Browsing by Author "Zviedre, Astra"

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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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    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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    Correlation of Acute Appendicitis and Acute Mesenteric Lymphadenitis with the Changes of Serum Cytokines in Children. Summary of the Doctoral Thesis
    (Rīga Stradiņš University, 2016) Zviedre, Astra; Eņģelis, Arnis; Tretjakovs, Pēteris
    The Aim of the study. To analyse the incidence changes for Acute Appendicitis (AA) and Acute Mesenteric lymphadenitis (AML), and to ascertain the compatibility of hospital admission and discharge diagnosis, as well as to investigate cytokine group serum inflammation mediator (CGSIM), epithelial growth factor (EGF), interleukine (IL)-10 IL-12 (p 70), IL-1β , IL-4, IL-6, IL-17, IL-8, monocyte hemotaxis protein 1 (MCP-1), tumour necrosis factor α (TNF-α) differential diagnostic value and to evaluate the connection between biomarkers and other diagnostic methods in case of AA and AML in children. Methods. Mixed type prospective case-control study. In the retrospective part of the thesis, data regarding incidence of AA and AML have been analysed, in time period from year 2010 until year 2013. A retrospective analysis for patients (n = 1228) in the age group from 0 to 18 years during first time hospital admissions Children’s Clinical University Hospital with suspicion of AA and admission and discharge diagnosis compatibility has been carried out (01.10.2010 – 01.10.2013). The prospective part of the study includes 57 patients (31 with AA and 26 with AML), that were compatible with the inclusion criteria, with addition of using control group (n = 17) for establishing CGSIM reference value. The main results of the study. During the time period (2010 – 2013) the incidence of AA in children (7–18 years of age) was on average diminished by 2%, however, the incidence for AML has risen on average by 5.8%. Hospital data revealed, that there is inconsistency of 76.2% of cases admission and discharge diagnosis for patients with suspicion of AA in the age group until 18 years. Comparing the clinical signs of the patients symptoms like nausea, vomiting, abdominal wall rigidity, and rebound tenderness they were more compatible with AA comparing to AML. The results of CGSIM and the rest of diagnostic methods revealed, that the diagnostic accuracy of AA increases to 89.5%, if the patients are clinically evaluated for Alvarado score ≥ 7 and laboratory criteria, taking in account cut-off values of these variables – WBC ≥ 10.7 × 10^3/μL un IL-6 ≥ 4.3 pg/mL. In the case of Alvarado score being ≥ 7, IL-6 with cut-off value in serum ≥ 4.3 pg/mL and additional ultrasound examination, combination of these criteria showed a 100% specificity and 100% PPV during precision of AA diagnosis. During analysis of CGSIM concentration changes in case of complicated and uncomplicated AA, inflammation marker, such as IL-6, IL-8, MCP-1, CRP, increased concentration was established in case of complicated AA. The serum level of IL-6 with cut-off level of ≥ 36.2 pg/mL, IL-8 ≥ 12.3 pg/mL and MCP-1 ≥ 400.2 pg/mL indicates the presence of complicated AA. Correlation analysis of IL-6 revealed a medium close connection between IL-8 and MCP-1 in case of AA. Conclusions. CGSIM concentration level varies in case of AA and AML in children, age group from 7 to 18 years. The main CGSIM in previously mentioned disease differential diagnosis is IL-6, that, together with other examination methods increases the diagnostic accuracy of AA. Pending clinical evaluation of children with AA and AML and establishing further tactic for prognosis and action of AA, patients should be evaluated using Alvarado score of ≥ 7 together with laboratory findings, taking into account the WBC ≥ 10.7 × 10^3/μL un IL-6 ≥ 4.3 pg/mL. Based on the results of the study, an algorithm suitable for AA prognosis and action in children in age group from 7 to 18 years was established to be used in hospital admission wards and out-patients units.
