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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 4 (April 2011) – 8 articles

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138 KiB  
Article
Intra-Aortic Balloon Counterpulsation in Acute Myocardial Infarction Complicated by Cardiogenic Shock
by Andrius Macas, Tomas Bukauskas, Ilona Šuškevičienė, Giedrė Bakšytė, Linas Pieteris, Tomas Tamošiūnas, Audra Mundinaitė and Remigijus Žaliūnas
Medicina 2011, 47(4), 30; https://doi.org/10.3390/medicina47040030 - 23 Apr 2011
Cited by 1 | Viewed by 793
Abstract
Acute myocardial infarction complicated by cardiogenic shock is one of the main reasons of death in severely ill patients. One of the main indications for intra-aortic balloon counterpulsation is acute myocardial infarction complicated by cardiogenic shock. Aortic counterpulsation is associated with the risk [...] Read more.
Acute myocardial infarction complicated by cardiogenic shock is one of the main reasons of death in severely ill patients. One of the main indications for intra-aortic balloon counterpulsation is acute myocardial infarction complicated by cardiogenic shock. Aortic counterpulsation is associated with the risk of several important complications: bleeding, thrombosis, thrombocytopenia, limb ischemia, and aortic wall damage. The analysis of complications is necessary to better understand the course of myocardial infarction using aortic counterpulsation and to reduce the risk of complications. The aim of the study was to analyze the course of acute myocardial infarction complicated by cardiogenic shock in patients managed by intra-aortic balloon counterpulsation as well as to determine intra-aortic balloon counterpulsation-related complications.
Material and Methods
. The course of acute myocardial infarction complicated by cardiogenic shock in patients with aortic counterpulsation was analyzed. Patients were recruited from the Cardiology Intensive Care Unit, Department of Cardiology, Lithuanian University of Health Sciences, during the period of 2004–2010. The study comprised 73 patients: 30 women (41.1%) and 43 men (58.9%).
Results
. Atrial fibrillation and asystolia were the most common cardiac complications during counterpulsation. Atrioventricular block was the predominant disorder of cardiac conduction system; acute renal failure was the most common noncardiac complication. Complications such as major bleeding, infection, aortic wall damage, or amputations were not documented in our study. Successful percutaneous coronary intervention was associated with fewer complications and reduced mortality rate.
Conclusions
. Aortic counterpulsation may be successfully employed providing significant hemodynamic support with rare major complications in a high-risk patient population. A unique finding of this study is a high rate of successful applications of aortic counterpulsation. Full article
131 KiB  
Article
The Impact of Surgical Ventricular Restoration on Ischemic Mitral Regurgitation
by Irena Butkuvienė and Loreta Ivaškevičienė
Medicina 2011, 47(4), 29; https://doi.org/10.3390/medicina47040029 - 23 Apr 2011
Cited by 1 | Viewed by 738
Abstract
Objective. The aim of current study was to evaluate and compare the changes in clinical status and mitral regurgitation (MR) grade and long-term postoperative survival after left ventricle surgical restoration (SVR) operations.
Material and Methods.
We retrospectively analyzed the data of 139 [...] Read more.
Objective. The aim of current study was to evaluate and compare the changes in clinical status and mitral regurgitation (MR) grade and long-term postoperative survival after left ventricle surgical restoration (SVR) operations.
Material and Methods.
We retrospectively analyzed the data of 139 patients suffering from ischemic heart disease and left ventricular aneurysms or large akinesia, who underwent SVR and coronary artery bypass grafting without MR surgical correction between 1999 and 2006. The mean long-term postoperative follow-up was 3.6 years (SD, 3.0). Nine patients (6.5%) died during the first 30 postoperative days.
Results. The mean MR grade during the long-term period increased significantly. The univariate logistic regression analysis showed that factors for the long-term mortality were age (P=0.002), decompensation signs before SVR (P=0.03), treatment with diuretics (P=0.01), NYHA functional class IV (P=0.008), and moderate and severe MR (P=0.04); however, multivariate logistic regression analysis demonstrated that only patient’s age was an independent predictive factor (P=0.004). MR correction was found to be a significant prognostic factor of borderline significance for perioperative mortality (P=0.05). The analysis of MR grade (mild versus moderate versus severe) impact on long-term survival failed to demonstrate any association (P=0.22).
