Medicina (Kaunas, Lithuania) (Medicina)

Publications in this journal

• Article: Susac's Syndrome: A Case Presentation and Radiological Approach to this Rare Autoimmune Endotheliopathy.

  Goda Randakevičienė, Rymantė Gleiznienė, Rūta Nylander
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  ABSTRACT: Susac's syndrome is an uncommon neurologic disorder, consisting of the clinical triad of encephalopathy, branch retinal artery occlusions, and hearing loss. We report a case of a sudden vision and hearing impairment in a 35-year-old female patient. Magnetic resonance imaging of the brain revealed multiple lesions in the white matter and the corpus callosum, typical of Susac's syndrome.
  Medicina (Kaunas, Lithuania) 01/2013; 49(1):15-7.
• Article: Comparison of changes in blood glucose, insulin resistance indices, and adipokine levels in diabetic and nondiabetic subjects with morbid obesity after laparoscopic adjustable gastric banding.

  Vaidotas Urbanavičius, Tomas Abalikšta, Gintautas Brimas, Agnė Abraitienė, Laima Gogelienė, Kęstutis Strupas
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  ABSTRACT: OBJECTIVE. The aim of the study was to evaluate blood glucose, insulin resistance indices, and adipokine (leptin and adiponectin) levels in morbidly obese individuals with and without type 2 diabetes mellitus and to compare the changes in these parameters 1 year after laparoscopic adjustable gastric banding surgery. MATERIAL AND METHODS. In total, 103 patients (37 subjects with and 66 subjects without type 2 diabetes mellitus) were studied preoperatively and again 1 year after laparoscopic adjustable gastric banding. RESULTS. One year after laparoscopic adjustable gastric banding, the leptin concentrations decreased signifi-cantly in both treatment groups, while the adiponectin levels increased significantly in the nondiabetic patients (11.19 µg/mL [SD 7.20] vs. 15.58 µg/mL [SD 7.8], P=0.003) and tended to increase in the group of the patients with type 2 diabetes mellitus (8.98 µg/mL [SD 6.80] vs. 13.01 µg/mL [SD 12.14], P>0.05). A considerable decrease in the insulin resistance indices was noted in the patients with type 2 diabetes mellitus 1 year after the intervention, and it was followed by a partial or complete remission of type 2 diabetes mellitus in 23 (85.19%) of the 27 investigated diabetic patients. The postoperative insulin resistance indices in the patients with type 2 diabetes mellitus became similar to the values in the nondiabetic subjects. CONCLUSIONS. Weight loss after laparoscopic adjustable gastric banding is associated with a significant increase in adiponectin secretion in nondiabetic morbidly obese patients and with improvement in adiponectin secretion in type 2 diabetes individuals. In subjects with type 2 diabetes, this surgical intervention results in a significant reduction in blood glucose and insulin resistance.
  Medicina (Kaunas, Lithuania) 01/2013; 49(1):9-14.
• Article: A systematic review of phacoemulsification cataract surgery in virtual reality simulators.

  Chee Kiang Lam, Kenneth Sundaraj, Mohd Nazri Sulaiman
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  ABSTRACT: The aim of this study was to review the capability of virtual reality simulators in the application of phacoemulsification cataract surgery training. Our review included the scientific publications on cataract surgery simulators that had been developed by different groups of researchers along with commercialized surgical training products, such as EYESI® and PhacoVision®. The review covers the simulation of the main cataract surgery procedures, i.e., corneal incision, capsulorrhexis, phacosculpting, and intraocular lens implantation in various virtual reality surgery simulators. Haptics realism and visual realism of the procedures are the main elements in imitating the actual surgical environment. The involvement of ophthalmology in research on virtual reality since the early 1990s has made a great impact on the development of surgical simulators. Most of the latest cataract surgery training systems are able to offer high fidelity in visual feedback and haptics feedback, but visual realism, such as the rotational movements of an eyeball with response to the force applied by surgical instruments, is still lacking in some of them. The assessment of the surgical tasks carried out on the simulators showed a significant difference in the performance before and after the training.
  Medicina (Kaunas, Lithuania) 01/2013; 49(1):1-8.
• Article: Maternal age-associated congenital anomalies among newborns: a retrospective study in latvia.

