Fatores associados à indicação de via alternativa de alimentação após câncer de língua: uma revisão sistemática / Factors associated with the indication of alternative feeding following tongue cancer: a systematic review / Factores asociados a la indicacíon de via alternativa de nutrición después del cáncer de lengua: una revisión sistemática

Introdução: O câncer de cavidade oral constitui lesões da superfície da mucosa oral, e, devido às sequelas da doença e de seu tratamento, frequentemente ocorrem quadros de disfagia. Quando a alimentação por via oral se torna impossibilitada, é fundamental a indicação de vias alternativas de alimentação. Objetivo: verificar a ocorrência e os fatores associados ao uso de via alternativa de alimentação após câncer de língua. Método: A busca foi conduzida por dois pesquisadores independentes nas bases de dados Medline (Pubmed), LILACS, SciELO, Scopus, WEB OF SCIENCE e BIREME sem restrição de idioma e localização, no período de 2010 a 2021. Para complementar e evitar viés de risco foi realizada uma busca por literatura cinza no Google Scholar. Critérios de Seleção: A revisão sistemática foi conduzida conforme as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Foram incluídos na pesquisa estudos que obtiveram pontuação ≥ a 6 pontos segundo o protocolo para pontuação qualitativa proposto por Pithon. Resultados: Os estudos mostram que a maioria dos indivíduos com câncer oral desenvolvem uma perda significativa de peso, necessitando de intervenção. O estágio geral da doença é um preditor significativo de perda de peso crítica em pacientes em tratamento. Conclusão: A indicação de via alternativa de alimentação após câncer de língua foi de 19,3% a 68,2%, e os fatores associados a essa indicação de VAA foram o estágio geral, cirurgia associada à terapia adjuvante, má adesão ao tratamento multidisciplinar, presença de complicações e baixa sobrevida. (AU)

Introduction: Oral cavity cancer constitutes lesions on the surface of the oral mucosa and, due to the consequences of the disease and its treatment, dysphagia often occurs. When oral feeding becomes impossible, it is essential to indicate alternative feeding routes. Objective: to verify the occurrence and factors associated with the use of an alternative feeding route after tongue cancer. Method: The search was conducted by two independent researchers in the Medline (Pubmed), LILACS, SciELO, Scopus, WEB OF SCIENCE and BIREME databases without language and location restrictions, from 2010 to 2021. To complement and to avoid risk bias, a search for gray literature on Google Scholar was performed. Selection Criteria: The systematic review was conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies that scored ≥ 6 points according to the protocol for qualitative scoring proposed by Pithon. Results: Studies show that most individuals with oral cancer develop significant weight loss, requiring intervention. The overall stage of the disease is a significant predictor of critical weight loss in patients undergoing treatment. Conclusion: The indication of an alternative feeding route after tongue cancer was 19.3% to 68.2%, and the factors associated with this indication of AAV were the general stage, surgery associated with adjuvant therapy, poor adherence to multidisciplinary treatment, presence of complications and poor survival. (AU)

Introducción: El cáncer de cavidad oral constituye lesiones en la superficie de la mucosa oral y, debido a las consecuencias de la enfermedad y su tratamiento, es frecuente que se presente disfagia. Cuando la alimentación oral se hace imposible, es imprescindible la indicación de vías alternativas de alimentación. Objetivo: verificar la ocurrencia y los factores asociados al uso de una vía alternativa de alimentación después del cáncer de lengua. Método: La búsqueda fue realizada por dos investigadores independientes en las bases de datos Medline (Pubmed), LILACS, SciELO, Scopus, WEB OF SCIENCE y BIREME, sin restricciones de idioma y ubicación, de 2010 a 2021. Para complementar y Evitar riesgo de sesgo, se realizó una búsqueda de literatura gris en Google Scholar. Criterios de selección: La revisión sistemática se llevó a cabo de acuerdo con las recomendaciones de Elementos de informe preferidos para revisiones sistemáticas y metanálisis (PRISMA). Los estudios que puntuaron ≥ 6 puntos según el protocolo de puntuación cualitativa propuesto por Pithon et al. (2015). Resultados: Los estudios muestran que la mayoría de las personas con cáncer oral desarrollan una pérdida de peso significativa, lo que requiere intervención. El estadio general de la enfermedad es un predictor significativo de pérdida de peso crítica en pacientes que reciben tratamiento. Conclusión: La indicación de vía alternativa de alimentación tras cáncer de lengua varió del 19,3% al 68,2%, y los factores asociados a esta indicación de AAV fueron el estadio general, cirugía asociada a terapia adyuvante, mala adherencia al tratamiento multidisciplinario, presencia de complicaciones y baja supervivencia. (AU)

Por que indivíduos saudáveis podem ter escores do Eating Assessment Tool (EAT-10) indicativos de disfagia? / Why healthy individuals may have Eating scores Assessment Tool (EAT-10) indicative of dysphagia?

Contexto: Eating Assessment Tool (EAT-10) é um método clínico de detecção de disfagia, entendida como dificuldade na deglutição. Em pesquisa realizada no Brasil, foi observado que 9,5% de indivíduos saudáveis assintomáticos têm resultados do teste compatível com disfagia. Objetivo: Avaliar os possíveis fatores que influenciam o resultado anormal do teste em indivíduos saudáveis. Método: Estudo transversal realizado na Faculdade de Medicina de Ribeirão Preto (FMRP-USP) em 358 voluntários sem doenças e sem sintomas, nos quais foi aplicado o teste EAT-10. Resultados: Em 316 o resultado nos 10 itens do teste foi zero, e em 42 os resultados da somatória dos 10 itens foi igual ou superior a 3, considerado indicativo de disfagia. O resultado ≥ 3 ocorreu em 10 homens entre 144 (7%) e 32 mulheres entre 214 (15%), (P = 0,01). A mediana (limites) de idades daqueles com resultado zero foi de 39 (20-84) anos, e com resultado ≥ 3 foi de 32 (20-83) anos (P = 0,04). O índice de massa corporal (IMC) não apresentou diferença entre pessoas com e sem indicação de disfagia. O máximo escore possível para o item 5 (dificuldade na ingestão de medicamentos) foi o que obteve o maior percentual (43,9%) de máximo escore possível, sendo o fator mais importante para o resultado anormal. Discussão: Em indivíduos saudáveis, a dificuldade em ingerir medicamentos foi o fator que mais influenciou a ocorrência de resultado do teste EAT-10 indicativo de disfagia. Conclusão: Dificuldade na ingestão de medicamentos sólidos deve ser considerada quando da interpretação do teste.

