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Symptomatic uterine rupture: a fifteen year review
No full textBackground and objectives: To assess the incidence of complete and partial eferral centre as well as the significant risk factors, symptoms and peripartum complications. Materials and Methods: A retrospective single-centre study involved all cases of uterine rupture at the Kaunas Perinatal Centre in 2004–2019. Data were from a local medical database complemented with written information from medical records. We included 45,893 women with an intact uterus and 5630 with uterine scars. Women (n=5626) with scarred uterus’ after previous cesarean delivery. The diagnosis was defined by clinical symptoms, leading to an emergency cesarean delivery, when complete or partial uterine rupture (n=35) was confirmed. Asymptomatic cases, when uterine rupture was found at elective cesarean section (n=3), were excluded. The control group is represented by all births delivered in our department during the study period (n=51,525). The outcome was complete (tearing of all uterine wall layers, including serosa and membranes) and partial uterine rupture (uterine muscle defect but intact serosa), common uterine rupture symptoms. Risk factors were parameters related to pregnancy and labour.[...]
Astrocyte-mediated spike-timing-dependent long-term depression modulates synaptic properties in the developing cortex
No full textAstrocytes have been shown to modulate synaptic transmission and plasticity in specific cortical synapses, but our understanding of the underlying molecular and cellular mechanisms remains limited. Here we present a new biophysicochemical model of a somatosensory cortical layer 4 to layer 2/3 synapse to study the role of astrocytes in spike-timing-dependent long-term depression (t-LTD) in vivo. By applying the synapse model and electrophysiological data recorded from rodent somatosensory cortex, we show that a signal from a postsynaptic neuron, orchestrated by endocannabinoids, astrocytic calcium signaling, and presynaptic N-methyl-D-aspartate receptors coupled with calcineurin signaling, induces t-LTD which is sensitive to the temporal difference between post- and presynaptic firing. We predict for the first time the dynamics of astrocyte-mediated molecular mechanisms underlying t-LTD and link complex biochemical networks at presynaptic, postsynaptic, and astrocytic sites to the time window of t-LTD induction. During t-LTD a single astrocyte acts as a delay factor for fast neuronal activity and integrates fast neuronal sensory processing with slow non-neuronal processing to modulate synaptic properties in the brain. Our results suggest that astrocytes play a critical role in synaptic computation during postnatal development and are of paramount importance in guiding the development of brain circuit functions, learning and memory
Multicentric Atrial Strain COmparison between Two Different Modalities: MASCOT HIT Study
No full textTwo methods are currently available for left atrial (LA) strain measurement by speckle tracking echocardiography, with two different reference timings for starting the analysis: QRS (QRS-LASr) and P wave (P-LASr). The aim of MASCOT HIT study was to define which of the two was more reproducible, more feasible, and less time consuming. In 26 expert centers, LA strain was analyzed by two different echocardiographers (young vs senior) in a blinded fashion. The study population included: healthy subjects, patients with arterial hypertension or aortic stenosis (LA pressure overload, group 2) and patients with mitral regurgitation or heart failure (LA volume-pressure overload, group 3). Difference between the inter-correlation coefficient (ICC) by the two echocardiographers using the two techniques, feasibility and analysis time of both methods were analyzed. A total of 938 subjects were included: 309 controls, 333 patients in group 2, and 296 patients in group 3. The ICC was comparable between QRS-LASr (0.93) and P-LASr (0.90). The young echocardiographers calculated QRS-LASr in 90% of cases, the expert ones in 95%. The feasibility of P-LASr was 85% by young echocardiographers and 88% by senior ones. QRS-LASr young median time was 110 s (interquartile range, IR, 78-149) vs senior 110 s (IR 78-155); for P-LASr, 120 s (IR 80-165) and 120 s (IR 90-161), respectively. LA strain was feasible in the majority of patients with similar reproducibility for both methods. QRS complex guaranteed a slightly higher feasibility and a lower time wasting compared to the use of P wave as the reference
Meningokoko B vakcina ir jos vaidmuo infekcijos prevencijoje.
