Medicina

251 KiB

Open AccessArticle

The evaluation of psychomotor development in preterm infants

by Inesa Rimdeikienė, Aleksandras Kriščiūnas and Eglė Markūnienė

Medicina 2008, 44(5), 378; https://doi.org/10.3390/medicina44050049 - 15 May 2008

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The aim of this study was to assess psychomotor development of very-low-birth-weight infants.
Material and methods. A prospective study was carried out in the Clinic of Neonatology, Kaunas University of Medicine Hospital. Two groups of infants were selected: the study group consisted [...] Read more.

The aim of this study was to assess psychomotor development of very-low-birth-weight infants.
Material and methods. A prospective study was carried out in the Clinic of Neonatology, Kaunas University of Medicine Hospital. Two groups of infants were selected: the study group consisted of 79 preterm infants treated in the Clinic of Neonatology; the control group consisted of 31 term infants. Psychomotor development of the infants was evaluated five times at the age of 1, 3, 6, 9, and 12 months by using the Bayley Scales of Infant Development.
Results. The results showed that at the age of 1 month, a significantly delayed psychomotor development was noted in 15.2% of preterm infants and in none of term infants; moderately delayed development – in 25.3% of preterm infants and in none of term infants; normal – in 54.4% and 90.3%, respectively; and accelerated development – 5.1% and 9.7%, respectively. At the age of 12 months, 21.8% of preterm infants and none of term infants showed a significantly delayed psychomotor development; 26.9% of study group patents and none in control group – moderately delayed development; 51.3% and 93.5%, respectively – normal development; and 6.5% and none, respectively – accelerated development.
Conclusion. Psychomotor development of preterm infants is retarded during all first year of life. Full article

327 KiB

Open AccessArticle

Extra-anatomic thoracic aortic bypass operations

by Arūnas Valaika, Gediminas Norkūnas, Gintaras Kalinauskas, Giedrė Nogienė, Jurgis Verižnikovas, Giedrius Uždavinys and Vytautas Sirvydis

Medicina 2008, 44(5), 373; https://doi.org/10.3390/medicina44050048 - 15 May 2008

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Abstract

Objective. When the patient condition contraindicates major surgery for descending thoracic aneurysms, the surgeon should consider using an ascending aorta to abdominal aorta bypass graft, leaving the diseased segment undisturbed. Our experience with eight patients is presented.
Material and methods. Between [...] Read more.

Objective. When the patient condition contraindicates major surgery for descending thoracic aneurysms, the surgeon should consider using an ascending aorta to abdominal aorta bypass graft, leaving the diseased segment undisturbed. Our experience with eight patients is presented.
Material and methods. Between 1988 and 2008, eight patients were treated for the following indications: reoperation for coarctation (two patients), complicated descending aortic aneurysms (five patients), and posttraumatic descending aorta dissection (one patient). The mean age of the patients was 44±8 years (range, 27–53 years). There were 6 (75%) males and 2 (25%) females. Emergency operations were performed in three patients (two with aortic recoarctation, one with posttraumatic aortic dissection). Two cases were reoperations (both after recoarctation). Descending aorta was ligated in seven cases. Distal anastomosis was connected with abdominal aorta in four cases and with iliac arteries in four patients.
Results. Three early deaths occurred. Two patients died after emergency operation after recoarctation and posttraumatic aortic dissection, and one patient died after descending aorta aneurysm correction because of bleeding.
Conclusions. In complex aortic coarctation, extra-anatomic bypass operation remains an effective procedure. The usage of these procedures in patients with descending aortic aneurysms remains complicated. Full article

310 KiB

Open AccessArticle

Paradigm errors in the old biomedical science

by Albertas Skurvydas

Medicina 2008, 44(5), 356; https://doi.org/10.3390/medicina44050046 - 15 May 2008

Cited by 2 | Viewed by 744

Abstract

The aim of this article was to review the basic drawbacks of the deterministic and reductionistic thinking in biomedical science and to provide ways for dealing with them. The present paradigm of research in biomedical science has not got rid of the errors [...] Read more.

