Testosterone Therapy with Subcutaneous Injections: A Safe, Practical and Reasonable Option

Context Injections with intramuscular testosterone esters have been available for almost 8 decades and not only result in predictable serum testosterone levels but are also the most inexpensive modality. However, they are difficult to self-administer and associated with some discomfort. Recently, subcutaneous administration of testosterone esters has gained popularity, as self-administration is easier with this route. Available data, though limited, support the feasibility of this route. Here we review the pharmacokinetics and safety of subcutaneous testosterone therapy with both long- and ultralong-acting testosterone esters. In addition, we provide guidance for clinicians on how to counsel and manage their patients who opt for the subcutaneous route. Evidence Acquisition Systematic review of available literature on subcutaneous testosterone administration including clinical trials, case series and case reports. We also review the pharmacology of testosterone absorption after subcutaneous administration. Evidence Synthesis Available evidence, though limited, suggests that subcutaneous testosterone therapy in doses similar to those given via intramuscular route results in comparable pharmacokinetics and mean serum testosterone levels. With appropriate training, patients should be able to safely self-administer testosterone esters subcutaneously with relative ease and less discomfort compared with the intramuscular route. Conclusion Although studies directly comparing the safety of subcutaneous vs intramuscular administration of testosterone esters are desirable, clinicians should consider discussing the subcutaneous route with their patients, as it is easier to self-administer and has the potential to improve patient adherence.

Determination of Candida albicans fungus proteins concentration by Elisa method at Intramuscular Introduction in Candidiasis Therapy

The objective of this work was to determine the C. albicans fungus protein concentration at intramuscular introduction in therapy of candidiasis. Therapeutic effect of C. albicans fungus proteins in concentrations 1, 2, 3, 4 and 5mg/mL has been examined in white mice. Animals were infected intraperitoneally with suspension of C. albicans fungus strain CCM 335-867 in the amount of 20 million cells per 1mL volume. After 5 days and repeatedly after 14 days mice were injected intramuscularly in the upper back hind paw with proteins of Candida fungus cells of volume 0.2mL. 14 days after each injection, the determination of the protective functions of the animal body has been carried out by the titer of specific C. albicans antibodies during immunoassay. According to the data obtained during studies on the treatment of candidiasis, it has been found that in the intramuscular route of administration after the first injection with C. albicans protein concentration of 3 mg/mL antibody titers increased 2 times, and after the second - 8 times. Proteins of C. albicans fungus at a concentration of 3 mg/mL activate the body's defence mechanisms.

Intradermal Synthetic DNA Vaccination Generates Leishmania-Specific T Cells in the Skin and Protection against Leishmania major

ABSTRACT Vaccination remains one of the greatest medical breakthroughs in human history and has resulted in the near eradication of many formerly lethal diseases in many countries, including the complete eradication of smallpox. However, there remain a number of diseases for which there are no or only partially effective vaccines. There are numerous hurdles in vaccine development, of which knowing the appropriate immune response to target is one of them. Recently, tissue-resident T cells have been shown to mediate high levels of protection for several infections, although the best way to induce these cells is still unclear. Here we compare the ability to generate skin-resident T cells in sites distant from the immunization site following intramuscular and intradermal injection using optimized synthetic DNA vaccines. We found that mice immunized intradermally with a synthetic consensus DNA HIV envelope vaccine by electroporation (EP) are better able to maintain durable antigen-specific cellular responses in the skin than mice immunized by the intramuscular route. We extended these studies by delivering a synthetic DNA vaccine encoding Leishmania glycosomal phosphoenolpyruvate carboxykinase (PEPCK) by EP and again found that the intradermal route was superior to the intramuscular route for generating skin-resident PEPCK-specific T cells. We observed that when challenged with Leishmania major parasites, mice immunized intradermally exhibited significant protection, while mice immunized intramuscularly did not. The protection seen in intradermally vaccinated mice supports the viability of this platform not only to generate skin-resident T cells but also to promote durable protective immune responses at relevant tissue sites.

(Re)discussing the drug administration technique by the intramuscular route: a systematic review / (Re)discutindo a técnica de administração de medicamentos pela via intramuscular: revisão sistemática

Objetivos:Identificar a produção do conhecimento da enfermagem atrelado a técnica de administração de medicamentos pela via intramuscular; descrever as divergências, congruências, e ocorrência de complicações acerca da técnica; e analisar as recomendações descritas na literatura com as melhores práticas e atualizações clínicas na enfermagem. Método: Revisão sistemática sem meta-análise.Realizada busca nas bases de dados LILACS, Pubmed, Medline, DEDALUS, Portal de Evidência em Saúde e Bibliotecas SciELO e Cochrane, no período de 1993 a 2012,totalizando 16 estudos. Resultados:Os estudos evidenciaram divergências na variações de demarcação da região ventroglútea; realização de antissepsia; e aplicação de pressão antes da administração intramuscular.Consonâncias na aspiração do conteúdo da seringa após inserção da agulha na massa muscular, rodízio do local de aplicação durante sequências de injeções IM, dentre outros.Conclusão:A incorporação das melhores evidências permite a execução segura da técnica intramuscular, gerando conforto ao paciente e excelência na assistência.