Medicina, Volume 45, Issue 2 (February 2009) – 11 articles

Extensive clinical and statistical studies have identified risk factors that increase the incidence of coronary heart disease. It is commonly suggested that more than 50% of patients with coronary heart disease lack any of the conventional risk factors.
Objective. To determine the prevalence of four conventional risk factors among patients with coronary heart disease.
Material and methods. We analyzed data of 606 patients with coronary heart disease (myocardial infarction, unstable and stable angina pectoris) hospitalized in the Clinics of Santariškės, Vilnius University Hospital, in 1997–2005.
Results. Among patients with coronary heart disease, at least one of four conventional risk factors was present in 98% of patients. Hypertension was present in 47.7% of patients, diabetes – in 12.9%, dyslipidemia – 90.1%, and smoking – in 24.1% of patients. In younger patients (<55 years), only 2.3% of patients lacked any of four conventional risk factors. Two-thirds (66.5%) of younger patients with coronary heart disease had two and more risk factors.
Conclusions. Considering the fact that patients with coronary heart disease often lack conventional risk factors, currently more attention is given to nontraditional risk factors as well as genetic causes of coronary heart disease. Nevertheless, the present study revealed that 98% of patients with coronary heart disease had at least one of four conventional risk factors. Among younger patients (younger than 55 years), conventional risk factors are identified very frequently. Thus, it can be concluded that in order to reduce the epidemic of coronary heart disease, much greater emphasis should be given to identify and to improve prevention of four conventional risk factors as well as the lifestyle of the patient. Full article

The aim of this study was to determine the efficiency of individual balanced replacement diet in treatment of children with atopic dermatitis, to compare the course of atopic dermatitis and gastrointestinal disorders, as well as the data of skin patch test after a one-year period of dietary treatment.
Patients and methods. The study group included 154 children (their age varied from 6 months to 18 years) with atopic dermatitis, for whomfood allergens were determined by allergic skin tests (skin prick and patch). These children were recommended an individual balanced replacement diet, where possible food allergens were replaced by other products that do not cause allergic reactions. After a one-year dietary treatment, 109 (70.8%) children (such number came for the second study) were tested repeatedly. The following aspects were evaluated for all these children: clinical course of atopic dermatitis (children’s mothers provided answers about exacerbation of allergic rash during the last 12 months, gastrointestinal disorders, and usedmedicines), severity of the progress of atopic dermatitis (SCORADindex). Besides, skin patch test with 25 food allergens was carried out.
Results. Children who followed dietary recommendations were younger than children who failed to follow dietary recommendations because of a variety of reasons (P=0.01). Even 49 (62.8%) patients who followed dietary recommendations have shown the following results during the second test: allergic rash disappeared and they did not have to take medicines against allergy anymore. Patients who followed their individual dietary recommendations more rarely suffered from severe allergic rash problems during a 12-month period (P=0.01) and they had to take fewer medicines against allergy, compared to children who did not follow their dietary recommendations (P=0.001). Clinical course of atopic dermatitis in children who followed individual dietary recommendations was easier compared to children who did not follow such recommendations (P=0.001). During a one-year dietary treatment, 28.2% of children with atopic dermatitis became more tolerant to earlier food allergens. After the comparison of skin patch test results (before dietary treatment and after a one-year period), it was determined that only skin patch tests against buckwheat, oat, beef, and cacao did not change statistically significantly. Results of skin patch tests against other food products were found to be positive more rarely. Besides, children who followed their dietary recommendations suffered from gastrointestinal disorders more rarely as compared to children who did not follow their dietary recommendations (P=0.01). They suffered less from abdominal pain (P=0.01), abdominal distention (P=0.044), and constipation (P=0.035).
Conclusions. Individual balanced replacement diet for children with atopic dermatitis helped to fully control nutrition of sick children from various age groups and had a positive effect on the clinical course of atopic dermatitis. Patients who followed their individual dietary recommendations suffered from severe allergic rash more rarely and they had to take fewer medicines against allergy as compared to children who did not follow dietary recommendations. Clinical course of atopic dermatitis in children who followed individual dietary recommendations was easier as compared to children who did not follow such recommendations. One-third of children with atopic dermatitis became more tolerant to earlier food allergens during a one-year period. After a oneyear dietotherapy treatment, positive patch test reactions to many food products appeared to be more rarely, except for buckwheat, oat, beef, and cacao. Besides, children who followed their dietary recommendations suffered from gastrointestinal disorders (abdominal pain, abdominal distention, and constipation) significantly more rarely as compared to children who did not follow their dietary recommendations. Full article

