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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they 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.

Medicina, Volume 51, Issue 1 (February 2015) – 9 articles , Pages 1-68

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391 KiB  
Article
Self-reported consequences and healthcare costs of falls among elderly women
by Vidmantas Alekna, Rimantas Stukas, Inga Tamulaitytė-Morozovienė, Genė Šurkienė and Marija Tamulaitienė
Medicina 2015, 51(1), 57-62; https://doi.org/10.1016/j.medici.2015.01.008 - 29 Jan 2015
Cited by 24 | Viewed by 1550
Abstract
Background and objective: Although the falls in elderly people lead to serious health consequences, the economic burden is underestimated. The aim of this study was to calculate the medical costs of fall consequences in elderly women.
Materials and methods: Women aged 65 years [...] Read more.
Background and objective: Although the falls in elderly people lead to serious health consequences, the economic burden is underestimated. The aim of this study was to calculate the medical costs of fall consequences in elderly women.
Materials and methods: Women aged 65 years and older were interviewed by phone recording the consequences and healthcare procedures related to every fall sustained during the previous 12 months. The healthcare costs were estimated by calculating the sum of costs for all self-reported contacts with medical care providers: ambulance, emergency department, visits to family doctor and other specialists, hospitalisations, and rehabilitation.
Results: The study population consisted of 878 community-dwelling women (mean age 72.2 ± 4.8 years). Falls were reported by 310 (35.3%) women; one in three of them had fallen twice or more. Of all women who fell, 280 (90.3%) reported their fall resulted in an injury, and 77 (15.3%) falls led to bone fractures. Fear of falling was reported by 72.9% of women. Fall-related medical care was provided to 135 women (43.5% of those fallen), and 18 (5.8%) subjects were hospitalised, mostly for the fracture. The mean estimated healthcare cost was 254 EUR per patient receiving fall-related medical care, and 116 EUR per women fallen. The highest mean cost (1289 EUR) was estimated in falls resulted in hip fracture; the lowest (135 EUR), in nonfracture injury.
Conclusion: The data on the self-reported consequences of falls in elderly women showed a significant number of fall-related injuries and a high cost of healthcare. Full article
923 KiB  
Review
E3 ubiquitin ligases as drug targets and prognostic biomarkers in melanoma
by Kristina Bielskienė, Lida Bagdonienė, Julija Mozūraitienė, Birutė Kazbarienė and Ernestas Janulionis
Medicina 2015, 51(1), 1-9; https://doi.org/10.1016/j.medici.2015.01.007 - 29 Jan 2015
Cited by 51 | Viewed by 921
Abstract
Melanomas are highly proliferative and invasive, and are most frequently metastatic. Despite many advances in cancer treatment over the last several decades, the prognosis for patients with advanced melanoma remains poor. New treatment methods and strategies are necessary.
The main hallmark of cancer [...] Read more.
Melanomas are highly proliferative and invasive, and are most frequently metastatic. Despite many advances in cancer treatment over the last several decades, the prognosis for patients with advanced melanoma remains poor. New treatment methods and strategies are necessary.
The main hallmark of cancer is uncontrolled cellular proliferation with alterations in the expression of proteins. Ubiquitin and ubiquitin-related proteins posttranslationally modify proteins and thereby alter their functions. The ubiquitination process is involved in various physiological responses, including cell growth, cell death, and DNA damage repair. E3 ligases, the most specific enzymes of ubiquitination system, participate in the turnover of many key regulatory proteins and in the development of cancer.
