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Biomedical subjects

Mel Rosenberg

Publications and source records attributed to Mel Rosenberg.

7 recordsLinked to original sources
PubMed2003

Pathogenic colonization of oral flora in frail elderly patients fed by nasogastric tube or percutaneous enterogastric tube.

BACKGROUND: Aspiration of infected oropharyngeal content is the main cause of aspiration pneumonia. This complication, mainly related to gram-negative bacteria, threatens percutaneous enterogastric tube as well as nasogastric tube (NGT) fed patients. The objective of this study was to examine the oral microbiota of tuboenterally fed patients and compare it with that of orally fed counterparts. METHODS: Patients were recruited for this study from six nursing and skilled nursing facilities with an overall number of 845 beds. Enrolled were 215 patients: Group 1 consisted of 78 patients on NGT feeding, Group 2 consisted of 57 patients on percutaneous enterogastric tube feeding, and Group 3 consisted of 80 patients fed orally who were from the same facilities. Cultures were performed by sampling the oropharynx of each subject in order to identify gram-negative bacteria and Staphylococcus aureus. RESULTS: A high prevalence of potentially pathogenic isolations was found in tuboenterally fed patients: 81% in Group 1 and 51% in Group 2, as compared with only 17.5% in Group 3 (p <.0001). Pseudomonas aeruginosa was cultured from 31% of the subjects in Group 1 and 10% of Group 2, but in none of Group 3 (p <.001). Klebsiella and Proteus were isolated mainly from the NGT fed patients (p <.003). No correlation was found between the time duration on tube feeding or the presence of residual dentition and pathogenic microbiota. CONCLUSION: This study shows that tuboenteral feeding in elderly patients is associated with pathogenic colonization of the oropharynx. These findings are related to the risk of aspiration pneumonia and are compelling for the reevaluation of current oral cleansing procedures.

Aged↗
PubMed2003

Halitosis.

Halitosis (oral malodour or breath odour) is a fairly common complaint. Halitosis is most often a consequence of oral bacterial activity, typically from anaerobes. Occasional causes include systemic disease, and some patients have a psychogenic background to the complaint. The management is outlined in this paper.

Bacteria, Anaerobic↗
PubMed2003

Saliva secretion and oral flora in prolonged nasogastric tube-fed elderly patients.

BACKGROUND: In a previous study we showed that prolonged nasogastric tube feeding is associated with pathogenic oral flora. OBJECTIVE: To reexamine the impact of prolonged nasogastric tube feeding on the oral microbiota and to explore the salivary flow and composition in elderly patients in long-term care. METHODS: We compared a group of elderly patients fed by nasogastric tube with a control group of elderly patients in long-term care who are fed orally. Bacteriologic studies were performed by culturing samples from the oropharynx. Saliva studies included quantitative and biochemical analysis of basal and stimulated salivary flow. RESULTS: Bacteriologic studies performed in 90 patients revealed a significantly higher prevalence of gram-negative bacteria in nasogastric tube-fed patients (73% vs. 13%, P < 0.001). It is emphasized that Pseudomonas aeruginosa and Klebsiella pneumoniae were commonly and exclusively isolated from the oral flora of the nasogastric tube-fed patients (P < 0.001, P < 0.05). In the saliva studies performed on 23 nasogastric tube-fed and 21 control patients, basal and stimulated salivary flow was not significantly different in the two groups, however the ratio of stimulated to basal flow was reduced in the nasogastric tube-fed group (P < 0.05). Significant differences were also found in the concentrations of sodium, amylase, phosphor and magnesium. Noteworthy was the concentration of uric acid, the main non-enzymatic antioxidant of saliva, which was significantly lower in nasogastric-tube fed patients (P < 0.002). CONCLUSIONS: These findings suggest that prolonged nasogastric tube feeding is associated with pathologic colonization of the oroparynx and with alterations in the saliva that are related to the risk of aspiration pneumonia. Further research is called for, as well as a thorough revision of the existing oral cleansing procedures in these patients.

Age Factors↗
PubMed2002

A simple technique for the determination of salivary gland hypofunction.

OBJECTIVE: Present volumetric or gravimetric techniques for measuring saliva output are often cumbersome and, therefore, not generally used. In the present study, a simple approach to study the weight loss of a standard hard sugar candy after 3 minutes of passive incubation between tongue dorsum and palate was tested. STUDY DESIGN: Subjects (n = 59), 27 of whom had a subjective complaint of dry mouth and the rest who were healthy control subjects, were tested with this procedure, together with gravimetric measurements of stimulated and unstimulated saliva output from various glands (parotid, submandibular, and sublingual). Correlations between a decrease in candy weight and salivary flow rate were determined for the 2 groups of subjects, taken separately, as well as for the entire subject population, by using the Pearson product moment correlation. RESULTS: In most cases, highly significant associations were found, particularly when comparing candy weight loss with stimulated parotid and submandibular and sublingual saliva. Data were submitted to dichotomous analysis and divided according to salivary flow rate by using a cutoff 0.23 g for candy loss; the sensitivity, specificity, and positive predictive values were 92%, 85%, and 82%, respectively. CONCLUSIONS: The candy weight-loss test is a simple, rapid measure of salivary hypofunction, which correlates with saliva output and reports of subjective dry mouth.

Candy↗