Annually, 7.9% of the general population in Latvia are suffering from depression. According to the official statistics, less than 8000 persons a year have been treated for depression in the state-paid health care services while the National Research Programme (NRP) BIOMEDICINE 2014–2017 found that more than 70 000 depressed patients annually are coming to family physicians (FPs) in Latvia. Within NRP researchers have developed an algorithm for diagnostics and treatment of depression and carried out ten educational courses for FPs all over Latvia in 2016. Data on the treatment of depression have been collected from the National Health Service (NHS) database from 01.01.2015 till 30.06.2017. Changes between the trained and control groups have been calculated for the time period before intervention — 2015–2016 and six months right after it. The “Depression School” was attended by 210 (15.2%) out of 1382 FPs, in contract with the NHS, who signed in for the course on first-to-come basis. There were no statistically significant demographic differences between trained and control groups, except, a larger proportion of FPs from rural places vs. the capital city attended the courses. Comparing the trained and control groups, during the period before the intervention there were on average 0.96 vs. 0.83 depressive episodes (F32) and 3.26 vs.1.74 recurrent depressive disorder (F33) episodes in 1/2 year (p < 0.001). Statistically significant increase was observed for F33 episodes (+1.42, p < 0.001), and numeric for F32 episodes (+0.18, p = 0.36) in the trained group of FPs in 2017. In total this gave a statistically significant (p < 0.001) increase by 43.6% of F33 diagnoses following the education course on depression for family physicians. Further analysis of data to access sustainability of training effect after 12 and 24 months are underway.
The aim of this study was to investigate parental perception of febrile illness in their children, the most commonly applied management practices, as well as the expectations from clinicians when coping with fever in children. The study included parents of patients admitted to the Emergency and Observation Department of Children’s Clinical University Hospital in Rīga, Latvia. Data were collected via semi-structured interviews. All interviews were transcribed, and the transcripts analysed by inductive thematic analysis. Thirty-four parental interviews were analysed. Six themes emerged from the study, which were: signs causing concern; beliefs regarding fever; assessment and monitoring of fever; fever management practices; help-seeking behaviour; and expectations from the healthcare personnel. Many parents believed that fever could potentially cause injuries to the nervous system, kidneys, the brain, other internal organs, and even cause death. The perceived threat of fever resulted in frequent temperature measurements and administration of antipyretics. Meeting the emotional and information needs of the parents were considered as equally important to meeting the child’s medical needs. The study found that fever phobia exists among parents. Parental misconceptions of fever lead to overly zealous management practices. Parental education initiatives must be organised in order to improve parental knowledge of fever and its management in children.
Necrotising enterocolitis (NEC) is one of the leading causes of neonatal morbidity, mortality and surgical emergencies. As the survival rate of extremely low birth weight (ELBW) infants is rising, so is the risk of NEC. The aim of this study was to compare diagnostics parameters like clinical and radiological findings and laboratory indicators and the treatment and outcome of NEC patients from 2000 till 2007 (Group 1) and from 2008 till 2016 (Group 2) treated in Neonatology Clinic (NC) of Children’s Clinical University Hospital (CCUH). In the rectrospective study, 277 newborns were divided among Group I and Group II – 105 and 172 patients, respectively. There were no statistically significant differences between both study groups in mean gestational age and birth weight. In both groups the first signs of NEC appeared on average eight days after birth. Differences in the diagnostic method used in both groups were not statistically significant; specific radiological findings were seen in approximately 1/3 of the cases. There were statistically significant differences in the management of NEC and patient mortality. Conservative therapy was applied in 70.0% of patients in both study groups. Over time, peritoneal drainage (PPD) as the sole surgical treatment decreased by 6.4%, but PPD with following enterostomy decreased by 8.9%. In Group 2 mortality of NEC patients decreased by 17.4%. Mortality among surgically treated NEC patients decreased as well, by 9.0%.
Due to increasing changes in demographics, maintaining cognitive functioning later in life has become both economic and social concerns, and thus finding a cost-effective solution is one of the priorities in research. Factors like physical and intellectual activities have been associated with better cognitive performance in later life. While several studies have considered the impact of short-term physical activity interventions on cognitive functioning, retrospective research focusing on life-time physical activity experience has been sparse. The aim of the study was to determine the relationship between memory performance and whole brain matter integrity in seniors with different regular life-long physical activity experience. Fifty-three Latvian seniors aged 65–85 (M = 72.25, SD = 5.03, 83% female) with no self-reported chronic disease participated in the study. Measures of memory, physical activity and whole brain matter integrity were obtained and analysed. The obtained results indicated no significant relationship between physical activity experience and short and long-term memory and whole brain matter integrity; however, brain matter integrity was significantly correlated with demographic factors like age and education. These results might be related to inadequate physical activity measures, as well as unequal physical activity experience in participants. In the future, more detailed assessment of physical activity experience should be considered.
Bone density of the femur body of rabbit was determined in vivo. Experimental osteoporosis was induced by ovariectomy and subsequent injections of methylprednisolone. In the greater trochanter region of right femur, defects were created and filled with granules of hydroxyapatite and tricalcium phosphate (HAP/TCP 70/30) or HAP/TCP 70/30 together with 5% strontium. After three months, the animals were euthanized. The bone mass density of the right and left body of femur was measured by cone beam computed tomography (CT) scan. The results of the study showed that the right femur of the rabbit, where biomaterials had been implanted, and the left femur, where no biomaterial implantation occurred, became denser after filling the defect with HAP/TCP 70/30 ceramic granules or 5% Sr modified HAP/TCP ceramic granules. There was no difference between operated and non-operated legs and HAP/TCP and HAP/TCP with 5% strontium groups.
