Organ Donation and Transplantation in Latvia

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Comparison of outcome between blood culture positive and negative infective endocarditis patients undergoing cardiac surgery

Publisher Copyright: © 2021, The Author(s).Background: Up to 30% or even more of all infective endocarditis (IE) cases are recognized as blood culture negative, meaning that the causative agent is left unidentified. The prompt diagnosis together with the identification of causative microorganism and targeted antibiotic treatment can significantly impact the prognosis of the disease and further patient’s health status. In some studies, blood culture negative endocarditis has been shown to be associated with delayed diagnosis, worse outcome and course of the disease, and a greater number of intra and postoperative complications. Methods: We retrospectively analysed the medical records of all patients who underwent cardiac surgery for endocarditis between years 2016 and 2019. The aim of this study was to analyse short and long-term mortality and differences of laboratory, clinical and echocardiography parameters in patients with blood culture positive endocarditis (BCPE) and blood culture negative endocarditis (BCNE) and its possible impact on the clinical outcome. Results: In our study population were 114 (55.1%) blood culture positive and 93 (44.9%) blood culture negative cases of infectious endocarditis. The most common pathogens in the blood culture positive IE group were S.aureus in 36 cases (31.6%), Streptococcus spp. in 27 (23.7%), E.faecalis in 24 (21.1%), and other microorganisms in 27 (23.7%). Embolic events were seen in 60 patients (28.9%). In univariate analyses, detection of microorganism, elevated levels of procalcitonin were found to be significantly associated with intrahospital death, however it did not reach statistical significance in multivariate analyses. Among microorganisms, S.aureus was significantly associated with intrahospital death in both univariate and multivariate analyses. Conclusions: There are no statistically significant differences between groups of BCPE and BCNE in terms of intrahospital mortality, hospital and ICU stay or 3-year mortality. There were higher levels of procalcitonin in BCPE group, however procalcitonin failed to show independent association with mortality in multivariate analysis. The most common microorganism in the BCPE group was S.aureus. It was associated with independently higher intrahospital mortality when compared to other causative microorganisms.publishersversionPeer reviewe

Influence of PAI-1 gene promoter-675 (4G/5G) polymorphism on fibrinolytic activity after cardiac surgery employing cardiopulmonary bypass

Background and Objective. The plasminogen activator inhibitor type-1 (PAI-1) gene promoter contains 675 (4G/5G) polymorphism. The aim of this study was evaluate the effect of the PAI-1 promoter-675 (4G/5G) polymorphism on the concentrations of PAI-1 and tissue plasminogen activator/PAI-1 (t-PA/PAI-1) complex and bleeding volume after on-pump cardiac surgery. Material and Methods. A total of 90 patients were included in the study at Pauls Stradins Clinical University Hospital. Seven patients were excluded due to surgical bleeding. Eighty-three patients were classified according to the PAI-1 genotype: 21 patients had the 4G/4G genotype; 42, the 4G/5G genotype; and 20, the 5G/5G genotype. Thefollowing fibrinolysis parameters were recorded: the PAI-1 level preoperatively, D-dimerlevel at 0, 6, and 24 hours after surgery, and t-PA/PAI-1 complex level 24 hours postoperatively. A postoperative bleeding volume was registered in mL 24 hours after surgery.Results. The patients with the 5G/5G genotype had significantly lower preoperative PAI-1 levels (17 [SD, 10.8] vs. 24 ng/mL [SD, 9.6], P=0.04), higher D-dimer levels at 6 hours (371 [SD, 226] vs. 232 ng/mL [SD, 185], P=0.03) and 24 hours (326 [SD, 207] vs. 209 ng/mL [SD, 160], P=0.04), and greater postoperative blood loss (568 [SD, 192] vs. 432 mL [168], P=0.02) compared with the 4G/4G carriers. There were no significant differences inthe levels of the t-PA/PAI-1 complex comparing different genotype groups. Conclusions. Thecarriers of the 5G/5G genotype showed the lower preoperative PAI-1 levels, greater chesttube blood loss, and higher D-dimer levels indicating that the 5G/5G carriers may have enhanced fibrinolysis.publishersversionPeer reviewe

Normas percebidas por estudantes universitários de enfermagem sobre seus pares e o uso de drogas, em Lima, Peru

