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Acta medica Lituanica
Number of Followers: 0  

  This is an Open Access Journal Open Access journal
ISSN (Print) 1392-0138 - ISSN (Online) 2029-4174
Published by Vilnius University Homepage  [38 journals]
  • Supplement

    • Authors: Zanna Kovalova , Anda Kivite-Urtane, Jelena Rascon , Audronė Mulevičienė , Goda Elizabeta Vaitkevičienė , Kajus Merkevičius , Eglė Stukaitė-Ruibienė, Sonata Šaulytė Trakymienė
      Pages: 1 - 17
      Abstract: Hematopoietic stem cell transplantation (HSCT) is a complex procedure that is curative for several fatal pediatric malignancies and non-malignant diseases. Despite its complexity, potential toxicity, and high costs HSCT has become a standard procedure worldwide for several decades. Pediatric HSCT programs encounter several specific challenges. The rarity and heterogeneity of primary diseases, result in an almost 10-fold inferior number of pediatric HSCT as compared to adults. In contrast to the adult programs, where autologous HSCT is more common, allogeneic HSCT (that is more complex) prevails in pediatric setting which is underpinned by a higher number of inborn disorders transplanted in early childhood.
      In Lithuania, the pediatric HSCT program (EBMT CIC* 508) was launched at Vilnius University Hospital Santaros Klinikos in February 2002. Currently, this is the only specialized pediatric HSCT center in Lithuania and in the Baltic countries. Since 2011 it is a reference center for Latvian children who need autologous or allogeneic transplantation.
      Here we summarize conference proceedings presented at the scientific event “Pediatric hematopoietic stem cell transplantation in Lithuania – 20 years of progress through collaboration”. The meeting held on September 22-23, 2022, in Vilnius and aimed at commemorating 20 years of the launch of the pediatric transplant program in Lithuania. The event pursued sharing the experience in the field of pediatric HSCT in the Baltic countries. Given a very small population in all three Baltic countries, Lithuania, Latvia, and Estonia face an additional challenge in maintaining sufficient transplant volume and gaining experience. Several distinguished speakers from USA, Denmark, Italy, Germany, Spain, UK and Ukraine shared their expertise in the field and emphasized the crucial role of national and international collaboration to achieve progress in the management of this very rare and complex procedure that offers cure for otherwise fatal pediatric conditions.
      PubDate: 2022-10-19
      DOI: 10.15388/Amed.Supp.2022.292.2
      Issue No: Vol. 29, No. 2 (2022)
       
  • Vertigo and Ischemic Stroke after Hyperextension (Beauty Parlour Stroke
           syndrome)

    • Authors: Bünyamin Tosunoğlu, Sultan Merve Ünal, Seyfi Emre Aksoy, Tahir Kurtuluş Yoldaş
      Pages: 2 - 2
      Abstract: Beauty parlour stroke syndrome is a stroke syndrome that occurs secondary to hyperextension of the neck due to compression of the vertebral artery in the atlanto-occipital region. It was first defined as “pearl beauty stroke syndrome” in 1992 by Weintraub et al. Vertigo syndrome caused by cervical region pathologies, bad posture of the neck and/or trauma [1]. We present a young, 23-year-old patient who has no disease, no trauma history nor substance-drug use. He was diagnosed with vertigo that started after going to the barber’s and then had an infarction in the cerebellum.
      PubDate: 2022-07-25
      DOI: 10.15388/Amed.2022.29.2.2
      Issue No: Vol. 29, No. 2 (2022)
       
