Acta medica Lituanica 2022-03-30T09:36:14+00:00 Rimantas Jankauskas Open Journal Systems <p>Founded in 1994. The periodical scholarly journal <em>Acta medica Lituanica</em> is published by the Lithuanian Academy of Sciences in collaboration with the Faculty of Medicine of Vilnius University and the National Cancer Institute. It publishes papers on high quality research, mostly from Lithuania, the Baltic states, and Eastern Europe. Indexed in the <em>Scopus</em> database since 2021.</p> Children’s Doctors Against the War: Call for Action Now 2022-03-15T07:58:21+00:00 Arūnas Valiulis <p>Two weeks have passed since the beginning of the invasion of Ukraine. Despite 141 countries voting in the UN General Assembly for the Russian army to stop fighting and withdraw from another sovereign country, Ukraine, the fighting is increasingly bloody and brutal. The war has led to 2.5 million people including about 1 million children fleeing from their homes and becoming refugees. There are 79 children confirmed killed including 18 months old infant in Mariupol. Most of child fatalities result from attacks from the air or with rockets. We stand together with Ukrainian children, families and the heroic medical and nursing staff calling for the action now:<br>• we ask the governments of our countries to do more to ensure the safety of children in Ukraine, to stop the war and first of all to stop rockets and bombs attacks on civil infrastructure of Ukraine;<br>• we ask Russian paediatricians and especially leaders of paediatric organizations in Russia to express clear and loud position against the war in Ukraine and to do everything in their power to stop the war;<br>• we confirm once again solidarity and professionalsupport for children’s doctors and nurses in Ukraine.</p> <p>Our voices are stronger than rockets and bombs! Slava Ukraine!</p> 2022-03-10T00:00:00+00:00 Copyright (c) 2022 Authors Vaccinating with a COVID-19 Vaccine: Experience of the Tertiary Allergology Center 2022-01-11T09:32:57+00:00 Eglė Žilėnaitė Laura Malinauskienė Kęstutis Černiauskas Linas Griguola Kotryna Linauskienė Violeta Kvedarienė Anželika Chomičienė <p xml:lang="en-GB"><strong>Background:</strong>&nbsp;Allergic reactions after messenger RNA (mRNA)-based COVID-19 vaccines have been reported but detailed descriptions and further actions are not well characterized.&nbsp;<br><strong>Objective:</strong><em>&nbsp;</em>To describe the symptoms of possible allergic reactions after the mRNA COVID-19 vaccine and outcomes of further vaccination.&nbsp;<br><strong>Methods:</strong>&nbsp;We descriptively analyzed data of adult (≥18 years of age) patients, who were sent for vaccination to<strong>&nbsp;</strong>our outpatient center for the Diagnostics and Treatment of Allergic and Immune diseases. All patients were vaccinated with the Pfizer–BioNTech Comirnaty® vaccine.<br><strong>Results:</strong>&nbsp;From January 2021 to July 2021 twenty-two patients were vaccinated in our center. Six patients experienced a reaction after the first Comirnaty® dose in different vaccination centers. The majority of them complained of various types of rashes after the first dose, one case was consistent with anaphylaxis. The latter patient was tested with the skin prick using Pfizer–BioNTech Comirnaty® vaccine and the test was negative. Other sixteen patients were vaccinated in our center from the first dose because of past allergic reactions to other medication or due to concomitant mast cell disorder. All patients were vaccinated without any immediate adverse reactions.<br><strong>Conclusions:</strong>&nbsp;None of our patients experienced repeated cutaneous reactions after the second dose. Patients with previous anaphylaxis or mastocytosis also were safely vaccinated.