Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 69
Filter
1.
Article in Chinese | WPRIM | ID: wpr-927870

ABSTRACT

Objective To investigate the clinical characteristics and genetic mutations in Kindler syndrome(KS)and provide a theoretical basis for the diagnosis and treatment of KS. Methods The clinical data of one case of KS from Peking Union Medical College Hospital and 185 cases reported in literature were collected. The gene mutation types,patient clinical data,and tumor characteristics were statistically analyzed. Results A total of 186 cases were enrolled,including 110 males and 76 females,with the mean age of(28±16)years. The data of gene mutation and specific clinical manifestations were available in 151 and 94 patients,respectively. The main clinical manifestations of KS included poikiloderma,occurrence of blister in childhood,and photosensitivity,and the secondary clinical manifestations included oral inflammation,palmoplantar keratoderma,webbing/pseudoainhum,dysphagia,urethral stricture and so on.Oral inflammation(r=0.234,P=0.023),palmoplantar keratoderma(r=0.325,P=0.001),webbing/pseudoainhum(r=0.247,P=0.016),dysphagia(r=0.333,P=0.001),urethral stricture(r=0.280,P=0.006)were significantly correlated with age,showing significantly higher incidence in the patients over 32 years old.Urethral stricture(χ2=11.292,P=0.001)and anal stenosis(χ2=4.014,P=0.045)were significantly correlated with sex,with higher incidence in males.Eighty different mutations were found in 151 patients,and the most common gene mutation was c.676C>T.Forty-one tumors occurred in 27 patients,among which squamous cell carcinoma accounted for 92.7%. The gene mutation site had no significant correlation with squamous cell carcinoma or patient country. Conclusions The c.676C>T in FERMT1 gene is the most common mutation in KS.The patients are prone to squamous cell carcinoma and mainly attacked at the exposure sites(hand and mouth).


Subject(s)
Adolescent , Adult , Ainhum , Blister , Carcinoma, Squamous Cell , Child , Constriction, Pathologic , Deglutition Disorders/complications , Epidermolysis Bullosa , Female , Humans , Inflammation , Keratoderma, Palmoplantar/complications , Male , Membrane Proteins , Mutation , Neoplasm Proteins/genetics , Periodontal Diseases , Photosensitivity Disorders , Urethral Stricture/complications , Young Adult
2.
Int. j. med. surg. sci. (Print) ; 7(3): 1-10, sept. 2020. graf, ilus, tab
Article in Spanish | LILACS | ID: biblio-1178944

ABSTRACT

La enfermedad conocida como Covid-19fue declarada pandemia a principios del año 2020, atacando de manera sustancial el aparato respiratorio de los contagiados. La insuficiencia respiratoria progresiva generada por la enfermedad genera incluso, la muerte en los estados más graves de la enfermedad. Debido a esta alteración algunos pacientes pueden requerir ventilación mecánica. Muchas investigaciones relacionan la intubación con las disfagias. El fonoaudiólogo es quien ayuda en la rehabilitación de las alteraciones deglutorias, por lo que el objetivo de esta investigación fue revisar literatura especializada para recabar información sobre el papel del fonoaudiólogo en el tratamiento de la disfagia en pacientes con alta clínica por Covid-19.La metodología usada, definió una búsqueda específica en las bases de datos PubMed, Sciencedirect y en la Biblioteca Virtual de Salud (BSV). Se utilizó el término clave MeSH "Covid-19" luego el booleano de intersección "AND" y el término clave MeSH "Dysphagia" en seguida el booleano de intersección "OR" y el termino clave MeSH "Swallowing Disorder". Se encontraron un total de 42 artículos en distribuidos de la siguiente manera: PubMed (14), ScienceDirect (7), BSV (21). En la presente investigación solo fueron incluidos artículos correspondientes a estudios experimentales, cuasi experiméntales, estudios de casos, revisiones bibliográficas y ensayos clínicos donde se observa el papel del fonoaudiólogo en el trabajo de la disfagia en pacientes con alta clínica después de haber tenido Covid-19.Los resultados obtenidos relacionan la intubación prolongada a la disfagia, aunque los artículos hallados no son suficientes para realizar una generalización, sumado a que la calidad de los artículos encontrados no tienen el nivel de evidencia esperada, a pesar de eso, los resultados encontrados confirman al fonoaudiólogos especialistas en motricidad orofacial como un actor relevante tanto en la evaluación como en la intervención de pacientes que poseen disfagia debido a la intubación prolongada por Covid-19.


The disease known as Covid-19 was declared a pandemic at the beginning of 2020, substantially attacking the respiratory system of those infected. The progressive respiratory failure generated by the disease even leads to death in severe stages of the disease. Due to this alteration some users may require mechanical ventilation. Much research links intubation to dysphagia. The Speech Therapist is the one who helps in the rehabilitation of swallowing disorders, the objective of this research was to review specialized literature to gather information on the Role of the Speech Pathologist in the Treatment of Dysphagia in High Clinic Users due to (Covid-19).A specific search was carried out in the databases PubMed, Science direct and in the Virtual Health Library (BSV). The key term Mesh "Covid-19" was used then the intersection boolean "AND" and the key term Mesh "Dysphagia" then the intersection boolean "OR" and the key term Mesh "Swallowing Disorder". A total of 42 articles in distributed as follows: PubMed (14), ScienceDirect (7), BSV (21). In the present investigation only articles corresponding to experimental studies, quasi-experimental studies, case studies, bibliographic reviews were included, clinical trials, where the role of the speech therapist in the work of dysphagia in patients with clinical discharge after having had Covid-19 is observed.The results obtained relate prolonged intubation to dysphagia, although the articles found are not enough to make a generalization, added to the fact that the quality of the articles found does not have the expected level of evidence, despite that, the results found confirm the speech pathologist specializing in orofacial motor skills as a relevant actor both in the evaluation and in the intervention of users who have dysphagia due to prolonged intubation by Covid-19.


