Medicina

158 KiB

Open AccessAbstract

The Influence of CYP2C9 and VKORC1 Gene Polymorphisms on Optimal Warfarin Doses After Heart Valve Replacement

by Vacis Tatarūnas, Vaiva Lesauskaitė, Audronė Veikutienė, Povilas Jakuška and Rimantas Benetis

Medicina 2011, 47(1), 4; https://doi.org/10.3390/medicina47010004 - 15 Jan 2011

Cited by 3 | Viewed by 866

A clinical effect of warfarin depends on highly polymorphic drug-metabolizing (CYP2C9) and drug-target (VKORC1) enzymes. The objective of this study was to investigate the impact of CYP2C9*2, CYP2C9*3, and VKORC1 (G-1639A) polymorphisms on the variability of warfarin dosage requirements in Lithuanian patients after [...] Read more.

A clinical effect of warfarin depends on highly polymorphic drug-metabolizing (CYP2C9) and drug-target (VKORC1) enzymes. The objective of this study was to investigate the impact of CYP2C9*2, CYP2C9*3, and VKORC1 (G-1639A) polymorphisms on the variability of warfarin dosage requirements in Lithuanian patients after heart valve replacement.
Materials and Methods. The study included 83 patients with a mean age of 65.2 years (SD, 13.31) after heart valve replacement with an achieved stable international normalized ratio of 2–3.5. The restriction fragment length polymorphism method was used to identify polymorphisms of VKORC1 and CYP2C9.
Results. Daily warfarin dosage significantly correlated with weight (r=0.4087) and height (r=0.3883) of the patients. Patients younger than 60 years required significantly higher daily warfarin dosages than older patients. Two-thirds (66.3%) of the patients had the wild-type (WT) CYP2C9* 1/*1 genotype; 38.6% and 54.2% of the patients had WT VKORC1 (G/G) and VKORC1 (G/A) genotypes, respectively. WT CYP2C9*1/*1 genotype was associated with a higher daily warfarin dosage (5.84 mg [SD, 2.84]) as compared to other CYP2C9 genotypes. Carriers of WT VKORC1 (G/G) required a higher warfarin dose as compared to (A/A) carriers (6.20±2.78 mg and 3.75±1.40 mg, respectively; P=0.04). Patients having CYP2C9*1/*1 or 1/*2 in combination with VKORC1 (G/G) or (G/A) genotypes required the highest daily warfarin dosage in comparison to other combinations of genotypes.
Conclusions. The Lithuanian study sample is characterized by high a frequency (92.8%) of VKORC1 G/G and G/A genotypes that determines a higher warfarin-loading dose. Analysis of combined CYP2C9 and VKORC1 gene variants allows the prediction of warfarin dosage. These results can be used to individualize treatment with warfarin in the field of heart surgery in Lithuania. Full article

154 KiB

Open AccessArticle

Hospitalized Adult Patients with 2009 Pandemic Influenza A (H1N1) in Kaunas, Lithuania

by Auksė Mickienė, Lina Daniusevičiūtė, Neringa Vanagaitė, Daiva Vėlyvytė, Ona Blauzdžiūnienė, Rūta Nadišauskienė, Andrius Macas, Raimundas Sakalauskas, Vidas Pilvinis, Irena Nedzelskienė and Liucija Jodžiūnienė

Medicina 2011, 47(1), 11-18; https://doi.org/10.3390/medicina47010002 - 11 Jan 2011

Cited by 7 | Viewed by 1129

Abstract

The objective of this study was to identify case characteristics and clinical course of the disease in patients hospitalized with 2009 pandemic influenza A (H1N1) infection during the first wave of the pandemic and to identify risk factors associated with the complicated course [...] Read more.

