Browsing by Author "Laivacuma, Sniedze"
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Item Adeno-associated virus 2 infection in children with non-A–E hepatitis(2023-05-18) Ho, Antonia; Orton, Richard; Tayler, Rachel; Thomson, Emma C.; DIAMONDS Consortium; ISARIC4C Investigators; Zavadska, Dace; Laivacuma, Sniedze; Rudzate, Aleksandra; Stoldere, Diāna; Barzdina, Arta; Barzdina, Elza; Madelane, Monta; Grāvele, Dagne; Rīga Stradiņš UniversityAn outbreak of acute hepatitis of unknown aetiology in children was reported in Scotland 1 in April 2022 and has now been identified in 35 countries2. Several recent studies have suggested an association with human adenovirus with this outbreak, a virus not commonly associated with hepatitis. Here we report a detailed case–control investigation and find an association between adeno-associated virus 2 (AAV2) infection and host genetics in disease susceptibility. Using next-generation sequencing, PCR with reverse transcription, serology and in situ hybridization, we detected recent infection with AAV2 in plasma and liver samples in 26 out of 32 (81%) cases of hepatitis compared with 5 out of 74 (7%) of samples from unaffected individuals. Furthermore, AAV2 was detected within ballooned hepatocytes alongside a prominent T cell infiltrate in liver biopsy samples. In keeping with a CD4+ T-cell-mediated immune pathology, the human leukocyte antigen (HLA) class II HLA-DRB1*04:01 allele was identified in 25 out of 27 cases (93%) compared with a background frequency of 10 out of 64 (16%; P = 5.49 × 10−12). In summary, we report an outbreak of acute paediatric hepatitis associated with AAV2 infection (most likely acquired as a co-infection with human adenovirus that is usually required as a ‘helper virus’ to support AAV2 replication) and disease susceptibility related to HLA class II status.Item Biobanking and consenting to research : a qualitative thematic analysis of young people’s perspectives in the North East of England(2023-12) van der Velden, Fabian J.S.; Lim, Emma; Gills, Lily; DIAMONDS Consortium; Zavadska, Dace; Laivacuma, Sniedze; Rudzate, Aleksandra; Barzdina, Arta; Madelane, Monta; Stoldere, Diāna; Barzdina, Elza; Grāvele, Dagne; Rīga Stradiņš UniversityBackground: Biobanking biospecimens and consent are common practice in paediatric research. We need to explore children and young people’s (CYP) knowledge and perspectives around the use of and consent to biobanking. This will ensure meaningful informed consent can be obtained and improve current consent procedures. Methods: We designed a survey, in co-production with CYP, collecting demographic data, views on biobanking, and consent using three scenarios: 1) prospective consent, 2) deferred consent, and 3) reconsent and assent at age of capacity. The survey was disseminated via the Young Person’s Advisory Group North England (YPAGne) and participating CYP’s secondary schools. Data were analysed using a qualitative thematic approach by three independent reviewers (including CYP) to identify common themes. Data triangulation occurred independently by a fourth reviewer. Results: One hundred two CYP completed the survey. Most were between 16–18 years (63.7%, N = 65) and female (66.7%, N = 68). 72.3% had no prior knowledge of biobanking (N = 73). Acceptability of prospective consent for biobanking was high (91.2%, N = 93) with common themes: ‘altruism’, ‘potential benefits outweigh individual risk’, 'frugality', and ‘(in)convenience’. Deferred consent was also deemed acceptable in the large majority (84.3%, N = 86), with common themes: ‘altruism’, ‘body integrity’ and ‘sample frugality’. 76.5% preferred to reconsent when cognitively mature enough to give assent (N = 78), even if parental consent was previously in place. 