  • Creutzfeldt–Jakob Disease with Stroke-Like Symptoms: Case report

    • Authors: Bünyamin Tosunoğlu, Sıddıka Sena Dilek, Ümmühanı Emektar, Tahir Kurtuluş Yoldaş
      Pages: 3 - 3
      Abstract: Creutzfeldt–Jakob disease (CJD) is a rare, progressive, and fatal prion disease. Often the first sign of CJD is rapidly progressive dementia, leading to memory loss, personality changes, and hallucinations. Myoclonus typically occurs in 90% of cases, but often may not be an initial symptom. Other frequently occurring psychiatric symptoms include depression, anxiety, paranoia, obsessive-compulsive symptoms, and psychosis. Speech disorder, loss of balance and coordination may also accompany. We present a case of CJD with sudden onset of right hemiparesis.
      PubDate: 2022-07-25
      DOI: 10.15388/Amed.2022.29.2.3
      Issue No: Vol. 29, No. 2 (2022)
       
  • Bizarre Parosteal Osteochondromatous Proliferation (Nora Lesion): A
           Narrative Review

    • Authors: Edoardo Ipponi, Elisa Ferrari, Alfio Damiano Ruinato, Silvia De Franco, Rodolfo Capanna, Lorenzo Andreani
      Pages: 4 - 4
      Abstract: 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.
      PubDate: 2022-07-25
      DOI: 10.15388/Amed.2022.29.2.4
      Issue No: Vol. 29, No. 2 (2022)
       
  • Early Bilateral Gonadoblastoma in a Patient with Mixed Gonadal Dysgenesis
           (Karyotype 45,X/46,XY): Case Report and Review of Literature

    • Authors: Ignas Trainavičius, Darius Dasevičius, Birutė Burnytė, Robertas Kemežys, Gilvydas Verkauskas
      Pages: 5 - 5
      Abstract: 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.
      PubDate: 2022-07-25
      DOI: 10.15388/Amed.2022.29.2.5
      Issue No: Vol. 29, No. 2 (2022)
       
  • Gubernaculum and Epididymo-Testicular Descent: Review of the Literature

    • Authors: Eleonora Ivanova, Beata Vincel, Gilvydas Verkauskas, Faruk Hadziselimovic
      Pages: 6 - 6
      Abstract: Cryptorchidism is a common disorder in boys that has been widely studied both experimentally and clinically. The role of the gubernaculum, a mesenchymal tissue extending from the fetal testis and epididymis to the developing scrotum, is still unclear. Even the name is debated: ‘gubernaculum epididymis’ or ‘gubernaculum testis’. This review does not aim to provide a global overview of competing theories on testicular descent, but focuses on the role of the gubernaculum in epididymo-testicular descent. We identified four major pitfalls of gubernaculum research: the role of the gubernaculum, of insulin-like peptide 3, anti-Müllerian hormone, and androgens. The major critical issues were that the gubernaculum plays a guiding role for the epididymis, descending prior to the testis and expanding the inguinal canal; insulin-like peptide 3 is not as important for the process of descent in humans as the rate of insulin-like peptide 3 mutations is low; anti-Müllerian hormone plays no significant role in epididymo-testicular descent; androgens and gonadotropins play a crucial role in epididymo-testicular descent. The role of the epididymis in the complex process of gubernaculum, epididymis, and testis migration is underestimated and should be included in future research.
      PubDate: 2022-07-25
      DOI: 10.15388/Amed.2022.29.2.6
      Issue No: Vol. 29, No. 2 (2022)
       
  • Polycystic Horseshoe Kidney: A Rare Coexistence as a Challenge for the
           Surgeons. Case Report

    • Authors: Dionysios Prevezanos, Nikolaos Garmpis, Dimitrios Dimitroulis, Anna Garmpi, Vasiliki Epameinondas Georgakopoulou, Christos Damaskos
      Pages: 7 - 7
      Abstract: Autosomal dominant polycystic kidney disease (ADPKD) with concomitant horseshoe kidney is an extremely rare entity. In this case, we report a 45-year-old male patient with ADPKD and a horseshoe kidney who demonstrated hypertension, urological complications and discomfort symptoms such as pain, breathing difficulties and abdominal meteorism. After preoperative assessment and planning, the patient underwent nephrectomy. Bilateral nephrectomy without dividing the isthmus was performed successfully. The isthmus, which had complicated vasculature and was full of cysts, remained intact avoiding severe bleeding and infection. The postoperative course was uneventful. Keeping the isthmus intact in such cases is a challenge for the surgeon. The rarity of polycystic horseshoe kidney in combination with the altered abdominal anatomy requires the proper preoperative strategy in order to avoid intraoperative complications.
      PubDate: 2022-07-25
      DOI: 10.15388/Amed.2022.29.2.7
      Issue No: Vol. 29, No. 2 (2022)
       
