Photobiomodulation therapy prevents dysgeusia chemotherapy induced in breast cancer women treated with doxorubicin plus cyclophosphamide: a triple-blinded, randomized, placebo-controlled clinical trial.

PURPOSE: To evaluate the effectiveness of photobiomodulation (PBMT) in preventing dysgeusia in breast cancer patients treated with doxorubicin-cyclophosphamide (AC). METHODS: This is a phase II, randomized, triple-blind, placebo-controlled clinical trial involving 112 breast cancer patients treated with AC. The patients were divided equally into two groups: a test group treated with 2 J red laser and 3 J infrared laser on 21 points that were symmetrically distributed on the tongue on day 0 of four cycles of AC, and an equal placebo group treated with simulated PBMT to blind the patient, evaluator, and statistician. The clinicopathological and sociodemographic data, results of taste test, and subjective taste analysis, and the QoL, ECOG performance status, body mass index, and other side effects were recorded. The data were analyzed using ANOVA-RM/Bonferroni, Friedman/Dunn, and chi-square/Fisher's exact tests. RESULTS: PBMT patients showed less objective and subjective taste loss (p<0.05). On the other hand, the placebo group showed a higher ECOG status (p=0.037) and more significant weight loss (p<0.001) after four cycles of AC. The QoL was significantly higher in the PBMT group (p<0.05) at all assessment periods, and PBMT treatment also reduced the incidence of cachexia (p=0.020), anorexia (p<0.001), diarrhea (p=0.040), oral mucositis (p=0.020), and vomiting (p=0.008). CONCLUSION: PBMT reduced the taste loss and improved the overall health status and QoL of patients with breast cancer treated with AC. TRIAL REGISTRATION: Brazilian Clinical Trials Registry ( www.ensaiosclinicos.gov.br ) approval number RBR-9qnm34y, registered on 01/05/2021.

Dysgeusia in deep brain stimulation for essential tremor.

Dysgeusia, or foul taste, is a rarely reported side effect in patients who have undergone deep brain stimulation (DBS) in the thalamus for essential tremor. This retrospective study evaluated the incidence, nature, neurophysiological and anatomical location of dysgeusia following DBS. Of 52 patients who had undergone DBS for essential tremor, eight (15%) reported dysgeusia, which was described as a "metallic," "sour," "foul," or "cold" taste in the mouth. Dysgeusia was separate and distinguishable from paresthesia. Dysgeusia was more frequently reported with bilateral than unilateral DBS implants (6 of 27 (22%) vs. 2 of 25 (8%) patients, respectively). The anatomical locations of the contacts causing dysgeusia were measured on postoperative MRI, and compared to those from seven control patients who did not experience dysgeusia after receiving bilateral DBS implants. Leads causing dysgeusia were more posterior than non-dysgeusia-associated leads (4.5 ±â€¯1.2 vs. 5.7 ±â€¯1.8 mm anterior to the posterior commissure, respectively, P < .001). Intraoperative microelectrode recording indicated that these contacts were in the sensory region of the thalamus. Intraoperative testing found that low sensory threshold for paresthesia predicted the development of dysgeusia postoperatively (1.5 ±â€¯0.5 V vs. 3.3 ±â€¯1.9 V; P < .05). These data indicate that taste perception can be altered in the human through DBS, with posterior leads likely within the sensory region of the thalamus. Dysgeusia can be reduced by changing stimulation parameters, or surgical revision of the lead.

A Non-Inferiority Study: Modified Dual Therapy Consisting Higher Doses of Rabeprazole Is as Successful as Standard Quadruple Therapy in Eradication of Helicobacter pylori.

The aim is to compare high-dose rabeprazole and amoxicillin containing modified dual therapy (MDT) with bismuth subcitrate containing standard quadruple therapy (SQT) as the first-line Helicobacter pylori eradication treatment in terms of efficacy, safety, and adherence to treatment. A total of 200 consecutive patients diagnosed endoscopically with nonulcer dyspepsia with H. pylori infection were randomly assigned into 2 groups, 1 treated with amoxicillin 750 mg thrice daily plus rabeprazole 20 mg thrice daily (MDT group) or rabeprazole 20 mg b.i.d., bismuth subcitrate 120 mg q.i.d., tetracycline 500 mg q.i.d., metronidazole 500 mg t.i.d. (SQT group). Overall, 196 patients (98 in the MDT group and 98 in the SQT group) completed the study. H. pylori eradication was achieved in 84.7% of patients in the MDT group by intention to treat analysis and 84.9% by per-protocol analysis, which were comparable with SQT group (87.8% and 88.8%, respectively). Adverse events including nausea (P = 0.03), dysgeusia (P < 0.001), diarrhea (P = 0.001), black colored stool (P < 0.001), headache (P = 0.01), and abdominal pain (P = 0.05) were significantly higher in SQT group. The MDT is an efficient and safe treatment choice that could be recommended in the first-line eradication treatment of H. pylori.

