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Background Patient-reported outcome measures (PROs) used to measure symptoms of patients with paroxysmal nocturnal hemoglobinuria (PNH) in trials do not measure PNH symptoms comprehensively and do not assess daily fluctuations in symptoms. Following a literature review and consultation with a PNH expert, we drafted the PNH Symptom Questionnaire (PNH-SQ) and a patient-centric conceptual model of PNH symptoms and impacts. We then interviewed 15 patients with PNH to assess comprehensiveness of symptom capture from the patient perspective and to cognitively debrief the PNH-SQ. Patient interview data were also used to finalize the PNH conceptual model. Results Participants mentioned 27 signs or symptoms of PNH spontaneously or after being probed; 93% reported experiencing ≥ 1 PNH symptom. Concept saturation was reached for all PNH symptoms. Further, interviews confirmed the instrument captured the most common PNH symptoms, including fatigue (87%), abdominal pain (60%), and difficulty swallowing (47%), with fatigue ranked as the most bothersome symptom. The interviews demonstrated that participants understood the items of the PNH-SQ (90–100%); considered the symptoms relevant (> 50– > 90%); the recall period appropriate (> 80–100%); and the response options suitable (> 80–100%). Participants also suggested changes regarding item redundancy and relevance; this feedback was used to finalize the instrument. Conclusions The finalized PNH-SQ assesses the presence and severity of 10 symptoms—abdominal pain, chest discomfort, difficulty sleeping, difficulty swallowing, difficulty thinking clearly, fatigue, headache, muscle weakness, pain in the legs or back, and shortness of breath—over 24 h. The PNH-SQ is a content-valid questionnaire suitable for assessing daily symptom presence and severity in PNH clinical trials.

Tonsillitis is a disease that is often experienced by a person, especially often occurs in children. Based on a survey from the Indonesian Ministry of Health in 2012, the incidence of tonsillitis in Indonesia reached around 23%. Acute tonsillitis that is not properly treated can cause chronic tonsillitis, therefore it is important to know the characteristics of tonsillitis symptoms in order not to develop into chronic tonsillitis. Tonsillitis is an inflammation of the tonsils caused by infection with the Streptococcus group of bacteria or viruses which can be acute or chronic. Symptoms that often appear in tonsillitis are sore throat, difficulty swallowing and when it reaches chronic it can block the respiratory tract. The purpose of this study was to determine the characteristics of tonsillitis patients in children aged 5-12 years at Rspba Bandar Lampung in 2020. The research method in this study was cross-sectional. It is known that the results of the study of tonsillitis patients in children, the most common symptom of which was pain during swallowing (40.5%), tonsillitis patients in children were often found in T2-T2 sizes (37.8%), tonsillitis patients in children were often experienced. by men (71.1%). tonsillitis patients in children are often experienced by ages 7-8 years (48.6%), the incidence of tonsillitis cases is 8.34%, the prevalence of tonsillitis cases in children aged 5-12 years is 41.1%, in children aged 5 -12 years have a lot of chronic tonsillitis. The characteristics found in tonsillitis patients aged 5-12 years, namely swallowing pain, widening of the T2-T2 tonsil size, mostly experienced by men and often occurs at 7-8 years of age, the incidence is 8.34%, prevalence in children. age 5-12 years as much as 41.1% and many children have chronic tonsillitis.

COVID-19 was first reported of in December of 2019 and has since developed into a global pandemic disease. An intratonsillar abscess is a rarely encountered diagnosis and the clinical presentation can mimic that of a peritonsillar abscess. Here, we report on two cases of intratonsillar abscess and concurrent COVID-19 infection. Case 1: A 19-year old male presented with a sore throat, right-sided neck pain and difficulty swallowing. Needle aspiration of a peritonsillar bulging was negative for pus. Computed tomography showed an intratonsillar abscess. Intratonsillar needle aspiration was again negative for pus. The patient was treated with antibiotics and his condition improved without surgical intervention. Case 2: A 43-year-old female presented with a sore throat, difficulty swallowing, fever and myalgia. Examination showed peritonsillar swelling on the right side. Computed tomography showed an intratonsillar abscess on the right side. Intratonsillar needle aspiration was positive for pus. The patient was treated with antibiotics and her condition improved. To our knowledge, this is the first publication to report the development of intratonsillar abscess in patients with COVID-19.

