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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 53, Issue 5 (October 2017), Pages 295-356

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Open AccessArticle Anterior capsulorhexis opening reduction after cataract surgery with subluxated lenses
Medicina 2017, 53(5), 310-315; https://doi.org/10.1016/j.medici.2017.10.003 (registering DOI)
Received: 5 December 2015 / Revised: 13 February 2017 / Accepted: 19 October 2017 / Published: 14 December 2017
PDF Full-text (512 KB)
Abstract
Background and objective: This study sought to evaluate anterior capsulorhexis opening (ACO) reductions after surgery for a subluxated lens. Significant reduction of an ACO supports direct zonular involvement (capsular factors excluded by use of capsular tension rings [CTRs] and modern intraocular lens [IOLs]),
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Background and objective: This study sought to evaluate anterior capsulorhexis opening (ACO) reductions after surgery for a subluxated lens. Significant reduction of an ACO supports direct zonular involvement (capsular factors excluded by use of capsular tension rings [CTRs] and modern intraocular lens [IOLs]), and these findings question the long-term efficacy of subluxated lens surgery by means of cataract surgery. A small ACO due to lens mobility, non-enlargement of the ACO, and no lens epithelial cell washing due to an additional risk of further zonular damage were left as additional features to evaluate the possible outcomes of this simplified but still complicated surgery.
Materials and methods: Data from 30 patients were used in the final analysis of this prospective study. Phacoemulsifications of subluxated lenses were performed in all patients, and iris/capsule hooks and CTRs or Cionni rings were used as stabilisers of the lens. Photography of the anterior parts (performed at 1 day, 1 week, 1 month, 3 months and 6 months after surgery) was used to evaluate the anterior capsulorhexis openings.
Results: Small initial anterior capsulorhexis openings (13.54 mm2) were achieved, and the area reduction at 6 months was 16.70% (mean area at month 6: 11.28 mm2, P < 0.001). The reduction of the ACO area in the pseudoexfoliation (PEX) syndrome patients was 20% relative to the initial size (13.49 mm2 vs. 10.92 mm2, P < 0.001). Two patients exhibited marked ACO reductions, and both were referred for anterior laser capsulotomy treatment.
Conclusions: A weak or partially absent zonule does not markedly affect the reduction of the anterior capsule opening if appropriate surgical techniques, support materials and IOLs are used, even in the presence of a small initial capsulorhexis opening area. Therefore, a cataract surgery approach on the subluxated lens should be used. Ocular comorbidities, particularly PEX syndrome, play more significant roles in ACO reduction, and appropriate ACO size reducing inhibitors (e.g., anterior laser capsulotomy) or other types of surgery should be used. Full article
Open AccessArticle Rat spinal ganglia in assessment of protective action of antioxidants: A morphological study
Medicina 2017, 53(5), 316-322; https://doi.org/10.1016/j.medici.2017.11.001 (registering DOI)
Received: 30 January 2017 / Revised: 7 November 2017 / Accepted: 21 November 2017 / Published: 29 November 2017
Cited by 1 | PDF Full-text (3508 KB)
Abstract
Background and objective: Mercury pollution is one of the most pressing environmental problems. Therefore, the impact of mercury on human body, the nervous system in particular, remains topical. The aim of the study was to identify the morphological characteristics of neurons and neuroglia
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Background and objective: Mercury pollution is one of the most pressing environmental problems. Therefore, the impact of mercury on human body, the nervous system in particular, remains topical. The aim of the study was to identify the morphological characteristics of neurons and neuroglia in spinal ganglia of rats receiving antioxidants in the presence of small doses of mercury (II) chloride.
Materials and methods: A total of 100 white Wistar rats were divided into 5 series (10 groups), with 10 animals in each group. The first series comprised intact animals receiving saline solution instead of drugs administered in other series (control). In the second series 10 injections of mercury (II) chloride were performed (group of short-term neurointoxication) and 50 injections (group of long-term neurointoxication). In the third to the fifth series, the short- and long-term neurointoxication was followed by 10 daily injection of the drugs: unithiolum, thiotriazolinum and mildronate respectively. Spinal ganglia were obtained two weeks after the completion of drugs administration and studied microscopically and ultramicroscopically.
Results: Administration of thiotriazolinum, unithiolum and mildronate mitigated manifestations of toxic effects of mercury (II) chloride on spinal ganglia. Unithiolum and thiotria-zolinum activated synthetic processes, while mildronate had a positive effect on restoration of cells metabolism.
