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1.
São Paulo; s.n; 20220601. 109 p.
Thesis in Portuguese | LILACS, BBO | ID: biblio-1370762

ABSTRACT

O carcinoma secretório em glândula salivar é uma neoplasia recentemente descrita que tem os mesmos aspectos morfológicos, imuno-histoquímicos e genéticos do carcinoma secretório de origem mamária. O carcinoma secretório tem características celulares reminiscentes de uma célula secretora lactacional, isto é, um citoplasma vacuolado repleto de gotas lipídicas e um material secretado, por vezes de forma apócrina, que pode lembrar o leite. Mais recentemente, algum nível de diferenciação lactacional foi sugerida no carcinoma secretório de origem salivar. O objetivo do estudo foi verificar se existe uma diferenciação do tipo lactacional em carcinomas secretórios de origem salivar, comparando a outros tipos de carcinomas salivares mais comuns. Foram realizadas reações imuno-histoquímicas para as seguintes proteínas: receptores hormonais (receptor de prolactina e receptor do hormônio do crescimento), proteínas associadas ao produto de secreção da glândula mamária lactacional (mucina-1 (MUC-1), MUC4, globulina de gordura 1 do leite humano, lactoferrina) e proteínas associadas à via Akt-mTOR (PTEN, p-Akt, p-mTOR, p4EBP1, eIF4E, pS6). A maioria dos casos de carcinoma secretório foi negativa para receptor de prolactina e de hormônio do crescimento. Lactoferrina foi positiva em todos os grupos tumorais, porém somente em carcinoma secretório observou-se um padrão de marcação intensa, difuso tanto em célula como em secreção. Todos os casos de carcinoma secretório foram positivos para globulina de gordura do tipo 1, porém o mesmo padrão de marcação foi observado em outros tumores. A maioria dos casos de carcinoma secretório foram positivos para MUC1 e MUC4. Nenhum caso de carcinoma secretório foi positivo para Akt, mas PTEN foi difusamente expresso em 57,1% dos casos. mTOR foi expresso em mais da metade dos casos de carcinoma secretório e dos outros tumores salivares. Entre as proteínas à jusante de mTOR, somente eIF4E demonstrou alta expressão no grupo de estudo. A expressão de marcadores lactacionais não é exclusiva do carcinoma secretório, porém a expressão de lactoferrina é distinta neste grupo de tumores quando comparado aos demais tumores salivares estudados.


Subject(s)
Cell Culture Techniques , Diphosphonates , Glucocorticoids
2.
Braz. dent. sci ; 25(2): 1-7, 2022. tab
Article in English | LILACS, BBO | ID: biblio-1363638

ABSTRACT

Objective: Bisphosphonates are anti-resorptive drugs used in the control and treatment of calcium and bone metabolism disorders. Despite their high clinical efficacy, these drugs have been associated with bisphosphonate-related osteonecrosis of the jaw. The goal of this study is to evaluate the knowledge of final year undergraduate dentistry students on bisphosphonate-related osteonecrosis of the jaw. Material and Methods: A sample of 100 students from private institutions in the state of São Paulo was invited to complete a questionnaire relating to bisphosphonates and the risk factors associated with the development of osteonecrosis of the jaws. Results: 66% of the students did not recognize any bisphosphonate (p=0.0019) and 79% did not recognize their trademark names (p<0.0001). 60% of the students recognized osteonecrosis of the jaws as a side effect of bisphosphonates (p<0.0001) and 56% identified at least one risk factor associated with the drug that may contribute to the side effect (p<0.0001). 66% of the students stated that their course did not provide any lectures on the topic (p<0.0001). Conclusion: The knowledge of dentistry students about bisphosphonates and bisphosphonate-related osteonecrosis of the jaw is variable. This may be related to an inadequate discussion of this topic during their undergraduate studies(AU)


Objetivo: Os bisfosfonatos são medicamentos antirreabsortivos utilizados no controle e tratamento de desordens do cálcio e do metabolismo ósseo. Apesar da elevada eficácia clínica, a terapia com estes medicamentos tem sido associada a uma importante complicação denominada de osteonecrose dos maxilares relacionada ao uso de bisfosfonatos. O objetivo deste estudo é avaliar conhecimento sobre a osteonecrose dos maxilares relacionada ao uso de bisfosfonatos entre os alunos do último ano do curso de graduação de Odontologia. Material e Métodos: Uma amostra de 100 alunos de instituições privadas do estado de São Paulo foi convidada a responder um questionário sobre as principais informações dos bisfosfonatos e fatores de risco associados com o desenvolvimento da osteonecrose dos maxilares. Resultados: Os 100 questionários foram respondidos: 66% dos estudantes não reconheceram algum bisfosfonato (p=0,0019), 79% não reconheceram seus nomes de marcas comerciais (p<0,0001); 60% dos alunos reconheceram a osteonecrose dos maxilares como um efeito colateral dos bisfosfonatos (p<0,0001) e 56% apontaram pelo menos um fator de risco associado com o medicamento que pode causar o desenvolvimento do efeito colateral (p<0,0001); 66% dos estudantes afirmaram que o curso não forneceu alguma aula abordando esta temática (p<0.0001). Conclusão: O grau de conhecimento dos alunos de Odontologia sobre bisfosfonatos e osteonecrose dos maxilares relacionada ao uso de bisfosfonatos é variável e está relacionado com a pouca discussão deste tema durante a graduação(AU)


Subject(s)
Humans , Osteonecrosis , Students, Dental , Diphosphonates
3.
Rev. Odontol. Araçatuba (Impr.) ; 42(2): 35-41, maio-ago. 2021.
Article in Portuguese | LILACS, BBO | ID: biblio-1252912

