Background: The COVID-19 infection had spread worldwide causing many deaths. Mortality rates and patients’ characteristics varied within and between countries, making it important to understand the peculiarities of different populations. The aim of this study was to identify the main predictors associated with in-hospital mortality due to COVID-19 in Vilnius, Lithuania. Materials and methods: This was a retrospective observational cohort study conducted at Vilnius University Hospital Santaros Clinics, Lithuania. The study included SARS-CoV-2 positive patients aged over 18 years and hospitalized between March 2020 and May 2021. Depersonalized data were retrieved from electronic medical records. The predictive values of laboratory parameters were evaluated using ROC analysis. Multivariable binary logistic regression was performed to reveal predictors of in-hospital mortality due to COVID-19. Results: Among 2794 patients, 54.4% were male, the age median was 59 years (IQR 48–70), 47.4% had at least one comorbidity. The most common comorbidities were arterial hypertension (36.9%) and diabetes mellitus (13.7%). Overall, 12.7% of patients died. Multivariable regression revealed that age (OR 1.04, 95%CI 1.02–1.06), congestive heart failure (OR 3.06, 95%CI 1.96–4.77), obesity (OR 3.90, 95%CI 2.12–7.16), COPD (OR 2.92, 95%CI 1.12–7.60), previous stroke (OR 5.80, 95%CI 2.07–16.21), urea >7.01 mmol/l (OR 2.32, 95%CI 1.47–3.67), AST/ALT >1.49 (OR 1.54, 95%CI 1.08–2.21), LDH >452.5 U/l (OR 2.60, 95%CI 1.74–3.88), CRP >92.68 mg/l (OR 1.58, 95%CI 1.06–2.35), IL-6 >69.55 ng/l (OR 1.62, 95%CI 1.10–2.40), and troponin I >18.95 ng/l (OR 2.04, 95%CI 1.38–3.02), were associated with increased risk for in-hospital mortality in COVID-19 patients. Conclusions: Age, congestive heart failure, obesity, COPD, prior stroke, and increased concentration of urea, LDH, CRP, IL-6, troponin I, ALT to AST ratio were identified to be the predictors for in-hospital mortality of COVID-19 patients.

Background and Objectives: SARS-CoV-2 affects multiple organ systems, including the cardiovascular system, leading to immediate and long-term cardiovascular complications. Acute myocardial injury is one of the earliest and most common cardiac issues in the acute phase of COVID-19. This study aimed to evaluate the prognostic value of cardiac troponin I (cTnI) levels in predicting in-hospital mortality among hospitalised COVID-19 patients. Materials and Methods: A retrospective observational cohort study included 2019 adult patients hospitalised with a confirmed COVID-19 infection stratified by cTnI levels on admission into three groups: 100 ng/L (172 patients). Myocardial injury was defined as blood serum cTnI levels increased above the 99th percentile upper reference limit. Depersonalised datasets were extracted from digital health records. Statistical analysis included multivariable binary logistic and Cox proportional hazards regressions. Results: Overall, 29.87% of patients experienced acute myocardial injury, which development was associated with age, male sex, chronic heart failure, arterial hypertension, obesity, and chronic kidney disease. Among patients with cTnI levels of 19–100 ng/L, the odds ratio for requiring invasive mechanical ventilation was 3.18 (95% CI 2.11–4.79) and, for those with cTnI > 100 ng/L, 5.38 (95% CI 3.26–8.88). The hazard ratio for in-hospital mortality for patients with cTnI levels of 19–100 ng/L was 2.58 (95% CI 1.83–3.62) and, for those with cTnI > 100 ng/L, 2.97 (95% CI 2.01–4.39) compared to patients with normal cTnI levels. Conclusions: Increased cardiac troponin I, indicating myocardial injury, on admission is associated with a more adverse clinical disease course, including a higher likelihood of requiring invasive mechanical ventilation and increased risk of in-hospital mortality. This indicates cardiac troponin I to be a beneficial biomarker for clinicians trying to identify high-risk COVID-19 patients, choosing the optimal monitoring and treatment strategy for these patients.

Retrorectal lipoma, as well as other retrorectal tumours, is a relatively rare disorder. Retrorectal tumours accounted for 1 in 40,000 hospital admissions. We present a case of retrorectal lipoma, 15 cmx10 cmx8 cm in size, treated by the laparoscopic approach. The preoperative magnetic resonance imaging visualised a mass, 12 cmx6.7 cmx8.6 cm in diameter, in the retrorectal space, spreading toward the left obturator foramen. Surgery was indicated due to exclude malignant process certainly, because it is difficult to differentiate lipoma from low-grade liposarcoma on non invasive imaging. Laparoscopic extirpation of the tumour was performed. The overall operative time was 80 min. The diagnosis of lipoma was established on histological examination. The patient was discharged from hospital on the 2nd day after the surgery. We have found this minimally invasive operation to be an effective and well-tolerated treatment option, determined by the experience of the surgeon.

