Complaints Of Dry Mouth Research Articles

The association between oral dryness and use of dry-mouth interventions in Sj\xf6gren\u2019s syndrome patients

ObjectiveSjögren’s syndrome patients use different dry-mouth interventions for the relieve of their oral dryness. Recently, it was shown that patients with dry-mouth complaints have regional differences in perceived intra-oral dryness. Therefore, the aim of the present study was to investigate whether the use of dry-mouth interventions is related to the perceived regional oral dryness.Materials and methodsA cross-sectional study was performed among Sjögren’s patients. Volunteers could anonymously administer various questionnaires, including the Regional Oral Dryness Inventory (RODI), Xerostomia Inventory (XI), Bother Index (BI) and a list of dry-mouth interventions.ResultsSjögren’s syndrome patients use a wide variety for the relieve of oral dryness. “Drinking water’’ and “moistening the lips’’ were used most frequently. Dry-mouth interventions, “drinking water’’, “rinsing of the mouth”, and “drinking small volumes” had significant associations with the RODI-scores of the posterior palate, and anterior and posterior tongue, respectively. On the other hand, “using mouth gel’’ had a significant association with the RODI-scores of the inside cheeks.ConclusionSjögren’s syndrome patients are more likely to use mouth gels when their inside cheeks were experienced as most dry, while they drank water, rinsed their mouth or drank small volumes if the posterior palate, and anterior and posterior tongue were considered as dry. It can be concluded that intra-oral dryness affects dry-mouth perception and thereby also the use of the various dry-mouth interventions.Clinical relevanceThe therapeutic choice of dry-mouth interventions by Sjögren’s syndrome patients seems to some extent to be related to dryness at specific intra-oral regions.

A Randomized, Double-Blind, Placebo-Controlled, Cross-Over Study to Evaluate the Efficacy of AqualiefTM Mucoadhesive Tablets in Head and Neck Cancer Patients Who Developed Radiation-Induced Xerostomia

Simple SummaryXerostomia, the subjective complaint of dry mouth, is caused by therapeutic interventions or diseases. Nowadays, radiotherapy in patients with head and neck cancer (HNC) stands out as one of the most important causes of xerostomia. Currently available therapies for the treatment of xerostomia are still less than optimal and xerostomia still represents an unmet clinical need. In this article, we present the results of a clinical study with a new product, AqualiefTM, in patients treated with curative radiotherapy for HNC. The results show that AqualiefTM stimulated salivation in these patients and reduced the pH drop that was observed in an equivalent population of patients treated with placebo. Moreover, no serious, treatment-related adverse events were observed. These encouraging results suggest that AqualiefTM may become a promising tool for the treatment of radiotherapy-related xerostomia. In addition, the results also suggest that AqualiefTM may have positive effects in the maintenance of oral health.Xerostomia, the subjective complaint of dry mouth, is caused by therapeutic interventions or diseases. Nowadays, radiotherapy (RT) in patients with head and neck cancer (HNC) stands out as one of the most important causes of xerostomia. Currently available therapies for the treatment of xerostomia are still less than optimal and xerostomia still represents an unmet clinical need. In this article, we present the results of a prospective clinical study with a new product, AqualiefTM, in patients treated with curative RT with or without chemotherapy for HNC. AqualiefTM is based on two main ingredients, carnosine and karkadé, which have acid buffering and antioxidant properties. The study was performed on 30 patients, with 4 of the patients being lost during the study period. Each patient received randomly one of the two treatments, AqualiefTM or placebo, for 8 days. After a 10-day wash-out period, each patient received the other treatment for a further 8 days. The results show that AqualiefTM stimulated salivation in these patients and reduced the pH drop that was observed in an equivalent placebo-treated population of patients. Moreover, no serious, treatment-related adverse events were observed. AqualiefTM has shown positive results, although with limitations due to unsuccessful trial accrual. Therefore, it may be further investigated as a tool for the treatment of RT-related xerostomia.

