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Siupsinskiene N.,Klaipeda University | Siupsinskiene N.,Kaunas Medical University Hospital | Lycke H.,University of Sfax
Journal of Voice | Year: 2011

Objectives: This prospective cross-sectional study examines the effects of voice training on vocal capabilities in vocally healthy age and gender differentiated groups measured by voice range profile (VRP) and speech range profile (SRP). Methods: Frequency and intensity measurements of the VRP and SRP using standard singing and speaking voice protocols were derived from 161 trained choir singers (21 males, 59 females, and 81 prepubescent children) and from 188 nonsingers (38 males, 89 females, and 61 children). Results: When compared with nonsingers, both genders of trained adult and child singers exhibited increased mean pitch range, highest frequency, and VRP area in high frequencies (P < 0.05). Female singers and child singers also showed significantly increased mean maximum voice intensity, intensity range, and total VRP area. The logistic regression analysis showed that VRP pitch range, highest frequency, maximum voice intensity, and maximum-minimum intensity range, and SRP slope of speaking curve were the key predictors of voice training. Age, gender, and voice training differentiated norms of VRP and SRP parameters are presented. Conclusions: Significant positive effect of voice training on vocal capabilities, mostly singing voice, was confirmed. The presented norms for trained singers, with key parameters differentiated by gender and age, are suggested for clinical practice of otolaryngologists and speech-language pathologists. © 2011 The Voice Foundation.


Kadusevicius E.,Kaunas Medical University | Kadusevicius E.,Kaunas Medical University Hospital | Kildonaviciute G.,Kaunas Medical University | Kildonaviciute G.,Quintiles | And 2 more authors.
International Journal of Technology Assessment in Health Care | Year: 2010

Objectives: The aim of this study was to compare efficacy, safety, and consumption of low-molecular-weight heparins with unfractionated heparin, and to develop a pharmacoeconomic decision model based on meta-analysis data. Methods: Review and meta-analysis were performed of published randomized control trials directly comparing the safety and efficacy of low-molecular-weight heparins (LMWHs)that is, nadroparin, enoxaparin, and dalteparinand unfractionated heparin (UFH) was performed by two reviewers using inclusion/exclusion criteria based on the research objectives. The value of fixed effects and random effects odds ratio (95 percent confidence interval) was calculated for each trial for the composite end point. Subsequently, a pharmacoeconomic decision modeling based on reference pricing methodology was implemented. Results: In comparison to UFH, all LMWHs have independently demonstrated greater safety and effectiveness. None of the LMWHs demonstrated a significant superiority over each other; therefore, the group of LMWHs was interchangeable and suitable for cost minimization analysis and reference price implementation. Being the least expensive option, dalteparin single DDD price was set as the reference. Introduction of reference pricing for LMWHs would decrease the total expenditure on LMWHs of approximately 30 percent and would result in total savings of 1.830-2.070 thousand LTL in the country of Lithuania (approximately 0.8 million USD) per year. Conclusions: The meta-analysis results of LMWHs could be used to support a policy on reference-based pricing and pharmacoeconomic decision modeling in healthcare institutions, which would allow a decrease in healthcare expenditures. Copyright © Cambridge University Press 2010.


Baranauskaite A.,Kaunas Medical University Hospital | Raffayova H.,National Institute for Rheumatology Diseases | Kungurov N.V.,Urals Dermatovenereology Institute | Kubanova A.,Central DermatoVenereology Institute | And 36 more authors.
Annals of the Rheumatic Diseases | Year: 2012

Objective: To compare the efficacy and safety of treatment with infliximab plus methotrexate with methotrexate alone in methotrexate-naive patients with active psoriatic arthritis (PsA). Methods: In this open-label study, patients 18 years and older with active PsA who were naive to methotrexate and not receiving disease-modifying therapy (N=115) were randomly assigned (1:1) to receive either infliximab (5 mg/kg) at weeks 0, 2, 6 and 14 plus methotrexate (15 mg/week); or methotrexate (15 mg/week) alone. The primary assessment was American College of Rheumatology (ACR) 20 response at week 16. Secondary outcome measures included psoriasis area and severity index (PASI), disease activity score in 28 joints (DAS28) and dactylitis and enthesitis assessments. Results: At week 16, 86.3% of patients receiving infliximab plus methotrexate and 66.7% of those receiving methotrexate alone achieved an ACR20 response (p<0.02). Of patients whose baseline PASI was 2.5 or greater, 97.1% receiving infliximab plus methotrexate compared with 54.3% receiving methotrexate alone experienced a 75% or greater improvement in PASI (p<0.0001). Improvements in C-reactive protein levels, DAS28 response and remission rates, dactylitis, fatigue and morning stiffness duration were also significantly greater in the group receiving infliximab. In the infliximab plus methotrexate group, 46% (26/57) had treatment-related adverse events (AE) and two patients had serious AE, compared with 24% with AE (13/54) and no serious AE in the methotrexate-alone group. Conclusions: Treatment with infliximab plus methotrexate in methotrexate-naive patients with active PsA demonstrated significantly greater ACR20 response rates and PASI75 improvement compared with methotrexate alone and was generally well tolerated. This trial is registered in the US National Institutes of Health clinicaltrials.gov database, identifier NCT00367237.