79.2% wanted to be informed if their biobanked biospecimen is reused (N = 80). Conclusion: Prospective and deferred consent acceptability for biobanking is high among CYP in the UK. Altruism, frugality, body integrity, and privacy are the most important themes. Clear communication and justification are paramount to obtain consent. Any CYP with capacity should be part of the consenting procedure, if possible.Item Clinical Features, Treatment Challenges and Outcomes of Patients with Autoimmune Hepatitis : Five Years Experience in Rīga East University Hospital(2024-08) Vašuka, Elina; Novika, Vita; Laivacuma, Sniedze; Krūmiņa, Angelika; Zeltiņa, Indra; Department of InfectologyAutoimmune hepatitis is an inflammatory disease of the liver of unknown aetiology that can progress to liver cirrhosis and end-stage liver failure. The clinical presentation is often acute hepatitis, but can be insidious or completely asymptomatic. It is characterised by an increase in serum transaminases and immunoglobulin G, an inflammatory liver histology, and the presence of circulating autoantibodies. An autoimmune hepatitis diagnosis justifies lifelong treatment in most patients to prevent the development of cirrhosis and end-stage liver disease. The cornerstone of treatment is steroid induction therapy followed by maintenance therapy with azathioprine, which is effective in most cases. Treatment should be optimised to reach these aims with a minimum of side effects. To achieve optimal results, individual treatment regimens and compromises between treatment aims and personal choices are needed. The aim of the study was to collect data on the clinical course, therapy, and results of autoimmune hepatitis, on the compliance of treatment choice with the criteria for starting therapy. A retrospective cohort study was conducted using data from the Rîga Eastern University Hospital Archives for the period 2019–2023. The study group consisted of 37 patients diagnosed with autoimmune hepatitis who were hospitalised or consulted in an outpatient clinic during the above period. Information relating to the patient's electronic medical records were obtained and no additional sources were used. In the study, it was found that the clinical and diagnostic criteria of autoimmune hepatitis in Rîga Eastern Clinical University Hospital over a five-year period usually correspond to the generally accepted diagnostic principles, but the therapeutic approach does not always correspond to the guidelines, especially regarding the duration of therapy.Item Distribution of HLA allele frequencies in patients with cystic and alveolar echinococcosis in Latvia(2019-08-01) Laivacuma, Sniedze; Eglite, Jeļena; Derovs, Aleksejs; Viksna, Ludmila; Department of Infectology; Klīniskās imunoloģijas un imunoģenētikas starpkatedru laboratorija; Department of Internal DiseasesThe 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.Item Echinococcus infections in the Baltic region(2015-10-30) Marcinkute, Audrone; Šarkunas, Mindaugas; Moks, Epp; Saarma, Urmas; Jokelainen, Pikka; Bagrade, Guna; Laivacuma, Sniedze; Strupas, Kestutis; Sokolovas, Vitalijus; Deplazes, Peter; Rīga Stradiņš UniversityIn the Baltic countries, the two zoonotic diseases, alveolar echinococcosis (AE) caused by Echinococcus multilocularis, and cystic echinococcosis (CE) caused by Echinococcus granulosus, are of increasing public health concern. Observations from Estonia, Latvia and Lithuania indicate that the distribution of both parasites is wider in the Baltics than previously expected. In this paper, we review and discuss the available data, regarding both parasitoses in animals and humans, from the Baltic countries and selected adjacent regions. The data are not easily comparable but reveal a worrisome situation as the number of human AE and CE cases is increasing. Despite improvements in diagnostics and treatment, AE has a high morbidity and mortality in the Baltic region. For the control of both zoonoses, monitoring transmission patterns and timely diagnosis in humans as well as the development of local control programs present major challenges.Item Ehinokokozes diagnostikas pilnveidošana, izmantojot etioloģiskus, bioķīmiskus, imunoloģiskus un imūnģenētiskus marķierus, un riska faktoru apzināšana Latvijā. Promocijas darba kopsavilkums(Rīgas Stradiņa universitāte, 2019) Laivacuma, Sniedze; Vīksna, Ludmila; Ivanovs, AndrejsPromocijas