International Health Sciences
Conference’13
Conference thesis book
Partners:
Lithuanian University of Health Sciences, LUHS Student Union, Lithuanian pharmaceutical students´ association, Lithuanian Medical Students’ Association, LUHS Academy of Veterinary
Students' Association, Lithuanian Dental Students’ Association. Kaunas International Medical Students Union
Special thanks to:
Prof. habil. dr. Remigijus Žaliūnas, Rectors of LUHS
Prof. habil. dr. Vaiva Lesauskaitė, Vice rector for research of LUHS
Prof. Vincentas Veikutis, Scientific superviser of LUHS Students Scientific Society
Compilers: Rūta Kinderytė, Jorūnė Šuipytė, Lukas Šemeklis, Viltė Sauliūnaitė, Aleksandras Petrauskas, LUHS Students Scientific Society
Contents
Welcome message ... 13 ANESTHESIOLOGY AND IT SECTION ... 14
1. SURGICAL TREATMENT URGENCY OF ACUTE EPIDURAL AND SUBDURAL
HAEMATOMAS ... 14 2. PROTHROMBIN COMPLEX CONCENTRATES INFLUENCE ON COAGULATION
DISORDERS ... 17 3. THE INFLUENCE OF PERIOPERATIVE HEMODYNAMIC FACTORS ON RECIPIENTS RENAL GRAFT FUNCTION ... 21 4. DELIRIUM: DIAGNOSTIC AND TREATMENT CHALLENGES ... 24 5. PERIOPERATIVE OPTIMIZATION OF FLUID STATUS BY MINIMAL VOLUME
LOADING TEST (MVLT) IMPROVES OUTCOMES IN PATIENTS UNDERGOING ELECTIVE PRIMARY TOTAL KNEE ARTHROPLASTY SURGERY ... 26 6. CORRELATION OF ALARM SYMPTOMS, PATIENTS‘ AGE AND CLINICALLY
SIGNIFICANT ENDOSCOPIC FINDINGS ... 30 7. THE EFFICIENCY OF POSTOPERTATIVE PAIN CONTROL USING EPIDURAL
ANALGESIA ... 33 BASIC SCIENCES AND PHARMACOLOGY SECTION ... 36 1. COMPARISON OF MULTIVARIATE ANALYSIS BASED METHODS FOR DETECTION OF ECG T-WAVE ALTERNANS ... 36 2. SYNTHESIS AND EVALUATION OF IN VITRO ACTIVITY OF 4-THIAZOLIDINONE COMPOUNDS AGAINST HL-60 LYMPHOMA CELLS ... 40 3. MORPHOLOGICAL CHARACTERISTICS OF THE BLOOD VESSEL IN THE
ATRIOVENTRICULAR NODE AND BUNDLE OF HIS ... 42 4. CYTOTOXICITY AND ANTIOXIDANT ACTIVITY OF LECTIN-ENRICHED PROTEIN FRACTION FROM HERB OF URTICA DIOICA L ... 45 5. ANTIBACTERIAL ACTIVITY OF LECTIN ENRICHED FRACTIONS FROM URTICA
6. PRODUCTION AND TESTING OF ANTI-ERBB2 F(AB’)2-S ... 51 7. ANALYSIS OF LUNG CANCER BY HISTOLOGICAL TYPE AND LOCATION IN LATVIA 53
8. THE EFFECT OF ELECTROLYZED (IONIZED) WATER ON RAT MATERNAL BODY PHYSICAL CONDITION (EXPERIMENTAL SCIENTIFIC WORK) ... 56 9. DIGITAL PATHOLOGY IMAGE ANALYSIS APPROACH TO MEASURE THE EXTENT OF KIDNEY FIBROSIS ... 59 10. JOB SATISFACTION IN VARIOUS SPECIALTIES ... 62 11. PATIENTS WITH AGE-RELATED MACULAR DEGENERATION, A RANDOM SAMPLE OF THE POPULATION AND 3 GENERATIONS OF ONE FAMILY GENETIC TREE
EVALUATION ACCORDING TO THE MATRIX METALLOPROTEINASE-3 GENE
POLYMORPHISM ... 66 CARDIOLOGY SECTION ... 68
1. RADIOLOGICAL ASSESSMENT OF CORONARY ARTERY OBSTRUCTIONS BY
LOCALISATION IN PATIENTS WITH CORONARY ARTERY DISEASE ... 68 2. ASSOCIATION BETWEEN LEFT VENTRICLE FUNCTION AND PSYCHO-EMOTIONAL STATUS IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE (sCAD) ... 70 3. CARDIAC SIZE AND FUNCTION IN ELITE FEMALE FITNESS ATHLETES ... 73 4. GENDER DIFFERENCES IN PROGNOSIS OF HOSPITALIZATION DURING ONE YEAR AFTER MYOCARDIAL INFARCTION WITH ST-SEGMENT ELEVATION ... 76 5. MITRAL VALVE ANULOPLASTY: SUTURE VS RIGID RING ... 79 6. R-R MULTIPLE SCLEROSIS IN LITHUANIA: COMPARISON BETWEEN AMOUNT OF VITAMIN D IN PERIPHERAL BLOOD AND SEVERITY OF MULTIPLE SCLEROSIS ... 82 7. CHRONOTROPIC RESPONSE BY EXERCISE STRESS TESTING ... 85 8. CHANGES IN AORTIC DIAMETER AFTER ENDOVASCULAR ANEURYSM REPAIR ... 88 9. THE PROGNOSTIC VALUE OF DIASTOLIC FUNCTION ASSESSMENT IN LEFT
VENTRICLE DYSFUNCTION PREDICTION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION ... 91 10. CLINICAL PROBLEMS IN THE USAGE OF NOVEL AND OLD GENERATION ORAL ANTICOAGULANTS IN PATIENTS WITH ATRIAL FIBRILLATION IN LATVIA ... 94 11. THE EFFICACY OF INTRAHOSPITAL TREATMENT OF HYPERTENSIVE CRISIS IN RIGA STRADINS CLINICAL UNIVERSITY HOSPITAL, 2012 ... 96
12. THE IMPACT OF UNCORRECTED MILD AND MODERATE ISCHEMIC MITRAL REGURGITATION DYNAMICS ON LEFT VENTRICULAR FUNCTION FOLLOWING
CORONARY ARTERY BYPASS GRAFTING ... 100 13. LONG TERM RESULTS OF CORONARY ARTERY BYPASS GRAFTING WITH
UNCORRECTED MILD AND MODERATE MITRAL REGURGUTATION ... 103 14. ISCHAEMIC MITRAL VALVE REGURGITATION AFTER MYOCARDIAL INFARCTION
105
ENDOCRINOLOGY SECTION ... 110 1. DHEAS SECRETING ADRENAL INCIDENTALOMA ... 110 2. THE FEATURES OF FIRST DIAGNOSING AND INITIAL TREATMENT OF TYPE 2
DIABETIC MALES THAT DO NOT NEED TREATMENT OF INSULIN ... 113 3. REALIZATION AND EFFECTIVENESS OF THE DIABETES PATIENT’S EDUCATION PROGRAM ... 116 4. ULTRASONOGRAPHIC FINDINGS IN THYROID GLAND OF MIDDLE-AGED
LITHUANIAN MALES AND FEMALES ... 120 5. EVALUATION OF MIDLLE AGED FEMALES MENOPAUSAL SYMPTOMS ... 122 6. EVALUATION OF SEXUAL FUNCTION AND SEX HORMONES IN 48-50-YEAR-OLD LITHUANIAN MEN ... 125 7. SEXUALITY OF 26-36-YEAR-AGED TYPE 1 DIABETICS AND AGE-MATCHED
CONTROL MEN ... 128 8. CORRELATION BETWEEN PITUITARY ADENOMA DIAMETER AND MUNSELL
FARNSWORTH 100 HUE TEST ... 131 9. DIABETIC RETINOPATHY AND BLOOD LIPIDS LEVELS' EVALUATION IN DIABETIC PATIENTS ... 134 10. DIFFERENCES IN SLEEP QUALITY OF MEN SUFFERING FROM TYPE 2 DIABETES MELLITUS WITH AND WITHOUT DEPRESSION SYMPTOMS ... 136 11. DIFFERENTIAL DIAGNOSIS OF HYPERANDROGENEMIA AND ITS CLINICAL
RELEVANCE ... 139 12. PSEUDOHYPOPARATHYROIDISM: A CASE REPORT OF RARE CAUSE OF
HYPOCALCAEMIA ... 142 INTERNAL MEDICINE SECTION ... 146 1. HEMODIALYSIS PATIENT‘S HYPERHIDRATION EVALUATION ... 146
2. OBSTRUCTIVE JAUNDICE: EVALUATION WITH RADIOLOGY IMAGING METHODS 148
3. SENSITIZATION TO CETEARYL ALCOHOL AMONG DERMATITIS PATIENTS ... 151
4. VAGINAL FLORA TYPES OF PREGNANT WOMEN IN THEIR FIRST TRIMESTER ... 153
5. TRAUMA TEAM ACTIVATION DEPENDENCY ON LUNAR PHASES ... 156
6. PROBABILITY OF BONE FRACTURE ESTIMATION IN 10 YEAR PERIOD ... 159
