Dalius Jatužis

Lithuanian High Cardiovascular Risk (LitHiR) primary prevention programme - rationale and design

Lithuanian High Cardiovascular Risk (LitHiR) primary prevention programme - rationale and design Objectives: According to the latest WHO data, coronary heart disease deaths in Lithuania reached 38.3% of total deaths. Based on the unfavourable situation with cardiovascular morbidity and mortality in Lithuania the Lithuanian High Cardiovascular Risk (LitHiR) programme aimed at estimation and aggressive managing of cardiovascular risk factors. This paper describes the Lithuanian High Cardiovascular Risk programme protocol. Design and methods: In 2006 the Lithuanian High Cardiovascular Risk programme was started. LitHiR programme recruited men - at the age of 40-54 years and women - 50-64 years without overt cardiovascular disease. The two-level approach - primary health care institutions (PHCI) and specialized cardiovascular prevention units (CVPU) - was applied. The subjects selected were tested for cardiovascular risk and those with high cardiovascular risk were sent to secondary (CVPU) level, for other the plan of preventive measures of risk factor reduction was created. In years 2006-2010 overall 266,391 persons (36.9% from all target population) were examined. Among them 164,657 subjects (61.8%) were tested for the first time, 68,832 (25.8%) were tested repeatedly one time, 32,848 subjects (12.3%) were tested repeatedly for two and more times. Conclusions: The programme aimed at estimation and managing of cardiovascular risk factors striving to reduce acute cardiovascular event related morbidity and mortality, to slow down the progression of sub-clinical atherosclerosis into overt cardiovascular disease, to increase the number of newly identified cases of diabetes, metabolic syndrome and latent course of atherosclerosis related diseases, to decrease hospitalizations for treatment of arterial hypertension and coronary heart disease.

Family and sexual life in people with epilepsy

Having epilepsy is much more than having seizures. Epilepsy can have a severe negative effect on quality of life, affecting social relationships, academic achievement, housing, employment, and the ability to live and function independently. We undertook a cross-sectional study in a tertiary epilepsy center in Lithuania, aiming to assess the influence of epilepsy and aspects relating to epilepsy (employment, stigma, anxiety) on patients and their families, and to estimate their quality of family life and sexual functioning. We asked patients to complete a questionnaire about their socio-demographic situation, their seizure types and antiepileptic medications, and their quality of family and sexual life. Our results confirmed that epilepsy seriously influences family life. One third of our patients are lonely and half are childless. Epilepsy leads to difficulty in finding a job, especially for men, and unemployment affects their status in the family. People with epilepsy are uncomfortable interacting with those of the opposite sex and tend to conceal their medical condition from their partner. One third have sexual dysfunction, yet only a quarter of them seek professional help. There is a clear need to improve self-confidence and to reduce social stigma in people with epilepsy, and to encourage them to discuss their problems with specialists.

Prevalence of cardiovascular risk factors in Lithuanian middle-aged subjects participating in the primary prevention program, analysis of the period 2009–2012

Abstract 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/m2; 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.

Prevalence of high-risk profile in middle-aged subjects with arterial hypertension: A nationwide survey

Abstract 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.

Epidemiological patterns of tick-borne encephalitis in Lithuania and clinical features in adults in the light of the high incidence in recent years: a retrospective study

Lithuania is one of the countries with the highest incidence of tick‐borne encephalitis (TBE) in Europe. The aim of this study was to describe the epidemiological patterns of TBE in Lithuania, and characterize clinical features in adults in the light of the high incidence in recent years.

Detection of aquaporin-4 antibodies for patients with CNS inflammatory demyelinating diseases other than typical MS in Lithuania

Abstract Objectives Neuromyelitis optica (NMO) is frequently associated with aquaporin‐4 autoantibodies (AQP4‐Ab); however, studies of NMO in Lithuania are lacking. Therefore, the main objective of our study is to assess positivity for AQP4‐Ab in patients presenting with inflammatory demyelinating central nervous system (CNS) diseases other than typical multiple sclerosis (MS) in Lithuania. Materials and methods Data were collected from the two largest University hospitals in Lithuania. During the study period, there were 121 newly diagnosed typical MS cases, which were included in the MS registry database. After excluding these typical MS cases, we analyzed the remaining 29 cases of other CNS inflammatory demyelinating diseases, including atypical MS (n = 14), acute transverse myelitis, TM (n = 8), acute disseminated encephalomyelitis, ADEM (n = 3), clinically isolated syndrome, CIS (n = 2), atypical optic neuritis, ON (n = 1), and NMO (n = 1). We assessed positivity for AQP4‐Ab for the 29 patients and evaluated clinical, laboratory, and instrumental differences between AQP4‐Ab seropositive and AQP4‐Ab seronegative patient groups. Results AQP4‐Ab test was positive for three (10.3%) patients in our study, with initial diagnoses of atypical MS (n = 2) and ADEM (n = 1). One study patient was AQP4‐Ab negative despite being previously clinically diagnosed with NMO. There were no significant clinical, laboratory, or instrumental differences between the groups of AQP4‐Ab positive (3 [10.3%]) and negative (26 [89.7%]) patients. Conclusions AQP4‐Ab test was positive for one‐tenth of patients with CNS inflammatory demyelinating diseases other than typical MS in our study. AQP4‐Ab testing is highly recommended for patients presenting with not only TM and ON but also an atypical course of MS and ADEM.

