Rezidentu zinātniski pētnieciskie darbi

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Transperineāla priekšdziedzera biopsija: Glīsona pakāpju summu salīdzinājums klīniski nozīmīga priekšdziedzera vēža noteikšanā
(Rīga Stradiņš University, 2024) Riekstiņš, Reinis; Lietuvietis, Vilnis; Faculty of Residency; Rezidentūras studiju fakultāte
Introduction: Prostate cancer (PCa) is the most diagnosed cancer in men. To ensure effective treatment, early and accurate diagnosis is crucial. Multiparametric magnetic resonance imaging (mpMRI) followed by transperineal (TP) prostate biopsy is currently recognized as an early diagnostic method for PCa, significantly improving the detection of clinically significant PCa. Morphological changes in cell architecture in biopsy samples are characterized by the Gleason Score (GS). The GS determined from biopsies can be compared with the GS obtained from full prostate histological examination after radical prostatectomy (RP). It has been shown that GS is a prognostic factor for disease outcomes and recurrence risk, making the GS analysis between biopsy and surgical tissue samples valuable for assessing biopsy quality. Methodology: In a retrospective study, 148 patients underwent both targeted and systematic transperineal biopsies and radical prostatectomy. All patients underwent mpMRI before biopsy, and changes observed during the examination were classified using the PI-RADS system. GS values were compared between biopsy and prostatectomy tissue samples. Data analysis was performed using SPSS software (IBM SPSS v23.0, Armonk, NY: IBM Corp.). A significance level of p<0.05 was used for statistical tests. Results: The combined biopsy approach (targeted + systematic) detected PCa in 56.08% of cases, compared to 40.54% with targeted biopsies alone and 3.38% with systematic biopsies alone. Targeted biopsies were most effective in identifying clinically significant cancer. Analysis and comparison of RP data with biopsy results revealed that GS matched in 52.03% of cases, while 28.38% showed clinically significant increases. Conclusions: The results indicate that GS concordance between biopsy and surgical samples was observed in more than half of the patients in the study population. Clinically significant GS increases were found in one-third of patients. The study results suggest that TP biopsy quality in the study group is adequate for patient selection for surgical treatment based on biopsy results. Further data analysis is needed to evaluate the early diagnostic process for prostate cancer and the impact of individual stages on GS differences between biopsy and surgical tissue samples.
Augšžokļa transversālās dimensijas saistība ar kanīnu impakciju
(Rīga Stradiņš University, 2024) Ozola, Ieva; Jākobsone, Gundega; Faculty of Residency; Rezidentūras studiju fakultāte
Introduction: the aim of the study was to compare the transverse dimension of an individual's maxilla on the side of the impacted canine and on the opposite side without canine impaction, using cone-beam computed tomography (CBCT). Materials and methods: a total of 104 CBCT images of patients with unilaterally impacted maxillary canines (79 palatally impacted and 25 buccally impacted) were analyzed. Maxillary transverse dimension measurements were performed at the dental, alveolar, basal, and nasal levels at both the first premolar and the first molar on both sides of the maxilla, using 3D Slicer software. Differences between the side with the impacted canine and the side without impaction were assessed using paired-samples t-tests. Correlations between variables were assessed using Spearman's correlation test with additional linear regression analysis. Results: statistically significant differences were observed in premolar alveolar width (0,35 mm, p = 0,029) and basal width (0,47 mm, p = 0,021), regardless of the impacted canine position, with the canine impaction side being narrower. In palatal canine impaction group, the premolar basal width on the impaction side was significantly reduced by an average of 0,4 mm (p = 0,027). No significant differences were found in the buccal impaction group as well as between the widths of palatally and buccally impacted canines. In females, the premolar alveolar width, whereas in males, the premolar basal width was significantly reduced on the impaction side (by an average of 0,38 mm, p = 0,019 and 1,03 mm, p = 0,004, respectively). In males, age was positively correlated with premolar dental width (r = 0,504, p = 0,005), molar dental width (r = 0,533, p = 0,004), premolar alveolar width (r = 0,441, p = 0,015) and molar alveolar width (r = 0,481, p = 0,011) differences - with each year of life, the difference in premolar dental width increases by 0,041 mm (p = 0,037), the difference in molar dental width by 0,045 mm (p = 0,028) and the difference in premolar alveolar width by 0,118 mm (p = 0,003) .Conclusions: canine impaction is associated with a local narrowing of the maxilla in the premolar region, which is influenced by gender and age.
Smaga akūta pankreatīta (pankreonekrozes) etioloģija, diagnostika, slimības gaita, ārstēšanas taktika, un iznākums pēdējo 5 gadu laika Daugavpils Reģionālajā slimnīcā
(Rīga Stradiņš University, 2024) Avelidi, Marija Darja; Lovčinovskis, Viktors; Faculty of Residency; Rezidentūras studiju fakultāte
Acute pancreatitis is a pancreatic inflamation that occurs in a short period of time. The pancreas is a small organ located behind the stomach near the duodenum and is involved in digestion. Pancreatitis is most often manifested by pain in the epigastrium. Most of the time ~80% resolve easily without any complications, but severe cases require a multidisciplinary approach. Acute pancreatitis is one of the most actual problems in modern medicine because it is common, ~20%-25% progress with the complication like pancreonecrosis. If acute pancreatitis is untreated can lead to serious health problems such as chronic pain or progress to a chronic form, sometimes with fatal outcome. The aim of this study is to find out how often pancreonecrosis develops compared to all acute pancreatitis, to find out the more common factors that lead to the development of pancreonecrosis, to find out the more common treatment outcome in patients after diagnosis of pancreonecrosis, and to find out the association of mortality with age, sex, aetiological factor, and location of pancreonecrosis. Patient history analysis will be used to investigate this question. Data will be structured and processed in MS Excel 2007 and SPSS 30. In total, 554 people with SSK10 diagnosis code K85 - acute pancreatitis were hospitalized in Daugavpils Regional Hospital in the last 5 years from 2019 to 2023, of which 84 people were diagnosed with acute pancreatitis with pancreonecrosis, 28 women (33.3%) and 56 men (66.7%). The highest number of patients is hospitalised in 2019 - 123 people and the lowest in 2021 - 93 people. On the other hand, the highest number of pancreonecrosis is in 2019 - 23 people or 18.69%, and the lowest number in 2020 - 13 people or 10.83%. The results show that the lethal outcome for pancreonecrosis was 15 patients or 17.9%, which is 2.7% of all pancreatitis cases. The mean age of the patients was 53.3 ± 15.7 years. In general, the predominant aetiological factor for the development of pancreonecrosis during the 5-year follow-up was excessive alcohol consumption in 38 patients (45.2%) and gallstone disease in 26 patients (31%).
