Medicina-Lithuania最新文献

Background and Objectives: COVID-19 disease, caused by the SARS-CoV-2 virus, has presented significant challenges to global health, with acute and chronic implications for various aspects of well-being, including sleep and quality of life. This study aimed to investigate the impact of SARS-CoV-2 infection on sleep quality, daytime sleepiness, and quality of life in hospitalised and home-treated patients after three and six months. Materials and Methods: A longitudinal cohort study was conducted, enrolling hospitalised patients from a single clinical university hospital and home-treated participants through a survey spread through social networks. Individuals who had tested positive for the SARS-CoV-2 virus in the past three months and had a symptomatic course of the disease were included in the study. Participants with previously diagnosed sleep disorders were excluded from the study. Participants were evaluated using internationally validated self-evaluation scales, including the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9 (PHQ-9) and Fatigue Severity Scale (FSS). Data were collected three and six months after laboratory-confirmed SARS-CoV-2 infection, with informed consent obtained from all participants. Statistical analysis was performed using the Wilcoxon signed rank test, Fisher-Freeman-Halton exact, Pearson Chi tests and Spearman correlation. Results were considered statistically significant with p value < 0.05. Results: In total, 66 participants with a mean age of 44.05 ± 21.61 years were enrolled in the study. Most patients (n = 36) were treated at home and 30 at hospital. Six months after SARS-CoV-2 infection, home-treated patients reported a higher prevalence of poor sleep quality (52.8%, n = 19, p = 0.015, PSQI) and hospitalised patients showed a lower prevalence of depressive symptoms (p < 0.001, PHQ-9) as 90% (n = 27) had minimal or no symptoms compared to 30.6% (n = 11) in a home-treated group. Conclusions: These findings mark the importance of the COVID-19 patients' management settings as people treated at home had worse sleep quality and more depressive symptoms six months after infection indicating worse life quality.

Background and Objectives: We investigated the effects of sling-suspension-based active shoulder joint exercise training on shoulder joint subluxation, pain, muscle strength, and upper extremity function in patients with subacute stroke. Materials and Methods: Twenty-eight patients with subacute stroke were randomly assigned to either the sling-suspension-based active shoulder joint exercise (SASE) group (n = 14) or the motorized upper extremity exercise (MUEE) group (n = 14). The SASE group actively performed shoulder joint flexion, extension, abduction, adduction, external and internal rotation, and horizontal abduction and adduction using a sling suspension system, whereas the MUEE group underwent an exercise program using a motorized upper extremity exercise machine. All participants underwent a 4-week intervention with 30 min of exercise once a day for 5 days a week. Additionally, both groups received general physical therapy and functional electrical stimulation for 30 min twice a day for 5 days a week. Shoulder joint subluxation was measured by radiographic examination before and after training, and pain was evaluated in the splenius, upper trapezius, and infraspinatus muscles using pressure parameters. In addition, a manual muscle tester was used to assess the muscle strength of the shoulder joint flexors, extensors, abductors, adductors, and external and internal rotators, and the Fugl-Mayer Assessment (FMA) and Manual Functional Test (MFT) were used to evaluate upper extremity function. Results: A significant group-time interaction was observed for pain, with F-values of F(1, 26) = 7.470, p < 0.011 for the splenius and F(1, 26) = 9.623, p < 0.005 for the upper trapezius. A significant time-group interaction was observed for the muscle strength of the shoulder, with F-values of F(1, 26) = 13.211, p < 0.001; F(1, 26) = 4.974, p = 0.035 and F(1, 26) = 9.674, p = 0.004 for flexors, abductors, and external rotators, respectively. A significant time-group interaction was observed in the FMA, with F-values of F(1, 26) = 13.243, p < 0.001. When comparing the interaction effects between time and group for MFT scores, a significant difference was observed, with F-values of F(1, 26) = 32.386, p < 0.001. Conclusions: This study confirmed that sling-suspension-based active shoulder joint exercises are effective in improving shoulder joint subluxation, pain, muscle strength, and upper extremity function in patients with subacute stroke.