ABSTRACT

O objetivo deste estudo é realizar uma revisão da literatura para identificar os principais fatores que levam às complicações em implantodontia. Os implantes osseointegráveis e sua aplicação na odontologia revolucionaram a reabilitação oral de pacientes sejam eles edêntulos totais ou parciais em busca de recuperação funcional e satisfação estética. A pesquisa científica em uma busca constante pela magnificação deste tratamento, possibilitaram o uso de reabilitações implantossuportadas como um método de tratamento previsível com um índice elevado de sucesso. No entanto, como qualquer modo de tratamento, complicações e falhas também podem ocorrer na implantodontia. Após a revisão de literatura pode-se concluir que as condições médicas do paciente, hábitos sociais e parafuncionais, inexatidão do planejamento cirúrgico e protético, conhecimento técnico e científico do cirurgião-dentista, a falta de relacionamento interdisciplinar e deficiente cooperação do paciente no pós-operatório, podem estar relacionadas às complicações no tratamento reabilitador com implantes dentários(AU)


The objective of this study is to carry out a complete literature review to elucidate and evaluate the factors that lead to complications in implantology. The osseointegrated implantsimplants and their application in dentistry have revolutionized the oral rehabilitation of patients who need this treatment, be they total or partial edentulous in search of functional recovery and aesthetic satisfaction. Scientific research and a constant search for the magnification of this treatment, allowed the use of implant-enhanced rehabilitation as a predictable treatment method with a high success rate. However, like any treatment mode, complications and failures can also occur in implantology. the patient's medical conditions, social and parafunctional habits, inaccuracy of surgical and prosthetic planning, technical and scientific knowledge of the dental surgeon, lack of interdisciplinary relationship and poor patient cooperation in the postoperative, may be related to complications in rehabilitating treatment with dental implants(AU)


Subject(s)
Dental Implants , Dental Implants/adverse effects , Dental Implantation, Endosseous , Tobacco Use Disorder , Dental Prosthesis, Implant-Supported , Diabetes Mellitus , Diphosphonates , Peri-Implantitis , Mouth Rehabilitation
4.
Rev. Soc. Odontol. La Plata ; 31(60): 23-26, jul. 2021. ilus
Article in Spanish | LILACS | ID: biblio-1284468

ABSTRACT

Las neoplasias malignas de la cavidad oral en gran medida (90%) consisten en carcinoma de células escamosas que surgen de la mucosa de revestimiento. El 10% restantes de neoplasias malignas orales de un grupo heterogéneo de tumores de diferente etiología. Presentamos dos casos de patología oncohematológica: Mieloma Múltiple (AU)


Malignant neoplasms of the oral cavity largely (90%) consist of squamous cell carcinoma arising from the lining mucosa. e remaining 10% of oral malignancies from a heterogeneous group of tumors of different etiology. We present two cases of oncohematological pathology: Multiple Myeloma (AU)


Subject(s)
Humans , Male , Middle Aged , Plasmacytoma/diagnosis , Plasmacytoma/pathology , Plasmacytoma/diagnostic imaging , Mouth Neoplasms/diagnosis , Radiotherapy , Biopsy/methods , Tomography, X-Ray Computed , Oral Surgical Procedures/methods , Diphosphonates/therapeutic use , Maxillary Sinus/surgery , Multiple Myeloma
5.
Dent. press endod ; 11(1): 78-83, Jan-Apr2021.
Article in English | LILACS | ID: biblio-1348257

ABSTRACT

Introdução: A infecção endodôntica pode alcançar a saída foraminal e, inclusive, ir além dela. Logo, a determinação da constrição apical como o limite ideal para instrumentação e obturação tem sido questionada. A instrumentação foraminal intencional é realizada com o intuito de diminuir o contingente microbiano a níveis mais favoráveis ao reparo. Entretanto, repercussões locais e sistêmicas estão associadas à sua execução. Objetivo: Realizar uma revisão crítica da literatura sobre repercussões locais e sistêmicas relativas à instrumentação foraminal intencional. Métodos: Em março de 2018, uma busca eletrônica realizada na base de dados PUBMED utilizando os termos "foraminal enlargement" OR "foraminal widening" OR "apical limit" AND "endodontics" identificou 74 artigos científicos. Esses artigos, a análise de suas referências bibliográficas e a utilização de mais 5 artigos base resultaram nos 111 estudos consultados para a realização dessa pesquisa. Resultados: A ampliação foraminal intencional nem sempre pode ser praticada em virtude de razões anatômicas e morfológicas. Quanto maior a ampliação do forame apical, maior a possibilidade de extravasamento de substâncias e/ou materiais utilizados para a realização do tratamento endodôntico. A instrumentação foraminal intencional parece ser contraindicada em pacientes que fazem ou fizeram uso de bisfosfonatos recentemente, com distúrbios de coagulação e/ou sob uso crônico de anticoagulantes e com alto risco de bacteremia. Conclusões: Os impactos da instrumentação foraminal intencional sobre o sucesso do tratamento endodôntico devem ser investigados. Contudo, os delineamentos metodológicos dos estudos clínicos devem ser cuidadosos, principalmente no tocante às condições sistêmicas dos pacientes que farão parte do universo amostral (AU).


Introduction: endodontic infection can reach and even go beyond the apical foramen. Therefore, determining apical constriction as the ideal limit for instrumentation and obturation has been questioned. Intentional foraminal enlargement is performed for the purpose of reducing the microbial contingent to levels more favorable to repair. However, local and systemic repercussions have been associated with this approach. Objectives: to critically review the literature on local and systemic repercussions relative to intentional foraminal enlargement. Methods: in March 2018, an electronic search performed on the PUBMED database using the terms "foraminal enlargement" OR "foraminal widening" OR "apical limit" AND "endodontics" identified 74 scientific articles. These articles, analysis of their references and use of another 5 base articles resulted in the 115 studies used for performing this research. Results: intentional foraminal enlargement cannot always be performed due to the anatomical and morphological conditions. The greater the apical foramen enlargement, the greater the possibility of extrusion of substances and/or materials used to perform endodontic treatment. Intentional foraminal enlargement seems to be contraindicated in patients who are taking or have recently used bisphosphonates, those with coagulation disorders and/ or under chronic use of anticoagulants and at high risk for bacteremia. Conclusions: the impacts of intentional foraminal enlargement on the success of endodontic treatment should be investigated. However, the methodological procedures of clinical studies should be carefully designed, especially taking into consideration the systemic conditions of patients who will be part of the sample (AU).


