Outcomes of low-risk birth care during the Covid-19 pandemic: A cohort study from a tertiary care center in Lithuania.

According to the World Health Organization, midwife-led care is the most appropriate and cost-effective type of perinatal care. As the Covid-19 pandemic with its drastic changes and challenges for the health systems and the medical staff made large adjustments to the healthcare delivery system, midwife-led care became an even more important supportive tool in maintaining unnecessary interventions. This retrospective cohort study aims to compare the outcomes of midwife-led care and team-led care in low-risk births between the Covid-19 pandemic and non-Covid-19 pandemic period. The total studied population was 1,185 singleton births and consisted of 727 births during the non-Covid-19 period and 458 births from the Covid-19 period. The study revealed the safety of low-risk birth care during the first wave of the Covid-19 pandemic in both groups. The maternal and perinatal outcomes remained stable without an increased rate of unsuccessful vaginal births and newborn asphyxia; moreover, birth care of low-risk women provided by midwives preserved autonomy, integrity, and resistance to responding to a disaster. The aforementioned results exhibit that high-quality, safe supervision by midwives in low-risk births can be provided even in high-stress circumstances.

Accuracy of Acoustic Voice Quality Index Captured With a Smartphone - Measurements With Added Ambient Noise.

OBJECTIVE: To evaluate the accuracy of Acoustic Voice Quality Index (AVQI) measures obtained from voice recordings simultaneously using oral and smartphone microphones in a sound-proof room, and to compare them with AVQIs obtained from the same smartphone voice recordings with added ambient noise. METHODS: A study group of 183 subjects with normal voices (n = 86) and various voice disorders (n = 97) was asked to read aloud a standard text and sustain the vowel /a/. The controlled ambient noise averaged at 29.61 dB SPL was added digitally to the smartphone voice recordings. Repeated measures analysis of variances (ANOVA) with Greenhouse-Geiser correction was used to evaluate AVQI changes within subjects. To evaluate the level of agreement between AVQI measurements obtained from different voice recordings Bland-Altman plots were used. RESULTS: Repeated measures ANOVA showed that differences among AVQI results obtained from voice recordings done with oral studio microphone, recordings done with a smartphone microphone, and recordings done with a smartphone microphone with added ambient noise were not statistically significant (P = 0.07). No significant systemic differences and acceptable level of random errors in AVQI measurements of voice recordings made with oral and smartphone microphones (including added noise) were revealed. CONCLUSION: The AVQI measures obtained from smartphone microphones voice recordings with experimentally added ambient noise revealed an acceptable agreement with results of oral microphone recordings, thus suggesting the suitability of smartphone microphone recordings performed even in the presence of acceptable ambient noise for estimation of AVQI.

Individualized care for older adults with diabetes and its relationship with communication, psychosocial self-efficacy, resources and support for self-management and socio-demographics.

AIM: To examine the relationship between patient-provider communication, psychosocial patient self-efficacy, resources and support for self-management and socio-demographics within individualized care of older adults with diabetes. DESIGN: A quantitative study with a cross-sectional survey design. METHODS: Data were collected from September 2019 to January 2021 using: Individualized Care Scale, The Communication Assessment Tool, The Diabetes Empowerment Scale and The Resources and Support for Self-Management Scale. Patients with either Type 1 or Type 2 diabetes mellitus that were 65 years old and over (N = 145) participated in the study. RESULTS: The most positive aspects of patient-provider communication were respect and creating a comfortable environment for the patient. A significant relationship was observed between patients' perceptions and support of individualized care and diabetes-related measures. Effective communication was the main factor associated with support for individualizing care, and together with education level, empowerment and access to resources, explained 23% of the variance.

Effectiveness of the ELLA Training for the Promotion of Emotional and Social Competences in Lithuanian Preschool Children.

