Effect of different low doses of intrathecal morphine (0.1 and 0.2 mg) on pain and vital functions in patients undergoing total hip arthroplasty: a randomised controlled study.

BACKGROUND: Orthopaedic surgeries are among the most painful procedures. By adding low-dose morphine to intrathecal bupivacaine for spinal anaesthesia, the analgesic effect can be improved. The objeсtive of the study was tо compare the efficacy and safety of lоw-dоse (0.1 mg аnd 0.2 mg) intrаtheсаl mоrphine (ITM). METHODS: А prоspeсtive rаndоmised study was соnduсted at the Hоspitаl оf Trаumаtоlоgy аnd Оrthоpaediсs, Riga, Latvia (February 2020 tо May 2021) and enrolled 90 patients undergoing primary hip arthroplasty. All subjects were randomised intо three study grоups, using the online tool оn www.randomiser.org . Treatment groups were allocated to intrathecal morphine (0.1 mg and 0.2 mg) in addition to bupivacaine (15 to 18 mg). The primary outcome was postoperative pain intensity among the three study groups within 24 hours by NRS. The secondary outcomes: pain at rest 4 h, 7 h, 12 h, 24 h postoperatively, respiratory rate, SpО2, morphine соnsumptiоn, оxygen supply, opioid-related аdverse reасtiоns within 24 hours postoperatively. Dаtа were аnаlysed using R version 4.2.0, applying the Mann-Whitney test, Pearson's chi-squared test, Fisher's exact test, Friedman test, Wilcoxon test. RESULTS: The primary outcome in the control, ITM 0.1 mg, ITM 0.2 mg groups, respectively: 2.56, 0.87, 0.28 (p < 0.001). The secondary outcomes in the control, ITM 0.1 mg, ITM 0.2 mg group, respectively: pain scores 4h - 1.21, 0.48, 0.17 (p = 0.068); 7 h - 2.62, 1.00, 0.17 (p < 0.001); 12 h - 3.08, 0.65, 0.37 (p < 0.001); 24 h - 2.50, 1.20, 0.41 (p < 0.001); rescue medication requests (incidence, %): 77%, 16.7%, 13.3% (p < 0.001); mean respiratory rate (breath/min) - 15.2; 15.2 (p > 0.05); mean SpO2 (%): 96.7%; 95.7%; 96.07%. Significant adverse effects: pruritus in ITM 0.2 mg group (23% of subjects, p < 0.001). CONCLUSIONS: Adult patients undergoing THA under spinal anaesthesia with bupivacaine and 0.2 mg morphine had superior analgesia to patients who received spinal analgesia with bupivacaine or bupivacaine and 0.1 mg morphine. TRIAL REGISTRATION: Study ID ISRCTN37212222; 20/04/2022 (registered retrospectively).

Leucine-Rich Alpha-2-Glycoprotein (LRG-1) as a Potential Kidney Injury Marker in Kidney Transplant Recipients.

BACKGROUND Kidney transplantation is the treatment of choice for most patients with end-stage renal disease. To improve patient and transplant survival, non-invasive diagnostic methods for different pathologies are important. Leucine-rich alpha-2-glycoprotein (LRG-1) is an innovative biomarker that is elevated in cases of angiogenesis, inflammation, and kidney injury. However, there are limited data about the diagnostic role of LRG-1 in kidney transplant recipients. The aim of this study was to evaluate the association between serum LRG-1, urine LRG-1, and kidney transplant function and injury. MATERIAL AND METHODS We enrolled 35 kidney transplant recipients in the study. LRG-1 in the serum and urine was detected using ELISA. We evaluated the correlation of serum and urine LRG-1 with traditional serum and urine kidney injury markers. RESULTS A higher level of serum LRG-1 correlates with a higher level of urine LRG-1. Serum LRG-1 has a positive correlation with transplant age, serum urea, serum creatinine, serum cystatin C, proteinuria, and fractional excretion of sodium (FENa) and a negative correlation with hemoglobin and estimated glomerular filtration rate (eGFR). Urine LRG-1 has a positive correlation with serum cystatin C, proteinuria, and urine neutrophil gelatinase-associated lipocalin (NGAL). CONCLUSIONS Higher levels of serum and urine LRG-1 are associated with kidney transplant injury and functional deterioration. Thus, LRG-1 might be also as a biomarker for tubular dysfunction in patients after kidney transplantation.

