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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Articles in this Issue were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence. Articles 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.

Table of Contents

Medicina, Volume 50, Issue 1 (February 2014), Pages 1-74

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Open AccessArticle Direct cost of patients with type 2 diabetes mellitus healthcare and its complications in Lithuania
Medicina 2014, 50(1), 54-60; https://doi.org/10.1016/j.medici.2014.05.007 (registering DOI)
Published: 14 June 2014
Cited by 7 | PDF Full-text (340 KB)
Abstract
Objective: The main objective of this study was to estimate the annual direct healthcare cost of type 2 diabetes mellitus healthcare and its complications in Lithuanian population.
Material and methods: The study uses a prevalence-based top-down approach. The random sample of study participants
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Objective: The main objective of this study was to estimate the annual direct healthcare cost of type 2 diabetes mellitus healthcare and its complications in Lithuanian population.
Material and methods: The study uses a prevalence-based top-down approach. The random sample of study participants was formed using the database of the National Health Insurance Fund under the Lithuanian Ministry of Health. 762 patients with diabetes mellitus type 2 data were analyzed in this research. The data on healthcare costs was recorded between January 1, 2011 and December 31, 2011.
Results: Ambulatory care cost mean per patients with diabetes mellitus type 2 in 2011 was EUR 156.14 (95% CI, 147.05–165.24). 34.4% patients had at least one hospitalization during the 2011 year. Mean annual cost per patients of hospitalization was EUR 1160.16 (95% CI, 1019.60–1300.73). Covered drugs and diabetes supplies annual direct cost mean per patients was EUR 448.34 (95% CI, 411.14–485.54). The more expensive treatment was with oral and non-insulin injectable hypoglycemic medications (P < 0.001). 65.1% participants were diagnosed one or more diabetes-related chronic complications. Average annual cost per person, increased gradually with the numbers of complications from EUR 671.94 (95% CI, 575.03–768.86) in patients without complications to EUR 1588.98 (95% CI, 1052.09–2125.86) in patients with 3 and more complications (P < 0.001).
Conclusions: The largest part of direct costs in diabetes mellitus healthcare composes hospital inpatient care and covered drugs expenditures. In our study we observed that the presence of microvascular, macrovascular chronic complication increased the direct cost per patient, compared with patients without complications. Full article
Open AccessArticle Prevalence of dyslipidemia in statin-treated patients in the Baltic states (Estonia, Latvia, and Lithuania): Results of the Dyslipidemia International Study (DYSIS)
Medicina 2014, 50(1), 44-53; https://doi.org/10.1016/j.medici.2014.05.003 (registering DOI)
Published: 10 June 2014
Cited by 6 | PDF Full-text (1369 KB)
Abstract
Background and objective: The Baltic nations (Estonia, Latvia, and Lithuania) are profoundly affected by cardiovascular disease (CVD). Studies have indicated that patients may experience persistent dyslipidemia despite chronic statin treatment. Therefore, the aim of this study was to analyze the risk factors for
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Background and objective: The Baltic nations (Estonia, Latvia, and Lithuania) are profoundly affected by cardiovascular disease (CVD). Studies have indicated that patients may experience persistent dyslipidemia despite chronic statin treatment. Therefore, the aim of this study was to analyze the risk factors for dyslipidemia despite statin-treatment in a large dataset from the Baltic nations.
Material and methods: Patients in primary care centers across the Baltic nations were enrolled into the cross-sectional, observational Dyslipidemia International Study (DYSIS). Patients were ≥45 years old and had been treated with statins for at least three months. Patient characteristics and lipid measurements were used to determine variables contributing to dyslipidemia (abnormal low-density lipoprotein cholesterol [LDL-C], high-density lipopro- tein cholesterol [HDL-C], or total triglyceride [TG] values).