The objective of this study was to identify case characteristics and clinical course of the disease in patients hospitalized with 2009 pandemic influenza A (H1N1) infection during the first wave of the pandemic and to identify risk factors associated with the complicated course of illness. Material and methods. A retrospective study of adult cases of the laboratory-confirmed 2009 pandemic influenza A (H1N1) virus admitted to three hospitals in Kaunas between November 1, 2009, and March 15, 2010, was carried out. The main outcome measures were clinical characteristics, risk factors for complicated disease, treatment, and clinical course of the disease. Results. The study enrolled 121 of the 125 patients hospitalized due to 2009 pandemic influenza A (H1N1) virus infection. The median age was 31 years (range, 18–83); 5% of the patients were aged more than 65 years. Pregnant and postpartum women comprised 26% of all hospitalized cases. Nearly half (49.5%) of those who underwent chest radiography had findings consistent with pneumonia, which was bilateral in one-third of cases. The risk to have pandemic influenza complicated by pneumonia increased significantly with one-day delay from symptom onset to antiviral treatment (OR, 2.241; 95% CI, 1.354–3.710). More than half (57%) of the patients received antiviral treatment. In 45% of the treated patients, antiviral drugs were administered within 48 hours from symptom onset. Intensive care was required in 7.4% of the cases. The overall mortality was 5% (6/121). The median age of the patients who died was 43.5 years (range, 23–62); 4 patients had been previously healthy, 1 patient suffered from chronic lympholeukemia, and 1 patient was a pregnant woman. Conclusion. The 2009 pandemic influenza A (H1N1) caused considerable morbidity in a significant proportion of hospitalized adults. The main risk factor associated with the complicated course of illness was delayed antiviral treatment. Full article

387 KiB

Open AccessReview

Aging and Changes in Complexity in the Neurobehavioral System

by Benoit Rey-Robert, Jean-Jacques Temprado and Eric Berton

Medicina 2011, 47(1), 1-10; https://doi.org/10.3390/medicina47010001 - 11 Jan 2011

Cited by 11 | Viewed by 993

Abstract

The issue of complexity is more and more present in numerous domains of biological research, including aging research. In the present paper, based on a selective review of literature, we propose both a conceptual and a methodological framework to address age-related changes in [...] Read more.

The issue of complexity is more and more present in numerous domains of biological research, including aging research. In the present paper, based on a selective review of literature, we propose both a conceptual and a methodological framework to address age-related changes in functional complexity of the neurobehavioral system, presumably resulting from modifications of the coupling between cognitive and sensorimotor processes. In particular, after reviewing pioneering and more recent studies on aging and complexity in the neuromusculoskeletal system, we explore the possibility that an age-induced increase in the coupling between cognitive and sensorimotor domains could be captured by a stronger covariation of high-order variables, common to both cognitive and sensorimotor functioning. Our main assumption is that these variables could behave as neurobehavioral markers of aging in the neuromusculoskeletal system. The present approach markedly differs from other traditional approaches, which focused on process-specific variable correlates of chronological age, domain-by-domain, and task-by-task. It provides a coherent conceptual framework, a terminology, and a method for studying age-related coupling of cognitive and sensorimotor processes with the use of complexity and nonlinear dynamical systems theories. Full article

143 KiB

Open AccessArticle

Evaluation of the Quality of Services in Primary Health Care Institutions

by Leonas Valius, Daiva Rastenytė, Vilija Malinauskienė and Daina Krančiukaitė-Butylkinienė

Medicina 2011, 47(1), 9; https://doi.org/10.3390/medicina47010009 - 11 Jan 2011

Cited by 4 | Viewed by 961

Abstract

The aim of the study was to evaluate patients’ satisfaction with the quality of provided services in private primary health care institutions in Kaunas.
Material and Methods. A questionnaire-based inquiry of 280 persons registered to family physicians at primary health care settings [...] Read more.

