Browsing by Author "Kakar, Mohit"

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    ACUTE APPENDICITIS IN PAEDIATRIC PATIENTS WITH DELTA AND OMICRON VARIANTS OF SARS-COV-2 : CASE SERIES
    (2024-12-01) Eņģelis, Arnis; Smane, Liene; Zviedre, Astra; Ķīvīte-Urtāne, Anda; Zurmutai, Timurs; Pavāre, Jana; Bormotovs, Jurijs; Kakar, Mohit; Pētersons, Aigars; Department of Paediatric Surgery; Department of Paediatrics; Department of Public Health and Epidemiology; Department of Anaesthesiology, Intensive Care and Clinical simulations
    COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is generally milder in children. Acute appendicitis (AA) is a common diagnosis in children, but greater understanding is needed for more adjusted treatment of these patients when in conjunction with acute COVID-19 infection. We provide a retrospective case series study of comparison of patients with AA and positive SARS-CoV-2 Delta (B.1.671.2) and Omicron (B.1.1.529) variants. There were 16 paediatric patients admitted to a tertiary hospital with suspected acute appendicitis and COVID-19. Compared with the Delta variant (B.1.617.2), children infected with Omicron variant (B.1.1.529) of SARS-CoV-2 infection were more likely to have fever (p = 0.04) and pain migration to the right lower quadrant (RLQ) (p = 0.02). Further studies are needed to characterise the differences between SARS-CoV-2 variants (Delta vs Omicron) in cases of acute appendicitis in children.
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    BCG-SSI® vaccine-associated lymphadenitis : Incidence and management
    (2016) Engelis, Arnis; Kakar, Mohit; Meikšāns, Roberts; Petersons, Aigars; Department of Paediatric Surgery
    Background and objective There is a high incidence of childhood tuberculosis in Latvia, including children aged less than 1 year, while BCG-associated lymphadenitis is one of the most frequent adverse events requiring surgical treatment. The aim of this study was to analyze the incidence of purulent BCG adenitis through-out the population of Latvia after the introduction of BCG-SSI® vaccine and to evaluate the treatment results. Material and methods The study included 194 patients. All patients had received the BCG-SSI® vaccine during the first week of life routinely or at a later time according to the indications. The indications for surgical treatment were lymph node destruction also affecting the skin. All patients in this study received surgical treatment – the affected lymph node extirpation. Results The mean age of the patients was 5.12 ± 0.96 months. A total of 172 patients had purulent axillar lymphadenitis, 14 had purulent supraclavicular lymphadenitis, 8 patients had lymphadenitis at both localizations. During the whole study period the incidence of BCG adenitis varied from 0.02% to 0.36%, while the mean rate was 0.11% ± 0.08% from 184,068 vaccinated children during the study period. We observed an increasing trend in the incidence of BCG lymphadenitis during the study period. The primary and complete healing rate at the end of period was 99.5% (n = 193) following an affected lymph node extirpation. The mean hospitalization time after the operation was 3.71 ± 0.18 days. Conclusions The incidence of BCG-SSI® vaccine associated purulent lymphadenitis varied widely with an increasing trend, followed by the return to the product characteristic limits. Indications for the surgical treatment should not be changed. Extirpation of the purulent BCG adenitis is a safe treatment method and leads to the primary wound healing in the majority of cases.
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    Case series of variable acute appendicitis in children with sars-cov-2 infection
    (2021-12) Engelis, Arnis; Smane, Liene; Pavare, Jana; Zviedre, Astra; Zurmutai, Timurs; Berezovska, Marisa M.; Bormotovs, Jurijs; Kakar, Mohit; Saxena, Amulya K.; Petersons, Aigars; Department of Paediatric Surgery; Department of Paediatrics; Department of Doctoral Studies
    This case series study consists of six children, aged 5–16 years, admitted to a centralized tertiary paediatric hospital serving a population of 1.9 million with acute appendicitis in the setting of SARS-CoV-2 infection. From the beginning of the pandemic in March 2020 until August 2021, 121 COVID-19-positive children were admitted to the hospital. A total of 49 (40.5%) of these patients presented with gastrointestinal symptoms, of which six were diagnosed with acute appendicitis. Five underwent an appendectomy, while one was treated conservatively. To date, it has been reported that appendicitis may have a plausible association with SARS-CoV-2 infection in children. With COVID-19 cases rising, every medical specialist, including all paediatric surgeons, must be ready to treat common acute diseases with SARS-CoV-2 infection as a comorbidity. Providers should consider testing for this infection in paediatric patients with severe gastrointestinal symptoms. Non-surgical treatment of acute appendicitis in children may gain new importance during and after the COVID-19 pandemic. Further studies are needed to prove the link of causality between COVID-19 and acute appendicitis in children.
