Low Carbohydrate Diet (SCD/GAPS) for Children with Autistic Spectrum Disorder

Objective of the study was to investigate the potential of low carbohydrate diet (SCD/ and supplements in reducing some autistic spectrum disorder ASD symptoms in children.Sponsors: Lotos Pharma (Latvia), Innopharma (Denmark) and Veselības Piramīda (Latvia)

Preferences of patients for discussing sudden unexpected death in epilepsy

Funding Information: The study was approved by the Medical and Biomedical Research Ethics Committee of the Riga East Clinical University Hospital. Publisher Copyright: © 2017 De Gruyter Open Ltd. All rights reserved.People with epilepsy have increased mortality rates, which is partially attributed to sudden unexpected death in epilepsy syndrome (SUDEP). Poor seizure control appears to be the strongest SUDEP risk factor. Management of epilepsy and adherence to therapy is critical to seizure control. The belief by caregivers of negative influence caused by being informed about the syndrome is the main reason SUDEP is not disclosed. There are no clear recommendations when to disclose the risk of SUDEP and how much information should be provided. We addressed the preferences of Latvian epilepsy patients for discussing SUDEP as well as awareness of the syndrome. Our study involved 55 epilepsy patients. We found that, as in other studies, our patients were relatively well informed about SUDEP. We found that a considerable proportion of patients preferred to receive information about SUDEP from a general practitioner. We note the belief of patients that the disclosure of SUDEP would either improve or have no effect on the quality of life. We were able to identify groups of patients with a self-reported belief of more frequent expected anxiety and poor adherence to medical treatment. Our data improves the understanding of preferences of patient for discussing the negative aspects of epilepsy.publishersversionPeer reviewe

External ventricular drain and associated infections

Purpose. To find out the infections rate associated with external ventricular drainage (EVD); to find out infectious agents and the risk factors and to compare gained data between two neurosurgical clinics in Riga.Materials and methods. This study is retrospective. The study analyzed the flies of 228 patients who underwent EVD from 2007 to 2014 in two neurosurgery hospitals. There were 105 (46.1%) male and 123 (53.9%) female patients. The patients average age was 60 years old (IQR = 75–47). One hundred and ten patients have been operated for rupture of aneurism, spontaneous intracerebral hemorrhage — 70, traumatic brain injury — 21, brain tumor — 12, rupture of arteriovenous malformation — 12, aqueductal stenosis — 2, cerebral infarction — 1. The data were analyzed using Microsoft Exel and SPSS Statistics.Results. Infections associated with EVD occurred in 42 (18.4%) cases: there were 30 (71.4%) bacterial meningitis, 7 (16.6%) bacterial ventriculitis, 5 (11.9%) bacterial meningitis combined with ventriculitis. In Paul Stradins Clinical University Hospital complications rate was 19.05% and in Neurosurgical Hospital Gailezers — 17.28%.Microbiological test revealed Staphylococcus spp. in 16 (38%) cases and Acinetobacter baumannii in 13 (31%) cases. For patients without neuroinfection median duration of drainage was 7 days (IQR = 8–6) and for patients with neuroinfection 10 days (IQR = 14–6,5). The average duration of staying at hospital was 14 days (IQR = 22–9) and 24 days (IQR = 34–19), respectively.Risk factors for EVD related infections were drainage duration (p = 0.000), repeated EVD (p = 0.000) and craniotomy or craniectomy (p = 0.029). EVD related infections treatment was associated with negligible increase of mortality rate (p = 0.106).Conclusion. Bacterial meningitis and ventriculitis are common complications associated with EVD. Neuroinfections were associated with negligibe increase in mortality rate, but significant increase in staying at hospital and might be associated with cognitive decline and enhanced costs.The risk factors for neuroinfections development are drainage duration, repeated EVD, craniotomy or craniectomy. Mortality is associated with initial low level consciousness (GCS ≤ 8 at admission to hospital)

Clinicopathological Significance of Exosomal Proteins CD9 and CD63 and DNA Mismatch Repair Proteins in Prostate Adenocarcinoma and Benign Hyperplasia

Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.Introduction. Recently, it has been shown that exosomal biomarkers and DNA mismatch repair proteins (MMR) could play an important role in cancer risk stratification and prognosis assessment. The gold standard for prostate carcinoma (PCa) diagnosis is biopsy and histopathological examination. Thus, the complex evaluation of exosomal and MMR proteins could be beneficial for prostate cancer risk stratification and diagnostics. The aim of the current study was to evaluate and compare the expression of exosomal proteins CD9 and CD63 and MMR proteins in the tissue of patients with prostate benign hyperplasia (BPH) and PCa. Methods. The study was retrospective. Altogether, 92 patients with PCa and 20 patients with BPH (control group) were enrolled in the study. Exosomal and MMR protein expression was analyzed by immunohistochemistry (IHC). The follow-up for each PCa patient in our study lasted till disease progression and/or a maximum of 5 years. Results. Low-grade PCa was observed in 56 patients and high-grade PCa in 36 patients. CD63 expression was significantly higher in patients with high-grade PCa compared to those with low-grade PCa. CD9 expression was significantly downregulated in PCa patients compared to the control group. MMR protein expression deficiency was observed in 10 PCa patients. MMR proteins were maintained in all cases of BPH. The study found a negative correlation between MMR protein loss and PCa ISUP grade groups. Progression-free survival (PFS) in patients with MMR deficiency was significantly shorter than in patients with maintained MMR expression. Conclusions. CD9 protein expression was downregulated in PCa, compared to BPH, while CD63 protein expression was upregulated in high-grade PCa but downregulated in low-grade PCa. CD63 protein upregulation, CD9 downregulation, and loss of MMR protein characterized the shorter PFS of high-grade PCa patients. CD9, CD63, and MMR could be the routine immunohistochemical biomarkers for the diagnosis and risk stratification of PCa.publishersversionPeer reviewe

Electrocardiographic Abnormalities and Mortality in Epilepsy Patients

Background and Objectives: People with epilepsy (PWE) have a 2-3 times higher mortality rate than the general population. Sudden unexpected death in epilepsy (SUDEP) comprises a significant proportion of premature deaths, whereas sudden cardiac death (SCD) is among the leading causes of sudden death in the general population. Cardiac pathologies are significantly more prevalent in PWE. Whether electrocardiographic (ECG) parameters are associated with remote death in PWE has yet to be elucidated. The study objective was to assess whether interictal ECG parameters are associated with mortality in the long-term. Materials and Methods: The study involved 471 epilepsy patients who were hospitalized after a bilateral tonic-clonic seizure(s). ECG parameters were obtained on the day of hospitalization (heart rate, PQ interval, QRS complex, QT interval, heart rate corrected QT interval (QTc), ST segment and T wave changes), as well as reported ECG abnormalities. Mortality data were obtained from the Latvian National Cause-of-Death database 3-11, mean 7.0 years after hospitalization. The association between the ECG parameters and the long-term clinical outcome were examined. Results: At the time of assessment, 75.4% of patients were alive and 24.6% were deceased. Short QTc interval (odds ratio (OR) 4.780; 95% confidence interval (CI) 1.668-13.698; p = 0.004) was associated with a remote death. After the exclusion of known comorbidities with high mortality rates, short QTc (OR 4.631) and ECG signs of left ventricular hypertrophy (OR 5.009) were associated with a remote death. Conclusions: The association between routine 12-lead rest ECG parameters-short QTc interval and a pattern of left ventricular hypertrophy-and remote death in epilepsy patients was found. To the best of our knowledge, this is the first study to associate rest ECG parameters with remote death in an epileptic population.publishersversionPeer reviewe

Objektivas audiometrijas metode bernu dzirdes traucejumu noteiksana un attistibas rehabilitacija

Long-term observations have obviously proved that possibly earlier diagnostics of hearing defects, adequate estimation and therapy are essential factors for elaboration of verbal contacts and integration in society of children with hearing defects. As the result of insufficient and inadequate stimulation at early age - deficit of sound impulse in infants could be the cause of incomplete functional development and further maturation of hearing centre. Unfortunately, the today known and widely used subjective methods of examination do not allow to detect precisely the threshold of hearing at early age. The aim of this study was to ascertain the effectivity of caustically initiated brain stem potential detection method (BERA) used for precise detection of hearing threshold in children of early age. The work was performed in the Children Hearing Centre of Latvia and in the Centre of Social Paediatrics, Medical Faculty of University of Latvia. Totally 136 children at the age from two to 168 months were examined. The objectivized detection of hearing threshold (BERA) was performed during medically provoked sleep period. We have detected that the data of the same child in subjective and objective audiometric examination were different, and besides, in the group of children at the age from two to 24 months these differences were statistically significant (p<0.05), in comparison with older children. That means that it indicates the group of children, where the audiometric examination could play essential role for further set up of rehabilitation strategy. Besides, the objectivized audiometric examination (BERA) allowed to detect precisely the asymmetry of hearing threshold in the age groups. It is interesting to mention that the asymmetry of hearing threshold was the same in left and right sides for the pre-schoolers, but the right side hearing threshold decrease prevailed in school children. It could be an indirect sign of elevation of functional inability of brain hearing centre with the age. The method of BERA of detecting caustically initiated brain stem potentials is evidently more precise and sensitive audiometric method for detection of hearing threshold elevation and asymmetry, specially at early age and thus gives wider possibilities for in due time development rehabilitation and integration in society of children with hearing defectsSeparate summary in Latvian, English, German, 21 p.Available from Latvian Academic Library / LAL - Latvian Academic LibrarySIGLELVLatvi

