RESUMEN
Background and objective: According to the World Health Organization (WHO), more than 100 million people have already recovered from SARS-CoV-2 infection. Therefore, it is imperative to understand the possible outcomes of COVID-19. The aim of our study was to evaluate pulmonary function, exercise capacity, residual radiological changes, and health-related quality of life (HRQoL) at follow-up in a cohort of SARS-CoV-2 pneumonia survivors. Materials and Methods: Patients with SARS-CoV-2 infection and radiologically confirmed lung injury, with no chronic lung disease prior to this infection, were included in the study. Patients' evaluation 2 months after their discharge from hospital included spirometry (FVC, FEV1, FEV1/FVC), determination of lung volume (TLC, VC, RV) and diffusing capacity of lung for carbon monoxide (DLCO, adjusted for hemoglobin), 6-Minute Walk Test (6MWT), chest CT scan, and 36-Item Short Form General Health Survey (SF-36). Results: Fifty-one patients (25 men, 26 women) were included. The mean age was 56 years (SD-11,72). Eighteen patients (35.3%) had experienced moderate COVID-19, 21 (41.2%) severe COVID-19, and 12 (23.5%) were critically ill. The mean follow-up visit time after the discharge from hospital was 60 days (SD-17). Pulmonary function at follow-up was impaired in 24 (47.2%) patients. Reduced lung volume was observed in 15 (29.4%) patients, DLCO reduction in 15 (29.4%) patients, and only one patient displayed obstruction. Twelve patients out of 51 (12/51, 27.3%) showed reduced physical capacity in the 6 MWT, and 3/51 (9.1%) showed desaturation, with SO2 < 90%. Different levels of abnormality were found in 49/51 (96,1%) patients on follow-up chest CT; the median radiological score was 10.9 (SD ± 8.87, possible maximal score, 25). Ground-glass opacity was the most common radiological feature, found in 45 (88.2%) patients. The SF-36 scores demonstrated a reduction in health status across all domains, with the lowest scores for limitations in social activities because of physical problems, vitality, and general health. Conclusion: In the group of COVID-19 pneumonia survivors 2 months after hospital discharge, residual changes in the lungs on chest CT and in lung function and reduced physical and HRQoL status were found in a significant number of patients. To evaluate COVID-19 long-term consequences, a longer follow-up period is needed.
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COVID-19 , Neumonía , Tolerancia al Ejercicio , Femenino , Estudios de Seguimiento , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Calidad de Vida , SARS-CoV-2RESUMEN
BACKGROUND: Coronary artery calcium (CAC) is known as a reliable tool for estimating risk of myocardial infarction, coronary death, all-cause mortality and is even used to evaluate suitable asymptomatic patients. We therefore aimed to evaluate whether CAC scoring can be applied in the algorithm for clinical examination of patients with severe hypercholesterolemia (SH). METHODS: During the period of 2016-2017 a total of 213 asymptomatic adults, underwent computed tomography angiography to evaluate their CAC scoring. The sample consisted of 110 patients with SH and 103 age and sex matched controls without dyslipidemia and established cardiovascular disease. RESULTS: In total there were 79 (37.2%) subjects with elevated (≥25th) CAC percentiles. Out of them 47 (59.5%) had SH and 32 (40.5%) did not. CAC score did not differ between groups (SH (+) 140.30 ± 185.72 vs SH (-) 87.84 ± 140.65, p = 0.146), however there was a comparable difference in how the participants of these groups distributed among different percentile groups (p = 0.044). Gender, blood pressure, tabaco use, physical activity, family history of coronary artery disease and diabetes mellitus were not associated with CAC score (p > 0.05). There were no significant correlations between biochemical parameters and CAC percentiles except for increase in lipoprotein(a) (p = 0.038). Achilles tendon pathology, visceral obesity, body mass index and increased waist-hip ratio were not associated with CAC percentiles either (p > 0.05). CONCLUSIONS: CAC score is not associated with presence of SH. CAC score is not an appropriate diagnostic tool in the algorithm for clinical examination of patients with SH. Further larger studies are needed to support our findings.