  • All that Glitters is not Cholecystitis. A Rare Presentation of Acute
           Pericarditis Mimicking Cholecystitis and Review of the Literature

    • Authors: Anna Garmpi, Christos Damaskos, Nikolaos Garmpis, Vasiliki Epameinondas Georgakopoulou, Vaios Vasileios Kaminiotis, Evangelos Diamantis, Alexandros Patsouras, Athanasios Syllaios, Dimitrios Dimitroulis
      Pages: 8 - 8
      Abstract: Acute pericarditis is the most common inflammatory disorder of the pericardium, responsible for approximately 5% of visits to the emergency departments, concerning chest pain without myocardial infarction. We report a case of a 41-year-old man who presented to our hospital, complaining about retrosternal and epigastrium pain. The transthoracic echocardiogram showed pericardial effusion while the electrocardiogram and laboratory findings revealed acute pericarditis. An abdominal ultrasound revealed gallbladder edema. The pericardial effusion was treated with pericardial catheter insertion, diuretics, and nonsteroidal anti-inflammatory drugs. This case shows that acute pericarditis can be clinically presented with many ways, one of them being gallbladder edema. Furthermore, in this case-based review we present all cases of simultaneous appearance of pericarditis and acalculous cholecystitis or gallbladder edema.
      PubDate: 2022-07-25
      DOI: 10.15388/Amed.2022.29.2.8
      Issue No: Vol. 29, No. 2 (2022)
       
  • Implementation and Evaluation of Preimplantation Genetic Testing at
           Vilnius University Hospital Santaros Klinikos

    • Authors: Eglė Stukaitė-Ruibienė, Živilė Gudlevičienė, Andrė Amšiejienė, Evelina Dagytė, Rimantas Gricius, Kristina Grigalionienė, Algirdas Utkus, Diana Ramašauskaitė
      Pages: 9 - 9
      Abstract: Background and Objectives: The most effective treatment of infertility is in vitro fertilization (IVF). IVF with Preimplantation Genetic Testing (PGT) allows to identify embryos with a genetic abnormality associated with a specific medical disorder and to select the most optimal embryos for the transfer. PGT is divided into structural rearrangement testing (PGT-SR), monogenetic disorder testing (PGT-M), and aneuploidy testing (PGT-A). This study mostly analyzes PGT-SR, also describes a few cases of PGT-M. The aim of this study was to implement PGT procedure at Vilnius University Hospital Santaros Klinikos (VUHSK) Santaros Fertility Centre (SFC) and to perform retrospective analysis of PGT procedures after the implementation.
      Materials and Methods: A single-center retrospective analysis was carried out. The study population included infertile couples who underwent PGT at SFC, VUHSK from January 01st, 2017 to December 31st, 2020. Ion PGM platform (Life Technologies, USA) and Ion ReproSeq PGS View Kit (Life Technologies, USA) were used for the whole genome amplification. Results were assessed using descriptive statistics.
      Results: PGT was successfully implemented in VUHSK in 2017. During the analyzed time period, thirty-four PGT procedures were performed for 26 couples. Two procedures were performed in 2017, 7 procedures – in 2018, 13 – in 2019, and 12 – in 2020. In comparison with all IVF procedures, 2.5% procedures were IVF with PGT, a highest percentage was in 2020 (3.8% of all procedures). The main indication for PGT was balanced chromosomal rearrangements (in 85.3% cases). In all 34 cases 515 oocytes were aspirated in total, 309 oocytes were fertilized, oocytes fertilization rate exceeded 60%. A normal diploid karyotype was found in 46 (16.8%) biopsied embryos. Out of all PGT procedures, 9 (26.5%) resulted in a clinical pregnancy. Six (66.7%) pregnancies were confirmed in 2019, and 3 (33.3%) – in 2020. Three (33.3%) pregnancies resulted in spontaneous abortion, 6 (66.7%) – in delivery.
      Conclusions: The implementation of PGT in VUHSK was successful. The most common indication for PGT was a reciprocal translocation. Oocytes fertilization rate exceeded 60%, a normal karyotype was found less than in one-fifth of biopsied embryos. A highest clinical pregnancy rate was achieved in 2019 when almost half of women conceived, which is probably related to the experience gained by the multidisciplinary team. This is the first study analyzing IVF with PGT in Lithuania, however, the results should be interpreted with caution due to a low number of total procedures performed.
      PubDate: 2022-08-24
      DOI: 10.15388/Amed.2022.29.2.9
      Issue No: Vol. 29, No. 2 (2022)
       
