Methotrexate Injection Research Articles

Validation of an Algorithm to Identify Ectopic Pregnancy in a Large Integrated Health Care Delivery System Database [40N

INTRODUCTION: Surveillance of ectopic pregnancy (EP) using electronic databases is important. We aimed to assess the validity of an enhanced version of a previously published algorithm, which used a combination of encounters with EP related diagnostic/procedure codes and methotrexate injections. The enhanced algorithm further included ICD-10 diagnostic/procedure codes along with telephone encounters and excluded cases with only abdominal EP codes. METHODS: Medical records of 681 women, aged 15–44 years with membership at Kaiser Permanente Southern and Northern California between 2009–2018 with a potential EP were reviewed and true cases were identified. The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and the overall performance (Youden's index and F-score) of the algorithm were evaluated and compared to the published algorithm. RESULTS: There were 418 true positive, 240 false positive, and 10 uncertain EP cases with available records. True positive and true negative EP cases did not differ significantly according to maternal age, race/ethnicity and smoking status. EP cases with only one encounter and non-tubal EP were more likely to be misclassified. The sensitivity, specificity, PPV, and NPV of the enhanced algorithm for EP were 96.4%, 80.8%, 89.8%, and 92.8%, respectively. The Youden index and F-score were 77.2% and 93.0%. The sensitivity and NPV were lower at 86.8% and 79.0%, respectively, for the published algorithm. CONCLUSION: The specificity of the algorithm for EP in the integrated healthcare databases is adequate to allow for use in future epidemiological studies. Use of the enhanced algorithm will likely result in better capture of true EP cases.

Effectiveness of conservative medical treatment for non-tubal ectopic pregnancies: a multicenter study

ObjectiveTo assess the effectiveness of conservative treatment for the management of non-tubal ectopic pregnancies (NTEP) MethodsRetrospective cohort study in three centers (two referral centers) of patients managed for NTEP diagnosed by 2D or 3D ultrasonograhy. Patients underwent one of the following: expectant management, systemic methotrexate (MTX) injection, local MTX injection, combined MTX injection (local and systemic), local injection of hyperosmolar glucose, or misoprostol administration. The primary endpoint was final success defined by resolution of hCG level without need for emergency surgical treatment. Sixty-four patients diagnosed with NTEP were included: 37 (57%) had an interstitial pregnancy, 23 (35.9%) a cesarean scar pregnancy, two (3.1%) a cervical pregnancy and two (3.1%) an ovarian pregnancy. ResultsSix patients (9.4%) underwent expectant management, 24 (37.5%) a systemic MTX injection, 28 (43.8%) a local injection of MTX, three (4.7%) a combined MTX injection, one (1.6%) a local injection of hyperosmolar glucose (1.6%), and two (3.1%) were administered misoprostol. The median age was 32 years (22-45) and mean follow-up was 41 months. The final success rate overall was 92.2%: 100% for expectant management, 87.5% for systemic MTX, 96.4% for local MTX, 100% for combined injection of MTX, 100% for local injection of hyperosmolar glucose, and 50% for misoprostol. No patient required a hysterectomy. Nine (14.1%) patients required surgery, including five (7.8% (5/64)) following a rupture of the NTEP. ConclusionsOur results suggest that conservative medical management of NTEP is effective and safe and should be the first-line treatment for pauci-symptomatic patients with an NTEP.

Intralesional methotrexate for keratoacanthomas: A retrospective cohort study

Intralesional methotrexate for keratoacanthomas: A retrospective cohort study

Intravitreal Injections of Bevacizumab Plus Methotrexate versus Bevacizumab Alone for the Treatment of Diabetic Macular Edema: A Randomized, Sham-Controlled Trial.