  Irisa Zīle, Anita Villeruša
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  ABSTRACT: BACKGROUND AND OBJECTIVE. In Latvia, the mean age of women giving birth increased from 27.3 in 2000 to 29.0 years in 2010 during the last 11 years. The aim of this study was to report on major congenital anomalies of newborns at birth by the maternal age and to compare the mean maternal age by different diagnosis subgroups and maternal and neonatal characteristics. MATERIAL AND METHODS. A cross-sectional retrospective study with the data from the Medical Birth Register (2000-2010) was carried out. The live birth prevalence rate was calculated for the subgroups of major congenital anomalies per 10 000 live births by the maternal age. RESULTS. The live birth prevalence rate of major congenital anomalies during the period 2000-2010 was 211.4 per 10 000 live births. The prevalence rate increased depending on the maternal age. Congenital heart defects, limb defects, and urinary system anomalies were the most common anomalies. The study results showed an age-related risk of abdominal wall defects, orofacial clefts, and chromosomal anomalies. There were significantly higher proportions of preterm births, newborns with low birth weight, and complications during pregnancy among mothers aged 35 years and more. CONCLUSIONS. The data on congenital anomalies from the Latvian Medical Birth Register can be used for the assessment of epidemiology of congenital anomalies. The results of this retrospective study showed a decrease in the live birth prevalence rate of major congenital anomalies despite an increase in the mean age of mothers in Latvia.
  Medicina (Kaunas, Lithuania) 01/2013; 49(1):29-35.
• Article: What are the predictors of self-assessed health in lithuanian health professionals?

  Irena Misevičienė, Loreta Strumylaitė, Birutė Pajarskienė, Kristina Zalnieraitienė
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  ABSTRACT: BACKGROUND AND OBJECTIVE. Scientific evidence indicates that patient safety and access to health care is linked to the well-being of health professionals. The self-assessed health status has been widely used as a health measure in different surveys. The aim of this study was to examine and determine the factors related to the self-assessed health status of health professionals. MATERIAL AND METHODS. The cross-sectional questionnaire surveys of nurses and physicians were carried out in randomly selected hospitals. A total of 1025 health professionals (739 nurses and 286 physicians) from 3 hospitals of different size located in 1 geographical region of Lithuania participated in the survey. The response rate among the nurses and the physicians was 89.2% and 52.5%, respectively. The overall response rate was 74.7%. The data on self-assessed health, demographic factors, anthropometric data, blood pressure, cholesterol level in blood, personal history of diseases, smoking, and alcohol consumption were gathered with the help of the questionnaire. RESULTS. About two-thirds (64.1%) of the health professionals reported good or quite good health, and only 1.5% of the respondents reported quite poor or poor health. Multivariate logistic regression analysis revealed that the SAH status of health professionals was dependent on age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02-1.05 [Model 1]; OR, 1.04; 95% CI, 1.02-1.06 [Model 2]), diseases (OR, 7.32; 95%, 5.18-10.35), heart diseases (OR, 12.09; 95% CI, 2.9-50.35), hypertension (OR, 2.53; 95% CI, 1.55-4.14), cancer (OR, 6.19; 95% CI, 1.27-30.13), gastrointestinal (OR, 3.54; 95% CI, 1.59-7.86) and musculoskeletal diseases (OR, 3.21; 95% CI, 1.71-6.02), smoking (OR, 2.1; 95% CI, 1.28-3.45 [Model 1]; OR, 2.00; 95% CI, 1.26-3.16 [Model 2]), and occupation (OR, 1.47; 95% CI, 1.04-2.07 [ Model 1]; OR, 1.54; 95% CI, 1.11-2.16 [Model 2]). CONCLUSIONS. Diseases are the main predictors of self-assessed health in health professionals. Advancing age and smoking also contribute to poorer self-assessed health.
  Medicina (Kaunas, Lithuania) 01/2013; 49(1):23-8.
• Article: Mortality of lithuanian population over 2 decades of independence: critical points and contribution of major causes of death.