By developing the emotional and social competences of children of preschool age, one can expect the prevention of emotional and behavioral problems and a better social and academic adaptation. The aim of this study was to evaluate the effectiveness of the ELLA training for the promotion of emotional and social competences in 3-6-year-old children in preschool education institutions in Lithuania. In total, 140 children aged 3-6 years participated in the quasi-experimental study, of which 86 children were assigned to the experimental group and 54 were assigned to the control group. Children of the experimental group were given a modified program-the ELLA training for the promotion of emotional and social competences. Children's emotional and social competences were assessed before and after the program. The EMK 3-6 inventory (germ. Inventar zur Erfassung Emotionaler Kompetenzen bei Drei-bis Sechsjährigen, EMK 3-6) was used to conduct a questionnaire survey of teachers and to carry out an individual assessment performed by psychologists in order to assess the children's competences. The ELLA training significantly improved children's emotional and social competences. Based on the teachers' assessment, the children's self-regulation abilities improved, and based on the children's individual assessment conducted by psychologists, the application of the program resulted in the improvement of the children's primary emotions, secondary emotions, and prosocial behavior competences.

Alzheimer's Disease Association with Metals and Metalloids Concentration in Blood and Urine.

As there is some evidence that the risk for Alzheimer's disease (AD) is partially attributable to environmental exposure to some metals and metalloids, we examined an association between AD and arsenic, chromium, and selenium in 53 AD patients and 217 controls. Urinary arsenic, blood chromium, and selenium were determined by inductively coupled plasma mass spectrometry. Logistic regression models calculating odds ratios (ORs) and 95% confidence intervals (CI) were used to estimate AD association with arsenic, chromium, and selenium. In AD patients, urinary arsenic and blood chromium were significantly higher, while blood selenium was significantly lower compared to controls. Increased blood selenium was related to a significant decrease in the odds of AD after adjustment for risk factors. Blood selenium per 1 kg × 10-9/m3 × 10-4 increment was associated with 1.4 times lower risk of AD (OR = 0.71; 95% CI 0.58-0.87). A significant increase in the odds of AD associated with increased blood chromium was also seen in the adjusted model: the OR per 1 kg × 10-9/m3 × 10-3 chromium increment was 2.39 (95% CI 1.32-4.31). The association of urinary arsenic with the risk of AD was not significant. The data obtained provide evidence that selenium reduces the risk of Alzheimer's disease, while chromium increases it.

Microvascular Complications, Peripheral Artery Disease and Mortality in Patients with Type 2 Diabetes Mellitus, in Two Counties of Southern Lithuania over 13 Years: Analysis Using a Cohort Database of the National Health Insurance.

Background and Objectives: People living with diabetes mellitus are at risk of developing many serious and life-threatening complications. The present study aimed to determine the occurrence of microvascular complications, peripheral artery disease, and mortality in patients with type 2 diabetes mellitus (T2DM), in 2 Lithuanian counties. Materials and Methods: The data on residents aged ≥ 18 years, who were diagnosed for the first time in 2004 with uncomplicated T2DM, were obtained from the National Health Insurance Fund database. The occurrence of T2DM microvascular complications, peripheral artery disease, and mortality during the period from 2004 to 2016 were assessed by gender and age groups (<65 and ≥65 years). Results: During the 13 years, 46.9% of the patients developed T2DM complications. More men than women developed at least 1 T2DM complication (50.8% vs. 44.8%, p = 0.035). The mean time for developing any T2DM complication was 9.2 years. The probability of occurrence of any complication was 0.07 in the second year and increased to 0.59 in the thirteenth year of living with diabetes. Within the 13 years, 38.2% of the patients died. More men (43.1%) than women (35.5%) died during the analysis period (p = 0.036). Mortality was higher among older patients (60.7%) than among younger patients (22.2%) (p < 0.001). Conclusions: The results of this study provide a comprehensive picture of microvascular complications, peripheral artery disease, and mortality among patients with T2DM of two Lithuanian counties. Information about the occurrence of T2DM complications and mortality will assist further studies in estimating the burden of T2DM and in performing economic evaluations of T2DM prevention and treatment in Lithuania.