An Overview of Adenoid Microbiome Using 16S rRNA Gene Sequencing-Based Metagenomic Analysis.

Background and Objectives: the upper respiratory tract harbors the highest bacterial density in the whole respiratory system. Adenoids, which are located in the nasopharynx, are a major site of bacterial colonies in the upper airways. Our goal was to use culture-independent molecular techniques to identify the breadth of bacterial diversity in the adenoid vegetations of children suffering from chronic rhinosinusitis and obstructive sleep apnea. Materials and methods: in total, 21 adenoid samples were investigated using amplification and sequencing of the V3-V4 hypervariable region of the bacterial 16S rRNA gene. Results: among the most common bacterial species found were Veillonella atypica, Fusobactrium nucelatum, Shaalia odontolytica, and Moraxella catarrhalis. Veillonella atypica and Fusbacteriumnucelatum dominated the microbiome in all 21 samples, attributing to more than 60% of all detected genetic material. Conclusions: since both Veillonella atypica and Fusobacterium nucleatum are, predominantly, oral cavity and dental microorganisms, our findings may suggest oral microbiome migration deeper into the oropharynx and nasopharynx where these bacteria colonize adenoid vegetations.

Experience of Vancomycin Therapeutic Drug Monitoring in Two Multidisciplinary Hospitals in Latvia.

Background and Objectives: Management of infectious diseases is a huge burden to every healthcare system worldwide. Antimicrobial resistance, including antibacterial resistance, is an increasing problem worldwide; therefore, more new antibiotics are necessary to be discovered. Meanwhile, "old" antibacterial agents are still administered to fight infectious diseases caused by resistant bacteria. One of these antibacterial agents is vancomycin, which is effective in treating serious systemic infections caused by gram-positive bacteria. Thus, it is necessary to perform vancomycin concentration measurements in plasma due to its narrow therapeutic index. Various approaches are implemented for more precise therapy, including therapeutic drug monitoring (TDM) of vancomycin and with a supervision of a clinical pharmacist. The purpose of the study was to investigate if the TDM practice is improved with a local vancomycin TDM protocol applied in a hospital. The results of TDM in two multidisciplinary hospitals, one with a local TDM protocol implemented and applied and the other with no local TDM protocol implemented and applied, were compared. Materials and Methods: A retrospective study was performed in two multidisciplinary hospitals in Latvia. The data were collected for a time period of 4 years (2016−2020) in a hospital without a local TDM protocol and for a time period of 2 years (2018−2020) in a hospital with a local TDM protocol, starting with a period of time when the vancomycin TDM protocol was developed. The data about the patients included in the study were analyzed based on gender, age, body weight, and renal function. Vancomycin therapy was analyzed based on dosing schemes (vancomycin dose and dosing interval), data about loading and maintenance doses, vancomycin concentration, and details about vancomycin concentration (sampling time and concentration level). Results: Differences between the hospitals were found in terms of the initiation of vancomycin administration and concentration sampling. In the hospital with a TDM protocol compared with the hospital without a TDM protocol, more accurate initiation was found, alongside adaption of therapy (97.22% vs. 18.95%, p < 0.001), better performance of administration of a loading dose (22.73% vs. 1.29%, p < 0.01), and reaching of target concentration (55.56% vs. 35.29%, p < 0.01). Concentration sampling in the correct timeframe before the vancomycin dose and vancomycin administration did not show statistically better results in either of the hospitals (4.60% vs. 6.29%, p = 0.786). Conclusions: Better results of adequate adjustments of vancomycin therapy were achieved in the hospital with a TDM protocol. In the long term, sustainable results and regular medical professionals' training is necessary.

