![]() Third, make sure your headphones or speakers are in good condition. This can help reduce internet congestion and provide a more reliable connection for your streaming. Second, if you can, use a wired connection (such as an ethernet) instead of a wireless connection to stream Pandora. To do this, go to Settings and make sure you select the highest available bitrate. Mobile players should be streaming at least 192 kbps. For web players, this will be at least 128 kbps. ![]() First, make sure you are streaming Pandora at the highest bitrate available on your device. Improving the sound quality of your music streaming on Pandora can be done by taking a few simple steps. How do I make my Pandora sound quality better? The extension even has an automatic feature that boosts the volume of specific songs, so if there’s a song you really want to hear, you can make sure it’s at the right volume. It enables you to adjust the volumes of your favorite Pandora stations and make sure you get the most out of your listening experience. It’s a free and easy-to-install extension that will give you complete control of your Pandora music playback. It’s called the Pandora Volume Booster extension for Chrome, and you can get it from the Chrome Web Store. Yes, there is a volume booster for Pandora. From there, you can click on the Bass option to adjust the bass level of the station.Īdditionally, you can also adjust the treble, feedback, and listening experience in the same settings menu. ![]() Then, select the Settings icon and scroll down to the bottom of the page. To do so, open the Pandora app and tap on the station name at the top of the screen. ” From there, you can adjust the bass, midrange, and treble to your preference. To access the EQ settings, simply go to the Settings tab, then scroll to the bottom of the page and click “Equalizer. The Streams Optimizer is available on the Pandora mobile app for Android and iOS, as well as on the desktop app. This equalizer is designed to provide listeners with a customized audio experience based on the type of device they’re using to listen, their connection strength, and the options chosen within their personal Pandora station settings. Keep your music fresh and organized with our feature-rich Playlist Manager and a simple interface focused on getting you listening with a few taps.Pandora exclusively works with its own custom equalizer, simply called the “Pandora Streams Optimizer”. Upgrade your listening experience today with our powerful equalizer app! Plus, our easy-to-use interface makes it simple to access all of our powerful features. With MPX EQ, you can enjoy crystal-clear audio on any device, whether you're listening through headphones, speakers, or your car's audio system. But we didn't stop there - our app also includes advanced audio customizations like audio crossfade, normalizer, speed and pitch adjust, and more.Ĭreate your own custom sound profiles and fine-tune every aspect of your audio experience. MPX EQ is the ultimate audio customization tool for music lovers! With a 10-band EQ, you can precisely adjust the sound quality of your favorite songs and playlists to fit your exact preferences. Fine-tune your sound with our powerful equalizer app!ġ0-band EQ & advanced audio customizations, create custom sound profiles & upgrade your listening experience today.
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10/30/2023 0 Comments Mortgage loan apr calculator![]() To learn more about relationship-based ads, online behavioral advertising and our privacy practices, please review the Bank of America Online Privacy Notice and our Online Privacy FAQs. You may also visit the individual sites for additional information on their data and privacy practices and opt-out options. To learn more about ad choices, or to opt out of interest-based advertising with non-affiliated third-party sites, visit YourAdChoices popup powered by the DAA or through the Network Advertising Initiative's Opt-Out Tool popup. Ads served on our behalf by these companies do not contain unencrypted personal information and we limit the use of personal information by companies that serve our ads. Relationship-based ads and online behavioral advertising help us do that.