Subject(s)
Tooth Apex , Endodontics/instrumentation , Anticoagulants , Diphosphonates , Infections
6.
Rev. cuba. invest. bioméd ; 40(1): e723, ene.-mar. 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1289448

ABSTRACT

Introducción: Los bifosfonatos son considerados como un grupo de fármacos de gran utilidad en el tratamiento de enfermedades del tejido óseo ya que promueven su resorción. Han sido la primera línea para el tratamiento de la osteoporosis, enfermedad de Paget, mieloma múltiple e hipercalcemia maligna. Por su parte, la vitamina D es un nutriente esencial cuya función principal es la homeostasis de calcio (Ca+2) y fosfato (P4 3-). Objetivo: Describir los aspectos moleculares y farmacológicos de la acción de un bifosfonato (alendronato sódico) y la vitamina D, por los cuales potencian mutuamente sus efectos en enfermedades óseas. Métodos: Fueron seleccionadas las referencias más actualizadas que abordaran aspectos relevantes acerca del alendronato y la vitamina D. Se consultaron las bases de datos de PubMed, Uniprot y Protein Databank. Conclusiones: El sinergismo entre alendronarto y vitamina D generan efectos benéficos en el tejido óseo. Sin embargo, existen efectos colaterales que pueden afectar a otros tejidos, por lo que su uso debe ser controlado(AU)


Introduction: Biphosphonates are considered to be a group of very useful drugs used to treat osseous tissue conditions, since they foster resorption. They are first line in the treatment of osteoporosis, Paget's disease, multiple myeloma and malignant hypercalcemia. Vitamin D, on the other hand, is an essential nutrient whose main function is calcium (Ca+2) and phosphate (P4 3-) homeostasis. Objective: Describe the molecular and pharmacological aspects of the action of a biphosphonate (alendronate sodium) and vitamin D on osseous diseases. Methods: A selection was made of the most updated references about relevant aspects of alendronate and vitamin D. The databases consulted were Pubmed, Uniprot and Protein Databank. Conclusions: The synergy between alendronate and vitamin D generates beneficial effects on osseous tissue. However, their use should be controlled, since side-effects may affect other tissues(AU)


Subject(s)
Humans , Therapeutics , Diphosphonates , Multiple Myeloma
7.
Rev. ADM ; 78(1): 28-32, ene.-feb- 2021. tab
Article in Spanish | LILACS | ID: biblio-1177455

ABSTRACT

Objetivo: Determinar el conocimiento y la conciencia que tienen los médicos sobre la osteonecrosis relacionada con bifosfonatos. Material y métodos: Se realizó un estudio transversal, en el cual se encuestó a médicos generales y especialistas con la finalidad de identificar el nivel de conocimientos y conciencia que tienen sobre el tema. Resultados: Se entrevistó a un total de 475 médicos generales y especialistas, de los cuales 210 (44.2%) mencionaron prescribir bifosfonatos, de este grupo 58.1% no envía a los pacientes con el odontólogo para eliminar factores de riesgo, a pesar de que 61.8% de los mismos mencionó conocer las reacciones adversas; 36 médicos (17.4%) han visto a algún paciente con osteonecrosis por bifosfonatos. El 37% de los médicos que prescriben medicamentos consideran que no es necesario remitir a los pacientes al odontólogo. Conclusiones: La prescripción de bifosfonatos en la práctica médica va en aumento, los médicos deben tener el conocimiento adecuado sobre las reacciones adversas de estos medicamentos para así poder referir oportunamente al odontólogo, educar al paciente y poder prevenir complicaciones como la osteonecrosis relacionada con bifosfonatos (AU)


Objectives : To evaluate the knowledge and awareness of physicians about bisphosphonate-related osteonecrosis of the jaws. Material and methods: A cross-sectional survey was carried out among general practitioners and specialized physicians to determine their knowledge and awareness of bisphosphonate-related osteonecrosis of the jaws. Results: Of the 475 interviewed general practitioners and specialized physicians, 210 (44.2%) claimed to prescribe bisphosphonates. A total of 58.1% of these physicians did not refer their patients to the dentist for the elimination of risk factors, despite the fact that 61.8% of them reported knowledge of the adverse reactions of these drugs. Thirty-six physicians (17.4%) had seen some patient with bisphosphonate-related osteonecrosis of the jaws. A total of 37% of the physicians that prescribed drugs considered it not necessary to refer patients to the dentist. Conclusions: Bisphosphonate prescription is increasingly common in medical practice, and physicians must have adequate knowledge of the adverse reactions of these drugs in order to ensure opportune patient referral to the dentist, educate their patients, and avoid complications such as bisphosphonate-related osteonecrosis of the jaws (AU)


Subject(s)
Humans , Male , Female , Physicians/psychology , Health Knowledge, Attitudes, Practice , Diphosphonates/adverse effects , Bisphosphonate-Associated Osteonecrosis of the Jaw , Referral and Consultation , Awareness , Cross-Sectional Studies , Statistical Analysis , Risk Factors , Health Surveys , Mexico
8.
Chinese Medical Journal ; (24): 1457-1464, 2021.
Article in English | WPRIM | ID: wpr-878178