7. THE INFLUENCE OF MOON PHASES ON THE NUMBER OF PATIENTS APPLYING TO THE CARDIOLOGY ADMISSION DEPARTMENT AT KAUNAS CLINICS OF HOSPITAL OF LITHUANIAN UNIVERSITY OF HEALTH SCIENCES ... 162
8. THE INFLUENCE OF THE TIME OF DAY, WORK AND NON-WORK DAY ON THE FREQUENCY OF PATIENT APPLICATIONS TO THE CARDIOVASCULAR ADMISSION DIVISION ... 165
9. HYPOCALCAEMIA COMPLICATIONS AFTER THYROIDECTOMIES ... 168
10. GENDER DIFFERENCES AND FREQUENCY OF ST-SEGMENT CHANGES OF LEAD AVR IN ACUTE MYOCARDIAL INFARCTION ... 171
11. PROGNOSTIC FACTORS OF SHORT TERM OUTCOME IN SEVERE ULCERATIVE COLITIS FLARE ... 174
12. CONNECTION BETWEEN THE PATIENTS’ COMPLAINTS BEFORE UPPER GASTROINTESTINAL ENDOSCOPY AND ENDOSCOPIC FINDINGS ... 177
13. REPLICATION OF GWAS RESULTS ON GASTRIC CANCER IN AN INDEPENDENT COHORT OF PATIENTS OF CAUCASIAN ETHNICITY ... 180
14. RHINOCONJUNCTIVITIS PREVALENCE AND HEALTH-RELATED QUALITY OF LIFE INVESTIGATION AMONG STUDENTS IN LITHUANIAN UNIVERSITY OF HEALTH SCIENCES ... 182
15. ANALYSIS OF PROGNOSTIC FACTORS IN MORTALITY DUE TO ESOPHAGEAL AND GASTRIC VARICEAL BLEEDING (DATA COLLECTED BETWEEN 2007 AND 2011 BY THE HOSPITAL OF LITHUANIAN UNIVERSITY OF HEALTH SCIENCES KAUNAS CLINICS) .... 185
16. EPIDEMIOLOGICAL PATTERNS OF PERTUSSIS IN VILNIUS CITY AND COUNTRY .. 188
17. SLEEPINESS AND VIGILANCE IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA ... 192
18. FIRST ORAL HEALTH KNOWLEDGE OF THE CHILD : SURVEY IN SCHOOLS OF MONTPELLIER, FRANCE ... 195
20. SELF-TREATMENT AND HOME MEDICATION BOX CHARACTERISTICS AND ATTITUDE TO SELF-MEDICATION OF STUDENTS’ FAMILIES’ OF LITHUANIAN
UNIVERSITY OF HEALTH SCIENCES PHARMACY FACULTY ... 202 21. AWARENESS OF TUBERCULOSIS AMONG ROMA PATIENTS IN BULGARIA ... 205 22. LOW BACK PAIN RED FLAG SYMPTOM CHARACTERISATION AND COMPARISON IN PATIENTS AT THE EMERGENCY ROOM AND GENERAL PRACTITIONER ... 207 22. TERMINAL STAGE CHRONIC KIDNEY DISEASE DEVELOPMENT DEPENDING ON GENDER ... 210 MAXILLOFACIAL SURGERY SECTION ... 213
1. INFLUENCE OF IMMEDIATE DENTIN SEALING ON MARGINAL MICROLEAKAGE OF INDIRECT COMPOSITE RESIN RESTORATIONS ... 213 2. IMPACT OF GASTROESOPHAGEAL REFLUX DISEASE ON ORAL CAVITY AND
DENTAL IMPLANTS: A LITERATURE REVIEW ... 215 3. EPIDEMIOLOGICAL ASSESSMENT OF PRIMARY ORAL CANCER DIAGNOSTICS ... 217 4. ROUGHNESS OF THE RESTORATIVE MATERIALS INFLUENCED BY DIFFERENT POLISHING MATERIALS FOR PROFESSIONAL ORAL HYGIENE ... 220 5. THE INFLUENCE OF CHRONIC STRESS AND DIABETES MELLITUS TYPE II ON BONE REPARATIVE MINERALS AND GROWTH FACTORS ... 222 6. FACIAL AND TRIGEMINAL NERVES ARTIFICIAL AND NATURAL ANASTOMOSIS. LITERATURE ANALYSIS ... 225 7. THE CHARACTERISTICS OF ISOLATED AND COMBINED ORBITAL FRACTURES IN ASSOCIATION WITH MIDFACE TRAUMA. INDICATION FOR ORBITAL SURGERY AND SURGICAL APPROACHES: RETROSPECTIVE STUDY ... 229 NEUROSCIENCES SECTION ... 232 1. EARLY POST OPERATION RESULT REVIEW BASED ON NERVE CONDUCTION STUDY DATA AFTER SIMPLE DECOMPRESSION OF NERVUS ULNARIS IN THE CUBITAL TUNNEL
232
2. AN ASSESSMENT OF NON-MOTOR SYMPTOMS IN PATIENTS WITH IDIOPATHIC PARKINSON'S DISEASE IN COMPARISON TO PARKINSONIAN SYNDROMES ... 234 3. RADIOLOGICAL FINDINGS OF ACUTE ISCHEMIC STROKE BEFORE AND AFTER ENDOVASCULAR THROMBECTOMY, TREATMENT RESULTS ... 237 4. VERBAL MEMORY IN TEMPORAL LOBE EPILEPSY SURGERY: THE LINK BETWEEN POSTICTAL AND POSTOPERATIVE MEMORY ... 240
5. TREATMENT ANALYSIS OF MIGRAINE ATTACKS IN A RANDOM LITHUANIAN
SAMPLE ... 243 6. LITHUANIAN PEOPLE’S ATTITUDE TOWARDS MENTAL HEALTH ... 246 7. RESTLESS LEGS SYNDROME IN DIALYSIS PATIENTS: A PILOT STUDY ... 250 8. ASSESSMENT OF THE CLINICAL VALIDITY AND STABILITY OF AUSTIN EAR CLINIC DIZZINESS QUESTIONNAIRE LITHUANIAN VERSION ... 253 9. METHANOL OPTIC NEUROPATHY ... 256 10. DIFFERENCES OF EMOTIONAL STATE AMONG MEN SUFFERING FROM TYPE 2 DIABETES MELLITUS CONSIDERING PRESENCE OR ABSENCE OF DEPRESSION
SYMPTOMS ... 259 11. TICK-BORNE ENCEPHALITIS AND LYME DISEASE (LYME BORRELIOSIS)
EPIDEMIOLOGICAL, CLINICAL AND LABORATORY ACTUAL NEWS IN RIGA EASTERN CLINICAL UNIVERSITY HOSPITAL “GAIĻEZERS" FROM YEAR 2007 TO 2012 ... 261 OBSTETRICS AND GYNAECOLOGY SECTION ... 265
1. COMPARATIVE STUDY ON SEX EDUCATION AND CONTRACEPTION AMONG
STUDENTS IN KAUNAS UNIVERSITIES ... 265 2. THE MEANING OF LYMPHADENECTOMY SELECTING POSTOPERATIVE TREATMENT STRATEGY FOR PATIENTS WITH ENDOMETRIAL CARCINOMA ... 268 3. LAPAROSCOPIC HYSTERECTOMY VERSUS ABDOMINAL HYSTERECTOMY: A
RETROSPECTIVE STUDY ... 271 4. LAPAROSCOPIC AND LAPAROTOMIC HYSTERECTOMY FOR TREATING UTERINE CANCER: SELECTION FACTORS, TREATMENT COURSE AND RESULTS ... 273 5. MULTIPLE PREGNANCY LABOR CARE TACTICS AND CHANGES IN THE RESULTS DURING THE PERIOD OF 2005-2012 ... 277 6. WATERBIRTH AND IT‘S RESULTS ... 279 7. GESTATIONAL HYPERTENSION, PRE-ECLAMPSIA, PREMATURE DELIVERY AND INTRAUTERINE GROWTH RETARDATION AMONG ADOLESCENTS IN RIGA MATERNITY HOSPITAL FROM 2008 TILL 2012 ... 281 ODONTOLOGY SECTION ... 284
1. SEM AND STEREO MICROSCOPE ANALYSIS OF ROOT CANAL WALLS AFTER
CALCIUM HYDROXIDE MEDICATION ... 284 2. DENTAL STUDENTS KNOWLEDGE OF HEPATITIS B VIRUS INFECTION AND IT’S
3. INFLUENCE OF PASSIVE ULTRASONIC IRRIGATION ON FINAL CANAL OBTURATION QUALITY AFTER CALCIUM HYDROXIDE MEDICATION ... 289 4. COMPLETE UNILATERAL CLEFT LIP AND PALATE: DIFFERENT POINT OF VIEW IN EVALUATION ... 291 5. THE RISK OF ORTHODONTIC MINI IMPLANTS ... 293 6. A COMPARATIVE STUDY BETWEEN TWO METHODS FOR PERFORMING BOLTON ANALYSIS ON DIGITAL MODELS ... 295 7. ORTHODONTIC ANOMALIES PREVALENCE IN PATIENTS WITH MIXED OR
PERMANENT DENTITION ... 299 8. THE EFFECT OF BOUNDED EDENTULOUS SIDE SPACES TO ATTACHMENT
APPARATUS OF ANTAGONIST AND ADJACENT TEETH ... 302 9. DENTAL EROSION PREVALENCE AMONG 13 – 17 YEARS OLD KAUNAS SPORTSMAN SWIMMERS ... 305 10. THE PREVALENCE OF THE USE OF RADIOGRAPHY AND THE APEX LOCATOR IN ENDODONTIC TREATMENT WITHIN THE DENTISTS IN LITHUANIA ... 308 ONCOLOGY SECTION ... 312 1. GASTRIC LYMPHOMAS. LITERATURE REWIEW AND CLINICAL CASE STUDIES ... 312 2. EFFECTIVENESS OF TUMOR ELECTROCHEMOTHERAPY IN VITRO USING
