VISUOMENĖS SVEIKATOS FAKULTETAS (07)

Genome editing has transformed the fields of biotechnology, medicine, agriculture, and synthetic biology by allowing for targeted modifications of genetic material. Despite the simplicity and efficiency of CRISPR-Cas systems making it the dominant genome editing platform, their off-target effects, PAM sequence dependence, delivery challenges and unwanted genomic alteration have spurred the development of advanced editing technologies beyond the conventional CRISPR systems. In this chapter, we summarise the design principles, optimization strategies, and applications of next-generation genome editing tools, such as base editors, prime editors, RNA-guided transposases, and epigenome editing technologies. The molecular mechanisms, advantages and limitations of these platforms are discussed with special emphasis on improving editing precision, efficiency, delivery and bio-safety.

Precision pharmacotherapy is a paradigm shift in managing vitiligo that has shifted from a one size fits all approach to a stratified, mechanism based approach. This chapter introduces an integrated approach addressing clinical phenotype, immune endotype, and therapeutic mechanism to maximize the use of both topical and systemic, as well as targeted Janus kinase inhibitors. Potency-stratified topicals, pulse systemic immunomodulators and selective JAK1 or JAK1/JAK2 or JAK3/TEC inhibitors fit into a step-up algorithm based on disease activity, anatomical location, age and comorbidity. The discussion highlights emerging enablers like lesion mapping using artificial intelligence, digital phenotyping, digital twins, and pharmacogenomic prediction as tools for response prediction on extent scoring and decision support for durable, personalized repigmentation with balanced safety.

Dauginis ligotumas didina sveikatos priežiūros poreikį, apsunkina priežiūros koordinavimą ir gali bloginti pacientų gyvenimo kokybę. Disertacijos tikslas – įvertinti integruotos kompleksinės pirminės sveikatos priežiūros intervencijos poveikį dauginiu ligotumu sergančių pacientų gydymo naštai ir gyvenimo kokybei. Kontroliuojamas įgyvendinimo tyrimas atliktas septyniuose Lietuvos pirminės sveikatos priežiūros centruose. Tyrime dalyvavo 789 pacientai nuo 40 iki 85 metų: 400 intervencinėje ir 389 kontrolinėje grupėje. Rodikliai vertinti tyrimo pradžioje ir po 15 mėnesių. Adaptuotas ir validuotas lietuviškas gydymo naštos klausimynas (MTBQ), įvertintos EQ-5D-5L psichometrinės savybės. Daugiau nei trečdalis pacientų patyrė vidutinę arba didelę gydymo naštą, susijusią su didesniu lėtinių ligų ir vartojamų vaistų skaičiumi, prastesne gyvenimo kokybe bei ryškesniais nerimo ir depresijos simptomais. Po 15 mėnesių bendras gydymo naštos balas tarp grupių statistiškai reikšmingai nesiskyrė, tačiau intervencinėje grupėje nustatyti palankesni gyvenimo kokybės, savo sveikatos vertinimo, judėjimo, nerimo ir depresijos simptomų rodikliai. Kaimo vietovėse gyvenantys pacientai buvo socialiai ir kliniškai pažeidžiamesni, gauti intervencijos rezultatai miesto ir kaimo grupėse buvo nevienodi. Integruota priežiūra gali pagerinti gyvenimo kokybę ir sumažinti nerimo bei depresijos simptomus, tačiau turi būti derinama su paciento galimybėmis ir vietos sąlygoms.

Background and aim. Medical students often face high rates of health complaints like fatigue, stress, and sleep disturbances, largely driven by intense academic demands. Living environment factors such as noise, privacy, air quality, and room design influence well-being. Most existing studies focus on isolated environmental factors rather than comprehensive patterns of multiple health complaints. Aim of this research survey was to improve the understanding on the living environment and the health of the medical students at the Lithuanian University of Health Sciences (LSMU) and to explore the relationship between living environmental and health complaints. Methods. Cross-sectional survey involved 200 students of Lithuanian University of Health Sciences (LSMU) studying at integrated degree study programme in Medicine and was conducted in 2025. A self-administered online questionnaire assessed sociodemographic characteristics, 11 living environment factors (5-point Likert scale; composite Living Environment Quality score), 10 health complaints, screen use patterns, and perceived stress. Data analysis in SPSS included descriptive statistics, correlations, and multiple regression. Results. Fatigue (82%), stress (78%), and sleep disturbances (65%) emerged as the most prevalent when any frequency above “never” was counted. Females and non-dormitory residents reported higher complaint burdens. Better perceived air quality was modestly associated with lower Total Health Complaints (r = –0.235, p < 0.01). The strongest predictor of health complaints was eye strain or headaches after prolonged device use (β = 0.37, p < 0.001), followed by average daily screen time (β = 0.20, p = 0.002). Conclusion. Suboptimal living environments compound health challenges for LSMU medical students, particularly when combined with excessive screen use. University interventions targeting dormitory ventilation, noise reduction, and privacy could meaningfully enhance student well-being and academic performance.

