Espesantes comerciales clásicos y de nueva generación. Cualidades organolépticas y utilidad en las pruebas diagnósticas de la disfagia / Classic and new-generation commercial thickeners. Organoleptic qualities and usefulness in the diagnostic tests of dysphagia

INTRODUCCIÓN: los espesantes son muy utilizados en los trastornos de la deglución, tanto para su diagnóstico como para conseguir una alimentación segura y eficaz. Recientemente se han comercializado en el mercado español productos compuestos por gomas con el fin de mejorar las cualidades organolépticas y físicas de los alimentos espesados. OBJETIVO: comparar agentes espesantes de ámbito clínico comercializados en España y verificar sus características organolépticas y físicas para ser utilizados en los procedimientos diagnósticos y en la alimentación del paciente con disfagia. MÉTODO: se valoraron las propiedades organolépticas (apariencia, color, olor, sabor y regusto) y físicas (solubilidad y estabilidad) de ocho espesantes (4 clásicos con almidón y 4 nuevos a base de gomas) en una muestra de 44 sujetos sanos. Además, se estudió su utilidad en las pruebas diagnósticas al mezclarlos con colorantes y contrastes hidrosolubles. RESULTADOS Y CONCLUSIONES: los espesantes de nueva generación, a base de gomas, obtienen en general mejores puntuaciones en sus cualidades físicas y organolépticas con respecto a los espesantes convencionales. Los espesantes con almidón son más adecuados en las pruebas diagnósticas, ya que los espesantes con gomas presentan algunas peculiaridades en las mezclas con colorantes y contrastes que deben ser tenidas en cuenta en dichas pruebas

INTRODUCTION: thickeners are widely used in swallowing disorders, both for diagnosis and to achieve a safe and effective diet. Recently, products composed of gums have been commercialized in the Spanish market in order to improve the organoleptic and physical qualities of thickened foods. OBJECTIVE: to compare thickening agents of clinical scope marketed in Spain, and to verify their organoleptic and physical characteristics, to be used in the diagnostic procedures and the feeding of patients with dysphagia. METHOD: the organoleptic (appearance, colour, smell, taste, aftertaste) and physical (solubility, stability) properties of eight thickeners (4 classic starch-based and 4 new gum-based) were assessed in a sample of 44 healthy subjects. In addition, their usefulness in diagnostic tests was studied by mixing them with dyes and water-soluble contrasts. RESULTS AND CONCLUSIONS: new-generation thickeners, based on gums, generally obtain better scores for their physical and organoleptic qualities than conventional thickeners. Starch thickeners are more suitable for diagnostic tests, as gum thickeners present some peculiarities in their mixtures with dyes and contrasts that must be taken into account in diagnostic tests

Peculiaridades anatómicas que influyen en la voz erigmofónica / Anatomical peculiarities having an influence on esophageal voice

La laringectomía total ocasiona un cambio morfológico trascendente en el aparato vocal, que altera totalmente el mecanismo fisiológico de la voz. Objetivo: describir aspectos claves de la morfología del aparato vocal de las personas que utilizan la voz erigmofónica para su comunicación. Material y método: estudio prospectivo de 15 pacientes laringectomizados que utilizan voz erigmofónica en los que se aplicaron los test VHI-30, CAPE-V y una exploración clínica y endoscópica, destacando los aspectos morfológicos que podrían influir en la voz. Resultados: el VHI-30 revela que perciben su voz como limitación leve y moderada. El CAPE-V indica una afectación media y grave. El VHI-30 (grados leve y moderado) se relaciona significativamente con la severidad global del CAPE-V. En la exploración clínica de la cavidad oral y el traqueostoma no se observan alteraciones que se relacionen con la valoración del CAPE-V. La exploración endoscópica muestra tendencias entre volúmenes y áreas de la cavidad faríngea y del esófago con el CAPE-V, pero sin llegar a valores significativos. Las formas de botón y diafragma del segmento faringoesofágico exhiben una tendencia similar. Conclusiones: la calidad de la voz erigmofónica percibida por el explorador dependería, en cierta medida, de las características anatómicas del nuevo aparato vocal del laringectomizado

