Medicina

192 KiB

Open AccessArticle

Paracetamol and Simvastatin: A Potential Interaction Resulting in Hepatotoxicity

by Gintautas Gumbrevičius, Audrius Sveikata, Renata Sveikatienė and Edgaras Stankevičius

Medicina 2012, 48(7), 56; https://doi.org/10.3390/medicina48070056 - 04 Aug 2012

Cited by 6 | Viewed by 1129

The safety profile of paracetamol and simvastatin is sufficiently well known, although no interactions between these two medicinal products have been described in the scientific literature so far. A 66-year-old female patient who experienced myocardial infarction and underwent coronary artery bypass grafting 9 [...] Read more.

The safety profile of paracetamol and simvastatin is sufficiently well known, although no interactions between these two medicinal products have been described in the scientific literature so far. A 66-year-old female patient who experienced myocardial infarction and underwent coronary artery bypass grafting 9 years ago was taking simvastatin at a daily dose of 10 mg. Liver enzyme tests were carried out regularly, and their results were always normal. Later on, the patient took 6 tablets of fixed combination medicinal product Gripex^TM (paracetamol, pseudoephedrine, and dextromethorphan) per day due to a fever. The daily dose of paracetamol taken by the patient totaled 1.95 g. The patient developed severe jaundice, nausea, vomiting; blood bilirubin levels increased more than 3 times; alanine transaminase, more than 10 times; and asparagine transaminase, more than 5 times. Paracetamol is metabolized by CYP enzymes (CYP2E1, 1A2, 2A6, 3A4) to a reactive metabolite, N-acetyl-p-benzoquinone-imine (NAPQI). Under conditions of excessive NAPQI formation or reduction in glutathione stores by approximately 70%, NAPQI covalently binds to the cysteinyl sulfhydryl groups of cellular proteins, forming NAPQI-protein adducts. Simvastatin is a substrate of CYP3A4 enzyme. Clinical and pharmacological data, available in the published literature, allow the assumption that simvastatin may induce CYP3A4 and result in increased hepatoxicity of paracetamol. Full article

222 KiB

Open AccessArticle

Sources and Reasons for Seeking Health Information by Lithuanian Adults

by Daiva Marazienė, Jūratė Klumbienė, Jūratė Tomkevičiūtė and Irena Misevičienė

Medicina 2012, 48(7), 55; https://doi.org/10.3390/medicina48070055 - 04 Aug 2012

Cited by 8 | Viewed by 983

Abstract

The aim of this study was to assess the attitudes of Lithuanian adults aged 20–64 years toward the reasons for accessing health information and to determine the main health information sources and their relation to sociodemographic factors.
Material and Methods. The data [...] Read more.

The aim of this study was to assess the attitudes of Lithuanian adults aged 20–64 years toward the reasons for accessing health information and to determine the main health information sources and their relation to sociodemographic factors.
Material and Methods. The data for this study were gathered in 2008 within the framework of the International Project Finbalt Health Monitor evaluating health behavior in a Lithuanian adult population.
Results. More than half of respondents searched for health information during the last year. Men were 2.7 times more likely to trust friends and family as a health information source compared with women. For each 1-year increase in age, the odds of using friends and family, and the Internet as the main sources of health information decreased, while the odds of using people with the same condition and different means of media increased. Marital status was associated with greater trust in health professionals and the Internet as health information sources. Higher education was positively associated with more frequent reporting courses and lectures, and the Internet as the sources of health information, while those with lower education preferred television and radio.
Conclusions. This study revealed the characteristics of the “risk group” in terms of the sources of health information that people, assigned to it, tend to use, and it is especially important when providing health information. Full article

219 KiB

Open AccessArticle

Changes in Caries Prevalence and Oral Hygiene Skills Among Preschool-Aged Children in Lithuania Between 2000 and 2010

by Jaunė Razmienė, Giedrius Vanagas, Eglė Aida Bendoraitienė, Vilija Andriuškevičienė and Eglė Slabšinskienė

Medicina 2012, 48(7), 54; https://doi.org/10.3390/medicina48070054 - 04 Aug 2012

Cited by 9 | Viewed by 960

Abstract

The aim of the study was to evaluate the factors associated with the prevalence and severity of dental caries as well oral hygiene habits among 4- to 6-year-old children in Kaunas (Lithuania) in 2000 and 2010.
Material and Methods. A repeated cross-sectional [...] Read more.

