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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 45, Issue 11 (November 2009) – 11 articles

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Open AccessArticle
Acquired immunodeficiency syndrome and opportunistic infections
Medicina 2009, 45(11), 929; https://doi.org/10.3390/medicina45110119 - 11 Nov 2009
Viewed by 237
Abstract
This article presents a clinical case of late diagnosis of cerebral toxoplasmosis and cytomegalovirus retinitis of right eye in a 32-year-old patient who was unaware of her HIV status. In addition, this article reviews the literature reflecting clinical, diagnostic, and treatment issues of [...] Read more.
This article presents a clinical case of late diagnosis of cerebral toxoplasmosis and cytomegalovirus retinitis of right eye in a 32-year-old patient who was unaware of her HIV status. In addition, this article reviews the literature reflecting clinical, diagnostic, and treatment issues of some opportunistic infections in AIDS. Full article
Open AccessArticle
Biomedical physics in continuing medical education: an analysis of learning needs
Medicina 2009, 45(11), 918; https://doi.org/10.3390/medicina45110118 - 11 Nov 2009
Cited by 2 | Viewed by 229
Abstract
Objective. To examine the learning and practice needs of medical professionals in the field of continuing education of biomedical physics in Lithuania.
Material and methods
. The study was based on a questionnaire survey of 309 medical professionals throughout Lithuania, 3 focus [...] Read more.
Objective. To examine the learning and practice needs of medical professionals in the field of continuing education of biomedical physics in Lithuania.
Material and methods
. The study was based on a questionnaire survey of 309 medical professionals throughout Lithuania, 3 focus group discussions, and 18 interviews with medical and physics experts.
Results. The study showed that medical professionals lack knowledge of physics: only 15.1% of the respondents admitted that they had enough knowledge in biomedical physics to understand the functioning of the medical devices that they used, and 7.5% of respondents indicated that they had enough knowledge to understand and adopt medical devices of the new generation. Physics knowledge was valued more highly by medical professionals with scientific degrees. As regards continuing medical education, it was revealed that personal motivation (88.7%) and responsibility for patients (44.3%) were the most important motives for upgrading competencies, whereas workload (65.4%) and financial limits (45.3%) were the main obstacles. The most popular teaching methods were those based on practical work (78.9%), and the least popular was project work (27.8%).
Conclusions
. The study revealed that biomedical physics knowledge was needed in both specializations and practical work, and the most important factor for determining its need was professional aspirations. Medical professionals’ understanding of medical devices, especially those of the new generation, is essentially functional in nature. Professional upgrading courses contain only fragmented biomedical physics content, and new courses should be developed jointly by experts in physics and medicine to meet the specialized needs of medical professionals. Full article
Open AccessArticle
Maternal socioeconomic and lifestyle factors during pregnancy and the risk of congenital heart defects
Medicina 2009, 45(11), 904; https://doi.org/10.3390/medicina45110116 - 11 Nov 2009
Cited by 16 | Viewed by 279
Abstract
The objective of study was to estimate the importance of maternal socioeconomic and lifestyle factors during pregnancy in the risk of congenital heart defects in Kaunas infant population in 1999–2005.
Material and methods. An epidemiological case-control study was conducted. The study comprised [...] Read more.
The objective of study was to estimate the importance of maternal socioeconomic and lifestyle factors during pregnancy in the risk of congenital heart defects in Kaunas infant population in 1999–2005.
Material and methods. An epidemiological case-control study was conducted. The study comprised 187 newborns with congenital heart defects (cases) and 643 randomly selected newborns without any defects (controls), born in Kaunas city during 1999–2005. Modern epidemiological methods were used for data analysis. A multivariate logistic regression was used to determine adjusted risk factors of congenital heart defects.
Results
. The logistic multivariate regression analysis showed that low and moderate maternal education significantly increased the risk of congenital heart defects (primary or basic [OR=3.43; 95% CI, 1.54–7.64] and secondary [OR=1.56; 95% CI, 1.00–2.45] vs advanced vocational or higher education). The housewives and workers had a higher risk of delivering a newborn with congenital heart defects than the office workers (OR=2.34; 95% CI, 1.34–4.10 and OR=1.28; 95% CI, 0.79–2.07, respectively). Maternal smoking during pregnancy tended to increase the risk of congenital heart defects by 48% (OR=1.48; 95% CI, 0.82–2.67).