Achalasia is a neurodegenerative disorder of the lower esophagus characterized by high lower esophageal pressures and aperistalsis of the esophageal body. It remains a difficult to treat disease with significant burden on patients due to difficulty swallowing leading to malnutrition. Peroral endoscopic myotomy (POEM) is a newer endoscopic treatment of achalasia. It involves dividing the muscular layer of the esophagus through a submucosal tunnel. Ten-year data show POEM is a safe and effective treatment of achalasia. However, postoperative gastroesophageal reflux disease remains an important consideration.

Dysphagia, defined as difficulty swallowing, is a common symptom negatively impacting millions of adults annually. Estimated prevalence ranges from 14 to 33 percent in those over age 65 to over 70 percent in a nursing home setting. The elderly, those with neurodegenerative diseases, head and neck cancer patients, and those with autoimmune conditions such as Sjögren's syndrome are disproportionately affected. Oropharyngeal dysphagia refers specifically to difficulty in initiating a swallow due to dysfunction at or above the upper esophageal sphincter, and represents a large proportion of dysphagia cases. Current treatments are limited and are often ineffective. Stem cell therapy is a new and novel advancement that may fill a much-needed role in our treatment regimen. Here, we review the current literature regarding stem cell treatments for oropharyngeal dysphagia. Topics discussed include tissue regeneration advancements as a whole and translation of these principles into research surrounding tongue dysfunction, xerostomia, cricopharyngeal dysfunction, and finally an overview of the challenges and future directions for investigation. Although this field of study remains in its early stages, initial promising results show potential for the use of stem cell-based therapies to treat oropharyngeal dysphagia and warrant further research.

Many older adults suffer from difficulty swallowing thin beverages like water or coffee. To improve swallowing safety, beverages are typically thickened. This creates a new problem: the thickened beverages can be disgusting. New research suggests chemesthesis, particularly spiciness, carbonation, or intense sourness, could improve swallowing without the need for thickeners. Yet, whether such beverages would be liked by older adults is unknown. We thus conducted this experiment to establish older adults' sensory perception and liking/disliking of commercially available chemesthetic beverages. We recruited participants to rate sweetness, sourness, fizziness, stinging, and liking/disliking of unsweetened carbonated waters (1 plain, 5 flavored), sour orange juice, spicy ginger beer, and colas (sugar or aspartame-sweetened). Initial tests (N = 30 older adults) indicated sour orange juice, spicy ginger beer, and two of the flavored waters were not well-liked, so other beverages were selected for a second test (N = 94, 30 younger adults, 64 older adults). Sweetened, carbonated colas were the best-liked of the beverages. The unsweetened, flavored carbonated waters were in general not liked. Regarding comparisons of sensory ratings between older and younger adults, only sweetness differed between age groups. In particular, intensity ratings for the chemesthetic aspects of the beverages (stinging/burning/spiciness, fizziness) and the sour taste did not differ by age. As the chemesthetic properties are the most likely reason the beverages could aid in swallowing safety, observing no suppression of these sensations in older adults is encouraging for the potential of these products as a treatment option.

Background This paper presents a peculiar first case of an allergy to Silybum marianum (milk thistle) and Eragrostis tef (teff). Both teff and milk thistle have been presented in the literature (both domestic and foreign) in a positive light, the former as a new part of gluten-free diet, and the latter as a treatment for a number of conditions, particularly those of the liver. Case presentation A 29-year-old male presented at our clinic due to an episode of itching and burning in his mouth, swollen tongue, and difficulty swallowing following ingestion of teff flakes. He also reported sneezing, runny nose, watering and burning eyes, and wheezing following inhalation exposure to ground milk thistle. The patient’s occupation is associated with exposure to these allergens. The patient underwent comprehensive allergy diagnostic assessments (including skin-prick testing, serum specific IgE levels, Faber test, spirometry, and acoustic rhinometry) and gastroenterological assessments. The diagnosis was established on skin tests with native allergens (milk thistle 16/35, teff flour 22/60, negative control 0/0, histamine 3/5) provided by the patient. There are no commercially available (standardized) tests for milk thistle or teff either in Poland or anywhere else in the world. Conclusions Milk thistle is available in the form of dry, finely-ground preparations (which are used as additives to bread, soups, and yoghurts) and extracts (which are used as ingredients in over-the-counter herbal remedies). Teff is a gluten-free cereal whose grains are rich in methionine, calcium, iron, folic acid, and antioxidants. This case report presents milk thistle and teff as potentially new allergens. A literature review revealed no similar allergy cases in Poland or elsewhere in the world.

