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Owing to the ever westernizing lifestyles in developing countries like India, the escalation of oral cancer patients are in need of urgent plan of action. With tobacco being the commonest cause for causation of oral cancer, Global Adult Tobacco Survey, 2016-17 revealed that almost 28% of whole population of India is consuming tobacco in either smoking or smokeless form. With these increasing numbers, the expected death toll to be expected to touch 1-2 million mark by the year 2035 [1]. Although, the current Onco-medicine fraternity excels in rendering care to oral cancer patients in the form of surgeries, chemotherapy and radiation-therapy. Often, these treatment modalities impart some unwanted adverse effects like, docetaxel (DCT) is known for its hepatotoxicity [2,3] whereas, one of the commonly used cisplatin (CIS) presents with nephrotoxicity, neurotoxicity, bone marrow suppression and vomiting [4,5]. Literature suggests of many non conventional medicaments being tested in past for their anti onco-genic effect, where few being effective and others being questionable ones. Chlorhexidine being one among them showing some how promising anti onco-genic activity with feeble amount of studies being conducted in past. Chlorhexidine, one of the most commonly prescribed mouthrinse in the field of dentistry, with varying concentrations of 0.12% and 0.2% concentrations. Although, apart from being broad spectrum antibiotic, its capability to dismantle the protein – protein bond between anti – apoptotic Bcl-2 family protein Bcl-xL and its pro – apoptotic binding partners [6]. The current study was conducted on three cell lines of squamous cell carcinoma (SCC-4, SCC-9, SCC -15) and two pharynx carcinoma cell lines (FaDu and Detroit 562). The compounds induced apoptosis through mitochondria dependent apoptotic pathway in oral tumour cell lines. Another study conducted to assess the similar anti – oncogenic activites of chlorhexidine mouthrinse along with cranberry [7]. It was evident from results that, with increasing concentrations of chlorhexidine mouthrinse, there was increase in mean percent growth inhibition. The authors concluded saying, chlorhexidine has showed both anti cancerous as well as anti bacterial activity required to tackle common oral infections, part of common anti cancer therapy. Fernando Martínez-Pérez et al (2019) conducted study, where antitumor activity of Lipophilic Bismuth Nanoparticles (BisBAL NPs) and chlorhexidine on human squamous cell carcinoma was assessed using energy dispersive X – ray spectroscopy in conjunction with scanning electron microscopy (EDS-SEM). Study revealed, BisBAL NPs and chlorhexidine both showed cell growth inhibition on both cancer cell line (CAL-27) and human gingival fibroblasts (HGFs). Although, chlorhexidine showed non specific cytotoxicity for both tumoral and non tumoral control cells. The suggestive mechanism of action might be loss of cell membrane integrity [8]. Although Eliot MN (2013) conducted study, to assess the risk of head and neck squamous cell carcinoma secondary to use of alcohol containing and non alcoholic mouthwashes including chlorhexidine. The study was concluded with an assumption based on chlorhexidine mouthwash alters the oral flora [9], thus resulting in increasing risk exponentially through diverse change in oral bacteria and altered immune response with contribution towards genesis or promotion of cancer [10]. On the contrary, alcohol consumption and smoking are predisposing factors towards upper digestive tract cancer. The main causative factor being the first metabolite of alcohol, acetaldehyde. And much higher levels are derived from oral bacteria and thus, same can be altered in favour through usage of chlorhexidine mouthwash, to avoid excessive production of acetaldehyde intra orally. In conclusion, chlorhexidine mouthwash has been into dental practice since long and the role it plays in either ways has to be assessed by a multi dimensional study with cell lines including that of control to derive better compared conclusions.