Results: We enrolled 1797 patients with a mean age of 66.1 years and 59.1% being female. Overall 63.4% had cardiovascular disease, 30.1% were diabetic and 77.8% at high risk for cardiovascular complications. LDL-C was not at target level for 80.7%; low HDL-C levels were observed for 26.0%, and elevated TG levels were found in 35.0% of all patients. Multivariate analyses indicated that a BMI ≥ 30 kg/m2 (OR, 2.12; 95% CI, 1.45–3.08) and hypertension (OR, 2.43; 95% CI, 1.1 6–5.10) were strongly associated with dyslipidemia (involving all three lipids) during statin therapy while age ≥70 years (OR, 0.63; 95% CI, 0.42–0.94) and female gender (OR, 0.48; 95% CI, 0.33–0.68) conferred reduced risk.
Conclusions: Our findings indicate many statin-treated patients in Estonia, Latvia, and Lithuania did not meet target lipid levels and had a very high risk of CVD. Combating other well-known CVD risk factors such as obesity and hypertension is vital to reduce the exceptionally high riskfor CVD mortality seen in the Baltic nations. Full article
Open AccessArticle The relationship between abuse, psychosocial factors, and pain complaints among older persons in Europe
Medicina 2014, 50(1), 61-74; https://doi.org/10.1016/j.medici.2014.05.006 (registering DOI)
Received: 9 December 2013 / Accepted: 2 February 2014 / Published: 6 June 2014
PDF Full-text (484 KB)
Abstract
Background and objective: Abuse and pain complaints are common among older persons. However, little is known about relationships between abuse (e.g. psychological) and pain complaints (e.g. backache) among older persons while considering other factors (e.g. depression). Therefore, the aim of this study was
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Background and objective: Abuse and pain complaints are common among older persons. However, little is known about relationships between abuse (e.g. psychological) and pain complaints (e.g. backache) among older persons while considering other factors (e.g. depression). Therefore, the aim of this study was to determine these relationships.
Materials and methods: The design was cross-sectional. A total of 4467 women and men aged 60–84 years from Germany, Greece, Italy, Lithuania, Portugal, Spain, and Sweden answered questionnaires regarding various areas such as abuse, mental health (e.g. anxiety) and pain complaints (e.g. backache). The data were examined with bivariate (analyses of variance) and multivariate methods (linear regressions).
Results: The bivariate analyses showed that psychological abuse was connected with all pain complaints; physical with headache and head pressure; sexual with neck or shoulder pain and headache; injury with all complaints (except pain in joints or limbs); financial with pain in joints or limbs and head pressure; and overall abuse (one or more types) with all complaints (except headache). The regressions showed that psychological abuse increased the likelihood of being affected by head pressure and heaviness or tiredness in the legs; physical abuse of being affected by headache and head pressure; financial abuse of being affected by head pressure; and overall abuse of being affected by headache and head pressure. In general, respondents from Sweden and younger (60–64 years) were less affected by the complaints than those from other countries (e.g. Germany) and older (e.g. 70–74 years), respectively. Respondents on medication (e.g. pain killers) were less affected by all pain complaints and those with high social support by pain in joints or limbs. High scores on anxiety and depression and having many diseases increased the likelihood of being affect by all pain complaints.
Conclusions: Abuse was related with certain pain complaints (e.g. headache), but other factors and in particular mental health and physical diseases impacted on all pain complaints. Medication and partly social support had a positive effect on the pain experience, i.e. the complaints interfered less with for instance the daily-life of the respondents. # 2014 Lithuanian University of Health Sciences. Production and hosting
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Open AccessArticle Cyclosporine therapeutic window evaluation by Chebyshev's inequality method in kidney recipients
Medicina 2014, 50(1), 37-43; https://doi.org/10.1016/j.medici.2014.05.008 (registering DOI)
Published: 6 June 2014
PDF Full-text (455 KB)
Abstract
Objective: The aim of this study was to identify a cyclosporine therapeutic range for kidney recipients.
Materials and methods: The cyclosporine exposure level was based on the calculation of the mean area under the concentration-time curve AUC(0–12). The AUC(0–12) was
[...] Read more.
Objective: The aim of this study was to identify a cyclosporine therapeutic range for kidney recipients.
