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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 5 (October 2014) , Pages 255-311

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Open AccessArticle
Insufficient control of heart rate in stable coronary artery disease patients in Latvia
Medicina 2014, 50(5), 295-302; https://doi.org/10.1016/j.medici.2014.10.005 - 04 Nov 2014
Cited by 1 | Viewed by 254
Abstract
Background and objective: Heart rate (HR) ≥70 beats per minute (bpm) increases cardiovascular risk in coronary artery disease (CAD) patients. The objective of the analysis is to characterize HR as well as other clinical parameters in outpatients with stable CAD in Latvia.
Materials [...] Read more.
Background and objective: Heart rate (HR) ≥70 beats per minute (bpm) increases cardiovascular risk in coronary artery disease (CAD) patients. The objective of the analysis is to characterize HR as well as other clinical parameters in outpatients with stable CAD in Latvia.
Materials and methods: CLARIFY is an ongoing international registry of outpatients with established CAD. Latvian data regarding 120 patients enrolled in CLARIFY and collected at baseline visit during 2009–2010 were analyzed.
Results: The mean HR was 67.7 ± 9.5 and 66.9 ± 10.7 bpm when measured by pulse palpation and electrocardiography, respectively. HR ≤60 bpm and ≥70 bpm was observed in 25% and 35.8% of patients, respectively. When analyzing patients with angina symptoms, 22.8% had HR ≤60 bpm while HR ≥70 bpm was observed in 33.3% of the cases. HR ≥70 bpm was observed in 36.2% of patients with symptoms of chronic heart failure. Beta-blockers were used in 81.7% of the patients. Metoprolol (long acting succinate), bisoprolol, nebivolol and carvedilol in average daily doses 63.8, 5.3, 4.5, and 10.4 mg/d were used in 47, 37, 11 and 3 cases, respectively. Among patients with HR ≥70 bpm 79.1% were using beta-blockers. Medications did not differ significantly between the three groups according to HR level (≤60, 61–69 and ≥70 bpm).
Conclusions: Despite the wide use of beta-blockers, HR is insufficiently controlled in the analyzed sample of stable CAD patients in Latvia. Target HR ≤60 bpm is achieved only in 25% of the patients while more than one third have increased HR ≥70 bpm. Full article
Open AccessArticle
Early development of endocrine and metabolic consequences after treatment of central nervous system tumors in children
Medicina 2014, 50(5), 275-280; https://doi.org/10.1016/j.medici.2014.10.006 - 04 Nov 2014
Cited by 7 | Viewed by 251
Abstract
Background and objective: Survival after childhood cancer has dramatically improved during last few decades, implying the need for evaluation and correction of late consequences of the disease and its treatment. The aim of this study was to characterize endocrine and metabolic late effects [...] Read more.
Background and objective: Survival after childhood cancer has dramatically improved during last few decades, implying the need for evaluation and correction of late consequences of the disease and its treatment. The aim of this study was to characterize endocrine and metabolic late effects after treatment of brain tumors in children.
Materials and methods: Late complications were analyzed in 51 children treated for brain tumors at the Hospital of Lithuanian University of Health Sciences during 2000–2011. Data on late endocrine and metabolic effects were collected from medical records. Most frequently patients suffered from low-grade glioma (n = 17, 33.3%) and medulloblastoma (n = 13, 25.5%). The majority (n = 42, 82.4%) of the patients underwent surgery; 29 (56.9%) received radiotherapy (RT); 26 (51.0%), chemotherapy; and 17 (33.4%), combined treatment.
Results: The median follow-up was 21 months (range 0.25–10.6 years). Most common endocrine consequence was low serum insulin-like growth factor (IGF-I) levels (58.3%), found on average in 30.7 months after cancer treatment. Short stature was observed in 34.6% (mean time to development, 47.7 months), and hypothyroidism in 40.7% of patients (mean time to development, 63.6 months). Low bone mineral density was found in 50.0% of the cases after 44.5 months and overweight in 30.0% after 49.9 months of follow-up.
