Pauls Stradins Clinical University Hospital Research Articles

#2859 Clinical and morphological characteristics of biopsy-proven kidney graft rejection in Latvia

Abstract Background and Aims Kidney transplantation is a treatment for many patients with end stage renal disease leading to increased quality of life. In last decades results in kidney transplantation have been improving, but allograft rejection remains an important clinical problem. Graft biopsy remains the gold standard to assess the cause of kidney transplant status. This study aimed to determine clinical and histopathological characteristics, treatment and short-term outcomes of biopsy-proved kidney graft rejection in Latvia. Method In this retrospective observational study all kidney allograft biopsies performed in Pauls Stradins Clinical University Hospital from January 2014 till December 2022 was reviewed. Biopsies with rejection, ≥7 glomeruli, patients ≥18 years old were included. Acute rejection was diagnosed according to clinical, laboratory and biopsy-proven acute rejection (BPAR) histological criteria. BPAR was classified and subdivided using Banff criteria. All recipients universally received either depleting or non-depleting induction therapy. Most of the patient (82%) for maintenance immunosuppression (MI) received triple therapy with calcineurin inhibitor, mycophenolate mofetil, and prednisone, others—in different combinations with above and mammalian target of rapamycin (mTOR), azathioprine. Graft function was evaluated according to glomerular filtration rate (GFR), calculated with the CKD-EPI Creatinine, 2021 equation. Treatment strategies, laboratory data at the time of biopsy and after 1 year follow-up were analysed. Repeated-control biopsies after receiving therapy were excluded. Data were analysed using descriptive statistics and T-test. Results From all 523 biopsies, further included and analysed were 153 (total 146 patients). 58% were males, average patient age was 45.5 years. Most 84% of the grafts were from deceased, 8%—living donors. Mean time from transplantation to biopsy was 32 months. Acute antibody-mediated rejection (AAMR) was diagnosed in 41% cases, chronic-active antibody mediated (CAAMR)—25%, followed by mixed 16%, acute cellular (ACR) 10% and borderline 8% rejection. Besides augmented MI for almost all patients, pulse steroids (GCS) were the most commonly 70% administered treatment, followed by plasma exchange 59% (PEX), rituximab (RTX) 50%, immunoglobulins (IG) 24% and anti-thymocyte globulin (ATG) 10% in different, mostly non-homogenous combinations. Non adherence, advanced fibrotic changes in biopsy and serious comorbidities were the main reasons patients did not receive specific treatment besides intensified MI. The most favourable outcomes were in ACR where mean allograft GFR increased +20.7 ml/min after one year, compared to the worst outcome CAAMR group where GFR decreased −4.7 ml/min (p = 0.03). In ACR group 92% graft function stayed the same or improved, moreover 54% graft function increased ≥20% from baseline; similarly in mixed and AAMR group GFR increase ≥20% were for 45% and 48%, compared to CAAMR where it was only for 6% of patient. Furthermore, the CAAMR group was with the most patients (48%) who returned to dialysis or died. In AAMR and mixed rejection groups mean GFR changes were close +13.4 ml/min and +12.9 ml/min (p = 0.95). There were no statistically significant associations between treatment outcomes in PEX+RTX+GCS vs PEX+RTX+GCS+IG in the AAMR group (p = 0.382). Overall, 3.9% of patients died. Conclusion Overall BPAR prevalence between kidney graft biopsies was high (29%). Antibody mediated rejection was diagnosed most often with least favourable short-term outcomes in CAAMR group. Despite various improvements in immunosuppression, CAAMR remains a serious cause of transplant dysfunction or loss.

The Initial Experience of Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension in Latvia.

Background: Treatment options for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or persistent pulmonary hypertension after pulmonary endarterectomy (PEA) include targeted medical therapy and balloon pulmonary angioplasty (BPA). BPA is an emerging treatment modality that has been reported to improve functional capacity, pulmonary hemodynamics, and right ventricular function. Reports from expert centers are promising, but more data are needed to make the results more generalizable. Materials and Methods: We conducted a prospective analysis of nine consecutive CTEPH patients who underwent balloon pulmonary angioplasty (BPA) sessions at Pauls Stradins Clinical University Hospital in Riga, Latvia between 1 April 2022 and 1 July 2023. We assessed World Health Organization (WHO) functional class, 6 min walk distance (6MWD), blood oxygen saturation (SpO2), brain natriuretic peptide (BNP) level at baseline and 3 months after the first BPA session. For two patients on whom repeated BPA sessions were performed, we additionally assessed cardiac output (CO), pulmonary vascular resistance (PVR), and mean pulmonary artery pressure (mPAP). Results: A total of 12 BPA procedures for nine patients were performed; repeated BPA sessions were performed for two patients. Our results show a reduction in BNP levels and improvement in WHO functional class, 6MWD, and SpO2 after the first BPA session. Improvement in 6MWD was statistically significant. Additionally, an improvement in pulmonary hemodynamic parameters was observed. Conclusions: Our data show that BPA is an effective interventional treatment modality, improving both the pulmonary hemodynamics and functional status. Moreover, BPA is safe and excellently tolerated.

