Clinical management of maxillary osteonecrosis associated with antiresorptive medication (MRONJ): Presentation of clinical cases

Antiresorptive drugs: Bisphosphonates (BPs) and Monoclonal Antibodies: Denosumab (DS) are known to suppress osteoclastic activity, affecting the expression of the RANKL (Kappa β Nuclear Activation Receptor), which corresponds to an osteoblastic differentiation factor and which is secreted by said cells, being responsible for inducing reabsorption by osteoclasts. Under certain circumstances, those medications may induce the development of Maxillary Osteonecrosis (MRONJ).The paper is aimed to share our experience of MRONJ treatment using minimally invasive therapies (including washes and antibiotics) that does not expand the necrotic bed volumetrically and provide non-recurrent resolution of the lesion. The patients we described were on long-term therapy either with BPs or DS.Conclusion: Interaction between health professional is essential for MRONJ prevention. The therapeutics consolidated in non-invasive maneuvers, and the manipulation of bone tissue with close follow up allows to avoid spread to deep planes. The pathological process could be successfully treated, and it is not necessary to suspend antiresorptive medications.

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Follow-up of patients with prolactinomas after discontinuation of long-term therapy with bromocriptine

Acta Endocrinologica ◽

10.1530/acta.0.1040139 ◽

1983 ◽

Vol 104 (2) ◽

pp. 139-142 ◽

Cited By ~ 48

Author(s):

Arturo Zárate ◽

Elías S. Canales ◽

Carlos Cano ◽

Carlos J. Pilonieta

Keyword(s):

Sella Turcica ◽

Ct Scanning ◽

Serum Levels ◽

Primary Treatment ◽

Term Therapy ◽

History Of ◽

Permanent Cure ◽

Long Term Therapy

Abstract. The effects of bromocriptine discontinuation after a 2 year course of therapy on prolactin (Prl) serum levels and the radiological size of the sella turcica were investigated in 16 women with amenorrhoea-galactorrhoea due to prolactinoma. During therapy, all but 2 patients had normalized serum Prl levels, and 4 women with macroprolactinomas exhibited a reduction in the size of the tumour as documented by CT-scanning and tomography of the sellae. After bromocriptine withdrawal and follow-up during 2 additional years, Prl levels remained normal in 6 patients, 2 of them with microprolactinomas and 4 with macroprolactinoma. The remaining 10 women developed hyperprolactinaemia associated with amenorrhoea and galactorrhoea within 3 months after discontinuation of therapy. No tumour expansion was observed in any case during the 4 year observation period. In the present study bromocriptine treatment seemed to result in permanent cure in 6 out of 16 cases of prolactinomas; nevertheless it is difficult to justify an indefinite medical treatment since the natural history of prolactinoma remains unknown. We presently feel that bromocriptine is more appropriate than neurosurgical transsphenoidal exploration for the primary treatment of prolactinomas. Further investigation is needed before a more definitive conclusion regarding the management of prolactinomas can be reached.

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Non-invasive EMG-guided biofeedback: Effective long term therapy for encopresis in children

Gastroenterology ◽

10.1016/0016-5085(95)27043-4 ◽

1995 ◽

Vol 108 (4) ◽

pp. A683

Author(s):

M. Saps ◽

K. Cox ◽

E. Rich ◽

M. Fitzsimmons ◽

W. Berguist

Keyword(s):

Term Therapy ◽

Non Invasive ◽

Long Term Therapy

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Long-term therapy with non-steroidal anti-inflammatory drugs for axial spondyloarthritis: focus on changes in liver function

Experimental and Clinical Gastroenterology ◽

10.31146/1682-8658-ecg-187-3-152-157 ◽

2021 ◽

pp. 152-157

Author(s):

A. P. Rebrov ◽

A. V. Aparkina ◽

E. V. Kchondkaryan

Keyword(s):

