Degree Of Dysphagia Research Articles

Long-term postoperative regional analgesia of the lower third of the face in patients with tumors of the oral cavity

Pain has a certain number of physical, psychological and social consequences. Pain is of particular importance in the postoperative period for patients with tumors of the oral cavity and of the oropharynx. The effectiveness of analgesia in the postoperative period is a serious problem in maxillofacial surgery. Postoperative pain is not always removable, sometimes it becomes chronic. Pronounced pain syndrome in the postoperative period is experienced by 40 to 75% of patients, but 50% of patients experience pain of medium and high intensity. The aim of this study was a comparative assessment of the effectiveness of a new alternative method of a long-term postoperative regional analgesia and the use of non-narcotic analgesics in patients with tumors of the oral cavity and oropharynx in the postoperative period. The study was conducted in 48 patients (38 men, 10 women, average age 58,05±12,31 years) with tumors of the oral cavity and oropharynx. Patients were divided into two groups depending on the method of postoperative analgesia. In the main group (22 patients) pain was suppressed by a long-term postoperative regional analgesia. In the control group (26 patients) analgesia was performed with non-narcotic analgesics. To control the effectiveness of analgesia, a visual analog scale was used, the duration of analgesia and the manifestation of dysphagia on the day 1, 3 and 10 after surgical intervention as well as similar effects were assessed. On the day 10 of using a long-term postoperative regional analgesia, a positive trend towards a reduction in pain syndrome was observed (2.0±0.63), in contrast to drugs of general action (p<0.05). Over the course of a long-term postoperative regional analgesia it was noted that analgesic effect increases from blockade to blockade. In 80% of patients of the main group, stage II-IVa the act of swallowing was nearly restored, only in 2 patients 2 degree of dysphagia was observed (p<0.05). The advantage of the proposed method in the adequacy and duration of analgesia was established (p<0.05), as well as a lower frequency of side effects – 9.1% and 23.3%, and restoration of act of swallowing (p<0.05). The technique of long-term postoperative regional analgesia allows reducing the invasiveness of the manipulation.

255 Preliminary findings from a prospective cohort study of Ireland’s first community Fibreoptic Endoscopic Evaluation of Swallowing (cFEES) service

Abstract Background Dysphagia is a common and resource-demanding symptom of many conditions. Dysphagia prevalence increases with age and can affect quality of life, nutritional status, hydration and increase healthcare utilisation/cost. Instrumental swallowing assessment is essential for accurate diagnosis and treatment. FEES is a gold standard diagnostic tool carried out by speech and language therapists (SLTs), typically in the acute setting. The aim of this study is to profile participants who accessed Ireland’s first cFEES service by describing clinical and process outcomes. Methods Adult patients referred for cFEES were invited to participate. Demographic, clinical and process data were recorded at index visit. A structured phone interview was completed at six months. Descriptive analysis was completed. Results In total, 53 participants were included: 70% were aged >65 years, median age was 72. Diagnoses included progressive neurological conditions such as motor neuron disease, multiple sclerosis and others (23%), Parkinson’s Disease, including Parkinson’s Plus Syndromes (15%), stroke (13%), head and neck cancer (11%), dysphagia unknown aetiology (9%), other (9%), chronic obstructive pulmonary disease (8%), other cancers (6%), and gastro-oesophageal reflux disease (4%). Nutritional status was screened using the Malnutrition Universal Screening Tool (MUST) at index visit for 44 participants. Of those, 23% (N = 10) had a MUST score ≥ 1. Dysphagia Outcome Severity Scale was used to rate swallowing: 43% had some degree of dysphagia (mild to severe). FEES referrals originated mainly from primary care SLTs: 75%, the remaining 25% from older person’s services (community nursing facilities, inpatient rehabilitation and integrated care for older persons). One participant was unable to tolerate the procedure, which was abandoned. Three participants experienced non-limiting gagging or hypersensitivity. Conclusion cFEES is a novel service model which was accessed mainly by older people. cFEES was tolerated well by most, leading to evidence-based outcomes including ruling out significant dysphagia in 57% of cases.

Acoustic Voice Analysis as a Useful Tool to Discriminate Different ALS Phenotypes.

