Med. Sci. Forum, 2021, IECMD 2021

Background and Objectives: The frequency with which people leave their homes and the time they spend in recreational places is significantly reduced at a time of pandemic, particularly during lockdown, due to which it is significantly more difficult for them to be active. The aim of the study was to assess to what extent the outbreak of the COVID-19 pandemic has affected young adults’ physical activity (PA). Materials and Methods: A total of 506 people aged 18 to 34 (24.67 years ± 4.23 years), who filled in a retrospective-pre-post online survey, qualified for the study. The survey began 12 days after the epidemic was announced at the site of the study, i.e., between weeks two and four of obligatory lockdown, including significant restriction of movement. The levels of physical activity and sedentary time were measured using a seven-item International Physical Activity Questionnaire—Short Form (IPAQ–SF). The respondents provided two answers to each question, i.e., information relating to the last 7 days during the pandemic (lockdown), and to a period of 7 days before the pandemic. Results: During the pandemic, young adults spent significantly less time performing physical activity, shown as median (Q1–Q3): Me = 8752.5 [5403.0–11,820.0] vs. 5483.0 [2380.0–9009.0] metabolic equivalents (MET) min/week (p < 0.001) and they spent more time engaging in sedentary behaviours, Me = 240 [120.0–360.0] vs. 300 [180.0–420.0] min/day (p < 0.001). During the pandemic, respondents spent less energy engaging in vigorous PA from Me = 480.00 [0.0–1920.0] vs. 0.00 [0.0–1920.0] (MET) min/week, 100% decline, (p < 0.001); or in moderate PA from Me = 360.00 [0.0–840.0] vs. 240.00 [0.0–720.0] (MET) min/week, 33.34% decline, and they walked much less from Me = 6930.0 [3762.0–9702.0] vs. 3861.0 [1485.0–7260.0] (MET) min/week, 44.29% decline (p < 0.001). Conclusions: During the COVID-19 pandemic young adults are significantly less involved in PA, which adversely affects their health status, including their physical and mental condition. The importance of sufficient PA should be highlighted during this specific period, particularly among young people. Full article

Background and Objectives: Cardiovascular diseases (CVDs) are among the leading causes of death worldwide, although CVD mortality has decreased in developed countries. Numerous pathophysiological processes lead to the development of CVDs. The circadian rhythm coordinates many physiological processes, and its disruption can lead to many pathophysiological changes. One of the significant circadian rhythm genes is the CLOCK gene, whose polymorphisms are associated with CVD risk factors. Research findings of the association between CLOCK gene polymorphism and CVDs and its comorbidities are not consistent. This meta-analysis was conducted to quantify the associations between T3111C polymorphism and the risk of CVDs. Materials and Methods: The PubMed and Scopus databases were searched for studies reporting onthe association between T3111C (rs1801260) in the circadian CLOCK gene and cardiovascular disease and its comorbidities such as obesity, hypertension, insulin resistance, and coronary artery disease. A fixed-effect model was used to calculate the pooled odds ratio and 95% confidence interval by comprehensive meta-analysis software. Results: Five independent studies, including case-control, cross-sectional, and cohort research methods, were analyzed with 3123 subjects in total. The meta-analysis revealed a significant association between T3111C polymorphism and cardiovascular disease (OR = 1.32, 95% CI: 1.16–1.50, p < 0.001) with significant heterogeneity (I² = 91.1%, p < 0.001) and no publication bias. The subgroup analysis on comorbidity related to CVDs revealed that hypertension was associated with T3111C polymorphism (OR = 2.02, 95% CI: 1.60–2.54, p < 0.001). Conclusions: Our meta-analysis based on available studies using a fixed model shows that T3111C polymorphism in the CLOCK gene is associated with CVD susceptibility. Full article

