Detection of late-onset hypogonadism in men with chronic internal diseases

Publisher Copyright: © 2019 Anatolijs Pozarskis et al. published by Sciendo.Late-onset hypogonadism (LOH) is a clinical and biochemical syndrome associated with age and featured by typical symptoms and reduced blood testosterone level. Among males aged over 30 years, the incidence of androgen deficiency is 7 to 30%. The aim of this study was to investigate the incidence of hypogonadism in patients aged over 40 years with an underlying condition and/or a comorbidity, such as arterial hypertension, Chronic obstructive pulmonary disease (COPD), metabolic syndrome, Type 2 of diabetes mellitus, dyslipidaemia, adiposity in various General practice (GP) and physician-sexologists' offices in Latvia, and to determine the influence of chronic diseases on the development of hypogonadism. Males aged 39 years who turned to family doctors at nine GP were offered to fill in Aging Male Study (AMS) questionnaires used for the diagnostics of late-onset hypogonadism. Males aged 40 years who visited the office of the physician sexologist Anatolijs PoÅarskis were offered to fill in the same questionnaires. After compiling the data from AMS questionnaires, a group of males exhibiting signs of LOH were isolated (in total 1222 persons). In these patients, we determined blood testosterone and sex-hormone binding globulin (SHBG) levels. Chronic diseases were found in these men in data evaluation of patient medical records, and after performing physical and laboratory examinations. Late-onset hypogonadism was laboratory-diagnosed in 79% of patients with signs of late-onset hypogonadism in accordance with the AMS questionnaires and with concomitant diseases and in 4.7% of patients with signs of late-onset hypogonadism in accordance with the AMS questionnaires and without the aforementioned concomitant diseases. Persons with arterial hypertension, dyslipidaemia, adiposity, metabolic syndrome, COPD and Type 2 of diabetes mellitus had higher chance of developing hypogonadism (p < 0.001). Arterial hypertension, dyslipidaemia, adiposity, metabolic syndrome, COPD statistically significantly (p < 0.001) decreased the level of total testosterone by 0.47, 1.18, 0.36, 0.67, and 0.18 ng/ml, respectively, and decreased the level of free testosterone by 2.52, 2.71, 1,69, 6.77, and 4.58 pg/ml, respectively. Type 2 diabetes mellitus had no statistically significant effect on the level of total and free testosterone (p = 0.95, p = 0.10). The most significant decrease in the level of testosterone was observed in cases of dyslipidemia, COPD and metabolic syndrome. General physicians should pay special attention to patients with this disease, as these patients belong to a group with a high risk of development of expressed LOH syndrome.publishersversionPeer reviewe

Renal anaemia : The role of haemoglobin control in patients with chronic kidney disease

