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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.

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Medicina, Volume 46, Issue 10 (October 2010) – 10 articles

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Open AccessArticle
Trauminį galvos smegenų sužalojimą patyrusių asmenų kineziterapija
Medicina 2010, 46(10), 712; https://doi.org/10.3390/medicina46100101 - 11 Oct 2010
Cited by 3 | Viewed by 271
Abstract
Trauminis galvos smegenų sužalojimas yra didelė visuomenės ir sveikatos problema, pažeidžianti psichines, pažinimo, elgesio bei motorikos funkcijas. Todėl ypatingas dėmesys turi būti skiriamas ankstyvajai reabilitacijai, kurios metu svarbus vaidmuo tenka kineziterapijai. Asmenų, patyrusių trauminį galvos smegenų sužalojimą, funkcinės būklės ir kineziterapijos efektyvumui įvertinti [...] Read more.
Trauminis galvos smegenų sužalojimas yra didelė visuomenės ir sveikatos problema, pažeidžianti psichines, pažinimo, elgesio bei motorikos funkcijas. Todėl ypatingas dėmesys turi būti skiriamas ankstyvajai reabilitacijai, kurios metu svarbus vaidmuo tenka kineziterapijai. Asmenų, patyrusių trauminį galvos smegenų sužalojimą, funkcinės būklės ir kineziterapijos efektyvumui įvertinti kineziterapeutai turi galimybę taikyti įvairių autorių sukurtas skales ir testus: Funkcinio nepriklausomumo testą; Negalios vertinimo skalę; Barthel indeksą; Glasgow komos skalę; Glasgow baigčių skalę; Ranchos Los Amigos pažinimo vertinimo skalę, Trumpąjį proto būklės vertinimo testą ir kt. Apžvalginiame straipsnyje pateikiama mirtingumo ir mirštamumo nuo trauminio galvos smegenų sužalojimo analizė, aptariamos ligonių po trauminio galvos smegenų sužalojimo funkcinės būklės vertinimo galimybės, gana išsamiai aprašomos funkciškai stipresnių ligonių kineziterapijos ypatybės bei atskleidžiami veiksniai, sąlygojantys nepakankamą kineziterapijos poveikį. Nurodoma, kad tokios komplikacijos, kaip kontraktūros, spazmiškumas, miego sutrikimai, sutrikusi pusiausvyra, dėmesio ir elgesio sutrikimai, motyvacijos stoka, depresija sunkina trauminį galvos smegenų sužalojimą patyrusių asmenų kineziterapijos procedūrų atlikimą bei reabilitaciją. Full article
Open AccessArticle
Effect of inhibitors of mitochondrial respiratory chain complexes on the electromechanical activity in human myocardium
Medicina 2010, 46(10), 679; https://doi.org/10.3390/medicina46100096 - 11 Oct 2010
Viewed by 211
Abstract
The aim of the study was to investigate the effect of inhibitors of mitochondrial respiratory chain complexes I, III, and IV on the electromechanical activity in human myocardium.
Material and methods
. The experiments were performed on the human myocardial strips obtained from [...] Read more.
The aim of the study was to investigate the effect of inhibitors of mitochondrial respiratory chain complexes I, III, and IV on the electromechanical activity in human myocardium.
Material and methods
. The experiments were performed on the human myocardial strips obtained from patients with heart failure (NYHA class III or IV) using a conventional method of registration of myocardial electromechanical activity. Under the perfusion with physiological Tyrode solution (control), contraction force (P) was 0.94±0.12 mN (n=16), relaxation time (t50) was 173.38±5.03 ms (n=15), action potential durations measured at 50% (AP50) and 90% (AP90) repolarization were 248.96±13.38 ms and 398.59±17.93 ms, respectively (n=13).
