Browsing by Author "Pētersons, Aigars"

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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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    The Assessment of CDX1, IHH, SHH, GATA4, FOXA2, FOXF1 in Congenital Intra-Abdominal Adhesions
    (2024) Freijere-Pope, Helēna; Pilmane, Māra; Junga, Anna; Pētersons, Aigars; Institute of Anatomy and Anthropology; Rīga Stradiņš University
    Congenital abdominal adhesions are a rare condition that can result in a small bowel obstruction at any age, more frequently in pediatric populations. The cause remains unknown, and the importance of aberrant congenital bands is related to the difficulty of diagnosis, and cases of death with late detection have been documented. This research examines the expression of Caudal Type Homeobox 1 (CDX1), Indian Hedgehog (IHH), Sonic Hedgehog (SHH), GATA Binding Protein 4 (GATA4), Forkhead Box A2 (FOXA2) and Forkhead Box F1 (FOXF1) gene expression in human abdominal congenital adhesion fibroblast and endothelium cells by chromogenic in situ hybridization, with the aim of elucidating their potential association with the etiology of congenital intra-abdominal adhesion band development. The potential genes’ signals were examined using a semi-quantitative approach. Significant correlations were observed between the expression of CDX1 (p <.001) and SHH (p=0.032) genes in fibroblasts from congenital intra-abdominal adhesions compared to fibroblasts from control peritoneal tissue. Statistically significant very strong correlations were found between the CDX1 and IHH comparing endothelium and fibroblast cells in congenital abdominal adhesion bands. There was no statistically significant difference found in the distribution of IHH, FOXA2, GATA4, and FOXF1 between the fibroblasts and endothelium of the patients compared to the control group. The presence of notable distinctions and diverse associations suggests the potential involvement of numerous morpho-pathogenetic processes in the development of intraabdominal adhesions.
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    Biomarķieru izvērtējums galvas traumas diagnostikā un prognozēšanā. Promocijas darba kopsavilkums
    (Rīgas Stradiņa universitāte, 2013) Bārzdiņa, Arta; Pilmane, Māra; Pētersons, Aigars
    Galvas traumas ir viens no biežākajiem nāves un invaliditātes cēloņiem visā pasaulē un rada nopietnas sociāli ekonomiskas problēmas. Procentuāli iedalot galvas traumas pēc smaguma pakāpēm, aptuveni 88% ir vieglas galvas traumas, 7% - vidēji smagas un 5% - smagas un fatālas galvas traumas, pēc kurām bērni bieži iegūst paliekamu invaliditāti. Ir pierādīts, ka visneprognozējamākās ir vieglās galvas traumas, kuras sākumā novērtētas ar GCS 13-15 ballēm, attālākā periodā pēc traumas notikuma pacientiem var izraisīt intrakraniālas asiņošanas, difūzu aksonālu bojājumu, tādēļ šo traumu guvušo pacientu grupai svarīga īpaši precīza akūtas diagnozes un gala rezultāta prognozes noteikšana. Līdz ar to īpaša loma tiek pievērsta biomarķieriem kā galvas traumas prognozes indikatoriem. Pētījuma mērķis bija smadzeņu sekundārajam bojājumam raksturīgu biomarķieru ekspresijas izpēte smadzeņu audu materiālā un perifēro asiņu paraugos dažādos laika periodos pēc traumas. Pētījuma morfoloģijas sadaļā tika iekļauti 28 dažāda vecuma pacienti pēc fatālām galvas traumām, klīniskajā sadaļā – 18 pacienti ar smagām, vidēji smagām un vieglām galvas traumām līdz septiņu gadu vecumam. Morfoloģijas sadaļā tika izpētīti un analizēti citoskeleta proteīna GFAP, diedziņu NF, citokīnu IL-6 un IL-10 ekspresija smadzeņu audos, tika noteikts apoptotisko šūnu daudzums un sadalījums smadzeņu audos traumas un pretsitiena vietās gan bērniem, gan pieaugušajiem, kuri miruši notikuma vietā, un tiem, kuri miruši attālinātā laikā pēc traumas. Klīniskajā sadaļā tika noteikti un analizēti 10 iekaisuma biomarķieri asins serumā bērniem vecumā līdz septiņiem gadiem četrās definētās laika vienībās (24;48;72 un 96 stundas pēc traumas) smagu, vidēji smagu un vieglu galvas traumu gadījumā.
