Total Oral Intake Research Articles

Effect of early versus delayed mobilization by physical therapists on oral intake in patients with sarcopenic dysphagia after pneumonia.

Older pneumonia patients with sarcopenic dysphagia have difficulty with oral intake. Physical rehabilitation might be beneficial in the treatment of sarcopenic dysphagia. This study aimed to test the hypothesis that early mobilization by physical therapists enhances oral intake after pneumonia in sarcopenic dysphagia. This retrospective observational study used data on consecutive pneumonia patients with sarcopenic dysphagia aged over 65years hospitalized in the acute care ward from May 2017 to October 2017. We compared characteristics and outcomes between the early mobilization group and the delayed mobilization group. The outcomes were total oral intake and functional oral intake scale score at discharge. Applying the exclusion criteria, 125 patients were eligible. Patients with early mobilization were 33.6% of all pneumonia patients. There were no significant differences in baseline characteristics between both groups. Total oral intake rates at discharge were higher in the early mobilization group compared with the delayed mobilization group (75.6% vs 51.8%; p = 0.012). Functional oral intake scale scores were higher in the early mobilization group than the delayed mobilization group (p = 0.001). On multiple logistic regression analysis, early mobilization was significantly associated with total oral intake at discharge (odds ratio, 3.06; p = 0.01). Multiple linear regression analysis revealed that early mobilization was a significant factor affecting functional oral intake scale score at discharge (coefficient, 0.25; p = 0.01). Our cohort analysis demonstrated that early mobilization by a physical therapist is associated with improved total oral intake in patients with sarcopenic dysphagia after pneumonia.

Postextubation Dysphagia in Children: The Role of Speech-Language Pathologists.

Postextubation dysphagia is common and associated with worse outcomes in the PICU. Although there has been an increased participation of speech-language pathologists in its treatment, there is limited evidence to support speech-language pathologists as core PICU team member. We aimed to assess the impact of speech-language pathologists interventions on the treatment of postextubation dysphagia. A quasi-experimental prospective study. In the historical group (controls), patients received a standard care management for dysphagia whereas the intervention group was routinely treated by speech-language pathologists. PICU of a tertiary hospital. Children who were endotracheally intubated for a period greater than 24 hours with greater oral intake limitation as defined by a Functional Oral Intake Scale less than or equal to 3. Routine speech-language pathologist assessment. A total of 74 patients were enrolled to receive intervention (January 2015 to December 2016) and 41 patients to the historical group (January 2014 to December 2014). There were no differences in the demographic and clinical characteristics. The historical group had both longer time to initiate oral intake (7 vs 4 d; p = 0.0002; hazard ratio, 2.33) and to reach full oral intake compared with intervention group (9 vs 13 d; p < 0.001; hazard ratio, 2.51). A total of 32 controls (78%) and 74 intervention patients (100%) were on total oral intake at discharge (p ≤ 0.001). Three of nine control patients were feeding tube dependent at hospital discharge. Also, controls had a longer length of hospital stay (25 vs 20 d) and a higher rate of reintubation when compared with those patients of intervention group (10% vs 2%). Incorporating speech-language pathologists in the routine management of postextubation dysphagia can result in faster functional improvement and favorable patient outcomes. Yet, further and larger studies in pediatric dysphagia are required to support the related interventions and strategies to guide clinical practice.

Traumatic cervical spinal cord injury: recovery of penetration/aspiration and functional feeding outcome.

