Sexual harassment

To the Editor: The Special Article by Phillips and Schneider (Dec. 23 issue)1 addresses what they define as sexual harassment of female doctors by patients. Sexual harassment is usually defined as the creation of a hostile atmosphere or abuse of a position of power in a relationship through sexual behavior or language. Since the relationship between doctor and patient invests the doctor with most of the power, it seems intrinsically contradictory to define the behavior described by Phillips and Schneider as harassment. The puritanical attitude that all sexual language and behavior constitute harassment has impaired the effectiveness of the medical. © 1994, Massachusetts Medical Society. All rights reserved.SCOPUS: le.jinfo:eu-repo/semantics/publishe

Genotypes associated with reduced activity of VKORC1 and CYP2C9 and their modification of acenocoumarol anticoagulation during the initial treatment period.

Item does not contain fulltextThe objective of this study was to investigate the influence of genotypes associated with reduced activity of vitamin K epoxide reductase complex subunit 1 (VKORC1) and cytochrome P450 2C9 (CYP2C9) on anticoagulation with acenocoumarol during the first 6 weeks of treatment. In 1,525 patients from the Rotterdam Study who were started on anticoagulation therapy with acenocoumarol, the presence of VKORC1 1173C>T and CYP2C9*2 and *3 allele variants was determined. The first international normalized ratio (INR) after initial standard dose, risk of overanticoagulation, and mean dosage at the end of the initiation period were compared between genotypes. The initial standard dosage significantly increased the risk of severe overanticoagulation by 85% for each additional VKORC1 T-allele present. At the end of the initiation period, each VKORC1 T-allele present was shown to decrease the required acenocoumarol dosage by 5.1 mg/week, while each CYP2C9 variant allele present reduced the required dosage by 1.8 mg/week. Our conclusion was that an initial standard dosing regimen with acenocoumarol increases the risk of severe overanticoagulation in patients with variant alleles of the VKORC1 and CYP2C9 genes