Real world data on outcomes of anti-CD38 antibody treated, including triple class refractory, patients with multiple myeloma: a multi-institutional report from the Canadian Myeloma Research Group (CMRG) Database.

Multiple myeloma (MM) remains incurable despite the availability of novel agents. This multi-center retrospective cohort study used the Canadian Myeloma Research Group Database to describe real-world outcomes of patients withanti-CD38 monoclonal antibody (mAb) refractory MM subsequently treated with standard of care (SoC) regimens. Patients with triple class refractory (TCR) disease (refractory to a proteasome inhibitor, immunomodulatory drug, and anti-CD38 mAb) were examined as a distinct cohort. Overall, 663 patients had disease progression on anti-CD38 mAb therapy, 466 received further treatment (346 with SoC regimens were included, 120 with investigational agents on clinical trial and were excluded). The median age at initiation of subsequent SoC therapy of 67.9 (range 39.6-89.6) years with a median of 3 prior lines (range 1-9). The median PFS and OS from the start of subsequent therapy was 4.6 (95% CI 4.1-5.6) months and 13.3 (95% CI 10.6-16.6) months, respectively. The median PFS and OS of patients with TCR disease (n = 199) was 4.4 (95% CI 3.6-5.3) months and 10.5 (95% CI 8.5-13.8) months. Our results reinforce that real-world patients with relapsed MM, particularly those with TCR disease, have dismal outcomes. There remains an urgent unmet need for the development of and access to effective therapeutics for these patients.

Incidence of spinal disease and role of spinal radiotherapy in multiple myeloma.

Background: Spinal disease (spd) in multiple myeloma (mm) can be a major source of morbidity in newly diagnosed patients and long-term survivors. We retrospectively assessed the incidence of spinal disease in patients newly diagnosed with myeloma, its effect on survival, and the possible effect of spinal radiation therapy (rt). Methods: Patients diagnosed with mm between 2010 and 2014 were identified through the provincial cancer registry. Plain radiography, computed tomography, and magnetic resonance imaging were reviewed to detect and document the type of spd. Data related to rt and systemic therapy were collected. Kaplan-Meier and time-varying Cox regression models were used to describe overall survival. Results: Of 306 identified patients with newly diagnosed mm, 51% had spd, including 17% with lytic disease, 68% with compression fractures, and 15% with spinal cord compression. Of the patients with spd, 61% received spinal rt. Of those patients, 84% received spinal rt within 3 months after their diagnosis. Median dose was 20 Gy. Most patients (89.2%) received chemotherapy, and 22.5% underwent autologous stem-cell transplantation. Only 6 of the patients treated with spinal rt received re-irradiation to the same site. Overall survival was similar for patients with and without spd. On multivariate analysis, spinal rt had no effect on survival. Conclusions: In patients newly diagnosed with mm, spd is a common presentation. With current systemic therapy, the presence of spd had no adverse effect on overall survival. The effect of spinal rt on overall survival was nonsignificant.

Dentin Topographic Features following Chemomechanical Caries Removal in Primary Teeth.

AIM: Study the topographic features of dentin after caries removal with a chemomechanical agent (Papacarie) compared with the conventional drilling method. STUDY DESIGN: The sample included 7 exfoliated and extracted primary teeth with carious dentin lesions, not reaching the pulp. Each tooth was sectioned longitudinally through the center of the carious lesions into two halves. The teeth were then divided into two groups according to the method of caries removal. Following caries removal, dentin topography and the cut section were examined using the scanning electron microscope. RESULTS: Papacarie produced an irregular, porous, rough and globular dentin appearance. The dentin surfaces were generally free of smear layer, visible bacteria and the dentinal tubules were opened. The dentin cut surfaces showed patent dentinal tubules with open orifices. The drilling method created a smooth and amorphous surface with a continuous smear layer occluding the dentinal tubules. Numerous bacteria were also observed. The cut dentin surfaces showed patent dentinal tubules with their orifices plugged with smear layer. CONCLUSIONS: Papacarie produced a rough and porous surface with partial or complete removal of the smear layer and opened dentinal tubules, while the drill produced a smooth surface with uniform smear layer occluding the dentinal tubules.

Self-medication with drugs and complementary and alternative medicines in Alexandria, Egypt: prevalence, patterns and determinants.

This study aimed to describe the prevalence, pattern and reasons for self-medication among adults in Alexandria, Egypt. In a community-based survey during 2012, a representative sample of 1100 adults completed a predesigned interview questionnaire on self-medication practices by drugs and complementary or alternative medicines (CAM). A majority of them practised self-medication (86.4%), mostly using both drugs and CAM (77.5%). The most commonly used drugs were analgesics (96.7%), and cough and cold preparations (81.9%), but 53.9% of respondents reported self-medication with antibiotics. The most frequently used CAM were herbs (91.6%), followed by spiritual healing (9.4%) and cupping and acupuncture (6.4%). CAM improved the condition according to 95.2% of users. Logistic regression analysis revealed that age, occupation and the presence of chronic conditions were the independent factors significantly affecting the practice of self-medication with drugs.