An Unusual Form of Type 1 Diabetes With an Elevated Proinsulin Level

Introduction: Diabetes is one of the most prevalent diseases in the world. We recognize the three most common types of diabetes: type1, type2 and gestational diabetes. It is estimated that around 425 million of people worldwide have diabetes and about 90% of those represent type 2 diabetes. The most common types of diabetes are polygenic -- they are caused by a defect in multiple genes. Monogenic diabetes is caused by a mutation in a single gene. We currently have over 10 different types of monogenic diabetes called MODY (Maturity Onset Diabetes of the Young). Sun et al. states that over the past few years, 30 different insulin gene mutations were reported to cause a new syndrome called MIDY (Mutant INS-gene-induced Diabetes of Youth). Most of these mutations lead to proinsulin misfolding in the endoplasmic reticulum. We present a rare case of a young obese female with an elevated proinsulin level and low C-peptide level diagnosed with type 1 diabetes requiring therapy with insulin. Case Description: A 21 year old female with past medical history of chronic diarrhea initially presented with a complaint of dry mouth, dizziness, excessive urination, and thirst. She was found to have hyperglycemia of 203 mg/dL, A1C 8.3, and negative ketones. Patient had a strong family history of diabetes. She had a family history of: father with type 1 diabetes; mother with a past medical history of gestational diabetes who became diabetic postpartum; and three of the patient’s grandparents with a history of diabetes. Patient was started on the oral hypoglycemic agents metformin and glipizide, but she only had partial response to these medications. Because of her strong family history and incomplete response to oral hypoglycemic agents, additional testing was performed. Patient was found to have a low C-peptide level (1.6 ng/mL), elevated proinsulin (72.9 pmol/L), positive GAD antibody (10.3 units/mL) and negative islet cell autoantibody. Patient had a very good response to insulin and subsequently became insulin dependent. She is currently on an insulin pump. Conclusion: Sun et al. reports that proinsulin misfolding causes beta cell failure. Increased misfolding occurs under certain pathological conditions that are currently unknown. We think that there might be some increased proinsulin misfolding abnormality that might be occurring in this patient. There are most likely many epigenetic modifiers that would trigger certain individuals to be more prone to this phenomena of misfolded proinsulin. Future research in diabetes may one day yield antibodies that would specifically recognize misfolded proinsulin in the plasma. Further research is required to elucidate how defective proinsulin folding may lead to beta cell dysfunction and subsequent evolution of diabetes mellitus.

Xerostomia symptoms and treatment strategies associated with salivary flows

<h3>Objectives</h3> We sought to analyze the types and quantity of dry mouth products patients use as well as the reported dry mouth symptom severity and frequency in relation to salivary flows. We hypothesized that respondents with higher stimulated flow would report better responses to products that stimulate flow. <h3>Methods</h3> Patients with complaints of dry mouth who had documented unstimulated and stimulated whole salivary flows (UWS and SWS, respectively) completed a questionnaire to assess dry mouth products used, current symptoms, and response to therapy. Statistical analyses included descriptive analyses and associations between dichotomized (low/normal) salivary flow levels, and symptom severity was assessed using nonparametric Wilcoxon rank-sum tests. <h3>Results</h3> Eighty-seven patients completed the questionnaire; 38 patients had a diagnosis of Sjögren syndrome. More than half of patients (55%; n = 48) reported using 4 or more dry mouth products. The most common product used was water (n = 78), followed by rinses (n = 54) and lozenges (n = 48). Twenty-five patients (29%) reported use of parasympathomimetics. More than half (56%) of patients using parasympathomimetics reported that their mouth felt "much better" compared with less than one-third of patients using other methods: water (29%), gum (23%), lozenges (27%), candies (4%), rinse (26%), spray (24%), or gel (20%). Among parasympathomimetic users with normal SWS, 71% reported their mouth felt "much better" compared with 36% of those with low SWS. For water, gum, lozenges, candies, and sprays, greater than 50% of respondents reported improvement lasting less than 1 hour. Regarding rinses, gels, and parasympathomimetics, greater than 50% of respondents reported improvement lasting greater than or equal to 1 hour. The dichotomized level of UWS rate was not associated with any measures of symptom severity, whereas the low SWS rate was associated with the following measures: dryness of the mouth (<i>P</i> = .004), difficulty speaking due to dryness (<i>P</i> = .03), and difficulty swallowing due to dryness (<i>P</i> = .004). <h3>Conclusions</h3> Different treatment categories for dry mouth symptoms provided varying degrees of relief. Patients with normal vs low stimulated flow who used parasympathomimetics reported the greatest treatment response and longest relief of dry mouth symptoms. Assessment of salivary flow levels may be a useful guide for more targeted recommendations of dry mouth products.