The aim of this article was to review the basic drawbacks of the deterministic and reductionistic thinking in biomedical science and to provide ways for dealing with them. The present paradigm of research in biomedical science has not got rid of the errors of the old science yet, i.e. the errors of absolute determinism and reductionism. These errors restrict the view and thinking of scholars engaged in the studies of complex and dynamic phenomena and mechanisms. Recently, discussions on science paradigm aimed at spreading the new science paradigm that of complex dynamic systems as well as chaos theory are in progress all over the world. It is for the nearest future to show which of the two, the old or the new science, will be the winner. We have come to the main conclusion that deterministic and reductionistic thinking applied in improper way can cause substantial damage rather than prove benefits for biomedicine science. Full article

210 KiB

Open AccessArticle

A new approach to the treatment of dyslipidemia

by Sigita Kėvelaitienė and Rimvydas Šlapikas

Medicina 2008, 44(5), 407; https://doi.org/10.3390/medicina44050053 - 14 May 2008

Cited by 5 | Viewed by 1011

Abstract

During the last decade, the evidence of beneficial effects of cholesterol lowering in patients with coronary heart disease has been proven in many clinical trials. The National Cholesterol Education Program (NCEP) released 2004 update to the Adult Treatment Panel III (ATP III) guidelines. [...] Read more.

During the last decade, the evidence of beneficial effects of cholesterol lowering in patients with coronary heart disease has been proven in many clinical trials. The National Cholesterol Education Program (NCEP) released 2004 update to the Adult Treatment Panel III (ATP III) guidelines. The new guidelines of European Society of Cardiology announced in 2007 support more intensive LDL-C lowering in patients at high risk of cardiovascular diseases. For patients at the highest risk of cardiovascular diseases (diabetic patients with coronary heart disease), the recommended LDL-C goal is <1.8 mmol/L. In very high-, high-, and moderately high-risk patients, statin therapy should be considered with a treatment targeting an LDL-C reduction of 30– 40%. Clinical studies have shown that statin therapy alone is not always effective, especially in patients with primary hypercholesterolemia. Furthermore, high doses of statins can increase the possibility of adverse events. The combination of statins with intestinal cholesterol absorption inhibitors is more effective than statin monotherapy in LDL-C lowering and is well tolerated. Full article

206 KiB

Open AccessArticle

Changes in the prevalence of metabolic syndrome and smoking habits during a 10-year period and relation between these risk factors and ischemic heart disease among men aged 45–64 years

by Dalia Ieva Lukšienė, Liucija Rita Černiauskienė, Lilija Margevičienė and Abdonas Tamošiūnas

Medicina 2008, 44(5), 400; https://doi.org/10.3390/medicina44050052 - 14 May 2008

Cited by 4 | Viewed by 724

Abstract

The aim of this work was to compare the prevalence of metabolic syndrome and smoking habits smokingduring a 10-year period and to evaluate the association between metabolic syndrome and smoking habits, and ischemic heart disease among Kaunas men aged 45–64 years.
Material and [...] Read more.

