Towards the Goal of Hepatitis C Elimination in Latvia — Using Patient Survey Results

The success of global strategies to eliminate hepatitis C as a public threat by 2030 depends on local country-wide activities of all involved stakeholders, the most important being general practitioners (GP) and the entire country population. The opinion of currently diagnosed patients can help stakeholders to plan further actions such as addressing new target groups. Our aim was to determine the experiences, opinions, and attitudes of viral hepatitis C (VHC) patients towards the hepatitis C virus (HCV) infection and corresponding healthcare services in Latvia. Questionnaires were distributed by nurses in hospitals of major cities in Latvia. The survey results highlighted the importance of the role of the general practitioner and time from diagnosis to specialist consultation. The majority of respondents were not aware of VHC symptoms, although they were informed about possible complications such as liver cirrhosis and hepatocellular carcinoma. The major VHC patient pool was not composed of drug users, but people who never used narcotics, highlighting the importance to increase VHC awareness in other risk groups and in the general population. Consequently, targeted VHC screening programmes are essential tools in achieving elimination of HCV infection as a public threat in Latvia. The action plans should be updated regularly aiming to strengthening of the GP role and shortening time to consultation with a specialist.publishersversionPeer reviewe

Amino acid metabolism is significantly altered at the time of admission in hospital for severe COVID-19 patients: findings from longitudinal targeted metabolomics analysis

The heterogeneity in severity and outcome of COVID-19 cases points out the urgent need for early molecular characterization of patients followed by risk-stratified care. The main objective of this study was to evaluate the fluctuations of serum metabolomic profiles of COVID-19 patients with severe illness during the different disease stages in a longitudinal manner. We demonstrate a distinct metabolomic signature in serum samples of 32 hospitalized patients at the acute phase compared to the recovery period, suggesting the tryptophan (tryptophan, kynurenine, and 3-hydroxy-DL-kynurenine) and arginine (citrulline and ornithine) metabolism as contributing pathways in the immune response to SARS-CoV-2 with a potential link to the clinical severity of the disease. In addition, we suggest that glutamine deprivation may further result in inhibited M2 macrophage polarization as a complementary process, and highlight the contribution of phenylalanine and tyrosine in the molecular mechanisms underlying the severe course of the infection. In conclusion, our results provide several functional metabolic markers for disease progression and severe outcome with potential clinical application. IMPORTANCE Although the host defense mechanisms against SARS-CoV-2 infection are still poorly described, they are of central importance in shaping the course of the disease and the possible outcome. Metabolomic profiling may complement the lacking knowledge of the molecular mechanisms underlying clinical manifestations and pathogenesis of COVID-19. Moreover, early identification of metabolomics-based biomarker signatures is proved to serve as an effective approach for the prediction of disease outcome. Here we provide the list of metabolites describing the severe, acute phase of the infection and bring the evidence of crucial metabolic pathways linked to aggressive immune responses. Finally, we suggest metabolomic phenotyping as a promising method for developing personalized care strategies in COVID-19 patients.publishersversionPeer reviewe

Intriguing findings of liver fibrosis following COVID-19

Funding Information: The authors would like to thank the Boris and Inara Teterev Foundation, R?ga Stradi?? University, and Riga East Clinical University Hospital for organizational support. Funding Information: The study was funded by the Ministry of Education and Science of the, Republic of Latvia, project “Clinical, biochemical, immunogenetic paradigms of Covid-19 infection and their correlation with socio-demographic, etiological, pathogenetic, diagnostic, therapeutically and prognostically important factors to be included in guidelines”, project No. VPP-COVID-2020/1-0023. Publisher Copyright: © 2021, The Author(s).Background: Studies on a new coronavirus disease (COVID-19) show the elevation of liver enzymes and liver fibrosis index (FIB-4) independently on pre-existing liver diseases. It points to increased liver fibrogenesis during acute COVID-19 with possible long-term consequences. This study aimed to assess liver fibrosis in COVID-19 patients by serum hyaluronic acid (HA) and FIB-4. Methods: The study included the acute COVID-19 group (66 patients, 50% females, mean age 58.3 ± 14.6), the post-COVID group (58 patients in 3–6 months after the recovery, 47% females, mean age 41.2 ± 13.4), and a control group (17 people, 47% females, mean age 42.8 ± 11.0). Ultrasound elastography was performed in the post-COVID and control groups. Results: Sixty-five percent of the acute COVID-19 group had increased FIB-4 (> 1.45), and 38% of patients had FIB-4 ≥ 3.25. After matching by demographics, 52% of acute COVID-19 and 5% of the post-COVID group had FIB-4 > 1.45, and 29% and 2% of patients had FIB-4 ≥ 3.25, respectively. Increased serum HA (≥ 75 ng/ml) was observed in 54% of the acute COVID-19 and 15% of the post-COVID group. In the acute COVID-19 group, HA positively correlated with FIB-4, AST, ALT, LDH, IL-6, and ferritin and negatively with blood oxygen saturation. In the post-COVID group, HA did not correlate with FIB-4, but it was positively associated with higher liver stiffness and ALT. Conclusion: More than half of acute COVID-19 patients had increased serum HA and FIB-4 related to liver function tests, inflammatory markers, and blood oxygen saturation. It provides evidence for the induction of liver fibrosis by multiple factors during acute COVID-19. Findings also indicate possible liver fibrosis in about 5% of the post-COVID group.publishersversionPeer reviewe

