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Background. The relevance of the study of the trips of Professor Aleksandrs Biezins lies in the need to highlight the most important trips for the professor, which affected his further studies, as well as the features of the application of his methods in medicine. The purpose of the article is to study the activities of Aleksandrs Biezins, his achievements, and successes in the field of pediatric surgery, as well as other areas of medicine for a more in-depth description of the outstanding surgeon. Materials and methods. The main methods used in the article include historical and analytical ones. Results. The main results are the study of the professor’s professional activities abroad, as well as within his main place of work. Medical surgeon, Aleksandrs Biezins (1897–1975), called the founder of pediatric surgery, actively practiced it and worked in the development of medicine and science, is one of the most prominent figures in pediatric surgery and medicine. The use of the information obtained in the study will be useful for a deeper and more detailed study of the work of the professor, as well as for studying the interaction of surgeons with Aleksandrs Biezins in the early and middle of the 21st century. Conclusions. In addition to his practical work in pediatric surgery and science, education of young physicians, for the scientific purposes of his missions, he was an active participant in medical forums, congresses, conferences in pediatrics, pediatric surgery, sports pedagogy, as well as actively trained in various foreign clinics.

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.

ABSTRACT Background/Aim Material and Methods Results Conclusions To evaluate the efficacy of the combined cone‐beam (CBCT)/3D‐replicas protocol on the clinical and radiographic outcomes of autotransplanted molars.Controlled clinical trial registered ISRCTN13563091 from August 2019 to September 2022. Patients aged 13–22 years requiring permanent premolar extraction and having at least one non‐erupted third molar were enrolled at the Institute of Stomatology, Stradins University, Riga, Latvia. Patients in the 3D‐replicas (n = 30) underwent maxillary CBCT scans and had 3D‐printed replicas of the third molar fabricated, while the control group (n = 28) did not. The clinical outcomes included tooth mobility, bleeding on probing, and periodontal pocket depth assessed at 3, 6, and 12 months. The radiographic outcomes included root development, obliteration, periapical status, and crown changes at 12 months.Of the 55 patients assigned to interventions, 46 completed the study. No significant differences in survival and radiographic outcomes were found between the control (n = 22) and 3D‐replica group (n = 24): root development (p = 0.3), root resorption (p = 0.057), periapical status (p = 0.7), and crown/root ratio change (p = 0.4). Logistic regression showed no significant associations between radiologic predictors (root resorption: p = 0.4; periapical status: p > 0.9; root development: p = 0.8). Significant clinical outcome predictors included total operative time (β = 0.0043, p = 0.049), Moorrees' stage (stage 4: β = −0.31, p < 0.001; stage 5: β = −0.39, p < 0.001), and four donor placement times (β = 0.93, p < 0.001), but group assignment was not a significant predictor.The CBCT/3D‐replica protocol showed no significant differences in the clinical or radiological outcomes. The high success rates in both groups suggest that the protocol is valuable primarily for optimizing surgical efficiency and as a training tool for clinicians. [ABSTRACT FROM AUTHOR]

Background and Objectives: Colorectal cancer (CRC) incidence is rapidly emerging among individuals Materials and Methods: Between September 2022 and February 2023, colonoscopy-based screening data from 1653 patients were included in this study. All eligible participants were divided into two groups, depending upon patient age, where Group 1 consisted of 1021 patients aged Results: Polyp detection rate was 42% for the Conclusions: This investigation served to highlight the importance of age stratification for CRC colonoscopy-based screening effectiveness, with particular reference to evaluations that are based on polyp localization within differing colon regions.