Anterior Capsule Opening Contraction and Late Intraocular Lens Dislocation after Cataract Surgery in Patients with Weak or Partially Absent Zonular Support.

BACKGROUND AND OBJECTIVES: To evaluate anterior capsule opening (ACO) contraction and late intraocular lens (IOL) dislocation after cataract surgery in patients with weak or partially absent zonular support and assess methods of reducing these complications. MATERIALS AND METHODS: For this prospective study, we enlisted cataract surgery patients in our hospital with preoperative diagnoses of weak zonules. All patients received phacoemulsification surgery with implantation of a hydrophobic acrylic IOL and capsular tension ring (CTR). ACO reductions were measured for six months after enrolment. Data on late IOL dislocations were collected five years after enrolment of the last patient. RESULTS: Fifty-three patients were enrolled from 2011 to 2015. Over the six-month active follow-up period, ACO area reduction was 23% in patients receiving CTRs of 11 mm diameter and 8% for patients with CTRs of 12 mm, with an overall mean of 15% reduction. Five years after the last patient was enrolled, seven patients (13%) had experienced late IOL-CTR-capsular bag dislocation. For these patients, the mean ACO reduction in the first six months of follow-up was 33%, including for those who had received neodymium-doped yttrium aluminum garnet (Nd: YAG) anterior capsulotomies. CONCLUSION: Use of hydrophobic acrylic lenses and CTR reduces ACO contraction, with rates comparable to those after cataract surgery without ocular comorbidity. Our patients experienced a relatively high rate of late IOL-CTR-capsular bag dislocation. However, dislocated complexes were easily repositioned and few patients required IOL exchange. Frequent visits are warranted to promptly detect late complications of cataract surgery in patients with weak zonular support.

Solar retinopathy: a new setting of red, green, and blue channels.

PURPOSE: To introduce a new color imaging technique using improved settings of red, green, and blue channels for improved delineation of retinal damage in patients with solar retinopathy. METHOD: A retrospective case series of patients with poor vision secondary to solar retinopathy were analyzed. All patients underwent visual acuity, refraction, and dilated fundus examination. A spectral domain-optical coherence tomography of the macula and color fundus imaging using optimized red, green, and blue color setting was performed. Patients were reviewed over a 6-month period. The data were analyzed for statistical significance using an independent t test and a receiver operating characteristic curve. RESULTS: In total, 20 eyes of 10 patients were included between 2009 and 2017. The mean age was 24.9 ± 18.1 years. Best corrected visual acuity at first consultation was 0.78 ± 0.11 and after 6 months was 0.83 ± 0.09. Spectral domain-optical coherence tomography demonstrated retinal abnormalities at the myoid zone, ellipsoid zone, and the outer segment of photoreceptors. Receiver operating characteristic curve analysis showed an improving effect (area under the curve = 0.62; 95% confidence interval = 0.42-0.79). The color channels parameters, which improve visualization of the lesions were found to be 67-0.98-255 for the R-guided setting, 19-0.63-121 for the B-guided setting, and 7-1.00-129 for the G-guided setting. The ideal red, green, and blue setting was in 24-0.82-229. CONCLUSION: The use of a new setting of red, green, and blue channels could improve the diagnosis and monitoring of solar retinopathy, hence improving patient care.

Naturalistic follow-up study of rehospitalization rates and assigned disability status of patients with first-episode schizophrenia spectrum psychosis in South East Latvia: preliminary results.

