Evaluating the safety of oral methylene blue during swallowing assessment: a systematic review

The Effects of Adding Particles in Texture Modified Food on Tongue Strength and Swallowing Function in Patients with Oropharyngeal Dysphagia: A Proof of Concept Study

The use of texture modified food (TMF) is widely spread in the daily care of patients with oropharyngeal dysphagia (OD). However, TMF have been shown to have a negative impact on the patients' quality of life. Adherence rates are low, increasing the risk of malnutrition and aspiration in an already vulnerable patient population. The aim of this exploratory study was to gain insight in the feasibility of adding particles to pureed food on tongue strength, swallowing safety and efficiency in patients with OD. Ten adult participants with OD swallowed three different boluses. Bolus 1 consisted of no particles (IDDSI level 4), small and bigger particles were added in bolus 2 and 3. Tongue strength during swallowing (Pswal) was measured using the Iowa Oral Performance Instrument (IOPI). Swallow safety (penetration and aspiration) and swallow efficiency (residu) were quantified during fiberoptic endoscopic evaluation of swallowing by means of the PAS scale and Pooling score. RM Anova and Friedman tests were performed for analyzing the impact of bolus on the outcome parameters. No significant effect of bolus type on Pswal was measured. Neither the PAS nor the Pooling score differed significantly between the three different boluses. Aspiration was never observed during swallowing any bolus with particles. This preliminary study shows that the addition of particles to pureed food had no impact on Pswal, swallowing efficiency or safety in patients with OD. This innovative project is the first step in research to explore the characteristics of TMF beyond bolus volume, viscosity and temperature.

Evaluation of Methylene Blue Migration from Time-Temperature Indicators Using LC-MS/MS

The purpose of this study was to evaluate and validate methylene blue migration from printed time-temperature indicators (TTIs) into food. It also highlights the importance of establishing regulatory measures and safety standards for food packaging, suggesting that this can contribute to improving food packaging safety. Liquid chromatography-mass spectrometry (LC-MS/MS) was used to quantify methylene blue migration in various food simulant and food matrix samples. The results show that the level of methylene blue migration varies significantly depending on the chemical properties of the food mimetic and the composition of the food matrix. The established method demonstrated a high sensitivity, with limits of detection (LODs) of 0.0019-0.0706 μg/L (kg) and limits of quantification (LOQs) of 0.0057-0.2138 μg/L (kg). This study highlights the need for a regulatory framework to mitigate the health risks associated with methylene blue in intelligent packaging systems and argues that regulatory thresholds should be set to ensure food safety and quality.

Microendoscopy in vivo for the pathological diagnosis of cervical precancerous lesions and early cervical cancer

BACKGROUND

Cervical cancer is an important public health problem. Conventional colposcopy is inefficient in the diagnosis of cervical lesions and massive biopsies result in trauma. There is an urgent need for a new clinical strategy to triage women with abnormal cervical screening results immediately and effectively. In this study, the high-resolution microendoscopy combined with methylene blue cell staining technology was used to perform real-time in vivo imaging of the cervix for the first time.

METHODS

A total of 41 patients were enrolled in the study. All patients underwent routine colposcopy and cervical biopsy, and high-resolution images of methylene blue-stained cervical lesions were obtained in vivo using microendoscopy. The cell morphological features of benign and neoplastic cervical lesions stained with methylene blue under microendoscopy were analyzed and summarized. The microendoscopy and histopathology findings of the high-grade squamous intraepithelial lesion (HSIL) and more severe lesions were compared.

RESULTS

The overall consistency of microendoscopy diagnosis with pathological diagnosis was 95.12% (39/41). Diagnostic cell morphological features of cervicitis, low-grade squamous intraepithelial lesion (LSIL), HSIL, adenocarcinoma in situ, and invasive cancer were clearly demonstrated in methylene blue stained microendoscopic images. In HSIL and more severe lesions, microendoscopic methylene blue cell staining technology can show the microscopic diagnostic features consistent with histopathology.

CONCLUSIONS

This study was an initial exercise in the application of the microendoscopy imaging system combined with methylene blue cell staining technology to cervical precancerous lesions and cervical cancer screening. The results provided the basis for a novel clinical strategy for triage of women with abnormal cervical screening results using in vivo non-invasive optical diagnosis technology.