Bandinelli F.,University of Florence | Bijlsma J.W.J.,University Utrecht | Ramiro M.S.,Hospital Garcia Of Orta | Elfving P.,Kuopio University Hospital | And 8 more authors.
Clinical and Experimental Rheumatology | Year: 2011

Objective. To evaluate the level of education and participation in an internship abroad and to European league against rheumatism (EULAR) on line course of young rheumatologists. To define new tools for learning. Methods. Questionnaires were administered to 170 trainees and young specialists in 2008-2009 during official EULAR meetings or using the mailing list of European young rheumatologists in training. The questions with related visual analogical scale (VAS score 0-10) for satisfaction encompassed the following issues: languages, computer, daily hours employed, different items of medical culture, internship abroad, EULAR on-line course and bursaries. VAS>6 was considered a good level of satisfaction. Results. 770 young rheumatologists (113 trainees and 57specialists, 33±4.2 years old) from 32 EULAR countries did not approve their own national training (42.3%), believed in an European common education system (90.5%), had a good knowledge of English (85.7%) and computer (90.5%) and spent the majority of time in clinical practice (57.5%) in comparison with study and research. The young rheumatologists had higher competence in drug management (93.5%) than in clinical assessment and knowledge of imaging and anatomy, and mostly suggested new ways of communication (61.4% on-line courses and 66.1% DVD) to improve their education. 38% made stage abroad and participated to EULAR on-line course, with high satisfaction, but only half of them were granted by bursaries. Conclusion. Young rheumatologists are low in confidence in their own education and believe that visits to other training centers and new ways of learning (on line and DVD) might improve their competence. © Copyright CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2011.


Mosca M.,University of Pisa | Govoni M.,University of Ferrara | Tomietto P.,University of Udine | Aringer M.,TU Dresden | And 28 more authors.
Lupus | Year: 2011

Aim: The creation of a physician-administered questionnaire to screen patients with Systemic Lupus Erythematosus (SLE) for the presence of symptoms suggestive of neuropsychiatric involvement (NPSLE). Methods: The development of the questionnaire followed three phases. First, a list of manifestations was prepared based on the ACR case definitions for NPSLE. A first questionnaire was constructed including 119 items. To reduce their number, a Delphi analysis was carried out and a second questionnaire with 62 questions was developed. This questionnaire was administered to 139 patients with SLE (58 with NPSLE: 29 active, 29 inactive; and 81 without NPSLE: 39 active, 42 inactive). Questions relevant to the screening of patients were selected on the basis of the receiver operating characteristic (ROC) curve analysis. Results: Twenty-seven questions concerning central nervous system and psychiatric manifestations were found to be relevant; the remaining could be eliminated without significantly affecting AUC. The area under the ROC curve (AUC) was 0.69 (95% CI 0.61-0.78). A score above 17 was considered as suggestive of the presence of NPSLE with a sensitivity of 92.9% (95% CI 85.1-97.3 %) and specificity of 25.4% (95% CI 14.7-39.00 %). Conclusions: This questionnaire could represent a 'core set' of questions that could help in clinical practice to identify patients with neuropsychiatric symptoms requiring further evaluation. © The Author(s), 2011.