Approximately 80-96% of people with amyotrophic lateral sclerosis (ALS) become unable to speak during the disease progression. Assessing upper and lower motor neuron impairment in bulbar regions of ALS patients remains challenging, particularly in distinguishing spastic and flaccid dysarthria. This study aimed to evaluate acoustic voice parameters as useful biomarkers to discriminate ALS clinical phenotypes. Triangular vowel space area (tVSA), alternating motion rates (AMRs), and sequential motion rates (SMRs) were analyzed in 36 ALS patients and 20 sex/age-matched healthy controls (HCs). tVSA, AMR, and SMR values significantly differed between ALS and HCs, and between ALS with prevalent upper (pUMN) and lower motor neuron (pLMN) impairment. tVSA showed higher accuracy in discriminating pUMN from pLMN patients. AMR and SMR were significantly lower in patients with bulbar onset than those with spinal onset, both with and without bulbar symptoms. Furthermore, these values were also lower in patients with spinal onset associated with bulbar symptoms than in those with spinal onset alone. Additionally, AMR and SMR values correlated with the degree of dysphagia. Acoustic voice analysis may be considered a useful prognostic tool to differentiate spastic and flaccid dysarthria and to assess the degree of bulbar involvement in ALS.

Intensive Dysphagia Rehabilitation Program Post Covid-19: Case Series Report

Dysphagia often occurs in the most severe cases of Covid-19 infection and has an impact on clinical outcomes and patients’ quality of life. Objective: This study aimed to describe the effects of intensive speech rehabilitation in cases of post-Covid-19 dysphagia in a hospital environment. Methods: This is a series of five patients admitted to a medical ward between May and August 2021. They were dysphagic, underwent orotracheal intubation and were submitted to evaluation and intensive speech therapy for five consecutive days. The intervention involved myofunctional exercises and in three cases electrical stimulation were also associated. The outcomes were: evolution of the Functional Oral Intake Scale (FOIS) and Penetration-Aspiration Scale (PAS) - according to videofluoroscopy - degree of dysphagia according to the Dysphagia Outcome and Severity Scale (DOSS) and improvement in quality of life (SWAL-QOL). Results: After therapy, one patient remained with severe dysphagia, two evolved to mild dysphagia, and two to functional deglutition. In four cases, there was an evolution of the PAS to level 1, showing reduction of aspiration episodes and laryngotracheal penetration, FOIS level 6 and improvement in the quality-of-life questionnaire scores. Conclusion: The therapy promoted an increase in the levels of oral intake, a reduction in the degree of severity of dysphagia and episodes of penetration and laryngotracheal aspiration, in addition to an improvement in the quality of life index in four of the five patients in this series.

Research on Relationship Between Dysphagia and Sudden Death After Medullary Infarction.

Medullary infarction (MI) often leads to severe dysphagia and sudden death. We investigated whether dysphagia was associated with sudden death. Patients with MI were divided into sudden death group and nonsudden death group. Dysphagia was evaluated in 2 ways: the water-swallowing test (WST) points and the degree of dysphagia. Random undersampling (RUS), random oversampling (ROS), and synthetic minority oversampling technique (SMOTE) techniques were used to process the original data and solve the imbalance problem between 2 classes. Univariate and multivariate logistic regressions were used to analyze the association between the independent variables (WST and degree of dysphagia) and the dependent variable (sudden death or not), while the National Institutes of Health Stroke Scale (NIHSS) score was used as a control. Univariate logistic regression analysis showed that for all resampling methods, both the WST and NIHSS were risk factors for sudden death after MI. For multivariable logistic regression, the fitting effect of RUS logistic regression was satisfactory, which showed the same results. The results of the univariate logistic regression analysis of dysphagia degree showed that for all resampling methods, compared with no dysphagia, both mild to moderate dysphagia degree and severe dysphagia degree were risk factors for sudden death. For multivariable logistic regressions, the logistic regressions of the original data and the RUS resampling method were satisfactory which showed the same results. Dysphagia is closely related to sudden death after MI. The more severe the dysphagia, the higher is the incidence of sudden death.

