Radzevičienė, Lina

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. [...]

Background and Objectives: Diabetic retinopathy (DR) is a major microvascular complication of diabetes mellitus (DM) and a leading cause of blindness among working-age adults. Advanced glycation end products (AGEs) contribute to DR pathogenesis through oxidative stress and inflammation. This study aimed to evaluate the association between AGE levels and DR severity in Lithuanian patients with type 1 (T1D) and type 2 (T2D) diabetes. Materials and Methods: An observational cross-sectional study enrolled 152 patients with T1D and T2D from a tertiary university hospital. AGE values were measured with a non-invasive AGE Reader device. DR severity was assessed through ophthalmological examination. Results: The overall DR prevalence was 54.6%. AGE values increased with the severity of DR, though not significantly between the DR groups (p = 0.386). The mean AGE value was higher in T2D compared with the T1D group (2.429 vs. 2.217, p = 0.011). In T1D, AGE values were higher in the advanced DR group compared with the non-DR patients (2.445 vs. 1.905, p = 0.007), whereas no significant difference was found in the T2D subgroups. In T1D, AGEs correlated positively with both DM duration and higher HbA1c (p < 0.05). Patients with AGE values > 2.35 in T1D and 2.15 in T2D had an increased likelihood of having advanced DR. Patients in the non-DR group had significantly lower AGE values compared to those in the advanced DR group (OR = 0.118, 95% CI 0.025–0.566, p = 0.008). Conclusions: AGEs measured using skin autofluorescence may indicate DR severity in T1D but not in T2D and might not be a suitable standalone risk predictor. DM duration remains a significant determinant of advanced DR, highlighting the importance of early monitoring and timely intervention.

Aim To investigate quality of life (QoL) in patients with type 2 diabetes (T2DM) experiencing low perceived psychological stress level and high perceived psychological stress level. Methods Perceived psychological stress level and QoL were assessed in 146 patients with T2DM (57 men, 89 women, age 56.7G12.6 years, T2DM duration 7.4G6.9 years, body mass index (BMI) 33.6G5.7 kg/m2 , HbA1c level 7.7G1.6%), using Perceived Stress Scale (a higher score denotes a higher level of stress) and WHO Bref Quality of Life questionnaire (a higher score denotes better QoL). Results. Patients with high perceived stress level had lower scores in physical health (10.9G 1.6 vs. 13.9G2.4, P!0.001), psychological health (11.4G2.8 vs. 13.7G2.1, P Z 0.018), and social relations domains (12.3G1.9 vs. 13.6G2.6, P Z 0.038) than those with low perceived stress level. No significant differences were found in QoL environmental domain as well as in age, T2DM duration, BMI, HbA1c level between patients experiencing low and high perceived stress. Perceived stress level in patients with T2DM correlated negatively with QoL physical health score (rZ -0.255, P Z 0.015). In conclusion. Patients with type 2 diabetes experiencing high perceived psychological stress level have worse quality of life in terms of physical health, psychological health and social relations than those with low level of perceived psychological stress.Perceived stress level in patients with type 2 diabetes is related to physical health.