Prospective cohort study. This prospective cohort study aims to evaluate the recovery of penetration/aspiration and functional feeding outcome in patients with acute TCSCI. Tampere University Hospital, Tampere, Finland METHODS: Forty-six patients with TCSCI were enrolled. All the patients received speech therapeutic interventions based on their clinical needs and were examined with a videofluoroscopic swallowing study (VFSS) at enrollment. The incidence of VFSS-verified laryngeal penetration/aspiration according to Rosenbek's Penetration-Aspiration Scale (PAS) served as the primary outcome. The secondary outcome was the level of functional oral intake (as per the Functional Oral Intake Scale; FOIS). Based on the PAS results, the patients were divided into two groups: (i) penetrator/aspirators (PAS score ≥3) and (ii) non-penetrator/aspirators (PAS score ≤2). Follow-up VFS studies were primarily conducted on the patients with penetration/aspiration in prior VFS studies. The follow-up VFS studies were scheduled on the basis of clinical demand. Of the 46 patients, 48% had penetration/aspiration in the first VFSS. The second VFSS was conducted on 20 patients, of whom 6 patients (30%) had penetration/aspiration. The third VFSS was conducted on 9 patients. Of these, only two (22%) patients were still penetrator/aspirators. The majority (n = 37, 88%) of the patients presented a total oral intake without restrictions at the time of the final follow-up. Only one patient (2%) was still tube-dependent with consistent oral intake. Swallowing physiology in patients with TCSCI improved during the first months after injury, and the number of penetrator/aspirators decreased progressively.

Swallowing dysfunction following endotracheal intubation: Age matters.

To evaluate postextubation swallowing dysfunction (PSD) 21 days after endotracheal extubation and to examine whether PSD is time-limited and whether age matters.For this prospective cohort study, we evaluated 151 adult critical care patients (≥20 years) who were intubated for at least 48 hours and had no pre-existing neuromuscular disease or swallowing dysfunction. Participants were assessed for time (days) to pass bedside swallow evaluations (swallow 50 mL of water without difficulty) and to resume total oral intake. Outcomes were compared between younger (20–64 years) and older participants (≥65 years).PSD, defined as inability to swallow 50 mL of water within 48 hours after extubation, affected 92 participants (61.7% of our sample). At 21 days postextubation, 17 participants (15.5%) still failed to resume total oral intake and were feeding-tube dependent. We found that older participants had higher PSD rates at 7, 14, and 21 days postextubation, and took significantly longer to pass the bedside swallow evaluations (5.0 vs 3.0 days; P = 0.006) and to resume total oral intake (5.0 vs 3.0 days; P = 0.003) than their younger counterparts. Older participants also had significantly higher rates of subsequent feeding-tube dependence than younger patients (24.1 vs 5.8%; P = 0.008).Excluding patients with pre-existing neuromuscular dysfunction, PSD is common and prolonged. Age matters in the time needed to recover. Swallowing and oral intake should be monitored and interventions made, if needed, in the first 7 to 14 days postextubation, particularly for older patients.

Determination of the cut-off score of an endoscopic scoring method to predict whether elderly patients with dysphagia can eat pureed diets.

To identify the cut-off value for predicting the ability of elderly patients with dysphagia to swallow pureed diets using a new endoscopy scoring method. Endoscopic swallowing evaluation of pureed diets were done in patients ≥ 65 years with dysphagia. The Hyodo-Komagane score for endoscopic swallowing evaluation is expressed as the sum (0-12) of four degrees (0-3) with four parameters: (1) salivary pooling in the vallecula and piriform sinuses; (2) the response of glottal closure reflex induced by touching the epiglottis with the endoscope; (3) the location of the bolus at the time of swallow onset assessed by "white-out" following swallowing of test jelly; and (4) pharyngeal clearance after swallowing of test jelly. We used receiver operating characteristic (ROC) curve analysis to retrospectively analyze the association between the total score and successful oral intake of pureed diets. One hundred and seventy-eight patients were enrolled including 113 men (63%), mean age 83 years (range, 66-98). One hundred and twenty-six patients (71%) were able to eat pureed diets during the observation period (mean ± SD, 19 ± 14 d). In ROC analysis, the cut-off value of the score for eating the pureed diets was 7 (sensitivity = 0.98; specificity = 0.91). The Hyodo-Komagane endoscopic score is useful to predict the ability to eat pureed diets in elderly patients with dysphagia.