Background and Objectives: In the surgical treatment of benign prostatic hyperplasia (BPH), laser enucleation of the prostate is recommended as an alternative to transurethral resection (TURP) and open prostatectomy (OP). The thulium fiber laser, with its superficial penetration depth, can offer a rapid learning process by causing less heat injury and capsule damage. This study compares the first 60 cases of an endourologist performing thulium fiber enucleation of the prostate (ThuFLEP) without a mentor to the results of OP and TURP performed by experienced surgeons. It also identifies the case number at which the operation time for ThuFLEP starts to plateau. Materials and Methods: Between 1 November 2021 and 1 November 2023, the initial 60 ThuFLEP cases of an endourologist with no prior enucleation experience were compared with TURP and OP operations performed by experienced surgeons. Since the first 60 ThuFLEP cases involved 80-120 cc prostates, TURP and OP operations within this size range performed during the same period were included in the study. The groups were assessed for age, preoperative and postoperative prostate volume, PSA levels, the IPSS, the IPSS Quality of Life (QoL), and maximum urinary flow (Q_max). The 60 consecutive ThuFLEP cases were divided into three groups of 20 (Groups 1, 2, and 3) and compared for operation time, IPSS, and Q_max. Results: The operation time for TURP was shorter than for ThuFLEP and OP (p < 0.001). There was no significant difference between ThuFLEP and OP in postoperative Q_max and IPSS, while TURP had lower values than the other two methods. For ThuFLEP, the operation time was longer in the first 20 cases but plateaued in groups 2 and 3 (p < 0.001). Postoperative Q_max and IPSS values showed no significant differences among the three ThuFLEP groups (p > 0.05). Conclusions: For large prostates, ThuFLEP provides better postoperative results than TURP and offers shorter catheterization and hospital stay times than OP. Its short learning curve makes it a preferable method for treating BPH compared to other laser techniques.

Background and Objectives: This study aimed to assess the impact of coronavirus disease 2019 (COVID-19) on patients with acute cholangitis (AC) by comparing outcomes, complications, and hospital stays in a tertiary Gastroenterology department. Materials and Methods: This retrospective observational cohort study was conducted in a tertiary gastroenterology department, collecting data from all AC and AC + COVID-19 patients between April 2020 and February 2022. Data included clinical and demographic information, COVID-19-specific details, acute cholangitis presentation, medical records, laboratory results, and interventions. AC was diagnosed using Tokyo Guidelines 2018 (TG18) criteria, with all patients undergoing bile culture sampling. Results: The study included 241 patients, 30 in the COVID group and 211 in the non-COVID group. The COVID group's mean age was significantly higher (74.3 vs. 67.3 years, p < 0.009). Abdominal pain was more common in the COVID group (90% vs. 70.6%, p < 0.025). Length of hospital stay was longer for COVID patients (13.5 vs. 7.9 days, p < 0.001). COVID patients had higher incidences of malignant causes of AC, with pancreatic cancer being the most common (30%). Pseudomonas spp. was significantly more prevalent in COVID patients (16.7% vs. 5.7%, p = 0.028). Conclusions: Our study results show that COVID-19 affected the duration of hospitalization for patients with AC. Furthermore, this study presents observations regarding the impact of COVID-19 on AC, revealing differences in microbial profiles.

Background and Objectives: We aimed to explore the association between cognitive performance and markers of hypertension-mediated organ damage (HMOD) in young adults with hypertension. Materials and Methods: A group of adults aged 16 to 45 years with primary arterial hypertension completed a battery of paper-pencil as well as computer-based neuropsychological tests across all major cognitive domains. They also underwent office and ambulatory 24 h blood pressure, intima-media thickness measurements, heart ultrasound, and laboratory analysis of their lipid profile, blood uric acid concentration, and urine albumin-creatinine ratio. Associations between cognitive test results and markers of HMOD were explored through correlation analysis and age-, sex-, and body mass index-adjusted linear regression modeling. Results: Seventy-six individuals (62, 81.6% male) aged 36.5 years (interquartile range 18.4 to 42.0 years) were enrolled. After adjusting for age, sex, and body mass index in linear regression models, worse categorical fluency was associated with higher left ventricular mass (β_st = -0.264, p = 0.043) and worse performance in a task of sustained attention-with higher left ventricular mass index (β_st = -0. 304, p = 0.016). Worse phonemic fluency was related to higher pulse pressure (β_st = -0.241, p = 0.049) in the respective model. Better strategy use in the task of spatial working memory was linked to higher daytime mean diastolic blood pressure (β_st = -0.343 p = 0.017). Conclusions: Performance among young adults with hypertension across selected cognitive domains was inversely associated with pulse pressure, markers of left ventricular damage, and directly associated with daytime diastolic blood pressure. Our study suggests that the previously reported relationship between cognitive and cardiovascular markers in hypertension exists earlier than in middle or late adulthood.