Evaluation of antireflux surgery effectiveness in patients with hiatal hernia

The generally accepted gold standard in the surgical treatment of hiatal hernias is laparoscopic fundoplication with cruroplasty. At the same time, the problem of choosing the best method of fundoplication to improve the results of surgical intervention remains disputable. Aim. Determination of the effectiveness of antireflux interventions and the frequency of postoperative dysphagia in patients with esophageal hernia. Materials and methods. The results of 38 patients in the early and late postoperative period, operated with the use of Nissen and Toupet fundoplication, with an integrated exhaustive examination of the manifestations of dysphagia syndrome were analyzed. 17 (44.7 %) patients (first group) underwent laparoscopic posterior crurorraphy with Nissen fundoplication in the Short-Floppy-Nissen modification, and 21 (55.3 %) patients (second group) underwent posterior crurorraphy with Toupet fundoplication. Results. In the postoperative period, the intensity of pain on the rating scale was minimal in 70.6 % and 71.4 %; moderate in 23.5 % and 14.3 %; strong in 5.9 % and 14.3 % of the patients in the first and second groups, respectively. The first degree of dysphagia (the ability to ingest liquid food and fluids) was observed in 5 of 17 (29.4%) patients of the first group, with subsequent regression in 4 of 5 patients within 5 days; in the second group there was no dysphagia. When comparing the results of all scales of integrated analysis of the quality of life of the patients of both groups, no significant difference was found between them. Conclusions. The obtained data demonstrate the compatibility of both methods, in the absence of differences in quality of life and patient’s satisfaction in the late postoperative period. Differences in the frequency of dysphagia syndrome after surgery indicate the need for a more differentiated approach to the choice of fundoplication technique.

Possibilities of endoscopic evaluation of swallowing function in patients with chronic disorders of consciousness

BACKGROUND: The period of coma in some patients after severe brain damage ends with a transition to one of the forms of chronic disorders of consciousness ― a vegetative state/unresponsive wakefulness syndrome or a minimally conscious state. Almost all patients with chronic disorders of consciousness have dysphagia of varying severity, and therefore nutrition of this category of patients is carried out initially through a nasogastric tube, and then through a gastrostomy. Early tracheostomy cannula removal may lead to the development of aspiration and pneumonia. Dysphagia is often not diagnosed in chronic disorders of consciousness patients.
 AIMS: Analysis of the results of fibrooptic endoscopic assessment of swallowing in chronic disorders of consciousness patients to identify the relationship between the presence and severity of dysphagia with the level of consciousness, data on the coma recovery scale, as well as the duration of consciousness disorders and dynamics of recovery of consciousness.
 MATERIALS AND METHODS: The study was of a prospective type, conducted in the period from 2019 to 2021. 39 chronic disorders of consciousness patients (18 ― vegetative state/unresponsive wakefulness syndrome, 18 ― minimally conscious state "minus" and minimally conscious state "plus" and 3 patients with a level of consciousness corresponding to the emergence from the minimally conscious state). The average duration of chronic disorders of consciousness was 7.79.4 months. All patients underwent a neurological examination using the CRS-R upon admission to the hospital and a month later, an endoscopic examination of the swallowing function was performed with scores calculated according to the Federal Endoscopic Dysphagia Severity Assessment Scale (FEDSS) and aspiration assessment scale in accordance with the Rosenbek criteria.
 RESULTS: Dysphagia of varying severity was detected in 36 patients (92.3%). The correlation of the total CRS-R score with the degree of dysphagia (Ro=-0.481, p=0.002) was found. The degree of dysphagia did not depend on the chronic disorders of consciousness duration.
 CONCLUSION: Regardless of the chronic disorders of consciousness severity (vegetative state/unresponsive wakefulness syndrome, minimally conscious state "minus", minimally conscious state "plus") before tracheostomy removing and switching to the oral feeding, it is necessary to perform fibrooptic endoscopic studies of swallowing to detect dysphagia, determine its degree, which is a method of preventing complications of the decanulation consequences.

Swallowing outcome to speech therapy intervention in resistant hypertensive patients with obstructive sleep apnea.

PurposeTo evaluate (i) the outcome of swallowing therapy program on the rehabilitation of oropharyngeal dysphagia in resistant hypertensive patients with obstructive sleep apnea (OSA) and (ii) the association between the clinical and anthropometric characteristics of these individuals and this outcome.MethodsThis was a prospective interventional study in which resistant hypertensives diagnosed with OSA by polysomnography and dysphagia by fiberoptic endoscopic evaluation of swallowing (FESS) participated. All participants underwent a FEES and assessment of the risk of dysphagia (Eating Assessment Tool, EAT-10) and swallowing-related quality of life (Swal–QoL) before and after the intervention. The therapeutic program was performed daily by the participants, with weekly speech-therapist supervision for eight weeks, including the following strategies: Masako, chin tuck against resistance, and expiratory muscle training.ResultsA total of 26 (78.8%) of the participants exhibited improvement in the degree of dysphagia in the intervention outcome. After the intervention, there was a statistically significant improvement in the level of penetration–aspiration (p = 0.007), the degree of pharyngeal residue (p = 0.001), the site of onset of the pharyngeal phase (p = 0.001), and the severity of dysphagia (p = 0.001) compared to before intervention. The EAT-10 score was 2 (0–6) before and 0 (0–3) after intervention (p = 0.023). Swal–QoL had a score on the symptom frequency domain of 92.8 (75–100) before and 98.2 (87.5–100) after intervention (p = 0.002).ConclusionsResistant hypertensive patients with OSA showed improved swallowing performance after swallowing therapy program.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00405-022-07612-3.

