Medicina, Volume 45, Issue 5 (May 2009) – 11 articles

Methadone is a long-acting synthetic opioid with high affinity for various opioid receptors, especially for μ-opioid receptors. Methadone has been used as a successful pharmacologic intervention for the treatment of heroin dependence and acute and chronic pain. This treatment is effective for opiate addiction, reducing morbidity and mortality associated with heroin use. However, overdosing with methadone has become a growing phenomenon because of the increased availability of this drug. Patients enrolled in a methadone maintenance treatment program may become physically dependent and may experience methadone withdrawal symptoms. In this review article, there are discussed about pharmacokinetic and pharmacodynamic properties of methadone, clinical symptoms of its overdose, dosage problems, detection of methadone in biological samples, treatment, and causes of methadone overdose-related deaths. Full article

Objectives. To describe the cohort of Lithuanian medical radiation workers and to estimate the risk of cancer during 1978–2004.
Methods. Analysis of cancer risk evaluation was done using the retrospective cohort method, an indirect standardization. The observed numbers of cancer cases were obtained from the National Cancer Registry. The expected numbers were based on the age- and gender-specific incidence rates for the general Lithuanian population in 5-year periods. The standardized incidence ratios and 95% confidence intervals (assuming that the incidence of cancer follows the Poisson distribution) were calculated.
Results. During the follow-up of 1978–2004, 159 cases of cancer were observed. There was no increased overall cancer risk in men (SIR=0.92, 95% CI=0.62–1.33, based on 29 cases) and women (SIR=0.97, 95% CI=0.81–1.15, based on 130 cases). The risk of leukemia among men and women was insignificantly increased. Conclusions. During the follow-up period, the overall cancer risk among medical radiation workers was the same as in the general population of Lithuania Full article

Arterial hypertension (AH) is one of the most important risk factors for development of ischemic heart disease; thus, control of AH and effective treatment are of great importance. Since arterial hypertension is commonly referred as asymptomatic condition, the question whether hypertensive condition is associated with the change of well-being and health-related quality of life is still debatable. The aim of the study. To evaluate the impact of duration and treatment of AH on health-related quality of life.
Material and methods. The contingent of the study consisted of patients who arrived for a cardiologist’s consultation at the Clinic of Cardiology, Hospital of Kaunas University of Medicine. The patients were randomly selected for the study. The inclusion criteria were as follows: diagnosed arterial hypertension, diabetes mellitus, and the metabolic syndrome. Diagnosed ischemic heart disease (chronic and acute coronary syndromes and their complications) and severe concomitant diseases were exclusion criteria. A total of 101 patients (19 males and 82 females) met the inclusion criteria and consented to participate in the study. Their mean age was 58.03±5.63 years. The patients’ quality of life was evaluated using the Medical Outcomes Study short form 36-item questionnaire (SF-36 questionnaire), which comprises 36 questions grouped into eight domains. The questionnaire was filled in by the subjects independently. Other methods applied to the study were inquiry (for the evaluation of risk factors, lifestyle, and medical history), analysis of medical documents (cholesterol levels and glycemia in blood), and objective examination (height, weight, waist circumference, and arterial blood pressure).
Results. The subjects with AH showed lower values compared to normotensive patients in the following domains: physical functioning (P=0.014), role limitations due to physical health (P=0.012), energy/vitality (P=0.016), and general health evaluation (P=0.023). We have not determined the differences in quality of life of the patients whose AH was regulated if compared to those patients without AH. The patients whose treatment of AH was not effective reported lower quality of life in the following SF-36 domains: physical functioning (P=0.003), role limitations due to physical health (P=0.003), general evaluation of health (P=0.017), energy/vitality (P=0.008), and emotional status (P=0.015), if compared to the patients without AH.
Conclusions. Patients with AH reported lower quality of life in the following domains: physical functioning, role limitations due to physical health, energy/vitality, and general evaluation of health. Compared to patients without AH, the quality of life of the patients who had the effective treatment did not differ, whereas patients with ineffective treatment had the lower quality of life. Functioning is more statistically significantly limited due to physical health in patients with AH. Full article

