Swallowing Research Articles

Effects of Capsaicin on Masticatory and Swallowing Function.

Recent studies have shown that capsaicin improves the pharyngeal swallowing reflex. However, the mechanism by which capsaicin alters mastication and oesophageal function remains unclear. This study aimed to investigate the effects of capsaicin on masticatory and oesophageal function. Participants were 12 healthy individuals (7 men, 5 women: aged 31.5 ± 3.0 years). The participants ingested five rice cakes without capsaicin and then five rice cakes containing capsaicin. Total mastication frequency, total mastication time, and mastication rate were measured. Pharyngeal and upper oesophageal sphincter (UES) parameters were evaluated using high-resolution manometry (HRM). The masticatory and HRM parameters were compared between the ingestion of capsaicin-containing and non-capsaicin containing rice cakes. The total mastication frequency and total mastication time(s) for capsaicin ingestion were significantly smaller (20.3 ± 9.4 vs. 22.4 ± 7.4; p = 0.011) and shorter (14.2 ± 7.0 vs. 15.4 ± 5.6; p = 0.038), respectively, than those for non-capsaicin ingestion. Comparison of the HRM parameters revealed significantly higher hypopharyngeal contractile integral (mmHg-s-cm) (56.6 ± 40.7 vs. 49.7 ± 43.6; p = 0.016) and proximal oesophageal contractile integral (mmHg-s-cm) (492.3 ± 292.64 vs. 381.2 ± 266; p < 0.001), significantly shorter UES basal pressure (mmHg) (93.6 ± 37.8 vs. 114.5 ± 43.4; p < 0.001), and significantly longer UES relaxation time (ms) (486.7 ± 90.7 vs. 431.2 ± 82.3; p < 0.001) for capsaicin ingestion than for non-capsaicin ingestion. Decreased mastication frequency and time, increased hypopharyngeal and proximal oesophageal contractile integral, and prolonged UES opening time with capsaicin ingestion suggests that capsaicin improves oral, pharyngeal and oesophageal phases of swallowing.

First record of Eurasian Crag Martin Ptyonoprogne rupestris (Scopoli, 1769) (Aves: Passeriformes: Hirundinidae) from Tamil Nadu, India

Eurasian Crag Martin Ptyonoprogne rupestris is a small-sized aerial insectivorous bird from the family Hirundinidae , commonly grouped under swallows and martins. Here I present the first photographic proof of Eurasian Crag Martin at Tamil Nadu of India.

Prevalence of Oropharyngeal Dysphagia in Children: A Systematic Review and Meta-Analysis.

This study aims to determine the prevalence of oropharyngeal dysphagia (OD) in children, as diagnosed through instrumental evaluation, and to identify associated risk factors. A systematic search was conducted across six databases (Embase, LILACS, LIVIVO, PubMed/MEDLINE, Scopus, and Web of Science), as well as gray literature sources (ASHA, Google Scholar, and ProQuest). Studies involving children (under 12 years of age), diagnosed using instrumental methods such as videofluoroscopic swallow study (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES), were included. A random-effects meta-analysis was performed to estimate the prevalence, with heterogeneity assessed through meta-regression. The risk of bias was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist. A total of 31 studies were included, yielding a pooled prevalence estimate of 69% (95% CI: 61%-77%; I² = 94%). Most studies involved children with predisposing conditions, potentially contributing to an overestimation of OD prevalence in the general pediatric population. Four studies were assessed as having a moderate risk of bias, while 27 were rated as having a low risk of bias. The findings suggest a high prevalence of OD, especially in children with underlying health conditions. These results underscore the importance of early diagnosis and tailored interventions to mitigate the health risks associated with deglutition disorders in pediatric populations.

Reliability and Validity of the Turkish Version of the Deglutition Handicap Index.