Results. The inhibition of respiratory chain complex I by rotenone (3×10–5 M, the highest concentration applied) decreased contraction force of human myocardium to 48.99%±14.74% (n=3) (P<0.05); AP50, to 81.34%±15.81%; and AP90, to 87.28%±7.25% (n=3) (P>0.05) of control level, while relaxation time and resting tension remained almost unchanged. Antimycin A, an inhibitor of complex III, applied at the highest concentration (3×10–4 M) reduced P to 41.66%±8.8% (n=5) (P<0.001) and marginally increased t50 and decreased the durations of AP. Anoxia (3 mM Na2S2O4) that inhibits the activity of complex IV reduced the contraction force to 9.23%±3.56% (n=6) (P<0.001), AP50 and AP90 to 65.46%±9.95% and 71.07%±8.39% (n=5) (P<0.05) of control level, respectively; furthermore, the resting tension augmented (contracture developed).
Conclusions
. Our results show that the inhibition of respiratory chain complex IV had the strongest inhibitory effect on the electromechanical activity of failing human myocardium. Full article
Open AccessArticle
Vidutinės tikėtinos gyvenimo be negalios trukmės Lietuvoje įvertinimas
Medicina 2010, 46(10), 707; https://doi.org/10.3390/medicina46100100 - 10 Oct 2010
Cited by 1 | Viewed by 226
Abstract
Tyrimo tikslas. Įvertinti ir palyginti Lietuvos vyrų ir moterų vidutinę tikėtiną gyvenimo be negalios trukmę (VGT be negalios) 2001 m.
Duomenų šaltiniai ir metodai. Statistiniai duomenys apie Lietuvos gyventojus ir mirusiuosius, reikalingi išgyvenimo lentelėms sudaryti, gauti iš Statistikos departamento prie Lietuvos Respublikos Vyriausybės [...] Read more.
Tyrimo tikslas. Įvertinti ir palyginti Lietuvos vyrų ir moterų vidutinę tikėtiną gyvenimo be negalios trukmę (VGT be negalios) 2001 m.
Duomenų šaltiniai ir metodai. Statistiniai duomenys apie Lietuvos gyventojus ir mirusiuosius, reikalingi išgyvenimo lentelėms sudaryti, gauti iš Statistikos departamento prie Lietuvos Respublikos Vyriausybės (toliau – Statistikos departamentas) demografinės statistikos, o apie negalios paplitimą – iš 2001 m. vykusio Lietuvos Respublikos visuotinio gyventojų ir būstų surašymo rezultatų. Vidutinė tikėtina gyvenimo be negalios trukmė apskaičiuota pagal D. F. Sullivan (1971) metodiką.
Rezultatai. Lietuvos vyrų VGT be negalios 2001 m. buvo 60,6 metų, moterų – 70,6 metų ir sudarė 91,9 proc. vyrų ir 91,0 proc. moterų bendrosios VGT. Sulaukusių 65 metų vyrų šis rodiklis sumažėjo iki 6,2, moterų – iki 11,7 metų ir sudarė atitinkamai – 45,8 ir 64,9 proc. bendrosios VGT. Su amžiumi intensyviau trumpėjo VGT be negalios nei bendrasis VGT rodiklis. Moterų VGT be negalios buvo 10 metų ilgesnė nei vyrų, o vyrų ir moterų VGT, esant negaliai, mažai skyrėsi.
Išvada
. VGT be negalios stebėsena, atliekama remiantis oficialiąja mirtingumo ir negalios paplitimo statistika, yra svarbi siekiant įvertinti socialinę ir ekonominę negalios naštą visuomenei bei valstybei. Full article
Open AccessArticle
Prognostication of long-term outcomes for patients with ischemic heart disease
Medicina 2010, 46(10), 700; https://doi.org/10.3390/medicina46100099 - 10 Oct 2010
Cited by 1 | Viewed by 227
Abstract
Cardiovascular disease, including coronary heart disease (CHD), is the leading cause of death among elderly adults across many European countries. In 2005, the Clinic of Cardiology, Hospital of Lithuanian University of Health Sciences (former Kaunas University of Medicine), started to gather the clinical [...] Read more.
