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Londhe C, Agrawal A, Pednekar S, Pandey D, Khan MF. Swallowing Dysfunction after Acute Stroke: The Incidence, Predictors and Outcome. J Assoc Physicians India 2023; 71:11-12. [PMID: 37651239 DOI: 10.59556/japi.71.0301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
INTRODUCTION Swallowing dysfunction is common after acute stroke. It increases the risk of aspiration pneumonia and affects nutrition. In this study, we aimed to determine the incidence of dysphagia after a single episode of acute stroke in conscious patients and the factors predisposing the patient to dysphagia. We also assessed the course of dysphagia over a period of 8 weeks after stroke. MATERIALS AND METHODS It was a prospective observational study. We included patients of acute stroke (ischemic, hemorrhagic, lacunar, anterior, as well as posterior circulation) with Glasgow Coma Scale (GCS) of ≥12; within 48 hours of onset. Patients were screened for dysphagia by the Gugging Swallowing Screen (GUSS) screening tool; then assessed in detail using by Mann Assessment of Swallowing Ability (MASA) scoring scale. Patients with dysphagia were reassessed at 7 days and at 8 weeks after stroke for the presence and severity of dysphagia. RESULTS We included 150 patients. The incidence of dysphagia at day 1, day 7, and 8 weeks was 42, 24, and 9%, respectively. The proportion of patients with moderate and severe dysphagia also decreased during a follow-up period of 8 weeks from 18 to 3% and from 20 to 6%, respectively. The incidence of dysphagia was significantly greater in moderately severe stroke [National Institutes of Health Stroke Scale (NIHSS 5-14)] than in mild stroke (NIHSS 1-4). It was also more common in total anterior circulation infarct (TACI) than partial anterior circulation or lacunar infarct (LacI) and in posterior circulation strokes than the strokes involving anterior circulation. Patients with dysphagia had longer hospital stays (7.29 ± 3.4 days vs 3.62 ± 1.5 days, p = 0.001) and higher mean modified Rankin score at discharge (3.45 vs 2.17, p = 0.001). CONCLUSION Swallowing dysfunction should be checked in all cases of strokes, including unilateral hemispheric strokes and in fully conscious patients. Swallowing improves with time, but the patient may require feeding assistance in an acute setting. Dysphagia is more common in strokes with higher NIHSS, involving more brain parenchyma and posterior circulation strokes.
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Affiliation(s)
| | | | - Sangeeta Pednekar
- Professor, Department of Medicine, Lokmanya Tilak Municipal Medical College and General Hospital (LTMGH), Mumbai, Maharashtra, India
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Pednekar SJ, Sabesan S, Pandey D, Mirg S, Pawar N, Nandwani J, Bansode M, Wadile R, Londhe C, Karnik N. Study of Clinical Spectrum of Severe COVID-19 Infection in Elderly Patients and its Outcome-A Major Mumbai Tertiary Care Hospital Observations. J Assoc Physicians India 2022; 70:11-12. [PMID: 35438275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND At 140 million, India has the second largest population of old people in the world, as per the 2011 census.1 The covid 19 pandemic has wreaked havoc in millions of lives. Elderly are especially vulnerable to COVID-19 and experience high morbidity and mortality as a result of immunosenescence. Age is independently linked with mortality, but age alone does not adequately capture the robustness of older adults who are a heterogeneous group. The current research was done in a tertiary healthcare hospital in Maharashtra to understand the clinical profile and factors that affected the outcome of elderly during the second wave of the COVID pandemic. METHOD This was a single centre retrospective observational study done in a tertiary hospital which was admitting both covid and non-covid patients during the time of this study. All elderly patients admitted with COVID 19 disease in Covid ward and covid ICU (Intensive care unit) were included in the study. Their Demographic details, duration of illness, vital parameters, oxygen saturation, partial pressure of arterial oxygen compared to fraction of inspired oxygen (PaO2-FiO2 ratio) were recorded and also relevant investigations such as complete blood count, kidney function tests, liver function tests, arterial blood gases, chest X-rayand ECG (Electrocardiogram),CT scan of the brain, CSF(cerebrospinal fluid) studies and other tests where relevant were recorded. Inflammatory markers such as C-Reactive Protein (CRP), Ferritin, D-Dimer and Chest CT scan were noted. Clinical profiles and outcomes were noted till discharge or death. RESULTS Among 231 patients that were included in this study, 81(35%) were female and 150 (65%) were male. Ninety-two patients died (39.8%) while 139 patients (60.2%) survived in our study. Majority of our patients (211;91.3%) presented in category E(pneumonia with respiratory failure) or category F(pneumonia with respiratory failure and multiorgan dysfunction syndrome). Factors which had a major impact on mortality were- a low PaO2-FiO2 ratio on admission, high C-Reactive Protein (CRP) levels, high d-dimer levels, a finding of bilateral ground glass opacities on x-ray, and need for invasive ventilation on admission. CONCLUSIONS Elderly remain vulnerable to severe consequences of COVID-19 infection owing to the increasing comorbidities and immunosenescence in them. Prolonged oxygen therapy and intensive respiratory rehabilitation are the mainstays of effective management. Given the constant threat of mutating virus, masking, maintaining hand sanitization, vaccination and also caring for our elders while still maintaining social distance are our best bet against a fatal third wave.
