impact.

Thyrotropin receptor autoantibodies (TSH-R-Ab) are heterogeneous in their biological function and play a significant role in the pathophysiology of both Graves’ disease and Graves’ orbitopathy (GO). The clinical significance and utility of determining functional TSH-R-Ab in a Serbian collective were evaluated. 91 consecutive patients with GO were included in this study. Total TSH-R-Ab concentration, referred to as TSH-R binding inhibitory immunoglobulins (TBII) was detected using a competitive-binding immunoassay. Stimulating and blocking TSH-R-Ab (TSAb and TBAb) were measured with cell-based bioassays. Stimulating TSAb activity and TBII positivity were detected in 85 of 91 (93.4%) and 65 of 91 (71.4%) patients with GO (P

There are three basic modalities for the treatment of thyrotoxicosis: thyrosuppresive drug therapy, ablation with radioactive iodine and surgical treatment. Patients who do not achieve adequate thyrotoxicosis control, as was the case of described patient, have a high mortality rate due to the possibility of developing a thyroid storm. The use of drug therapy for hyperthyroidism, as the first line of treatment, is associated with the appearance of various side effects, as was the case in our patient. Side effects of Methimazole are dose-dependent, while in the case of Propylthiouracil, the occurrence of side effects is not clearly dose-dependent. In the case of the described patient, all alternative, lesser known modalities for the treatment of hyperthyroidism were applied, after the occurrence of adverse reactions to thyrosuppressive therapy. Sodium perchlorate, ie. Sodium with perchloric acid is rarely used in the treatment of hyperthyroidism, as in cases of severe idiosyncratic reactions to thionamides, agranulocytosis or hepatitis, if the eumetabolic state is not achieved and the application of a therapeutic dose of radioiodine is not possible. It is applied in the form of a solution, usually 8%; In more severe forms of the disease, when hyperthyroidism is very pronounced, 10 to 15 drops a day are given 4 to 6 times and the dose is sometimes reduced to the minimum maintenance dose. After the adverse reaction even to sodium perchlorate therapy we were left with one more, last option-Plasma Therapy exchange. Plasma Therapy Exchange (TPE) is an out-of-body blood purification technique designed to remove high-molecular-weight substances bound to plasma proteins (autoantibody pathogens, immunocomplexes, cryoglobulins, myeloma light chains, endotoxins, lipoprotein-containing cholesterol, and thyroid). The effectiveness of treatment depends on the volume of blood being processed, the volume of plasma exchanged in each process, the number of procedures performed, the frequency of exchange and the rate of mobilization, stabilization and re-synthesis of cells or plasma components. TPE is an effective alternative treatment that provides an opportunity to prepare patients for definitive treatment: ablative therapy such as RAI ablation or thyroidectomy. Therapeutic plasmapheresis, if performed in specialist centers, is a safe, fast and effective method.

Parathyroid cancer (PC) is an uncommon malignant disease, with less than 1,000 cases reported in the literature since de Quervain first described it in 1904 as a non-functional metastatic cancer. With an estimated prevalence of 0.005% of all cancers, PC is the rarest endocrine cancer and accounts for only 0.5-5% of all cases of primary hyperparathyroidism (PHPT). The pathogenesis of PC is unknown. The etiology of PC is not clear and there is no evidence that PC is formed by the transformation of pre-existing parathyroid lesions. The aberrant profile of microRNA expression and methylation recently identified by PCR provides evidence that malignant forms of the parathyroid gland are different from benign lesions. PC may be sporadic or part of a genetic syndrome. Sporadic PC is most often associated with exposure to external radiation, and rarely with secondary and tertiary HPT due to chronic renal failure. The association of PC, synchronous or metachronous, with a history of PT gland hyperplasia, parathyroid adenoma (PA), or thyroid cancer with concomitant PA has also been reported. PC usually presents with indolent but persistent clinical symptoms; patients often show symptoms and complications of severe PHPT such as anxiety, depression, weakness, weight loss, bone and kidney disease, abdominal pain, nausea, pancreatitis, and peptic ulcer. In the investigation series, 50% of patients show manifestations of renal and bone pathology, including osteopenia, osteoporosis, osteoofibrosis, osteitis fibrosa cystica, subperiosteal resorption and pathological fractures. Renal disease manifests mainly as nephrolithiasis and renal failure with a prevalence of 56 and 84%, respectively. It has been observed that serum calcium levels are often higher than 3.5 mmol / l (as opposed to 3 cm should cause PC suspicion. Intraoperative findings suspected on PC have been described. In most series, the median maximum PC diameter is 3-3.5 cm (

