Expression and clinical significance of miR-28-5p in aspiration pneumonia / 中华急诊医学杂志

Objective:To investigate the expression level and clinical value of miR-28-5p in patients with aspiration pneumonia.Methods:This was a retrospective controlled study. A total of 60 patients with severe pneumonia in the Intensive Care Unit of Jinshan Hospital Affiliated to Fudan University were selected as the study group. According to the pathogenic factors, the patients were divided into the aspiration pneumonia group and other infectious pneumonia group. At the same time, 20 healthy physical examination patients in our hospital were selected as the healthy control group. Venous blood was collected from patients in the study group on days 1, 4, and 7. The expression level of miR-28-5p in serum was detected by reverse transcription-polymerase chain reaction (RT-PCR), and the serum levels of interleukin-4 (IL-4), IL-6, IL-8, IL-10, and tumor necrosis factor-α (TNF-α) were detected by enzyme-linked immunosorbent assay (ELISA) assay. The clinical detection results of C-reactive protein (CRP) and procalcitonin (PCT) in the study group were collected. Statistical analysis was conducted with SPSS 26.0. Then the diagnostic value of serum miR-28-5p for aspiration pneumonia was analyzed by receiver operating characteristic (ROC) curve, and the correlation between serum miR-28-5p and IL-4, IL-6, IL-8, IL-10, TNF-α, CRP and PCT was analyzed by Pearson method. According to the clinical effect of 10 days of treatment, the patients were divided into the good prognosis and poor prognosis groups, and the relationship between miR-28-5p and the expression levels of various inflammatory factors and prognosis was analyzed.Results:Compared with the healthy control group, the level of serum miR-28-5p in the study group was significantly increased, and the level of serum miR-28-5p in the aspiration pneumonia group was much lower than that in the other infectious pneumonia group ( P<0.05). Compared with day 0, the expression level of serum miR-28-5p in the aspiration pneumonia group was highly increased, with statistical significance ( P<0.05). ROC curve of serum miR-28-5p expression in aspiration pneumonia showed that AUC was 0.871. When the critical value was 1.211, the sensitivity was 76.67% and the specificity was 95%. Pearson correlation analysis showed that miR-28-5p was positively correlated with IL-6 ( P<0.05), and negatively correlated with IL-4 and IL-10 ( P<0.05). ROC curve analysis showed that the area under the curve of age, miR-28-5p, IL-8, IL-10, TNF-α, CRP, and PCT were 0.695, 0.813, 0.655, 0.668, 0.724, 0.651, and 0.661, respectively. Conclusions:Serum miR-28-5p has important reference significance for the diagnosis of aspiration pneumonia, and has certain value for distinguishing different types of aspiration pneumonia. The expression of miR-28-5p in serum is expected to be a new biomarker to judge the prognosis of patients with severe pneumonia. Age, TNF-α, IL-8, IL-10, CRP and PCT are correlated to the prognosis of severe pneumonia.

Analysis of clinical characteristics of 294 acute poisoning patients with gastric lavage / 中华急诊医学杂志

Objective:To describe the current situation of gastric lavage operation and put forward measures for improvement by analyzing the clinical characteristics of 294 patients with gastric lavage in Poisoning Treatment Center of The First Affiliated Hospital of Nanjing Medical University.Methods:The clinical data of 294 patients with acute poisoning and gastric lavage from 2019 to 2021 were collected and analyzed retrospectively, and the related parameters (poison type, gastric lavage volume, poisoning to gastric lavage time, etc.) of each year were compared.Results:A total of 653 poisoning patients underwent gastric lavage from 2019 to 2021, with an average age of (44.2 ±20.1) years, and 134 (45.6%) were male. The main causes of gastric lavage were pesticide poisoning (52.72%) and drug poisoning (42.86%). The volume of gastric lavage was less than 10 L for 43.8% of patients and 10-20 L for 32.7% of patients. Patients with gastric lavage within 60 min after ingestion of poison accounted for 45.3%, followed by 25.8% within 61-120 min. The in-hospital mortality rate was 17.7%. The common complications of gastric lavage were: the incidence of gastrointestinal bleeding (55/121, 45.5%), the incidence of aspiration pneumonia (54/140, 38.6%), and the incidences of electrolyte disorder (21% of low potassium, 29% low calcium, and 10.0% low sodium). Compared with the groups in different years, the proportion of gastric lavage in poisoning was 58.85% vs. 46.60% vs. 32.41%, which decreased year by year, with statistical difference ( P <0.05). And there was no difference in the period from ingestion to gastric lavage and gastric lavage fluid volume. There was an increasing trend in poison types between diquat and other insecticides, but there was no statistical difference. Conclusions:From 2019 to 2021, the most common causes of acute gastric lavage were pesticide poisoning and drug poisoning, and the proportion of diquat and other pesticides showed an overall upward trend. A majority of the patients (71.1%) had gastric lavage within 2 h, and 76.5% of the patients had less than 20 L gastric lavage fluid. In the future, we will further control the amount of gastric lavage fluid and pay attention to the gastric lavage operation of new insecticide poisoning.

