Vocal cord paralysis: what matters between idiopathic and nonidiopathic cases?

Objective: To evaluate the clinical and demographic characteristics of patients with idiopathic and non-idiopathic vocal cord paralysis [VCP]

Study Design: Descriptive cross sectional study

Place and Duration of Study: Department of ENT Combined Military Hospital Quetta and Rawalpindi, from 10 Dec 2012 to 31 Dec 2015

Material and Methods: The study was a descriptive cross sectional study. The study was conducted after approval by the ethical committee. Patients with fixed vocal cords due to some growth of glottic region were enrolled. All the patients presenting with hoarseness of voice in ENT outpatient department CMH Quetta and Rawalpindi undergoing indirect laryngoscopy and the patients with vocal cord paralysis were selected. Informed written consent was taken and gender, age, name, hospital record number, address and phone number of each individual was noted. Every patient was evaluated by detailed history and thorough clinical examination. Patients were not investigated further if cause were revealed after some investigation. Follow-up of patients was done regularly in ENT OPD. CT scans/US neck was done by radiologist and FNAC/biopsy was reported by histopathologist. Data collected were recorded on proforma

Results: In our study, out of 245 cases, 47.76% [n=117] were 16-40 years old and 52.24% [n=128] were 41-80 years, mean +/- SD was calculated as 41.23 +/- 11.25 years, 45.71% [n=112] male and 54.29% [n=133] were females. Frequency of causes of vocal cord paralysis was recorded as 15.92% [n=39] for idiopathic, 46.53% [n=114] had iatrogenic, 33.06% [n=81] had malignant neoplasm while 4.49% [n=11] had radiation

Conclusion: Vocal cord paralysis is a common clinical condition with substantial morbidity. Awareness on the clinical characteristics and identification of the underlying etiology are keystones for foreseeing complications and determining the required therapeutic modality

Effect of hyosine butylbromide on first stage of labour in term pregnancy

Objective: To determine the effect of hyosine butyl bromide on mean duration of first stage of labor in term pregnancy by comparing with control group

Study Design: Randomized, double-blind, controlled trial

Place and Duration of Study: Department of obstetrics and gynecology CMH Rawalpindi, from Oct 2012 to Sep 2013

Material and Methods: This was a randomized, double-blind, controlled trial, conducted at department of Gynecology and Obstetrics Combined Military Hospital [CMH] Rawalpindi. Total patients included in the study were 108. Patients were distributed in two groups on the basis of drug given to them. Group-A was labeled as drug Hyoscine Butyl Bromide [HBB] and Group-B was labeled as placebo. Patients selection was done by using a pre defined inclusion and exclusion criteria. Women were admitted with spontaneous and active labour [4cm or more cervical dilation with regular uterine contraction] between 37 to 40 weeks of gestation, with singleton pregnancy, vertex presentation and intact membrane. Laboring mothers were monitored in bed till full dilatation of cervix. The collected data was endorsed on patient's performa. Data entry and analysis was done by using SPSS 12 and analyzed accordingly to the statistical plan

Results: Mean age of patients in group A was 25.85 +/- 3.85 and in group B was 28.07 +/- 4.71 years. Mean gestational age in Group-A and group- B was 38.67 +/- 1.06 and 38.33 +/- 1.09 weeks. Mean duration of first stage of labor in Group-A was 178.98 +/- 92.44 and in group-B was 214.74 +/- 147.44 minutes. According to p-value mean duration of first stage of labor in both groups was statistically same. i.e. [p-value= 0.135]

Conclusion: Use of hyoscine butylbromide allows reduction in the mean duration of first stage of labour as compared to the control group. It not only minimizes the possibility of hastened delivery but also its use can prevent prolonged labour

Thyrotoxicosis with primary presentation as dysphagia: a rare manifestation.

Thyrotoxicosis refers to the clinical manifestations associated with elevated serum levels of T4 or T3 in an individual. Dysphagia is a common problem but a rare manifestation of hyperthyroidism. Dysphagia is an uncommon manifestation of thyrotoxic myopathy. Reports have been sparse and its incidence is not clear. In our case report patient presented who with dysphagia and weight loss and investigation revealed hyperthyroidism. Patient dysphagia subsequently resolved after receiving treatment with methimazole and beta-blockers. This case report the need to include thyrotoxicosis in the differential diagnosis of an otherwise unexplained case of dysphagia.

To study prevalence of incipient iron deficiency in primary hypothyroidism.

Background: Hypothyroidism, affects around 1% of general population. Anemia in association with hypothyroidism has been studied since 1881. Iron deficiency has multiple adverse effects on thyroid metabolism. It decreases circulating thyroid hormone concentration, blunts thyrotrophic response to TRH, decreases serum T3. Objective of current study was to find prevalence of iron deficiency in primary hypothyroid. Methods: In our study 70 patients were selected, out of which 50 were females and 20 were males, who were suffering from hypothyroidism. Iron deficiency in the study group was confirmed at baseline using multiple iron status indicators (serum ferritin, serum iron, TIBC & percentage Saturation). These patients were between age group 18-65 years. Results: In our study only 14 patients (20%) manifested with anemia (which was defined as Hb<12gm/dl), where as the prevalence of iron deficiency (with or without anemia) was 34.2%, in which 28.5% were females and 5.70% were males, thus showing that prevalence of iron deficiency (with or without anemia) can be higher than iron deficiency anemia itself, which is supported by literature. Conclusion: Iron deficiency was present in a significant portion of patients with primary hypothyroidism. It also concluded that frequency of iron deficiency (with or without anemia) was higher than iron deficiency anemia.