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    Biomarķieru izvērtējums galvas traumas diagnostikā un prognozēšanā. Promocijas darbs
    (Rīgas Stradiņa universitāte, 2013) Bārzdiņa, Arta; Pilmane, Māra; Pētersons, Aigars
    Galvas traumas ir viens no biežākajiem nāves un invaliditātes cēloņiem visā pasaulē un rada nopietnas sociāli ekonomiskas problēmas. Procentuāli iedalot galvas traumas pēc smaguma pakāpēm, aptuveni 88% ir vieglas galvas traumas, 7% - vidēji smagas un 5% - smagas un fatālas galvas traumas, pēc kurām bērni bieži iegūst paliekamu invaliditāti. Ir pierādīts, ka visneprognozējamākās ir vieglās galvas traumas, kuras sākumā novērtētas ar GCS 13-15 ballēm, attālākā periodā pēc traumas notikuma pacientiem var izraisīt intrakraniālas asiņošanas, difūzu aksonālu bojājumu, tādēļ šo traumu guvušo pacientu grupai svarīga īpaši precīza akūtas diagnozes un gala rezultāta prognozes noteikšana. Līdz ar to īpaša loma tiek pievērsta biomarķieriem kā galvas traumas prognozes indikatoriem. Pētījuma mērķis bija smadzeņu sekundārajam bojājumam raksturīgu biomarķieru ekspresijas izpēte smadzeņu audu materiālā un perifēro asiņu paraugos dažādos laika periodos pēc traumas. Pētījuma morfoloģijas sadaļā tika iekļauti 28 dažāda vecuma pacienti pēc fatālām galvas traumām, klīniskajā sadaļā – 18 pacienti ar smagām, vidēji smagām un vieglām galvas traumām līdz septiņu gadu vecumam. Morfoloģijas sadaļā tika izpētīti un analizēti citoskeleta proteīna GFAP, diedziņu NF, citokīnu IL-6 un IL-10 ekspresija smadzeņu audos, tika noteikts apoptotisko šūnu daudzums un sadalījums smadzeņu audos traumas un pretsitiena vietās gan bērniem, gan pieaugušajiem, kuri miruši notikuma vietā, un tiem, kuri miruši attālinātā laikā pēc traumas. Klīniskajā sadaļā tika noteikti un analizēti 10 iekaisuma biomarķieri asins serumā bērniem vecumā līdz septiņiem gadiem četrās definētās laika vienībās (24;48;72 un 96 stundas pēc traumas) smagu, vidēji smagu un vieglu galvas traumu gadījumā.
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    Complex Postoperative Result Evaluation of Congenital Thumb Hypoplasia for the New Thumb Reconstructive Method’s Substantiation. Summary of the Doctoral Thesis
    (Rīga Stradiņš University, 2019) Ozols, Dzintars; Pētersons, Aigars
    Title. Complex postoperative outcome evaluation for the congenital thumb hypoplasia treatments to promote the new surgical method for the thumb hypoplasia reconstruction. Congenital upper extremity deformations are rare, the reported incidence is from 0.15–0.2%.[44,51] Vast majority ~ 70% are slight deformities, e.g., syndactyly or polydactyly, and only 1–2 % out of all congenital defects is thumb hypoplasia or development disorder. Thumb is very important for hand’s functionality, it provides up to 50% from hand’s performance and thus in child’s development. Proper pinch grip formation at the age of 12–16 months can affect child’s psychoemotional development. Thumb reconstruction historically has been significant, the first successful thumb reconstruction is considered the staged procedure performed by Nicoladini in 1897. With advancement of optical zoom instruments, in 1965 Buncke did the first microvascular toe-to-hand transplantation on rhesus monkeys. The surgery was successful, although only one of the transplanted toes survived. Shortly after – in 1968 Cobett performed toe-to-hand transplantation on a human patient.[19] The first ever second toe transplantation for congenital thumb defect’s surgical treatment was done in 1976 by May.[72] The development of the microsurgery in Latvia started in 1985, then the department of microsurgery was founded in hospital ‘Gailezers’. The first microvascular toe-to-hand transplantation in Latvia for the child patient with congenital defect was done in 2008. With continuous improvement of congenital hand defects’ treatment techniques in 2010 a new technique for thumb hypoplasia stage IIIb–V was developed – second toe transplantation with MTP joint arthrodesis. The technique allows to maintain five-digit hand and provides good functionality ad aesthetics.[75,76] For thumb hypoplasia stage II – IIIa reconstruction second digit’s tendon transposition is used. The EIP tendon transposition technique was created in 2007. In this research a detailed literature analysis on congenital thumb hypoplasia treatment options and their outcomes are analyzed. The most common described method for congenital thumb hypoplasia stage IIIb–V reconstruction is pollicization, i.e., hand’s second digit is placed in thumb’s position. A functional thumb is created, but patient is left with four-digit hand, which is considered normal in western countries.[12,64] The second most common technique – foot’s second metatarsal bone transplantation, which has advantage is preserved five-digit hand, but the reconstructed thumb has little motion. In the first part of this research 21 patients were examined, 18 patients were included. In the retrospective part functionality data was analyzed, determining the strength of power and pinch grip, range of active motions in the thumb’s joints. Also for data evaluation DASH and PEDI scales were used, and for evolution for aesthetic results – VAS scale. Obtained functional data was compared with patient’s healthy (non-operated) hand and RSU institute of anatomy and anthropology, laboratory of the anthropology research on Latvia’s children functional norm’s determination results. Congenital hand deformation’s thumb hypoplasia patient’s functional data is significantly lower in comparison with healthy Latvian children. Foot’s second toe’s transplantation with MTP joint arthrodesis techniques functional results are similar to pollicization’s technique results, nevertheless VAS scale results were higher exactly to new technique. In the research’s prospective part a questionnaire was done to compare aesthetic outcomes of thumb hypoplasia stage IIIb–V treatment techniques – foot’s second toe transplantation with MTP joint arthrodesis and pollicization. The survey was completed by 285 respondents, who with statistical confidence better appreciated second toe transplantation with MTP joint arthrodesis and newly created five-digit hand is considered better looking rather than four-digit hand in case of pollicization. Foot’s second toe transplantation with MTP joint arthrodesis method’s achieved functional and aesthetic results allow us to change the prevailing view on the congenital hand’s first digit’s hypoplasia treatment methods and to recommend this new hand reconstruction method as an alternative to pollicization method. New surgical methode – toe to hand transplantation using MTP arthrodesis were used for treatment of two patients with congenital hipoplasia of thumb degree IIIb–V EIP transpozition methode with suberiosteal fixation were used for treatment of forteen patients with congenital hipoplasia of thumb degree II and IIIa and clasical methode – policization were used for treatment of two patients with congenital hipoplasia af thumb degree IIIb–V. Aesthetical results survey were completed by 285 responders. Received postoperative functional and aesthetical results showed that results for the new – transplantation methode is similar like policization but cosmethical outcome for tthe new methode was evaluated much hire then clasical pollicization methtod.
