A standardized Hippophae extract (SBL-1) counters neuronal tissue injuries and changes in neurotransmitters: implications in radiation protection.

CONTEXT: Effects of a radioprotective, standardized leaf extract (code SBL-1) from traditional medicinal plant, sea buckthorn [Hippophae rhamnoides L. (Elaeagnaceae)], on neurotransmitters and brain injuries in rats showing radiation-induced conditioned taste aversion (CTA), are not known. Understanding CTA in rats is important because its process is considered parallel to nausea and vomiting in humans. OBJECTIVE: This study investigated the levels of neurotransmitters, antioxidant defences and histological changes in rats showing radiation CTA, and their modification by SBL-1. MATERIALS AND METHODS: The inbred male Sprague-Dawley rats (age 65 days, weighing 190 ± 10 g) were used. Saccharin-preferring rats were selected using standard procedure and divided into groups. Group I (untreated control) was administered sterile water, group II was 60Co-γ-irradiated (2 Gy), and group III was administered SBL-1 before irradiation. Observations were recorded up to day 5. RESULTS: Irradiation (2 Gy) caused (i) non-recoverable CTA (≥ 64.7 ± 5.0%); (ii) degenerative changes in cerebral cortex, amygdala and hippocampus; (iii) increases in brain dopamine (DA, 63.4%), norepinephrine (NE, 157%), epinephrine (E, 233%), plasma NE (103%) and E (160%); and (iv) decreases in brain superoxide dismutase (67%), catalase (60%) and glutathione (51%). SBL-1 treatment (12 mg/kg body weight) 30 min before irradiation (i) countered brain injuries, (ii) reduced CTA (38.7 ± 3.0%, day 1) and (iii) normalized brain DA, NE, E, superoxide dismutase, catalase and CTA from day 3 onwards. DISCUSSION AND CONCLUSION: Radiation CTA was coupled with brain injuries, disturbances in neurotransmitters and antioxidant defences. SBL-1 pretreatment countered these disturbances, indicating neuroprotective action.

Metallic taste in cancer patients treated with chemotherapy.

BACKGROUND: Metallic taste is a taste alteration frequently reported by cancer patients treated with chemotherapy. Attention to this side effect of chemotherapy is limited. This review addresses the definition, assessment methods, prevalence, duration, etiology, and management strategies of metallic taste in chemotherapy treated cancer patients. METHODS: Literature search for metallic taste and chemotherapy was performed in PubMed up to September 2014, resulting in 184 articles of which 13 articles fulfilled the inclusion criteria: English publications addressing metallic taste in cancer patients treated with FDA-approved chemotherapy. An additional search in Google Scholar, in related articles of both search engines, and subsequent in the reference lists, resulted in 13 additional articles included in this review. Cancer patient forums were visited to explore management strategies. FINDINGS: Prevalence of metallic taste ranged from 9.7% to 78% among patients with various cancers, chemotherapy treatments, and treatment phases. No studies have been performed to investigate the influence of metallic taste on dietary intake, body weight, and quality of life. Several management strategies can be recommended for cancer patients: using plastic utensils, eating cold or frozen foods, adding strong herbs, spices, sweetener or acid to foods, eating sweet and sour foods, using 'miracle fruit' supplements, and rinsing with chelating agents. INTERPRETATION: Although metallic taste is a frequent side effect of chemotherapy and a much discussed topic on cancer patient forums, literature regarding metallic taste among chemotherapy treated cancer patients is scarce. More awareness for this side effect can improve the support for these patients.

Subtotal glossectomy preserving half the tongue base prevents taste disorder in patients with tongue cancer.

Most patients diagnosed with tongue carcinoma undergo surgical resection and reconstructive surgery to preserve tongue mobility and swallowing functions. Twenty-four patients who underwent a total or subtotal glossectomy and surgical reconstruction were evaluated for residual taste sensation. The graded filter paper test for all four tastes (sweet, salt, sour, and bitter) was performed on the posterior wall of the oropharynx and on tongue remnants if they were visible from the mouth. Eleven of the 24 patients were aware of their taste disorder after surgery. Four patients with more than 1/2 residual tongue base had no taste complaints, whereas seven of 14 patients with less than 1/3 residual tongue base reported taste abnormalities. Patients who could only tolerate a poor diet or tube feeding tended to have taste complaints (P=0.017). The taste test showed that the taste threshold of the residual tongue was significantly lower compared to controls. The taste threshold was significantly correlated with the remaining volume of tongue base. Patients with >1/2 the tongue base remaining had good taste sensation, whereas those with <1/3 residual tissue had impaired taste. This study suggests that glossectomy strategies aimed at preserving at least half the tongue base may substantially reduce dysgeusia in the patients.

