Medicina, Volume 45, Issue 7 (July 2009) – 10 articles

The aim of this review is to summarize the current knowledge on Hashimoto’s thyroiditis and its pathogenesis and to introduce the readers to the basic concept of autoimmune thyroid disease. Hashimoto’s thyroiditis and Graves’ disease are different expressions of a basically similar autoimmune process, and the clinical appearance reflects the spectrum of the immune response in a particular patient. During this response, cytotoxic autoantibodies, stimulatory autoantibodies, blocking autoantibodies, or cellmediated autoimmunity may be observed. Persons with classic Hashimoto’s thyroiditis have serum antibodies reacting with thyroglobulin and thyroid peroxidase. These antibodies (particularly antibodies against thyroid peroxidase) are complement-fixing immunoglobulins and may be cytotoxic. In addition, many patients have cell-mediated immunity directed against thyroid antigens. Cell mediated-immunity is also a feature of experimental thyroiditis induced in animals by injection of thyroid antigen with adjuvants. Hashimoto’s thyroiditis is predominantly the clinical expression of cell-mediated immunity leading to destruction of thyroid cells, which in its severest form causes thyroid failure. The significance of genetic component and nongenetic risk factors (pregnancy, drugs, age, sex, infection, and irradiation) in the development of Hashimoto’s thyroiditis is also reviewed. Epidemiologic studies have demonstrated that the genetic component is important in the pathogenesis of Hashimoto’s thyroiditis, although the pattern of inheritance is non-Mendelian and is likely to be influenced by subtle variations in the functions of multiple genes. Nongenetic risk factors (environmental factors) are also etiologically important, because the concordance rate in monozygotic twins is below 1. Full article

In 2008, an international survey on obesity among first-graders and its risk factors was performed in Lithuania. The objective of this study was to assess physical activity of first-graders during leisure time according to family socioeconomic status. The study was performed in Šiauliai region schools selected randomly in 2008. The anonymous questionnaires were distributed among 630 first-graders and filled out by 515 parents (response rate was 81.8%). It was showed that physical activity of first-graders during leisure time is insufficient. More than half of them (60.4%) did not attend sports or dancing clubs; children spent much time passively watching TV or playing on a computer. Mostly children watched TV for 2 hours on workdays (45.1%) and for 3 hours or more on weekends (41.4%). Mostly children spent about an hour per day playing on a computer: one-third of first-graders spent it on workdays; during weekends, the percentage of children spending about an hour per day playing on a computer was lower (28.5%). One-third of first-graders (36.9%) spent their leisure time outside for 3 or more hours on workdays and 87.1% on weekends independently of parents’ educational level, income, and place of residence. The associations between family socioeconomic status and physical activity of children were observed. The lowest percentage of children attending sports or dancing clubs and playing computer games was seen in low-income families and families where parents had low educational level. They spent more time outside (on workdays) compared with those children whose parents had university education and high income. Fewer first-graders from families living in villages than those living in cities attended sports or dancing clubs and played on a computer, but more of them spent leisure time outside. Full article

Depression is prevalent postpartum and is a major health problem.
Objective. In this study, we aimed to evaluate how precise the Edinburgh Postnatal Depression Scale (EPDS) is in screening for depressive disorders postpartum.
Materials and methods. A random sample of 94 women was interviewed two weeks postpartum using the Composite International Diagnostics Interview Short-Form (CIDI-SF). In addition, they filled in the EPDS. We evaluated (a) internal consistency of the EPDS by the means of Cronbach’s alpha coefficient; (b) area under the ROC curve, sensitivity, specificity of the EPDS against the CIDI-SF diagnoses of depressive disorders.
Results. The internal consistency of the EPDS was 0.83. The optimal cutoff score of the EPDS for screening CIDI-SF diagnoses of depressive disorders was found to be 7 and more with an area under the ROC curve of 0.83, sensitivity of 92%, and specificity of 73%.
Conclusions. The EPDS has a good reliability as a screening instrument, and a cutoff score of 7 and more has to be used in screening for postpartum depressive disorders. Full article

The aim of this study was to determine the association between dietary patterns and others lifestyle factors. In 1998–2004, four cross-sectional surveys were carried out within the FINBALT HEALTH MONITOR project. For every survey, a random sample of 3000 Lithuanians, aged 20–64 years, was taken from the National Population Register. The response rates varied from 61.7% to 74.4%. The study material was collected by mailed questionnaires. The 20 food groups were included into food frequency questionnaire. Factor analysis was employed in order to reduce the number of food items. Four main factors were identified: “Light food,” “Sweets,” “Heavy food,” and “Cereals.” They accounted for 46% of total variance in food intake in men and women. The associations between dietary patterns and lifestyle factors were examined by applying logistic regression analysis. Nonsmokers, physical active people, wine drinkers, and men consuming beer were more likely to follow the “Light food” pattern (consumption of fresh vegetables, fruits, chicken, and fish). People having positive values of the “Cereals” pattern smoked and drank alcohol less often and were more physical active than those with negative values of the factor. “Heavy food” factor was associated with daily smoking and drinking of strong alcohol in men and drinking of beer in women. The consumers of strong alcohol and people less physically active in leisure time were more likely to follow “Sweets” pattern.
Conclusions. Nutrition habits were related to lifestyle factors. Men and women who followed the “Cereals” pattern have the healthiest lifestyle. Full article

