MF Laboratorinės medicinos klinika (04.25)

Nauja Lietuvos sveikatos mokslų universiteto mokomoji knyga „Laboratorinės medicinos pagrindai“ parengta LSMU MA MF Laboratorinės medicinos klinikoje dirbančių autorių kolektyvo. Šis leidinys reikalingas ir svarbus visiems savo veikloje susiduriantiems su laboratoriniu darbu. Knyga skirta tiksliniams skaitytojams - II pakopos Laboratorinės medicinos biologijos studijų programos studentams, laboratorinės medicinos gydytojams rezidentams, taip pat pirmos pakopos studijų programų - Medicininės ir veterinarinės biochemijos bei Medicininės ir veterinarinės genetikos - studentams, tačiau tikimės, kad ji galėtų būti naudinga ir mokslo tiriamuosius darbus vykdantiems įvairių studijų programų studentams. Naudingos informacijos šioje knygoje ras ir studijas jau baigę specialistai - medicinos biologai, laboratorinės medicinos gydytojai. Laboratorinio tyrimo atlikimas tiek medicinos, tiek ir ne medicinos laboratorijose neapsiriboja vien tik techniniu mechaniniu darbu, todėl laboratorijos darbo reglamentavimo, metrologijos ir standartizacijos, laboratorijose naudojamų prietaisų ir priemonių, tarp jų ir matavimo priemonių, pasirinkimo ir naudojimo, gauto rezultato vertinimo išmanymas neabejotinai prisidės prie atliekamų tyrimų patikimumo. Rengdami knygą rėmėmės ir glaustai pateikėme akademinių ir techninių šaltinių, taip pat aktualių teisės aktų informaciją, kuri padės suprasti ir sėkmingai taikyti praktikoje pagrindinius laboratorinio darbo principus, spręsti įvairias laboratorinės diagnostikos problemas.

Tikslas. Įvertinti imuninio atsako, susijusio su periferinio kraujo vienbranduolėmis ląstelėmis (PKVL), pokyčius po chirurginio kiaušidžių vėžio (KV) gydymo. Metodai. Atliktas perspektyvusis stebimasis tyrimas, į kurį įtrauktos 23 pacientės, sergančios III-IV stadijos КV ir kurioms atlikta citoredukcinė operacija, ir 23 kontrolinės grupės moterys. Tirta periferinio kraujo ląstelių sudėtis, PKVL subpopuliacijos, jų funkcinis aktyvumas, citokinų raiška PKVL ir jų kiekis serume. Rezultatai. KV sergančioms pacientėms prieš operaciją nustatytas sumažėjęs CD8+ T ląstelių kiekis, padidėjusi М2 monocitų dalis ir pakitusi citokinų raiška. Ankstyvuoju laikotarpiu po operacijos šie imuninės sistemos slopinimo požymiai išliko, be to, sumažėjo PKVL metabolinis aktyvumas ir fagocitozė bei padidėjo IL-6 kiekis serume. Išvados. KV sergančių pacienčių imuninės sistemos pokyčiai rodo galimą priešnavikinio imuniteto slopinimą, kuris išlieka ankstyvuoju laikotarpiu po operacijos.

Bronchoscopic cryotherapy is routinely used for endobronchial tumor debulking, but may also exert systemic immunologic effects that could interact with immune checkpoint blockade. We investigated peripheral blood T-cell dynamics following bronchoscopic cryotherapy and subsequent pembrolizumab-based first-line therapy in metastatic non-small-cell lung cancer (NSCLC). In this prospective, randomized, controlled single-center study, patients with metastatic NSCLC were randomized into treatment groups of bronchoscopic cryotherapy performed 7 (±1) days before standard-of-care pembrolizumab (with or without platinum-based chemotherapy) or to standard-of-care therapy alone. Peripheral blood mononuclear cells were analyzed by flow cytometry at baseline, week 3, and week 6. Radiologic response was assessed using RECIST 1.1. Progression-free survival (PFS) and overall survival (OS) were evaluated using the Kaplan–Meier test and Cox regression. Flow cytometry was performed on 34 cryotherapy and 42 control patients. The cryotherapy group demonstrated a decrease in circulating CD4+ T cells (p = 0.002) and an increase in circulating CD8+ T cells (p = 0.013) by week 6. CD25+FOXP3+CD4+ Tregs decreased from baseline to week 3 (p = 0.024) and remained reduced through week 6. Overall response rate was higher in the cryotherapy group (41.2% vs. 16.7%; p = 0.022), while PFS and OS were numerically longer, although not statistically different (median PFS 9.5 vs. 5.3 months; median OS 17.6 vs. 14.8 months). The decrease in Tregs at week 3 was observed to predict better PFS. In patients with metastatic NSCLC receiving first-line pembrolizumab with or without chemotherapy, the addition of bronchoscopic cryotherapy was associated with a detectable peripheral immune remodeling and a higher objective response rate, whereas PFS and OS were numerically longer but not statistically different.

