Dekerytė-Banienė, Inga

Surgical services were poorly prepared for the COVID-19 pandemic, leading to widescale disruption to elective activity. This study aimed to identify actionable priorities to strengthen pandemic preparedness of surgical and hospital systems.

Aim of the study. To assess the experience and challenges associated with diagnosing peritoneal tuberculosis in children. Methods. A literature review was conducted using the PubMed, Web of Science and Cochrane databases, including reported cases of paediatric peritoneal tuberculosis published between 2007 and 2022. Results. The search identified 219 potentially relevant articles; 12 met the inclusion criteria, comprising 37 patients. The most common symptoms were abdominal pain (67.6%), abdominal distension (67.6%) and fever (64.9%). The most frequent ultrasound findings were free fluid in the pelvic cavity (86.5%) and enlarged mesenteric lymph nodes (56.8%). Most culture samples for Mycobacterium tuberculosis were negative. Surgical intervention was performed in 32 cases (86.5%). Histological examination revealed granulomas in all evaluated biopsy samples. Conclusions. The clinical presentation, laboratory findings, and radiological findings of peritoneal tuberculosis are non-specific. This literature review indicates that peritoneal tuberculosis is most often diagnosed following surgery. An algorithm of less invasive procedures and tests is suggested before considering surgical intervention.

Introduction: Over recent decades, the study of the bacterial microbiome has gained increasing attention due to its vital role in human health. The development of the gut microbiome is especially critical during infancy, as it supports nutrient absorption, metabolic regulation, and immune system maturation. Several perinatal factors, including delivery mode, gestational age, and health status, have been shown to influence micro -biome establishment. Preterm and low-birth-weight infants, in particular, face heightened vulnerability to disruptions in microbiome development, which may contribute to adverse health outcomes. Aims & Methods: This study aimed to analyze the longitudinal development of the gut microbiome in preterm, low-birth-weight neonates over the first two months of life and to identify microbial patterns and alterations associated with delivery mode, gestational age, and clinical conditions. The study cohort included 115 low-birth-weight preterm infants and 99full-term, normal-weight controls. Stool samples from preterm infants were collected at multiple time points between day 1 and day 61 of life and grouped into six age categories for analysis. In total, 819 stool samples were examined. DNA was extracted and amplified targeting the V3–V4 region of the 16S rRNA gene, followed by sequencing on the Illumina MiSeq platform. Microbiome data were analyzed using bioinformatic and statistical tools to assess taxonomic composition, alpha diversity, and beta diversity. Results: Significant differences in microbiome profiles were associated with gestational age, mode of delivery, postnatal age, maternal medication, and the presence of necrotizing enterocolitis (NEC). Bacterial com-munities began to stabilize between days 26 and 35. A total of 56 bacterial genera — including Bifidobacterium, Clostridium, Escherichia-Shigella, Gemella, Klebsiella, Lactobacillus, and Streptococcus — showed a positive correlation with infants’ age in days, while 31 genera — including Bacillus, Cutibacterium, Flavobacterium, Macrococcus, Pseudomonas, and Staphylococcus — were negatively correlated. Eighteen bacterial genera were associated with the mode of delivery at various time points. Genera such as Fusobacterium, Bacteroides, Entero-coccus, Streptococcus, Gemella, and Corynebacterium were more commonly associated with vaginal birth, while Staphylococcus, Rahnella, Yokenella, Millisia, Negativicoccus, Finegoldia, Haemophilus, Acinetobacter, Conservatibacter, Serratia, Stenotrophomonas, and Peptoniphilus were associated with Caesarean section delivery. Moderate differences in early-life microbiome composition were also ob -served between low-birth-weight preterm and full-term infants. Conclusion: Gut microbiome development in preterm, low-birth-weight newborns is strongly influenced by clinical and perinatal factors, particularly during the first month of life. Mode of delivery, gestational maturity, and disease presence such as NEC contribute to microbial variability and delayed community stabilization. These findings highlight the importance of early-life monitoring and tailored interventions to support healthy microbiome development in vulnerable neonates.