Background and Objectives: This study was performed for the purpose of assessing whether antiepileptic levetiracetam treatment produces a change in brain volumes in children with epilepsy. To that end, we compared the volumes of the basal ganglia (caudate nucleus, putamen, globus, hip-pocampus, and thalamus) at magnetic resonance imaging (MRI) before and after treatment (months 18-24) in pediatric epilepsy patients using levetiracetam. Materials and Methods: This retrospective study involved a volumetric comparison of patients presenting to the Balikesir University Medical Faculty pediatric neurology clinic between 01.08.2019 and 01.11.2023 and diagnosed with epilepsy, and who underwent cranial MRI before and 18-24 months after treatment at the radiology department. The demographic and clinical characteristics (age, sex, family history of epilepsy, type of epilepsy, and EEG features (normal, abnormal, epileptiform)) of the patients included in the study were recorded. Results: The comparison of basal ganglia volumes at cranial MRI before and at months 18-24 of treatment revealed significant differences in the left caudate nucleus, right putamen, left putamen, left globus pallidus, right thalamus, left thalamus, and right hippocampal regions. Conclusions: In conclusion, differing findings are encountered at cranial imaging in patients with epilepsy, depending on the seizure frequency, activity, and the type of antiepileptic drugs used. This study compared basal ganglia volumes on cranial MRIs taken before and 18-24 months after treatment in pediatric epilepsy patients using levetiracetam. A significant increase was observed in the volumes of basal ganglia (caudate nucleus, putamen, globus pallidus, hippocampus, and thalamus) on the MRIs of pediatric epilepsy patients using levetiracetam.

The patient we present here had many clinical, morphological, and laboratory findings characteristic of acute leukemia. During the course of the disease, the diagnosis changed from acute leukemia to chronic small B-cell lymphoproliferative disease, a blastoid variant of mantle cell lymphoma, and finally to atypical plasma cell leukemia. Atypical plasma cell leukemia is a rare condition with aggressive biological behavior. Our patient relapsed a short time after achieving complete remission, in spite of aggressive therapy and autologous stem cell transplantation. During relapse, it was possible to morphologically identify malignant cells as being of plasma cell origin, although immature and atypical. Atypical plasma cell leukemia presents a diagnostic challenge as it may mimic other neoplasms both morphologically and clinically. It is also recognized that plasma cell neoplasm immunophenotype may not be entirely specific for its lineage where common diagnostic biomarkers are applied by immunohistochemistry or flow cytometry. Where this is the case, only focused investigation for plasma cell lineage will be more informative. This patient has unusual clinical presentation, a nondescript morphology of the circulating plasma cells, as well as an immunophenotype, detected by the initial panels used for flow cytometry and immunohistochemistry, that was not entirely specific for plasma cells. Such cases present a good reminder of the diagnostic complexity of atypical plasma cell leukemia and emphasize that plasma cell differentiation needs to be interrogated in cases where the initial work-up shows unusual results.