īank of America participates in the Digital Advertising Alliance ("DAA") self-regulatory Principles for Online Behavioral Advertising and uses the Advertising Options Icon on our behavioral ads on non-affiliated third-party sites (excluding ads appearing on platforms that do not accept the icon). We strive to provide you with information about products and services you might find interesting and useful. Select the About ARM rates link for important information, including estimated payments and rate adjustments. ARM interest rates and payments are subject to increase after the initial fixed-rate period (5 years for a 5y/6m ARM, 7 years for a 7y/6m ARM and 10 years for a 10y/6m ARM the 6m shows that the interest rate is subject to adjustment once every six months thereafter). provides FREE mortgage annual percentage rate calculators and loan calculator. Should you choose to waive escrows, your rate, costs and/or APR may increase. Press the 'View Report' button for a full amortization schedule, either by year or by month. ![]() Advertised loans assume escrow accounts (monthly collection of subject property taxes and any applicable homeowners insurance with your monthly principal and interest payment) unless you request otherwise and the loan program and applicable law allows. Any other fees such as property tax and homeowners insurance are not included and will result in a higher actual monthly payment. ![]() Monthly payments shown include principal and interest only, and (if applicable), any required mortgage insurance. Chart accuracy is not guaranteed and products may not be available for your situation. Your actual rate and APR may differ from chart data. Advertised rate, points and APR are based on a set of loan assumptions (refer Loan assumptions and disclosures above for important information). Chart data is for illustrative purposes only and is subject to change without notice. 10/30/2023 0 Comments Numerology 333 doreen virtue![]() It symbolizes the act of bringing things back to life.įor example, Jesus was resurrected on the 8th day after his crucifixion and Elijah performed a total of 8 miracles in the Bible. This number represents resurrection and regeneration. ![]() In the bible, angel number 88 can be reduced to its singular form – number 8. What Does Angel Number 88 Mean in the Bible? It holds a significant place as a special angel number delivered by your spirit guides. The repetitive occurrence of this number signifies that you are likely to experience positive outcomes and favorable circumstances.Īngel number 88 brings forth not only good fortune but also serves as a reminder to exercise caution in managing your finances. Now is the opportune time to start actively working towards those goals to manifest them into reality. Your angels have been attentive to your prayers and witnessed the incredible goals and dreams you have formed in your mind. ![]() Is Angel Number 88 a Good Number?Īngel number 88 is a blessing from the universe, indicating that great things are on the horizon if you take action. It’ll help you remove hurdles that are blocking your path to stability and abundance so you can succeed in your physical and spiritual life. So, you need to get rid of negative influences, experiences, and circumstances, and align yourself with the spiritual world. It means that your positive thoughts and actions will be rewarded, and your negative thoughts and actions will have negative consequences. It is a reminder that you are capable of achieving anything you set your mind to and that your angels are supporting you on your physical, as well as, spiritual journey.Ĩ8 is also a karmic number and it reflects the universal spiritual laws of cause and effect. Many people get very excited by the financial prosperity this number brings but it also carries a deep spiritual meaning. What Does 88 Mean Spiritually?Ī number with intense vibrations of luck and positivity, angel number 88 is an incredibly exciting number to receive from your angels. Allow this ending to work the way it should, the closure you will experience will open the doors to your new beginning. You may be reaching the end of something. They may happen in your career, home life, or both.Įither way, these fresh beginnings will bring a newly charged positivity to your life. Keep going and give your focus all of your energy and attention.Īngel number 88 also symbolizes changes, but these are not changes to fear. Your angels want you to know that they support you and they’re here to give you all the encouragement you need to succeed.Īlthough great financial success is coming, they want you to be aware not to let up. Naturally, you are very responsible, so keep a level head as you enter the next phase of your life.Īngel number 88 also symbolizes the fruition of all your hard work and determination. You should take care when it comes to your finances and any business decisions you may have to make. It is a sign that you need to be responsible for your situation right now. Symbolizing integrity, inspiration, creativity, knowledge, business, and intuition, angel number 88 is all about a big success that lingers in your very near future. ![]() Keep dedicated to your goals, and anticipate a future filled with exciting possibilities and abundant blessings. 