https://www.journals.vu.lt/AML/issue/feed Acta medica Lituanica 2021-10-08T06:31:31+00:00 Rimantas Jankauskas rimantas.jankauskas@mf.vu.lt 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> https://www.journals.vu.lt/AML/article/view/24529 Access to Healthcare for Cancer Patients in Lithuania During the COVID-19 Pandemic 2021-10-08T06:31:31+00:00 Vidas Petrauskas vidoks@gmail.com Šarūnas Narbutas sarunas.narbutas@pola.lt Neringa Čiakienė neringa.ciakiene@pola.lt Guoda Gudelytė guoda.gudelyte@pola.lt Audrius Dulskas audrius.dulskas@gmail.com <p>Letter to the editor</p> 2021-08-17T10:15:18+00:00 Copyright (c) 2021 Vidas Petrauskas | Šarūnas Narbutas | Neringa Čiakienė | Guoda Gudelytė | Audrius Dulskas https://www.journals.vu.lt/AML/article/view/24273 Genome Editing in Medicine: Tools and Challenges 2021-08-20T06:53:56+00:00 Gunda Petraitytė gunda.petraityte@mf.vu.lt Eglė Preikšaitienė egle.preiksaitiene@mf.vu.lt Violeta Mikštienė violeta.mikstiene@mf.vu.lt <p>Studies which seek fundamental, thorough knowledge of biological processes, and continuous advancement in natural sciences and biotechnology enable the establishment of molecular strategies and tools to treat disorders caused by genetic mutations. Over the years biological therapy evolved from using stem cells and viral vectors to RNA therapy and testing different genome editing tools as promising gene therapy agents. These genome editing technologies (Zinc finger nucleases, TAL effector nucleases), specifically CRISPR-Cas system, revolutionized the field of genetic engineering and is widely applied to create cell and animal models for various hereditary, infectious human diseases and cancer, to analyze and understand the molecular and cellular base of pathogenesis, to find potential drug/treatment targets, to eliminate pathogenic DNA changes in various medical conditions and to create future “precise medication”. Although different concerning factors, such as precise system delivery to the target cells, efficacy and accuracy of editing process, different approaches of making the DNA changes as well as worrying bioethical issues remain, the importance of genome editing technologies in medicine is undeniable. The future of innovative genome editing approach and strategies to treat diseases is complicated but interesting and exciting at once for all related parties – researchers, clinicians, and patients.</p> 2021-08-17T05:13:59+00:00 Copyright (c) 2021 Gunda Petraitytė | Eglė Preikšaitienė | Violeta Mikštienė https://www.journals.vu.lt/AML/article/view/23790 Hemoptysis in Renal Transplant Recipients 2021-08-18T05:09:10+00:00 Vasiliki Epameinondas Georgakopoulou vaso_georgakopoulou@hotmail.com Aikaterini Gkoufa katergkouf@yahoo.gr Aikaterini Aravantinou k_aravantinou@hotmail.com Nikolaos Garmpis nikosg@hotmail.com Konstantinos Mantzouranis c_mantzouranis@gmail.com Serafeim Chlapoutakis chlapoutakis@yahoo.gr Pagona Sklapani nisklap@otenet.gr Anna Garmpi annag@windowslive.com Nikolaos Trakas niktrakas@otenet.gr Christos Damaskos c_damaskos@yahoo.gr <p><strong>Background</strong><em>:&nbsp;</em>Hemoptysis is the expectoration of blood from respiratory system. Clinical entities associated with hemoptysis in renal transplant recipients differ from those causing hemoptysis in common population. This review summarizes all reported clinical conditions related to hemoptysis in renal transplant patients, their causes, diagnostic approach and management.<br><strong>Methods and Materials:&nbsp;</strong>Primary literature was researched through MEDLINE/PubMed database and Google Scholar without restrictions. Relevant and current literatures related to hemoptysis in renal transplant recipients were used.<br><strong>Results:&nbsp;</strong>Overall 23 articles were included, since they report clinical conditions associated with hemoptysis in renal transplant recipients. Opportunistic lung infections, pulmonary hemorrhage associated with drugs and malignancies are usual causes of hemoptysis in these patients,&nbsp;sometimes with a fatal outcome.