Juta Kroiča

Report of the MEDINE2 Bachelor of Medicine (Bologna First Cycle) Tuning Project

Abstract Background: European Higher Education institutions are expected to adopt a three-cycle system of Bachelor, Master and Doctor degrees as part of the Bologna Process. Tuning methodology was previously used by the MEDINE Thematic Network to gain consensus on core learning outcomes (LO) for primary medical degrees (Master of Medicine) across Europe. Aims: The current study, undertaken by the MEDINE2 Thematic Network, sought to explore stakeholder opinions on core LO for Bachelor of Medicine degrees. Method: Key stakeholders were invited to indicate, on a Likert scale, to what extent they thought students should have achieved each of the Master of Medicine LO upon successful completion of the first three years of university education in medicine (Bachelor of Medicine). Results: There were 560 responses to the online survey, representing medical students, academics, graduates, employers, patients, and virtually all EU countries. There was broad consensus between respondents that all LO previously defined for primary medical degrees should be achieved to some extent by the end of the first three years. Conclusions: The findings promote integration of undergraduate medical curricula, and also offer a common framework and terminology for discussing what a European Bachelor of Medicine graduate can and cannot do, promoting mobility, graduate employability and patient safety.

Staphylococcus Epidermidis and Pseudomonas Aeruginosa Adhesion Intensity on a TiO2 Ceramic in an in Vitro Study

Extrusion is a perspective forming technology for obtaining objects with certain profile, important for the TiO2 application as biomaterial. Extruded samples were calcinated at 1100 °C, thermally treated in different atmospheres: at 1450 °C in air and at 1300 °C in vacuum. An approach was made to examine the adhesion and colonization intensity of Staphylococcus epidermidis and Pseudomonas aeruginosa on TiO2 ceramic in vitro. It was found that Ps.aeruginosa demonstrated higher adhesion and colonization intensity as S.epidermidis and TiO2 samples treated in vacuum demonstrated higher attachment of microorganisms as TiO2 samples treated in air. It was supposed that surface charge promoted the bacterial adhesion on the vacuum treated samples.

In vitro and in vivo Examinations for Detection of Minimal Infective Dose for Biomaterials

The objective of the study is to examine the minimal infective dose of Staphylococcus epidermidis and Pseudomonas aeruginosa on biomaterials in vivo and in vitro. In this research originally synthesized bioactive biomaterials – 4N glass and 4NK glass-ceramics are calcium phosphate with Na2O and Nb2O5 additives with different crystallinity. For microbiological investigation of biomaterialsS.epidermidis strain ATCC 12228, Ps.aeruginosa strain ATCC 27853, 4 rabbit animal models, broth and agar, scanned electron microscope Tescan, Vortex centrifuge, sonicator and histological methods were used. We observed that different biomaterials had various attachments of S.epidermidis and Ps.aeruginosa in laboratory animal models. The minimal infective dose of S.epidermidis for biomaterial 4NK is more than 103 CFU/ml, for biomaterial 4N less than 103 CFU/ml. The minimal infective dose of Ps.aeruginosa for biomaterial 4N and biomaterial 4NK is less than 103 CFU/ml.

In Vitro Characterization Perspectives Using Fourier Transform Infrared Photoacoustic Spectroscopy (FTIR-PAS) and Diffuse Reflectance Infrared Spectroscopy (DRIFT)

The activity of antibacterial material is conventionally estimated by using an indirect method – a bacteria suspension is inoculated onto a surface, and then the bacteria are collected from the surface and examined as to whether they can form colonies on the agar plate. In the present study, the presence of bacteria was examined by direct detection. Our study is based on FTIR-PAS with an interferometer cantilever detector. Our work discusses the possibility of identifying and distinguishing the presence of different bacteria (Staphylococcus epidermidis and Pseudomonas aeruginosa) and the possibility to evaluate the crystallization processes on the pressed calcium phosphate surface.

Sol-Gel Synthesis of SnO2-TiO2 System - Morphologic, Photocatalytic and Antibacterial Properties

SnO2-TiO2 sol-gel coatings on soda-lime silicate glass heat treated at 500 °C and xerogel specimens also heat treated at 500 °C were investigated in this study. The morphology of 1, 3, 5 and 7 mol% SnO2 doped titanium oxide coatings were evaluated with a scanning electron microscope (SEM), an atomic force microscope (AFM) and an UV-VIS light spectrophotometer, whilst xerogel structure was analysed with X-ray diffraction spectroscopy (XRD). The physicochemical properties of the TiO2-SnO2 systems depended mainly on the Sn-to-Ti ratio. The surface morphology of the layer was compact and homogeneous with no visible cracks. Anatase and rutile phase was found in the tested 1, 3, 5, 7 and 10 mol% SnO2 doped and heat treated xerogel specimens. Rutile phase content in the heat treated xerogel was reduced, if Sn4+ content was increased. Photocatalytic activity and antibacterial properties were evaluated as well.

The Oral Microbiome of Smokeless Tobacco Users in Latvia

Abstract Snus is a tobacco product containing nicotine and is widely used in Sweden. Now it is becoming more and more popular among young athletes and teenagers in Latvia, even though it is forbidden for sale in the European Union. The use of snus is considered to induce various oral illnesses, especially periodontal diseases, diabetes, heart and cardiovascular diseases as well as cancer. Comparison of the microbiome of saliva and tooth biofilm in snus tobacco users with that in people who never use snus showed that, the number and diversity of periodontal pathogenic microorganisms was much higher in samples taken from snus users. The observed features of the oral microbiome, such as the presence of periodontal pathogens and their high concentration, may have adverse effect on periodontal tissues of snus users and their general health in the future.