The aim of this work was to compare the prevalence of metabolic syndrome and smoking habits smokingduring a 10-year period and to evaluate the association between metabolic syndrome and smoking habits, and ischemic heart disease among Kaunas men aged 45–64 years.
Material and methods. In this study, we have used data from two epidemiological studies, which had been carried out according to the MONICA study protocol (359 men aged 45–64 years were enrolled in 1992–1993 and 408 men aged 45–64 years – in 2001–2002). The association between metabolic syndrome and smoking habits, and ischemic heart disease was established according to the data of 2001–2002 years. Ischemic heart disease was diagnosed based on the following criteria: previous myocardial infarction, angina pectoris, or ischemic changes in electrocardiogram. Metabolic syndrome was defined by Adult Treatment Panel III (ATP III) criteria.
Results. The prevalence of ischemic heart disease did not change among men aged 45–64 years during a 10-year period. During this period, the decreased prevalence of metabolic syndrome was observed; decreased rate of hyperglycemia, decreased high-density lipoprotein cholesterol level, increased rate of hypertriglyceridemia, and increased waist circumference were noted. During this period, the proportion of regular male smokers increased significantly. After the evaluation of association between and metabolic syndrome and smoking habits, and ischemic heart disease (according to the data of 2001–2002 years), it was determined that the highest rate of ischemic heart disease was among regular smokers with metabolic syndrome (32.3%), and the lowest rate of ischemic heart disease was noted among men who had never smoked and were without metabolic syndrome (11.6%) (OR=3.63; P=0.013). The highest rate of previous myocardial infarction and/or angina pectoris was determined among regular smokers with metabolic syndrome (19.4%), and the lowest rate of ischemic heart disease was determined among men who had never smoked and were without metabolic syndrome (3.6%) (OR=6.43; P=0.008).
Conclusion. Combination of metabolic syndrome and smoking is significantly associated with ischemic heart disease among men aged 45–64 years. Full article

269 KiB

Open AccessArticle

Matrix metalloproteinase-3 gene polymorphism and dilatative pathology of ascending thoracic aorta

by Vaiva Lesauskaitė, Giedrė Šinkūnaitė, Rimantas Benetis, Vilius Grabauskas, Jolanta Vaškelytė, Alina Smalinskienė, Sandrita Šimonytė, Giedrė Jarienė, Vacis Tatarūnas, Jūratė Klumbienė, Janina Petkevičienė, Šarūnas Kinduris, Saulius Giedraitis, Juozas Sakalauskas, Ramūnas Bolys, Edmundas Širvinskas, Tadas Lenkutis and Dalia Pangonytė

Medicina 2008, 44(5), 386; https://doi.org/10.3390/medicina44050050 - 14 May 2008

Cited by 19 | Viewed by 926

Abstract

Matrix metalloproteinase-3 (MMP-3) degrades extracellular matrix and may lead to development of dilatative pathology of ascending thoracic aorta. Expression of MMP-3 depends upon the 5A/6A polymorphism in the promoter region. An increased number of 5A alleles leads to high expression of MMP-3. Thus, [...] Read more.

Matrix metalloproteinase-3 (MMP-3) degrades extracellular matrix and may lead to development of dilatative pathology of ascending thoracic aorta. Expression of MMP-3 depends upon the 5A/6A polymorphism in the promoter region. An increased number of 5A alleles leads to high expression of MMP-3. Thus, objective of the study was to determine whether the 5A/6A polymorphism in the promoter region of MMP-3 gene is associated with the development of dilatative pathology of ascending thoracic aorta. We studied 76 patients (age ranged from 31 to 81 years; median age, 64 years) who underwent aortic reconstruction surgery due to dilatative pathology of ascending thoracic aorta and a random sample of the population (n=604) aged 25–64 years, all from Lithuania. DNA was analyzed by using real-time polymerase chain reaction to genotype polymorphism 5A/6A at a position – 1171 of the MMP3 gene promoter. The prevalence of MMP-3 genotypes was similar in the group of dilatative pathology of ascending thoracic aorta and random sample of population. The frequency of 5A allele did not differ significantly between both groups and was 0.506 and 0.514, respectively. Male carriers of 5A/5A genotype were significantly younger compared with those with the 6A/6A genotype. In conclusion, the frequency of MMP-3 promoter 5A/6A genotypes did not differ between the group of patients with dilatative pathology of ascending thoracic aorta and the random sample of population, but the males with dilatative pathology of ascending thoracic aorta and 5A/5A genotype required aortic reconstruction surgery at the younger age than the males carrying 6A/ 6A genotype in the MMP-3 promoter region. Full article

237 KiB

Open AccessArticle

Lithuanian physical activity strategy: The culture of the body or the body cult?

by Rasa Jankauskienė

Medicina 2008, 44(5), 346; https://doi.org/10.3390/medicina44050045 - 06 Apr 2008

Cited by 6 | Viewed by 958

Abstract

The article is devoted to disclosure of the tendencies in the promotion of Lithuanian physical activity. During the Soviet times, Lithuanian sports politics was oriented to elite sport and it is still. The attempts to foster physical activity of the population lie on [...] Read more.