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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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    Laboratory Tests in Addition to the Alvarado Score in the Management of Acute Appendicitis in School-Age Children
    (2019-08-01) Zviedre, Astra; Eņgelis, Arnis; Tretjakovs, Peteris; Zile, Irisa; Petersons, Aigars; Department of Paediatric Surgery; Department of Human Physiology and Biochemistry; Department of Public Health and Epidemiology
    The aim of the study was to determine whether the Alvarado score (AS) together with laboratory tests could be used to distinguish patients with acute appendicitis (AA) from acute mesenteric lymphadenitis (AML). Fifty-seven patients (7-18 years) with suspected AA were included in the prospective study (October 2010 - October 2013). Thirty-one patients underwent surgery for AA and 26 were not treated surgically and were diagnosed AML on ultrasonography. AS, white blood cell count (WBC), C - reactive protein (CRP) and serum cytokines (EGF, IL-10, IL-12(p70), IL-1β, IL-4, IL-6, IL-8, IL-17, MCP-1, TNF-α) were obtained on admission and were compared between groups. Mean age of the 57 patients was 12.9 (SD 3.2). Accuracy (AR) for AS ≥ 7 alone was 73.7% for AA. Modified AS with certain serum cytokines seemed to be a reliable tool for initial differential diagnosis between AA and AML in school-age children. Based on these results, AS ≥ 7, WBC ≥ 10.7 × 103/μL and serum IL-6 ≥ 4.3 pg/mL assessed altogether will yield more sensitivity for AA. Also for further advanced diagnostics, we propose to take into account the serum IL-6, IL-8, MCP-1, CRP cut-off levels in the differential diagnosis between complicated and uncomplicated AA to decide whether the treatment should be conservative or surgical.
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    Prenatal and postnatal diagnostics problems of the most common surgical congenital malformations of newborns in Latvia
    (2009) Abola, Zane; Petersons, Aigars; Pugačevska, Daila; Zviedre, Astra; Lackaja, Jana; Rīga Stradiņš University
    The most common surgical congenital malformations of newborns in Latvia are esophageal atresia (EA) with or without tracheoesophageal fistula (TEF), duodenal atresia (DA) and abdominal wall defects - gastroschisis (G) and omphalocele (O). Survival and quality of life of these patients depend on precise pre- and postnatal diagnosis, timely and qualified treatment, and presence of associated anomalies and prematurity. The aim of our study was to define prenatal and postnatal diagnostic problems of the most common surgical congenital malformations of new-borns in Latvia. Data concerning pre- and postnatal diagnostics from case-records of patients treated in Children's Clinical University Hospital from 1998 till 2008 with esophageal atresia (58 patients), duodenal atresia (20 patients) and congenital abdominal wall defects - gastroschisis (17 patients) and omphalocele (28 patients) were analysed. Results showed that in case of EA prenatal USG was performed in 62% of expectant mothers and in neither case suspicion about. EA was expressed. In all patients after birth diagnostic placement of nasogastric tube was performed. In approximately one-third catheter of bad opaqueness was used. Preoperative bronchoscopy and esophagoscopy in order to exclude upper tracheoesophageal fistula were performed in two patients from the analysed group. In 40% of cases DA was diagnosed in prenatal ultrasonography. G was diagnosed prenatally in 29.4%, O - only in 3.7%.
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    Role of serum cytokines in acute appendicitis and acute mesenteric lymphadenitis among children
    (2016) Zviedre, Astra; Engelis, Arnis; Tretjakovs, Peteris; Jurka, Antra; Zile, Irisa; Petersons, Aigars; Department of Paediatric Surgery; Department of Human Physiology and Biochemistry; Department of Public Health and Epidemiology
    Background and objective The diagnostic role of serum cytokines depends on the etiology and pathogenesis of acute appendicitis (AA) and acute mesenteric lymphadenitis (AML). The aim of this study was to evaluate differences in cytokine levels between AA and AML. Materials and methods Data of 7- to 18-year-old children were collected prospectively from October 2010 to October 2013. There were 31 patients with AA (AA group), 26 with AML (AML group), and 17 with elective non-inflammatory surgical disease (control group). Serum levels of IL-10, IL-12(p70), IL-1β, IL-4, IL-6, IL-8, IL-17, MCP-1, EGF, TNF-α and white blood count (WBC) were measured three times consecutively in each group. Results The level of IL-6 and IL-10 was significantly higher in the AA group than the AML group at the first measurement (8 pg/mL vs. 3.2 pg/mL, P = 0.000; 6.1 pg/mL vs. 3.2 pg/mL, P = 0.005, respectively). There was a significant difference observed in time dynamics of concentration of IL-6 and MCP-1 for AA and AML. The area under the curve (AUC) was 0.77 (95% CI 0.64–0.89; P = 0.001) for IL-6 with a cut-off value of 4.3 pg/mL (67.7% sensitivity and 76.9% specificity) for AA 1 h before surgery. The AUC for WBC was 0.72 (95% CI 0.58.4–0.85; P = 0.005) with a cut-off value of 10.7 × 103/μL (sensitivity 71.0% and specificity 46.2%). Conclusions Serum IL-6 with a cut-off value of 4.3 pg/mL and WBC with a cut-off value of 10.7 × 103/μL assessed together will yield more sensitivity for AA.
