Formulation and Pharmaceutical Assessment of Annona muricata Oral Capsules and Suspension as Antidiarrhea Dosage Forms

Annona muricata (Annonaceae) is a tropical plant widely known for its edible fruits. Recent scientific studies have confirmed the folkloric use of its seeds as an antidiarrheal agent. This study sought to formulate capsules and suspensions using the ethanolic extract from Annona muricata seeds. The dried ethanolic extract was formulated into granules and subsequently encapsulated. The suspension formulated was assessed for sedimentation rate, sedimentation volume, viscosity, dissolution, drug content, and flow rate, while pharmacopeia tests such as disintegration, dissolution, uniformity of weight, and drug content were carried out on the formulated capsules. The formulated suspension passed the drug content and in vitro release studies. Annona muricata suspension exhibited pseudoplastic flow with good sedimentation rate and sedimentation volume. The formulated capsules passed the in vitro dissolution studies, weight uniformity, disintegration, and drug content tests. The ethanolic extract of Annona muricata seeds was appropriately formulated into standardized solid and liquid oral dosage forms.

Chronic Obstructive Pulmonary Disease and Dysphagia: What Have We Learned So Far and What Do We Still Need to Investigate?

Purpose Dysphagia is an underrecognized concern in people with chronic obstructive pulmonary disease (COPD) and may contribute to disease exacerbations. In this review article, we share information regarding dysphagia in people with COPD, synthesizing knowledge both from the literature and from studies performed in the context of a multidisciplinary clinical pulmonary rehabilitation program at the Federal University of Santa Maria in Brazil. Results This narrative review presents evidence showing that awareness of dysphagia and patient-reported symptoms of dysphagia are rare in individuals with stable COPD. However, evidence from the routine collection of patient-reported symptom data using the Eating Assessment Tool 10 and about dysphagia-related quality of life using the Swallowing Quality of Life questionnaire do suggest that dysphagia is experienced by some individuals with COPD. Several studies suggest that patients with stable COPD present with altered swallowing physiology on videofluoroscopic exams, including silent aspiration in a small number of these individuals. However, both patient self-report and clinical screening using the Volume–Viscosity Swallowing Test have been found to be poor predictors of these videofluoroscopic findings. We discuss the possibility that altered laryngeal sensation and respiratory–swallow discoordination play a role in dysphagia in people with COPD, and highlight assessment tasks that appear to have the highest sensitivity for detecting penetration–aspiration in this population. Finally, we review preliminary evidence suggesting that physical therapy techniques targeting altered respiratory muscle biomechanics may benefit swallowing in people with COPD. Knowledge gaps requiring further research are identified, and implications for clinical practice are discussed.

Prevalence and Biological Correlates of Oropharyngeal Dysphagia in Outpatients of a Geriatric Evaluation Clinic: A Brief Report

<b><i>Background:</i></b> Oropharyngeal dysphagia (OD) is a relevant disease among older adults and is associated with serious adverse health-related outcomes, such as malnutrition, sarcopenia, or frailty. Increasing its recognition and the related mechanisms will allow us to its prevention and treatment at different levels of care. <b><i>Objectives:</i></b> This study aimed to determine the prevalence and biological correlates of OD in outpatient older adults. <b><i>Method:</i></b> This is a cross-sectional study including 100 adults aged 60 or older from a geriatric clinic of a tertiary hospital in Mexico City. Health variables and geriatric syndromes were recorded. The Eating Assessment Tool-10 detection test and the volume-viscosity swallowing test were used to diagnose OD. Logistic regression models were performed to identify the factors associated with OD. <b><i>Results:</i></b> Mean age was 81.2 (±7.5) years and 21% had OD. The presence of xerostomia (<i>p</i> = 0.05) and a worst nutritional status (<i>p</i> = 0.035) were obtained. <b><i>Conclusions:</i></b> The prevalence of OD among older adults was high. Inadequate nutrition status and the presence of xerostomia are more likely to be present with this swallowing disorder.

A Systematic and a Scoping Review on the Psychometrics and Clinical Utility of the Volume-Viscosity Swallow Test (V-VST) in the Clinical Screening and Assessment of Oropharyngeal Dysphagia