Multicentre, randomised, placebo-controlled trial of extract of Japanese herbal medicine Daikenchuto to prevent bowel dysfunction after adult liver transplantation (DKB 14 Study)

IntroductionThis multicentre randomised controlled clinical trial will aim to determine the ability of an extract (TJ-100) of Daikenchuto (traditional Japanese herbal medicine; Kampo) to prevent bowel dysfunction in at least...

Factors affecting return to oral intake in inpatient rehabilitation after acquired brain injury

Primary objective: To extend previous observations by investigating if differences exist in time to initiation or to recovery of total oral intake in patients with acquired brain injury assessed by either Facial-Oral Tract Therapy (F.O.T.T.®) or Fibreoptic Endoscopic Evaluation of Swallowing (FEES) and to investigate whether other factors influence these outcomes.Research design: Randomized controlled trial.Methods: One hundred and nineteen patients with dysphagia in inpatient neurorehabilitation were randomized. The main outcome was time to maximum on the Functional Oral Intake Scale.Results: There was no difference in time to initiation or recovery of total oral intake using F.O.T.T.® or FEES. Oral intake was initiated for 42% on admission and 92% at discharge; 2.5% of the patients were on total oral intake within 24 hours of admission and 37% at discharge. The likelihood of recovery to total oral intake before discharge was found to depend on age, Functional Independence Measure score, length of stay and number of dysphagia interventions.Conclusion: There was no significant difference in time to initiation and recovery of total oral intake before discharge, whether assessed by F.O.T.T.® or FEES, indicating that an instrumental assessment is unnecessary for standard evaluation. Age, functional independence and length of stay had a significant influence.

Predictive factors for oral intake after aspiration pneumonia in older adults.

The purpose of the present study was to clarify the predictive factors for achieving oral intake after aspiration pneumonia in elderly patients. This retrospective observational study used data from the Japanese Diagnosis Procedure Combination inpatient database. We identified patients who were admitted to acute-care hospitals with aspiration pneumonia. The outcome was time to achieve total oral intake. We carried out Cox regression analysis to identify predictors for the early initiation of total oral intake. Of 66 611 elderly patients with aspiration pneumonia, 59% achieved total oral intake within 30 days. Cox regression analysis showed that early initiation of total oral intake was associated with female sex and higher Barthel Index. Delayed initiation of total oral intake was associated with underweight, higher scores of pneumonia severity and comorbidities. We clarified prognostic factors for total oral intake in elderly aspiration pneumonia patients. Our findings will be helpful in nutritional care planning for elderly aspiration pneumonia patients. Geriatr Gerontol Int 2016; 16: 556-560.

The Efficacy of Oral Elemental Diet in Patients with Hematopoietic Stem Cell Transplantation

