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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 53, Issue 1 (February 2017) – 9 articles , Pages 1-71

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1182 KiB  
Article
Left atrial mechanics in patients with acute STEMI and secondary mitral regurgitation: A prospective pilot CMR feature tracking study
by Tomas Lapinskas, Paulius Bučius, Laura Urbonaitė, Agnieta Stabinskaitė, Živilė Valuckienė, Lina Jankauskaitė, Rimantas Benetis and Remigijus Žaliūnas
Medicina 2017, 53(1), 11-18; https://0-doi-org.brum.beds.ac.uk/10.1016/j.medici.2017.02.001 - 01 Mar 2017
Cited by 4 | Viewed by 1484
Abstract
Background and objective: Left atrium (LA) is an important biomarker of adverse cardiovascular outcomes and cerebrovascular events. This study aimed to evaluate LA myocardial deformation using cardiac magnetic resonance feature tracking (CMR-FT) in patients with acute ST-segment elevation myocardial infarction (STEMI) and [...] Read more.
Background and objective: Left atrium (LA) is an important biomarker of adverse cardiovascular outcomes and cerebrovascular events. This study aimed to evaluate LA myocardial deformation using cardiac magnetic resonance feature tracking (CMR-FT) in patients with acute ST-segment elevation myocardial infarction (STEMI) and secondary mitral regurgita- tion (MR). Additionally, to assess interobserver and intraobserver variability of the technique.Materials and methods: Twenty patients with STEMI underwent CMR with a 1.5 Tesla MRI scanner. According to the presence of MR patients were divided into two groups: MR(+) and MR(−). Total LA strain (εs), passive LA strain (εe), and active LA strain (εa) were obtained. Additionally, total, passive and active strain rates (SRs, SRe, and SRa) were calculated. To assess interobserver agreement data analysis was performed by second independent observer.Results: LA volumetric and functional parameters were similar in both groups. All LA strain values were significantly higher in patients with MR: εs (27.67 ± 10.25 for MR(−) vs. 32.80 ± 6.95 for MR(+); P = 0.01), εe (15.29 ± 7.30 for MR(−) vs. 19.22 ± 6.04 for MR(+); P = 0.01) and εa (12.38 ± 4.23 for MR(−) vs. 14.44 ± 5.19 for MR(+); P = 0.03). Only SRe significantly increased in patients with MR (−0.57 ± 0.24 for MR(−) vs. −0.70 ± 0.20 for MR(+); P = 0.01). All LA deformation parameters demonstrated high interobserver and intraobserver agreement. Conclusions: Conventional volumetric and functional LA parameters do not detect early changes in LA performance in patients with STEMI and secondary MR. In contrast, LA reservoir, passive and active strain are significantly higher in patients with MR. Only peak early negative strain rate substantially increases during secondary MR. LA deformation parameters derived from conventional cine images using CMR-FT technique are highly reproducible. Full article
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768 KiB  
Article
Assessment of coronary care management and hospital mortality from ST-segment elevation myocardial infarction in the Kazakhstan population: Data from 2012 to 2015
by Zhanar Akimbaeva, Zhumagali Ismailov, Aikan A. Akanov, Ričardas Radišauskas and Žilvinas Padaiga
Medicina 2017, 53(1), 58-65; https://0-doi-org.brum.beds.ac.uk/10.1016/j.medici.2017.01.006 - 20 Feb 2017
Cited by 3 | Viewed by 1143
Abstract
Objective: The aim of this study was to assess and evaluate factors related to coronary care management and hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) hospitalized in the Kazakhstan County and city hospitals in which percutaneous coronary intervention (PCI) [...] Read more.