DIFFERENT CHEMOTHERAPEUTIC DRUGS COMBINATION WITH DOXORUBICIN ... 315 OPHTALMOLOGY SECTION ... 319 1. IMPACT OF VISUAL IMPAIRMENT ON DAILY LIFE OF THE CARDIAC PATIENTS .... 319 2. CLINICAL MANIFESTATION OF IRIDOCYCLITIS ASSOCIATED WITH JUVENILE
IDIOPATHIC ARTHRITIS AT CHILDREN CLINICAL UNIVERSITY HOSPITAL, LATVIA .... 321 OTORHINOLARYNGOLOGY SECTION ... 324
1. VISUALIZATION OF THE SIMULATED OSSICULAR CHAIN INJURIES IN THE SHEEP TEMPORAL BONE: RADIOLOGICAL AND ANATOMICAL CORRELATIONS ... 324 2. MIDDLE EAR DISORDERS OF THE PATIENTS OF VSIA "P.STRADINS CLINICAL
HOSPITAL" OTORHINOLARYNGOLOGY CLINIC ... 327 3. CORRELATION BETWEEN USE OF PERSONAL MUSIC PLAYERS (PMP) AND HEARING TRESHOLD SHIFT ... 330 4. TUMOR RECIDIVUM WITH TRACHEAL LUMEN COMPRESSION AFTER TOTAL
5. INCIDENCE OF CLINICAL FEATURES AND QUALITY OF LIFE IN PATIENTS WITH CHRONIC DACRYOCYSTITIS ... 336 6. COMPLICATIONS OF TRACHEOTOMY IN LUHS KC DURING 2006– 2011 YEARS ... 339 7. TRANSLATION, CROSS-CULTURAL ADAPTATION AND VALIDATION OF
SINO-NASAL OUTCOME TEST (SNOT) - 22 TO LITHUANIAN PATIENTS ... 342 PEDIATRIC SECTION ... 344
1. ULTRASONOGRAPHIC MEASUREMENTS OF SHOULDER AND ELBOW JOINT
CARTILAGE THICKNESS IN YOUNG BASEBALL PLAYERS ... 344 2. CHILDREN’S ARTERIAL BLOOD PRESSURE MEASUREMENTS AND EVALUATION OF THE RESULTS IN CHILDREN'S CLINICAL UNIVERSITY HOSPITAL IN RIGA, LATVIA. .... 347 3. FACTORS OF RISK OF CHILDREN WITH FUNCTIONAL CONSTIPATION ... 350 4. CLINICAL MANIFESTATION AT THE ONSET OF TYPE 1 DIABETES MELLITUS IN CHILDREN IN LATVIA ... 352 5. PEDIATRIC AGE BENIGN BONE TUMORS OF LONG BONES – RADIOLOGIC
DIAGNOSIS AND DIFFERENTIALDIAGNOSIS ... 356 6. NON-URGENT CARE AT PAEDIATRIC EMERGENCY DEPARTMENT OF UNIVERSITRY HOSPITAL. WHAT INFLUENCES PARENTS’ DECISIONS? ... 358 SURGERY SECTION ... 362 1. VALIDATION OF D’AMICO CRITERIA FOR LOW-RISK PROSTATE CANCER ... 362 2. MULLERIAN DUCT DEVELOPMENT MALFORMATION'S COMBINATION:
EXAMINATIONS DIFFICULTIES ... 364 3. IATROGENIC GALLBLADDER PERFORATION DURING LAPAROSCOPIC
CHOLECYSTECTOMY. SERIOUS PROBLEM, OR NOT? ... 366 4. FACTORS INFLUENCING LONG TERM SURVIVAL AFTER MAJOR PANCREATIC
SURGERY FOR ADENOCARCINOMA OF THE HEAD OF THE PANCREAS ... 368 5. BILIARY TRACT INFECTION AFTER PREOPERATIVE BILIARY DRAINAGE
FOLLOWING OPERATION FOR PERIAMPULLARY TUMORS OR CHRONIC PANCREATITIS 370
6. A PROSPECTIVE ANALYSIS OF PAIN REDUCTION AND IMPROVEMENT OF
PHYSICAL FUNCTIONS AFTER OPEN CARPAL TUNNEL RELEASE OPERATIONS ... 373 7. THE ROLE OF MALNUTRITION RISK IN PREDICTING THE INCIDENCE AND
8. ARTICULAR CARTILAGE SURGICAL TREATMENT EXPEDIENCE WHEN KNEE ARTICULAR CARTILAGE AND OSTEOCHONDRAL DEFECTS WERE FOUND DURING THE KNEE ARTHROSCOPIC AND LIGAMENT RECONSTRUCTION SURGERIES ... 378 9. THE INFLUENCE OF AGE ONTO THE RESULTS OF ACUTE CHOLECYSTITIS
OPERATIVE TREATMENT ... 382 10. CORRELATION BETWEEN HALLER'S INDEX AND LUNG FUNCTION TESTS BEFORE
PECTUS EXCAVATUM CORRECTION ... 385 11. HYPOCALCAEMIA AFTER TOTAL THYROIDECTOMY ... 387 12. AN OBSERVATIONAL STUDY ON CORRELATION BETWEEN SCALDING AND
PATIENTS RESIDENTIAL AREA ... 390 13. ANALYSIS OF LATE COMPLICATIONS AFTER INGUINAL HERNIA SURGERY ... 392 14. THE CHARACTERISTICS OF ISOLATED AND COMBINED ORBITAL FRACTURES IN ASSOCIATION WITH MIDFACE TRAUMA. INDICATION FOR ORBITAL SURGERY AND SURGICAL APPROACHES: RETROSPECTIVE STUDY. ... 394 15. CHARACTERIZATION OF DISTAL HUMERUS FRACTURES IN CHILDREN AT LUHS KAUNAS CLINICS IN 2010 AND 2011 ... 397
Welcome message
Dear young colleagues,
It is our great honor to organize the scientific event which is designed to promote and encourage the development and exchange of information in all aspects of basic and practical medicine, new techniques and methods. Our impressive start two years ago showed high interest in our conference ant this was a great stimulus for us.
For 2nd International Health Science Conference our Scientific Community received 157 abstracts from 5 countries and regions. We tried our best to cover wide range of topics and make the program be first-rate scientifically and to offer a unique opportunity to the participants to share ideas. I hope our conference will be a great platform for your intellectual and social improvement.
On behalf of our Scientific Committee, I wish you an interesting set of basic and practical scientific presentations relevant to your role and a good use of time in Kaunas.
ANESTHESIOLOGY AND IT SECTION
1. SURGICAL TREATMENT URGENCY OF ACUTE EPIDURAL AND
SUBDURAL HAEMATOMAS
Authors: Petras Petkevičius, Kęstutis Petniūnas, Ieva Zujūtė Supervisor of the absract: doc. Tomas Tamošuitis
INTRODUCTION
Epidural and subdural haematomas are rare but serious complications of head trauma. Sources states that an epidural haematoma is diagnosed for 1-4% patients with traumatic head injury and for 5-15% are found during autopsy. [1] Acute subdural haematomas, according to research, occurr for 5-25% patients with acute head injuries. [1] Patients with acute subdural or epidural haematomas with indications for surgical treatment require immediate surgical intervention. According to studies, if the surgical intervention is performed up to 4 hours after trauma, mortality rate is 30-47%, but later than 4 hours after trauma, mortality rate increases to 80-90%. [3]
AIM
To identify if fixed pre-operative time affects outcomes of patients with severe coma (GCS<9) who suffered acute subdural or epidural haematoma caused by head trauma, which happened in the first 24hours till surgery.
OBJECTIVES
1. To determine and compare outcomes of patients who underwent surgeries up to 4 hours after trauma and later than 4 hours after trauma.
