Browsing by Author "Jurjans, Kristaps"

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    CARDIOEMBOLIC STROKE IN LATVIA : PREVENTION AND LONG-TERM OUTCOME
    (Central Bohemia University, 2016) Pucite, Elina; Jurjans, Kristaps; Miglane, Evija; Lurina, Baiba; Kalējs, Oskars; Millers, Andrejs; Priede, Zanda; Department of Neurology and Neurosurgery; Department of Internal Diseases
    NTRODUCTION:Untreated non-valvular atrial fibrillation is one of major causes of stroke. The goalof the study was to evaluate the use of antithrombotic medication stroke prevention and assess long-term stroke outcome.METHODS:This study involved 531 cardio embolicstroke patients of thePaul’sStradins Clinical University Hospital, Riga, Latvia,in 2014. After dischargethe patients or their relatives were interviewed by phone after 30, 90, 180, and 365 days. Standardized questions were asked about the patients’abilities and use of prescribed secondary prevention medication. Theresults were compared between patient groups, assigned according to prescribed medications. RESULTS:Of all the patients included in the study,8.9% were using oral anticoagulants before stroke onset. One year after discharge,1.44% of patients were not using any preventivemedication, 23.56%were using antiplatelet agents, 43.27% warfarin,and 31.73% target-specificoralanticoagulants. The one-year mortality ratewas 40.7%. The mortality rate was significantly higher in the patient group using no secondary preventivemedication or antiplatelet agents compared to the patient group that used oral anticoagulants. CONCLUSION:Cardio embolicstroke primary and secondary prevention in Latvia islacking. The study outcomes suggest that action is neededto increase the use of oral anticoagulants in primary stroke prevention in patients with atrial fibrillation. Poor function outcomes, dementia,and patients’incompliance limits the use of oral anticoagulants in secondary prevention
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    IMPACT OF CAROTID ENDARTERECTOMY ON COGNITIVE PERFORMANCE AND DEPRESSIVE SYMPTOMS
    (Central Bohemia University, 2016) Pucite, Elina; Slisers, Marius; Miglane, Evija; Krievins, Dainis; Erts, Renars; Jurjans, Kristaps; Krievina, Ildze; Department of Neurology and Neurosurgery
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    Interactive Training of the Emergency Medical Services Improved Prehospital Stroke Recognition and Transport Time
    (2022-04-07) Sveikata, Lukas; Melaika, Kazimieras; Wiśniewski, Adam; Vilionskis, Aleksandras; Petrikonis, Kȩstutis; Stankevičius, Edgaras; Jurjans, Kristaps; Ekkert, Aleksandra; Jatužis, Dalius; Masiliūnas, Rytis; Department of Neurology and Neurosurgery
    Background and Purpose: Acute stroke treatment outcomes are predicated on reperfusion timeliness which can be improved by better prehospital stroke identification. We aimed to assess the effect of interactive emergency medical services (EMS) training on stroke recognition and prehospital care performance in a very high-risk cardiovascular risk population in Lithuania. Methods: We conducted a single-center interrupted time-series study between March 1, 2019 and March 15, 2020. Two-hour small-group interactive stroke training sessions were organized for 166 paramedics serving our stroke network. We evaluated positive predictive value (PPV) and sensitivity for stroke including transient ischemic attack identification, onset-to-door time, and hospital-based outcomes during 6-months prior and 3.5 months after the training. The study outcomes were compared between EMS providers in urban and suburban areas. Results: In total, 677 suspected stroke cases and 239 stroke chameleons (median age 75 years, 54.8% women) were transported by EMS. After the training, we observed improved PPV for stroke recognition (79.8% vs. 71.8%, p = 0.017) and a trend of decreased in-hospital mortality (7.8% vs. 12.3, p = 0.070). Multivariable logistic regression models adjusted for age, gender, EMS location, and stroke subtype showed an association between EMS stroke training and improved odds of stroke identification (adjusted odds ratio [aOR] 1.6 [1.1–2.3]) and onset-to-door ≤ 90 min (aOR 1.6 [1.1–2.5]). The improvement of PPV was observed in urban EMS (84.9% vs. 71.2%, p = 0.003), but not in the suburban group (75.0% vs. 72.6%, p = 0.621). Conclusions: The interactive EMS training was associated with a robust improvement of stroke recognition, onset to hospital transport time, and a trend of decreased in-hospital mortality. Adapted training strategies may be needed for EMS providers in suburban areas. Future studies should evaluate the long-term effects of the EMS training and identify optimal retraining intervals.
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    Problems of Cardioembolic Stroke Primary and Secondary Prevention in the Latvian Population
    (2015-09-01) Jurjans, Kristaps; Sabelnikova, Santa; Miglane, Evija; Lurina, Baiba; Kalejs, Oskars; Millers, Andrejs; Priede, Zanda; Rīga Stradiņš University; Department of Neurology and Neurosurgery
    Atrial fibrillation is one of major risk factors of cerebral infarction. The use of oral anticoagulants is the only evidence-based method of reducing the risk of cardioembolic accidents. The guidelines of oral anticoagulant admission and usage have been available since 2012. The results of this study show that of 550 stroke patients that were admitted to Pauls Stradiņš Clinical University Hospital, Riga, Latvia, from 1 January 2014 until 1 July 2014, atrial fibrillation was diagnosed in 247 (45%) cases, and of these patients, only 8.5% used oral anticoagulants before the onset of stroke. Six months after discharge of 111 (44.9%) stroke survivors, five (4.5%) used no secondary prevention medication, 27 (24.3%) used antiplatelet agents, 54 (48.6%) warfarin, and 25 (22.5%) used target specific oral anticoagulants (TSOACs). The mortality rate was significantly higher in the patient group that used no secondary prevention medication or antiplatelet agents compared to the patient group that used oral anticoagulants. The use of oral anticoagulants for primary stroke prevention in Latvia is insufficient. The mortality of cardioembolic stroke in 180 days is very high-40.4%. Secondary prevention is essential to prevent recurrent cardioembolic accidents.