Įžanga Įgimtos inkstų ir šlapimo takų anomalijos (ĮIŠTA) – ligų grupė, atsirandanti dėl ydingo šių organų formavimosi [1]. Dažniausia iš šių anomalijų – hidronefrozė, kurios pagrindinė priežastis – pieloureterinės jungties obstrukcija dėl jungties susiaurėjimo arba papildomos inksto kraujagyslės [2]. Tai retos ir įvairialypės patologijos, kurios ilgalaikėje perspektyvoje gali lemti lėtinės inkstų ligos išsivystymą. Būtent dėl to, svarbiausias šių ligų gydymo tikslas – išsaugoti geriausią įmanomą inkstų funkciją [1]. Dabartiniai diagnostiniai metodai vaikų populiacijoje kelia iššūkius (sunkiai prieinami, gali būti atliekami bendrinėje nejautroje), o kartais yra ir nepakankamai jautrūs ar specifiški. Nesant aiškių diagnostikos algoritmų, sunku parinkti tinkamiausius tyrimus konkretiems pacientams. Taip pat nėra tikslių chirurginio gydymo indikacijų: sprendimas dėl intervencijos priimamas įvertinus inkstų obstrukcijos laipsnį ir prognozuojant, inkstų nepakankamumo progresavimą ateityje [3]. Dėl šių priežasčių vyksta naujų diagnostikos ir prognostikos priemonių paieška – biologinių žymenų analizė. MCP-1 yra C-C superšeimai priklausantis citokinas, atsakingas už uždegiminius procesus, pritraukiant ir aktyvinant uždegimines ląsteles, taip skatinant fibrozės vystymąsi. Šio tyrimo tikslas įvertinti MCP-1 žymens diagnostinę reikšmę vaikams, sergantiems įgimtomis inkstų ir šlapimo takų anomalijomis [4]. Metodika Atliktas prospektyvinis atvejo – kontrolės tyrimas, į kurį įtraukti pacientai, gydyti LSMUL KK Vaikų chirurgijos skyriuje 2021–2025 m. Pacientai suskirstyti į 2 grupes: tiriamųjų ir kontrolinę. Tiriamųjų grupei priskirti pacientai vaikai, kuriems buvo diagnozuota hidronefrozė ir taikytas chirurginis gydymas. Kontrolinei grupei – sveiki pacientai. Tyrimo metu buvo renkami demografiniai ir klinikiniai duomenys, kraujo mėginiai. Laboratorijoje mėginiai buvo centrifuguojami 1,800 × g 10 min, serumas iki tyrimo buvo saugomas –80 °C. Vasaros praktikos projekto metu buvo atliktas kiekybinis imunologinis tyrimas PGR metodu. MCP-1 kiekis buvo įvertintas ProQuantum™ Human MCP-1 imunoanalizės rinkiniu pagal nurodytus protokolus (kalibravimo kreivė: 0.064–1,000 pg/mL). Serumo mėginiai buvo atskiesti santykiu 1:10. Panaudojant QuantStudio™ 5 System termociklerį buvo atliktas ELISA tyrimas. Gauti duomenys apdoroti naudojant ProQuantum™ analizės sistemą – taikant keturių parametrų logistinės regresijos (angl. four-parameter logistic, 4-PL) metodą kartu su pusiau logaritmine skale. Rezultatai Į tyrimą įtraukti 64 pacientai: 34 tiriamieji ir 30 kontrolinės grupės. Tiriamojoje grupėje buvo 18 (52,9 %) berniukų ir 16 (47,1 %) mergaičių, o kontrolinėje 20 (66,7 %) berniukų ir 10 (33,3 %) mergaičių. Į tyrimą įtrauktų pacientų amžiaus mediana buvo 49,5 (0 – 209) mėn.: tiriamojoje grupėje – 63,5 (0–209) mėn., o kontrolinėje 46,0 (5–201) mėn. Didžiajai daliai tiriamųjų operacijos metu diagnozuota II-III laipsnio hidronefrozė, pagal ONEN klasifikaciją: 8 (23,5%) II laipsnio ir 18 (52,9%) – III laipsnio. GFG mediana pagal Schwartz tiriamųjų grupėje buvo 108 (71–214). AP matmens mediana prieš operaciją – 24,5 (11–89) mm. Tik 9 (26,5%) tiriamieji buvo persirgę šlapimo organų infekcijomis iki operacijos. Remiantis tyrimo duomenimis galima teigti, kad tiriamosios grupės MCP-1 koncentracijos (198,8 pg/ml (22,0–491,1 pg/ml)) yra reikšmingai mažesnės nei kontrolinės grupės (271,6 pg/ml (101,4–1138,8 pg/ml)), (Z = –2,126, p = 0,034). (1 lent.) Tyrimo metu nustatyta, kad MCP-1 koncentracijos serume yra reikšmingai mažesnės pacientų, sergančių įgimtomis inkstų ir šlapimo takų anomalijomis. MCP-1 gali būti vertinamas kaip potencialus biologinis žymuo įgimtoms inkstų ligų patologijoms, vaikų populiacijoje, tačiau tikslesnei diagnostinei ir prognostinei reikšmei įvertinti reikalingi didesnės imties tyrimai. Tyrimo ribotumas Gauti rezultatai patvirtina MCP-1 biologinę reikšmę ir sąsają su uždegiminiais procesais inkstuose. Nustatytas vidutinio stiprumo efektas rodo, kad MCP-1 galėtų būti laikomas potencialiu biomarkeriu, tačiau jo diagnostinė vertė šiuo metu yra ribota. Maža imtis ir klinikinės tiriamųjų charakteristikos galėjo turėti įtakos rezultatams. Norint patikimai įvertinti MCP-1 diagnostines ir prognostines galimybes reikalingi tolimesni tyrimai.

