Search

BACKGROUND Scientific data regarding transthoracic impedance cardiography (ICG) parameters and its utility in patients with heart failure (HF) remains controversial. This study from a single center in Lithuania aimed to evaluate the role of ICG in the diagnosis and outcome evaluation of patients who were admitted to the hospital due to HF exacerbation. MATERIAL AND METHODS The sample consisted of 301 consecutive patients with a previous chronic HF diagnosis (166 men, 135 women) hospitalized for HF flare-ups. ICG data were compared to other noninvasive HF diagnostic tests. Data about patient outcomes were gathered from the Lithuanian Medical Record Database. RESULTS A weak correlation of amino-terminal pro-brain natriuretic peptide (NT-proBNP) with thoracic fluid content (TFC) and thoracic fluid content index (TFCI) was found (r=0.204, P0.001 and r=0.207, P0.001, respectively). There was weak to moderate correlation of 6-min walk distance with main ICG data. There was weak correlation between left ventricular ejection fraction (LVEF) with TFCI (r=-0.163, P=0.005), systolic index (r=-0.137, P=0.017), and systolic time ratio (r=0.236, P0.001). By multivariate Cox proportional analysis, the following parameters were independently associated with cardiac death (P0.001): NT-proBNP ≥425.5 pmoL/L (hazard ratio (HR), 5.104, 95% confidence interval (CI) 3.326-7.832), TFC ≥36.9 1/kOhm (HR, 4.604, 95% CI 2.701-7.849), LVEF ≤40% (HR, 4.942, 95% CI 2.8256-8.647). CONCLUSIONS The combination of non-invasively measured TFC, LVEF, and NT-proBNP showed great prognostic value for predicting readmissions and cardiac death in patients with HF.

Periferinių arterijų liga (PAL) apibūdinama kaip sisteminės aterosklerozės sąlygotas pagrindinių organizmo arterijų, išskyrus širdies ir smegenų, pažeidimas, susijęs su padidėjusiu sergamumu širdies ir kraujagyslių ligomis ir mirtingumu. Daugiau nei pusei sergančiųjų PAL pasireiškia besimptomė eiga, todėl labai svarbi ankstyva ligos diagnostika. Tyrimo tikslas. Palyginti neinvazinius tyrimo metodus, taikomus periferinių arterijų ligos diagnostikai, esant prieširdžių virpėjimui (PV), įvertinti jų jautrumą ir specifiškumą. Metodai. Ketverių metų laikotarpiu atliktas prospektyvinis stebėsenos tyrimas, kurio metu 352 širdies ir kraujagyslių ligomis sergantiems pacientams atlikta PAL diagnostika neinvaziniais tyrimo metodais: kulkšnies ir žasto indeksas (KŽI) bei impedanso pletizmografija. Palyginti šie tyrimai ir įvertintas ryšys tarp gautų tyrimų rezultatų bei lėtinio prieširdžių virpėjimo. Rezultatai. 78 (44,1 proc.) moterims nustatyta periferinių arterijų liga, 25 (33,3 proc.) iš jų ligos eiga besimptomė. Moterų, sergančių PV, KŽI vidurkis – 0,83 (±0,28), o šio ritmo sutrikimo neturinčių moterų KŽI – 0,97 (±0,28) (p