#5133 MONTREAL COGNITIVE ASSESSMENT (MOCA) AND DYSMORPHIC RED BLOOD CELLS IN PATIENTS WITH IMMUNOGLOBULIN A NEPHROPATHY

Abstract Background and Aims Patients with chronic kidney disease (CKD) are at an increased risk of cognitive dysfunction, which is characterized by deficits in executive functions, memory and attention. Previous studies have suggested that albuminuria and lower estimated glomerular filtration rate (eGFR) are related to mild cognitive impairment (MCI) and dementia. There are no studies that have noticed connection between glomerular activity presented by dysmorphic red blood cells (RBC) count and cognitive evaluation results. The aim of the study was to investigate the association of cognitive decline with renal function and other possible risk factors such as albuminuria, proteinuria, and hematuria in patients with immunoglobulin A nephropathy (IgAN). Method A prospective study that took place from January 2020 till January 2022 at Pauls Stradins Clinical University Hospital Nephrology center included patients with IgAN. Diabetes mellitus, oncology, acute inflammation processes, transplantation in anamnesis were exclusion criteria. Demographic, anamnestic, clinical, laboratory data for renal function evaluation were collected. GFR was calculated using CKD-EPI Creatinine Equation. Urine spot protein/creatine ratio was used for proteinuria measurement. Urine microscopy was performed by a nephrologist. Patients were assessed with a MoCA. Results of MoCA have been compared with potential risk factors. Results Sixty-five patients were included in the study. The mean age of the participants was 42.06 ± 10.71 years (IQR 35-47.75; range, 21-65), with predominance of male sex (62.1%), mainly with higher education (45.5%). Dialysis was performed in 7 patients. The average duration of illness was 89.97 months ± 97.95 (IQR 31.5-120, range 1-456 months/38 years). Average GFR was 59.26 ± 38.66 (IQR 20.25-91.75, range 3-131) ml/min/1,73m2, urea 12.57± 9.88 (IQR 6.3-15.45, range 4-62). Patients did not have anemia, average hemoglobin 135.20± 14.8. Average proteinuria was 0.53±0.99 g/g (IQR 0.064-0.52, range 0.06-6.20), albuminuria - 69.34±107.3 g/mol (IQR 10.95-69.4, range 0.45-620). Average hematuria was 116.68±239.67 RBC/mkl (IQR 9.9-92.1, range 1.5-1421.3), while dysmorphic RBC count was 4.02±12.08 RBC/hpf (IQR 0-2.5, range 0-80). MoCA ≤ 26 was observed in 41% of the patients. The MoCA total score have moderate correlation with the patients age (p = 0.01, r = -0.39). Patients age correlated with memory task score (p = 0.002, r = -0.42). Dysmorphic RBC count in urine sediment corelated with attention task (p = 0.002, r = -0.42). Conclusion Mild cognitive impairment is frequent even in our young age IgAN patient's cohort. Even small age difference plays role in MoCA evaluation score. No correlations have been found between proteinuria or albuminuria and MoCA score. Association between dysmorphic RBC and cognitive decline should be studied in bigger cohorts’ studies.

Sporadic pancreatic neuroendocrine neoplasms: A retrospective clinicopathological and outcome analysis from a Latvian study group.

Although pancreatic neuroendocrine neoplasms (PNEN) are rare, there has been a constant increase in incidence. Furthermore, PNEN present unique clinical behaviors and long-term survival can be expected even in the presence of metastases as compared with ductal adenocarcinoma of the pancreas. Determining the best therapeutic approach and proper timing of therapy requires knowledge of reliable prognostic factors. Therefore, the aim of this study was to explore clinicopathological features, treatment, and survival outcomes of patients with PNEN based on Latvian gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN) registry data. Patients with confirmed PNEN at Riga East Clinical University Hospital and Pauls Stradins Clinical University Hospital, between 2008 and 2020, were retrospectively analyzed. Data were collected and included in EUROCRINE, an open-label international endocrine surgical registry. In total, 105 patients were included. The median age at diagnosis was 64 years (IQR 53.0-70.0) for males and 61 years (IQR 52.5-69.0) for females. In 77.1% of patients, tumors were hormonally nonfunctional. Among those with functioning PNEN, 10.5% of patients presented with hypoglycemia and were diagnosed with insulinoma, 6.7% of patients presented with symptoms related to carcinoid syndrome; 30.5% of patients showed distant metastases at the time of diagnosis, and surgery was performed in 67.6% of patients. Notably, for five patients with nonfunctional PNEN <2 cm, a "watch and wait" approach was used; none of the patients developed metastatic disease. The median length of hospital stay was 8 days (IQR 5-13). Major postoperative complications were found in 7.0% of patients, and reoperation was conducted for 4.2% of patients, due to postpancreatectomy bleeding (2/71) and abdominal collection (1/71). The median follow-up period was 34 months (IQR 15.0-68.8). The OS at the last follow-up was 75.2% (79/105). The observed 1-, 5- and 10-year survival rates were 87.0, 71.2 and 58.0, respectively. Seven of the surgically treated patients had tumor recurrence. The median time of recurrence was 39 months (IQR 19.0-95.0). A univariable Cox proportional hazard analysis provided evidence that a nonfunctional tumor, a larger tumor size, the presence of distant metastases, a higher tumor grade, and the tumor stage were strong, negative predictors of OS. Our study represents the general trends of clinicopathological features and treatment of PNEN in Latvia. For PNEN patients, tumor functionality, size, distant metastases, grade, and stage may be useful to predict OS and must be confirmed in further studies. Furthermore, a "surveillance" strategy might be safe for selected patients with small asymptomatic PNEN.

