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Warfarin Therapy Induced a Rare Complication: Spontaneous Intramural Hematoma of the Jejunum: Case Report
(2017) Arslan, Hanifi; Gül, Mehmet; Başar, Cander; Güner, Hakan; Medni, Mohamed Refik
Warfarin is an oral anticoagulant drug that prevents clotting, used in treating many diseases as well as prophylaxis. Despite its widespread use and efficacy, it may lead to a wide range ofadverse effects, mainly bleeding, due to its quite narrow therapeutic index and interaction withother medications. Most commonly, it may result in epistaxis, hematuria and subcutaneous hemorrhage. In addition, it is likely to cause bleeding in the gastrointestinal tract, soft tissues, and cerebral region. It is rare to develop intramural hematoma in the jejunum resulted from warfarintoxicity. Here, we present a case admitted to the emergency department with abdominal pain, anddiagnosed with intramural hematoma after physical examination, laboratory findings and imaging.Emergency physicians should consider intestinal hematoma as differential diagnosis in patientsusing warfarin and presenting with abdominal pain.
Two Case with Tourniquet Syndrome
(2013) Ergin, Mehmet; Özer, Muhammed Raşit; Koçak, Sedat; Girişgin, Abdullah Sadık; Gül, Mehmet; Cander, Başar
The Hair-Thread Tourniquet syndrome is a rare and dangerous, but preventable condition. Involvements of the genitalia, such as of the penis and clitoris, have been reported as well as that of the fingers and toes. We report two patients: a 4-year-old girl with swelling of her 4th finger of the right foot and a 2-month-old infant with swelling of the 3rd and 4th fingers of the right foot. The time interval between the initiation and removal of the hair-thread is critical. Clinical presentation may vary from simple oedema to ulceration, necrosis, and amputation of the organ. Emergency physicians should consider tourniquet syndrome for children with unexplained restlessness. (JAEM 2013; 12: 220-1).
Rhabdomyolysis Associated with Opiate Abuse: A Case Report
(2015) Gülpembe, Mustafa; Acar, Demet; Akıllı, Nazire Belgin; Göknil Çalık, Saniye; Günaydın, Yahya Kemal; Köylü, Ramazan; Cander, Başar
Opioid kötüye kullanımı ile ilişkili pek çok komplikasyon bildirilmiştir. Bunların arasında solunum depresyonu, bilinç bulanıklığı, aspirasyon ğnömonisi, pulmoner ödem, miyokardit, rabdomiyoliz ve kompartman sendromu sayılabilir. Bu komplikasyonların bazıları hayatı tehdit eder.Olgu Sunumu: Burada genç bir erkek hastada opioid kötüye kullanımına bağlı gelişen rabdomiyoliz vakası sunacağız. Sonuç: Rabdomiyoliz intravenöz opioid kötüye kullanımına bağlı nadir görülen bir komplikasyondur. Rabdomiyoliz hayatı tehdit edebilecek sonuçlar doğurabileceği için erken tanı ve tedavisi çok önemlidir. Bu nedenle klinisyenler opioid kullanıcılarında bu komplikasyona karşı uyanık olmalılardır.
Melena Associated with Ganoderma Lucidum: A Case Report
(2015) Acar, Demet; Gülpembe, Mustafa; Akıllı, Nazire Belgin; Göknil Çalık, Saniye; Köylü, Ramazan; Günaydın, Yahya Kemal; Cander, Başar
Melena acil servis hastaları arasında görülen hayatı tehdit edebilecek bir bulgudur. Olgu Sunumu: Biz burada, önceden bilinen herhangi bir mide şikayeti olmayan genç bir erkek hastada Ganoderma Lucidum kullanımı ile indüklenen bir melena olgusu sunacağız. Sonuç: G. lucidum'un bazı toksik etkileri bildirilmiştir ancak bildiğimiz kadarıyla, bu vaka bildirilen G. lucidum ile ilişkili ilk üst gastrointestinal sistem kanamasıdır.