Association of xerostomia and taste alterations of patients receiving antineoplastic chemotherapy: A cause for nutritional concern.

The symptoms of xerostomia and taste alteration are adverse effects which frequently occur in patients under chemotherapy and once associated they can potentially impair their nutritional status. The aim of this study was to investigate the association of xerostomia and taste alterations in patients being treated by neoplastic chemotherapy. Fifty patients scheduled to receive neoplastic chemotherapy were followed for their first two chemotherapy cycles for solid tumors and the Chemotherapy-Induced Taste Alteration Scale (CiTAS) was adopted. Xerostomia was defined by the presence of dry mouth complaints reported by the patients and signs of hyposalivation identified during the intraoral examination. Of the 50 patients, 33 were women, mean age; 61,48±9,07 years, and 17 were men, mean age; 57,35±11,50 years. The most common tumor was located in the breast affecting 15 patients (30%). The Mann-Whitney test showed that the mean scores of CiTAS were significantly higher for those patients who reported having xerostomia when compared with those without xerostomia after the first two chemotherapy cycles. The cofounding variables such as age, smoking habits and use of antidepressants were not statistically associated with taste alterations (p>0.05). Taste alterations were worse for patients who complained of xerostomia during the first two cycles of antineoplastic chemotherapy and the association of both symptoms can potentially impair their nutritional status and quality of life.

Xerostomia diagnosis and management

Xerostomia, or dry mouth, is a common complaint that may be caused by several conditions, which include side effects of a wide variety of drugs, such as antidepressants, therapeutic radiation to the head and neck, dehydration, diabetes, and diseases involving salivary glands, such as Sjogren's syndrome. The complaint of dry mouth may or may not be associated with decreased salivary gland function. Individuals with xerostomia complain of problems with eating, speaking, swallowing, and wearing dentures. Some people also complain of salivary gland enlargement or changes in taste. Lack of saliva may predispose one to oral infections, such as candidiasis, and increase the risk of dental caries. Management of the individual patient with xerostomia includes assessment of salivary gland function, replacement therapy, and prevention of caries and oral candidiasis. Early recognition and management of xerostomia may prevent devastating dental disease and help to improve the quality of life.

Progressive Systemic Sclerosis and its Dental Implications: A Case Report

Scleroderma is a complex autoimmune rheumatic disease characterised by the widespread fibrosis of skin and visceral organs, dysregulation of immune system and vasculopathy. The aetiology of this disease remains unknown till now. It is known to exist in two forms namely localised and generalised/progressive. It is known to affect females more commonly than males, and also shows a wide range of oral and paraoral manifestations including xerostomia, periodontal disease, restricted mouth opening, burning mouth syndrome, dysphagia, gastroesophageal reflux. Here, authors presents a case of 76-year-old female patient presented with the chief complaint of dry mouth, restricted mouth opening, burning sensation in mouth and reduced taste perception for the past seven years. On the basis of gastrointestinal disorder, Raynaud’s phenomenon, fish mouth appearance and various other extraoral and intraoral features a diagnosis of Progressive Systemic Sclerosis (PSS) was made. The present case also emphasised upon the crucial role of a general dentist in diagnosing such rare systemic diseases. This disease is known to carry a significant burden in the form of pain and disability which potentially limits the proper functioning of major internal organs and results in various life limiting complications. Thus, early diagnosis with appropriate investigations followed by specialist and multidisciplinary approach to treatment, is the key for the successful management of disease.

Relationship between polypharmacy, xerostomia, gustatory sensitivity, and swallowing complaints in the elderly: A multidisciplinary approach.