Subject(s)
Humans , Deglutition Disorders/complications , Coronavirus Infections/complications , Speech, Language and Hearing Sciences , Pneumonia, Viral , Betacoronavirus
3.
Einstein (Säo Paulo) ; 18: eAO4952, 2020. tab, graf
Article in English | LILACS | ID: biblio-1056063

ABSTRACT

ABSTRACT Objective: To define physician´s behavior in the face of a mentally capable elderly dysphagic patients at risk of pulmonary aspiration, who do not accept oral restriction. Methods: Observational, cross-sectional study, presenting a clinical case of an independent elderly with clinical complaints of dysphagia and laryngotracheal aspiration by flexible endoscopic evaluation of swallowing who rejected the proposal to restrict oral diet. A questionnaire about the patient's decision-making process was used to assess whether the physician was sympathetic and justify their answer, and if they are aware of hierarchy of ethical principles (recognition of the person´s value, autonomy, beneficence, nonmaleficence and justice), in the decision-making process, and which was the main principle that guided their decision. Results: One hundred participants were classified by time since graduation as Group I (less than 10 years) and Group II (more than 10 years). Of them, 60% agreed with the patient's decision, with no difference between the groups. The main reason was autonomy of patients, in both groups. Among those who were not sympathetic, the main argument was beneficence and nonmaleficence, considering the risk between benefit and harm. As to awareness about the hierarchy of principles, we did not find differences between the groups. Autonomy was the principle that guided those who were sympathetic with the patient's decision, and justice among those who didnot agree. Conclusion: Physicians were sympathetic with the patient's decision regarding autonomy, despite the balance between risks of beneficence and nonmaleficence, including death. We propose to formalize a non-compliance term.


RESUMO Objetivo: Definir o comportamento médico diante de paciente idoso disfágico com risco de aspiração laringotraqueal e mentalmente capaz que não aceita a restrição da via oral. Métodos: Estudo observacional, transversal. Apresentamos um caso clínico de idoso, que vive independente, com queixas clínicas e videoendoscopia da deglutição comprovando disfagia e aspiração, que recusou a proposta de restrição da via oral. Um questionário foi aplicado sobre o processo de decisão do paciente, procurando avaliar se o médico torna-se solidário, e que justifique sua resposta, e se tem ciência da hierarquia dos princípios éticos (reconhecimento do valor da pessoa, autonomia, beneficência, não maleficência e justiça), no processo de decisão e qual o principal princípio que norteia sua decisão. Resultados: Cem participantes foram classificados por tempo de formados em Grupo I (até 10 anos) e Grupo II (mais de 10 anos). Deles 60% tornaram-se solidários à decisão do paciente, sem diferença entre os grupos. O principal argumento foi a autonomia do paciente nos dois grupos. Entre os não solidários, foi o binômio beneficência e não maleficência, e o balanço do risco/benefício e malefício. Considerando a ciência sobre a hierarquia dos princípios que regem a decisão, não encontramos diferença entre eles. A autonomia foi o principal princípio na decisão entre os solidários e a justiça entre os não solidários. Conclusão: O médico foi solidário à decisão do paciente em respeito à sua autonomia, apesar dos riscos ponderados da beneficência e da maleficência, inclusive de morte. Propomos o termo de recusa de conduta formalizada.


Subject(s)
Humans , Male , Aged, 80 and over , Practice Patterns, Physicians'/statistics & numerical data , Deglutition Disorders/complications , Treatment Refusal/statistics & numerical data , Respiratory Aspiration/etiology , Physician-Patient Relations , Time Factors , Gastrostomy/methods , Deglutition Disorders/prevention & control , Cross-Sectional Studies , Surveys and Questionnaires , Risk Factors , Gastroscopy/methods , Personal Autonomy , Respiratory Aspiration/prevention & control , Clinical Decision-Making , Intubation, Gastrointestinal/methods
4.
Int. arch. otorhinolaryngol. (Impr.) ; 23(1): 25-30, Jan.-Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-1002179

ABSTRACT

Abstract Introduction Feeding, swallowing and breathing are fundamental activities for the survival and well-being of humans; these functions are performed by themost complex neuromuscular unit of the human body, which, when altered, may raise morbidity and mortality rates. Objective To evaluate deglutition in patients with mental disability in order to determine the incidence and the severity of dysphagia. Methods A total of 189 institutionalized adult patients with mental disability were analyzed using a 3.2 mm flexible fiberscope (Machida, Japan 1995). The following food consistencies were tested: pasty, thickened liquid and liquid. Results Among the total of 189 patients, 101 (53.4%) were female aged between 14 and 55 years old. Most of them 120 (63.5%) had profound mental deficiency, 58 (30.7%) had severe mental deficiency, 9 (4.8%) had moderate mental deficiency, and 2 (1.1%) had mild mental deficiency. Gender and the degree of mental deficiency did not influence significantly the degree of dysphagia. Age, degree of disability and interaction between age groups and degrees of disability influenced significantly the degree of dysphagia. Younger patients are more likely to present more severe dysphagia. Stabilization occurs between 31 and 40 years of age, and above this age, a greater chance of less severe dysphagia, because the increase in the degree of mental deficiency decreases the probability of more severe dysphagia. Conclusion The population that mostly presented severe dysphagia was characterized by being mostly female, with profound mental deficiency, with an average age of 36.7 years. There was no relationship between gender and the degree of mental disability concerning the degree of dysphagia. (AU)