The Importance of Electrocardiographic Screening in Cardiac Contusion after Blunt Chest Trauma: Case Reports
(2013) Uçar Karabulut, Keziban; Narcı, Hüseyin; Cander, Başar; Gül, Mehmet; Duman, Çetin
Künt göğüs travması geçiren hastaların takip ve monitorizasyonu önemlidir.İzole künt göğüs travmasına bağlı kardiyak kontüzyon takiben akut koroner sendrom gelişebileceği unutulmamalıdır. Künt göğüs travması sonucu akut koroner sndrom gelişen iki hasta tanımlamaya çalıştık.Hastarın EKG lerinde inferior derivasyonlarda ST elevasyonu tespit ettik,hastalar medikal tedavi ve koroner anjiografi yapıldı. koroner anjiografi sonucu koroner arterlerde herhangi bir patoloji saptanmadı.Onların durumu, travma ve stres nedeniyle kardiyak kontüzyona bağlandı.Kardiyak kontüzyon izole künt göğüs travmalarında oluşabilir, bununla birlikte hertürlü travma ve stres sonucu akut koroner sendromu gelişebileceği unutulmamalıdır.
Datura Stramonium Poisoning: Two Case Reports
(2017) Günaydın, Yahya Kemal; Cander, Başar; Işıkoğlu, Vahdet; Kokulu, Kamil; Muraçar, Nurser; Akıllı, Nazire Belgin; Yıldız, Can Gökay; Köylü, Ramazan
Introduction: Datura stramonium is a wild plant, which grows in almost every region of Turkey and is found in the native flora. D. stramonium is used as a herbal medicine for asthma, bronchitis, eczema, and hemorrhoid treatment. Because of D. stramonium’s hallucinative and euphoric effects, it can be abused, particularly by drug addicts. Excessive oral intake may cause anticholinergic toxicity. In the case of a very high dose intake, it may result in coma. In this study, we have discussed two patients who presented to the emergency department of our hospital with anticholinergic findings and were diagnosed with D. stramonium intoxication.Case Report: Two patients presented to the emergency department of our hospital with signs and symptoms of anticholinergic poisoning. Two cases were also fell complaints with symptomatic treatment. Both the patients were admitted to the toxicology department and were followed-up for 2 days. The complaints regressed the next day, and the both the patients were discharged with complete recovery.Conclusion: Our study reporting the present cases shows that D. stramonium, which is used for therapeutic purposes, also causes severe intoxication. Therefore, wild plant poisoning should be considered for every patient presenting to the emergency department with unexplained anticholinergic symptoms and complaints.
Epidemiological Characteristics of Geriatric Patients in Emergency Departments: Results of a Multicenter Study
(2015) Ergin, Mehmet; Karamercan, Mehmet Akif; Ayrancı, Mehmet; Yavuz, Yücel; Yavaşi, Özcan; Serinken, Mustafa; Acar, Tarık; Avcil, Mücahit; Al, Behçet; Bayramoğlu, Atıf; Durgun, Hasan Mansur; Gölcük, Yalçın; Arzıman, İbrahim; Dündar, Zerrin Defne
Girifl: Beklenen yaflam süresinin uzamasının sonucu olarak yafllı popülasyondaki artıfl, bu yaflgrubu için daha sık sağlık bakımı verilmesini zorunlu kılmaktadır. Bu çalıflmada acil servise baflvuran 65 yafl ve üzeri hastaların genel özelliklerini, baflvuru nedenlerini, acil servis ve hastane ziyaretlerinin sonuçlarının saptanması amaçlandı. Gereç ve Yöntem: Çok merkezli, prospektif, gözlemsel çalıflma Türkiye'de 13 hastaneninacil servislerinde bir hafta süre ile gerçekleflti. Çalıflma süresi içinde akut tıbbi veya cerrahi sorunlar ile acil servise baflvuran 65 yafl ve üstü hastalar çalıflmaya dahil edildi. Altmıfl befl yafl altı ve/veya travma nedenli baflvurular ise çalıflma kapsamına alınmadı.Bulgular: Ortalama yaflı 74.87.3 yıl olan toplam 1299 hasta çalıflmaya dahil edildi. Bu hastalardan %51.9'u (n674) 65-74 yafl grubundaydı, %67.5'u (n877) hastaneden taburcu edildive %5.8'i (n75) yatıfl süreci içinde öldü. Acil serviste en sık konulan tanılar kardiyovasküler, gastrointestinal ve solunum hastalıklarıydı. Hastaneden taburcu olan ve hastane yatıflı sırasında ölenhasta grupları kıyaslandığında yafl açısından istatistiksel olarak anlamlı fark varken (p0.001), cinsiyet dağılımı (p0.259), hastane yatıfl süresi (p0.259) ve yoğun bakım ünitesi yatıfl süresi(p0.055) açısından fark tespit edilmedi. Sonuç: Yafllı nüfusunun ve genel nüfusa oranının artıflı ile birlikte yafllı hastaların acil servisbaflvuru sayısı artıyor ve gelecekte daha da artacaktır. Bu çalıflma, çalıflma merkezlerine baflvuranyafllı hastaların demografik özelliklerini ve klinik seyirlerinin sonuçlarını ortaya koymaktadır.
