Volume 75 (2021): Issue 1 (February 2021)

Haemorrhoids are highly vascular cushions of connective tissue in the anal canal, which are normal structures of the human body. Haemorrhoidal disease in clinical practice means that there is an abnormal enlargement of the anal cushions when these transform into “anal nodules”, bleed and/or prolapse. Haemorrhoidal disease is very common. Despite numerous studies undertaken and knowledge accumulated on the aetiology and pathogenesis of haemorrhoidal disease in the last decade, the specific mechanisms responsible for the development of the disease are not thoroughly understood. The pathophysiology is most likely multifactorial and complex, manifested by muscle weakness, intrarectal prolapse, changes in vascular pressure and flow in blood vessels, malformations, sphincter damage and failure, venostasis, inflammatory reactions, endothelin and collagen abnormalities, matrix metalloproteinases activity, etc. Currently, treatment guidelines for the haemorrhoidal disease are based on Goligher’s classification. The classification of haemorrhoidal disease should be submitted to revision by including aetiological factors, the dynamism of prolapse, symptomatology, enteropathogenesis, and gender characteristics. The present review is focused on recent data gained by exploring the anatomy, pathophysiology, classification, theories explaining the development of haemorrhoids, as well as aetiological invasive and surgical treatment modalities.

The incidence of hypopharyngeal cancer globally is about 0.8 per 100 000. Globally, approximately 38 000 cases of head and neck cancer are considered yearly to be high-risk human papillomavirus (HR-HPV) related. Biopsy material fixation in formalin and embedding in paraffin (FFPE) creates many challenges. The extraction of nucleic acid material requires a more complicated approach, and often the extracted DNA is fragmented. The aim of the study was to compare several HR-HPV detection methods in nucleic acid material extracted from FFPE samples. The extracted DNA was analysed with different molecular biology methods to assess DNA quality and to determine the presence of HPV DNA with various HPV detection systems. The results were compared and statistically analysed. There was good agreement between two real-time PCR methods — Anyplex II HPV28 and Sacace HPV High-Risk Screen Real-TM Quant. We failed to reach a conclusion on agreement between real-time PCR methods and HPV16 type-specific primer PCR. There was moderate positive correlation between Anyplex II HPV28 semiquantitative results and Sacace quantitative results. We suggest that real-time PCR assays detecting smaller DNA amplicons are good and reliable methods for detecting HPV genetic material in FFPE samples.

The functions of human natural killer cells are controlled by diverse families of antigen receptors. Prominent among these are the killer cell immunoglobulin-like receptors (KIR), controlled by a family of genes clustered in one of the most variable regions of the human genome — on chromosome 19q13.4. This study aimed to investigate the possible interplay between KIR allotype, B19 infection, and thyroid disorders. Thyroid gland tissue of 30 patients with autoimmune thyroid gland diseases (AITD), 30 patients with non-autoimmune thyroid gland diseases (non-AITD) and 30 deceased subjects whose histories did not show any of autoimmune or thyroid diseases (control group) were enrolled in the study. The presence of B19V, KIR2DL2/DS2, and KIR2DL3 was detected using PCRs (nPCR, PCR). The results showed that 28% of samples of thyroid tissue from patients with AITD and 67% with non-AITD were positive for the presence of B19V, in contrast only 5% control tissue samples harbored B19V DNA. B19V-positive AITD patients had higher frequency of KIR2DL2/DS2 homozygosity and lower frequency of homozygous KIR2DL3 genotype compared to B19V negative cases (33% vs 21% and 17% vs 46%, respectively). Although our data showed that B19V positive patients with AITD had a higher frequency of homozygosity for KIR2DL2/DS2, further studies with larger groups of patients are necessary to confirm the relationship between KIR, B19V and susceptibility to thyroid disease.

