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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 52, Issue 3 (June 2016) , Pages 139-204

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Open AccessArticle
BCG-SSI® vaccine-associated lymphadenitis: Incidence and management
Medicina 2016, 52(3), 187-191; https://doi.org/10.1016/j.medici.2016.05.001 - 30 May 2016
Cited by 2 | Viewed by 247
Abstract
Background and objective: There is a high incidence of childhood tuberculosis in Latvia, including children aged less than 1 year, while BCG-associated lymphadenitis is one of the most frequent adverse events requiring surgical treatment. The aim of this study was to analyze the [...] Read more.
Background and objective: There is a high incidence of childhood tuberculosis in Latvia, including children aged less than 1 year, while BCG-associated lymphadenitis is one of the most frequent adverse events requiring surgical treatment. The aim of this study was to analyze the incidence of purulent BCG adenitis through-out the population of Latvia after the introduction of BCG-SSI® vaccine and to evaluate the treatment results.
Material and methods: The study included 194 patients. All patients had received the BCGSSI ® vaccine during the first week of life routinely or at a later time according to the indications. The indications for surgical treatment were lymph node destruction also affecting the skin. All patients in this study received surgical treatment – the affected lymph node extirpation.
Results: The mean age of the patients was 5.12 0.96 months. A total of 172 patients had purulent axillar lymphadenitis, 14 had purulent supraclavicular lymphadenitis, 8 patients had lymphadenitis at both localizations. During the whole study period the incidence of BCG adenitis varied from 0.02% to 0.36%, while the mean rate was 0.11% 0.08% from 184,068 vaccinated children during the study period. We observed an increasing trend in the incidence of BCG lymphadenitis during the study period. The primary and complete healing rate at the end of period was 99.5% (n = 193) following an affected lymph node extirpation. The mean hospitalization time after the operation was 3.71 0.18 days.
Conclusions: The incidence of BCG-SSI® vaccine associated purulent lymphadenitis varied widely with an increasing trend, followed by the return to the product characteristic limits. Indications for the surgical treatment should not be changed. Extirpation of the purulent BCG adenitis is a safe treatment method and leads to the primary wound healing in the majority of cases. Full article
Open AccessArticle
Pilot study of safety and efficacy of polyprenols in combination with coenzyme Q10 in patients with statin-induced myopathy
Medicina 2016, 52(3), 171-179; https://doi.org/10.1016/j.medici.2016.05.002 - 30 May 2016
Cited by 2 | Viewed by 274
Abstract
Background and objective: Statin-induced myopathy (SIM) has been partially attributed to deficiency of dolichol and coenzyme Q10 (CoQ10). We aimed to test the safety and efficacy of plant polyprenols in combination with CoQ10 for alleviation of SIM.
Materials and methods: In an open-label, [...] Read more.
Background and objective: Statin-induced myopathy (SIM) has been partially attributed to deficiency of dolichol and coenzyme Q10 (CoQ10). We aimed to test the safety and efficacy of plant polyprenols in combination with CoQ10 for alleviation of SIM.
Materials and methods: In an open-label, one-center prospective pilot study patients with SIM received conifer-tree needle polyprenols (4 mg/day) and CoQ10 (100 mg/day) for 8 weeks. Symptoms and safety were evaluated according to symptom severity score (0–10), creatine kinase (CK) levels, exercise test, dynamometry, complete blood count, clinical biochemistry and electrocardiography.
Results: Of the 14 patients, 11 completed the study per protocol. Two patients withdrew consent due to travels abroad, and it was discontinued for one patient with stage 3 chronic kidney disease due to asymptomatic elevations of liver enzymes at week 4. No safety parameters changed significantly in per protocol group. Non-significant increase of CK levels was observed (P = 0.231). Muscle pain (n = 10) and weakness (n = 7) scores improved significantly (P < 0.001 and P = 0.018, respectively). Muscle pain completely disappeared in 2 patients, weakness resolved in 3 patients and cramps disappeared in two patients. Four patients assessed improvement strong enough to consider increase of statin dose. No changes were observed in exercise test or dynamometry.
Conclusions: Conifer-tree polyprenols in combination with CoQ10 may be generally safe in patients with SIM, but caution should be exercised in patients with glomerular filtration rate <60 mL/min and routine monitoring of the liver enzymes and CK is advocated in all patients. The observed efficacy provides the rationale for a larger, double-blind controlled study with polyprenols. Full article
Open AccessReview
The importance of n-6/n-3 fatty acids ratio in the major depressive disorder
Medicina 2016, 52(3), 139-147; https://doi.org/10.1016/j.medici.2016.05.003 - 30 May 2016
Cited by 21 | Viewed by 362
Abstract
This review aims to clarify the relation between the ratio of omega-6 to omega-3 fatty acids and the development of depression. It is explained how these fatty acids are involved in the production of eicosanoids and how these fatty acids can affect the [...] Read more.
