Search Results (161)

Background: Community-acquired pneumonia (CAP) is the leading cause of mortality in children from middle- to low-income countries; diagnosing CAP includes clinical evaluation, laboratory testing and pulmonary imaging. Lung ultrasound (LUS) is a sensitive, accessible, non-invasive, non-radiant method for accurately evaluating the lung involvement in acute diseases. Whether LUS findings can be correlated with CAP’s severity or sepsis risk remains debatable. This study aimed to increase the importance of LUS in diagnosing and monitoring CAP. We analyzed 102 children aged 1 month up to 18 years, hospital admitted with CAP. Mean age was 5.71 ± 4.85 years. Underweight was encountered in 44.11% of children, especially below 5 years, while overweight was encountered in 11.36% of older children and adolescents. Patients with CAP presented with fever (79.41%), cough (97.05%), tachypnea (18.62%), respiratory failure symptoms (20.58%), chest pain (12.74%) or poor feeding. Despite the fact that 21.56% had clinically occult CAP and six patients (5.88%) experienced radiologically occult pneumonia, CAP diagnosis was established based on anomalies detected using LUS. Conclusions: Detailed clinical examination with abnormal/modified breath sounds and/or tachypnea is suggestive of acute pneumonia. LUS is a sensitive diagnostic tool. A future perspective of including LUS in the diagnosis algorithm of CAP should be taken into consideration. Full article

Background/Objectives: Tongue thrust (TT) occurs when abnormal tongue movements cause anterior tongue placement with pressure and contact against or between the teeth, potentially affecting the oral phase of swallowing, impacting eating, breathing and speaking. There is limited literature on the diagnostic and treatment approaches for TT, as well as involvement of health practitioners in its management. This study aims to examine the current knowledge and practices related to TT diagnosis and treatment among health professionals in Australia. Methods: A two-phase explanatory sequential mixed methods approach was adopted, comprising an online survey that collected participants’ demographic information and details on assessment, diagnosis, management, referral practices, and relevant experience and training. Phase one involved 47 health professionals from various disciplines in Australia who completed an online survey in its entirety. Phase two included in-depth interviews with seven speech-language pathologists (SLPs) to gain further insights into their experiences in managing TT. Survey data were analysed descriptively, and interview data was analysed thematically. Results: Most participants diagnosed TT using clinical assessments, such as general observation and oral motor examinations. Treatment approaches commonly included orofacial myofunctional therapy and the use of myofunctional devices. Interviews with SLPs identified four key themes: tongue thrust as a symptom rather than a diagnosis, facilitators to effective treatment, multidisciplinary approaches to management, and training and education gaps in clinical practice. Conclusions: This study provides valuable insights into how TT is identified, assessed, diagnosed, and managed by health professionals in Australia. It highlights the perspectives of SLPs on treatment approaches, as well as their views on the availability and adequacy of training and education in this field. The findings suggest the need for a broader understanding of TT management, emphasising the importance of multidisciplinary collaboration and professional development. These insights are globally relevant, as they stress the shared challenges and the value of international collaboration in improving TT diagnosis and treatment practices. Full article

Rett syndrome (RTT) is an X-linked neurodevelopmental disorder marked by neurological regression, autonomic dysfunction, seizures, and significant sleep and breathing abnormalities. About 80% of affected individuals, especially young children, experience sleep disturbances such as insomnia, sleep-disordered breathing, nocturnal vocalizations, bruxism, and seizures. Breathing irregularities during sleep—like apnea, alternating hyperventilation, and hypoventilation—are common, with both obstructive and central sleep apnea identified through polysomnography. This review focuses on the prevalent sleep disorders in children with Rett syndrome and highlights current recommendations for the management of sleep disorders. Full article

The accurate and early detection of respiratory diseases is vital for effective diagnosis and treatment. This study presents a new approach for classifying lung sounds using a double denoising method combined with a 1D Convolutional Neural Network (CNN). The preprocessing uses Fast Fourier Transform to clean up sounds and High-Pass Filtering to improve the quality of breathing sounds by eliminating noise and low-frequency interruptions. The Short-Time Fourier Transform (STFT) extracts features that capture localised frequency variations, crucial for distinguishing normal and abnormal respiratory sounds. These features are input into the 1D CNN, which classifies diseases such as bronchiectasis, pneumonia, asthma, COPD, healthy, and URTI. The dual denoising method enhances signal clarity and classification performance. The model achieved 96% validation accuracy, highlighting its reliability in detecting respiratory conditions. The results emphasise the effectiveness of combining signal augmentation with deep learning for automated respiratory sound analysis, with future research focusing on dataset expansion and model refinement for clinical use. Full article

