Protracted or recurrent COVID-19 associated cytokine storm in a patient with chronic lymphocytic leukemia receiving rituximab-based chemotherapy

© 2022 Elsevier Inc.A 52-year-old male patient who was diagnosed with chronic lymphocytic leukemia two years ago; admitted to our hospital with complaints of fever (>38C), shortness of breath, and fatigue. He was receiving fludarabine, cyclophosphamide, and rituximab (FCR) regimen for one year after two courses of cyclophosphamide, vincristine, and prednisolone (CVP) regimen. The patient was diagnosed with COVID-19 associated cytokine storm and tocilizumab 800 mg was administered in addition to corticosteroids. Significant improvement was observed in both clinical and laboratory parameters and his hypoxemia resolved. The patient whose complaints recurred on the 13 th day of discharge was admitted to the hospital again with severe hypoxemia (oxygen saturation 38C). Pulse steroid (250 mg methylprednisolone for three days, followed by 40 mg/day) and anakinra 400 mg/day intravenously were started. Despite the treatment, the patient progressed to respiratory failure and died on the sixth day of second hospitalization

Ritüksimab İçeren Kemoterapi Alan Bir Kronik Lenfositik Lösemi Hastasında Gelişen COVİD-19 İlişkili Rekürren Makrofaj Aktivasyon Sendromu

Giriş: COVİD-19 infeksiyonu pandemi olmasının yanında sıklıkla makrofaj aktivasyon sendromunun (MAS) eşlik edebilmesi nedeniyle romatologların ilgi alanına girmiştir. Olgu: 52 yaşında erkek hasta ateş,nefes darlığı,halsizlik şikayetiyle başvurdu.İki yıl önce kronik lenfositik lösemi tanısı konulan hastaya bir yıl önce siklofosfamid,vinkristin,prednizolon iki kür sonrası yanıtsızlık nedeniyle fludarabin,siklofosfamid ve ritüksimab başlanmış. Son dozunu 4 ay önce alan hasta 03.09.21’de mevcut bulgularla yatırıldı. Öyküsünden yaklaşık bir yıl önce kemoterapi almadığı dönemde COVİD-19 nedeniyle altı günlük hastane yatışı olduğu ancak oksijen veya yoğun bakım ihtiyacı olmadığı ve sonrasında da aşılanmadığı öğrenildi.Yatışındaki laboratuvar tetkiklerinde WBC:9500,NEU:8800,LYM:360,PLT:154000,INR:1.26,ALT:71,AST:29,kreatinin:0.6,CRP:165,ferritin>1500,prokalsitonin:0.4,D-dimer:933 saptandı.Yatışı sırasında hipoksemisi derinleşen ve ateşi devam eden transaminazları akut hepatit düzeyinde yükselen ve INRdüzeyi artan hastaya COVİD ilişkili MAS tanısıyla 17.09’da 3 gün pulse steroide ilave tosilizumab 800 mg yapıldı.İki gün sonra ateşi tekrarlamayan ve oksijen ihtiyacı ortadan kalkan hasta yatışının 20. günü (23.09) taburcu edildi. Taburculuğunun 13. günü şikayetleri tekrarlayan hasta benzer bulgularla servise yatırıldı. Toraks BT'si COVİD-19 ile uyumlu olan ve PCR sonucu tekrar pozitif gelen hasta derin hipoksemi ve ateş yüksekliği ile ferritin:722,CRP:103,LYMP:560,prokalsitonin:0.1,D-dimer:690 MAS olarak değerlendirilerek üç gün 250 mg pulse prednol ve anakinra 400 mg/gün başlandı. Tedaviye rağmen ferritin:3800'e progrese olan hasta yatışının altıncı günü kaybedildi. Sonuç: COVİD-19'un kas-iskelet sistemi veya hematolojik malignite nedeniyle ritüksimab alanlarda yüksek mortaliteyle ilişkisi gösterilmiştir. Aynı zamanda bu hastalarda uzamış PCR pozitifliği ve uzamış pnömoni bulgularının geliştiği iyi bilinmesine rağmen MAS bulgularının tekrarlaması ile ilgili bilgi sınırlıdır. Olgumuzda MAS bulgularının tosilizumaba iyi yanıt vermesine rağmen nüksetmesi ve sonrasında anakinraya yanıt vermemesi dikkat çekiciydi. Klinisyenler özellikle kemoterapi ve/veya ritüksimab alan hastalarda COVİD-19 ilişkili rekürren MAS açısından uyanık olmalıdır. Bu hastaları tamamen iyileşse bile bir süre taburculuk sonrası yakın takip etmek gerekebilir. Öte yandan aynı hastada gelişen MAS tablosunun tosilizumaba dramatik yanıt verirken anakinraya yanıt vermemesi bu hasta grubunda tosilizumabın anakinraya tercih edilebileceğini düşündürmüştür

The role of the political skills of employees in providing person-organization fit: A study on hotel businesses in İstanbul province