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    Cultural bias in the AAP's 2012 Technical Report and Policy Statement on male circumcision
    (2013-04) Frisch, Morten; Aigrain, Yves; Barauskas, Vidmantas; Bjarnason, Ragnar; Boddy, Su Anna; Czauderna, Piotr; De Gier, Robert P.E.; De Jong, Tom P.V.M.; Fasching, Günter; Fetter, Willem; Gahr, Manfred; Graugaard, Christian; Greisen, Gorm; Gunnarsdottir, Anna; Hartmann, Wolfram; Havranek, Petr; Hitchcock, Rowena; Huddart, Simon; Janson, Staffan; Jaszczak, Poul; Kupferschmid, Christoph; Lahdes-Vasama, Tuija; Lindahl, Harry; MacDonald, Noni; Markestad, Trond; Märtson, Matis; Nordhov, Solveig Marianne; Pälve, Heikki; Pētersons, Aigars; Quinn, Feargal; Qvist, Niels; Rosmundsson, Thrainn; Saxen, Harri; Söder, Olle; Stehr, Maximilian; Von Loewenich, Volker C.H.; Wallander, Johan; Wijnen, Rene
    The American Academy of Pediatrics recently released its new Technical Report and Policy Statement on male circumcision, concluding that current evidence indicates that the health benefits of newborn male circumcision outweigh the risks. The technical report is based on the scrutiny of a large number of complex scientific articles. Therefore, while striving for objectivity, the conclusions drawn by the 8 task force members reflect what these individual physicians perceived as trustworthy evidence. Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report's conclusions are different from those reached by physicians in other parts of the Western world, including Europe, Canada, and Australia. In this commentary, a different view is presented by non-US-based physicians and representatives of general medical associations and societies for pediatrics, pediatric surgery, and pediatric urology in Northern Europe. To these authors, only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.
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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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    Different Cytokine Profiles in Children with Acute Appendicitis and Acute Mesenteric Lymphadenitis
    (2015-12-01) Zviedre, Astra; Eņģelis, Arnis; Tretjakovs, Pēteris; Jurka, Antra; Zīle, Irisa; Pētersons, Aigars; Department of Paediatric Surgery; Department of Human Physiology and Biochemistry; Department of Public Health and Epidemiology
    The aim of this study was to investigate the role of serum cytokines in the diagnosis of acute appendicitis (AA) and acute mesenteric lymphadenitis (AML). Data were collected prospectively on 7 to 18 year old children (October 2010 - October 2013): 31 patients with AA, 26 patients with AML, and 17 patients with elective non-inflammatory surgical disease were selected as controls. Serum levels of IL-10, IL-12(p70), IL-1β, IL-4, IL-6, IL-8, IL-17, MCP-1, EGF, TNF-α were measured. Patients with AA had significantly increased serum levels of IL-6(1) (z = -3.72; p = 0.0002) and IL-10(1) (z = -2.81; p = 0.005) compared to AML before any treatment. The consecutive measurements of MCP-1 in serum demonstrated a significant difference within 72 hours in the AA group (Wilks' Lambda test 0.80; F(2;29) = 3.5; p = 0.04) and also in the AML group (Wilks' Lambda test 0.70; F(2;24) = 5.0; p = 0.01). The increased values of IL-6 and IL-10 were the most reliable cytokines one hour before surgical intervention for patients with AA. MCP-1 values changed significantly within 72 hours after patient hospitalisation but did not differ between the groups, and could not be a helpful serum biomarker in distinguishing patients with AA and AML.
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    Do we require to use antibacterial prophylaxis in hand trauma? Results of a randomised prospective case-control trial
    (2021-04-01) Ozols, Dzintars; Nefjodovs, Vadims; Zariņš, Jānis; Pētersons, Aigars; Rīga Stradiņš University
    The proper management of traumatic hand injury is crucial for wound infection prevention. Antibiotics in various forms and conditions are prescribed to avoid this complication, but the effectiveness is unclear. Most forms used are intravenous solutions, topical ointments, and oral tablets. This prospective case-control trial was conducted in a tertiary care hospital. Healthy adult patients with simple, non-bite, surgically treated hand wounds were included. During the surgery, a proper debridement and irrigation with simple saline was consistently performed. Patients were randomly assigned to one of the eight groups. Seven groups received different antibacterial prophylaxis and one received none. At the two-week postoperative follow-up the wound site was assessed and any local infection was documented. Patients were excluded from the trial if they did not comply to treatment recommendations (i.e. commence antibiotics, applied solutions or ointments on the wound). Overall, 240 patients (80.2% male, mean age 38.7 years), 30 in each study group were included. 226 patients returned for the follow-up, and seven patients were excluded from the trial. Wound infection was observed in five patients from different groups. Thus, the rate of wound infection was 2.28%. A Chi-square test revealed no difference in infection incidence between the groups (p > 0.05). In this study, antibiotics did not affect incidence of wound infection after hand trauma. Attention should be paid to proper debridement and irrigation of the wound as these interventions reduce the risk for wound infection and avoid unnecessary usage of antibiotics.
