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1.
J Clin Microbiol ; 48(3): 852-6, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20053857

RESUMO

Rapid antigen testing of upper respiratory secretions collected with various swab types is often utilized for laboratory diagnoses of influenza virus infection. There are limited data on the effects of swab composition on test performance. This study compared the performance of the Quidel QuickVue Influenza A+B test on secretions from the anterior nares when a polyurethane foam swab was used for collection to that when a nylon flocked swab was used for collection. One hundred subjects who presented to a pediatric emergency department with symptoms suggestive of an influenza virus infection were recruited for the study. Foam and flocked swabs of the anterior nares were obtained from separate nares of each subject before a posterior nasopharyngeal swab was collected and placed into viral transport medium. The QuickVue test was performed directly on each swab type, and the results were compared to the results of reverse transcription-PCR (RT-PCR), direct fluorescent antibody (DFA) test, and viral culture performed on the transport medium. RT-PCR alone and DFA combined with culture were utilized as separate gold standards. There were 56 cases of influenza detected by RT-PCR; the QuickVue test was positive for 40 foam and 30 flocked swabs, for sensitivities of 71% and 54%, respectively (P = 0.01). Similarly, there were 49 influenza cases detected by DFA and/or culture; the QuickVue test was positive for 38 foam and 30 flocked swabs, for sensitivities of 78% and 61%, respectively (P = 0.13). This study suggests that polyurethane foam swabs perform better than nylon flocked swabs for the collection of secretions from anterior nares in the Quidel QuickVue Influenza A+B test.


Assuntos
Antígenos Virais/análise , Secreções Corporais/virologia , Técnicas de Laboratório Clínico/métodos , Influenza Humana/diagnóstico , Nariz/virologia , Orthomyxoviridae/isolamento & purificação , Manejo de Espécimes/métodos , Adolescente , Criança , Serviços Médicos de Emergência , Humanos , Nasofaringe/virologia , Nylons , Poliuretanos , Sensibilidade e Especificidade
2.
J Pediatr Gastroenterol Nutr ; 48(2): 186-92, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19179881

RESUMO

BACKGROUND AND OBJECTIVES: Abnormal swallowing (dysphagia) among neonates is commonly evaluated using the videofluoroscopic swallow study (VSS). Radiological findings considered high risk for administration of oral feeding include nasopharyngeal reflux, laryngeal penetration, aspiration, or pooling. Our aims were to determine pharyngoesophageal motility correlates in neonates with dysphagia and the impact of multidisciplinary feeding strategy. METHODS: Twenty dysphagic neonates (mean gestation +/- standard deviation [SD] = 30.9 +/- 4.9 weeks; median 31.1 weeks; range = 23.7-38.6 weeks) with abnormal VSS results were evaluated at 49.9 +/- 16.5 weeks (median 41.36 weeks) postmenstrual age. The subjects underwent a swallow-integrated pharyngoesophageal motility assessment of basal and adaptive swallowing reflexes using a micromanometry catheter and pneumohydraulic water perfusion system. Based on observations during the motility study, multidisciplinary feeding strategies were applied and included postural adaptation, sensory modification, hunger manipulation, and operant conditioning methods. To discriminate pharyngoesophageal manometry correlates between oral feeders and tube feeders, data were stratified based on the primary feeding method at discharge, oral feeding versus tube feeding. RESULTS: At discharge, 15 of 20 dysphagic neonates achieved oral feeding success, and the rest required chronic tube feeding. Pharyngoesophageal manometry correlates were significantly different (P < 0.05) between the primary oral feeders versus the chronic tube feeders for swallow frequency, swallow propagation, presence of adaptive peristaltic reflexes, oral feeding challenge test results, and upper esophageal sphincter tone. VSS results or disease characteristics had little effect on the feeding outcomes (P = NS). CONCLUSIONS: Swallow-integrated esophageal motility studies permit prolonged evaluation of swallowing reflexes and responses to stimuli under controlled conditions at cribside. The dysfunctional neuromotor mechanisms may be responsible for neonatal dysphagia or its consequences. Manometry may be a better predictor than VSS in identifying patients who are likely to succeed in vigorous intervention programs.


Assuntos
Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Deglutição/fisiologia , Nutrição Enteral , Transtornos da Motilidade Esofágica/diagnóstico , Transtornos de Deglutição/diagnóstico , Transtornos da Motilidade Esofágica/etiologia , Transtornos da Motilidade Esofágica/terapia , Métodos de Alimentação , Feminino , Fluoroscopia , Idade Gestacional , Humanos , Lactente , Cuidado do Lactente/métodos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Valor Preditivo dos Testes , Resultado do Tratamento , Gravação em Vídeo
3.
J Pediatr Gastroenterol Nutr ; 47(2): 158-64, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18664867

