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BACKGROUND: Swallowing is a complex process that requires the coordination of muscles in the mouth, pharynx, larynx, and esophagus. Dysphagia occurs when a person has difficulty swallowing. In the case of subjects with respiratory diseases, the presence of oropharyngeal dysphagia potentially increases lung disease exacerbations, which can lead to a rapid decline in lung function. This study aimed to analyze the swallowing of patients with idiopathic pulmonary fibrosis (IPF). METHODS: Patients with IPF were evaluated using the Eating Assessment Tool (EAT-10), tongue pressure, the Timed Water Swallow Test (TWST), and the Test of Mastication and Swallowing Solids (TOMASS). The findings were related to dyspnea severity assessed by the modified Medical Research Counsil (mMRC) score; the nutritional status screened with Mini Nutritional Assessment (MNA) tool; and pulmonary function tests, specifically spirometry and measurement of the diffusing capacity for carbon monoxide (DLCO), the maximal inspiratory pressure (PImax), and the maximal expiratory pressure (PEmax). RESULTS: The sample consisted of 34 individuals with IPF. Those who exhibited swallowing modifications scored lower on the MNA than those who did not (9.6 ± 0.76 vs. 11.64 ± 0.41 points; mean difference 1.98 ± 0.81 points; p = 0.02). They also showed poorer lung function when considering the predicted force vital capacity (FVC; 81.5% ± 4.61% vs. 61.87% ± 8.48%; mean difference 19.63% ± 9.02%; p = 0.03). The speed of liquid swallowing was altered in 31of 34 of the evaluated subjects (91.1%). The number of liquid swallows correlated significantly with the forced expiratory volume in 1 s (FEV1)/FVC ratio (r = 0.3; p = 0.02). Solid eating and swallowing assessed with the TOMASS score correlated with lung function. The number of chewing cycles correlated negatively with PImax% predicted (r = -0.4; p = 0.0008) and PEmax% predicted (r = -0.3; p = 0.02). FVC% predicted correlated with increased solid swallowing time (r = -0.3; p = 0.02; power = 0.6). Swallowing solids was also impacted by dyspnea. CONCLUSION: Patients with mild-to-moderate IPF can present feeding adaptations, which can be related to the nutritional status, lung function, and the severity of dyspnea.
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Transtornos de Deglutição , Deglutição , Fibrose Pulmonar Idiopática , Língua , Humanos , Masculino , Feminino , Idoso , Fibrose Pulmonar Idiopática/fisiopatologia , Fibrose Pulmonar Idiopática/complicações , Deglutição/fisiologia , Transtornos de Deglutição/fisiopatologia , Transtornos de Deglutição/etiologia , Pessoa de Meia-Idade , Língua/fisiopatologia , Testes de Função Respiratória , Pressão , Estado Nutricional , Pulmão/fisiopatologia , Dispneia/fisiopatologia , Dispneia/etiologia , Avaliação Nutricional , Idoso de 80 Anos ou maisRESUMO
OBJECTIVE: To determine associations between presenting symptoms and oropharyngeal dysphagia diagnoses, gastroesophageal reflux disease (GERD) diagnoses, and treatment with acid suppression medication in infants with brief resolved unexplained event (BRUE). STUDY DESIGN: We performed a prospective cohort study of infants with BRUE to review presenting symptoms and their potential impact on testing and treatment. Videofluoroscopic swallow study (VFSS) results and explanatory diagnoses were obtained from medical record review; acid suppression use was determined by parental survey. Binary and multivariable logistic regression models were used to evaluate associations between presenting symptoms and obtaining VFSS, VFSS results, GERD diagnoses, and acid suppression medication. RESULTS: Presenting symptoms were varied in 157 subjects enrolled at 51.0 ± 5.3 days of age, with many symptoms that may be related to GERD or dysphagia. Of these, 28% underwent VFSS with 71% abnormal. Overall, 42% had their BRUE attributed to GERD, and 33% were treated with acid suppression during follow-up. Presenting symptoms were significantly associated with the decision to obtain VFSS but not with abnormal VFSS results. Presenting symptoms were also associated with provision of GERD explanatory diagnoses. Both presenting symptoms and GERD explanatory diagnoses were associated with acid suppression use (aOR 2.3, 95% CI 1.03-5.3, P = .04). CONCLUSIONS: Presenting symptoms may play a role in clinicians' decisions on which BRUE patients undergo VFSS but are unreliable to make a diagnosis of oropharyngeal dysphagia. Presenting symptoms may also influence assignment of GERD explanatory diagnoses that is associated with increased acid suppression medication use.