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    Culture Based Evaluation of Microbiota in Children with Acute Appendicitis
    (2020-04-01) Kroiča, Juta; Reinis, Aigars; Kakar, Mohit; Delorme, Mathilde; Broks, Renārs; Asare, Lāsma; Berezovska, Marisa; Janšins, Vladislavs; Zviedre, Astra; Enģelis, Arnis; Saxena, Amulya; Pētersons, Aigars; Department of Biology and Microbiology; Department of Paediatric Surgery; Statistics Unit
    Treatment strategies for acute uncomplicated appendicitis have evolved and now conservative antibacterial treatment is recommended over surgical treatment, especially for paediatric patients. The aim of this study was to evaluate microbiota in paediatric patients with acute uncomplicated and complicated appendicitis, and antibacterial susceptibility of the causative microorganisms. Bacteriological identification was conducted using the VITEK2 analyser. Antibacterial susceptibility tests were performed and the results were evaluated in accordance with the recommendations of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) “Clinical breakpoints and dosing of antibiotics” (Version 7.0, January 2019). Serodiagnosis of Yersinia enterocolitica was performed using indirect haemagglutination. The results revealed differences in microbiota in cases of acute complicated and acute uncomplicated appendicitis. Pseudomonas aeruginosa was identified more frequently in cases of acute complicated appendicitis. Mixed culture was prevalent in cases of both acute complicated and acute uncomplicated appendicitis. Very few positive extended spectrum beta-lactamase (ESBL) Escherichia coli cultures were identified. Most of strains of Pseudomonas aeruginosa were resistant to amoxicillin with clavulanic acid, ertapenem, ampicillin and cefotaxime. Some of E. coli isolates were resistant to ampicillin and to amoxicillin with clavulanic acid.
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    Microbiota Assessment of Pediatric Simple and Complex Acute Appendicitis
    (2022-09) Kakar, Mohit; Reinis, Aigars; Kroiča, Juta; Eņģelis, Arnis; Broks, Renārs; Asare, Lāsma; Vermeulen, Marelize; Senica, Simone Oliver; Saxena, Amulya; Pētersons, Aigars; Department of Paediatric Surgery; Department of Biology and Microbiology; Statistics Unit
    Background and Objectives. The aim of this study is to determine the prevailing microbiota in samples from pediatric patients with acute appendicitis, as well as evaluate the antibacterial sensitivity of the isolated microorganisms, comparing the data obtained with the clinic's antibacterial therapy guidelines. Materials and Methods. The study group consisted of 93 patients between the ages of 7 and 18. All patients underwent a laparoscopic or conventional appendectomy. The children were hospitalized with signs and symptoms suggestive of acute appendicitis. Microbiological cultures from the appendix and abdominal cavity were collected intraoperatively. Results. E. coli was identified in most cases irrespective of the clinical presentation of acute appendicitis. Most strains were susceptible to ampicillin and amoxicillin/clavulanic acid. Five strains of E. coli produced extended spectrum beta-lactamase (ESBL). Pseudomonas aeruginosa (P. aeruginosa) was the second most commonly isolated causative agent. Furthermore, it was common in cases of acute complex appendicitis. Most strains of P. aeruginosa were resistant to amoxicillin/clavulanic acid, ertapenem, ampicillin and cefotaxime, yet were susceptible to ceftazidime. Regardless of the clinical presentation, the samples yielded mixed isolates. Conclusion. E. coli is the main causative agent of acute appendicitis in the pediatric population displaying susceptibility to various antibiotics. P. aeruginosa was more prevalent in cases of acute complex appendicitis. P. aeruginosa isolates were susceptible to ceftazidime; however, they were resistant to cefotaxime, which should, therefore, be removed from guidelines for empirical antibacterial treatment of acute appendicitis due to phenotypic resistance of P. aeruginosa. We recommend antibiotics with distinct implementation to avoid antibiotic resistance.
