To the best of our knowledge, this study is the first which shows that anaerobic bacteria were identified in patients' oral flora before and after HSCT by using a mass spectrometer. These results indicate that Enterococcus species and Candida species may have been associated with OM. OM affected the patients' improvement in nutritional status and their prognosis. We concluded that it is important to provide more complete oral care instructions and interventions to prevent these bacterial infections.
In April 2012, the Center of Special Needs Dentistry SND was established at Showa University Dental Hospital to provide function training for children with eating and swallowing disorders. A statistical clinical assessment was performed on new patients ≤ 18 years of age who visited the Center over a 1-year period April 2012-March 2013 to assess the conditions present at the initial visit. In all, 60 patients 29 boys, 31 girls, mean SD age 4.2 4.1 years, range 0-18 years of age were included in the study. Most patients were 1 year of age 32 and most came from one of four cities in the Johnan area Shinagawa City, Meguro City, Ota City and Setagaya City. The most common primary diseases at the initial visit were cerebral palsy and cleft lip and palate. The third largest patient group was of healthy children with oral function problem. Over 60 of patients attended the Center of SND because of an eating-related complaint. More than 50 of patients were obtaining nutrients via oral intake ; the remaining patients were obtaining nutrients via non-oral or a combination of oral and nonoral intake. Because of the young age of the patients and the fact that most were from neighboring areas, it can be inferred that effective community health care is being provided. It is necessary for the Center of SND to continue to provide professional treatment for dysphagia and to contribute to community medicine.
to treat patients who need special care. In cooperation with the Division of Dentistry for Persons with Disabilities, the Division of Hygiene and Oral Health is mainly engaged in the treatment of patients with eating and swallowing disorders. It has been ve years since the establishment of the Center. The present study was aimed to establish an effective medical support method through a comparative study of changes in patient trends. A total of 65 patients who visited the Center from April 2017 to March 2018 were examined and their statistics were compared with those of 60 previously reported patients who initially visited the Center for medical examination in 2012. In 2012, many visits occurred during the nursing period; however, in 2017, the number of patients who visited after the weaning period increased. Other noted trends were increased diversity in primary disease, more patient referrals, fewer patients with severe swallowing dysfunction, and more patients with oral dysfunction. The necessity of eating and swallowing practice is thought to increase when lifestyle and oral environment change. The treatment of eating and swallowing disorders is important in the dental profession. Due to the introduction of insurance coverage in Japan in 2018 for developmental insuf ciency of oral function, more pediatric patients with eating and swallowing disorders will likely be treated in the future.
Objective: To estimate the incidence of IFD in multiple myeloma patients receiving autologous stem cell transplantation (ASCT) using novel agents (bortezomib, thalidomide) in addition to high-dose melphalan (VTD Mel). Patients and methods: Retrospective chart review of patients who received an ASCT with the novel regimen VDT Mel between 2012 and 2014 at UIHC. All toxicities related to transplant regimen were calculated for the first 100 days after ASCT. IFD were classified as proven, probable and possible according to the EORTC/MSG revised classification, 2008. Results: 100 consecutive patients who received ASCT with VTD Mel conditioning were analyzed; 47 patients received a single and 53 had tandem transplants (TT), respectively; all patients received standard fluconazole prophylaxis of 100 mg per day. Only infections ≥ grade 3 were listed; there were a total 5 episodes of IFD with 4 proven and 1 probable fungal infections. Only 1 of the 4 proven infections was a mold infection (Alternaria sp).The 3 other proven infections were candida sepsis; 2 occurred in the same patient with the TT. Infections occurred between 6 and 10 days post-transplant. All patients were treated with appropriate antifungal therapy and one patient with proven mold infection required debridement of the sinus. There were no mortalities related to fungal infections in the first 100 days or long term with a median follow-up of 16.2 months. All patients except one had extensive prior therapy with 3 lines. We observed false positive beta D glucan and galactomannan tests in 7 other patients. Conclusion: This is the first study to report on the rates of invasive fungal disease in MM patients treated with novel agents as part of conditioning regimen. The rate of IFD, 4% (4/100 patients) in our patients, is within the range of published literature which reported IFD rates of~2.5% and~15% in patients receiving ASCT and more than 3 lines of therapy, respectively. We did not observe any mortality associated with IFD. History of prior heavy chemotherapy could be an additional risk factor. Risk of infection is high in the early posttransplant phase and prompt, aggressive treatment may lead to good outcomes. Fluconazole remains the standard prophylactic agent, since the duration of neutropenia is limited for most patients.
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