Purpose:To evaluate the efficacy of intravitreal bevacizumab (IVB) combined with intravitreal methotrexate (IVM) in the treatment of diabetic macular edema (DME).Methods:In this prospective, interventional contralateral eye study, patients with bilateral DME were randomly allocated to receive three monthly injections of IVB (1.25 mg/0.05 mL) plus IVM (400 μg; 0.16 cc) or IVB alone. The outcome measure was changes in the best corrected visual acuity (BCVA), central macular thickness (CMT), and central macular volume (CMV).Results:Thirty-six treatment-naive eyes of 18 patients with a mean age of 62.38 ± 6.2 years were included in the study. BCVA logMAR changed from 0.95 ± 0.53 at baseline to 0.75 ± 0.53 in the combination group and from 0.72 ± 0.57 to 0.49 ± 0.50 in the IVB alone group at 1 month after the 3rd injection. BCVA improvement in both groups was not statistically significant compared with the baseline value (P > 0.99). Compared with the baseline values, mean CMT and CMV were reduced in both groups; however, these changes did not reach a significant level. The differences of CMT changes between the groups were not statistically significant at month 1 (P = 0.82), month 2 (P = 0.21), and month 3 (P = 0.10). Furthermore, the differences of CMV changes between the groups were not statistically significant at month 1 (P = 0.76), month 2 (P = 0.82), and month 3 (P = 0.11).Conclusions:This pilot study demonstrated no significant therapeutic effects for IVB combined with IVM compared to IVB alone in treatment-naive DME patients over a 3-month course.

Glutamin ve β-hidroksi β-metil bütiratin metotreksatin indüklediği intestinal mukozit üzerine etkisi

Purpose: We aimed to evaluate preventing effects of Glutamine (Gln) and β-hydroxy β-methylbutyrate (HMB) on methotrexate induced intestinal mucositisMaterials and Methods: Fifty Wistar albino rats were divided into 5 groups (G). Group G1 defined as control and G2 was the methotrexate (MTX) treated group. The group G3, G4 and G5 were MTX plus Gln, Mtx plus HMB, MTX plus Gln and HMB respectively. Distilled water was applied by gavage to the first 2 groups. Rat received intraperitoneal injections of MTX at the third day. On the fifth day intestinal tissue samples were obtained. Results: The G5 had similar results with the G1 group in the crypt length. According to Park scoring, G1 and G5 were both the highest scores among five study groups. When the tissue was inspected by caspase-3 coating, the lowest apoptotic rate is found in the G5. Conclusion: This research showed that the combination of Gln and HMB use is more effective then the separate use of both chemicals.

Effect of methotrexate on embryonal implantation: an experimental rat model

The aim of this study is to investigate the methotrexate (MTX) in rat embryonal implantation and its association with Glycodelin A (GdA) and Mucin-1 (MUC-1) expression. For this purpose, 32 pregnant rats were divided into four equal groups: non-pregnant rats in group I (n = 8, control) and pregnant rats in group III (n = 8) were injected intraperitoneal with single dose of normal saline, non-pregnant rats in group II (n = 8) and pregnant rats in group IV (n = 8) were given 0.2 mg i.m. injection of MTX before three months of pregnancy. The dams were killed on 5th day of gestation and uterine horn samples were removed. Following dissection and routine histological preparation, immunohistochemical analysis was carried out. During immunohistochemical examination of the tissue samples prepared from the control and experimental groups, a statistically significant difference was observed between the groups in the luminal–glandular–decidualized epithelium of the uterus with GdA and MUC-1. Finally, in light of our findings, MTX adversely affected the expression of two molecules in Wistar Albino rats embryonal implantation model.

Heterotopic pregnancy: Simultaneous viable and nonviable pregnancies.

Heterotopic pregnancy occurs when a patient has simultaneous intrauterine and ectopic pregnancies. Rates of heterotopic pregnancy have been rising with increased availability and access to in vitro fertilization and other advanced fertility technologies. Symptoms of heterotopic pregnancy are nonspecific, such as vague abdominal pain, so transvaginal ultrasound is a crucial part of the diagnostic process. Laparoscopy is the most commonly performed treatment of the ectopic pregnancy; other options include localized injections of methotrexate and/or potassium chloride. Following definitive termination of the ectopic pregnancy, many patients will successfully deliver the intrauterine pregnancy at term. Early identification of heterotopic pregnancy can reduce maternal morbidity and mortality.

Tranilast attenuates methotrexate-induced renal and hepatic toxicities: Role of apoptosis-induced tissue proliferation.

