Incidence of Primary Punctal Stenosis in Adult Patients with Epiphora

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Sheriff Elwan ◽  
Ossama Tarek Nada ◽  
Eman Mohamed Salah Eldeen Madbouli
Keyword(s):  
Outpatient Clinic ◽  
Adult Patients ◽  
University Hospital ◽  
Slit Lamp ◽  
Convenience Sample ◽  
Grade 5 ◽  
Grade 3 ◽  
Grade One ◽  
Punctal Stenosis

Abstract Background Punctal stenosis is one of the etiologies of epiphora, which is caused by an anatomical narrowing or occlusion of the external opening of the lacrimal canaliculi. Punctal stenosis is graded according to punctal sizes examined under slit-lamp biomicroscopy into grade 0 (could not find papilla and punctum), grade 1: Papilla is covered by a membrane (exudative or true membrane), grade 2: Smaller than normal size but recognizable, grade 3: normal, grade 4: Small slit (<2 mm) and grade 5: Large slit (>2 mm). Objective To assess the incidence of punctal stenosis in adult patients with epiphora attending outpatient’s ophthalmology clinic at Ain Shams University Hospital during the months of January and February 2020. Patients and Methods This is an observational study, conducted at the Ophthalmology Outpatient Clinic, Ophthalmology Department, Ain Shams University, using non-probability (convenience) sample. It included all patients above 18 years old who presented to the Ophthalmology Outpatient Clinic during the months of January and February 2020 with tearing, proved to be epiphora on clinical examination. Results Thirty one patients, out of 1800 patients attending the Outpatient Ophthalmology Clinic during the study period had epiphora with incidence of 1.6 %. Incidence of punctal stenosis was reported to be 68.4%. Other reported causes of epiphora were: Canaliculitis (3.5%), chronic dacrocystitis (5.3%), lacrimal sac mucocele (1.8%) and lower lid laxity (21.1%). Punctal stenosis was more common in females (61.5%) with mean age 58.55 years ± 11.67 SD. Punctal stenosis usually presented as bilateral (93.3%). Regarding ocular history 41% of cases were on topical anti glaucoma treatments. Most patients were medically free (54%). Conclusion Incidence of epiphora was 1.6% out of patients attending ASU Ophthalmology Outpatient Clinic. Punctal stenosis incidence was reported to be 68.4%. Most of the cases were females, above 63 years, grade one was the most common, with significant association with the long term use of topical anti-glaucoma medications.

Three-snip punctoplasty versus perforated plugs for management of lacrimal punctal stenosis

2020 ◽  
pp. 112067212092503
Author(s):  
Salma S Tamer ◽  
Ahmed A Abdelghany ◽  
Ahmed MK Elshafei ◽  
Raafat Mohyeldeen Abdelrahman Abdallah
Keyword(s):  
University Hospital ◽  
Punctal Plugs ◽  
Group A ◽  
Fluorescein Dye ◽  
The Mean ◽  
Grade 3 ◽  
Tear Meniscus Height ◽  
Group B ◽  
Complete History ◽  
Punctal Stenosis

Purpose To compare rectangular three-snip punctoplasty and polyvinylpyrrolidone-coated perforated punctal plugs for treatment of acquired lacrimal punctal stenosis. Patients and methods In a prospective comparative non-randomized interventional study, 80 eyes with acquired lacrimal punctal stenosis were classified into two groups. Group A was treated by insertion of polyvinylpyrrolidone-coated perforated punctal plugs (FCI ophthalmics)™ and Group B was treated by rectangular three-snip punctoplasty. The study was done in Minia University Hospital between January 2018 and April 2019. Exclusion criteria included allergic punctal stenosis, lid malposition, and lacrimal obstruction distal to the punctum. All patients were subjected to complete history taking, slit lamp examination of tear meniscus height, fluorescein dye disappearance test, punctal position, shape, size, grading of stenosis, and grading of epiphora. Results The mean age of the patients was 43.85 ± 14.93 years. They were 30 females and 10 males. Eepiphora Grade 3 or 4, improved postoperatively to Grade 0 or 1 in 97.5% of eyes in Group A versus 55% of eyes in Group B. All eyes (100%) in Group A versus 21 eyes (52.5%) in Group B improved regarding fluorescein dye disappearance test grade ( p < 0.001). Restenosis did not occur after plug removal, while it occurred in 10% of eyes subjected to three-snip punctoplasty. Conclusion Perforated punctal plugs and three-snip punctoplasty are safe and effective in treatment of punctal stenosis. However, perforated plugs are less invasive, better tolerated, and have more stable results compared to three-snip punctoplasty.

scholarly journals The Socio-Demographic and Clinical Profiles of Adult ADHD Patients in a University Hospital in Oman