This review aims to clarify the relation between the ratio of omega-6 to omega-3 fatty acids and the development of depression. It is explained how these fatty acids are involved in the production of eicosanoids and how these fatty acids can affect the membrane fluidity, by their incorporation into membrane phospholipids. In addition, it is described how omega-3 derivatives are shown to regulate gene transcription. In view of the pathophysiology of depression, the mechanisms of how an altered ratio of omega-6 to omega-3 could be involved in depression are discussed. Possible mechanisms could include an increased production of pro-inflammatory cytokines, which can activate the HPA axis and a changed membrane fluidity, which potentially affects membrane bound enzymes, ion channels, receptor activity and neurotransmitter binding. In view of clinical trials, it is also discussed whether omega-3 supplementation could have a beneficial effect in the treatment of depressive patient. There are strong indications that an increased ratio of membrane omega-6 to omega-3 is involved in the pathogenesis of depression and so far, omega-3 supplementation has shown positive effects in clinical trials. Full article
Open AccessArticle
Comparison of the Ponseti method versus early tibialis anterior tendon transfer for idiopathic clubfoot: A prospective randomized study
Medicina 2016, 52(3), 163-170; https://doi.org/10.1016/j.medici.2016.04.004 - 12 May 2016
Cited by 1 | Viewed by 273
Abstract
Objective: The aim of the study was to compare functional and radiological outcomes in clubfoot patients treated by early Tibialis anterior tendon transfer and Ponseti method.
Materials and methods: A prospective, randomized study was conducted. A total of 39 children with a mean [...] Read more.
Objective: The aim of the study was to compare functional and radiological outcomes in clubfoot patients treated by early Tibialis anterior tendon transfer and Ponseti method.
Materials and methods: A prospective, randomized study was conducted. A total of 39 children with a mean age of 17.05 days (55 clubfeet) were randomly allocated into one of two groups: first (conservative Ponseti method) group (n = 28) or second (early tibialis anterior tendon transfer [TATT]) group (n = 27). Foot function and radiographic measure- ments were evaluated. The condition of the subjects was observed until they reached the age of 2 years.
Results: The clinical and radiological data did not differ between groups at the age of 6 months. No statistically significant difference regarding Pirani and Dimeglio scale among the groups was observed at the last follow-up. A statistically significant difference was observed in the foot dorsal flexion; it was lower in the second group (P = 0.03). Other clinical parameters did not differ between groups. According radiographic data, only the talocalcaneal angle (TCA) was significantly higher in the second group (P = 0.003). Children who underwent TATT were 5.00-fold (P = 0.002) and 1.67-fold (P = 0.017) more likely to have TCA larger than 308 (which reflects the normal range of the TCA) in DP and lateral views, respectively, and 3.40-fold (P = 0.019) more likely to have foot dorsal flexion of less than 158 than their counterparts undergoing the conservative Ponseti treatment.
Conclusions: Early TATT allowed a significant reduction in the brace wear duration and resulted in the same outcomes as using the Ponseti method. Additionally, TATT can provide some improvement of hindfoot varus. However, a possible weakening of dorsiflexion should be also taken into account. Our experience has shown the need for a larger sample and longer term studies. Full article
Open AccessArticle
Pay for performance of Estonian family doctors and impact of different practice- and patient-related characteristics on a good outcome: A quantitative assessment
Medicina 2016, 52(3), 192-198; https://doi.org/10.1016/j.medici.2016.04.003 - 26 Apr 2016
Viewed by 237
Abstract
Background and objective: Several practice- and patient-related characteristics are reported to have an influence on a good quality outcome. Estonia started the pay-for-performance (P4P) system for family doctors (FDs) in 2006. Every year the number of FDs participating in P4P has increased, but [...] Read more.
Background and objective: Several practice- and patient-related characteristics are reported to have an influence on a good quality outcome. Estonia started the pay-for-performance (P4P) system for family doctors (FDs) in 2006. Every year the number of FDs participating in P4P has increased, but only half of the FDs achieved good outcome. The aim of this study was to find out which practice- and patient-related characteristics could have an impact on a good outcome.
Materials and methods: The study was conducted using the database from the Estonian Health Insurance Fund. All working FDs were divided into two groups (with ‘‘good’’ and ‘‘poor’’ outcomes) according their achievements in P4P. We chose characteristics which described structure (practice list size, number of doctors, composition of FDs list: age, number of chronically ill patients) during the observation period 2006–2012.
Results: During the observation period 2006–2012, the number of FDs with a good outcome in P4P increased from 6% (2006) to 53% (2012). The high number of FDs in primary care teams, longer experience of participation in P4P and the smaller number of patients on FDs' lists all have an impact on a good outcome. The number of chronically ill patients in FDs lists has no significant effect on an outcome, but P4P increases the number of disease-diagnosed patients.
