Assessing usability, label comprehension, pen robustness and pharmacokinetics of a self-administered prefilled autoinjector pen of methotrexate in patients with rheumatoid arthritis.

OBJECTIVE: To assess usability, bioavailability, and safety of subcutaneous self-administration of 0.3 mL of methotrexate 50 mg/mL solution via a prefilled autoinjector pen (methotrexate pen) in patients with rheumatoid arthritis. METHODS: The study enrolled methotrexate-naïve and methotrexate-experienced patients aged ≥16 years. Visit 1 (Day 1) included methotrexate pen usage training with documentation, patient self-injection, and a patient-training questionnaire completed by the healthcare professional. Visit 2 (Days 8-10) included evaluation of patient self-injection through four scenarios: holding needle in place for 5 s, confirming methotrexate delivery, skin pinch, and pen disposal. At Visit 2, patient opinion and training retention (since Visit 1) were also assessed. Pharmacokinetic parameters were assessed in 25 patients, who were stratified by body weight and randomized to receive injections in the abdomen or the upper thigh. RESULTS: At Visit 1, 12 of 106 patients had questions about the pen, and 4 required self-injection assistance. At Visit 2, the mean performance rating for all scenarios was ≥9.8 (scale: 1 (very difficult)-10 (very easy)). Successful completion rates were 96.2%-100%; 91.3%-100% of patients required no assistance. Impressions of the pen were favorable; 98.1% of patients passed the written examination. All methotrexate pens effectively delivered 0.3 mL methotrexate and were intact after use. Body weight >100 kg significantly decreased total and peak methotrexate exposure when administered abdominally. No adverse effects resulted in drug discontinuation. CONCLUSION: The methotrexate pen was used with a high degree of effectiveness, satisfaction, and safety, indicating that this delivery system may be a viable option for patients requiring subcutaneous methotrexate.

Meningitis por Listeria monocytogenes: un caso en el servicio de Pediatría deñ Hospital San José, Bogotá, DC / Meningitis for Listeria monocytogenes: a case in the service of Pediatrics of San José's Hospital, Bogotá

L.monocytogenes es un cocobacilo Gram positivo, no esporulado, anaerobio facultativo, que se encuentra ampliamente distribuido en la naturaleza y crece en un amplio rango de temperatura (-0.4 C a 50 C), y constituye una causa importante de infección, en especial en mujeres embarazadas, recién nacidos e inmunosuprimidos, causando bacteriemia y meningitis en estos pacientes. En pediatría la L. monocytogenes está dentro de las tres principales causas de meningitis neonatal y se presenta como una infección temprana, hasta el tercer día de nacido, comportándose como un cuadro clínico de sepsis neonatal temprana. La listeriosis neonatal de presentación tardía es menos común. Se presenta en recién nacidos a término, después de la segunda semana de vida y cursa como una meningitis. Posterior al período neonatal, 30-50 por ciento de los pacientes presenta un cuadro clínico de meningitis, asociada a inmunosupresión