Medicina, Volume 51, Issue 4 (August 2015) – 9 articles , Pages 201-261

Background and objective: Post-PCI TIMI flow grade 3 in infarct-related artery not always is associated with follow-up improvement in myocardial perfusion and function. We compared the improvement in myocardial perfusion and function in cases of rapid and slow electrocardiographic (ECG) stage dynamics between patients with TIMI-3 flow after primary angioplasty for acute myocardial infarction (MI). Materials and methods: Ten patients with post-PCI TIMI-3 flow were divided into group A (n = 50, no rapid change of ECG stages) and group B (n = 50, with a ≥2 ECG stages per 2 days change rate). Results: There were no significant changes after 3 months in scintigraphic (ejection fraction 44.6 ±
9.3% vs. 42.0
± 3.4%, P = 0.4; perfusion deficit severity 3.0 ±
0.7 vs. 2.3 ±
0.8, P = 0.1) and echocardiographic (dysfunction score 1.9 ±
0.2 vs. 1.6 ±
0.5, P = 0.2) data in group A. Scinti-graphic data improved (ejection fraction 34.6
± 3.9% vs. 52.0
± 7.3, P = 0.03; perfusion deficit severity 2.8 ±
0.6 vs. 1.5 ±
0.8, P = 0.03) and changes in echocardiographic data were of borderline significance (dysfunction score 1.8 ±
0.2 vs. 1.4 ±
0.4, P = 0.06) in group B. Conclusions: There was not any change in myocardial perfusion and function in a case of slow change of ECG stages after reached post-PCI TIMI flow grade 3, while myocardial perfusion improved and function tended to improve in a case of the rate at least two ECG stages in 2 days after primary angioplasty for acute MI. Full article

Background and objective: Management of outpatients with stable coronary artery disease (CAD) is important in secondary prevention. The objective was to describe differences in the characteristics of CAD patients in Latvia compared with other countries.
Materials and methods: CLARIFY is an ongoing international, prospective, observational, longitudinal registry of outpatients with CAD. Data regarding treated outpatients with established CAD from the CLARIFY registry in Latvia (n = 120) were compared with those from the rest of Central-Eastern Europe (CEE) (n = 2888) and worldwide (n = 33,163).
Results: Patients in Latvia had a larger waist circumference (101 [95–109] vs. 99 [91–106] in CEE, 96.5 [88–105] cm worldwide; P = 0.023 and P < 0.001, respectively) and higher blood pressure (systolic: 138.28 ± 17.13 vs. 133.77 ± 16.47 in CEE and 130.97 ± 16.65 mm Hg worldwide, P = 0.003 and P < 0.001; diastolic: 82.98 ± 8.58 vs. 80.01 ± 9.61 in CEE and 77.22 ± 9.97 mm Hg worldwide, P < 0.001 and P < 0.001, respectively). Body mass index in Latvia did not differ significantly from that in CEE (P = 0.422), but was higher than worldwide (28.8 [26.2–32.0] vs. worldwide 27.3 [24.8–30.3] kg/m², P < 0.001). The history of percutaneous coronary intervention was more frequent in Latvia (74.17% vs. 59.34% in CEE and 58.61% worldwide, P = 0.001 and P < 0.001, respectively). Latvian patients more frequently used aspirin (97.50% in Latvia vs. 89.75% in CEE and 87.64% worldwide, P = 0.005 and P = 0.001, respectively).
Conclusions: Latvian CAD patients are well managed in terms of aspirin use and frequency of percutaneous coronary intervention. Control of obesity and high BP is poorer and needs further improvement. Full article

Objective: The aim of the study was to investigate the relation between health-related quality of life (HRQoL) and left ventricular systolic and diastolic function parameters in stable coronary artery disease (CAD) patients with mild and moderate heart failure.
Materials and methods: This study included 758 CAD patients. Left ventricular ejection fraction (LVEF) and ratio of peak velocities of early (E) and late (A) diastolic mitral inflow, ratio E/A, deceleration time, isovolumic relaxation time were assessed. Patients completed the SF-36 questionnaire.
Results: There were no strong and significant associations between echocardiographic measures and HRQoL in NYHA I-II class patients. In NYHA III class in univariate linear regression analyses significant associations were found between LVEF and physical functioning (β = 0.230, P = 0.009) and role limitations due to physical problems (β = 0.230, P = 0.009) and these associations remain significant after adjustment for age, gender, hypertension, angina pectoris class, nitrate, ACE inhibitors and diuretics use. E/A ratio was significantly associated only with mental health domain (β = 0.188, P = 0.048), and this association remains significant after all adjustments.
Conclusions: In stable CAD patients with NYHA I-II functional class HRQoL was not strongly associated with left ventricular function; in NYHA III functional class patients' greater systolic function mainly was associated with better physical health and better diastolic function, with better mental health. Full article