Įvadas. COVID-19 yra greitai plintanti kvėpavimo sistemos infekcinė liga, kurią sukelia virusas, vadinamas ūminiu kvėpavimo sindromu koronavirusu-2 (SARS-CoV-2). Ši infekcija naudoja angiotenziną konvertuojamųjų fermentų 2 (AKF 2) receptorius ir paprastai plinta per kvėpavimo takus. SARS-CoV-2 pažeidžia ir kitus organus, kurie ekspresuoja AKF 2 receptorius. Patekę į organizmą virusai veikia imuninį atsaką. Padidėjęs imuninis atsakas dažnai sukelia citokinų antplūdžius, kurie gali sąlygoti mirtį nuo COVID-19. Sergantiesiems šia liga pastebėti pokyčiai ir elektrokardiogramose. Dažniausi iš jų yra: sinusinė tachikardija, PV, PP, skilvelių aritmijos, rečiau: bradikardijos, ašies nuokrypis, ST segmento ir T bangos pokyčiai. Tikslas. Apžvelgti LSMU Kauno ligoninėje hospitalizuotų pacientų, sirgusių COVID-19 infekcija, demografinius, klinikinius duomenis bei EKG pokyčius hospitalizavimo metu. Metodai. tyrimui naudotos 30 pacientų, hospitalizuotų LSMU Kauno ligoninėje dėl COVID-19, atliktos EKG. Rezultatai analizuoti naudojant „IBM SPSS statistics 20“ duomenų analizės paketą, pritaikytą „Windows“ operacinei sistemai ir analizuoti EKG pokyčiai sergantiesiems COVID-19. Rezultatai. 33,33 proc. pacientų – prailgėjęs QRS, 30,00 proc. pacientų stebėta levograma, 10,00 proc. – dekstrograma, 23,33 proc. pacientų EKG stebima ST segmento elevacija, 16,66 proc. – T inversija, 10,00 proc. – ST segmento depresija, 10,00 proc. PV, 13,33 proc. pacientų kairės Hiso pluošto kojytės blokada, o mažiausiai pacientų sudarė turintys dešinės Hiso pluošto kojytės blokadą – 3,33 proc. Išvados. Atliktų tyrimų analizių ir LSMU Kauno ligoninės tyrimo išvados: 1. Sergantiesiems COVID-19 liga, hospitalizavimo metu atliktose elektrokardiogramose dažniausiai stebimi šie pokyčiai: prailgėjęs QRS, ašies nuokrypis į kairę, ST segmento elevacija, T dantelio inversija, ST segmento depresija, kairės Hiso pluošto kojytės blokada, PV, dekstrograma ir mažiausiai pacientų sudarė turintys dešinės Hiso pluošto kojytės blokadą. 2. Norint įvertinti ilgalaikius širdies ir kraujagyslių sistemos pokyčius po persirgto COVID-19 reikalingi tolesni pacientų tyrimai.

Analysis of inflammatory biomarkers and lymphocytes during the treatment of tuberculosis (TB) could yield findings that influence the routine clinical practice and use of new anti-TB drugs. This study aimed to evaluate whether the selected biomarkers—soluble intercellular adhesion molecule type 1, soluble urokinase-type plasminogen activator receptor (suPAR), and C-reactive protein (CRP)—and T-cell subpopulations are useful for predicting culture conversion, treatment outcomes, and the extent of radiological lesions (calculated using X-ray score) in patients with drug-sensitive pulmonary TB. This study included 62 patients with drug-sensitive pulmonary TB. CRP and suPAR levels significantly decreased after 1 month of treatment. Before treatment initiation, CRP and suPAR levels were significantly higher in patients without culture conversion; however, none of the selected host biomarkers appeared to significantly influence the conversion status or treatment outcomes. Some lymphocyte subpopulations were correlated with X-ray scores before TB treatment initiation, but lung destruction, as determined using X-ray scores, showed the highest correlation with the baseline CRP value. We conclude that selected host biomarkers have a very limited role in predicting TB treatment outcomes and culture conversion and do not appear to be superior to CRP in monitoring TB treatment.

