Rimantas Žalinkevičius

The incidence of type 1 diabetes mellitus among 15-34 years aged Lithuanian population: 18-year incidence study based on prospective databases

BackgroundThe aim of this prospective study was to determine the incidence of type 1 diabetes mellitus in 15-34-year-aged Lithuanian males and females during 1991 - 2008MethodsA contact system with general practitioners covering 100% of the 15-34-year-aged Lithuanian population was the primary data source. Reports from regional endocrinologists and statistical note-marks of State patient insurance fund served as secondary sources for case ascertainment.ResultsThe average age-standardized incidence rate was 8.30 per 100,000 persons per year (95% Poisson distribution confidence interval [CI] 7.90-8.71) during 1991 - 2008 and was statistically significantly higher among males (10.44 per 100,000 persons per year, 95% CI 9.82-11.10) in comparison with females (6.10 per 100,000, 95% CI 5.62-6.62). Male/female rate ratio was 1.71 (95% CI 1.63-1.80). Results of the linear 1991 - 2008 regression model showed that the incidence of Type 1 diabetes in 15-34-year-aged males and females decreased slightly over the time (r = -0.215, p > 0.05).ConclusionsOur data demonstrated the male predominance in primary incidence of type 1 diabetes mellitus in 15-34-year-aged population in Lithuania. The incidence of type 1 diabetes mellitus in 15-34-year-aged males and females decreased slightly during 1991-2008.

Gestational diabetes, obesity, and metabolic syndrome diagnosed during pregnancy.

BACKGROUND The aim was to analyze the impact of obesity on women with gestational diabetes mellitus (GDM) and the association of obesity and GDM with the metabolic syndrome. METHODS In a retrospective study, the data of 233 obese women with GDM were compared with the data of 96 women with GDM and normal weight. RESULTS Significantly higher fasting glycemia before the oral glucose tolerance test (5.2±1.1 mmol/L vs. 4.5±0.8 mmol/L, P<0.00001) and higher frequency of hypertensive disorders of pregnancy (26.2% vs. 9.4%, P=0.0003) were found in obese women with GDM than in GDM women of normal weight. These women needed insulin therapy more often (18.9% vs. 8.3%, P=0.007). Also 31 (13.3 %) of them had chronic hypertension as compared with 3.1% in women of normal weight (P=0.003). These 31 women had three components necessary for diagnosing of metabolic syndrome according to the World Health Organization-impaired glucose tolerance, obesity, and hypertension. No difference in gestational age and mean weight of their newborns was found, but newborns of obese GDM women with metabolic syndrome components more often were significantly macrosomic with features of diabetic fetopathy and had more often symptoms of hypoglycemia after birth. CONCLUSIONS The presence of obesity and GDM has a significant impact on both maternal and fetal complications. The metabolic syndrome can be diagnosed not only after pregnancy but also during pregnancy.

The effect of a drospirenone-containing combined oral contraceptive on female sexual function: a prospective randomised study

Abstract Objectives: The study investigated the effects on female sexual function of a progestogen-containing combined oral contraceptives (COCs) with an antiandrogenic profile taken in a continuous regimen. Methods: In this prospective randomised single-institution study, 80 healthy women with a monogamous partner and an active sexual life were randomised into two groups for a period of 3 months. Women in the exposed group (n = 40) took a COCs containing 30 μg ethinylestradiol (EE) and 3 mg drospirenone (DRSP) in a 21/7 regimen. Women in the control group (n = 40) used either a barrier contraceptive method (BCM) or a natural family planning method (NFPM). Participants were asked to complete a set of validated questionnaires to assess sociodemographic variables and measure Female Sexual Function Index (FSFI). Results: The total FSFI score (p < 0.0001), as well as the desire (p = 0.04) and arousal (p = 0.03) scores, were significantly lower in the COCs group after 3 months of hormonal contraceptive use compared with baseline. Women using BCM or NFPM showed an improvement in total FSFI score (p = 0.02). Hormonal contraception with DRSP increased the likelihood of worse sexual function in the desire (odds ratio [OR] 2.47; 95% confidence interval [CI] 1.22, 4.98; p = 0.01) and arousal domains (OR 2.85; 95%CI 1.34, 5.93; p = 0.005) and in total FSFI score (OR 2.01; 95%CI 1.45, 2.79; p < 0.001). The results remained statistically significant even after adjustment for smoking status. Conclusions: The study found evidence that women taking a combined EE/DRSP COCs for 3 months may have a worsening of sexual function as measured by FSFI.

