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The purpose of this paper is a systematic review of articles and research in the context of drugs used and suicide in elderly patients. Suicide in the elderly may be much more frequent than in the younger population. In addition to factors such as mental illness, dementia, deteriorating health, or problems with adapting to old age, the impact of chronic and reliever medications in this age group should also be considered. The greatest challenge of pharmacotherapy in the elderly is polypharmacy, drug interactions, different metabolism, pharmacokinetics and pharmacodynamics of the drugs used, as well as the side effects appearing in chronic therapy. In elderly patients, strong groups of drugs such as benzodiazepines and opioids are used extensively and sometimes too often. These drugs can cause addiction and overdose. Prescribing benzodiazepines alone carries a high risk of suicide. On the other hand, opioids often lead to addiction and abuse of these drugs, which may be associated with the development of respiratory depression. According to estimates by the Centers for Disease Control and Prevention (CDC), suicide accounts for approximately 7% of all opioid overdose deaths. Therapy should be carefully selected with regard to the use of other medications, drug interactions, and possible dependence and drug abuse by patients.The use of some classes of drugs in the elderly requires increased vigilance and control in the context of depression and episodes of suicide attempts. Drugs such as B blockers, digitalis glycosides, NSAIDs, opioids, ACEIs, calcium channel blockers, corticosteroids, diuretics, levodopa, and benzodiazepines can cause symptoms of depression. Older people are more susceptible to side effects of drugs, for example because of polypharmacy and the chronicity of treatment.

Introduction and purpose: Ruptured intracranial aneurysm causes a life-threatening subarachnoid hemorrhage, which is characterized by a high percentage of disability and mortality. As of today, we have two main treatments for this condition: microsurgical clipping and endovascular coil embolization. The aim of the study was to evaluate both treatment modalities, assess their limitations and compare them in terms of mortality, postoperative condition/complications and long-term patient’s condition Materials and methods: This study was based on the analysis of medical databases’ analysis. Results: Four randomized controlled trials, one guideline and one meta-analysis were reviewed. The results did not significantly differ between the studies. They proved that endovascular coiling technique showed fewer poor outcomes, deaths or dependency, one year after the treatment. These differences decreased in the following years. The microsurgical clipping was more effective at total obliteration of the aneurysm but was not related to better quality of life for those patients. Both techniques also did not differ in terms of the patients’ distant long-term neuropsychological state. Conclusion: Endovascular coiling embolization is still a rapidly developing technique that may be the main treatment modality in the future. However, at this point, both treatments have advantages and limitations. It is crucial to assess every patient individually.

Introduction and purpose: Urinary tract infection (UTI) is very common, mostly bacterial infection in childhood. UTI may affect the lower urinary tract or the upper urinary tract. Infection typically require antibiotics for treatment. Brief description of the state of knowledge: The prevalence of urinary tract infection is between 2 and 8% and it is more common in female, infants and uncircumcised male infants. Most paediatric UTIs are caused by Gram negative bacteria Escherichia coli (E.coli). Symptoms of this infection are nonspecific and may be confused with signs of other clinical conditions. The most common symptoms are suprapubic pain, back pain, dysuria, urinary frequency and systemic symptoms such as fever, vomiting, lethargy. Antibiotics are the standard treatment for urinary tract infections. Conclusion: This article reviews basic informations, epidemiology, clinical presentation, diagnosis and treatment of urinary tract infection.

Introduction and purpose: Acne is a diverse, multifactorial disease. A specific subtype of acne is mechanical acne, which is recurrent acne that occurs at the site of physical trauma to the skin due to repeated mechanical or frictional obstruction of the pilosebaceous outlet. The aim of the article is to present the available information on the pathophysiology, clinical picture, diagnosis, and treatment of mechanical acne. Description of the state of knowledge: Mechanical acne may be a complication of preexisting acne or can occur independently in a patient with no previous history of acne. Inflammatory acneiform papules and pustules result from friction from repetitive rubbing, stretching, squeezing, pressure, tension, pinching, or pulling of the skin accompanied by heat, pressure, moisture, and occlusion. Mechanical stress on the skin can be triggered by any pressure or friction inducing physical factors, such as tight clothing, sports gear, accessories, medical equipment, seat backs or hands. Mechanical acne most commonly occurs in athletes and develops from wearing tight-fitting clothing, accessories, or equipment. The severity of lesions increases with excessive sweating and overheating of the skin. In the era of the COVID-19 pandemic, the incidence of mechanical acne caused by prolonged wearing of protective masks ("maskne") has also increased. Summary: The most important aspect of mechanical acne treatment and preventions is the identification and elimination (or at least minimization) of the inciting factors. Supporting activities include maintaining cleanliness, proper skin care and applying topical acne treatments. Some patients require oral pharmacotherapy. Preventing recurrence of mechanical acne is important as it can leave unsightly scars and skin discoloration.