Oral dysfunctions are common in the elderly but the literature lacks a multidisciplinary approach on the relationship between polypharmacy, saliva flow, xerostomia, taste, and swallowing complaints. This cross-sectional study included 204 non-institutionalized elderly (>60 years; 123 women/81 men), free of severe disabilities and non-alcohol/tobacco consumers, from whom specific pharmacological therapies were evaluated, as well xerostomia (Xerostomia Inventory-XI) and swallowing complaints (EAT-10 questionnaire), salivary flow rate and gustatory sensitivity. Statistical analysis included Chi-square, Mann-Whitney, Two-way ANCOVA, and linear multiple regression. Polypharmacy (≥5 drugs daily), hyposalivation, and severe taste dysfunction were found in 18, 46, and 10% of the participants, respectively. Polypharmacy was related with xerostomia (p = .041) and swallowing complaints (p < .001; power = 94%), but not with taste dysfunction. Dry mouth complaint and higher risk of swallowing disorders were found in 50 and 12% of the elderly, respectively, and angiotensin-converting enzyme (ACE) inhibitors users (n = 36) showed higher EAT-10 scores (p = .038). Regression models showed that stimulated salivary flow rate was dependent on gender and diuretic use, while xerostomia scores were dependent on the number of medications and unstimulated saliva flow (p < .001). In conclusion, the results draw attention to the high frequency of oral and maxillofacial dysfunctions found in non-institutionalized elderly, especially polypharmacy, xerostomia and swallowing complaints, and the side effects of drugs that can disturb the oral functions, the acceptance of food, and the adherence to oral therapies.

The relationship between xerostomia and saliva secretion in young adults

The relationship between xerostomia and reduced saliva secretion is known to occur in patients suffering from dry mouth. These are mainly (frail) older people experiencing reduced saliva secretion as a result of the use of medication. In the current research, we investigated whether the severity of xerostomia could be used as predictor for saliva secretion in young adults. 369 dentistry students participated in this study, of whom 33.4% were male and 66.6% were female, with an average age of 20.2 ± 2.4 years. It was found that the severity of xerostomia in the young adult students had a weak correlation with the unstimulated saliva secretion rate. This indicates that dry mouth complaints in this age group are not a good predictor for saliva secretion. In addition, it is concluded that hyposalivation is not restricted to older people or to specific patient groups, but that even among a trial population of young adults, individuals can suffer from dry mouth and/or reduced saliva secretion.

Gastroesophageal reflux-like symptoms are associated with hyposalivation and oropharyngeal problems in patients with asthma.

Previous studies have suggested a significant relationship between hyposalivation and inhalation therapy-induced oropharyngeal problems. However, salivary secretion tests are not widely performed in daily clinical practice. In fact, xerostomia, the complaint of dry mouth, may not indicate hyposalivation. Therefore, we determined the clinical factors associated with hyposalivation in patients with asthma. This study is a post-hoc analysis of our previous studies. Adult patients with asthma on maintenance inhalation therapy were enrolled. The participants completed questionnaires on oropharyngeal symptoms and underwent a salivary secretion test. Symptom severity was evaluated using a numerical rating scale (NRS), and salivary secretion was measured using the modified cotton roll method. Using logistic regression analysis, we identified the clinical factors associated with hyposalivation. In total, 531 patients completed the questionnaire (43.8±16.9 years and male/female=171/360), and 234 patients successfully performed a salivary secretion test, of which 126 (53.8%) were diagnosed with hyposalivation (<0.25g/min). The patients with hyposalivation were significantly older (p<0.0001) and had severe xerostomia and/or gastroesophageal reflux-like symptoms (GERLS) (p<0.0001). Many of these patients had also used inhaled long-acting beta agonists (p=0.012) and high-dose inhaled corticosteroids (p=0.024). Multivariate analysis revealed that advanced age (odds ratio [OR] 1.05, p<0.0001), severe xerostomia (OR 1.02, p=0.0006) and severe GERLS (OR 1.02, p=0.001) were independently and significantly associated with hyposalivation. Age, xerostomia, and GERLS were significantly related to hyposalivation in patients with asthma. To identify oropharyngeal problems in these patients, a careful assessment of the suspected symptoms of gastroesophageal reflux may be useful.