darba “Ehinokokozes diagnostikas pilnveidošana, izmantojot etioloģiskus, bioķīmiskus, imunoloģiskus un imūnģenētiskus marķierus, un riska faktoru apzināšana Latvijā” ir veltīts Latvijā vēl pilnībā neapzinātai hroniski noritošai parazitārai slimībai, kuras diagnostikas un ārstēšanas principi būtu uzlabojami. Saslimstība ar ehinokokozi Eiropas valstīs ir variabla, svārstoties 0,1–10/100000 gadījumu robežās, arī Latvijā katru gadu ir samērā liels pirmreizēji diagnosticētu ehinokokozes gadījumu skaits neskatoties uz salīdzinoši nelielo iedzīvotāju skaitu. Būtiski, ka Latvija ģeogrāfiski atrodas blakus endēmiskiem šīs zoonozes rajoniem, piemēram, Krievijai, Baltkrievijai, Polijai, bet mērķtiecīgi pētījumi par saslimstību, riska faktoriem, diagnostiku un ārstēšanu tieši mūsu valstī nav bijuši. Darba mērķis bija noteikt ehinokokozes izplatību Latvijā, apzināt saslimšanas riska faktorus, pilnveidot diagnostikas un ārstēšanas taktiku. Lai sasniegtu izvirzīto mērķi, pētījumā tika iekļauti vairāk nekā simts pacienti, kuru dati tika analizēti retrospektīvi, kā arī tika izveidota pacientu grupa, kura tika anketēta, lai konstatētu iespējamos riska faktorus, un šajā grupā arī tika meklēti iespējamie imūnģenētiskie riska faktori un iespējamie diagnostikā noderīgie imunoloģiskie marķieri. Darba rezultātā tika noskaidrots, ka tiešām Latvijas pacientu populācijā var izdalīt riska faktorus, piemēram, risku saslimt palielina dzīvošana lauku sētā, un risks paaugstinās, pieaugot dzīves ilgumam, risku palielina arī mājlopu esamība un to kaušanas paradumi, arī dabiskā mēslojuma izmantošana piemājas dārzos un fakts, ka saimniecībā ir turēti kaķi. Tika konstatēts arī, ka IL-10 noteikšana var būt lietderīga alveolārās ehinokokozes gadījumā, jo tas varētu būt marķieris, kas ļauj precīzāk izvēlēties terapijas ilgumu šiem pacientiem. Promocijas darbā, veicot HLA II klases gēnu alēļu sastopamības analīzi, konstatēts, ka ir alēles un haplotipi, pēc kuriem var noteikt smagākas slimības gaitas iespēju, savukārt, citi ir saistīti ar vieglu un nekomplicētu slimības gaitu. Tika konstatēts, ka ir iemesls pieturēties rekomendētām terapijas shēmām, jo labāks ārstēšanas rezultāts būs tiem pacientiem, kuri terapiju saņem agrīni, proti, jau pirmā gada laikā pēc inficēšanās, kuriem ir pietiekoši gari terapijas kursi, vismaz nepārtraukti 6 mēneši, kā arī terapija tiek lietota katru gadu. Analizējot bioķīmiskos parametrus, var secināt, ka risku nomirt palielina paaugstināts EGĀ, SF, GGT un bilirubīna līmenis. Darba gaitā arī tika konstatēts, ka nozīmīgi ir imūnģenētiskie dati, jo tika secināts, ka cistiskās ehinokokozes gadījumā par smagāku slimības gaitu var liecināt HLA-DRB1 alēles *17:01 un *04:01, -DQB1*03:02, -DQA1*04:01 un haplotipi HLA-DRB1*04/-DQB1*0301/-DQA1*0103, HLA-DRB1*11:01/-DQB1*0602-8/-DQA1*0103, bet alveolārās ehinokokozes gadījumā par smagāku slimības gaitu var liecināt HLA-DRB alēles *17:01 un *11:01, -DQB1*03:01 un haplotipi HLA-DRB1*17:01/-DQB1*03:01/-DQA1*01:02, HLA-DRB1*11:01/-DQB1*03:01/-DQA1*01:03 un HLA-DRB1*11:01/-DQB1*03:01/-DQA1*03:01. Savukārt par protektīvām cistiskās ehinokokozes gadījumā var uzskatīt HLA-DRB1 alēles *01:01 un *15:01, -DQA1 *01:01, bet alveolārās ehinokokozes gadījumā – HLA-DRB alēli *01:01. Kā protektīvus visās pacientu grupās var izdalīt šādus haplotipus: HLA-DRB1*01:01/-DQВ1*03:01/-DQA1*01:01 un HLA-DRB1*01:01/-DQB1*02:01-2/-DQA1*02:01. Viss minētais ļāva secināt, ka ehinokokozes pacientu bioķīmiskajiem, imunoloģiskajiem un imūnģenētiskajiem faktoriem ir būtiska nozīme slimības diagnostikā un ārstēšanā, un tie daļēji ļauj paredzēt slimības gaitu un iznākumu.Item Ehinokokozes diagnostikas pilnveidošana, izmantojot etioloģiskus, bioķīmiskus, imunoloģiskus un imūnģenētiskus marķierus, un riska faktoru apzināšana Latvijā. Promocijas darbs(Rīgas Stradiņa universitāte, 2019) Laivacuma, Sniedze; Vīksna, Ludmila; Ivanovs, AndrejsPromocijas darba “Ehinokokozes diagnostikas pilnveidošana, izmantojot etioloģiskus, bioķīmiskus, imunoloģiskus un imūnģenētiskus marķierus, un riska faktoru apzināšana