  • The Insight into Obstetric Care near the Front Line in Kharkiv

    • Authors: Igor Lakhno
      Pages: 10 - 10
      Abstract: Objectives: The invasion of Russian troops into independent Ukraine has changed the humanitarian situation in the Kharkiv region. The paper is focused on the peculiarities and issues of the management of labor and delivery near the front line.
      Materials and methods: Totally 2030 patients were enrolled in the study. 1410 women who delivered in the second half of 2021 were enrolled in Group I. 620 women who delivered in the first half of 2022 were observed in Group II. Some patients from Group II were used for the investigation of the comparative situation during first months of 2022. 85 women who delivered in January were included in Subgroup IIA. 94 women who have completed their pregnancies and delivered in February were observed in Subgroup IIB. 67 case histories of deliveries which occurred during March were united in Subgroup Group IIC.
      Results: The level of anemia, uterine contractile activity in labor abnormalities, and episiotomies were surprisingly lower during wartime in March. The obtained results showed an almost similar level of obstetric complications, maternal comorbidities, and interventions during labor and delivery in all groups. The stressed environment was a possible reason for the elevation of cardiovascular disease and endocrine disorders.
      Conclusion: The study did not reveal any significant changes in the structure of maternal pathologies and obstetric complications during the first months of wartime near the front line. But later the levels of cardiovascular disease and endocrine disorders were found to be elevated.
      PubDate: 2022-09-26
      DOI: 10.15388/Amed.2022.29.2.10
      Issue No: Vol. 29, No. 2 (2022)
       
  • Attitudes toward COVID-19 Pandemic among Fully Vaccinated Individuals:
           Evidence from Greece Two Years after the Pandemic

