Dysphagia Research Articles

Cleft lip and palate surgery in the Otolaryngology and Head-neck surgery department of a Medical College Hospital in Bangladesh

Background: Cleft lip and palate (CLP) are one of the most common developmental anomalies in orofacial region. CLP surgery lies in the anatomical domain of Ear Nose Throat and Head - Neck Surgery. In Bangladesh specialty of plastic surgery is still in developing stage and plastic surgeons are not easily available everywhere. ENT and Head-Neck surgeon had to take up the responsibility of some of cleft patients. This article is a retrospective analysis of a series of 200 cases of cheiloplasty and palatoplasty done in ENT and Head-Neck Surgery department of Khulna City Medical College Hospital, Bangladesh. Results were satisfactory in our, patient and parent's consideration. Objective: Our aim is to discuss the demographic profile, presentations, degree & type of cleft and outcome of CLP surgery in Otolaryngology and Head-Neck Surgery department of a Medical College Hospital of Bangladesh. We will also discuss the embryology of face & historical background of the cleft surgery. Materials and Methods: This is a retrospective analysis of CLP surgery for 200 cleft patients. We based on inclusion and exclusion criteria for selection of patients. Majority of cleft lip patients were operated following the Millard modified rotation advancement technique and isolated cleft palate patients were operated following Von Langenbeck bipedicle flap and Veau-Wardil-Kilner V-Y pushback technique in the ENT and Head-Neck Surgery Department of a Medical College Hospital. Patients were advised for periodic follow up. Results: Total of 200 patients of CLP were operated in our department out of which male was 92 (46%) and female was108 (54%)), male and female ratio being 1:1.08. The age range was 3 months to 40 years with a mean of 8.38 years. Pre alveolar group both male and female comprised of 134 (67%) and alveolar group 66 (33%) patients and that of isolated cleft palate 7 (10.60%) patients. Pre alveolar unilateral CLP was high. The results of surgery were satisfactory in our postoperative evaluation. Patients and parents were also satisfied with the outcome. Conclusion: Majority of CLP patients don’t suffer functional problem apart from facial disfigurement. Restoration of normal anatomy, facial appearance and function can be achieved by surgery in appropriate time and age. Few cases may be associated with feeding difficulties, dental and hearing problems. Some cases are associated with other congenital anomalies and syndromes. Those cases demand team approach of different specialty.

Israeli neonatal herpes simplex infection: Unique epidemiology and clinical profile

AbstractTo gather national level data on Israeli neonatal HSV (NHSV) infection and to evaluate the distinct clinical characteristics of NHSV and neonatal enteroviral meningitis (NEM). Israeli NHSV patients, hospitalized between January 2015 and April 2022 in 22 medical centers were assessed, together with NEM patients, hospitalized at Sheba Medical Center during the same period. NHSV demographic and clinical characteristics were documented and compared to those of NEM. Eighty‐five NHSV (73% males) and 130 NEM (62% males) patients were included. The incidence of NHSV was 5.9/100 000 live births, the common phenotype and HSV type were SEM (53%) and HSV1 (91%), respectively. Horizontal transmission was suspected in 50% cases (of which 67% underwent a Jewish ritual circumcision with direct wound sucking, 33% had relatives with highly suspicious herpetic lesions). Compared with NEM, NHSV tends to present with rash (14% vs. 60%, p‐value < 0.01) and seizures (0% vs. 6%, p‐value 0.02), while fever, irritability and poor feeding appear more frequently in NEM (94% vs. 18%, p‐value < 0.01; 37% vs. 1%, p‐value < 0.01; 25% vs. 1%, p‐value < 0.01 respectively). Of NEM patients, 28% were treated with acyclovir. Our results mark a decrease in the incidence rate of NHSV in Israel and a prominent mode of horizontal infection acquisition. We underscore the unique localized phenotype of NHSV, in contrast to enterovirus, which tends to cause a systemic disease with constitutional symptoms. These findings should be considered when evaluating the need for comprehensive empirical treatment for HSV in the context of neonatal fever, or according to a certain clinical presentation.

Longitudinal assessment of quality of life indicators and prognosis in esophageal cancer patients with curative resection.

