Competitiveness as a factor of a company selling its services in the market is becoming more relevant in the healthcare sector. The number of institutions that offer their services to international patients is growing. Research shows that the development of medical tourism is country-specific. The main objective of this publication is to discover positive and negative factors for engagement in the provision of services to non-residents. The data was obtained from a cross-sectional study in which 86 managers of health care institutions in Latvia completed a questionnaire. A total of 80.2% of health care institutions had provided services to non-resident patients in the previous year while 19.8% did so regularly. Institutions mainly used websites to advertise their services. Only a small number of institutions employed a marketing specialist or had a strategy to attract non-resident patients. Heads of institutions pointed to a number of internal and external barriers in this connection, including lack of staff, low motivation, limited language skills, inadequate infrastructure, insufficient state-level support to promote the export of services, the social environment, and problems in the health system itself. The study revealed areas that need to be improved regarding future policies to attract non-resident patients and to increase global competitiveness.
Colistin is used systemically in critically ill patients for treatment of infections caused by multi-drug resistant (MDR) Gram-negative bacteria, e.g., Acinetobacter baumanii. It is potentially nephro- and neurotoxic. It is recommended to decrease the dose of colistin in case of renal impairment or renal replacement therapies (RRT) but clear recommendations are not available yet. The aim of this retrospective study was to determine colistin use patterns in critically ill patients in Pauls Stradiņš University Hospital. Forty patients were included in this study. The most common indications for colistin were pneumonia associated with mechanical ventilation or sepsis caused by MDR A. baumanii. Median duration of colistin therapy was 11.5 (IQR 7.0; 17.0) days and median cumulative dose was 91.5 (43.0; 150.0) million units (MU). The usual regimen was 9 MU as loading dose and 3 MU three times daily as maintenance dose, but in case of renal impairment and RRT colistin regimens varied a lot between the patients. In 21% (7 from 33) of cases, acute kidney injury (AKI) was observed during colistin therapy (serum creatinine increases more than twice from baseline). All these AKI cases occurred in patients with previously normal renal function and none of the patients in this group needed RRT.
Sepsis is widespread among hospitalised patients worldwide. In fact, severe sepsis and septic shock is a major cause of patient admission and mortality in intensive care units and the difficulty in diagnosing the initial stage of the disease is a major obstacle to the reduction of mortality from sepsis. Retrospective analysis of medical records of 72 patients was carried out within the framework of the study. The study included patients of both sexes and all ages, who were hospitalised at the stationary “Gaiļezers” of the Rīga East Clinical University Hospital from 2011 to 2014. The study aim was to determine the clinical course of treated septic patients and conduct a pharmaco-economic analysis. In the course of the disease, almost half of the patients - 34 (48.6%) showed development of septic shock. Mortality in these patients exceeded a half (60.0%; 21 patients). Artificial lung ventilation during hospitalisation was received by 43 (59.7%) of patients. Artificial lung ventilation had been required in a significantly larger number of cases in the dead patient group (75%, p = 0.01). The average costs per one patient day (including bed-day price and manipulation costs) was 383 euros. Septic shock was associated with high mortality. Severe sepsis is an expensive diagnosis, as the average cost of one patient exceeds costs of other departments by 4.5 times.