The Behavioral Problems in 2.5-5 Years Old Children Linked with Former Neonatal/Infantile Surgical Parameters.

Studies report the link between exposure to major neonatal surgery and the risk of later neurodevelopmental disorders. The aim of this study was to find out the behavioral problem scores of 2.5-5 years old children who had undergone median/major non-cardiac surgery before the age of 90 days, and to relate these to intraoperative cerebral tissue oxygenation values (rSO2), perioperative duration of mechanical ventilation (DMV) and doses of sedative/analgesic agents. Internalizing (IP) and externalizing problems (EP) of 34 children were assessed using the CBCL for ages 1½-5. Median (range) IP and EP scores were 8.5 (2-42) and 15.5 (5-33), respectively and did not correlate with intraoperative rSO2. DMV correlated and was predictive for EP (ß (95% CI) 0.095 (0.043; 0.148)). An aggregate variable "opioid dose per days of ventilation" was predictive for EP after adjusting for patients' gestational age and age at the day of psychological assessment, after further adjustment for age at the day of surgery and for cumulative dose of benzodiazepines (ß (95% CI 0.009 (0.003; 0.014) and 0.008 (0.002; 0.014), respectively). Neonatal/infantile intraoperative cerebral oxygenation was not associated with later behavioral problems. The risk factors for externalizing problems appeared to be similar to the risk factors in preterm infant population.

Impaired Subjective Visual Vertical and Increased Visual Dependence in Older Adults With Falls.

Aging affects the vestibular system and may disturb the perception of verticality and lead to increased visual dependence (VD). Studies have identified that abnormal upright perception influences the risk of falling. The aim of our study was to evaluate subjective visual vertical (SVV) and VD using a mobile virtual reality-based system for SVV assessment (VIRVEST) in older adults with falls and evaluate its relationship with clinical balance assessment tools, dizziness, mental state, and depression level. This study included 37 adults >65 years who experienced falls and 40 non-faller age-matched controls. Three tests were performed using the VIRVEST system: a static SVV, dynamic SVV with clockwise and counter-clockwise background stimulus motion. VD was calculated as the mean of absolute values of the rod tilt from each trial of dynamic SVV minus the mean static SVV rod tilt. Older adults who experienced falls manifested significantly larger biases in static SVV (p = 0.012), dynamic SVV (p < 0.001), and VD (p = 0.014) than controls. The increase in static SVV (odds ratio = 1.365, p = 0.023), dynamic SVV (odds ratio = 1.623, p < 0.001) and VD (odds ratio = 1.460, p = 0.010) tilt by one degree significantly related to falls risk in the faller group. Fallers who had a high risk of falling according to the Tinetti test exhibited significantly higher tilts of dynamic SVV than those who had a low or medium risk (p = 0.037). In the faller group, the increase of the dynamic SVV tilt by one degree was significantly related to falls risk according to the Tinetti test (odds ratio = 1.356, p = 0.049). SVV errors, particularly with the dynamic SVV test (i.e., greater VD) were associated with an increased risk of falling in the faller group. The VIRVEST system may be applicable in clinical settings for SVV testing and predicting falls in older adults.

Cadmium Exposure and Risk of Breast Cancer by Histological and Tumor Receptor Subtype in White Caucasian Women: A Hospital-Based Case-Control Study.