Conclusions: Different practice and patient-related characteristics have an impact on a good outcome. As workload increases, smaller lists of FDs patients or increased staff levels are needed in order to maintain a good outcome. Full article
Open AccessArticle
Problematic computer game use as expression of Internet addiction and its association with self-rated health in the Lithuanian adolescent population
Medicina 2016, 52(3), 199-204; https://doi.org/10.1016/j.medici.2016.04.002 - 22 Apr 2016
Cited by 10 | Viewed by 368
Abstract
Background and objective: Computers and the Internet have become an integral part of today's life. Problematic gaming is related to adolescent's health. The aim of our study was to evaluate the prevalence of Internet addiction among 13–18-year-old schoolchildren and its relation to sex, [...] Read more.
Background and objective: Computers and the Internet have become an integral part of today's life. Problematic gaming is related to adolescent's health. The aim of our study was to evaluate the prevalence of Internet addiction among 13–18-year-old schoolchildren and its relation to sex, age, and time spent playing computer games, game type, and subjective health evaluation.
Materials and methods: A total of 1806 schoolchildren aged 13–18 years were interviewed. The evaluation of Internet addiction was conducted by the Diagnostic Questionnaire according to Young's methodology. The relation between the choice of computer games type, time spent while playing computer games and respondents' Internet addiction were assessed by using multivariate logistic regression analysis.
Results: One-tenth (10.6%) of the boys and 7.7% of the girls aged 13–18 years were Internet addicted. Internet addiction was associated with the type of computer game (action or combat vs. logic) among boys (OR = 2.42; 95% CI, 1.03–5.67) and with the amount of time spent playing computer games per day during the last month (≥5 vs. <5 h) among girls (OR = 2.10; 95% CI, 1.19–3.70). The boys who were addicted to the Internet were more likely to rate their health poorer in comparison to their peers who were not addicted to the Internet (OR = 2.48; 95% CI, 1.33–4.62).
Conclusions: Internet addiction was significantly associated with poorer self-rated health among boys. Full article
Open AccessArticle
Genetic linkage studies of a North Carolina macular dystrophy family
Medicina 2016, 52(3), 180-186; https://doi.org/10.1016/j.medici.2016.04.001 - 19 Apr 2016
Cited by 2 | Viewed by 278
Abstract
Background and objective: North Carolina macular dystrophy (NCMD) is a very rare autosomal dominant hereditary disease. Up to date there are three types of NCMD described and consequently named macular dystrophy, retinal: MCDR1, MCDR2 and MCDR3. The aim of this study was to [...] Read more.
Background and objective: North Carolina macular dystrophy (NCMD) is a very rare autosomal dominant hereditary disease. Up to date there are three types of NCMD described and consequently named macular dystrophy, retinal: MCDR1, MCDR2 and MCDR3. The aim of this study was to perform linkage and copy number variation analysis for the family affected by NCMD followed by the selected candidate gene sequencing.
Materials and methods: This study concerned a 3-generation, non-consanguineous Latvian family with NCMD. Genome-wide scan, copy number variation and non-parametric linkage analysis was performed. Analysis resolved the locus of interest to the 5p15.33 region. Two of the genes, iroquois homeobox 2 (IRX2) and iroquois homeobox 4 (IRX4), were selected and sanger sequencing was performed.
Results: Linkage analysis indicated a region on chromosome 5 for the analyzed family, corresponding to a genetic locus previously described for MCDR3 (5p15-p13). Chromosomal aberrations were not identified in the affected family members. An upstream intron variant (NM_001278634: c.-139G > A (rs6876836)) in IRX4 gene segregated with NCMD phenotype in the analyzed family.
Conclusions: It is unlikely to be the causative mutation of NCMD due to its high minor allele frequency 0.3532. Therefore, the role of IRX2 and IRX4 genes in the pathogenesis of NCMD has not been proved. Considerable variability in visual acuity between individuals of the same age group in all the families examined was noted. No overlap between NCMD grade and family generation was seen in the family described in the present study. Full article
Open AccessReview
Multiplicity of effects and health benefits of resveratrol
Medicina 2016, 52(3), 148-155; https://doi.org/10.1016/j.medici.2016.03.003 - 07 Apr 2016
Cited by 38 | Viewed by 646
Abstract
Resveratrol is mainly found in grapes and red wine, also in some plants and fruits, such as peanuts, cranberries, pistachios, blueberries and bilberries. Moreover, nowadays this compound is available as purified preparation and dietary supplement. Resveratrol provides a wide range of benefits, including [...] Read more.
Resveratrol is mainly found in grapes and red wine, also in some plants and fruits, such as peanuts, cranberries, pistachios, blueberries and bilberries. Moreover, nowadays this compound is available as purified preparation and dietary supplement. Resveratrol provides a wide range of benefits, including cardiovascular protective, antiplatelet, antioxidant, antiinflammatory, blood glucose-lowering and anticancer activities, hence it exhibits a complex mode of action. During the recent years, these properties have been widely studied in animal and human models, both in vitro and in vivo. This paper is intended to present information published during the recent years on the biological activities and multiple effects of resveratrol. Full article
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