Subject(s)
Adolescent , Adult , Middle Aged , Deglutition Disorders/complications , Deglutition Disorders/diagnostic imaging , Endoscopy/methods , Intellectual Disability/complications , Deglutition Disorders/epidemiology , Logistic Models , Incidence , Cross-Sectional Studies , Endoscopes , Patient Acuity
5.
Audiol., Commun. res ; 24: e2236, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1100894

ABSTRACT

RESUMO Objetivos trata-se de revisão sistemática da literatura científica sobre a associação entre o acidente vascular cerebral, desidratação e disfagia orofaríngea. Estratégia de pesquisa o levantamento bibliográfico foi realizado nas bases de dados científicos: MEDLINE, LILACS, SciELO, Web of Science e Cochrane. Critérios de seleção foram incluídos os estudos que preencheram os seguintes critérios de inclusão: ser artigo original, com resumo disponível; ter sido publicado entre os anos de 2001 e 2018 e nos idiomas português, inglês ou espanhol; abordar o tema desidratação em indivíduos após acidente vascular cerebral. A triagem e análise dos estudos foram realizadas por dois avaliadores independentes. Resultados dentre os 484 artigos localizados para a triagem, 43 foram selecionados para leitura completa e 18 foram incluídos na análise final. Foram descritos diferentes métodos de avaliação do estado de hidratação nos indivíduos após acidente vascular cerebral, tais como: análise da relação BUN /creatinina, osmolaridade plasmática, relação ureia/creatinina, gravidade específica da urina, coloração da urina, ingestão hídrica, balanço hídrico, bioimpedância elétrica, avaliação clínica, análise de eletrólitos isolados. A prevalência de desidratação em pacientes após acidente vascular cerebral, durante a internação, variou de 11% a 66% e está associada à gravidade e piora na evolução clínica. Conclusão foi possível compreender a complexidade do processo de mensuração do estado de hidratação em indivíduos após acidente vascular cerebral e sua associação com a disfagia. Estudos enfocando essa temática são de extrema relevância, visto a sua influência sobre a taxa de mortalidade e morbidade nesta população.


ABSTRACT Purpose this is a systematic review of scientific literature associated with stroke, dehydration and oropharyngeal dysphagia (OD). Research Strategy bibliographic survey was conducted in scientific databases: MEDLINE, LILACS, SciELO, Web of Science and Cochrane. Selection criteria studies that met the following inclusion criteria were included: being original article with summary available; have been published in the last seventeen years (2001-2018) and in Portuguese, English or Spanish languages; and addressing dehydration in individuals after stroke Screening and analysis of the studies were performed by two independent evaluators. Results among the 484 articles found for screening, 43 were selected for full reading and 18 articles were included in the final analysis. Different methods of assessing hydration status have been described in individuals post-stroke, such as ratio analysis blood urea nitrogen (BUN)/creatinine, plasma osmolality, urea / creatinine, urine specific gravity, urine color, water intake, water balance, bioelectrical impedance analysis (BIA), clinical evaluation and analysis of electrolytes. The prevalence of dehydration in post-stroke during hospitalization varied from 11% to 66% and is associated with severity and deterioration in the clinical evolution. Conclusion It was possible to understand the complexity of the measurement of hydration status in individuals after stroke and its association with dysphagia. Studies focusing on the association between dehydration and stroke are very important, due to its influence on mortality and morbidity in this population.


Subject(s)
Humans , Deglutition Disorders/complications , Stroke/complications , Dehydration/complications , Deglutition Disorders/epidemiology , Prevalence , Dehydration/epidemiology , Organism Hydration Status
6.
Rev. pesqui. cuid. fundam. (Online) ; 10(3, n. esp): 217-220, jun. 2018.
Article in Portuguese | LILACS, BDENF | ID: biblio-905879

ABSTRACT

Os estudos com base nas situações-problema de clientes com disfagia orofaríngea necessitam ser ampliados, por se acreditar que ainda existem dificuldades dos enfermeiros em identificar os distúrbios relacionados às alterações de deglutição. Assim, a integração dos conhecimentos da fonoaudiologia e da enfermagem pode resultar no desenvolvimento de diretrizes, protocolos de apoio e material de orientação aos profissionais de enfermagem e, portanto, prover medidas básicas de qualidade a estes clientes


Subject(s)
Humans , Male , Female , Deglutition Disorders/complications , Deglutition Disorders/nursing , Inpatients , Internship, Nonmedical , Nursing Care , Speech, Language and Hearing Sciences
7.
Clinics ; 73: e182, 2018. tab
Article in English | LILACS | ID: biblio-952799

ABSTRACT

OBJECTIVES: To compare the results respectively obtained from the utilization of 60% barium sulfate suspension and Iohexol as contrast agents for videofluoroscopic swallowing studies and the relationship between the clinical application of the two kinds of contrast agents and the incidence of pneumonia. METHODS: Sixty cases of stroke patients with dysphagia were selected in rehabilitation department of our hospital, and the gender, age, position of the disease, and stroke nature between groups had no significant difference. Among which, 30 patients who were administered 350 mgI/ml Iohexol, and the other 30 patients with 60% barium sulfate suspension as contrast agent. We performed videofluoroscopic swallowing studies with barium 60% versus Iohexol within 1 week after admission and 2 weeks after admission. RESULTS: After 2 weeks in hospital, the aspiration pneumonia incidence of two groups was statistically significant (p<0.05), the pneumonia incidence of Iohexol group was lower than barium sulfate group which might have a impossble relevance with barium aspiration. CONCLUSIONS: During the videofluoroscopic swallowing study of dysphagia after stroke, barium sulfate can enhance the pneumonia incidence, and Iohexol can be widely applied in videofluoroscopic swallowing study.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Pneumonia, Aspiration/chemically induced , Barium Sulfate/adverse effects , Fluoroscopy/methods , Deglutition Disorders/diagnostic imaging , Contrast Media/adverse effects , Pneumonia, Aspiration/diagnosis , Barium Sulfate/administration & dosage , Video Recording/methods , Iohexol/administration & dosage , Iohexol/adverse effects , Deglutition Disorders/complications , Contrast Media/administration & dosage , Deglutition/drug effects , Stroke Rehabilitation/methods
8.
Clin. biomed. res ; 38(3): 265-272, 2018.
Article in English | LILACS | ID: biblio-1046875

