Donielaitė, Gytė

Vėjaraupiai - tai virusinė infekcija, sukeliama tik žmogui patogeniško Varicella-Zoster viruso (VZV), pasireiškianti karščiavimu, odos ir gleivinių išbėrimu. Pirmą kartą užsikrėtus VZV, susergama vėjaraupiais ir, nors persirgus įprastai įgyjamas ilgalaikis imunitetas šiai ligai, virusas lieka nervinių mazgų neuronuose visą gyvenimą. Nors dažniausiai ligos eiga gana lengva, vėjaraupiai gali sukelti sunkias odos, kvėpavimo takų bei neurologines komplikacijas. Neurologinės vėjaraupių komplikacijos sąlyginai retos, tačiau jos yra viena dažniausių vėjaraupiais sergančių pacientų hospitalizacijos priežasčių. Vaikams dažniausiai nustatomas ūminis cerebelitas, pasireiškiantis ataksine eisena, nistagmu, dizartrija. Įprastai ligos prognozė gerybinė, tačiau retais atvejais gali likti ir ilgalaikių liekamųjų reiškinių. Vakcinacija yra patikimiausia apsauga nuo vėjaraupių bei jų komplikacijų.

Aims/Purpose: To determine the cause and progression of chronic kidney disease (CKD) among children diagnosed with cystic kidney diseases in our outpatient clinic. Methods: A retrospective cohort study was conducted, analyzing the registration data of outpatient clinic between the years 2011 and 2021. Inclusion criteria were children consulted by a pediatric nephrologist and diagnosed with a cystic kidney disease. We analyzed the included patients’ medical data, determining the diagnosis, age at diagnosis, presence and progression of CKD at diagnosis and after 1, 5, and 10 years. Results: A total of 139 children were consulted for cystic kidney diseases during the study period. 75 children were diagnosed with nonspecific cystic kidney disease or uncomplicated single cysts. No patients in this group developed CKD during the study period. 31 children were diagnosed with a multicystic dysplastic kidney (MDK), 14 (45.2%) were boys. 14 (45.2%) were diagnosed under 12 months of age, 9 (29%) at an age of 1-9 years and 8 (25.8%) at an age of 10-17 years. None had CKD at diagnosis, 1 patient (3.2%) developed stage 2 CKD within 5 years after diagnosis with no further progression during the study period. 24 children were diagnosed with autosomal dominant polycystic kidney disease. 10 (41.7%) were boys, 7 (29.3%) were diagnosed under 12 months of age, 8 (33.3%) at an age of 1-9 years and 9 (37.5%) at an age of 10-17 years. None developed CKD. 9 children had autosomal recessive polycystic kidney disease (ARPKD), all diagnosed in infancy. 7 (77.8%) were boys. At diagnosis, 2 (22.2%) had CKD, stages 3 and 4, the latter patient developed stage 5 within 10 years. One patient with no CKD at diagnosis developed stage 5 within 1 year. At 5 years from diagnosis, one patient had newly developed CKD stage 2 and one CKD stage 3. 4 patients did not develop CKD during the study period, most likely due to insufficient data (single visits without long-term monitoring). Conclusion: Most cystic kidney diseases in children are self-limiting and do not result in CKD. Only 3.2% of children with MDK had a reduction in glomerular filtration rate, confirming the unilateral presentation of the disease and good compensation in children with a single functioning kidney. Although rare, ARPKD represents most of the CKD burden in children with cystic kidney diseases.

