Comparison of chemotherapy treatment administration via venous port and peripheral vascular access in terms of quality of life and costs.

PURPOSE: In this study, it was aimed to compare the administration of chemotherapy drugs via venous port catheter and peripheral vein in metastatic colon cancer patients in terms of quality of life and treatment costs. METHODS: The research was carried out in a university hospital in Turkey. The population of the study consists of 130 patients with metastatic colon cancer who were treated with chemotherapy. The sample of the study consists of 103 participants. During the data collection phase of the study, three data collection tools were used: demographic information form, EOTC QLQ-30 quality of life scale and invoices for treatments. Data were analyzed using Microsoft Office Excel and IBM SPSS 20 package programs. RESULTS: In the study, 71.8% of the participants received chemotherapy with a venous port catheter, 65% for more than 3 months, 56.3% in the day unit. As a result of the study, it was found that there were no significant differences in the quality of life (except social function) according to the chemotherapy method. In addition, when the research results are examined in terms of cost, statistically significant differences were found in the treatment cost (except total costs excluding drugs) according to the chemotherapy application method. CONCLUSION: In line with these results, it is thought that when choosing the chemotherapy application method, factors such as the treatment duration of the patients, the ease of opening the vascular access, and the patient's psychological state should be taken into consideration.

Determining Post-COVID-19 Symptoms and Rehabilitation Needs in Hospitalized and Nonhospitalized COVID-19 Survivors with Tele-Assessment Methods.

Objectives: This study aimed to evaluate the post-COVID-19 symptoms, the severity of symptoms, and functional capacities seen in hospitalized and nonhospitalized COVID-19 survivors according to time periods (total 6, 1-3, and 3-6 months) by tele-assessment methods and to predict the need for periodic rehabilitation of COVID-19 survivors. Methods: Three hundred ninety-four COVID-19 survivors (50.18 ± 15.14 years) who were between 1 and 6 months after PCR(+) were included in the study, and their ongoing symptoms and the severity of these symptoms (0-10 points) were assessed with COVID-19 Yorkshire Rehabilitation Screening (C19-YRS) Tool, and the 30-s Chair Stand Test (CST) was applied by tele-assessment methods. Results: In hospitalized and nonhospitalized survivors of COVID-19, 87% experienced at least one symptom within the first 6 months. The most prevalent symptoms were anxiety (47.7%), fatigue (46.7%), and muscle pain (45.7%). The most common symptom in the nonhospitalized group was fatigue (52.6%), whereas anxiety was 46.8% in the hospitalized group. The 30-s CST score of the nonhospitalized group was significantly higher than the hospitalized group (p < 0.001). Conclusions: In the first 6 months post-COVID-19, musculoskeletal problems, anxiety, fatigue, and muscle pain were observed to be the most prevalent symptoms, regardless of time, in hospitalized and nonhospitalized survivors. There was a serious decrease in their functional capacity. Priority should be given to psychiatric, cardiopulmonary, and musculoskeletal rehabilitation in post-COVID-19. Inclusion of hospitalized/nonhospitalized COVID-19 survivors in a comprehensive rehabilitation program tailored to their needs by following a comprehensive tele-assessment by a multidisciplinary team will reduce the "long COVID-19 syndrome." ClinicalTrials.gov Registration Number: NCT04900441.

The accumulation of element and heavy metal concentrations in different parts of some carrot and radish types.

