Chewing side preference is associated with hemispheric laterality in healthy adults

Purpose To investigate if chewing side preference (CSP) can be used as an indicator of hemispheric laterality in healthy adults. Materials and methods Seventy-five individuals were included. The visual analogue scale (VAS) was used to determine CSP and laterality test for preferred peripheral organs. Results Significant correlation between CSP and hand, foot, ear, and eye side preference was found (r = .41, p < .001; r = .34, p = .003; r = .35, p = .03; r = .36, p = .002). Conclusion Besides peripheral organs, the CSP can also be used in determination of hemispheric lateralization.

Both pharyngeal and esophageal phases of swallowing are associated with recurrent pneumonia in pediatric patients

INTRODUCTION

One of the underlying causes of recurrent pneumonia in children is swallowing dysfunction, with aspiration syndrome. Swallowing dysfunction should be considered not only a problem of the oropharyngeal phase but also a problem of the esophageal phase.

OBJECTIVES

This study aimed to determine the relationship between findings from a swallowing study and a history of recurrent pneumonia in pediatric patients.

METHODS

A videofluroscopic swallowing study of 274 pediatric patients who had swallowing dysfunction was conducted. Information on a history of recurrent pneumonia during a 1-year period was obtained from hospital files.

RESULTS

The median age of the participants was 33 months (min =10, max = 180), of whom 51.8% were females. In the study, 83.2% of the patients had cerebral palsy, 7.7% had syndromic symptoms, 3.6% had muscular dystrophy, and 5.5% were classified as "other." During the 1-year period, 67.9% of the participants had a history of recurrent pneumonia history. Furthermore, 66.4% had oral dysfunction, 32.5% had laryngeal penetration, 46.4% had aspiration, 45.3% had abnormal esophageal body function, and 35.8% had reflux symptoms. There was no correlation between oral dysfunction and recurrent pneumonia (P = .902), but there was a positive correlation between recurrent pneumonia and laryngeal penetration (P < .001, r = .26), aspiration (P < .001, r =.49), abnormal esophageal body function (P = .002, r = .18), and reflux (P < .001, r = .22).

CONCLUSION

Both pharyngeal swallowing disorders, such as penetration and aspiration, and esophageal disorders and reflux may result in recurrent pneumonia in pediatric patients. Thus, all phases of deglutition should be considered and followed up during swallowing evaluation.

Effect of a new treatment protocol called Functional Chewing Training on chewing function in children with cerebral palsy: a double-blind randomised controlled trial

Cerebral palsy (CP) is a group of permanent sensorimotor impairments. Children with CP have various feeding difficulties including chewing disorder, which may affect their nutritional status. Functional Chewing Training (FuCT) was designed as a holistic approach to improve chewing function by providing postural alignment, sensory and motor training, and food and environmental adjustments. This study aimed to investigate the effect of FuCT on chewing function in children with CP. This study was designed as a double-blind, randomised controlled trial. Eighty CP children with chewing disorder were randomised and split between the FuCT group (31 males, 19 females; mean age 3·5 ± 1·9 years) and the control group (16 males, 14 females; 3·4 ± 2·3 years) receiving traditional oral motor exercises. Each group received the training programme for 12 weeks with weekly follow-up and with two evaluations at baseline and end of 12 weeks. Chewing function was evaluated by analysing video recordings and scored with the Karaduman Chewing Performance Scale (KCPS). The Behavioral Pediatrics Feeding Assessment Scale (BPFAS) was used to evaluate feeding behaviours of children. A significant improvement was observed in KCPS scores at 12 weeks after training in the FuCT group (P < 0·001), but no change was found in the control group (P = 0·07). A significant improvement was detected in all parameters of BPFAS at 12 weeks after training in the FuCT group (P < 0·001) and in four parameters of BPFAS in the control group (P = 0·02, P = 0·02). FuCT is an effective method to improve chewing function compared with traditional oral motor exercises.