Cardiovascular disease, including coronary heart disease (CHD), is the leading cause of death among elderly adults across many European countries. In 2005, the Clinic of Cardiology, Hospital of Lithuanian University of Health Sciences (former Kaunas University of Medicine), started to gather the clinical data of patients with acute and chronic coronary syndromes according to the standards set by the Cardiology Audit and Registration Data Standards Project. The aim of our study was to evaluate one-year mortality after inpatient treatment for acute and chronic coronary syndromes in different risk groups. Material and methods. A total of 3268 patients who were treated for coronary heart disease - acute myocardial infarction, unstable angina, stable angina – at the Clinic of Cardiology, Hospital of Lithuanian University of Health Sciences (former Kaunas University of Medicine) in 2005 were randomly selected. Clinical data of the patients were collected by means of a standardized questionnaire. After one year, 1908 patients were reexamined, and predominant symptoms, treatment during one-year period, outcomes were evaluated.
Results. Multiple logistic regression analysis revealed that one-year mortality after acute coronary syndromes was most influenced by age of 70–80 years, history of stroke, Killip class III-IV, and reduced high-density lipoprotein cholesterol levels. For patients who were treated for chronic coronary syndromes, reduced EF (<40%) and increased heart rate (>70 beats per minute) were the strongest independent predictors of one-year mortality.
Conclusion
. A scoring system for the assessment of mortality risk within one year for patients with acute and chronic coronary syndromes was constructed, which could be useful for cardiologists as well as family physicians for risk evaluation in inpatient and outpatient settings. Full article
Open AccessArticle
Associations between depressiveness and psychosocial factors in Lithuanian rural population
Medicina 2010, 46(10), 693; https://doi.org/10.3390/medicina46100098 - 10 Oct 2010
Cited by 6 | Viewed by 166
Abstract
Background and objective. Data from various scientific studies all over the world show that depression is becoming one of the biggest health problems in society. The aim of this study was to evaluate characteristics of depressiveness and its associations with psychosocial factors [...] Read more.
Background and objective. Data from various scientific studies all over the world show that depression is becoming one of the biggest health problems in society. The aim of this study was to evaluate characteristics of depressiveness and its associations with psychosocial factors (stress, social support, suicidal intentions) in Lithuanian adult rural population.
Material and methods. Within the Countrywide Integrated Non-communicable Diseases Intervention (CINDI) program, the survey was carried out in a stratified random sample of population aged 25–64 in 5 rural regions of Lithuania between 2006 and 2007. A total of 1754 participants were examined.
Results.
About half (43.8%) of respondents experienced high and moderate levels of depressiveness. Women in comparison to men reported higher levels of depressiveness. The likelihood of depressiveness among women was related to older age, lower education, small social network, lower level of social support, higher level of stress, and suicidal intentions. Whereas, the same indicator among men was associated with older age, lower education, being divorced, small social network, having no social support, higher level of stress, and suicidal intentions.
Conclusions
. Depressiveness is highly prevalent among Lithuanian rural population with a higher prevalence among women than men. Older persons and persons with lower education of both genders were more likely to be depressed than younger and more educated persons. Absence of social support, high level of stress, and suicidal intentions were related to higher levels of depressiveness in both genders. Depressiveness was more common among women having a small social network and divorced men. Full article
Open AccessArticle
Pharmacy specialists’ attitudes toward pharmaceutical service quality at community pharmacies
Medicina 2010, 46(10), 686; https://doi.org/10.3390/medicina46100097 - 10 Oct 2010
Cited by 3 | Viewed by 220
Abstract
Objective. The main objective of this study was to analyze pharmacy specialists’ attitudes toward the quality of pharmaceutical services at Lithuanian community pharmacies. Material and methods. Between April and June 2009, a total of 471 Lithuanian community pharmacy specialists completed a questionnaire [...] Read more.
Objective. The main objective of this study was to analyze pharmacy specialists’ attitudes toward the quality of pharmaceutical services at Lithuanian community pharmacies. Material and methods. Between April and June 2009, a total of 471 Lithuanian community pharmacy specialists completed a questionnaire designed to evaluate their attitudes toward the quality of pharmaceutical services at community pharmacies. The main dimensions of pharmaceutical service quality were extracted by principal component analysis.
