Search Results (54)

Background/Objectives: Dental anxiety represents a major challenge in paediatric dentistry and is a frequent cause of non-cooperative behaviour during dental treatment. Nitrous oxide/oxygen inhalation conscious sedation is widely used to reduce anxiety in children, while audiovisual distraction is a non-pharmacological behavioural technique aimed at diverting attention from stressful stimuli. Evidence regarding the combined effect of these two approaches during dental treatment is still limited. Methods: This randomized crossover clinical trial included 25 paediatric patients aged 4–7 years with dental anxiety and previous failed attempts at conventional dental treatment. Each child underwent two dental treatment sessions under nitrous oxide/oxygen conscious sedation, one with and one without audiovisual distraction. Anxiety and behaviour were assessed using the Modified Venham Scale and the Facial Image Scale (FIS). Vital parameters were recorded before, during, and after sedation. Results: A significant reduction in heart rate over time was observed in both groups (p < 0.05). In children aged 4–5 years, the combined audiovisual distraction and conscious sedation approach was associated with significantly lower heart rate values compared to conscious sedation alone (p < 0.05). No significant differences were found between the two approaches for behavioural scores assessed by the Venham and FIS scales. Conclusions: Although behavioural scores did not differ significantly, audiovisual distraction contributed to greater physiological stability, particularly in terms of heart rate control. This no-pharmacological approach may complement the pharmacological effects of nitrous oxide sedation by enhancing the overall sense of relaxation and comfort during dental care. Full article

Background. Atherosclerosis is a long-standing process that starts in childhood and leads to a number of major adverse cardiovascular events in adulthood. It is therefore crucial that children at potential risk of atherosclerosis-related harmful consequences are identified. Nevertheless, relatively few studies have focused on primary prevention in paediatric patients. Methods. Fifty-four children (mean age 9.0 ± 2.8 years) and 72 parents (mean age 44.0 ± 8.2 years) were recruited. Blood pressure (BP) was measured and lipid panel was checked, together with carotid intima–media thickness (IMT) and several indexes of carotid stiffness. Results. No statistically significant differences in IMT and indexes of carotid stiffness were detected between children and parents, with the exception of the alpha index (p < 0.05). In children, IMT was correlated with the alpha index (p = 0.01). Seventeen children (31%) had a pathological IMT. The diastolic BP difference between children with normal and pathological IMT was statistically significant (p < 0.05). Parents’ total, LDL and HDL cholesterol, as well as triglyceride levels, differed statistically from those of children with both physiological and pathological IMT: p < 0.05 for all differences. Children with hypercholesterolemia had a three-fold higher likelihood of having a pathological IMT than children with normal cholesterol (p < 0.01). Among children with pathological IMT, 59 percent had one and 41 percent had two parents who were affected by pathological IMT. Conclusions. Carotid stiffness was similar in children and their parents, suggesting early familial influences on vascular properties. Many children had a pathological carotid IMT, highlighting how subclinical atherosclerosis is diffuse even at a young age. IMT in children was associated with cholesterol levels, underscoring the importance of early lipid screening and management. The strong association between pathological IMT in both children and their parents supports the hypothesis of a shared genetic or environmental predisposition to early vascular alterations. Full article