Vegetables, which are an important part of human nutrition, are very rich in minerals necessary for human health, and heavy metals can be found in vegetables at high rates because they can be easily taken by plant roots and leaves. In this study, the macro, micro element and heavy metal element concentrations accumulated in different parts of some carrot and radish types were investigated. The element concentrations in the samples were analyzed by Inductively coupled plasma optical emission spectrometry (ICP-OES; Varian-Vista Model) equipment. P, K, Ca, Mg and S contents of the head of orange and black carrot samples were determined as 602.30 and 727.23 mg/kg, 19,790.91 and 22,230.21 mg/kg, 1765.66 and 1609.41 mg/kg, 580.34 and 660.79 mg/kg and 376.21 and 4444.46 mg /kg respectively. Also, exterior parts of orange and black carrots contained 281.65 and 336.43 mg/kg P, 7768.37 and 10,109.44 mg/kg K, 169.88 and 272.18 mg/kg Ca, 112.08 and 189.28 mg/kg Mg and 135.43 and 217.60 mg/kg S, respectively. P and K contents of the head parts of radish samples (white, red and black radish) were determined between 302.14 (red radish) and 1111.53 mg/kg (black radish) to 13,717.2 (red radish) and 22,202.4 mg/kg (white radish), respectively. Fe amounts of the roots of radish samples changed between20.47 (red radish) and 45.93 mg/kg (white radish). As and Ba were the most abundant heavy metals in both carrot and radish parts. The Ni contents of the parts of the carrots contain more than 50% lower than the head part. Also, while Pb contents of the parts of orange carrot change between 0.189 µg/g (interior of body) and 0.976 µg/g (shell), Pb amounts of the black carrot parts were recorded between 0.136 (head) and 0.536 µg/g (interior of body). The results obtained differed according to the vegetable type and parts. The head part of the radishes was the richest in zinc, followed by root, shell, exterior of body and interior of body in descending order. In general, the parts where heavy metals were most localized were the head and shell parts. The most localized parts of heavy metals in radishes were the head, shell and root parts. As a result, the most of the edible inner parts of carrots and radishes are thought to have a positive effect on human health, since their heavy metal content is low.

Macro-, micro-, and heavy metal element levels in different parts of celery (Apium graveolens L.) plant.

Potassium (K) was found in the highest amount in the macroelements of the celery plant, followed by P, Ca, Mg, and S in decreasing order. P and K amounts of celery plant parts were measured between 619.57 (leaf of celery) and 1244.80 mg/kg (root of celery) to 5594.83 (head of celery) and 7587.35 mg/kg (root of celery), respectively. Exterior and interior parts of celery body contained 866.51 and 1017.45 mg/kg P, 6786.97 and 7325.07 mg/kg K, 615.13 and 491.59 mg/kg Ca, and 286.34 and 224.74 mg/kg Mg, respectively. In general, the celery part with the richest microelements was the leaves, followed in descending order by the head of celery, exterior of celery body, interior of celery body, and root. Fe and Mn contents of the parts of celery plants were recorded between 0.351 (interior of celery body) and 67.79 mg/kg (leaf of celery) to 2.70 (root) and 6.84 mg/kg (leaf of celery), respectively. The lowest and highest concentrations of each heavy metal were found in different parts of the celery plant. In general, the leaves were the part of the celery plant with the most heavy metals. As and Pb accumulated in large amounts in the inner parts of the celery tuber. The highest Pb (0.530 µg/g) was determined in interior of celery body. The highest Co (0.409 µg/g), Cr (0.377 µg/g), Mo (0.854 µg/g), and Ni (0.741 µg/g) were found in the leaf of celery plant.

Coronaphobia and academic procrastination in health sciences students during the first 3-month pandemic lockdown.

OBJECTIVE: To determine the correlation between coronaphobia and academic procrastination among university students during the first 3-month coronavirus disease-2019 lockdown. Methods: The cross-sectional study was conducted from June to July 2020 at the Hamidiye Faculty of Health Sciences, the University of Health Sciences, Istanbul, Turkey, and comprised Health Sciences students of either gender across 10 departments. The coronavirus disease-2019 Phobia Scale and the Scale of Academic Procrastination Behaviour were used to gather data. The relationship of the scores was examined with respect to gender and academic level. Data was analysed using SPSS 21. RESULTS: Of the 743 subjects enrolled, 681(91.65%) completed the survey; 548(80.5%) females and 133(19.5%) males. The overall mean age was 20.91±1.94 years (range: 18-35 years). The largest group was that of first year students 229(33.6%). There was a significant correlation between coronaphobia and academic procrastination (p=0.001). Total coronaphobia (p=0.023) and psychological subscale scores (p=0.001) of women were significantly higher than men. Negative perceptions regarding instructors were higher in men than women (p=0.038). The academic year was not significantly associated with either coronaphobia (p=0.249) or procrastination (p=0.546). CONCLUSIONS: The coronavirus disease-2019 created a phobia and this caused academic procrastination in health sciences students, especially women.