Poor sleep quality and excessive daytime sleepiness are commonly reported by individuals with cystic fibrosis. The potential impact of comorbid sleep-disordered breathing (SDB), particularly obstructive sleep apnea (OSA), has not been extensively studied in the CF population. At present, there are no specific recommendations available to help clinicians identify patients with CF who are at increased risk of sleep disorders. Home sleep apnea testing using a validated peripheral arterial tonometry (PAT) device may offer an accurate diagnosis of OSA in a more convenient and low-cost method than in-lab polysomnography. In this single-center study of 19 adults with CF, we found an increased prevalence of OSA among individuals with CF compared to general population estimates. Although associations with an FEV < 70% predicted and a modified Mallampati score ≥ 3 were observed, these odds ratios did not reach statistical significance, likely reflecting limited power in this small pilot sample. There was no association found between the self-reported presence of nocturnal cough or snoring and OSA. We also found no association between OSA and abnormal scores on commonly used, validated sleep questionnaires, suggesting that CF-specific scales may be needed for effective screening in the CF clinic. Full article

Aim: The aim of this study was to evaluate the specificity, sensitivity and accuracy of the Indicator Plaster Neuropad in detecting established Diabetic Autonomic Neuropathy (DAN). Methods: We studied 180 patients with Diabetes Mellitus (DM, mean age 49.5 ± 16 years, 82 with DM type 1). All patients underwent the following Cardiovascular Reflex Tests (CARTs): R-R variation during deep breathing (Mean Circular Resultant (MCR) and standard deviation (SD)), Valsalva maneuver, R-R variability after a rapid change from lying to standing position and postural hypotension. The presence of DAN was established if ≥2 CARTs were abnormal. According to the result the patients were divided into two groups, one with DAN and one without DAN. Assessment with Neuropad was performed also in all patients. Results: Abnormal perspiration with Neuropad (uncompleted or no change in color) was detected in 94 patients. Established DAN was detected in 85 patients. The sensitivity, specificity and accuracy of Neuropad for the diagnosis of established DAN were 87.1%, 78.9% and 82.8%, respectively and area under the curve was 0.846 and 95% CI (0.787, 0.905). Conclusions: Neuropad has high sensitivity, specificity, and accuracy in detecting established DAN, as defined by ≥2 abnormal CARTs. Full article

Ankyloglossia causes impairment of normal tongue motility and disrupts the average balance of the muscle forces that form the orofacial complex. Inadequate swallowing from birth can cause long-term anatomical and functional consequences in adult life. Using the video presented herein, we describe the current knowledge about the long-term implications of ankyloglossia. After a literature review of the Medline, Google Scholar, and Embase databases on the relations between ankyloglossia and sleep-disordered breathing, we designed and created a three-dimensional (3D) video using Adobe After Effects based on the anatomical and functional changes produced by repeated deglutition, with and without ankyloglossia, from childhood to adulthood. The animated video (Blender 3D, Amsterdam, The Netherlands, 2024) presented herein was based on the most recent literature review of dentition, breathing, posture, and abnormal swallowing, emphasizing the importance of the potential consequences of sleep-disordered breathing. The resulting animated 3D video includes dynamic sequences of a growing child, demonstrating the anatomy and physiology of deglutition with and without ankyloglossia, and its potential consequences for the surrounding structures during growth due to untreated ankyloglossia. This visual instructional video regarding the impacts of ankyloglossia on deglutition/swallowing may help motivate early childhood diagnosis and treatment of ankyloglossia. This instrument addresses the main myofunctional aspects of normal deglutition based on the importance of free tongue motion and can be used by students or professionals training in myofunctional disorders. Full article