BACKGROUND: Patients with first-episode schizophrenia spectrum psychosis (FEP) are at risk of not visiting an out-patient psychiatrist and are assigned disability status within a short period after diagnosis. OBJECTIVE: The aim of this study was to conduct a naturalistic follow-up of FEP patients to explore their use of mental healthcare services and the rate of assigned disability status after FEP. METHODS: This was the first study in Latvia to include all consecutive patients with FEP admitted to the largest regional hospital in South East Latvia, Daugavpils Psychoneurological Hospital (DPNH). Patients received standard treatment in a real-world environment. The mean follow-up time was 33 months (Min = 20 months, Max = 40 months). RESULTS: From the 94 consecutive FEP patients admitted to DPNH (1 January 2016 to 31 December 2017), 68 participated and provided informed consent to be followed up. During the first 12 months after discharge from the acute psychiatric ward, 23% (n = 14) never visited a psychiatrist, and 6.5% (n = 4) had a single visit to get prescription for medication. Furthermore, 36.1% (n = 22) had a rehospitalization during the first 12 months. At the end of follow-up period, 34.4% (n = 21) of patients were assigned disability status within a median time of 8 months (IQR 4.5‒20.0). CONCLUSION: Approximately, one-third of patients did not continue treatment as out-patients after FEP. One-third of FEP patients were assigned disability status. We suggest that Latvia needs improved treatment options for FEP patients, such as early intervention.

Thiopurine S-methyltransferase genetic polymorphisms in adult patients with inflammatory bowel diseases in the Latvian population.

BACKGROUND: Thiopurine methyltransferase (TPMT) plays a significant role in the metabolism of thiopurines, and, for patients with inflammatory bowel disease (IBD), it is useful to perform TPMT genotyping prior to azathioprine (AZA) treatment. In this study, we determined TPMT gene polymorphisms in a cohort of IBD patients in Latvia. METHODS: DNA samples were obtained from 244 IBD patients, and qPCR was performed for detection of rs1800462, rs1800460, and rs1142345 single-nucleotide polymorphisms (SNPs). Three common, non-functional TPMT alleles (TPMT*2, *3B, and *3C) were identified (women, 51%; men, 49%). TPMT*2, *3A, *3B, and *3C allelic variants detected using qPCR were consistent with restriction fragment length polymorphism (RFLP) data. RESULTS: Among patients, 78% had ulcerative colitis and 22% had Crohn's disease, with 93.9% of the former carrying a wild-type homozygous TPMT*1/*1 genotype and 6.1% carrying heterozygous genotypes. The most frequent polymorphisms were TPMT*1/*3A (5.3%: two variants: TPMT*3B and TPMT*3C), TPMT*1/*3C (0.4%), and TPMT*1/*2 (0.4%). None of the patients carried a TPMT*3B polymorphism and no patients were homozygous for any mutation. CONCLUSION: This is the first study to identify TPMT gene polymorphisms in adult IBD patients in Latvia. The results indicate that the frequency of common TPMT alleles is similar to that of other European populations.

Factors influencing myopic shift in children after intraocular lens implantation.

INTRODUCTION: Intraocular lenses have always been a controversial topic in pediatric cataract surgery. In the early 1990s in the post-Soviet states of Eastern Europe, intraocular lenses promised an easier full-time correction and amblyopia treatment. Since 1991, ophthalmologists in Latvia have been implanting intraocular lenses in infants. Amount of the postoperative myopic shift and its influencing factors, analyzed in this article, are important indicators of congenital cataract treatment. MATERIALS AND METHODS: A retrospective chart review off 85 children (137 eyes) who underwent foldable posterior chamber intraocular lens implantation at the Clinical University Hospital in Riga, Latvia, from 1 January 2006 until 31 December 2016, was performed. Depending on the age at surgery, patients were divided into six groups: 1-6, 7-12, 13-24, 25-48, 49-84, and 85-216 months. RESULTS: The largest and more variable myopic shift was found in a group of diffuse/total and nuclear cataract with surgery before the age of 6 months. There was a statistically significant correlation between the acquired best-corrected visual acuity and the amount of myopic shift (rs = 0.33; p < 0.001). Comparing the amount of myopic shift in two groups of different intraocular lens implantation target refraction tactics, we did not find statistically significant differences. Comparing the amount of myopic shift and implanted intraocular lens power, a negative, statistically significant correlation was found. CONCLUSION: The earlier the cataract extraction surgery and intraocular lens implantation is performed, the larger the myopic shift. The morphological type of cataract, best-corrected visual acuity, secondary glaucoma, and intraocular lens power influence the amount of myopic shift.