[Taste disorders in cancer patients]. / Le alterazioni gustative nei pazienti con cancro.

Taste disorders in cancer patients. Introduction. Taste disorders are a relevant but often underestimated and under reported symptom in cancer patients. Taste disorders can be a consequence of the illness or its treatment, especially in head and neck cancer patients. Aims. To describe the physiologic mechanisms of taste disorders in cancer patients, their assessment and possible strategies for prevention and treatment. Methods. Literature review. Results. Taste disorders affect quality of life and may be responsible of the occurrence of food aversions with possible weight loss and malnutrition, associated to worst outcomes for toxicity and survival. In spite of the progresses in the last decade, the assessment of taste disorders is far from being satisfactory. In fact research focused on gastrointestinal consequences of illness and treatments, reserving only a marginal attention to taste disorders, in spite of their prevalence. The available knowledge of the mechanisms underlying the development of taste disorders in cancer patients are presented, together with assessment and treatment and prevention strategies. Discussion. Taste disorders are underreported and underestimated, in spite of their prevalence, especially in cancer patients, possibly for the wrong assumption that they cannot be treated. This may explain why they are often not reported by patients.

Identification and treatment of nontuberculous Mycobacterium sinusitis.

BACKGROUND: The purpose of this study was to identify the incidence of atypical Mycobacterium identified by routine sinus cultures and review the recent literature on management. METHODS: A retrospective case series was performed in a tertiary academic hospital. A retrospective case series of all patients treated with atypical Mycobacterium rhinosinusitis from 2005 to 2010 was performed. Cases were identified from a prospective database of 676 endoscopically guided sinus cultures. RESULTS: Eight patients with atypical Mycobacterium sinusitis were identified. There were five women and three men. Median age was 63 years (range, 55-71 years). All patients had prior endoscopic sinus surgery a median of 14 months (range, 0.8-162 months) before a positive culture result. Species identified included Mycobacterium chelonae, Mycobacterium fortuitum, Mycobacterium abscessus, and Mycobacterium avium complex. Chief presenting symptoms were postnasal discharge (88%), followed by decreased smell and taste (63%), and facial pain/pressure (38%). Patients were treated based on sensitivity results with long-term oral antibiotics for at least 2 months based on improvements on endoscopy. Median follow-up for patients in this study after treatment was 1.3 years (range, 0.6-4.6 years). CONCLUSION: In this study, atypical mycobacteria were identified in <1% of sinus cultures. Prolonged, culture-directed antibiotic therapy remains the mainstay of treatment when there is clinical evidence of infection. Previous endoscopic sinus surgery may represent a risk factor for colonization and subsequent infection. Further research is necessary to determine the optimal treatment duration and management to prevent disease relapse.

Treating bugs with bugs: the role of probiotics as adjunctive therapy for Helicobacter pylori.

OBJECTIVE: To review the literature on the role of probiotics as adjunctive therapy in the treatment of Helicobacter pylori infections. DATA SOURCES: Literature was accessed through MEDLINE (1966-March 2011) using the terms H. pylori, probiotic, Lactobacillus, Bifidobacterium, Saccharomyces, Bacillus clausii, and Propionibacterium. Article references were hand-searched for additional relevant articles and abstracts. STUDY SELECTION AND DATA EXTRACTION: All English-language articles published in full were evaluated. Randomized, double-blind, placebo-controlled trials assessing the use of probiotics combined with standard eradication therapy of H. pylori infection in adults were included in the review. DATA SYNTHESIS: Various probiotics, including Lactobacillus spp., Saccharomyces spp., Bifidobacterium spp., and B. clausii, reduce adverse effects such as nausea, taste disturbance, diarrhea, and epigastric pain, and increase tolerability of H. pylori eradication therapy. Based on the studies reviewed, probiotics do not affect H. pylori eradication rates. CONCLUSIONS: Probiotics may be beneficial in reducing adverse effects and increasing tolerability of H. pylori eradication regimens. They may especially be helpful in patients with recurrent H. pylori infection and a history of gastrointestinal adverse effects with antibiotics. Pharmacists can play an important role in educating patients regarding probiotic use during H. pylori eradication therapy.