Evaluating the Psychometric Properties of the Eating Assessment Tool (EAT-10) Using Rasch Analysis

Early and reliable screening for oropharyngeal dysphagia (OD) symptoms in at-risk populations is important and a crucial first stage in effective OD management. The Eating Assessment Tool (EAT-10) is a commonly utilized screening and outcome measure. To date, studies using classic test theory methodologies report good psychometric properties, but the EAT-10 has not been evaluated using item response theory (e.g., Rasch analysis). The aim of this multisite study was to evaluate the internal consistency and structural validity and conduct a preliminary investigation of the cross-cultural validity of the EAT-10; floor and ceiling effects were also checked. Participants involved 636 patients deemed at risk of OD, from outpatient clinics in Spain, Turkey, Sweden, and Italy. The EAT-10 and videofluoroscopic and/or fiberoptic endoscopic evaluation of swallowing were used to confirm OD diagnosis. Patients with esophageal dysphagia were excluded to ensure a homogenous sample. Rasch analysis was used to investigate person and item fit statistics, response scale, dimensionality of the scale, differential item functioning (DIF), and floor and ceiling effect. The results indicate that the EAT-10 has significant weaknesses in structural validity and internal consistency. There are both item redundancy and lack of easy and difficult items. The thresholds of the rating scale categories were disordered and gender, confirmed OD, and language, and comorbid diagnosis showed DIF on a number of items. DIF analysis of language showed preliminary evidence of problems with cross-cultural validation, and the measure showed a clear floor effect. The authors recommend redevelopment of the EAT-10 using Rasch analysis.

Effective management of cricopharyngeal achalasia in infants and children with dilatation alone

AIM

Cricopharyngeal achalasia (CPA) is a rare clinical condition that is characterized by aspiration, choking, and nasopharyngeal regurgitation. The aim of this study is to introduce the outcomes of dilatation alone in children with CPA.

PATIENTS AND METHOD

After the evaluation of upper esophageal sphincter with endoscopy, dilatation was performed. All patients underwent videofluoroscopic evaluation and swallowing therapy after the surgical procedure. A retrospective chart review was performed in children with CPA.

RESULTS

Thirty children who were videofluoroscopically proven to have CPA were included in the study. Their age range was 15days-7years (median 11months). Twenty-one of them were neurologically impaired. Two children were lost to follow-up. Nineteen patients (68%) had a total resolution of CPA and were symptom-free with 1-6 dilatations (median 2). Three of the children (11%) who were severely neurologically impaired had resistant CPA. Three children (11%) treated recently with short follow-up were added to the group. Their VFS evaluations demonstrated improvement, thus we accepted their result as successful. There were two perforations in the series. Three patients died; one 2-month-old (2500g) baby who was accepted from the intensive care unit passed away on postoperative on the 7th day. Two other babies who were unresponsive to dilatation therapy died on follow-up.

CONCLUSION

Dilatation can be a safe and effective method on children who are correctly diagnosed to have CPA.

Expression of aquaporin-7 and aquaporin-9 in tanycyte cells and choroid plexus during mouse estrus cycle

Tanycytes are special ependymal cells located in the ventrolateral wall and floor of the third ventricle having processes extending nuclei that regulate reproductive functions and around of vessels in median eminance. The aquaporins (AQPs) are a family of transmembrane proteins that transport water and glycerol. AQP-7 and -9 are permeable to other small molecules as glycerol and therefore called aquaglyceroporins. In this study, we aimed to show localization of AQP-7 and -9 in epithelial cells of choroid plexus and tanycytes during female mouse estrus cycle. AQP-7 and -9 proteins were detected in α2 and β1 tanycytes in prœstrus stage. Interestingly, there is no staining in estrus stage in any type of tanycytes. We observed weak immunoreactivity in α1, α2 and β1 tanycyte cells in metestrus stage for AQP-7 and α1 for AQP-9 protein. AQP-7 and -9 showed intense immunoreactivity in α2, β1 and β2 tanycyte cells during diestrus stage. Consequently, AQP-7 and -9 showed differential staining pattern in different stages of mouse estrus cycle. In the light of our findings and other recent publications, we suggest that AQP-7 and -9-mediated glycerol transport in tanycyte cells might be under hormonal control to use glycerol as a potential energy substrate during mouse estrus cycle.

Validity and Reliability of the Turkish Version of the Questionnaire for the Assessment of Dysphagia in Multiple Sclerosis

Introduction

The aim of this study was to investigate the validity and reliability of the Turkish version of the Questionnaire for the Assessment of DYsphagia in MUltiple Sclerosis (DYMUS) that has been developed for evaluating dysphagia in patients with multiple sclerosis.