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Calcio , Vasos Coronarios/diagnóstico por imagen , Hipercolesterolemia/diagnóstico por imagen , Calcificación Vascular/diagnóstico por imagen , Tendón Calcáneo/patología , Adolescente , Adulto , Composición Corporal , Estudios de Casos y Controles , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Femenino , Humanos , Hipercolesterolemia/sangre , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Background and Objectives: The available research shows conflicting data on the heart rate variability (HRV) in metabolic syndrome (MetS) subjects. The discrepancy suggests a methodical shortcoming: due to the influence of physical activity, the standard measuring of HRV at rest is not comparable with HRV assessment based on 24h Holter monitoring, which is preferred because of its comprehensiveness. To obtain a more reliable measure and to clarify to what extent HRV is altered in MetS, we assessed a 24h HRV before and after the elimination of the influence of physical activity. Materials and Methods: We investigated 69 metabolic syndrome (MetS) and 37 control subjects, aged 50-55. In all subjects, 24h monitoring of electrocardiogram, blood pressure, and actigraphy profiles were conducted. To eliminate the influence of day-time physical activity on RR intervals (RRI), a linear polynomial autoregressive model with exogenous terms (ARX) was used. Standard spectral RRI analysis was performed. Results: Subjects with MetS had blunted HRV; the diurnal SDNN index was reliably lower in the MetS group than in control subjects. The elimination of the influence of physical activity did not reveal a significant HRV change in long-term indices (SDNN, SDANN, and SD2), whilst adjacent RRI values (RMSSD, pNN50, and SD1) and SDNN index significantly increased (p < 0.001). An increase in the latter indices highlighted the HRV difference between the MetS and control groups; a significant (p < 0.001) decrease of all short-term HRV variables was found in the MetS group (p < 0.01), and low-frequency spectral components were less pronounced in the MetS group. Conclusion: The application of a polynomial autoregressive model in 24h HRV assessment allowed for the exclusion of the influence of physical activity and revealed that MetS is associated with blunted HRV, which reflects mitigated parasympathetic tone.
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Ejercicio Físico/fisiología , Indicadores de Salud , Frecuencia Cardíaca/fisiología , Síndrome Metabólico/fisiopatología , Actigrafía/métodos , Electrocardiografía/métodos , Femenino , Humanos , Masculino , Síndrome Metabólico/complicaciones , Persona de Mediana Edad , Monitoreo Fisiológico/métodosRESUMEN
BACKGROUND: Cardiovascular mortality in Lithuania is extremely high and abnormal lipid levels are very common among Lithuanian adults. Dyslipidemia is one of the main independent risk factors for cardiovascular diseases (CVD) leading to high absolute CVD risk. The aim of this study was to assess CVD risk in dyslipidemic middle-aged subjects. METHODS: During the period of 2009-2016 a total of 92,373 people (58.4% women and 41.6% men) were evaluated. This study included men aged 40-54 and women aged 50-64 without overt CVD. RESULTS: Any type of dyslipidemia was present in 89.7% of all study population. 7.5% of dyslipidemic patients did not have any other conventional risk factors. Three and more risk factors were detected in 60.1% of dyslipidemic subjects. All analyzed risk factors, except smoking, were more common in dyslipidemic adults compared to subjects without dyslipidemia: arterial hypertension (55.8% vs. 43.3%, p < 0.001), diabetes (11.1% vs. 7.3%, p < 0.001), abdominal obesity (45.3% vs. 30.2%, p < 0.001), BMI ≥30 kg/m2 (35.8% vs. 23.7%, p < 0.001), metabolic syndrome (34.0% vs. 9.2%, p < 0.001), family history of coronary heart disease (26.3% vs. 23.1%, p < 0.001), unbalanced diet (62.5% vs. 52.9%, p < 0.001) and insufficient physical activity (52.0% vs. 44.2%, p < 0.001). The prevalence of all evaluated risk factors, except smoking, increased with age. Average SCORE index was 1.87 in all study population, while dyslipidemic subjects had higher SCORE compared to control group (1.95 vs 1.20, p < 0.001). CONCLUSIONS: Almost two thirds of dyslipidemic middle-aged Lithuanian adults without overt cardiovascular disease had three or more other CVD risk factors, which synergistically increase absolute risk of CVD. The average 10-year risk of CVD death in patients with dyslipidemia was 1.95%. The importance of managing dyslipidemia as well as other risk factors in order to reduce burden of cardiovascular disease in Lithuania is evident.
