Adukauskienė, Dalia

Data on the effects of conventional cardiac resynchronization therapy (CRT) upgrading by implantation of a left ventricular lead via the coronary sinus on functional mitral regurgitation (MR) in patients with pacing-induced cardiomyopathy are scarce.

Pratarmė. Mieli studentai, Gastroenterologija yra viena įdomiausių ir greičiausiai besiplėtojančių medicinos sričių. Dėl mokslo ir technologijų pažangos XXI a. gastroenterologija apima vis platesnį kepenų ir virškinamojo kanalo ligų, gydymo metodų spektrą. Tai neabejotinai viena įvairiapusiškiausių specialybių, kur akivaizdi klinikinių įgūdžių, molekulinių ir ultragarsinių tyrimų bei sudėtingų endoskopinių intervencijų sąsaja. Uždegiminės žarnyno ligos, retos virškinamojo kanalo ligos, mikrobiotos ir kepenų transplantacija yra tik nedidelė dalis sričių, kurios yra patikėtos gydytojams gastroenterologams. Šis Lietuvos sveikatos mokslų universiteto Medicinos akademijos Medicinos fakulteto Gastroenterologijos klinikos (toliau - Gastroenterologijos klinika) kolektyvo parengtas vadovėlis yra skirtas studentams, siekiantiems susipažinti su gastroenterologijos pagrindais. Jau beveik 30 metų Gastroenterologijos klinika aktyviai dalyvauja rengiant tarptautines diagnostikos ir gydymo gaires, yra prestižinių tarptautinių mokslo projektų ir konsorciumų dalyvė, o 2020 m. klinika tapo ir asocijuota Europos retų kepenų ligų tinklo nare. Mūsų klinikos mokslinių tyrimų rezultatai yra publikuojami prestižiniuose mokslo leidiniuose: Nature, Lancet, New England Journal of Medicine, Nature Genetics ir kituose. Rengdami šį vadovėlį stengėmės perteikti visą klinikos sukauptą ilgametę pedagoginę ir klinikinę patirtį bei naujausius mokslo pasiekimus. Tikimės, kad šis vadovėlis ne tik suteiks Jums pagrindinių žinių apie gastroenterologiją, bet ir paskatins rinktis šią specialybę rezidentūros studijose. Autorių vardu prof. Juozas Kupčinskas

Pasikartojančios Clostridioides difficile infekcijos gydymas kelia didelių klinikinių iššūkių, nes gydymas antibiotikais dažnai lemia tik trumpalaikį simptomų palengvėjimą ir neturi pakankamo ilgalaikio gydomojo poveikio. Ieškant būdų kaip sumažinti pasikartojančių infekcijų dažnį buvo atkreiptas dėmesys į žarnyno mikrobiotos transplantaciją. Literatūroje vis daugiau įrodymų, kad mikrobiotos transplantacija po gydymo antibiotikais sumažina Clostridioides difficile infekcijos recidyvų skaičių ir mažina sergančiųjų mirtingumą. Nepaisant daug žadančių pradinių rezultatų, tebevyksta diskusijos dėl tinkamiausio procedūros atlikimo metodo, jos klinikinio efektyvumo bei ilgalaikio saugumo. Šios disertacijos tikslas yra įvertinti žarnyno mikrobiotos transplantacijos efektyvumą ir ilgalaikį saugumą gydant pasikartojančią Clostridioides difficile infekciją, naudojant du skirtingus viršutinio virškinamojo kanalo transplantacijos metodus. Tyrimo uždaviniai buvo įvertinti žarnyno mikrobiotos transplantacijos efektyvumą, kai procedūra atliekama per enterinį zondą arba naudojant geriamąsias šaldytas kapsules. Taip pat buvo lyginimas abiejų metodų pirminis efektyvumas bei vertinamas žarnyno mikrobiotos transplantacijos ilgalaikis saugumas. Šios disertacijos rezultatai rodo, kad žarnyno mikrobiotos transplantacija, atliekama per viršutinį virškinamąjį kanalą enteriniu zondu, arba kapsulėmis, yra veiksminga gydant pasikartojančią Clostridioides difficile infekciją. Pirminis efektyvumas siekia iki 80 proc., o pakartotinės procedūros pagerina infekcijos gydymo rezultatus. Taip pat nustatyta, kad žarnyno mikrobiotos transplantacija per viršutinį virškinimo kanalą yra saugus gydymo metodas. Tyrimo metu nebuvo stebėta sunkių ar gyvybei grėsmingų šalutinių reiškinių, o atliekant ilgalaikį pacientų stebėjimą nebuvo fiksuota naujų su žarnyno mikrobiotos transplantacijos susijusių patologijų.