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    Sedation and Analgesia for Reduction of Pediatric Ileocolic Intussusception
    (2023-06-07) Poonai, Naveen; Cohen, Daniel M.; MacDowell, Doug; Paediatric Emergency Research Networks (PERN) PAINT Study Group; Pučuka, Zanda; Zviedre, Astra; Zeltiņa, Emīlija; Kolbergs, Jānis
    Importance: Ileocolic intussusception is an important cause of intestinal obstruction in children. Reduction of ileocolic intussusception using air or fluid enema is the standard of care. This likely distressing procedure is usually performed without sedation or analgesia, but practice variation exists. Objective: To characterize the prevalence of opioid analgesia and sedation and assess their association with intestinal perforation and failed reduction. Design, Setting, and Participants: This cross-sectional study reviewed medical records of children aged 4 to 48 months with attempted reduction of ileocolic intussusception at 86 pediatric tertiary care institutions in 14 countries from January 2017 to December 2019. Of 3555 eligible medical records, 352 were excluded, and 3203 medical records were eligible. Data were analyzed in August 2022. Exposures: Reduction of ileocolic intussusception. Main outcomes and measures: The primary outcomes were opioid analgesia within 120 minutes of reduction based on the therapeutic window of IV morphine and sedation immediately before reduction of intussusception. Results: We included 3203 patients (median [IQR] age, 17 [9-27] months; 2054 of 3203 [64.1%] males). Opioid use was documented in 395 of 3134 patients (12.6%), sedation 334 of 3161 patients (10.6%), and opioids plus sedation in 178 of 3134 patients (5.7%). Perforation was uncommon and occurred in 13 of 3203 patients (0.4%). In the unadjusted analysis, opioids plus sedation (odds ratio [OR], 5.92; 95% CI, 1.28-27.42; P =.02) and a greater number of reduction attempts (OR, 1.48; 95% CI, 1.03-2.11; P =.03) were significantly associated with perforation. In the adjusted analysis, neither of these covariates remained significant. Reductions were successful in 2700 of 3184 attempts (84.8%). In the unadjusted analysis, younger age, no pain assessment at triage, opioids, longer duration of symptoms, hydrostatic enema, and gastrointestinal anomaly were significantly associated with failed reduction. In the adjusted analysis, only younger age (OR, 1.05 per month; 95% CI, 1.03-1.06 per month; P <.001), shorter duration of symptoms (OR, 0.96 per hour; 95% CI, 0.94-0.99 per hour; P =.002), and gastrointestinal anomaly (OR, 6.50; 95% CI, 2.04-20.64; P =.002) remained significant. Conclusions and Relevance: This cross-sectional study of pediatric ileocolic intussusception found that more than two-thirds of patients received neither analgesia nor sedation. Neither was associated with intestinal perforation or failed reduction, challenging the widespread practice of withholding analgesia and sedation for reduction of ileocolic intussusception in children.
