Evaluation of pharyngeal muscle activity through nasopharyngeal surface electromyography in a cohort of dysphagic patients with acute ischaemic stroke.

Oro-pharyngeal dysphagia is frequently present during the acute phase of stroke. The aim of the present study was to evaluate whether the recording of surface EMG using a nasopharyngeal (NP) electrode could be applied to evaluation of pharyngeal muscle activity in acute stroke patients and if this neurophysiological measure is related with clinical assessment of swallowing. Patients were examined and clinical severity was assessed with the National Institute of Health Stroke Scale (NIHSS) score; dysphagia was evaluated through bedside screening test using the Gugging Swallowing Scale (GUSS). Extension of the ischaemic lesion was measured by quantitative score, based on CT scan [Alberta Stroke Programme Early CT Score (ASPECTS)]. We analysed 70 patients; 50 were classified as dysphagic (Dys+), and 20 as non-dysphagic (Dys-). Each participant underwent a surface NP EMG recording performed with a NP electrode, made of a Teflon isolated steel catheter, with a length of 16 cm and a tip diameter of 1.5 mm. The electrode was inserted through the nasal cavity, rotated and positioned approximately 3 mm anteroinferior to the salpingo-palatine fold. At least four consecutive swallowing-induced EMG bursts were recorded and analysed for each participant. Swallowing always induced a repetitive, polyphasic burst of activation of the EMG, lasting around 0.25 to 1 sec, with an amplitude of around 100-600mV. Two parameters of the EMG potentials recorded with the NP electrode were analyzed: duration and amplitude. The duration of the EMG burst was increased in Dys+ patients with a statistically significant difference compared to Dys- patients (p < 0.001). The amplitude was slightly reduced in the Dys+ group, but statistically significant differences were not observed (p = 0,775). Nevertheless, the burst amplitude showed a significant inverse correlation with NIHSS [r(48) = -0.31; p < 0.05] and ASPECTS scores [r(48) = -0.27; p < 0.05], meaning that the burst amplitude progressively reduced with an increase of clinical severity (NIHSS) and topographic extension of brain lesions in CT (ASPECTS). These results suggest that NP recordings can give a semi-quantitative measure of swallowing difficulties originating from pharyngeal dysfunction, in fact, electromyographic findings suggest reduced pharyngeal motility.

Body fluid compartments in hypertension.

BACKGROUND AND OBJECTIVES: There is a correlation between the fluid and ionic homeostasis and blood pressure but it is not known if these body fluid changes represent the cause or rather the effect of the blood pressure rise. We have estimated the compartmental distribution of body fluids by means of the Bioimpedance Spectroscopy (BIS) analysis in a hypertensive cohort compared to control subjects. MATERIAL AND METHODS: We have enrolled 28 hypertensive patients (14 females, 14 males, mean age 47 +/- 5) and a sex- and age-matched control group of 37 healthy subjects (17 females and 20 males, mean age 45 +/- 8). They underwent anthropometric measurements, then extracellular (ECW) and intracellular water (ICW) were assessed using BIS. RESULTS: Both mean weight and BMI of hypertensive patients resulted significantly higher than of the control group (p < 0.05). We found higher ICW values in hypertensive compared to normotensive subjects. This difference was proportional to the difference of mean blood pressure values, reaching significance only as regards the stage II hypertensive subgroup (p < 0.03). DISCUSSION: Our data confirm that the blood pressure increases are associated to TBW, and caused mainly by ICW increases. The BIS, a simple, reliable, non invasive and cost effective methodical approach, estimating the distribution of body fluids, offers new possibility of the management of the hypertensive disease, to establish a more appropriate antihypertensive treatment. Moreover, the BIS, estimating the volume restoration of the different body compartments, may be helpful in evaluating the effectiveness of the pharmacological treatment.

Evaluation of a community-based poison education program.

This study suggests that: (1) a program directed at a specific town and coordinated by a local community group is more effective in transmitting poison control knowledge than is a statewide poison prevention week effort; (2) that transmission of educational material is optimized through programs directed at a specific age group (in this study ages 6 through 14); and, (3) that information about where to get the poison center number and actual acquisition of Ipecac syrup in homes was well transmitted.