Acta Medica Lituanica最新文献

Objective: Artificial intelligence models human thinking and problem-solving abilities, allowing computers to make autonomous decisions. There is a lack of studies demonstrating the clinical utility of GPT and Gemin in the field of toxicology, which means their level of competence is not well understood. This study compares the responses given by GPT-3.5 and Gemin to those provided by emergency medicine residents.

Methods: This prospective study was focused on toxicology and utilized the widely recognized educational resource 'Tintinalli Emergency Medicine: A Comprehensive Study Guide' for the field of Emergency Medicine. A set of twenty questions, each with five options, was devised to test knowledge of toxicological data as defined in the book. These questions were then used to train ChatGPT GPT-3.5 (Generative Pre-trained Transformer 3.5) by OpenAI and Gemini by Google AI in the clinic. The resulting answers were then meticulously analyzed.

Results: 28 physicians, 35.7% of whom were women, were included in our study. A comparison was made between the physician and AI scores. While a significant difference was found in the comparison (F=2.368 and p<0.001), no significant difference was found between the two groups in the post-hoc Tukey test. GPT-3.5 mean score is 9.9±0.71, Gemini mean score is 11.30±1.17 and, physicians' mean score is 9.82±3.70 (Figure 1).

Conclusions: It is clear that GPT-3.5 and Gemini respond similarly to topics in toxicology, just as resident physicians do.

Background: Newborn patients with cyanotic congenital heart diseases with ductus-dependent pulmonary blood flow require neonatal repair, or palliation with a secure source of pulmonary blood flow, up to definitive surgical correction or palliation of the malformation. There is growing experience of percutaneous patent ductus arteriosus stenting to maintain the ductal flow. Patients in need of PDA stenting are newborns or small infants and recent data suggests that a weight of <4 kg increases the risk of thrombosis from femoral arterial catheterisation. Carotid access for newborn cardiac catheterisation avoids femoral arterial injury and improves the catheter course for certain transvasal procedures.

The aim of this study: was to report the Riga Children's Clinical University Hospital`s (CCUH) 7 year experience of patent ductus arteriosus stenting using the percutaneous transcarotidal approach in newborn babies and small infants with ductus-dependent critical heart diseases.

Methods: A retrospective review of all newborn and small infants who underwent transcatheter arterial duct stenting through the percutaneous carotid artery approach at the CCUH in Riga, Latvia between the years 2013 and 2020.

Results: In total, 8 patients underwent PDA stenting using the transcarotid approach between the years 2013 and 2020 in CCUH. The approach in all cases was chosen based on the anatomical features seen on echocardiography. In two cases, early restenting was necessary, while other patients had no procedure-associated complications. In the long term follow-up of 4 patients in two cases, dopplerography of the accessed common carotid artery showed stenotic changes up to 50%.

Conclusions: PDA stenting using the transcarotid approach is currently considered a relatively safe method and does not have a greater risk of developing postprocedural complications compared to the transfemoral approach. Transcarotidal PDA stenting in neonates and small infants with ductus-dependent critical congenital heart disease is possible in small volume paediatric cardiac surgery centre to stabilise the patient prior to definitive surgery or palliation of complex CHD. The vascular access should be chosen depending on the anatomical features of the patient and the competency of the cardiac interventionalist. From our experience, long-term changes in the affected common carotid artery may develop in a substantial number of cases, they may not be clinically significant in midterm follow-up period but have to be reevaluated. However, further randomised studies are necessary with large cohorts and longer follow-up period.

Background: Persistent human papillomavirus (HPV) infection is a necessary cause for development of cervical precancerous lesions and cervical cancer, however, only a small percentage of women progress to cervical cancer. The local immune response, determined, among other factors, by Human Leucocyte Antigen (HLA) genes, is thought to be significant. Still the results of genome studies are inconsistent and differ between ethnical populations. The aim of the study was to assess an association between HLA-DQA1*; DQB1*; DRB1* allele's genetic variants between women with cervical precancerous lesions and healthy controls in Latvia.

Materials and methods: From January until April 2017 we enrolled 84 consecutive patients referred for colposcopy to Riga East University Hospital (Latvia) due to abnormal cervical cytology results. 57 women who came for a regular check-up and had normal cytology smears were included in the control group. Material from the cervix was taken for subsequent HLA genotyping of 13 DRB1*, 8 DQA1*, and 12 DQB1* alleles. Colposcopy was performed on all participants. In case of visual suspicion for CIN cervical biopsy was done.