ABSTRACT

BACKGROUND@#Clinical observational studies revealed that 99Tc-methylene diphosphonate (99Tc-MDP) could reduce joint pain and swollenness in rheumatoid arthritis (RA) patients. This multicenter, randomized, double-blind, double-dummy study aimed to evaluate the effects of 99Tc-MDP plus methotrexate (MTX) vs. MTX alone or 99Tc-MDP alone on disease activity and structural damage in MTX-naïve Chinese patients with moderate to severe RA.@*METHODS@#Eligible patients with moderate to severely active RA were randomized to receive 99Tc-MDP plus MTX (n = 59) vs. MTX (n = 59) alone or 99Tc-MDP (n = 59) alone for 48 weeks from six study sites across four provinces in China. The primary outcomes were the American College of Rheumatology 20% improvement (ACR20) response rates at week 24 and changes in modified total Sharp score at week 48.@*RESULTS@#At week 24, the proportion of participants achieving ACR20 was significantly higher in the MTX + 99Tc-MDP combination group (69.5%) than that in the MTX group (50.8%) or 99Tc-MDP group (47.5%) (P = 0.03 for MTX + 99Tc-MDP vs. MTX, and MTX + 99Tc-MDP vs.99Tc-MDP, respectively). The participants in the MTX + 99Tc-MDP group and the 99Tc-MDP group had significantly less important radiographic progression than the participants in the MTX group over the 48 weeks (MTX + 99Tc-MDP vs. MTX: P = 0.03, 99Tc-MDP vs. MTX: P = 0.03, respectively). There was no significant difference in terms of adverse events (AEs) among the groups. No serious AEs were observed.@*CONCLUSIONS@#This study demonstrated that the combination of 99Tc-MDP with MTX inhibited structural damage and improved disease activity in RA patients compared with MTX and 99Tc-MDP monotherapies, without increasing the rate of AEs. Additional clinical studies of 99Tc-MDP therapy in patients with RA are warranted.@*TRIAL REGISTRATION@#Chictr.org, ChiCTR-IPR-14005684; http://www.chictr.org.cn/showproj.aspx?proj=10088.


Subject(s)
Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , China , Diphosphonates , Double-Blind Method , Drug Therapy, Combination , Humans , Methotrexate/therapeutic use , Technetium/therapeutic use , Treatment Outcome
9.
Chinese Journal of Oncology ; (12): 622-628, 2021.
Article in Chinese | WPRIM | ID: wpr-887466

ABSTRACT

Bone-modifying agents currently include bisphosphonates and desumumab, which are the main drugs for the treatment of malignant tumor bone metastasis, hypercalcemia and osteoporosis. Due to its wide clinical application, the adverse events of this kind of drugs are gradually increasing and affecting the quality of life of patients. Therefore, it needs to arouse the attention of the majority of medical personnel. Based on the substantial evidence, the expert committee has thoroughly discussed the management of adverse reactions of bone modifying agents and put forward reasonable suggestions, to guide clinicians in the safety management of such drugs.


Subject(s)
Bone Density Conservation Agents/adverse effects , Consensus , Diphosphonates/adverse effects , Humans , Osteoporosis/drug therapy , Quality of Life , Safety Management
10.
Rev. Ateneo Argent. Odontol ; 64(1): 22-27, 2021. ilus, tab
Article in Spanish | LILACS | ID: biblio-1248381

ABSTRACT

La Asociación Americana de Cirugía Oral y Maxilofacial (American Association of Oral and Maxillofacial Surgeons [AAOMS]): define el concepto de osteonecrosis maxilar asociada a drogas antirresortivas (MRONJ) como: «área ósea necrótica expuesta al medio bucal con más de ocho semanas de permanencia, en presencia de tratamiento crónico con bifosfonatos en ausencia de radioterapia en cabeza y cuello¼. El objetivo de este artículo es asociar la enfermedad oncológica en relación con las drogas antirresortivas consumidas por pacientes, la prescripción de dichas drogas y el depósito de ellas en el organismo. Al mismo tiempo, la interacción médico-odontológico debe implementarse en favor de la salud de nuestros pacientes (AU)


American Association of Oral and Maxillofacial Surgeons AAOMS defined Medication Related of the Jaw (MRONJ) as «necrotic bone area exposed to the oral environment with more than eight weeks of permanence, in the presence of chronic treatment with BPs, in the absence of radiation therapy to the head and neck¼. The objective of this article is associate oncology antiresorptives treatments prescribed by physicians, their prescription and body accumulation in patients whose are treated with them. Interdisciplinary dental and physician clinical treatments must be implemented in patient favours (AU)


Subject(s)
Humans , Female , Diphosphonates/adverse effects , Bone Density Conservation Agents/adverse effects , Bisphosphonate-Associated Osteonecrosis of the Jaw , Radiotherapy/adverse effects , Breast Neoplasms/complications , Risk Factors , Diphosphonates/pharmacokinetics , Interprofessional Relations
11.
Article in Portuguese | ColecionaSUS, LILACS, ColecionaSUS, CONASS, SES-GO | ID: biblio-1151190

ABSTRACT

Tecnologia: Teriparatida, comparada a bifosfonados orais ou Raloxifeno. Indicação: prevenção de fraturas em pessoas com osteoporose. Pergunta: A Teriparatida é mais eficaz e segura que os bifosfonados orais ou o Raloxifeno para tratamento da osteoporose e prevenção de fraturas secundárias à osteoporose? Métodos: Levantamento bibliográfico foi realizado na base de dados PUBMED, seguindo estratégias de buscas predefinidas. Foi feita avaliação da qualidade metodológica das revisões sistemáticas com a ferramenta Assessing the Methodological Quality of Systematic Reviews version 2 (AMSTAR-2). Resultados: Foram selecionadas 2 revisões sistemáticas, que atendiam aos critérios de inclusão. Conclusão: Para a população em geral com osteoporose, a Teriparatida evita mais fraturas vertebrais que o Alendronato de sódio ou Risedronato de sódio, mas efeito similar para fraturas não vertebrais. Teriparatida previne mais fraturas vertebrais e não vertebrais que Raloxifeno. Teriparatida tem maior efeito sobre a massa óssea corporal que o Risedronato de sódio e o Raloxifeno, mas tem efeito similar ao Alendronato de sódio. Na população masculina com osteoporose, a terapia com bifosfonados orais é mais eficaz que suplementação nutricional ou placebo para prevenir fraturas. Já o tratamento com Teriparatida não é mais eficaz que a suplementação nutricional ou placebo