</p> 2022-01-11T06:46:07+00:00 Copyright (c) 2022 Eglė Žilėnaitė | Laura Malinauskienė | Kęstutis Černiauskas| Linas Griguola| Kotryna Linauskienė | Violeta Kvedarienė | Anželika Chomičienė Predictors of Real-World Parents’ Acceptance to Vaccinate Their Children Against the COVID-19 2022-01-26T09:33:41+00:00 Petros Galanis Irene Vraka Olga Siskou Olympia Konstantakopoulou Aglaia Katsiroumpa Ioannis Moisoglou Daphne Kaitelidou <p><strong>&nbsp;Background:&nbsp;</strong>As the COVID-19 pandemic continues to threaten public health, the vaccination of children against the disease appears to be a key factor to control the pandemic. Our aim was to investigate the prevalence of parents who have vaccinated their children against the COVID-19 and the factors influencing this decision.<br><strong>Materials and Methods:</strong>&nbsp;We conducted a web-based cross-sectional study in Greece during the first week of September 2021. The study questionnaire was distributed through social media and a convenience sample was obtained. Only parents with children aged 12–17 years old could participate in the study. We collected socio-demographic data of parents and we measured their attitudes towards vaccination and COVID-19 pandemic.<br><strong>Results:&nbsp;</strong>Study population included 656 parents. Regarding vaccination, 27.1% of parents had their children vaccinated against the COVID-19, while almost all children had a complete vaccination history (98.9%). The most important reasons for decline of COVID-19 vaccination were doubts about the safety and effectiveness of COVID-19 vaccines (45.3%) and fear of side effects (36.6%). Regarding the information about the COVID-19 vaccines, parents showed more trust in family doctors than in scientists and the government. We found that increased parents’ age, increased trust in COVID-19 vaccines, and positive attitude of parents towards vaccination had a positive effect on children’s vaccination.<br><strong>Conclusions:&nbsp;</strong>Understanding the factors influencing parents’ decision to vaccinate their children against the COVID-19 is crucial to increase the COVID-19 vaccination coverage rate. Implementation of public health policies is necessary to spread knowledge about COVID-19 vaccines and to regain vaccine confidence.</p> 2022-01-25T09:38:44+00:00 Copyright (c) 2022 Petros Galanis | Irene Vraka | Olga Siskou | Olympia Konstantakopoulou | Aglaia Katsiroumpa | Ioannis Moisoglou | Daphne Kaitelidou Analysis of Epigenetic Changes in Vitamin D Pathway Genes in Rheumatoid Arthritis Patients 2022-01-31T09:33:53+00:00 Eglė Puncevičienė Justina Gaiževska Rasa Sabaliauskaitė Kristina Šnipaitienė Lina Vencevičienė Dalius Vitkus Sonata Jarmalaitė Irena Butrimienė <p><strong>Background:&nbsp;</strong>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 (<em>VDR</em>,&nbsp;<em>CYP24A1, CYP2R1</em>), vitamin D level and associations with RA.<br><strong>Materials and Methods:&nbsp;</strong>Totally 76 participants (35 RA patients and 41 healthy controls) were enrolled from a case-control vitamin D and&nbsp;<em>VDR</em>&nbsp;gene polymorphisms study regarding age and vitamin D concentration. CpG islands in promoter regions of the&nbsp;<em>VDR</em>,&nbsp;<em>CYP24A1</em>,&nbsp;<em>CYP2R1</em>&nbsp;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.<br><strong>Results:&nbsp;</strong>The study showed similar methylation pattern in the promoter regions of vitamin D pathway genes in RA and control group with&nbsp;<em>p</em>&gt;0.05 (<em>VDR</em>&nbsp;gene 2.39%&nbsp;<em>vs.</em>&nbsp;2.48%,&nbsp;<em>CYP24A1</em>&nbsp;gene 16.02%&nbsp;<em>vs.</em>&nbsp;15.17% and&nbsp;<em>CYP2R1&nbsp;</em>2.53%&nbsp;<em>vs.</em>&nbsp;2.41%).&nbsp;<em>CYP24A1&nbsp;</em>methylation intensity was significantly higher in compare to methylation intensity of&nbsp;<em>VDR</em>&nbsp;and&nbsp;<em>CYP2R1</em>&nbsp;genes in both groups (<em>p</em>&lt;0.0001). A tendency of higher vitamin D concentration in cases having methylated&nbsp;<em>VDR (</em>57.57±28.93&nbsp;<em>vs.</em>&nbsp;47.40±29.88 nmol/l),&nbsp;<em>CYP24A1 (</em>53.23±26.22&nbsp;<em>vs.</em>&nbsp;48.23±34.41 nmol/l) and&nbsp;<em>CYP2R1&nbsp;</em>(60.41±30.73&nbsp;<em>vs.</em>&nbsp;44.54±27.63 nmol/l) genes and a positive correlation between&nbsp;<em>VDR</em>,&nbsp;<em>CYP2R1&nbsp;</em>methylation intensity and vitamin D level in RA affected participants was revealed (<em>p</em>&gt;0.05). A significantly higher&nbsp;<em>CYP24A1&nbsp;</em>methylation intensity (<em>p</em>=0.0104) was detected in blood cells of vitamin D deficient (&lt;50 nmol/l) RA patients&nbsp;<em>vs.