Montenegro faces serious challenges in terms of waste tire management. The main goal of our paper is to consider the financial and economic justification of the implementation of the first phase of the project of collection, takeover and transport, sorting, and storage of waste tires from the three municipalities in Montenegro. The financial feasibility analysis pointed out the need to organize the second phase of the project and the production of commercially usable and energy efficient products. That phase would lead to the desired commercial effects and will probably ensure the financial sustainability of the project. The economic feasibility analysis of the project included an assessment of the socio-economic benefits from the emission reduction of the first group of pollutants (PM, SOX, NOX, VOC, CO) as a consequence of the waste tires’ destruction, predominantly by combusting them. Unit values of pollution costs by types of gases, adjusted for Montenegro, were defined in the interval from 192 EUR/t for CO to 24,294 EUR/t for PM. We proved that the direct socio-economic benefits of this project are savings in the cost of environmental pollution. The total present value of discounted costs in the observed time period was calculated at the level of EUR 1,620,080, while the total present value of the positive socio-economic effects was estimated at EUR 1,991,180. Dynamic justification indicators suggest that this investment has a satisfactory socio-economic justification, i.e., the economic rate of return is higher than the opportunity cost of capital (ERR = 15.82%), the economic net present value is greater than 0 (ENPV = 371,100 EUR), and the benefit–cost ratio is greater than 1 (B/C ratio = 1.23).

Improved Cost-Benefit Analysis (CBA) analysis requires a broader analytical framework, in order to perceive each project individually from the perspective of potentially measurable and significant effects on the environment and society as a whole. The main goal of our paper is to assess the financial and economic justification for variant V3 (as the most technically optimal) of the wastewater treatment plant (WWTP) construction project in Nov Dojran, North Macedonia, with the purpose of advancing municipal infrastructure and environmental benefits from improved water treatment. Based on the economic analysis conducted, we conclude that the investment in the WWTP project is justified, because the economic internal rate of return is higher than the opportunity cost of capital (EIRR = 16.38%), the economic net present value is higher than 0, and EBCR (benefit-cost ratio) is greater than 1 (EBCR = 2.11). The highest environmental benefit of 49.2% in total environmental benefits is associated with nitrogen, while phosphorus is the next pollutant in the structure of environmental benefits at 46.1%. The environmental benefits of removing biological oxygen demand (BOD) and chemical oxygen demand (COD) are significantly less important, despite the removal of significant amounts of these pollutants during treatment. The situation is similar with suspended particles.