2. To determine surgery timing range when the difference of outcome becomes statistically significant for patients in severe coma (GCS<9) caused by acute epidural or subdural haematoma.
3. To determine, whether time till the surgery could be used as a predictor prognosing outcomes for patients in severe coma (GCS<9) caused by acute epidural or subdural haematoma.
METHODS
Retrospective biomedical research, in which 238 cases were reviewed with acute isolated traumatic brain injury (epidural or subdural haematoma) surgically treated in LUHS KK Neurosurgery Clinic during 2008-2012 period and postoperative treatments applied in Neurosurgery ICU. Patients with polytrauma or severe chronic diseases were excluded. Out of 238 cases 129 cases where selected with patients who had GCS <9 estimated before surgery. 40 cases were rejected because patients were treated surgically later than 24 hours after head trauma. Patients were divided into two groups: up to 4 hours and later than 4 hours from trauma to surgery. Patients with epidural or subdural haematoma were analysed separately. Last registred GCS was used for estimating patient's outcome, GOS was registred only in a few cases. We used SPSS 17.0 Statistics for statistical analysis. Non-parametric Tests were used to evaluate dependence between groups according GCS (Mann-Whitney Test, Spearman‘s correlation).
We compared groups of patients who have undergone surgery up to 4 hours, with the groups, where surgery was performed after 4 hours.
RESULTS
Out of 89 patients, 73 (82%) suffered from subdural haematoma and 16 (18%) from epidural. Average age in subdural group was 53,34 ± 1,91 years, in epidural group 50,13 ± 2,34. Head trauma caused death in subdural group 32 (43,8%) cases, in epidural group 6 (37,5%). Among survivors in subdural group 11 (26,8%) patients had severe outcome (GCS <9), 5 (12,2%) had
moderate outcome (GCS 9-12) and 25 (61%) had mild outcome (GCS >12), in epidural 1 (10%) - severe outcome, 2 (20%) - moderate outcome, 7 (70%) - mild outcome. In the 1st group (surgery performed up to 4 hours after head trauma) among patients with subdural hematoma average GCS outcome was 7,17 ± 1,04, 13 (54,2%) patients died. In the 2nd group (surgery performed later than 4 hours after head trauma) average GCS outcome was 8,53 ± 0,77, 19 (38,8%) patients died. However there wasn't statistically significant difference between 1st and 2nd group among cases of subdural hematoma, p > 0,05. In the 1st group among patients with epidural hematoma average GCS outcome was 11,33 ± 2,2, 1 (16,7%) patients died. In the 2nd group average GCS outcome was 8,2 ± 1,58, 5 (50%) patients died. However there wasn't statistically significant difference between 1st and 2nd group among cases of epidural hematoma, p > 0,05.
According to our data, using pre-operative time 5 hours there was statistically significant difference among patients with acute subdural hematoma. In the 1st group (surgery performed up to 5 hours after head trauma) average GCS outcome was 6,75 ± 0,84. In the 2nd group (surgery performed later than 5 hours after head trauma) average GCS outcome was 9,37 ± 0,87. The difference between 1st and 2nd group was significantly different, p < 0,05. However average GCS in 2nd group was higher than in 1st one, so we have compared initial GCSes (GCS evaluated before surgery by anesthesiologist) to make sure that patients with higher intial GCSes are being operated later. Initial GCS's average was 3,97 ± 0,14 in the 1st group and 5 ± 0,25 int the 2nd group. Difference between initial GCSes was significantly different, p<0,05. To get objective results we have compared the difference between otucome and initial GCSes with the time till surgery. Delta GCS (difference between outcome GCS and initial) correlated statistically significantly in 2nd group (p<0,05; Spearman's correlation coeficient -0,330) – this means that when time till surgery gets higher, delta GCS drops in the 2nd group of patients. Using 5 hours pre-operative time among patients with acute epidural hematoma, there wasn't statistically significant difference.
Time till the surgery didn't correlate with outcome GCS statistically significantly (p > 0,05, Spearman's correlation coeficient 0,170 in subdural group, -0.253 in epidural group).
CONCLUSIONS
1. Group, where surgery was performed up to 4 hours from head trauma didn‘t have statistically significantly better outcomes than the group where surgery was performed after 4 hours from head trauma for patients with acute epidural or subdural haematoma. 2. According to our research 5 hours could be the limit time to perform surgery for patients
with acute subdural haematoma. In addition to this, according to our data, patients with higher initial GCS are being operated later (after 5 hours) while patients with lower ones earlier. However, according to correlation, in a group of patients who underwent surgery later than 5 hours after head trauma outcome GCS decreases while time increases statistically significantly.
3. Time till surgery didn‘t have statistically significant correlation with the outcome GCS in our research, so it shouldn't be used as a single factor of prognosis for patient's with acute epidural and subdural haematoma outcome.
REFERENCES
1. Bullock MR, Chesnut R, Ghajar J et al. Surgical Management of Traumatic Brain Injury Author Group – „Surgical management of acute epidural haematomas“. Neurosurgery. 2006;58(3 Suppl):S7
2. W. A. van den Brink, M. Zwienenberg, S. M. Zandee. The Prognostic Importance of the Volume of Traumatic Epidural and Subdural Haematomas Revisited. Acta Neurochirurgica, 1999. 141: 509±514
3. W. McBride MD, J. Biller MD, J. L. Wilterdink MD. Intracranial epidural hematoma in adults. UpToDate Inc. 2011 Aug 17. 21.4 – C21.44
2. PROTHROMBIN COMPLEX CONCENTRATES INFLUENCE ON
COAGULATION DISORDERS
Authors: Dominykas Dvylys, Petras Petkevičius, Erika Ruočkaitė Intensive Care Department
Lithuanian University of Health Sciences, Lithuania Supervisor of Scientific work: Prof. Vidas Pilvinis
INTRODUCTION
Prothrombin complex concentrates (PCCs) normalize levels of vitamin K dependent clotting factors and re-establish homeostasis. PCCs contain II, VII, IX, X blood clotting factors in addition to the vitamin K-dependent coagulation inhibitors protein C and protein S [1]. These products provide a rapid and effective method for correcting clotting factor deficiency, particularly in patients treated with vitamin K antagonists (VKAs) and liver dysfunction [2]. However the efficiency and dosage profile of prothrombin complex concentrates in each of the pathologies are still unclear, especially in Lithuania, where PCCs have been used in recent years only.
AIM
To determine the Prothrombin complex concentrates (PCCs) influence on coagulation disorders.
OBJECTIVES
1. To determine and compare coagulation meanings before Prothrombin complex concentrates injection.
2. To determine and compare the efficiency of Prothrombin complex concentrates in reversing coagulation disorders related with vitamin K antagonists overdose and liver dysfunction.
3. To determine and compare the efficiency of different doses of Prothrombin complex concentrates in reversing coagulation disorders related with vitamin K antagonists overdose and liver dysfunction.
METHODS
Retrospectively 52 cases of patients were selected who received PCCs therapy in LSMU Clinics (32 cases) and the Republic Hospital of Panevezys (20 cases). From all the cases coagulograms before and after PCCs injection (within 24 hours) were selected. 2 cases were rejected because the 2nd coagulogram wasn’t done after the injection of PCCs within 24 hours. 2 cases were rejected because after PCCs injection patients gained fresh frozen plasma and only then the 2nd coagulogram was made. So out of 48 cases left, 37 (77%) were with overdose of VKAs, 11 (23%) were with liver dysfunction. Prothrombin Time (PT) and International Normalized Ratio (INR) measures were used to determine the activity of PCCs. SPSS 21.0 was used for statistical analysis. Nonparametric statistic methods were used for calculations (Mann-Whitney Test for 2 independent values or 2 related values). Data were considered statistically significant if value p < 0.05.
RESULTS
Out of 48 cases, 22 (45.8%) were female, 26 (54.2%) were male. Average age was 68.46 ± 12.64 years. Initial PT (PT1) and INR (INR1) between patients with VKAs overdose and liver dysfunction were analysed. Initial PT mean was 18.6 ± 2.09 and initial INR mean was 3.91 ± 0.38 among patients with VKAs overdose. PT1 mean was 16.45 ± 2.66 and initial INR1 mean was 3.89 ± 0.61 among patients with liver dysfunction. PT1 and INR1 were not significantly different between VKAs overdose group and liver dysfunction group, p>0,05.
PT1 and INR1 were compared with PTs and INRs after the PCCs injection (PT2 and INR2). PT2 mean was 51.27 ± 3.46, INR2 mean was 1.52 ± 0.07 among patients with VKAs overdose. PT2 mean was 45.36 ± 7.6, INR2 mean was 2.17 ± 0.56 among patients with liver dysfunction. The difference between PT1, INR1 and PT2, INR2 was statistically significant in both groups, p<0,05.
