Ingus Skadiņš, Juta Kroiča, Ilze Salma, Aigars Reinis, Marina Sokolova and Dagnija Rostoka
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.
Vineta Viktorija Vinogradova, Jeļena Vrubļevska and Elmārs Rancāns
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).
Ieva Kalere, Ilze Konrāde, Anna Proskurina, Sabīne Upmale, Tatjana Zaķe, Normunds Limba, Gita Krieviņa, Aivars Lejnieks and Pēteris Tretjakovs
There is a close relationship between melatonin as a circadian regulator and insulin, glucagon and somatostatin production. This study aimed to describe subgroups of type 2 diabetes mellitus (T2DM) patients that may benefit from melatonin clock-targeting properties. The study involved 38 participants: 26 T2DM patients, and 12 participants without diabetes in the control group. Subjects were asked to complete the questionnaire of Pittsburgh Sleep Quality Index (PSQI). Standard biochemical venous sample testing was performed, and a sample of saliva was collected for melatonin testing. Melatonin concentration in participants without obesity (body mass index (BMI) < 30 kg/m2) was significantly higher than in obese participants: 13.2 (6.4; 23.50) pg/ml vs 5.9 (0.78; 13.1) pg/ml, p = 0.035. Subjects with BMI 30 kg/m2 had a significantly higher PSQI score than non-obese subjects: 7 (4.5; 10) vs 5.5 (3; 7), p = 0.043. T2DM patients showed significantly lower levels of melatonin than the control group: 6.1 (0.78; 12.2) pg/ml vs 17.8 (8.2; 25.5) pg/ml, p = 0.003. T2DM patients using short-acting insulin analogues showed a significantly higher PSQI score than patients not using insulin: 9 (6; 10) vs 6 (3; 8), respectively (p = 0.025). Poor sleep quality was more prevalent in patients with diabetic retinopathy than in those without this complication (p = 0.031). Lower melatonin levels were detected in T2DM and obese patients. Furthermore, poor sleep quality was observed in T2DM patients using short-acting insulin analogues and those with diabetic retinopathy, and obese individuals.
The aim of this study was to investigate the possibility of using monocytes/macrophages as mediators in human herpesvirus-6 (HHV-6) infection of thyroid gland tissues in autoimmune thyroiditis (AIT). Seventy-three AIT patients were enrolled in this study. The control group consisted of 80 blood donors. Monocyte/macrophage isolation for AIT patient samples was performed by adherence. HHV-6 was detected in peripheral blood mononuclear cell (PBMC) DNA samples using nested polymerase chain reaction (nPCR). Gene expression of HHV-6 active infection marker (U79/80) and chemokine receptors (U12, U51) in patient monocyte/macrophage samples and blood donor PBMC samples was detected using reverse-transcription PCR. HHV-6 viral load was detected by using quantitative-PCR technique. The HHV-6 genomic sequence was found significantly more frequently among AIT patient than control group samples. Markers of active infection were found in 8 AIT patient monocyte/macrophage samples (11%) and in none of control group PBMC samples. HHV-6 U51 mRNA expression was detected only in AIT patient samples (2/24 previously positive for HHV-6). Since HHV-6 genomic sequences were found significantly more frequently in AIT patient samples and active infection markers were found in patient monocytes/macrophages, our results suggest that monocytes/macrophages may be used by HHV-6 as mediators for thyroid gland infection.
Jēkabs Krastiņš, Aigars Pētersons and Aivars Pētersons
Acute kidney injury (AKI) is a serious complication in the perioperative period and is consistently associated with increased morbidity and case fatality rate. This has been best studied in the cardiac surgery setting where it has been shown that up to 11.5–86.0% of patients exposed to cardiopulmonary bypass (CPB) will develop AKI, with 2.0–18.9% requiring renal replacement therapy (RRT). A prospective uncontrolled cohort study was conducted between 2011 and 2015, in which 93 children with various congenital heart lesions undergoing CPB were enrolled. Serum creatinine (SCr) level was determined by Jaffé’s method (Cobas 6000 analyser, Roche). Postoperative fluid balance was estimated as the difference between fluid intake and output. Data for further processing were retrieved from anaesthesia and intensive care data management system flowsheets (IntelliView, Philips). AKI developed in 42 patients (45.6%) by meeting at least KDIGO (Kidney Disease: Improving Global Outcomes) stage I criteria (with SCr rise by more than 50% from the baseline). Thirty eight patients complied with the 1st stage of AKI, three with 2nd stage and two with 3rd stage, according the KDIGO classification and staging system. One patient having severity stage II and two patients having severity stage III of AKI required initiation of RRT using peritoneal dialysis. Two patients from the RRT group survived, one died. The median intraoperative urine output was 2.32 ml/kg/h, (range from 0.42–5.87 ml/kg/h). Median CPB time was 163 min., median aortic cross-clamping time was 97.9 min., cooling during CPB to 29.5 °C. The diagnosis of AKI using SCr was delayed by 48 hours after CPB. Median fluid balance (FB) on the first postoperative day in non-AKI patients was 13.58 ml/kg (IQR 0–37.02) vs 49.38 ml/kg (IQR 13.20–69.32) in AKI patients, p < 0.001. AKI is a frequent complication after open heart surgery in children with congenital heart lesions. From 93 patients included in the study, 42 (45.2%) met at least KDIGO Stage I criteria for AKI. FB is a sensitive marker of kidney dysfunction. Median FB in the 1st postoperative day significantly differed between AKI patients: 49.38 ml/kg (13.20–69.32) versus 13.58 ml/kg in patients with intact kidney function (AUC = 0.84; p = 0.001). Thus it can be used as a marker of AKI.