Materials and methods: The cyclosporine exposure level was based on the calculation of the mean area under the concentration-time curve AUC(0–12). The AUC(0–12) was estimated using a Bayesian estimator and a 3-point limited sampling strategy. Cyclosporine exposure levels were obtained from 3 blood samples: 0, 1, and 3 h postdose; and analyses were performed using a liquid chromatography–tandem mass spectrometry method. The therapeutic window of cyclosporine was calculated by the Chebyshev's inequality method with a 99% guarantee (a = 0.01) using the IBM SPSS Statistics 20 software.
Results: It was found that the therapeutic window of cyclosporine estimated by the Cheby- shev's inequality method and put on the AUC(0–12) exposure lies in the ranges from 2.84– 3.13 mg h/L with the 99% confidence for the patients with the target AUC(0–12) exposure of 3.8 mg h/L (posttransplantation time >1 year). The therapeutic window of cyclosporine differs in different posttransplantation time groups: the estimated AUC exposure range in the group of patients who have a graft longer than 5 years is 2.70–2.98 mg h/L, and the estimated AUC exposure range in the group of patients who have a graft for 1–5 years is 3.05–3.75 mg h/L.
Conclusions: Chebyshev's inequality could be an appropriate and more precise method to determine the therapeutic window for cyclosporine in kidney recipients than the target AUC(0–12) value and further studies should be conducted to evaluate patients with postoperative time <1 year.
Full article
Open AccessArticle Cure rates of childhood acute lymphoblastic leukemia in Lithuania and the benefit of joining international treatment protocol
Medicina 2014, 50(1), 28-36; https://doi.org/10.1016/j.medici.2014.05.005 (registering DOI)
Published: 6 June 2014
Cited by 4 | PDF Full-text (868 KB)
Abstract
Background: Childhood acute lymphoblastic leukemia (ALL) represents the largest group of pediatric malignancies with long-term survival rates of more than 80% achieved in developed countries. Epidemiological data and survival rates of childhood ALL in Lithuania were lacking. Therefore, the aim of this study
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Background: Childhood acute lymphoblastic leukemia (ALL) represents the largest group of pediatric malignancies with long-term survival rates of more than 80% achieved in developed countries. Epidemiological data and survival rates of childhood ALL in Lithuania were lacking. Therefore, the aim of this study was to analyze the population-based long-term treatment results of childhood ALL in Lithuania during 1992–2012.
Materials and methods: Data of all 459 children with T-lineage and B-cell precursor ALL treated in Lithuania from 1992 to 2012 were collected and analyzed. Results were compared among four time-periods: 1992–1996 (N = 132), 1997–2002 (N = 136), 2003–2008 (N = 109) and 2009–2012 (N = 82).
Results: The incidence of childhood ALL in Lithuania was 3.2–3.6 cases per 100 000 children per year during the study period. Five-year probability of event-free survival increased from 50% 4% in 1992–1996 to 71% ± 4% in 2003–2008 (P < 0.001). Five-year cumulative incidence of relapses reduced from 27% ± 4.5% in 1992–1996 to 14% ± 3.6% in 2003–2008 (P = 0.042). After introduction of high-dose methotrexate of 5 g/m2, cumulative incidence of CNSinvolving relapses reduced from 17% ± 3.9% in 1992–1996 to 1% ± 1.0% in 2003–2008 (P < 0.001). Trend for further improvement in survival was seen in 2009–2012 when Lithuania joined international the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL-2008 treatment protocol.
Conclusions: Cure rates of childhood ALL in Lithuania are improving steadily and are now approaching those reported by the largest international study groups. The reasons for such a positive effect are both better financial support for treatment of children with cancer in Lithuania and international collaboration with joining international treatment protocol for childhood ALL. Full article
Open AccessArticle Role of genetic factors on the effect of additional loading doses and two maintenance doses used to overcome clopidogrel hyporesponsiveness
Medicina 2014, 50(1), 19-27; https://doi.org/10.1016/j.medici.2014.05.004 (registering DOI)
Published: 6 June 2014
Cited by 1 | PDF Full-text (825 KB)
Abstract
Background and objective: Additional loading doses and higher maintenance doses (MDs) have been used to overcome hyporesponsiveness of clopidogrel. We aimed to investigate whether genetic polymorphisms of two cytochromes (CYP2C19 and CYP2C9) and ABCB1 modify effect of such dose-adjustment strategy.