Background and Objectives: According to guidelines, patent foramen ovale (PFO) closure is recommended for secondary stroke prevention in patients with cryptogenic stroke. Paradoxial embolism from PFO-mediated right to left shunt has been described as the mechanism of stroke in these cases. The aim of the study was to determine whether PFO closure can be associated with improvement of complaints (headaches, fatigue, heart palpitations, dizziness, and visual impairment) and determine its long-term effectiveness on recurrent stroke risk reduction. Materials and Methods: A total of 103 patients were enrolled in a retrospective study and followed-up by phone up to five years after PFO closure. Standardized survey was conducted about their well-being, recurrent cerebrovascular events, and the use of prescribed medication. Patients were also followed up for residual shunts 24 h, 30 days, 1 year, and 2 years after PFO. The pathogenic ischemic stroke subtypes are determined using CCS (Causative Classification System for Ischemic Stroke). Results: Male patients accounted for 43.7% (n = 45). The mean age was—44.4 ± 13 (18–75). The most probable cause for cryptogenic stroke for 53.4% (n = 55) of patients with possible cardio-aortic embolism was PFO. Residual shunts were mostly observed in patients with Amplatzer occluder—87.5% (n = 14). There was correlation between residual shunt and increased risk of transient ischemic attack recurrence (p = 0.067). Five-years after PFO closure recurrent cerebrovascular events were reported in only 5.1% (n = 5) of patients, this difference is statistically relevant (p < 0.001). Out of 51 patients presented with complaints before PFO closure, 25.5% (n = 13) did not present with any complaints after PFO closure. Conclusions: PFO can be considered a possible risk factor for cryptogenic stroke. PFO closure is effective in reducing recurrent cerebrovascular events. Residual shunt after PFO closure increases the risk of transient ischemic attack recurrence. Amplatzer occluder device is associated with a higher risk for residual shunts after PFO closure. PFO closure can be associated with improvement of complaints. Full article

Background and Objectives: According to recent physiotherapy recommendations (WHO, WCPT, 2020) for patients with COVID-19, after discharge from an ICU, they are expected to experience respiratory, physical, cognitive, and psychological problems due to the duration and nature of the immobilization and sedation, ventilation duration, and underlying morbidity. Moreover, only patients with a limitation in physical capacity and/or physical activity have an indication for physiotherapy. However, little is known about the effect of physiotherapy treatment on the functional capacity of patients with COVID-19. Purpose: The aim of the present study was to provide information for the effectiveness of physiotherapy intervention on the respiratory and physical functional status of patients with COVID-19, since there will be a great demand for physiotherapy treatment for these people soon. Materials and Methods: The Ethics Committee of the AHEPA University Hospital, School of Medicine, Health Sciences Faculty, Aristotle University of Thessaloniki, Greece granted approval for this study. This pilot clinical study was conducted from March to June 2020. The sample consisted of 11 patients with COVID-19, discharged from an ICU and hospitalized in the COVID-19 clinic of AHEPA University Hospital. All participants had an indication for physiotherapy, according to the recommendations, and a medical referral as well. The duration of their hospitalization ranged from two to six weeks. Among participants, there were seven males and four females, aged from 44–75 yrs, five smokers and six nonsmokers, four obese and seven nonobese. According to the recommendations, physiotherapy intervention was tailored to the patients’ needs and goals. Breathing exercises, early mobilization, and self-management for daily living were performed once a day, for five days a week, as tolerated. Measurement tools: Pulse oximeter (SpO₂), respiratory rate (RR), the Borg scale (intensity of dyspnea), Medical Research Council scale for disability (MRCd), clinical evaluation for dysfunctional breathing (DB), Medical Research Council scale for muscle strength (MRCms), Berg balance scale, Sit to Stand test (leg strength and endurance), Time Up and Go test (TUG) (general mobility), 1 min walk test (1MWT) (aerobic capacity), and the Barthel Index (BI) (performance in daily activities). For the purposes of the study, two measurements were conducted: at admission and at discharge from the COVID-19 