We evaluated the effect of antihyperglycemic therapy on the survival of patients with lung cancer (LC). The analysis included patients with LC and concomitant type 2 diabetes. 15,929 patients were classified into five groups: metformin users, insulin users, metformin and insulin users, sulphonylurea users and non-diabetic group. A multivariate analysis showed that exposure to either metformin or to insulin was associated with a lower risk of LC-specific mortality, and this approached statistical significance (HR 0.82, 95% CI 0.72–92 for metformin and HR 0.65, 95% CI 0.44–95 for insulin). When deaths from all causes were considered, only metformin exposure was associated with a significantly lower risk of death (HR 0.82, 95% CI 0.73–0.92). Users of sulphonylurea were at a higher risk of LC-specific and overall mortality (HRs 1.19, 95% CI 0.99–1.43 and 1.22, 95% CI 1.03–1.45). Our study shows a positive effect of metformin on the survival of patients with LC. Moreover, our results show that exposure to insulin was associated with a lower risk of LC-specific mortality, but not with deaths from all causes. The study results suggested that users of sulphonylurea may be at a higher risk of LC-specific and overall mortality.

Tyrimo tikslas. Išnagrinėti pleuros empiemos ir komplikuoto parapneumoninio pleurito priežastis ir rizikos veiksnius.
Tirtųjų kontingentas ir tyrimo metodai. Ištirta 120 ligonių, sirgusių pleuros empiema (n=67) ir komplikuotu parapneumoniniu pleuritu (n=53). Pleuros empiema diagnozuota radus pūlingo pleuros skysčio. Komplikuotas parapneumoninis pleuritas diagnozuotas ultragarsiniu tyrimu, aptikus inkapsuliuoto skysčio pleuros ertmėje, pleuros skysčio pH<7,0 bei pleuros skystyje nustačius neutrofilų daugiau kaip 50 proc. visų leukocitų. Tyrimo tikslas – įvertinti tiriamųjų amžių, lytį, gretutinę patologiją, nustatyti laikotarpį, per kurį ligoniai kreipėsi į gydytoją, įvertinti, kokiais antibiotikais ligoniai buvo gydomi iki diagnozės nustatymo.
Rezultatai. Pleuros empiema ir komplikuotu parapneumoniniu pleuritu sirgo vidutinio amžiaus tiriamieji (53 metų), vyrai du kartus dažniau nei moterys. 46 proc. ligonių nustatytas bent vienas rizikos veiksnys, dažniausiai neoplazija (37 proc.), imunosupresuojamųjų vaistų (15 proc.) ir nesaikingas alkoholinių gėrimų vartojimas (15 proc.). Atsiradus ligos simptomams, tiriamieji į gydytojus kreipėsi vidutiniškai po 12 dienų. Ligoniams, kuriems buvo diagnozuota pleuros empiema, rizikos veiksniai buvo dažnesni (pleuros empiemos – 50,75 proc., komplikuoto parapneumoninio pleurito – 39,62 proc. atvejų), į gydytojus jie kreipėsi vėliau (21±28,6 dienos) nei sirgusieji komplikuotu parapneumoniniu pleuritu (9,5±9,8 dienos, p=0,0052). 75 proc. tiriamųjų buvo gydyti antibiotikais, daugelis gydyti monoterapija (86 proc. atvejų). Dažniausiai buvo skiriama penicilinų (29 proc.), cefalosporinų (25 proc.), aminoglikozidų (20 proc.), makrolidų (10 proc.). 25 proc. tiriamųjų dažniausiai dėl klaidingai diagnozuotos tarpšonkaulinės neuralgijos antibiotikų neskirta.
Išvada. Pleuros empiemos ir komplikuoto parapneumoninio pleurito priežastys yra daugialypės: tiriamieji, atsiradus ligos simptomams, per vėlai kreipiasi į gydytoją, beveik pusei tiriamųjų nustatytos imunosupresinę būklę galinčios sukelti patologijos, daliai ligonių neskirta antibiotikų arba jų buvo skiriama netinkamai.