The article is devoted to disclosure of the tendencies in the promotion of Lithuanian physical activity. During the Soviet times, Lithuanian sports politics was oriented to elite sport and it is still. The attempts to foster physical activity of the population lie on the movement “Sport for all,” but the results of the movement are not effective enough, because only a small part of the population (approximately 6%) took part in it. No one governmental institution has full and clear responsibility for the results of physical activity promotion. The poor environment of physical activity results in poor possibilities to be physically active in leisure domain. Differently, the huge expansion of the private sport, health, and beauty industries fosters the adoration of the body and overemphasizes the meaning of body image in the society. Physical activity is represented as the measure to achieve ideal body image or good health, but not as the measure of the overall culture of the human or society.
Conclusions. The long-lasting, health-related physical activity-oriented national strategy is essential to foster physical activity, health, and quality of life at the national level. The multiplicity of possibilities in the physical activity would foster lifestyle activity instead of adoration of body image and would improve the psychological and physical well-being of the population. Full article

204 KiB

Open AccessArticle

Liver diseases unique to pregnancy

by Jūratė Kondrackienė and Limas Kupčinskas

Medicina 2008, 44(5), 337; https://doi.org/10.3390/medicina44050044 - 06 Apr 2008

Cited by 15 | Viewed by 884

Abstract

The aim of this review article is to improve knowledge of the liver disease in pregnancy. The article summarizes the results of own experience and the recent reviews of liver disorders unique to pregnancy. Abnormalities in liver tests occur in 3% of pregnancies [...] Read more.

The aim of this review article is to improve knowledge of the liver disease in pregnancy. The article summarizes the results of own experience and the recent reviews of liver disorders unique to pregnancy. Abnormalities in liver tests occur in 3% of pregnancies with causes ranging from self-limiting to rapidly fatal. In Kaunas University of Medicine Hospital, a retrospective analysis disclosed a rate of 0.52% of liver diseases in 16252 pregnant women over a 5-year period. Several liver diseases occur only during pregnancy and are considered to be associated with the pregnant state. The liver disorders unique to pregnancy have characteristic clinical features and timing of onset. Hyperemesis gravidarum occurs in the first trimester, intrahepatic cholestasis of pregnancy in the second or third trimester, preeclampsia, HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome, and acute fatty liver of pregnancy usually in the third trimester. The disorders of late pregnancy – preeclampsia, HELLP syndrome, and acute fatty liver of pregnancy – may progress to severe liver dysfunction. The correct diagnosis is critical, as any delay can result in morbidity or mortality of both the mother and fetus. Early delivery and advances in supportive management are the only available option for improving the prognosis. Full article

212 KiB

Open AccessArticle

Evaluation of a chronic fatigue in patients with moderate-to-severe chronic heart failure

by Lina Jasiukevičienė, Donatas Vasiliauskas, Aušra Kavoliūnienė, Jolanta Marcinkevičienė, Regina Grybauskienė, Vytautas Grižas and Vida Tumynienė

Medicina 2008, 44(5), 366; https://doi.org/10.3390/medicina44050047 - 17 Mar 2008

Cited by 7 | Viewed by 938

Abstract

The aim of the study. To evaluate the chronic fatigue and its relation to the function of hypothalamus-pituitary-adrenal axis in patients with New York Heart Association (NYHA) functional class III–IV chronic heart failure.
Material and methods. A total of 170 patients with [...] Read more.