Anterior servikal omurga cerrahisi sonrası farklı endotrakeal tüp kaf basınçlarının disfajı üzerine etkileri

of two different endotracheal cuff pressures on postoperative dysphagia, sore throat, dysphonia, and hospital stay in anterior cervical spine surgery.
 Materials and Methods: Seventy patients scheduled for surgery were randomly divided into two groups. After intubation, the endotracheal cuff pressure was inflated to 20 cmH2O and 25 cmH2O in Group I (n=35) and Group II (n=35), respectively. The degree of dysphagia was assessed with the Bazaz dysphagia score. The sore throat was evaluated via Visual Analog Scale. Total pain score regarding the operation site was evaluated using VAS. Hoarseness was evaluated based on the presence of any changes to the voice asharsh or strained. Dysphagia, dysphonia, and sore throat were assessed on the post-surgical 1st and 24th hours. 
 Results: No differences in demographic data were present between the groups. Dysphagia and sore throat at the post-surgical 1st and 24th hours were significantly lesser in Group I than in Group II. The frequency of dysphonia was significantly less in Group I than compared to Group II only at the post-surgical 1st hour. No differences in VAS scores at the post-surgical 1st and 24th hours were present between the groups. 
 Conclusion: In this study, it was shown that the risk of developing dysphagia after surgery was significantly reduced with 20 cmH2O endotracheal cuff pressure compared to 25 cmH2O. Also, lower cuff pressure was associated with a milder sore throat, less hoarseness at 1 hour postoperatively, and a shorter hospital stay.

Combined conventional speech therapy and functional electrical stimulation in acute stroke patients with dyphagia: a randomized controlled trial

BackgroundStroke is the main cause of oropharyngeal neurogenic dysphagia. Electrostimulation has been used as a therapeutic tool in these cases. However, there are few studies that prove its effectiveness. We evaluated the effect of functional electrostimulation as a complement to conventional speech therapy in patients with dysphagia after a stroke in a stroke unit.MethodsWe performed a clinical, randomized, and controlled trial divided into intervention group (IG) (n = 16) and control group (CG) (n = 17). All patients were treated with conventional speech therapy, and the IG also was submitted to the functional electrotherapy. Primary outcomes were Functional Oral Ingestion Scale (FOIS) and Swallowing videoendoscopy (FEES). The degree of dysphagia was scored in functional, mild, moderate and severe dysphagia according to FEES procedure. Dysphagia Risk Evaluation Protocol (DREP) was considered a secondary outcome.ResultsThere was a significant difference regarding FOIS scores after 5 days of intervention in groups. Both groups also showed a tendency to improve dysphagia levels measured by FEES, although not statistically significant. Improvements on oral feeding was seen in both groups. No significant differences between groups before and after the intervention were detected by DREP scores. Electrical stimulation did not show additional benefits beyond conventional therapy when comparing outcomes between groups.ConclusionConventional speech therapy improved oral ingestion even regardless the use of electrostimulation in a stroke unit.Trial registrationThis research was registered in ClinicalTrials.gov (Identifier: NCT03649295) in 28/08/2018 and in the Brazilian Registry of Clinical Trials (ReBEC) (Register Number: RBR-56QK5J), approval date: 18/12/2018. HGF Ethics Committee Approval Number: N. 2.388.931.

Dysphagia Continues to Impact Recovery at One Year After Stroke-An Observational Study

ObjectivesDysphagia is one of the most common medical complication after acute stroke, which can impact hospital stay and discharge outcome. Here we sought to study the predictors and 1 year outcome of patients with acute post stroke dysphagia. MethodsSingle centre hospital based observational study of all acute ischemic stroke patients who had undergone formal swallow assessment within 24 hours of admission with a 1 year completed follow-up were recruited by screening of medical records. Clinical, imaging and swallow assessment details were extracted as per proforma. 3 month and 1 year outcome were assessed using modified Rankin scale. Correlations were made with clinical and imaging findings, in hospital worsening and dysphagia at discharge with short and long term functional outcome. ResultsWe had 469 patients included in our study, with a mean age 61. 04(±19. 09) years and median NIHSS 9. 52(IQR 4). 56. 75% of AIS patients had some degree of dysphagia at admission. We found that admission stroke severity and in-hospital worsening were independently predictive of severe swallow dysfunction at discharge. At 3-4 weeks after stroke, only 20.27% of the patients with moderate-severe dysphagia at baseline has persistent swallow deficits requiring modification of feeds. Dysphagia continued to have a significant association with outcome at 1 year, independent of admission stroke severity. ConclusionsMajority of patients with acute post stroke dysphagia recover well within 3-4 weeks after stroke. Patients with post stroke dysphagia had more in hospital neurological worsening. Post stroke dysphagia continued to have an impact on functional outcome up to 1 year after stroke.

