Stiklioraitis, Simas

Introduction Hand-foot syndrome (HFS), also known as palmoplantar erythrodysesthesia or acral erythema, is a well-known adverse reaction to systemic chemotherapy. Clinical presentation includes palmoplantar pain, dysesthesia, or numbness, and is frequently followed by demarcated erythema, edema, fissuring, or scaling. High-grade events may include blistering and ulceration. The most common culprit medications include liposomal doxorubicin, docetaxel, 5-fluorouracil, and its prodrug capecitabine. Case report An 81-year-old male presented to the dermatology department due to severe pain and lesions in soles of both feet. From documentation it was discovered that the patient was diagnosed with stage III sigmoid colon adenocarcinoma and had received a 7th course of capecitabine chemotherapy two days prior. Upon clinical examination, sharply demarcated erythema and complete plantar desquamation was seen. A grade 4 capecitabine-induced hand-foot syndrome was diagnosed. The patient was started on a 30mg prednisone taper and wound treatment with topical chlorhexidine irrigation and paraffin gauze dressing applications every two days. Upon improvement, the patient was discharged and outpatient treatment with hydrocolloid dressings was recommended. The case was discussed in a multidisciplinary tumor board and further adjuvant treatment was discontinued. There were no HFS exacerbations after withdrawal of capecitabine, with a continuous reduction in HFS severity and improvement in the patient’s Activities of Daily Living (ADL). Conclusion HFS is a common side effect of capecitabine and can rarely present as a high-grade adverse event, requiring prompt treatment and modification of systemic chemotherapy regimens. Anticipation and early diagnostics can ensure a reduction in morbidity and an improvement in patients’ quality of life.

Introduction: COVID-19 pandemic has changed the way patients seek medical attention and the manner medical service is provided. Purpose: To examine the changes in patient characteristics, clinical course and rates of rehospitalization due to decompensated heart failure for patients admitted with acute myocardial infarction (AMI) during the COVID-19 pandemic compared to the corresponding period in the previous year. Methods: This is a region-wide, multicenter, retrospective cohort study of consecutive COVID-19 negative patients with AMI from March 11, 2020 to April 20, 2020 compared to patients admitted with the same diagnosis during the same period in the previous year. Six-month follow-up was obtained for all patients included in the study. Results: A total of 269 AMI patients were evaluated in this study. Pain-to-door times (858 [360, 2600] vs. 385.5 [200, 745] min, p < 0.0001) and troponin I levels (7.8 [2.6, 37.2] vs. 4.5 [1.1, 25.4] µg/l, p = 0.013) were significantly higher for AMI patients presenting during the pandemic. Similarly, NSTEMI patients had a significantly prolonged pain-to-door time during the pandemic than prior to it (2021 [960, 5746] vs 558 [369, 882.5] min, p < 0.0001) and there is evidence to suggest a trend toward longer door-to-wire times, as well (302.5 [179, 600] vs 200.5 [98, 434.5] min, p = 0.0948). furthermore, STEMI patients waited significantly longer before presenting to the hospital during the pandemic (582 [180, 1212] vs 262 [120, 525] min, p = 0.0003). However, door-to-wire times were similar (75 [53.5, 106.5] vs 71 [43, 119] min, p = 0.2257). Additionally, Post-revascularization ejection fraction was significantly lower for AMI patients during the pandemic (35 [30, 45] vs. 45 [40, 50] %, p < 0.0001). During follow-up we observed a significantly higher rate of re-hospitalization due to decompensated heart failure in patients admitted with NSTEMI and STEMI during the pandem[...].

The Coronavirus disease 2019 (COVID-19) pandemic has changed the way patients seek medical attention and how medical services are provided. We sought to compare characteristics, clinical course, and outcomes of patients presenting with acute myocardial infarction (AMI) during the pandemic compared to before it. This is a multicenter, retrospective cohort study of consecutive COVID-19 negative patients with AMI in Lithuania from March 11, 2020 to April 20, 2020 compared to patients admitted with the same diagnosis during the same period in 2019. All patients underwent angiography. Six-month follow-up was obtained for all patients. A total of 269 patients were included in this study, 107 (40.8%) of whom presented during the pandemic. Median pain-to-door times were significantly longer (858 [quartile 1=360, quartile 3 = 2600] vs. 385.5 [200, 745] mins, p<0.0001) and post-revascularization ejection fractions were significantly lower (35 [30, 45] vs. 45 [40, 50], p<0.0001) for patients presenting during vs. prior to the pandemic. While the in-hospital mortality rate did not differ, we observed a higher rate of six-month major adverse cardiovascular events (MACE) for patients who presented during vs. prior to the pandemic (30.8% vs 13.6%, p = 0.0006). In conclusion, 34% fewer patients with AMI presented to the hospital during the COVID-19 pandemic, and those who did waited longer to present and experienced more 6-month MACE compared to patients admitted before the pandemic.