As the majority of experimental studies suggest cadmium being metalloestrogen, we examined cadmium/breast cancer (BC) association by histological and tumor receptor subtype in 509 invasive BC patients and 1170 controls. Urinary cadmium was determined by atomic absorption spectrometry, and categorized using tertiles of its distribution in the controls: <0.18, 0.18-0.33, >0.33 kg × 10-9/kg × 10-3 creatinine. Relative to the lowest category of urinary cadmium adjusted odds ratio (OR) of ductal BC was 1.18 (95% confidence interval (CI): 0.89-1.58) in the intermediate and 1.53 (95% CI: 1.15-2.04) in the highest category. There was a significant association for hormone receptor-positive ductal BC: ORs per category increase were 1.34 (95% CI: 1.14-1.59) for estrogen receptor-positive (ER+), 1.33 (95% CI: 1.09-1.61) for progesterone receptor-positive (PR+) and 1.35 (95% CI: 1.11-1.65) for ER+/PR+ BC. We found a significant association between cadmium and human epidermal growth factor receptor 2-negative (HER2-) ductal BC. The strongest association with cadmium was for ER+/PR+/HER2- ductal BC. The associations between cadmium and lobular BC with hormone receptor-positive and HER2- were positive but insignificant. There was no evidence that the associations with cadmium differed for cancers with different tumor histology (p-heterogeneity > 0.05). This study provides evidence that urinary cadmium is associated with the risk of hormone receptor-positive and HER2- breast cancer independent of tumor histology.

Validation of the EFFECT questionnaire for competence-based clinical teaching in residency training in Lithuania.

BACKGROUND AND AIM: In 2013, all residency programs at the Lithuanian University of Health Sciences were renewed into a competency-based medical education curriculum. To assess the quality of clinical teaching in residency training, we chose the EFFECT (evaluation and feedback for effective clinical teaching) questionnaire designed and validated at the Radboud University Medical Centre in the Netherlands. The aim of this study was to validate the EFFECT questionnaire for quality assessment of clinical teaching in residency training. MATERIALS AND METHODS: The research was conducted as an online survey using the questionnaire containing 58 items in 7 domains. The questionnaire was double-translated into Lithuanian. It was sent to 182 residents of 7 residency programs (anesthesiology reanimathology, cardiology, dermatovenerology, emergency medicine, neurology, obstetrics and gynecology, physical medicine and rehabilitation). Overall, 333 questionnaires about 146 clinical teachers were filled in. To determine the item characteristics and internal consistency (Cronbach's α), the item and reliability analyses were performed. Furthermore, confirmatory factor analysis (CFI) was performed using a model for maximum-likelihood estimation. RESULTS: Cronbach's α within different domains ranged between 0.91 and 0.97 and was comparable with the original version of the questionnaire. Confirmatory factor analysis demonstrated satisfactory model-fit with CFI of 0.841 and absolute model-fit RMSEA of 0.098. CONCLUSIONS: The results suggest that the Lithuanian version of the EFFECT maintains its original validity and may serve as a valid instrument for quality assessment of clinical teaching in competency-based residency training in Lithuania.

Association between lifetime exposure to passive smoking and risk of breast cancer subtypes defined by hormone receptor status among non-smoking Caucasian women.

Tobacco smoking is inconsistently associated with breast cancer. Although some studies suggest that breast cancer risk is related to passive smoking, little is known about the association with breast cancer by tumor hormone receptor status. We aimed to explore the association between lifetime passive smoking and risk of breast cancer subtypes defined by estrogen receptor and progesterone receptor status among non-smoking Caucasian women. A hospital-based case-control study was performed in 585 cases and 1170 controls aged 28-90 years. Information on lifetime passive smoking and other factors was collected via a self-administered questionnaire. Logistic regression was used for analyses restricted to the 449 cases and 930 controls who had never smoked actively. All statistical tests were two-sided. Adjusted odds ratio of breast cancer was 1.01 (95% confidence interval (CI): 0.72-1.41) in women who experienced exposure to passive smoking at work, 1.88 (95% CI: 1.38-2.55) in women who had exposure at home, and 2.80 (95% CI: 1.84-4.25) in women who were exposed at home and at work, all compared with never exposed regularly. Increased risk was associated with longer exposure: women exposed ≤ 20 years and > 20 years had 1.27 (95% CI: 0.97-1.66) and 2.64 (95% CI: 1.87-3.74) times higher risk of breast cancer compared with never exposed (Ptrend < 0.001). The association of passive smoking with hormone receptor-positive breast cancer did not differ from that with hormone receptor-negative breast cancer (Pheterogeneity > 0.05). There was evidence of interaction between passive smoking intensity and menopausal status in both overall group (P = 0.02) and hormone receptor-positive breast cancer group (P < 0.05). In Caucasian women, lifetime exposure to passive smoking is associated with the risk of breast cancer independent of tumor hormone receptor status with the strongest association in postmenopausal women.