Average dose of PCCs in VKAs overdose group was 1419 ± 109 IU, in liver dysfunction group 1591 ± 211 IU. Doses weren’t significantly different between both groups, p>0,05. The mean of the difference between PT1 and PT2 was 32.67 ± 3.92 (delta PT), between INR1 and INR2 was
2.38 ± 0.35 (delta INR) among patients with VKAs overdose. The mean of the difference between PT1 and PT2 was 28.91 ± 7.58 (delta PT), between INR1 and INR2 was 1.73 ± 0.72 (delta INR) among patients with liver dysfunction. Doses of PCCs correlate significantly with delta PT, p<0,05 (Spearman‘s correlation coefficient 0,343). However doses do not correlate significantly with delta INR (p=0,084; Spearman‘s correlation coefficient 0,288) among patients with VKAs overdose. Correlation between PCCs doses and delta PT, delta INR was not significant among the patients with liver dysfunction.
CONCLUSIONS
1. There is no significant difference of PT1 and INR1 between VKAs overdose and liver dysfunction groups.
2. PCCs have statistically significant efficiency for patients with both pathologies – VKAs overdose and liver dysfunction. PCCs are more effective for patients with VKAs overdose.
3. Doses were not statistically significant different in both groups. Higher PCCs doses for patients with VKAs overdose have more effect on coagulation measures. However higher doses of PCCs in liver dysfunction group were not more significantly effective than lower one.
REFERENCES
1. Dentali F., Pierfranceschi M. G., Crowther M., Garcia D., Hylek E., Witt D. M., et al. Safety of Prothrombin complex concentrates for rapid anticoagulation reversal of vitamin K antagonists. A meta-analysis, Thrombosis and Haemostasis, Schattauer. 2011 Jul, p.429-436.
2. S Schick K., Fertmann J. M., Jauch K. W., Hoffmann J N. Prothrombin complex concentrate in surgical patients: retrospective evaluation of vitamin K antagonist reversal and treatment of severe bleeding. Department of Surgery, University of Munich. Critical Care 2009 30 Nov. Available from: http://ccforum.com/content/13/6/R191
3. THE INFLUENCE OF PERIOPERATIVE HEMODYNAMIC
FACTORS ON RECIPIENTS RENAL GRAFT FUNCTION
Authors: Akvilina Jacunskaitė, Vytautė Kadusauskaitė
Supervisor of the abstract: N. Balčiūnienė MD, PhD, A. Macas MD, PhD, Assoc. Prof.
INTRODUCTION
Despite substantial progress in renal transplant surgery, the risk of perioperative complications remains.About 25% of all kidney recipients suffer from postoperative delayed graft function, needing renal replacement therapy, resulting in an increase in mortality of 40%. The quality and efficient function of the transplanted kidney are determined by many factors that can disrupt graft function. One of the most important factors of adequate organ function is perfusion. Several studies over the last 30 years have indicated that the hemodynamic status of the recipient during kidney transplantation relates to graft function. Therefore diagnosis of these factors in kidney recipients is important.
AIM
To evaluate the influence of perioperative hemodynamic factors on renal graft function.
OBJECTIVES
1. To evaluate and identify which hemodynamic factors influence the immediate graft function most.
METHODS
This retrospective study included 95 adult patients who underwent kidney transplantations in LUHS Kaunas Clinic from 2009 to 2012. 102 transplantations were performed during this period of time. The kidneys were retrieved from multiorgan brain dead donors, who were treated at Neurosurgery intensive care unit in LUHS Kaunas Clinic. Based on the function of the kidneys posttransplantation, all 95 recipients were divided into 2 groups: A) patients with immediate graft function (IGF), B) patients with delayed graft function (DGF). IGF was defined as there was no need for dialysis and/or when creatine level was reduced by half during the first week as compared to the value before transplantation. DGF was defined as the need for dialysis and/or when creatine level was not reduced by half during the first week after renal transplantation. The examined perioperative hemodynamic factors were central venous pressure (CVP); systolic, diastolic, and mean arterial blood pressure (MAP) were recorded at surgery start time, at graft reperfusion and at awakening. MAP was calculated using the formula: diastolic pressure - 1/3 (systolic pressure - diastolic pressure). The following were also recorded: the amount of crystalloid, colloid infusions, the use of dopamine, antihypertensive therapy, and urine output. IGF and DGF recipient groups were compared according to mentioned criteria. Statistical analysis was performed using SPSS 20.0 programme. Categorical variables were compared using chi-square (χ2) and continuous variables, the Student t test. Multiple regression analysis is shown as parameter estimates standard errors, and corresponding P values with P < 0, 05 indicating statistical significance.
RESULTS
The mean age of 95 patients was 46±1,181 years. Of 95 recipients, 42 (44%) experienced DGF and 53 (56%) had IGF. Lower CVP before the surgery did not make influence on IGF: in group A mean CVP before the surgery was 7,4±0,658 cmH2O (n=36), in group B - 9.4±0,742 cmH2O (n=26), p=0,053. In group A, mean CVP at the time of renal graft reperfusion was 11,5±1,203 cmH2O (p=0,454) and at the time of awakening - 11,3±0,801 cmH2O, p=0,853. There was 2,7 greater risk of IGF among the group with CVP <9,5 cmH2O at surgery start time, p=0,045.
Systolic, diastolic and MAP did not make influence on IGF at the surgery start time, the time of renal graft reperfusion and awakening. There was threefold greater risk of IGF among the group with MAP <120 mmHg at surgery start time, p=0,017. There was 4,3 increase in risk of IGF with systolic arterial blood pressure <121 mmHg at the time of renal graft reperfusion, p=0,008. There was 2,6 greater risk of IGF among the group with MAP <106 mmHg at the time of awakening, p=0,048. According to ROC curve we divided recipients into two groups: with infusion therapy during operation <2800 ml (n=65) versus infusion therapy ≥2800 ml (n=30). There was no significant relation between amount of infusion therapy administrated in IGF, p=0.121.
CONCLUSIONS
1. The followings were the risk factors of the IGF: CVP <9,5 cmH2O at surgery start
2. time, MAP <120 mmHg at surgery start time, systolic arterial blood pressure <121 mmHg at the time of renal graft reperfusion, MAP <106 mmHg at the time of awakening. 3. There was no significant relation between amount of infusion therapy and IGF.
REFERENCES
1. Bacchi G, Buscaroli A, Fusari M, et al. The influence of intraoperative central venous pressure on delayed graft function in renal transplantation: A single-center experience. Transplant Proceedings. 2010; 42:3387–3391.
2. Campos L, Parada B, Furriel F, Castelo D, et al. Do Intraoperative Hemodynamic Factors of the Recipient Influence Renal Graft Function? Transplantation Proceedings. 2012; 44:1800-1803.
3. Schmid S, Jungwirth B. Anaesthesia for renal transplant surgery: an update. Eur J Anaesthesiol. 2012; 29: 552- 558.
4. Zukowski M, Bohatyrewicz R, Krawczyk AA. Influence of selected factors on occurrence of delayed kidney graft function: A multivariate analysis. Transplant Proc. 2007; 39:2704–2706
4. DELIRIUM: DIAGNOSTIC AND TREATMENT CHALLENGES
Authors: Zane Glazniece, Ruta Reca, Riga Stradins University, Faculty of Medicine Suprevisor: Roberts Stasinskis, MD, Riga Stradins University
INTRODUCTION
Delirium is a common clinical syndrome characterised by disturbed consciousness, cognitive function or perception (1-4). The occurance of delirium varies widely, but, when high-risk populations are considered,such as the elderly and mechanically ventilated, delirium may occur in up to 80% of ICU patients (5). It usually develops over 1–2 days. It is a serious condition that is associated with poor outcomes. However, it can be prevented and treated if dealt with urgently. Delirium is associated with increased time of hospitalization, increased costs, greater risk, that after discharcing patient will be sent to care facility rather than home and greater risk of death (3,4). Delirium can be hypoactive or hyperactive but some people show signs of both (mixed). People with hyperactive delirium have heightened arousal and can be restless, agitated and aggressive. People with hypoactive delirium become withdrawn, quiet and sleepy. Hypoactive and mixed delirium can be more difficult to recognise (1,2). Althought delirium has great influence on clinical outcome, it still often remains undiagnosed.
AIM
To analyse diagnostic criteria actually used for detection of delirium and association between patient’s mental status and provided therapy.
1. To analyze medical records of patients, who were hospitalized in a toxicological and sepsis unit and patients who later died, to find out what information is provided about patient's mental status;
2. To determine whether there is a correlation between information about patients mental status and provided therapy;
3. Translate Confusion Assessment Method (CAM) scale to adapt it for Latvia.
METHODS
A retrospective study. Was conducted and included data about 212 patients who had any of the toxicologial diagnosis. Also there were acquired data about 45 patients who lately died. Data were summarized and analyzed with SPSS software.
RESULTS
The delirium was diagnosed to 12 (4.6%) patients. But, when data about patients mental status were observed, appeared, that clear consciousness had 88 (41.1%) of patients. In 7.5% of histories there were no data about patiens mental state. Other patients (46.3%) had some delirium criteria but didn't fulfil the diagnosis for delirium. Diagnose of delirium, correlates with usage of haloperidol and benzodiazepines (0.551 and 0,402, p<0.05), but more significant correlation it has with haloperidol usage. Some of diagnostic criteria for delirium were conneced with use of bezodiazepines and haloperidol, even if there were no data about diagnosed delirium. Use of benzodiazepines correlated with prolonged hospitalization time (0.335, p<0.05).
