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Nutritional supplements in the management of oral mucositis in patients with head and neck cancer: Narrative literary review.
de Sousa Melo, A, de Lima Dantas, JB, Medrado, ARAP, Lima, HR, Martins, GB, Carrera, M
Clinical nutrition ESPEN. 2021;:31-38
Abstract
BACKGROUND AND AIMS Oral mucositis is the most common side effect in response to anticancer therapies in the head and neck region. It has a debilitating potential for the health of affected individuals, negatively interfering with nutritional status and quality of life. Due to the great complexity of its pathogenicity, different forms of interventions for prevention and treatment are being studied, including nutritional supplements with vitamin E, zinc and glutamine. This study aimed to review the literature on the influence of nutrients, in supplement form, for prevention and/or treatment of mucositis in patients with head and neck cancer. METHODS A survey of studies related to the definition, treatment and prevention of mucositis with nutrients was carried out between January 2018 and July 2019, using the Pubmed, Cochrane Library and Scielo databases. In the end, 61 relevant scientific publications were selected between the years 2004 and 2019. RESULTS Nutrients such as vitamin E, glutamine and zinc are forms of supplementation that have positive effects on the manifestation and severity of oral mucositis due to their antioxidant and immunomodulatory properties. However, some studies reveal that antioxidant properties may reduce the effectiveness of antineoplastic therapy. CONCLUSIONS This study suggests the effectiveness of vitamin E, zinc and glutamine in preventing and treating oral mucositis. However, the importance of new clinical researches to clarify possible doubts is highlighted, as well as the creation of a protocol that includes the dose, route and time of administration, for greater safety in use.
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Prevention of Recurrent Acute Otitis Media in Children Through the Use of Lactobacillus salivarius PS7, a Target-Specific Probiotic Strain.
Cárdenas, N, Martín, V, Arroyo, R, López, M, Carrera, M, Badiola, C, Jiménez, E, Rodríguez, JM
Nutrients. 2019;11(2)
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Plain language summary
20–30% of infants suffer from recurrent acute otitis media (rAOM) which is usually treated with antibiotics, leading to increasing antimicrobial resistance rates. A bacterial strain, Lactobacillus salivarius PS7, was identified and characterised by in vitro studies which showed antimicrobial activity against most of otitis-related organisms. It was shown to be safe in rat toxicity studies. The investigators then carried out this prospective pilot study to test the efficacy and safety of L. Salivarius PS7 in infants and children with rAOM. 61 subjects completed the study and received the probiotic for the duration of 6 months. Oral intakes of L. salivarius PS7 over 6 months led to a statistically significant reduction (84%) in the number of episodes of AOM in comparison to those observed in the same children during the 6 months preceding probiotic intake. When AOM occurred, the duration of AOM episodes was shorter than in control children not receiving the probiotic. Ear samples showed that the probiotic treatment led to a statistically significant decrease in potential otopathogens. Limitations of this preliminary “proof of concept” trial were lack of placebo group and randomisation.
Abstract
Acute otitis media (AOM) is one of the most common bacterial infections in children. Empiric antibiotherapy leads to increasing antimicrobial resistance rates among otopathogens and may impair the correct development of the microbiota in early life. In this context, probiotics seem to be an attractive approach for preventing recurrent AOM (rAOM) through the restoration of the middle ear and nasopharyngeal microbiota. The aim of this study was the selection of a probiotic strain (Lactobacillus salivarius PS7), specifically tailored for its antagonism against otopathogens. Since L. salivarius PS7 was safe and displayed a strong antimicrobial activity against otopathogens, its efficacy in preventing rAOM was assessed in a trial involving 61 children suffering from rAOM. Children consumed daily ~1 × 10⁸ CFU of L. salivarius PS7, and the number of AOM episodes were registered and compared with that observed in the previous 6 and 12 months. The microbiota of samples collected from the external auditory canal samples was quantitatively and qualitatively assessed. The number of AOM episodes during the intervention period decreased significantly (84%) when compared to that reported during the 6 months period before the probiotic intervention. In conclusion, L. salivarius PS7 is a promising strain for the prevention of rAOM in infants and children.
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A double-blind, vehicle-controlled clinical study to evaluate the efficacy of MAS065D (XClair), a hyaluronic acid-based formulation, in the management of radiation-induced dermatitis.
