rss_2.0General Interest FeedSciendo RSS Feed for General Interest Interest Feedānis Priedkalns – Outstanding Latvian Medical Scientist, 1934–2022 of the Difficult Laryngoscopy with Ultrasound Measurements of Hyomental Distance<abstract> <title style='display:none'>Abstract</title> <p>Ultrasound measurement of hyomental distance is promising as a predictor for difficult laryngoscopy in cases of difficult airway management. The aim of the study was to evaluate the prognostic value of ultrasound measurement of hyomental distance (HMD) for prediction of difficult laryngoscopy. Hyomental distance was sonographically measured in neutral (HMDn) and extreme head extension (HMDe) positions for fifty-six patients scheduled for elective surgery requiring tracheal intubation. Then the hyomental distance ratio (HMDR) was calculated. According to presence of difficult laryngoscopy assessed by the Cormack–Lehane (CL) score, patients were divided into a difficult laryngoscopy group (DL, n = 15) and easy laryngoscopy group (EL, n = 41). We calculated the sensitivity and specificity of HMDn, HMDe, and HMDR for difficult laryngoscopy. DL was present in 15 (27%) patients. We found a significant intergroup difference in HMDR between the DL and EL groups (1.12 ± 0.04 vs. 1.24 ± 0.06, respectively; p &lt; 0.001). In contrast, we were not able to find a significant difference for HMDn and HMDr. HMDR had the highest sensitivity 86.7% and specificity 85.4% (p &lt; 0.01) to predict difficult laryngoscopy, where the area under the curve was 0.939; p &lt; 0.01 for HDMR &lt; 1.2 cm. Moreover, we found that difficult laryngoscopy was associated with higher body mass index (BMI), with higher values in the DL group compared to EL patients (34.3 ± 9.1 vs. 28.5 ± 5.7 kg/m<sup>2</sup>, respectively; p = 0.035). HMDR &lt; 1.2 cm measured by ultrasound might have a good predictive value for prediction of difficult laryngoscopy.</p> </abstract>ARTICLE2022-07-23T00:00:00.000+00:00Transcranial Duplex Ultrasonography Measurements Towards Identification of Blood Vessel Conditions: Artificial Cerebral Blood Flow in Pathologies<abstract> <title style='display:none'>Abstract</title> <p>The aim of the study was to investigate how cerebral vasospasm, vasodilation and haemorrhage under artificial circulation conditions during cardiopulmonary bypass affect transcranial duplex ultrasonography measurements. A description of transcranial duplex ultrasonography and phantom development is provided. Measurements were made using a commercially available ultrasound system and cardiopulmonary bypass machine, water phantom and 32% glycerol solution with cornstarch. The experiments showed that the cerebral blood vessel condition in artificial circulation affects transcranial duplex ultrasonography measurement limit values. The most sensitive parameter for blood vessel condition changes is Peak Systolic Velocity (PSV) for which changes were observed in 100% of cases. The most insensitive was Time-Averaged Peak-Velocity (TAPV), and Minimum Diastolic Velocity (MDV) for which changes were observed in 83% of cases.</p> </abstract>ARTICLE2022-07-23T00:00:00.000+00:00Effect of a Modified AN69ST Membrane on the Clinical Course of Adult Patients with Bacterial Septic Shock<abstract> <title style='display:none'>Abstract</title> <p>Sepsis is among the leading causes of mortality globally. Blood purification techniques are evolving in sepsis therapy, aiming at pathogenic antigens and host cytokines. The aim of this study was to determine whether continuous renal replacement therapy (CRRT) with modified AN69ST membrane, brand name oXiris, improves the clinical course of adult patients with septic shock. The study had a retrospective, longitudinal, propensity score matching (PSM) design with two groups: treatment — CRRT started with oXiris, control — used ST150 filters only. Data from 636 patients were analysed. The oXiris and control groups included 40 and 57 patients, respectively. PSM left 19 patients in each group. Ten of 19 patients died in the oXiris group. Survival, CRRT duration, intensive care unit or hospital length of stay did not differ between the groups. The oX-iris group had a tendency for lower mortality in Gram-negative infection cases, though not statistically significant. During the first 72h of CRRT, both groups had improvement in noradrenaline requirement, arterial pressure and blood lactate. However, with oXiris treatment, increase of arterial pressure (TA) was greater during CRRT during the first 24h and there was a more significant decrease of noradrenaline infusion and lactate during the first 72 h. We concluded that in septic shock early CRRT with oXiris may be beneficial and that there might be decreased hospital mortality in the case of Gram-negative infection. Further larger studies are required.