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The Assessment of Systemic Inflammation Markers in Patients with Chronic Urticaria
No full textAuthor of the Master thesis: Agnė Baronaitė. Master thesis: The assessment of systemic inflammation markers in patients with chronic urticaria. Aim: To assess systemic inflammation markers in chronic urticaria and chronic urticaria with angioedema patients. The tasks of the thesis: 1. To assess composition of peripheral blood (leukocytes, lymphocytes, neutrophils, eosinophils, basophils), concentration of humoral inflammatory markers (CRP, IgE), ESR and compare these between chronic urticaria and chronic urticaria with angioedema patients. 2. To assess frequency of positive autoimmune markers (anti-TPO, ANA), H. pylori infection and commorbidic allergic diseases and compare these between chronic urticaria and chronic urticaria with angioedema patients. 3. To assess links between inflammatory and autoimmune markers and disease duration, patients’ age and gender. Methods. 86 patients with chronic urticaria data from medical history was retrospectively analysed. Patients from 2018-01-01 to 2019-12-31 were treated in Department of Immunology and Allergology in the Hospital of Lithuanian University of Health Sciences, Kaunas Clinics. Based on symptoms, patients were categorized into chronic urticaria and chronic urticaria with angioedema groups. Inflammatory, infection and autoimmune markers were assessed. Statistical analysis was performed with „SPSS 20.0 for Windows“. Results. Patients in chronic urticaria with angioedema group were more frequent with basopenia (<0,01x109/l) compare to chronic urticaria group (45% vs 16,7%, p=0,01). There were higher ESR and CRP concentration in chronic urticaria with angioedema patients compare to those in chronic urticaria group (ESR: 14,0 vs 8,45 mm/h, p=0,048; CRP: 4,95 vs 3,25 mg/l, p=0,005). Comorbidic allergic diseases were more prevalent among patients with chronic urticaria than chronic urticaria with angioedema (42,2% vs 18,2%, p=0,04). Longer duration was associated with more frequent positive ANA (p=0,013) and higher ESR (p=0,025). Positive anti-TPO were more common in females compare to males (p=0,009). Conclusions. Chronic urticaria with angioedema patients had higher CRP concentration, higher ESR and lower basophil count compared to chronic urticaria patients. There was no difference in other systemic inflammatory markers. 2. ANA, anti-TPO and H. pylori infection were equally frequent between chronic urticaria with and without angioedema groups. Comorbidic allergic diseases were more prevalent among patients with chronic urticaria. 3. ANA were more frequent in patients with longer disease duration, while positive anti-TPO were more common among females. Higher ESR was linked with longer disease duration and greater age of patients
Apatinio žandikaulio pakėlimo įtaiso veiksmingumas obstrukcinės miego apnėjos gydymui suaugusiesiems
No full textThe aim of the present review is to assess effectiveness of MADs in treating patients with OSA, based on measurements obtained from polysomnography such as Apnea-Hypopnea Index (AHI) and sleep efficiency
Comparative Value Of Radiological Imaging Modalities In The Diagnostics Of Acute Appendicitis And Diverticulitis
No full textAim: To evaluate the possibilities and value of ultrasound (US) and computed tomography (CT) in diagnosing acute appendicitis and diverticulitis - one of the most common pathologies causing acute pain in the lower abdominal quadrants. Objectives: 1. To evaluate the distribution of acute appendicits and diverticulitis by patient age and gender. 2. To determine the possibilities of ultrasound and computed tomography in the diagnostics of acute appendicitis. 3. To determine the possibilities of ultrasound and computed tomography in the diagnostics of acute diverticulitis. 