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Medicina
Volume 47
Issue 10
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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 47, Issue 10 (October 2011) – 10 articles

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138 KiB  
Article
Blood Pressure Control in Treated Hypertensive Patients in Daily Practice of Latvian Family Physicians
by Inga Stukena, Daiva Asta Apanavičienė, Guntis Bahs, Andrejs Kalvelis, Vilnis Dzerve, Baiba Ansmite, Oskars Kalejs and Aivars Lejnieks
Medicina 2011, 47(10), 84; https://doi.org/10.3390/medicina47100084 - 05 Nov 2011
Cited by 3 | Viewed by 941
Abstract
Background and Objective. The aim of this study was to evaluate blood pressure (BP) control level in treated hypertensive patients in Latvia and to compare their characteristics according to the adequacy of BP control.
Materials and Methods. Family physicians collected information [...] Read more.
Background and Objective. The aim of this study was to evaluate blood pressure (BP) control level in treated hypertensive patients in Latvia and to compare their characteristics according to the adequacy of BP control.
Materials and Methods. Family physicians collected information on demographic and clinical characteristics, and current antihypertensive treatment of 455 18–80-year-old patients with essential arterial hypertension treated for 1 or more years. Target BP was defined as values of <140/90 mm Hg for patients with low or moderate cardiovascular risk and <135/85–125/75 mm Hg for patients with high or very high risk. BP was measured in the office setting after a 5-minute rest in a sitting position using a calibrated aneroid sphygmomanometer.
Results. Nearly half of patients (46.2%) attained their target BP. The proportion of patients with effective BP control was higher in the group of low and moderate added cardiovascular risk than in the high and very high added cardiovascular risk group (61.7% vs. 34.4%, P<0.0001). The majority of patients were given two-drug (26.2%) or three-drug (31.6%) combined antihypertensive therapy. Current pharmacological treatment was similar in the patients who attained target BP and in those who did not. Overall, physicians did not modify antihypertensive treatment in 37.9% of patients; such a recommendation was more common among patients with controlled BP. Very few patients (7.4%) who did not attain target BP did not receive recommendations to modify antihypertensive treatment.
Conclusions. The rate of effective BP control was less than 50% and was even worse (34.4%) in patients with high or very high added cardiovascular risk in the present sample of treated hypertensive patients. Full article
240 KiB  
Article
Epidemiologic, Clinical, and Molecular Characteristics of Hereditary Prostate Cancer in Latvia
by Andris Ābele, Egils Vjaters, Arvīds Irmejs, Genadijs Trofimovičs, Edvīns Miklaševičs and Jānis Gardovskis
Medicina 2011, 47(10), 83; https://doi.org/10.3390/medicina47100083 - 05 Nov 2011
Cited by 5 | Viewed by 902
Abstract
Background and Objective. Prostate cancer is one of the most commonly diagnosed malignancy affecting men in Latvia. The aim of this study was to evaluate the epidemiological features and molecular basis of hereditary prostate cancer in Latvia.
Material and Methods. A [...] Read more.
Background and Objective. Prostate cancer is one of the most commonly diagnosed malignancy affecting men in Latvia. The aim of this study was to evaluate the epidemiological features and molecular basis of hereditary prostate cancer in Latvia.
Material and Methods. A total of 1217 newly diagnosed prostate cancer patients were recruited in our study. Data were analyzed according to clinical diagnostic criteria for hereditary prostate cancer. Molecular testing for the founder mutation 657del5 of the NBS1 gene was performed for the first 280 prostate cancer patients and 173 control cases, and for the founder mutations 300T/G, 4153delA, and 5382insC of the BRCA1 gene for 112 prostate cancer patients with a history of breast or ovarian cancer in their families.
Results. Of the 1217 families, 14 (1.2%; 95% CI, 0.7%–1.9%) matched clinical diagnostic criteria for definitive hereditary prostate cancer, and of the 1217 families, 196 (16.1%; 95% CI, 14.1%–18.3%) for suspected hereditary prostate cancer. The founder mutation of the NBS1 gene was detected in 1 (0.4%, 95% CI, 0.1%–2.0%) of the 280 cases in the prostate cancer group and in 1 (0.6%; 95% CI, 0.1%–3.2%) of the 173 cases in the control group. The mutation 5382insC of the BRCA1 gene was detected in 2 (1.8%; 95% CI, 0.5%–6.3%) of the 112 cases analyzed in the prostate cancer group. No other BRCA1 founder mutations were detected.