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Enfermedades Cardiovasculares/epidemiología , Dislipidemias/complicaciones , Adulto , Enfermedades Cardiovasculares/etiología , Diabetes Mellitus , Femenino , Humanos , Hipertensión , Lituania/epidemiología , Masculino , Síndrome Metabólico , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , FumarRESUMEN
BACKGROUND: Dyslipidemia is highly prevalent and is one of the major risk factors for cardiovascular disease in Lithuania. The purpose of this study was to determine the prevalence of severe dyslipidemia in Lithuanian middle aged primary prevention population and to investigate cardiovascular risk profile. METHODS: The group of 83,376 people were examined in the Lithuanian High Cardiovascular Risk primary prevention program (LitHiR), during 2009-2015 years. This study recruited middle aged men and women without overt cardiovascular disease. The prevalence of cardiovascular risk factors was compared between severe dyslipidemia group and control group. RESULTS: Severe dyslipidemia was present in 13.5% (11265) of the subjects; 66.6% (7508) were females. The subjects with severe dyslipidemia had significantly higher rates of arterial hypertension (63.5% vs. 44.2%, p < 0.001), diabetes mellitus (16% vs. 8.1%, p < 0,001), abdominal obesity (51% vs. 30.3%, p < 0.001), body mass index (BMI) > 30 (kg/m2) (38.8% vs. 24.1%, p < 0.001), metabolic syndrome (47.2% vs. 9.2%, p < 0.001), unbalanced diet (66.5% vs. 53.5%, p < 0.001), insufficient physical activity (56% vs. 44.2%, p < 0.001), family history of cardiovascular disease (29.7% vs. 22.7%, p < 0.001) in comparison with control group. Subjects without dyslipidemia had significantly higher rates of smoking (26.4% vs. 22.7%, p < 0.001). The prevalence of familial hypercholesterolemia was 0.1%, very high hypertriglyceridemia - 0.2% and familial mixed dyslipidemia - 0.1% of the subjects examined in the LitHiR programme. CONCLUSIONS: High prevalence of dyslipidemia remains a major problem in Lithuania. 9 out of 10 people have dyslipidemia, 1 out of 10 - severe dyslipidemia. Severe dyslipidemia is associated with higher frequency of other cardiovascular risk factors.
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Diabetes Mellitus/epidemiología , Dislipidemias/epidemiología , Hipertensión/epidemiología , Síndrome Metabólico/epidemiología , Obesidad Abdominal/epidemiología , Adulto , Anciano , Índice de Masa Corporal , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Estudios de Cohortes , Comorbilidad , Estudios Transversales , Diabetes Mellitus/sangre , Diabetes Mellitus/fisiopatología , Dislipidemias/sangre , Dislipidemias/fisiopatología , Femenino , Humanos , Hipertensión/sangre , Hipertensión/fisiopatología , Lituania/epidemiología , Masculino , Síndrome Metabólico/sangre , Síndrome Metabólico/fisiopatología , Persona de Mediana Edad , Obesidad Abdominal/sangre , Obesidad Abdominal/fisiopatología , Prevalencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Fumar/sangre , Fumar/epidemiología , Triglicéridos/sangreRESUMEN
BACKGROUND: Atherogenic dyslipidemia (AD) is a blood serum lipid profile abnormality characterized by elevation of triglycerides and reduced levels of high density lipoprotein cholesterol (HDL-C). It is associated with residual cardiovascular risk. This study evaluated and compared the risk profiles of patients with hypertriglyceridemia, low-HDL-C levels or AD, in order to understand, which lipid profile is associated with greater risk. METHODS: During the period of 2009-2016 a population of 92,373 Lithuanian adults (men 40-54 years old and women 50-64 years old) without overt cardiovascular disease were analyzed. Data of 25,746 patients (68.6% women and 31.4% men) with hypertriglyceridemia and/or low HDL-C low levels were collected and used for further statistical analysis. RESULTS: Participants with AD tend to have more unfavorable risk profile than participants with hypertriglyceridemia or low-HDL-C. AD tends to cluster with other atherogenic risk factors, such as arterial hypertension [odds ratio (OR) 1.96, 95% confidence intervals (CI) 1.87-2.01], smoking [OR 1.20, 95% CI 1.14-1.27], diabetes mellitus [OR 2.74, 95% CI 2.58-2.90], obesity [OR 2.92, 95% CI 2.78-3.10], metabolic syndrome [OR 22.27, 95% CI 20.69-23.97], unbalanced diet [OR 1,59, 95% CI 1.51-1.68], low physical activity [OR 1.80, 95% CI 1.71-1,89], CHD history in first degree relatives [OR 1.18, 95% CI 1.12-1.25] and total number of risk factors [OR 1.47, 95% CI 1.38-1.57]. CONCLUSION: AD is associated with more unfavorable cardiovascular risk profile than hypertriglyceridemia or low-HDL cholesterol levels. Once identified AD should require additional medical attention since it is an important factor of residual cardiovascular risk.
