Browsing by Author "Lejnieks, Aivars"
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Item Age-Based Comparative Analysis of Colorectal Cancer Colonoscopy Screening Findings(2023-11-16) Vilkoite, Ilona; Tolmanis, Ivars; Abu Meri, Hosams; Polaka, Inese; Mezmale, Linda; Lejnieks, Aivars; Department of Doctoral Studies; Department of Internal DiseasesBackground and Objectives: Colorectal cancer (CRC) incidence is rapidly emerging among individuals <50 years, termed as early-onset colorectal cancer (EOCRC). This study aimed to probe variations in tumorigenic pathology and relevant manifestations (polyp and adenoma incidence) between suspected cases of EOCRC and late-onset CRC (LOCRC; ≥50 years of age). Materials and Methods: Between September 2022 and February 2023, colonoscopy-based screening data from 1653 patients were included in this study. All eligible participants were divided into two groups, depending upon patient age, where Group 1 consisted of 1021 patients aged <50 years while Group 2 consisted of 632 patients aged ≥ 50 years. Polyp samples were collected when identified peri-procedurally and characterized according to World Health Organization criteria. Results: Polyp detection rate was 42% for the <50-year age group, while this was 76% for the ≥50-year age group. Additionally, the <50-year age group predominated in hyperplastic polyp manifestation, particularly within the rectum and sigmoid colon. In addition, the ≥50-year age group had increased prevalence of serrated polyps and differing adenoma manifestations. Conclusions: This investigation served to highlight the importance of age stratification for CRC colonoscopy-based screening effectiveness, with particular reference to evaluations that are based on polyp localization within differing colon regions.Item Alkilrezorcīnu, lignānu metabolīti un D vitamīns priekšdziedzera vēža pacientiem. Promocijas darba kopsavilkums(Rīgas Stradiņa universitāte, 2014) Meija, Laila; Lejnieks, Aivars; Lietuvietis, VilnisUzturs ir nepieciešams visu cilvēka bioloģisko procesu normālai funkcionēšanai. Pilnvērtīgs uzturs šūnu līmenī nodrošina visu organismu ar uzturvielām, kas nepieciešamas audu struktūras un funkcijas saglabāšanai. Turklāt uzturs ir viens no ietekmējamiem onkoloģisko slimību riska faktoriem. Uzskata, ka ar uzturu var novērst trešdaļas vēžu veidošanos. Priekšdziedzera vēzis ir otra biežākā ļaundabīgā onkoloģiskā slimība vīriešiem visā pasaulē. Latvijā tas ir pirmais biežākais vēzis un otrs biežākais nāves cēlonis starp visiem vēža veidiem vīriešiem. Augstā slimības prevalence un bieži lēnā attīstība padara priekšdziedzera vēzi par ļoti piemērotu prevencijai. Par uzturu kā priekšdziedzera vēža risku ietekmējošo faktoru lika domāt zemā priekšdziedzera vēža incidence un prevalence Āzijas valstīs, kur protektīvo ietekmi saistīja ar fitoestrogēnu – sojas produktu – iespējamo iedarbību. Rietumvalstīs galvenie fitoestrogēnu avoti ir lignāni. Ziemeļvalstīs galvenais lignānu avots ir rudzu maize, kas ir arī bagāts šķiedrvielu avots. Šķiedrvielas maizē saistītas ar daudzām bioloģiski aktīvām vielām, tostarp lignāniem un alkilrezorcīniem. Cits iespējamais faktors, kas var ietekmēt priekšdziedzera vēža attīstību, ir D vitamīns, kam, iespējams, piemīt ne tikai imunitāti modulējošā, bet arī antikancerogēnā aktivitāte. Pētījuma mērķis bija izpētīt, kurš alkilrezorcīnu metabolīts ir vispiemērotākais, lai novērtētu rudzu maizes un rudzu maizes šķiedrvielu daudzumu uzturā, kā arī izvērtēt alkilrezorcīnu un lignānu metabolītu saistību ar priekšdziedzera vēža risku. Otrs mērķis bija novērtēt pilngraudu rudzu maizes iespējamo ietekmi uz priekšdziedzera vēža progresēšanu. Cits mērķis bija novērtēt D vitamīna iespējamo saistību ar priekšdziedzera vēža risku. Lai izpildītu izvirzītos mērķus, noteicām potenciāli bioloģiski aktīvo vielu – alkilrezorcīnu un lignānu – daudzumu Latvijas maizes veidos, novērtējām uzņemto uzturu, tostarp maizes, rudzu maizes, šķiedrvielu, alkilrezorcīnu, lignānu un D vitamīna daudzumu uzturā, kā arī alkilrezorcīnu metabolītu (DHPPA – 3-(3,5-dihidroksifenil) propānskābes un DHBA – 3,5-dihidroksibenzoskābes) un lignānu metabolīta (ENL – enterolaktona) daudzumu asins plazmā, 12 stundu dienas un 12 stundu nakts urīnā un D vitamīna līmeni serumā priekšdziedzera vēža un kontroles grupas pacientiem. Lai novērtētu rudzu maizes iespējamo ietekmi uz priekšdziedzera vēža progresēšanu, nozīmējām rudzu maizes lietošanu un veicām izmeklējumus pirms un pēc rudzu maizes iekļaušanas uzturā – noteicām priekšdziedzera specifisko antigēnu (PSA), alkilrezorcīnu un lignānu metabolītus plazmā, dzimumhormonus, kā arī tika veikti morfoloģiskie izmeklējumi. Mūsu pētījuma rezultāti parādīja, ka alkilrezorcīnu un lignānu daudzums Latvijas sēklu un rudzu maizē, kā arī uzturā kopumā ir augsts. Alkilrezorcīnu koncentrāciju maizē var izmantot par marķieri kliju un šķiedrvielu daudzumam maizē. Arī uzturā alkilrezorcīnu un lignānu daudzums ir augsts. Galvenie lignānu avoti uzturā bija sēklu un rudzu maize. Nebija atšķirību uzņemtā uztura datos, tostarp maizes daudzumā un veidā, kā arī alkilrezorcīnu un lignānu daudzumā starp priekšdziedzera vēža un kontroles grupas vīriešiem. Piemērotākais biomarķieris rudzu maizes un rudzu šķiedrvielu daudzuma uzturā novērtēšanai ir DHPPA 12 stundu nakts urīnā. Alkilrezorcīnu metabolītu koncentrācijas plazmā un urīnā saistība ar uztura datiem atšķīrās abās pētījuma grupās. Iespējamais atšķirības iemesls ir kavēts alkilrezorcīnu metabolisms priekšdziedzera vēža pacientiem. Analizējot lignānu metabolītu ENL, konstatējām, ka tā koncentrācija bioloģiskajos šķidrumos atspoguļo lignānu daudzumu uzturā tikai intervences pētījuma apstākļos. Konstatējām, ka rudzu maize, iespējams, kavē priekšdziedzera vēža pro- gresēšanu. Potenciālie darbības mehānismi – dzimumhormonu saistošā globulīna, enterolaktona un alkilrezorcīnu metabolītu koncentrācijas palielināšanās plazmā, kā rezultātā pazeminājās PSA un tika novērota apoptozes rādītāju pieauguma tendence. Jāturpina pētījumi ar lielāku dalībnieku skaitu, tie jāveic ilgākā laika periodā, un jāizmanto rudzu maize ar vēl augstāku rudzu šķiedrvielu daudzumu. Analizējot D vitamīna līmeni, konstatējām, ka D vitamīna deficīts un/vai nepietiekamība ir plaši izplatīta priekšdziedzera vēža grupā un kontroles grupas