Approach to pleural effusions in the emergency department
(2013) Tokur, Mahmut; Ergin, Mehmet; Girişgin, Abdullah Sadık; Demiröz, Mustafa
Benign ve malign hastalıklar neticesinde plevral boşlukta sıvı salınım-emilim dengesinin bozulması sonucu oluşan plevral efüzyon sıklıkla karşılaşılan bir du- rumdur. Torasentez hem efüzyon tanısını teyit etme hem de efüzyonun niteliği hakkında ön bilgi edinme amacıyla yapılmalıdır. Alınan numuneden yapılan biyokimyasal, mikrobiyolojik ve sitolojik incelemeler tedavinin etiyolojiye yöne- lik olarak belirlenmesine yardımcı olur. Benign nedenlerin tedavisi altta yatan etiyolojiye yönelik iken, malign durumlarda ise ilk önce sıvı drenajı ve takiben yeniden sıvı birikiminin önlenmesine yönelik ileri tedavi gerekir. (JAEM 2013; 12: 155-63)
Relationship between the neutrophil-to-lymphocyte ratio in acute pancreatitis and the severity and systemic complications of the disease
(2018) Kokulu, Kamil; Günaydın, Yahya Kemal; Akıllı, Nazire Belgin; Köylü, Ramazan; Sert, Ekrem Taha; Köylü, Öznur; Cander, Başar
Background/Aims: In 80% of the patients, Acute pancreatitis (AP) occurs as a self-limiting disease that does not require any specifictreatment; however, in 20% of the cases it occurs in its clinically severe form that may lead to local or systemic complications. The aimof this prospective study was to examine the relationship between the neutrophil to lymphocyte ratio (NLR) and the systemic complications and severity of AP.Materials and Methods: This prospective study included 100 patients with AP. Age, sex, NLR, Ranson scores and the revised Atlantaclassification of the patients were recorded. The patients were divided into two groups according to the Ranson scores as mild andsevere AP. According to the Revised Atlanta classification, the patients were divided into two groups as mild and moderatesevere AP.Results: According to the Ranson score, NLR at the time of admission and at the 48th hour in the severe group was found to be statistically higher than the mild AP group (p0.01). The receiver operating characteristic (ROC) curve analysis was performed to determinethe cut-off value of NLR at the emergency department in order for it to be used for distinguishing AP patients with and without systemiccomplications. The area under the ROC curve was 0.81. Sensitivity and specificity were 87.50% and 69.05%, respectively, when the NLRcut-off value was 7.13.Conclusion: Neutrophil to lymphocyte ratio is associated with severe AP. We also regard NLR as a valuable parameter for predicting thedevelopment of systemic complications in patients with AP.
The role of soluble urokinase plasminogen activator receptor (SuPAR) as an indicator of the severity of acute pancreatitis
(2018) Küçükceran, Kadir; Ergin, Mehmet; Kılınç, İbrahim; Karaibrahimoğlu, Adnan; Çolak, Tamer; Tuncar, Alpay; Dündar, Zerrin Defne; Koçak, Sedat; Girişgin, Abdullah Sadık; Gül, Mehmet; Cander, Başar
Background/aim: Soluble urokinase plasminogen activator receptor (suPAR) has been reported to have a positive correlation with theactivation degree of the immune system. This study’s aim is to investigate the efficiency of SuPAR serum levels in acute pancreatitis (AP)patients in determining the severity of disease.Materials and methods: This prospective research involves patients who arrived at the emergency service, were over 18 years old, hadnontraumatic abdominal pain and diagnosis of AP, and agreed to join the study. Demographic characteristics, contact information,laboratory and imaging test parameters, Ranson’s criteria, the Balthazar Severity Index, the Rapid Acute Physiologic Score (RAPS), andthe modified Glasgow (Imrie) score of all patients were recorded. Two study groups were created as score of 3 (mild, Group I) and 3(severe, Group II) for pancreatitis according to Ranson’s criteria.Results: During the study period, 59 sequential patients with AP were included in the study. It was seen that 79.7% of the study group(n 47) were in Group I. Etiologically 67.8% (n 40) cases were biliary and 32.3% (n 19) were nonbiliary diseases. According to theresults, suPAR level was effective in distinguishing the severity of AP (AUC 0.902, P 0.001 (95% CI: 0.821–0.984)). With regardto determining severe disease, suPAR had an optimum cutoff value of 6.815 ng/mL, sensitivity of 91.66%, specificity of 82.97%, andnegative predictive value of 97.5%.Conclusion: Our study was performed the determine the efficiency of suPAR level in predicting severe disease in AP patients. We foundit significant in indicating the severity of disease according to the study results.