The aim of the study was to evaluate patients’ satisfaction with the quality of provided services in private primary health care institutions in Kaunas.
Material and Methods. A questionnaire-based inquiry of 280 persons registered to family physicians at primary health care settings was performed. The study was carried out using 20-item anonymous questionnaires with questions about the quality of services provided in primary health care settings.
Results. More than 50.0% of the respondents stated that they waited for more than 15 minutes at the physician’s office, while 17.0% of the respondents stated that the waiting time exceeded 30 minutes. More than 25.0% of the respondents positively evaluated the possibility to consult their family physician by phone. In 67.0% of patients, the family physician determined the cause of the disorder and administered treatment; in 32.0% of patients, the family physician referred them to a specialist, and 1.0% of patients were urgently sent to hospital. More than 90.0% of the respondents were satisfied with the services provided by their family physicians. Those who were dissatisfied with these services indicated that the provided treatment failed to eliminate the disorder, that they wanted to be referred to a specialist, and that they expected more diagnostic tests to be performed for more effective treatment.
Conclusions. A greater part of the patients indicated that the main reason for long waiting at the physician’s office was physicians’ wish to serve too many patients. More than two-thirds (67.0%) of the patients stated that their family physicians determined the cause of the disorder and prescribed treatment. The overwhelming majority (more than 90.0%) of the patients were satisfied with the services provided by their family physicians. Full article

215 KiB

Open AccessArticle

Survival of Patients With Testicular Cancer in Lithuania During 1999–2002

by Agnius Juška, Albertas Ulys, Laura Kairevičė, Giedrė Smailytė, Edgaras Stankevičius, Rasa Jančiauskienė and Mindaugas Jievaltas

Medicina 2011, 47(1), 8; https://doi.org/10.3390/medicina47010008 - 11 Jan 2011

Cited by 6 | Viewed by 844

Abstract

The aim of this study was to evaluate the survival of patients with testicular cancer in Lithuania during 1998–2002 and factors that influenced the survival.
Material and methods. The survival rates of testicular cancer patients were evaluated using the data of the Lithuanian [...] Read more.

The aim of this study was to evaluate the survival of patients with testicular cancer in Lithuania during 1998–2002 and factors that influenced the survival.
Material and methods. The survival rates of testicular cancer patients were evaluated using the data of the Lithuanian Cancer Registry for 1998–2002. The survival was evaluated using the Kaplan-Meier method and log-rank test in order to compare the survival rates. The observed survival rates were calculated.
Results. The 5-year observed survival rate in Lithuania was 71.2% (95% CI, 64.4%–77.5%). The survival of testicular cancer patients depended on age at the time of diagnosis, histology of tumor, stage and extent of disease.
Conclusions. The survival of patients with testicular cancer in Lithuania was substantially lower than in other European countries. The better survival was associated with younger age and lesser extent of metastases. Full article

571 KiB

Open AccessArticle

The Effect of β-Carotene Against Adriamycin Toxicity on the Embryo Formation

by Violeta Žalgevičienė, Gražina Graželienė, Janina Žukienė and Janina Didžiapetrienė

Medicina 2011, 47(1), 7; https://doi.org/10.3390/medicina47010007 - 11 Jan 2011

Viewed by 786

Abstract

Adriamycin is an anthracycline antibiotic widely used for the treatment of many types of cancer. The cytotoxic effect of Adriamycin occurs by a free radical-mediated mechanism. Thus, to prevent or reduce the toxic effect of Adriamycin, it is possible to use it in [...] Read more.

