Acute Respiratory Distress Revealing an Unrecognized Tracheostomy Cannula at the Bronchial Level in the Pandemic COVID Era

The tracheostomy is a surgical opening of the trachea which is made at the level of its anterior face, 2 cm above the sternal fork permitting the placement of a tracheostomy cannula in a temporary or definitive way and this according to the indication of its realization. The tracheostomy is the surgical connection of the trachea to the skin. The prolonged wearing of a tracheostomy cannula at the level of the tracheostomy orifice can expose to certain complications which can prove to be serious. It presents risks of postoperative complications, especially late ones. The most frequent are granulomas, tracheal stenosis, infections, and fistulas. Tracheal or tracheobronchial migration of the tracheostomy cannula remains exceptional. We present a very rare case of an elderly subject followed for Parkinson's disease with a dementia syndrome, who underwent a total laryngectomy 3 years ago with prolonged placement of a tracheostomy cannula at the tracheostomy orifice. The patient presented to the emergency room with progressively worsening respiratory distress and desaturation, evolving in a febrile context, suggesting a sars cov19 infection in the current epidemiological context. A thoracic CT scan rectified the diagnosis by showing a pneumopathy on an unrecognized tracheotomy cannula at the tracheobronchial level. Indeed, this complication is secondary to the embrittlement of the cannula following poor maintenance. The use of a tracheostomy cannula for a long period of time requires a regular and particular surveillance, a rigorous maintenance and care of the cannula to avoid the occurrence of complications which can be seriousThe tracheostomy is a surgical opening of the trachea which is made at the level of its anterior face, 2 cm above the sternal fork permitting the placement of a tracheostomy cannula in a temporary or definitive way and this according to the indication of its realization. The tracheostomy is the surgical connection of the trachea to the skin. The prolonged wearing of a tracheostomy cannula at the level of the tracheostomy orifice can expose to certain complications which can prove to be serious. It presents risks of postoperative complications, especially late ones. The most frequent are granulomas, tracheal stenosis, infections, and fistulas. Tracheal or tracheobronchial migration of the tracheostomy cannula remains exceptional. We present a very rare case of an elderly subject followed for Parkinson's disease with a dementia syndrome, who underwent a total laryngectomy 3 years ago with prolonged placement of a tracheostomy cannula at the tracheostomy orifice. The patient presented to the emergency room with progressively worsening respiratory distress and desaturation, evolving in a febrile context, suggesting a sars cov19 infection in the current epidemiological context. A thoracic CT scan rectified the diagnosis by showing a pneumopathy on an unrecognized tracheotomy cannula at the tracheobronchial level. Indeed, this complication is secondary to the embrittlement of the cannula following poor maintenance. The use of a tracheostomy cannula for a long period of time requires a regular and particular surveillance, a rigorous maintenance and care of the cannula to avoid the occurrence of complications which can be serious.

“Grow Old Along With Me”: Robert Browning’s Conception of Jewish Old Age

Robert Browning often explored the concepts of old age and dying in his poems, and surprisingly enough, some of these most striking poems use Hebraic sources as intertexts. This article will explore Robert Browning’s idea of old age as it is conveyed in “Rabbi Ben Ezra,” “Pisgah Sights,” and “Jochanan Hakkadosh,” three poems in which Browning turns to Hebrew sources to explore philosophical and mystical narratives of aging. Written against the emerging Victorian conception of the elderly subject, these poems merge two forms of Victorian Otherness—Judaism and old age—so as to create an alternative and celebratory vision of the last stage of life. These representations of old age also reflect Robert Browning’s biographical old age, which introduced long-awaited popularity and critical acclaim, and the evolution of his favorite form, the dramatic monologue.

L-Glutamine Supplementation Improves the Benefits of Combined-Exercise Training on Oral Redox Balance and Inflammatory Status in Elderly Individuals

Although regular combined aerobic-resistance exercises can ameliorate the inflammatory status and redox balance in elderly population, it is unclear whether protein or specific amino acid supplementation could improve such benefits. Therefore, we aimed to evaluate the inflammatory status and redox indexes through of the saliva of 34 elderly subject nonpractitioners (NP group, 73.3±6.6 years) and 49 elderly subject practitioners of a combined-exercise training in moderate intensity (CET group, 71.9±5.8 years) before (pre) and after (post) 30 days of supplementation with L-glutamine (Gln) or placebo (PL). Our results showed that, both in pre- and postsupplementation, the salivary levels of nitric oxide (NO⋅) and TNF-α were lower, whereas the levels of uric acid and IL-10 (as well as IL-10/TNF-α ratio) were higher in the CET groups than in the NP groups. In postsupplementation, both groups supplemented with Gln (NP-Gln and CET-Gln) showed higher salivary uric acid levels compared to baseline. In addition, lower NO⋅ levels were found in the CET-Gln group postsupplementation than presupplementation values. Whereas the CET-Gln group showed lower GSH levels postsupplementation, NP-Gln subjects showed lower GSSG levels at the same time point, both compared to baseline. Interestingly, salivary peroxidase activity was lower only in NP groups (NP-PL and NP-Gln) postsupplementation than baseline values. A positive significant correlation between salivary peroxidase activity and GSH levels, and also between salivary peroxidase activity and uric acid levels were observed in the CET-Gln group both pre- and postsupplementation. No differences were found in albumin, total antioxidant activity (TEAC), and reducing power analysis between groups, pre- or postsupplementation. In conclusion, the elderly subjects from the CET group showed a better inflammatory response and redox balance and, for the first time, it was shown that daily supplementation with Gln for 30 days can improve these benefits with putative association with a healthy aging.