Breast cancer (BC) is the most common cause of cancer-related deaths among women in Europe and worldwide. Adherent (2D) cell cultures have been the routine in vitro model system employed in preclinical BC research for the last half-century. Over the past decade, new protocols have been developed allowing patient-derived three-dimensional organoid (3D) cell culture development from a range of solid tumours, including BC. These 3D models offer a promise of closer resemblance to the native tumour than the 2D cultures. To test the assumption that an in vitro 3D BC model system provides increased faithfulness to the molecular processes happening in vivo, as compared to 2D BC cultures, post-operational material from three BC patients was used to simultaneously develop 2D and 3D cultures in vitro. When analysed by quantitative polymerase chain reaction (PCR), the gene expression patterns of the cells from 3D cultures resembled the original tissues, while the gene expression patterns of the conventional 2D cultures were more distant.

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 < 49% and RV free wall longitudinal strain > –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.

Atrial fibrillation (AF) conversion to sinus rhythm by electrical cardioversion (ECV) is followed by the challenge of preventing arrhythmia recurrence, especially in high-risk patients. The properties of class IC, class III and also class II antiarrhythmic medications have been established, but not all effects have been studied. The aim of the study was to compare efficacy of class IC and class III antiarrhythmic medications, and additionally medication with a class II mechanism of action, or taken concomitantly with a beta-blocker, for post-cardioversion sinus rhythm maintenance in patients with high-risk AF. A total of 112 patients who underwent successful ECV in Latvian Centre of Cardiology were included. Data was acquired by a face-to-face interview and 1-, 3-, 6-month follow-up interviews. Comparing class IC (used by 34.8%) and class III (used by 65.2%) drugs, there was no statistically significant difference between six-month sinus rhythm maintenance rates (53.8% vs. 63.0%, p = 0.346) and arrhythmia-free survival (p = 0.313). Comparing amiodarone (used by 57.1%) and ethacizine, concurrently with a beta-blocker (used by 25.9%), no statistically significant difference was found between six-month sinus rhythm maintenance (64.1% vs. 58.6%, p = 0.616) and arrhythmia-free survival (p = 0.706). The results showed that specific antiarrhythmic drug choice was not associated with superior effectiveness, highlighting that, if not contraindicated, ethacizine, concomitantly with a beta-blocker, could be used as a similarly effective alternative for amiodarone, which has adverse health effects.

There have been a limited number of studies in Latvia that were focused on vancomycin therapeutic drug monitoring (TDM), especially during the initiation phase of the therapy. The aim of this study was to investigate details of vancomycin therapy in its initiation phase and to analyse the results of the first therapeutic drug monitoring within a multidisciplinary hospital in Latvia. A retrospective observational study was performed in a multidisciplinary hospital in Latvia. Adult patients hospitalised in an intensive care unit and undergoing vancomycin therapy with at least one concentration measurement were included in this study. Data about patients included demographic and clinical data, renal function prior to initiation of vancomycin therapy, data about vancomycin therapy, data about the first TDM, and details about the first measurement of vancomycin concentration according to determined reference range — subtherapeutic, therapeutic and supratherapeutic levels. A total of 60 intensive care unit patients who received vancomycin with at least one concentration measurement were included in this study. Fifty-eight patients received vancomycin as intermittent intravenous infusion. The first measurement of concentration was taken before the 3^rd–4^th vancomycin dose in 38.3% cases, and in 33.3% cases — before the 2^nd dose. Sampling to determine the concentration within 30 minutes before vancomycin administration was performed in zero cases. In 35% cases, sampling was done within 2–5 hours before vancomycin administration and in 23.3% — immediately after or within a few hours after vancomycin infusion. Twelve (20%) patients had a concentration in the subtherapeutic level, and 14 (23.3%) patients had concentrations above the therapeutic level. In 42.8% of patients who had concentrations in supratherapeutic level, sampling had been performed immediately after or within several hours after vancomycin administration. The first concentration measurement was performed more than one hour before an infusion in all cases. Data on concentrations and timing were not adequate to perform appropriate therapy modification. Interpretation of dosing regime and concentration results were not adequate, and therefore correct modification of vancomycin therapy was often not possible. Routines of correct dosing regime and the 1^st TDM during the initiation phase of vancomycin therapy can be improved.