The Deglutition Handicap Index (DHI) is a self-reported questionnaire focus on dysphagia related quality of life of patients. The present study was aimed to translate the DHI into Turkish, and investigate the reliability and validity of the Turkish version of the DHI (T-DHI). A total of 100 patients with different diagnoses participated. The study was carried out in 3 phases including translation, reliability and validation phases. The translation phase was performed by the forward-backward-forward translation methodology. The internal consistency and test-retest reliability were used for reliability phase. The criterion validity of the T-DHI was investigated for validation phase. The Cronbach's alpha value of the T-DHI was 0.93 of which indicates excellent internal consistency. The Intraclass Correlation Coefficient ranged from 0.96 to 0.99 for test-retest reliability. There was negative and weak correlation between functional subscale score from the T-DHI and the Functional Oral Intake Scale (r=-0.29, p = 0.004), and positive and moderate to strong correlations between total and subscale scores from the T-DHI and the Turkish version of the Eating Assessment Tool (r = 0.67-0.78, p < 0.001) indicating sufficient criterion validity. The T-DHI is a reliable and valid questionnaire to define dysphagia related quality of life of patients. Clinicians could be used the T-DHI during swallowing evaluation part during the management process of deglutition disorders to plan patient centered rehabilitation, improve care and follow up.

The pathophysiology of dysphagia post-lung transplant: A systematic review.

One major consequence of lung transplantation is the development of oropharyngeal dysphagia. This systematic review aims to appraise and synthesize the available evidence of the use of instrumental assessments to outline the characteristics of post-lung transplant dysphagia. Following the identification of appropriate search terms for the question, a literature search was conducted in PubMed, Scopus, and the Health and Medical Collection of Proquest Research Library and included records between inception and September 14, 2023. Search strategies included the use of text words and subject headings (e.g., MeSH and Index terms) related to (1) dysphagia or swallowing (swallow*, deglutition disorder*), (2) lung transplant (lung transplant*, post-operative, post-lung), and (3) complications (adverse effects, *complications, treatment outcome). The literature search strategy yielded a total of 883 studies from the electronic database search, with no additional records identified through other sources. After the removal of duplicates (n = 96), a total of 787 studies were screened through title and abstracts which eliminated 775 studies. Six studies were ultimately included in the systematic review. The selected articles included patients who underwent lung transplantation and all but one study utilized a retrospective design. A lack of transparency regarding instrumental evaluation protocols (videofluoroscopic [VFSS] and Flexible Endoscopic Evaluation of Swallowing [FEES]) including the number and bolus types used during the instrumental evaluations appeared as a theme in the studies included. The Penetration-Aspiration Scale (PAS) was systematically utilized to measure dysphagia safety outcome. Handling of the PAS scale was not consistent across studies, however penetration or aspiration ranged from 52.4% up to 100%. Additionally, silent aspiration rates ranged from 14.2% to 61.9%. This review sought to describe the post-operative swallowing function and its physiological parameters following lung transplantation. We examined the results reported and the methods utilized in obtaining these results in the existing literature. Limited reporting practices for physiological parameters were found, however the airway invasion was reported in all studies with variation in degrees of swallowing safety related deficits, with PAS being the most widely used scale to describe airway invasion depth and response. Future studies exploring dysphagia outcomes post-lung transplant should comment on the altered physiological mechanisms of the swallow to further expand on the physiological deficits observed following transplantation in this group and allow for treatment planning. Level 1.

Population monitoring and conservation implications of intra- and interspecific nest occupation rates in swallows.

With the exception of a few groups of birds, such as large raptors and colonial seabirds, direct counts of nests cannot be conducted over very large areas for most of the abundant and widely distributed species, and thus indirect methods are used to estimate their relative abundances and population sizes. However, many species of the Family Hirundinidae (swallows and martins) build their mud nests in discrete, predictable and accessible sites, which are reused across years. Therefore, the direct count of active nests could constitute a reliable method for estimating breeding population sizes and their changes at large spatial and temporal scales. We illustrate the feasibility of this monitoring approach through a single year survey of >2700 nests of three coexisting Old-World species, the barn swallow (Hirundo rustica), the red-rumped swallow (Cecropis daurica), and the crag martin (Ptyonoprogne rupestris), distributed across Portugal and Spain. Our results revealed changes in the use of nesting substrates and increases in interspecific nest usurpation rates over recent decades. While 56% of the nests of C. daurica were located in rocks five decades ago, almost 100% are nowadays located in anthropogenic substrates such as bridges, road culverts, and abandoned buildings, which could have favored the range expansion of this species. Nest occupation rates were surprisingly low (12% in C. daurica, 21% in H. rustica, and 37% in P. rupestris), and the proportion of abandoned nesting sites was very high (65% in C. daurica, 50% in H. rustica, and 27% in P. rupestris). Abandonment rates reflect the population decline reported for H. rustica. Notably, the usurpation of nests of C. daurica by house sparrows Passer domesticus, which is the main cause of breeding failure, has increased from 2.4% in 1976-1979 to 34.7% of the nests nowadays. The long-term monitoring of nests may constitute a reliable and affordable method, with the help of citizen science, for assessing changes in breeding population sizes and conservation threats of these and other mud-nest building hirundines worldwide.