Liver Function ◽

Liver Enzymes ◽

Genetically Engineered ◽

Term Therapy ◽

Acute Liver Damage ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

Long Term Therapy

The purpose of the study is to analyze the state of liver function in patients with spondyloarthritis taking non-steroidal anti-inflammatory drugs continuously for 24 months. Materials and methods of the study include 198 patients with spondyloarthritis. The prospective study involved 36 patients with spondyloarthritis who took non-steroidal anti-inflammatory drugs (NSAIDs) prescribed by a physician in the community for 24 months. The level of liver enzymes in blood serum at admission and in dynamics was studied. The increase of liver enzymes was detected in 12 (6.06%) of 198 patients with spondyloarthritis. Among them 6 (50%) patients took methotrexate, 1 (8.33%) - genetically engineered drug, 2 (16.67%) patients-sulfasalazine and 3 (25%) - nonsteroidal anti - inflammatory drugs. 19.4% of patients were registered with a periodic increase of transaminase levels on the background of NSAIDs for the last 24 months. At the same time, no cases of acute liver damage or progressive deterioration of liver function requiring discontinuation of therapy were recorded during the entire follow-up period.

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Renal Toxicity of Long-Term Therapy With Tenofovir in HIV-Infected Patients

Journal of Pharmacy Practice ◽

10.1177/0897190012442718 ◽

2012 ◽

Vol 25 (5) ◽

pp. 552-559 ◽

Cited By ~ 16

Author(s):

Maricelle O. Monteagudo-Chu ◽

Mei H. Chang ◽

Horatio B. Fung ◽

Norbert Bräu

Keyword(s):

Renal Toxicity ◽

Care Center ◽

Tertiary Care ◽

Term Therapy ◽

Kaplan Meier ◽

Ckd Stage ◽

Advanced Stages ◽

Long Term Therapy

Data are sparse on long-term renal toxicity of tenofovir as measured by estimated glomerular filtration rate (eGFR) and progression to advanced stages of chronic kidney disease (CKD). The objective of the study is to determine the incidence of renal impairment associated with the use of tenofovir in HIV-infected patients, using abacavir as a control. In a single tertiary care center, all HIV-infected patients with baseline CKD stage 0 or 1 (CKD-1), who were started on either tenofovir or abacavir from 1998 to 2008 and had at least 1 follow-up eGFR measure on therapy, were included in this retrospective analysis. Progression to CKD stages 2 to 5 was compared using Kaplan-Meier analysis. Progression to CKD-2 and CKD-3 occurred more frequently in patients who received tenofovir than those receiving abacavir (CKD-2, 2-year actuarial frequency, 48.8% vs 23.7%; P < .001, log rank; CKD-3, 5.8% vs 0.0%; P = .028). Only 1 patient in the tenofovir group progressed to CKD-4 and none to CKD-5. Treatment with tenofovir was the only independent factor associated with progression to CKD-2 (hazard ratio [HR], 2.12; 95% confidence interval [CI]: 1.41-3.18; P < .001) and to CKD-3 (HR, 4.91; 95% CI, 1.02-23.7; P = .048). In HIV-infected patients, long-term therapy with tenofovir is associated with mild-to-moderate nephrotoxicity which is significantly higher than in abacavir-treated patients.

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Sustained Antihypertensive Response with Minizide: Long-Term Follow-Up in a Multicentre Study

Journal of International Medical Research ◽

10.1177/030006058100900502 ◽

1981 ◽

Vol 9 (5) ◽

pp. 309-314 ◽

Cited By ~ 1

Author(s):

A E Woeltjen ◽

A J Gordon

Keyword(s):