Conclusions: Morphological data show that unithiolum and thiotriazolinum action decreases toxic effects of mercury chloride and are similar. They demonstrate pronounced activation of synthetic processes in sensory neurons and satellite cells of spinal ganglia. Mildronate also restores cell ultrastructure and has more pronounced effect on their energetic processes and interaction between neurons and satellite cells. Full article
Open AccessArticle Gender differences in residual effect of prior drop jumps on oxygen uptake during heavy cycling exercise
Medicina 2017, 53(5), 331-338; https://doi.org/10.1016/j.medici.2017.10.001 (registering DOI)
Received: 30 November 2016 / Revised: 5 September 2017 / Accepted: 17 October 2017 / Published: 1 November 2017
Cited by 1 | PDF Full-text (524 KB)
Abstract
Background and objective: Unaccustomed eccentric or eccentric–concentric exercise leaves us stiff and sore the next day and can cause muscle damage. The data about the residual effect of prior eccentric–concentric exercises on oxygen uptake (VO2) during constant cycling exercise in women
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Background and objective: Unaccustomed eccentric or eccentric–concentric exercise leaves us stiff and sore the next day and can cause muscle damage. The data about the residual effect of prior eccentric–concentric exercises on oxygen uptake (VO2) during constant cycling exercise in women or the data about differences of such effect between genders are scarce. Therefore, the aim of this study was to assess differences of the residual effect of PDJ on VO2 during HCE and indirect muscle damage parameters between women and men.
Materials and methods: The study aimed to asses differences of the residual effect of prior drop jumps (PDJ) on VO2 during heavy cycling exercise (HCE) and indirect muscle damage parameters between men (n = 8) and women (n = 11). On four different days participants performed one incremental cycling exercise and three HCE (control [CON], 45 min [450 PDJ] and 24 h [24 h PDJ] after 100 drop jumps). The intensity of HCE was set to work rate corresponding to 50% of the difference between the second and the first ventilatory thresholds which were determined analyzing pulmonary gas exchange parameters during incremental cycling exercise. Capillary blood samples were collected in order to measure blood lactate concentration immediately after HCE and serum creatine kinase (CK) activity 24 h after PDJ. Subjects rated perceived exertion and delayed onset muscle soreness (DOMS) using 20 and 10 point scales, respectively.
Results: VO2 at 3–6 min of HCE performed 450 after PDJ was significantly increased as compared to CON HCE only in the male group. Both men and women felt moderate muscle pain. CK activity was significantly increased 24 h after PDJ in the male group. Both during HCE 450 PDJ and 24 h PDJ, the significant positive correlation was observed between relative changes of VO2 during steady state of HCE and CK activity only in the male group.
Conclusions: Prior eccentric–concentric exercise of thigh muscles (100 drop jumps) accelerates VO2 kinetics at the start and increases VO2 during steady state of heavy cycling only in the male group. So, prior exercise of such type has a higher negative impact on cycling economy in men than in women and this might be related to greater muscle damage and fatigue in physically active male persons after plyometric exercise. Full article
Open AccessArticle Workplace health promotion in health care settings in Finland, Latvia, and Lithuania
Medicina 2017, 53(5), 348-356; https://doi.org/10.1016/j.medici.2017.10.002 (registering DOI)
Received: 28 January 2017 / Revised: 29 August 2017 / Accepted: 17 October 2017 / Published: 31 October 2017
Cited by 1 | PDF Full-text (374 KB)
Abstract
Background and objective: Health care workers (HCWs) have a great background to promote their health – not only their professional knowledge on health but often also special equipment in their work environment. However, it is unclear if HCWs can use such infrastructure to
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Background and objective: Health care workers (HCWs) have a great background to promote their health – not only their professional knowledge on health but often also special equipment in their work environment. However, it is unclear if HCWs can use such infrastructure to promote their own health as well as what is their motivation to change their own lifestyles. Thus, the aim of the article was to describe workplace health promotion (WHP) situation in health care settings in Finland, Latvia, and Lithuania.
Materials and methods: A questionnaire survey of 357 workers from health care sector in three European countries was conducted. Participants were asked to indicate various WHP activities/facilities/programs organized at their workplaces, WHP needs, opportunities to initiate changes related to the healthiness of their workplaces, and readiness to change their lifestyles.
Results: Participants from three European countries differed in their WHP needs and in their responses on various activities/facilities/programs implemented at the institutions. Workers from Finnish institutions had the greatest opportunities to make initiatives relevant to their workplaces' healthiness, while Lithuanian workers were least provided with such opportunities. Furthermore, the results showed that there were differences of readiness to change among the workers from the three countries.