The aim of the study. To evaluate the chronic fatigue and its relation to the function of hypothalamus-pituitary-adrenal axis in patients with New York Heart Association (NYHA) functional class III–IV chronic heart failure.
Material and methods. A total of 170 patients with NYHA functional class III–IV chronic heart failure completed MFI-20L, DUFS, and DEFS questionnaires assessing chronic fatigue and underwent echocardiography. Blood cortisol concentration was assessed at 8:00 AM and 3:00 PM, and plasma N-terminal brain natriuretic pro-peptide (NT-proBNP) concentration was measured at 8:00 AM. Neurohumoral investigations were repeated before cardiopulmonary exercise test and after it.
Results. The results of all questionnaires showed that 100% of patients with NYHA functional class III–IV heart failure complained of chronic fatigue. The level of overall fatigue was 54.5±31.5 points; physical fatigue – 56.8±24.6 points. Blood cortisol concentration at 8:00 AM was normal (410.1±175.1 mmol/L) in majority of patients. Decreased concentration was only in four patients (122.4±15.5 mmol/L); one of these patients underwent heart transplantation. In the afternoon, blood cortisol concentration was insufficiently decreased (355.6±160.3 mmol/L); reaction to a physical stress was attenuated (∆ 92.9 mmol/L). Plasma NTproBNP concentration was 2188.9±1852.2 pg/L; reaction to a physical stress was diminished (∆ 490.3 pg/L).
Conclusion. All patients with NYHA class III–IV heart failure complained of daily chronic fatigue. Insufficiently decreased blood cortisol concentration in the afternoon showed that in the presence of chronic fatigue in long-term cardiovascular organic disease, disorder of a hypothalamus-pituitary-adrenal axis is involved. Full article

242 KiB

Open AccessArticle

Association of metabolic syndrome and oxidative stress with ischemic heart disease in middle-aged persons

by Liucija Rita Černiauskienė, Dalia Ieva Lukšienė, Abdonas Tamošiūnas, Regina Rėklaitienė and Lilija Margevičienė

Medicina 2008, 44(5), 392; https://doi.org/10.3390/medicina44050051 - 10 Mar 2008

Cited by 5 | Viewed by 834

Abstract

The aim of this study was to evaluate the association of metabolic syndrome and oxidative stress with ischemic heart disease in middle-aged persons (men and women aged 45–64 years).
Material and methods. In this study, we have used data of 533 persons [...] Read more.

The aim of this study was to evaluate the association of metabolic syndrome and oxidative stress with ischemic heart disease in middle-aged persons (men and women aged 45–64 years).
Material and methods. In this study, we have used data of 533 persons (247 men and 286 women) aged 45– 64 years from Kaunas population cohort investigated according to WHO MONICA study protocol during 2001–2002 in whom concentrations of malondialdehyde, a marker of lipid peroxidation, and antioxidant vitamin E in blood serum were determined. Metabolic syndrome was defined by the criteria of Adult Treatment Panel III. Oxidative stress was determined in the presence of increased level of malondialdehyde (≥5 mmol/L) and decreased level of lipid-standardized vitamin E (<20 mmol/L). The levels of malondialdehyde and vitamin E were measured by fluorimetric methods.
Results. Ischemic heart disease was diagnosed in 19.8% of men and 21.3% of women. The frequency of ischemic heart disease among persons (men and women) with metabolic syndrome was significantly higher than among persons without metabolic syndrome (27.4% vs. 17.8%, respectively; odds ratio, 1.63; P=0.032). The frequency of ischemic heart disease among persons with oxidative stress was significantly higher than among persons without oxidative stress (29.1% vs. 17.6%, respectively; odds ratio, 1.88; P=0.029). The highest prevalence of ischemic heart disease (30.0%) was among persons with metabolic syndrome and oxidative stress, and the lowest prevalence of this disease (13.8%) was among persons without metabolic syndrome and without oxidative stress (odds ratio, 2.54; P=0.017). These data were adjusted by sex and age.
Conclusion. Metabolic syndrome and oxidative stress are significantly associated with ischemic heart disease among 45–64-year-old persons. Full article

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Medicina, Volume 44, Issue 5 (May 2008) – 10 articles

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