Several studies have documented reverse zoonotic transmission of SARS-CoV-2, including in farmed mink which are susceptible to human respiratory viruses and are known for serving as a reservoir capable of generating new virus variants in densely populated farms. Here, we present the results of a genomic investigation launched in response to detected human infections with mink-origin SARS-CoV-2 lineages, and show evidence of at least 14 high-confidence introductions of SARS-CoV-2 from humans into farmed mink in Lithuania where sustained transmission in farmed mink lasted up to a year. We estimated the most likely timeframes for these introductions encompassing at least six SARS-CoV-2 lineages, some of which were already extinct in humans, with Bayesian phylogenetic and molecular clock analyses. This study highlights the public health risks posed by fur farms and underscores that passive genomic surveillance systems are ineffective without the active involvement and expertise of responsible institutions.

Community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality, particularly in older adults and patients with chronic co-morbidities. Cytokine patterns and simple hematological indices may improve risk stratification beyond conventional clinical scores. In this prospective single-center study, 41 adults with CAP treated at Kaunas Hospital of Lithuanian University of Health Sciences between November 2024 and March 2025 were enrolled. Clinical data, pneumonia severity index (PSI), complete blood count-derived indices (neutrophil-lymphocyte ratio [NLR], platelet-lymphocyte ratio [PLR], systemic immune-inflammation index [SII]), and serum concentrations of interleukin (IL)-6, IL-8, interferon (IFN)-γ, and G-CSF were obtained on admission (Visit 1) and after 7 days of treatment (Visit 2). Patients were stratified by age (≤65 vs >65 years), co-morbidities, and PSI class. Non-parametric tests and Spearman correlations were applied. The results indicate that patients with co-morbidities and those > 65 years had significantly higher IL-6 levels than younger and non-comorbid patients. IL-6, IFNγ, and G-CSF concentrations were highest at admission and declined by day 7, particularly in PSI Class II patients. Higher PSI classes were associated with increased IL-8, IL-6, and IFNγ. NLR and SII were significantly higher in older patients and in PSI III-IV compared with PSI I-II. IL-6 and G-CSF showed strong positive correlations with NLR and SII, especially in elderly and comorbid patients, whereas PLR displayed weaker and less consistent associations. From these data, it is concluded that in CAP, serum IL-6, IFNγ, and G-CSF reflect age, co-morbidity burden, and disease severity, while NLR and SII closely mirror cytokine-driven systemic inflammation. These readily available indices may serve as cost-effective prognostic markers and, combined with cytokine profiling, could enhance early risk stratification and guide individualized management in CAP.

Background: Transrectal ultrasound-guided prostate biopsy remains the gold standard in diagnosing prostate cancer, but is associated with infectious and non-infectious complications. Increasing fluoroquinolone resistance and regulatory restrictions have prompted evaluation of alternative prophylactic strategies, including fluoroquinolone-sparing agents and targeted prophylaxis. This study compared ciprofloxacin and fosfomycin as empirical prophylactic agents, focusing on microbiological concordance, clinical outcomes, and patient-reported outcomes. Methods: In this prospective observational study, 265 men undergoing transrectal ultrasound-guided prostate biopsy received empirical antibiotic prophylaxis with either ciprofloxacin (n = 146) or fosfomycin trometamol (n = 119). Rectal swabs were obtained prior to biopsy, and antimicrobial susceptibility was analyzed post hoc. Infectious and non-infectious complications were recorded. Lower urinary tract symptoms (IPSS), erectile function (IIEF-5), and patient-reported quality of life were assessed before and after biopsy. Results: Microbiological concordance between administered prophylaxis and rectal flora susceptibility was higher in the ciprofloxacin group than in the fosfomycin group (80.1% vs. 65.0%, p = 0.007), while resistance rates were similar (10.9% vs. 10.2%). Post-biopsy fever occurred in 5.3% of patients, and hospitalization was required in 3.1%, with no significant differences between prophylaxis groups. IPSS increased significantly after biopsy (p < 0.001), while IIEF-5 scores remained unchanged. Patients with microbiological concordance reported significantly better post-biopsy quality of life (p = 0.006). Conclusions: Ciprofloxacin and fosfomycin showed similar safety profiles as empirical prophylaxis before transrectal prostate biopsy. Although ciprofloxacin achieved higher microbiological concordance, fosfomycin remains a viable alternative. The link between microbial concordance and improved patient-reported quality of life underscores the importance of targeted prophylaxis and supports antimicrobial stewardship in prostate cancer diagnostics.