Objective: The aim of this study was to assess and evaluate factors related to coronary care management and hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) hospitalized in the Kazakhstan County and city hospitals in which percutaneous coronary intervention (PCI) was performed during the period of 2012–2015. Materials and methods: A total of 22,176 adult patients (18> years) with acute STEMI were hospitalized from January 2012 to December 2015. All the investigated STEMI patients underwent PCI.Results: The mean age of STEMI patients was 61.52 ± 11.48 years, 72.2% of the patients were male and 75.2% living in the rural regions. The mean time from hospitalization to PCI was 2104.41 ± 5060.68 min (median 95.0 and IQR 1034.5). The mean and median of time from hospitalization to PCI tended to decrease from 2747.7 ± 5793.9 min and 155.0 min in 2012 to 1874.7 ± 4759.2 min and 73.5 min in 2015. Among all STEMI events the percentage of patients from hospitalization to PCI within 0–59 min was up to 39.0% during all study period. From 2012 to 2015, the percentage of STEMI patients with short time (0–59 min) of hospitalization to PCI tended to increase in average by 11.4% per year (P = 0.09). Among all STEMI patients hospital mortality from 2012 to 2015 did not change significantly and ranged from 9.0% in 2012 to 8.6% in 2015. By multiple logistic regression analysis, study years (2012), gender (female), age (60> years), time from hospitalization to PCI (60> min) and number of bed-days were statistically significant factors associated with patients' hospital mortality from STEMI with PCI.Conclusions: The present study demonstrated that hospitalization delay in the treatment of STEMI patients in Kazakhstan population was without significant changes, meanwhile the number of patients perfused within 1 h from hospitalization to PCI tended to increase during 2012–2015. The higher hospital mortality was associated with study year, female gender, older age, longer-time from hospitalization to PCI and shorter hospitalization. Full article
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467 KiB  
Article
Evaluation of atrial fibrillation management and cardiovascular risk profile in atrial fibrillation patients: A cross-sectional survey
by Gediminas Račkauskas, Vytautas Zabiela, Germanas Marinskis, Arvydas Baranauskas, Deimilė Balkutė, Justina Alunderytė, Aras Puodžiūkynas, Tomas Kazakevičius, Vilius Kviesulaitis and Audrius Aidietis
Medicina 2017, 53(1), 19-25; https://0-doi-org.brum.beds.ac.uk/10.1016/j.medici.2017.01.005 - 20 Feb 2017
Cited by 2 | Viewed by 840
Abstract
Objective: The aim of this study to investigate the most frequent risk factors of atrial fibrilla- tion (AF), co-morbidities, complications associated with AF and the use of anticoagulants and other medications in patients who were referred to university hospitals in Lithuania.Materials [...] Read more.
Objective: The aim of this study to investigate the most frequent risk factors of atrial fibrilla- tion (AF), co-morbidities, complications associated with AF and the use of anticoagulants and other medications in patients who were referred to university hospitals in Lithuania.Materials and methods: This cross-sectional study enrolled consecutive inpatients and outpatients with AF presenting to cardiologists in the two biggest Lithuanian university hospitals from November 2013 to May 2014. AF diagnosis was confirmed by a 12-lead ECG or 24-h Holter with an episode duration of >30 s.Results: A total number of 575 patients were recruited, and complete data on clinical subtype were available for 515 patients (mean age of 70.7 years; 48.5% of women). Permanent AF was the most frequent type of AF (46.6%). Common comorbidities were hypertension (85.8%), heart failure (77.9%) and coronary artery disease (51.8%). Amiodarone was the most common antiarrhythmic agent used in 14.6% of the patients, while beta-blockers and digoxin were the most often used rate control drugs (59.6% and 10.7%, respectively). Oral anticoagulants were used by 53.3% of the patients; of them, 95.6% used vitamin K antagonists, while non-vitamin K antagonist were used by only 4.4%. The INR within a therapeutic range (2.0–3.0) was documented in 19.2% of the patients. Other antithrombotic drugs such as aspirin and clopidogrel were used in 13.7% and 2.0% of the patients, respectively; dual antiplatelet treatment was administered in 6.2% of the patients. Of the entire cohort, the mean CHA2DS2-VASc score was 3.97 ± 1.6 and the mean HAS-BLED score was 2.25 ± 1.0.Conclusions: Compliance with the treatment guidelines remains suboptimal and further patient education is needed. Full article
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Article
VEGF-A, sVEGFR-1, and sVEGFR-2 in BCR-ABL negative myeloproliferative neoplasms
by Grażyna Gadomska, Katarzyna Stankowska, Joanna Boinska, Robert Ślusarz, Marzena Tylicka, Małgorzata Michalska, Anna Jachalska and Danuta Rość
Medicina 2017, 53(1), 34-39; https://0-doi-org.brum.beds.ac.uk/10.1016/j.medici.2017.01.004 - 02 Feb 2017
Cited by 7 | Viewed by 1073
Abstract
Background and objective: Data from the literature indicate the relationship between the bone marrow microvessel density and the blood parameters of angiogenesis. The aim of this study was to evaluate selected parameters of angiogenesis (VEGF-A, sVEGFR-1, and sVEGFR- 2) and their correlations [...] Read more.