Impulsivity and substance misuse among Turkish people: Serial mediating effect of emotion dysregulation and general anxiety disorder.

Substance misuse is an alarming issue worldwide that causes serious problems at both the individual and societal levels, placing a burden on public health systems and economies. Understanding the predictors of substance misuse may help prevent it and may be an adjunct to treatment. The present study examined the relationship among impulsivity, emotion dysregulation, generalized anxiety disorder, and substance misuse. A total of 462 participants age between 18 and 74 years (M = 33.67, SD = 12.91) from 49 cities across Türkiye, completed the measures of impulsivity, emotion dysregulation, generalized anxiety disorder, and substance misuse. Structural equation modeling indicated that impulsivity, emotion dysregulation, and generalized anxiety have a significant predictive role in substance misuse. Further, emotion dysregulation and generalized anxiety disorder mediate the relationship between impulsivity and substance misuse. These findings suggest that noticing and treating impulsivity, emotion dysregulation, and generalized anxiety may minimize the effects of substance misuse.

Childhood Maltreatment and Spiritual Well-Being: Intolerance of Uncertainty and Emotion Regulation as Mediators in Turkish Sample.

Spiritual well-being is a phenomenon that enhances the quality of life and acts as a protective factor against stress and negative emotions. The purpose of this study was to investigate whether childhood psychological maltreatment is related to spiritual well-being and whether intolerance of uncertainty and emotion regulation serially mediate this relationship. The study sample comprised 330 participants aged between 18 and 55 years from 46 out of the 81 cities in Türkiye. The study participants completed the Psychological Maltreatment Questionnaire, Intolerance of Uncertainty Scale, Emotion Regulation Scale, and Spiritual Well-Being Scale, a scale derived from the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being that measures spiritual well-being by using the conceptualization of meaning and peace. The data obtained were analyzed using a two-step structural equation modeling approach, which indicated that childhood psychological maltreatment has an association with spiritual well-being, and this relationship is mediated by both intolerance of uncertainty and emotion regulation. The findings are discussed in the context of the literature on spiritual well-being.

Proteome analysis of the circadian clock protein PERIOD2.

Circadian rhythms are a series of endogenous autonomous 24-h oscillations generated by the circadian clock. At the molecular level, the circadian clock is based on a transcription-translation feedback loop, in which BMAL1 and CLOCK transcription factors of the positive arm activate the expression of CRYPTOCHROME (CRY) and PERIOD (PER) genes of the negative arm as well as the circadian clock-regulated genes. There are three PER proteins, of which PER2 shows the strongest oscillation at both stability and cellular localization level. Protein-protein interactions (PPIs) or interactome of the circadian clock proteins have been investigated using classical methods such as two-dimensional gel electrophoresis, immunoprecipitation-coupled mass spectrometry, and yeast-two hybrid assay where the dynamic and weak interactions are difficult to catch. To identify the interactome of PER2 we have adopted proximity-dependent labeling with biotin and mass spectrometry-based identification of labeled proteins (BioID). In addition to known interactions with such as CRY1 and CRY2, we have identified several new PPIs for PER2 and confirmed some of them using co-immunoprecipitation technique. This study characterizes the PER2 protein interactions in depth, and it also implies that using a fast BioID method with miniTurbo or TurboID coupled to other major circadian clock proteins might uncover other interactors in the clock that have yet to be discovered.

The effect of acid use as a preservative on the results of biochemical tests measured in 24-h urine.