Concordância da avaliação da via alimentar entre fonoaudiólogo e médico baseado na escala FOIS: coorte retrospectiva / Agreement in the assessment of the food pathway between speech therapists and physicians based on the FOIS scale: a retrospective cohort study / Concordancia en la evaluación de la vía alimentaria entre fonoaudiólogos y médicos basada en la escala FOIS: un estudio de cohorte retrospectivo

Introdução: A avaliação fonoaudiológica hospitalar tem um importante papel na prevenção e manejo de pacientes com risco de broncoaspiração. No entanto, nem sempre cabe ao fonoaudiólogo a primeira avaliação e definição da via alimentar nos pacientes hospitalares. Objetivo: Comparar as decisões fonoaudiológicas e médicas quanto à viabilidade da via alimentar em um hospital geral e identificar fatores associados com a melhora da deglutição. Métodos: Trata-se de um estudo retrospectivo de pacientes internados em hospital em Joinville durante março a agosto de 2018. A via alimentar foi considerada com base na Functional Oral Intake Scale (FOIS) sendo a primeira decisão comparada entre o fonoaudiólogo e o médico para o mesmo paciente. Resultados: Dos 171 pacientes, houve maior concordância entre as condutas médica e fonoaudiológica para alimentação por sonda nasoenteral (SNE) (88,7%) e alimentação oral livre (81,9%). No entanto, houve apenas 35% de concordância na definição de dieta adaptada, sendo a concordância geral moderada (Kappa 0,486). Houve evolução na alimentação por via oral em 62 pacientes (36%). Maior limitação da via alimentar, verificado pela necessidade de SNE (OR = 3,17; p = 0,025) e o maior número de atendimentos fonoaudiológicos intra-hospitalares (OR = 1,09; p = 0,020) foram associados com a melhora da disfagia. Conclusão: Encontrou-se concordância entre a avaliação dietética de casos para uso de SNE ou dieta livre entre o fonoaudiólogo e médico. Uso de SNE, como indicador de gravidade do paciente, e o maior número de sessões de fonoterapia foram associados com a melhora da disfagia durante a internação. (AU)

Introduction: Hospital-based speech-language pathology plays a crucial role in preventing and managing patients at risk of bronchoaspiration. However, the initial evaluation and determination of the feeding route in hospitalized patients may not always fall under the responsibility of the speech-language pathologist. Objective: To compare the decisions of speech-language pathologists and medical professionals regarding the feasibility of the feeding route in a general hospital and identify factors associated with swallowing improvement. Methods: This is a retrospective study of patients admitted to a hospital in Joinville from March to August 2018. The feeding route was assessed based on the Functional Oral Intake Scale (FOIS), with the initial decision compared between the speech-language pathologist and the physician for the same patient. Results: Among 171 patients, there was higher agreement between medical and speech-language pathology decisions for nasoenteral tube feeding (88.7%) and oral unrestricted intake (81.9%). However, there was only 35% agreement in defining an adapted diet, with overall moderate agreement (Kappa 0.486). Oral feeding improved in 62 patients (36%). The presence of nasoenteral tube feeding (OR = 3.17; p = 0.025) and a higher number of in-hospital speech-language pathology appointments (OR = 1.09; p = 0.020) were identified as independent predictors for dysphagia improvement. Conclusion: Concordance was found in the dietary assessment for the use of nasoenteral tube feeding or oral unrestricted intake between speech-language pathologists and physicians. The use of nasoenteral tube feeding as an indicator of patient severity and a higher number of speech-language pathology sessions were associated with dysphagia improvement during hospitalization. (AU)

Introducción: La evaluación fonoaudiológica hospitalaria desempeña un papel crucial en la prevención y el manejo de pacientes con riesgo de broncoaspiración. Sin embargo, no siempre corresponde al fonoaudiólogo la primera evaluación y definición de la vía alimentaria en los pacientes hospitalizados.Objetivo: Comparar las decisiones fonoaudiológicas y médicas sobre la viabilidad de la vía alimentaria en un hospital general e identificar factores asociados con la mejora de la deglución. Métodos: Se trata de un estudio retrospectivo de pacientes hospitalizados en un hospital de Joinville durante marzo a agosto de 2018. La vía alimentaria se evaluó según la Escala Funcional de Ingesta Oral (FOIS), siendo la primera decisión comparada entre el fonoaudiólogo y el médico para el mismo paciente. Resultados: De 171 pacientes, hubo una mayor concordancia entre las decisiones médicas y fonoaudiológicas para la alimentación por sonda nasoenteral (SNE) (88,7%) y la alimentación oral libre (81,9%). Sin embargo, solo hubo un 35% de concordancia en la definición de una dieta adaptada, siendo la concordancia general moderada (Kappa 0,486). La alimentación oral mejoró en 62 pacientes (36%). Una mayor limitación de la vía alimentaria, indicada por la necesidad de SNE (OR = 3,17; p = 0,025), y un mayor número de sesiones fonoaudiológicas intrahospitalarias (OR = 1,09; p = 0,020) se asociaron con la mejora de la disfagia.Conclusión: Se encontró concordancia en la evaluación dietética para el uso de SNE o dieta libre entre el fonoaudiólogo y el médico. El uso de SNE, como indicador de la gravedad del paciente, y un mayornúmero de sesiones de fonoterapia se asociaron con la mejora de la disfagia durante la hospitalización. (AU)

Necrosis esofágica aguda (esófago negro) asociado a neoplasias digestivas / Acute esophageal necrosis (black esophagus) associated with digestive neoplasms

INTRODUCCIÓN. La necrosis esofágica aguda es un síndrome raro que se caracteriza endoscópicamente por una apariencia negra circunferencial irregular o difusa de la mucosa esofágica intratorácica, la afectación es generalmente del esófago distal y la transición abrupta de mucosa normal en la unión gastroesofágica, con extensión proximal variable. CASOS. Se presentan dos casos con diferentes comorbiliades, presentación de signos y síntomas, antecedentes y tratamiento, teniendo en común el diagnóstico a través de endoscopía digestiva alta. RESULTADOS. Caso clínico 1: tratamiento clínico basado en hidratación, suspensión de vía oral, omeprazol intravenoso y sucralfato; mala evolución clínica caracterizada por: disfagia, intolerancia oral y recurrencia del sangrado digestivo alto, se realiza colocación de gastrostomía endoscópica. Caso clínico 2: esófago con mucosa con fibrina y parches de necrosis extensa, se realiza compensación tanto de foco infeccioso pulmonar como hidratación y nutrición, en estudios complementarios se observa masa colónica, con estudio histopatológico confirmatorio de adenocarcinoma de colon en estado avanzado. DISCUSIÓN. La esofagitis necrotizante aguda es una entidad inusual, de baja prevalencia e incidencia, asociada con estados de hipoperfusión sistémica y múltiples comorbilidades que favorezcan un sustrato isquémico. Al revisar los reportes de casos que hay en la literatura médica, los casos que reportamos se correlaciona con las características clínicas, epidemiológicas, endoscópicas y factores de riesgo causales de la enfermedad. La presentación clínica más frecuente es el sangrado digestivo alto, que se debe correlacionar con el hallazgo endoscópico clásico. Nuestro primer caso reportado termina con la colocación de una gastrostomía para poder alimentarse. CONCLUSIÓN. El pronóstico de la necrosis esofágica aguda es malo y se requiere un alto índice de sospecha clínica y conocimiento de esta infrecuente patología para un diagnóstico temprano y un manejo oportuno. Se requiere una evaluación por endoscopia digestiva alta. Es una causa de sangrado gastrointestinal que conlleva tasas altas de mortalidad, principalmente en adultos mayores frágiles. El reconocimiento temprano y la reanimación agresiva son los principios fundamentales para un mejor resultado de la enfermedad.