    • Authors: Petros Galanis, Irene Vraka, Aglaia Katsiroumpa, Olga Siskou, Olympia Konstantakopoulou, Theodoros Katsoulas, Theodoros Mariolis-Sapsakos, Daphne Kaitelidou
      Pages: 11 - 11
      Abstract: Background: Considering the major effects of COVID-19 pandemic on health, social, economic, and political dimensions of all countries, positive attitudes toward COVID-19 pandemic are essential to control the pandemic. In our study, we investigated attitudes toward COVID-19 pandemic among fully COVID-19 vaccinated individuals two years after the pandemic and we identified predictors of attitudes. Materials and Methods: We conducted an on-line cross-sectional study with 815 fully COVID-19 vaccinated individuals in Greece during May 2022. A self-administered and valid questionnaire was disseminated through social media platforms. We measured socio-demographic variables and COVID-19-related variables as potential predictors of attitudes toward COVID-19 pandemic. The outcome variable was attitudes toward COVID-19 pandemic (compliance with hygiene measures, trust in COVID-19 vaccination, fear of COVID-19, and information regarding the COVID-19 pandemic and vaccination). Results: We found a very high level of compliance with hygiene measures, a high level of trust and information about the COVID-19 pandemic and vaccination, and a moderate level of fear of COVID-19. Also, we identified that females, participants with a higher educational level, those with a chronic disease, those with a better self-perceived physical health, and those without a previous COVID-19 diagnosis adhered more in hygiene measures. Trust in COVID-19 vaccination was higher among females, older participants, those with a higher educational level, those with a better self-perceived physical health, and those without a previous COVID-19 diagnosis. Moreover, females, older participants, those with a higher educational level, those with a chronic disease, those with a better self-perceived physical health, those that received a flu vaccine in previous season, and those without a previous COVID-19 diagnosis experienced more fear of the COVID-19. Finally, level of information regarding COVID-19 pandemic and vaccination was higher for participants with a higher educational level, those without a chronic disease, those with a better self-perceived physical health, and those that received a flu vaccine in previous season. Conclusions: Understanding predictors of attitudes toward COVID-19 pandemic among fully vaccinated individuals is crucial for developing appropriate public health campaigns in the future. Vaccination should be accompanied by positive attitudes in order to decrease the frequency of negative outcomes of COVID-19, such as hospitalization, complications and mortality.
      PubDate: 2022-09-26
      DOI: 10.15388/Amed.2022.29.2.11
      Issue No: Vol. 29, No. 2 (2022)
       
  • Incidentally Diagnosed Extraluminal Leiomyosarcoma of Infrarenal Inferior
           Vena Cava: A Case Report and Literature Review from a Radiologist’s
           Perspective

    • Authors: Ebinesh A, Aanchal Ashta, Satyam Satyam, Gaurav Shanker Pradhan, Rohin Sharma, Prince Das
      Pages: 12 - 12
      Abstract: Background: Vascular leiomyosarcoma is a rare but most common vascular tumor of the inferior vena cava.
      Case presentation: We present the case of an incidentally diagnosed extraluminal leiomyosarcoma of the inferior vena cava in a 62 year old patient who presented with abdominal pain following blunt trauma. Ultrasonography showed a lobulated hypoechoic lesion in the upper abdomen. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a circumscribed lobulated near homogeneously enhancing retroperitoneal lesion in anterior relation to the infrarenal inferior vena cava, right paramedian in location with imperceptible vena caval lumen at the site of maximum contact. In positron emission tomography (PET) CT the lesion showed mild fluorodeoxyglucose (FDG) uptake with no distant metastases. CT guided biopsy with immunohistochemical analysis showed leiomyosarcoma. Patient underwent surgical resection with inferior vena cava reconstruction.
      Conclusions: Leiomyosarcoma of the inferior vena cava is a rare tumor of vascular origin. Imaging plays an imperative role in the diagnosis and preoperative evaluation. This article also provides a comprehensive literature review of the radiological features of inferior vena caval leiomyosarcoma that would aid in optimal preoperative characterization and evaluation.
      PubDate: 2022-10-26
      DOI: 10.15388/Amed.2022.29.2.12
      Issue No: Vol. 29, No. 2 (2022)
       
  • Immunohistochemical Evaluation of BARX1, DLX4, FOXE1, HOXB3, and MSX2 in
           Non-syndromic Cleft-affected Tissue

