Nasal packing with ventilated nasal packs; a comparison with traditional vaseline nasal pack

Objective: To compare the benefits of ventilated nasal packing with traditional vaseline guaze nasal packing

Study Design: Randomized controlled trial

Place and Duration of Study: This study was conducted at CMH Multan, from Jun 2014 to Dec 2014

Material and Methods: In this study, sample size of 80 patients was calculated using WHO calculator. Patients were divided in two groups using lottery method endotracheal tube and piece of surgical glove filled with ribbon guaze was utilized for fabricated ventilated nasal pack and compared with traditional nasal packs. Nasal obstruction and sleep disturbance were studied at eight hours and twenty-four hours following surgery using visual analog scale

Results: Mean nasal obstruction with ventilated nasal pack was 45.62 +/- 6.17 and with Vaseline nasal pack was 77.67 +/- 4.85 which was statistically significant [p=0.001] in both the groups. Mean sleep disturbance in both the groups was 46.32 +/- 5.23 and 68.75 +/- 2.70 respectively which was statistically significant [p=0.001] in both the groups

Conclusion: Patients with ventilated nasal packs were found to have better tolerance to nasal packs due to less nasal obstruction and sleep disturbance

case of mucocutaneous leishmaniasis from Interior Sindh

A case of mucocutaneous leishmaniasis of a 10 year-old-boy from Chachro district of interior Sind is presented here who presented with a nonhealing mucocutaneous ulcer of 3 years duration

Comparison of locally made phonating device versus oesophageal speech in postlaryngectomy speech rehabilitation

To compare the effectiveness of locally made phonating device with oesophageal speech as a communication method in a laryngectomized patient. Randomized Controlled Trial. Combined Military hospital Lahore from January 2004 to July 2007. Twenty five patients who had undergone total laryngectomy were divided in two groups by random sampling. 13 patients were placed in experimental group and provided with a locally made phonating device El [Electro-larynx, 'BM Talk'] and speech training with this device started between 20th to 30th post-operative day. The results were compared to a Control Group consisting of 12 laryngectomized patients who were provided instruction and training on oesophageal speech for communication. Speech assessment was made at the end of 2nd, 4th and 6th month post-operatively in both the groups. Assessment parameters were defined according to the patient's ability to communicate ten predetermined sentences of Urdu and Punjabi to a team of three speech assessors on each speech assessment day. Speech communication score was fixed at 100 if all the spoken sentences were fully understood by all the three assessors irrespective of character of speech, while it was 0 if none of the sentence spoken could be understood by any of the three assessors. In between the two were different percentages of speech communication scores depending on the number of sentences understood by the speech assessors. The character of voice was assessed by Visual Analogue Score where variation between robotic and normal speech character were divided into ten grades from 1 to 10. At the end of six months, speech communication score was 76.62 with SD 17.29 for EL [Electro-Larynx]; while for control group [oesophageal speech] it was 34.17 with standard deviation of 8.63. Those score was compared by using t test and was highly significant i.e. <0.001 in favor of EL. The character of voice was closer to normal in case of oesophageal speech compared to EL where it was closer to robotic. Locally made EL [Electro-larynx] 'BM Talk' is a useful device for speech rehabilitation in laryngectomised patient. It has added advantage of local availability and cost effectiveness. The character of voice may be robotic and monotonous, nevertheless full sentence can be communicated with relative ease to the listener, which is more important factor in our setup

Efficacy of epley maneuver in BPPV

Benign paroxysmal positional vertigo [BPPV] is one of the most common causes of vertigo. The diagnosis is confirmed by observing a classical response during the Dix-Halipike maneuver. The cause of BPPV is usually idiopathic. There are two popular hypotheses described regarding the pathogenesis i.e. cupulolithiasis and canalithiasis. The clinical course of BPPV is spontaneous recovery in weeks or months. Treatments for BPPV have ranged from no intervention to surgical treatment. The new treatment, "Canal it h-repositioning procedure [CRP]" which was introduced by Epley in 1992 produces a very high rate of success. This treatment has caused interest and has been modified and studied worldwide in recent years. To determine the efficacy of Epley maneuver in BPPV. We recruited 100 patients with a history of positional vertigo and unilateral positional nystagmus on physical examination [Dix-Halipike maneuver]. Patients were randomized to either the Epley [n=50] or a prochlorperazine [n=50]. Measured outcomes included resolution of vertigo and positional nystagmus at follow-up examination. RESULTS: The mean duration of follow-up was 14 days for both groups. In Epley's group resolution of symptoms was reported by 36[72%] of the patients after first visit on single maneuver treatment and by 46 [92%] patients on second visit on repeating maneuver, while 4 patients had minimal symptomatic improvement and were offer other treatment options. While in prochlorperazine group, 11 [22%] patients reported improvement in symptoms on first visit and 17[34%] on second visit and 19 [38%] had improved by 14th day. The Epley's maneuver is safe, economical and effective treatment of benign paroxysmal positional vertigo and this procedure can be performed by general internists on outpatients with this disorder