Teriparatide compared to oral bisphosphonates or Raloxifene. Indication: prevention of fractures in people with osteoporosis. Question: Is Teriparatide more effective and safer than oral bisphosphonates or Raloxifene for treating osteoporosis and preventing fractures secondary to osteoporosis? Methods: Bibliographic survey was carried out in the PUBMED database, following predefined search strategies. Evaluation of the methodological quality of systematic reviews was carried out using the tool Assessing the Methodological Quality of Systematic Reviews version 2 (AMSTAR-2). Results: Two systematic reviews were selected, which met the inclusion criteria. Conclusion: For the general population with osteoporosis, Teriparatide prevents more vertebral fractures than Alendronate or Risedronate sodium, but has similar effect for non-vertebral fractures. Teriparatide prevents more vertebral and non-vertebral fractures than Raloxifene. Teriparatide has a greater effect on body bone mass than Risedronate sodium and Raloxifene, but it has a similar effect to Alendronate sodium. In the male population with osteoporosis, oral bisphosphonates is more effective than nutritional supplementation or placebo to prevent fractures. Treatment with teriparatide is no more effective than nutritional supplementation or placebo


Subject(s)
Humans , Teriparatide/therapeutic use , Raloxifene Hydrochloride/therapeutic use , Diphosphonates/therapeutic use , Osteoporotic Fractures/drug therapy , Efficacy , Spinal Fractures/drug therapy , Alendronate/therapeutic use , Evidence-Based Medicine , Risedronic Acid/therapeutic use , Denosumab/therapeutic use , Hip Fractures/drug therapy
12.
Actual. osteol ; 17(2): 104-111, 2021. ilus, tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1370318

ABSTRACT

El síndrome de dolor regional complejo (SDRC) es una patología poco frecuente, caracterizada por dolor crónico y cambios locales del sitio afectado. Ocurre en forma posterior a un traumatismo, o, menos frecuentemente, sin desencadenante claro. El diagnóstico se realiza de forma clínica, evaluando la presencia de hallazgos típicos detallados en los criterios de Budapest, como el dolor continuo y desproporcionado, y síntomas y signos típicos, como edema, asimetría térmica y disminución del rango de movilidad. Los estudios por imágenes, así como la radiografía, la resonancia magnética o el centellograma óseo de 3 fases, también brindan información valiosa, sobre todo en los casos que se presentan con más dudas, y para realizar diagnóstico diferencial de otras patologías. En este sentido, la medición de la densidad mineral ósea por absorciometría dual de rayos X (DXA) se presenta también como herramienta de utilidad, no solo en la fase diagnóstica, al evidenciar la mayor desmineralización del miembro afectado, sino también en la evaluación de la respuesta terapéutica a bifosfonatos. Presentamos el caso de una paciente con SDRC del miembro inferior, donde la densitometría ósea resultó de gran utilidad en su manejo clínico. (AU)


Complex regional pain syndrome (CRPS) is a rare pathology, characterized by chronic pain and local changes of the affected site. It occurs after trauma or, less frequently, without a clear trigger. The diagnosis is made clinically, evaluating the presence of typical findings detailed in the Budapest criteria, such as continuous and disproportionate pain, and typical signs and symptoms, like edema, thermal asymmetry, and decreased range of motion. Imaging studies, such as radiography, magnetic resonance imaging, or 3-phase bone scintigraphy also provide valuable information, especially in cases that present with more doubts, and to make a differential diagnosis with other pathologies. In this regard, the measurement of bone mineral density by dual X-ray absorptiometry (DXA) is also a useful tool, not only in the diagnostic phase, by showing the greater demineralization of the affected limb, but also in the evaluation of the therapeutic response to bisphosphonates. We present the case of a patient with CRPS of the lower limb, where bone densitometry was very useful in her clinical management. (AU)


Subject(s)
Humans , Female , Middle Aged , Complex Regional Pain Syndromes/diagnosis , Complex Regional Pain Syndromes/pathology , Complex Regional Pain Syndromes/drug therapy , Densitometry , Bone Density , Complex Regional Pain Syndromes/diagnostic imaging , Diagnosis, Differential , Diphosphonates/administration & dosage , Chronic Pain/etiology
13.
Rev. Ateneo Argent. Odontol ; 63(2): 13-17, nov. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1150415

ABSTRACT

La acción terapéutica favorable que los antirresortivos (bifosfonatos BPs, denosumab DS) y drogas antiangiogénicas ocasionan en el tejido óseo en aquellos pacientes que presentan como causa etiológica cáncer o discrasias óseas incluyen hipercalcemias malignas o ­si requieren el consumo de dicha droga a baja concentración­ como ser: osteoporosis, osteopenia, enfermedad de Paget, displasia fibrosa, Osteogénesis Imperfecta. (1) La presente actualización pretende relacionar el tratamiento odontológico con prescripción crónica y drogas antirresortivas, para lo cual American Association of Oral and Maxillofacial Surgeons AAOMS: define el concepto de Osteonecrosis Maxilar Asociada a drogas Antirresortivas (MRONJ) como: «Área ósea necrótica expuesta al medio bucal con más de ocho semanas de permanencia, en presencia de tratamiento crónico con bifosfonatos en ausencia de radioterapia en cabeza y cuello¼. La AAOMS estableció los siguientes grupos de acuerdo con sus características clínicas en 4 estadios (0, 1 ,2 y 3) de acuerdo con el aspecto clínico y radiológico de la lesión osteonecrótica. Estadío 0: lesión osteonecrótica sin evidencia de hueso necrótico en pacientes bajo consumo de drogas antirresortivas. Estadío 1: lesión osteonecrótica con signos clínicos y ausencia de sintomatología clínica. Estadío 2: lesión osteonecrótica con signo y sintomatología clínica evidente. Estadío 3: lesión osteonecrótica con signo y sintomatología evidente que compromete a estructuras nobles: fracturas patológicas, anestesia del nervio dentario inferior, comunicación buco-nasal, comunicación buco-sinusal, fístulas cutáneas (2) (AU)