Correlation between our symptom-based scoring system and the Eckardt score for assessing patients with esophageal achalasia.

The Eckardt score (ES) is a famous scoring system used for assessing achalasia patients. We studied the correlation between our scoring system and the ES and examined the relationship between each score and the pathophysiology of achalasia. The subjects were 143 patients with diagnosed achalasia. We assessed the frequency and degree of dysphagia, regurgitation (vomiting), and chest pain on a 5-point scale from 0 to 4, with the product of the frequency and degree score defined as each symptom score (0-16). The sum of the three symptom scores was the Total Symptom Score (TSS). We then studied the correlation between the TSS and the ES, including whether these scores reflected the pathophysiology. The median scores were 20 for TSS and 6 for the ES, indicating a high correlation between the two scores (r = 0.7280, p < 0.0001). A relationship was found between the morphologic type and both scores (TSS: p = 0.002, ES: p = 0.0036). On creating a receiver operating characteristic (ROC) curve for the Straight type and each score, the AUC was 0.6740 for TSS and 0.6628 for ES. A high positive correlation was found between the TSS and the ES. Both scoring systems reflected the morphologic type well, demonstrating that the TSS was a scoring system comparable to the ES.

Dysphagia, Fear of Choking and Preventive Measures in Patients with Huntington\u2019s Disease: The Perspectives of Patients and Caregivers in Long-Term Care

ObjectivesTo explore the prevalence of dysphagia and fear of choking in patients with Huntington’s disease (HD) as well as preventive measures, both those applied and those not included in managing dysphagia. Also, to investigate related problems encountered by their formal and informal caregivers.DesignA multi-center observational cross-sectional studySetting and Participants158 HD patients, recruited from six Dutch nursing homes specialized in HD, and their formal and informal caregiversMeasurementsPatients were assessed by means of questionnaires enquiring about dysphagia, fear of choking and measures to manage dysphagia. Also, questionnaires were administered about awareness of dysphagia symptoms, cognition and anxiety. Because we expected individuals with greater care dependency to have a higher severity of dysphagia, we distinguished between a care-independent and a care-dependent group of HD patients.ResultsIn the total group, 90.5% of HD patients had one or more dysphagia symptoms. The prevalence of FoC in HD patients and the formal and informal caregivers’ fears about choking in HD patients was 45.7%, 19.0% and 59.5%, respectively, for care-independent patients and 58.7%, 50.1% and 77.5% for care-dependent patients. The score on the Huntington’s Disease Dysphagia Scale was a predictor for fear of FoC in care-independent patients. Speech-language therapy, supervision during eating and drinking and adaptation of food and drink consistency were the most frequently applied measures to manage dysphagia, a combination was used in most HD patients.ConclusionsIn HD patients, the prevalence of dysphagia is high and fear of choking is common among both patients and caregivers. A more severe degree of dysphagia is a predictor of FoC in care-independent HD patients. A combination of measures was used to manage dysphagia in most HD patients.

Incidence and risk factors of pneumonia following acute traumatic cervical spinal cord Injury

Objectives To elucidate the incidence and risk factors for pneumonia after acute traumatic cervical spinal cord injury (CSCI) Design Retrospective cohort study. Setting: Spinal injuries center in Japan. Participants: Of 184 individuals who were admitted within 2 weeks after acute traumatic cervical spinal injuries, 167 individuals who met the criteria were included in this study. Interventions: The occurrence of pneumonia, degree of dysphagia using the Dysphagia Severity Scale, patient age, history of smoking, presence of tracheostomy, vital capacity, level of injury, and the American Spinal Injury Association Impairment Scale (AIS) 2 weeks after injury were assessed. Outcomes: Incidence of pneumonia were analyzed. Moreover, the risk factors of pneumonia were evaluated using logistic regression analysis. Results From the 167 individuals who met the criteria, 30 individuals (18%) had pneumonia; in 26 (87%) of these individuals, pneumonia was aspiration related, defined as Dysphagia Severity Scale ≤ 4. The median occurrence of aspiration pneumonia was 11.5 days after injury. A logistic regression analysis revealed that severe AIS and severe Dysphagia Severity Scale scores were significant risk factors of pneumonia after CSCI. Conclusions It was highly likely that the pneumonias following CSCI were related to aspiration based on the Dysphagia Severity Scale. In addition, most of the patients developed aspiration pneumonia within 1 month after injury. Aspiration and severe paralysis were significant risk factors for pneumonia. The treatment of dysphagia in the acute phase should be considered an important indicator to prevent pneumonia.