The Association of Low-To-Moderate Alcohol Consumption with Breast Cancer Subtypes Defined by Hormone Receptor Status.

BACKGROUND: Alcohol is a well-established risk factor for breast cancer, but pathways involved in alcohol-related breast carcinogenesis are not clearly defined. We examined the association between low-to-moderate alcohol intake and breast cancer subtypes by tumor hormone receptor status. MATERIALS AND METHODS: A hospital-based case-control study was performed in 585 cases and 1,170 controls. Information on alcohol intake and other risk factors was collected via a questionnaire. Logistic regression was used for analyses. All statistical tests were two-sided. RESULTS: The odds ratio of breast cancer was 1.75 (95% confidence interval [CI]: 1.21-2.53) in women who consumed ≤5 drinks/week, and 3.13 (95% CI: 1.81-5.43) in women who consumed >5 drinks/week, both compared with non-drinkers for ≥10 years, after adjustment for age and other confounders. The association of alcohol intake with estrogen receptor-positive breast cancer was stronger than with estrogen receptor-negative: the odds ratio per 1 category increase was 2.05 (95% CI: 1.49-2.82) and 1.29 (95% CI: 0.85-1.94) (P-heterogeneity = 0.07). There was no evidence of an interaction between alcohol intake and menopausal status (P = 0.19) in overall group; however, it was significant in estrogen receptor-positive breast cancer (P = 0.04). CONCLUSIONS: Low-to-moderate alcohol intake is associated with the risk of estrogen receptor-positive breast cancer with the strongest association in postmenopausal women. Since alcohol intake is a modifiable risk factor of breast cancer, every woman should be informed and advised to control alcohol use.

The cost of newly diagnosed breast cancer in Lithuania, 2011.

BACKGROUND AND OBJECTIVE: Although the cost of treating women with breast cancer (BC) is an important component for cost saving and effectiveness in relation to the benefits of BC treatment interventions, there is limited information on the direct cost reported for BC in Lithuania. Therefore the aim of this study was to evaluate annual direct medical cost for newly diagnosed BC in Lithuania in the year 2011. MATERIALS AND METHODS: The retrospective incidence-based top-down direct cost analysis was used. From January 1 to December 31, 2011 incident cases of BC (N=1142) registered by the National Health Insurance Fund, the stage determined by Lithuanian Cancer Registry were included in the study. RESULTS: The total average direct cost of BC amounted per patient was 2580 (95% CI 2444-2752)EUR in 2011. The main cost driver per BC patients was the inpatient hospital stay, respectively 1655 (95% CI 1478-2334)EUR. The average outpatient cost for one BC patient was 564 (95% CI 547-898)EUR. The dominant proportion of inpatient expenditures was assigned to BC surgery and chemotherapy treatment. The BC direct medical cost increased according to the diagnosed stage of diseases from 2409 (95% CI 2196-2621)EUR in stage 1 to 3688 (95% CI 2703-4672)EUR in stage 4. The direct medical cost was inversely proportional to age. CONCLUSIONS: The direct BC medical cost estimates provided by this analysis can be used to determine priorities for the future research on BC treatment interventions.

Comparison of the pharmacokinetic and pharmacodynamic properties of two recombinant granulocyte colony-stimulating factor formulations after single subcutaneous administration to healthy volunteers.