Conclusions. Remodeling continued during the long-term period after SVR and CABG: there was an increase in the mean MR degree. Left ventricular remodeling with moderate and severe MR decreased survival rates during long-term period after surgical ventricular restoration; however, mitral regurgitation was not found to be an independent predictor of poor outcome. Full article
361 KiB  
Article
Gastroesophageal Reflux and Idiopathic Pulmonary Fibrosis: A Prospective Study
by Ahmed Fahim, Peter W. Dettmar, Alyn H. Morice and Simon P. Hart
Medicina 2011, 47(4), 28; https://doi.org/10.3390/medicina47040028 - 23 Apr 2011
Cited by 32 | Viewed by 1050
Abstract
Background and Objective. Idiopathic pulmonary fibrosis (IPF) is the most common of the idiopathic interstitial pneumonias. There is evidence of the increased prevalence of gastroesophageal reflux disease in patients with IPF. The aim of this prospective study was to evaluate reflux in patients [...] Read more.
Background and Objective. Idiopathic pulmonary fibrosis (IPF) is the most common of the idiopathic interstitial pneumonias. There is evidence of the increased prevalence of gastroesophageal reflux disease in patients with IPF. The aim of this prospective study was to evaluate reflux in patients with IPF by analyzing the scores of the reflux cough questionnaire, measurement of pepsin in exhaled breath condensate (EBC) to detect extraesophageal reflux, and Helicobacter pylori serology to evaluate the prevalence of this stomach bacterium in patients with IPF.
Material and Methods.
The Hull airway reflux questionnaire (HARQ) was completed by 40 patients with IPF and 50 controls in order to evaluate reflux symptoms. EBC was collected from 23 patients (17 patients with IPF and 6 controls) for measurement of pepsin by the lateral flow technique. A prospective study of 57 subjects (34 patients with IPF and 23 controls) for H. pylori antibody detection by ELISA was performed.
Results
. Significantly higher HARQ scores (maximum score, 70) were recorded in patients with IPF compared with controls (19.6 [SD, 12.4] vs. 3 [SD, 2.9], P<0.001). There was no significant difference in EBC pepsin positivity between patients with IPF and controls (2 of the 17 patients vs. none of the 6 controls, P=0.38). There was no significant difference in H. pylori serology between patients with IPF and controls (17 of the 34 patients vs. 14 of the 23 controls, P=0.42).
Conclusion. Patients with IPF had significantly increased scores of airway reflux symptoms. However, no objective evidence of extraesophageal reflux or H. pylori infection in patients with IPF was obtained in this study. The role of gastroesophageal and extraesophageal reflux in pathogenesis of IPF should be evaluated in a larger prospective study. Full article
852 KiB  
Article
Takotsubo Cardiomyopathy in Association With Hyperthyroidism
by Ahmad Syadi Mahmood Zuhdi, Zul Hilmi Yaakob, Muhammad Athar Sadiq, Muhammad Dzafir Ismail, Abdul Wahab Undok and Wan Azman Wan Ahmad
Medicina 2011, 47(4), 31; https://doi.org/10.3390/medicina47040031 - 20 Apr 2011
Cited by 1 | Viewed by 893
Abstract
Takotsubo cardiomyopathy is a rare, acute, nonischemic cardiomyopathy causing transient left ventricular dysfunction, which can mimic myocardial infarction on its presentation. While many cardiac manifestations have been associated with hyperthyroidism, we report a rare case where it has precipitated takotsubo cardiomyopathy. Full article
165 KiB  
Article
Total Antioxidant Capacity of Venous Blood, Blood Plasma, and Serum of Patients With Periodontitis, and the Effect of Traumeel S on These Characteristics
by Juozas Žilinskas, Ričardas Kubilius, Gediminas Žekonis and Jonas Žekonis
Medicina 2011, 47(4), 27; https://doi.org/10.3390/medicina47040027 - 20 Apr 2011
Cited by 10 | Viewed by 946
Abstract
Introduction. Periodontal diseases are among the most common chronic infections in humans. Chronic low-level bacteremia and a septicemic inflammatory response have been suggested as a pathogenetic link between periodontal disease and atherosclerosis, diabetes and other systemic diseases. All this significantly increases the [...] Read more.
Introduction. Periodontal diseases are among the most common chronic infections in humans. Chronic low-level bacteremia and a septicemic inflammatory response have been suggested as a pathogenetic link between periodontal disease and atherosclerosis, diabetes and other systemic diseases. All this significantly increases the relevance of the search for the means for treatment and prevention of periodontal diseases. The aim of the present study was to evaluate blood count and the antioxidant capacity of venous blood, blood plasma, and serum in patients with periodontitis and control subjects with healthy periodontal tissues, and to investigate the effect of the homeopathic medication Traumeel S on the antioxidant capacity of venous blood, plasma, and serum.