Krauss G.,Johns Hopkins Hospital | Ben-Menachem E.,Sahlgrenska University Hospital | Mameniskiene R.,Vilnius University | Vaiciene-Magistris N.,Kaunas Medical University Hospital | And 3 more authors.
Epilepsia | Year: 2010

Purpose: Lacosamide is a new antiepileptic drug effective for adjunctive treatment of partial-onset seizures. We evaluated the safety and tolerability of an intravenous (i.v.) formulation of lacosamide (200-800 mg/day) infused over 10, 15, and 30 min as short-term replacement for oral lacosamide in patients with partial-onset seizures. Methods: This multicenter, open-label, inpatient trial enrolled 160 patients from ongoing open-label, long-term trials who were taking stable doses of oral lacosamide and up to three concomitant antiepileptic drugs (AEDs). Serial cohorts of patients were converted from oral lacosamide treatment to the same intravenous doses infused over progressively shorter infusion durations: 30, 15, and 10 min for 2-5 days. A data monitoring committee (DMC) reviewed safety data for each cohort. The safety of intravenous lacosamide was assessed from adverse events (AEs), laboratory variables, electrocardiography findings, and physical/neurologic examinations. Results: A total of 160 patients received lacosamide 200-800 mg/day, i.v., for 2-5 days, of which 69% received 400-800 mg/day doses. The most common AEs (reported by ≤10% of patients) were headache, dizziness, and somnolence. There was no increase in frequency or severity of AEs with shorter durations of infusion or increased days of exposure. AEs were similar, but more frequent, with higher doses (≥400 mg/day). Injection-site events were rare and did not appear to be linked to infusion doses or rates. Lacosamide plasma concentrations were linearly related to dose across the cohorts. Discussion: This comprehensive evaluation supports the safety of an intravenous lacosamide infusion duration as short as 15 min for short-term (2-5 days) replacement for patients temporarily unable to take oral lacosamide. © 2009 International League Against Epilepsy.


Baranauskaite A.,Kaunas Medical University Hospital | Raffayova H.,National Institute for Rheumatology Diseases | Kungurov N.V.,Urals Dermatovenereology Institute | Kubanova A.,Central DermatoVenereology Institute | And 5 more authors.
Annals of the Rheumatic Diseases | Year: 2011

Objective: To compare the efficacy and safety of treatment with infliximab plus methotrexate with methotrexate alone in methotrexate-naive patients with active psoriatic arthritis (PsA). Methods: In this open-label study, patients 18 years and older with active PsA who were naive to methotrexate and not receiving disease-modifying therapy (N=115) were randomly assigned (1:1) to receive either infliximab (5 mg/kg) at weeks 0, 2, 6 and 14 plus methotrexate (15 mg/week); or methotrexate (15 mg/week) alone. The primary assessment was American College of Rheumatology (ACR) 20 response at week 16. Secondary outcome measures included psoriasis area and severity index (PASI), disease activity score in 28 joints (DAS28) and dactylitis and enthesitis assessments. Results: At week 16, 86.3% of patients receiving infliximab plus methotrexate and 66.7% of those receiving methotrexate alone achieved an ACR20 response (p<0.02). Of patients whose baseline PASI was 2.5 or greater, 97.1% receiving infliximab plus methotrexate compared with 54.3% receiving methotrexate alone experienced a 75% or greater improvement in PASI (p<0.0001). Improvements in C-reactive protein levels, DAS28 response and remission rates, dactylitis, fatigue and morning stiffness duration were also significantly greater in the group receiving infliximab. In the infliximab plus methotrexate group, 46% (26/57) had treatment-related adverse events (AE) and two patients had serious AE, compared with 24% with AE (13/54) and no serious AE in the methotrexate-alone group. Conclusions: Treatment with infliximab plus methotrexate in methotrexate-naive patients with active PsA demonstrated significantly greater ACR20 response rates and PASI75 improvement compared with methotrexate alone and was generally well tolerated. This trial is registered in the US National Institutes of Health clinicaltrials.gov database, identifier NCT00367237. Copyright Article author (or their employer) 2011.


Adliene D.,Kaunas University of Technology | Cibulskaite I.,Kaunas University of Technology | Cibulskaite I.,Kaunas Medical University Hospital | Laurikaitiene J.,Kaunas University of Technology | And 2 more authors.
Radiation Protection Dosimetry | Year: 2010

The entrance surface dose (ESD) (skin dose) and its variation due to overlapping radiation fields at mammography have been experimentally investigated on patients during two-view mammography screening examinations of both breasts and on phantoms of silicon gel. Measurements were done using multiple thermoluminescence dosemeters for mapping the variations in absorbed dose at the surface of the breast phantoms. It was found that the total resulting skin dose at the reference point on the breast surface, described in the European Protocol [Zoetelief, Fitzgerald, Leitz and Sabel (European protocol on dosimetry in mammography. EUR 16263 (Luxemburg: EC), 1996)] after multiple exposure of patient's breasts during two-view, four exposures mammography screening examinations is approximately 50 % higher as compared with the skin dose at the same point measured during one single (CC) exposure. The dose distributions on the breast phantom surface were non-uniform and indicated areas of higher doses, which were related to the regions of the superimposed fields on the surface during the examinations. The dosimetric importance of the superposition of X-ray fields on the ESD is discussed. © The Author 2010. Published by Oxford University Press.