ABSTRACT

Introduction: Part of the prognosis of hospitalized patient depends on nutritional status and the safety and efficacy of the feeding administration route. Therefore, the aim of this study was to identify data on the indication of nasoenteric tube (NET) prescription to analyze the profile of these patients. Methods: A retrospective cross-sectional study was carried out with data collection in medical records of patients over 18 years of age, of both sexes, treated at the Emergency Adult Service (EAS), using NET. Results: there was a predominance of females (51.9%); neurological disease was the most prevalent underlying disease, and 57.8% had more than one diagnosed disease. Malnutrition, bronchopneumonia, and dysphagia were present in 23.6%, 27% and 40% of the cases, respectively. There was a request for speech-language evaluation in only 8.7% of the patients. And 80.7% did not use NET prior to emergency care. Regarding the indications for the use of NET by group of underlying disease, low food intake was the most prevalent clinical reason described in the medical records, followed by dysphagia, with a higher prevalence of patients taking NET for nutritional reasons. There was no justification for prescription in 15.2% of the sample. There was an association between the variables bronchopneumonia and dysphagia (p = 0.01). Conclusion: It was verified that in the studied population there are risk factors for dysphagia. The analysis of the population profile in the present study contributed to increased knowledge and information about this population regarding the criteria for indication of the use of the alternative route. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Deglutition Disorders/complications , Enteral Nutrition/adverse effects , Deglutition Disorders/therapy , Enteral Nutrition/methods , Malnutrition/rehabilitation , Emergency Service, Hospital
11.
J. bras. pneumol ; 43(4): 313-318, July-Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-893846

ABSTRACT

ABSTRACT The objective of this systematic review was to characterize chest CT findings in patients with dysphagia and pulmonary aspiration, identifying the characteristics and the methods used. The studies were selected from among those indexed in the Brazilian Virtual Library of Health, LILACS, Indice Bibliográfico Español de Ciencias de la Salud, Medline, Cochrane Library, SciELO, and PubMed databases. The search was carried out between June and July of 2016. Five articles were included and reviewed, all of them carried out in the last five years, published in English, and coming from different countries. The sample size in the selected studies ranged from 43 to 56 patients, with a predominance of adult and elderly subjects. The tomographic findings in patients with dysphagia-related aspiration were varied, including bronchiectasis, bronchial wall thickening, pulmonary nodules, consolidations, pleural effusion, ground-glass attenuation, atelectasis, septal thickening, fibrosis, and air trapping. Evidence suggests that chest CT findings in patients with aspiration are diverse. In this review, it was not possible to establish a consensus that could characterize a pattern of pulmonary aspiration in patients with dysphagia, further studies of the topic being needed.


RESUMO O objetivo deste estudo foi realizar uma revisão sistemática dos achados de TC de tórax que caracterizem aspiração pulmonar em pacientes com disfagia, identificando as características e os métodos utilizados. Para a seleção dos estudos, foram utilizadas as bases de dados da Biblioteca Virtual em Saúde, LILACS, Indice Bibliográfico Español de Ciencias de la Salud, Medline, Biblioteca Cochrane, SciELO e PubMed. A busca foi realizada no período entre junho e julho de 2016. Foram incluídos e revisados cinco artigos, todos realizados nos últimos cinco anos, publicados em língua inglesa e oriundos de diferentes países. O tamanho da amostra nos estudos selecionados variou de 43 a 56 pacientes, com predominância de sujeitos adultos e idosos. Os achados tomográficos em pacientes com aspiração relacionada à disfagia foram variados, abrangendo bronquiectasias, espessamento da parede brônquica, nódulos pulmonares, consolidações, derrame pleural, atenuação em vidro fosco, atelectasias, espessamento septal, fibrose, aprisionamento aéreo, entre outros. As evidências sugerem que os achados de TC de tórax em pacientes que apresentam aspiração são diversificados. Nesta revisão, não foi possível estabelecer um consenso que pudesse caracterizar um padrão de aspiração pulmonar nos pacientes com disfagia, sendo importantes investigações futuras sobre o assunto.


Subject(s)
Humans , Pneumonia, Aspiration/etiology , Pneumonia, Aspiration/diagnostic imaging , Deglutition Disorders/complications , Deglutition Disorders/diagnostic imaging , Tomography, X-Ray Computed
12.
CoDAS ; 29(6): e20170004, 2017. tab
Article in Portuguese | LILACS | ID: biblio-890803

ABSTRACT

RESUMO Objetivo Verificar se a modificação da voz após a deglutição relaciona-se com os dados do exame de videofluoroscopia. Método 27 indivíduos com disfagia orofaríngea realizaram a gravação da vogal sustentada /a/ antes e após a deglutição durante exame de videofluoroscopia. Utilizou-se a escala GRBAS e acrescentou-se o aspecto voz molhada para avaliação dos dados. Em relação ao exame, verificou-se estase de alimento em valéculas e recessos piriformes, penetração laríngea, aspiração traqueal e grau de disfagia. Resultados Houve diminuição do grau de alteração e astenia e aumento da tensão fonatória após a deglutição, sem diferença para o parâmetro voz molhada. Obteve-se sensibilidade e especificidade de ±50% para estase em recessos piriformes e valéculas; porém, sensibilidade de 80% para detecção de penetração e de 66-75% para aspiração e modificação da tensão fonatória, com 77-91% de valores preditivos negativos para os três parâmetros de avaliação, sem correlação com o grau de disfagia. Conclusão A modificação dos parâmetros da escala GRBAS após a deglutição apresentou boa compatibilidade com achados da videofluoroscopia.