Medical Foods for the management of Chronic Illness and their Regulations in India, US and European Union

As many chronic illnesses are incurable and require repeated treatments, this problem contributes to long-term drug use. But when it comes to managing and treating chronic illnesses, medical foods can provide an alternative to natural medications. Medical foods are foods that have been particularly prepared to meet the unique dietary needs of people with specific illnesses. When it comes to therapeutic applications such as deglutition, dyspepsia, or eating disorders, they are crucial in providing patients with nutritional support. In addition, they significantly improve patients' quality of life by lowering drug use, averting problems that could result from an excessive reliance on pharmaceuticals, and saving treatment costs. Depending on the illness, medical foods' nutritional content can be adjusted and customized. They are exempt from laws pertaining to drugs since they are not drugs. Every medical food is created especially for the chronic condition in question. As a result, the purpose of this review is to clarify the use of medical foods for conditions such as Parkinson's, Alzheimer's, anxiety and sleep disorders, pain syndrome, cancer, congenital metabolic disorders, and diabetes mellitus, and to suggest their use as a dietary supplement for these long-term illnesses.

264. SIGNIFICANCE AND USEFULNESS OF PLASMA SUBSTANCE P CONCENTRATION IN PREDICTING HIGH-RISK PATIENTS FOR ASPIRATION AFTER ESOPHAGEAL CANCER SURGERY

Abstract Background The greatest challenge in postoperative complications of esophageal cancer is the prevention of pulmonary complications, especially aspiration pneumonia. Although the introduction of minimally invasive surgery and intervention in breathing and swallowing rehabilitation can improve the motor function of breathing and swallowing, we reported the possibility that a decline in the swallowing reflex may play a significant role in esophageal cancer patients, many of whom are elderly. In fact, about 80% of esophageal cancer patients in Japan are over 60 years old, and 53% of them have asymptomatic cerebral infarction, about half of which are reported to be found near the basal ganglia, which control the swallowing reflex. The swallowing reflex is controlled by the secretion of substance P, synthesized in the cervical sympathetic ganglia, into the pharynx and trachea upon stimulation of dopamine synthesized in the basal ganglia. Methods To test the hypothesis that patients with preoperative subclinical cerebral infarction are more likely to develop aspiration postoperatively due to decreased substance P secretion. To compare the association between the presence or absence of cerebral infarction near the basal ganglia and serum substance P levels and the development of postoperative aspiration or aspiration pneumonia due to videoendoscopy and video fluorography in patients with thoracic esophageal cancer scheduled for video-assisted esophagectomy by preoperative brain MRI imaging and blood sampling. Results We report the results of an interim analysis of 54 cases in which the measurement of substance P was completed. Male: 39 cases, female: 15 cases. Mean age: 69.3 (49-82) years. Tumor location: Ut/Mt/Lt=13/25/14. MRI showed infarction in or near the basal ganglia in only 2 cases. Median preoperative blood substance P concentration: 48.2 pg/ml. Eleven one patients had postoperative aspiration. Preoperative substance P levels ≥48.2 pg/ml were defined as the High group, and those below 48.2 pg/ml were defined as the Low group. Postoperative aspiration was observed in 2/27 (7.4%) patients in the High group, while 9/26 (34.6%) patients in the Low group, which was significantly higher (p=0.015). Conclusion In fact, subclinical cerebral infarction was much less common than reported and was not useful as a predictor of postoperative aspiration. On the other hand, patients with low preoperative blood substance P levels had a very high risk of developing aspiration postoperatively due to impaired swallowing reflexes, suggesting that preoperative blood substance P levels may be useful in assessing postoperative aspiration risk in patients with thoracic esophageal cancer.

Effect of Tongue Position on Facial Morphology of Pakistani Adults and Different Growth Patterns.