Background and aim. Internet-based technologies have become an integral component of contemporary society, shaping a wide range of activities, including interpersonal communication, professional and academic work, leisure, and access to information and services. The aim of this study was to examine the relationship between personality traits, problematic internet use (PIU) and sleep quality among first-year bachelor university students. Methods. A cross-sectional study of 437 university students from three universities in Kaunas, Lithuania was carried out. Data were collected on-line during October and November 2025. Problematic internet use was assessed using special instrument – Problematic Internet Use Questionnaire (PIUQ-9). For evaluation of personality traits, the Ten-Item Personality Inventory (TIPI) was applied. The sleeping quality was assessed by using the Pittsburgh Sleep Quality Index (PSQI). Statistical analysis included descriptive statistics, group comparisons, correlations, linear regression, and mediational analysis. Results. The mean score of PIU was 21.65±6.3. Women reported higher PUI scores than men (22.57±6.3 vs 19.85±5.8; p < 0.001). Poor sleep quality (PSQI > 5) was reported by 74.4% of participants; women had poorer sleep quality than men (7.83±2.9 vs 6.85±2.7; p < 0.001). Low conscientiousness and emotional stability predict high PIU. High levels of agreeableness (r = -0.133; p = 0.005), emotional stability (r = -0.284; p < 0.001) and openness (r = -0.105; p = 0.028) were related to better sleep quality, however only emotional stability was a predictive factor (β = -0.599; p < 0.001). Students with higher PIU had poorer sleep quality (r = 0.268; p < 0.001). Emotional stability directly (c’ = -0.521, p < 0.001) and indirectly through PIU (ab = -0.120; 95% CI [-0.194, -0.058]) influences sleep quality. Conclusions: 13.6% of first year university students exhibit the high risk of problem internet use (PIU). Female students were more susceptible and showed higher PIU risk scores. Female students demonstrated a significantly poorer sleep quality than male students. High levels of agreeableness, emotional stability and openness are related to better sleep quality, however only emotional stability is a predictive factor of good sleep quality. Students who have higher PIU exhibit poorer sleep quality. Emotional stability directly and indirectly through PIU influences sleep quality. Even though PIU plays an important role in the relationship between emotional stability and sleep quality, it only partly explains the relation between emotional stability and sleep quality.

Bereavement research has frequently focused on psychopathology, while comparatively less attention has been given to well-being as a component of mental health. This study is the first to examine mental health profiles based on ICD-11 Prolonged Grief (PG) symptoms, posttraumatic stress (PTS) symptoms, and well-being in a sample of Ukrainians bereaved during the full-scale Russian invasion. Participants were 290 adults (Mage = 34.3, SD = 9.1 years), who had lost a loved one on average 5.3 months earlier. Over a third (35%) had lost a partner or child, due to illness (43%) or war (40%). The majority of participants (55%) scored above the threshold of clinically relevant PG symptoms. Latent profile analyses identified three distinct mental health profiles: (1) low PG symptoms/low PTS symptoms/high well-being (13%), (2) moderate PG symptoms/low PTS symptoms/moderate well-being (57%), (3) high PG symptoms/low PTS symptoms/low well-being (30%). People evidencing the third profile were more likely to have experienced the loss of a close person (partner or child) and to have been forcibly displaced compared to people in other profiles. Notably, the distribution of these profiles differs from previous studies, where profiles marked by low symptoms and high well-being were typically most common. Moreover, PG and well-being appeared to lie on opposite ends of a single continuum rather than functioning as distinct dimensions, providing limited support for the dual-continua model. This pattern suggests that Ukrainians may be facing unique challenges due to ongoing war-related stressors. Identifying those most in need of support and highlighting potential intervention targets are particularly important in under-resourced populations where access to care is limited.

Iodine is a rapidly acting antiseptic with bactericidal, fungicidal, sporicidal properties (McDonnell and Russell, 1999). Iodine-based teat dips are widely used in dairy farms for teat disinfection (Ruegg, 2017). Fungi have been associated with subclinical and clinical mastitis in dairy cattle (Mahendra Pal, 2022). Therefore, evaluation of iodine-based teat disinfectants against fungal species isolated from teat skin is important for improving udder hygiene and mastitis prevention.