Conclusions. Our study did not reveal predisposition genes for hereditary prostate cancer as the founder mutations of the BRCA1 and NBS1 genes are rarely detected in Latvia, but showed the importance of evaluation risk individually as a positive family history of cancer was associated with the earlier onset of prostate cancer. Full article
313 KiB  
Article
Analysis of Body Composition of 9- and 10-Year-Old Children in Latvia
by Helena Karklina, Peteris Apinis, Liga Kalnina, Melita Sauka, Dzintars Mozgis, Dzanna Krumina and Gundega Knipse
Medicina 2011, 47(10), 82; https://doi.org/10.3390/medicina47100082 - 05 Nov 2011
Cited by 3 | Viewed by 1005
Abstract
Background and Objective. According to the data of epidemiologic research, the prevalence of both excessive and insufficient body weight is increasing in a pediatric population leading to the growing burden of health problems due to these changes. The aim of the study [...] Read more.
Background and Objective. According to the data of epidemiologic research, the prevalence of both excessive and insufficient body weight is increasing in a pediatric population leading to the growing burden of health problems due to these changes. The aim of the study was to understand the current situation of physical development of 9- and 10-year-old boys and girls in Latvia and to estimate the prevalence of underweight, normal weight, overweight, and obesity among young adolescents.
Material and Methods. During 2007–2009, a random sample of healthy 9-year-old (n=184) and 10-year-old (n=320) children from all regions and different socioeconomic groups of Latvia was surveyed in a cross-sectional study. The anthropometric measurements of height, weight, 3 circumferences, and 5 skinfolds were performed. The percentage of body fat was calculated by the equation of Slaughter et al. Body mass index and fat mass index were calculated for each respondent. Children were divided into groups according to these indexes. At the age of 9 years, 69.5% of boys had a normal nutritional level either by BMI or FMI, and 54.5% and 72.2% of the girls of the same age had a normal nutritional level by BMI and by FMI, respectively. Obesity according to BMI in 9-year-old boys was found to be 4.7% and in girls 6.1%; according to FMI, 3.7% and 2.3%, respectively. A similar trend was also observed in the cohort of 10-year-old children.
Conclusions. The results of the research showed that the problem of high prevalence of Latvian children with underweight is not smaller than the problem of children with obesity. Evaluation of physical development in children based only body mass index may lead to overdiagnosis of obesity. Full article
1646 KiB  
Article
Plexus brachialis Strain and Compression Deformation in the Costo-Axillary-Brachial Region: A Cadaveric Study
by Edgars Vasilevskis, Sandra Skuja, Irina Evansa, Eva Šteina, Anna Sondore Pīlipa, Grigorijs Vābels, Uldis Teibe, Haralds Jansons, Valērija Groma and Indulis Vanags
Medicina 2011, 47(10), 81; https://doi.org/10.3390/medicina47100081 - 05 Nov 2011
Cited by 5 | Viewed by 1030
Abstract
Objective. The aim of this study was to clarify the role of different mechanisms in nerve injury during arm abduction positions. The tasks were to determine the strain deformation of the plexus brachialis during arm abduction, to measure the pressures in the [...] Read more.
Objective. The aim of this study was to clarify the role of different mechanisms in nerve injury during arm abduction positions. The tasks were to determine the strain deformation of the plexus brachialis during arm abduction, to measure the pressures in the neurovascular bundle in the cervico-costoclavicular-axillary area, and evaluate the histological changes of nerve after the stretch test.
Material and Methods. During the cadaveric study on 7 specimens 7–20 h after death, strain deformation of plexus brachialis as well as compression deformation caused by the surrounding structures of the neurovascular bundle were investigated in the arm abduction position of 0°, 90°, 12°, 150°, and 180°. One nerve sample was studied histologically after 15% stretch on the bench.
Results. The relative strain deformation of 3%–23% was documented during 0° to 180° abduction tests. The strain deformation from 0° to 90° was significant (P<0.001). The mean pressure change in the bundle was 13.6 mm Hg at 90°, 53.7 mm Hg at 120°, 73.4 mm Hg at 150°, and 89.0 mm Hg at 180° arm abduction. An increase in pressure was significant in the intervals: 0°–90° (P<0.001), 91°–120° (P<0.001), 121°–150° (P<0.001) and 151°–180° (P<0.05).