▪Background: Oral elemental diet (ED) is easily assimilated form of liquid nutrients composed of amino acids, sugars, vitamins and minerals. It alleviates the digestive loading from the intestine and mainly used for enteral nutritional support in the treatment of patients with Crohn’s disease. High dose alkylating agents and total body irradiation (TBI) commonly used in conditioning regimens for hematopoietic stem cell transplantation (HSCT) are well known to cause severe gastro intestinal toxicities including mucositis associated with oral pain which often disturb oral intake of the patient. Inadequate nutrition requiring total parenteral nutrition (TPN) prolongs hospitalization and life-threatening infection may result from bacterial translocation through damaged mucosal membranes.Objectives: To our best knowledge, there are no previous reports of the efficacy of ED in patients with HSCT. We conducted a prospective cohort study to determine whether ED improved patients’ outcome.Patients: We enrolled 73 consecutive patients who underwent HSCT between Mar. 2011 and Mar. 2013 in Anjo Kosei Hospital. Fifty patients undergone allogeneic HSCT, and 23 patients undergone autologous HSCT. The sources of allogeneic HSCT were unrelated bone marrow (n=16), related peripheral blood stem cell (n=16), unrelated cord blood (n=18). Median age was 47 years old (range, 17-72 years). There were 41 male and 32 female patients. Patients had leukemia (n = 38), malignant lymphoma (n = 24), multiple myeloma (n = 7), and others (n = 3). At transplant, 52 patients were in complete remission (CR), 21 patients were in non-CR. Twenty-one patients who were transplanted before November 2011 did not receive any ED (non-ED group; NEG), and 52 patients transplanted afterward November 2011 received an ED as standard care (ED-group; EG).Methods: ED administration was initiated from day -8 to day -4 to all patients when conditioning regimens for HSCT began, and ended on day +28 after HSCT. The recommended dose was 80g (1255 kJ) daily for total oral ED intake. We didn’t exclude the intake after failure of ED administration, additional food intake, and total parenteral nutrition (TPN). Our standard practice for allogeneic HSCT has been to start TPN on day -1 and continue until patients achieve a documented caloric intake of 6279 kJ per day after engraftment. For autologous HSCT, our protocol has been to start TPN when patients fail to reach a documented caloric intake of 6279 kJ per day by food intake and continue until this level is reached. This study was approved by our institutional review board.Results: Patient characteristics were not significantly different between the two groups. The median days of ED administration was 30 days (range, 3–37 days). The median number of days of oral food intake for EG and NEG were 22 days (range, 2–37) and 25 days (range, 3–35 days) days, respectively (P = 0.90). There were no adverse events reported due to ED administration. Grade 3/4 oral mucositis occurred in 13 (25%) EG patients and 10 (48%) NEG patients (P=0.06). Mean duration of mucositis in EG and NEG were 2.8 days and 5.6 days (P=0.07), respectively. Grade 2 to 4 fever occurred in 43 (83%) EG patients and 14 (67%) NEG patients (P=0.13), and the mean duration of fever were 3.9 days and 5.0 days, respectively (P=0.95). Acute GVHD occurred in 8 (19%) EG patients and 7 (46%) NEG patients (P=0.21). The mean duration of patient hospitalization was 36.6 days in EG patients and 57.3 days in NEG patients (P=0.003). Day100 non-relapse mortalities were 4 (8%) in EG patients and 3 (14%) in NEG patients (P=0.40).Conclusions: Oral intake of ED in patients with HSCT significantly reduced the duration of hospitalization and showed the possibility to improve the occurrence of grade 3/4 oral mucositis without adverse events. DisclosuresNo relevant conflicts of interest to declare.

Effect of dysphagia rehabilitation on oral intake in elderly patients with aspiration pneumonia.

To clarify the effects of dysphagia rehabilitation on oral intake after aspiration pneumonia in older adults. The present retrospective observational study used data from the Japanese Diagnosis Procedure Combination inpatient database. We identified patients who were admitted to acute care hospitals with aspiration pneumonia. Patients were subdivided into those with and without dysphagia rehabilitation. The main outcome variable was total oral intake on discharge. We carried out multivariate logistic regression analysis to assess the effect of dysphagia rehabilitation on the outcome, with adjustment for patient backgrounds. We also carried out analyses based on pneumonia severity, and the timing and duration of dysphagia rehabilitation. We identified 22,819 patients with dysphagia rehabilitation and 75,555 patients without dysphagia rehabilitation. The rates of total oral intake on discharge were 78.0 and 75.2%, respectively. The multivariate regression model showed that the dysphagia rehabilitation group had a significantly higher proportion of total oral intake on discharge (odds ratio 1.32; P < 0.001). Mild pneumonia patients had a higher odds ratio for total oral intake associated with dysphagia rehabilitation than patients with moderate and severe pneumonia (odds ratio 2.27; P < 0.001). Among patients who underwent a short period of dysphagia rehabilitation, those with early rehabilitation were more likely to achieve total oral intake at discharge than those with late rehabilitation. The data suggest that dysphagia rehabilitation had a positive effect on total oral intake in elderly patients with aspiration pneumonia. Dysphagia rehabilitation showed greater benefit in patients with mild pneumonia than with more severe pneumonia.