Objective: Information on the impact of SARS-COV-2 on the daily life of thyroid patients during lockdown is sparse. The main objective was explorative, focusing on how SARS-COV-2 affected thyroid patients. Design: Cross-sectional, questionnaire-based, using an online platform. Patients: Patients >18 years with a history of thyroid disease. Measurements: Demographic data, psychological impact of SARS-COV-2, medical care during the pandemic. Results: Valid responses were received from 609 responders. The median age was 50 years, 94% were female and 98.5% were UK residents. The commonest diagnosis was primary hypothyroidism (52.2%). Negative psychological effects following the lockdown were reported by 45.6%–58.7%. Cancellations of appointments with thyroid specialists were reported by 43.8%, although cancellations of thyroid investigations and treatments were relatively infrequent (12.9%–14.1%). Overall satisfaction rates for thyroid services were low (satisfaction score 40.1–42.8 out of 100), but nearly 80% were satisfied with remote consultations. Responder ratings of online information sources about SARS-COV-2 and thyroid diseases were lowest for government sites. Unmet needs during lockdown were: more remote access to thyroid specialists, more online information in ‘plain English’, and psychological support. In multivariate analyses, younger age, female gender, history of depression, hyperthyroidism, not having contracted SARS-COV-2 and multiple comorbidities were risk factors for a negative psychological impact of lockdown. Conclusions: This survey identified a significant negative impact of SARS-COV-2 and lockdown on psychological wellbeing, particularly in some groups of patients defined by demographic factors, history of hyperthyroidism and comorbidities. Low satisfaction with healthcare services among thyroid patients was noted, but remote consultations were rated favourably.

Although thyroid hormones have significant effect on cardiovascular system, the impact of subtle thyroid dysfunction such as subclinical hypothyroidism (SCH) remains to be determined. We investigated coronary flow reserve (CFR) in patients with subclinical hypothyroidism.Thirty two subjects with SCH and eighteen control subjects with normal serum thyroid hormones and thyroid-stimulating hormone (TSH) levels were included in the study. TSH, free thyroxine, free triiodothyronine, glucose, insulin, HbA1c, cholesterol, triglyceride and plasma levels of C-reactive protein were measured. Coronary diastolic peak flow velocities in left anterior descending coronary artery were measured at baseline and after adenosine infusion. CFR was calculated as the ratio of hyperemic to baseline diastolic peak velocity.CFR values were not significantly different between the two groups (SCH 2.76±0.35 vs controls 2.76±0.42). There was a significant correlation of CFR with waist to hip ratio, hypertension, smoking habits, markers of glucose status (glucose level, HbA1c, insulin level, HOMA IR), cholesterol, LDL-cholesterol and triglyceride levels in SCH group, whereas only cholesterol level showed significant correlation with CFR in controls. There was no correlation between CFR and thyroid hormones.We concluded that there is a different impact of cardiovascular risk factors on CFR in SCH patients compared to healthy control and that these two groups behave differently in the same circumstances under the same risk factors. The basis for this difference could be that the altered thyroid axis "set point" changes the sensitivity of the microvasculature in patients with SCH to known risk factors.Poznato je da tiroidni hormoni imaju značajan efekat na kardiovaskularni sistem, ali i dalje ostaje da se utvrdi uticaj suptilnih promena na nivou tiroidne osovine kao što je subklinička hipotireoza (SHT). Ispitivali smo koronarnu rezervu protoka (KRP) kod pacijenata sa subkliničkim hipotireoidizmom.Trideset dva ispitanika sa subkliničkom hipotireozom i osamnaest kontrolnih ispitanika sa urednim tiroidnim hormonskim statusom su bili uključeni u studiju. Mereni su TSH, fT4, fT3, glukoza, insulin, HbA1c, holesterol, trigliceridi i CRP. Koronarne dijastolne brzine protoka u levoj prednjoj silaznoj koronarnoj arteriji merene su na početku i nakon infuzije adenozina. Koronarna rezerva protoka je izračunata kao odnos hiperemijske i osnovne dijastolne brzine protoka.Vrednosti koronarne rezerve protoka se nisu značajno razlikovale između dve grupe (SHT 2,76 ± 0,35 u odnosu na kontrole 2,76 ± 0,42). Postojala je značajna korelacija KRP sa odnosom struka i kukova, hipertenzijom, navikama pušenja, markerima glikoregulacije (nivo glukoze, HbA1c, nivo insulina, HOMA IR), holesterolom, LDL holesterolom i nivoom triglicerida u SHT grupi, dok je samo nivo holesterola pokazao značajnu korelaciju sa KRP u kontrolnoj grupi. Nije bilo korelacije između KRP i hormona štitaste žlezde.Zaključili smo da postoji drugačiji uticaj kardiovaskularnih faktora rizika na koronarnu rezervu protoka kod pacijenata sa subkliničkom hipotireozom u poređenju sa zdravom kontrolom i da se ove dve grupe ponašaju različito u istim okolnostima, pod istim faktorima rizika. Osnova za ovu razliku mogla bi biti da promenjen "set point" tiroidne osovine menja osetljivost mikrovaskulature kod pacijenata sa SHT na poznate faktore rizika.

