Putriūtė, Lina

Kardiologinės kilmės ligos yra paplitusios ir dažnai tarp sveikais laikomų žmonių − sportininkų. Dažnai jos pasireiškia staigia mirtimi sporte. Svarbu, kad medicinos specialistai mokėtų atskirti patologijas sportininkų elektrokardiografinio tyrimo analizės metu, kad išvengtų ir sumažintų letalios baigties dažnį. Atliekant sportininko kardiologinę medicininę analizę ir vertinant jo elektrokardiogramą (EKG) galima rasti įvairių rezultatų, neatitinkančių normos ribų. Tokie vidutinio ryškumo ar ryškūs bei struktūriniai pokyčiai sportininkų EKG pasireiškia maždaug 40 proc. šios populiacijos tiriamųjų [1]. Dažniausiai šie pokyčiai susiję su fiziologine miokardo remodeliacija [1]. Pagal tarptautines atletų elektrokardiografinių tyrimų interpretacijos gaires, nukrypimai EKG yra skirstomi į tris grupes: normalius, ribinius ir patologinius radinius. Pagal tai sprendžiama, ar pacientui reikalingas tolesnis išsamus kardiologinis ištyrimas [2].

Nuolatinis vaistų ar kitų preparatų vartojimas prieš chirurgines intervencijas kelia klausimus visam su paciento gydymu susijusiam medicinos personalui. Preparatų vartojimas rekomendavus nutraukti vartojimą ar atvirkščiai, gali didinti komplikacijų riziką, todėl labai svarbu tiksliai žinoti, kokius preparatus (receptinius ir nereceptinius vaistus, maisto papildus) ir kaip juos vartoja pacientas perioperaciniu laikotarpiu, kad rizika būtų kuo mažesnė. Šiuo tyrimu buvo siekiama išanalizuoti Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų (LSMUL KK) pacientų, kuriems atliekama chirurginė intervencija, vaistų vartojimo ypatumus perioperaciniu laikotarpiu. Duomenys buvo renkami 2022 m. gruodžio 1-30 dienomis. Tyrimo atlikimui gautas LSMU BEC leidimas BEC-MF-82. Tyrime dalyvauti sutiko 55 asmenys. Buvo naudojamas originalus klausimynas, sudarytas iš 29 klausimų. Tyrimo metu gauta, jog 9 iš 10 pacientų vartoja įvairios kilmės preparatus, iš kurių du trečdaliai vartoja vaistus. 81,82 proc. pacientų apie vaistų vartojimą perioperaciniu metu sužinojo iš juos gydančių gydytojų. 60,00 proc. pacientų farmacinių priemonių vartojimą nutraukė pagal gydytojų rekomendacijas. 61,82 proc. tiriamųjų turėjo galimybę vaistų vartojimą perioperaciniu laikotarpiu išsamiai aptarti su šeimos gydytoju.

Objectives (oral/poster only) Eating disorders are a significant and widespread problem both - in the general population and in athletes. Many studies have been performed on specific populations, such as rowers, figure skaters, or long-distance runners to determine eating disorders. Although the latter are track and field athletes, this group alone does not reflect the prevalence of the problem in athletics. Aim of this study is to determine the prevalence of suspected eating disorders and their related symptoms in Lithuanian athletes and their association with athletic performance. Materials and methods (oral/poster only) 60 competitive Lithuanian track and field athletes were surveyed using an original questionnaire and SMHAT-1 questionnaire, in which Brief Eating Disorder in Athletes Questionnaire (BEDA-Q) is included. Athletes self-reported their personal best performance based on the World Athletics scoring system used to measure athletes' mastery. Pearson correlation was calculated to determine the correlation between the two scale variables, while point biserial correlation – between scale and nominal variables. The Chi-square test was used to determine the dependence between two nominal variables, Cramer's V test was used to calculate the effect size. Results (oral/poster only) 33.3% of respondents scored above the thresholds for predicting the presence of eating disorders. 25% of respondents had attempted to lose weight during the study, compared with 71.67% of respondents who had done so overall. Predicted eating disorder risk was also moderately positively correlated with depression and anxiety questionnaire scores (r = 0.55, p < 0.001 and r = 0.51, p < 0.001 respectively). No statistically significant association was found between athlete performance and predicted risk of eating disorder (p > 0.05). Conclusions This study found that one-third of the athletes are at risk for an eating disorder and that this pathology is associated with anxiety and depression. The study also found no association between eating disorders and athletic performance.