Seminal Vesicle-Rectal Fistula Secondary to Anastomotic Leakage After Low Anterior Resection for Rectal Cancer: A Case Report and Brief Literature Review

We report a case of a patient with seminal vesicle-rectal fistula, an extremely rare complication of low anterior resection of the rectum. A 53-year-old man with rectal adenocarcinoma underwent low anterior resection in our hospital. The patient experienced diarrhea, pneumaturia, and low-grade fever on postoperative day 13. A computed tomography scan showed emphysema in the right seminal vesicle. We concluded that anastomotic leakage induced a seminal vesicle-rectal fistula. The patient underwent conservative therapy with total parenteral nutrition and oral intake of metronidazole. Diarrhea and pneumaturia rapidly improved after metronidazole administration and the patient was successfully cured without invasive therapy such as colostomy or surgical drainage. A seminal vesicle-rectal fistula is a rare complication of low anterior resection, and therapeutic strategies for this condition remain elusive. Our report provides valuable information on the successful conservative treatment of a secondary seminal vesicle-rectal fistula that developed after low anterior resection of the rectum in a patient.

A Case of Total Oral Intake Reestablished with Prosthetic Appliance for Swallowing Disorders and Botulinum Toxin Treatment in Conjunction with Swallowing Therapy after Cerebellar and Brain Stem Infarction

A Case of Total Oral Intake Reestablished with Prosthetic Appliance for Swallowing Disorders and Botulinum Toxin Treatment in Conjunction with Swallowing Therapy after Cerebellar and Brain Stem Infarction

Faecal D/L Lactate Ratio Is a Metabolic Signature of Microbiota Imbalance in Patients with Short Bowel Syndrome

Our objective was to understand the functional link between the composition of faecal microbiota and the clinical characteristics of adults with short bowel syndrome (SBS).Sixteen patients suffering from type II SBS were included in the study. They displayed a total oral intake of 2661±1005 Kcal/day with superior sugar absorption (83±12%) than protein (42±13%) or fat (39±26%). These patients displayed a marked dysbiosis in faecal microbiota, with a predominance of Lactobacillus/Leuconostoc group, while Clostridium and Bacteroides were under-represented. Each patient exhibited a diverse lactic acid bacteria composition (L. delbrueckii subsp. bulgaricus, L. crispatus, L. gasseri, L. johnsonii, L. reuteri, L. mucosae), displaying specific D and L-lactate production profiles in vitro. Of 16 patients, 9/16 (56%) accumulated lactates in their faecal samples, from 2 to 110 mM of D-lactate and from 2 to 80 mM of L-lactate. The presence of lactates in faeces (56% patients) was used to define the Lactate-accumulator group (LA), while absence of faecal lactates (44% patients) defines the Non lactate-accumulator group (NLA). The LA group had a lower plasma HCO3− concentration (17.1±2.8 mM) than the NLA group (22.8±4.6 mM), indicating that LA and NLA groups are clinically relevant sub–types. Two patients, belonging to the LA group and who particularly accumulated faecal D-lactate, were at risk of D-encephalopathic reactions. Furthermore, all patients of the NLA group and those accumulating preferentially L isoform in the LA group had never developed D-acidosis. The D/L faecal lactate ratio seems to be the most relevant index for a higher D- encephalopathy risk, rather than D- and L-lactate faecal concentrations per se. Testing criteria that take into account HCO3− value, total faecal lactate and the faecal D/L lactate ratio may become useful tools for identifying SBS patients at risk for D-encephalopathy.

