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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 49, Issue 10 (October 2013) – 6 articles

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Open AccessArticle
Incidentally Diagnosed Malignant Coronary Artery Anomaly: A Clinical Case
Medicina 2013, 49(10), 72; https://doi.org/10.3390/medicina49100072 - 04 Nov 2013
Viewed by 256
Abstract
The incidence of congenital coronary artery anomalies is estimated to range between 1% and 2% in the general population. The separate types of coronary artery anomalies are even rarer – the left main coronary artery arising from the right coronary sinus and passing [...] Read more.
The incidence of congenital coronary artery anomalies is estimated to range between 1% and 2% in the general population. The separate types of coronary artery anomalies are even rarer – the left main coronary artery arising from the right coronary sinus and passing between the thoracic aorta and the pulmonary artery is one of them. In this case, the segment of the artery that courses between the aorta and the pulmonary artery is prone to compression, especially during heavy exercise. Outcomes may be fatal due to myocardial hypoperfusion, which is associated with sudden cardiac death especially among children, young adults, and athletes. Nowadays, innate coronary artery anomalies may be incidentally diagnosed in older age using new investigation methods such as computed tomography angiography. Full article
Open AccessArticle
Infant Mortality Gap in the Baltic Region – Latvia, Estonia, and Lithuania – in Relation to Macroeconomic Factors in 1996–2010
Medicina 2013, 49(10), 71; https://doi.org/10.3390/medicina49100071 - 04 Nov 2013
Viewed by 270
Abstract
Background and Objective. A constant gap has appeared in infant mortality among the 3 Baltic States - Latvia, Estonia, and Lithuania – since the restoration of independence in 1991. The aim of the study was to compare infant mortality rates in all the [...] Read more.
Background and Objective. A constant gap has appeared in infant mortality among the 3 Baltic States - Latvia, Estonia, and Lithuania – since the restoration of independence in 1991. The aim of the study was to compare infant mortality rates in all the 3 Baltic countries and examine some of the macro- and socioeconomic factors associated with infant mortality.
Material and Methods
. The data were obtained from international databases, such as World Health Organization and EUROSTAT, and the national statistical databases of the Baltic States. The time series data sets (1996–2010) were used in the regression and correlation analysis.
Results
. In all the 3 Baltic States, a strong and significant correlation was found: Latvia (r=–0.81, P<0.01), Lithuania (r=–0.93, P<0.01), and Estonia (r=–0.91, P<0.01). There was also a correlation between infant mortality and healthcare expenditure in local currency per capita: Latvia (r=– 0.81, P<0.01); Lithuania (r=–0.90, P<0.01) and Estonia (r=–0.88, P<0.01). In Latvia (r=0.87, P<0.01) and Estonia (r=0.70; P<0.01), a significant correlation between infant mortality and unemployment levels was observed from 1996 to 2008, whereas the statistical significance disappeared in the period from 1996 to 2010. In Lithuania, the relationship was not significant.
Conclusions
. Higher infant mortality rates and a less stable decreasing tendency in Latvia are apparently explained by less successful adaptation to a new political and economic situation and limited skills in adjusting the healthcare system to the reality of life. Full article
Open AccessArticle
The Effect of Atmospheric Temperature and Pressure on the Occurrence of Acute Myocardial Infarction in Kaunas
Medicina 2013, 49(10), 70; https://doi.org/10.3390/medicina49100070 - 04 Nov 2013
Cited by 2 | Viewed by 234
Abstract
Objective. The aim of the study was to evaluate the impact of meteorological variables (atmospheric temperature and pressure) on the daily occurrence of acute myocardial infarction (AMI).
Material and Methods
. The study used the daily values of atmospheric temperature and pressure [...] Read more.
Objective. The aim of the study was to evaluate the impact of meteorological variables (atmospheric temperature and pressure) on the daily occurrence of acute myocardial infarction (AMI).