Objectives (oral/poster only) This study aims to investigate SAPS II score, remdesivir use and their associations with treatment outcome (ICU mortality/survival) in patients infected with SARS-CoV-2 and treated in the Intensive Care Clinic of Hospital of LUHS Kauno Klinikos in year 2020. Materials and methods (oral/poster only) Retrospective analysis of 103 patients admitted to the Hospital of LUHS Kauno Klinikos Intensive Care Clinic between April and December 2020 was performed. Inclusion criteria: ≥18 y/o, confirmed SARS-CoV-2 infection, testing for SAPS II scale performed. IBM SPSS Statistics 23.0 was used. Pearson, point-biserial correlations, χ², Student's t-tests, ROC-AUC curve, two-way ANOVA were used. Result was considered statistically significant at p<0.05. Results (oral/poster only) 51.46% (n=53) of subjects were male, 48.54% (n=50) were female. Mean age was 65.50±1.36 years (range 20-92), length of hospitalisation - 6.97±0.60 days (range 1-29). 63.11% (n=65) of patients have died. No statistically significant correlation was found between duration of hospitalisation or age with patients mortality (p>0.05). Mean SAPS II score was 42.52±1.72 (deceased - 49.20±1.92, survivors - 31.11±2.34), average predicted mortality rate was 34.77%. Statistically significant moderate correlation was found between higher SAPS II scores and mortality (r=0.501; p<0.001), with ROC-AUC curve value at 0.807. Remdesivir was administered to 27.18% (n=28) of subjects, while others (72.82%; n=75) were not treated with this drug. There was no statistically significant difference between different treatment groups regarding SAPS II score, age or sex (p>0.05). No statistically significant difference in survival was observed considering use of remdesivir (with remdesivir - 21.43% (n=6); without remdesivir - 42.67% (n=32); p>0.05). Conclusions 1. There is significant moderate correlation between higher SAPS II scores and SARS-CoV-2 infected ICU patients mortality. 2. ICU patients infected with SARS-CoV-2 have a higher mortality rate than predicted by SAPS II scale. 3. In our small-sample retrospective study remdesivir had no statistically significant effect on survival in SARS-CoV-2 infected ICU patients.

Objectives (oral/poster only) Anxiety and depression are well-known conditions that very often interfere with daily activities. Sports activities are no exception. It is known that one-third of athletes who actively train and compete are likely to suffer from anxiety and depression. However, there is no sufficient data yet on the number of these athletes in each sport and how these symptoms are related to the performance level of the athletes. In this study, we aimed to investigate the prevalence of anxiety and depressive symptoms and their relationship with athletes' level of performance. Materials and methods (oral/poster only) 60 competitive Lithuanian track and field athletes were surveyed using an original, where athletes self-reported their personal best performance based on the World Athletics scoring system, and SMHAT-1 questionnaire, in which General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) are included. IBM SPSS Statistics 23.0 was used. Pearson correlation was calculated to determine the correlation between the two scale variables, point biserial correlation – between scale and nominal, Spearman correlation – between scale and ordinal variables. Results (oral/poster only) In the GAD-7 and PHQ-9 questionnaires athletes scored 6.633 ± 4.258 points out of 21 and 7.117 ± 5.132 points out of 27, respectively. The analysis showed that 23.3% of the subjects scored moderate or higher levels of anxiety, while 33.3% scored moderate or higher levels of depression. No symptoms of anxiety or depression at all were found in 36.7% and 40% of subjects, respectively. The results of correlations showed that there was no significant relationship between the athletes' performance and the presence and severity of depression or anxiety symptoms (p>0.05). Conclusions This study showed that mild to severe symptoms of anxiety and depression are observed in 63,3% and 60% of Lithuanian track and field athletes, respectively. Whatsoever there is no significant relationship between these symptoms and performance level of the athlete.