The aim of this study was to evaluate the antifungal activity of different iodine concentrations against Aspergillus species isolated from dairy cow teat skin.

Aspergillus spp. were isolated from teat skin samples using direct plating and washing–dilution methods on Sabouraud Dextrose Agar supplemented with chloramphenicol. Pure cultures were identified according to cultural and morphological characteristics using light microscopy. Antifungal activity was evaluated using the disk diffusion method. 1 mL fungal suspension (3 × 10^8 CFU mL) was inoculated onto Sabouraud Dextrose Agar. Iodine concentrations of 0.15%, 0.25%, 0.50%, and 0.75% (w/w iodine) were tested. Plates were incubated at 25 ± 1°C for 72–96 h, and antifungal activity was assessed by measuring fungal growth inhibition zones (mm).

Antifungal activity varied depending on iodine concentration and fungal species susceptibility. The strongest antifungal effect was observed at 0.50% iodine concentration. The highest susceptibility was detected in Aspergillus candidus (19.58 mm), followed by A. oryzae (11.0 mm), A. flavus (10.42 mm), and A. ochraceus (9.17 mm). A. niger showed the lowest sensitivity (5.58 mm). Lower iodine concentrations demonstrated weaker and species-dependent activity, while increasing iodine concentration to 0.75% did not improve antifungal efficacy.The results indicate that iodine-based teat disinfectants possess antifungal activity against environmental Aspergillus species isolated from teat skin. The 0.50% iodine concentration showed the highest inhibitory effect and may contribute to improved teat hygiene and reduced fungal contamination in dairy farms.

Introduction: From 2015 to 2020, Lithuania implemented the package of evidence-based populationlevel alcohol control policy measures. Evaluation of their impact on the prevalence of alcohol use disorders (AUDs) is crucial, as it is often claimed in public debate that restricting the affordability and availability of alcohol would not affect alcohol abusers who always find their way to satisfy their thirst for alcohol. This study aims to examine changes in the prevalence of AUDs between 2015 and 2020, in the context of strengthened alcohol control policies introduced during this period. Material and methods: The analysis is based on data from the Standard European Alcohol Survey, conducted in 2015 and repeated in 2020. We integrated variables on DSM-IV alcohol abuse and alcohol dependence, comparing the survey results with official statistics on AUDs. Results: Our findings demonstrated a notable reduction in alcohol use disorders in Lithuania between 2015 and 2020. The decrease is particularly strong among women. In both years, men consistently exhibit a much higher prevalence than women. Discussion: While the results demonstrate a temporal association between the observed decline in AUDs and the implementation of alcohol control policy measures, they do not prove a causal relationship. However, our findings are in line with results from earlier studies, which confirmed a substantial decline in alcohol harm in the study period. Conclusions: This study demonstrates a significant decline in self-reported alcohol use disorders between 2015 and 2020 in Lithuania, indicating a positive shift in alcohol-related health outcomes that could be attributed to the introduction of alcohol control policies.

Background

Early identification of treatment response in head and neck squamous cell carcinoma (HNSCC) remains challenging, as conventional imaging mainly reflects anatomical changes rather than ongoing biological processes. Although cone-beam CT (CBCT) has limited quantitative accuracy due to artefacts and intensity variability, its routine longitudinal acquisition during radiotherapy is an opportunity to monitor dynamic intratumoural changes. This study investigates if temporal radiomic feature transitions, can reveal patterns of tumour evolution and potentially indicate treatment response, even in a setting where such information is least expected.

Methods

HNSCC patients daily longitudinal CBCT images were analysed. Tumour volumes from planning CT were propagated across treatment fractions using rigid alignment. Radiomic heterogeneity features were extracted to evaluate temporal intratumoural changes during treatment. Feature trajectories were analysed using linear mixed-effects models incorporating nonlinear time effects and tumour differentiation groups.

Results

Distinct temporal patterns were observed across radiomic features. Entropy showed nonlinear (p < 0.001) dynamics with substantial inter-patient variability, while strength demonstrated moderate temporal variation with no group discrimination. Coarseness revealed consistent temporal trajectories with significant group-dependent differences (p < 0.01) and transition points. Differences between tumour groups were driven by the timing of structural changes rather than absolute feature values, highlighting the importance of temporal pattern analysis over static assessment.

Conclusions

Longitudinal CBCT-derived radiomic features capture tumour evolution during radiotherapy, with temporal patterns providing insight beyond static metrics. Coarseness emerged as a relatively stable indicator of structural phase shifts, while entropy reflected earlier but more variable instability. These findings support time-resolved radiomic phenotyping for identifying intra-treatment response trajectories and may contribute to adaptive radiotherapy using routinely acquired imaging without additional patient burden.