Conclusions: Survivors of brain tumors suffer from numerous endocrine and metabolic consequences, majority of them developing within the first 5 years after brain tumor therapy. An active follow-up aiming for early diagnosis and therapy is essential for improvement of quality of life in these patients. Full article
Open AccessArticle
A new maximum color contrast sensitivity test for detecting early changes of visual function in age-related macular degeneration
Medicina 2014, 50(5), 281-286; https://doi.org/10.1016/j.medici.2014.10.008 - 01 Nov 2014
Cited by 2 | Viewed by 236
Abstract
Background and objective: To determine the association between age-related macular degeneration (AMD) and color perception established by the Farnsworth–Munsell 100 hue (F–M 100) and maximum color contrast sensitivity (MCCS) tests.
Materials and methods: We performed a case–control study, which comprised of 100 patients [...] Read more.
Background and objective: To determine the association between age-related macular degeneration (AMD) and color perception established by the Farnsworth–Munsell 100 hue (F–M 100) and maximum color contrast sensitivity (MCCS) tests.
Materials and methods: We performed a case–control study, which comprised of 100 patients with AMD and 100 healthy controls. To test visual acuity (VA), a typical Snellen chart was used. The computerized F–M 100 and MCCS programs were used for color discrimination.
Results: The results of VA, and the F–M 100 and MCCS tests in the healthy controls were statistically significantly better than in the patients with AMD (1.0 vs. 0.82 ± 0.16, P = 0.005; 87.39 ± 24.11 vs. 185.39 ± 74.43, P = 0.005; 1.33 ± 1.17 vs. 1.96 ± 0.46, P = 0.005, respectively). When VA was 1.0 in patients with AMD, the total error scores of the F–M 100 test and MCCS test compared with healthy persons were even worse (166.09 ± 66.57 vs. 87.39 ± 24.11, P = 0.002; 1.67 ± 0.92 vs. 1.33 ± 1.17, P = 0.001, respectively). Analysis of the results of patients with AMD compared to healthy controls showed the highest error score in the blue color range.
Conclusions: The results of the color contrast sensitivity test decreased by half in patients with AMD compared with ophthalmologically healthy patients when they performed the F–M 100 test and by one and half when they performed a MCCS test in the blue color range. Full article
Open AccessArticle
Evaluation of fluid status related parameters in hemodialysis and peritoneal dialysis patients: Clinical usefulness of bioimpedance analysis
Medicina 2014, 50(5), 269-274; https://doi.org/10.1016/j.medici.2014.10.007 - 01 Nov 2014
Cited by 12 | Viewed by 285
Abstract
Background and objective: Fluid overload is a common and serious problem that leads to severe complications in dialysis patients. We aimed to compare hydration status as measured with bioimpedance analysis (BIA) method in hemodialysis (HD) and peritoneal dialysis (PD) patients, as well as [...] Read more.
Background and objective: Fluid overload is a common and serious problem that leads to severe complications in dialysis patients. We aimed to compare hydration status as measured with bioimpedance analysis (BIA) method in hemodialysis (HD) and peritoneal dialysis (PD) patients, as well as investigating the association between blood pressure, left ventricular mass index (LVMI) and hydration status.
Materials and methods: We examined 43 HD and 33 PD patients. Blood pressure was recorded. In each group, echocardiographic examinations were performed on all patients. Hydration status was assessed using multifrequency bioelectrical impedance analysis. Overhydration was defined as an overhydration (OH)/extracellular water (ECW) ratio of >0.15.
Results: The OH/ECW ratio was significantly higher in PD patients compared to post-HD patients. Overhydration was statistically more frequent in PD than in post-HD patients (30.3% vs. 11.6%, P = 0.043). Systolic blood pressure (SBP) in both post-HD and PD groups, and LVMI in the PD group were found to be significantly higher in overhydrated patients than non-overhydrated patients. In multiple linear regression analyses, increased OH/ECW ratio was independently associated with higher SBP and LVMI.
Conclusions: Fluid overload may be an even more prevalent and serious problem in PD patients. Overhydration is closely associated with increased blood pressure and LVMI. OH/ ECW ratio, a derived parameter of fluid load measured by BIA, was a significant and independent determinant of SBP and LVMI. Full article
Open AccessArticle
Predictive value of early near-infrared spectroscopy monitoring of patients with traumatic brain injury
Medicina 2014, 50(5), 263-268; https://doi.org/10.1016/j.medici.2014.10.001 - 30 Oct 2014
Cited by 5 | Viewed by 233
Abstract
Background and objective: Traumatic brain injury (TBI) is the leading cause of death and disability in young adults. Study aimed to define the predictive value of early near-infrared spectroscopy (NIRS) monitoring of TBI patients in a Lithuanian clinical setting.
