Syöpäpotilaan suun ja hampaiston hoito

Vertaisarvioitu.Syöpähoitoa edeltävän suun tarkastuksen tavoite on ehkäistä infektiokomplikaatioita sekä parantaa suun terveydentilaa hoidon aikana ja sen jälkeen. Näyttö suun kroonisten infektiopesäkkeiden vaikutuksesta syöpähoidon ennusteeseen on vähäistä ja akuutit hammasperäiset infektiot hoidon aikana harvinaisia. Silti suun tarkastuksen sisällyttäminen hoitokokonaisuuteen heti diagnoosin jälkeen on suositeltavaa sairauden tai hoitojen takia suurentuneen infektioriskin vuoksi. Syöpähoitoja edeltävän hammashoidon tulee painottua sairautta ehkäiseviin toimenpiteisiin. Kroonisten infektiopesäkkeiden radikaaliin saneeraukseen on yleensä syytä suhtautua pidättyvästi. Suuhygienian omaehtoinen ja ammattimainen ylläpito hoidon aikana ja jälkeen on tärkeää, sillä kuiva suu, limakalvovauriot, karies sekä luustolääkkeiden ja sädehoidon aiheuttama kudosten heikentynyt paranemiskyky altistavat uusille suun sairauksille. Lisäksi ne vaikuttavat hoidosta toipumiseen ja elämänlaatuun.Peer reviewe

Suun mukosiitti

English summaryPeer reviewe

Combining Phi6 as a surrogate virus and computational large-eddy simulations to study airborne transmission of SARS-CoV-2 in a restaurant

COVID-19 has highlighted the need for indoor risk-reduction strategies. Our aim is to provide information about the virus dispersion and attempts to reduce the infection risk. Indoor transmission was studied simulating a dining situation in a restaurant. Aerosolized Phi6 viruses were detected with several methods. The aerosol dispersion was modeled by using the Large-Eddy Simulation (LES) technique. Three risk-reduction strategies were studied: (1) augmenting ventilation with air purifiers, (2) spatial partitioning with dividers, and (3) combination of 1 and 2. In all simulations infectious viruses were detected throughout the space proving the existence long-distance aerosol transmission indoors. Experimental cumulative virus numbers and LES dispersion results were qualitatively similar. The LES results were further utilized to derive the evolution of infection probability. Air purifiers augmenting the effective ventilation rate by 65% reduced the spatially averaged infection probability by 30%-32%. This relative reduction manifests with approximately 15 min lag as aerosol dispersion only gradually reaches the purifier units. Both viral findings and LES results confirm that spatial partitioning has a negligible effect on the mean infection-probability indoors, but may affect the local levels adversely. Exploitation of high-resolution LES jointly with microbiological measurements enables an informative interpretation of the experimental results and facilitates a more complete risk assessment.Peer reviewe

The impact of the duration of the palliative care period on cancer patients with regard to the use of hospital services and the place of death: a retrospective cohort study

Background: In order to avoid unnecessary use of hospital services at the end-of-life, palliative care should be initiated early enough in order to have sufficient time to initiate and carry out good quality advance care planning (ACP). This single center study assesses the impact of the PC decision and its timing on the use of hospital services at EOL and the place of death. Methods: A randomly chosen cohort of 992 cancer patients treated in a tertiary hospital between Jan 2013 -Dec 2014, who were deceased by the end of 2014, were selected from the total number of 2737 identified from the hospital database. The PC decision (the decision to terminate life-prolonging anticancer treatments and focus on symptom centered palliative care) and use of PC unit services were studied in relation to emergency department (ED) visits, hospital inpatient days and place of death. Results: A PC decision was defined for 82% of the patients and 37% visited a PC unit. The earlier the PC decision was made, the more often patients had an appointment at the PC unit (> 180 days prior to death 72% and Conclusions: The PC decision to initiate a palliative goal for the treatment had a distinct impact on the use of hospital services at the EOL. Contact with a PC unit further increased the likelihood of EOL care at primary care.</div

Mutation update and genotype-phenotype correlations of novel and previously described mutations in TPM2 and TPM3 causing congenital myopathies

Mutations affecting skeletal muscle isoforms of the tropomyosin genes may cause nemaline myopathy, cap myopathy, core-rod myopathy, congenital fiber-type disproportion, distal arthrogryposes, and Escobar syndrome. We correlate the clinical picture of these diseases with novel (19) and previously reported (31) mutations of the TPM2 and TPM3 genes. Included are altogether 93 families: 53 with TPM2 mutations and 40 with TPM3 mutations. Thirty distinct pathogenic variants of TPM2 and 20 of TPM3 have been published or listed in the Leiden Open Variant Database (http://www.dmd.nl/). Most are heterozygous changes associated with autosomal-dominant disease. Patients with TPM2 mutations tended to present with milder symptoms than those with TPM3 mutations, DA being present only in the TPM2 group. Previous studies have shown that five of the mutations in TPM2 and one in TPM3 cause increased Ca2+ sensitivity resulting in a hypercontractile molecular phenotype. Patients with hypercontractile phenotype more often had contractures of the limb joints (18/19) and jaw (6/19) than those with nonhypercontractile ones (2/22 and 1/22), whereas patients with the non-hypercontractile molecular phenotype more often (19/22) had axial contractures than the hypercontractile group (7/19). Our in silico predictions show that most mutations affect tropomyosin–actin association or tropomyosin head-to-tail binding