The aim of the study was to evaluate the factors associated with the prevalence and severity of dental caries as well oral hygiene habits among 4- to 6-year-old children in Kaunas (Lithuania) in 2000 and 2010.
Material and Methods. A repeated cross-sectional study was carried out to reveal the changes in dental caries prevalence in 2000 and 2010. The study population comprised 4- to 6-year-old children living in Kaunas city and attending kindergartens. The study consisted of two parts: questionnaires on oral health behavior and clinical examination of children’s teeth by the World Health Organization methodology.
Results. A total of 941 4–6-year-old children were examined in 2000 and 2010. The prevalence of dental caries increased from 85.4% in 2000 to 88.4% in 2010; however, the difference was not significant (P=0.28). A significant increase in the dmf-t index, describing the severity of dental caries, was observed (from 7.42 in 2000 to 12.03 in 2010, P<0.001). The percentage of 4- to 5-yearold girls and 5-year-old boys brushing their teeth regularly decreased in 2010. During the period of the study, a significant change in the accumulation of plaque on children’s tooth surfaces was documented (P=0.001).
Conclusions. Comparing 2000 and 2010, no significant difference in the prevalence of dental caries among 4- to 6-year-old children in Kaunas was observed; however, the severity of dental caries differed significantly. A significant decrease in regular toothbrushing skills was documented for 4- and 5-year-old girls and 5-year-old boys. The Silness-Loe oral hygiene index was assessed as satisfactory. Full article

281 KiB

Open AccessArticle

Associations Between TFPI-2 Methylation and Poor Prognosis in Glioblastomas Paulina Vaitkienė, Daina Skiriutė, Kęstutis Skauminas

by Paulina Vaitkienė, Daina Skiriutė, Kęstutis Skauminas and Arimantas Tamašauskas

Medicina 2012, 48(7), 51; https://doi.org/10.3390/medicina48070051 - 04 Aug 2012

Cited by 4 | Viewed by 931

Abstract

Background and Objective. The epigenetic silencing of tumor suppressor genes plays an important role in gliomagenesis. Recently, tissue factor pathway inhibitor 2 (TFPI-2) has been suggested as a tumor suppressor gene involved in tumorigenesis and metastasis in some cancers. However, to date, [...] Read more.

Background and Objective. The epigenetic silencing of tumor suppressor genes plays an important role in gliomagenesis. Recently, tissue factor pathway inhibitor 2 (TFPI-2) has been suggested as a tumor suppressor gene involved in tumorigenesis and metastasis in some cancers. However, to date, little is known about the methylation status of TFPI-2 gene in glioblastoma tissues. In this study, we aimed to investigate the methylation status of TFPI-2 promoter and its associations with patient prognosis in glioblastoma.
Material and Methods. The methylation status of TFPI-2 was investigated by methylationspecific polymerase chain reaction in 99 glioblastoma patients. The associations between patients’ clinical variables and overall survival time were assessed.
Results. TFPI-2 was aberrantly methylated in 22.2% (22/99) of glioblastoma tumors, but was not methylated in normal brain samples. The survival of patients with glioblastoma differed significantly between the methylated and unmethylated TFPI-2 groups (P=0.047). The 2-year survival among patients carrying methylated TFPI-2 tumors was significantly lower compared with that of patients with unmethylated TFPI-2 (27% versus 4.7%, P=0.037).
Conclusions. The present work demonstrated that the epigenetic inactivation of TFPI-2 by promoter hypermethylation was a frequent and tumor-specific event in glioblastoma, and TFPI-2 promoter methylation might be considered as a prognostic marker in glioblastoma. Full article

200 KiB

Open AccessArticle

Behavioral Problems in Children with Benign Childhood Epilepsy With Centrotemporal Spikes Treated and Untreated with Antiepileptic Drugs

by Rūta Samaitienė, Jolita Norkūnienė, Giedrė Jurkevičienė and Jurgita Grikinienė

Medicina 2012, 48(7), 50; https://doi.org/10.3390/medicina48070050 - 29 Jul 2012

Cited by 24 | Viewed by 920

Abstract

The aim of this study was to investigate behavioral problems in two groups of children with benign childhood epilepsy with centrotemporal spikes (BECTS), i.e., those treated with antiepileptic drugs and those not treated in order to identify the factors associated with behavioral problems. [...] Read more.

