2011-10 - EFCC Corner LMI.pdf - European Federation of Clinical ...

News from the World of the InternationalFederation of Clinical Chemistry and Laboratory MedicineVisit www.ifcc.org for more informationChamber of Biochemists:Beginning the New Age ofLaboratory Practice in Serbiaby Dr. Snezana Jovicic, Institute ofMedical Biochemistry, Belgrade, SerbiaFor many years, the leading organization that dealt with the developmentof the profession of medical biochemistry in Serbia has beenthe Society of Medical Biochemists of Serbia (formerly Society ofMedical Biochemists of Yugoslavia). As part of the healthcare systemreforms conducted in the last decade, the Law of Healthcare WorkersChambers, was adopted six years ago. Medical biochemists were thefirst that completely implemented the law, constituted Assembly of theChamber and five years ago delivered the first licenses. Prof. Dr. NadaMajkic-Singh was the first elected president of the Assembly, and Dr.Velibor Canic the first elected director of the Chamber.The Chamber of Biochemists is professionalorganization of medical biochemistsand clinical chemists with the mandatorymembership for colleagues working in publichealthcare institutions and private practice. Inaccordance with the Law, the Chamber has anumber of public authorities, including the definitionof codex of professional ethics, keepingdirectory of all the members of the Chamber,issuing, renewing and depriving the licensesfor independent practice to all of the members,representing and protecting professionalinterests of members, proposing the list ofsupervisors for external quality audit, organizingCourt of Honor for determination of violationof professional duties and responsibilitiesof members, and many others.What are the first and obvious benefits ofthe work of such an organization? First of all,with the introduction of licenses, which have tobe renewed every seven years, professionaldevelopment has achieved continuity. Medicalbiochemists and clinical chemists in Serbiatoday are more focused to continuous educationafter graduation - in order to keep theirlicense they need to collect 24 credits per yearminimum. Thanks to attendance of variouscourses, seminars, symposia, congresses,more colleagues are now up-to-date with latestdevelopments in the practice of laboratorymedicine, which enable them to implement thisnew knowledge in their every day workload.Also, more educational courses are organizedthroughout the year than before. In addition,with one of the major activities of the Chamber--the enhancement of control of the work of laboratoriesthroughout the whole territory ofRepublic of Serbia, the quality of their work issignificantly improving, which is evident in theresults of our national external quality assessmentscheme (SNEQAS). Furthermore, all laboratories,both in private and in public healthcaresystem, are encouraged and advised bythe Chamber to commence the accreditationprocess according to standard ISO 15189.The Chamber of Biochemists of Serbiahas been created five years ago. Every fouryears delegates for the Assembly, SupervisoryBoard, Steering Committee, Commissionfor Mediation, Director, and Court ofHonor are elected. Last year, we had electionsand the first convening, when the sessionof the constituent assembly handedover its duties to new delegates. We are allconfident that they will continue the fruitfulwork of their predecessors.NEWSPhoto: Assembly of the Chamber of Biochemists of Serbia29LabMedica InternationalOctober/2011 LINKXPRESS COM LMI-10-11 126

EFCC CORNEREdited by Dr. Bernard GougetEuropean Federation of ClinicalChemistry and Laboratory MedicinePromoting Vaccination Programsby Dr. Bernard GougetSFBC-EFCC Representative; Secretary General InternationalFrancophone Federation of Clinical Biology and LaboratoryMedicine (FIFBCML); IFCC Executive Board Member, Secretary GeneralImmunizations are a cornerstone ofa nation's efforts to protect peoplefrom a host of infectious diseases.Large-scale implementation of vaccinationprograms during the past thirtyyears has led to a spectacularreduction in illness and death due todiseases preventable by vaccines.The European region of WorldHealth Organization (WHO) wasdeclared free of poliomyelitis in 2002,and for these past 6 years, cases ofmeasles in the Region havedecreased by