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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Lithuanian Medical Association, Lithuanian University of Health Sciences, and Vilnius University.

Medicina, Volume 46, Issue 8 (August 2010) – 10 articles

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Article
The usage of blood components in obstetrics
Medicina 2010, 46(8), 561; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina46080081 - 11 Aug 2010
Cited by 3 | Viewed by 495
Abstract
Major obstetric hemorrhage remains the leading cause of maternal morbidity and mortality worldwide. Even though blood transfusion may be a life-saving procedure, an inappropriate usage of blood products in obstetric emergencies especially in cases of massive bleeding is associated with increased morbidity and [...] Read more.
Major obstetric hemorrhage remains the leading cause of maternal morbidity and mortality worldwide. Even though blood transfusion may be a life-saving procedure, an inappropriate usage of blood products in obstetric emergencies especially in cases of massive bleeding is associated with increased morbidity and risk of death. Thorough knowledge of the etiology, pathophysiology, and optimal therapeutic options of major obstetric hemorrhage may help to avoid lethal outcomes. There are evidence-based data about some risks related with transfusion of blood components: acute or delayed hemolytic, febrile, allergic reactions, transfusion-related acute lung injury, negative immunomodulative effect, transmission of infectious diseases, dissemination of cancer. This is why the indications for allogeneic blood transfusion are restricted, and new safer methods are being discovered to decrease the requirement for it. Red cell alloimmunization may develop in pregnancy; therefore, all pregnant women should pass screening for irregular antibodies. Antierythrocytic irregular antibodies may occur due to previous pregnancies or allogeneic red blood cell transfusions, and it is important for blood cross-matching in the future. Under certain circumstances, such as complicated maternal history, severe coagulation abnormalities, severe anemia, the preparation of cross-matched blood is necessary. There is evidence of very significant variation in the use of blood products (red cells, platelets, fresh frozen plasma, or cryoprecipitate) among clinicians in various medical institutions, and sometimes indications for transfusion are not correctly motivated. The transfusion of each single blood product must be performed only in case of evaluation of expected effect. The need for blood products and for their combination is necessary to estimate for each patient individually in case of obstetric emergencies either. Indications for transfusion of blood components in obstetrics are presented in order to improve the skills of doctors and to optimize therapeutic options in obstetric emergencies. Full article
Article
The level of endotoxins in hemodialysis water and dialysate in Lithuanian hemodialysis centers
Medicina 2010, 46(8), 556; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina46080080 - 11 Aug 2010
Cited by 2 | Viewed by 481
Abstract
The composition and quality of the dialysis fluid play an important role in the modulation of dialysis-related complications. During hemodialysis, patient’s blood has a contact with dialysate through a semipermeable membrane. Bacterial endotoxins can pass through the membrane pores into the patient’s blood [...] Read more.
The composition and quality of the dialysis fluid play an important role in the modulation of dialysis-related complications. During hemodialysis, patient’s blood has a contact with dialysate through a semipermeable membrane. Bacterial endotoxins can pass through the membrane pores into the patient’s blood and cause a silent chronic microinflammation. The aim of this study was to determine the level of endotoxins in hemodialysis water and dialysate in Lithuanian hemodialysis centers. Dialysis water (n=50) and dialysate (n=50) were collected from 91% (n=50) of all hemodialysis centers. The presence of bacterial endotoxins was evaluated using a sensitive Limulus amebocyte lysate test, which detects intact lipopolysaccharides. The level of endotoxins was lower than 0.25 EU/mL in 43 (86%) dialysis water samples and in 46 (92%) dialysate samples, and complied with the recommendations of the European Pharmacopoeia and the European Best Practice Guidelines for pure dialysis fluid. The dialysate of 39 (78%) Lithuanian hemodialysis centers complied with the definition of an ultrapure dialysis fluid. The water and dialysate were of insufficient quality in 14% and in 8% of Lithuanian hemodialysis centers, respectively, and this could be improved by the establishment of routine investigation of endotoxins. Full article
Article
Vascular access for hemodialysis: creation, functioning, and complications (Data of the Hospital of Kaunas University of Medicine)
Medicina 2010, 46(8), 550; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina46080079 - 11 Aug 2010
Cited by 1 | Viewed by 482
Abstract
Background. There are no data about arteriovenous fistulas (AVF) formation, survival, and complications rate in patients with end-stage renal failure in Lithuania.