Background and objective: Data from the literature indicate the relationship between the bone marrow microvessel density and the blood parameters of angiogenesis. The aim of this study was to evaluate selected parameters of angiogenesis (VEGF-A, sVEGFR-1, and sVEGFR- 2) and their correlations with white blood cells, platelets, and red blood cells.Materials and methods: The study included 72 patients (mean age, 61.84 years) with myeloproliferative neoplasms (MPNs): essential thrombocythemia (ET) (n = 46), polycythemia vera (PV) (n = 19), and primary myelofibrosis (PMF) (n = 7). Serum VEGF-A, sVEGFR-1, and sVEGFR- 2 were determined using the ELISA assay.Results: We observed a significantly higher level of VEGF-A and reduced concentrations of sVEGFR-1 and sVEGFR-2 in the whole group of patients with MPNs as compared to controls. Detailed analysis confirmed significantly higher level of VEGF-A and lower concentration of sVEGFR-2 in each subgroups of MPNs patients. However, sVEGFR-1 concentrations were significantly lower only in PV and ET patients.Conclusions: The study showed an increased level of VEGF-A, which may indicate the intensity of neoangiogenesis in the bone marrow. Decreased sVEGFR-1 and sVEGFR-2 in the blood of patients with MPNs may reflect consumption of these soluble receptors. Full article
319 KiB  
Article
Unscheduled return visits to a pediatric emergency department
by Sigita Burokienė, Ignė Kairienė, Marius Strička, Liutauras Labanauskas, Rimantė Čerkauskienė, Juozas Raistenskis, Emilija Burokaitė and Vytautas Usonis
Medicina 2017, 53(1), 66-71; https://0-doi-org.brum.beds.ac.uk/10.1016/j.medici.2017.01.003 - 31 Jan 2017
Cited by 10 | Viewed by 1443
Abstract
Background and objective: Return visits (RVs) to a pediatric emergency department (ED) within a short period after discharge have an influence on overcrowding of the ED and reveal some weaknesses of the health care system. The aim of this study was to [...] Read more.
Background and objective: Return visits (RVs) to a pediatric emergency department (ED) within a short period after discharge have an influence on overcrowding of the ED and reveal some weaknesses of the health care system. The aim of this study was to determine the rate of RVs and factors related to RVs to the pediatric ED in Lithuania.Materials and methods: A retrospective study in an urban, tertiary-level teaching hospital was carried out. Electronic medical records of all patients (n = 44 097) visiting the ED of this hospital between 1 January and 31 December 2013 were analyzed. Demographic and clinical characteristics of patients who return to the ED within 72 h and those who had not visited the ED were compared. Factors associated with RVs were determined by multivariable logistic regression.Results: Of the overall ED population, 33 889 patients were discharged home after the initial assessment. A total of 1015 patients returned to the ED within 72 h, giving a RV rate of 3.0%. Being a 0–7-year old, visiting the ED during weekdays, having a GP referral, receiving of laboratory tests and ultrasound on the initial visit were associated with greater likelihoods of returning to the ED. Patients who arrived to the ED from 8:01 a.m. to 4:00 p.m. and underwent radiological test were less likely to return to the ED within 72 h. Diseases such as gastrointestinal disorders or respiratory tract/earth–nose–throat (ENT) diseases and symptoms such as fever or pain were significantly associated with returning to the ED. The initial diagnosis corresponded to the diagnosis made on the second visit for only 44.1% of the patients, and the highest rate of the congruity in diagnosis was for injuries/poisoning, surgical pathologies (77.2%) and respiratory tract diseases (76.9%).Conclusions: RVs accounted for only a small proportion of visits to the ED. RVs were more prevalent among younger patients and patients with a GP referral as well as performed more often after discharging from the ED in the evening and at night. Full article
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917 KiB  
Review
Familial hematuria: A review
by Pavlína Plevová, Josef Gut and Jan Janda
Medicina 2017, 53(1), 1-10; https://0-doi-org.brum.beds.ac.uk/10.1016/j.medici.2017.01.002 - 31 Jan 2017
Cited by 19 | Viewed by 1168
Abstract
The most frequent cause of familial glomerular hematuria is thin basement membrane nephropathy (TBMN) caused by germline COL4A3 or COL4A4 gene mutations. Less frequent but important cause with respect to morbidity is Alport syndrome caused by germline COL4A5 gene mutations. The features of [...] Read more.