CONCLUSIONS
1. Delirium often remains undiagnosed;
2. The diagnostic difficulties are connected with the lack of unified criteria for evaluation of patient's mental status in the whole hospital;
3. Health professionals should avoid benzodiazepines in managing patient with delirium, except for toxicological patients;
4. More attention should be paid to nonmedicamentous treatment of delirium and managment of the risk factors.
REFERENCES
1. Adamis D., Sharma N., Whelanc P.J.P., Alastair J.D. Delirium scales: A review of current evidence Macdonald. Aging & Mental Health, 2010 Jul; 14 (5); 543–555
2. Camus V., Burtin B., Simeone I., Schwed P., Gonthier R., Dubos G.. Factor analysis supports the evidence of existing hyperactive and hypoactive subtypes of delirium. International Journal of Geriatric Psychiatry. 2000 Apr; 15 (4); 313–316
3. Devlin J. W., Al-Qadhee N. S., Skrobik Y. Pharmacologic prevention and treatment of delirium in critically ill and non-critically ill hospitalised patients. Best Practice & Research Clinical Anaesthesiology. 2012 Sept; Pages 289–309
4. National Collaborating Centre for Acute and Chronic Conditions. Delirium: diagnosis, prevention and management. London (UK): National Institute for Health and Clinical Excellence (NICE); 2010 Jul.; (Clinical guideline; no. 103)
5. The DECCA (Delirium Epidemiology in Critical Care) Study Group. Delirium epidemiology in critical care (DECCA): an international study. [Internet] Critical Care 2010 [Cited on 2012 Dec 27][About 7 lpp.]. Available from: http://www.biomedcentral.com/content/pdf/cc9333.pdf
5. PERIOPERATIVE OPTIMIZATION OF FLUID STATUS BY
MINIMAL VOLUME LOADING TEST (MVLT) IMPROVES
OUTCOMES IN PATIENTS UNDERGOING ELECTIVE PRIMARY
TOTAL KNEE ARTHROPLASTY SURGERY
Authors: Indrė Sakavičiūtė, Mantas Radzevičius, Aleksandras Briedis Supervisor of the abstract: docent Audrius Andrijauskas
INTRODUCTION
Perioperative goal directed fluid therapy improves outcomes of treatment by individually optimizing the fluid status (1). It implies a stepwise infusion of fluids for optimization of circulation, but ignores changes in hydration status. Potentially it could save up to 860,000 lives during high-risk surgery every year (2). The mini volume loading test (mVLT) was recently proposed for evaluation and optimization of hydration status during goal directed protocols by monitoring the advance of plasma dilution (3).
AIM
Aim of the study was to test the hypothesis that mVLT applied immediately before elective primary total knee arthroplasty (TKA) surgery and 24 hours later improves outcomes.
OBJECTIVES
1. Apply perioperative mVLT in the intervention group, and use our institution’s standard of care in the control group of TKA patients.
2. Determine outcomes of treatment: (a) postoperative mobilization evaluated by the timed up and go (TUG) test, and (b) the day when the fit-to-discharge criteria are met.
3. Compare outcomes between intervention and control groups.
METHODS
Ethical approval N° 158200-9-071-22 was provided by Vilnius Regional Bioethics Committee (Chairperson G.Andrulionis) on 2009-09-16. It was a prospective randomized open interventional study. 47 patients scheduled for TKA were enrolled and randomized to either
intervention (n=21) or control (n=26) groups. Intervention group received mVLT immediately before anaesthesia induction and 24 hours later. The mVLT implied administration of mini fluid challenges consisting of 5 mL·kg-1 bolus of acetated Ringer’s infused over 3–5 min followed by 5 min period without fluid. In each mVLT session, arterial and capillary plasma dilution efficacies of consecutive mini fluid challenges were immediately calculated on a laptop computer from bed-side measures of invasive arterial Hb (HemoCue) and noninvasive capillary Hb (Masimo Radical-7) before the first bolus and after each of the 3 mini fluid challenges. Minimization of capillary plasma dilution efficacy of a mini fluid challenge associated with negative arterio-capillary plasma dilution efficacy difference were cut-off criteria to stop infusing boluses and switch to maintenance infusion. Arterial line was also used for simultaneous monitoring of deviations in cardiac stroke volume (LiDCOPlus). The cut-off criteria to stop boluses was stroke volume decrease for >10%. During 24 hours between mVLT sessions patients received fluid therapy on discretion of the physician routinely responsible for the patients care. All patients were operated by the same lead surgeon and using the same technique. Spinal anaesthesia and postoperative multimodal analgesia was managed by the same anaesthesiologist using the same methodology. Postoperative rehabilitation program was the standard used in this hospital. Control group patients received fluid therapy during the whole study period on discretion of the physician routinely responsible for the patients care. Monitoring of stroke volume and noninvasive measures of Hb were not applied for guiding the fluid therapy in controls. Overall outcomes of treatment in both groups were evaluated by determining the day when the fit-to-discharge criteria were met and monitoring the functional recovery - a degree of postoperative mobilization evaluated by the timed up and go (TUG) test. Kaplan–Meier method was used to calculate the discharge from hospital rate. The log-rank test was used to detect differences in the time of discharge from hospital between groups. Statistical analysis was performed using PASW (PASW Statistic 17, SPSS, IBM Corporation, NY).
RESULTS
The protocol was part of the on-going larger inter-disciplinary study (4). 47 (40 females and 7 males) completed the study: intervention (n=21) or control (n=26) groups. Groups were comparable in respect to age and weight.
1. Fit-to-discharge criteria were met significantly more rapidly in intervention group than in controls (log-rank test, p < 0.01).
2. The functional recovery (TUG test) was better in intervention group than in control group (log-rank test, p < 0.05).
CONCLUSIONS
Our hypothesis was confirmed. Patients who received optimization of fluid status by the combined perioperative mVLT and GDT protocols met the criteria for discharge from the hospital sooner than the controls, and their functional recovery was faster. The simultaneous use of monitoring fluid responsiveness by haemodynamic parameters and plasma dilution allows for a better detection of a time point when no more fluid should be given so as to prevent both - circulation and tissues - from being overfilled. It encourages future research.
REFERENCES
1. Chappell D, Jacob M, Hofmann-Kiefer K, Conzen P, Rehm M (2008) A Rational Approach to Perioperative Fluid Management. Anesthesiology 109:723-740.
2. Hamilton MA, Cecconi M, Rhodes A (2011) A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg 112 (6):1392-1402.
3. Andrijauskas A, Svensen C, Ivaskevicius J, Porvaneckas N, Kvederas G, Marmaite U (2012) Goal directed fluid therapy revised: indirect monitoring of interstitial fluid accumulation during mini fluid challenges with crystalloids. The Open Conference Proceedings Journal 3:42-51.
4. Kvederas G, Porvaneckas N, Andrijauskas A, Svensen CH, Ivaskevicius J, Mazunaitis J, Marmaite U, Andrijauskas P. A randomized double-blind clinical trial of tourniquet application strategies for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. (in press) (Published online 28 September, 2012). DOI 10.1007/s00167-012-2221-1.
6. CORRELATION OF ALARM SYMPTOMS, PATIENTS‘ AGE AND
CLINICALLY SIGNIFICANT ENDOSCOPIC FINDINGS
Authors: Lina Mockutė, Sandra Rimšelytė, Saulius Sriuoginys Department of Gastroenterology,
Medical Academy, Lithuanian University of Health Sciences Supervisor of the abstract: Prof. G. Kiudelis, Prof. L. Jonaitis
INTRODUCTION
According to gastroenterologists’ guidelines, esophagogastroduodenoscopy (EGD) should be performed for patients younger than 45 years old with dyspepsia and alarm symptoms (AS) or patients older than 45 years old with or without alarm symptoms. Alarm symptoms that are evaluated as an indication to perform EGD are: dysphagia, anaemia, icterus, fever, bleeding from upper gastrointestinal tract, newly originated dyspepsia for patients over 45 years, weight loss of unknown origin, recurrent vomiting.
AIM
The aim of this study was to evaluate the correlation of alarm symptoms, patients’ age and clinically significant organic pathology found on upper endoscopy.
OBJECTIVES
2. To evaluate and compare the incidence of clinically significant organic pathology between 2 groups of patients: younger than 45 years old without alarm symptoms (1’st grp.) and older than 45 years old with or without alarm symptoms (2’nd grp.).
3. To evaluate the correlation between alarm symptoms and clinically significant organic pathology found on EGD.
METHODS
1. A perspective study was held in 4 medical centers: in Hospital of Lithuanian University of Health Sciences (HLUHS), in Kaunas Clinical Hospital, in Panevėžys Hospital and in Alytus Hospital. The results of outpatient EGD were evaluated from September 2012 till February 2013.