Copyright: Copyright 2011 Elsevier B.V., All rights reserved.Chronic kidney disease (CKD) is a significant and prevalent health problem in the world. Anaemia is one of the most common manifestations in patients with CKD. The correction of anaemia with erythropoietin normalises haemoglobin level and improves quality of life. Many aspects of the impact of anaemia treatment with erythropoiesis-stimulating agents on the progression of CKD remain unresolved and disputable. The present study is a retrospective chart review of 1654 outpatients with CKD. The data were collected from the Centre of Nephrology between 1 January 2002 and 31 December 2006. The aims of the study were to assess the causes of CKD; the prevalence of anaemia based on the current guidelines for anaemia management in CKD (Kidney Disease Dialysis Outcomes Quality Initiative; K/DOQI); to evaluate haemoglobin (Hb), systolic and diastolic blood pressure (SBP and DBP), glomerular filtration rate (GFR) at the first referral to a nephrologist and at the start of renal replacement therapy (RRT). The most common causes of CKD were arterial hypertension (17.2%), chronic glomerulonephritis (17.2%), chronic intersticial nephritis (13.3%), and diabetes (12.8%). Twenty-three percent of end-stage renal disease (ESRD) patients had diabetes mellitus. At the first visit in the renal department, 16% of the patients had an advanced degree of CKD (GFR <30 ml/min). The proportion of patients under an observation in the kidney centre for a period of six months and more was only 34% (554 of 1654). Hypertension was recorded in 72% of study subjects. The blood pressure (BP) values in patients at the first visit (n = 1633) vs. at the start of RRT (n = 154) were: mean SBP 147.4 ± 24.8 mm Hg vs. 152.2 ± 23.0 mm Hg (P < 0.05); mean DBP 88.8 ± 13.6 mm Hg vs. 88.4 ± 12.0 mm Hg (P 0.05). Anaemia was recorded in 41% of study subjects, estimated using K/DOQI recommendations. The prevalence of anaemia was increased from 30.2% to 44.8% of study patients with a rise of BP (from normal BP to hypertension; P < 0.05). The mean Hb level at the start of RRT was 9.8 ± 2.1 g/dl. Only 18% of patients with renal anaemia had used erythropoiesis-stimulating agents before RRT (28 of 155). Anaemia is the prevalent condition at moderate degrees of CKD. The severity of anaemia in the CKD population is determined by evidence of diabetes, cardiovascular disease, and renal function. Anaemia may often be unrecognised or untreated.publishersversionPeer reviewe

Epidemiological, Clinical and Morphological Characteristics of Immunoglobulin A Nephropathy in Latvia

Immunoglobulin A nephropathy (IgAN) is the most common chronic glomerulopathy with variable clinical manifestations. IgAN diagnostics became possible in Latvia in 2013. The study aim was to describe IgAN manifestations in the Latvian population by analysing epidemiological, clinical, histological data, and reveal factors that might determine the course of the disease. The retrospective, one-centre study included biopsy-proven IgAN patients over a five-year period in the Nephrology Centre at Pauls Stradiņš Clinical University Hospital. Data from inpatient and outpatient medical records were collected. The study included 69 patients with histologically confirmed IgAN (23% of all renal biopsies): 52% men with mean age of 37. More than a half of them had hypertension, changes in urinalysis and kidney structure, and GFR < ml/min before the biopsy. Pathology data stratified by MEST-C score were: M1 (93%), E1 (5%), S1 (81%), T1 and T2 (24%), C1 (18%). 20% started renal replacement therapy (RRT). Proteinuria, obesity, hyperuricemia, high total MEST-C score, and low serum C3 were associated with a worse prognosis. As a significant part of patients start RRT in the five-year period after the biopsy, the disease course is not benign. IgAN in the study population was diagnosed with clinical and histological signs of advanced disease.publishersversionPeer reviewe

Pediatric surgical contributions of Professor Aleksandrs Biezins : an analysis of clinical and academic activities abroad

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.Peer reviewe

Decreasing Prevalence of Multidrug-Resistant Acinetobacter Baumannii in Rīga East University Hospital