Introduction Medication usage or withdrawal during perioperative period can impose complications. To avoid that physicians should learn about all patients’ supplements: not only prescribed but also over the counter and complementary medications [1]. With that information, medical personnel could verify which substances should be continued or not during perioperative period and give clear instructions to patients that risks of continuation or discontinuation of drugs would be minimal [1, 2]. Aim To analyse awareness of patients, who use medication and supplements and are having surgery requiring anaesthesia, regarding consumption of said substances during perioperative period in Hospital of LUHS Kaunas Clinics. Methods In December 2022 50 patients, that were having surgery and were using any substances (drugs or supplements), were asked to participate in survey. They were surveyed with original questionnaire consisting 29 questions related to patient demographics, medication habits, familiarity with drugs, perioperative information on drug use and related aspects. Patients were invited to participate voluntarily during waiting time. Questionnaire was anonymous, designed in paper format. Results were estimated by statistic data analysis using IBM SPSS Statistics 23.0. Pearson and point-biserial correlations, χ2 and Student's t-tests were used. Result was considered statistically significant at p<0.05. Results Majority of respondents were females (74%; N=37). Mean age of patients was 51±15.27 years. Statistically significant difference was observed in age regarding respondents' sex (women – 48.97±16.00 years; men – 59.00±10.17 years; p=0.014). 70.00% (N=35) of respondents use drugs continuously. 70.00% (N=35) of patients use supplements. 20 (40.00%) participants use both. 32 respondents stopped using drugs (N=8), supplements (N=8) or both (N=16) during perioperative period. Most of them got information from doctors: 58.00% (N=29) from surgeon, 28.00% (N=14) from family physician, also 20.00% (N=10) already knew about it. Others read Internet (14.00%; N=7), booklets (14.00%; N=7) or social media (2.00%; N=1). Then they were asked by whose recommendation they stopped using substances before surgery: 66.00% (N=33) stopped taking it by doctors' recommendations (40.00% (N=20) by surgeon and 26.00% (N=13) by family physician’s recommendations), 20.00% (N=10) of them did that at their own discretion and 14.00% (N=7) used terms recommended on Internet, social media or booklets. All followed recommendations to stop taking substances but there were few (10.00%, N=5) who stopped taking medication that doctors said to continue because they weren’t sure how to use it before surgery. Only 20 (40.00%) discussed surgery with family physician because physician only did tests, said too little, didn’t have time, didn’t say anything because surgeon will talk about surgery, or there was no need because they had surgery in the past and know how to prepare. Furthermore, only 9 patients (18.00%) talked about drugs renewal after surgery with doctors beforehand: 4 with family physician and 5 with surgeon. Overall, 78% (N=39) of respondents understood information that they were given about surgery, including substances use. Conclusions Study demonstrated that patients’ apprehension about medication and supplements use during perioperative period is quite good but there could be improvement from doctors' side so that patients wouldn’t look for obscure information on Internet or other places.

Introduction Various medications can affect physiologic parameters, so information about preoperative medication use is very important to the anaesthesiologist and is routinely part of the questionnaire during the patient examination. It should be noted that not only prescription drugs but also over-the-counter drugs or herbal preparations must be considered and analysed during the patient questioning, since they have the same effect [1]. It is worth noting that during preoperative consultations with various specialists preoperative medication use and a plan for postoperative management should be discussed [2]. However, the question remains to what extent all these goals are achieved in reality. Aim To identify peculiarities of medication use during the perioperative period in women, who underwent surgical treatment with anaesthesia at the Hospital of Lithuanian University of Health Sciences Kauno Klinikos Methods From 1 to 30 December 2022 at Hospital of LUHS Kauno Klinikos adults who were scheduled to undergo surgical procedures requiring anaesthesia were invited to participate in a questionnaire survey during their time in the waiting room. 41 women were surveyed with an original questionnaire of 29 questions related to patient demographics, medication familiarity and habits, perioperative information on medication use and related aspects. IBM SPSS Statistics 23.0 was used. Pearson and point-biserial correlations, χ² and Student's t-tests were used. The result was considered statistically significant at p<0.05.ResultsMedian age of respondents was 45 years (min - 27; max - 84). 25 (60.98%) of them live in the major cities, while others (n=16; 39.02%) - in the regions. 58.54% (n=24) of respondents reported suffering from chronic diseases. Majority of respondents (78.05%; n=32) have already undergone surgery in the past. When asked about regular drug use, respondents' answers were almost evenly distributed: 51.22% (n=21) use drugs regularly, 48.78% (n=20) do not. Drug use was statistically moderately correlated with older age of patients (r=0.45; p=0.003). 73.17% (n=30) of subjects also regularly take dietary supplements. No difference was found between the use of dietary supplements according to the age of the patients (p>0.05). Overall, 85.37% (n=35) of respondents regularly used medications, dietary supplements or a combination of both. 60.00% (n=21) of respondents who were taking medications discontinued them before surgery. Analysis of respondents' answers to the multiple-choice question about where they learned how to take or stop medications revealed that 48.78% (n=20) learned from the attending surgeon, 34.15% (n=14) from the primary care physician, 17.07% (n=7) from informational brochures, 14.63% (n=6) from the Internet and 2.44% (n=1) from social media. 85.71% (n=30) reported that information about the specifics of taking medications during the preoperative period was sufficiently clear. Only 19.51% (n=8) of respondents had a discussion about renewing medications after surgery. Conclusions 1. During our trial 85.37% of women, who underwent surgical treatment with anaesthesia, used medications (drugs or dietary supplements). 2. Majority of the women, who underwent surgical treatment with anaesthesia, indicated that information about preoperative medication use was clear. 3. Less than one fifth of women, who underwent surgical treatment with anaesthesia, had conversation about medication use after the surgery.