vīriešiem pēc 45 gadu vecuma. Atšķirības D vitamīna koncentrācijā serumā starp grupām netika konstatētas. Ar uzturu netiek nodrošināts nepieciešamais D vitamīna daudzums abās pētījuma grupās. Lai sasniegtu vēlamo D vitamīna koncentrāciju serumā un lai izvērtētu D vitamīna iespējamo protektīvo efektu priekšdziedzera vēža prevencijā, ieteicams lietot D vitamīna neaktīvās formas preparātus un uzturā vairāk lietot zivis. Iegūtie rezultāti izmantojami kā pamats turpmākiem padziļinātiem pētījumiem par pilngraudu produktu un D vitamīna lomu priekšdziedzera vēža prevencijā.Item Alkilrezorcīnu, lignānu metabolīti un D vitamīns priekšdziedzera vēža pacientiem. Promocijas darbs(Rīgas Stradiņa universitāte, 2014) Meija, Laila; Lejnieks, Aivars; Lietuvietis, VilnisUzturs ir nepieciešams visu cilvēka bioloģisko procesu normālai funkcionēšanai. Pilnvērtīgs uzturs šūnu līmenī nodrošina visu organismu ar uzturvielām, kas nepieciešamas audu struktūras un funkcijas saglabāšanai. Turklāt uzturs ir viens no ietekmējamiem onkoloģisko slimību riska faktoriem. Uzskata, ka ar uzturu var novērst trešdaļas vēžu veidošanos. Priekšdziedzera vēzis ir otra biežākā ļaundabīgā onkoloģiskā slimība vīriešiem visā pasaulē. Latvijā tas ir pirmais biežākais vēzis un otrs biežākais nāves cēlonis starp visiem vēža veidiem vīriešiem. Augstā slimības prevalence un bieži lēnā attīstība padara priekšdziedzera vēzi par ļoti piemērotu prevencijai. Par uzturu kā priekšdziedzera vēža risku ietekmējošo faktoru lika domāt zemā priekšdziedzera vēža incidence un prevalence Āzijas valstīs, kur protektīvo ietekmi saistīja ar fitoestrogēnu – sojas produktu – iespējamo iedarbību. Rietumvalstīs galvenie fitoestrogēnu avoti ir lignāni. Ziemeļvalstīs galvenais lignānu avots ir rudzu maize, kas ir arī bagāts šķiedrvielu avots. Šķiedrvielas maizē saistītas ar daudzām bioloģiski aktīvām vielām, tostarp lignāniem un alkilrezorcīniem. Cits iespējamais faktors, kas var ietekmēt priekšdziedzera vēža attīstību, ir D vitamīns, kam, iespējams, piemīt ne tikai imunitāti modulējošā, bet arī antikancerogēnā aktivitāte. Pētījuma mērķis bija izpētīt, kurš alkilrezorcīnu metabolīts ir vispiemērotākais, lai novērtētu rudzu maizes un rudzu maizes šķiedrvielu daudzumu uzturā, kā arī izvērtēt alkilrezorcīnu un lignānu metabolītu saistību ar priekšdziedzera vēža risku. Otrs mērķis bija novērtēt pilngraudu rudzu maizes iespējamo ietekmi uz priekšdziedzera vēža progresēšanu. Cits mērķis bija novērtēt D vitamīna iespējamo saistību ar priekšdziedzera vēža risku. Lai izpildītu izvirzītos mērķus, noteicām potenciāli bioloģiski aktīvo vielu – alkilrezorcīnu un lignānu – daudzumu Latvijas maizes veidos, novērtējām uzņemto uzturu, tostarp maizes, rudzu maizes, šķiedrvielu, alkilrezorcīnu, lignānu un D vitamīna daudzumu uzturā, kā arī alkilrezorcīnu metabolītu (DHPPA – 3-(3,5-dihidroksifenil) propānskābes un DHBA – 3,5-dihidroksibenzoskābes) un lignānu metabolīta (ENL – enterolaktona) daudzumu asins plazmā, 12 stundu dienas un 12 stundu nakts urīnā un D vitamīna līmeni serumā priekšdziedzera vēža un kontroles grupas pacientiem. Lai novērtētu rudzu maizes iespējamo ietekmi uz priekšdziedzera vēža progresēšanu, nozīmējām rudzu maizes lietošanu un veicām izmeklējumus pirms un pēc rudzu maizes iekļaušanas uzturā – noteicām priekšdziedzera specifisko antigēnu (PSA), alkilrezorcīnu un lignānu metabolītus plazmā, dzimumhormonus, kā arī tika veikti morfoloģiskie izmeklējumi. Mūsu pētījuma rezultāti parādīja, ka alkilrezorcīnu un lignānu daudzums Latvijas sēklu un rudzu maizē, kā arī uzturā kopumā ir augsts. Alkilrezorcīnu koncentrāciju maizē var izmantot par marķieri kliju un šķiedrvielu daudzumam maizē. Arī uzturā alkilrezorcīnu un lignānu daudzums ir augsts. Galvenie lignānu avoti uzturā bija sēklu un rudzu maize. Nebija atšķirību uzņemtā uztura datos, tostarp maizes daudzumā un veidā, kā arī alkilrezorcīnu un lignānu daudzumā starp priekšdziedzera vēža un kontroles grupas vīriešiem. Piemērotākais biomarķieris rudzu maizes un rudzu šķiedrvielu daudzuma uzturā novērtēšanai ir DHPPA 12 stundu nakts urīnā. Alkilrezorcīnu metabolītu koncentrācijas plazmā un urīnā saistība ar uztura datiem atšķīrās abās pētījuma grupās. Iespējamais atšķirības iemesls ir kavēts alkilrezorcīnu metabolisms priekšdziedzera vēža pacientiem. Analizējot lignānu metabolītu ENL, konstatējām, ka tā koncentrācija bioloģiskajos šķidrumos atspoguļo lignānu daudzumu uzturā tikai intervences pētījuma apstākļos. Konstatējām, ka rudzu maize, iespējams, kavē priekšdziedzera vēža pro- gresēšanu. Potenciālie darbības mehānismi – dzimumhormonu saistošā globulīna, enterolaktona un alkilrezorcīnu metabolītu koncentrācijas palielināšanās plazmā, kā rezultātā pazeminājās PSA un tika novērota apoptozes rādītāju pieauguma tendence. Jāturpina pētījumi ar lielāku dalībnieku skaitu, tie jāveic ilgākā laika periodā, un jāizmanto rudzu maize ar vēl augstāku rudzu šķiedrvielu daudzumu. Analizējot D vitamīna līmeni, konstatējām, ka D vitamīna deficīts un/vai nepietiekamība ir plaši izplatīta priekšdziedzera vēža grupā un kontroles grupas vīriešiem pēc 45 gadu vecuma. Atšķirības D vitamīna koncentrācijā serumā starp grupām netika konstatētas. Ar uzturu netiek nodrošināts nepieciešamais D vitamīna daudzums abās pētījuma grupās. Lai sasniegtu vēlamo D vitamīna koncentrāciju serumā un lai izvērtētu D vitamīna iespējamo protektīvo efektu priekšdziedzera vēža prevencijā, ieteicams lietot D vitamīna neaktīvās formas preparātus un uzturā vairāk lietot zivis. Iegūtie rezultāti izmantojami kā pamats turpmākiem padziļinātiem pētījumiem par pilngraudu produktu un D vitamīna lomu priekšdziedzera vēža prevencijā.Item Alkylresorcinol, Lignan Metabolites and Vitamin D in Prostate Cancer Patients. Summary of the Doctoral Thesis(Rīga Stradiņš University, 2014) Meija, Laila; Lejnieks, Aivars; Lietuvietis, VilnisFood is essential in all biological processes of the human body. Food provides human body with all nutrients needed to maintain its tissue structure and run its functions. Furthermore, food is an important factor affecting the course of oncological disease one can change. There is some evidence showing that one third of all cancers can be prevented. Prostate cancer is the second most common cancer in men worldwide, while it is the first most common cancer and second leading