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Affiliation(s)
- Sangeeta J Pednekar
- Professor, Head of Unit and In-Charge Geriatric Services, Department of Medicine, LTM Medical College General Hospital, Mumbai, Maharashtra
| | - Sneha Sabesan
- Assistant Professor, Department of Medicine, LTM Medical College General Hospital, Mumbai, Maharashtra
| | - Dharmendra Pandey
- Associate Professor,Department of Medicine, LTM Medical College General Hospital, Mumbai, Maharashtra
| | - Shivam Mirg
- Junior Resident, Department of Medicine, LTM Medical College General Hospital, Mumbai, Maharashtra
| | - Nisha Pawar
- Junior Resident, Department of Medicine, LTM Medical College General Hospital, Mumbai, Maharashtra
| | - Jagriti Nandwani
- Junior Resident, Department of Medicine, LTM Medical College General Hospital, Mumbai, Maharashtra
| | - Mangesh Bansode
- Junior Resident, Department of Medicine, LTM Medical College General Hospital, Mumbai, Maharashtra
| | - Rahul Wadile
- Junior Resident, Department of Medicine, LTM Medical College General Hospital, Mumbai, Maharashtra
| | - Charulata Londhe
- Associate Professor, Department of Medicine, LTM Medical College General Hospital, Mumbai, Maharashtra
| | - Niteen Karnik
- Professor and Head, Department of Medicine, LTM Medical College General Hospital, Mumbai, Maharashtra
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Sundar U, Karnik ND, Mukhopadhyay A, Darole P, Kolte S, Bansal A, Gokhale YA, Asole D, Joshi A, Pednekar S, Chavan S, Trivedi T, Padwal N, Kalekar L, Londhe C. COVID-19 Associated Stroke-A Single Centre Experience. J Assoc Physicians India 2021; 69:11-12. [PMID: 34472782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND PURPOSE Various neurological complications have been reported in association with COVID-19. We report our experience of COVID-19 with stroke at a single center over a period of eight months spanning 1 March to 31 October 2020. METHODS We recruited all patients admitted to Internal Medicine with an acute stroke, who also tested positive for COVID-19 on RTPCR. We included all stroke cases in our analysis for prediction of in-hospital mortality, and separately analyzed arterial infarcts for vascular territory of ischemic strokes. RESULTS There were 62 stroke cases among 3923 COVID-19 admissions (incidence 1.6%). Data was available for 58 patients {mean age 52.6 years; age range 17-91; F/M=20/38; 24% (14/58) aged ≤40; 51% (30/58) hypertensive; 36% (21/58) diabetic; 41% (24/58) with O2 saturation <95% at admission; 32/58 (55.17 %) in-hospital mortality}. Among 58 strokes, there were 44 arterial infarcts, seven bleeds, three arterial infarcts with associated cerebral venous sinus thrombosis, two combined infarct and bleed, and two of indeterminate type. Among the total 49 infarcts, Carotid territory was the commonest affected (36/49; 73.5%), followed by vertebrobasilar (7/49; 14.3%) and both (6/49; 12.2%). Concordant arterial block was seen in 61% (19 of 31 infarcts with angiography done). 'Early stroke' (within 48 hours of respiratory symptoms) was seen in 82.7% (48/58) patients. Patients with poor saturation at admission were older (58 vs 49 years) and had more comorbidities and higher mortality (79% vs 38%). Mortality was similar in young strokes and older patients, although the latter required more intense respiratory support. Logistic regression analysis showed that low Glasgow coma score (GCS) and requirement for increasing intensity of respiratory support predicted in-hospital mortality. CONCLUSIONS We had a 1.6% incidence of COVID-19 related stroke of which the majority were carotid territory infarcts. In-hospital mortality was 55.17%, predicted by low GCS at admission.