Primary aldosteronism (PA) is associated with increased prevalence of metabolic disorders (impaired glucose and lipid metabolism and insulin resistance), but also with more frequent cardiovascular, renal and central nervous system complications.Biochemical and clinical parameters were retrospectively analysed for 40 patients with PA caused by aldosterone-producing adenoma (APA) and compared to the control groups of 40 patients with nonfunctioning adrenal adenoma (NFA) and essential hypertension (HT), and 20 patients with adrenal Cushing syndrome (CS) or subclinical CS (SCS).Systolic, diastolic and mean arterial blood pressures were significantly higher in the PA group (p=0.004; p=0.002; p=0.001, respectively) than in NFA+HT group. PA patients had longer hypertension history (p=0.001) than patients with hypercorticism and all had hypokalaemia. This group showed the smallest mean tumour diameter (p0.001). The metabolic syndrome was significantly less common in the PA group (37.5% vs. 70% in CS+SCS and 65% in NFA+HT group; p=0.015), although there was no significant difference in any of the analysed metabolic parameters between groups. PA group was found to have the most patients with glucose intolerance (81.8%), although the difference was not significant. The mean BMI for all three groups was in the overweight range. Patients with PA had higher microalbuminuria and a higher tendency for cardiovascular, renal and cerebrovascular events, but the difference was not significant.Our results support the importance of the early recognition of primary aldosteronism on the bases of clinical presentation, as well as an increased screening intensity.Primarni aldosteronizam (PA) je praćen povećanom prevalencom metaboličkih poremećaja, (oštećen glukozni i lipidni metabolizam i insulinska rezistencija), ali i češćim kardio vaskularnim, renalnim i komplikacijama centralnog nervnog sistema.Analizirane su retrospektivno biohemijske i kliničke karakteristike 40 pacijenata sa PA zbog aldosteron-produkujućeg adenoma (APA) i upoređene sa kontrolnim grupama od 40 pacijenata sa afunkcionim adrenalnim adenomom (NFA) i esencijalnom hipertenzijom (HT), i 20 pacijenata sa adrenalnim Cushing-ovim sindromom (CS) ili subkliničkim CS (SCS).Sistolni, dijastolni i srednji arterijski pritisci su bili značajno viši u grupi sa PA (p=0,004; p=0,002; p=0,001, redom) nego u grupi NFA+HT. PA pacijenti su imali dužu istoriju hipertenzije (p=0,001) nego pacijenti sa hiperkorticizmom i svi su imali hipokalemiju. Ova grupa je imala najmanji srednji prečnik tumora (p0,001). Metabolički sindrom je bio značajno ređi u PA grupi (37,5% vs. 70% u CS+SCS i 65% u NFA+HT grupi; p=0,015), mada nije bilo značajne razlike u bilo kom analiziranom metaboličkom parametru među grupama. U PA grupi je nađen najveći procenat pacijenata sa glikoznom intolerancijom (81,8%), mada razlika nije bila značajna. Srednja vrednost BMI za sve tri grupe je bila u rangu prekomerne težine. Pacijenti sa PA su imali veći stepen mikroalbuminurije, veću tendencija ka javljanju kardiovaskularnih, renalnih i cerebrovaskularnih događaja, ali razlika nije bila značajna.Naši rezultati podržavaju značaj ranog prepoznavanja primarnog aldosteronizma na osnovu kliničke prezentacije, ali i povećanog korišćenja skrininga.