Aims/Purpose: To analyse the frequency of clinical presentations and the need for renal replacement therapy (RRT) in children with the typical hemolytic uremic syndrome (tHUS) during the hospitalization and 6 months after the discharge. Methods: 26 case histories of children with clinical diagnosis of tHUS who were treated in LSMU Hospital Kauno klinikos between 2007-2022 were analyzed in this retrospective study. Data of sex, age, hospitalisation period, RRT, mortality and clinical presentations of the patients at the time of arrival, discharge and 6 months after the discharge were evaluated. Results: 26 patients formed the study group: n = 16 (61.5%) boys and 10 (38.5%) girls. The median age at the time of hospitalization was 22 (7-90) months. Median hospitalization period was 14.5 (4-66) days. 61.5% (n = 16) of the patients arrived for the follow-up visit 6 months after the discharge. 61.5% (n = 16) of the children developed arterial hypertension during the acute period of the disease, which remained in 62.5% (n = 10) from them at the time of discharge and in 37.5% (n = 6) 6 months after. 23.1% (n = 6) of the patients experienced temporal disturbances of consciousness during the hospitalization. Although proteinuria was found in all the patients at the time of arrival (median proteinuria 3 (0.5-6.0) g/l), in half of them (50%, n = 13) it disappeared during hospitalisation. Proteinuria remained in 37.5% (n = 6) of those who arrived for the follow-up visit. All the patients presented with hematuria (38.5% with macrohematuria) which remained in most of these cases (46.2%, n = 12) at the discharge. At the time of arrival, kidney dysfunction was found in 76.9% (n = 20) patients (median creatinine level of 196.5 (23-619) μmol/l and urea level of 26.85 (2.8-49.6) mmol/l). 26.9% (n = 7) of the children developed anuria. RRT was applied in 50% (n = 10) of the children with a median duration of 12 (4-48) days. Hemodialysis was a primary choice in most (80%, n = 8) of these patients. Remaining kidney function impairment at discharge was observed in 42.3% (n = 11) but only in 6.3% (n = 1) 6 months after. No deaths appeared in the study sample. Conclusion: In most patients who developed proteinuria and arterial hypertension during the acute phase, it remained 6 months after the discharge. Even though RRT had to be performed in more than a third of the patients, remaining kidney function impairment 6 months after the discharge was only found in 1 patient.

Background Global COVID-19 pandemic significantly impacted everyday life. Vaccine development brought possibility to control SARS-CoV-2, nevertheless, many controversies and prejudice regarding efficacy and safety of immunization emerged. Objective To assess adolescents’ attitude to immunization against COVID-19 and investigate factors associated with vaccination hesitancy. Methods The anonymous questionnaire was used. Children 12-17y were questioned about COVID-19 disease and vaccination, their parents‘ vaccination status and their viewpoints on children’s immunization. Answers were collected between April and December 2022. Data were analyzed with SPSS 28.0. P value <0.05 was considered significant. Results 42 adolescents participated in the survey. Mean age-15.14±1.52y. 78.6% were vaccinated according to the national immunization schedule. Almost half of children (47.6%) received COVID-19 vaccine and considered the benefit outweighs the risk (p<0.005). The correlation between inoculated children and caregivers was observed-vaccinated parents tended to vaccinate their child (p<0.005). Parents’ (57.1%) or physicians’ (31%) attitude was a major factor in forming children’s perception toward immunization. 50% of teenagers presumed the vaccines to be completely or partially effective and safe. Awareness of vaccination was estimated positively by 35.7% of children, 45.2% evaluated their knowledge as average,16.7% were lacking information. The majority of respondents concurred with their parents’ viewpoint about immunization-50% of parents were unanimously positive,38.1% against vaccination. 4.8% preferred to be inoculated regardless of opposite parents’ belief. Only 1 child did not agree with vaccination. Unvaccinated adolescents showed no interest to be inoculated (p<0.005). Conclusion Almost a half of respondents have been vaccinated against COVID-19 disease and assented to the statement that vaccines are effective and harmless. The children’s attitude toward immunization was frequently affected by parents’ attitude.

Background During the global SARS-CoV-2 pandemic, the development of COVID-19 vaccines made significant changes in the healthcare system. However, it brought additional uncertainty and prejudice about the effectiveness and harmfulness of children’s immunization. Objective To evaluate parents’ perception toward their children’s vaccination status against SARS-CoV-2 virus-induced COVID-19 disease and determine factors leading to vaccination refusal. Methods The anonymous questionnaire was used to comprehend the parents’ attitudes regarding childhood SARS-CoV-2 vaccination against. Caregivers of 5 to 17 years old children were questioned about their child’s immunization status, COVID-19 illness, knowledge and opinion about vaccines against SARS-CoV-2 and their own vaccination status regarding COVID-19. The responses were collected between April and December 2022. Statistical analysis was performed with “IBM SPSS 28.0”. P value <0.05 was considered significant. Results Total of 123 parents answered the survey. The mean age of their children was 9.46±3.72y. 88.6% of children were vaccinated according to the national immunization schedule and 27.6% had received additional vaccines. Majority of respondents (69.1%) obtained a COVID-19 inoculation themselves, nonetheless, only 12.2% vaccinated their children. Despite the low rate of children vaccination, 41.5% of parents stated that COVID-19 vaccines are completely effective for children. A majority assessed their knowledge about vaccination as average or fine (47.2%,44.7% respectively). 50% of respondents looked for additional information about immunization in social media (68.3%) or consulted a family physician/pediatrician (55.3%). The main hesitancy about children’s vaccination was the lack of information about safety of immunization for children (p<0.005), 52% expressed concern of side effects. Conclusion Almost a half of respondents came to an agreement that data about safety of COVID-19 vaccines for children were lacking. Most parents presumed the substantial impact on their attitude for children’s vaccination was related to concern of complications.