Зовнішнє вентрикулярне дренування і асоційовані з цим інфекції

Purpose. To find out the infections rate associated with external ventricular drainage (EVD); to find out infectious agents and the risk factors and to compare gained data between two neurosurgical clinics in Riga.Materials and methods. This study is retrospective. The study analyzed the flies of 228 patients who underwent EVD from 2007 to 2014 in two neurosurgery hospitals. There were 105 (46.1%) male and 123 (53.9%) female patients. The patients average age was 60 years old (IQR = 75–47). One hundred and ten patients have been operated for rupture of aneurism, spontaneous intracerebral hemorrhage — 70, traumatic brain injury — 21, brain tumor — 12, rupture of arteriovenous malformation — 12, aqueductal stenosis — 2, cerebral infarction — 1. The data were analyzed using Microsoft Exel and SPSS Statistics.Results. Infections associated with EVD occurred in 42 (18.4%) cases: there were 30 (71.4%) bacterial meningitis, 7 (16.6%) bacterial ventriculitis, 5 (11.9%) bacterial meningitis combined with ventriculitis. In Paul Stradins Clinical University Hospital complications rate was 19.05% and in Neurosurgical Hospital Gailezers — 17.28%.Microbiological test revealed Staphylococcus spp. in 16 (38%) cases and Acinetobacter baumannii in 13 (31%) cases. For patients without neuroinfection median duration of drainage was 7 days (IQR = 8–6) and for patients with neuroinfection 10 days (IQR = 14–6,5). The average duration of staying at hospital was 14 days (IQR = 22–9) and 24 days (IQR = 34–19), respectively.Risk factors for EVD related infections were drainage duration (p = 0.000), repeated EVD (p = 0.000) and craniotomy or craniectomy (p = 0.029). EVD related infections treatment was associated with negligible increase of mortality rate (p = 0.106).Conclusion. Bacterial meningitis and ventriculitis are common complications associated with EVD. Neuroinfections were associated with negligibe increase in mortality rate, but significant increase in staying at hospital and might be associated with cognitive decline and enhanced costs.The risk factors for neuroinfections development are drainage duration, repeated EVD, craniotomy or craniectomy. Mortality is associated with initial low level consciousness (GCS ≤ 8 at admission to hospital).Цель исследования: определить частоту возникновения ассоциированных инфекций при наружном вентрикулярном дренировании (НВД), уточнить их возбудителей и факторы риска. Сопоставить результаты в двух нейрохирургических клиниках одного города.Материалы и методы. Исследование ретроспективное. Проанализированы истории болезни 228 пациентов двух нейрохирургических клиник, у которых в период с 2007 по2014 г. осуществлено НВД. Мужчин было 105 (46,1%), женщин — 123 (53,9%). Возраст больных в среднем 60 лет (IQR=75–47). По поводу разрыва аневризмы оперированы 110 пациентов, нетравматической внутримозговой гематомы (НВМГ) — 70, травматического повреждения мозга — 21, опухоли мозга — 12, АВМ — 12; стеноза водопровода большого мозга — 2, инфаркта мозжечка — 1. Полученные данные анализировали с использованием программ Microsoft Exel и SPSS Statistics.Результаты. НВД-ассоциированные инфекции выявлены у 42 (18,4%) пациентов, у 30 (71,4%) из них — менингит, у 7 (16,6%) — вентрикулит, у 5 (11,9%) — менингит в сочетании с вентрикулитом. В клинике больницы П. Страдыня частота осложнений составила 19,05%, в нейрохирургической клинике «Гайльэзерс» — 17,28%.По данным микробиологического исследования, Staphylococcus spp. выявлен в 16 (38%) наблюдениях, Acinetobacter baumannii — в 13 (31%). Продолжительность НВД без осложнений составляла в среднем 7 сут (IQR=8–6), при возникновении ассоциированных инфекций — 10 сут (IQR=14–6,5); продолжительность лечения в стационаре — соответственно 14 сут (IQR=22–9) и 24 сут (IQR=34–19).В качестве факторов риска установлены: продолжительность НВД (р=0,000), повторное НВД у одного пациента (р=0,000), краниотомия и краниэктомия (р=0,029). При лечении НВД-ассоциированных инфекций отмечено незначительное увеличение летальности (р=0,106). Летальность тесно связана с уровнем сознания пациента при госпитализации: при уровне сознания по ШКГ 8 баллов и меньше она составляла 61%.Заключение. Бактериальный менингит и вентрикулит являются достаточно частыми ассоциированными инфекциями при НВД. При возникновении нейроинфекции незначительно повышалась летальность, существенно увеличивалась продолжительность госпитализации, дополнительно снижались когнитивные функции, увеличивались финансовые затраты.Факторами риска возникновения НВД-ассоциированных инфекций являются: продолжительность НВД, повторное НВД у одного больного; краниотомия и краниэктомия. При исходно низком уровне сознания (ШКГ 8 баллов и меньше) заметно повышалась летальность.Мета дослідження: визначити частоту асоційованих інфекцій при зовнішньому вентрикулярному дренуванні (ЗВД), уточнити їх збудників і фактори ризику. Зіставити результати у двох нейрохірургічних клініках одного міста.Матеріали і методи. Дослідження ретроспективне. Проаналізовані історії хвороби 228 пацієнтів двох нейрохірургічних клінік, у яких в період з 2007 по 2014 р. здійснено ЗВД. Чоловіків було 105 (46,1%), жінок — 123 (53,9%). Вік хворих у середньому 60 років (IQR=75–47). З приводу розриву аневризми оперовані 110 пацієнтів, нетравматичної внутрішньомозкової гематоми (НВМГ) — 70, травматичного ушкодження мозку — 21, пухлини мозку — 12, АВМ — 12, стенозу водопроводу великого мозку — 2, інфаркту мозочка — 1. Отримані дані піддавали аналізу за програмою Microsoft Exel і SPSS Statistics.Результати. НВД-асоційовані інфекції виявлені у 42 (18,4%) пацієнтів, у 30 (71,4%) з них — менінгіт, у 7 (16,6%) — вентрикуліт, у 5 (11,9%) — менінгіт у поєднанні з вентрикулітом. У клініці лікарні П. Страдиня частота ускладнень становила 19,05%, у нейрохірургічній клініці «Гайльезерс» — 17,28%.За даними мікробіологічного дослідження, Staphylococcus spp. виявлений у 16 (38%) спостереженнях, Acinetobacter baumannii — у 13 (31%). Тривалість НВД без ускладнень становила у середньому 7 діб (IQR=8–6), при виникненні асоційованих інфекцій — 10 діб (IQR=14–6,5); тривалість лікування у стаціонарі — відповідно 14 діб (IQR=22–9) та 24 доби (IQR=34–19).Як фактори ризику встановлені: тривалість ЗВД (р=0,000), повторне ЗВД в одного пацієнта (р=0,000), краніотомія і краніектомія (р=0,029). При виникненні ЗВД-асоційованих інфекцій дещо збільшувалась летальність (р=0,106). Летальність тісно пов’язана з рівнем свідомості пацієнта під час госпіталізації: за ШКГ 8 балів і менше летальність становила 61%.Висновок. Бактеріальний менінгіт і вентрикуліт є досить частими асоційованими інфекціями при ЗВД. При виникненні нейроінфекції незначно підвищувалася летальність, суттєво збільшувалася тривалість госпіталізації, додатково знижувалися когнітивні функції, збільшувалися фінансові витрати.Як фактори ризику ЗВД-асоційованих інфекцій встановлені: тривалість ЗВД, повторні операції ЗВД в одного хворого, краніотомія і краніектомія. За початково низького рівня свідомості (за ШКГ 8 балів і менше) істотно підвищувалася летальність