The relationship between quality of life and survival outcomes in esophageal cancer patients following curative resection is not well established. This study aimed to longitudinally assess quality of life indicators and their association with overall survival (OS) in these patients. A total of 232 patients were included in the study, and their quality of life was prospectively assessed at different time points using the European Organisation for Research and Treatment of Cancer (EORTC) 30-item core quality of life questionnaire (QLQ-C30) and the disease-specific esophageal module (QLQ-OES18). The scores of QLQ indicators at each time point were summarized, and changes in postoperative assessment were compared with preoperative assessments. The association of deterioration in certain indicators with OS was evaluated at each time point using Cox univariable analysis. Further confirmation of independent variables was carried out using Cox multivariable analysis. The study cohort comprised 62 females (26.7%), and 113 patients (48.7%) aged over 60 years. The median follow-up time was 80 months (range, 8-118 months). At 24 months after discharge, patients reported improvements in role function, fatigue, cognition function, emotional function, social function, insomnia, appetite loss, nausea and vomiting, constipation, financial status, trouble swallowing saliva, and pain related to esophageal cancer. However, physical function, dyspnea, diarrhea, global health status, choking when swallowing, trouble talking, and reflux remained compromised. Multivariable regression analysis revealed deterioration in role function, emotional function, and coughing difficulty at 6 months, and dyspnea, pain, and cognitive function at 24 months post-discharge were identified as independent prognostic factors for OS. Our findings underscore the importance of monitoring quality of life indicators in esophageal cancer patients as they may significantly influence survival outcomes. The identification of specific quality of life indicators as prognostic factors highlights the need for a patient-centered approach in clinical practice to enhance care and potentially improve survival.

Alterations in Child Feeding Behavior: An Underrecognized Clinical Complication of Food Allergy

BackgroundFood allergy (FA) affects around 5.6 million children in the US, conferring risk for negative impacts on growth and psychosocial functioning. While evidence suggests a higher prevalence of feeding difficulties in children with FA, the link between FA and feeding dysfunction remains unclear. ObjectiveTo investigate feeding problems in children with parent-reported IgE-mediated FA and/or pediatric feeding disorder (PFD) compared to healthy children in a community-based sample, and to explore factors associated with feeding problems in children with FA. MethodsA matched cross-sectional cohort study utilized survey data from 352 parents of children aged 6 months to 7 years who reported a diagnosed IgE-mediated FA and/or PFD (50 with FA only, 67 with FA and PFD, and 235 with PFD only). Healthy children were matched based on age, gender, race, and socio-economic factors. Feeding problems were assessed using the Pediatric Eating Assessment Tool (PediEAT). Matched-pairs generalized linear regressions compared each cohort and explored factors associated with feeding problems in children with FA. ResultsChildren with FA exhibited significantly higher feeding problems compared to healthy children. Children with a diagnosed PFD had more severe feeding problems, irrespective of comorbid FA. Factors linked with feeding problems in children with FA included older age, non-White race, increased medical comorbidity, and limited dietary variety. ConclusionThis study adds to evidence indicating a higher prevalence of feeding problems in children with FA. Clinicians treating FA patients should routinely screen for feeding and growth concerns and consider referral to multidisciplinary feeding programs as needed.

LA DETRESSE RESPIRATOIRE CHEZ LENFANT

The objective of this study was to examine the clinical and epidemiological characteristics of respiratory distress in children, identify the responsible pathologies, and describe the therapeutic management. This retrospective study analyzed medical records of children aged between 1 month and 14 years admitted for respiratory distress over a one-year period, with a sex ratio (M/F) of 1.4. Dyspnea was the primary symptom (100%), cough was present in 57% of cases, feeding difficulties in 18%, and influenza-like illness in 15%. Pneumonia was the leading cause of pulmonary respiratory distress in our study, accounting for 35.5% of cases, while congenital heart defects were the most common extrapulmonary cause (16% of cases). The outcome was favorable in 76.5% of patients. Death was noted in 21% of cases. Respiratory distress is a true emergency that requires a thorough clinical assessment to quickly detect signs of severity necessitating urgent, symptomatic, and etiological management.