4. To compare the diagnostic value of ultrasound and computed tomography in the diagnostics of acute appendicitis and diverticulitis. Methods: A retrospective study was performed at the Lithuanian University of Health Sciences Hospital in Kaunas Clinics following the permission of the Center of Bioethics of the Lithuanian University of Health Sciences. The study included 318 patients over the age of 18 who were examined at the Trauma and Emergency Department of Kaunas Clinics and had a diagnosis of acute appendicitis or diverticulitis. Data from patient’s records were collected: gender, age, preliminary and final diagnosis, descriptions of radiological findings after US and CT examinations. Data analysis was performed using Microsoft Excel, R and SPSS software packages. Results: 231 patients were diagnosed with AA, the mean age was 42 ± 18,64 years, 51,08% were women (the mean age was 44 ± 19,05 years) and 48,92% were men (the mean age was 40 ± 18,15 years). The average age of women was 4 years higher than of men. 87 patients were diagnosed with AD, the mean age was 60 ± 15,10 years, 71,26% were women (the mean age was 63 ± 13,66 years) and 28,74% were men (the mean age was 52 ± 15,70 years). The average age of women was 11 years higher than of men. US was performed for 93,07% of the patients who were suspected of having AA. 13,02% of these had no pathology, 20,47% were not informative enough and 66,51% confirmed the diagnosis. Acute appendicitis without complications was the most common (63,72%). 22,51% of the patients had CT examination and in 98,98% of the cases the diagnosis was confirmed. US was performed for 80,45% of the patients who were suspected of having AD. In 42,86% of the cases the examination was not informative enough, in 20,00% of the cases the diagnosis was confirmed and 37,14% of the patients had no pathological findings. The most common diagnosis (14,29%) was diverticular colon disease without perforation or abscess. CT was performed for 94,28% of the patients and diagnosis was confirmed in 100% of the cases. Correlation analysis revealed a weak bond between the diagnoses made by using US (the value of 0,4). The correlation between diagnoses made by using CT was moderate (the value of -0,5). The diagnosis is more statistically dependent on CT than US. Conclusions: 1.) The mean age of patients with acute appendicitis was 42 ± 18.64 years. The incidence of men and women was similar in this study. The mean age of women was 44 ± 19.05 years and the mean age of men was 40 ± 18.15 years. The mean age of patients with acute diverticulitis was 60 ± 15.10 years. In this study, women (the mean age was 63 ± 13.66 years) were more likely to have this diagnosis than men (the mean age 52 ± 15.70 years). 2.) On suspicion of acute appendicits, ultrasound was performed more often than computed tomography, though the diagnosis was comfirmed in less amount of cases. 3.) On suspicion of acute diverticulitis, computed tomography was performed more often than ultrasound and the diagnosis was confirmed in 100% of cases. 4.) In the diagnostics of acute abdominal pain, the diagnosis is more statistically dependent on computed tomography than on ultrasound
Influence of Local Infiltration Analgesia for Pain and Knee Function After Total Knee Arthroplasty in Early Post-Operative Period
No full textAuthor: Daugirdas Puras Title: Influence of Local Infiltration Analgesia for Pain and Knee Function After Total Knee Arthroplasty in Early Post-Operative Period Academic supervisor: Prof. Alfredas Smailys Aim: To evaluate and to compare efficiency of local infiltration analgesia for pain, knee function and quality of life in early post-operative period after total knee arthroplasty. Objectives: 1. To evaluate pain, knee function and quality of life (using KOOS) before total knee arthroplasty. 2. To evaluate post-operative pain on day 1, day 3 and day 5 after surgery using VAS and compare results of I group which got LIA during surgery with II group which did not get it. 3. To evaluate knee function and quality of life (using KOOS) on day 1, 5 after surgery and compare results of I group which got LIA during surgery with II group which did not get it. Object: Patients of department of orthopedic surgery of Alytus county S. Kudirka hospital who had elective total knee arthroplasty. Methods: Two groups were formed by random sampling: I gr. – LIA during surgery, II gr. – did not get LIA during surgery. Inclusion criteria: age > 18; osteoarthritis ( 85; severe forms of comorbidity; RA; IV degree osteoarthritis; revision surgery of the knee; same side hip arthroplasty; disagreement of patient. Methods: 1. Anamnesis, survey of patients(KOOS on 1, 5 POD; VAS on 1, 3, 5 POD). 