Medicina, Volume 49, Issue 6 (June 2013) – 7 articles

Background and Objective. Timely assessment and prevention of risk factors for the main perioperative complications in elderly patients provide an opportunity to avoid them, decrease mortality, and diminish costs associated with longer hospital stay. The aim of this study was to estimate perioperative factors that could potentially predict the length of stay and to estimate their predictive value using a comprehensive geriatric assessment among elderly patients.
Material and Methods. The study population comprised 99 surgical patients aged 65 and more. The patients were followed up until discharge. Study data analysis included questionnaires, anthropometric measurements before surgery, assessment and interviews after surgery, and case histories. Univariate and multivariate logistic regression analysis was performed.
Results. Malnutrition was detected in 53.5% of the patients. Postoperative cognitive disorder was documented in 18.2% of elderly patients. The mean length of hospital stay was 10.1 days (SD, 9.14). Multivariate logistic regression analysis revealed that the best predictors for longer hospital stay in elderly patients were malnutrition (OR, 4.2; 95% CI, 1.5–11.8; P=0.007) together with postoperative cognitive impairment (OR, 9.2; 95% CI, 1.0–83.3; P=0.048). The total predictive value of the model was 70.5%.
Conclusions. Malnutrition and a postoperative cognitive disorder were independent risk factors for longer hospital stay, while depression, cognitive impairment, functional dependence, and poor physical status were not independently associated with longer hospital stay. A comprehensive geriatric assessment can help assess the risk factors for longer treatment and predict the length of hospital stay, thus enabling the planning of optimal healthcare management of elderly patients. Full article

Corneal transplant surgery after chemical or thermal burns has a very low success rate. Vision in these patients can be restored by using an artificial cornea (keratoprosthesis). In this report, we present 5 clinical cases of implanting a fresh corneal graft with Boston type 1 keratoprosthesis in patients with corneas inappropriate for standard corneal transplantation. The mean follow-up was 26.4 months (range, 12 to 36 months; SD, 13.1). The main measures of outcomes were visual acuity and keratoprosthesis stability. At least 1 year after the operation (5 eyes), vision acuity was >0.1 in 100% of the eyes and >0.4 in 50% of the eyes. Retention of the initial keratoprosthesis was 100%. The results of this study seem to be similar to those reported internationally. The anatomical and visual functions of the eyes were stable after keratoprosthesis implantation, though for a longer follow-up period, additional surgical procedures may be required. Full article

Background and Objective. The number of new entrants to higher medical schools of Kazakhstan increased by 1.6 times from 2007 to 2012. However, it is not known how it will affect the shortage of human resources for health. Additionally, human resources for health in rural areas of Kazakhstan are 4 times scarcer than in urban areas. The aim of the present study was to investigate the intentions of students toward their professional future and readiness to work in rural areas, as well as to determine the causes for dropping out from medical schools.
Material and Methods. A cross-sectional survey was conducted in 2 medical universities in Almaty during the academic year 2011–2012. The study sample included medical students and interns. In total, 2388 students participated in the survey. The survey tool was an anonymous questionnaire.
Results. The students of the first years of studies compared with those of later years of studies were more optimistic about the profession and had more intentions to work in the medical field. Only 8% of the students reported a wish to work in rural localities. On the other hand, 4% of the students did not plan to pursue the profession. On the average, every third medical student dropped out on his/her own request.
Conclusions. Associations between intentions to work according to the profession and the year of studies, faculty, and residence area before enrolling in a medical school were documented. The majority of the students who came from rural areas preferred to stay and look for work in a city, which might contribute to an unequal distribution of physicians across the country. Full article

Background and Objective. An insufficient supply of oxygen to the heart influences the process of protein synthesis. The aim of this study was to determine the effect of the Polyscias filicifolia Bailey biomass tincture on the protein synthesis process in a heterogeneous translation system from the isolated pig heart.
Materials and Methods. The effect of anoxia was evaluated after 20- and 90-minute anoxia. With the aim to determine the effect of Polyscias, the pig hearts were perfused with a buffer containing the Polyscias filicifolia Bailey biomass tincture. To determine the rate and the level of translation, the incorporation of [14C]-leucine into translational products in a cell-free system was measured.
Results. The protein synthesis level decreased by 23%–42% when the translation system containing cytosol from the anoxic heart was used. When the translation system containing a ribosomal fraction after 20-minutes anoxia was used, the protein synthesis level was the same as in the control. In the case of 90-minute anoxia, it decreased by 16%. The protein synthesis rate and the level in the translation system containing cytosol from the heart after 20-minute anoxic perfusion with the buffer containing Polyscias was the same as in the control.
Conclusions. A decrease in the protein synthesis rate and the level after 20-minute anoxia was determined by changes in cytosol. On the other hand, 90-minute anoxia caused changes in cytosol and the ribosomal fraction. The Polyscias filicifolia Bailey biomass tincture restored the protein synthesis process acting on the components of the translation system in cytosol and the ribosomal fraction. Full article