  Ramunė Kalėdienė, Skirmantė Sauliūnė
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  ABSTRACT: The aim of the study was to analyze trends in overall mortality and mortality from major causes of death, detect differences in cut points, and estimate the contribution of the major causes of death to the changes in overall mortality throughout 2 decades of independence in Lithuania (1991-2000 and 2001-2010). MATERIAL AND METHODS. Overall mortality and mortality from cardiovascular diseases, cancer, and external causes were analyzed for the periods of 1991-2000 and 2001-2010. Joinpoint analysis was used to identify the best-fitting points wherever a statistically significant change in mortality occurred, and analysis of components was applied for the assessment of the contribution of major causes of death. RESULTS. The 1991-1994 period was identified as the most negative in terms of increasing mortality from all major causes of death, while the 2007-2010 period was most favorable, when the most significant decline in overall mortality was observed (4.84% per year for males and 4.41% per year for females). External causes contributed most to the growing overall mortality in 1991-1994 both for males and females (37.20% and 25.29%, respectively). Since 2007, all major causes contributed positively to the declining overall mortality of the Lithuanian population. The most significant contribution was made by cardiovascular diseases and external causes. CONCLUSIONS. Despite the considerable transformations of socioeconomic situation and economic crisis, it is likely that Lithuania is entering into the stage of positive health development. For assuring this trend in the future, investments in sustainable health and social developments are inevitable.
  Medicina (Kaunas, Lithuania) 01/2013; 49(1):36-41.
• Article: Ultrasonography and magnetic resonance imaging of the brain in hypoxic full-term newborns.

  Aušrelė Kudrevičienė, Saulius Lukoševičius, Jūratė Laurynaitienė, Vitalija Marmienė, Rasa Tamelienė, Algidas Basevičius
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  ABSTRACT: The aim of this article was to review the studies on diagnostic and prognostic value of radiological investigations (cranial sonography, Doppler ultrasonography, and magnetic resonance imaging) in the detection of hypoxic-ischemic brain injuries in full-term newborns. MATERIALS AND METHODS. A systematic search of studies on the diagnostic and prognostic possibilities of radiological investigations for the detection of hypoxic-ischemic injuries in full-term newborns was performed. RESULTS. A total of 13 prospective and 4 retrospective studies that analyzed the incidence of hypoxic-ischemic cerebral injuries, determined by means of cranial sonography, Doppler sonography, and magnetic resonance imaging, and associations with the stages of hypoxic-ischemic encephalopathy and long-term neurodevelopmental outcomes were included in this systematic review. CONCLUSIONS. Magnetic resonance imaging detects lesions in 75%-100% of cases. Magnetic resonance imaging performed at the age of 7-11 days demonstrated a high sensitivity (100%) and negative predictive value (100%) to predict unfavorable outcomes at 4 years of age. In newborns with hypoxic-ischemic encephalopathy, substantial cerebral hemodynamic alterations are detected after birth. The sensitivity and negative predictive value of cerebral blood flow velocities (peak systolic flow velocity, end-diastolic flow velocity) changes at 12±2 hours of age to predict the severity of hypoxic-ischemic encephalopathy and unfavorable outcomes at 18 months of age were found to be high (90% and 94%, respectively). A low resistive index (<0.56) at the age of 1-3 days had a specificity of 95% to predict unfavorable outcomes at 3 years of age. The data on the diagnostic and prognostic potential of cranial sonography are limited scarce and contrary.
  Medicina (Kaunas, Lithuania) 01/2013; 49(1):42-9.
• Article: Dependence of reaction time and movement speed on task complexity and age.