Prognosis of middle-aged and elderly patients with aspiration pneumonia in integrated medical and elderly care institutions and logistic regression analysis of related influencing factors / 公共卫生与预防医学

Objective To investigate the prognosis of middle-aged and elderly patients with aspiration pneumonia and related influencing factors in integrated medical and elderly care institutions. Methods A total of 604 elderly patients with aspiration pneumonia were selected from integrated medical and elderly care institutions from January 2016 to December 2020. The prognosis of the patients was counted, and the prognostic factors were analyzed by univariate and multivariate logistic regression equations. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to analyze the predictive value of logistic regression model for the prognosis of elderly patients with aspiration pneumonia. Results Univariate analysis showed that Alzheimer's disease, severe pneumonia, ability of daily living (ADL), and the number of rescues were related to the prognosis of elderly patients with aspiration pneumonia (P12.97), the predictive value was the best, with the predictive sensitivity being 83.87%, and the specificity being 84.15%. Conclusion Alzheimer's disease, severe pneumonia, moderate and severe dependence in the ability of daily living and rescue times ≥ 2 are related to the prognosis of middle-aged and elderly patients with aspiration pneumonia in the integrated medical and elderly care institutions, which can be used as a prognostic plan for clinical treatment and nursing management. At the same time strengthening the intervention of patients with the above characteristics will help to promote the improvement of prognosis.

Evaluation of Antimicrobial Activity of Chlorhexidine-Containing Oral Gels against Aspiration Pneumonia-Inducing Bacteria: An In Vitro Study

Aim: Hospitalised patients have a high risk of developing aspiration pneumonia because of poor oral care and oral microbial flora changes. Chlorhexidine (CHX) solution has been used to reduce inflammation and prevent infections in oral cavity, but it is difficult to use in inpatients. Gel?type antimicrobial agents rather than the liquid form may be effective for the oral management of hospitalised patients. Therefore, we evaluated the in vitro antimicrobial effects of CHX?containing oral gels on aspiration pneumonia?inducing bacteria compared to the CHX solution. Materials and Methods: The experimental products of two oral gel types containing 1% and 0.1% CHX, respectively, were selected. Hexamedine, a 0.12% CHX solution, was used as a positive control. The antimicrobial activity of CHX agents against six pneumonia?causing bacteria and Streptococcus mutans, one of the most common oral bacteria, was comparatively analysed using the agar disk diffusion method. Results: In the disk diffusion assay, the 1% CHX gels showed the highest inhibitory effect on all bacteria. All CHX agents including gels and solution had the highest antibacterial activity against Staphylococcus aureus compared with other bacteria. Conclusions: We confirmed the significant antimicrobial effects of the 1% CHX oral gels on aspiration pneumonia?inducing bacteria. These results suggest that CHX gels may be an effective oral care method for preventing infection in inpatients who have difficulty using the solution.

Effect of early tracheoscopic treatment on patients with aspiration pneumoni / 中华急诊医学杂志

Objective:To investigate the clinical effect of early bronchoalveolar lavage on patients with aspiration pneumonia.Methods:A retrospective study was conducted on 55 patients with aspiration pneumonia who met inclusion criteria but not exclusion criteria in the Intensive Care Department of our hospital from January 2020 to April 2021. The patients were divided into the control group (32 cases) and the bronchoscopic lavage group (23 cases) according to whether they received bronchoscopic lavage within 24 h after aspiration. Basic information (sex, age, body mass index, chest X-ray score, oxidation index, temperature, heart rate, respiratory rate, white blood cells, PCT, IL-6, CPR and APACHE Ⅱ score), etiology changes at the early stage (≤ 3 d) and later stage (4-7 d after admission), and changes in prognostic indexes (mechanical ventilation time, length of ICU stay, length of stay and mortality) were compared between the two groups. The clinical efficacy of early endoscopy lavage for aspiration pneumonia was evaluated.Results:The positive rate of early etiological culture was 85.2%, the bacterial positive rate was 72.9% and the fungal positive rate was 14.6%. Pseudomonas aeruginosa accounted for 20.8%, Klebsiella pneumoniae accounted for 14.6%, Staphylococcus aureus and Streptococcus accounted for 12.5%, and there was no significant difference in the distribution between the bronchoscopic lavage group and the control group (all P>0.05). The positive rate of late etiological culture was 88.6%, the bacterial positive rate was 85.7% and the fungal positive rate was 2.9%. The positive rate of late bacterial culture was significantly decreased in the bronchoscopic lavage group ( P < 0.05), and the other results were not significantly different from the control group (all P>0.05). After early bronchoscopic lavage, the duration of mechanical ventilation, length of ICU stay and length of stay were significantly shortened, and the fifth day CPIS score was significantly decreased (all P< 0.05). Conclusions:Early endotracheal lavage can reduce mechanical ventilation time, length of ICU stay and length of stay of aspiration pneumonia, and reduce the positive rate of bacterial culture in the lung at the later stage, which needs to be further verified by a large randomized controlled study.