INTRODUCTION. Acute esophageal necrosis is a rare syndrome that is characterized endoscopically by an irregular or diffuse circumferential black appearance of the intrathoracic esophageal mucosa, the involvement is generally of the distal esophagus and the abrupt transition of normal mucosa at the gastroesophageal junction, with variable proximal extension. CASES. Two cases are presented with different comorbidities, presentation of signs and symptoms, history and treatment, having in common the diagnosis through upper gastrointestinal endoscopy. RESULTS. Clinical case 1: clinical treatment based on hydration, oral suspension, intravenous omeprazole and sucralfate; poor clinical evolution characterized by: dysphagia, oral intolerance and recurrence of upper digestive bleeding, endoscopic gastrostomy placement was performed. Clinical case 2: esophagus with mucosa with fibrin and patches of extensive necrosis, compensation of both the pulmonary infectious focus and hydration and nutrition is performed, in complementary studies a colonic mass is observed, with a confirmatory histopathological study of colon adenocarcinoma in an advanced state. DISCUSSION. Acute necrotizing esophagitis is an unusual entity, with low prevalence and incidence, associated with states of systemic hypoperfusion and multiple comorbidities that favor an ischemic substrate. When reviewing the case reports in the medical literature, the cases we report correlate with the clinical, epidemiological, endoscopic characteristics and causal risk factors of the disease. The most common clinical presentation is upper gastrointestinal bleeding, which must be correlated with the classic endoscopic finding. Our first reported case ends with the placement of a gastrostomy to be able to feed. CONCLUSION. The prognosis of acute esophageal necrosis is poor and a high index of clinical suspicion and knowledge of this rare pathology is required for early diagnosis and timely management. Evaluation by upper gastrointestinal endoscopy is required. It is a cause of gastrointestinal bleeding that carries high mortality rates, mainly in frail older adults. Early recognition and aggressive resuscitation are the fundamental principles for a better outcome of the disease.

Manifestaciones laríngeas de COVID-19 / Laryngeal manifestations of COVID-19

Introducción: la infección por COVID-19 afecta el tracto aerodigestivo superior a través de la enzima convertidora de angiotensina 2 (ECA2) y/o la proteasa transmembrana serina 2 (TMPRSS2). Sus manifestaciones agudas y secuelas han sido muy variadas y no todas están relacionadas con la intubación orotraqueal. El objetivo es describir las características sociodemográficas, clínicas y los hallazgos endoscópicos de los pacientes con síntomas laringofaríngeos posteriores a una infección por SARS-CoV-2 evaluados en el Hospital Militar Central y Hospital Universitario Clínica San Rafael entre marzo de 2020 y marzo de 2022. Materiales y métodos: estudio observacional de corte transversal con datos sociodemográficos, comorbilidades, necesidad de intubación orotraqueal, variedad de síntomas y sus hallazgos endoscópicos. Resultados: se recolectaron datos de 118 pacientes; la edad media fue de 51 años ± 14,4. El síntoma más frecuente fue la disfonía (69,5 %), seguido de la disnea (39,8 %). El 58,9 % requirió intubación orotraqueal y, de estos, la manifestación más frecuente fue disfonía por tensión muscular (DTM) y estenosis subglótica-traqueal. En el 41,1 % restante su hallazgo más frecuente fue la laringitis irritativa. Conclusiones: la COVID-19 tiene múltiples manifestaciones laringofaríngeas en relación con su mecanismo de infección e invasión en los tejidos de esta zona, de tipo inflamatorio y estructural, y no todos están relacionados con la intubación.

Introduction: COVID 19 infection affects the upper aerodigestive tract through angiotensin-converting enzyme 2 (ACE2) and/or Transmembrane serine protease 2 (TMPRSS2). Its acute manifestations and sequelae have been very varied, and not all of them are related to orotracheal intubation. The objective is to describe the sociodemographic and clinical characteristics and the endoscopic findings of patients with laryngopharyngeal symptoms after SARS-CoV-2 infection evaluated at the Hospital Militar Central and Hospital Universitario Clínica San Rafael between March 2020 and March 2022. Methods: Cross-sectional observational study, obtaining sociodemographic data, comorbidities, need for orotracheal intubation, variety of symptoms and their endoscopic findings. Results: 118 patients were collected; the mean age was 51 years ± 14.4. The most frequent symptom was dysphonia (69.5%), followed by dyspnea (39.8%). 58.9% required orotracheal intubation and of these the most frequent manifestation was muscular tension dysphonia (MTD) and subglottictracheal stenosis. In the remaining 41.1%, the most frequent finding was irritative laryngitis. Conclusions: COVID-19 has multiple laryngopharyngeal manifestations in relation to its mechanism of infection and invasion in the tissues of this area, as an inflammatory and structural type, and not all of them are related to intubation.

Manejo de la disfagia en pacientes con antecedente de infección severa por COVID-19 / Manejo de la disfagia en pacientes con antecedente de infección severa por COVID-19

de la deglución, los cuales representan todas las alteraciones del proceso fisiológico encargado de llevar el alimento desde la boca al esófago y después al estómago, salvaguardando siempre la protección de las vías respiratorias. OBJETIVO. Definir el manejo óptimo, de la disfagia en pacientes con antecedente de infección severa por COVID-19. METODOLOGÍA. Se realizó una revisión de la literatura científica en las bases de datos PubMed y Elsevier que relacionan el manejo de la disfagia y pacientes con antecedente de infección severa por SARS-CoV-2. Se obtuvo un universo de 134 artículos que cumplieron los criterios de búsqueda. Se seleccionaron 24 documentos, para ser considerados en este estudio. RESULTADOS. La incidencia de disfagia posterior a infección severa por SARS-CoV-2 fue del 23,14%, siendo la disfagia leve la más frecuente 48,0%. Los tratamientos clínicos más empleados en el manejo de la disfagia fueron rehabilitación oral y cambio de textura en la dieta en el 77,23% de los casos, mientras que el único tratamiento quirúrgico empleado fue la traqueotomía 37,31%. Un 12,68% de pacientes recuperó su función deglutoria sin un tratamiento específico. La eficacia de los tratamientos clínicos y quirúrgicos en los pacientes sobrevivientes de la infección severa por SARS-CoV-2 fue del 80,68%, con una media en el tiempo de resolución de 58 días. CONCLUSIÓN. La anamnesis es clave para el diagnóstico de disfagia post COVID-19. El tratamiento puede variar, desde un manejo conservador como cambios en la textura de la dieta hasta tratamientos más invasivos como traqueotomía para mejorar la función deglutoria.

INTRODUCTION. The difficulty to swallow or dysphagia is included within the problems of swallowing, which represent all the alterations of the physiological process in charge of carrying the food from the mouth to the esophagus, and then to the stomach, always taking into account the protection of the airways. OBJECTIVE. To define the optimal management, both clinical and surgical, for the adequate treatment of dysphagia produced as a consequence of severe SARS-CoV-2 infection. METHODOLOGY. A review of the scientific literature was carried out using both PubMed and Elsevier databases, which relate the management of dysphagia and patients with a history of severe SARS-CoV-2 infection. RESULTS. The incidence of dysphagia following severe SARS-CoV-2 infection was of 23,14%, with mild dysphagia being the most frequent 48,00%. The most frequently used clinical treatments for dysphagia management were oral rehabilitation and change in dietary texture in 77,23% of cases, while tracheotomy was the only surgical treatment used 37,31%. A total of 12,68% of patients recovered their swallowing function without specific treatment. The efficacy of clinical and surgical treatments in survivors of severe SARS-CoV-2 infection was 80,68%, with a mean resolution time of 58 days. CONCLUSION. An adequate medical history is key to the diagnosis of post-COVID-19 dysphagia. Treatment can range from conservative management such as changes in diet texture to more invasive treatments such as tracheotomy to improve swallowing function.