Horizon Scan reports provide brief summaries of information regarding new and emerging health technologies. These technologies are identified through the CADTH Horizon Scanning Service as topics of potential interest to health care decision-makers in Canada. This Horizon Scan summarizes the available information regarding an emerging technology, Phagenyx, a pharyngeal electrical stimulation device for the treatment of difficulty swallowing associated with neurologic conditions.

Amyotrophic lateral sclerosis (ALS) occurs in older adults, but it can show itself in many different ways. ALS mostly affects muscle strength. It can affect different muscles in our bodies, and because of this, does not always look the same from one person to another. For instance, some people will have a form of ALS that mostly affects their breathing (or respiratory) muscles. When this happens, they have shortness of breath, even after minor exercise. For others, ALS may affect their throat and mouth muscles first: this results in difficulty swallowing (often called bulbar ALS). With increasing study, scientists have also recognized that may people with ALS not only have muscle weakness, but may also have problems with thinking, or changes in their behavior.

Aim To examine the association between a decrease in the frequency of going out and oral function in independent older adults living in the urban area of Tokyo. Methods The participants analyzed were 785 older adults from the "Takashimadaira Study" (344 men and 441 women, age 77.0 +/- 4.6 years). This study investigated the following items: decrease in frequency of going out; basic characteristics (sex, age); physical factors, such as oral function (difficulty chewing, difficulty swallowing, dry mouth); body pain; the Japan Science and Technology Agency Index of Competence; physical activities; psychological factors, such as the Geriatric Depression Scale-15 score; and social and environmental factors, such as the presence or absence of participation in organization activities. Results To investigate the factors associated with a decrease in frequency of going out, logistic regression analysis showed an association with age (OR 1.08, 95% CI 1.03-1.13), difficulty chewing (OR 2.41, 95% CI 1.52-3.83), dry mouth (OR 1.68, 95% CI 1.07-2.64), body pain (OR 1.78, 95% CI 1.14-2.78), Japan Science and Technology Agency Index of Competence scores (OR 0.91, 95% CI 0.84-0.99), physical activities (OR 0.99, 95% CI 0.98-1.00), Geriatric Depression Scale-15 scores (OR 1.13, 95% CI 1.05-1.21) and organization activities (OR 1.94, 95% CI 1.22-3.07). Covariance structural analyses showed that both "difficulty chewing" and "dry mouth" significantly affected "decrease in frequency of going out." In addition, decrease in frequency of going out was significantly affected by " Geriatric Depression Scale-15 scores" through oral function. Conclusions The relationship between oral function and decrease in frequency of going out was clarified, after the multifaceted factors were adjusted. Geriatr Gerontol Int 2019; center dot center dot: center dot center dot-center dot center dot.

Dysphagia, the perceived impediment to swallowing food, is a common postsurgical symptom that can have debilitating consequences. This study presents the successful treatment of severe esophageal dysphagia with a problem-focused and patient-centered approach to hypnosis, informed by long-term empirical follow-up. The authors describe a case history involving significant and persistent difficulty swallowing for which no medical or surgical treatment could be found. Over the course of 10 sessions, the patient was assessed, treated with imaginal exposure, and instructed in self-hypnosis. Outcomes were measured at treatment conclusion, and 6-, 9-, and 18-month follow-ups. Following hypnosis, the patient exhibited significant and reliable change (RC) in visceral hypersensitivity (RC = -3.16, p = .002), emotional distress (RC = -2.21, p= .03), subjective well-being (RC = 4.14, p< .0001), and posttraumatic symptoms (RC = -3.33, p= .001). Gains were maintained at 18-month follow-up.