cause of death from cancer in Latvian men. The high prevalence and often slow progression of prostate cancer makes it suitable for prevention. The low incidence and prevalence of prostate cancer in Asia suggests that nutrition may play a role in the progression of prostate cancer. It has been suggested that the protective effect found in Asia may be due to soy products rich in phytoestrogens. Lignans are the most important phytoestrogen sources in the Western countries. In North Europe, rye bread is the main source of lignans, which is also rich in fiber. Bread ‘fiber complex’ is linked to many bioactive compounds, including lignans and alkylresorcinols. An insufficient concentration of vitamin D is another possible risk factor of prostate cancer because vitamin D may have not only immunomodulating, but also anticarcinogenic effects. The objective of this thesis was to find out alkylresorcinol metabolites most suitable to estimate rye bread and rye bread fiber intake and also to evaluate relationships between metabolites of alkylresorcinols and lignans and their links to the risk of prostate cancer. The second objective was to assess any possible effect of whole grain rye bread on the progression of prostate cancer. The third objective of the thesis was to evaluate any possible links between vitamin D and the risk of prostate cancer. We detected alkylresorcinols and lignans, bioactive compounds, in Latvian breads while carrying out dietary assessment. This included intake of bread, rye bread, fiber, alkylresorcinols, lignans and vitamin D, concentrations of alkylresorcinols` metabolites (DHPPA-3-(3,5-dihydroxyphenyl)-1-propanoic acid and DHBA –3,5-dihydroxy-benzoic acid), and lignan metabolite (ENL – enterolactone) in plasma, 12-h day and 12-h night urine and serum concentration of vitamin D in prostate cancer in the group of PC patients and the control group. Using dietary intervention of rye bread, we investigated the effects on prostate cancer progression by assessing Prostate Specific Antigen (PSA), metabolites of alkylresorcinols and lignans in plasma, sex hormones and morphological examination before and after the intervention. The results show that alkylresorcinol and fiber concentration are high in Latvian breads. Alkylresorcinols` concentration in bread may be used as a marker of bran and fiber amount in bread. Alkylresorcinol and lignan intake were also found to be high. Seed and rye breads were found to be the main dietary sources of lignans. There was no difference found between the prostate cancer and control groups in the dietary intake data, including bread quantity and bread types, alkylresorcinol and lignan intake. DHPPA in 12 h overnight urine may be the most suitable alkylresorcinol metabolite to estimate the intake of rye bread and rye fiber. Differences were found between the prostate cancer and the control group regarding associations between alkylresorcinol metabolite concentrations in plasma, urine and food intake data, possibly due to a delay in the metabolism of alkylresorcinols in the prostate cancer group. It was found that enterolactone, a lignan metabolite, is linked to the intake of lignans only under the conditions of intervention. The results of the intervention study reveal a possible delay in the progression of prostate cancer via elevated concentration of sex hormone binding globulin, enterolactone and alkyresorcinols metabolites in the group of prostate cancer, which resulted in lower rates of PSA and presumably increased apoptosis. We suggest the future studies on this subject with longer time periods covered, with larger numbers of participants and the use of bread with higher concentrations of rye fiber. We found that vitamin D deficiency and/or insufficiency is highly prevalent in the group of prostate cancer and in men aged over 45 in the control group. There were no differences found between the groups in the concentration of vitamin D in serum. Vitamin D dietary intake was found to be insufficient in both study groups. To assess possible vitamin D protective effect in the prevention of prostate cancer, it is advisable to reach higher concentrations of the vitamin using vitamin D supplementation, also a higher amount of fish in the diet.Item Ārstēšana ar uzturu no Hipokrata laikiem līdz mūsu dienām(Paula Stradiņa Medicīnas vēstures muzejs. RSU Medicīnas vēstures institūts, 2005) Neimane, Lolita Vija; Lejnieks, AivarsItem Assessment of Cardiac Resynchronisation Therapy Efficacy Determining Factors for Patients with Moderate and Severe Heart Failure in the Population of Latvia in a 12 and 24 Month Study(2018-12-01) Vikmane, Maija; Kalejs, Oskars; Kamzola, Ginta; Upite, Dana; Ventiņa, Madara; Nesterovičs, Nikolajs; Lejnieks, Aivars; Department of Internal DiseasesThe aim of this study was to evaluate treatment of patients with moderate and severe heart failure (HF) who were resistant to pharmacotherapy in Latvia and to assess the cardiac resynchronisation therapy (CRT) by exploring the predisposing factors which provides CRT efficacy. We accomplished prospective analysis of left ventricle ejection fraction (LVEF) and other parameter changes 12 and 24 months after CRT device implantation, dividing the population into two groups: responders - to whom LVEF improvement was ≥10% and non-responders where ≥ 10% LVEF improvement was not achieved. The study included 50 chronic HF patients with preserved sinus rhythm, who underwent CRT device implantation in Latvia at the Pauls Stradiņš Clinical University Hospital from June 2009 to March 2012. In the group of patients where 12 and 24 months after CRT device implantation LVEF improvement ≥10% was achieved, there were statistically significantly more patients with left bundle branch block (LBBB) QRS morphology, wider QRS complex, nonischemic genesis of HF, and normal systolic blood pressure. Patients with LVEF improvement had more pronounced ventricular dyssynchrony measured by Echo before CRT device implantation and, accordingly, the CRT mode was programmed as left ventricle paced before right ventricle and close to 100% biventricular pacing was achieved and the patient was female.Item Assessment of Factors Determining Efficacy of Cardiac Resynchronisation Therapy for Patients with Heart Failure in the Population of Latvia. Summary