Material and methods. We analyzed the data of patients (N=272) with end-stage renal failure, dialyzed at the [...] Read more.
Background. There are no data about arteriovenous fistulas (AVF) formation, survival, and complications rate in patients with end-stage renal failure in Lithuania.
Material and methods. We analyzed the data of patients (N=272) with end-stage renal failure, dialyzed at the Hospital of Kaunas University of Medicine from January 1, 2000, until March 30, 2010, and identified 368 cases of AVF creation. The patients were divided into two groups: group 1 included the patients with an AVF that functioned for <15 months (n=138) and group 2 included patients with an AVF that functioned for ≥15 months (n=171).
Results and conclusions. Less than half (47%) of the patients started planned hemodialysis and 51% of the patients started hemodialysis urgently. The mean time of AVF functioning was 15.43±8.67 months. Age, gender, the kidney disease, and time of AVF maturation had no influence on AVF functioning time. AVFs of the patients who started planned hemodialysis functioned longer as compared to AVFs of the patients who started hemodialysis urgently (P<0.05). Hospitalization time of the patients who started hemodialysis urgently was longer as compared that of the patients who had a matured AVF (37.63±20.55 days vs. 16.54±9.43 days). The first vascular access had better survival than repeated access. AVF survival in patients with ischemic brain vascular disease was worse than in patients without this comorbidity. Full article
Article
Risk factors for cardiovascular hospitalization in hemodialysis patients
Medicina 2010, 46(8), 544; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina46080078 - 11 Aug 2010
Cited by 2 | Viewed by 420
Abstract
The aim of this study was to evaluate the risk factors for cardiovascular hospitalization in hemodialysis patients.
Materials and methods
. A cross-sectional cohort analysis of risk factors during one census month (November) and one-year follow-up for cardiovascular hospitalization rates during 5 consecutive [...] Read more.
The aim of this study was to evaluate the risk factors for cardiovascular hospitalization in hemodialysis patients.
Materials and methods
. A cross-sectional cohort analysis of risk factors during one census month (November) and one-year follow-up for cardiovascular hospitalization rates during 5 consecutive years (2002–2006) in all end-stage renal disease patients hemodialyzed in Kaunas region was carried out. During the census month, we collected data on patient’s age and sex, disability status, comorbidities, anemia control, malnutrition and inflammation, calciumphosphorus metabolism, and patient’s compliance with prescribed medications. We analyzed 559 patients during 1163 patient-years of observation. Patients were considered as new patients every year (1520 cases). Kaplan-Meier method and Cox regression analysis were used to evaluate time to first hospitalization.
Results. The mean number of cardiovascular hospitalizations was 0.31 per patient-year at risk, the total days of cardiovascular hospitalizations per patient-year at risk were 3.93, and the mean length of one hospitalization was 13.2±12.9 days. Cardiovascular diseases were the most frequent cause of hospitalization (25% of all hospitalizations). The relative risk of cardiovascular hospitalization increased by 1.03 for every year of age, by 1.7 for worse disability status, by 1.4 for nonadherence to medications, by 1.1 for every additional medication prescribed to the patient. Cardiovascular hospitalization risk was decreased by 0.99 with a 1-g/L rise in hemoglobin level.
Conclusions
. Older age, worse disability status, patient’s noncompliance with medications, and higher number of medications used were associated with a higher risk for cardiovascular hospitalization. Higher hemoglobin level was associated with a lower risk for cardiovascular hospitalization. Full article
Article
Ten-year experience of kidney transplantation at the Hospital of Kaunas University of Medicine: demography, complications, graft and patient survival
Medicina 2010, 46(8), 538; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina46080077 - 11 Aug 2010
Cited by 2 | Viewed by 476
Abstract
During 10 years, 163 cadaveric kidney transplantations were performed at the Hospital of Kaunas University of Medicine. The aim of this study was to analyze the first 10-year experience in kidney transplantation and to evaluate the most frequent early and late complications after [...] Read more.