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Aterosclerosis/epidemiología , HDL-Colesterol/sangre , Dislipidemias/sangre , Triglicéridos/sangre , Adulto , Aterosclerosis/patología , Dislipidemias/epidemiología , Dislipidemias/patología , Femenino , Humanos , Hipertrigliceridemia/sangre , Hipertrigliceridemia/epidemiología , Hipertrigliceridemia/patología , Lituania , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de RiesgoRESUMEN
BACKGROUND: The aim of our study was to determine the association of anxiety and depression symptoms, as well as the main socio-demographic factors, with patients' satisfaction with primary healthcare services. METHODS: The respondents were asked to fill out an anonymous questionnaire that included information on the patients' gender, age, place of residence, education, ethnicity, the type of clinic they visited and the presence of chronic diseases. Patient satisfaction was evaluated by using a short version of the Patient Satisfaction Questionnaire. We also used the Hospital Anxiety and Depression Scale. RESULTS: Poor evaluations of primary healthcare services were more characteristic of males, older patients, those living in district centres and villages, individuals with lower (secondary or lower) education levels, respondents of Russian ethnicity (compared to Lithuanian), patients with chronic diseases and higher anxiety and depression symptom scores. In the final regression analysis, better satisfaction with primary healthcare services was observed in respondents who were less depressed, of Polish ethnicity and who were living in a city rather than a village. CONCLUSIONS: Being more depressed or anxious, living in the district centre or countryside related to patients' worse satisfaction with primary healthcare services. The results of nationality of patients and their satisfaction are ambiguous. The is strong correlation between the symptoms of depression and anxiety.
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Ansiedad , Enfermedad Crónica , Depresión , Satisfacción del Paciente , Atención Primaria de Salud , Calidad de Vida , Ansiedad/diagnóstico , Ansiedad/epidemiología , Enfermedad Crónica/epidemiología , Enfermedad Crónica/psicología , Comorbilidad , Correlación de Datos , Depresión/diagnóstico , Depresión/epidemiología , Etnicidad , Femenino , Humanos , Lituania , Masculino , Persona de Mediana Edad , Satisfacción del Paciente/etnología , Satisfacción del Paciente/estadística & datos numéricos , Atención Primaria de Salud/métodos , Atención Primaria de Salud/normas , Atención Primaria de Salud/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Factores SocioeconómicosRESUMEN
BACKGROUND: The aim of this study was to assess the prevalence and changes of cardiovascular risk factors in the middle-aged Lithuanian subjects after conducting the primary prevention program. DESIGN AND METHODS: Four cross-sectional investigations of cardiovascular risk factors were conducted in 2009 (n = 9625), 2010 (n = 7716), 2011 (n = 5018) and 2012 (n = 4348). The program recruited men aged 40-54 and women aged 50-64 without overt cardiovascular disease. RESULTS: During the period 2009-2012, the mean number of risk factors significantly increased (from 3.95 to 4.03, p < 0.001), while the numbers of people having metabolic syndrome (from 34.1% to 28.7%; p < 0.001), arterial hypertension (from 60.2% to 54.5%; p < 0.001), the average body mass index (BMI) value (from 29.17 to 28.92 kg/m(2); p = 0.001) and abdominal obesity (from 48.4% to 45.3%; p < 0.001) significantly decreased. The percentage of subjects with dyslipidemia, as well as the average values of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides, remained unchanged. The percentage of smoking subjects have significantly increased (from 19.3% to 22.7%; p < 0.001). CONCLUSIONS: The analysis showed that the prevalence of arterial hypertension, metabolic syndrome and obesity in Lithuania is slowly decreasing while conducting the primary prevention program; however, dyslipidemia, diabetes mellitus and smoking are still hard to manage for both genders.
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Dislipidemias/epidemiología , Hipertensión/epidemiología , Síndrome Metabólico/epidemiología , Obesidad/epidemiología , Adulto , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Dislipidemias/sangre , Dislipidemias/prevención & control , Femenino , Humanos , Hipertensión/sangre , Hipertensión/prevención & control , Lituania/epidemiología , Masculino , Síndrome Metabólico/sangre , Síndrome Metabólico/prevención & control , Persona de Mediana Edad , Obesidad/sangre , Obesidad/prevención & control , Prevalencia , Factores de Riesgo , Triglicéridos/sangreRESUMEN
OBJECTIVE: To explore the relationship between laboratory, functional, disease activity markers and bone mineral density (BMD) loss in patients with spondyloarthropathies (SpAs). METHODS: A cohort of 41 SpA patients were followed up for 4 years. Disease activity indices, spinal mobility and laboratory tests, BMD using were monitored at the baseline and 4-year follow-up. The 4% BMD loss at either of the proximal femurs was defined as significant. RESULTS: Over the 4-year study period, 27% of SpA patients experienced femoral BMD loss. Baseline BMD>0.85g/cm(2) (p=0.011) was the baseline factor associated with BMD loss at 4-year follow-up. Several clinical and functional tests were helpful in identifying the BMD loss at follow-up: CRP>15.6mg/L (sens. 91%, spec. 70%), ESR>29mm/h (sens. 82%, spec. 73%), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)>4.75 (sens. 91%, spec. 62%). At follow-up anti-TNFα treatment history, stable or improved lateral flexion and intermalleolar distance (NPV, accordingly, 95%, 88% and 87%), made BMD loss unlikely. Deterioration of the physician assessment of global disease activity (PAGDA) score from baseline to follow-up was a remarkable predictor of BMD loss (PPV=0.83), while stable or improved score excluded the BMD loss (NPV=0.83). According to multiple logistic regression analysis, baseline BMD value and follow-up CRP levels, when considered together, identify BMD status correctly in 85% of SpA patients (Nagelkerke R(2)=0.676). CONCLUSION: Baseline BMD, anti-TNFα treatment, PAGDA score, spinal mobility tests and disease activity markers are useful factors in predicting the BMD loss in SpA patients and can provide surrogate information on BMD status.
