Medicina, Volume 44, Issue 3 (March 2008) – 11 articles

In Lithuania, the stroke is not only medical, but social issue as well, since only 20% of patients suffering from stroke remain active at work. Yearly stroke incidence in Lithuania is 7000–8000 cases. The most common outcome of stroke is unilateral paralysis (hemiplegia) followed by disorders of coordination, balance, and movements. Due to dysfunctions of movements, self-care, cognition, behavior, and communication, some part of stroke patients remains disabled. They need assistance and care provided by other people. Occupational therapy, which is part of rehabilitation of patients after stroke, is directed to independence training. There are scarce data related to effectiveness of occupational therapy depending on motor, cognitive, and psychosocial dysfunctions. Goals of study were to estimate effectiveness of occupational therapy at the early stage of rehabilitation depending on type of stroke, localization of brain injury, grade of lesion, age, and gender, to identify factors influencing effectiveness of occupational therapy, and to estimate their positive predictive value. The study included 106 patients at the early stage of rehabilitation, who were admitted to Department of Neurorehabilitation after stabilization of clinical condition from Departments of Neurology and Neurosurgery (mean duration of 14±2 days after stroke). The program of occupational therapy was not fulfilled by 6 patients: 2 patients were transferred to Nursing Hospital due to severe condition, and 4 patients were discharged prematurely and continued rehabilitation in outpatient setting. Hence, study population consisted of 100 subjects (47 men and 53 women) who were diagnosed with stroke (ischemic or hemorrhagic). Patient’s functional status and disorders of activities were evaluated using Barthel Index and Functional Independence Measure. Complexes of occupational therapy were adjusted according to examination of patient’s disorders of activities, age, grade of lesion, other diseases, and complications during rehabilitation process. Effectiveness of occupational therapy in patients after stroke at then early stage of rehabilitation was influenced by gender, age, degree of lesion, type of stroke. Better effectiveness of occupational therapy was observed in men (P<0.05), persons younger than 59 years (P<0.05), persons with hemiparesis (P<0.05) and hemorrhagic stroke (P<0.05). Low effectiveness in stroke patients at the early stage of rehabilitation was influenced by neglect (P<0.05), hemiplegia (P<0.001), and older age of patient (P<0.05). Application of individualized occupational therapy complexes for stroke patients at the early stage of rehabilitation with consideration of motoric and cognitive-psychosocial disorders, significantly improves recovery of impaired functions, though occupational therapy should be continued in later rehabilitation stages, since patients after early stage of rehabilitation still have limited independence in daily activities. Full article

The aim of this study was to evaluate the course of gastroesophageal reflux disease in gastric ulcer patients after successful Helicobacter pylori eradication (group A), in patients with persistent infection after attempt to eradicate Helicobacter pylori (group B), and in control group without Helicobacter pylori eradication treatment (group C).
Materials and methods. Gastric ulcer patients (n=88) were assigned either to the group receiving Helicobacter pylori eradication treatment (54 patients) or to the control group (34 patients; omeprazole treatment for 4 weeks) and were followed up for 1-year or until gastric ulcer relapsed. Gastroesophageal reflux disease was diagnosed in patients who had erosive esophagitis and/or without esophagitis if they experienced heartburn and/or regurgitation at least 2 times a week and it was associated with impairment of daily activities (Genval consensus).
Results. The study was completed by 69 patients: 25 in group A, 19 in group B, and 25 in group C. At the beginning and at the end of the follow-up, gastroesophageal reflux disease was diagnosed in 10 (40%) and 9 (36%) group A patients, respectively (P>0.05); in 12 (63%) and 8 (42%) group B patients, respectively (P>0.05); and in 9 (36%) and 5 (20%) group C patients, respectively (P>0.05). At the beginning and at the end of the follow-up, reflux esophagitis was found in 3 (12%) and 5 (20%) group A patients, respectively (P>0.05); in 5 (26%) and 5 (26%) group B patients (P>0.05); in 4 (16%) and 3 (12%) group C patients (P>0.05).
Conclusion. There was no statistically significant difference regarding the development of gastroesophageal reflux disease in gastric ulcer patients after Helicobacter pylori eradication, in the patients with persistent infection after attempt to eradicate, and in the control group without Helicobacter pylori eradication treatment. Full article