Background There are an increasing number of older housebound patients who are not seen by the pharmacists responsible for the provision of their medications. This growing population is increasingly dependent on time-limited carers for their medication support. Objectives To evaluate the findings of pharmacist led holistic domiciliary medicine use reviews (dMUR) targeted at this group of housebound patients, in terms of required medication support and the identification of unmet social care needs. Methods Patients were identified in the London Borough of Richmond (UK) who were predominantly housebound and taking multiple medications. Twelve community pharmacists visited patients and carried out interviews as part of a structured holistic dMUR, which included understanding the patients' living conditions. Results Altogether 133 patients completed the dMUR with the pharmacist. Patients had a mean age of 81.7 years (range 49–98 years) and took an average of 9.4 different medications, 3 of which being high risk. Nearly 40% had difficulties taking their medications, including a lack of dexterity or difficulty swallowing. Over a quarter (26.8%) of diabetic patients lacked monitoring. Patients were identified with a risk of falling (14.3%) and inadequate social care (11.3%). Continence, dehydration, hygiene and nutrition issues were found, often caused by mobility problems or a lack of suitable toilet facilities. A need for home modifications such as hand rails to prevent falls was also identified. Conclusions This study highlighted the varied difficulties facing housebound patients identified during the pharmacists' visits, including a lack of social care provision and fall hazards. Domiciliary visits by pharmacists may be able to help identify the diverse care needs of isolated housebound patients helping to integrate their care requirements.

Situs inversus totalis (SIT) is a rare congenital condition in which the abdominal and thoracic organs are completely reversed from right to left, and their diagnosis is usually incidental. However, patients with SIT need a comprehensive radiological evaluation before undertaking any invasive procedures. Percutaneous endoscopic gastrostomy (PEG) insertion is an effective procedure for enteral feeding in patients with difficulty swallowing. Many post-procedural complications have been reported after the PEG procedure. We performed PEG insertion in an 85-year-old Qatari SIT patient, who was admitted to the hospital as a case of aspiration pneumonia and on nasogastric feeding tube (NGT). The procedure was started while the patient was in left lateral decubitus position as in normal anatomy patients after careful examination and in accordance with the general principles of PEG insertion. No complications were seen, neither intraoperative nor postoperative in two months follow-up. We suggest that in a patient with SIT, PEG insertion can be performed while the patient is in left decubitus position with no additional risk or extra intraoperative time if the pre-operative anatomical position of vital organs is carefully evaluated.

A 58-year-old male patient was admitted to the Otorhinolaryngology department with acute hemoptysis. In his history, it was understood that he drank natural water 2 days ago. The patient had hemoptysis, which occurred with spitting. The patient had difficulty swallowing and discomfort when swallowing. Endoscopic examination revealed a blackish live foreign object in the hypopharynx with right local posterior hypopharyngeal oozing. Hypopharyngeal leech was suspected and removed immediately using forceps. After the leech was removed, the bleeding stopped immediately and the patient started swallowing and breathing comfortably. Pharyngeal leeches should be included in the differential diagnosis of patients with hemoptysis, especially in patients with a history of drinking unfiltered water from sources where aquatic leeches are commonly found.

Author(s): Rabinowitz, Sarah; Solano, Joshua J. | Abstract: Introduction: Histamine-mediated angioedema is a potentially life-threatening reaction following exposures that incite mast cell activation. In Florida, red tides are a frequent phenomenon caused by overgrowth of the harmful algae species Karenia brevis, which contain environmentally detrimental brevetoxins. Even in low concentrations, brevetoxins can cause disease in humans through inducing histamine release. We report the first documented case of angioedema associated with red tide exposure.Case Report: A 52-year-old-male presented with severe angioedema encompassing both lips within a few hours after exposure to red tide algae. Other symptoms included voice changes and difficulty swallowing. Laboratory findings revealed complement factors that were within reference range, which ruled out a bradykinin-mediated pathology and supported the diagnosis of histaminergic angioedema. Symptoms resolved after 24 hours in the intensive care unit under management with epinephrine, diphenhydramine, methylprednisolone, and famotidine.Conclusion: In coastal regions, red tide algae should be recognized as a rare cause of acute angioedema. Emergency management of histamine-mediated angioedema should focus on preventing respiratory compromise with frequent airway monitoring and treatment with steroids, antihistamines, and epinephrine.

A 38-year-old female presented with itching and erythema of the scalp. She had been treated with antifungal shampoos and topical steroids with little improvement. She also reported a rash on the sun-exposed sites of her chest and back that would also itch. The rashes were treated with topical steroids and improved but would typically recur, especially after sun exposure. She reported difficulty with getting out of a chair and walking upstairs. She stated that her muscles just felt fatigued at times; she could not complete basic activities. In addition, she reported difficulty swallowing, joint pain, and fatigue.

