Ridikaitė, Karolina

Tyrimo tikslas. Įvertinti nuotolinio darbo poveikį sausos akies sindromo išsivystymui mokytojams bei palyginti vyravusius sausos akies simptomus dirbant nuotoliniu ir kontaktiniu būdu. Metodai. Tyrime dalyvavo 80 skirtingų gimnazijų mokytojų. Rezultatai. Nuotolinio darbo metu tarp mokytojų vyravo šie sausos akies sindromui būdingi simptomai: padidėjęs jautrumas šviesai, „smėlio“ jutimas akyse ir pablogėjusi rega. Daugumą mokytojų minėti simptomai vargino visą laiką arba dažnai. Kontaktinio darbo metu sausos akies sindromui būdingi simptomai pasireiškė rečiau ir mokytojai juos jautė vidutiniškai dažnai arba retai. Remiantis tyrimo duomenimis, nuotolinis darbas turėjo statistiškai reikšmingą poveiki sausos akies sindromui būdingų simptomų pasireiškimui mokytojams.

Introduction (Case Reports Only) In clinical practice, there are 2 main types of exudative age-related macular degeneration (AMD): classic and occult. Meanwhile the scientific literature describes a total of 3, including retinal angiomatous proliferation (RAP). This neovascularization specifically starts at the retina and progresses posteriorly into sub retinal space. RAP is difficult to diagnose because it is a rare pathology (about 20% cases of AMD). Case Description (Case Reports Only) A 64-year-old white man presented to the Ophthalmology Outpatient Department with decreased vision in his left eye. Clinical examination revealed visual acuity (VA) (Snellen chart) VOD = 1.0, VOS = 0.8, normal intraocular pressure. Routine and instrumental examinations were performed: OCT, OCT-A, FA. The findings included choroidal neovascularization (CNV), intraretinal fluid, subretinal fluid, hemorrhage, drusen, paracentral areas of retinal pigment epithelium atrophy, and swollen retina in the left eye. After long discussions about the results of the examinations the final diagnosis was made of exudative AMD - RAP. After 3 weeks the treatment was started with ranibizumab, an anti-VEGF intravitreal injection (IVT). The efficacy of the treatment was monitored by VA testing and OCT examination. After the first dose of IVT, VA improved to VOS = 0.7, after the second, third and fourth doses improved to VOS = 1.0. After the 4th IVT, the OCT examination showed changes: OS macular parafoveal CNV with mild scarring and reduced retinal swelling. 4 months after the start of the treatment the patient's condition has improved, and further follow-up is prescribed. Summary (Case Reports Only) A 64-year-old patient experienced a decreased vision in the left eye, after a rare diagnosis of RAP IVT were performed and his condition successfully improved. Conclusions While it is challenging to diagnose RAP, this case report represents the importance of applying appropriate evaluations and interventions to diagnose and treat this rare pathology.

Introduction (Case Reports Only) We present a case report of an 18-year-old male who was first diagnosed with ocular toxocariasis (OT) in 2010 and experienced two recurrences of the disease since 2019. Case Description (Case Reports Only) An 18-year-old male presented with complaints of decreased vision in his right eye. His medical history revealed that he had been diagnosed with OT 9 years ago, and at that time, a blood test had shown a positive result for serum anti-Toxocara IgG. After treatment, the patient's symptoms had improved, and a focal, raised whitish retinal lesion in the right eye had disappeared. However, in 2019, examination revealed a decrease in visual acuity (VA) (Snellen chart) to 0.3 in the right eye. Slit lamp examination revealed cells in the anterior chamber and vitreous. Fundus examination revealed a swollen optic disc and a whitish, focally raised lesion with a swollen inferotemporal arcade. A blood test revealed eosinophilia, negative anti-Toxocara IgG (tested 6 days after recurrence), and anti-Toxocara IgM was not determined. The diagnosis OT was made based on the patient's history and clinical presentation. The patient was treated with albendazole 400 mg twice daily and topical eye drops for 5 days. All of the above findings improved significantly, and best corrected visual acuity (BCVA) increased to 0.8 within 3 months. Two years later, the patient's vision in the right eye deteriorated after infection COVID -19. Clinical examination revealed a VA of 0.4, and fundus examination revealed an active focal lesion, and systemic treatment was not prescribed at this time. Improvement in the condition was observed, and within 2 months, the BCVA improved to 1.0. Summary (Case Reports Only) An 18-year-old patient had two recurrences of OT in two years, but his VA fully recovered. Conclusions Monitor patients closely after treatment as parasites can remain in the body for years and cause recurrences.

