Oropharyngeal Secretions Research Articles

Bacteriology of Aspiration Pneumonia: The Lung Microbiome and the Changing Microbial Etiology.

Aspiration pneumonia refers to the process of alveolar inflammation induced by the inhalation of oropharyngeal secretions into the lower respiratory tract. Predisposing factors comprise swallowing dysfunction, impaired cough reflex, and degenerative neurological diseases. Accumulating evidence projects a fading contribution of anaerobic bacteria in aspiration pneumonia at the expense of Gram-negative bacilli, with Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa, becoming the predominant organisms recovered from respiratory specimens. Aspiration of oropharyngeal secretions colonized with respiratory pathogens induces a profound disequilibrium of the lung microbiota resulting in a state of dysbiosis. Understanding this complex temporal variability between microbiome-host associations was only made possible with the introduction of metagenomic sequencing. In this narrative review, we summarize existing knowledge and elaborate on the evolving microbiology of aspiration pneumonia including the link between oral microbiome and pulmonary aspiration. We also highlight the progress and challenges in instituting microbiome-targeted strategies for preventing and treating the sequelae of aspiration pneumonia.

Assessment of Oral Bacterial Microflora in Patients with Stable Chronic Obstructive Pulmonary Disorders

Background & Objectives: Chronic obstructive pulmonary disorder is an inflammatory disease characterized by the progressive deterioration of pulmonary function and increasing airway obstruction, includes chronic bronchitis and emphysema. The oral cavity has been considered a potential reservoir for respiratory pathogens. Oral bacteria may play a vital role in the exacerbation of chronic obstructive pulmonary diseases. Hence, we intend to study the bacterial microflora of oral cavity in stable COPD patients. Methods: In this study 20 patients aged between 20 to 60 years diagnosed with stable COPD and 20 normal healthy controls were selected based on the set inclusion and exclusion criteria. A detailed case history, physical examination and investigations and all the subjects were examined for gingival and periodontal status by recording the Oral hygiene which comprises debris index and calculus index and periodontal index and Quantitative oropharyngeal cultures were obtained by oral washing using isotonic saline as the collecting fluid. Results: A significant higher score of OHI(S) and PI was observed in COPD patients. There is a direct correlation between periodontal pathogens with the severity of COPD. Conclusion: The predominant organisms found in the oropharyngeal secretions were porphyromonas gingivalis and haemophilus influenza, in COPD patients.

Cases of Meningococcal Disease Associated with Travel to Saudi Arabia for Umrah Pilgrimage - United States, United Kingdom, and France, 2024.

Invasive meningococcal disease (IMD), caused by infection with the bacterium Neisseria meningitidis, usually manifests as meningitis or septicemia and can be severe and life-threatening (1). Six serogroups (A, B, C, W, X, and Y) account for most cases (2). N. meningitidis is transmitted person-to-person via respiratory droplets and oropharyngeal secretions. Asymptomatic persons can carry N. meningitidis and transmit the bacteria to others, potentially causing illness among susceptible persons. Outbreaks can occur in conjunction with large gatherings (3,4). Vaccines are available to prevent meningococcal disease. Antibiotic prophylaxis for close contacts of infected persons is critical to preventing secondary cases (2).

Contribution of Wireless Wi-Fi Intraoral Cameras to the Assessment of Swallowing Safety and Efficiency.

Clinical evaluation of swallowing provides important clinical information but is limited in detecting penetration, aspiration, and pharyngeal residue in patients with suspected dysphagia. Although this is an old problem, there remains limited access to low-cost methods to evaluate swallowing safety and efficiency. The purpose of this technical report is to describe the experience of a single center that recently began using a wireless Wi-Fi intraoral camera for transoral endoscopic procedures as an adjunct to clinical swallowing evaluation. We describe the theoretical structure of this new clinical evaluation proposal. We present descriptive findings on its diagnostic performance in relation to videofluoroscopic swallowing study as the gold standard in a cohort of seven patients with dysphagia following head and neck cancer. We provide quantitative data on intra- and interrater reliability. Furthermore, this report discusses how this technology can be applied in the clinical practice of professionals who treat patients with dysphagia and provides directions for future research. This preliminary retrospective study suggests that intraoral cameras can reveal the accumulated oropharyngeal secretions and postswallow pharyngolaryngeal residue in patients with suspected dysphagia. Future large-scale studies focusing on validating and exploring this contemporary low-cost technology as part of a clinical swallowing evaluation are warranted.

