The effects of selective serotonin reuptake inhibitors on male and female fertility: a brief literature review.

Objective: The aim of this review was to determine whether selective serotonin reuptake inhibitors (SSRIs) affect the ability to conceive in men and women of reproductive age, as well as to find out whether there are certain differencies between them in terms of effects on fertility. Methods: Our review was based on systematic search of literature in four online databases: Medline (PubMed), Scopus, Web of Science and SCIndex (Serbian Citation Index). Results: Several clinical studies reported that SSRIs can decrease the number and viability of sperm, and cause a disruption of their morphological structure. Regarding the effect of these antidepressants on female fertility, some experimental findings suggest that paroxetine and escitalopram may have a negative effect on the ability to conceive due to their stimulatory effect on fallopian tube motility. However, several observational studies favor the use of SSRIs in women with depression/anxiety undergoing in vitro fertilization (IVF) given their efficiency in suppressing these unpleasant symptoms without a relevant negative impact on IVF outcomes. Conclusions: SSRIs should be avoided male patients of reproductive age who wish to conceive, while the use of these antidepressants seems to be justified in women with depression or anxiety who have undergone IVF.Key pointsSSRIs could cause dose and duration-dependent reversible adverse effects on male fertility parameters.In depressed or anxious male patients of reproductive age who wish to conceive mirtazapine or bupropion should be used because of their lower potential to cause sexual side effects.The results of certain experimental studies indicate that paroxetine and escitalopram may have a negative effect on the fertility of female patients.The use of SSRIs in women with depression or anxiety who have undergone IVF seems to be justified, because these psychiatric disorders reduce the likelihood of becoming pregnant.

Risk factors for potential drug-drug interactions in patients with myasthenia gravis.

OBJECTIVES: Our aim was to determine risk factors for and frequency of potential drug-drug interactions (pDDIs) among hospitalized patients with myasthenia gravis (MG). METHODS: This was a retrospective cross-sectional study of the-first time hospitalized MG patients or patients hospitalized because of the exacerbation of MG at the Neurology Clinic of the Clinical Center of Serbia, Belgrade. Medical records and discharge summaries of hospitalized MG patients over a 10-year period were reviewed. The pDDIs were identified by means of Micromedex, and multivariate regression methods were used to reveal potential predictors of number of pDDIs per patient. RESULTS: The study included 687 patients with MG. In total, 2041 pDDIs were detected in 608 (88.5%) patients. Among the discovered pDDIs, 329 different pDDIs were observed. The most frequent pDDIs were pyridostigmine-prednisone (487patients/70.9%) and aspirin-prednisone (90 patients/13.1%) classified as moderate, and enalapril-potassium chloride (71patients/10.3%) classified as major pDDI. Five drugs (aspirin, insulin, prednisone, cyclosporine, metformin) were responsible for 22.6% of different pDDIs. Dyspnea, generalized form of MG, diabetes mellitus, hypertension, total number of drugs-used, use of antiplatelets were identified as the relevant risk factors for total number of pDDIs (R2 = 0.626,F = 73.797, p < 0.001), while age of patients and history of cancer were inversely correlated with such an outcome. CONCLUSION: The frequency of the pDDIs in hospitalized MG patients is high, and adversely influenced by dyspnea, generalized MG, diabetes mellitus, hypertension, total number of drugs-used and use of antiplatelets.

Mapping differential elemental accumulation in fish tissues: assessment of metal and trace element concentrations in wels catfish (Silurus glanis) from the Danube River by ICP-MS.

Studies of metal accumulation in fish are mainly focused on the muscle tissue, while the metal accumulation patterns in other tissues have been largely neglected. Muscle is not always a good indicator of the whole fish body contamination. Elemental accumulation in many fish tissues and organs and their potential use in monitoring programs have not received proper attention. In the present study, As, Cd, Co, Cr, Cu, Fe, Hg, Mn, Ni, Pb, Se, and Zn concentrations were assessed by inductively coupled plasma mass spectrometry (ICP-MS) in the following 14 tissues of the wels catfish (Silurus glanis) from the Danube River: muscle, gills, spleen, liver, kidneys, intestine, gizzard, heart, brain, gallbladder, swim bladder, vertebra, operculum, and gonads. A high level of differential elemental accumulation among the studied tissues was observed. The maximum overall metal accumulation was observed in the vertebra, followed by the kidneys and liver, with the metal pollution index (MPI) values of 0.26, 0.25, and 0.24, respectively. The minimum values were observed in the gallbladder, muscle, brain, and swim bladder, with MPI values of 0.03, 0.06, 0.07, and 0.09, respectively. Average metal concentrations in the fish muscle were below the maximum allowed concentrations for human consumption. The mean As, Cd, Pb, Cu, Fe, and Zn concentrations in the muscle were 0.028, 0.001, 0.001, 0.192, 3.966, and 3.969 µg/g wet weight, respectively. We believe that the presented findings could be of interest for the scientific community and freshwater ecosystem managers. There is a need for further research that would assess less studied tissues in different fish species.