The most frequent cause of familial glomerular hematuria is thin basement membrane nephropathy (TBMN) caused by germline COL4A3 or COL4A4 gene mutations. Less frequent but important cause with respect to morbidity is Alport syndrome caused by germline COL4A5 gene mutations. The features of Alport syndrome include hematuria, proteinuria and all males with X-linked disease and all individuals with recessive disease will develop end stage renal disease, usually at early youth. In X-linked Alport syndrome, a clear genotype-phenotype correlation is typically observed in men. Deleterious COL4A5 mutations are associated with a more severe renal phenotype and more frequent high-frequency sensorineural hearing loss and ocular abnormalities. Less severe COL4A5 mutations result in a milder phenotype, with less frequent and later onset extrarenal anomalies. The phenotype in females is highly variable, mostly due to inactivation of one of the X chromosomes. Isolated cases may be caused by de novo COL4A5 mutations or by gonosomal mosaicism. Untreated autosomal recessive Alport syndrome, caused by COL4A3 and COL4A4 mutations, is typically associated with ESRD at the age of 23–25 years and extrarenal symptoms in both men and women. The TBMN phenotype is associated with heterozygous carriers of COL4A3, COL4A4 mutations. Molecular genetic testing is the gold standard for diagnosing these diseases. Although genotype-phenotype correlations exist, the phenotype is influenced by modifying factors, which remain mainly undefined. No therapy is available that targets the cause of Alport syndrome; angiotensin-converting enzyme inhibitor therapy delays renal failure and improves lifespan. Full article
695 KiB  
Article
Contribution of mitochondria to injury of hepatocytes and liver tissue by hyperthermia
by Rasa Žūkienė, Zita Naučienė, Giedrė Šilkūnienė, Tomas Vanagas, Antanas Gulbinas, Aurelijus Zimkus and Vida Mildažienė
Medicina 2017, 53(1), 40-49; https://0-doi-org.brum.beds.ac.uk/10.1016/j.medici.2017.01.001 - 09 Jan 2017
Cited by 9 | Viewed by 1201
Abstract
Objective: The aim of this study was to investigate functional changes of liver mitochondria within the experimentally modeled transition zone of radiofrequency ablation and to estimate possible contribution of these changes to the energy status of liver cells and the whole tissue. [...] Read more.
Objective: The aim of this study was to investigate functional changes of liver mitochondria within the experimentally modeled transition zone of radiofrequency ablation and to estimate possible contribution of these changes to the energy status of liver cells and the whole tissue.Materials and methods: Experiments were carried out on mitochondria isolated from the perfused liver and isolated hepatocytes of male Wistar rats. Hyperthermia was induced by changing the temperature of perfusion medium in the range characteristic for the transition zone (38–52 °C). After 15-min perfusion, mitochondria were isolated to investigate changes in the respiration rates and the membrane potential. Adenine nucleotides extracted from isolated hepatocytes and perfused liver subjected to hyperthermic treatment were analyzed by HPLC.Results: Hyperthermic liver perfusion at 42–52 °C progressively impaired oxidative phosphorylation in isolated mitochondria. Significant inhibition of the respiratory chain components was observed after perfusion at 42 ºC, irreversible uncoupling became evident after liver perfusion at higher temperatures (46 °C and above). After perfusion at 50–52 °C energy supplying function of mitochondria was entirely compromised, and mitochondria turned to energy consumers. Hyperthermia-induced changes in mitochondrial function correlated well with changes in the energy status and viability of isolated hepatocytes, but not with the changes in the energy status of the whole liver tissue.Conclusions: In this study the pattern of the adverse changes in mitochondrial functions that are progressing with increase in liver perfusion temperature was established. Results of experiments on isolated mitochondria and isolated hepatocytes indicate that hyperthermic treatment significantly and irreversibly inhibits energy-supplying function of mitochondria under conditions similar to those existing in the radiofrequency ablation transition zone and these changes can lead to death of hepatocytes. However, it was not possible to estimate contribution of mitochondrial injury to liver tissue energy status by estimating only hyperthermia- induced changes in adenine nucleotide amounts on the whole tissue level.