2021 ◽  
Author(s):  
Hassan Mirza ◽  
Salim Al-Huseini ◽  
Shamsa Al-Jamoodi ◽  
Naser Al-Balushi ◽  
Amira Al-Hosni ◽  
...  
Keyword(s):  
Outpatient Clinic ◽  
Adult Adhd ◽  
Scientific Evidence ◽  
Tertiary Care ◽  
Adult Patients ◽  
University Hospital ◽  
Care Hospital ◽  
Co Morbidity ◽  
Inattentive Subtype ◽  
Clinical Profiles

Objectives: Although typically considered a condition affecting children, scientific evidence has shown that 30–50% of those diagnosed with ADHD in childhood continue to suffer from this condition after the age of 18. This study sought to address the gap in the literature, and to describe the socio-demographic and clinical characteristics of ADHD patients in a sample of adult patients attending an outpatient clinic at a tertiary care hospital in Oman, and to evaluate their association with the different subtypes of the disorder. Methods: Data from adult patients with ADHD from the outpatient clinic at Sultan Qaboos University Hospital (SQUH), Muscat, Oman, were retrospectively collected from medical records from January 2018 to April 2020. Socio-demographic characteristics, clinical profiles and psychiatric co morbidities were examined. Results: This study included 100 adults who fulfilled the standard diagnosis of ADHD, with 54% (n=54), and 46% (n=46) from the inattentive and combined subtypes, respectively. It was found that ADHD was more prevalent among males (64.0%) compared to females (36%), with the inattentive subtype being more predominant among females. The ADHD patients with the inattentive subtype were associated with co-morbid substance use disorders (OR=11.29, P = 0.049), personality disorders (OR=7.96, P = 0.017), and major depressive disorder (OR=15.94, P = 0.002) compared to patients with the predominantly combined subtype. Conclusion: This study from Oman echoes the findings from the current literature, that adult patients with ADHD commonly have co-morbid psychiatric disorders, leading to significant functional impairment. Psychiatric co-morbidities must be identified and urgently treated, to allow for better clinical and functional outcomes in adult patients with ADHD. Keywords: ADHD, co-morbidity, hyperactivity, Oman, psychiatry

scholarly journals Long-term toxicity and survival outcomes after stereotactic ablative radiotherapy for patients with centrally located thoracic tumors

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Banu Atalar ◽  
Teuta Zoto Mustafayev ◽  
Terence T. Sio ◽  
Bilgehan Sahin ◽  
Gorkem Gungor ◽  
...  
Keyword(s):  
Complete Response ◽  
Lung Tumors ◽  
Tracheobronchial Tree ◽  
Stereotactic Ablative Radiotherapy ◽  
Factors Affecting ◽  
Grade 5 ◽  
Thoracic Cancer ◽  
Grade 3

AbstractBackgroundStereotactic ablative radiotherapy (SABR) is effective for thoracic cancer and metastases; however, adverse effects are greater for central tumors. We evaluated factors affecting outcomes and toxicities after SABR for patients with primary lung and oligometastatic tumors.Patients and methodsWe retrospectively identified consecutive patients with centrally located lung tumors that were treated at our hospital from 2009-2016. The effects of patient, disease, and treatment-related parameters on local control (LC), overall survival (OS), and toxicity-free survival (TFS) were evaluated with multivariate analyses.ResultsAmong 65 consecutive patients identified with 70 centrally located tumors, 20 tumors (28%) were reirradiated. Median (range) total dose for all tumors was 55 (30–60) Gy in 5 (3–10) fractions. Radiographic complete response was obtained in 43 lesions (61%). None of the analyzed factors were correlated with complete response. After a median follow-up of 57 (95% CI, 48–65) months, 10 tumors (14%) relapsed and 37 patients (57%) died; the actuarial 2- and 5-year OS rates were 52% and 28%, respectively. Median OS was significantly lower in patients with grade 3 or higher toxicity vs. lower toxicity (5 vs. 39 months; P < 0.001). Among 17 severe toxicities, 5 were grade 5, and 3 of them were reirradiated to the same field. Grade 3 to 5 TFS was lower with vs. without reirradiation (2-year TFS, 63% vs. 96%; P = 0.02).ConclusionsOur study showed that modern SABR is effective for central lung tumors, and toxicities are acceptable. SABR for reirradiated central lung lesions and possibly for lesions abutting the tracheobronchial tree may result in higher risk of serious toxicities.

scholarly journals Safety and Efficacy of Peptide-Receptor Radionuclide Therapy in Elderly Neuroendocrine Tumor Patients