According to the World Health Organization definition, palliative care is an approach aimed at increasing the quality of life of patients and their relatives by addressing physical, psychosocial and spiritual needs and treating conditions early, such as pain while they are coming to terms with a life-threatening disease [1]. Palliative care services have started a rapid progress in developed countries such as Scandinavian countries, England and Canada since the beginning of 1990 [2]. Although palliative care cares for any patient who is in need of care, whether bed-bound or unable to look after themselves, one of the main area of interest is of course oncological patients and their relatives. Patients with advanced cancer, frequent sufferings from physical and psychological symptoms - primarily pain, reduced functional capacity, and reduced quality of life are in the scope of palliative care protocol [3]. The most common end-of-life symptoms and signs in palliative cancer patients are pain, anorexia, nausea, cachexia, weakness, dyspnea, ascites, anxiety, agitation, delirium, confusion and pressure sores. In order to achieve quality and continuous care in case management, a family doctor, specific branch specialist, nurse, dietician, psychologist, cleric, etc. should work together in a multidisciplinary approach and clinical guidelines and care protocols should be implemented [4]. However, it should be kept in mind that increasing the medication dose may not always be beneficial to the oncological patients in palliative services. The goal should always be maximum benefit with minimal tests and treatment. Palliative care does not aim to accelerate or postpone death; but it has many benefits in cancer patients and their relatives including the integration of the psychosocial and spiritual aspects of patient care into physical care, providing support for patients to live as active as possible until the last moment, improving the quality of life and the disease process, providing help and support in the grieving process [1,5]. Providing good care to advanced cancer patients requires that caregivers are educated and supported about their patients’ physical, psychological and social care needs. Balancing the physical and emotional needs of the caregivers will reduce the stress they experience, as well as increase the quality of life of their patients [6,7]. Professionalism in palliative care comes into play right at this point. There is no consensus in the medical world about by whom, when and to whom palliative care should be given. In this regard, the conflicts of opinion between specific branches such as anesthesia, internal medicine and neurology are inevitable. We think that the team leader should be a family physician or a palliative care specialist. The reason for this is the family medicine’s principles of core competencies including biopsycosocial, holistic, comprehensive approach and equal distance to specific branches. Of course when the palliative care specialist is the team leader the patient’s own family doctor still provides invaluable service because of his intimate and long-term knowledge about the patients. One key difference in some countries is that no distinction is being made between palliative and hospice care. Neither the insurance companies nor the state demands such classification because it doesn’t serve any practical purpose at the moment. However, in due time such distinction will be inevitable as one of the cost-cutting measure. Medical oncology will have to report about the expected survival of the cancer patients and it will further increase their workload given the exponential increase in cancer cases.

Introduction: Allergen immunotherapy is the only targeted therapy that can modify the natural course of allergic diseases. In pediatric patients, SCIT with aeroallergens is an effective treatment and should be considered as a preventive strategy in the treatment of allergic diseases, even though one of the major concerns about it is its safety. The main purposes of this study were to assess the safety of SCIT ultra-rush schedules with polymerized extracts in a pediatric population and to determine the impact of the COVID-19 pandemic on the safety and time of administration of subcutaneous immunotherapy among pediatric patients.Methods: A retrospective medical records review of patients under 18 years of age undergoing SCIT was made and re-scheduling due to restrictions imposed by the COVID-19 pandemic was recorded. Results: A total of 192 pediatric patients were included. Fifty-nine (31%) had local reactions and systemic reactions were not reported. In March 2020, the first case of COVID-19 was diagnosed in Portugal and all non-urgent appointments and procedures were postponed. In our group of pediatric patients, 43 (22%) were referred to primary care, 38 (20%) stopped AIT definitively and 111 (58%) maintained administrations in the hospital. Only 2 (2%) of them had reactions upon reinitiation. Conclusion: In this study, the ultra-rush protocol using polymerized extracts was safe in pediatric patients. Although the effectiveness of AIT may be compromised due to prolonged suspension of the treatment, it is important to note that despite longer interruptions, administrations may continue without compromising safety, maintaining shorter visits and a lower number of injections.

A 79 years old woman presented with one-day history of pain, redness, pain and swelling without discharge in her left ear, later her right ear started with the same symptoms as in her contralateral ear spreading around the scalp and the forehead (Figure 1), she denied fever, or other constitutional symptoms. 

 23-year-old man had a 2-year history of ketamine abuse and presented intermittent abdominal pain, urinary urgency and dysuria for one year. Two weeks ago, laboratory analysis showed within normal limits. This time, he visited our emergency department due to hematuria and bilateral flank pain. CT scan and MRI revealed bilateral hydronephrosis, hydroureter, irregular thickened wall of urinary bladder, and fusiform common bile duct with distal stenosis

Rhabdomyosarcomas are the most common soft tissue tumors of childhood. They are characterized by their poor prognosis. Vaginal location is very rare after puberty and exceptional in the post menopause. Treatment is based on several therapeutic measures combining neoadjuvant chemotherapy followed by surgery and/or external beam radiation therapy. We report herein the case of a 25 years-old woman, presented with vaginal embryonal RMS revealed by metrorrhagia and pelvic pain. The diagnosis was confirmed by biopsy and histopathological study. Pre-treatment workup was negative for metastatic disease. She has received chemotherapy based on vincristine, doxorubicin, and cyclophosphamide. The clinical evolution was marked by improvement of symptoms, unfortunately the patient died following febrile neutropenia after the third cycle of chemotherapy.