Introduction: Both leucocytosis and elevated serum creatinine levels are severity criteria of Clostridioides difcile (C. difcile) infectious disease (CDID) [1]. The aim of this study was to analyze the association of the presence of both severity criteria on CDID-related adverse outcomes in case of treatment with metronidazole [2]. Methods: A single-center, retrospective cohort study was conducted in the largest university-afliated hospital in Lithuania from 2011 to 2020. Cases with primary CDID (diarrhea and positive stool test for C. difcile toxin A/B) were enrolled. Leukocytes≥15× 109 /L and/or serum creatinine level>133 μmol/L were used as CDID severity criteria. The association of the presence of two vs. one severity criteria with the rate of CDID-related Intensive Care Unit (ICU) admission and CDID-related mortality has been estimated in cases of treatment with metronidazole. IBM SPSS 23.0, Fisher’s exact test were used for statistics, level of signifcance—p<0.05. Results: N=65 pt were included from a total of study n=370 pt. CDID-related ICU admission rate was n=3/16 (18.8%) in pt with two severity criteria compared to n=0/49 (0.0%) in pt with one severity criterion, p<0.05. CDID-related mortality rate was n=4/16 (25.0%) in pt with two criteria in comparison with n=1/49 (2.0%) in pt with one severity criterion, p=0.01. Conclusions: Severe CDID treatment with metronidazole in presence of both severity criteria is associated with CDID-related adverse outcomes.

Background: Complications, particularly pneumothorax, are common following lung interventions and occasionally necessitate further examinations, extend hospital stays, increase treatment costs, and result in long-term health impairment or even death. A few lung intervention tract sealants have been explored to reduce procedure-related complications. Objectives: The primary objective of this prospective non-randomized study was to assess the complication rates and risk factors for computed tomography-guided lung microwave ablation (MWA) with autologous blood clot as a tract sealant. Methods: Twenty-one patients underwent a total of 26 MWA sessions for lung malignancy followed by injection of the patient's clotted venous blood into the ablation tract while retracting the coaxial needle. Ablation tract sealing was successful in all MWA sessions. Results: Pneumothorax was the only complication observed in five (19.2%) sessions, with one patient (3.8%) requiring chest tube insertion. The male sex was a statistically significant risk factor for pneumothorax (p = 0.042), and patients with lung emphysema had almost fivefold higher odds of developing pneumothorax (OR 4.8; 95% CI, 0.617-37.351; p = 0.281). Conclusions: This study concludes that pneumothorax is the primary complication following lung MWA, and the male sex is a risk factor. Ablation tract sealing with autologous venous blood is a straightforward and inexpensive technique that can reduce the incidence of procedure-related pneumothorax.

Viena hiponatremiją lemiančių priežasčių - tiazidinių diuretikų vartojimas. Hiponatremija nustatoma, kai natrio (Na1) kiekis kraujyje yra < 135 mmol/1. Literatūroje nurodoma, kad dėl tiazidinių diuretikų sukeltos hiponatremijos į ligoninę patenka daugiau nei 10 proc. visų pacientų, kuriems nustatytas šis sutrikimas. Ji gali sunkinti tiazidinių diuretikų vartojimą asmenimis, kurie jautrūs šiai diuretikų grupei, ir didinti sergamumą bei mirštamumą. Be to, hiponatremiją gali lemti ir kiti paciento kartu vartojami vaistai bei esamos ligos. Daugeliui pacientų Na+ sumažėjimas yra besimptomis arba simptomai nėra labai ryškūs. Tačiau pacientams, kuriuos hiponatremija ištinka staiga, gali atsirasti tokios komplikacijos, kaip traukuliai ir koma.

Introduction: During the episode of Clostridioides difcile (C. diffcile) infectious disease (CDID) antibiotics may need to be used concomitantly for treatment of infection other than CDID [1]. The aim of this study was to evaluate the impact of the continuation of concomitant antibiotics (cAB) on outcomes in CDID patients (pt) when the CDID treatment was concordant with Guidelines. Methods: A single-center, retrospective 10-yr cohort study was conducted in the largest university-afliated hospital in Lithuania. Pt with primary episodes of CDID (diarrhea and positive stool test for C. diffcile toxin A/B) in the period of 2011–2020 were included. cAB was defned as AB used concomitantly for treatment of other infection than CDID≥3 days after CDID diagnosis. The impact of continuation of cAB on 30-day all-cause mortality and 30-day survival has been estimated. IBM SPSS 23.0, binary logistic regression analysis, Kaplan– Meier model, log-rank, Breslow, Tarone-Ware, and Pearson’s χ2 tests were used for statistics, level of signifcance—p<0.05. Results: The treatment was concordant with Guidelines in 224 cases out of study total of 370 pt. In CDID pt the treatment with cAB was estimated as a predictor for 30-day all-cause mortality (OR 0.3; 95% CI 0.1–0.9; p=0.047). The 30-day follow-up included 53/224 pt. The 30-day all-cause mortality was n=13/25 (52.0%) in CDID pt with cAB, as compared with n=7/28 (25.0%) in cases with their discontinuation, p=0.053. The 30-day survival decreased (p<0.05) in CDID pt treated with cAB (Figure). Conclusions: The use of concomitant antibiotics in CDID patients is associated with worse outcomes even in cases of CDID treatment concordant with Guidelines; therefore, this antibiotic therapy always should be justifed, de-escalated, or ceased.