Background: Nocebo effects are described as adverse symptoms arising from negative expectations rather than direct physiological harm, and are increasingly recognised across healthcare. While traditionally examined within pharmacological trials, emerging literature suggests that nocebo effects are shaped by broader interactional, situational, and communicative processes. In dentistry and paediatric care, where behaviour support and reassurance are central to practice, these mechanisms remain under-synthesised. Objectives: This scoping review aimed to map how nocebo effects are conceptualised across healthcare literature, with particular attention to the role of communication, reassurance, and behaviour support, and to explore how these mechanisms are discussed in paediatric, procedural, and dental contexts. Methods: An interpretive scoping review was conducted in line with JBI guidance and PRISMA-ScR reporting standards. Multidisciplinary literature spanning experimental, clinical, ethical, and applied domains was systematically identified and charted. Studies were grouped using a conceptual framework encompassing expectancy, learning, communication-mediated, ethical, and contextual mechanisms, allowing overlap between categories. Results: A large and heterogeneous body of literature was identified, with most studies conceptualising nocebo effects through overlapping mechanisms rather than discrete pathways. Expectancy and learning processes formed a foundational substrate across contexts, while communication, including framing, tone, reassurance, and checking-in, emerged as an active mechanism shaping symptom perception and vigilance. Ethical discussions highlighted tensions between transparency and potential harm, particularly in consent and risk communication. Paediatric and procedural settings, including dental sedation, were comparatively underrepresented despite features likely to amplify nocebo effects, such as reduced agency and heightened attentional focus. Conclusions: Nocebo effects are best understood as interactional phenomena that emerge within everyday clinical encounters. This review highlights the need to critically examine behaviour support practices, including reassurance, that are typically assumed to be benign. Greater conceptual clarity and reflexivity in communication may support future research and training aimed at minimising unintended distress within dental and paediatric care. These findings suggest that routine communication practices, including reassurance and expectation-setting, should be understood as active components of care that can influence patient experience, rather than as neutral or purely supportive interactions. Full article

Background/Objectives: Accurate quantification of left-to-right shunt volume is central to clinical decision-making in patients with atrial septal defect (ASD). Conventional echocardiographic Qp:Qs estimation is widely used but limited by operator dependency, Doppler alignment sensitivity, and the quadratic amplification of diameter measurement errors in flow calculations. These factors contribute to clinically relevant variability, particularly in paediatric populations with small vessel dimensions. Simulation-based haemodynamic modelling offers an alternative approach by integrating structural and functional cardiac parameters within a patient-specific computational framework, independent of direct Doppler flow measurements. Methods: This retrospective single-centre study evaluated agreement between conventional Doppler-derived and software-based Qp:Qs quantification using a three-dimensional haemodynamic simulation model. Transthoracic echocardiographic datasets from patients with isolated secundum ASD undergoing defect closure between 2018 and 2024 were analysed. Conventional Qp:Qs was calculated using pulmonary and aortic valve diameter and velocity–time integral measurements, while software-derived Qp:Qs was computed from patient-specific haemodynamic modelling based on cardiac chamber geometry and physiological parameters. Mean values were compared using Student’s t-test. Agreement was assessed using Bland–Altman analysis. A predefined ± 20% deviation threshold was considered clinically acceptable according to the study protocol. Results: A total of 98 echocardiographic examinations from 94 patients were included. Mean Qp:Qs was 1.83 ± 0.45 by echocardiography and 1.73 ± 0.47 by simulation modelling, with no statistically significant difference between methods (p Using the predefined ± 20% deviation criterion, 53.1% of examinations fell within the acceptable range. Larger ASD diameter was associated with increased inter-method deviation. Conclusions: This study provides an initial feasibility evaluation of a novel haemodynamic simulation approach enabling patient-specific three-dimensional modelling of cardiac structures and shunt physiology based on routine echocardiographic data. Simulation-derived Qp:Qs estimates demonstrated no systematic difference in comparison with conventional Doppler-based quantification and were feasible within routine clinical workflows. Ongoing prospective validation against invasive haemodynamic reference standards will further define analytical accuracy and potential clinical applicability. Full article