METHODS OF SALIVATION REDUCTION ASSESSMENT AT A DENTAL APPOINTMENT

The aim: To develop and study the methods of assessing the decrease in salivation during a dental appointment. Materials and methods: We formed an observation group of 185 people (61 men and 124 women), which complained of dry mouth. Results: According to the results of the survey, we found that 10.3% (19 patients) had moderate xerostomia and 89.7% (166 patients) had pronounced xerostomia. In 179 patients (96.8%) with complaints of dry mouth and with a subjective assessment as pronounced xerostomia, salivation rate was, on average, 0.08 ± 0.01 ml/min. That was reliably objectified by laboratory indicator of hyposalivation - less than 0.1 ml/min. Conclusions: In our studies, we proved a direct relationship between patient complaints of dry mouth and laboratory-confirmed data. This makes it possible for a stomatologistto quickly identify this pathology, analyze it and choose the right treatment tactic during clinical appointment.

Prevalence of xerostomia in women during breast cancer chemotherapy.

To identify the prevalence of xerostomia in women undergoing chemotherapy for breast cancer. Prospective cohort with 27 women who underwent up to 16 sessions of intravenous chemotherapy. Data collection was performed at the outpatient clinic of a university hospital in the city of São Paulo, where two forms were applied before the start of treatment and the Xerostomia Inventory before and after each chemotherapy session. Complaints of dry mouth were present in 48.1% of women before chemotherapy, and they were approximately 28 times more likely to develop dry mouth during treatment. It was observed that the use of antiemetics contributed to the occurrence of xerostomia, and the anti-ulcerous were presented as a protective factor. The study identified both a high prevalence of xerostomia regardless of the chemotherapy used and the need to create protocols to improve the quality of life of these patients.

Management of Xerostomia and its Impact on Dental Caries:A Review

Many elder groups have been studied to determine their frequency of dry mouth complaints and their salivary flow rates. To appreciate these it is first necessary to understand two related concepts. First, complaints of dry mouth (or xerostomia) may not reflect reduced salivary function may instead reflect dehydration or other systemic conditions. Therefore studies that only examine the complaints of dry mouth will not reflect the true risk for oral diseases in the population. Second, it is very difficult to determine values for normal salivary function. Other studies suggest that salivary flow rates in elders are related to the number of medications they take on a regular basis, time number of systemic disorders they report, and the length of time for which they consume the drugs.