Erysipelas is a common skin infection of the upper dermis. Its most common complications are local; these include abscess formation, skin necrosis, etc. In the present article, we introduce a case of a 75-year-old patient with erysipelas of the face complicated with acute exudative pericarditis. The patient came to Kaunas Clinical Hospital complaining of extreme fatigue and fever, oedema of the left side of the face, and erythema typical for erysipelas. The patient also felt sternum and epigastric pain, especially during breathing, and dyspnoea. Heart work was rhythmic 100 bpm; blood pressure was 142/70 mmHg. Pericardial friction rub was heard over the left sternal border. There were no alterations in other systems. In the electrocardiogram, concave ST segment elevation in leads II, III, and aVF was identified. In addition, during hospitalisation, the patient experienced atrial fibrillation paroxysm, which was treated with amiodarone intravenously. The blood test showed C-reactive protein: 286 mg/L; white blood cells: 20 × 109/L; troponin I was within the normal range. During echocardiography, pericardial fluid in pericardial cavity was identified. As no changes in troponin I were observed, according to the ST segment elevation, the woman was diagnosed with erysipelas of the left side of the face complicated with acute exudative pericarditis. Antibacterial treatment of cephalosporins was administered. After the treatment, C-reactive protein decreased to 27.8 mg/L; whereas, in the electrocardiogram, the return of the ST segment to the isoline was observed, and pericardial fluid resorbed from the pericardial cavity. To the best of the authors’ knowledge, this case is a rare combination of erysipelas complicated with acute exudative pericarditis.

In 1992, R. Brugada and J. Brugada were the first to describe a syndrome characterized by right-bundle branch block (RBBB) with ST segment elevation followed by an inverted T-wave in the right precordial leads, which predisposes apparently healthy subjects to Sudden Cardiac Death (SCD).

Peripheral Arterial Disease (PAD) is defined as a systemic atherosclerotic disease, which occurs due to narrowing and obstruction of major systemic arteries other than coronary arteries and aorta...

Supplemental Digital Content is available in the text, Kazakhstan has a high burden of multidrug-resistant tuberculosis (TB). The patient-centered National Program for the treatment and prevention of TB has been implemented in Kazakhstan. The program is aimed at meeting the needs of patients and expansion of the outpatient treatment of TB in the country. The aim of the study was to compare the efficacy of the outpatient and inpatient treatment of drug-susceptible TB. This study was a retrospective cohort study. A total of 36.926 TB cases were included. The majority of patients were treated as inpatients. The socioeconomic factors, sex, age, HIV status, and other diagnostic factors (e.g., sputum smear results, extrapulmonary disease) may serve as risk factors to estimate the likely TB treatment outcome. The outpatient treatment of drug-susceptible TB seems to be a comparable option to the inpatient treatment in terms of efficacy. The socioeconomic factors are the main modifiable risk factors for treatment failure. The outpatient treatment of drug-susceptible TB is safe and effective.

The prevalence and integration of self-monitoring devices is increasing across healthcare systems, [1] and this is leading to patients taking greater responsibility for their health and well-being. Our aim was to compare two groups of patients with reoccurring atrial fibrillation (AF) and their ability to detect AF with the Microlife BP A6 device. The groups were divided according to being symptomatic or asymptomatic for AF. Method: The study was conducted for 3 years. The patients were selected from Kaunas clinical hospital in Kaunas, Lithuania. In total, 60 people took part in the study. The major criterion for inclusion was based on patients having AF upon arrival. During the period of hospitalisation, they were restored to having sinusoidal rhythm (SR). There were two groups of patients in the study. The first group had clear symptoms during the onset of rhythm disturbance and the second group was asymptomatic. All patients under the age of 18 years and those who did not sign the agreement to participate were excluded from the study. The patients were contacted every 6 months by phone call and a questionnaire was filled. The statistical analysis was performed using SPSS 23 and Microsoft Office Excel 2007 software. The results were deemed statistically significant when p

BACKGROUND This study aimed at evaluating the diagnostic and outcome prediction value of transthoracic impedance cardiography (ICG) in heart failure (HF) patients admitted for in-hospital treatment due to flare-ups of their condition. MATERIAL AND METHODS In total, 120 patients of intensive care units who were admitted due to HF flare-ups were involved to the study. The findings of ICG were compared to data obtained by other methods used for diagnosing HF. RESULTS Statistically significant (p