It is known the favourable action which antiresorptive (Bisphosphonates BPs, Denosumab: DS) and Antiangiogenic drugs produce in bone tissue. High concentrations are primarily used as an effective treatment in the management of cancer-related disorders, including hypercalcemia of malignant. Besides, low concentrations are used for other metabolic bone diseases including Osteoporosis, Osteopenia, Paget's Disease, Fibrous Dysplasia, Imperfect Osteogenesis. (1) The update relate relationship between dentistry and chronic treatment with antiresorptive drugs. According to the American Association of Oral and Maxillofacial Surgeons (AAOMS), MRONJ is defined as exposed or necrotic bone in the maxillofacial region that has persisted for more than 8 weeks in association with current or previous BPs or DS therapy and with a lack of head and neck radiotherapy. AAOMS divided the MRONJ into 4 stages (0,1, 2 and 3) according to the clinical and radiological aspect of the osteonecrotic lesion: Stage 0: osteonecrotic lesion without sign-pathognomonic evidence of osteonecrosis. Stage 1: osteonecrotic lesion with clinical signs and absence of clinical symptoms. Stage 2: osteonecrotic lesion with sign and evident clinical symptoms. Stage 3: osteonecrotic lesion with signs and evident symptoms that involve noble structures: pathological fractures, anaesthesia of the lower dental nerve, oral-nasal communication, oral-sinus communication, skin fistulas (2) (AU)


Subject(s)
Humans , Female , Aged , Bone Resorption , Diphosphonates/adverse effects , Bone Density Conservation Agents , Bisphosphonate-Associated Osteonecrosis of the Jaw , Bone Diseases , Dental Care for Chronically Ill , Angiogenesis Inhibitors , Denosumab , Mouthwashes/therapeutic use
14.
Rev. bras. ortop ; 55(5): 543-550, Sept.-Oct. 2020. graf
Article in English | LILACS | ID: biblio-1144202

ABSTRACT

Abstract Objective The aim of the present study was to determine the effect of combined zoledronic acid and alendronate therapy on bone edema and knee pain in cases of spontaneous osteonecrosis of the knee. We report our experience with this treatment. Methods A retrospective case series of 11 patients with spontaneous osteonecrosis of the knee confirmed by magnetic resonance image (MRI). The patients were treated with a single dose of 5 mg of intravenous zoledronic acid combined with 35 mg twice a week of oral alendronate, for 16 weeks. The visual analogue scale scores were noted before the beginning of the therapy, at 8 weeks, and at 16 weeks of follow-up. The size of the bone marrow edema adjacent to the lesion was measured on T2-weighted MRI coronal images at the beginning of the therapy and at 16 weeks. Results The average visual analogue scale score at 0 weeks was of 7.72, and of 0.81 at 16 weeks of therapy; the difference was statistically significant (p= 0.03). The mean bone marrow involvement at 0 weeks was of 80%, which reduced to 11.81% at 16 weeks of therapy. This change was statistically significant (p= 0.03). Conclusion Our data shows that the combination therapy causes early pain relief and reduction of the bone edema, and it is safe, effective and well-tolerated for a painful disease entity like spontaneous osteonecrosis of the knee.


Resumo Objetivo Determinar o efeito do tratamento combinado de ácido zoledrônico e alendronato no edema ósseo e na dor no joelho em casos de osteonecrose espontânea do joelho. A experiência dos autores com este tratamento é relatada. Métodos Série de casos retrospectiva, incluindo 11 pacientes com osteonecrose espontânea do joelho confirmada por ressonância magnética. Os pacientes foram tratados com uma dose intravenosa única de 5 mg de ácido zoledrônico combinada com 35 mg de alendronato oral, 2 vezes por semana, por 16 semanas. Os escores da escala visual analógica foram aferidos antes do começo do tratamento, em 8 semanas e em 16 semanas de acompanhamento. O tamanho do edema da medula óssea adjacente à lesão foi medido em imagens de ressonância magnética coronal ponderadas em T2 no início do tratamento e em 16 semanas. Resultados O escore médio da escala visual analógica em 0 semanas foi de 7,72, contra 0,81 em 16 semanas de tratamento, uma diferença estatisticamente significativa (p= 0,03). O envolvimento médio da medula óssea em 0 semanas foi de 80%, e foi reduzido para 11,81% em 16 semanas de tratamento, uma diferença também estatisticamente significativa (p= 0,03). Conclusão Os dados mostram que a terapia combinada proporciona alívio da dor inicial e redução do edema ósseo, sendo segura, eficaz e bem tolerada em uma enfermidade dolorosa como a osteonecrose espontânea do joelho.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Osteoarthritis , Pain , Bone and Bones , Bone Marrow , Magnetic Resonance Spectroscopy , Combined Modality Therapy , Alendronate , Diphosphonates , Dosage , Visual Analog Scale , Zoledronic Acid , Knee Joint , Necrosis
15.
Rev. ADM ; 77(4): 197-202, jul.-ago. 2020. tab
Article in Spanish | LILACS | ID: biblio-1129803

ABSTRACT

La osteonecrosis de los maxilares está definida como la exposición de hueso necrótico en la región maxilofacial al menos por ocho semanas en pacientes que están recibiendo medicamentos antirresortivos para el tratamiento del cáncer primario o metastásico hacia el hueso, osteoporosis o enfermedad de Paget, sin historia previa de radiación. Desde el año 2003, la terminología utilizada estaba en relación con los bifosfonatos, en la actualidad ha sido introducido el término osteonecrosis de los maxilares relacionada por medicamentos (OMAM). La cirugía oral (implantología o cirugía periapical) incrementa el riesgo de OMAM, así como los desbalances concomitantes de la salud oral (inflamación dental y formación de abscesos). Las estrategias conservadoras en el tratamiento varían desde el cuidado local conservador hasta la resección quirúrgica radical del hueso necrótico. En el presente artículo se expone un análisis sistemático retrospectivo de la literatura en páginas como PubMed, ScienceDirect y Springer, Cochrane Library. Con el objetivo de resaltar el aumento de la incidencia de OMAM a nivel mundial con el uso de antirresortivos y otros medicamentos asociados en su patogenia en el Hospital Regional «General Ignacio Zaragoza¼ del ISSSTE, UNAM, en la Ciudad de México (AU)