CLINICAL AND LABORATORY FEATURES OF ANTICENTROMERE ANTIBODY-POSITIVE SJö GREN’S SYNDROME

Objective: to study the clinical and laboratory features of patients with anticentromere antibody (ACA) positive Sjö gren’s syndrome (SjS); to assess the spectrum of autoantibodies in patients of this group; to determine the frequency with which the SjS patients who are highly positive for ACA, meet the international classification criteria for SjS and systemic sclerosis (SS); to reveal the incidence of MALT lymphomas in this patient group; to estimate the incidence of primary biliary cirrhosis (PBC)/biliary lesions as part of autoimmune epithelitis in SjS in this patient group.Material and methods. A total of 83 patients with ACA positive SjS were comprehensively examined at the V.A. Nasonova Research Institute of Rheumatology during the period 2012 to 2018. The inclusion criteria were con formity to the 2001 Russian SjS criteria and a high ACA level. MALT lymphomas were diagnosed on the basis of histological and immunohistochemical studies and polymerase chain reaction-based determination of B-cell clonality in the biopsy samples of affected organs according to the World Health Organization classification of Hematopoietic Tumors. The diagnosis of PBC/biliary lesions was made on the basis of histological and immunohistochemical studies of liver biopsy specimens.Results and discussion. The investigation revealed low detection rates for anti-Ro antibodies (32.5%), anti-La antibodies (7.2%) and rheumatoid factor (RF) (21.7%), which were typical for the classical SjS immunophenotype), increased ESR (14%), leukopenia (7%), hypergammaglobulinemia (17.6%), elevated levels of IgG (9.5%) and IgA (18.7%), and hypocomplementemia (16.1%) in the ACA positive SjS patients. Despite the low detection rate of RF, 15 (18%) patients in this group developed MALT lymphomas: 14 patients had salivary gland MALT lymphoma and one patient had tonsil MALT lymphoma with peripheral lymph node involvement (generalized marginal zone lymphoma). Also, the patients of this group showed high detection rates for AMA antibodies (34.6%), increased IgM level (29.7%) and a higher risk for PBC/biliary lesions as a manifestation of autoimmune epithelitis in SjS (14.5%). AMA-antibodies were absent in only two patients who were diagnosed with liver disease according to biopsy specimens. Nervous system and renal lesions, antiphospholipid syndrome, rheumatoid arthritis, hypergammaglobulinemic purpura, and cryoglobulinemic vasculitis were much less common and sporadic. Also ACA-positive SjS patients often have Raynaud’s phenomenon (54.9%) with scleroderma-type capillaroscopic changes (68%) and a limited form of SS (24%) according to the 2013 ACR criteria.Conclusion. ACA-positive SjS is a subtype of the disease, which is significantly different from the classic one in a number of clinical and laboratory signs and characterized by an increased risk for SS, MALT lymphomas, and PBC/biliary lesions as a manifestation of autoimmune epithelitis in SjS which in some cases leads to the underdiagnosis of SjS. ACA should be considered as pathogenetically related to SjS autoantibodies; and all patients who are seropositive for ACA should be examined for SjS and PBC/biliary lesions as a manifestation of autoimmune epithelitis in SjS regardless of whether they have SS or not, as well as complaints of dry mouth and eyes. Patients with significantly enlarged salivary glands should undergo biopsy to rule out or confirm MALT lymphoma before initiating hormonal, antilymphoproliferative, and anti-B-cell therapy.

SOME FEATURES OF THE RELATIONSHIP BETWEEN PATHOGENETIC MECHANISMS OF HYPOSALIVATION IN RHEUMATOID ARTHRITIS AND SJOGREN'S SYNDROME

Oral cavity damage, impaired salivation, the presence of autoantibodies and the level of inflammatory markers were studied in 150 patients with rheumatoid arthritis – RA (27 males and 123 females), mean age – (50.10 ± 0.44 years); 90 patients without complaints of dry mouth, 31 patients with complaints of dry mouth and 29 patients with Sjogren's syndrome. It was found that all patients with RA (without complaints of dry mouth and with them) had a decrease in salivation (0.29 ml/min ± 0.07 ml/min and 0.25 ml/min ± 0.05 ml/min) , which is associated with an increase in the activity of the inflammatory process and the presence of autoantibodies. Shegren's syndrome in RA was detected in 19% of patients, it is associated with significant deterioration of oral hygiene, expressed by hyposalivation (0.14 ml/min ± 0.06 ml/min), high activity of the inflammatory process, a wide spectrum of autoantibodies (rheumatoid factor, antinuclear antibodies in low titres, antibodies Ro and La), an increase in the content of C-reactive protein and interleukin-1.

SOME FEATURES OF THE RELATIONSHIP BETWEEN PATHOGENETIC MECHANISMS OF HYPOSALIVATION IN RHEUMATOID ARTHRITIS AND SJOGREN'S SYNDROME

Oral cavity damage, impaired salivation, the presence of autoantibodies and the level of inflammatory markers were studied in 150 patients with rheumatoid arthritis – RA (27 males and 123 females), mean age – (50.10 ± 0.44 years); 90 patients without complaints of dry mouth, 31 patients with complaints of dry mouth and 29 patients with Sjogren's syndrome. It was found that all patients with RA (without complaints of dry mouth and with them) had a decrease in salivation (0.29 ml/min ± 0.07 ml/min and 0.25 ml/min ± 0.05 ml/min) , which is associated with an increase in the activity of the inflammatory process and the presence of autoantibodies. Shegren's syndrome in RA was detected in 19% of patients, it is associated with significant deterioration of oral hygiene, expressed by hyposalivation (0.14 ml/min ± 0.06 ml/min), high activity of the inflammatory process, a wide spectrum of autoantibodies (rheumatoid factor, antinuclear antibodies in low titres, antibodies Ro and La), an increase in the content of C-reactive protein and interleukin-1.

