Fiberoptic endoscopic evaluation of swallowing (FEES) in children with spinal muscular atrophy type 1: feasibility, swallowing safety and efficacy, and dysphagia phenotype.

PURPOSE: Although dysphagia is a common symptom among patients with Spinal Muscular Atrophy Type 1 (SMA1), scant data exist on the application of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in this population. The aim was to analyze FEES feasibility, swallow safety and efficacy, dysphagia phenotype, and agreement with VideoFluoroscopic Swallow Study (VFSS) in children with symptomatic, medication-treated SMA1 and oral feeding. METHODS: 10 children with SMA1 underwent FEES. Six patients had also a VFSS. Two clinicians independently rated FEES and VFSS videos. Swallowing safety was assessed using the Penetration-Aspiration scale (PAS). Dysphagia phenotypes were defined according to the classification defined by Warnecke et al. Swallowing efficacy was evaluated with the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) in FEES, whereas pharyngeal residue was rated as present or absent in VFSS. RESULTS: FEES was performed in all children without complications. Four children tolerated bolus trials during FEES, in 4 children swallowing characteristics were inferred based on post-swallow residues, while 2 children refused to eat and only saliva management was assessed. The dysphagia phenotype of predominance of residue in the piriform sinuses was documented in 7/8 children. The PAS score was < 3 in 3 children and > 5 in one child. Swallowing efficacy was impaired in 8/8 children. VFSS showed complete agreement with FEES. CONCLUSIONS: FEES is a feasible examination in children with SMA1. Swallowing safety and efficacy are impaired in nearly all patients with strong agreement between FEES and VFSS. Dysphagia is characterized by the predominance of residue in the piriform sinus.

Dysphagia characteristics at FEES examination in post-extubation patients with COVID-19.

Objective: The aims of this study was to analyse fibreoptic endoscopic evaluation of swallowing (FEES) findings in tube-fed patients with coronavirus disease 2019 (COVID-19). Methods: Seventeen patients who had been intubated during intensive care unit (ICU) stay were enrolled. Pooling of secretions, dysphagia phenotype, penetration/aspiration and residue after swallow were assessed through FEES. The Functional Oral Intake Scale (FOIS) scores were also collected. Patients with significant swallowing impairment were evaluated again after 2 weeks. Results: All patients were tube-fed at enrollment. According to the FEES results, 7 started total oral feeding with at least one consistency. The more common dysphagia phenotypes were propulsive deficit and delayed pharyngeal phase. Pooling of secretions, penetration/aspiration, and residue after swallow were frequently documented. A significant improvement in FOIS scores was found during the second FEES examination. Conclusions: Swallowing impairment in patients with severe COVID-19 after discharge from the ICU is characterised by propulsive deficit and delayed pharyngeal phase. Most of these patients required feeding restrictions even if feeding abilities seem to improve over time.

Role of nutraceuticals on neurodegenerative diseases: neuroprotective and immunomodulant activity.

Neurodegeneration is a degenerative process characterized by the progressive loss of the structure and function of neurons that involves several immune cells. It is the primary cause of dementia and other several syndromes, known as neurodegenerative diseases. These disorders are age-related and it is estimated that by 2040 there will be approximately 81.1 million people suffering from these diseases. In addition to the traditional pharmacological therapy, in recent years nutraceuticals, naturally based compounds with a broad spectrum of biological effects: anti-aging, antioxidants, hypoglycaemic, hypocholesterolemic, anticancer, anxiolytic, antidepressant, etc., assumed an important role in counteracting these pathologies. In particular, several compounds such as astaxanthin, baicalein, glycyrrhizin, St. John's wort, and Ginkgo biloba L. extracts show particular neuroprotective and immunomodulatory abilities, involving several immune cells and some neurotransmitters that play a critical role in neurodegeneration, making them particularly useful in improving the symptoms and progression of neurodegenerative diseases.

Immunogenicity, effectiveness, safety and psychological impact of COVID-19 mRNA vaccines.

In December 2019, a new single-stranded RNA coronavirus, SARS-CoV-2, appeared in China and quickly spread around the world leading to a pandemic. Infection with SARS-CoV-2 generates symptoms ranging from asymptomatic to severe, occasionally requiring hospitalization in intensive care units, and, in more severe cases, leading to death. Scientists and researchers around the world have made a real race against time to develop various vaccines to slow down and stop the spread of the virus. In addition to conventional viral vector vaccines, new generation mRNA vaccines, BNT152b2 (Comirnaty) and mRNA-1273 (Spikevax), have been developed respectively by Pfizer/BioNTech and Moderna. These vaccines act on immune cells to induce an immune response with the production of specific antibodies against Spike protein of SARS-CoV-2, and to stimulate the differentiation of T and B memory cells. The objective of this review is to provide a detailed picture of the validity of these new vaccines and the safety of vaccination. Not only was the immunogenic effect of mRNA vaccines evaluated, but also the psychosocial impact they had on the population. The data collected show that this type of vaccine can also be an excellent candidate for future treatment and eradication of possible new pathologies with viral and non-viral etiology.