Material and Methods.
The study was performed using venous blood of 21 individuals with chronic periodontitis and 22 healthy subjects. Reduction properties of venous blood, blood plasma, and serum were investigated using the method of reduction of nitroblue tetrazolium, proposed by Demehin et al.
Results. The data showed that there was no significant difference in venous blood hemoglobin levels or erythrocyte counts between the groups, while significantly higher leukocyte counts were observed in the periodontitis group (P<0.05). The antioxidant capacity of blood plasma was significantly higher in the periodontitis group than it was in the controls (P<0.05). Meanwhile, the antioxidant capacity of serum was significantly lower in the periodontitis group as compared with controls (P<0.05). The preparation Traumeel S had no effect on the antioxidant capacity of venous blood or blood plasma in the studied groups.
Conclusions. Compared to healthy individuals, the antioxidant capacity of blood plasma in patients with periodontitis was higher, while the antioxidant capacity of serum was lower. The homeopathic medication Traumeel S had no effect on the antioxidant capacity of venous blood, blood plasma, or serum. Our findings concerning the elevated leukocyte counts in venous blood of patients with periodontitis confirm the presumption that periodontal diseases cause low-grade systemic inflammation induced by the host response to periodontal bacteria. Full article
183 KiB  
Article
β-adrenoblokatorių, AKF slopiklių, kalcio antagonistų, diuretikų, antikoaguliantų, antiagregantų, širdį veikiančių glikozidų ir fizinio krūvio poveikis krešėjimo sistemos rodmenims sergant lėtiniu širdies nepakankamumu
by Aušra Mongirdienė
Medicina 2011, 47(4), 34; https://doi.org/10.3390/medicina47040034 - 19 Apr 2011
Cited by 1 | Viewed by 821
Abstract
Moksliniais tyrimais įrodyta, jog sergančiųjų lėtiniu širdies nepakankamumu (LŠN) krešėjimo sistema yra aktyvesnė nei sveikų žmonių. Todėl šio tyrimo tikslas buvo peržvelgti literatūros duomenis apie krešėjimo sistemos rodmenų pokyčius gydant LŠN sergančius ligonius β-adrenoblokatoriais, AKF slopikliais, kalcio antagonistais, diuretikais, antikoaguliantais, antiagregantais, širdį veikiančiais [...] Read more.
Moksliniais tyrimais įrodyta, jog sergančiųjų lėtiniu širdies nepakankamumu (LŠN) krešėjimo sistema yra aktyvesnė nei sveikų žmonių. Todėl šio tyrimo tikslas buvo peržvelgti literatūros duomenis apie krešėjimo sistemos rodmenų pokyčius gydant LŠN sergančius ligonius β-adrenoblokatoriais, AKF slopikliais, kalcio antagonistais, diuretikais, antikoaguliantais, antiagregantais, širdį veikiančiais glikozidais ir fiziniu krūviu. Nustatyta, kad atskirai vartojami β-adrenoblokatoriai mažina trombocitų agregaciją, o AKF slopikliai – ir P-selektino ekspresiją; MMMH mažina protrombino fragmentų, D-dimerų, o geriamieji antikoaguliantai – interleukin-6, von Vilebrando faktoriaus, tarpląstelinių adhezijos molekulių, fibrinogeno fragmentų 1+2, didina plazminogeno aktyvintojo slopiklio koncentracijas; taip pat antikoaguliantai mažina VII:C faktoriaus ir trombino-antitrombino komplekso koncentraciją. Vartojant aspiriną kartu su klopidogreliu, sumažėja tarpląstelinių bei trombocitų-endotelio adhezijos molekulių koncentracija ir P-selektino ekspresija, nors, vartojant tik aspiriną, šių žymenų koncentracijos nekinta. Gydant AKF inhibitoriais, kalcio antagonistais ir β-adrenoblokatoriais, mažėja DATL, D-dimerų, plazminogeno aktyvintojo slopiklio, kraujagyslių adhezijos molekulių, trombocitų tankiųjų granulių baltymo koncentracijos, L- ir P-selektinų ekspresija. Nagrinėjant minėtų gydymo priemonių įtaką konkretiems krešėjimo sistemos rodmenims, būtina pastebėti, kad skirtingų autorių duomenys ne visada sutampa. Todėl konkrečių vaistų poveikis konkretiems hemostazės rodmenims dar nepakankamai ištirtas. Full article
143 KiB  
Article
Competence of Nurses and Factors Associated With It
by Natalja Istomina, Tarja Suominen, Artūras Razbadauskas, Arvydas Martinkėnas, Riitta Meretoja and Helena Leino-Kilpi
Medicina 2011, 47(4), 33; https://doi.org/10.3390/medicina47040033 - 19 Apr 2011
Cited by 54 | Viewed by 3079
Abstract
Objective. Nurse competence became a relevant topic for discussion among nurse practitioners and nurse researchers. However, the factors connected with nurse competence need deeper exploring. The aim of this study was to explore nurse competence and factors associated with it from the [...] Read more.
