MF Intensyviosios terapijos klinika (04.23)

Background. The key to optimizing insulin administration and simplifying the management of Type 1 diabetes (T1D) lies in accurately predicting future blood glucose (BG) levels. Consistently predicting BG levels is a challenging goal due to interindividual biological variability, data quality issues, and the inherent variability of glucose metabolism.

Background: People with type 1 diabetes mellitus (T1DM) show glucose variability driven by insulin dosing, meals, activity, and circadian rhythms. Many deep learning approaches treat glucose forecasting and hypoglycemia detection as separate tasks and provide limited transparency.

Background: Critically ill patients receiving mechanical ventilation are at high risk of physical deconditioning due to immobility. Early physiotherapy and adjunctive interventions, such as in-bed cycling, may help maintain or improve physical function in this population. Objective: To evaluate the changes in functional indicators in mechanically ventilated adult patients undergoing physiotherapy, with or without in-bed cycling. Methods: The study included thirty mechanically ventilated adult patients (18 men and 12 women) hospitalized in the Intensive Care Unit of the Hospital of Lithuanian University of Health Sciences Kaunas Clinics. All received daily physiotherapy. One group underwent conventional physiotherapy (early mobilisation and respiratory exercises), while the other received physiotherapy combined with passive in-bed cycling. Functional status was assessed using ventilation parameters, haemodynamic indicators, oxygen saturation, and the Intensive Care Unit Mobility Scale (ICUMS). Results: Both groups demonstrated improvement in functional indicators during their ICU stay. In the physiotherapy-only group, a statistically significant increase in ICU Mobility Scale (ICUMS) was observed (p = 0.029), indicating enhanced functional mobility throughout the treatment period. In the physiotherapy-plus-cycling group, ICUMS scores also showed an upward trend (from 17.8 to 27.5). Other physiological parameters remained stable (p > 0.05). Between-group differences were not statistically significant, though higher mean ICUMS ranks were observed in the cycling group, suggesting a potential additive effect. Conclusions: Physiotherapy contributes positively to functional recovery in mechanically ventilated ICU patients. The addition of in-bed cycling may enhance these outcomes, supporting its integration into early rehabilitation protocols.

Ethnopharmacological studies are growing in number in Europe; however, research on medicinal plants in Lithuania focusing on dermatological and cosmetic applications is still scarce. This study aimed to evaluate ethnobotanical heritage related to the treatment of skin diseases and cosmetic use in Northern Lithuania and to assess the compliance of traditional medicinal plant use indications with European Union herbal monographs. This study involved 36 participants aged 40 to 89. Data were collected using semi-structured interviews. This study documented 76 plant species belonging to 41 botanical families for the treatment of skin diseases and cosmetic purposes. This knowledge was primarily transmitted through family traditions, with 59.2% of respondents reporting that they acquired this knowledge from parents or grandparents. The medicinal plants most frequently mentioned for the treatment of skin diseases and cosmetic purposes were Aloe vera (L.) Burm. f. and Plantago major L. The most popular preparation method was topical application (32.4%) for treating skin diseases and decoction (38.5%) for cosmetic purposes. Plant-based raw materials were most often used to treat skin wounds (24.5%), as well as skin inflammation (16.3%) and burns (12.1%). For cosmetic purposes, the most frequently mentioned indication was dry skin (23.6% of plants). Of the 76 recorded plant species, 41 (53.9%) were not included in herbal monographs, and only 15 species (42.86%) were used in accordance with approved medical indications for skin diseases. Many plant species are used without European Medicines Agency-approved medical indications, relying solely on traditional and folk knowledge.

Background Pneumococcal meningitis is a life-threatening infection, frequently requiring critical care support due to sepsis and adverse neurological outcome. In acute otitis media, meningitis and intracranial complications are rare but may be fulminant with rapid progression from local infection to coma and limited response to treatment. Case Report A healthy 56-year-old woman developed sore throat followed by right-sided otalgia and otorrhea. Within 24 hours of ear symptoms onset, she was found unresponsive at home. On the arrival around midday, patient was febrile, hypotensive, with a Glasgow Coma Scale (GCS) score of 6 and positive meningeal symptoms. Initial head computed tomography (CT) revealed diffuse cerebral oedema with signs of brain herniation. Blood tests showed elevated inflammatory markers, while lumbar puncture revealed inflammatory cerebrospinal fluid (CSF). Patient was assessed by an otorhinolaryngologist. Otoscopy confirmed acute otitis media with mastoid effusion and paracentesis was performed. Patient was intubated and treatment of ceftriaxone and vancomycin, acyclovir, norepinephrine, hyperosmolar therapy was initiated. At 19:15, patient developed anisocoria and repeated CT showed progression of cerebral oedema and cerebellar herniation through the foramen magnum. For advanced evaluation and management, she was transferred to a tertiary intensive care unit (ICU) at 21:55. Intensive medical and anti-oedema treatment was continued, while neurosurgical interventions were not performed in the absence of a surgically treatable lesion. Follow-up CT scans showed progressive cerebral oedema and effacement of basal cisterns. Previously obtained cultures from CSF and middle-ear fluid grew Streptococcus pneumoniae. After 72 hours, sedation was withdrawn but patient remained with GCS of 3 and absent brainstem reflexes. She met the clinical criteria for brain death and cerebral angiography demonstrated lack of intracranial arterial opacification. Following the confirmation of brain death, the patient was assessed as a potential organ donor and managed according to the donor care protocols. Conclusions This case underscores that otogenic meningitis may evolve with fulminant progression, emphasizing the importance of early recognition of acute otitis media and prompt initiation of appropriate treatment. In cases of irreversible neurological injury, timely assessment for potential organ donation should be considered as an important component of high-quality intensive care..