Soon after haemodialysis was introduced into clinical practice, a high risk of cardiac death was noted in end-stage renal disease. However, only in the last decade has it become clear that any renal injury, acute or chronic, is associated with high overall and cardiovascular lethality. The need for early recognition of kidney damage in cardiovascular pathology to assess risk and develop tactics for patient management contributed to the emergence of the concept of the “cardiorenal syndrome” (CRS). CRS is a pathophysiological disorder of the heart and kidneys in which acute or chronic dysfunction of one of these organs leads to acute or chronic dysfunction of the other. The beneficial effect of ultrafiltration as a component of renal replacement therapy (RRT) is due to the elimination of hyperhydration, which ultimately affects the improvement in cardiac contractile function. This review considers the theoretical background, current status of CRS, and future potential of RRT, focusing on the benefits of ultrafiltration as a therapeutic option.

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare and progressive condition; however, the true characteristics of CTEPH are still unknown, as notable regional variations exist in terms of patients’ age, baseline hemodynamic data, and management choices. This report aims to investigate the baseline clinical characteristics, incidence, and risk factors associated with CTEPH patients in Latvia from 2019 to 2020. Methods: The data were analyzed from a prospective, nationwide, Latvian pulmonary hypertension registry for incident CTEPH cases. The patients’ clinical characteristics were assessed at the time of diagnosis. Results: During the course of this study, a cohort of 13 patients with CTEPH were included for analysis. Among the enrolled CTEPH patients, most exhibited low exercise and functional capacity, with a median (±IQR) 6 min walk distance of 300.0 (±150.0) m. The median values (±IQR) for mean pulmonary artery pressure and pulmonary vascular resistance were 40.0 ± 13.0 mmHg and 7.35 ± 2.82 Wood units, respectively. The most common risk factors for CTEPH were a history of acute pulmonary embolism and a blood group other than O. Conclusions: The findings of this report revealed the characteristics of the Latvian CTEPH population, indicating that a significant proportion of patients are elderly individuals with multiple comorbidities.

Maternal vitamin D deficiency, which is highly prevalent in pregnant women in Europe, is linked to adverse health effects for both the mother and child. The objective was to assess vitamin D status in pregnant women by evaluating their dietary and supplemental vitamin D intake, serum vitamin D levels, parathyroid hormone levels, and lifestyle factors. This cross-sectional study, with a total of 735 participants (145 pregnant and 590 up to the seventh day postpartum), took place in Latvia. Blood samples, a food frequency questionnaire, and medical documentation were used for data collection. The median serum vitamin D concentration was 34.0 ng/mL, with pregnant women having higher levels (42.9 ng/mL) than postpartum women (31.8 ng/mL). There was no association between vitamin D serum concentration and dietary intake of vitamin D (p > 0.05), whereas there was a significant correlation with use of vitamin D supplements (r = 0.41; p < 0.001 in pregnant women and r = 0.35; p < 0.001 in postpartum women). This study demonstrated that a minority of pregnant women (21.9%) had optimal serum vitamin D concentration (>45 ng/mL), and diet had no significant impact on vitamin D levels. Thus, our proposed recommendation for vitamin D intake during pregnancy was 63 mcg (2500 IU) year-round for optimal levels in pregnant women in Northeastern Europe.

Research purpose. The purpose of this article is to investigate the most important risk factors in the assessment of the reliability and reputation of the Board Member for the implementation of responsible business activities in Latvia.

Background: Colorectal cancer (CRC) is the third most common cancer worldwide. Colonoscopy is the gold standard examination that reduces the morbidity and mortality of CRC. Artificial intelligence (AI) could be useful in reducing the errors of the specialist and in drawing attention to the suspicious area. Methods: A prospective single-center randomized controlled study was conducted in an outpatient endoscopy unit with the aim of evaluating the usefulness of AI-assisted colonoscopy in PDR and ADR during the day time. It is important to understand how already available CADe systems improve the detection of polyps and adenomas in order to make a decision about their routine use in practice. In the period from October 2021 to February 2022, 400 examinations (patients) were included in the study. One hundred and ninety-four patients were examined using the ENDO-AID CADe artificial intelligence device (study group), and 206 patients were examined without the artificial intelligence (control group). Results: None of the analyzed indicators (PDR and ADR during morning and afternoon colonoscopies) showed differences between the study and control groups. There was an increase in PDR during afternoon colonoscopies, as well as ADR during morning and afternoon colonoscopies. Conclusions: Based on our results, the use of AI systems in colonoscopies is recommended, especially in circumstances of an increase of examinations. Additional studies with larger groups of patients at night are needed to confirm the already available data.