Conclusions
. According to our study results, unfavorable maternal socioeconomic factors and smoking during pregnancy increased the risk of congenital heart defects. Full article
Open AccessArticle
Laser Doppler vibrometry of the middle ear in humans: derivation dependence, variability, and bilateral differences
Medicina 2009, 45(11), 878; https://doi.org/10.3390/medicina45110113 - 11 Nov 2009
Cited by 5 | Viewed by 281
Abstract
Objective. Derivation dependence, inter- and intrasubject/intertest variability, bilateral differences of the eardrum vibration characteristics have been investigated using laser Doppler vibrometry (LDV).
Material and methods. A total of 31 normally hearing adults were examined. In each subject, both ears were consecutively [...] Read more.
Objective. Derivation dependence, inter- and intrasubject/intertest variability, bilateral differences of the eardrum vibration characteristics have been investigated using laser Doppler vibrometry (LDV).
Material and methods. A total of 31 normally hearing adults were examined. In each subject, both ears were consecutively stimulated by the chirp acoustic stimulus that covered 500–3700-Hz frequencies. The laser beam was directed to and the reflection was consecutively picked up from the tympanic membrane surface.
Results
. LDV curves derived from different eardrum loci possessed dissimilar characteristics. The derivation area dependence was particularly apparent for the stimulus frequency constituents above 1500 Hz. The intersubject variability of LDV parameters exceeded the intrasubject/ intertest one. The intersubject divergences looked selectively distinct for the frequencies over 2000 Hz. Under repeated recordings, LDV parameters remained stable. The intertest differences, if appeared, concerned predominantly the magnitudes of separate frequency bands. LDV waveforms registered by experienced and beginner investigators were alike. Bilaterally derived LDV curves regularly differed from each other. In individual cases, the bilateral divergences approximated the intersubject deviation.
Conclusions. The derivation area on the eardrum should be taken into account when estimating the actual LDV recording. Over repeated recordings in separate individuals, LDV waveforms are stable while the experience of investigator has slight if any influence on the principal LDV characteristics. Due to bilateral differences in the middle ear transfer function, in LDV testing of the ear suspected to the pathology, LDV recording from the opposite healthy ear could hardly be taken as an appropriate reference sample. Full article
Open AccessArticle
Three-part Oppel-Kundt illusory figure
Medicina 2009, 45(11), 871; https://doi.org/10.3390/medicina45110112 - 11 Nov 2009
Cited by 6 | Viewed by 229
Abstract
The Oppel-Kundt illusion was examined in the psychophysical experiments with the classical two-part stimuli and modified three-part figures. The modified versions comprised either one filled medial interval and two empty flanking intervals or one empty space situated in between two fillings. The illusion [...] Read more.
The Oppel-Kundt illusion was examined in the psychophysical experiments with the classical two-part stimuli and modified three-part figures. The modified versions comprised either one filled medial interval and two empty flanking intervals or one empty space situated in between two fillings. The illusion was measured as a function of the number of filling elements in the referential parts of the figures. The curves obtained by two modified figures and by the original two-part stimulus were quite similar in shape, but the magnitudes of the illusions differed significantly. The figure with two filled intervals yielded about twice-stronger illusory effect than the contrasting figure with a single filled and two empty intervals. The two-part stimulus showed the illusion magnitudes in the midst. Our assumption suggests the illusory effect being related particularly to overestimations of the filled interval when compared with the empty interval displayed side-to-side. The unfilled interval might not contribute to the illusion. Full article
Open AccessArticle
Characteristics and management of acute heart failure patients in a single university hospital center
Medicina 2009, 45(11), 855; https://doi.org/10.3390/medicina45110111 - 11 Nov 2009
Cited by 3 | Viewed by 246
Abstract
Objective. To evaluate the causes of acute heart failure, complications, management, and outcomes.
