Lepiota castanea mushroom growing in Turkiye does not contain phallotoxins and amatoxins.

The number of poisoning cases caused by the Lepiota genus is globally increasing. This genus has more poisonous species than the Amanita genus, and many Lepiota species can cause severe toxicity and death if ingested. As recognized in the literature, L. castanea is a toxic species containing amatoxin. Although crude analytical methods have shown that L. castanea contains amatoxins, more recent and sensitive analyses suggest otherwise. Toxin concentrations can vary even among the same fungal species due to geographical and climatic differences. Therefore, this confusion can be resolved by analyzing L. castanea toxins from different geographical regions. This study aimed to demonstrate the toxin levels of L. castanea collected from forests in different regions of Turkiye (Istanbul and Kocaeli) using sensitive methods. The collected mushrooms were analyzed for alpha amanitin, beta amanitin, gamma amanitin, amanin, phallacidin, and phalloidin levels using RP-HPLC-UV and LC-ESI-MS/MS methods. L. castanea mushroom was found to be free of amatoxin and phallotoxin. Our study revealed for the first time that L. castanea mushrooms from different geographical regions of Turkiye do not contain amatoxin and phallotoxin. Supporting these findings with new studies from different parts of the world would be appropriate.

The Characterization and Beta-Lactam Resistance of Staphylococcal Community Recovered from Raw Bovine Milk.

Staphylococci is an opportunistic bacterial population that is permanent in the normal flora of milk and poses a serious threat to animal and human health with some virulence factors and antibiotic-resistance genes. This study was aimed at identifying staphylococcal species isolated from raw milk and to determine hemolysis, biofilm, coagulase activities, and beta-lactam resistance. The raw milk samples were collected from the Düzce (Türkiye) region, and the study data represent a first for this region. The characterization of the bacteria was performed with MALDI-TOF MS and 16S rRNA sequence analysis. The presence of coa, icaB, blaZ, and mecA was investigated with PCR. A nitrocefin chromogenic assay was used for beta-lactamase screening. In this context, 84 staphylococci were isolated from 10 different species, and the dominant species was determined as S. aureus (32.14%). Although 32.14% of all staphylococci were positive for beta hemolysis, the icaB gene was found in 57.14%, coa in 46.42%, mecA in 15.47%, and blaZ in 8.33%. As a result, Staphylococcus spp. strains that were isolated from raw milk in this study contained some virulence factors at a high level, but also contained a relatively low level of beta-lactam resistance genes. However, considering the animal-environment-human interaction, it is considered that the current situation must be monitored constantly in terms of resistance concerns. It must not be forgotten that the development of resistance is in constant change among bacteria.

Chemical, Electrochemical, and Surface Morphological Studies of the Corrosion Behavior of the AZ31 Alloy in Simulated Body Fluid: Effect of NaOH and H2O2 Surface Pretreatments on the Corrosion Resistance Property.

Magnesium and its alloys have attracted attention for biomedical implant materials in dental and orthopedic applications because of their biodegradability and similar properties to human bones. The very high rate of degradation in the physiological systems is, however, a major setback to their utilization. Chemical modification is one of the approaches adopted to enhance the corrosion resistance property of Mg and its alloys. In this work, NaOH and H2O2 were used as a pretreatment procedure to improve the corrosion resistance of the AZ31 Mg alloy in simulated body fluid (SBF). Advanced techniques such as dynamic electrochemical impedance spectroscopy (dynamic-EIS), atomic force microscopy, and optical profilometry were used in addition to the classical mass loss, hydrogen evolution, EIS, and polarization techniques to study the corrosion resistance property of the alloy in SBF for 30 h. Results obtained show that the surface treatment significantly enhanced the corrosion resistance property of the alloy. From dynamic-EIS at 30 h, the charge transfer resistance of the untreated AZ31 Mg alloy is 432.6 Ω cm2, whereas 822.7 and 2617.3 Ω cm2 are recorded for NaOH- and H2O2-treated surfaces, respectively. H2O2 is a better treatment reagent than NaOH. The mechanism of corrosion of both untreated and treated samples in the studied corrosive medium has been discussed.