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    Evaluation of PGP 9.5, NGFR, TGFβ1, FGFR1, MMP-2, AT2R2, SHH, and TUNEL in Primary Obstructive Megaureter Tissue
    (2022-02) Junga, Anna; Siņicins, Ivo; Pētersons, Aigars; Pilmane, Māra; Institute of Anatomy and Anthropology; Department of Paediatric Surgery
    Primary obstructive megaureter (POM) morphogenesis is not fully known. The aim of the study was to evaluate the appearance of different factors that might take part in the pathogenesis of POM. Megaureter tissues of 14 children were stained with hematoxylin and eosin as well as with immunohistochemistry for protein gene product 9.5, nerve growth factor receptor, transforming growth factor beta 1 (TGFβ1), fibroblast growth factor receptor 1 (FGFR1), matrix metalloproteinase 2 (MMP-2), angiotensin 2 receptor type 2, and sonic hedgehog (SHH) protein. Apoptosis was detected by terminal dUTP nick-end labeling reaction. POM tissues revealed transitional epithelium with scattered vacuolization, submucosa with inflammatory cells, and focally vacuolized and chaotically organized muscle layers. Apoptosis, appearance of MMP-2, FGFR1, and SHH prevailed, but TGFβ1 positive cell number was lower in patients. Correlation between MMP-2 in epithelium and endothelium, FGFR1 and MMP-2 in epithelium, and TGFβ1 in epithelium and connective tissue in patients was detected. POM morphopathogenesis involves an apoptotic cell death of epithelium and smooth muscle as well as tissue degradation in epithelium and connective tissue of the ureter wall. The decrease of tissue growth through diminished TGFβ1 expression and stimulation of FGFR1 and MMP-2 suggests a disbalance of tissue remodelation in the megaureter wall.
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    Evaluation of the Role of Biomarkers in Diagnostics and Prognostication of Head Injuries. Summary of the Doctoral Thesis
    (Rīga Stradiņš University, 2013) Bārzdiņa, Arta; Pilmane, Māra; Pētersons, Aigars
    Head trauma is one of the most common causes of death and disability throughout the world, and it causes serious social and economic problems. The proportions of severity of head trauma are as follows: approximately 88% is light head trauma, 7% - medium severe head trauma, and 5% severe and fatal head injuries, which are followed by permanent disability in children. It has been proven that the most unpredictable are the light head injuries, which on the initial evaluation show 13 – 15 points of GCS, later after the trauma moment they can cause intracranial bleeding, diffuse axonal damage, and that is the reason why it is very important to make precise diagnosis in the acute stage and also give prognosis about the end result in the group of patients with this kind of trauma. This brings focus on biomarkers as the prognostic indicators in patients with head injuries. The aim of the study was to investigate the biomarkers characteristic to the secondary injury, their expression in the brain tissue samples and in peripheral blood samples in different time points after the injury. The morphology chapter included 28 patients of different age after fatal head injuries. The patients were divided in several groups: children and adults. Each of those groups were sub-divided further – those, who died on the spot of the injury, and those who died after a period of time. In all patients cytoskeletal protein GFAP, filaments NF, cytokines IL-6 and IL-10 expression in the brain tissue, apoptotic cell count and distribution in the brain tissue in the spot of the injury and counterstroke were analyzed. The clinical chapter included 18 patients with severe, medium severe and light head injuries up to 7 years of age. In these patients of 10 inflammatory biomarkers were measured in four defined time points (24, 48, 72 and 96 hours after the trauma).
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    Gallbladder Interleukins in Children with Calculous Cholecystitis
    (2021-09) Deņisova, Arina; Pilmane, Māra; Eņģelis, Arnis; Pētersons, Aigars; Institute of Anatomy and Anthropology; Department of Paediatric Surgery
    Calculous cholecystitis connects to inflammation and various complications. It is a common disease in the paediatric population, yet it is still uncertain how inflammation factors are involved in its morphopathogenesis. Twenty calculous cholecystitis surgery tissue samples were obtained from 20 children. As a control, seven unaffected gallbladders were used. Tissues were immunohistochemically stained for IL-1α, IL-4, IL-6, IL-7, IL-8, IL-10, and IL-17A, and the slides were inspected by light microscopy. To evaluate statistical differences and correlations between interleukins, Mann–Whitney U and Spearman’s tests were used. Statistically significant difference between patient and control gallbladder epithelium was for IL-1α and IL-17A, but connective tissue—IL-1α, IL-4, IL-6, IL-7, IL-8, and IL-17A positive structures. A strong positive correlation in patients was detected between epithelial IL-1α and IL-1α in connective tissue, epithelial IL-6 and IL-7, IL-6 and IL-17A, IL-7 and IL-10, IL-7 and IL-17A, as well as between IL-6 and IL-7, IL-7 and IL-10 in connective tissue. The increase of IL-1α, IL-4, IL-6, IL-7, IL-8 and IL-17A positive structures suggests their role in the morphopathogenesis of calculous cholecystitis. The correlations between interleukins in epithelium and in connective tissues prove that the epithelial barrier function and inflammatory response in deeper layers are sustained through intercellular signalling pathways.