Antidepressant-Resistant Depression in Patients With Comorbid Subclinical Hypothyroidism or High-Normal TSH Levels.

Antidepressant-Resistant Depression in Patients With Comorbid Subclinical Hypothyroidism or High-Normal TSH Levels.

Does Morphine Influence Blood Count in Palliative Patients? : A Longitudinal Study from an Oncology Center in Nepal

Introduction: Morphine has been the cornerstone of pain management in palliative care patients. The easy accessibility and availability of opioids at most tertiary care centers of Nepal have made possible, the once thought impossible fundamental right of palliative patients. The availability of morphine has not only eased the pain of palliative patients but health care providers equally. The mainstay of pain management has had its success but several subjective complaints of dry mouth, sedation, feeling of incomplete wellbeing and decreased immune function is often heard of. The present study aims at evaluating the effects of morphine on complete blood count profile in palliative care patients. Methods: Complete blood count of 114 palliative patients was estimated using an automatic hematology analyzer after 24-48 hours and 14 days of morphine administration. The data was recorded using a preformed proforma and analyzed using SPSS (20). Results: A statistically significant increase in total white blood cell count, neutrophil and platelet count was observed following morphine administration but there was a decrease in lymphocyte count (p0.05). Conclusion: Morphine is found to influence the total white blood cells, neutrophils, and lymphocytes and NLR in palliative patients. However, withholding morphine in palliative patients is never an option. Furthermore, larger randomized controlled trials are necessary to analyze the predictive value of NLR and PLR in palliative patients.

Quality-of-life after radiotherapy for advanced laryngeal cancer: Results of a phase III trial of the Dutch Head and Neck Society

Background/purposeTo report on health-related quality-of-life (HRQoL) of patients with laryngeal cancer, treated in a randomized trial comparing accelerated radiotherapy with carbogen and nicotinamide (ARCON) against accelerated radiotherapy alone (AR). Material/methodsHRQoL was assessed using the HRQoL Questionnaire-C30 (QLQ-C30) and the Head & Neck cancer module (QLQ-H&N35) at baseline, at completion of radiotherapy and at 6, 12, and 24months post-baseline. ResultsFrom 269/345 patients (AR: 136/174; ARCON: 133/171) data on HRQoL were available for analysis. Moderate to severe clinical impact of the treatment was observed for nearly all items of the QLQ-C30 and QLQ-H&N35 between baseline and end-of-treatment. At 6months, scores returned to baseline level with exception of dry mouth, sticky saliva, and taste/smell. No difference between AR and ARCON was observed. At 2years from baseline, the percentage of patients reporting moderate to severe complaints of dry mouth, sticky saliva, or changes in taste/smell was 30%, 22% and 18%, respectively, while the majority of patients had no or few complaints of swallowing (79%) or speech (64%). ConclusionsWith accelerated radiotherapy, high local tumor control was obtained while maintaining good speech and swallowing function. Long-term dry mouth, sticky saliva and changes in taste/smell are limited to one quarter of patients. (ClinicalTrials.gov number, NCT00147732).

Antihypertensive Drugs Induced Xerostomia: A Short Review

Xerostomia refers to a subjective sensation of a dry mouth, its frequently, but not always associated with salivary gland hypofunctions. Xerostomia is a common problem that has reported in 25% of older adults. In the past, complaints of dry mouth in older patient was ascribed to the predictable result of aging. However, it is now generally accepted that any reductions in salivary functions associated with age are modest and probably are not associated with any significant reductions in salivary functions. Instead, xerostomia in older asults is more likely to be the result of other factors, especially medications. More than 500 drugs have been reported to produce xerostomia as side effect. This review brief discuss about the antihypertensive drugs causing xerostomia.