Intravenous Drug Administration Research Articles

Vagal nerve activity and sympathetic nerve activity are suppressed by alpha-2 adrenergic receptor agonists in conscious rats

Vagal nerve activity (VNA) and sympathetic nerve activity (SNA) have been known to influence each other and changes in their activity directly, but details on this remain unknown. This study used an alpha-2 adrenergic receptor agonist (dexmedetomidine) to study how SNA affects VNA in the conscious state. Electroencephalography, electromyography, electrocardiography, cervical VNA, renal SNA, and catheters for arterial pressure measurement and intravenous drug administration were measured after male Wistar rats were anesthetized and implanted with electrodes. Dexmedetomidine (50 micro g/kg) was intravenously administered in conscious rats. Cervical VNA decreased and reached its lowest values about 10 min after intravenous dexmedetomidine administration. However, renal SNA, electromyography, and heart rate decreased immediately after administration, whereas arterial pressure increased immediately. These results show that alpha-2 adrenergic receptor agonists simultaneously inhibit VNA and SNA. Furthermore, the present data suggest that excessive SNA activation increases norepinephrine release, inducing an increase in the concentration of circulating norepinephrine, which in turn inhibits SNA via negative feedback and suppresses VNA. JST (JPMJMS2023) This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Description of gender, intravenous drug administration, and QT interval view at dr. Wahidin general hospital sudirohusodo Makassar

Description of gender, intravenous drug administration, and QT interval view at dr. Wahidin general hospital sudirohusodo Makassar

GEDEFO-SEFH management of antineoplastic extravasations survey results.

Extravasation is a potentially severe complication of intravenous administration of antineoplastic drugs. The limited data makes it difficult to develop an optimal management scheme. The objective of this study is to describe the clinical practice in the extravasation management of antineoplastic agents in Spanish centers. An online survey was distributed to oncology pharmacists using the email distribution list of the Spanish Society of Hospital Pharmacists. Respondents were surveyed on the standard operational protocol (SOP) of extravasation, tissue damage risk classification, and specific measures of extravasation management. A total of 68 surveys were completed. A specific extravasation SOP was available in 82.4% centers. The pharmacist participates in the authorship (100%) and actively collaborates in extravasation management (76.5%). A tissue damage risk classification based on the three categories was mostly adopted (48.2%) and 73.2% applied specific criteria based on concentration and/or extravasated volume. Extravasation management was mainly performed with the application of physical measures and/or antidotes (91.2%). High variability in the choices of pharmacological and/or physical measures recommended is outstanding. The results of this study highlight the involvement of Spanish pharmacists in extravasation management, the application of physical measures and/or pharmacological measures as the method of choice in extravasation management, as well as the existing discrepancies in tissue damage risk classification and management recommendations.

Numerical solution of a new mathematical model for intravenous drug administration

We develop and analyze a new mathematical model for intravenous drug administration and the associated diffusion process. We use interval analysis to obtain a system of weakly singular Volterra integral equations over ordinary functions. We then use the operational method based on Chebyshev polynomials for obtaining an approximate solution of the numerical form. We show that for a certain class of fuzzy number valued functions, their generalized Hukuhara derivatives can be reduced to the derivatives of ordinary real-valued functions. By using our approach, we are able to estimate numerical solutions very accurately.

Usefulness of direct intratumoral administration of doxorubicin hydrochloride with an electro-osmosis–assisted pump

Patients receiving chemotherapy by intravenous (i.v.) or oral administration of anticancer drugs often experience side effects. In this study, an electro-osmotic flow (EO) pump was used for the direct administration of an anticancer drug with minimum side effects. Doxorubicin hydrochloride (DXR) was used as an anticancer drug, and its antitumor effect and toxicity were evaluated in comparison with i.v. administration. Balb/c female mice were subcutaneously transplanted with a breast cancer cell line (4T1/Luc) stably expressing luciferase, and 20 μL of DXR solution (1.0 mg/mL) was administered intratumorally (i.t.) at a slow rate (0.6 µL/min) using an EO pump or rapidly using a syringe. For comparison, 100 μL of DXR solution was injected through the tail vein at the same dose and a 5-times higher dose. A tumor growth inhibitory effect without significant weight loss was observed with direct i.t. administration of DXR using an EO pump. On the other hand, no suppressive tumor growth effect was observed with i.v. administration of DXR at the same dose. Although there was no significant difference in the suppression effect on tumor growth between i.t. administration with EO pump and syringe, the peripheral skin concentration of DXR were decreased after slow administration with EO pump compared with that after rapidly administration with a syringe. These results indicated that direct i.t. administration of DXR with lower dosing using an EO pump at slower administration rate may be useful for exhibiting antitumor effects and suppressing systemic side effects. In addition, the blood concentration and the peripheral skin concentration of DXR after administration at lower rate with EO pump were decreased compared with those after the rapidly administration with a syringe.