To determine the effect of tongue position on facial morphology of Pakistani adults and different growth patterns. Cross-sectional study. Place and Duration of the Study:Department of Orthodontics, Karachi Medical and Dental College, Karachi, Pakistan, from January to April 2021. The study included individuals aged 17 to 30 years with no history of prior orthodontic treatment, absence of wound, burn, or scar tissue in the neck region, comfortable breathing through the nose, absence of deglutition disorder, and a skeletal Class I or II relationship. The exclusion criteria were a cleft lip or palate, or a history of chronic mouth breathing, snoring, or tonsillectomy. According to their skeletal relationships, the subjects were split into three groups; Group I (low-angle), Group II (normal growth), and Group III (high-angle). Vertical growth pattern was assessed on radiograph by interpreting the values of NS / ML (nasion-sella / mandibular plane) angle, and angle formed between FH / ML (Frankfort horizontal plane / mandibular plane). A predesigned proforma was used to record all the measurements made on pre-treatment lateral cephalograms by the sole investigator. Data were analysed using SPSS 24.0. Data from the lateral cephalogram of 79 patients, consisting of 18 (22.8%) males and 61 (77.2%) femaleswho met the inclusion criteria, were analysed.The sample included 15 low-angle, 45 normal vertical growth, and 19 high-angle cases. Fifty participants had Class I skeletal relationships, while 29 had Class II relationships. According to the ANOVA test, FH / ML and NS / ML measurements showed no statistically significant variations in tongue position and growth trends. There was no statistically significant difference between tongue position and facial morphology of Class I or II subjects with different vertical growth patterns. However, there was a statistically sufficient evidence showing the tongue height was greater in Class I skeletal relationship patients as compared to Class II skeletal cases (p = 0.008). Tongue position, Tongue space, Tongue length, Growth pattern.

The diagnostic work-up in a 2-year-old girl with persistent mouth opening and oral malfunctions of unknown aetiology – case report

This study presents possible causes of recurrent prolonged episodes of oral malfunctions manifesting as permanently open mouth, salivation, and deglutition disorders. We present the case study of a girl hospitalised in the paediatric ward and then diagnosed by a multidisciplinary approach due to the lack of active and passive ability of mouth closing. Despite the comprehensive diagnostic work-up performed, no typical causes or organic reasons were determined. The comparative analysis included infectious, neurological, laryngological, vascular and orthopaedic diseases, and psychological and psychiatric factors. The diagnosis was made by exclusion; the psychological and habitual background was approved as the most probable reason for the symptoms.

Pathogen Surveillance in Swallows (family Hirundinidae): Investigation into Role as Avian Influenza Vector in Eastern Canada Agricultural Landscapes.

First detected in Atlantic Canada in December 2021, highly pathogenic avian influenza virus (HPAIV) subtype H5N1 clade 2.3.4.4b, A/Goose/Guangdong/1/96 lineage, has caused massive mortality in wild birds and domestic poultry in North America. Swallows (Hirundinidae), abundant in North American agricultural ecosystems, have been proposed as possible (bridge) species for HPAIV transmission between wild and domestic birds. We aimed to seek evidence of the potential role of swallows in bridging AIV infection between wild bird reservoirs and poultry flocks in eastern Canada. During a wide-scale outbreak of HPAIV in wild birds and poultry farms across eastern Canada, 200 samples were collected from swallow breeding sites in the Canadian provinces of New Brunswick, Nova Scotia, Ontario, and Quebec, June-August 2022. Samples came from Barn Swallow (Hirundo rustica; n=142), Tree Swallow (Tachycineta bicolor; n=56), and Cliff Swallow (Petrochelidon pyrrhonota; n=2) nests. All samples tested negative for AIV, suggesting that HPAIV and low pathogenic AIV (LPAIV) strains were probably not circulating widely in swallows during the 2022 breeding season in eastern Canada; thus swallows may present a low risk of transmitting AIV. Within a management context, these findings suggest that removing nests of Barn Swallows, a species at risk in Canada, from the exterior of biosecure domestic poultry facilities may not significantly reduce risks of HPAI transmission to poultry.

Back Stimulation with Gaussian Frequency Biphasic Burst Stimulation for Swallowing Motor Activation