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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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    Seruma citokīnu pārmaiņas akūta apendicīta un akūta mezenteriāla limfadenīta gadījumā bērniem. Promocijas darba kopsavilkums
    (Rīgas Stradiņa universitāte, 2016) Zviedre, Astra; Eņģelis, Arnis; Tretjakovs, Pēteris
    Darba mērķis. Analizēt akūta apendicīta (AA) un akūta mezenteriāla limfadenīta (AML) incidences izmaiņas Latvijā (2010. – 2013.) un noskaidrot stacionāra iestāšanās un izrakstīšanās diagnožu sakritību, kā arī izpētīt citokīnu grupas seruma iekaisuma mediatoru (CGSIM) (epiteliālā augšanas faktora (EGF), interleikīna (IL)-10, IL-12(p70), IL-1β, IL-4, IL-6, IL-17, IL-8, monocītu hemotakses proteīna 1 (MCP-1), tumora nekrozs faktora alfa (TNF-α)) diferenciāli diagnostisko nozīmi un izvērtēt biomarķieru saistību ar citām diagnostiskām metodēm AA un AML gadījumā bērniem. Darba metodes. Jaukta tipa prospektīvs gadījuma – kontroles pētījums. Retrospektīvajā daļā tika analizēti dati saistībā ar AA un AML saslimstību Latvijā laikposmā no 2010. līdz 2013. gadam. Retrospektīvi tika veikta analīze arī par pirmreizēji hospitalizētajiem pacientiem (n = 1228) vecumā no 0 līdz 18 gadiem VSIA Bērnu klīniskās universitātes slimnīcā (VSIA BKUS) ar aizdomām par AA, lai izvērtētu iestāšanās un izrakstīšanās diagnožu sakritību. Prospektīvajā daļā (01.10.2010. – 01.10.2013.) tika iekļauti 57 pacienti (31 ar AA un 26 ar AML), kuri atbilda iekļaušanas kritērijiem, papildus izmantojot kontroles grupu (n = 17) CGSIM referento vērtību noteikšanai. Darba galvenie rezultāti. Laika periodā (2010. – 2013.) bērniem (7–18 gadi) kopējā saslimstība ar AA vidēji samazinājusies par 2%, tomēr saslimstība ar AML ir pieaugusi vidēji par 5,8%. Stacionāra dati atklāja, ka vidēji 76,2% gadījumu tika konstatēta iestāšanās un izrakstīšanās diagnožu nesakritība pacientiem ar aizdomām par AA vecumā līdz 18 gadiem. Veicot pacientu klīnisko pazīmju salīdzināšanu, slikta dūša, vemšana, pasīva vēdera priekšējās sienas muskulatūras rezistence un pozitīvi vēderplēves kairinājuma simptomi biežāk bija sastopami AA kā AML gadījumā. Rezultātu analīze saistībā ar CGSIM un pārējām diagnostiskajām metodēm atklāja, ka AA diagnostiskā precizitāte palielinās līdz 89,5%, ja pacienti klīniski tiek novērtēti pēc Alvarado skalas ≥ 7 balles un laboratoriskajiem rādītājiem, ņemot vērā šo rādītāju robežvērtības: WBC ≥ 10,7 × 10^3/μL un IL-6 ≥ 4,3 pg/mL. Savukārt, gadījumā, kad pacientam tiek konstatēta Alvarado skalas rezultāts ≥ 7 ballēm, IL-6 ar robežvērtības līmeni serumā ≥ 4,3 pg/mL un papildus tiek izmantots USG izmeklējums, visu šo kritēriju rezultātā tiek iegūts 100% specifiskums un 100% pozitīvā paredzošā vērtība (PPV), atklājot AA. Analizējot CGSIM koncentrācijas izmaiņas komplicēta un nekomplicēta AA gadījumā, tādu iekaisuma marķieru kā IL-6, IL-8, MCP-1 un CRP paaugstināta koncentrācija konstatēta komplicēta AA gadījumā. Serumā IL-6 ar robežvērtību ≥ 36,2 pg/mL, IL-8 ≥ 12,3 pg/mL un MCP-1 ≥ 400,2 pg/mL liecina par komplicēta AA klātbūtni. Korelācijas analīzē IL-6 atklāja vidēji ciešu savstarpējo saistību ar IL-8 un MCP-1 AA gadījumā. Secinājumi. CGSIM koncentrācijas ir atšķirīgas AA un AML gadījumos bērniem vecumā no 7 līdz 18 gadiem. Nozīmīgākais CGSIM minēto slimību diferenciālajā diagnostikā ir IL-6, kas kopā ar citām izmeklēšanas metodēm paaugstina AA diagnostisko precizitāti. Izvērtējot bērnus ar AA un AML un nosakot turpmāko AA prognozēšanas un rīcības taktiku, pacientam būtu jānovērtē klīniskais stāvoklis pēc Alvarado skalas ar rezultāta ≥ 7 ballēm kopā ar laboratoriskajiem rādītājiem, ņemot vērā šo rādītāju robežvērtības – WBC ≥ 10,7 × 10^3/μL un IL-6 ≥ 4,3 pg/mL. Pamatojoties uz pētījuma rezultātiem, izstrādāts slimnīcu NMPN un ambulatoram aprūpes etapam piemērots AA prognozēšans un rīcības algoritms bērniem ar AA un AML vecumā no 7–18 gadiem.
