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Introduction. Radiotherapy (RT) for head and neck cancer (HNC) is associated with acute neu- rotoxic and functional sequelae affecting peripheral nerves, mucosal sensory pathways, speech, and swallowing mechanisms. Many of these symptoms remain under-recognised in oncological practice. Patient-reported outcome measures (PROMs) enable systematic identification of early neurological and functional impairments that emerge during treatment. Methods. A prospective observational study was conducted at the Lithuanian University of Health Sciences Oncology Hospital. Adult HNC patients undergoing active RT completed the EORTC QLQ-C30 and the head and neck–specific module (QLQ-H&N35). Clinically relevant symptom burden was defined as Likert-scale responses of 3 or higher. Descriptive statistics were used to determine the prevalence of functional, neurological, and psychological impairments. Results. Interim analysis included 20 patients (15% female, 85% male). The mean age was 60.5 ± 3.4 years for females and 64.8 ± 7.3 years for males. Clinically relevant emotional dys- function was reported by 41% of patients, and physical impairment by 40%. The most prevalent systemic symptoms were insomnia (60%), pain (57.5%), and fatigue (51.7%). Neurologically ori- ented impairments were frequent: chewing difficulties (55%), sticky saliva (50%), neuropathic pain (46.3%), speech disturbances (46%), coughing (45%), and xerostomia (45%). Sensory dis- turbances were less common (20%). Females tended to report a higher symptom burden across several domains, although the sample size was limited. Conclusions. Active radiotherapy for head and neck cancer is associated with a substantial early neurological and functional symptom burden. Structured integration of patient-reported outcome measures may enhance detection of treatment-related neurofunctional toxicity and support proactive multidisciplinary management within radiotherapy workflows.

Introduction. Delirium is an acute disturbance of brain function, characterized by confusion, disorientation and hallucinations. In clinical practice, it is more common in older people and often becomes apparent at night. Risk increases when predisposing factors are present, such as cerebrovascular disease (CeVD) and anemia. It is often triggered by precipitating factors, such as medications, hospitalization, drug interactions. Methods. A clinical case involving an 85-year-old woman is presented. Data were obtained from medical records and inpatient treatment. Medications were reviewed for potential interac- tions and their link to the observed neuropsychiatric symptoms. Results. The patient had chronic anemia and a history of CeVD. After a fall, back pain devel- oped. Tramadol was prescribed for persistent pain. She was also taking: amitriptyline, duloxetine, cabamazepine, bromazepam. After starting tramadol, she developed disorientation, drowsiness and incoherent speech. When tramadol is combined with amitriptyline or duloxetine, it may in- crease adverse drug reactions. On admission, ketoprofen was prescribed for pain control. During the treatment course, fluctuating neuropsychiatric symptoms appeared. At night, she talked to herself, was disoriented and had visual hallucinations. By day, she was oriented and appropriate, but did not recall the night episodes. Given the acute onset, symptomatic treatment with tiapride was initiated, as it is often well tolerated in geriatric patients. Night-time agitation decreased and the hallucinatory symptoms resolved. The patient was discharged home with continuation of the prescribed treatment. Conclusions. This case shows geriatric delirium in a patient with polypharmacy, older age, anemia and a history of CeVD. A newly prescribed opioid likely triggered acute confusion, diso- rientation and visual hallucinations. A neuroleptic reduced night-time agitation and resolved hallucinations. Long-term prevention requires addressing precipitating factors and reviewing medications.

