Postgraduate medical journal
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Review Case Reports
Classification of the mechanisms by which cardiotoxic plant poisons exert their effects.
Episodes of poisoning due to plant-based toxins are an unusual presentation to the emergency department. Plant poisons may be ingested if the source plant is misidentified as benign (eg, Lily of the Valley being mistaken for wild garlic and water hemlock being mistaken for wild celery), or taken as part of a complementary medicine regime or otherwise for psychotropic effect. Numerous plant poisons demonstrate cardiotoxic effects resulting from action against cardiac myocyte ion channels, or other cardiac receptor targets. ⋯ These mechanisms are stereotyped and may be grouped by toxidromic effect. This article proposes a novel classification of cardiotoxic plant poisons based on these actions. Given that these mechanisms mirror the Vaughan Williams classification used to categorise therapeutic antiarrhythmic agents, it is felt that this will serve as a mnemonic and diagnostic aid in clinical situations of cardiotoxic plant ingestion.
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Fibromyalgia syndrome (FMS) is a chronic pain syndrome, characterised by diffuse pain in musculoskeletal system and accompanied by stiffness, fatigue, tender points, sleep disturbances and cognitive and gastrointestinal symptoms. It affects middle-aged women (between 40 and 65) predominantly. Climacteric syndrome, which is characterised by vasomotor, somatic (headache, sleep disorders, myalgia and arthralgia) and psychical (mood changes) symptoms, results from the change in brain neurotransmitter concentrations due to gradual decline of ovarian hormone levels. ⋯ Hormonal fluctuation during menopausal transition is likely the triggering factor for both syndromes. Therefore, hormone replacement therapy is a favourable approach in the treatment of FMS due to the antiallodynic, anti-inflammatory and neuroprotective effect of oestrogen. In this review, we emphasise the similarity of FMS and climacteric syndrome and suggested that FMS could be considered as a characteristic symptom of climacterium.
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Polyclonal hypergammaglobulinaemia (PH) represents a classic diagnosis problem in internal medicine. However, there is no consensus threshold for PH. The aim of this study was to define a threshold for PH. ⋯ This is the first study to scientifically define a PH threshold. The main limitation is that our threshold is only biological. The study was not designed to associate this threshold with a clinically active disease. In conclusion, while the 19 g/L cut-off seems the most relevant threshold, but it will need to be validated by prospective studies.
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Routine transthoracic echocardiography (TTE) in patients with syncope or presyncope is resource-intensive. We assessed if risk thresholds defined by a validated risk score may identify patients at low risk of cardiac abnormality in whom TTE is unnecessary. ⋯ In general medicine patients with syncope/presyncope, using the CSRS to stratify risk of a cardiac abnormality on TTE can almost halve TTE use.