The aim of the study was to establish the influence of muscle cooling on muscle recovery after concentric and eccentric-concentric exercise. Healthy untrained males (n=40) took part in this study. During the first experiment, subjects performed concentric and during the second – eccentric-concentric exercise. During both experiments, the subjects were divided into the groups. In the first group, the muscles of the lower limbs were cooled down after the physical load, while the muscles of the subjects of the second group were not cooled. The rectal, skin, and muscle temperature was repeatedly measured immediately after physical load and after cooling of the muscle. Before exercise and after 2 min and 4, 8, 24, 48, 72 hours after performing exercise, quadriceps muscle strength, generated by electrical stimulation at frequencies of 20 Hz and 50 Hz, and maximal voluntary contraction force were registered. Serum creatine kinase levels were measured before and 24 hours after exercise. In addition, the subjects subjectively rated their muscle pain on a 10-point scale 24, 48, 72 hours after exercise. The results show that cooling applied to muscles after concentric and eccentricconcentric exercise affected the indicators of muscle damage – the activity of creatine kinase was decreased and muscle strength recovered faster. The cooling effect is greater when it is applied after eccentric-concentric exercise. Full article

Background. Fine-needle aspiration biopsy is the most important procedure for differentiating benign thyroid nodules from malignant ones. Traditionally, findings of fine-needle aspiration biopsy are divided into four categories: nondiagnostic, benign lesions, suspected cancer, and malignant lesions. Group suspicious for cancer largely involves follicular neoplasms as well as lesions with cytological features of malignancy.
Objective. The purpose of this study was to establish the value of ultrasound-guided fine-needle aspiration biopsy in the diagnosis of nonpalpable thyroid cancer and to assess the frequency of malignant disease in the group of suspected cancer.
Patients and methods. A total of 184 patients with nonpalpable thyroid nodules (less than 1.5 cm in diameter) were examined by means of ultrasound-guided fine-needle aspiration biopsy. Patients were included in the study based on sonographic findings implicating possible malignant nature of nodules.
Results. During 1997–2002, 204 ultrasound-guided fine-needle aspiration biopsies of thyroid nodules were performed; findings were nondiagnostic in 5.9% of cases. In 59.8% of cases, cytological examination revealed benign lesions; in 11.8%, suspected cancer; and in 22.5%, malignant lesions. Eighty-five patients underwent subsequent surgery with histological examination of specimens obtained. In 45 cases, cytological diagnosis of malignant or suspected thyroid cancer was confirmed by histological examination after surgery.
Conclusion. We conclude that ultrasound-guided fine-needle aspiration biopsy has a high accuracy in the diagnostic evaluation of nonpalpable thyroid nodule with cytological features of malignancy. However, fineneedle aspiration biopsy is not effective diagnostic method for differentiating benign thyroid nodules from malignant ones in follicular neoplasm group. Full article

Objective. The aim of the study was to establish factors associated with poor sleep and to assess the relationship between self-evaluated sleep quality and health-related quality of life.
Material and methods. Sleep complaints were evaluated using Basic Nordic Sleep Questionnaire, and health-related quality of life was assessed by SF-36. Subjective data about sleep quality were obtained from 1602 randomly selected persons: 600 males and 1002 females, aged 35–74 years. SF-36 was filled in by 1016 persons: 379 males and 637 females. Health status was evaluated by Perceived Health Questionnaire. The odds ratios of poor sleep were calculated using binary logistic regression analysis.
Results. Among males poor self-evaluated health, frequent stress events, regular nighttime awakenings, and sleep latency period longer than 15 min in workdays were significant predictors of poor sleep. Among females, duration of sleep shorter than 7 h, frequent stress events, poor self-evaluated health, sleep latency period longer than 15 min in workdays, and regular nighttime awakenings predicted poor sleep. Poor sleepers, as compared with good ones, had poorer healthrelated quality of life.
Conclusions. Poor perceived health, frequent stress events, regular nighttime awakenings, and sleep latency period longer than 15 min were indicated as significant predictors of poor sleep. Poor sleep worsened health-related quality of life in all domains of SF-36. Full article

