Suchergebnisse

Abstract
The aim of this study was to assess the relationship between HLA Class II alleles in two groups of patients in Latvia: patients with cystic and alveolar echinococcosis. The study included 37 patients from the Rīga East Clinical University Hospital with echinococcosis (29 patients with cystic echinococcosis and eight patients with alveolar echinococcosis) and 100 healthy control persons without echinococcosis. HLA Class II allele genotyping was performed using Real-time polymerase chain reaction–sequence specific primer (RT-PCR-SSP). The odds ratios (OR), with 95% confidence intervals (95% CI), were calculated using statistical analysis performed with IBM SPSS Statistics for Windows, Version 22.0, to evaluate the risk of developing the disease in an individual having a particular HLA genotype. In the case of cystic echinococcosis a more severe course of a disease can be anticipated in the presence of HLA-DRB1 alleles *17:01 and *07:01, -DQB1 *03:02, and *03:01, -DQA1*04:01 and haplotypes HLA-DRB1*04:01/-DQB1*03:01/ -DQA1*03:01, HLADRB1*11:01/ -DQB1*03:01 /-DQA1*05:01. However, in the group with alveolar echinococcosis it was associated with the HLA-DRB1 alleles *17:01 and *07:01, -DQB1 *05:01 and haplotypes HLA- DRB1*17:01/-DQB1*02:01-2/-DQA1*01:01, HLA-DRB1*11:01/ -DQB1*03:01/-DQA1*01:03 and HLA-DRB1*11:01/-DQB1*03:01/-DQA1*03:01. HLADRB1*15:01/-DQÂ1*06:02-8/-DQA1*05:01 and HLA-DRB1*13:01/-DQB1*02:01-2/-DQA1*05:01 haplotypes were protective in all patient groups. The limitations of this exploratory study indicate that a broader study needs to be conducted for revealing specific risk and protective HLA Class II haplotypes for patients with cystic and alveolar echinococcosis in Latvia.

Abstract
Toxoplasmosis is an important infection caused by the single-celled parasite Toxoplasma gondii, which is a zoonotic parasite causing widespread human and animal diseases, mostly involving the central nervous system. Humans can acquire toxoplasmosis by ingestion of raw or undercooked meat containing T. gondii tissue cysts, ingestion of oocysts shed by infected felids via contaminated food or water, and by vertical transmission to the fetus through the placenta from the mother during pregnancy. The aim of the present study was to determine the seroprevalence of specific anti-T. gondii IgG and IgM antibodies using a large set of clinical diagnostic laboratory data obtained over a 14-year period. In total, 25 069 unique patients were included in the present study. The overall specific anti-T. gondii IgG prevalence were 36.3%, which was significantly (p < 0.01) higher than IgM prevalence (2.4%). Mean age for IgG antibody-positive patients was 33.7 ± 12.2 years. A significant positive correlation (r = 0.99; p < 0.01) was observed between age group and anti-T. gondii IgG antibody prevalence, which ranged from 4.2% to 66.7%. The most prevalent (69.9%; 95% CI 69.2–70.7) comorbidities of patients tested for presence of anti-T. gondii IgG and IgM antibodies were classified as factors affecting health status which includes also monitoring of normal pregnancy.

Abstract
Ready-to-eat (RTE) foods are challenging for food business operators as they need to remain qualitative and safe for consumers. However, consumers tend to choose them more and more often because of fast and easy handling. The highest risk from RTE foods is microbiological contamination, particularly for vulnerable groups like children, elderly, and pregnant women. The aim of the research was to assess the microbiological quality of RTE meat and fish products to highlight possible risks for consumers. A total of 15 984 analyses performed on RTE meat and fish products were included in this study. It was found that RTE meat and fish product samples representative of the market in Latvia in the period 2012-2015 had high microbiological quality and only in rare cases was contamination with hygiene indicatororganisms (coliforms and Escherichia coli) and pathogens (Salmonella spp., Listeria monocytogenes, Staphylococcus aureus, and sulphite-reducing clostridia) detected. However, it is important to pay attention to customer habits of cooking and preparing RTE foods as well - thermal processing for products intended to be used cooked, use before expiration date and adequate storage rules for products, as these have important regarding microbiological risks for health.