clinic. Results: Dependent sample tests showed a significant effect (p < 0.001) for the recommended physiotherapy treatment on respiratory variables: 6.9 (1.4)% for SpO₂, 3.4 (0.9) breaths for respiratory rate, and 5.0 (1.3) for the Borg scale score. Significant improvements (p < 0.001) were additionally noted for physical functioning: 25.3 (13.0) for the Berg balance scale, 18.5 (11.2) for the MRCms score, 3 (1.3) s for the Sit to Stand test, 40.4 (40.6) s for the TUG efforts, 44.1 (25.5) s for 1MWT, and 65.9 (20.2) for BI. All patients displayed DB at admission to the COVID-19 clinic, while nine of them adopted a diaphragmatic breathing pattern at discharge. At admission to the COVID-19 clinic, all patients were at level five disability (MRCd), whereas at discharge 10 out of 11 patients improved (three at level four, four at level three, and three at level two). Conclusions: The present pilot study provided first evidence for the effectiveness of the WHO and WCPT physiotherapy recommendations on the respiratory and physical functioning status of patients with COVID-19. Further studies are needed to support these early findings. Full article

Background and Objectives: Mortality rates among patients with rheumatoid arthritis (RA) have been reported to be higher than in the general population. The long-term prognosis of RA has improved in recent years due to early diagnosis, as well as effective pharmacological treatment, and this may be able to diminish the excess mortality risk. This study was designed to investigate mortality (a) in patients with RA in a retrospectively defined national RA cohort in comparison with the general Lithuanian population, and (b) to conduct a systematic review of the literature from different countries and meta-analysis. Materials and Methods: In this national retrospective cohort study, patients with a first-time diagnosis of RA in the period between 1 January 2013 and 31 December 2017 were identified from the Lithuanian Compulsory Health Insurance Information System database SVEIDRA. All cases were cross-checked with the Health Information Center at the Institute of Hygiene, for the vital status of these patients and date of death if documented. The standardized mortality ratios (SMRs) with 95% confidence intervals (CI) obtained for all-cause mortality in patients with RA adjusted for age, sex, and calendar year were calculated. The search for published studies using the combination of keywords “rheumatoid arthritis AND standardized mortality ratio” was performed in MEDLINE (via PubMed, OVID, and EBSCO), Science Direct, Taylor & Francis, and Springer databases. Studies were selected according to described inclusion and exclusion criteria listed in the paper, and a meta-analysis was conducted. A random-effect meta-analysis model was used to compute the pooled standardized mortality ratios (meta-SMRs). Results: Overall, 4623 patients with newly diagnosed RA during the 2013–2017 period were identified and enrolled in the Lithuanian population-based cohort. The mean age of patients at the time of RA diagnosis was 58.7 (standard deviation (SD) 15.1) years, and 77.1% of the patients were women. The estimated SMR for all-cause mortality was 1.15 (95% CI 1.02, 1.29). The SMR for men (SMR 1.14, 95% CI 0.94, 1.39) was higher than for women (SMR 1.03, 95% CI 0.89, 1.19). A systematic literature search revealed 12 studies meeting the inclusion criteria, starting from 2010 to 2020, representing 50,072 patients. The meta-SMR in patients with RA for all-cause mortality was 1.41 (95% CI 1.29, 1.55). All-cause mortality risk was higher for men (meta-SMR 1.53, 95% CI 1.31, 1.78) than for women (meta-SMR 1.46, 95% CI 1.2, 1.77). Conclusions: In a retrospectively defined population-based national RA cohort, a 15% excess risk of death was observed among patients with RA compared to the general Lithuanian population. Patients with RA have a higher mortality risk than the general population. Published data indicate that the risk of mortality is increased by 41% in patients with RA compared to the general population. Excessive all-cause mortality risk is higher in men than in women. National data showed lower standardized mortality compared to literature data. Full article