Results
. Two main dimensions of pharmaceutical service quality were extracted: pharmacotherapeutic aspects (provision of information about drug therapy, possible side effects, health promotion, the amount of time spent with a patient, and the ascertainment that a patient understood the provided information) and socioeconomic aspects (considering patient’s needs and financial capabilities, making a patient confident with the services provided). Pharmacy specialists evaluated the quality of both dimensions positively, but the quality of the first dimension was rated significantly worse than that of the second dimension. The attitudes of pharmacy specialists working at independent pharmacies were more positive toward pharmacotherapeutic aspects as compared to the specialists working at chain or state pharmacies. Pharmacotherapeutic aspects were rated better by pharmacy specialists, aged ≥55 years, than those younger than 45 years. Moreover, the attitudes of 45–54-year-old pharmacy specialists toward the socioeconomic aspects were more positive as compared with those of 35–44-year olds. Pharmacists rated the socioeconomic aspects of pharmaceutical service quality worse as compared with pharmacy technicians. The attitudes of pharmacy specialists working at pharmacies with 6–9 specialists were more negative toward pharmacotherapeutic aspects than those of the pharmacies with 1–2 specialists. Pharmacy specialists working at pharmacies with ≥10 specialists reported lower scores of socioeconomic aspects as compared to those working at pharmacies with fewer specialists. Men evaluated both pharmacotherapeutic and socioeconomic aspects worse than women. The evaluation of pharmaceutical service quality did not differ by pharmacy location.
Conclusions. Two dimensions of pharmaceutical service quality were determined. According to Lithuanian pharmacy specialists, the quality of pharmacotherapeutic aspects at community pharmacies was worse than that of socioeconomic aspects. The evaluation of the quality of pharmaceutical service significantly differed according to the specialists’ sex, age, qualification, and type and size of pharmacies. Full article
Open AccessArticle
Evaluation of arterial hypertension control and treatment in daily practice of family physicians
Medicina 2010, 46(10), 657; https://doi.org/10.3390/medicina46100093 - 10 Oct 2010
Cited by 3 | Viewed by 261
Abstract
The objective of this study was to evaluate the percentage of patients with primary arterial hypertension treated with antihypertensive drug(s), who achieved target arterial blood pressure (ABP), and to compare the characteristics of patients with controlled and uncontrolled ABP, their current treatment, and [...] Read more.
The objective of this study was to evaluate the percentage of patients with primary arterial hypertension treated with antihypertensive drug(s), who achieved target arterial blood pressure (ABP), and to compare the characteristics of patients with controlled and uncontrolled ABP, their current treatment, and treatment modifications.
Material and methods. A total of 429 18–80-year-old patients with primary arterial hypertension treated for ≥1 year participated in this study. General practitioners collected data on patients’ demographic and clinical characteristics, current treatment for primary arterial hypertension, and treatment modifications.
Results
. According to physicians, 45.4% of patients achieved target ABP levels. Adequately controlled ABP was documented more often in the group of low and moderate cardiovascular risk than in high- and very high-risk group (n=141, 62.9% versus n=54, 26.3%; P<0.0001). Based on ABP measurements, 160 (37.3%) patients had ABP of <140/90 mm Hg. The majority of patients were treated with a combination of two (n=153, 35.7%) to three (n=144, 33.6%) antihypertensive drugs. Patients with uncontrolled ABP more frequently than patients with controlled ABP were given combination therapy. Treatment was not modified in 37.8% (n=162) of patients, more commonly in those with controlled ABP.
Conclusions. The level of hypertension control in study population was far from optimal, especially in the group of patients at high- and very high-risk where target ABP was lower. Almost 12% of patients with uncontrolled ABP were still undergoing monotherapy, whereas 16% of patients were not recommended any modifications of antihypertensive treatment despite their ABP was not controlled. Full article
Open AccessReview
Pathogenesis and treatment modalities of localized scleroderma
Medicina 2010, 46(10), 649; https://doi.org/10.3390/medicina46100092 - 10 Oct 2010
Cited by 11 | Viewed by 386
Abstract
Localized scleroderma is a chronic inflammatory disease primarily of the dermis and subcutaneous fat that ultimately leads to a scar-like sclerosis of connective tissue. The disorder manifests as various plaques of different shape and size with signs of skin inflammation, sclerosis, and atrophy. [...] Read more.