Abstract
Legionella pneumophila is an environmental pathogen of engineered water systems that can cause different forms of legionellosis - from mild fever to potentially lethal pneumonia. Low concentrations of legionellae in natural habitats can increase markedly in engineered hot water systems where water temperatures are below 55 °C. In the current study, we aimed to investigate the influence of sampling season, hot water temperature and sampling protocol on occurrence of L. pneumophila. A total of 120 hot water samples from 20 apartment buildings were collected in two sampling periods - winter 2014 (n = 60) and summer 2015 (n = 60). Significantly higher occurrence of L. pneumophila was observed in summer 2015. Significant differences in temperature for negative and positive samples were not observed, which can be explained by low water temperatures at the point of water consumption. Temperature above 55 °C was observed only once, for all other sampling events it ranged from 14 °C to 53 °C.

Abstract
Sepsis is widespread among hospitalised patients worldwide. In fact, severe sepsis and septic shock is a major cause of patient admission and mortality in intensive care units and the difficulty in diagnosing the initial stage of the disease is a major obstacle to the reduction of mortality from sepsis. Retrospective analysis of medical records of 72 patients was carried out within the framework of the study. The study included patients of both sexes and all ages, who were hospitalised at the stationary "Gaiļezers" of the Rīga East Clinical University Hospital from 2011 to 2014. The study aim was to determine the clinical course of treated septic patients and conduct a pharmaco-economic analysis. In the course of the disease, almost half of the patients - 34 (48.6%) showed development of septic shock. Mortality in these patients exceeded a half (60.0%; 21 patients). Artificial lung ventilation during hospitalisation was received by 43 (59.7%) of patients. Artificial lung ventilation had been required in a significantly larger number of cases in the dead patient group (75%, p = 0.01). The average costs per one patient day (including bed-day price and manipulation costs) was 383 euros. Septic shock was associated with high mortality. Severe sepsis is an expensive diagnosis, as the average cost of one patient exceeds costs of other departments by 4.5 times.

Abstract
In this study, we sought to identify human leukocyte antigen (HLA) DRB1 alleles that might be associated with Lyme borreliosis in Latvian patients. Case patients and control subjects were similar in age, sex, and ethnic heritage and differed only in the presence of Borrelia burgdorferi infection. The frequency of HLA-DRB1*07 (OR 3.52; p = 0.001), HLA-DRB1*15 (OR 3.02; p = 0.001) and HLA-DRB1 *17 (03) (OR 2.63; p = 0.001) were significantly increased in the Lyme disease patients compared with the control groups. The frequency of the alleles -DRB1*11(OR 0.37; p = 0.005) and -DRB1*13 (OR 0.34; p = 0.002) was smaller in Borreliosis patients and significantly higher in the control group.

Abstract
The aim of this study was to assess the main effects and interaction between viral hepatitis C (HCV) coinfection and antiretroviral therapy (ART) by using a nonparametric ANOVA on direct and indirect markers of liver fibrosis in HIV-infected patients. The sample included 178 HIV patients aged from 23 to 65 (36% females). The following parameters were determined in blood of patients: hyaluronic acid, pro-matrix metalloproteinase-1, alanine aminotransferase, aspartate aminotransferase, and platelet count. The FIB-4 index was also calculated. The nonparametric ANOVA revealed no significant interaction between HCV coinfection and ART. This provides evidence for an independent contribution of each factor on promotion of the pathology. The results also demonstrated that the direct and indirect indicators of liver fibrosis are associated differently with the studied factors. Therefore, a combination of markers should be used for monitoring of liver fibrosis in HIV-infected patients.