A population based study of multiple myeloma patients with medication-related osteonecrosis of the jaw.

OBJECTIVE: Medication-related osteonecrosis of the jaw (MRONJ) is a rare complication of antiresorptive or antiangiogenetic therapy that manifests as an exposed bone with clinical signs of infection, persisting for more than 8 weeks, without history of radiation therapy or metastases to the jaws. The aim of the study was to describe the incidence, risk factors, staging process and clinical course of MRONJ in patients with multiple myeloma (MM). MATERIALS AND METHODS: We retrospectively analyzed all (126) newly diagnosed MM patients at Riga East Clinical University Hospital (Riga. Latvia) from June 2014 to June 2017. RESULTS: Among 88 MM patients treated with bisphosphonates (BP), 6 (6.8%) patients developed MRONJ. All six patients received intravenous nitrogen-containing BPs. The average time until MRONJ manifestation was under two years. For our patients the severity of MRONJ was stage I in two, stage II in three, and stage III in one patient. Five patients had MRONJ of mandibula and one of maxilla. All patients with MRONJ had undergone a dental extraction or a trauma before the development of MRONJ. CONCLUSION: We found that MRONJ correlated with the patient's age. The average time until MRONJ manifestation in reserach group is 2 years. One of triggerring MRONJ factors are tooth extraction or trauma.

Tear osmolarity after cataract surgery.

PURPOSE: To evaluate the changes in tear film osmolarity and Schirmer I test after cataract surgery. METHODS: This single-center, prospective study included patients with no subjective complaints about dry eye disease. Patients with the following conditions were excluded: contact lens wearers, patients with diabetes, pseudoexfoliation, pterygia, and eye drops users. The eye that had not undergone surgery was considered the control group. Tear osmolarity and Schirmer I test were evaluated before surgery and during the first postoperative month. RESULTS: Thirty-seven patients were enrolled in the study. Before surgery, tear osmolarity was 301.2 ± 15.09 Osm/L in the study group and 302.3 ± 14.21 mOsm/L in the control group (P = 0.2), while Schirmer I test averaged 13.4 ± 10.50 mm in the study group and 13.7 ± 10.79 mm in the control group (P = 0.6). The next morning, the tear osmolarity decreased to <275 mOsm/L in the study group while in the control group, the value increased to 303.1 mOsm/L ± 13.68 (P = 0.008). The Schirmer I test in the same morning showed an increase up to 19.9 ± 9.73 mm in the study group and to 15.7 ± 10.19 mm in the control group (P = 0.01). One week later, the tear osmolarity increased to 311.8 ± 14.85 mOsm/L, while the control group averaged 301.7 ± 11.84 mOsm/L (P = 0.013). The Schirmer I test results decreased to 15.8 ± 9.37 mm in the study group and 13.9 ± 10.19 mm in the control group (P = 0.07) one week after the surgery. One month after surgery, tear osmolarity and Schirmer I test results in the study group decreased to the control group level (P > 0.05). CONCLUSIONS: The tear osmolarity results increased to the dry eye disease level in the first postoperative week. Over the course of one month, the difference in tear osmolarity and Schirmer I test values for the study and control groups leveled off.

Changes in Cognition, Depression and Quality of Life after Carotid Stenosis Treatment.