Temporomandibulārās locītavas patoloģijas ārstēšanas nepieciešamība Rīgas Stradiņa universitātes Stomatoloģijas institūta studentu klīnikas pacientiem
(Rīga Stradiņš University, 2024) Blumfelde, Līva; Blumfelde, Līva; Faculty of Residency; Rezidentūras studiju fakultāte
Dysfunctions of the temporomandibular joint and tissues associated with its functioning are the most common causes of chronic pain in the orofacial region. Their diagnostics and treatment are complex and require in-depth knowledge of human anatomy, physiology, and psychology. Globally, the treatment of these conditions is receiving increasing attention, and research is being conducted to test the effectiveness of various methods. Aim: This research work aimed to find out how often temporomandibular disorders occur among the Latvian population, using as a research group patients who visit the student clinic of the Institute of Stomatology of Rīga Stradiņš University. Methodology: The INfORM DC/ TMD pain screener questionnaire was translated, and demographic questions were added. Adult patients who visited the RSU SI student clinic from 15.04.2024 to 22.05.2024 were surveyed. The data was collected in Microsoft Office Excel and processed using SPSS statistics software. Results: A total of 201 respondents participated in the study, from which respondents who did not suffer from toothache at the time of filling out the questionnaire were selected for analysis (178). Data from the study indicated that 16.85% of respondents scored at least three points in the TMD pain screener, suggesting a potentially painful TMD. No statistically significant differences were found between the prevalence of TMD among women and men. No relationship was observed between the development of painful TMDs and the age, income, marital status, and educational attainment of respondents. The highest percentage of respondents with painful TMD lived in the capital of the Republic of Latvia, Riga. Conclusions: According to DC/TMD, the prevalence of TMD in the study group was lower than the European average (29%). Further research is necessary to ascertain whether these results correspond to the indicators in the Latvian population.
Krūts barošana, tās ietekme uz augšanas attīstību un svaru pirmsskolas vecuma posmā
(Rīga Stradiņš University, 2024) Breiha, Dagnija; Šmitiņa, Anda; Faculty of Residency; Rezidentūras studiju fakultāte
Background. Breastfeeding is providing lots of benefits for infant and mother, and human milk is known as an optimal source of nutritients for newborn in the first months of life. There are numerous studies that shows positive effect of breastfeeding on physical and cognitive development of a child, including reduced risk of childhood obesity even after breastfeeding has been ceased. Nevertheless, breastfeeding rates don’t reach a target set by World Health Organization, with rates being lower in high income countries. Objective: Objective of this study was to investigate the association between breastfeeding duration and child body mass, height and body mass index. Methods: For a retrospective study medical records of 123 children were selected, data about body mass and height at age of 12 months, 3, 5 and 7 years were retrieved. Statistical methods were used to compare group of children who were breastfed less than three months with those who were breastfed for longer. Results: 85,4% of children were breastfed for 3 months, 70,7% for 6 months, and 47% were breastfed for 12 months. Breastfeeding for less than 3 month is asssociated with increased body mass and height at all ages, but statistically significant association is seen with body mass at 12 month age. Mean weight of children who were breastfed less than three months is 10,79(±1,34) kg, three months breastfed 9,81(±1,05), six months brestfed 9,81(±1,08)kg and nine months brestfed 9,73(±1,06) kg. Obesity rate in all ages is higher for those who were breastfed for less than 3 months- 11,1% versus 3,8% at age of three, 5,6% versus 2,9% at age of five and 16,7% versus 4,8% at age of seven. Conclusion: Study shows association between early cesation of breastfeeding and higher body mass in the first year of life, but there is no relation between breastfeeding and body mass index. Breastfeeding for at least 3 months reduce the risk of obesity at preschool age.