Localized scleroderma is a chronic inflammatory disease primarily of the dermis and subcutaneous fat that ultimately leads to a scar-like sclerosis of connective tissue. The disorder manifests as various plaques of different shape and size with signs of skin inflammation, sclerosis, and atrophy. This is a relatively rare inflammatory disease characterized by a chronic course, unknown etiology, and insufficiently clear pathogenesis. Many factors may influence its appearance: trauma, genetic factors, disorders of the immune system or hormone metabolism, viral infections, toxic substances or pharmaceutical agents, neurogenic factors, and Borrelia burgdorferi infection. Various therapeutic modalities are being used for the treatment of localized scleroderma. There is no precise treatment scheme for this disease. A majority of patients can be successfully treated with topical pharmaceutical agents and phototherapy, but some of them with progressive, disseminated, and causing disability localized scleroderma are in need of systemic treatment. The aim of this article is not only to dispute about the clinical and morphological characteristics of localized scleroderma, but also to present the newest generalized data about the possible origin, pathogenesis, and treatment modalities of this disease. Full article
Open AccessArticle
Impedanskardiografijos metodo galimybės diagnozuojant plaučių hipertenziją
Medicina 2010, 46(10), 669; https://doi.org/10.3390/medicina46100095 - 07 Oct 2010
Viewed by 278
Abstract
Tyrimo tikslas. Ištirti klinikinių, impedanskardiografijos, echokardioskopijos, krūtinės ląstos rentgenografijos duomenų sąsajas diagnozuojant plaučių hipertenziją sergantiesiems širdies ir kraujagyslių arba kvėpavimo sistemų ligomis.
Tyrimo medžiaga ir metodai. 181 pacientui (80 pacientų, sergančių širdies ir kraujagyslių sistemos patologija, kai echokardioskopiškai nustatyta plaučių arterijos hipertenzija; 69 [...] Read more.
Tyrimo tikslas. Ištirti klinikinių, impedanskardiografijos, echokardioskopijos, krūtinės ląstos rentgenografijos duomenų sąsajas diagnozuojant plaučių hipertenziją sergantiesiems širdies ir kraujagyslių arba kvėpavimo sistemų ligomis.
Tyrimo medžiaga ir metodai. 181 pacientui (80 pacientų, sergančių širdies ir kraujagyslių sistemos patologija, kai echokardioskopiškai nustatyta plaučių arterijos hipertenzija; 69 pacientams, sergantiems širdies ir kraujagyslių sistemos patologija, kai echokardioskopiškai plaučių arterijos hipertenzijos nerasta; 19 pacientų, sergančių plaučių patologija, kai echokardioskopiškai plaučių arterijos hipertenzijos rasta; 13 pacientų, sergančių plaučių patologija, kai plaučių arterijos hipertenzijos nerasta) ištirti buvo taikomi klinikiniai, dvimatės širdies echoskopijos, impedanskardiografijos, kiti instrumentiniai tyrimai siekiant įvertinti, sergančiųjų plaučių hipertenzija duomenų pokyčius.
Rezultatai
. Impedanskardiografijos metodo jautrumas, diagnozuojant plaučių hipertenziją pagal vidutinį kraujo spaudimą plaučių arterijoje, 72 proc., specifiškumas – 90 proc., pagal sistolinį kraujo spaudimą plaučių arterijoje jautrumas – 96 proc., specifiškumas – 90 proc. Sudarytas matematinis dvejetainės logistinės regresijos modelis, pagal kurį 96,7 proc. tikslumu galima diagnozuoti plaučių hipertenziją. Svarbiausi impedanskardiografijos duomenys: sistolinis spaudimas plaučių arterijoje bei sistolinio laiko indeksas.
