Minelga, Andrius Kazimieras

Introduction. Gamma Knife radiosurgery is a widely used treatment for convexity and parasagittal meningiomas. Although local control rates are high, individual responses vary, and some patients develop perifocal edema. Radiomics, which refers to the quantitative analysis of medical images, offers a non-invasive way to identify biomarkers that may predict treatment outcomes. Using this information in clinical practice may help adjust treatment decisions to the unique characteristics of each patient’s tumor, supporting a more personalized approach to care. Aim. The aim of this study was to evaluate whether pre-treatment MRI radiomic features are associated with tumor volume changes and perifocal edema after Gamma Knife radiosurgery. Methods. A total of 41 meningiomas in 34 patients were retrospectively analyzed. From pre-treatment MRI, 107 radiomic features were extracted using 3D Slicer with PyRadiomics. Tumor volume and perifocal edema were measured before and 12 months after treatment using Leksell GammaPlan. Nonparametric statistical tests were used to identify significant associations. Discussion. At follow-up, 88% of tumors were locally controlled, with 66.7% showing more than a 10% volume reduction. Six radiomic features, mostly related to heterogeneity, were significantly associated with tumor volume changes (p < 0.05). Patients who developed perifocal edema exhibited distinct pretreatment radiomic profiles, with 38 features showing statistically significant differences (p < 0.05), suggesting a potential link with increased edema risk. These findings suggest that radiomics may help predict treatment response and guide individualized care. Moreover, radiomic features could help evaluate whether surgery is needed. By estimating tumor progression likelihood and edema risk, radiomics may aid in identifying cases that require early surgery or conservative management, especially in anatomically complex areas. Conclusion. Radiomic analysis of pre-treatment MRI shows potential as a non-invasive tool for predicting outcomes after Gamma Knife radiosurgery. Incorporating radiomic biomarkers into clinical decision-making may enable more personalized and effective management of meningiomas.

Introduction: Giant cell arteritis (GCA) is a systemic vasculitis that impacts large and medium arteries, primarily in people aged over 50. Conventional therapy using high-dose corticosteroids is effective but frequently results in considerable side effects. Progress in the comprehension of GCA's pathophysiology has led to the development of personalized medicine strategies, focusing on improving treatment effectiveness and minimizing negative consequences. Aim: This review examines the present state of personalized medicine in GCA, emphasizing genetic, molecular, and proteomic indicators that guide tailored treatment approaches. Methods: A thorough literature review was performed using PubMed and Scopus, concentrating on research from the past ten years. Chosen articles were examined for information on biomarkers and customized treatments in GCA. Keywords: "Giant cell arteritis," "personalized medicine," "genetic markers," "proteomics," and "biological therapy." Discussion: Genetic research has identified links between GCA and certain HLA-DRB1 alleles, indicating a genetic susceptibility. Studies on epigenetics have shown that DNA methylation alterations in monocytes of individuals with GCA impact inflammation-related gene expression. Proteomic investigations have revealed unique protein patterns in the bloodstream, which help distinguish between active disease and remission phases. These molecular discoveries have led to the creation of targeted therapies, like tocilizumab, an IL-6 receptor blocker that has been approved for the treatment of GCA. Current research into additional biomarkers offers potential for enhancing treatment strategies further. Conclusion: The combination of genetic, epigenetic, and proteomic information is reshaping the management of GCA from a uniform strategy to more individualized methods. Discovering particular biomarkers allows for customized therapies that enhance effectiveness while reducing adverse effects. Ongoing research is crucial to confirm these methods and broaden the range of targeted therapies, ultimately improving patient outcomes in GCA.

