Shift Work and Shift Work Sleep Disorders: Definition, Symptoms and Treatment

Today, due to the rapid progress of the global industrial economy, the use of new technologies and the economic competition environment, the necessity of 24 hour interrupted job production has increased and this has caused the obligation to work with the shift system. Approximately 20% of the population is working on shifts and turns apart from the standard working hours. While the shift system has many positive effects on work and manufacture life, it also has negative effects on the life quality of employees and it brings many comorbid health and sleep problems. Shift work sleep disorder is categorized as a subgroup of circadian rhythm sleep disorders family. The primary symptoms of shift work sleep disorder are insomnia and excessive daytime sleepiness. The goal of shift work sleep disorder treatment is to improve the quality of life and work efficiency while improving the current symptoms related to sleep disturbances, and to minimize accidents by increasing attention and alertness. The goal of this review is to determine the clinical findings, diagnostic criteria, systemic outcomes, and treatment methods of shift work sleep disorder and the associated sleep disorders

Assessment of the Level of Knowledge about Migraines and Medication Among Pharmacy Technicians

Objective: A limited number of studies focus on pharmacy technicians (PT) and their knowledge level regarding migraines. The present study aimed to determine their level of awareness and knowledge regarding migraines and migraine treatment. Materials and Methods: This cross-sectional study was conducted at Erciyes University Faculty of Medicine in Kayseri, Türkiye. It was conducted from February 2019 to May 2019 and completed with the participation of 324 PTs (75.8% response rate). Forms containing questions about the diagnosis of migraines, the characteristics, and the treatments were administered to the PTs in person and then evaluated by a neurologist. Results: The ratio of PTs who knew of a drug therapy that reduced migraine attacks was 10.2%. Most PTs (85.2%) had no training in migraine treatment and obtained knowledge from their work experience. Ninety-one participants (28.1%) recommended medication to patients who visited the pharmacy due to headaches. When asked about the drug they recommend for migraines, 29.6% suggested ergotamine, 26.9% suggested analgesics, and 15.7% suggested triptans. Conclusion: The results of this study revealed that PTs working in pharmacies that support primary care services might not have sufficient awareness and knowledge about migraine treatments, and appropriate training should be provided on this subject

Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria

BackgroundMigraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in the diagnosis of comorbid MwoA, using a zone concept, in patients with I/GEs with headaches who were diagnosed by an experienced headache expert.MethodsIn this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were reevaluated. Eligible patients were divided into three subgroups, namely, full diagnosis, zone I, and zone II according to their status of fulfilling the ICHD-3 criteria. A Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis.ResultsLonger headache duration (<4 h) followed by throbbing pain, higher visual analog scale (VAS) scores, increase of pain by physical activity, nausea/vomiting, and photophobia and/or phonophobia are the main distinguishing clinical characteristics of comorbid MwoA in patients with I/GE, for being classified in the full diagnosis group. Despite being not a part of the main ICHD-3 criteria, the presence of associated symptoms mainly osmophobia and also vertigo/dizziness had the distinguishing capability of being classified into zone subgroups. The most common epilepsy syndromes fulfilling full diagnosis criteria (n = 62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% epilepsy with generalized tonic-clonic seizures alone.ConclusionLonger headache duration, throbbing pain, increase of pain by physical activity, photophobia and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs. Evaluating these characteristics could be helpful to close the diagnostic gaps in everyday clinical practice and fasten the diagnostic process of comorbid MwoA in patients with I/GEs

Sleep Quality and Parasomnia Frequency in Shift Workers.