Ceragenin-coated endotracheal tubes for the reduction of ventilator-associated pneumonia: a prospective, longitudinal, cross-over, interrupted time, implementation study protocol (CEASE VAP study)

BackgroundCritically ill patients are at high risk of acquiring ventilator-associated pneumonia (VAP), which occurs in approximately 20% of mechanically ventilated patients. VAP results either from aspiration of pathogen-contaminated oropharyngeal secretions...

The utilization of video laryngoscopy in nasotracheal intubation for oral and maxillofacial surgical procedures: a narrative review.

The video laryngoscope is a novel instrument for intubation that enables indirect visualization of the upper airway. It is recognized for its ability to enhance Cormack-Lehane grades in the management of difficult airways. Notably, video laryngoscopy is associated with equal or higher rates of intubation success within a shorter time frame than direct laryngoscopy. Video laryngoscopy facilitates faster and easier visualization of the glottis and reduces the need for Magill forceps, thereby shortening the intubation time. Despite the advanced glottic visualization afforded by video laryngoscopy, nasotracheal tube insertion and advancement occasionally fail. This is particularly evident during nasotracheal intubation, where oropharyngeal blood or secretions may obstruct the visual field on the monitor, thereby complicating video laryngoscopy. Moreover, the use of Magill forceps is markedly challenging or nearly unfeasible in this context, especially in pediatric cases. Furthermore, the substantial blade size of video laryngoscopes may restrict their applicability in individuals with limited oral apertures. This study aimed to review the literature on video laryngoscopy, discuss its clinical role in nasotracheal intubation, and address the challenges that anesthesiologists may encounter during the intubation process.

Safety, Efficacy, and Ease of Insertion of Gnana Laryngeal Airway (GLA-4): A Prospective Clinical Study Utilizing the Unique Laryngeal Mask Airway With a Suction Tubing.

Utilizing laryngeal mask airways to maintain patients' airways is advantageous because it enables the anesthesiologist to keep the patient spontaneously inhaling and is less traumatic to the airway than intubation. Newer designssuch as the Gnana laryngeal mask airway design permit real-time suctioning while the mask is on a patient. This is a prospective observational study of the efficacy of Gnana laryngeal airway 4 (GLA-4) in 50 patients undergoing colonoscopy. Induction and maintenance of anesthesia were provided with propofol; GLA-4 was applied to secure the airway; and correct placement was verified. Fifty patients were included in the study (44% female, 56% male, mean age: 56.5 years, mean BMI: 33.3). Twelve patients were assigned American Society of Anesthesiologists (ASA) class 2, and 38 were assigned ASA class 3. The first attempt of GLA-4 insertion was successful in 47 patients, and two attempts were required for the successful placement of the GLA-4 in two patients. The successful placement was not achieved in one patient. The average time to successful insertion was 27.1± 3.9s. The average volume of oropharyngeal secretions suctioned through the suction catheter was 9.96 ± 2.31 mL. No intraoperative or postoperative complications occurred in the 50 patients. There were no reports of sore throat, hoarseness, dysphagia, or cough immediately postop. GLA-4 can be inserted safely with adequate periglottic occlusion. This laryngeal mask is unique and desirable due to its ability to evacuate oropharyngeal secretions while in place to prevent laryngospasm. To establish the role of GLA-4 in broader clinical situations, additional clinical trials and studies are required.

Epstein-Barr virus positive mucocutaneous ulcer – A diagnostic challenge

A significant portion of the global population carries the asymptomatic Epstein-Barr virus (EBV). Transfusions of blood and blood derivatives, organ and tissue transplantation, and oropharyngeal secretions are the main routes of transmission. The World Health Organization recently recognized the EBV mucocutaneous ulcer (EBVMU) as a provisional pathological entity in its classification of hematopoietic and lymphoid tissues. It affects patients who are elderly or immunosuppressed. Histologically, it may be difficult to distinguish from Hodgkin lymphoma (HL). Although skin or mucosa are uncommon sites of HL involvement, diagnosis at these sites should be made with extreme caution. The prognosis for EBVMU is good; cases regress on their own or after immunosuppressive therapy is reduced. We present a 67-year-old woman with a non-healing oral cavity ulcer which was diagnosed as EBV-positive mucocutaneous ulcer.