The purpose of the study was to assess the association of bullying and being bullied with indicators of subjective health and problem behaviors among schoolchildren aged 11–15 years.
Material and methods. The data of the anonymous survey of 5645 filth-, seventh-, and ninth-grade students (aged 11, 13, and 15 years, respectively), conducted in the spring of 2002, were analyzed. The students completed the World Health Organization’s Health Behavior in School-aged Children questionnaire that included selfreport of involvement in bullying and being bullied by others as well as subjective health and well-being estimates, health complains (headache, stomachache, back pain, anxiety, etc.), and problem behaviors (smoking, alcohol and drug use, suicidal ideation). The response rate was 95%.
Results. More than half (52.3%) of students were involved in bullying process at least two times per month: 17.9% were involved as bullies (“victims”), 18.3% were bullied (“aggressors”), and 16.1% bullied others and were bullied themselves. A significant association between experiencing bullying and adverse health outcomes was found. Perpetrating bullying increased the odds of smoking, alcohol and drug use. Perpetrating and/or experiencing bullying increased the risk of high suicidal ideation that had cumulative effect. The established associations varied between genders and groups of students defined as “victims,” “aggressors,” and “victims/aggressors.”
Conclusions. In Lithuania, school bullying is extremely prevalent and is associated with health disorders, poorer well-being, and problem behavior of schoolchildren. Urgent antibullying efforts, including both research and preventive measures, are needed in order to deal with this social phenomenon. Full article

Objective. To investigate bacterial populations in subgingival and supragingival plaque samples of patients with inflammatory periodontal diseases and activities of the lysosomal enzymes – lysozyme, alkaline phosphatase, and b-glucuronidase – in peripheral venous blood, in gingival crevicular fluid, and mixed nonstimulated saliva.
Methods and materials. The study included 60 patients with inflammatory periodontal diseases without any internal pathology and 24 periodontally healthy subjects. Molecular genetic assay (Micro-IDent plus, Germany) for complex identification of additional six periodontopathic bacteria was applied. The activity of lysozyme was determined turbidimetrically, the activity of alkaline phosphatase – spectrophotometrically with a “Monarch” biochemical analyzer, the activity b-glucuronidase – according to the method described by Mead et al. and modified by Strachunskii.
Results. A statistically significant association between clinical and bacteriological data was found in the following cases: gingival bleeding in the presence of Eubacterium nodatum, Eikenella corrodens, Capnocytophaga spp. (P<0.01); pathological periodontal pockets in the presence of Peptostreptococcus micros (α≤0.05 and β≤0.2), Fusobacterium nucleatum (α≤0.05 and β≤0.2), Campylobacter rectus (α≤0.05 and β≤0.2), and Capnocytophaga spp. (P<0.05); and satisfactory oral hygiene in the presence of all microorganisms investigated (P<0.05). The activity of lysozyme in gingival crevicular fluid and mixed nonstimulated saliva indicates the severity of periodontal inflammation. Based on clinical data, in assessing the amount of lysozyme in mixed nonstimulated saliva, sensitivity and specificity of 100% was found. Increased activities of lysozyme, alkaline phosphatase, and b-glucuronidase were found in peripheral venous blood of patients with inflammatory periodontal disease as compared to control group.
Conclusions. The main principles of the treatment of periodontal inflammatory diseases should be based on microorganism elimination, creation of individual treatment means affecting microflora in the mouth and immune system of macroorganisms. Full article

Objective. Many studies report that the components of the metabolic syndrome – arterial hypertension, abdominal obesity, diabetes mellitus, and atherogenic dyslipidemia – are associated with an increased risk of cardiovascular disease. We investigated the prevalence of different components of the metabolic syndrome and frequency of their combinations and acute hyperglycemia among patients with acute coronary syndromes.
Methods and results. The study population consisted of 2756 patients (1670 men and 1086 women with a mean age of 63.3±11.3 years) with acute coronary syndromes: Q-wave myocardial infarction was present in 41.8% of patients; non-Q-wave MI, in 30.7%; and unstable angina pectoris, in 27.5%. The metabolic syndrome was found in 59.6% of the patients according to modified NCEP III guidelines. One component of the metabolic syndrome was found in 13.5% of patients; two, in 23.0%; and none, in 3.9%. Less than one-third (29.2%) of the patients had three components of the metabolic syndrome, and 30.4% of the patients had four or five components. Arterial hypertension and abdominal obesity were the most common components of the metabolic syndrome (82.2% and 65.8%, respectively). Nearly half of the patients had hypertriglyceridemia and decreased level of high-density lipoprotein cholesterol (55.0% and 51.1%, respectively), and 23.9% of patients had diabetes mellitus. Acute hyperglycemia (≥6.1 mmol/L) without known diabetes mellitus was found in 38.1% of cases. The combination of arterial hypertension and abdominal obesity was reported in 57.8% of patients in the case of combinations of two-five metabolic syndrome components.
Conclusion. More than half of patients with acute coronary syndromes had three or more components of the metabolic syndrome, and arterial hypertension and abdominal obesity were the most prevalent components of the metabolic syndrome. Full article

