Bilateral hemotympanum as a result of spontaneous epistaxis

Hemotympanum is a rare condition and usually depends on a secondary reason. Therefore, idiopathic hemotympanum is rarely seen in the literature. In this paper, we report a case of this problem

İlköğretim öğrencilerinin yaşam kalitesinin toplumsal sınıf değişkeni açısından incelenmesi: Aydın ilinde betimsel bir çalışma

The main purpose of this study is to examine 4th and 5th grade childrens’ quality of life in terms of their social class indicators. Child’s Quality of Life Inventory was used as a data gathering tool in this study. Data were obtained from the study was analyzed in accordance to information about schools’ social economic statues that gathered from The National Education Directorship in Aydın. Number, percentage, frequency, and chi square were used as a statistical method in present study. The finding of the study shows that life quality of children could be mainly revealed with socio economic statues of them. Also the study reveals the most of the children from low socio economic statue are working as a child labor for contributing to the family budget. The most of the families involved in the study explained that they were willing to send their children to the school after the compulsory elementary education. Beside of this finding, some of the families in the sample % 11,9  (n=16)  stated that they were reluctant to send their children to the school after the elementary education. The finding of the study can be considered in terms of public health, school health and general well-being statue of the children in Turkey. ÖzetBu çalışmanın temel amacı Aydın İlinde, ilköğretim 4. ve 5. sınıf öğrencilerinin yaşam kalitesinin sosyo-ekonomik düzey açısından incelenmesidir. Araştırmada veri toplama aracı olarak araştırmacılar tarafından geliştirilen “Çocuk Yaşam Kalitesi Tarama Envanteri” kullanılmıştır. Çalışmada elde edilen veriler, Aydın İl Milli Eğitim Müdürlüğü’nden alınan bilgiler doğrultusunda belirlenen alt, orta ve üst sosyo-ekonomik düzeylerden toplam 6 ilköğretim okulunun 4. ve 5. sınıf öğrencilerinden toplanarak bu veriler üzerinde sayı, yüzde, frekans ve ki kare analizleri gerçekleştirilmiştir. Araştırmanın bulguları, çocuk yaşam kalitesinin büyük oranda sosyo-ekonomik düzey ile açıklanabileceğini göstermektedir. Alt sosyo ekonomik düzeyden çocuklar okul dışında gelir getirici bir iş yaparak aile bütçesine katkıda bulunmaktadırlar. Sosyo-ekonomik düzeyi ne olursa olsun ailelerin çoğunluğu çocuklarının eğitimlerine ilköğretimden sonra da devam etmelerini isterken, alt sosyo-ekonomik düzeydeki okullara devam eden öğrenci ailelerinin %11,9 (n=16)’u “çocuğunun ilköğretimden sonra eğitimine devam etmemesini istemektedir. Tüm bu bulgular, toplum sağlığı, okul sağlığı ve çocuğun genel iyi olma durumu üzerine önemli önlemleri gerekli kılmaktadır.Bu çalışmanın temel amacı Aydın İlinde, ilköğretim 4. ve 5. sınıf öğrencilerinin yaşam kalitesinin sosyo-ekonomik düzey açısından incelenmesidir. Araştırmada veri toplama aracı olarak araştırmacılar tarafından geliştirilen “Çocuk Yaşam Kalitesi Tarama Envanteri” kullanılmıştır. Çalışmada elde edilen veriler, Aydın İl Milli Eğitim Müdürlüğü’nden alınan bilgiler doğrultusunda belirlenen alt, orta ve üst sosyo-ekonomik düzeylerden toplam 6 ilköğretim okulunun 4. ve 5. sınıf öğrencilerinden toplanarak bu veriler üzerinde sayı, yüzde, frekans ve ki kare analizleri gerçekleştirilmiştir. Araştırmanın bulguları, çocuk yaşam kalitesinin büyük oranda sosyo-ekonomik düzey ile açıklanabileceğini göstermektedir. Alt sosyo ekonomik düzeyden çocuklar okul dışında gelir getirici bir iş yaparak aile bütçesine katkıda bulunmaktadırlar. Sosyo-ekonomik düzeyi ne olursa olsun ailelerin çoğunluğu çocuklarının eğitimlerine ilköğretimden sonra da devam etmelerini isterken, alt sosyo-ekonomik düzeydeki okullara devam eden öğrenci ailelerinin %11,9 (n=16)’u “çocuğunun ilköğretimden sonra eğitimine devam etmemesini istemektedir. Tüm bu bulgular, toplum sağlığı, okul sağlığı ve çocuğun genel iyi olma durumu üzerine önemli önlemleri gerekli kılmaktadır

