Acta Medica Lituanica最新文献

Background: Bizarre parosteal osteochondromatous proliferation (BPOP), or Nora lesion, is a rare proliferative disease arising from the parosteal region of bones. Although BPOP's pathogenesis is still not certain, modern literature suggests it to be a tumor-like lesion or even a benign neoplasm. Due to the extremely low incidence, to this date studies on the topic are limited to case reports and a few case series. This narrative review aims to resume literature on BPOP and provide an overview of its natural history, morphologic characteristics and prognostic horizon.

Materials and methods: A systematic research of the literature was done to identify studies reporting on patients who suffered from BPOP between 1983 and 2021. We collected data regarding aetiologic and pathogenetic theories, patients' personal data and anamnesis, lesions' location, clinical presentation, imaging features, pathological appearance, treatment and prognosis.

Results: We identified 322 cases of BPOP with a mean age of 34.3 years at the moment of diagnosis. There was no gender difference. The most involved site was the hand, followed by the foot. A history of trauma was reported for 14.7% of the cases. 38.7% of the patients had pain. Literature defined typical radiographic and microscopic patterns that characterize Nora lesions. While imaging is fundamental to orientate towards BPOP, histological evaluation is mandatory to get the definitive diagnosis. To this date, only reliable therapeutic option is represented by surgical resection. BPOP is burdened by a risk of recurrence that accounts to 37.4%.

Conclusion: BPOP is a rare benign disease that should be considered during the differential diagnosis of parosteal lesions, especially in the acral regions. Careful diagnostic evaluations are necessary to get the correct diagnosis and wide margins of resection are recommended to minimize the relatively high risk of local recurrence.

Background: A medieval mummy known as the Blessed Antonio (Patrizi) is held in the church of Saints Peter and Paul at Monticiano, Sienna, central Italy.

Objectives: The aim of our investigation was to complete a biological profile of the subject, as well as to assess the impact of deterioration to the concerned remains.

Methods: As a follow-up of our bioanthropological, macroscopic approach, two of the samples taken underwent rehydration, fixation, desiccation, paraffin-embedding, and staining according to standard histological techniques applied to mummified remains.

Results: The body was determined to be that of an adult male, who showed some pathological changes such as dental calculus and what is suspected to be hallux valgus. The overall preservation of a skin sample revealed damage caused by a post-mortem infestation of insects, while a second, inner sample was identified as lung tissue, and revealed a case of anthracosis.

Conclusions: The Blessed Antonio was an adult male, who had poor dental hygiene and was likely exposed to smoke during his lifetime. Damage observed on the remains indicated that a conservation treatment was desirable for the future preservation of the body.

Objective: To investigate the hospital visits and mortality rate during the COVID-19 in emergency department of Vlora regional hospital in Albania and to compare with the three previous years (2017-2019).

Methods: Secondary data of patients that visited emergency department of Vlora Regional hospital Albania (largest hospital in the south of the country), since January 1, 2017 till December 31, 2020. This is a retrospective study. We used the hard copy of the patients' health register records. The data extraction was conducted during March 2021 till June 2021. Eligible were all patients admitted and recorded in the registry of the emergency department. The causes of admission were categorized in 14 different disease categories. All registered patients admitted to the Vlora regional hospital were included in the study.

Results: Study population included 44,917 patients during 2017-2020. Mean age of patients was 51.5 years, while 53.6% were females. The highest number of patients was in 2017 (n=12,407) and the lowest in 2020 (n=9,266). Increase of patients presented with cardiovascular, psychiatric and renal/urinary tract was observed in 2020 in comparison to 2019. Patients decreased over time with an average annual percent decrease of 7% (p-value=0.22). Joinpoint analysis revealed that mortality rate increased over time with an average annual percent increase of 34.3% (95% confidence interval=42.7% to 214.8%, p-value=0.27).

Conclusions: The number of patients visiting emergency department decreased while mortality rate increased. Educating and raising awareness of patient to seek medical assistance should be a key objective of health policy makers and health personnel.