During 10 years, 163 cadaveric kidney transplantations were performed at the Hospital of Kaunas University of Medicine. The aim of this study was to analyze the first 10-year experience in kidney transplantation and to evaluate the most frequent early and late complications after transplantation, graft and patient survival, and impact of delayed graft function on graft survival.
Material and methods
. A total of 159 patients were included into the study. Graft and patient survival was calculated at 1, 3, and 5 years after transplantation using the Kaplan-Meier method; graft function was also analyzed.
Results
. Fifty-three patients (33.3%) in the early period and 72 (55.4%) in the late period had at least one episode of urinary tract infection. Less than half (47.2%) of patients had complications related to immunosuppressive treatment, mostly cytomegalovirus infection, in the late period. The risk of CMV reactivation was 3.98 times higher among recipients who received prophylaxis only with intravenous ganciclovir as compared to patients who received valganciclovir after a brief course of ganciclovir (OR, 3.98; 95% CI, 1.48–8.19; P=0.003). Delayed graft function was observed in 53 cases (33.3%); 37 (23.3%) grafts were lost. Graft and patient survival at 1, 3, and 5 years after transplantation was 85%, 82%, and 71% and 97%, 94%, and 94%, respectively. Graft survival at 1, 3, and 5 years was worse among patients with delayed graft function as compared to patients with good graft function (69%, 69%, 50% vs. 93%, 86%, 84%, respectively; P<0.05).
Conclusions
. Urinary tract infection was the most frequent complication after kidney transplantation. Reactivation of cytomegalovirus infection was present only in a quarter of our patients. The administration of valganciclovir was associated with a significantly lower incidence of CMV infection/disease. Graft and patient survival was sufficiently good. Delayed graft function was an independent risk factor for worse graft survival. Full article
Article
The association between health-related quality of life and mortality among hemodialysis patients
Medicina 2010, 46(8), 531; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina46080076 - 11 Aug 2010
Cited by 18 | Viewed by 470
Abstract
Introduction. Mortality rates for patients undergoing maintenance hemodialysis remain high. Published data regarding association between health-related quality of life (HRQOL) and mortality among hemodialysis patients are inconsistent. Very few data are published on the change in HRQOL over time as a predictor [...] Read more.
Introduction. Mortality rates for patients undergoing maintenance hemodialysis remain high. Published data regarding association between health-related quality of life (HRQOL) and mortality among hemodialysis patients are inconsistent. Very few data are published on the change in HRQOL over time as a predictor of mortality. The aim of this study was to assess whether HRQOL and change of it over time could be considered an independent predictor of mortality in hemodialysis patients.
Material and methods. This prospective observational study enrolled 183 patients undergoing maintenance hemodialysis. HRQOL was measured annually 2004–2008 using a generic Short Form 36 questionnaire. Physical component summary (PSC) and mental component summary (MSC) scores were calculated. The change of the patient’s HRQOL over time was calculated as a difference between SF-36 scores of the first and the last HRQOL measurements.
Results. The median follow-up was 48 months (range, 1–72 months). Cutoff values for HRQOL predicting mortality for PSC score was ≥35 and for MSC score was ≥45. In the model adjusted for age, sex, dialysis months, creatinine, albumin and hemoglobin levels, mortality risk decreased by 0.96 (95% CI, 0.95–0.99) for 1-point increase in the baseline PSC score and decreased by 0.97 (95% CI, 0.95–0.98) for 1-point increase in the baseline MSC score. A 1-point decline in the PSC score (relative risk, 1.11; 95% CI, 1.008–1.221) and MSC score (relative risk, 1.07; 95% CI, 1.002–1.149) over the period of follow-up were associated with a significant additional increase in mortality.
Conclusions
. Both baseline HRQOL and decline of HRQOL are independent predictors of mortality in hemodialysis patients. Full article
Article
The influence of mean blood pressure on arterial stiffening and endothelial dysfunction in women with rheumatoid arthritis and systemic lupus erythematosus
Medicina 2010, 46(8), 522; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina46080075 - 11 Aug 2010
Cited by 20 | Viewed by 629
Abstract
Objective. To investigate the carotid-radial pulse wave velocity, augmentation index, and flow-mediated dilation of the brachial artery and factors possibly influencing them in women with rheumatoid arthritis and systemic lupus erythematosus.