Background and objective: Low-T3 syndrome is common in patients with acute myocardial infarction (AMI). Recent experimental and clinical data have suggested a potential negative impact of low-T3 syndrome on myocardial function in patients with AMI. The aim of this study was to assess left ventricular (LV) myocardial function in patients with low-T3 syndrome and to investigate the association between hormonal profile and the severity of LV dysfunction using speckle-tracking echocardiography (STE). Materials and methods: In 130 patients with first-onset ST-segment elevation acute myocardial infarction (STEMI), conventional 2D and speckle-tracking echocardiography within 48–72 h after the hospitalization was performed, and blood samples for TSH, fT4, fT3, and anti-TPO levels were obtained to investigate thyroid hormone production within 24 h and on the fourth day after the onset of STEMI symptoms. Results: The patients were divided into two groups according to their serum level of fT3: group 1 with fT3 concentration below 3.2 pmol/L (n = 34) and group 2 with normal fT3 (>3.2 pmol/L) level (n = 96). LV ejection fraction (EF) tended to be lower in the low fT3 group. The systolic longitudinal strain did not differ between the groups, but the late diastolic longitudinal strain rate was lower in group 1 (P = 0.011). The systolic basal LV rotation positively correlated with the level of fT3 (r = 0.4; P < 0.001), while a negative correlation was detected between myocardial rotational parameters – systolic apical rotation (r =
0.2; P < 0.05), torsion (r =
0.3; P < 0.001), and diastolic apical rotation rate (r =
0.3; P < 0.01) – and fT3 levels. Conclusions: The late diastolic longitudinal LV strain rate and LV rotation evaluated by speckle-tracking echocardiography were impaired in patients with low-T3 syndrome after AMI. Full article

Background and objective: Health-related quality of life (HRQOL) is an important health indicator in medical outcome research and clinical practice. This issue tends to attract even more attention with the recent improvements of patient survival after liver transplan-tation. This review article aims at providing a deeper insight into practices used for evaluating HRQOL in chronic liver diseases (CLDs) and especially cirrhosis patients during different stages of the disease including liver transplantation.
Materials and methods: A systematic review of the MEDLINE database and Cochrane library was conducted. A search using the Medical Subject Headings (MeSH) major terms ‘‘liver disease’’ AND ‘‘quality of life’’ was applied for the period from 1966 to 2012.
Results: Our review identified 1483 publications. The searched showed that significant increase of publications (from 362 to 1018) was observed during last decade (period 2003–2012) in comparison with previous. The majority of publications were in English (n = 1179). The literature search and analysis provided information on the most common generic and disease-specific HRQOL instruments, which are used in CLD patients: Medical Outcomes Study Short Form-36, the National Institute of Diabetes and Digestive and Kidney Diseases Quality of Life questionnaire, the Chronic Liver Disease questionnaire, the Liver Disease Quality of Life questionnaire, and other.
Conclusions: Quality of life instruments are potentially powerful tools for evaluating the functional status, presenting gains of treatment and reflecting patients' ability to return to a normal lifestyle in CLD patients. More attention should be paid by clinicians for integrated use of clinical tests together with HRQOL instruments in liver transplantation for establishing the reference levels of mental, physical, and role-social functioning. Full article

Background and objective: Somatotyping is helpful in sports in which the body shape could influence the resulting performance. The purpose of this study was to determine the somatotype of high profile Lithuanian athletes in kayaking, basketball and football and to compare between disciplines and with low level sportsmen of the same age.
Materials and methods: A total of 72 young male sportsmen aged from 18 to 24 years were divided into three groups (kayakers, basketball and football players). Each group contained almost equal numbers of low level and elite, international level sportsmen. Anthropometric measurements of the players were used to establish somatotypes.
Results: The greatest difference was observed in the mesomorphic component of elite kayakers compared to the low profile sportsmen. Mesomorphy could also be used to predict sport ability. The range of mesomorphy for elite footballers was from 0 to 4.6, for basketball players from 4.6 to 5.9, and for kayaking, from 5.9 and higher. Individual groups of elite sportsmen displayed different modes of somatotype. The kayakers were predominantly endomorphic; the basketball players mostly endomorphic and the footballers most often ectomorphic. No distinguishable patterns of somatotype were displayed by the low level sportsmen.
Conclusions: Morphometric characteristics of the athlete's body and the fractional somatotype can be used as guiders and markers of the chosen sport and method of training.
The results emphasize the necessity for a specific somatotype to reach a high profile in the selected area of sport and thus support morphometric oriented studies. Further studies could elucidate differentiation by age and sex. Full article