Background/Objectives: The main goal of this study was to determine whether ductal constriction in the third trimester of a pregnancy during fetal echocardiography examination has an impact on the neonatal clinical condition during the first days after birth. Methods: A retrospective study was based on 348 newborns who were examined during their fetal life in the third trimester of a pregnancy in our fetal cardiology center. They were divided into two groups: the study group (n = 49): neonates with “normal heart anatomy” (NHA), assessed by fetal echocardiography (ECHO) examination and prenatally diagnosed ductal constriction (NHA-DC); and the control group (n = 299): NHA neonates without DC (NHA-NDC). Results: Prenatally, DC was associated with other functional abnormalities, such as myocardial hypertrophy, cardiomegaly, tricuspid regurgitation, pericardial effusion and abnormal flow through foramen ovale. Neonates with prenatally diagnosed DC in 43% of cases presented with elevated neonatal bilirubin levels requiring phototherapy treatment (p < 0.006). In the study group 27% of neonates showed signs of breathing difficulties in the first hours of life (p < 0.001). Neonates with a prenatal diagnosis of DC were hospitalized longer than neonates with a normal heart study (NHS) (p < 0.001). Conclusions: Neonates with a prenatal diagnosis of ductal constriction are prone to having transient respiratory problems (up to 27%) and mild neonatal hyperbilirubinemia (in presented series up to 43%). Gestational diabetes can be associated with ductal constriction. Full article

Purpose: Post-COVID-19 syndrome (PCS) is characterized by low cardio-respiratory fitness (CRF). Recent research focuses on the role of autonomic nervous system dysfunction (AD) as a potential contributor to the diminished exercise performance. The aim is to determine the prevalence of AD—chronotropic insufficiency (CI) and abnormal heart rate recovery (HRR) in long-term PCS subjects and to analyse their association with exercise capacity. Patients and Methods: A total of 192 subjects with a history of SARS-CoV-2 infection were included. Chronic Fatigue Syndrome Questionnaire (CFSQ) was applied, and two symptomatic and asymptomatic emerged. Forty-seven had post-COVID complaints, persisting up to thirty months post-acute episode. CI and HRR were determined during the cardio-pulmonary exercise test (CPET). Results: Symptomatic subjects were divided into mild (20) and moderate-severe (27), depending on the CFSQ score; forty-eight PCS subjects without complaints served as a control group. Subjects with moderate-severe PCS showed lower peak VO2 (24.13 ± 6.1 mL/min/kg vs. 26.73 ± 5.9 mL/min/kg, vs. 27.01 ± 6.3 mL/min/kg), as compared to the mild/asymptomatic subjects. Diminished physical activity was established in 10 (37%) of the moderate-severe, 7 (35%) of the mildly symptomatic and 14 (29%) of the asymptomatic groups. The occurrence of AD in the mild/moderate-severe and control groups were, respectively, CI 35% vs. 81.5% vs. 12.5%. Abnormal HRR was, respectively, 20% vs. 33% vs. 8%. None of the subjects had depleted breathing reserve, dynamic hyperinflation, exercise bronchospasm or desaturation. Neither CI nor abnormal HRR correlated to peak O2. Conclusions: AD is present among long-term PCS subjects and may limit the cardio-respiratory response to exercise but is not independently associated with it. Assuming the multiorgan ANS innervation, it is highly probable that AD has diverse pathological pathways in the various PCS phenotypes and contributes differently by cerebral, cardiovascular, respiratory, peripheral or mixed pathways to the diminished neuro-cognitive and physical performance. Full article