</p> </abstract>ARTICLE2022-07-23T00:00:00.000+00:00Assessment of Anaesthesia Nurses’ Attitude to Teamwork<abstract> <title style='display:none'>Abstract</title> <p>Teamwork is one of the most important aspects in medicine today. It is known that the operating room is the place where communication is most needed between doctors and other medical staff. The purpose of this study was to analyse the view of nurses towards collaboration between the physician and nurse in an anaesthesiology department depending on education and work experience. The study was conducted in three Lithuanian hospitals. The questionnaires “Jefferson scale of attitudes toward physician–nurse collaboration” and “Barriers of communication between doctors and nurses” were used. The statements of the questionnaires were rated using the Likert scale; the attitude was evaluated as positive when the assessment was more than median (2.5). The results were processed by SPSS Statistics 23.0 pack, using descriptive statistics and ANOVA, with statistically significant results when p &lt; 0.05. A total of 138 nurses participated in this study, all female, aged 43.00 ± 12.48 years and with different education levels. According to the nurses, the most important aspects of teamwork were dominance of physicians (3.08 ± 0.65), nurse’s autonomy (3.46 ± 0.54), patient care (3.33 ± 0.56) and sharing knowledge and cooperation (3.33 ± 0.47) (F = 12.47; p &lt; 0.001). Patient care and autonomy of nurses were most important aspects for nurses with higher education and short job experience, and physician dominance was the most important for nurses with a longer job experience and lower education level. Barriers to cooperation arising from environmental factors are the greatest drivers for ineffective teamwork.</p> </abstract>ARTICLE2022-07-23T00:00:00.000+00:00Clinical Characteristics of Invasively Ventilated Covid-19 Patients: An Overview of Clinical Experience in Pauls Stradiņš Clinical University Hospital, Rīga, Latvia<abstract> <title style='display:none'>Abstract</title> <p>This retrospective single-centre study was conducted in an intensive care unit (ICU) in Pauls Stradiņš Clinical University Hospital (Rīga, Latvia) between 1 October 2020 and 30 April 2021. The aim was to assess the baseline clinical characteristics and their association with outcome for critically ill coronavirus disease 2019 (COVID-19) patients admitted to the ICU and requiring invasive mechanical ventilation (IMV). Demographic, clinical, laboratory, length-of-stay and mortality data were collected from medical records. In total, 66 critically ill patients admitted to the ICU were enrolled in this study. 77% were male, and the median age was 65.5 [57.0–70.8] years. Comorbidi-ties included obesity (67.2%), cardiovascular disease (63.6%) and type II diabetes (38.1%). Prone positioning was performed in most cases (68.2%) and one-third (34.8%) of patients required renal replacement therapy during their stay in the ICU. The median time to intubation after hospitalisation was eight [3.3–10.0] days. The median length-of-stay in the ICU was 12 [6.0–18.5] days and the overall mortality among all invasively ventilated patients in the ICU was 86%. In survivors, the duration of time between the onset of symptoms and hospitalisation, and time between the onset of symptoms and intubation, were found to be shorter than in non-survivors.</p> </abstract>ARTICLE2022-07-23T00:00:00.000+00:00Causes of Suboptimal Preoxygenation Before Tracheal Intubation in Elective and Emergency Abdominal Surgery<abstract> <title style='display:none'>Abstract</title> <p>Optimal preoxygenation (PO) prior to tracheal intubation reduces the risk of arterial desaturation and prolongs the period of safe apnoea. The common methods of PO are mask ventilation with 100% O<sub>2</sub> for 3–5 minutes or, alternatively, asking the patient to take eight deep breaths in a minute. Our study group conducted a prospective study to assess the impact of the most common risk factors on PO and to compare the efficiency of PO in patients undergoing elective and emergency abdominal surgery without premedication. PO was performed using mask ventilation with 6 l/min of 100% oxygen for 5 minutes. End-tidal oxygen (EtO<sub>2</sub>) was documented in 30-second increments. We found that optimal PO (EtO<sub>2</sub> &gt; 90%) was not achieved by almost half of the patients (46%) and that this was more common in the elective surgery group. Effective PO was not impacted by any of the evaluated risk factors for suboptimal oxygenation. Despite these findings, we believe that the identification of potential risk factors is crucial in the pre-anaesthesia stage, given the benefits of optimal PO.