Background and Objectives: The revascularization strategy for percutaneous coronary intervention (PCI) in patients with multivessel (MV) acute coronary syndrome (ACS) remains controversial. Certain gaps in the evidence are related to the optimal timing of non-culprit lesion revascularization and the utility of instantaneous wave-free ratio (iFR) in the management of MV ACS intervention. The major benefits of iFR utilization in MV ACS patients in one-stage complete revascularization are: (1) the possibility to virtually plan the PCI, both the location and the extension of the necessary stenting to achieve the prespecified final hemodynamic result; (2) the opportunity to validate the final hemodynamic result of the PCI, both in culprit artery and all non-culprit arteries and (3) the value of obliviating the uncomfortable, costly, time consuming and sometimes deleterious effects from Adenosine, as there is no requirement for administration. Thus, iFR use fosters the achievement of physiologically appropriate complete revascularization in MV ACS patients during acute hospitalization. Materials and Methods: This pilot study was aimed to test the feasibility of a randomized trial research protocol as well as to assess patient safety signals of co-registration iFR-guided one-stage complete revascularization compared with that of standard staged angiography-guided PCI in de novo patients with MV ACS. This was a single-center, prospective, randomized, open-label clinical trial consecutively screening patients with ACS for MV disease. The intervention strategy of interest was iFR-guided physiologically complete one-stage revascularization, in which the virtual PCI planning of non-culprit lesions and the intervention itself were performed in one stage directly following treatment of the culprit lesion and other critical stenosis of more than ninety percent. Seventeen patients were recruited and completed the 3-month follow-up. Results: Index PCI duration was significantly longer while the volume of contrast media delivered in index PCI was significantly greater in the iFR-guided group than in the angiography-guided group (119.4 ± 40.7 vs. 47 ± 15.5 min, p = 0.004; and 360 ± 97.9 vs. 192.5 ± 52.8 mL, p = 0.003). There were no significant differences in PCI-related major adverse cardiovascular events (MACE) between the groups during acute hospitalization and at 3-months follow-up. One-stage iFR-guided PCI requires fewer PCI attempts until complete revascularization than does angiography-guided staged PCI. Conclusions: Complete revascularization with the routine use of the virtual planning tool in one-stage iFR-guided PCI is a feasible practical strategy in an everyday Cath lab environment following the protocol designed for the study. No statistically significant safety signals were documented in the number of PCI related MACE during the 3-month follow-up.

Background: Osteoporosis is a disease which is characterized by a decrease in general bone mineral density (BMD), resulting in decreased bone strength and an increased risk of bone fractures. The effect of reduced BMD on the jawbones is still not fully understood. The purpose of the study was to evaluate the impact of BMD on the quality and quantity of the edentulous mandible. Methods: The present study included 127 edentulous postmenopausal women who underwent cone beam computed tomography (CBCT) examinations. BMD measurements of the lumbar spine and femoral necks were performed by dual-energy X-ray absorptiometry. In the cross-sectional CBCT images, three different areas of the mandible (lateral incisor, first premolar, and first molar) were selected. The complete mandibular, trabecular, and cortical bone volumes were measured. All measurements were performed on the total mandibular area, and the basal and alveolar parts of the mandible. Results: The volume of the cortical bone was reduced for females with reduced BMD in the lateral incisor and first premolar regions, both in the total mandibular area and in the basal part of the mandible. The trabecular bone volume statistically significantly increased when the BMD decreased in the complete mandibular area and the basal part of the mandible (linear regression). The total bone volume significantly decreased with a decrease in BMD in the basal part of the mandible. Conclusions: Reduced BMD has a negative effect on the quantity and quality of bone in the basal part of the edentulous mandible.