Objective: Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder in children, characterized by inattention, hyperactivity, and impulsive behavior. In recent years, studies have shown that patients with ADHD often experience sleep problems, raising clinical interest in the potential role of polysomnography (PSG) in the diagnosis and management of ADHD. This study examines polysomnographic findings in children with ADHD who present with diverse sleep complaints. Methods: A cohort of children aged younger than 18 years, diagnosed with ADHD based on DSM-5 criteria, underwent overnight polysomnography. The study assessed various sleep parameters, including sleep latency, sleep efficiency, total sleep time, and the presence of sleep-disordered breathing. Results: A retrospective analysis was conducted on 36 children (29 boys and 7 girls) aged 6 to 14 years, diagnosed with ADHD, who underwent polysomnography between 2021 and 2024. Polysomnographic findings revealed that 77.78% of the children demonstrated significant snoring. Furthermore, 50.0% were diagnosed with obstructive sleep apnea syndrome (OSAS). In addition, eight children exhibited parasomnias. Among them, six had bruxism, three were diagnosed with periodic limb movement disorder (PLMD), and two experienced sleep talking. Other notable sleep-related conditions included two cases of narcolepsy, one case of prolonged sleep onset latency, and one case of central apnea syndrome. Total sleep time (TST) was significantly longer in females compared to males (400.71 ± 32.68 min vs. 361.24 ± 41.20 min, p = 0.0215), whereas rapid eye movement (REM) latency was longer in males compared to females (118.62 ± 55.60 min vs. 78.57 ± 27.82 min, p = 0.0194). These findings highlight the high prevalence of sleep-disordered breathing (SDB) in children with ADHD who present with sleep disturbances. Furthermore, sleep quality, as indicated by longer TST and shorter REM latency, appears to be better in females with ADHD. Conclusions: The findings of this study underscore the critical role of polysomnography (PSG) in the assessment of children with ADHD. PSG provides an objective evaluation of sleep abnormalities commonly associated with ADHD, which may influence symptom manifestation and treatment outcomes. Notably, the results suggest that females with ADHD exhibit better sleep quality, as indicated by longer total sleep time (TST) and shorter rapid eye movement (REM) latency compared to males. We recommend incorporating polysomnography (PSG) into the comprehensive assessment of children with ADHD who present with significant sleep disturbances. Further research is warranted to investigate the impact of targeted interventions for sleep abnormalities on ADHD symptoms, prognosis, and potential sex-specific differences. Full article

Background: Heart rate variability (HRV) provides both linear and nonlinear autonomic proxies that can be informative of health status in fibromyalgia (FM), where sympatho-vagal abnormalities are common. This retrospective observational study aims to: 1. detect differences in correlation dimension (D2) between FM patients and healthy controls (HCs); 2. correlate D2 with standard HRV parameters; 3. correlate the degree of HRV changes using a global composite parameter called HRV grade, derived from three linear indices (SDNN = intervals between normal sinus beats; RMSSD = mean square of successive differences; total power), with FM clinical outcomes; 4. correlate all linear and nonlinear HRV parameters with clinical variables in patients. Methods: N = 85 patients were considered for the analysis and compared to 35 healthy subjects. According to standard diagnostic protocol, they underwent a systematic HRV protocol with a 5-min paced breathing task. Disease duration, pain intensity, mood, sleep, fatigue, and quality of life were assessed. Non-parametric tests for independent samples and pairwise correlations were performed using JMP (all p < 0.001). Results: Mann-Whitney U found a significant difference in D2 values between FM patients and HCs (p < 0.001). In patients, D2 was associated with all HRV standard indices (all p < 0.001) and FM impairment (FIQ = −0.4567; p < 0.001). HRV grade was also associated with FM impairment (FIQ = 0.5058; p < 0.001). Conclusion: Combining different HRV measurements may help understand the correlates of autonomic dysregulation in FM. Specifically, clinical protocols could benefit from the inclusion and validation of D2 and HRV parameters to target FM severity and related dysautonomia. Full article

Background/Objectives: Small Intestinal Bacterial Overgrowth (SIBO) and Small Intestinal Fungal Overgrowth (SIFO) are distinct yet often overlapping conditions characterized by an abnormal increase in microbial populations within the small intestine. SIBO results from an overgrowth of colonic bacteria, while SIFO is driven by fungal overgrowth, primarily involving Candida species. Both conditions present with nonspecific gastrointestinal (GI) symptoms such as bloating, abdominal pain, diarrhea, and malabsorption, making differentiation between SIBO and SIFO challenging. This review aims to elucidate the underlying mechanisms, risk factors, diagnostic challenges, and management strategies associated with SIBO and SIFO. Methods: A comprehensive review of current literature was conducted, focusing on the pathophysiology, diagnostic modalities, and therapeutic approaches for SIBO and SIFO. Results: SIBO is commonly associated with factors such as reduced gastric acid secretion, impaired gut motility, and structural abnormalities like bowel obstruction and diverticula. It is frequently diagnosed using jejunal aspirates (≥10⁵ colony forming units (CFUs)/mL) or breath tests. In contrast, SIFO is linked to prolonged antibiotic use, immunosuppression, and gut microbiome dysbiosis, with diagnosis relying on fungal cultures from small intestinal aspirates due to the absence of standardized protocols. Conclusion: The clinical overlap and frequent misdiagnosis of SIBO and SIFO highlight the need for improved diagnostic tools and a multidisciplinary approach to management. This review emphasizes the importance of understanding the mechanisms behind SIBO and SIFO, how they relate to other health outcomes, and potential management strategies to optimize patient care and therapeutic outcomes. Full article