Background: Dipylidium caninum, a zoonotic cyclophyllidean tapeworm, mainly infects dogs, cats, and occasionally humans as well. Here, we present D. caninum infection in a domestic cat. A cat of about one year of age with a history of intermittent diarrhea and shedding stool containing whitish cooked rice like soft particles. Methods: The case was identified by thorough clinical, coprological, and parasitological examinations, and treated accordingly.Results: During the physical examination, the cat was found to be infested with flea, and coprological investigation revealed the presence of gravid segments of cestodes. By preparing a permanent slide, we conducted a microscopic examination, and the cestode was confirmed as D. caninum. The cat was treated with albendazole and levamisole, which were ineffective; additionally, levamisole showed toxicity. Then, we administered niclosamide which completely cured the animal. On re-examination after a week, feces were found negative for eggs/gravid segments of any cestode. Conclusion: Niclosamide was found effective against dipylidiasis and can be treated similar infections in pets.

The National Health Surveillance Agency (ANVISA) is a public institution created by Law 9782/1999, which integrates the field of Collective Health and acts in the prevention, control, and inspection of sanitary conditions in various sectors, such as food, health, pharmacies, hospitals, and commercial establishments. Its main objective is to guarantee the protection of public health, ensuring that products, services, and environments comply with established standards, to promote health and preventing diseases. To exercise its inspection and control function, Sanitary Surveillance has the power of sanitary police, which gives it the authority to apply necessary measures and curb practices that pose risks to the health of the population.The performance of the Sanitary Surveillance is fundamental to prevent health risks in any part of society and to guarantee national programs for patient safety. It is also essential to prevent diseases, control risks, and monitor compliance with health standards and specific regulations. The police power of Sanitary Surveillance consists of establishing norms and technical regulations, carrying out inspections and inspections, issuing temporary or permanent interdiction orders in establishments that do not comply with the norms, as well as forwarding complaints to the Public Ministry in cases of crimes against public health. Arrests carried out by Sanitary Surveillance agents are extreme measures and applied in serious situations of risk to public health or when there is repeated disrespect for sanitary regulations. The prohibited establishments have the right of defense and may seek to regularize the situation to obtain the release of activities.The performance of the Sanitary Surveillance has significant impacts on the prevention of disease outbreaks and epidemics. Identifying and correcting inappropriate practices helps to prevent the spread of pathogenic agents and reduce the risk of contagion in collective environments. The institution’s preventive and supervisory activities contribute to reducing risks to the population’s health, preventing disease outbreaks, food poisoning, and the proliferation of pests, among other problems. Finally, the importance of exercising police power with transparency, impartiality, and respect for individual rights is emphasized, always aiming at the collective interest and the promotion of the common good. In summary, Health Surveillance plays an essential role in protecting public health, seeking to ensure that the population has access to safe products and services, contributing to the improvement of quality of life and disease prevention.

We describe the first individual treatment trial with D-mannose in a young girl with PIGV-CDG. PIGV-CDG belongs to the GPI anchor deficiencies leading to intellectual disability, dysmorphic features, epilepsy, and, less frequently, organ malformations. A hallmark of the GPI anchor deficiencies is the elevated serum alkaline phosphatase (AP). Our patient carried the germline homozygous PIGV variant c.1022C>A, p. (Ala341Glu), the most commonly reported pathogenic variant leading to PIGV-CDG so far. We aimed to improve the impaired enzymatic function of PIGV through elevated substrate levels by giving D-mannose orally. We monitored the clinical status, developmental progress as well as serum AP levels. Our patient experienced no side effects. Standardized developmental testing showed better developmental progress during the 21-month treatment period with D-mannose than in the 12 months following the discontinuation of treatment. The D-Mannose treatment might have had a positive effect on the development of our patient with PIGV-CDG.

The incidence of heart failure with preserved ejection fraction (HFpEF) continues to rise, and obesity continues to be a predominant comorbid condition affecting patients with HFpEF. Recent research sheds light on the important pathophysiologic role that obesity plays in the development of HFpEF, with many areas of opportunity existing for future developments in understanding the etiology and management of the disease. Crucial in these pathophysiologic developments are studies that clearly characterize the obesity phenotype in HFpEF and compare it to presentations of HFpEF in patients without obesity. This paper reviews the existing literature on the obesity phenotype within HFpEF and discusses some of the prevailing ideas behind the pathophysiologic interplay between the conditions, as well as the existing treatments demonstrating improved outcomes in HFpEF.