Aspiration of food containing bacteria or saliva into the trachea, leading to bacterial lung infection, is termed aspiration pneumonia. In the United States, aspiration pneumonia results in over 57,000 deaths annually, constituting 2.3% of the total mortality. Similarly, according to data from 2021 in Japan, more than 49,000 individuals succumbed to aspiration pneumonia, accounting for approximately 3.4% of the total mortality, making it the sixth leading cause of death in Japan. Notably, the risk of mortality due to aspiration pneumonia can be mitigated through early detection and prevention of swallowing disorders. Consequently, this research focuses on rehabilitation strategies for swallowing disorders. Swallowing is a coordinated motor function, orchestrated by a program involving multiple muscles under the directives of the Swallow Central Pattern Generator (CPG) located in the medulla. Thus, activation of the Swallowing CPG is pivotal for effective swallowing rehabilitation. To this end, we propose a novel method to activate the Swallow CPG by electrical stimulating of the back. The back has been recognized as a site that activates the expiratory phase of respiration, where the swallow reflex is often triggered. Moreover, given the adjacency of the Swallowing CPG and the Respiratory CPG, we postulate that stimulating the back to activate the expiratory phase can lead to enhanced activation of swallowing movements. Methods: Surface electrodes were placed on the back (T9~T10) and neck of adult rats. Initially, burst stimuli of two polarities were randomly generated at frequencies of either 30 Hz or 300 Hz in accordance with a Gaussian distribution at one of the two sites. The electric stimuli were applied for 120 seconds, three times at each location. To evaluate the impact of stimulus frequency and location on swallowing movements, we compared four groups (n=4 in each group). Following stimulation at one site, identical waveforms of stimulation were administered to both the back and neck for 120 seconds, three times. Swallowing was induced by water injection into the mouth after each stimulation. Electromyography (EMG) of three swallow-related muscles (mylohyoid, thyroarytenoid, and thyropharyngeus) was recorded and their amplitudes compared, both before stimulation (control) and after six consecutive stimulations. Results: It was observed that stimulation of both the back and neck resulted in larger maximum muscle potentials in all measured cases. Furthermore, the lower frequency of 30 Hz yielded larger muscle potentials than 300 Hz. Statistical analysis revealed that back stimulation led to early activation of the thyropharyngeus muscle compared to neck stimulation. Conclusion: The discovery that burst electrical stimulation with Gaussian frequency applied to the back activates swallow muscle groups suggests a potential novel swallow therapy option. This work was supported by NIH grants HL 111215, HL 103415 and OT20D001983, the Craig H. Neilsen Foundation Pilot Research Grant 546714, Kentucky Spinal Cord and Head Injury Research Trust, the Commonwealth of Kentucky Challenge for Excellence, and Grant-in-Aid for JSPS Fellows Number JP23KJ0966. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Nodose afferent fibers require PIEZO2 for esophageal mechanosensation

The esophagus receives dual innervation of extrinsic afferent fibers from both the dorsal root ganglia as well as the vagal ganglia. These are polymodal sensory afferents that are able to sense a variety of stimuli that include chemical and mechanical stimuli. Previous research has demonstrated that the esophagus is innervated by low threshold mechanoreceptors arising from the nodose ganglia, which provide critical peripheral feedback that is required for proper swallowing and peristaltic reflexes. We know that in the vagal system, PIEZO2 plays a critical role in lung inflation and baroreceptor function in the aorta and carotid sinus. Hence, we hypothesize that PIEZO2 is the mechanotransducer in these nodose esophageal low threshold mechanoreceptors. We used a two-pronged approach to elucidate PIEZO2’s role in esophageal mechanosensation: first, GCaMP6s imaging and then single fiber electrophysiology to understand the kinetics of nodose esophageal afferent fiber activation. Both of these approaches used our ex-vivo intact vagal esophageal preparation. Our proof-of-principle studies were conducted in PIRT-GCaMP6s mice, obtained through the crossbreeding of Pirt-Cre (Cre expressed in all sensory neurons) mice with Cre-dependent, ROSA26 based, GCaMP6s reporter (B6.129S6-Gt(ROSA)26Sor-tm96(CAG-CGaMP6s)Hze). Our preliminary data in Pirt-GCaMP6s mice showed a profound increase in the Ca2+ influx in a subset of nodose neurons in response to mechanical distention of the esophagus at 5, 10, and 30mmHg pressures. For our knockout group, we obtained nodose-specific knockout of PIEZO2 by crossing P2X2-Cre mice (P2X2 is expressed in all nodose neurons) with PIEZO2fl/fl mice (P2X2/PIEZO2 KO mice). Upon performing our GCaMP6s imaging experiments in this group, we saw that there was a significant reduction in the number of nodose neurons that were responsive to esophageal distention (58% down to 17%). Comparing the fluorescence intensities of all esophageal neurons between the control and KO groups, we observed a significant reduction at all three intraesophageal pressures (p&lt;0.05, n=458 and 395 neurons in control and KO groups, respectively). In our single fiber electrophysiology experiments, our control and KO groups were PIEZO2fl/fl mice and P2X2/PIEZO2 KO respectively. We were able to successfully record APs from A-fiber mechanosensitive esophageal neurons. The number of APs recorded from KO group was reduced at all the three intraesophageal pressures when compared to the control PIEZO2fl/fl mice. Our findings support the hypothesis that PIEZO2 is the mechanotransduction protein involved in vagal nodose afferent fibers innervating the esophagus. NIH. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Design an Automatic Condenser in Swallow Bird House