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    GFAP and NF expression in brain tissue in children and adults after fatal traumatic brain injury
    (2011) Barzdina, Arta; Pilmane, Māra; Pētersons, Aigars; Department of Anaesthesiology, Intensive Care and Clinical simulations; Institute of Anatomy and Anthropology; Department of Paediatric Surgery
    Background and objectives. Still, there is almost no information about the role of biomarkers in the pathological processes of the brain in those patients, which die immediately after the injury, and those, which die several hours after the trauma. Design and Settings. A retrospective study. The human brain tissue material from the archive of the Institute of Anatomy and Anthropology in Riga Stradins University (RSU). Methods. We used the brain tissue material from the trauma and counterstroke spots of 28 patients. Brain tissue specimens were routinely fixed, embedded into paraffin, cut in 5 μm thick slides. For immuno-histochemistry we used monoclonal antibodies against NF proteins to detect axonal injury and monoclonal antibodies against GFAP to detect astrocytes. Results. Statistical correlation was seen between the lethal cases and survived in the brain tissue in the areas of counterstroke between lethal cases and survived for NF and GFAP presence (p=0.017) The data was compared, by dividing patients into groups of children and adults. Each of these groups was divided into 2 sub-groups. Statistically significant differences were noted between the lethal and the survived cases in the group of children for GFAP (Mann-Whitney U Test, p = 0.015) and in the group of adults for NF in the area of the counterstroke (Mann-Whitney U Test, p = 0.019). Conclusions. Higher quantities of intermediated filaments such as GFAP and NF are characteristic in the patients who survived after a head trauma in comparison to those, who died on the spot of the accident. Children under 2 years of age with severe head trauma have more dynamic glial cell reaction than other patients.
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    Il-6 and Il-10 Expression in Brain Tissue in Children and Adults after Fatal Traumatic Brain Injury
    (2011) Bārzdiņa, Arta; Pilmane, Māra; Pētersons, Aigars; Rīga Stradiņš University; Institute of Anatomy and Anthropology
    Introduction. One of the leading secondary damage processes determining the outcome of head injury is cerebral ischemia. The inflammatory reactions are important factors in cases of ischemic brain damage. Some studies characterize generalized reactions of cytokines in brain, but there are less studies about inflammatory reactions in the determined areas of the brain in different time points. Aim of the study. To determine the reaction of brain tissue after fatal brain injury in different time points after the trauma, by detecting IL-6 in the pyramidal neurons of CNS gray matter (GM) and in the white substance (WS) and IL-10 in the WS of the impact and counterstroke areas. Materials and methods. We used brain tissue material from the trauma and counterstroke spots of 11 patients died after fatal traumatic brain injury in different time points. Brain tissue specimens were routinely fixed, embedded into paraffin, cut in 5 μm thick slides. For immunohistochemistry we used monoclonal antibodies against recombinant IL-6 of human origin and polyclonal rabbit antibodies against IL-10 of human. Results. There were found statistically significant differences in IL-6 positive neurons in the GM, and IL-6 and IL-10 positive glial cell numbers in the WS in the spot of counterstroke and in the spot of direct impact in both patient groups (Mann-Whitney U Test p ≤ 0,001 for all groups). Conclusions. The IL-6 and IL-10 positive glial cell numbers correlate with the outcome of trauma. The inflammatory reaction in the WS in the spot of counterstroke was more marked than in the spot of direct impact. The activity of inflammatory reaction depends on the time period after the traumatic event.
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    Immunomodulatory tissue factors in the gallbladder walls of pediatric patients with chronic calculous cholecystitis
    (2025-02-08) Zīle Zariņa, Kaiva; Pilmane, Māra; Pētersons, Aigars; Institute of Anatomy and Anthropology; Department of Paediatric Surgery
    Background: The rising rates of gallstones and cholecystectomy in pediatric populations underscore the increasing concern regarding chronic cholecystitis. However, the morphopathogenesis of pediatric calculous cholecystitis is still not well understood. This study aimed to determine the expression and distribution of immunomodulatory factors interleukin-12 (IL-12), interleukin-13 (IL-13), interleukin-1β (IL-1β), sonic hedgehog protein (SHH), nuclear factor NF-kappa-B p65 subunit (NFkBp65), and heat shock protein 60 (HSP60) in the gallbladder walls of pediatric patients with chronic calculous cholecystitis. Methods: In total, 11 gallbladder samples were collected from pediatric patients with calculous cholecystitis during cholecystectomy, while 5 healthy gallbladder samples served as controls. IL-12, IL-13, IL-1β, SHH, NFkBp65, and HSP60 were detected by immunohistochemistry. The number of positive structures in gallbladder wall epithelium, vasculature, and inflammatory infiltrate was assessed semi-quantitatively by microscopy. A Mann–Whitney U test and Spearman’s rank-order correlation coefficient were calculated. Results: Statistically significant differences were observed between patient and control samples in the expression of IL-1β, SHH, and NFkBp65 in the epithelium, as well as in the expression of IL-12, SHH, and HSP60 in the blood vessels. The expression of IL1β was stronger in the epithelium of controls, while other markers were more prominent in patient samples. Conclusions: An increased number of NFkBp65, IL-12, and HSP60 positive cells in patient gallbladder tissue suggests a significant role of these tissue factors in driving immune modulation and sustaining the inflammation in pediatric chronic calculous cholecystitis. The noticeable expression of SHH in patient gallbladder tissue indicates its part in tissue regeneration and repair processes, as well as in modulating inflammation and vascular responses in calculous cholecystitis. The significant positive correlations between the factors studied highlight the importance of their coordinated interaction and intricate crosstalk in the morphopathogenesis of calculous cholecystitis.