Enhanced recovery after surgery (ERAS) are specially designed multimodal perioperative care pathways which are intended to attain and improve rapid recovery after surgical interventions by supporting preoperative organ function and attenuating the stress response caused by surgical trauma, allowing patients to get back to normal activities as soon as possible. Evidence-based protocols are prepared and published to implement the conception of ERAS. Although they vary amongst health care institutions, the main three elements (preoperative, perioperative, and postoperative components) remain the cornerstones. Postoperative pain influences the quality and length of the postoperative recovery period, and later, the quality of life. Therefore, the optimal postoperative pain management (PPM) applying multimodal analgesia (MA) is one of the most important components of ERAS. The main purpose of this article is to discuss the concept of MA in PPM, particularly reviewing the use of opioid-sparing measures such as paracetamol, nonsteroid anti-inflammatory drugs (NSAIDs), other adjuvants, and regional techniques.

BACKGROUND Heart failure (HF) accounts for about 5% of all causes of urgent hospital admissions, and the overall mortality of HF patients within 1 year after hospitalization is 17-45%. Transthoracic impedance cardiography (ICG) is a safe, non-invasive diagnostic technique that helps to detect various parameters that define different cardiac functions. The aim of this study was to investigate the value of ICG parameters in patients hospitalized due to HF flare-ups. MATERIAL AND METHODS The study included 60 patients (24 women and 36 men) who were admitted to intensive care units because of an acute episode of HF without signs of myocardial infarction. The diagnosis of HF as the main reason for hospitalization was verified according to the universally accepted techniques. ICG data were compared to those obtained via other HF diagnostic techniques. RESULTS A moderately strong relationship was found between the ejection fraction (EF) and the systolic time ratio (STR) r=-0.4 (p=0.002). Findings for STR and thoracic fluid content index (TFCI) differed after dividing the subjects into groups according to the EF (p

Background and objective: In the diagnosis of peripheral artery disease (PAD), the ankle-brachial index (ABI) is considered as the standard, and other noninvasive methods have received too little attention. Therefore, the aim of the study was to determine the diagnostic accuracy of impedance plethysmography in diagnosing PAD and to compare this method with other methods. Materials and methods: A total of 66 patients with a mean age of 76.1 ± 9.6 years who had been treated for various cardiovascular diseases at Kaunas Clinical Hospital during 2011–2012 were enrolled into the study. All the patients were screened for PAD. Impedance plethysmography was performed with a new-generation NiccomoTM device. The receiver operating characteristic analysis was employed to determine the diagnostic accuracy of 4 parameters of impedance plethysmography: crest time (CT), crest width (CW), pulse amplitude (Pampl), and alternating blood flow (ABF). Results: There were a significant correlation between the ABI and the CT (r = 0.699, P &lt, 0.001), between the ABI and the ABF (r = 0.552, P &lt, 0.001), and between the ABI and the Pampl only among men (r = 0.652, 0001). No correlation was found between the ABI and the CW. Among all the parameters, the CT had the highest sensitivity and specificity (73.2% and 96.0%, respectively). Other parameters had the following sensitivities and specificities: ABF, 61.0% and 96.0%, and Pampl, 90.0% and 20.0%, respectively. Conclusions: Impedance plethysmography, especially its parameter CT, is an alternative non- invasive method in diagnosing PAD and could be used for the screening of patients with PAD.