Abstract
Immune activation in human immunodeficiency virus (HIV) infection is driven by microbial translocation and in HIV patients is one of the contributors to faster progression of liver disease along with increased cell apoptosis. The aim of the study was to compare microbial translocation and apoptosis markers in HIV monoinfected and HIV/hepatitis C virus (HCV) coinfected patients, depending on HIV immune status and antiretroviral treatment (ART). We analysed data for 78 HIV monoinfected and 105 HIV/HCV coinfected patients from the Rīga East University Hospital. Lipopolysaccharide (LPS), endotoxin core antibodies (EndoCAb), cytokeratin 18 (CK18) and cyto-chrome c (Cyt-c) levels were measured. No significant difference in LPS, EndoCAb, Cyt-c levels between HIV and HIV/HCV patients was found. The CK18 level was higher in the HIV/HCV group. Correlation between CD4+ cell count and EndoCAb antibodies was found in HCV positive patients. There was a significant effect of ART on markers for EndoCAb IgA and EndoCAb IgM antibodies in the HIV monoinfected group. Correlation between CD4+ cell count and EndoCAb antibodies and LPS was found in HIV/HCV patients on ART. Coinfection with HCV can lead to more pronounced response in EndoCAb antibody production and higher levels of cell apoptosis markers, despite similar LPS levels. ART has a positive effect on immune activation.

Abstract
Antiretroviral therapy (ART) aims at suppressing viral replication and strengthening immune system in patients with HIV-1. Human Leukocyte Antigens (HLA) are among factors responsible for effectiveness of ART. The aim of this study was to determine the effect of HLA Class II alleles on the response to long-time ART, assessed by a change in CD4+ T-cell count in relation to viral load. The sample included 69 patients (17 females and 52 males) aged 20 to 50 with HIV-1 infection, who were undergoing ART in the Latvian Centre of Infectious Diseases. The median period of observation was 5.7 years. CD4+ T-cell count and viral load were analysed at the baseline and end of the period of observation. HLA typing was performed by polymerase chain reaction with low resolution sequence specific primers. Multiple hierarchical linear regression analysis confirmed that an increase in HIV-1 viral load was associated with a decrease in the level of CD4+ T-cell count. In addition, HLA-DRB1*04 and HLA-DQB1*06:01 alleles contributed negatively to the level of CD4+ T-cell count.

Abstract
Undeniably, sepsis is still a profoundly damaging and life-threatening condition for many individuals. With multiple changes in sepsis patients it is difficult to precisely classify an individual's response in sepsis as proinflammatory or immunosuppressed. The aim of this study was to investigate genetically determined predisposition to developed sepsis by analysis of distribution of human leukocyte antigen (HLA) class II genes. Samples from patients with sepsis were collected at Pauls Stradiņš Clinical University Hospital, Latvia, in an intensive care unit between October 2016 and May 2017. The study group included 62 patients with sepsis, who were genotyped for HLA-DR; DQ using real time polymerase chain reaction – sequence specific primer (RT PCR-SSP). As a control group, data of 100 individuals were taken from the genetic bank of RSU Joint Laboratory of Clinical Immunology and Immunogenetics. The summarised results showed that the frequency of alleles DRB1*04:01 (OR = 5.54; 95% CI = 1.88–16.29); DRB1*07:01 (OR = 19.03; 95% CI = 2/37–152.82); DQA1*05:01 (OR = 14.17; 95% CI = 5.67–35.4); and DQB1*02:01 (OR = 50.00; 95% CI = 2.90–861.81) were significantly increased in patients with sepsis compared to the control group patients. The frequency of DRB1*16:01 (OR = 0.17, 95% CI = 0.04–0.59); DRB1*17:01 (OR = 0.04; 95% CI = 0.00–0.69); DQA1*01:01 (OR = 0.04; 95% CI = 0.00–0.31); DQA1*01:02 (OR = 0.03; 95% CI = 0.00–0.23); DQB1*02:02 (OR = 0.12; 95% CI = 0.03–0.42) alleles was lower in sepsis patients than in control subjects. The most frequent HLA-DRB1/DQA1/DQB1 haplotypes that was significantly increased in patients with sepsis were: DRB1*01:01/DQA1*05:01/DQB1*03:01 (OR = 12.6; 95% CI = 1.51–105.0; p < 0.003). Sepsis patients with pneumonia and alleles and DRB1 04:01; 07:01, DQB1 02:01 had the highest mortality rate. Undoubtedly, our preliminary data showed that development of sepsis can be associated with alleles and haplotypes of HLA class II genes. For more precise conclusion the research should be continued to include a larger patient group.