Material and methods. A total of 200 patients with diagnosed de novo acute heart failure (27.5%) or worsening chronic heart failure (72.5%) were treated at the Department of [...] Read more.
Objective. To evaluate the causes of acute heart failure, complications, management, and outcomes.
Material and methods. A total of 200 patients with diagnosed de novo acute heart failure (27.5%) or worsening chronic heart failure (72.5%) were treated at the Department of Cardiology, Hospital of Kaunas University of Medicine, which was participating in the Euro Heart Failure Survey-II (EHFS-II). The patients were divided into five groups: 1) chronic decompensated heart failure (66.0%); 2) pulmonary edema (13.0%); 3) hypertensive heart failure (7.5%); 4) cardiogenic shock (11.0%); and 5) right heart failure (2.5%).
Results. Hypertensive and coronary heart diseases were the most common underlying conditions of acute heart failure. Noncompliance with the prescribed medications was present as the most frequent precipitating factor in more than half of the cases. Left ventricular ejection fraction of >45% was found in 28.64% of cases. Intravenous diuretics (74.5%), nitrates (44.0%), and heparin (71.0%) were the most widely used in the acute phase. At discharge from hospital, 96.69% of patients were given diuretics; 80.11%, angiotensin-converting enzyme inhibitors; and 62.43%, beta-blockers. The mean duration of inhospital stay was 13 days; death rate was 9.5%: after 3 months and 12 months, it was 7.5% and 11.5%, respectively.
Conclusion
. Preserved systolic function, multiple concomitant diseases, and high mortality rates were observed in a substantial proportion of the patients hospitalized due to acute heart failure. The management of the patients in a university hospital center was performed in accordance with the international guidelines. Full article
Open AccessArticle
Late outcomes of on-pump and off-pump redo coronary artery bypass grafting
Medicina 2009, 45(11), 848; https://doi.org/10.3390/medicina45110110 - 11 Nov 2009
Cited by 1 | Viewed by 249
Abstract
Benefits of off-pump surgery are still widely debated in the literature comparing with conventional coronary artery bypass grafting. The aim of our study was to compare the late outcomes of patients who underwent on-pump redo coronary artery bypass surgery with those who had [...] Read more.
Benefits of off-pump surgery are still widely debated in the literature comparing with conventional coronary artery bypass grafting. The aim of our study was to compare the late outcomes of patients who underwent on-pump redo coronary artery bypass surgery with those who had off-pump redo coronary artery bypass surgery.
Material and methods
. Two groups of patients were compared. Group 1 consisted of 34 patients who underwent off-pump redo coronary artery bypass surgery, and Group 2 included 160 patients who underwent on-pump redo coronary artery bypass surgery. Both groups of patients were operated on by the same team of surgeons at the same time period. Groups did not differ by age, gender, functional class, preoperative myocardial infarction rate, and left ventricular function. More patients with hypertension were in the off-pump group. Significantly more grafts were performed in the on-pump group. Survival, presence of angina, reoccurrence of postoperative myocardial infarction, necessity of percutaneous transluminal coronary angioplasty and reoperations were evaluated in late follow-up period. The duration of follow-up was 3.37±2.15 years in the off-pump group and 3.27±2.36 years in the on-pump group.
Results
. Survival after 6 years in the off-pump and on-pump redo coronary artery bypass surgery groups was 85.3% and 83.6%, respectively (P=0.758). Five years after redo operation, 54.9% of patients who underwent off-pump coronary artery bypass surgery and 69.3% of patients who underwent on-pump coronary artery bypass surgery had no angina (P=0.174). There were no major cardiac events (percutaneous transluminal coronary angioplasty, death, myocardial infarction, and reoperations) after 6 years in 69.7% of patients in the off-pump group and 76.9% of patients in the on-pump group (P=0.343). Five years after redo surgery, 79.4% of patients in the off-pump group and 91.9% in the on-pump group were free of percutaneous transluminal coronary angioplasty (P<0.02).