Background and objective: The prevalence and etiology of midfacial fractures varies among countries. Until now, knowledge about such type of injuries in the region of the Baltic countries was rather scarce. The purpose of the study was to analyze the prevalence, etiology and localization of midfacial fractures treated at the Vilnius University Hospital Žalgiris Clinic, Vilnius, Lithuania.
Materials and methods: The medical records of patients treated for midfacial fractures during the period January 2005 to December 2010 were analyzed for gender, age distribution, frequency and type of injury, cause of fractures, consciousness status and alcohol abuse during trauma.
Results: The records of 799 patients were analyzed. The male-to-female ratio was 4.4:1. The mean age of the patients was 33.16 ±
14.0 years (min 1, max 87). As much as 68.8% of injuries were zygomatic fractures, 27.9% were maxillary, and 3.3% were isolated orbital floor fractures. The most frequent causes for injury were interpersonal violence (64%), followed by falls (16.3%) and traffic accidents (8.3%). Most midfacial fractures (65.3%) occurred between April and October (P < 0.05), on weekends (58.2%; P < 0.05) and at night (62.0%; P < 0.05). In 14%, trauma reports indicated the abuse of alcohol. More often such persons received more than one midfacial bone fracture (P < 0.05) concurrently.
Conclusions: This study revealed that the main cause of midfacial fractures was assault. Male patients, aged 15–34 years, more often sustain midfacial fractures. Preventive health care programs should seek measures in the reduction of aggression and violence in close future involving family, school and community institutions. Full article

Background and objective: There has been relatively little investigation of the effect of temperature on skin permeation compared to other methods of penetration enhance-ment. A principal physicochemical factor which controls the passive diffusion of a solute from a vehicle into the skin arises from the skin temperature. The aim of this ex vivo study was to probe into the effect of heat on transdermal absorption of alfuzosin hydrochloride from ethyl cellulose-polyvinyl pyrrolidone (EC-PVP) based transdermal systems.
Materials and methods: Principles of design of experiment (DoE) were used to systematically study the influence of temperature on transdermal permeation of alfuzosin. Ex vivo transdermal permeation studies were carried out at varied donor compartment tempera-tures. Permeation data analysis was carried out and activation energy for transdermal permeation was estimated.
Results: Temperature found to enhance ex vivo permeation parameters of alfuzosin hy-drochloride from its transdermal systems. It was also noted that chemical permeation enhancers potentiate permeation enhancing effect of temperature. The permeation flux values approximately doubled after exposure to 45 °C. The activation energy for transder-mal permeation was found lower for the runs with chemical permeation enhancers indicating existence of a lower energy barrier in the presence of chemical permeation enhancers.
Conclusion: The method reported here is a simple and useful tool for studying the effect of heat on percutaneous absorption. Such temperature dependent enhancement of flux can be more pronounced at skin surface temperatures >45 °C. Full article

Objective: The aim of the study was to verify the influence of a genetic factor on the etiology of oral bony outgrowths and to determine the prevalence and type of oral bony outgrowths (tori and exostoses) among a group of Lithuanian twins.
Materials and methods: In total, 162 twins (81 twin pairs) were analyzed for the presence or absence, type, and size of oral bony outgrowths. Statistical analysis was carried out to find the prevalence of bony protuberances and the relationship between zygosity and occurrence of oral bony enlargements. Zygosity of twins was confirmed by DNA analysis.
Results: 59.9% of the subjects had oral bony outgrowths. Mandibular tori were found in 56.8% and palatal tori in 1.8% of the sample. Palatal exostoses and mandibular exostoses were present in 1.8% and 3.1% of the sample, respectively, whereas maxillary exostoses were not found. A higher percentage of tori and exostoses were found in the group of older subjects (>18 years old, p = 0.025). No significant difference was found between men and women in the prevalence of bony outgrowths. High κ and r values (0.91 ± 0.062) showed very good concor-dance of oral bony outgrowths between monozygotic and moderate concordance (0.58 ± 0.141) between dizygotic co-twins ( p < 0.001). The calculation of heritability estimate verifies domi-nant influence of genetic factor on the etiology of oral bony outgrowths (h² = 0.658).
Conclusion: The most common bony outgrowth was torus mandibularis. Our results show that the genetic factor is dominant in the etiology of oral bony outgrowths. Full article