Dificuldades de deglutição nas diferentes formas de oferta de alimentação em lactentes cardiopatas congênitos: uma revisão sistemática / Swallowing difficulties in the different forms of food supply in congenital heart disease infants: a systematic review / Dificultades para tragar em las diferentes formas de su ministro de alimentos em lactantes com cardiopatias congénitas: una revisión sistemática

Introdução: A forma de alimentação mais segura nos bebês cardiopatas pode ser um desafio para escolha da equipe multiprofissional. Objetivo: Identificar as principais dificuldades de deglutição nas diferentes formas de oferta de alimentação em lactentes cardiopatas congênitos. Métodos: A questão norteadora foi: "Quais as principais dificuldades de deglutição nas diferentes formas de oferta de alimentação em lactentes cardiopatas congênitos?". A população foi delimitada como lactentes cardiopatas, considerando amamentação como exposição de interesse e alimentação em mamadeira considerado grupo comparação. Dificuldades de deglutição foram consideradas desfecho. Foram selecionados artigos sem restrição de idioma, independentemente do ano de publicação até abril de 2019, que apresentassem no título, resumo ou corpo do artigo relação com o objetivo da pesquisa e os critérios de elegibilidade, com delineamento observacional. Após a extração dos dados, as medidas foram transformadas em percentagem, e descritas em uma síntese qualitativa. Resultados: Foram encontrados 828 artigos ao total, sendo que após análises, foram incluídos 11 artigos ao total. As principais dificuldades apresentadas pelos lactentes cardiopatas em seio materno foram: tosse, engasgo, cianose, queda da saturação periférica de oxigênio e incoordenação entre sucção, respiração e deglutição. As dificuldades de deglutição mais encontradas na oferta de seio materno foram: tosse, engasgo, cianose, queda de saturação, incoordenação entre sucção-respiração-deglutição, fadiga, escape oral, tempo prolongado de alimentação, vedamento-labial inadequado, preensão inadequada do bico, e ausculta cervical alterada. Conclusão: Os lactentes cardiopatas apresentam dificuldades de deglutição tanto em seio materno quanto em mamadeira, sendo observada maior frequência de apresentações das dificuldades, com mamadeira. (AU)

Introduction: The safest way of feeding babies with heart disease can be a challenge for the multidisciplinary team to choose. Objective: To identify the main swallowing difficulties in the different forms of feeding in infants with congenital heart disease. Methods: The guiding question was: "What are the main swallowing difficulties in the different forms of feeding in infants with congenital heart disease?". The population was defined as infants with heart disease, considering breastfeeding as exposure of interest and bottle feeding considered a comparison group. Swallowing difficulties were considered the outcome. Articles without language restriction were selected, regardless of the year of publication until April 2019, which presented in the title, abstract or body of the article a relationship with the objective of the research and the eligibility criteria, with an observational design. After data extraction, the measurements were transformed into percentages and described in a qualitative synthesis. Results: A total of 828 articles were found, and after analysis, 11 articles were included in total. The main difficulties presented by infants with heart disease at the mother's breast were coughing, choking, cyanosis, drop in peripheral oxygen saturation and incoordination between sucking, breathing and swallowing. The swallowing difficulties most found in the offer of the mother's breast were: cough, choking, cyanosis, drop in saturation, incoordination between sucking-breathing-swallowing, fatigue, oral leakage, prolonged feeding time, inadequate lip sealing, inadequate nipple grip, and altered cervical auscultation. Conclusion: Infants with heart disease have swallowing difficulties both in the mother's breast and in the bottle, with a higher frequency of presentations of difficulties being observed with the bottle. (AU)

Introducción: La forma más segura de alimentación en bebés com enfermidades del corazón puede ser um desafío para el equipo multidisciplinario para elegir. Objetivo: Identificar las principales dificultades deglutorias em las diferentes formas de alimentación en lactantes com cardiopatías congénitas. Métodos: La pregunta orientadora fue: "¿Cuáles son las principales dificultades deglutorias em las diferentes formas de alimentación en lactantes com cardiopatías congénitas?" La población se definió como lactantes com cardiopatías, considerando la lactancia materna como exposición de interés y la alimentación com biberón considerada una grupo de comparación. Las dificultades para tragar se consideraron el desenlace. Se seleccionaron artículos sin restricción de idioma, independentemente del año de publicación hasta abril de 2019, que presentaran em el título, resumen o cuerpo del artículo relación com el objetivo de la investigación y los criterios de elegibilidad, com um diseño observacional. Después de la extracción de datos, las medidas se transformaron em porcentajes y se describieron en una sínteses cualitativa. Resultados: Se encontraron un total de 828 artículos, y después del análisis, se incluyeron 11 artículos en total. Las principales dificultades que presentaron los lactantes com cardiopatia em el pecho materno fueron: tos, ahogo, cianosis, caída de la saturación periférica de oxígeno y falta de coordinación entre la succión, la respiración y la deglución. Las dificultades de deglución más encontradas em la oferta del pecho de la madre fueron: tos, ahogo, cianosis, descenso de la saturación, descoordinación entre succión-respiración-deglución, fatiga, escape oral, tiempo de alimentación prolongado, sellado labial inadecuado, agarre inadecuado del pezón y auscultación cervical alterada. Conclusión: Los lactantes com cardiopatia presentan dificultades para la deglución tanto em el pecho materno como em el biberón, observándose una mayor frecuencia de presentaciones de dificultades con el biberón. (AU)

Z-POEM: ¿Procedimiento ideal para el tratamiento del divertículo de Zenker? / Z-POEM: Ideal procedure for the treatment of Zenker's diverticulum?

Introducción. El divertículo de Zenker es una patología poco frecuente, caracterizada por la presencia de disfagia, halitosis, tos y pérdida de peso, que afectan la calidad de vida de los pacientes. El tratamiento es quirúrgico y las técnicas han evolucionado de forma permanente. El objetivo de este estudio fue evaluar la mejoría de la disfagia en pacientes a quienes se les realizó la técnica de miotomía endoscópica peroral (Z-POEM). Métodos. Estudio descriptivo de una serie de 23 pacientes con divertículo de Zenker diagnosticado por endoscopia y esofagograma, tratados entre mayo de 2018 y noviembre de 2021 en diferentes instituciones de la ciudad de Bogotá, D.C., Colombia, mediante una miotomía endoscópica del cricofaríngeo con la técnica de Z-POEM. Resultados. La mayoría de los pacientes fueron adultos mayores, de sexo masculino. Los síntomas más frecuentes correspondieron a disfagia y regurgitación. El tamaño promedio del divertículo fue de tres centímetros. La estancia hospitalaria fue de un día. Un paciente presentó disfagia postoperatoria en relación con los clips y otro presentó un absceso mediastinal, el cual fue resuelto de manera endoscópica. Actualmente, todos los pacientes se encuentran asintomáticos y no han presentado recurrencia. Conclusiones. El tratamiento endoscópico mínimamente invasivo mediante la miotomía endoscópica peroral (Z-POEM) en el paciente con divertículo de Zenker es una alternativa segura y eficaz, con buenos resultados y poca morbilidad

Introduction. Zenker's diverticulum is a rare pathology characterized by the presence of dysphagia, halitosis, cough, and weight loss, which affect the patients' quality of life. The treatment is surgical and the techniques have evolved permanently. The objective of this study was to evaluate the improvement of dysphagia in patients who underwent peroral endoscopic myotomy technique (Z-POEM). Methods. Descriptive study of a series of 23 patients with Zenker's diverticulum diagnosed by endoscopy and esophagram, treated between May 2018 and November 2021 at different institutions in Bogotá, Colombia, by means of an endoscopic cricopharyngeal myotomy with the Z-POEM technique. Results. Most of patients were older males. The most frequent symptoms corresponded to dysphagia and regurgitation. The average size of the diverticulum was three centimeters. The hospital stay was one day. One patient presented postoperative dysphagia related to the clips and another presented a mediastinal abscess which was resolved endoscopically. Currently, all patients are asymptomatic and have not presented recurrence. Conclusions. Minimally invasive endoscopic treatment by peroral endoscopic myotomy (Z-POEM) in patients with Zenker's diverticulum is a safe and effective alternative, with good results and low morbidity