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Affiliation(s)
- Uma Sundar
- Professor, Medicine, Lokmanya Tilak Municipal Medical College and General Hospital (LTMMC&GH), Mumbai, Maharashtra; Corresponding Author
| | - Niteen D Karnik
- Professor, Medicine, Lokmanya Tilak Municipal Medical College and General Hospital (LTMMC&GH), Mumbai, Maharashtra
| | - Amita Mukhopadhyay
- Associate Professor, Community Medicine, Dr Chandramma Dayananda Sagar Institute of Medical Education and Research, Kanakapura, Ramanagara District, Karnataka
| | - Pramod Darole
- Associate Professor, Radiology, LTMMC & GH, Mumbai, Maharashtra
| | - Shaonak Kolte
- Research Assistant, Medicine, Radiology, LTMMC & GH, Mumbai, Maharashtra
| | - Ashank Bansal
- Assistant Professor, Radiology, Radiology, LTMMC & GH, Mumbai, Maharashtra
| | - Yojana A Gokhale
- Professor, Medicine, Lokmanya Tilak Municipal Medical College and General Hospital (LTMMC&GH), Mumbai, Maharashtra
| | - Dnaneshwar Asole
- Assistant Professor, Medicine, Radiology, LTMMC & GH, Mumbai, Maharashtra
| | - Anagha Joshi
- Professor, Radiology, LTMMC & GH, Mumbai, Maharashtra
| | - Sangeeta Pednekar
- Professor, Medicine, Lokmanya Tilak Municipal Medical College and General Hospital (LTMMC&GH), Mumbai, Maharashtra
| | - Swati Chavan
- Professor, Medicine, Lokmanya Tilak Municipal Medical College and General Hospital (LTMMC&GH), Mumbai, Maharashtra
| | - Trupti Trivedi
- Professor, Medicine, Lokmanya Tilak Municipal Medical College and General Hospital (LTMMC&GH), Mumbai, Maharashtra
| | - Namita Padwal
- Associate Professor, Radiology, LTMMC & GH, Mumbai, Maharashtra
| | - Lalana Kalekar
- Associate Professor, Radiology, LTMMC & GH, Mumbai, Maharashtra
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Kl NK, Pednekar SJ, Londhe C, Pandey DB, Athawale AD. Study of Low Bone Mineral Density in Ambulant Elderly Population by Quantitative Ultrasonography and it's Implications on Fragile Fracture Risk. J Assoc Physicians India 2021; 69:62-65. [PMID: 34189889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Naveen Kumar Kl
- Senior Resident, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra;Corresponding Author
| | - Sangeeta J Pednekar
- Professor and Head of Unit, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra
| | - Charulata Londhe
- Associate professor, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra
| | - Dharmendra B Pandey
- Associate professor, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra
| | - Ajay D Athawale
- Senior Resident,Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra
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Gokhale Y, Mehta R, Kulkarni U, Karnik N, Gokhale S, Sundar U, Chavan S, Kor A, Thakur S, Trivedi T, Kumar N, Baveja S, Wadal A, Kolte S, Deolankar A, Pednekar S, Kalekar L, Padiyar R, Londhe C, Darole P, Pol S, Gokhe SB, Padwal N, Pandey D, Yadav D, Joshi A, Badgujar H, Trivedi M, Shah P, Bhavsar P. Tocilizumab improves survival in severe COVID-19 pneumonia with persistent hypoxia: a retrospective cohort study with follow-up from Mumbai, India. BMC Infect Dis 2021; 21:241. [PMID: 33673818 PMCID: PMC7934984 DOI: 10.1186/s12879-021-05912-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cytokine storm triggered by Severe Coronavirus Disease 2019 (COVID-19) is associated with high mortality. With high Interleukin -6 (IL-6) levels reported in COVID-19 related deaths in China, IL-6 is considered to be the key player in COVID-19 cytokine storm. Tocilizumab, a monoclonal antibody against IL-6 receptor, is used on compassionate grounds for treatment of COVID-19 cytokine storm. The aim of this study was to assess effect of tocilizumab on mortality due to COVID-19 cytokine storm. METHOD This retrospective, observational study included patients of severe COVID-19 pneumonia with persistent hypoxia (defined as saturation 94% or less on supplemental Oxygen of 15 L per minute through non-rebreathing mask or PaO2/FiO2 ratio of less than 200) who were admitted to a tertiary care center in Mumbai, India, between 31st March to 5th July 2020. In addition to standard care, single Inj. Tocilizumab 400 mg was given intravenously to 151 consecutive COVID-19 patients with persistent hypoxia, from 13th May to 5th July 2020. These 151 patients were retrospectively analysed and compared with historic controls, ie consecutive COVID-19 patients with persistent hypoxia, defined as stated above (N = 118, from our first COVID-19 admission on 31st March to 12th May 2020 i.e., till tocilizumab was available in hospital). Univariate and multivariate Cox regression analysis was performed for identifying predictors of survival. Statistical analysis was performed using IBM SPSS version 26. RESULTS Out of 269 (151 in tocilizumab group and 118 historic controls) patients studied from 31st March to 5th July 2020, median survival in the tocilizumab group was significantly longer than in the control group; 18 days (95% CI, 11.3 to 24.7) versus 9 days (95% CI, 5.7 to 12.3); log rank p 0.007. On multivariate Cox regression analysis, independent predictors of survival were use of tocilizumab (HR 0.621, 95% CI 0.427-0.903, P 0.013) and higher oxygen saturation. CONCLUSION Tocilizumab may improve survival in severe COVID-19 pneumonia with persistent hypoxia. Randomised controlled trials on use of tocilizumab as rescue therapy in patients of severe COVID-19 pneumonia with hypoxia (PaO2/FiO2 less than 200) due to hyperinflammatory state, are warranted.