of the Doctoral Thesis(Rīga Stradiņš University, 2020) Vikmane, Maija; Kalējs, Oskars; Lejnieks, AivarsIntroduction. Heart failure (HF) is one of the main causes of hospitalisation, disabilities and death worldwide and in Latvia as well. Pharmacological therapy often has proven to be ineffective since it fails to prevent uncoordinated ventricular contraction. Application of cardiac resynchronisation therapy (CRT) helps restore proper coordination between both ventricles, thus improving the HF prognosis. Nevertheless, it remains unclear what initial factors may affect the CRT efficiency. Aim. The aim of the study is to analyse progression of treatment and the factors affecting the efficiency in HF patients with moderate and severe clinical course with implanted cardiac resynchronisation devices. Methods. The prospective single-centre study analysed patients with HF who had undergone scheduled implantation of CRT. Efficiency of CRT was detected by echocardiography, studying the improvement in ejection fraction (EF) of the left ventricular after 12 and 24 months, respectively. ΔEF improvement ≥ 10% – CRT responders and ΔEF improvement <10% – CRT non-responders. The study focused on the analysis of the initial clinical, laboratory factors, electrocardiographic, echocardiographic, programmed parameters of CRT devices and their changes within 12 and 24 months. Results. ΔEF improvement ≥ 10% within 24 months was observed in 27 (60.0%) patients. After CRT implantation, patient hospitalisation due to HF decompensation decreased statistically significant, functional class (FC) of HF and 6-minute walking test improved, value of natriuretic factors decreased and EchoCG parameters improved. Patients (n = 27) with ΔEF ≥ 10% showed statistically significant higher average systolic blood pressure (SBP), wider QRS and more prominent interventricular mechanical dyssynchrony (IVMD) compared to patients (n = 18) with ΔEF < 10%: 131.89 ± 14.73 versus (vs.) 117.78 ± 14.37 mm Hg; p = 0.003, 175.15 ± 20.29 vs. 161.22 ± 25.40 ms; p = 0.048, 51.37 ± 9.45 vs. 27.65 ± 13.5 ms; p < 0.001, respectively. Patients with left His bundle branch block (LBBB) (n = 35) statistically significant more often were in the CRT efficiency group in comparison to patients without LBBB (n = 10) – 26 (96.3%) vs. 1 (3.7%; p < 0.001), respectively. Patients (n = 21) with a scar in the left ventricle wall statistically significant less frequent were in the CRT efficiency group compared to the patients without a scar (n = 24) – 7 (25.9%) vs. 20 (74.1%; p = 0.001), respectively. Patients with left ventricle before right ventricle (n = 22) statistically significantly / significant more frequent were in the CRT efficiency group compared to the patients with a different stimulation sequence (n = 23) – 17 (63.0%) vs. 10 (37.0%; p = 0.021), respectively. Multivariate analysis indicates that the most significant CRT efficiency affecting factors initially were LBBB, significant – IVMD, higher SBP. Conclusions. More than a half of the study population reached CRT efficiency. CRT implantation is a safe and effective HF treatment method. Predominant prognostic CRT efficacy factors are baseline LBBB, IVMD > 50 ms, SBP above 130 mm Hg.Item Assessment of iodine and selenium nutritional status in women of reproductive age in Latvia(2021-11-05) Veisa, Vija; Kalere, Ieva; Zake, Tatjana; Strele, Ieva; Makrecka, Marina; Upmale-Engela, Sabine; Skesters, Andrejs; Rezeberga, Dace; Lejnieks, Aivars; Pudule, Iveta; Grinberga, Daiga; Velika, Biruta; Dambrova, Maija; Konrade, Ilze; Department of Obstetrics and Gynaecology; Department of Internal Diseases; Institute of Occupational Safety and Environmental Health; Bioķīmijas zinātniskā laboratorijaBackground and Objectives: Adequate dietary intake of iodine and selenium is essential during pregnancy. While iodine is vital for maternal thyroid function and fetal development, selenium contributes to the regulation of thyroid function and thyroid autoimmunity. This study aimed to assess the consumption of iodine-and selenium-containing products by women of reproductive age and the iodine and selenium nutritional status of pregnant women in Latvia. Materials and Methods: Population health survey (2010–2018) data were used to characterize dietary habits in women of reproductive age. Additionally, 129 pregnant women in the first trimester were recruited; they completed a questionnaire and were tested for thyroid function, urinary iodine concentration (UIC), and serum selenium and selenoprotein P levels. Results: The use of some dietary sources of iodine (e.g., milk and dairy products) and selenium (e.g., bread) has decreased in recent years. Less than 10% of respondents reported the use of iodized salt. The use of supplements has become more common (reported by almost 50% of respondents in 2018). Dietary habits were similar in pregnant women, but the use of supplements was even higher (almost 70%). Nevertheless, most supplements used in pregnancy had insufficient contents of iodine and selenium. Thyroid function was euthyreotic in all women, but 13.9% of participants had a thyroid peroxidase antibodies (TPO-ab) level above 60 IU/mL. The median UIC (IQR) was 147.2 (90.0–248.1) µg/gCr, and 52.8% of pregnant women had a UIC below 150 µg/gCr. The mean selenium (SD) level was 101.5 (35.6) µg/L; 30.1% of women had a selenium level below 80 µg/L. The median selenoprotein P level was 6.9 (3.1–9.0) mg/L. Conclusions: Iodine nutrition in Latvian population of pregnant women was near the lower limit of adequate and a third of the population had a selenium deficiency. Supplements were frequently used, but most did not contain the recommended amounts of iodine and selenium.Item Association between inflammatory markers and clinical and metabolic risk factors for cardiovascular diseases(2009) Stuķena, Inga; Kalvelis, Andrejs; Bahs, Guntis; Teibe, Uldis; Tretjakovs, Peteris; Lejnieks, Aivars; Rīga Stradiņš UniversityThe inflammatory reaction plays an important role in the development of atherosclerosis. The clinical significance of the main inflammatory markers - C-reactive protein (CRP), interleukin 6 (IL6), tumour necrosis factor alpha (TNF-α), plasminogen activator inhibitor 1 (PAI1), etc. - has not been fully established. CRP, IL6, TNF-α, and PAI1 were assessed