Prevalence of Self-Reported Swallowing Difficulties and Swallowing-Related Quality of Life Among Community-Dwelling Older Adults in India.

Self-reported swallowing difficulties are highly prevalent but underreported among older adults. The aging population in India is increasing, yet there is a lack of empirical data on self-reported swallowing difficulties in older adults. In the present study, we aimed to estimate the prevalence of self-reported swallowing difficulties and assess the swallowing-related quality of life (QOL) among community-dwelling older adults in India. We recruited 361 older adults (60-91 years) from the community. Participants completed the Eating Assessment Tool-10 (EAT-10) to assess self-reported swallowing difficulties and the Dysphagia Handicap Index (DHI) to assess swallowing-related QOL. Participants rated the EAT-10 from 0 for 'no problem' to 4 for 'severe problem'. The DHI rating included 0 for 'never', 2 for 'sometimes', and 4 for 'always'. The total scores of EAT-10 and DHI were summarised using descriptive statistics. Statistically significant differences between pass-fail groups of EAT-10 and DHI were evaluated using an independent t-test and multivariate analysis of variance test, respectively. The overall mean score for EAT-10 was 3.34, and 7.56 for DHI, with higher scores observed among females. 36.6% of older adults self-reported experiencing swallowing difficulties, while 47.4% self-reported having poor swallowing-related QOL at p < 0.05. A strong positive correlation (r = 0.86) was found between EAT-10 and total DHI scores at p < 0.001. The present study sheds light on the widespread yet underreported issue of self-reported swallowing difficulties and the impact on swallowing-related QOL among older adults in India. These findings emphasize the urgent need for early swallowing screening programs among older adults.

A Survey of Speech-Language Pathologists' Applications of Motor Learning Principles in Dysphagia Therapy in Adults in India.

PURPOSE: In the study, we investigated whether speech-language pathologists (SLPs) in India use practice and feedback conditions of motor learning principles (MLPs), including biofeedback, in dysphagia therapy in adults using a problem-solution approach. METHOD: Based on a literature review and clinical experience, we developed and validated a hypothetical case involving an adult with dysphagia (representing the problem) and a purpose-built 22-item questionnaire (representing the solution). We distributed the questionnaire electronically by sending an e-mail to 2,069 SLPs and also published a flyer on the dysphagia special interest group of India. RESULTS: A total of 107 SLPs anonymously submitted their responses. In practice conditions, most of the SLPs reported following massed over distributed, small over large, blocked over random, whole over part, variable over constant, and internal over external practice strategies. In feedback conditions, most of the participants reported using knowledge of results over performance, high over low, immediate over delayed, and self over therapist feedback strategies. Lastly, more than two thirds of SLPs did not use biofeedback devices for dysphagia therapy. CONCLUSION: The findings from our study indicate that SLPs in India do not adhere uniformly to the recommended practices of MLPs for dysphagia therapy in adults.

Normative data for certain vocal fold biomarkers among young normophonic adults using ultrasonography.

PURPOSE: The current study aimed to profile vocal fold morphology, vocal fold symmetry, gender and task-specific data for vocal fold length (VFL) and vocal fold displacement velocity (VFDV) in young normophonic adults in the age range of 18-30 years using ultrasonography (USG). METHODS: Participants underwent USG across quiet breathing, /a/ phonation and /i/ phonation tasks, and acoustic analysis was conducted to explore the relationship between USG and acoustic measures. RESULTS: The study found that males have longer vocal folds than females, and overall greater velocities were observed in /a/ phonation, followed by /i/ phonation, with the lowest velocity observed in the quiet breathing task. CONCLUSIONS: The obtained norms can be used as a quantitative benchmark for analyzing the vocal fold behavior in young adults.

Delineation of Subarachnoid Cisterns Using CT Cisternography, CT Brain Positive and Negative Contrast, and a Three Dimensional MRI Sequence: A Pictorial Review.

The basic anatomy and morphology of subarachnoid cisterns of the brain are interesting and challenging topics with high clinical significance. These enlarged CSF-filled expansions are important as they transmit various neurovascular structures. The cisterns can be classified based on their location as supratentorial, at the level of the tentorium, and infratentorial. They are also classified as paired and unpaired cisterns. The anatomical and radiological information about the cisterns is clinically and surgically relevant in diagnosing and managing many neurological disorders. It is also essential in medical teaching. This pictorial essay reviews the radiological images where the subarachnoid cisterns are delineated in four unique circumstances.

Neuroendocrine tumour of the breast: A challenging diagnosis on cytology.