Diabetes distress in adult type 1 diabetes mellitus men and women with disease onset in childhood and in adulthood

THE AIM To determine whether or not diabetes distress varies by age of type 1 diabetes mellitus (T1DM) onset and/or gender. SUBJECTS AND METHODS A total of 700 adult T1DM patients were randomly selected from the Lithuanian Diabetes Registry; 214 of them (30.6%) agreed to participate and were recruited for the study. Diabetes distress (emotional burden, physician-related distress, regimen-related distress, interpersonal distress) was compared in 105 (42 men and 63 women) patients with T1DM diagnosed during 0-18years of life, and in 109 (61 men and 48 women) with T1DM diagnosed in adulthood, using Diabetes Distress Scale (DDS). RESULTS Adult childhood-onset T1DM women have higher regimen-related distress (36.3±21.3 vs 26.6±16.2, p=0.016) than adulthood-onset women. Adult childhood-onset T1DM women experience higher diabetes distress (higher emotional burden (27.0±22.0 vs 15.6±16.4, p=0.006), physician-related distress (34.4±33.9 vs 20.7±29.4, p=0.024), total diabetes distress (41.2±13.6 vs 34.8±10.9, p=0.011)) than childhood-onset men. Adulthood-onset T1DM women experience higher physician-related distress (39.2±37.6 vs 23.4±32.5, p=0.013), but lower regimen-related distress (26.6±16.2 vs 35.8±21.6, p=0.014) than adulthood-onset men. In conclusion our findings reinforce the interdependence of psychological and biomedical factors in influencing health outcomes and support the need to provide psychological assessment and support to patients with T1DM.

Profile of mood states in adult type 1 diabetes mellitus men and women with disease onset in childhood and in adulthood.

Abstract Introduction: Although diabetes may not be associated with psychopathology, it may be associated with less severe disturbances in psychosocial functioning. Emotional problems in relation to type 1 diabetes are usually analysed as symptoms of psychiatric conditions but not as states of mood. The aim was to compare profiles of mood states in adult patients with childhood-onset and adulthood-onset type 1 diabetes mellitus and to outline possible gender-specific differences. Subjects and methods: A total of 214 adult type 1 diabetic patients were randomly selected from the Lithuanian Diabetes Registry. The mood states were compared in 105 (42 men and 63 women) patients with type 1 diabetes diagnosed during 0–18 years of life and in 109 (61 men and 48 women) diagnosed in adulthood. The scores of tension-anxiety, depression-dejection, anger-hostility, vigour-activity, fatigue-inertia and confusion-bewilderment were evaluated using the Profile of Mood States. Results: Depression-dejection was higher in adulthood-onset diabetic women than in childhood-onset (p=0.005) diabetic patients. In childhood-onset diabetic patients depression-dejection (p=0.046) and confusion-bewilderment (p=0.033) were higher in women than in men. Adulthood-onset women with diabetes had higher tension-anxiety (p=0.027), depression-dejection (p=0.001), and confusion-bewilderment (p=0.004) scores than men. Multiple logistic analyses showed that adulthood-onset period of type 1 diabetes is associated with higher levels of depression-dejection [OR=1.1; 95% confidence intervals (CI) 1.01–1.19, p=0.025], longer diabetes duration (OR=2.00; 95% CI 1.27–2.03, p=0.012), higher HbA1c level (OR=1.15; 95% CI 1.02–1.3, p=0.023), and female gender (OR=2.51; 95% CI 1.29–2.90, p=0.021). Conclusions: Profile of mood states in adult women with type 1 diabetes is worse than in men. Adulthood-onset type 1 diabetic women have higher depression-dejection than do childhood-onset diabetic patients. Adulthood-onset period of type 1 diabetes is associated with higher levels of depression-dejection, longer diabetes duration and female gender.

Thirty-Five Years of Thyroid Cancer Experience in a Paediatric Population: Incidence Trends in Lithuania between 1980 and 2014

Background: Thyroid cancer (TC) is a rare condition in children. It may be associated with radiation, iodine deficiency or familial inheritance. Aims: The objectives of this study were to analyse the prevalence and incidence trends over 3 decades and clinical features of TC in the paediatric population in Lithuania. Methods: We reviewed all TC cases diagnosed in children aged less than 18 years during the period 1980-2014 using medical records from 3 main hospitals in Lithuania where such TC cases are managed. Results: During the 35-year period (1980-2014) there were 57 cases (45 females) of TC in children in Lithuania. The mean age at the time of diagnosis was 14.51 ± 0.52 years. The crude incidence rate of TC ranged from 0 to 0.93 cases per 100,000 children per year and the mean annual increase was 5.26% (p < 0.001). Papillary carcinoma was the most common histological type (73.7%). No association was found between the incidence of TC and the reported areas of radioactive contamination after the Chernobyl accident. In total, 8.8% of patients had secondary TC after initial radiotherapy of a primary oncologic disease. Conclusion: The incidence of TC in the Lithuanian paediatric population between 1980 and 2014 ranged from 0 to 0.93 cases per 100,000 children per year and there was a 5.26% annual increase (p < 0.001), most probably related to the increased use of ultrasound testing.