Araştırmanın amacı otel çalışanlarının politik yeteneklerinin birey-örgüt uyumuna olan etkisini ortaya çıkarmaktır. Bu amaç doğrultusunda politik yetenek ile birey-örgüt uyumu arasında ilişkiyi veya etkiyi belirlemeye yönelik bir model önerilmiş ve bu model çoklu regresyon analizi ile test edilmiştir. Otel işletmelerindeki çalışanların politik yetenek düzeylerini ve birey-örgüt uyumunu ölçmek için daha önce geliştirilen ölçekler kullanılmıştır. Çalışanların politik yeteneklerini ölçmek için "Politik Yetenek Envanteri" kullanılmıştır. Ölçek sosyal zeka, kişilerarası etki, ağ kurma yeteneği ve samimi görünme olmak üzere 4 boyuttan ve 18 maddeden oluşmaktadır. Çalışanların birey-örgüt uyumu algısını ölçmek için ise tek faktör altında toplanan 3 soruluk ölçek kullanılmıştır. Örnekleme yöntemi olarak yargısal örnekleme tercih edilmiş ve araştırmanın kapsamına İstanbul'daki dört ve beş yıldızlı otellerde çalışan 364 kişi örneklem olarak dahil edilmiştir. Veriler anket yöntemi ile toplanmıştır. Bu araştırmanın verileri bilgisayar ortamında uygun analiz teknikleri kullanılarak analiz edilmiştir. Bu verilere aritmetik ortalama, standart sapma, korelasyon ve çoklu regresyon analizleri yapılmıştır. Araştırma sonucunda politik yeteneğin ağ kurma yeteneği boyutunun ve kişilerarası etki boyutunun birey-örgüt uyumuna etkisinin pozitif doğrusal yönde olduğu fakat sosyal zeka boyutunun birey-örgüt uyumuna doğrusal negatif yönde bir etkisinin olduğu ortaya çıkarılmıştır. Son olarak samimi görünme boyutunun birey-örgüt uyumuna herhangi bir etkisinin olmadığı sonucuna ulaşılmıştır. Anahtar Kelimeler: Otel çalışanları, politik yetenek, birey-örgüt uyumuThe aim of the study is to reveal the influence of hotel employees' political skills on person-organization fit. With this aim, a model for determining the relationship or effectiveness between political skill and person-organization fit was proposed and tested with multiple regression analysis. Developed scales in advance were used to measure the political skill levels of employees and person-organization fit working in hotels. The "Political Skill Inventory" was used to measure the political skill of employees. The scale consists of 4 dimensions and 18 items including social intelligence, interpersonal effect, network ability and intimate appearance. In order to measure the level of person-organization fit of the employees, a three-question scale was used collected under the single factor. Judicial sampling was preferred as sampling method and 364 people working in four and five star hotels in Istanbul were included as sample. The data were collected by the survey method. The results of this research analyzed with proper analyses techniques on computer. Arithmetic mean, standard deviation, correlation and multiple regression analyses were performed on these data. As a result of the research, it has been found out that the effect of the political ability, network capability dimension and the interpersonal effect dimension on individual-organization coherence was positive linear, but the effect of social intelligence dimension on individual-organization fit was negative linear. Finally, the dimension of sincere appearance has been reached as a result of no effect on individual-organization harmony. Key Words: Hotel workers, political skill, person-organization fit

Organizational support and self-efficacy as the predictors of dissenter behavior among hotel employees

The aim of this study is to manifest the degree of the predictive role that the self-efficacy levels of employees and organizational support have on the formation of organizational dissent trends. A structural equation model covering the variables relevant to the subject based on the theoretical basis obtained as a result of the executed literature search has been established and the adaptive values regarding the model have been studied. A survey study has been carried out among the employees working in hotel operations in Istanbul, one of the metropolitan provinces of Turkey. According to the empiric findings obtained as a result of the survey the support provided by administrators to employees has an impact on the self-efficacy levels and articulated type of organizational dissent (articulated, antagonistic, displaced and hidden). At the same time faith in self-efficacy which is significantly affected by organizational support has a linear impact on the articulated dissension trends of employees. At the same time the selfefficacy level of employees undertakes a mediating variable role in the interaction of organizational support and articulated dissent. The strategic importance of the participatory management approach of organizational support as well as the versatile development of employees is emphasized with this study which is resolved with a structural equation model using a combination of three variables for the first time

Views of Science Teachers regarding Conceptual Integration in terms of Physics, Chemistry, and Biology Concepts

