Timing and sequencing of oro-pharyngeal swallow events in persistent dysphagia post-stroke / Momento y secuencia de los eventos de deglución orofaríngea en la disfagia persistente post-ictus

Introduction and objectives: Evidence from videofluoroscopic analysis of healthy swallowing physiology shows that typical swallowing function is not entirely ‘sequential’ but are clusters of precisely coordinated movements. It is unknown if disruption of this fine orchestra of events could be associated with persistent dysphagia in individuals post-stroke. This investigation studied the time of onset and sequencing of specific oro-pharyngeal swallowing events as seen in the modified barium swallow study in a population with airway penetration of swallowed bolus post-stroke. Materials and methods: A retrospective frame to frame analysis of 29 time points in single cued 5ml liquid barium swallows obtained from 23 individuals who satisfied inclusion criteria was conducted independently by two investigators. Relative temporal measures with reference to upper esophageal sphincter activity were calculated. Results and conclusion: Statistical analysis revealed five temporal clusters of swallowing events while the onset of oral bolus transport, soft palate elevation, upper esophageal sphincter opening, hyoid descent, and complete laryngeal closing occurred independently. A timeline of event sequences was also developed that showed multiple deviations from the known sequences reported in healthy swallowing literature. There was a delay as well as deviance from known normality in the order of swallowing events considered in this study. The findings suggested a difference in the underlying programming for a swallow in post-stroke dysphagia, that may also contribute to the airway intrusion. The study provides preliminary evidence for the inclusion of temporal measures of swallowing physiology during an instrumental assessment of swallowing function in persons with dysphagia.(AU)

Introducción y objetivos: La evidencia del análisis videofluoroscópico de la fisiología de la deglución saludable muestra que la función de la deglución típica no es completamente «secuencial», sino que son grupos de movimientos coordinados con precisión. Se desconoce si la interrupción de esta fina armonía de eventos podría asociarse con una disfagia persistente en individuos después del accidente cerebrovascular. Esta investigación estudió el tiempo de inicio y la secuenciación de eventos específicos de deglución orofaríngea, como se observa en el estudio modificado de deglución de bario en una población con penetración de las vías respiratorias del bolo ingerido después del accidente cerebrovascular. Materiales y métodos: El análisis retrospectivo paso a paso de 29 momentos de la deglución de 5ml de bario líquido analizados en 23 individuos que cumplieron con los criterios de inclusión fue realizado de forma independiente por dos investigadores. Se calcularon medidas temporales relativas a la actividad del esfínter esofágico superior. Resultados y conclusiones: El análisis estadístico reveló cinco grupos temporales de eventos de deglución, mientras que el inicio del transporte de bolo oral, la elevación del paladar blando, la apertura del esfínter esofágico superior, el descenso de hioides y el cierre laríngeo completo se produjeron de forma independiente. También se desarrolló una línea de tiempo de secuencias de eventos que mostraba múltiples desviaciones de las secuencias conocidas reportadas en la literatura de deglución saludable. Hubo un retraso, así como una desviación de la normalidad en el orden de los eventos de deglución considerados en este estudio. Los hallazgos sugirieron una diferencia en la programación subyacente para una deglución en la disfagia tras el accidente cerebrovascular, que también puede contribuir a la intrusión de las vías respiratorias.(AU)

Immunogenicity of the ChAdOx1 nCoV-19 and the BBV152 Vaccines in Patients with Autoimmune Rheumatic Diseases

IntroductionThere is limited information on the effectiveness of COVID-19 vaccination in patients with autoimmune rheumatic diseases (AIRD). Methods136 consecutive patients with rheumatic diseases who never had a diagnosis of COVID-19 previously, and had completed vaccination with either the ChAdOx1 or BBV152 vaccines were recruited. Their IgG antibody titres to the Spike protein were estimated 1 month after the second dose. Results102 patients had AIRD while the 34 had non-AIRD. Lesser patients with AIRD (92/102) had positive antibodies titres than ones with non-AIRD(33/34) [p<0.001]. Amongst patients who received the ChAdOX1 vaccine, the AIRD group had lower antibody titres. Although the AIRD patients receiving BBV152 had similarly lower titres numerically, this did not attain statistical significance probably due to lesser numbers. Comparing the two vaccines, 114(95%) of those who received ChAdOx1 (n=120) and 11(68.7%) of those who received BBV152(n=16) had detectable antibodies [p=0.004]. Antibody titres also were higher in ChAdOx1 recipients when compared to BBV152. To validate the findings, we estimated antibody titres in 30 healthy people each who had received either vaccine. All 30 who had received ChAdOX1 and only 23/30 of those who had received BBV152 had positive antibodies (p=0.011). ConclusionIn this preliminary analysis, patients with AIRD had lower seroconversion rates as well as lower antibody titres as compared to patients with non-AIRD. Also,the humoral immunogenicity of the BBV152 vaccine appears to be less than that of the ChAdOX1 vaccine. Validation using larger numbers and testing of cellular immunity is urgently required.

Asymptomatic Hearing Impairment Frequently Occurs in Early-Onset Parkinson's Disease

OBJECTIVE: Recent reports of hearing impairment in Parkinson's disease (PD) have suggested that auditory dysfunction could be a non-motor manifestation of PD. These reports were based on observations of elderly patients for whom presbycusis may, to some extent, have contributed to hearing dysfunction. Therefore, we aimed to explore the auditory functions in younger patients with PD. METHODS: We conducted a case-control study in a relatively younger (< 55 years of age at study time) population of PD patients and healthy volunteers to test whether auditory dysfunction is a significant non-motor dysfunction in PD. Pure tone audiometry (PTA) and brainstem evoked response audiometry (BERA) were performed in all participants. RESULTS: None of the patients or controls reported hearing deficits. Fifty-one patients with PD and 50 healthy volunteers who were age- and gender-matched to the patients participated. PTA-detected hearing impairment was found in 64.7% of patients and 28% of controls (p < 0.001) for both low-mid and/or high frequencies. Hearing impairment was more frequent in the younger subgroups of patients than age-matched controls, while the frequency of hearing impairment was similar in older groups of subjects. BERA was not different between patients and controls. CONCLUSION: Asymptomatic auditory dysfunction is a common non-motor manifestation of early-onset PD and more frequent in younger patients, indicating that it may be independent of aging. The mechanism underlying this dysfunction appears to be peripheral, although a central dysfunction cannot be ruled out based on the findings of this study.

Photoletter to the editor: Squamous cell carcinoma associated with and masquerading as molluscum contagiosum.

Squamous cell carcinoma is a non-melanoma skin cancer with a significant risk of mortality if not diagnosed promptly. A high index of suspicion is required, since it may mimic many benign conditions. Molluscum contagiosum is an innocuous viral infection which can also mimic a wide variety of other conditions. We report a case of squamous cell carcinoma on the anterior chest wall resembling a giant molluscum contagiosum, where the patient also had molluscum contagiosum at other sites. In addition, he developed herpes zoster of the left fifth thoracic dermatome. After surgical removal of the cancer, there was prompt subsidence of the molluscum contagiosum lesions without any specific treatment. This report highlights the importance of early biopsy in the diagnosis of squamous cell carcinoma. As the patient had no other conditions or therapy that could account for the immunosuppression, we hypothesize that the occurrance of molluscum contagiosum and zoster along with the squamous cell carcinoma indicates possible immunosuppression due to the carcinoma, though no metastatic spread could be detected.