Material and methods
. A total of 63 women with rheumatoid [...] Read more.
Objective. To investigate the carotid-radial pulse wave velocity, augmentation index, and flow-mediated dilation of the brachial artery and factors possibly influencing them in women with rheumatoid arthritis and systemic lupus erythematosus.
Material and methods
. A total of 63 women with rheumatoid arthritis, 31 with systemic lupus erythematosus, and 72 controls, aged 18–55 years, were examined. Parameters of arterial stiffness, augmentation index and carotid-radial pulse wave velocity, were obtained by applanation tonometry (Sphygmocor (v.7.01) AtCor Medical). Flow-mediated dilatation of the brachial artery, reflecting endothelial function was determined by ultrasound system (Logiq 7, General Electric).
Results
. The groups of women with rheumatoid arthritis and systemic lupus erythematosus lupus differed from controls regarding augmentation index (P<0.001; P=0.008) and did not differ between each other. Women with systemic lupus erythematosus differed from controls regarding pulse wave velocity (P=0.018), while women with rheumatoid arthritis – did not. Flow-mediated dilatation in both the groups of diseases was not different from controls. In rheumatoid arthritis patients, mean blood pressure was the main explanatory factor for augmentation index and pulse wave velocity; vessel diameter and high-density lipoprotein cholesterol – for flow-mediated dilatation. In women with systemic lupus erythematosus, pulse wave velocity was not related to any of the pending parameters; augmentation index was dependent on organ damage index, age, and mean blood pressure, and flow-mediated dilatation on vessel diameter, body mass index, and disease duration.
Conclusions
. The mean blood pressure was the major and the only one risk factor of arterial stiffening in rheumatoid arthritis, while the disease damage index played the most important role in the systemic lupus erythematosus group. The mean blood pressure in the systemic lupus erythematosus group was not as important as in the rheumatoid arthritis group, though may have a partial influence. Full article
Article
Impact of hemodialysis dose and frequency on survival of patients on chronic hemodialysis in Lithuania during 1998–2005
Medicina 2010, 46(8), 516; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina46080074 - 11 Aug 2010
Cited by 30 | Viewed by 499
Abstract
Introduction. The question of the targets of dialysis dosing remains controversial since the beginning of the long-term dialysis treatment era. It is still uncertain if higher dialysis dose is better. The aim of our study was to investigate issues of dialysis dose [...] Read more.
Introduction. The question of the targets of dialysis dosing remains controversial since the beginning of the long-term dialysis treatment era. It is still uncertain if higher dialysis dose is better. The aim of our study was to investigate issues of dialysis dose in Lithuania during the period of 1998–2005 and to determine associations between hemodialysis dose and survival of patients on chronic hemodialysis.
Material and methods.
We analyzed data of all patients who started hemodialysis due to endstage renal disease in Lithuania between January 1, 1998, and December 31, 2005. The information about hemodialysis frequency, duration, and adequacy (according to Kt/V) was obtained from medical documentation. The overall survival rate was estimated using the Kaplan- Meier method. Survival comparisons were made using the log-rank or Breslow tests. Univariate Cox proportional hazards analysis was used to select variables significantly associated with the risk of death; then these variables were included in multivariate Cox proportional hazards models.
Results. During the study period, from 2428 patients who started chronic hemodialysis, 58.5% of patients started hemodialysis three times a week. More than one-third (36.2%) of patients were dialyzed twice weekly, and 5.3% of patients started hemodialysis once weekly. Survival analysis revealed that patients dialyzed less than three times per week survived shorter than patients receiving a higher dialysis dose. Duration of HD session of ≤8 hours per week was an independent risk factor for mortality. A higher mean Kt/V was associated with better survival of patients on chronic hemodialysis.
Conclusions. Dialysis frequency and weekly duration of HD sessions were dependent on HD accessibility in Lithuania during the period of 1998–2005. Better survival of patients on chronic hemodialysis was associated with a higher hemodialysis dose. Full article
Article
Acute kidney injury in pediatric patients: experience of a single center during an 11-year period
Medicina 2010, 46(8), 511; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina46080073 - 11 Aug 2010
Cited by 14 | Viewed by 510
Abstract
The aim of our study was to determine the causes of acute kidney injury (AKI) in children, to compare outcomes between two periods – 1998–2003 and 2004-2008 – and to evaluate the influence of new methods of renal replacement therapy on mortality.