This design is a system development carried out by swallow breeders in stabilizing the temperature and humidity of swallow houses. This design uses the principles of the Internet of Things (IoT), which will monitor temperature and humidity through internet media. This design aims to make a temperature and humidity control system in the swallow house automatically and find out the level of accuracy of temperature and humidity readings in the design made. This design uses a Wemos D1 Mini Board microcontroller that controls components such as DHT22 sensors, DS18B20 sensors and relays. The result of this design can control the condenser automatically, when the temperature and humidity are above the standard temperature, it will turn on the condenser automatically.

Neuroendocrine cells initiate protective upper airway reflexes.

Airway neuroendocrine (NE) cells have been proposed to serve as specialized sensory epithelial cells that modulate respiratory behavior by communicating with nearby nerve endings. However, their functional properties and physiological roles in the healthy lung, trachea, and larynx remain largely unknown. In this work, we show that murine NE cells in these compartments have distinct biophysical properties but share sensitivity to two commonly aspirated noxious stimuli, water and acid. Moreover, we found that tracheal and laryngeal NE cells protect the airways by releasing adenosine 5'-triphosphate (ATP) to activate purinoreceptive sensory neurons that initiate swallowing and expiratory reflexes. Our work uncovers the broad molecular and biophysical diversity of NE cells across the airways and reveals mechanisms by which these specialized excitable cells serve as sentinels for activating protective responses.

Evaluation of risk factors for postoperative neurologic intensive care admission after brain tumor craniotomy: A single-center longitudinal study.

Perioperative variable parameters can be significant risk factors for postoperative intensive care unit (ICU) admission after elective craniotomy for intracranial neoplasm, as assessed by various scoring systems such as Cranio Score. This observational study evaluates the relationship between these factors and early postoperative neurological complications necessitating ICU admission. In total, 119 patients, aged 18 years and above, of either sex, American Society of Anesthesiologists (ASA) grades I-III, scheduled for elective craniotomy and tumor excision were included. The primary objective was to evaluate the relationship between perioperative risk factors and the incidence of early postoperative complications as a means of validation of the Cranio Score. The secondary outcomes studied were 30-day postoperative morbidity/mortality and the association with patient-related risk factors. Forty-five of 119 patients (37.82%) required postoperative ICU care with the mean duration of ICU stay being 1.92 ± 4.91 days. Tumor location (frontal/infratemporal region), preoperative deglutition disorder, Glasgow Coma Scale (GCS) less than 15, motor deficit, cerebellar deficit, midline shift >3 mm, mass effect, tumor size, use of blood products, lateral position, inotropic support, elevated systolic/mean arterial pressures, and duration of anesthesia/surgery were associated with a higher incidence of ICU care. Maximum (P = 0.035, AOR = 1.130) and minimum systolic arterial pressures (P = 0.022, Adjusted Odds Ratio (AOR) = 0.861) were the only independent risk factors. Cranio Score was found to be an accurate predictor of complications at a cut-off point of >10.52%. The preoperative motor deficit was the only independent risk factor associated with 30-day morbidity (AOR = 4.66). Perioperative hemodynamic effects are an independent predictor of postoperative ICU requirement. Further Cranio Score is shown to be a good scoring system for postoperative complications.

Nesting habitat of the Brown-throated Martin Riparia paludicola mauritanica in Morocco

The Brown-throated Martin Riparia paludicola (subspecies mauritanica) of family Hirundinidae is endemic to Morocco and known for its ability to dig tunnels in earthen banks in which it nests. The nature of the sediment and the morphological features of the nest holes and riverbank habitat have not been thoroughly described across the species’ range in Morocco. Here, we present a qualitative and quantitative analysis of the textural characteristics of the sediment chosen by the martins in two successive breeding seasons, using a sample of 104 nests, which covered most of the species’ distribution range in Morocco. We also studied the surrounding landscape and morphological features of a total of 114 nests. Our observations show that besides nesting in natural riverbank habitat, the Brown-throated Martin can use both manmade embankments and substrates (even cement and concrete) to carry out a successful breeding cycle. This study provides important information on the nesting habitat of the Brown-throated Martin across Morocco. We believe that such descriptive work can help with the conservation of this Moroccan endemic by better targeting the right habitat to either protect or restore. The findings also include information useful to assist in creating new nesting sites for the species.