Abstract
Health care personnel (HCP) are at high risk of acquiring influenza due to exposure to patients. However, vaccination in HCP is lower than 40% for most European countries. The aim of this study was to determine the attitude towards influenza vaccination and possible reasons for this attitude in HCP. A cross-sectional study was performed in a multidisciplinary hospital of Latvia. The sample (n = 1099) included doctors (239), nurses (418), care services (236), administrative staff (108), and technical support staff (98). Five questions addressed vaccination of planned patients and HCP, knowledge of etiological anti-influenza drugs, and their storage at the hospital for immediate use. The results revealed that the level of regular vaccination against influenza in HCP was relatively low (14%). This contrasted with a more positive attitude towards vaccination of patients (53%) and personnel (60%). This contrast provided evidence for a low level of proactive action. High expectations regarding medications covered by the hospital (82%) indicated transferring of part of personal responsibility to the organisation. Doctors demonstrated a better understanding of the problem and a higher level of vaccination. However, some of doctors' attitudes showed underestimation of influenza-associated risk.

Abstract
Tuberculosis (TB) is still one of the top ten leading causes of death in the world. Compared to other Baltic and Eastern European countries, TB incidence (24.8 new cases per 100 000 people in 2017) in Latvia is relatively high. One of the regions with the highest TB incidence is Latgale (31.1 cases per 100 000 people). The aim of this pilot study was to identify markers of genetic predisposition to TB in Latgale. The study included 26 patients (16 males and 10 females) aged between 18 and 85 with bilateral TB pneumonia and without HIV infection. HLA typing was performed in HLA-DRB1, -DQA1, and -DQB1 loci by a polymerase chain reaction with low resolution sequence-specific primers. HLA-DRB1*07 and HLA-DRB1*11 alleles were identified as risk alleles for TB. HLA-DRB1*15 allele was a protective allele. Due to the limitations of this exploratory study, a broader study needs to be conducted to revealing specific risk and protective HLA Class II alleles for TB in the subpopulation of Latgale.

Abstract
Hospitalisation course and outcome for patients with extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae infection is less favourable due to extensive antibacterial resistance. This study was conducted to identify possible risk factors that could influence the hospitalisation course and outcome in these patients. The study protocol included demographic, clinical, hospitalisation, bacteriological and plasmid genetic data. The preliminary study results showed that hospitalisation course and outcome was less favourable for internal medicine profile patients with ESBL producing bacteria, TEM gene presence in the bacterial plasmid genome, patient age < 65 years and patients with infectious and musculoskeletal diseases. The study includes preliminary data only and further studies should be carried out to verify the suggested risk factors.

Novel Laboratory Tests in Assessment of Liver Function in Acute and Chronic Liver Diseases
Liver biopsy in clinical practice has been widely used for the diagnosis and management of patients with liver diseases, particularly, with chronic liver diseases. However, liver biopsy is an invasive method with potential complications, sampling and interpretation errors. Therefore, noninvasive tests are being developed and introduced to replace liver biopsy. The aim of the present study was to identify the new noninvasive methods to be used for the assessment of liver structure and function, by use of the appropriate serum surrogate markers and to evaluate the clinical diagnostic and prognostic accuracy of these methods, including immunogenetic methods, in cases of acute and chronic liver diseases. The obtained data showed that serum markers of apoptosis (cytokeratin-18 neoepitope and citochrome c) and fibrosis (hyaluronic acid) should be included in viral and toxic liver damage management algorithms. The punctual identification of immunogenetic factors (HLA class II antigens) may prove to be useful in predicting disease evolution, and in guiding the appropriate therapy for patients with poor prognosis.