Over the past decades, bacterial microbiome studies have become increasingly important. The development of the gut microbiome has been shown to play an essential role in human health, and to be especially decisive in infants [1]. It influences nutrient absorption, metabolism regulation, and immune system development. Various factors have been proposed to modulate the development of the microbiome and therefore shape the growth and health of newborns [2]. Premature babies are often lowweight and even more sensitive to health issues. This study aims to analyse the development of the microbiome in preterm neonates over the first two months of life and look for patterns and alterations associated with several factors, like delivery mode, gestation time and necrotizing enterocolitis (NEC). A total of 78 preterm newborns were included in the study, with stool samples being taken at several timepoints from each baby. In total 515 samples were collected. The timepoints varied between ages of one and 61 days and were grouped in six age groups during the analysis. Genomic DNA was extracted from stool samples, and the bacterial V3–V4 hypervariable region of the 16S rRNA gene was amplified and sequenced on the Illumina MiSeq platform. The data were processed using bioinformatical tools and analysed bioinformatically and statistically to access microbiome composition, abundancies, alpha- and beta-diversities. The analysis revealed significant differences in the bacterial profiles across different timepoints, gestational ages, delivery modes, and in relation to the development of NEC. Alpha diversity indices increased over time; however, fewer or no significant differences were observed between the later timepoints. Consistent patterns emerged from both PCoA and PERMANOVA analyses. Notably, NEC was associated with distinct bacterial. Additionally, the abundance of several bacterial taxa correlated with gestational age. The bacterial profile of premature, low-birth-weight newborns varies according to factors such as age, delivery mode, gestational age, and the presence of disease. Comparing these microbiome dynamics in low-birth-weight infants with those in full-term newborns could provide valuable insights into the development of neonatal diseases such as necrotizing enterocolitis.

Introduction: Obstructive urinary tract dilatation (OUTD) is a prevalent condition in paediatric urology that often necessitates surgical intervention. Understanding factors contributing to reoperations is critical for optimizing outcomes. This study aimed to analyze factors associated with reoperations in OUTD. Methods: A prospective cohort study was conducted from 2019 to 2023, including 81 paediatric patients who underwent surgery for OUTD. Patients were categorized into reoperated and non-reoperated groups. Data on diagnostic characteristics, surgical management, and outcomes were collected. The study was approved by the Research Ethics Committee (No. BE-2-34). Statistical analyses was made SPSS, significance level of p<0.05. Main results: The cohort of 81 patients consisted of 51 (63%) patients with ureteropelvic junction obstruction, 20 (24.7%) with ureterovesical junction obstruction, and 10 (12.3%) with aberrant vessel-related obstruction. Over a median follow-up of 16 months (range: 2–72), 17 patients (21%) required reoperations, with a median time to reoperation of 5 months (range: 1–48). Early post-operative complications (56.3% vs. 15.5%, p<0.001) and early UTI during first 3 month after primary operation (52.9% vs. 15.5%, p=0.001) were significantly associated with higher reoperation rates. UTIs occurring later than 3 months postoperatively were not correlated with higher reoperation rates (p>0.05). Conclusion: Reoperation rates in paediatric OUTD highlight the critical role of early postoperative management. Early post-operative complications and UTIs within 3 months after primary surgery are strong predictors of reoperation, emphasizing the need for targeted interventions to reduce these risks. Close follow-up during the first 6 months post-surgery is recommended to improve outcomes.