Pathological complete response to neoadjuvant chemotherapy in triple negative breast cancer – single hospital experience

BackgroundTriple-negative breast cancer is a heterogeneous molecular subtype of BC. Pathological complete response (pCR) is an important surrogate marker for recurrence-free and overall survival.Aim of studyThe aim of this study was to evaluate clinical and pathological factors that are associated with complete pathological response status in triple-negative breast cancer patients receiving neoadjuvant chemotherapy.Materials and methodsEighty triple-negative breast cancer patients who underwent neoadjuvant chemotherapy followed by surgery at Pauls Stradins Clinical University Hospital between January 2018 and January 2020 were retrospectively analysed. Twenty-six patients (32.5%) were BRCA1/2 pathogenic variant carriers.ResultsA total of 32.5% (n = 26) of patients in all study groups and 57.7% (n = 15) of patients with BRCA1/2 pathogenic variants achieved pCR. Forty-seven patients received platinum-based neoadjuvant chemotherapy, and 19 patients (40.4%) achieved complete pathological response. Patients in the pCR group presented with significantly higher Ki-67 scores (p = 0.007), BRCA1/2 pathogenic variants (p = 0.001) and younger age (p = 0.02) than those in the non-pCR group. pCR did not significantly impact recurrence-free survival (RFS) or overall survival (OS). Multivariate analysis revealed that pretreatment N stage (clinical nodal status) was an independent prognostic factor for RFS and OS.ConclusionsBRCA1 pathogenic variants, high Ki67 score and young age were predictors of pathological complete response, while clinical nodal status predicted survival outcomes in triple-negative breast cancer.

The Impact of Revascularization in a Patient with Atypical Manifestations of Hypoperfusion

Background and Objectives: Carotid revascularization is one of the most effective treatment options in patients with severe carotid artery stenosis causing hypoperfusion in basal ganglia. Atypical manifestations include hyperkinetic movements, noted as extremely rare. We report a case about a patient with 2-months-long complaints of Uncontrollable movements in his right side of the body subsided after carotid revascularization. Case presentation: A 71-year-old male was admitted to Pauls Stradins Clinical University Hospital with the main complaints of 2-months-long uncontrollable movements in his right hand and his right leg. When performing coordination tasks, slight inaccuracy was noted with the right-side extremities. Hyperkinetic movements—choreoathetosis in the right side of the patient’s face, arm, and leg—were seen. Computed tomography angiography revealed subocclusion in the proximal segment of the left internal carotid artery and 30% stenosis in the proximal segment of the right internal carotid artery. The patient was consulted by a vascular surgeon. Eversion endarterectomy of the left internal carotid artery was performed. The early postoperative period occurred without complications. The patient was discharged from the hospital 2 days after the surgery in good overall health condition. Two months later, choreoathetotic movements in his right side of the body had markedly decreased. No focal neurologic deficits were noted. Conclusions: Revascularization may be effective by eliminating emboli and stenosis, leading to hypoperfusion in watershed territories. A case of a 71-year-old male patient with the main complaints of 2-months-long uncontrollable movements in his right side of the body subsiding after carotid revascularization was demonstrated. It is vital to recognize atypical manifestations of hypoperfusion, associated with stenosis in internal carotid arteries, to early make a diagnosis, to perform an appropriate treatment, and to reduce the risk of cerebral infarction in the future, resulting in a longer high-quality life for the patient.

COMPARATIVE EFFICACY OF ANTIARRHYTHMIC MEDICATIONS FOR SINUS RHYTHM MAINTENANCE AFTER ELECTRICAL CARDIOVERSION FOR ATRIAL FIBRILLATION