Nutukimas - viena aktualiausių dabartinės visuomenės problemų, neigiamai veikianti daugelį organizmo sistemų ir trikdanti sergančiojo šia liga gyvenimo kokybę, darbingumą bei trumpinanti gyvenimą. Tai - metaboliškai aktyvi ir recidyvuojanti liga, kurios metu kūno masė didėja riebalinio audinio sąskaita. Nutukimą kaip ligą Amerikos medicinos asociacija oficialiai pripažino 2013 metais. Nutukimas pastaruoju metu yra labiausiai aptarinėjama tema tiek medicinos, tiek plačiojoje visuomenėje. Kalbant apie nutukimą, dažnai ši būklė siejama su asmeniniu kaltės priskyrimu: „reikia tik noro“, „reikia suimti save į rankas“ ir t. t. Įvairiais istoriniais laikotarpiais požiūris į žmogaus kūno formas keitėsi nuo Rubenso tipo moterų iki anoreksinių mados manekenių formų. Menamų kūno formų standartų neatitinkantis žmogus gali būti pavadintas putliu, stambiu, apkūniu, didelio dydžio ar net storuliu ar apsileidusiu. Medicinos bendruomenėje vyrauja terminai: antsvoris, hipotalaminis, pilvinis, centrinio tipo, kušingoidinis, morbidinis nutukimas ir kt. Nutukimas turi kompleksines pasekmes - skatina lėtines ligas, galinčias sutrumpinti žmogaus amžių 10-15 metų. Per pastaruosius 5 dešimtmečius nutukimo paplitimas pasaulyje padidėjo daugiau nei 3 kartus, ir dabar tai įvardijama kaip nutukimo pandemija. Klinikinėje praktikoje nustatomos įvairiausios nutukimo priežastys - nuo genetinių (Prader-Willi sindromas, Aistrom sindromas, LEPR (leptino receptoriaus) ar LEP (leptino) geno mutacijos ir kt.), endokrininių (hipotirozė, hiperkorticizmas, hipogonadizmas ir kt.) iki valgymo priklausomybių. Skirtingos yra ir nutukusių kūno formos bei kūno kompozicija. Todėl kūno masės indeksas (KMI) klinikiniu požiūriu jau nebetenka prasmės. KMI tikslinga naudoti populiaciniams, palyginamiesiems tyrimams. Statistiniais duomenimis (HIS Lietuva, Eurostat, 2019-2022 m.), pagal KMI nutukusių suaugusių Lietuvoje buvo 21-23 proc. Skaičiuojama, kad apie 60 proc. suaugusiųjų Lietuvoje turi antsvorio ar yra nutukę. Tai - tik statistika, neatspindinti konkrečios individo būklės. 2025 m. pasaulio 58 ekspertų grupė, atstovaujanti įvairioms medicinos specialybėms ir šalims, išanalizavo turimus įrodymus ir, pritarus 75 medikų ir pacientų organizacijoms, rekomendavo klasifikaciją, kurioje išskiriamas ikiklinikinis ir klinikinis nutukimas. Pagal epidemiologinius ir klinikinius duomenis, nutukimas susijęs su daugiau nei 200 skirtingų ligų ir sveikatos sutrikimų. [...]