Black Tea Jelly Candy (Camellia Sinensis) to Increase Salivary Volume in Elderly: Preliminary Research

Background: Physiological changes in the elderly include decreased saliva production that causes dry mouth, difficulty in chewing and swallowing. Chewing gum and candies with a chewy texture like jelly can help stimulate the salivary glands. Black tea contains some phenolic and flavonoid compounds that have antioxidant properties that can increase the saliva flow rate. Objective: To determine the gap in saliva volume of elderly subjects before and after chewing black tea jelly candy compared to the saliva production when subjects chewed non-black tea candies and the control group (no treatment). This study also determined the prevalence of xerostomia in subjects. Materials and Methods: This field experiment was conducted using a Randomized Controlled Clinical Trials design with a pretest-posttest control group design. 30 elderly subjects aged 45-90 years in the Tresna Werda Budi Mulia 1 Nursing home, Jakarta were selected based on the predetermined inclusion criteria. They signed the informed consent and answered the Summated Xerostomia Inventory Questionnaire (SXI). Salivary volume before and after chewing black tea jelly candy was measured using a measuring cup. Statistical tests consisting of Oneway ANOVA and Dependent T-Test were performed to analyze the data. Results: The prevalence of elderly who complaining of xerostomia in this research was 40%. There was a significant gap in saliva volume between the three groups with p = 0.002 (P<0.05). An increase in saliva volume in the black tea jelly candy treatment group was identified. The average volume before intervention in the black tea jelly candy treatment group was 1.26 mL and after the intervention was 2.15 mL. Conclusion: Chewing black tea jelly candy increase the saliva volume in elderly subjects.

LASER ASSISTED TONGUE TIE RELEASE:A CASE REPORT

Tongue is an essential oral structure that is associated with several functions that directly or indirectly affect the speech, swallowing, nursing, position of teeth in the arch, periodontal structures, nutrition and certain social activities. Ankyloglossia or Tongue tie is a congenital anomaly characterised by short, thick lingual frenum which thereby restricts the movement of the tongue and is associated with infant feeding difficulties, speech disorders, and various mechanical and social issues related to the inability of the tongue to protrude. It is not a serious problem, but it effects the day-to-day activities. Detection of this anomaly in any stage of life and its management improves the quality of life. Considering the high vascularity and mobile structure of the tongue, management using laser is the simplest, safest and less traumatic of all the treatment modalities available with most promising results. This case report discusses management of ankyloglossia using Diode LASER.

Exclusive Breastfeeding Practice and Associated Factors among Mothers of Infants under 6-Months of Age

The consequences of poor feeding practices might exhibit in the form of poor nutritional status in the early part of life whereas delayed mental as well as motor developmental disorders are some most commonly exhibited long term consequences. Objective: To determine the prevalence and associated factors of exclusive breastfeeding (EBF) among mothers of infants below six months of age. Methods: This cross-sectional study was done at the Department of Pediatrics, Sheikh Khalifa Bin Zayed Al Nahyan Hospital, Rawlakot, Azad Kashmir, Pakistan from August 2022 to January 2023. Results: In a total of 237 mothers, the mean age was 27.15 ± 3.87 years. The EBF was reported by 151 (63.7 %) mothers. High socio-economic status (adjusted odds ratio = 5.87, p = 0.003), having fewer than 4 antenatal visits (adjusted odds ratio = 4.15, p < 0.001), cesarean delivery (adjusted odds ratio = 5.57, p < 0.001). the absence of postnatal advice on EBF (adjusted odds ratio = 3.06, p = 0.004), and children aged 4-6 months (adjusted odds ratio = 8.58, p < 0.001) had significantly higher odds of absence of EBF. Conclusions: It was concluded that the exclusive breastfeeding was practiced by 63.7% mothers. High socio-economic status, fewer antenatal visits, cesarean section, absence of postnatal advice on exclusive breastfeeding, and relatively older age of the infant were associated with lack of exclusive breastfeeding practices.

Association between self-reported difficulty in chewing or swallowing and frailty in older adults: A retrospective cohort study.