Total laryngectomy causes a morphological change in the vocal apparatus, which totally alters the physiological mechanism of the voice. Aim: the objective of this article is to describe key aspects of the vocal apparatus morphology of patients who use the esophageal voice to communicate. Material and method: prospective study of 15 patients with esophageal voice in which the VHI-30, CAPE-V and a clinical and endoscopic exploration were performed, highlighting the morphological aspects that could influence the voice. Results: the VHI-30 reveals that they perceive their voice as a mild and moderate limitation. The CAPE-V indicates a medium and severe affectation. Both tests are significantly related in the mild and severe grades of VHI with the global severity of CAPE-V. The clinical exploration of the oral cavity and tracheostoma doesn't show that its variables present a trend with CAPE-V. Endoscopic exploration shows trends in the relationship between volumes and areas of the pharyngeal cavity and esophagus with the CAPE-V, but without reaching significant values. The button and diaphragm shapes of the pharyngoesophageal segment exhibit the same tendency. Conclusions: the variables studied indicate that the quality of the esophageal voice would depend, to some extent, on the anatomical characteristics of the new laryngectomized vocal apparatus

Trastornos de la deglución en la enfermedad de Parkinson / Swallowing disorders in Parkinson's disease

Introducción. La enfermedad de Parkinson es una patología neurodegenerativa crónica, con síntomas motores característicos y otros menos estudiados como la disfagia. Suele relacionarse con desnutrición, deshidratación o neumonías por aspiración por trastornos en la eficacia y seguridad en la deglución. El objetivo de este trabajo es identificar y analizar los trastornos deglutorios en la enfermedad de Parkinson. Sujetos y métodos. Muestra inicial de 52 sujetos con enfermedad de Parkinson a los que se aplicó el test SDQ, específico para la disfagia. Se seleccionaron 19 (36,5%) participantes con algún grado de disfagia en dicho test para ser evaluados con el método de exploración clínica volumen-viscosidad y la videoendoscopia de la deglución. Resultados. Se detectaron trastornos de eficacia y seguridad de la deglución en el 94,7%, siendo las alteraciones de la eficacia: dificultad en el transporte de alimento (89,5%), deglución fraccionada (78,9%), mal sello labial (68,4%) y residuos orales (47,4%), relacionándose con el tiempo que dura la ingesta. Se observaron también alteraciones en la seguridad como residuos faríngeos (52,7%), tos (47,4%), penetración (31,64%), aspiración y descenso de SaO2 (5,3%), relacionándose con el diagnóstico de patología respiratoria en el último año. Conclusiones. El test SDQ detectó trastornos deglutorios en el 36,5% de los pacientes con enfermedad de Parkinson. Las alteraciones en la eficacia y seguridad de la deglución se demostraron en el 94,7% de ellos, siendo más frecuentes los trastornos de eficacia que los de seguridad, estableciendo relación con el mayor tiempo en la ingesta y la aparición de patología respiratoria y neumonías (AU)

Introduction. Parkinson's disease is a type of chronic neurodegenerative pathology with a typical movement pattern, as well as different, less studied symptoms such as dysphagia. Disease-related disorders in efficacy or safety in the process of swallowing usually lead to malnutrition, dehydration or pneumonias. The aim of this study was identifying and analyzing swallowing disorders in Parkinson's disease. Subjects and methods. The initial sample consisted of 52 subjects with Parkinson's disease to whom the specific test for dysphagia SDQ was applied. Nineteen participants (36.5%) with some degree of dysphagia in the SDQ test were selected to be evaluated by volume-viscosity clinical exploration method and fiberoptic endoscopic evaluation of swallowing. Results. Disorders in swallowing efficiency and safety were detected in 94.7% of the selected sample. With regards to efficiency, disorders were found in food transport (89.5%), insufficient labial closing (68.4%) and oral residues (47.4%), relating to duration of ingestion. Alterations in security were also observed: pharynx residues (52.7%), coughing (47.4%), penetration (31.64%), aspiration and decrease of SaO2 (5.3%), relating to the diagnosis of respiratory pathology in the previous year. Conclusion. The SDQ test detected swallowing disorders in 36.5% of the subjects with Parkinson's disease. Disorders in swallowing efficiency and safety were demonstrated in 94.7% of this subset. Disorders of efficiency were more frequent than those of safety, establishing a relationship with greater time in ingestion and the appearance of respiratory pathology and pneumonias (AU)

Swallowing disorders in Parkinson's disease. / Trastornos de la deglución en la enfermedad de Parkinson.