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    Seruma citokīnu pārmaiņas akūta apendicīta un akūta mezenteriāla limfadenīta gadījumā bērniem. Promocijas darbs
    (Rīgas Stradiņa universitāte, 2016) Zviedre, Astra; Eņģelis, Arnis; Tretjakovs, Pēteris
    Darba mērķis. Analizēt akūta apendicīta (AA) un akūta mezenteriāla limfadenīta (AML) incidences izmaiņas Latvijā (2010. – 2013.) un noskaidrot stacionāra iestāšanās un izrakstīšanās diagnožu sakritību, kā arī izpētīt citokīnu grupas seruma iekaisuma mediatoru (CGSIM) (epiteliālā augšanas faktora (EGF), interleikīna (IL)-10, IL-12(p70), IL-1β, IL-4, IL-6, IL-17, IL-8, monocītu hemotakses proteīna 1 (MCP-1), tumora nekrozs faktora alfa (TNF-α)) diferenciāli diagnostisko nozīmi un izvērtēt biomarķieru saistību ar citām diagnostiskām metodēm AA un AML gadījumā bērniem. Darba metodes. Jaukta tipa prospektīvs gadījuma – kontroles pētījums. Retrospektīvajā daļā tika analizēti dati saistībā ar AA un AML saslimstību Latvijā laikposmā no 2010. līdz 2013. gadam. Retrospektīvi tika veikta analīze arī par pirmreizēji hospitalizētajiem pacientiem (n = 1228) vecumā no 0 līdz 18 gadiem VSIA Bērnu klīniskās universitātes slimnīcā (VSIA BKUS) ar aizdomām par AA, lai izvērtētu iestāšanās un izrakstīšanās diagnožu sakritību. Prospektīvajā daļā (01.10.2010. – 01.10.2013.) tika iekļauti 57 pacienti (31 ar AA un 26 ar AML), kuri atbilda iekļaušanas kritērijiem, papildus izmantojot kontroles grupu (n = 17) CGSIM referento vērtību noteikšanai. Darba galvenie rezultāti. Laika periodā (2010. – 2013.) bērniem (7–18 gadi) kopējā saslimstība ar AA vidēji samazinājusies par 2%, tomēr saslimstība ar AML ir pieaugusi vidēji par 5,8%. Stacionāra dati atklāja, ka vidēji 76,2% gadījumu tika konstatēta iestāšanās un izrakstīšanās diagnožu nesakritība pacientiem ar aizdomām par AA vecumā līdz 18 gadiem. Veicot pacientu klīnisko pazīmju salīdzināšanu, slikta dūša, vemšana, pasīva vēdera priekšējās sienas muskulatūras rezistence un pozitīvi vēderplēves kairinājuma simptomi biežāk bija sastopami AA kā AML gadījumā. Rezultātu analīze saistībā ar CGSIM un pārējām diagnostiskajām metodēm atklāja, ka AA diagnostiskā precizitāte palielinās līdz 89,5%, ja pacienti klīniski tiek novērtēti pēc Alvarado skalas ≥ 7 balles un laboratoriskajiem rādītājiem, ņemot vērā šo rādītāju robežvērtības: WBC ≥ 10,7 × 10^3/μL un IL-6 ≥ 4,3 pg/mL. Savukārt, gadījumā, kad pacientam tiek konstatēta Alvarado skalas rezultāts ≥ 7 ballēm, IL-6 ar robežvērtības līmeni serumā ≥ 4,3 pg/mL un papildus tiek izmantots USG izmeklējums, visu šo kritēriju rezultātā tiek iegūts 100% specifiskums un 100% pozitīvā paredzošā vērtība (PPV), atklājot AA. Analizējot CGSIM koncentrācijas izmaiņas komplicēta un nekomplicēta AA gadījumā, tādu iekaisuma marķieru kā IL-6, IL-8, MCP-1 un CRP paaugstināta koncentrācija konstatēta komplicēta AA gadījumā. Serumā IL-6 ar robežvērtību ≥ 36,2 pg/mL, IL-8 ≥ 12,3 pg/mL un MCP-1 ≥ 400,2 pg/mL liecina par komplicēta AA klātbūtni. Korelācijas analīzē IL-6 atklāja vidēji ciešu savstarpējo saistību ar IL-8 un MCP-1 AA gadījumā. Secinājumi. CGSIM