Oral frailty can contribute to physical and mental health disorders. Previous research has shown an association between frailty and self-reported difficulty in chewing or swallowing. However, their combined assessment has obscured their specific impact on frailty-related outcomes. To investigate the independent associations between difficulty in chewing or swallowing and 1-year frailty outcomes, while also examining their interactions. This retrospective cohort study utilized the DeSC database to identify older adults aged ≥ 75years who underwent health checkups between April 2014 and November 2022. Multivariate Cox regression analyses were conducted to assess the association between self-reported difficulty in chewing or swallowing and outcomes, including hospitalization due to aspiration pneumonia, all-cause hospitalization, and all-cause mortality within 1year. Interactions between chewing and swallowing difficulties were also evaluated. Among 359,111 older adults, 39.0% reported oral function difficulties. Swallowing difficulty alone lacked significant outcome association. However, chewing difficulty alone was significantly associated with higher risks of hospitalization due to aspiration pneumonia (hazard ratio (HR), 1.35; 95% confidence interval (CI), 1.15-1.58; P < 0.001), all-cause hospitalization (HR, 1.08; 95% CI, 1.05-1.11; P < 0.001), and all-cause mortality (HR, 1.28; 95% CI, 1.14-1.44; P < 0.001) compared with no self-reported difficulty. A significant positive interaction between self-reported difficulty in chewing and swallowing was observed for all-cause mortality (P = 0.009). Self-reported difficulty in chewing was significantly associated with higher risks of hospitalization due to aspiration pneumonia, all-cause hospitalization, and all-cause mortality among older adults. Chewing and swallowing difficulties showed a synergistic effect, significantly increasing all-cause mortality risk.

Risk Stratification Of Signs Of Possible Serious Bacterial Infection For Prediction Of Mortality Among Young Infants

Objective: Possible serious bacterial infection (PSBI) is one of the leading causes of infant mortality. Based on WHO multi-centric study, signs of PSBI are categorized into: signs of clinical severe infection (CSI) and signs of critical illness (CI). Assessment of signs of PSBI helps to divide infants into risk groups for appropriate management and prognostication. This study aimed to assess risk stratification of signs of PSBI among young infants (0- 59 days of age) by correlating signs of PSBI with mortality. Methods: In this hospital-based prospective cohort study, 220 young infants with signs of PSBI were recruited. Infants were categorized into two: those with signs of CSI and those with signs of CI. Correlation of each sign of PSBI was done with mortality. Time to death was assessed by using the Kaplan Meier survival analysis. Results: 220 infants were analyzed for outcomes. Signs of CSI including fever, fast breathing, poor feeding, and movement only on stimulation had a low fatality rate; however low body temperature and severe chest pain was associated with high mortality of 20% and 9%, respectively. CI signs – convulsion, no movement at all, and no feeding at all were associated with high death rates of 14%, 63.7%, and 47.4% respectively. The majority of deaths were occurred within 48 hours of presentation. Conclusions: Mortality was high in infants with low body temperature, chest pain, or any sign of CI. Risk stratification based on clinical signs could help prioritize infants in need for urgent intervention and thus decrease infant mortality.

Evaluation of the physicochemical and sensory properties of branched‐chain amino acid‐fortified perilla mousse after retort sterilisation as a dysphagia diet

SummaryDysphagia and difficulty swallowing, lead to a heightened risk of respiratory disorders and malnutrition. This study aimed to assess the physicochemical and sensory properties of a branched‐chain amino acids‐fortified perilla mousse (PM) and its retorted version (RPM) to determine their suitability for dysphagia patients. PM and RPM were evaluated for texture, colour, free amino acids content, sensory acceptance, and the International Dysphagia Diet Standardisation Initiative (IDDSI) levels were determined. The results showed that PM and RPM met IDDSI Levels 3–4. RPM exhibited a redder, darker colour and a firmer texture compared with PM. Moreover, RPM showed no syneresis and maintained high viscoelasticity from 20 °C to 80 °C. Additionally, retort sterilisation increased essential amino acid levels in RPM, and it received high sensory acceptance. This mousse offers a promising option for dysphagia patients, providing enhanced nutritional value with ease of swallowing. Future research should explore the long‐term impacts on dysphagia management.

