Comparison of altered fractionation schedule with concurrent chemo-radiation for squamous cell carcinoma of head and neck

Background: Aim of the study was to compare the response of altered fractionation schedule with concurrent chemo-radiation in patients with primary and the nodal disease.Methods: Total of 40 patients (20 in each arm) with stage 1- 4 squamous cell carcinoma of the head and neck with a performance status of 0-2 (ECOG) were included in the study. Arm A was altered fractionation schedule where in patients received 6 fractions per week to a total dose of 6600 cGy in 33 fractions. In Arm B, patients received conventional radiotherapy with concurrent chemotherapy three weekly Inj. of cisplatin (100 mg/m2). Patients were evaluated for acute toxicity every week using the Acute Radiation Morbidity Scoring Criteria. The response was assessed after 6 weeks and 12 weeks post treatment using the RECIST criteria. Data was statistically analyzed.Results: Seventeen patients in Arm A and 18 patients in Arm B completed the treatment. At the end of three months, In Arm A, 7 patients had complete response and in Arm B, 9 patients had complete response of the primary (p>0.05).  When the complete nodal response was compared in both the arms, there was no difference (2 vs 4 in Arm A vs Arm B resp.). But there were more partial nodal responders in Arm B (p = 0.016). The acute toxicities were comparable in both the arms.Conclusions: Altered fraction radiotherapy can be used in early lesions with minimal nodal burden but with locally advanced disease or large nodal burden addition of chemotherapy should not be avoided.

HLA antigens in Omani psoriasis vulgaris patients

To determine the frequency of different HLA- antigens in patients with plaque psoriasis in the Omani Arab population. Fifty four Omani patients clinically diagnosed with plaque psoriasis attending the dermatology outpatient clinic in Al-Nahdah Hospital [the tertiary dermatology centre in Oman] were selected for HLA studies. HLA-B52 was present in 20.4% of patients 11/54 and in 5% of controls without psoriasis 5/100. For the association p was <0.004 and the relative risk [RR] was 4.86. Psoriasis does not appear to be associated universally with the same HLA antigens. The association of HLA-B52 with plaque psoriasis in Omani patients compares with the HLA- Cw6, -Bw57 and -DR7 preponderance in most other ethnic groups

Effect of 10 percent phenylephrine eye drops on systemic blood pressure in normotensive and hypertensive patients

A prospective study to evaluate the effect of 10% Phenylephrine eye drops on systemic blood pressure in normotensive and hypertensive patients. The sample comprised of 55 normotensive patients and 34 hypertensive patients were subjected to 10% Phenylephrine eye drops during routine eye examination. No statistically and clinically significant increase in blood pressure after the instillation of 10% Phenylephrine eye drops was seen in 87% of normotensive patients and 76% of hypertensive patients. Mild rise of blood pressure was seen in 11% of normotensive patients and in 15% of the hypertensive patients. Only one patient [3%] had severe rise of blood pressure in the hypertensive group. This study shows that pupillary dilatation with 10% Phenylephrine eye drops did not significantly increase systemic blood pressure in normotensive and hypertensive patients. Although precautions should be taken when used in hypertensive patients

unusual presentation of intraorbital foreign bodies in an eye injury at work place

We report a case of a 27 year old male who presented to us with a badly lacerated upper lid in left eye with proptosis, chemosis and decreased vision associated with traumatic cataract, iridodialysis, vitreous and retrobulbar haemorrhage following a work place injury with paper grinding machine. The diagnosis of an intraorbital foreign body initially evaded us, as clinical examination, plain x-ray and ultrasound of orbit failed to show it

Management of refractory vernal keratoconjunctivitis with supra tarsal triamcinolone injection: our results

Vernal keratoconjunctivitis [VKC] cases are sometimes resistant to conventional treatments. We aimed to assess the efficacy, safety and longevity of the effect of supratarsal injection of intermediate acting steroid triamcinolone acetonide in the management of recalcitrant vernal keratoconjunctivitis. A prospective study comprising of Forty five patients [90 eyes] with severe VKC, and resistant to conventional method of treatments were selected and underwent injection of 0.6 ml triamcinolone acetonide in supratarsal area [in conjunctival side of upper lid] and were followed up for 12 months. Dramatic relief of symptoms [burning, itching, lacrimation and photophobia, tenacious discharge] was seen in all patients, in first few days after the supratarsal injection. Size of the cobble stone papillary hypertrophy in tarsal conjunctiva, gelatinous thickening of conjunctiva at limbus decreased significantly in the first month, but never disappeared completely. The mean period of recurrence of symptoms was 156.6 days [range 13-359 days]. No complication was noticed during the follow up period. All patients tolerated the treatment well. Supra tarsal injection of triamcinolone acetonide is a cheap, effective and safe modality for temporary suppression of clinical signs and symptoms of eyes with recalcitrant vernal keratoconjunctivitis. Rapid and dramatic symptomatic and clinical response and lack of complications suggest that supratarsal injection of triamcinolone acetonide could be a therapeutic approach for refractory vernal keratoconjunctivitis