2. Comparing the overall rate of alarm symptoms manifestation, patients were divided according to their age into two groups: younger than 45 years old (1’st grp.) and older than 45 years old (2’nd grp.). Alarm symptoms that were evaluated as an indication to perform EGD were: dysphagia, anaemia, icterus, fever, bleeding from upper gastrointestinal tract, newly originated dyspepsia for patients over 45 years, weight loss of unknown origin, recurrent vomiting.
3. To evaluate the incidence of clinically significant organic pathological findings between different groups of individuals, patients were also divided into two groups: younger than 45 years old without alarm symptoms (1’st grp.) and older than 45 years old with or without alarm symptoms (2’nd grp.). As an organic pathology, these findings were considered: erosive esophagitis (EE) (grades: A, B, C, D), gastric ulcer, duodenal ulcer, gastric polyp, suspected malignant tumor.
4. Data analysis was accomplished using the SPSS 21.0 program. The statistically significant difference was considered to be, when p<0,05.
Data were collected from 502 patients: in HLUHS- 99 (20%), in Kaunas Clinical Hospital- 100 (20%), in Panevėžys Hospital- 151 (30%), in Alytus Hospital- 152 (30%). The study included 204 (41%) males and 298 (59%) females. The mean age of the study sample was 55,6±16,7, the mean age of men- 54,1±16,3, women- 56,6±16,9 years, p>0,05.
When analyzing the overall rate of alarm symptoms manifestation, alarm symptoms were found in 22 (15%) of 148 individuals among patients aged less than 45 years and in 117 (33%) of 354 individuals among patients aged more than 45 years, p<0,05.
Clinically significant organic pathological findings in esophagus were diagnosed: among patients aged less than 45 years without alarm symptoms (1’st grp.)- in 36 (26%) of 138 individuals (EE A was found in 22 (16%) patients, EE B- in 12 (9%) patients, EE C- in 2 (1%) patients); among patients aged more than 45 years with or without alarm symptoms (2’nd grp.)- in 81 (22%) of 364 individuals (EE A was found in 51 (14%) patients, EE B- in 25 (7%) patients, EE C- in 5 (1%) patients). There was no statistically significant difference between these groups, p>0,05. Clinically significant organic pathological findings in stomach were diagnosed in 14 (10,1%) patients of 138 in 1’st group (gastric ulcer was found in 3 (2,2%) patients, duodenal ulcer- in 9 (6,5%) patients, gastric polyp- in 2 (1,4%) patients, suspected malignant tumor- in 0 (0%) patients). In 2’nd group, which consisted of 364 individuals, 51 (14%) patients had organic pathological findings in stomach (gastric ulcer was found in 8 (2,2%) patients, duodenal ulcer- in 6 (1,6%) patients, gastric polyp- in 35 (9,6%) patients, suspected malignant tumor- 2 (0,5%)). There was a statistically significant difference between these groups, p<0,05.
When analyzing the correlation between alarm symptoms and clinically significant organic pathology found on EGD, 139 (28%) individuals presented with alarm symptoms and organic pathology was found in 56 (40,3%) of them; 363 (72%) individuals did not present with alarm symptoms and organic pathology was found in 131 (36,1%) of these patients. There was no statistically significant correlation between clinically significant organic pathology and alarm symptoms, p>0,05.
1. Alarm symptoms manifest statistically significantly more often among patients over 45 years.
2. There is no significant difference in the rate of clinically significant organic pathology found in esophagus between patients younger than 45 years old without alarm symptoms and older than 45 years old with or without alarm symptoms.
3. Patients older than 45 years with or without alarm symptoms are more often diagnosed with clinically significant organic pathology in the stomach.
4. Alarm symptoms do not predict clinically significant organic pathology.
REFERENCES
1. Vakil N, Moayyedi P, Fennerty MB, Talley NJ. Limited Value of Alarm Features in the Diagnosis of Upper Gastrointestinal Malignancy: Systematic Review and Meta-analysis. Gastroenterology. 2006; 131: 390–401.
7. THE EFFICIENCY OF POSTOPERTATIVE PAIN CONTROL
USING EPIDURAL ANALGESIA
Authors: Artūras Kalniūnas, Sandra Ramanavičiūtė, Erika Ruočkaitė Anesthesiology Clinic, Lithuanian University of Health Sciences, Lithuania Supervisor of the abstract: Docent, MD, Aurika Karbonskienė
INTRODUCTION
Epidural analgesia is one of the most effective method to manage postoperative pain. We can achieve improved early rehabilitation results by using this method postoperatively. Appropriate care for epidural catheters is important for effective epidural analgesia.
AIM
To evaluate the efficiency of postoperative pain control using epidural analgesia. OBJECTIVES
1. To evaluate the efficiency of postoperative pain control using epidural analgesia assessing pain intensity and requirements of rescue analgesic medications.
2. To evaluate patients’ postoperative mobility and its influence on the dislodgement of epidural catheter.
3. To evaluate the patients’ requirements for analgesics during their increasing mobility.
METHODS
Patients who received postoperative epidural analgesia during one month period (07-01-2013 – 07-02-2013) at the departments of Traumatology-Orthopaedics and Surgery (Hospital of LUHS Kaunas Clinics) were included in the study. The patients were observed during all period of epidural analgesia delivery. 89 patients were visited daily and postoperative mobility, motor block (Bromage score), pain intensity by Visual Analog Scale (VAS), requirements of rescue analgesic were assessed. The statistical analysis was performed by using SPSS 17.0 and Microsoft Office Excel. Data are presented as means, medians (were appropriate), proportions as percentages, standard deviations, frequencies. χ2 test was used to check significant association between variables. P level of significance was p<0,05
RESULTS
The average age of patients was 69,00±13,13 years, average BMI 28,59±6,19 kg/m². Lumbar epidural catheter was inserted in 91% of patients, thoracic epidural - 9% of patients. Spinal-epidural anesthesia was performed in 92,1% of patients, general anesthesia and Spinal-epidural analgesia - 7,9% of patients. Duration of epidural analgesia was planned for three postoperative days in 49,4% of patients, four days - 50,6% of patients. Mean pain score (VAS) on the first day
- 1,86 ±2,44, second day – 1,36±2,37, third day – 1,97±2,67, fourth day – 1,75±2,5. There was no statistically significant difference between pain scores in those 4 days. Rescue analgesics (RA) were requested by 60,67% of patients during first postoperative day, 39,77% - during second day, 38,46% - during third day, 22,22% - during fourth day.
Patients were divided into three groups according postoperative mobility: group 1 (lying in bed during all period of observation), group 2 (moving within limits of bed: sitting up, turning from side to side), group 3 (getting out of bed on the second postoperative day and walking). Catheter was taken out timely in 100% of patients in group 1. No dislodgement of catheter or preterm removal of it was observed in this group. Group 1 showed no requirement for RA in 39,53% of patients during first postoperative day and 42,86% during second postoperative day. Catheter was removed timely in 65,4% of patients in group 2. Catheter dislodgement was observed in 11,5%, preterm removal due to difficult management of blockage in 7,7%, due to ineffective blockage in 3,9%, post-term removal in 11,5% of patients in this group. Group 2 showed no requirement for RA in 33,33% of patients during first postoperative day and 59,7% during second postoperative day. Catheter was removed timely in 84% of patients in group 3. Catheter dislodgement was observed in 14%, post-term removal in 2% of patients of this group. Group 3 showed no requirement for RA during second postoperative day. There was a statistically significant difference in requirements of rescue analgesics between group 1 and 2 on first and second day, p<0,05.
CONCLUSIONS
1. Pain intensity remains unvaried during whole postoperative period in patients with epidural analgesia. Rescue analgesic requirements are getting lower with
2. Preterm dislodgement of epidural catheters is increased with increasing postoperative mobility.
3. Rescue analgesic requirements are higher in patients with increased mobility during first day and it is becoming lower during second day of epidural analgesia.
REFERENCES
1. Competency in managing care in epidural analgesia. Bird A, Allcock N, Cooper J. Nurs Times. 2013 Feb 5-11;109(5):18-20.
2. Hermanides J, Hollmann MW, Stevens MF, Lirk P. Failed epidural: causes and
management. Br J Anaesth. 2012 Aug;109(2):144-54.
BASIC SCIENCES AND PHARMACOLOGY SECTION
1. COMPARISON OF MULTIVARIATE ANALYSIS BASED METHODS FOR DETECTION OF ECG T-WAVE ALTERNANS
Author: Solventa Krakauskaitė
Institute of Biomedical Engineering, Kaunas University of Technology Robertas Petrolis
Neuroscience Institute, Lithuanian University of Health Sciences Renata Šimoliūnienė
Dept. Physics, Mathematics and Biophysics, Lithuanian University of Health Sciences Supervisor of the abstract: Algimantas Kriščiukaitis
Dept. Physics, Mathematics and Biophysics, Neuroscience Institute, Lithuanian University of Health Sciences
INTRODUCTION
ECG T-Wave Alternans (TWA) is reported to be a reliable predictor of ventricular sudden cardiac death [1], so detection and evaluation of it could reveal a new possibilities for the clinicians. Numerous methods for detection of and evaluation of non-visible TWA in the microvolt range are elaborated over the last two decades, however, their results sometimes are controversial. Multivariate methods despite their need for comparatively high computational resources reported as giving promissing results, while testing on simulated signals and specially selected recordings.