</em>&nbsp;vitamin D deficient controls.<br><strong>Conclusions:&nbsp;</strong>Our data suggests some indirect associations between DNA methylation status of vitamin D pathway genes and vitamin D level in RA.</p> 2022-01-31T08:41:05+00:00 Copyright (c) 2022 Eglė Puncevičienė | Justina Gaiževska | Rasa Sabaliauskaitė | Kristina Šnipaitienė | Lina Vencevičienė | Dalius Vitkus | Sonata Jarmalaitė | Irena Butrimienė COVID-19 in Hospitalised Children and Adolescents: Review of the First Pandemic Year at Vilnius University Hospital Santaros Klinikos 2022-03-15T07:58:21+00:00 Inga Ivaškevičienė Kamilė Donielaitė – Anisė Virginija Žilinskaitė Daiva Vaičiūnienė Rimvydas Ivaškevičius <p><strong><em>Background</em>.</strong>&nbsp;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.<br><strong><em>Materials and methods.</em>&nbsp;</strong>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.<br><strong><em>Results.</em>&nbsp;</strong>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.<br><strong><em>Conclusions.</em></strong>&nbsp;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.</p> 2022-03-15T05:42:39+00:00 Copyright (c) 2022 Inga Ivaškevičienė | Kamilė Donielaitė – Anisė | Virginija Žilinskaitė | Daiva Vaičiūnienė | Rimvydas Ivaškevičius Vaccination Against COVID-19 Disease During Pregnancy 2022-03-30T09:36:14+00:00 Austėja Voiniušytė Miglė Černiauskaitė Virginija Paliulytė Rūta Einikytė Diana Ramašauskaitė <p><strong>Background.</strong>&nbsp;The effect of COVID-19 disease during pregnancy is still under investigation, however scientific studies have shown that pregnant women with COVID-19 infection are at increased risk for severe illness or complications [1]. Risk factors for severe disease and death in pregnancy include maternal age (especially ≥35 years), obesity, preexisting medical comorbidities (particularly hypertension and diabetes or more than one comorbidity), and being unvaccinated [2]. Many societies of obstetricians and gynecologists recommend that all pregnant patients undergo COVID-19 vaccination [1]. The aim of this study is to observe demographic characteristics, including education, place of residence and type of employment of women who chose to be vaccinated against COVID-19 in Lithuania, as well as to investigate any adverse reactions following the COVID-19 vaccine during pregnancy and compare the results to published scientific data.<br><strong>Materials and methods.</strong>&nbsp;An online questionnaire for pregnant women primarily located in Lithuania who received at least one dose of COVID-19 vaccine before giving birth has been launched in July, 2021. Data were entered via&nbsp;<em>Google Forms</em>&nbsp;and analyzed using&nbsp;<em>Microsoft Excel</em>&nbsp;and&nbsp;<em>IBM SPSS Statistics</em>. Literature review was performed on&nbsp;<em>PubMed</em>&nbsp;and&nbsp;<em>Google Scholar</em>&nbsp;search engines on inclusion criteria: publication date 2019–2021, used keywords&nbsp;<em>pregnancy, COVID-19, vaccination, side effects</em>.<br><strong>Results.&nbsp;</strong>Data were collected from 227 women vaccinated against COVID-19 during pregnancy. It was observed that the most chosen vaccine was Pfizer-BioNTech BNT162b2 (196 out of 227 individuals (86%)). More pregnant women confirmed having fever after the second dose compared to the first dose (p=0.006). In addition, injection site pain was the most common local side effect after both doses (98%) and more common after the first dose compared to the second (p=0.002). Regarding systemic reactogenicity more women experienced fatigue after the second dose comparing to the first dose (p=0.01). Furthermore, more women were unable to engage in daily activities after the second dose (p=0.03). All other symptoms did not differ&nbsp;after doses 1 and 2.<br><strong>Conclusions.