Balancing of different dimensions of development—economic, environmental, social, is an imperative of policies and strategies of sustainable growth, which are practiced today in the EU and globally. The main aim of our paper is to investigate the relationship between renewable (REC) and non-renewable energy consumption (NREC), greenhouse gas (GHG) emissions and share of ICT in total exports, on one hand, and GDP p.c. on the other. We created a model for EU countries divided in two groups—old and new EU members, by using PMG and ARDL models. Considering the size and structure of the sample of countries, the selected variables in the model and the relevant period (2000–2020), to a certain extent, we filled the research gap in the existing literature. Our results indicate that a 1% increase in the share of REC and ICT in total exports leads to GDP p.c. growth in the long run by 0.151% and 0.168% in old EU countries, i.e., 0.067% and 0.039% in new EU countries, respectively. Contrary, an increase of NREC by 1% has a significant and negative impact on GDP p.c. in the long run, in both groups, leading to a decrease of economic growth by 0.512% in the old and 1.306% in the new EU group. We find a 1% increase of GHG emissions was accompanied by an increase of GDP p.c. in new EU countries by 0.939%, while that impact is insignificant in old EU countries in the long run. We conclude our paper with final remarks and policy implications.

Objective: Dissatisfaction with treatment and impaired quality of life (QOL) are reported among people with treated hypothyroidism. We aimed to gain insight into this. Design and patients: We conducted an online survey of individuals with self-reported hypothyroidism. Results: Nine hundred sixty-nine responses were analysed. Dissatisfaction with treatment was common (77.6%), and overall QOL scores were low. Patient satisfaction did not correlate with type of thyroid hormone treatment, but treatment with combination levothyroxine (L-T4) and liothyronine (L-T3) or with desiccated thyroid extract (DTE) was associated with significantly better reported QOL than L-T4 or L-T3 monotherapies (P

Purpose: Graves’ orbitopathy (GO) is an inflammatory autoimmune disorder of the orbit and while the antiphospholipid antibodies (aPL) Abs were associated with the markers of inflammation in the antiphospholipid syndrome (APS), there is no literature that investigate the presence of aPL Abs in GO. We analyzed the prevalence of aPL Abs and the differences between aPL (+) and aPL (−) subgroups of GO patients. Methods: Study included consecutive patients with GO (66 with Graves’ (GD), 10 with Hashimoto (HD), and 8 were euthyroid). Anticardiolipin (aCL) and anti-beta 2glycoprotein I (aβ2gpI) Abs were measured by ELISA. Results: aPL Abs were present in 9/84 (10.71%) patients. The IgM aβ2gpI Abs were present in 8/66 and in 1/10 patients with GD and HD. The IgG aCL Abs were present in one GD patient, and IgM aCL were present in 3/66 GD and in 1/10 patients with HD. In GD group, anti-Tg Abs were in positive correlation with aβ2gpI IgG (p = 0.000) and with anti-TPO Abs (p = 0.016). In HD group, anti-Tg Abs were in positive correlation with IgM aCL (p = 0.042), while anti-TPO Abs were in positive correlation with aβ2gpI IgM (p = 0.014). Conclusion: This study is the first report of the aPL Abs presence in GO patients. The anti-thyroid Abs were linked to aPL suggesting that their presence is not the sole consequence of hyperstimulation of autoreactive B-lymphocytes. Larger studies are necessary to confirm potential cause-effect relations. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

The European Union, as a signatory to the Paris Agreement, has approached the action against greenhouse gas (GHG) emissions and climate change quite ambitiously, striving to achieve climate neutrality by 2050. Extension of the European Green Deal policy implementation to the Western Balkans can only increase the chances of the climate neutral agenda. Expectations from Montenegro in the coming period are transposable to other Western Balkans countries as they are urged to start implementing the Paris Agreement by establishing appropriate policies and measures. In this regard, this paper presents the analysis of the financial and economic analysis results of measures to reduce GHG emissions in Montenegro. With this respect, least cost analysis—cost effectiveness analysis and cost–benefit analysis were conducted. The analysis results indicated that due to the thermal power plant reconstruction, increased use of renewable energy sources and measures to increase energy efficiency, the largest reduction in GHG emissions in Montenegro in the next 10 years is expected in the energy sector.