Objective. To estimate the associations between educational load and health, and elements of day’s routine among Lithuanian schoolchildren, attending classes of first stage of basic education curriculum.
Material and methods. During 14–28 November, 2005, the study was performed in 108 secondary schools, providing basic secondary education in Lithuanian language. A total of 3744 schoolchildren and 1601 parents filled in an original, specially designed questionnaire.
Results. More than two-thirds of the schoolchildren (69.2%) estimated their health as very good or good, and 19.2% indicated that they were not ill during the last year. Schoolchildren who reported educational load to be too high estimated their health worse (P<0.001), were ill more frequently (P<0.001), and due health disorders had to limit their regular activities. Educational load had an impact on schoolchildren’s well-being and relationships with parents. Elements of day’s routine depended on gender, grade, and place of residence. Less than one-third (32.8%) of schoolchildren reported 9–10-hour night’s sleep, 33.8% – spending 3 hours outdoors on workdays. Passive activities dominate during schoolchildren’s leisure time. More than half of schoolchildren (60.3%) spend 2–3 hours watching television, 30.7% – 2 or more hours working with computer on workdays.
Conclusions. Too high educational load have a negative impact on schoolchildren’s health and well-being, relationships with parents. Schoolchildren with an adequate educational load follow recommendations of the day’s routine more frequently. Full article

The aim of this study was to identify and evaluate the prevalence of urinary incontinence and risk factors that influenced it among inpatients treated in the departments of internal medicine.
Material and methods. A total of 151 inpatients were questioned using a standardized geriatric questionnaire (InterRAI-Acute Care). Inpatients aged 65 years and more and who gave written informed consent were enrolled into the study. The mean age of the inpatients was 78±0.6 years. There were 58.9% of women and 41.06% of men.
Results. Urinary incontinence was significantly influenced by the age of the inpatients. Inpatients with urinary incontinence were 3 years older on the average as compared to those without urinary continence (P<0.025). Women were more frequently affected than men (74.2% vs. 48.4%). A significant association between urinary and fecal incontinence and memory problems, movement disorders, delirium, dependence in daily activities, falls was established. The odds of having double incontinence were increased by dementia (OR=20.9; 95%, CI 2.3–186) and residual effects of a stroke (OR=3.5; 95%, CI 1.2–9.6). The prevalence of urinary incontinence decreased from 63.6% before hospitalization to 39.7% after hospitalization. According to standard medical documentation, urinary incontinence was diagnosed in 3.3% of cases, while using the interRAI-AC questionnaire, it was documented in 63.6% of cases.
Conclusions. The prevalence of urinary incontinence increases in the elderly; therefore, it has to be investigated and treated. Memory problems, delirium, dependence in daily activities, movement disorders, and falls are directly related to the risk of urinary, fecal, and double incontinence among elderly inpatients. Double incontinence was significantly influenced by dementia (20.9 times) and residual effects of a stroke (3.5 times). Underdiagnosis of urinary and fecal incontinence in inpatients burdens the possibility of providing aid for elderly patients with this disorder. Full article