Examination Of Pain And Quality Of Life in Patients With Chronic Pain Before And After TENS and Their Satisfaction Levels Regarding Nurses

Giriş: Transkutanöz Elektriksel Sinir Uyarımı sağlıkla ilgili yaşam kalitesini bozan kronik ağrının tedavisinde yaygın olarak kullanılmaktadır. Hemşireler, multidisipliner ekibin bir üyesi olarak kronik ağrılı hastaların ağrılarını azaltmada ve yaşam kalitelerini iyileştirmede rol oynayan sağlık profesyonelleridir. Amaç: Kronik ağrı nedeniyle ağrı ünitesine başvuran hastaların TENS uygulaması öncesi ve sonrası yaşam kalitesi, ağrı ve hemşirelerden memnuniyet düzeylerinin incelenmesidir. Yöntem: Tanımlayıcı ve kesitsel araştırmanın yapılabilmesi için etik kurul izni ve hastalardan yazılı aydınlatılmış onam alınmıştır. Veriler hemşireler tarafından 22 Nisan 2012- 20 Şubat 2013 tarihlerinde bir üniversite hastanesinin ağrı ünitesinde TENS uygulaması öncesi ve sonrası Hasta Tanıtım Formu, SF-36 Yaşam Kalitesi Ölçeği, Sayısal Ağrı Ölçeği, Hemşire Memnuniyet Formu kullanılarak toplanmıştır. Bulgular: Ortalama yaşı 53.50±16.60 olan hastaların %85.2'si kadın, %63.0'ü kronik hastalığa sahip, %90.7'si analjezik kullanmakta ve %27.8'i lumbar disk hernisi nedeniyle ağrı yaşamaktadır. Kronik ağrısı olan hastaların TENS uygulaması sonrası öncesine göre istatistiksel olarak anlamlı bir şekilde yaşam kalitesinin mental işlev alt boyutu hariç diğer yedi alt boyut puan ortalamalarının arttığı, ağrı puan ortalamalarının azaldığı ve hemşirelerden memnuniyet puan ortalamalarının yüksek olduğu saptanmıştır. Sonuç: Sonuçlar, TENS uygulaması sonrası ağrı ile yaşam kalitesinin birçok boyutunun iyileştiğini ve bu süreçte hemşireden memnuniyetin yüksek olduğunu göstermektedir. TENS uygulamasının hastaların kronik ağrılarını azaltmada ve yaşam kalitelerini iyileştirmede kullanılması önerilmektedir. Introduction: Transcutaneous Electrical Nerve Stimulation (TENS) is widely used for the treatment of chronic pain causes the impairment of health-related quality of life (QoL). Nurses, as a membe rof multidisciplinary team, are a health professional that play a role to reducing pain in patients with chronic pain and develop the life qualities of patients by approaching them. Aim: The aim of this study was to investigated quality of life, pain, and patients' satisfaction levels from nurses of patients that was applicated to pain unit before and after TENS application.Methods: Informed consent and ethical permission were obtained for performed to descriptive and cross-sectional study. Data was collected obtained by nurses using Patients Identification Form, Numerical Rating Pain Scale (NPRS), Short Form 36 (SF 36), and Nurse Saticfaction Form between 22th April 2012-20th February 2013 in a university hospital pain unit before and after TENS. Results: The patients' mean age was 53.50±16.60, 85.2% of the patients were female, 63.0% has chronical disease. 90.7% was used analgesic drugs. 27.8% of the pain etiology was lumbar disc hernia. It is found that significantly increased to seven subsclaes means of quality of life, expect mental health, decreased to pain mean and increased to satisfaction from nurses mean of the patients with chronic pain after TENS application compared to before. Conclusion: The results showed that improvements in pain and QoL after TENS, and satisfaction from nurses during the process. As a result, it is suggested that TENS can use to reduce for chronic pain and improve for QO

Isatuximab plus pomalidomide and dexamethasone in patients with relapsed/refractory multiple myeloma according to prior lines of treatment and refractory status: ICARIA-MM subgroup analysis.