Особливості стану місцевого імунітету в дітей при запаленні слухової труби

Purpose - to find the factors of local immunity in secret in the region of the pharyngeal opening of the auditory tube (SPOAT) in normal conditions and in the inflammatory process; а compare indicators of local immunity in SPOAT and oropharyngeal secretion (OPS). Materials and methods. In the ENT department of the National Children’s Specialized Hospital “OKHMATDYT” were examined 38 children from 2.5 to 15 years old, 27 of them with inflammation of the auditory tube (IAT) and 11 patients without inflammation of the auditory tube (control group). Radial immunodiffusion was used to detect the level of immunoglobulins (Ig) A, E, M, G, secretory and the IgA monomer in SPOAT and OPS. The level of cytokines and lactoferrin was determined by enzyme immunoassay using a Stat-Fax 2100 reader (USA). Results. It was found that in children with IAT, the concentration of secretory IgA in the SPOAT was lower, the level of lactoferrin was lower, the level of IgG was higher, and total IgE was three times lower than in children of the control group. The concentration of γ-interferon in SPOAT in children of the control group was 7 times higher than in children with IAT. It has been found that delayed hypersensitivity reactions in the development of IAT in children are not significant. The concentration of secretory leukocyte protease inhibitors (SLPI) in SPOAT in sick children was almost 10 times higher than in the control group. At the same time, in the OPS, the content of SLPI in healthy children was within 37.6 pg/ml, and in children with IAT, the average content of SLPI was 7.6 pg/ml. Conclusions. A comprehensive study of immune defense factors at the local and systemic levels in children with IAT was carried out. The protective role of IgE in healthy donors, the importance of lactoferrin and SLPI were revealed. The concentration of inflammatory factors (interleukin-1, 8, IgG, tumour necrosis factor α) can increase near the focus of inflammation, which indicates a high content of reaginic antibodies in the SPOAT of practically healthy children and can be determined as a protective element, which is a new immunodiagnostic test. Significant differences in the content of γ-interferon and SLPI were revealed. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Insights into enterovirus a-71 antiviral development: from natural sources to synthetic nanoparticles.

Enteroviruses are pathogens responsible for several diseases, being enterovirus A71 (EVA71) the second leading cause of hand, foot, and mouth disease (HFMD), especially in Asia-Pacific countries. HFMD is mostly common in infants and children, with mild symptoms. However, the disease can result in severe nervous system disorders in children as well as in immunosuppressed adults. The virus is highly contagious, and its transmission occurs via fecal-oral, oropharyngeal secretions, and fomites. The EVA71 burdens the healthy systems and economies around the world, however, up to date, there is no antiviral approved to treat infected individuals and the existent vaccines are not available or approved to be used worldwide. In this context, an extensive literature research was conducted to describe and summarize the recent advances in natural and/or synthetic compounds with antiviral activity against EVA71. The summarized data presented here might simply encourage the future studies in EVA71 antiviral development, by encouraging further research encompassing these compounds or even the application of the techniques and technologies to improve or produce new antiviral molecules.

Use of Saliva-PCR as an alternative diagnostic tool for COVID-19 positive cases.

Objective: To find the presence of SARS-CoV-2 in saliva and oropharyngeal secretions in confirmed cases of COVID 19 to establish them as potential diagnostic alternatives. Study Design: Cross Sectional study. Setting: Hayatabad Medical Complex and Public Reference Lab of Khyber Medical University, Peshawar. Period: April 2022 to September 2022. Material & Methods: Study included SARS-CoV-2 patients confirmed by a positive RT-qPCR diagnosed through nasopharyngeal swab. Data was collected using a digital questionnaire. Saliva was collected using "passive drool" procedure. RNA was extracted from saliva samples and virus was detected through one-step-RT-qPCR using Universal qPCR Master Mix. The data obtained was presented using graphical representation in the form of proportions. Results: The study included 211 individuals with a wide range from 12 to 75 years. There were 146 (69%) males and 65 (31%) females.17% reported being hospitalized or received medical treatment recently. Only six individuals reported regular use of medications for hypertension and diabetes. 30% of participants reported a positive response when asked about their pervious respiratory allergic conditions. Results showed that out of 211 participants 75 (36%) were positive for COVID-19 using saliva-PCR, while the remaining 136 (64%) were negative. The findings showed that saliva-PCR had lower sensitivity than nasopharyngeal-PCR in detecting COVID-19. Conclusion: The results of saliva-PCR diagnosis showed lower sensitivity than nasopharyngeal-PCR in detecting COVID-19. Additional research is required to substantiate the effectiveness of PCR using saliva as an alternative diagnostic option.