Background/Aim: This study aimed to develop a protocol that combines cone‐beam computed tomography (CBCT), software, and 3D printing to design 3D replicas for tooth autotransplantation. The goal was to evaluate the impact of this approach on the extraoral time of the donor teeth and the total surgical time, thereby enhancing surgical efficiency and outcomes. Materials and Methods: A non‐randomized trial (protocol 10.1186/ISRCTN13563091) was conducted at Riga Stradins University, enrolling 46 patients (13–22 years old) who required molar extraction and possessed a non‐erupted third molar. The patients were sequentially assigned to a 3D replica group (24 patients) or a control group (22 patients). The primary outcome measured was the extra‐alveolar time of the donor tooth, and the secondary outcome was the total duration of surgery. Both were assessed using a sample size capable of detecting a 10‐min difference. A generalized linear model adjusted for various factors was used to test for significant time differences (p <.05) between the groups. Results: Forty‐six patients were included in this analysis. The effect of using 3D replicas was not statistically significant and was associated with a decrease in the extraoral time of the donor tooth in seconds (β = −9.35, 95% CI [−40.86, 22.16]). For the total surgical time in minutes, the use of 3D replicas had a statistically significant impact, reducing the operation duration in minutes (β = −13.42, 95% CI [−24.50, −2.34]). No early complications were observed in either group, with all teeth present at 3–4 weeks post‐surgery. Conclusions: The integration of 3D printing technology can enhance the efficiency of autotransplantation surgeries, primarily by reducing surgical time. [ABSTRACT FROM AUTHOR]

Abstract Background There have been several reports on dasatinib-induced reversible pulmonary hypertension. This is the first reported case in Latvia; the patient did not discontinue the drug after the first adverse effects in the form of pleural effusions, which we speculate led only to partial reversion of the disease. Case presentation A 67-year-old white man with chronic myelogenous leukemia was treated with the dual Src and BCR-ABL tyrosine kinase inhibitor dasatinib. After treatment with dasatinib he had multiple pleural effusions which were suspected to be caused by congestive heart failure. Later a transthoracic Doppler echocardiography and right-sided heart catheterization revealed severe pulmonary hypertension with pulmonary vascular resistance of 12 Wood units and mean pulmonary artery pressure of 53 mmHg. Computed tomography ruled out a possible pulmonary embolism; laboratory specific tests for human immunodeficiency virus, rheumatoid factor, and anti-nuclear antibodies were negative, and dasatinib-induced pulmonary arterial hypertension was diagnosed. A follow-up right-sided heart catheterization and 6-minute walk test done a month after the discontinuation of dasatinib showed significant improvement: mean pulmonary artery pressure of 34 mmHg and pulmonary vascular resistance of 4 Wood units. Conclusions Patients should always be closely monitored when using dasatinib for a prolonged time. Dasatinib-induced pulmonary hypertension may be fully reversible after the therapy is suspended, but the key factors involved are still unclear and need to be further studied.

Background and Objectives: Adequate dietary intake of iodine and selenium is essential during pregnancy. While iodine is vital for maternal thyroid function and fetal development, selenium contributes to the regulation of thyroid function and thyroid autoimmunity. This study aimed to assess the consumption of iodine- and selenium-containing products by women of reproductive age and the iodine and selenium nutritional status of pregnant women in Latvia. Materials and Methods: Population health survey (2010–2018) data were used to characterize dietary habits in women of reproductive age. Additionally, 129 pregnant women in the first trimester were recruited; they completed a questionnaire and were tested for thyroid function, urinary iodine concentration (UIC), and serum selenium and selenoprotein P levels. Results: The use of some dietary sources of iodine (e.g., milk and dairy products) and selenium (e.g., bread) has decreased in recent years. Less than 10% of respondents reported the use of iodized salt. The use of supplements has become more common (reported by almost 50% of respondents in 2018). Dietary habits were similar in pregnant women, but the use of supplements was even higher (almost 70%). Nevertheless, most supplements used in pregnancy had insufficient contents of iodine and selenium. Thyroid function was euthyreotic in all women, but 13.9% of participants had a thyroid peroxidase antibodies (TPO-ab) level above 60 IU/mL. The median UIC (IQR) was 147.2 (90.0–248.1) μg/gCr, and 52.8% of pregnant women had a UIC below 150 μg/gCr. The mean selenium (SD) level was 101.5 (35.6) μg/L; 30.1% of women had a selenium level below 80 μg/L. The median selenoprotein P level was 6.9 (3.1–9.0) mg/L. Conclusions: Iodine nutrition in Latvian population of pregnant women was near the lower limit of adequate and a third of the population had a selenium deficiency. Supplements were frequently used, but most did not contain the recommended amounts of iodine and selenium.