Introduction. Gorlin syndrome is a hereditary cancer predisposition disorder caused by ger- mline mutations in the Sonic hedgehog (SHH) pathway, most commonly involving SUFU and PTCH1. SUFU mutations confer high risk of early-onset SHH-activated medulloblastoma. Ra- diotherapy is often avoided due to secondary malignancy risk, and characteristic intracranial calcifications may complicate imaging and mimic metastases or relapse. Methods. We report a pediatric case of classic SHH-activated medulloblastoma associated with a germline SUFU mutation. Results. A 16-month-old boy presented with vomiting, ataxia and abducens nerve palsy. Brain MRI revealed a fourth-ventricle tumor causing obstructive hydrocephalus with cerebellar lep- tomeningeal dissemination and bilateral calcifications, some demonstrating contrast enhance- ment; no spinal dissemination was detected. Near-total resection was performed. Histopathology confirmed classic medulloblastoma, SHH-activated, TP53 wildtype. Genetic testing identified a SUFU mutation. The patient received three induction and two maintenance chemotherapy courses. Treatment was complicated by myelosuppression and febrile neutropenia requiring an- timicrobial therapy and transfusions. Subsequently, focal seizures and unilateral weakness de- veloped. MRI showed progressive white matter changes consistent with posterior reversible en- cephalopathy syndrome (PRES) and calcified lesions. EEG was normal, carbamazepine was initi- ated. Given lesion distribution, temporal evolution, and the underlying SUFU mutation, imaging findings were interpreted as mutation-associated and treatment-related rather than relapse. The patient remains under surveillance without recurrence; his condition has improved. Conclusions. In SUFU-associated Gorlin syndrome, intracranial calcifications and PRES may mimic medulloblastoma relapse. Accurate interpretation requires integration of genetic back- ground, clinical course, and multidisciplinary imaging review to avoid overtreatment.

Introduction. In Lithuania, the relationship between academic anxiety and social support among 11th–12th grade students remain insufficiently studied. Aim. To analyze the relationship between academic anxiety and perceived social support. Methods. The study involved 422 respondents (response rate 86%). Of these, 46% (n=194) were boys and 56% (n=228) were girls, with a mean age of 17.4 years (SD=0.56). A quantitative method was used – an anonymous questionnaire. Academic anxiety was assessed using the Academic Anxiety Scale (11 items), and social support was measured using HBSC subscales (14 items). Added sociodemographic questions were created by the authors. The study was conducted during class in schools from Kaunas, Marijampolė, and Panevėžys. Results. It was found that 40% of students experienced average or above-average academic anxiety. Girls and younger students reported significantly higher anxiety (p<0.001; p<0.001, respectively). It was found that most students received the greatest support from classmates and the least from teachers. Girls received the most support from friends and classmates (p<0.001; p<0.001, respectively). Older students reported more support from friends, family, and teachers mokytojų (p<0,001; p=0,010; p=0,002, respectively), while classmate support did not differ between age groups. The results revealed a statistically significant association between perceived social support and academic anxiety. Students who felt greater support from teachers and classmates experienced higher academic anxiety (p<0.001). Conversely, support from family and friends was negatively associated with anxiety (p<0.05). This means that students who felt greater support from family and friends experienced lower academic anxiety. Conclusions. Higher academic anxiety was characteristic of girls and younger students. Sources of social support varied according to age and gender: girls typically received support from classmates and friends, while older students received support from family, teachers, and friends. Support from teachers and classmates was associated with higher academic anxiety, while greater support from family and friends was associated with lower levels of anxiety.

Introduction. Scientific literature indicates that for women, engaging in sexual activity out of a sense of obligation may be associated with lower relationship satisfaction (RS). Research on sexual motives has primarily focused on student samples, while studies on relationship satisfaction often involve married couples. Therefore, it remains unclear how different sexual motivations (SM) relate to relationship satisfaction across genders and age groups. Aim. To examine the associations between sexual motives and relationship satisfaction. Methods. The study included participants aged 18 to 50 (n = 205) who had been in a romantic relationship for at least one year (regardless of whether they were cohabiting, married, or not living with their partner). The research was conducted via publicspace surveying across Lithuania. Data were collected through an anonymous questionnaire comprising the CSI scale (to measure relationship satisfaction), the SexMS scale (to assess sexual motives), and questions about socio-demographic variables. Data analysis was conducted using both univariate and bivariate methods. Results. Among participants aged 18–30, no significant associations between sexual motives and relationship satisfaction were observed (p > 0.05). However, among women aged 31–50, lower satisfaction was associated with External sexual motives or Amotivation, while higher satisfaction was associated with Intrinsic sexual motives (p < 0.05). In the same age group, men reported lower satisfaction when more strongly endorsing Introjected motives, and higher satisfaction when more strongly endorsing Identified, Intrinsic, or Integrated sexual motives (p < 0.05). Conclusions. Autonomous sexual motives (Intrinsic, Identified, Integrated) are associated with higher relationship satisfaction, while non-autonomous motives (External, Introjected, Amotivation) are associated with lower satisfaction. However, these associations were observed only within the 31–50 age group.

