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Since March 2020, when World Health Organisation (WHO) declared global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an overwhelming amount of information related to covid-19 has been published on a daily basis. At the beginning of pandemic only acute presentation of covid-19 was described. In recent months, increasing attention has been focused on long-term consequences of covid-19, which affect patients’ everyday life. While an increasing number of publications emerge about long covid in adults, the data on children are limited. This was a retrospective cohort study conducted in Children’s Clinical Hospital of Latvia from March 2020 to March 2021. Patients were offered an in-depth face-to-face assessment by our research team 1 to 3 months after COVID-19 onset, according to specially designed post-covid-19 symptom assessment protocol. To identify the long-term consequences of SARS-CoV-2 infection, we defined post-acute covid-19 as extending beyond three weeks from onset of first symptoms. During the study, comparison group of 140 children (age ≤ 18 years) also was recruited. The inclusion criteria for this group were (1) no medical history of covid-19, (2) signs and symptoms of other seasonal infections, e.g., fever. Eligible subjects in the comparison group were asked the same interview questions as those in the cohort. From March 2020 to March 2021 195 paediatric Covid-19 patients (age ≤ 18 years) with microbiologically confirmed (nasopharyngeal swab) covid-19 were enrolled in the study (the median (IQR) age was 11.0 years (range 1 month to 18 years), 112 (57.4 %) male). In covid-19 patient group, only 45 interviewees (28.0%) had returned to the previous level of health with no long-covid complaints at the time of the interview. The majority of children (n= 116, 72.0%) reported that they still had one or more persisting symptoms at the time of interview. Overall, the most dominant complaint in covid-19 patient group was about persistent fatigue (25.1%, n=44). All of the children who complained about fatigue also noted that they feel tired in the mornings after good quality night sleep. Second most prevalent group of long-term covid-19 symptoms was cognitive impairment. Thirty-two (18.2%) patients complained about irritability, moreover, 31 children (17.6%) had never-before seen mood swings. Many children also suffered from difficulties to concentrate (14.3%, n=25) and to keep attention (13.6%, n=24). Other common long-term symptoms in study group were related to physical activity disturbances. Twenty-two patients (13%) had trouble to walk for more than 15 minutes or to climb to 3rd floor. Approximately one-sixth of patients had recurrent headache (17.1%, n=30), 14.9% (n=26) of children reported anosmia and/or dysgeusia. Comparing long term symptoms prevalence in covid-19 patient group vs controls, it was evident, that in covid-19 patient group post-covid symptoms were statistically more often found than in any other infectious diseases. Keywords: paediatrics, SARS-CoV-2, long-Covid, clinical sequel

Rotavirus is a non-enveloped double-stranded RNA virus that causes severe gastroenteritis in children, but complications are rarely reported. Some reports have shown that rotavirus can induce diverse complications of the central nervous system, such as seizures, encephalopathy with a reversible splenial lesion, encephalitis, cerebral white matter abnormalities, and cerebellitis. Here, we present a 2-year-old patient with seizures, who had an isolated splenial lesion in the corpus callosum on neuroimaging, and the rotavirus antigen detected in faeces.SantraukaRotavirusas yra dvigrandės RNR virusas be apvalkalo, sukeliantis sunkų vaikų gastroenteritą, tačiau apie komplikacijas pranešama retai. Kai kurie atvejų aprašymai rodo, kad rotavirusas gali sukelti įvairias centrinės nervų sistemos komplikacijas, tokias kaip traukuliai, encefalopatija su trumpalaikiu didžiosios smegenų jungties pažeidimu, encefalitas, smegenų baltosios medžiagos anomalijos ir cerebelitas. Čia pristatome dvejų metų pacientą su traukuliais, kuriam laikinas didžiosios smegenų jungties pažeidimas buvo nustatytas neurovaizdinimo metu, o rotaviruso antigenas aptiktas išmatose.

In developed and developing countries, most cases of acute gastroenteritis in children are caused by viruses, and rotaviruses are known as the leading cause. The aim of our study was to estimate the main circulating serotypes of rotavirus before the introduction of routine immunisation in Latvia, and to search for their possible correlation with clinical symptoms and circulating genotypes. A cross-sectional study was carried out among children who had been hospitalised in the Children’s Clinical University Hospital from April 2013 to December 2015. Genotyping was done for 462 stool samples. Among G/P combinations, the most predominant genotypes were G4P[8] (61.3%), G9P[8] (12.4%) and G2P[4] (10.0%) in children of age < 5 years, G4P[8] (45.5%), G2P[4] (18.2%), G9P[8], G3P[8], and G1P[8] (9.1%) in children of age > 5 years. There was a statistically significant correlation (p < 0.05) between clinical signs (vomiting, dehydration, chronic diseases) and G1P[8] and G8P[8] genotypes. Infants infected with genotype G4P[4] had a statistically significant negative correlation with severity of acute gastroenteritis episodes (p < 0.05). We detected nine different rotavirus G genotypes, and two different P genotypes. G4P[8], G9P[8], and G2P[8] were predominant. We observed correlation between the dominant genotypes and clinical manifestations of rotavirus infection.

