Symptom management during and after treatment with concurrent chemoradiotherapy for oropharyngeal cancer:A review of the literature and areas for future research

Patients with locally advanced oropharyngeal cancer are at risk for poor outcomes due to the multi-modal nature of treatment and the potential for treatmentrelated toxicity.Although treatment with concurrent chemotherapy and radiotherapy has drastically reduced the need for a debilitating and disfiguring surgery,treatment related toxicities are often difficult to control.Acute toxicities include mucositis,skin desquamation,depression,cachexia,fatigue and nausea and vomiting.Failure to control these symptoms can adversely affect the patient's ability to complete their treatment regimen.Although there are many promising new treatments in the area of symptom management for this patient population,a review of the literature reflects the need for more research.

Traditional Chinese Medicine nursing protocols for psoriasis vulgaris（英文）

Psoriasis is a common chronic inflammatory skin disease with a spectrum of clinical phenotypes including psoriasis vulgaris, pustular psoriasis, guttate psoriasis and erythrodermic psoriasis, in which psoriasis vulgaris is most common. In recent years, Traditional Chinese Medicine(TCM) has attracted widespread attention in the treatment of psoriasis because of better efficacy and a lower incidence of adverse reactions. In TCM, psoriasis is considered to be caused by blood heat and the stagnation of Qi and blood. This article primarily investigated the key points of common syndromes, TCM nursing methods and healthy guidance of psoriasis vulgaris, aiming at maintaining and developing the strengths of TCM, improving its efficacy and standardizing its behavior.

Neonatal Kawasaki Disease: A Case Report

Objective: To report a case of Kawasaki disease (KD) with unusual age at presentation. Case Report: A 26-day-old Saudi boy presented with fever, irritability and poor feeding for 3 days. There was right cervical lymph node enlargement. There was mild throat congestion and bilateral congested tympanic membrane. The liver was palpable. Otherwise, there were no more abnormal physical findings. Laboratory findings revealed high erythrocyte sedimentation rate and positive C-reactive protein. The patient was admitted into an isolation room and antibiotics were started. On the 5th day, the condition of the patient deteriorated. Ampicillin was discontinued and vancomycin was started till getting the results of the culture sensitivity. On the 7th day, he developed diaper rash and fever spikes continued. On the 8th day, the patient developed swelling, redness and hotness of the right hand. Possibility of sepsis was considered and the administered antibiotics were imipenem and vancomycin, while cefotaxime was discontinued. On the 12th day, the patient developed anemia and leukocytosis. Gamma glutamyl transpeptidase was high. On the 15th day, the patient started to develop maculopapular rash on the trunk and desquamation of both hands and feet with swelling, cracked lips, bilateral conjunctival injection and unilateral neck lymph node swelling. So, the infant’s condition was clinically diagnosed as KD. Aspirin was started and 2 doses of intravenous immunoglobulins were given. On the 18th day, the condition of patient improved and the fever subsided. Conclusions: The diagnosis of KD among neonates is a clinical challenge. Diagnosis is based on clinical criteria after the exclusion of other diseases presenting with high persistent fever. Early treatment by administering intravenous immunoglobulins and aspirin can help prevent cardiac complications. There is a pressing need to raise awareness among pediatricians about this disease.

Xeroderma Pigmentosum with Desquamative Gingivitis a Rare Case Report and Detailed Review of Literature

In xeroderma pigmentosum, a rare genodermatosis, transmitted as an autosomal recessive disorder, excessive solar damage to the skin develops at an early age. The disease is characterized by cutaneous, ocular, neurological and oral changes. Oral features in the form of early development of Squamous cell carcinoma, usually at the lower lip and tip of the tongue may be seen. The disorder is associated more commonly in populations where marriage of close blood relatives is common. Treatment of the disorder includes avoidance of Ultra violet radiation, topical application of 5 fluorouracil to treat actinic keratoses, and regular evaluation by an optholmologist, dermatologist, and neurologist. Genetic counseling is an important aspect as an increased incidence of consanguineous marriages have been reported with this disorder. Here, we report an interesting case of xeroderma pigmentosum in an 18 year old male patient who presented with characterstic desquamation of gingiva, fissured tongue and geoghraphic tongue.