Conclusions
. There was no difference in survival despite the fact that patients in the on-pump group received more grafts than those in the off-pump group. Recurrence of angina and incidence of major cardiac events were almost equal in both the groups. Percutaneous transluminal coronary angioplasty was more frequently performed in the patients of off-pump group at late follow-up. Full article
Open AccessArticle
Psychosocial job characteristics, social support, and sense of coherence as determinants of mental health among nurses
Medicina 2009, 45(11), 910; https://doi.org/10.3390/medicina45110117 - 10 Nov 2009
Cited by 25 | Viewed by 401
Abstract
Objective. Employment in human service occupations as nursing is reported to display high risk for mental health, and occupational stress has been found to be one of the major work-related health problems. The objective of the study was to explore the associations [...] Read more.
Objective. Employment in human service occupations as nursing is reported to display high risk for mental health, and occupational stress has been found to be one of the major work-related health problems. The objective of the study was to explore the associations between psychosocial job characteristics, social support, and internal resources as determinants of mental health status in a sample of Kaunas district nurses.
Material and methods
. A survey was conducted among the nurses of Kaunas district community in 2008–2009. A total of 638 nurses were randomly selected, and 372 filled in the questionnaire (response rate, 58.3%). Mental distress was measured using the Goldberg 12-item General Health Questionnaire and psychosocial job characteristics using the Swedish version of the Karasek Demand-Control questionnaire. Sense of coherence was measured by the three-item version questionnaire. The logistic regression was performed.
Results
. Less than one-third (23.0%) of nurses had symptoms of mental distress; 31.9% of nurses had weak sense of coherence. High job demands were associated with mental distress after adjustment for age, smoking, alcohol consumption, physical activity, job control, social support, sense of coherence, family crisis, self-rated health as compared to one year ago (OR=2.15; 95% CI, 1.07–4.30), low job control (OR=1.22; 95% CI, 0.64–2.31), job strain-low social support at work (OR=3.78; 95% CI, 2.08–6.87).
Conclusions
. Mental distress among the nurses of Kaunas district was associated with adverse psychosocial job characteristics. Job strain-low social support at work was the strongest risk factor for mental distress among nurses. Strong sense of coherence as personal characteristic served as a buffer, protecting nurses against the development of mental health problems. Full article
Open AccessArticle
Physical and mental health of stroke survivors and their daily activities
Medicina 2009, 45(11), 896; https://doi.org/10.3390/medicina45110115 - 10 Nov 2009
Cited by 2 | Viewed by 266
Abstract
The aim of the study was to compare the quality of life between stroke survivors and controls with respect to their health, daily activities, and emotional status.
Contingent and methods of the study
. The studied group consisted of 508 25–84-year-old inhabitants of [...] Read more.
The aim of the study was to compare the quality of life between stroke survivors and controls with respect to their health, daily activities, and emotional status.
Contingent and methods of the study
. The studied group consisted of 508 25–84-year-old inhabitants of Kaunas city who have survived first-onset stroke. The control group consisted of 508 age- and sex-matched randomly selected inhabitants of Kaunas city who had not experienced stroke. The SF-12 Quality of Life Questionnaire was used for the study. Logistic regression was used to compare quality of life with respect to health, daily activities, and emotional status.
Results. Only 1.0% of stroke survivors evaluated their health as excellent or very good, compared to 24.4% of the controls (P=0.0005); the respective percentages of those who evaluated their health as poor or fair were 78.9% and 26.4% (P=0.0005). Health significantly limited moderate activities in 35.2% of stroke survivors and 3.5% of controls (P=0.0005). During the last 4 weeks, health status or emotional problems most of the time or a little of the time impeded social activities in 19.3% of stroke survivors and 1.6% of controls (P<0.05). When comparing with respect to age, sex, and diseases (arterial hypertension, myocardial infarction, atrial fibrillation, diabetes mellitus, transient ischemic attack), stroke had the greatest negative effect on social activities (odds ratio, 36.7), caused sadness (odds ratio, 16.0), and significantly limited home activities (odds ratio, 15.5).