Materials and methods:
[...] Read more.
Background and objective: Additional loading doses and higher maintenance doses (MDs) have been used to overcome hyporesponsiveness of clopidogrel. We aimed to investigate whether genetic polymorphisms of two cytochromes (CYP2C19 and CYP2C9) and ABCB1 modify effect of such dose-adjustment strategy.
Materials and methods: We enrolled 118 patients undergoing elective or acute percutaneous coronary intervention (PCI) with drug eluting stent (DES). Platelet reactivity index (PRI) was measured using the vasodilator-stimulated phosphoprotein (VASP) index and a cut-off value of ≥60% was defined as hyporesponsiveness. Polymorphism of two cytochromes (CYP2C19, CYP2C9) and gene ABCB1 were determined. In patients hyporesponsive to the initial LD the dose-adjustment was performed using up to 3 additional 600 mg LDs in order to achieve PRI <60%, and both 150 mg and 75 mg MD were tested at the follow-up.
Results: Patients with at least one CYP2C19*2 allele had higher baseline PRI after the initial LD (78.2 ± 13.1 vs. 65.3 ± 19.5, P = 0.005). The PRI reduction with additional LD was significantly smaller in carriers of the CYP2C19*2 (25.2 ± 15.6 vs. 35.5 ± 16.8, P = 0.025) and similar trend was observed with subsequent additional LDs. Both MDs were less effective in presence of CYP2C19*2. Target PRI was, however, more frequently achieved with higher MD even in presence of CYP2C19*2 (in 70.6% vs. 23.5% of hyporesponders, P = 0.008). No such differences were observed for other polymorphisms.
Conclusions: In patients hyporesponsive to a routine clopidogrel doses the potency of additional LD and higher MD of clopidogrel is compromised by presence of CYP2C19*2 allele. The dose-adjustment strategy is not affected by ABCB1 C3435T or CYP2C9 genotypes. Full article
Open AccessArticle NOTCH1, NOTCH3, NOTCH4, and JAG2 protein levels in human endometrial cancer
Medicina 2014, 50(1), 14-18; https://doi.org/10.1016/j.medici.2014.05.002 (registering DOI)
Published: 6 June 2014
Cited by 8 | PDF Full-text (484 KB)
Abstract
Background and objective: Notch signaling is a conserved developmental pathway, which plays an important role in the regulation of cell proliferation, differentiation and death. Deregulation of Notch pathway has been connected with the carcinogenesis in a variety of cancers. The aim of this
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Background and objective: Notch signaling is a conserved developmental pathway, which plays an important role in the regulation of cell proliferation, differentiation and death. Deregulation of Notch pathway has been connected with the carcinogenesis in a variety of cancers. The aim of this study was to investigate the level of the Notch signaling pathway proteins (NOTCH1, 3, 4 and JAG2) in the samples from human endometrial cancer.
Materials and methods: The amount of the Notch receptors NOTCH1, 3, 4 and ligand JAG2 protein was determined by Western blot analysis in the samples from stage I endometrial cancer and adjacent nontumor endometrial tissue of 22 patients.
Results: The level of NOTCH4 receptor was 1.7 times lower in stage I endometrial cancer as compared with the healthy tissue of the same patients (P = 0.04). The protein level of ligand JAG2 was significantly reduced by 2.5 times in stage IB endometrial adenocarcinoma samples (P = 0.01). It was reduced in the majority of stage IB adenocarcinomas. There were no significant changes in the protein amount of NOTCH1 and NOTCH3 receptors comparing stage I endometrial adenocarcinoma and healthy tissues.