Restriction of oral intake of water for aspiration lung disease in children

Primary aspiration of food and fluid is commonly seen in children with feeding and swallowing difficulties associated with a range of diseases and complex medical conditions. Respiratory sequelae and pneumonia are known to be associated with primary aspiration of ingested material, however causality between primary aspiration of specific food and fluid types and pulmonary effects in children is yet to be established in controlled trials. The relative pulmonary morbidity of aspiration of ingested food and fluid materials versus other causes of respiratory disease such as viral and bacterial causes, secondary aspiration of gastrointestinal contents and predisposing lung conditions such as chronic neonatal lung disease in a developing immune system is also unclear. Current management decisions for children who aspirate have to optimise oral nutrition and hydration, while reducing the risk of aspiration to preserve pulmonary integrity. This generally includes restricting aspirated food or fluids and providing texture-modified diets and thickened fluids. Young children frequently refuse thickened fluids providing a management dilemma for both families and health professionals. Our objective was to evaluate the efficacy of restriction of oral water ingestion on the pulmonary status of children with thin fluid aspiration demonstrated on a modified barium swallow study. The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Airways Collaborative Review Group Specialised Register, MEDLINE, EMBASE and CINAHL databases were searched by the Cochrane Airways Group. The latest search was performed in May 2102. All randomised controlled trials comparing restriction of oral intake of water with unlimited oral water ingestion were eligible to be included. Results of searches were reviewed against a pre-determined criteria for inclusion. No eligible trials were identified for a paediatric population and thus no data were available for analysis. One trial in an adult population was identified and reported. No randomised controlled trials examining the efficacy of restriction of oral intake of water in the management of children with thin fluid aspiration were found. In a single study in an adult population with stroke, no significant differences were seen between a control group of oral water restriction and the experimental group of unlimited oral water ingestion on outcomes such as pneumonia, total oral fluid intake and dehydration. There are no trials that have adequately evaluated the pulmonary effects of allowing or restricting oral water ingestion in children known to have primary aspiration of thin fluids. Thus, there is currently an absence of evidence to support a strict approach of full restriction of oral intake of water or support a more liberal approach of allowing oral water ingestion in children with primary aspiration of thin fluids.

Vitamin Serum Level Variations Between Cycles of Intermittent Parenteral Nutrition in Adult Patients With Short Bowel Syndrome

An alternative form of nutrition therapy for patients with short bowel syndrome (SBS) who do not have home parenteral nutrition (PN) available is the administration of the PN cycle during regular hospital admissions and oral vitamin supplement at home. The aim of this study was to evaluate serum levels of folic acid and vitamins A, B(12), C, and E before and after the PN cycle in patients with SBS. This research was conducted with 10 patients with SBS (less than 15 minutes of total barium transit time) who were receiving the PN cycle and oral vitamin supplement at home. Patients were evaluated regarding total food ingestion and oral vitamin supplement intake. Serum levels of vitamins were evaluated immediately after the end of each PN cycle (phase 1) and before the beginning of the next PN cycle (phase 2). Patients' nutrient ingestion was in accordance with recommendations for healthy individuals. Regarding the oral vitamin supplement intake, 20% of the patients presented low adherence. Although all patients had a normal serum level of folic acid and vitamin B(12), PN vitamin infusion during hospitalization and home oral vitamin supplement were not enough to make the serum levels of vitamins A, C, and E achieve normal values. This study documented that patients did not receive an adequate administration of oral vitamin supplements of vitamins A, C, and E through PN. More studies need to be conducted investigating higher doses of vitamin administration (oral or intravenous administration), assessing differences between water and liposoluble supplements.