Drug-induced organ toxicity is a frequently encountered obstacle in the field of medical practice that limits the use of numerous pharmacologically valuable drugs. Methotrexate (MTX)-induced organ toxicity is unfortunately the rate-limiting factor for its clinical application. In the current study, MTX injection induced significant renal and hepatic toxicities manifested on functional, biochemical, and histopathological scales. This was associated with a significant elevation in both renal and hepatic contents of TNF-related apoptosis-inducing ligand (TRAIL) and caspase-8, biomarkers of tissue apoptosis. Inline, immunohistochemical analysis confirmed that tissue increased expression of Ki67 as a biomarker of tissue regeneration in both organs. Tranilast (TRAN) is a small molecular weight anti-inflammatory and antiallergic agent. TRAN's coadministration with MTX in the current study induced a significant tissue recovery via modulation of TRAIL/caspase-8 signaling and modulation of apoptosis-induced tissue proliferation confirmed by quantification of Ki67 expression. In conclusion, TRAN can be proposed as an effective drug to attenuate MTX-induced organ toxicity via modulation of apoptosis-induced tissue proliferation pathway.

Ocular Manifestations of Leukemia and Results of Treatment with Intravitreal Methotrexate

Ocular involvement in leukemia is considered rare. Ocular symptoms can be the presenting signs of leukemia, they can appear after diagnosis has been established, or they can be the first manifestation of a relapse after remission. We report, to the best of our knowledge for the first time, the ocular manifestation of a series of patients with ocular leukemia and the result of their treatment with intravitreal methotrexate (MTX) injections. This is a retrospective cohort study. The medical records of 12 consecutive patients with ocular leukemia (24 eyes, 11 eyes treated with MTX) treated at the Sheba Medical Center from January 2010 to December 2017 were retrospectively reviewed. Details on ocular inflammatory reaction and tumor cell infiltration at presentation and the end of follow-up were recorded as main outcome measures. The 12 patients included 7 women and 5 men (mean age ± standard deviation at diagnosis 25.92 ± 23.91 years, range 2–82 years). Eleven eyes of 6 patients were treated with intravitreal MTX injections. The indication for treatment was biopsy proven, tumor cell infiltration. The mean number of MTX injections was 3.37 ± 5.35 (range 1–18). The mean follow-up was 27.08 ± 36.79 months (range 1–93). All treated eyes showed improvement in the inflammatory reaction and tumor cell infiltration. In conclusion we found that Intravitreal MTX injections may be an effective therapeutic approach for eyes with intraocular leukemic tumor cell infiltration.

Outcome of cesarean scar pregnancy treated with local methotrexate injection.

ABSTRACTLocal injection of methotrexate (MTX) has been widely used for caesarean scar pregnancy (CSP), but the optimal candidate remains undetermined. The aim of this study is to determine the risk factors associated with treatment failure among patients who received a single dose of local MTX.This is a retrospective cohort study. Clinical information was compared between treatment success vs. failure groups. Risk factors related to treatment failure were also investigated with multivariate analysis.Of 47 patients diagnosed with CSP, 30 received local MTX injection. The initial serum ß- human chorionic gonadotropin (hCG) level in the failure group was significantly higher than in the success group (p = 0.048), and the cut-off value was 47,000 mIU/ml. The rate of type 2 position of the gestational sac in the failure group was significantly higher than in the treatment success group (p = 0.031). A high initial serum ß-hCG level (≥ 47,000 mIU/ml) was identified as the independent risk factor for treatment failure (adjusted odds ratio = 21.9; 95% confidence interval = 1.3–383.1).Type 2 gestational sac position and a higher level of ß-hCG at diagnosis appear to be associated with poor outcomes after local injection of a single dose of MTX.