Self-medication with drugs and complementary and alternative medicines in Alexandria, Egypt:prevalence, patterns and determinants

تباع مجموعة واسعة من أدوية الوصفات الطبية بدون وصفة في كثير من البلدان النامية. وقد هدفت هذه الدراسة إلى وصف انتشار التطبيب الذاتي وأنماطه وأسبابه بن البالغن في الإسكندرية بمصر. ففي مسح مجتمعي أجري خال عام 2012 قامت عينة ممثِّلة تتألف من 1100 بالغ باستكمال استبيان مصمم مسبقاً عن ممارسات التطبيب الذاتي بواسطة العقاقر والأدوية التكميلية أو البديلة. ولقد أظهرت النتائج أن معظمهم مارسوا التطبيب الذاتي 86.4 %، في الغالب باستخدام العقاقر وكذلك الأدوية التكميلية أو البديلة 77.5 %. ولقد كانت الشكوى من الإصابة بالمشاكل الهضمية الأكثر شيوعاً لممارسة التطبيب الذاتي. وكانت الأدوية الأكثر استخداماً المسكنات 96.7 % ومستحضرات السعال والرد 81.9 %، ولكن 53.9 % من المستطلَعين أبلغوا عن تطبيب ذاتي بالمضادات الحيوية. وكانت الأدوية التكميلية أو البديلة الأكثر استخداماً الأعشاب % 91.6 ، يليها العاج الروحي 9.4 % والحجامة والوخز بالإبر 6.4 %. ولقد تحسنت الحالة بفعل الأدوية التكميلية أو البديلة وفقاً ل 95.2 % من المستخدِمين. وكشف تحليل الانحدار اللوجستي أن العمر والمهنة ووجود أمراض مزمنة كانت العوامل المستقلة التي تؤثر بشكل كبر عى ممارسة التطبيب الذاتي بالعقاقر.

This study aimed to describe the prevalence, pattern and reasons for self-medication among adults in Alexandria, Egypt. In a community-based survey during 2012, a representative sample of 1100 adults completed a predesigned interview questionnaire on self-medication practices by drugs and complementary or alternative medicines (CAM). A majority of them practised self-medication (86.4%), mostly using both drugs and CAM (77.5%). The most commonly used drugs were analgesics (96.7%), and cough and cold preparations (81.9%), but 53.9% of respondents reported self-medication with antibiotics. The most frequently used CAM were herbs (91.6%), followed by spiritual healing (9.4%) and cupping and acupuncture (6.4%). CAM improved the condition according to 95.2% of users. Logistic regression analysis revealed that age, occupation and the presence ofchronic conditions were the independent factors significantly affecting the practice of self-medication with drugs.

La présente étude avait pour objectif de décrire la prévalence, les tendances ainsi que les motifs de l’automédication chez des adultes à Alexandrie (Égypte). Dans une enquête communautaire en 2012, un échantillon représentatif de 1100 adultes a répondu à un questionnaire prédéfini au cours d'un entretien sur leurs pratiquesd'automédication à base de médicaments conventionnels, complémentaires et alternatifs. Une majorité d'entre eux pratiquait l'automédication (86,4 %), et la plupart consommait à la fois des médicaments conventionnels et des médicaments complémentaires et alternatifs (77,5 %). Les médicaments conventionnels les plus utilisés étaient les analgésiques (96,7 %), et les préparations contre la toux et le rhume (81,9 %), tandis que 53,9 % des répondants indiquaient consommer des antibiotiques en automédication. Dans la catégorie de la médecine complémentaire et alternative, le recours aux médicaments à base de plantes (91,6 %) arrivait en tête, suivi par les soins spirituels (9,4 %), l'application de ventouses et l'acupuncture (6,4 %). La consommation de médicaments complémentaires et alternatifs permet d'améliorer l'état de santé selon 95,2 % des utilisateurs. L'analyse de régression logistique a révélé que l'âge, l'emploi occupé et la présence de maladies chroniques étaient les facteurs indépendants qui influaient significativement sur la pratique de l'automédication à base de médicaments conventionnels.

Risk of aggression and criminal behaviour among adolescents living in Alexandria Governorate, Egypt.

Adolescent risk-taking and aggressive behaviours are among the most visible forms of violence in society. A study was carried out to identify the prevalence and risk factors for aggression, violence and criminal behaviour among adolescents in Alexandria, Egypt. Using multistage, cluster sampling of families from all health districts in Alexandria, the mothers of 783 adolescents aged 11-19 years answered an Arabic version of the Mentor Research Institute screening questionnaire. Overall 26.9% of adolescents were assessed to be at high risk and 20.2% at extremely high risk of aggression and criminal behaviour. Living in urban/slum areas, male sex, low level of parents' education/occupation, exposure to violence within the family and changes in behaviour of any family member were associated with risk of aggression/violence. In multivariate analysis, the significant independent variables were adolescents' sex, presence of behavioural changes in the family, violence against brothers and sisters and substance abuse by any family member.

