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Background A significant portion of critically ill patients with COVID-19 are at high risk of developing ICU-acquired swallowing dysfunction (neurogenic dysphagia) as a consequence of requiring prolonged mechanical ventilation. Pharyngeal Electrical Stimulation (PES) is a simple and safe treatment for neurogenic dysphagia. Previously it has been shown that PES can restore safe swallowing in orally intubated or tracheotomised ICU-patients with neurogenic dysphagia following severe stroke. We report the case of a patient with severe neurogenic post-extubation dysphagia (PED) due to prolonged intubation and severe general muscle weakness related to COVID-19, which was successfully treated using PES.Case Presentation A 71-year-old female patient with confirmed SARS-CoV-2 infection developed neurogenic dysphagia following prolonged intubation in the ICU. To avoid aerosol generating procedures, her swallowing function was evaluated non-instrumentally as recommended by recently published international guidelines in response to the COVID-19 pandemic. Her swallowing function was markedly impaired and PES therapy was recommended. PES led to a rapid improvement of the post-extubation dysphagia (PED), as evaluated by bedside swallowing assessments using the Gugging Swallowing Screen (GUSS), Dysphagia Severity Rating Scale (DSRS) and diet screening using the Functional Oral Intake Scale (FOIS). The improved swallowing, as reflected by these measures, allowed this patient to transfer from the ICU to a non-intensive medical department five days after completing PES treatment.Conclusions PES treatment contributed to the restoration of a safe swallowing function in this critically ill patient with COVID-19 and ICU-acquired swallowing dysfunction. Early clinical bedside swallowing assessment and dysphagia intervention in COVID-19 patients is crucial to optimise their full recovery. Pharyngeal Electrical Stimulation may contribute to a safe and earlier ICU discharge of patients with ICU-acquired swallowing dysfunction. Earlier ICU discharge and reduced rates of re-intubation following PES can help alleviate some of the pressure on ICU bed capacity, which is critical in times of a health emergency such as the ongoing COVID-19 pandemic.

Eur J Clin Invest 2010; 40 (4): 339–343 Abstract Background Gestational diabetes (GDM) is an increasing and common complication of pregnancy. The involvement of inflammatory mechanisms in GDM remains unclear. YKL-40 is a novel inflammatory marker that has been recently found to be associated with type 2 diabetes. This is the first study to investigate YKL-40 in GDM. Material and methods A total of 58 subjects were included, 28 patients with GDM (BMI 33·2 ± 6·1 kg m-², 33 ± 6 years) and 30 healthy pregnant controls (BMI 28·4 ± 5·2 kg m-², 33 ± 4 years; mean ± SD). Standard risk factors for GDM (weight and BMI prior to pregnancy, family history, former GDM, high birthweight offspring) were evaluated. A 2-h 75-g oral glucose tolerance test (oGTT) and measurement of YKL-40 were conducted in gestational week 28 ± 4, as well as 8 weeks after delivery. Results YKL-40 was not different between GDM and controls, neither during (65·8 ± 44·4 vs. 60·3 ± 30·1 ng mL−1), nor after pregnancy (63·4 ± 30·5 vs. 66·9 ± 32·7 ng mL−1). YKL-40 was correlated with insulin, HOMA and BMI. GDM had higher fasting insulin (14·1 ± 7·4 vs. 8·3 ± 4·3 μU mL−1) and glucose (88 ± 13 – 200 ± 31 – 160 ± 33 vs. 76 ± 10 – 146 ± 37 – 112 ± 28 mg dL−1 for fasting, 1- and 2-h-concentrations in the oGTT, respectively), higher HbA1c (5·3 ± 0·4 vs. 5·0 ± 0·5%;), HOMA (3·1 ± 1·7 vs. 1·6 ± 0·9), and BMI (33·2 ± 6·1 vs. 28·5 ± 5·2 kg m−2) (means ± SD, all P