A case of occupational allyl alcohol inhalation poisoning / 中华劳动卫生职业病杂志

Allyl alcohol is an intermediate widely used in industrial production activities, which has caused many occupational damage in China. In this paper, the data of a case of skin damage and clinical cure of inhalation pneumonia caused by occupational allyl alcohol exposure were analyzed and summarized. The patient accidentally inhaled large amounts of allyl alcohol at work and had skin exposure, which was mainly manifested as aspiration pneumonia, respiratory failure, eye damage and skin bullae. After short-term hormone shock therapy, mechanical ventilation, infection prevention, local treatment and other comprehensive treatment, the patient was clinically cured. This case suggests that chemical pneumonia and respiratory failure may be caused by inhalation of allyl alcohol, and skin bullae may be caused by skin contact. Early treatment and hormone use should be emphasized.

Clinical and microbiological characteristics of children with drowning-associated aspiration pneumonia / 中国当代儿科杂志

OBJECTIVES@#To study the clinical and microbiological characteristics of children with drowning-associated aspiration pneumonia, so as to provide a reference for empirical selection of antibacterial agents.@*METHODS@#A retrospective analysis was performed on the medical data of 185 children with drowning-associated aspiration pneumonia who were admitted to Children's Hospital of Chongqing Medical University from January 2010 to October 2020. According to the drowning environment, these children were divided into four groups: fecal group (n=44), freshwater group (n=69), swimming pool group (n=41), and contaminant water group (n=31). The clinical characteristics and pathogen detection results were reviewed and compared among the four groups.@*RESULTS@#The 185 children had an age of 4 months to 17 years (median 34 months). Sputum cultures were performed on 157 children, and 103 were tested positive (65.6%), with 87 strains of Gram-negative bacteria (68.5%), 37 strains of Gram-positive bacteria (29.1%), and 3 strains of fungi (2.4%). Gram-negative bacteria were the main pathogen in the fecal group and the contaminant water group, accounting for 88.2% (30/34) and 78.3% (18/23), respectively. The freshwater group had a significantly higher detection rate of Gram-positive bacteria than the fecal group (P<0.008), and the swimming pool group had an equal detection rate of Gram-negative bacteria and Gram-positive bacteria.@*CONCLUSIONS@#For pulmonary bacterial infection in children with drowning in feces or contaminant water, antibiotics against Gram-negative bacteria may be applied empirically, while for children with drowning in a swimming pool or freshwater, broad-spectrum antibiotics may be used as initial treatment, and subsequently the application of antibiotics may be adjusted according to the results of the drug sensitivity test.

Neumonía lipoidea exógena aguda por aspiración accidental de hidrocarburos / Acute exogenous lipoid pneumonia for accidental aspiration of hydrocarbons

La neumonía lipoidea es una enfermedad respiratoria poco conocida que resulta de la acumulación de lípidos de origen endógeno o exógeno a nivel del alveolo pulmonar. Suele ser subdiagnosticada ya que la presentación clínica es inespecífica, por lo que suele confundirse con otras patologías broncopulmonares. Se presentó el caso de un paciente de 18 años antecedentes de aspiración accidental de combustible que seis horas después comenzó con fiebre, hemoptisis, tos y disnea. Se realizó radiografía de tórax donde se observó una neumonía en base derecha que unido al interrogatorio y a la realización de la broncoscopía confirmaron el diagnóstico de neumonía lipoidea. El paciente evolucionó favorablemente con el tratamiento(AU)

Lipoid pneumonia is a little known respiratory disease that results from the accumulation of lipids of endogenous or exogenous origin in the pulmonary alveolus. It is usually underdiagnosed since the clinical presentation is nonspecific, which is why it is often confused with other bronchopulmonary pathologies. We report the case of an 18-year-old patient with a history of accidental fuel aspiration, who ran fever six hours later, together with hemoptysis, cough, and dyspnea. Chest X-rays showed a right base pneumonia. The questioning and the performance of the bronchoscopy confirmed the diagnosis of lipoid pneumonia. The patient evolved favorably with the treatment(AU)

Risk factors for pulmonary infection among stroke survivors with dysphagia / 中华物理医学与康复杂志