Background and Objectives: Prolactinomas are the most common pituitary adenomas, comprising 30-50% of such tumors. These adenomas cause hyperprolactinemia, leading to decreased fertility, reduced energy and libido, and galactorrhea. Diagnosing and treating prolactinomas in adolescents present unique challenges, as symptoms may be confused with age-related developmental variations. This case report explores the outcomes of early surgical intervention in an adolescent with a prolactinoma. Materials and Methods: A 14-year-old female presented delayed menarche and absent pubertal development. Initial evaluation revealed hyperprolactinemia (228.37 ng/mL) with normal estradiol levels. Initial management through observation was adopted, but persistent amenorrhea and severe headaches prompted further investigation. Magnetic resonance imaging revealed a cystic pituitary mass with apoplexy. Due to concerns regarding delayed puberty and the need for rapid normalization of prolactin levels, the patient underwent transsphenoidal surgery. Results: After operation, prolactin levels normalized, menarche occurred within three months, and secondary sexual characteristics developed within eight months. Pathology confirmed a pituitary adenoma with a high Ki-67 index (15%). Conclusions: Early surgical intervention for prolactinomas in adolescents can achieve successful biochemical remission and resolution of endocrine symptoms. Adolescents, particularly those with a high Ki-67 index and potential resistance to dopamine agonists, may benefit from prompt surgical management, resulting in improved clinical outcomes and complete tumor resection.

Background and Objectives: The frequency of multidrug-resistant Klebsiella pneumoniae (MDRKP) has dramatically increased worldwide in recent decades, posing an urgent threat to public health. The aim of this study was to assess the extent of K. pneumoniae in the Aseer region and explore the corresponding antimicrobial resistance profile over the last ten years. Materials and Methods: A record-based retrospective study was conducted in a tertiary hospital during the period of 2013 to 2022. The study targeted laboratory samples taken from patients admitted to the hospital and sent for K. pneumoniae culturing. We included only samples taken from the patient and confirmed by the lab. Data were extracted using a pre-structured data extraction sheet to avoid data-collection bias and confirm the inter-rater precision. Statistical Package for Social Sciences (SPSS) version 26 was employed for statistical analysis. All relationships were tested using Pearson X² test for categorical data or chi-square for linear trend for resistance rate over years. Results: We obtained 3921 samples of isolated K. pneumoniae out of 28,420 bacterial samples. The isolation rate began at 11.3% in 2013, decreased to 6.1% in 2016, and then increased to a peak of 16.3% in 2021, before slightly decreasing to 12.8% in 2022. In total, 23.7% of K. pneumoniae samples were identified in urine samples, 19% in sputum samples, 14% in wound samples, and 11.7% in blood samples. The overall antibiotic resistance rate of K. pneumoniae from 2013 to 2022 showed a significant increase, particularly during 2020 and 2021, before decreasing again in 2022. The resistance rate decreased from 22.2% in 2013 to 18.6% in 2016 and increased to 54.6% and 56.4% during 2020 and 2021, respectively (p = 0.039). Conclusions: We observed a significant shift in K. pneumoniae resistance for some antibiotics during the study period, highlighting the urgent need for enhanced antimicrobial stewardship and infection-control measures.

Background and Objectives: Ventilator-associated pneumonia (VAP) is a common complication in critically ill patients receiving mechanical ventilation. The incidence rates of VAP vary, and it poses significant challenges due to microbial resistance and the potential for adverse outcomes. This study aims to explore the microbial profile of VAP and evaluate the utility of biomarkers and illness severity scores in predicting survival. Materials and Methods: A retrospective cohort study was conducted involving 130 patients diagnosed with VAP. Microbial analysis of bronchoalveolar lavage (BAL) fluid, as well as measurements of C-reactive protein (CRP) and procalcitonin (PCT) levels, were performed. Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were calculated to assess illness severity. Statistical analyses were conducted to determine correlations and associations. Results: The study revealed that Klebsiella pneumoniae (K. pneumoniae) (50.7%) and Pseudomonas aeruginosa (P. aeruginosa) (27.69%) were the most identified microorganisms in VAP cases. SOFA (p-value < 0.0001) and APACHE II (p-value < 0.0001) scores were effective in assessing the severity of illness and predicting mortality in VAP patients. Additionally, our investigation highlighted the prognostic potential of CRP levels (odds ratio [OR]: 0.980, 95% confidence interval [CI] 0.968 to 0.992, p = 0.001). Elevated levels of CRP were associated with reduced survival probabilities in VAP patients. Conclusion: This study highlights the microbial profile of VAP and the importance of biomarkers and illness severity scores in predicting survival. Conclusions: The findings emphasize the need for appropriate management strategies to combat microbial resistance and improve outcomes in VAP patients.