Functional and Physiological Outcomes from an Exercise-Based Dysphagia Therapy: A Pilot Investigation of the McNeill Dysphagia Therapy Program

Crary MA, Carnaby GD, LaGorio LA, Carvajal PJ. Functional and physiological outcomes from an exercise-based dysphagia therapy: a pilot investigation of the McNeill Dysphagia Therapy Program. ObjectiveTo investigate functional and physiological changes in swallowing performance of adults with chronic dysphagia after an exercise-based dysphagia therapy. DesignIntervention study: before-after trial with 3-month follow-up evaluation. SettingOutpatient clinic within a tertiary care academic health science center. ParticipantsAdults (N=9) with chronic (>12mo) dysphagia after unsuccessful prior therapies. Subjects were identified from among patients referred to an outpatient dysphagia clinic. Subjects had dysphagia secondary to prior treatment for head/neck cancer or from neurologic injury. All subjects demonstrated clinical and fluoroscopic evidence of oropharyngeal dysphagia. No subject withdrew during the course of this study. InterventionsAll subjects completed 3 weeks of an intensive, exercise-based dysphagia therapy. Therapy was conducted daily for 1h/d, with additional activities completed by subjects each night between therapy sessions. Main Outcome MeasuresPrimary outcomes were clinical and functional change in swallowing performance with maintenance at 3 months after intervention. Secondary, exploratory outcomes included physiological change in swallow performance measured by hyolaryngeal elevation, lingual-palatal and pharyngeal manometric pressure, and surface electromyographic amplitude. ResultsClinical and functional swallowing performances improved significantly and were maintained at the 3-month follow-up examination. Subject perspective (visual analog scale) on functional swallowing also improved. Four of 7 subjects who were initially feeding tube dependent progressed to total oral intake after 3 weeks of intervention. Physiological indices demonstrated increased swallowing effort after intervention. ConclusionsSignificant clinical and functional improvement in swallowing performance followed a time-limited (3wk) exercise-based intervention in a sample of subjects with chronic dysphagia. Physiological changes after therapy implicate improved neuromuscular functioning within the swallow mechanism.

Efficacy and safety of intraoperative dexmedetomidine in pediatric posttonsillectomy pain: Peritonsillar versus intravenous administration

BackgroundAlthough being used off-label, the utility of dexmedetomidine in pediatric settings is increasing. Alpha-2 agonists have peripheral analgesic effects. This prospective, randomized, double-blind, Placebo-controlled study was designed to evaluate the safety and efficacy of dexmedetomidine single intraoperative preincisional dose in pediatric patients undergoing tonsillectomy and adenoidectomy.Patients and methodsEighty-four children (5–12 years) were randomized into three groups: DEX.IV (n = 28) received dexmedetomidine 1 μg/kg iv. infusion in 10 min, DEX.PT (n = 28) received dexmedetomidine 1 μg/kg peritonsillar infiltration, and the Placebo controls (n = 28). Assessment parameters included pain, sedation, hemodynamics, and adverse effects.ResultsIntraoperative dexmedetomidine administration resulted in a significant reduction in pain scores postoperatively in the DEX.IV and DEX.PT groups, with no significant difference between them. The time to first postoperative analgesic request was significantly prolonged in DEX.IV (583.45 ± 157.94 min, P < 0.000) and DEX.PT (537.61 ± 106.17 min, P < 0.000) groups compared with the Placebo group (119.75 ± 43.44 min). Similarly, a significantly lower paracetamol consumption during the first postoperative day was recorded in the DEX.IV (459.37 ± 114.82 mg, P < 0.000) and DEX.PT (475.38 ± 143.11 mg, P < 0.000) groups, than in the Placebo group (705.00 ± 249.27 mg), with no significant difference between DEX.IV and DEX.PT groups. Patients in the DEX.IV group exhibited significantly prolonged extubation times ((13.83 ± 3.38 min, P < 0.000) and significantly higher mean Ramsay sedation scores at 15, 30, 60, 120, and 180 min postoperative (P < 0.000), compared with DEX.PT and Placebo groups. The mean intraoperative heart rates were significantly slower in DEX.IV group during and after the intravenous infusion of dexmedetomidine and at 15th min intraoperative (p < 0.05), compared with DEX.PT and Placebo groups, with no significant differences in mean heart rates among the groups in other time points measured. Patients in DEX.PT group had a significantly higher total oral intake in first day postoperative (P < 0.000) and a significantly higher family satisfaction (p < 0.000), compared with DEX.IV and Placebo groups.ConclusionPeritonsillar infiltration or iv. dexmedetomidine similarly enhanced the postoperative analgesia after tonsillectomy in pediatric patients. However, locally applied dexmedetomidine was associated with no systemic effects, higher total oral intake in first day postoperative, and higher family satisfaction.

