Žumbakytė, Austėja

As the population continues to age, the occurrence of chronic illnesses and comorbidities that often necessitate the use of polypharmacy has been on the rise. Polypharmacy, among other factors that tend to coincide with chronic diseases, such as obesity, impaired kidney and liver function, and older age, can increase the risk of medication errors (MEs). Our study aims to evaluate the prevalence of MEs in the Internal medicine, Cardiology, and Neurology departments at the secondary-level university hospital. We conducted a prospective observational study of 145 patients' electronic or paper-based data of inpatient prescriptions and patients' pharmacokinetic risk factors, such as an impairment of renal and/or hepatic function, weight, and age. All included patients collectively received 1252 prescribed drugs. The median (Q1; Q3) number of drugs per patient was 8 (7;10). At least one ME was identified in 133 out of the 145 patients, indicating a significantly higher prevalence than hypothesized (91.7% vs. 50%; p < .001). There was moderate, positive correlation between the quantity of prescribed drugs and the number of MEs, meaning that the more drugs are prescribed, the higher the number of identified MEs (Spearman's ρ = 0.428; p < .001). These findings suggest that there is a need for continuous medication education activity for prescribing physicians, continuous evaluation of prescription appropriateness to objectively identify the MEs and to contribute to more rational patient treatment.

Background and Objectives Breast cancer stands out as the primary cause of cancer-related death in women worldwide. Long non-coding RNA HOTAIR has been named as an essential epigenetic regulator in carcinogenesis, citing its role in chromatin regulation and transcriptional silencing. It has been suggested that SNPs in the HOTAIR gene may play a part in its aberrant expression observed in most solid cancers, but precise mechanisms remain elusive. Therefore, this study aimed to analyze the association between HOTAIR rs920778, rs7958904, rs12826786 polymorphisms and the clinical and morphological features, and prognosis in breast cancer patients. [...].

Introduction Brain metastases (BM) stand out as the predominant neurological complication associated with cancer, and constitute the most prevalent form of brain cancer [1]. BM from thyroid cancer is rare and associated with a poor survival rate. Data on incidence of BM in thyroid cancer is lacking [2]. Aim To analyze cases reporting cerebral metastases of thyroid cancer.[...].

Introduction: Tuberculosis (TB) stands as the primary cause of death globally from a single bacterial pathogen. It has long been known that children carry a higher risk of serious complications and associated mortality. Still the stigma surrounding TB remains a significant challenge in healthcare, delaying timely diagnosis and negatively impacting TB treatment outcomes. Case report: A 13-year-old girl with no underlying medical conditions, screened negative for TB 12 months ago after household contact with open pulmonary TB, presented with a week-long episode of febrile fever, subsiding to the subfebrile range only to reoccur a week later, accompanied by right-sided chest pain and cough. A diagnosis of pneumonia followed after examination and X-ray at the primary care facility. After failure to achieve an adequate imaging response to several cycles of macrolide therapy over 3 weeks and in light of suboptimal spirometry results, the patient was transferred to inpatient care at a tertiary-level hospital for further investigation and treatment. Bronchoscopy and CT findings being indicative of bacterial lobar pneumonia, ampicillin-sulbactam followed by amoxicillin was prescribed to improve accuracy of differential diagnosis in follow-up imaging tests. Sputum culture and Bactec test for TB were performed. A month later, further progression of the disease was observed on CT, followed by TB-positive Bactec and Mantoux test results. Importantly, a previously intentionally undisclosed close contact with open isoniazid-resistant TB was discovered. Although the patient was efficiently treated with anti-TB therapy, TB-caused lung bronchiectases persist a year from establishing diagnosis, and thus impose a question whether the disease outcome would have been better if the contact with open TB had been reported sooner and appropriate screening measures had been taken. Discussion: This case highlights the effects of enduring stigma surrounding TB, preventing adequate screening for TB and resulting in a higher incidence of long-term serious TB sequelae.

Introduction: Angiotensin-converting enzyme inhibitors (ACEi) are among the most common antihypertensive drugs. Adverse ACEi reactions are often cutaneous and can mimic various skin diseases. Case report: An 86-year-old male with a history of coronary heart disease treated with Metoprolol, Aspirin and Zofenopril/Hydrochlorothiazide presented with a generalized pruritic rash which temporarily subsided after Betamethasone cream was prescribed in 2019. Suspecting a medication-induced skin reaction, Zofenopril was replaced with Perindopril. In 2021, to alleviate newly aggravated symptoms, outpatient treatment with oral Prednisolone, Clobetasol cream and antihistamines was prescribed. However, pruritus returned following termination of treatment. Skin biopsy revealed superficial spongiotic dermatitis. Given the extensive nature of the disease, inpatient care with oral corticosteroids, antihistamines, as well as regular use of emollients and Metronidazole ointment was administered. In May 2023, to investigate the etiology of persisting symptoms, an allergist performed routine and immunology tests, skin prick test and punch biopsy, which exhibited perivascular and periadnexal dermatitis only. Suspecting possible psychosomatic origin the patient was referred to a psychiatrist who prescribed Sertraline, Lorazepam and Tiapride. Despite additional therapy, symptoms persisted. In July 2023, the patient’s daughter noticed that symptoms seemed to subside when Perindopril was not administered. The plausible connection between pharmacotherapy and cutaneous manifestations was then investigated by a clinical pharmacologist (MD). According to the Naranjo Scale, the likelihood of an adverse drug reaction was definite – total score ≥9. Therefore, cessation of all ACEis and switching to angiotensin receptor blockers was advised. Discussion: ACEi-triggered skin reactions are thought to be mediated by bradykinin excess. This results from ACEis blocking the action of bradykininase identical to ACE, thus decreasing degradation of bradykinin. Inexplicable cutaneous reactions might be drug induced, emphasizing the necessity to assess concomitant medications in order to prevent needless specialist visits and treatments.

Introduction: Despite attempts to develop evidence-based algorithms for prescribing antidepressants, research indicates that as many as half of patients either do not respond to these medications or encounter major side effects. Since genetic variations can significantly impact drug responses, pharmacogenetic testing has emerged as a promising approach to optimize psychiatric treatment. Research estimates that one in four patients receives a drug unsuitable for their metabolic phenotype, emphasizing the utility of such testing to improve clinical outcomes. Case report: A 32-year-old woman was referred to a clinical pharmacologist (MD) for optimization of depression treatment following suspected adverse drug reactions. Treatment with Mirtazapine resulted in significant weight gain, reversed after discontinuation. Later, a recurrence of suicidal thoughts, increased anxiety, and insomnia were observed under Sertraline. To avoid further deterioration of the patient’s condition through trial-and-error pharmacotherapy, pharmacogenetic testing was carried out. The results showed the patient to be an ultrarapid CYP2D6 metabolizer, while other cytochrome-P450-encoding alleles tested were consistent with those of the general population. As CYP2D6 has not been shown to play a significant role in the metabolism of either Mirtazapine or Sertraline, though it may aid in metabolizing the latter in some individuals, it was established that the symptoms experienced were indeed a result of adverse drug reactions, as opposed to suboptimal concentrations. Ruling out the possibility of dose correction, it was recommended to put the patient under treatment with Escitalopram combined with Bupropion, as these drugs are typically metabolized by cytochrome P450 enzymes other than CYP2D6. So far, no further clinical pharmacologist-assisted treatment corrections have been required. Discussion: The collaboration between psychiatrists and clinical pharmacologists, along with pharmacogenetic testing, has the potential to significantly enhance the antidepressant selection process and lead to fewer adverse effects for patients as well as lower costs for the healthcare sector.