10/30/2023 0 Comments Php 8.1 install ubuntuSave the file and exit the editor and restart Nginx for the changes to take effect. ![]() You need to replace the old PHP version with the new version.įastcgi_pass unix:/run/php/ The line you need to modify will look like this…įastcgi_pass unix:/run/php/ This will be located inside the location block location ~ .php$ Sudo service apache2 restart Upgrade/Downgrade PHP for Nginxįor Nginx you need to update or downgrade the PHP-FPM socket in your Nginx configration located inside the sites-available directory. Restart Apache for the changes to take effect. Replace the current enabled PHP version with your version. Disable the old PHP module ( below I have mentioned php 8.1, you need to use your other php version used by Apache) and enable the new PHP module using the following command. You need to tell Apache to use the correct PHP version you installed right now. If you want to use a different PHP version you can upgrade or downgrade to the other PHP version as shown below. Press to keep the current choice, or type selection number: Sudo update-alternatives -config php There are 3 choices for the alternative php (providing /usr/bin/php). You will be prompted with an interactive mode to choose your PHP version. Prepare yourself for a role working as an Information Technology Professional with Linux operating systemĪs you are switching PHP version for your web applications you will also need to change the PHP version in your CLI (Command Line Interface).Įxecute the below command to change PHP version on your CLI. Now you are having PHP 8.1 Installed and configured. Once you have updated your PHP FPM settings you need to restart it to apply the changes. Hit CTRL+X and Y to save the configuration and check if the configuration is correct and restart PHP. If you want to change the username name you can change the following lines by replacing the www-data with your username. Sudo nano /etc/php/8.1/fpm/pool.d/www.conf PHP-FPM allows you to configure the user and group that the service will run under. Sudo service php8.1-fpm restart Configure PHP 8.1 FPM Pools Once you have modified your PHP settings you need to restart your Apache for the changes to take effect.įor users with Nginx to who use PHP-FPM, you need to restart PHP-FPM. ![]() Hit F6 for search inside the editor and update the following values for better performance. Now we configure PHP for Web Applications by changing some values in php.ini file.įor PHP 8.1 with Apache the php.ini location will be in following directory.įor PHP 8.1 FPM with Nginx the php.ini location will be in following directory. With Zend OPcache v8.1.5, Copyright (c), by Zend Technologies Configure PHP 8.1 Zend Engine v4.1.5, Copyright (c) Zend Technologies You can easily verify PHP version using the below command. Sudo apt install php8.1-common php8.1-mysql php8.1-xml php8.1-xmlrpc php8.1-curl php8.1-gd php8.1-imagick php8.1-cli php8.1-dev php8.1-imap php8.1-mbstring php8.1-opcache php8.1-soap php8.1-zip php8.1-redis php8.1-intl -y Verify PHP Version Now, install some commonly used php-extensions with the following command. ![]() Installing PHP extensions are simple with the following syntax. ADVERTISEMENT php-fpm8.1 -v Install PHP 8.1 Extensions 10/30/2023 0 Comments Extractor vacuum car![]() You can use it to clean stairs, car interiors, carpets, furniture, seats, cushions and all other hard-to-reach places. Great for extracting solutions from vehicles and living room upholstery. ⚒【CLEAR-HEAD DESIGN】The transparent head design allows you to see the dirt and impurities being cleaned, and directly see the entire cleaning process and effect. You can therefore save the expensive cost of a pro extractor. ![]() If you are considering buying a professional extractor, it will be a good substitute. ⚒【DIY AN EXTRACTOR】Our Extractor Hand Wand can be used as a replacement for many Extractor heads More importantly, it can turn your wet/dry vacuum cleaner into an extractor. Also great for cleaning boats with a 12V cigarette lighter port or are within the 16ft cord range. The 16-foot cord gives the slack needed to clean the back seat or trunk without a snag. Must-have car accessories for women or men these gadgets will keep the interior cute and tidy.ĬONVENIENT: Is the battery always dying when you need a car vac? These truck accessories for men & women use the 12v aux outlet. Our mini car vacuum even has a top of the line washable filter.