This letter describes the cytological features in a case of primary neuroendocrine tumour of breast.

Aquatic geochemistry of a major freshwater lake in the Kashmir Himalaya: solute acquisition and denudation process in the lacustrine system.

Lakes, the main entities of lacustrine environments, are a rich archive of environmental and geogenic changes in terms of compositional variation of water and sediment. Water and sediment samples (N = 173) were collected during 2013-2014 from the Wular Lake, one of the important fresh lakes within the Indian landmass. The study provides insights on the solutes acquisition mechanism and provenance of ionic constituents within the lake water and the sediments. Besides, the impact of catchment attributes on the lake system was in addition assessed. The hydrochemical results suggest that the chemical weathering of silicate and carbonates within the catchment shapes the lake water chemistry and characterizes the facies pattern into a hybrid type. The geochemical results of the lake sediments demonstrate that the improved abrasion rates and ensuant settling of detritus into the lake are closely linked with the prominent physical weathering over chemical weathering. The new finding of the present study is that sediments represent an unweathered basalt compositional trend, plausible provenance from mafic rocks, experiencing low to moderate degree of chemical weathering. The study found that increased encroachment within the lake catchment due to continued anthropogenic forcing is the primary source contributing the organic matter (OM) as well as the higher levels of Cl, NO3, SO4, and P to the lake. These findings corroborate with the land use-land cover changes (from the last 50 years) within the lake catchment in significantly deteriorating the lake system. The study recommends that the ongoing conversion of lake peripheral areas into urban settlement and agro-horticulture land by filling activities should be restricted.

High-altitude meteorology of Indian Himalayan Region: complexities, effects, and resolutions.

The Himalaya, by virtue of its location and stupendous height, acts as a great climatic divide and regulates meteorological conditions in the subcontinent regions of South Asia. However, the associated complexities and their effects are yet to be resolved to understand the meteorology of the Indian Himalayan Region (IHR). In this review volume, we synthesize the results and inferences of several studies carried out in the IHR using in situ data, remotely sensed data, and model-based meteorological observations. Results provide insights into climate change, scientific gaps, and their causes in deciphering meteorological observations from the last century to recent decades and envisage impacts of climate change on water reservoirs in the future. Warming trend of air temperature, in contrast to global temperature, has been projected in recent decades (after 1990) with a greater warming rate in the maximum temperature than the minimum temperature. This drifting of air temperature from the beginning of last century accelerates the diurnal temperature range of the Himalayas. An elevation-dependent warming trend is mostly perceived in the northwest Himalayan region, implicating an increased warming rate in the Greater Himalaya as compared to the lower and Karakoram Himalaya. No definite trends of precipitation have been observed over different regions of the IHR, suggesting heterogeneous cryosphere-climate interaction between western and central Himalaya. In this review, we have tried to emphasize to the scientific community and policy-makers for enhancing the knowledge of physical and dynamical processes associated with meteorological parameters in the Himalayan terrain.

A Rare Bug and Recurrent Bleed.

Isolated pulmonary actinomycosis is a rare entity. Its clinical features and radiological findings are nonspecific, making early diagnosis difficult for clinicians. We report a case of 40-year-old nonsmoker, immunocompetent male without an underlying structural lung disease who presented to us with recurrent hemoptysis and was diagnosed to have Actinomycosis after multiple readmissions.

Efficacy and Validity of Image-Guided Percutaneous Fine Needle Aspiration and Core Biopsy of Liver Pathologies: Saga of Focal Hepatic Lesions from the Nodule to the Needle to the Slide.

