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Indeed, besides a familial component in insulin resistance, as in general population, patients with PWS have fairly low fasting insulin concentrations and a lower incidence of insulin resistance compared to that expected considering the body mass index (BMI), probably due to a greater distribution of adipose tissue in the subcutaneous than in visceral site [15, 29, 30]

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also stated that MTX-induced oxidative stress may cause glomerular and tubular damage by causing MTX accumulation in the kidney (Reference Li, Abe and Yamakawa42)

Therefore, it is recommended that individuals at an elevated risk of bleeding, those taking specific anticoagulants and antiplatelet agents, and those undergoing surgical or other invasive operations should avoid it (Rosenblatt and Mindel, 1997)