Treatment Compliance ◽

Term Therapy ◽

Once Daily ◽

Long Term Follow Up ◽

Antihypertensive Response ◽

Laboratory Changes ◽

Long Term Therapy ◽

Toxic Potential

The safety and effectiveness of prazosin hydrochloride combined with polythiazide for the treatment of hypertension was studied in four European countries by ten investigators. One-hundred and seventy-seven adult male and female patients, 91% with essential hypertension, were treated for an average of 7 months. Reductions from placebo-controlled baseline blood pressure exceeded 15% over the 8-week short-term phase of the study with further reductions of up to 22% observed at the end of the study. Ninety-six per cent of all patients completed therapy with a diastolic blood presssure of 90 mm Hg or less. Most patients were adequately controlled on 2 tablets or less once daily. Each tablet contained 0.5 mg prazosin hydrochloride and 0.25 mg polythiazide. Long-term toleration was excellent. Side-effects were typical of those expected with antihypertensive medication and nearly all were reported during the first 8 weeks of treatment with no interruption or discontinuation of drug. Nearly all patients were followed throughout for laboratory changes. There were minimal changes consistent with the therapy and there was no pattern indicative of toxic potential. It is concluded that the drug combination, Minizide, is effective and well tolerated as initial and long-term therapy in hypertension and that the convenient dosage regimen will lead to enhanced treatment compliance for this chronic condition.

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Efficacy and side-effect profile of long-term bisphosphonate therapy in patients (pts) with multiple myeloma (MM): MRC myeloma IX study results.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.8015 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 8015-8015 ◽

Cited By ~ 1

Author(s):

Gareth J Morgan ◽

Graham H. Jackson ◽

Faith Davies ◽

Ping Wu ◽

Walter Gregory ◽

...

Keyword(s):

Cumulative Incidence ◽

Term Therapy ◽

Low Grade ◽

Efficacy And Safety ◽

Cox Models ◽

Dental Surgery ◽

Study Results ◽

Long Term Therapy

8015 Background: Bisphosphonates (BPs) are recommended in pts with osteolytic lesions from MM. However, data on the long-term efficacy and safety of BPs beyond 2 y is somewhat limited. The MRC Myeloma IX study has already revealed significant overall survival (OS) and progression-free survival (PFS) benefits for zoledronic acid (ZOL) over clodronate (CLO) in MM pts (N = 1960) initiating chemotherapy (Morgan GJ, et al. Lancet. 2010). We now report the efficacy and safety of BP therapy with long-term follow-up. Methods: Newly diagnosed MM pts were randomized to ZOL (4 mg IV q 21-28 days) or CLO (1600 mg/day PO) plus antimyeloma therapy. BPs continued at least until disease progression. PFS and OS were estimated using Kaplan-Meier methodology. Hazard ratios (HRs) were calculated using stratified Cox models. Adverse events (AEs) were monitored continuously and analyzed using cumulative incidence functions. Results: At a median follow-up of 5.8 y in 1960 evaluable pts, ZOL improved PFS (HR = 0.88; P = .01) and OS (HR = 0.88; P = .03) vs CLO. Both BPs were generally well tolerated, and acute renal failure events were similar between groups (ZOL 5.2% vs CLO 5.8% at 2 y, with incidence plateaued thereafter). Overall incidence of confirmed osteonecrosis of the jaw (ONJ) has remained low (ZOL 3.7% vs CLO 0.5%; P < .0001). ONJ incidence was lower among pts receiving thalidomide-containing regimens (1.4%) vs no thalidomide (2.76%; P = .041). Events were generally low-grade, most occurred between 8 and 30 mo (median time to ONJ = 23.7 mo), and cumulative incidence plateaued at ~36 mo. Ten pts had data on ONJ recovery: complete recovery in 4 pts, improvement in 2 pts, no change in 3 pts in the ZOL group; and no change in 1 CLO pt. Dental surgery or trauma preceded ONJ in 6 ZOL pts. Conclusions: ZOL provided sustained PFS and OS improvements vs CLO during long-term therapy in the MRC Myeloma IX study. Overall incidence of AEs was similar between groups, with no notable changes during long-term therapy. ONJ incidence remained low during long-term (> 2.5 y) therapy and was reduced in pts receiving thalidomide (possibly because of anticytokine effects of this agent).