CONTEXT: Radiology and pathology are pivotal tools in the investigational artillery for management of wide spectrum of hepatic lesions and early detection is of a paramount importance. AIMS: The study aimed at analyzing the efficacy, comparative yield and validity of image-guided aspiration cytology (FNA)/core biopsy (CB) in focal hepatic lesions. SETTINGS AND DESIGN: A retrospective hospital-based study was conducted in departments of Pathology and Radiology and Imaging of a tertiary care center. MATERIALS AND METHODS: Cases of focal hepatic lesions that underwent percutaneous image guided-FNA reported (2011-2018) were analyzed. Cytological-histopathological correlation was performed where available. FNA diagnoses were divided into four categories-positive for malignancy (group 1), atypical (group 2), negative for malignancy (group 3), and non-diagnostic (group 4). STATISTICAL ANALYSIS USED: Categorical data was depicted in the form of frequencies and proportions. Validity of percutaneous image-guided FNA diagnosis was collated with the final diagnosis and results were analyzed. RESULTS: A total of 338 FNA of focal hepatic lesions were reported in which 217 (68.2%) cases in group 1; 21 (6.2%) in group 2; 58 (17.2%) in group 3 and 42 (12.4%) in group 4. CB correlation was available in 123 cases. Based on clinical, radiological and pathological findings, conclusive final diagnoses were obtained and the cases were regrouped [malignant cases-245, benign lesions-57 and uncertain lesions-36]. Metastasis was the most common malignancy (175/245; 71.4%). Sensitivity, specificity, and overall diagnostic accuracy of FNA to categorize the lesion as benign or malignant were 96.94%, 100% and 97.51%, respectively. However, the cytology-histopathology correlation revealed discordance of subtyping the lesion in 20% of cases and sensitivity and specificity reduced to 80% and 50% respectively in rendering the specific diagnosis. CONCLUSIONS: Percutaneous image-guided FNA is a sensitive and specific tool with high diagnostic accuracy in evaluating focal hepatic lesions. The study highlights the pre-eminence of interventional radiology and cytology in the care of patients with liver lesions.

Shine like gold and sparkle like glitter: Three cases of lipoid pneumonia.

Lipoid pneumonia (LP) is an unwonted, mostly asymptomatic entity which has no classical radiological appearance. It can be endogenous or exogenous depending upon the type of exposure or underlying milieu. It simulates a number of infective and malignant respiratory conditions and can go undiagnosed or delayed leading to morbidity and mortality. We put forward three cases that initially presented as classical pneumonia, but on further assessment and investigations were diagnosed to be LP. All the three cases manifested with symptoms of fever, productive cough and breathlessness. Chest Xray and CT scan were indicative of consolidation. Bronchoalveolar lavage (BAL) evinced lipid laden macrophages that stained positive with fat stains (Sudan IV and Oil Red O). Two cases were endogenous and one was exogenous type. LP, owing to its nonspecific clinical presentation and radiographic signs, needs a high index of suspicion, and a detailed clinical history for accurate diagnosis. Corroboration of lipid laden alveolar macrophages in BAL is the crux to the diagnosis. Hence, clinicians should be cognizant of this condition and rule out LP in cases of non-resolving pneumonia in an appropriate clinical context.

Respiratory Muscle Function and Exercise Capacity in a Stage 4 Head and Neck Cancer Patient Receiving Chemoradiotherapy.

BACKGROUND: Reduced physical and functional capacity is one of the main treatment-related side effects of chemoradiation therapy in head-and-neck cancer patients. We evaluated a case of a head-and-neck cancer patient who was undergoing chemoradiation and was assessed for various components of cardiopulmonary function that plays a vital role in the treatment prognosis. The aim of this case report was to evaluate the respiratory muscle function and exercise capacity of a head-and-neck cancer patient receiving chemoradiation therapy. SETTINGS AND DESIGN: From among the newly diagnosed admitted to the hospital care, a 60-year-old male with supraglottic carcinoma, who was undergoing concomitant chemoradiation for 7 weeks, was evaluated for various components of cardiopulmonary function. SUBJECTS AND METHODS: Outcomes assessed were diaphragm function (mobility and thickness), maximal inspiratory pressure and maximal expiratory pressure, and 6-min walk test at baseline (pre), after 3 weeks, and after 7 weeks of chemoradiation therapy. The data were quantitatively analyzed to interpret the difference of respiratory muscle function and exercise capacity. RESULTS: Evaluation of these outcomes showed a significant decrease from the baseline till the end of the 7th week. CONCLUSIONS: Therefore, concomitant chemoradiation therapy substantially decreased the respiratory muscle function and exercise capacity in the head-and-neck cancer patient.

Massive hemoptysis: A rare case with uncommon presentation and rapid response - A case report.

We report an unusual case of massive haemoptysis in young patient with mass lesion in left upper lobe. Bronchoscopic biopsy, percutaneous CT guided biopsy & serum marker confirmed the lesion to be granulomatous with polyangiitis (GPA). Rarity of the case was endoluminal bronchial lesion in GPA and radiographic presentation of mass lesion on the Computed Tomography. Also this case highlights that massive haemoptysis can be a sole and initial manifestation of GPA. Prompt diagnosis & pulse therapy led to dramatic symptomatic, clinical & radiological improvement, emphasizing the fact that GPA can present as acute emergency and rapid diagnosis with early treatment initiation with pulse steroid therapy & rituximab can be life saving measure.