Risk of aggression and criminal behaviour among adolescents living in Alexandria governorate, Egypt

Adolescent risk-taking and aggressive behaviours are among the most visible forms of violence in society.A study was carried out to identify the prevalence and risk factors for aggression, violence and criminal behaviour among adolescents in Alexandria, Egypt.Using multistage, cluster sampling of families from all health districts in Alexandria, the mothers of 783 adolescents aged 11-19 years answered an Arabic version of the Mentor Research Institute screening questionnaire.Overall 26.9% of adolescents were assessed to be at high risk and 20.2% at extremely high risk of aggression and criminal behaviour.Living in urban/slum areas, male sex, low level of parents' education/occupation, exposure to violence within the family and changes in behaviour of any family member were associated with risk of aggression/violence.In multivariate analysis, the significant independent variables were adolescents' sex, presence of behavioural changes in the family, violence against brothers and sisters and substance abuse by any family member

يعتبر إقدام المراهقين على المخاطرة والسلوك الإجرامي من أكثر أشكال العنف مشاهدة في المجتمع. وقد أجرى الباحثون هذه الدراسة للتعرف على معدل انتشار عوامل التعدي والسلوك الإجرامي والعنيف وخطره بين المراهقين في الإسكندرية، مصر، وقاموا بأخذ عينات عنقودية متعددة المراحل من أسر تنتمي إلى جميع المناطق في الإسكندرية، ووجهوا أسئلة مستمدة من النسخة العربية لدليل معهد البحوث واستبيان التحري فيه إلى 783 من أمهات المراهقين الذين تتراوح أعمارهم بين 11 - 19 عاما، واتضح من إجاباتهن أن 26.9 % من مجمل المراهقين الذين خضعوا للتقييم كانوا معرضين لخطر مرتفع، و 20.2 % منهم معرضون لخطر مرتفع ارتفاعا بالغا للتعدي وللسلوك الإجرامي. وقد ترافق ذلك الخطر مع العيش في العشوائيات، والذكورة، وتدني مستوى التعليم والعمل لدى الوالدين، والتعرض للعنف ضمن الأسرة، والتغير في السلوك لدى أي فرد من أفراد الأسرة. ومن خلال التحليل المتعدد المتغيرات، تبين أن المتغيرات ذات الأهمية التي يعتد بها هي جنس المراهق، ووجود ثغرات سلوكية لدى الأسرة، والعنف الموجه ضد الأخوة والأخوات، وإدمان أحد أفراد الأسرة لإحدى مواد الإدمان

La prise de risque chez les adolescents et les comportements agressifs sont les formes les plus visibles de la violence en société.Une étude a été menée pour identifier la prévalence et les facteurs de risque d'un comportement agressif, violent et criminel chez des adolescents à Alexandrie [Egypte]. A l'aide d'un échantillonnage en grappes à plusieurs degrés de familIes dans tous les districts sanitaires d'Alexandrie, les mères de 783 adolescents âgés de 11 à 19 ans ont rempli le questionnaire de dépistage du Mentor Research Institute dans sa version en langue arabe.Globalement, 26, 9 % des adolescents ont été évalués comme étant à haut risque et 20, 2 % à extrêmement haut risque de comportement agressif et criminel.Le fait de vivre dans des zones urbaines/d'habitat insalubre, d'être de sexe masculin, d'avoir des parents dont le niveau d'études/professionnel est faible, d'être exposé à une forme de violence familiale et a des modifications de comportements de membres de la famille ont été des facteurs associés au risque de comportement agressif/violent.A l'analyse multivariée, le sexe de l'adolescent, la présence de changements comportementaux dans la famille, la violence envers les frères et surs et la toxicomanie de membres de la famille étaient des variables indépendantes importantes

Efficacy of third-line therapy using bevacizumab in a patient with metastatic colorectal cancer.

Bevacizumab is currently approved in association with first- and second-line 5-fluorouracil-based chemotherapy regimens for patients with metastatic colorectal cancer. Few data about the usefulness of bevacizumab in third-line settings are available. We describe a patient refractory to FOLFIRI and FOLFOX chemotherapy regimens who showed a dramatic and durable response to bevacizumab and FOLFIRI. We also review and discuss the available literature.

Failure of rituximab to treat a lupus flare-up with nephritis.

The autoantibodies secreted by B lymphocytes have recently been shown to play an important role in autoimmune disease. B lymphocyte depletion by rituximab, a monoclonal anti-CD20 antibody, has been introduced for the treatment of several autoimmune disorders. Few reports have underlined its potential use for the treatment of systemic lupus erythematosus (SLE). We report here the occurrence of extracapillary glomerulonephritis associated with a thrombotic event shortly after rituximab treatment for a lupus flare-up in a patient with anticardiolipin antibodies. This observation suggests that rituximab alone may be insufficient to control severe SLE with glomerulonephritis and should therefore be used with caution in patients with this condition.

Cutaneous and mediastinal lymphadenitis due to Mycobacterium kansasii.

Mycobacterium kansasii most commonly causes a slowly progressive pulmonary disease. Skin and disseminated infections are seen less frequently and only in immunocompromised hosts. To our knowledge, no case of Mycobacterium kansasii infection or skin infection associated with additional organ involvement in an immunocompetent patient has been reported.