Conclusions: The reduced amount of NOTCH4 and JAG2 proteins and the decreased level of mRNA coding Notch proteins, as reported in our previous studies, supports the notion that Notch pathway has rather tumor-suppressive than oncogenic role in human endometrial cancer cells. It suggests that Notch pathway activation is a potential therapeutic target. Full article
Open AccessReview Takotsubo cardiomyopathy: The challenging diagnosis in clinical routine
Medicina 2014, 50(1), 1-7; https://doi.org/10.1016/j.medici.2014.05.009 (registering DOI)
Received: 5 September 2013 / Accepted: 24 November 2013 / Published: 6 June 2014
Cited by 4 | PDF Full-text (790 KB)
Abstract
Takotsubo cardiomyopathy is rapidly reversible heart failure syndrome that usually mimics the symptoms of acute myocardial infarction with the characteristic regional wall-motion abnormalities (classically with a virtual apical ballooning caused by hypokinetic or akinetic apical or midventricular myocardium and hypercontraction of the basal
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Takotsubo cardiomyopathy is rapidly reversible heart failure syndrome that usually mimics the symptoms of acute myocardial infarction with the characteristic regional wall-motion abnormalities (classically with a virtual apical ballooning caused by hypokinetic or akinetic apical or midventricular myocardium and hypercontraction of the basal segments) and absence of obstructive coronary artery disease. TC is usually associated with identifiable emotional, psychological or physical stress event and most commonly appears in postmen- opausal women. The certain pathophysiological mechanism remains unknown. However, the central hypothesis is supported by the excess of catecholamines and hyperactivity of nervous system. In the last decades the frequency of the TC diagnosis is increasing rapidly but at the initial presentation the diagnosis remains challenging due to the close similarities between TC and ST elevation myocardial infarction clinical presentations that consider TC as an important part of differential diagnosis in acute coronary syndrome. Full article
Open AccessArticle Pepsinogen testing for evaluation of the success of Helicobacter pylori eradication at 4 weeks after completion of therapy
Medicina 2014, 50(1), 8-13; https://doi.org/10.1016/j.medici.2014.05.001 (registering DOI)
Received: 20 July 2013 / Accepted: 11 January 2014 / Published: 5 June 2014
Cited by 4 | PDF Full-text (642 KB)
Abstract
Background and objective: Pepsinogen levels in plasma are increased by inflammation in the gastric mucosa, including inflammation resulting from Helicobacter pylori infection. A decrease in pepsinogen II level has been suggested as a reliable marker to confirm the successful eradication of infection. The
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Background and objective: Pepsinogen levels in plasma are increased by inflammation in the gastric mucosa, including inflammation resulting from Helicobacter pylori infection. A decrease in pepsinogen II level has been suggested as a reliable marker to confirm the successful eradication of infection. The aim of our study was to evaluate the potential role of pepsinogens I and II, gastrin-17 and H. pylori antibodies in confirming successful eradication.
Material and methods: Altogether 42 patients (25 women, 17 men), mean age 45 years (range 23–74), were enrolled. Pepsinogens I and II, gastrin-17 and H. pylori IgG antibodies were measured in plasma samples using an ELISA test (Biohit, Oyj., Finland) before the eradication and 4 weeks after completing the treatment. The success of eradication was determined by a urea breath test.
Results: Eradication was successful in 31 patients (74%) and unsuccessful in 11 patients (26%). Pepsinogen II decreased significantly in both the successful (P = 0.029) and unsuccessful (P = 0.042) eradication groups. Pepsinogen I decreased significantly in the successful (P = 0.025) but not the unsuccessful (P = 0.29) eradication group. The pepsinogen I/II ratio increased in the successful eradication group (P = 0.0018) but not in the group in which treatment failed (P = 0.12). There were no differences in gastrin-17 or H. pylori antibody values.
Conclusions: A decrease in pepsinogen II levels cannot be used as a reliable marker for the successful eradication of H. pylori 4 weeks after the completion of treatment. The increase in pepsinogen I/II ratio reflects differences in pepsinogen production following the eradication irrespective of improvement in atrophy.
Full article
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