AIM
To test and compare results of two multivariate analysis methods based on Principal Component Analysis (PCA) and Periodic Component Analysis (πCA) for detection and evaluation of T-wave alternans analyzing synthetic and clinical recordings.
METHODS
1. Periodic Component Analysis was performed using modified method, elaborated on the basis of described in [2] with additional data pre-processing – time stretching procedure to normalize in duration analyzed ST-T intervals. Every ordinary QRS-T,T interval was aligned with the others using bi-cubic spline interpolation, maximizing cross-correlation with the template, constructed from the first 10 cardio cycles. The method constructs the transformation: k T T k w X y' = ' , (1)
which maximizes periodicity of the analyzed signal at the TWA frequency – 0,5 cycles per beat. Such measure of periodicity is ratio of squared differences between original sequence of concatenated S-T,T segments y’ and one cardio cycle right shifted same sequence y’ :
∑
∑
− = − = + − = 1 0 2 1 0 2 ' ' ' ) , ( K k k K k k m k y y y m w ε . (2)As estimate of TWA we used energy of the signal represented in first row of constructed transformation Y TX
Ψ
= , where Ψ is the generalized eigenvector matrix of original sequence
of concatenated S-T,T segments y’k and one cardio cycle right shifted same sequence y’k+m.
2. Principal Component Analysis was performed using algorithm, elaborated during our previous investigations described in [3], which analyzes extracted and time-normalized T,T segments ensemble after the same time stretching procedure as used in πCA case. The PCA transforms the original data set into a new set of vectors (the principal components) which are uncorrelated and each of them involves information represented by several interrelated variables in the original set. Every vector xi representing ordinary ST-T complex is then represented by linear combination of the principal components fk
multiplied by coefficients wi,k:
∑
= = p k k k i i w 1 ,ϕ x . (3)Variation of coefficients wi,k represents variation in shape of S-T,T complexes. Method
uses normalized estimate of power spectral density of the coefficients w at the highest frequency.
3. Data sets. Firstly, the methods were performed using synthetic ECG with added TWA. The signal consisted of 10 generated cardio cycles in 6 leads. T-wave alternans and random noise was added according to the recommendations described in [2]. Each ST-T complex was modeled as:
x!,! n = s! n +!!a! n ∙ -‐1 !
+ v!,! n
where 𝑠! 𝑛 is the background ST-T complex, which is periodically repeated in each beat, 𝑎! 𝑛 is the alternans waveform, and 𝑣!,! 𝑛 is additive random noise.
Secondly, the methods were tested using clinical recordings from subjects with risk factors for sudden cardiac death as well as healthy controls, lasting approximately 2 minutes, which we took from “PhysioNet/Computers in Cardiology Challenge 2008” Databank (www.physionet.org/challenge).
RESULTS
1. PCA and πCA were giving congruous results when analyzing the synthetic signals. Our results analyzing recordings from “St. Petersburg Inst. of Cardiol. Technics 12-lead Arrhythmia Database” by means of PCA comply with the reference ranks showing significant Kendall tau rank correlation coefficient 0.592 (p=0.036). The results obtained by means of πCA did not show significant correlation. TWA episodes were mostly expected in “Sudden Cardiac Death Holter Database”. Six out of 10 recordings have significant reference rank given by PhysioNet. Results of PCA method showed TWA positive results in 8 out of 10 recordings. πCA method did not show any significant results, because of limited amount of leads in the recordings.
2. Both methods not only detected the TWA phenomena, but also revealed morphological features of alternans in shape of S-T,T segment of the synthetic ECG signals. Only PCA showed significant results on clinical recordings.
CONCLUSIONS
1. Multivariate analysis based method PCA gave significant results in detection of TWA in clinical recordings while compared with reference ranks from PhysioNet database.
2. Both methods could be used for monitoring of heart activity in severe cardiac situations and ordinary examinations collecting morphological features of the signal for future investigations.
REFERENCES
Ikeda T, Saito H, Tanno K, et al. T-wave alternans as a predictor for sudden cardiac death after myocardial infarction. Am J Cardiol. 2002;89: 79–82.
V. Monasterio, G.D. Clifford, P. Laguna, J. P. Martinez, Annals of Biomedical Engineering, Vol. 38, No. 8, August 2010 A Multilead Scheme Based on Periodic Component Analysis for T-Wave Alternans Analysis in the ECG pp. 2532–2541.
R. Simoliuniene, A. Krisciukaitis, A. Macas, G. Baksyte, V. Saferis, R. Zaliunas. Principal Component Analysis Based Method for Detection and Evaluation of ECG T-Wave Alternans. Computers in Cardiology 2008, vol. 1-2, p. 757-760.
2. SYNTHESIS AND EVALUATION OF IN VITRO ACTIVITY OF
4-THIAZOLIDINONE COMPOUNDS AGAINST HL-60 LYMPHOMA
CELLS
Authors: Jonas Salys, Liudas Šlepikas, Eduardas Tarasevičius, Liudas Ivanauskas, Valdas Jakštas, Mindaugas Marksa, Hiliaras Rodovičius, Jūratė Savickienė
Lithuanian University of Health Sciences, Pharmacy Faculty, Department of Drug Chemistry, A.Mickevičiaus 9, LT 44307 Kaunas, Lithuania
Lithuanian University of Health Sciences, Pharmacy Faculty, Department of Analitical and Toxicological Chemistry, A.Mickevičiaus 9, LT 44307 Kaunas, Lithuania
Vilnius University, Institute of Biochemistry, Department of Molecular Cell Biology, Mokslininkų 12, Vilnius, LT 08662, Lithuania
Supervisor of the abstract: Jonas Salys
INTRODUCTION
Recent data shows that 4-thiazolidinones possessing a variety of biological effects such as antifungal, antibacterial, antiviral, anti-inflammatory, antidiabetic. It also has been a favorable scaffold for developing novel anticancer compounds. Proto-oncogene serine/threonine-protein kinase (Pim-1), necrostatin-7, B-cell lymphoma 2 (Bcl-2) are promising targets of 4-thiazolidinones for an anticancer therapeutics. Unfortunately, neither of the 4-thiazolidinone compounds, possessing an anticancer activity, undergoes clinical trials.
AIM
To investigate how structure modifications affects an anticancer activity in vitro.
OBJECTIVES
1. To synthesize 4-thiazolidinone compounds bearing substituents in 5 and 2 positions. 2. To investigate their anticancer activity against promyelocytic leukemia HL-60 cells.
METHODS
Synthesis. Modifications of a 4-thiazolidinone ring were performed in a 5 position by the
Knoevenagel condensation reaction. To modify a 2 position a nucleophilic substitution reaction performed, previously incorporating a good leaving group to the 4-thiazolidinone ring. Thin layer chromatography (TLC) was used to monitor a progress of reaction. Purity of compounds were analyzed using a high performance liquid chromatography (HPLC). Structures of compounds were determined using an IR spectroscopy.
Cell culture experiments. The human promyelocytic leukemia HL-60 cells were cultured in a
RPMI 1640 medium supplemented with 10% fetal bovine serum, 100 U/mL penicillin and 100 µg/mL streptomycin (Gibco, Grand Island, NY) at 37°C in a humidified 5% CO2 atmosphere. In each experiment, logarithmically growing cells were seeded in 4 mL of medium at a density 5 x
105 cells/mL. Cell survival was assessed by the trypan blue exclusion test. Viable and dead (blue coloured) cells were counted in a haemocytometer.
RESULTS
All synthesized compounds were greater than 90% pure. Synthesized compounds TSS-1, TSS-3 and TSS-4 inhibited cell growth at a concentration of 50 µM. However TSS-2 and TSS-5 did not affect cell growth at the 50 µM concentration.
CONCLUSIONS
4-thiazolidinones is a privileged scaffold for drug discovery due to ease and vast possibility of modifications in 5, 3, 2 positions. More than 60 percent of our synthesized compounds possessed a micromolar range activity. In this work we used modifications that give possible trends for further development of compounds with an increased activity.
3. MORPHOLOGICAL CHARACTERISTICS OF THE BLOOD
VESSEL IN THE ATRIOVENTRICULAR NODE AND BUNDLE OF
HIS
Author: Saule Kiaunyte
Supervisor of the abstract: dr. Kristina Rysevaite
INTRODUCTION
Atrioventricular node (AVN) and bundle of His are structures of the conduction system of the heart. AVN receives heartbeat impulses from the sinoatrial node (SAN) and directs them to the bundle of His. The areas contain numerous ChAT (choline acetyltransferase) and TH (tyrosine hydroxylase) positive nerve bundles and fibers [1]. Thus, it is important to understand how the
