Pneumorachis associated with multiorgan infection due to Citrobacter koseri

Pneumorachis rarely occurs after spreading from a contiguous site of infection or after a traumatic event. We describe an adult patient who developed sepsis and a renal abscess due to Citrobacter koseri, and computed tomographic imaging identified gas within the entire spinal canal as well as an iliopsoas abscess. This patient recovered from pneumorachis caused by disseminated infection.     

Changes of energy metabolism,nutritional status and serum cytokine levels in patients with Crohn’s disease after anti-tumor necrosis factor-α therapy

We investigated the effects of treatment with antibodies against tumor necrosis factor (TNF)-α on energy metabolism, nutritional status, serum cytokine levels in patients with Crohn’s disease (CD). Twelve patients were enrolled. Resting energy expenditure (REE) levels were measured by indirect calorimetry. Crohn’s disease activity index (CDAI) significantly decreased after treatment with anti-TNF-α therapy. Anti-TNF-α therapy did not affect REE, but respiratory quotient (RQ) significantly increased after treatment. Serum interleukin-6 levels were significantly decreased and RQ were significantly increased in high REE (≥25 kcal/kg/day) group as compared to low REE (<25 kcal/kg/day) group. In conclusion, high REE value on admission is a predictive factor for good response to treatment with anti-TNF-α antibodies in active CD patients.     

Risk scoring tool for forearm skin tears in Japanese older adults: A prospective cohort study

[Aim] Because painful skin tears frequently occur in older patients, the prevention of skin tears is fundamental to improve their quality of life. However, a risk assessment tool for skin tears has not been established yet in Japan. Therefore, we aimed to propose a risk scoring tool for skin tears in Japanese older adult. [Methods] We conducted a prospective cohort study with 6-month follow-up in two long-term care hospitals in Japan. A total of 257 inpatients were recruited. Patient and skin characteristics were collected at baseline, and the occurrence of forearm skin tears were examined during follow-up. To develop a risk scoring tool, we identified risk factors, and converted their coefficients estimated in the multiple logistic regression analysis into simplified scores. The predictive accuracy of the total score was evaluated. [Results] Of 244 participants, 29 developed forearm skin tears during the follow-up period, a cumulative incidence of 13.5%. Senile purpura, pseudoscar, contracture, and dry skin were identified as risk factors for skin tears. Their weighted scores were 6, 4, 5, and 6, respectively. The area under the receiver operating characteristic curve of the total score was 0.806. At a cut-off score of 12, the sensitivity was 0.86, and the specificity was 0.67. [Conclusion] Our forearm skin tear risk scoring tool showed high accuracy, whereas specificity was low. This tool can contribute to prevent forearm skin tears in Japanese older adults.     

慢性疼痛的评估及缓解对策

慢性疼痛是21世纪全球的主要健康问题,不但严重影响了患者的日常生活,更加重了公共医疗的经济负担。本文阐述了慢性疼痛的概念和分类,常用的评估方法 ,以及慢性疼痛的缓解对策。指出:缓解慢性疼痛的有效对策,就是打破疼痛的恶性循环:第一步,降低疼痛级别;第二步,建立一个长期的治疗方案,包括主流治疗法和身心治疗法。     

Job Satisfaction and Perceived Importance of Oral Medicine Amongst Dentists

BackgroundCompounded by the needs of an aging society, interactions between oral condition and systemic diseases may require that dentists pursue additional training in oral medicine beyond that received in dental school. The purpose of this study was to investigate whether pursuing oral medicine professional education is recognised by dental practitioners as an important factor regarding job satisfaction.MethodsA questionnaire was mailed to 1,379 dental practitioners in Japan, along with a follow-up survey to assess repeatability, in 2017. The questionnaire consisted of 19 items/questions related to the respondents’ attributes and job satisfaction (5 items), willingness to learn oral medicine (4 items), willingness to learn more about dentistry (4 items), and willingness to contribute to society (6 items). Representative questions were extracted via binomial logistic regression analysis. Multivariable logistic regression analysis was performed to assess the relationships between job satisfaction and the explanatory variables.ResultsAmongst 337 respondents, multivariable logistic regression analysis showed an association between strong job satisfaction (n = 126, 37%) and willingness to learn more about oral medicine and dentistry and contribute to society, with odds ratios (95% confidence interval) of 4.22 (1.84-9.68), 3.16 (1.16-8.62), and 7.32 (3.14-17.06) and κ values of 0.38, 0.58, and 0.51, respectively.ConclusionsOur results from dental practitioners suggest additional benefits of oral medicine professional education for future job satisfaction.     

Oral candidiasis mimicking tongue cancer

Candida species inhabit the mucosal surfaces of healthy individuals. Major forms of oral candidiasis are pseudomembranous and atrophic form, but chronic hyperplastic candidiasis (CHC) is rarely seen. We encountered a nodule caused by candidal infection on a forearm flap in the oral cavity mimicking a recurrent tongue cancer, which revealed as CHC by histopathological examination. Like other forms of oral candidiasis, the nodule well responded to the treatment of antifungal agents and eventually disappeared. When an intraoral nodule is observed, the possibility of CHC should be taken into consideration.