Safety and tolerability of zoledronic acid and other bisphosphonates in osteoporosis management

Bisphosphonates (BPs) are widely used in the treatment of postmenopausal osteoporosis and other metabolic bone diseases. They bind strongly to bone matrix and reduce bone loss through inhibition of osteoclast activity. They are classified as nitrogen- and non-nitrogen-containing bisphosphonates (NBPs and NNBPs, respectively). The former inhibit farnesyl diphosphate synthase while the latter induce the production of toxic analogs of adenosine triphosphate. These mechanisms of action are associated with different antifracture efficacy, and NBPs show the most powerful action. Moreover, recent evidence indicates that NBPs can also stimulate osteoblast activity and differentiation. Several randomized control trials have demonstrated that NBPs significantly improve bone mineral density, suppress bone turnover, and reduce the incidence of both vertebral and nonvertebral fragility fractures. Although they are generally considered safe, some side effects are reported (esophagitis, acute phase reaction, hypocalcemia, uveitis), and compliance with therapy is often inadequate. In particular, gastrointestinal discomfort is frequent with the older daily oral administrations and is responsible for a high proportion of discontinuation. The most recent weekly and monthly formulations, and in particular the yearly infusion of zoledronate, significantly improve persistence with treatment, and optimize clinical, densitometric, and antifracture outcomes

Internal evaluation of the European network for Health Technology Assessment project

Objectives: The internal evaluation studied the development of the European network for Health Technology Assessment (EUnetHTA) Project in achieving the general objective of establishing an effective and a sustainable network of health technology assessment (HTA) in Europe. Methods: The Work Package 3 group was dedicated to this task and performed the work. Information on activities during the project was collected from three sources. First, three yearly cross-sectional studies surveyed the participants' opinions. Responses were by individuals or by institutions. The last round included surveys to the Steering Committee, the Stakeholder Forum, and the Secretariat. Second, the Work Package Lead Partners were interviewed bi-annually, five times in total, to update the information on the Project's progress. Third, additional information was sought in available documents. Results: The organizational structure remained stable. The Project succeeded in developing tools aimed at providing common methodology with intent to establish a standard of conducting and reporting HTA and to facilitate greater collaboration among agencies. The participants/agencies expressed their belief in a network and in maintaining local/national autonomy. The Work Package Leaders expressed a strong belief in the solid base of the Project for a future network on which to build, but were aware of the need for funding and governmental support. Conclusions: Participants and Work Package Leaders have expressed support for a future network that will improve national and international collaboration in HTA based on the experience from the EUnetHTA projec

A tutela antecipada como instrumento para a justiça do terceiro milênio

Aborda a antecipação de tutela, versando sobre seus pressupostos, procedimentos e características e também enfocando a tutela antecipada como um instrumento importante no processo civil que pode proporcionar a efetividade na prestação jurisdicional

Telomerase mRNA detection in serum of patients with prostate cancer.

Telomerase functions as a reverse transcriptase enzyme in the process of telomere synthesis and telomerase activity have been detectedin a large part of neoplastic tissues, whereas in normal somatic cells they were low or undetectable. The aim of this study was to investigatethe telomerase mRNA detection in the serum of patients with a prostate tumor by using real-time reverse transcription PCR. The results werecompared with biological samples obtained by age-matched normal donors and by patients with cardiovascular or metabolic diseases. Ourdata demonstrated that telomerase mRNA is detectable in the serum of patients with prostate cancer whereas it is not amplifiable in normaldonors. This marker, assayed with the molecular method of quantitative PCR in serum, may be useful for diagnosing and monitoring prostatecancer patients