</p> </abstract>ARTICLE2022-07-23T00:00:00.000+00:00Changes in Cerebral Oximetry in Patients Undergoing Shoulder Replacement Surgery<abstract> <title style='display:none'>Abstract</title> <p>Degenerative joint diseases affect the elderly population, and advanced orthopaedic surgery offers novel solutions. The semi-sitting position is used during shoulder replacement surgery. There have been reports of transient and permanent neurological damage following surgery. We aimed to determine cerebral desaturation events (CDEs) during shoulder replacement surgery under general anaesthesia. This prospective, observational study was conducted at the Hospital of Traumatology and Orthopaedics. A cohort of 24 patients received combined plexus brachialis block and endotracheal anaesthesia. Their cerebral regional oxygen saturation index (rSO<sub>2</sub>) and mean arterial blood pressure (MAP) were recorded and compared in predefined intervals: before induction, post-induction, after getting in a sitting position, after cementing, and after extubation. Hypotension was defined as the occurrence of any of the following: either a &gt; 30% decline in MAP from the baseline or a MAP &lt; 65 mmHg. CDEs were defined as a 20% reduction in frontal lobe oxygenation. Calculations were made using SPSS software (Version 14.0.2, SPSS Inc.). There was a significant correlation between MAP and rSO<sub>2</sub> after positioning, between MAP after intubation and rSO<sub>2.</sub>, and between MAP before intubation and rSO<sub>2</sub> at the end of surgery. One in three patients who experienced hypotension also experienced a CDE. rSO<sub>2</sub> fluctuations correlated with MAP.</p> </abstract>ARTICLE2022-07-23T00:00:00.000+00:00Extraction of B12 Reference Intervals from a Large Amount of General Patient Data<abstract> <title style='display:none'>Abstract</title> <p>This study compared the reference intervals (RI) of B12 vitamin concentration in blood found in the literature with RIs extracted from data accumulated from a large number of patients by E. Gulbis Laboratory in Latvia. This paper investigated and demonstrated the possibility of using large amounts of random patient data to establish the RI for clinical laboratory tests. The blood level of B12 vitamin was selected as the model system for this study. The study used blind data for B12 blood level measurements from 132 379 patients accumulated in E. Gulbis Laboratory over a period of 15 years. In order to establish the reference intervals, the frequency distribution of log transformed B12 values was fit to a Gaussian distribution. The established B12 reference interval of 196 pg/ml and 942 pg/ml was found to be in good agreement with RIs reported elsewhere.</p> </abstract>ARTICLE2022-07-23T00:00:00.000+00:00Aerosol and Droplet Generation During Intubation and Normal Breathing: A Simulation Study<abstract> <title style='display:none'>Abstract</title> <p>The recent COVID-19 pandemic has made important changes to the everyday practice of anaesthetists. Current research has shown that the virus spreads via respiratory droplets and aerosolisation. The aim of this study was to examine the extent of contact contamination, droplet spread and aerosolisation, which may occur with normal breathing and intubation in a mannequin study. In the first experiment, an Ambu bag was attached to the simulation mannequin’s trachea and an atomiser device was placed into the mannequin’s pharynx. This model simulated normal ventilation as 0.5 ml of luminescent fluid was sprayed through the atomiser. In the second experiment, the mannequin was intubated with a videolaryngoscope while spraying 0.5 ml of luminescent fluid through the atomiser, after which the laryngoscope was removed. The spread of the luminescent aerosol cloud after three full breaths, droplet spread and contact contamination were visualised using ultraviolet light. The extent of spread was evaluated using a 4-point Likert scale (0 to 3) by two observers. Each of the experiments was repeated five times. For the first experiment, aerosol formation, droplet spread and contact contamination were 2.5 (2–3), 1 (0–1), 0 (0–1) points. In the second experiment, aerosol formation, droplet spread and contact contamination were 0.5 (0–1), 1 (0–1), 3 (2–3) points, accordingly. Noticeable contact contamination occurs during laryngoscopy and removal of the laryngoscope, whereas droplet contamination with laryngoscopy and normal breathing is minimal. Normal breathing leads to significant aerosol formation.