Methods

This methodological study was conducted in the neurology clinic and outpatient department of a training hospital between March 15 and September 15, 2015. The study included 117 patients aged 18 years and over who had a definite diagnosis of multiple sclerosis, could communicate in Turkish, and volunteered to be included. Data were collected using a descriptive information form, the DYMUS, and the Eating Assessment Tool (EAT-10). The scale was translated and back translated to determine the language validity, and a specialist was consulted to make sure the content was valid. We used the EAT-10 and Kurtzke's Expanded Disability Status Scale (EDSS) concurrently to test the criterion-related validity. The test-retest procedure was used at 1-week intervals for 37 patients in this study. Descriptive statistics, factor analysis, Kappa analysis, reliability analysis, and correlation analysis were used to analyze the data.

Results

Factor analysis revealed that the scale was bifactorial, and this was consistent with its original form. There were positive and statistically significant relationships between the DYMUS and EAT-10 (r=0.90, p<0.001) and the mean EDSS scores (r=0.49, p<0.001). The internal consistency of the total scale was high (Cronbach's alpha coefficient= 0.91). The Cronbach's alpha coefficients pertaining to dysphagia for solids and liquids were determined to be 0.88 and 0.83, respectively. The total scale and subscales demonstrated a high test-retest reliability (r=0.79-0.95, p<0.001).

Conclusion

In this study, the Turkish version of the DYMUS was found to be a valid and reliable tool for evaluating dysphagia in patients with multiple sclerosis.

Otorhinolaryngological, audiovestibular and swallowing manifestations of patients with Niemann-Pick disease Type C

OBJECTIVES

The aim of this study is to evaluate audiovestibular and swallowing impairment of patients with NPC.

METHODS

Audiovestibular and swallowing evaluation were performed on patients with Niemann-Pick disease type C (NPC) at Hacettepe University between 20013 and 2015 prospectively. Pure-tone audiometry (PTA), Auditory Brain stem response (ABR), Flexible endoscopic evaluation of swallowing (FEES) test and posturography were done. Hearing, swallowing and balance states were measured.

RESULTS

There were 16 patients (5 male and 11 female, with a median age of 6.5 years old). The most common ABR abnormalities observed were absent waves I and III (%70 absent I waves, %43.75 absent III waves). Twelve of sixteen patients (%75) had an ABR abnormality in at least one ear, of these, four patients had normal hearing and three of them had periferal hearing loss. 12 (75%) patients had complaint of postural imbalance. 11(69%) of patients had peripheral and one (6%) patient had central impairment. Nine of sixteen patients (56.25%) show some degree of dysphagia (either penetration or aspiration). Two patients (12.5%) showed aspiration both liquid and viscous nutrition. Three patients (18.75%) showed aspiration primarily in liquids and two of them had penetration with viscous nutrition. Three patients (18.75%) had penetration with no aspiration neither liquid nor viscous nutrition (PEN-ASP score was 3, 3, 5, respectively).

CONCLUSION

There is no curative treatment for this devastating and fatal disorder and hearing impairment, balance and swallowing disorders can be seen especially late onset form of disease.

Role of circulating nesfatin-1 in the underweight children with poor appetite

OBJECTIVE

To investigate serum concentration of nesfatin-1 in underweight children who have poor appetite, and its association with anthropometric markers of malnutrition.

PATIENTS AND METHODS

We recruited 50 underweight children and adolescents (aged 2-18 years) who presented with loss of appetite. Thirty age- and sex-matched controls were also included in the study. Fasting serum nesfatin-1 concentrations were measured by using Enzyme-Linked Immunosorbent Assay (ELISA) technique.

RESULTS

Mean nesfatin-1 level was significantly higher in underweight children when compared to controls (p<0.001). There was no correlation between serum nesfatin-1 levels and anthropometrics markers.

CONCLUSIONS

Our results suggest that nesfatin-1 might have an important role in regulation of food intake and pathogenesis of loss of appetite in children.

Swallowing dysfunction as a factor that should be remembered in recurrent pneumonia: videofluoroscopic swallow study

BACKGROUND

The swallow function is one of the strong defense mechanism against aspiration. Aspiration and pneumonia are unavoidable in patients with defective mechanism of swallowing. The aim of this study was to evaluate patients with recurrent pneumonia in terms of videofluoroscopic examination results.

METHODS

The study comprised fifty pediatric cases (22 boys, 28 girls) with an average age of 2.9 years (2 months-7.5 years) who were referred to our clinic due to suffering from recurrent pneumonia. The videofluoroscopic swallow study (VFSS) was performed on all patients. The presence of a correlation with pneumonia was investigated.