Hickman Catheter Use for Long-Term Vascular Access in a Preclinical Swine Model

Central venous catheters (CVCs) are invaluable devices in large animal research as they facilitate a wide range of medical applications, including blood monitoring and reliable intravenous fluid and drug administration. Specifically, the tunneled multi-lumen Hickman catheter (HC) is commonly used in swine models due to its lower extrication and complication rates. Despite fewer complications relative to other CVCs, HC-related morbidity presents a significant challenge, as it can significantly delay or otherwise negatively impact ongoing studies. The proper insertion and maintenance of HCs is paramount in preventing these complications, but there is no consensus on best practices. The purpose of this protocol is to comprehensively describe an approach for the insertion and maintenance of a tunneled HC in swine that mitigates HC-related complications and morbidity. The use of these techniques in >100 swine has resulted in complication-free patent lines up to 8 months and no catheter-related mortality or infection of the ventral surgical site. This protocol offers a method to optimize the lifespan of the HC and guidance for approaching issues during use.

Some clinical and epidemiological aspects of HIV/ hepatitis C coinfection

Aim . To study some clinical and epidemiological aspects of HIV/hepatitis C coinfection in the Republic of Tajikistan. Materials and methods . The material for the study was the data from clinical, epidemiological and virological examinations of 70 patients with HIV/hepatitis C coinfection. In all observed patients, the diagnosis was confirmed based on clinical and epidemiological data and confirmed by rapid testing, ELISA, and PCR. Results discussion . The disease in patients with HIV/hepatitis C coinfection clinically proceeds with weakness and general malaise (92.8%), loss of appetite (67.1%), heaviness in the liver (45%), heartburn (25%), bitterness in the mouth (19%), nausea and anorexia (32.8%), bleeding from the gums (13%), yellowness of the sclera (11.4%), weight loss (41.4%), hepatomegaly (83%). Opportunistic pathology is represented by candidiasis (32.8%), herpes infection (22.8%), CMV (7.1%), pneumocystis pneumonia (4.2%), Kaposi’s sarcoma (4.2%), cerebral toxoplasmosis (1.4%). People who practice intravenous drug administration, as well as their sexual partners, are more likely to be infected. It has been established that males under the age of 45 predominate among coinfected patients. As for secondary and opportunistic infections, they are associated with a decrease in the immune status in the face of CD4+ - lymphocytes in patients with coinfection. Conclusion . The studies carried out make it possible to identify the category of people most at risk of infection with HIV and hepatitis C, which must be taken into account when screening the population. Early diagnosis of HIV/ hepatitis C coinfection will help reduce the number of complications and mortality in this category of patients.

Straightforward adsorption-based formulation of mesoporous silica nanoparticles for drug delivery applications

Mesoporous silica nanoparticles (MSNs) have emerged as a very promising drug delivery platform. However, multi-step synthesis and surface functionalization protocols rise the hurdle for translation of this promising drug delivery platform to the clinic. Furthermore, surface functionalization aiming at enhancing the blood circulation time, typically through surface functionalization with poly(ethylene glycol) (PEG) (PEGylation), has repeatedly been shown to be detrimental for the drug loading levels that can be achieved. Here, we present results related to sequential adsorptive drug loading and adsorptive PEGylation, where the conditions can be chosen so that the drug desorption during PEGylation is minimized. At the heart of the approach is the high solubility of PEG both in water and in apolar solvents, which makes it possible to use a solvent for PEGylation in which the drug exhibits a low solubility, as demonstrated here for two model drugs, one being water soluble and the other not. Analysis of the influence of PEGylation on the extent of serum protein adsorption underline the promise of the approach, and the results also allow the adsorption mechanisms to be elaborated. Detailed analysis of the adsorption isotherms enables determination of the fractions of PEG residing on the outer particle surfaces in comparison to inside the mesopore systems, and also makes it possible to determine the PEG conformation on the outer particle surfaces. Both parameters are directly reflected in the extent of protein adsorption to the particles. Finally, the PEG coating is shown to be stable on time-scales compatible with intravenous drug administration, which is why we are convinced that the presented approach or modifications thereof will pave the way for faster translation of this drug delivery platform to the clinic.