The aim of the study was to evaluate associations of emotional state and quality of life with lipid concentration, duration of the disease, and the way of treating the disease in males and females with type 2 diabetes mellitus. A total of 53 persons with type 2 diabetes mellitus (27 males and 26 females; mean age, 58.7±8.9 years) and 56 healthy persons (26 males and 30 females; mean age, 54.7±8.3 years) participated in the study. Emotional state was evaluated by means of Profile of Mood State and quality of life by means of WHO Brief Quality of Life Questionnaire. Emotional state and quality of life were significantly worse, tension-anxiety and fatigue-inertia were significantly higher, vigor-activity was significantly lower in male patients with type 2 diabetes mellitus than in healthy males. In females, no significant differences in emotional state and quality of life comparing type 2 diabetes mellitus group and controls were detected. In females with type 2 diabetes mellitus, emotional state and quality of life were significantly better, scores of tension-anxiety, depression dejection, anger-hostility, and fatigue-inertia were significantly lower, and score of vigor-activity was significantly higher than in males with type 2 diabetes mellitus. Some significant correlations were found. In males, vigor-activity correlated with total cholesterol level and negatively correlated with triglyceride level. In females, significant correlations were found between scores of emotional state (tension-anxiety, depression-dejection, confusion-bewilderment, and total score of emotional state) and lipid levels (total cholesterol, triglyceride, and low-density lipoprotein cholesterol levels). There were no significant associations of emotional state and quality of life with duration of the disease in males and females with type 2 diabetes mellitus. No significant differences in emotional state and quality of life were found between males and females with type 2 diabetes mellitus, who were treated with oral antidiabetic preparations and insulin preparations. Full article

System of organism defense is an important complex of interrelated cellular, molecular, genetic, and other components, which regulate homeostasis of host. Experimental and clinical data show that immune system functions are significant, but also a complicated question in cancer development. It is very important to investigate and understood how immune system coordinates the response to cancer cells. Our understanding about innate and adaptive immunity functions and interaction with transformed cells is constantly changing. Different responses of these system components can promote, reduce, or inhibit tumor development. It is established that malignant cells develop into invasive cancer with interaction with tumor microenvironment, which is influenced by inflammation. Clinical and experimental studies have revealed the link between inflammation and cancer risk. Many cancers develop in the sites of inflammation. Activation of humoral and cellular immunity may predispose to neoplastic or cancer development. Despite the scientific progress, understanding of the immune system mechanisms responding to malignance remains insufficient. Full article

According to the literature data, Roma health and living conditions in Central and Eastern Europe are poorer than of the rest of population. However, the more detailed information about Roma health is lacking. The aim of the study was to evaluate morbidity, health self-assessment, and prevalence of addictions among Roma children in Vilnius and Ventspils and to compare with health indicators of non-Roma children. Participants and methods. A descriptive epidemiological study was carried out, anonymously questioning all volunteer Roma children – 59 in Vilnius (Lithuania) and 31 in Ventspils (Latvia) schools.
Results were compared with identical study, carried out in five Vilnius schools (reference group, 640). Results. The appliance rate of Roma children to doctor did not differ from reference group – half of all questioned children visited doctor 1–3 times during the last year. However, more Roma children (74.6% from Vilnius and 64.6% from Ventspils) considered their health as poor and very poor as compared to reference group (4.3%). The proportion of children indicating somatic symptoms often and very often did not differ statistically significantly among groups with exception of vomiting and nausea, which was most prevalent among Vilnius Roma and Ventspils Roma. The proportion of children indicating emotional symptoms often and very often differed significantly in all groups and was the biggest in Ventspils Roma group. The proportion of daily alcohol, drug users, and smokers was higher in Vilnius Roma and Ventspils Roma groups, although the differences among all three groups were not statistically significant.
Conclusion. Although the morbidity of Vilnius Roma and Ventspils Roma groups did not differ from reference group, essential discrepancy was found in health self-assessment – more Roma children considered their health as poor and very poor. Full article