Material and Methods
. The study used the daily values of atmospheric temperature and pressure in 2000–2007. The meteorological data were obtained from the Lithuanian Hydrometeorological Service for Kaunas. The relative risks of event occurrence were computed for 5°C atmospheric temperature and for 10-hPa atmospheric pressure variations by means of the Poisson regression model.
Results.
The occurrence of AMI and atmospheric temperature showed an inverse linear relationship, while the occurrence of AMI and atmospheric pressure, a positive linear relationship. Among the youngest subjects (25–44 years old), no relationships were detected. Contrary, among the subjects aged 45–64 years and those aged 65 years and older, the occurrence of AMI significantly decreased with higher temperature (P=0.001 and P=0.002, respectively). A decrease in atmospheric temperature by 10ºC reduced the risk of AMI by 8.7% in the age groups of 45–64 and 65 years and older and by 19% in the age group of 25 years and older. Among the first AMI cases, the risk increased by 7.5% in the age group of 45–64-year olds and by 6.4% in the age group of 25–64-year olds. The relationship between atmospheric temperature and pressure, and AMI occurrence was found to be linear but inverse. An increase in atmospheric pressure by 10 hPa resulted in an increase in risk by 4% among the subjects aged 65 years and more and by 3% among the subjects aged 25 years and more.
Conclusions
. Atmospheric temperature and pressure variations had the greatest effect on middle- aged and aging subjects (starting from 45 years). At younger age, the effect of such factors on the AMI risk was considerably lower. Full article
Open AccessArticle
The Influence of Self-Stretching Based on Postisometrical Relaxation, Static Stretching Combined with Stabilizing Exercises, and Stabilizing Exercises Only on the Flexibility of One-Joint and Two-Joint Hip Flexors
Medicina 2013, 49(10), 69; https://doi.org/10.3390/medicina49100069 - 04 Nov 2013
Cited by 1 | Viewed by 267
Abstract
Background and Objective. The limitations of muscle flexibility are a common dysfunction of the musculoskeletal system. Therefore, various therapeutic techniques are used in rehabilitation programs to increase their flexibility. The aim of this prospective, randomized, single-blind study was to evaluate the changes [...] Read more.
Background and Objective. The limitations of muscle flexibility are a common dysfunction of the musculoskeletal system. Therefore, various therapeutic techniques are used in rehabilitation programs to increase their flexibility. The aim of this prospective, randomized, single-blind study was to evaluate the changes in the flexibility of hip flexors in children who participated in a 6-week therapeutic program consisting of one physiotherapy session per week with a physiotherapist and daily home exercises.
Material and Methods
. A total of 94 children aged 10–13 years were randomly assigned to 3 experimental groups: postisometrical relaxation group (PIR group), static stretching combined with stabilizing exercise group (SE/SS group), and stabilizing exercise group (SS group). To assess the flexibility of one- and two-joint hip flexors, the modified Thomas test was used. The examination was conducted by blinded observers.
Results
. A significant improvement in the flexibility of one-joint hip flexors was documented in all 3 groups (P<0.01). The flexibility of two-joint hip flexors increased significantly only in the SS/SE group (P<0.05). After the program, the highest range of motion of the hip extension (test for one-joint hip flexors) was recorded in the SS/SE group (20.6°±4.5°), and it was significantly greater than in the SE group (16.6°±4.0°, P<0.05). There were no significant differences in the knee flexion (test for two-joint hip flexors) among all 3 groups (P>0.05).
Conclusions
. The 6-week therapeutic program regardless of the technique applied (postisometrical muscle relaxation, static stretching with stabilizing exercises, and stabilizing exercises only) resulted in the increased flexibility of one-joint hip flexors. Only static stretching combined with stabilizing exercises led to a significant increase in the flexibility of two-joint hip flexors. Full article
Open AccessArticle
Maternal Serum Soluble HLA-G Levels in Missed Abortions
Medicina 2013, 49(10), 68; https://doi.org/10.3390/medicina49100068 - 04 Nov 2013
Viewed by 306
Abstract
Background and Objective. It is unclear how immune tolerance develops to a semiallograft fetus in pregnancy. Human leukocyte antigen G (HLA-G) expressed by extravascular trophoblasts plays an important role in the recognition of the gestational tissues as self and the development of [...] Read more.