Materials and methods: Data [...] Read more.
Background and objective: Traumatic brain injury (TBI) is the leading cause of death and disability in young adults. Study aimed to define the predictive value of early near-infrared spectroscopy (NIRS) monitoring of TBI patients in a Lithuanian clinical setting.
Materials and methods: Data of 61 patients was analyzed. Predictive value of early NIRS monitoring, computed tomography data and regular intensive care unit (ICU) parameters was investigated.
Results: Twenty-six patients expressed clinically severe TBI; 14 patients deceased. Patients who survived expressed higher NIRS values at the periods of admission to operative room (75.4% ± 9.8% vs. 71.0% ± 20.5%; P = 0.013) and 1 h after admission to ICU (74.7% ± 1.5% vs. 61.9% ± 19.4%; P = 0.029). The NIRS values discriminated hospital mortality groups more accurately than admission GCS score, blood sugar or hemoglobin levels. Admission INR value and NIRS value at 1 h after admission to ICU were selected by discriminant analysis into the optimal set of features when classifying hospital mortality groups. Average efficiency of classification using this method was 88.9%. When rsO2 values at 1 h after admission to ICU did not exceed 68.0% in the left hemisphere and 68.3% in the right hemisphere, the hazard ratio for death increased by 17.7 times (P < 0.01) and 5.1 times (P < 0.05), respectively.
Conclusions: NIRS plays an important role in the clinical care of TBI patients. Regional brain saturation monitoring provides accurate predictive data, which can improve the allocation of scarce medical resources, set the treatment goals and alleviate the early communication with patients' relatives. Full article
Open AccessCase Report
Left anterior descending coronary artery spasm and ‘‘accordion effect’’ mimicking coronary artery dissection
Medicina 2014, 50(5), 309-311; https://doi.org/10.1016/j.medici.2014.10.004 - 29 Oct 2014
Viewed by 216
Abstract
We present an illustrative case report of the mid-vessel left anterior descending (LAD) coronary artery spasm, which has been enhanced by straightening of the tortuous LAD segment with a guidewire (‘‘accordion effect’’) thus resistant to intracoronary nitroglycerine and mimicking a coronary artery dissection. [...] Read more.
We present an illustrative case report of the mid-vessel left anterior descending (LAD) coronary artery spasm, which has been enhanced by straightening of the tortuous LAD segment with a guidewire (‘‘accordion effect’’) thus resistant to intracoronary nitroglycerine and mimicking a coronary artery dissection. Dynamic appearance of this iatrogenic pseudolesion upon administration of intracoronary nitrates and recognition of these angiographic phenomena prevented from unnecessary further intervention. Full article
Open AccessArticle
Relationship between ACTN3 R577X polymorphism and maximal power output in elite Polish athletes
Medicina 2014, 50(5), 303-308; https://doi.org/10.1016/j.medici.2014.10.002 - 29 Oct 2014
Cited by 12 | Viewed by 244
Abstract
Background and objective: The main purpose of this study was to examine the association between ACTN3 R577X polymorphism and the ability to produce peak power in young male athletes from various sports. Our hypothesis was that the ACTN3 R577X polymorphism is associated with [...] Read more.
Background and objective: The main purpose of this study was to examine the association between ACTN3 R577X polymorphism and the ability to produce peak power in young male athletes from various sports. Our hypothesis was that the ACTN3 R577X polymorphism is associated with jumping performance and athletes with RR genotype have better scores in tests than athletes with XX or RX genotype independently of the sport discipline.
Materials and methods: Two hundred young Polish male participants representing different disciplines were recruited for this study. Genotyping for ACTN3 gene was performed using polymerase chain reaction. The power output of lower extremities and the height of rise of the body mass center during vertical jumps were measured on a force plate.
Results: The genotype distribution of the ACTN3 gene did not differ significantly between groups of athletes. The significant difference in height of counter-movement jump was found between athletes with RR and XX genotype (0.446 ± 0.049 m vs. 0.421 ± 0.036 m, respectively, P = 0.026). The ACTN3 RR genotype was associated with greater muscle power and height of jump in young male athletes.