Shewanella algae is an emerging marine bacterium capable of causing serious infections in immunocompromised individuals. We report the first documented case in Lithuania of bullous cellulitis caused by S. algae, complicated by necrotizing soft-tissue infection and ultimately requiring leg amputation. To determine whether similar cases had been described earlier in Lithuania, a structured literature review was conducted. We searched PubMed/MEDLINE, Embase, Scopus, Web of Science, and Google Scholar by combining the terms "Shewanella algae," "Shewanella," "Baltic Sea," "wound infection," "necrotizing infection," "sepsis," "case report," and "Lithuania." No date limits were set, and all titles and abstracts were screened. A 74-year-old woman with poorly controlled type 2 diabetes and recent seawater exposure presented with acute right leg pain and skin lesions. Blood and wound cultures confirmed S. algae infection. Despite broad-spectrum antibiotics and intensive care, the patient's condition deteriorated, requiring below-knee and later above-knee amputation. This case emphasizes the aggressive clinical course S. algae can take in vulnerable patients and highlights the importance of early recognition and multidisciplinary management of severe skin and soft tissue infections.

Background/Objectives: While it is known that Hashimoto’s thyroiditis (HT), goiter, thyroid nodules, and thyroid dysfunction may affect women’s reproductive health through hormonal and metabolic mechanisms, data are limited regarding the specific impacts on female sexual function. This study evaluated sexual function in women with thyroid disorders and examined its associations with thyroid function, age, menopausal status, and body mass index (BMI). Methods: A population-based survey was conducted in Kaunas, Lithuania, within the WHO MONICA framework. A random sample of 1569 women aged 25–69 years was included in the final analysis after applying the exclusion criteria. Anthropometric measurements were taken using standardized procedures, and the BMI was calculated. Sexual function was assessed using the 19-item Female Sexual Function Index (FSFI). Thyroid structure was evaluated by a team of trained physicians using ultrasound, while thyroid function was assessed via serum analysis (ELISA-based assays for TSH, fT4, and anti-TPO antibodies). Results: Of the 1569 women analyzed, 64.1% had sexual dysfunction (SD) (FSFI ≤ 26.55). Age and BMI showed significant negative correlations with all FSFI domains, with the strongest associations for arousal, lubrication, and total FSFI score (p < 0.01). SD was more prevalent among postmenopausal (43.6%) women than in premenopausal women (22.6%, p < 0.001) and increased with a higher BMI (p < 0.001). HT was found in 28.3% of participants. Compared with the reference group, women with HT were older, had higher BMI, higher TSH levels, and more hypothyroidism (p < 0.001). SD was more common in the HT group (71.7% vs. 64.2%, p < 0.001), with significantly lower lubrication and higher pain scores. In the multivariate analysis, only goiter remained an independent predictor of SD (p = 0.04). Conclusions: In conclusion, women with HT were older; had a higher BMI; and more frequently experienced SD, particularly reduced lubrication and increased pain, compared with the reference group. Although several thyroid conditions were associated with sexual dysfunction, only goiter remained an independent predictor after adjusting for age and BMI.

Aim of the study: This study aimed to assess inflammatory mar- kers in patients with community-acquired pneumonia (CAP) to identify targets for clinical and therapeutic interventions. Methods: 40 patients with confirmed CAP were included. IL-6, IL-8, IFNγ, and G-CSF concentrations were measured using the Invitrogen Procarta Plex kit on a Luminex 200 system. Statistical analysis was performed with IBM SPSS v. 30.0 using non-para- metric tests (Mann–Whitney U, Kruskal–Wallis, Wilcoxon Sig- ned-Rank) according to distribution. Results were presented as the median and interquartile range (M(IQR)). Results:Typical bacterial pathogens compared to atypical etiological agents were found in more elderly patients (71.5 (27) vs. 41 (41) years, p=0.03). The IFNγ concentration was significantly higher in patients with atypical pneumonia compared to those with an unk- nown etiology (4998.5(20913) vs. 0.7 (1222.6) pg/mL, p=0.029). The IFNγ concentration after 7-days of treatment significantly de- creased compared to the concentration found on the 1st day (2445 (5877.9) vs. 0.83 (2444.3) pg/mL, p=0.004). IL-8 andG-CSF con- centrations were associated with the treatment setting: higher con- centrations were found in inpatient care compared to outpatient clinic patients (34763.5 (38799.5) vs. 27964 (36832.5) pg/mL, p=0.001; 14696.5 (24524.5) vs. 7.0 (20470) pg/mL, p=0.013). IL-6 concentrations after 7-days of treatment were significantly higher in patients treated in the hospital compared to ambulatory patients (3653.5 (10066.8) vs. 727.6 (2744) pg/mL, p=0.029). Conclusions: The inflammatory markersIL-6, IL-8,IFNγ and G- CSF can be helpful in the management of CAP.