Prolonged hyperglycemia results in the formation and accumulation of complex and heterogeneous groups of compounds - advanced glycation end-products (AGEs) that increase oxidative stress and induce inflammatory reaction, which exacerbate the occurrence and progression of diabetic complications. The project “Integrated model for personalized diabetic retinopathy screening and monitoring using risk-stratification and automated AI-based fundus image analysis – PerDiRe” involved data on type 1 diabetes (T1D) and type 2 diabetes (T2D) patients from four countries - Latvia, Lithuania, Estonia, and Norway, on two consecutive annual visits. The project was funded by EEA-RESEARCH-60 grant. The objective of this substudy was to assess the relationship between AGE levels and diabetic retinopathy (DR) course in patients with diabetes across all four countries. Methods 410 patients with diabetes attended the initial visit, and 226 patients returned for the 1st year follow-up. At both visits, the patients with diabetes underwent full ophthalmological and diabetes-specific clinical examinations. The patients were stratified according to the DR status as follows: no retinopathy, non-proliferative (simple) retinopathy, proliferative retinopathy, and diabetic macular edema. AGEs were measured non-invasively using an AGE Reader device (DiagnOptics Technologies B. V., SN 00010604, Netherlands). AGE z-scores were calculated with the formula: AGE z-scoreZAGE mean-(0. 024*age, yearsC0. 83). Results During the initial visit, 47. 3% (n Z 194) of the patients had some form of DR. By the second visit, 52. 2% (n Z 118) presented with DR (PZ0. 23). 9. 3% of the study subjects experienced progression to a more severe stage of DR (P!0. 05). A significant change in DR severity from first to second visit was found only within the T2D group (P ! 0. 05). During both visits, T2D patients had significantly higher median AGE values and z-scores, compared to T1D (P ! 0. 001). Patients with T1D exhibited a statistically significant increase in median AGE values and z- scores at the second visit compared to the first one (P ! 0. 05 for both measures). Conversely, patients with T2D showed no significant change in either AGE values or AGEs z-scores between the two visits. In both groups combined, marginal means of AGE values and z-scores increased significantly with progression of DR stages during both visits (general linear models’ P ! 0. 001). Conclusions The results indicate a notable change in the distribution of DR stages between the first and second visits, especially in T2D. AGE levels were significantly higher in T2D patients and were directly related to more advanced stages of DR.

Background. Obstructive sleep apnea (OSA) is a chronic sleep disorder characterized by repeated episodes of the upper airway obstruction during sleep, resulting in hypoxemia, hypercapnia, sleep fragmentation. Individuals with sleep apnea are often unaware of their breathing difficulties during sleep, leading to frequent underdiagnosis of the condition. If left untreated, OSA can lead to hypertension, cardiovascular diseases, neurocognitive impairments, and metabolic dysfunction. OSA is frequently associated with type 2 diabetes (T2D), with prevalence reaching up to 86%, particularly among obese diabetic patients. OSA increases cardiovascular risk and is associated with high oxidative stress levels and inflammation. Under conditions of increased oxidative stress, the accumulation of advanced glycation end-products (AGEs) is accelerated. Higher AGEs levels are associated with metabolic syndrome, cardiovascular disease, and diabetes-related complications. This study aimed to analyze the relationship between AGEs levels and the presence of OSA in patients with diabetes. Materials and methods AGEs concentration in the skin was non-invasively measured using AGE Reader in 117 patients with type 1 diabetes (T1D, n Z61) and T2D (n Z56), with low (nZ39), intermediate (n Z42) and high (n Z36) risk of OSA. The STOP-BANG questionnaire, validated and adapted for Lithuanian patients, was used. High risk for OSA was defined by as any of the following: a total score of 5-8 points; positive responses to R2 of 4 questions plus male gender or plus BMI O35 kg/m2 or plus neck circumference R40 cm. Intermediate risk was defined by 3-4, low risk by 0-2 positive answers. Data on patients’ clinical characteristics were collected from medical records. Results The median diabetes duration was 16 years (range1-60), age – 56 years (range 20- 81). The study cohort consisted of 67 (57.3%) women and 50 (42.7%) men. The risk of developing OSA significantly depended on gender (P!0.001) and type of diabetes (P!0.001). Men and patients with T2D have higher risk of developing OSA compared with woman and patients with T1D. There were no significant associations between OSA and HbA1c or the duration of diabetes (P Z 0.602 and P Z 0.267, respectively). However, we revealed a progressive increase in AGE median values as OSA risk increases (P!0.05). Conclusions Patients with T2D, particularly males, demonstrate a higher risk of developing OSA. Our findings suggest that non-invasive measurement of skin AGEs could be useful additional tool for OSA risk evaluation as the association between higher AGEs levels and OSA risk shows the potential role of oxidative stress in the pathophysiology of both conditions.

Diabetic kidney disease (DKD) is a serious diabetes complication caused by both environmental and genetic risk factors. Previous genome-wide association studies (GWAS) have identified several loci associated with kidney function and kidney disease in the general population and, to a lesser extent, in diabetes.