ĬAR CLEANING KIT: Includes 3 attachments for detailing (flathead, extendable, or brush nozzle), carry bag, filter brush, and spare HEPA filter. STRONG SUCTION: The cyclonic force and strong suction of the 106w motor on these handheld vacuums will terminate any dirt, debris, or hard-to-reach crumbs. A very sandy day at the beach? A coat of dog hair? The portable vacuum cleaner for car is designed to solve problems. POWERFUL: This hand held vacuum is made for on-the-go use and solving out-of-reach problems. A fully loaded interior car detailing kit housed in an ergonomic design. Equipped with a HEPA filter, this small dustbuster is ready for ash, dust, or drive-thru food spills. PRACTICAL: A mini vacuum for car or truck that is compact, lightweight (2.4 lbs), and easy to use. German Engineered, German Quality - FEIN is a well-known global company with German roots that manufactures high-quality power tools and accessories created for the toughest jobs in the metal and interior industries. Industry Made - It has an autostart outlet with power-on delay to prevent current spikes, anti-static function against electrostatic charging, and tool coupling with suction control for easy control of suction power.Ĭonvenience + Versatility - Our practical storage area with rim lets you leave your tool bag on top as you move around or have a DIY cyclone dust extractor addition. With a large 8.5-gallon tank and powerful 151 CFM suction capacity, you'll be able to clean up any mess in record time. Ideal for industrial job site or DIY use.Ĭlean Up Any Mess - Whether it's a liquid, dust, or debris, this wet dry vacuum cleaner will take care of it in no time. Outstanding Performance - The dust extractor is very effective at dust collection when attached to power woodworking tools or used for car vacuum detailing or even to keep your carpet or upholstery cleaner. Aldehydes and formic acid (and formates) also give a positive test. Reaction with double or triple bonds (-C=C- or -C≡C-) causes the color to fade from purplish-pink to brown. The reagent is an alkaline solution of potassium permanganate. It is sometimes referred to as Baeyer's reagent after the German organic chemist Adolf von Baeyer. KMnO 4 is used in qualitative organic analysis to test for the presence of unsaturation. Significant amounts are required for the synthesis of ascorbic acid, chloramphenicol, saccharin, isonicotinic acid, and pyrazinoic acid. Synthesis of organic compounds A solution of KMnO 4 in water, in a volumetric flaskĪ major application of KMnO 4 is as a reagent for the synthesis of organic compounds. It currently finds application in the control of nuisance organisms such as zebra mussels in fresh water collection and treatment systems. Modern hiking and survivalist guides advise against using potassium permanganate in the field because it is difficult to dose correctly. Historically it was used to disinfect drinking water and can turn the water pink. "Pot-Perm" is also obtainable at pool supply stores and is used additionally to treat wastewater. It is used as a regeneration chemical to remove iron and hydrogen sulfide (rotten egg smell) from well water via a "manganese greensand" filter. Potassium permanganate is used extensively in the water treatment industry. ![]() It is on the World Health Organization's List of Essential Medicines. This includes fungal infections of the foot, impetigo, pemphigus, superficial wounds, dermatitis, and tropical ulcers. Potassium permanganate is used for a number of skin conditions. Main article: Potassium permanganate (medical use) As a strong oxidant that does not generate toxic byproducts, KMnO 4 has many niche uses. Uses Īlmost all applications of potassium permanganate exploit its oxidizing properties. The purplish-black color of solid potassium permanganate, and the intensely pink to purple color of its solutions, is caused by its permanganate anion, which gets its color from a strong charge-transfer absorption band caused by excitation of electrons from oxo ligand orbitals to empty orbitals of the manganese(VII) center. In the solid (as in solution), each MnO − 4 centre is tetrahedral. ![]() The overall motif is similar to that for barium sulfate, with which it forms solid solutions. KMnO 4 forms orthorhombic crystals with constants: a = 910.5 pm, b = 572.0 pm, c = 742.5 pm. Potassium permanganate is the potassium salt of the tetrahedral transition metal oxo complex permanganate, in which four O 2− ligands are bound to a manganese(VII) center. In 2000, worldwide production was estimated at 30,000 tons. ![]() Potassium permanganate is widely used in the chemical industry and laboratories as a strong oxidizing agent, and also as a medication for dermatitis, for cleaning