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Adverse drug reaction monitoring in patients of hypertension at a tertiary care hospital, Aurangabad, Maharashtra, India

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20212084 ◽

2021 ◽

Vol 10 (6) ◽

pp. 720

Author(s):

Shruti Chandra ◽

Sukhmeen Kaur ◽

Deepali Jayabhaye ◽

Amol Ubale

Keyword(s):

Antihypertensive Drugs ◽

Patient Adherence ◽

Tertiary Care ◽

Term Therapy ◽

Care Hospital ◽

Cross Sectional ◽

Hypertensive Patients ◽

Long Term Therapy

Background: Hypertension is one of the highest prevailing diseases worldwide. Due to long term therapy antihypertensive drugs are commonly associated with adverse drug reactions (ADRs). Therefore, the study was conducted with the objective to examine the incidence of different types of ADRs in drug treated hypertensive patients.Methods: Present study was a prospective cross sectional observational study carried out in the outpatient of department of medicine of MGM hospital, a tertiary care teaching hospital, in Aurangabad. 320 diagnosed hypertensive patients were studied. Questionnaire was asked and their prescription were analysed and follow up was done.Results: Among 320 patient’s 75 patients were reported ADR. Males accounted for higher percent of ADRs 46 (61%) than females 29 (38.6%). Most of the patients 147 (55.9%) were on mono therapy. Calcium channel blocker was the frequently used class of drug, showed maximum number of ADR (30.6%) followed by ACE inhibitor (28%) and ARB (21.3%). As per WHO-UMC scale, type of reactions and their percentage were as certain (9.3%), Probable/ Likely (64%), possible (22.6%), and unlikely (4%). According to Naranjo scale most of the reactions were possible (64%). severity assessment is done by Hartwig and Siegel scale. No lethal ADR were reported. 4% reactions were severe, 32% were of moderate category and 64% were mild reactions.Conclusions: Such type of studies are helpful in selection of appropriate medicines for hypertensive patients, enhancing patient adherence with the therapy by selecting medicines of lesser ADR profile, reducing unnecessary economic burden to the patients due to unwanted effects of the therapy.

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Clinical Outcome of Pneumatic Dilatation in Patients with Achalasia Cardia: A Single-Center Prospective Study

Journal of Digestive Endoscopy ◽

10.4103/jde.jde_33_17 ◽

2017 ◽

Vol 08 (04) ◽

pp. 182-186

Author(s):

Amit Hanmant Shejal ◽

Thazhath Mavali Ramachandran ◽

Sunil Kumar N

Keyword(s):

Clinical Improvement ◽

Balloon Dilation ◽

Pneumatic Dilatation ◽

Term Therapy ◽

Symptom Duration ◽

Achalasia Cardia ◽

Eckardt Score ◽

Long Term Therapy

ABSTRACT Background and Aim: Pneumatic balloon dilation is one of the most commonly used and effective methods for treating patients with achalasia cardia. This study was performed to assess immediate and long-term response of pneumatic dilatation (PD) in these patients. Materials and Methods: Forty-four achalasia cardia patients, who underwent PD in our center from January 2013 to December 2015, were prospectively studied. Data from these patients were analyzed for clinical improvement in symptoms after dilatation procedure over this period as per Eckardt score. Patients who required repeated procedure and factors influencing remission of symptoms were analyzed. Results: A total of 44 patients underwent PD, among which three lost to follow up. Of the 41 patients, 21 were male (51.22%) and 20 were females (48.78%). Mean age was 38.68 (13–64) years. Median symptom duration before first dilatation was 18 months (2–240). Major symptoms at presentation were dysphagia (n = 41, 100%), regurgitation (n = 38 92.68%), chest pain (n = 31, 75.6%), and weight loss (n = 20, 48.78%). Mean follow-up period was 22.22 months (9–38). Forty (97.56%) patients had immediate clinical improvement after 1 dilatation, of which 38 (92.68%) patients did not require any further treatment. Mean Eckardt score was 6.82 (4–11) at the time of first dilatation which improved to 0.66 during follow-up. Two patients required second dilatation (one 5 months and other 18 months after the first procedure). Conclusion: PD is a safe and effective long-term therapy for achalasia cardia and has a good long-term clinical remission.

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