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The basis of the discovery process for a new pharmaceutical product is in understanding the mechanism of action of a particular disease or processes in the organism related to the disease and/or its symptoms. The essence of a pharmaceutical is in the active ingredient capable of affecting processes within the organism beneficially. The discovery process includes a particular sequence of activities of various profiles of experts, about which various authors agree. The history of pharmaceutical industry (and pharmacy) is measured from one discovery of an innovative drug or approach to treatment of a particular disease to the next one. The cost of pharmaceutical products is one of the key causes of controversy related to this industry. Numerous cultures have proverbs expressing the opinion that health is priceless or that health is the greatest wealth. What if health does have a price? One of the basic premises of marketing is that price should reflect consumer value.

We report a case of a 63-year-old male who has been admitted to the Emergency department with nonspecific symptoms. Lithium toxicity was not at first recognized. When we obtained sufficient information about previous medication and medical history, we measured lithium levels found to be 1.46 mmol/L. Although the value of lithium was mildly elevated, nephrotoxicity was produced leading to severe renal insufficiency and neurological symptoms. Hemodialysis was started, and we succeed to treat the patient without squeals. This case illustrates some of the factors that lead to lithium toxicity as well as the need to consider lithium toxicity to the differential diagnosis of a patient presenting with renal insufficiency with or without change in mental status and neurologic symptom.

Accumulating evidence suggests that the nongenomic cardiovascular actions of aldosterone are produced by varied cellular pathways and mediated by a multitude of messenger systems including the reactive oxygen and nitrogen species. Considering the involvement of the oxidative and nitrosative stress in the pathways leading to the activation of the angiotensin — aldosterone system, in the current study we tried to evaluate the functional interactions between aldosterone, angiotensin II and antioxidants in isolated vascular smooth muscle of aortic rings from rats. Our data provide additional arguments that the nongenomic actions of aldosterone on aortic smooth muscle cells of rats are a question of cross-talk and balance between its rapid vasoconstrictor and vasodilator effects, as result of the activation of reactive oxygen species in the first case and of nitrogen species in the second. In this way, it seems that at low ambient oxidative stress, aldosterone promotes nitric oxide (NO) production and vasodilatation, while in situations with increased oxidative stress the endothelial dysfunction and detrimental effects induced by vasoconstriction will prevail. Thus, aldosterone could be considered both “friend and foe”. This could be relevant for the ways in which aldosterone damages cardiovascular functions and could lead to significant therapeutic improvements.

We present the first documented case of laparoscopically assisted resection of a jejunal diverticulum. A 53 year old gentleman presented with right sided abdominal pain along with raised inflammatory markers. Computed tomography revealed multiple diverticula in the proximal jejunum, one of which was inflamed. The patient was managed conservatively, and subsequently underwent an elective laparoscopically assisted resection of a jejunal diverticulum with no complications.

Colonic diverticulosis is a condition which causes extensive bleeding of the lower gastrointestine in 40–50% of cases. In particular, right-sided diverticulosis, although uncommon requires lifesaving colectomy. Transfusion related acute lung injury (TRALI) is a transfusion reaction, which can occur after administration of various blood products. Although life threatening, it can be completely reversed usually within 72 to 96 hours. Here, we report a case of a young Caucasian male hospitalized due to severe anemia, hematochezia and extensive blood loss, all due to lower gastrointestinal hemorrhage from right-sided diverticulosis. These conditions were overlooked endoscopically and diagnosed then treated surgically with the right-sided hemicolectomy. During postoperative course, four hours after the last transfusion, patient developed fever, hypoxia and noncardiogenic pulmonary oedema, but made complete recovery through aggressive oxygen support within 96 hours. The aim of this case was to review current literature, to draw attention to a serious and under-diagnosed transfusion reaction, as well as discuss possible explanations for the diagnostic difficulties that occurred in this case.