Objective:To analyze the risk factors for aspiration pneumonia among persons with post-stroke dysphagia.Methods:A total of 105 dysphagic stroke survivors were examined using videofluoroscopy. Those suffering from aspiration pneumonia constituted a pneumonia group, and the others were a non-pneumonia group. Univariate and multivariate logistic regression were conducted using data on nasal feeding, pharyngeal transit time (PTT), pharyngeal remnants, active coughing, diet adjustment and Rosenbek Penetration-aspiration Scale (PAS) scores to analyze the risk factors for aspiration pneumonia.Results:There were 29 in the pneumonia group and 76 in the non-pneumonia group. Significant age differences were observed between the two groups, and also significant differences in the location of the stroke, the course of the disease, the incidence of diabetes mellitus, nasal feeding, active coughing, PAS score, PTT, pharyngeal remnants and diet adjustment. But there were no significant differences in gender, Kubota drinking water grade, the incidence of hypertension or atrial fibrillation, or leukocyte count. Univariate analysis showed that stroke site, age≥65, type 2 diabetes, nasal feeding, active coughing, diet adjustment, a PAS score >6, prolonged PTT and pharyngeal residue were all significant predictors of pneumonia. Multivariate logistic analysis indicated that the incidence of pneumonia was significantly higher in patients with a brainstem or bilateral stroke than among those with unilateral stroke. Patients older than 64, with a PAS score >6, pharyngeal residue or prolonged PTT were at significantly greater risk of coming down with pneumonia, though active coughing was correlated with lower risk.Conclusions:Age >64, bilateral or brainstem stroke, a PAS score >6, prolonged pharyngeal transit time and pharynx remnants are independent risk factors for aspiration pneumonia among dysphagic stroke survivors, while active cough is a protective factor.

Morbimortalidad asociada a la disfagia en pacientes ingresados en un hospital general universitario

RESUMEN Introducción: La disfagia tiene una morbimortalidad importante en pacientes hospitalizados. Objetivos: principal; describir las características de los pacientes con disfagia hospitalizados y, secundarios; cuantificar y analizar la prevalencia de mortalidad y de reingresos. Metodología: Estudio transversal descriptivo de las hospitalizaciones por disfagia durante el año 2015 en un Hospital General Universitario. Resultados: Se evaluaron 431 historias clínicas. La edad de los pacientes fue de 83,21 (DE 11,4) años, el 52,5% fueron mujeres y el 47,2% varones; la estancia media fue de 11,1 (DE 7,99) días. En el 71,2 % de los casos la disfagia fue por afectación de la fase orofaríngea. En el 80,51% de los casos se diagnosticaron complicaciones respiratorias: 48,12% neumonía aspirativa por líquidos, 40,05 % neumonitis química por aspiración y 11,81% neumonía aspirativa por sólidos. La mortalidad general asociada a las complicaciones respiratorias respecto del total de los casos de disfagia fue del 24,49%. El 50,48% de los pacientes con neumonía aspirativa fallecieron. La principal causa de la disfagia fue las enfermedades neurológicas (un 77,25%). La mortalidad fue significativamente mayor en las mujeres - 42,3% frente al 7,8% - (p < 0,01) y esta diferencia se mantuvo tras ajustar el resultado por edad: OR 9,937, IC95%: 5,446; 18,131. El 13,10% de los pacientes reingresaron al menos en una ocasión. Los pacientes de geriatría presentaron un mayor número de reingresos por número de ingresos. Discusión: las enfermedades neurológicas fueron la principal causa de disfagia. La mortalidad fue significativamente mayor en las mujeres.

ABSTRACT Introduction: Dysphagia is an important associated morbidity and mortality in hospitalized patient. Objectives: Main; to describe the characteristics of patients admitted for dysphagia and secondary; quantify and analyze the prevalence of mortality and readmissions. Methodology: Cross-sectional study descriptive revenues by dysphagia during the year 2015 in a University General Hospital. Results: 431 records were evaluated. The age of the patients was 83,21 (11.4), 52.5% women and 47.2% male; the average stay was 11.1 (7.99) days. In 71,2% of cases the dysphagia was involvement of the oropharyngeal phase. 80.51% of cases were diagnosed respiratory complications. The percentage distribution of these complications were: in 48.12% aspiration pneumonia due to fluids, in 40.05% chemical aspiration pneumonitis and in 11.81% aspiration pneumonia due to solids. The overall mortality associated with respiratory complications compared to the total of cases of dysphagia was 24.49%. 50.48% of patients diagnosed with aspiration pneumonia died. The main cause of dysphagia was neurological diseases (77.25%). Mortality was significantly higher in women - 42.3% of women compared with 7.8% of males - (p < 0.01) and this difference remained after adjusting the result by age: OR 9,937, 95% CI: 5,446; 18,131. 13.10% of patients re-entered at least on one occasion. Patients of geriatric unit that presented in greater number of readmissions by admissions. Discussion: neurological diseases were the main cause of dysphagia. Mortality was significantly higher in women

Protocolo de Higiene Oral para Establecimientos de Larga Estadía para Adultos Mayores en Estado de Pandemia COVID-19. Prevención de Neumonía por Aspiración / Oral Hygiene Protocol for Long-Term Establishments for Older Adults in a State of Pandemic COVID-19. Aspiration Pneumonia Prevention

RESUMEN: ¿Por qué es importante la salud oral en la prevención de enfermedades respiratorias en tiempos de pandemia? La razón es simple, cualquier enfermedad respiratoria en la persona mayor, podría eventualmente activar alarma de COVID-19 positivo, pudiendo ser esta ocasionada por otro motivo, sin mencionar el riesgo aumentado de tener una enfermedad previa de tipo respiratoria en tiempos de pandemia, sobre todo, en una población de riesgo como las personas mayores institucionalizadas. Por esta razón, la prevención en higiene oral de personas mayores mediante un Protocolo que proponga lineamientos a seguir en Establecimientos de Larga Estadía para Adultos Mayores, es fundamental en la prevención de Neumonía por aspiración. Cabe mencionar, que desde antes de surgir el COVID-19, ya la Neumonía se considera la principal causa de muerte por enfermedades infecciosas en la población chilena, y la primera causa específica de muerte en los mayores de 80 años.