Efficiency of using deflu silver nose in patients with acute rhinosinusitis

ABSTRACT. Acute rhinosinusitis is one of the most common diseases that affects up to 15% of the world's population every year and can occur at any age. The provisions of EPOS 2020 do not provide for the appointment of antibiotics in acute viral and acute post-viral rhinosinusitis. Thus, there is a need to find medicines to improve the well-being of patients, speed up recovery and prevent complications. One of such promising means of combating viral and bacterial infection of the ENT organs is the use of drugs with silver nanoparticles. Purposes. The purpose of this work was to study the effectiveness of using Deflu Silver Nose in the treatment of patients with acute rhinosinusitis. There was a study of its influence on the clinical course of the disease and parameters of local immunity.Materials and methods. Two groups of patients with acute rhinosinusitis were under our observation. The first group (main) consisted of 32 patients who, together with traditional symptomatic therapy (saline solution intranasally for 2 injections 3 times a day, multivitamins) received the aid Deflu Silver Nose (intranasally for 2 injections 3 times a day for 7 days). The drug was used from the 3rd day after the onset of the disease. The second group (comparison group) consisted of 30 patients who received similar therapy, except for Deflu Silver Nose.Clinical examinations and studies of local immunity were carried out before and after the start of therapy (on the 3rd and 7th day, on the 6th and 10th day of the disease). The results of the examination of 10 healthy people were used as an indicator of the norm. Rhinocytograms (cytological studies of scrapings from the nasal mucosa) were studied.Immunoglobulins, lysozyme, and cationic proteins were carried out in oropharyngeal secretions. Results. Clinical observations showed that under the influence of Deflu Silver Nose, patients with acute rhinosinusitis on the 3rd day from the start of treatment had a noticeable reduction or complete disappearance of the clinical symptoms of the disease. On the 3rd day of treatment, in the rhinocytograms, in the patients of the main group, there was a decrease in the nasal mucosa of destroyed cells and the percentage of lymphocytes in the scraping of cells of the flat and prismatic epithelium. On the 7th day of using Deflu Silver Nose, the level of all antimicrobial factors in nasal secretions in patients of group 1 decreases to normal levels.During this period, the inflammatory process was stopped and excessive swelling of the nasal mucosa was not observed in the vast majority of patients in the main group. No such positive changes were observed in the 2nd group of patients. Conclusion. Intranasal use of Deflu Silver Nose has a positive effect on the clinical course of acute rhinosinusitis, contributes to the prevention of bacterial complications, and increases the local immunoreactivity of the body. Under the influence of the nasal spray, the duration of the disease is reduced and the quality of life of patients improves.

Effect of different head-high lateral extubation on adverse reactions in the peri-extubation period of pediatric OSAS surgery under general anesthesia

BackgroundChildren with OSAS are prone to various airway complications during tracheal extubation after tonsillectomy and adenoidectomy due to oropharyngeal secretions and oozing blood. However, few studies have examined the effect of position on airway complications after tracheal extubation in children with OSAS. The aim of this study was to investigate the appropriate position for extubation in children with OASA.MethodsA total of 459 children aged 3–14 years with OSAS who underwent tonsillectomy and adenoidectomy were recruited for this study. All children were treated with the same surgical approach and standard anesthesia methods of induction of anesthesia, tracheal intubation and maintenance of anesthesia. At the end of surgery, the children were delivered to the post anesthesia care unit and randomly divided into three groups: Group A: Head-high 0° in lateral position; Group B: Head-high 15° in lateral position; Group C: Head-high 30° in lateral position. The main outcomes of this study were the pulse oxygen saturation (SpO2) and the Sedation-Agitation Scale (SAS) scores of the children after extubation, the outflow of oral-nasal secretions and the respiratory complications. Secondary outcomes were blood pressure, heart rate, end-respiratory carbon dioxide, respiratory rate, and post-operative awakening time of the children in three groups.ResultsData from a total of 423 children were statistically analyzed, 141 in Group A, 142 in Group B, and 140 in Group C. The main results showed a significant decrease in choking response after extubation in Group B (46.5%) and Group C (40.7%) compared to Group A (60.3%) (P < 0.05). The SAS score for postoperative agitation was higher in Group A (4.6 pm 0.9) than in Group B (4.4 pm 0.7) and Group C (4.3 pm 0.6) (P < 0.05). Also the SpO2 after extubation was higher in Group B (97.2%) and Group C (97.1%) than in Group A (95.8%) (P < 0.05). In contrast, there was no difference in the occurrence of respiratory complication and postoperative agitation in children between Group B and Group C (all P > 0.05). In addition, there was no difference in the amount of oral-nasal secretions among the children in the three groups (all P > 0.05).ConclusionThe head-high 15° lateral position and head-high 30° lateral position can reduce the incidence of airway complications and agitation and provide safe and comfortable extubation conditions for children during the peri-extubation period after tonsillectomy and adenoidectomy, which has certain clinical guidance value.Trial registrationRegistration Number: NO.ChiCTR2200055835(20,01,2022) https://www.chictr.org.cn