    • Authors: Mārtiņš Vaivads, Ilze Akota, Māra Pilmane
      Pages: 13 - 13
      Abstract: Background: Nonsyndromic craniofacial clefts are relatively common congenital malformations which could create a significant negative effect on the health status and life quality of affected individuals within the pediatric population. Multiple cleft candidate genes and their coded proteins have been described with their possible involvement during cleft formation. Some of these proteins like Homeobox Protein BarH-like 1 (BARX1), Distal-Less Homeobox 4 (DLX4), Forkhead Box E1 (FOXE1), Homeobox Protein Hox-B3 (HOXB3), and Muscle Segment Homeobox 2 (MSX2) have been associated with the formation of craniofacial clefts. Understanding the pathogenetic mechanisms of nonsyndromic craniofacial cleft formation could provide a better knowledge in cleft management and could be a possible basis for development and improvement of cleft treatment options. This study investigates the presence of BARX1, DLX4, FOXE1, HOXB3, and MSX2 positive cells by using immunohistochemistry in different types of cleft-affected tissue while determining their possible connection with cleft pathogenesis process.
      Materials and Methods: Craniofacial cleft tissue material was obtained during cleft-correcting surgery from patients with nonsyndromic craniofacial cleft diagnosis. Tissue material was gathered from patients who had unilateral cleft lip (n=36), bilateral cleft lip (n=13), and cleft palate (n=26). Control group (n=7) tissue material was received from individuals without any craniofacial clefts. The number of factor positive cells in the control group and patient group tissue was evaluated by using the semiquantitative counting method. Data was evaluated with the use of nonparametric statistical methods.
      Results: Statistically significant differences were identified between the number of BARX1, FOXE1, HOXB3, and MSX2-containing cells in controls and cleft patient groups but no statistically significant difference was found for DLX4. Statistically significant correlations between the evaluated factors were also notified in cleft patient groups.
      Conclusions: HOXB3 could be more associated with morphopathogenesis of unilateral cleft lip during postnatal course of the disorder. FOXE1 and BARX1 could be involved with both unilateral and bilateral cleft lip morphopathogenesis. The persistence of MSX2 in all evaluated cleft types could indicate its possible interaction within multiple cleft types. DLX4 most likely is not involved with postnatal cleft morphopathogenesis process.
      PubDate: 2022-11-22
      DOI: 10.15388/Amed.2022.29.2.13
      Issue No: Vol. 29, No. 2 (2022)
       
  • Reproductive Outcome of the Patients with Uterus Unicornis: Five Year
           Experience in a Tertiary Center

    • Authors: Sule Atalay Mert, Berna Dilbaz, Ece Sevin Cukurova, Caner Kose, Yaprak Engin Ustun
      Pages: 15 - 15
      Abstract: Aim: The aim is to evaluate the pregnancy outcomes of patients with uterus unicornis for 5-year experience in a tertiary center.  Material & Method: Twenty patients with uterus unicornis who were diagnosed with hysterosalpingography and/or 3D TVUSG between 2017 and 2021 and then confirmed with laparoscopy and simultaneous hysteroscopy were recruited for this retrospective study. The reproductive outcome and obstetric complications of the patients were followed up for two years postoperative period.  Results: Overall 20 patients who fulfilled the inclusion criterion were recruited for the study. The mean age was 28.65±5.03 years. Thirteen patients (65%) had primary infertility while the remaining seven had secondary infertility with two of them having a previous ectopic pregnancy. Rudimentary communicating uterine horn was observed in 7 (35%) of the patients. The horns were excised during laparoscopy. Overall, 14 (70%) pregnancies were achieved during the 2 years follow-up period. Twelve (85.7%) patients had a live birth, (71.4% term delivery, 21.4% preterm delivery), and two had a first-trimester spontaneous abortion (15.3%). Six (50%) of 12 patients who had a live birth received tocolytics for preterm labor.  Conclusion: Unicorn uterus is a rare anomaly diagnosed mostly during infertility work-out and might be related to the poor obstetric outcome, but early diagnosis is important for successful pregnancy results for preterm delivery especially in the secondary infertile group. In addition, rudimentary horn excision is recommended due to the high risk of obstetric complications.
      PubDate: 2022-11-22
      DOI: 10.15388/Amed.2022.29.2.14
      Issue No: Vol. 29, No. 2 (2022)
       