Conclusions: HCWs recognized various WHP activities, facilities and programs organized at their workplaces; however, their needs were notably higher than the situation reported. WHP situation differed among the three European countries. Full article
Open AccessArticle Relations between longitudinal trajectories of subjective financial wellbeing with self-rated health among elderly
Medicina 2017, 53(5), 323-330; https://doi.org/10.1016/j.medici.2017.09.001 (registering DOI)
Received: 30 August 2016 / Revised: 17 July 2017 / Accepted: 4 September 2017 / Published: 21 September 2017
PDF Full-text (454 KB)
Abstract
Background and objective: The relationship between income and health in late life is well established, but the link between subjective financial wellbeing (SFW) and self-rated health (SRH) has been relatively ignored, especially among elderly in Europe. Adopting a longitudinal person-oriented analytical approach this
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Background and objective: The relationship between income and health in late life is well established, but the link between subjective financial wellbeing (SFW) and self-rated health (SRH) has been relatively ignored, especially among elderly in Europe. Adopting a longitudinal person-oriented analytical approach this study investigates the relationship between SFW and SRH in late life in Italy.
Materials and methods: Analysis of the European Statistics on Income and Living Conditions survey (EU-SILC) for the period 2010–2013 in Italy examined these relationships at ages 65–78 (N = 1268). Latent class growth analysis and growth mixture modeling were used to identify latent trajectories of SFW. Post hoc analysis of variance examined how SFW latent groups differed in terms of SRH across time.
Results: A three-group latent trajectory model fitted the data best. The three SFW groups were named average-decreasing (n = 238), low-stable (n = 216), and high-stable (n = 814). Repeated measures analysis of variance indicated a significant multivariate effect of SFW latent trajectory class on SRH, controlling for age, gender, and presence of chronic diseases. Post hoc analyses revealed that levels of SRH in the high-stable SFW group remained the highest compared to the other two groups and did not decrease over time, while the averagedecreasing group showed a decrease in SRH levels.
Conclusions: Results suggest that in late life longitudinal negative changes in perceptions of financial wellbeing may occur together with decreases levels of self-reported health. Future research on health inequalities in elderly should pay specific attention to the link between financial wellbeing and health from a self-reported perspective. Full article
Open AccessReview The clinical significance of endocardial endothelial dysfunction
Medicina 2017, 53(5), 295-302; https://doi.org/10.1016/j.medici.2017.08.003 (registering DOI)
Received: 13 February 2017 / Revised: 7 August 2017 / Accepted: 29 August 2017 / Published: 21 September 2017
Cited by 2 | PDF Full-text (334 KB)
Abstract
Endocardial endothelium (EE) is essential in the embryonic development of the heart, the optimal contractility and rhythm as well as the remodeling of the heart. Endocardial endothelium affect the contractility of cardiomyocytes through paracrine signaling substances such as nitric oxide (NO), endothelin (ET-1),
[...] Read more.
Endocardial endothelium (EE) is essential in the embryonic development of the heart, the optimal contractility and rhythm as well as the remodeling of the heart. Endocardial endothelium affect the contractility of cardiomyocytes through paracrine signaling substances such as nitric oxide (NO), endothelin (ET-1), prostaglandins (PGI2, PGF2, PGE2) and angiotensin II (ANG II). Typical lesions of endocardial endothelium have been described in atrial fibrillation, ischemia/reperfusion injury, cardiac hypertrophy, heart failure, sepsis, myocardial infarction, inflammation and thrombosis. In patients with atrial fibrillation, there can be a systemic endothelial dysfunction that combines endocardial and vascular endothelial dysfunction and leads to increased hemodynamic load of the left atrium and increased synthesis and release of natriuretic peptides, angiotensin II, aldosterone and growth factors from the atrial myocardium. A dysfunction of endothelial cells in the local inflammatory status can lead to increased plaque vulnerability, which contributes to plaque rupture and favors the formation of thrombus. Preserving the endocardial-myocardial integrity plays a significant role in the prevention of a coronary artery disease. Endocardial endothelial dysfunction is, similarly to coronary endothelial dysfunction, an early event that leads to the progression of heart failure. Multimarker strategy, that would include a different set of biomarkers, could significantly help in the assessment of patients with cardiovascular diseases. The challenge lays in finding new therapeutic strategies that would, by preserving endothelial function, prevent the onset of cardiovascular diseases. Full article
Open AccessArticle Evaluation of clinical teaching quality in competency-based residency training in Lithuania
Medicina 2017, 53(5), 339-347; https://doi.org/10.1016/j.medici.2017.08.002 (registering DOI)
Received: 31 May 2017 / Revised: 17 August 2017 / Accepted: 28 August 2017 / Published: 7 September 2017
PDF Full-text (525 KB)
Abstract
Background and aim: In 2013, all residency programs at the Lithuanian University of Health Sciences were renewed into the competency-based medical education curriculum (CBME). In 2015, we implemented the validated EFFECT questionnaire together with the EFFECTSystem for quality assessment of clinical teaching in
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Background and aim: In 2013, all residency programs at the Lithuanian University of Health Sciences were renewed into the competency-based medical education curriculum (CBME). In 2015, we implemented the validated EFFECT questionnaire together with the EFFECTSystem for quality assessment of clinical teaching in residency training.