in 100 patients in terms of certain clinical indicators (sex, obesity indicators, blood pressure, and heart rate), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), triglycerides (TG), glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), adiponectin, and leptin levels. CRP and PAI1 levels were elevated in subjects with increased body mass index (BMI) and waist circumference. CRP correlated positively with indicators of carbohydrate metabolism and negatively with TC, HDL-C, and adiponectin. PAI1 correlated positively with insulin levels, HOMA-IR, leptin, and TG, but negatively with HDL-C. IL6 correlated negatively with TC, but TNF-α correlated negatively with HDL-C. Both IL6 and TNF-α correlated positively with leptin levels. TNF-α correlated with TG levels and the indicators of carbohydrate metabolism only in women. CRP and PAI1 are the most sensitive inflammatory markers; their levels were higher in adipose subjects.Item Atrial fibrillation recurrence prevention after electrical cardioversion in high-risk patients – benefits of non-antiarrhythmic drugs(2021) Kokina, Baiba; Kalejs, Oskars; Maca, Aija; Strelnieks, Aldis; Jubele, Kristine; Rudaka, Irina; Apsite, Ketija; Lejnieks, Aivars; Faculty of Medicine; Department of Internal Diseases; Residency Unit; Scientific Laboratory of Molecular GeneticsBackground: Recurrence prevention after Atrial Fibrillation (AF) termination by Eelectrical Cardioversion (ECV) remains challenging. Increasing attention is paid to pathophysiological effects of non-Antiarrhythmic Drugs (non-AADs), nevertheless, with heterogeneous results. Objective: We evaluated the potential benefits of different non-AADs as adjunctive therapy to Antiarrhythmic Drugs (AADs) for AF recurrence prevention after sinus rhythm restoration by ECV in high-risk patients. Methods: The study was conducted among high-risk AF patients after successful ECV. Prescription of class IC or class III AAD was required. Data were acquired in a face-to-face baseline interview and 1-, 3-, 6-, 9-, 12-month follow-up interviews. Results: 113 patients were included. Total AF recurrence rate reached 48.7%. Angiotensin-Converting Enzyme Inhibitor (ACEI) or angiotensin receptor blocker (ARB) intake, compared with non-use, demonstrated AF recurrence rate reduction by 8.5% (46.3 vs. 54.8%), with odds ratio (OR) reduced by 28.9% (OR 0.711, 95% confidence interval (CI) 0.310-1.631, p = 0.420). Among mineralocorticoid receptor antagonist (MRA) users, AF recurrence rate was reduced by 25.1% (29.6 vs. 54.7%) and OR by 65.1% (OR 0.349, 95%CI 0.138-0.884, p = 0.023). Present statin therapy reduced AF recurrence rate by 4.2% (46.8 vs. 51.0%) and OR by 15.5% (OR 0.845, 95%CI 0.402-1.774, p = 0.656). Diuretic use showed reduction of AF recurrence rate by 10.2% (41.7 vs. 51.9%) and OR by 33.9% (OR 0.661, 95%CI 0.297-1.469, p = 0.308). Conclusion: Non-AADs demonstrated practical benefits as adjunctive therapy to AADs for AF recurrence prevention after ECV in high-risk patients, with statistically significant results established for concomitant MRA intake.Item Atrial fibrillation, oral anticoagulants and health related quality of life(2018-12) Apsite, Ketija; Luriņa, Baiba; Tupahins, Andris; Voicehovskis, Vladimirs; Ivascenko, Tarass; Kalejs, Oskars; Lejnieks, Aivars; Faculty of Medicine; Department of Internal Diseases; Department of Doctoral StudiesIntroduction: Atrial fibrillation (AFib) is a disease that can influence the health related quality of life. Also oral anticoagulants can influence it both because of its therapeutic benefits or complications as well as how the anticoagulant usage influence the person's life style by regular laboratory test necessity or diet restrictions. Aim: Determine and analyze whether there is a statistically significant difference comparing health related quality of life between K vitamin antagonist, warfarin, users, novel anticoagulant (NOAC), rivaroxaban, dabigatran, users and patients, who do not use any kind of oral anticoagulant. Materials and methods: A cross-sectional analytic research was made in Pauls Stradins Clinical university hospital, Center of Cardiology in Riga, Latvia during the time period from October 2016 till June 2017. Persons with high-risk non-valvular atrial fibrillation were offered to participate in this research. If the person agreed, an oral interview with questions about disease anamnesis, demographic data, laboratory test results, echocardiography results, modified SF-36 survey, used oral anticoagulant type was held. Data were precised with the help of the case anamnesis information. For statistical data analysis was used SPSS Statistics database. Results: Altogether 218 patients were enrolled, of which 56.9% were female and 43.1% – male, mean age – 70.4 years, mean CHA2D2-VASc score – 4.4. Warfarin used 37.6%, 33.0% – novel oral anticoagulants, but 29.4% did not use any kind of oral anticoagulant. A statistically significant difference was discovered between the mean ranks in physical functioning sections comparing warfarin (mean rank 95.85) with NOACs (mean rank 124.57); p = 0.012. Also a statistically significant difference was in social functioning comparing warfarin (mean rank 96.16) with NOACs (mean rank 119.08); p = 0.026. Age had low negative correlation (r = −0.23) with physical functioning. Duration of atrial fibrillation diagnosis did not have correlations with the results. Conclusion: NOAC usage correlates with the best health related quality of life scores, gaining a statistically significant difference compared to warfarin users in physical functioning (warfarin – 95.85, NOACs – 124.57; p = 0.012) and social functioning mean ranks (warfarin – 95.16, NOACs – 119.08; p = 0.026). Age had low negative correlation with physical functioning scores.Item Baseline Clinical Characteristics and Incidence of Chronic Thromboembolic Pulmonary Hypertension Patients in Latvia, 2019–2020(2023-08-06) Kauliņš, Ričards; Rudzītis, Ainārs; Lejnieks, Aivars; Kigitoviča, Dana; Skride, Andris; Department of Internal DiseasesBackground: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare and progressive condition; however, the true characteristics of CTEPH are still unknown, as notable regional variations exist in terms of patients’ age, baseline hemodynamic data, and