Descriptive study of mandibular canal visibility: morphometric and densitometric analysis for digital panoramic radiographs

OBJECTIVES To assess the visibility of the mandibular canal (MC) morphology in different jaw dental segments (JDSs) in relation to morphometric and densitometric parameters on digital panoramic radiographs (DPRs). METHODS 32 DPRs (155 JDSs) were selected randomly after retrieval. MC visibility in conjunction with superior and inferior border visibility was scored on a 5-point scale in four places on the JDS-that is, for the medial, distal, superior and inferior MC parts. Morphometric and densitometric analyses were made horizontally and vertically in the JDS region. Descriptive statistics, Fishers exact test, Mann-Whitney U test and additional tests were performed. RESULTS There was no significant difference in MC visibility for the superior, inferior, medial and distal parts of the JDSs. Statistically significant (p < 0.05) differences were identified between particular visibility scores of the superior and inferior MC borders. In 22.0-24.7% of JDSs, the superior MC border was not visible, more than twice as often as the inferior MC border was not visible (9.1-10.2%). The visibility of superior and inferior MC borders in JDSs was not related to the morphometric or densitometric assessment parameters, or to age, gender, JDS location, condition or the visibility of neighbouring MC parts or contralateral JDSs. CONCLUSIONS DPRs failed to provide MC visibility based on a single factor. Particular differences were identified between the levels of visibility of the superior and inferior MC borders. More advanced radiological investigation methods could be required for the evaluation of about 25% of JDSs when superior MC border identification is obligatory.

Comparison of the Ponseti method versus early tibialis anterior tendon transfer for idiopathic clubfoot: A prospective randomized study.

OBJECTIVE The aim of the study was to compare functional and radiological outcomes in clubfoot patients treated by early Tibialis anterior tendon transfer and Ponseti method. MATERIALS AND METHODS A prospective, randomized study was conducted. A total of 39 children with a mean age of 17.05 days (55 clubfeet) were randomly allocated into one of two groups: first (conservative Ponseti method) group (n=28) or second (early tibialis anterior tendon transfer [TATT]) group (n=27). Foot function and radiographic measurements were evaluated. The condition of the subjects was observed until they reached the age of 2 years. RESULTS The clinical and radiological data did not differ between groups at the age of 6 months. No statistically significant difference regarding Pirani and Dimeglio scale among the groups was observed at the last follow-up. A statistically significant difference was observed in the foot dorsal flexion; it was lower in the second group (P=0.03). Other clinical parameters did not differ between groups. According radiographic data, only the talocalcaneal angle (TCA) was significantly higher in the second group (P=0.003). Children who underwent TATT were 5.00-fold (P=0.002) and 1.67-fold (P=0.017) more likely to have TCA larger than 30° (which reflects the normal range of the TCA) in DP and lateral views, respectively, and 3.40-fold (P=0.019) more likely to have foot dorsal flexion of less than 15° than their counterparts undergoing the conservative Ponseti treatment. CONCLUSIONS Early TATT allowed a significant reduction in the brace wear duration and resulted in the same outcomes as using the Ponseti method. Additionally, TATT can provide some improvement of hindfoot varus. However, a possible weakening of dorsiflexion should be also taken into account. Our experience has shown the need for a larger sample and longer term studies.

Relationship between the mandibular cortical index and calcaneal bone mineral density in postmenopausal women

BACKGROUND AND OBJECTIVE In clinical practice, a comparative analysis of bone mineral density (BMD) is carried out by examining different skeletal bones. This is useful for screening of postmenopausal osteoporosis (OP). The objective of this study was to determine the relation between the mandibular cortical index (MCI) and calcaneal BMD among postmenopausal women. MATERIALS AND METHODS The study sample included 129 randomly selected postmenopausal women aged 50-77 years. The participants were examined using panoramic radiography for the analysis of the cortical layer in the mandibular base for MCI determination and using DXL for the examination of calcaneal BMD. According to T scores, the subjects were divided into three groups (Groups 1, 2, and 3). The panoramic radiographic examination of the mandible was performed; the MCI was determined and distributed into groups (C1; C2; C3). The MCI validity in determining the calcaneus BMD status was analyzed. RESULTS The differences in BMD were statistically significant between Groups C1 and C3 (P<0.01), Groups C2 and C3 (P=0.01), and between the calcaneal BMD groups (P<0.001). There was a statistically significant inverse correlation between the MCI and calcaneal BMD (r=-0.3; P<0.001). The changes characteristic of Group C2 were documented more frequently than those of other morphological groups. The analysis of the MCI validity in BMD status showed low sensitivity (69.4%) and specificity (53.9%). CONCLUSIONS The relation between MCI and calcaneal BMD was determined. The diagnostic discrimination of the MCI was found to be not sufficient in screening the women with postmenopausal osteoporosis and its application in clinical practice might be limited.