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Densidad Ósea , Osteoporosis/epidemiología , Espondiloartropatías/epidemiología , Adulto , Anciano , Proteína C-Reactiva/análisis , Femenino , Fémur , Estudios de Seguimiento , Humanos , Lituania/epidemiología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Índice de Severidad de la Enfermedad , Espondiloartropatías/tratamiento farmacológico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adulto JovenRESUMEN
Hypertension is the most common non-communicable disease and the leading cause of cardiovascular disease in the world. It presents an important public health challenge in both economically developed and developing countries. In 2006, the Lithuanian High Cardiovascular Risk programme was launched. The programme recruited men aged 40-54 and women aged 50-64 without overt cardiovascular disease. We analysed a group of 23,204 subjects included in the programme at the primary level. Arterial hypertension was present in 57.6% of the subjects: 63.2% in the females and 49.2% in the males. In the hypertensive middle-aged subjects, grade 1 hypertension was present in 53.1%, grade 2 in 22.4%, and grade 3 in merely 5.9% of the subjects. The prevalence of a minimum of three concomitant risk factors among the hypertensive patients was 78.0%, compared with 52.1% in the patients without hypertension (p < 0.001). Blood pressure goals were attained in 20.8% of the hypertensive women and in 14.4% of the hypertensive men. In Lithuania, a high prevalence of hypertension was characteristic of middle-aged subjects. Although the blood pressure elevation had not reached high levels, the presence of at least three risk factors concomitant to hypertension was more expressed in them compared with the non-hypertensive subjects.
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Diabetes Mellitus/fisiopatología , Dislipidemias/fisiopatología , Hipertensión/epidemiología , Obesidad Abdominal/fisiopatología , Adulto , Antihipertensivos/uso terapéutico , Presión Sanguínea , Determinación de la Presión Sanguínea , Femenino , Encuestas Epidemiológicas , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/fisiopatología , Lituania/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Factores SexualesRESUMEN
OBJECTIVES: The aim of this study was to investigate the parameters of ante-mortem delirium of the patients in a closed psychiatric institution and to compare them with the ante-mortem psychopathology of the medical patients. METHODS: There were 139 medical records of the patients analyzed, who died during the period of 1997-2003 at the in-patient psychiatric institution. The diagnoses were recorded according to the International Classification of Diseases, 10th Revision (ICD-10) criteria. Patients' data included age, gender, previous psychiatric disorders, current somatic and psychiatric morbidity, and comorbidity. RESULTS: The incidence of delirium was 83.7%. The delirium group included more elder, male persons who were more likely to have dementia and less inclined to depression. Surprisingly the incidence of delirium among non-dementia men was quite high--76.9%, as compared to non-dementia women--23.1% (P = 0.008). The duration of delirium differed from 1 to 1335 days. Longer delirium was observed among elder than 75 years (87.7, SD 183.9 vs 52.6, SD 121.4 days; P = 0.019) and dementia (8.6, SD 173.6 vs 13.5, SD 11.6 days; P < 0.001) patients, but did not differ in gender groups. CONCLUSIONS: Ante-mortem delirium occurred more commonly in more elder and demented patients The duration of ante-mortem delirium was shorter in younger and non-dementia patients. Patients of the psychiatric institution tend to have longer deliriums than medical patients. The patients with depression and the history of alcohol abuse were not likely to get ante-mortem delirium. Before death in many persons hyperactive and mixed delirium transformed into hypoactive.
