Latest Articles and News - Jun 18, 2025
post on 18 Jun 2025
Derivation and internal validation of a clinical diagnostic score for acute Chinese medicine poisoning involving aconite.
Aconitum spp. alkaloids, used in traditional Chinese medicine, are potent cardiotoxins and neurotoxins. Timely diagnosis of aconite poisoning remains challenging due to the long laboratory turnaround time. We aimed to derive and internally validate a diagnostic score for rapid recognition of acute Chinese medicine poisoning involving aconite using clinical parameters. We conducted a retrospective cross-sectional study on consecutive patients with laboratory-confirmed Chinese medicine poisoning reported to the Hong Kong Poison Control Centre between 1 July 2008 and 30 June 2021. The reference standard was the diagnosis of acute aconite poisoning by a clinical toxicologist and laboratory detection of aconitine or related alkaloids in the patients' urine, serum, or gastric lavage specimens. Univariate analyses, followed by multivariable logistic regression, were performed to identify independent predictors of laboratory-confirmed aconite poisoning. A scoring system was developed based on the regression coefficients of the independent predictors and internally validated using bootstrapping. We identified 542 eligible episodes, of which 179 involved aconite and 363 involved other herbs. The median patient age of the included episodes was 55 years (range 4-98 years). A clinical diagnostic score was developed based on the six independent predictors: hypotension (systolic blood pressure <90 mmHg in adults or < age-appropriate ranges in children, 3 points), herbal decoction or wine formulation (2 points), facial or oral numbness (2 points), ventricular tachycardia (1 point), limb numbness (1 point), and premature atrial or ventricular contractions (1 point). The score ranges from 0 to 10, with a higher score indicating a higher likelihood of aconite poisoning. At the cutoff point of ≥3, the sensitivity and negative predictive value of the score were 0.98 and 0.99, respectively. A higher specificity (0.92) and positive predictive value (0.84) could be achieved with a cutoff point at ≥4. The area under the receiver operating characteristic curve was 0.965 (95% CI: 0.950-0.980) during derivation and 0.965 (95% bias-corrected and accelerated CI: 0.947-0.977) during internal validation. The newly derived Clinical Aconite Poisoning Score is simple to use, but its real-time discriminatory performance in diverse populations with Chinese medicine poisoning in real-world settings and its impacts on clinical management are unknown. In the context of Chinese medicine poisoning, the Clinical Aconite Poisoning Score might be useful in early recognition of aconite poisoning before laboratory confirmation. Future prospective studies are warranted to externally validate its real-time discriminatory performance in real-world settings before clinical adoption.
https://pubmed.ncbi.nlm.nih.gov/40528738/Incidence of and risk factors for mortality in children with mushroom poisoning.
We aimed to evaluate the incidence of and risk factors for mortality in children with mushroom poisoning. Sixty-seven children with mushroom poisoning who were hospitalized at the Children's Hospital of Chongqing Medical University were retrospectively enrolled. The clinical characteristics of the children in the surviving and non-surviving groups were compared. Variables with a P value < 0.1 in the univariate logistic regression analysis were included in the multivariate logistic regression analysis. A receiver operating characteristic (ROC) curve was generated to determine the optimal cutoff point. The mortality rate of children with mushroom poisoning was 23.88% (16/67), and the incidence of death during hospitalization was 35.02 per 1,000 person-days. The median pediatric sequential organ failure assessment (pSOFA) score was 1.00 (interquartile range [IQR] 0.00-3.00). Logistic regression analysis revealed that the pSOFA score was independently associated with mortality (odds ratio [OR] 4.92, 95% confidence interval [CI] 1.59-62.21; P = 0.040). The optimal cutoff point of the pSOFA score for predicting mortality was 2.00, with an area under the curve (AUC) of 0.84 (95% CI 0.71-0.88, P < 0.001*). In this study, the incidence of death among children with mushroom poisoning was retrospectively evaluated. The pSOFA score may serve as a good prognostic indicator in children with mushroom poisoning, and children with a pSOFA score ≥ 2 have a significantly increased risk of mortality.
https://pubmed.ncbi.nlm.nih.gov/40528168/Early retinal electrophysiology changes in quinine overdose.
To report the early and subsequent electrophysiological findings of 2 patients following quinine overdose. Serial assessments including: Medical history, visual acuity (VA), fundus autofluorescence, spectral-domain macular optical coherence tomography (OCT) and full-field electroretinogram (ffERG) were performed on 2 patients, between 2 and 47 days after quinine overdose. Both patients experienced a similar clinical course. After almost total vision loss within the first 24 h, VA dramatically improved by day 3. Early OCT changes demonstrated central macula hyperautofluorescence, which coincided with a hyperreflectivity of the macular inner retina on OCT. The initial ffERG findings demonstrated changes consistent with marked inner retinal dysfunction of the cone system, affecting both the cone ON- and OFF-bipolar cell pathways. In contrast, rod bipolar cell function was unaffected in the early phase of toxicity. Between days 10 and 17, the retinal arterioles showed narrowing which coincided with attenuation of ffERG parameters of rod system inner retinal function between days 10-40. These cases suggest the early stages of quinine toxicity affect function of the presynaptic cone bipolar cell junction. This is then followed by retinal arteriolar attenuation and the well described electronegative scotopic ffERG.
https://pubmed.ncbi.nlm.nih.gov/40528095/
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