TEZ11547Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2017.Kaynakça (s. 105-118) var.xi, 142 s. : tablo ; 29 cm.Amaç: Bu çalıGmanın amacı; gece vardiyasında çalıGanların uyku kalitelerini, vardiyalı çalıGmaya bağlı ortaya çıkan uyku bozukluklarının sıklığını, özelliklerini ve özellikle parasomni görülme sıklığını belirlemek ve gündüz vardiyasında çalıGanların uyku özellikleri ile karGılaGtırmaktır. Yöntem: Bu çalıGmaya Adana merkezinde 3 farklı alanda (sağlık, güvenlik ve iGçi) vardiyalı (% 78,5) ve sadece gündüz (% 21,5) mesaisinde çalıGan 1473 kiGi dahil edilmiGtir. AraGtırmada veri toplama aracı olarak 132 soru içeren bir anket formu kullanılmıGtır. Anket formunun içerisinde kiGinin gündüz aGırı uykululuğunu değerlendiren Epworth Uykululuk Ölçeği, son bir ay içerisindeki uyku kalitesini değerlendiren Pittsburg Uyku Kalitesi Ölçeği, major depresyon bulgularını belirlemek için Birinci Basamak Gçin Beck Depresyon Ölçeği, obstruktif uyku apnesi riskini belirlemek için Berlin anketi bulunmaktadır. Bulgular: ÇalıGmaya katılanların % 24,4‘ ünde parasomni saptandı. Parasomni vardiyalı çalıGanların % 27,5 inde görülürken, sadece gündüz vardiyasında çalıGanların ise % 13‘ünde belirlendi (p<0,001). Sıklıkla gece vardiyasında çalıGan genç yaG grubunda parasomni sıklığı anlamlı ölçüde yüksek saptandı. Vardiyalı çalıGanların % 24,9‘unda hipersomni, % 16,2‘sinde insomni saptandı ve bu bulgular gündüz çalıGma grubuna göre anlamlı ölçüde yüksek idi (p=0,004, p<0,001). Vardiyalı çalıGanların % 5,3‘ünde huzursuz bacaklar sendromu, % 7‘sinde obstruktif uyku apne sendromunu düGündürtür bulgular belirlendi (p=0,708, p=0,963). Mesai saatlerine göre gruplar arasında anlamlı fark saptanmadı. Sonuç: Vardiyalı çalıGmak uyku kalitesini önemli oranda bozmaktadır. Özellikle sürekli gece mesaisinde veya değiGen vardiya düzeninde çalıGanlarda yalnız gündüz vardiyasında çalıGanlara oranla daha fazla oranda subjektif uyku kalitesinde bozulma ve gündüz aGırı uykululuğu meydana gelmekte, kronik insomni ve parasomni daha sık rastlanmaktadır.Objective: The aim of this study is to determine the sleep quality of night shift workers, the frequency of sleep disorders due to the shift work, investigate if different shift work shedules are associated with parasomnias and compare sleep characteristics between different work shedules. Method: A total of 1473 employees working in different business areas (healthcare, security, laborer) in Adana were included in this study. And 78,5 % of these employees were working in shift works while 21,5% were working in daytime jobs only. A questionnaire, containing 132 questions, was used to collect data tool in the study. The questionnaire included the Epworth Sleepiness Scale assessing daytime sleepiness, the Pittsburg Sleep Quality Scale assessing sleep quality during the last month, the Beck Depression Scale to determine major depressive symptoms, and the Berlin questionnaire to determine obstructive sleep apnea risk. Results: Parasomnia was determined in 24,4% of all participants. Parasomnia was found in 27,5% of the shift workers, and in only 13% of the day shift workers (p <0.001). The frequency of parasomnia was found significantly higher in the young age group who worked most often at night shift. Hypersomnia was found in 24,9% of the shift workers and insomnia was detected in 16,2%, which were significantly higher than the daytime group (p = 0.004, p <0.001). Symptoms of restless legs syndrome were found in 5,3% of shift workers and OSAS in 7% (p = 0.708, p = 0.963, and these frequency were similar in day shift workers.Bu çalışma Ç.Ü. Bilimsel Araştırma Projeleri Birimi tarafından desteklenmiştir. Proje No: TTU -2015-4626

Evaluation of Factors Associated with the Clinical Course and Prognosis of Patients with Guillain-Barre Syndrome

Aim: This study aims to investigate the clinical, laboratory, electrophysiological, and demographic characteristics of patients with Guillain-Barre Syndrome (GBS) who were admitted to our clinic and underwent treatment and the factors contributing to the prognosis at discharge.Materials and Methods: The study included 138 patients admitted to our clinic for treatment between January 2013 and December 2017, whose patient records were reviewed retrospectively. The Hughes scores, demographic characteristics, and clinical and laboratory data of the patients at admission and discharge were recorded.Results: The study sample comprised 61 female (44.2%) and 77 male (55.8%) patients with a mean age of 58.1 years. In evaluations of the Hughes scores at admission and discharge, 117 patients were considered to have a good prognosis and 21 patients to have a poor prognosis at discharge. In the poor prognosis group, advanced age (p=0.028), being in the acute motor axonal neuropathy (AMAN) subtype (p=0.001), development of sepsis (p=0.007), need for mechanical ventilation (p&lt;0.001), high Hughes scores on admission (p&lt;0.001), extended hospitalization (p=0.030), increased WBC count (p=0.033), presence of hyponatremia (p&lt;0.001), abnormal liver function test (p=0.08) were higher than the good prognosis group.Conclusion: Early identification of GBS patients who may have a poor prognosis and rapid application of appropriate treatment methods are essential in creating positive effects on the clinical course and prognosis in this patient group

