A multinational consensus on dysphagia in Parkinson's disease: screening, diagnosis and prognostic value

Background: Parkinson’s disease (PD) is a neurodegenerative disorder characterized by a combination of motor and non-motor dysfunction. Dysphagia is a common symptom in PD, though it is still too frequently underdiagnosed. Consensus is lacking on screening, diagnosis, and prognosis of dysphagia in PD. Objective: To systematically review the literature and to define consensus statements on the screening and the diagnosis of dysphagia in PD, as well as on the impact of dysphagia on the prognosis and quality of life (QoL) of PD patients. Methods: A multinational group of experts in the field of neurogenic dysphagia and/or PD conducted a systematic revision of the literature published since January 1990 to February 2021 and reported the results according to PRISMA guidelines. The output of the research was then analyzed and discussed in a consensus conference convened in Pavia, Italy, where the consensus statements were drafted. The final version of statements was subsequently achieved by e-mail consensus. Results: Eighty-five papers were used to inform the Panel’s statements even though most of them were of Class IV quality. The statements tackled four main areas: (1) screening of dysphagia: timing and tools; (2) diagnosis of dysphagia: clinical and instrumental detection, severity assessment; (3) dysphagia and QoL: impact and assessment; (4) prognostic value of dysphagia; impact on the outcome and role of associated conditions. Conclusions: The statements elaborated by the Consensus Panel provide a framework to guide the neurologist in the timely detection and accurate diagnosis of dysphagia in PD

Consensus on the treatment of dysphagia in Parkinson's disease

BACKGROUND: Dysphagia is common in Parkinson's disease (PD). The effects of antiparkinsonian drugs on dysphagia are controversial. Several treatments for dysphagia are available but there is no consensus on their efficacy in PD. OBJECTIVE: To conduct a systematic review of the literature and to define consensus statements on the treatment of dysphagia in PD and related nutritional management. METHODS: A multinational group of experts in the field of neurogenic dysphagia and/or Parkinson's disease conducted a systematic evaluation of the literature and reported the results according to PRISMA guidelines. The evidence from the retrieved studies was analyzed and discussed in a consensus conference organized in Pavia, Italy, and the consensus statements were drafted. The final version of statements was subsequently achieved by e-mail consensus. RESULTS: The literature review retrieved 64 papers on treatment and nutrition of patients with PD and dysphagia, mainly of Class IV quality. Based on the literature and expert opinion in cases where the evidence was limited or lacking, 26 statements were developed. CONCLUSIONS: The statements developed by the Consensus panel provide a guidance for a multi-disciplinary treatment of dysphagia in patients with PD, involving neurologists, otorhinolaryngologists, gastroenterologists, phoniatricians, speech-language pathologists, dieticians, and clinical nutritionists

Classification of cassava starch films by physicochemical properties and water vapor permeability quantification by FTIR and PLS

Cassava starches are widely used in the production of biodegradable films, but their resistance to humidity migration is very low. In this work, commercial cassava starch films were studied and classified according to their physicochemical properties. A nondestructive method for water vapor permeability determination, which combines with infrared spectroscopy and multivariate calibration, is also presented. The following commercial cassava starches were studied: pregelatinized (amidomax 3550), carboxymethylated starch (CMA) of low and high viscosities, and esterified starches. To make the films, 2 different starch concentrations were evaluated, consisting of water suspensions with 3% and 5% starch. The filmogenic solutions were dried and characterized for their thickness, grammage, water vapor permeability, water activity, tensile strength (deformation force), water solubility, and puncture strength (deformation). The minimum thicknesses were 0.5 to 0.6 mm in pregelatinized starch films. The results were treated by means of the following chemometric methods: principal component analysis (PCA) and partial least squares (PLS) regression. PCA analysis on the physicochemical properties of the films showed that the differences in concentration of the dried material (3% and 5% starch) and also in the type of starch modification were mainly related to the following properties: permeability, solubility, and thickness. IR spectra collected in the region of 4000 to 600 cm(-1) were used to build a PLS model with good predictive power for water vapor permeability determination, with mean relative errors of 10.0% for cross-validation and 7.8% for the prediction set.724E184E18

Identification and molecular characterization of Van A-type vancomycin-resistant Enterococcus faecalis in Northeast of Brazil

The isolation of vancomycin resistant enterococci (VRE) in Brazil has rapidly increased, following the world wide tendency. We report in the present study the first isolation of vancomycin resistant Enterococcus faecalis (VRE) in the Northeast of Brazil. The four VRE isolates were characterized for antimicrobial susceptibility, genotypic typing by macro restriction of chromosomal DNA followed by pulsed-field gel electrophoresis and for characterization of the Tn1546-like element and plasmid contents. The isolates showed resistance to multiple antibiotics and a single genotype profile, suggesting the dissemination of a single clone among the patients. Tn1546 associated to genetic elements as plasmids shows the importance of infection control measures to avoid the spreading of glycopetide resistance by conjugative transfer of VanA elements