Pediatric dysphagia overview: best practice recommendation study by multidisciplinary experts

BACKGROUND

Currently, there is no comprehensive and multidisciplinary recommendation study covering all aspects of pediatric dysphagia (PD). This study aimed to generate PD management recommendations with methods that can be used in clinical practice to fill this gap in our country and in the world, from the perspective of experienced multidisciplinary experts.

METHODS

This recommendation paper was generated by a multidisciplinary team, using the seven-step process and a three-round modified Delphi survey via e-mail. First, ten open-ended questions were created, and then detailed recommendations including management, diagnosis, treatment, and follow-up were created with the answers from these questions. Each recommendation item was voted on by the experts as overall consensus (strong recommendation), approaching consensus (weak recommendation) and divergent consensus (not recommended).

RESULTS

In the 1st Delphi round, a questionnaire of 414 items was prepared based on the experts' responses to ten open-ended questions. In the 2nd Delphi round, 59.2% of these items were accepted as pre-recommendation. In the 3rd Delphi round, 62.6% of 246 items were accepted for inclusion in the proposals. The final version recommendations consisted of 154 items.

CONCLUSIONS

This study includes comprehensive and detailed answers for every problem that could be posed in clinical practice for the management of PD, and recommendations are for all pediatric patients with both oropharyngeal and esophageal dysphagia.

Respiratory outcome of spinal muscular atrophy type 1 patients treated with nusinersen

BACKGROUND

Respiratory failure is the leading cause of mortality in spinal muscular atrophy type 1 (SMA1) children. The current study aims to evaluate the effect of nusinersen treatment on respiratory outcome of the patients with SMA1.

METHODS

In this retrospective, single-center study, 52 SMA1 patients treated with nusinersen were included in the analysis. Patients were divided into two groups based on their age at the time of their first nusinersen treatment (Group 1: ≤6 months, Group 2: >6 months). Respiratory outcome on the 180th day of treatment is defined as the type of ventilation support (spontaneous breathing, noninvasive ventilation (NIV), and tracheostomized or intubated on invasive mechanical ventilation). Demographic data, respiratory outcome, and Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders scores were obtained from medical records.

RESULTS

On the 180th day of treatment, 46 of the 52 (88.4%) children were alive. Prevalence of the mortality was similar in both groups (P = 0.65). The comparison of respiratory outcome in patients between group 1 and group 2 was as follows: spontaneous breathing, 7 (43.7%) versus 4 (13.3%) (P = 0.03); NIV <16 h/day, 3 (18.7%) versus 4 (13.3%) (P = 0.68); invasive mechanical ventilation, 6 (37.5%) versus 22 (73.3%) (P = 0.01). There were no patients using NIV ≥16 h/day. There were significant improvements in Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders scores of the patients at day 180 in comparison with the baseline (P < 0.001).

CONCLUSIONS

Early initiation of nusinersen treatment in SMA1 patients may alter the disease's natural course.

Analysis of Postural Stability and Daily Energy Expenditure to Manage Tumor Patients' Functional Expectation

Background

Advances in surgical techniques, implant technology, radiotherapy, and chemotherapy have increased the recovery chances of patients with bone sarcomas. Accordingly, patients' expectations on life quality have also increased, highlighting the importance of objective evaluation of the functional results of reconstruction.

Methods

Thirteen patients with distal femoral endoprosthesis, who had been followed for an average of 2.9 years were evaluated. Postural stability, daily energy expenditure, muscle power, and range of motion were the four parameters analyzed in this study. The Musculoskeletal Tumor Society (MSTS) score and Toronto Extremity Salvage Score (TESS) were used to assess postoperative function and examine correlations with other parameters.

Results

Patients had sedentary activities in 84% of their daily lives. They exhibited a slower speed in the walk across test and a higher sway velocity in the sit-to-stand test (p = 0.005). MSTS scores were significantly correlated with the daily energy expenditure and walking speed.

Conclusions

Objective functional results acquired from various clinics will provide significant data to compare reconstruction techniques, rehabilitation protocols, and surgical techniques. In this way, it will be possible to satisfy the expectations of patients that increase in relation to enhanced recovery.

The effectiveness of shin guards used by football players

In football, injuries from opponent contact occur commonly in the lower extremities. FIFA the world's governing body for football requires players to wear shin guards. The aim of this study was to compare the protective effectiveness of polypropylene based shin guards with custom-made carbon fiber ones. Three commercial polypropylene shin guards (Adidas Predator™, Adidas UCL™, and Nike Mercurial™) and two custom-made carbon fiber shin guards were examined. The experimental setup had the following parts: 1) A pendulum attached a load cell at the tip (CAS Corp., Korea) and a fixed prosthetic foot equipped with a cleat to simulate an attacker's foot. 2) An artificial tibia prepared by condensed foam and reinforced by carbon fibers protected with soft clothing. 3) A multifunctional sensor system (Tekscan Corp., F-Socket System, Turkey) to record the impact on the tibia. In the low impact force trials, only 2.79-9.63 % of the load was transmitted to the sensors. When comparing for mean force, peak force and impulse, both carbon fiber shin guards performed better than the commercial ones (Adidas Predator™, Adidas UCL™, and Nike Mercurial™) (p = 0.000). Based on these same parameters, the Nike Mercurial™ provided better protection than the Adidas Predator™ and the Adidas UCL™ (p = 0.000). In the high impact force trials, only 5.16-10.90 % of the load was transmitted to the sensors. For peak force and impulse, the carbon fiber shin guards provided better protection than all the others. Carbon fiber shin guards possess protective qualities superior to those of commercial polypropylene shin guards. Key PointsShin guards decrease the risk of serious injuries.Carbon shin guards provide sufficient protection against high impact forces.Commercially available Polypropylene based shin guards do not provide sufficient protection against high impact forces.