Latvijā” ir veltīts Latvijā vēl pilnībā neapzinātai hroniski noritošai parazitārai slimībai, kuras diagnostikas un ārstēšanas principi būtu uzlabojami. Saslimstība ar ehinokokozi Eiropas valstīs ir variabla, svārstoties 0,1–10/100000 gadījumu robežās, arī Latvijā katru gadu ir samērā liels pirmreizēji diagnosticētu ehinokokozes gadījumu skaits neskatoties uz salīdzinoši nelielo iedzīvotāju skaitu. Būtiski, ka Latvija ģeogrāfiski atrodas blakus endēmiskiem šīs zoonozes rajoniem, piemēram, Krievijai, Baltkrievijai, Polijai, bet mērķtiecīgi pētījumi par saslimstību, riska faktoriem, diagnostiku un ārstēšanu tieši mūsu valstī nav bijuši. Darba mērķis bija noteikt ehinokokozes izplatību Latvijā, apzināt saslimšanas riska faktorus, pilnveidot diagnostikas un ārstēšanas taktiku. Lai sasniegtu izvirzīto mērķi, pētījumā tika iekļauti vairāk nekā simts pacienti, kuru dati tika analizēti retrospektīvi, kā arī tika izveidota pacientu grupa, kura tika anketēta, lai konstatētu iespējamos riska faktorus, un šajā grupā arī tika meklēti iespējamie imūnģenētiskie riska faktori un iespējamie diagnostikā noderīgie imunoloģiskie marķieri. Darba rezultātā tika noskaidrots, ka tiešām Latvijas pacientu populācijā var izdalīt riska faktorus, piemēram, risku saslimt palielina dzīvošana lauku sētā, un risks paaugstinās, pieaugot dzīves ilgumam, risku palielina arī mājlopu esamība un to kaušanas paradumi, arī dabiskā mēslojuma izmantošana piemājas dārzos un fakts, ka saimniecībā ir turēti kaķi. Tika konstatēts arī, ka IL-10 noteikšana var būt lietderīga alveolārās ehinokokozes gadījumā, jo tas varētu būt marķieris, kas ļauj precīzāk izvēlēties terapijas ilgumu šiem pacientiem. Promocijas darbā, veicot HLA II klases gēnu alēļu sastopamības analīzi, konstatēts, ka ir alēles un haplotipi, pēc kuriem var noteikt smagākas slimības gaitas iespēju, savukārt, citi ir saistīti ar vieglu un nekomplicētu slimības gaitu. Tika konstatēts, ka ir iemesls pieturēties rekomendētām terapijas shēmām, jo labāks ārstēšanas rezultāts būs tiem pacientiem, kuri terapiju saņem agrīni, proti, jau pirmā gada laikā pēc inficēšanās, kuriem ir pietiekoši gari terapijas kursi, vismaz nepārtraukti 6 mēneši, kā arī terapija tiek lietota katru gadu. Analizējot bioķīmiskos parametrus, var secināt, ka risku nomirt palielina paaugstināts EGĀ, SF, GGT un bilirubīna līmenis. Darba gaitā arī tika konstatēts, ka nozīmīgi ir imūnģenētiskie dati, jo tika secināts, ka cistiskās ehinokokozes gadījumā par smagāku slimības gaitu var liecināt HLA-DRB1 alēles *17:01 un *04:01, -DQB1*03:02, -DQA1*04:01 un haplotipi HLA-DRB1*04/-DQB1*0301/-DQA1*0103, HLA-DRB1*11:01/-DQB1*0602-8/-DQA1*0103, bet alveolārās ehinokokozes gadījumā par smagāku slimības gaitu var liecināt HLA-DRB alēles *17:01 un *11:01, -DQB1*03:01 un haplotipi HLA-DRB1*17:01/-DQB1*03:01/-DQA1*01:02, HLA-DRB1*11:01/-DQB1*03:01/-DQA1*01:03 un HLA-DRB1*11:01/-DQB1*03:01/-DQA1*03:01. Savukārt par protektīvām cistiskās ehinokokozes gadījumā var uzskatīt HLA-DRB1 alēles *01:01 un *15:01, -DQA1 *01:01, bet alveolārās ehinokokozes gadījumā – HLA-DRB alēli *01:01. Kā protektīvus visās pacientu grupās var izdalīt šādus haplotipus: HLA-DRB1*01:01/-DQВ1*03:01/-DQA1*01:01 un HLA-DRB1*01:01/-DQB1*02:01-2/-DQA1*02:01. Viss minētais ļāva secināt, ka ehinokokozes pacientu bioķīmiskajiem, imunoloģiskajiem un imūnģenētiskajiem faktoriem ir būtiska nozīme slimības diagnostikā un ārstēšanā, un tie daļēji ļauj paredzēt slimības gaitu un iznākumu.Item Genomic investigations of unexplained acute hepatitis in children(2023-03-30) Morfopoulou, Sofia; Buddle, Sarah; Torres Montaguth, Oscar Enrique; Breuer, Judith; DIAMONDS Consortium; PERFORM consortium; Zavadska, Dace; Laivacuma, Sniedze; Rudzāte, Aleksandra; Barzdina, Arta; Madelane, Monta; Grāvele, Dagne; Balode, Anda; Grope, Ilze; Meiere, Anija; Nokalna, Ieva; Pavare, Jana; Pucuka, Zanda; Urbane, Urzula Nora; Selecka, Katrina; Deksne, Dārta; Rīga Stradiņš UniversitySince its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children.Item Improvement of Echinococcosis Diagnostics Using