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Delirio/diagnóstico , Delirio/epidemiología , Pacientes Internos/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Adulto , Distribución por Edad , Anciano , Causalidad , Comorbilidad , Demencia/diagnóstico , Demencia/epidemiología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Incidencia , Tiempo de Internación/estadística & datos numéricos , Lituania , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Estudios Retrospectivos , Distribución por Sexo , Suicidio/estadística & datos numéricos , Intento de Suicidio/estadística & datos numéricos , Adulto JovenRESUMEN
Background/Objectives: Both hypertension and carotid atherosclerosis are independent risk factors for cardiovascular disease. We aim to investigate the synergistic effects of hypertension and carotid plaques on cardiovascular events and all-cause mortality. Methods: A follow-up study was conducted at the Preventive Cardiology Department of Vilnius University Hospital Santaros Klinikos between 2012 and 2021. The study recruited participants aged 40-65 who did not have overt cardiovascular disease (CVD) and were part of the Lithuanian High Cardiovascular Risk primary preventive program. The study collected demographic and clinical data, including an ultrasound assessment of carotid plaque. Results: The participants were monitored for 4-10 years for CVD events and all-cause mortality. Among 6138 participants, 954 (16%) experienced CVD events. The presence of carotid plaque on both sides was significantly associated with CVD events, myocardial infarction, and all-cause mortality. However, the combination of hypertension and carotid plaque did not significantly increase the risk for CVD events or all-cause mortality. Conclusions: The risk of CVD events or all-cause mortality was not significantly increased by the combination of hypertension and carotid plaque. Cardiovascular events depend on the extent of atherosclerosis in the carotid arteries.
RESUMEN
BACKGROUND AND OBJECTIVE: It has been proposed that the same cardiovascular risk (CV) factors predispose middle-aged men to the development of both coronary artery disease and erectile dysfunction (ED). Moreover, several recently published studies have identified ED as a possible early marker of CV disease. The aim of this particular study was to evaluate the association between ED and early asymptomatic heart and vascular damage in middle-aged men with CV risk factors. MATERIAL AND METHODS: In this case-control study, the International Index of Erectile Function (IIEF) questionnaire was employed to assess the erectile function of the study participants and to allocate them either into the ED group (N=21; mean IIEF score, 18.15 [SD, 2.54]; mean age, 48.2 years [SD, 4.4]) or the control group (N=24; mean IIEF score, 23.45 [SD, 0.99]; mean age, 46.8 years [SD, 3.1]). Additionally, pulse wave velocity, augmentation index, pulse pressure, carotid intima media thickness (IMT), and atherosclerotic plaque count were determined, and echocardiography was performed in every subject. RESULTS: The mean IMT and left ventricular mass index (LVMI) of both carotid arteries in the ED group were significantly higher when compared with controls (598.57 vs. 535.54 mm·10(-3), P=0.03, and 107.26 vs. 98.67 g/m2, P=0.04, respectively). Using multiple regression analysis, an independent association between the IIEF score and the LVMI was found (P=0.002). No significant differences in the results of pulse wave velocity, atherosclerotic plaque count, and other laboratory tests were found between the 2 study groups. CONCLUSIONS: The study suggests that ED is associated with a higher LVMI and may be an early marker of CV disease.
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Enfermedad de la Arteria Coronaria/epidemiología , Disfunción Eréctil/epidemiología , Hipertrofia Ventricular Izquierda/epidemiología , Presión Sanguínea , Grosor Intima-Media Carotídeo , Estudios de Casos y Controles , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/fisiopatología , Humanos , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/fisiopatología , Lituania/epidemiología , Masculino , Persona de Mediana Edad , Análisis de la Onda del Pulso , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
BACKGROUND: Prediabetes is a reversible condition, but lifestyle-changing measures, such as increasing physical activity, should be taken. This article explores the use of Fitbit activity trackers to assess physical activity and its impact on prediabetic patient health. METHODS: Intervention study. In total, 30 volunteers (9 males and 21 females), aged 32-65 years, with impaired glucose levels and without diabetes or moving disorders, received Fitbit Inspire activity trackers and physical activity recommendations. A routine blood check was taken during the first and second visits, and body composition was analyzed. Physical activity variability in time was assessed using a Poincare plot. RESULTS: The count of steps per day and variability differed between patients and during the research period, but the change in total physical activity was not statistically significant. Significant positive correlations between changes in lipid values, body mass composition, and variability of steps count, distance, and minutes of very active physical activity were observed. CONCLUSIONS: When assessing physical activity, data doctors should evaluate not just the totals or the medians of the steps count, but also physical activity variability in time. The study shows that most changes were better linked to the physical activity variability than the total count of physical activity.
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Diabetes Mellitus Tipo 2 , Estado Prediabético , Acelerometría , Composición Corporal , Diabetes Mellitus Tipo 2/prevención & control , Femenino , Monitores de Ejercicio , Humanos , MasculinoRESUMEN
BACKGROUND: Monitoring physical activity with consumers wearables is one of the possibilities to control a patient's self-care and adherence to recommendations. However, clinically approved methods, software, and data analysis technologies to collect data and make it suitable for practical use for patient care are still lacking. OBJECTIVE: This study aimed to analyze the potential of patient physical activity monitoring using Fitbit physical activity trackers and find solutions for possible implementation in the health care routine. METHODS: Thirty patients with impaired fasting glycemia were randomly selected and participated for 6 months. Physical activity variability was evaluated and parameters were calculated using data from Fitbit Inspire devices. RESULTS: Changes in parameters were found and correlation between clinical data (HbA1c, lipids) and physical activity variability were assessed. Better correlation with variability than with body composition changes shows the potential to include nonlinear variability parameters analysing physical activity using mobile devices. Less expressed variability shows better relationship with control of prediabetic and lipid parameters. CONCLUSIONS: Evaluation of physical activity variability is essential for patient health, and these methods used to calculate it is an effective way to analyze big data from wearable devices in future trials.