  Tomas Darbutas, Vilma Juodžbalienė, Albertas Skurvydas, Aleksandras Kriščiūnas
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  ABSTRACT: The aim of this study was to determine the differences in reaction time, reaction complexity, and movement speed depending on age. MATERIAL AND METHODS. The study included 40 healthy subjects (20 young and 20 older women and men). The study was conducted at the Human Motorics Laboratory, Lithuanian Sports University. An analyzer DPA-1 of dynamic upper and lower limb movements was used for the research purposes. RESULTS. The reaction time of the right arm of the young subjects was 0.26 s (SD, 0.01) and that of the left arm was 0.25 s (SD, 0.02), when an accuracy task was performed. The reaction time of the older subjects was 0.29 s (SD, 0.03) and 0.28 s (SD, 0.03) for the right and left arms, respectively. The reaction time of the right leg of the young subjects was 0.26 s (SD, 0.02) and that of the left leg was 0.27 s (SD, 0.03). The reaction time of the right and left legs of the older subjects was 0.33 s (SD, 0.02) and 0.35 s (SD, 0.04), respectively. The reaction of the young subjects was almost two times faster compared with the older persons after the accuracy task with each limb was accomplished. CONCLUSIONS. In case of movements with arms and legs, reaction time and movement speed directly depend on the complexity of a task. Reaction time and movement speed are slower for the older subjects in comparison with the young ones; the results worsen in proportion to the increasing complexity of a task.
  Medicina (Kaunas, Lithuania) 01/2013; 49(1):18-22.
• Article: Reliability and validity of DPA-1 testing after anterior cruciate ligament reconstruction.

  Sigitas Kamandulis, Agnė Kanavolaitė, Albertas Skurvydas, Laimutis Škikas, Vytautas Streckis, Dalia Mickevičienė, Kazimieras Pukėnas, Vilma Jurevičienė, Nerijus Masiulis
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  ABSTRACT: There is a lack of equipment and methods for the reliable and valid measurements of human neuromuscular control. To overcome this limitation, an analyzer of dynamic parameters (DPA-1) of human hand and leg movements was constructed by Kaunas University of Technology and "Katra" engineers in collaboration with the Lithuanian Academy of Physical Education. The aim of the study was to determine the reliability and validity of the tests performed on the DPA-1 in healthy and injured subjects after the anterior cruciate ligament (ACL) reconstruction surgery. MATERIAL AND METHODS. The men who had undergone a unilateral ACL reconstruction (n=17, on the average 3.8 months [SD, 2.1] after the surgery) and healthy untrained men (n=17) performed the research protocol twice within 24 hours in between. Average reaction time, mean and maximal movement speed, time to reach maximal speed, and movement distance of the right and left feet for the patients and of the dominant foot for the healthy subjects using the DPA-1 as well as the scores of isokinetic muscle strength and self-assessment tests were registered. RESULTS. There was a significantly reduced concentric peak torque on the injured knee compared with the uninjured knee during knee extension, and the mean score of the Lysholm scale for the injured knee was 69.1 (SD, 13.7) (P<0.05, compared between legs). The test-retest reliability for all the DPA-1 tests varied from 0.68 to 0.94 (P<0.05). However, there were no significant differences in most variables measured by the DPA-1 between injured knee, uninjured knee, and control knee. CONCLUSIONS. The results revealed low validity of the DPA-1 tests for the evaluation of patients following ACL surgery, despite the reliability of these tests varied from moderate to very high.
  Medicina (Kaunas, Lithuania) 04/2012; 48(2):84-90.
• Article: Quality of life in patients with age-related macular degeneration.

  Lina Šiaudvytytė, Dovilė Mitkutė, Jūratė Balčiūnienė
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  ABSTRACT: The aim of this study was to evaluate the quality of life in persons affected by age-related macular degeneration. The study was performed in the Clinic of Ophthalmology, Hospital of Lithuanian University of Health Sciences. A total of 140 patients completed the Visual Functioning Questionnaire and the Hospital Anxiety and Depression Scale (HADS) during this prospective study. The patients were divided into two groups: patients with age-related macular degeneration (70 patients) and control patients (70 patients). There was a significant difference in the quality of life between groups (P<0.0001). Analyzing patients with age-related macular degeneration within the group (patients with monocular or binocular disorders), significant differences in near vision (P=0.003), far vision (P=0.04), color vision (P=0.01), and social functioning (P=0.02) were observed. Mental health (r=0.326, P=0.02), dependency (r=0.340, P=0.02), and role difficulties (r=0.355, P=0.01) were found to be significantly associated with general vision in the age-related macular degeneration group. Age-related macular degeneration appeared to have a great impact on the quality of life. General vision impairment caused by age-related macular degeneration affects patient's mental health, dependency, and role difficulties.
  Medicina (Kaunas, Lithuania) 04/2012; 48(2):109-11.
• Article: Escherichia coli colonization in neonates: prevalence, perinatal transmission, antimicrobial susceptibility, and risk factors.