Children’s skin is uniquely vulnerable, requiring specialised design solutions that transcend traditional aesthetics. This exploratory study investigates the importance of paediatric dermatology in informing functional fashion design through expert medical perspectives. Using a qualitative approach, data were gathered from a purposive cohort of paediatric dermatologists and immunoallergologists and analysed through inductive thematic analysis. Findings identify four core themes: the physiological immaturity of children’s skin (notably the prevalence of atopic dermatitis), clothing’s role as a symptomatic aggravator rather than a primary aetiology, the clinical risks posed by chemical additives in synthetic textile processes, and the therapeutic potential of natural fibres and biofunctional agents. The data also highlights significant diagnostic constraints in paediatric patch testing, emphasising the necessity of proactive material safety. The findings suggest that integrating healthcare expertise into human-centred design may support the development of safer paediatric clothing solutions, ensuring that fashion industry innovation meets the physiological requirements of children. By transitioning from hazardous synthetic processes to biocompatible textiles, such as undyed natural fibres and medicinal plant-derived dyes, the industry can transform apparel from a potential irritant into a secondary protective barrier. This provides initial insights for developing clothing that safeguards the skin barrier and improves the overall wellbeing of vulnerable populations. Full article

Pulmonary hypertension (PH) is a complex condition in which early diagnosis remains challenging, particularly in patients with exertional symptoms and normal or borderline resting haemodynamics. Although right heart catheterisation is the diagnostic gold standard, transthoracic echocardiography is the recommended first-line non-invasive test. However, resting echocardiography provides only a static assessment and may underestimate disease severity in early or latent pulmonary vascular disease due to preserved pulmonary vascular compliance and adaptive right ventricular responses. Because pulmonary haemodynamics are intrinsically flow-dependent, pathological abnormalities may only emerge during increased cardiac output. Stress echocardiography, performed using exercise or pharmacological stress, enables dynamic evaluation of pulmonary pressure responses, cardiac output augmentation, right ventricular contractile reserve, and ventricular interaction. Increasing evidence indicates that stress echocardiography can unmask abnormal pulmonary pressure–flow relationships, impaired pulmonary vascular reserve, and reduced right ventricular–pulmonary arterial coupling that are not apparent at rest, thereby improving functional and haemodynamic characterisation in selected patients. This Diagnostic Review outlines the physiological basis for stress echocardiographic assessment of pulmonary circulation, proposes practical recommendations for patient selection and testing protocols, and provides a framework for interpretation centered on pressure–flow relationships rather than absolute pulmonary pressure thresholds. Particular attention is given to clinical scenarios with high diagnostic yield, including unexplained exertional dyspnoea, systemic sclerosis, suspected heart failure with preserved ejection fraction, at-risk relatives of patients with pulmonary arterial hypertension, selected athletes, and paediatric populations. Stress echocardiography should not be considered a standalone diagnostic test for PH but, when performed in experienced centers and integrated within structured diagnostic pathways, it represents a valuable non-invasive adjunct to guide referral for invasive haemodynamic confirmation. Full article

Background: Primary central nervous system tumours in pregnancy are exceptionally rare, with posterior fossa lesions presenting particular diagnostic and management challenges due to their confined anatomical location and proximity to critical neurovascular structures. Pilocytic astrocytoma (PA), typically a paediatric tumour, is uncommon in adults and exceedingly rare in pregnant patients. The physiological changes in pregnancy can obscure tumour-related symptoms, contributing to diagnostic delay and increased maternal–fetal risk. Methods: We report the case of a 24-year-old pregnant woman at 23 weeks and 5 days’ gestation who presented with progressive neurological deterioration secondary to a cystic mass in the right cerebellar hemisphere. MRI revealed significant brainstem compression and triventricular hydrocephalus. Results: A multidisciplinary team performed an urgent retrosigmoid craniotomy with gross total tumour resection under general anaesthesia and continuous intraoperative fetal monitoring. Histopathology confirmed PA (CNS WHO Grade I). Postoperative recovery was uneventful, and both maternal and fetal outcomes were favourable. Conclusions: This case highlights the importance of early neuroimaging, multidisciplinary coordination, and timely surgical intervention in managing posterior fossa tumours during pregnancy. Although PAs are considered low-grade gliomas, their behaviour in pregnancy can be unpredictable. With careful perioperative planning, neurosurgical treatment can be safely undertaken during gestation, offering optimal outcomes for both mother and fetus. Full article