[Orally administered polaprezinc significantly improves taste disorders in ovarian cancer patient undergoing chemotherapy].

The subject was a 75-year-old female who was receiving paclitaxel and carboplatin(TC)chemotherapy every other week after surgery for ovarian cancer. She greatly complained of taste disorders after four cycles(of every other week administration) of TC chemotherapy. To understand how the taste disorder was caused by chemotherapy objectively, taste examinations were conducted for the patient in our department. These examinations were conducted after receiving the informed consent from the patient. The authors conducted taste examinations for the patient using serum zinc measurement, tongue cell culture, electrogustometry, and filter paper disc tests(before and after starting chemotherapy), and found that her serum zinc level fell significantly after four cycles of chemotherapy. Orally disintegrating tablets of polaprezinc were then administered to the patient, after which the subjective symptom of taste disorder improved. Her serum zinc level increased, and the electrogustometric threshold rapidly fell(an improvement). The filter paper disc test showed some improvement, particularly in the glossopharyngeal nerve and the greater petrosal nerve field.

"The food here is tasteless!" Food taste or tasteless food? Chemosensory loss and the politics of under-nutrition.

A common complaint voiced by older people living in residential care is that the food lacks taste. When older people find food tasteless, the pleasure gained from eating and therefore, their appetite may be compromised, as will their food choices, nutrition, immune systems, functional status and well-being. However, often nurses overlook these symptoms as 'inevitable and irreversible' aspects of ageing, which they are not. In fact, many older people experience chemosensory (taste and smell) disorders or loss which means they lose the ability to taste the flavour of food. Commonly overlooked is the fact that chemosensory loss may well be a significant contributing factor to the high level of under-nutrition reported in residential care in Australia. Our purpose in this article is to explore important issues related to taste and smell dysfunction; the physiology of these sensations; several causes distinct from ageing; and interventions to help older people again enjoy their food with the concomitant advantages to their health and well-being. We also consider the way in which legislation related to Government funding has influenced gerontological nurses' assessment skills and values, particularly concerning nutrition assessment to the detriment of not only older people living in residential care but also the profession of gerontological nursing. Attention is drawn to the need for nurses to up-date their clinical knowledge, assessment skills and practice including enhancing the flavour of food and the social occasion of dining for older people living in residential care.

Taste dysfunction in head and neck malignancy.

Disturbance of taste is common following radiotherapy of head and neck malignancy, that adversely affect systemic health and quality of life. Therapy remains problematic and there is thus a need for effective preventative and curative strategies for radiotherapy-associated taste disturbance. The present article reviews current knowledge of taste dysfunction associated with head and neck malignancy.

The meaning of adolescents' eating experiences during bone marrow transplant recovery.

Bone marrow transplant (BMT) is a common treatment option for adolescents with various diseases; however, the aggressive therapy often causes significant side effects that can lead to poor eating. There is little documentation of eating experiences and necessary support needed after the initial BMT hospitalization. This phenomenological study, guided by Martin Heidegger's philosophical influences, revealed the meaning of adolescents' eating experiences, eating strategies, and the impact of eating on the adolescents' quality of life during the first 100 days post-BMT. Individual interviews were conducted at 50 and 100 days post-BMT. Data analysis used the hermeneutic circle and revealed 5 themes. Adolescents discussed the slow return of eating, barriers that affected their eating, personal eating strategies, significance of eating, and feelings regarding eating. Eating issues do not end when a BMT patient is discharged from the hospital, and caregivers need to have a better understanding of the ongoing issues affecting adolescents throughout the BMT recovery phase.

[Cepharanthin effect on radiation-induced xerostomia and taste disorder in patients with head and neck cancer].

In evaluating the effect of cepharanthin on xerostomia and taste disorder in 40 patients undergoing radiotherapy for head and neck cancer, we administered cepharanthin intravenously during chemoradiotherapy to 22 patients, with 18 others as a control group. Cepharanthin did not significantly affect salivary secretion during and after chemoradiotherapy, although taste disorder and oral discomfort were alleviated. Cepharanthin may thus be effective in maintaining the quality of life of patients with head and neck cancer.