Prognostic Value of Red Cell Distribution Width in Patients with Organophosphate Poisoning
(2015) Dündar, Zerrin Defne; Ergin, Mehmet; Köylü, Ramazan; Günaydın, Yahya Kemal; Özer, Raşit; Cander, Başar
The aim of this retrospective study was to investigate the prognostic value of red cell distribution width (RDW) and other hematological parameters measured on admission to the emergency department in patients with organophosphate poisoning.Materials and Methods_ All patients aged ? 15 years who were admitted to the emergency department from 2008 to 2013 on account of organophosphate poisoning were included in the study. The written and electronic medical charts of the patients were reviewed. Hematological parameters were recorded. Mechanical ventilation requirement was used as the primary endpoint. Results: A total of 72 patients were included in the study for evaluation. Mechanically ventilated patients had significantly higher leukocyte counts and RDW levels than non-ventilated patients (p0.004 and p0.001, respectively). The area under the receiver-operating characteristic curve of RDW levels for predicting mechanical ventilation requirement was 0.716 (95% CI: 0.581-0.852, p0.010). RDW had a sensitivity of 73%, specificity of 70%, and negative predictive value of 91% with a cut-off value of 14.5% in predicting mechanical ventilation requirement in patients with organophosphate poisoning. Conclusion: RDW can be a valuable and easy-to-use parameter in estimating prognosis in the follow-up of patients with organophosphate poisoning. Conclusion: RDW can be a valuable and easy-to-use parameter in estimating prognosis in the follow-up of patients with organophosphate poisoning.
Analysis of cardiac and pulmonary injuries resulting from an experimental penetrating thoracic injury
(2014) Tokur, Mahmut; Ergin, Mehmet; Okumuş, Mehmet
BACKGROUND: This study was planned to analyze the internal and external anatomical findings of cardiac injuries and the presence of accompanying pulmonary injuries in intentionally inflicted thoracic injuries to swine models. METHODS: We inflicted a penetrating heart injury in six suis domesticus female swine models. Two cardiac injuries, one on the left paratracheal of fourth intercostal space (ICS) and the other on the right side were inflicted on each model by the same researcher using a 20-cm long scalpel. All animals were then sacrificed for morphological evaluation. RESULTS: After strikes to the left fourth ICS, external evaluation showed that 50% of the subjects suffered a single laceration and that 33% suffered multiple lacerations. Internal evaluation showed additional intracardiac injuries in all five subjects. However, the subject that suffered a single laceration on the outer surface of the heart had multiple internal injuries while another subject that had multiple outer lacerations had only one intracardiac injury. Only three subjects suffered cardiac injuries and only two out of those three with pulmonary injuries after right fourth intercostal intrusions. CONCLUSION: This experiment has shown that external evaluation of the heart tissue may not alone be sufficient to determine the extent of cardiac injuries and accompanying pulmonary injuries caused by penetrating thoracic injuries.
N Terminal prohormone brain natriuretic peptit level in patients with arhythmia
(2016) Uçar Karabulut, Keziban; Cander, Başar
Objective: Brain natriuretic peptides are the marker protein structures released in response to wall tension from ventricular myocytes, and have been increasingly used in recent years. The use of N-Terminal Prohormone Brain Natriuretic Peptide is getting more expanded in acute heart failure, left ventricular diseases and acute dyspnea. Here, we aimed at investigating the level of N-Terminal Prohormone Brain Natriuretic Peptide in patients diagnosed with arrhythmias. Materials and Methods: Patients admitted to the emergency department and with any rhythm disorder were included into this study. Bedside echocardiography was performed for each patient. Patients were classified into two groups with and without heart failure. Blood samples of 1 cc were drawn from patients and put into ethylene diamine tetraacetic acid (EDTA)-containing tubes, and N-Terminal Prohormone Brain Natriuretic was investigated. Collected data were recorded into the prepared forms. Statistical analyses were performed with SPSS for Windows 13.0 software package. While average N-Terminal Prohormone Brain Natriuretic level was 25100±10955 pg/Ml in patients with heart failure, average level of NTerminal Prohormone Brain Natriuretic was seen as 5767.61±6225 pg/mL in those with any rhythm disorder but no heart failure.Brain Natrıuretıc Peptıt And Arhythmia Conclusion: N Terminal Prohormon Brain Natriuretik Peptid are important markers in the diagnosis of acute heart failure. In recent years, studies on their association with other diseases have become widespread. In our study, we also found BNP levels more than normal ranges in patients with arrhythmia but no cardiac failure, as well as finding N-Terminal Prohormone Brain Natriuretic levels at higher rates in heart failure patients with dysrhythmia.