BACKGROUND: Although several studies have evaluated the change of cognitive performance after severe carotid artery stenosis, the results still remain elusive. The objective of this study was to assess changes in cognitive function, depressive symptoms and Health Related Quality of Life (HRQoL) after carotid stenosis revascularisation and Best Medical Treatment (BMT). METHODS: Study involved 213 patients with ≥70% carotid stenosis who underwent assessment of cognitive function using Montreal Cognitive Assessment scale (MoCA), depressive symptoms - using Patient Health Questionnaire-9 (PHQ-9) and HRQoL - using Medical Outcome Survey Short Form version 2 (SF-36v2). The assessment was performed before and at 6 and 12 months followup periods in patients who had Carotid Endarterectomy (CEA), Carotid Artery Stenting (CAS) or received BMT only. RESULTS: Improvement in the total MoCA scores was observed after 6 and 12 months (p<0.001, Kendall's W=0.28) in the CEA group. In the CAS group - after 12 months (p=0.01, Kendall's W=0.261) whereas in the BMT group - no significant changes (p=0.295, Kendall's W=0.081) were observed. Reduction of depressive symptoms was not found in any of the study groups. Comparing mean SF-36v2 scores in the CEA group, there was no significant difference in any of 10 subscales. Likewise in the CAS group - no significant difference in 9 of 10 subscales (p=0.028, η2=0.343) was observed. Three subscales worsened in the BMT group during the 1-year follow-up period. CONCLUSION: Patients with severe carotid stenosis who underwent revascularisation enhanced their cognitive performance without exerting significant change of depressive symptoms. Preoperative HRQoL may be maintained for at least one year in the CEA group.

Influence of Severe Carotid Stenosis on Cognition, Depressive Symptoms and Quality of Life.

BACKGROUND: Carotid artery disease is not just a causal risk factor of ischemic stroke, but may predispose patients to depressive symptoms and low health related quality of life (HRQoL). OBJECTIVES: The objectives of the present study were to assess the association between severe carotid artery stenosis (CAS) and cognitive impairment, frequency of depressive symptoms and status of HRQoL. METHODS: Cross - sectional study involved 55 patients with severe CAS and 54 patients with lower extremity peripheral artery disease (PAD). Cognitive impairment was assessed using Montreal Cognitive Assessment Scale (MoCA), depressive symptoms - PHQ-9 scale. HRQoL was measured using Medical Outcome Survey Short Form version 2 (SF-36v2). RESULTS: Median MoCA score 24 [23;26] was significantly lower in patients with severe CAS than in patients with PAD - 26 [25-28],(p=0.005; effect size r=0.3). There was no statistically significant difference of median PHQ-9 scores the in CAS group (median PHQ-9 score 4.0 [5]) and in the PAD group (median PHQ-9 score 5.5 [7]), (p=0.08, effect size r=0.18). Mean SF-36v2 scores were similar in CAS and PAD groups except for bodily pain (p=0.001, Cohen's d value = 0.77) and vitality (p=0.02, Cohen's d value = 0.49). CONCLUSION: In summary, our findings indicate that severe CAS could play a role in cognitive decline. Further studies should be conducted using larger patient cohorts without ischemic brain lesions and with balanced vascular risk profiles to investigate impact of CAS on cognition. There was no association between severe CAS and depressive symptoms in the present study. As patients with severe CAS did not exhibit physical symptoms, HRQoL was better for those patients than for patients with lower extremity PAD.

Anterior capsulorhexis opening reduction after cataract surgery with subluxated lenses.

BACKGROUND AND OBJECTIVE: This study sought to evaluate anterior capsulorhexis opening (ACO) reductions after surgery for a subluxated lens. Significant reduction of an ACO supports direct zonular involvement (capsular factors excluded by use of capsular tension rings [CTRs] and modern intraocular lens [IOLs]), and these findings question the long-term efficacy of subluxated lens surgery by means of cataract surgery. A small ACO due to lens mobility, non-enlargement of the ACO, and no lens epithelial cell washing due to an additional risk of further zonular damage were left as additional features to evaluate the possible outcomes of this simplified but still complicated surgery. MATERIALS AND METHODS: Data from 30 patients were used in the final analysis of this prospective study. Phacoemulsifications of subluxated lenses were performed in all patients, and iris/capsule hooks and CTRs or Cionni rings were used as stabilisers of the lens. Photography of the anterior parts (performed at 1 day, 1 week, 1 month, 3 months and 6 months after surgery) was used to evaluate the anterior capsulorhexis openings. RESULTS: Small initial anterior capsulorhexis openings (13.54mm2) were achieved, and the area reduction at 6 months was 16.70% (mean area at month 6: 11.28mm2, P<0.001). The reduction of the ACO area in the pseudoexfoliation (PEX) syndrome patients was 20% relative to the initial size (13.49mm2 vs. 10.92mm2, P<0.001). Two patients exhibited marked ACO reductions, and both were referred for anterior laser capsulotomy treatment. CONCLUSIONS: A weak or partially absent zonule does not markedly affect the reduction of the anterior capsule opening if appropriate surgical techniques, support materials and IOLs are used, even in the presence of a small initial capsulorhexis opening area. Therefore, a cataract surgery approach on the subluxated lens should be used. Ocular comorbidities, particularly PEX syndrome, play more significant roles in ACO reduction, and appropriate ACO size reducing inhibitors (e.g., anterior laser capsulotomy) or other types of surgery should be used.