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Affiliation(s)
- Yojana Gokhale
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India.
| | - Rakshita Mehta
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Uday Kulkarni
- Christian Medical College, Vellore, Tamil Nadu, India
| | - Nitin Karnik
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Sushant Gokhale
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Uma Sundar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Swati Chavan
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Akshay Kor
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Sonal Thakur
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Trupti Trivedi
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Naveen Kumar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Sujata Baveja
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Aniket Wadal
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Shaonak Kolte
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Aukshan Deolankar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Sangeeta Pednekar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Lalana Kalekar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Rupal Padiyar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Charulata Londhe
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Pramod Darole
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Sujata Pol
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | | | - Namita Padwal
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Dharmendra Pandey
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Dhirendra Yadav
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Anagha Joshi
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Harshal Badgujar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Mayuri Trivedi
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Priyanshu Shah
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Prerna Bhavsar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
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Chopra S, Pednekar S, Karnik ND, Londhe C, Pandey D. A Study of the Outcome of Critically Ill Elderly Patients in a Tertiary Care Hospital Using SOFA Score. Indian J Crit Care Med 2021; 25:655-659. [PMID: 34316145 PMCID: PMC8286402 DOI: 10.5005/jp-journals-10071-23883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background With a rapidly rising geriatric population, the magnitude of elderly patients requiring intensive care is a major cause of concern. Data on critically ill geriatric patients is scarce, especially in developing countries. Aim and objective The aim of the study is to identify the etiology, clinical profile, and outcome in elderly patients admitted to the intensive care unit (ICU) and to predict their survival using the sequential organ failure assessment (SOFA) score. Materials and methods A prospective observational study was performed over a period of 18 months with analysis of 100 patients admitted to the ICU, above the age of 60 years, with multi-organ dysfunction. The outcome of discharge or death was studied using the SOFA score on admission, on day 2, and the delta SOFA score. Results In this study of 100 patients, 88% of patients were in the 60–70 years age-group. The number of male and female patients was equal. Seventy percent of patients had comorbidities, of which hypertension was most common. The two most common etiologies were acute febrile illness and pneumonia. The use of mechanical ventilation, inotropic support, and serum creatinine has a significant association with the outcome. The SOFA score at admission did not have a significant association, but the score at 48 hours and delta SOFA score co-related with the outcome of the patients. Sixty-four patients got discharged; thus, there was a survival rate of 64%. Conclusion The SOFA score at 48 hours is the most sensitive predictor of outcome, followed closely by the delta SOFA score, as compared to the SOFA score on admission, for critically ill elderly patients. There is a significant association of use of mechanical ventilation, inotropic support, and serum creatinine with the outcome. How to cite this article Chopra S, Pednekar S, Karnik ND, Londhe C, Pandey D. A Study of the Outcome of Critically Ill Elderly Patients in a Tertiary Care Hospital Using SOFA Score. Indian J Crit Care Med 2021;25(6):655–659.