wounds, and general disinfection. It is a purplish-black crystalline salt, that dissolves in water as K + and MnO − Sometimes there may be multiple compounds with that element on one side, so you'll need to use your best judgement and be prepared to go back and try the other options.Potassium permanganate is an inorganic compound with the chemical formula KMnO 4. Step 2: Multiply coefficients for compounds to balance out each elementįor each element that is not equal, try to balance it by adding more of it to the side with less. Step 1: Count the number of each element on the left and right hand sides When using the inspection method (also known as the trial-and-error method), this principle is used to balance one element at a time until both sides are equal and the chemical equation is balanced. To be balanced, every element in Pb(NO3)2 + KI = KNO3 + PbI2 must have the same number of atoms on each side of the equation. ![]() The law of conservation of mass states that matter cannot be created or destroyed, which means there must be the same number atoms at the end of a chemical reaction as at the beginning. 10/30/2023 0 Comments Nikon fx wide angle lensesHaving the vibration reduction built into the Nikon 85mm f/3.5G Micro is a great help in this regard. To be able to get the entire object in focus, you’ll usually need to use smaller apertures, meaning slower shutter speeds or higher ISOs (unless you can add more light). Sharp with built in image stabilization, the Nikon 85mm f/3.5G Micro is good value for money and gets the job done.įor those who’ve ever tried macro photography before, you’ll know you either need a lot of light and/or a tripod. The Nikon 85mm f/3.5G ED VR AF-S DX Micro is a lens with a huge name for shooting small things -) It also happens to be the number one macro lens for Nikon DX format dSLRs. You’ll notice that all the lenses I recommend here have numerous 5 star reviews. I’ll make this section short and sweet – just click through the links if you’d like to read real user reviews of the different lenses.Īmazon’s a great place to make a buying decision since its reviews are by those who’ve actually bought and used the lens. Now it’s time to introduce you to the Nikon lenses that I wanted to include in this roundup, but felt they were a little too specific to be considered good all-rounders. Recommended Nikon Lenses for Specific Usage Nikon is slowly discontinuing its range of F-mount lenses to focus on producing lenses for their range of mirrorless cameras, so you may need to head to second-hand sellers to pick these up. It’s also worth bearing in mind that F-mount lenses are fully compatible with Z series cameras when using the Mount Adapter FTZ and FTZ II, opening up your options for building a lens collection. ![]() Once you’ve done this, you can decide which lens to go for based on your photography style and preferences, for example, choosing a wide-angle lens for landscapes or a telephoto lens for wildlife and sports photography. In contrast, the Z-mount is a relatively new system that was introduced in conjunction with their full-frame mirrorless cameras in 2018 for their FX sensor format.īefore you opt for a particular lens, you should check the model of your Nikon camera to verify which mount it features so you know whether to look for F-mount or Z-mount lenses. Nikon first introduced the F-mount system for their cameras over 60 years ago, so there are hundreds of available lenses that are compatible with this format. There are a wide range of F and Z-mount cameras available from Nikon Nikkor AF-P DX 10-20mm f/4.5-5.6 VRĬompatible Format: DX Diaphragm Blades: 7 Minimum Focus Distance: 0.8 ft (0.22 m) Filter Size: 72mm Dimensions (Diameter x Length): 3.0 in. Nikon’s range of DX lenses is designed for cameras with a DX-format sensor, which is Nikon’s smaller sensor at 24x16mm found on their DSLR cameras such as the flagship D500 and the entry-level D3500. Tokina atx-i 11-20mm f/2.8 CF Plus HIGHLY RECOMMENDED What Nikon Lenses Should You Buy First in 2023? Image What are other common questions about Nikon camera lenses?.What is the Nikon Z Lens Roadmap for 2023?.What do the letters on a Nikon Lens mean?.Which Nikon lens is best for wildlife photography?.What are the best Nikon lenses for landscape photography?.What are the best Nikon lenses for portraits?. ![]() Which Nikon lens produces the nicest bokeh?.Which Nikon lens is best for architecture photography?.Recommended Nikon Lenses for Specific Usage.How Do I Choose a Lens for a Nikon F-Mount or Z-Mount Camera?.What are the Best Nikon FX Mirrorless Lenses?. ![]()