management choices. This report aims to investigate the baseline clinical characteristics, incidence, and risk factors associated with CTEPH patients in Latvia from 2019 to 2020. Methods: The data were analyzed from a prospective, nationwide, Latvian pulmonary hypertension registry for incident CTEPH cases. The patients’ clinical characteristics were assessed at the time of diagnosis. Results: During the course of this study, a cohort of 13 patients with CTEPH were included for analysis. Among the enrolled CTEPH patients, most exhibited low exercise and functional capacity, with a median (±IQR) 6 min walk distance of 300.0 (±150.0) m. The median values (±IQR) for mean pulmonary artery pressure and pulmonary vascular resistance were 40.0 ± 13.0 mmHg and 7.35 ± 2.82 Wood units, respectively. The most common risk factors for CTEPH were a history of acute pulmonary embolism and a blood group other than O. Conclusions: The findings of this report revealed the characteristics of the Latvian CTEPH population, indicating that a significant proportion of patients are elderly individuals with multiple comorbidities.Item Bioķīmisko un onkoloģisko marķieru diagnostiskā nozīme malignu pleiras eksudātu diferencēšanā no citas etioloģijas šķidruma pleiras dobumā. Promocijas darba kopsavilkums(Rīgas Stradiņa universitāte, 2020) Žentiņa, Dace; Lejnieks, Aivars; Krams, AlvilsŠķidrums pleiras dobumā ir bieža dažādu slimību komplikācija. Atkarībā no patoģenētiskā mehānisma šķidrumus iedala transudātos un eksudātos. Biežākais transudāta cēlonis ir sirds mazspēja. Biežākie eksudātu veidi ir parapneimonisks pleirīts un maligns pleiras eksudāts. Dažādas etioloģijas šķidrumu pleiras dobumā ārstēšana un prognoze būtiski atšķiras, tāpēc ir svarīga precīza diagnoze. Maligna pleiras eksudāta (MPE) diagnostika ne vienmēr ir vienkārša, tāpēc joprojām tiek meklēti papildu diagnostiskie marķieri. Darba teorētiskajā daļā tika apkopoti un analizēti literatūras dati par šķidruma pleiras dobumā epidemioloģiju, diagnostiku un ārstēšanu. Oriģinālā pētījuma mērķis bija noskaidrot, vai iespējams uzlabot malignu pleiras eksudātu diagnostiku, izmantojot onkoloģiskos vai bioķīmiskos marķierus. Lai noskaidrotu esošo situāciju un problēmas aktualitāti, retrospektīvi tika analizētas to pacientu medicīniskās kartes, kuri no 2010. gada 1. janvāra līdz 2010. gada 31. decembrim ārstējušies un izrakstīti no Rīgas Austrumu Klīniskās universitātes slimnīcas stacionāra “Gaiļezers” iekšķīgo slimību profila nodaļām vai šajā slimnīcā miruši. Tika atlasītas un analizētas tās medicīniskās kartes, kurās izrakstīšanās diagnozē bija norādes par šķidrumu pleiras dobumā. Lai noskaidrotu papildu bioķīmisko un onkoloģisko marķieru nozīmi maligna pleiras eksudāta (MPE) diagnostikā, prospektīvi tika analizēti no 2011. gada 8. augusta līdz 2014. gada 13. jūnijam Rīgas Austrumu klīniskās universitātes slimnīcas stacionāra “Gaiļezers” Iekšķīgo slimību klīnikas Pulmonoloģijas nodaļā secīgi stacionēti pacienti ar šķidrumu pleiras dobumā. Papildus rutīnas izmeklējumiem šiem pacientiem pleiras šķidrumā un serumā tika noteikti B tipa nātrijurētiskais faktors (BNP), plazminogēna aktivatora inhibitors 1 (PAI-1), karcinoembrionālais antigēns (CEA) un vēža karbohidrāta antigēns 125 (CA 125). Retrospektīvi analizējot medicīniskās dokumentācijas datus, tika konstatēts, ka 741 (4,6 %) pacientam no gada laikā stacionārā “Gaiļezers” ārstētiem, izrakstītiem vai mirušiem pacientiem diagnozē minēts šķidrums pleiras dobumā. 47 % no tiem diagnosticēts maligns pleiras eksudāts, 29 % – kardiāls hidrotorakss un 19 % – parapneimonisks pleirīts. Mirstība pacientiem ar šķidrumu pleiras dobumā bija 3 reizes augstāka nekā visiem ārstētajiem pacientiem kopā (attiecīgi 14,1 % un 4,4 %). Tika konstatēts, ka aplūkotajā laika posmā izmeklēšanas metodes pacientiem ar šķidrumu pleiras dobumā bija nepietiekamas, salīdzinot ar medicīnas literatūrā rekomendētajām. Prospektīvi tika analizēti 144 pacienti ar šķidrumu pleiras dobumā. Tika konstatēts, ka CA 125 pacientiem ar malignu pleiras eksudātu ir statistiski ticami augstāks gan pleiras punktātā, gan serumā. Tas liecina, ka CA 125 var kalpot kā papildu marķieris malignu pleiras eksudātu diagnostikā. Būtiska nozīme dažādu pleiras šķidrumu patoģenēzē ir fibrinolītiskajai sistēmai. Parapneimonisku pleirītu gadījumā fibrinolīze ir kavēta un veidojas norobežotas šķidruma kolekcijas, savukārt malignu pleiras erksudātu gadījumā parasti norobežošanās nenotiek. Iespējams, ietekmējot fibrinolītisko sistēmu, varētu uzlabot dažādas etioloģijas pleiras eksudātu ārstēšanu. Tāpēc darbā pētīts viens no fibrinolītiskās sistēmas marķieriem – protrombīna aktivētāja inhibitors 1 (PAI-1). Tika konstatēts, ka PAI-1 līmenis malignos pleiras eksudātos bija statistiski ticami zemāks nekā parapneimonisku pleirītu gadījumā. Tas var liecināt par procesa tendenci izplatīties ļaundabīgu slimību gadījumā pretēji parapneimonisku pleirītu tendencei norobežoties ar fibrīna septām. Darbā konstatēts, ka kardiāla hidrotoraksa diferencēšanai informatīvs marķieris ir BNP asins serumā, taču BNP pleiras punktātā papildu diagnostisku informāciju nesniedz.Item Bioķīmisko un onkoloģisko marķieru diagnostiskā nozīme malignu pleiras eksudātu diferencēšanā no citas etioloģijas šķidruma pleiras dobumā. Promocijas darbs(Rīgas Stradiņa universitāte, 2020) Žentiņa, Dace; Lejnieks, Aivars; Krams, AlvilsŠķidrums pleiras dobumā ir bieža dažādu slimību komplikācija. Atkarībā no patoģenētiskā mehānisma šķidrumus iedala transudātos un eksudātos. Biežākais transudāta cēlonis ir sirds mazspēja. Biežākie eksudātu veidi ir parapneimonisks pleirīts un maligns pleiras eksudāts. Dažādas etioloģijas šķidrumu pleiras dobumā ārstēšana un prognoze būtiski atšķiras, tāpēc ir svarīga precīza diagnoze. Maligna pleiras eksudāta (MPE) diagnostika ne vienmēr ir vienkārša, tāpēc joprojām tiek meklēti papildu diagnostiskie marķieri. Darba teorētiskajā daļā tika apkopoti un analizēti literatūras dati par šķidruma pleiras dobumā epidemioloģiju, diagnostiku un ārstēšanu. Oriģinālā pētījuma mērķis bija noskaidrot, vai iespējams uzlabot malignu pleiras eksudātu diagnostiku, izmantojot onkoloģiskos vai bioķīmiskos marķierus. Lai noskaidrotu esošo situāciju un problēmas aktualitāti, retrospektīvi tika analizētas to pacientu medicīniskās kartes, kuri no 