2. Goniometry on 1 and 5 POD. 3. Results of I gr. and II gr. were compared using SPSS 20.0. Results: Selected 11 men, 19 women: I gr. – 6 men, 9 women, II gr. – 5 men, 10 women; Mean age: 70,93 ± 6,297, I gr. 71,07 ± 6,006, II gr. 70,80 ± 6,784. Pain: before surgery – 3,7 ± 0,877, day 1 – I gr. 3,73 ± 1,033, II gr. 4,87 ± 1,125, day 3 – I gr. 4,60 ± 0,507, II gr. 4,07 ± 0,799, day 5 – I gr. 4,00 ± 0,756, II gr. 3,93 ± 0,799. Knee flexion: before surgery – 112,13 ± 14,796, day 1 – I gr. 54,87 ± 7,873, II gr. 46,73 ± 7,372, day 5 – I gr. 72,73 ± 6,681, II gr. 71,13 ± 6,937. Quality of life (using KOOS): before surgery – 24,30 ± 12,761, day 1 – I gr. 24,27 ± 7,255, II gr. 12,27 ± 5,688, day 5 – I gr. 31,33 ± 5,499, II gr. 31,67 ± 5,690. Conclusion: 1. There was no statistically significant difference in the groups before total knee arthroplasty. 2. On first post-operative day pain was lower when LIA was used during TKA (I gr.) (p<0,05); on POD 3 – I gr. pain was higher (p<0,05) 3. On first post-operative day knee flexion (p<0,05) and quality of life (p<0,001) was better when LIA was used during TKA (I gr.). On POD 5 there was no significant difference between groups
Chest Imaging in Granulomatous Lung Diseases
No full textThe aim of this study was to evaluate radiologic features of granulomatous lung diseases. Features include size, shape, distribution pattern, margins, cavitation, calcification and necrosis
Early Epileptic Seizures After Ischaemic Stroke: Association with Stroke Characteristics and Impact on Stroke Outcome
No full textAim: to determine the association of early epileptic seizures (ES) after ischaemic stroke with stroke characteristics and impact on stroke outcome. Objectives: 1. To assess the incidence of early and late epileptic seizures in the ischaemic stroke patient group. 2. To determine associations of demographic data (age, sex) and clinical properties (ischaemic stroke risk factors, affected brain area, stroke severity) with the occurrence of early epileptic seizures in the ischaemic stroke patient group. 3. To determine associations of early epileptic seizures with outcomes of ischaemic stroke (occurrence of late seizures, functional independence (modified Rankin Scale), death) in the ischaemic stroke patient group. Methods: We performed a prospective analysis of demographic (age, sex), clinical (stroke risk factors (arterial hypertension, diabetes mellitus, atrial fibrillation, dyslipidemia), affected brain area, stroke severity, occurrence of late and early poststroke seizures, time period between stroke and seizures, seizure type, treatment with antiepileptic drugs, functional independence and death after ischaemic stroke) and encephalographic data of 166 ischaemic stroke patients. Mann-Whitney U test, χ2 test and Kaplan-Meier analysis were used for statistical analysis. P-values lower than 0,05 were considered to be statistically significant. Results: The study group (n=166) consisted of 94 (56,6%) men and 72 (43,4%) women. Average age during stroke was 68,1 ± 11,7 years. Epileptic seizures after ischaemic stroke occurred in 17 (10,2 proc.) participants, early seizures – 11 (6,6%), late – 8 (6,9%) participants. Men and women, younger (≤65 years) and older (>65 years) participants had the same probability of developing early ES after ischaemic stroke (accordingly – Log Rank=1,281, p>0,05 and Log Rank=0,129, p>0,05). Participants without prior history of arterial hypertension had a higher probability (Log Rank=4,453; p0,05). Participants that developed early ES after ischaemic stroke had a higher probability of developing late seizures (Log Rank=5,093; p0,05). The probability of survival after ischaemic stroke was the same for participants with or without early ES (Log Rank=2,413, p>0,05). Conclusions: 1. One-tenth of participants developed epileptic seizures after ischaemic stroke. Early epileptic seizures occurred in 6,6% of participants: more than half – during the first day, ¾ - during the first two days after stroke, all – during the first two days after stroke. More than half of immediate early epileptic seizure cases occurred during the first hour after ischaemic stroke. Late epileptic seizures occurred in 6,9% of participants: one-fourth – during the first month, all – during the first 7 months after ischaemic stroke. 