koncentrācijas ir atšķirīgas AA un AML gadījumos bērniem vecumā no 7 līdz 18 gadiem. Nozīmīgākais CGSIM minēto slimību diferenciālajā diagnostikā ir IL-6, kas kopā ar citām izmeklēšanas metodēm paaugstina AA diagnostisko precizitāti. Izvērtējot bērnus ar AA un AML un nosakot turpmāko AA prognozēšanas un rīcības taktiku, pacientam būtu jānovērtē klīniskais stāvoklis pēc Alvarado skalas ar rezultāta ≥ 7 ballēm kopā ar laboratoriskajiem rādītājiem, ņemot vērā šo rādītāju robežvērtības – WBC ≥ 10,7 × 10^3/μL un IL-6 ≥ 4,3 pg/mL. Pamatojoties uz pētījuma rezultātiem, izstrādāts slimnīcu NMPN un ambulatoram aprūpes etapam piemērots AA prognozēšans un rīcības algoritms bērniem ar AA un AML vecumā no 7–18 gadiem.
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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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    Torsion of the Diverticulum of the Appendix
    (2011) Eņģelis, Arnis; Zviedre, Astra; Pilmane, Māra; Pētersons, Aigars; Rīga Stradiņš University
    We report a case of a 1-year-old girl, operated on due to the symptoms of acute appendicitis. Torsion, necrosis and perforation of the large diverticulum of the appendix vermiformis, causing peritonitis were found during the operation. The complete luminary connection between appendix and the diverticulum was proved. Although appendix vermiformis itself was not the reason for the peritonitis, it was removed together with the diverticulum. The child’s recovery after the operation was stable. The morphology revealed that the diverticulum of appendix vermiformis generally possessed features typical of a large intestine columnar epithelium, while its other layers, including a muscular layer and an irregularly expanded sub-mucosal layer, remained similar to the wall of the appendix. We suggest that the torsion of the true congenital diverticulum of the vermiform appendix mimicked acute appendicitis and caused peritonitis in the above-mentioned girl.
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    A Unique Type or Variation of Bile Duct Cyst in a 9-Year-Old Girl : A Remarkable Case Study
    (2023-07-31) Paņina, Aleksandra; Zviedre, Astra; Laizāns, Paulis; Apine, Ilze; Department of Paediatric Surgery; Department of Radiology
    Patients with bile duct cysts require careful radiological assessment of the hepatobiliary system prior to surgical intervention. This clinical case is uncommon with an atypical clinical presentation and radiological findings. According to the most widely used classification of choledochal cysts, this case presents a combination of Type I and Type IV of choledochal cyst (CC) combining the form of extra, intrahepatic bile ducts and cystic duct dilations.
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    Variability of COVID-19 and MIS-C Related Abdominal Surgical Presentations in Children: Case Report Series
    (2021-05-21) Engelis, Arnis; Zviedre, Astra; Pavare, Jana; Zurmutai, Timurs; Berezovska, Marisa Maija; Bormotovs, Jurijs; Laizans, Paulis; Pētersons, Aigars; Department of Paediatric Surgery; Faculty of Medicine