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    Interdisciplinary Simulation-Based Education Curriculums on Patient Rights : For the Safety of Healthcare Professionals and Patients
    (2024-08-01) Slavinska, Andreta; Šāberte, Laura; Birzniece, Marika Daila; Grigoroviča, Evita; Edelmers, Edgars; Palkova, Karina; Pētersons, Aigars; Medical Education Technology Centre; Faculty of Social Sciences; Rīga Stradiņš University
    In 2020, the World Health Organisation (WHO) published the document “Charter: Health Worker Safety: a Priority for Patient Safety,” which emphasised the importance of enhancing health worker safety to improve patient safety. The significance of patient safety remains undiminished, as evidenced by the recent WHO document, “Patient Safety Rights Charter” (2024), which encompasses critical aspects of patient rights. It must be acknowledged that patient safety is intricately linked to the domain of patient rights, which underpins the necessity for healthcare professionals to possess interdisciplinary competence to effectively fulfil their duties and provide comprehensive patient care. However, it is essential to accurately determine and justify the specific knowledge and skills from other fields that are necessary for healthcare professionals. Moreover, healthcare specialists must not only acquire knowledge but also develop the ability to apply and integrate it into professional practice—participation in interdisciplinary clinical simulations that incorporate aspects of patient rights enables learners to think and act in clinical situations according to generally accepted algorithms and evidence-based practices, while considering the legal aspects of patients' rights. This study was carried out at the Medical Education Technology Centre, Rīga Stradiņš University, between 2023 and 2024, involving 107 residents from different specialties. The survey results reflect a strong interest and positive attitude towards interdisciplinary simulation-based training on patient rights, with participants emphasising its significance and value in enhancing resident education, highlighting the need for its continued and expanded implementation.
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    Kompleksa pēcoperācijas rezultātu izvērtēšana bērniem ar iedzimtu plaukstas pirmā pirksta hipoplāziju jaunas ķirurģiskas plaukstas rekonstrukcijas metodes pamatojumam. Promocijas darba kopsavilkums
    (Rīgas Stradiņa universitāte, 2019) Ozols, Dzintars; Pētersons, Aigars
    Iedzimtas augšējās ekstremitātes deformācijas ir reti sastopamas, to biežums literatūrā variē no 0,15 līdz 0,2%.[44,51] Lielākā daļa jeb ~ 70% no šīm deformācijām – sindaktīlijas vai polidaktīlijas – ir nelielas, un tikai 1–2% no visām iedzimtām augšējās ekstremitātes deformācijām ir pirmā pirksta hipoplāzija jeb attīstības traucējumi. Pirmais pirksts ir ļoti nozīmīgs plaukstas funkcionalitātē, nodrošinot līdz pat 50% no plaukstas veiktspējas un tam ir būtiska loma bērna attīstībā. Pareiza pincetes tvēriena izveide notiek12–16 mēnešu vecumā. Nepilnīga pirmā pirksta attīstība var ietekmēt bērna psihoemocionālo attīstību.[27] Pirmā pirksta rekonstrukcija jau vēsturiski ir bijusi nozīmīga. Par pirmo sekmīgo īkšķa rekonstrukciju tiek uzskatīta Nicoladoni 1897. gadā veiktā etapveida īkšķa rekonstrukcija. Attīstoties optiskā palielinājuma ierīcēm, 1965. gadā Buncke veica pirmo mikrovaskulāro kājas pirmā pirksta transplantācijas operāciju rēzus pērtiķiem. Operācija bija sekmīga, lai arī izdzīvoja tikai viens no pārstādītajiem pirkstiem, un jau 1968. gadā Cobett veica kājas lielā pirksta transplantāciju cilvēkam.[19] Pirmo reizi kājas otrā pirksta transplantācija iedzimtas plaukstas pirmā pirksta deformācijas ķirurģiskai ārstēšanai tika veikta 1976. gadā.[72,88] Mikroķirurģijas attīstība Latvijā sākās 1985. gadā, kad slimnīcā „Gaiļezers” tika izveidota mikroķirurģijas nodaļa. Pirmā mikrovaskulārā kājas pirksta transplantācija bērnam ar iedzimtu deformāciju Latvijā veikta 2008. gadā. Turpinot pilnveidot iedzimto deformāciju ārstēšanas tehniku, 2010. gadā tika izveidota jauna ķirurģiska metode iedzimtas īkšķa hipoplāzijas IIIb–V pakāpes rekonstrukcijā – kājas otrā pirksta transplantācija ar MTP locītavas artrodēzi. Metode ļauj saglabāt piecu pirkstu plaukstu un nodrošina labu pirmā pirksta funkcionālo un estētisko izskatu.