Guidelines recommend large decompressive craniectomies (DC) in traumatic brain injury (TBI), yet the optimal size remains debated. Real-world practice often differs from guideline recommendations and generalizability of prior evidence to a broader TBI population is uncertain.

Methemoglobinemia is a potentially life-threatening condition caused by oxidation of hemoglobin iron, impairing oxygen delivery to tissues. This case highlights severe methemoglobinemia with persistent tissue hypoxia despite appropriate antidotal therapy and complicated by intravascular hemolysis and acute kidney injury, requiring intensive care management and renal replacement therapy. A 32-year-old man was admitted to the intensive care unit after ingesting a large amount of zopiclone obtained from an unregulated source. He was unconscious, cyanotic, required intubation and mechanical ventilation. Arterial blood gas analysis showed severe methemoglobinemia (MetHb 44.9%) and a significant saturation gap (>5%). Intravenous antidote methylene blue reduced methemoglobin levels, but hypoxia persisted. During hospitalization, hemolytic anemia progressed, hemoglobin decreased to 64 g/L. Laboratory findings confirmed intravascular hemolysis: elevated lactate dehydrogenase, low haptoglobin, and hemoglobinuria. The course was further complicated by acute kidney injury requiring four hemodialysis sessions. Due to persistent severe hypoxemia and ongoing hemolysis with an inadequate response to methylene blue, six units of packed red blood cells were transfused to improve oxygen delivery. After comprehensive treatment, hemolysis resolved, hypoxemia and respiratory failure regressed, and renal function recovered. Although zopiclone is not a typical oxidizing agent, the use of a substance from an unregulated source raised suspicion of possible contamination or co-ingestion of oxidants. Limited response to methylene blue-which is effective only with a properly functioning G6PD system-and the development of hemolysis suggested a possible underlying glucose-6-phosphate dehydrogenase (G6PD) deficiency, reducing treatment efficacy and increasing susceptibility to oxidative damage. Severe methemoglobinemia may be resistant to methylene blue and complicated by hemolysis and organ dysfunction. This case underscores that early recognition, assessment for possible enzymatic deficiencies, and individualized treatment–including antidote administration, renal replacement therapy, and transfusion therapy–are essential in complex toxicological emergencies.

Septic shock, a life-threatening condition, is treated with corticosteroids (CS), but their effectiveness remains debated. While some studies show benefits in reducing mortality and vasopressor use time, others find no significant impact. Corticosteroids can stabilize hemodynamics, especially in patients with adrenal insufficiency or refractory shock, but side effects like hyperglycemia require monitoring. Current guidelines suggest using CS for patients unresponsive to fluid resuscitation and vasopressors. However, optimal dosing, timing, and tapering strategies need further research to improve outcomes.

Epilepsinė būklė yra skubiosios medicinos pagalbos reikalaujanti pavojinga neurologinė būklė, kai traukuliai tęsiasi ilgiau nei 5 minutes arba, kartojantis priepuoliams, žmogus neatgauna sąmonės. Dažniausiai tokia būklė kyla dėl nepakankamo epilepsijos gydymo, ūminių galvos smegenų pažeidimų ar metabolinių sutrikimų. Epilepsinė būklė skirstoma į du pagrindinius tipus – konvulsinį, kai traukuliai matomi, ir nekonvulsinį, kurio diagnozei patvirtinti būtina elektroencefalografija (EEG). Pradžioje skiriami benzodiazepinai, vėliau – antros eilės vaistai nuo epilepsijos. Sunkesniais atvejais taikoma intraveninė sedacija. Šie pacientai dažnai gydomi intensyviosios terapijos skyriuje (ITS), kur užtikrinamas kvėpavimo, kraujotakos stabilumas ir neurologinės būklės stebėjimas. Mirtingumas ir ilgalaikės pasekmės yra glaudžiai susijusios su traukulių trukme, jų priežastimis bei gydymo pradžios laiku. Ankstyvas ir adekvatus gydymas gali ženkliai pagerinti paciento prognozę bei sumažinti komplikacijų riziką.