Medicina, Volume 49, Issue 9 (September 2013) – 6 articles

In this case report, we present familiar hypertrophic cardiomyopathy with age-dependent heterogeneity of the disease phenotype among the members of one family who carry the same mutation of the myosin-binding protein C gene. Phenotypic heterogeneity is common in patients with familial forms of hypertrophic cardiomyopathy, both in clinical expression and outcome. Compared with other noninvasive cardiac imaging modalities, cardiovascular magnetic resonance provides an opportunity to more accurately characterize the varying phenotypic presentations of hypertrophic cardiomyopathy. Full article

Background and Objective. The assessment of the factors associated with breastfeeding duration helps in creation of a national policy according to the World Health Organization strategy and recommendations. The objective of the study was to identify the factors associated with breastfeeding duration.
Material and Methods. These analyses are based on a sample of mothers with babies attending one family health center in Kaunas, Lithuania. Completed questionnaires were obtained from 195 mothers (response rate, 97.5%). One year later, the same respondents, who had 1-year-old children, answered questions of the second questionnaire.
Results. Half (53.8%) of the surveyed women breastfed for 3–5 months, 29.7% for 6 months and more, and 16.5% of the respondents breastfed for less than 3 months. The oldest (31–40 years) women breastfed their babies significantly longer than the youngest (<20 years) mothers. The mothers with a higher education breastfed their babies significantly longer than the less educated mothers. The married women breastfed longer than single or living with a partner. The mothers who did not give extra fluids and pacifiers breastfed significantly longer than the women who gave them. The majority of the mothers who had sore nipples, milk stasis, and mastitis breastfed for only up to 3 months.
Conclusions. Mothers at risk of short breastfeeding duration should be targeted as a group for breastfeeding promotion early in the pregnancy. The education of healthcare professionals who provide prenatal and postnatal care allows them to choose women who need additional breastfeeding support. Full article

Background and Objective. Dental general anesthesia (DGA) is an efficient treatment modality for young pediatric dental patients. The aim of this study was to identify the reasons for DGA, characteristics of patients receiving treatment under DGA, and treatment performed under DGA for children under school age in Kaunas, Lithuania.
Material and Methods. The study population comprised all patients younger than 6 years treated under GA for dental reasons (n=144) at the University Hospital during a 3-year period from 2010 to 2012. The data were collected by means of clinical dental examinations, a survey of the parents, and the patients’ dental records and included personal background, reasons for DGA, dental status, and treatment provided.
Results. More than half (54%) of the children were younger than 4 years; 40% of them resided in cities. The dental caries experience was high: the mean dmft and d were 12.9 (SD, 3.5) and 12.1 (SD 3.9), respectively. The majority (81%) of the children had multiple reasons for DGA, with the need for excessive treatment (93%), followed by dental fear and uncooperativeness (66%), being the most common. The extent of treatment increased with age and was greater among patients from rural areas. Of the 1975 primary teeth treated under GA, 50% were restored, 32% extracted, and 18% targeted with preventive procedures.
Conclusions. Young children with very high levels of untreated tooth decay are treated under DGA at the Lithuanian University of Health Sciences Hospital. The need for complex treatment as well as dental fear and uncooperativeness are the major reasons for DGA. Multiple caries treatments and extractions are performed for these patients. This study highlights a great need to develop the healthcare system with regard to the appropriate management of caries among young children and postoperative DGA care. Full article

