Warfarin: pharmacological profile and drug interactions with antidepressants.

Oral anticoagulants are among the drugs with the greatest number of drug interactions. The concomitant use of several medications is a common practice in patients with cardiovascular problems, who often also present with depression; therefore, the probability of an interaction occurring between warfarin and the antidepressants is high, and may result in increased or decreased anticoagulant activity. Since the possible interactions between these two classes of drugs have been poorly explored in literature, with a risk to the patients who use them, we reviewed the pharmacology of warfarin and its possible interactions with antidepressants. Of the antidepressants analyzed, those that showed relevant effects on the interaction with warfarin were, in decreasing order: paroxetine, venlafaxine, fluoxetine, and duloxetine.

Warfarin: pharmacological profile and drug interactions with antidepressants / Varfarina: perfil farmacológico e interações medicamentosas com antidepressivos

Oral anticoagulants are among the drugs with the greatest number of drug interactions. The concomitant use of several medications is a common practice in patients with cardiovascular problems, who often also present with depression; therefore, the probability of an interaction occurring between warfarin and the antidepressants is high, and may result in increased or decreased anticoagulant activity. Since the possible interactions between these two classes of drugs have been poorly explored in literature, with a risk to the patients who use them, we reviewed the pharmacology of warfarin and its possible interactions with antidepressants. Of the antidepressants analyzed, those that showed relevant effects on the interaction with warfarin were, in decreasing order: paroxetine, venlafaxine, fluoxetine, and duloxetine.

Os anticoagulantes orais estão entre as drogas com maior número de interações medicamentosas. O uso concomitante de vários medicamentos é uma prática comum em pacientes com problemas cardiovasculares, os quais frequentemente também apresentam depressão; assim, a probabilidade de ocorrer alguma interação entre a varfarina e os antidepressivos é bem expressiva, podendo resultar em um aumento ou uma diminuição da atividade anticoagulante. Como as possíveis interações entre essas duas classes de medicamentos se mostraram pouco exploradas na literatura, com risco aos pacientes que fazem uso delas, revisamos a farmacologia da varfarina e suas possíveis interações com antidepressivos. Dos antidepressivos analisados, os que apresentaram efeitos relevantes na interação com a varfarina foram, em ordem decrescente: paroxetina, venlafaxina, fluoxetina e duloxetina.

COMT polymorphism and the risk of endometriosis-related infertility.

Estrogens are important factors in the development of endometriosis, and can induce cell proliferation and stimulate cell division. COMT constitutes a crucial element in estrogen metabolism and has been suggested to be involved in the development of endometriosis. This study had the objective of to determine whether the presence of COMT val/met polymorphism (rs4680) increases the risk to endometriosis in infertile patients. A case-control study that included 198 infertile women with endometriosis, 71 infertile women without endometriosis, and 168 fertile women as control group of the Faculdade de Medicina do ABC. COMT (val/met) genotypes were identified by real time PCR (genotyping TaqMan assay) and the results were analyzed statistically by χ² test. The data showed no statistical difference in the distribution of COMT genotypes neither between infertile patients with endometriosis and control group (p = 0.567), regardless disease degree, nor between infertile patients without endometriosis and control group (p = 0.460). In conclusion, the COMT val/met polymorphism is not associated to endometriosis-related infertility in the Brazilian population evaluated. However, more studies in larger populations are necessary to confirm these results.

Analysis of vitamin D receptor gene polymorphisms in women with and without endometriosis.

An aberrant immunologic mechanism has been suggested to be involved in the pathogenesis of endometriosis. Genetic alterations in the vitamin D receptor gene (VDR) may lead to important defects in gene activation that principally affect immune function. We have hypothesized a possible relationship between endometriosis and/or infertility and the VDR polymorphisms (ApaI, TaqI, FokI, and BmsI). The study was a case-control study including 132 women with endometriosis-related infertility, 62 women with idiopathic infertility, and 133 controls. VDR polymorphisms were studied by restriction fragment length polymorphism. We found relatively similar VDR polymorphism genotype frequencies in cases and controls. When patients with minimal/mild and moderate/severe endometriosis were studied separately, no difference was found. When we compared infertile groups with and without endometriosis there was no statistically significant difference. The data suggest that VDR polymorphisms did not play an important role in the pathogenesis of endometriosis and/or infertility in the Brazilian women studied.

Polymorphism of the estrogen receptor ß gene is related to infertility and infertility-associated endometriosis.

OBJECTIVE: To determine the frequency of the estrogen receptor b gene (ERß) +1730 G/A polymorphism in infertile women with and without endometriosis and controls. SUBJECTS AND METHODS: Case-control study that included 136 women with endometriosis, 69 women without endometriosis and 209 fertile women as controls. The ERß gene + 1730 G/A polymorphism was identified by RFLP-PCR (Restriction Fragment Length Polymorphism - Polymerase Chain Reaction). RESULTS: Genotypes GG, GA and AA of the ERß gene presented frequencies of 60.3%, 38.2% and 1.5%, respectively, in the women with endometriosis (p < 0.0022). Of the infertile women without endometriosis, 63.8% presented the normal homozygous genotype GG, 30.4% the GA heterozygous genotype, and 5.8% the homozygous mutated genotype AA (p < 0.0275). In the control group, 77.5% presented the normal homozygous genotype GG, 21.1% the heterozygous genotype GA, and 1.4% the homozygous mutated genotype AA. CONCLUSION: The data suggest that the estrogen receptor ß gene (ERß) +1730 G/A polymorphism can be associated with risk of infertility and endometriosis-associated infertility.