Multivariate statistical analysis is performed using clinical data characterizing the state of patients subject to early enteral (EEN) and pareneteral (PN) nutrition after major gastrointestinal surgery. Several patterns of linkage, between the clinical parameters for both groups of observed patients (with mixed (EEN+PN) and with parenteral nutrition only (TPN)), were found and interpreted. Discriminating indices for the internal grouping of patients were found related to the type of nutrition and the clinical status of the patients. It was found that the mixed (enteral and parenteral) nutrition offers better options for the overcoming of the metabolic stress after the surgery.

Spontaneous pneumothorax is most common in adolescents and young adults. Some of them develop contralateral pneumothorax. In this paper, we report the case of a patient with spontaneous contralateral pneumothorax, whose body mass index (BMI) was 18.8 kg/m2. For either chest physicians or thoracic surgeons, follow up with recognition of increased risk of the contralateral pneumothorax is important especially in patients with contralateral bullous lesions and low BMI.

Hematological neoplasms associated with systemic mast cell disease are most frequently of myeloid origin. There are a few reports, however, of systemic mastocytosis (SM) cases associated with lymphoid or plasma cell neoplasms as well. In this report, the authors present a case of SM (with D816V mutation in the c-KIT gene) associated with JAK2 V617F mutation negative essential thrombocythemia. The leading symptom of the 78-year-old female was recurring hydrothorax that responded only to interferon alpha therapy. During the first year of therapy, the patient developed insulin-dependent diabetes and hypothyroidism. The hematological workup also revealed IgG kappa monoclonal gammopathy that was non-progressive in the following next three years. Low levels of complements without known clinical significance accompanied the entire picture.

Many women suffer from new or worsening anxiety during pregnancy. In this pilot study, we investigated the effect of timing and severity of prenatal state anxiety symptoms on reduced birth weight. We hypothesized that: (1) Women with state anxiety symptoms during mid-gestation would deliver newborns with lower birth weight in comparison to participants with symptoms in early gestation and (2) compared to women with lower anxiety symptoms (< 50th percentile), women with medium-to-high state anxiety symptoms (> 50th percentile) would have lower birth weight offspring. The sample consisted of the first 30 pregnant women who agreed to participate in this pilot study. We assessed anxiety symptoms, using the State-Trait Anxiety Inventory during early and mid-gestation. We obtained birth weight from clinical charts. A hierarchical multiple regression showed that, after controlling for covariates, state anxiety symptoms in mid-gestation were associated with lower infant birth weight [F(9, 7) = 20.30, p<.001]. However, birth weight did not differ as a function of the severity of maternal state anxiety [F(1, 23)=.14, p=.71 and F(1, 24)=1.76, p=.20., respectively]. Clearly, our pilot data need replication. Once statistical significance is established with larger samples, it will be informative to examine the clinical significance of those findings.

The aim of the research was to determine the intestinal carriers of C. difficile in different human population groups in Serbia. The research enrolled 877 persons with formed stools: (newborn children in maternity hospitals for up to two weeks old) (23), group A; children aged from two weeks to two years (121), group B; children aged two to 10 years (54), group C, healthy individuals aged 10 and over (516), group D; patients hospitalized for at least 48 hours (100), group E; staff of the Clinical Center in Nis, Serbia, (63), group F. The toxins A and B of C. difficile were detected by ELISA-ridascreen Clostridium difficile Toxin A/B (R — Biopharm AG, Darmstadt, Germany). The toxin A of C. difficile was detected using ColorPAC Toxin A test (BectonDickinson, New Jersey, USA). Out of the total number of persons (877), the carriers of certain types of toxin-producing strains of C. difficile were distributed as: 6.04% (A−/B−), 1.83% (A+/B+) and 0.11% (A−/B+). In most groups (5/6), the dominance of non-toxigenic (A−/B−) isolates was established, with the rate of carriers 1.75 – 30.43% depending on the group. Toxigenic isolates were prevalent only in the group F in relation to non — toxigenic (7.94% versus 4.76% of persons). In other groups, the carriers of toxigenic strains ranged from 0.00 – 17.45%. The presence of asymptomatic intestinal carriers of C. difficile in the human population, indicate the possible reservoirs and sources of infection.