[Haematopoietic stem cell transplantation and oral complications]. / Hematopoëtische stamceltransplantaties en orale problemen.

New haematopoietic stem cell transplantation procedures make the treatment available to patients who previously did not qualify, such as the elderly. In addition, the spectrum of oral complications associated with haematopoietic stem cell transplantation has altered as a result of the recent developments. This article is a review of the main principles of haematopoietic stem cell transplantation and provides information on oral complications which may develop, such as mucositis, infections, bleeding, graft-versus-host disease, xerostomia, hyposalivation, altered taste, secondary tumors, osteoporosis, osteonecrosis and growing and developing disturbancies. Finally, the role of dental care providers in cases of haematopoietic stem cell transplantation is addressed.

Self-care strategies to cope with taste changes after chemotherapy.

PURPOSE/OBJECTIVES: To describe factors related to taste changes, to examine patients' use of a self-care suggestion sheet to manage taste changes associated with chemotherapy, and to identify potentially useful strategies for managing specific taste changes after chemotherapy. DESIGN: Quasi-experimental, pre/post design. SETTING: Four outpatient urban and suburban oncology centers in Illinois. SAMPLE: 42 patients who had received at least two cycles of chemotherapy previously identified to be associated with taste changes. METHODS: Pre- and postintervention survey of taste changes; patient education regarding self-care for taste changes. MAIN RESEARCH VARIABLES: Taste changes, taste change strategies, and self-care. FINDINGS: Most patients that reported taste changes had affected their ability to eat. Taste changes and strategies varied somewhat according to chemotherapy regimen. Avoiding strong-smelling or -tasting foods, eating blander foods, drinking more water with foods, oral care before eating, and eating smaller, more frequent meals were reported to help. CONCLUSIONS: Taste changes are common in patients receiving cisplatin, carboplatin, or cyclophosphamide. At-risk patients may benefit from prechemotherapy teaching regarding specific taste change management suggestions. Use of a taste change suggestion sheet encouraged self-care, and counseling patients regarding strategies to deal with taste changes may help them during chemotherapy. IMPLICATIONS FOR NURSING: Nurses should incorporate patient education tools that promote self-care regarding the management of taste changes in patients with known factors that could affect taste early in their chemotherapy.

Evaluation of efficacy of estrogen and phytotherapy in oral cavity alterations of women in menopause.

AIM: Hypo-estrogenism during menopause is the cause of numerous disturbances affecting various structures such as the oral cavity which can present with the following symptoms: changes in salivary secretion, gingivitis, bleeding and altered taste sensation. The object is to study whether hormone replacement therapy prescribed for female patients in menopause have any beneficial effect on the oral discomfort which affects the quality of life of these patients. METHODS: The study enrolled 95 female patients; 14 were the control group and received no hormone replacement therapy while 81 patients underwent two types of therapy: 38 were prescribed estrogen therapy and 43 phytotherapy. The main outcome measures were alterations of the oral cavity: salivary change, gingivitis, bleeding and taste changes. RESULTS: It was observed that the patients receiving treatment had an improvement or disappearance of symptoms in the oral cavity and that estrogen was more effective than phytotherapy regarding the salivary change while the gingivitis, bleeding and taste changes was the same for both therapies. CONCLUSIONS: Estrogen and phytotherapy have beneficial effect on oral discomfort in women in menopause. The proposed treatment can have a beneficial effect on osteopenia and osteoporosis and therefore also on possible increase of future tooth loss during menopause.

Future perspectives in smell and taste disorders.

Large sections of the medical community have, in the past, thought of human olfaction as a minor sense that was destined to disappear soon. This view has changed completely in the last two decades. This article will attempt to highlight the most important recent advances in our understanding of the human olfactory function and focus in particular on questions for the future and developments required in this field.