</p> </abstract>ARTICLE2022-07-23T00:00:00.000+00:00Liquid Biopsy — A Novel Diagnostic Tool for Management of Early-Stage Peripheral Lung Cancer<abstract> <title style='display:none'>Abstract</title> <p>Lung cancer is the leading cause of cancer-related mortality worldwide. Early diagnosis of lung cancer is hampered by the absence of specific symptoms and the lack of a widely recognised cost-effective screening programme. Acquisition of a tumour tissue sample for morphological and molecular genetic examination is of paramount importance for cancer diagnosis. We describe diagnostic challenges for early-stage lung cancer and their possible current solutions. Liquid biopsy is a relatively new technology that was developed for evaluation of tumour-related circulating genetic material. Recent achievements in data processing provide more opportunities for wider implementation of Next Generation Sequencing (NGS) in clinical practice. This article summarises available data on the current and future role of liquid biopsy in the management of lung cancer. We also present an ongoing Latvian lung cancer study that focuses on integration of liquid biopsy with comprehensive clinical data utilising advantages of information technologies.</p> </abstract>ARTICLE2022-07-23T00:00:00.000+00:00Anaesthesia for Liver Transplantation<abstract> <title style='display:none'>Abstract</title> <p>Since the first liver transplantation at the Kaunas Clinic of the Hospital of Lithuanian University of Health Sciences (LUHS), in 2000, many changes have been implemented and an increasing number of cases led to the development of expertise. The aim of this article was to summarise 12-years out of liver transplantation experience. Data was obtained retrospectively from inpatient medical records at the Hospital of LUHS, Kaunas Clinic. All cases of liver transplantations from November 2009 to September 2021 were included (n = 96). The median age of transplant recipients was 50 years (IQR 46–56). Two-thirds of recipients were male (n = 66, 69%). The mean Model for End-Stage Liver Disease (MELD) score was 23 (SD 6). The most common indication for liver transplantation was hepatitis C virus-related end-stage liver disease (n = 24, 25%). Immediate extubation was performed with a median of 63% of cases (IQR 14.3–75.7%). We further compared data between the early (November 2009 – December 2015) and late phases (January 2016 – September 2021) of experience: the number of liver transplantation cases increased by 66% from 36 to 60), MELD scores stayed similar (an average of 22 vs 24, p = 0.282), and mean intraoperative time did not change significantly (543 minutes vs 496 minutes, p = 0.078). Liver transplantation has been gaining momentum in Lithuania. Increasing experience enables our centre to meet an increasing demand for liver transplantations.</p> </abstract>ARTICLE2022-07-23T00:00:00.000+00:00Management of Proximal Femoral Fractures<abstract> <title style='display:none'>Abstract</title> <p>Proximal femoral fractures are typical injuries in the elderly population. We conducted a retrospective study to estimate postoperative mortality and risk factors affecting patient outcomes at Tartu University Hospital. We retrospectively evaluated patients who were hospitalised in 2017 with a proximal femoral fracture diagnosis and who were operated (osteosynthesis, partial and total hip replacement). In the study we included 313 patients of 361 (219 women and 94 men). We did not find statistically significant difference between the choice of anaesthesia and mortality or between the time getting to the OR and mortality. Cognitive impairment and postoperative delirium were significantly associated with increased one-year mortality was 37% (p &lt; 0.05). In the group of the patients who did not have postoperative delirium the overall mortality was 15%. 23% of the patients had preoperatively cognitive impairment, and 45.8% of them died in the first year after the operation (p &lt; 0.001). Mortality of patients who did not have cognitive impairment was 14%. As the sample group of patients included in the study was small, further investigation should encompass a larger group in the future.</p> </abstract>ARTICLE2022-07-23T00:00:00.000+00:00Instructional Leadership of Private and Public Schools in Kosovo<abstract> <title style='display:none'>Abstract</title> <p>Managing a company or organization in today’s market is a challenge that each leader has to face. Companies have to adapt and embrace challenges, or they will be left behind by the competitors in the market. The leadership of a company has to be creative in order to fulfill the needs of the customers, the market, and its employees.