Background and objectives. A synthetic ACTH stimulation test is a gold standard to detect occult adrenal insufficiently. The advantages of the test are the ability to perform it at any time and well-known normal or pathological levels of cortisol during the test 30 or 60 minutes after the injection of synthetic ACTH. The aim. Of the work was to find out how often ACTH stimulation test was performed at the Kaunas Endocrinology Center in 2014-2017. Material and methods. Medical documentation of 1471 patients (764 - 52% - women, 707 - 48% - males) was performed for 3 main reasons: 1100 -for investigation of importance of DHEAS in males, 220 - for investigation of adrenal function in ENSAT study and 151 patients for the recent study of clinical expressions in the patients with adrenal tumors. Since cortisol is the most important vital hormone of the adrenal glands, we analyzed the conditions under which it was studied. Results. A suppression test of 1 mg of dexamethasone was usually performed. It was followed by small or high dose dexamethasone suppression tests. It was not possible to determine what time of day cortisol was tested. Of 1471 patients no patient could be found who underwent an ACTH stimulation test. [...].

In men, prolactinomas are diagnosed in around their 40- 50- ties, and only incidentally – in younger persons. The main symptoms of prolactinoma in men are non-specific: headache, decrease of libido, erectile dysfunction and sign – gynaecomasty. Here we descibe an incidental aggressive oligosymptomatic macroprolactinoma in a 25-yearold man, with very good response to medical treatment as well as predictable consequences (2 ) of COVID-19 – related restrictions on the chronically ill patients. Case report. A 25 years old man was admitted to the hospital after falling off the harvester during fieldwork in 19 May 2018. An MRI scan revealed a large (30.3x23.4x22mm) previously unsuspected heterogeneous mass of a pituitary tumour with the invasion into the right cavernous system with the prolabation of the tumour into sphenoid synus. Prolactin was 100 fold upper limit of normal. LH, FSH, testosterone were low. DHEAS was 1.75 fold upper limit of normal. The treatment with bromocriptine had been initiated 2,5 mg/d, gradually increasing to 5 mg/d. Macroadenoma shrank by 45% with decrease of invasion to cavernous space. Serum prolactin decreased to normal levels. LH, FSH and T levels, despite the gradual increase, remained low. As the patient’s mother explained, following the limitations of movement and healthcare access during the Covid-19 pandemic, the patient experenced difficulties continuing his regular visits to the endocrinologist and stopped bromcriptine intake. He intrerupted bromocriptine for 3 months, and repeated MRI scan revealed the increase of the tumour by 50% comparing to the latest scan. Progression of invasion to the right cavernous sinus was also prominent.. After the patient restarted the treatment with bromocriptine (5 mg/d), prolactin quickly decreased to normal levels (70 mU/l). Among many other lessons, COVID-19 pandemic made medical professionals reanalyse and improve medical care in conditions of reduced direct contact to assure the optimal management for patients with chronic illnesses. This is especially important for majority of endocrine diseases, which are oligosymptomatic or asymptomatic.