Radiofrekvences un krioablācijas metožu salīdzinošais novērtējums paroksismālās priekškambaru fibrilācijas arstēšanā
(Rīga Stradiņš University, 2024) Tupahins, Andris; Kupics, Kārlis; Faculty of Residency; Rezidentūras studiju fakultāte
Introduction. Atrial fibrillation (AF) is the most common type of arrhythmia, affecting approximately 50 million people in 2020. AF is associated with an increased risk of hospitalization, heart failure (HF), stroke, dementia, sudden cardiac death, chronic kidney disease (CKD), and peripheral artery disease (PAD). Due to numerous randomized controlled trials and evidence from large registries, catheter ablation has become a recognized method for AF therapy, and it continues to evolve. Recent studies suggest that controlling AF is much more effective with pulmonary vein isolation (PVI) compared to antiarrhythmic drugs. Cryoablation is increasingly being used as the primary PVI method, replacing the previously used radiofrequency catheter ablation (RFCA) method. Objective. The aim of this study is to evaluate whether there are statistically significant differences between the radiofrequency and cryoablation methods. Materials and Methods. This study conducted a retrospective case-control study with a quantitative approach. Two treatment methods, cryoablation and radiofrequency ablation, were compared. Information was obtained from the following sources: medical offices, Sektra, DiaLab, patient medical histories, and AngioPAC-EIRKAU. The collected data were compiled using IBM SPSS and Excel software. The following statistical methods were used for data analysis: Shapiro-Wilk test, Mann-Whitney test, descriptive statistics, Pearson's chi-square test, and Fisher's exact test. Patients with both initial and repeat PVI were analysed separately. Results. Initial Procedure: 73% underwent PVI with the cryoablation method, and 27% with the radiofrequency method. Of 511 patients, 308 were men and 203 were women. The median age in the cryoablation group was 62.5 years (IQR: 52.8 – 69.0), and the same in the radiofrequency PVI group (IQR: 52.8 – 69.0). The median duration for cryoablation was 90 minutes (IQR: 80.0 – 110.0), with a minimum of 50 minutes and a maximum of 210 minutes. For radiofrequency ablation, the median procedure duration was 150 minutes (IQR 120.0 -180.0), with a minimum of 70 minutes and a maximum of 285 minutes. During cryoablation, the median radiation duration was 8.44 minutes (IQR 6.32 – 12.13), with a minimum of 2.33 minutes and a maximum of 92.0 minutes. For radiofrequency ablation, the median radiation duration was 6.59 minutes (IQR 5.198 -10.51), with a minimum of 2.29 minutes and a maximum of 62.25 minutes. The minimum radiation dose was 38 mGy, and the maximum was 15764 mGy. During radiofrequency ablation, the median radiation dose was 588.5 mGy (IQR 295.0 -1320.3), with a minimum of 45.0 mGy and a maximum of 8794.0 mGy. In 21.7% of RFCA PVI cases, rhythm disturbances occurred during the operation, with AF being the most common type (9.4%). In cryoablation cases, rhythm disturbances occurred in 6.4% of cases, with AF observed in 4.0%. Sinus rhythm was observed at the end of 99.6% of the procedures. The most common types of rhythm disturbances at the end of the procedure were AF and atrial flutter (AFL). Repeat Procedure: 82 patients underwent a repeat procedure. Of these, 7.3% underwent pulmonary vein re-isolation (PVR) with the cryoablation method, and 92.7% with RFCA. 41.4% of the patients were women, and 58.6% were men. The median age in the cryoablation group was 60.0 years (IQR: 53.0 – 70.0), and in the radiofrequency PVI group, it was 62.0 years (IQR: 52.25 – 69.0). The median duration for cryoablation was 160 minutes (IQR: 147.50 – 170.0), with a minimum of 140 minutes and a maximum of 170 minutes. For radiofrequency ablation, the median duration was 127.50 minutes (IQR 112.5 -150.0), with a minimum of 80 minutes and a maximum of 365 minutes. During cryoablation, the median radiation duration was 14.45 minutes (IQR 9.49 – 15.46), with a minimum of 9.32 minutes and a maximum of 18.33 minutes. For radiofrequency ablation, the median radiation duration was 8.36 minutes (IQR 6.02 -11.26), with a minimum of 2.22 minutes and a maximum of 26.11 minutes. The median radiation dose during cryoablation was 824.50 mGy (IQR 293.0 – 3437.0), with a minimum dose of 140 mGy and a maximum of 3437 mGy. During radiofrequency ablation, the median radiation dose was 460.5 mGy (IQR 227.0 – 969.3), with a minimum dose of 59 mGy and a maximum of 15708 mGy. Conclusions. 1. Based on Pearson's chi-square test results, there are no statistically significant differences between the presence of sinus rhythm at the end of the procedure and the type of procedure. 2. Statistically significant differences in procedure duration were found between the two isolation methods for both initial and repeat PVI. Overall, the cryoablation method was shorter in initial procedures and longer in repeat procedures compared to the radiofrequency method. 3. In initial procedures, there were statistically significant differences in radiation duration between the PVI methods. The cryoablation method had a longer median radiation duration compared to the radiofrequency method. In repeat procedures, there were no statistically significant differences, but the cryoablation method had a significantly longer median radiation duration compared to the radiofrequency method. 4. In initial procedures, the cryoablation method had a lower median radiation dose (530 mGy) compared to the radiofrequency method (588.5 mGy). In repeat procedures, the cryoablation method had a higher median radiation dose (824.50 mGy) compared to the radiofrequency method (460.5 mGy). 5. There is a statistically significant but weak association between isolated vein reconnection and the type of initial procedure, particularly in RFCA cases with left atrial posterior wall isolation (LAPV), left atrial posterior and pulmonary vein isolation (LAPPV), and cryoablation cases with left atrial scar isolation. 6. In initial PVI, there is a statistically significant association between LAPV and LAPPV isolation with the cryoablation method and transient n. phrenicus palsy. This complication is rare, occurring in about 2.41% of cases. This study was unable to detect complications of reoperation. 7. There are statistically significant differences between new rhythm disturbances during the procedure and the PVI method. Rhythm disturbances developed more frequently in RFCA isolation cases, with AFL being observed. In cryoablation cases, AFL was also the most common type of arrhythmia, but it occurred less frequently. These differences are statistically significant but with a weak association.