Introduction and Purpose: Solitary bone plasmacytoma (SBP) is a rare, malignant form of plasma cell tumor, commonly diagnosed in people over 50. It usually affects the spine, pelvic bones or long bone structures. Symptoms include pain, restricted movement, muscle weakness, paresthesias. Diagnosis is based on radiological, laboratory and histological examinations. Materials and Methods: A 61-year-old woman presented to a family physician with lumbar spine pain persisting for one year, radiating to her right leg, accompanied by numbness in right foot. Upon detailed examination, a positive right-sided Lasègue test and restricted lumbar motion were noted. Neurological evaluation revealed pain along the right n. ischiadicus projection. A lumbar spine X-ray showed spondylosis. Magnetic resonance imaging (MRI) of the lumbar spine revealed no intervertebral disc herniation but raised suspicion of metastasis. A contrast-enhanced MRI of the lumbar region showed contrast accumulation in the L3 and L4 vertebrae. A CT scan of the spine showed a pathological fracture of the L3 vertebral body caused by an osteolytic neoplasm, with no clear evidence of a neoplasm in L4. Instrumental examinations were performed to search for the primary tumor: DXA showed osteoporosis, X-ray of the pelvis indicated sacroiliitis. No thyroid, gastrointestinal or gynecological primary tumor site was identified. Cancer markers were within normal limits. Suspecting the vertebrae as the primary location of cancer, a vertebral biopsy was taken which revealed SBP. A positron emission tomography/CT was performed, revealing destruction of the L3 vertebra with moderate metabolic activity. Radiotherapy was started and remission was observed. Results: Solitary bone plasmacytoma can be mistaken as an intervertebral disc herniation due to the initial onset of lumbar pain, paresthesia of the lower limbs, and limited lumbar motion. Discussion and Conclusion: Differential diagnosis requires an extensive examination of the patient to exclude other pathologies.

Cabozantinib is a second-line drug for treating advanced metastatic renal cell carcinoma in patients that had progressed after VEGFR-targeted therapy. It is a tyrosine kinase inhibitor that is able to inhibit various receptors like MET, AXL, and others. In fact, these receptors play a major role in tumor growth and are responsible for angiogenesis. Even though cabozantinib can achieve spectacular results, this drug is well-known for causing hypothyroidism. A 50-year-old woman was presented to the emergency room with complaints of progressive weakness and weight loss. Ultrasound revealed an 11 cm mass in her left kidney. She underwent a left nephrectomy, which revealed renal clear cell carcinoma. Chest computed tomography identified multiple metastases up to 1 cm in both lungs. The diagnosis was established as stage IV renal cell carcinoma with lung metastases. The patient received a first-line drug sunitinib, but the treatment has resulted in new metastases in the lungs. Physicians have decided to switch to the second-line drug cabozantinib. Unfortunately, after the 11th treatment course, the patient developed fatigue, anorexia and further weight loss. Thyroid tests have revealed severe hypothyroidism (TSH 85 mU/l, FT4 6.38 pmol/l). The patient received levothyroxine and cabozantinib at a reduced dose of 40 mg/day. The patient tolerated the treatment well and was monitored by endocrinologists every 3 months. As a matter of fact, compensated hypothyroidism persisted. Thyroid dysfunction is a serious endocrine disease, which is often associated with tyrosine kinase inhibitors. Most commonly it is believed that cabozantinib is toxic for thyroid follicular cells and the toxicity leads to impaired thyroid stimulating hormone (TSH), thyroxine (T4) and triiodothyronine (T3) hormone production in the gland. According to clinical trials, 93 % of all patients treated with cabozantinib developed thyroid hormone dysfunction. It is clear that all patients receiving cabozantinib treatment need to receive additional attention and thyroid function tests to avoid damaging their thyroid gland and causing serious consequences in the near future. We presented a case of drug-induced hypothyroidism when treating renal cell carcinoma with metastases. With cases of kidney cancer rising every year, it is important to be aware of adverse side effects of the cabozantinib.

