The Use of Herbal Medicines Among Cancer Patients.

Background and objective The use of herbal medicines has been increasing among cancer patients, as a way to control cancer and treatment-related symptoms; however, many patients are reluctant to disclose this use to their medical practitioners. The fact that oncological treatments have a narrow therapeutic margin, associated with the lack of control and clinical evidence concerning these supplements, makes medication-herbal interactions a reality. These interactions could lead to increased toxicity or a decreased effectiveness of oncological treatment. In light of this, we aimed to assess the prevalence of herbal medicine use in a patient population at a Portuguese central hospital: Centro Hospitalar Lisboa Ocidental. Materials and methods Patients with breast, prostate, or colorectal cancer diagnoses between August 2022 and July 2023 and undergoing oncological treatment were included. Data were collected through a survey during their first appointment, as well as by consulting the patients' clinical files. An interaction evaluation was carried out to assess potential medication-herbal interactions. Finally, a statistical analysis was performed to identify predictive factors for the use of herbal medicines. Results Among the 65 patients included in the study, 52% were females, and the median age of the cohort was 65 years. Breast cancer was the most prevalent diagnosis and the majority of the patients were undergoing palliative treatment. We found that 46% of patients used herbal medicines regularly: to strengthen the immune system, detoxification of the body, and treat insomnia and constipation. A medication-herbal interaction was found in 37% of the cases, the most frequent being doxorubicin-vitamin C, through an antioxidant mechanism. The univariable analysis failed to show any predictive factors associated with the use of herbal medicines. Conclusions This study sheds light on herbal medicine use among cancer patients and the reality of medication-herbal interactions. There is an urgent need for further research and evidence-based medical protocols regarding herbal medicine use, especially in complex cases such as cancer patients, to provide better and safer care.

Utility of Prophylactic Percutaneous Gastrostomy in Patients With Head and Neck Cancer Receiving Concurrent Chemoradiotherapy: A Multicenter Analysis.

INTRODUCTION: Patients with head and neck cancer (HNC) have an elevated incidence of cachexia and malnutrition due to the tumor's location interfering with oral feeding. Concurrent chemoradiation (CCRT) can have an emetic effect and cause dysphagia and oral mucositis. Adequate nutrition improves immunity, raises the response to therapy, reduces adverse effects, and improves survival. Numerous studies have suggested the utility of nutritional support from percutaneous endoscopic gastrostomy (PEG) in HNC patients. Although PEG is usually considered a safe procedure, it has a mortality rate of 0-2.2% and a risk of other procedure-related complications of 17-40%. Our work intends to evaluate the utility of PEG in patients with locally advanced HNC who underwent CCRT. METHODS: We performed a cohort study at three institutions. We included patients with HNC who underwent definitive CCRT treatment from January 2013 to December 2022. The study consisted of an observational, descriptive, retrospective analysis of prespecified clinical data. Descriptive statistics were used to compare the data between the PEG group and the non-PEG group. Analysis of covariance (ANCOVA) was used for covariance analysis. Fisher's exact test was used to compare proportional data and Student's t-test was used to assess the differences in continuous data. Survival analysis was performed using the Kaplan-Meier estimator. P-values of <0.05 were considered to be indicative of statistical significance. The SPSS Statistics version 28.0 (Armonk, NY: IBM Corp.) was used to perform all statistical evaluations. RESULTS:  We identified 90 eligible patients diagnosed with local advanced HNC who had received definitive CCRT with three weekly cycles of cisplatin as follows: 44 with a prophylactic PEG tube and 46 without a prophylactic PEG tube. Most patients were male (84.4%) and 50% of patients were diagnosed with stage IVa HNC at the time of diagnosis. There wasn't an effect of PEG placement on BMI at the end of CCRT after controlling for the effect of baseline BMI (F {1.84}=0.065 {p=0.799}). In the study population, BMI was significantly lower after CCRT (21.30 kg/m2 vs. 23.97 kg/m2), t (86)=12.389, p<0.001. In the subgroup with baseline BMI <18.5 kg/m2 (15 patients), 90% of patients with prophylactic PEG were able to complete the three planned cycles of chemotherapy vs. 66.7% in the non-PEG group. Ten patients in the PEG group (22.7%) referred feeding tube dependency. Patients with dysphagia were 3.2 times more likely to have placed prophylactic PEG (p=0.007). The difference in overall survival and progression-free survival between the two groups was not statistically significant (p=0.57 and p=0.497, respectively). CONCLUSION: In this study using real-world data, we found a potentially protective effect of PEG in underweight patients with locally advanced HNC performing CCRT in order to complete three cycles of treatment.