Ethiological, Biochemical, Immunological and Immunogenetic Markers and Identification of Infection Risk Factors in Latvia. Summary of the Doctoral Thesis(Rīga Stradiņš University, 2019) Laivacuma, Sniedze; Vīksna, Ludmila; Ivanovs, AndrejsThe doctoral thesis “Improvement of Echinococcosis Diagnostics Using Ethiological, Biochemical, Immunological and Immunogenetic Markers and Identification of Infection Risk factors in Latvia” is devoted to the chronic parasitic disease that is not yet fully understood in Latvia and its diagnostic and treatment principles should be improved. The incidence of echinococcosis in European countries varies, ranging from 0.1 to 10/100,000 cases, and Latvia also has a relatively high number of newly diagnosed cases every year despite the relatively small population. It is important to mention that Latvia is geographically close to endemic areas of this zoonosis, such as Russia, Belarus, Poland, but there have been no targeted studies of morbidity, risk factors, diagnosis and treatment in our country. The aim of the thesis was to determine the prevalence of echinococcosis in Latvia, to identify risk factors of disease and to improve diagnostic and treatment tactics. To achieve our goal the study included more than a hundred patients whose data were analyzed in retrospective manner and a group of patients was surveyed to identify potential risk factors also immunogenetic and we also sought for new immunologic markers that could improve diagnostics. As a result of the analysis, it was found that risk factors can be distinguished in the Latvian patient population, for example, the risk will be increased if patient lives in a rural household as well if he owns livestock and slaughter them at home as well there is increased risk in owning dogs and cats. It was also found that IL-10 detection may be useful in cases of alveolar echinococcosis, as it could be a marker that allows a more accurate choice of treatment duration for these patients. The analysis of the prevalence of HLA Class II gene alleles revealed that there are alleles and haplotypes that can determine severity of the disease. There is also a reason to comply with the recommended treatment regimens as better result of the treatment will be for those patients who receive treatment early, that is, in the first year after the detection of the infection, those who have longer courses of treatment, at least continuously for 6 months and those who have the treatment every year. Analyzing biochemical parameters, it can be concluded that the risk of dying is increased in those patients who have increased levels of ESR, SF, GGT and bilirubin. From immunogenetic data it was concluded that in the case of cystic echinococcosis, a more severe course of the disease may be connected with alleles HLA-DRB1*17:01 and *04:01, -DQB1*03:02, -DQA1*04:01 and haplotypes HLA-DRB1*04/-DQB1*0301/-DQA1*0103, HLA-DRB1*11:01/-DQB1*0602-8/-DQA1*0103 but in case of alveolar echinococcosis more severe presentation with alleles *17:01 and *11:01, -DQB1*03:01 and haplotypes HLA-DRB1*17:01/-DQB1*03:01/-DQA1*01:02, HLA-DRB1*11:01/-DQB1*03:01/-DQA1*01:03 and HLA-DRB1*11:01/-DQB1*03:01/-DQA1*03:01. On the other hand we concluded that following alleles may be protective: in case of cystic echinococcosis HLA-DRB1*01:01 and *15:01, -DQA1*01:01, in case of alveolar echinococcosis alleles HLA-DRB*01:01. And protective haplotypes in all patients were HLA-DRB1*01:01/-DQВ1*03:01/-DQA1*01:01 and HLA-DRB1*01:01/-DQB1*02:01-2/-DQA1*02:01. All of this has led to the conclusion that biochemical, immunological and immunogenetic markers of echinococcosis patients play an important role in the diagnosis and treatment of the disease, as well may partially predict the course and outcome of the disease.Item Intriguing findings of liver fibrosis following COVID-19(2021-12) Koļesova, Oksana; Vanaga, Ieva; Laivacuma, Sniedze; Derovs, Aleksejs; Koļesovs, Aleksandrs; Radzina, Maija; Platkājis, Ardis; Eglīte, Jeļena; Hagina, Elvīra; Arutjuņana, Seda; Putriņš, Dāvis Sīmanis; Storoženko, Jeļena; Rozentāle, Baiba; Vīksna, Ludmila; Klīniskās