Conclusions. Nerve traction and tissue compression arising during the arm abduction above 90° were found to be sufficient to induce lesions in neural bundles of the plexus brachialis. Full article
1568 KiB  
Article
An In Vitro and In Vivo Study on the Intensity of Adhesion and Colonization by Staphylococcus epidermidis and Pseudomonas aeruginosa on Originally Synthesized Biomaterials With Different Chemical Composition and Modified Surfaces and Their Effect on Expression of TNF-α, β-Defensin 2 and IL-10 in Tissues
by Aigars Reinis, Māra Pilmane, Agnese Stunda, Jānis Vētra, Juta Kroiča, Dagnija Rostoka, Ģirts Šalms, Antons Vostroilovs, Aleksejs Dons and Līga Bērziņa-Cimdiņa
Medicina 2011, 47(10), 80; https://doi.org/10.3390/medicina47100080 - 05 Nov 2011
Cited by 7 | Viewed by 899
Abstract
The aim of this study was to determine adhesion and colonization of bacteria on the surface of originally synthesized glass-ceramic biomaterials and their effect on inflammation reactions in tissues surrounding the implant.
Materials and Methods. Biomaterial discs were contaminated with bacterial suspensions of [...] Read more.
The aim of this study was to determine adhesion and colonization of bacteria on the surface of originally synthesized glass-ceramic biomaterials and their effect on inflammation reactions in tissues surrounding the implant.
Materials and Methods. Biomaterial discs were contaminated with bacterial suspensions of 10, 102, and 103 colony forming units (CFU)/mL (P. aeruginosa ATCC 27853 and S. epidermidis ATCC 12228), and after 2 hours of cultivation, the intensity of bacterial adhesion was determined. For in vivo tests, the samples were contaminated with 102 and 103 CFU/mL cultivated at 37oC for 2 h to ensure bacterial adhesion. Contaminated biomaterial samples were implanted in the interscapular area of chinchilla rabbits for 2 and 4 weeks. The biomaterials were removed, and using plate count and sonification methods, bacterial colonization on the surface of biomaterials was determined. Moreover, the expression of TNF-α, β-defensin 2, and IL-10 in the surrounding tissues was assessed by using immunohistochemistry methods.
Results. P. aeruginosa more intensively colonized biomaterials in the in vivo study as compared with S. epidermidis. Il-10 is a regulatory cytokine, which reduces the intensity of inflammatory cell activity, thus reducing nonspecific resistance of the organism.
Conclusions. The expression of TNF-α and IL-10 was not affected by short (2 and 4 weeks) biomaterial implantation. Pronounced cytokine expression in tissues around implanted biomaterials contaminated with P. aeruginosa was observed. Full article
431 KiB  
Article
Mildronate as a Regulator of Protein Expression in a Rat Model of Parkinson’s Disease
by Sergejs Isajevs, Darja Isajeva, Ulrika Beitnere, Baiba Jansone, Ivars Kalvinsh and Vija Klusa
Medicina 2011, 47(10), 79; https://doi.org/10.3390/medicina47100079 - 05 Nov 2011
Cited by 14 | Viewed by 1035
Abstract
Background. Mildronate (3-[2,2,2-trimethylhydrazinium] propionate dihydrate) traditionally is a well-known cardioprotective drug. However, our recent studies convincingly demonstrated its neuroprotective properties. The aim of the present study was to evaluate the influence of mildronate on the expression of proteins that are involved in [...] Read more.
Background. Mildronate (3-[2,2,2-trimethylhydrazinium] propionate dihydrate) traditionally is a well-known cardioprotective drug. However, our recent studies convincingly demonstrated its neuroprotective properties. The aim of the present study was to evaluate the influence of mildronate on the expression of proteins that are involved in the differentiation and survival of the nigrostriatal dopaminergic neurons in the rat model of Parkinson’s disease (PD). The following biomarkers were used: heat shock protein 70 (Hsp70, a molecular chaperone), glial cell line-derived nerve growth factor (GDNF, a growth factor promoting neuronal differentiation, regeneration, and survival), and neural cell adhesion molecule (NCAM).
Material and Methods. PD was modeled by 6-hydroxydopamine (6-OHDA) unilateral intrastriatal injection in rats. Mildronate was administered at doses of 10, 20, and 50 mg/kg for 2 weeks intraperitoneally before 6-OHDA injection. Rat brains were dissected on day 28 after discontinuation of mildronate injections. The expression of biomarkers was assessed immunohistochemically and by Western blot assay.
Results. 6-OHDA decreased the expression of Hsp70 and GDNF in the lesioned striatum and substantia nigra, whereas in mildronate-pretreated (20 and 50 mg/kg) rats, the expression of Hsp70 and GDNF was close to the control group values. NCAM expression also was decreased by 6-OHDA in the striatum and it was totally protected by mildronate at a dose of 50 mg/kg. In contrast, in the substantia nigra, 6-OHDA increased the expression of NCAM, while mildronate pretreatment (20 and 50 mg/kg) reversed the 6-OHDA-induced overexpression of NCAM close to the control values.