Background/Objectives: Hydroxyurea is currently the standard disease-modifying therapy for reducing sickle cell disease (SCD) complications; however, drug labels currently advise discontinuation of breastfeeding during hydroxyurea therapy due to limited human data on the risk of hydroxyurea exposure in breastfed neonates. Methods: A physiologically based pharmacokinetic (PBPK) model for hydroxyurea was built and verified with data from non-lactating adult patients with SCD. The model was then extended to predict hydroxyurea in nursing and in paediatric populations. Predictions were compared to the observed data. Results: The PBPK model predictions for hydroxyurea pharmacokinetics described the observed data in both adult and paediatric subjects with SCD. Observed concentration profiles were within the 5th–95th prediction intervals, and predicted PK parameters were within 2-fold of the observed values. The predicted milk-to-plasma ratio was 0.8. Neonatal exposure to hydroxyurea via breast milk as a percentage of maternal exposure increased from 0.6% at 1 day to 10% at the 4th week postpartum before declining to 5%, 3%, and 2% at 6, 9, and 12 months postpartum, respectively. Conclusions: About 56% of total milk hydroxyurea exposure is within the first 3 h of post-maternal dose. Disposal of this early milk would reduce the exposure of breastfed children. The reduction in exposure is especially pronounced around the first 1 month postpartum. Lactation PBPK models offer a physiological approach to assess real-life scenarios that are difficult to investigate in clinical studies and provide useful results for future clinical study design and clinical recommendations. This was exemplified with hydroxyurea in the current work. Full article

Precision medicine, which relies on genomic, multi-omic, phenotypic, and environmental data, has the potential to transform healthcare from population-focused heuristics to individualized prevention, diagnosis, and treatment. Moreover, recent advances in sequencing, molecular profiles, wearable sensors, and machine learning have created opportunities for rapid translational innovation: rapid genomic diagnosis in neonatal and paediatric rare diseases, targeted oncology, pharmacogenomic-based prescribing strategies, and individual sport performance. Nevertheless, the vast majority of innovations remain in centers of specialism or pilot programs, rather than routinely or equitably integrated into clinical or athletic practice. This narrative review synthesizes translational evidence across the life course—in pregnancy, paediatrics, adult medicine, geriatrics, and sportomics—to find reproducible clinical and performance examples which enable precision-based alternative approaches to management, outcome, or preparation; and to reshape those examples into pragmatic, scalable priorities which minimize inequity, and maximize benefit. We undertook a structured narrative synthesis of peer-reviewed literature, trials, clinician translation programs, implementation studies, and sportomics reports, prioritizing examples that demonstrate utility, reproducibility, and impact. Important findings suggest that multi-omics and rapid sequencing improve diagnostic yield and time to diagnosis. Molecular profiling and circulating tumor DNA help realize adaptive treatment selection. Integrated genomics, metabolomics, wearable physiology, and AI analytics facilitate individualized training, injury-risk stratification, and recovery optimization. But systematic value is limited by insufficient representative validation, dataset bias, poor interoperability, regulatory uncertainty, workforce preparedness, and inequities of access. Converting a promise into population- and performance-level value requires coordinated action across four fronts: representative validation; interoperable, privacy-preserving infrastructures; clinician- and coach-centered implementation; and templates for scalable, cost-sensitive deployment. Full article

Paediatric formulations are pharmaceutical dosage forms specifically designed to meet the physiological, developmental, pharmacokinetic, and practical needs of patients from birth to adolescence. Developing safe, effective, and age-appropriate medicines for children remains a significant challenge due to their age-dependent variability in physiological development, pharmacokinetic profiles, and therapeutic needs. These differences, combined with practical barriers such as poor palatability, limited swallowability, inappropriate dosage form size, and instability, often lead to the modification of adult medicines—practices that can cause dosing inaccuracies, contamination risks, and reduced therapeutic efficacy. Three-dimensional printing has emerged as a promising solution to address these limitations by creating personalised paediatric dosage forms with adjustable strengths, multilayer structures for controlled release, and child-friendly shapes that may improve acceptability and adherence. This review offers an overview of the physiological, technological, and regulatory factors involved in developing 3D-printed paediatric medicines. The Critical Quality and Performance Attributes relevant to this field—including dose accuracy and flexibility, release kinetics, palatability, product dimensions, material choice, safety, stability, cost-effectiveness, production time, scalability, and reproducibility—are discussed in the article. Additionally, the review discusses the evolving Good Manufacturing Practice and regulatory landscape necessary to ensure the quality, safety, and consistency of 3D-printed medicinal products. Overall, these insights underline the transformative potential of 3D printing as a pathway towards safer, more effective, and truly personalised pharmacotherapy for paediatric patients. Full article

