Vaičiulytė, Donata

COVID-19 pandemija sukėlė precedento neturinčią pasaulinę sveikatos krizę. Nors pradiniuose COVID-19 tyrimuose daugiausia dėmesio skiriama ūminiams kvėpavimo takų simptomams, vis daugiau tyrimų rodo, kad viruso poveikis apima ne tik ūminę, bet ir lėtinę fazę, kitaip - pokovidinj sindromą (angl. post-acute COVID-19 syndrome). Virškinamojo trakto simptomai tapo svarbiu pokovidinio sindromo komponentu, nes vis dažniau pranešama apie pacientus, kuriems po pasveikimo nuo ūminės infekcijos pasireiškia įvairūs virškinamojo trakto sutrikimai. Šiame straipsnyje gilinamasi į įvairiapusį poūminio COVID-19 virškinamojo trakto sindromo pobūdį, nagrinėjamos jo klinikinės apraiškos, epidemiologija, galimi pagrindiniai mechanizmai, diagnostiniai iššūkiai ir klinikinio valdymo pasekmės. Išanalizavus sudėtingus viruso ir virškinamojo trakto sistemos ryšius, galima įgyti vertingų įžvalgų apie šį sudėtingą sindromą ir sudaryti sąlygas geresnei pacientų priežiūrai bei tikslinėms intervencijoms.

Research problem and objectives: Lithuania remains a region with a higher MS incidence rate which has a tendency to increase every year. Although there is much unknown about the characteristics of MS prodrome period, understanding of the duration and phenotypic features of it could be helful not only for the early MS recognition, but also for the ability to prevent disability progression and identify individuals at a higher risk. This research investigated patients from a local MS center in order to determine features of prodromal symptoms they experience. Methods: 166 patients were examined using an anonymous questionnaire. All patients were treated or consulted at the Department of Neurology in the Hospital of LUHS Kaunas Clinics from February 2020 to February 2021. Results: Most often experienced prodromal symptoms were cardiovascular (n=75, 42,2%), such as cold limbs, skin and mucous membrane discoloration, faster and stronger heartbeats, syncope (p=0.006). 42.2% of respondents (n=75) noted mental disorders such as anxiety, depression, migraine, insomnia, cognitive and memory disorders. 36,7% of the patients experienced gastrointestinal disoredrs, most common complains were nausea (n=29, 17,5 %), obstipation (n=22, 14.3%), vomit...[...].

Background: Despite improvements over time with regard to morbidity, mortality, and long-term survival, deep sternal wound infection (DSWI) continues to be a major complication after open-heart surgery. This is why it is important to identify possible risk factors for postoperative development of DSWI in patients undergoing coronary artery bypass grafting and valve replacement. The aim of this study was to identify the risk factors for postoperative development of deep sternal wound infection in patients after coronary artery bypass grafting and heart defect surgery at the Department of Thoracic, Cardiac, and Vascular Surgery of the Hospital of Lithuanian University of Health Sciences. Methods: This retrospective study analyzed 201 patients, who underwent coronary artery bypass grafting and heart defect surgery between January 2017 and December 2018. The case group contained 45 patients, who had to be reoperated because of deep sternal wound infection, and the control group consisted of 156 randomly selected patients. For descriptive statistics, we used means, median values, ranges, standard deviations, and 95% confidence intervals, where appropriate. Categorical data were analyzed using the chi-square or Fisher's exact test. Student T-test and Mann-Whitney used to compare numerical variables. Logistic regression model adjusting for age and gender was used to compare the risk of infection. A P-value of < 0.05 was considered to be statistically significant. SPSS 26.0 was used for calculations. Results: Logistic regression analysis revealed that independent risk factors for sternal wound infection were high BMI (odds ratio [OR] 1.15, CI 1.06-1.24), preoperative CRP (OR 1.08, CI 1.01-1.16), long duration of cardiopulmonary bypass (OR 1.02, CI 1.01-1.03), intraoperative anemia (OR 0.97, CI 0.95-0.99), and postoperative CRP concentration (OR 1.10; CI 1.05-1.16). Conclusions: Preoperative assessment to identify obese individuals as being at risk [...].