Understanding the Corrosion Behavior of the AZ91D Alloy in Simulated Body Fluid through the Use of Dynamic EIS.

Dynamic electrochemical impedance spectroscopy (dynamic EIS) has the capacity to track changes on surfaces in a changing corrosive system, an advantage it holds over classical EIS. We used the dynamic EIS approach to provide insight into the corrosion behavior of the AZ91D Mg alloy in simulated body fluid for 30 h at 25 °C. The results reveal that the impedance response of the alloy is influenced by the immersion time. Between 0 and 7 h, impedance with three time constants was obtained, whereas two-time-constant impedance spectra were obtained between 8 and 30 h of immersion. The results confirm the breakdown of the corrosion product at longer immersion times.

Erdosteine reduces cytotoxicity induced by alpha- and beta-amanitin, but not gamma-amanitin, in CA3 hepatocyte cultures.

Amanitin poisoning still has no particular, effective antidote. Erdosteine has been shown to protect numerous tissues, particularly those in the liver. This study investigates the potential therapeutic effects of erdosteine on alpha-, beta- and gamma-amanitin-induced hepatotoxicity in in vitro models. Three hours after administering amatoxins at various concentrations (1-50 µg/mL) to the cells of the C3A human hepatocyte cell line, erdosteine was administered in different concentrations (i.e., 1, 10, 50, 100 and 250 µg/mL). The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was selected to determine cell viability. When concentrations of 1, 10, 50, 100 and 250 µg/mL of erdosteine were applied to cell lines, the following cell viability rates were obtained: 106%,99%,93%,86% and 86%, respectively, at a 10 µg/mL alpha-amanitin-induced toxicity; 43%,41%,41%,37% and 35%, respectively, at a 25 µg/mL alpha-amanitin-induced toxicity; 44%,42%,41%,39% and 41%, respectively, at a 50 µg/mL alpha-amanitin-induced toxicity; 136%,142%,143%,137% and 120%, respectively, at a 10 µg/mL beta-amanitin-induced toxicity; 113%,107%,107%,106% and 86%, respectively, at a 25 µg/mL beta-amanitin-induced toxicity; 78%,77%,77%,74% and 70%, respectively, at a 10 µg/mL gamma-amanitin-induced toxicity; and 39%,40%,39%,35% and 31%, respectively, at a 25 µg/mL gamma-amanitin-induced toxicity. This study was the first to evaluate the in vitro efficacy of erdosteine in cytotoxicity induced by alpha-, beta- and gamma-amanitin. Non-high (low and medium) doses of erdosteine are capable of nearly entirely preventing toxicity at mild hepatotoxic concentrations caused by amatoxin and partially preventing toxicity at moderate and severe concentrations. The beneficial effects of erdosteine, especially on the toxicity of alpha- and beta-amanitin, are promising.

Effects of thymoquinone on alpha-amanitin induced hepatotoxicity in human C3A hepatocytes

Abstract Thymoquinone (TQ) has shown hepatoprotective effects in various experimental studies. We aimed to investigate the possible beneficial effects of TQ regarding its prevention of alpha-amanitin induced hepatotoxicity in human C3A hepatocytes. After administering alpha-amanitin in a concentrations of 1 and 10µg/mL on the cells in a hepatocyte cell line, TQ was administered in various concentrations (10, 5, 1, 0.5, 0.1, 0.05, 0.01, 0.005 µg/mL). The MTT test was used to determine cell viability. For the groups given only TQ at various concentrations, the cell viability rates at 48 hours post-administration were found at 82.6, 98.3, 102.1, 102.5, 99.4, 99.4, 101.9 and 106.3%, respectively. For the group with 1μg/mL alpha-amanitin and various TQ concentrations, the cell viability rates were found at 74.6, 88.5, 87.4, 88.7, 85.7, 86.8, 88.4, and 92.9%, respectively. For the group with 10μg/mL alpha-amanitin and various TQ concentrations, the cell viability rates for each TQ subgroup were found at 65.2, 79.2, 81.4, 81.1, 81.8, 81.8, 82.2 and 91.9%, respectively. Our study is the first in vitro study that investigates TQ's effects on alpha-amanitin induced hepatotoxicity. Although TQ had beneficial effect in low doses did not significantly increase cell viability in liver damage due to alpha-amanitin toxicity.