Objective: Sinusa rhythm maintenance while using IC class medications is not practically studied. IC class medications aethacizinum is widely used, but has no large studies proving safety and efficacy. The aim of this study was to compare the efficacy of class IC antiarrhythmic medications, for sinus rhythm maintenance, after ECV (electrical cardioversion), in patients with atrial fibrillation (AF). Design and method: It is an open-label, one-center prospective study that held in the Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital from September 2019 to June 2020. Before hospitalisation patients have not received any antiarrhythmic drugs except of amiodarone and beta blockers. Patients with persistent form of AF received beta blockers (bisoprolol 5 mg daily), amiodarone (200 mg daily), propaphenone (300 mg daily) or aethacizinum (100 mg daily) for 6 months after conversion to sinus rhytm by ECV. Rest ECG, Holter monitoring, echocardiography, ergometer stress test, blood tests were performed. Results: The total number of patients finished study per protocol – n = 52. On echocardiographical study no significant changes in AFR (AF paroxysm group) and MSR (maintained sinus rhythm) groups were found. No safety parameters were significantly changed in this group. All patients were followed up for 6-month period. Reccurance rate of AF in aethacizinum group showed a statistically significant superiority compared to propafenone (55,6% vs 72,5%) (p = 0,05). Patients with higher atrial strain and strain rate appear to have a greater likelihood of staying in sinus rhythm. In our research, duration of AF was not predictive value of maintenance of SR at follow-up after 6 months from ECV. Conclusions: Antiarrhythmic medications of Ic class may be safe in patients with persistent form of atrial fibrillation and have no negative impact on inotropic function of myocardium. The most commonly used drug from Ic class ir etacizin. The observed efficacy provides the rationale for a larger, double-blind controlled study with different antiarrhythmic medications in different daily dosage.

MO213: Sars-COV-2 Vaccination DID Not Affect the Clinical Course of IGA Nephropathy in Latvian Adult Cohort

BACKGROUND AND AIMSThe current strategy to fight against the COVID-19 pandemic involves active patient vaccination. Patients with renal and autoimmune diseases are in high risk for severe COVID-19 infection [1]. Therefore they should be prioritized for vaccination. Immunoglobulin A nephropathy (IgAN) is one of the most common primary glomerulonephritis triggered by mucous membrane alteration; however, there is a discussion about vaccination-caused IgA flare [2]. The immunological nature of IgAN and misleading information in public sources leaves patients skeptical about whether to get vaccinated [3]. The study aimed to investigate the impact of SARS-CoV-2 vaccination on the clinical course of IgA nephropathy.METHODAdult patients treated in Pauls Stradins Clinical University Hospital with morphologically proven IgAN were included in the study. Patients with secondary IgAN were excluded. Evaluation of clinical and laboratory markers was performed on inclusion visit and on the second visit 6 months later. SARS-CoV-2 vaccination type and status were noted on both visits. Estimated GFR was calculated with CKD-EPI creatinine–cystatin equation. IBM SPSS Statistics version 27 and Microsoft Excel 10 were used for data analysis.RESULTSThe study involved 54 patients, 36 were unvaccinated and 18 were fully vaccinated. A significant difference between the two groups was observed by baseline proteinuria. Other differences were not observed. Fourteen patients were vaccinated with mRNA vaccine, 13 with Comirnaty and 1 with Spikevax, and four patients were vaccinated with Vaxzevria vector vaccine. The differences between the two groups are shown in Table 1. During study period, two patients had COVID-19 infection; a patient in the vaccinated group had COVID-19 prior to vaccination.Table 1.CharacteristicsVaccinatedUnvaccinatedP-value*Total, n1836Male/female, n (%)13/5 (72/28)22/14 (61/39).425Age, years43.4 (9.8)41.6 (11.0).451Baseline eGFR**46.1 (30.7)49.8 (31.6).569Baseline 24-h proteinuria***0.28 (0.32)0.8 (0.97).014Baseline hematuria, n (%)16 (89)28 (78).143Baseline IgA, g/L3.5 (1.2)3 (0.8).147Baseline C3c, g/L1.2 (0.8)1 (0.2).689Delta eGFR**1.8 (5.4)−0.5 (8.5).612Delta 24-h proteinuria***−0.19 (0.33)0.07 (0.65).214Hematuria after 6 months, n (%)13 (72)29 (81).44IgA after 6 months, g/L3.6 (1.1)3.1 (0.8).183C3c after 6 months, g/L1.1 (0.2)1.1 (0.2).517Diseased with COVID-19, n (%)1 (5)1 (3).614Estimates are given as mean values (standard deviation)*Results were analyzed using Mann-Whitney U test and were expressed as P-values.**Estimated GFR, mL/min/1.73 m2.***Estimated 24-h proteinuria, g/24 h/1.73 m2.CONCLUSIONSARS-CoV-2 vaccination did not affect the clinical course of IgA nephropathy. Our study results indicate that SARS-CoV-2 vaccination in IgA nephropathy patients was safe regarding renal function and disease activity markers.

Risk factors associated with mortality in the infective endocarditis patients requiring cardiac surgery: a study based on Latvian population.