Alterações gustativas no envelhecimento / Gustatory alterations in aging

Neste artigo são discutidos alguns dos aspectos mais relevantes na literatura científica sobre o sistema gustativo, transmissão dos sinais gustativos e combinações dos sentidos, além de focar as alterações gustativas no envelhecimento, tratamento paliativo e métodos para a avaliação da percepção gustativa. É imprescindível atentar para as queixas dos idosos quanto às alterações gustativas, pois podem acarretar outras intercorrências na saúde e na qualidade de vida do idoso.AU

In this article, we revise the most relevant aspects considered in the scientific literature on the gustatory system, on transmission of gustatory signals and sense combinations. In addition, the article focuses on gustatory alterations in aging, palliative care and methods to evaluate taste threshold. It is important to pay attention to complaints from the elderly concerning taste alterations since this may account for other clinical events in health and quality of life of elderly adults.AU

Alterações gustativas no envelhecimento / Gustatory alterations in aging

Neste artigo são discutidos alguns dos aspectos mais relevantes na literatura científica sobre o sistema gustativo, transmissão dos sinais gustativos e combinações dos sentidos, além de focar as alterações gustativas no envelhecimento, tratamento paliativo e métodos para a avaliação da percepção gustativa. É imprescindível atentar para as queixas dos idosos quanto às alterações gustativas, pois podem acarretar outras intercorrências na saúde e na qualidade de vida do idoso.

In this article, we revise the most relevant aspects considered in the scientific literature on the gustatory system, on transmission of gustatory signals and sense combinations. In addition, the article focuses on gustatory alterations in aging, palliative care and methods to evaluate taste threshold. It is important to pay attention to complaints from the elderly concerning taste alterations since this may account for other clinical events in health and quality of life of elderly adults.

The effect of hyperbaric oxygen therapy on quality of life in oral and oropharyngeal cancer patients treated with radiotherapy.

Radiotherapy is used in the setting of curative treatment for head and neck cancer. Xerostomia and related problems occur when major salivary glands are included in the irradiation fields. This reduces quality of life (QOL). Hyperbaric oxygen therapy (HBOT) is a well accepted treatment or prevention modality for osteoradionecrosis of the jawbones and soft-tissue necrosis. It is unknown if and to what extent HBOT influences xerostomia and xerostomia-related QOL. To address this, a prospective study was conducted. Twenty-one patients who underwent radiotherapy for an oral or oropharyngeal carcinoma completed a European Organization for Research and Treatment of Cancer QOL questionnaire before HBOT, as part of the treatment/prevention of osteoradionecrosis, and 1 and 2 years after HBOT. Swallowing-related problems significantly decreased in time, and there was a reported subjective increase in saliva quantity and an improvement in sense of taste. The results suggest that HBOT may positively influence these long-term radiotherapy sequelae.

Does zinc sulfate prevent therapy-induced taste alterations in head and neck cancer patients? Results of phase III double-blind, placebo-controlled trial from the North Central Cancer Treatment Group (N01C4).

PURPOSE: Taste alterations (dysgeusia) are well described in head and neck cancer patients who undergo radiotherapy (RT). Anecdotal observations and pilot studies have suggested zinc may mitigate these symptoms. This multi-institutional, double-blind, placebo-controlled trial was conducted to provide definitive evidence of this mineral's palliative efficacy. METHODS AND MATERIALS: A total of 169 evaluable patients were randomly assigned to zinc sulfate 45 mg orally three times daily vs. placebo. Treatment was to be given throughout RT and for 1 month after. All patients were scheduled to receive > or =2,000 cGy of external beam RT to > or =30% of the oral cavity, were able to take oral medication, and had no oral thrush at study entry. Changes in taste were assessed using the previously validated Wickham questionnaire. RESULTS: At baseline, the groups were comparable in age, gender, and planned radiation dose (<6,000 vs. > or =6,000 cGy). Overall, 61 zinc-treated (73%) and 71 placebo-exposed (84%) patients described taste alterations during the first 2 months (p = 0.16). The median interval to taste alterations was 2.3 vs. 1.6 weeks in the zinc-treated and placebo-exposed patients, respectively (p = 0.09). The reported taste alterations included the absence of any taste (16%), bitter taste (8%), salty taste (5%), sour taste (4%), sweet taste (5%), and the presence of a metallic taste (10%), as well as other descriptions provided by a write in response (81%). Zinc sulfate did not favorably affect the interval to taste recovery. CONCLUSION: Zinc sulfate, as prescribed in this trial, did not prevent taste alterations in cancer patients who were undergoing RT to the oral pharynx.