Toxin components and toxicological importance of Galerina marginata from Turkey.

Amatoxins, most of which are hepatotoxic, can cause fatal intoxication. While mushrooms in the amatoxin-containing Galerina genus are rare, they can poison humans and animals worldwide. Few studies have profiled the toxicity of Galerina marginata. In addition, many studies indicate that macrofungi can have different characteristics in different regions. In this study, the quantities of toxins present in G. marginata from different provinces in Turkey were analysed using reversed-phase high-performance liquid chromatography with ultraviolet detection (RP-HPLC-UV) and liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS). G. marginata samples were collected from three different regions of Turkey. The taxonomic categorization of mushrooms was based on their micro- and macroscopic characteristics. The presence of toxins α-amanitin (AA), ß-amanitin (BA), γ-amanitin (GA), phalloidin (PHD) and phallacidin (PHC) quantities were measured using RP-HPLC-UV and then were confirmed using LC-ESI-MS/MS. BA levels were higher than AA levels in G. marginata mushrooms collected from all three regions. Moreover, the levels of GA were below the detection limit and no phallotoxins were detected. This is the first study to identify and test the toxicity of G. marginata collected from three different regions of Turkey using RP-HPLC-UV. This is also the first study to confirm the UV absorption of amatoxins in G. marginata using LC-ESI-MS/MS, which is a far more sensitive process. More studies evaluating the toxicity of G. marginata in other geographic regions of the world are needed.

First Report of a Neotropical Agaric (Lepiota spiculata, Agaricales, Basidiomycota) Containing Lethal α-Amanitin at Toxicologically Relevant Levels.

A recent collection of Lepiota spiculata from the Dominican Republic is presented here. Macro- and micromorphological features of L. spiculata are described in detail, and its evolutionary (phylogenetic) position within Lepiota sect. Ovisporae, in the subincarnata/brunneoincarnata clade, is assessed on the basis of a combined nrLSU + nrITS + rpb2 + tef1 analysis. Additionally, high levels of deadly amatoxins were detected and quantified in L. spiculata for the first time by HPLC analysis; in particular, α-amanitin was found at concentrations up to approximately 4 mg/g dry weight, which render L. spiculata a potentially lethal mushroom, if ingested.

Two new species of Amanitasect.Phalloideae from Africa, one of which is devoid of amatoxins and phallotoxins.

Two new species of Amanitasect.Phalloideae are described from tropical Africa (incl. Madagascar) based on both morphological and molecular (DNA sequence) data. Amanitabweyeyensis sp. nov. was collected, associated with Eucalyptus, in Rwanda, Burundi and Tanzania. It is consumed by local people and chemical analyses showed the absence of amatoxins and phallotoxins in the basidiomata. Surprisingly, molecular analysis performed on the same specimens nevertheless demonstrated the presence of the gene sequence encoding for the phallotoxin phallacidin (PHA gene, member of the MSDIN family). The second species, Amanitaharkoneniana sp. nov. was collected in Tanzania and Madagascar. It is also characterised by a complete PHA gene sequence and is suspected to be deadly poisonous. Both species clustered together in a well-supported terminal clade in multilocus phylogenetic inferences (including nuclear ribosomal partial LSU and ITS-5.8S, partial tef1-α, rpb2 and ß-tubulin genes), considered either individually or concatenated. This, along with the occurrence of other species in sub-Saharan Africa and their phylogenetic relationships, are briefly discussed. Macro- and microscopic descriptions, as well as pictures and line drawings, are presented for both species. An identification key to the African and Madagascan species of Amanitasect.Phalloideae is provided. The differences between the two new species and the closest Phalloideae species are discussed.