Paraneoplastic Syndrome: A Missed Diagnosis

AbstractParaneoplastic syndrome can involve a single organ or diverse organ systems. It is one of the rare manifestations of occult malignancy. A 47-year-old female patient with history of recent suspected herpes infection presented with features of extensive skin darkening and thickening, associated with poor swallowing and cough reflex. Patient was not able to lift both arms nor able to sit or stand which was suggestive of proximal muscle weakness involving the shoulders and hip. Patient's initial workup for autoimmune disorders including dermatomyositis was negative. With paraneoplastic syndrome as differential diagnosis contrast-enhanced computed tomography chest and abdomen and tumor markers CA125 and CA19.9 done showed no evidence of occult malignancy. Patient was started on empirical steroids for polyradiculoneuropathy. After starting steroids patients was able to sit and walk with support. Patient was able to swallow liquids without aspiration. On regular follow-up over a period of 3 months, patient developed abdomen pain and abdominal distention which on evaluation showed ascites and multiple new cystic ovarian lesions suggestive of ovarian malignancy. Patient's CA125 was repeated and was markedly elevated. Patient was referred to an oncologist and was started on chemotherapy along with immunosuppressants. This case report emphasizes the need for regular follow-up of patients suspected of paraneoplastic syndrome. Although the initial workup for malignancy did not give a clue, on periodic review we were able to make the primary diagnosis and start appropriate treatment and achieve a better patient survival.

Short-term and long-term effects of unilateral external carotid artery ligation on orofacial functions in rats.

The external carotid artery (ECA) plays a major role in supplying blood to the head and neck. Although impeded blood flow in the ECA is expected to affect orofacial functions, few studies have shown how blood flow obstruction in the ECA contributes to impairment of these functions, including chewing and swallowing. This study was performed to investigate the effects of ECA ligation (ECAL) on immediate and long-term changes in masticatory and swallowing functions as well as the jaw-opening reflex evoked in the digastric muscle. The experiments were carried out using male Sprague-Dawley rats. In the acute experiment, the digastric reflex evoked by low-threshold electrical stimulation of the inferior alveolar nerve and the swallow reflex, identified by digastric and thyrohyoid electromyographic (EMG) bursts, were compared between before and 1 h after ECAL. The chronic experiment was conducted on freely moving rats. EMGs of the masseter, digastric, and thyrohyoid muscles were chronically recorded. The long-term effects of ECAL on behavior and muscle histology were compared between rats with an intact ECA and rats with ECAL. In the acute experiment, the peak amplitude of the digastric reflex on the ECAL side was significantly decreased 1 h after ECAL. In the chronic experiment, although most parameters of the masticatory and swallowing EMGs were not significantly different between the groups, the results suggest wide variation of the effect of ECAL on the muscles. Blood supply compensation from collaterals of the internal carotid artery may be permanent in some animals.NEW & NOTEWORTHY The inhibitory effect of unilateral external carotid artery ligation (ECAL) on the ipsilateral digastric reflex was small but evident. Most parameters of masticatory and swallowing muscle activity were not significantly different after ECAL. Wide variation was noted in the effect of ECAL on the ipsilateral muscle activity. Blood supply compensation from collaterals of the internal carotid artery may occur in response to the impaired blood flow.

Eagle’s syndrome. A clinical case

Eagle syndrome represents the set of symptoms caused by the elongation of styloid process. This can trigger the irritation of neuro–vascular structures near its vicinity, for example the glossopharyngeal nerve that can lead to deglutition disorders, dysphagia, globus sensation, neck and facial pain, headache. It is a diagnosis of exclusion and needs a high level of clinical suspicion being a rare condition without reports of incidence in the population of Moldova. In this article we present a case of bilateral elongation of styloid processes that caused persistent neck and facial pain in a patient that does not respond to analgetic drugs. The patient underwent unilateral styloidectomy by cervical approach, which resulted for the symptoms to disappear.