Introduction Intrathyroidal parathyroid adenoma is a rare anomaly with an incidence of 1.4-6% [1]. Case Presentation A 67 – years old female patient presented with 3 years of general and muscle weakness, fatigue. Anamnesis: partial gastrectomy due to stomach carcinoma, hysterectomy, osteoporosis. In the laboratory tests were found increased levels of PTH, calcium, anti-TPO and low level of vitamin D. Patient was treated with Colecalciferolum 25000 TV. In dynamics PTH increased from 26,47 to 210 pmol/l, calcium from 2,71 to 2,79 mmol/l over 4 months. Thyroid ultrasound showed EU-TIRADS 3-4. During physical examination thyroid gland was mobile, a mobile induration was palpable, no peripheral lymph nodes were detected. After 18 months thyroid ultrasound was repeated and FNA was performed. In biopsy: epithelium hyperplasia (III category of Bethesda). Thyroid scintigraphy performed: radiopharmaceutical-accumulating nodule in the right lobe of the thyroid (possibly adenoma). Radiopharmaceuticalaccumulating parathyroid glands were not visible. Radiologist suggested FNA with staining due to parathyroid gland adenoma, based on repeated thyroid scintigraphy and FNA after 4 months. It showed parathyroid gland tissue in the thyroid. Multidisciplinary team performed right hemithyroidectomy - removing right thyroid lobe with intrathyroidal hyperplastic parathyroid gland. After the biopsy report, the final diagnosis: right parathyroid gland adenoma. Status post right hemithyroidectomy. Autoimmune thyroiditis (euthyrosis). Osteoporosis. Discussion Primary hyperparathyroidism (PHPT) is a common endocrine disease. Intrathyroidal parathyroid adenoma (ITPA) is a rare reason for PHPT and site of ectopia [2]. The latter may be located ectopically in 11-25% of cases [1]. Clinical scenarios in which an ectopic parathyroid adenoma should be considered in clinical practice include patients with PHPT in whom preoperative imaging suggests the presence of an ectopic parathyroid adenoma or initial preoperative imaging fails to identify a target adenoma [3]. Conclusions Intrathyroidal parathyroid adenoma is rare disease in patient with PHPT. Diagnosis and management are challenging, and it requires a combination of tests.

Some studies suggest that Advanced Glycation End products (AGEs) formation represent important and interconnected pathogenic mechanisms in diabetic retinopathy (DR). The aim of this study was to investigate the association of AGEs products with DR in a cohort at Hospital of LHUS. Methods It was a cross-sectional study of a cohort of adults with type 1 or 2 type diabetes (T1D/T2D). Results 78 patients with T1D and 81 with T2D were recruited. The overall incidence of any DR was 50.9 %. The prevalence of DR was significantly higher among patients with T1D compared to T2D group (70.5 vs 32.1 %, P!0.001). Patients with T1D had higher risk for DR in comparison to T2D (OR 5,059 [2,578-9,927], P!0.001). Univariate logistic regression revealed that higher risk for DR in T1D was related with diabetes duration O 11 years OR 60,563 [13,75-266,752], P!0,001, mean AGE Reader levelO1,8 OR 6,947[2,242-21,526], PZ0,003, male gender OR 2,938[1,007-8,569] (PZ0,044) and dyslipidaemia OR 3,231[1,103-9,464] (PZ0,029). Higher risk for DR in T2D was related with diabetes duration O 13 years OR 4,604 [1,701-12,462], PZ0,002, OR 6,947 [2,242-21,526], P!0,001 and albuminuria O6.3 mg/24 hrs OR 10,431[2,681- 40,586], PZ0,001. In binary logistic regression analysis, the highest risk for DR was associated with dyslipidaemia OR 6 (0.99-36.26) PZ0.051 and diabetes duration O 11 years OR 76 (13.63-423.73), P!0.001 in T1D. In T2D DR was associated with HbA1c O 7.5 % OR 7.42 (2.23-24.58), PZ0.001 and diabetes duration O13 years OR 4.35 (1.42-13.34), PZ0.01. Conclusions Diabetic retinopathy prevalence in Lithuanian cohort was 50.9 %. Patients with T1D had a five times higher risk for DR in comparison to T2D. In univariate models, DR in T1D was significantly associated with mean AGE score, diabetes duration, male gender and dyslipidaemia, in T2D - with HbA1c level, increased albuminuria level and diabetes duration. In binary logistic regression analysis, diabetes duration remained the most significant predictor for DR in both types of diabetes. T1D patients with diabetes duration O 11 years and T2D patients with diabetes duration O 13 years, will have the highest rate risk of DR.