Results: There were 57 "no CIN" patients, 23 histologically proven CIN 1 and 61 CIN2+ cases in the study population. CIN2+ was more often associated with DQA1*0401 (OR 6.68, 95% CI 1.47-30.29, p=0.014), DRB*15 (OR 2.99, 95% CI 1.22-7.39, p=0.017), DQB1*0401 (OR 2.91, 95%CI 1.11-7.68, p=0.03), DQA1*0103 (OR 2.72, 95% CI 1.02-7.21, p=0.045), DRB1*11 (OR 2.42, 95% CI 1.10-5.33, p=0.029) and DQB1*0301 (OR 1.94, 95% CI 1.12-3.38, p=0.018). Women with "no CIN" more often had DQB1*0501 (OR 0.17, 95% CI 0.04-0.81, p=0.026), DRB1*16 (OR 0.21, 95% CI 0.06-0.78, p=0.019), DQA1*0301 (OR 0.35, 95% CI 0.14-0.87, p=0.024) and DRB1*14 (OR 0.59, 95% CI 0.01-0.46, p=0.007).

Conclusions: In the current study we have demonstrated a strong association with risk and protective HLA class II alleles that are determined by the HLA-DRB1*; DQA1*; DQB1*.

Background: The article talks about a patient who had nonrheumatic disease of the aortic valve and had a left ventricular rupture during a transcatheter aortic valve implantation (TAVI) procedure.

Methods: The discrepancy between the size of the prosthesis and the size of the native aortic valve (mismatch) led to the need to deploy a second prosthesis, which was dislocated into the left ventricular cavity and led to myocardial damage and the development of tamponade.

Results: As a result of timely cardiac surgery and effective measures of the emergency support service, both prostheses were removed from the left ventricular cavity, the aortic valve was replaced with a "Medtronic Hankock No. 25" biological prosthesis, and the left ventricular myocardial rupture was sutured.

Conclusions: In case of the development of such complications during the transcatheter aortic valve implantation (TAVI) procedure with asystole and cardiac tamponade, it was suggested to conduct cardioplegia (instead of chest compressions).

Background: Poststroke patients often experience cognitive impairments, motor weakness, and difficulties in daily activities. A multicomponent educational-rehabilitation approach offers a holistic treatment by integrating cognitive and motor training with relaxation, adaptive skills training, and motivational components. Despite its potential benefits, there is limited evidence supporting its effectiveness during the subacute stroke phase. This study evaluates the impact of this approach on cognitive functions, upper extremity motor skills, and daily activity independence during the subacute phase.

Materials and methods: In a prospective, randomized clinical trial, 40 patients participated in a 20-session multicomponent educational-rehabilitation program consisting of 45-minute sessions, five days a week. This program combined cognitive and motor training with additional components such as relaxation and patient education. The control group (N=30) received standard physical therapy, including electrotherapy and speech therapy as needed. Assessments were conducted at admission, after the final session for the experimental group, and one month later for the control group.

Results: The experimental group demonstrated significantly greater improvements in cognitive abilities, upper extremity functionality, and daily activity independence compared to the control group (p < 0.001).

Conclusion: The multicomponent educational-rehabilitation approach significantly enhances cognitive function, motor skills, and daily activity independence during the subacute phase of stroke recovery. These findings suggest that this approach offers superior recovery outcomes compared to standard care, warranting further investigation into its long-term effects.

Background: Progerias are rare hereditary genetic disorders that cause the onset of aging to occur earlier than generally expected, which initiates the progression of many age-related diseases. Syndromes assigned to this group are usually a compound disturbance of multiple systems. Werner syndrome is among a few well described premature aging disorders associated with a higher likelihood of malignancies.

Clinical case: We present a 45-year-old man with a history of painful muscle spasms, general muscle pain and weakness. There was a progression of contractures of the plantar tendons, as well as the atrophy of the subcutaneous adipose tissue of the extremities. The patient was initially diagnosed with secondary small fiber sensory polyneuropathy and myotonia, but further genetic testing revealed the homozygous pathogenic variant c.1578del in the WRN gene associated with Werner syndrome.

Conclusions: The c.1578del variant, previously not described in literature in a homozygous state, causes Werner syndrome and is associated with the pronounced hallmarks of early senescence in the proband's fibroblasts. Molecular diagnosis brings better treatment of manifestations and monitoring options for the patients, helping to establish more sufficient and secure patient care.

Background: Bariatric and metabolic surgery has emerged as an effective intervention for morbid obesity, offering substantial and sustained weight loss along with improvements in various comorbidities. Among the diverse spectrum of potential postoperative complications, thromboembolic events have garnered increasing attention due to their significant morbidity and mortality.The aim of this study is to present a single-center experience of thromboembolic complications following bariatric and metabolic surgery. Additionally, we present two distinctive cases, highlighting the clinical manifestations, diagnostic challenges, and therapeutic interventions associated with postoperative thromboembolism.