  Rasa Tamelienė, Eglė Barčaitė, Dalia Stonienė, Jūratė Buinauskienė, Eglė Markūnienė, Aušrelė Kudrevičienė, Astra Vitkauskienė, Daiva Jomantienė, Rūta Nadišauskienė
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  ABSTRACT: Escherichia coli is one of the leading causes of early-onset neonatal sepsis in many industrialized countries. However, there is a lack of studies on Escherichia coli colonization in women and neonates. The study aimed at determining the prevalence Escherichia coli among pregnant women and newborns, perinatal transmission, antimicrobial susceptibility, and risk factors for neonatal colonization. In this prospective, cross-sectional study, 827 infants born to 808 mothers were enrolled. The study was carried out from October 1, 2006, to June 30, 2007. Women were screened for E. coli carriage at 35-37 weeks of gestation or on admission for premature rupture of membranes and delivery; neonates, within 15 minutes of their lives. Risk factors for colonization were collected by a questionnaire and were recorded during labor. Maternal E. coli colonization rate was 19.9%; neonatal, 14.4%; and transmission rate, 21.4%. Less than one-fourth (22.7%) of neonatal E. coli strains were resistant to ampicillin. Logistic regression analysis revealed that anal sexual intercourse (OR, 3.91; 95% CI, 1.87-8.19), one sexual partner (OR, 2.01; 95% CI, 1.30-3.11), maternal vaginal Escherichia coli colonization (OR, 1.81; 95% CI, 1.12-2.93), maternal body mass index of ≤27 (OR, 1.77; 95% CI, 1.15-2.73), and maternal education lower than university level (OR, 1.70; 95% CI, 1.06-2.74) were associated with neonatal Escherichia coli colonization. The prevalence of maternal Escherichia coli colonization was higher in this study than other studies (19.9%). Neonatal Escherichia coli colonization was 14.4%. The resistance of Escherichia coli isolates to ampicillin was not high (22.7%). Improvement of maternal education and modification of mothers' sexual habits need to be undertaken to prevent neonatal Escherichia coli colonization.
  Medicina (Kaunas, Lithuania) 04/2012; 48(2):71-6.
• Article: Biomechanical aspects of locking reconstruction plate positioning in osteosynthesis of transverse clavicle fracture.

  Egidijus Kontautas, Andrej Pijadin, Andrius Vilkauskas, Aurelijus Domeika
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  ABSTRACT: The aim of this study was to evaluate and compare the biomechanical effects of locking reconstruction plate positioning on the osteosynthesis of clavicle midshaft simulated transverse fractures. Twelve synthetic clavicles with simulated midshaft transverse fractures were repaired with a 3.5-mm locking reconstruction plate in the anteroinferior or the superior position. The clavicles were randomly assigned to 2 groups (6 per group). Each repaired clavicle was tested in cantilever bending by using the universal testing machine. The maximal load and the displacement of the specimens at a load of 40 N were recorded for each group. The anteroinferior plating osteosynthesis with a 3.5-mm locking reconstruction plate could bear an average maximal load of 183.3 N (SD, 11.3); the corresponding load for the superior plating osteosynthesis with the identical implants was 444.8 N (SD, 102.3), and the mean displacement was 1.5 mm (SD, 0.5) and 0.7 mm (SD, 0.2), respectively. The superior plating osteosynthesis of simulated midshaft transverse clavicle fractures with the 7-hole 3.5-mm locking reconstruction plate had a significantly higher bending (from top to bottom) load to failure in comparison with the anteroinferior plating osteosynthesis of the clavicle with the identical implants. Clavicles plated with the 7-hole 3.5-mm locking reconstruction plate at the superior aspect exhibited a significantly greater biomechanical stability at a load of 40 N than those plated at the anteroinferior aspect.
  Medicina (Kaunas, Lithuania) 03/2012; 48(2):80-3.
• Article: Two cases of takotsubo syndrome related to tracheal intubation/extubation.