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Transtornos de Deglutição , Refluxo Gastroesofágico , Humanos , Feminino , Masculino , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/complicações , Estudos Prospectivos , Lactente , Transtornos de Deglutição/diagnóstico , Recém-Nascido , Evento Inexplicável Breve Resolvido/diagnóstico , Evento Inexplicável Breve Resolvido/terapia , Fluoroscopia , Inibidores da Bomba de Prótons/uso terapêuticoRESUMO
Abstract Objective: To examine the prevalence and characteristics of dysphagia and suck-swallow-breath incoordination as phenotypes of oral feeding difficulties. Method: A cross-sectional study with secondary data collected consecutively over 2 years from October 2020 to October 2022 to measure the prevalence of swallowing and oral feeding difficulty in preterm infants using Flexible endoscopic evaluation of swallowing examination at the tertiary Integrated Dysphagia Clinic. Results: The prevalence of swallowing disorders was 25 % and the prevalence of suck-swallow-breath incoordination was 62.5 %. The significant risk factor that may show a possible correlation with oral feeding difficulty was mature post-menstrual age (p = 0.006) and longer length of stay (p = 0.004). The dominant percentage of upper airway abnormality and disorder were retropalatal collapse (40 %), laryngomalacia (42.5 %), paradoxical vocal cord movement (12.5 %), and gastroesophageal reflux disease (60 %). The dominant characteristic of oral motor examination and flexible endoscopic evaluation of swallowing examination was inadequate non-nutritive sucking (45 %), inadequate postural tone (35 %), and inadequate nutritive sucking (65 %). Conclusion: Dysphagia in preterm infants is mostly observed in those with mature post-menstrual age, longer length of stay, and the presence of gastroesophageal reflux disease with inadequate non-nutritive sucking and nutritive sucking abilities. Suck-swallow-breath incoordination is primarily observed in those with immature post-menstrual age, a higher prevalence of cardiopulmonary comorbidity, and a higher prevalence of upper airway pathologies (laryngomalacia, paradoxical vocal cord movement) with inadequate nutritive sucking ability.
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OBJECTIVE: To examine the prevalence and characteristics of dysphagia and suck-swallow-breath incoordination as phenotypes of oral feeding difficulties. METHOD: A cross-sectional study with secondary data collected consecutively over 2 years from October 2020 to October 2022 to measure the prevalence of swallowing and oral feeding difficulty in preterm infants using Flexible endoscopic evaluation of swallowing examination at the tertiary Integrated Dysphagia Clinic. RESULTS: The prevalence of swallowing disorders was 25 % and the prevalence of suck-swallow-breath incoordination was 62.5 %. The significant risk factor that may show a possible correlation with oral feeding difficulty was mature post-menstrual age (p = 0.006) and longer length of stay (p = 0.004). The dominant percentage of upper airway abnormality and disorder were retropalatal collapse (40 %), laryngomalacia (42.5 %), paradoxical vocal cord movement (12.5 %), and gastroesophageal reflux disease (60 %). The dominant characteristic of oral motor examination and flexible endoscopic evaluation of swallowing examination was inadequate non-nutritive sucking (45 %), inadequate postural tone (35 %), and inadequate nutritive sucking (65 %). CONCLUSION: Dysphagia in preterm infants is mostly observed in those with mature post-menstrual age, longer length of stay, and the presence of gastroesophageal reflux disease with inadequate non-nutritive sucking and nutritive sucking abilities. Suck-swallow-breath incoordination is primarily observed in those with immature post-menstrual age, a higher prevalence of cardiopulmonary comorbidity, and a higher prevalence of upper airway pathologies (laryngomalacia, paradoxical vocal cord movement) with inadequate nutritive sucking ability.