more than 90%.However, further efforts are necessary.In Europe, nearly 650,000 childrendo not receive their first dose ofmeasles vaccine, a fundamentalrequirement to satisfy for vaccination;and there remain still vulnerable populationsin every country. Paradoxically,the fact that vaccination hasled to a situation where numerousinfectious disease have become rareor seldom heard from, sometimesleads some parents and health professionalsto believe that vaccines areno longer necessary. As a result, thepublic confidence in these vaccinationsis regularly shaken by accusedharmful, even dramatic, side effects,and may be threatened by the influenceof groups opposed to vaccinationand websites dedicated to theirmovement. It has reached the pointthat parents are increasingly hesitantto immunize their children, becausethey are afraid of making them sickrather than protecting them.For the first time since 1994, theProf. Mauro PanteghiniProf. Mauro Panteghini, MD, is full professor of ClinicalBiochemistry and Clinical Molecular Biology atUniversity of Milan (Italy) Medical School. Prof.Panteghini holds directorships in the chairs of ClinicalBiochemistry and Clinical Molecular Biology at theMedical School of the University of Milan and at theCenter for Metrological Traceability in LaboratoryMedicine (CIRME) of the University of Milan, and leadsthe Accredited Reference Laboratory for EnzymeStandardization (a JCTLM listed reference laboratory).Prof. Panteghini has served in numerous internationaland national scientific capacities in laboratory medicine,and has held many positions within the IFCC andthe JCTLM. He is editor-in-chief of Biochimica Clinica,the official journal of the Italian Society of ClinicalBiochemistry and Clinical Molecular Biology (SIBioC).He has published numerous manuscripts and abstract,and lectures at many national and international congresses,meetings, and symposia.American Institute of Medicine (IOM)published a well-documented reporton the risks linked to eight commonlyadministered vaccines. This synthesisof more than a thousand studiesshows that serious side effectscaused as a result of injectionsremain very rare. The vaccines studiedare those that protect againstseasonal influenza (H1N1 excluded),hepatitis B, papillomavirus (HPV)(notably responsible for cervical cancer),hepatitis A, meningitis (meningococcalvaccines), the measlesmumps-rubella(MMR) triple combination,tetanus, or even varicella.The IOM has studied more than ahundred cause-effect relationshipsbetween a vaccine and a more orless serious side effect. They rejectedthe existence of a link betweenMMR and autism; a study publishedin 1998 on this subject had created apanic in the English-speaking world.The same vaccine does not lead totype 1 diabetes either. As for seasonalflu vaccines, they do not aggravateasthma and are not responsiblefor peripheral facial paralysis.Conversely, side effects alreadyknown to physicians were confirmed.All the vaccines studied, exceptthose against hepatitis A and papillomavirus(HPV), can cause strongallergic reactions called anaphylacticshock. All, without exception, regularlycause shoulder pain and fainting.MMR may cause febrile convulsionsfollowing very high fevers in youngchildren, even rare cases ofNew EFCC Executive Board MembersDr. Ana-Maria SimundicAna-Maria Simundic, PhD, heads the EmergencyLaboratory department at the Sestre MilosrdniceUniversity Hospital in Zagreb (Croatia). Dr. Simundicgraduated from the faculty of Pharmacy andBiochemistry University of Zagreb, where she defendedher masters and PhD theses, and was awarded thetitle Assistant Professor. Dr. Simundic also receivedtraining at the university of Connecticut (USA) HealthCenter, where worked on molecular genetic techniquesand did research on developmental biology. CurrentlyDr. Simundic is the Editor-in-Chief of BiochemiaMedica, the journal of the Croatian Society of MedicalBiochemists. She chairs the Committee for PublicRelations for the Croatian Society of Biochemistry, andis the EFCC National representative for Croatia. Dr.Simundic also functions as ISO 15189 accreditationassessor for Molecular Diagnostics and General clinicalchemistry. Her work experience includes teachingcourses at the undergraduate and postgraduate levels.encephalitis with inclusions that damagethe nervous