Risk factors for intraoperative arrhythmias in general surgery patients operated under general anesthesia: our one-year experience.

AIM: To analyze the importance of previously un-investigated (or not completely investigated) potential risk factors for new-onset intra-operative arrhythmias in general surgery patients, operated under general anesthesia. METHODS: In this case-control study the population consisted of all patients who underwent elective non-cardiovascular, non-thoracic surgery under general inhalation anesthesia during the period of 12 months in a secondary care hospital in Foca, Republic of Srpska, Bosnia and Herzegovina, and were classified according to the American Society of Anesthesiologists classification to class I or II. Cases (n=57) included patients with at least one episode of ECG-recorded arrhythmia during general anesthesia, and controls (n=90) were sex and age matched. RESULTS: Significant association was found between intra-operative arrhythmias and history of cardiac arrhythmias in the last five years (adjusted OR 43.5; CI 2.3, 820.1; p = 0.012). Synergistic effects on intra-operative arrhythmias were found for history of cardiac arrhythmias and history of abnormal ECG, as well as for history of cardiac arrhythmias and use of propofol for induction of anesthesia. CONCLUSION: The non-cardiovascular, non-thoracic surgery patients with history of arrhythmias and ECG abnormalities deserve special attention, correction of electrolyte disturbances and avoidance of propofol for induction of general anesthesia.

Evaluation and validation of two different chromatographic methods (HPLC and LC-MS/MS) for the determination and confirmation of ochratoxin A in pig tissues.

This study was undertaken to compare two different analytical methods for the determination and confirmation of ochratoxin A (OTA) in blood serum, kidney and liver of pigs. Sample clean-up was based on liquid-liquid phase extraction. The detection of OTA was accomplished with high-performance liquid chromatography (HPLC) combined either with fluorescence detection (FL) or electro spray ionization (ESI+) tandem mass spectrometry (MS-MS). Comparative method evaluation was based on the investigation of 90 samples of blood serum, kidney and liver per animal originating from different regions of Serbia. The analytical results are discussed in view of the respective method validation data and the corresponding experimental protocols. In general, analytical data obtained with (LC-MS-MS) liquid chromatography electro spray tandem mass spectro metry detection offered comparable good results at the sub-ppb concentration level. The results indicate that the liquid chromatography electro spray tandem mass spectrometric (LC-MS/MS) method was more specific and sensitive for the analysis and confirmation of ochratoxin A in pig tissues then high pressure liquid chromatography (HPLC) method after methylation of OTA.

Toxicological assessment of toxic element residues in swine kidney and its role in public health risk assessment.

In order to ensure the safety of consumers in Serbia the prevalence of toxic elements (As, Cd, Hg, Pb) in swine kidney collected from three different areas in Serbia (n = 90) was determined by atomic absorption spectrometry. Also, in order to find information on the effects of accumulation of toxic elements on swine kidney, pathohistological examination of the kidneys was performed. The presence of mercury was found in 33.3% of kidney samples in the range of 0.005-0.055 mg/kg, while the presence of cadmium was detected less often (27.7%) but in larger amounts (0.05-1.23 mg/kg). The presence of arsenic was found only in one sample, while no lead was found. The results of the metal-to-metal correlation analysis supported there were the result of different sources of contamination. Pathohistological examination of kidneys confirms tubulopathies with oedema and cell vacuolization. In addition, haemorrhages and necrosis of proximal kidney tubule cells were found. This study demonstrates that toxic elements in Serbian slaughtered pigs are found at levels comparable to those reported in other countries, and consequently the levels reported in this study do not represent a concern from a consumer safety point of view. The lack of a strong correlation between histopathological changes and the incidence of toxic elements found in this study might be explained as the result of synergism among toxic elements and other nephrotoxic compounds which enhance the toxicity of the individual toxins even at the relatively low mean concentrations observed in this study.