Newborn Exposed to the Monkeypox Virus: A Brief Report.

To the Editors: The increase in the number of cases of monkeypox in nonendemic areas has led the World Health Organization to declare monkeypox a global health emergency. In this report, a 37-week and 3-day pregnant woman presented with papular lesions, evolving into a pustule. She had visible adenomegaly in the submental region. Samples were collected for polymerase chain reaction (PCR) for the monkeypox virus (Table 1) and it was detected only from scrapings from a skin lesion. TABLE 1. - Polymerase Chain Reaction Results of the Mother and Newborn for Monkeypox Virus Date Sample material Methods Result Samples of the mother 04/08/22 Scraping of the lesion Real-time PCR Detectable 04/08/22 Lesion exudate Real-time PCR Not detectable 04/08/22 Serum Real-time PCR Not detectable 16/08/22 Breast milk Real-time PCR Not detectable Samples of the newborn 14/08/22 Oropharyngeal secretion Real-time PCR Not detectable 17/08/22 20/08/22 25/08/22 28/08/22 31/08/22 03/09/22 PCR indicates polymerase chain reaction. The patient developed a total of 15 lesions during the disease course. Nine days after, she was admitted to the maternity hospital because of spontaneous rupture of the amniotic membranes for 24 hours and uterine contractions at a gestational age of 39 weeks. The hospital infection control isolates the patient observing all precautions related to contact, droplets and aerosols, and recommended sample collection for PCR in the newborn after birth. On physical examination at the maternity ward, the patient had 5 lesions and a lymph node in the submental region of approximately 1.5 cm and another one in the right cervical region of approximately 1 cm, both elastic, mobile and painless. The newborn was born vaginally asymptomatic, without skin or mucosal lesions. There was no skin-to-skin contact with the mother. The newborn was admitted at the intermediate care neonatal unit. Breastfeeding was contraindicated. The mother was discharged around 40 h postpartum in good condition but still with active lesions. A sample of breast milk was collected for analysis. The PCR for the monkeypox virus was not detectable. The newborn was kept in the hospital because of active maternal lesions and for clinical follow-up. On postpartum day 8, the mother reported resolution of the lesions, confirmed by the primary care physician, and breastfeeding was established. The newborn remained asymptomatic during the follow-up evaluation. Oropharyngeal swab samples were collected to perform PCR for the monkeypox virus every 3 days until 21 days old (Table 1). Whether gestational age or disease presentation are determinants of the manifestation of the disease in the fetus remains debatable. Mbala et al.1 reported 4 cases: 2 miscarriages; 1 stillbirth 21 days after the mother’s disease onset; and 1 case with a live fetus. In another case report of coinfection of monkeypox virus and adenovirus, Ramnarayan et al.2 did not rule out transplacental infection, because the mother had a skin rash on a postpartum day. The current literature recommends that postpartum women with active monkeypox lesions should avoid close contact with the newborn, considering the risk of transmission and the potential for severe disease.3–5 It is unknown whether the monkeypox virus can be transmitted through breast milk.3,4 In the present case, all samples tested negative for the monkeypox virus and the newborn remained asymptomatic after 21 days, which suggested he did not acquire the infection from his mother. The consequences of monkeypox during pregnancy or the occurrence of its transmission through breastfeeding remains unknown. Therefore, reported cases that occurred in this population are important in view of the current advancing outbreak to define guidelines for appropriate management.4