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Estado Prediabético , Dispositivos Electrónicos Vestibles , Ejercicio Físico , Monitores de Ejercicio , Humanos , MetabolomaRESUMEN
Various comorbidities and multimorbidity frequently occur in chronic obstructive pulmonary disease (COPD), leading to the overload of health care systems and increased mortality. We aimed to assess the impact of COPD on the probability and clustering of comorbidities. The cross-sectional analysis of the nationwide Lithuanian database was performed based on the entries of the codes of chronic diseases. COPD was defined on the code J44.8 entry and six-month consumption of bronchodilators. Descriptive statistics and odds ratios (ORs) for associations and agglomerative hierarchical clustering were carried out. 321,297 patients aged 40-79 years were included; 4834 of them had COPD. A significantly higher prevalence of cardiovascular diseases (CVD), lung cancer, kidney diseases, and the association of COPD with six-fold higher odds of lung cancer (OR 6.66; p < 0.0001), a two-fold of heart failure (OR 2.61; p < 0.0001), and CVD (OR 1.83; p < 0.0001) was found. Six clusters in COPD males and five in females were pointed out, in patients without COPD-five and four clusters accordingly. The most prevalent cardiovascular cluster had no significant difference according to sex or COPD presence, but a different linkage of dyslipidemia was found. The study raises the need to elaborate adjusted multimorbidity case management and screening tools enabling better outcomes.
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Enfermedad Pulmonar Obstructiva Crónica , Adulto , Anciano , Broncodilatadores , Análisis por Conglomerados , Comorbilidad , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , PrevalenciaRESUMEN
SUMMARY BACKGROUND: Betacoronavirus SARS-CoV-2 has spread in early 2020 worldwide just in several months. The official statistics are consistently collected, but this is mainly based on symptomatic reports. This study was aimed to estimate the seroprevalence of SARS-CoV-2 infection in Lithuanian population. MATERIALS AND METHODS: Study was conducted during August-September 2020 in 6 municipalities of Lithuania. The sample comprised 3087 adult participants from the general population (mean age 53.7 years, 64% female). SARS-CoV-2 antibodies were assessed using AMP IgM/IgG Rapid Test, other data were based on self-report. Seroprevalence was assessed as a crude estimate and as adjusted by sensitivity-specificity of the test. RESULTS: The crude seroprevalence in the total sample was 1.9%, the adjusted - 1.4%, ranging from 0.8% to 2.4% across municipalities. Among seroprevalent cases, 67.2% had IgG, 29.3% had IgM, and 3.5% had both IgG and IgM. An increased risk for seropositive test was observed among people who reported having had close contacts with SARS-CoV-2 positives (OR=5.49, p<0.001). At the borderline significance were female gender (OR=1.75, p=0.082) and non-smoking status (OR=2.95, p=0.072). Among the seropositive participants, 69.0% reported having had no COVID-19 symptoms since 1 March 2020, while 31.0% reported having had at least one of the symptoms. CONCLUSIONS: The SARS-CoV-2 seroprevalence in Lithuanian sample in August-September 2020 was 1.4%, ranging from 0.8% to 2.4% across municipalities. Given the overall official data, by the end of study (11 September 2020) the total COVID-19 rate in Lithuania was 117.5 per 100,000 population or 0.12%. This suggests more than 10 times higher prevalence of virus across the population than the official estimates.