E3 ligases are of interest as drug targets for their ability to regulate proteins stability and functions. Compared to the general proteasome inhibitor bortezomib, which blocks the entire protein degradation, drugs that target a particular E3 ligase are expected to have better selectivity with less associated toxicity. Components of different E3 ligases complexes (FBW7, MDM2, RBX1/ROC1, RBX2/ROC2, cullins and many others) are known as oncogenes or tumor suppressors in melanomagenesis. These proteins participate in regulation of different cellular pathways and such important proteins in cancer development as p53 and Notch. In this review we summarized published data on the role of known E3 ligases in the development of melanoma and discuss the inhibitors of E3 ligases as a novel approach for the treatment of malignant melanomas. Full article
973 KiB  
Article
Do hemophiliacs have a higher risk for dental caries than the general population?
by Rūta Žaliūnienė, Jolanta Aleksejūnienė, Vilma Brukienė and Vytautė Pečiulienė
Medicina 2015, 51(1), 46-56; https://doi.org/10.1016/j.medici.2015.01.003 - 28 Jan 2015
Cited by 8 | Viewed by 951
Abstract
Objective: The aim of this study was to examine if patients with hemophilia were at increased risk for dental decay as compared to the general population.
Materials and methods: Census sampling was used in this case–control study to recruit cases (patients with hemophilia) [...] Read more.
Objective: The aim of this study was to examine if patients with hemophilia were at increased risk for dental decay as compared to the general population.
Materials and methods: Census sampling was used in this case–control study to recruit cases (patients with hemophilia) and a control group individuals recruited randomly from the general population, which were matched with cases based on gender, age and place of residence. Clinical examinations included dental health and salivary assessments (flow rate, buffer capacity, caries-associated bacteria) and a structured questionnaire which inquired about socioeconomic status and dental health-related behaviors.
Results: In the deciduous dentition, the overall caries experience (dmf) differed statistically significantly (P = 0.003) between the hemophiliacs (2.6  2.6) and their matched healthy controls (6.1  2.5). Bivariate analyses did not reveal significant differences between cases and controls regarding salivary functions, except that higher bacteriological counts were found in healthy controls in deciduous dentitions than in patients with hemophilia (P = 0.019). Children without hemophilia were from higher socioeconomic status families than hemophiliacs (P = 0.004), but such differences were not found for adults (P = 0.090). When compared to healthy adults, adult hemophiliacs had more gum bleeding at rest (P < 0.001) as well as during their tooth brushing (P = 0.007) and they also consumed more soft drinks than controls (P = 0.025).
Conclusions: Better dental health was observed in children with hemophilia as compared to children without it. There were no differences in dental health between adult hemophiliacs and healthy controls from the general population. None of the linear multiple regression models confirmed hemophilia to be an additional caries risk when it was controlled for other caries determinants. Full article
684 KiB  
Article
Impact of hypertension on postreperfusion left ventricular recovery in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease
by Edvardas Vaicekavičius, Donatas Vasiliauskas, Ramūnas Navickas, Irena Milvidaitė, Ramūnas Unikas, Jonė Venclovienė and Raimondas Kubilius
Medicina 2015, 51(1), 38-45; https://doi.org/10.1016/j.medici.2015.01.005 - 28 Jan 2015
Viewed by 798
Abstract
Objective: The aim of this study was to investigate the impact of admission systolic blood pressure (ASBP) and left ventricular (LV) mass on the postreperfusion LV recovery in patients with ST-segment elevation myocardial infarction (STEMI) and concomitant coronary multi- vessel disease (MVD).
Materials [...] Read more.
Objective: The aim of this study was to investigate the impact of admission systolic blood pressure (ASBP) and left ventricular (LV) mass on the postreperfusion LV recovery in patients with ST-segment elevation myocardial infarction (STEMI) and concomitant coronary multi- vessel disease (MVD).
Materials and methods: A retrospective analysis of 12-month postreperfusion LV recovery was performed in 104 patients after primary percutaneous coronary intervention (PPCI). Patients with elevated ASBP (>140 mmHg) were assigned to the first group ( n = 58); with normal ASBP (<140 mmHg), to the second group ( n = 46); with increased myocardial mass index (MMI) (>100 g/m2), to the third group ( n = 70); and with normal MMI (<100 g/m2), to the fourth group ( n = 34). Severity of MVD was evaluated by the Syntax score. The LV recovery was assessed by evolution of quantitative characteristics of electrocardiography (QRS score, ST score, ECG STEMI stage) and echocardiography (LV ejection fraction, volume and mass indices) registered before and after PPCI, at discharge, and after 1, 6, and 12 months.