Objective. We present our experience in diagnosing, gender assignment, and surgical management of sexual ambiguity in 46,XY mixed gonadal dysgenesis.
Material and methods. A retrospective study of five cases treated from 2003 to 2006 was performed. Clinical picture, operative findings, testosterone levels, and immunohistochemistry of gonads for the expression of FOXL2, SOX9, AMH, AMHr, C-kit, and PLAP were analyzed.
Results. All patients had ambiguous genitalia, urogenital sinus, uterus, testicle on one side, and a streak gonad on the other. Four patients were reared as male and one as female. Stimulation by human chorionic gonadotropin showed good penile size and testosterone response. All patients underwent laparoscopic gonadal biopsy and/or gonadectomy. Histological studies showed the presence of sparse primordial follicles surrounded by embryonic sex cords in the streak portion of gonads. Germ cells were C-kit positive in all and PLAP positive in four patients. FOXL2 expression was detected in four streak gonads and in none of testes. AMH expression was found only in testes. SOX9 expression was found in both investigated testes and in three out of four streak gonads investigated.
Conclusions. 46,XY mixed gonadal dysgenesis should be differentiated from ovotesticular and other types of 46,XY disorders of sexual differentiation by the typical gonadal histology and internal genital structure. High testosterone level after stimulation and good response to testosterone treatment in 46,XY mixed gonadal dysgenesis could orient toward male sex assignment. There are different patterns of gene expression in testicular and streak gonads with a switch to FOXL2 positivity in streak gonads. Early gonadal and genital surgery is recommended. Full article

The most important attention is paid to the search of natural antioxidants and their evaluation in medicinal and food raw materials of plant origin. A number of plants, their extracts, food products, and medicinal preparations appear to be the objects of scientific research. Effectiveness and informative character of research, undoubtedly, depend on relevance, sensitivity, and efficiency of the methods chosen. The aim of this work was to develop and validate the postcolumn high-performance liquid chromatography (HPLC)-DPPH method as well as its application in the evaluation of antioxidant activity of known and unknown compounds scavenging free radicals and existing in medicinal plant raw materials. HPLC-separated compounds were identified at the wavelength of 275 nm, and then the mobile phase with analytes flowed through a mixing tee to the reaction coil, where DPPH reagent solution was supplied. The solution flow rate was 0.4 mL/min. The reaction coil was connected with UV/VIS type detector, which measured absorption of flowing solution at the wavelength of 520 nm. It was determined that vitexin rhamnoside, the dominant compound in the leaves of Crataegus monogyna, was not a significant radical scavenger. The most active antioxidant in the leaves and flowers of Crataegus monogyna was chlorogenic acid. The most active antioxidant in Origanum vulgare raw material was rosmarinic acid. Identified analytes in the extracts of Achillea millefolium that possessed radical-scavenging properties were chlorogenic acid, luteolin-7-Oglucoside, rutin, and luteolin. Full article

Objective. The aim of the study was to assess the relationship between thyroid pathology and visual acuity, including refraction disorders.
Material and methods. The data of visual acuity, refraction, and exophthalmos were analyzed, which were obtained from 105 patients with thyroid pathology. The data were compared with the findings of 23 healthy persons of similar age (control group).
Results. In case of thyroid pathology, visual acuity (right eye 0.71±0.035, left eye 0.73±0.045) was worse than in the control group (right eye 0.89±0.06, P<0.05; left eye 0.92±0.07, P<0.05). Myopia dominated in patients with thyroid pathology (refraction: right eye M 1.1±0.61 D, left eye M 1.0±0.64 D). In patients with exophthalmos of ≥17 mm, visual acuity was significantly worse (right eye 0.68±0.04, left eye 0.68±0.03) than in persons of the control group (right eye 0.89±0.06, P<0.05; left eye 0.92±0.07, P<0.05), and myopic refraction was found more frequently (right eye M 1.3±0.48 D, left eye M 1.3±0.56 D). Visual acuity was significantly better in patients when exophthalmos was <17 mm (right eye 0.80±0.05, P<0.05; left eye 0.80±0.05, P<0.05) than in cases when exophthalmos was ≥17 mm.
Conclusions. Thyroid pathology and exophthalmos have an influence on visual acuity and refraction. In case of thyroid pathology, visual acuity appears to be worse than in the control group, and myopic refraction is more frequent. Visual acuity was found to be worse in patients with exophthalmos being ≥17 mm than in the control group, and myopic refraction was found to be more frequent. Full article