Cancers ◽  
2021 ◽  
Vol 13 (24) ◽  
pp. 6290
Author(s):  
Deborah Theiler ◽  
Marco Cattaneo ◽  
Lawrence O. Dierickx ◽  
Peter Igaz ◽  
Simona Grozinsky-Glasberg ◽  
...  
Keyword(s):  
Radionuclide Therapy ◽  
Somatostatin Receptor ◽  
Peptide Receptor Radionuclide Therapy ◽  
University Hospital ◽  
Secondary Outcome ◽  
Old Patients ◽  
Safety And Efficacy ◽  
Peptide Receptor ◽  
Grade 3

Peptide receptor radionuclide therapy (PRRT) is a well-established treatment in somatostatin receptor-expressing neuroendocrine tumours (NETs). The safety and efficacy of PRRT in >79 years old patients (EP) have not been systematically investigated. All patients with inoperable/metastatic/progressive G1/G2 NET, >79 years (EP), treated with PRRT at the University Hospital of Basel between 2006 and 2018, were enrolled in this retrospective matched cohort study. Each patient was manually matched with ≥1 younger patient (YP = 60–70 years). The primary endpoint was toxicity. Toxicity (subacute, long-term) was graded according to the criteria for adverse events (CTCAE) v5.0. All toxicity grades ≥ 3, or whose delta (Δ) to baseline were ≥2, were considered significant. The odds ratio (OR) for developing toxicity was tested for non-inferiority of EP vs. YP. Clinical response to PRRT and overall survival (OS) were assessed as secondary outcome measures. Forty-eight EP and 68 YP were enrolled. Both cohorts were balanced regarding median time since diagnosis, tumour location, grading, treatment scheme, and baseline biochemical parameters, except for eGFR (EP: 61 ± 16 vs. YP: 78 ± 19; mL/min/1.73 m2). Twenty-two grade ≥ 3 or Δ ≥ 2 subacute hematotoxicities occurred in 10 EP (10.3% of cycles) and 37 in 19 YP (11.6% of cycles; p = NS). Long-term grade ≥ 3 renal toxicity occurred in 7 EP and 2 YP (p = NS). The median OS was 3.4 years (EP) vs. 6.0 years (YP), HR: 1.50 [0.75, 2.98], p = NS. PRRT is a valid therapeutic option in elderly NET patients with similar toxicity and non-inferior survival compared to matched younger patients.

INDUCE-1: Report on safety run-in cohorts combining Inducible T-cell co-stimulatory receptor (ICOS) agonist GSK3359609 (GSK609) with platinum+5-FU chemotherapy (5-FU/plat), with or without pembrolizumab (PE), for the treatment of advanced solid tumors.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 6544-6544
Author(s):  
Erminia Massarelli ◽  
Ani Sarkis Balmanoukian ◽  
Maria Vieito ◽  
Christophe Le Tourneau ◽  
Tatiana Hernandez-Guerrero ◽  
...  
Keyword(s):  
Solid Tumors ◽  
Safety Profile ◽  
Kidney Injury ◽  
Advanced Solid Tumors ◽  
Grade 5 ◽  
Grade 3 ◽  
Anti Tumor Activity ◽  
Additional Safety

6544 Background: The KEYNOTE-048 study (Burtness, at al. Lancet 2019;394:1915–28) led to approval of PE in combination with 5-FU/plat for first-line (1L) treatment of head and neck squamous cell carcinoma (HNSCC). The Phase I INDUCE-1 study (NCT02723955) has shown that GSK609±PE has a manageable safety profile in patients (pts) with advanced solid tumors (Hansen, at al. Annals of Oncology 2018;29[suppl_8]:viii404) and that GSK609 combined with PE has anti-tumor activity in pts with anti-PD-1/L1-naïve HNSCC (Rischin, et al. Annals of Oncol 2019;30[Supplement_5]:v454–5). To evaluate the safety of GSK609±PE in combination with 5-FU/plat, we initiated additional safety cohorts. Methods: Pts eligible for GSK609+5-FU/plat had a diagnosis of advanced selected solid tumors and ≤5 prior lines of systemic therapy. Pts eligible for GSK609+PE+5-FU/plat had a diagnosis of recurrent or metastatic 1L HNSCC deemed incurable by local therapies. 5-FU/plat was administered every 3 weeks (Q3W) for 4-6 cycles (Burtness, at al. Lancet 2019;394:1915–28); GSK609 24 or 80 mg ±PE 200 mg were administered Q3W for up to 2 years/35 cycles or until disease progression or unacceptable toxicity. Results: Twenty-nine pts were enrolled in the 5-FU/plat safety cohorts: 10 pts in the GSK609+5-FU/plat cohort and 19 pts in the GSK609+PE+5-FU/plat cohort. With GSK609+5-FU/plat, 9/10 (90%) pts experienced ≥ 1 adverse event (AE). Of 32 AEs of any grade, 9 were Grade ≥3 and 3 were serious AEs (SAEs). Two of the 3 SAEs were related to study treatment (oral mucositis and febrile pancytopenia). With GSK609+PE+5-FU/plat, 18/19 (94.7%) pts experienced ≥ 1 AE. Of 119 AEs of any grade, 24 were Grade ≥3 and 15 were SAEs. Of the 15 SAEs, 11 were related to study treatment (febrile neutropenia [n=4], colitis [n=2], diarrhea [n=1], vomiting [n=1], acute kidney injury [n=1], cardiac chest pain [n=1] and lung infection [n=1]). For all cohorts, no Grade 5 AEs were observed. For 10 pts evaluable for confirmed best overall response in all cohorts, 2 pts had partial response, 6 pts had stable disease and 2 pts were nonevaluable. No difference in GSK609 exposure was observed relative to GSK609 monotherapy. Conclusions: The safety profile of GSK609 in combination with 5-FU/plat±PE is manageable. Most AEs were Grades 1 or 2 and consistent with PE and chemotherapy toxicities. Continued follow-up to investigate long-term safety and efficacy of this combination is warranted. Clinical trial information: NCT02723955 .