Background: The rate of fetal tachycardia is approximately 0.5% of all pregnancies and it is an important cause of fetal morbidity and mortality. CASE REPORT: A 33-year-old woman, gravida III, presented at 37 weeks of gestation due to the lack of fetal movements. She had vaginal delivery and miscarriage in anamnesis. At 34 weeks of gestation fetal paroxysmal tachycardia 300 bmp, fetal hydrops, ascites, pericardial effusion and heart failure (HF) were detected. Treatment with intravenous propafenone 140 mg was started, fetal heart rate (HR) was normal for several hours, but atrial flutter was monitored 5 hours later. Additional doses of propafenone 150 mg and metoprolol 50 mg were given orally. There was no therapeutic effect, mother refused emergency c-section and further cardiological treatment. Next day echoscopy showed no movements, fetal HR was 307 bpm. Intravenous digoxin 0.25 mg was initiated, the dose was repeated 2 hours later. Fetus vital functions after 9 hours: HR 142-144 bpm, normal heart rhythm, HF and hydrops disappeared, umbilical and brain circulation normal. Mother's vital functions remained stable. She was discharged. Further treatment with oral digoxin 0.25 mg a day and sotalol 80 mg twice a day until the end of pregnancy was prescribed. After readmission she was monitored in the ICU and got additional intravenous digoxin 0.25 mg with verapamil 40 mg and oral sotalol 80 mg. Despite this treatment fetal state was deteriorating. Caesarean section under spinal anesthesia was performed. Hemodynamics of mother remained stable. Newborn's APGAR scores of 1st and 5th minutes were 7 and 8 respectively. Conclusions: Fetal tachycardia has a high risk for developing low cardiac output, hydrops and sometimes fetal death or adverse neurological effect after birth. Digoxin is an antiarrhythmic drug which has a positive inotropic effect and could be safe to use when HF occurs. Sotalol is often added while treating with digoxin, because digoxin alone is poorly transferred to the fetus in the presence of hydrops and quicker control of arrhythmia is achieved. If the fetus is at term of delivery, emergency delivery and antiarrhythmic therapy must be provided to a newborn. If the fetus is nonhydropic, vaginal delivery can be taken into the consideration.

Background: The term “polytrauma” refers to multiple injuries that involve multiple organs or systems. The management of the patients who have suffered multiple injuries has been improving during the past century. We present a case of a patient who experienced polytrauma including bone fractures, ruptured spleen and cardiac tamponade. Case report: A 57 year old woman presented to the Emergency department after she experienced epilepsy attack and fell down the stairs. The patient has a history of epilepsy, mitral valve replacement and she has been taking warfarin for 16 years. She was in rehab after a traumatic subarachnoid hemorrhage with no neurological deficit. On admission to the regional hospital, woman was conscious (GCS 15/15), drowsy, experienced pain in the abdomen, legs, hands and face, but cardiovascular system and respiration were normal. Wounds on the right hand and femur were observed. X-ray showed right distal femur and right elbow dislocated and splintered, multiple foot, hand, jaw and pubis fractures. Free fluid in RUQ and Douglas pouch was observed during FAST. The patient was transferred to the Trauma center where additional observation revealed hemoptysis, BP 149/105, HR 111 bpm. Additional FAST showed that spleen might be ruptured and unidentified findings in the pericardial sac. Full-body CT scan revealed 1,1 cm of fluid around heart, ruptured spleen, hematoma in obturatorius muscle. The hemodynamics of the patient were deteriorating and the woman was taken to the operation room for splenectomy. Blood test results were INR 4,38, APTT 54 s, SPA 10% and tranexamic acid 1 mg was injected IV. After surgery patient was taken into the ICU and an immediate 2d echo revealed hyperkinetic LV, 3.8 cm fluid by RA - cardiac tamponade. A cardiac surgeon performed US-guided drainage of 250 ml and patient’s hemodynamics were quickly improved. Overall 4 units of RBC were transfused and angioembolization of arteria obturatoria was performed. The next day the patient’s femur was externally fixated. The patient remained stable during hospitalization. Conclusions: Early and adequate treatment of severely injured patients can only be successful if its management starts at the beginning of the accident. The trauma team should be prepared to manage severe injuries and follow standardized guidelines to detect and correct changes that can be life-threatening.

