Symptoms of oropharyngeal dysphagia, efficiency, and safety of swallowing in patients after treatment for head and neck cancer.

PURPOSE: The aim of this study is to investigate the relation between symptoms and signs of oropharyngeal dysphagia after treatment for head and neck cancer. METHODS: An observational analytical study with retrospective and prospective components was carried out including 25 adult and elderly patients with head and neck cancer who had completed the treatment at least 3 months before data collection. Data from the Eating Assessment Tool (EAT-10) protocol were analyzed, as well as from the videofluoroscopic swallowing exams. Based on videofluoroscopy, the degree of oropharyngeal dysphagia was classified, as well as the safety and efficiency grade using the DIGEST (Dynamic Imaging Grade of Swallowing Toxicity) scale. Pearson's correlation test was applied, adopting a significance level of 5%. RESULTS: There was a significant correlation between question 4 of the EAT-10 (swallowing solids takes extra effort) and the efficiency profile (p = 0.004), as well as between question 4 and the DIGEST score (p = 0.002). No significant relation was found between the DIGEST score and EAT-10 total score (p = 0.180) and not even between EAT-10 total score and efficiency (p = 0.129) or safety grade (p = 0.878). CONCLUSION: In conclusion, no relation was found between most of the dysphagia signs and symptoms investigated, demonstrating that the individual's perception of the swallowing function may not be consistent with the findings of the instrumental evaluation after long-term treatment for head and neck cancer.

Swallowing, nutritional status, and salivary flow in patients after head and neck cancer treatment, a pilot study.

Determine the relationship between swallowing function, nutritional status, and salivary flow in patients after head and neck cancer treatment. This pilot study included 17 patients. Swallowing was assessed through videofluoroscopy and surface electromyography (sEMG), nutritional status through anthropometry and dietary assessment, and salivary flow both with and without mechanical stimulation. Test analysis showed that 66.7% of patients had functional limitations in swallowing in 58.3%, 66.7%, and 58.3% residue scale with an average of a line of barium on a structure for pudding, honey, and liquid consistencies, respectively. Laryngeal penetration was found in 8.3% during the swallowing of liquid. Surface electromyography (sEMG) showed above normal values for muscle activity time during the swallowing of pudding. Anthropometric assessment and muscle and adipose tissue indicated eutrophy. Salivary flow test with mechanical stimulus showed that 82.3% of patients' salivary production was well below the appropriate level. There was a significant correlation between muscle tissue reserve and muscle activity time during swallowing in the studied muscles (left masseter p = 0.003, right masseter p = 0.001, suprahyoid p = 0.001, orbicularis oris = 0.020), all in pudding consistency. This pilot study confirmed the relationship between swallowing and nutritional status for its participants, showing that appropriate protein intake influences muscle activity during swallowing in head and neck cancer survivors.

Immediate effect of neuromuscular electrical stimulation on swallowing function in individuals after oral and oropharyngeal cancer therapy.

OBJECTIVE: To analyze the immediate effect of sensory and motor neuromuscular electrical stimulation, in oral and pharyngeal stages of swallowing, in individuals after oral and oropharyngeal cancer therapy. METHODS: The study was conducted on 10 individuals (mean age of 58 years) submitted to oral and oropharyngeal cancer therapy. The individuals were submitted to videofluoroscopy, during which they were randomly asked to swallow 5 mL of liquid, honey, and pudding, in three conditions: without stimulation, with sensory neuromuscular electrical stimulation, and with motor neuromuscular electrical stimulation. The degree of swallowing dysfunction was scored (Dysphagia Outcome and Severity Scale), as well as the presence of food stasis (Eisenhuber scale), and measurement of the oral and pharyngeal transit time. The results were statistically analyzed by the Friedman test or analysis of variance for repeated measures. RESULTS: The Dysphagia Outcome and Severity Scale revealed improvement for one individual with both sensory and motor stimuli, and worsening in two individuals, being one with motor and one with sensory stimulus. In the Eisenhuber scale, the neuromuscular electrical stimulation changed the presence of residues to variable extents. Concerning the oral and pharyngeal transit time, no difference was observed between the different stimulation levels for the consistencies tested (p > 0.05). CONCLUSION: Both sensory and motor neuromuscular electrical stimulations presented a varied immediate impact on the oral and pharyngeal stages of swallowing in individuals after oral and oropharyngeal cancer therapy. Thus, the results of the immediate effect suggest that the technique is not indicated, evidencing the need of caution in the use of neuromuscular electrical stimulation for the rehabilitation of dysphagia, after HNC treatment.