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Affiliation(s)
- Shivani Chopra
- Department of Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Sangeeta Pednekar
- Department of Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Niteen D Karnik
- Department of Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Charulata Londhe
- Department of Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Dharmendra Pandey
- Department of Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
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Londhe C, Londhey V. Health Care Workers in Covid-19: From Lockdown to Unlock and Beyond! J Assoc Physicians India 2020; 68:11-12. [PMID: 33247635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Charulata Londhe
- Associate Professor of Medicine, LTMMC and GH, Mumbai, Maharashtra
| | - Vikram Londhey
- Associate Professor of Medicine, HBTMC and RN Cooper Hospital, Mumbai, Maharashtra
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Shilimkar Y, Londhe C, Sundar U, Darole P. Dysphagia in Parkinsonism: Prevalence, Predictors and Correlation with Severity of Illness Fasting). J Assoc Physicians India 2020; 68:22-25. [PMID: 32610861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Dysphagia is frequently present in Parkinsonian syndromes and is associated with increased morbidity and mortality. Early identification of swallowing dysfunction is critical to minimize complications like aspiration pneumonia and malnutrition. Published prevalence rates for dysphagia in Parkinsonian syndromes vary widely with a very few studies from India. In this study we aimed to determine prevalence of dysphagia in Parkinson's disease and other Parkinson plus syndromes; to correlate it with severity of underlying illness and to determine the factors predicting dysphagia in patients of Parkinson's disease. METHODS It was a prospective observational study performed over 18 months in the neurology clinic of tertiary care public teaching hospital in Mumbai. All patients of Parkinson's disease (PD) diagnosed by UKPDS criteria and all patients of Parkinson-plus syndromes diagnosed clinically were included in the study serially. Patients with cognitive dysfunction (MMSE<24) and those having other neurological or non-neurological causes of dysphagia were excluded from the study. Swallowing dysfunction was assessed by MASA scoring sheet. Disease severity of PD was assessed by modified Hoehn and Yahr scale. Peripheral oxygen desaturation after swallowing water was monitored by pulse-oxymetry; as a bedside test for micro-aspiration. The data was tabulated and analyzed. RESULTS 70 patients were included in the study including 63 with PD, 5 with PSP and 2 with MSA. Dysphagia was present in 40 (57.4%). 27 had mild; 12 had moderate and 1 had severe dysphagia. In Parkinson's disease dysphagia was significantly associated with following predicting factors: age > 65 years, disease duration > 3 years, modified Hoehn and Yahr scale > 2 and MMSE < 27 (p < 0.001 for all). By multiple logistic regression analysis, the duration of disease and MMSE score were the independent predictors for dysphagia in Parkinson's disease. Severity of dysphagia directly correlated with severity of underlying disease demonstrated by decreasing MASA score with rising Hoehn and Yahr stage. CONCLUSIONS Prevalence of dysphagia in Parkinsonian syndromes was overall 57.14%; being 55.16% in Parkinson's disease. Prevalence and severity of dysphagia showed direct correlation with severity of Parkinson's disease. Duration of disease and cognitive dysfunction are the independent predictors of dysphagia in Parkinson's disease.
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Affiliation(s)
| | - Charulata Londhe
- Associate Professor, Department of Medicine, LTMMC and GH, Mumbai, Maharashtra
| | - Uma Sundar
- Professor of Medicine, In-charge Neurology Services, LTMMC and GH, Mumbai, Maharashtra
| | - Pramod Darole
- Associate Professor, Department of Medicine, LTMMC and GH, Mumbai, Maharashtra
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Londhe C, Ganeriwal A, deSouza R. Study of clinical profile of acute respiratory distress syndrome and acute lung injury in Plasmodium vivax malaria. J Vector Borne Dis 2014; 51:339-342. [PMID: 25540968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- Charulata Londhe
- Department of Medicine, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, India
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