Efficacy of intralesional methotrexate in the treatment of plantar warts

Warts are tumors or growths caused by infection with human papilloma virus (HPV). Currently, over 170 HPV types have been identified. This study aimed to evaluate the efficacy and safety of intralesional injection of methotrexate (MTX) for the treatment of plantar warts. Sixty patients presented with plantar warts were divided into two groups. Group A patients were injected with intralesional MTX (2 mg/ml). Group B patients were injected with intralesional saline as a placebo. The injections were repeated every week for a maximum of six sessions or until complete clearance, whichever was earlier. The patients were followed up for 6 months after the last injection. In the intralesional MTX group, 2 patients (6.7%) showed complete improvement, 8 patients (26.7%) showed partial improvement, and 20 patients (66.7%) showed no improvement. In the intralesional saline group, 3 patients (10%) showed complete improvement, 4 patients (13.3%) showed partial improvement, and 23 patients (76.7%) showed no improvement. Reported adverse events were local reactions in the form of swelling, pain, and infection in both groups. There was no statistically significant difference between the therapeutic responses to intralesional MTX injection and saline.

甲氨蝶呤皮下注射治疗应用与展望

甲氨蝶呤皮下注射治疗应用与展望

Longitudinal observation of OCT imaging is a valuable tool to monitor primary vitreoretinal lymphoma treated with intravitreal injections of methotrexate

BackgroundDeveloping objective and repeatable indicators to evaluate the efficacy of PVRL treatment is important. The quantification of vitreous cells is a traditional criterion; however slight changes are difficult to ascertain. Spectral domain optical coherence tomography (SD-OCT) is objective, repeatable, and easily explained. The purpose of this study is to provide a longitudinal observation of OCT in PVRL treated with intravitreal injections of methotrexate (MTX) and to evaluate the utility of OCT in monitoring responsiveness of PVRL to treatment.MethodsThe medical records of patients with biopsy-positive PVRL attending our hospital between January 2016 and September 2017 who received intravitreal injections of MTX were included in this study. Pre- and post-treatment OCT images were reviewed independently by two researchers.ResultsOf the 24 cases reviewed, 10 patients (18 eyes) were included. SD-OCT abnormalities at the initial visit included vitreous cells (18/18), OR (outer retina) fuzzy borders (12/18), PED (pigment epithelium detachments) (9/18), subretinal hyperreflective infiltration (3/18), intraretinal infiltration (8/18), and SRF (subretinal fluid) (4/18). Post induction treatment, SRF in cases with RD (retinal detachment) was absorbed, and subretinal fibrosis appeared. Other lesions were significantly reduced. Post consolidation treatment, OR fuzzy borders, PED and SRF disappeared in 2 eyes, intraretinal infiltration disappeared in 1 eye, and other abnormalities further improved. Additionally, retinal fibrosis was observed in 3 eyes. One month post maintenance treatment, all abnormalities observed at the first visit vanished. At the last visit, OCT showed subretinal fibrosis and in 3 eyes (16.7%), the disruption of outer retina in 9 eyes (50%) and thinning of the whole layer in 4 eyes (22.2%).ConclusionsOur observations reveal that characteristic OCT features in PVRL patients can reduce gradually and finally vanish with therapy. We propose that SD-OCT may be employed to monitor the responsiveness of PVRL to treatment, which may influence decision making in the management of this disease.

Placenta Previa Partial Accreta Managed Successfully with Lower Segment Caesarean and Methotrexate Injection

Placenta Previa Partial Accreta Managed Successfully with Lower Segment Caesarean and Methotrexate Injection

Ginkgo biloba Extract Attenuates Methotrexate-Induced Testicular Injury in Rats: Cross-talk Between Oxidative Stress, Inflammation, Apoptosis, and miRNA-29a Expression.