Staphylococcal-scalded skin syndrome:evaluation,diagnosis,and management

Background Staphylococcal-scalded skin syndrome(SSSS),also known as Ritter disease,is a potentially life-threatening disorder and a pediatric emergency.Early diagnosis and treatment is imperative to reduce the morbidity and mortality of this condition.The purpose of this article is to familiarize physicians with the evaluation,diagnosis,and treatment of SSSS.Data sources A PubMed search was completed in Clinical Queries using the key terms"Staphylococcal scalded skin syn-drome"and"Ritter disease".Results SSSS is caused by toxigenic strains of Staphylococcus aureus.Hydrolysis of the amino-terminal extracellular domain of desmoglein 1 by staphylococcal exfoliative toxins results in disruption of keratinocytes adhesion and cleavage within the stratum granulosum which leads to bulla formation.The diagnosis is mainly clinical,based on the findings of tender erythroderma,bullae,and desquamation with a scalded appearance especially in friction zones,periorificial scabs/crusting,positive Nikolsky sign,and absence of mucosal involvement.Prompt empiric treatment with intravenous anti-staphylococcal antibiotic such as nafcillin,oxacillin,or flucloxacillin is essential until cultures are available to guide therapy.Clarithromycin or cefuroxime may be used should the patient have penicillin allergy.If the patient is not improving,critically ill,or in com-munities where the prevalence of methicillin-resistant S.aureus is high,vancomycin should be used.Conclusion A high index of suspicion is essential for an accurate diagnosis to be made and treatment promptly initiated.

Cosmetics use-related adverse events

To the Editor: Cosmetics (non-prescription skin care products) use-induced adverse events could present as skin erythema, papules, pruritus, dryness, desquamation, and abnormal discoloration. Non-medicated cosmetics use is more and more common in the China, but little is known about the characteristics of cosmetic-related adverse events.

Gross and Histopathological Changes in Gastrointestinal Tract in Cases of Acute Transoral Paraquat Poisoning

Background and Justification: Paraquat is one of the easily available household poisons and has become an easy source of committing suicide, especially in rural India including in West Bengal where it is used as a “weedkiller.” Out of the fatal 272 poisoning cases where autopsies were done at NRSMCH Morgue in the year 2019, 56.6% of cases died due to transoral paraquat poisoning. Though adequate literature is available showing gross and microscopic changes in lungs, liver, and kidneys following transoral paraquat poisoning, data showing the effect of the poison in the gastrointestinal (GI) tract is limited though its detrimental effects on the GI tract are associated with increased morbidity. Objectives: The objectives of the study were to assess the gross and histopathological changes in different parts of the GI Tract involving lips, tongue, esophagus, and stomach in paraquat death cases brought for autopsy in NRSMCH Morgue, Kolkata, to fill the gap in the existing literature to a certain extent. Methods: The study was a descriptive, cross-sectional study that was done over 5 months and during which we got 38 cases based on inclusion and exclusion criteria. Results: Macroscopically Congestion with erosion and hemorrhage was seen mostly in the stomach followed by the esophagus. Histopathologically desquamation was the consistent finding in all organs attributed to the corrosive property of the paraquat solution. Chronic inflammatory cell infiltrations are predominantly seen in the tongue followed by the esophagus and lips. Hyperplasia of the surface epithelium was noticeable mostly in the esophagus followed by the tongue and lips but not in the stomach. Involvement of Distortion of glandular architecture in the stomach outnumbers the other organs, followed by the tongue. Necrotic changes were limited to the stomach and esophagus only. Both ulceration and necrotic changes were predominantly limited to the lowermost part of the esophagus than its rest portion, mainly at the junction of the esophagus and stomach where the surface epithelium shifted from squamous to columnar variety. Conclusion: The result of the study can be utilized by healthcare professionals to prepare proper medical/surgical interventions to reduce mortality and morbidity in transoral paraquat poisoning cases concerning GI complications.