Determination of histological, immunohistochemical and biochemical effects of acute and chronic grayanotoxin III administration in different doses in rats.

Grayanotoxin (GTX)-III is a Na-channel neurotoxin. Grayanotoxins can be found in the nectar, pollen, and other plant parts of the Rhododendron genus plants from the Ericaceae family. It is widely believed that honey produced from these plants, which are concentrated in the Black Sea region, is traditionally characterized as enhancing sexual performance. It is thought that the effective factor is dose for this compound, which has both beneficial and toxic effects reported. Therefore, it is aimed to evaluate the histological, immunohistochemical, and biochemical effects of acute and chronic impact of GTX-III in different doses on testes tissue in this study. For this purpose, 100 Sprague-Dawley male rats were divided into 5 separate groups for acute and chronic research. While dose groups were (control, 0.1, 0.2, 0.4, ve 0.8 µg/kg/bw) for experimental groups, a single dose (i.p.) was administered for acute impact whereas the same doses were administered daily for 3 weeks to assess chronic effect. At the end of the experiment, Johnsen testicular biopsy scoring was performed on testicular tissue samples, seminiferous tubule diameters were measured, and apoptotic cells were evaluated by TUNEL method. Testosterone, LH, and FSH levels were measured by ELISA method in serum and tissue specimens. It was found that Johnsen score of acute doses was significantly lower than the control group, and the diameter of the seminiferous tubules decreased significantly in acute and chronic dose-administered groups compared to the control. Hemorrhage, epithelial shedding, irregularity in seminiferous epithelium, and vacuolization were observed in acute and chronic dose-administered groups, and increase in apoptotic cells was determined. Hormone levels varied depending on the dose. In conclusion, it was found that dose-dependent acute and chronic effects of GTX-III are different, and this factor should be taken into account in studies to be carried out due to the adverse effects of high doses.

Omentin Val/Val genotype increases predisposition to acne vulgaris without changing omentin serum level.

Acne vulgaris is the most frequent and multifactorial inflammatory skin disorder in all races. Obesity is considered to be a risk factor for acne due to its contribution to inflammation. The involvements of inflammatory (leptin and resistin) and anti-inflammatory (adiponectin) adipokines in the pathogenesis of acne were reported. Omentin resembles adiponectin in terms of having inhibitory effect on tumor necrosis factor-α (TNF-α) induced inflammation, a vital process in the acne formation. This study was designed to investigate the putative involvement of omentin in acne formation. The genotyping was performed by restriction fragment length polymorphism (RFLP) method. Serum omentin protein levels were analyzed by enzyme-linked immunosorbent assay (ELISA). Serum omentin level was not significantly changed between groups. However, the decreased serum omentin level was observed as the mean value of BMI increased. The Asp/Asp, Val/Asp and Val/Val genotypes distributions for control and patient groups (19[17.4%], 22[20.2%], and 3[2.8%] respectively, vs. 31[28.4%], 25[22.9%], and 9[8.3%], respectively) were obtained. The Val/Val (mutant homozygote) genotype was found nearly 1.8 times more in the patient group (p=0.403, OR=1.839 (0.442-7.653)). This is the first time to clarify a linkage between anti-inflammatory omentin and acne vulgaris. Omentin Val109Asp polymorphism affects the overall function of the protein. In conclusion, omentin Val/Val (mutant homozygote) genotype increases predisposition to acne vulgaris by probably disrupting overall protein function of omentin.

Evaluation of the corrosion inhibiting efficacy of a newly synthesized nitrone against St37 steel corrosion in acidic medium: Experimental and theoretical approaches.