Ginkgo biloba leaf extract (GIN) is a popular Chinese herbal medicine. It has a nephroprotective effect against the nephrotoxicity induced by the chemotherapeutic agent methotrexate (MTX). This work was designed to explore the testicular protective role of GIN on MTX-induced testicular injury in a rat model. The experimental protocol lasted for 10 days for the 4 studied groups. First group: received saline (normal control, NC group). The second group was administered GIN (100 mg/kg/day) orally for 10 days (GIN C). Third group: injected with MTX (20 mg/kg ip) only on the fifth day (MTX group). Fourth group: administered GIN for 10 days with MTX injection on the fifth day (GIN+MTX group). MTX induced testicular injury as evident by a marked rise in the malondialdehyde (MDA) content, interleukin-6 (IL-6) and IL-1β protein levels, nuclear factor kappa-B (NF-κB) protein expression, bcl-2 associated × protein (Bax) mRNA expression, p53 mRNA and protein expressions, and miRNA29-a expression along with a marked decline in the serum level of testosterone and superoxide dismutase (SOD) content in testicular tissue in relation to the NC group. Moreover, histopathological testicular damage with a notable decrease in the Johnsen score together with a significant elevation in the testicular injury score was observed in the MTX group in comparison to the NC group. The administration of GIN ameliorated the biochemical changes as well as the testicular histopathological findings and scores. GIN could protect against MTX-induced gonadotoxicity by its antioxidant, anti-inflammatory, antiapoptotic activities plus the regulation of the miRNA-29a testicular expression.

Psoriasis presenting as targetoid lesions: First of its kind

Psoriasis is a common chronic inflammatory and proliferative condition of the skin and its presentation as targetoid lesions has not been described. A 29-year-old male came to the outpatient department with multiple red color elevated skin lesions over the forehead and trunk for the past 10 days. Multiple targetoid lesions of size 2 cm × 2 cm to 5 cm × 4 cm having central edematous crusted zone and the peripheral zone of erythema with irregular to well-defined margins present almost all over the body. Differential diagnosis included psoriasis, erythema multiforme, pemphigus erythematosus, and reiter's disease. The biopsy confirmed the diagnosis of psoriasis. The patient was started on injection methotrexate and responded well.

Gestational Trophoblastic Neoplasia: A Retrospective Study of 23 Cases

<i>Background</i> – The aim of this study is to analyze the clinicopathological features, diagnosis and appropriate treatment outcome of patients with gestational trophoblastic neoplasia (GTN), a heterogenous group of disorder in a government tertiary care hospital center. <i>Method</i>– This is a retrospective study of 23 patients from 2002-2020 over 18 years. The patients were evaluated on the basis of their age, obstetric history and the treatment received. All the patients were scored according to Modified World Health Organization (WHO) prognostic scoring system as adapted by FIGO Year 2000. Low risk group patients were given injection Methotrexate + Calcium Leucovorin and high risk group were given EMACO regimen. After treatment, the patient follow up was till date or minimum up to 2 years. The response to treatment was evaluated by regular clinical and radiological examination and serum β-hCG level estimation. <i>Results</i> – Three out of 23 patients who relapsed after primary chemotherapy were given second line chemotherapy. All three patients achieved complete remission (CR) after salvage chemotherapy. Thus overall response rate is 100%. <i>Conclusion</i> – Proper diagnosis, close monitoring and follow up with β-hCG value is of utmost importance in the management of GTN, WHO/FIGO scoring should be done and managed with chemotherapy treatment according to the risk assessment.

Atypical cytomegalovirus retinitis in an immunocompetent individual with diffuse large B-cell lymphoma posing a diagnostic enigma

Cytomegalovirus (CMV) retinitis is a vision-threatening condition seen with CD4+ count below 50/μL. In the presence of systemic lymphoma, CMV retinitis may pose a diagnostic dilemma due to similar clinical features with intraocular lymphoma. We, hereby, report a rare case of bilateral CMV retinitis in a patient with normal CD4+ counts and a past history of diffuse large B-cell lymphoma (DLBCL). A 51-year-old male presented with sudden-onset painless diminution of vision in the right eye (RE) for a 2-week duration. He had a past history of DLBCL and had been treated with chemotherapy. On examination, his best-corrected visual acuity was perception of light in RE and 20/20 in the left eye (LE). RE fundus examination showed yellowish-white deep retinal lesions with scanty superficial retinal hemorrhages and perivascular exudates. LE fundus examination showed only one focal area of yellowish-white deep retinal lesions along the inferotemporal arcade. A provisional diagnosis of bilateral intraocular lymphoma was made based on the past history of systemic lymphoma. RE vitreous tap was done, and intravitreal injection of methotrexate was given. Vitreous sample revealed CMV DNA on polymerase chain reaction but no evidence of malignant cells on cytology. CD4 count was 393 cells/μl. The patient was subsequently treated with intravenous ganciclovir and oral valganciclovir for bilateral CMV retinitis. This case report highlights the importance of vitreous sample analysis in patients of systemic lymphoma presenting with atypical retinal necrotic lesions to establish an accurate diagnosis and to differentiate between closely mimicking lesions of intraocular lymphoma and viral retinitis.