Endometriosis is a common disease that occurs in 6-10% of women of reproductive age. The disease is often associated with chronic pelvic pain and infertility. Endometriosis is an inflammatory disease and is estrogen dependent. Its definition is the presence of endometrial-like tissue outside the uterus. The etiology of the disease remains unclear. It is believed that a variety of immunological, genetic, hormonal, and environmental factors may be responsible for the development of endometriosis. Surgical confirmation of the presence of endometrial tissue outside the uterus is necessary for the diagnosis of endometriosis. For this reason, endometriosis is considered to be underdiagnosed. Currently, available treatments have many limitations and cause many side effects during their long-term use. For this reason, other treatment and prevention methods for this disease are being sought. Research on the influence of dietary factors on endometriosis allows concluding that diet and particular food ingredients can be considered a factor reducing the risk of endometriosis. Therefore, understanding the role of nutrition in the development of endometriosis is of great importance for the development of effective guidelines related to the prevention of this disease. Therefore, we have reviewed the available literature related to the impact of individual components of the daily diet on the risk of developing endometriosis. Omega-3 fatty acids, dairy products, and soy in particular appear to be promising dietary factors that could potentially reduce the risk of endometriosis. Further research is needed to solidify this knowledge.

Introduction and purpose: Hypothyroidism is a common disorder of the endocrine system in which the thyroid gland is not able to produce enough of certain thyroid hormones. Brief description of the state of knowledge: The prevalence of hypothyroidism is between 1 and 6% and it is more common in women and older adults. Untreated significantly decreases the quality of life and increases mortality. Symptoms of hypothyroidism are nonspecific and may be confused with signs of other clinical conditions. The most common symptoms are chronic tiredness and fatigue, weight gain, cold intolerance, dry skin and hair loss. Serum thyroid-stimulating hormone (TSH) is the primary screening test for thyroid disfunction. Standard treatment for hypothyroidism consists of thyroid hormone replacement called levothyroxine. Conclusion: This article reviews basic informations, clinical presentation, diagnosis and treatment of hypothyroidism.

Introduction and purpose: Multisystem inflammatory syndrome (MIS) in children and adolescents is an excessive inflammatory response syndrome after storage of COVID-19, which can lead to serious complications. The course of the disease may vary from mild to requiring intensive therapy. In our review, we try to draw attention to the importance of cardiological complications and present the currently used treatment. In medical professionals vigilant should be increased in order to early recognize this disease, and to be alert to the need for early cardiological evaluation and follow-up. Description of the state of knowledge: MIS can cause myocardial dysfunction, shock, coronary artery lesions, pericardial effusion, valvulitis, and electrophysiological abnormalities. Patients may require intensive medical care, careful fluid therapy, the use of pressor amines and, in rare cases, extra corporeal membranę oxygenation (ECMO). Coronary aneurysms are the most important long-term complication of MIS. They occur in up to 25% of patients. Most abnormalities are retreated within 2-3 months. MIS has a good prognosis with a mortality rate of 2%. Summary: Cardiac complications, although serious, rarely require urgent intervention. Patients with diagnosed dilatation of the coronary arteries or aneurysm require intensive medical review in the initial period of recovery. The control must include a medical examination, ECG, ECHO and evaluation of markers of myocardial damage. Patients who have undergone MIS should be released from physical education for at least 6 weeks or until the changes in the coronary arteries disappear. The lesions resolve spontaneously in 2-3 months in most patients and do not recur, suggesting the possibility of waiving long-term patient follow-up.

Introduction and purpose: Sarcoidosis is a chronic, multi-system inflammatory disorder of unknown etiology. Due to the varied clinical picture of patients, the diagnosis of the disease is complicated, especially when the heart is affected.The aim of this article is to review the available diagnostic tools used for the diagnosis, evaluation and monitoring of patients with suspected cardiac sarcoidosis. Description of the state of knowledge: Sarcoidosis may affect any organ, but in particular lungs, skin, lymph nodes, eyes, liver and spleen. The most common manifestations are persistent cough, skin changes, visual disturbances, peripheral lymphadenopathy, fatigue and incidental abnormal chest radiograph. Cardiac sarcoidosis, occurring in about 5% of patients, is clinically significant with a wide range of symptoms including conduction abnormalities, ventricular arrhythmias, heart failure and sudden death. The diagnosis of cardiac sarcoidosis is challenging and often requires a combined approach using clinical data and advanced imaging. Invasive and non-invasive diagnostic tests are helpful in assessing the severity of heart involvement, with non-invasive tests becoming increasingly important, due to low sensitivity (30%) and high complication rate of endomyocardial biopsy for the diagnosis of cardiac sarcoidosis. Summary: Sarcoidosis significantly increases the mortality of patients and furthermore causes impaired quality of life and disability. Attempts to accurately assess the development of disease provide a more comprehensive and personalized care for patients. Especially cardiac sarcoidosis, as a potentially life-threatening localization, requires early diagnosis and appropriate treatment.

