Evaluation of daily outpatient multidisciplinary rehabilitative treatment of patients with musculoskeletal, neurological and traumatic disorders in a municipality outpatient setting.

BACKGROUND AND OBJECTIVE: Musculoskeletal, neurological, and traumatic injuries are a considerably increasing problem. There is a lack of studies evaluating the results of outpatient rehabilitative treatment of patients with the abovementioned diseases. The aim of this study was to determine the effectiveness of daily outpatient multidisciplinary rehabilitation. MATERIALS AND METHODS: This observational study enrolled 223 adult people undergoing outpatient rehabilitation performed in a municipality outpatient clinic during 14 days. The functional assessment of disability was performed by using the Barthel index (BI), functional performance was estimated by the modified Keitel functional test (MKFT), and pain perception was evaluated by the visual analogue scale (VAS). The mean scores of the tests were compared before and after outpatient multidisciplinary rehabilitation. RESULTS: Significantly reduced disability and pain perception as well as increased functional performance were documented after outpatient rehabilitation. The mean scores of BI, MKFT, and VAS before and after rehabilitation did not differ significantly among patients ranked to each cluster of diseases. Increased functional performance of patients had a moderate-to-weak association with decreased disability and pain perception. The positive changes in health status considering disability, functional performance, and pain perception were documented after 14-day rehabilitation. CONCLUSIONS: Multidisciplinary outpatient rehabilitation can be considered as effective treatment. However, it is necessary to implement specific, well-adapted consuming assessment instruments in order to evaluate the outcomes of daily multidisciplinary outpatient rehabilitative treatment.

Fatal outcome of late-onset angiotensin-converting enzyme inhibitor induced angioedema: A case report.

RATIONALE: Angiotensin-converting enzyme (ACE) inhibitors are one of the most used medication among patients with arterial hypertension. In most cases, ACE inhibitors caused side effects are mild; however, from 0.1% to 0.7% of patients can develop life threatening adverse effect, angioedema. Unlike histamine mediated, ACE inhibitor-related angioedema can develop at any time during the treatment course. PATIENT CONCERNS: An 89-year-old woman with a medical history for arterial hypertension, ischemic heart disease, heart failure, chronic atrial fibrillation developed ACE inhibitor-induced angioedema after 5 years of daily ramipril administration. DIAGNOSES: Arterial hypertension, ischemic heart disease, heart failure, chronic atrial fibrillation and late onset ACE inhibitor-induced angioedema. INTERVENTIONS: The ACE inhibitor was used for arterial hypertension on a daily basis for the past 5 years. Patient developed airway obstruction requiring intubation. Standard therapy with epinephrine, methylprednisolone and clemastine was administered. Treatment was ineffective, considering that angioedema persisted. OUTCOMES: Angioedema resolved after 13 days from the discontinuation of ramipril. Death due to cardiopulmonary insufficiency occurred 24 days after the admission to intensive care unit, despite full clinical resolution of ACE inhibitor-induced angioedema. LESSONS: Our case highlight the importance of educating clinicians about ACE inhibitor-induced angioedema, as potentially fatal adverse drug reaction. Considering the fact, that no laboratory or confirmatory test exist to diagnose ACE inhibitor-induced angioedema, clinicians' knowledge is the key element in recognition of ACE inhibitor-related angioedema.

[Secondary prevention of ischemic heart disease: pharmacological treatment after myocardial infarction according to follow-up protocol]. / Antrine isemines sirdies ligos profilaktika persirgus miokardo infarktu (medikamentinio gydymo ivertinimas remiantis anketines apklausos duomenimis).

UNLABELLED: The aim of this work was to assess the quality of pharmacological treatment in patients within one year after acute myocardial infarction. MATERIAL AND METHODS: We performed a prospective survey of 985 consecutive patients with acute myocardial infarction who were treated in the Clinic of Cardiology of Kaunas University of Medicine Hospital in 2004. About half of patients were hospitalized from different regions of Lithuania. According to the follow-up protocol, an information on 514 patients and their used treatment within 13.8+/-3.2 months after myocardial infarction were collected by letter with questionnaire. RESULTS: Beta-adrenoblockers, angiotensin-converting enzyme inhibitors, and antithrombotic drugs were the most drug used (76%, 74%, and 76%, respectively) in patients following myocardial infarction. Most of the patients used a three-drug combination (36.8%), more rarely--two-drug (24.1%) or four-drug complex (19.8%). One drug was used only in 12.1% of cases; 7.2% of patients did not use any cardiac drugs. Beta-adrenoblocker with angiotensin-converting enzyme inhibitor was the most common (40.3%) used drug combination in patients on two drug complex. The combination of beta-adrenoblocker, angiotensin-converting enzyme inhibitor, and antithrombotics was more frequently used in patients on three drug complex. The combination of two or three cardiac drugs with statin was used in several cases (1.6-10.3%). CONCLUSIONS: These findings underscore that the use of beta-adrenoblockers, angiotensin-converting enzyme inhibitors, and antithrombotics was high (about 75%) in patients during the first year after myocardial infarction, and the combination of these three drugs was used more commonly. The discordance between existing guidelines for statin use after myocardial infarction and current practice was determined in patients following myocardial infarction.