ABSTRACT Purpose Verify whether voice modification after swallowing is associated with videofluoroscopic examination data. Methods 27 patients with oropharyngeal dysphagia underwent recording of sustained phonation of vowel /a/ before and after swallowing during videofluoroscopy. The GRBAS scale and the wet voice parameter were used to evaluate the data. Videofluoroscopy results showed stasis of food in the valleculae and piriform recesses, laryngeal penetration, tracheal aspiration, and degree of dysphagia. Results Decreased dysphonia grade and asthenia and increased strain were observed after swallowing, with no difference for the wet voice parameter. Sensitivity and specificity of ± 50% were observed for food stasis in the valleculae and piriform recesses. Sensitivity values of 80 and 66-75% were observed for detection of laryngeal penetration and tracheal aspiration and modification of vocal strain, respectively. Negative predictive values of 77-91% were found for the three assessment parameters with no correlation with the degree of oropharyngeal dysphagia. Conclusion Modification of the GRBAS scale parameters after swallowing showed good compatibility with videofluoroscopy findings.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Voice Quality , Deglutition Disorders/complications , Deglutition Disorders/diagnostic imaging , Voice Disorders/etiology , Voice Disorders/diagnostic imaging , Fluoroscopy/methods , Deglutition Disorders , Cross-Sectional Studies , Predictive Value of Tests , Prospective Studies , Sensitivity and Specificity , Respiratory Aspiration , Middle Aged
13.
Rehabil. integral (Impr.) ; 11(1): 25-32, jun. 2016. tab
Article in Spanish | LILACS | ID: biblio-869325

ABSTRACT

Introduction: Cerebral Palsy (CP) is frequently accompanied by other cooccurring clinical conditions (CCC). Feeding and swallowing disorders (FSD) are a common problem among CP population and tend to be more complex when associated to certain CCC. Objective: To quantify the frequency of CCC in a group of children with CP and FSD, of both genders, GMFCS I to V, between the age of 3 to 6 years. Patients and Methods: 49 patients diagnosed with CP and FSD underwent 5 assessments: 1) physiatric evaluation; 2) Gross Motor Functional Classification System (GMFCS); 3) Eating and Drinking Ability Classification System (EDACS); 4) videofluoroscopic swallowing study; and 5) sensory processing test.Results: All 49 patients had at least one of the CCC usually present in CP, with an average of 3,8 (from 1 to 6). All GFMCS and EDACS levels were affected, including mild ones. Some of the CCC showed high frequencies: intellectual disability (ID) (83,7 percent), sensory processing disorder (SPD) (75,5 percent), sialorrhea (71,4 percent), malnutrition (67,4 percent), altered alertness (67,4 percent) and constipation (61,2 percent).There was a high frequency of association between CCC. In more than 50 percent of the cases, the association of ID with most of the other conditions was the commonest.Conclusions: Children diagnosed with CP and FSD present with multiple CCC able to worsen their prognosis. All GMFCS and EDACS levels are affected. ID is the most frequent CCC, being also the most associated with the others.


Introducción: La Parálisis Cerebral (PC) cursa junto a numerosas condiciones clínicas acompañantes (CCA), destacando los trastornos de la alimentación y deglución (TAD). En PC numerosas CCA pueden interactuar con los TAD y complicarlos. Objetivo: Cuantificar la frecuencia de determinadas CCA en niños con PC, GMFCS I a V, de 3 a 6 años, portadores de TAD. Pacientes y Métodos: 49 pacientes con PC y TAD fueron sometidos a 5 evaluaciones: 1) valoración fisiátrica; 2) Gross Motor Functional Classification System (GMFCS); 3) Eating and Drinking Ability Classification System (EDACS); 4) videofluoroscopía (VFC); y 5) pauta de integración sensorial. Resultados: Todos los pacientes con PC y TAD presentaron alguna de las CCA consideradas, con un promedio de 3,8 por niño (rango 1-6), afectando a todos los niveles GMFCS y EDACS, incluidos los leves. Algunas tuvieron elevada frecuencia: déficit cognitivo (DC) (83,7 por ciento), trastorno de la integración sensorial (TIS) (75,5 por ciento), sialorrea (71,4 por ciento), desnutrición (67,4 por ciento), alerta alterada (67,4 por ciento) y constipación (61,2 por ciento). Hubo una alta frecuencia de asociación de CCA, siendo más común la asociación de DC con varias de las otras condiciones, en más del 50 por ciento de los casos. Conclusiones: Los niños con PC y TAD cursan con CCA múltiples que complican su cuadro clínico. Todos los niveles GMFCS y EDACS se ven afectados. El DC es la condición más frecuente y muestra más asociación con las otras.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Cerebral Palsy/complications , Cerebral Palsy/physiopathology , Feeding and Eating Disorders/complications , Feeding and Eating Disorders/physiopathology , Deglutition Disorders/complications , Deglutition Disorders/physiopathology , Disability Evaluation , Deglutition/physiology , Fluoroscopy/methods , Eating/physiology , Severity of Illness Index
14.
Rev. bras. anestesiol ; 66(3): 318-320, May.-June 2016.
Article in English | LILACS | ID: lil-782885

ABSTRACT

ABSTRACT Aberrant right subclavian artery-esophageal fistula is a rare but potentially fatal complication. It may be associated with procedures, such as tracheostomy and tracheal or esophageal intubation, and yields massive upper gastrointestinal bleeding difficult to identify and to control. A high index of suspicion is essential for early diagnosis and better prognosis. We report a rare case of a patient who survived after emergent surgical procedure for massive upper gastrointestinal bleeding secondary to aberrant right subclavian artery-esophageal fistula after prolonged intubation.