imunoloģijas un imunoģenētikas starpkatedru laboratorija; Department of Infectology; Department of Radiology; Department of Public Health and EpidemiologyBackground: Studies on a new coronavirus disease (COVID-19) show the elevation of liver enzymes and liver fibrosis index (FIB-4) independently on pre-existing liver diseases. It points to increased liver fibrogenesis during acute COVID-19 with possible long-term consequences. This study aimed to assess liver fibrosis in COVID-19 patients by serum hyaluronic acid (HA) and FIB-4. Methods: The study included the acute COVID-19 group (66 patients, 50% females, mean age 58.3 ± 14.6), the post-COVID group (58 patients in 3–6 months after the recovery, 47% females, mean age 41.2 ± 13.4), and a control group (17 people, 47% females, mean age 42.8 ± 11.0). Ultrasound elastography was performed in the post-COVID and control groups. Results: Sixty-five percent of the acute COVID-19 group had increased FIB-4 (> 1.45), and 38% of patients had FIB-4 ≥ 3.25. After matching by demographics, 52% of acute COVID-19 and 5% of the post-COVID group had FIB-4 > 1.45, and 29% and 2% of patients had FIB-4 ≥ 3.25, respectively. Increased serum HA (≥ 75 ng/ml) was observed in 54% of the acute COVID-19 and 15% of the post-COVID group. In the acute COVID-19 group, HA positively correlated with FIB-4, AST, ALT, LDH, IL-6, and ferritin and negatively with blood oxygen saturation. In the post-COVID group, HA did not correlate with FIB-4, but it was positively associated with higher liver stiffness and ALT. Conclusion: More than half of acute COVID-19 patients had increased serum HA and FIB-4 related to liver function tests, inflammatory markers, and blood oxygen saturation. It provides evidence for the induction of liver fibrosis by multiple factors during acute COVID-19. Findings also indicate possible liver fibrosis in about 5% of the post-COVID group.Item Liver Abscesses — Seven-Year Experience of a Single Tertiary Care Hospital(2020) Krūmiņa, Angelika; Laivacuma, Sniedze; Drjagunovs, Iļja; Zeltiņa, Indra; Vīksna, Ludmila; Derovs, Aleksejs; Department of Infectology; Department of Internal DiseasesWe reviewed medical records of cases of liver abscesses (LA) registered in Riga East University Hospital clinical centre "Gaiiezers" from January 2012 to October 2018 to assess sociodemographic factors, clinical, laboratory, microbiological and radiological findings, as well as therapeutic modalities and their efficacy associated with LA. A total of 95, including five recurrent, cases were included in this study. No statistically significant differences in gender distribution were found. Mean patient's age was 64.5 +/- 15.9. The most common documented risk factors for the development of LA were underlying biliary tract abnormalities (37.9% of cases), and diabetes mellitus (12.7%), while in 21.1% of cases, LA were defined as cryptogenic. Most patients presented with fever (70.5%); right upper abdominal pain was reported in 61.1%, while vomiting and / or nausea - in 25.3% of cases. The most common isolates identified from LA were Klebsiella pneumonia (40.3% of cases), mainly in monomicrobial LA, and Escherichia coli (22.6% of cases), predominantly in polymicrobial LA. Ceftriaxone and metronidazole intravenous formulations were used in 35.5% cases as the principal antimicrobial combination at hospital. Median overall expected duration of antimicrobial treatment was 15 days. LA drainage was performed in 87.4% of cases for the median duration of seven days. In 86.3% of cases both approaches were combined.Item A quick guide to diagnosis and treatment of cytomegalovirus infection in the gut: current dilemmas(2022-12-10) Drjagunovs, Iļja; Laivacuma, Sniedze; Zeltiņa, Indra; Derovs, Aleksejs; Department of Infectology; Department of Internal DiseasesItem Rare liver tumour - epithelioid haemangioendothelioma: a case report(2022-12-01) Laivacuma, Sniedze; Zeltiņa, Indra; Derovs, Aleksejs; Norko, Andris; Isajevs, Sergejs; Makejeva, Karīna; PH Drenth, Joost; Department of