Prognostic factors for tube feeding in type I SMA patients treated with disease-modifying therapies: a cohort study

The aim of this study was to assess the need for tube feeding in a cohort of treated infants with type I SMA and to identify predictive factors. All patients were classified at baseline, when treatment started, and at follow-up according to their functional level and the need for tube feeding. Fisher’s exact test was used to examine the associations between the outcome at the last follow-up and SMA type, SMN2 copy number, and baseline nutritional status. ANOVA was performed to compare CHOP INTEND scores and age at treatment initiation with outcomes. The cohort includes 75 type I SMA infants treated between 0.1 and 5 years of age. At the last follow-up, 34 had no need for tube feeding, 9 had tube feeding but were also able to be fed by mouth, and 32 had tube feeding and were unable to be fed by mouth. Thirty of the 41 infants with tube feeding at follow-up already had feeding difficulties when treatment was started. The need for tube feeding at follow-up was associated with the level of feeding involvement at baseline and with CHOP INTEND scores [p < 0.001] but not with SMN2 copy number, SMA type 1 subtypes or age at treatment. The results of this study suggest that the need for tube feeding is not frequent in treated infants with type I SMA and, when occurring, can be predicted by the level of feeding involvement and low CHOP INTEND scores at baseline.What is Known:• The advent of disease-modifying therapies is increasingly changing the approach to swallowing and nutritional management in type I SMA.• Clinical trials and real-world data using all three disease-modifying therapies report a rather wide variability of feeding outcome and need for tube feeding that is often related to different cohorts that makes comparison between studies very difficult.What is New:• The real-world findings of this study, including all the children treated since treatments became available, confirmed that the need for tube feeding is not an invariable finding.• The level of feeding involvement at baseline appears to be a reliable prognostic indicator of bulbar outcome.• The results highlight the need for interventional studies with structured Speech and Language Therapist protocols that will help to better understand the extent to which bulbar function can be maintained or regained even in children requiring tube feeding.

Habitual intake of carbonated drinks is associated with subjective difficulty in swallowing in community-dwelling older adults: a survey-based cross-sectional study

Carbonated drinks have been reported to increase muscle activity during swallowing compared with water. Older adults who habitually consume carbonated drinks may use their swallowing-related muscles to a greater extent, thereby preserving their swallowing function. This study investigated the relationship between habitual carbonated drink intake, amount of carbonated drink consumed, and subjective difficulty in swallowing in community-dwelling older adults. We administered a questionnaire to determine subjective difficulty in swallowing, nutritional status, presence of sarcopenia, and habitual intake of carbonated drinks. Statistical analysis of the subjective difficulty in swallowing was performed using logistic regression analysis with the presence or absence of suspected dysphagia, using the Eating Assessment Tool-10 as the dependent variable. The results showed that older age (odds ratio [OR]: 1.077; p = 0.011), nutritional status (OR: 0.807; p = 0.040), systemic sarcopenia (OR: 1.753, p < 0.001), and habitual intake of carbonated drinks (OR: 0.455; p = 0.039) were associated with subjective difficulty in swallowing. In conclusion, the daily habits of community-dwelling older adults impact their swallowing function.

The association between maternal sleep and circadian rhythms during pregnancy and infant sleep and socioemotional outcomes.

Studies have established that maternal sleep and circadian rhythm disturbances during pregnancy are associated with poor prenatal and perinatal outcomes for mothers and offspring. However, little work has explored its effects on infant sleep or socioemotional outcomes. The current study examined the relationship between maternal sleep and circadian rhythm disturbances during pregnancy and infant sleep and socioemotional outcomes in a diverse sample of N = 193 mothers and their infants (51% White; 52% Female; Mage = 11.95months). Maternal sleep and circadian rhythms during pregnancy were assessed using self-reports and actigraphy. Mothers reported on infants' sleep and socioemotional outcomes when infants were one year old. When controlling for infant sex, age, gestational age at birth, family income-to-needs ratios, and maternal depression, mothers who reported more sleep problems during pregnancy had infants with more sleep disturbances when they were one year old. Moreover, mothers who had later sleep timing (i.e., went to bed and woke up later, measured via actigraphy) during pregnancy had infants with more dysregulation (e.g., increased feeding difficulties, sensory sensitivities) and externalizing problems, and mothers with increased intra-daily variability in rest-activity rhythms (as measured via actigraphy) had infants with more externalizing problems. Findings suggest that maternal sleep and circadian rhythm disturbances during pregnancy may be a risk factor for infant sleep problems and socioemotional difficulties.