RESUMO A fístula de artéria subclávia direita anômala com o esôfago é uma complicação rara, mas potencialmente fatal. Pode estar associada a procedimentos como traqueostomia e intubação traqueal ou esofágica e originar hemorragia digestiva alta maciça, de difícil identificação e controle. Um elevado índice de suspeição é essencial para o diagnóstico precoce e a melhoria do prognóstico. Relatamos caso raro de doente que sobreviveu após intervenção cirúrgica emergente por hemorragia digestiva alta maciça secundária a fístula de artéria subclávia direita anômala com esôfago, após intubação gástrica prolongada.


Subject(s)
Humans , Male , Adult , Young Adult , Subclavian Artery/abnormalities , Deglutition Disorders/complications , Esophageal Fistula/complications , Cardiovascular Abnormalities/complications , Gastrointestinal Hemorrhage/complications , Intubation, Intratracheal/adverse effects , Aneurysm/complications , Time , Esophageal Fistula/surgery , Gastrointestinal Hemorrhage/surgery
15.
J. bras. pneumol ; 42(2): 114-120, Mar.-Apr. 2016. tab
Article in English | LILACS | ID: lil-780890

ABSTRACT

Objective: To determine whether the severity of non-neurological critically ill patients correlates with clinical predictors of bronchial aspiration. Methods: We evaluated adults undergoing prolonged orotracheal intubation (> 48 h) and bedside swallowing assessment within the first 48 h after extubation. We collected data regarding the risk of bronchial aspiration performed by a speech-language pathologist, whereas data regarding the functional level of swallowing were collected with the American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) scale and those regarding health status were collected with the Sequential Organ Failure Assessment (SOFA). Results: The study sample comprised 150 patients. For statistical analyses, the patients were grouped by ASHA NOMS score: ASHA1 (levels 1 and 2), ASHA2 (levels 3 to 5); and ASHA3 (levels 6 and 7). In comparison with the other patients, those in the ASHA3 group were significantly younger, remained intubated for fewer days, and less severe overall clinical health status (SOFA score). The clinical predictors of bronchial aspiration that best characterized the groups were abnormal cervical auscultation findings and cough after swallowing. None of the patients in the ASHA 3 group presented with either of those signs. Conclusions: Critically ill patients 55 years of age or older who undergo prolonged orotracheal intubation (≥ 6 days), have a SOFA score ≥ 5, have a Glasgow Coma Scale score ≤ 14, and present with abnormal cervical auscultation findings or cough after swallowing should be prioritized for a full speech pathology assessment.


Objetivo: Correlacionar a gravidade de pacientes críticos não neurológicos com preditores clínicos do risco de broncoaspiração. Métodos: Participaram do estudo adultos com histórico de intubação orotraqueal prolongada (> 48 h) e submetidos à avaliação da deglutição à beira do leito nas primeiras 48 h após a extubação. Dados relacionados a avaliação fonoaudiológica clínica do risco de aspiração broncopulmonar, nível funcional da deglutição por meio da escala American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) e status de saúde pelo Sequential Organ Failure Assessment (SOFA) foram coletados. Resultados: A amostra do estudo foi composta por 150 pacientes. Para fins da análise estatística, os pacientes foram agrupados com base nos escores ASHA NOMS: ASHA1 (níveis 1-2), ASHA2 (níveis 3-5) e ASHA3 (níveis 6-7). Os indivíduos no grupo ASHA3 eram significativamente mais jovens, permaneceram intubados por menos tempo e apresentaram menor gravidade de quadro clínico geral (escore SOFA) do que os indivíduos nos demais grupos. Os preditores clínicos de broncoaspiração que melhor caracterizaram os grupos foram achados de ausculta cervical alterada e presença de tosse após a deglutição. O grupo ASHA3 não apresentou esses sinais. Conclusões: Pacientes críticos com idade ≥ 55 anos, período de intubação ≥ 6 dias, gravidade de quadro clínico geral (escore SOFA ≥ 5), escore na Escala de Coma de Glasgow ≤ 14, ausculta cervical alterada e tosse após a deglutição devem ser priorizados para a avaliação fonoaudiológica completa.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Bronchial Diseases/etiology , Critical Illness , Deglutition Disorders/complications , Respiratory Aspiration/etiology , Critical Care , Cross-Sectional Studies , Deglutition Disorders/physiopathology , Intubation, Intratracheal/adverse effects , Prospective Studies , Reference Values , Risk Assessment/methods , Risk Factors , Severity of Illness Index , Time Factors
16.
Neumol. pediátr. (En línea) ; 10(2): 82-85, abr. 2015. ilus
Article in Spanish | LILACS | ID: lil-773906

ABSTRACT

Aspiration is defined as the entrance of foreign material through the respiratory tract to the lungs. This syndrome is relatively frequent in children and often under diagnosed. It can occur at any age and may cause acute or chronic lung disease. Clinical symptoms depend on the amount and frequency of events, individual response, the kind of aspirated material and the underlying cause. There are different diseases that can cause aspiration. Swallowing disorders, often associated with neuromuscular diseases are a common causal factor. Imaging studies can play an important role in the diagnostic approach and may identify aspiration cause. Among these studies, the most important is videofluoroscopy which allows a dynamic and real-time study of swallowing. Chest radiography and computed tomography can support the diagnosis.