Introduction: Androgen insensitivity syndrome (AIS) is an inherited disorder of sexual development caused by mutations in the androgen receptor encoding gene. Case report: A female patient born in 1984, at the age of 17, was diagnosed with complete androgen insensitivity syndrome, during the diagnosis of primary amenorrhea. She was assigned grade 7 in the Quigley scale. Cytogenetic analysis showed a 46 XY karyotype. Gynecological examination revealed a blind ending vagina and a lack of uterus. Physical examination revealed normal breast development and scanty pubic and axillary hair. The patient kept seeing herself as a woman. At the age of 18, the patient underwent laparoscopic gonadectomy. After the procedure, the patient was under medical supervision and was taking orally 1 mg of estradiol daily. At the age of 24 patient was diagnosed with. The patient received sodium alendronate and ibandronic acid. The level of FSH was 35.50 mlU / ml and LH was 13.05 mlU/ml. Discussion: Quigley grades 6 and 7 correspond to complete androgen insensitivity. The genitals are completely feminized and newborns at birth are assigned as females. The diagnosis is usually established during the diagnostics of primary amenorrhea. CAIS is associated with high risks of gonad carcinogenesis and therefore a gonadectomy must be performed. Hormone replacement therapy (HRT) is required after gonadectomy in order to maintain secondary sexual characteristics. Due to the high risk of osteoporosis patient requires calcium and vitamin D supplementation and bone density control. The prognosis is good, and gonadectomy and HRT usually give satisfactory long-term results.

Introduction and purpose: Acute pharyngitis and tonsillitis is the most common reason why people want to visit their primary care physician. Viruses are the most common cause of acute pharyngitis and acute tonsillitis in children and adults. The patient complains about pain with sudden onset and throat irritation, pain on swallowing, fever and headache, and in children also abdominal pain, nausea and vomiting. Brief description of the state of knowledge: Most acute tonsillopharyngitis is due to rhinoviruses (35%), influenza (30%), RSV and parainfluenza. Bacteria causes 30% of the infections and S. pyogenes is the most common cause. Viral infections are seasonal. S.pyogenes infection is most often in winter and early spring. Changes in the pharyngeal mucosa look similar in both bacterial and viral etiologies. Because of that, scales have been developed to assess the probability of a bacterial infection. The most used is Centor / McIsaac scale. The gold standard of diagnostics is throat swab culture. In the treatment of streptococcal pharyngitis and tonsillitis, penicillins are used as first-line treatment. Antibiotic treatment reduces infectivity, lowers the risk of rheumatic fever and made symptoms disappear two days earlier. Tonsillectomy does not reduce the number of recurrent pharyngitis and tonsillitis, therefore it cannot be recommended. Conclusion: Acute tonsillopharyngitis can result in many complications, the most serious of them is rheumatic fever. Therefore, it is very important to properly diagnose and use antibiotic therapy when necessary.

Introduction: Androgen insensitivity syndrome (AIS) is an inherited disorder of sexual development caused by mutations in the androgen receptor encoding gene. Case report: A female patient born in 1984, at the age of 17, was diagnosed with complete androgen insensitivity syndrome, during the diagnosis of primary amenorrhea. She was assigned grade 7 in the Quigley scale. Cytogenetic analysis showed a 46 XY karyotype. Gynecological examination revealed a blind ending vagina and a lack of uterus. Physical examination revealed normal breast development and scanty pubic and axillary hair. The patient kept seeing herself as a woman. At the age of 18, the patient underwent laparoscopic gonadectomy. After the procedure, the patient was under medical supervision and was taking orally 1 mg of estradiol daily. At the age of 24 patient was diagnosed with. The patient received sodium alendronate and ibandronic acid. The level of FSH was 35.50 mlU / ml and LH was 13.05 mlU/ml. Discussion: Quigley grades 6 and 7 correspond to complete androgen insensitivity. The genitals are completely feminized and newborns at birth are assigned as females. The diagnosis is usually established during the diagnostics of primary amenorrhea. CAIS is associated with high risks of gonad carcinogenesis and therefore a gonadectomy must be performed. Hormone replacement therapy (HRT) is required after gonadectomy in order to maintain secondary sexual characteristics. Due to the high risk of osteoporosis patient requires calcium and vitamin D supplementation and bone density control. The prognosis is good, and gonadectomy and HRT usually give satisfactory long-term results.