Abstract Number ‐ 269: Brainstem Stroke Secondary to Lyme Neuroborreliosis Vasculitis

Introduction Clinical presentations of Lyme disease are variable. A rash is often the first symptom, subsequently evolving into late complications including arthritic, cardiac, and neurological manifestations. CNS pathologies of Borrelia burgdorferi are diverse and usually include meningitis, encephalitis, strokes, intracranial hemorrhages, and central and peripheral cranial neuropathies. Stroke secondary to Lyme vasculitis is a rare entity as such there are few cases reported in the literature. The presumed mechanism of cerebral ischemia is perivascular and vascular lymphocytic infiltration causing inflammation and vasculitis, resulting in a stroke. Methods We present a case of neuroborreliosis from our stroke service in a patient who presented with sudden onset of right‐sided facial droop, dizziness, and difficulty walking. Results A 53‐year‐old male tobacco smoker (his only known risk factor for stroke) presented to the emergency department with acute onset right‐sided facial paresis, difficulty walking, double vision, and trouble managing his oropharyngeal secretions. CT Head showed no acute intracranial pathology and angiography was negative for proximal large vessel occlusion. He was eligible for and received intravenous alteplase due to concerns for acute ischemic stroke. Notably, he disclosed a history of a tick bite (roughly two and half years prior) and daily headaches (for the past 1.5 months). His exam revealed bidirectional nystagmus, negative head impulse, right LMN facial nerve palsy, left‐sided face and arm numbness, and left‐sided tongue weakness. MRI brain revealed acute infract in the right medulla, leptomeningeal and bilateral cranial (3rd, 5th, and 7th) nerves enhancement. Serum Lyme IgG and IgM antibodies were positive. Lumbar puncture revealed an elevated protein with lymphocytic predominance. CSF Lyme antibody revealed 3 bands of IgG and 1 band of IgM, consistent with Lyme meningitis. Intravenous Ceftriaxone was started and his difficulty walking and cranial neuropathies improved during the hospital course. The patient required g‐tube placement and was discharged to sub‐acute rehab. A four‐month follow MRI brain showed decreased cranial nerve enhancement without new evidence of ischemia. He eventually regained the ability to swallow, and his exam had otherwise returned to baseline. Conclusions The proposed mechanism of ischemic stroke due to Lyme Neuroborreliosis is secondary to localized inflammatory vasculitis. Lyme vasculitis can present with hemorrhagic or ischemic strokes, the latter being more common and usually affecting posterior circulation, as seen in this case. Negative CTA or transcranial Doppler studies do not exclude the diagnosis of arteriopathy as stenosis primarily involves small vessels and is usually segmental. Parenchymal brain imaging often reveals multiple territory strokes, leptomeningeal, and multiple cranial nerves enhancement in contrast studies. A thorough history of tick exposure or symptoms consistent with Erythema Migrans should be obtained in suspicious cases. Notably, patients will often complain of meningitic symptoms (including headache, neck stiffness, and malaise) usually weeks to months before any stroke‐like symptoms or deficits. Our case of Lyme Neuroborreliosis presenting as stroke illustrates the importance of considering rare etiologies in younger patients without any significant cerebrovascular risk factors, especially those residing in or traveling to endemic areas.

STUDY OF CLINICAL PROFILE OF OROPHARYNGEAL DYSPHAGIA USING FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING (FEES) TECHNIQUE

In elderly, dysphagia and its consequences have a marked effect on quality of life. Patients with oropharyngeal dysphagia shows various structural and functional alterations. Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is now widely accepted method for assessment of swallowing. This study was undertaken to know the prevalence of swallowing disorders and also assess anatomical and physiological changes seen in oropharyngeal dysphagia cases. A cross sectional study was conducted in the Methods: tertiary care hospital from January 2019 to June 2020. All patients underwent FEES examination using exible breoptic nasopharyngoscope. Anatomy and physiology of the pharynx, and larynx was assessed. Presence of oropharyngeal secretions, penetration, aspiration, residue, and spontaneous swallowing was observed. In 37 patients of Oropharyngeal dysphagia mean age Results: was 53.56 years with male preponderance (73%). In our study, oropharyngeal, laryngopharyngeal and supraglottic growth (40.54%) was the most common cause of oropharyngeal dysphagia, followed by LPR (18.9%) and neurological disorders (18.9%). In 37 patients examined 43.24% cases had secretions, 40.5% cases showed penetration, 35.1% cases showed aspiration. The most common cause of oropharyngeal Conclusion: dysphagia was oropharyngeal, laryngopharyngeal and supraglottic growth and was more frequently seen in elderly patients. FEES can be used as screening procedure and gives complete assessment of pharyngeal phase of swallowing

