Energy drinks - product ingredients and their potential toxicity

Energy drinks (NE) are popular stimulants among adolescents and adults. They are commercial, advertised, widely available products that contain increased amounts of caffeine, and are designed to reduce feelings of fatigue in favor of increased mental and physical performance. In addition to caffeine, various ingredients such as vitamins, dyes or substances that impart a certain flavor are added to NEs. Many cases have been described of the harmful effects of NE used alone and in combination with alcohol on the human body: including on the digestive system, central nervous system, cardiovascular system or kidneys. We decided to analyze and compare with each other the composition of NEs from the most popular manufacturers available in most Polish grocery stores. We then briefly described the most important substances available in NE and reviewed the literature on their potential toxicity.  It is reasonable for physicians and teachers to educate young people and their parents about the harmfulness of NE, especially when children are suspected of taking large amounts. Further observations and studies monitoring the harmfulness of NEs are needed, and the drinks themselves should be subject to special surveillance

Malignant melanoma: epidemiology, pathogenesis, diagnostics and innovative therapeutic methods

Melanoma is the most common cause of death among people with skin cancer, and its development is most often associated with excessive exposure to ultraviolet radiation and predisposing genetic factors. Early detection of melanoma significantly reduces mortality in both the short and long term. Unfortunately, this cancer has the ability to quickly reach the malignant phase and metastasize to other organs. The typical treatment for melanoma is surgical resection, but over the last few years significant progress has also been made in the field of systemic therapies, which has led to a noticeable improvement in survival in patients with metastases. The article summarizes information about modern therapeutic methods used in patients with melanoma. Drugs belonging to BRAF kinase inhibitors: vemurafenib and dabrafenib are currently the first-line therapy for advanced melanomas with a confirmed BRAF gene mutation. Modern therapeutic strategies that have revolutionized the treatment of melanoma also include immunotherapy. By blocking inhibitory checkpoints of the immune system, it is possible to generate an anti-cancer response alone or in synergy with other types of therapy. These drugs target molecules that are pathologically overexpressed in melanoma, such as PD-1 or CTLA-4. Intralesional agents, such as oncolytic viruses, can also induce immune stimulation to destroy cancer cells. The only drug of this type registered so far for the treatment of melanoma is talimogene laherparepvec, which uses a genetically modified herpes simplex virus type 1. The possibility of individually tailored treatment to the patient is created by CAR-T therapy, which involves collecting tumor-infiltrating T lymphocytes from the patient, modifying them to obtain a receptor that specifically recognizes melanoma cells, and then multiply and introduce it into the patient's body. Recent findings have shown higher success rates with combinations of immunotherapy and chemotherapy, radiotherapy, or targeted molecular therapy. Despite the success of modern systemic therapy, many melanoma patients do not respond to treatment or develop drug resistance, which leads to the constant need to look for new solutions in the fight against this cancer

Diagnosis and treatment of obstructive sleep apnoea in patients with pauses in Holter ECG monitoring: case series

Obstructive sleep apnoea (OSA) is a common disease in today’s society and may affect even more of the population in the near future. Ailments and complications of OSA result from a decrease in the muscle tone of the soft palate, which causes shallow breathing or complete apnoea. The consequences of such episodes may be the development of arterial hypertension, the occurrence of cardiac arrhythmias, and also the deterioration of the quality of life. Diagnosis is based on polysomnography in people with suspected OSA. Continuous Positive Airway Pressure (CPAP) therapy is the most effective treatment for OSA. A case series is presented in which patients with OSA risk factors and nocturnal pauses in Holter ECG monitoring (HEM) were diagnosed due to suspected OSA. In the polysomnographic test, severe OSA was diagnosed and CPAP therapy was introduced. Follow-up HEM performed during treatment showed complete resolution or significant reduction in the number and length of nocturnal pauses. Based on the case series, current medical knowledge and guidelines for pacemaker implantation, it was concluded that in the event of pauses in the HEM, the diagnosis of OSA should be considered in each patient, especially if the pauses occur predominantly at night and the patient is at high risk of OSA. Such a procedure may protect the patient from serious complications related to the pacemaker implantation. It should be emphasized, however, that CPAP therapy requires close cooperation of the patient because it brings effects only when it is used for each sleep

The use of protective masks and the level of arterial oxygen saturation at rest and after exercise

BackgroundStudies of influenza, and human coronaviruses provide evidence that the use of a medical mask can prevent the spread of infectious droplets from an infected person to someone else. After global public health emergency of coronavirus SARS-CoV-2 causing illness of COVID-19 was changing frequency of wearing a mask. Therefore, study was undertaken to assess whether the use of protective masks affects the level of oxygen saturation during rest and during exercise.Material and MethodsThe test consisted of a non-invasive measurement of oxygen saturation by percutaneous determination of arterial oxygen saturation with the use of the pulse oximeter. Oxygen saturation was measured during rest and after physical exertion performed without a protective mask (2 types of masks were used: surgical and FFP2), as well as during rest and after physical exertion performed with the use of a protective mask. The analysis of the oxygen saturation, heart rate, blood pressure and respiratory rate included data on 48 subjects.ResultsComparing the post-exercise and pre-exercise values showed a significant difference between all of them. There were no differences found in any variables according to the mask/no-mask status.ConclusionsA short-term physical exercise performed in a group of healthy young people using protective masks did not affect oxygen saturation, heart rate, blood pressure and respiratory rate

Nutritional Risk Assessment and Adverse Events in Patients Undergoing Left Ventricular Assist Device Implantation—A Retrospective Cohort Study Using Hospital Information System

Clinical or subclinical malnutrition occurs in 30% to 70% of patients with advanced heart failure and increases the risk of postoperative adverse events. The main objective of this study was to assess the nutritional status of patients prior to left ventricular assist device (LVAD) implantation using different methods of malnutrition assessment and to evaluate the relationship between nutritional status and postoperative adverse events. A retrospective cohort study included 120 patients aged 26–74 years referred for LVAD surgery. Preoperative nutritional status (NRS-2002—Nutritional Risk Score 2002, NRI—Nutritional Risk Index, PNI—Prognostic Nutritional Index; TLC—total lymphocyte count) and postoperative adverse events were assessed. Moderate to severe malnutrition was found in 55.8%, 43.3%, 40.0%, and 20% of all patients, respectively, according to the PNI, NRI, TLC, and NRS-2002 scores. Patients with a TLC 3 had a higher risk of postoperative acute renal failure [hazard ratio (HR): 2.5; 95% confidence interval (95% CI): 1.01–6.3] and death during the observation period [HR = 2.1; 95% CI: 1.2–3.5]. Moderate to severe malnutrition was also associated with a significantly increased risk of in-hospital death [for the NRI score, HR = 4.9 (95% CI: 1.1–22.0); for the PNI score, HR = 5.0 (95% CI: 1.1–22.3)]. In conclusion, moderate to severe malnutrition prior to LVAD implantation has been identified as a risk factor for postoperative acute renal failure and mortality. Assessment of nutritional risk may improve patient selection and early initiation of nutritional support