Immediate effect of neuromuscular electrical stimulation on deglutition after treatment of laryngeal cancer: a case report. / Efeito imediato da estimulação elétrica neuromuscular na deglutição após tratamento do câncer de laringe: relato de caso.

The objective of this study was to verify the immediate effect of sensory and motor neuromuscular electrical stimulation (NMES), in the oral and pharyngeal phases of deglutition, in a 64 year male patient after laryngeal cancer treatment. Videofluoroscopy was performed during deglutition of 5 ml of honey and pudding, under three conditions: without stimulation, with sensory NMES, with motor NMES, randomly defined. The degree of dysfunction of deglutition (DOSS), the presence of food stasis (Eisenhuber scale), laryngeal penetration and laryngotracheal aspiration (PAS) and oral and pharyngeal transit time were evaluated. An evaluator without knowing about the applied stimulus. On the DOSS scale there was improvement with sensory and motor stimulation. In the PAS scale, there was improvement, both for the sensorial and motor stimulus in the honey consistency, but the worsening of the motor stimulus for the pudding consistency was observed. There was reduction of the residues in the base of the tongue with sensorial and motor stimulus for the consistency of pudding and honey; worsening motor stimulus in the posterior wall of the pharynx for honey consistency. There was no difference between stimulation levels regarding to oral and pharyngeal transit time. The results showed that NMES at the sensory and motor levels improved the degree of dysphagia in an individual after the treatment of laryngeal cancer, with greater benefits of the sensory level in relation to the motor regarding to the presence of penetration and residues.

Este trabalho teve por objetivo verificar o efeito imediato da Estimulação Elétrica Neuromuscular (EENM) sensorial e motora, nas fases oral e faríngea da deglutição, em um homem de 64 anos, após tratamento de câncer de laringe. Foi realizado exame de videofluoroscopia durante a deglutição de 5 ml de mel e pudim, em três condições: sem estimulação, com EENM sensorial, com EENM motora, definidas de forma randomizada. Foi classificado o grau da disfunção da deglutição (DOSS), a presença de estase de alimentos (escala de Eisenhuber), de penetração laríngea e aspiração laringotraqueal (PAS), além da medida do tempo de trânsito oral e faríngeo, realizadas por uma avaliadora sem conhecimento sobre o estímulo aplicado. Na escala DOSS, houve melhora com a estimulação sensorial e motora. Na escala PAS, verificou-se melhora, tanto para o estímulo sensorial quanto motor na consistência mel, porém observou-se piora no estímulo motor para a consistência pudim. Houve diminuição dos resíduos em base de língua com estímulo sensorial e motor para as consistências pudim e mel; piora no estímulo motor na parede posterior da faringe para a consistência mel. Em relação ao tempo de trânsito oral e faríngeo, não foi observada diferença entre os níveis de estimulações. Os resultados demonstraram que a EENM em nível sensorial e motor melhorou o grau da disfagia em um indivíduo após o tratamento de câncer de laringe, com maiores benefícios do nível sensorial em relação ao motor no que diz respeito à presença de penetração e resíduos.

Molecular typing of Mycobacterium Abscessus isolated from cystic fibrosis patients.

BACKGROUND: The possibility of inter-human transmission of Mycobacterium abscessus in cystic fibrosis centres has been recently hypothesized suggesting the need for the molecular characterization of strains isolated from such patients. MATERIALS AND METHODS: One hundred and forty one isolates of M. abscessus grown from sputum samples of 29 patients with cystic fibrosis were genotyped resorting to variable number of tandem repeats (VNTR) determination and whole genome sequencing (WGS). RESULTS: Out of 29 VNTR profiles, 15 were unique to the same number of patients while seven were shared by multiple patients. WGS showed that only two of the patients sharing common VNTR patterns were indeed infected by the same strain. The shared VNTR patterns were mostly present among the isolates of M. abscessus subsp. abscessus. CONCLUSION: As expected WGS showed a clearly higher discriminatory power in comparison with VNTR and appeared the only molecular epidemiology tool suitable to effectively discriminate the isolates of M. abscessus subsp. abscessus.