Background: Mixed gonadal dysgenesis is a rare congenital and challenging condition, characterized mainly by 45,X/46,XY karyotype mosaicism, asymmetrical gonadal development and various internal and external genital anatomy. Because of frequent disorder of genital development and a higher risk of germ cell neoplasia, management of these patients is complex and requires multidisciplinary approach.

Case: We present a 45,X/46,XY mixed gonadal dysgenesis patient diagnosed with gonadoblastoma in both gonads after bilateral gonadectomy at 1 year of age.

Conclusions: Because of high risk for malignant transformation, gonadectomy of a streak-like gonad and biopsy with orchidopexy or gonadectomy of a dysgenetic testicle is recommended at an early age.

Background: Since the start of the pandemic with SARS-CoV-2 virus, very little data was known about clinical features and outcomes of COVID-19 in children and adolescents not only in Lithuania, but also in other European countries. This study was started in collaboration with 82 participating healthcare institutions across 25 European countries, using a well-established research network-the Paediatric Tuberculosis Network European Trials Group (ptbnet). This multinational, multicentre cohort study was performed during the first wave of the pandemic, between April 1 and April 24, 2020. Each participating country was allowed to continue further research individually encompassing brighter time limits and using the same methodology. We present here data of children hospitalised at Vilnius University Hospital Santaros Klinikos (VUH SK) during the first year of the pandemic.

Materials and methods: We included all paediatric patients with PCR confirmed SARS-CoV-2 infection who were hospitalised at VUH SK. The study was performed between March 12, 2020 and March 12, 2021. A standardised data collection spreadsheet was used to record epidemiological, clinical and treatment data.

Results: A total of 104 patients were included in the study. The median age of participants was 5 years (IQR 1.0-11.0, range 0-17 years). Males accounted for 50 (48%) of all patients. The average duration of hospitalisation was 3 days. Ten (9.6%) patients had pre-existing medical conditions. Among all hospitalised patients 16 (15%) were asymptomatic, 5 (4.8%) were treated in intensive care unit (ICU). The most common symptoms among COVID-19 patients were pyrexia 71 (68%) followed by upper respiratory tract infection 49 (47%) and gastrointestinal symptoms 33 (32%). Among the entire cohort only 3 (3%) patients required oxygen support, but none of them was started on continuous positive airway pressure (CPAP), mechanical ventilation or extracorporeal membrane oxygenation (ECMO). None of the patients admitted to ICU needed inotropic support. There was no fatal outcome.

Conclusions: Our data indicate that COVID-19 may affect children of any age. The COVID-19 disease was usually mild in hospitalized children and adolescents. The most common clinical findings of COVID-19 were pyrexia and symptoms of upper respiratory tract infection. Severe COVID-19 disease cases when oxygen support or treatment in ICU was required were very rare. No patient received antiviral drugs for Covid-19 treatment. There was no fatal outcome due to COVID-19 in our study population.

Background: Left ventricular hypertrophy (LVH) regardless of other risk factors may be associated with an increased risk of mortality from cardiovascular diseases. Therefore, timely diagnosis for LVH is important in order to avoid possible complications. One of the simplest and cheapest methods to diagnose LVH is electrocardiography (ECG). Although a number of ECG criteria for LVH is known, their reliability varies in many studies.

Aim: To evaluate the reliability of ECG criteria for LVH based on transthoracic echocardiography (TTE) data.

Methods: The study included all consecutive patients in Kaunas Clinical Hospital Department of Cardiology from December 2019 until March 2020 and from September until October 2020, after applying the inclusion and exclusion criteria. The sensitivity and specificity of the ECG criteria for LVH were assessed based on TTE measurements performed during the same inpatient setting. The reliability of the ECG criteria for LVH was assessed using ROC curves. Reliability differences in gender, age and nutritional status groups were assessed using ANOVA statistical method.