Introduction. A case report of a patient diagnosed with angiomatoid fibrous histiocytoma, with rainbow pattern sign on dermoscopy. Case Description. A 31-year-old HIV-negative patient was referred to a tertiary dermatology clinic due to a slow-growing lesion on the right forearm, which bled upon trauma, present for 2 years. Physical examination revealed a blue-grey nodule 11x8 mm in size. On dermoscopy, a central brown structureless area with white structures, peripheral bluegray homogenous area, regular radial streaming, rainbow pattern and crystalline structures were seen. Siascopic examination registered blood displacement with erythematous blush and dermal melanin. Wide local excision and histopathologic investigation were performed. Microscopically, a poorly demarcated tumor of the reticular dermis was seen, with nests of spindle and ovoid cells dispersed within the collagen fibers, Touton giant cells, sparse erythrocyte-filled cystic spaces and abundant hemosiderophages. Diagnosis of angiomatoid fibrous histiocytoma was established, with no recurrence at 6 months follow up. Summary. The rainbow pattern dermoscopic sign present in angiomatoid fibrous histiocytoma – a rare soft tissue neoplasm with histologic features of nodular distribution of ovoid and spindle cells with blood-filled cystic cavities. Few specific clinical and dermoscopic features have been previously described, making early diagnosis challenging. Conclusion. Angiomatoid fibrous histiocytoma (AFH) is a rare tumor of intermediate biological behavior, most commonly occurring in children and young adults. It is difficult to diagnose clinically, with no established dermoscopic criteria. To our knowledge, this is the first description of the rainbow pattern dermoscopic sign for AFH, a feature most strongly associated [...]

Introduction. A case report of a male patient who was diagnosed with interstitial lung disease due to illicit stimulants abuse. Case Description. A 33-year-old man was found sleeping breathlessly. Resuscitation was initiated by his girlfriend until the paramedics arrived. Naloxone was injected. Signs of respiratory failure began appearing upon arrival at the emergency room. The patient was somnolent through examination, his limbs were cyanotic, saturation was 49 percent. Positive dynamics was observed after another naloxone injection. Toxicology screen had been carried out. Test results were positive for cocaine, amphetamine, 3,4-Methylenedioxymethamphetamine (MDMA), benzodiazepines, and opioids. A chest roentgenogram and a computed tomography scan show altered lung tissue. CT images show infiltration of ground-glass opacity (GGO) predominating in central parts of the lungs in all lobes. The radiograph shows infiltrates of GGO and interstitial edema in all parts of the lungs. Positive dynamics was observed radiologically during the treatment and lung aeration increased on both lungs in chest x-rays performed later. Summary. Illicit stimulants, such as cocaine, amphetamine, and their derivatives (e.g., “ecstasy”), continue to exact heavy toll on health care. Abuse of both inhaled and intravenous forms of these substances can result in a variety of acute and chronic injuries to practically every part of the respiratory tract, leading potentially to permanent morbidities as well as fatal consequences - including but not limited to nasal septum perforation, pulmonary hypertension, pneumothorax, pneumomediastinum, interstitial lung disease, alveolar hemorrhage, reactive airway disease, pulmonary edema, pulmonary granulomatosis, infections, foreign body aspiration, infections, bronchoconstriction, and thermal injuries. Conclusion. In the meantime, health care providers must be aware of the host of respiratory toxidromes-associated stimulant abuse to [...].

Streso echokardiografija, žinoma jau keletą dešimtmečių, dėl įstaigų politikos, specialistų nepakankamų įgūdžių ar kitų įvairių priežasčių, kol kas mažai kur taikoma technika. Tyrimas, skirtas vertinti vainikinių arterijų ligą, šiomis dienomis apima ir kitų patologijų diagnostiką, tokių kaip diastolinė disfunkcija ar širdies vožtuvų ligos. Procedūra gali būti atliekama taikant tiek fizinį, tiek medikamentais sukeltą krūvį. Pastaruoju atveju dažniausiai naudojamas preparatas yra dobutaminas, kurio dozė priklauso nuo tiriamo paciento klinikinių parametrų. Šiame straipsnyje glaustai apibendrinamos naujienos apie streso echokardiografiją, aptariamos tyrimo indikacijos, atlikimo struktūra, kliūtys bei galimos baigtys.