Introduction (case reports only) Recurrent corneal erosion (RCE) typically occurs in eyes that have had previous abrading injuries or corneal dystrophies (even years prior). Commonly RCE is treated conservatively. But in this case report phototherapeutic keratectomy (PTK) was performed after a long-term failure of conservative treatment to improve the patient's quality of life. Case description (case reports only) A 32-year-old woman presented to the Ophthalmology Outpatient Department with pain and tearing in her left eye (LE). Her medical history revealed that she had been diagnosed with corneal erosion after ocular trauma in autumn 2021, when LE was injured with a tree branch. After treatment at that time the patient's condition had improved and her symptoms had disappeared. However, in 2022 winter, tearing and severe pain in the LE recurred, especially when upon awakening at night – the patient was diagnosed with RCE. The patient has used VitA-Pos ointment since then, unfortunately all the above symptoms have been reoccurring, also visual acuity had decreased. At the admission the patient’s best corrected visual acuity was 0.4 in the LE. Slit lamp examination revealed corneal erosion and unstable peeled off epithelium in the center of the cornea. The final diagnosis of RCE was made based on the patient’s medical history and examinations. Next day PTK was performed under local sol. Alcaine anesthesia. After surgical procedure a protective contact lens was applied, and local treatment was prescribed with Levofloxacin 0,5% eye drops 4 times a day for 2 weeks in the left eye. The patient did not have any recurrence of erosion since then. Summary (case reports only) A 32-year-old patient one year after trauma was diagnosed with RCE again and successfully treated with PTK. Conclusions Conservative treatment is often ineffective, and the pathology significantly reduces patients' quality of life, so PTK is a treatment option with good results.

Įvadas. Ptozė – viršutinio voko nusileidimas žemiau įprastinės padėties (> 2 mm). Atsižvelgiant į išsivystymo laiką, ptozės skirstomos į įgytas bei įgimtas. Pastarosios dažniausiai pasireiškia vaikams, gali būti paveldimos, pasireikšti vienoje ar abejose akyse kaip izoliuotas sutrikimas arba kartu su kitomis sisteminėmis ligomis. Manoma, kad šio sutrikimo patogenezę lemia ne tik raumenų vystymosi sutrikimas, bet ir jų inervacijos pažaida. Kita vertus, šiuo metu tikslaus įgimtos vokų ptozės patogenezės apibūdinimo dar nėra. Tikslas. Pristatyti pagrindines įgimtų ptozių klinikines išraiškas tam, kad būtų pasirenkamas ankstyvas ir tikslus ligos gydymas. Medžiaga ir metodai. Literatūros apžvalga buvo atlikta „PubMed“ duomenų bazėje, naudojant terminą „įgimta ptozė“ kartu su „miogeninė įgimta ptozė“, ,,neurogeninė įgimta ptozė“ nuo 2010 – 2023 m. Į literatūros apžvalgą įtraukti straipsniai, atitinkantys paieškos kriterijus. Rezultatai. 1) Miogeninės ptozės atsiradimo mechanizmas yra susijęs su viršutinio voko keliamojo raumens vystymosi pažaida, kai raumens skaidulos pakeičiamos kitu audiniu. Jai būdingi dažniausi klinikiniai pasireiškimai: izoliuota įgimta ptozė ir blefarofimozės - ptozės - inversinio epikanto sindromas. 2) Neurogeninė įgimta ptozė atsiranda esant voko keliamųjų raumenų inervacijos sutrikimui. Jos kilmę lemia didesnė grupė ligų, priskiriamų įgimtai kaukolės inervacijos sutrikimų grupei: įgimta ekstraokulinių raumenų fibrozė, Markuso - Guno, Duano, Mebiuso sindromai, paveldima įgimta veido parezė, Hornerio sindromas bei įgimtas III galvinio nervo paralyžius. Išvados. Įgimtos ptozės etiologija įvairi, tačiau miogeninės ir neurogeninės kilmės įgimtos ptozės literatūroje aprašomos dažniausiai, o jų pasireiškimas didesnis vaikų amžiuje. Pagrindinis įgimtos ptozės etiopatogenezės mechanizmas išlieka neaiškus.

Introduction: Multiple endocrine neoplasia type 2 (MEN2) is a rare inherited condition, that is related to mutation in the RET proto-oncogene. A clinical diagnosis of MEN2A could be suspected if the patient has two or more of the endocrine tumors such as medullary thyroid carcinoma, pheochromocytoma (PC) and primary hyperparathyroidism and the syndrome could be confirmed via genetic testing. We present a rare clinical case of bilateral PC in the patient with MEN2A syndrome. Case report: A 53-year-old woman with MEN2A syndrome was admitted to our department due to a left adrenalectomy for suspected PC. Her medical history revealed that 20 years ago she had partial thyroidectomy, but there are no medical records about histological findings. Later in 2010 right adrenalectomy revealed malignant PC. Assessing the diagnosis of malignant PC at an early age (41 years at that time) and the history of thyroid surgery, a molecular genetic method was performed and detected a pathological mutation in exon 10 of the RET gene p.Cys611Trp (C611W) - the patient was diagnosed with MEN2A syndrome. The patient was followed by oncologists for possible contralateral pheochromocytoma. Unfortunately, after 12 years, an abdominal computerized tomography scan revealed a probable malignant mass in the left adrenal gland. A surgery was recommended. Before operation she had PC attack episode accompanied by headache, flickering eyes, hot flushes, general weakness, blood pressure increase of 182/111 mmHg. Patient underwent a preoperative preparation with alpha blocker and successful laparoscopic left adrenalectomy was performed, histopathology report confirmed PC. For adrenal insufficiency replacement therapy with hydrocortisone and fludrocortisone was prescribed. The patient was discharged from the hospital in stable condition and referred for further outpatient follow-up. The case was discussed by the multidisciplinary team, due to the high risk of MTC prophylactic total thyroidectomy was recommended. The operation is planned to be performed in the near future. Conclusions: Patients with MEN2A require regular screening for MEN2A-associated tumors and multidisciplinary team management because this can significantly prolong survival.