Increased life expectancy, developments in medicine and intracardiac devices, accessibility of cardiac surgery, decrease in the prevalence of rheumatic heart disease are changing infective endocarditis patient profile and thus risk factors for the adverse events. This single-center-based study covering the whole Latvian population aimed to assess the intrahospital and 3-year mortality of infective endocarditis patients who underwent cardiac surgery, as well as risk factors and laboratory indices predictive of adverse outcomes of the disease. Clinical profiles, data of laboratory and instrumental analyses, operation and intensive care unit records of cardiac surgery patients treated in Pauls Stradins Clinical University Hospital, Riga, Latvia, between 2015 and 2019 were analyzed. We analyzed data from 242 episodes of surgically treated infective endocarditis in 233 patients. The median age of patients was 57.00 (45.00-68.00) years. The rate of intrahospital mortality was 11.16%. Risk factors associated with mortality in the univariate analyses were S. aureus infection (HR=2.27, 95% CI: 1.36-3.80; P=0.002) and systemic embolization of vegetations (HR=1.63, 95% CI: 1.00-2.64; P=0.048). Perivalvular complications (HR=1.98, 95% CI: 1.19-3.29; P=0.009) were found to be independently associated with mortality in multivariate analysis (HR=1.99, 95% CI: 1.05-3.78; P=0.035). One-year survival was 78.3%, whereas three-year -71.3%. Intrahospital mortality of surgically treated IE patients was 11.2%; however, one- and three-year mortality was 21.7 and 28.7%, respectively. Perivalvular complications were independently associated with mortality. Laboratory indices were not predictive of adverse outcomes.

MO319BEDSIDE URINE SEDIMENT EXAMINATION IN IMMUNOGLOBULIN A NEPHROPATHY PATIENTS PERFORMED BY NEPHROLOGISTS

Abstract Background and Aims Urine sediment microscopy is mostly abandoned by nephrologists nowadays, however it is an important diagnostic tool in kidney and urinary tract diseases. The aim of this study is to emphasize the benefits of urine microscopy performed by a nephrologist. Method A prospective cohort study at Pauls Stradins Clinical University Hospital Nephrology center included patients with histologically confirmed diagnosis of IgA nephropathy from 1st January 2020 till December 2020. Appropriately collected urine samples were examined using manual microscopy within an hour after sample collection and by automated urinalysis. Samples were centrifuged at 4000 rpm for 4 minutes, the supernatant urine was carefully decanted, 1 - 1,5 ml of the left urine was mixed by gentle agitation and placed on a standard glass slide with a cover slip. Sample examination was performed using low (magnification x10) and high power (magnification x40) using brightfield microscopy with a minimum of 10 fields. Results A total of 37 patients (24 men, mean age 42.7 ± 10.9 years) were included in the study. 59.5 % of patients (n = 22) had hematuria based on automated urine sediment analysis and 62.2 % (n = 23) of patients had hematuria based on manual urine microscopy. 45.9 % of patients (n=17) had dysmorphic erythrocytes, 13.5 % of patients (n = 5) had isomorphic red blood cells (RBC) and 40.5 % of patients (n = 15) did not have RBC in urine samples by manual urine microscopy. 54.2 % (13/24) of men and 30.8 % (4/13) of women had dysmorphic RBC in urine. Conclusion Manual urine sediment examination was more sensitive than automated analysis. Majority of IgA nephropathy patients have active urine sediment with hematuria and dysmorphic RBC. Manual microscopy remains an effective and reliable method that can be easily and quickly performed by nephrologists.

Long-Term Out come Evaluation in Patient Undergoing Deep Hypo-thermic Circulatory Arrest in Aortic Arch Surgery

Background: Aortic dissection is usually associated with low survival rates due to high prehospital and perioperative mortality, in addition with increased risk of postoperative complication in survivals. Since 1985, deep hypothermic circulatory arrest (DHCA) is often used in aortic arch surgery with main advantage to provide bloodless surgical field while protecting brain tissue during hypothermia. Nevertheless, it still raises concern of increasing neurologic sequelae and a potential decrease of long-term quality of life. The aim of study: To evaluate the effect of DHCA used in aortic surgery on long-term quality of life. Methods: In this observational case series we included a total of 24 patients who had aortic arch surgery requiring DHCA in the Pauls Stradins Clinical University Hospital Cardiac Surgery center, from January 2019 to December 2020. Seven patients were excluded due to intrahospital death. For the rest of the patients Quality of life (QOL) was evaluated using RAND SF36 questionnaire and MMSE test. Data regarding demographics, clinical characteristics, surgery type, duration of circulatory arrest, rectal and bladder temperatures were collected and analyzed using the SPSS 23 Statistics software IBM SPSS Statistics 21 (IBM Corporation, NY, USA). Statistical significance was assumed as two- tailed p &lt;0.05. Results: A total of 17 patients were analyzed, we had 12 (71%) males and 5 (29%) females. A mean age was 60.71 (±13.8 SD) years, leading co-morbidity was hypertension – 11 (64.7%). There were 6 (35.3%) elective and 11 (64.7%) acute surgeries. Stan-ford A dissection (82.4%) constituted the main part of all cases. A 94.7% had aortic arch replacement. Most common postopera-tive complication was wound infection- 29.4%. The mean cardiopulmonary bypass time, aortic cross-clamping and reperfusion time was 212 (±38.3, SD), 124 (±33.8, SD) and 70.2 (±32.9, SD) minutes, respectively. Core temperature during DHCA was 23.2 Cº (±3.2, SD) and a rewarming rate was 0.12 (±0.07, SD) Cº/min. No significance correlation between RAND SF36 questionnaire score (QoL questionnaire) and lowest DHCA temperature, aortic cross - clamping, reperfusion time, CPB time was observed, respectively - p=0.367, p=0.544, p=0.619, p=0. We found statistically significant moderate strength correlation between QOL and rewarming rate (r=0.550; p=0.022). Mean RAND SF36 questionnaire score was 71.9±10. and mean MMSE score was 27.9±5,3. Conclusions: We found no correlation between quality of life and lowest temperature during surgery, aortic cross- clamping time, reperfusion time, however we found positive moderate strength correlation between rewarming rate and quality of life. Patient quality of life after surviving aortic arch surgery and deep hypothermic circulatory arrest compared to general healthy population quality of life is slightly reduced. Mini-mental state exam and RANDO short form health survey can be useful scoring system to evaluate patient quality of life.