Evaluation of PCR Negativity in Respiratory Specimens of COVID-19 Patients After Hydroxychloroquine and/or Favipiravir Treatment

Objective: We evaluated PCR negativity in oropharyngeal and nasopharyngeal secretions of COVID-19 patients at the end of hydroxychloroquine and/or favipiravir treatments. Methods: Study inclusion criteria were being hospitalized, being older than 18 years, PCR positivity in oropharyngeal and nasopharyngeal secretions and being tested for SARS CoV-2-RNA PCR after treatment. Initially hydroxychloroquine treatment (group 1) was administered to the patients according to COVID-19 guide of Health Ministry. Favipiravir (group 2) alone or in combination with hydroxychloroquine (group 3) was administered to patients who were unresponsive to hydroxychloroquine or had severe pneumonia or were admitted to intensive care unit. Control respiratory specimens were taken no earlier than 24 hours, after the end of therapy. Repeated tests with 24–48-hour intervals were performed in patients with still positive PCR test results. The detection of SARS CoV-2-RNA was made by real-time PCR. Results: The study group included 492 patients who received treatment. Mean duration of symptoms was similar among three groups. PCR negativity rate was 52.8% in the specimens taken 24 hours after the end of treatment. PCR negativity rates was 27.9% (200/492) in 48 hours after the end of treatment, %13.8 (123/492) in 72nd hour and %3.8 (80/492) in 96th hour. The ratios of PCR negativity for all specimen days were similar in three groups. There was no statistically significant difference between the groups for time to PCR negativity from the date of positivity and after the end of treatment. We determined that early or late treatment did not make a difference in terms PCR negativity time. Conclusion: No difference was found in terms of the ratios of PCR negativity or time for negativity in oropharyngeal and/or nasopharyngeal specimens taken after the end of treatment in COVID-19 patients receiving hydroxychloroquine and/or favipiravir treatment.

The role of the palatine tonsils in the regulation of the state of humoral local immunity in patients with chronic inflammatory diseases of the nose and perinasal sinuses when infected with viruses of the respiratory group

Topicality: Acute respiratory diseases of the upper respiratory tract, which in the vast majority of cases are caused by viruses, especially with frequent recurrences of diseases, reduce local and system immunity, which often leads to the accumulation of bacterial infection due to the activation of endogenous microflora or exogenous infection and causes the development of viral-bacterial diseases. Recurrent respiratory diseases contribute to the formation of chronic pathology of the oro- and nasopharynx, which in turn supports the violation of the body's protective mechanisms. Previous studies have shown that the tonsils of the lymphadenoid pharyngeal ring perform the function of immunological protection, and the absence of palatine tonsils (PT) negatively affects the state of both local and system immunity. Aim: to determine the role of the palatine tonsils in the realization of local humoral reactions in patients with chronic inflammatory diseases of nose and paranasal sinuses when infected with viruses of the respiratory group. Materials and methods: Studies were conducted in 134 patients with chronic inflammatory diseases (CID) of nose and paranasal sinuses (PNS) in remission, among whom 93 had a diagnosis of chronic rhinosinusitis, 27 – chronic catarrhal rhinitis, 14 – allergic rhinitis with chronic bronchitis. The control group consisted of 47 practically healthy persons without pathology from the ENT organs. The examined persons were divided into those who had PT and those from whom they were surgically removed no earlier than five years ago. All examinees were divided into those who had anamnestic antibodies in their blood to one or more of the respiratory viruses, such as: adenovirus, respiratory syncytial virus and influenza A virus in a clinically significant titer, and those in whom antibodies were not detected. The local humoral immunity state of patients was assessed by the content of immune complexes (IC) and concentrations of secretory immunoglobulin A (sIgA), interferons alpha- (α-IFN) and gamma- (γ-IFN) in the oropharyngeal secretion (OS), which were determined by the immunoenzymatic method using sets of reagents for enzyme-linked immunosorbent assays ("Cytokin", RF) and the Stat Fax-2100 analyzer (USA). All examined patients had a healthy state of the oral cavity. Results: The presence or absence of palatine tonsils changes the levels of number of humoral factors of local immunity in oropharyngeal secretion in practically healthy donors and in patients with chronic inflammatory diseases of the nose and PNS. The production of sIgA and α-IFN in OS depends on PM, decreasing in practically healthy persons of the control group who underwent tonsillectomy. Chronic inflammatory diseases of the nose and PNS caused a decrease in the concentration of IC and α-IFN in the OS of patients of both groups- with or without PT. In patients with normal PMs who got sick with viral infections, in contrast to those with removed PMs, α-IFN level in OS increased and practically did not differ from those in healthy donors. The greatest suppression of α-IFN production was determined in patients with CID of the nose and PNS with removed PM and with the absence of clinically significant titers of antiviral antibodies. The level of γ-IFN production did not reliably change in the OS of patients with CID of nose and PNS in the remission phase both with normal PT and after tonsillectomy, but depended to a greater extent on the transferred infectious disease caused by viruses of the respiratory group. Conclusion: PTs play a significant role in the formation of a number of reactions of local immunity in the naso- and oropharynx, both in practically healthy individuals and in patients with chronic inflammatory disease of nose and paranasal sinuses. Therefore, the determination of local immunity indices in patients with chronic inflammatory diseases of the upper respiratory tract with different status of the palatine tonsils, who are in contact or had contact with respiratory viruses, provides an opportunity to identify the most vulnerable links in the system of their anti-infective protection, which should first of all be paid attention to during examination and treatment of patients with chronic inflammatory diseases of the upper respiratory tract, especially in cases of frequent recurrence of acute respiratory diseases.