Aim to assess sleep quality in patients with type 2 diabetes (T2D) experiencing low perceived psychological stress and high perceived psychological stress. Methods Perceived stress level and sleep quality were assessed in 154 patients with T2D (58 men, 96 women, age 58.7G11.8 years), using Perceived Stress Scale (a higher score denotes a higher level of perceived stress) and Pittsburgh Sleep Quality Index (a higher score denotes worse sleep quality). Results Patients with T2D with high stress level had worse subjective sleep quality (PZ0.027), higher use of sleeping medication (PZ0.023), daytime dysfunction (P!0.001) than those with low stress level. No significant differences were found in sleep latency, sleep duration, habitual sleep efficiency and sleep disturbances as well as in T2D duration, body mass index and glycated haemoglobin (HbA1c) level between patients experiencing low and high perceived stress. Perceived stress level in patients with T2D correlated with subjective sleep quality (rZ 0.260, PZ0.002), sleep duration (rZ0.228, PZ0.005), use of sleep medication (rZ0.245, PZ0.004), daytime dysfunction (rZ0.326, P!0.001). In conclusion, patients with type 2 diabetes experiencing high perceived psychological stress level have worse subjective sleep quality, higher use of sleeping medication, daytime dysfunction than patients experiencing low perceived stress level. Perceived stress level in patients with type 2 diabetes is related to subjective sleep quality, sleep duration, use of sleep medication, daytime dysfunction

Background Diabetic neuropathy (DN) is a major complication of diabetes, affecting one in three people with diabetes. The presence of peripheral neuropathy increases their risks of developing foot ulceration and subsequent necrosis that results in lower limb amputation. Good diabetes control helps to lower the risk of diabetic complications, which can be accelerated by advanced glycation end-products (AGEs) or alcohol consumption. AGEs are heterogeneous group of molecules, that normally accumulate slowly and in healthy people with natural ageing. Higher AGEs levels were associated with metabolic syndrome, cardiovascular disease, and diabetes-related complications such as DN. Alcohol consumption by persons with diabetes can worsen glucose control and diabetes-related medical complications, such as disturbances in fat metabolism or nerve damage. This study aimed to analyze the relationship between AGEs levels, patients’ alcohol consumption and the presence of DN. Materials and methods AGEs concentration in the skin was non-invasively measured using ultra-violet light to excite autofluorescence with AGE Reader in 151 patients (age 18-85): no DN (78), with DN (73). Data on patients’ clinical characteristics were collected from medical records and used to investigate associations between the presence of DN and the patients’ AGEs concentration and alcohol consumption. Results The median diabetes duration was 14 years, age – 55 years. The study cohort consisted of 83 (55.0%) women and 68 (45.0%) men. The presence of DN significantly depended on alcohol consumption (rcramer’sZ0.232, P!0.01). Patients who consume alcohol are more likely to have complications of DN than patients who do not consume alcohol (P!0.01). There were no significant associations between AGEs concentration and alcohol consumption (PZ0.232) and the presence of DN complication (PZ0.575). However, there was a positive correlation between AGEs concentration and age (rZ0.474, P!0.001), BMI (rZ 0.161, P!0.05), duration of diabetes (rZ0.293, P!0.001). The odds of developing DN is 2.57 (CI 1.33 – 4.96) times greater for people, who consume alcohol (P!0.01). Conclusions Patients consuming alcohol were more likely to have a DN complication. Alcohol consumption did not have any influence on the levels of AGEs.