Taxus (yew) is one of the most frequently reported plants causing potentially fatal outcome when taken incidentally or for suicidal reasons. A fast and reliable method of detection of poisonous compounds or their metabolites is critical in life-saving procedures in cases of yew ingestion. Previously, several chromatographic analytical procedures have been described usually taking longer than one hour of total analysis time. In this report we describe a suicide case study and an ad hoc developed fast method of detection and quantitation of 3,5-dimethoxyphenol – the main taxane metabolite in the blood plasma from the patient as well as the determination of major taxine components in the plant material (Taxus baccata). At present, there is no reasonable alternative for mass spectrometry that could match its high sensitivity and accuracy, and Multiple Reaction Monitoring could be adequate and useful mass spectrometry technique in analyzing and identification of plants material compounds that cause severe poisoning in humans. In the reported case, intensive cardiac care together with the astuteness of the treating physicians not only saved the patient’s life, but also allowed for his complete recovery and return to work. The development of ultra fast liquid chromatography tandem mass spectrometry UFLC-MS/MS method provides a fast means to confirm yew alkaloids and their metabolite in various material. The applied analytical procedure allows early detection of main metabolite in patient material as well as comparing to those extracted from the plant. In our study, the taxanes remained undetected, probably due to the time elapsing from the patient admittance and collection of plasma. In cases like those reported in this study, retaining the gastric material should be obligatory to confirm the ingestion of yew. The possibility of using this approach in detection of native taxine compounds in human plasma remains to be verified.

INTRODUCTION YKL-40 is a protein released locally by inflammatory cells. Thus, it may constitute a biomarker of inflammatory conditions, such as atherosclerosis. OBJECTIVES The aim of the study was to determine YKL-40 levels in patients with ischemic heart disease and to analyze the correlation of this biomarker with the severity of coronary atherosclerosis. PATIENTS AND METHODS The study included 158 patients: 52 with stable ischemic heart disease and 67 with acute coronary syndrome: ST-segment elevation myocardial infarction (STEM I; n = 47) or non- ST-segment elevation myocardial infarction (NSTEMI; n = 20). The control group included 39 individuals without abnormalities in coronary vessels. We evaluated plasma YKL-40 levels and their correlation with the severity of coronary atherosclerosis assessed with the SYNTAX score. RESULTS Patients with myocardial infarction had higher plasma YKL-40 levels than those with stable ischemic disease (median [range], 235.3 [161.6-366.1] ng/ml vs 61.2 [53.1-83.1] ng/ml; P <0.001) or controls (median [range], 235.3 [161.6-366.1] ng/ml vs 55.7 [51.2-75.2] ng/ml; P <0 .001) . No differences were found in YKL-40 concentrations between STEMI and NSTEMI patients (median [range], 263 [150.3-363.7] ng/ml and 214.9 [163.4-367.6] ng/ml, respectively; P = 0.7). The SYNTAX score in patients with ischemic heart disease correlated positively with YKL-40 concentrations (R = 0.34; P <0.001). CONCLUSIONS YKL-40 can be considered a potential biomarker of coronary atherosclerosis severity.

Background. Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel administered to treat patients with acute coronary syndrome (ACS) is still being used. However, despite the proven efficacy of this treatment regimen, thromboembolic complications have been observed in some individuals. The reason for this phenomenon is linked to the so-called increased responsiveness of platelets despite high platelet resistance (HPR). A significant role in HPR is attributed to genetically determined differences in the absorption and activation of clopidogrel. Objectives. The aim of the study was to assess the incidence of polymorphisms of the AKB1 and CYPC19 genes that encode proteins involved in the absorption and metabolism of clopidogrel. Material and methods. The analysis was performed in 199 consecutive patients from Lower Silesian voivodeship (Poland) who underwent coronary angioplasty with stenting for ACS. The single nucleotide polymorphism of the CYP2C19 and ABCB1 genes was performed using a mini sequencing or restriction fragment length polymorphism method. Results. The results of this study revealed the high incidence of patients who may be unresponsive to antiplatelet treatment due to genetic causes. The CYPC19*2 allele in the form of homozygote or mutation heterozygote appeared in 26.1% of the study population. ABCB1 (C3435C> T) polymorphism was associated with 84% of patients. The total incidence of allelic disorders of low drug absorption and metabolism reached 14.6%. Conclusions. The data obtained should prompt clinicians to use more recent antiplatelet agents (ticagrelor or prasugrel) first, instead of clopidogrel.