<br><strong>Conclusions:&nbsp;</strong>Hemoptysis is an important manifestation in renal transplant patients, caused frequently by rare clinical entities, different from those in common population.</p> 2021-07-29T07:31:13+00:00 Copyright (c) 2021 Vasiliki Epameinondas Georgakopoulou | Aikaterini Gkoufa | Aikaterini Aravantinou | Nikolaos Garmpis | Konstantinos Mantzouranis | Serafeim Chlapoutakis | Pagona Sklapani | Anna Garmpi | Nikolaos Trakas | Christos Damaskos https://www.journals.vu.lt/AML/article/view/23533 Local Diagnostic Reference Levels for Paediatric Head CT Procedures 2021-09-01T09:28:09+00:00 Birutė Gricienė birute.griciene@gmail.com Monika Šiukšterytė monika.siuk@gmail.com <p><strong>&nbsp;Background.&nbsp;</strong>Patients, especially children, are exposed to substantially high doses of ionising radiation during computed tomography (CT) procedures. Children are several times more susceptible to ionising radiation than adults. Diagnostic reference levels (DRLs) are an important tool for monitoring and optimising patient radiation exposure from radiological procedures. The aim of this study is to estimate the ionising radiation exposure doses and set local DRLs for head CT examinations according to age and to compare local DRLs with national and European DRLs and with literature data in other countries.<br><strong>Materials</strong><em>&nbsp;</em><strong>and methods.</strong><em>&nbsp;</em>Scan parameters of single-phase head CT examinations were collected. Patients were grouped by age in the following intervals: &lt;1, 1−5, 5−10, 10−15 and 15−18 years. Local age-based DRLs set as the 3rd quartile of the median dose-length product (DLP) were calculated. Literature analysis was performed on&nbsp;<em>PubMed</em>&nbsp;search engine on inclusion criteria: publication date 2015–2020, used keywords&nbsp;<em>paediatric computed tomography, paediatric CT, diagnostic reference levels (DRLs)</em>. The 23 articles discussing paediatric DRLs were further analysed.<br><strong>Results.&nbsp;</strong>Data was collected from 194 paediatric head CT examinations performed in 2019. The median DLP values for head CT were 144.3, 233.7, 246.4, 288.9, 315.5 for &lt;1, 1−5, 5−10, 10−15 and 15−18 years old groups. Estimated local DRLs for head CT examinations are 170, 300, 310, 320, 360 mGy*cm for &lt;1, 1−5, 5−10, 10−15 and 15−18 years age groups respectively and 130, 210, 275, 320 mGy*cm for 0−3 months, 3 months−1 year, 1−6 years and ≥ 6 years age groups respectively.<br><strong>Conclusions.&nbsp;</strong>Results of this study showed that settled new local DRLs of head CT examinations were 2–4 times lower than national DRLs and about 2 times lower than European DRLs. Moreover, the study indicated that paediatric head CT doses are significantly lower in comparison with those indicated in the majority of published data from other hospitals over the last 6 years. Patient dose assessment and local DRLs establishment plays important role in future exposure optimisation.</p> 2021-08-31T10:04:01+00:00 Copyright (c) 2021 Birutė Gricienė | Monika Šiukšterytė https://www.journals.vu.lt/AML/article/view/24067 Endovascular Parent Artery Occlusion for Intracranial Aneurysms is a Viable, Cost-Effective Alternative: An Institutional Experience from Northeast India 2021-08-04T09:27:35+00:00 Pranjal Phukan pphukan10@gmail.com Kalyan Sarma sarmakalyan@ymail.com Donboklang Lynser bokdlynser@yahoo.co.in Barun Kumar Sharma drbarun2003@gmail.com Deb Kumar Baruah debpal8028@gmail.com Bishwajit Saikia bishwajeetsaikia3@gmail.com Binoy Kumar Singh drbinoysingh@yahoo.com <p><strong>Purpose.</strong>&nbsp;Endovascular parent artery occlusion (PAO) may be an alternative approach for complex intracranial aneurysm with potentially life-threatening complications. Moreover, the long-term follow-up of the PAO for an intracranial aneurysm is reported sparingly, limited to the case series. It is therefore important to carry out more research on long-term follow-up of the implication of PAO of intracranial aneurysm. The aim of the study was to analyses our experience of PAO for intracranial aneurysms with emphasis on long-term follow-up.