<b><i>Background:</i></b> Recently, time to treatment initiation has been observed to be increasing specifically for head and neck cancer. It is acknowledged that the pattern of increase is reflective of the use of sophisticated diagnostic and therapeutic techniques but was also determined to affect survival. <b><i>Objectives:</i></b> Our study sought to further investigate time to surgery (TTS) for surgically treated patients to see whether TTS would influence patient survival. <b><i>Method:</i></b> TTS was defined as the time from the earliest pathological report or scan, whichever was earlier, to surgery. The endpoints were overall survival (OS) and event-free survival (EFS). <b><i>Results:</i></b> A total of 294 patients with head and neck cancer were included. Patients were organized into TTS quartiles of 0–14 days (quartile 1), 15–29 days (quartile 2), 30–49 days (quartile 3), and ≥50 days (quartile 4). The median follow-up time was 651 days, and the median TTS was 32 days. Using a univariable analysis of Cox regression, TTS was not significantly associated with OS or EFS. Kaplan-Meier curves were not significant for OS (<i>p</i> = 0.8904) and EFS (<i>p</i> = 0.9556). <b><i>Conclusion:</i></b> In this cohort study, we could not conclude that TTS was associated with OS or EFS.

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Pemphigus vulgaris (PV) is a rare disease that affects the skin and mucous membranes, causing blistering and erosions. Identifying and effectively managing atypical presentations of pemphigus vulgaris can be challenging due to its rarity. We describe a 32-year-old male patient with a medical history including prediabetes, moderate asthma, hyperlipidemia, coccidioidomycosis, and respiratory infections. He was evaluated via telehealth in the allergy and immunology clinic for uncontrolled asthma. Initially, he complained of a whitish film in the mouth while on treatment with fluticasone and salmeterol. He also noted new vesicular lesions on his scalp and body. When evaluated later in the clinic, he was found to have oral and periungual erosions as well as paronychia. After promptly referring to dermatology, histopathological examination and direct immunofluorescence testing were performed on the patient's lesions, revealing changes consistent with PV. Treatment with prednisone and rituximab resulted in the complete resolution of the patient's bullae and nail deformities over several months. This case highlights the importance of a thorough evaluation of complex medical histories and diagnostic testing in managing asthma and allergy symptoms. It also emphasizes the need for a multidisciplinary approach involving specialists such as immunologists, dermatologists, and infectious disease experts in the diagnosis and management of complex cases.

47I submit, Sir, that an antenatal screening programme of a general population has nothing to recommend it at this time, and that to advocate such a programme in the absence of a full discussion of the relevant issues, some of which I have touched upon here, is little short of irresponsible. (14 November, p. 392) and to compare it with our work on clonidine. Since our preliminary communication' a detailed report has been published.2 Our work on methyldopa and clonidIne extended over a period of six months each, and we were able to study in 30 patients the side-effects, effectiveness, and tolerance of the two drugs. Unlike the experience with clonidine of Dr. Macdougall and colleagues who found that "side-effects from the drug were not disabling and were often transient" two of our patients developed such marked drowsiness that they refused to continue with clonidine. We feel that the greater number of side-effe-ts from dlonidine compared with methyldopa which has been observed by Dr. Amery and colleagues and by us, should make the clinician prefer methyldopa to clonidine, as one of the main factors dissuading a hypertensive patient from continuing with his therapy is unwanted side-effects. Tolerance occurred in six of our patients on methyldopa and in seven patients on clonidine. Our average dosage was 916 mg daily of methyldopa and 0-86 mg daily of clonidine.It seems a pity that Dr. Amery and colleagues used chlorthalidone in combination with both clonidine and methyldopa, as thiazides themselves may be effective hypotensive agents.-We are, etc.,