Elective Course for Medical Students: Topicality, Development, Implementation, Benefits

A growing trend in Latvia’s healthcare is patients’ choice to use phytotherapy alongside pharmaceutical drugs both as a preventive measure and means of therapy for various diseases. A number of medical students of the Faculty of Medicine at Rīga Stradiņs University (hereinafter – RSU) plan to become general practitioners in the future. These specialists should have an overall understanding of phytotherapy, skills to evaluate its effects on the body and possible side effects in order to professionally advise and give suggestions to their patients. Therefore an innovative elective course Medicinal Plants and Their Use was introduced in the curriculum of the Medicine programme in 2011. In order to be chosen by the students the course must correspond to the highest quality standards. Important aspects of quality are the evaluation of implementation and perfection. The university by involving students in the content creation of elective courses promotes the belonging of students, extends the range of courses, develops maximum practical benefit of students and is able to ensure high quality of education. The article summarizes the experience in developing the elective course, analyses its implementation, evaluation and perfection as well as benefits for medical students.

Interleukin IL-1α, IL-6, IL-8, IL-10 Expression in Different Staging of Cervical Intraepithelial Neoplasia

Summary Introduction. Cervical cancer is the fourth most common form of cancer in women [19]. The precancerous stages are divided into three distinctive stages, labelled cervical intraepithelial neoplasia (CIN) I, II and III. One of the aetiological factors is chronic inflammation in cervical tissue, most often induced by Human papilloma virus (HPV). 88,5% of the patients regress from low grade intraepithelial changes to unchanged epithelium [14]. It has been proposed that cytokine balance plays a key role in the development of high grade epithelial changes (CIN I – CIN III) in the remaining 11.5% of patients, however, the exact trigger of this event remains to be found. Aim of the Study. The aim of the study was to determine three pro-inflammatory (IL-1α, IL-6, IL-8) and one anti-inflammatory (IL-10) interleukin expression in different CIN cervix uteri biopsies. Material and methods. 16 biopsies were obtained with different CIN staging: one with CIN I stage, five with CIN II stage and 10 with CIN III stage. The samples were stained with haematoxylin and eosin and immunohistochemistry for IL-1α, IL-6, IL-8 and IL-10. Slides were evaluated semi-quantitatively grading the intensity of positively stained structures in the visual field. Results. Examination of the samples yielded the following: IL-1α expression increased from CIN II to CIN III in squamous epithelium, while IL-8 expression decreased. A few IL-1α containing inflammatory cells were found in all CIN stages. IL-8 expression in subepithelium and the number of inflammatory cells decreased from CIN II stage to CIN III, although, it increased in the blood vessel endothelium. Conclusions. There was constant moderate expression of both IL-6 and IL-10 during all CIN stages, except for inflammatory cells, where IL-6 expression was high during all stages, yet there were few IL-10 containing cells during CIN. The balanced expression of both cytokines suggests that pro- and anti-inflammatory cytokine balance has an important role in CIN morfopathogenesis. The high expression of IL-6 in inflammatory cells and constant expression trough CIN staging indicates sustentation of chronic inflammation and production of other cytokines, such as IL-8, IL-1α. The variable IL-8 expression and its decrease in CIN III stage suggests the depletion of IL-8 production. The high expression of cytokines in blood vessel endothelium indicates their important role in CIN morfopathogenesis.

Antibacterial Efficiency of Hydroxyapatite Biomaterials with Biodegradable Polylactic Acid and Polycaprolactone Polymers Saturated with Antibiotics / Bionoārdāmu Polimēru Saturošu Un Ar Antibiotiskajām Vielām Piesūcinātu Biomateriālu Antibakteriālās Efektivitātes Noteikšana

Abstract Infections continue to spread in all fields of medicine, and especially in the field of implant biomaterial surgery, and not only during the surgery, but also after surgery. Reducing the adhesion of bacteria could decrease the possibility of biomaterial-associated infections. Bacterial adhesion could be reduced by local antibiotic release from the biomaterial. In this in vitro study, hydroxyapatite biomaterials with antibiotics and biodegradable polymers were tested for their ability to reduce bacteria adhesion and biofilm development. This study examined the antibacterial efficiency of hydroxyapatite biomaterials with antibiotics and biodegradable polymers against Staphylococcus epidermidis and Pseudomonas aeruginosa. The study found that hydroxyapatite biomaterials with antibiotics and biodegradable polymers show longer antibacterial properties than hydroxyapatite biomaterials with antibiotics against both bacterial cultures. Therefore, the results of this study demonstrated that biomaterials that are coated with biodegradable polymers release antibiotics from biomaterial samples for a longer period of time and may be useful for reducing bacterial adhesion on orthopedic implants.

Simultaneous Identification of Amorphous Calcium Phosphate and S.epidermidis Bacteria by Photoacoustic Spectroscopy

The incorporation of biomaterials in human tissue requires methods to study the interface of the implant with the biological setting. We set out to study whether Photoacoustic spectroscopy with a higher level of sensitivity from the cantilever detector could simultaneously detect amorphous calcium phosphate and the bacteria. The calcium phosphate was synthesized, pressed into tablets, and then immersed in a solution containing S.epidermidis bacteria. Spectra were recorded after 1, 2, 3, 4 and 5 days. Deconvolution of the spectra at different time periods was able to separate bands belonging to the bacteria and carbonate bands arising from the calcium phosphate. This allowed the simultaneous identification of the biomaterial and bacteria. It was found that the PAS spectra could not identify the bacterial adhesion process due to the low concentration, but the amide peaks at 3 days inferred colonization of bacteria. This was confirmed by SEM that shoed an increase in the bacteria concentration. This is the first step in showing the simultaneous detection of calcium phosphate and bacteria by Photoacoustic spectroscopy, a method that required more research to show changes on the surface of the implant.