Išvados
. Impedanskardiografijos tyrimo metu nustatomi vidutinio ir sistolinio kraujo spaudimo plaučių arterijoje parametrai yra informatyvūs. Plaučių hipertenzijos diagnostikos algoritmuose galima būtų naudoti šiuos požymius: prieširdžių virpėjimas, giliųjų venų trombozė, dusulys, cianozė, II tono akcentas plaučių arterijos vožtuvo išklausymo taške, sistolinis ūžesys ties triburiu vožtuvu, plaučių rentgenografijoje rastas padidėjęs plaučių arterijos spindis ≥18 mm, padidėjęs dešiniojo skilvelio diametras, impedanskardiografijos metodu apskaičiuotas sistolinis spaudimas plaučių arterijoje bei sistolinio laiko indeksas. Full article
Open AccessArticle
Normali krūvio miokardo perfuzija ir vainikinių arterijų būklė
Medicina 2010, 46(10), 664; https://doi.org/10.3390/medicina46100094 - 27 Sep 2010
Viewed by 241
Abstract
Tyrimo tikslas. Nustatyti klinikinius požymius, būdingus pacientams, jaučiantiems krūtinės skausmus, kurių vainikinės arterijos susiaurėjusios, o miokardo krūvio perfuzija normali.
Tirtųjų kontingentas ir tyrimo metodai
. Tirtųjų kontingentą sudarė 84 pacientai, jaučiantys krūtinės skausmus, kuriems 2000–2007 m. buvo nustatyta normali miokardo krūvio (veloergometrija) radionuklidinė [...] Read more.
Tyrimo tikslas. Nustatyti klinikinius požymius, būdingus pacientams, jaučiantiems krūtinės skausmus, kurių vainikinės arterijos susiaurėjusios, o miokardo krūvio perfuzija normali.
Tirtųjų kontingentas ir tyrimo metodai
. Tirtųjų kontingentą sudarė 84 pacientai, jaučiantys krūtinės skausmus, kuriems 2000–2007 m. buvo nustatyta normali miokardo krūvio (veloergometrija) radionuklidinė kompiuterinė tomografi ja ir atlikta širdies vainikinių arterijų angiografija. Miokardo krūvio radionuklidinė kompiuterinė tomografi ja atlikta pagal vienos dienos standartinį protokolą dviem etapais. Vertinimui buvo naudojamas 20 balų modelis. Perfuzija laikoma normalia, kai suminis krūvio balas buvo 0–3.
Rezultatai
. Didelė pretestinė išeminės širdies ligos tikimybė nustatyta 25 proc. pacientų, informatyvūs krūvio nutraukimo kriterijai – 45,2 proc. atvejų. Reikšmingų (≥75 proc.) vainikinių arterijų susiaurėjimų nustatyta 26 (31 proc.) pacientams, iš jų 6 (7,1 proc.) – trijų arterijų. Vienaveiksnės logistinės regresijos būdu įvertinta klinikinių rodmenų reikšmė didelių vainikinių arterijų stenozių tikimybei esant normaliai miokardo krūvio perfuzijai. 1–3 arterijų stenozė dažniau nustatyta pacientams, kurie jautė būdingus angininius skausmus (šansų santykis 3,8, p=0,008) ir turėjo didelę pretestinę išeminės širdies ligos tikimybę (šansų santykis 3,43, p=0,023). Trijų vainikinių arterijų liga dažniau nustatyta pacientams, kurie jautė būdingus angininius skausmus (šansų santykis – 11,2, p=0,009), turėjo didelę pretestinę išeminės širdies ligos tikimybę (šansų santykis – 7,93, p=0,018) ir kuriems krūvio metu buvo sukelti išeminiai pokyčiai (šansų santykis – 6,4, p=0,037).
Išvada. Būdingi angininiai skausmai, didelė pretestinė išeminės širdies ligos tikimybė ir krūvio sukeliami išeminiai pokyčiai patikimai didina vainikinių arterijų reikšmingų stenozių tikimybę net esant normaliai miokardo krūvio perfuzijai, todėl tokiems pacientams turi būti atliekamas angiografijos tyrimas. Full article
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