Arabic coffee infusion based kombucha: Characterization and biological activity during fermentation, and in vivo toxicity.

In this study, arabic coffee infusion was used to produce a fermented beverage known as kombucha. The physicochemical, antioxidant and antimicrobial activities, as well as in vivo toxicity were evaluate throughout 21 days of fermentation. Reduction in pH and sugar levels were observed throughout the fermentation period. There was no significant difference in the content of total phenolic compounds between the unfermented and fermented beverage, nor between the fermentation times, as well as in the antioxidant activity. The 5-caffeoylquinic acid was identified at all fermentation times evaluated, and no significant difference was observed regarding its concentration. It showed antibacterial and antifungal activity against all strains tested. No toxic effect of the beverages was observed in the in vivo model (Galleria mellonella) studied. These results demonstrated that coffee infusion is a possible alternative for kombucha production since the physicochemical changes prove the metabolic activity of Symbiotic Culture of Bacteria and Yeast.

Evolution of the metabolic profile of virgin olive oil during deep-frying: Assessing the transfer of bioactive compounds to the fried food.

Deep-frying in virgin olive oil (VOO) is favorable due to its desirable composition and high content of bioactive compounds that can be transferred to fried food. The main goal of this work was to investigate the evolution of VOO metabolic profile during consecutive deep-frying cycles and assess the transfer of metabolites to French fries. The evolution of 56 compounds was monitored by two complementary liquid chromatography methods, using mass spectrometry, diode array, and fluorescence detectors. Sterols and lignans were remarkably stable (greater than 70 % retention in frying oil). Seven out of the ten compounds' classes identified in the oil were transferred to the fried food. Potatoes fried in Arbequina oil from Brazil incorporated the highest amounts of VOO minor components, among the analyzed samples, and sterols presented the highest transfer rate. French fries were enriched by VOO bioactive compounds during deep-frying, especially on the first two days, improving their nutritional value.

Baru (Dipteryx alata Vogel) Oil Extraction by Supercritical-CO2: Improved Composition by Using Water as Cosolvent.

Baru (Dipteryx alata) almond is an emerging nut from the Brazilian savannah, that presents unique flavor and an interesting specialty oil. In this study, we aimed at investigating the effects of pressure, temperature, type (alcohol and/or water), and concentration of polar cosolvent on the extraction yield and tocopherol contents of baru oil obtained by supercritical-CO2 extraction (SC-CO2); and to investigate the effect of temperature and pressure on phytosterol, phenolic, and volatile compounds' profile in the oil when H2O was the cosolvent. Baru oil extracted with SC-CO2 using alcohol as a cosolvent showed a higher extraction yield (20.5-31.1%) than when using H2O (4.16-22.7%). However, when 0.3% H2O was used as cosolvent, baru oils presented the highest γ-tocopherol (107 and 43.7 mg/100 g) and total tocopherol (212 and 48.7 mg/100 g) contents, depending on the temperature and pressure used (50°C and 10 MPa or 70°C and 30 MPa, respectively). Consequently, the lowest pressure (10 MPa) and temperature (50°C) values resulted in baru oils with better γ/α-ratio, and the highest contents of ß-sitosterol (107 mg/100 g) and phenolic compounds (166 mg/100 g). However, the highest pressure (30 MPa) and temperature (70°C) values improved the volatile profile of oils. Therefore, although alcohol as a cosolvent improved oil yield, small amounts of H2O provided a value-added baru oil with either high content of bioactive compounds or with a distinctive volatile profile by tuning temperature and pressure used during SC-CO2 extraction.

Total Pain Management and a Malignant Wound: The Importance of Early Palliative Care Referral.