Websites em português sobre disfagia orofaríngea no idoso / Websites in Portuguese about oropharyngeal dysphagia in elderly / Websites portugués sobre disfagia orofaríngea en el adulto mayor

INTRODUÇÃO: Recursos de Telessaúde são importantes para a transmissão do conhecimento sobre as disfagias orofaríngeas no idoso. OBJETIVO: Localizar, avaliar a qualidade e abrangência de websites em português sobre as disfagias orofaríngeas no idoso, voltados à população em geral. MÉTODOS: Foi utilizada a ferramenta de busca Google, com as palavras-chave "disfagia orofaríngea" AND "idoso" e ''orientação'' AND ''disfagia orofaríngea'' AND ''idoso''. Foram considerados como critérios de inclusão: sites e blogs em português que disponibilizassem informações e/ou orientações sobre disfagias orofaríngeas no idoso decorrente do envelhecimento e/ou de doenças neurológicas ou oncológicas. Os websites selecionados foram analisados quanto à qualidade por dois juízes, utilizando o protocolo Health On the Net Code (HON Code), quanto à abrangência (assuntos abordados), utilização figuras/vídeos e seu objetivo central. RESULTADOS: Dezenove websites foram selecionados, observando baixa pontuação do protocolo HON Code para os itens: atribuição (fonte das informações publicadas) (média 0,8) e atualizações (informações quanto às datas de atualização do assunto abordado) (média 0,6), apresentando a pontuação geral média de 7,87, além de observar restrita abrangência dos assuntos. Quanto à disponibilidade de ilustrações, observou que 90% dos websites não apresentaram figuras e 89% não apresentaram vídeos para facilitar a retenção do conteúdo. Quanto ao objetivo central do website, a disfagia foi o tema central em 6% dos websites. CONCLUSÃO: Os websites apresentaram uma qualidade parcial segundo os critérios éticos, com uma abrangência restrita, não apresentaram a disfagia orofaríngea como tema central, além da não utilização de ilustrações no decorrer do conteúdo. Desta forma, sugere-se o aperfeiçoamento dos websites já existentes sobre as disfagias orofaríngeas no idoso.

INTRODUCTION: Telehealth resources are important for the transmission of knowledge about oropharyngeal dysphagia in elderly. OBJECTIVE: To determine the quality and comprehensiveness of websites in Portuguese on oropharyngeal dysphagia in the elderly, aimed at the general population. METHODS: We used the Google search tool, with the keywords "oropharyngeal dysphagia" AND "elderly" and "orientation" AND "oropharyngeal dysphagia" AND "elderly". Inclusion criteria were: websites and blogs in Portuguese that provided information and/or guidelines on oropharyngeal dysphagia in the elderly due to aging and/or neurological or oncological diseases. The selected websites were analyzed for quality by two judges, using the Health On the Net Code (HON Code) protocol, regarding the coverage (subjects covered), use of pictures/videos and their central objective. RESULTS: Nineteen websites were selected, observing a low HON Code score for the attribution items (source of information published) (mean 0.8) and updates (information on the update dates of the subject addressed) (mean 0.6), presenting the average overall score of 7.87, in addition to observing a narrow range of subjects. Regarding the availability of illustrations, observed that 90% of the websites did not present figures and 89% did not present videos to facilitate content retention. As for the central objective of the website, dysphagia was the central theme in 6% of websites. CONCLUSION: The websites presented a partial quality according to the ethical criteria, with a restricted scope, did not present the oropharyngeal dysphagia as a central theme, besides the non use of illustrations during the content. Thus, it is suggested to improve the existing websites on oropharyngeal dysphagia in the elderly.

INTRODUCCIÓN: Recursos de Telessalud son importantes para la transmisión del conocimiento sobre las disfagias en el adulto mayor. OBJETIVO: Localizar y evaluar la calidad y alcance de websites en portugués sobre las disfagias orofaríngeas en adultos mayores, direccionas a la población en general. MÉTODOS: Se utilizó la herramienta de búsqueda Google, con las palabras clave "disfagia orofaríngea" AND "adulto mayor" y "orientación" AND "disfagia orofaríngea" AND "adulto mayor". Se consideraron como criterios de inclusión: websites y blogs en portugués con informaciones y/o orientaciones sobre disfagias orofaríngeas en el adulto mayor debido al envejecimiento y/o a enfermedades neurológicas u oncológicas. Los websites seleccionados fueron analizados cuanto a la calidad, por dos jueces, utilizando el protocolo Health On the Net Code (HON Code), cuanto a la exhaustividad de los temas contemplados, al uso de figuras /videos y a su objetivo central. RESULTADOS: Se seleccionaron 19 websites con baja puntuación del HON Code para: asignación (fuente de la información publicada) (promedio 0,8) y actualizaciones (información sobre las fechas de actualización del asunto abordado) (promedio 0,6), presentando la puntuación general promedio de 7,87, además de observar restringido alcance de los asuntos. En cuanto a la disponibilidad de ilustraciones, se observó que el 90% de los websites no presentan figuras y el 89% no presentó vídeos para facilitar la retención del contenido. En cuanto al objetivo central de los website, la disfagia fue el tema central en el 6%. CONCLUSIÓN: Los websites presentaron una calidad parcial según los criterios éticos, con un alcance restringido, no presentaron la disfagia orofaríngea como tema central, además de no utilizar ilustraciones en el transcurso del contenido. De esta forma, se sugiere el perfeccionamiento de los websites ya existentes sobre las disfagias orofaríngeas en adultos mayores.