<br><strong>Materials and Methods.</strong>&nbsp;The data of patients treated with PAO for intracranial aneurysms were reviewed. The outcome was evaluated based on aneurysmal occlusion on immediate angiography, follow-up magnetic resonance angiography (MRA), and complications. The modified Rankin score (mRS) was used to evaluate the functional outcome during the last follow-up. The mean, range, and standard deviation were reported for other variables&nbsp;– the patient’s age, number, and percentage.<br><strong>Results.</strong>&nbsp;Endovascular treatment was performed in 178 patients including PAO in 18 patients. Of these 18 (eighteen) patients, there were 13 dissecting aneurysms, 4 mycotic aneurysms, and one traumatic aneurysm.<br>10 (ten) patients underwent PAO for proximal intracranial artery aneurysm and 8 (eight) patients for distal cerebral aneurysms. Complete occlusion of the aneurysm was achieved in 16patients (88.89%) and retrograde filling of the aneurysm was seen in 2 (11.11%) patients. One patient had intraprocedural coil migration resulting in a major infarct with an mRS of 2. Another patient (5.56%) had recanalization of the aneurysm and presented with rupture and intracranial hemorrhage with an mRS score of 4. The mRS of the other 16 patients (88.89%) was zero.<br><strong>Conclusions.</strong>&nbsp;Endovascular PAO for cerebral aneurysms was highly feasible and achieved complete occlusion. The morbidity and mortality rates were at the long-term follow-up also acceptable with negligible complications.</p> 2021-08-04T05:21:25+00:00 Copyright (c) 2021 Pranjal Phukan | Kalyan Sarma | Donboklang Lynser | Barun Kumar Sharma | Deb Kumar Baruah | Bishwajit Saikia | Binoy Kumar Singh https://www.journals.vu.lt/AML/article/view/23040 Depression, Anxiety and Quality of Life in Greek Hospital Staff: A Study in the Aftermath of the Debt Crisis Era 2021-07-29T09:27:24+00:00 Despoina Melemeni dmelemeni@yahoo.gr Konstantinos Mantzouranis c_mantzouranis@gmail.com Vasiliki Epameinondas Georgakopoulou vaso_georgakopoulou@hotmail.com Kyriakos Tarantinos tarantinos@gmail.com Nikolaos Garmpis nikosg@hotmail.com Christos Damaskos c_damaskos@yahoo.gr Pagona Sklapani nisklap@otenet.gr Serafeim Chlapoutakis chlapoutakis@yahoo.gr Nikolaos Trakas niktrakas@otenet.gr Xanthi Tsiafaki xtsiafaki@gmail.com Ioanna V Papathanasiou ipapathanassiou@gmail.com <p class="western" align="justify"><strong>Background:</strong>&nbsp;Several studies investigated the mental health needs of hospital staff in Greece during the debt crisis era. Yet, no relevant data are available regarding the mental health of hospital staff after this period. The aims of this study are: 1) To investigate the prevalence of clinically significant depression and anxiety in healthcare workers in a general hospital in Athens, Greece; 2) to search for the association of quality of life with anxiety and depression in those workers; 3) to investigate the association of sociodemographic characteristics with those parameters.<br><strong>Methods:</strong><em>&nbsp;</em>The Zung Depression Rating Scale, the Zung Anxiety Rating Scale, the Short-Form Survey-12, assessing quality of life, and sociodemographic assessments were administrated in 110 workers of a public hospital in Athens, Greece. The assessments were completed during January, 2020.<br><strong>Results</strong><em>:&nbsp;</em>Of the study participants, 38.2% had clinically significant anxiety and 6.4% had clinically significant depression. Males had lower scores of depression compared to females (p=0.003). As for the effects of educational level, differences were noted in psychological quality of life between secondary education participants when compared to tertiary education (Mean Difference -3.527, p=0.021), post-graduate (Mean Difference -3.937, p=0.012) and PhD participants (Mean Difference -5.100, p=0.007). Quality of life and its psychological and physical health subscales had strong inverse associations with depression and anxiety (p=0.000).