2. Participants without prior history of arterial hypertension had a higher probability of developing early epileptic seizures after ischaemic stroke. The probability of developing early epileptic seizures after ischaemic stroke between different sex, age, other risk factors (atrial fibrillation, diabetes mellitus, dyslipidemia), stroke severity and affected brain area groups did not differ. 3. Participants that developed early ES after ischaemic stroke had a higher probability of developing late seizures. No participants that developed early epileptic seizures and were treated with antiepileptic drugs had late epileptic seizures. Functional independence and death rate after ischaemic stroke were the same between participants with or without early epileptic seizures.
Early Biomarkers of Serious Bacterial Infections
No full textIntroduction: The majority of febrile cases in children are caused by viral infection. However, 5 – 20% of febrile children might be at risk of having serious bacterial infections (SBI). Infants and children usually do not demonstrate clinical signs and symptoms which could reliably indicate that a patient has serious bacterial infection. Various biomarkers are used to determine diagnosis. C – reactive protein is the most common biomarker used in diagnosis and prognosis of SBI in pediatric patients. C – reactive protein, procalcitonin have limitations on differentiating SBIs from non-bacterial inflammatory conditions and have poor value on predicting disease outcomes. For this reason, studies on biomarkers with higher diagnostic values remain important research objects in studies related to SBI and sepsis in pediatric patients. Purpose: To perform a systematic review and to assess the diagnostic value of early biomarkers of severe bacterial infections. Objectives: 1. To perform a literature search and identify articles about early biomarkers of serious bacterial infections. 2. To determine and compare diagnostic values of early biomarkers and C-reactive protein for severe bacterial infections in the diagnosis of serious bacterial infections and sepsis in children. 3. To identify and compare diagnostic possibilities of biomarkers in differentiating serious bacterial infections from viral in children. 4. To summarize the data of early biomarkers presented in selected scientific literature. Methods: A systematic literature review was performed in 3 electronic databases (PubMed, Science Direct, Cochrane Library) by using the following keywords: “early”, “biomarker”, “diagnosis”, “serious bacterial infection”, “severe bacterial infection”, “sepsis”. The quality of selected publications was assessed by using QUADAS – 2 tool. Results: 5095 scientific articles were identified. Full-text analysis was performed on 132 publications and 25 articles were included into qualitative analysis. There were 31 different biomarkers studied in articles. The most common biomarkers were C-reactive protein (22/25, 88,5%), white blood cell count (14/25, 56%), procalcitonin (9/25, 36%). CRP sensitivity ranged from 20.9% to 93.0%, specificity from 30.0% to 97.3%, AUC values from 0.670 to 0.940. Procalcitonin had ranges between 41.7% – 91%, 36% – 95.9%, 0.648 – 0.938 respectively. White blood cell count had sensitivity ranges from 37.6% to 76.1%, specificity from 37.6% to 82.88% and AUC values varied from 0.630 to 0.787. Cytokines demonstrated high diagnostic accuracy in differential diagnosis of serious bacterial infections and viral infections in children. NGAL was identified as a specific biomarker for urinary tract infections. Conclusion: The most common biomarkers among neonatal and pediatric patients are CRP, white blood cell count, procalcitonin, cytokines, NGAL. CRP remains one of the most important biomarkers in diagnosing neonatal and pediatric serious bacterial infections due to easy identification of CRP during infection and its’ usefulness in monitoring infection dynamics. PCT as well as CRP are recommended to use in combination with complete blood count and other available biomarkers. CSF lactates, CSF cytokines (IL–6, IL–8, TNF–α) can differentiate bacterial meningitis from aseptic meningitis. PCT might be useful in determination of etiology in pediatric patients with community-acquired pneumonia