Material [...] Read more.
The aim of our study was to determine the causes of acute kidney injury (AKI) in children, to compare outcomes between two periods – 1998–2003 and 2004-2008 – and to evaluate the influence of new methods of renal replacement therapy on mortality.
Material and methods. A retrospective analysis of medical record data of all children treated for AKI at the Clinic of Children Diseases, Hospital of Kaunas University of Medicine, during the period of 1998–2008 was made. Both periods were compared regarding various variables.
Results. Of the 179 children with AKI, 75 (41.9%) were treated during 1998–2003 and 104 (58.1%) during 2004–2008. Primary glomerular disease and sepsis were the leading causes of AKI in both the periods. AKI without involvement of other organs was diagnosed for 106 (59.2%) children: for 42 (56.0%) children in the first period and 64 (61.5%) in the second. A total of 124 (69.3%) children were treated in a pediatric intensive care unit. Multiple organ dysfunction syndrome with AKI was diagnosed for 33 (44%) patients in the first period and for 40 (38.5%) in the second. A significant decrease in mortality among patients with multiple organ dysfunction syndrome during the second period was observed (78.8% vs. 37.5%).
Conclusions
. More than half of patients had secondary acute kidney injury of nonrenal origin. More than two-thirds (69.3%) of patients with AKI were treated in the pediatric intensive care unit. Multiple organ dysfunction syndrome was diagnosed for 40.8% of children with AKI. Renal replacement therapy was indicated for one-third of patients with AKI. A 2.5-fold decrease in mortality was observed in the second period as compared to the first one. Full article
Article
HLA class II alleles and haplotypes in Lithuanian children with type 1 diabetes and healthy children (HLA and type 1 diabetes)
Medicina 2010, 46(8), 505; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina46080072 - 11 Aug 2010
Cited by 9 | Viewed by 525
Abstract
Objective. Type 1 diabetes mellitus is a slowly progressive autoimmune disease. The genetic background of type 1 diabetes mellitus is polygenic with the major disease locus located in the human leukocytes antigen (HLA) region. High risk and protective alleles, haplotypes, and genotypes [...] Read more.
Objective. Type 1 diabetes mellitus is a slowly progressive autoimmune disease. The genetic background of type 1 diabetes mellitus is polygenic with the major disease locus located in the human leukocytes antigen (HLA) region. High risk and protective alleles, haplotypes, and genotypes have been determined in Lithuanian children with type 1 diabetes mellitus and healthy children.
Material and methods. In this case-control study, 124 children with diabetes (55 males and 69 females; mean age, 9.2±3.9 years) were tested for HLA class II and compared with 78 healthy controls (43 males and 35 females; mean age, 10.8±3.4 years; range, 0–15 years). HLA DRB1, DQA1, and DQB1 alleles were genotyped using a polymerase chain reaction.
Results. T1D risk-associated haplotypes (DR4)-DQA1*0301-DQB1*0302, (DR3)- DQA1*0501-DQB1*0201, and (DR1)-DQA1*0101-04-DQB1*0501 were more prevalent among children with diabetes than controls (50.0%, 41.1%, and 37.9% vs. 10.3%, 5.1%, and 24.4%, P<0.001). The haplotypes (DR4)-DQA1*0301-DQB1*0302 and (DR3)-DQA1*0501-DQB1*0201 increased T1D risk by 8.75 and 12.93 times, respectively (P<0.001). Protective haplotypes (DR2)- DQA1*0102-B1*0602, (DR11/12/13)-DQA1*05-DQB1*0301, and (DR13)-DQA1*0103- DQB1*0603 were significantly more prevalent among controls than children with diabetes (25.6%, 33.3%, 19.2% vs. 0%, 3.2%, 0%; P<0.001). These frequencies are quite similar to those from neighbor countries with varying incidence of type 1 diabetes mellitus.
Conclusions. HLA class II haplotypes associated with type 1 diabetes mellitus positively or negatively were the same in Lithuanian children as in other European Caucasian populations. Differences in incidence and clinical manifestations of type 1 diabetes might be due to different environmental factors and/or lifestyle. Full article
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