Pembrolizumab monotherapy for patients with advanced MSI-H colorectal cancer: Longer-term follow-up of the phase II, KEYNOTE-164 study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4032-4032 ◽  
Author(s):  
Luis A. Diaz ◽  
Dung T. Le ◽  
Tae Won Kim ◽  
Eric Van Cutsem ◽  
Ravit Geva ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Adverse Events ◽  
Antitumor Immunity ◽  
Best Response ◽  
Grade 5 ◽  
Independent Review ◽  
Secondary Endpoints ◽  
Grade 3

4032 Background: Pembrolizumab provides effective antitumor immunity and durable responses in patients (pts) with advanced, colorectal cancer (CRC) with microsatellite instability-high (MSI-H) tumors. We present data on antitumor immunity with pembrolizumab in pts from the phase 2, KEYNOTE-164 study who had approximately 3 years of follow-up, and in pts re-treated after disease progression. Methods: KEYNOTE-164 enrolled pts with metastatic MSI-H CRC, MSI-H status confirmed locally by IHC or PCR, and ≥2 (cohort A) or ≥1 (cohort B) prior lines of therapy (fluoropyrimidine, oxaliplatin, irinotecan, or anti VEGF/EGFR). Eligible pts received pembrolizumab 200 mg Q3W for 2y (35 administrations) or until progression, unacceptable toxicity, or withdrawal. Pts who stopped pembro due to a confirmed CR or after completing 2y of treatment and who progressed after stopping were eligible for re-treatment with up to 17 administrations in the second-course phase, at investigator discretion. Tumor response was assessed Q9W per RECIST v1.1 by independent review. The primary endpoint was ORR. Secondary endpoints included DOR, PFS, OS, and safety. The data cutoff date was Sep 9, 2019. Results: At data cutoff, the median follow-up was 31.4 mo (range, 0.2-47.8) for 61 pts in cohort A and 36.1 mo (0.1-39.3) for 63 pts in cohort B. ORR was 32.8% (3CR, 17PR; 95% CI% 21.3-46.0) for cohort A and 34.9% (8CR, 14PR; 95% CI 23.3-48.0) in cohort B. Median DOR was not reached (NR [range, 6.2-41.3+]) and not reached (range, 3.9+ to 37.1+), respectively. Fifteen pts in cohort A and 17 in cohort B had ongoing responses at data cutoff. Median PFS was 2.3 mo (95% CI 2.1-8.1) with 3-yr PFS rate of 31% in cohort A and was 4.1 mo (2.1-18.9) with 3-yr PFS rate of 34% in cohort B. Median OS was 31.4 mo (21.4-NR) with 3-yr OS rate of 49% in cohort A and was not reached (19.2-NR) with 3-yr OS rate of 52% in cohort B. Nine pts (6 in cohort A, 3 in cohort B) had a second course of treatment. The best response in second course was PR in 1 patient each in cohort A and B. Grade 3-4 drug-related adverse events occurred in 10 (16%) pts in cohort A and 8 (13%) pts in cohort B. No grade 5 drug-related events occurred. Conclusions: After approximately 3 y of follow-up, pembrolizumab continues to provide effective long-term antitumor immunity with durable responses, with small numbers of drug-related adverse events and no drug-related deaths in pts with advanced, MSI-H CRC. Clinical trial information: NCT02460198 .

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