2010. gada 1. janvāra līdz 2010. gada 31. decembrim ārstējušies un izrakstīti no Rīgas Austrumu Klīniskās universitātes slimnīcas stacionāra “Gaiļezers” iekšķīgo slimību profila nodaļām vai šajā slimnīcā miruši. Tika atlasītas un analizētas tās medicīniskās kartes, kurās izrakstīšanās diagnozē bija norādes par šķidrumu pleiras dobumā. Lai noskaidrotu papildu bioķīmisko un onkoloģisko marķieru nozīmi maligna pleiras eksudāta (MPE) diagnostikā, prospektīvi tika analizēti no 2011. gada 8. augusta līdz 2014. gada 13. jūnijam Rīgas Austrumu klīniskās universitātes slimnīcas stacionāra “Gaiļezers” Iekšķīgo slimību klīnikas Pulmonoloģijas nodaļā secīgi stacionēti pacienti ar šķidrumu pleiras dobumā. Papildus rutīnas izmeklējumiem šiem pacientiem pleiras šķidrumā un serumā tika noteikti B tipa nātrijurētiskais faktors (BNP), plazminogēna aktivatora inhibitors 1 (PAI-1), karcinoembrionālais antigēns (CEA) un vēža karbohidrāta antigēns 125 (CA 125). Retrospektīvi analizējot medicīniskās dokumentācijas datus, tika konstatēts, ka 741 (4,6 %) pacientam no gada laikā stacionārā “Gaiļezers” ārstētiem, izrakstītiem vai mirušiem pacientiem diagnozē minēts šķidrums pleiras dobumā. 47 % no tiem diagnosticēts maligns pleiras eksudāts, 29 % – kardiāls hidrotorakss un 19 % – parapneimonisks pleirīts. Mirstība pacientiem ar šķidrumu pleiras dobumā bija 3 reizes augstāka nekā visiem ārstētajiem pacientiem kopā (attiecīgi 14,1 % un 4,4 %). Tika konstatēts, ka aplūkotajā laika posmā izmeklēšanas metodes pacientiem ar šķidrumu pleiras dobumā bija nepietiekamas, salīdzinot ar medicīnas literatūrā rekomendētajām. Prospektīvi tika analizēti 144 pacienti ar šķidrumu pleiras dobumā. Tika konstatēts, ka CA 125 pacientiem ar malignu pleiras eksudātu ir statistiski ticami augstāks gan pleiras punktātā, gan serumā. Tas liecina, ka CA 125 var kalpot kā papildu marķieris malignu pleiras eksudātu diagnostikā. Būtiska nozīme dažādu pleiras šķidrumu patoģenēzē ir fibrinolītiskajai sistēmai. Parapneimonisku pleirītu gadījumā fibrinolīze ir kavēta un veidojas norobežotas šķidruma kolekcijas, savukārt malignu pleiras erksudātu gadījumā parasti norobežošanās nenotiek. Iespējams, ietekmējot fibrinolītisko sistēmu, varētu uzlabot dažādas etioloģijas pleiras eksudātu ārstēšanu. Tāpēc darbā pētīts viens no fibrinolītiskās sistēmas marķieriem – protrombīna aktivētāja inhibitors 1 (PAI-1). Tika konstatēts, ka PAI-1 līmenis malignos pleiras eksudātos bija statistiski ticami zemāks nekā parapneimonisku pleirītu gadījumā. Tas var liecināt par procesa tendenci izplatīties ļaundabīgu slimību gadījumā pretēji parapneimonisku pleirītu tendencei norobežoties ar fibrīna septām. Darbā konstatēts, ka kardiāla hidrotoraksa diferencēšanai informatīvs marķieris ir BNP asins serumā, taču BNP pleiras punktātā papildu diagnostisku informāciju nesniedz.Item Biomarkers in community-acquired pneumonia assessment(2017-04) Voskresenska, Natalja; Babikovs, Sergejs; Voicehovska, Julija; Sķesters, Andrejs; Silova, Alise; Voicehovskis, Vladimirs; Aleksejeva, Renija; Lejnieks, Aivars; Karpovs, Jurijs; Department of Internal Diseases; Bioķīmijas zinātniskā laboratorijaThe paper presents information on pneumonia (P) patients with features of oxidative stress (OS). Identifying features of OS in patients with P is of interest not only for diagnosis, but also for monitoring of treatment efficiency. We recruited 73 patients with community-acquired P (CAP), previously healthy adults, both males and females with mean age of 68.0 ± 15.2, hospitalised, and 61 healthy control patients matched for age. For quantitative evaluation of lipid peroxidation in CAP patients, the levels of aldehydic lipid peroxidation products like malondialdehyde (MDA) and 4-hydroxynon-2-enal (HNE) were quantified. Furthermore, concentrations of reduced glutathione (GSH) and several antioxidant enzymes and selenium in plasma were determined. In CAP patients, decreased levels of GSH and plasma selenium were observed. Plasma levels of MDA, and HNE did significantly differ between patient and control groups. We also noted reduced activity of antioxidant enzymes, namely, glutation peroxidase and superoxide dismutase. Low antioxidant enzymes activity was associated with a more severe CAP pattern. Both GSH and antioxidant enzymes may serve as markers for inflammation-related OS in CAP patients, and measurement of these biomarkers may be a valid indentifier for its management.Item Blood pressure control in treated hypertensive patients in daily practice of Latvian family physicians(2011) Stukena, Inga; Apanavičiene, Daiva Asta; Bahs, Guntis; Kalvelis, Andrejs; Dzerve, Vilnis; Ansmite, Baiba; Kalejs, Oskars; Lejnieks, Aivars; Department of Internal DiseasesBackground and Objective: The aim of this study was to evaluate blood pressure (BP) control level in treated hypertensive patients in Latvia and to compare their characteristics according to the adequacy of BP control. Materials and Methods: Family physicians collected information on demographic and clinical characteristics, and current antihypertensive treatment of 455 18-80-year-old patients with essential arterial hypertension treated for 1 or more years. Target BP was defined as values of <140/90 mm Hg for patients with low or moderate cardiovascular risk and <135/85-125/75 mm Hg for patients with high or very high risk. BP was measured in the office setting after a 5-minute rest in a sitting position using a calibrated aneroid sphygmomanometer. Results: Nearly half of patients (46.2%) attained their target BP. The proportion of patients with effective BP control was higher in the group of low and moderate added cardiovascular risk than in the high and very high added cardiovascular risk group (61.7% vs. 34.4%, P<0.0001). The majority of patients were given two-drug (26.2%) or three-drug (31.6%) combined antihypertensive therapy. Current pharmacological treatment was similar in the patients who attained target BP and in those who did not. Overall, physicians did not modify antihypertensive treatment in 37.9% of patients; such a recommendation was more common among patients with controlled BP. Very few patients (7.4%) who did not attain target BP did not receive recommendations to modify antihypertensive treatment. Conclusions: The rate of effective BP control was less than 50% and