Background: Newborns, including preterm infants, are capable of responding to pain. Recurrent pain exposure is associated with suboptimal motor development, cognitive impairments, abnormal brain growth, and maladapted nociceptive reactions. Problem: Current agents, primarily opioids and benzodiazepines, raise major concerns due to their adverse effects, including insufficient sedation or analgesia, withdrawal, depressed respiratory effort, tolerance, and occasional paradoxical agitation. Commonly used drugs such as midazolam and morphine have been shown to induce neuroapoptosis and neurodevelopmental abnormalities in animal studies. Evaluation—Dexmedetomidine: As a specific alpha-2 adrenergic agonist, dexmedetomidine causes a significantly lower reduction in breathing effort. It has over 800 times greater affinity for alpha-2 receptors compared to alpha-1 receptors. Common side effects include bradycardia and hypotension. Prolonged use may necessitate a transition to clonidine during the weaning process. Dexmedetomidine can be administered intravenously as a bolus or infusion or intranasally. Indications include sedation and analgesia for mechanical ventilation, therapeutic hypothermia, procedural premedication, and as an adjunct to inhalational anesthesia and nerve-blocking agents. Research across varying age groups has demonstrated that dexmedetomidine shortens periods of invasive ventilation and decreases the need for other sedatives. Neonatal studies suggest that dexmedetomidine may help accelerate the achievement of full enteral feeds and can be safely administered within specific dosage ranges without causing significant adverse events that would necessitate abrupt discontinuation. Conclusions: Dexmedetomidine can be used alone or in combination with other agents. By increasing the use of dexmedetomidine, it is possible to reduce the dosage of concurrent medications, thereby minimizing the risk of complications while still achieving the desired sedation and analgesia. Full article

In recent years, several studies have examined the impact of sleep-disordered breathing (SBD) on the quality of life and prognosis of patients with idiopathic pulmonary fibrosis (IPF). Among these disorders, obstructive sleep apnea (OSA) and nocturnal hypoxemia (NH) are the most prevalent and extensively studied, whereas central sleep apnea (CSA) has only been documented in recent research. The mechanisms underlying the relationship between IPF and SBDs are complex and remain an area of active investigation. Despite growing recognition of SBDs in IPF, no standardized guidelines exist for their management and treatment, particularly in a population characterized by distinct structural pulmonary abnormalities. This review outlines the pathophysiological connections between sleep-breathing disorders (SBDs) and idiopathic pulmonary fibrosis (IPF), as well as current therapeutic options. A comprehensive literature search using PubMed identified relevant studies, confirming the efficacy of CPAP in treating severe OSA and CSA. While high-flow oxygen therapy has not been validated in this patient cohort, it may offer a potential solution for select patients, particularly the elderly and those with low compliance. Conventional oxygen therapy, however, is limited to cases of isolated nocturnal hypoxemia or mild central sleep apnea. Full article

A 2-year-3-month-old neutered male domestic shorthair cat was presented for cardiological evaluation at the University of Agricultural Sciences and Veterinary Medicine in Cluj-Napoca, Romania, with a history of dyspnea, open-mouth breathing, cyanosis, and exercise intolerance. Physical examination identified a grade 4/6 systolic murmur, cyanosis, and mild dyspnea, with no abdominal abnormalities. Echocardiography revealed right ventricular hypertrophy, severe right atrial dilation, a thickened tricuspid valve, and a large nonrestrictive ventricular septal defect with a left-to-right shunt, consistent with persistent truncus arteriosus (PTA), confirmed postmortem. During necropsy, in addition to the clinically confirmed diagnoses, bilateral myxomatous degeneration of the A-V valves, and associated anomalies such as an atrial diverticulum and splenopancreatic fusion were observed and confirmed histologically. This case emphasizes the clinical and morphological complexity of congenital heart defects in felines, highlighting the importance of advanced diagnostic and histopathological techniques for accurate diagnosis and characterization. Full article