Results: There were no significant differences in the baseline QRS and ST scores, ECG STEMI stage, LVEF, MMI, and Syntax score comparing all the patients' groups. The serial ECG criteria showed only a very small impact of ASBP on postreperfusion LV recovery. Only ECG STEMI stage progression was slower in the patients with elevated ASBP. In patients with different MMI, the QRS and ST scores were higher and ECG STEMI stage was lower in patients with increased MMI. LVEF after 1 year was significantly lower in the third group as compared to the fourth group (42.58%  8.25% vs. 46.8%  7.13%, P = 0.018).
Conclusion: Postreperfusion LV recovery was more related not to ASBP but to the increased LV mass assessed by echocardiography in patients with STEMI and MVD. Full article
385 KiB  
Article
Short-term results of quality of life for curatively treated colorectal cancer patients in Lithuania
by Paulius Lizdenis, Justas Birutis, Ieva Čelkienė, Narimantas Samalavičius, Justas Kuliavas, Vytautas Slunskis, Tomas Poškus, Valdemaras Jotautas, Eligijus Poškus, Kęstutis Strupas, Žilvinas Saladžinskas and Algimantas Tamelis
Medicina 2015, 51(1), 32-37; https://doi.org/10.1016/j.medici.2015.01.006 - 28 Jan 2015
Cited by 8 | Viewed by 729
Abstract
Background and objective: Treatment options for colorectal cancer patients create the need to assess the quality of life (QoL) of colorectal cancer patients in the early postoperative period when changes are potentially greatest. The aim of the current study was to assess the [...] Read more.
Background and objective: Treatment options for colorectal cancer patients create the need to assess the quality of life (QoL) of colorectal cancer patients in the early postoperative period when changes are potentially greatest. The aim of the current study was to assess the QoL of colorectal cancer patients following open and laparoscopic colorectal surgery.
Materials and methods: A total of 82 consecutive patients requiring elective open or laparoscopic colorectal surgery were recruited to the study for 3 months in the three colorectal surgery centers of Lithuania. Patients completed the EORTC QLQ-C30 (version 3.0) questionnaire before surgery, 2 and 5 days, 1 and 3 months after operation. The EORTC QLQ-CR29 questionnaire was completed before surgery and at 1 and 3 months after operation. Analysis was done according to the manual for each instrument.
Results: EORTC QLQ-C30 reflected the postoperative recovery of QoL. The global health status, cognitive and emotional functioning came back to the preoperative level in one month after operation. Physical and role functioning for laparoscopic group was significantly improved in 1 month after operation and in 3 months for open surgery group respectively. Colorectal module EORTC-QLQ-CR29 found that future perspective increased significantly in laparoscopic group 1 month after operation.
Conclusions: The present study showed that majority of functional scale scores came back to the preoperative level during the first 3 months after colorectal cancer surgery. Differences in QoL according to surgical approach are mostly expressed on this period. Full article
1002 KiB  
Article
Use of exploratory factor analysis to ascertain the correlation between the activities of rheumatoid arthritis and infection by human parvovirus B19
by Natalja Kakurina, Anda Kadisa, Aivars Lejnieks, Helena Mikazane, Svetlana Kozireva and Modra Murovska
Medicina 2015, 51(1), 18-24; https://doi.org/10.1016/j.medici.2015.01.004 - 28 Jan 2015
Cited by 13 | Viewed by 691
Abstract
Background and objective: We evaluated a possible correlation between the clinical activities of rheumatoid arthritis (RA) and human parvovirus B19 (B19) infection using exploratory factor analysis (EFA).
Materials and methods: RA patients were organized into two groups: 100 patients in the main groupand97intheRA(DAS28)group.Foursubgroupsweredefinedfromthemaingroupaccording [...] Read more.