Background and Objective: Respiratory assistance tactic that is best for COVID-19-associated acute hypoxemic respiratory failure (AHRF) individuals has yet to be determined. Patients with AHRF may benefit from the use of a high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV). The goals of this prospective observational research were to estimate predictive factors for HFNC and NIV failure in COVID-19-related AHRF subjects. Materials and Methods: The research enlisted the participation of 124 patients. A stepwise treatment approach was used. HFNC and NIV were used on 124 (100%) and 64 (51.6%) patients, respectively. Thirty (24.2%) of 124 patients were intubated and received invasive mechanical ventilation. Results: 85 (68.5%) patients were managed successfully. Patients who required NIV exhibited a higher prevalence of treatment failure (70.3% vs. 51.6%, p = 0.019) and had higher mortality (59.4% vs. 31.5%, p = 0.001) than patients who received HFNC. Using logistic regression, the respiratory rate oxygenation (ROX) index at 24 h (odds ratio (OR) = 0.74, p = 0.018) and the Charlson Comorbidity Index (CCI) (OR = 1.60, p = 0.003) were found to be predictors of HFNC efficacy. It was the ROX index at 24 h and the CCI optimum cut-off values for HFNC outcome that were 6.1 (area under the curve (AUC) = 0.73) and 2.5 (AUC = 0.68), respectively. Serum ferritin level (OR = 0.23, p = 0.041) and lymphocyte count (OR = 1.03, p = 0.01) were confirmed as predictors of NIV failure. Serum ferritin level at a cut-off value of 456.2 ng/mL (AUC = 0.67) and lymphocyte count lower than 0.70 per mm³, (AUC = 0.70) were associated with NIV failure with 70.5% sensitivity, 68.7% specificity and sensitivity of 84.1%, specificity of 56.2%, respectively. Conclusion: The ROX index at 24 h, CCI, as well as serum ferritin level, and lymphocyte count can be used as markers for HFNC and NIV failure, respectively, in SARS-CoV-2-induced AHRF patients.

Coccidioidomycosis is an infectious disease caused by Coccidioides immitis or C. posadasii fungus. Humans usually get infected by inhaling spores risen from the soil. Although in 60 percent of cases symptoms are absent, remaining patients can develop various manifestations of the disease, from flu-like symptoms to severe dissemination or meningitis. In endemic regions (California, Arizona, Mexico, Central, and South America), pulmonary coccidioidomycosis causes 25% of community-acquired cases of pneumonia. We present the first registered case of pulmonary coccidioidomycosis in Lithuania. Clinical presentation, pathogenesis, treatment options, and diagnostic alternatives are discussed.

Background and Objectives: Kidney transplant recipients are at risk of developing more severe forms of COVID-19 infection. The aim of this study was to compare the clinical course of COVID-19 infection among kidney transplant patients and a control group. Materials and Methods: We examined 150 patients hospitalized with COVID-19 infection. Patients were divided into study (kidney transplant recipients, n = 53) and control (without a history of kidney transplantation, n = 97) groups. Demographics, clinical characteristics, treatment data, and clinical outcomes were assessed. Results: The median patient age was 56.0 (46.0–64.0) years, and seventy-seven patients (51.3%) were men. The median Charlson comorbidity index was higher in the study group (3.0 vs. 2.0, p < 0.001). There was a higher incidence of hypoxemia in the control group upon arrival (52.6% vs. 22.6%, p = 0.001) and a higher NEWS index median (2.0 vs. 1.0 points, p = 0.009) and incidence of pneumonia during hospitalization (88.7% vs. 73.6%, p = 0.023). In the study group, there were more cases of mild (26.4% vs. 11.3%, p = 0.023) and critically severe forms of COVID-19 infection (26.4% vs. 3.1%, p < 0.001), kidney failure was more prevalent (34.0% vs. 1.0%, p < 0.001), and a greater number of patients were transferred to the intensive care unit (22.6% vs. 3.1%, p < 0.001) and died (18.9% vs. 1.0%, p < 0.001). Multivariable analysis revealed that treatment in the intensive care unit correlated with a higher mortality rate than transplantation itself (HR = 20.71, 95% CI 2.01–213.33, p = 0.011). Conclusions: The course of the COVID-19 disease in kidney transplant recipients is heterogeneous and can be more severe than in the general population. Even though patients may be hospitalized with fewer symptoms, complications and death are more likely to occur.