  Triin Jakobson, Nikolai Svitškar, Kadri Tamme, Joel Starkopf, Juri Karjagin
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  ABSTRACT: Takotsubo cardiomyopathy is an acute, reversible left ventricular dysfunction with characteristic contractility disorder and is usually preceded by emotional or physical stress. Two cases of Takotsubo cardiomyopathy related to tracheal manipulation are presented. Both the patients had all the typical symptoms and signs of Takotsubo cardiomyopathy, and both of them recovered completely within weeks. Tracheal manipulation is a well-known stress factor during the perioperative period, and experience from these two cases stresses the crucial role of measures aimed to stress reduction. Proper premedication and calm environment are recommended to produce anxiolysis before intubation. The administration of α- and β-blockers is also recommended to inhibit sympathetic stress caused by tracheal manipulation.
  Medicina (Kaunas, Lithuania) 03/2012; 48(2):77-9.
• Article: Two dog-related infections leading to death: overwhelming Capnocytophaga canimorsus sepsis in a patient with cystic echinococcosis.

  Raimonda Matulionytė, Ingrida Lisauskienė, Gintautas Kėkštas, Arvydas Ambrozaitis
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  ABSTRACT: Capnocytophaga canimorsus is a fastidious, capnophilic, fusiform, and filamentous gram-negative rod. It is part of the normal oral flora of dogs and cats and can cause an infection in humans, but is of generally low virulence in healthy individuals. A case of fatal sepsis due to Capnocytophaga canimorsus in a 46-year-old woman with clinically silent cystic echinococcosis discovered postmortem is present. She had been bitten by a dog 3 days before the symptoms appeared. The family had owned the dog for 4 years. A preliminary diagnosis of septic shock of unknown etiology with multisystem organ failure was established. Despite all the efforts, the patient died on the seventh day of hospitalization. Laboratory findings received postmortem showed Capnocytophaga canimorsus isolated from the blood culture after 7 incubation days. Autopsy showed a cyst in the liver with a fibrotic wall and necrotic eosinophilic interiors containing fragments of Echinococcus granulosus scolices. In conclusion, an interaction possibly established long ago between the host and Echinococcus granulosus conditioned immunosuppression mechanisms developed by the parasite in this case, which can explain such an aggressive course of the infection with Capnocytophaga. Two dog-related infections were fatal in the middle-aged dog owner considered healthy before this hospitalization. Vigilance concerning recent exposure to dogs or cats and potential immunosuppression risk factors must be maintained in a patient presenting with clinical features of fulminant sepsis.
  Medicina (Kaunas, Lithuania) 03/2012; 48(2):112-5.
• Article: Parenting style, locus of control, and oral hygiene in adolescents.

  Jolanta Aleksejūnienė, Vilma Brukienė
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  ABSTRACT: The aim of the study was to test if variations in oral hygiene levels in adolescents were associated with locus of control and parenting styles after controlling for demographic factors. The study sample comprised 237 adolescents aged 12-13 years. The structured questionnaire included demographic characteristics and items about parenting style and locus of control. The Individual Quantitative Plaque % Index (IQPI) and toothbrushing frequency were used as clinical outcome measures. In the bivariate analyses, socioeconomic status (P=0.012), number of children in the family (P=0.003), and frequency of toothbrushing (P=0.001) were related to dental plaque levels. Gender (P<0.001), socioeconomic status (P=0.022), and external locus of control (Spearman rho, -0.144, P=0.027) were statistically significantly associated with toothbrushing frequency. In the multivariate analyses, only socioeconomic status and toothbrushing frequency were statistically significantly related to the IQPI. When toothbrushing frequency as the second outcome variable was used, the IQPI and gender were statistically significant. The association with socioeconomic status did not reach statistical significance (P=0.07). Only socioeconomic status and toothbrushing frequency explained variation in dental plaque levels among adolescents. The expected relationship among parenting styles, locus of control, and oral hygiene levels was not confirmed.
  Medicina (Kaunas, Lithuania) 03/2012; 48(2):102-8.
• Article: Primary epithelioid sarcoma of the neck: a rare case report.