Objective. Nurse competence became a relevant topic for discussion among nurse practitioners and nurse researchers. However, the factors connected with nurse competence need deeper exploring. The aim of this study was to explore nurse competence and factors associated with it from the perspective of nurses for predicting the possible ways for upgrading the nursing practice.
Materials and Methods. A multicenter, descriptive study was performed in 11 surgical wards of 7 Lithuanian hospitals. Data were collected from November 2007 to January 2008. Lithuanian nurses (n=218) who were working with patients after abdominal surgery participated in this study. The response rate was 91%. Two instruments, both originally developed in Finland, were used: the Nurse Competence Scale and the Good Nursing Care Scale for Nurses.
Results. The overall level of nurse competence and the frequency of using the competencies in practice as perceived by nurses were high. Nurses assessed the competencies in managing situations and work role the highest and in teaching-coaching and ensuring quality the lowest. Sociodemographic factors such as nurse education, experience, professional development, independence, and work satisfaction as well as the evaluation of quality of nursing care were identified as factors associated with nurse competence.
Conclusions
. The findings of study allow us to make the assumption that nurse education, nurse experience, and nurse professional development play a significant role in the evaluation of nurse competence as well as the evaluation of quality of nursing care. It is necessary to upgrade nursing education programs at all levels of nursing education in Lithuania: university, non-university, and professional development courses. The qualities of preconditions for nursing care, cooperation with relatives, caring and supporting initiative are related to nurse competence. Full article
451 KiB  
Article
Cigarette Smoking and Trends in Lung Cancer Incidence in Lithuania: An Analysis by Histological Type
by Rūta Everatt, Irena Kuzmickienė and Andrius Senulis
Medicina 2011, 47(4), 32; https://doi.org/10.3390/medicina47040032 - 19 Apr 2011
Viewed by 845
Abstract
Objective. The aim of this study was to investigate time trends of lung cancer incidence by histological type in Lithuania during the period from 1996 to 2005. The results were evaluated in relation to tobacco smoking trends.
Material and Methods.
The incidence [...] Read more.
Objective. The aim of this study was to investigate time trends of lung cancer incidence by histological type in Lithuania during the period from 1996 to 2005. The results were evaluated in relation to tobacco smoking trends.
Material and Methods.
The incidence rates of the most common lung cancer cell types (squamous cell carcinoma, adenocarcinoma, small cell carcinoma, other types, and morphologically not specified cases) were studied using data from the Lithuanian Cancer Registry. The world standard population was used for age adjustment. Data on tobacco smoking in Lithuania were obtained from various published sources.
Results
. Among men, squamous cell carcinoma was the most common type of lung cancer. The age-adjusted rates of squamous cell carcinoma decreased from 25 per 100 000 in 1998–1999 to 19.1 per 100 000 in 2004–2005; the incidence rates for adenocarcinoma and small cell carcinoma rose to around 7 per 100 000 in 2002–2003. Among women, adenocarcinoma was the most common histological type. The incidence rates for adenocarcinoma increased to 1.9 per 100 000 until 2002–2003 and thereafter did not change. The rates of squamous cell carcinoma in women were relatively stable at around 1.1 per 100 000. In 2000, the prevalence of regular smoking among men and women peaked at 51.5% and 15.8%, respectively; there was a significant change from smoking nonfilter cigarettes to filter cigarettes.
Conclusions
. The decreasing squamous cell carcinoma rates among men and increasing adenocarcinoma rates among men and women are similar to those reported in other European countries and may be due to a shift from nonfilter type cigarettes to filter type. Full article
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