Diagnóstico y manejo actual de la acalasia / Diagnosis and current management of achalasia

Introducción. La acalasia es un trastorno motor del esófago poco común, de etiología no clara, caracterizado por la pérdida de relajación del esfínter esofágico inferior, pérdida del peristaltismo normal, regurgitación y disfagia. Métodos. Se realizó una revisión narrativa de la literatura en revistas científicas y bases de datos en español e inglés, con el fin de presentar información actualizada en lo referente al diagnóstico y tratamiento de esta patología. Resultado. Se presenta la actualización de los criterios de los trastornos motores esofágicos según la clasificación de Chicago (CCv4.0) para el diagnóstico de acalasia y sus subtipos de acuerdo con los nuevos criterios, así como los tratamientos actuales. Conclusión. La acalasia es un trastorno esofágico multimodal, con manifestaciones de predominio gastrointestinal, por lo que su diagnóstico y abordaje terapéutico oportuno es esencial para mejorar la calidad de vida de los pacientes

Introduction. Achalasia is a rare motor disorder of the esophagus of unclear etiology, characterized by loss of lower esophageal sphincter relaxation, loss of normal peristalsis, regurgitation, and dysphagia. Methods. A narrative review of the literature in scientific journals and databases in Spanish and English was carried out, in order to present updated information regarding the diagnosis and treatment of this pathology. Result. The update of the Chicago esophageal motor disorders criteria (CCv4.0) is presented for the diagnosis of achalasia and its subtypes according to the new criteria, as well as current treatments. Conclusion. Achalasia is a multimodal esophageal disorder, with predominantly gastrointestinal manifestations, so its timely diagnosis and therapeutic approach is essential to improve the quality of life of patients.

Influência da obesidade, idade e sexo na dificuldade de ingestão de água espessada em indivíduos saudáveis / Influence of obesity, age and sex on difficulty swallowing thickened water in healthy subjects

Contexto e Objetivo: Ingestão de água com espessante diminui a aspiração para vias aéreas em pacientes com disfagia orofaríngea, entretanto pode causar dificuldade na ingestão. Nosso objetivo foi avaliar, em pessoas saudáveis, a influência da obesidade, idade e sexo na ingestão de água espessada. Desenho e local: Estudo transversal realizado em amostra de conveniência na Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Método: Ingestão de água sem e com espessante foi avaliada em 75 indivíduos saudáveis (42 mulheres) com idades entre 18 e 62 anos, pelo teste de ingestão de água, com os voluntários ingerindo 100 ml de água na temperatura ambiente, sem e com 2,4 g de espessante alimentar. Foram medidos o tempo para ingerir todo o volume, o número de deglutições, e calculados o fluxo de ingestão e o volume em cada deglutição, com os voluntários indicando a sensação e a dificuldade na ingestão. Resultados: Com espessante, o fluxo de ingestão e o volume em cada deglutição foram menores, e houve maior dificuldade e pior sensação durante a ingestão. Obesidade e idade não influenciaram a ingestão. As mulheres tiveram menor fluxo de ingestão que os homens. Discussão: A utilização de água espessada em pacientes com disfagia pode ter dificuldades que comprometem a hidratação. Alteração do sabor e temperatura do líquido podem facilitar a ingestão. Conclusão: A ingestão de água em pessoas saudáveis tem influência da consistência e do sexo dos indivíduos, sem influência de idade ou obesidade.

Emotional aspects of parents of children with dysphagia / Aspectos emocionais dos pais de crianças com disfagia

Dysphagia is a common swallowing disorder in the pediatric population, which may influence the quality of life and well-being of the family. The literature points to stress, guilt, and social isolation of family members. However, the management of psychosocial aspects involved in the treatment of pediatric dysphagia is rarely discussed. This study aimed to carry out an integrative review of the literature regarding the emotional aspects of parents of children with dysphagia. Therefore a search in the databases SciELO and PubMed was made, from January 2013 to June 2020, using the descriptors in Health Sciences (DeCs): "deglutition disorders" and "child". The search was performed with English and Portuguese language limiters using associated descriptors. The selection of the studies was performed by reading the title, abstract and, if necessary, full text, applying the inclusion and exclusion criteria. There were 2,169 publications, and 8 met the inclusion criteria. The included studies were examined according to the author, type of study, goals, emotional aspects involved in the treatment of swallowing disorders, and conclusions. The analysis was performed according to the presence of certain variables of the emotional aspects presented in the face of swallowing disorders, namely, parental stress, negative impact on parent/child interaction, guilt and frustration, and social isolation. The literature points out that pediatric dysphagia causes an emotional impact on the parents; indicating that it is necessary to offer emotional support and to adapt the clinical management to the different demands present in the clinic.

A disfagia é um distúrbio de deglutição comum na população pediátrica, podendo influenciar na qualidade de vida e no bem-estar da família. A literatura aponta estresse, culpa e isolamento social dos familiares. Entretanto, o manejo dos aspectos psicossociais envolvidos no tratamento da disfagia pediátrica raramente é discutido. Este estudo teve como objetivo realizar uma revisão integrativa da literatura sobre os aspectos emocionais de pais de crianças com disfagia. Para tanto, foi realizada uma busca nas bases de dados SciELO e PubMed, no período de janeiro de 2013 a junho de 2020, utilizando os descritores em Ciências da Saúde (DeCs): "distúrbios da deglutição" e "criança". A busca foi realizada com limitadores dos idiomas inglês e português usando descritores associados. A seleção dos estudos foi realizada por meio da leitura do título, resumo e, se necessário, texto completo, aplicando-se os critérios de inclusão e exclusão. Houve 2.169 publicações e 8 preencheram os critérios de inclusão. Os estudos incluídos foram examinados quanto ao autor, tipo de estudo, objetivos, aspectos emocionais envolvidos no tratamento dos distúrbios da deglutição e conclusões. A análise foi realizada de acordo com a presença de algumas variáveis ​​dos aspectos emocionais apresentados diante dos distúrbios da deglutição, a saber, estresse parental, impacto negativo na interação pais/filhos, culpa e frustração e isolamento social. A literatura aponta que a disfagia pediátrica causa impacto emocional nos pais; indicando que é necessário oferecer suporte emocional e adequar o manejo clínico às diferentes demandas presentes na clínica.