A man in his mid 50s with type 2 diabetes and hypertension presented with four days of fever and worsening neck pain and swelling, initially left sided but subsequently spreading to the right. The pain and swelling had rapidly increased over the preceding 12 hours, forcing him to remove his dentures, and causing restricted mouth opening and progressive difficulty swallowing. His only remaining native tooth was his lower left first molar (LL7), all others having been extracted several years earlier owing to advanced decay. Examination showed firm, tender bilateral submental and submandibular swelling with skin induration, mouth opening reduced to less than two finger breadths, and elevation and rightward displacement of the tongue by a prominent, fluctuant swelling of the left side of …

To assess challenges with daily oral antiretroviral therapy (ART), we analyzed data for 2389 participants in the 2019 Positive Perspectives survey of people living with HIV in 25 countries. ART-related challenges reported included difficulty swallowing pills (33.1% [790/2389]); stress from daily dosing routine (33.3% [795/2389]); bad memories from daily intake of HIV medication (35.1%[839/2389]), and concern “that having to take pills every day means a greater chance of revealing my HIV status to others” (37.9% [906/2389]). Individuals who felt empowered by daily oral dosing [“taking my pill(s) every day reassures me that my HIV is being kept under control”] had 69% higher odds of optimal overall health (AOR 1.69, 95% CI 1.40–2.04). Conversely, odds of optimal overall health were lower among those who felt daily pill intake “limits my day-to-day life” (AOR 0.53, 95% CI 0.44–0.64). These findings show that there is need for increased flexibility of ART delivery to meet diverse patient needs. Electronic supplementary material The online version of this article (10.1007/s10461-020-03055-1) contains supplementary material, which is available to authorized users.

To study the jitter parameters in the distant (DM) and the adjacent muscle (AM) after botulinum neurotoxin type A (BoNT/A) injection in 78 patients, jitter was measured by voluntary activation in DM (n = 43), and in AM (n = 35). Patients were receiving BoNT/A injections as a treatment for movement disorders. Mean age 65.1 years (DM) and 61.9 years (AM). The mean jitter was abnormal in 13.9% (maximum 41.4 &micro, s) of DM, and 40% (maximum 43.7 &micro, s) of AM. Impulse blocking was sparse. We found no correlation of the mean jitter to age, BoNT/A most recent injection (days/units), number of muscles injected, total BoNT/A units summated, number of total BoNT/A sessions, beta-blockers/calcium channel blockers use, and cases with local spread symptoms such as eyelid drop/difficulty swallowing. Maximum mean jitter (41.4/43.7 &micro, s) for DM/AM occurred 61 and 131 days since the most recent BoNT/A, respectively. The far abnormal mean jitter (32.6/36.9 &micro, s) occurred 229 and 313 days since the most recent BoNT/A. We suggested that jitter measurement can be done after BoNT/A in a given muscle other than the injected one, after 8 (DM) and 11 (AM) months, with reference &gt, 33 &micro, s and &gt, 37 &micro, s, respectively.

Author(s): Lassiter, Nolan; Yang, Nhia; Tiyyagura, Lakshma; Whitlow, K. Scott | Abstract: Introduction: Silica gel packets are commonly used desiccants for medication products; these packets generally only pose a choking risk in young children. However, new cylindrical desiccant canisters have been developed, which may increase the risk for obstruction in adults.Case Report: An elderly male presented to the emergency department complaining of difficulty swallowing after taking his morning medications. Through a diligent work-up a desiccant canister was found lodged in the lower esophageal sphincter. The patient was endotracheally intubated and a Roth Net retriever was used to remove the canister.Conclusion: Cylindrical desiccant canisters pose an increased risk of esophageal obstruction.

Dysphagia, or difficulty swallowing, is a serious health problem that reduces the quality of life of those affected. The standard method to diagnose dysphagia is the x-ray video fluoroscopic swallowing exam (VFSE). In this paper we investigate the use of deep learning networks to classify VFSE as normal or abnormal. The proposed network is based on a long term recurrent convolutional network (LRCN). This network was trained and validated using 1154 VFSE. Using 10-fold cross-validation, the accuracy of classification was 85% and the area under the ROC curve was 0.89. This work shows the promise of using deep learning networks as a screening tool to detect dysphagia in VFSE.