The COVID-19 related state of emergency in Latvia was declared on 12 March 2020. Consequently, Children’s Clinical University Hospital in Riga, Latvia, established a postacute outpatient service for individuals after recovery from COVID-19. Although information regarding the epidemiology and clinical features of COVID-19 in children has accumulated, relevant reports about persistent symptoms after recovery are lacking. We aimed to determine data on COVID-19 persistent symptoms after recovery in children in Latvia. Persistent symptoms have been reported in 9 out of 30 children.

Background and Aims: Morphogenesis of the upper lip and palate is a complex process involving highly regulated interactions between epithelial and mesenchymal cells. Genetic evidence in humans and mice indicates the involvement of matrix metalloproteinases (MMPs) and their endogenous tissue inhibitors (TIMPs) in cleft lip palate (CLP) aetiology. This study investigated whether expression of MMP-2, MMP-8, MMP-9, TIMP-2, and TIMP-4, which are essential for the upper lip and palate fusion, is dysregulated in children with CLP. Methods: Oral mucosa tissue samples were obtained from patients with complete unilateral (CU) CLP (n = 25) and complete bilateral (CB) CLP (n = 19) during corrective plastic surgery and in unaffected control subjects (n = 10). MMPs and TIMPs expression was assessed by immunohistochemistry, and the data were analyzed using the Kruskal - Wallis test with the Bonferroni correction. Results: In CLP patients, MMP-2, TIMP-2 immunoreactivity in the oral mucosa was seen to have a few to abundant structures, but the overall number of MMP-2, TIMP-2-positive structures was greater than that in controls (P < 0.01). The total number of TIMP-4, MMP-9-positive cells showed a significant decrease in the CBCLP compared with that of CUCLP (P < 0.001). MMP-8 expression trends in the CLP group were similar to those of the control group. Conclusions: The results suggest that TIMP-4 and MMP-9 are the main ECM remodeling regulatory proteins expressed in CUCLP affected tissues of the oral mucosa. The increased expression of MMP-2 and TIMP-2 in CLP tissues implicates these factors in the regulation of cell migration during ECM turnover independently of different types of clefts. Investigation of MMP and TIMP expression in tissue samples from patients with CLP appears to be a promising approach to the etiopathogenesis of CLP.

Information on family health-related quality of life (FHRQoL) among families of children with the coronavirus disease 2019 (COVID-19) is limited. This qualitative study explores the impact of pediatric COVID-19 on FHRQoL from the parents’ perspective. Semi-structured interviews were conducted with parents (n = 20) whose children had tested positive for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Inductive thematic analysis revealed the following 10 themes that represented parents’ perception of FHRQoL while taking care of a child with COVID-19: pediatric COVID-19 as a disease with many unknowns; emotional saturation; internal family relationships in the context of “a new experience”; routine household activities and daily regimen while family is in lockdown; plenty of free time; a wide social support network; social stigma associated with COVID-19; different options for work; savings and debts; challenges with family housing and transport availability. Our results show that parents experience multiple effects of pediatric COVID-19 with regard to FHRQoL.

La fisura labial y palatina (FLP) son anomalias congenitas caracterizadas por la fusion inadecuada del labio superior, alveolo y paladar secundario. En este estudio se investigo si en ninos con FLP hay una desregulacion de la expresion del factor regulador de interferon 6 (IRF6), del receptor de la tirosina quinasa (RYK), y del factor de transcripcion PAX9, que son esenciales para el desarrollo normal y la morfogenesis de las estructuras craneofaciales. Se obtuvieron muestras de la mucosa oral de pacientes con FLP completa bilateral (CB) (n= 19), tomadas durante la realizacion de cirugia plastica correctiva, y de sujetos de control no afectados (n= 7). Se evaluo la expresion de IRF6, RYK y PAX9 por inmunohistoquimica, y los datos se analizaron con la prueba de Mann-Whitney. En los pacientes, la inmunoreactividad de IRF6 en el tejido conectivo fue de moderada a alta, pero el numero total de celulas epiteliales orales positivas para IRF6 fue menor que en los controles (z= -3,41; P= 0,01). La expresion de RYK se observo solo esporadicamente en el epitelio oral de 4 pacientes, en contraste con el grupo control (z= -3,75; P

