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Candidiasis is a highly pervasive infection posing major health risks, especially for immunocompromised populations. Pathogenic Candida species have evolved intrinsic and acquired resistance to a variety of antifungal medications. The primary goal of this literature review is to summarize the molecular mechanisms associated with antifungal resistance in Candida species. Resistance can be conferred via gain-of-function mutations in target pathway genes or their transcriptional regulators. Therefore, an overview of the known gene mutations is presented for the following antifungals: azoles (fluconazole, voriconazole, posaconazole and itraconazole), echinocandins (caspofungin, anidulafungin and micafungin), polyenes (amphotericin B and nystatin) and 5-fluorocytosine (5-FC). The following mutation hot spots were identified: (1) ergosterol biosynthesis pathway mutations (ERG11 and UPC2), resulting in azole resistance; (2) overexpression of the efflux pumps, promoting azole resistance (transcription factor genes: tac1 and mrr1; transporter genes: CDR1, CDR2, MDR1, PDR16 and SNQ2); (3) cell wall biosynthesis mutations (FKS1, FKS2 and PDR1), conferring resistance to echinocandins; (4) mutations of nucleic acid synthesis/repair genes (FCY1, FCY2 and FUR1), resulting in 5-FC resistance; and (5) biofilm production, promoting general antifungal resistance. This review also provides a summary of standardized inhibitory breakpoints obtained from international guidelines for prominent Candida species. Notably, N. glabrata, P. kudriavzevii and C. auris demonstrate fluconazole resistance. [ABSTRACT FROM AUTHOR]

Objective: The aim of this sub-analysis was to highlight the MASCC/ISOO clinical practice guidelines for the management of oral mucositis (OM) in pediatric patients and to present unique considerations in this patient population.Methods: This sub-analysis of the pediatric patient population is based on the systematic review conducted by the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISSO) published in 2019/2020. Studies were scored and assigned a level of evidence based on previously published criteria. Data regarding adverse effects and compliance was collected from the original publications.Results: A total of 45 papers were included and assessed in this sub-analysis, including 21 randomized controlled trials (RCTs). Chewing gum was demonstrated to be not effective in preventing OM in pediatric cancer patients in 2 RCTs. The efficacy of all other interventions could not be determined based on the available literature.Conclusion: There is limited or conflicting evidence about interventions for the management of OM in pediatric cancer patients, except for chewing gum which was ineffective for prevention. Therefore, currently, data from adult studies may need to be extrapolated for the management of pediatric patients. Honey and photobiomodulation therapy in this patient population had encouraging potential. Implementation of a basic oral care protocol is advised amid lack of high level of evidence studies. [ABSTRACT FROM AUTHOR]

Background: Mucositis is a significant toxicity of cancer therapy with numerous systemic sequelae. The goal of this systematic review was to update the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) Clinical Practice Guidelines for the management of mucositis.Methods: The literature was reviewed systematically to identify interventions for mucositis. Studies were rated according to the presence of major and minor flaws according to previously published criteria. The body of evidence for each intervention and in each treatment setting was assigned a level of evidence based on previously published criteria. Guidelines were developed based on the level of evidence, with 3 possible guideline determinations: recommendation, suggestion, or no guideline possible.Results: The guideline covers evidence from 1197 publications related to oral or gastrointestinal mucositis. Thirteen new guidelines were developed for or against the use of various interventions in specific treatment settings, and 11 previous guidelines were confirmed after aa review of new evidence. Thirteen previously established guidelines were carried over because there was no new evidence for these interventions.Conclusions: The updated MASCC/ISOO Clinical Practice Guidelines for mucositis provide professional health caregivers with a clinical setting-specific, evidence-based tool to help with the management of mucositis in patients who have cancer. [ABSTRACT FROM AUTHOR]