Objective. The aim of this study was to evaluate T-wave normalization during the 6-month follow-up in the patients who underwent early or late mechanical recanalization of the infarct-related artery with and without stent implantation. Material and Methods. A total of 248 consecutive patients were divided into the following groups: early angioplasty (≤24 hours) without (n=114) or with stents (n=6) and late angioplasty (>24 hours) without (n=114) or with stents (n=14). The changes in T-wave recovery, QRS score, and echocardiographic left ventricular ejection fraction were compared between the groups. Results. At 3 months, a greater percentage of patients in the group of early angioplasty with stents had again positive T wave than in the group of early angioplasty without stents (75% vs. 35%, P=0.05). After 6 months, all patients in the group of early angioplasty with stents had again positive T wave. A significant increase in left ventricular ejection fraction after 3 months was also observed only in the groups of early angioplasty, especially that with stents (30.0% [SD, 3.5%] vs. 38.4% [SD, 5.2%], P=0.008). However, there was no significant difference in the QRS score in this group comparing the data at discharge and after 3 months (5.4 [SD, 4.3] vs. 5.0 [SD, 1.9], P>0.05). Conclusions. The group of early angioplasty with stents showed the best recovery of T wave and left ventricular ejection fraction, but the QRS score did not change significantly from discharge to the 3-month follow-up, so the evolution of T wave corresponded to an improvement in ejection fraction at follow-up better than the evolution of QRS score.

THE OBJECTIVE OF THIS STUDY was to investigate the associations among clinical, impedance cardiography, echocardiography, and chest roentgenography data in diagnosis of pulmonary hypertension for patients with cardiovascular and pulmonary diseases.Pulmonary artery pressure was measured by impedance cardiography method in 181 patients: 80 patients with cardiovascular pathology when pulmonary hypertension was determined by echocardiography, 69 patients with cardiovascular pathology when pulmonary hypertension was not observed using echocardiography, 19 patients with pulmonary pathology when pulmonary hypertension was determined by echocardiography, and 13 patients with pulmonary pathology when pulmonary hypertension was not observed using echocardiography. Clinical data, parameters of impedance cardiography, echocardiography, and chest roentgenography were evaluated.Pulmonary hypertension (impedance cardiography) was diagnosed by computed mean blood pressure in pulmonary artery with a sensitivity and specificity of 72% and 90%, respectively, and by systolic blood pressure with a sensitivity and specificity of 96% and 90%, respectively. A mathematical model of binary regression was developed with a 96.7% accuracy to diagnose pulmonary hypertension. The most important parameters of impedance cardiography were systolic blood pressure in pulmonary artery and systolic time index.Mean and systolic blood pressures in the pulmonary artery, assessed by a computerized impedance cardiogram, are diagnostically valuable parameters. In diagnostic algorithms of pulmonary hypertension, the following features can be used: atrial fibrillation; thrombosis of deep veins; dyspnea; cyanosis; accent of II tone at the auscultation point of the pulmonary valve; systolic murmur at the tricuspid valve area; increased diameter of the pulmonary artery more than ≥ 18 mm on chest x-ray; increased diameter of the right ventricle; systolic blood pressure in the pulmonary artery and systolic time index measured by impedance cardiography method.

Tyrimo tikslas. Ištirti klinikinių, impedanskardiografijos, echokardioskopijos, krūtinės ląstos rentgenografijos duomenų sąsajas diagnozuojant plaučių hipertenziją sergantiesiems širdies ir kraujagyslių arba kvėpavimo sistemų ligomis. Tyrimo medžiaga ir metodai. 181 pacientui (80 pacientų, sergančių širdies ir kraujagyslių sistemos patologija, kai echokardioskopiškai nustatyta plaučių arterijos hipertenzija, 69 pacientams, sergantiems širdies ir kraujagyslių sistemos patologija, kai echokardioskopiškai plaučių arterijos hipertenzijos nerasta, 19 pacientų, sergančių plaučių patologija, kai echokardioskopiškai plaučių arterijos hipertenzijos rasta, 13 pacientų, sergančių plaučių patologija, kai plaučių arterijos hipertenzijos nerasta) ištirti buvo taikomi klinikiniai, dvimatės širdies echoskopijos, impedanskardiografijos, kiti instrumentiniai tyrimai siekiant įvertinti, sergančiųjų plaučių hipertenzija duomenų pokyčius. Rezultatai. Impedanskardiografijos metodo jautrumas, diagnozuojant plaučių hipertenziją pagal vidutinį kraujo spaudimą plaučių arterijoje, 72 proc., specifiškumas – 90 proc., pagal sistolinį kraujo spaudimą plaučių arterijoje jautrumas – 96 proc., specifiškumas – 90 proc. Sudarytas matematinis dvejetainės logistinės regresijos modelis, pagal kurį 96,7 proc. tikslumu galima diagnozuoti plaučių hipertenziją. Svarbiausi impedanskardiografijos duomenys: sistolinis spaudimas plaučių arterijoje bei sistolinio laiko indeksas. Išvados. Impedanskardiografijos tyrimo metu nustatomi vidutinio ir sistolinio kraujo spaudimo plaučių arterijoje parametrai yra informatyvūs. Plaučių hipertenzijos diagnostikos algoritmuose galima būtų naudoti šiuos požymius: prieširdžių virpėjimas, giliųjų venų trombozė, dusulys, cianozė, II tono akcentas plaučių arterijos vožtuvo išklausymo taške, sistolinis ūžesys ties triburiu vožtuvu, plaučių rentgenografijoje rastas padidėjęs plaučių arterijos spindis ≥18 mm, padidėjęs dešiniojo skilvelio diametras, impedanskardiografijos metodu apskaičiuotas sistolinis spaudimas plaučių arterijoje bei sistolinio laiko indeksas.