Gaitas subjektīvs un objektīvs novērtējums pacientiem ar diagnosticētu cerebrovaskulāru notikumu pirmreizējas stacionāras rehabilitācijas laikā
(Rīga Stradiņš University, 2024) Paga, Helga; Pavāre, Zane; Faculty of Residency; Rezidentūras studiju fakultāte
In Latvia, as the frequency of cerebrovascular events increases and at the same time treatment improves, the number of patients who will have permanent functional impairment in mobility is increasing. Objective: To determine the relationship between changes in the objective parameters of gait and the patient's self-assessment of mobility. Methods and tasks: To assess patients in the first rehabilitation course of NRC "Vaivari" after a cerebrovascular event with the following instruments: Hausser Ambulation and Rivermead Mobility Index; The Walking Impact Scale; Time up and Go; 10 Meter Comfortable and Fast Gait Speed Test; Berg Balance Scale; G-walk sensor and program for gait analysis; MoCA. To find out if there is a relationship between the patient's subjectively assessed movement abilities after a cerebrovascular event with the objectively performed measurements; whether there is a relationship between the The Walking Impact Scale rating and the results of the G-walk gait analysis of 10 meters of comfortable and fast walking, which is within the patient's normal values. To assess whether it would be useful to use the 10-meter walk test in conjunction with G-walk gait analysis to set a measurable task of improving gait pattern function. Results: A total of 29 patients were evaluated, 14 women and 15 men, mean age 63.72 years (+/- 12.6 years). 11 had left-sided paresis, 10 right-sided paresis. 15 participants did not use a technical aid to improve mobility, 14 did, 5 of them a rollator, 8 a cane and 1 a tripod. On The Walking Impact Scale, the average self-assessment was 50.24% (+/- 18%) on a scale of 0 - 100%. A negative correlation was obtained between 10-meter comfortable walking speed (ρ = -0.47, P<0.05) and The Walking Impact Scale and 10-meter fast walking speed (ρ = -0.60, P<0.01) and The Walking Impact Scale. There is also a negative correlation between the results of the 10-meter comfortable G-walk gait analysis, which is within the patient's normal values, and The Walking Impact Scale (ρ = -0.50, P<0.01). Conclusions: Patients assessed themselves adequately on the Walking Impact Scale, according to the obtained objective measurements, which overturned the proposed working hypothesis that patients overestimate or underestimate their mobility abilities. A patient who rates himself worse has fewer normal values in the gait analysis data. G-walk gait analysis data, performing a 10-meter comfortable and fast walking test, could be used to objectively evaluate and reflect the obtained data in the patient's medical documentation and set a measurable task about the functions of the gait pattern during the rehabilitation course.
Šāviena produkti, to analīze ar rentgenanalītisko mikroskopu Horiba "XGT-9000" un pielietošana šāviena distances noteikšanā
(Rīga Stradiņš University, 2024) Bukulītis, Miks; Krasiļņikovs, Sergejs; Faculty of Residency; Rezidentūras studiju fakultāte
Introduction: Firearms is still one of the leading causes of deaths in the world. Their usage in USA from years 2006 to 2021 in homicides have grown from 67,8% to 85,7%. In Latvia from 2009 to 2019 firearm use in homicide related deaths grew from 0,35 to 0,54 per 100 000 population. Although firearms are effective and easy-to-use murder weapons, they leave gunshot residue, and based on the results of its examination, forensic experts and forensic scientists can determine the distance of the shot, as well as the presence of metals inherent in the particular firearm and its ammunition. In Latvia, the commonly used methods of investigating gunshot traces are X-ray fluorescence spectral analysis and the contact diffusion method. Both are proven and specific forensic methods for investigating gunshot wounds, but modern technology allows for equivalent results using a new generation of X-ray fluorescence spectrometry equipment with elemental mapping functionality. Hypothesis: 1. The new generation x-ray fluorescence spectroscopy systems (Horiba XGT-9000) elemental mapping results can be used to determine shot distance. 2. Gunshot residue analysis with new generation x-ray fluorescence spectroscopy system (Horiba XGT-9000) can replace currently used conventional x-ray fluorescence analysis and contact-diffusion method. Purpose of work: Detect, study, describe and analyze gunshot residues on human skin fragments with gunshot wounds using x-ray analytical microscope Horiba XGT-9000 and compare the obtained data with already known and accredited methods. Materials: This research is based on the examination of skin fragments with wounds that were gathered in the autopsies in the Thanatology department and the Regional departments of the State Forensic Medical Expertise Center, with the cause of death being gunshot injuries. In total, 12 cases with death occurring between November 1, 2022 and April 1, 2024 were analyzed. Results and conclusions: The hypotheses proposed in the research are confirmed - the element map data obtained with the new generation X-ray fluorescent spectral examination device Horiba XGT-9000 can be used to determine the shot distance, as well as this device can replace the currently used conventional X-ray fluorescent investigation and the contact diffusion method.
Latvijas iedzīvotāju viedoklis un attieksme pret telemedicīnas lietošanu veselības aprūpē
(Rīga Stradiņš University, 2024) Kalve, Madara; Vētra, Anita; Faculty of Residency; Rezidentūras studiju fakultāte
Introduction: The availability of technology provides opportunities to deliver various services remotely, including telemedicine. The spread of COVID-19 to a pandemic level also posed a challenge to healthcare. By introducing telemedicine services, the healthcare system would become more resilient to crises while simultaneously addressing existing challenges. Objective: To determine the opinion and attitude of Latvian residents towards the use of telemedicine in healthcare. Methods: A quantitative cross-sectional study was conducted using an online questionnaire translated from English. The questionnaire was digitized using Google Forms and published on social media. The Mann-Whitney U test was used to assess statistical significance between genders; the Kruskal-Wallis H test and Spearman's correlation were used for age groups. Results: The study included 150 adult respondents aged 18 to 85 years. Respondents agreed that telemedicine is useful during the pandemic, improves communication between patient and doctor, and accelerates the delivery of medical care. It reduces the number of visits to clinics, improves access to care, and can facilitate accurate diagnoses. The majority believe that Latvia is capable of adopting and integrating telemedicine services. However, regarding the possibility of medical errors (80% believe telemedicine does not reduce the number of errors) and information privacy (43.6% consider it a threat to data security), respondents disagreed. The Mann-Whitney U test did not show significant differences between age groups (all p-values > 0.05); the Kruskal-Wallis H test revealed a significant difference between age groups regarding telemedicine's ability to reduce costs (p-value 0.018). Spearman's correlation was negative (-0.150), indicating that older people are less likely to agree that telemedicine reduces costs, although the correlation was not statistically significant (p-value 0.066). Conclusions: Overall, the view of Latvian residents on telemedicine across all age groups is positive, although respondents have concerns about data privacy and the possibility of medical errors. The majority believe that it is possible to implement telemedicine services and integrate them into the healthcare system in Latvia, indicating a public readiness to accept digital medical solutions. A sample of 150 respondents provides an initial insight into trends but is not large enough to represent the entire population of the country.