Snoring may transmit infectious aerosols from the upper to the lower respiratory tract

Migration to the lungs of an initial upper airway infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or other respiratory pathogens can lead to pneumonia, associated with progression from mild to severe symptoms. Chemical pneumonitis or bacterial pneumonia may be caused by the ‘macroaspiration’ of large volumes of oropharyngeal or gastroesophageal secretions into the lower respiratory tract. ‘Microaspiration’, i.e., a similar mechanism but involving much smaller amounts of oropharyngeal secretions, is considered the pathogenetic mechanism for most pneumonias, including that associated with COVID-19. Here, we hypothesize an alternative mechanism: Rather than by microaspiration, these fluids enter the lungs as microdroplets that are generated by snoring and then carried by the inspired airstream. Laboratory measurements indicate that snoring generates (a) comparable numbers and sizes of oral fluid droplets as loud speaking and (b) total fluid quantities that are similar to those reported for microaspiration. Snoring propensity is strongly correlated to known risk factors for severe COVID-19, including male gender, age, obesity, diabetes, obstructive sleep apnea, and pregnancy. Therefore, more research is urgently needed to determine if various methods that decrease snoring can prevent progression to pneumonia after initial infection of the upper airways.

Are Cirrhotic Patients Receiving Invasive Mechanical Ventilation at Risk of Abundant Microaspiration.

Previous studies have identified cirrhosis as a risk factor for ventilator-associated pneumonia (VAP). The aim of our study was to determine the relationship between cirrhosis and abundant gastric-content microaspiration in intubated critically ill patients. We performed a matched cohort study using data from three randomized controlled trials on abundant microaspiration in patients under mechanical ventilation. Each cirrhotic patient was matched with three to four controls for gender, age ± 5 years and simplified acute physiology score II (SAPS II) ± 5 points. Abundant microaspiration was defined by significant levels of pepsin and alpha-amylase in >30% of tracheal aspirates. All tracheal aspirates were collected for the first 48 h of the study period. The percentage of patients with abundant gastric-content microaspiration was the primary outcome. The abundant microaspiration of oropharyngeal secretions, VAP incidence, the duration of mechanical ventilation, length of intensive care unit (ICU) stay and mortality were the secondary outcomes. A. total of 39 cirrhotic patients were matched to 138 controls. The percentage of patients with abundant gastric-content microaspiration did not differ between the two groups (relative risk: 0.91 (95% CI: 0.75 to 1.10)). There was no significant difference between the two groups in terms of the abundant microaspiration of oropharyngeal secretions, VAP, the duration of mechanical ventilation, the length of ICU stay and mortality. Our results suggest that cirrhosis is not associated with abundant gastric-content microaspiration.