(1) Background: The volume-viscosity swallow test (V-VST) is a clinical tool for screening and diagnosis of oropharyngeal dysphagia (OD). Our aims were to examine the clinical utility of the V-VST against videofluoroscopy (VFS) or fiberoptic endoscopic evaluation of swallow (FEES) and to map the V-VST usage with patients at risk of OD across the years since it was described for the first time, carrying a systematic and a scoping review. (2) Methods: We performed both a systematic review (SR) including studies that look at the diagnostic test accuracy, and a scoping review (ScR) with articles published from September 2008 to May 2020. Searches were done in different databases, including PubMed and EMBASE from September 2008 until May 2020, and no language restrictions were applied. A meta-analysis was done in the SR to assess the psychometric properties of the V-VST. Quality of studies was assessed by Dutch Cochrane, QUADAS, GRADE (SR), and STROBE (ScR) criteria. The SR protocol was registered on PROSPERO (registration: CRD42020136252). (3) Results: For the diagnostic accuracy SR: four studies were included. V-VST had a diagnostic sensitivity for OD of 93.17%, 81.39% specificity, and an inter-rater reliability Kappa = 0.77. Likelihood ratios (LHR) for OD were 0.08 (LHR–) and 5.01 (LHR+), and the diagnostic odds ratio for OD was 51.18. Quality of studies in SR was graded as high with low risk of bias. In the ScR: 34 studies were retrieved. They indicated that V-VST has been used internationally to assess OD’s prevalence and complications. (4) Conclusions: The V-VST has strong psychometric properties and valid endpoints for OD in different phenotypes of patients. Our results support its utility in the screening and clinical diagnosis and management of OD.

Dysphagia Screening Protocol for Acute Stroke Patient: A Literature Review

Background: Nearly two-thirds of acute stroke patients have dysphagia. Dysphagia is difficulty to swallow food or liquids. Early detection of dysphagia is crucial in stroke patients as a result of increased morbidity and mortality due to malnutrition and respiratory tract infections. Aim: Our purpose was to conduct a literature review of dysphagia screening for stroke patient. Methods: We used the bolean operator to search articles of &ldquo;or&rdquo; and &ldquo;and&rdquo; with the key words were "Dysphagia" or &ldquo;Screening&rdquo;, AND "Stroke" or Acute Stroke&rdquo; AND "Nursing". Data based used were Scopus, Proquest and Science Direct with inclusion criteria using full text in English which published from 2019 to 2021. We obtained 240 articles and then we screened by reading the main focus of articles with paying attention to the topics and the suitability of article content.Result: Twenty five publications relating to dysphagia screening met the inclusion criteria. There are five methods of dysphagia screening performed by nurses or other health workers: 1) a simple Questionnaire Test (4QT) method; 2) Water Swallow Test (WST) method; 3) Bed Side Screening Tool for Dysphagia (BSTD) method; 4) Volume Viscosity Swallow Test (V-VST) method; 5) EAT-10 method.Conclusion: screening is the first step in the identification of swallowing impairment or dysphagia of stroke patient. Dysphagia is an independent predictor of poor patient outcome and prolonged recovery time. Nurse has an important role to conduct a screening and must ensure that the selected tools has high reliability and concurrent validity. Key Words: Dysphagia, Nursing, Screening, Stroke

Dysphagia Screening Protocol For Acute Stroke Patient: A Literature Review

ABSTRACT Background: Nearly two-thirds of acute stroke patients have dysphagia. Dysphagia defined as difficulty in swallowing of liquids or food, vary in severity with symptoms ranging from mild throat discomfort to inability to eat. It&rsquo;s well known that dysphagia is associated with aspiration pneumonia, dehydration, malnutrition, prolonged length of stay, and increased mortality. Early screening reduces pneumonia rates in stroke and it is usually performed by nurses. Dysphagia screening is recommended but no protocol or tool is pointed.Aim: the aim of this study is to conduct a literature review of dysphagia screening for stroke patient Methods: Literature search three databases (Scopus, Proquest, and Science Direct), with the keywords "Dysphagia" AND "Stroke" AND "Nursing", published in English between 2019 and 2021. Result: Twenty five publications relating to dysphagia screening met the inclusion criteria. There are five methods of dysphagia screening performed by nurses or other health workers: 1) a simple Questionnaire Test (4QT) method, which is by asking the following four questions: does the patient cough or choke while eating or drinking; whether the patient takes longer than usual to eat; does the patient change the thickness of the food to be able to swallow, and whether the voice turns hoarse after eating or drinking; 2) Water Swallow Test (WST) method; 3) Bed Side Screening Tool for Dysphagia (BSTD) method; 4) Volume Viscosity Swallow Test (V-VST) method, namely modification of feeding with first pudding, nectar and finally water; 5) Simplified Cough Test Method. The five screening methods for dysphagia above have been tested for sensitivity and specificity, as well as positive and negative predictive valuesConclusion: screening is a first step in the identification of swallowing impairment or dysphagia of stroke patient. Dysphagia is an independent predictor of poor patient outcome and prolonged recovery time. Nurse has an important role to conduct a screening and must ensure that the selected tools has high reliability and concurrent validity. Key Words: Stroke, Dysphagia, Screening, Nursing

Oropharyngeal dysphagia in older patients with hip fracture

Background oropharyngeal dysphagia (OD) and hip fracture are common problems in older patients, both associated with important complications. Objective the aim of this study was to measure the prevalence and identify the main risk factors of dysphagia in older patients with hip fracture. Design a prospective study in an orthogeriatric unit of a university hospital over 10 months. Methods a total of 320 patients (mean age 86.2 years, 73.4% women) were assessed for dysphagia within 72 hours post-surgery using the Volume-Viscosity Swallow Test. Geriatric assessment, hip fracture management and complications were examined to determine their relationship with the presence of OD. Results dysphagia was present in 176 (55%) patients. Multivariate logistic regression analysis showed that the presence of delirium during hospitalization and the inability to perform instrumental activities of daily living before admission were associated with OD. Conclusions the prevalence of OD is high in hip fracture patients. Objective dysphagia assessment should be routinely included as part of the geriatric assessment of such patients.