Background and Objectives. Ischemic stroke (IS) is one of the leading causes of disability, morbidity, and mortality worldwide. The goal of the study was to evaluate patient demographics, characteristics, and intrahospital mortality among different ischemic stroke subtypes. Materials and Methods. A retrospective observational non-randomized study was conducted, including only ischemic stroke patients, admitted to Pauls Stradins Clinical university hospital, Riga, Latvia, from January of 2016 until December 2020. Ischemic stroke subtypes were determined according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria as a stroke due to (1) large-artery atherosclerosis (atherothrombotic stroke (AS)), (2) cardioembolism (cardioembolic stroke (CS)), (3) small-vessel occlusion (lacunar stroke (LS)), (4) stroke of other determined etiology (other specified stroke (OSS)), and (5) stroke of undetermined etiology (undetermined stroke (US)). The data between different stroke subtypes were compared. Results. There was a slight female predominance among our study population, as 2673 (56.2%) patients were females. In our study group, the most common IS subtypes were cardioembolic stroke (CS), 2252 (47.4%), and atherothrombotic stroke (AS), 1304 (27.4%). CS patients were significantly more severely disabled on admission, 1828 (81.4%), and on discharge, 378 (16.8%), p < 0.05. Moreover, patients with CS demonstrated the highest rate of comorbidities and risk factors. This was also statistically significant, p < 0.05. Differences between the total patient count with no atrial fibrillation (AF), paroxysmal AF, permanent AF, and different IS subtypes among our study population demonstrated not only statistical significance but also a strong association, Cramer’s V = 0.53. The majority of patients in our study group were treated conservatively, 3389 (71.3%). Reperfusion therapy was significantly more often performed among CS patients, 770 (34.2%), p < 0.05. The overall intrahospital mortality among our study population was 570 (12.0%), with the highest intrahospital mortality rate noted among CS patients, 378 (66.3%), p < 0.05. No statistically significant difference was observed between acute myocardial infarction and adiposity, p > 0.05. Conclusions. In our study, CS and AS were the most common IS subtypes. CS patients were significantly older with slight female predominance. CS patients demonstrated the greatest disability, risk factors, comorbidities, reperfusion therapy, and intrahospital mortality. Full article

Background and Objectives: Inflammation is a recognized factor in disease progression in both heart failure (HF) patients with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). Neutrophils take part in maintaining the pro-inflammatory state in HF. Hypercholesterolemia is stated to heighten neutrophil production, which contributes to accelerated cardiovascular inflammation. HF pathogenesis differences in the different HF phenotypes are yet to be investigated. Aim: To determine differences in complete blood count, C-reactive protein (CRP) concentration and lipidogram between chronic HF patients with an absence/presence of myocardial infarction (MI) history and preserved/reduced EF. Materials and Methods: We separated the patients (n = 266) according to chronic HF phenotype: (1) HFrEF patients (n = 149) into groups according to presence of MI: those who had had no MI (n = 91) and those with MI (n = 58); (2) chronic HF without MI according to left ventricular ejection fraction (LVEF): LVEF ≥ 50%, n = 117; LVEF < 50%, n = 91. Laboratory and clinical readings (age, weight, pulse, blood pressure, and body mass index (BMI)) were taken from the patients’ medical histories. Results: Mean corpuscular hemoglobin concentration (MCHC) was lower and red cell distribution width—coefficient of variation (RDW-CV) was higher in the lower EF group without a history of MI (337.32 (10.60) and 331.46 (13.13), p = 0.004; 13.6 (11.5–16.9), and 14.7 (12.6–19.1), p = 0.001). Lymphocyte percentage and lymphocyte-to-monocyte ratio (LYM/MON) were lower in the lower EF group without a history of MI (30.48 (10.87), 26.98 (9.08), p = 0.045; 3.33 (1.22–9.33), 3 (0.44–6.5), p = 0.011). In the group according to LVEF without MI neutrophil count positively correlated with weight (r_p = 0.196, p = 0.024); lymphocyte count correlated with RDW-CV (r_s = −0.223; p = 0.032) and body mass index (r_p = 0.186, p = 0.032). RDW-CV and monocyte count