Based on epidemiological data, osteoarthritis (OA) is the most common joint disease of populations of industrialised countries. The increasing prevalence of OA is closely related to an ageing population and a sedentary lifestyle. Load-bearing joints, such as hip, knee, and intervertebral joints, are the primary ones that are being subjected to the degenerative changes. The patho-physiology of the disease is based on progressive damage and gradual deterioration of the micro and macrostructure of hyaline cartilage. In today’s radiological practice, the first-line method for assessing the condition of articular cartilage is magnetic resonance imaging (MRI). However, the sensitivity of standard clinical MRI in articular cartilage assessment is limited. For this reason, for the last five years there has been a rapidly growing interest in developing advanced MRI techniques for cartilage structure evaluation. The purpose of this pilot study was to highlight the possibilities of Artificial Intelligence Computed Vision Analysis (MEDH 3.0 algorithm) in the evaluation of cartilage changes of the knee joint. The study was carried out at Rīga East Clinical University Hospital (RAKUS) and included 25 patients. After assessment by a rheumatologist, the participants were divided into two groups: 15 (60%) participants with OA and 10 (40%) healthy individuals. All patients underwent MRI examinations according to a unified RAKUS Gaiïezers Radiology clinic protocol. MRI data were analysed using the Computed Vision Analysis MEDH 3.0 algorithm. The results showed substantial differences in intensity variance (p < 0.01) parameters, as well as in pixel entropy and homogeneity values (p < 0.01). The results of the pilot study confirmed the potential use of Artificial Intelligence Computed Vision Analysis in further development and integration in the assessment of cartilage changes in the knee joint.

The majority of reported injuries among military populations are injuries due to cumulative repetitive microtrauma — overuse injuries. Plantar pressure measurement is a simple tool to analyse lower limb biomechanics through the assessment of forces applied to the foot. This study aimed to determine the relation between peak plantar pressure and lower extremity overuse. Sixty-six active-duty infantry male soldiers, with mean age 29.7 years (range 22–40 years), and mean service time 5.2 years (range 1–15 years) participated. The highest peak plantar pressure (PPP) at the forefoot occurred at the hallux (cases: 50.82 n/cm², SD = 38.84; control: 34.39 n/cm², SD= 28.03) and 3^rd metatarsal head (cases: 54.40 n/cm², SD = 33.83; control: 49.16 n/cm², SD=28.87). The study demonstrated elevated PPP among cases. Statistically significant results were found at the hallux (χ2(1) = 6.8; p = 0.01), medial heel (χ2(1) = 5.18; p = 0.02) and lateral heel (χ2(1) = 12.12; p < 0.01) regions. The results show that plantar pressure assessment could be used as a useful screening tool for early lower extremity overuse injury detection.

The article presents the results of a retrospective study that included 70 patients with intraarticular (AO Type C [Arbeitsgemeinschaft für Osteosynthesefragen]) distal radius fractures, who were treated using an arthroscopically assisted approach with volar locking plates or just a fluoroscopically assisted surgery. Thirty-seven of them were treated using volar locking plates using only fluoroscopically guided surgery and 33 patients were treated with the arthroscopically assisted fracture fixation method. Data of the patients who attended a full cycle of the postoperative observation within the first year after the surgery and postponed to the last visit 1 to 5 years after the surgery were included in the analysis for both groups. Postoperative analysis was carried out using X-ray assessment, clinical data, patient-rated wrist evaluation score, Gartland and Werley score, Modern Activity Subjective Survey of 2007 score, range of motion, grip, pinch and tripod pinch assessment at 1, 3, 6 and 12 months postoperatively. Despite the statistically significant differences found in a number of parameters during the follow-up period, there were no clinically relevant differences determined between the two methods in the long-term period. There was a greater arch of motions in extension and radial deviation in the arthroscopic surgery group. Duration of the surgery was longer in the arthroscopic surgery group, but comminuted or AO-C3 type fractures also were more often presented in this group. One complex regional pain syndrome occurred in the arthroscopic surgery group and two in the control group. None of patients suffered tendon ruptures, hardware migration or infections.