Effect of frenotomy on breastfeeding and reflux:results from the BRIEF prospective longitudinal cohort study

OBJECTIVES: To assess the Efficacy of Frenotomy with regard to Breastfeeding and Reflux Improvement (BRIEF) in infants with breastfeeding problems. MATERIALS AND METHODS: A cohort of 175 consecutive breastfeeding women with breastfeeding and reflux problems related to a tongue-tie or lip-tie fulfilling the inclusion criteria was longitudinally followed for 6 months. The effect of frenotomy on these problems was studied by a standardized oral assessment and completing the validated Breastfeeding Self-Efficacy Short Form (BSES-SF), nipple pain score (Visual Analogue Scale, VAS), and Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) questionnaires pre-frenotomy and at 1 week, 1 month, and 6 months’ post frenotomy. RESULTS: All 175 women completed the 1-month follow-up and 146 women the 6 months’ follow-up. Frenotomy resulted in a significant improvement of BSES-SF, nipple pain score, and I-GERQ-R after 1 week, which improvement maintained to be significant after 1 month for BSES-SF and I-GERQ-R, and after 6 months for I-GERQ-R. The improvements were irrespective of the type lip-tie or tongue-tie underlying the breast feeding and reflux problems. No post-operative complications were observed. About 60.7% of infants still was breastfed 6 months after treatment. CONCLUSIONS: Frenotomy is a safe procedure with no post-operative complications and resulting in significant improvement of breastfeeding self-efficacy, nipple pain, and gastro-oesophageal reflux problems. CLINICAL RELEVANCE: Frenotomy of a tongue-tie and or lip-tie can lead to improvement of breastfeeding and reflux problems irrespective of the type of tongue-tie or lip-tie and should be considered by clinicians as a proper tool to resolve these problems if non-interventional support did not help. INTERNATIONAL TRIAL REGISTER: ISRCTN64428423 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00784-020-03665-y

Endoscopic Treatment of Esophageal Foreign Bodies in the Elderly

SummaryBackgroundIngestion of a foreign body is a prevalent condition among children and psychiatric patients; however, such an issue has seldom been discussed in the elderly.MethodsA retrospective review of medical records of patients more than 60 years of age with a diagnosis of esophageal foreign body (EFB) from December 2007 to December 2010 was performed. A total of 45 elderly patients (24 men and 21 women) were analyzed. Demographic data, impaction level of esophagus, types of EFB, underlying diseases, duration from ingestion to endoscopic intervention, endoscopic managements, and outcomes were analyzed.ResultsThe average age of these patients was 75.0 years (60–95 years). Among the materials that caused esophageal impaction, the most frequent were bones of animal origin (17/45 = 37.8%), followed by meat or food bolus (16/45 = 35.6%), dental prostheses (8/45 = 17.8%), and medicine packing (4/45 = 8.8%). In about half of these patients, the EFBs were entrapped in the cervical esophagus. There was no mortality. The success of removing EFB at an initial stage in these patients was about 88.8% (40/45). The retrieval-associated complications occurred in six patients with mis-swallowing of fish bones and medicine packing; four had wound bleeding, which need endoscopic hemostasis, and the other two had penetrating wounds that needed surgical repair.ConclusionFlexible upper endoscopy is relatively safe and effective for extracting EFB in the elderly. Elderly patients with EFBs had a high rate of underlying diseases. Thus, additional care and considerations must be given to such population

Leptin levels in SARS-CoV-2 infection related respiratory failure:A cross-sectional study and a pathophysiological framework on the role of fat tissue

Obesity is a risk factor for SARS-CoV-2 infected patients to develop respiratory failure. Leptin produced in visceral fat might play a role in the deterioration to mechanical ventilation. A cross sectional study was performed. The mean BMI was 31 kg/m2 (range 24.8-48.4) for the 31 SARS-CoV-2 ventilated patients and 26 kg/m2 (range 22.4-33.5) for 8 critically ill non-infected control patients. SARS-CoV-2 infected patients with a similar BMI as control patients appear to have significantly higher levels of serum leptin. The mean leptin level was 21.2 (6.0-85.2) vs 5.6 (2.4-8.2) ug/L for SARS-CoV-2 and controls respectively (p = 0.0007). With these findings we describe a clinical and biological framework that may explain these clinical observations. The ACE2 utilization by the virus leads to local pulmonary inflammation due to ACE2-ATII disbalance. This might be enhanced by an increase in leptin production induced by SARS-CoV-2 infection of visceral fat. Leptin receptors in the lungs are now more activated to enhance local pulmonary inflammation. This adds to the pre-existent chronic inflammation in obese patients. Visceral fat, lung tissue and leptin production play an interconnecting role. This insight can lead the way to further research and treatment

Novel insights in the pathogenesis of renal interstitial damage during ACE inhibition : a role for ACE2 and the (pro)renin-receptor?