</p> <p>The same rules apply for language teaching organizations, which have to follow the rapid changes in the field of education, technology and marketing all the same. Therefore, the purpose of this paper is to acquire knowledge of key aspects of instructional leadership in private and public schools, to find the parameters that make an organization successful, and to compare key management decisions taken by organizations over the years. In focus of this paper is a case study with two primary schools in Kosovo, one public and one private, how they operate, how are they managed and the possible ways of further development. Interviews with the leaders of the schools have been conducted, and the findings have been compared and supported with contemporary literature review. The paper starts provides an introduction, the literature review, the framework used, an interpretation and critical discussion of the data collected, and it ends with the conclusion on instructional leadership.</p> </abstract>ARTICLE2022-07-04T00:00:00.000+00:00Efforts Towards Creating a National Brand in Kosovo (2008-2021)<abstract> <title style='display:none'>Abstract</title> <p>States in the context of foreign policy apply specific strategies that relate with strengthening their international position, especially in relation to the promotion of attributes and values that make changing the perceptions of citizens of other states, and consequently of decision makers. Small states find it difficult to impose on the large international system knowing that their power and potential is little measurable.</p> <p>Kosovo since its proclamation as a state, is facing this dilemma, as crises, political instability and the inability to conclude the problem of recognition have cost it in external perception as a country with unsolvable political problems, while from within as the place where opportunities for work and well-being are seen as difficult to achieve, while interethnic cooperation remains dependent on the fate of the Brussels Talks or reconciliation and forgiveness, which are also linked to political talks. The need to affirm the truth of Kosovo, found it without concrete strategies, while the application of some marketing on foreign television, was not followed by any concrete plan.</p> <p>Kosovo had launched a campaign entitled “Young Europeans”, while only a few years later, 200,000 young people left the country, producing paradigmatic upheavals, in “young European immigrants”. Applying a series of methods, such as content analysis, statistics and interviews, the paper concludes that Kosovo has not had a national strategy for creating a national brand, while there are some sporadic efforts, which are not accompanied by concrete strategies, while political instability did not allow the functioning of foreign policy and consequently increased impatience of the citizens towards the institutions which was reflected in the efforts for their mass departure from the country.</p> </abstract>ARTICLE2022-07-04T00:00:00.000+00:00Freedom of Information and Journalism in Kosova 2010 - 2020<abstract> <title style='display:none'>Abstract</title> <p>The beginnings of the practical implementation of the right on access to public documents, also known as the freedom of information in Kosova date fifteen years back from now, when the first law on access to public documents was adopted (Official Gazette of RKS, 2007).</p> <p>The freedom of information was attained with difficulties by journalists in relation with public institutions until two years ago. This was because of the oversight body of this law’s implementation was a coordinating office within Prime Minister’s Office, without a specific binding mechanism to public institutions, whilst the Ombudsperson served as a second instance, also without an executive mandate to empower achievement of this right.</p> <p>The content of this paper’s body entails, among others, aims to highlight the degree of difficulty journalists faced to provide information in the absence of an appellant authority in the country during a ten years’ period, which is the subject matter of this writing.</p> <p>Notwithstanding difficulties to freely access public documents, provided by law to be open for the public, as well as the people’s lost trust for public institutions in this regard, since 2019 when the oversight mission of the Law on Access to Public Documents was entrusted to the Information and Privacy Agency, the general perception began to change positively.</p> <p>The current situation in terms of the respect for the freedom of information may be considered to be relatively satisfactory, because public institutions are made aware of the existence of the oversight authority, which acts as an appellate authority for citizens.