Depression and social phobia in essential tremor and Parkinson's disease.

BACKGROUND: Essential tremor (ET) and Parkinson's disease (PD) are the two most common movement disorders, and tremor is the most visible symptom. Comparative study on ET and PD clinical neuropsychiatric symptoms was performed to assess the impact of emotional state on tremor. OBJECTIVES: To investigate the most common psychiatric symptoms (depression, anxiety and social phobia) and their correlations with motor symptoms, especially tremor, in ET and PD patients. MATERIALS AND METHODS: This comparative cross-sectional study consisted of neurological examinations, five self-assessment questionnaires (Depression Anxiety Stress Scale [DASS], Beck Depression Inventory [BDI], Social Interaction Anxiety Scale [SIAS], Social Phobia Scale [SPS], and State-Trait Anxiety Inventory[STAI]), clinical interviews with 45 ET patients, 40 PD patients, and 40 controls (CG), and statistical analysis was performed for 40:35:39 respectively. RESULTS: BDI revealed depressive disorders of various severities in all groups (ET=79.5%, PD=91.2%, and CG=66.7%). The study found no significant difference between ET and PD groups (p = .708) and significant difference between the patients and controls (ET/CG p = .049; PD/CG p = .007). Depression (DASS(D), BDI) did not correlate with tremor severity (p > .05) in ET and PD patients. The prevalence of social phobia was ET=50.0%, PD=42.9%, and CG=20.5%. There was significant difference between ET/CG (SIAS p = .02, SPS p = .001) and PD/CG (SPS p = .018), but no difference between ET and PD groups (p > .05). Tremor and SPS moderately correlated in ET patients (r = .35, p = .02). CONCLUSIONS: ET and PD patients showed high comorbidity of psychiatric disorders, but there was no significant difference between these two groups. ET severity correlated with social phobia scale scores.

A profile of traumatic spinal cord injury and medical complications in Latvia.

STUDY DESIGN: A single centre retrospective study. OBJECTIVES: To collect data and analyse the epidemiological profile of traumatic spinal cord injury and its medical complications during the subacute rehabilitation period. SETTING: Spinal Cord Injury Rehabilitation Programme of the National Rehabilitation Centre, 'Vaivari', Jurmala, Latvia. METHODS: Information was collected in 2015 from the medical records of 134 patients with a traumatic spinal cord injury admitted for primary rehabilitation between January 2011 and December 2014. RESULTS: During this period, the median age of patients with a traumatic spinal cord injury was 39.5 years, and the male to female ratio was 5:1. The leading causes of traumatic spinal cord injuries were falls (37%), road traffic accidents (29%), sport and leisure activities (19%), other cause (8%), unidentified causes (5%), and assault (2%). The most common medical complications were pain (77%), spasticity (48%), urinary tract infections (45%), pressure ulcers (25%), and orthostatic hypotension (14%). CONCLUSIONS: Preventive measures in Latvia should be aimed primarily to address falls, road traffic accidents, and sport and leisure activities in the young male population. Medical complications are varied, and they are an important factor following traumatic spinal cord injury. The results obtained in this study comply with the data from studies in countries of the Baltic and North Sea regions of Europe.

Insufficient assessment of sexual dysfunction: a problem in gynecological practice.