Background and objectives: Increased blood glucose levels atadmission are frequently observed in COVID-19 patients, even in those without pre-existing diabetes. Hyperglycaemia is associated with an increased incidence of severe COVID-19 infection. The aim of this study was to evaluate the association between hyperglycaemia at admission with the need for invasive mechanical ventilation (IMV) and in-hospital mortality in patients without diabetes who were hospitalized for COVID-19 infection. Materials and methods: This retrospective observational study was conducted at Vilnius University Hospital Santaros Clinics, Lithuania with adult patients who tested positive for severe acute respiratory syndrome coronavirus 2 SARS-CoV-2 and were hospitalized between March 2020 and May 2021. Depersonalized data were retrieved from electronic medical records. Based on blood glucose levels on the day of admission, patients without diabetes were divided into 4 groups: patients with hypoglycaemia (blood glucose below 4.0 mmol/L), patients with normoglycaemia (blood glucose between ≥4.0 mmol/L and <6.1 mmol/L), patients with mild hyperglycaemia (blood glucose between ≥6.1 mmol/L and <7.8 mmol/L), and patients with intermittent hyperglycaemia (blood glucose levels ≥7.8 mmol/L and <11.1 mmol/L). A multivariable binary logistic regression model was created to determine the association between hyperglycaemia and the need for IMV. Survival analysis was performed to assess the effect of hyperglycaemia on outcome within 30 days of hospitalization. Results: Among 1945 patients without diabetes at admission, 1078 (55.4%) had normal glucose levels, 651 (33.5%) had mild hyperglycaemia, 196 (10.1%) had intermittent hyperglycaemia, and 20 (1.0%) had hypoglycaemia. The oddsratio (OR) for IMV in patients with intermittent hyperglycaemia was 4.82 (95% CI 2.70–8.61, p < 0.001), and the OR was 2.00 (95% CI 1.21–3.31, p = 0.007) in those with mild hyperglycaemia compared to patients presenting normal glucose levels. The hazardratio (HR) for 30-day in-hospital mortality in patients with mild hyperglycaemia was 1.62 (95% CI 1.10–2.39, p = 0.015), while the HR was 3.04 (95% CI 2.01–4.60, p < 0.001) in patients with intermittent hyperglycaemia compared to those with normoglycaemia at admission. Conclusions: In COVID-19 patients without pre-existing diabetes, the presence of hyperglycaemia at admission is indicative of COVID-19-induced alterations in glucose metabolism and stress hyperglycaemia. Hyperglycaemia at admission in COVID-19 patients without diabetes is associated with an increased risk of invasive mechanical ventilation and in-hospital mortality. This finding highlights the importance for clinicians to carefully consider and select optimal support and treatment strategies for these patients. Further studies on the long-term consequences of hyperglycaemia in this specific population are warranted.

We present a case of tularemia complicated by rhabdomyolysis in a 43-year-old male who presented with fever, swelling, and pain of the right groin and a history of a week-old tick bite. Empirical parenteral amoxicillin/clavulanic acid treatment was initiated. Suspecting tularemia, parenteral gentamycin was added. Later, the patient started to complain of muscle pain, weakness, and difficulties in breathing and walking. Heightened levels of creatine kinase and myoglobin concentration (42,670 IU/L and >12,000 μg/L, respectively) were found. Due to rhabdomyolysis, large amounts of intravenous fluid therapy were initiated to prevent kidney damage, continuing intravenous antibiotic therapy. Francisella tularensis IgG in serum was found to be positive only on the sixteenth day of hospitalization. Upon discharge, the laboratory analyses returned to normal levels, and the patient was in good condition. The successful outcome could be associated with the early appropriate therapy of tularemia and its rare complication of rhabdomyolysis.

The COVID-19 pandemic highlighted the need for novel biomarkers to identify patients at risk of developing severe disease. Circulating cell-free nucleic acids (cfNAs) are released from injured host cells or can be derived from pathogens. As cfNA is suggested to be a useful biomarker in oncologic, autoimmune, and other diseases, the aim of our study was to investigate the role of serum cfNA in predicting the course and outcome of COVID-19 disease. We conducted a retrospective cohort study at Vilnius University Hospital Santaros Klinikos, utilizing serum samples collected upon admission and accompanying health information obtained from the Vilnius Santaros Klinikos Biobank. A total of 108 adult COVID-19 patients hospitalized between November 24, 2020, and November 10, 2021, and 24 healthy controls were enrolled. cfDNA concentration was measured using capillary electrophoresis. cfRNA was detected using quantitative real-time PCR. cfDNA concentration was higher in COVID-19 patients compared with controls (4.28 vs. 0.51 ng/µL, p < 0.001) and increased with disease severity: from 1.06 ng/µL in mild to 2.65 ng/µL in severe, and 6.68 ng/µL in critical disease. cfDNA levels were higher in intensive care unit (ICU) patients (6.68 vs. 2.30 ng/µL, p < 0.001), patients requiring advanced respiratory support (ARS) (7.11 vs. 2.74 ng/µL, p < 0.001), and non-survivors (16.68 vs. 3.44 ng/µL, p < 0.001). cfDNA showed high predictive values for ICU admission (AUC 0.79), ARS (AUC 0.77), and lethal outcome (AUC 0.81), outperforming other routine biomarkers. In logistic regression analysis, cfDNA remained an independent predictor for ICU admission (OR 1.21, 95%CI 1.08-1.36), ARS requirement (OR 1.15, 95%CI 1.03-1.28), and in-hospital mortality (OR 1.08, 95%CI 1.02-1.14), while serum SARS-CoV-2 RNAemia remained an independent predictor of ARS requirement (OR 4.18, 95%CI 1.15-15.20). Higher serum cfDNA concentrations were independently associated with greater COVID-19 disease severity, increased likelihood of requiring intensive care, ARS, and in-hospital mortality. cfDNA demonstrated superior prognostic performance, surpassing established biomarkers. Serum SARS-CoV-2 RNAemia was associated with the need for ARS. This indicates that cfNAs may serve as clinically valuable biomarkers for early risk stratification and outcome prediction in COVID-19 patients. Further validation in independent cohorts is required to confirm generalizability. Not applicable.