This quantitative, cross-sectional study was performed to estimate the difference between the perceived norms among university students, based on a survey of 196 nursing students from Lima, Peru. A questionnaire was used to measure the students' perception about drug use and their actual use. Descriptive statistical analysis was performed, considering a value greater, smaller or equal to 10 to establish the difference. The perceived norms for alcohol and tobacco were above 50%, against 6% for marijuana and cocaine; with 57.7% of participants reporting tobacco use, 84.7% alcohol, 2.6% marijuana and 1% cocaine. Marijuana and cocaine use was overestimated, while alcohol use was underestimated. The perception of tobacco use was correct. The study findings are useful to sensitize university authorities and put prevention policies in practice.Con el objetivo de estimar la diferencia entre las normas percibidas sobre el uso de drogas por los pares y el uso real de drogas entre estudiantes universitarios se efectuó un estudio cuantitativo transversal, basado en una encuesta de 196 estudiantes de enfermería de Lima. Se utilizó un cuestionario que midió la percepción del uso de drogas y el propio uso. La información fue analizada con estadística descriptiva; fue considerando un valor mayor, menor o igual a 10% para establecer la diferencia. Las normas percibidas para alcohol y tabaco fueron mayores de 50%, mientras que para marihuana y cocaína fue de 6%. El 57,7% informó haber usado tabaco, 84,7% alcohol, 2,6% marihuana y 1% cocaína; se encontró que existe sobreestimación sobre el uso de marihuana y cocaína, subestimación para el alcohol, y percepción exacta para el uso de tabaco. Los resultados serán de utilidad para sensibilizar a las autoridades universitarias e para implementar políticas o programas de prevención.Com o objetivo de estimar a diferença entre as normas percebidas sobre o uso de drogas por estudantes universitários, foi realizado estudo quantitativo transversal, baseado em censo com 196 estudantes de enfermagem de Lima, Peru. Utilizou-se questionário com a finalidade de medir a percepção do uso de drogas e do próprio uso, analisando-se a informação com estatística descritiva, considerando valor maior, menor ou igual a 10 pontos para estabelecer a diferença. As normas percebidas para o álcool e tabaco foram maiores que 50%, enquanto que para maconha e cocaína foi de 6%; 57,7% referiram ter usado tabaco, 84,7% álcool, 2,6% maconha e 1% cocaína. Existe superestimação do uso de maconha e cocaína, subestimação para o uso de álcool e percepção exata para o uso de tabaco. Os resultados são úteis para sensibilizar as autoridades universitárias e implementar políticas de prevenção

Case Report: VV-ECMO as a bridge to recovery from ACE inhibitor induced post-obstructive negative pressure pulmonary edema

The indications for extracorporeal membrane oxygenation (ECMO) are becoming increasingly widespread nowadays. This case report describes the unique presentation of an adult patient with a combination of two rare complications: life-threatening angioedema caused by angiotensin-converting enzyme inhibitors (ACEi) and subsequent post-obstructive negative pressure pulmonary edema (NPPE). In this case, worsening angioedema that was unresponsive to medication led to severe airway obstruction and near-fatal acute respiratory syndrome due to NPPE. The worsening clinical course required a multidisciplinary approach and immediate initiation of extracorporeal membrane oxygenation (VV-ECMO). The literature reports that most NPPE cases resolve with oxygenation. However, in our case, the NPPE was refractory to mechanical ventilatory support, and we had to initiate VV-ECMO to prevent the patient from going into cardiac arrest due to severe hypoxia. This case underscores the critical role of VV-ECMO as a bridge to recovery from severe NPPE. It also highlights the need to raise clinicians’ awareness of the potential life-threatening side effects of the commonly used antihypertensive drug perindopril

PAI-1 and t-PA/PAI-1 complex potential markers of fibrinolytic bleeding after cardiac surgery employing cardiopulmonary bypass

Background: Enhanced bleeding remains a serious problem after cardiac surgery, and fibrinolysis is often involved. We speculate that lower plasma concentrations of plasminogen activator inhibitor - 1 (PAI-1) preoperatively and tissue plasminogen activator/PAI-1 (t-PA/PAI-1) complex postoperatively might predispose for enhanced fibrinolysis and increased postoperative bleeding.Methods: Totally 88 adult patients (mean age 66 ± 10 years) scheduled for cardiac surgery, were enrolled into a prospective study. Blood samples were collected pre-operatively, on admission to the recovery and at 6 and 24 hours postoperatively. Patients with a surgical bleeding that was diagnosed during reoperation were discarded from the study. The patients were allocated to two groups depending on the 24-hour postoperative chest tube drainage (CTD): Group I > 500ml, Group II ≤ 500ml. Associations between CTD, PAI-1, t-PA/PAI-1 complex and D-dimer were analyzed with SPSS.Results: Nine patients were excluded because of surgical bleeding. Of the 79 remaining patients, 38 were allocated to Group I and 41 to Group II. The CTD volumes correlated with the preoperative plasma levels of PAI-1 (r = - 0.3, P = 0.009). Plasma concentrations of preoperative PAI-1 and postoperative t-PA/PAI-1 complex differed significantly between the groups (P < 0.001 and P = 0.012, respectively). Group I displayed significantly lower plasma concentrations of fibrinogen and higher levels of D-dimer from immediately after the operation and throughout the first 24 hours postoperatively.Conclusions: Lower plasma concentrations of PAI-1 preoperatively and t-PA/PAI-1 complex postoperatively leads to higher plasma levels of D-dimer in association with more postoperative bleeding after cardiac surgery.publishersversionPeer reviewe