The role of neopterine in the diagnosis of patients with acute pancreatitis on admission to the emergency department
(2016) Gül, Mehmet; Uçar Karabulut, Keziban; Uçar, Yıldız; Erdem, Sami
Purpose: There are difficulties observed in the diagnosis of acute pancreatitis in emergency departments due to its different clinical properties and the insufficiencies in the methods of diagnosis. Since there is no specific biochemical indicator, the diagnosis is made usually late or with difficulty. Neopterine is an enzyme secreted from the macrophages and is an indicator of cellular immunity activation. The aim of this study was to determine the role of neopterine in the early diagnosis of acute pancreatitis. Material and Methods: 39 patients, who had been hospitalized with the complaints of abdominal pain and diagnosed as acute pancreatitis via laboratory and screening methods, and 30 healthy controls were included in the study. Amylase, lipase, cholesterol and neopterine were measured in the patients' samples. The diagnoses were confirmed with abdominal ultrasound and computed tomography. Results: The neopterine values in patients with acute pancreatitis were significantly higher than those of the control group. Conclusion: Neopterine is an indicator which is elevated in certain inflammatory and autoimmune situations. We believe that it is important in the early diagnosis of acute pancreatitis. Further experimental and clinical studies should be conducted on the subject.
Acil serviste pulmoner tromboembolili hastaların farklı puanlama araçları ile değerlendirilmesi
(2018) Özer, Muhammet Raşit; Ergin, Mehmet; Altunay, Fatih; Gökal, Aliye Nur; Dündar, Zerrin Defne; Vişneci, Emin Fatih; Koçak, Sedat
Amaç: Acil serviste pulmoner tromboemboli (PTE) tanısı alan hastaların mortalite ile demografik, klinik, laboratuvar ve skorlamaözellikleri arasındaki ilişkiyi araştırmak.Gereç ve Yöntem: Bu retrospektif çalışmada, 2012-2015 yılları arasında acil servise başvuran torasik bilgisayarlı tomografi (BT) veyapulmoner BT anjiyografisi ile PTE tanısı alan 166 hasta çalışmaya dahil edildi. Hasta grubu Grup I (sağ kalan) ve Grup -II (hayattakalmayan)olarak iki gruba ayrıldı. Hematolojik ve biyokimyasal laboratuvar parametreleri, laktat içeren arteriyel kan gazı değerleri vetüm hastaların klinik şiddeti MWS, PESI ve MEWS skorlama sistemleri kullanılarak değerlendirildi.Bulgular: Arteriyel oksijen basıncı (PaO2) ve laktat düzeyleri açısından, hasta grupları arasında istatistiksel olarak anlamlı bir farkbulundu. Grup II'de, PESI ve MEWS skorları Grup-I hastaları ile karşılaştırıldığında anlamlı olarak yüksek bulundu. Grup II hastalarındaMWS skoru daha yüksekti.Sonuç: Burada kullanılan parametreler ve skorlama araçları sayesinde, PTE olgularını tanılamayı amaçladık. PTE'nin bu bulgularınyardımıyla klinisyen tarafından daha erken teşhis edildiğinde, mortalite ve morbidite oranlarının azaltılacağını ve tedavinin dahaetkili olacağını düşünmekteyiz.
Cranial Subdural Hematoma Following Spinal Anesthesia: Case Report
(2017) Gül, Mehmet; Ayrancı, Mustafa Kürşat; Güner, Hakan; Medni, Mohamed Refik; Cander, Başar
Although post dural puncture headache is the most common complication of spinalanesthesia, subdural hematoma is a rare complication. The mortality would be high if untreated. Inthis case, a patient of 28 years old presented to our emergency department with headache after cesarean section performed with spinal anesthesia 20 days prior. She had received analgesic drugtreatment for post dural puncture headache. Despite treatment, she presented to our emergency department for unresolved headache. A subdural hematoma was detected using a brain computed tomography (CT) because of complaint of double vision accompanied by headache. For headacheoccurring after spinal anesthesia without response to medical therapy, subdural hematoma shouldbe considered.