Miastenija (lot. myasthenia gravis, MG) – tai autoimuninė liga, kuri pažeidžia nervo ir raumens jungtį, o dėl to atsiranda patologinis raumens nuovargis. Pagrindinis ligos simptomas – raumenų nuovargis, kuris yra ryškesnis pavargus, taip pat gali būti labiau pastebimas antroje dienos pusėje. Liga gali pažeisti veido arba visus kūno raumenis. Pastaraisiais metais ligos paplitimas ir sergamumas ja labai išaugo, todėl vis daugiau dėmesio skiriama ligos simptomus ūminančių veiksnių išaiškinimui ir jų poveikio mažinimui. Nėštumas gali būti vienas tokių veiksnių – jo metu miastenijos simptomai gali blogėti, ypač pirmąjį trimestrą ir (ar) po gimdymo, nepaisant ligos eigos sunkumo. Miastenijos simptomų pablogėjimą taip pat gali išprovokuoti tam tikrų vaistų, tokių kaip antibiotikai (pvz., azitromicinas, aminoglikozidai, fluorochinolonai) vartojimas. Kardiologijoje vartojami vaistai, kaip antai beta adrenoblokatoriai, taip pat gali turėti neigiamą poveikį. Be to, miastenija sergantiems pacientams nerekomenduojama vartoti magnio preparatų, nes jie gali sutrikdyti impulso perdavimą neuroraumeninėje jungtyje. Imunoterapija, naudojant imuninės kontrolės patikros taškų inhibitorius gydant onkologines ligas, taip pat gali sukelti miastenijos paūmėjimų. Svarbu paminėti, kad botulino toksinas, kuris yra naudojamas estetinėse procedūrose, taip pat sukelia raumenų silpnumą. Miastenijos simptomų pablogėjimą gali išprovokuoti ir daugelis kitų faktorių: padidėjusi kūno temperatūra, depresija, kvėpavimo sistemos infekcijos, nemiga. Taigi nėštumas, medikamentai, šiluma, skydliaukės ligos, depresija, infekcijos, nemiga – visi šie veiksniai miastenija sergantiems pacientams turi būti vertinami ir, jei galima, kontroliuojami, siekiant užtikrinti geresnę jų gyvenimo kokybę, lengvesnę ligos eigą. Šiame straipsnyje apžvelgiami literatūros duomenys apie miasteniją ūminančius veiksnius.

Joint hypermobility is a condition in which one or more joints move beyond their normal range of motion. If joint hypermobility is accompanied by pain, recurrent subluxations and musculoskeletal overload injuries, such joint hypermobility may be classified as symptomatic. Increased joint mobility has been associated with spinal and peripheral joint pain and postural disturbances, flatfoot or impaired proprioception, balance and coordination. There is growing evidence of a high prevalence of psychiatric disorders, including anxiety disorders, depression and neurodevelopmental disorders such as attention deficit hyperactivity disorder, as well as other clinical manifestations associated with joint hypermobility, in cases of syndromic joint hypermobility. The aim of this systematic review was to determine whether there is an association between joint hypermobility and anxiety. This systematic review is based on the PRISMA guidelines. PubMed, EBSCO, Cochrane Library, ClinicalTrials.gov, MedlinePlus and UpToDate databases were searched for research articles. Key search terms were “joint hypermobility” and “anxiety”. The search was conducted between 1 and 20 May 2025. After applying the inclusion/exclusion criteria, the number of studies finally included in the review was 16. All of the studies reviewed found a statistically significant association between joint hypermobility and anxiety. All analyzed studies have found a relationship between anxiety symptomatology and joint hypermobility therefore, it can be concluded that individuals with joint hypermobility are at an increased risk for developing anxiety disorders. Children, adolescents, and adults with joint hypermobility may all exhibit vulnerability to anxiety. Both generalized joint hypermobility and syndromic forms of joint hypermobility are associated with an increased predisposition to anxiety.