A novel amphiphilic nitrone, N-phenyl-1-(4-((11-(pyridin-1-ium-1yl) undecanoyl) oxy)phenyl)methanimine oxide bromide (NP-1-4-11-PUOPMOB) has been synthesized from a fatty acid derivative as a starting material. Structural characterization of the new compound has been realized by spectroscopic techniques (FTIR, 1H NMR, and 13C NMR). The corrosion inhibition effect of the compound for St37 steel corrosion in 1 M HCl medium has been investigated using experimental (weight loss, electrochemical impedance spectroscopy, potentiodynamic polarization, dynamic electrochemical impedance spectroscopy) and theoretical approaches complemented by surface morphological examination using energy dispersive X-ray spectroscopy, scanning electron microscope, and atomic force spectroscopy. Results from both chemical and electrochemical techniques reveal that the presence of the nitrone in the acid solution impedes St37 steel corrosion. The inhibition efficiency obtained at 125 ppm and 150 ppm concentrations for all methods is found to be over 90%. NP-1-4-11-PUOPMOB behaves as a mixed type corrosion inhibitor according to the potentiodynamic polarization studies. The adsorption of NP-1-4-11-PUOPMOB molecules onto the metal surface follows Langmuir adsorption isotherm and the calculated Kads (equilibrium constant of the adsorption process) value reflects strong interaction. There is evidence of NP-1-4-11-PUOPMOB adsorption on the metal surface from SEM, EDAX, and AFM studies. Experimental and theoretical results are in good agreement.

Gum Arabic-silver nanoparticles composite as a green anticorrosive formulation for steel corrosion in strong acid media.

A green anticorrosive composite (GA-AgNPs) has been formulated for steel in 15% HCl and 15% H2SO4 media. Characterization of GA-AgNPs is achieved via FTIR, UV-vis, EDAX, and SEM. Gravimetric, electrochemical (EIS, EFM, DEIS, & TP), and surface assessment (SEM, EDAX, AFM, & XPS) techniques have been deployed in the anticorrosion studies. Results from all applied methods potray GA-AgNPs as effective anticorrosive agent. Inhibition is by adsorption mechanism and follows Langmuir isotherm. GA-AgNPs acts as mixed type inhibitor in 15% H2SO4 solution but as anodic type in 15% HCl solution. Results from surface techniques confirm adsorption of GA-AgNPs molecules on specimen surface. Oxides, hydroxides, carbonates, and sulphates (H2SO4 medium) or chlorides (HCl medium) are the corrosion products in the free corrodent according to XPS results. In the presence of composite, both ionic and neutral forms of GA-AgNPS are adsorbed. AgNPs are present on the surface in the form: Ag°, Ag2O, and AgO.

Comparison of Changes in Anxiety and Depression Level Between Dabigatran and Warfarin Use in Patients With Atrial Fibrillation.

We hypothesized that patients taking warfarin require frequent hospital follow-up and they are at higher risk for complications, so the incidence of depression and anxiety is higher in patients with atrial fibrillation (AF) in the period of taking warfarin compared to the period of taking dabigatran. Fifty patients having AF without valvular diseases under treatment of warfarin in whom a transition to dabigatran was planned were consecutively enrolled in this study and followed up prospectively between July 2013 and July 2014. All patients completed Beck Depression Inventory and Hamilton Anxiety Scale (HAS) at the initiation of study and 6 months after initiation of study. Of the patients enrolled in the study, age, gender, smoking status, and comorbidities were questioned. A total of 50 patients (28 women; mean age 74.6 ± 8.7 years) treated with warfarin in whom a transition to dabigatran was planned were included. Basal mean value of BDS (15.6 ± 7.8 vs 11.5 ± 4.8, P < .001) and HAS (16.8 ± 10.4 vs 12.6 ± 8.1, P < 0.001) was significantly higher in patients when they used warfarin than when they switched to dabigatran. In categorical analysis, frequency of patients with depression (mild, moderate, and severe) was significantly higher in period of warfarin use than after dabigatran transition (n = 24, 48% vs n = 14, 28%, P = .039). Our study demonstrates that patients with nonvalvular AF under treatment of dabigatran had lower BDS and HAS scores compared to warfarin. These findings suggest that dabigatran may increase quality of life and decrease morbidity and mortality due to reduction in anxiety and depression.

A Case Study: What Doses of Amanita phalloides and Amatoxins Are Lethal to Humans?

