The underestimated burden of aspiration event and pneumonia within hospitals: what happens after dysphagia.

Study design: Prospective observational study. Background: Despite dysphagia large prevalence and the growing ageing phenomenon occurring in European countries, aspiration events among inpatients are often underestimated, given their frequent spontaneous resolution or silent contribution to aspiration syndromes. Our main objective was to evaluate the incidence of aspiration events among medical inpatients and to identify risk factors influencing the outcome of the event. Methods: Data about aspiration events - day, hour, type and outcome of the event occurred - along with underlying patient clinical conditions at the admission were collected. Between May 2015 and September 2016, data about aspiration event occurred among medical inpatients were collected in three large Italian hospitals. Results: Patients affected by aspiration events were 135 on 102,619 cumulative days of hospitalization; they were mostly females (53%) with an average age of 82. The total incidence of aspiration events was of 1.4 every 1,000 days of hospitalization (C.I. 95%: 1.2-1.7) and the most frequent manifestation was cough (61.6%). The addition of drugs or an infection diagnosis during the 24 hours preceding the event acted as risk factors for those events that needed additional interventions during the hospitalization (OR 3.1 e OR 1.9 respectively), while the elimination of one or more prescribed drugs seemed to lead to aspiration events without impact on the hospitalization. Conclusions: Results showed a large incidence of aspiration events within medical wards, many of them influencing patient outcomes. Healthcare professionals' attention concerning aspiration events should be fostered during the first hours and days of hospitalization.

Cochlear, auditory brainstem responses in Type 1 diabetes: relationship with metabolic variables and diabetic complications.

AIMS: Few studies have analysed the presence of hearing abnormalities in diabetes. We assessed the presence of subclinical auditory alterations and their possible association with early vascular and neurological dysfunction in young adults with Type 1 diabetes of long duration. METHODS: Thirty-one patients with Type 1 diabetes (mean age 33 ± 2.3 years, disease duration 25.7 ± 4.2 years) and 10 healthy controls underwent pure tone audiometry (PTA), distortion product otoacoustic emission (DPOAE) and auditory brainstem response (ABR) analyses. Associations with metabolic variables and chronic complications were explored. RESULTS: Compared with healthy controls, patients with diabetes had significantly higher mean hearing thresholds, although still within the normoacusic range. DPOAE intensities at medium frequencies (2.8-4 kHz) were significantly lower in patients with diabetes. In ABR, in addition to waves I, III and V, we observed the appearance of a visible wave IV in patients with diabetes compared with controls (prevalence 61% vs. 10%, P < 0.05), and its appearance was related to a prolonged I-V interval (4.40 ± 0.62 ms vs. 4.19 ± 0.58 ms, P < 0.05). Diastolic blood pressure was higher in people with abnormal DPOAE (P < 0.05), whereas systolic blood pressure correlated with wave V and interpeak I-V interval latencies. A trend towards an association between evidence of wave IV and the presence of somatic neuropathy or abnormal cardiovascular autonomic tests was observed. CONCLUSIONS: Young adults with long-term Type 1 diabetes have subclinical abnormalities in qualitative auditory perception, despite normal hearing thresholds, which might reflect neuropathic and/or vascular alterations.