Vaskulārās pieejas disfunkcijas, to ārstēšanas iespējas un iznākumi hemodialīzes pacientiem Paula Stradiņa klīniskās universitātes slimnīcā no 2018. gada līdz 2022. gadam
(Rīga Stradiņš University, 2024) Sila, Daniela; Kuzema, Viktorija; Faculty of Residency; Rezidentūras studiju fakultāte
Introduction Hemodialysis requires a permanent vascular access, typically achieved through an arteriovenous fistula (AVF) or an arteriovenous prosthesis (AVP). However, these access methods often encounter complications, such as stenosis, thrombosis, and aneurysms, which require medical intervention. Aim of the study To study the incidence of vascular access dysfunction in haemodialysis patients, to analyse the associated risk factors, and to evaluate the treatment methods used and their effectiveness at Pauls Stradins Clinical University Hospital from January 2018 to December 2022. Material and Methods This study analysed data on vascular access dysfunctions at Pauls Stradins University Hospital between 2018 and 2022, summarising 621 manipulations, 155 of which were related to vascular access dysfunctions. SPSS 26-2018, Microsoft Excel software was used for calculations. Results The study found that AVF dysfunctions were more common than AVP dysfunctions. Key risk factors for recurrent thrombosis were identified, including longer time on renal replacement therapy and elevated phosphorus levels in the blood. The analysis of treatment outcomes revealed that slightly more than half of the patients experienced successful treatment, with the restoration of vascular access function. Evaluating the survival of vascular access at three, six, and twelve months post-treatment revealed a high risk of recurrent dysfunction, with less than half of the cases avoiding repeated invasive interventions within a year. Surgical therapy was performed for all patients with AVF aneurysms, while stenosis and thrombosis were treated with both surgical and endovascular methods, often combining the two approaches. Conclusions The study highlights the need for regular monitoring of vascular access and the education of medical staff to reduce the risk of complications. To improve diagnosis and treatment, close collaboration among nephrologists, surgeons, and interventional radiologists is essential.
Pacientu raksturojums un veselības iznākumi Insulta vienībā 6 mēnešu periodā 2009., 2019. un 2023. gadā
(Rīga Stradiņš University, 2024) Bērziņa, Evija; Mihejeva, Illa; Faculty of Residency; Rezidentūras studiju fakultāte
Relevance: In Latvia, approximately 26 new stroke cases are registered every day, and stroke is one of the leading causes of death. According to the Center for Disease Prevention and Control, 1806 people died from stroke in 2019, and 1688 in 2022 in Latvia, with around 14-16% of them being younger than 64 years old. Mortality from stroke in Latvia is higher than the average in the European Union (Center for Disease Prevention and Control, 2024). The objective of this study was to evaluate the risk factors for mortality and disability in stroke patients at the Riga Eastern Clinical University Hospital "Gaiļezers" Stroke Unit over a 6-month period in the years 2009, 2019, and 2023. Methods: The study analyzed data from 1911 patients who were hospitalized and treated at the Riga Eastern Clinical University Hospital (RAKUS) Stroke Unit from February 1 to June 30 in the years 2009, 2019, and 2023. The analyzed data included patient age, length of hospitalization, gender, stroke risk factors, and outcomes using the Modified Rankin Scale and the National Institutes of Health Stroke Scale (NIHSS). The main statistical methods used were cross-tabulations, Chi-square tests, independent samples Kruskal-Wallis test, pairwise comparisons, and Wilcoxon Signed Ranks test. Results: Stroke patients with atrial fibrillation had a 1.5 times higher risk of mortality compared to those without atrial fibrillation. Primary arterial hypertension was associated with a 1.3 times higher risk of mortality after stroke. From 2009 to 2023, mortality rates after stroke in the hospital decreased by approximately 20%, indicating a significant improvement in patient outcomes. The incidence of stroke was higher in men than in women, while women had worse outcomes. Conclusions: Atrial fibrillation and primary arterial hypertension were significant predictors of mortality after stroke. Demographic and lifestyle factors (gender, alcohol consumption, smoking) did not significantly affect mortality after stroke. Overall, the study results indicate a positive trend in reducing mortality among stroke patients, which may be associated with improved treatment protocols and the certification of the RAKUS Stroke Unit in 2021.
Antidepresantu loma agrīnas remisijas sasniegšanā alkohola atkarības pacientiem ar depresīviem traucējumiem
(Rīga Stradiņš University, 2024) Timofejeva, Jūlija; Landsmane, Inga; Faculty of Residency; Rezidentūras studiju fakultāte
The aim of the study is to analyze the impact of antidepressants on achieving remission in patients with alcohol dependence and depressive disorder. Hypothesis: The use of antidepressants as adjunctive therapy reduces depressive symptoms and helps achieve faster and longer-lasting remission. Material and Methods: The study consists of two parts, retrospective and prospective. The retrospective group includes 185 participants. The treatment period is from 2020 to 2024. Data on patients and the course of treatment were taken from outpatient medical records. The prospective group includes 15 participants. In addition to the diagnosis of "alcohol dependence" participants were clinically diagnosed with depressive symptoms and completed a PHQ- 9 test, with test scores ranging from 5 to 27. In the analysis of the study data, a comparison of the achieved remission in both groups was made. Result of the study: The data of thr retrospective part of the study show that no significant difference in the duration of remission was observed between patients who were treated only with specific therapy or did not receive any therapy, and those patients who were prescribed antidepressants as adjunctive therapy. Analyzing the remission duration of thesecond group of patients, it was concluded that 80% of patients achieved remission from 6 months to one year and 20% of patients achieved remission duration from one year and more. None of the patients in the second group was found to have consumed alcohol. Conclusions: The author concluded that there was no significant difference in the duration of remission between patients treated solely with specific therapy and those who received adjunctive antidepressants. Patients in the prospective part of the study who received antidepressants achieved relatively quicker and earlier remission. Achieving better treatment outcomes requires careful patient assessment and evaluation of treatment necessity throughout the course of therapy.
