Silent Disorders Research Articles

Assessment of the effectiveness of laryngeal protection mechanisms in patients with iatrogenic, unilateral laryngeal paralysis

Introduction: Postoperative paresis of the laryngeal nerves may disrupt the protection function of the larynx during swallowing. Material and method: Stage 1: Retrospective analysis of FEES reports in patients with unilateral laryngeal paralysis (n = 99) in terms of the occurrence of penetration or aspiration of saliva and liquid and solid food. Stage 2: Prospective analysis of the results of the EAT-10 screening questionnaire and reports (n = 12) of FEES examination performed in the early postoperative period (up to 7 days after the surgery) in patients with iatrogenic palsy of the X cranial nerve. Assessment of: sensory of the larynx, effectiveness for cough and pressure tests, presence of "white out", PAS scale for a regular diet according to IDDSI (ST 0; ST 7). Results: Stage 1: Penetration or aspiration was found in 65% of patients, in 29% of patients it were silent symptoms. Salivary penetration or aspiration concerned 60.60% of patients. Among people who developed silent disorders, 20 had isolated n. X paralysis, and 79% - polyneuric palsy. The PAS level between 2-8 was found in 65% of patients. Stage 2: 11/12 patients obtained the result of the EAT 10 questionnaire > = 3. "White out" elongation and sensory loss were found in 75% of patients, ineffective cough in 33%. In oral trials, residue (50% ST0), premature swallowing (8% ST0), penetration (33% ST0, 8% ST7) and aspiration (16% ST0, 8% ST7) were found. Adaptive and compensatory techniques were the most frequently combined (66%), and the dominant technique was turning the head towards the affected side. Conclusions: In every sixth patient with iatrogenic laryngeal paralysis, aspiration of non-condensed fluids occurs early after the surgery, and the penetration of these contents into the larynx occurs in every third patient. It is therefore advisable to improve the comfort associated with the quality of life dependent on swallowing and to prevent complications of dysphagia in the study group. Therefore, it is justified to extend diagnostics to include clinical assessment of swallowing and qualify patients for FEES assessment. Key words: dysphagia, penetration, aspiration, laryngeal paralysis, FEES, vocal fold paresis, oropharyngeal dysphagia

Coping mechanisms and resilience in psychiatric trainees during COVID-19 pandemic

Introduction The Covid-19 pandemic has a profound impact on all domains of day to day life, forcing individuals to make substancial change in the way of living. Such change is known to cause an important psychological distress, and in some persons evidencing silent disorders among apparently functional individuals. Good coping mechanisms and resilience can be the key to overpass this difficult period.ObjectivesThe aim of this study is to evaluate the coping mechanisms and resilience that Romanian psychiatric trainees used during Covid19 pandemic.Methods We developed an online questionnaire. We included questions about different socio-demographical variables and about coping mechanisms (using COPE scale), resilience (using Connor-Davidson Resilience Scale) and quality of life (using QoL Scale).Results The preliminary data show that staying busy, seeking social support and having a positive minset are emotion-focused coping strategies present in individuals who overpass easier this period.ConclusionsThe Covid-19 pandemic is creating significant distress and impairment in functioning, but individuals who have good psychological mechanisms and who are more adaptable are less vulnerable during Covid-19 pandemic. Future research should build upon these findings to better understand coping mechanisms during crises and also social policies should be developed to acknowledge the variable needs in adults.

Primary Prevention of Sudden Death in Young Competitive Athletes by Preparticipation Screening

Competitive sports activity is associated with an increase in the risk of sudden cardiovascular death in susceptible adolescents and young adults with clinically silent cardiovascular disorders. Screening including 12-lead electrocardiogram (ECG) has been demonstrated to allow identification of athletes affected by malignant heart muscle diseases at a presymptomatic stage and to lead to substantial reduction of the risk of sudden cardiovascular death during sports (primary prevention). The use of modern criteria for interpretation of the ECG in the athlete significantly improves the screeningaccuracybyreducingthefalse-positiverate(increasedspecificity),withtheimportantrequisite of maintaining the ability for detection of life-threatening heart diseases (preserved sensitivity). Screening including ECG has a more favorable cost–benefit ratio than that based on history and physical examination alone, with cost estimates per year of life saved below the threshold allowing one to consider a health intervention to be cost effective.

An update in prevention and treatment of pediatric obesity

Obesity prevalence is growing as well as its severity with increasing morbidity and mortality. This "globesity" also affects developing countries where under nutrition and stunting frequently coexist with overweight and obesity. One third of obese adults began to be so in the pediatric ages. There are two main types of prevention: general one representing greater actions from health authorities and the individual one carried out by the pediatrician and the patient at risk. Once the state of obesity is reached (relative body mass index, rBMI >121%) the longer lasting care becomes more complex and frequently unsuccessful. The treatment of obesity is aimed to care for the present and silent disorders and for preventing its further tracking to adulthood. Identification of pediatric population at risk which is the one with an rBMI of 111%-120% plus other risk factors. Specific individual actions include reduction of food intake, increase of energy expenditure, involvement of parents, and the child-adolescent himself in the prevention. Therapy is based on some principles plus the important medical and emotional approach. A Cochrane study based on only 10 appropriate studies showed a predominant poor efficacy of the undergone preventive action. Treatment guides are presented after our own experience with a group of 400 kids with an average follow-up of 7 years and other individual prevention studies. Involving motivated pediatricians with a minimum of time for visits and better follow-up in the frame of a general national preventive programme could be a rational outcome. Treatment of obesity should never be postponed whatever the clinical care is.