SB reports honoraria from Amgen, Bristol-Myers Squibb, Celgene, and Janssen; and reports a consultancy/advisory role for Celgene, Janssen, Karyopharm, and Takeda. VV reports a consultancy/advisory role for Astellas, Biocad, Bristol-Myers Squibb, Janssen, Roche, Sanofi, and Takeda. VM reports a consultancy/advisory role for Amgen, Bristol-Myers Squibb, Celgene, Janssen, and Takeda. LK reports honoraria from Amgen, Celgene, Janssen, and Takeda; a consultancy/advisory role for Amgen, Celgene, Janssen, and Takeda; and travel support from Amgen and Janssen. MP reports honoraria from Celgene, Pfizer, and Takeda; consultancy/advisory role for Amgen, Celgene, Janssen, Roche, and Takeda; and research funding from Amgen, Celgene, Janssen, Pfizer, Roche, and Takeda. PGR reports a consultancy/advisory role for Amgen, Janssen, Karyopharm, Oncopeptides, Sanofi, and Takeda; and research funding from Bristol-Myers Squibb, Celgene, Oncopeptides, and Takeda. LP, FV, KW, LB, and YK have no disclosures. FC, SLG, FM, and HvdV are employees of Sanofi

Health-related quality-of-life results from the phase 3 OPTIMISMM study: pomalidomide, bortezomib, and low-dose dexamethasone versus bortezomib and low-dose dexamethasone in relapsed or refractory multiple myeloma

This is an accepted manuscript of an article published by Taylor & Francis in Leukemia & Lymphoma on 09/04/2020, available online: https://www.tandfonline.com/doi/full/10.1080/10428194.2020.1747066 The accepted version of the publication may differ from the final published version.In the randomized phase-3 OPTIMISMM study, the addition of pomalidomide to bortezomib and low-dose dexamethasone (PVd) resulted in significant improvement in progression-free survival (PFS) in lenalidomide-pretreated patients with relapsed or refractory multiple myeloma (RRMM), including lenalidomide refractory patients. Here, we report health-related quality of life (HRQoL) results from this trial. Patients received PVd or Vd in 21-day cycles until disease progression or discontinuation. HRQoL was assessed using the EORTC QLQ-C30, QLQ-MY20, and EQ-5D-3L instruments on day 1 of each treatment cycle. Mean score changes for global QoL, physical functioning, fatigue, side effects of treatment domains, and EQ-5D-3L index were generally stable over time across treatment arms. The proportion of patients who experienced clinically meaningful worsening in global QoL and other domains of interest was similar. These HRQoL results with PVd along with previously demonstrated improvement in PFS vs Vd continue to support its use in patients with RRMM.This work was supported by Celgene Corporation.Published versio

Ibrutinib as initial therapy for patients with chronic lymphocytic leukemia

Background: chronic lymphocytic leukemia (CLL) primarily affects older persons who often have coexisting conditions in addition to disease-related immunosuppression and myelosuppression. We conducted an international, open-label, randomized phase 3 trial to compare two oral agents, ibrutinib and chlorambucil, in previously untreated older patients with CLL or small lymphocytic lymphoma. Methods: we randomly assigned 269 previously untreated patients who were 65 years of age or older and had CLL or small lymphocytic lymphoma to receive ibrutinib or chlorambucil. The primary end point was progression-free survival as assessed by an independent review committee. Results: the median age of the patients was 73 years. During a median follow-up period of 18.4 months, ibrutinib resulted in significantly longer progression-free survival than did chlorambucil (median, not reached vs. 18.9 months), with a risk of progression or death that was 84% lower with ibrutinib than that with chlorambucil (hazard ratio, 0.16; P<0.001). Ibrutinib significantly prolonged overall survival; the estimated survival rate at 24 months was 98% with ibrutinib versus 85% with chlorambucil, with a relative risk of death that was 84% lower in the ibrutinib group than in the chlorambucil group (hazard ratio, 0.16; P=0.001). The overall response rate was higher with ibrutinib than with chlorambucil (86% vs. 35%, P<0.001). The rates of sustained increases from baseline values in the hemoglobin and platelet levels were higher with ibrutinib. Adverse events of any grade that occurred in at least 20% of the patients receiving ibrutinib included diarrhea, fatigue, cough, and nausea; adverse events occurring in at least 20% of those receiving chlorambucil included nausea, fatigue, neutropenia, anemia, and vomiting. In the ibrutinib group, four patients had a grade 3 hemorrhage and one had a grade 4 hemorrhage. A total of 87% of the patients in the ibrutinib group are continuing to take ibrutinib. Conclusions: ibrutinib was superior to chlorambucil in previously untreated patients with CLL or small lymphocytic lymphoma, as assessed by progression-free survival, overall survival, response rate, and improvement in hematologic variables. (Funded by Pharmacyclics and others; RESONATE-2 ClinicalTrials.gov number, NCT01722487.)