Fluorīdu biopieejamība siekalās Latvijas tirgū pieejamām zobu pastām: Kopējās un šķīstošā fluorīdu analīze
(Rīga Stradiņš University, 2024) Kronberga, Elīna Ilze; Maldupa, Ilze; Faculty of Residency; Rezidentūras studiju fakultāte
Since the 1970s, the prevalence of caries has decreased, yet a significant portion of the population still suffers from this disease. If caries are not treated promptly, it can lead to serious health issues. The most accepted and widely used method for caries prevention is regular tooth brushing with toothpaste containing fluoride concentrations above 1000 ppm. However, studies indicate that the fluoride concentration in toothpaste may be lower than stated on the packaging, which can mislead consumers and reduce the effectiveness of caries prevention. Additionally, myths questioning the efficacy of fluoride remain prevalent in society. It is crucial for dentists to have a solid understanding of fluoride mechanisms to withstand societal pressure and industry marketing activities. Therefore, this study developed an experimental protocol for a co-curricular activity in a diploma program to investigate fluoride's ability to inhibit demineralization under acidic conditions. The experiment was refined by exploring various toothpaste and acid exposure durations and concentrations to determine the most effective and shortest experimental timeframe. The result was the development of the shortest effective experimental protocol, in which boiled eggs are kept in toothpaste for 48 hours and in 9% acetic acid for 7 hours. It was concluded that the experiment is an effective way to understand fluoride's ability to inhibit tooth demineralization.
Trīsdimensiju sejas mīksto audu izmaiņas pēc ortognātiskās ķirurģijas
(Rīga Stradiņš University, 2024) Jefimova, Irina; Ābeltiņš, Andris; Faculty of Residency; Rezidentūras studiju fakultāte
Introduction: The introduction of the whole range of digital data acquisition devices and types of software in recent years, allows to analyze soft tissue changes after orthognathic surgery by using three-dimensional images, that overcome the disadvantages of two-dimensional analysis and obtain a more accurate image of facial soft tissues morphology. Superimposition of CBCT and 3D- photographic data allows to determine the soft-to-hard tissue ratio in different types of orthognathic surgery. This data can improve 3D surgical planning and provide more accurate soft tissue changes predictions. Aim: The aim of this study was to review the available scientific literature about 3D soft tissue changes after orthognathic surgery. As well as to evaluate the intra- and inter-operator reliability and reproducibility of soft tissue landmarks on three-dimensional stereophogrammetric images. Materials and methods: A search for the relevant studies was performed in the free access databases as well as in RSU subscribed e-databases – full text, English language, systematic reviews, meta-analysis, randomized controlled trials, retrospective and prospective studies. To evaluate the intra- and inter-operator reliability stereophotogrammetric images of patients with skeletal Class II and III malocclusion who underwent orthodontic treatment and orthognathic surgery were used. Stereophotogrammetric images were obtained using the 3dMD Face (3dMD TM Ltd, USA) system before surgery, 24 and 36 months after orthognathic surgery. The 21 anthropometric landmarks were digitally marked on 3D facial image in 3dMD Vultus. Intra- class correlation coefficient (ICC) with 95% confidence interval was used to assess intra- and inter-operator reliability. Results: The intraclass correlation coefficient 95% CI range was 0.947–1. That indicate excellent reliability. Inter-class correlation coefficient showed good inter-examiner agreement (ICC 95% CI range 0.990-1), indicating no statistically significant difference in the accuracy of landmark positions between both operators’ measurements obtained within 2-week interval. Conclusions: The analysis of research available on 3D soft tissue changes after orthognathic surgery revealed methodological differences between articles, small sample size, there are differences in surgical techniques used, magnitude of skeletal movement, patient ethnicity, age and sex. That means that available data should be interpreted with caution. Available studies that evaluate 3D soft tissue changes after orthognathic surgery have 6 to 12 months follow up periods. A long-term evaluation should be performed to study skeletal relapse and soft tissue stability after orthognathic surgery.
Biroja darbinieku mazkustīguma paradumu izmaiņas faktori atkarībā no darba dienas ilguma
(Rīga Stradiņš University, 2024) Skujiņa, Vivita; Reste, Jeļena; Faculty of Residency; Rezidentūras studiju fakultāte
Background: Prolonged sedentary work is a contributor to sedentary behaviour in office workers who are constantly working with a computer. Working hours spent sitting and reduced movement throughout the working day can have adverse effects and consequences on employees' health. Prolonged sitting and sedentary time are occupational hazards for office workers and can lead to occupational musculoskeletal disorders, the most prevalent in Europe [25]. Workers' health conditions can have a negative impact on individuals, families, communities and a fulfilling long term health. Aim of the paper: To investigate the relationship between office worker sedentariness in relation to the length of the working day, the age of the employee, and employer factors motivating physical activity, and factors hindering the employee's ability to move. Materials and methods. This is a cross-sectional study. Data were collected in 2022 and 2023 from an anonymous online questionnaire distributed on social networks using a "snowball" method. The participants were 552 office workers aged 19-69 years, whose daily work involves a computer and prolonged sitting. Pearson Chi-square test and standardised residuals method were used to analyse the responses. Results. Office workers who work more than 9 hours find both meetings (AR=3.5; p=0.000) and intensive work (AR=4.4; p=0.000) disturb their mobility at work. In the 19-29 age group, those who work more than 9 hours consider that the nature of their work prevents them from moving (AR=2.2; p=0.027) and they do not see any reason to do so (AR=2.3; p=0.019). Office workers in the 40-49 age group who work up to 8 hours, the desire to look better is a motivation to engage in physical activity in their free time (AR=2.1; p=0.040). Employees are well aware of the need to exercise, would support motivational benefits, including space to exercise. A dynamic workplace is favoured by respondents aged 30-39 with a working day over 9 hours. Conclusions. Office workers who work more than 9 hours (61.0%) are reluctant to move unnecessarily during the working day because of too much work and intense work, work meetings, they try to save on working hours, less energy is left for other physical activities. 19-39 year olds are willing to accept change and reduce sedentariness, while over 50s are less responsive, especially if their working day is more than 9 hours.