Health care workers are attributed to the group at highest risk of biological factors, as they are daily exposed to fluids of the human body. The risk of sharps injuries and exposure to blood is associated with bloodborne infections.
The aim of this study was to determine the frequency and type of professional biological risk factors, to evaluate the use of personal protective devices, application of immunoprophylaxis to health care workers in the surgical departments.
Methods. A retrospective study was carried out from January to June 2006. Data were collected in the surgical departments of Hospital of Kaunas University of Medicine. An anonymous questionnaire survey was performed.
Results. More than half (51.4%) of the respondents experienced sharps injuries, 62.1% were exposed to biological fluids, and 39.6% of the workers experienced both injury and exposure. In all cases, the hands were injured during sharps injuries. Exposure of healthy skin and eyes to biological fluids occurred in 63% and 20% of the cases, respectively. Majority of exposures were blood splashes (60%). Physicians most frequently experienced sharps injury during the surgery (79.3%), nurses – during the preparation of instruments (35.1%), supporting staff – disposing the waste (75.8%). Commonly physicians were injured by surgical needles (72.4%), nurses – by needlestick (72.4%), and supporting staff – by glass waste (60.6%). Majority of the respondents (86%) were not vaccinated with HB vaccine. No personal protective equipment was used by 14.5% of the respondents during sharps injuries and 5% during exposures.
Conclusions. More than half of the respondents experienced sharps injury or exposure to biological fluids during the study period. Physicians and nurses experience sharps injury and exposure to biological fluids more commonly as compared to supporting staff. Hepatitis B vaccination is insufficient among health care workers. Full article

The aim of this study was to determine the prevalence of addictive substance use among students during one-year period, to evaluate the present situation, and to substantiate the necessity of prevention.
Material and methods. The participants of the study were students of the Lithuanian University of Agriculture: 1475 students were inquired in 2005 and 1575 in 2006. The study was performed by applying a questionnaire consisting of 26 standard questions for the evaluation of respondents’ health and health-related behavior. The obtained results showed the stability of addictive substance usage among students during oneyear period: on the average, 33.6% of males and 20.4% of females were daily smokers. No changes were found in the number of nonsmokers, but the number of students who quit smoking was increased. There were no changes in the pattern of ethanol use during one-year period: the highest percentage of male students used alcoholic beverages once or several times per week (38.5%) and several times per month (39.5%). The highest percentage of female students used ethanol several times per month (55.9%). Ethanol and tobacco consumption per day was high, and there were no changes during one year. The rates of drug use were 35.9% among male students, and 17.7% among female. The amount of psychoactive substances used by students (ethanol per one evening and tobacco per one day) did not change and remained dangerously high. Male students consumed 400 mL of vodka, 280 mL of other strong alcoholic beverages, and 2 liters of beer per one evening, while the mean consumption of wine decreased from 383 mL to 308 mL. The respective findings for female students were as follows: 200 mL of vodka, 150 mL of other strong alcoholic beverages, 300 mL of wine, and 750 mL of beer. Male students smoked 11 and females 7 cigarettes per day, on the average.
Conclusions. It seems that the stability of addictive substance use among students demonstrates that high risk of chronic diseases is related to the balance between social supply of these substances, and prevention of their distribution and usage. Full article

The aim of the study was to identify the effect of overweight, obesity, and conditions related to body weight on quality of life and to assess the relationship between body weight and satisfaction with body image between middle-aged Lithuanian inhabitants of Kaunas city.
Material and methods. A random sample of 1403 Kaunas men and women, aged 35–64 years and stratified by age and sex, was examined in 2001–2002. Response rate was 62.4%. Examination included physical measurements and information on risk factors related to lifestyle. Quality of life was assessed by World Health Organization Quality of Life 100 questionnaire. Multivariate analyses were performed to identify the effect of excess body weight and conditions linked to body weight on quality of life.
Results. Less than three-fourths (73%) of men and women had excess body weight (body mass index, ≥25.0 kg/m2). Obesity in a complex with other analyzed factors had a negative effect on men’s quality of life in the independence domain as compared to ones with BMI of <25.0 kg/ m2 (OR=1.87; 95% CI=1.08–3.26). Obesity for women increased the odds of having worse quality of life in the psychological and independence domains. Mean scores of body image and appearance facet for men with normal body mass were 73.5, for overweigh ones 72.2, and for obese 66.8 (for women 69.9, 63.3, and 52.9, respectively; P=0.0001).
Conclusions. Among women excess body weight was associated with impaired quality of life. Men with excess body weight reported better overall quality of life. Obese persons were less satisfied with their body image as compared to ones with normal body weight. Full article

