Pamidronate disodium 90mg/10ml solution for infusion vials

Diffuse sclerosing osteomyelitis is an uncommon and poorly understood chronic inflammatory disease, for which many etiological theories and treatment modalities have been suggested. Recurrent swelling and pain in the lower jaw are typical symptoms, often accompanied by trismus. The management of diffuse sclerosing osteomyelitis is a challenging and often long term with several drug therapies being reported in the literature, including anti-resorptive therapies. This study aimed to investigate the effects of bisphosphonates therapy in diffuse sclerosing osteomyelitis patients and report an atypical case in a young patient. A systematic review of the literature was performed including 130 patients with diffuse sclerosing osteomyelitis treated with bisphosphonates. Complete resolution of the clinical symptoms, with regression of pain and swelling were reported in 105 (80,76 %) patients. Pamidronate IV was the most frequent medication applied with stable and satisfactory long-term results. In this study, the patient was treated with intravenous administration of 45 mg of pamidronate disodium, once a day, for three continues days. The follow-up was uneventful with complete regression of the clinical symptoms. Bisphosphonates seem to be a good option in the treatment of diffuse sclerosing osteomyelitis in the jaw, especially pamidronate IV.

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BackgroundPeople with advanced chronic kidney disease (CKD) and secondary hyperparathyroidism (sHPT) refractory to medical therapy often require surgical parathyroidectomy. Severe and prolonged hypocalcemia immediately following parathyroidectomy for sHPT is often termed "hungry bone syndrome" (HBS).ObjectiveTo systematically review the effect of pre-operative interventions on post-operative hypocalcemia, HBS, and other related outcomes in patients with CKD and sHPT undergoing parathyroidectomy.DesignThis is a systematic review study.SettingDiverse study designs conducted in any country.PatientsAdult patients with CKD complicated by sHPT undergoing parathyroidectomy.MeasurementsPost-operative hypocalcemia, HBS, symptomatic hypocalcemia, and other related outcomes.MethodsWe searched Ovid MEDLINE, Embase, and Cochrane Controlled Trials Registry from inception until June 2024 for trials and observational studies of adults with CKD and sHPT that evaluated pre-operative interventions aimed at reducing the risk of hypocalcemia following parathyroidectomy. After 2 phases of study screening conducted in duplicate, we extracted data on study design, patient characteristics, interventions, and outcomes. Hypocalcemia was defined as serum calcium ResultsWe identified 3616 studies; 35 underwent full-text review, and 9 met final eligibility criteria. Interventions included pre-operative calcitriol (n = 2), pre-operative cinacalcet (n = 3), pre-operative alkaline phosphatase (ALP) measurement to guide intravenous (IV) calcium administration (n = 3), and pre-operative pamidronate (n = 1). All studies reported on at least one of: median/mean post-operative calcium (n = 7), incidence of post-operative hypocalcemia (n = 3), HBS (n = 1), and symptomatic hypocalcemia (n = 4). Interventions that reported on the risk of post-operative hypocalcemia included pre-operative pamidronate (n = 1, 37 participants, odds ratio [OR] = 0.003, 95% confidence interval [CI] = 0.000-0.072) and IV calcium guided by pre-operative ALP (n = 1, 271 participants, OR = 0.292, 95% CI = 0.175-0.488). There were insufficient data to meta-analyze study-specific effects for any intervention or outcome.LimitationsOur study was limited by significant heterogeneity in outcome reporting, which resulted in substantial outcome reporting bias and prevented pooled analyses. Furthermore, no randomized control trials met our inclusion criteria, which limited assessment of publication bias.ConclusionsPre-operative risk factors for HBS have been established in patients with CKD undergoing parathyroidectomy. However, limited research has evaluated pre-operative interventions to reduce the risk of HBS, and due to heterogeneity in outcome reporting across studies, there is still uncertainty about the effectiveness of such interventions. These findings support the need for future clinical trials.

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Background: The clinical definition of Ventilator Associated Pneumonia (VAP) is infection arising during intubation. The topic has attracted considerable interest as a subject of clinical efficacy research. Cost is an important factor when we consider similar options of antibiotic treatments. This study aims to review pharmacoeconomic evaluations made of different VAP treatments and summarize the evaluation methods utilized. Methods: : A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The search strategy was created considering the “PICOS” question, and data was sourced from PubMed, LILACS, Web of Science and Scopus databases, on October 2022. Inclusion and exclusion criterials were applied to filter the results. Findings: The search resulted in 574 studies, of which 12 were used. Of these, four studies evaluated empirical therapy. Antibiotic analysis was performed in eight case studies of Gram-negative infections and four of Gram-positive spectrum. The most prevalent analysis mode was Cost-effectiveness. Cost-minimization, Cost-benefit and general costs comparison were also seen. Different modellings were applied when performing the pharmacoeconomic analysis, such as Tree decision, Markov cohort, as well as methodologies like discrete event micro simulation and sequential simulation. Monte Carlo simulation was then used in five studies to analyze model sensitivity. The Linezolid treatment was shown to be more cost-effective than vancomycin in MRSA pneumonia. Doripinem also showed similar behavior when compared to imipinem in all included studies. Ceftazidime-avibactam and ceftalozane-tazobactam presented an advantage in cost-effectiveness when compared with meropenem. Clarithromycin and ceftriaxone+sulbactam+disodiumedetate used in adjuvant treatments, promoted reduction of the costs in patients with A. baumannii . Meropenem-varbobactam was also found to be a cost-effective treatment option when compared with standard therapies used in patients with CRE-KPC infections. Conclusion: Even though many models were used in pharmacoeconomic evaluations for VAP, Cost-effectiveness was clearly the most prevalent one. In short, the studies showed an advantage when using new medications. Nonetheless, we must be cautious when interpreting such findings, since they reflect a different reality for each country. Long-term impact and resource availability should also be considered.

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