Mačiulienė, Asta

Introduction. The handbook provides recommendations that regulate the process of preparing the final master's theses (henceforth, FMT) in the integrated study programme Medicine. The document outlines the principles of work planning, research ethics, methodological requirements and scientific communication, thereby ensuring academic quality and the reliability of the research. [...].

Įvadas. Mokomojoje knygoje pateikiamos Medicinos vientisųjų studijų programos baigiamojo magistro darbo (BMD) rengimo rekomendacijos. Dokumentas apibrėžia darbo planavimo, tyrimų etikos, metodologinių reikalavimų ir mokslinės komunikacijos principus, užtikrinančius akademinę kokybę ir tyrimų patikimumą. [...]

Community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality, particularly in older adults and patients with chronic co-morbidities. Cytokine patterns and simple hematological indices may improve risk stratification beyond conventional clinical scores. In this prospective single-center study, 41 adults with CAP treated at Kaunas Hospital of Lithuanian University of Health Sciences between November 2024 and March 2025 were enrolled. Clinical data, pneumonia severity index (PSI), complete blood count-derived indices (neutrophil-lymphocyte ratio [NLR], platelet-lymphocyte ratio [PLR], systemic immune-inflammation index [SII]), and serum concentrations of interleukin (IL)-6, IL-8, interferon (IFN)-γ, and G-CSF were obtained on admission (Visit 1) and after 7 days of treatment (Visit 2). Patients were stratified by age (≤65 vs >65 years), co-morbidities, and PSI class. Non-parametric tests and Spearman correlations were applied. The results indicate that patients with co-morbidities and those > 65 years had significantly higher IL-6 levels than younger and non-comorbid patients. IL-6, IFNγ, and G-CSF concentrations were highest at admission and declined by day 7, particularly in PSI Class II patients. Higher PSI classes were associated with increased IL-8, IL-6, and IFNγ. NLR and SII were significantly higher in older patients and in PSI III-IV compared with PSI I-II. IL-6 and G-CSF showed strong positive correlations with NLR and SII, especially in elderly and comorbid patients, whereas PLR displayed weaker and less consistent associations. From these data, it is concluded that in CAP, serum IL-6, IFNγ, and G-CSF reflect age, co-morbidity burden, and disease severity, while NLR and SII closely mirror cytokine-driven systemic inflammation. These readily available indices may serve as cost-effective prognostic markers and, combined with cytokine profiling, could enhance early risk stratification and guide individualized management in CAP.

Leidinyje pateikiamos rekomendacijos, reglamentuojančios baigiamojo magistro darbo (BMD) rengimo procesą Medicinos vientisųjų studijų programoje. Dokumentas apibrėžia darbo planavimo, tyrimų etikos, metodologinių reikalavimų ir mokslinės komunikacijos principus, užtikrinančius akademinę kokybę ir tyrimų patikimumą.

Background and Objectives: Hepatitis C virus (HCV) remains a significant cause of chronic liver disease worldwide. While direct-acting antivirals achieve high cure rates, the interplay between viral load, gender, and routine laboratory parameters remains unclear. This study aimed to investigate hematological, biochemical, and coagulation profiles, as well as derived non-invasive indices, in HCV-infected patients, stratified by gender and viremia levels. Materials and Methods: This retrospective study included 367 patients with HCV infection (223 males and 144 females). Patients were divided into four groups: high viremia males (hiVM), high viremia females (hiVF), low viremia males (loVM), and low viremia females (loVF), using 800,000 IU/mL as the threshold. Routine hematological, biochemical, and coagulation tests were conducted, and derived indices (FIB-4, APRI, AST/ALT ratio, PLR, NLR, SII, AISI, PNI, HALP, PAR, NAR) were calculated. Results: Significant gender- and viremia-specific differences were observed. hiVM showed higher erythrocyte indices and altered coagulation parameters, whereas hiVF had increased lymphocyte counts and AST/ALT ratio elevation. loVM displayed reduced hemoglobin and hematocrit, along with worse coagulation results. Biochemical analysis revealed gender differences in GGT, bilirubin, and albumin levels. Among derived indices, FIB-4 and APRI were higher in loVM, while SII and PLR were elevated in loVF. At the second visit after 17±4 weeks, when patients had no detectable HCV DNA in the peripheral blood, most indices improved significantly across groups. Conclusions: HCV infection affects laboratory profiles depending on gender and viremia levels. Non-invasive indices from routine tests offer valuable insights into inflammatory and nutritional status. Using these indices alongside traditional markers may aid hypothesis generation or clinical assessment and help prioritize further assessment for HCV patients.