BACKGROUND AND OBJECTIVE: The aim of this randomized, single dose, two-period crossover study with two weeks wash-out period was the demonstration of bioequivalence of two recombinant human granulocyte colony-stimulating factor (rG-CSF) formulations after subcutaneous administration of 300µg comparing their pharmacokinetic (primary endpoints AUC0-24, AUC0-∞ and Cmax) and pharmacodynamic (primary endpoints ANC AUC0-72, ANC AUC0-∞ and ANCmax) profiles in healthy male subjects. MATERIALS AND METHODS: A total of 36 (23.0±6.0 years, 76.6±7.2kg) healthy subjects were recruited. Using a 1:1 randomization ratio, subjects were randomly assigned to one of two possible treatment-sequence groups to receive the single dose of test formulation (Gp-02) and reference product (Neupogen™) concentrations were measured by enzyme-linked immunosorbent assay (ELISA) up to 24h and the Absolute Neutrophil Count (ANC) was determined using hematology analyzer Coulter STKS™ (Beckman Coulter) up to 72h after injection. The geometric mean of primary pharmacokinetic and pharmacodynamic variables were considered bioequivalent if the 90% confidence intervals (CI) would fall in the bioequivalence range of 80%-125%. RESULTS: AUC0-24 (ratio of means 103.4, 90% CI: 95.6-111.9), AUC0-∞ (103.4, 90% CI: 95.7-111.7), Cmax (99.6, 90% CI: 89.0-111.4), ANC AUC0-72 (100.0, 90% CI: 96.6-103.5), ANC AUC0-∞ (100.8, 90% CI: 96.5-105.3), and ANCmax (100.2, 90% CI: 95.4-105.1) were determined. Single doses of test and reference formulations were well tolerated. The incidence of AEs was equally distributed across treatment groups with the most frequent AEs being headache, fever, and back pain. CONCLUSIONS: The study results demonstrated the bioequivalence of Gp-02, a new formulation of filgrastim, and the reference product Neupogen™.

Association between cadmium and breast cancer risk according to estrogen receptor and human epidermal growth factor receptor 2: epidemiological evidence.

The study aimed to examine the association between cadmium (Cd) and the risk of breast cancer according to estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2). A hospital-based case-control study was carried out in 585 cases and 1,170 controls. Information on possible risk factors was collected via a structured questionnaire. Urinary Cd was determined by atomic absorption spectrometry. The ER and HER2 levels in tumor tissue were analyzed by immunohistochemistry. Logistic regression was used to calculate odds ratios (ORs) and 95 % confidence intervals (CIs) for breast cancer by creatinine-adjusted urinary Cd. Women with greater creatinine-adjusted urine Cd (3rd quartile: 0.241-0.399 µg/g and 4th quartile: ≥ 0.4 µg/g) experienced 1.6 times higher risk of breast cancer compared with those having Cd concentration lower than 0.147 µg/g (1st quartile) [OR = 1.6, (95 % CI 1.19, 2.17) and OR = 1.62 (95 % CI 1.19, 2.21), respectively, P trend = 0.001] after adjustment for age and other confounders. Both ER+ and HER2- cases from the highest quartile of urine Cd exhibited approximately twice the breast cancer risk of those in the lowest quartile [OR = 1.9, (95 % CI 1.31, 2.74) and OR = 1.87, (95 % CI 1.33, 2.62), respectively, P trend <0.001) after adjustment for confounders. The data support cadmium as a risk factor for breast cancer, especially for both ER+ and HER2- cancer patients.

Assessment of a questionnaire for breast cancer case-control studies.

