Compared to placebo, treatment with myrtol stand. was well tolerated but evidently superior in terms of efficacy, resulting in a more rapid and more complete recovery; although well comparable with the other active treatments, myrtol stand. tended to be superior to cefuroxime and ambroxol for several ancillary criteria. Myrtol stand. is a well-evidenced alternative to antibiotics for acute bronchitis without specified infective agent, without the risk to promote the development of bacterial resistance.

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Background: Intramuscular long acting testosterone injections are widely used, convenient form of androgen replacement in patients with hypogonadism. Aims: To evaluate the long term effects of parenteral long acting testosterone replacement on patients commenced on treatment in years 2006-2014 and adherence to monitoring undertaken by primary care after discharge from specialist service. Method: We reviewed the results of 64 patients (mean age 58.5 years). Indications for starting testosterone treatment were both primary and secondary hypogonadism. Patients were followed up for an average of 4.33 years (between 3 months and 9 years). Total follow up time was 277.2 patient-years. 53 patients continued with treatment, 7 patients discontinued the treatment and 4 patients died during the follow up period time. We followed the changes of the following blood tests: alanine transaminase (ALT), aspartate transaminase (AST), total cholesterol (TC), haematocrit (HCT), haemoglobin (Hb), prostate-specific antigen (PSA) and testosterone. Adherence to the advised monitoring intervals of these parameters was reviewed. Results: Over the follow up period time the mean changes in the results were as follows: ALT +1.05 IU/L (+5%), TC -0.41 mmol/L (-8.1%), HCT +0.030 (+7.0 %), Hb +7.06 g/L (+4.9%), PSA +0.91 µg/L (+96%), testosterone +19.2 nmol/L (+206%). Adherence to the monitoring intervals advised by our specialist service was: ALT 78.9%, HCT and Hb 80.3%, PSA 52.2% and testosterone 66.3%. Conclusions: Long acting parenteral testosterone replacement in our group of patients resulted in insignificant changes in liver function tests, haematocrit and haemoglobin. We observed a rise in PSA levels, although the mean value remained in the normal range. Reduction of TC levels was noticed and testosterone replacement is reported in the literature to have no adverse effects on lipid profiles. Adherence to the advised monitoring intervals, especially for PSA and testosterone levels needs further attention. METHODDuring the follow up time -out of 64 patients: -53 patients continued with the treatment, -7 patients discontinued the treatment -4 patients died during the follow up period time. We reviewed the adherence to the advised monitoring intervals of the following parameters by primary care after discharge from specialist service. DISCUSSIONDuring the follow up period (on average 4.3 years), on long acting parenteral testosterone replacement we have not observed significant changes in the levels of alanine transaminase (ALT), aspartate transaminase (AST). Thich is consistent with the reports in the literature, as the unfavorable hepatic effects do not appear to be associated with intramuscular injections 1 . We observed only slight increase in the levels of both haematocrit (HCT) and haemoglobin (Hb), 7% and 4.6% respectively. Out of total of 371 checks of HCT, only 5.1 % were in the polycythaemic range (HCT above 51%), which is lower than observed elsewhere 5 . Reduction of total cholesterol levels by 6.4% during the follow up...

The prevalence of the type 2 diabetes and obesity are on the rise globally. Initial interventions for these groups of patients remain diet, exercise and medications. If these measures are insufficient gastrointestinal surgery offers a very good alternative for obesity and type 2 diabetes treatment. We report the outcome results for patients who underwent either adjustable gastric banding (AGB) or Roux-en-Y (RNY) gastric bypass in the years 2009-2012. Out of 33 patients (7 men, 26 women, average age 48.4 yrs), 11 underwent AGB and 22 had RNY. Preoperatively there were no statistically significant differences in: weight, excess of weight, Body Mass Index (BMI), HbA1c, blood pressure between AGB and RNY subgroups. In the AGB subgroup the following results were obtained 6 months after the operation: average loss of weight (LOW) 10.87 kg, 18.18 % achieved 50% estimated weight loss (EWL), 0 % achieved 70% EWL. We observed HbA1c reduction of 5.66 mmol/mol. 12 months after the operation average LOW was 14.8 kg, 9.09 % achieved 50% EWL, 0 % achieved 70% EWL. We observed HbA1c reduction of 7.41 mmol/mol and reduction in BP of 9.6/5.6 mmHg. In the RNY subgroup 6 months after operation the results were as follows: average LOW 30.9 kg, 71.43 % achieved 50% EWL, 23.81 % achieved 70% EWL. We observed HbA1c reduction of 24.1 mmol/mol. 12 months after the operation average LOW was 39.95 kg, 100 % achieved 50% EWL, 58.33 % achieved 70% EWL. We observed HbA1c reduction of 13.27 mmol/mol. We observed overall reduction in BP 12.5/4.95 mmHg The results show significantly better achievement of EWL and reduction in HbA1c in the RNY subgroup. These results were more sustainable in RNY group 12 months after the operation. Our report supports the more favourable outcomes in patients undergoing RNY gastric bypass procedures.

Although TIH is a well-established complication of this drug class, the extent of this problem and the serious morbidity that can result is often not appreciated. At our centre, we became aware of 3 serious cases of TIH over a 2 week period during the 'heat wave' in July 2013. In at least 1 of these cases excessive water drinking was a clear precipitant. We therefore aimed to determine the incidence of TIH at our hospital and in particular whether there was a seasonal effect on admission rates.We retrospectively reviewed records of all admissions to our hospital containing a discharge diagnosis code of hypo-osmolality / hyponatraemia over a 14 month period. The medical discharge summary of each case was reviewed to identify cases where TIH was implicated as the predominant cause. Patients with a co-morbidity of heart failure, malignancy or liver disease were excluded from the analysis. Average monthly temperature data were obtained from public records (Met Office). 443 patients were admitted with a coding diagnosis of hypo-osmolality / hyponatraemia between June 2012 and August 2013. Amongst these there were 73 cases of TIH. Cases of TIH were sorted chronologically by month of admission. The monthly average temperature was then compared with the monthly TIH admission rate. Our data demonstrate a background monthly admission rate of 3-4 cases of TIH but with evidence of seasonal peaks in the hotter months with 9 and 7 cases admitted in July and August 2012 respectively and 10 cases in July 2013.TIH is common cause for acute medical admission in the UK. Our data suggest evidence of seasonal variation in the incidence of the problem with patients being at greater risk of developing this complication during the hotter months of the year. An increase in fluid intake during hotter weather may underlie this association. Abstract