No full textAim: Overview of Meningococcal B vaccine Objectives of the study: to review the history of meningococcal vaccine development, the development of meningococcal B vaccine and its role in infection prevention, to elucidate the situation of meningococcal infection and meningococcal serotype B vaccination in Lithuania. Articles on PubMed database were reviewed. Search terms such as Meningococcal vaccines, Meningococcal history, MenB vaccines were utilized. A more advanced search was conducted to include the terms MenB4C, MenB-FHbp, Trumenba, Bexsero. Articles went through extensive review, and some relevant references were found to be more explanatory, so it was included. Information about meningococcal vaccination and meningococcal epidemiology in Lithuania was obtained from the Center for Communicable Diseases and AIDS (Ulac.lt)
Vaikų pooperacinė analgezija opioidais (Tramadoliu)
No full textPain control in the pediatric population is a challenge for the health care team because of their vulnerability. Physiologic responses to drugs differ from that of the adult population. Tramadol belongs to the class of weak opioid receptor agonists. Tramadol is used for moderate and severe pain treatment, and as an adjuvant to anesthesia to prolong the analgesic effect. But its use has fewer side effects that can range from mild to life-threatening, such as gastrointestinal symptoms, respiratory depression, angioedema, seizure, Serotonin syndrome, and death if not resolved quickly. Therefore the Objectives of our study are: 1. To find out the proportion of patients given opioids for postoperative pain 2. To find out the proportion of patients given Tramadol for postoperative pain 3. To compare the incidence of side effects for the patients given and not given tramadol for postoperative analgesi
“Modeling and quality evaluation of microstructural carriers“
No full textFinal master‘s thesis of I. Samokaitytė “Modeling and quality evaluation of microstructural carriers“. Scientific supervisor lect. dr. V.Kurapkienė; Lithuanian University of Health Sciences, Faculty of Pharmacy, Department of Clinical Pharmacy. Kaunas, 2020. The aim of the study: to modelate microstructural carriers that meet quality requirements and to apply them for the active substance resveratrol. Main tasks: to evaluate the suitability of excipients for the production of microemulsions; to perform optimization and quality evaluation of formulated microemulsions; to determine the quality parameters of modeled microstructural carriers with resveratrol; to evaluate the release of resveratrol from microstructural carriers. Object of the study: microstructural carriers with incorporated active substance resveratrol. Methods: identification and quantification of resveratrol was performed by validated high–performance liquid chromatography method. Particle size and polydispersity index of microstructured carriers were determined by dynamic light scattering method. The pH–meter, viscometer and conductometer were used to determine the pH value, viscosity and conductivity, respectively. Biopharmaceutical in vitro release studies were performed by modified Franz– type diffusions cells system. Results: after applying experimental planning and optimization, the optimal composition microemulsion, complied with the requirements of the quality, was modelled. This microemulsion containing 6.65% of isopropyl myristate, 37.35% of purified water, 56.0% of the mixture of Labrasol® and propilene glycol (6:1 ratio). The average particle size of microemulsions with 1% and 2% of resveratrol was 72.65 nm and 99.74 nm, respectively, polydispersity index – 0.275 and 0.267, pH – 4.87 and 4.84, electrical conductivity 7.43 and 6.66 μS/cm2 and the viscosity values was 33.43 and 34.43 mPa∙s. Selected 0.5% and 1% concentrations of poloxamer 407 statistically significantly (p<0.05) increased the viscosity of 1% and 2% resveratrol microemulsions. The addition of 0.5% and 1% polymer to 1% resveratrol microemulsions increased the aveage particle size of the microemulsion systems by 7.57% and 17.72%, respectively, and the polydispersity index by 41.82% and 63.63%. Modification of the viscosity of a 2% resveratrol microemulsion with 0.5% and 1% polymer increased the average particle size by 7.83% and 14.79%, respectively, and the polydispersity index by 38.57% and 68.53%. After 4 hours the highest amount of released resveratrol was 4.3% from a 2% resveratrol microemulsion when a 0.5% polymer was selected as the gelling agent. Conclusions: selected suitable components of microemulsion allowed to produce stable and quality systems. The modeled microemulsion of optimal composition corresponded to the quality parameters and was adapted to the incorporation of the active substance resveratrol. The polymer added to these resveratrol microemulsions statistically significantly (p<0.05) increased particle size, polydispersity index and viscosity of the systems. Higher amounts of dissolved active ingredient were released from polymer-stabilized microemulsion systems
Health Care Practices for Pregnant Women at Kaunas City Ambulance Service
