Medicina, Volume 44, Issue 7 (July 2008) – 10 articles

The purpose of the present study was to examine mothers’ internal representations of experience with their developmentally disordered children. Maternal perceptions of children have been considered important in clinical work with developmentally disordered children and their families. Using developmental disability sample of 17–34-month-old children, we compared mothers’ representations of their children in clinically referred and not referred groups, using the Working Model of the Child Interview. Twenty mothers of children with developmental disorders and twenty matched controls participated. Six (30%) children of experiment group had a diagnosis of cerebral palsy; 5 (25%) were diagnosed with Down’s syndrome, while the remaining 9 (45%) had a diagnosis of mixed specific developmental disorder. Many children with disability also were diagnosed with heart disease, epilepsy, and hydrocephalus. Maternal representations’ measures were compared to their self-perceived impact of child disability on family, their sensitivity to child, and some demographic and family characteristics. Compared to controls, mothers of children with developmental disability had representations of their children that were significantly more likely to be classified distorted or disengaged (χ2=7.24; df=2; P<0.05). More severe disability status was significantly associated with mothers’ disengaged representations, fear for safety of children, and intensity of involvement in care giving (P<0.05). The study did not confirm relationships between maternal representation classifications and their self-perceived impact of child disability on family. No differences were found concerning mothers’ emotional empathy index in clinical and control groups. The differences in mean emotional empathy scores were related to many aspects of maternal internal representations and to some areas of self-perceived stress. The results of Working Model of the Child Interview did not correlate with child age and gender, birth order, and parents’ level of education. Full article

Bipolar disorder in adolescents is a serious mental illness with problematic diagnosis that adversely affects social, academic, emotional, and family functioning. The objective of this study was to analyze features of premorbid and clinical symptoms, comorbidity, and course of bipolar disorder in adolescence. Data for analysis were collected from all case histories (N=6) of 14–18-year-old patients, hospitalized with diagnosis of bipolar disorder in theUnit of Children’s and Adolescents’ Psychiatry, Department of Psychiatry, Hospital of Kaunas University of Medicine, during the period from 2000 to 2005. Analysis of bipolar disorder course showed that five patients previously had been diagnosed with an episode of depression. The most frequent symptoms typical to bipolar disorder were disobedience and impulsive behavior, rapid changes of mood. The most common premorbid features were frequent changes of mood, being active in communication, hyperactive behavior. Adolescence-onset bipolar disorder was frequently comorbid with emotionally instable personality disorder, borderline type. Findings of the study confirm the notion that oppositional or impulsive behavior, rapid changes of mood without any reason, dysphoric mood and euphoric mood episodes with increased energy were cardinal symptoms of bipolar disorder with mania in adolescents. Most frequent premorbid features of these patients were quite similar to attention-deficit/hyperactivity disorder making differential diagnosis problematic. Full article

The objective of this article is to overview and present the burn incidence and burn care in Lithuania.
Materials and methods. In this study, data from the period of 1991–2004 were collected from the Lithuanian Department of Statistics, Department of Fire and Rescue, Lithuanian Health Information Center, State Patient Fund, health care institutions, burn care facilities.
Results. In the 14-year period, 9459 persons per year (2.6/1000 population) in average sustained burn injuries. The majority of burned patients (74.8%) were adults and 25.2% were children; 21.5% of all burned patients were hospitalized (2013 inpatients per year). The number of hospitalizations per 100 000 individuals has decreased from 65.6 to 39.5, but it is still very high and worrying. Among all the patients admitted to hospitals, 67% were males and 33% females, with a male-to-female ratio of 2:1. The length of hospitalization decreased from 16.2 to 12.7 days. The number of fire-related deaths for the 14-year period was 289 deaths per year (8 per 100 000 persons). The number of deaths among inpatients was 63.6 deaths per year, the age being an important factor in mortality rates. Although the mortality of inpatients has increased in recent years, the mortality in the age group up to 14 years has decreased to 0. Children made up 24.6%of burn patients; among those admitted to hospital, they accounted for 41.1%. Mortality rates for males and females were almost the same.
Conclusions. The number of burns is decreasing. The hospitalization rate and hospitalization time are becoming shorter. In the last few years, patients suffer from more severe burns, while children sustain more severe burns requiring hospitalization. Children and working-age persons make up 91.9% of hospitalized burn patients. Number of deaths in fire accidents is increasing. Full article