Background: Dental anxiety is a common challenge in paediatric dentistry, often leading to avoidance of treatment and compromised oral health. Non-pharmacological interventions such as music therapy have gained increasing attention as safe and cost-effective alternatives to pharmacological approaches. Although several clinical studies have examined the impact of music on children’s dental anxiety, the evidence has not yet been systematically summarised with quantitative synthesis. Objective: This systematic review and meta-analysis aimed to evaluate the effectiveness of music therapy in reducing dental anxiety and fear among paediatric patients. Methods: A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library from inception to August 2025. Randomised controlled trials (RCTs) evaluating music therapy for dental anxiety in children were included. Primary outcomes were self-reported dental anxiety/fear scales and physiological measures (heart rate, blood pressure, oxygen saturation). Risk of bias was assessed using the revised Cochrane risk of bias tool (RoB 2, version 2019; Cochrane Collaboration, London, UK) Meta-analyses were performed using a random-effects model with Review Manager (RevMan, version 5.4; Cochrane Collaboration, London, UK). Results: Seven randomized controlled trials (RCTs) involving 476 children aged 4–14 years were included. Music therapy significantly reduced self-re-ported dental anxiety compared with control groups (SMD = −0.48, 95% CI: −0.72 to −0.25, p < 0.001). Heart rate was also significantly reduced (SMD = −0.42, 95% CI: −0.68 to −0.16, p = 0.002), whereas changes in blood pressure and oxygen saturation were not statistically significant. The overall risk of bias was moderate, with most concerns related to blinding. Conclusions: Music therapy is an effective non-pharmacological intervention to reduce dental anxiety in children, particularly improving subjective anxiety and physiological arousal as measured by heart rate. Its integration into paediatric dental practice may enhance cooperation and treatment outcomes, offering a safe, inexpensive, and child-friendly approach. Full article

Introduction: In clinical practice, the presence of abnormal physiological root resorption frequently results in the retention of deciduous teeth. Also, unilateral mastication may contribute to the altered physiological process of root resorption. This delayed exfoliation and retention of deciduous teeth may compromise the integrity of adjacent soft tissue. In recent years, ozone therapy can be considered a promising strategy in accelerating healing and reducing pain in both traumatic and autoimmune ulcers. Case Presentation: This case report describes a 12 year-old male patient with localized damaged gingival tissue resulting from chronic trauma due to the retention of a deciduous tooth. Following the application of gaseous ozone therapy, complete mucosal healing was achieved. Conclusions: This case supports the potential of ozone therapy in paediatric soft tissue management. Full article

Background: Cardiopulmonary exercise testing (CPET) is increasingly recognized as a key tool for evaluating patients with congenital heart disease (CHD). While traditional assessments focus on resting parameters, CPET provides dynamic, integrated insight into cardiovascular, respiratory, and muscular function during exertion. Objectives: This review explores the clinical value of CPET across the spectrum of CHD, with dedicated focus on its applications in both adult and paediatric populations. We analyse the prognostic significance of key CPET parameters—particularly peak oxygen consumption (peak VO₂), ventilatory efficiency (VE/VCO₂ slope), and heart rate dynamics—within distinct anatomical and physiological categories of CHD. Findings: CPET reliably detects exercise intolerance, guides intervention timing, informs exercise prescription, and stratifies risk. Peak VO₂ and heart rate reserve are consistently associated with adverse outcomes across most CHD types. However, the prognostic utility of other variables, such as the VE/VCO₂ slope, varies with pathophysiology—being less reliable in cyanotic lesions like Eisenmenger syndrome. In paediatric patients, CPET must be adapted to growth-related physiological variability and is increasingly used to assess quality of life, functional limitation, and response to therapy. Conclusions: CPET is a powerful, non-invasive tool that should be integrated into routine management of CHD patients across all ages. It enhances risk assessment, supports tailored care, and promotes safe physical activity, ultimately contributing to improved long-term outcomes and quality of life. Full article