Sairaalahoitoa vaativat hammasperäiset infektiot

Odontogenic infections can spread locally causing cellulitis and abscess formation, or by dissemination causing distant site infections. The aim was to analyse the course of infection and predisposing factors for local and systemic odontogenic infections requiring hospital care. This retrospective cohort study consisted of four populations (Studies I-IV). The clinical picture and predisposing factors of local and systemic odontogenic infections requiring hospital care was analysed from patient data (2000 - 2003), held in the Finnish Patient Insurance Centre (n=35) (Study I). To analyse predisposing factors and the course of locally invasive odontogenic infection, material was gathered from the Department of Oral and Maxillofacial Diseases of Helsinki University Central Hospital (Studies II-IV). Medical records from all patients hospitalised during 1994 - 1996 (n=71) and 2004 (n=101) comprised Study II. Study III consisted of panoramic radiographs and medical records of patients hospitalised in 2004 (n=84). Medical records and panoramic radiographs of patients hospitalised due to periapical pathology as the source of infection in 2004 (n=60) comprised Study IV. Medically compromised patients were more susceptible to developing systemic infection with longer hospital care and, occasionally, fatal outcome. Previously healthy patients, on the contrary, developed local infections (Study I). The course of odontogenic maxillofacial infections became more severe and the incidence increased from 5.3 to 7.2 per 100,000 inhabitants in one decade (Study II). The need for intensive care increased from 15% to 32%. Odontogenic maxillofacial infections requiring hospital care developed mainly after dental treatment (58%) (Study III). Ongoing primary root canal treatment (RCT) was the most common endodontic procedure (70%) preceding the spread of infection due to apical periodontitis. Initiation of primary RCT with inadequate or incomplete RCT of acute apical periodontitis seems to open a risk window for spread of infection (Study IV). Microbiological findings from pus samples showed considerable differences between the groups with different antecedent dental care history (Study IV). Aerobic gram-positive bacteria were more commonly found in pus cultures from patients with preceding endodontic treatment compared to those from patients without preceding treatment, where anaerobic gram-negative bacteria were predominant. Thus, RCT was shown to prevent the growth and reduce the number of anaerobic bacteria in the root canal system and subsequently in the periapical abscesses. Although a dental procedure may provoke a flare-up of a pre-existing infection, leaving the potential source untreated creates a considerable risk for severe infection complications. The presence of multiple chronic infection sites led to stronger systemic response and more severe course of infection (Studies III and IV).Hammasperäiset infektiot voivat levitä paikallisesti aiheuttaen selluliittiä ja paiseenmuodostusta tai systeemisesti aiheuttaen sepsiksen tai etäinfektioita. Tämän tutkimuksen tarkoituksena oli analysoida ja selvittää paikallisten ja systeemisten sairaalahoitoa vaativien hammasperäisten infektioiden kulkua ja altistavia tekijöitä. Tutkimusaineistoksi valittiin Potilasvakuutuskeskuksessa käsitellyt hammasperäisiä infektioita koskevat potilastapaukset ja Suu- ja leukasairauksien klinikan Töölön sairaalassa ja Kirurgisessa sairaalassa (HYKS) hoidetut potilastapaukset. Tutkimus osoitti, että lääketieteelliset riskipotilaat olivat alttiimpia saamaan systeemisen sairaalahoitoa vaativan hammasperäisen infektion johtaen satunnaisesti menehtymiseen. Aiemmin terveet ja immunokompetentit potilaat puolestaan kehittivät paikallisen infektion, kuten selluliitin tai abskessin. Paikallisten sairaalahoitoa vaativien infektioiden kliininen kuva muuttui vuosikymmenen kohorttitutkimuksen aikana vakavammaksi ja insidenssi nousi 5,3:sta 7,2:een per 100 000 asukasta. Tehohoidon tarve kaksinkertaistui seuranta-aikana 15%:sta 32%:iin. Paikalliset sairaalahoitoa vaativat infektiot kehittyivät tavallisimmin hammastoimenpiteen jälkeen (58%). Primaaristi aloitettu juurihoito oli yleisin endodonttinen hoito edeltäen akuutin periapikaalisen parodontiitin paikallista leviämistä. Tutkimustulokset viittaavat primaaristi aloitetun ja keskeneräisen juurihoidon lisäävän riskiä infektion paikalliselle leviämiselle. Märkänäytteiden mikrobiologiset löydökset erosivat oleellisesti riippuen paikallista leviämistä edeltävästä fokushampaan hammastoimenpiteestä. Aerobiset gram-positiiviset bakteerit olivat yleisimpiä löydöksiä edeltävän juurihoidon jälkeen, kun taas anaerobiset gram-negatiiviset bakteerit olivat tavallisimpia potilasnäytteissä ilman edeltäviä hammastoimenpiteitä. Tutkimustulokset osoittavat juurihoidon ehkäisevän ja vähentävän anaerobien kasvua juurikanavasysteemissä ja näin ollen periapikaalisissa märkäpesäkkeissä. Hammastoimenpide voi provosoida infektoituneen fokushampaan paikallista infektion leviämistä. Infektoituneen hampaan hoitamatta jättäminen aiheuttaa kuitenkin suuremman riskin vakaville infektiokomplikaatioille. Tutkimustulokset korostavat suun terveyden ylläpitämistä etenkin infektioalttiilla potilailla