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617 KiB  
Article
How the changes in the system affect trauma care provision: The assessment of and implications for Lithuanian trauma service performance in 2007–2012
by Žilvinas Dambrauskas, Vytautas Aukštakalnis, Aurika Karbonskienė, Dmitrijus Kačiurinas, Jolanta Vokietienė, Robertas Lapka, Algimantas Pamerneckas, Narūnas Porvaneckas, Kęstutis Stašaitis, Nedas Jasinskas, Paulius Dobožinskas, Dinas Vaitkaitis and Raimundas Lunevičius
Medicina 2017, 53(1), 50-57; https://0-doi-org.brum.beds.ac.uk/10.1016/j.medici.2016.12.002 - 06 Jan 2017
Cited by 2 | Viewed by 1252
Abstract
Objective: The aim of this study was to identify and assess the effects of changes in the Lithuanian trauma service from 2007 to 2012. We postulate that the implications derived from this study will be of importance to trauma policy planners and [...] Read more.
Objective: The aim of this study was to identify and assess the effects of changes in the Lithuanian trauma service from 2007 to 2012. We postulate that the implications derived from this study will be of importance to trauma policy planners and makers in Lithuania and throughout other countries of Eastern and Central Europe.Materials and methods: Out of 10,390 trauma admissions to four trauma centers in 2007, 294 patients (2.8%) were randomly selected for the first arm of a representative study sample. Similarly, of 9918 trauma admissions in 2012, 250 (2.5%) were randomly chosen for comparison in the study arm. Only cases with a diagnosis falling into the ICD-10 ‘‘S’’ and ‘‘T’’ codes were included. A survey of whom regarding changes in quality of trauma care from 2007 to 2012 was carried out by emergency medical service (EMS) providers.Results: The Revised Trauma Score (RTS) mean value was 7.45 ± 1.04 for the 2007 year arm; it was 7.53 ± 0.93 for the 2012 year arm (P = 0.33). Mean time from the moment of a call from the site of the traumatic event to the patient's arrival at the trauma center did not differ between the arms of the sample: 49.95 min in 2007 vs. 51.6 min in 2012 (P = 0.81). An application of the operational procedures such as a cervical spine protection using a hard collar, oxygen therapy, infusion of intravenous fluids, and pain relief on the trauma scene was more frequent in 2012 than in 2007. Management of trauma patients in the emergency department improved regarding the availability of 24/7 computed tomography scanner facilities and an on-site radiographer. Time to CT-scanning was reduced by 38.8%, and time to decision- making was reduced by 16.5% in 2012.Conclusions: Changes in operational procedures in the Lithuanian pre-hospital care provision and management of trauma patients in emergency departments of trauma centers improved the efficiency of trauma care delivery over the 2007–2012 period. Full article
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Article
Response inhibition, set shifting, and complex executive function in patients with chronic lower back pain
by Rytis Masiliūnas, Dalia Vitkutė, Edgaras Stankevičius, Vaidas Matijošaitis and Kęstutis Petrikonis
Medicina 2017, 53(1), 26-33; https://0-doi-org.brum.beds.ac.uk/10.1016/j.medici.2016.12.001 - 02 Jan 2017
Cited by 7 | Viewed by 1091
Abstract
Objective: The aim of our study was to evaluate how response inhibition, set shifting, and complex executive function (represented by risky decision-making) are altered in chronic lower back pain patients.Materials and methods: A total of 29 patients with chronic lower [...] Read more.
Objective: The aim of our study was to evaluate how response inhibition, set shifting, and complex executive function (represented by risky decision-making) are altered in chronic lower back pain patients.Materials and methods: A total of 29 patients with chronic lower back pain (CLBP >6 months) aged 49–69 years and 30 healthy volunteers matched for age, gender, and education were enrolled in a case–control study. The study was conducted in the Departments of Neurology and Neurosurgery of Panevėžys Regional Hospital, Lithuania. Pain was evaluated by the visual analog scale, Pakula Pain Questionnaire (Lithuanian analog of McGill Pain Questionnaire), and Fibromyalgia Tender Points Examination. A battery of neuropsychological tests used included Stroop Test Victoria version, Trail Making Test parts A and B, and Game of Dice Task (GDT).Results: CLBP patients did not score significantly worse in any examined neuropsychological tests. Response Inhibition correlated inversely with number of tender points in CLBP patients. GDT performance showed no significant difference in net score (number of safe minus risky decisions). Unexpectedly, both groups favored risky decisions.Conclusions: We found no statistically significant difference in response inhibition, set shifting, or complex executive function between CLBP patients and healthy older adults. Moreover, a risky decision-making pattern found in the Lithuanian population may underscore the importance of cultural context when examining complex executive function. However, further studies are needed to prove this point.
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