Publisher Copyright: © 2016 by Maris Liepiņš. Copyright: Copyright 2016 Elsevier B.V., All rights reserved.There has been an increasing tendency of infections caused by multidrug-resistant organisms (MDRO), including multidrug-resistant Acinetobacter baumannii (MDRAB), in the Rīga East University Hospital (REUH) during the last decade. Over the last two years (2014-2015), this tendency has reversed and the prevalence of MDRAB has decreased considerably. In this study we assessed the prevalence of MDRAB in intensive care units (ICUs), internal medicine, surgery units and analysed antibiotic sensitivity profiles. In addition, we determined if current infection control measures are preventing further increase of infections caused by MDRAB in REUH. Retrospective Acinetobacter baumannii prevalence data were collected for the period from 2009 until 2012. For the time period from the beginning of 2013 until 2015, after implementing such infection control measures as control of compliance to hand hygiene guidelines, a review of central venous catheter insertion protocols and regular search for sources of MDRAB in hospital environment, prospective follow-up of new cases was conducted. Antimicrobial sensitivity profiles were assessed for the period from 2013 until 2015. Data were processed with the statistical software WHONET 5.5. Bacteria identification and antibiotic susceptibility testing were performed by VITEK 2 compact, BioMerieux, France. The prevalence of MDRAB in the period 2009 to 2013 increased from 71 to 217 cases per year, but from between 2013 (time of implementing infection control measures) and 2015 it decreased to 113 cases in 2015. In the three year period (2013-2015), the proportion of MDRAB causing bloodstream infections (BSI) and central nervous system infections (CNSI) was 15.85% from all identified MDRAB cases. Of the 113 MDRAB infections diagnosed in 2015, BSI was found in 16.81% cases (n = 19). Antibiotic resistance testing showed that colistin is the most effective drug against MDRAB. The majority of Acinetobacter baumannii isolates were resistant to Ampicillin/Sulbactam, Piperacillin/Tazobactam, Ceftazidime, Cefepime, Imipenem, Meropenem, Amikacin, Gentamicin, Tobramycin, and Ciprofloxacin. Over the last two years (2014-2015), prevalence of MDRAB infections decreased considerably. In the time period from 2013 to 2014, resistance of Acinetobacter baumannii increased to imipenem, ciprofloxacin and colistin, while decreased slightly to amikacin. Rigorous infection control measures, such as identification and elimination of new MDRAB sources in environment, review of the central venous catheter insertion protocol and improvements in hand hygiene, are crucial for decreasing distribution of and invasive infections caused by MDRAB in the hospital environment.publishersversionPeer reviewe

Right ventricle involvement in patients with acute ST elevation myocardial infarction : Is echocardiography good enough in diagnosing it?

Publisher Copyright: © 2021 Sciendo. All rights reserved.Right ventricle (RV) dysfunction in patients with ST elevation myocardial infarction (STEMI) is more common and important than previously considered. The aim of this study was to determine the incidence of RV involvement in acute STEMI by using advanced echocardiography (Echo) methods, such as RV longitudinal strain and three-dimensional (3D) ejection fraction, and to prove that RV involvement is not exclusive to right coronary artery damage in STEMI. The study group was formed of 73 patients aged 30 to 60 years with confirmed first-time acute STEMI and coronary angiography performed. Abnormality thresholds for standard and advanced Echo parameters in case of STEMI for predicted RV dysfunction were RV 3D ejection fraction –24.5 %. Using these abnormality thresholds it was possible to detect RV dysfunction in 60% of STEMI cases. The acquired results are close to the cardiac magnetic resonance data found in literature, which is the gold standard for determination of RV systolic function. RV involvement did not depend on the damaged coronary artery, as there was no association detected (p = 0.09); therefore, RV function should be assessed in every STEMI patient, and Echo is an effective method for this purpose.publishersversionPeer reviewe

Comparison among different scoring systems in predicting procedural success and long-term outcomes after percutaneous coronary intervention in patients with chronic total coronary artery occlusions

Publisher Copyright: © 2019 by the authors. Licensee MDPI, Basel, Switzerland.Background and objectives: Different scoring systems are used to stratify patients with chronic total coronary artery occlusions (CTO) according to disease complexity to predict the success of the percutaneous coronary intervention (PCI). Comparison among different CTO scoring systems and long-term outcome for patients with CTO after PCI has not been well established. The objectives of the study were to assess the ability of different disease severity scoring systems to predict, first, procedural success and, second, overall survival in patients with a successful procedure. Materials and Methods: A total of 551 patients who underwent elective CTO PCI in Riga East University hospital from January 2007 to December 2016 were included in the study. Four scoring systems (J CTO, PROGRESS CTO, CL, and CASTLE) were calculated. ROC curves were used to assess the association between scores and procedural success, and the Kaplan–Meier method and Cox regression were used to estimate the association with death from any cause after a successful procedure, Results: 454 of 551 cases were successful. With increasing disease complexity, the procedural success rate was significantly reduced in all scoring systems (p < 0.001): Area under the curve was 0.714 for J CTO score, 0.605 for PROGRESS CTO, 0.624 for CL and 0.641 for CASTLE scores. During the median 6.8 years of follow-up time, survival was better in the successful procedure group (p = 0.041). Among patients with procedural success, only PROGRESS and CASTLE scores showed an association with all-cause risk of death. After adjustment for baseline characteristics, patients having high PROGRESS score had almost twice higher risk of death (HR 1.81(95% CI 1.19–2.75)), and those with high and intermediate CASTLE score experienced almost four (HR 3.68(95% CI 1.50–9.05)) and two (HR 2.15, (95% CI 1.42–3.23)) times higher risk of death than the low score patients, respectively. Conclusions: All four CTO scoring systems had moderate ability to predict procedural success. More complex CTO PCI patients, assessed by PROGRESS and CASTLE scores, has worse all-cause survival in six to seven years after a successful procedure; whereas J CTO and CL scores had no association with survival.publishersversionPeer reviewe