Turkish adaptation of the Neonatal Eating Assessment Tool-Bottle-Feeding in preterm infants discharged to home.

Preterm infants often continue to have feeding difficulties after hospital discharge. Parental use of assessment tools and collaboration with health professionals are important for the early diagnosis of postdischarge feeding difficulties. This methodological study examined the validity and reliability of the Turkish version of the Neonatal Eating Assessment Tool (NeoEAT)-Bottle-feeding in postdischarge preterm infants in Türkiye. A Turkish version of the NeoEAT-Bottle-feeding was developed and applied to 321 mothers of preterm infants younger than 7 months of corrected age between August 2021 and December 2022. Cronbach's alpha, exploratory factor, confirmatory factor, item-total correlation, test-retest, and known-groups validity analyses were performed. The Turkish NeoEAT-Bottle-feeding has 60 items in five factors explaining 55.785% of the total variance. Exploratory factor analysis indicated that the item factor loading ranged from 0.320 to 0.792. The known-group validity analysis confirmed that preterm infants with diagnosed feeding problems had higher total and subscale scores than those without (p = 0.001). The Cronbach's alpha (α) of the entire scale was 0.96. The item-total correlation coefficients were between 0.31 and 0.77 (p = 0.001). There was excellent agreement between test values and retest values obtained after a 2-week interval (intraclass correlation coefficient: 0.930-1.000). The Turkish NeoEAT-Bottle-feeding was shown to be a reliable and valid parent-reported assessment tool for oral feeding skills and difficulties after neonatal intensive care unit discharge in bottle-fed preterm infants younger than 7 months of corrected age. Healthcare professionals can use this assessment tool during the initial evaluation of risk factors contributing to problematic feeding and to determine the effectiveness of planned interventions in preterm infants.

Effect of Cold Vapor Application on Postoperative Sore Throat, Dry Throat, and Difficulty Swallowing: A Randomized Controlled Trial.

Background: Postoperative sore throat, dry throat, and difficulty swallowing are frequently reported complications following general anesthesia, imposing discomfort and challenges to patients during their recovery. Objective: The aim of this study was to determine the effect of cold vapor application for 15 minutes at 0, 2, and 6 hours after extubation on sore throat, dry throat, and difficulty swallowing. Methods: This was a randomized controlled experimental study. The research was carried out with 64 patients who underwent cholecystectomy in the operating room and general surgery clinic of a state hospital between December 2016 and August 2017. Research data were collected using the American Society of Anesthesiologists classification, Mallampati scoring, patient identification form, intraoperative patient evaluation form, Ramsey Sedation Scale, Numerical Rating Scale, dry throat and difficulty swallowing evaluation form, and cuff pressure gauge. Results: It was found that cold vapor application at the 0th, 2nd, and 6th hours postoperatively had no effect on sore throat and swallowing difficulty. Mean dry throat scores of the patients in the intervention group at the second and sixth hours were significantly lower than those in the control group. At the 24th hour, there was no statistically significant difference between the mean scores of sore throat, swallowing difficulty, and dry throat in the intervention and control groups. Conclusion: According to the results of this study, it was found that cold vapor application in the early postoperative period had no effect on sore throat and swallowing difficulty but reduced throat dryness at the second and sixth hours. Implications for Nursing: In the early postoperative period, cold vapor can be applied to relieve hoarseness due to extubation.

Feeding and Nutritional Key Features of Crisponi/Cold-Induced Sweating Syndrome.

Feeding difficulties are constantly present in patients with Crisponi/cold-induced sweating syndrome type 1 (CS/CISS1). The aim of our study was to describe their prevalence and evolution from birth to adult age. We performed an observational study at the Department of Life Sciences and Public Health, Rome. Fourteen patients were included in this study (six M; mean age: 18 years; SD: 10.62 years; median age: 15 years; age range: 6-44 years); six were adults (43%). Data on oral motor abilities from birth were collected. Meal duration, presence of swallowing reflex, dysphagia symptoms, difficulty chewing, and drooling management were assessed. At birth, all patients needed enteral feeding. Introduction of solid food was postponed beyond the age of 18 months in 43% of patients. During childhood and adolescence, mealtime was characterized by increased duration (43%) accompanied by fatigue during chewing (43%), food spillage from the nasal cavities (21%), sialorrhea (86%), and poor/reduced appetite (57%). A mature rotatory chewing skill was never achieved. This report expands the phenotype description of CS/CISS1 and also improves the overall management and prevention of complications in this ultra-rare disease.