RESUMO

BACKGROUND: Feeding problems in neonates with gastroschisis are commonly attributed to foregut dysmotility. However, the dysmotility mechanisms are not well understood. OBJECTIVE: Our aim was to differentiate the pharyngoesophageal motility characteristics in neonates with gastroschisis compared with the controls. Specifically, the characteristics of swallowing, upper esophageal sphincter (UES), esophageal body, and lower esophageal sphincter (LES) were evaluated during basal state and upon provocation. PATIENTS AND METHODS: Surgically repaired and recovered study infants with persistent feeding difficulties (n = 8; 36 +/- 2 weeks gestational age) and controls (n = 8; 38 +/- 2 weeks gestational age) were evaluated at 40 +/- 2 weeks and 42 +/- 2.5 weeks postmenstrual age, respectively. The basal and adaptive pharyngoesophageal motility characteristics were evaluated using a specially designed esophageal motility catheter with UES and LES sleeves and pneumohydraulic micromanometric water perfusion system at the crib side. Analysis of variance, chi-square, and t tests were applied; data are shown as mean +/- standard deviation, and P < 0.05 was considered significant. RESULTS: Birth weight was less in gastroschisis (P < 0.03, vs controls) and length was less at motility study (P < 0.01, vs controls). The study group (vs controls) needed prolonged respiratory support (21 +/- 23 vs 1 +/- 2 days; P < 0.001) and prolonged gavage feeding (167 +/- 100 vs 9 +/- 16 days; P < 0.01). Compared with the controls, the gastroschisis group had lower frequency (P < 0.05) and poor propagation of spontaneous swallows (P < 0.001), UES relaxation time was shorter (P < 0.05), rate of relaxation was faster (P < 0.001), and esophageal peristaltic propagation velocity was slower (P < 0.05). Upon esophageal provocation with air and liquids, frequency occurrence of the esophageal reflexes was low (P < 0.05) with respect to primary peristalsis, secondary peristalsis, UES contractile reflex, and LES relaxation reflex. CONCLUSIONS: In gastroschisis feeding milestones and respiratory milestones were delayed, basal pharyngoesophageal peristaltic failure was common, adaptive peristaltic reflexes were less frequent and failed to occur, and frequency occurrences of UES and LES responses were impaired. These neuromotor markers may provide clues to define the esophageal motor function abnormalities in infants with an abnormality thought to be limited to the intestine.


Assuntos
Transtornos da Motilidade Esofágica/etiologia , Esfíncter Esofágico Inferior/fisiologia , Esfíncter Esofágico Superior/fisiologia , Gastrosquise/fisiopatologia , Músculo Liso/fisiopatologia , Peso ao Nascer/fisiologia , Estudos de Casos e Controles , Deglutição/fisiologia , Transtornos de Deglutição/etiologia , Eletromiografia , Transtornos da Motilidade Esofágica/diagnóstico , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Manometria
4.
J Pediatr ; 151(6): 597-603, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18035137

RESUMO

OBJECTIVE: To test the hypothesis that the sensorimotor characteristics of the reflexes evoked on stimulation with air and water infusions differ by studying the effect of pharyngeal stimulation on pharyngeal-upper esophageal sphincter (UES) interactions in healthy neonates. STUDY DESIGN: Pharyngo-UES-esophageal manometry was recorded in 10 neonates at 39 +/- 4 weeks postmenstrual age. Pharyngeal infusions (n = 155) of air (0.1 to 2.0 mL) and sterile water (0.1 to 0.5 mL) were given. Two types of reflexes were recognized: pharyngeal reflexive swallowing (PRS) and pharyngo-UES-contractile reflex (PUCR). Frequency occurrence, distribution of reflexes, threshold volume, response time, and stimulus-response relationship were evaluated. RESULTS: The reflex response rates were 30% for air and 76% for water (P < .001). PRS was more frequent than PUCR with air and water (P < .05), even though the stimulation thresholds and response latencies were similar. Graded volumes of water but not air resulted in an increased frequency of PRS (P < .01). CONCLUSIONS: PRS is more frequent than PUCR, and the 2 reflexes have distinctive characteristics in air and water stimuli. Both PRS and PUCR have implications for the evaluation of swallowing in infants.


Assuntos
Deglutição/fisiologia , Esfíncter Esofágico Superior/fisiologia , Recém-Nascido/fisiologia , Faringe/fisiologia , Reflexo/fisiologia , Humanos , Manometria , Estimulação Física
5.
Dysphagia ; 21(1): 75-81, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16786412

RESUMO

OBJECTIVES: Endoscopic procedures to assess aerodigestive symptoms by evaluating glottal motion are not practical in neonates because of small nares, respiratory difficulties, or additional stress. Our objective was to determine the temporal correlation between concurrent nasolaryngoscopy (NLS) and ultrasonography (USG) evaluation of glottal motion. METHODS: Simultaneous USG of the glottis was performed in 10 subjects (5 males, 5 females, age = 4.5 months to 7.1 years) that underwent diagnostic flexible outpatient NLS. The USG transducer was placed on the anterior neck at the level of the vocal cords. The video signals from NLS and USG were integrated and synchronized into real-time cine loops of 1-min duration. RESULTS: Frame-by-frame evaluation of 10,800 frames identifying glottal opening and closure time was compared between the two modalities by three observers and the timing of glottal closure was marked. Two investigators, blinded to NLS images, identified ultrasonographically determined glottal closure with 99% and 100% accuracy, and the mean probability of missing a closure frame was 0.007 (95% CI = 0.0008-0.024). CONCLUSIONS: Temporal characteristics of glottal motion can be quantified by USG with perfect reliability and safety. This method can be useful in measuring the presence and the duration of laryngeal adduction.


Assuntos
Deglutição/fisiologia , Glote/diagnóstico por imagem , Glote/fisiologia , Fonação/fisiologia , Criança , Pré-Escolar , Intervalos de Confiança , Feminino , Humanos , Lactente , Laringoscopia/métodos , Masculino , Reprodutibilidade dos Testes , Fatores de Tempo , Ultrassonografia , Prega Vocal/fisiologia , Qualidade da Voz
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