The epidemiological data on the prevalence of malocclusion is an important determinant in planning appropriate levels of orthodontic services. The occurrence of occlusal anomalies varies between different countries, ethnic and age groups. The aim of this study was to describe the prevalence of malocclusion among Lithuanian schoolchildren in the 7–9-, 10– 12-, and 13–15-year age groups assessing occlusal morphology. The study included 1681 schoolchildren aged 7–15 years. The crowding, spacing, overbite, overjet, the relationship of the first upper and lower molars according Angle’s classification, and posterior crossbite were assessed. The study demonstrated that only 257 children had normal occlusion, and 44 had undergone orthodontic treatment among them. The greatest overjet in the studied contingent was 11 mm, and the negative overjet – 3 mm. The overbite ranged between 0 and 6 mm with a mean of 2.29±1.23 mm. Posterior crossbite was recorded in 148 children (8.8%). This study showed that the prevalence of malocclusion among 7–15-year-old Lithuanian schoolchildren is 84.6%. The most common malocclusion was dental crowding. The upper dental arch crowding was registered for 44.1% and lower for 40.3% of all schoolchildren. The class I molar relationship was detected in 68.4% of the subjects, class II – in 27.7%, and class III – in 2.8%. Full article

The aim of this study is to identify how widely deliberate self-harm is spread and the types of deliberate self-harm among 15–17-year-old teenagers in Lithuania.
Material and methods. The anonymous Lifestyle and Coping Questionnaire was used for the study carried out in 2006. This countrywide study involved 3848 respondents (2200 girls (57.2 %) and 1648 boys (42.8%)) aged 15–17 years from all 10 regions of Lithuania.
Results. According to the findings of this study, 7.3% of 15–17-year-old Lithuanian teenagers (9.9% girls and 3.8% boys) stated that they had deliberately overdosed drugs or tried to inflict self-injury in other ways. Less than half of them (43.4%) reported that they were thinking to repeat such behavior. Half of the adolescents who inflicted self-injury were living in a two-parent family, 27.4% – with one of the parents, 7% – with other member of the family, and 9% – with other people. One-third of adolescents (34.2%) choose internal ways of self-harm, 26% – external self-injury, 11% – tried to harm themselves in mixed way, and 28.8% – did not indicate the way. In case of a self-injury mentioned above, 13.5% of adolescents were admitted to hospital.
Conclusions. In Lithuania, adolescent self-harm is relatively frequent: 7.3% of 15–17-year-old Lithuanian adolescents deliberately self-harmed during their life. The most frequent way to self-harm is to overdose. This study confirms the need for preventive activities and necessity of further studies in this field. Full article

Glioblastoma is the most malignant tumor in the range of cerebral astrocytic gliomas. A lot of experimental models are used to evaluate various properties of glioblastoma. Chicken chorioallantoic membrane model is one of them.
Objective. To evaluate histology and survival of glioblastoma tumors taken immediately from operating theatre and transplanted on chicken chorioallantoic membrane.
Materials and methods. Glioblastoma samples obtained from 10 patients were transplanted onto 200 eggs. Overall, we used 15 tumors; only 5 of them were not glioblastomas as it was revealed later.
Results. The transplanted tumors survive up to 6 days. Transplants do not survive longer because during embryo’s development the nourishing membrane dries. Transplanted glioblastomas exhibited the same features as original glioblastomas – necrosis, endothelium proliferation, cellular polymorphism – while transplanted glioblastomas also showed glial fibrillary acidic protein (GFAP), vimentin, Ki67, S100 protein, neurofilament immunoreactivity, and infiltration of macrophages (CD68) and T cells (CD3+, CD8+). Transplanted glioblastomas did not show any immunoreactivity of p53. Invasion of vessels from the chicken into transplanted tumor is not observed. Chicken erythrocytes did not appear within the transplants, and tumor cells invade chicken tissue at the minimum.
Conclusion. Our data show that transplanted pieces of glioblastoma survive with all cytological features. The presence of macrophages (marker CD68) and T cells (markers CD3+ and CD8+) can be registered in the transplant. The data revealed that transplanted glioblastoma remains as insulated unit, which survives from nourishment of the chorioallantoic membrane apparently only by diffusion. The features of original tumor-host reaction of the patient remained too. Full article