Purpose: Whereas antithyroid drugs (ATD) are the preferred treatment modality for Graves’ hyperthyroidism (GH), there is still controversy about the optimal regimen for delivering ATD. To evaluate whether ‘Block and Replace’ (B + R) and ‘Titration’ (T) regimes are equivalent in terms of frequency of euthyroidism and Graves’ Orbitopathy (GO) during ATD therapy. Methods: A prospective multicentre observational cohort study of 344 patients with GH but no GO at baseline. Patients were treated with ATD for 18 months according to B + R or T regimen in line with their institution’s policy. Results: Baseline characteristics were similar in both groups. In the treatment period between 6 and 18 months thyrotropin (TSH) slightly increased in both groups, but TSH was on average 0.59 mU/L (95% CI 0.27–0.85) lower in the B + R group at all time points (p = 0.026). Serum free thyroxine (FT4) remained stable during the same interval, with a tendency to higher values in the B + R group. The point-prevalence of euthyroidism (TSH and FT4 within their reference ranges) increased with longer duration of ATD in both groups; it was always higher in the T group than in the B + R group: 48 and 24%, respectively, at 6 months, 81 and 58% at 12 months, and 87 and 63% at 18 months (p < 0.002). There were no significant differences between the B + R and T regimens with respect to the fall in thyrotropin binding inhibiting immunoglobulins (TBII) or thyroid peroxidase antibodies (TPO-Ab). GO developed in 15.9% of all patients: 9.1 and 17.8% in B + R group and T group, respectively, (p = 0.096). GO was mild in 13% and moderate-to-severe in 2%. Conclusion: The prevalence of biochemical euthyroidism during treatment with antithyroid drugs is higher during T compared to B + R regimen. De novo development of GO did not differ significantly between the two regimens, although it tended to be higher in the T group. Whether one regimen is clinically more advantageous than the other remains unclear.

In this paper, the authors made their contribution by constructing a model for the forecast of average annual net earnings in the EU countries. The model is based on the artificial neural network (ANN) use and for the needs of its creation the authors have presented their proposal for a model entry – economic variables that determine earnings. Generally, implementing an economic policy aimed at preventing stagnation of earnings levels can be achieved by running a sustainable earnings policy and our model can be used as an acceptable tool in the function of keeping that policy.

Tiroidni hormoni su neophodni za normalan rad i razvoj bubrega. Bubrezi nisu samo organi koji ucestvuju u metabolizmu i eliminaciji tiroidnih hormona, vec mogu biti i meta njihovog delovanja. Tiroidna disfunkcija dovodi do znacajnih promena u glomerularnoj i tubulskoj funkciji, kao i u elektrolitnoj i vodenoj homeostazi, ali je pojava bubrežne bolesti kao posledica bolesti stitaste žlezde redak i neuobicajen događaj. Može se javiti ANCA-posredovan vaskulitis / glomerulonefritis kao posledica lecenja propiltiouracilom, ili je bubrežna bolest posledica autoimunske tiroidne bolesti (Hasimoto tiroiditis i Grejvsova bolest) u kojima pacijenti formiraju antitela na tiroglobulin i TPO. Ovaj tip nefritisa može biti i u vezi sa aplikacijom I131. Najcesci tip glomerulopatije je membranski glomerulonefritis (MGN) udružen sa nefrotskim sindromom, ali se mogu javiti i ređi oblici glomerulonefritisa. Pacijentkinja stara 49 godina sa hipertireozom uzrokovanom Grejvsovom bolescu primljena je u cilju lecenja Grejvsove orbitopatije. Tokom ispitivanja nađena je proteinurija nefrotskog ranga, zbog cega je sprovedena nefroloska dijagnostika i postavljena dijagnoza membranskog glomerulonefritisa. Pacijentkinji je hipertireoza definitivno resena aplikacijom terapijske doze I131, a s obzirom na dve autoimuinske bolesti (orbitopatija i membranski glomerulonefritis), pacijentkinja je lecena kortikosteroidima po protokolu za bubrežnu bolest. Po zavrsenom lecenju registruje se redukcija proteinurije.