Objectives. Acute liver failure (ALF) is a life-threatening condition that can rapidly progress into coma and death due to the cerebral edema and multi-organ dysfunction. The ALF etiology and risk factors have been investigated inWest Europe, North America, and Asia; however, there are still no published data about the causes and prognosis of ALF in Central and East European countries. The aim of our study was to analyze the causes, outcomes, and prognostic factors of ALF in patients referred to tertiary care center in Lithuania.
Material and methods. A total of 28 consecutive patients admitted to the tertiary care center (one of two university-level medical centers in Lithuania) over the period of January 1996 and December 2004 and who fulfilled the entry criteria of ALF (presence of hepatic encephalopathy (HE) and prothrombin international normalized ratio (INR) >1.5) were included into a prospective study.
Results. In our study the most frequent causes of ALF were acute viral hepatitis B (21.4 %), drug-induced hepatitis (21.4%), and indeterminate hepatitis (17.9%); other etiologies included Budd-Chiari syndrome (10.7%), ischemic hepatitis (10.7%), Wilson’s disease (7.1%), Amanita phalloides-induced liver damage (3.6%), acute fatty liver of pregnancy (3.6%), and malignant infiltration of the liver (3.6%). Among patients with drug-induced liver injury, only one case of acetaminophen poisoning was diagnosed. Clinical status of 9 persons in all patients with ALF corresponded to criteria for liver transplantation (LT) (one liver transplantation was performed), 6 of them had contraindications, and 13 patients did not fulfill requirements for urgent LT. The patients’ survival rate in these groups was 11.1%, 16.7% and 69.2%, respectively. In 27 nontransplanted patients univariate analysis revealed the grade of HE on the day of enrolment, total serumbilirubin, pH, and prothrombin INR as risk factors for death fromALF.Multivariate logistic regressive analysis determined only prothrombin INR >3.24 and serum pH £7.29 as independent predictors of lethal outcome in ALF.
Conclusions. Acute viral hepatitis B, drug-induced liver injury, and indeterminate hepatitis are the main ALF causes in Lithuania. In non-transplanted patients, the main predictors of lethal outcome were severe coagulopathy and metabolic acidosis. Improvement of liver donation system for urgent liver transplantation is essential requirement for amelioration of ALF patient’s survival. Full article

This review analyzes the structure and regulation mechanisms of voltagedependent L-type Ca²⁺ channel in the heart. L-type Ca²⁺ channels in the heart are composed of four different polypeptide subunits, and the pore-forming subunit a1 is the most important part of the channel. In cardiac myocytes, Ca²⁺ enter cell cytoplasm from extracellular space mainly through L-type Ca²⁺ channels; these channels are very important system in heart Ca²⁺ uptake regulation. L-type Ca²⁺ channels are responsible for the activation of sarcoplasmic reticulum Ca²⁺ channels (RyR2) and force of muscle contraction generation in heart; hence, activity of the heart depends on L-type Ca²⁺ channels. Phosphorylation of channel-forming subunits by different kinases is one of the most important ways to change the activity of L-type Ca²⁺ channel. Additionally, the activity of L-type Ca²⁺ channels depends on Ca²⁺ concentration in cytoplasm. Ca²⁺ current in cardiac cells can facilitate, and this process is regulated by phosphorylation of L-type Ca²⁺ channels and intracellular Ca²⁺ concentration. Disturbances in cellular Ca2+ transport and regulation of L-type Ca²⁺ channels are directly related to heart diseases, life quality, and life span. Full article