  • Experience with Dopamine Agonists in the Treatment of Prolactinomas

    • Authors: Nadiya Barabash, Tetiana M. Tykhonova
      Pages: 15 - 15
      Abstract: The article is devoted to the conservative treatment of hyperprolactinemia of tumor origin. Cabergoline is considered as an effective treatment not only for microadenomas but also for large pituitary tumors which is illustrated by the clinical case of the patient P. The most important effects of cabergoline demonstrated in this clinical case are reduction in the size of the adenoma from macro to micro, reverse development of chiasmal syndrome with restoration of visual functions, achievement and maintenance of the target level of prolactin. Besides the article focused on the possible development of primary and secondary resistance to dopamine analogues. One of such difficult clinical scenario is illustrated by clinical case of patient M., who was treated with different dopamine analogues with the development of secondary dopamine resistance. Along with described in literature possible mechanisms for its development in our patient we also suggest the role of prolonged inadequate therapy with dopamine agonists, when the dose of the drug was not properly adjusted, despite not reaching the target prolactin level. The literature considers several ways of optimization of treatment in resistant patients but despite of this fact it remains one of unresolved problems in the management of patients with hyperprolactinemia.
      PubDate: 2022-11-22
      DOI: 10.15388/Amed.2022.29.2.15
      Issue No: Vol. 29, No. 2 (2022)
       
  • Ultrasound Simulation for Training Trainees when the Luxury Becomes
           Essential: Opinion and Evidence Obtained during the Latvian Research
           Council Project Implementation

    • Authors: Natālija Vedmedovska, Anda Ķīvīte-Urtāne, Ija Lisovaja, Laura Rācene, Līva Ķīse, Beāte Sārta, Agnija Vaska, Zane Rostoka, Violeta Bule, Ieva Pitkēviča, Dace Rezeberga
      Pages: 16 - 16
      Abstract: Background. Simulation as a proxy tool for conditional clinical training became a powerful technique for introducing trainees to the ultrasound imaging world, allowing them to become a trained sonographer taking into consideration different rates of progress completing a specific task against the time and ensuring the long-lasting maintenance of the obtaining practical skills. Adding a costly, but effective high-fidelity simulator to the residency program justified the expense, demonstrating efficiency of training for improving the clinical performance and confidence of trainees. Materials and methods. A pilot study in Riga Maternity Hospital within the framework of the study “Role of metabolome, biomarkers and ultrasound parameters in successful labour induction” (Fundamental and Applied Research Programme lzp-2021/1-0300) was performed between March 1st 2022 and 31st April 2022. A virtual-reality simulator (Scantrainer, MedaphorTM, Cardiff, UK) was used with the teaching module for assessment of the uterine cervix. Five trainees in obstetrics and two young specialists included in the study. None of them had Fetal Medicine Foundation certificate of competence in the assessment of the uterine cervical lenght before. The time used on the simulator, the number of simulations and a mean confidence in cervical length assessment before and after simulation were recorded. Results. The study on assesment of uterine cervical lenght demonstrated statistically significant increase in confidence (p=0.008) and statistically significant decrease in time needed to complete correctly the same tasks for the trainees (p=0.008) that shows a positive learning curve over the time of training on ScanTrainer, Medaphor. Conclusions. The simple task allows to become a certified specialist in uterine cervical assessment in the short period of time. That support the productiveness of the simulation-based education. The training program should be updated taking into consideration simulation curriculum.
      PubDate: 2022-11-22
      DOI: 10.15388/Amed.2022.29.2.16
      Issue No: Vol. 29, No. 2 (2022)
       
  • The Blessed Antonio (Patrizi) from Monticiano, Sienna (Italy):
           Bioanthropological and Palaeohistological Considerations

    • Authors: Dario Piombino-Mascali, Albert Zink, Frank Maixner
      Pages: 20 - 20
      Abstract: 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.
      PubDate: 2022-07-04
      DOI: 10.15388/Amed.2022.29.1.20
      Issue No: Vol. 29, No. 1 (2022)
       
 
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