Charcot-Marie-Tooth (CMT) liga – genetinė nervų sistemos liga, sukelianti periferinių nervų pažeidimus, dėl kurių sutrikdoma raumenų jėga ir jutimo funkcijos [1]. Šiai ligai būdingi galūnių motorikos ir jutimo sutrikimai bei pėdos deformacijos, dažniausia – pes cavus [2]. Sergant CMT liga, dėl amiotrofijos raumenys negeba stabilizuoti sąnarių, todėl vystosi deformacijos, netaisyklinga padėtis sukelia netinkamą apkrovą, greitesnį kremzlės dėvėjimąsi, artrozę bei equinus, cavus, varus, valgus deformacijas [3]. Specifinio CMT ligos gydymo nėra, todėl taikomas simptominis gydymas ir reabilitacija [4]. Esant sunkioms deformacijoms ir sąnarių artrozei, rekomenduojamos chirurginės intervencijos. Chirurgiškai galima atlikti minkštųjų audinių operacijas, koreguojančias osteotomijas, artrodezes arba čiurnos sąnario artroplastiką [7, 9, 10]. Ankstyva chirurginė intervencija gali sustabdyti deformacijų progresavimą [17]. Šiame straipsnyje aptariami dviejų pacienčių, sergančių CMT liga, atvejai. Pirmajai pacientei išsivystė cavovarus deformacija, paskutinių stadijų čiurnos ir subtalarinio sąnario artrozė abiejose kojose. Chirurginiam gydymui pasirinkta tibiotalokalkaninė (TTC) artrodezė intrameduline vinimi. Antrajai, jaunesnei pacientei, išsivystė cavovarus deformacija, kuri ištaisyta atlikus ankstyvas chirurgines intervencijas: abiejų kulnakaulių ašį koreguojančias osteotomijas, subtalarinių sąnarių artrodezes sraigtais, Achilo sausgyslių ilginimą, pirmų padikaulių uždaro kampo kylines osteotomijas ir kairės kojos lateralinių čiurnos sąnario raiščių plastiką dėl čiurnos sąnario nestabilumo.

Kasos solidinė pseudopapilinė karcinoma (SPN) – reta, mažo piktybiškumo potencialo kasos neoplazma, dažniausiai pasireiškianti jauniems pacientams. Nors liga dažniau diagnozuojama suaugusiesiems, SPN sudaro apie 8–12 proc. visų vaikams nustatomų kasos navikų. Diagnostiką apsunkina tai, kad dažniausiai navikai ilgą laiką nesukelia jokių simptomų, todėl aptinkami jau dideli – 5–7 cm. Be to, daliai sergančiųjų gali pasireikšti nespecifiniai simptomai, kurie taip pat gali komplikuoti diagnostinį procesą. Pirmojo pasirinkimo gydymas – kasos rezekcinė operacija, kurios metu radikaliai pašalinamas navikas. Ilgalaikė SPN prognozė įprastai gera, tačiau pooperaciniu laikotarpiu dažnai išsivysto kasos fistulė, kuriai gydyti gali reikėti antibiotikų terapijos ir parapankreatinio skysčio sankaupų drenavimo. Straipsnyje pristatomas klinikinis atvejis, kai 15 m. mergaitei atsitiktinai diagnozuota kasos solidinė pseudopapilinė karcinoma, lokalizuota kasos uodegoje, ir atlikta formali kasos rezekcija. Aptariama atidaus paciento stebėjimo pooperaciniu laikotarpiu svarba, galimos pooperacinių komplikacijų priežastys.