The aim of the present study was to assess criterion validity and external reliability of a questionnaire on risk factors for breast cancer. Materials and Methods. Women with breast cancer diagnosis (the cases) (N=40) and matched individuals without cancer (the controls) (N=40) were asked to fill in a questionnaire twice: on a day of admission to hospital (Q1) and on a day before discharge (Q2), with a time interval of 4-6 days. The questionnaire included questions (N=150) on demographic and socioeconomic factors, diseases in the past, family history of cancer, woman's health, smoking, alcohol use, diet, physical activity, and work environment. Criterion validity of the questionnaire Q2 relative to reference questionnaire Q1 was assessed with the Spearman correlation coefficient (SCC); external reliability of the questionnaire was measured in terms of the intraclass correlation coefficient (ICC). Statistical analysis was performed with SPSS 16. Results. The responses to most of the questions on socioeconomic factors, family history on cancer, female health, lifestyle risk factors (smoking, alcohol use, physical activity) correlated substantially in both the cases and the controls with SCC and ICC>0.7 (p<0.01). Statistically non significant relationships defined only between the responses on amount of beer the cases drank at the ages up to 25 years and 26-35 years as well as time of use of estrogen and estrogens-progestin during menopause by the cases. Moderate and substantial SCC and ICC were determined for different food items. Only the response of the cases on veal consumption did not correlate significantly. Conclusions. The questionnaire on breast cancer risk factors is valid and reliable for most of the questions included.

Associations between the fracture type and functional outcomes after distal radial fractures treated with a volar locking plate.

OBJECTIVE. The aim of this study to investigate the associations of fracture type, age, and gender with hand function after distal radius fractures treated with a volar locking plate at a 6-month follow-up. MATERIAL AND METHODS. A total of 120 patients with displaced distal radius fractures were included into the study. They were operated on using a volar locking plate system. All the fractures were classified according to the AO classification, and the patients were divided into 3 groups by the fracture type. The range of motion and grip strength were evaluated at the 6-month follow-up. Multivariate linear regression analysis was used to evaluate the associations of age, gender, and fracture type with the score of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The DASH questionnaire was completed as an outcome measure. RESULTS. A total of 28 patients experienced type A fractures; 70 patients, type B fractures; and 22 patients, type C fractures. No statistically significant difference regarding age and sex among the groups was observed. At 6 months after the surgery, the mean DASH score for type A, B, and C fractures was 16, 13, and 32, respectively (P=0.01). After the surgery, the radiographic parameters such as the volar tilt and the ulnar variance were significantly worse in the patients with type C fractures. Grip strength and the range of motion of the contralateral healthy hand at the 6-month follow-up were significantly better than those of the operated hand. The linear regression analysis showed that the type C fracture was the only factor significantly associated with lower DASH score. CONCLUSIONS. The patients with type C fractures treated with a volar locking plate had a worse wrist function as compared with the patients type A and B fractures at the 6-month follow-up. The postoperative hand function was significantly associated only with the type C fracture, while age and gender had no significant impact.

Incidence of inflammatory bowel disease in Kaunas region, Lithuania.

OBJECTIVE: The aim of this study was to evaluate the incidence of inflammatory bowel disease in Kaunas and its region during a 3-year period. MATERIAL AND METHODS: The study was conducted during the 3-year period (2007-2009) and enrolled the patients from Kaunas with its region, which has a population of 381,300 inhabitants. The data were collected from all practices in the area where the diagnosis of inflammatory bowel disease was made by practicing gastroenterologists and consulting pediatricians along with endoscopists. Only new cases of inflammatory bowel disease were included into analysis. The diagnosis of ulcerative colitis and Crohn's disease was strictly made according to the Copenhagen criteria. Age- and sex-standardized incidence was calculated for each year of the study period. RESULTS: A total of 108 new inflammatory bowel disease cases were diagnosed during the study period: 87 had ulcerative colitis, 16 Crohn's disease, and 5 indeterminate colitis. The incidence of ulcerative colitis, Crohn's disease, and indeterminate colitis for each study year was 6.85, 5.33, and 7.38 per 100,000; 0.95, 1.11, and 1.57 per 100,000; and 0.47, 0.21, and 0.42 per 100,000, respectively. The average 3-year standardized incidence of ulcerative colitis, Crohn's disease, and indeterminate colitis was 6.52, 1.21, and 0.37 per 100,000, respectively. The mean patients' age at onset of ulcerative colitis, indeterminate colitis, and Crohn's disease was 49.95 (SD, 17.03), 49.80 (SD, 17.71), and 34.94 years (SD, 0.37), respectively. CONCLUSIONS: The average 3-year incidence of ulcerative colitis in Kaunas region was found to be lower as compared with that in many parts of Central and Western Europe. The incidence of Crohn's disease was low and very similar to other countries of Eastern Europe. Age at onset of the diseases appeared to be older than that reported in the Western industrialized countries.