A COMPARATIVE STUDY OF CHEMOPORT VERSUS PERIPHERAL VENOUS ACCESS IN BREAST CANCER PATIENTS IN GOA MEDICAL COLLEGE.

Background: Totally implantable venous access devices (TIVADs) considered standard of care for administration of intravenous chemotherapeutic drugs for patients needing long term chemotherapeutic drugs. Methodology: This prospective comparative study carried over a period 2 years in all patients diagnosed with breast cancer. Patients will be divided into 2 groups-1 group will receive chemotherapy using the chemoport and the other group through peripheral intravenous access. The group will be divided based on simple randomization on alternate basis. While the average dura Results: tion for the procedure of port insertion was 59mins, almost 90% patients were discharged within 24 hrs with no complications Of the 50 patients that underwent the procedure of chemoport implantation, 21 patients underwent by Internal Juglar Vein while the remainder by Subclavian vein out of which in 2 patients the procedure was abandoned owing to complications of migration of guide wire and hemothorax, both of which occurred while attempting subclavian catheterization. While the guide wire was retrieved under uoroscopic guidance, Intercoastal drainage tube was passed for patient with hemothorax. This complication can be avoided by using radiological guidance or under uoroscope. Of the remaining patients, 13 patients the port was removed as they had completed chemotherapy were termed disease free. While in 2 patients port was removed pre-maturely due local port site infection and generalized sepsis due to neutropenia. During the process of chemotherapy through port, 1 patient developed blockage of port as evidenced by no return ow by aspiration. This was managed by giving heparin ush and visualized under C-arm for patency. When it comes to morbidity of the port, majority of the people were in the opinion that the process of port insertion was painless, they had no sensation of foreign body, no itching/pain and did not interfere with day to day life.And on inquiring regarding the satisfaction by the patient, maximum people were of the opinion that port helped speed up chemotherapy sessions, satised with cosmesis, and preferred port over peripheral iv line. About 60% would agree to recommend port over peripheral iv line. In comparison to patients who received chemotherapy through peripheral iv line, out of 50, 11 patients had serious complication of extravasation and thrombophlebitis which required hospital admission and surgical debridement. In terms of patient morbidity, >40% experienced difculty in initiation of chemotherapy in more than 50% of cycles, 26 patients were forced to receive multiple pricks, 34 patients required a second iv line to complete the session in half the cycles and 10 patients required iv at the leg/neck as others were inaccessible. High satisfaction rate Conclusion: observed in patients using chemoports for chemotherapy-it speeded up the sessions, less painful and only few people felt its presence affecting cosmesis/ day-to-day activities. It avoids the blunt of undergoing painful process of multiple pricks, use of 2nd line, thrombophlebitis and prolonged sessions seen in peripheral IV lines. Although the procedure of port implantation has got serious complications, the rate is minimal and with the help of radiological tools and surgical expertise, these can be made negligible. The only set-back by using a port is the maintenance part, which requires periodic ushing with heparinized saline to prevent blockage when not in use for prolong period (>4weeks). And so, it is advisable to remove the port promptly after completion of treatment if patient is labelled cured. Complications like infection can be avoided by strict aseptic precautions taken while handling the port for chemotherapy sessions by trained personal. Above all patient education and compliance is utmost important to ensure proper functioning of the port.

Extravasation injuries in the intravenous therapy with drugs with properties vesicants and irritants in the veterinary medicine of small animals

The extravasation injuries are uncommon complications during the administration of intravenous therapy in the small animal veterinary clinic. However, the efflux of drugs with vesicant or irritant properties can cause severe and/or irreversible functional and aesthetic changes. The correct catheterization technique and vigilance during intravenous administration of drugs with vesicant or irritant properties are fundamental in preventing the appearance of iatrogenic injuries. The therapeutic approach to this iatrogenic complication involves the combination of non-pharmacological, pharmacological, and surgical measures. In small animal veterinary medicine, there are no uniform recommendations about the best strategy could be adopted, and the interventions described in the literature lack evidence of effectiveness based on scientific studies.