Genotype Distribution and Characteristics of Chronic Hepatitis C Infection in Estonia, Latvia, Lithuania, and Ukraine : The RESPOND-C Study

Publisher Copyright: © 2023 by the authors.Background and objectives: Since 2013, highly effective direct-acting antiviral (DAA) treatment for chronic hepatitis C (CHC) has become available, with cure rates exceeding 95%. For the choice of optimal CHC treatment, an assessment of the hepatitis C virus (HCV) genotype (GT) and liver fibrosis stage is necessary. Information about the distribution of these parameters among CHC patients in Estonia, Latvia, and Lithuania (the Baltic states) and especially in Ukraine is scarce. This study was performed to obtain epidemiologic data regarding CHC GT and fibrosis stage distribution for better planning of resources and prioritization of patients for DAA drug treatment according to disease severity in high-income (the Baltic states) and lower-middle-income (Ukraine) countries. Materials and methods: The retrospective RESPOND-C study included 1451 CHC patients. Demographic and disease information was collected from medical charts for each patient. Results: The most common suspected mode of viral transmission was blood transfusions (17.8%), followed by intravenous substance use (15.7%); however, in 50.9% of patients, the exact mode of transmission was not clarified. In Ukraine (18.4%) and Estonia (26%), transmission by intravenous substance use was higher than in Lithuania (5%) and Latvia (5.3%). Distribution of HCV GT among patients with CHC was as follows: GT1—66.4%; GT3—28.1; and GT2—4.1%. The prevalence of GT1 was the highest in Latvia (84%) and the lowest in Ukraine (63%, p < 0.001). Liver fibrosis stages were distributed as follows: F0—12.2%, F1—26.3%, F2—23.5%, F3—17.1%, and F4—20.9%. Cirrhosis (F4) was more prevalent in Lithuanian patients (30.1%) than in Estonians (8.1%, p < 0.001). Conclusions: This study contributes to the knowledge of epidemiologic characteristics of HCV infection in the Baltic states and Ukraine. The data regarding the patterns of HCV GT and fibrosis stage distribution will be helpful for the development of national strategies to control HCV infection in the era of DAA therapy.Peer reviewe

Supervision as an Instrument to Promote Teachers' Well-being

Maģistra darbā aplūkota supervīzijas loma un vieta Latvijas izglītības sistēmā. Tēmas aktualitāte meklējama gan vietējā kontekstā (jaunā izglītības satura ieviešana), gan starptautiskos notikumos (COVID-19 pandēmijas radītās pārmaiņas, šobrīd notiekošais Ukrainas – Krievijas karš), kas kopā rada vidi, kurā vajadzība pēc emocionāla atbalsta ne tikai skolēniem, bet arī skolotājiem ir kļuvusi aizvien būtiskāka. 2021. gadā, saistībā ar attālinātā darba sekām, supervīzija kļuva pieejama arī valstiskā līmenī, ar mērķi sniegt psihoemocionālo atbalstu un mazinātu profesionālās izdegšanas risku skolotāju vidū. Maģistra darbs ir izstrādāts, lai analizētu supervīzijas nozīmi skolotāju labijzūtas sekmēšanā un sniegtu praktiskus ieteikumus tās ieviešanā. Maģistra darbā tika veikts aptaujas pētījums, kurā piedalījās skolotāji un divi supervizori. Veicot literatūras avotu, skolotāju aptaujas anketu un supervizoru interviju datu analīzi, secināts, ka supervīzija ir nozīmīga skolotāju labizjūtas sekmēšanā. Lai supervīzijas plašās iespējas izmantotu efektīvāk, nepieciešama skaidrāka vajadzību apzināšanās, mērķu izvirzīšana, lai spētu piemērot atbilstošāko supervīzijas veidu. Atslēgvārdi: labizjūta, skolotāji, supervīzija, profesionālā darbība.This master’s thesis is dedicated to the exploration of the role and place of supervision in the Latvian education system. The topicality of the topic is based both in the local context (introduction of the new curricula) and international events (changes caused by the COVID-19 pandemic, the ongoing Ukraine-Russia war), which together create an environment where the emotional support is becoming increasingly important not only for students, but also for teachers. In 2021, due to the consequences of remote work, it also became available at the national level, with the aim of providing psycho-emotional support and reducing the risk of burnout among teachers. The master's thesis is designed to analyze the role of supervision in promoting the well-being of teachers and to provide practical recommendations for its implementation. A survey was conducted in the master's thesis. The study involved 104 teachers and two supervisors. An analysis of literature sources, teacher questionnaires and supervisor interview data has shown that supervision is important in promoting teachers' well-being. In order to use the wide possibilities of supervision more effectively, it is necessary to have a clearer awareness of needs, and establishment of clear goals in order to be able to apply the most appropriate type of supervision. Keywords: well-being, teachers, supervision, professional work