Results: Data from 95 patients were analyzed (63.2% were women and 36.8% were men). The sensitivity, specificity and AUC of Sokolow-Lyon criterion were 9.38%, 85.71% and 0.44 (p = 0.034), R in aVL - 6.25%, 90.48% and 0.51 (p = 0.038), Cornell - 21.88%, 100 % and0.69 (p = 0.084), Cornell product - 31.25%, 95.24% and 0.72 (p = 0.070), Peguero-Lo Presti - 31.25%, 85.71% and 0.68 (p = 0.053), respectively. No statistically significant differences were observed among the individual gender, age and nutritional status groups.

Conclusions: Sokolow-Lyon and RaVL criteria were not statistically significantly reliable in LVH diagnosis compared to TTE, unlike the Cornell, Cornell product, and Peguero-Lo Presti criteria.

The three Baltic States (Estonia, Latvia, and Lithuania) are among the European Union countries with the highest incidence and mortality rates for cervical cancer. In order to tackle this public health challenge, there is an urgent need to implement more advanced and effective methods in cervical cancer prevention in Baltic countries. Nationwide cervical cancer screening programs in the Baltic States commenced in 2004-2009. While the organized screening programs in these countries differ in some relevant details (target age groups, screening interval), the underlying principles and problems, barriers are universal. However, the outcomes of present screening programs are unsatisfactory. In addition, universal screening programs are extremely costly. There is a potential need for more intelligent and personalized cervical cancer screening program. In 2019 the project "Towards elimination of cervical cancer: intelligent and personalized solutions for cancer screening" (2020-2023) was developed with the main objective - to develop improved and personalized cancer screening methods within a sustainable health care system. It is expected, that more sophisticated cervical cancer screening model will be implemented in Estonia, Latvia, and Lithuania, and will have a positive impact to epidemiology of cervical cancer and public health in general.

Background: Rheumatoid arthritis (RA) is an autoimmune inflammatory disease with complex etiopathogenesis launched by multiple risk factors, including epigenetic alterations. RA is possibly linked to vitamin D that is epigenetically active and may alter DNA methylation of certain genes. Therefore, the study aimed to evaluate the relationship between DNA methylation status of vitamin D signaling pathway genes (VDR, CYP24A1, CYP2R1), vitamin D level and associations with RA.

Materials and methods: Totally 76 participants (35 RA patients and 41 healthy controls) were enrolled from a case-control vitamin D and VDR gene polymorphisms study regarding age and vitamin D concentration. CpG islands in promoter regions of the VDR, CYP24A1, CYP2R1 genes were chosen for DNA methylation analysis by means of pyrosequencing. Chemiluminescent microplate immunoassay was used to assess 25(OH)D serum levels. RA clinical data, i.e. the disease activity score C-reactive protein 28 (DAS28 - CRP) as well as patient-reported outcome questionnaires were recorded.

Results: The study showed similar methylation pattern in the promoter regions of vitamin D pathway genes in RA and control group with p>0.05 (VDR gene 2.39% vs. 2.48%, CYP24A1 gene 16.02% vs. 15.17% and CYP2R1 2.53% vs. 2.41%). CYP24A1 methylation intensity was significantly higher in compare to methylation intensity of VDR and CYP2R1 genes in both groups (p<0.0001). A tendency of higher vitamin D concentration in cases having methylated VDR (57.57±28.93 vs. 47.40±29.88 nmol/l), CYP24A1 (53.23±26.22 vs. 48.23±34.41 nmol/l) and CYP2R1 (60.41±30.73 vs. 44.54±27.63 nmol/l) genes and a positive correlation between VDR, CYP2R1 methylation intensity and vitamin D level in RA affected participants was revealed (p>0.05). A significantly higher CYP24A1 methylation intensity (p=0.0104) was detected in blood cells of vitamin D deficient (<50 nmol/l) RA patients vs. vitamin D deficient controls.

Conclusions: Our data suggests some indirect associations between DNA methylation status of vitamin D pathway genes and vitamin D level in RA.