Invasive candidiasis is a rising global health threat with increasing incidence, persistently high mortality, and diminishing treatment options. Antifungal resistance has rapidly emerged and spread, with multidrug-resistant species deemed an urgent and serious threat. While acknowledging the key role of antifungal stewardship and infection control in curbing spread, we examine the role of antifungal monotherapy in driving resistance and the potential for combination therapy to prevent stress adaptation and emergence of drug resistance. In addition to its role in mitigating resistance, combination treatment may improve drug penetration, expedite fungal clearance, and allow lower, less toxic doses of individual drugs to be used. A growing body of laboratory-based evidence suggests that antifungal combinations can yield synergistic activity against Candida spp., including against frequently multidrug-resistant Candida auris. It is imperative to test these combinations in clinical trials, incorporating resistance end points as a marker of success.

Worldwide, the majority of countries are actively devising strategies to address the challenges associated with unregulated and unmanageable development, the decline in environmental quality and the depletion of valuable agricultural land. This has led to a growing emphasis on understanding land use and land cover. In order to determine a better land use policy, legislators and planners need to know the current distribution of agricultural and urban lands, as well as information about changes in their proportions. Our approach combines data centred on main four themes-geology, slope gradient, hydrographic network and land use-in order to exploit classifier complementarities in our targeted agricultural study area of Tamlouka Basin, Algeria. Landsat 8 OLI-TIRs multispectral imagery and Shuttle Radar Topography Mission (SRTM-1arc v3) were used experimentally for classification and Digital Elevation Model (DEM) analysis. The classification\'s accuracy is confirmed by comparing the results of the decision tree classification with the validation samples. Results of the combination of several maps of classifications from the different methods show that the Tamlouka alluvial plain, having an area of 19,300 ha and an average slope gradient of less than 2°, drains the elevated reliefs that surround it via hydrographic network. The plain occupies 37% of the total basin area, with over of 60% being used for crop cultivation, regardless of fallow land areas in agricultural rotation at that time. The slope has been identified as a crucial factor determining land use patterns in the study area. This result can be used in prospective watershed management.

BACKGROUND: Coronavirus disease 2019 (COVID-19) infection in lung transplant recipients can be lethal owing to the use of immunosuppressants. Antiviral agents may be administered to these patients. Co-packaged nirmatrelvir-ritonavir is a new agent currently being used in combination.
METHODS: In this report, we present a case of a 64-year-old woman, a lung transplant recipient, who experienced hyponatremia and showed a high serum tacrolimus concentration following the administration of the co-packaged nirmatrelvir-ritonavir combination.
CONCLUSIONS: Although the nirmatrelvir-ritonavir and tacrolimus combination is not contraindicated, other treatment strategies should be considered first, if available, and the dose of tacrolimus should be reduced when using the nirmatrelvir-ritonavir combination. In cases where combination therapy is necessary, serum tacrolimus levels should be closely monitored in lung transplant recipients. Documentation of more such reports is important to identify drug interactions between nirmatrelvir-ritonavir and other agents, with the aim of preventing severe adverse effects.

Granuloma annulare (GA) is an uncommon disease in dermatology. Here, we report a case of generalized GA combined with Sjogren\'s syndrome (SS) in a 65-year-old woman. To our knowledge, generalized GA combined with SS has not been reported before.

Penile squamous cell carcinoma is a rare disease entity with poor overall survival in an advanced stage. Few studies have investigated the role of immunotherapy in advanced penile squamous cell carcinoma. Herein, we report a case of stage IV unresectable penile squamous cell carcinoma presenting with anal bleeding and urethra obstruction who responded dramatically to combination therapy of durvalumab and cisplatin-based chemotherapy. The patient had HPV-positive penile squamous cell carcinoma, cT3N3M0, with concomitant anus squamous cell carcinoma. After 2 months of the combination treatment, almost all bulky inguinal lymph nodes shrank, and the main tumor of the anus and penis responded completely. A durable response was seen 16 months after initiating the combination therapy. This case report highlights the potential role of the combination of immunotherapy and chemotherapy in patients with advanced penile cancer. The promising results of this combination resulted in the conversion of unresectable disease to a potentially curable disease.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired demyelinating disease of the peripheral nervous system with unknown etiology. Alopecia universalis, an advanced form of alopecia areata (AA), is a condition characterized by complete hair loss. Here we report the first case of childhood CIDP associated with AA who was successfully treated with a combination of intravenous immunoglobulin (IVIg) and corticosteroids. CASE REPORT: This case describes a nine-year-old Japanese girl who developed alopecia, progressive muscle weakness, and eventually loss of walking ability (at ages 2, 4, and 7, respectively). She was treated with IVIg and prednisolone combination therapy, which improved muscle weakness and alopecia. She was positive for serum IgG-GM2 type anti-glycolipid antibodies, which may be associated with this rare combination of diseases.