This study aimed to evaluate levels of expression of nestin, CD34 and transforming growth factor β3 (TGFβ3) in facial tissue of children with complete unilateral (CU) and complete bilateral (CB) cleft lip and palate (CLP).Twenty-nine CLP patients were enrolled in this study (18 boys and 11 girls). Tissue samples were collected during primary and repeated plastic surgery correction for CU (n=10) or CB (n=19) cleft palate (age range 3 months - 9 years, 6 months). Immunohistochemistry was used to assess levels of nestin, CD34 and TGFβ3. Positively stained cells were graded semi-quantitatively. Data were analyzed to compare cell counts between CUCLP and CBCLP, and CLP at an age before and during primary dentition and CLP in mixed dentition age patients using the Mann Whitney U-test (P0.05).Moderate to abundant numbers of nestin immunoreactive structures were observed in the oral mucosa. CD34 antibodies labeled all microvessels in lamina propria of the CLP affected tissue, while low numbers of TGFβ3 positive cells were scattered in the connective tissue. There were no statistically significant differences between the study groups.Expression of nestin in complete unilateral and bilateral cleft lip and palate affected soft tissue indicates a potential increase of tissue regeneration. CD34 positive oral mucosa cells suggest increased angiogenesis, while the sporadic expression of TGFβ3 indicates an insignificant role in the maintenance and growth of cleft affected oral mucosa stem or progenitor cells. Nevertheless, scarce expression of TGFβ3 suggests a role in cleft morphopathogenesis.

Alcohol-induced damage causes dysfunction of selected brain regions. Multidisciplinary studies have provided an extensive description of changes observed in neurons and glia following alcohol consumption. In this study the authors have elucidated preferential cellular vulnerability in three different brain regions. Autopsy material of the prefrontal cortex, striatum, and substantia nigra obtained from the brain tissue of alcoholic subjects was used in this study. We found that dendritic tree and astroglial damage is irreversible, while neuronal somata and most axons do not display irreversible changes.

Aim of our study was complex detection of appearance and distribution of specific signalling proteins and apoptosis in facial tissue of children with complete bilateral cleft lip and palate (CBCLP). MATERIALS AND METHODS. Nineteen CBCLP patients and 11 unaffected subjects were involved in this study. All the tissue samples were proceeded for detection of matrix metalloproteinase-2 (MMP-2), tissue inhibitor of matrix metalloproteinase-2 (TIMP-2), and apoptosis. The intensity of immunostaining was graded semi-quantitatively. Results of the terminal deoxynucleotidyl transferase mediated dUTP nick-end labeling (TUNEL) method were obtained by counting apoptosis positive cells in five unintentionally chosen fields of vision. Groups were compared using the Mann-Whitney test. RESULTS. TUNEL-positive oral epithelial cells were significantly increased in the control group when compared with the CBCLP group. Connective tissue cells have a statistically significant lower expression of TIMP-2 in the control group compared to the CBCLP group. CONCLUSIONS. TIMP-2 positive connective tissue cells increasingly found in oral mucosa lamina propria proves the decrease of local apoptosis in CLP patients. Prominent expression of MMP-2 in cleft affected soft tissue indicates a possible increase of tissue remodelling.

OBJECTIVE. Mixed salivary gland tumors are characterized by a marked diversity in the cell proliferation. It course in the stromal component, and, especially in recurrent neoplasms, is not completely understood. This study evaluated cell proliferative potential, its value and the clinical course of primary and recurrent salivary gland pleomorphic adenomas (PA). MATERIALS AND METHODS. 322 benign salivary gland tumors were used in this study. The cell proliferation was estimated by Ki-67 expression levels. RESULTS. Ki-67 immunoreactivity showed a wide range of spectra; in the epithelial and stromal type of PA the cell proliferation had the value from 0.07±0.03 (95% CI 0.01-0.14) to 4.81±0.60 (95% CI 3.61-6.02) and from 0 to 0.79±0.11 (95% CI 0.57-1.00), respectively. The Ki-67 value was higher in recurrent tumors compared with primary, and the mean number of Ki-67-positive cells per visual microscopic field constituted 2.14±1.60 (95% CI 1.47-2.47) comparing with 1.43 (95% CI 0.97-1.55) revealed in primary tumors. CONCLUSION. Cell proliferation values correlate with a recurrence of neoplasm, and elevation of proliferation potential in the stromal component of recurrent PA is indicative of clinical course change for the worse.