ABSTRACT: Why is oral health important in the prevention of respiratory diseases in times of pandemic? The reason is simple, any respiratory disease in the elderly could eventually trigger a positive COVID-19 alarm, and this could be caused by another reason, not to mention the increased risk of having a previous respiratory-type illness in times of pandemic, over everything, in a population of risk like the institutionalized older people. For this reason, the prevention of oral hygiene in older people through a Protocol that proposes guidelines to be followed in long-stay establishments for older adults, is essential in the prevention of aspiration Pneumonia. It is worth mentioning that, before the emergence of COVID-19, Pneumonia was considered the main cause of death from infectious diseases in the Chilean population and the first specific cause of death in those over 80 years of age.

Factors associated with aspiration pneumonia and preventive measures in hospitalized elderly: a systematic review of observational studies

ABSTRACT Purpose: to identify associated factors and preventive measures for aspiration pneumonia in hospitalized elderly patients. Methods: the PPOT (population, predictor, outcome, and type of study) was the strategy used to define the eligibility criteria: (1) Population: people over 60 years of age; (2) predictor: hospitalized patients (3) Outcomes: associated factors and measures to prevent aspiration pneumonia; (4) Type of study: Observational Studies (transversal and case-control). We performed the data collection in the PubMed, Lilacs, Scielo, Google Scholar, Science Direct, and Web of Science databases. Observational studies on factors associated with aspiration pneumonia and preventive measures in the elderly, without language restriction and available in full, were included. Data on authors/year/country, objective, methodology, sample, and results, were collected. The risk of bias was assessed, according to the JBI Critical Appraisal Checklist. Results: a case-control and two cross-sectional studies were analyzed. One paper presented a smaller sample with 86 patients, and another presented a larger sample comprising 443 patients. The median age was 77 years old. Conclusion: factors such as severe stroke, dysphagia, advanced age, male gender, coronary heart disease, lower Glasgow coma scale score, use of mechanical ventilation for more than 48 hours, and aspiration of colonized gastric juice were associated with aspiration pneumonia.

A Case of Hangekobokuto Improved Dysphagia and Aspiration Pneumonia Considered to be Caused by Late-Stage Neurosyphilis / 日本東洋医学雑誌

We investigated the effectiveness of hangekobokuto in alleviating dysphagia and aspiration pneumonia attributed to late­stage neurosyphilis. Our study subject, a 67-year-old man treated for his leg pain in our department, hoped this treatment would relieve his severe cough and sore throat. According to a neurological investigation and the analysis of blood and cerebrospinal fluid, his symptoms (swallowing disturbance and aspiration pneumonia in the lower lobes of both lungs) led to the diagnosis of cerebral bulbar paralysis caused by latestage neurosyphilis. The patient requested drug therapy ; thus, we prescribed 7.5 g/day of hangekobokuto, to be administered orally, based on his medical findings of qi stagnation and tan yin. Dysphagia was relieved one week after oral administration of hangekobokuto, and after three weeks, the patient's discomfort had almost disappeared. Moreover, aspiration pneumonia was also improved in his chest CT image finding. Late-stage neurosyphilis symptoms usually develop within 20 to 30 years of contracting syphilis, an infection caused by the bacterium Treponema pallidum. Symptoms may include a loss of swallowing reflex and cough reflex due to the paralysis of cerebral basal ganglia. However, hangekobokuto was found to increase the concentration of substance P released in the pharyngeal head and tracheal mucosa, and thus improve swallowing function. We conclude that hangekobokuto is a useful agent for alleviating the swallowing abnormality of late-stage neurosyphilis.

Prevalência de penetração e/ou aspiração laringotraqueal na Doença de Parkinson em centro especializado de reabilitação / Prevalence of penetration and aspiration in Parkinson's disease in rehabilitation center / Prevalencia de penetración y aspiración en la Enfermedad de Parkinson en centro especializado de rehabilitación