Hand-Washing Video Dataset Annotated According to the World Health Organization’s Hand-Washing Guidelines

Washing hands is one of the most important ways to prevent infectious diseases, including COVID-19. The World Health Organization (WHO) has published hand-washing guidelines. This paper presents a large real-world dataset with videos recording medical staff washing their hands as part of their normal job duties in the Pauls Stradins Clinical University Hospital. There are 3185 hand-washing episodes in total, each of which is annotated by up to seven different persons. The annotations classify the washing movements according to the WHO guidelines by marking each frame in each video with a certain movement code. The intention of this “in-the-wild” dataset is two-fold: to serve as a basis for training machine-learning classifiers for automated hand-washing movement recognition and quality control, and to allow to investigation of the real-world quality of washing performed by working medical staff. We demonstrate how the data can be used to train a machine-learning classifier that achieves classification accuracy of 0.7511 on a test dataset.

Diabetic Retinopathy. Association with Metabolic Compensation, Duration of Diabetes and Other Micro and Macrovascular Complications in Patients with Type 1 Diabetes Mellitus

Summary Introduction Diabetic retinopathy (DR) is a severe complication that can lead to complete vision loss and still is one of the main blindness-causing reasons among patients with type 1 diabetes mellitus (T1DM). DR as a complication can cause vision loss to people at their working age. More than 90% of patients with type 1 diabetes will develop DR by 20 years post diagnosis (Leslie R. Dye, 2018). DR is more likely to develop in patients with T1DM (Kanski's Clinical Ophthalmology, 2016). This complication can be very serious speaking of the ability to see. Sometimes vitrectomy plays a vital role in the management of severe complications of DR at its end-stage (Myron Yanoff et al., 2020). Aim of the study To prove the development severity of DR that depends on the duration of diabetes and metabolic compensation. Additionally, to determine retinopathy's association with other micro and macrovascular diabetes mellitus complications for a better understanding of what are the contributory factors for these complications to develop and which of those may coexist. Materials and Methods A retrospective study was held at the Pauls Stradins Clinical University Hospital (Riga, Latvia). From January 2016 to March 2018, 79 (158 eyes) patient histories were analyzed who have type 1 diabetes mellitus. To obtain more precise research results, almost all patients have done check-up visits to one certain ophthalmologist. The IBM SPSS Statistics version 25.0 was used to process data. Tables were made in SPSS and Microsoft Excel 2016 programs. Statistically significant value (p) was set at &lt; 0,05. Results No statistically significant difference is seen in the mean duration of the disease: in the group of proliferative diabetic retinopathy (PDR): 25.23 (median = 22.0) years and non-proliferative group: 24.68 (median = 23.50) years. Results show that the duration of diabetes mellitus is considerably smaller in a group without DR 11.24 (median = 8.50) years. Metabolic compensation (%) in diabetes mellitus is not statistically different between patients with diverse forms of DR; no association found either. No statistically significant difference in best corrected visual acuity (BCVA) was detected among patients with various forms of DR. Three groups were compared: both types of DR and no DR. It was detected that BCVA in patients without DR was higher in both eyes: 0.83 ± 0.27 dioptres. No statistically significant difference (pχ &gt; 0.05) was detected between the groups of DR and therefore no association was made between the form/existence of DR and arterial hypertension. There is a strong association between DR and microvascular complications (V = 0.40) with the existence of DR and there is an even stronger association (V = 0.61) with the forms of DR. There is no statistically reliable difference (pχ &gt; 0.05) between the groups of DR; therefore, no association with the existence of microvascular complications and also risk factors. Conclusions More than two-thirds of patients included in the research have some signs of DR. Because of the strong association of DR and other microvascular complications, patients with diabetes should be screened regularly for retinopathy, nephropathy, and neuropathy. And likewise, if a patient has at least one microvascular complication, he or she should be tested for the rest possible complications as well. According to data, most of the patients in this study have poor metabolic compensation; consequently, the metabolic compensation screening should be done certainly every three months.