Blood lead levels (BLLs) have been falling steadily worldwide due to restricted use of lead (Pb) and its compounds. although they remain above preindustrial Pb levels. Elevated BLL can still be found in children living near secondary Pb smelters that represent around 50% of Pb production. There have been no studies on Pb exposure in children living in Serbia ever since the 1980s. The aim of this study was to evaluate the BLLs in children living in two villages in Serbia (Zajaca, the location of a secondary lead smelter, and Paskovac, 5 km away), identify the primary determinants of children’s BLLs, and investigate the impact of BLLs on children’s health symptoms and school achievement. The study was conducted in 2011 on 127 children, aged 1–18 years, whose BLLs were measured using inductively coupled argon plasma mass spectrometry (ICP-MS). The median BLL in children was 12 μg/dl, with a significantly higher value of 17.5 μg/dl in Zajaca, compared to 7.6 μg/dl in Paskovac. Only 1 out of 75 and 12 out of 52 children from Zajaca and Paskovac, respectively, had BLLs below the CDC recommended 5 μg/dl level. Living near the smelter resulted in 19 times, and having a father who works in the plant 4 times higher odds of elevated BLLs. No significant effects of elevated BLLs health symptoms were seen in this study. BLLs of children living near a battery recycling plant in Serbia, an upper-middle income European country, were in the range and even higher than those of children living in developing countries. For the first time, the contribution of environmental and take-home lead exposure was quantified using mixed-effect modeling, and our results indicate a contribution of 25–40% of the take-home lead exposure to the BLLs of children living in the vicinity of a secondary lead smelter.

OBJECTIVE: The aim of the study was to assess whether sudden change in blood glucose concentration in healthy subject would produce insulin secretory pattern similar to one in type 2 diabetic subjects (T2D). DESIGN: The concept of the study was to 'reset' the pancreas and empty the stored insulin pool, so that subtle derangements of the pulsatile insulin secretion could be studied. METHODS: The study group included 6 control and 7 T2D subjects. For insulin and glucose determination, blood was sampled for 60 minutes with 2 minutes inter-sample interval. To increase blood glucose an intravenous glucose bolus was given (0.3 g/kg body weight). RESULTS: The average glucose level in the T2D group was significantly higher, but the average insulin concentration was not different between the groups. Insulin half-life, pulse amplitude, number of pulses and interpulse interval did not differ between the groups. CONCLUSIONS: Therefore, the sudden increase in blood glucose causes insulin secretory pattern to become similar in the healthy and in the T2D subjects. However, the defect in the insulin secretion or glucose sensing inherent to β-cell exists, as the insufficient quantity of insulin is secreted in response to the increased glucose level.

Objective To construct a predictive score for the development or progression of Graves’ orbitopathy (GO) in Graves’ hyperthyroidism (GH). Design Prospective observational study in patients with newly diagnosed GH, treated with antithyroid drugs (ATD) for 18 months at ten participating centers from EUGOGO in 8 European countries. Methods 348 patients were included with untreated GH but without obvious GO. Mixed effects logistic regression was used to determine the best predictors. A predictive score (called PREDIGO) was constructed. Results GO occurred in 15% (mild in 13% and moderate to severe in 2%), predominantly at 6–12 months after start of ATD. Independent baseline determinants for the development of GO were clinical activity score (assigned 5 points if score > 0), TSH-binding inhibitory immunoglobulins (2 points if TBII 2–10 U/L, 5 points if TBII > 10 U/L), duration of hyperthyroid symptoms (1 point if 1–4 months, 3 points if >4 months) and smoking (2 points if current smoker). Based on the odds ratio of each of these four determinants, a quantitative predictive score (called PREDIGO) was constructed ranging from 0 to 15 with higher scores denoting higher risk; positive and negative predictive values were 0.28 (95% CI 0.20–0.37) and 0.91 (95% CI 0.87–0.94) respectively. Conclusions In patients without GO at diagnosis, 15% will develop GO (13% mild, 2% moderate to severe) during subsequent treatment with ATD for 18 months. A predictive score called PREDIGO composed of four baseline determinants was better in predicting those patients who will not develop obvious GO than who will.