Objective. To investigate the significance of DHEAS assessment in males of different ages. Methods. Retrospective cohort study of patients investigated in two large academic centres. Results. The data of DHEAS assessment of 3533 patients (3013 females and 520 males) was analysed. DHEAS was 1.6 - 13.5 times more frequently investigated in women than in men. A peak of DHEAS evaluation test for women was at 25 years old and distribution was uniform in males over decades, excepting being lower in 0-9 and 75+ages. In the age group 10-24 years, DHEAS levels were higher in females. After 45 years, DHEAS was higher in men than in women. Analysis of 510 case records showed low DHEAS levels in boys (0-9 years) and in men aged 65 84+. Higher DHEAS levels were detected as a peak at 30 years old, but never after 55 years. In individuals with low DHEAS levels prevailed congenital adrenal hyperplasia (32%), adrenal tumours (30%) and primary or secondary adrenal insufficiency (19%). High DHEAS levels prevailed in patients with arterial hypertension (26%), overweightobesity -(19%), non-toxic goiter (17%) and alopecia (9%). In the normal DHEAS miscellaneous diagnoses were met most frequently - 40%. Disorders exceeding 5% were non-toxic goiter (19%), adrenal tumours - 17%, overweight/obesity 16% and arterial hypertension- 8%. In 71 women and 124 men adrenal neoplasms were detected. Higher frequency of these was observed in women in their 30s. A peak of adrenal neoplasms in men was at their 70s. This gender difference was not conditioned by earlier attempts to seek medical care by women. A significant correlation of DHEAS, weight, body mass index and systolic blood pressure with diastolic blood pressure was found. Conclusion. Our study permits to determine which DHEAS secretion and clinical pattern might be associated in males of different ages.

Introduction Sepsis is a clinical syndrome resulting from an inadequate systemic inflammatory response to infection [1]. Sepsis is conditioned by many risk factors (RF) such as early medical interventions, hospitalisation period, chronic illnesses, immunocompromise and others [2]. However, it is crucial to treat sepsis with empirical antibiotic therapy as early as possible, taking in mind patient’s age and the probable site of the infection [3]. Aim To analyze microbiological etiology of sepsis and its coherence with RF as well as the frequency of clinical presentations and mortality in various children age groups in 2017-2018 at Kaunas Clinics PICU. Methods 33 case histories of patients with the clinical sepsis diagnosis who were treated in Kaunas Clinics PICU between January 2017 and June 2018 were analyzed in this retrospective study. Data of sex, age, hospitalization period (HP), primary infection site (PIS), mortality, causative pathogen (CP), RF and clinical presentations of the patients were evaluated. The patients were divided into 4 age groups as follows: I 0-28 d; II 29 d - 1 yo; III 2-6 yo; IV 7-18 yo. Statistical analysis was performed using “IBM SPSS 23.0”. Results 33 patients formed the study group: 19 boys (57,6%) and 14 girls (42,4%). Mean age was 2,88 ± 5,07 years. II age group was the biggest (57,6%). HP ranged from 1 to 153 days, mean length was 28,15 ± 35,08 d. 51,5% of patients had at least 1 RF and 24,2% had 2 or more. The most common RF for sepsis was chronic disabling condition (21,2%) followed by medical intervention and hospitalization in PICU (15,2% each). PIS and CP were identified in 69,7% of cases. Most frequent PIS were genitourinary tract and bloodstream (21,2% each). Predominant CP of sepsis was bacterial species (57,6%). G+ and Gbacteria frequency was similar (47,4% vs 52,6%). Most frequently found CP were S. aureus and Aspergillus spp. (15,2% each). In 22,2% of cas... [...].

Background: Turner syndrome (TS) occurs in approximately 1 in 2500 live female births. The frequency of pregnancies in TS patients is 2-5%. However, these pregnancies are at high risk of recurrent miscarriage, malformations in the children and poor cardiovascular outcomes in pregnant TS females. Case Presentation: A 34 year-old woman was diagnosed with TS (46XX/46Xr) at age 9. From 16 to 20 years old she was treated with sex hormone replacement therapy and had regular menstrual cycles (MC 28/5). Physical examination at age 18 showed: weight 50 kg, final height 151,7 cm, BMI 21,92 kg/m², pubertal stage P5, B5. Patient did not have any cardiovascular or other organ pathologies neither before nor after pregnancies. After withdrawal of hormonal therapy she continued to have regular menstrual cycles (MC 30/5). Woman conceived naturally at 22, 24 and 28 years. All three newborns were born at full-term by cesarean section due to fetopelvic disproportion. 1st child, a girl, was born healthy, weighing 3460 g. Subsequent growth and development were normal. 2nd child, a boy, was born healthy, with 3660 g. He was diagnosed with growth retardation at age 3 but did not require treatment with growth hormone. 3rd child, a boy, was born weighting 4160 g. He was diagnosed with cleft lip and cleft palate at birth. These malformations were repaired by surgery. No maternal or pregnancy complications were detected. Conclusions: Pregnancy and child bearing in TS can be particularly challenging due to maternal and neonatal complications. All TS pregnancies should be under multidisciplinary supervision during pregnancy and after delivery.