Multiple Myeloma Treatment in Real-world Clinical Practice : Results of a Prospective, Multinational, Noninterventional Study

Funding Information: The authors would like to thank all patients and their families and all the EMMOS investigators for their valuable contributions to the study. The authors would like to acknowledge Robert Olie for his significant contribution to the EMMOS study. Writing support during the development of our report was provided by Laura Mulcahy and Catherine Crookes of FireKite, an Ashfield company, a part of UDG Healthcare plc, which was funded by Millennium Pharmaceuticals, Inc, and Janssen Global Services, LLC. The EMMOS study was supported by research funding from Janssen Pharmaceutical NV and Millennium Pharmaceuticals, Inc. Funding Information: The authors would like to thank all patients and their families and all the EMMOS investigators for their valuable contributions to the study. The authors would like to acknowledge Robert Olie for his significant contribution to the EMMOS study. Writing support during the development of our report was provided by Laura Mulcahy and Catherine Crookes of FireKite, an Ashfield company, a part of UDG Healthcare plc, which was funded by Millennium Pharmaceuticals, Inc, and Janssen Global Services, LLC. The EMMOS study was supported by research funding from Janssen Pharmaceutical NV and Millennium Pharmaceuticals, Inc. Funding Information: M.M. has received personal fees from Janssen, Celgene, Amgen, Bristol-Myers Squibb, Sanofi, Novartis, and Takeda and grants from Janssen and Sanofi during the conduct of the study. E.T. has received grants from Janssen and personal fees from Janssen and Takeda during the conduct of the study, and grants from Amgen, Celgene/Genesis, personal fees from Amgen, Celgene/Genesis, Bristol-Myers Squibb, Novartis, and Glaxo-Smith Kline outside the submitted work. M.V.M. has received personal fees from Janssen, Celgene, Amgen, and Takeda outside the submitted work. M.C. reports honoraria from Janssen, outside the submitted work. M. B. reports grants from Janssen Cilag during the conduct of the study. M.D. has received honoraria for participation on advisory boards for Janssen, Celgene, Takeda, Amgen, and Novartis. H.S. has received honoraria from Janssen-Cilag, Celgene, Amgen, Bristol-Myers Squibb, Novartis, and Takeda outside the submitted work. V.P. reports personal fees from Janssen during the conduct of the study and grants, personal fees, and nonfinancial support from Amgen, grants and personal fees from Sanofi, and personal fees from Takeda outside the submitted work. W.W. has received personal fees and grants from Amgen, Celgene, Novartis, Roche, Takeda, Gilead, and Janssen and nonfinancial support from Roche outside the submitted work. J.S. reports grants and nonfinancial support from Janssen Pharmaceutical during the conduct of the study. V.L. reports funding from Janssen Global Services LLC during the conduct of the study and study support from Janssen-Cilag and Pharmion outside the submitted work. A.P. reports employment and shareholding of Janssen (Johnson & Johnson) during the conduct of the study. C.C. reports employment at Janssen-Cilag during the conduct of the study. C.F. reports employment at Janssen Research and Development during the conduct of the study. F.T.B. reports employment at Janssen-Cilag during the conduct of the study. The remaining authors have stated that they have no conflicts of interest. Publisher Copyright: © 2018 The AuthorsMultiple myeloma (MM) remains an incurable disease, with little information available on its management in real-world clinical practice. The results of the present prospective, noninterventional observational study revealed great diversity in the treatment regimens used to treat MM. Our results also provide data to inform health economic, pharmacoepidemiologic, and outcomes research, providing a framework for the design of protocols to improve the outcomes of patients with MM. Background: The present prospective, multinational, noninterventional study aimed to document and describe real-world treatment regimens and disease progression in multiple myeloma (MM) patients. Patients and Methods: Adult patients initiating any new MM therapy from October 2010 to October 2012 were eligible. A multistage patient/site recruitment model was applied to minimize the selection bias; enrollment was stratified by country, region, and practice type. The patient medical and disease features, treatment history, and remission status were recorded at baseline, and prospective data on treatment, efficacy, and safety were collected electronically every 3 months. Results: A total of 2358 patients were enrolled. Of these patients, 775 and 1583 did and did not undergo stem cell transplantation (SCT) at any time during treatment, respectively. Of the patients in the SCT and non-SCT groups, 49%, 21%, 14%, and 15% and 57%, 20%, 12% and 10% were enrolled at treatment line 1, 2, 3, and ≥ 4, respectively. In the SCT and non-SCT groups, 45% and 54% of the patients had received bortezomib-based therapy without thalidomide/lenalidomide, 12% and 18% had received thalidomide/lenalidomide-based therapy without bortezomib, and 30% and 4% had received bortezomib plus thalidomide/lenalidomide-based therapy as frontline treatment, respectively. The corresponding proportions of SCT and non-SCT patients in lines 2, 3, and ≥ 4 were 45% and 37%, 30% and 37%, and 12% and 3%, 33% and 27%, 35% and 32%, and 8% and 2%, and 27% and 27%, 27% and 23%, and 6% and 4%, respectively. In the SCT and non-SCT patients, the overall response rate was 86% to 97% and 64% to 85% in line 1, 74% to 78% and 59% to 68% in line 2, 55% to 83% and 48% to 60% in line 3, and 49% to 65% and 36% and 45% in line 4, respectively, for regimens that included bortezomib and/or thalidomide/lenalidomide. Conclusion: The results of our prospective study have revealed great diversity in the treatment regimens used to manage MM in real-life practice. This diversity was linked to factors such as novel agent accessibility and evolving treatment recommendations. Our results provide insight into associated clinical benefits.publishersversionPeer reviewe