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Transtornos de Deglutição , Refluxo Gastroesofágico , Laringomalácia , Lactente , Recém-Nascido , Humanos , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/etiologia , Recém-Nascido Prematuro , Laringomalácia/complicações , Estudos Transversais , Unidades de Terapia Intensiva Neonatal , Comportamento de Sucção , Fatores de Risco , Ataxia/complicaçõesRESUMO
Resistant arterial hypertension (RAH) is strongly associated with obstructive sleep apnea (OSA). Individuals with OSA may have subclinical swallow impairment, diagnosed by instrumental assessments, such as videofluoroscopy and fiberoptic endoscopic evaluation of swallowing (FEES). However, few studies have evaluated this population and included a control group of individuals without OSA. To evaluate, through FEES, the swallowing characteristics of resistant hypertensive patients with and without OSA and to investigate the association between the signs of swallow impairment and OSA. This was an observational study in which individuals with RAH underwent baseline polysomnography and were diagnosed with and without OSA. All participants underwent an initial assessment with the collection of demographic characteristics and FEES. Individuals were divided into 2 groups based on the presence or absence of OSA. Seventy-nine resistant hypertensive patients were evaluated: 60 with OSA (19 with mild OSA, 21 with moderate OSA, and 20 with severe OSA) and 19 without OSA. The most prevalent swallowing differences between groups with and without OSA were piecemeal deglutition, in 61.7% and 31.6%, respectively (p = 0.022); spillage, in 58.3% and 21.1% (p = 0.005); penetration/aspiration, in 55% and 47.4% (p = 0.561); and pharyngeal residue, in 51.5% and 26.3% (p = 0.053). The prevalence of swallow impairment among the participants in this study was 58.3% and 47.4% in the groups with OSA and without OSA, respectively (p = 0.402). This study shows a high prevalence of swallow impairment both in hypertensive patients with OSA and without OSA. The characteristics of swallowing associated with hypertensive patients with OSA are spillage, piecemeal deglutition, and the onset of the pharyngeal phase in the hypopharynx.
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Transtornos de Deglutição , Hipertensão , Apneia Obstrutiva do Sono , Deglutição , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/etiologia , Humanos , Hipertensão/complicações , Sono , Apneia Obstrutiva do Sono/complicaçõesRESUMO
Morphology of cimicid eggs are scarce, and this is the first record for the genus Ornithocoris Pinto, 1927 (Hemiptera: Cimicidae), using scanning electron microscopy (SEM). This genus comprises two species: Ornithocoris toledoi Pinto, 1927 (Hemiptera: Cimicidae) and Ornithocoris pallidus (Usinger, 1959). The eggs of O. pallidus are ellipsoid, and an evident 'lateral flattening', which may give clear asymmetry from the longitudinal axis. The exochorion of the body of the egg and operculum of O. pallidus present spherical or polygonal structures in relief, and pseudomicropyles on the border of the operculum, both differing from Cimex lectularius. The internal face of the operculum is smooth and the border also presented three layers. It was not possible to observe micropyles in the egg of O. pallidus. Bed bugs have a great psychological impact on people, and some people can develop a more or less severe allergic reaction against the bite. Successful control of bed bugs needs serious organization. Studies on egg morphology will add more information to assist in taxonomy studies of O. pallidus and can serve as a basis for control studies because eggs are resistant to insecticides.
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Cimicidae/ultraestrutura , Animais , Cimicidae/crescimento & desenvolvimento , Microscopia Eletrônica de Varredura , Óvulo/crescimento & desenvolvimento , Óvulo/ultraestruturaRESUMO
(1) Background: The effect of dopaminergic treatment on swallowing response in patients with Parkinson's disease (PD) suffering oropharyngeal dysphagia (OD) is not understood. Aim: To characterize OD pathophysiology in PD and to assess whether dopaminergic states affect swallow function and the effect of thickeners. (2) Methods: Fifty patients with PD (40 evaluated in OFF/ON states) and 12 healthy volunteers (HVs) were evaluated with videofluoroscopy (VFS) to assess the swallowing biomechanics and kinematics of the swallowing response at three different shear-viscosities (<50, 120, and 4000 mPa·s); (3) Results: Patients presented a mean age of 70.46 ± 10.03 years. Disease evolution was 5.09 ± 3.86 year and Hoehn-Yahr stage was 2.32 ± 0.81. For HVs, mean age was 40.20 ± 2.50 year. Penetrations were present in 37.50% of PD patients and were associated with delayed laryngeal vestibule closure (LVC = 293.33 ± 90.07 ms). In contrast, HVs presented a LVC = 164.00 ± 39.78 ms (p < 0.05). An LVC ≥ 260 ms cutoff predicted unsafe swallow (sensitivity ≥ 0.83, specificity ≥ 0.57, AUC = 0.80) in PD. Increasing bolus viscosity improved deglutition safety but increased oropharyngeal residue. There were no differences in swallowing between the OFF/ON states. (4) Conclusions: In initial PD stages, oropharyngeal swallow response is severely delayed, while mildly impaired swallow safety improves with increasing bolus viscosity, which increases residue. Dopaminergic treatment does not affect swallowing or the therapeutic effect of thickeners.