The aim of this study was to investigate the influence of characteristics of the resident (year of training) and clinical teacher (gender, age, and type of academic position) on teaching quality, as well as to assess areas for teaching quality improvement.
Materials and methods: Residents from 7 different residency study programs filled out 333 EFFECT questionnaires evaluating 146 clinical teachers. We received 143 self-evaluations of clinical teachers using the same questionnaire. Items were scored on a 6-point Likert scale. Main outcome measures were residents' mean overall (MOS), mean subdomain (MSS) and clinical teachers' self-evaluation scores. The overall comparisons of MOS and MSS across study groups and subgroups were done using Student's t test and ANOVA for trend. The intraclass correlation coefficient (ICC) was calculated in order to see how residents' evaluations match with self-evaluations for every particular teacher. To indicate areas for quality improvement items were analyzed subtracting their mean score from the respective (sub) domain score.
Results: MOS for domains of ‘‘role modeling’’, ‘‘task allocation’’, ‘‘feedback’’, ‘‘teaching methodology’’ and ‘‘assessment’’ valued by residents were significantly higher than those valued by teachers (P < 0.01). Teachers who filled out self-evaluation questionnaires were rated significantly higher by residents in role modeling subdomains (P < 0.05). Male teachers in (sub)domains ‘‘role modeling: CanMEDS roles and reflection’’, ‘‘task allocation’’, ‘‘planning’’ and ‘‘personal support’’ were rated significantly higher than the female teachers (P < 0.05). Teachers aged 40 years or younger were rated higher (P < 0.01). Residents ratings by type of teachers' academic position almost in all (sub)domains differed significantly (P < 0.05). No correlation observed between MOS of a particular teacher and MOS as rated by residents (ICC = 0.055, P = 0.399). The main areas for improvement were ‘‘feedback’’ and ‘‘assessment’’.
Conclusions: Resident evaluations of clinical teachers are influenced by teachers' age, gender, year of residency training, type of teachers' academic position and whether or not a clinical teacher performed self-evaluation. Development of CBME should be focused on the continuous evaluation of quality, clinical teachers educational support and the implementation of e-portfolio. Full article
Open AccessArticle Safety and efficacy of stereotactic aspiration with fibrinolysis for deep-seated spontaneous intracerebral hemorrhages: A single-center experience
Medicina 2017, 53(5), 303-309; https://doi.org/10.1016/j.medici.2017.07.006 (registering DOI)
Received: 9 June 2016 / Revised: 26 June 2017 / Accepted: 20 July 2017 / Published: 3 August 2017
Cited by 1 | PDF Full-text (474 KB)
Abstract
Objective: The aim of this study was to evaluate feasibility and safety of stereotactic aspiration with fibrinolysis of deep-seated intracerebral hemorrhages (ICH).
Materials and methods: From March 1995 until December 2016, 58 adult patients (34 men and 24 women; mean age of 56.8
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Objective: The aim of this study was to evaluate feasibility and safety of stereotactic aspiration with fibrinolysis of deep-seated intracerebral hemorrhages (ICH).
Materials and methods: From March 1995 until December 2016, 58 adult patients (34 men and 24 women; mean age of 56.8 ± 11.8 years) presenting with deep-seated spontaneous supratentorial ICH were treated using a minimally invasive technique. Intracerebral hematomas were aspirated until obvious resistance to free-hand suction and subsequent clot fibrinolysis was done using either streptokinase or recombinant tissue-type plasminogen activator. CT scans were performed at intervals ranging from 24 to 72 h. At discharge, functional outcomes were evaluated using the Glasgow outcome scale (GOS). The 30-day mortality rate was evaluated in all patients.
Results: The average ICH volume on initial CT scan was 34.7 ± 11.1 cm3 (range, 20–90 cm3). Mean residual hematoma volume after the treatment was 8.0 ± 5.1 cm3 (range, 3–32 cm3). There was statistically significant reduction of ICH volume after the treatment (P < 0.001). Median ICH reduction rate was 5 cm3/d (range, 1.5–16.0 cm3/d) and 17.2%/d (range, 5.27– 40.0%/d). Median discharge GOS score was 3 (range, 1–4). Six (10.9%) patients died during the 30-day follow-up period. Treatment related complications were observed in three (5.5%) patients. In two patients asymptomatic increase of ICH volume occurred and one patient was diagnosed with CNS infection.
Conclusions: Stereotactic clot aspiration with subsequent fibrinolytic therapy is safe and feasible treatment procedure associated with significant hematoma resolution rates and acceptable patient outcomes. Full article
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