Adriamycin is an anthracycline antibiotic widely used for the treatment of many types of cancer. The cytotoxic effect of Adriamycin occurs by a free radical-mediated mechanism. Thus, to prevent or reduce the toxic effect of Adriamycin, it is possible to use it in combination with antioxidants. The aim of this study was to evaluate a potential effect of β-carotene against Adriamycin-induced toxicity on the embryo formation.
Materials and Methods. Pregnant rats were treated with Adriamycin, β-carotene, and their combination during the critical stages of embryogenesis. The first group was control group. Adriamycin was administered on day 9 (group 2a) and day 12 (group 2b) of gestation by a single intraperitoneal injection at a dose of 5 mg/kg. β-Carotene was given at a dosage of 0.6 mg/(kg.day) from day 6 to 10 or from day 9 (group 3a) to 13 (group 3b) of gestation 5 times per os; in the case of their combination, β-carotene was given per os 3 times before Adriamycin injection, one time simultaneously with Adriamycin and one time after its injection (groups 4a and 4b). Animals were euthanized on day 21 of gestation. Embryo resorptions and alive fetuses were counted, weighed, and measured. The embryos of each litter were examined macroscopically after the Buen solution fixation for the embryo defects. In order to render the skeleton visible, the soft tissues were macerated using caustic soda, stained with alizarin red, and cleared with glycerin.
Results. Adriamycin induced embryotoxicity; the combination of Adriamycin and β-carotene decreased the number of Adriamycin-induced embryo resorptions about two times. A gavage with Adriamycin alone decreased fetal body weights (P<0.05), while giving it in combination, the fetal body weight was similar to that in the control group. Adriamycin induced the retardation of skeletogenesis and external fetal malformations (microphthalmia, hydrocephaly, anencephaly, and others). After an exposure to β-carotene, external malformations (diaphragmatic hernia) of embryos were found only occasionally. β-Carotene in combination with Adriamycin produced no positive effect on Adriamycin-induced skeletodysgenesis or external malformations.
Conclusions. Antioxidant β-carotene in combination with Adriamycin slightly reduced the Adriamycin- induced embryotoxicity, but produced no positive effect on Adriamycin-induced skeletodysgenesis or external malformations. Full article

279 KiB

Open AccessArticle

The Effect of Heating and Cooling on Time Course of Voluntary and Electrically Induced Muscle Force Variation

by Marius Brazaitis, Albertas Skurvydas, Kazys Vadopalas, Laura Daniusevičiūtė and Žibuoklė Senikienė

Medicina 2011, 47(1), 6; https://doi.org/10.3390/medicina47010006 - 11 Jan 2011

Cited by 9 | Viewed by 1014

Abstract

The aim of this study was to investigate the effect of heating and cooling on time course of voluntary and electrically induced muscle force variation.
Material and Methods. Ten volunteers performed 50 maximal voluntary and electrically induced contractions of the knee extensors [...] Read more.

The aim of this study was to investigate the effect of heating and cooling on time course of voluntary and electrically induced muscle force variation.
Material and Methods. Ten volunteers performed 50 maximal voluntary and electrically induced contractions of the knee extensors at an angle of 120 degrees under the control conditions and after passive lower body heating and cooling in the control, heating, and cooling experiments. Peak torque, torque variation, and half-relaxation time were assessed during the exercise.
Results. Passive lower body heating increased muscle and core temperatures, while cooling lowered muscle temperature, but did not affect core temperature. We observed significantly lower muscle fatigue during voluntary contraction compared with electrically induced contractions. Body heating (opposite to cooling) increased involuntarily induced muscle force, but caused greater electrically induced muscle fatigue. In the middle of the exercise, the coefficient of correlation for electrically induced muscle torque decreased significantly as compared with the beginning of the exercise, while during maximal voluntary contractions, this relation for torque remained significant until the end of the exercise.
Conclusion. It was shown that time course of voluntary contraction was more stable than in electrically induced contractions. Full article

1320 KiB

Open AccessArticle

Expression of Cytokeratin 7 as a Histological Marker of Cholestasis and Stages of Primary Biliary Cirrhosis

by Aušrinė Barakauskienė, Danutė Speičienė, Valentina Liakina, Teresė Semuchinienė and Jonas Valantinas

Medicina 2011, 47(1), 5; https://doi.org/10.3390/medicina47010005 - 11 Jan 2011

Cited by 7 | Viewed by 881

Abstract

The aim of this study was to estimate cytokeratin 7 (CK-7) expression in biopsy specimens of patients with different stages of primary biliary cirrhosis and clinicopathological patterns (cholestatic and hepatitic) and its correlation with some biochemical and pathological parameters and to examine a [...] Read more.