PARP inhibitoru terapijas efektivitātes izvērtēšana pacientēm ar BRCA1/2 pozitīvo olnīcu vēzi
(Rīga Stradiņš University, 2024) Rustamova, Tamara; Plāte, Signe; Faculty of Residency; Rezidentūras studiju fakultāte
Ovarian cancer is one of the leading causes of death from cancer among women worldwide. Surgical cytoreduction followed by platinum-based chemotherapy have been established as a standard of care for the past 20 years. However, majority of patients relapse within the first three years of therapy. The development of poly (ADP-ribose) polymerase (PARP) inhibitors have transformed the treatment landscape and significantly improved survival in patients with advanced ovarian cancer. Maintenance therapy with PARP inhibitors is approved both in the first line and relapsed platinum-sensitive ovarian cancer setting. Although distinct differences in tolerability profile were observed between PARP inhibitors, they were generally well tolerated and majority of adverse effects can be managed by dose modification. The aim of the study was to explore clinical factors which have an impact on prolonged therapeutic efficacy of PARP inhibitors in patients with newly diagnosed and relapsed BRCA mutated ovarian cancer who were treated in Latvian Oncology Centre. Methods. Forty-one ovarian cancer patients with BRCA1/2 mutation who received maintenance therapy with PARP inhibitor after platinum-based chemotherapy between October 2018 and February 2024 in Riga East Clinical University Hospital Latvian Oncology Centre were included in retrospective study. Clinical factors (patient age, FIGO stage, line of treatment, serum CA-125 level before the start of therapy with PARP inhibitor, radiological treatment response) and their impact on progression-free survival were analysed. The results of the study confirmed the efficacy and clinical benefit of PARP inhibitors both in first line and subsequent line therapy settings. Complete response to platinum-based chemotherapy and serum CA-125 <10 U/ml were independent clinical factors which prolonged progression-free survival (p=0,001 and p=0,011). Other factors did not influence survival (p>0,153). Conclusion. Clinical factors such as complete response to platinum-based chemotherapy and low (<10 U/ml) serum CA-125 level may be used to predict the treatment efficacy of PARP inhibitors.
Nealkohola taukainās aknu slimības klīniskie aspekti un novitātes internista skatījumā
(Rīga Stradiņš University, 2024) Oblate, Olga; Zeltiņa, Indra; Faculty of Residency; Rezidentūras studiju fakultāte
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. It affects ~ 1/3 of the entire population and the incidence of the disease only increases every year. As the disease progresses, serious complications develop, i.e. liver fibrosis, cirrhosis, hepatocellular carcinoma, death due to liver failure. The aim of the work was to investigate the risks of NAFLD, identify the situation and analyze the therapeutic strategy, based on the analysis of scientific evidence literature. The tasks of the work were to find out the actuality of NAFLD in the world, analyze the correlation of the new nomenclature of NAFLD with the earlier classification, identify high-risk patients, study literature data on the mechanisms of NAFLD pathogenesis, clinical features and extrahepatic manifestations, diagnosis, prevention and treatment options. The work explored the USA and Europe, incl. Latvian, hepatologist guidelines, which were developed together with endocrinologists and other specialists, and also used information from medical Internet resources and databases. Several images and diagrams were translated and adapted from cited international medical sources. During the writing of the residency work, changes occurred in the field of medicine - the NAFLD nomenclature was changed. Since 2023, the new definition has been used, i.e. metabolic associated steatotic liver disease (MASLD). Keeping the previous name (NAFLD), the work was supplemented with new facts and information. NAFLD is a multifactorial disease whose pathogenesis is based on insulin resistance and hyperinsulinemia. Due to this, people with adiposity, metabolic syndrome and diabetes are at risk, and according to statistics, the number of people at risk is increasing. NAFLD is being diagnosed at an increasingly earlier age, as the prevalence of obesity is increasing among young people and children. But as research data shows, liver steatosis is also verified in people with normal body mass and the level of laboratory indicators characterizing normal liver function. NAFLD diagnosis is a complex process. It is based on the patient's anamnesis, recognition of metabolic risk factors, clinical examination with blood biochemical indicators and imaging, non-invasive liver tests, as well as invasive tests - liver puncture with 4 subsequent histological examination of the liver is still the gold standard in determining the diagnosis. Due to the lack of specific medications, the main treatment for NAFLD is lifestyle changes. These include dietary changes and restrictions, gradual increases in aerobic exercise and strength training, and gradual weight loss. Lifestyle changes are mandatory for all patients, with individual adjustments for each. Considering that the prevalence of NAFLD is increasing worldwide in parallel with obesity and cardiometabolic diseases (insulin resistance, dyslipidemia, central obesity and hypertension), it can be concluded that it is the work of a multispecialty medical team. Initially, these are family doctors, internists and endocrinologists, who must identify at-risk persons in time. Further work to prevent the occurrence of complications should be carried out by such doctors as hepatologists, gastroenterologists, surgeons, nutritionists.