Effect of Aging, Gender and Sensory Stimulation of TRPV1 Receptors with Capsaicin on Spontaneous Swallowing Frequency in Patients with Oropharyngeal Dysphagia: A Proof-of-Concept Study

Spontaneous swallowing contributes to airway protection and depends on the activation of brainstem reflex circuits in the central pattern generator (CPG). We studied the effect of age and gender on spontaneous swallowing frequency (SSF) in healthy volunteers and assessed basal SSF and TRPV1 stimulation effect on SSF in patients with post-stroke oropharyngeal dysphagia (OD). The effect of age and gender on SSF was examined on 141 healthy adult volunteers (HV) divided into three groups: GI—18–39 yr, GII—40–59 yr, and GIII—>60 yr. OD was assessed by the Volume–Viscosity Swallowing Test (VVST). The effect of sensory stimulation with capsaicin 10−5 M (TRPV1 agonist) was evaluated in 17 patients with post-stroke OD, using the SSF. SSF was recorded in all participants during 10 min using surface electromyography (sEMG) of the suprahyoid muscles and an omnidirectional accelerometer placed over the cricothyroid cartilage. SSF was significantly reduced in GII (0.73 ± 0.50 swallows/min; p = 0.0385) and GIII (0.50 ± 0.31 swallows/min; p < 0.0001) compared to GI (1.03 ± 0.62 swallows/min), and there was a moderate significant correlation between age and SFF (r = −0.3810; p < 0.0001). No effect of gender on SSF was observed. Capsaicin caused a strong and significant increase in SSF after the TRPV1 stimulation when comparing to basal condition (pre-capsaicin: 0.41 ± 0.32 swallows/min vs post-capsaicin: 0.81 ± 0.51 swallow/min; p = 0.0003). OD in patients with post-stroke OD and acute stimulation with TRPV1 agonists caused a significant increase in SSF, further suggesting the potential role of pharmacological stimulation of sensory pathways as a therapeutic strategy for CPG activation in patients with OD.

A STUDY OF ABNORMAL SEMEN PARAMETERS IN INFERTILE COUPLES IN BHAGALPUR, BIHAR

Background: The importance of male factor contribution to infertility is well recognised. Semen analysis is an indispensable diagnostic tool in the evaluation of the male partners of infertile couples. Aim and objective of the study was conducted to determine the abnormalities in semen among male partners in infertile couples. Detailed history, examination and Methods: semen analysis was done. Semen samples were analysed for volume, viscosity, sperm concentration, motility, and morphology, according to WHO guidelines. This study, done at Obstetrics and Gynaecology Department of Results: JLNMCH, Bhagalpur, Bihar has demonstrated that abnormal semen quality is a major factor contributing to infertility in couples. Total number of participants were 94. Most of the male partners i.e. 65.96%, who came for infertility evaluation were between 30-39 years of age with 56.38% participants having abnormal semen parameters. The most common abnormality found was asthenozoospermia seen in 35.11% of cases followed by oligozoospermia seen in 25.53% of cases. Teratozoospermia and azoospermia were seen in 7.45% and 4.26% of cases respectively. Males contribute towards infertility in Conclusions: couples signicantly. Abnormal semen pattern is a common cause. More research is needed to render more valuable and signicant results regarding male infertility

Abstract P820: Fast Prediction of the Dysphagia Severity Using Clinical Signs in Acute Ischemic Stroke Patients

Objective: The purpose of this study was to compare the clinical signs in patients with acute ischemic stroke(AIS) and identify which of them was associated with the severity of dysphagia. Methods: This was a prospective observational study enrolled AIS within 14 onset days. All patients had swallowing evaluations by the modified Volume Viscosity Swallowing Test (the modified V-VST). Five clinical signs suggestive of swallow function impaired were directly observed in the patients who failed the test. We compared the performance of clinical signs between different completing volumes at three viscosity series. The area under curves (AUCs) were made to show the ability of specific clinical signs in predicting the dysphagia severity in patients with AIS. Results: 184 hospital-based AIS patients who failed the modified V-VST were enrolled from June 2017 to December 2019. 123 patients were identified as moderate swallow function impaired and 61 patients were identified as serious. Larynx movement and tongue movement were significant different clinical signs at all of three viscosities (p≤0.001). The AUC of larynx movement in predicting severity of dysphagia was 0.733( 95% CI 0.658-0.808,P<0.001). Conclusions: Larynx movement and tongue movement were easy clinical signs for medical staffs to assess the dysphagia severity quickly. Additionally, larynx movement showed stronger ability to predict the severity of dysphagia in AIS patients.