Introduction. A frontal meningioma is a slow-growing tumour that arises from the meninges, the membranes that surround the brain. It is most commonly benign and often occurs in the frontal region of the brain. Neuropsychological assessment plays a crucial role in understanding and addressing the cognitive and psychiatric implications of frontal meningiomas, ultimately contributing to better patient care and outcomes. Aim. This paper aims to review the existing literature regarding neuropsychological assessment of patients with frontal meningiomas cognitive and emotional functioning. . Methods. After thorough examination, out of 109 studies 16 were included into review using PRISMA protocol for systematic literature reviews. Conclusions. Mini-Mental State Exam (MMSE), Montreal Cognitive Assessment (MoCA) and Trail Making Test (TMT) were found to be the most popular neuropsychological instruments used to assess cognitive functioning. Results indicate, that in most cases shortterm memory, attention and visuospatial functions were impaired. 8 articles also mentioned progressive personality or behavioural change. Emotional functioning was assessed in 15 out of 16 studies using neuropsychological instruments and/or interview. Vast majority of cases mentioned changes in mood, most common being depression or anxiety symptoms and/or diagnosis of major depressive disorder.

Background. Epidemiological evidence suggests that the prevalence of ischemic stroke in young adults (18-50 years) has increased significantly. This is partly attributed to a rise in the incidence of standard risk factors such as hypertension, hypercholesterolemia, obesity, diabetes mellitus, smoking and heart disease. Additionally, there are non-modifiable risk factors including migraine, pregnancy and postnatal period, illicit drug use, oral contraceptives and hypercoagulable state. Over 150 identified causes of early-onset ischemic stroke exist, including rare monogenic disorders. Although the chances of surviving stroke at a young age are distinctly better than for those at an older age, young survivors face an increased risk of recurrent strokes and other adverse events, such as neuropsychological problems and seizures for a much longer time span. Aim. The aim of the study is to review the scientific literature and summarize information about the risk factors of early onset ischemic stroke. Methods. A PubMed search was conducted according to PRISMA guidelines. Using keywords and their combinations the most relevant articles in English language were selected. The majority of the analysed publications were published over the last 10 years. Out of 392 scientific publications collected with keywords and filters, 57 potentially relevant studies were left after the elimination of duplicates and a brief analysis of titles and abstracts. Full texts were further screened for final inclusion and 35 studies were included in this systematic literature review. Conclusions. While early onset stroke is less common, the pathogenesis of stroke in younger adults requires consideration of some less common risk factors. An assiduous workup including testing for drug use, hypercoagulable causes, vascular imaging, and echocardiography can often identify or narrow down a list of possible pathogeneses, which is critical for prevention of recurrent strokes in younger adults. Systematic identification of risk factors and causes, as well as motivating patients for long-term prevention and lifestyle changes, is of utmost significance in improving prognosis of early-onset ischemic stroke. More research is needed to find novel risk factors and causes explaining the large proportion of cryptogenic strokes and better understand the factors influencing long-term prognosis to enhance management.

General practitioners (GPs) often see patients with a low platelet count. The etiology of thrombocytopenia usually is not immediately obvious. Thrombocytopenia is defined as a platelet count of less than 150 × 103 per μL. Usually it is discovered incidentally when obtaining a complete blood count test. The etiology usually is not obvious, and additional investigation is required. The aim of this pilot study was to investigate the clinical prevalence for a primary disease or comorbidity on the diagnosis for thrombocytopenia among general practitioners. We collected and analyzed data from medical histories of 45 GPs patients with thrombocytopenia. Most patients had thrombocytopenia as comorbidity (84.5%) compared to those who had thrombocytopenia as main disease (15.5%).The frequency of laboratory phenomenon called pseudothrombocytopenia (a low platelet count resulting from a laboratory artifact) was 2.2%. There was no thrombocytopenia associated as a side effect of COVID-19 vaccine among patients. This collected data and the results showed that the incidence of thrombocytopenia is more often diagnosed as comorbidity and less as a primary disease. Although pseudothrombocytopenia is a rare condition it is mandatory to differentiate it from true thrombocytopenia. Further research is required to explore the links between possible interactions with SARS-CoV-2 vaccines and thrombocytopenia.

24 metų moteris 2019 m. rugsėjo 19 d. dėl dešinės juosmens pusės skausmo, plintančio į dešinįjį petį, karščiavimo iki 37,5 oC temperatūros kreipėsi į VšĮ RVUL skubiosios pagalbos skyrių.