Prieširdžių virpėjimas (PV) yra dažnai klinikinėje praktikoje sutinkama aritmija, kurios paplitimas pasaulyje vis didėja. Šiuo metu yra nustatyta, jog šia patologija serga daugiau kaip 11mln. Europos gyventojų [1]. Tikėtina, kad iki 2060 m. Europoje PV atvejų stipriai daugės – busmaždaug 2,3 karto daugiau nei iki šiol [2]. Žinant tai galima numatyti, jog šia liga sergančiųjų,kuriems bus reikalingas operacinis gydymas, taip pat daugės. Prieširdžių virpėjimas gali kilti irpasireikšti visu perioperaciniu laikotarpiu, todėl svarbu žinoti, kokia paciento būklės kontrolėsir gydymo taktika yra geriausia ir saugiausia pacientui [3]. Nors ši problema yra plačiai nagrinėjama kardiologijoje, tačiau rizikoms, susijusioms su operaciniu gydymu, ypač atliekant neširdies operacijas (NŠO), dar nėra skiriama pakankamai dėmesio [4]. Siekdami apie tai pateiktisusistemintą informaciją, šiame straipsnyje trumpai aptariame gydytojo anesteziologo-reanimatologo požiūrį, kodėl tai yra svarbu ir kaip reaguoti į sutrikusio ritmo formą – PV perioperaciniulaikotarpiu, kuomet atliekama NŠO. Prieširdžių virpėjimo profilaktika ir valdymas perioperaciniulaikotarpiu. Pasireiškus pooperaciniam PV per 5 metus 4–5 kartus padidėja PV epizodų pasikartojimo tikimybė,todėl pacientams, kurie priklauso rizikos grupei,reikia taikyti prevencines priemones prieš numatomą NŠO [3]. Tai ypač svarbu, nes pooperacinis PVyra susijęs su ilgalaikio mirtingumo ir sergamumodidėjimu [5]. Yra žinoma, jog PV pasireiškimo tikimybė NŠO metu svyruoja nuo 4,8 proc. po visosąnario protezavimo operacijų iki 12–19 proc. postemplės, krūtinės ląstos ar pilvo operacijų [6].Siekiant sumažinti riziką, reikia nustatyti, kuriems pacientams padidėjusi perioperacinio PVgrėsmė. Pirmiausia reikia atsižvelgti į galimus irnesunkiai įvertinamus rizikos veiksnius. Vieni išjų yra susiję su pacientu: vyresnis amžius, PV epizodai anamnezėje, (stazinis) širdies nepakankamumas, išeminė širdies liga, hipertenzija, lėtinėinkstų liga, sepsis, astma ir miego apnėja. Stebintšiuos rizikos veiksnius taip pat rekomenduojamagyd. kardiologo konsultacija prieš operaciją, kurios metu būtų įmanoma įvertinti, ar pacientuiyra didelė PV rizika [6]. Prasada S, Desai MY,Saad M ir kitų autorių atliktame retrospektyviajame tyrime buvo pastebėta, kad pacientams,... [...].