Background and Objective. It is unclear how immune tolerance develops to a semiallograft fetus in pregnancy. Human leukocyte antigen G (HLA-G) expressed by extravascular trophoblasts plays an important role in the recognition of the gestational tissues as self and the development of immune tolerance against the gestational tissues by the maternal immune system. The soluble form of the HLA-G (sHLA-G) molecule in the maternal serum is also reported to contribute to the prevention of rejection during pregnancy. The aim of the study was to compare the maternal serum sHLA-G levels of the women with missed abortions and control subjects with uncomplicated pregnancies.
Material and Methods
. The prospective cross-sectional study involving 40 with missed abortions and 40 control women, matched by age, gestational age, and body mass index, was carried out. The study group consisted of the women with singleton pregnancies, who were diagnosed with a missed abortion. Only the patients who were confirmed to have an uncomplicated term delivery during follow-up were included in the control group. The serum sHLA-G level was compared between the groups.
Results. There was no significant difference in the mean serum sHLA-G levels in terms of gravidity (P=0.761) and a history of abortion (P=0.379) in the control group. The median serum sHLA-G level in the missed abortion group was significantly lower compared with the control group (16.8 [8.5–35.8] vs. 26 [11–135] U/mL, P<0.001). All the women in the control group had uncomplicated term deliveries.
Conclusion
. Our results showed that the women with missed abortions had significantly lower serum sHLA-G levels compared with the healthy pregnant controls, which may have potentially played a role in the impairment of physiological immunological tolerance during pregnancy. However, the determination of the exact role and the potential clinical utility of maternal serum sHLA-G for the detection/prediction of a missed abortion risk requires further detailed studies. Full article
Open AccessArticle
Independent Pretreatment Predictors of Graves’ Disease Outcome
Medicina 2013, 49(10), 67; https://doi.org/10.3390/medicina49100067 - 04 Nov 2013
Cited by 2 | Viewed by 231
Abstract
Background and Objective. Current treatment options of Graves’ disease (GD) are often unsatisfactory. This study aimed at determining the independent baseline predictors of medical treatment failure in GD.
Material and Methods
. A retrospective study of 194 patients with GD was carried out. [...] Read more.
Background and Objective. Current treatment options of Graves’ disease (GD) are often unsatisfactory. This study aimed at determining the independent baseline predictors of medical treatment failure in GD.
Material and Methods
. A retrospective study of 194 patients with GD was carried out. According to the disease outcome, patients were divided into groups. The remission group included the patients who achieved long-term remission after initial antithyroid drug (ATD) treatment with no relapse (group 1) or after 2 or 3 courses of ATD therapy (group 2). The treatment failure group included the patients who underwent thyroid ablation due to relapse (group 3) or without ATD withdrawal (group 4).
Results
. A family history of thyroid disorders was associated with greater odds of failure (P=0.046). Higher thyrotropin receptor antibodies (TRAb) levels and a larger goiter size (grade 2/ grade 3) at the onset of the disease were both independently associated with a greater likelihood of failure. The initial TRAb concentration of 30.2 U/L and the TRAb concentration of 12.97 U/L at the end of ATD therapy were found to be the best cutoff values predicting the treatment failure. A hypoechogenic thyroid after ATD therapy, but not before therapy, increased the likelihood of failure by nearly 7.5 times (P<0.001).
Conclusions.
Higher TRAb levels and a larger goiter size at the onset of the disease were found to be the independent predictors of medical treatment failure in GD. Full article
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