Conclusions: These results suggest that the ACTN3 gene may play a significant role in determining muscle phenotypes. However, this gene is only one of many factors which could contribute to athletes' performance and muscle phenotypes. Full article
Open AccessArticle
Factors affecting primary patency of stenting for TransAtlantic Inter-Society (TASC II) type B, C, and D iliac occlusive disease
Medicina 2014, 50(5), 287-294; https://doi.org/10.1016/j.medici.2014.10.003 - 29 Oct 2014
Cited by 5 | Viewed by 249
Abstract
Background and objective: The purpose of our study was to evaluate 1- and 2-year results and the influence of risk factors on the outcome in the patients undergoing iliac artery stenting for TASC II type B, C, and D iliac lesions.
Materials and [...] Read more.
Background and objective: The purpose of our study was to evaluate 1- and 2-year results and the influence of risk factors on the outcome in the patients undergoing iliac artery stenting for TASC II type B, C, and D iliac lesions.
Materials and methods: In this prospective nonrandomized study conducted between April 15, 2011, and April 15, 2013, 316 patients underwent angiography with a diagnosis of aortoiliac atherosclerotic disease. Of these, 62 iliac endovascular procedures (87 stents) were performed in 54 patients.
Results: The indications for revascularization were disabling claudication (Rutherford 2, 5.9%; Rutherford 3, 35.2%), rest pain (Rutherford 4, 22.2%), and gangrene (Rutherford 5, 16.7%). The overall complication rate was 9.2%. The cumulative primary stent patency at 1 and 2 years was 83.0% ± 5.2% and 79.9% ± 5.8%, respectively. Early stent thrombosis in ≤30 days was detected in two patients (3.7%). The primary patency rates for the stents ≤61 mm at 12 and 24 months were 90.6% ± 4.5% and 86.6% ± 5.8%, respectively; those for the stents >61 mm were 67.7% ± 10.9% and 60.2% ± 12.0%, respectively (P = 0.016). The multivariate Cox regression analysis enabled the localization of a stent in both the CIA and the EIA (hazard ratio [HR], 3.3; 95% confidence interval [CI], 1.1–9.5; P = 0.021) and poor runoff (HR, 3.2; 95%, CI 1.0–10.0; P = 0.047) as independent predictors of decreased stent primary patency.
Conclusions: The localization of a stent in both iliac (CIA and EIA) arteries and poor runoff significantly reduce the primary stent patency. Patients with stents >61 mm have a higher risk of stent thrombosis or in-stent restenosis development. Full article
Open AccessArticle
Evaluation of hydration status calculated from differences in venous and capillary plasma dilution during stepwise crystalloid infusions: A randomized crossover study in healthy volunteers
Medicina 2014, 50(5), 255-262; https://doi.org/10.1016/j.medici.2014.09.007 - 01 Oct 2014
Cited by 5 | Viewed by 214
Abstract
Background and objective: A mini volume loading test (mVLT) was proposed for estimating hydration status and interstitial fluid accumulation during stepwise infusion of crystalloids. The method is based on both the transcapillary reflux model and the hypothesis that when subjects are dehydrated, venous [...] Read more.
Background and objective: A mini volume loading test (mVLT) was proposed for estimating hydration status and interstitial fluid accumulation during stepwise infusion of crystalloids. The method is based on both the transcapillary reflux model and the hypothesis that when subjects are dehydrated, venous plasma dilution induced by a fluid challenge is higher than in the capillaries, and that difference is diminished when the fluid challenge is given to more hydrated individuals. Our objective was to test that hypothesis by evaluating the venocapillary dilution difference during mVLT in subjects with different hydration status.
Materials and methods: In a prospective randomized crossover study, three mini fluid challenges were given to 12 healthy volunteers on two occasions. The subjects were either dehydrated or hydrated before the experiments.
Results: In dehydrated subjects only, capillary plasma dilution was significantly lower than venous (P = 0.015, 0.005 and 0.006) after each mini fluid challenge.
Conclusions: Veno-capillary dilution difference during mVLT depends on the hydration status. The mVLT method could possibly discriminate between the different states of hydration. Full article
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