Objective. To show differences in the changes of electrocardiographic and echocardiographic data after early and late mechanical recanalization of infarct related artery with and without stent implantation and to assess the value of QRS score in the follow-up period. Material and methods. A total of 248 consecutive patients were divided into these groups: early angioplasty (≤24 hours) without stents (n=114) or with stents (n=6) and later (&gt, 24 hours) angioplasty without stents (n=114) or with stents (n=14). The changes in QRS score and echocardiographic left ventricular ejection fraction during the hospital and 3-month follow-up periods were compared between the groups. Results. QRS score did not increase in a hospital in early or late angioplasty with stents groups, while in the groups without stents especially of early angioplasty increased (2.6±2.5 vs. 3.6±2.4, P=0.001). Left ventricular ejection fraction increased after 3 months only in early angioplasty groups especially with stents (30.0±3.5 vs. 38.4±5.2, P=0.008), but there were no significant differences between the QRS score at discharge and after 3 months (5.4±4.3 vs. 5.0±1.9). Conclusions. Myocardial injury did not increase in a hospital in the cases of early or late angioplasty with stents, while in the cases without stents increased. Left ventricular ejection fraction increased after 3 months only in the cases of early angioplasty especially with the stent implantation, but the QRS score showed no differences, so the QRS score may be not predictive of improvement in ejection fraction at follow-up.

Bacillus Calmette-Guérin (BCG) is an attenuated strain of Mycobacterium bovis that has been effectively used in the treatment of non-muscle invasive bladder carcinoma. The complications of this treatment are uncommon, and the causes of dissemination are still discussed. We report a case of disseminated tuberculosis in a 66-year-old smoking man without a history of pulmonary diseases, who underwent immunotherapy with BCG after the initial surgical treatment of bladder cancer. After the last BCG instillation, he developed a fever. The diagnosis of sepsis was not confirmed, and miliary pulmonary tuberculosis was suspected. The diagnosis was confirmed by clinical manifestation, computed tomography of the lungs, and histological examination.

The aim of this study was to compare the ankle-brachial index between patients with atrial fibrillation (AF) and those without atrial fibrillation. Material and Methods. A total of 286 patients admitted to the Departments of Neurology or Cardiology, Kaunas Clinical Hospital, during 2008–2010 and referred for a consultation with an internist and/or a cardiologist were included in this study. All patients had at least one prevalent cardiovascular disorder and were screened for diagnosis of permanent AF based on medical records and electrocardiogram and evaluated for the ankle-brachial index (ABI). Peripheral artery disease (PAD) was defined as an ABI of 69 years (OR, 2.4; 95% CI, 1.3–4.7), and myocardial infarction (OR, 2.4; 95% CI, 1.1–5.5). Nearly one-fourth (24.5%) of all patients with an ABI of