Elaboração e Avaliação de uma Cartilha sobre os Cuidados para Realizar uma Alimentação Segura na Clínica de Cuidados Paliativos Oncológicos / Elaboration and Appraisal of a Booklet on Care for Safe Eating at an Oncology Palliative Care Clinic / Elaboración y Evaluación de Cartilla de Cuidados para una Alimentación Segura en la Clínica de Cuidados Paliativos Oncológicos

Introdução: Cuidados paliativos são uma abordagem que busca compreender e auxiliar pacientes com comorbidades que ameaçam a vida. O fonoaudiólogo paliativista atua na interação entre paciente e familiar por meio da reabilitação da comunicação e manutenção da alimentação por via oral. Manter os pacientes, cuidadores e a própria equipe de saúde informados sobre os cuidados com a alimentação e prevenção do risco de broncoaspiração é de extrema importância, e a utilização de materiais impressos, como cartilhas educativas, é uma grande aliada na educação em saúde. Objetivo: Elaborar e avaliar uma cartilha educativa sobre os cuidados para realizar uma alimentação segura para cuidadores de pacientes em cuidados paliativos. Método: Pesquisa de campo com a participação de dez cuidadores/ acompanhantes de pacientes em cuidados paliativos e dez profissionais de saúde de um hospital oncológico que trabalham nas clínicas de cuidados paliativos. Para a avaliação da cartilha proposta, todos os participantes responderam a questionários que continham perguntas referentes ao entendimento, linguagem utilizada, compreensão dos cuidados com a alimentação, entre outras informações pertinentes para sua avaliação. Em seguida, realizou-se a estatística descritiva para tratamento dos dados obtidos. Resultados: A média de aprovação da cartilha foi de 9,65 para o grupo de profissionais de saúde e 10,00 para os cuidadores/acompanhantes. Conclusão: A cartilha intitulada "Guia de Cuidados para Realizar uma Alimentação Segura" obteve alta aprovação pelo público pesquisado e foi considerada válida para ser utilizada pela população

Introduction: Palliative care is an approach that seeks to understand and help patients who have life-threatening comorbidities. The palliative speech therapist acts in the interaction between patient and family through the rehabilitation of communication and maintenance of oral feeding. Keeping patients, caregivers and the health team informed about care with nutrition and prevent the risk of bronchoaspiration is extremely important, and the utilization of printed materials, such as educational booklets, are great allies in health education. Objective: To develop and evaluate an educational booklet on care for safe eating for caregivers of patients in palliative care. Method: A field survey was carried out with the participation of ten caregivers/companions of patients in palliative care and ten health professionals from an oncology hospital who work in palliative care clinics. For the evaluation of the proposed booklet, all participants responded to a questionnaire addressing topics as comprehension, language utilized, understanding of food care, among other relevant information to their evaluation. Afterwards, descriptive statistics was performed to treat the data obtained. Results: The average approval of the booklet by the group of health professionals was 9.65 and by caregivers/companions, 10.00. Conclusion: The booklet entitled "Care guide for safe eating" was highly approved by the public investigated and considered valid to be adopted by the population

Introducción: Los cuidados paliativos son un abordaje que busca comprender y ayudar a los pacientes que presentan comorbilidades que amenazan su vida. El fonoaudiólogo paliativo actúa en la interacción entre paciente y familia mediante la rehabilitación de la comunicación y el mantenimiento de la alimentación oral. Mantener informados a los pacientes, cuidadores y al equipo de salud sobre los cuidados con la nutrición y la prevención del riesgo de broncoaspiración es de suma importancia, y el uso de materiales impresos, como cartillas educativas, es un gran aliado en la educación en salud. Objetivo: Desarrollar y evaluar una cartilla educativa sobre cuidados para realizar una alimentación segura para cuidadores de pacientes en cuidados paliativos. Método: Se realizó una encuesta de campo con la participación de diez cuidadores/acompañantes de pacientes en cuidados paliativos y diez profesionales de la salud de un hospital oncológico que laboran en clínicas de cuidados paliativos. Para la evaluación de la cartilla propuesta, todos los participantes respondieron cuestionarios que contenían preguntas sobre comprensión, lenguaje utilizado, comprensión del cuidado con la alimentación, entre otras informaciones relevantes para su evaluación. Después, se realizó estadística descriptiva para el tratamiento de los datos obtenidos. Resultados: El promedio de aprobación de la cartilla fue de 9,65 para el grupo de profesionales de la salud y de 10,00 para los cuidadores/ acompañantes. Conclusión: La cartilla titulada "Guía de cuidados para una alimentación segura" fue altamente aprobada por el público encuestado y considerada válida para su uso por la población

Associação entre a Enfermagem e a Fonoaudiologia na identificação de risco para disfagia: estudo transversal analítico / Asociación entre Enfermería y Fonoaudiología en la identificación de riesgo de disfagia: estudio transversal analítico / Association between Nursing and Speech, Language and Hearing Sciences in identifying risk for dysphagia: analytical cross-sectional study

Resumo Objetivo investigar e demonstrar a associação entre a avaliação de autopercepção da deglutição realizada pelo enfermeiro e a classificação de risco de disfagia realizada pelo fonoaudiólogo em idosos hospitalizados. Método estudo transversal analítico realizado com a aplicação dos instrumentos Eating Assessment Tool e do Protocolo Fonoaudiológico de Avaliação de Risco para Disfagia em 52 idosos em clínica médica, além da coleta de dados sociodemográficos e de condições de saúde. Para a análise estatística foi utilizado o teste exato de Fisher e a regressão logística para a razão de chances. Resultados houve a associação (p=0,01) entre a avaliação do enfermeiro e a do fonoaudiólogo, com razão de chances de um idoso hospitalizado exposto ao risco de disfagia pelo Eating Assessment Tool apresentar a alteração no Protocolo Fonoaudiológico de Avaliação do Risco para Disfagia (OR 3,89 IC 95%: 1,10-13,68). Conclusão e implicações para a prática os achados apontam que há uma associação entre a avaliação do enfermeiro e a do fonoaudiólogo nas alterações da deglutição e que a Enfermagem poderá atuar na identificação de riscos, prevenção e reabilitação em disfagia.

Resumen Objetivo investigar y demostrar la asociación entre la evaluación de la autopercepción de la deglución realizada por enfermeros y la clasificación del riesgo de disfagia realizada por el audiólogo en ancianos hospitalizados. Método estudio analítico transversal realizado con la aplicación de los Eating Assessment Tool y del Protocolo de Evaluación del Riesgo de Disfagia por Logopedas en 52 pacientes ancianos de una clínica médica, además de la recogida de datos sociodemográficos y condiciones de salud. Para el análisis estadístico se utilizó la prueba exacta de Fisher y la regresión logística para el odds ratio. Resultados hubo asociación (p=0,01) entre la evaluación del enfermero y del logopeda, con odds ratio de un anciano hospitalizado expuesto al riesgo de disfagia por la Eating Assessment Tool presentar una alteración en el Protocolo Logopédico de Evaluación del Riesgo de Disfagia (OR 3,89 IC 95%: 1,10-13,68). Conclusión e implicaciones para la práctica los hallazgos indican que existe una asociación entre la valoración de enfermería y logopedia en los trastornos de la deglución y que la Enfermería puede actuar en la identificación de riesgos, prevención y rehabilitación en la disfagia.

Abstract Objective to investigate and demonstrate the association between the self-perceived swallowing assessment carried out by nurses and the dysphagia risk classification carried out by speech therapists in hospitalized elderly patients. Method an analytical cross-sectional study using the Eating Assessment Tool and the Speech and Hearing Therapy Protocol for Dysphagia Risk Assessment in 52 elderly patients in a medical clinic, as well as collecting sociodemographic data and health conditions. Fisher's exact test and logistic regression for odds ratios were used for statistical analysis. Results there was an association (p=0.01) between the nurse's assessment and that of the speech therapist, with an odds ratio of a hospitalized elderly person exposed to the risk of dysphagia by the Eating Assessment Tool presenting a change in the Speech Therapy Protocol for Dysphagia Risk Assessment (OR 3.89 95% CI: 1.10-13.68). Conclusion and implications for practice the findings indicate that there is an association between the nurse's assessment and that of the speech therapist in swallowing disorders and that Nursing can act to identify risks, prevent and rehabilitate dysphagia.