Aim of the Study To evaluate how the age at which gastrostomy tube (GS) insertion occurs affects caregivers ‘perspectives on its benefits, particularly regarding their emotional well-being and their child’s quality of life. Methods A cross-sectional analysis was conducted using caregiver-completed questionnaires and retrospective medical records. Participants included caregivers of children with GS. Patients were grouped by age at GS placement: <1 year, 1–6 years, and >6 years. The caregiver questionnaire assessed emotional wellbeing, quality of life (QL), perceived GS benefits. Medical records provided clinical data. Ethical approval No. BEC-MF-75 was obtained. Main Results The study included 101 cases. Parental emotional well-being improved significantly when the GS was placed between 1–6 years (26, 83.9%, p=0.007). According to parental reports, weight gain positively impacted child’s QL if GS was placed before 1 year (24, 82.8%, p=0.033) or between 1–6 years (17, 100%, p=0.042). However, for children >6 years, weight gain did not significantly influence emotional well-being or QL (p>0.05). Additional factors, including GS placement indications, tracheostomy presence, and psychologist availability, showed no significant effects on parental emotional well-being or QL (p>0.05). Conclusions Parental emotional well-being improves when GS placement occurs before a child turns 6 years old. Weight gain is perceived as enhancing child QL only when GS placement happens within this timeframe. These findings suggest that caregivers of older children undergoing GS placement may require additional support to achieve comparable improvements in emotional well-being and QL.

Introduction: Congenital anomalies of the kidneys and urinary tract (CAKUT) are increasingly prevalent, underscoring the importance of integrating prenatal and postnatal ultrasound (US) assessments for early diagnosis. This study aimed to evaluate the correlation between prenatal US findings and postnatal US results in patients with CAKUT who subsequently underwent surgical treatment. Patients and Methods: This study included mothers monitored at our center during pregnancy and their children treated for CAKUT. Demographic, clinical, instrumental (prenatal and postnatal US), and surgical data were collected. Ethical approval was obtained (No. BE-2-34). Statistical analyses were made by SPSS, significance level of p<0.05. Results: The study included 46 infants with a median age at surgery of 5 (1-201) months. The final diagnosis in 26 (56.5%) patients was ureteropelvic junction obstruction, in 9 (19.6%) - ureterovesical junction obstruction, in 5 (10.9%) - ureteral stricture and in 6 (13%) - other diagnoses. In 42 (91%) cases, CAKUT were diagnosed in 3rd trimester. Median anteroposteric (AP) diameter in II pregnancy trimester was 6.7 (4-20) mm, while in III trimester – 20 (10-36). At the time of surgery, median AP was 19 (12-23) mm. The Spearman correlation coefficient between the assessed AP diameter in the third trimester of pregnancy and the preoperative measured AP diameter was 0.483 (CI 0.112-0.533). The median followup period was 21 (1-68) months. Conclusions: A significant correlation exists between third trimester fetal ultrasound and preoperative imaging in CAKUT patients. These findings highlight the need for close postnatal monitoring in patients with severe AP dilatation in the third trimester.

Introduction Acquired tracheoesophageal fistula (aTEF) resulting from button battery ingestion (BBI) present significant management challenges due to high morbidity and recurrence rates following surgery [1,2,3]. Early diagnosis and prompt intervention are crucial for optimal outcomes. This case report highlights the importance of proper management of both BBI and TEF to improve clinical outcomes and reduce long-term complications. Case Presentation An 11-month-old boy presented to the emergency department 1 hour after lithium battery ingestion. It was immediately removed by a flexible esophagoscope. A week later the patient presented with respiratory distress and dysphagia. A contrast x-ray suggested aTEF, which was confirmed by chest CT and endoscopy. The patient was taken to the operating room for nasogastric tube insertion and intubation to maintain esophageal and tracheal patency and prevent aspiration. Furthermore, a gastrostomy was formed to maintain enteral feeding. The patient was treated in pediatric intensive care for 9 days, under sedation and mechanical ventilation. The patient's condition continued to deteriorate, leading to thoracotomy and aTEF repair. A month later, due to concerns about the fistula reopening, it was confirmed by a bronchoscopy. A second tracheoplasty and esophagoplasty were performed, and the gastrostomy was removed 2 months later. A follow-up at 15 months, no issues regarding breathing or swallowing reported. Discussion BBI can lead to rapid, severe complications including aTEF [1]. While some cases of aTEF respond to conservative management [4,5,6], surgical repair remains definitive treatment [1]. Endoscopic stenting can serve as a temporary bridging technique [4,6]. The present case highlights the potential for failure of conservative approaches and emphasizes the need for prompt surgical intervention when necessary to avoid significant complications. Conclusions This case demonstrates the importance of prompt surgical intervention for aTEF resulting from BBI, particularly when conservative management fails. Early diagnosis and appropriate surgical intervention can significantly improve clinical outcomes and reduce long-term complications.

Background. Pulmonary complications are the most common cause of death after surgery. This study aimed to derive and externally validate a novel prognostic model that can be used before elective surgery to estimate the risk of postoperative pulmonary complications and to support resource allocation and prioritisation during pandemic recovery.