Analysis of Factors Affecting Bad Early Outcomes after Simultaneous Coronary Artery Bypass Grafting and Carotid Endarterectomy
No full textThe aim: To identify factors affecting bad early complications after simultaneous coronary artery bypass grafting and carotid endarterectomy. Objectives of the study: 1. To evaluate the demographic data of all patients who underwent simultaneous coronary artery bypass grafting and carotid endarterectomy; 2. To evaluate the early results after simultaneous coronary artery bypass grafting and carotid endarterectomy; 3. To evaluate the demographic data of patients who had an early stroke, myocardial infarction (MI), or death after simultaneous coronary artery bypass grafting and carotid endarterectomy; 4. To identify risk factors affecting an early postoperative stroke, MI and death after simultaneous coronary artery bypass grafting and carotid endarterectomy. Methods: A retrospective analysis of 67 patients who underwent simultaneous coronary artery bypass grafting and carotid endarterectomy in 2014-2017 was performed at the Clinic of Cardiovascular Surgery at the Hospital of LUHS. The data were collected from case histories and analyzed using the standard statistical package SPSS (Statistical Package for the Social Sciences) 23.0 and Microsoft Excel 2016 program. Results: The mean age of all patients was 70.8±9 years. In the early postoperative period 6 patients (9%) have suffered stroke, 1 patient (1.5%) had a MI and 6 patients (9%) have died. Logistic regression analysis identified significant risk factors for an early postoperative stroke, MI or death that occurred after complex cardiac and carotid artery surgery - older age (OR = 1,26 proc. CI: 1,02-1,55, p = 0,034), smoking (OR = 9,31, 95 proc. CI: 0,93-93,5, p = 0,058), obesity (OR = 4,81 proc. CI: 1,08-21,45, p = 0,039), peripheral vascular disease (OR = 6,81, 95 proc. CI: 1,79-25,97, p = 0,005), prior stroke or transient ischemic attack (OR = 24,61, 95 proc. CI: 1,98-305,84, p = 0,013), prior MI (OR = 37,76, 95 proc. CI: 2,95-483,11, p = 0,005), heart rhythm disturbance (OR = 8,45, 95 proc. CI: 0,87-81,85, p = 0,065) or emergency surgery (OR = 51,67, 95 proc. CI: 1,33-2006,74, p = 0,035). Conclusions: The risk factors that lead to an early postoperative stroke, MI and death after simultaneous coronary artery bypass grafting and carotid endarterectomy is older age, smoking, obesity, peripheral vascular disease, prior stroke or transient ischemic attack, prior MI, heart rhythm disturbance or emergency surgery
The Role of Religion in Nutrition
No full textObjective: To evaluate differences in nutrition related to religion and draw the comparison to classical nutrition. Tasks: 1. Evaluation of food products according to dietary rationality and classical diet; 2. Identify dietary differences between various religions; 3. Possible nutritional disadvantages comparing religion-based diet with a classical one. Applied methodology: Articles were searched applying LSMU subscription, utilizing databases, such as PubMed, Cochrane Library, Science Direct, Web of Science, UpToDate. The search was performed following PRISMA recommendations. Articles published in English had been selected, based on criteria that they are not older than 10 years and cover the age group of 0 - 18 years. The following keywords had been used: "nutrition recommendation" and "dietary guidelines". Results: Assessing the diets of different religions, we observe that most of them do not consume meat, fish and eggs; instead, they are based on consumption of other foods and supplements, which fully satisfy human body’s nutrition needs. The only Jainists have no alternatives to non-consumable foods, so their only viable option is to use food supplements. Conclusions: 1. The classic diet is the most rational, as it offers a significant diversity of foods, so a person is provided with all the necessary nutrients. 