Evaluation of the effects of shift work on parasomnia prevalence

Shift work is increasingly common in industrialized countries but is associated with numerous health problems, especially sleep disorders. This study compared the frequency of NREM (confusional arousal, sleep terrors, sleepwalking, sleep-related eating disorder), REM parasomnias (REM sleep behavior disorder, nightmare disorder), and isolated symptoms/normal variants (sleeptalking) between shift workers and daytime workers. A total of 1473 participants in 3 different professional groups and working different shift schedules (daytime, night, or rotating shifts) were included. Participants completed a questionnaire consisting of 132 questions about parasomnia, occupational stress, history of occupational and traffic accidents, depression, and other sleep disorders. The lifetime parasomnia prevalence was 43.7% and the 1-year parasomnia prevalence was 24.4% overall. The 1-year parasomnia prevalence was 27.5% among shift workers and 13% among daytime workers. This rate was highest among rotating shift workers (27.9%), followed by night shift workers (21.2%), and lowest in daytime workers (13%) (P < .001). The most common parasomnias reported were sleep terrors, confusional arousals, and sleeptalking. Parasomnia prevalence rates among workers with and without a history of occupational accidents were 43.7% and 24.2%, while those of workers with and without a history of car accidents were 47.4% and 23.8%, respectively (P < .001). Shift work was associated with higher parasomnia prevalence. Working rotating shifts in particular was an independent risk factor for parasomnia. The parasomnias most frequently associated with shift work were confusional arousal, sleeptalking, and sleep terrors. It should be kept in mind that higher parasomnia rates may increase the risk of occupational and traffic accidents in this population

Motor Nöron Hastalığını Taklit Eden Spinal Dural Arteriovenöz Fistül

karakterize nadir vasküler lezyonlardır. Venöz hipertansiyona sekonder konjestif ödem ve sonuçta gelişen spinalkord infarktı, polinöropati ya da radikülopatiyi düşündüren asendan motor ve duysal semptomlara yol açar.Başlangıç belirtileri genellikle nonspesifiktir, yürüyüş zorlukları, bir veya her iki ayakta paraesteziler gibi simetrikveya asimetrik duyusal semptomlar ve radiküler ağrıyı içerir. Miksiyon ve defekasyon bozuklukları sıklıkla hastalığınileri aşamalarında gelişir. Erken tanı ve tedavi geri dönüşümsüz tablolara engel olması sebebi ile çok önemlidir.Olgu sunumu ve Bulgular: 62 yaşında erkek hasta iki yıl önce başlayan ve giderek artan yürüme güçlüğü yakınmasıile başvurdu. Nörolojik muayenesinde bilateral alt ekstremitelerde silik kuvvet kaybı ve derin tendon reflekslerindekayıp izlendi. Laboratuvar testleri normal sınırlarda olan hastanın elektrofizyolojik incelemesinde bilateral altekstremitelerde birleşik kas aksiyon potansiyeli amplitüdleri yaygın olarak düşük, duyu iletim çalışmaları normalsınırlardaydı. İğne elektromiyografide (EMG) bilateral alt ekstremitede yoğun spontan aktivitenin izlendiği ağır yaygınnörojenik lezyon bulguları izlendi. Üst ekstremitelerde ise motor ve duysal sinir iletim çalışması ve iğne EMG bulgularınormal sınırlardaydı. Bulguların alt ekstremitelere sınırlı olması nedeni ile yapılan spinal görüntülemede spinalkordda ödem ve artmış vaskülarite izlendi (Resim 1 A,B,C). Dijital substraksiyon anjiografi (DSA)’da ise SDAVF ileuyumlu görünüm izlendi (Resim 1 D) ve embolize edildi (Resim E). İşlem sonrası hastanın spinal görüntülemesindespinal korddaki ödem bulgularının geriledi (Resim 1 F) ve semptomlarında işlem sonrası kısmi düzelme görüldü.Sonuç: SDAVF’li hastaların elektrofizyolojik değerlendirmesinin yapıldığı çalışmalarda alt motor nöron, üst motor noronve miks tip tutulum bildirilmiştir. Olgumuzda olduğu gibi alt motor nöron bulgularının alt ekstremiteye sınırlı olduğuprogresif yürüme güçlüğü yakınması ile başvuran özellikle orta yaşlı erkek hastalarda ayırıcı tanıda mutlaka SDAVFdüşünülmelidir. Hastalık nadir görülmekle birlikte erken tanı ve tedavi ile oldukça başarılı sonuçlar elde edilmektedir.Anahtar Kelimeler: Motor nöron hastalığı, radiküler ağrı, spinal dural arteriovenöz fistül, yürüme güçlüğü</p