Drastic changes in fecal and mucosa-associated microbiota in adult patients with short bowel syndrome

Short bowel syndrome (SBS) is observed in Humans after a large resection of gut. Since the remnant colon and its associated microbiota play a major role in the outcome of patients with SBS, we studied the overall qualitative and quantitative microbiota composition of SBS adult patients compared to controls. The population was composed of 11 SBS type II patients (with a jejuno-colonic anastomosis) and 8 controls without intestinal pathology. SBS patients had 38 ± 30 cm remnant small bowel length and 66 ± 19% of residual colon. The repartition of proteins, lipids, carbohydrates and fibres was expressed as % of total oral intake in patients and controls. The microbiota was profiled from stool and biopsy samples with temporal temperature gradient gel electrophoresis and quantitative PCR. We show here that microbiota of SBS patients is unbalanced with a high prevalence of Lactobacillus along with a sub-dominant presence and poor diversity of Clostridium leptum, Clostridium coccoides and Bacteroidetes. In addition, Lactobacillus mucosae was detected within the fecal and mucosa-associated microbiota of SBS patients, whereas it remained undetectable in controls. Thus, in SBS the microbial composition was deeply altered in fecal and mucosal samples, with a shift between dominant and sub-dominant microbial groups and the prevalence of L. mucosae.

Lack of Correlation between Calcium Intake and Serum Calcium Levels in Stable Haemodialysis Subjects

Background: The relationship between calcium intake and serum calcium level in hemodialysis patients is poorly understood. Methods: We quantify total oral calcium intake using detailed 7-day food diaries with 294 patient days of observation in 42 stable, non-diabetic hemodialysis subjects. Results: Mean (SD) albumin-corrected serum calcium was 9.84 mg/dl (0.8). The albumin-corrected serum calcium was low (<8.4 mg/dl) in 2 patients, low-normal (8.4–9.49) in 9 patients, high-normal (9.5–10.2) in 18 patients and high (>10.2) in 13 patients. Mean (SD) total (diet plus binder) oral calcium intake was 1996 mg/day (1,020); 16 patients (38%) had a total calcium intake >2,000 mg/day. Calcium intake and serum calcium were poorly correlated (Spearman rank method), r = 0.14, p = 0.39. Median calcium intakes were similar in those with normal (1,990 mg/day), high-normal (1,926 mg/day) and high calcium groups (1,713 mg/day), p = 0.73 (Kruskal-Wallis), p = 0.29 (linear test for trend). Forty-one percent (11/27) of patients who had serum calcium in the normal range had a calcium intake greater than 2 g/day, while 11.5% had a calcium intake greater than 3 g/day. In subjects with a parathyroid hormone (PTH) concentration <300 pg/ml (n = 20), the correlation between calcium intake and either uncorrected serum calcium or albumin-corrected serum calcium was stronger, r = 0.45, p = 0.05 and r = 0.38, p = 0.10, respectively, though there remained wide variability in calcium intake. Conclusion: Serum calcium is not a reliable indicator of calcium intake, especially at PTH ≥300 pg/ml. An excessive calcium intake may coexist with a normal serum calcium level.

Abstract ED07-03: Role of Vitamin D in prevention of cancer: dose-response relationships

Abstract ED07-03: Role of Vitamin D in prevention of cancer: dose-response relationships