Antiretroviral therapy (ART) aims at suppressing viral replication and strengthening immune system in patients with HIV-1. Human Leukocyte Antigens (HLA) are among factors responsible for effectiveness of ART. The aim of this study was to determine the effect of HLA Class II alleles on the response to long-time ART, assessed by a change in CD4+ T-cell count in relation to viral load. The sample included 69 patients (17 females and 52 males) aged 20 to 50 with HIV-1 infection, who were undergoing ART in the Latvian Centre of Infectious Diseases. The median period of observation was 5.7 years. CD4+ T-cell count and viral load were analysed at the baseline and end of the period of observation. HLA typing was performed by polymerase chain reaction with low resolution sequence specific primers. Multiple hierarchical linear regression analysis confirmed that an increase in HIV-1 viral load was associated with a decrease in the level of CD4+ T-cell count. In addition, HLA-DRB1*04 and HLA-DQB1*06:01 alleles contributed negatively to the level of CD4+ T-cell count.
Autoimmune thyroid diseases (AITD) mainly include Hashimoto’s thyroiditis (HT) and Graves’ disease (GD), which are characterised by the presence of circulating antibodies against various thyroid autoantigens and infiltration of the thyroid gland by autoreactive lymphocytes. Despite the significant advancement in the knowledge of AITD pathogenesis in the last decade, the specific immunological mechanisms responsible for development of the disease are not thoroughly understood. Classically, HT has long been considered as a T helper (Th)1-mediated disease, while a Th2-driven autoimmune response is dominant for GD development. However, this classification has changed due to the description of Th17 lymphocytes, which suggested participation of these cells in AITD, particularly HT pathogenesis. Moreover, a shift in the balance between Th17 and T regulatory (Treg) cells has been observed in thyroid autoimmunity. We have observed overexpression of IL-17, the prominent effector cytokine of Th17, within thyroid tissues from HT and GD patients in our studies. The present review will focus on recent data regarding the role of Treg and Th17 lymphocytes in AITD pathogenesis. In addition, the impact and proposed mechanisms of the predominant environmental factors triggering the autoimmune response to the thyroid will be discussed.
Local antibiotic therapy has several advantages over systemic antibiotic treatment. Using antibiotics in local biomaterial systems can reduce the number of microorganisms that can adhere to implanted biomaterials. In this in vitro study, antibacterial properties of hydroxyapatite biomaterials impregnated with antibiotics and biodegradable polymers were examined. The antibacterial efficiency of hydroxyapatite biomaterials impregnated with antibiotics and biodegradable polymers against Staphylococcus epidermidis and Pseudomonas aeruginosa was studied by evaluating the expression of inflammatory cytokines (Interleukin-10 (IL-10), -defensin-2 and tumour necrosis factor alpha (TNF- )) in tissue surrounding implanted biomaterials in vivo. The results of this study demonstrated that hydroxyapatite biomaterials impregnated with antibiotics and biodegradable polymers had a prolonged antibacterial effect in comparison to biomaterials without biodegradable polymers. Surrounding tissue displayed higher levels of inflammatory cytokines when implanted biomaterials had not been previously impregnated with antibiotics.
Depression is among the most common mental disorders in primary care. Despite high prevalence rates it remains to be under-diagnosed in primary care settings over the world. This study was aimed to identify Latvian family physicians’ (FPs) experience and attitude in diagnosing and managing depression. It was carried out within the framework of the National Research Programme BIOMEDICINE 2014–2017. After educational seminars on diagnosing and managing depression, FPs were asked to complete a structured questionnaire. In total 216 respondents were recruited. Most of the doctors, or 72.2% (n = 156), agreed with the statement that patients with depression use primary care facilities more often than other patients. More than a half of physicians, or 66.3% (n = 143) quite often asked their patients about their psycho-emotional status and 65.7% (n = 142) of clinicians thought that they can successfully assess a patient’s psychoemotional status and possible mental disorders. The majority, or 91.6 % (n = 198), supposed that routine screening for depression is necessary in Latvia. Despite the fact that a significant number, or 62.6% (n = 135) of FPs thought that their practice was well suitable for the treatment of depressive patients, half of the respondents, or 50.9% (n = 110), assessed their ability to build a trustful contact and to motivate patients for treatment as moderate. Although FPs acknowledged the importance and necessity to treat depression, current knowledge and management approaches were far from optimal. This justifies the need to provide specific training programmes for FPs.
Congenital thumb hypoplasia is a rare deformity of the upper extremity. Incidence of thumb hypoplasia type I–V was 2–3 and type IIIb-V was 0.5–1 per 20 000 newborns per year in Latvia. The classification of thumb hypoplasia was created by Blauth in 1967 (type I to V). The base of the metacarpal bone is absent for hypoplasia type IIIb–V; therefore, toe-to hand transplantation is not recommended. A stable first carpometacarpal joint has been considered a mandatory factor for successful toe-to-hand transplantation. A technique for toe-to-hand transplantation for thumb hypoplasia type IIIb–V patients has been described in literature but overall results were not better than pollicisation. The aim of this study is to describe a new technique for thumb reconstruction with a second toe transfer with metatarsophalangeal joint arthrodesis, which can provide a 5-digit hand and restore the functionality of the thumb for thumb hypoplasia IIIb–V. Long-term follow up was done to evaluate the functions and aesthetics of the hands. A survey to evaluate aesthetical outcome for the transplantation method and pollicisation method was completed by 290 respondents. The overall population rated the aesthetic outcomes of the new transplantation method significantly higher than for pollicisation (p < 0.0001).