Polymorphisms on PAI-1 and ACE genes in association with fibrinolytic bleeding after on-pump cardiac surgery

Publisher Copyright: © 2015 Ozolina et al.Background: Carriers of plasminogen activator inhibitor -1 (PAI-1) -675 genotype 5G/5G may be associated with lower preoperative PAI-1 plasma levels and higher blood loss after heart surgery using cardiopulmonary bypass (CPB). We speculate if polymorphisms of PAI-1 -844 A/G and angiotensin converting enzyme (ACE) intron 16 I/D also might promote fibrinolysis and increase postoperative bleeding. Methods: We assessed PAI-1 -844 A/G, and ACE intron 16 I/D polymorphisms by polymerase chain reaction technique and direct sequencing of genomic DNA from 83 open heart surgery patients that we have presented earlier. As primary outcome, accumulated chest tube drainage (CTD) at 4 and 24 h were analyzed for association with genetic polymorphisms. As secondary outcome, differences in plasma levels of PAI-1, t-PA/PAI-1 complex and D-dimer were determined for each polymorphism. SPSS® was used for statistical evaluation. Results: The lowest preoperative PAI-1 plasma levels were associated with PAI-1 -844 genotype G/G, and higher CTD, as compared with genotype A/A at 4 and 24 h after surgery. Correspondingly, 4 h after the surgery CTD was higher in carriers of ACE intron 16 genotype I/I, as compared with genotype D/D. PAI-1 plasma levels and t-PA/PAI-1 complex reached nadir in carriers of ACE intron 16 genotype I/I, in whom we also noticed the highest D-dimer levels immediately after surgery. Notably, carriers of PAI-1 -844 genotype G/G displayed higher D-dimer levels at 24 h after surgery as compared with those of genotype A/G. Conclusions: Increased postoperative blood loss secondary to enhanced fibrinolysis was associated with carriers of PAI-1 -844 G/G and ACE Intron 16 I/I, suggesting that these genotypes might predict increased postoperative blood loss after cardiac surgery using CPB.publishersversionPeer reviewe

Penetrance of neurodevelopmental copy number variants is associated with variations in cortical morphology

BACKGROUND Copy number variants (CNVs) increase risk for neurodevelopmental conditions. The neurobiological mechanisms linking these high-risk genetic variants to clinical phenotypes are largely unknown. An important question is whether brain abnormalities in individuals carrying CNVs are associated with their degree of penetrance. METHODS We investigated if increased CNV-penetrance for schizophrenia and other developmental disorders was associated with variations in cortical and subcortical morphology. We pooled T1-weighted brain magnetic resonance imaging and genetic data from 22 cohorts from the ENIGMA-CNV consortium. In the main analyses, we included 9,268 individuals (aged 7 to 90 years, 54% females), from which we identified 398 carriers of 36 neurodevelopmental CNVs at 20 distinct loci. A secondary analysis was performed including additional neuroimaging data from the ENIGMA-22q consortium, including 274 carriers of the 22q11.2 deletion and 291 non-carriers. CNV-penetrance was estimated through penetrance scores that were previously generated from large cohorts of patients and controls. These scores represent the probability risk to develop either schizophrenia or other developmental disorders (including developmental delay, autism spectrum disorder and congenital malformations). RESULTS For both schizophrenia and developmental disorders, increased penetrance scores were associated with lower surface area in the cerebral cortex and lower intracranial volume. For both conditions, associations between CNV-penetrance scores and cortical surface area were strongest in regions of the occipital lobes, specifically in the cuneus and lingual gyrus. CONCLUSIONS Our findings link global and regional cortical morphometric features with CNV-penetrance, providing new insights into neurobiological mechanisms of genetic risk for schizophrenia and other developmental disorders