system. However, inthe large majority of cases, the existingstudies are not sufficient for theexperts to be able to validate or rejectthe cause-effect link. This wasnotably the case when the number ofcases counted was too low to generalize,like for the papillomavirus vaccine.In France, two girls filed a claimbecause they believed they were thevictim of Gardasil side effects.However, the link yet remains to beproven scientifically.The IOM report was not intendedto guide nervous parents, but ratherto inform the organization that compensatespeople who contracted anillness after a vaccine. It does notspecify the frequency at whichadverse effects are observed. Itsauthors point out, however, that vaccinesremain one of the most powerfultools in the health system.Nevertheless, having a basic understandingof how patients and parentsof patients view vaccine risk anddeveloping effective approaches toaddress vaccine safety concerns areimperative for vaccination providers.Each person understands and reactsto vaccine information based on differentfactors, including previousexperience, education, personal values,method of data presentation,perceptions of the risk for diseaseand perceived ability to controlthese risks, and risk preference.Increasingly, decisions about vaccinationare based on inaccurate informationabout risk provided by themedia and certain websites.Websites and other sources of vaccineinformation might be inaccurateor incomplete. The specialist in laboratorymedicine together with healthcareproviders can be a pivotalsource of science-based credibleinformation by discussing the risksfrom and benefits of vaccines, whichhelp patients make informed decisions.When a parent or patient initiatesa discussion about a perceivedvaccine adverse reaction, the healthcareprovider should discuss thespecific concerns and provide factualinformation. Effective, empatheticvaccine risk communication usingappropriate language is essential inresponding to misinformation andconcerns.Vaccines are continually monitoredfor safety and like any medication;a decision not to immunize achild also involves risk and could putthe child and others who come intocontact with him or her at risk of contractinga potentially deadly disease.Every year, vaccination savesmillions of human lives and this greatsuccess in terms of public healthmust continue. European countriesmust share precise, nuanced, andclear information on the risks linkedto diseases and the advantages ofvaccination. By recognizing thateach child deserves good healthfrom the beginning of their existence,specialists in laboratory medicinecan benefit from the impetus givenby WHO to conduct an awarenesscampaign and to enhance vaccinationsystems. As health careprovider, we should work closely withpublic health agencies and otherhealth partners to improve and sustainimmunization coverage and tomonitor the safety of vaccines sothat this public health success storycan be maintained and expanded inthis beginning of this new century.Dr. Huibert StormDr. Huibert Storm is a clinical chemist, head of laboratoryat the Stichting KCL Medical Center inLeeuwarden (The Nederlands). Dr. Storm, a graduatebiochemist, received his PhD from the University ofLeiden (The Nederlands). He is the past president ofthe Netherlands Society for Clinical Chemistry andLaboratory Medicine (NVKC). During his tenure aspresident of NVKC he hosted the successfulEUROMEDLAB 2007 in Amsterdam (TheNederlands), which was honored by a visit from HMQueen Beatrix. Dr. Storm founded the NVKC workinggroup for molecular biology, and was member of acommittee on DNA-diagnostics of the Health Councilof The Netherlands advising the minister of health. Atpresent, Dr. Storm is the national representative ofNVKC for IFCC and EFCC. His major professional,scientific, and clinical interests lie in the field of molecularbiology, hematooncology, and flow cytometry.Cont’d on page 32LabMedica InternationalOctober/201130