Autoavaliação da qualidade de vida, risco para disfagia e alteração de deglutição em pacientes internados com COVID-19

ABSTRACT Purpose: to identify the impact of swallowing changes and dysphagia complaints on quality-of-life and eating self-assessments of COVID-19 inpatients. Methods: the study comprised 54 COVID-19 inpatients above 18 years old, whose swallowing was clinically assessed by a speech-language-hearing therapist. They were classified regarding food intake (with the FOIS scale) and degree of dysphagia. They also filled out a sample characterization questionnaire and the SWAL-QOL and EAT-10 protocols. Results: the respiratory condition led to worse quality-of-life self-assessment Fatigue results, oral food intake and dysphagia severity classifications. Females had worse quality-of-life self-assessment Burden and Food selection scores. Swallowing complaints were associated with worse eating self-assessments. Patients at risk of dysphagia had worse quality-of-life self-assessments in five out of the 11 domains, worse oral food intake levels, and worse dysphagia severity. Conclusion: COVID-19 inpatients commonly have swallowing complaints and are at risk of dysphagia, with worse quality-of-life self-assessment, lower oral food intake classification, and worse dysphagia severity rating.

Sarcopenic dysphagia in institutionalised older adults

IntroductionSarcopenic dysphagia, defined as dysphagia caused by sarcopenia, is a swallowing disorder of great interest to the medical community. The objective of our study was to evaluate the prevalence and factors associated with sarcopenic dysphagia in institutionalised older adults. Material and methodsAn observational, analytical, cross-sectional study was conducted in a nursing home between September and December 2017, with 100 participants. The presence of dysphagia was assessed using the volume-viscosity clinical examination method, and the diagnostic algorithm for sarcopenic dysphagia was followed. The participants’ grip strength, gait speed, calf circumference, nutritional assessment (Mini Nutritional Assessment), Barthel Index, cognitive assessment (Mini-Mental State Examination) and Charlson Comorbidity Index were evaluated. Bivariate and multivariate logistic regression analyses were performed. ResultsThe median age was 84 years, and 55% were women; 48% had functional dependence, 49% had positive screening for malnutrition and 64% had some degree of dysphagia. The prevalence of sarcopenic dysphagia was 45%, and the main factors related to less sarcopenic dysphagia were a good nutritional status (OR 0.85, 95% CI, 0.72−0.99) and a better functional performance status (OR 0.98, 95% CI 0.97−0.98). ConclusionSarcopenic dysphagia has a high prevalence in institutionalised older adults; and functional dependence and poor nutritional status were associated with sarcopenic dysphagia.

Phenotype assessment in neurologically impaired paediatric patients: Impact of a nutrition intervention protocol