Undeniably, sepsis is still a profoundly damaging and life-threatening condition for many individuals. With multiple changes in sepsis patients it is difficult to precisely classify an individual’s response in sepsis as proinflammatory or immunosuppressed. The aim of this study was to investigate genetically determined predisposition to developed sepsis by analysis of distribution of human leukocyte antigen (HLA) class II genes. Samples from patients with sepsis were collected at Pauls Stradiņš Clinical University Hospital, Latvia, in an intensive care unit between October 2016 and May 2017. The study group included 62 patients with sepsis, who were genotyped for HLA-DR; DQ using real time polymerase chain reaction – sequence specific primer (RT PCR-SSP). As a control group, data of 100 individuals were taken from the genetic bank of RSU Joint Laboratory of Clinical Immunology and Immunogenetics. The summarised results showed that the frequency of alleles DRB1*04:01 (OR = 5.54; 95% CI = 1.88–16.29); DRB1*07:01 (OR = 19.03; 95% CI = 2/37–152.82); DQA1*05:01 (OR = 14.17; 95% CI = 5.67–35.4); and DQB1*02:01 (OR = 50.00; 95% CI = 2.90–861.81) were significantly increased in patients with sepsis compared to the control group patients. The frequency of DRB1*16:01 (OR = 0.17, 95% CI = 0.04–0.59); DRB1*17:01 (OR = 0.04; 95% CI = 0.00–0.69); DQA1*01:01 (OR = 0.04; 95% CI = 0.00–0.31); DQA1*01:02 (OR = 0.03; 95% CI = 0.00–0.23); DQB1*02:02 (OR = 0.12; 95% CI = 0.03–0.42) alleles was lower in sepsis patients than in control subjects. The most frequent HLA-DRB1/DQA1/DQB1 haplotypes that was significantly increased in patients with sepsis were: DRB1*01:01/DQA1*05:01/DQB1*03:01 (OR = 12.6; 95% CI = 1.51–105.0; p < 0.003). Sepsis patients with pneumonia and alleles and DRB1 04:01; 07:01, DQB1 02:01 had the highest mortality rate. Undoubtedly, our preliminary data showed that development of sepsis can be associated with alleles and haplotypes of HLA class II genes. For more precise conclusion the research should be continued to include a larger patient group.
Whole-grain rye intake has been suggested to have anti-cancer effect, including changes in serum hormones and reduced prostate specific antigen (PSA) in animals and humans. In this study, we investigated the effect of high intake of whole-grain rye bread on prostate cancer progression as assessed by PSA concentration in men diagnosed with prostate cancer. Fifteen men with prostate cancer who did not receive prior therapy were randomised and given a daily supplement of 250 g refined wheat bread for two weeks and, afterwards, 250 g whole-grain rye bread for six weeks. Blood samples were taken from fasting men at baseline and after two and six weeks to measure the PSA and sex hormones. The dietary intake was: energy intake 3452 kcal; protein intake 166 g, carbohydrate intake 334 g, fat 149 g, saturated fat intake 52 g, and fibre intake 40 g. Plasma total PSA, free PSE, testosterone concentrations and free androgen index tended to be higher after refined white bread treatment and lower after whole-grain rye treatment. However, none of the differences were statistically significant. There were no significant changes in sex hormone binding globulin, luteinising hormone, and follicle stimulating hormone. In this intervention trial, whole-grain rye consumption did not result in significant changes in PSA and sex hormones, which may be related to high fat intake. Further prospective trials are indicated to evaluate the potential of whole-grain rye bread, taking into account other factors.
Milk and dairy products are studied as alternative iodine sources, because salt iodisation is controversial due to high salt consumption leading to cardiovascular diseases. However, the iodine concentration in milk markedly varies. This study evaluated the iodine concentration in cow’s milk available in the Latvian market. Iodine and fat concentration was analysed with a spectrophotometer “Varian Cary 50” based ISO 2446:2008 in 20 milk samples. Data from the Central Statistical Bureau and survey among pregnant women were used to analyse milk product consumption and its impact on iodine status. Average iodine concentration in milk samples was 457.6 (179.6) μg/L, winter samples had a higher concentration of iodine than summer samples: 563.4 (329.6) μg/L and 469.2 (162.0) μg/L, but this is not statistically significant p < 0.05. Iodine concentration in skimmed milk was 490 μg/L, milk with the reduced fat content 501.7 (174.8) μg/L, and whole milk — 422.6 (192.1)1 μg/L. Milk consumption decreased from 2002 to 2014, while yogurt and cheese consumption increased. Higher consumption of milk and milk products was related to higher urinary iodine concentration ρ = 0.115; p = 0.003. Milk and milk products are an important iodine source in Latvia and their consumption should be promoted.