Endoscopic botulinum toxin injection combined with balloon dilatation for treatment of cricopharyngeal achalasia in patient with brainstem stroke / 中南大学学报(医学版)

OBJECTIVES@#At present, there are many reports about the treatment of cricopharyngeal achalasia by injecting botulinum toxin type A (BTX-A) into cricopharyngeal muscle guided by ultrasound, electromyography or CT in China, but there is no report about injecting BTX-A into cricopharyngeal muscle guided by endoscope. This study aims to evaluate the efficacy of endoscopic BTX-A injection combined with balloon dilatation in the treatment of cricopharyngeal achalasia after brainstem stroke, and to provide a better method for the treatment of dysphagia after brainstem stroke.@*METHODS@#From June to December 2022, 30 patients with cricopharyngeal achalasia due to brainstem stroke were selected from the Department of Rehabilitation Medicine, the First Hospital of Changsha. They were randomly assigned into a control group and a combined group, 15 patients in each group. Patients in both groups were treated with routine rehabilitation therapy, while patients in the control group were treated with balloon dilatation, and patients in the combined group were treated with balloon dilatation and BTX-A injection. Before treatment and after 2 weeks of treatment, the patients were examined by video fluoroscopic swallowing study, Penetration-aspiration Scale (PAS), Dysphagia Outcome Severity Scale (DOSS), and Functional Oral Intake Scale (FOIS) were used to assess the swallowing function.@*RESULTS@#In the combined group, 1 patient withdrew from the treatment because of personal reasons. Two weeks after treatment, the scores of DOSS, PAS, and FOIS in both groups were better than those before treatment (all P<0.01), and the combined group was better than the control group (all P<0.001). The effective rate was 85.7% in the combined group and 66.7% in the control group, with no significant difference between the 2 groups (P>0.05).@*CONCLUSIONS@#BTX-A injection combined with balloon dilatation is more effective than balloon dilatation alone in improving swallowing function and is worthy of clinical application.

A family with early onset myopathy caused by MEGF10 gene defect and literature review / 中华儿科杂志

Objective: To summarize the genetic and clinical phenotypic characteristics of patients with early-onset myopathy, areflexia, respiratory distress and dysphagia (EMARDD) caused by multiple epidermal growth factor 10 (MEGF10) gene defect. Methods: The clinical data of 3 infants in 1 family with EMARDD caused by MEGF10 gene defect diagnosed in the Department of Neonatology, Xiamen Children's Hospital in April 2022 were analyzed retrospectively. Using "multiple epidermal growth factor 10" "myopathy" or "MEGF10" "myopathy" as the key words, and searching the relevant literature reports of CNKI, Wanfang Database and PubMed Database from the establishment of the database to September 2022. Combined with this family, the main clinical information and genotype characteristics of EMARDD patients caused by MEGF10 gene defect were summarized. Results: The proband, male, first infant of monozygotic twins, was admitted to hospital 7 days after birth "due to intermittent cyanosis with weak sucking". The infant had dysphagia accompanied with cyanosis of lips during feeding and crying after birth. Physical examination on admission revealed reduced muscle tone of the extremities, flexion of the second to fifth fingers of both hands with limited passive extension of proximal interphalangeal joints, and limited abduction of both hips. He was diagnosed as dysphagia of newborn, congenital dactyly. After admission, he was given limb and oral rehabilitation training, breathing gradually became stable and oral feeding fully allowed, and discharged along with improvement. The younger brother of the proband was admitted to the hospital at the same time, and his clinical manifestations, diagnosis and treatment process were the same as those of the proband. The elder brother of the proband died at the age of 8 months due to the delayed growth and development, severe malnutrition, hypotonia, single palmoclal crease and weak crying. A whole exon sequencing of the family was done, and found that the 3 children were all compound heterozygous variations at the same site of MEGF10 gene, with 2 splicing variants (c.218+1G>A, c.2362+1G>A), which came from the father and mother respectively, and the new variation was consistent with the autosomal recessive inheritance model. Three children were finally diagnosed as EMARDD caused by MEGF10 gene defect. There are 0 Chinese literature and 18 English literature that met the search conditions. Totally 17 families including 28 patients were reported. There were 31 EMARDD patients including 3 infants from this family. Among them, there were 13 males and 18 females. The reported age of onset ranged from 0 to 61 years. Except for 5 patients with incomplete clinical data, 26 patients were included in the analysis of phenotypic and genotypic characteristics. The clinical features were mainly dyspnea (25 cases), scoliosis (22 cases), feeding difficulties (21 cases), myasthenia (20 cases), and other features including areflexia (16 cases) and cleft palate or high palatal arch(15 cases). Muscle biopsy showed non-specific changes, with histological characteristics ranging from slight muscle fiber size variation to minicores change which was seen in all 5 patients with at least 1 missense mutation of allele. In addition, the adult onset was found in patients with at least 1 missense variant of MEGF10 gene. Conclusions: MEGF10 gene defect related EMARDD can occur in the neonatal period, and the main clinical features are muscle weakness, breathing and feeding difficulties. Patients with myopathy who have at least 1 missense mutation and muscle biopsy indicating minicores change may be relatively mild.

Analysis on status quo of outcomes and measurement instruments of randomized controlled trials of acupuncture for post-stroke dysphagia / 中国针灸

OBJECTIVE@#To analyze the report status of outcomes and measurement instruments of randomized controlled trials (RCTs) of acupuncture for post-stroke dysphagia, so as to provide a basis for designing clinical trials and developing the core outcome set in acupuncture for post-stroke dysphagia.@*METHODS@#RCTs of acupuncture for post-stroke dysphagia were searched in databases i.e. CNKI, SinoMed, Wanfang, PubMed, EMbase, Web of Science and clinical trial registries i.e. ClinicalTrials.gov and Chinese Clinical Trial Registry (ChiCTR), from January 1st, 2012 to October 30th, 2021. By literature screening and data extraction, outcomes and measurement instruments were summarized and analyzed.@*RESULTS@#A total of 172 trials (including 165 RCTs and 7 ongoing trials registrations) were included, involving 91 outcomes. The outcomes could be classified into 7 domains according to functional attributes, namely clinical manifestation, physical and chemical examination, quality of life, TCM symptoms/syndromes, long-term prognosis, safety assessment and economic evaluation. It was found that there were various measurements instruments with large differences, inconsistent measurement time point and without discriminatively reporting primary or secondary outcomes.@*CONCLUSION@#The status quo of outcomes and measurement instruments of RCTs of acupuncture for post-stroke dysphagia is not conducive to the summary and comparison of each trial's results. Thus, it is suggested to develop a core outcome set for acupuncture for post-stroke dysphagia to improve the normative and research quality of their clinical trial design.

Effect of acupuncture on swallowing function for patients of Parkinson's disease with dysphagia / 中国针灸

OBJECTIVE@#To observe the effects of acupuncture on swallowing function and quality of life for patients with dysphagia in Parkinson's disease (PD).@*METHODS@#A total of 60 patients of PD with dysphagia were randomly divided into an observation group (30 cases, 2 cases dropped off) and a control group (30 cases, 3 cases dropped off). The control group was given conventional medication therapy and rehabilitation training. On the basis of the treatment as the control group, the observation group was given acupuncture at Fengfu (GV 16), Baihui (GV 20), Shenting (GV 24), Yintang (GV 24+), Yansanzhen and bilateral Fengchi (GB 20), 30 min each time, once a day, 6 times a week for 4 weeks. Before and after treatment, the Kubota water swallowing test, standardized swallowing assessment (SSA) and swallowing quality of life (SWAL-QOL) were used to evaluate the swallowing function and quality of life of the two groups.@*RESULTS@#After treatment, the Kubota water swallowing test grade, SSA scores in the two groups were decreased compared with those before treatment (P<0.05, P<0.001)，the SWAL-QOL scores were increased compared with those before treatment (P<0.001); in the observation group，the Kubota water swallowing test grade and SSA score were lower than those in the control group (P<0.05)，the SWAL-QOL score was higher than that in the control group (P<0.001).@*CONCLUSION@#On the basis of conventional medication therapy and rehabilitation training，acupuncture could improve the swallowing function and quality of life for patients of PD with dysphagia.