Intra ocular pressure measurement with Goldmann applanation tonometer without using fluorescein: our results

The purpose of this prospective, double blind study was to evaluate a modified technique of Goldmann applanation tonometry without the use of fluorescein and compare these results when Goldmann applanation tonometry was done with fluorescein in same patients. The intraocular pressure in 86 eyes of 43 patients was measured with and without fluorescein by Goldmann applanation tonometry. Goldmann applanation tonometry without fluorescein underestimated IOP levels by 1 mm Hg. The modified technique of Goldmann applanation tonometry without fluorescein reflects standard Goldmann tonometry with fluorescein after a correction factor of + 1 mm Hg

Safety and efficacy of supra- tarsal injection of triamcinolone in the management of refractory vernal keratoconjunctivitis

We aimed to assess the efficacy, safety and longevity of the effect of supratarsal injection of intermediate acting steroid triamcinolone acetonide in the management of recalcitrant vernal catarrh. In this prospective study 45 patients [90 eyes] with severe Vernal Keratoconjunctivitis [VKC], resistant to conventional method of treatments underwent injection of 0.6 ml triamcinolone acetonide in supratarsal area [in conjunctival side of upper lid]. The effects were monitored and cases were followed for 12 months. Dramatic relief of symptoms [burning, itching, lacrimation and photophobia, ropy discharge] was seen in all patients in first few days after the supratarsal injection. Size of the cobble stone papillary hypertrophy in tarsal conjunctiva and gelatinous thickening of conjunctiva at limbus decreased significantly in the first month but never disappeared completely. Mean period of recurrence of symptoms was 156.6 days [range13-359 days]. All patients tolerated the treatment well and no complication was noticed. Rapid and dramatic symptomatic and clinical response and lack of complications shows that supratarsal injection of triamcinolone acetonide is safe and effective therapeutic approach for refractory VKC

Safety, efficacy and success with supero-temporal free conjunctivo-limbal autograft in the surgical management of pterygium: Our technique and results

The objective was to study the safety, efficacy and success with supero-temporal free conjunctivo-limbal autograft transplantation in the surgical management of pterygium. Prospective case series where superotemporal free conjunctivo-limbal auto grafting was performed on 24 eyes of 24 patients with vascular progressive pterygium. Pterygium recurrence was considered a surgical failure. Recurrence was defined as fibrovascular tissue crossing the corneoscleral limbus on to the clear cornea in the area of previous pterygium excision. recurrence of pterygium was noted in one out of 24 eyes [4.16%], after a minimum follow up of 6 months to maximum of 25 months [mean 14.6 months]. No major intraoperative or postoperative complications were encountered. In conclusion, superotemporal free conjunctivo-limbal autograft appears to be a safe and effective technique in the surgical management pterygium. The inclusion of limbal tissue in the conjunctival autograft following pterygium excision appears to be essential to ensure low recurrence rate

Bilateral pseudo-papilloedema due to optic nerve head drusen in a young patient

We report a case of 15 year old boy, who was found to have raised bilateral optic nerve heads on routine eye examination. After an initial dilemma of diagnosis, detailed eye examination supported by imaging studies confirmed the diagnosis of bilateral pseudo-papilloedema due to optic nerve head drusen. Parents of the patient were reassured and patient was discharged from eye clinic with the advice of follow up every 6 to 12 months

Gyrate retinal atrophy of choroid and retina: a case report of 3 members in one family

Hyperornithinemia associated with gyrate atrophy of the choroid and retina is a rare, autosomal recessive disorder resulting from a deficiency of the mitochondrial matrix enzyme, ornithine d-aminotransferase [OAT]. Highest rate of gyrate atrophy is reported in Finland. We report for the first time 3 cases [siblings] in one Omani family in the Gulf, presenting with the classical clinical features and biochemical abnormality of this condition. The available forms of treatments which include treatment with pyridoxine, dietary restriction of arginine and supplementation with creatinine andproline, are known to slow the progress of disease process and help to delay the patient s morbidity, but no form of therapy is found to be unequivocally effective