Het renine-angiotensine-aldosteron-systeem (RAAS) is een hormonaal systeem dat in belangrijke mate betrokken is bij de regulatie van bloeddruk en nierfunctie. Een overactief RAAS leidt tot hoge bloeddruk en is betrokken bij het ontstaan van hart- , vaat- en nierziekten. Het RAAS kan geremd worden door geneesmiddelen, zoals bijvoorbeeld ACE remmers. Deze middelen verlagen de bloeddruk, en bij nierpatiënten, ook het eiwitverlies in de urine. Door deze effecten beschermen ze tegen nierschade. Ondanks de gunstige effecten van ACE remmers treedt er toch vaak progressieve nierschade op. Dit proefschrift probeert een verklaring te vinden voor de voortgang van nierschade tijdens ACE remming. De dierexperimentele studies beschreven in dit proefschrift laten zien dat tijdens intensieve behandeling progressie van nierschade kan optreden, ondanks effectieve verlaging van het eiwitverlies in de urine. Deze nierschade hoeft niet perse het gevolg te zijn van de nierziekte zelf. Wij laten zien dat de behandeling met ACE remmers zelf mogelijk negatieve bijeffecten heeft. Of deze bijwerkingen ook bij patiënten aanwezig zijn, moet in de toekomst onderzocht worden. Tevens is het mechanisme ervan nog onduidelijk, maar mogelijk speelt een te sterke bloeddrukverlaging een rol. Kennis over nieuwe componenten binnen het RAAS, zoals ACE2 en de (pro)renine receptor, kunnen mogelijk een verklaring geven voor de tekortkomingen in de werking van ACE remmers. Al met al geeft dit onderzoek nieuwe aanknopingspunten voor verdere optimalisatie van nierbeschermende therapieën.

Effect of frenotomy on breastfeeding and reflux: results from the BRIEF prospective longitudinal cohort study

OBJECTIVES: To assess the Efficacy of Frenotomy with regard to Breastfeeding and Reflux Improvement (BRIEF) in infants with breastfeeding problems. MATERIALS AND METHODS: A cohort of 175 consecutive breastfeeding women with breastfeeding and reflux problems related to a tongue-tie or lip-tie fulfilling the inclusion criteria was longitudinally followed for 6 months. The effect of frenotomy on these problems was studied by a standardized oral assessment and completing the validated Breastfeeding Self-Efficacy Short Form (BSES-SF), nipple pain score (Visual Analogue Scale, VAS), and Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) questionnaires pre-frenotomy and at 1 week, 1 month, and 6 months' post frenotomy. RESULTS: All 175 women completed the 1-month follow-up and 146 women the 6 months' follow-up. Frenotomy resulted in a significant improvement of BSES-SF, nipple pain score, and I-GERQ-R after 1 week, which improvement maintained to be significant after 1 month for BSES-SF and I-GERQ-R, and after 6 months for I-GERQ-R. The improvements were irrespective of the type lip-tie or tongue-tie underlying the breast feeding and reflux problems. No post-operative complications were observed. About 60.7% of infants still was breastfed 6 months after treatment. CONCLUSIONS: Frenotomy is a safe procedure with no post-operative complications and resulting in significant improvement of breastfeeding self-efficacy, nipple pain, and gastro-oesophageal reflux problems. CLINICAL RELEVANCE: Frenotomy of a tongue-tie and or lip-tie can lead to improvement of breastfeeding and reflux problems irrespective of the type of tongue-tie or lip-tie and should be considered by clinicians as a proper tool to resolve these problems if non-interventional support did not help. INTERNATIONAL TRIAL REGISTER: ISRCTN64428423