Nonoperative Management of Pediatric Uncomplicated Acute Appendicitis Tied to Higher Failure and Complication Rates: JAMA

Brazil: A recent meta-analysis revealed increased treatment failure and major complications within a year among children and adolescents with uncomplicated acute appendicitis managed nonoperatively, emphasizing the need for individualized, patient-centered treatment decisions.                

The systematic review and meta-analysis published in JAMA Pediatrics by Isabella Faria and colleagues from the University of Texas Medical Branch, Galveston, examined whether nonoperative management (NOM) using antibiotics can match the outcomes of traditional appendectomy in pediatric patients with uncomplicated acute appendicitis. While NOM has been increasingly considered as a less invasive alternative, questions about its long-term efficacy and safety have persisted.
The analysis incorporated seven randomized clinical trials (RCTs) encompassing a total of 1,480 children and adolescents. Key findings were as follows:
  • Nonoperative management (NOM) was associated with a significantly higher risk of treatment failure within one year compared with appendectomy (RR, 4.97).
  • Treatment success at 12 months was lower in the NOM group (RR, 0.67).
  • Major complications (Clavien-Dindo grade IIIb or higher) occurred more frequently with NOM (RR, 33.37).
  • Appendicitis recurrence among NOM patients was 18.47 events per 100 patients.
  • NOM showed modest short-term benefits, including a slightly faster return to school (mean difference, –1.36 days).
  • NOM was associated with a quicker return to normal daily activities (mean difference, –4.93 days).
  • These short-term benefits could be offset by higher readmission rates and eventual need for surgical intervention, potentially prolonging overall recovery.
The meta-analysis highlights that while NOM may provide a shorter initial recovery period, its higher rates of failure and serious complications limit its role as a primary treatment strategy. Appendectomy, in contrast, demonstrated superior treatment success and lower risk of major adverse events, supporting its continued role as the standard of care for uncomplicated appendicitis in pediatric populations.
The study also highlighted some limitations, including variability in follow-up durations, differing definitions of treatment success across studies, and limited long-term data. In addition, mild to moderate complications may have been underreported, and the analysis was restricted to RCTs, which reduces, but does not eliminate, bias. Future research is encouraged to standardize outcome definitions, utilize longer follow-up periods, and consider patient-centered factors such as quality of life, school absence, and caregiver burden.
The comprehensive review provides updated evidence to guide pediatricians, surgeons, and families in making informed, individualized decisions regarding the management of uncomplicated acute appendicitis in children and adolescents.
“While NOM remains a viable option in selected cases, appendectomy continues to offer more reliable long-term outcomes, emphasizing the importance of shared decision-making that balances clinical effectiveness with patient preferences and circumstances,” the authors concluded.
Reference:
Faria I, Cintra ACG, de Oliveira LGAM, et al. Reevaluating Nonoperative Management for Pediatric Uncomplicated Acute Appendicitis: A Systematic Review and Meta-Analysis. JAMA Pediatr. Published online October 05, 2025. doi:10.1001/jamapediatrics.2025.4091

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Lavender-Neroli Aromatherapy Reduces Anxiety in Pediatric Dental Anesthesia: Study

Researchers have found in a new study that lavender–neroli aromatherapy was a safe, inexpensive, and effective complementary approach for lowering anxiety and discomfort in children undergoing dental anesthesia. The findings, published in Medical Sciences by Rama Abdalhai, Yasser Alsayed Tolibah, Racha Alkhatib, Chaza Kouchaji, and Ziad D. Baghdadi, highlight how simple, non-pharmacological interventions can improve pediatric dental experiences and support overall patient comfort. Dental procedures often trigger anxiety in children, which can affect cooperation, procedural success, and long-term attitudes toward oral care. Aromatherapy, as a calming and low-risk intervention, provides an accessible method to ease these challenges.

The randomized controlled trial included children scheduled for dental procedures under local anesthesia, who were randomly assigned to either receive lavender–neroli aromatherapy or standard care. Researchers evaluated anxiety and pain levels using validated pediatric scales and observed that the aromatherapy group showed significant reductions in both measures. These effects are likely related to the aromatic compounds’ influence on the limbic system, which modulates mood and stress responses. The study underscores that integrating aromatherapy into clinical settings is feasible, low-cost, and well-received by children and their caregivers, offering a valuable adjunct to conventional behavioral and pharmacological approaches.

