Allergies and risk of head and neck cancer: a case-control study.

Although the relationship between allergies and cancer has been investigated extensively, the role of allergies in head and neck cancer (HNC) appears less consistent. It is unclear whether allergies can independently influence the risk of HNC in the presence of substantial environmental risk factors, including consumption of alcohol, betel quid, and cigarettes. This study aims to find this association. We examined the relationship between allergies and HNC risk in a hospital-based case-control study with 300 cases and 375 matched controls. Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals, controlling for age, sex, tobacco smoking and opium usage history, alcohol consumption, and socioeconomic status. Our study showed a significant reduction in the risk of HNC associated with allergy symptoms after adjusting for confounders. The risk of HNC was greatly reduced among those with any type of allergy (OR 0.42, 95% CI 0.28, 0.65). The ORs were considerably reduced by 58-88% for different kinds of allergies. The risk of HNC reduction was higher in allergic women than in allergic men (71% vs. 49%). Allergies play an influential role in the risk of HNC development. Future studies investigating immune biomarkers, including cytokine profiles and genetic polymorphisms, are necessary to further delineate the relationship between allergies and HNC. Understanding the relationship between allergies and HNC may help to devise effective strategies to reduce and treat HNC.

A case of palmar-plantar erythrodysesthesia in a lung cancer patient receiving atezolizumab maintenance.

INTRODUCTION: Immune checkpoint inhibitors (ICIs) are linked with various cutaneous side effects ranging from mild to life-threatening. Herein, we present a unique case of palmar-plantar erythrodysesthesia (PPE) in a patient treated with atezolizumab. CASE REPORT: A 72-year-old white man was diagnosed with Tumor, node, metastasis (TNM) stage IIIA lung adenocarcinoma in November 2022. He underwent right lower lobectomy and mediastinal lymphadenectomy followed by adjuvant cisplatin-pemetrexed. As of May 2023, he did not have any evidence of relapse. He then started switch maintenance therapy with atezolizumab. At 24 weeks, the patient developed erythematous palmar skin lesions, followed by blisters and peeling of both palms, which were associated with swelling and pain, consistent with grade 2 PPE. MANAGEMENT AND OUTCOME: Causality assessment between nivolumab and PPE via adverse drug reaction probability scale revealed a score of 5. Atezolizumab was continued, and he started on a cream consisting of trolamine and 75% water to palms twice daily. A follow-up visit 6 weeks later showed significant improvement in symptoms and appearance of palmar lesions. DISCUSSION: Cutaneous side effects are commonly seen with ICIs. PPE is a common dermatologic toxicity of certain tyrosine kinase inhibitors (TKIs). This effect has been previously reported with combination therapies consisting of an ICI plus a TKIs, but not with ICI monotherapy. Awareness of this potential side effect of ICIs would prevent unnecessary work-up, and lead to its prompt diagnosis and treatment.

Problem-based learning as an effective method for teaching theoretical surgery courses to medical students.

BACKGROUND: This study was designed to assess the clinical judgment of medical students in surgery clinical decision-making by a standard examination after lecture-based learning (LBL) or problem-based learning (PBL). MATERIALS AND METHODS: A prospective randomized trial study on 175 medical students whom were randomly allocated to three groups was performed during November 2017 and January 2018. LBL group (n = 103), PBL group led by an attending (n = 39), and PBL group (n = 33) led by an intern. Chi-squared test and independent student t-test were used to compare between the two groups. All the analyses were performed by the two-sided method using the Statistical Package for the Social Sciences software (SPSS version 22; SPSS, Inc., Chicago, IL, USA), and a P < 0.05 set as statistically significant. RESULTS: The students in the PBL group scored significantly higher on the posttraining multiple-choice examination, compared to the LBL group (P = 0.048). However, there was no significant difference between the PBL group led by an attending and the PBL group led by an intern (P = 0.892). CONCLUSION: We concluded that PBL remarkably increased the students' scores in the problem-solving examination, as compared to the conventional method. We found no significant differences in PBL facilitated by an attending or an intern.

Approach to Acute Abdominal Pain: Practical Algorithms.

CONTEXT: Acute abdominal pain is one of the most common complaints of patients admitted to emergency units. This study aimed to propose a new approach to abdominal pain by designing a more structured diagnostic workup for physicians. EVIDENCE ACQUISITION: A comprehensive review of relevant articles and algorithms presented in books and websites was conducted. Approaches which were relevant to the study concept, were selected. RESULTS: Seven algorithms were introduced with respect to the site of abdominal tenderness. The mainstay of these algorithms was differential diagnosis of the tenderness site. CONCLUSION: Based on the findings, the designed approach can prevent confusion among physicians and reduce requests for many unnecessary paraclinical tests, which delay the final diagnosis and impose unacceptable costs on patients and healthcare systems.

Clinical Cancer Registry of the Islamic Republic of Iran: Steps for Establishment and Results of the Pilot Phase.

INTRODUCTION: Despite the importance of clinical cancer registries in improving the quality of cancer care and clinical research, few reports on clinical cancer registries are available from low- and middle-income countries. We designed a program to establish a clinical cancer registry in Iran. PATIENTS AND METHODS: We established a clinical cancer registry at the Cancer Institute of Iran as a pilot center. We defined the organizational structure, developed minimal data sets and data dictionaries, verified data sources and registration processes, and developed the necessary registry software. During the pilot phase, we studied the clinical characteristics and outcomes of patients with cancer in 4 sites (breast, colorectal, stomach, and esophagus) who were admitted to the Cancer Institute of Iran in 2014. RESULTS: We registered 1,117 patients (650 breast, 199 colorectal, 163 stomach, and 105 esophageal cancer patients) in the pilot phase of this program. Completeness of the registry in the pilot phase was 99%. Overall, 15.57% of patients were at stage IV at diagnosis, 30.43% were at stage III, and 43.6% were diagnosed at an earlier stage (stages 0-II). Stage was unknown in 10.3% of patients. Five-year observed survival for breast, colorectal, stomach, and esophageal cancers was 78.57% (95% CI, 74%-82%), 57.91% (95% CI, 49%-65%), 17.97% (95% CI, 12%-24%), and 18.44% (95% CI, 11%-26%), respectively. DISCUSSION: This registry provides important information that can be the basis for evaluation and improvement of quality of care among Iranian patients. This registry will be scaled up to the national level as an important resource for measuring quality of care and conducting clinical cancer research in Iran.