Twenty-four-hour urine measurements play a crucial role in the diagnosis, follow-up and treatment of various diseases. There are different approaches to the collection of urine in patients who need to collect multiple urine samples at a time, especially in hospitals with heavy workloads. In this study, we compared the sodium, potassium, chloride, amylase, calcium, creatinine, phosphorus, microalbumin, protein, magnesium, urea, uric acid, adrenaline, noradrenaline, dopamine, metanephrine, normetanephrine, vanillylmandelic acid, 5-hydroxyindoleacetic acid and homovanillic acid results of 24-h urine samples analyzed immediately without acid addition, which we accepted as the reference and baseline measurement, with the results of the samples analyzed after waiting for 24 h without acid addition, analyzed immediately with acid addition and analyzed after waiting for 24 h with acid addition. Chloride, microalbumin, amylase and protein tests, which are recommended to be measured in the sample without preservatives, are affected by acid addition. Adrenaline, noradrenaline and dopamine, which are the tests recommended to be measured in acid-added urine are degraded in the samples without acid, and the levels of metanephrine and normetanephrine were not significantly degraded in the absence of preservatives.

Self-reported changes in alcohol and tobacco use during COVID-19: findings from the eastern part of WHO European Region.

BACKGROUND: The COVID-19 pandemic might impact substance use behaviours around the globe. In this study, we investigate changes in alcohol and tobacco use in the second half of 2020 in countries of the eastern part of the WHO European Region. METHODS: Self-reported changes in alcohol and tobacco use among 11 295 adults from 18 countries in the eastern part of the WHO European Region were collected between August 2020 and January 2021. The non-probabilistic sample was weighted for age, gender and education. For each country, proportions of respondents reporting a decrease, no change or increase in substance use over the past 3 months were examined, and multinomial regression models were used to test associations with age, gender and past-year alcohol use. RESULTS: In most countries, about half of the respondents indicating past-year alcohol or tobacco use reported no change in their substance use. Of those alcohol users who reported changes in their alcohol use, a larger proportion reported a decrease than an increase in most countries. The opposite was true for tobacco use. Women, young adults and past-year harmful alcohol users were identified as being more likely to change their substance use behaviour. CONCLUSION: We found diverging overall trends for alcohol and tobacco use in the second half of 2020. The patterns of change vary according to age, gender and past-year substance use. Individuals at risk to increase their substance use during the COVID-19 pandemic require most policy considerations.

Vitreous hemorrhage: A rare ophthalmic adverse effect due to imatinib treatment.

INTRODUCTION: Imatinib is generally well tolerated by patients. The most common ophthalmic side effects are eyelid edema and periorbital edema. Other side effects which occur at rates of <1% include blepharitis, blurred vision, conjunctival hemorrhage, conjunctivitis, retinal hemorrhage, etc. An uncommon case is here reported of a 51-year-old male with chronic myeloid leukemia who developed vitreous hemorrhage due to imatinib after 9 months of treatment. CASE REPORT: A 51-year-old male with leukocytosis detected in the blood test examination was referred to the Hematology Department. The bone marrow biopsy result was compatible with chronic myeloid leukemia. Imatinib treatment (400 mg/day) was started. In the ninth month of imatinib treatment, the patient complained of a sudden decrease in vision. Vitreous hemorrhage was detected in the left eye and the patient underwent surgery. Vitreous hemorrhage recurred 1 month after the operation. On the fourth day after the discontinuation of imatinib treatment, the patient's ophthalmic complaints improved significantly. The Naranjo algorithm was applied and a score of 9 was detected. The vitreous hemorrhage of the patient was attributed to imatinib, and so the treatment of the patient was switched to bosutinib. DISCUSSION: Imatinib is an oral signal inhibitor that targets tyrosine kinase for BCR/ABL, platelet-derived growth factor, stem cell factor, and c-kit (CD117). The conjunctiva and sclera have a large amount of c-kit positive mast cells which are inhibited by imatinib. The inhibition of c-kit positive mast cells by imatinib may be responsible for further exposure of the conjunctival mucosa to injuries.

Effects of different universal adhesives and surface treatments on repair bond strength between resin composites.