Breast cancer may metastasize to the lung, liver, bone, brain, and skin, with especially high rates of metastasis to skin sites.These skin metastases are called malignant wounds. Patients with malignant wounds often report multiple symptoms, and pain is one of the most common and distressing among them. Despite the availability of multiple guidelines about treatment to relieve pain, almost half of all cancer patients still receive inappropriate care for pain. A multidisciplinary approach can improve outcomes in terms of symptom control and quality of life and enable the detection of previously unmet needs of both patients and caregivers. Palliative care is a multidisciplinary therapy that aims to alleviate physical, psychological, and emotional suffering in patients at any stage of the disease. We present the case of a 53-year-old male with a three-year history of stage IV breast cancer. He was admitted to the internal medicine ward in July 2021 with uncontrolled pain related to a malignant wound in the left hemithorax. This was a case with physical, emotional, social, and existential factors contributing to severe pain, necessitating a multidisciplinary approach for adequate relief. Opioid titration and insomnia and anxiety treatment were initiated. Dressing care was applied with metronidazole impregnation and aminocaproic acid for hemorrhagic spots, followed by fat gauze. He was proposed to undergo antalgic radiotherapy, which was unfortunately associated with new onset of symptoms. Psychological support was provided for the patient and his family. We managed to control the pain and stabilize the wound; however, cachexia become evident with the disease progression. In the last week of his life, the patient still believed he would be able to undergo chemotherapy. He died in the emergency room, where he had gone to seek relief for uncontrolled symptoms. Even though the patient had an incurable disease associated with immense suffering since early 2019, he was only referred to the palliative care team during the last three months of his life. Existential suffering was an important dimension of this patient's pain and was present until his death despite receiving psychological support. Late referral to palliative care is unfortunately frequent and often associated with poor quality of life and inability to plan or make end-of-life care decisions. Radiotherapy was proposed for pain control but was associated with serious side effects. In a palliative care setting, decision-making always needs careful consideration related to benefit versus harm and must involve the patient and his family. Living with stage IV cancer is an everyday challenge for patients, and clinicians may also find managing such patients very arduous and stressful. Symptoms must be actively studied and evaluated from a multidimensional perspective. Managing expectations throughout this process while maintaining hope is a delicate balancing act and should be undertaken by specialized palliative care teams.

Evaluating Quality Parameters, the Metabolic Profile, and Other Typical Features of Selected Commercial Extra Virgin Olive Oils from Brazil.

The production of extra virgin olive oil (EVOO) in Brazil developed quite recently, and information on commercial Brazilian EVOO's typical features is very scarce. In just one of the previously published works on Brazilian olive oil, the assessed samples were commercially available. In this study, a comprehensive characterization of EVOO samples acquired at local stores (at Rio de Janeiro and Rio Grande do Sul, from the two most prevalent cultivars, Arbequina and Koroneiki) was carried out considering the most relevant quality parameters, antioxidant capacity, oxidative stability, total phenolic content, fatty acid composition, and minor component metabolic profiling. The latter included: (1) the determination of individual phenolic compounds (belonging to four diverse chemical classes) and triterpenic acids by means of a powerful multi-class reversed-phase LC-MS method; (2) the quantitative profiling of tocopherols, phytosterols, and pigments by normal-phase LC-DAD/fluorescence; and (3) the quantitative appraisal of the volatile pattern of the oils by solid-phase microextraction (SPME)-gas chromatography (GC)-MS. By applying these methods, the concentrations of approximately 70 minor compounds were determined in commercial EVOOs from Brazil. To the best of our knowledge, the content of a very large number of phenolic compounds of those determined in the current report (mainly secoiridoids), the three triterpenic acids (maslinic, betulinic, and oleanolic acids), and the individual chlorophyll derivatives had not been previously evaluated in Brazilian EVOOs. The present work provides a broad picture of the compositional profile and other parameters of relevance of selected commercial Brazilian EVOOs available on local markets, describing their typicity and most particular features, some of which are known to have potential impacts on consumers' health.

Hass avocado (Persea americana Mill.) oil enriched in phenolic compounds and tocopherols by expeller-pressing the unpeeled microwave dried fruit.

This study investigated how the quality of avocado oil is affected by the fruit ripening stage and peeling, and the drying process used. Expeller pressed avocado oils were obtained from unripe or ripe pitted avocados after drying peeled or unpeeled pulps by convection oven, microwave or freeze-drying. Oils from the unpeeled microwave dried pulp (from unripe or ripe avocados) showed the highest induction period (54.2-83.6 h) and antioxidant capacity (4.07-5.26 mmol TE/kg), and high amounts (mg/100 g) of α-tocopherol (11.6-21.0), ß-carotene (0.49-0.65) and chlorophyll (44.3-54.0), and unsaponifiable matter (2.48-2.99 g/100 g). Pulp drying process and avocado (un)peeling were the major contributors to the induction period (R2 = 0.61; p = 0.0139) and antioxidant capacity (R2 = 0.62; p = 0.011), and the oils from microwave dried unpeeled pulp were those that presented the best performance. The phenolic composition of these oils improved with ripening and keeping the peel during the pressing process.

Bread formulated with guava powder was enriched in phenolic and aroma compounds, and was highly acceptable by consumers.