Intranasal Ketamine for Premedication in Children: A Comparative Study in Ghana

BACKGROUND: Premedication is helpful especially in children in reducing the stress associated with anesthesia and surgery. Pediatric patients for surgery in Korle Bu Teaching Hospital are currently not sedated preoperatively due to unavailability of effective pediatric sedative preparations. Ketamine is readily available, inexpensive, and has been used for pediatric sedation through various routes with good outcomes in other geographical regions. Its intra-nasal use shows promise and avoids the anxiety and pain associated with establishing of an intravenous access and administration of drugs intravenously and intramuscularly. AIM: The aim of this study was to assess the efficacy of intranasal ketamine as premedication for pre-operative sedation. MATERIALS AND METHODS: A double-blind, randomized, and controlled trial was conducted on 76 pediatric elective surgical patients aged between 1 and 6 years at the Korle-Bu Teaching Hospital. Subjects were randomly assigned to receive 10 mg/kg intranasal ketamine (Treatment group) or 0.9% normal saline (Control group) 30 min before induction of anesthesia. Ease of separation from parents was assessed before (Pre-intervention) and 30 min after administration of intranasal solution (Postintervention). The level of sedation and acceptance of face mask were assessed 30 min after intranasal administration. RESULTS: The mean separation score in the treatment group was significantly lower pre-intervention (p = 0.026) but significantly higher 30 min post-intervention compared to control group (p < 0.0001). There was a significantly higher mean sedation score (2.8 ± 0.8 vs. 1.7 ± 0.7; p < 0.0001) and face mask acceptance score (3.4 ± 0.8 vs. 1.9 ± 1.2; p < 0.0001) among the treatment group compared to the control group. The incidence of salivation was significantly higher among the treatment group compared to the control group (17.9% vs. 0%; p = 0.007). CONCLUSION: The use of intranasal ketamine as premedication preoperatively in pediatric surgical patients is safe and results in improved sedation scores, better separation scores, and acceptance of face mask.

Incidence, time to occurrence and predictors of peripheral intravenous cannula-related complications among neonates and infants in Northwest Ethiopia: an institutional-based prospective study

BackgroundPeripheral intravenous cannulas (PIVC) are venous access devices commonly used for the administration of intravenous fluids, drugs, blood products, and parenteral nutrition. Despite its frequent use, it has complications that can seriously threaten patient safety, prolong hospital stays, and increases medical care costs. PIVC complications are associated with increased morbidity and reinsertion attempts are painful and anxiety-provoking for children and their parents. Therefore, this study was aimed to assess the incidence, time to occurrence and identify predictors for PIVC complications among infants admitted to Debre Tabor Comprehensive Specialized Hospital (DTCSH), Northwest Ethiopia.Methods and settingAn institutional-based prospective cohort study was conducted on 358 infants admitted to a neonatal intensive care unit and pediatric ward, DTCSH from January 1 to April 30, 2022. A systematic sampling technique was employed.ResultsThe incidence rate of PIVC complication was 11.6 per 1000 person-hours observation. PIVC complication was observed in 56.4% (202) of PIVCs, of which infiltration (42.1%) was the most common complication followed by phlebitis (29.7%). The median time to complication was 46 h. Anatomical insertion site (AHR = 2.85, 95%CI: 1.63–6.27), admission unit (AHR = 1.88, 95%CI: 1.07–4.02), sickness (AHR = 0.24, 95% CI: 1.31–4.66), medication type (AHR = 2.04, 95%CI: 1.13–3.66), blood transfusion (AHR = 0.79, 95%CI: 0.02–0.99), clinical experience (AHR = 0.52, CI:0.26–0.84), and flushing (AHR = 0.71, 95%CI: 0.34–0.98) were potential predictors of PIVC complication.ConclusionKnowing the predictor factors helps clinicians to provide effective care and to detect complications early.

OPIOID FREE GENERAL ANESTHESIA IN CLINICAL PRACTICE - A REVIEW ARTICLE.