Polymorphism of the estrogen receptor β gene is related to infertility and infertility-associated endometriosis / O polimorfismo do gene do receptor β de estrógeno está relacionado com infertilidade e endometriose associada à infertilidade

OBJECTIVE: To determine the frequency of the estrogen receptor b gene (ERβ) +1730 G/A polymorphism in infertile women with and without endometriosis and controls. SUBJECTS AND METHODS: Case-control study that included 136 women with endometriosis, 69 women without endometriosis and 209 fertile women as controls. The ERβ gene + 1730 G/A polymorphism was identified by RFLP-PCR (Restriction Fragment Length Polymorphism - Polymerase Chain Reaction). RESULTS: Genotypes GG, GA and AA of the ERβ gene presented frequencies of 60.3 percent, 38.2 percent and 1.5 percent, respectively, in the women with endometriosis (p < 0.0022). Of the infertile women without endometriosis, 63.8 percent presented the normal homozygous genotype GG, 30.4 percent the GA heterozygous genotype, and 5.8 percent the homozygous mutated genotype AA (p < 0.0275). In the control group, 77.5 percent presented the normal homozygous genotype GG, 21.1 percent the heterozygous genotype GA, and 1.4 percent the homozygous mutated genotype AA. CONCLUSION: The data suggest that the estrogen receptor β gene (ERβ) +1730 G/A polymorphism can be associated with risk of infertility and endometriosis-associated infertility.

OBJETIVO: Determinar a frequência do polimorfismo +1730 G/A do gene do receptor beta de estrógeno (ERβ) em mulheres inférteis com e sem endometriose e controles. SUJEITOS E MÉTODOS: Estudo caso-controle que incluiu 136 mulheres com endometriose, 69 mulheres sem endometriose e 209 mulheres férteis como controles. O polimorfismo ERβ + 1730 G/A foi identificado por RFLP-PCR (Restriction Fragment Length Polymorphism - Polymerase Chain Reaction). RESULTADOS: Os genótipos GG, GA e AA do polimorfismo ERβ + 1730 G/A apresentaram frequência de 60,3 por cento, 38,2 por cento e 1,5 por cento, respectivamente, nas mulheres com endometriose (p = 0,0022). Das mulheres inférteis sem endometriose, 63,8 por cento apresentaram o genótipo homozigoto normal GG, 30,4 por cento o genótipo heterozigoto GA e 5,8 por cento o genótipo homozigoto mutado AA (p = 0,0275). No grupo controle, os genótipos GG, GA e AA apresentaram frequência de 77,5 por cento, 21,1 por cento e 1,4 por cento. CONCLUSÃO: Os dados sugerem que o polimorfismo ERβ +1730G/ pode estar associado ao risco de infertilidade e infertilidade associada à endometriose.

Insuficiência ovariana precoce em mulheres submetidas a tratamento contra câncer de mama: alternativas para preservação da fertilidade / Precoce ovarian insuficience in women submitted to breast cancer treatment: alternatives for fertility preservation

O câncer de mama é o segu ndo tipo de câncer mais frequente no mundo e o mais comum entre as mulheres, sendo responsável, a cada ano, por 22% dos casos novos de câncer em mulheres, além de representar 30% dos tumores malignos que ocorrem na idade reprodutiva. Nas últimas décadas, houve uma melhora nas taxas de sobrevida devido ao aumento de consciência sobre doenças da mama e programas de triagem bem estabelecidos, o que levou à detecção precoce e ao melhor tratamento, que inclui o uso liberal de quimioterapia citotóxica adjuvante. Entretanto, o uso de regimes quimioterápicos adjuvantes, juntamente com o aumento do número de mulheres que retardam o primeiro filho para além dos 35 anos, tem resultado numa ampla proporção de pacientes com câncer de mama enfrentando infertilidade, levando à maior procura de ajuda para preservação da fertilidade. Isso se reflete na proliferação de técnicas de reprodução assistida, as quais vão desde as bem estabelecidas clinicamente, como a criopreservação de embriões, até as mais experimentais, como a criopreservação de oócitos e de tecido ovariano. O objetivo do presente estudo foi realizar uma revisão sobre as técnicas disponíveis para preservação da fertilidade nas mulheres submetidas ao tratamento contra câncer de mama.

Breast cancer is the second most frequent type of cancer world wide and most common among women, accounting for each year by 22% of newcases of cancer in women, and it represents 30% of malignant tumors in women of reproductive age. In recent decades, there was an improvementin survival rates due to increased of knowledge about breast diseases and well-established screening programs, that lead to early detection and better treatment, which includes the liberal use of adjuvant cytotoxic chemotherapy. However, the use of adjuvant chemotherapy regimens, with the increasing number of women who delay the first child beyond 35 years, has resulted in a large proportion of patients in reproductive age with breast cancer experiencing infertility. This resulted in an increased demand for assistance for preservation of fertility, which is reflected in theproliferation of techniques to preserve fertility through techniques of assisted reproduction, ranging from well established clinically technique, asembryo cryopreservation, to the most experimental, such as oocytes and ovarian tissue cryopreservation. The aim of this study was to make a review of the available techniques for fertility preservation in women under breast cancer chemotherapy.