Deficits in nutritional status and functional feeding disorders are common in Neurologically Impaired Paediatric Patients (NIPP). Interventions addressing these problems could offer better overall health status and quality of life in this group of patients, but the extent of their effectiveness is yet to be determined. Recent guidelines concerning the nutritional care of NIPP have been published from ESPGHAN but compliance to them has not been assessed. The study aimed to assess the phenotypic profile of a group of NIPP attending the outpatient clinic of a pediatric department, and to implement, for the first time to our knowledge, an individualized nutritional intervention protocol following ESPGHAN guidelines 2017 as well as to assess the impact on phenotypic parameters and nutritional status. 68NIPP and their caregivers aged 1m-17 years (83.8% suffering from cerebral palsy (CP) were invited to assess their phenotypic parameters and to implement in a nutrition intervention protocol in order to improve their dietary intake and nutritional status. Anthropometry (weight, height, triceps skinfold thickness, mid upper arm circumference) was expressed as z-scores for age and sex using WHO Anthro software and classified following the WHO criteria. Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Dysphagia Disorder Survey (DDS), Saliva Severity Scale (SSS), gastrointestinal complications, energy and nutrient intake were assessed at the beginning (zero point), after 6 (point 1) and 12 (point 2) months period. Intake to Requirement ratio (I/R) was derived. At zero point, following the baseline evaluation, caregivers were advised and educated on nutrition protocol and customized nutrition plans were handed out. The impact of the nutritional intervention on the phenotypic parameters was recorded on follow up visits (points 1, 2).The primary outcomes analyzed were anthropometric parameters (Waz), as indicators of nutritional status. GMFCS, MACS, DDS, SSS, FA were evaluated as possible predictors of this outcome. Secondary outcomes included the impact of the intervention protocol on the phenotypic parameters during the study period. Based on weight for age z-score (Waz≤-2) (WHO) 17 patients (32.1%) were undernourished, 5/68 (10, 4%) were with triceps skinfold thickness z-score (TSTz) <-2 and 3/68 (7%) with mid upper arm circumference z-score (MUACz) <-2. Z-scores (WHO) for weight (p1=0, 036) (p2=0, 003), body mass index (BMI) (p2=0,000), MUAC (p1=0, 029) and TST (p1=0, 021) (p3=0, 044) were significantly improved in follow-up evaluations compared to the baseline. Less NIPP were found to be underweight according to Waz from point 1 to point 2 (p3=0, 006), as well as stunding according to height for age z-score (Haz) from point 1 to point 2 (p≤0,001). Patients with higher levels of GMFCS (p1=0,040), MACS (p1=0,028) DDS (p1=0,001) and SSS (p1=0,005) had significantly lower Haz. Patients with higher levels of SSS (p1=0,002) had significantly lower TSTz scores. There were no significant changes in the classification of NIPP according to DDS or the patients' feeding ability. The energy (kcals) intake/kg of body weight (bw) was significantly higher at point 2 compared to point zero (p3=0,028), protein intake/kg of body weight was significantly higher at points 1 and 2 compared to point zero (p1=0,026, p3=0,003), and fat intake/kg of body weight (bw) was significantly higher at point 2 compared to point zero (p3=0,012). Intake of energy (kcals)/bw (p1=0,026), (p2=0,046), (p3=0,048) carbs/bw (p1=0,014) (p2=0,042), I/R of pro (p1=0,032), (p3=0,013), and fat/kg (p2=0, 033) (p3=0,037) were found to be significantly lower in higher GMFCS levels. DQI did not improve during the study period nor correlated to any of the anthropometric parameters. Gastrointestinal complications correlated with Waz (r=-, 285 p1=0, 011). Feeding Ability (FA) was found to be the only strong predictor for Waz at baseline evaluation (p=0,012) when a multiple regression was run along with DDS. Underweight was detected in one third of the patients, some degree of dysphagia in 69% and gastrointestinal complications in 58.8% of the sample. Height for age z-score (Haz) was the anthropometric parameter most sensitive to the changes in ranking on motor and functional feeding scores. The implementation of a customized nutrition intervention protocol in line with ESPGHAN's guidelines had a beneficial effect on improving dietary intake and nutritional status of NIPP after a 12 months period. Better results could be expected if dysphagia and feeding ability were also addressed by appropriate intervention protocols. Patients' feeding ability is of importance for predicting Waz.

ASSESSMENT OF THE GENERAL CONDITION OF PATIENTS IN THE DETECTION OF MALIGNANT TUMORS OF THE MOUTH AND OROPHARYNX BEFORE TREATMENT AND IN THE POSTOPERATIVE PERIOD