Maternal and Neonatal Characteristics for Late Foetal Death in Latvia between 2001 and 2014: Population-Based Study

Introduction. Stillbirth is one of the most common adverse pregnancy outcomes worldwide. Late foetal death (LFD) rates are mostly used for international comparisons because of the large variations in stillbirth rates between countries. Objective. To examine trends in LFD (including antepartum and intrapartum) by multiple births, birth weight, and maternal age in two time periods. Methods. A retrospective cohort study was used to analyse data from the Medical Birth Register (2001–2014), divided into 2 periods of 7 years each. In total, data on 1,340 singletons were analysed. This study calculated LFD rates and rate ratios (RR). Results. The overall LFD rate showed a slight statistically significant reduction (p < 0.001) of 18% between 2001–2007 and 2008–2014. There was a slight increase in the mortality rate from multiple pregnancies (RR 1.1/1000; 95% CI 0.6-1.9). There were no major differences in the LFD rate by maternal age during the time periods. Conclusions. LFD decreased (RR 0.8/1000 births), as well as intrapartum LFD (RR 0.6/1000 births). Older maternal age influenced pregnancy outcomes, and higher LFD rates were observed in the age group ≥35 years. Substantial intrapartum stillbirths rates indicate problems with quality of intrapartum care and emergency obstetric care. Further research is needed to evaluate the strategies necessary to substantially reduce the number of stillbirths in the country