Introduction and purpose of the work: Hoarseness is a symptom of a disease characterized by a hoarse, tense or hoarse voice resulting from disturbance of the vibration of the vocal folds. It is a common symptom of the disease in patients during medical consultations in primary health care, and the causes of its occurrence can be varied. State of knowledge (brief description): Treating hoarseness depends on what causes it. For this reason, during the diagnosis, various causes that may be the cause of hoarseness should be taken into account, such as infections, structural changes caused by the use of the voice organ, psychogenic causes, autoimmune diseases, systemic diseases or neoplastic diseases. Summary: In-depth diagnosis and an interdisciplinary approach are necessary to identify the cause of chronic hoarseness and initiate effective treatment.

Introduction and purpose of the work: Urinary incontinence (UI) is a common problem among women and the incidence increases with age. It is estimated that about 50% of women will be affected by this problem. There are 5 types of urinary incontinence: exercise, pressure, mixed, overflow and functional. Stress UI is the most common cause among young women, while stress UI is the second most common cause among older women. The widespread use of this phenomenon makes it a significant economic burden. State of knowledge (brief description): Due to the different types of UI and its many causes, treating this disorder becomes a significant challenge. It is important to use combination therapy, starting with pelvic floor muscle strengthening exercise, lifestyle modification, weight loss, and smoking cessation, followed by drug therapy and surgery as necessary. Summary: Currently, many drugs are used in the treatment of urinary incontinence, with different mechanisms of action, which allow the treatment of various types of UI, but pharmacotherapy often does not bring the expected benefits. Surgical treatment appears to be a promising form of treatment, but more research is needed on the long-term effects.

Introduction and purpose of the work: Obesity is a chronic disease that leads to many complications. Almost a third of the world's population is now classified as overweight or obese. This is a huge global problem. The base of treatment is diet and physical activity, but fortunately nowadays we also have pharmacological and surgical treatment - which are increasingly used. The aim of this study is to draw attention to obesity disease which may lead to serious complications and compare available pharmacological and surgical treatment. State of knowledge (brief description): Treating obesity is a difficult and often multidisciplinary challenge. Currently many drugs with different mechanisms and different efficiencies has been approved for treatment. All of them show efficiency, but the available studies show that surgical treatment produces better results than pharmacological treatment. Summary: We currently have a huge range of obesity treatment options available. Surgical treatment produces better results than pharmacological treatment. Nevertheless, not every patient qualifies for bariatric surgery. Pharmacological methods are also effective. The treatment method should be individually selected for the patient.

Introduction and purpose: Cardiovascular diseases (CVD) are the leading cause of death worldwide. The classic cardiovascular risk factors include age, gender, obesity, diabetes, hypertension, dyslipidemia, smoking and genetic factors. Some dermatological disorders are also potential risk factors for the development of CVD. The aim of the study is to review recent knowledge on the impact of dermatological diseases on cardiovascular risk. Description of the state of knowledge: The relationship between skin diseases and cardiovascular risk is influenced by various common dependencies such as: shared pathophysiological basis of disorders, risk factors, presence of a chronic inflammatory process, genetic susceptibility and environmental influences. Increased cardiovascular risk has been reported for several dermatological conditions, including psoriasis, systemic lupus erythematosus, systemic sclerosis, pemphigus, hidradenitis suppurativa, rosacea, atopic dermatitis. Chronic systemic inflammation, typically present in skin conditions, is a cardiovascular risk factor, because inflammation accelerates atherosclerosis, and furthermore may predispose patients to the development of metabolic syndrome, insulin resistance and diabetes mellitus. In patients who are initially metabolically unbalanced, these processes may be even more intense. Cardiovascular disorders, the frequency of which increases in patients with skin diseases, include atherosclerosis, coronary artery disease, ischemic heart disease, cardiac dysfunction, arrhythmias, heart failure, cerebrovascular disease (stroke, TIA) and peripheral arterial disease. Summary: Many cutaneous disorders, in addition to significantly increasing cardiovascular morbidity and mortality, also reduce the patient's quality of life. The cooperation of dermatologists and cardiologists in the care of patients with dermatological diseases is crucial for the proper treatment of the disease and prevention of cardiovascular complications.