The aim of our study was to determine if electroporation could improve the efficacy of photodynamic tumor therapy. A disadvantage of photodynamic therapy is a slow and in some cases insufficient accumulation of photosensitizer in tumor tissue, which could restrict the achievement of an efficient dose. Under the action of electric pulses, cells undergo membrane electroporation, which results in an increased permeability to various exogenous molecules. In this study, murine hepatoma MH22A cells were exposed to light in vitro in the presence of a photosensitizer, either chlorin e6 or aluminum phthalocyanine tetrasulfonate, following electroporation. Accumulation of the photosensitizers was registered by fluorescence microscopy. Cell viability was determined by the MTT assay. Our results demonstrate that electroporation improves an access of chlorin e6 and aluminum phthalocyanine tetrasulfonate to MH22A cells. Electroporation in combination with photosensitization significantly reduces viability of the treated cells even at low doses of photosensitizers. Full article

Apical periodontitis is an inflammation of dental periapical tissues developed as a response to colonization of microorganisms in root canal system. Etiology of periapical pathology is associated with different species of microorganisms that are not fully defined yet. The changes in the composition of root canal microbiota as well as other factors, such as host resistance to various infections and concomitant viral infection, etc., can influence development of the symptomatic apical periodontitis. Etiology of disease is reviewed in this article. The purpose of treatment of symptomatic apical periodontitis is to eliminate the infection in root canal system and to obtain relief of symptoms. It can be done by conventional root canal therapy, which can be combined with anti-inflammatory medication. Indications for antibiotic therapy in such cases are limited to particular occasions, which are considered in article. Nevertheless, findings show that usually dentists prescribe antibiotics improperly in clinical practice. It can render drugs ineffective against diseases of dental origin as well as against potentially fatal infectious diseases. Selection of antibiotics for the treatment of root canal infections is reviewed in this article. Importance of antimicrobial susceptibility testing is emphasized. There is a need for more research on microbial causes and interactions in different forms of apical periodontitis to improve diagnosis and treatment. Full article

Candidemia is becoming more actual because of better survival of even critically ill patients, wide use of antimicrobials, and increased numbers of invasive procedures and manipulations. Diagnosis of candidemia remains complicated, and costs of treatment and mortality rates are increasing.
Objective. To evaluate the pathogens of candidemia, risk factors and their influence on outcome.
Material and methods. Data of 41 patients with positive blood culture for Candida spp., who were treated in the intensive care units at the Hospital of Kaunas University of Medicine, were analyzed retrospectively.
Results. Candidemia was caused by Candida albicans (C. albicans) in 48.8% (n=20) of patients and by non-albicans Candida in 51.2% (n=21) of patients. The main cause of candidemia was C. albicans in 2004 (83.3%, n=5), but in 2005 (63.6%, n=7), in 2006 (57.1%, n=4), and in 2007 (52.9%, n=9), the main cause was non-albicans Candida spp. The number of candidemia cases caused by C. albicans was decreased in 2005, 2006, and 2007 as compared with 2004, and the number of candidemia caused by non-albicans Candida spp. was decreased, respectively (P<0.05). More than 65% (n=34) of patients had severe disease (P<0.05). Lethal outcome was recorded in 58.5% of patients with candidemia. Mechanical ventilation was used in 76.9% (n=20) and urinary bladder catheter in 72.1% (n=19) of non-survivors and in 23.1% (n=6) and 26.9% (n=7) of survivors, respectively (P<0.05).
Conclusions. There is an increase in the prevalence of candidemia in the intensive care units during the 4-year period; half of candidemia cases were caused by non-albicans Candida spp., and patients with candidemia caused by non-albicans Candida spp. are at higher risk of mortality. Therefore, for the empirical treatment of septic conditions in an intensive care unit, when invasive fungal infection is suspected, we recommend using an antifungal agent of non-azole class until a pathogen of candidemia is determined. Severe disease is evaluated as a risk factor for candidemia. Patients with oncological diseases are at significantly higher risk for candidemia caused by non-albicans Candida spp. Use of mechanical ventilation and urinary bladder catheter is a risk factor for lethal outcome. Full article