La broncoaspiración corresponde a la entrada de material extraño a la vía aérea y pulmones. Es un síndrome relativamente frecuente y muchas veces subdiagnosticado. Puede presentarse a cualquier edad y ser factor causal de enfermedad pulmonar aguda o crónica. El cuadro clínico dependerá del volumen y frecuencia de los eventos, la respuesta individual, el material aspirado y el factor causal. Las causas de broncoaspiración son variadas. Las alteraciones en los mecanismos de la deglución, muchas veces asociadas a enfermedades neuromusculares son un factor causal frecuente. Los estudios de imágenes juegan un rol importante en la aproximación diagnóstica y pueden orientar a la etiología. Dentro de estos el de mayor relevancia es la videofluoroscopía, que permite un estudio dinámico y en tiempo real de la deglución. La cintigrafía también puede ser de utilidad diagnóstica, al igual que la radiografía de tórax y la tomografía computada.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child , Respiratory Aspiration/etiology , Deglutition Disorders/complications , Deglutition Disorders/diagnosis , Fluoroscopy , Magnetic Resonance Imaging , Pneumonia, Aspiration/etiology , Radionuclide Imaging , Tomography, X-Ray Computed
17.
Int. arch. otorhinolaryngol. (Impr.) ; 19(1): 61-66, Jan-Mar/2015. tab
Article in English | LILACS | ID: lil-741530

ABSTRACT

Introduction Voice modification after swallowing may indicate changes in the transit of the bolus. Objective The aim of this study is to verify the use of perceptual voice analysis to detect oropharyngeal dysphagia. Study Design Case series. Methods Twenty-seven patients with dysphagia as diagnosed by videofluoroscopy and 25 without were evaluated. The sustained vowel /a/ was recorded before this exam and after swallowing different consistencies (pasty, liquid and solid). For the voice evaluation, the GRBAS scale (grade, roughness, breathiness, asthenia and strain) and the parameter "wet voice" were used. Three judges blinded to study group and time of emission performed voice analysis. Results Individuals with dysphagia showed significant decrease in grade of voice and asthenia and increase in strain after swallowing pasty substances, differing from individuals without dysphagia who showed no modification of the parameters after swallowing. The wet voice parameter showed no difference after swallowing in both study groups. Conclusion The decrease in grade and asthenia and increased strain are indicative of a swallowing disorder, indicating increased vocal strain to clean the vocal tract of food. The modification of vocal production after swallowing proved to be a trusted resource for detection of swallowing disorders. .


Subject(s)
Humans , Male , Female , Deglutition Disorders/complications , Voice , Voice Quality , Diagnostic Imaging
18.
São Paulo; s.n; 2015. 83 p. ilus, tab.
Thesis in Portuguese | LILACS, Inca | ID: biblio-870243

ABSTRACT

Introdução: Identificar fatores que contribuem para a aspiração e o desenvolvimento de complicações pulmonares nos pacientes disfágicos após tratamento do câncer de cabeça e pescoço (CCP) poderá contribuir para uma intervenção fonoaudiológica mais efetiva, melhorando a qualidade de vida destes indivíduos. Objetivo: identificar fatores de risco relacionados à penetração/aspiração, pneumonia e à função pulmonar pós-tratamento e avaliar a qualidade de vida (QV) de pacientes tratados do CCP. Método: Trata-se de um estudo prospectivo, realizado no Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, com pacientes com diagnóstico de CCP, sem tratamento prévio, no período de fevereiro de 2012 a maio de 2014, independentes de sexo e idade. Foram coletadas informações da evolução clínica pulmonar e possíveis fatores de risco para a penetração/aspiração: dados demográficos e clínicos, consumo de tabaco e álcool, uso de drogas que mudam o pH gástrico, HAD – Escala de ansiedade e depressão hospitalar, apoio da família, adesão do paciente, índice de massa corporal (IMC), higiene oral, nível de atividade física (IPAQ) e nível de consciência (Escala de Glasgow). Os pacientes foram submetidos à avaliação videofluoroscópica da deglutição, prova de função pulmonar e aplicação dos questionários de QV (UW-QOL – QV da Universidade de Washington; SGRQ – Questionário do Hospital Saint George na doença respiratória; MDADI – Questionário de disfagia M.D. Anderson)...


Introduction: To identify factors that contribute to aspiration and the development of pulmonary complications in dysphagia patients following head and neck cancer (HNC) treatment, which may contribute to a more effective SLP therapy intervention, thus improving the quality of life of these individuals. Objective: To identify risk factors related to penetration/aspiration and pulmonary clinical outcome post-treatment, and also to assess the quality of life (QOL) of patients treated for HNC. Methods: This was a prospective study conducted at the Head and Neck and Otorhinolaryngology Department with patients diagnosed with HNC, without prior treatment, from February 2012 to May 2014, independent of sex and age. The following information relating to pulmonary clinical outcome and possible risk factors for penetration/aspiration were collected: demographic and clinical data, tobacco and alcohol consumption, the usage of drugs that change gastric pH, HAD - Hospital Anxiety and Depression scale, family support, patient adherence, body mass index (BMI), oral hygiene, level of physical activity (IPAQ) and level of consciousness (Glasgow Scale). Patients were submitted to videofluoroscopic swallowing assessment, pulmonary function test and application of QOL questionnaires (UW-QOL – QV, University of Washington; SGRQ, Saint George Hospital Questionnaire; MDADI, MD Anderson Dysphagia Inventory). Patients were assessed in four stages: pretreatment, 1 to 3 months post-treatment, 6 to 9 months post-treatment and 12 to 18 months post-treatment. Results: The study consisted of 38 patients (28 males; 73.7%), with a mean age of 60 years (27-85 years). History of aspiration pneumonia was observed in 4 patients (10.5%). About half of the patients (47.4%) were dysphagic in pretreatment...