Over recent years the impact of weather on human health has become more severe, especially for people living in urban areas. Even though many studies have analysed the impact of weather on human mortality, few have quantified the impact of heat on morbidity, including ambulance response calls. In this study, 13,354 calls collected in the city of Florence (Italy) during summer were analyzed by month, day of the week, hour, and time slot of the day. An objective air mass classification was used to classify days and time slots with similar weather characteristics and a multiple variable analysis was applied to evaluate the relationship between emergency calls and weather. A positive trend was observed in the morning and a negative one during the night for all emergency calls, but only for food poisoning and alcoholic diseases. Calls for cardiovascular events increased in the morning and on hot days. Calls for psychiatric disorders rose significantly with temperature during the afternoon. The total number of calls and those for alcoholic diseases rose during the hottest nights. Our results, which show a clear relationship between ambulance response calls, periodicity, and weather, could contribute to an understanding the impact of weather on morbidity.

The objectives of this study were to examine (a) the prevalence of overweight/obesity, (b) the relationship between body mass index (BMI) and body fat percent (BF), and (c) the association between BMI, BF and power output in adult male soccer players. Members of competitive soccer clubs (n=169, aged 22.7±4.2yr) were examined for anthropometric characteristics and body composition, and performed the physical working capacity in heart rate 170 min−1 test (PWC170), a force-velocity test (F-v) and the Wingate anaerobic test (WAnT). Based on international BMI cut-off points, 17.8% (n=30) of participants were classified as overweight. BMI was correlated with BF (r=0.67, p<0.001) and could be predicted based on the equation BF=1.193·BMI-12.24 (standard error of estimate 2.49). BMI and BF were in inverse relationship with mean power during WAnT (r=−0.30, p<0.001; r=−0.47, p<0.001, respectively). BF was also in inverse relationship with PWC170 (r=−0.26, p<0.001) and maximal power of the F-v test (r=−0.18, p=0.020).The prevalence of overweight among participants was lower than what is observed in general population. The findings confirmed previous observations on general population about the negative effect of overweight and fatness on selected parameters of physical fitness.

Background. Globally, general practitioners (GPs) write more than 90% of all antibiotic prescriptions. This study examines the experiences of Lithuanian and Russian GPs in antibiotic prescription for upper respiratory tract infections, including their perceptions of when it is not indicated clinically or pharmacologically. Methods. 22 Lithuanian and 29 Russian GPs participated in five focus group discussions. Thematic analysis was used to analyse the data. Results. We identified four main thematic categories: patients’ faith in antibiotics as medication for upper respiratory tract infections; patient potential to influence a GP’s decision to prescribe antibiotics for upper respiratory tract infections; impediments perceived by GPs in advocating clinically grounded antibiotic prescribing with their patients, and strategies applied in physician-patient negotiation about antibiotic prescribing for upper respiratory tract infections. Conclusions. Understanding the nature of physician-patient interaction is critical to the effective pursuit of clinically grounded antibiotic use as this study undertaken in Lithuania and the Russian Federation has shown. Both physicians and patients must be targeted to ensure correct antibiotic use. Further, GPs should be supported in enhancing their communication skills about antibiotic use with their patients and encouraged to implement a shared decision-making model in their practices.

Different techniques are used for reconstruction of degloving hand or foot injuries, however the best option has not been found yet. In this paper we present two clinical cases when degloving hand and foot injuries were successfully covered with the omental free flap.

Step aerobics is one of the most popular exercises with established benefits to cardiovascular status. This activity is associated with injuries which include patellar or talar chondral lesions, quadriceps tendinopathy, Achilles tendinopathy or tear, shin splints and muscle soreness. The purpose of this case report is to present two step aerobics athletes, suffering from anterior knee pain. We observed that their knee MR examination disclosed only suprapatellar fat pad edema. No other findings were noticed. In addition, we discuss the possible pathogenetic mechanism of this entity which has not been previously reported in the literature.