Hepatit B virüsüne bağlı (HBV) kronik aktif hepatit ve siroz sürecindeki hastalarda kemik metabolizması değişiklikleri

In this study, we evaluated 15 pts with cirrhosis and 14 pts with CAH due to HBV etiology. 20 healthy volunteers with similar age and sex were admited to study as control. We measured the plasma ionised Ca, 25(OH)Vit D, PTH levels as a marker of bone mineralization; bone spesific alkaline phophatase (BAP), osteocalcin and type-1 collagen propeptide as the marker of bone formation; and urinary calcium and deoxypyridinoline excretion for determination of bone resorption. Bone mineral density of the lumbar spine and proximal part of femur was assesed by dual emission X-ray absorptiometry (DEXA) method. There was no statistically significant difference between cirrhosis, CAH and control groups for plasma ionised Ca, 25(OH)Vit D and PTH levels. Both in CAH and cirrhosis groups significantly increased bone loss were found by measurements of BMD of L1-L4 lumbar spine and 5 different areas of femur (neck, trochanter, intertrochanter, Ward's triangle and total). Plasma osteocalcin level was found significantly higher in both pts groups than controls (p;lt;0.05). On ffie other hand, BAP and type 1 collagen propeptide levels were high only in cirrhosis group.In conclusion, contrary to expection we didn't found the presence of osteomalasia, but high turnover bone loss was displayed in both CAH and cirrhosis group.Bu çalışmada, HBV'ne bağlı kronik aktif hepatit (KAH) ve sirozlu hastalarda kemik metabolizmasındaki değişiklikleri göstermek amacıyla, HBV'ne bağlı gelişmiş 14 KAH ve 15 siroz hastasında kemik mineralizasyonu belirleyicisi olarak plazma iyonize kalsiyum (Ca), 25 hidroksi vitamin D (25(OH)vitD), paratiroid hormon (PTH) seviyeleri; kemik yapımı belirleyicileri olarak, kemik spesifik alkelen fosfataz (KAP), osteokalsin (OK), tip-1 kolajen propeptid (T-1KP) ve yıkım parametreleri olarak idrarda Ca ve deoksipridinolin (DP) atılımı ile X-ray emisyon absorptiometre (DEXA) yöntemiyle lumbar vertebra ve femur proksimalinin kemik mineral dansiteleri (KMD) çalışıldı. Benzer yaş ve cinsten 20 sağlıklı gönüllü kişi kontrol grubu olarak çalışmaya katıldı. KAH, siroz ve kontrol grubunda plazma iyonize Ca, 25(OH)vitD ve PTH düzeyleri anlamlı bir farklılık göstermedi. L1-L4 vertebra ve femurun değerlendirilen 5 bölgesinde (boyun, trokanter, intertrokanter, Ward's üçgeni, total) her iki hasta grubunda kontrol grubuna göre kemik kitlesinde belirgin kayıp olduğu gösterildi. Plazma OK düzeyinde her iki hasta grubunda kontrole göre istatistiksel olarak anlamlı artış saptandı. Buna karşılık KAP ve T-1KP düzeyleri sadece sirotik evredeki hastalarda kontrollere göre anlamlı yüksek bulundu. Sonuç olarak, beklenenin aksine HBV'ne bağlı gelişen KAH ve siroz hastalarının hiçbirinde osteomalazik bir tablo saptanmazken, her iki hasta grubunda yüksek dönüşüm hızlı osteopeni ve osteoporoz varlığı belirlendi