<br><strong>Conclusions</strong><em>:</em>&nbsp;Relevant interventions are necessary to decrease anxiety in hospital staff, which is elevated in the aftermath of the debt crisis period. In addition, health policy makers have to reduce the gender gap in mental health between male and female workers, since the latter had higher levels of depression.</p> 2021-07-29T07:24:34+00:00 Copyright (c) 2021 Despoina Melemeni | Konstantinos Mantzouranis | Vasiliki Epameinondas Georgakopoulou | Kyriakos Tarantinos | Nikolaos Garmpis | Christos Damaskos | Pagona Sklapani | Serafeim Chlapoutakis | Nikolaos Trakas | Xanthi Tsiafaki | Ioanna V Papathanasiou https://www.journals.vu.lt/AML/article/view/23048 Case of Severe Treatment-Resistant Cryptogenic Organizing Pneumonia 2021-08-27T09:28:02+00:00 Domas Grigoravičius domas.grigoravicius@mf.stud.vu.lt Edvardas Žurauskas Edvardas.Zurauskas@vpc.lt Vygantas Gruslys Vygantas.Gruslys@santa.lt Rolandas Zablockis rolandas.zablockis@santa.lt Edvardas Danila edvardas.danila@mf.vu.lt <p>Cryptogenic organizing pneumonia is a rare interstitial lung disease with different onset of symptoms, which responds rapidly to glucocorticoid treatment. We present a case of cryptogenic organizing pneumonia which manifested as a progressive 3-year dyspnea that ultimately has led to acute respiratory failure. Moreover, treatment with prednisone for this patient exhibited slow onset of the effect.</p> 2021-08-26T11:48:45+00:00 Copyright (c) 2021 Domas Grigoravičius | Edvardas Žurauskas | Vygantas Gruslys | Rolandas Zablockis | Edvardas Danila https://www.journals.vu.lt/AML/article/view/22852 Ellis–van Creveld Syndrome in Iran, a Case Report and Review of Disease Cases in Iran, Middle East 2021-08-20T09:27:54+00:00 Behnam Baghianimoghadam behnam.baghian@gmail.com Aidin Arabzadeh info@leidykla.vu.lt Yousef Fallah info@leidykla.vu.lt <p>Introduction:<em>&nbsp;</em>Chondroectodermal dysplasia (Ellis–van Creveld syndrome (EVC)) (OMIM:&nbsp;<strong>#</strong>225500) is a rare skeletal dysplasia with unknown exact prevalence. EVC patients may have abnormal skeletal and extra skeletal symptoms. We report a case of EVC patient and review previous cases reported in Iran.<br>Materials and methods: The patient was a 30 years old woman referred to our hand clinic for an extra finger in both hands. She was born to a consanguineous marriage. The patient had a history of bilateral valgus deformity of the knees, for which she underwent proximal tibial and distal femoral osteotomy. Upon examination, the patient had bilateral polydactyly and brachymetacarpia with hypotrophic fingernails. She was about 120 cm tall and had acromesomelic type dwarfism. Oral examination revealed serrated incisal margins, dental transposition, a diastema, conical teeth and, enamel hypoplasia. In the radiographic examination of upper extremity, postaxial polydactyly and polymetacarpia, enlarged distal radius, and fusion of capitate and hamate were seen. We searched online databases (Pubmed, Scopus, Google Scholar) and found 14 Iranian papers with 21 reported patients (there was no time limit). We reviewed available clinical and genetic data and the geographic origins of patients.<br>Results:<em>&nbsp;</em>14 articles reporting 22 EVC patients (including our patient) from Iran have been published in Persian and English (7 in Persian and 7 in English). All patients presented with characteristic EVC symptoms but were diagnosed at a relatively late age, 18 patients were born to consanguineous marriages.<br>Conclusions: It seems that based on these studies, it is possible to identify some families with this genetic mutation. We can warn such families of the dangers of consanguineous marriage through genetic counseling before marriage. In addition, by identifying families with such problems, we can detect such anomalies in the baby earlier with more careful prenatal care.