Diadococinesia oral e função mastigatória em idosos saudáveis / Oral diadochokinesis and masticatory function in healthy elderly

Objetivo Relacionar os achados da diadococinesia (DDC) oral com a função mastigatória em idosos saudáveis.Métodos Análise de prontuários e arquivos de imagens de 35 idosos saudáveis, entre 60 e 74 anos de idade. Considerou-se o tipo mastigatório e outros comportamentos associados à mastigação de uma fatia de pão francês de 1cm de espessura, análise da apreensão do alimento, formação do bolo alimentar e mensuração do tempo de mastigação, utilizando cronômetro. Para avaliação da DDC, foram analisadas as emissões silábicas "pa", "ta", "ka" e a trissílaba "pataka", quanto aos parâmetros fornecidos automaticamente pelo programaMotor Speech Profile Advanced -KayPentax®. Para correlação entre os aspectos qualitativos da função mastigatória e a DDC, foi realizada estatística pertinente.Resultados A análise estatística demonstrou correlação entre o tempo mastigatório e os parâmetros coeficiente de variação do pico da intensidade da sílaba ‘'ta'' e perturbações do período da sílaba ‘'ka'', indicando instabilidade da DDC. Para o tipo mastigatório, apreensão e formação do bolo alimentar não houve correlação com os dados da DDC oral.Conclusão A DDC oral correlacionou-se com o tempo mastigatório em idosos saudáveis, evidenciando que, quanto maior a instabilidade na repetição dos movimentos de ponta e dorso de língua durante a produção articulatória, maior o tempo necessário para a preparação do alimento para a deglutição.

Purpose To relate the findings of oral diadochokinesis (DDK) and masticatory function in healthy elderly.Methods Analysis of medical records and images files of 35 healthy elderly subjects aged 60 to 74 years. The masticatory type and other behaviors associated with mastication of bread (1cm thick), the analysis of food seizure, bolus formation and measurement of chewing time, using a timer, were considered. For DDK assessment, the syllabic emissions "pa", "ta", "ka" and the tri-syllable "pataka", as to the parameters automatically provided by the Motor Speech Profile Advanced program (KayPentax®), were analyzed. Relevant statistics was performed for the correlation between the qualitative aspects of masticatory function and DDK.Results The statistical analysis showed a correlation between the chewing time and the parameters coefficient of peak intensity variation of syllable ‘'ta'' and disturbance time of syllable "ka'', indicating DDK instability. No correlation with the data of oral DDK was seen for the masticatory type, seizure and bolus formation.Conclusion Oral DDK correlated with the chewing time in healthy elderly, showing that the higher the instability in the repetition of movements of the tip and the back of the tongue, during articulatory production, the longer the time required to prepare the food for swallowing.

Multicenter evaluation of mycobacteria growth indicator tube (MGIT) compared with the BACTEC radiometric method, BBL biphasic growth medium and Löwenstein---Jensen medium.

OBJECTIVE: To evaluate the new BBL mycobacteria growth indicator tube (MGIT) in comparison with other media. METHODS: MGIT was evaluated in 10 Italian centers on 433 clinical samples, mainly of respiratory origin and mainly smear positive, in comparison with Löwenstein---Jensen and with one or more other methods represented, according to participating centers, by the BACTEC radiometric method or by the biphasic BBL Septi-Chek AFB system. While MGIT and Löwenstein---Jensen were used for all the samples, 285 of them were also inoculated in BACTEC vials and 274 in biphasic bottles. Of these samples, 132 were investigated with all the four methods. RESULTS: Although less rapid and sensitive than the radiometric method, the results of MGIT were equal when compared with the other two media with respect to overall isolation yield; furthermore, it allowed the detection of growth in significantly shorter times. CONCLUSIONS: The results of this study indicate the value of MGIT for the detection of mycobacteria and, thanks to its extreme simplicity of use, its suitability for small and large laboratories. Its combined use with a solid medium can substantially improve the diagnosis of mycobacterial infection.