Primavera, G, Carrera, M, Berardesca, E, Pinnaró, P, Messina, M, Arcangeli, G
Cutaneous and ocular toxicology. 2006;(3):165-71
Abstract
This study was designed to assess the efficacy and tolerability of MAS065D (Xclair) compared to a vehicle control in the management of radiation dermatitis in patients receiving radiotherapy for breast cancer. Twenty patients were randomized blindly to use the two study substances, three times daily, on separate sections of irradiated skin throughout the duration of radiotherapy and for two weeks afterwards. Patients were monitored before therapy, weekly during therapy, and for 2 weeks after radiotherapy was completed. Skin appearance according to National Cancer Institute (NCI) toxicity criteria, erythema rating, transepidermal water loss (TEWL), skin hydration, patients' view of itch, pain, acceptance, and view of each cream and adverse events, were monitored; at the final visit patients and investigators expressed their preference for one of the creams. MAS065D showed statistically significant superiority in the outcomes of NCI grading for radiation dermatitis and erythema. Patients' and investigators' preferences for one of the study substances were statistically in favor of MAS065D. Very few patients recorded nonzero itch and pain scales, so no significant differences emerged between the two groups. It was concluded that MAS065D can provide an effective option for managing radiation dermatitis although further studies are needed to assess its effect on pain and itch.
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Histologic findings in protocol biopsies performed in stable renal allografts under different immunosuppressive schedules.
Moreso, F, Alperovich, G, Fulladosa, X, Gil-Vernet, S, Ibernon, M, Carrera, M, Castelao, AM, Hueso, M, Grinyo, JM, Serón, D
Transplantation proceedings. 2003;(5):1666-8
Abstract
Protocol biopsies performed in stable renal allografts show different degrees of acute and chronic lesions. Histologic findings in protocol biopsies have been related to graft outcome. We evaluated histologic lesions observed in protocol biopsies performed in patients under different immunosuppression therapies. From June 1988 a protocol biopsy was performed at approximately 4 months in patients who fulfilled the following criteria: serum creatinine <300 micromol/L; stable renal function; and proteinuria <1 g/d. Histologic lesions were graded according to 1997 Banff criteria. For the present study we considered the following groups according to immunosuppressive schedule: (i) induction therapy with polyclonal or monoclonal antilymphocytic antibodies associated with cyclosporine and prednisone (n=201); (ii) cyclosporine, mycophenolate mofetil, and prednisone (n=127); and (iii) tacrolimus, mycophenolate mofetil, and prednisone (n=51). On protocol biopsy patients treated with tacrolimus displayed a lower acute score (0.61+/-1.01 vs 1.24+/-1.23 in group I, 1.28+/-1.41 in group II; P<.0001) and a higher proportion of normal biopsies (57.1% vs 41.9% in group I, 45.1% in group II; P=.016). A similar proportion of chronic lesions (chronic score of group I: 1.30+/-1.56; group II: 1.34+/-1.80; group III: 1.51+/-0.95; P=NS) was observed in the three groups. Protocol biopsies displayed fewer acute lesions in patients treated with tacrolimus. This result suggests that the efficacy of new immunosuppression schedules can be evaluated using the protocol biopsy as a surrogate marker of graft outcome.
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[Management of sepsis of the biliary tract: indications to surgical treatment].
De Paolis, P, Marchigiano, E, Carrera, M, Leone, N, Pellicano, R, Fronda, GR
Minerva gastroenterologica e dietologica. 2002;(1):37-43
Abstract
Sepsis of the biliary tract is a severe disease, due to its course and its significant association with relevant diseases, either benign or malignant, of the biliary tract, pancreas, hepatic hilus. In many cases it remains difficult to set the limit between medical therapy, percutaneous or endoscopic therapy and surgical treatment. Through a thorough review of the last 20 years' literature, we have studied this topic and classified cholangitis according to its etiology: Iithiasis, benign stenosis or Klatskin tumor as malignant diseases. The sequential approach, endoscopy-surgery, seems to provide the best results in lithiasic cholangitis. In patients with benign stenosis of the biliary tract, a percutaneous drainage is indicated as a first choice, meanwhile surgery is limited to unsuccessful bilioplasty and to segmental extrahepatic localization of sclerosing cholangitis. On the contrary, in Klatskin tumours preoperative percutaneous drainages are useful to obtain an accurate map, which is indispensable to perform an aggressive radical hepatic resection.