</strong>&nbsp;Overall findings of this study did not suggest any obvious safety signals among pregnant individuals who received COVID-19 vaccine and all the side effects were comparable to the general population. Completed literature review indicates that pregnant women vaccinated against COVID-19 experience the same side effects as individuals in general population and no specific postvaccination reactions among pregnant individuals are observed.</p> 2022-03-29T10:27:53+00:00 Copyright (c) 2022 Austėja Voiniušytė | Miglė Černiauskaitė | Virginija Paliulytė | Rūta Einikytė | Diana Ramašauskaitė Embryonal Rhabdomyosarcoma of the Biliary Tree as a Differential in a Paediatric Patient Presenting with Biliary Dilatation: Not Always a Choledochal Cyst 2022-01-25T09:33:37+00:00 Tara Prasad Tripathy Yashwant Patidar Karamvir Chandel Annapoorani Varadarajan Vikrant Sood Shalini Thapar Laroia <p>Rhabdomyosarcoma is a soft tissue malignant musculoskeletal tumour and is the most prevalent soft-tissue sarcoma in the paediatric population. Although, Embryonal RMS of the biliary tree is a rare entity, however, it is the most common cause of paediatric malignant obstructive jaundice. We present a 4-year-old child who had symptoms of obstructive jaundice and palpable liver. The non-contrast magnetic resonance imaging and magnetic resonance cholangiopancreatography (MRCP) features were consistent with choledochal cyst. However, contrast enhanced computed tomography and PET CT images revealed biliary RMS as the differential diagnosis. Percutaneous biopsy followed by histopathology confirmed the diagnosis of embryonal biliary RMS. Since embryonal rhabdomyosarcoma is uncommonly recorded in the literature and can mimic the appearance of a choledochal cyst, this case report emphasises the necessity of keeping embryonal RMS as a differential in paediatric cases of obstructive jaundice.</p> 2022-01-24T11:14:00+00:00 Copyright (c) 2022 Tara Prasad Tripathy | Yashwant Patidar | Karamvir Chandel | Annapoorani Varadarajan | Vikrant Sood | Shalini Thapar Laroia Appendicitis in a Newborn: Case Report and Review of the Literature 2022-01-25T09:49:55+00:00 Eleonora Ivanova Rasa Garunkštienė Arūnas Liubšys <p><strong>Background:</strong>&nbsp;Acute appendicitis in a newborn is rare and may be fatal. The reported incidence is 0,04 % to 0,2 %. Diagnosis remains challenging as the symptoms are undefined.<br><strong>Case presentation:</strong>&nbsp;Here we present a full-term newborn boy of 9 days presenting with malaise, reluctance to feed and subfebrile fever. Over the course of 6 days his condition became worse. The newborn was febrile, passed no stool and his stomach became distended. Perforation due to necrotizing enterocolitis was highly suspected. The diagnosis of acute appendicitis was finalized perioperatively after the perforation and worsening condition made the emergency surgery inevitable. After 16 days of admission the patient was discharged in good condition.<br><strong>Conclusion:</strong>&nbsp;Appendicitis in neonates is a dangerous yet manageable condition. While rare it should be included in differential diagnosis when presented with atypical necrotizing enterocolitis or unexplained peritonitis. Quick and accurate diagnosis may increase survival rates.</p> 2022-01-25T09:32:32+00:00 Copyright (c) 2022 Eleonora Ivanova | Rasa Garunkštienė | Arūnas Liubšys Cutaneous Melanoma with Tonsillar Metastasis: Treatment with Cryoablation 2022-01-26T09:33:40+00:00 Audrius Dulskas Mantas Trakymas Jolita Gibavičienė Vytautas Čepulis Agnė Čižauskaitė Narimantas Samalavičius <p>Metastasis of cutaneous melanoma to the oral cavity is a rare condition. Male patient with cutaneous melanoma metastasis to right tonsil 2 years after radical skin lesion resection was treated with surgery: tonsillectomy and later resection of soft palate were performed. Two years later the patient was diagnosed with progressive disease to right tonsil and soft palate. Rapid inoperable relapse was detected six months later. The patient underwent two procedures of palliative cryoablation of the metastasis. Postoperative course was uneventful. Patient died 7 months later due to progression of the disease.<br>Cryoablation alone or together with surgery may be a relatively safe option for treatment of inoperable disease of head and neck tumours.