Venous thromboembolism is a serious complication in patients with cancer. The seriousness of venous thromboembolism as a complication in cancer patients is becoming recognized as an important medical issue. Venous thromboembolism is a multifactorial disease associated with vascular endothelial damage, stasis of blood flow, and hypercoagulation. Preexisting morbidity, mutations of factor V Leiden or prothrombin 20210A, type of cancer, presence of metastases, use of central venous access, surgery, anesthesia, etc., increase the risk of venous thromboembolism. The patients with malignancies have a 7-fold increase in the risk of venous thromboembolism compared with individuals without cancer. Venous thromboembolism is the second most common cause of mortality in cancer patients. Venous thromboembolism is the most common cause of death at 30 days after surgery in patients undergoing surgery for cancer. Venous thromboembolism caused death in 46.3% of the cases after surgery for cancer. The Geneva prognostic index identified predictive factors for an adverse outcome, and the American College of Chest Physicians (ACCP) has suggested the guidelines for the prevention of venous tromboembolism in cancer patients. Cancer patients should receive appropriate venous thromboembolism prophylaxis. The methods used for venous thromboembolism prophylaxis are mechanical, pharmacological, or a combination of both. Well-timed thromboprophylaxis may protect patients from venous thromboembolism, early lethal outcome and even influence survival. Full article

Aortic dissection is an acute lesion of the aortic wall accompanied by separation of the media due to rupture or intramural hematoma. The incidence rate of aortic dissection is 5 to 30 cases per million people a year. Acute aortic dissection is a highly lethal cardiovascular emergency with an incidence of 2000 new cases per year in the United States and 3000 in Europe. The mortality rate of aortic dissection is 3.2/100 000 per year. In case of sudden death of nonhospitalized patients, aortic dissection was proved in 1.5% of necropsy cases. Most of patients die within 48 hours after admission or 1.4% per each hour. The main clinical manifestations of aortic dissection are acute myocardial infarction, stroke, pulmonary embolism, acute heart failure, acute pancreatitis, mesenteries thrombosis, which mislead the physician. The main measure, which might reduce the mortality, is early diagnosis of aortic dissection. The standard diagnosis is based on clinical symptoms and verification by instrumental (imaging) methods. An alternative mean for diagnosis of aortic dissection might be the determination of concentration of smooth muscle myosin heavy chain protein in blood serum, the peak of which is found after 3 hours after the onset of pain. Normal value of smooth muscle myosin heavy chain protein concentration is 2.5 mg/L, while in case of aortic dissection it exceeds 22.4 mg/L. This diagnostic method has not been introduced in Lithuania yet. Full article

Alterations in neutrophil function by tobacco products may play a central role in the pathogenesis of periodontal diseases and several smoking-related systemic diseases. The aim of the study was to evaluate the effect of smoking on neutrophil oxidative metabolism.
Materials and methods. The study included 17 smoking men free of systemic diseases who were referred for treatment of various odontological diseases to outpatient department of Kaunas University of Medicine Hospital. The age of subjects varied from 22 to 43 years. All subjects answered the questions about smoking habits. Clinical examination included assessment of oral hygiene status according to the OHI-s index and periodontal status according to Russell and Ramfjord indices. To evaluate the oxidative metabolism of neutrophils, luminol- and liucigenin-dependent chemiluminescence and nitroblue tetrazolium test were used.
Results. After smoking, extracellular liucigenin-dependent chemiluminescence response was higher as compared to the response before smoking, but total (intra- and extracellular) luminol-dependent chemiluminescence response was the same both before and after smoking. Exposure of neutrophils to smoking caused a significant increase in nitroblue tetrazolium reduction.
Conclusion. The release of reactive oxygen species in neutrophils exposed to smoking may alter the pathogenic processes in periodontal diseases. Full article