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Duane retraction syndrome (DRS) is a congenital cranial dysinnervation disorder that is characterized by paradoxical lateral rectus muscle innervation of the affected eye by axons meant to innervate the ipsilateral medial rectus muscle, with resultant varying degrees of co-contraction. It is characterized by severe abduction deficiency, variable limitation of adduction, globe retraction with narrowing of the palpebral fissure, and oblique elevation or depression on adduction. A total of 16 patients with unilateral DRS were identified. The mean age was 13 ± 8 years (range: 6 to 28 years). There were 5 males and 11 females. The cohort included 8 patients with DRS type I, 3 patients with DRS type II, 4 patients with DRS type III, and 1 patient with synergistic divergence (DRS type IV). The mean width of the palpebral fissure in primary gaze was 9.95 ± 0.25 mm, increased in abduction to 11.11 ± 1.16 mm, and changed on adduction to 10.03 ± 1.19 mm. The mean reduction in the size of the palpebral fissure on adduction was 11.7 ± 10.2% (range: 0 to 30%). The difference in the palpebral fissure width between adduction and abduction was statistically significant ( = .0018). Of the 16 patients, 8 (50%) showed narrowing of the palpebral fissure of the contralateral eye on adduction compared to abduction of more than 10%. In this case series of unilateral Duane retraction syndrome, there was a common association between widening of the palpebral fissure of the unaffected eye and adduction of the eyes with DRS in DRS types II, III, and IV and DRS type I with upshoot or downshoot. .

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INTRODUCTION: Prognostic scoring systems are increasingly used in cancer care. One of these systems is the Palliative Prognostic Index (PPI) which is based on clinical findings. Few studies validated the PPI in different settings. Our aim was to test the predictive value of the PPI in an acute cancer care setting. METHODS: Prospective study that included patients with advanced cancer admitted to a tertiary cancer center in Kuwait. Patients were divided according to the PPI score into three groups: A (PPI≤3), B (PPI>3- ≤6), and C (>6). RESULTS: The study included 91 hospitalized patients. At the time of PPI assessment, the plan of treatment was best supportive care only in 70 (77%) patients. The majority (80%) of included patients died in-hospital. The in-hospital mortality rate for patients with a PPI>6 was significantly higher than those with ≤6 (93% versus 56%, p<0.001). Using a cutoff point of PPI>6, in-hospital mortality was predicted with a 73% sensitivity, 78% specificity, 93% positive predictive value, and 41% negative predictive value. The median survival was 61 days (95% confidence interval [CI]: 25.8-96.2) for group A, 20 days (95% CI: 4.5-35.5) for group B, and 6 days (95% CI: 4-8) for group C. The difference in survival was highly significant (p<0.001). CONCLUSION: The results suggest that the PPI may be helpful for oncologists in predicting survival and in-hospital mortality of patients with advanced cancer in the acute care setting.