A 51-year-old man visited our hospital with a main complaint of precordial pain, difficulty swallowing, and pyrexia. The patient was diagnosed with esophageal carcinosarcoma, based on the characteristic morphology noted on upper gastrointestinal endoscopy and histology tests, and he underwent surgical treatment. His preoperative blood granulocyte-colony stimulating factor (G-CSF) and interleukin-6 (IL-6) levels were high, and the surgical specimens were positive in both immunohistochemical tests; therefore, he was diagnosed with a G-CSF- and IL-6-producing tumor. When pyrexia is seen as a paraneoplastic symptom, it is important to consider and investigate the possibility of a cytokine-producing tumor.

Se presenta el caso de una paciente de 18 años de edad, que es evaluada en la unidad de Hospital de Día, con historia de 8 meses de dificultad para deglutir alimentos sólidos, tolerando únicamente la ingestión de alimentos líquidos, asociado a regurgitaciones nocturnas por lo que consulta a médico particular quien realiza exámenes complementarios y la refiere a esta unidad para tratamiento. Al examen físico no presenta alteraciones, persistiendo con disfagia por lo que se programa para realizar esofagomiotomia de Heller videolaparoscópica.

Introduction: There have been countless surgical techniques developed for the purpose of removing the hyperplasia (FH) and improving the alveolar ridge to provide a better adaptation to full prostheses. Techniques used for this procedure may lead to post-operative complications, including oedema, pain, difficulty swallowing, compromised movement, haemorrhage and/or infection. With the advent of the harmonic scalpel, removal of FH can be completed more quickly and less traumatically for the patient due to its intrinsic properties. With standard excision, episodes of pain, swelling and bleeding may be experienced post-operatively, leading to dysphonia and dysphagia, creating challenges to the surgeon. The aim of this study was to examine the efficacy of the Harmonic Synergy® scalpel (HSS) (Johnson & Johnson, Suprimed - Brazil) in the surgical removal of FH. Methods: eleven patients underwent FH removal with HSS. Post-operative examination was conducted at 3, 7 and 30 days after surgery. In all instances, the surgeon was consistently able to control the tissue volume and maintain adequate surgical margins. Results and conclusions: The results demonstrated that the use of the HSS offered better haemostasis, reduce the possibility of post-operative infection and, principally, provided more comfort when compared with a conventional scalpel. Re-establishing an aesthetic and functional state was also quicker with HSS.

Background In many health settings, administration of medicinal cannabis poses significant implementation barriers including drug storage and safety for administering staff and surrounding patients. Different modes of administration also provide different yet potentially significant issues. One route that has become of clinical interest owing to the rapid onset of action and patient control of the inhaled amount (via breath timing and depth) is that of vaporisation of cannabinoid products. Although requiring a registered therapeutic device for administration, this is a relatively safe method of intrapulmonary administration that may be particularly useful for patients with difficulty swallowing, and for those in whom higher concentrations of cannabinoids are needed quickly. A particular concern expressed to researchers undertaking clinical trials in the hospital is that other patients, nurses, and clinical or research staff may be exposed to second-hand vapours in the course of administering vaporised products to patients. Objective The objective of this study was to take samples from two research staff involved in administering vaporised Δ9-tetrahydrocannabinol to participants in a clinical trial, to examine and quantitate cannabinoid presence. Methods Blood samples from two research staff were taken during the exposure period for three participants (cannabis users) over the course of approximately 2.5 h and analysed using tandem mass spectrometry. Results Blood samples taken over a vaporised period revealed exposure below the limit of detection for Δ9-tetrahydrocannabinol and two metabolites, using tandem mass spectrometry analytical methods. Conclusions These results are reassuring for hospital and clinical trial practices with staff administering vaporised cannabinoid products, and helpful to ethics committees wishing to quantify risk.