[75,76] Iedzimtas pirmā pirksta hipoplāzijas II un IIIa pakāpes rekonstrukcijā tiek pielietota plaukstas otrā pirksta atliecējcīpslas pārvietošanas operācija. EIP cīpslas transpozīcijas metode tika izveidota 2007. gadā. Šajā pētījumā veikta detalizēta literatūras avotu analīze par iedzimtas plaukstas pirmā pirksta hipoplāzijas ārstēšanas metodēm un to rezultātiem. Literatūrā visbiežāk aprakstītā metode iedzimtu plaukstas pirmā pirksta IIIb–V pakāpes hipoplāziju rekonstrukcijai ir pollicizācijas metode jeb rokas otrā pirksta pārvietošana īkšķa pozīcijā. Tiek izveidots funkcionāls īkšķis, bet iegūta četru pirkstu plauksta, kuru daudzi autori uzskata par normu rietumvalstīs.[12,64] Otra biežākā rekonstrukcijas metode ir kājas otrā metatarsālā kaula daļas transplantācijas metode, kuras ieguvums ir saglabāta piecu pirkstu plauksta, taču rekonstruētais pirmais pirksts ir mazkustīgs.[16] Pētījuma pirmajā daļā tika apskatīts 21 pacients, no kuriem pētījumā iekļauti 18 pacienti. Pētījuma retrospektīvajā daļā tika veikta funkcionālo datu analīze, nosakot plaukstas tvēriena un pincetes tvēriena spēku, izvērtējot kustību apjomu locītavās. Datu izvērtēšanai izmantotas DASH un PEDI skalas un veikta estētisko rezultātu izvērtēšana, pielietojot VAS skalu. Iegūtie funkcionālie dati tika salīdzināti ar pacientu veselās (neoperētās) rokas datiem un RSU Anatomijas un antropoloģijas institūta Antropoloģijas laboratorijas veiktā funkcionālo datu pētījuma Latvijas bērnu funkcionālo normu noteikšanai rezultātiem. Pacientu ar iedzimtas plaukstas deformācijas pirmā pirksta hipoplāziju funkcionālie dati ir ievērojami vājāki nekā veseliem Latvijas bērniem. Kājas otrā pirksta transplantācijas ar MTP locītavas artrodēzi metodes funkcionālo datu rezultāti ir ļoti līdzīgi kā pollicizācijas metodes funkcionālo datu rezultāti, taču VAS skalas uzrādītie rezultāti bija labāki tieši jaunajai transplantācijas metodei. Pētījuma prospektīvajā daļā tika izstrādāta aptaujas anketa ar mērķi salīdzināt estētiskos rezultātus iedzimtas pirmā pirksta IIIb–V pakāpes hipoplāzijas ārstēšanas metožu salīdzināšanai. Aptaujas anketās tika lūgts vērtēt jaunās ķiruģijas metodes (kājas otrā pirksta transplantācijas ar MTP locītavas artrodēzi) un klasiskās ķiruģijas metodes (pollicizācijas) estētiskos rezultātus. Tika iegūtas 285 respondentu atbildes, kurās ar statistisku ticamību tika labāk novērtēta tieši metode kājas otrā pirksta transplantācijai ar MTP locītavas artrodēzi. Tāpēc piecu pirkstu jaunizveidotā plauksta ir uzskatāma par estētiskāku nekā četru pirkstu plauksta pollicizācijas gadījumā. Kājas otrā pirksta transplantācijas ar MTP locītavas artrodēzi metodes iegūtie funkcionālie un estētiskie rezultāti ļauj mainīt valdošo uzskatu par iedzimtu plaukstas pirmā pirksta hipoplāzijas ārstēšanas metodēm un jauno plaukstas rekonstrukcijas metodi ieteikt kā alternatīvu pollicizācijas metodei. Jaunā ķiruģijas metode, kājas otrā pirksta transplantācija ar MTP locītavas artrodēzi, ir izmantota divu slimnieku ar IIIb pakāpes pirmā pirksta hipoplāziju ārstēšanā. EIP cīpslas transpozīcijas metode ar subperiostālu fiksāciju pielietota II un IIIa pakāpes hipoplāzijas ārstēšanā 14 pacientiem. Klasiskā pollicizācijas metode pielietota divu pacientu ar IIIb–V pakāpes hipoplāziju ārstēšanā. Iegūtie pēcoperācijas funkcionālie un estētiskie rezultāti liecina par līdzvērtīgu funkcionālo rezultātu kājas otrā pirksta transplantācijas metodei un klasiskajai pollicizācijas metodei, bet estētiskie rezultāti izteikti labāki ir pacientiem, kuriem operācija veikta ar jauno transplantācijas metodi.
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    Kompleksa pēcoperācijas rezultātu izvērtēšana bērniem ar iedzimtu plaukstas pirmā pirksta hipoplāziju jaunas ķirurģiskas plaukstas rekonstrukcijas metodes pamatojumam. Promocijas darbs
    (Rīgas Stradiņa universitāte, 2019) Ozols, Dzintars; Pētersons, Aigars
    Iedzimtas augšējās ekstremitātes deformācijas ir reti sastopamas, to biežums literatūrā variē no 0,15 līdz 0,2%.[44,51] Lielākā daļa jeb ~ 70% no šīm deformācijām – sindaktīlijas vai polidaktīlijas – ir nelielas, un tikai 1–2% no visām iedzimtām augšējās ekstremitātes deformācijām ir pirmā pirksta hipoplāzija jeb attīstības traucējumi. Pirmais pirksts ir ļoti nozīmīgs plaukstas funkcionalitātē, nodrošinot līdz pat 50% no plaukstas veiktspējas un tam ir būtiska loma bērna attīstībā. Pareiza pincetes tvēriena izveide notiek12–16 mēnešu vecumā. Nepilnīga pirmā pirksta attīstība var ietekmēt bērna psihoemocionālo attīstību.[27] Pirmā pirksta rekonstrukcija jau vēsturiski ir bijusi nozīmīga. Par pirmo sekmīgo īkšķa rekonstrukciju tiek uzskatīta Nicoladoni 1897. gadā veiktā etapveida īkšķa rekonstrukcija. Attīstoties optiskā palielinājuma ierīcēm, 1965. gadā Buncke veica pirmo mikrovaskulāro kājas pirmā pirksta transplantācijas operāciju rēzus pērtiķiem. Operācija bija sekmīga, lai arī izdzīvoja tikai viens no pārstādītajiem pirkstiem, un jau 1968. gadā Cobett veica kājas lielā pirksta transplantāciju cilvēkam.