RESULTS

In 45 of the children, VFSS results were not normal. Of the children, 41 had mental-motor retardation. The results of the videofluoroscopic study show that silent aspiration was the most common pathology in participants with the percentage of 40 (27.5% mild, 17.5% severe). Patients in the study had pneumonia with an incidence of 2.6 illnesses per year. Having one than more results on VFSS was found to be associated with more number of annual pneumonia episodes.

CONCLUSIONS

Children with neurological impairments are at risk of recurrent acute pneumonia due to aspiration. Disturbances of swallowing phases should be remembered as a cause of pneumonia in these patients.

The effects of some tumor markers on human erythrocyte (HCA-I and HCA-II), bovine erythrocyte (BCA) and bovine lung (CA-IV) carbonic anhydrase enzyme activities in vitro

OBJECTIVE

The influence of prostatic acid phosphatase (PAP) and human chorionic gonadotropin (HCG), tumor markers have been investigated on human erythrocyte carbonic anhydrase (HCA-I and HCA-II) and bovine erythrocyte (BCA) and bovine lung carbonic anhydrase (CA-IV) in vitro.

BACKGROUND

Tumor markers are substances that can often be detected in higher-than-normal amounts in the blood, urine, or body tissues of some patients with certain types of cancer. Tumor markers are produced either by the tumor itself or by the body in response to the presence of cancer or certain benign (noncancerous) conditions. In addition to their role in cancer diagnosis, some tumor marker levels are measured before treatment to help doctors plan appropriate therapy.

RESULTS AND CONCLUSION

All of the tumor markers were determined to have inhibition effect, on human CA-I, CA-II, bovine erythrocyte CA (BCA) and bovine lung CA-IV isoenzymes. The effect of each tumor marker on CA was investigated by Wilbur-Andersen method modified by Rickly et al Inhibition effects of two different tumor markers on human CA-I, CA-II, bovine erythrocyte CA (BCA) and bovine lung CA-IV isoenzymes were determined by using the CO2-Hydratase method by plotting activity % vs (tumor markers). I50 values of tumor markers exhibiting inhibition effects were found by means of these graphs (Tab.1, Fig. 2, Ref. 20).

MEGALENCEPHALY, POLYMICROGYRIA, POLYDACTYLY AND HYDROCEPHALUS (MPPH) SYNDROME: A NEW CASE WITH OCCIPITAL ENCEPHALOCELE AND CLEFT PALATE

The megalencephaly, polymicrogyria, polydactyly, and hydrocephalus (MPPH) syndrome is quite rarely seen. The four main findings in this syndrome may be accompanied by severe psychomotor retardation, blindness, hypotonia, convulsions, and facial dysmorphism. In this paper, we present a female newborn at 39 weeks gestational age born to parents who are first degree cousins. Beside the facial dysmorphism and four main features of the MPPH syndrome, the findings on the physical examination of the patient were, hypertonicity, occipital encephalocele, cleft palate, and multiple polyps in the tongue. The presence of occipital encephalocele, cleft palate, and polyps in the tongue in this patient was not reported previously in the literature.

Traumatic multiple lower cranial nerve palsy: a case report and review of the literature

Lower cranial nerve palsy, also known as Collet-Sicard syndrome, is a fairly rare pathology characterized by unilateral palsy of the IX-X-XI-XII cranial nerves. We report a multiple cranial nerve palsy developing after a head trauma that might have been considered negligible. A 16-year-old boy was admitted with swallowing and articulation problems and difficulty lifting one shoulder after a head trauma suffered during a football match. No pathology was revealed in the subsequent imaging. Cranial nerve palsies due to head trauma are very rare. Awareness of the possibility of such a condition, leading to early recognition and treatment, may result in significant functional recovery.

A male newborn with Simpson-Golabi-Behmel syndrome, presenting with metopic synostosis, anal atresia, and total anomalous pulmonary venous return

Simpson-Golabi-Behmel syndrome is a clinical condition described by Simpson, characterized with multiple congenital anomalies and caused by Glypican 3 (GPC3) mutations of the X-linked gene. Typical findings such as overgrowth, hypoplastic changes of hands and feet, visceromegaly, cleft palate and macrocephalic distinctive facial features and multiple organ anomalies might be observed. GPC3 mutation is claimed to generally cause metopic synostosis. This case was reported because even though a lot of anomalies accompanying Simpson-Golabi-Behmel syndrome had been noticed, combination of metopic synostosis, has not been reported before.