NONMELANOMA SKIN CANCER IN A HEART TRANSPLANT PATIENT: A CASE REPORT AND REVIEW OF THE LITERATURE.

Nonmelanoma skin cancers (NMSC) are the most common malignancies in solid organ transplant recipients. The most common types of skin cancer in these patients are squamous cell carcinoma (SCC), followed by basal cell carcinoma. In immunosuppressed patients, specifically patients after solid organ transplantation, these carcinomas tend to be more aggressive and have a much higher incidence of metastasizing compared to general population. We present a case of a patient who developed numerous SCCs after successful heart transplantation. SCCs which occurred in our patient were mostly treated surgically. However, the lesion on the scalp relapsed after it had been treated surgically three times and therefore superficial x-ray radiation therapy was administered due to its localization and extensive size. In the next year, five more new SCCs occurred throughout the patient's body and all of them were removed surgically. Soon afterwards, the patient died from adenocarcinoma of the colon which rapidly progressed and metastasized.

Global Warming and Prescribing: A Review on Medicines' Effects and Precautions.

INTRODUCTION: Global warming is slowly but surely becoming one of the greatest problems of the modern world. Heatwaves with extremely high temperatures and humidity changes are particularly dangerous as they can lead to increased mortality rates and increased side effects of certain medications. The goal of this study was to give a short review of the most critical issues healthcare professionals should be mindful of when it comes to prescription of medicines during high temperature periods. METHODS: A PubMed literature search was conducted in January 2021 in order to identify studies showing stability changes of most prescribed drugs in high temperatures as well as studies demonstrating impact of some drugs on human thermoregulation. RESULTS: A vast majority of the commonly prescribed drugs, including Simvastatin, Levothyroxine, Omeprazole and Atorvastatin aren't susceptible to heat. However, some studies found that Amlodipine and Lansoprazole degrade following heat exposure. A study demonstrated the effects of low relative humidity environment on Levothyroxine tablets. While Levothyroxine remained stable at high temperatures, it significantly degraded with the decrease in humidity. Since all vaccines, both viral and bacterial, are most stable at exactly 2-8 °C, providing adequate storage has turned out to be an immense challenge. In general, killed whole-cell bacterial vaccines, like pertussis vaccine, show a higher degree of stability of potency compared to live attenuated vaccines, such as BCG. However, when tested in high-temperature conditions, BCG vaccine has proven to be more stable than Pertussis vaccine. Also, diphtheria and tetanus toxoids have proven to be most stable during exposure to various conditions. Many medicines can potentially have their side effects enhanced during heatwaves and cause serious health issues. Using the percutaneous form of nitroglycerin could lead to an additional decrease in blood pressure in warm weather. Subdermally injected insulin could create a severe hypoglycemia in diabetic patients. Studies have shown that schizophrenic patients on antipsychotic treatment have much lower heat tolerance, with a higher possibility of developing hyperthermic syndromes such as febrile catatonia or neuroleptic malignant syndrome. CONCLUSION: Heatwave periods are not to be taken lightly and should be approached with utmost caution when prescribing therapy. It is of critical importance to inform and educate vulnerable populations early in the season and promote proper hydration throughout the periods when temperatures exceed local averages.