[19] Pirmo reizi kājas otrā pirksta transplantācija iedzimtas plaukstas pirmā pirksta deformācijas ķirurģiskai ārstēšanai tika veikta 1976. gadā.[72,88] Mikroķirurģijas attīstība Latvijā sākās 1985. gadā, kad slimnīcā „Gaiļezers” tika izveidota mikroķirurģijas nodaļa. Pirmā mikrovaskulārā kājas pirksta transplantācija bērnam ar iedzimtu deformāciju Latvijā veikta 2008. gadā. Turpinot pilnveidot iedzimto deformāciju ārstēšanas tehniku, 2010. gadā tika izveidota jauna ķirurģiska metode iedzimtas īkšķa hipoplāzijas IIIb–V pakāpes rekonstrukcijā – kājas otrā pirksta transplantācija ar MTP locītavas artrodēzi. Metode ļauj saglabāt piecu pirkstu plaukstu un nodrošina labu pirmā pirksta funkcionālo un estētisko izskatu.[75,76] Iedzimtas pirmā pirksta hipoplāzijas II un IIIa pakāpes rekonstrukcijā tiek pielietota plaukstas otrā pirksta atliecējcīpslas pārvietošanas operācija. EIP cīpslas transpozīcijas metode tika izveidota 2007. gadā. Šajā pētījumā veikta detalizēta literatūras avotu analīze par iedzimtas plaukstas pirmā pirksta hipoplāzijas ārstēšanas metodēm un to rezultātiem. Literatūrā visbiežāk aprakstītā metode iedzimtu plaukstas pirmā pirksta IIIb–V pakāpes hipoplāziju rekonstrukcijai ir pollicizācijas metode jeb rokas otrā pirksta pārvietošana īkšķa pozīcijā. Tiek izveidots funkcionāls īkšķis, bet iegūta četru pirkstu plauksta, kuru daudzi autori uzskata par normu rietumvalstīs.[12,64] Otra biežākā rekonstrukcijas metode ir kājas otrā metatarsālā kaula daļas transplantācijas metode, kuras ieguvums ir saglabāta piecu pirkstu plauksta, taču rekonstruētais pirmais pirksts ir mazkustīgs.[16] Pētījuma pirmajā daļā tika apskatīts 21 pacients, no kuriem pētījumā iekļauti 18 pacienti. Pētījuma retrospektīvajā daļā tika veikta funkcionālo datu analīze, nosakot plaukstas tvēriena un pincetes tvēriena spēku, izvērtējot kustību apjomu locītavās. Datu izvērtēšanai izmantotas DASH un PEDI skalas un veikta estētisko rezultātu izvērtēšana, pielietojot VAS skalu. Iegūtie funkcionālie dati tika salīdzināti ar pacientu veselās (neoperētās) rokas datiem un RSU Anatomijas un antropoloģijas institūta Antropoloģijas laboratorijas veiktā funkcionālo datu pētījuma Latvijas bērnu funkcionālo normu noteikšanai rezultātiem. Pacientu ar iedzimtas plaukstas deformācijas pirmā pirksta hipoplāziju funkcionālie dati ir ievērojami vājāki nekā veseliem Latvijas bērniem. Kājas otrā pirksta transplantācijas ar MTP locītavas artrodēzi metodes funkcionālo datu rezultāti ir ļoti līdzīgi kā pollicizācijas metodes funkcionālo datu rezultāti, taču VAS skalas uzrādītie rezultāti bija labāki tieši jaunajai transplantācijas metodei. Pētījuma prospektīvajā daļā tika izstrādāta aptaujas anketa ar mērķi salīdzināt estētiskos rezultātus iedzimtas pirmā pirksta IIIb–V pakāpes hipoplāzijas ārstēšanas metožu salīdzināšanai. Aptaujas anketās tika lūgts vērtēt jaunās ķiruģijas metodes (kājas otrā pirksta transplantācijas ar MTP locītavas artrodēzi) un klasiskās ķiruģijas metodes (pollicizācijas) estētiskos rezultātus. Tika iegūtas 285 respondentu atbildes, kurās ar statistisku ticamību tika labāk novērtēta tieši metode kājas otrā pirksta transplantācijai ar MTP locītavas artrodēzi. Tāpēc piecu pirkstu jaunizveidotā plauksta ir uzskatāma par estētiskāku nekā četru pirkstu plauksta pollicizācijas gadījumā. Kājas otrā pirksta transplantācijas ar MTP locītavas artrodēzi metodes iegūtie funkcionālie un estētiskie rezultāti ļauj mainīt valdošo uzskatu par iedzimtu plaukstas pirmā pirksta hipoplāzijas ārstēšanas metodēm un jauno plaukstas rekonstrukcijas metodi ieteikt kā alternatīvu pollicizācijas metodei. Jaunā ķiruģijas metode, kājas otrā pirksta transplantācija ar MTP locītavas artrodēzi, ir izmantota divu slimnieku ar IIIb pakāpes pirmā pirksta hipoplāziju ārstēšanā. EIP cīpslas transpozīcijas metode ar subperiostālu fiksāciju pielietota II un IIIa pakāpes hipoplāzijas ārstēšanā 14 pacientiem. Klasiskā pollicizācijas metode pielietota divu pacientu ar IIIb–V pakāpes hipoplāziju ārstēšanā. Iegūtie pēcoperācijas funkcionālie un estētiskie rezultāti liecina par līdzvērtīgu funkcionālo rezultātu kājas otrā pirksta transplantācijas metodei un klasiskajai pollicizācijas metodei, bet estētiskie rezultāti izteikti labāki ir pacientiem, kuriem operācija veikta ar jauno transplantācijas metodi.
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