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Abstract Breeding colonies of Storm-petrels (family Hydrobatidae) are poorly known and can be difficult to find because they typically nest on islands in crevices and burrows inside caves. In the past decade, some breeding locations of the Wedge-rumped Storm-petrel (Hydrobates tethys kelsalli) have been reported on islands off central Peru and northern Chile. Here we report the northernmost breeding colony of this subspecies from Isla Foca, northern of Peru. In April 2006 we found 28 nests, of which 46% had chicks and 54% had eggs. Nests consisted of small holes in the rock with no nest material used for construction. Nesting season coincided with that of other reproductive zones found on the Peruvian coast. These results contribute to the knowledge of the distribution of reproductive colonies of this subspecies on the Peruvian coast.
Resumen Las colonias reproductoras de golondrinas de tempestad son poco conocidas y difíciles de encontrar debido a que estas especies anidan en grietas, madrigueras y dentro de cuevas ubicadas en islas. En la última década, se reportaron algunos sitios de reproducción de Golondrinas de Tempestad Peruana (Hydrobates tethys kelsalli) en islas cercanas al centro de Perú y norte de Chile. En este trabajo se presenta el hallazgo de la colonia reproductora ubicada más al norte de esta subespecie, en la Isla Foca (noroeste peruano). En abril de 2006 se registraron 28 nidos, de los cuales el 46% tenían crías y el 54% huevos. Los nidos consistían en pequeñas hoyos en la roca sin ningún tipo de material para su construcción. La temporada de anidación coincidió con la de otras zonas reproductivas encontradas en la costa peruana. Estos resultados contribuyen al conocimiento de la distribución de las colonias reproductivas de esta subespecie en la costa peruana.
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INTRODUCTION AND AIM: Sixty percent of the patients with gastric carcinomas are candidates for surgical resection through total gastrectomy and esophagojejunostomy, the latter of which is associated with leaks in up to 12.3% of cases. There is no standardized procedure for diagnosing anastomotic leaks. The aim of the present study was to establish the diagnostic sensitivity of the contrast-enhanced swallow study for detecting esophagojejunostomy leakage after total gastrectomy. MATERIALS AND METHODS: A retrospective analysis was conducted on patients that underwent total gastrectomy due to gastric adenocarcinoma, within the time frame of 2002 and 2017. Demographic, clinical, and laboratory factors were identified, emphasizing the clinical and radiologic detection of anastomotic leaks. Descriptive statistics were carried out and the sensitivity of the contrast-enhanced swallow study for diagnosing leakage was calculated. RESULTS: Fifty-eight patients were included in the study. Their mean age was 61.5 years. A total of 55.2% of the patients were men and 44.8% were women. Gastric adenocarcinoma was the indication for gastrectomy in 100% of the cases. Anastomotic leak presented in 31.01% of the patients. Diagnostic sensitivity of the contrast-enhanced swallow study for detecting leaks was 66%. CONCLUSIONS: According to our analysis, the contrast-enhanced swallow study had limited diagnostic efficiency for detecting anastomotic leaks, with a sensitivity of 66%. We suggest maintaining high diagnostic suspicion in patients with studies that are initially negative and basing decisions on a more extensive approach.
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Adenocarcinoma/cirurgia , Fístula Anastomótica/diagnóstico por imagem , Meios de Contraste , Esôfago/cirurgia , Gastrectomia , Jejuno/cirurgia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Compensatory deglutition strategies such as change of posture, swallowing maneuvers, and sensory stimulation have been used by speech-language pathologists (SLPs) to alter oral and pharyngeal biodynamics. OBJECTIVE: To analyze the immediate effect of the dry swallowing maneuver in patients with neurogenic dysphagia. METHODOLOGY: The participants were 11 individuals with neurogenic dysphagia who underwent videofluoroscopic swallowing study while performing dry swallow maneuvers for different consistencies. The amount of pre- and post-maneuver residue was measured for the tongue base, vallecula, posterior pharyngeal wall, and pyriform sinus. Two experienced SLPs analyzed the videos blindly as to the timing, pre- or post-maneuver, and information about the videos. In cases of disagreement between the judges, a third judge broke the tie for each structure whose analysis was in disagreement. RESULTS: There was a significant reduction of residue after dry swallowing maneuvers on the tongue and vallecula. There was no significant difference in the amount of pre- and post-maneuver residue for the posterior pharyngeal wall and pyriform sinus. The amount of pre- and post-maneuver residue showed no significant interference from the different consistencies tested. CONCLUSION: The dry swallowing maneuver showed an immediate improvement effect for the clearance of residues on the base of tongue and vallecula.