Factores que condicionan la aceptación y consumo de los suplementos nutricionales en el paciente ingresado / Factors determining the compliance and intake of nutritional supplements in hospitalized patients

La malnutrición calórico-proteica, que puede afectar al 30-50% de los pacientes hospitalizados, aumenta el tiempo de hospitalización y el coste por proceso patológico en nuestros pacientes. Existe suficiente evidencia científica que avala que la administración de suplementos nutricionales (SN) puede mejorar tanto parámetros nutricionales como funcionales y previene la aparición de malnutrición en pacientes que no cubren todas sus necesidades nutricionales con la dieta convencional o con la dieta adaptada. También, se ha documentado que pueden reducir la duración de la estancia hospitalaria y las tasa de mortalidad en algunas condiciones. Sin embargo, se ha observado, tanto en la práctica clínica habitual como en algunos ensayos clínicos, que el cumplimiento terapéutico y la adherencia al tratamiento son bajos, observándose en algunos ensayos que hasta menos de la mitad de los pacientes llegaban a consumir lo prescrito. Son múltiples los factores que intervienen en el cumplimiento terapéutico, aunque hasta el momento, no han sido bien estudiados. En este artículo, vamos a hacer una reflexión sobre este aspecto. Las causas que ocasionan este incumplimiento se podrían agrupar en tres tipos de motivos: factores socio sanitarios, factores relacionados con el paciente y su patología; y factores relacionados con las características de los suplementos. Entre los factores socio sanitarios, cabe destacar aquellos relacionados con la adecuada formación en Nutrición de los médicos y de todos los profesionales sanitarios implicados en el tratamiento del paciente, así como la implicación en el tratamiento por parte de los cuidadores en general, incluyendo a los familiares; siendo fundamental el tipo de institución en la que se encuentra ingresado el paciente (sobre todo cuando se trata de unidades de agudos frente a las de crónicos ) y de la existencia de servicio de nutrición en el centro en cuestión. Entre los factores dependientes del paciente son importantes: la edad, pues se describe peor adherencia en los más mayores; la patología de base: la presencia de enfermedad tumoral, la insuficiencia renal, la disgeusia y disfagia, entre otras causas, condicionan una peor adherencia al tratamiento), así como la duración del ingreso, ya que cuando se prolonga empeora también la adherencia. Finalmente, también tienen trascendencia los factores relacionados con el suplemento en sí mismo, en función de su composición, forma de presentación, tipo de envase y sus características organolépticas (olor, sabor y textura). Hecha esta reflexión se sugieren unas pautas a seguir para conseguir una tasa mayor de cumplimiento del tratamiento indicado con suplementos nutricionales al paciente ingresado (AU)

Protein-calorie malnutrition, which can affect 30-50% of hospitalized patients, increases the length of hospital stay and cost per pathological process in our patients. There is enough scientific evidence supporting that the administration of nutritional supplements (NS) can improve both nutritional and functional parameters and prevents malnutrition in patients who do not meet all their nutritional needs through conventional diet or with an adapted diet. It has also been documented that NS can reduce the length of hospital stay and mortality rate in some conditions. However, it has been observed both in clinical practice and in some clinical trials that compliance and adherence are low. In fact, in some trials, less than half of the patients came to consume the supplements prescribed. There are many factors involved in adherence, but so far they have not been properly analyzed. In this article, we want to reflect on this matter. The reasons behind this lack of compliance could be grouped into three categories: socio-sanitary factors, factors related to the patient and its pathology, and those related to the characteristics of supplements. Among the socio-sanitary factors, it should be highlighted the relevance of adequate nutrition training of physicians and all health professionals involved in patient care, the collaboration in the treatment by caregivers, including family, being essential to this matter the type of institution where the patient is admitted (especially when it comes to acute care units compared to those of chronic care) and the availability of a nutrition service at the center in question. Regarding patient-dependent factors, the most important are: age, as it has been described poorer adherence in the elderly, the underlying disease (the presence of oncologic disease, kidney failure, dysgeusia and dysphagia, among other causes, determine a worse adhesion to treatment) and length of stay, with longer stays correlating with a lesser grade of compliance. Finally, there are also of relevance the factors related to the supplement itself, such as their composition, presentation, packing and their organoleptic properties (smell, taste and texture). Once made this reflection, we suggest some advices to achieve a higher rate of compliance with the prescribed nutritional supplements in hospitalized patients (AU)

Dysgeusia related to urinary obstruction from benign prostatic disease: a case control and qualitative study.

Anecdotal reports suggest that dysgeusia may be related to a variety of systemic factors, including bladder outflow obstruction. This is a hospital-based case-controlled study involving 111 patients who were admitted to urological wards for transurethral resection of the prostate for benign prostatic disease with age- and sex-matched control of 137 subjects. We used a semi-structured questionnaire by a trained interviewer at admission (preoperative), at the postoperative period and at follow-up between 4-6 months (median 5 months). Analysis used unpaired t-test and chi(2) test. The incidence of dysgeusia was 22% in the study group and 13% in the control group (P=N.S.). However, strikingly, the dysgeusia in the study group was relieved promptly by relief of urinary obstruction in 100% of cases and did not return within the follow-up period. The mechanism of the dysgeusia associated with dysuria in benign prostatic disease is unknown, but we suggest that the dysgeusia could be from the stress of dysuria or due to a release of an unknown chemical from the urinary tract or an overflow of neural impulse from pontine/cortical micturition centres to the taste centres. An association between dysgeusia and dysuria has not been described before.