Introdução: Penetração e/ou aspiração laringotraqueal (PA) são achados clínicos que constituem importante parâmetro na mensuração do risco para a segurança da deglutição devido às possíveis complicações pulmonares. Objetivo: Identificar a prevalência de penetração e/ou aspiração na Doença de Parkinson (DP) em Centro Especializado de Reabilitação (CER). Método: Estudo clínico observacional retrospectivo. Foram analisados 39 laudos de exames de videoendoscopia da deglutição realizadas em Centro Especializado de Reabilitação "Universidade Estadual Paulista-UNESP/Marília", no período de 2006 a 2016. Dos 39 (100%) indivíduos, 19 (48,71%) eram do gênero feminino e 20 (51,28%) do gênero masculino, com idade que variou de 43 a 85 anos (média de idade de 71 anos) e somente 29 (74,35%) desses indivíduos apresentavam classificação de Hoehn & Yahr (1967) variando de um a cinco. Realizada análise da PA nas consistências pastosa, líquida espessada e líquida e com volume que variou de 5 a 10 ml segundo a definição proposta por Rosenbek et al, 1996. Para análise estatística foi utilizado o Teste de Fisher. Resultados: Constatou-se que 28 (71,79%) indivíduos não apresentaram penetração e/ou aspiração laringotraqueal e 11 (28,21%) apresentaram. Desses 11 (28,21%), quatro (10,25%) apresentaram penetração/aspiração na consistência pastosa (p=0,05), nove (23,07%) no líquido espessado (p=0,07) e nove (23,07%) no líquido ralo (p=0,02). Conclusão: Na população estudada nesse setting a ausência de PA foi mais frequente e a presença significante apenas no líquido ralo.

Introduction: Laryngotracheal penetration and/or aspiration are clinical findings that are an important parameter in the measurement of the risk for swallowing safety due to possible pulmonary complications. Objective: To identify the prevalence of penetration and/or aspiration in Parkinson's disease (PD) in a Specialized Rehabilitation Center. Method: Retrospective observational clinical study. We analyzed 39 reports of fiberoptic endoscopy swallowing test performed at the Dysphagia Rehabilitation Center "University of São Paulo-UNESP/Marília" from 2006 to 2016. Of the 39 (100%) individuals, 19 (48.71%) were female and 20 (51.28%), ranging from 43 to 85 years old (mean age of 71 years), and only 29 (74.35%) of these individuals presented a classification of Hoehn & Yahr (1967) ranging from one to five. The analysis of the penetration and aspiration was performed in paste, liquid, thickened and liquid consistencies, with a volume varying from 5 to 10 ml according to the definition proposed by Rosenbek et al., 1996. For the statistical analysis Fisher's test was used. Results: It was verified that 28 (71.79%) individuals presented no laryngotracheal penetration and/or aspiration and 11 (28.21%) presented. Of these 11 (28.21%), four (10.25%) presented penetration / aspiration in paste consistency (p = 0.05), nine (23.07%) in the thickened liquid (p = 0.07) and nine (23.07%) in the thin liquid (p = 0.02). Conclusion: In the population studied in this setting, the absence of penetration and/or aspiration was more frequent and the presence was significant only of the liquid.

Introducción: Penetración y/o aspiración laringotraqueal (PA) son hallazgos clínicos que constituyen un importante parámetro en la medición del riesgo para la seguridad de la deglución debido a las posibles complicaciones pulmonares. Objetivo: Identificar la prevalencia de penetración y / o aspiración en la Enfermedad de Parkinson (DP) en Centro Especializado de Rehabilitación (CER). Método: Estudio clínico observacional retrospectivo. Se analizaron 39 casos de exámenes de videoendoscopia de la deglución realizados en Centro Especializado de Rehabilitación "Universidade Estadual Paulista-UNESP/Marília", del período de 2006 a 2016. De los 39 (100%) individuos, 19 (48,71%) eran del género femenino y 20 (51,28%) del género masculino, con edad que varía de 43 a 85 años (mediana de edad de 71 años) y solamente 29 (74,35%) de estos individuos presentaban clasificación de Hoehn & Yahr (1967) variando de uno a cinco años. Se realizó un análisis de la PA en las consistencias pastosa, líquida espesa y líquida y con volumen que varía de 5 a 10 ml según la definición propuesta por Rosenbek et al, 1996. Para el análisis estadístico se utilizó el test de Fisher. Resultados: Se constató que 28 (71,79%) individuos no presentaron penetración y / o aspiración laringotraqueal y 11 (28,21%) presentaron. En la mayoría de los casos, se observó una disminución de la producción de leche en la leche materna, (23,07%) en el líquido ralo (p = 0,02). Conclusión: En la población estudiada en ese ajuste la ausencia de PA fue más frecuente y la presencia significante sólo en el líquido.