Accuracy of Modified Blue-Dye Testing in Predicting Dysphagia in Tracheotomized Critically Ill Patients

(1) Background: Diagnosis of dysphagia in critically ill patients with a tracheostomy is important to avoid aspiration pneumonia. The objective of this study was to analyze the validity of the modified blue-dye test (MBDT) on the diagnosis of dysphagia in these patients; (2) Methods: Comparative diagnostic test accuracy study. Tracheostomized patients admitted to the Intensive Care Unit (ICU) were studied with two tests for dysphagia diagnosis: MBDT and fiberoptic endoscopic evaluation of swallowing (FEES) as the reference standard. Comparing the results of both methods, all diagnostic measures were calculated, including the area under the receiver-operating-characteristic curve (AUC); (3) Results: 41 patients, 30 males and 11 females, mean age 61 ± 13.9 years. The prevalence of dysphagia was 70.7% (29 patients) using FEES as the reference test. Using MBDT, 24 patients were diagnosed with dysphagia (80.7%). The sensitivity and specificity of the MBDT were 0.79 (CI95%: 0.60-0.92) and 0.91 (CI95%: 0.61-0.99), respectively. Positive and negative predictive values were 0.95 (CI95%: 0.77-0.99) and 0.64 (CI95%: 0.46-0.79). AUC was 0.85 (CI95%: 0.72-0.98); (4) Conclusions: MBDT should be considered for the diagnosis of dysphagia in critically ill tracheostomized patients. Caution should be taken when using it as a screening test, but its use could avoid the need for an invasive procedure.

Intra and interobserver agreement of the Dynamic Imaging Grade of Swallowing Toxicity Scale (DIGEST) in fiberoptic endoscopic evaluation of swallowing (FEES): the importance of observer-tailored training

PURPOSE

The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a scale to quantify the severity of pharyngeal dysphagia in head and neck cancer (HNC) patients. This study (1) described the training process of the observers for DIGEST in fiberoptic endoscopic evaluation of swallowing (FEES), (2) determined observer agreement on the DIGEST in FEES, (3) explored the effect of bolus consistency on observer agreement, and 4) explored criterion validity of the DIGEST in FEES.

METHODS

Twenty-seven dysphagic HNC patients were enrolled. Two observers completed a training program for DIGEST in FEES. Observer agreement on the Penetration-Aspiration Scale (PAS), percentage of pharyngeal residue (PPR), and DIGEST grades was determined using linearly weighted Cohen's kappa coefficient (κ).

RESULTS

Due to insufficient observer agreement after the first measurement attempt, additional training was organized using an elaborated manual with descriptions of the visuoperceptual variables, thereby improving observer agreement. Intraobserver agreement was almost perfect on the PAS (κ = 0.86-0.88) and PPR (κ = 0.84-0.86). Interobserver agreement was substantial on the PAS (κ = 0.78), almost perfect on the PPR (κ = 0.82), substantial on the safety grade (κ = 0.64), almost perfect on the efficiency grade (κ = 0.85), and substantial on the summary grade (κ = 0.71). Bolus consistency had an effect on observer agreement. A significant correlation was found between DIGEST efficiency grade and EAT-10.

CONCLUSION

The DIGEST showed to be a reproducible measurement for FEES in terms of observer agreement. However, agreement between novice observers on the DIGEST was only reached after specific observer-tailored training. Observer agreement should be analyzed by taking bolus consistency into account during training, as this might affect the interpretation of the outcome. A manual with well-defined descriptions can optimize the reproducibility of DIGEST measurements.

Phoniatricians and otorhinolaryngologists approaching oropharyngeal dysphagia: an update on FEES

PURPOSE

Oropharyngeal dysphagia (OD) is a common phenomenon in otorhinolaryngology and phoniatrics. As both sub-disciplines have a strong tradition and clinical experience in endoscopic assessment of the upper aerodigestive tract, the implementation of fiberoptic endoscopic evaluation of swallowing (FEES) was an almost self-evident evolution. This review aims to provide an update on FEES and the role of phoniatricians and otorhinolaryngologists using FEES in Europe.

METHODS

A narrative review of the literature was performed by experts in the field of FEES both in the clinical context and in the field of scientific research.

RESULTS

FEES is the first-choice OD assessment technique for both phoniatricians and otorhinolaryngologists. FEES is becoming increasingly popular because of its usefulness, safety, low costs, wide applicability, and feasibility in different clinical settings. FEES can be performed by health professionals of varying disciplines, once adequate knowledge and skills are acquired. FEES aims to determine OD nature and severity and can provide diagnostic information regarding the underlying etiology. The direct effect of therapeutic interventions can be evaluated using FEES, contributing to design the OD management plan. Standardization of FEES protocols and metrics is still lacking. Technological innovation regarding image resolution, frame rate frequency, endoscopic light source specifications, and endoscopic rotation range has contributed to an increased diagnostic accuracy.

CONCLUSION

The rising number of phoniatricians and otorhinolaryngologists performing FEES contributes to the early detection and treatment of OD in an aging European population. Nevertheless, a multidisciplinary approach together with other disciplines is crucial for the success of OD management.