Background: The therapeutic effect of Lithium as a mono therapy or as an augmenting agent in a variety of medical and psychiatric disorders is under doubt. However, lithium is associated with a number of adverse effects. Method and objective: A review of the literature on lithium use in older adults and a case report presentation. Summary of results: The literature, concerning current uses of Lithium in older patients, especially for patients with neurologic or cognitive impairments is limited due to the lack of well-designed, large clinical trials. Elderly patients are at higher risk to develop neurotoxicity in the course of lithium therapy. We present a case of 66 years old female patient, suffering bipolar disorder, who developed lithium toxicity and was admitted at the gerontopsychiatric department due to a confusional state, tremor and gait abnormality. Lithium toxicity was suspected when sufficient information about previous medical history of lithium therapy has been obtained. Lithium level found to be 1.69mmol/L. The patient has developed intoxication during maintenance therapy with a lithium dosage which had been unchanged for months. Conclusion: Elderly patients require lower doses of Lithium to achieve similar serum concentrations as those in younger adults. Neurotoxicity could be suspected at serum lithium levels which are considered therapeutic in younger adults. When prescribing lithium agents in elderly we should consider age-related changes in pharmacokinetics. The best way to prevent lithium toxicity is to control the serum concentration regularly during therapy.

Introduction: The patients with persistent forms of Helicobacter pylori (HP) infection are refractory to eradication treatment. They receive unsuccessful therapies, experience frequent recurrences and re-infections. One of the main reasons for the development of persistent forms is an inadequate and insufficient treatment. The persistent forms of HP infection create conditions for the maintenance of activity and for the progression of the induced chronic gastritis. In this aspect these cases will be at a higher risk for the development of gastric cancer. The aim of this study is: to monitor and analyze the cases with persistent HP infection and to establish an approach for their management. Clinical material and methods: The study includes 12 patients (8 female and 4 male) at a middle age of 63,7, with a persistent HP infection, who have been observed for a period of five years. Two methods for the detection of HP infection are used – one invasive and one non-invasive. Upper endoscopy with morphological examination was performed. Results: In 9/12 patients HP was unsuccessfully treated for three times, in 2 patients – four times, and in 1 patient – five times. In all patients the initial treatment consisted of a standard triple therapy (STT). In 5 of them STT was conducted twice, with the same regimen for a period of seven days. Two patients received three courses of STT. In four patients an antibiotic resistance was established by means of a cultured assessment. In three cases an HP resistance to Clarithromycine and Metronidazole was demonstrated. Significant gastro-duodenal pathology with atrophic gastritis, intestinal metaplasia, and hyperplastic polyposis was found in all patients. The persistent clinical symptoms had 9 patients. Conclusion: We believe that a devised and proposed step strategy which covers early detection of infection, reliable diagnosis, adequate and successful treatment, and dispensary monitoring, contributes to the prevention of gastric cancer.

JAK2V617F mutation is a well-recognized feature in most Ph-negative myeloproliferative neoplasms (MPNs). An activated bone marrow (BM) angiogenesis has been established in these disorders as well. Consequently, the rational question is to ascertain a possible relation among JAK2 mutation, morphological features and angiogenesis in MPNs bone marrow. Aim: To assess bone marrow microvessel density (MVD), bone marrow cellularity and fibrosis in newly diagnosed patients with BCR-ABL-negative MPNs, and define a correlation between the degree of angiogenesis in the bone marrow and JAK2V617F mutant allele burden. Methods: JAK2 mutational burden was determined by RT-PCR, BM angiogenesis was defined by MVDassessment using anti-CD34 for BM endothelium staining. The BM fibrosis was evaluated according to the Hanover system. The statistical analysis was performed with SPSS 17.0 software. 52 patients with newly diagnosed MPN were included in the study. Results: The distribution of the mutational burden was as follows: 26 patients with polycythaemia vera (PV), 16 patients with primary myelofibrosis (PMF) and 10 patients with essential thrombocythaemia (ET). In patients with PV the homozygosity was found prevalent in frequency whereas in PMF and ET the heterozygous variants were dominant. In all patients a significant positive correlations between JAK2V617F and BM MVD (r=0.306, p<0.002) and between MVD and fibrosis, (r=0.523, p<0.0001), was found.JAK2 correlated positively but borderline with fibrosis. The MVD and JAK2 burden were found in significant negative correlation with the BM cellularity (r=-0.405; p<0.002 and r=-0.431, p<0.0001, resp.). Conclusions: The significant correlation between JAK2V617F, BM angiogenic activity and the fibrosis marks out the JAK2 allele burden as a feasible parameter with prognostic significance for evolution and progression of MPN.

The strength of the bone is a function of its mechanical properties and bone geometry. The probability of the occurrence of femoral neck fracture is associated with both the trauma mechanism and magnitude of the acting forces as well as with the bone quality, the mental state, the incidence of falls, the use of medications, and other factors, the knowledge of which may help for better prevention of this devastating injury.

The incidence of femoral neck fractures, one of the most common traumatic injuries in the elderly increases continuously due to the ageing of population on the planet and urbanization. In terms of global economic instability, increasingly more funds would have to be paid by the health systems for treatment of those fractures. Probably it will be necessary to revise and optimize some current therapeutic standards.