Guava powder (GP) was used as source of aroma and phenolic compounds to fortify wheat bread 10% (GB10) and 20% (GB20), substituting for wheat flour. Phenolic compounds, antioxidant capacity, volatile compounds profile, and sensory acceptability of control bread (CB; without GP) and guava breads (GB) were evaluated. Incorporation of GP increased roughly 2-to-3-fold the phenolic compounds contents of bread. Ten phenolic compounds were identified in GB20, and quercetin-3-O-rutinoside was the major compound, while in CB, ferulic acid was the major among the six phenolic compounds in CB. Bread making seemed to promote the release of phenolic compounds from structural components. Breads incorporated with GP presented a richer volatile profile than CB, especially due to the presence of terpenes. GB improved aroma profile of bread. GP added aroma compounds and phenolic antioxidants, and seemed to be an interesting approach to enhance bread bioactivity and acceptability.

Effect of drying method on volatile compounds, phenolic profile and antioxidant capacity of guava powders.

We studied the chemical composition of oven and freeze dried guava powders for future use as antioxidant-rich flavour enhancers. Among thirty-one volatiles in guava powders, terpenes were predominant, even after both drying processes. In contrast, esters and aldehydes, volatiles characteristic of fresh guava fruit, appeared to have been decreased by drying. Insoluble phenolics were predominant and among the sixteen compounds identified, quercetin-3-O-rutinoside and naringenin corresponded to 56% of total phenolics. Drying processes decreased total phenolics contents by up to 44%. Oven drying promoted the release of insoluble flavonoids, generating mainly quercetin. Antioxidant capacity also decreased due to both drying processes, but guava powders still presented similar antioxidant capacity in comparison to other tropical fruit powders. Our results suggest that oven drying is a viable option for the production of a functional ingredient that would improve the phenolic content of cereal foods while adding desirable guava flavour.

Linhaça marrom e dourada: propriedades químicas e funcionais das sementes e dos óleos prensados a frio / Brown and golden flaxeed: chemical and functional properties of the seeds and the cold-pressed oils

O objetivo do estudo foi comparar a composição química e a capacidade antioxidante das sementes e dos óleos de linhaça marrom e dourada, e avaliar a estabilidade oxidativa dos óleos. Nas sementes, foram determinados: composição centesimal, capacidade antioxidante total e compostos fenólicos totais. Nos óleos, foram determinados: índice de acidez e peróxido, matéria insaponificável, composição em ácidos graxos, tocoferóis, capacidade antioxidante, compostos fenólicos totais e estabilidade oxidativa em quatro condições de estocagem por até um ano. Não houve diferenças significativas entre os tipos de sementes quanto às variáveis investigadas, e ainda entre os óleos quanto ao rendimento da prensagem, composição em ácidos graxos insaturados, índice de acidez, teores de insaponificáveis e compostos fenólicos totais. Apesar do declínio da estabilidade oxidativa de ambos os óleos durante o armazenamento, o óleo de linhaça marrom e os óleos estocados sob refrigeração apresentaram-se mais estáveis. O índice de peróxido foi maior no óleo de linhaça dourada. O teor de tocoferol total e capacidade antioxidante total foram maiores no óleo de linhaça marrom. Contudo, observou-se uma igualdade entre as sementes de ambas as variedades de linhaça e uma superioridade do óleo de linhaça marrom.

The aim of the study was to compare the chemical composition and antioxidant capacity of the brown and golden flaxseed and their cold-pressed oils, and evaluate the oxidative stability of oils. We determined the chemical composition, total antioxidant capacity and total phenolic compounds of the seeds. In the oils we determined acid and peroxide value, unsaponifiable matter, composition of fatty acids and tocopherols, phenolic compounds, antioxidant capacity and oxidative stability in four storage conditions up to one year. There were no significant differences between the flaxseed types in the analyzed properties and between the oils in terms of yield after pressing, composition of unsaturated fatty acids, acid value, unsaponifiables and phenolic compounds. The oxidative stability of both oils decreased with storage time, however the brown flaxseed oil and the oils stored under refrigeration were more stable. The peroxide value was higher in the golden flaxseed oil. The total tocopherol content and antioxidant capacity were higher in brown flaxseed oil. It was observed equality between the brown and golden flaxseed and a superiority of brown flaxseed oil.