Objective. The aim of this study was to assess age-related visual functions (visual acuity and contrast sensitivity) and compare the results by different age groups.
Material and Methods. A total of 231 patients were examined. The patients were divided into 5 age groups: 10 patients in group 1, 30–39 years; 40 patients in the group 2, 40–49 years; 77 patients in the group 3, 50–59 years; 71 patients in the group 4, 60–70 years; and 33 patients in the group 5, 71–85 years. A typical Snellen’s chart (the direction of the gap in Landolt C) was used for noncorrected and best-corrected visual acuity testing. Contrast sensitivity was evaluated by employing a Ginsburg Box, VSCR-CST-6500.
Results. Noncorrected visual acuity was significantly better in the group 2 than the group 3 (0.86 [0.28] vs. 0.69 [0.33], P=0.018). Moreover, noncorrected and best-corrected visual acuity was significantly better in the group 4 than the group 5 (0.52 [0.35] vs. 0.35 [0.28], P<0.001; and 0.9 [0.21] vs. 0.69 [0.27], P<0.005, respectively). Contrast sensitivity at the nighttime without glare was significantly worse in the group 2 than the group 1 at the spatial frequencies of 3, 12, and 18 cycles per degree (P=0.001, P=0.05, and P=0.01, respectively). The patients in the group 2 had significantly worse contrast sensitivity at the nighttime and daytime with glare at the spatial frequencies of 1.5, 12, and 18 cycles per degree (P=0.054, P=0.04, and P=0.01 and P=0.011, P=0.031, and P=0.011, respectively). The greatest differences in contrast sensitivity were observed between the groups 4 and 5, and it was 2 to 4 times better in the group 4. Comparing these groups, all the differences at the nighttime and daytime with and without glare were significant.
Conclusions. Contrast sensitivity was worst among the oldest persons (71–85 years), and it began to worsen already in the persons aged 40–49 years. Contrast sensitivity was very similar in the age groups of 40–49 and 50–59 years. Full article

Background and Objective. The objective of our study was to investigate whether the combination of markers of heart rate variability (HRV) and impedance cardiography (ICG) help evaluate the risk of in-hospital death, ventricular arrhythmia, or complicated course secondary to myocardial infarction (STEMI) and to clarify whether combined analysis of HRV and ICG improve prognosis of STEMI, comparing 3 groups: 1) diabetic, 2) nondiabetic, and 3) diabetes-unselected patients.
Material and Methods. The parameters reflecting heart rate variability and central hemodynamics were estimated from a 24-hour synchronic electrocardiogram and thoracic impedance signal recordings in 232 patients (67 diabetic) on the third day after myocardial infarction. Logistic regression analysis was used to determine the predictors of selected outcomes. Different prognostic models were compared with the receiver operating characteristic curve analysis.
Results. The model consisting of low- and high-frequency power ratio (LF/HF) and cardiac output (CO) was elaborated for the prognosis of in-hospital death in the group 3 (odds ratios [ORs] were 9.74 and 4.85, respectively). Very low-frequency power (VLF), cardiac index (CIN), and cardiac power output (CPO) were the predictors of ventricular arrhythmia in the group 2 (ORs of 1.005, 5.09, and 66.7, respectively) and the group 3 (ORs of 1.004, 3.84, and 37.04, respectively). The predictors of the complicated in-hospital course in the group 1 were the baseline width of the minimum square difference triangular interpolation of the highest peak of the histogram of all NN intervals (TINN) and stroke volume (SV) (ORs of 1.006, and 1.009, respectively); in the group 2, the mean of the standard deviations of all NN intervals for all 5-minute segments of the recording (SDNN index) and CPO (ORs of 1.06 and 2.44, respectively); and in the group 3, SDNN index, VLF, LF/HF, CIN (ORs of 1.04, 1.004, 2.3, and 3.49, respectively).
Conclusions. The patients with decreased HRV and low estimates of central hemodynamics evaluated by ICG are at an increased risk of the adverse in-hospital course of STEMI. The combined analysis of HRV and ICG hemodynamic estimates contributes to the risk assessment of the complicated in-hospital course of STEMI, in-hospital hemodynamically significant ventricular arrhythmia, and in-hospital death secondary to STEMI. The in-hospital prognostic value of the combined estimates of HRV and ICG is lower in the STEMI patients with diabetes mellitus as compared with the nondiabetic patients. Full article

Background and Objective. The aim of the present study was to describe the cognitive profile of patients with focal and generalized epilepsy syndrome in comparison with healthy control subjects and to investigate whether depression was related to neuropsychological functioning in these patients.
Material and Methods. A total of 36 patients with focal epilepsy and 26 patients with generalized epilepsy were compared with the control group of healthy volunteers (n=53). A battery of neuropsychological tests assessing verbal and visual spatial memory and executive functioning was carried out in addition to the completion of the Beck Depression Inventory (BDI).
Results. The results indicated that patients with epilepsy performed significantly worse than controls on all verbal memory subscales and verbal fluency domains. The patients with focal epilepsy scored significantly worse than the patients with generalized epilepsy. The BDI scores were significantly correlated with several scores of the cognitive test in both patients’ groups but not in the control group.
Conclusions. Our results suggest that patients with epilepsy, especially with focal-onset epilepsy, show cognitive disturbances predominantly in the verbal memory domain. In addition, depression was found to have a negative effect on cognitive functioning in patients with epilepsy. Full article