In order to achieve conceptual integration (CI) among different subject areas in science, students must have enough prior knowledge and promote meaningful learning (diSessa, 1993; Matthews, 1993, Taber, 2005). Therefore, the CI can be defined as the promoting meaningful learning that learners can employ pre-requisite knowledge or concepts in a certain science subject whilst learning a concept or topic in another science subject (Taber, 2003; Toomey & Garafalo, 2003). Likewise, Taber (2005) defined CI as the person’s organized knowledge structures which is formed making connections between different areas. For instance, when teachers teach certain chemistry topics at a more advanced level, they should use more fundamental chemistry topics, ideas, and concepts at a less advanced level and think about some pre-requisite knowledge taken physics or biology topics since learners can learn this topic meaningfully (Taber, 2008). It is important to investigate the CI in terms of eliminating misconceptions (Ganaras, Duman, & Larcher, 2008), providing meaningful learning (Taber, 2005). Moreover, when scientists are dealing with a paradigm, they should look science completely (Lederman, 2007). As the CI requires combining different disciplines, it helps students to behave as a scientist. If science concepts are not integrated with each other properly, students cannot achieve the CI among science concepts. Also, they cannot link between new knowledge and prior learning, facilitate new meaningful learning and reinforce the previous learning. Chemistry, physics, and biology are closely linked domains and needs conceptual integration in order to provide meaningful learning. In this integration, using appropriate instructional strategies and assessment techniques is crucial. Thus, studying on teacher education need to understand opinions of science teachers about CI are worth to study in that it is difficult to deeply understand science concepts without connecting physics chemistry and biology concepts each other, it is important to examine whether science teachers know the CI since it affects directly students’ science learning. (Caudill, Hill, Hoke, & Lipan, 2010; Godrick & Hartman 2000, Taber, 2005), and when we looked at the studies on the CI in the literature, there are very few studies on the subject, which are mainly high school and university students (Taber, 2005, 2008; Toomey & Garafalo, 2003) and pre-service physics and chemistry teachers (Nakipoğlu, 2003; Sinan, 2009; Tuysuz, Bektas, & Geban, 2014). It is hoped that this study might provide some information about usage of the CI. In today’s science education, teachers should have ability and skills to teach science in an integrated way to introduce it as a whole, because contemporary science understanding requires integration of different disciplines and collaboration among different fields. In this sense, science technology engineering mathematics (STEM) movement in education is a good example to indicate how integration is important in science education where integration is best practiced. Especially, science teachers are expected to teach physics, chemistry, and biology in primary schools’ science classes, understanding their ideas about the CI and how they conceptualize it will help both educators and curriculum designers understand how the CI can be effectively integrated into curriculum. This study might put a brick to the construction. Hence, the study examines how science teachers’ views regarding the CI with following research questions are: What are the views of science teachers about conceptual integration in terms of whether they use CI between concepts related to physics, chemistry, and biology in the past and future? whether they have difficulties in using CI in their instructions? whether they use different instructional strategies when they use CI in their lessons? whether they ask questions related with CI in their lessons? whether they have examined curriculum in terms of CI

In-service and Pre-service Science Teachers’ Views regarding Conceptual Integration of Physics, Chemistry, and Biology Disciplines

The purpose of the study was to understand knowledge and opinions of in-service (ISTs) and preservice science teachers (PSTs) regarding the conceptual integration (CI). The research design of this study was phenomenology as a type of qualitative research methods. Purposive sampling methodology was chosen for this study. A sample of the study consisted of ten ISTs and 40 PSTs. Twostage open-ended questions were utilized as the primary data source to evaluate ISTs’ and PSTs’ subject matter knowledge in terms of integrating biology, physics, and chemistry concepts with each other and their views about CI. The content analysis was used to evaluate the data. It was given information regarding validity and reliability studies. Findings indicated that most of the ISTs and PSTs had insufficient subject matter knowledge regarding the CI and most of them responded questions with only biology, physics and chemistry concepts without any integration. Moreover, all participants stated that the CI was crucial and necessary owing to the interrelationships among the concepts of biology, chemistry, and physics. Also, most of ISTs had difficulty in applying the CI. Moreover, ISTs did not mention any specific teaching strategy and assessment technique while using the CI. Finally, most of ISTs stated that they were not aware of the presence of the CI in curriculum. Furthermore, PSTs mentioned that the CI has some contribution to their learning; however, participants had the difficulties in using the CI in their learning. Implementation of the study was discussed. In light of these results, training workshops can be organized to inform teachers and preservice science teachers about the CI and encourage them to use it in class

Pre-Service Physics and Chemistry Teachers' Conceptual Integration of Physics and Chemistry Concepts

This study examines the pre-service teachers' opinions about conceptual integration (CI) and their understanding of it. A qualitative phenomenology design was used in the study. Data was collected through in-depth semi-structured interviews comprising ten guiding questions. Three pre-service physics and three pre-service chemistry teachers participated conveniently in the study. While the pre-service chemistry teachers took a course regarding the CI explicitly taught, the pre-service physics teachers were not subjected to any information relating to the CI in their course. Data was analyzed by forming the codes and themes. Generally speaking, while the pre-service chemistry teachers think that physics concepts should be used in the chemistry lessons, the preservice physics teachers believe that these two subjects' concepts generally are not related to each other. Moreover, the participants had some difficulties in understanding the CI between physics and chemistry concepts. The possible implication for science teacher education and research is discussed