Neoadjuvant Chemoradiotherapy in the Downstaging of Locally Advanced Rectal Cancer and its Impact on Progression–Free Survival

Summary Introduction The standard treatment for locally advanced rectal cancer (LARC) is neoadjuvant chemoradiotherapy (NACRT) followed by radical surgery, which allows to reduce local recurrence, downsize the tumor and facilitate its R0 resection. Aim of the study The aim of this study was to evaluate the downstaging of LARC after NACRT and to assess the impact of downstaging on progression–free survival (PFS). Materials and methods 65 patients diagnosed with LARC from 2012 to 2018, who received NACRT with subsequent radical surgery were identified in the Pauls Stradins Clinical University Hospital in Riga and included in this retrospective study. Average follow–up period was 31 months. Data were analysed with SPSS Statistics 22.0, Wilcoxon signed–rank test and Kaplan–Meier survival analysis were performed. Results Overall, 66.7% (n=40) of patients experienced a downstaging in response to NACRT, of which 37.5% (n=24, p=0.004) had a downstaging of T and 63.3% (n=38, p=0.0001) of N. 12–month PFS was 87.8%, 24–month PFS – 66.1% and 3–year PFS – 62.7%, median PFS (mPFS) was not met. 3–year PFS of those patients treated with intravenous 5FU/LV boluses was significantly higher (76.5%) than those who received oral tegafur (45.6%, mPFS 32 months), p=0.038. 3–year PFS of patients with downstaged T was 85.9%, compared to 52.1% without it; mPFS not met, p=0.04. Similarly, 3–year PFS of patients with downstaged N was 71.5%, compared to 43.3% without it (mPFS 24 months), p=0.112. Lymphatic and vascular invasion were associated with significantly lower PFS compared to the patients with absent lymphatic and vascular invasion (p=0.0001 and p=0.014, respectively), while perineural invasion did not show any impact on PFS. Age at diagnosis, tumor location, type of surgery and adjuvant chemotherapy did not have a significant impact on PFS. Conclusions Results confirm the efficacy of NACRT in LARC in the downstaging of T and N. Downstaging of LARC, intravenous chemotherapy and absence of lymphovascular invasion are associated with significantly increased PFS.

Postoperative Antibacterial Prophylaxis in Vascular Surgery: Analysis of its Parameters Before and After Evaluation of Justification of Chosen Indications

Summary In surgical practice, antibacterial prophylaxis (AP) is widely used to reduce the risk of possible infectious complications; it is not always administrated according to evidence-based clinical indications. Administration of AP in cases when its inefficiency for exact situation has been scientifically proven, should be considered as unwarranted. A one-year-long retrospective analysis of AP cases in the Department of Vascular Surgery of Pauls Stradins Clinical University Hospital was performed and the results were broadly analyzed within the local structural unit. It was followed by the development of the local guidelines for administration of antibiotics, as a result, a significant decrease in cases of unwarranted AP has been achieved.

Lead-Related Infective Endocarditis in Latvia: A Single Centre Experience.

Background and Objectives: Over the last five decades cardiac implantable electronic devices (CIED) have become established as the mainstay for the treatment of permanent bradycardias, chronic heart failure and dangerous heart rhythm disturbances. These devices improve survival and quality of life in many patients. However, infections associated with CIED implantation, particularly lead-related infective endocarditis (LRIE), can offset all benefits and make more harm than good for the patient. To date, there are no other studies in Latvia, addressing patients with lead-related infective endocarditis. The objective of this study was to identify the most common pathogens associated with LRIE and their antimicrobial resistance and to identify possible risk factors of patients who present with LRIE. Materials and Methods: The study was performed retrospectively at Pauls Stradins Clinical University Hospital (PSCUH). The study included patients who were referred to PSCUH due to LRIE for lead extraction. Patients were identified from procedural journals. Information about isolated microorganisms, patient comorbidities and visual diagnostics data was taken from patient records. Results: Forty-nine patients with CIED related infective endocarditis were included in the study, 34 (69.4%) were male, median age of all patients was 65.0 (50.5–73.0) years, median hospital stay was 15.5 (22.0–30.5) days. Successful and complete lead extraction was achieved in all patients. Thirty-two (65.3%) had received antibiotics prior to blood sample. Only in 31 (63.3%) positive culture results were seen. The most common isolated pathogens were Staphylococcus aureus (23.5%) and coagulase negative staphylococci (23.5%). Other bacteria were isolated considerably less often. The atrial lead was most common location for lead vegetations, seen in 50.0% of cases. Five (10.2%) patients have died due to the disease. Conclusions: Lead-related infective endocarditis is a major complication of cardiac implantable electronic devices with considerable morbidity and mortality, which in our study was as high as 10.2%.