Ultrasound assessment of gastric antrum in term pregnant women before elective cesarean section / Ultrassom de antro gástrico em gestantes a termo antes de cesariana eletiva

Abstract Background and objectives: Pregnant women are considered patients at risk for pulmonary aspiration of gastric contents. The study aim was to evaluate the gastric antral cross-sectional area using ultrasound. Method: In this prospective study, 85 scheduled term pregnant women underwent gastric ultrasound. The outcomes were the measurement of the gastric antral cross-sectional area (main outcome), the estimated gastric volume, the incidence of pregnant women at risk for pulmonary aspiration, and the association between gastric antral cross-sectional area and clinical-demographic characteristics. Gastric antral cross-sectional area and gastric volume were compared according to body mass index <30 or ≥30. Results: The median (IIQ) for gastric antral cross-sectional area was 4 cm2 (2.8-6.3), for the estimated gastric volume it was 49.8 mL (33.7-87.2), and for the gastric volume estimated in mL.kg-1 it was 0.62 mL.kg-1 (0.39-0.95). The 95th percentile [95% confidence interval (CI)] of the gastric antral cross-sectional area and the estimated gastric volume were ≤10.3 cm2 (95% CI: 7.6-15.6) and 1.42 mL.kg-1 (95% CI: 1.20-2.64), respectively. The incidence of pregnant women at risk for pulmonary aspiration was 3.5% (CI: 3.5 (1.2-9.8)). There was a positive correlation between gastric antral cross-sectional area and weight, p < 0.001 and body mass index <0.001. Patients with a body mass index ≥30 had a gastric antral cross-sectional area and an estimated gastric volume greater than those with a body mass index <30, respectively, p < 0.01 and p < 0.02. Conclusion: Measuring the gastric antral cross-sectional area of pregnant women is feasible and easy. There was positive correlation between gastric antral cross-sectional area, body weight and body mass index. The estimation of gastric volume by measuring the gastric antral cross-sectional area can identify patients at risk for pulmonary aspiration. Obese patients had a gastric antral cross-sectional area and an estimated gastric volume greater than non-obese patients.

Resumo Justificativa e objetivos: As gestantes são consideradas pacientes de risco para aspiração pulmonar do conteúdo gástrico. O objetivo foi avaliar a área transversal do antro gástrico por meio de ultrassonografia. Método: Neste estudo prospectivo, 85 gestantes a termo agendadas foram submetidas à ultrassonografia do antro gástrico. Os desfechos foram a mensuração da área transversal do antro gástrico (desfecho principal), a estimativa do volume gástrico, a incidência de gestantes sob risco de aspiração pulmonar, a associação entre a área transversal do antro gástrico e características clínico-demográficas. A área transversal do antro gástrico e do volume gástrico foi comparada de acordo com o índice de massa corporal < 30 ou ≥ 30. Resultados: A mediana (IIQ) da área transversal do antro gástrico foi 4 cm2 (2,8-6,3), do volume gástrico estimado 49,8 mL (33,7-87,2) e do volume gástrico estimado em mL.kg-1 de 0,62 mL.kg-1 (0,39-0,95). O percentil 95 [intervalo de confiança (IC) 95%] da área transversal do antro gástrico e do volume gástrico estimado foi ≤ 10,3 cm2 (IC 95%: 7,6-15,6) e 1,42 mL.kg-1 (IC 95%: 1,20-2,64), respectivamente. A incidência de gestantes sob risco de aspiração pulmonar foi de 3,5% (IC: 3,5 (1,2-9,8). Houve correlação positiva entre a área transversal do antro gástrico e peso, p < 0,001 e índice de massa corporal p < 0,001. As pacientes com índice de massa corporal ≥ 30 apresentaram maior área transversal do antro gástrico, e do volume gástrico estimado, do que as com índice de massa corporal < 30, respectivamente p < 0,01 e p < 0,02. Conclusão: A mensuração da área transversal do antro gástrico de gestantes é factível e fácil. A área transversal do antro gástrico correlacionou-se positivamente com peso e índice de massa corporal. A estimativa do volume gástrico através da mensuração da área transversal do antro gástrico pode identificar pacientes sob risco de aspiração pulmonar. As pacientes obesas apresentaram área transversal do antro gástrico e volume gástrico estimado maior do que as não obesas.

Analysis of risk factors affecting short-term prognosis in elderly patients with aspiration pneumonia / 中华急诊医学杂志

Objective To explore the effects of nutritional status and severity of infection on short-term prognosis in elderly patients with aspiration pneumonia (AP),and to evaluate the risk factors of the disease.Methods Total of 116 elderly AP patients were retrospectively analyzed who were treated in emergency of Beijing Tongren Hospital between January 2015 and March 2018.Nutrition index,PSI and BMI of the patients were assessed on admission,while white blood cell count(WBC),neutrophil ratio,high sensitivity C-reactive protein (CRP),procalcitonin(PCT),total lymphocyte count,serum albumin,hemoglobin,cholesterol,triglycefides and cholinesterase were assessed during hospitalization.All 116 patients were divided into survival group or death group after admission 30 days.Results Totally 116 elderly AP patients treated in Emergency Department of Beijing Tongren Hospital between January 2015 and March 2018 were retrospectively analyzed.Nutrition index,PSI and body mass index (BMI) of the patients were assessed on admission,while white blood cell count (WBC),neutrophil ratio,high sensitivity C-reactive protein (CRP),procalcitonin (PCT),total lymphocyte count,serum albumin,hemoglobin,cholesterol,triglycerides and cholinesterase were assessed during hospitalization.All 116 patients were divided into the survival group or the death group according to the prognosis on 30 days after admission.Conclusions Nutrition status and the severity of infection have significant impact on the prognosis of elderly patients with AP,and for indicators,nutrition index,WBC,PSI and cholinesterase levels were crucial.The effective anemia amelioration,nutrition improvement and infection control are essential components for reducing mortality of elderly patients with AP.