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BACKGROUND: Patients with multimorbidity account for ever-increasing healthcare resource usage and are often summarised as big spenders. Comprehensive analysis of health care resource usage in different age groups in patients with at least two non-communicable diseases is still scarce, limiting the quality of health care management decisions, which are often backed by limited, small-scale database analysis. The health care system in Lithuania is based on mandatory social health insurance and is covered by the National Health Insurance Fund. Based on a national Health Insurance database. The study aimed to explore the distribution, change, and interrelationships of health care costs across the age groups of patients with multimorbidity, suggesting different priorities at different age groups. METHOD: The study identified all adults with at least one chronic disease when any health care services were used over a three-year period between 2012 and 2014. Further data analysis excluded patients with single chronic conditions and further analysed patients with multimorbidity, accounting for increasing resource usage. The costs of primary, outpatient health care services; hospitalizations; reimbursed and paid out-of-pocket medications were analysed in eight age groups starting at 18 and up to 85 years and over. RESULTS: The study identified a total of 428,430 adults in Lithuania with at least two different chronic diseases from the 32 chronic disease list. Out of the total expenditure within the group, 51.54% of the expenses were consumed for inpatient treatment, 30.90% for reimbursed medications. Across different age groups of patients with multimorbidity in Lithuania, 60% of the total cost is attributed to the age group of 65-84 years. The share in the total spending was the highest in the 75-84 years age group amounting to 29.53% of the overall expenditure, with an increase in hospitalization and a decrease in outpatient services. A decrease in health care expenses per capita in patients with multimorbidity after 85 years of age was observed. CONCLUSIONS: The highest proportion of health care expenses in patients with multimorbidity relates to hospitalization and reimbursed medications, increasing with age, but varies through different services. The study identifies the need to personalise the care of patients with multimorbidity in the primary-outpatient setting, aiming to reduce hospitalizations with proactive disease management.
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Costos de la Atención en Salud , Multimorbilidad , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Gastos en Salud , Hospitalización , Humanos , Lituania , Persona de Mediana EdadRESUMEN
AIMS: To assess cardiac safety in COVID-19 patients treated with the combination of Hydroxychloroquine and Azithromycin using arrhythmia risk management plan. METHODS AND RESULTS: We retrospectively examined arrhythmia safety of treatment with Hydroxychloroquine and Azithromycin in the setting of pre-defined arrhythmia risk management plan. The data was analyzed using R statistical package version 4.0.0. A two-tailed p-value<0.05 was considered significant. 81 patients were included from March 23rd to May 10th 2020. The median age was 59 years, 58.0% were female. The majority of the study population (82.7%) had comorbidities, 98.8% had radiological signs of pneumonia. Fourteen patients (17.3%) experienced QTc ≥ 480 ms and 16 patients (19.8%) had an increase of QTc ≥ 60 ms. Seven patients (8.6%) had QTc prolongation of ≥ 500 ms. The treatment was discontinued in 4 patients (4.9%). None of the patients developed ventricular tachycardia. The risk factors significantly associated with QTc ≥ 500 ms were hypokalemia (p = 0.032) and use of diuretics during the treatment (p = 0.020). Three patients (3.7%) died, the cause of death was bacterial superinfection with septic shock in two patients, and disseminated intravascular coagulation with multiple organ failure in one patient. None of these deaths were associated with cardiac arrhythmias. CONCLUSION: We recorded a low incidence of QTc prolongation ≥ 500 ms and no ventricular tachycardia events in COVID-19 patients treated with Hydroxychloroquine and Azithromycin using cardiac arrhythmia risk management plan.
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INTRODUCTION: Lithuania has one of the highest mortality rates from coronary heart disease (CHD) among European countries. Most CHD are preventable, but when they occur, the management of these patients is important in secondary prevention. The purpose of the present analysis was to describe the demographics, clinical profile, and contemporary management of patients with stable CHD in the Lithuanian population and to compare data with other Central Eastern European countries. METHODS: CLARIFY (prospective observational longitudinal registry of patients with stable CHD) is an international cohort study in outpatients with stable CHD. Treated outpatients with established CHD from the CLARIFY registry in Lithuania (214 patients) were compared with those from the rest of Central Eastern Europe (2794 patients). RESULTS: Lithuanian patients were younger (p = 0.0275), had a higher body mass index (p = 0.0003), and more frequently received treatment for hypertension (p < 0.0001). Prevalence of dyslipidemia (p < 0.0001) was higher in Lithuanian patients but a smaller group of people had diabetes (p < 0.0001). The total cholesterol (p < 0.0001), low-density lipoprotein cholesterol (p < 0.0001), and blood pressure (p < 0.0001) were higher in the Lithuanian population. A smaller proportion of Lithuanian patients were physically inactive, and the majority of patients in Lithuania were engaged in light physical activity compared with Central Eastern European patients (p = 0.0018). CONCLUSION: The data analysis shows that management of hypertension, dyslipidemia, smoking, and obesity in patients with CHD in Lithuania is insufficient and needs further improvement.
Type 2 diabetes mellitus [Lithuania has one of the highest mortality rates from cardiovascular disease (CVD) among European countries. The purpose of the present analysis was to describe the demographics, clinical profile, and contemporary management of patients with stable CVD in the Lithuanian population and to compare data with other Central Eastern European countries. Our data shows that management of elevated blood pressure, abnormal amounts of lipids, smoking, and excessive weight in Lithuanian patients with CVD is insufficient compared with the rest of Central Eastern Europe and needs further improvement].