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.

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.

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.

[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.

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.

Chemosensory declines in older adults with HIV: identifying interventions.

Olfactory and gustatory impairments are observed with aging and with HIV infection. Thus, the synergistic effects of aging with HIV infection on olfactory and gustatory declines may be profound. Such declines can jeopardize several areas for an older adult living with HIV such as safety, appetite and malnutrition, cognition, mood, and quality of life. Potential interventions that need to be investigated include hormone replacement therapy, lifestyle changes, medical assessment, and compensation strategies. Nurses are the primary providers of care and education to address sensory alterations of those who have HIV and those who are aging.

Aspects of taste and compliance in patients with cancer.

Taste alterations are common in patients with cancer, and can be the result of the disease itself and/or its treatment(s). Specifically, chemotherapy and/or radiotherapy to the head and neck area have been shown to induce significant taste changes. Alterations in taste are distressing for patients and can lead to food aversions, a reduction in food intake and nutritional deficits. Ultimately, this can lead to weight loss and, in severe cases, malnutrition, which has been associated with poor patient outcomes, including a negative effect on survival. Dietary counselling and advice tailored to the individual can improve nutritional status, and several effective strategies are available to accommodate taste changes and increase nutritional intake. Oral supplements may provide additional nutritional support when dietary intake is insufficient. The success of supplementation depends, however, on the product acceptability and on patient compliance over the long term. Patient compliance is linked to perceived supplement taste, which may be affected by a variety of taste changes reported by patients both before and after therapy, or as a consequence of disease progression. Supplements which offer a variety of flavours are likely to prove beneficial by helping to prevent taste fatigue. In addition, individuals appear to exhibit distinct preferences for particular flavours at different time points during treatment.

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.

Cisplatin-induced conditioned taste aversion: attenuation by dexamethasone but not zacopride or GR38032F.

The 5-HT3 receptor antagonists zacopride and GR38032F are highly effective inhibitors of emesis induced by ionizing radiation and chemotherapeutic drugs such as cisplatin. The present study evaluated zacopride and GR38032F for efficacy in inhibiting the formation of the conditioned taste aversion (CTA) induced by cisplatin or lithium chloride in rats. The glucocorticoid dexamethasone, which has been reported to be effective against both the emetic and CTA-inducing effects of cisplatin, was included as a reference compound. When administered alone by i.p. injection, zacopride (0.1-10 mg/kg), GR38032F (10 mg/kg) and cisplatin (0.32-1.8 mg/kg) induced a CTA to an 0.1% saccharin solution; lower doses of each compound were ineffective. When administered as a pretreatment, neither zacopride (0.001-0.1 mg/kg) nor GR38032F (0.01-10 mg/kg) attenuated the CTA induced by cisplatin (0.32 and 0.56 mg/kg) or lithium chloride (10 mg/kg). In contrast, dexamethasone (0.32 and 1.0 mg/kg) attenuated the CTA induced by 0.32 but not 0.56 mg/kg of cisplatin. In an attempt to evaluate higher doses of zacopride against cisplatin without the potentially confounding factor that these doses by themselves induce a CTA, rats were injected with zacopride on three separate days prior to the aversion conditioning session. This pre-exposure treatment blocked the formation of the zacopride-induced CTA, but did not improve the efficacy of zacopride in attenuating the cisplatin-induced CTA. These results suggest that neither the cisplatin- nor the lithium-induced CTA in rats are due to effects that are sensitive to 5-HT3 receptor blockade.

The pilot trial of the prevention of the increase in electrical taste thresholds by zinc containing fluid infusion during chemotherapy to treat primary lung cancer.

It is well known that there are various adverse effects during chemotherapy for cancer treatment. A taste disorder is also seen in 35-70% of patients. It has been reported that a zinc deficiency is associated with the development of these alterations in taste sensation. The purpose of this pilot study was to determine whether the zinc including infusion had the effect on taste disorder in patients with lung cancer. Taste disorder was evaluated as the increase in electrical taste thresholds using an electrogustometer. The plasma zinc concentration was also measured. Although there was no significant correlation, the increase in taste thresholds was detected in many patients who had a low zinc concentration even before receiving chemotherapy. Moreover, after 2 weeks of chemotherapy, almost all patients who did not have a zinc containing infusion showed development of taste disorder (5/5, 100% at chorda tympani area; 4/5, 80% at glossopharyngeal area), whereas no development of taste disorder was observed in those patients receiving a zinc containing infusion. These results suggest the possibility that the administration of zinc during chemotherapy could be a useful supportive therapy for preventing taste disorder and to help maintain a better quality of life.

Changes in taste associated with intravenous administration of pentamidine.

In this pilot study the authors set out to: (a) describe the incidence of taste changes associated with intravenous (i.v.) pentamidine treatment; and (b) determine the factors that are related to making the taste changes better and worse. A convenience sample (N = 18) of adult male outpatients with AIDS participated in this study. One hundred percent of the participants experienced an unpleasant taste after the administration of pentamidine. The largest percentage of patients had a metallic taste (89%, n = 16); while 67% (n = 12) experienced a bitter taste. These data suggest that healthcare providers need to assess for the unpleasant taste associated with i.v. pentamidine and develop appropriate management strategies.

Symptoms and their impact on nutrition.

OBJECTIVES: To provide assessment guidelines and management strategies for symptoms affecting nutritional status in patients with cancer. DATA SOURCES: Published articles, book chapters, and research reports. CONCLUSIONS: Patients with cancer experience a variety of symptoms that affect their nutritional status. It is possible to reduce the impact of these symptoms on the nutritional status of the patient through effective symptom management strategies, nutritional assessments, and interventions. IMPLICATIONS FOR NURSING PRACTICE: The nutritional status of cancer patients can be supported by anticipating and managing disease- and treatment-related symptoms. Nurses contribute actively to the achievement of positive patient outcomes when they manage symptoms in a manner that enhances nutrition.

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.