Pacientų pasitenkinimas suteikta anestezija yra daugialypis kintamasis, todėl siekiant aukštesnės sveikatos priežiūros paslaugų kokybės, svarbu nustatyti svarbiausius veiksnius, galinčius turėti įtakos pacientų emocinei būsenai ir psichologiniam komfortui. Tikslas – įvertinti pacientų, kuriems numatoma operacija, emocinius ir fizinius pojūčius perioperaciniu laikotarpiu prieš ir po anestezijos. Tyrimo metodai. Tyrimas atliktas Lietuvos sveikatos mokslų universiteto ligoninėje Kauno klinikose (LSMUL KK) Anesteziologijos skyriuje nuo 2023 m. lapkričio 17 d. iki gruodžio 15 d. Tyrimo atlikimui gautas LSMU BEC leidimas BEC2-316. Tyrime dalyvauti sutiko 102 asmenys. Buvo naudojamas originalus klausimynas, sudarytas iš 30 klausimų. Rezultatai. Tyrimo metu nustatyta, kad prieš operaciją nerimą statistiškai reikšmingai dažniau jautė moterys nei vyrai, 76,1 proc. (n = 54) moterų nurodė jaučiančios nerimą, lyginant su 32,3 proc. (n = 10) vyrų (p =< 0,001). Nustatytas ryšys tarp nerimo prieš operaciją ir pooperaciniu periodu (p = 0,021, rs= 0,228). 90 pacientų (88,2 %) teigė, kad informacijos apie anesteziją, jos būdą gavo pakankamai, 12 respondentų (11,8%) nurodė, kad informacijos trūko. Pacientai reikšmingai dažniau patyrė nemalonius fizinius pojūčius prieš operaciją, atvykus į operacinę šių potyrių dažnumas buvo statistiškai mažesnis (p < 0,001, rs = 0,485). Vertindami pooperacinio skausmo gydymą, pacientai nurodė: adekvatus (n=86; 84,3%.), patenkinamas (n=14; 13,7%), neadekvatus (n=2; 2,0%). Išvados. Gauti rezultatai pabrėžia svarbų poreikį užtikrinti, kad pacientai būtų tinkamai informuoti, gerai pasirengę operacijai ir gautų reikiamą emocinę bei fizinę priežiūrą perioperaciniu laikotarpiu, siekiant pagerinti jų patirtį ir pasitenkinimą medicininėmis paslaugomis.

Vadovėlis „Vaikų anestezija“ skirtas gydytojams rezidentams, studijuojantiems Anesteziologijos ir Intensyvios terapijos rezidentūroje, Vaikų intensyvios terapijos rezidentūroje ir Skubiosios medicinos rezidentūroje bei Išplėstinės slaugos studentams, studijuojantiems Anesteziologijos cikle. Ši knyga taip pat gali būti naudinga ir gydytojams, atliekantiems anesteziją įvairaus amžiaus vaikams. Knygos autoriai - ilgametę patirtį, dirbant su vaikais, turintys gydytojai. Tikimės, kad ši knyga bus ne tik naudinga besimokantiems, bet taip pat bus vienu iš įrankių, padėsiančių užtikrinti saugią ir kokybišką anesteziją ir sklandų poanestezinį periodą vaikams.

Introduction Anesthesiological care plays a significant role in influencing patients' satisfaction with the provided services, although evaluating it within the context of perioperative care can be complex. The emotional state of patients before surgery, particularly preoperative anxiety, is crucial throughout the surgical process, potentially affecting the operation and postoperative recovery [1]. Therefore, addressing this factor is essential for delivering high-quality medical services [2]. [...].

Background. The assessment of diastolic function is often overshadowed by the evaluation of significant valve anomalies and systolic function, which is determined by ejection fraction. To accurately predict a surgical procedure's outcome, it is beneficial to consider the diastolic evaluation findings alongside the conventional perioperative risk assessment. Aim. This article aims to provide a thorough summary of the diagnostic methods, treatment options, and how the perioperative pathway can be optimized for patients with diastolic dysfunction (DD). Methods. The literature used for this review was selected using “Elsevier”, “Pubmed”, and “UptoDate” databases. The search used the following keywords and their combinations: diastolic dysfunction perioperatively, diastolic heart failure, diastolic dysfunction and anaesthesia, perioperative hypertension, and diastolic dysfunction ESC. Results. Echocardiography is a crucial diagnostic tool for assessing DD, providing detailed information about the structure and function of the heart. Talking about the choice of anesthetic technique, sevoflurane better preserves diastolic relaxation during spontaneous ventilation than propofol and isoflurane has no adverse lusitropic effects and do not exacerbate preexisting DD. Several studies have demonstrated that reducing afterload, isoflurane, sevoflurane, and desflurane can enhance left ventricular relaxation. Moreover, adequate blood pressure, heart rate, rhythm, fluid status, and avoidance of noticeable variations in hemodynamics and volume are the cornerstones of the perioperative care of DD. Conclusion. Anesthesia plans should be individualized to minimize the potential impact on diastolic function and maintain optimal hemodynamic stability. Close monitoring and vigilant management of fluid balance, heart rate, and blood pressure are paramount intraoperatively.