Infectology; Department of Internal DiseasesEpithelioid haemangioendothelioma (EHE) is a rare vascular soft tissue malignant tumour with unknown etiology; the estimated prevalence of EHE is less than one in 1 million. A 56-year-old man was admitted in our department due to pain in the right side of the abdomen lasting for two years and weight loss up to 10 kg. Since 2012, the patient underwent lung and abdominal CT scanning as well as biopsy, however the diagnosis was challenging. In 2015, repeated abdominal CT scanning and a liver core biopsy was performed. The epithelioid haemangioendothelioma was diagnosed based by histopathological examination with subsequent radiological and clinical correlation. Therefore, accurate histopathological examination with radiological and clinical correlation is essential in the diagnosis of epithelioid haemangioendothelioma.Item Targeting microbiota : What do we know about it at present?(2019-08) Derovs, Aleksejs; Laivacuma, Sniedze; Krumina, Angelika; Department of Internal Diseases; Department of InfectologyThe human microbiota is a variety of different microorganisms. The composition of microbiota varies from host to host, and it changes during the lifetime. It is known that microbiome may be changed because of a diet, bacteriophages and different processes for example, such as inflammation. Like all other areas of medicine, there is a continuous growth in the area of microbiology. Different microbes can reside in all sites of a human body, even in locations that were previously considered as sterile; for example, liver, pancreas, brain and adipose tissue. Presently one of the etiological factors for liver disease is considered to be pro-inflammatory changes in a host’s organism. There are lot of supporting data about intestinal dysbiosis and increased intestinal permeability and its effect on development of liver disease pointing to the gut–liver axis. The gut–liver axis affects pathogenesis of many liver diseases, such as chronic hepatitis B, chronic hepatitis C, alcoholic liver disease, non-alcoholic liver disease, non-alcoholic steatohepatitis, liver cirrhosis and hepatocellular carcinoma. Gut microbiota has been implicated in the regulation of brain health, emphasizing the gut–brain axis. Also, experiments with mice showed that microorganisms have significant effects on the blood–brain barrier integrity. Microbiota can modulate a variety of mechanisms through the gut–liver axis and gut–brain axis. Normal intestinal flora impacts the health of a host in many positive ways, but there is now significant evidence that intestinal microbiota, especially altered, have the ability to impact the pathologies of many diseases through different inflammatory mechanisms. At this point, many of the pathophysiological reactions in case of microbial disbyosis are still unclear.Item The virology of human monkeypox virus (hMPXV) : A brief overview(2022-12) Lansiaux, Edouard; Jain, Nityanand; Laivacuma, Sniedze; Reinis, Aigars; Faculty of Medicine; Department of Infectology; Department of Biology and MicrobiologyFirst described in 1958, the human monkeypox virus (hMPXV) is a neglected zoonotic pathogen closely associated with the smallpox virus. The virus usually spreads via close contact with the infected animal or human and has been endemic mostly in parts of the African continent. However, with the recent increase in trade, tourism, and travel, the virus has caused outbreaks in countries outside Africa. The recent outbreak in 2022 has been puzzling given the lack of epidemiological connection and the possible sexual transmission of the virus. Furthermore, there is limited understanding of the structural and pathogenetic mechanisms that are employed by the virus to invade the host cells. Henceforth, it is critical to understand the working apparatus governing the viral-immune interactions to develop effective therapeutical and prophylactic modalities. Hence, in the present short communication, we summarize the previously reported research findings regarding the virology of the human monkeypox virus.