You are more beautiful than a summer sunset on the ocean horizon. I can’t love you enough because you are a precious jewel in my world. I thank God for making it possible for us to cross the path right from the beginning because that was where my life gained so much impact on your love.
10/30/2023 0 Comments Sessionbox edge![]() This website search box writes Sessionbox uses a Search menu and Now opens on this extension. Open your Google Chrome browser and then go to After then search Session box chrome at. Next step I will provide you How to install the Session box file used on this website. Which is best Free Session box chrome?Įveryone Knows Sessionbox is a Great plugin works perfect saves a lot of time. Are you searching Sessionbox address? We’ll describe to you how to mask your position using the Session box chrome addons in your Google Chrome browser in this article. Another is adding a Chrome extension named SessionBox to create multiple WhatsApp accounts.If you also want to get download this Sessionbox keep see the image & reading below notice this short information. ![]() First, you can use Chrome to create multiple accounts and log in one after one. Here are the two steps by which you can create multiple WhatsApp accounts on your computer. With this extension, you can open multiple WhatsApp Web pages simultaneously. Proceed to scan the WhatsApp web barcode for each session you have opened, starting with the original one. Give the new session a name and click OK to save it. In the SessionBox window, click the plus icon (which is circled) next to the WhatsApp Web link to create a new stored session. Follow the instructions on the screen and select “Sign in as guest” to proceed. ![]() Click on the SessionBox extension to create a replica of the WhatsApp Web tab on the homepage. Open WhatsApp Web in your browser and log out of any previously logged accounts. You’ll see a demo of SessionBox in a new tab, but you can close it. Once you’ve installed the extension, pin it to your browser’s toolbar. Visit the Chrome Web Store page for SessionBox and install it as an extension. Here are the steps to use SessionBox for using multiple WhatsApp accounts on the desktop: With the help of this extension, users can utilize multiple WhatsApp accounts on their desktop, using Chrome or Microsoft Edge. While its primary focus is on browsers, SessionBox can also function as a smartphone app cloner. SessionBox is a Chrome extension that enables users to log in to multiple accounts on a single website through their browser. To connect your additional WhatsApp account(s), follow the same steps as before, but this time select the new Chrome profile you just created. Click “Done” to finish creating the new profile. Create a name for the new profile and decide whether or not to create a desktop shortcut for it. Click on the option “Continue without an account.” Click on the profile icon, typically a picture associated with your default Google account, located at the top-right corner of the Chrome homepage. To create a new Chrome profile, follow these steps: Here is a guide on how to create a new browser profile with Chrome and one of its extensions: For Chrome: However, there is a solution: by creating separate browser profiles, you can connect multiple WhatsApp accounts to your browser and use them all on your Windows 11 desktop. In that case, you must log out of that account to access another WhatsApp account, which can be inconvenient if you use multiple accounts. ![]() Suppose you connect a WhatsApp account to a specific browser profile. With this feature, you can connect multiple WhatsApp accounts to the same browser, as each profile you create acts as a new browser with no shared data. Each profile is a separate space for your browser activities, preventing confusion. Most popular browsers, such as Chrome, Firefox, Edge, and others, offer a feature that allows you to create multiple profiles. You can try one of these methods: Create a new browser profile. There are a few ways to open multiple WhatsApp accounts on your Windows 11 PC/desktop/surface using the same browser. Here are some ways to use multiple WhatsApp accounts on your desktop if you have more than one account and want to connect them to your computer simultaneously: Method 1: Use Multiple WhatsApp Accounts on the same browser How to create multiple WhatsApp accounts on your Windows 11 desktop Wait until your WhatsApp account connects to your PC, and you’re done. Follow the on-screen prompts to display the QR code scanner and scan the code displayed on the WhatsApp web page. Select “Linked devices” and tap on “Link a Device.” On your phone, open WhatsApp and click the icon with three dots. Visit on your PC to access the QR code