Studied nature of the “blood vessels relaxing factor” derived fromendotheliumthat was identified as nitric oxide caused intensive scientific research on nitric oxide regarding some aspects of its impact on human physiological and pathological processes. The objective of this short review is to discuss widely used (in the clinical practice) direct and indirect donors of nitric oxide and/or other agents, increasing nitric oxide concentration in human body, and their beneficial role for the prevention of atherosclerosis. Under physiological conditions, endotheliumregulates the tone of blood vessels, homeostasis of which is maintained by endotheliumgenerated vasoconstrictors and vasodilators. The most important vasodilator and the main substance produced by the endothelium is nitric oxide. The failure of synthesis and/or the lost of nitric oxide bioavailability is the major feature of endothelial dysfunction and key factor initiating progression of atherosclerosis. The endothelial dysfunction initiates the series of events, which stimulate and aggravate the course of atherosclerosis by increasing endothelial permeability, platelet aggregation, and leukocyte adhesion, and cytokine expression. Further, the review deals with the mechanisms of action of statins, angiotensin-converting enzyme inhibitors, L-arginine, direct nitric oxide donors (nitroglycerin, isosorbide mononitrate and isosorbide dinitrate), and indirect nitric oxide donors (phosphodiesterase-V inhibitors, K_ATP openers). Full article

This article attempts to explore the phenomenology of religious delusions in patients suffering from schizophrenia and to determine parallels between personal religiosity and content of religious delusions. We have studied the content of delusions in patients with schizophrenia looking for religious themes using Fragebogen fur psychotische Symptome (FPS) – a semistructured questionnaire developed by the Cultural Psychiatry International research group in Vienna. A total of 295 patients suffering from schizophrenia participated in this study at Vilnius Mental Health Center in Lithuania, among whom 63.3% reported religious delusions. The most frequent content of religious delusion in women was their belief that they were saints and in men – that they imagined themselves as God. Univariate multiple logistic regression analyses revealed that four factors such asmarital status, birthplace, education, and subjective importance of religion were significantly related to the presence of religious delusions. However, multivariate analyses revealed that marital status (divorced/separated vs. marriedOR (odds ratio)=2.0; 95% CI, 1.1 to 3.5) and education (postsecondary education vs. no postsecondary education OR=2.3; 95% CI, 1.4 to 3.9), but not personal religiosity, were independent predictors of the religious delusions. We conclude that the religious content of delusions is not influenced by personal religiosity; it is rather related to marital status and education of schizophrenic patients. Full article

During the last decade, it has been shown that the metabolic syndrome and its different components – arterial hypertension (AH), abdominal obesity (AO), diabetes mellitus (DM), atherogenic hypertriglyceridemia (HTG), and/or low concentration of high-density lipoprotein cholesterol (HDL-C)) – increase the risk of cardiovascular diseases. There is increasing evidence that the incidence of the metabolic syndrome and the distribution of its components in combinations in the general male and female population differ. The aim of our study was to determine the incidence of the metabolic syndrome in men and women with acute ischemic syndromes and to evaluate the distribution of the metabolic syndrome component combinations in the presence of the metabolic syndrome.
Contingent and methods. The study included 2756 patients (1670 males and 1086 females) with acute ischemic syndromes (1997 with myocardial infarction and 759 with unstable angina pectoris), in whom all five components of the metabolic syndrome were assessed. Women were significantly older than men (68.1±9.5 vs. 60.2±11.8 years, P<0.001). The metabolic syndrome was found (according to modified NCEP III) in 1641 (59.5%) patients (in 70.2% of females and in 52.6% of males, P<0.001). The most common components in both men and women were AH andAO(94.0%vs. 95.9%and 86.4%vs. 84.5%, respectively). HTGwas significantlymore common in men than in women (80.0% vs. 73.0%, P<0.001), while decreased HDL-C concentration was more common in women (82.8% and 59.2%, P<0.001). The DM component, detected in more than one-third of patients with acute ischemic syndromes, was significantly more common in women than in men (39.2% vs. 33.1%, P<0.05). Combinations of three components were significantly more common in men than in women, while combinations of four–five components were more common in women (55.6% vs. 41.4%, P<0.001; and 58.6% vs. 44.4%, P<0.01). The most common combination of three components in men was AH+AO+HTG and in women – AH+AO+lowHDL-C; themost common combination of four components in bothmen and women was AH+AO+HTG+low HDL-C.
Conclusion. In the metabolic syndrome, the differences between the components of atherogenic dyslipidemia in patients with acute ischemic syndromes were related to the patients’ gender: men significantly more frequently had increased TG concentration and women – decreased HDLC concentration; this is the problem to be addressed in further studies of dyslipidemia. Full article