Paediatric brain tumours and their treatments are associated with long-term cognitive impairment. While the aetiology of cognitive impairment is complex and multifactorial, multiparametric Magnetic Resonance Imaging (MRI) can identify many risk factors including tumour location, damage to eloquent structures and tumour phenotype. Hydrocephalus and raised intracranial pressure can be observed, along with risk factors for post-operative paediatric cerebellar mutism syndrome or epilepsy. MRI can also identify complications of surgery or radiotherapy and monitor treatment response. Advanced imaging sequences provide valuable information about tumour and brain physiology, but clinical use is limited by extended scanning times and difficulties in processing and analysis. Brain eloquence classifications exist, but focus on adults with neurological deficits and are outdated. For the analysis of childhood tumours, limited numbers within tumour subgroups and the investigation of long-term outcomes necessitate using historical scans and/or multi-site collaboration. Variable imaging quality and differing acquisition parameters limit the use of segmentation algorithms and radiomic analysis. Harmonisation can standardise imaging in collaborative research, but can be challenging, while data-sharing produces further logistical challenges. Consequently, most research consists of small single-centre studies limited to regional analyses of tumour location. Technological advances reducing scanning times increase the feasibility of clinical acquisition of high-resolution standardised imaging including advanced physiological sequences. The RAPNO and SIOPE paediatric brain tumour imaging guidelines have improved image standardisation, which will benefit future collaborative imaging research. Modern machine learning techniques provide more nuanced approaches for integration and analysis of the complex and multifactorial data involved in cognitive outcome prediction. Full article

Background: Intravenous arginine vasopressin is increasingly used for the treatment of critically ill children. It bears the risk of hyponatraemia with potential severe long-term sequelae, but data on hyponatraemia as a side effect of continuous vasopressin infusion for paediatric intensive care patients is scarce. Methods: In this retrospective analysis performed at a tertiary care paediatric intensive care unit with 2000 annual admissions, patients were included if they were treated with intravenous vasopressin between 2016 and 2022. Baseline sodium concentrations, lowest sodium concentrations during arginine vasopressin treatment, and time to lowest sodium concentration (nadir) were derived. Results: In total, 170 patients with a median age of 4 months [interquartile range, IQR, 0–33] were included, 92.4% underwent surgery, and 28.8% died. Median arginine vasopressin dose rate was 0.027 IU/kg/h [0.019–0.036] and arginine vasopressin was started 3.2 [0–26] h after intensive care admission. Median arginine vasopressin application duration was 13.6 h [6.2–32.6]. Baseline sodium was 141 mmol/L [138–145], and lowest median sodium during arginine vasopressin infusion was 137 mmol/L [132–141] (nadir at 8.4 h [1.0–28.1] after arginine vasopressin start). Hyponatraemia (<135 mmol/L) occurred in 38.2% of patients during AVP treatment, and physicians administered a median of 10.2 mmol/kg/d [6.2–16.4] sodium during arginine vasopressin therapy. Conclusions: Under arginine vasopressin infusion, hyponatraemia was common, although high daily doses of sodium were administered to keep the serum values in physiologic ranges. This emphasises the need for close electrolyte monitoring and sodium substitution in children and adolescents under arginine vasopressin treatment to avoid hyponatraemia and related sequelae. Full article