correlated with NT-proBNP and serum creatinine (r_s = 0.358, p = 0.034; r_s = 0.424, p < 0.001 and r_s = 0.354, p = 0.012; r_s= 0.205, p = 0.018 respectively). CRP concentration (6.9 (1.46–62.97), 7 (1–33.99), p = 0.012) was higher and HDL concentration was lower (0.96 (0.44–2.2), 0.92 (0.56–1.97), p = 0.010) in HFrEF with MI in comparison with the group without MI. LVEF correlated with MCHC and RDW-CV (r_s = 0.273, p = 0.001; r_s = −0.404, p < 0.001). HDL cholesterol concentration was lower (0.96 (0.44–2.2); 0.92 (0.56–1.97, p = 0.010) and CRP concentration (6.9 (1.46–62.97), 7 (1–33.99), p = 0.012) was higher in the HFrEF with MI group. Uric acid concentration correlated with platelet-to-lymphocyte ratio and LYM/MON (r_s = 0.321, p = 0.032; r_s = −0.341, p = 0.023). Creatinine concentration correlated with monocyte percentage and count (r_p = 0.312, p = 0.001; r_p = 0.287, p = 0.003). A correlation between CRP and MCHC (r_s = 0.262, p = 0.008) was observed. Conclusions: Our findings revealed the higher pro-inflammatory condition in HFrEF group without MI in comparison with HFpEF without MI. LYM/MON can be appropriate as additional reading for evaluation of functional condition in HFrEF group without MI. It seems inflammation environment could be higher in HFrEF with MI in disease history in comparison with those without MI. HDL concentration inversely correlated with monocyte count and the percentages could show the relationship between the low-grade inflammation and lipid metabolism in HFrEF. Both MCHC and RDW-CV may be relevant in assessing the chronic HF patients’ condition. Full article

Background and Objectives: As the work environment is one of the most significant sources of stress, employers in the European Union are obliged to identify psychosocial risk determinants and take preventive measures to improve workers’ health and well-being while at work. The aim of this study was to determine which medical occupational group is the most exposed to stress and where any differences lie among medical occupational groups regarding the perception of psychosocial risk determinants and organizational intervention objects in the Lithuanian public healthcare institution. Materials and Methods: Using a cross-sectional study design, paper questionnaires were delivered to all health workers (n = 690) of the Lithuanian public healthcare institution; the response rate was 68% (n = 467). The questionnaire consisting of three parts was completed for the survey. It covered 14 psychosocial risk determinants and work-related stress, 10 organizational intervention objects, and sociodemographic data of health workers. Results: The results showed that perceived stress had mean rank scores differing statistically significant (p-value < 0.05) across occupational groups. The highest stress rating was given by the doctors’ group. Regarding psychosocial risk determinants, there were statistically significant differences (p-value < 0.05) in work overload scores among doctors, heads of units, and other health workers; in overtime scores and in tight deadlines scores between doctors and other health workers; in unclear role scores among all medical occupational groups; in being under-skilled for job scores between nurses and doctors; in responsibility for decision making scores among heads of units, doctors, and other health workers. Concerning organizational intervention objects, there were statistically significant differences (p-value < 0.05) in work-life balance scores, ensuring skills/abilities matching to the job demands scores, social support scores, organizational support scores, participation in decision-making scores, justice of reward scores, manager feedback scores, variety of tasks scores among heads of units, doctors, nurses, other health workers. Conclusions: The results of the study confirmed that different occupational groups emphasized different psychosocial risk determinants and organizational intervention objects. The findings suggest that focusing on the average worker does not have practical value and that it is important to understand the differential effects of different job characteristics on work outcomes considering occupational status while developing coping strategies in the institution. The risk group with the most exposure to stress were doctors in the healthcare institution. Full article