European Federation of ClinicalChemistry and Laboratory MedicineEFCC CORNER7th EFCC Symposium for Balkan RegionBiomarkers: From Standardizationto Performanceby Snezana Jovicic, Institute of Medical Biochemistry,Clinical Centre of Serbia, Belgrade, SerbiaAt the end of June this year, the Society of Medical Biochemists of Serbia once again hadthe pleasure to welcome colleagues to the 7th IFCC Symposium for the Balkan Regionorganized traditionally under the auspicesof the International Federation of ClinicalChemistry (IFCC) and European Federationof Clinical Chemistry and LaboratoryMedicine (EFCC) in Belgrade. This year,the Symposium was dedicated to theburning issue of biomarkers, entitled“Biomarkers: From Standardization toPerformance.” As in the past six years,many prominent lecturers marked thismeeting.In the first section, Prof. Nada Majkic-Singh (Institute for Medical Biochemistry,Clinical Center of Serbia, Belgrade,Serbia) acquainted us with biomarkers,the process of their validation, and developmentof guidelines for biomarker applicationin her lecture entitled “What is aBiomarker? From Discovery to ClinicalApplication.” Prof. Mauro Pantheghini'slecture (Department of Clinical Sciences“Luigi Sacco,” University of Milan, Italy)was about standardization approachesand definition of performance requirementsfor heterogeneous biomarkerassays. Professor Patrick M. M. Bossuyt(Department of Clinical Epidemiologyand Biostatistics, Academic MedicalCenter, University Amsterdam, TheNetherlands) defined biomarker performanceand clinical validity, expressed interms of the marker's accuracy, and summarizedand presented the availablemeasures of diagnostic accuracy.The second section was dedicated tothe use of biomarkers in cardiovascularevents and it opened with Prof. VictorBlaton's talk (Department of ClinicalChemistry, Hospital AZ Sing-Jan AV,Brugge, Belgium) about noveltiesamong prospective markers in this field.Prof. Grazyna Sypniewska (Departmentof Laboratory Medicine, CollegiumMedicum, Nicolaus CopernicusUniversity, Bydgoszcz, Poland) presentedresults of her group's study about theperformance of apolipoproteins B and Aby comparing apolipoprotein concentrationsand apoB:apoA-I with traditionallipid measures and atherogenic indicesas biomarkers in acute coronary syndromepatients. Adriana Unic (ClinicalDepartment of Laboratory Diagnostics,Dubrava University Hospital, Zagreb,Croatia) summarized the recentprogress in the diagnostic use of copeptine,C-terminal part of the argininevasopressin precursor peptide found tobe stable and sensitive marker for antidiuretichormone release in cardiovasculardiseases. The section was closedby Sanja Stankovic (Institute of MedicalBiochemistry, Clinical Centre of Serbia,Cont’d on page 32Photo IMG-0961: Symposium lecturers duringtrip to Mokra Gora (from left to right):Aslan Diler, Grazyna Sypniewska, BernardGouget, Nada Majkic-Singh, Patrick MMBossuyt, Sanja Stankovuc, Victor Blaton.31LabMedica InternationalOctober/2011

EFCC CORNEREuropean Federation of ClinicalChemistry and Laboratory MedicineBiomarkers: From Standardizationto Performancecont’d from page 31Belgrade, Serbia) with an overview ofpotential new roles for myeloperoxidaseas biomarker in cardiovasculardisease.The second day of the symposiumstarted with Dr. Bernard Gouget(Federation Hospitailiere France,Paris, France), who opened the thirdsection with his special lecture onbiomarkers, biospecimen andEuropean biobanking infrastructuresfor translational research. Prof.Philippe Gillery (Laboratory ofPediatric Biology and Research -University Hospital of Reims andLaboratory of Medical Biochemistryand Molecular Biology, Faculty ofMedicine of Reims, France) introducednon-enzymatic posttranslationalmodification-derived productsas new biomarkers of protein aging.This section was concluded withProf. Diler Aslan's lecture (PamukkaleUniversity School of Medicine,Department of Medical Biochemistry,Denizli, Turkey), where biomarkersrecommended for prediction or diagnosisof diabetes complications in theclinical practice and laboratory medicineguidelines were reviewed andthe results of several clinical studieswere summarized.The fourth section started with thelecture about a novel combination ofbiomarkers for the prediction of ovariancancer, including human epididymisprotein 4 (HE4) and CA125, presentedby Prof. Demetrios Rizos (MedicalSchool, University of Athens, Greece).Prof. Andrea Griesmacher (CentralInstitute of Medical and ChemicalLaboratory Diagnostics, LKH -University Hospital of Innsbruck,Austria) continued with the overview ofbiomarkers for bone turnover. Thissection was concluded with the reviewof biomarkers of fetal anomalies