</p> 2021-08-20T05:26:01+00:00 Copyright (c) 2021 Behnam Baghianimoghadam | Aidin Arabzadeh | Yousef Fallah https://www.journals.vu.lt/AML/article/view/24058 Hepatocellular Carcinoma with Inferior Vena Cava and Right Atrium Tumor Thrombus 2021-08-19T09:27:53+00:00 Arun Kumar Gunasekaran dr.arunguna@gmail.com Amit Malviya dramit_malviya@rediffmail.com Tony Ete tonyete14@gmail.com Animesh Mishra dranimeshmshillong@gmail.com Bhupen Barman drbhupenb@gmail.com Md Jamil mdjamil81@gmail.com Donboklang Lynser bokdlynser@yahoo.co.in <p>Hepatocellular carcinoma (HCC) is one of the leading causes of cancer and cancer related deaths worldwide. Metastasis of HCC into the cardiac cavity is mostly caused by direct tumor thrombus invasion through the major hepatic veins and of vena cava inferior with continuous extension into the right cardiac cavity. Right heart metastasis without invasion of inferior vena cava (IVC), which may be caused by haematogenous spread of cancer cells, is rarely reported. We report a case of HCC with IVC and right atrium (RA) thrombus in a patient who presented to us with decompensated cardiac failure. Strikingly, the patient was young and with negative serum HBsAg, and anti-HCV results. Our case highlights a rare presentation of meta­static intracardiac tumor thrombus involving the RA in advanced HCC without any symptoms of cardiac failure, and henceforth, the role of screening echocardiography for all patients with advanced HCC especially with vena caval involvement to rule out intracardiac thrombus.</p> 2021-08-18T09:39:46+00:00 Copyright (c) 2021 Arun Kumar Gunasekaran | Amit Malviya | Tony Ete | Animesh Mishra | Bhupen Barman | Md Jamil | Donboklang Lynser https://www.journals.vu.lt/AML/article/view/24184 Bell’s Palsy After Second Dose of Moderna COVID-19 Vaccine: Coincidence or Causation? 2021-08-04T09:27:34+00:00 Sohil Pothiawala drsohilpothiawala@yahoo.com <p>US Food and Drug Administration (FDA) recommended enhanced safety surveillance to monitor for cases of Bell’s palsy following Moderna vaccine administration in larger populations. The author reports a patient who developed right sided Bell’s palsy 2 weeks after administration of the second dose of Moderna COVID-19 vaccine. Considering this development of symptoms 2 weeks after the second dose of Moderna vaccine administration, there remains a possibility of a causal association. As more people get vaccinated, more information may be available in the future to establish association. Physicians need to maintain enhanced safety surveillance to monitor for cases of Bell’s palsy following mRNA vaccine administration.</p> 2021-08-04T05:31:10+00:00 Copyright (c) 2021 Sohil Pothiawala https://www.journals.vu.lt/AML/article/view/22712 Reverse Phenotyping Maternal Cystic Kidney Disease by Diagnosis in a Newborn: Case Report and Literature Review on Neonatal Cystic Kidney Diseases 2021-08-18T05:09:57+00:00 Dovilė Ruzgienė dovile.ruzgiene@santa.lt Meda Sutkevičiūtė meda.sutkeviciute@santa.lt Birutė Burnytė birute.burnyte@santa.lt Kristina Grigalionienė kristina.grigalioniene@santa.lt Augustina Jankauskienė augustina.jankauskiene@santa.lt <p>Kidney cysts are the most common kidney lesion, while congenital kidney cysts are mostly found in pediatric population. Neonatal kidney cysts can develop due to fetal malformations, rare genetic disorders or can be acquired which is very rare. Kidney cysts may be the only isolated finding or be part of the overall phenotype. They can be asymptomatic, found by ultrasound accidentally or can manifest from mild to life-threatening symptoms. Therefore, early diagnosis is very important. Autosomal dominant polycystic kidney disease and autosomal recessive polycystic kidney disease are the most common causes of kidney cysts in the neonatal population. This review highlights the most common kidney cystic diseases during the neonatal period and a rare clinical case of HNF1B-associated disease.