Introduction Despite improvements over time with regard to morbidity, mortality and long-term survival, deep sternal wound infection (DSWI) continues to be a major complication after an open heart surgery (1,2). This is why it is important to identify possible risk factors for postoperative development of DSWI in patients undergoing coronary artery bypass grafting and valve replacement. Aim The aim of this study was to identify the risk factors for postoperative development of deep sternal wound infection in patients after coronary artery bypass grafting and heart defect surgery at the Department of Thoracic, Cardiac and Vascular Surgery of the hospital of Lithuanian University of Health Sciences. Methods This retrospective study analyzed 201 patients who underwent coronary artery bypass grafting and heart defect surgery between January 2017 and December 2017. The case group contained 45 patients who had to be reoperated because of deep sternal wound infection and the control group consisted of 156 randomly selected patients. For descriptive statistics we used means, median values, ranges, standard deviations and 95% confidence intervals where appropriate. Categorical data were analyzed using the chi-square or Fisher’s exact test. T-test and Mann-Whitney used to compare numerical variables. Logistic regression model adjusting for age, gender, were used to compare the risk of infection. A p value of<0.05 was considered to be statistically significant. STATA v13 was used for calculations. Results Logistic regression analysis revealed that independent risk factors for sternal wound infection were: high BMI (odds ratio [OR] 3.14), long duration of cardiopulmonary bypass (odds ratio [OR] 2.26) and intraoperative anemia (odds ratio [OR] -3.8). Conclusions This study demonstrates that higher BMI, anemia, and the duration of extracorporeal circulation are independent risk factors for the development of postoper[...].

Introduction Despite improvements over time with regard to morbidity, mortality and long-term survival, deep sternal wound infection (DSWI) continues to be a major complication after an open-heart surgery (1,2). It is important to identify possible risk factors for postoperative development of DSWI in patients undergoing coronary artery bypass grafting (CABG) and valve replacement. Aim. The aim of this study was to identify the risk factors for postoperative development of DSWI in patients after CABG and heart defect surgery at the Department of Thoracic, Cardiac and Vascular Surgery of the hospital of Lithuanian University of Health Sciences. Methods. This retrospective study analyzed 201 patients who underwent CABG and heart defect surgery between January 2017 and December 2017. The case group contained 45 patients who had to be reoperated because of DSWI and the control group consisted of 156 randomly selected patients. For descriptive statistics we used means, median values, ranges, standard deviations and 95% confidence intervals where appropriate. Categorical data were analyzed using the chi-square or Fisher's exact test. T-test and Mann-Whitney used to compare numerical variables. Logistic regression model adjusting for age, gender, were used to compare the risk of infection. A p value of <0.05 was considered to be statistically significant STATA v13 was used for calculations. Results. Logistic regression analysis revealed that independent risk factors for DSWI were: high BMI (odds ratio [OR] 3.14), long duration of cardiopulmonary bypass (odds ratio [OR] 2.26) and intraoperative anemia (odds ratio [OR] - 3.8).[...].

Granulomatozė su poliangitu (GPA) yra reta sisteminė autoimuninė liga, pažeidžianti smulkiąsias ir vidutinio dydžio kraujagysles. GPA paplitimas yra 148,1 atvejų 1000 000 gyv., dažniau pasireiškia iš Šiaurės Europos kilusiems žmonėms. Šios patologijos etiologija nėra tiksliai žinoma, tačiau manoma, jog genetinė predispozicija turi didžiausią įtaką GPA išsivystymui. Kiti riziką sirgti GPA didinantys veiksniai – infekciniai, aplinkos, cheminiai, toksiniai, farmakologiniai dirgikliai bei imuninės sistemos sutrikimai. GPA patogenezė yra sudėtingas procesas, susijęs su antikūnų prieš neutrofilų citoplazmos antigenus (ANCA) susidarymu. Apie 80% GPA sergančių pacientų ANCA susidaro prieš proteinazę-3 (PR3), 10% pacientų ANCA susidaro prieš mieloperoksidazę (MPO). Liga yra klasifikuojama pagal 1990m. Amerikos Reumatologijos Koledžo sudarytus GPA klasifikacijos kriterijus. Dėl GPA pacientams gali atsirasti labai įvairių simptomų. Dažniausiai pasireiškianti klinika yra susijusi su viršutinių ir apatinių kvėpavimo takų bei inkstų pažeidimu. Pacientams gali atsirasti greitai progresuojantis inkstų funkcijos nepakankamumas, granulomatozinis plaučių uždegimas, parenchiminiai mazgeliai ir alveolinės hemoragijos plaučiuose. 50% pacientų pasireiškia sisteminiai simptomai – karščiavimas, svorio kritimas, nuovargis. Didžiajai daliai sergančiųjų (nuo 70 iki 100%) būna pažeidžiamos ausys, nosis arba gerklė. Nors ir rečiau, gali atsirasti odos, širdies, akių, virškinimo sistemos, centrinės bei periferinės nervų sistemos pažeidimų. Diagnozuojant GPA svarbu šią ligą diferencijuoti nuo kitų sisteminių vaskulitų. Atliekama įvairių tyrimų: bendras kraujo ir biocheminis kraujo tyrimas, imunologiniai tyrimai, šlapimo tyrimai, radiologiniai tyrimai bei gali būti atliekamos biopsijos. [...].