Síndrome de Ogilvie após cirurgia citorredutorae quimioterapia hipertérmica: relato de caso / Ogilvie?s syndrome secondary to cytoreductive surgeryand hyperthermic chemotherapy: a case report

A associação entre cirurgia citorredutora com aquimioterapia intraperitoneal hipertérmica combinaa máxima citorredução do peritônio lesado ede diversas partes de órgãos lesados com a administraçãode um quimioterápico a alta temperatura.Isso permite elevada concentração da droga nolocal e potencializa seu resultado com um mínimode efeitos sistêmicos. Relata-se o caso de pacientefeminina, 39 anos, submetida a procedimentode peritoniectomia com quimioterapia hipertérmicapara câncer de ovário recidivado. Três anosantes, submeteu-se a tratamento para câncer deovário com cirurgia e quimioterapia baseado emplatina. Foi realizada uma combinação da cirurgiacitorredutora com a quimioterapia intraperitonealhipertérmica. No sétimo dia pós-operatório, apaciente teve distensão abdominal, ruídos hidroaéreosaumentados, sem eliminação de fezes ouflatos. A radiografia de abdome mostrou dilataçãoacentuada do cólon (10 cm) e o diagnósticofoi síndrome de Ogilvie. Foi introduzida sonda porvia retal, levando à eliminação de grande volumegasoso com melhora do quadro de distensão abdominal.A sonda foi mantida por quatro dias, quandoa paciente começou a eliminar flatos e aceitardieta, recebendo alta hospitalar no décimo sextodia pós-operatório.

The combination of cytoreductive surgery and hyperthermicintraperitoneal chemotherapy for the treatmentof cancer associates maximum cytoreduction ofthe injured peritoneum and other parts of lesioned organswith the administration of chemotherapy agentsat a high temperature. This results in increased levelsof the drug at the site of lesion and enhances the cytotoxiceffect of the drug with minimal systemic effects.We report the case of a 39-year-old female patient whounderwent peritonectomy with hyperthermic chemotherapyto treat a recurrent ovarian cancer. Three years earlier, the patient had undergone surgery andplatinum-based chemotherapy. A combination of cytoreductivesurgery and hyperthermic intraperitonealchemotherapy was chosen. On the seventh postoperativeday, the patient evolved with a distended abdomen,increased bowel sounds and absence of bowelmovement or flatulence. An abdominal radiographywas performed and revealed a massive colonic dilatation(10 cm). The patient was diagnosed with Olgivie?ssyndrome. A tube was inserted into her rectum and alarge volume of gas was expelled, which immediatelyreduced her abdominal distention. The tube was leftinside her colon for four days, and the patient beganto expel flatus and have a good food intake. She wasdischarged on the 16th postoperative day. Despite beinga major surgery, according to our research, this case isthe first record of Ogilvie?s syndrome developing as aconsequence of cytoreductive surgery combined withhyperthermic intraperitoneal chemotherapy.

Capacidade antioxidante total de óleos vegetais comestíveis: determinantes químicos e sua relação com a qualidade dos óleos / Total antioxidant capacity of edible vegetable oils: chemical determinants and associations with oil quality

A capacidade antioxidante total de óleos vegetais comestíveis é determinada por sua composição físico-química e pode estar associada a atributos de qualidade dos óleos, especialmente a sua bioatividade e possivelmente a sua estabilidade oxidativa. Este artigo apresenta os fundamentos dos ensaios de capacidade antioxidante total e avalia criticamente os ensaios aplicáveis na análise de óleos e os pontos críticos nas aplicações dos ensaios para a análise dessas amostras. Discute-se o potencial papel dos componentes químicos dos óleos comestíveis como determinantes da capacidade antioxidante total, assim como a possível relação da capacidade antioxidante com a bioatividade e a estabilidade oxidativa dos óleos. Finalmente, discutem-se evidências de que, caso seja sistematicamente investigado em trabalhos experimentais futuros, o uso de ensaios de capacidade antioxidante total na análise de óleos vegetais pode contribuir para integrar o conhecimento da composição química com a bioatividade e possivelmente com a estabilidade de óleos vegetais específicos. Dessa forma, os ensaios de capacidade antioxidante apresentam potencial para aplicação no controle da qualidade integral de óleos comestíveis.

The total antioxidant capacity of edible vegetable oils is determined by their physical-chemical composition and might be associated with their quality attributes, especially with bioactivity and possibly with oxidative stability. The current review presents the fundamentals of total antioxidant capacity assays and critically evaluates the assays applicable to the analysis of oils. The role of the chemical components of edible oils as determinants of total antioxidant capacity is discussed, as well as the potential associations between antioxidant capacity and bioactivity or oxidative stability of the selected oils. Finally, we discuss evidences that, if systematically addressed in future experimental work, the application of total antioxidant capacity assays to vegetable oils might contribute to link the knowledge about their chemical composition with their bioactivity, and possibly with the stability of specific vegetable oils. Thus, antioxidant capacity assays can potentially be used for the quality control of edible oils.