The aim of this study was to investigate behavioral problems in two groups of children with benign childhood epilepsy with centrotemporal spikes (BECTS), i.e., those treated with antiepileptic drugs and those not treated in order to identify the factors associated with behavioral problems.
Material and Methods. In total, 20 newly diagnosed untreated, 23 treated patients with BECTS, and 20 patients with acute/subacute peripheral nervous system disorders as a comparison group (aged 6–11 years) were examined. The evaluation was performed using the Lithuanian version of the Child Behavior Checklist (CBCL). Schooling parameters, clinical parameters, EEG parameters, and their relation to the results of the CBCL were also investigated.
Results. The treated patients with BECTS had significantly higher scores in the subscales of Social Problems, Anxious/Depressed, Aggressive Behavior, and Attention Problems compared with the scores of the patients with peripheral nervous system disorders. A significant relationship was established between the scores of native language grades and Attention Problems; grades in mathematics and treatment duration; and age when the first seizure occurred and Delinquent Behavior in the group of treated patients. The duration of epilepsy was positively correlated with the scores in the subscales of Withdrawn and Delinquent Behavior. The presence of additional extrarolandic focus and spread of focal specific discharges to the centrofrontotemporal and centroparietotemporal areas were related to higher scores in Social Problems, Attention Problems, and Delinquent Behavior in the group of the treated patients with BECTS.
Conclusions. Children with BECTS, especially those treated and with a longer epilepsy course, were found to be at risk of behavioral problems. Lower grades were associated with a longer disease course and medications. The presence of extrarolandic discharges was related to higher CBCL scores in the group of the treated patients with BECTS. Full article

400 KiB

Open AccessArticle

Shoulder Muscle Isometric Strength and Active Range of Motion in Patients With Frozen Shoulder Syndrome After Manipulation Under Anesthesia

by Jelena Sokk, Helena Gapeyeva, Jaan Ereline, Mati Merila and Mati Pääsuke

Medicina 2012, 48(7), 49; https://doi.org/10.3390/medicina48070049 - 07 Jul 2012

Cited by 3 | Viewed by 1168

Abstract

Background and Objective. Frozen shoulder syndrome (FSS) causes pain and restriction of movement in the shoulder. The aim was to assess changes in shoulder muscle isometric maximal voluntary contraction (MVC) force and active range of motion (AROM) in patients with frozen shoulder syndrome [...] Read more.

Background and Objective. Frozen shoulder syndrome (FSS) causes pain and restriction of movement in the shoulder. The aim was to assess changes in shoulder muscle isometric maximal voluntary contraction (MVC) force and active range of motion (AROM) in patients with frozen shoulder syndrome (FSS) after manipulation under general anesthesia (MUA).
Material and Methods. In total, 18 patients with FSS (9 women and 9 men) with a mean age of 53.6 years (SD, 9.7) participated in this study. MVC force of shoulder flexors, adductors, and internal and external rotators was measured by a handheld dynamometer. AROM in the same directions was measured goniometrically. The patients were screened according to the intensity of pain by day and at night. The data were collected before MUA and 1 and 6 months after MUA. A significant reduction in MVC force and AROM was noted before MUA in the involved extremity as compared with the uninvolved extremity (P<0.05). These parameters for the involved extremity were significantly increased 1 month after MUA (P<0.05). However, 6 months after MUA, MVC force and AROM did not differ significantly compared with the uninvolved extremity (P>0.05), whereas AROM of flexion and external rotation remained significantly reduced (P<0.05). A significant reduction in shoulder pain by day and at night was recorded 1 and 6 months after MUA (P<0.05).
Conclusions. In the patients with FSS, the fastest improvement of MVC force and AROM occurred following the first month after MUA. However, 6 months after MUA, shoulder muscle MVC force for the involved extremity did not differ significantly as compared with the uninvolved extremity, whereas the shoulder AROM in flexion and external rotation remained lower. Full article