The aim is to study the dynamics of weight, pain, psycho-emotional state in cancer patients with pathology of the oral cavity and oropharynx from the beginning of the disease and at the stages of treatment.&#x0D; Materials and methods The study included 45 patients, aged 38-55 years (men), who were treated in the Department of Head and Neck Tumors "Podilskyi Regional Oncology Center" with malignant tumors of the tongue, mouth and oropharynx stage I-III. All patients had problems with chewing and swallowing. The patient's weight, severity of the pain syndrome were determined by VAS, the degree of dysphagia and the psychological state according to the hospital scale of anxiety and depression (HADS) at the time of hospitalization and in the postoperative period for 3, 5, 7, 9, 12 days. The weight was determined 3-3 months after the first signs of the disease.&#x0D; Results Weight loss from the first signs of the disease to diagnosis and treatment is 6-9 kg. Preoperative nutritional training, which we conducted 1-1.5 weeks before surgery allowed to increase the patient's weight by only 1.0-1.5 kg in 32% of patients, and in the remaining 68% - only to stabilize the existing condition. That is, in most patients, the correction of nutritional status is a big problem and in some cases is unsuccessful.&#x0D; Patients have severe postoperative pain when swallowing, depending on the volume of surgery. Thus, it is more pronounced in patients with stage III, which manifested itself as weak and moderate. Mild stage patients were characterized by mild pain, and stage I patients were barely noticeable when swallowing. There were similar changes in dysphagia. Thus, patients with stage III disease had difficulty eating solid and gel foods, and some liquid, depending on the location of the tumor. Patients with stage II had problems mainly with the consumption of solid foods. Stage I patients mostly had stage I dysphagia. There is dysphagia of I-II degree up to 7 days in the postoperative period, which must be taken into account when choosing an additional therapeutic diet.&#x0D; An important factor is the anxiety and emotional state and mental disorders at the first signs of the tumor process, so these figures reached high values. This is due to the emotional response to the diagnosis, the complexity of the treatment, the concern for possible recurrences and the potential threat of death.&#x0D; Conclusions: &#x0D; &#x0D; Weight loss from the first signs of the disease is 6-9 kg, and in the postoperative period 4-7 kg. At 9-12 days, the stabilization of this indicator.&#x0D; The appointment of additional nutrition in the preoperative period in only 1/3 of patients leads to a slight increase in weight, and in 2/3 - is not effective.&#x0D; Patients have a pronounced pain in the postoperative period when swallowing (1.63-3.63).&#x0D; In the postoperative period, depression (12.44-16.23) and anxiety (11.75-13).&#x0D; &#x0D; Thus, patients in these groups need rational nutritional support in the form of additional nutrition and the development of their schemes, taking into account pain, dysphagia and correction of psycho-emotional state.&#x0D; Thus, patients in these groups need rational nutritional support in the form of additional nutrition and the development of their schemes, taking into account pain, dysphagia and correction of psycho-emotional state.

Functional outcomes in tongue reconstruction with myomucosal buccinator flaps

Buccal myomucosal local flaps in oral cavity reconstruction are a valid option for small-to-moderate defects. Nevertheless, few articles report about functional recovery. The purpose of the present analysis is to evaluate the impact of these flaps on function and quality of life. The study, retrospectively conducted on 36 patients who were surgically treated for tongue cancer between 2012 and 2018 at the Unit of Maxillo-Facial Surgery, Foundation IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (Italy), evaluates functional outcomes using the following 4 questionnaires: Performance Status Scale for Head and Neck Cancer Patients, M.D. Anderson Dysphagia Inventory, Speech Handicap Index, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module. All patients are able to eat soft or more solid foods, and most of them eat quietly in public. Although 50% of cases reported a certain degree of dysphagia, it does not impact self-esteem and social relationships. Only 20% of patients have severe problems with speech. However, more than half of the cases (65%) report oral problems. The collected data confirm the suitability of the myomucosal cheek flaps for tongue reconstruction. Most patients report a good functional recovery and satisfactory quality of life even if none of them has a recovery comparable to the presurgical state.

THERAPEUTIC TACTICS FOR PEPTIC STRICTURES OF THE ESOPHAGUS. LITERATURE REVIEW

The work is based on the analysis of literature data devoted to the choice of treatment for peptic esophageal strictures. The main goal of this review is to identify treatment tactics for patients with stenosing reflux esophagitis. Researchers point out that the main causes of GERD are a decrease in pressure in the lower esophageal sphincter, the action of the damaging properties of the refluctant. Untimely treatment of GERD can lead to complications such as peptic stricture, Barrett's esophagus. The appearance of GERD stricture is most often promoted by: persistent heartburn after bougienage, erosion of the lower third of the esophagus, shortening of the II degree esophagus, and inadequate antisecretory therapy.Various methods of treatment at all stages of the appearance of peptic stricture are presented, depending on the degree of dysphagia and the length of the stricture, the use of adequate conservative therapy regimens for PPIs, bougienage, as well as a description of various methods of antireflux operations. Endoscopic dilation is the first treatment option for all symptomatic benign esophageal strictures. There are treatments for benign refractory esophageal strictures such as endoscopic dilatation with intraluminal steroid injection, endoscopic postoperative therapy or stricturoplasty, esophageal stenting, self-bougienage, as well as surgery - antireflux surgery, esophagectomy with replacement of the esophagus by the stomach or colon [1].The main goal in the treatment of peptic esophageal strictures, according to most authors, is to eliminate the progression of GERD, conduct bougienage or balloon dilatation, and select the optimal antireflux surgery. Treatment for peptic strictures should minimize the risk of re-stricture of the esophagus.