Postprandial Glycaemic and Insulinaemic Responses after Consumption of Activated Wheat and Triticale Grain Flakes

Funding Information: We thank Vinita Cauce for her invaluable help with data analyses and interpretation. ,e present research leading to these results has received funding from the Norwegian Financial Mechanism 2009–2014 under Project “Innovative approach to hull-less spring cereals and triticale use from human health perspective” (NFI/R/2014/011). Publisher Copyright: © 2019 Laila Meija et al.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.publishersversionPeer reviewe

Overlaps in the Pathogenesis of Rosacea and Atherosclerosis

Publisher Copyright: © 2018 Aleksejs Zavorins et al., published by Sciendo.Rosacea is a chronic inflammatory skin disease characterised by transient or persistent erythema, telangiectasia, papules, and pustules that predominantly involve central regions of the face. Recent studies have shown a possible clinical association between rosacea and cardiovascular diseases (CVDs). Rosacea and atherosclerosis are both known to have alterations in the innate immune system, enhanced oxidative and endoplasmic reticulum stress. The aim of this review is to delve deep into the pathogenesis of rosacea and atherosclerosis to uncover possible pathogenic overlaps between these chronic inflammatory diseases.publishersversionPeer reviewe

PAI-1 level differences in malignant plural effusion, parapneumonic pleuritis, and cardiac hydrothorax

Publisher Copyright: © 2019 by the authors. Licensee MDPI, Basel, Switzerland.Background and Objectives: Plasminogen activator inhibitor-1 (PAI-1) is a fibrinolytic system enzyme whose role in various fibrinolytic processes is currently unknown. In clinical manifestations of pleural liquids of diverse etiology, various levels of fibrinolytic activity can be observed—parapneumonic processes tend to loculate in fibrin septa, while malignant pleural effusion (MPE) does not. The purpose of this study was to determine possible differences in PAI-1 levels in pleural effusions of varied etiology. Material and Methods: PAI-1 level in pleural effusion and serum was determined in 144 patients with pleural effusions of various etiology (cardiac hydrothorax—42 patients (29.2%), MPE—67 patients (46.5%), parapneumonic pleuritis—27 (18.8%), tuberculous pleuritis—6 patients (4.1%), pancreatogenic pleuritis—1 patient (0.7%) and pulmonary artery thromboembolism with pleuritis—1 patient (0.7%)). Results: The median PAI-1 level (ng/mL) was the highest in the parapneumonic pleuritis group both in the effusion and the serum, with values of 291 (213–499) ng/mL and 204 (151–412) ng/mL, respectively, resulting in a statistically significant difference (p < 0.001) from the cardiac hydrothorax and MPE groups. However, there was no statistically significant difference between PAI-1 levels in the pleural effusion and serum in the cardiac hydrothorax and MPE groups. Conclusion: The PAI-1 level in MPE and cardiac hydrothorax was statistically significantly lower than in parapneumonic pleuritis.publishersversionPeer reviewe