was even worse (34.4%) in patients with high or very high added cardiovascular risk in the present sample of treated hypertensive patients.Item Cardiovascular Consequences of Acute Kidney Injury : Treatment Options(2023-09) Voicehovska, Julija G.; Trumpika, Dace; Voicehovskis, Vladimirs V.; Bormane, Eva; Busmane, Inara; Grigane, Anda; Moreino, Eva; Lejnieks, Aivars; Department of Internal DiseasesSoon after haemodialysis was introduced into clinical practice, a high risk of cardiac death was noted in end-stage renal disease. However, only in the last decade has it become clear that any renal injury, acute or chronic, is associated with high overall and cardiovascular lethality. The need for early recognition of kidney damage in cardiovascular pathology to assess risk and develop tactics for patient management contributed to the emergence of the concept of the “cardiorenal syndrome” (CRS). CRS is a pathophysiological disorder of the heart and kidneys in which acute or chronic dysfunction of one of these organs leads to acute or chronic dysfunction of the other. The beneficial effect of ultrafiltration as a component of renal replacement therapy (RRT) is due to the elimination of hyperhydration, which ultimately affects the improvement in cardiac contractile function. This review considers the theoretical background, current status of CRS, and future potential of RRT, focusing on the benefits of ultrafiltration as a therapeutic option.Item Characteristics and survival data from Latvian pulmonary hypertension registry : comparison of prospective pulmonary hypertension registries in Europe(2018-07-01) Skride, Andris; Sablinskis, Kristaps; Lejnieks, Aivars; Rudzitis, Ainars; Lang, Irene; Rīga Stradiņš UniversityPatient registries are a valuable tool in the research of rare conditions such as pulmonary hypertension (PH). We report comprehensive hemodynamic and survival data of 174 patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), included in the prospective Latvian PH registry over a period of > 9 years. In total, 130 adult PAH patients (75%) and 44 adult CTEPH patients (25%) were enrolled. The median follow-up period was 33 months for PAH and 18 months for CTEPH, P = 0.001. Latvian CTEPH patients had significantly higher plasma levels of B-type natriuretic peptide, higher pulmonary vascular resistance, and lower cardiac index than Latvian PAH patients. Calculated incidence of PAH and CTEPH in Latvia in 2016 was 13.7 and 5.1 cases per million inhabitants, calculated prevalence was 45.7 and 15.7 cases per million inhabitants, respectively. Survival rates at one, three, and five years for PAH patients was 88.0%, 73.3%, and 58.1%, and 83.8%, 59.0%, and 44.2% for CTEPH patients, respectively. We compared our study results with data from European adult PH registries. Latvian PAH patients had the fourth lowest and CTEPH patients the lowest one-year survival rate among European adult PH registries. As most PH registries in Europe are small, yet with equivalent patient inclusion criteria, it would be desirable to combine these registries to produce more reliable and high-quality study results.Item Characteristics of cardiovascular risk factors and their correlation with the sex and age of patients in the Latvian population(2009) Stuķena, Inga; Kalvelis, Andrejs; Bahs, Guntis; Teibe, Uldis; Tretjakovs, Peteris; Lejnieks, Aivars; Rīga Stradiņš UniversityVarious cardiovascular risk factors (RFs) were determined in 773 out-patients (mean age 55.8 ± 14.5 years). Male individuals had a larger waist circumference (WC) than did female patients (99.1 ± 13.6 cm vs 93.3 ± 15.2 cm), higher diastolic blood pressure (DBP) (83.6 ± 9.6 mmHg vs 81.8 ± 9.6 mmHg), and higher levels of blood glucose (5.73 ± 1.4 mmol/L vs 5.49 ± 1.3 mmol/L) and triglycerides (TG) (1.89 ± 1.3 mmol/L vs 1.60 ± 1.0 mmol/L), but lower levels of total cholesterol (TC) (5.54 ± 1.2 mmol/L vs 5.79 ± 1.2 mmol/L) and high-density lipoprotein cholesterol (HDL-C) (1.21 ± 0.4 mmol/L vs 1.44 ± 0.4 mmol/L). Compared with the younger age group (i.e., males, < 7 years; females, < 65 years), patients in the older age group had a larger WC (98.4 ± 14.2 cm vs 92.8 ± 15.1 cm), higher systolic blood pressure (SBP) (144.2 ± 19.2 mmHg vs 131.6 ± 18.5 mmHg), higher DBP (84.5 ± 8.8 mmHg vs 80.9 ± 9.8 mmHg), higher blood glucose level (5.74 ± 1.3 mmol/L vs 5.46 ± 1.3 mmol/L), and higher low-density lipoprotein cholesterol level (LDL-C) (3.68 ± 1.0 mmol/L vs 3.52 ± 1.0 mmol/L), but lower HDL-C level (1.3 ± 0.4 mmol/L vs 1.41 ± 0.4 mmol/L). Age was significantly correlated with all RFs, with the exception of the level of C-reactive protein. In conclusion, analysis of cardiovascular RFs in different age subgroups of both sexes clearly showed individual peculiarities of risk profile. This conclusion challenges the usual way of risk calculation using "universal" markers like adiposity or dyslipidemia in all population. The new approach requires individual attention depending on sex and age also in management of risk.Item Chronic Thromboembolic Pulmonary Hypertension and Antiphospholipid Syndrome with Immune Thrombocytopenia : A Case Report(2018-10-19) Skride, Andris; Sablinskis, Matiss; Sablinskis, Kristaps; Lejniece, Sandra; Lejnieks, Aivars; Klepetko, Walter; Lang, Irene M.; Rīga Stradiņš UniversityBACKGROUND Antiphospholipid syndrome is an autoimmune disorder characterized by a hypercoagulable state associated with circulating antiphospholipid antibodies. The presence of antiphospholipid antibodies can result in a variety of clinical symptoms, such as thrombocytopenia, stillbirth, endocardial pathologies, and recurrent pulmonary embolism. CASE REPORT We present the case of a 23-year-old man with antiphospholipid syndrome and chronic thromboembolic pulmonary hypertension who developed severe thrombocytopenia. The patient died from right heart failure before the thrombocytopenia could be managed, preventing performance of a pulmonary endarterectomy procedure. CONCLUSIONS Managing platelet counts in patients with antiphospholipid syndrome prior to major surgery is very problematic, and requires similar treatment strategy as in patients with immune thrombocytic thrombocytopenia. Platelet transfusions may further decrease platelet count, as it can trigger formation of new antibodies.