</p> 2021-08-02T05:35:46+00:00 Copyright (c) 2021 Dovilė Ruzgienė | Meda Sutkevičiūtė | Birutė Burnytė | Kristina Grigalionienė | Augustina Jankauskienė https://www.journals.vu.lt/AML/article/view/22500 Uterine Didelphys with Transverse Vaginal Septum – A Complex rare Müllerian Anomaly 2021-07-29T09:27:25+00:00 Dina Aisha Khan dinaaishakhan90@gmail.com Nalini Sharma nalinisharma100@rediffmail.com Anusmita Saha anusmita.saha29@gmail.com Rituparna Das dasrituparna30@gmail.com Subrat Panda pandadrsubrat@rediffmail.com <p>During the development of the female genital tract, any insult to the normal development process results in a set of intriguing abnormalities known as Müllerian duct abnormalities. The uterine didelphys is the second least common type of anomaly among these, which may commonly be associated with a longitudinal vaginal septum (lateral fusion defect). However uterine didelphys along with a transverse vaginal septum (lateral fusion plus resorption defect) is a very rare finding and to the best of our knowledge, thecase that we hereby report is the second one in literature.<br>A 16-year-old unmarried girl presented with primary amenorrhoea and cyclical pain for 18months.On clinical examination and imaging, a case of uterine didelphys and transverse vaginal septum was found. Her urinary tract was normalon USG and MRI evaluation. Excision of the septum was done by abdomino-vaginal approach. The patient was discharged well.<br>We conclude that a patient presenting with primary amenorrhea especially with cyclical dysmenorrhea with a transverse vaginal septum on examination should be thoroughly investigated for associated upper genital tract abnormalities as the treatment strategy and prognosis is largely dependent on the correct classification of the anomaly.</p> 2021-07-29T07:16:42+00:00 Copyright (c) 2021 Dina Aisha Khan | Nalini Sharma | Anusmita Saha | Rituparna Das | Subrat Panda https://www.journals.vu.lt/AML/article/view/23976 Paraneoplastic Phenomena of Disseminated Intravascular Coagulopathy in Hepatic Angiosarcoma – Rare, Challenging and Fatal. Case Report and Literature Review 2021-07-29T09:27:26+00:00 Sandra Strainienė sandra.strainiene@yahoo.com Kipras Jauniškis kiprasjau@gmail.com Ilona Savlan ilona.savlan@santa.lt Justinas Pamedys justinas.pamedys@santa.lt Ieva Stundienė ieva.stundiene@santa.lt Valentina Liakina valentina.liakina@santa.lt Jonas Valantinas jonas.valantinas@santa.lt <p><strong>Background.</strong> Hepatic angiosarcoma is an uncommon, malignant, primary liver tumor, comprising 2% of liver cancers and accounting for &lt; 1% of all sarcomas. Patients usually present with nonspecific symptoms, such as fatigue, weight loss, right upper quadrant pain, anemia, which leads to late diagnosis of an advanced stage tumor. The median life expectancy after the diagnosis of hepatic angiosarcoma is about 6 months, with only 3% of patients surviving more than 2 years. Liver failure and hemoperitoneum are the leading causes of death in patients with liver angiosarcoma. In rarer cases, it might cause paraneoplastic syndromes such as disseminated intravascular coagulopathy. The treatment of angiosarcomas is complicated as there are no established and effective treatment guidelines due to the tumor’s low frequency and aggressive nature.<br><strong>Case summary.</strong> We present the case of a 68-year old woman who was admitted to the hospital due to fatigue<br>and severe anemia (hemoglobin 65 g/l). Laboratory results also revealed high-grade thrombocytopenia<br>(8 × 109/l). The abdominal ultrasound and computed tomography scan showed multiple lesions throughout with hepatic angiosarcoma. The treatment with first-line chemotherapy (doxorubicin) was initiated despite<br>ongoing paraneoplastic syndrome – disseminative intravascular coagulopathy. However, the disease was terminal, and the patient died 2 months since diagnosed.<br><strong>Conclusions</strong>. Hepatic angiosarcoma is a rare and terminal tumor. Therefore, knowledge about its manifestations and effective treatment methods is lacking. Disseminative intravascular coagulopathy is a unique clinical characteristic of angiosarcoma seen in a subset of patients.</p> 2021-07-29T05:38:08+00:00 Copyright (c) 2021 Sandra Strainienė | Kipras Jauniškis | Ilona Savlan | Justinas Pamedys | Ieva Stundienė | Valentina Liakina | Jonas Valantinas