Osteonecrosis of the jaws is defined as the exposure of necrotic bone in the maxillofacial region for at least 8 weeks in patients receiving antiresorptive medications for the treatment of primary or metastatic cancer towards the bone, osteoporosis, or Paget's disease, without previous history of radiation. Since 2003, the terminology used was related to bisphosphonates, the term medication-related osteonecrosis of the jaws has now been introduced. Oral surgery (implantology or periapical surgery) increases the risk of avascular necrosis, as well as concomitant imbalances in oral health (dental inflammation and abscess formation). Conservative strategies in treatment vary from conservative local care to radical surgical resection of the necrotic bone. In this article, a systematic retrospective analysis of the literature is presented on pages such as PubMed, Science Direct and Springer, Cochrane Library. And in which the objective is to highlight the increase in the incidence of medication related osteonecrosis of the jaws worldwide with the use of antiresorptive, and other associated medications in its pathogenesis at the Hospital Regional «General Ignacio Zaragoza¼ ISSSTE, UNAM in Mexico City (AU)


Subject(s)
Humans , Diphosphonates/adverse effects , Bisphosphonate-Associated Osteonecrosis of the Jaw , Osteoporosis , Bone Neoplasms , Angiogenesis Inhibitors , Dental Service, Hospital , TOR Serine-Threonine Kinases , Bevacizumab , Sunitinib , Mexico
16.
Actual. osteol ; 16(2): [104]-[115], mayo.-ago. 2020. graf, tab
Article in Spanish | LILACS | ID: biblio-1129698

ABSTRACT

La fosfatasa alcalina baja o hipofosfatasemia, ya sea debida a causas genéticas (hipofosfatasia) o secundarias, presenta correlato clínico. Nuestro objetivo es estimar la prevalencia de hipofosfatasemia crónica persistente y describir sus hallazgos osteometabólicos. Se realizó una búsqueda electrónica de afiliados adultos al Hospital Italiano de Buenos Aires, entre 2013 y 2017, con al menos 2 determinaciones de fosfatasa alcalina igual a 30 UI/l o menor y ninguna mayor de 30 UI/l (rango de referencia 30-100 UI/l). Se excluyeron aquellos con causas secundarias diagnosticadas y se analizaron los correlatos clínico y bioquímico. Se detectó hipofosfatasemia crónica persistente en 78 de 105.925, 0,07% (0,06-0,09) de los afiliados. Solo uno fue excluido por tener causa secundaria. Eran 61,1% mujeres de 44 (34-56) años, fosfatasa alcalina 24 (20-27) UI/L, fosfatemia 4,1 (3,8-4,6) mg/dl. Se observaron osteoartritis, calcificaciones vasculares y fracturas, menos frecuentemente litiasis renal, calcificación del ligamento longitudinal común anterior, pérdida dental y convulsiones. El 63,6% tenían al menos una de las características clínico-radiológicas evaluadas, pero en solo 5,2% fue mencionado el diagnóstico de hipofosfatasemia en la historia clínica. La densitometría evidenció algún grado de afección (osteopenia u osteoporosis) en 76,2%. Se constataron 19 fracturas, con predominio en radio. La prevalencia de hipofosfatasemia fue similar a lo previamente reportado. El reconocimiento fue bajo; sin embargo, se observaron variadas manifestaciones músculo-esqueléticas, similares a las descriptas en la hipofosfatasia del adulto, por lo cual ­ante una hipofosfatasemia sin causa secundaria­ se sugiere considerar este diagnóstico. (AU)


Low alkaline phosphatase (ALP) or hypophosphatasemia either due to genetic (hypophosphatasia) or secondary causes, presents a clinical correlate. Our objectives are to estimate the prevalence of persistent hypophosphatasemia and to describe the clinical findings. We performed a search using the electronic medical records of the members of the Hospital Italiano de Buenos Aires health care system, between 2013 and 2017. Adult members with ≥ 2 ALP ≤ 30 IU/l, no ALP >30 IU/l (normal range 30-100 UI/l) and without diagnosed secondary causes were analyzed. Persistent hypophosphatasemia was detected in 78 of 105.925, 0.07% (0.06-0.09) of members. Only one was excluded due to a secondary cause, 61.1% were women, 44 (34-56) year-old, ALP 24 (20-27) IU/l and phosphatemia 4.1 (3.8-4.6) mg/dl. Osteoarthritis, vascular calcifications and fractures were detected, and nephrolithiasis, DISH (Diffuse idiopathic skeletal hyperostosis), tooth loss, and seizures were less frequently observed. At least one of the mentioned characteristics were present in 63.6 %, but only 5.2% had hypophosphatasemia registered in their clinical record. Densitometry showed osteopenia or osteoporosis in 76.2%. There were 19 fractures, most of them in radius. The prevalence of hypophosphatasemia was similar to what has been previously reported. Hypophosphatasemia finding in medical records was low, but far from being asymptomatic, clinical manifestations were observed. In the presence of hypophosphatasemia without a secondary cause, adult hypophosphatasia should be uspected. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Muscle, Skeletal/pathology , Hypophosphatasia/etiology , Osteoporosis/etiology , Bone Diseases, Metabolic/etiology , Bone Density , Prevalence , Cross-Sectional Studies , Hypophosphatemia/diagnosis , Hypophosphatemia/etiology , Diphosphonates/therapeutic use , Alkaline Phosphatase/deficiency , Alkaline Phosphatase/physiology , Alkaline Phosphatase/blood , Osteoporotic Fractures/etiology , Hypophosphatasia/diagnosis , Hypophosphatasia/genetics
17.
Säo Paulo med. j ; 138(4): 326-335, July-Aug. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1139704