Conclusion. The obtained data showed that mildronate was capable to regulate the expression of proteins that play a role in the homeostasis of neuro-glial processes. Full article
140 KiB  
Article
A Dose-Dependent Improvement in Exercise Tolerance in Patients With Stable Angina Treated With Mildronate: A Clinical Trial “MILSS I”
by Vilnis Dzerve and MILSS I Study Group
Medicina 2011, 47(10), 78; https://doi.org/10.3390/medicina47100078 - 05 Nov 2011
Cited by 27 | Viewed by 1237
Abstract
Objective. To assess the efficacy of various doses of Mildronate in combination with standard therapy for the exercise tolerance of patients with stable angina pectoris. The primary efficacy variable was the change in exercise time in bicycle ergometry from the baseline to [...] Read more.
Objective. To assess the efficacy of various doses of Mildronate in combination with standard therapy for the exercise tolerance of patients with stable angina pectoris. The primary efficacy variable was the change in exercise time in bicycle ergometry from the baseline to 12 weeks of treatment. The secondary endpoints were the changes in maximum achieved load and time to the onset of angina from the baseline to week 12.
Material and Methods. A total of 512 patients with chronic coronary heart disease who had ischemia as the limiting factor in the exercise test from 72 study centers in 4 countries were enrolled in this prospective, randomized, double-blind, placebo controlled phase 2 study. The patients were assigned to either 4 groups receiving standard therapy plus Mildronate at different daily doses or 1 group receiving standard therapy plus placebo.
Results. The mean change in the total exercise time in the mildronate 100 mg and mildronate 300 mg groups was –2.12±108.45 and 11.48±62.03 seconds, respectively. The mean change for the placebo group was –7.10±81.78 seconds. The difference between Mildronate 100 mg and 300 mg and placebo groups was not significant. Patients in the Mildronate 1000 mg group showed a remarkable increase in the mean change in the total exercise time (35.18±53.29 seconds, P=0.002). Mildronate at a dose of 3000 mg caused a smaller increase as compared with a dose of 1000 mg. Similar changes in the secondary end parameters were observed.
Conclusion. The most effective dose of Mildronate in combination with standard therapy was found to be 500 mg twice a day. Full article
376 KiB  
Article
Are Paclitaxel-Eluting Stents Better in Unprotected Left Main Coronary Artery Disease? Three-Year Clinical and Intravascular Imaging Results From a Randomized Study
by Inga Narbute, Sanda Jegere, Indulis Kumsars, Iveta Mintale, Ilja Zakke, Kristine Bumeistere, Dace Sondore, Alona Grave and Andrejs Erglis
Medicina 2011, 47(10), 77; https://doi.org/10.3390/medicina47100077 - 05 Nov 2011
Cited by 3 | Viewed by 864
Abstract
Background and Objective. Recent publications have demonstrated superior outcomes in unprotected left main patients after paclitaxel-eluting stent (PES) implantation. Long-term data in these patients are limited. The aim of this study was to evaluate if intravascular ultrasound (IVUS)-guided PES implantation is superior [...] Read more.
Background and Objective. Recent publications have demonstrated superior outcomes in unprotected left main patients after paclitaxel-eluting stent (PES) implantation. Long-term data in these patients are limited. The aim of this study was to evaluate if intravascular ultrasound (IVUS)-guided PES implantation is superior to bare metal stent (BMS) implantation in unprotected left main disease after lesion pretreatment with cutting balloon during long-term follow-up.
Material and Methods. Unprotected left main patients were randomized to BMS (n=50) or PES implantation (n=53). All interventions were IVUS-guided and cutting balloon pretreatment before stenting was performed in all patients. All patients were scheduled for 6-month and 3-year follow-up. Subgroups of patients who underwend IVUS and OCT imaging at 3-year follow-up were analyzed. The primary endpoint was the major adverse cardiac events (MACEs) defined as death, Q-wave myocardial infarction, or target lesion revascularization.
Results. Baseline characteristics were similar in both the groups with a mean SYNTAX score of 31.4±14.5 in BMS and 32.6±11.7 in PES patients (P=0.718). At 3 years, MACEs occurred in 18 patients (36.0%) in the BMS and 7 patients (13.2%) in the PES group (P=0.011). By IVUS, percent neointimal volume obstruction at 3 years was reduced from 18.1%±8.7% with BMSs to 10.0%±5.4% with PESs (P<0.001). The total number of uncovered stent struts per OCT image and IVUS image was 0.4±0.8 and 1.2±1.5, respectively (P<0.001).