This paper is the result of theoretical and empirical research carried out in the framework of the scientific research project “The competitiveness of the construction sector in Montenegro – the conditions, possibilities and directions for improvement” on the basis of which are identified some of the main directions of improving the competitiveness of the construction sector in Montenegro in the future.

BACKGROUND/AIMS: The epidemiology of Graves' orbitopathy (GO) may be changing. The aim of the study was to identify trends in presentation of GO to tertiary centres and initial management over time.METHODS: Prospective observational study of European Group On Graves' Orbitopathy (EUGOGO) centres. All new referrals with a diagnosis of GO over a 4-month period in 2012 were included. Clinical and demographic characteristics, referral timelines and initial decisions about management were recorded. The data were compared with a similar EUGOGO survey performed in 2000.RESULTS: The demographic characteristics of 269 patients studied in 2012 were similar to those collected in the year 2000, including smoking rates (40.0% vs 40.2%). Mild (60.5% vs 41.2%, pCONCLUSIONS: These findings suggest that the clinical manifestations of patients with GO may be changing over time in Europe.

Even though it entered the privatization process unprepared, and despite the privatization process leading to the collapse of a vast number of the largest construction companies, the construction sector in Montenegro has undergone a significant expansion in the period between 2005-2008. This was possible thanks to the opening of the Montenegrin market and creation of a favorable investment climate and a large inflow of foreign direct investment. However, the global financial crisis and a recession in the developed market economies after the mentioned period was affected by the slowdown of economic growth in Montenegro including the construction industry.

Construction is an important part of every country's economy because it includes a range of economic activities that are pooled and manifested through the construction of an object. Construction sector has specific characteristics that are strictly regulated and which are largely different from other sectors.

Assessment of insulin sensitivity based on a single measurement of insulin and glucose, is both easy to understand and simple to perform. The tests most often used are HOMA and QUICKI. The aim of this study was to assess the biological variability of estimates of insulin sensitivity using HOMA and QUICKI indices. After a 12-h fast, blood was sampled for insulin and glucose determination. Sampling lasted for 90 min with an intersample interval of 2 min. A total of 56 subjects were included in the study, and in nine subjects sampling was done before and after weight reduction, so total number of analyzed series was 65. To compute the reference value of the insulin sensitivity index, averages of all 46 insulin and glucose samples were used. We also computed point estimates (single value estimates) of the insulin sensitivity index based on the different number of insulin/glucose samples (1-45 consecutive samples). To compute the variability of point estimates a bootstrapping procedure was used using 1000 resamples for each series and for each number of samples used to average insulin and glucose. Using a single insulin/glucose sample HOMA variability was 26.18 ± 4.31%, and QUICKI variability was 3.30 ± 0.54%. For 10 samples variability was 11.99 ± 2.22% and 1.62 ± 0.31% respectively. Biological variability of insulin sensitivity indices is significant, and it can be reduced by increasing the number of samples. Oscillations of insulin concentration in plasma are the major cause of variability of insulin sensitivity indices.

This paper presents the key development measures for boosting economic growth in Montenegro in the future with a focus on the main goals of the construction and housing sector and proposed measures for their implementation - in order to improve the competitiveness of the construction sector.