The authors conclude that lavender–neroli aromatherapy can be considered a practical complementary strategy to enhance pediatric dental care. By reducing anxiety and discomfort, it may improve procedural outcomes, enhance patient cooperation, and foster positive experiences that encourage regular dental visits. The study also highlights the broader potential of aromatherapy in pediatric and procedural medicine, emphasizing safe, patient-friendly interventions that complement traditional care. Further research could explore long-term effects, optimal administration methods, and potential applications in other pediatric medical settings.

Keywords: pediatric dental anxiety, aromatherapy, lavender, neroli, complementary therapy, pain reduction, Medical Sciences, Rama Abdalhai, Yasser Alsayed Tolibah, Racha Alkhatib, Chaza Kouchaji, Ziad D. Baghdadi, randomized controlled trial

Reference: Abdalhai R, Tolibah YA, Alkhatib R, Kouchaji C, Baghdadi ZD. Lavender–Neroli Aromatherapy for Reducing Dental Anxiety and Pain in Children During Anesthesia: A Two-Arm Randomized Controlled Trial. Med Sci. 2025;13(3):166. doi: 10.3390/medsci13030166
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Carbonic anhydrase 3 protein in urine may be Potential Biomarker for ARAS: Study

A new study published in BMC Nephrology in 2025, reports that carbonic anhydrase 3 detected in urine may serve as a useful biomarker for monitoring renal injury in patients with atherosclerotic renal artery stenosis. The authors explain that this vascular condition reduces blood supply to the kidneys, leading to progressive functional decline, yet current diagnostic methods rely heavily on imaging and invasive procedures. Identifying a protein such as carbonic anhydrase 3 in urine, which reflects interstitial damage, could provide a safe and non-invasive alternative to monitor disease progression and treatment response.

The researchers applied proteomic screening to identify candidate proteins and then validated carbonic anhydrase 3 as the most promising urinary signal. They found that levels of this protein, normalized to creatinine, were consistently elevated in patients with renal artery stenosis compared to disease and healthy controls. Because urine collection is simple, inexpensive, and non-invasive, this approach could potentially allow earlier identification of renal damage and closer tracking of patient outcomes. However, the authors stress that their findings need confirmation through larger trials and more detailed mechanistic work to establish specificity and clinical reliability.

This work adds to the growing field of urinary proteomics, where molecular signals are being explored as tools for early detection of cardiovascular and renal disease. By pointing to carbonic anhydrase 3 as a marker of ischemic kidney injury, the study opens new possibilities for patient-friendly diagnostics. Still, the translation of these findings into practice will depend on whether future studies can show that urinary carbonic anhydrase 3 not only reflects existing injury but also predicts progression or response to intervention.

Reference:
Li X, Liu N, Liu T, Liang G, Shao C, Ma T, Zhang M. The carbonic anhydrase 3 protein in urine: a potential biomarker to monitor atherosclerotic renal artery stenosis. BMC Nephrology. 2025;26:530. doi:10.1186/s12882-025-04457-w

Keywords: Carbonic anhydrase 3, urine biomarker, renal interstitial injury, atherosclerotic renal artery stenosis, Xiufeng Li, BMC Nephrology

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Menstrual cycle found to affect women’s reaction time, but not as much as being active

Women performed best on cognitive tests during ovulation but physical activity level had a stronger influence on brain function, according to a new study from researchers at UCL.

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Menstrual cycle found to affect women’s reaction time, but not as much as being active

Women performed best on cognitive tests during ovulation but physical activity level had a stronger influence on brain function, according to a new study from researchers at UCL.

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Housing associations found more effective than government in supporting unemployed in deprived areas of the UK

New research reveals that “third-sector” services, such as those run by housing associations, are far more effective than government work programs at helping the long-term unemployed in deprived areas.

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Housing associations found more effective than government in supporting unemployed in deprived areas of the UK

New research reveals that “third-sector” services, such as those run by housing associations, are far more effective than government work programs at helping the long-term unemployed in deprived areas.

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Digital therapeutic approach to health literacy can enhance patients’ engagement with educational materials

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A team of researchers from Concordia University and McGill University has developed a “lab-on-a-chip” device that models how Alzheimer’s disease advances in the brain.

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Digital therapeutic approach to health literacy can enhance patients’ engagement with educational materials

About 93% of U.S. adults access the internet, and 80% of those search for health information, despite low levels of proficiency in health literacy. In a new study, researchers have developed an automated approach to assess how easily understandable patient educational videos are for individuals looking for information on diabetes.

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