Aortic valve stenosis (AS) develops not only with a pronounced local inflammatory response, but also oxidative stress is involved. The aim of this study was to evaluate the plasma levels of thioredoxin-1 (TRX1), myeloperoxidase (MPO), chemerin, growth differentiation factor 15 (GDF-15), angiopoietin-2 (Ang-2), vascular endothelial growth factor A (VEGF-A), fibroblast growth factor 2 (FGF-2), fibroblast growth factor 21 (FGF-21), and metalloproteinase (MMP)-1, -3, and -9 in acquired AS patients as well as to clarify the correlations of TXR1 and the plasma inflammatory biomarkers regarding AS severity. AS patients were classified into three groups: 16 patients with mild AS stenosis, 19 with moderate and 11 with severe AS, and 30 subjects without AS were selected as a control group. AS patients had significantly higher plasma levels of TRX1 compared to controls, but the highest difference was found in mild AS patients compared to the controls. We conclude that AS is associated with significantly increased plasma TRX1 levels, and TRX1 might serve as a specific and sensitive biomarker of AS. TRX1 and also chemerin, GDF-15, VEGF-A, FGF-2 and FGF-21 significantly correlate with AS severity degrees. TRX1 also showed positive association with FGF-2, VEGF-A, and MMP-3 in all AS patients.

Background and objectives: At present, there is insufficient evidence to support the use of continuous veno-venous haemofiltration (CVVH) in the early treatment of septic shock. This study focuses on the association between survival and different parameters of oxidative stress (RedOx). Thereby, we evaluated whether RedOx markers are associated with the outcome of septic shock in patients under early-initiated CVVH treatment. Materials and Methods: We conducted a prospective observational study of 65 patients with septic shock who started CVVH within 12 h after hospital admission. Blood samples were taken from each patient prior to the start of CVVH. The following RedOx markers were measured: glutathione peroxidase, glutathione reductase (GR), total antioxidant capacity, superoxide dismutase, nitric oxide, malondialdehyde and 4-hydroxynonenal. The odds ratio (OR) was calculated using binary logistic regression and stepwise multivariable regression. Results: The 65 patients had a median age of 66 years and 39 were male. Based on the outcome, the patients were divided into two groups—non-survivors (n = 29) and survivors (n = 36)—and the levels of RedOx markers were compared between them. Of all the markers, only higher GR activity was found to be significantly associated with the fatal outcome; 100.3 U/L versus 60.5 U/L, OR = 1.027 (95% CI, 1.010–1.044). Following adjustment for the sequential organ failure assessment score and other parameters, GR activity still presented a significant association with the fatal outcome, OR = 1.020 (95% CI, 1.002–1.038). Conclusions: GR activity is associated with in-hospital fatal outcomes among septic shock patients under early-initiated CVVH treatment. Septic shock patients who have a lower GR activity at hospital admission may have a favourable outcome of the early initiation of CVVH.