Clostridioides difficile (C. difficile) is a predominant nosocomial infection, and guidelines for improving diagnosis and treatment were published in 2017. We conducted a single-center, retrospective 10-year cohort study of patients with primary C. difficile infectious disease (CDID) at the largest referral Lithuanian university hospital, aiming to evaluate the clinical and laboratory characteristics of CDID and their association with the outcomes, as well as implication of concordance with current Clinical Practice Guidelines. The study enrolled a total of 370 patients. Cases with non-concordant CDID treatment resulted in more CDID-related Intensive Care Unit (ICU) admissions (7.5 vs. 1.8%) and higher CDID-related mortality (13.0 vs. 1.8%) as well as 30-day all-cause mortality (61.0 vs. 36.1%) and a lower 30-day survival compared with CDID cases with concordant treatment (p < 0.05). Among cases defined by two criteria for severe CDID, only patients with non-concordant metronidazole treatment had refractory CDID (68.8 vs. 0.0%) compared with concordant vancomycin treatment. In the presence of non-concordant metronidazole treatment for severe CDID, only cases defined by two severity criteria had more CDID-related ICU admissions (18.8 vs. 0.0%) and higher CDID-related mortality (25.0 vs. 2.0%, p < 0.05) compared with cases defined by one criterion. Severe comorbidities and the continuation of concomitant antibiotics administered at CDID onset reduced (p < 0.05) the 30-day survival and increased (p = 0.053) 30-day all-cause mortality, with 57.6 vs. 10.7% and 52.0 vs. 25.0%, respectively. Conclusions: CDID treatment non-concordant with the guidelines was associated with various adverse outcomes. In CDID with leukocytes ≥ 15 × 109/L and serum creatinine level > 133 µmol/L (>1.5 mg/dL), enteral vancomycin should be used to avoid refractory response, as metronidazole use was associated with CDID-related ICU admission and CDID-related mortality. Severe comorbidities worsened the outcomes as they were associated with reduced 30-day survival. The continuation of concomitant antibiotic therapy increased 30-day all-cause mortality; thus, it needs to be reasonably justified, deescalated or stopped.

Algoritmas (lot. algorismus

VAP due to multidrug-resistant (MDR) bacteria is a frequent infection among patients in ICUs. Patient characteristics and mortality in mono- and polybacterial cases of VAP may differ. A single-centre, retrospective 3-year study was conducted in the four ICUs of a Lithuanian referral university hospital, aiming to compare both the clinical features and the 60-day ICU all-cause mortality of monobacterial and polybacterial MDR Klebsiella spp. VAP episodes. Of the 86 MDR Klebsiella spp. VAP episodes analyzed, 50 (58.1%) were polybacterial. The 60-day mortality was higher (p < 0.05) in polybacterial episodes: overall (50.0 vs. 27.8%), in the sub-group with less-severe disease (SOFA < 8) at VAP onset (45.5 vs. 15.0%), even with appropriate treatment (41.7 vs. 12.5%), and the sub-group of extended drug-resistant (XDR) Klebsiella spp. (46.4 vs. 17.6%). The ICU mortality (44.0 vs. 22.5%) was also higher in the polybacterial episodes. The monobacterial MDR Klebsiella spp. VAP was associated (p < 0.05) with prior hospitalization (61.1 vs. 40.0%), diabetes mellitus (30.6 vs. 5.8%), obesity (30.6 vs. 4.7%), prior antibiotic therapy (77.8 vs. 52.0%), prior treatment with cephalosporins (66.7 vs. 36.0%), and SOFA cardiovascular ≥ 3 (44.4 vs. 10.0%) at VAP onset. Patients with polybacterial VAP were more likely (p < 0.05) to be comatose (22.2 vs. 52.0%) and had a higher SAPS II score (median [IQR] 45.0 [35.25–51.1] vs. 50.0 [40.5–60.75]) at VAP onset. Polybacterial MDR Klebsiella spp. VAP had distinct demographic and clinical characteristics compared to monobacterial, and was associated with poorer outcomes.