There are few data estimating the human lethal dose of amatoxins or of the toxin level present in ingested raw poisonous mushrooms. Here, we present a patient who intentionally ingested several wild collected mushrooms to assess whether they were poisonous. Nearly 1 day after ingestion, during which the patient had nausea and vomiting, he presented at the emergency department. His transaminase levels started to increase starting from hour 48 and peaking at hour 72 (alanine aminotransferase 2496 IU/L; aspartate aminotransferase 1777 IU/L). A toxin analysis was carried out on the mushrooms that the patient said he had ingested. With reversed-phase high-performance liquid chromatography analysis, an uptake of approximately 21.3 mg amatoxin from nearly 50 g mushroom was calculated; it consisted of 11.9 mg alpha amanitin, 8.4 mg beta amanitin, and 1 mg gamma amanitin. In the urine sample taken on day 4, 2.7 ng/mL alpha amanitin and 1.25 ng/mL beta amanitin were found, and there was no gamma amanitin. Our findings suggest that the patient ingested approximately 0.32 mg/kg amatoxin, and fortunately recovered after serious hepatotoxicity developed.

Effect of Montelukast on Spinal Cord Ischemia- Reperfusion Injury.

AIM: Paraplegia due to ischemia-reperfusion (I/R) injury of the spinal cord is a devastating complication of thoracoabdominal aortic surgery. Cysteinyl leukotrienes are potent mediators of inflammation that are associated with I/R injury. The present study was designed to investigate the role of montelukast, a selective reversible CysLT1 receptor antagonist, on spinal cord I/R injury in an experimental model. MATERIAL AND METHODS: Twenty-one male Sprague-Dawley rats were randomly assigned to three groups (n=7 per group) as G1 (no aortic occlusion and montelukast administration), G2 (45 min. aortic occlusion; no montelukast administration) and G3 (45 min. aortic occlusion, 10 mg/kg montelukast administration). After neurologic evaluation using the Motor Deficit Index (MDI) score at the 48th hour of reperfusion, lumbar spinal cords were removed for histopathological evaluation and immunohistochemical staining for HSP70, interleukin-6 and myeloperoxidase (MPO). RESULTS: All rats in the G1 group had a normal neurological status and their MDI score was 0 (p < 0.05). The MDI score of G3 was significantly lower than G2 group (2.8 vs. 5.5; p < 0.05). Vacuolar congestion was found to be significantly lower in G1 than the other groups (p=0.0001). The interleukin-6 receptor level was found to be significantly lower in G3 group than the control group (p=0.013). There was no statistically significant difference found among the groups in terms of the degree of HSP70 and MPO staining. CONCLUSION: Increased generation of leukotrienes in postischemic organs play an important role in I/R injury. The findings of the current study demonstrated that montelukast improved motor recovery and decreased IL-6 levels in spinal cord I/R injury.

Erythropoietin stimulates patellar tendon healing in rats.

BACKGROUND: Erythropoietin (EPO), regulating erythropoiesis, is used to provide protective and regenerative activity in non-haematopoietic tissues. There is insufficient knowledge about the role of EPO activity in tendon healing. Therefore, we investigated the effect of EPO treatment on healing in rat patellar tendons. METHODS: One hundred and twenty-six, four-month-old male Sprague-Dawley rats were randomly assigned to three experimental groups: 1, no treatment; 2, treatment with isotonic saline (NaCl) and 3, treatment with EPO. Each group was randomly subdivided into two groups for sacrifice at three (1a, 2a, 3a) or six weeks (1b, 2b, 3b). Complete incision of the left patellar tendon from the distal patellar pole was performed. We applied body casts for 20 days after the incised edges of the patellar tendon were brought together with a surgical technique. Both legs were harvested and specimens from each group underwent histological, biomechanical, and protein mRNA expression analyses. RESULTS: There were statistically significant differences in the ultimate breaking force between the EPO group and others at both weeks three and six (p<0.05); significant differences in fibroblast proliferation, capillary vessel formation, and local inflammation were found between groups 1a and 3a, and 2a and 3a (p<0.05). There were statistical differences between 1a, 3a and 2a, 3a for Col III, TGF-ß1, and VEGF and between 1b, 3b and 2b, 3b for Col I, Col III, TGF-ß1, and VEGF mRNA expressions. CONCLUSION: EPO had an additive effect with surgery on the injured tendon healing process in rats compared to the control groups biomechanically, histopathologically and with tissue protein mRNA expression. CLINICAL RELEVANCE: This is the first experimental study to analyze the relationship between EPO treatment and the patellar tendon repair process by biomechanical, histopathological, and tendon tissue mRNA expression methodologies.