Proportion of Aspiration Pneumonia Cases Among Patients With Community-Acquired Pneumonia: A Single-Center Study in Korea

OBJECTIVE: To investigate the proportion of aspiration pneumonia cases among patients with community-acquired pneumonia in Korea. METHODS: This retrospective study included patients with community-acquired pneumonia who had been admitted to the emergency department of a university-affiliated tertiary hospital in Gyeonggi Province, Korea between January 1, 2016 and December 31, 2016. Among these patients, those with aspiration pneumonia were identified using ICD-10 codes (J69.*). Patients with recurrent pneumonia were excluded, as were those who were immunocompromised. The proportion of cases of aspiration pneumonia was calculated, and the characteristics and clinical outcomes of patients with aspiration pneumonia and non-aspiration pneumonia were compared. RESULTS: The proportion of aspiration pneumonia cases among patients with community-acquired pneumonia was 14.2%. Patients with aspiration pneumonia were significantly more likely to be older (p<0.001) and male (p<0.001), and to have a higher confusion, uremia, respiratory rate, blood pressure, and age ≥65 years (CURB-65) score (p<0.001) as compared to patients with non-aspiration pneumonia. They were also more likely to require admission to the intensive care unit (p<0.001) and a longer hospital stay (p<0.001). CONCLUSION: Aspiration pneumonia accounts for 14.2% of all cases of community-acquired pneumonia in Korea. These data may contribute to the establishment of healthcare strategies for managing aspiration pneumonia among Korean adults.

Isolated Congenital Tracheobiliary Fistula

Background: Congenital tracheobiliary fistula is a rare developmental anomaly with apersistent communication between the biliary system and the trachea. Characteristics: A7-day-old baby with severe respiratory distress and aspiration pneumonia. Outcome:Tracheobilliary fistula identified on bronchoscopy. Open surgical excision of fistula wasfollowed by improvement. Message: This condition should be considered in the differentialdiagnosis of intractable aspiration pneumonia.

Tratamiento endoscópico de una hendidura laríngea posterior: reporte de un caso y revisión de la literatura / Endoscopic treatment of a laryngeal cleft: case report and literature review

RESUMEN Las hendiduras laríngeas posteriores son anomalías congénitas de la laringe de baja incidencia que comprometen la región interaritenoidea o la lámina cricoidea. En caso de extenderse hasta la tráquea son denominados clefts laringo-tráqueo-esofágicos. Su clínica es inespecífica y debe sospecharse en todo niño con trastorno de deglución y neumonía aspirativa a repetición. A continuación, presentamos un caso de un cleft laríngeo tipo 2 tratado endoscópicamente.

ABSTRACT The posterior laryngeal clefts are congenital anomalies of the larynx of low incidence that comprise the interaritenoid region or the cricoid lamina. In case of extending to the trachea they are called laryngo-tracheo-esophagic clefts. Its clinic is non-specific and should be suspected in any child with swallowing disorder and aspiration pneumonia. We present a case of an endoscopically treated laryngeal cleft type 2.

Neumopatía por aspiración (sindrome aspirativo / Aspiration pneumonia (aspiration syndrome)

Aspiration pulmonary disease is the condition in which there is a passage of gastric or oral content to the airways; the extent of aspiration is conditioned by the amount and frequency with which it occurs. The diagnostic approach of this pathology begins with an adequate clinical history with special emphasis on pathologies that generate poor swallowing mechanics such as neurological diseases, esophageal atresia and patients with a history of gastroesophageal reflux. The studies used for the diagnosis of this syndrome are chest X-ray, swallowing mechanics evaluation with barium, Ph-metry, scintigraphy with Tc99 for gastroesophageal reflux, delayed pulmonary scanning, endoscopic study of the digestive tract and bronchoscopy in search of lesions in the respiratory mucosa and bronchial lavage to detect lipid-laden alveolar macrophages which have been linked to the presence of aspiration syndromes in several publications

La neumopatía por aspiración es la condición en la que existe un paso de contenido gástrico a la vía aérea. La magnitud de la aspiración depende de la cantidad y la frecuencia con la que se presenta. El abordaje diagnóstico de esta patología se inicia con una historia clínica adecuada con especial énfasis en patologías que generen una mala mecánica de deglución como pueden ser enfermedades neurológicas, atresia esofágica y pacientes con antecedentes de reflujo gastroesofágico. Los estudios que se requieren para el diagnóstico de esta enfermedad constan de radiografía de tórax, estudio de deglución, Ph-metria, gamagrama para reflujo, estudio endoscópico de vía digestiva y broncoscopia en búsqueda de lesiones en la mucosa respiratoria y realización de lavado bronquial para macrófagos alveolares cargados de lípidos