Post-stroke dysphagia treated with four-step acupuncture therapy for opening orifices and benefiting throat combined with neuromuscular electrical stimulation: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the clinical efficacy on post-stroke dysphagia treated with four-step acupuncture therapy for opening orifices and benefiting throat combined with neuromuscular electrical stimulation.@*METHODS@#Sixty patients with post-stroke dysphagia were randomly divided into an observation group and a control group, with 30 cases in each group. The neuromuscular electrical stimulation was adopted in the control group. Besides the treatment as the control group, in the observation group, the four-step acupuncture therapy for opening orifices and benefiting throat was supplemented. Step 1: the three areas of scalp acupuncture on the affected side were stimulated. Step 2: pricking method was operated on the posterior pharyngeal wall. Step 3: bleeding technique was operated at Jinjin (EX-HN 12) and Yuye (EX-HN 13). Step 4: deep insertion of needle was operated at three-pharynx points. The needles were retained for 30 min at the three areas of scalp acupuncture and the three-pharynx points. The intervention of each group was delivered once daily, 6 times a week, at the interval of 1 day. One course of treatment was 1 week and 4 successive courses were required. The rating of Kubota water swallow test, the score of standardized swallowing assessment (SSA) and the rating of Rosenbek penetration- aspiration scale (PAS) were observed before and after treatment in patients of the two groups. The incidence of clinical complications and clinical efficacy were compared between the two groups.@*RESULTS@#Compared with those before treatment, the rating of Kubota water swallow test, the scores of SSA and the rating of PAS of patients in the two groups were decreased after treatment (P<0.01), and the values of the observation group were lower than those of the control group after treatment (P<0.05). The incidence of clinical complications in the observation group was 13.3% (4/30), lower than 36.7% (11/30) in the control group (P<0.05). The total effective rate in the observation group was 93.3% (28/30), which was better than 70.0% (21/30) in the control group (P<0.05).@*CONCLUSION@#The four-step acupuncture therapy for opening orifices and benefiting throat combined with neuromuscular electrical stimulation can improve the swallowing function of patients with post-stroke dysphagia and reduce the incidence of clinical complications.

Deep neck space infections: a retrospective cohort study of surgical risk factors / 中华耳鼻咽喉头颈外科杂志

Objective: To explore risk factors affecting treatment for deep neck space infections (DNSIs) so as to provide guidance for appropriate early managements. Methods: A retrospective cohort study was conducted on inpatients with DNSIs admitted to the Department of Otolaryngology, Head and Neck Surgery, Affiliated Hospital of Qingdao University from March 2013 to February 2021. Patients were divided into surgical and non-surgical groups based on whether they had surgery or not. Information collected included demographic data, disease-related signs and symptoms, treatment history, systemic comorbidities, imaging data and laboratory indicators. Hypothesis testing, univariate Logistic regression and multivariate Logistic regression were used for data processing. Resuts A total of 61 patients were included, including 37 males and 24 females, aged 6-96 years. There were 35 cases (57.4%) in the surgical group and 26 cases (42.6%) in the non-surgical group. Multivariate analysis showed that risk factors for surgery as followings: neck dyskinesia (OR=0.03, 95%CI: 0.00-0.24), dysphagia (OR=0.10, 95%CI: 0.02-0.72), serum white blood cell count≥16.74×109/L (OR=1.18, 95%CI: 1.01-1.39) and interspace gas (OR=0.03, 95%CI: 0.00-0.30). Conclusion: Clinicians should be alert to these risk factors for surgery in the course of treatment and timely surgical treatment for patients who meet the conditions.

Preliminary exploration of clinical prediction model of severe swallowing disorder after acute ischemic stroke based on nomogram model / 中华危重病急救医学

OBJECTIVE@#To establish a predictive model for severe swallowing disorder after acute ischemic stroke based on nomogram model, and evaluate its effectiveness.@*METHODS@#A prospective study was conducted. The patients with acute ischemic stroke admitted to Mianyang Central Hospital from October 2018 to October 2021 were enrolled. Patients were divided into severe swallowing disorder group and non-severe swallowing disorder group according to whether severe swallowing disorder occurred within 72 hours after admission. The differences in general information, personal history, past medical history, and clinical characteristics of patients between the two groups were compared. The risk factors of severe swallowing disorder were analyzed by multivariate Logistic regression analysis, and the relevant nomogram model was established. The bootstrap method was used to perform self-sampling internal validation on the model, and consistency index, calibration curve, receiver operator characteristic curve (ROC curve), and decision curve were used to evaluate the predictive performance of the model.@*RESULTS@#A total of 264 patients with acute ischemic stroke were enrolled, and the incidence of severe swallowing disorder within 72 hours after admission was 19.3% (51/264). Compared with the non-severe swallowing disorder group, the severe swallowing disorder group had a higher proportion of patients aged of ≥ 60 years old, with severe neurological deficits [National Institutes of Health stroke scale (NIHSS) score ≥ 7], severe functional impairments [Barthel index, an activity of daily living functional status assessment index, < 40], brainstem infarction and lesions ≥ 40 mm (78.43% vs. 56.81%, 52.94% vs. 28.64%, 39.22% vs. 12.21%, 31.37% vs. 13.62%, 54.90% vs. 24.41%), and the differences were statistically significant (all P < 0.01). Multivariate Logistic regression analysis showed that age ≥ 60 years old [odds ratio (OR) = 3.542, 95% confidence interval (95%CI) was 1.527-8.215], NIHSS score ≥ 7 (OR = 2.741, 95%CI was 1.337-5.619), Barthel index < 40 (OR = 4.517, 95%CI was 2.013-10.136), brain stem infarction (OR = 2.498, 95%CI was 1.078-5.790) and lesion ≥ 40 mm (OR = 2.283, 95%CI was 1.485-3.508) were independent risk factors for severe swallowing disorder after acute ischemic stroke (all P < 0.05). The results of model validation showed that the consistency index was 0.805, and the trend of the calibration curve was basically consistent with the ideal curve, indicating that the model had good prediction accuracy. ROC curve analysis showed that the area under the ROC curve (AUC) predicted by nomogram model for severe swallowing disorder after acute ischemic stroke was 0.817 (95%CI was 0.788-0.852), indicating that the model had good discrimination. The decision curve showed that within the range of 5% to 90%, the nomogram model had a higher net benefit value for predicting the risk of severe swallowing disorder after acute ischemic stroke, indicating that the model had good clinical predictive performance.@*CONCLUSIONS@#The independent risk factors of severe swallowing disorder after acute ischemic stroke include age ≥ 60 years old, NIHSS score ≥ 7, Barthel index < 40, brainstem infarction and lesion size ≥ 40 mm. The nomogram model established based on these factors can effectively predict the occurrence of severe swallowing disorder after acute ischemic stroke.