Materials and methods: We retrospectively reviewed data from patients with obesity who underwent various bariatric and metabolic operations at Republican Vilnius University Hospital from January 2018 to February 2024. All patients, regardless of the type of operation performed, were included. Two patients with thromboembolic complications are presented as illustrative cases.

Results: A total of 633 patients were included in the analysis: 278 underwent laparoscopic adjustable gastric banding, 345 underwent sleeve gastrectomies, and 10 underwent gastric bypasses. Thromboembolic complications occurred in only two patients, with one developing portal vein thrombosis and the other developing pulmonary embolism.

Conclusions: This single-center experience emphasizes the unpredictable nature of thromboembolic events in postbariatric surgery patients and highlights the critical role of vigilant monitoring, early detection, and individualized therapeutic interventions. Continued research efforts are warranted to refine risk stratification, enhance preventive measures, and improve overall patient outcomes in the landscape of bariatric surgery.

Aim: To compare the effects of laparoscopic intraperitoneal onlay mesh plus repair versus open Rives-Stoppa repair for abdominal wall hernias.

Materials and methods: A total of 99 patients with midline primary, umbilical or incisional hernias who underwent surgery in "Medikom" clinic and Kyiv city hospital #5 in the period from 2016 to 2022 were involved in the study. The group I included 50 patients who underwent intraperitoneal onlay mesh (IPOM) plus, and the group II 49 patients who underwent open Rives-Stoppa (RS) repair.

Result: Both groups were comparable in mean age, gender, body mass index, patient distribution based on hernia type, defect size, ASA score distribution (p > 0.05).The operating time in minutes was 75.36 ± 4.99 in group I and 97.85 ± 6.5 in group II (p < 0.05). The blood loss in IPOM plus approach group is on average in 2 times less than in open RS technique (p < 0.05). The pain score 12 hours after surgery was 5.5 ± 0.64 in group I comparing to 7.26 ± 0.78 in group II (p < 0.05). The pain score 24 hours after surgery was 4.46 ± 0.7 in group I comparing to 4.95 ± 0.61 in group II (p < 0.05). The pain score 8 days after surgery in group I was on average in 1.46 times less than in group II (p < 0.05).No significant difference was found in incidence of early complications between two groups (p > 0.05).47 (94%) patients of group I and 46 (93.87%) patients of group II were evaluated over 22 months follow-up period. No one complication was noted.

Conclusions: IPOM plus approach for the ventral and incisional hernias repair is a viable and relatively more safe operation by comparing with open RS repair. IPOM plus approach takes significantly in 1.3 less time as compared open RS technique.

In this case report, we describe the experience of a patient who was initially admitted for rectal cancer treatment. However, during the preoperative evaluation, severe stenosis of the coronary arteries was unexpectedly detected, presenting the medical team with a complex decision-making process.

Background: There is strong evidence that alcohol consumption is a significant risk factor for fatal road traffic accidents. It is estimated that the number of alcohol-related road accidents remains high in the past few years in Lithuania. This study aims to examine the prevalence of alcohol in blood samples collected from the autopsy results of road traffic accident victims.

Materials and methods: A retrospective study of 136 road traffic accident victims was performed in State Forensic Medicine Service of Lithuania in the period of 2013 to 2023. We analyzed blood alcohol concentration (BAC) in relation to sex, age, road user type, place and time of the day at death.

Results: 31% of the victims were under influence of alcohol at the time of death, with mean BAC 1.99 ± 0.92‰. The mean BAC was 2.16 ± 0.8‰ in male and 1.18 ± 1.12‰ in female group. By the type of road users, 23% of the pedestrians (mean BAC 2.45 ± 0.71‰), 32% of car drivers (mean BAC 2.13 ± 0.75‰), 41% of vehicle passengers (mean BAC of 1.73 ± 1.19‰), 37% of the motorcycle riders (mean BAC of 1.28 ± 0.53‰), 37% of the cyclists (mean BAC of 1.15 ± 0.75‰) were found to be intoxicated during the time of accident. Highest mean blood alcohol concentration was found during the night time hours (9 p. m. - 5 a. m.) 2.28 ± 0.91, comparing to in afternoon hours (12 p. m. - 5 p. m.) 1.49 ± 0.99, evening hours (5 p. m. - 9 p. m.) 2.10 ± 0.73 and morning hours (5 a. m. - 12 p. m.) 1.94 ± 1.00. The mean BAC in road traffic accidents during summer was 1.48 ± 0.71‰, spring 2.25 ± 0.76‰, autumn 2.12 ± 1‰, winter 2.42 ± 1‰.

Conclusions: Alcohol consumption by road users is a significant contributing factor in road traffic accidents and their outcomes in Lithuania.