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    Paediatric appendicitis : International study of management in the COVID-19 pandemic
    (2022-11-01) Van Amstel, Paul; El Ghazzaoui, Ali; Hall, Nigel J.; Wester, Tomas; Morini, Francesco; Van Der Lee, Johanna H.; Singer, Georg; CONNECT collaborative study group; Kakar, Mohit; Rīga Stradiņš University
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    Serum and Urine Biomarker Leucine-Rich Alpha-2 Glycoprotein 1 Differentiates Pediatric Acute Complicated and Uncomplicated Appendicitis
    (2021-05-11) Kakar, Mohit; Berezovska, Marisa Maija; Broks, Renars; Asare, Lasma; Delorme, Mathilde; Crouzen, Emile; Zviedre, Astra; Reinis, Aigars; Engelis, Arnis; Kroica, Juta; Saxena, Amulya; Petersons, Aigars; Department of Paediatric Surgery; Department of Biology and Microbiology; Statistics Unit
    Purpose: This prospective, single-center cohort study analyzes the potential of inflammatory protein mediator leucine-rich alpha-2 glycoprotein 1 (LRG1) for the early and accurate diagnosis of acute appendicitis (AA), and differentiation of acute complicated (AcA) from uncomplicated appendicitis (AuA). Methods: Participants were divided into the AcA, AuA, and control groups, and their serum (s-LRG1) and urine LRG1 (u-LRG1) levels were assayed preoperatively on the second and fifth postoperative days. Results: 153 patients participated, 97 had AA. Preoperative u-LRG1 with a cut-off value of 0.18 µg/mL generated an area under the receiver operated characteristic (AUC) curve of 0.70 (95% CI 0.62–0.79) for AA versus control (p < 0.001), while the results for AcA versus AuA were not significant (AUC 0.60, 95% CI 0.49–0.71, p = 0.089). The s-LRG1 levels of AA versus the control with a cut-off value of 51.69 µg/mL generated an AUC of 0.94 (95% CI 0.91–0.99, p < 0.001). The cut-off value of s-LRG1 was 84.06 µg/mL for diagnosis of AcA from AuA, and therefore, significant (AUC 0.69, 95% CI 0.59–0.80, p = 0.001). Conclusions: LRG1 exhibited excellent diagnostic performance as an inexpensive, non-invasive, rapid, and accurate biomarker able to reflect the pathogenesis of AA. LRG1 has the potential to replace advanced imaging to diagnose clinically ambiguous AA cases.
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    Surgical and non-surgical treatment of paediatric appendicitis : can algorithms help us to predict perforation?
    (2022-12-10) Eņģelis, Arnis; Kakar, Mohit; Zviedre, Astra; Laizāns, Paulis; Zurmutaī, Timurs; Bormotovs, Jurijs; Pētersons, Aigars; Department of Paediatric Surgery; Department of Doctoral Studies
    The recent interest in and evidence of non-surgical treatment with antibiotic therapy has led to the recurring issue of differentiating acute no-complicated appendicitis (AnA) and acute complicated appendicitis (AcA) when these are presented in an emergency department. To create the initial version of an acute appendicitis (AA) diagnostic and treatment algorithm, we analysed treatment results of 178 children with AnA and AcA treated at the Children's Clinical University Hospital in Rīga, in the period between 2010 and 2013. Evaluation of the clinical symptoms, laboratory and radiological findings was included in development of the algorithm. The algorithm was created in 2016 and accepted by the hospital administration. We present the algorithm's updated version of 2020. The introduction of diagnostic scores and algorithms has standardised and improved the diagnosis of paediatric AA. New diagnostic tests with higher sensitivity and specificity may improve the accuracy of diagnostic algorithms. Measuring multiple effective biomarkers simultaneously may improve the accuracy of diagnostic algorithms and predict the severity of paediatric AA. Machine learning algorithms may be able to process a much larger amount of data and provide a faster conclusion, helping the surgeon make the right decision in diagnosing appendicitis in children and prevent unnecessary surgery.
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    Transitional Care for Patients with Congenital Colorectal Diseases : An EUPSA Network Office, ERNICA, and eUROGEN Joint Venture
    (2023-12) de Beaufort, Cunera M C; Aminoff, Dalia; de Blaauw, Ivo; Transition of Care study group; Kakar, Mohit
    BACKGROUND: Transition of care (TOC; from childhood into adulthood) of patients with anorectal malformations (ARM) and Hirschsprung disease (HD) ensures continuation of care for these patients. The aim of this international study was to assess the current status of TOC and adult care (AC) programs for patients with ARM and HD. METHODS: A survey was developed by members of EUPSA, ERN eUROGEN, and ERNICA, including patient representatives (ePAGs), comprising of four domains: general information, general questions about transition to adulthood, and disease-specific questions regarding TOC and AC programs. Recruitment of centres was done by the ERNs and EUPSA, using mailing lists and social media accounts. Only descriptive statistics were reported. RESULTS: In total, 82 centres from 21 different countries entered the survey. Approximately half of them were ERN network members. Seventy-two centres (87.8%) had a self-reported area of expertise for both ARM and HD. Specific TOC programs were installed in 44% of the centres and AC programs in 31% of these centres. When comparing centres, wide variation was observed in the content of the programs. CONCLUSION: Despite the awareness of the importance of TOC and AC programs, these programs were installed in less than 50% of the participating centres. Various transition and AC programs were applied, with considerable heterogeneity in implementation, content and responsible caregivers involved. Sharing best practice examples and taking into account local and National Health Care Programs might lead to a better continuation of care in the future. LEVEL OF EVIDENCE: III.