Acute intoxication cases admitted to the emergency department of a university hospital.

BACKGROUND: This study aimed to describe the clinical and socio-demographic aspects of acute poisoning in 2010 in Duzce City, Northwest Anatolian Region of Turkey. METHODS: Acute poisoning was due to the intentional ingestion of drugs in young and adult people (≥16), who were treated at the Emergency Service of Duzce University Medical Hospital, Turkey from January 1, 2010 to December 31, 2010. In this retrospective and descriptive study, 95 patients were diagnosed with intoxications and 30 of them intentionally ingested drugs to commit suicide. Records of the patients diagnosed with intoxication were obtained from the Clinical Archive of the hospital. Their diagnoses were established according to the International Statistical Classification of Diseases and Related Health Problems. Codes X60-X84 of this classification were used to classify self-infringed drug injuries and drug poisoning. RESULTS: In this series, 35 (36.8%) patients were male and 60 patients (63.2%) female. The male/female ratio was 1.0/1.7. The mean age of the patients was 33.1±14.2 years; 17 (17.9%) patients were below 20 years old and 9 (9.5%) were older than 50 years. Of these patients, 29 (30.5%) were single, 7 (7.4%) divorced or separated, and 59 (62.1%) married. Their mean time for admission to the emergency service after the incident was 208±180 (15-660) minutes. The mean time for admission to the emergency service for patients with food intoxication after the incident was 142±160 minutes, for those with drug intoxication 173±161 minutes, for those with carbon monoxide (CO) intoxication 315±209 minutes, and for those with undefined intoxication 289±166 minutes (P=0.005). Most of the intoxication cases occurred in winter (41.1%, 39 of 95 patients). Admissions to the emergency service were most common in December and April (21 and 16 of 95 patients, respectively). Sixty-five (68.4%) cases were involved in non-deliberate poisoning, whereas 30 (31.6%) were involved in deliberate poisoning. Twenty-six of the 95 patients with acute poisonings had mortality risk at admission, however only one died from CO intoxication in the emergency service (1.1%). Suicide attempts were more common in females than in males (21 of 30 patients, 70%, P<0.05). CONCLUSION: In Duzce City of Turkey, most intoxication cases occurred in winter, especially in December. They had non-deliberate poisoning, but deliberate poisoning in suicide attempts was more common in females than in males.

A Case Study: Rare Lepiota brunneoincarnata Poisoning.

Amatoxin poisoning from the genus Lepiota may have a deadly outcome, although this is not seen as often as it is from the genus Amanita. In this report, we present a patient who was poisoned by a sublethal dose of Lepiota brunneoincarnata mushrooms. The patient was hospitalized 12 hours after eating the mushrooms. The patient's transaminase levels increased dramatically starting on day 4. Aspartate transaminase peaked at 78 hours. Starting at 1265 IU/L, alanine transaminase peaked at 90 hours at 5124 IU/L. The patient was discharged on day 8 to outpatient care, and his transaminase levels returned to normal ranges in the subsequent days. A toxin analysis was carried out on the mushrooms that the patient claimed to have eaten. Using reversed-phase high-performance liquid chromatography analysis, an uptake of approximately 19.9 mg of amatoxin from nearly 30 g of mushrooms was calculated. This consisted of 10.59 mg of α-amanitin, 9.18 mg of ß-amanitin, and 0.16 mg of γ-amanitin. In conclusion, we present a patient from Turkey who was poisoned by L. brunneoincarnata mushrooms.