Nieru artērijas denervācijas ietekme uz ehokardiografijas parametriem pacientiem ar rezistentu arteriālo hipertensiju
(Rīga Stradiņš University, 2024) Hiļkevičs, Jevgenijs; Trušinskis, Kārlis; Faculty of Residency; Rezidentūras studiju fakultāte
This work investigates the effect of renal artery denervation (RAD) on various echocardiographic parameters in patients diagnosed with resistant arterial hypertension (RAH). The aim of the study is to evaluate the effectiveness of RDN in improving cardiac structure and function by analysing echocardiographic data before and after the procedure. Introduction: Resistant arterial hypertension (RAH) is a significant global healthcare problem due to its widespread prevalence and severe complications. It is a leading risk factor for cardiovascular disease, chronic kidney disease and cognitive disorders. The introduction points out that the prevalence of RAH is increasing and that effective treatment strategies beyond conventional pharmacotherapy are required. Methods: Seventeen patients with resistant hypertension undergoing RDN participated in the study. Participants included both men and women with a mean age of 59.7 years. Echocardiographic measurements were performed before the RDN procedure and three months after the procedure. Paired t-tests were used to determine the statistical significance of changes in echocardiographic parameters. The main echocardiographic parameters that were analysed were: Diastolic diameter (EDD),End systolic diameter (ESD),Ventricular septal thickness (IVSD),Posterior wall thickness (PWD),Left ventricular mass index (LWMI),Ejection fraction (EF),Deceleration time (DT),E/A ratio,E mean (E),E/E' ratio. RESULTS: The findings showed statistically significant improvements in several parameters including: LWMI (p=0.0263): This indicates a reduction in left ventricular hypertrophy. DT (p = 0.0135): This indicates an improvement in diastolic function. Other parameters such as IVSD (p-0.062) and E/E' (0.0646) showed positive trends but did not reach the usual level of statistical significance (p < 0.05). Discussion: The discussion compares the results with similar studies and highlights the potential clinical role of RDN in improving cardiac function and structure in patients with RAH. It discusses limitations such as small sample size and variability in patient response, and suggests directions for future research. Conclusions: Renal artery denervation is a promising intervention to improve cardiac echocardiographic parameters in patients with resistant hypertension. The study provides evidence supporting the efficacy of RDN in reducing left ventricular mass and improving diastolic function, highlighting the need for larger and longer-term studies to confirm these results. The thesis cites an extensive list of studies and guidelines related to hypertension, echocardiography and renal denervation, providing a solid basis for the study conducted.
Ērču encefalīta vakcinēto pacientu skaits un saslimstība Kuldīgas novadā vienas ģimenes ārstu prakses ietvaros saistība ar sociāli demogrāfiskajiem faktoriem, informētību par slimību, nodarbošanos un inficēšanās reģionu
(Rīga Stradiņš University, 2024) Sudraba, Dace; Eglīte, Rūta; Faculty of Residency; Rezidentūras studiju fakultāte
The dynamics of tick-borne encephalitis affected endemic areas are spreading, not only in Latvia but throughout Europe. Given the growing public health issue of this disease, the containment of tick-borne encephalitis, active immunization, and informing the public about the disease have been primary tasks for all European countries and the WHO in recent years. In this study, an anonymous survey was conducted from March to June of 2024. 278 respondents participated in the anonymous survey. Respondents were patients at a family doctor's practice in Kuldīga district, located in a tick-borne encephalitis endemic zone. The primary goal of this study is to identify adult residents' of Kuldīga district social factors, awareness of infectious diseases, vaccination status, whether they had suffered from tick-borne encephalitis, and any lasting consequences. The secondary aim of the research is to promote vaccination against tick-borne encephalitis, especially for those living in high-risk geographical regions. Three hypotheses were proposed: - patients who engage in outdoor activities undergo vaccination more activeley; - patients living in high-risk geographical regions of tick-borne encephalitis vaccination and preventive protection rates are low; - patients who have suffered severe consequences from tick-borne encephalitis had not been vaccinated. 55% of all 278 respondents were not caccinated, citing disbelief in vaccine effectiveness, unwillingness, or financial circumstances as the main reasons. Compared to other countries, 63.7% of respondents in Kuldīga district are informed about tick-borne encephalitis and its consequences. These figures, compared to other endemic countries, are average. [1] Data collected in the research did not confirm that patients who engage in outdoor activities are more likely to be vaccinated. Only 38.7% of the respondent group that spends an average amount of time in nature have been vaccinated against tick-borne encephalitis, and the group that frequently spends time in nature has a vaccination rate of 37%. Therefore spending more time outdoors or in nature is not determining factor for increased activity for vaccination against tick-born encephalitis. Among the patient group that suffered lasting effects after recovering from encephalitis, no one had been actively immunized at the time of illness. Meanwhile, in the study group that had been infected and vaccinated during their lifetime, no one had lasting health consequences. 5 The lack of personal risk and reduced awareness about the disease and vaccine effectiveness are the main risks for not conducting full-scale immunization and thereby increasing the risk to public health.
Dažādu metožu pielietojums nepieciešamās enerģijas izvērtēšanai enterālās barošanas pacientiem
(Rīga Stradiņš University, 2024) Rusecka, Svetlana; Meija, Laila; Faculty of Residency; Rezidentūras studiju fakultāte
Enteral nutrition (EN) is an important part of the patient's nutrition and complex treatment. EB allows nutrients to be delivered in the gastrointestinal tract to patients who cannot take in sufficient amounts orally at all. There are many and often complex diseases that necessitate the provision of EN. More common include swallowing disorders due to neurological diseases and malignant tumors, diseases of the gastrointestinal tract. An integral part of successful EN provision is prevention of the risk of malnutrition or overfeeding the patient, a personalized approach and achieving the goal of energy and protein intake by evaluating the individually required amount of energy for each patient. This study was created to evaluate the required amount of energy for EN patients, to find out the compliance of energy requirements with the recommended amount of energy according to the guidelines, as well as to draw conclusions that will help doctors to better understand the real energy consumption of EN patients. In my work, I put emphasis on oncology patients who receive EN, because data from the world literature show that the number of new oncology patients who need EN is increasing significantly, as well as the duration of EN is increasing, which indicates the need to monitor patients and adjust the EN plan. My study included 24 patients who had their resting state energy consumption measured using indirect calorimetry (IC) and bioelectrical impedance analysis (BIA) methods. The obtained data were compared with each other and with the amounts recommended in the ESPEN guidelines. Results: A statistically reliable difference was observed between the two methods when comparing both the results of basal metabolism (BM) and the results of the amount of required energy (RE). Comparison of RE volume obtained by indirect calorimetry and bioelectrical impedance analysis showed a difference of up to 2 kcal/kg/day in some cases. Comparing the obtained results with those recommended in the guidelines, only 10(41.7%) of the participants in IC and respectively 9(37.5% )of the patients in BIA showed the RE volume indicated according to the guidelines. For all other study participants, the amount of RE was less than recommended in the guidelines or exceeded the recommended energy consumption.

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