Objective. Hepatitis C virus infection (HCV) has a high rate of chronic evolution; however, the underlying mechanisms remain to be elucidated. We investigated natural clinical, virological, and immunological course of acute HCV infection in order to identify possible prognostic factors of spontaneous resolution and to gain more understanding of early characteristics responsible for viral clearance or persistence.
Materials and methods. Eight patients with acute symptomatic hepatitis C were prospectively followed up for more than 6 months (range, 8–14 months). None of the individuals received antiviral therapy during the study period. We analyzed biochemical, virological, and immunological parameters of these patients detected at different time-points of the follow-up. Plasma HCV RNA was quantitated using TaqManâ real-time polymerase chain reaction. Virusspecific CD4+ T cells were enumerated by interferon-gamma (IFN-g) ELISpot assay.
Results. Two of eight individuals resolved HCV spontaneously, while the remaining patients developed chronic HCV infection. HCV RNA became undetectable within 14 days of the study, followed by a rapid alanine aminotransferase normalization in patients with resolved infection. On the contrary, chronically infected subjects demonstrated persistent viremia or intermittently undetectable HCV-RNA, accompanied by polyphasic alanine aminotransferase profile throughout the study. Patients with self-limited hepatitis C displayed the strongest virus-specific CD4+ T (IFN-g) cell reactivity within the first weeks of the follow-up, while persistently infected subjects initially showed a weak antiviral CD4+ T (IFN-g) cell response.
Conclusions. In most cases, acute hepatitis C progresses to chronic disease. Viral clearance within the first month after clinical presentation accompanied by monophasic alanine aminotransferase profile could predict recovery. Early and strong CD4+/Th1 immune response against HCV might play an important role in the disease resolution. Full article

The aim of the study was to determine the functions influencing the recovery of the motor and cognitive functions and general functional state in cerebral stroke patients during the second rehabilitation stage, and their prognostic value.
The contingent and methods. The studied contingent consisted of 226 cerebral stroke patients: 109 men and 117 women who had undergone the second stage rehabilitation in Viršužiglis Rehabilitation Hospital, a branch institution of Hospital of Kaunas University of Medicine. The mean age of the patients was 67.8±10.4 years. The greatest proportion of the patients (88.5%) was with cerebral infarction. The mean duration of rehabilitation was 38.8±8.9 days. The functional state of the patients was assessed by functional IndependenceMeasure; the cognitive function, by the short mental function study method; the severity of the stroke, in accordance with the National Institutes of Health Stroke Scale. The prognostic value of the factors was evaluated by the logistic regression method. A study analyzed the influence of patient’s gender, age, social factors, clinical symptoms and signs, risk factors for stroke, comorbities, the character and localization of the stroke, and psychoemotional state on the recovery of capacities related to motor and cognitive functions, and restoration of general functional state.
Results. During the second stage of rehabilitation, the score of the functional state of the patients assessed by the Functional Independence Measures significantly improved from 65.9±20.3 to 93.5±20.9 (P<0.0001). At the end of rehabilitation, good efficacy of rehabilitation was determined in 64.2% of the rehabilitees; moderate, in 19.4%; insufficient, in 16.4%. In prognosing insufficient recovery of general functional state during the second stage of rehabilitation, the following factors had a significant influence: extremity hemiplegia, disturbed cognitive functions, urination impairment, joint and heart diseases. In cases of insufficient recovery of capacities linked with motor function in the second stage of rehabilitation, exerted extremity hemiplegia, neglect of the affected side of the body, urination impairments, joint and heart disorders had a significant influence, whereas localization of the stroke lesion in the left hemisphere of the brain, impairment of cognitive functions (disturbance of speech and perception), urination disturbances – on the insufficient recovery of capacities related to cognitive functions.
Conclusion. Insufficient efficacy of rehabilitation of the rehabilitees with cerebral stroke in the second stage of rehabilitation was influenced by impairment of motor and cognitive functions, urination disturbancies, and comorbidities. In forming individualized inpatient rehabilitation programs and prognosing the further health care of patients with cerebral stroke, it is important to pay attention to factors, influencing insufficient efficacy of rehabilitation. Full article