OBJECTIVE: This study aimed to evaluate the effects of different universal adhesives and surface treatments on the repair bond strength between resin composites. MATERIALS AND METHODS: A total of 220 composite samples were divided into three groups according to the adhesive resin to be applied: 1) Scotchbond Universal, 2) G-Premio Bond, and 3) Peak Universal Bond. They were then divided into seven subgroups according to surface treatments (n = 10): A) air abrasion, B) air abrasion+silane, C) hydrofluoric acid, D) hydrofluoric acid+silane, E) air abrasion+hydrofluoric acid+silane, F) silane, and G) no surface treatment (negative control). After surface treatment, a repair composite was applied. Samples aged in the thermocycle were subjected to micro-tensile bond strength testing. Cohesive strength values of 10 non-aged composite blocks were used as a positive control. Kruskal-Wallis and one-way ANOVA tests were used for statistical evaluation. Fractured surfaces were evaluated using a scanning electron microscope. RESULTS: In Scotchbond Universal and G-Premio Bond, the mean micro-tensile bond strength value of the no surface treatment subgroup was significantly lower than that of the positive control. All subgroups of Peak Universal Bond showed similar values to the positive control. CONCLUSION: While Scotchbond Universal and G-Premio Bond required mechanical roughening before adhesive application, Peak Universal Bond did not require any surface treatment. CLINICAL SIGNIFICANCE: Different universal adhesives may show different repair bonding strengths with different surface treatments. Since achieving a standard in this regard can be associated with many independent factors, clinicians should determine how to apply the adhesive they use most effectively with the most appropriate surface treatment based on their own clinical experience.

Determination of macro-, micro-element and heavy metal contents localized in different parts of three different colored onions.

The element found at the highest amount in onion samples was sulfur, and followed by K, Ca, P, Na, and Mg in decreasing order. While K contents of white onion parts are determined between 1406.31 (outer most edible) and 1758.72 mg/kg (inner most edible), K contents of the parts of brown onions were measured between 1779.79 (head) and 2495.89 mg/kg (inner most edible). Also, K amounts of purple onions were detected between 2248.73 (shell) and 3064.64 mg/kg (middle edible). In addition, in general, the highest P, S, and K were detected in the middle edible and inner most edible parts of the edible onion samples. While the highest Ca content was localized in brown and purple onion roots, it was most localized in the shell part of white onions. In edible white and brown onions, the highest Na content was found in the inner most edible part. Fe amounts of white and brown onion samples were identified between 7.94 (head) and 20.41 mg/kg (root) to 9.56 (middle edible) and 23.67 mg/kg (head), respectively. Also, Fe contents of the parts of purple onions varied between 13.04 (shell) and 20.61 mg/kg (inner most edible). While the highest Fe and Zn are determined in the middle edible part in edible white onions, the highest Fe and Zn were determined in the outer most edible part in brown onions. In general, the most heavy metals were localized in the bark, head, and root parts of the onions. This had a positive effect on the safe edibility of onions. The heavy metal detected in the highest amount in onion samples was arsenic, followed by Cr, Al, Ni, Se, Ba, Pb, Mo, Co, and Cd in descending order. Generally, purple onion type showed maximum values. Therefore, results of the present study seen to be beneficial in the way that it allowed us to selected some varieties with nutrition value that could be interesting to introduce in gastronomy.

The role of loneliness and aggression on smartphone addiction among university students.

The COVID-19 pandemic has become a major health problem worldwide. In addition to the physical effects of COVID-19 on individuals, it has caused psychological and social problems on individuals. One of these problems is related to feelings of loneliness they experienced during the pandemic process and the increase in aggression and smartphone addiction levels, which are thought to be related. The main goal of current research is to explore the effects of loneliness and aggression behaviors on smartphone addiction. The data of the study were obtained from 843 university students (565 female and 278 male; 17-54 age range) who voluntarily participated in the research from 68 of 81 provinces in Turkey. Research data were obtained based on participants' self-reports through an online questionnaire. Personal information form, Smartphone Addiction Scale, UCLA Loneliness Scale, and Buss-Perry Aggression Questionnaire were used as data collection tools. Research findings show that the feeling of loneliness affects aggression behaviors and smartphone addiction, and aggression behaviors also affect smartphone addiction. Therefore, it can be said that loneliness and aggression are variables in predicting university students' smartphone addiction.