2. Religious nutrition cannot be considered a diet therapy. Most religions refuse some particular foods and replace them with other substitutes thereby ensuring a sufficient and wholesome diet, except for Jains, whose diet is very limited and therefore does not provide adequate nutrients. 3. Comparing the religious diet with the classical one, we observe that all religions receive the right amount of nutrients because they have to replace the products, which are not consumed. This group does not include only Jainists, due to the narrow dietary range of their food. Recommendations: 1. Although certain foods are restricted In the diet of different religions, an adequate diet is ensured due to the possibility to substitute particular products with other alternatives. Consequently, we cannot conclude that the diet of these religions is detrimental to human health. 2. Jainism diet is deficient. To remain healthy, I would recommend supplementing the diet with food supplements. 3. Assessing the peculiarities of the diet of all religions, it can be pointed out that the classical diet is still the most diverse, so I would recommend everyone to adhere to the principles of the classical diet. 4. A balanced diet is very important for children's development. Whatever the religion of the child, their diet is suitable for them (except for Jainists); however, I do not recommend diet therapy for children aged from 0 to 18 years
Differences in Outcomes After Acute Ischemic Stroke Treatment with Mechanical Thrombectomy in Anticoagulated Patients Compared to Patients with Normal Blood Clotting
No full textObjective: To evaluate differences in outcomes between patients with reduced blood coagulation and with normal blood coagulation after acute ischemic stroke treatment with mechanical thrombectomy. Research tasks: To compare group age and gender, evaluate the success rate of mechanical thrombectomy, determine the incidence of intracranial haemorrhage and mortality rate of patients with reduced blood coagulation and with normal blood coagulation. Analyse non-contrast CT examination images of both patient groups before mechanical thrombectomy, 24 hours after procedure, and in dynamics. Methods: A retrospective study of 235 patients with acute ischemic stroke who were admitted to the Hospital of Lithuanian University of Health Sciences Kauno Klinikos in 2015-2019 and underwent treatment - mechanical thrombectomy. Patients were divided into two groups: anticoagulated patients (A group) and patients with normal blood coagulation (B group). Demographic characteristics of those groups such as age and gender were compared. The success rate of mechanical thrombectomy, the incidence of intracranial haemorrhage and mortality between the two groups was evaluated. Statistically significant changes in non-contrast CT images were analysed. We looked for the following pathological changes in non-contrast CT images: signs of acute ischemia, signs of haemorrhagic transformation, cerebral ventricular deformities, and midline shift. Each change found was equal to a score of 1 and the added amounts were compared with each other. Statistically significant differences were found if p < 0,05. Results: When comparing age, it was found that the A group was statistically significantly (p < 0,001) older than the B group. The incidence of intracranial haemorrhage (p = 0,404), the success rate of mechanical thrombectomy (p = 0,143), and the mortality rate (p = 0,579) were not statistically significantly different between the two groups. Changes in non-contrast CT images prior to thrombectomy were not statistically significant (p = 0,263). Similarly, no significant changes were detected 24 hours (p = 0,455) after the treatment procedure and when comparing changes in dynamics (p = 0,836). Conclusions: The study found that patients after mechanical thrombectomy with reduced blood coagulation had no statistically significant outcome differences compared to patients with normal blood coagulation when treating acute ischemic stroke. No statistically significant differences were found in the number of pathological changes in non-contrast CT images, thrombectomy success rate, intracranial haemorrhage rate, mortality. When comparing age, A group was significantly older