</p> 2022-01-25T09:44:57+00:00 Copyright (c) 2022 Audrius Dulskas | Mantas Trakymas | Jolita Gibaviciene | Vytautas Cepulis | Agne Cizauskaite | Narimantas Samalavicius Jackstone: A Calculus “Toy” in the Bladder. A Case Report of Rare Entity and Comprehensive Review of the Literature 2022-01-26T09:33:39+00:00 Evangelos N. Symeonidis Dimitrios Memmos Anastasios Anastasiadis Ioannis Mykoniatis Eliophotos Savvides Georgios Langas Panagiotis Baniotis Athanasios Bouchalakis Stavros Tsiakaras Panagiotis Stefanidis Michail Stratis Wilbert F. Mutomba Ioannis Vakalopoulos Georgios Dimitriadis <p>&nbsp;<strong>Background:</strong><em>&nbsp;</em>An uncommon type of urinary calculus, Jackstone was named after its distinct resemblance to the children’s game “Jacks.” It typically involves the bladder and, to a lesser extent, the upper urinary tract.<br><strong>Case Presentation:&nbsp;</strong>Herein, we report a case of Jackstone vesical calculus in a 75-year-old male undergoing elective open prostate surgery for benign prostate hyperplasia refractory to medical treatment. Preoperative clinical examination revealed intermittent gross hematuria and symptoms suggestive of bladder outlet obstruction, while radiological investigation confirmed the presence of a solitary star-shaped spike-like bladder stone along with an overly enlarged prostate. Following open simple prostatectomy and concomitant intact stone removal, our patient made an uneventful postoperative recovery.<br><strong>Conclusion:</strong>&nbsp;This case highlights an infrequent subtype of bladder lithiasis and further expands upon the importance of promptly treating the underlying cause once this rare entity is detected. A comprehensive review of the literature on Jackstone calculi is further presented.</p> 2022-01-26T06:16:53+00:00 Copyright (c) 2022 Evangelos N. Symeonidis | Dimitrios Memmos | Anastasios Anastasiadis | Ioannis Mykoniatis | Eliophotos Savvides | Georgios Langas | Panagiotis Baniotis | Athanasios Bouchalakis | Stavros Tsiakaras | Panagiotis Stefanidis | Michail Stratis | Wilbert F. Mutomba | Ioannis Vakalopoulos | Georgios Dimitriadis Unrecognized Primary Hypoparathyroidism with Severe Hypocalcemia in the Presence of COVID-19 Infection 2022-03-15T07:58:56+00:00 Domas Grigoravičius Laura Šiaulienė Žydrūnė Visockienė <p>Primary hypoparathyroidism (PHPT) is a rare disease most commonly caused by surgical parathyroid glands destruction or genetic disorders. PHPT manifestation varies from subclinical to acute or even lethal symptoms. In atypical presentation the signs of hypocalcemia could be missed, and asymptotic chronic hypocalcemia could manifest only in the presence of exacerbated comorbidities, infections, hypomagnesemia or certain medications. We present a case of PHPT with severe hypocalcemia manifesting as seizures and delirium in a presence of COVID-19 infection.</p> 2022-03-15T05:49:53+00:00 Copyright (c) 2022 Domas Grigoravičius | Laura Šiaulienė | Žydrūnė Visockienė A case of post-COVID-19 fibrosis mimicking Thoracic Manifestation of Ankylosing Spondylitis. 2022-03-30T09:36:13+00:00 Emrah Doğan Sabri Serhan Olcay Tuba Çınar Olcay Utku Tapan Ozge Oral Tapan Fatih Alaşan <p>The most common thoracic manifestation form of ankylosing spondylitis is apical fibrocystic changes. It is also known as apical fibrobullous disease (AFBD). The patient was diagnosed with ankylosing spondylitis before 9 years. He suffered COVID-19 infection and passed an intensive care period. However, post-covid fibrosis (PCF) atypically affected dominantly apical zones. If we had no sequential CT evaluations, our case could be easily confused with AFBD. On CT taken before COVID-19, the lung apex was normal. Thus, it was confirmed that there was no rheumatologic thoracic manifestation in the patient before suffering from COVID-19 pneumonia. PCF created similar changes as AFBD. Our case is the first reported paper on this topic.</p> 2022-03-29T10:41:27+00:00 Copyright (c) 2022 Emrah Doğan | Sabri Serhan Olcay | Tuba Çınar Olcay | Utku Tapan | Ozge Oral Tapan | Fatih Alaşan