A CLOCK-binding small molecule disrupts the interaction between CLOCK and BMAL1 and enhances circadian rhythm amplitude.

Proper function of many physiological processes requires a robust circadian clock. Disruptions of the circadian clock can result in metabolic diseases, mood disorders, and accelerated aging. Therefore, identifying small molecules that specifically modulate regulatory core clock proteins may potentially enable better management of these disorders. In this study, we applied a structure-based molecular-docking approach to find small molecules that specifically bind to the core circadian regulator, the transcription factor circadian locomotor output cycles kaput (CLOCK). We identified 100 candidate molecules by virtual screening of ∼2 million small molecules for those predicted to bind closely to the interface in CLOCK that interacts with its transcriptional co-regulator, Brain and muscle Arnt-like protein-1 (BMAL1). Using a mammalian two-hybrid system, real-time monitoring of circadian rhythm in U2OS cells, and various biochemical assays, we tested these compounds experimentally and found one, named CLK8, that specifically bound to and interfered with CLOCK activity. We show that CLK8 disrupts the interaction between CLOCK and BMAL1 and interferes with nuclear translocation of CLOCK both in vivo and in vitro Results from further experiments indicated that CLK8 enhances the amplitude of the cellular circadian rhythm by stabilizing the negative arm of the transcription/translation feedback loop without affecting period length. Our results reveal CLK8 as a tool for further studies of CLOCK's role in circadian rhythm amplitude regulation and as a potential candidate for therapeutic development to manage disorders associated with dampened circadian rhythms.

Sensitive and selective detection of amitrole based on molecularly imprinted nanosensor.

SPR sensor used for amitrole detection was prepared without using any modification. Molecularly imprinted SPR sensor enabled high selectivity for amitrole pesticide. Amino acid-based functional monomer MATrp was integrated as a recognition element. Tailor-made SPR sensor enables real-time monitoring of amitrole pesticide. Synthetic recognition sites provided by MATrp were prepared without labeling.

S-citalopram imprinted monolithic columns for capillary electrochromatography enantioseparations.

In this study, the molecular imprinting method was used to separate enantiomeric forms of chiral antidepressant drug, R,S-citalopram (R,S-CIT) in aqueous solution by CEC system combining the advantages of capillary electrophoresis (CE) and high-performance liquid chromatography (HPLC). For that, an amino acid-based molecularly imprinted monolithic capillary column was designed and used as a stationary phase for selective separation of S-citalopram (S-CIT) for the first time. S-CIT was selectively separated from the aqueous solution containing the other enantiomeric form of R-CIT, which is the same in size and shape as the template molecule. Morphology of the molecularly imprinted (MIP S-CIT) and non-imprinted (NIP S-CIT) monolithic capillary columns was observed by scanning electron microscopy. Imprinting efficiency of MIP S-CIT monolithic capillary column used for selective S-CIT separation was verified by comparing with NIP S-CIT and calculated imprinting factor (I.F:1.81) proved the high selectivity of the MIP S-CIT for S-CIT. Cavities formed for S-CIT form enabled selective (α = 2.08) separation of the target molecule from the other enantiomeric R-CIT form. Separation was achieved in a short period of 10 min, with the electrophoretic mobility of 7.68 × 10-6 m2 /Vs for R,S-CIT at pH 7.0 10 mM PB and 50% ACN ratio. The performance of both MIP S-CIT and NIP S-CIT columns was estimated by repeating the R,S-CIT separations with intra-batch and inter-batch studies for reproducibility of retention times of R,S-CITs. Estimated RSD values that are lower than 2% suggest that the monolithic columns separate R,S-CIT enantiomers without losing separation efficiency.