Background and objective: We evaluated a possible correlation between the clinical activities of rheumatoid arthritis (RA) and human parvovirus B19 (B19) infection using exploratory factor analysis (EFA).
Materials and methods: RA patients were organized into two groups: 100 patients in the main groupand97intheRA(DAS28)group.Foursubgroupsweredefinedfromthemaingroupaccording to the presence or absence of certain infection-specific markers: group I comprised 43 patients whohadIgGantibodiesagainstB19;groupII,25patientswithactiveB19infection(B19-specificIgM antibodies and/or plasma viremia); group III, 19 patients with latent/persistent B19 infection (virus-specific sequences in peripheral blood leukocytes' DNA with or without B19-specific IgG antibodies), and group IV, 13 patients without infection markers. The RA(DAS28) group was divided into four subgroups similarly to the main group: group I, 35; group II, 31; group III, 19; and group IV, 12 patients. Disease-specific clinical values in both groups were analyzed employing EFA, and the RA(DAS28) group was additionally assessed using Disease Activity Score (DAS)28. Results: RA activitywashigherinpatientswhohad markersofB19infection.Thehighestactivity of RA in both study groups was in patients with latent/persistent infection. In the RA(DAS28) group, according to DAS28, the highest activity of RA was in patients with active B19 infection. Conclusions: Using EFA and DAS28, a correlation between the clinical activity of RA and B19 infectionwasconfirmed.ThesedatasuggestthatEFAisapplicableformedico-biologicalstudies. Full article
440 KiB  
Article
Peripheral blood Th9 cells and eosinophil apoptosis in asthma patients
by Deimantė Hoppenot, Kęstutis Malakauskas, Simona Lavinskienė, Ieva Bajoriūnienė, Virginija Kalinauskaitė and Raimundas Sakalauskas
Medicina 2015, 51(1), 10-17; https://doi.org/10.1016/j.medici.2015.01.001 - 28 Jan 2015
Cited by 46 | Viewed by 863
Abstract
Background and objective: Th9 cells producing interleukin (IL) 9 are novel subset of CD4+ T helper cells, which might contribute to airway inflammation in asthma. Moreover, the effect of IL-9 on eosinophils is still not fully understood. Study aim was to evaluate [...] Read more.
Background and objective: Th9 cells producing interleukin (IL) 9 are novel subset of CD4+ T helper cells, which might contribute to airway inflammation in asthma. Moreover, the effect of IL-9 on eosinophils is still not fully understood. Study aim was to evaluate peripheral blood Th9 cells and eosinophil apoptosis in allergic asthma patients.
Materials and methods: Eighteen patients with allergic asthma and fourteen patients with allergic rhinitis were examined. Control group included sixteen healthy subjects. Allergic asthma and rhinitis patients did not use corticosteroids and antihistamines at least for 1 week. Peripheral blood eosinophils and CD4+ cells were isolated by high density gradient centrifugation and magnetic separation. Th9 cells and apoptotic eosinophils were estimated by flow cytometer. Serum IL-9 and IL-5 concentration were determined by ELISA.
Results: Peripheral blood Th9 cells percentage was increased in allergic asthma group compared with allergic rhinitis and control group (0.74% ± 0.32% vs. 0.19% ± 0.10% and 0.15% ± 0.08%, respectively, P < 0.05). The same tendency was observed for IL-9 (P < 0.01). Percentage of peripheral blood apoptotic eosinophils was decreased in allergic asthma and allergic rhinitis groups compared with control group (P < 0.05). IL-9 concentration corre- lated with percentage of Th9 cells (r = 0.64, P < 0.05) and negatively with percentage of apoptotic eosinophils in allergic asthma group (r = 0.58, P < 0.05). Negative correlation was found between apoptotic eosinophils count and IL-5 concentration in allergic asthma group (r = 0.76, P < 0.05).
