The effectiveness of the head-turn-plus-chin-down maneuver for eliminating vallecular residue

ABSTRACT Purpose When swallowing efficiency is impaired, residue accumulates in the pharynx. Cued or spontaneous swallows in the head neutral position do not always successfully clear residue. We investigated the impact of a novel maneuver on residue clearance by combining a head turn with the chin down posture. Methods Data were collected from 26 participants who demonstrated persistent vallecular residue after an initial head neutral clearance swallow in videofluoroscopy. Participants were cued to perform a head-turn-plus-chin-down swallow, with the direction of head turn randomized. Pixel-based measures of residue in the vallecular space before and after the maneuver were made on still frame lateral images using ImageJ software. Measures of % full and the Normalized Residue Ratio Scale (NRRS) were extracted. Univariate analyses of variance were used to detect significant reductions in residue. Results On average, pre-maneuver measures showed residue filling 56-73% of the valleculae, depending on stimulus consistency (NRRS scores: 0.2-0.4). More than 80% of pre-swallow measures displayed NRRS ratios > 0.06, a threshold previously linked to increased risk of post-swallow aspiration. Conclusion The head-turn-plus-chin-down maneuver achieved significant reductions in residue for thin and nectar-thick fluids, suggesting that this maneuver can be effective in reducing persistent vallecular residue with these consistencies.

Diarrhea due to parasites particularly cryptosporidium parvum in great Cairo, Egypt

A total of 110 stool samples from out and in-patients from different areas in Great Cairo suffering from diarrhea were examined for parasitic causes. Stool samples were subjected to the direct wet smear method and Sheathers sugar flotation and stained with Giemsa and/or modified Ziehl-Neelsen. Also, stool samples were cultured on agar plates for strongyloidiasis. The overall parasitic infection rate was 60.9% and non parasitic cause was 39.1%. The parasitic infection rate in a descending order was 31.1% for Cryptosporidium parvum, 19.8% for Giardia lamblia, 9.9% for Entamaeba histolytica and lastly 1.8% for Strongyloides stercoralis. The main clinical presentation of diarrheic patients in a descending order was vomiting [31.3%], dehydration [29.86%], abdominal pain [29.86%], flatulence [26.86%], anorexia [23.89%], tenesmus [17.9%] and lastly fever [4.47%]. The risk factors were living in rural areas, education level, contact with farm animals and/or pet animals. However, most of these risk factors although showed high percent, yet they occurred in patients with other causes of diarrheas. Artificial breast feeding was not evaluated as only 3 infants had C. parvum compared to non parasitic cause in 1 on the breast feeding