Objective. The aim of this study to investigate the associations of fracture type, age, and gender with hand function after distal radius fractures treated with a volar locking plate at a 6-month follow-up.
Material and Methods. A total of 120 patients with displaced distal radius fractures were included into the study. They were operated on using a volar locking plate system. All the fractures were classified according to the AO classification, and the patients were divided into 3 groups by the fracture type. The range of motion and grip strength were evaluated at the 6-month follow-up. Multivariate linear regression analysis was used to evaluate the associations of age, gender, and fracture type with the score of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The DASH questionnaire was completed as an outcome measure.
Results. A total of 28 patients experienced type A fractures; 70 patients, type B fractures; and 22 patients, type C fractures. No statistically significant difference regarding age and sex among the groups was observed. At 6 months after the surgery, the mean DASH score for type A, B, and C fractures was 16, 13, and 32, respectively (P=0.01). After the surgery, the radiographic parameters such as the volar tilt and the ulnar variance were significantly worse in the patients with type C fractures. Grip strength and the range of motion of the contralateral healthy hand at the 6-month follow-up were significantly better than those of the operated hand. The linear regression analysis showed that the type C fracture was the only factor significantly associated with lower DASH score.
Conclusions. The patients with type C fractures treated with a volar locking plate had a worse wrist function as compared with the patients type A and B fractures at the 6-month follow-up. The postoperative hand function was significantly associated only with the type C fracture, while age and gender had no significant impact. Full article

Increasing resistance of Escherichia coli (E. coli) to antibiotics, especially to the third-generation cephalosporins, has prompted studies on widespread resistance genes such as bla_CTX-M and differentiation of E. coli to phylogenetic groups. The aim of this study was to determine the associations between the CTX-M type and the phylogenetic group, the site of infection, and coresistance in Lithuanian E. coli isolates producing β-lactamases.
Material and Methods. A total of 90 E. coli ESBL strains were recovered from the lower respiratory tract, the urinary tract, sterile body sites, wounds, and other body sites between 2008 and 2012. The E. coli isolates resistant to at least 2 antibiotics with different modes of action along with resistance to cefotaxime were considered as multiresistant. The bla_CTX-M, bla_TEM, bla_OXA-1, and blaSHV genes, the phylogenetic groups, and the resistance profiles were analyzed.
Results. Of the 90 isolates, 84 (93.3%) were classified as multiresistant and 6 (6.6%) as resistant. The bla_CTX-M-15 gene was the most prevalent gene followed by the bla_CTX-M-14 and bla_CTX-M-92 genes. The logistic regression analysis revealed the associations between CTX-M-15 and resistance to ceftriaxone, between CTX-M-14 and resistance to cefoxitin, aztreonam, ampicillin/sulbactam, ticarcillin/clavulanic acid, and tobramycin, and between CTX-M-92 and resistance to cefepime, piperacillin/tazobactam, gentamicin, and tobramycin.
Conclusions. The results of this study showed a significant association between CTX-M-15, CTX-M-14, and CTX-M-92 β-lactamases and resistance to some antibiotics as well as CTX‑M-14 β-lactamase and phylogenetic group A in the Lithuanian population. The associations between the CTX-M type and the site of infection were not determined. Full article

The aim of the study was to explore the effects of memantine on responses elicited in the frog tectum by the bursts of spikes of moderate strength of a single retina ganglion cell and to gain an insight about the effect of memantine on the L-type Ca²⁺ current.
Material and Methods. The experiments were performed in vivo on adult frogs (Rana temporaria). An individual retina ganglion cell (or its retinotectal fiber) was stimulated by current pulses delivered through a multichannel stimulating electrode positioned on the retina. Responses to the discharge of a single retinal ganglion cell were recorded in the tectum by an extracellular carbonfiber microelectrode positioned in the terminal arborization of the retinotectal fiber in the tectum layer F. The solution of memantine (1-amino-3,5-dimethyladamantane) hydrochloride (30 or 45 μM) was applied onto the surface of the tectum by perfusion at a rate of 0.4 mL/min.
Results. Memantine (30–45 μM) largely inhibited the L-type Ca²⁺ channel-mediated slow negative wave and late discharges seen in the tectum responses without any effect on fast synaptic retinotectal transmission.
Conclusions. Our results suggest that the neuroprotective effect of memantine could arise not only through the inhibition of the NMDA receptor current but also through the suppression of the L-type Ca²⁺ current. Full article