ABSTRACT

ABSTRACT BACKGROUND: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is still the most prevalent type of osteonecrosis with clinical relevance. In Brazil, bisphosphonate use is high but there is a lack of epidemiological studies on BRONJ. OBJECTIVE: To determine the clinical profile of BRONJ in a Brazilian population through an integrative review. DESIGN AND SETTING: Integrative review of BRONJ in a Brazilian population. METHODS: Cases and clinical research on Brazilians with BRONJ between 2010 and 2019, indexed in PubMed/MEDLINE, Scopus, Web of Science and LILACS were reviewed. Age, sex, type and time of bisphosphonate intake, administration route, related diseases, region of the BRONJ, diagnostic criteria, staging, triggering factor and type of treatment were analyzed. RESULTS: Fifteen articles on 128 subjects were included. Most patients were women (82.03%); the mean age was 63 years. Intravenous zoledronic acid was mostly used (62.50%), for breast cancer treatment (46.87%). The main localization of BRONJ was the mandible (54.68%), associated mainly with tooth extractions (45.98%). The diagnostic criteria were clinical (100%) and radiographic (89.06%), mostly in stage II (68.08%). The surgical treatments were sequestrectomy (37.50%) and platelet-rich plasma (PRP) (36.71%). Microbial control was done using chlorhexidine (93.75%) and infection control using clindamycin (53.90%). CONCLUSIONS: BRONJ had higher prevalence in Brazilian women receiving treatment for breast cancer and osteoporosis. The mandible was the region most affected with a moderate stage of BRONJ, particularly when there were histories of tooth extraction and peri-implant surgery. Sequestrectomy with additional drugs and surgical therapy was the treatment most accomplished.


Subject(s)
Humans , Female , Middle Aged , Tooth Extraction , Diphosphonates/adverse effects , Bone Density Conservation Agents/adverse effects , Bisphosphonate-Associated Osteonecrosis of the Jaw/surgery , Osteoporosis/drug therapy , Brazil , Breast Neoplasms/drug therapy , Dental Care , Treatment Outcome , Angiogenesis Inhibitors , Diphosphonates/administration & dosage , Bone Density Conservation Agents/administration & dosage , Bisphosphonate-Associated Osteonecrosis of the Jaw/etiology , Bisphosphonate-Associated Osteonecrosis of the Jaw/diagnostic imaging
18.
Arch. endocrinol. metab. (Online) ; 64(4): 331-336, July-Aug. 2020. graf
Article in English | LILACS | ID: biblio-1131117

ABSTRACT

ABSTRACT Osteoporosis is a systemic skeletal disease characterized by reduced bone mass and deterioration of bone tissue microarchitecture leading to an increased risk of fractures. Fragility fractures, especially hip fractures, are associated with a significant reduction in the physical function and quality of life of affected patients, as well as increased mortality, leading to a major financial impact on health care. Many drugs have been registered for the treatment of osteoporosis and very recently, a new anabolic agent, romosozumab, has been approved in some countries. Despite the expansion of efficacious antiresorptive and anabolic therapies in recent years, a concomitant increase in concerns have been raised by physicians, patients and the lay press about the potential for adverse events, especially atypical femoral fractures (AFF) following prolonged use of bisphosphonates. Whatever the mechanism(s) may be, direct or indirect, linking prolonged bisphosphonate use to atypical femoral fractures, this adverse event is very rare in comparison to the magnitude of risk reduction of typical osteoporotic fractures. An estimated 162 osteoporosis-related fractures are prevented for each atypical femoral fracture associated with an anti-resorptive medication. Until a risk calculator for predicting risk of atypical fractures, becomes available in clinical practice, and we view this as an unlikely scenario, it is up to the physician to consider continuing or discontinuing bisphosphonate use after the critical 3-5 year period of treatment with zoledronic acid or alendronate, but close monitoring for the residual bone effects overtime should be planned. For other bisphosphonates, in which no residual effects are expected, drug holiday is usually not applied.


Subject(s)
Humans , Female , Osteoporosis, Postmenopausal , Diphosphonates/therapeutic use , Quality of Life , Alendronate , Bone Density Conservation Agents/therapeutic use
19.
Rev. méd. Chile ; 148(7): 983-991, jul. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1139400

ABSTRACT

Medication-related osteonecrosis of the jaw is a disease where there is necrotic bone exposed or that can be explored by means of a fistula in the maxillofacial region. It has been associated with the use Biphosphonates and denosumab for osteoporosis. Although its etiology is unclear, it may be related to a decrease in bone turnover produced by these drugs, rendering the bone more prone to generate cell necrosis during invasive dental procedures, especially in the posterior region of the jaw. There is no consensus about the prevention and treatment of this condition. The aim of this paper is to present a review of the literature with the main characteristics of osteonecrosis of the jaws associated with drugs, together with a proposal for prevention and treatment for these patients.


Subject(s)
Humans , Osteonecrosis/chemically induced , Osteonecrosis/prevention & control , Jaw Diseases/chemically induced , Jaw Diseases/prevention & control , Osteoporosis/drug therapy , Diphosphonates/adverse effects , Bisphosphonate-Associated Osteonecrosis of the Jaw/prevention & control , Denosumab/adverse effects
20.
Rev. colomb. reumatol ; 27(2): 103-111, ene.-jun. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1251642

ABSTRACT

RESUMEN La enfermedad de Paget ósea es una enfermedad metabólica del hueso de etiología no esclarecida, que se caracteriza por una fase de resorción aumentada seguida por una fase de osteoformación aberrante. Es frecuente en Europa, Norteamérica, Nueva Zelanda y Australia, pero infrecuente en Asia, Medio Oriente y África. En población colombiana hay reportes de casos. Generalmente cursa asintomática y se diagnostica incidentalmente por hallazgos radiográficos o fosfatasa alcalina elevada. El uso de bifosfonatos favorece el control del recambio óseo y permite prevenir complicaciones como las fracturas. Se presenta una serie de casos en Colombia y una revisión de la literatura.


A B S T R A C T Paget's disease of the bone is a metabolic bone disease of unknown origin, and is characterised by an increased phase of resorption, followed by an aberrant osteoformation phase. It is common in Europe, North America, New Zealand, and Australia, but infrequent in Asia, the Middle East, Africa, and in the Colombian population there are case reports. It is usually asymptomatic and is diagnosed incidentally by radiographic findings or an elevated alkaline phosphatase. The use of bisphosphonates favours the control of bone turnover and prevents complications such as fractures. A series of cases in Colombia is presented, along with a review of the literature.


Subject(s)
Humans , Middle Aged , Aged , Osteitis Deformans , Fractures, Bone , Population , Bone and Bones , Bone Diseases, Metabolic , Diphosphonates
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