Background. The nutritional status of patients in hospitals has a significant impact on the effectiveness of treatment, the occurrence of complications, and the length of hospitalization. The purpose of this study was to evaluate the nutritional status of patients with heart failure (HF) and its impact on patient outcomes. Material and Methods. This study included 213 patients (153 men, 71.8%) aged 74.7 ± 14.3 years treated for HF at the cardiology clinic of the 4th Military Clinical Hospital between 2018 and 2021. Sociodemographics, clinical data, the Model for End-Stage Liver Disease (MELD), CHILD-PUGH, and the Nutritional Risk Score (NRS) were analyzed. Results. Patients at high nutritional risk (NRS ≥ 3 score) were older (85 years vs. 75 years; p < 0.001), had longer hospitalizations (12 days vs. 9 days, p = 0.027), lower hemoglobin (10.5 g/dL vs. 11.7 g/dL, p = 0.001), lower TIBC (292 vs. 336; p = 0.012), and iron (32 mg/nL vs. 39 ng/mL, p = 0.009) compared with patients at low risk (NRS < 3 score). Patients hospitalized ≤7 days had significantly lower CHILD-PUGH score compared with patients hospitalized >7 days. Patients hospitalized ≥14 days were significantly more likely to die compared with other groups of HF patients (10.6% vs. 0.0%, p = 0.004). Conclusions. Abnormal nutritional status among hospitalized HF patients is associated with longer hospitalization duration and higher rates of death. In addition to clinical factors, the CHILD-PUGH scale can be helpful in estimating the length of hospitalization of HF patients. It is necessary to determine the impact of nutritional status on the outcome of patients with heart failure in further multicenter prospective or interventional studies.

Ticagrelor and prasugrel are widely used as antiplatelet therapy after coronary angioplasty. However, there is a group of patients with indications for clopidogrel treatment. This population includes patients with chronic or acute coronary syndrome who are treated invasively and have contraindications to the use of novel antiplatelet drugs due to antithrombotic treatment (particularly with non-vitamin K antagonist oral anticoagulants). A wide range of generic forms of clopidogrel are available on the market. However, it is unclear whether they are as effective as the originator drug. In the current study, we aimed to assess the concentrations of the active metabolite of clopidogrel and its effect on platelet aggregation inhibition in patients receiving the originator drug in comparison with those receiving generic clopidogrel. We enrolled 22 healthy individuals without polymorphisms in the ABCB1 gene and the allele variants CYPC19*2 and CYPC19*3. All participants received a loading dose of clopidogrel (600 mg), followed by a maintenance dose of 75 mg for the next 3 days. On day 3, blood samples were obtained 1 h after drug administration to assess active metabolite concentrations using liquid chromatography with tandem mass spectrometry. In each participant, platelet aggregation was assessed with light transmission aggregometry after 5-μmol/L and 10-μmol/L adenosine diphosphate (ADP) stimulation. Assays were performed for the originator clopidogrel and 2 different generic groups. The mean ± standard deviation (SD) concentrations of active clopidogrel did not differ between the originator drug and 2 generic products with clopidogrel (12.7±5 pg/μL compared to 13.0 ±4 pg/μL compared to 14.4 ±4 pg/μL). Platelet aggregation inhibition after stimulation with 5 μmol/L and 10 μmol/L ADP was similar for all preparations. In comparison with original clopidogrel, the use of its generic form does not affect the blood concentrations of the active metabolite or its antiplatelet effect.