Įvadas. Sarkopenija yra su amžiumi susijusi būklė, kuriai būdingas raumenų silpnumas, sutrikusios fizinės funkcijos ir raumenų audinių kokybės pablogėjimas. Susidomėjimo sarkopenija priežastis yra akivaizdus šios ligos ryšys su pacientų sergamumu, mirštamumu, ilgai trunkančiu hospitalizavimu ir gyvenimo kokybės pablogėjimu. Šios apžvalgos tikslas – pristatyti kai kuriuos su amžiumi susijusius biologinius pokyčius, galinčius sukelti sarkopeniją. Medžiaga ir metodai. Literatūros apžvalga atlikta remiantis Medline (PubMed), Google Scholar, Science Direct ir CAIRN duomenimis. Tyrimas atliktas remiantis straipsniais anglų arba prancūzų kalbomis, paskelbtais iki 2019 m. gruodžio 31 d. Tyrimui buvo atrinkti medicinos mokslo straipsniai, kurių antraštėse rasti žodžiai: „sarkopenija“ ir „senėjimas“ arba „raumenų netekimas“. Rezultatai. Literatūros apžvalga atskleidė pagrindinius su amžiumi susijusių biologinių pokyčių, galinčių sukelti sarkopeniją, veiksnius. Šiai nesisteminei peržiūrai buvo panaudota 19 tyrimų. Analizuotos literatūros apžvalgos (N=5) ir nekontroliuojami tyrimai (N=14). Metodikos kokybė ribojo rezultatų aiškinimą ir ekstrapoliaciją. Kitas apribojimas buvo tyrimai, apimantys bandymus su gyvūnais. Tolesni tyrimai yra būtini, norint nustatyti panašių tyrimų koreliaciją tarp bandymų su gyvūnais ir žmonėmis. Išvados. Apžvalgoje aprašyta daugybė etiologinių veiksnių, sukeliančių su senėjimu susijusių raumenų masės ir funkcijos pablogėjimą, kurie konstatuoja sarkopeniją, pavyzdžiui, nesubalansuota baltymų sintezė ir skaidymasis, mažėjantys anaboliniai hormonai, uždegimas ir su amžiumi susiję morfologiniai pokyčiai. [...].

Background: The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, has had a major impact on the behavior of patients, as well as on the delivery of healthcare services. With older and more medically vulnerable people tending to stay at home to avoid contracting the virus, it is unclear how the behavior of people with acute myocardial infarction (AMI) has changed. The aim of this study was to determine if delays in presentation and healthcare service delivery for AMI exist during the COVID-19 pandemic compared to the same period a year prior. Methods: In this single-center, retrospective study, we evaluated patients admitted with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI) during early months of the COVID-19 pandemic (March 11, 2020 to April 20, 2020) compared to patients admitted with same diagnosis during the same period a year prior. Results: There were 30 and 62 patients who presented with NSTEMI in the pandemic and pre-pandemic eras, respectively. [...].

Obstrukcinė miego apnėja yra klinikinė būklė, kelianti grėsmę žmogaus sveikatai. Nuolatinio teigiamojo slėgio ventiliacija yra pagrindinis šios patologijos gydymo būdas, duodantis teigiamus rezultatus, tačiau jo netinkamas taikymas mažina gydymo efektyvumą. Plačiai žinomos įvairios alternatyvos, tokios kaip viršutinių kvėpavimo takų chirurginės operacijos, pakeičia tik anatominį obstrukcinės miego apnėjos komponentą. Per pastaruosius keletą dešimtmečių nemažai klinikinių tyrimų parodė, jog poliežuvinio nervo stimuliacija, kuri koreguoja anatominį ir neuromuskulinį patologijos komponentus, yra pažangus šios ligos gydymo pasirinkimas.

Introduction Percutaneous transluminal angioplasty (PTA) can be used to ameliorate tissue perfusion in ischemic diabetic feet. Nevertheless, there are concerns about its feasibility and efficiency in the severely ischemic diabetic foot. This case describes a successful diabetic limb preservation after PTA. Case report A 59 years old female patient who was diagnosed with type-II diabetes at age 36 two years ago worked in a garden and was injured. She was diagnosed with bullous erysipelas, ischemic diabetic foot. Her treatment included antibiotic therapy and left leg a.femoralis and a.poplitea sinistra PTA and a.tibialis anterior recanalization and PTA. Aspirin and clopidogrel were used for the prevention of restenosis. Dynamically, the condition was improving, with antibacterial therapy discontinued, however, in 2019.04, she was hospitalized in the Endocrinology department for the left foot finger gangrene with a spread to the pad. On 2020.02 she underwent finger resection and necrotic mass removal. She was given antibiotic therapy unasyn 1.5 g x 4 i/v and sol. vancomycin 1 g x 2 i/v. During the multidisciplinary consilium, it was decided to remove part of I metatarsal bone in the left foot. 2020.03.15 reconstruction and necrectomy of the proximal end of I metatarsal bone in the left foot was performed. Currently, the left foot has an exuding ulcer. Disscusion/conclusions Patients with diabetic foot remains a clinical and surgical challenge for surgeons. Primarily, peripheral revascularization aims to provide sufficient blood flow to relieve rest pain and facilitate skin wound healing. The results of PTA in diabetic patients have improved, with an acceptable limb salvage rate and perioperative mortality. However, even after successful revascularization local wound treatment must be continued and minor amputation might be performed if appropriate to defend limb salvage. As such, PTA can be an effective method for increasing.