Conclusions: Patients with allergic asthma demonstrate increased peripheral blood Th9 cells count and serum IL-9, while eosinophil apoptosis is inversely related to IL-9 concentration. Full article
500 KiB  
Article
The cost of newly diagnosed breast cancer in Lithuania, 2011
by Rugilė Ivanauskienė, Auksė Domeikienė, Rima Kregždytė, Žemyna Milašauskienė and Žilvinas Padaiga
Medicina 2015, 51(1), 63-68; https://doi.org/10.1016/j.medici.2015.01.002 - 27 Jan 2015
Cited by 6 | Viewed by 683
Abstract
Background and objective: Although the cost of treating women with breast cancer (BC) is an important component for cost saving and effectiveness in relation to the benefits of BC treatment interventions, there is limited information on the direct cost reported for BC in [...] Read more.
Background and objective: Although the cost of treating women with breast cancer (BC) is an important component for cost saving and effectiveness in relation to the benefits of BC treatment interventions, there is limited information on the direct cost reported for BC in Lithuania. Therefore the aim of this study was to evaluate annual direct medical cost for newly diagnosed BC in Lithuania in the year 2011.
Materials and methods: The retrospective incidence-based top-down direct cost analysis was used. From January 1 to December 31, 2011 incident cases of BC (N = 1142) registered by the National Health Insurance Fund, the stage determined by Lithuanian Cancer Registry were included in the study.
Results: The total average direct cost of BC amounted per patient was2580 (95% CI 2444–2752) EUR in 2011. The main cost driver per BCpatients was the inpatient hospital stay, respectively 1655 (95% CI 1478–2334) EUR. The average outpatient cost for one BC patient was 564 (95% CI 547–898) EUR. The dominant proportion of inpatient expenditureswas assigned to BC surgery and chemotherapy treatment. The BC direct medical cost increased according to the diagnosed stage of diseases from2409 (95% CI 2196–2621) EUR in stage 1 to3688 (95% CI 2703–4672) EUR in stage 4. The direct medical cost was inversely proportional to age.
Conclusions: The direct BC medical cost estimates provided by this analysis can be used to determine priorities for the future research on BC treatment interventions. Full article
852 KiB  
Article
Predictors of mortality in patients with rheumatoid arthritis in Lithuania: Data from a cohort study over 10 years
by Jolanta Dadonienė, Sigita Stropuvienė, Rimantas Stukas, Algirdas Venalis and Tuulikki Sokka-Isler
Medicina 2015, 51(1), 25-31; https://doi.org/10.1016/j.medici.2014.11.001 - 26 Nov 2014
Cited by 9 | Viewed by 650
Abstract
Background and objective: Increased mortality and shorter survival among rheumatoid arthritis (RA) patients are recognized but not fully explained. This cohort study aimed to identify predictors of mortality among RA patients at a tertiary clinical setting.
Materials and methods: Patients with RA were [...] Read more.
Background and objective: Increased mortality and shorter survival among rheumatoid arthritis (RA) patients are recognized but not fully explained. This cohort study aimed to identify predictors of mortality among RA patients at a tertiary clinical setting.
Materials and methods: Patients with RA were recruited during 1998–2003 and followed up until April 1, 2012, or death whichever happened first. Baseline variables included sociodemographic and disease characteristics, and comorbidities. Cox regression and hazard risk (HR) were computed to estimate risks for mortality.
Results: One hundred ninety-one patients were included into the study, 186 patients were eligible for the analysis and of these 131 patients (70.4%) completed the entire period of followed-up while 55 patients (29.6%) died. The average follow up period was equivalent to 9.24 year per person. A Cox regression model identified four major factors having an impact on survival. History of a stroke at baseline was identified as a major factor (HR = 5.33; 95% CI, 2.13–13.32). Statistically significant risk factors were also age over 50 years (HR = 4.59; 95% CI, 2.04–10.30); education less than 11 years (HR = 3.3; 95% CI, 1.72–6.33) and angina pectoris (HR = 1.98; 95% CI, 1.03–3.80).
Conclusions: Higher age, lower education and cardiovascular comorbidities were identified as predictors of mortality in this prospective cohort study while disease-related variables were not independent predictors of mortality. Full article
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