incorporatedin first and second trimesterscreening strategies presented byProf. Svetlana Ignjatovic (Institute ofMedical Biochemistry, Clinical Centerof Serbia, Belgrade, Serbia).The fifth and last section was traditionallydedicated to experiencefrom Balkan region in the use anddevelopment of biomarkers. It startedwith the lecture of Miroslava Jankovic(Institute for the application ofNuclear Energy - INEP, University ofBelgrade, Serbia) about the statusand perspective of glycans as biomarkers,and about the glycome aspromising source of new biomarkers.Afterwards, Prof. Majkic-Singh, Prof.Blaton, and Prof. Ignjatovic chairedthe round table discussion on presentedtopics.This closed the formal part of thesymposium, but it continued outsideBelgrade. The two following weekenddays the participants and lecturersspent on the road, or on the railroadto be precise. They went on the nostalgictravel through time with theBlue Train - a special train used forthe needs of Josip Broz Tito, lifelongPresident of the Socialistic FederalRepublic of Yugoslavia. It is one ofthe most famous and most populartrains in the whole world, built in 1959for special needs of President Tito.Designed as a place that providesaccommodation, working conditionsand opportunity to complete all protocolobligations while traveling, thistrain was real residence on wheels inthe country and abroad. The destinationwas Mokra Gora, a mountain inthe western part of Serbia, betweenmountains Zlatibor and Tara. Therethey have changed the accommodationsof the presidential train with“Sargan eight,” another curiosity ofthe Railway Museum of Serbia. From1925 to 1974, this was the popularroute from Belgrade to Dubrovnik andZelenika on the Adriatic coast, whereon 760 mm narrow-gauge track,through tunnels, over the bridges andthrough mountain gorges, ran thefamous steam locomotive train “Cira.”Now, one part of this railway isrenewed on the route from stationSargan Vitasi to Mokra Gora, whichrepresents unique construction work,as it passes through 22 tunnels, overfive bridges, overcoming a grade of300 meters, and all that on a total distanceof 15,440 meters. Here, theparticipants had an opportunity to seeall the beauty and richness of thenature of this region. The visit to thetown of Drvengrad was unforgettable.Situated on the top of Mecavnik hill,Drvengrad (Wooden Town) was builtby the world famous film director EmirKusturica after the shooting of his film“Life is a miracle” in the site of MokraGora. Drvengrad presents uniqueethno village, typical settlement of thisarea of 19th century, consisting ofwooden buildings, such as so-calledcottages, characteristic for living onthe nearby mountains.After two days of enjoying theintact nature of Western Serbia andits food specialties, the caravan ofbiochemists arrived back toBelgrade's Main Railway Station.This definitely ended this year'sEFCC Symposium for BalkanRegion, leaving all participants withvaluable new knowledge of biomarkers,as well as with some unforgettablememories.New EFCC Executive Board Memberscont’d from page 30Prof. Tomás ZimaProf. Tomás Zima, MD, DSc, PhD,MBA, is the Dean of the First Faculty ofMedicine, Charles University Prague(Czech Republic), consultant to theCzech Republic Ministry of Education,and professor of Medical Chemistryand Biochemistry. Prof. Zima graduatedwith honors from Charles University,where he obtained his MD, a PhD inbiochemistry, and the higher doctorate,DSc. He has also earned an MBA fromPrague International Business Schoolat the University of Economics (PIBS).His research is focused on oxidativestress, new diagnostic techniques,screening for Down's syndrome, tumormarkers, and the metabolism of alcohol.He is a PhD lecturer in Biochemistryand Pathobiochemistry. Prof. Zimais the author of four monographs andmany articles. He is the winner ofnumerous awards, among them Awardof the Rector of Charles University.Prof. Zima is a member of the CzechMedical Academy, president of theCzech Society of Clinical Biochemistry,Chairperson of the ExecutiveCommittee of FEBS (Federation of theSocieties of Biochemistry and MolecularBiology), and several other nationaland international professional organizations.He is the Editor-in-Chief ofFolia Biologica and Addictology.LINKXPRESS COMLMI-10-11 129LabMedica InternationalOctober/201132