Ksenija Kramiča, Jeļena Eglīte, Aleksandrs Koļesovs, Tatjana Kramiča, Gaļina Titoviča, Diāna Džeriņa, Glafira Nikolajeva, Ludmila Vīksna and Oksana Koļesova
Tuberculosis (TB) is still one of the top ten leading causes of death in the world. Compared to other Baltic and Eastern European countries, TB incidence (24.8 new cases per 100 000 people in 2017) in Latvia is relatively high. One of the regions with the highest TB incidence is Latgale (31.1 cases per 100 000 people). The aim of this pilot study was to identify markers of genetic predisposition to TB in Latgale. The study included 26 patients (16 males and 10 females) aged between 18 and 85 with bilateral TB pneumonia and without HIV infection. HLA typing was performed in HLA-DRB1, -DQA1, and -DQB1 loci by a polymerase chain reaction with low resolution sequence-specific primers. HLA-DRB1*07 and HLA-DRB1*11 alleles were identified as risk alleles for TB. HLA-DRB1*15 allele was a protective allele. Due to the limitations of this exploratory study, a broader study needs to be conducted to revealing specific risk and protective HLA Class II alleles for TB in the subpopulation of Latgale.
Viral infections have been frequently cited as important environmental factors implicated in autoimmune thyroiditis (AIT) development, although no specific virus has yet been conclusively associated with the disease. Some evidence implicates human herpesvirus-6 (HHV-6) in this disease. The aim of this study was to investigate the role of the HHV-6 U83 gene expression in autoimmune thyroiditis development. Fifty-one patients with AIT following thyroidectomy and a control group of 30 autopsied subjects without thyroid pathologies for comparing virology results and 30 healthy blood donors for comparing serology results were enrolled in this study. HHV-6 U83 gene expression was determined using nested PCR with complementary DNA as the template acquired from thyroid gland extracted RNA. Plasma samples of AIT patients and blood donors were tested for IL-2, IL-4, IL-10, sTNF-RII and IL-1beta levels by ELISA. Virology results were compared with pro- and anti-inflammatory cytokine levels to determine possible interaction of HHV-6 with host immune response. HHV-6 U83 gene expression was found only in 24% (12/49) of AIT patient thyroid gland tissue samples and in none of the control group individuals, showing possible involvement of this gene in AIT development. However, no interaction between HHV-6 and changes in cytokine levels was found.
Anda Vilmane, Inga Ziemele, Santa Rasa, Anna Terentjeva, Modra Murovska, Dace Gardovska, Yung-Cheng Lin and Zaiga Nora-Krūkle
Lower respiratory tract infection (LRTI) is the major cause of morbidity and mortality of children in the world. In addition to respiratory syncytial virus, influenza virus types A and B, parainfluenza types 1, 2 and 3, and adenoviruses, several new respiratory viruses associated with LRTI were discovered in the 21st century. These are metapneumovirus, coronaviruses NL63 and HKU1, parainfluenza virus type four and human bocavirus one (HBoV1). HBoV1 was discovered in 2005 and is considered as the fourth most prevalent respiratory virus worldwide. However, the high frequency of co-infections detected together with HBoV1 raises doubt about whether HBoV1 is a true pathogen or just a bystander. This is the first study aimed to determine the presence of HBoV1 and 18 other respiratory viruses in nasopharyngeal aspirates (NPA) of children with LRTI in Latvia. Using multiplex real-time polymerase chain reaction method, the HBoV1 genomic sequence was detected in 60.0% of NPA samples, showing that HBoV1 prevalence is high among children with LRTI in Latvia. HBoV1 mono-infection was revealed in 6.67%. The most common co-infections associated with HBoV1 were rhinovirus, adenovirus, respiratory syncytial virus A and B, metapneumovirus, and enterovirus.
Pēteris Tretjakovs, Juris Hofmanis, Dace Hofmane, Gita Krieviņa, Leons Blumfelds, Vitolds Mackēvičs, Aivars Lejnieks and Guntis Bahs
The aim of the present study was to evaluate plasma levels of chemerin, myeloperoxidase (MPO), fibroblast growth factor-21 (FGF-21), thioredoxin reductase-1 (TrxR1), and matrix metallopeptidase-9 (MMP-9) in acquired aortic valve (AoV) stenosis patients to determine correlations between the studied cellular factors, and also clarify the predictive values of these factors as biomarkers in AoV stenosis. AoV stenosis patients were classified into three groups: 17 patients with mild AoV stenosis; 19 with moderate and 15 with severe AoV stenosis. Twenty-four subjects without AoV stenosis were selected as a control group. Our findings suggest that AoV stenosis might be associated with increased chemerin, TrxR1, MPO, and FGF-21 levels in plasma. Moreover, these factors and also MMP-9 already reached statistically significantly elevated levels in the early stages of AoV stenosis, but MPO levels were more pronounced in patients with moderate and severe AoV stenosis. Chemerin was correlated with all of the studied cytokines; TrxR1 and MMP-9 were correlated with several other cellular factors. Our findings (by ROC analysis) suggest that MPO and chemerin might serve as specific and sensitive biomarkers for AoV stenosis without grading the severity, but, in relation to mild AoV stenosis, TrxR1, FGF-21, and MMP-9 also reached good or moderate levels as biomarkers. The cellular factors might serve as novel diagnostic and prognostic biomarkers in AoV stenosis patients, while chemerin and MPO may be more powerful.