Diabetes mellitus (DM) is an independent risk factor for cardiovascular diseases. Metformin, the most commonly used antidiabetic, also has an antiatherogenic effect. Mean platelet volume (MPV) is increased in patients with high thrombogenic activation and also at risk for atherosclerosis. The purpose of this study was to examine the effects of metformin on MPV values in newly diagnosed type II DM patients on metformin monotherapy. In this study, 60 newly diagnosed type II DM patients (45 females, 15 males), who had applied to the Kocaeli University School of Medicine Endocrinology outpatient clinic, and 47 healthy individuals (35 females, 12 males) were included. The two groups have similarity for age, sex and body mass index. The patients with additional disease, nephropathy, smoking and using drugs that may affect the MPV were excluded. At baseline and 6 months after metformin treatment, patient demographics and laboratory values were compared. MPV was higher among type II DM patients than the control group (p < 0.001). After 6 months of metformin treatment, MPV values were significantly decreased (p < 0.001). HbA1c and mean platelet mass were also significantly decreased (p = 0.022 and 0.001, respectively). There was no correlation between MPV and HbA1c values (r = -0.13, p = 0.926). Metformin, which has been shown to exhibit antiatherogenic effect through positive effects on cholesterol levels, inflammatory markers and vascular adhesion molecules, decreased MPV values that appear to play a crucial role at the beginning of atherosclerosis development. We conclude that our result may contribute to the explanation for antiatherogenic effect of metformin.

IntroductionApproxiamately 70-80% of patients receiving chemotherapy experience nausea and/or vomiting. However, emesis, nausea and vomiting significantly affect patients quality of life and can lead to poor compliance with further treatment. They can also cause metabolic imbalances, nutrient depletion, anorexia, decline of the patient's performance status and even withdrawal from curative anticancer treatment. There are several factors affecting the severity and incidence of emesis and vomiting, including type of chemotherapy, dosage, schedule and even individual patient variability (1-3).Vomiting is triggered by impulses to the vomiting center from the chemoreceptor trigger zone, pharynx, gastrointestinal tract and cerebral kortex. The principal neuroreceptors involved in emetic response are dopamine and the seratonin receptors. The others are, corticosteroid, histamine, cannabinoid, acetylcholine and neurokinin-1 (NK-1) receptors. Antiemetics can block different neuronal pathways and exert their effects at different points during emesis course (4).Aprepitant (AP) is a selective NK-1 receptor blocker that blocks the binding of substance -P at the NK-1 receptor in the central nervous system. It differs from the other antiemetics by augmenting the antiemetic activity of the 5-HT3-receptor anatagonists and dexamethasone to inhibit both acute and delayed cisplatin-induced emesis. However, most of the studies, including two phase III studies evaluated the efficieny of aprepitant by self-diary reports and reported only the incidence and severity of emesis. It is also commonly claimed that the nausea and vomiting accompanying cytotoxic chemotherapy have a negative impact on quality of life but there is little empirical data demonstrating that the failure to control postchemotherapy emesis affects aspects of quality of life other than directly related physical symptoms (5, 6). ABSTRACTObjective: Functional Living Index Emesis (FLIE) is developed to evaluate the relationship between emesis and it's effects on patient's daily life and is far more relevant to detect the effectiveness of antiemetic treatment compared with self-diary reports. In this study, the efficacy of oral neurokinin-1 antagonist aprepitant on the prevention of chemotherapy-induced nausea and vomiting and quality of life is evaluated with FLIE.Study Design: Cross sectional study. Material and Methods:Sixty patients with Non-Small Cell Lung Cancer (NSCLC) receiving a chemotherapy regimen consisting of Cisplatin and Docetaxel were evaluated. The patients were prospectively randomized to two groups before the first cycle of chemotherapy. Patients in Group A (31 patients) received 3 daily doses of aprepitant along with oral ondansetron and dexamethasone. The patients in group B (29 patients) received only ondansetron and dexamathasone. The efficacy of both regimens was evaluated by a modified Turkish version of FLIE scale consisting of 18 questions. Results:The number of patients with complete response was 31 in the whole group. Of these 18 patients (58%...

disease, is a non-competitive reversible inhibitor of acetylcholinesterase. We present a case of rivastigmine toxicity at a dose of 90 mg, with evidence of respiratory depression. To our knowledge, this case report provides evidence of the highest rivastigmine ingestion recorded (90 mg) that caused respiratory depression but requiring only supportive intervention without the need for ralidoxime. Emergency physicians should strongly consider cholinesterase inhibitor (rivastigmine, galantamine, and tacrine) ingestion in patients who present with short and temporary organophosphate-like toxidromes.

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