Subject(s)
Spirometry , Risk Factors , Pneumonia, Aspiration/complications , Quality of Life , Deglutition Disorders/complications , Head and Neck Neoplasms
19.
Article in English | AIM | ID: biblio-1264561

ABSTRACT

Background: Stroke patients commonly experience dysphagia post stroke. Complications of dysphagia include aspiration leading to chest infection and pneumonia; malnutrition; dehydration; and a subsequent increased risk of death. Its early diagnosis and management is an important prerequisite for recovery from stroke during the rehabilitation phase. As nurses are the first health personnel that interact with a patient post stroke; it is important that they are knowledgeable and skilled in the screening of these patients for dysphagia. Objective: The aim of the study was to determine the knowledge and factors associated with knowledge of nurses regarding dysphagia in stroke patients. Methods: The study used a quantitative survey to determine the knowledge of the nurses employed at an intermediate hospital in Namibia. A convenient sample of 182 participants completed a self-administered questionnaire with closed-ended questions; which was developed by the researcher. The data was analysed using descriptive and inferential statistics. Results: The findings of the study confirmed that nurses have a moderate knowledge of the signs; symptoms; and complications of dysphagia; but poor knowledge about its management.Training and experience in the care of dysphagia patients was a stronger predictor of knowledge than the initial qualification or years of experience as a nurse. Conclusion: Post basic training in dysphagia would better equip nurses to manage stroke patients in the acute phase


Subject(s)
Deglutition Disorders/complications , Deglutition Disorders/diagnosis , Knowledge , Nurses , Stroke
20.
São Paulo; s.n; 2014. [167] p. tab.
Thesis in Portuguese | LILACS | ID: lil-730781

ABSTRACT

Introdução: A deglutição e suas características principais ainda são desconhecidas na demência frontotemporal. Objetivos: Caracterizar a deglutição e o comportamento alimentar de pacientes com diagnóstico de demência frontotemporal que apresentam a variante comportamental (DFTvc) e a afasia progressiva primária (APP). Caracterizar os pacientes com DFT e seus cuidadores. Descrever aspectos cognitivos e comportamentais, funcionalidade global, comunicação funcional, e a funcionalidade da deglutição na DFT. Descrever os problemas de deglutição e do comportamento alimentar na DFTvc e APP. Correlacionar os aspectos cognitivos e comportamentais, funcionalidade global e a comunicação com as características da deglutição. Identificar fatores preditivos da piora da funcionalidade da deglutição e do comportamento alimentar na DFT. Avaliar o comportamento dos instrumentos empregados. Desenvolver a versão reduzida do Questionário de Habilidades de Alimentação e Deglutição nas Demências e do Questionário de Comunicação Funcional na Afasia. Método: Este estudo incluiu 46 indivíduos com DFT nas fases leve, moderada e grave, e seus 46 cuidadores. O Mini exame do estado mental (MEEM) e o Mini exame do estado mental grave (MEEM-g) foram usados para avaliar os aspectos cognitivos. A Escala de estadiamento da demência (CDR-DLFT) foi usada para confirmar a fase da doença. O Inventário Neuropsiquiátrico (INP) foi aplicado para investigar os problemas comportamentais. A Bateria de Avaliação Frontal (BAF) investigou as funções executivas. O Índice das Atividades de Vida Diária (Katz), Questionário para Avaliação da Comunicação Funcional na Afasia (QACFA) e a Escala de funcionalidade da deglutição (EFD) avaliaram as habilidades funcionais. O Questionário de Habilidades de Alimentação e Deglutição nas Demências (QHADD) avaliou as dificuldades na deglutição e alimentação. Resultados: Os grupos DFTvc e APP não mostraram diferença estatisticamente significante no MEEM,...


Introduction: Swallowing and its main characteristics are still unknown in frontotemporal dementia. Objectives: To characterize swallowing and feeding behavior of patients with frontotemporal dementia who have behavioral variant (bvFTD) and primary progressive aphasia (PPA). To characterize patients with FTD and their caregivers.To describe cognitive and behavioral aspects, functionalstatus, functional communication, and swallowing function in FTD.To describe swallowing problems and feeding behavior in bvFTD and PPA. To correlate cognitive and behavioral aspects, functional status, and communication with swallowing. To identify predictive factors associated with worsening of functionality of swallowing and feeding behavior in FTD. To evaluate the instruments used. To develop reduced versions of: "Assessment of Feeding and Swallowing Difficulties in Dementia" and "Functional Outcome Questionnaire Aphasia". Method: This study included 46 individuals with FTD in mild, moderate and severe phases, and their 46 caregivers. The Mini mental state examination (MMSE) and the Severe Mini mental state examination (SMMSE) were used to assess the cognitive aspects. The FTLD-modified Clinical Dementia Rating scale (FTLD-CDR) was used to confirm the stage of the disease. The Neuropsychiatric Inventory (NPI) was applied to investigate the behavioral problems. The Frontal Assessment Battery (FAB) investigated executive functions. The Index of Activities of Daily Living (Katz), Functional Outcome Questionnaire- Aphasia and Swallowing rating scale (SRE) evaluated the functional abilities. The Assessment of Feeding and Swallowing Difficulties in Dementia (QHADD) evaluated the difficulties in swallowing and feeding. Results: bvFTD and PPA groups showed no statistically significant difference in MMSE, CDR and FAB. Caregivers of patients with bvFTD had more hours of care per day compared to patients with PPA (p < 0.05). The groups differed in SRE (p < 0.05). The behavioral...


Subject(s)
Humans , Aphasia, Primary Progressive , Behavior , Cognition Disorders , Communication , Feeding Behavior , Frontotemporal Dementia , Frontotemporal Lobar Degeneration , International Classification of Functioning, Disability and Health , Deglutition Disorders/complications , Deglutition Disorders/diagnosis , Caregivers , Surveys and Questionnaires
SELECTION OF CITATIONS
SEARCH DETAIL