A 25-year-old otherwise healthy male presented with new-onset odynophagia, rash, and orogenital ulcers. Despite treatment with antibiotics for presumed bacterial pharyngitis, the patient remained symptomatic, with abnormal vital signs and laboratory values. Upon dermatology consultation and histopathologic correlation, he was diagnosed with Behçet disease. Behçet disease is a rare rheumatologic condition that presents with recurrent oral ulcers and varying degrees of ophthalmic, neurologic, cardiac, and vascular disease. Given its protean nature, the treatment of Behçet disease is tailored to the patient's presentation and severity of organ involvement. Following treatment with colchicine and prednisone, the patient's symptoms improved rapidly.

Dysphagia (difficulty swallowing) is a common outcome for stroke patients, who often require feeding through a percutaneous endoscopic gastrostomy (PEG). Before the procedure, clinicians must take the patient's consent. To fill a gap in existing literature, this research explored the experiences of gastroenterologists and gerontologists who have worked with stroke patients regarding the consent process for post-stroke PEG. The research used a qualitative, hermeneutical and phenomenological design. Data collection involved unstructured interviews with 10 doctors of varied experience, which were transcribed and analysed thematically. Four main themes were found. The first, ‘task vs process’, identified that consent was not a single task or document, but a process with several stages that included consideration of patient needs and physical assessment. The second, ‘collaborative working’, considered the importance of a multidisciplinary approach. The third, ‘process of interaction’, emphasised the necessity of ascertaining patient capacity. The fourth, ‘preparation for consent’, found that some junior doctors were afraid to take patient consent due to lack of knowledge. To improve patient outcomes, junior doctors should not be expected to take consent unless they are fully trained in clinical nutrition, PEG and consent taking.

Although skin rashes may not necessarily prompt a visit to the school nurse’s office, a rash associated with other systemic symptoms, such as fever, headache, difficulty swallowing or breathing, weakness, or abdominal pain, may cause a child to visit your office. This article describes the initial assessment and management of skin rashes in children and adolescents and delineates reasons that may prompt the school nurse to transfer a student with a rash to a local emergency department.

"嚥下内視鏡検査は嚥下機能の評価や嚥下障害の診断に必須の検査であるが，内視鏡挿入による不快感や鼻咽腔の閉鎖制限あるいは咽頭への刺激が嚥下動態に何らかの影響を及ぼすことも考えられる。本研究では内視鏡挿入の有無および外径の違いが嚥下動態にどのように影響するかを，健常人を対象に嚥下造影検査で検討した。実際にはシリコン製チューブを経鼻的に咽頭に挿入して内視鏡の代用とした。また各条件での嚥下困難感や不快感について自覚的評価も行った。その結果，チューブの有無および径の違いによる嚥下動態への影響はみられなかったものの，内視鏡の太さの違いは自覚的な嚥下困難感や挿入後の不快感に大きく影響することが示された。健常人ではチューブの有無や径の違いは嚥下動態にほとんど影響しないと思われるものの，自覚的評価の結果から嚥下内視鏡検査には，より外径の細い内視鏡を使用することが望ましいと考えられる。", "Although videoendoscopic swallowing examination is indispensable for diagnosis or evaluation of swallowing disorders, discomfort or excessive stimulation of the pharynx due to insertion of endoscopic instruments, as well as possible interference with velopharyngeal closure by the endoscope, may affect some aspects of swallowing dynamics. In this study, we examined the extent to which the diameter of the endoscope or insertion of the endoscope itself could affect swallowing dynamics in healthy adults with no complaint of dysphagia, using videofluoroscopic swallowing examination (VF). We also examined the degree of pharyngeal discomfort and difficulty swallowing caused by insertion of the endoscope, using a visual analog scale (VAS). Silicone suction tubes with two different diameters were inserted as substitutes for a real endoscope. VF showed no significant differences in swallowing dynamics related to the presence and diameter of the suction tube, whereas the VAS score reported significant differences in pharyngeal discomfort and difficulty swallowing. We concluded that a thinner endoscope is preferable for endoscopic swallowing examination, although the diameter of the endoscope may not significantly affect swallowing dynamics in healthy adults.", 原著