No full textAim: To review and evaluate health care practices for pregnant women at Kaunas city ambulance service. Objectives: 1. To analyse Kaunas city ambulance service patients data, recorded 2018 01 01 – 2018 12 31 and related to pregnancy and childbirth and summarise results. 2. To evaluate crew leaders‘ confidence in cases related to pregnant women. 3. To evaluate crew leaders‘ attitude to quality of provided services and its improvement. Methods: The thesis is divided into two parts. The first part is a retrospective cohort study using Kaunas city ambulance service’ case data, recorded 2018 01 01 – 2018 12 31 with chosen health aid protocol “Pregnancy/Childbirth/Miscarriage”. The second part is conducting semi-structured interviews with Kaunas city ambulance service crew leaders. Results: The first part. The mean on-scene time was 10 min ± 6 min, the mean transportation time was 29 min ± 9 min. Most of the cases were attended by Advanced Life Support crews (87 %). Most of the calls were categorised as high-priority calls and ambulance beacons were turned on 74 % of cases. Any other health aid despite transportation was given in 5 % of cases. The second part. 62,5 % of medics feel stress and fear while on their way to pregnant patients. All crew leaders reported a lack of confidence. Most of them describe the quality of services as good. 68,8 % of medical staff reports a lack of training and courses related to pregnancy and childbirth. Conclusion: 1. Calls related to pregnancy and childbirth represent a small minority of only 0,46 % of all ambulance calls. Most of them are categorised as high-priority calls, but 95 % of cases only need transportation. 2. Medics feel stress and fear while working with a pregnant patient and report a lack of confidence. 3. Most of the crew leaders report the need for more training and a quarter of medics report a need for additional equipment such as Doppler stethoscopes. Recommendations: To organise regular obstetric training courses at Kaunas city ambulance service including the possibility for practice in real situations. Furthermore, it is recommended to purchase Doppler stethoscopes
The Assessment of independence of older patients discharged from the supportive care and nursing hospital to home care and the continuity of nursing services at home
No full textNovelty of the research This scientific research is significant for the improvement of the Lithuanian system of nursing services. It not only overviews scientific studies related to the experiences of Lithuania and other countries when planning social services at home but also analyses legislation on the provision of nursing services, reveals systemic shortcomings in the planning and provision of services at home and at the supportive treatment and nursing hospitals, and provides possible solutions based on scientific research. Aim of the study: to assess the independence of older people discharged from the supportive treatment and nursing hospital and the need for nursing services at home. Objectives of the study: 1. To determine the most common health disorders and the main nursing problems of older people discharged from the supportive treatment and nursing hospital. 2. To establish the independence of older people discharged from the supportive treatment and nursing hospital and the need for nursing services. 3. To identify the change in the independence of older people discharged from the nursing hospital and the continuity of the nursing services 90–120 days after the discharge. 4. To reveal the assessment of the nursing service system at the home of the person and future prospects for primary outpatient care services from the point of view of the heads of institutions providing the beforementioned service
The Association Between Age-related Macular Degeneration and VEGF-A (rs833061, rs1413711) Polymorphisms.
No full textTo determine the association of age-related macular degeneration and VEGF-A (rs833061, rs1413711) polymorphisms
The Clinical And Radiological Peculiarities Of Typical And Atypical Pneumonia In Children.
No full textGoal of thesis: To find out the variety of clinical and radiological peculiarities of typical and atypical pneumonia in children and find the differences between them. Tasks of thesis: 1. Compare the rate of certain signs between typical and atypical pneumonia in children. 2. Determine the differences of inflammation indicators between typical and atypical pneumonia. 3. Evaluate the frequency of radiological signs in typical and atipical pneumonia. 4. Review potential complications of typical and atypical pneumonia and evaluate the frequency of these complications. 5. Review the antibacterial treatment of typical and atypical pneumonia. Methods: The study was conducted using the retrospective research method. The subjects of the study are the 60 patients who were treated at HLUHS KC I children diseases department from 2017.01.01 to 2019.01.01. Patients with severe congenital genetic disorders and/or nosocomial pneumonia were not added to the sample. Findings: Demographic data had no connection to the increased morbidity of a certain form of pneumonia. The most common sign of both types of pneumonia was a dry cough (78,3%), while fever in patients with typical pneumonia was significantly higher (p=0,007). Children with atypical pneumonia took significantly longer to seek help from a physician (p=0,001), while auscultation data was significantly varied between the two forms of pneumonia (p=0,004). No significant connection was found between the infiltrate type in chest radiographs and the form of pneumonia. The values of CRP and leukocytes were significantly higher (p=0,002 and 0,007) in children with typical pneumonia than atypical. The only complication that was documented in these cases was pleural effusion for both types of pneumonia, although the rate of it was not significantly different. Typical pneumonia was most often treated with one antibiotic and atypical pneumonia was treated with two (p<0,001). Results: 1) Children with typical pneumonia had significantly higher fever and sought help from a physician sooner 2) Blood tests of patients with typical pneumonia showed higher levels of inflammation indicators which were statistically significant. 3) The study showed no significant relation between the type of infiltrate and diagnosed type of pneumonia in chest radiographs. 4) The only complication of pneumonia this study found was pleural effusion, which was insignificantly more frequent in typical pneumonia. 5) Children with atypical pneumonia were statistically significantly more often treated with two antibiotics instead of one