Purpose: To update the clinical practice guidelines for the use of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the prevention and/or treatment of oral mucositis (OM).Methods: A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. The findings were added to the database used to develop the 2014 MASCC/ISOO clinical practice guidelines. Based on the evidence level, the following guidelines were determined: Recommendation, Suggestion, and No Guideline Possible.Results: A total of 9 new papers were identified within the scope of this section, adding to the 62 papers reviewed in this section previously. A new Suggestion was made for topical 0.2% morphine for the treatment of OM-associated pain in head and neck (H&N) cancer patients treated with RT-CT (modification of previous guideline). A previous Recommendation against the use of sucralfate-combined systemic and topical formulation in the prevention of OM in solid cancer treatment with CT was changed from Recommendation Against to No Guideline Possible. Suggestion for doxepin and fentanyl for the treatment of mucositis-associated pain in H&N cancer patients was changed to No Guideline Possible.Conclusions: Of the agents studied for the management of OM in this paper, the evidence supports a Suggestion in favor of topical morphine 0.2% in H&N cancer patients treated with RT-CT for the treatment of OM-associated pain. [ABSTRACT FROM AUTHOR]

The article discusses popular notions on stop-smoking treatments and its medical validity. It notes that nicotine is not essentially the harmful ingredient in cigarettes but rather the presence of toxins such as vinyl chloride, nickel, and arsenic and other tobacco combustion products may lead to cancer. It also states that nicotine replacement therapy (NRT) is medically safe as it provides the same effect of smoking without its combustible toxins.

The article features the position statement of the Ontario Dental Association (ODA) regarding electronic cigarettes (e-cigarettes). Topics covered include over-the-counter nicotine replacement therapy (NRT) and pharmacotherapy, increase in the number of young people who use e-cigarettes, lack of research on e-cigarette use's behavioural and long-term effects, and ODA's support for e-cigarette regulation in Ontario and for continued scientific study regarding e-cigarette use and its effects.

An abstract of the articles about the screening tools for the identification of patients with obstructive sleep apnea (OSA) including the Epworth Sleepiness Scale (ESS), the Four-Variable Screening Tool (FVST) and the Upper Airway Physical Examination Protocol (UAPP) is presented.

The article presents a summary of the Clinical Guidelines for Evaluation, Management and Long-Term Care of Obstructive Sleep Apnea (OSA) in Adults, which were established by the Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Apnea. It characterizes OSA and describes the basis for the diagnosis of the disorder. It points out the importance of patient education and offers information on the treatment options for the management of OSA, including oral appliances.

The article discusses the findings from the International Tobacco Control (ITC) four Country Survey, a prospective cohort survey which was conducted to assess the real- world effectiveness of stop-smoking medications in Great Britain, U.S., Canada, and Australia. Topics covered include use of data from 2006 to 2009, profiles of participants who did not use medications in their quit attempt, and link of use of varenicline, bupropion, and nicotine patch to better success in smoking cessation.

The article discusses the impact of tobacco on oral cancer and the role of dentists in oral cancer prevention in Canada and around the world. Topics covered include the 2016 Annual Spring Meeting of the Ontario Dental Association (ODA), the Oral Health Strategy (OHS)-Centre for Addiction and Mental Health (CAMH)/Training Enhancement in Applied Cessation Counselling and Health (TEACH) Clinical Tobacco Intervention and Dentistry symposium, and the Global Oral Cancer Forum (GOCF).

The article offers information on the effects of smoking tobacco cigarette on the oral health among older adults. Among the implications includes the reduction of approximately seven years life expectancy of tobacco users, the risk for dental carries, chronic periodontitis, and tooth loss, and chronic diseases. Also mentioned the association of smoking with stroke, Alzheimer's disease and cancer and the encouragement for smoking cessation in older adults. INSET: Oral Health 2016: Clinical Tobacco Intervention.

The article focuses on increasing popularity of tobacco smoking using water pipes in Canada. Topics discussed are wrong notion about safe alternative as the tobacco still contains additive drug nicotine, extent of health hazard as per World Health Organization (WHO), and role of health care providers and dental team to spread awareness of risks involved and prevent smoking related disease such as cancer.