BACKGROUND AND OBJECTIVE: Sexual health is an important part of a woman's life and well-being. Female sexual dysfunction is a complicated problem, it is often underestimated in the healthcare process, and its management is complex. Giving women the opportunity to talk about sexual problems is a fundamental part of healthcare and may improve their quality of life. The aim of this study was to find out patients' experience and attitudes toward the involvement of gynecologists addressing sexual issues, to disclose the main barriers to initiate a conversation, and to assess the prevalence of sexual disorders among patients in a gynecological clinic. MATERIAL AND METHODS: A questionnaire-based approach was used to survey 18- to 50-year-old voluntary patients in the gynecological clinic. The study population comprised 300 different gynecological (except oncologic) patients independently of reasons for being in the clinic. The duration of the study was 6 months. RESULTS: Only one-third of the patients had ever been asked about their sexual life by a gynecologist, whilst the majority (80%) of the respondents reported they would like to be asked abaut and discuss sexual issues. The patients mostly did not complain because of psychoemotional barriers, and shame was the main barrier for patients to talk about their problems. Sexual dysfunction was a frequent disorder among gynecological patients, reaching especially high levels in the arousal (46.41%) and lubrication (40.67%) domains. CONCLUSIONS: The assessment of sexual health is insufficient in gynecological care, and sexual history-taking and evaluation of sexual functions should be included in routine gynecological health assessments.

Evaluation of axonal optic nerve damage using visual evoked potentials and optical coherence tomography in patients with multiple sclerosis.

BACKGROUND AND OBJECTIVE: Axonal tissue impairment plays a substantial role in the development of disability in multiple sclerosis. The aim of our study was to analyze the clinical utility of visual evoked potentials (VEP) and optical coherence tomography (OCT) in the diagnosis of optic nerve axonal damage and to determine the correlation between the retinal nerve fiber layer at the temporal quadrant (RNFLT) thickness and the VEP amplitude in multiple sclerosis patients with and without a history of acute optic neuritis (ON). MATERIAL AND METHODS: This cross-sectional study included 69 relapsing-remitting patients with multiple sclerosis from Pauls Stradins Clinical University Hospital, who were divided into 2 groups: with and without a history of ON. The RNFLT thickness and the VEP amplitude were measured. RESULTS. A total of 25 clinically affected eyes were studied. VEP showed a higher sensitivity (64%) than OCT (50%) in supporting a clinical diagnosis of ON. A significant correlation was found between the RNFLT thickness in the temporal segment and the average VEP amplitude both in the eyes of MS patients with (rs=0.42, P=0.01) and without a history of ON (rs=0.44, P<0.001). CONCLUSIONS: The evidence from this study suggests that diagnostics of optic nerve axonal damage is feasible by means of using the average VEP amplitude instead of OCT alone. However, the combination of VEP and OCT increases the chance to confirm the existence of ON. A significant correlation was found between structural and functional vision parameters for both patients with and without a history of ON.

Imaging of laser-excited tissue autofluorescence bleaching rates.

Experimental methodology for imaging of laser-excited tissue autofluorescence bleaching rates has been developed and clinically tested. The fluorescence images were periodically captured from the same tissue area over a certain time, with subsequent detection of the fluorescence intensity decrease rate at each image pixel and further imaging the planar distribution of those values. Spectral features at each image pixel were analyzed with a hyperspectral imaging camera. Details of the equipment and image processing are described as well as some measurement results that confirm the feasibility of the proposed technology.

Simultaneous recording of skin blood pulsations at different vascular depths by multiwavelength photoplethysmography.

A new technique for parallel recording of reflection photoplethysmography (PPG) signals in a broad spectral band (violet to near-infrared) has been developed, and its potential for assessment of blood microcirculation at various depths from the skin surface is discussed. PPG signals have been simultaneously detected at cw laser wavelength sets comprising 405, 532, 645, 807, and 1064 nm. Various signal baseline responses to breath holding and different shapes of the PPG pulses originated from the same heartbeat but recorded at different wavelengths have been observed, indicating a depth variety of the skin blood pulsation dynamics.