Ramanauskiene K.,Lithuanian University of Health Sciences | Zilius M.,Lithuanian University of Health Sciences | Kancauskas M.,Lithuanian University of Health Sciences | Juskaite V.,Lithuanian University of Health Sciences | And 5 more authors.
Acta Poloniae Pharmaceutica - Drug Research | Year: 2016

Scientific literature provides a great deal of studies supporting antioxidant effects of rosemary, protecting the bodyis cells against reactive oxygen species and their negative impact. Ethanol rosemary extracts were produced by maceration method. To assess biological activity of rosemary extracts, antioxidant and antimicrobial activity tests were performed. Antimicrobial activity tests revealed that G+ microorganisms are most sensitive to liquid rosemary extract, while G- microorganisms are most resistant to it. For the purposes of experimenting, five types of semisolid systems were modeled: hydrogel, oleogel, absorption-hydrophobic ointment, oil-in-water-type cream and water-in-oil-type cream, which contained rosemary extract as an active ingredient. Study results show that liquid rosemary extract was distributed evenly in the aqueous phase of water-in-oil-type system, forming the stable emulsion systems. The following research aim was chosen to evaluate the semisolid systems with rosemary exctract: to model semisolid preparations with liquid rosemary extract and determine the influence of excipients on their quality, and perform in vitro study of the release of active ingredients and antimicrobial activity. It was found that oil-in-water type gel-cream has antimicrobial activity against Staphylococcus epidermidis bacteria and Candida albicans fungus, while hydrogel affected only Candida albicans. According to the results of biopharmaceutical study, modeled semisolid systems with rosemary extract can be arranged in an ascending order of the release of phenolic compounds from the forms: waterin- oil-type cream < absorption-hydrophobic ointment < Pionier PLW oleogel < oil-in-water-type eucerin cream < hydrogel < oil-in-water-type gel-cream. Study results showed that oil-in-water-type gel-cream is the most suitable vehicle for liquid rosemary extract used as an active ingredient.


PubMed | Kaunas Medical University Hospital
Type: Clinical Trial, Phase III | Journal: Annals of the rheumatic diseases | Year: 2012

To compare the efficacy and safety of treatment with infliximab plus methotrexate with methotrexate alone in methotrexate-naive patients with active psoriatic arthritis (PsA).In this open-label study, patients 18 years and older with active PsA who were naive to methotrexate and not receiving disease-modifying therapy (N=115) were randomly assigned (1:1) to receive either infliximab (5 mg/kg) at weeks 0, 2, 6 and 14 plus methotrexate (15 mg/week); or methotrexate (15 mg/week) alone. The primary assessment was American College of Rheumatology (ACR) 20 response at week 16. Secondary outcome measures included psoriasis area and severity index (PASI), disease activity score in 28 joints (DAS28) and dactylitis and enthesitis assessments.At week 16, 86.3% of patients receiving infliximab plus methotrexate and 66.7% of those receiving methotrexate alone achieved an ACR20 response (p<0.02). Of patients whose baseline PASI was 2.5 or greater, 97.1% receiving infliximab plus methotrexate compared with 54.3% receiving methotrexate alone experienced a 75% or greater improvement in PASI (p<0.0001). Improvements in C-reactive protein levels, DAS28 response and remission rates, dactylitis, fatigue and morning stiffness duration were also significantly greater in the group receiving infliximab. In the infliximab plus methotrexate group, 46% (26/57) had treatment-related adverse events (AE) and two patients had serious AE, compared with 24% with AE (13/54) and no serious AE in the methotrexate-alone group.Treatment with infliximab plus methotrexate in methotrexate-naive patients with active PsA demonstrated significantly greater ACR20 response rates and PASI75 improvement compared with methotrexate alone and was generally well tolerated. This trial is registered in the US National Institutes of Health clinicaltrials.gov database, identifier NCT00367237.

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