Comparison of the Clinical Process Outcomes of Non-Surgical and Surgical Treatment for Cornual Pregnancy : A Retrospective Randomized Case-Control Study

Objectives: To compare the clinical process outcomes of ultrasound (US) - guided intragestational sac injection of methotrexate (MTX) and cornual resection for cornual pregnancies. Methods: The retrospective case-control study included 31 women diagnosed with cornual pregnancy at a single center, between January 2007 and February 2017. Of these, we enrolled 31 women who had implantation in the cornual area at the time of diagnosis; 12 were treated with local injection of MTX under ultrasound guidance and 19 underwent with cornual resection. Procedure-related outcomes, including operating time, time to normal state β-hCG serum level, and hemoglobin level changes. Statistical significance was assessed using the chi-square test, Mann-Whitney test, and Student’s t-test. Results: Compared to the cornual resection group, the local MTX treatment group had a much shorter mean procedure time (21.64±7.18 minutes versus 60.53±5.16 minutes p< 0.01) and length of hospital stay (2.40±0.54 days versus 3.43±0.37 days, p= 0.018). Also, decreases in hemoglobin levels post-procedure were lower in the local MTX treatment group (1.59±0.16 g/dL versus 2.54±0.29 g/dL, p= 0.012). There was one case of uterine rupture in a subsequent pregnancy in the cornual resection group. Conclusion: Non-surgical treatment has better clinical process outcomes than cornual resection for managing cornual pregnancies which desire future pregnancies without uterine rupture.

Medical Management of Cesarean Scar Pregnancy at Latifa Hospital Dubai Health Authority, Dubai, UAE

Introduction: Cesarean scar pregnancy (CSP) is defined as implantation of gestational sac at the site of cesarean scar. It’s a serious diagnosis that has become more prevalent in recent years and related to the increasing rate of cesarean sections reported worldwide. Identifying these cases and treating them is challenging, with no agreed upon universal protocol for successful treatment. We aim to evaluate the success rate and outcome of medical management for Cesarean scar pregnancy. Methods: It was a retrospective descriptive study of all cesarean scar pregnancies managed at fetal medicine unit at Latifa Hospital in Dubai, UAE the main obstetrics & Gynecology tertiary hospital in Dubai Emirate, UAE from 2015 to 2017. Certainly, a set of diagnostic criteria were implemented to confirm the diagnosis of CSP. The cases were then offered our proposed management which is systemic methotrexate injections ± KCL. Follow up made by serial βhcg and ultrasound scan. The data were collected used specified data collection sheet for this purpose then analyzed and presented using statistical package for social sciences (SPSS) version 26. Results: 33 cases of cesarean scar pregnancies are confirmed and medically managed during the study period. The study subjects composed of a group of patients who had a viable CSP and received local KCL injection + systemic methotrexate, a second group who had non-viable CSP and received systemic methotrexate 20 cases were viable pregnancies who received combined local potassium chloride plus systemic methotrexate, and 13 were non-viable received systemic methotrexate only. The mean gestational age at diagnosis was 8 weeks (SD ± 1.8). On average our cases had a history of 3 previous cesarean sections (range 1 - 6). Overall, the success rate calculated from our study population for medical management of CSP was 77.8%; this varied between viable CSP which had a success rate of 66.7% and non-viable CSP which had a success rate of 100%. The average period of outpatient follow-up for the patients to achieve complete resolution was 14 weeks (SD ± 7.5). Conclusions: Medical management of CSP in the form of systemic methotrexate ± local KCL injections proves to have acceptability and a good success rate especially for non-viable CSP, low complications rate and with the benefit of preserving future fertility.