Objective. This prospective observational study of the Short-Form Health Survey (SF-36), Oswestry Disability Index, Lithuanian version of the McGill Pain Questionnaire, and Visual Analogue Scale (VAS) for pain was performed to evaluate their effectiveness in the additional preoperative screening of patients with disc herniation disease.
Patients and methods. In the present study, we investigated a cohort of 100 patients with lumbar disc herniation causing low back pain and the second one of 100 patients with nonspecific low back pain by applying physical activity, pain scales and Short-Form 36 General Health Questionnaire.
Results. The quantitative analysis of SF-36 domain scores showed the substantial differences in both examined (herniated and control) groups. In the present study, we estimated moderate but statistically significant (P<0.05) correlations between the bodily pain domain scores and assessment of back and leg pain on the VAS, as well as between the physical function and walking/standing ability (Oswestry). According to appropriate pain assessment instruments (Lithuanian version of the McGill Pain Questionnaire), qualitative and quantitative analysis of the preoperative patients was performed.
Conclusion. The provided methodology could be used in population-based studies or in clinical samples that focus on specific impairments and seek to control the pain frequency and intensity, for example, follow-up assessments testing the effectiveness of surgical procedures performed, and to elicit the pathways leading to other impairments. Full article

Ischemic heart disease in European countries over decades causes up to 55% of all cases of sudden death and also has a high rate of mortality, morbidity, and hospital admission. Patients with such chronic diseases also require intensive home care facilities from community nurses. The aim was to establish international multilingual platform for transtelephonic ECG system as an alternative solution for home care and assess its performance.
Methods. During this pilot study, the international toll-free line between Lithuania and Germany was established, and practical applicability of the tele-ECG device was tested. Transtelephonic ECG system was implemented between Telemedicine Center in Bad Segeberg (Bad Segeberg Clinic, Germany), the Call Center in Kaunas at the Hospital of Kaunas University of Medicine, and a patient residence.
Results. Over a 6-month follow-up period, 34 patients were recruited. Following the ECG transmission, 86 teleconsultations were done. During the study, a total of 329 ECGs were sent by the patients; out of them, 14 ECGs were with clinical changes. Technical problems due to insufficient patient training, telecommunication systems, acoustic data transmission, and device itself were reported. Up to 23% of ECGs sent by patients were unreadable and not applicable for further clinical analysis.
Conclusions. Our study showed the potential of telemedicine facilities to overcome the problems of access that makes the technique so potentially useful, but for telemonitoring application at patient homes in a wider population, it needs to be improved in terms of technical performance, transmission and analysis automatization. Full article

The aim of the study was to investigate the peculiarities of medical students’ nutrition, to compare the dietary habits between first-year and third-year students, to compare male and female students’ nutrition, and to evaluate the tendencies of its change.
Material and methods. An anonymous survey using a specially designed questionnaire was carried out on 349 first- and third-year students of the Faculties of Medicine and Pharmacy at Kaunas University of Medicine. Students’ factual nutrition was evaluated by the number of meals per day, the time of eating, and the frequency of consumption of food products. The findings of the questionnaire-based study were stored in a database and analyzed using Excel software. Statistical relationships were determined using EPI Info software by applying the nonparametric c2 criterion. Statistical significance was determined using Student’s criterion.
Results. The nutrition of first- and third-year students is irregular and differs in the time and number of meals. Only 20% of students daily ate 400 g of fruit and vegetables as recommended by the World Health Organization. Medical students, especially males, used excessive amounts of animal fat. Every seventh student consumed too salty food. Medical students consumed insufficient amounts of bread, potatoes, cereals, and other products that constitute the basis of the pyramid of healthy nutrition. Twenty-three percent of males and nearly as many females used alcohol once per week. Nearly one-half of students did not exercise at all, and 9.1% of third-year female and 14.5% of third-year male students were overweight.
Conclusions. The majority of students did not follow the dietary regimen and consumed the majority of food products during the second half of the day. Students’ nutrition was not balanced – medical students consumed too much fat, especially those of animal origin. Students consumed insufficient amounts of vegetable fats and fish products, fruit and vegetables, and thus their food may lack soluble dietary fibers and vitamins. First-year and third-year female students used vegetable oils more frequently, used more vegetables, and complied with dietary regimen more often than male students. The nutrition of first- and third-year students does not differ statistically significantly. Alternative types of nutrition (vegetarian nutrition and various diets) are not popular among medical students. Full article