Currently, enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways with the goal to achieve early patient recovery after surgery with minimal postoperative complications. According to studies, opioid free general anesthesia has many perioperative benefits and should be part of the ERAS protocols in specific surgical and patient indications. Opioid free general anesthesia is a multimodal balanced technique that is based on the concept that opioids are not used preoperatively or intraoperatively until the patient has aroused. The basic concept of opioid free general anesthesia is intravenous administration of several nonopioid drugs that operate at different pharmacological sites blocking surgical stress and sympathetic activation response. Moreover, current studies have shown that opioid free anesthesia is a technique which satisfactorily controls postoperative pain as the fifth vital sign, and has minimal side effects and better patient recovery with the same surgical conditions as general multimodal balanced anesthesia. However, further research is needed.

Fracture of an Intravenous Cannula in the Hand: A Case Report

BackgroundIntravenous cannula insertion is important, given that it is the most common invasive procedure in the emergency department for blood sampling, fluid resuscitation, and intravenous drug administration. Complications of intravenous catheterization include pain, phlebitis, extravasation, inflammation, and embolization. Fracture of an intravenous cannula is rare, but delayed removal may result in secondary damage, such as vasculitis or embolization, with critical consequences. Here, we report a case of intravenous cannula fracture that occurred in our emergency department. Case PresentationA 63-year-old woman with a history of left ovarian cancer visited our emergency department owing to poor oral intake and general weakness. Intravenous catheterization using an 18 gauge cannula was attempted for intravenous fluid administration by a skilled operator, but it failed owing to collapsed veins and poor skin condition. After several attempts, a vein in the patient’s hand was ruptured, and the patient complained of severe pain. The cannula was removed, but one-third of the cannula tip could not be seen. X-ray imaging was performed to locate the fragment of the cannula, and venotomy was performed for removal of the foreign body in the emergency department. ConclusionEmergency physicians and nurses should be vigilant about potential risk factors that can cause fracture of an intravenous cannula, and after the fracture is discovered, rapid removal of the cannula tip should be performed in the emergency department.

Internet of Things for Monitoring Infusion Fluids in Intravenous Chemotherapy Patients: Literature Review

Administration of intravenous chemotherapy drugs to cancer patients requires sophisticated infusion fluid monitoring tools so that the therapy process is smooth, safe, and comfortable. Internet-based technology of things to monitor intravenous chemotherapy drug infusion fluids more accurately and easily. Non-systematic review literature, using online data base: Elsevier (ScienceDirect), IEEE Xplore, ProQuest, Sage Journal with keywords: "internet of things" AND "infusion monitoring" AND "chemotherapy", "infusion monitoring system" with filter: " full text”, “Published in the last 5 years”, “journal” AND “2017-2022”. Literature review of 10 journals using the internet of things to accurately monitor infusion fluids is beneficial for chemotherapy patients. Making a monitoring system for chemotherapy drug infusions in Indonesia based on the internet of things that is accurate, easy and cheap.

Towards understanding the binding affinity of lipid drug carriers to serum albumin

In the past several years there has been a rapid rise in the use of lipid-based drug formulations. In the case of intravenous drug administration the interaction of lipid carrier with serum albumin is crucial for the distribution of the bioactive molecules in the bloodstream and reaching the target tissue. In this work, we have explored the interaction of serum albumin with three-component lipid monolayer build of palmitoyloleoylphosphatidylcholine (POPC), sphingomyelin (SM), and cholesterol (Chol). Using wide range of lipid compositions and various concentrations of serum albumin we identified the factors governing the lipid-protein binding. Our study revealed that albumin can penetrate selectively the monolayers of POPC/SM/Chol depending on the lipid composition in the mixture. Moreover, the interaction of albumin with monolayer can be controlled by the molecular density of the film and the concentration of protein. The adsorbed albumin exists in the film on the top of lipid monolayer. This behavior may lead to the increase of the size and charge of the lipid carrier and affect the drug transport throughout the bloodstream. The results of this work provide essential physicochemical data that can be used for predicting the pharmacokinetic profile of lipid-based formulations.

MIGRATION OF CENTRAL VENOUS CATHETER LEADING TO MASSIVE PLEURAL EFFUSION: A CASE REPORT AND TIPS TO REMEMBER

Central venous cannulation is a common procedure done in hospitals both in operating room (OR) and Intensive care unit (ICU) settings to provide uid, blood and blood component infusions, and to monitor central venous pressure, and administration of intravenous drugs to the patients. Various non-invasive modalities are used for the successful positioning and conrmation of correct placement of needles, guidewires, and venous catheters, including intra atrial electrocardiography (ECG) guidance, ultrasound guidance, X-ray imaging, with contrast enhanced computed tomography remaining the gold standard for conrmation of catheter placement (1).