Methods for detection of direct oral anticoagulants and their role in clinical practice

Introduction: Atrial fibrillation (AF) is the most common arrhythmia that increases by age, doubles for every decade after age of 50 years and reaches about 10% patients ≥ 80 years. Despite direct oral anticoagulants (DOACs’) predictable pharmacokinetics and pharmacodynamics, the laboratory tests are necessary for effective and safe medical treatment, also for prediction and detection of thrombotic and bleeding events, as well as in situations when temporary discontinuation could be desirable. Aim: of this study was to identify and analyze the need of coagulation tests for AF patients with high cardiovascular risk in clinical practice. Methods: Quantitative, analytic, cross-sectional clinical trial, during the period from October 2016 till June 2017, was performed at Pauls Stradins Clinical University Hospital, Center of Cardiology, Latvia. There were collected data about patients with non-valvular AF, under anticoagulative therapy ≥ 3 months, defined as a high-risk group by CHA2DS2 -VASc score-more or equal to 2 or 3, men and women respectively. Data were analyzed using SPSS. Results: There were collected data about 143 patients of whom 46.2% (n=66) were male; the mean age was 69.7 (SD ± 9.9) years. About 2/3 (73.1%) of all patients the AF were longer than 1 year. The mean CHA2DS2 -VASc score was 4.2 (SD ± 1.5). The most common comorbidies were arterial hypertension (65.0%; 93), chronic heart failure (48.3%; 69), coronary artery disease (32.9%; 47), diabetes mellitus (24.5%; 35), and dyslipidemia (25.9%; 37). Almost half of patients (46.2%; 66) used DOACs, 31.5% rivaroxaban and 14.7% dabigatran respectively; furthermore, 1.4% patients used DOACs’ with antiaggregants. 49.7% (71) patients had increased risk of possible drug-drug interactions, most frequently with proton pump inhibitors (16.8%; 24), amiodarone (24.5%; 35), antiinflammatory drugs (49.0%; 70). The use of DOACs and possible drug-drug interactions increases by risk score, reaching the maximum score 3 (16.1%; 23) and the mean frequent score 4.4 of 86 (60.1%) AF patients respectively. Conclusion: Coagulation tests were applicable more than half of patients (60.1%) to detect DOACs concentration in plasma. Despite DOACs’ expected pharmacokinetics and pharmacodynamics, the anticoagulant tests are necessary for effective and safe medical treatment, also for prediction and detection of thrombotic and bleeding events, as well as in situations when temporary discontinuation is desirable .

Control of Acinetobacter baumannii outbreak in the neonatal intensive care unit in Latvia: whole-genome sequencing powered investigation and closure of the ward

BackgroundAcinetobacter baumannii is an emerging pathogen capable of causing hospital-acquired infections (HAIs). It has the ability to survive on environmental surfaces for months, making transmission difficult to control. Our report describes the investigation and restriction of an outbreak of A.baumannii in the Neonatal Intensive Care Unit (NICU) using whole-genome sequencing (WGS) and multi-modal infection control measures.MethodsA prospective surveillance of HAIs was initiated in the NICU at the Pauls Stradins Clinical University Hospital (PSCUH) in Latvia on 1/9/2012 and identified an outbreak of A.baumannii. Case definitions for A.baumannii bloodstream infection (BSI) and colonization were implemented; surveillance cultures were obtained from all admitted patients to monitor the rate of colonization; an infection prevention and control team was formed and infection control interventions implemented. Environmental sampling of the NICU and Labour ward was performed. We employed WGS to differentiate phenotypically identical multidrug-resistant A.baumannii (MDRAB) strains from simultaneous intrahospital outbreaks in the adult Intensive Care Unit and NICU.ResultsBetween 1/9/2012 and 31/12/2017 the surveillance included 2157 neonates. A total of 17 neonates had A.baumannii BSI, with the highest rate of 30.0 cases per 1000 bed-days in November 2012. Rectal screening samples were positive for A.baumannii-complex in 182 neonates reaching 119.6 per 1000 bed-days in July 2015. All 298 environmental cultures were negative. Two phenotypically identical MDRAB isolates from the simultaneous intrahospital outbreaks were differentiated using WGS, ruling out an inter-ward transmission. Adherence to stringent infection control measures decreased BSI cases but colonization remained persistent. With several relapses, the outbreak was ongoing for four years. No new A.baumannii BSI cases were registered after total environmental decontamination in the NICU in July 2015. Colonization reappeared and persisted until in November 2016 when the ward was temporarily closed, relocated and renovated. No A.baumannii cases were registered after the renovation.ConclusionThe HAI surveillance system successfully detected and facilitated the control of the A.baumannii outbreak. Whole-genome sequencing was found to be a useful method for differentiation of phenotypically identical A.baumannii strains from the intrahospital outbreak. Only multi-modal infection control program, including closure, temporary relocation, and renovation of the ward, restricted the outbreak.

55 - The effectiveness of European guidelines recommended empirical antibiotic treatment of complicated urinary tract infection in Pauls Stradins Clinical University Hospital

55 - The effectiveness of European guidelines recommended empirical antibiotic treatment of complicated urinary tract infection in Pauls Stradins Clinical University Hospital

87 - Antibiotic resistance in patients with complicated urinary tract infections and acute pyelonephritis in Pauls Stradins Clinical University Hospital

87 - Antibiotic resistance in patients with complicated urinary tract infections and acute pyelonephritis in Pauls Stradins Clinical University Hospital