Serious Games in Orofacial Myofunctional Disorder Therapy for Children: An Expert Survey.

Orofacial Myofunctional Disorder (OMD) is believed to affect approximately 30-50% of all children. The various causes of OMD often revolve around an incorrect resting position of the tongue and cause symptoms such as difficulty in speech and swallowing. While these symptoms can persist and lead to jaw deformities, such as overjet and open bite, manual therapy has been shown to be effective, especially in children. However, much of the therapy must be done as home exercises by children without the supervision of a therapist. Since these exercises are often not perceived as exciting by the children, half-hearted performance or complete omission of the exercises is common, rendering the therapy less effective or completely useless. To overcome this limitation, we implemented the LudusMyo platform, a serious game platform for OMD therapy. While children are the main target group, the acceptance (and usability) assessment by experts is the first milestone for the successful implementation of an mHealth application for therapy. For this reason, we conducted an expert survey among OMD therapists to gather their input on the LudusMyo prototype. The results of this expert survey are reported in this manuscript.

Complications of button battery ingestion or insertion in children: a systematic review and pooled analysis of individual patient-level data.

Button battery (BB) exposures are common in children and can have devastating consequences. We reviewed current evidence on the complications associated with BB exposure and identified predictors of outcomes using individual patient-level data. We carried out a systematic review and pooled analysis by searching MEDLINE, Embase, and Scopus up to May 19, 2023. Included studies describe complications following BB exposures in children (aged < 18years). Odds ratios (ORs) were calculated using binary logistic regression to measure associations between predictive factors and different outcomes. Two-hundred seventeen studies (439 children) were included. The median age at presentation was 1.75 [interquartile range (IQR) 1.00-3.00] years and 399 (90.9%) exposures were ingestions. Of the 380 cases reporting sex, 162 (42.6%) were female. Feeding (192, 48.1%) and respiratory difficulties (138, 34.6%) were common presenting features for ingestions, while symptomatology was site-specific for insertions. Common complications included oesophageal mucosal damage alone (105, 26.3%) and tracheooesophageal fistula (93, 23.3%) for ingestions, and nasal septal perforation (22, 55.0%) and mucosal damage alone (13, 32.5%) for insertions. Intestinal perforation occurred in 2.5% of ingestion cases, including perforation of Meckel's diverticulum, peritonitis, and jejunocolic fistula. Vascular complications were common among children who died. Age (≤ 2years), battery exposure duration (> 6hours), and battery diameter (≥ 20mm) were associated with common and severe complications of ingestions. BB injuries are time-critical, with severe sequelae predominantly affecting young children. Diagnosis is challenging. Preventative work through regulation and safer battery design are required to eliminate this problem.

Report of a child with Bainbridge-Ropers syndrome due to a novel variant of ASXL3 gene and a literature review

To explore the clinical phenotype and genetic basis of a child with Bainbridge-Ropers syndrome (BRPS). A child with BRPS who had visited Nanjing Children's Hospital on June 26, 2019 was selected as the study subject. Clinical data of the child was reviewed. Genomic DNA was extracted from peripheral blood samples of the child and her parents. Whole exome sequencing (WES) was carried out, and candidate variant was verified by Sanger sequencing and bioinformatic analysis. The child was a 6-month-old girl with peculiar facial features, feeding difficulties, malnutrition, global developmental delay, hypotonia, mildly elevated aminotransferase and ulnar deviation. Results of WES showed that she has harbored a c.1533_1534del variant of the ASXL3 gene. Sanger sequencing confirmed that neither of her parents has carried the same variant. No similar case had been retrieved from the HGMD and ClinVar databases. No frequency for this variant among Asian populations was available in the ExAC, 1000 Genomes, and gnomAD databases. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the c.1533_1534del variant of the ASXL3 gene was determined to be likely pathogenic (PVS1+PS2+PM2_Supporting). The ASXL3 gene c.1533_1534del variant probably underlay the BRPS in this child. Above finding has provided a reference for the clinical diagnosis and genetic counseling for children with similar disorders.