Can Serum Vitamin B12 and Folate Levels Predict HPV Penetration in Patients with ASCUS?

In the process of progression to cancer from atypical squamous cells of undetermined significance (ASCUS), mostly Human Papilloma Virus (HPV) is responsible. Additionally, patients with cell cycle disorders are thought to be at risk. The aim of this prospective cohort trial was to analyze the association between presence of ASCUS and HPV persistence with folate and vitamin B12 levels. 200 patients who had Papanicolaou (PAP) smear test were divided into a ASCUS group (n:100) and control group (n:100). Control group consisted of women who did not have intraepithelial neoplasia, based on PAP smear results. HPV testing was also done in study group. Serum vitamin B12 and folate levels in ASCUS (+) HPV (+) patients were significantly lower than that of ASCUS (-) or ASCUS (+) HPV (-) patients (p < 0.01). In our study, there was no statistically significant difference between folate levels in patients with different types of HPV (p > 0.05), however vitamin B12 levels of patients with other high-risk HPV types were significantly lower than patients with positive HPV16-18 (p = 0.01). The positivity of HPV in women with ASCUS is associated with low serum vitamin B12 and folate levels.

Convalescent plasma therapy in patients with COVID-19.

INTRODUCTION: Passive antibody therapy has been used to immunize vulnerable people against infectious agents. In this study, we aim to investigate the efficacy of convalescent plasma (CP) in the treatment of severe and critically ill patients diagnosed with COVID-19. METHOD: The data of severe or critically ill COVID-19 patients who received anti-SARS-CoV-2 antibody-containing CP along with the antiviral treatment (n = 888) and an age-gender, comorbidity, and other COVID-19 treatments matched severe or critically ill COVID-19 patients at 1:1 ratio (n = 888) were analyzed retrospectively. RESULTS: Duration in the intensive care unit (ICU), the rate of mechanical ventilation (MV) support and vasopressor support were lower in CP group compared with the control group (p = 0.001, p = 0.02, p = 0.001, respectively). The case fatality rate (CFR) was 24.7 % in the CP group, and it was 27.7 % in the control group. Administration of CP 20 days after the COVID-19 diagnosis or COVID-19 related symptoms were associated with a higher rate of MV support compared with the first 3 interval groups (≤5 days, 6-10 days, 11-15 days) (p=0.001). CONCLUSION: CP therapy seems to be effective for a better course of COVID-19 in severe and critically ill patients.

Hypercalcemia associated with the interaction between all trans retinoic acid and posaconazole in an acute promyelocytic leukemia case.

INTRODUCTION: All-trans retinoic acid (ATRA) is a physiological metabolite of vitamin A and it is used for the treatment of acute promyelocytic leukemia (APL). Hypercalcemia is a rare side effect of ATRA and it may be potentiated after interaction of ATRA with azole group antifungals. Herein, we have reported an APL case with hypercalcemia that is caused by the interaction of ATRA and posaconazole. CASE REPORT: A 49-year-old female patient was diagnosed as APL after the examinations performed upon the detection of pancytopenia when she had presented with the complaints of widespread bruising and fever. After the initiation of posaconazole and ATRA, her serum calcium levels begin to increase (10.3 to 11.1mg/dl). Her vitamin D level was 21.9 ng/ml and PTH 17.8 pg/ml, both were in the normal ranges. The Drug Interaction Probability Scale score of our case was calculated as 6, indicating that the probable adverse drug reaction. Therefore, the high level of serum calcium was attributed to the interaction between ATRA and posaconazole. MANAGEMENT & OUTCOME: Although hypercalcemia with ATRA and other antifungal agents have been previously reported in the literature, this is the first report of hypercalcemia with the concomitant use of ATRA and posaconazole. DISCUSSION: This case highlights the importance of monitoring ATRA's side effects when it is used in combination with drugs inhibiting the cytochrome P450 enzymes. In conclusion, the concomitant use of posaconazole and ATRA may lead to hypercalcemia and serum calcium levels return to normal ranges with the discontinuation of these drugs.