</p> </abstract>ARTICLE2022-07-04T00:00:00.000+00:00Hybrid Warfare in the Western Balkans: How Structural Vulnerability Attracts Maligned Powers and Hostile Influence<abstract> <title style='display:none'>Abstract</title> <p>This study analyzes the domestic political, economic, and social conditions in the Western Balkans that provide fertile ground for hostile and maligned actors to manipulate and exploit governments and societies with hybrid war measures, namely cyberattacks and cyber intrusions and disinformation and fake news. It begins with a review and assessment of the prevailing empirical and theoretical literature on hybrid warfare. It then describes two leading empirical indices that measure degrees of permeability and structural vulnerability that elevate or reduce the risks associated with maligned and hostile interventions. The article also examines leading indicators measuring resilience levels in cybersecurity and media/information literacy, highlighting political, social, and economic vulnerabilities. It concludes by suggesting that domestic conditions in the region encourage maligned and hostile actors, especially Russia and for different reasons and to a lesser extent China and Turkey, to use hybrid measures to exploit the region. The article proposes that in addition to strengthening institutions and trust, membership in NATO and the E.U. are directly related to mitigating structural vulnerability and reducing uncertainty and insecurity in the Western Balkans.</p> </abstract>ARTICLE2022-07-04T00:00:00.000+00:00Editorial Preface Importance of Project Based Learning in Teaching English as a Foreign Language - A Case Study from the Republic of Kosovo<abstract> <title style='display:none'>Abstract</title> <p>This small-scale research paper analyses both teachers’ and students’ perceptions and their roles towards the use of Project Based Learning (PBL) in a research context in the Republic of Kosovo. The study was completed by sixty students of three lower-secondary private schools in Kosovo and eight English language teachers who work there. The aim of this study was to investigate teachers’ perspectives on using PBL in their classes, the challenges they face while applying PBL, the most common benefits PBL implementation, the materials used with this method, and the impact of PBL on students’ motivation to learn English as a Foreign Language. The data obtained from interviews with teachers highlight that teachers use PBL to a certain extent, though it works much effectively with lower-secondary and upper-secondary education. Teachers preferred to use Project Based Learning in their classrooms in general, although there appears to be some uncertainty between doing projects and Project Based Learning as a strategy. English language instructors have only seen themselves as facilitators of initiatives carried out in the classroom, resulting in a student-centered environment. In contrast to the past, it appears that teachers make extensive use of technology and involve students in a variety of activities to boost their learning and keep them engaged in PBL. Students on the other hand, through a very small number, highlighted that PBL is a better teaching approach in comparison to the traditional textbook teaching and learning.</p> </abstract>ARTICLE2022-07-04T00:00:00.000+00:00The Nobility of Drivasto and Scanderbeg<abstract> <title style='display:none'>Abstract</title> <p>This article aims to elaborate on the relationships between Georges Castriota Scanderbeg and noble families from Drivasto. Drivasto was an Albanian medieval city located in the Northern Albania, about 12 km away from Shkodra. Its origin dates to antiquity but it has achieved its cultural, economic, and political peak during the Middle Age. Drivasto had its schools, church, and social life. The city elite consisted of noble families, such as Engjelli, Spani, Suma, Moneta, and Dushmani. The city elite played an important role in the resistance against the establishment of Ottoman rule in Albanian lands, so many figures deriving from that elite closely cooperated with Georges Castriota Scanderbeg. They used their diplomatic and military background to transmit Scanderbeg’s claims abroad or to fight against the Ottomans.</p> <p>Therefore, this article aims also to elaborate on the social aspects of the society of Drivasto and its role in political circumstances, aiming thus to present to the audience some historical and social features and international relations during the Middle Age. The first part of this scientific research provides a brief presentation about the city of Drivasto during the Middle Age, continues with noble families and their role and cooperation with Scanderbeg; lastly summarises circumstances that derived from the return of Scanderbeg until the year 1478 when Drivasto fell under the Ottoman rule. The work “The nobility of Drivasto and Scanderbeg” derived of intensive scientific research. The comparative and synthetic methodologies have been used to draft this article.</p> </abstract>ARTICLE2022-07-04T00:00:00.000+00:00en-us-1