Conclusions
. Less that one-third (28.2%) of stroke survivors evaluated their health as poor, and 50.7% as fair as compared to 1.8% and 24.6% of controls, respectively. Stroke significantly impaired the subjects’ emotional status and limited their daily activities. Full article
Open AccessArticle
Analysis of dental caries prevention program in 7–12-year-old Lithuanian schoolchildren
Medicina 2009, 45(11), 887; https://doi.org/10.3390/medicina45110114 - 10 Nov 2009
Cited by 3 | Viewed by 268
Abstract
Objective. The present study aimed to assess dental status in 7–12-year-old Lithuanian children and to evaluate the extent and the efficiency of the Pit and Fissure Sealing in Permanent Molars program.
Material and methods. This cross-sectional study was performed between September [...] Read more.
Objective. The present study aimed to assess dental status in 7–12-year-old Lithuanian children and to evaluate the extent and the efficiency of the Pit and Fissure Sealing in Permanent Molars program.
Material and methods. This cross-sectional study was performed between September 2007 and May 2008. Children, aged 7–12 years, from secondary schools in five biggest cities of Lithuania were invited for the examination using a cluster random sampling method. The data for the present study were collected following the general principles for basic oral health surveys of the World Health Organization.
Results
. The prevalence of dental caries was 85.5%, 88.9%, and 70.6% in 7–8-, 9–10-, and 12-year olds, respectively. The prevalence of dental caries in permanent molars increased with age and became as high as 57.7% in 12-year-old children. The data showed that the mean number of sealed teeth depends on the county and ranged from 0.83 (1.31) to 1.45 (1.85) in 7–8-year olds, from 0.95 (1.29) to 2.54 (1.15) in 9–10-year olds, and from 0.26 to 2.13 (1.15) in 12-year olds.
Conclusions
. The prevalence and incidence of dental caries in 7–12-year-old Lithuanian children are high. Only half of all examined children have at least one sealed molar. The financial resources allocated for the Pit and Fissure Sealing in Permanent Molars program were used insufficiently; therefore, there is a need for systematic measures in order to improve the efficacy of the aforementioned program. Full article
Open AccessArticle
Human rhinoviruses, allergy, and asthma: a clinical approach
Medicina 2009, 45(11), 839; https://doi.org/10.3390/medicina45110109 - 10 Nov 2009
Cited by 5 | Viewed by 234
Abstract
The prevalence of allergic diseases is increasing in Lithuania as in the world. The prevalence of allergic sensitization is often higher than 50% of the population. The “hygiene hypothesis” proposed that reduced immune-stimulation by infections may have resulted in the more widespread clinical [...] Read more.
The prevalence of allergic diseases is increasing in Lithuania as in the world. The prevalence of allergic sensitization is often higher than 50% of the population. The “hygiene hypothesis” proposed that reduced immune-stimulation by infections may have resulted in the more widespread clinical expression of atopic disease. However, it alone does not provide an adequate explanation for the observed increase of allergic diseases. Human rhinovirus infections are the major infections with a worldwide distribution. Viral infections of the respiratory tract are the most common triggers of acute asthma exacerbations. These exacerbations are poorly responsive to current asthma therapies and new approaches to therapy are needed. The aim of this review is to present the current knowledge and clinical implications of human rhinovirus infection in allergy and asthma development and needs for further research. Recent evidence has shown that the immune responses to human rhinoviruses differ between asthmatic and nonasthmatic subjects. Novel insights into the mechanisms of virus-induced asthma exacerbations support the possibility that viral infections may be involved in the epithelial cells damage, inflammation, and airway hyperresponsiveness as well as in profibrotic response and induction of airway remodeling. The data of original investigations support the concept that the immune stimulation by rhinovirus infections contributes to the development of asthma, when an atopic host is infected with human rhinoviruses. Early rhinoviral wheezing is the predictor of subsequent asthma development in high-risk children. Synergistic effect of allergic sensitization, allergen exposure, and viral infection was suggested in the increased risk of hospitalization for asthma in both children and adults. Timing of allergen exposure may be important in a synergistic outcome. The increased susceptibility to rhinovirus infections was identified in atopic asthma. This review also presents the current options on the treatment and prevention of virus-induced asthma. Further studies are needed in order to differentiate between the response to viruses of healthy and atopic or nonatopic asthmatic children and adults. New research data may lead to novel strategies in treatment and prevention of asthma exacerbations as well as prevention of asthma induction Full article
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