"嚥下内視鏡検査は嚥下機能の評価や嚥下障害の診断に必須の検査であるが，内視鏡挿入による不快感や鼻咽腔の閉鎖制限あるいは咽頭への刺激が嚥下動態に何らかの影響を及ぼすことも考えられる。本研究では内視鏡挿入の有無および外径の違いが嚥下動態にどのように影響するかを，健常人を対象に嚥下造影検査で検討した。実際にはシリコン製チューブを経鼻的に咽頭に挿入して内視鏡の代用とした。また各条件での嚥下困難感や不快感について自覚的評価も行った。その結果，チューブの有無および径の違いによる嚥下動態への影響はみられなかったものの，内視鏡の太さの違いは自覚的な嚥下困難感や挿入後の不快感に大きく影響することが示された。健常人ではチューブの有無や径の違いは嚥下動態にほとんど影響しないと思われるものの，自覚的評価の結果から嚥下内視鏡検査には，より外径の細い内視鏡を使用することが望ましいと考えられる。"|"Although videoendoscopic swallowing examination is indispensable for diagnosis or evaluation of swallowing disorders, discomfort or excessive stimulation of the pharynx due to insertion of endoscopic instruments, as well as possible interference with velopharyngeal closure by the endoscope, may affect some aspects of swallowing dynamics. In this study, we examined the extent to which the diameter of the endoscope or insertion of the endoscope itself could affect swallowing dynamics in healthy adults with no complaint of dysphagia, using videofluoroscopic swallowing examination (VF). We also examined the degree of pharyngeal discomfort and difficulty swallowing caused by insertion of the endoscope, using a visual analog scale (VAS). Silicone suction tubes with two different diameters were inserted as substitutes for a real endoscope. VF showed no significant differences in swallowing dynamics related to the presence and diameter of the suction tube, whereas the VAS score reported significant differences in pharyngeal discomfort and difficulty swallowing. We concluded that a thinner endoscope is preferable for endoscopic swallowing examination, although the diameter of the endoscope may not significantly affect swallowing dynamics in healthy adults.", 原著

SARS-Cov-2, whose symptoms include difficulty swallowing, coughing, diarrhea, and breathing failure, has caused the loss of many lives around the world. In the absence of a vaccine or medication to help prevent or decrease the effects of the disease, we suggest that amantadine may reduce the effects of COVID-19.

The oral cavity is a unique environment; it includes a range of different tissue types that rely on maintenance of a constant environment or homeostasis. The health of the mucosa and teeth relies on maintenance of good salivary function and also integrity of the mucosa. Toxicities associated with cancer treatments presenting in the mouth do not occur in isolation from each other or other systemic toxicities. Oral toxicities broadly include mucosal damage (mucositis), changes in salivary gland function (most notably by causing reduced salivary flow), and also can affect the integrity of bone (osteonecrosis of the jaws). These effects can have additional outcomes which affect quality of life including loss of taste, difficulty swallowing, compromised nutrition, increased dental caries, and oral infections. For most patients, the most debilitating acute toxicity is oral mucositis, and this is the main focus of this chapter. Important chronic toxicities include long-term salivary hypofunction and osteonecrosis of the jaws.

We report a case of a 70-year-old female who presented with a four-year history of progressive headaches in the occipital area. MRI revealed a right inferior clival meningioma. Treatment was delayed for over a year due to multiple referrals resulting in the development of new symptoms including decreased balance, generalized weakness, and difficulty swallowing.

GERD correlated with the disease Amlapitta, described in ayurveda. GERD occurs when digestive juices moves upward from the stomach in to the esophagus causing Acid reflux. Lifestyle eating too late at night , spicy food , alcohol , smoking tobacco, coffee , tea ,causes GERD. heartburn , regurgitation and difficulty swallowing are common symptoms seen in GERD. till date no satisfactory treatment is available for GERD with reflux esophagitis. In the present article an attempt has been made to emphasis on herbal option for GERD.

Sialorrhea, or relative excess of salivary excretion, is a vexing problem for many patients. This symptom is precipitated by dysfunction in one of two interrelated processes-salivary production and oropharyngeal clearance. While medications primarily precipitate the former, dysphagia, often due to neurologic dysfunction, often causes the latter. This overabundance of saliva coupled with difficulty swallowing can predispose patients to respiratory issues, infections, and poor quality of life. There are, however, a myriad of treatment options that have shown clinical efficacy in treating this dysfunction. The purpose of this article is to present some background and etiology behind sialorrhea as well as present treatment options-non-pharmacologic, pharmacologic, surgical, and radiotherapeutic-that can help to ameliorate symptoms and improve quality of life for patients.