We report the case of a 20-year-old man with acne conglobata (AC) who was treated with 5-aminolevulinic acid photodynamic therapy (ALA-PDT) sequentially to deroofing, and finally used fractional carbon dioxide laser for esthetic requirements, achieving satisfying results. AC is a severe form of acne vulgaris that can lead to significant scarring and has serious negative effects on a patient\'s psychological well-being and quality of life. Some cases are likely resistant to currently available treatments. This report describes a promising, and effective method for the treatment of AC.

UNASSIGNED: Drug interactions are important causes of adverse events. Assessments of pharmacological interactions outside healthcare services settings are scarce.
UNASSIGNED: To assess the frequency and factors associated with these potential interactions in adults living in Manaus, Amazonas, Brazil.
UNASSIGNED: We conducted a case-control study in 2019 with residents who had taken two or more medicines two weeks before the interview. The cases involved people with potential drug interaction, according to Micromedex™, and adults without drug interactions formed the control group. The factors associated with interaction were identified by multivariate logistic regression.
UNASSIGNED: 752 adults out of 2321 interviewed were using two or more medicines and were included. The prevalence of potential drug interactions was 30.2% (95% CI: 26.9; 33.5%). We identified 457 drug interactions, more frequently one interaction per person (49.7%), of major severity (61.9%), and with fair documentation (61.7%); three individuals were using contraindicated associations. Individuals aged 45-59 years (OR 1.88, 95% CI 1.03-3.42), using 3 or more drugs simultaneously (p-value<0.001), had higher chance of drug interactions.
UNASSIGNED: Drug interaction was common in among adults living in Manaus, mostly of major severity. The odds of interaction increased with age and number of concomitantly medicines.

BACKGROUND: Little is known about the safety and efficacy of using two or more biologics for the treatment of immune-mediated diseases, including Crohn\'s disease (CD).
METHODS: This case report and narrative review demonstrate the potential safety of dual biologic therapy (DBT) in a 45-year-old female with two separate immune-mediated diseases. She had a history of multiple sclerosis for which she was receiving treatment with ocrelizumab, and she had been recently diagnosed with CD after presenting with diarrhoea. The CD diagnosis was confirmed radiologically, endoscopically, histologically, and biochemically. The patient received treatment with vedolizumab, a gut-specific inhibitor of the α4β7 integrin on leukocytes. No adverse reactions were observed for the duration of treatment. The safety of ocrelizumab and vedolizumab for the treatment of different immune-mediated diseases was demonstrated.
CONCLUSIONS: DBT may be a safe and effective option for the treatment of refractory disease or multiple immune-mediated diseases. Newer biologics, which have improved safety profiles and gut specificity, may provide promising avenues for treatment. However, caution must be exercised in the appropriate selection of biologics given their inherent immunosuppressive properties, side effects, and efficacy profiles. Current evidence suggests that biologic therapy is not associated with a worse prognosis in patients with coronavirus disease 2019, but treatment decisions should be made in a multidisciplinary setting. Further research from controlled trials is needed to better understand the safety profile of DBT in CD. The immunopathological mechanisms underlying DBT also remain to be clarified.

Defects resulting from surgical procedure may be challenging to reconstruct depending on the size and location. In case of large defects, primary closure is often not possible and thus requires skin flap or graft. In such cases, skin flap is advantageous as it produces a similar color and texture with the surrounding tissue. Skin flap techniques such as advancement flap, rotation flap dan transposition flap are useful in closing small defects. In moderate to large-sized defects, especially in areas with high tension, a combination of more than one type of flap might be necessary. This report describes two cases of large defects on the temple and cheek following basal cell carcinoma excisional surgery which were successfully closed using a combination of rotation and advancement flaps. Both patients showed excellent functional and cosmetic outcome.