The aim of the study was to analyze self-rated health among physicians depending on their sex, age, workplace (hospital or polyclinic), and specialty.
Material and methods. The studied group consisted of 377 26–70-year-old physicians randomly selected from various county hospitals and polyclinics of Lithuania. There were 85 men and 292 women. The inquiry was performed using the complemented (by the authors of the study) version of the WHO anonymous questionnaire of the quality of life (1995). Responses were evaluated based on physicians’ evaluation of their own health, which was rated as very good, good, satisfactory, poor, and very poor.
Results. Only 8.2% of males and 5.8% of females evaluated their health as very good (P>0.05). More men, compared to women, evaluated their health as good (62.3% and 53.1%, respectively; P<0.05), whereas more females evaluated their health as satisfactory, compared to males (36.0% and 25.9%, respectively; P<0.05); 2.4% of males and 5.1% of females (p>0.05) stated that their health was poor. In most cases, physicians of different age groups presented equal evaluations of their health except for physicians in the age groups of 26–37 and 38–43 years – those who evaluated their health as very good comprised a significantly higher percentage (P<0.05), compared to other age groups. As expected, a higher percentage of older physicians evaluated their health as satisfactory. In addition to that, more hospital physicians, compared to those working in polyclinics, evaluated their health as good (12.8% and 1.8%, respectively; P<0.05) and vice versa – significantly more physicians working in polyclinics evaluated their health as satisfactory, compared to those working in hospitals (38.1% and 26.8%, respectively; P<0.05). A significantly higher percentage of surgeons, compared to general practitioners or therapists, evaluated their health as very good (15.8%, 4.5%, and 6.1%, respectively; P<0.05) and a significantly lower percentage – as satisfactory (P<0.05).
Conclusions. Irrespectively of sex, 6.4% of the studied physicians evaluated their health as very good; 55.2%, as good; 33.7%, as satisfactory; 4.7%, as poor; and 0.3%, as very poor. A higher percentage of physicians who evaluated their health as very good or good were 26–37 and 38–43 years of age, whereas more physicians in older age groups evaluated their health as satisfactory. A higher percentage of physicians working in hospital evaluated their health as very good, whereas more physicians who worked in polyclinics evaluated their health as satisfactory. Compared to general practitioners and therapists, surgeons more frequently evaluated their health as very good and significantly less frequently – as satisfactory. Full article

Aminopyridines are known to inhibit acetylcholine-activated K⁺ current (I_KACh) in cardiac myocytes. The aim of this study was to examine the effect of 2-aminopyridine sulfonylcarbamide derivative 2-AP27 on isoprenaline-stimulated L-type Ca²⁺ current (I_CaL) and to identify whether 2-AP27 acts via blocking of muscarinic M₂-receptors in frog cardiomyocytes. The whole-cell configuration of the patch-clamp technique was used to record I_CaL in enzymatically isolated cardiac myocytes. Isoprenaline (0.1 μM), an agonist of β₁-β₂-adrenoreceptors, stimulated the I_CaL up to 475±61% (n=4) (P<0.05) vs. control. Then, in the first series of experiments, carbachol (0.01 μM), an agonist of M2 muscarinic receptors, reduced the stimulatory effect of isoprenaline to 42±15% vs. isoprenaline alone. 2- AP27 (100 μM) alone completely abolished the inhibitory effect of carbachol on isoprenaline-stimulated ICaL, which recovered to 95±5.8% of the effect of isoprenaline. In the second series of experiments, adenosine (1 μM), an agonist of A₁-adenosine receptors, reduced the stimulatory effect of isoprenaline on I_CaL to 56±10% (n=3) (P<0.05). Then 2-AP27 (100 μM) applied in the presence of adenosine, had no effect on I_CaL, which remained at 51±7.9% (n=3) (P<0.05) of the effect of isoprenaline. These results suggest that 2-AP27, a new derivative of 2-AP, containing 4-toluolsulfonylcarbamide instead of amino group and quaternizated nitrogen by 4-nitrobenzylbromide in pyridine ring, is acting as an antagonist of muscarinic M₂ receptors in frog ventricular myocytes. Full article

In vitro fertilization technology consists of the selection and fertilization of oocytes, the production and transplantation of embryos to recipients. The quality of oocytes has a direct impact on the fertilization and developmental competence of oocytes. Criteria that show the quality of oocytes are subdivided into morphological, cellular, and molecular. The aim of this article was to review the morphological criteria that are used for estimation of the quality of oocytes before their fertilization in vitro. These criteria include the evaluation of the structure of oocyte: cumulus complex, oocyte cytoplasm, polar body, perivitelline space, zona pellucida, and meiotic spindle. Full article