Is There a Difference Between the Readabilities of Informed Consent Forms Used for Procedures in the Emergency Services of State and University Hospitals in Turkey?
(2018) Öztürk Sönmez, Leyla; Sönmez, Mehmet Giray; Mustafa Kürşat, Ayrancı; Evrin, Togay; Katipoğlu, Burak; Cander, Başar
Aim: The aim of the present study was to evaluate the readability levels of informed consent forms (ICFs) used for procedures in the emergency services of state and university hospitals by comparing through readability formulas.Materials and Methods: ICFs used in emergency medicine clinics in different university and state hospitals in Turkey were collected, and forms that were the same were included in the evaluation only once. A total of 32 ICFs, with 15 from university hospitals and 17 from state hospitals, were evaluated. Average word number, syllable number, and words with syllable number of four and above were calculated. Different formulas were used to determine readability levels.Results: Although the readability of ICFs used in university hospitals was found to be better than those in state hospitals, the readability levels of the ICFs for both groups were detected to have medium difficulty according to the Atesman formula, very difficult according to the Flesch-Kincaid formula, difficult according to the Gunning-Fog formula, and at high school level according to the Bezirci-Yilmaz formula.Conclusion: In conclusion, the readability rates of emergency procedure ICFs in both state hospitals and university hospitals were detected to be rather low according to the present study. The education level of our country and the local environment should be considered while preparing these ICFs.
Thrombolysis in STEMI at Prehospital Settings
(2014) Ergin, Mehmet; Dündar, Zerrin Defne; Cander, Başar
Thrombolysis is a rapidly available but semi-effective treatment, whereas percutaneous coronary intervention is a potentially delayed but highly effective therapy. What about thrombolysis in the prehospital setting for ST-elevated myocardial infarction? Does scientific evidence support or oppose? Which patient group is more eligible for prehospital thrombolysis? Is there any skirmish between emergency medicine and cardiovascular professionals? You can find a history of prehospital thrombolysis on the basis of scientific evidence in this writing
Sleep Disorders in Shift Workers in the Emergency Department and Efficacy of Melatonin
(2016) Emet, Mücahit; Uzkeser, Mustafa; Güçlü, Sibel; Ergin, Mehmet; Aslan, Şahin
No statistical data is available on the number of employees working on night shifts in Turkey. Working on shifts is associated with decreased sleep time, decreased daily sleep quality, and decreased alertness during night shifts. Increased incidences of cardiovascular disorders, peptic ulcers, and some types of cancer in shift workers are well known. Exposure to light at nighttime suppresses melatonin production. In non-synchronized circadian rhythm, disturbed melatonin secretion may lead to excessive sleep, hunger for carbohydrates, and weight gain. Melatonin is the hormone that governs sleep. It seems to be the key regulator of the sleep/wake rhythm. Exposure to light at night and disturbance of the circadian rhythm contribute to the health problems of night shift workers by disturbing melatonin production. In this review, the definitions of social jetlag, delayed sleep phase syndrome, and insomnia will be discussed. Sleep disorders in psychiatric diseases will be reviewed. Melatonergic drugs available on the market will be listed, including their contraindications and side effects. The physiopathology of sleep, sleep disorders, depression, and melatonin will be given with an extended discussion. Two recent reviews about the effect of melatonin on sleep patterns will be discussed. Finally, other treatments for sleep disorders will be summarized. In conclusion, in shift workers, sleep problems are a complex subject in which multiple pathophysiological mechanisms play roles. The double-blind randomized controlled studies, systematic reviews, and meta-analyses that have been conducted can provide only weakly positive data about the beneficial effect of melatonin use in shift workers. In the future, multi-centered and multi-participant studies will shed more light on this issue.
Rhabdomyolysis Induced by Agaricus Bisporus
(2014) Akilli, Nazire Belgin; Dündar, Zerrin Defne; Köylü, Ramazan; Günaydin, Yahya Kemal; Cander, Başar
Mushroom poisoning may present with a variety of clinical conditions, extending from simple food poisoning to life-threatening liver and renal failure. Rhabdomyolysis is a recently described syndrome that is observed within the clinical spectrum associated with mushroom poisoning. In this report, we present two patients-one presenting with a state of rhabdomyolysis and the other case with simple symptoms only-following consumption of cultivated mushroom together in the same meal.

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