Descriptions of Apoplexy by Joseph Frank in the Beginning of the Nineteenth Century in Vilnius

In the beginning of the 19th century, apoplexy was understood to be a disease of the cerebral blood vessels, manifesting with a sudden weakening or extinction of sensation and the patients inability to move. In this study, we examined the situation of neurology in the beginning of the 19th century in Vilnius through the perspective of a nervous system disease - apoplexy. Case reports and descriptions of apoplexy in the textbook and memoirs by Joseph Frank (1771-1842), descriptions of patients with apoplexy from the proceedings of Vilnius University Clinic were analysed. It was identified that the main cause of apoplexy was not an imbalance of the four humours but the pathology of cerebral blood vessels. However, following ancient tradition, the principles of recreation and moderation were thought to be important for the prevention of apoplexy, and bloodletting and diet were believed to be essential for the treatment.

Early ischemic brain lesions after carotid angioplasty and stenting on diffusion-weighted magnetic resonance imaging study

Summary Aim: The aim of the paper is to evaluate the appearance of the new early ischemic lesions in the brain after carotid angioplasty and stenting on diffusion-weighted magnetic resonance imaging, and their relationship with clinical and procedural factors. Methods: Carotid artery stenting (CAS) procedures performed by a single interventional cardiologist in years November 2006 to January 2013 were evaluated retrospectively. In total, 227 procedures for 211 patients (mean age 69.8 ± 8.5 years) were performed, from which 171 (75.3%) for male and 56 (24.7%) for female patients. Seventy-two (34.1%) patients had symptomatic stenosis of carotid artery. The following protection systems to avoid the distal microembolism were used during the CAS: (1) Filters: FilterWire EZ (Boston Scientific Corporation); Emboshield NAV (Abbott Vascular); SpideRX (EV3); Defender (Medtronic); FiberNet Filter (Invatec-Medtronic); (2) Occlusion MoMa Baloon System (Invatec-Medtronic). Acute ischemic damages of the brain before and after CAS procedure were diagnosed using magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) sequences. Sixty-five (30.8%) patients underwent MRI test. Exact and asymptomatic χ2 criteria were applied for testing the hypothesis of inter-dependency of the symptoms. Results: Forty-six (70.8%) patients had new ischemic foci in the brain on MRI DWI after CAS procedures. Among those patients, focal damage of the brain was diagnosed in 36 (78.3%) cases; linear damage of the brain - in 9 (19.6%) patients; ipsilateral damage of the brain - in 37 (80.4%) patients; bilateral damage of the brain - in 16 (34.8%) patients, 38 (82.6%) patients were diagnosed with forebrain damage; 4 (8.7%) patients were diagnosed with damage of brainstem; 5 (10.9%) patients were diagnosed with cerebellum damage. Clinical symptoms of brain damage were diagnosed only for 2 (4.3%) patients. Focal damage of the brain was significantly less frequent only for aortic arch type 1, if compared with aortic arch type 2 and 3: 64.3%, 93.3% and 100.0%, respectively (p < 0.05). Focal damage of the brain occurred least in patients (28.6%) with Emboshield NAV protection type, if compared to other types of protection (71.4-100.0%). Linear >10mmbrain damage was less frequent when using FilterWire EZ, Emboshield NAV and SpideRX protection type. Ipsilateral ischemic brain damage also occurred less frequent when using Emboshield NAV protection type; bilateral damage occurred less frequent when using FilterWire EZ, Emboshield NAV and SpideRX protection type. Ischemic forebrain damage was also diagnosed less often in patients for whom protection type FilterWire EZ and Emboshield NAV was applied. Conclusions: Most frequent findings by MRI after CAS procedures were focal, ipsilateral and forebrain damage (about 80%), but less than 5% patients had clinical symptoms. In the case of aorta arch type 1 focal ischemic damage of the brain was significantly less frequent, then in aortic arch type 2 and 3. The localization and extent of brain damage was associated with the type of protection systems that have been used.