  Viktoras Rudžianskas, Elona Juozaitytė, Arturas Inčiūra, Valdas Sarauskas, Milda Rudžianskienė
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  ABSTRACT: This report presents a case of a neck epithelioid sarcoma in a 20-year-old man with poor prognosis. The patient underwent surgery followed by external beam radiotherapy and brachytherapy performed as a boost. The treatment was well-tolerated, and there was no local recurrence or distant metastasis.
  Medicina (Kaunas, Lithuania) 02/2012; 48(1):57-60.
• Article: Noninvasive monitoring of cerebrovascular autoregulation response to resistance exercises.

  Vytautas Petkus, Aurija Kalasauskienė, Arminas Ragauskas, Romanas Chomskis, Gražina Krutulytė, Laimutis Kalasauskas
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  ABSTRACT: BACKGROUND AND OBJECTIVE. A novel noninvasive monitor is presented by demonstrating its capabilities to perform the real-time estimation of dynamics in cerebrovascular autoregulation in athletes during their training. The aim was to explore the characteristics of human cerebrovascular autoregulation by performing the monitoring of cerebrovascular autoregulation responses to resistance exercises in healthy volunteer athletes. MATERIAL AND METHODS. Cerebrovascular autoregulation status was monitored in 20 amateur and 20 elite male athletes (weightlifters and bodybuilders) in the supine position at rest during and after the resistance exercises by using a novel noninvasive monitor "Vittamed." Blood pressure and heart rate were also measured noninvasively. During the exercises, the athletes lifted 50 kg and 80% of 1RM (repetition maximum) weights in a dynamic and static manner in separate tests. RESULTS. The cerebrovascular autoregulation reactivity index showed a temporal improvement in the cerebrovascular autoregulation status for almost all sportsmen after the exercises. No disturbances of cerebrovascular autoregulation response occurred in the weightlifters and amateur athletes after the static and dynamic exercises. However, an unstable status of cerebrovascular autoregulation was observed for the elite bodybuilders during the interval of 400 to 600 s after the exercises. CONCLUSIONS. The data of this study demonstrated significant differences in cerebrovascular autoregulation response to the resistance exercises between the elite bodybuilders and other subjects (amateurs and weightlifters) - a temporarily unstable status of cerebrovascular autoregulation was observed in the group of elite bodybuilders. This study also demonstrated the applicability of the noninvasive device for exploring the physiology of cerebrovascular autoregulation mechanism in elite athletes and healthy volunteers.
  Medicina (Kaunas, Lithuania) 02/2012; 48(1):39-47.
• Article: Clinical and pathological findings of fatal 2009-2010 pandemic influenza A (H1N1) infection in Estonia.

  Kadri Tamme, Ave Minajeva, Vivika Adamson, Kaarina Ristmägi, Jaak Põder, Irja Lutsar
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  ABSTRACT: The aim of this study was to analyze all deaths from A (H1N1) in Estonia during the 2009-2010 epidemic to find out the reasons of high mortality and optimize management strategies for future influenza epidemics. MATERIAL AND METHODS. A retrospective review of medical records, autopsy reports, and reassessment of autopsy slides of all fatal cases of proven A (H1N1) influenza in Estonia from October 2009 to May 2010 was carried out. RESULTS. There were a total of 21 proven fatal cases (median age, 57 years); the population mortality rate of 1.56 per 100 000 inhabitants was one of the highest in the world. Altogether, 18 of the 21 patients had known risk factors for influenza, and 3 patients were previously healthy children. Three decedents had received antiviral treatment, and none had been immunized. There were 19 decedents autopsied, with viral pneumonia (58%) being the most frequent pathological finding; 40% had evidence of bacterial superinfection. In 4 cases, influenza was not clinically suspected and was diagnosed postmortem. Influenza was the primary cause of death in 15 decedents, while in 9 cases, comorbidities played a significant role in fatal outcome. In the remaining 4 cases, another illness was considered the primary cause of death with influenza as an accompanying factor. CONCLUSIONS. High autopsy rate and liberal postmortem PCR testing enables the detection of additional A (H1N1) influenza cases, yet it might lead to overestimation of the population mortality rates, especially in a small population with low number of events. Increased vaccine coverage, vigilant diagnosing including wide PCR testing, and early more liberal use of antiviral medications during the influenza A (H1N1) epidemic may hold the potential of lowering population mortality.
  Medicina (Kaunas, Lithuania) 02/2012; 48(1):48-56.