Conclusions. The current study demonstrated that IVUS-guided PES implantation was superior to BMS implantation after cutting balloon pretreatment in unprotected left main disease at 3 years. If compared with IVUS, OCT was more precise in the assessment of stent endothelization. Full article
115 KiB  
Article
The Prevalence of Viral Hepatitis C in Latvia: A Population-Based Study
by Ieva Tolmane, Baiba Rozentale, Jazeps Keiss, Frida Arsa, Girts Brigis and Aivars Zvaigzne
Medicina 2011, 47(10), 76; https://doi.org/10.3390/medicina47100076 - 05 Nov 2011
Cited by 19 | Viewed by 983
Abstract
Background and Objective. Chronic viral hepatitis C (VHC) is one of the most discussed infectious diseases worldwide. The number of infected persons worldwide is approximately 170 million, and in Europe, it exceeds 9 million. The aim of this study was to determine [...] Read more.
Background and Objective. Chronic viral hepatitis C (VHC) is one of the most discussed infectious diseases worldwide. The number of infected persons worldwide is approximately 170 million, and in Europe, it exceeds 9 million. The aim of this study was to determine the prevalence of antibodies to hepatitis C virus (anti- HCV prevalence) and prevalence of HCV viremia (HCV-RNA prevalence) in Latvia.
Material and Methods. A multistage randomized selection was used. A total of 42 primary care physicians (PCPs) were randomly selected from the register of PCPs from different regions of Latvia. From each PCP register, 60 subjects were selected (1651 individuals in total) and invited for the anti-HCV test with a screening method (ELISA). In case of positive results, antibodies were confirmed by the Western blot test, and all these subjects were tested for HCV-RNA by polymerase chain reaction.
Results. Of the 1459 subjects tested, 57 were positive for anti-HCV (3.9%; 95% CI 3% to 5%); 35 of them were positive for anti-HCV with a confirmatory test (2.4%; 95% CI, 1.7% to 3.3%): 19 men and 16 women (3.8% and 1.7%, respectively; P=0.011). The results of HCV RNA test were positive in 25 subjects (1.7%; 95% CI, 1.2% to 2.5%): 15 men and 10 women (3% and 1% respectively, P=0.019).
Conclusions. The prevalence of anti-HCV and HCV-RNA in Latvia was found to be 2.4% and 1.7%, respectively. The prevalence of anti-HCV and HCV-RNA was higher in men than women. Full article
117 KiB  
Article
Human Herpesvirus 6 and 7 Reactivation and Disease Activity in Multiple Sclerosis
by Zaiga Nora-Krukle, Svetlana Chapenko, Inara Logina, Andrejs Millers, Ardis Platkajis and Modra Murovska
Medicina 2011, 47(10), 75; https://doi.org/10.3390/medicina47100075 - 05 Nov 2011
Cited by 31 | Viewed by 1313
Abstract
Recent studies have focused on the associations between human herpesvirus 6 (HHV-6) and human herpesvirus 7 (HHV-7), and multiple sclerosis (MS). The aim of this study was to investigate the associations between HHV-6 and HHV-7 reactivation and MS disease activity, and interleukin 12 [...] Read more.
Recent studies have focused on the associations between human herpesvirus 6 (HHV-6) and human herpesvirus 7 (HHV-7), and multiple sclerosis (MS). The aim of this study was to investigate the associations between HHV-6 and HHV-7 reactivation and MS disease activity, and interleukin 12 (IL-12) and tumor necrosis factor α (TNF-α) production.
Material and Methods. The frequency of plasma viremia by nested polymerase chain reaction and transcription of viral mRNA in peripheral blood mononuclear cells by reverse transcriptasepolymerase chain reaction (RT-PCR) of 14 relapsing/remitting (RR) and 14 secondary progressive (SP) MS patients were studied in comparison with clinical manifestation of the disease. Serum concentrations of cytokines IL-12 and TNF-α were analyzed by enzyme-linked immunosorbent assay.
Results. Plasma samples from 25 of the 28 MS patients with estimated latent/persistent HHV-6 and/or HHV-7 infection were examined during relapse and remission/relative remission. HHV-6 reactivation was found in 4 of the 7 RRMS and 4 of the 7 SPMS patients, and HHV-7 reactivation was identified in 3 of the 7 RRMS and 1 of the 7 SPMS patients (all in relapse). In 2 of the 3 RRMS patients without viremia in relapse, HHV-6 mRNA transcription was detected. In RRMS and SPMS patients with active HHV-6 and HHV-7 infection in relapse, the serum concentrations of IL-12 and TNF-α were significantly higher than in those with latent virus infection.
Conclusions. HHV-6 and HHV-7 reactivation could be implicated in the exacerbation of MS via activation of Th1 lymphocyte subsets. Full article
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