Introduction: Takotsubo cardiomyopathy (TCM) - typically characterized by transient systolic dysfunction, limited elevation in cardiac biomarkers and newly presented changes in ECG. This pathology mimics acute coronary syndrome (ACS), however, TCM is mostly associated with physical or emotional stress. In our study we present the case of TCM caused by an unknown factor. Case report: A 70-year-old female was hospitalized in a regional hospital with sudden chest pain, which spread to the neck and back. ECG demonstrated ST elevation in I, II, III, aVF, V3-6 leads, in laboratory tests troponin I was 1700 ng/L (normal range < 2 ng/L). The patient with suspected ACS was transferred to our department for further investigations and treatment. An emergency coronary angiography was performed, which showed normal coronary arteries without stenosis, but indicated severe left ventricular (LV) systolic dysfunction. Furthermore, during ventriculography it was noticed that the shape of LV was similar to the octopus trap due to the characteristic apical ballooning appearance - this diagnostic finding is specific to TCM. Anyway, the patient's medical history did not reveal any signs of acute physical or emotional stress. A sudden echocardiogram was performed, the findings included hypercontraction of the LV basal segments, left ventricular ejection fraction (LVEF) 34%. Finally, after cardiac magnetic resonance (CMR) imaging results, the patient was diagnosed with TCM. The echocardiogram was repeated four days later, at which time showed minimal positive dynamic changes in LVEF (evaluated to 40%), but there also was found a thrombotic mass in the apex of LV as a complication of TCM. The appropriate medicament treatment was prescribed, the patient’s condition had improved, and she was discharged for further outpatient follow-up. Three months later the patient arrived for a CMR scan, which results showed regression in the LV: LVEF increased to 64% and the thrombus from the apex had vanished out too. Conclusions: Stress is one of the main risk factors for TCM, but the syndrome can also develop in the presence of an unknown factor, like in our case. Thus, it is necessary to properly differentiate this disease, even in the absence of the usual clinical manifestations.

Įvadas. Žinios apie miokardo infarkto (MI) simptomus ir gebėjimas juos identifikuoti padeda pasiekti medicinos įstaigas greičiau. Tikslas. Mūsų tikslas buvo išsiaiškinti Lietuvos hospitalizuotų pacientų žinias apie miokardo infarktą ir palyginti žinių lygį skirtingose amžiaus, lyties ir išsilavinimo grupėse. Metodika. Tyrimas įtraukė 101 pacientą jo hospitalizacijos laikotarpiu Lietuvos Sveikatos Mokslų Universiteto (LSMU) Kauno ligoninės kardiologijos skyriuje 2020 metų vasario-kovo mėnesiais. Apklausa vykdyta remiantis originaliu klausimynu, kurį sudarė bendriniai klausimai, daugybinio pasirinkimo klausimai apie miokardo infarktą ir pacientų nuomonė, kokios priemonės padėtų sumažinti mirtingumą dėl MI. Tyrėjai apklausė pacientus jų hospitalizacijos metu. Rezultatai. Iš viso 70 % respondentų identifikavo pagrindinį MI simptomą – skausmą už krūtinkaulio. Be to, 62,4 % respondentų žinojo, kad MI skausmas gali plisti; daugiausiai žinomos plitimo sritys buvo kairė ranka (26,3 %), mentė bei tarpumentė (19,6 %). Didžioji dalis respondentų (36,7 %) daugiau sužinoti apie MI simptomus norėtų iš savo šeimos gydytojo. Išvados. Pacientų žinios apie MI simptomus ir rizikos faktorius nesiskyrė tarp skirtingų amžiaus, lyties ir išsilavinimo grupių. Pacientai turi ribotą žinių kiekį apie MI: nors daugiau nei pusė pacientų teisingai identifikuoja tipinius MI simptomus, jų žinios apie kitus simptomus yra nepakankamos. Tai gali būti pagerinta šviečiant visuomenę apie šį susirgimą.