Increasing evidence shows that whole grain consumption is protective against metabolic disorders. Protective bioactive substances of whole grains include fibre and antioxidants. Activation of grains can increase the amount of phenolic compounds and their bioavailability, but there is little evidence about their effect on glycaemic and insulinemic responses. Therefore, the aim of this study was to investigate glycaemic and insulinemic responses after consumption of flakes made from activated wheat and activated triticale grains. Eighteen healthy subjects (7 men and 11 women) were given activated wheat or activated triticale flakes. As a reference, a standard glucose solution was used. Plasma glucose and serum insulin were measured during 120 minutes. Both, activated wheat and activated triticale flakes, show improved glycaemic profile, inducing a lower and more stable glycaemic response. However, statistically significant differences in insulin response were found only in the group who have taken activated triticale flakes and not in the group who have taken activated wheat flakes. Activated triticale flakes induced lower insulin response in all postprandial phases and a more stable concentration of insulin. Thus, activated triticale flakes could be beneficial for the prevention and treatment of metabolic disorders.

Background and Objectives: Aortic valve stenosis (AS) develops with a pronounced local inflammatory response, where a variety of growth factors are involved in the process, and may have a pro-inflammatory and anti-inflammatory effect. The aim of our study was to elucidate whether circulating growth factors: growth differentiation factor 15 (GDF-15), angiopoietin-2 (Ang-2), vascular endothelial growth factor A (VEGF-A), fibroblast growth factor 2 (FGF-2), and fibroblast growth factor 21 (FGF-21) could be proposed as clinically relevant biomarkers to improve risk stratification in AS patients. Materials and Methods: AS patients were classified into three groups: 16 patients with mild AS stenosis; 19 with moderate and 11 with severe AS, and 30 subjects without AS (echocardiographically approved) were selected as a control group. GDF-15, Ang-2, VEGF-A, FGF-2, and FGF-21 were measured in plasma by the ELISA method. Results: GDF-15 levels differed significantly not only when comparing AS patients with control groups (p < 0.0001), but also a statistically significant difference was achieved when comparing AS patients at a mild degree stage with control individuals. We found a strong relationship of GDF-15 levels regarding AS severity degree (p < 0.0001). VEGF-A, FGF-2 and FGF-21 levels were significantly higher in AS patients than in controls, but relationships regarding the AS severity degree were weaker (p < 0.02). ROC analysis of the study growth factors showed that GDF-15 might serve as a specific and sensitive biomarker of AS stenosis (AUC = 0.75, p = 0.0002). FGF-21 correlated with GDF-15, Ang-2, and FGF-2, but it did not reach the level to serve as a clinically relevant biomarker of AS stenosis. Conclusions: AS is associated with significantly increased GDF-15, VEGF-A, FGF-2, and FGF-21 levels in plasma, but only GDF-15 shows a pronounced relationship regarding AS severity degree, and GDF-15 might serve as a specific and sensitive biomarker of AS stenosis.

Patient registries are a valuable tool in the research of rare conditions such as pulmonary hypertension (PH). We report comprehensive hemodynamic and survival data of 174 patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), included in the prospective Latvian PH registry over a period of > 9 years. In total, 130 adult PAH patients (75%) and 44 adult CTEPH patients (25%) were enrolled. The median follow-up period was 33 months for PAH and 18 months for CTEPH, P = 0.001. Latvian CTEPH patients had significantly higher plasma levels of B-type natriuretic peptide, higher pulmonary vascular resistance, and lower cardiac index than Latvian PAH patients. Calculated incidence of PAH and CTEPH in Latvia in 2016 was 13.7 and 5.1 cases per million inhabitants, calculated prevalence was 45.7 and 15.7 cases per million inhabitants, respectively. Survival rates at one, three, and five years for PAH patients was 88.0%, 73.3%, and 58.1%, and 83.8%, 59.0%, and 44.2% for CTEPH patients, respectively. We compared our study results with data from European adult PH registries. Latvian PAH patients had the fourth lowest and CTEPH patients the lowest one-year survival rate among European adult PH registries. As most PH registries in Europe are small, yet with equivalent patient inclusion criteria, it would be desirable to combine these registries to produce more reliable and high-quality study results.