Rationality of administered gentamicin dose in cerebral coma patients treated in an intensive care unit.

Gentamicin is still widely used in the treatment of patients in an intensive care unit (ICU). The efficacy of aminoglycosides correlates with the peak serum concentration (Cmax), and the toxicity with the minimum serum concentration (Cmin). The aim of this study was to determine Cmax and Cmin in serum of cerebral coma ICU patients when a dosage of gentamicin of 5 mg/kg body weight was administered once daily; to evaluate the rationality of mentioned dose; and to identify factors associated with these concentrations. Material and METHODS. A total of 24 ICU patients suffering from cerebral coma were included into this analysis. A dosage of gentamicin of 5 mg/kg body weight was administered once a day. Gentamicin concentrations were tested twice after the first dose infusion (immediately and 5 hours after 1-hour infusion). Cmax, Cmin, volume of distribution (Vd), and elimination half-life (T1/2) were obtained. RESULTS. The mean Cmax was 17.96 (SD, 4.31) µg/mL (range, 10.30-27.87 µg/mL). The desirable Cmax (≥ 20 µg/mL) was reached only in 6 patients (25%). Cmin was calculated using a special pharmacokinetic program "Kinetica." Cmin of 0.5 µg/mL was not exceeded in any patient. A correlative analysis indicated a significant inverse direct correlation between Cmax and Vd and between Cmax and treatment duration in the ICU. An inverse correlation was observed between Cmin and T1/2, evaluation of coma according to the Glasgow coma scale, and creatinine clearance. CONCLUSIONS. A dosage of 5 mg/kg body weight once a day was not sufficient in cerebral coma ICU patients. This dose was not associated with the nephrotoxic effect of gentamicin (additional risk factors were absent). It is recommended to obtain gentamicin concentration at two time points following administration of the first dose (e.g., immediately after 1-hour infusion and 5 hours later), and using a special pharmacokinetic software, to calculate a necessary dose and interval of administration.

Cadmium concentration in biological media of breast cancer patients.

The study aimed to determine and compare cadmium (Cd) concentration in different biological media of breast cancer and benign breast tumor patients. Concentration of Cd was determined in breast tissue, urine, and blood of 57 breast cancer and 51 benign tumor patients. Two samples of breast tissue from each patient, i.e., tumor and healthy tissue were taken for the analysis. Cd in biological media was determined by atomic absorption spectrometry (Perkin-Elmer, Zeeman 3030). The mean Cd concentration in breast cancer patients was 0.053 µg/g (95% confidence intervals, CI 0.042-0.065) for tumor sample and 0.02 µg/g (95% CI 0.014-0.026) for healthy breast tissue sample (P < 0.001). In benign tumor patients, the figures were as follows: 0.037 µg/g (95% CI 0.023-0.051) and 0.032 µg/g (95% CI 0.018-0.047) (P > 0.05). Cd content in malignant tumor significantly differed from that in benign tumor (P < 0.01). Cancer patients with positive estrogen receptors (ERs) had significantly greater concentration of breast tissue Cd compared to patients with negative ERs (P = 0.035). Adjusted for creatinine, Cd in urine was significantly higher in cancer patients than in controls (P < 0.001). In cancer patients, a positive Spearman's correlation was found between Cd in tumor and healthy breast tissue, blood (r = 0.44 and r = 0.39, respectively, P < 0.01). Correlation between Cd in urine of cancer patients and number of cigarettes smoked during lifetime was suggestive (r = 0.59, P = 0.075). The data obtained show higher concentration of cadmium in breast tumor and urine of cancer patients and support a possible relationship between cadmium and breast cancer.