The aim of this study was to estimate cytokeratin 7 (CK-7) expression in biopsy specimens of patients with different stages of primary biliary cirrhosis and clinicopathological patterns (cholestatic and hepatitic) and its correlation with some biochemical and pathological parameters and to examine a diagnostic value of CK-7 expression.
Material and Methods. A total of 82 biopsy specimens of patients with primary biliary cirrhosis were analyzed. CK-7 expression was graded by 4 grades depending on the extent into parenchymal areas and bile duct epithelium. The correlations of CK-7 expression grade with copper deposition, bile duct/portal tract ratio, bilirubin concentration, and activity of alkaline phosphatase and gamma-glutamyl transpeptidase were studied. CK-7 expression was evaluated as a marker of cholestasis (cholestatic pattern) and inflammation (hepatitic pattern).
Results. A positive correlation of CK-7 expression grade with copper-binding protein grade (r=0.698, P<0.0001; OR=6.199, P<0.0001), serum bilirubin level (r=0.375, P=0.001), and alkaline phosphatase activity (r=0.276, P=0.014) was found. CK-7 expression grades correlated positively with histological stages of primary biliary cirrhosis (r=0.639, P<0.000) and negatively with granulomas (r=–0.432, P<0.0001; OR=0.173, P=0.0011).
Conclusions. CK-7 expression is a sensitive marker of bile duct injury, which correlated well with histological stages of primary biliary cirrhosis, copper deposits, and biochemical markers of cholestasis: serum bilirubin level and alkaline phosphatase activity. Evaluation of CK-7 expression may improve the diagnosis of this serious and progressive disease. It is recommended to evaluate copper staining together with cytokeratin 7 expression in liver biopsy specimens for more precise diagnostic evaluation of asymptomatic primary biliary cirrhosis. Full article

130 KiB

Open AccessArticle

Giant Peptic Ulcer Hemorrhages: Epidemiology, Treatment, and Outcome in the Teaching Hospital of Tartu

by Ants Peetsalu, Ülle Kirsimägi and Margot Peetsalu

Medicina 2011, 47(1), 3; https://doi.org/10.3390/medicina47010003 - 11 Jan 2011

Cited by 1 | Viewed by 809

Abstract

The aim of the study was to analyze the management and outcome in the case of giant peptic ulcer hemorrhage (GPUH).
Material and Methods. We analyzed the data of all 372 cases of 348 patients treated for acute peptic ulcer hemorrhage during 2005–2007. [...] Read more.

The aim of the study was to analyze the management and outcome in the case of giant peptic ulcer hemorrhage (GPUH).
Material and Methods. We analyzed the data of all 372 cases of 348 patients treated for acute peptic ulcer hemorrhage during 2005–2007. The source and intensity of hemorrhage was assessed endoscopically according to the Forrest classifi cation: class I+II, persistent hemorrhage or signs of recent hemorrhage; and class III, ulcer without signs of recent hemorrhage. Of the 372 cases, 64 (17%) were GPUH (diameter, ≥2 cm) (group 1) and the remaining 308 (83%) were peptic ulcer hemorrhages of a standard size (SPUH) (diameter, <2 cm), which formed the control group (group 2).
Results. Forrest class I+II hemorrhage occurred significantly more frequently in the group 1 as compared with the group 2 (97% [62/64] vs. 77% [238/308]), as well as endoscopic hemostasis, (80% [51/64] vs. 57% [175/308]), repeat hemostasis procedures (22% [11/51] vs 6.3% [11/175]), and operative treatment (27.6% [16/58] vs 1.7% [5/290]) were needed more frequently in the group 1. No postoperative in-hospital deaths occurred in either group. Five patients died: 2 (3.4% [2/58]) in the group 1 and 3 (1.0% [3/290]) in the group 2.
Conclusions. GPUHs were more intensive as compared with SPUHs and needed more endoscopic hemostasis, including repeat procedures and operative treatment. Endoscopic hemostasis and operative treatment allowed reducing mortality due to GPUH to 3.4%. Full article

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Medicina, Volume 47, Issue 1 (January 2011) – 9 articles

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