to connect to WhatsApp. To sign in to WhatsApp on your desktop, follow these steps: Method 1: Use Multiple WhatsApp Accounts on the same browserīefore we explore various ways of using multiple WhatsApp accounts on a desktop, let’s first discuss how to log in to WhatsApp on your PC or Windows 11.How to create multiple WhatsApp accounts on your Windows 11 desktop.How to log in to WhatsApp on a Desktop?. ![]() Chronic anemia mainly results in fatigue, shortness of breath on exertion, and reduction of physical activity, whilst dark urine are the typical symptom of intravascular hemolysis. GPI deficiency results in complement-mediated intravascular hemolysis 5–7 and thrombophilia, the main cause of morbidity and mortality in PNH. The latter encodes for a glycosyl-phosphatidylinositol (GPI) that anchors several molecules on the cellular membrane, 3, 4 including the complement inhibitory proteins CD55 (decay accelerating factor ) and CD59 (membrane inhibitor of reactive lysis ). PNH is a clonal disorder of the hematopoietic stem cell caused by acquired somatic mutations of PIGA gene. Furthermore, we will focus on available reports that evaluate fatigue and QoL in PNH patients. In this article, we will briefly address the unmet needs of PNH treatment and describe how novel therapies might fill the gap in patients’ management. To aid the objective evaluation of QoL and the effect of treatment, the use of structured surveys has been implemented in the clinic. For this reason, there is a need for instruments to measure PROs. Clinicians usually evaluate patients’ QoL by simply asking them “how are you” during routine visits and the ability to elicit PROs varies between professionals. Objectivating and grading patient’s fatigue is one of the most difficult medical tasks given the highly heterogeneous communication skills of patients and caregivers and the multitude of meanings that might be attributed to this term. There are many components of fatigue, one of which is anemia, as frequently shown in other diseases, particularly cancer. 2 Fatigue has been identified as a prevalent disturbance in PNH patients. ![]() Regarding therapy, the beneficial impact on survival and/or on a meaningful aspect of a patient’s life is fundamental, and health features affecting the way a patient feels or functions should be considered. ![]() 1 PROs are used as indicators for assessing health-related QoL (impacts of disease and its treatment and symptoms). A Patient-Reported Outcome (PRO) is any report of the status of a subject’s health condition (QoL and symptoms) that comes directly from the patient, without interpretation of the response by a clinician or anyone else. Additionally, PNH patients carry the emotional burden of a chronic life-long disease with heterogeneous treatment requirement, risk of hemolytic exacerbations (breakthrough hemolysis) and of thrombosis. Paroxysmal nocturnal hemoglobinuria (PNH) is a rare condition characterized by chronic hemolysis resulting in anemia of various degree and fatigue, variably affecting quality of life (QoL). In this review, we focus on available studies that evaluated fatigue and QoL in PNH patients, and the effect of old and new therapeutic strategies. Several novel drugs have been designed to improve patients’ convenience and alleviate anemia and fatigue. ![]() However, the intravenous fortnightly administration, the presence of residual anemia, and the risk of extravascular hemolysis are some of the unmet needs impacting QoL under eculizumab. Eculizumab was the first drug utilized and was shown to improve QoL scores in the registrative trials. In the last decade, structured surveys and scores have been adapted from cancer settings to evaluate fatigue and QoL in patients with PNH, and to assess the benefit of complement inhibitors in this setting. Along with anemia, QoL in PNH is also affected by the emotional burden of a chronic life-long disease with heterogeneous treatment requirement, risk of hemolytic exacerbations (breakthrough hemolysis) and of thrombosis. Objectivating QoL and grading patient’s fatigue is one of the most difficult medical tasks given the highly heterogeneous communication skills of patients and caregivers and the multitude of meanings that might be attributed to this term. The latter seems the best word to communicate patient’ perception of personal health status and disease impact on daily living, namely quality of life (QoL). The most frequently reported symptom in patients with paroxysmal nocturnal hemoglobinuria (PNH), a disease characterized by complement mediated hemolysis and chronic anemia, is “fatigue”. |
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