Europoje sergamumas širdies ir kraujagyslių ligomis (ŠKL) yra vienas didžiausių, o šių ligų grupė yra pagrindinė mirties priežastis tarp visų Europos kardiologų draugijoje (EKD) esančių šalių [1]. Ne išimtis, kad šiems pacientams prireikia ne tik širdies, bet ir kitų sričių chirurginių intervencijų. Pasaulyje ne širdies operacijos (NŠO) yra susijusios su vidutiniškai 7–11 proc. visų komplikacijų, iš kurių 42 proc. sudaro širdies komplikacijos, todėl nesunku suprasti, kodėl anesteziologams pacientai, sergantys ŠKL, tampa iššūkiu [2, 3]. Viena šiai grupei priklausančių ligų – širdies nepakankamumas (ŠN), dažnas tarp Lietuvos gyventojų: sergamumas ŠN siekia 60,84 atvejų 1 000 suaugusiųjų (≥ 18 metų) gyventojų [4]. Šiame straipsnyje aptarsime, kaip reikėtų pasiruošti NŠO, kai pacientas serga širdies nepakankamumu. Bendrieji principai. Širdies nepakankamumu sergantį pacientą ruošiant ne širdies operacijai laikomasi bendrųjų širdies ligomis sergančių pacientų perioperacinio paruošimo principų. Suprantama, kad ŠN sergantis pacientas, ypač jei matoma klinikinė šios ligos išraiška, anesteziologui ir chirurgui kelia didesnį nerimą. Visgi savo sprendimus derėtų grįsti keliais principais: - operacijos skuba (planinė / neatidėliotina /skubi); - operacijos (chirurginė) rizika; - paciento ŠN išraiška. Pastarųjų metų gairės aiškiai teigia, kad neatidėliotinais atvejais operacija, jei ji būtina, atliekama nesvarstant. Žinoma, kad mažos (chirurginės) rizikos operacijoms atlikti taikomi ir žemesni ŠN (kaip ir bendrai bet kokia kita kardialine patologija sergančio ligonio) ištyrimo reikalavimai. Jei operacija planinė, o chirurginė rizika didelė – tada ištyrimui skiriama daug daugiau dėmesio: atliekami laboratoriniai, instrumentiniai tyrimai, svarstoma galimybė optimizuoti paciento būklę. Tokiu atveju neretai daugiadalykio aptarimo metu svarstoma apskritai atliekamos operacijos nauda ir rizika. Paciento ir operacijos rizika. Norint atsakyti į šį klausimą, pirmiausia reikia žinoti, ar pacientas serga ŠN, o jei ŠN yra įtariamas – reikia patvirtinti ar paneigti šios ligos buvimą, įvertinti galimą ŠN atsiradimą perioperaciniu laikotarpiu [5]. Siekiant nustatyti paciento rizikas atliekant NŠO ŠN sergantiems pacientams, reikia įvertinti ligos sunkumą, kadangi sergantieji ŠKL yra priskiriami didelės rizikos grupei, jiems yra didelė širdies ir kraujagyslių komplikacijų tikimybė [6]. Įvertinti paciento būklę galime surinkdami anamnezę, atlikdami instrumentinius ar laboratorinius tyrimus (1 lentelė) 1 lentelė. Tyrimai pacientui, sergančiam širdies nepakankamumu, prieš planuojamą ne širdies operaciją […].[6]. Iš pirmo žvilgsnio įvertinti būklę gali būti ganėtinai sunku, nes ŠN sergantys pacientai gali atrodyti labai skirtingai, pavyzdžiui, žmogus gali atrodyti sveikas, bet tyrimų rezultatai – prasti (pvz., besimptomė kairiojo skilvelio disfunkcija), arba, atvirkščiai, pacientas gali atrodyti kaip sunkiu ŠN sergantis asmuo, tačiau atliktų tyrimų rezultatai yra pakankamai geri (pvz., sunku vaikščioti dėl nutukimo, ne dėl ŠN). […].