Background: Infective endocarditis (IE) is a life-threatening disease associated with serious complications, including heart failure, usually because of severe valvular insufficiency, and embolic stroke. Significant changes have been reported in IE epidemiology concerning pathogens and patients’ characteristics. The clinical features of IE have significantly changed as well as the role of pathogens. Despite trends toward earlier diagnosis and surgical intervention, in-hospital mortality rates have not improved over the last three decades. Therefore, the analysis of in-hospital mortality factors becomes important. The purpose of the present study was to determine in-hospital mortality factors among patients with IE in the Department of Cardiology, of our University Clinics in the period 2014-2017. Methods: Retrospective analysis of IE cases (N=135) at our University Clinics Cardiology department during the period 2014-2017. 78 males (57.8 % and 57 females (42.2 %) were investigated. Data collected about IE clinical features, course, complications, pathogens. Package "SPss 19.0" was used in the statistical analysis. Primary, the distribution of the investigated variables (gender, age, IE forms, pathogens, complications) among dead and survivors was evaluated, compared and tested for statistical significance. Secondly, the multifactorial logistic regression analysis was performed to reveal the significant independent in-hospital mortality related factors. Results: Primary IE was defined in 45 patients (33.3%), secondary IE in 90 patients (66.7 %), prosthetic valve IE in 40 patients (30.3 %). When analysing clinical forms of IE, the most common was classical IE clinical form (38.5 %), heart failure form presenting as acute heart failure in 20.0 % cases, pulmonary form in 8.9 % of cases. Septic shock was in 7.4 % of cases, embolic events were determined in 25.9 % of cases, renal failure in 55.6 %, severe heart...[...].

Aktualumas. Infekcinis endokarditas (toliau – IE) yra klastinga, širdies vožtuvus pažeidžianti infekcinė liga, dažnai sukelianti organų funkcijos nepakankamumą. Nepaisant naujų diagnostikos ir gydymo metodų taikymo, sergančiųjų šia liga mirštamumo rodikliai nemažėja. Kinta jos manifestavimo formos, eigos ypatumai, sukėlėjo reikšmė, todėl aktuali šios ligos hospitalinio mirštamumo priežasčių analizė. Tyrimo tikslas. Išanalizuoti Lietuvos sveikatos mokslų universiteto (toliau – LSMU) ligoninės Kauno klinikų Kardiologijos skyriaus 2014-2017 m. hospitalinio mirštamumo nuo infekcinio endokardito priežastinius veiksnius. Tiriamieji ir tyrimo metodai. Atliktas retrospektyvinis tyrimas. Tiriamųjų grupę sudarė LSMU ligoninės Kauno klinikų Kardiologijos skyriaus pacientai (N=135): 78 vyrai (57,8 proc.) ir 57 moterys (42,2 proc.), 2014-2017 m. gydyti dėl IE. Surinkti duomenys apie IE formas, eigos ypatumus, komplikacijas, sukėlėjus. Statistinė analizė atlikta naudojant SPSS 19.0 programos paketą. Tyrimo pradžioje lygintas kintamųjų (lyties, amžiaus, IE formų, sukėlėjų, komplikacijų) pasiskirstymas tarp mirusių ligoninėje nuo IE ir išgyvenusių pacientų, vėliau atlikta daugiaveiksnė logistinės regresijos analizė, siekiant įvertinti nepriklausomus priežastinius hospitalinio mirštamumo nuo IE veiksnius. Rezultatai ir apibendrinimas. Pirminiu IE sirgo 45 ligoniai (33,3 proc.), antriniu – 90 (66,7 proc.). Protezuoto vožtuvo IE nustatytas 40 ligonių (30,3 proc.), 92 (69,7 proc.) IE pažeidė natyvinius vožtuvus. Dažniausiai (38,5 proc. atvejų) liga manifestavo klasikine forma, 20,0 proc. – širdies nepakankamumu, 8,9 proc. plautine forma, 7,4 proc. atvejų pasireiškė sepsis su šoku. [...].