INTRODUCTION: Parkinson's disease is a type of chronic neurodegenerative pathology with a typical movement pattern, as well as different, less studied symptoms such as dysphagia. Disease-related disorders in efficacy or safety in the process of swallowing usually lead to malnutrition, dehydration or pneumonias. The aim of this study was identifying and analyzing swallowing disorders in Parkinson's disease. SUBJECTS AND METHODS: The initial sample consisted of 52 subjects with Parkinson's disease to whom the specific test for dysphagia SDQ was applied. Nineteen participants (36.5%) with some degree of dysphagia in the SDQ test were selected to be evaluated by volume-viscosity clinical exploration method and fiberoptic endoscopic evaluation of swallowing. RESULTS: Disorders in swallowing efficiency and safety were detected in 94.7% of the selected sample. With regards to efficiency, disorders were found in food transport (89.5%), insufficient labial closing (68.4%) and oral residues (47.4%), relating to duration of ingestion. Alterations in security were also observed: pharynx residues (52.7%), coughing (47.4%), penetration (31.64%), aspiration and decrease of SaO2 (5.3%), relating to the diagnosis of respiratory pathology in the previous year. CONCLUSION: The SDQ test detected swallowing disorders in 36.5% of the subjects with Parkinson's disease. Disorders in swallowing efficiency and safety were demonstrated in 94.7% of this subset. Disorders of efficiency were more frequent than those of safety, establishing a relationship with greater time in ingestion and the appearance of respiratory pathology and pneumonias.

La voz del laringectomizado: incapacidad, percepción y análisis acústico / Laryngectomized voice rehabilitation: handicap, perception and acoustic analysis

Los pacientes laringectomizados tienen una limitación muy importante al perder la función vocal. La rehabilitación de la voz se realiza por erigmofonía o prótesis fonatoria. Ambos procedimientos son útiles pero tienen diferencias evidentes en la calidad vocal obtenida. Objetivo. Determinar cómo es percibida la voz rehabilitada con ambos procedimientos por los pacientes y observadores, completando el estudio con su análisis acústico. Material y método. Pacientes laringectomizados (n = 18) con voz rehabilitada con erigmofonía (n = 10) y prótesis fonatoria (n = 8). Estudio por medio de VHI-30, análisis acústico (F0, TMF, HNR, «speech-rate», intensidad y espectrograma) y evaluación perceptual (GRBAS y CAPE-V). Resultados. El VHI-30 presenta valores similares en ambos tipos de voz rehabilitada. El análisis acústico muestra diferencias importantes entre ambos tipos de voces, siendo los valores obtenidos con prótesis fonatoria más parecidos a los de la voz laríngea. La evaluación perceptual indica mayor grado de afectación en la voz erigmofónica que en la prótesis fonatoria. No se observa relación significativa entre lo percibido por los pacientes con ambos tipos de voces rehabilitadas y lo valorado por el observador. Los estudios acústicos y perceptuales muestran valores más próximos a la normalidad en la voz de prótesis fonatoria (AU)

Laryngectomized patients have a very important limitation when they lose the vocal function. Voice rehabilitation is fulfilled by means of the esophageal voice or by means of a phonatory prosthesis. Both methods are useful but they have evident differences concerning the vocal quality obtained. Objective. Determine how rehabilitated voice is perceived with both methods by patients and observers, completing the study with its acoustic analysis. Material and method. Laryngectomized patients (n = 18) with rehabilitated voice by means of esophageal voice (n = 10) and phonatory prosthesis (n = 8). A study was made through the VHI-30, acoustic analysis (F0, TMF,HNR, «speech rate», intensity and spectrogram) and perceptual evaluation (GRBAS and CAPE-V). Results. VHI-30 displays similar values in both types of rehabilitated voice. The acoustic analysis shows differences between both types of rehabilitated voices and the usual laryngeal voice. The perceptual study presents a higher degree of affectation on the esophageal voice than on the PF one. There is no relation between what the patient perceives and what the observer values. The acoustic and perceptual studies show closer values to normality in the phonatory prosthesis voice (AU)

Nitrous oxide (N2O) emissions from waste and biomass to energy plants.

Following the Kyoto protocol with respect to reducing emissions of greenhouse gases emissions, and EU energy policy and sustainability in waste management, there has been an increased interest in the reduction of emissions from waste disposal operations. From the point of view of nitrous oxide (N2O) emissions, waste incineration and waste co-combustion are very acceptable methods for waste disposal. In order to achieve very low N2O emissions from waste incineration, particularly for waste with higher nitrogen content (e.g. sewage sludge), two factors are important: temperature of incineration over 900 degrees C and avoiding the selective non-catalytic reduction (SNCR) de-NO(X) method based on urea or ammonia treatments. The more modern selective catalytic reduction (SCR) systems for de-NO(X) give rise to negligible sources of N2O.