[Rational treatment of diabetes mellitus in Siauliai and Telsiai regions, Lithuania]. / Racionalus cukrinio diabeto gydymas Siauliu ir Telsiu apskriciu ligoninese.

OBJECTIVE: The evaluation of adherence to guidelines on rationality in prescribing reimbursed medicines for the treatment of diabetes mellitus. MATERIAL AND METHODS: A retrospective evaluation of drug utilization in national public health insurance database and analysis of 906 case histories of diabetic patients in respect of nonadherence to guidelines. RESULTS: A total of 184 (20.3%) case histories with 370 events were found to be nonadherent to: a) national guidelines on prescription of medicines (66.49%); b) authorized indications and contraindications (13.24%); c) insufficient monitoring (4.32%); d) nonadherence to the recommendations for prescription writing (11.35%); and e) nonadherence to the requirements for service provisions (4.6%). The analysis of nonadherence to national guidelines revealed: 1) failure to assess patient's height, weight, and body mass index (30.1%); 2) poor glycemia control (26%); 3) failure in referring to an endocrinologist in case of noncontrolled glycemia (17.5%); 4) monotherapy with long-acting insulin or started combined oral therapy without monotherapy (10.2%); 5) noncompliance with the recommendations of endocrinologist (8.5%); 6) unsubstantiated changes in diabetes mellitus treatment (4.1%). Thiazolidinediones are often administered in case of liver failure or without investigation of its function (60.4%) or in case of heart failure (29.2%). CONCLUSIONS: 1) Nonadherence was observed in 20.3% of cases; 2) the most frequent cause was nonadherence to guidelines (66.5%) and to authorized indications and contraindications (13.2%); 3) thiazolidinediones were prescribed in the presence of the contraindications. The areas for intervention are: 1) more active monitoring of glycemia; 2) the assessment of height, weight, and body mass index; and 3) the prescription of thiazolidinediones according to authorized indications and contraindications.

[Breastfeeding and medications]. / Zindymas ir medikamentai.

Breastfeeding is the most healthful method of feeding neonates and infants. In 2001 about 98% of new mothers in Lithuania started breastfeeding their neonates. One-third of nursing women (34%) discontinued breastfeeding at the time when infant reached the age of 3 months. About 56% of women breastfed their infants longer than 4 months. Only 3-6% of nursing women discontinued breastfeeding after the fourth month. Discontinuation of breastfeeding in 21-23% of all cases was directly or indirectly associated with use of medications. Such data suggest that there is a lack of information often leading physicians to advise mothers to discontinue breastfeeding because of medication use. The aim of this article was to survey the situation about classification of drugs used during breastfeeding and factors influencing drug transfer into milk in order to give more information for physician concerning the use of medication during breastfeeding. In this review, a short description of main pharmacokinetic characteristics, influencing drug transfer into milk; information on the classification of drugs used during breastfeeding; some considerations on drug safety and possible adverse effects of medications on breastfed infant; the list of drugs preferred for nursing women are presented.

[Height, weight and body mass index of preterm very low birth weight infants at the preschool age]. / Neisnesiotu labai mazo gimimo svorio vaiku ugis, svoris ir kuno mases indeksas sulaukus ikimokyklinio amziaus.

UNLABELLED: THE AIM of this study was to reveal trends in height, weight, and body mass index of preterm very low birth weight children from birth up to 5 years of age. MATERIAL AND METHODS: The present study is based on cross-sectional growth study carried out in the Clinic of Neonatology of Kaunas University of Medicine. Total sample consisted of 735 children from birth up to 5 years of age: 379 preterm children with very low birth weight; and 356 term children with normal (appropriate for gestation age) birth weight. Height, weight, body mass index were measured. In order to verify if normal birth weight group corresponds to Lithuanian standards, the data of normal birth weight group children were compared with Lithuanian standard measures. Then data of very low birth weight group and normal birth weight group were compared. RESULTS: We found that height and weight of very low birth weight girls and boys were significantly lower than height and weight of term normal birth weight infant from birth up to 5 years of age (p<0.01). The body mass index of very low birth weight girls was significantly lower than that of term normal birth weight girls at birth (p<0.01) and at age of 4 years (p<0.05). The body mass index of very low birth weight boys was significantly lower than that of term normal birth weight boys at birth and from age of 2 up to the age of 5 years (p<0.01). These data show that very low birth weight boys differently from girls were more slender than term normal birth weight infant of the same age. CONCLUSIONS: It has been shown that preterm very low birth weight infants have different patterns of growth than term normal birth weight infants. The very low birth weight infants have not caught up on their retardation at the age of 5 years.