246 KiB

Open AccessArticle

Impedance Cardiography and Heart Rate Variability for Long-Term Cardiovascular Outcome Prediction After Myocardial Infarction

by Rūta Ablonskytė-Dūdonienė, Giedrė Bakšytė, Indrė Čeponienė, Algimantas Kriščiukaitis, Kęstutis Drėgūnas and Eglė Ereminienė

Medicina 2012, 48(7), 52; https://doi.org/10.3390/medicina48070052 - 17 Jun 2012

Cited by 12 | Viewed by 1019

Abstract

Background and Objective. The objective of our study was to evaluate the predictive power of a combined assessment of heart rate variability (HRV) and impedance cardiography (ICG) measures in order to better identify the patients at risk of serious adverse events after [...] Read more.

Background and Objective. The objective of our study was to evaluate the predictive power of a combined assessment of heart rate variability (HRV) and impedance cardiography (ICG) measures in order to better identify the patients at risk of serious adverse events after ST-segment elevation myocardial infarction (STEMI): all-cause or cardiac mortality (primary outcomes) and in-hospital recurrent ischemia, recurrent nonfatal MI, and need for revascularization (secondary outcomes).
Material and Methods. A total of 213 study patients underwent 24-hour electrocardiogram (used for HRV analysis) and thoracic bioimpedance monitoring (used for calculation of hemodynamic measures) immediately after admission. The patients were examined on discharge and contacted after 1 and 5 years. Cox regression analysis was used to determine the predictors of selected outcomes.
Results. The standard deviation of all normal-to-normal intervals (SDNN) and cardiac power output (CPO) were found to be the significant determinants of 5-year all-cause mortality (SDNN ≤100.42 ms and CPO ≤1.43 W vs. others: hazard ratio [HR], 11.1; 95% CI, 4.48–27.51; P<0.001). The standard deviation of the averages of NN intervals (SDANN) and CPO were the significant predictors of 5-year cardiac mortality (SDANN ≤85.41 ms and CPO ≤1.43 W vs. others: HR, 11.05; 95% CI, 3.75–32.56; P<0.001). None of the ICG measures was significant in predicting any secondary outcome.
Conclusions. The patients with both impaired autonomic heart regulation and systolic function demonstrated by decreased heart rate variability and impedance hemodynamic measures were found to be at greater risk of all-cause and cardiac death within a 5-year period after STEMI. An integrated analysis of electrocardiogram and impedance cardiogram helps estimate patient’s risk of adverse outcomes after STEMI. Full article

499 KiB

Open AccessCase Report

Epileptic Laughter: 2 Case Reports

by Inga Talvik, Riina Vibo, Maarika Liik, Sulev Haldre and Tiina Talvik

Medicina 2012, 48(7), 53; https://doi.org/10.3390/medicina48070053 - 02 Jun 2012

Cited by 5 | Viewed by 797

Abstract

Two cases of gelastic epilepsy in a 6-year-old girl with attacks of mirthful laughter and a 38-year-old male patient with episodes of laughter without any positive emotions are presented. Temporal lobe epilepsy was diagnosed in the first case and possible frontal lobe epilepsy [...] Read more.

Two cases of gelastic epilepsy in a 6-year-old girl with attacks of mirthful laughter and a 38-year-old male patient with episodes of laughter without any positive emotions are presented. Temporal lobe epilepsy was diagnosed in the first case and possible frontal lobe epilepsy in the second case. It is concluded that that this rare form of epilepsy can be difficult to diagnose and treat, and can clinically be accompanied by urinary incontinence. Full article

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Medicina, Volume 48, Issue 7 (July 2012) – 8 articles

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