Correlation of spectroscopic and structural properties of indocyanine green j-aggregates

Indocyanine green (ICG), when in free form in a liquid, can form stable nanoparticle structures or colloidal solution, while changing its spectroscopic properties. In the work, the aggregation degree and the average size of nanoparticles depending on the concentration of a colloidal solution of indocyanine green (ICG NPs) in the form of J-aggregates were investigated by various methods based on light scattering. The size of nanoparticles is an important parameter from the point of view of clinical application, because the technique of intravenous administration of drugs, in order to avoid microvascular thrombosis and embolism, provides dosage forms with inclusions of individual molecules or their clusters, not exceeding 500 nm diameter. In turn, small nanoparticles less than 30 nm lead to prolonged circulation of the drug in the body with an increased possibility of permeation into cells of healthy tissue. In the course of studies, it was found that an increase in the concentration of ICG NPs in the solution leads to an increase in the average size of spontaneously formed J-aggregates, which, in turn, leads to a decrease in the absorption coefficient in the aggregates. Presumably, this phenomenon, i.e. the established nonlinear dependence of the J-aggregate absorption on its size, can be explained by the formation of absorption centers on the J-aggregate surface in the form of mobile surface molecules. The threshold range of ICG molecule concentration was determined, at which there is a transition from aggregation with an increase in size with a slow addition of ICG J-aggregate molecules in height to a rapid addition in width.

Intravenous Nicotinamide Riboside Administration Has a Cardioprotective Effect in Chronic Doxorubicin-Induced Cardiomyopathy.

Doxorubicin, which is widely used to treat a broad spectrum of malignancies, has pronounced dose-dependent side effects leading to chronic heart failure development. Nicotinamide riboside (NR) is one of the promising candidates for leveling the cardiotoxic effect. In the present work, we performed a comparative study of the cardioprotective and therapeutic actions of various intravenous NR administration modes in chronic doxorubicin-induced cardiomyopathy in Wistar rats. The study used 60 mature male SPF Wistar rats. The animals were randomized into four groups (a control group and three experimental groups) which determined the doxorubicin (intraperitoneally) and NR (intravenous) doses as well as the specific modes of NR administration (combined, preventive). We demonstrated the protective effect of NR on the cardiovascular system both with combined and preventive intravenous drug administration, which was reflected in a fibrous tissue formation decrease, reduced fractional-shortening decrease, and better antioxidant system performance. At the same time, it is important to note that the preventive administration of NR had a more significant protective effect on the animal organism as a whole. This was confirmed by better physical activity parameters and vascular bed conditions. Thus, the data obtained during the study can be used for further investigation into chronic doxorubicin-induced cardiomyopathy prevention and treatment approaches.

Association Between Malignant Diseases and Medication-Related Osteonecrosis of the Jaw (MRONJ): A Systematic Review and Meta-Analysis.

The aim was to identify whether malignant diseases increase the risk of medication-related osteonecrosis of the jaw (MRONJ) occurrence when patients are exposed to bisphosphonate, antiresorptive or antiangiogenic drugs. To analyze related factors. A systematic literature searching was performed in PubMed, Embase, and Google Scholar for studies with information about whether patients have malignant diseases. Patients involved must be treated with MRONJ-related drugs and at high risk of developing MRONJ. A total of 6 cohort studies and 3 case-control studies were included. Analysis according 9 studies shows that malignant diseases have significant influence on MRONJ occurrence (risk ratio (RR): 2.62; 95% confidence interval (95% CI): 1.58-4.33; P =0.0002). Subgroup analysis according 6 cohort studies also shows that malignant diseases significantly affect MRONJ occurrence (RR: 3.50; 95% CI: 1.63-7.52; P =0.001). Chemotherapy have no obvious influence on MRONJ occurrence (RR: 1.64; 95% CI: 0.79-3.39; P =0.18). Intravenous drug administration significantly influences MRONJ occurrence (RR: 2.67; 95% CI: 1.27-5.58; P =0.009). Patients with malignant diseases have higher risk of MRONJ occurrence when exposed to bisphosphonate, antiresorptive, or antiangiogenic drugs. Cumulative dosages from intravenous drugs administration contribute to MRONJ developing. Prevention of MRONJ in patients with malignancy should be emphasized.