Autoimmune thyroid diseases in patients with primary pulmonary hypertension

Abnormal metabolism due to thyroid disorders could cause the additional significant right ventricular (RV) overload in patients with primary pulmonary hypertension (PPH). The purpose of this study was the prospective determination of autoimmune thyroid status in PPH patients. 45 patients (33 women and 12 men, mean age 38 years+/-13) with moderate and severe PPH (mean pulmonary artery pressure 61 mmHg+/-18 mmHg). PPH was diagnosed when other reason of pulmonary hypertension had been excluded especially thromboembolic, venous and hypoxemic. Titer of antibodies to thyroglobulin and thyroid peroxidase were measured. Thyroid gland dysfunction was determined by biochemical measurements of thyrotropin and free thyroxine; thyroid ultrasonographic examination was also performed. The prevalence of thyroid autoantibodies is estimated at 13% in general population. RESULTS. In 14 patients (31%) increased titer of thyroid antibodies was found in our group. Hyperthyroidism was recognized in 2 patients and in 3 cases we diagnosed hypothyroidism with high antibodies level requiring treatment. Ultrasonographic abnormalities were revealed in 21 patients (nodular changes--11 patients, fibrosis--3 patients, chronic inflammation symptoms--7). Ultrasonographic abnormalities were present in all patients with detectable antithyroid antibodies. We haven't confirmed more frequent prevalence of hormonal disorders in patient treated with prostacyclin's analogues. The prevalence of autoimmune thyroid diseases is about 3 times higher in PPH patients than in general population. The treatment of patients with clinically evident hyper- or hypothyroidism is necessary. The monitoring of clinically silent disorders seems to be recommended especially prior to lung transplantation qualification.

The Influence of Silent Learning Disorders on the Lives of Women

Longstanding neurocognitive deficits such as learning disorders greatly influence development of a woman's personality, relationships, and educational and vocational attainment. In our clinical practice, we increasingly see women with previously undiagnosed “silent learning disorders.” Educational and career milestones, problems in the workplace, parenting a child with a learning disorder, and normal aging along with common medical conditions can exacerbate these “silent learning disorders.” As a result, neurocognitive deficits might appear more pronounced as former ways of compensating for learning problems no longer are adequate. When such learning disorders are not detected, women and their therapists might not avail themselves of interventions that can help to treat the reading, visual-spatial, organizational, or other neurocognitive deficits, and indirectly help with patterns of anxiety, depression, and low self-esteem. In the present paper, we characterize women with silent learning disorders, discuss implications if disorders remain undetected, and present case examples. A model and strategies for detecting silent learning disorders also are presented.

Groups Want Depression Screening To Be Part of School Examinations

Groups Want Depression Screening To Be Part of School Examinations

Cerebral blood flow and metabolism in silent brain infarction and related cerebrovascular disorders

The appropriate management of silent stroke requires better understanding of the haemodynamic status in the brain. However, only a few studies have examined cerebral blood flow and metabolism in subjects with silent stroke. Positron emission tomography demonstrated a slight decrease in cortical blood flow with an increase in oxygen extraction fraction (ie misery perfusion) in subjects with silent brain infarction, whereas both cerebral blood flow and oxygen metabolism decreased in patients with symptomatic brain infarction (matched hypoperfusion). These findings confirm that brain circulation is haemo-dynamically compromised in subjects with silent stroke. Another important point is that subcortical silent stroke may induce a reduction in cortical blood flow and metabolism by a disconnection mechanism (ie diaschisis) between the cortex and the subcortical structures. Silent infarction is not innocuous in terms of compromised cerebral circulation, which may lead to cognitive decline or subsequent clinical stroke. In the future, further developments in functional imaging will permit a more sophisticated analysis of brain circulation and metabolism in silent stroke.

Potenciales evocados visuales (PEV). Perspectivas actuales

The objective of this study is to describe current tendencies in the recording and interpretation of visual evoked potentials (VEP). In the introduction we describe the history of the three main classical schools and the modern methodology which combines them, so as to study the photopic and scotopic systems together and thus be better able to determine the origin of the underlying pathology. We describe recording techniques using flash and chequer-board and a strategy for study of the visual pathway. The application of this technique is described for pathologies in which its findings are of particular interest: Silent multiple sclerosis, Parkinson, hepatic encephalopathy, dementia and psychiatric disorders in which certain neurotransmitters play a part; visual acuity; coma and brain death; cortical blindness. A separate section deals with paediatrics, in view of its special characteristics. We call for a return to the use of this technique with great future diagnostic potential.

Sudden Death in Athletes

Competitive sports activity is associated with an increase in the risk of sudden cardiovascular death (SCD) in susceptible adolescents and young adults with clinically silent cardiovascular disorders. Screening including 12-lead electrocardiogram (ECG) has been demonstrated to allow identification of athletes affected by malignant heart muscle diseases at a pre-symptomatic stage and lead to substantial reduction of the risk of SCD during sports. The use of modern criteria for interpretation of the ECG in the athlete significantly improves the screening accuracy by reducing the false positive rate (increased specificity), with the important requisite of maintaining the ability for detection of life-threatening heart diseases (preserved sensitivity). Screening including ECG has a more favorable cost-benefit ratio than that based on history and physical examination alone, with cost estimates per year of life saved below the threshold to consider a health intervention as cost-effective. Screening with exercise testing middle aged/senior athletes engaged in leisure sports activity is likely to be cost-effective in older patients with coronary risk factors, while it is not justified in low-risk subgroups.