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

Patterns of nasal trauma during close combat training in military training institutions

Objective: To identify the patterns and optimum management of nasal trauma during close combat training in military training institutions. Study Design: Descriptive study

Place and Duration of Study: The study was conducted in ENT department, Combined Military Hospital Abbottabad from August 2007 to July 2010

Material and Methods: All patients who reported with nasal trauma during the training were included in the study. A total of 200 cases were studied. They were all males and their ages were between 16 to 24 years

Results: The most common presentation of nasal trauma was epistaxis [92.5%] while 7.5% of cases were having no nasal bleed. Nineteen percent cases had external deviation of nasal axis while only 17% revealed inferior turbinate injury after initial treatment. Septal hematoma was present in 15% and was drained immediately in all cases. Nasal bone fracture was present in 36.5%. Anterior nasal packing was sufficient to stop nasal bleed in 80% cases of episatxis while 20% cases of nasal bleed required post nasal packing

Conclusion: The close combat techniques in army training institutions have increased the risk of nasal trauma and many different patterns of this trauma have been identified. Addressing the epistaxis, septal heamatoma and fracture nasal bone reduces the chances of complications

Patient's influx at outpatient medical laboratory [OPML]; Forecasting of patient's influx at Mayo hospital, Lahore using arima model

Uni-variate time series data analysis has been reported in medical literature for prediction the patients volume, emergency overcrowding, stay length in hospital on surgical procedure and bed occupancy in hospital wards, patients influx or patients arrival, moreover to estimate the cost of hospital stay or any medical or surgical procedure. The present study was designed to fit an appropriate uni-variate ARIMA model [Box-Jenkin methodology] to forecast the patient's incoming at OPML, Mayo Hospital, Lahore. Mayo Hospital Lahore, September 2009 to December 2013 were used for fitting the best model. Time series data of male, female and peads patients coming/reporting in OPML, OPD. The appropriate model for male and female data was found as ARIMA [1, 0, 1] and for peads as ARIMA [1, 1, 1] after residuals diagnostic checks. The estimated number of male patients for Month of January2014 is 632 whereas the actual incoming of male patients in the month of January, 2014 was 649, which shows that the estimated model has ability to forecast the number of incoming patients accurately. It is now concluded that the fitted ARIMA model can be used to forecast the patients incoming to OPD Medical Laboratory for future planning and management

Office management of benign paroxysmal positional vertigo with Epley's maneuver

The underlying cause of benign paroxysmal positional vertigo is free floating endolymph particles [otoconia displaced from the otolithic membrane of the utricle] in the posterior semicircular canal. Particle repositioning techniques are one of the effective method of treatment. The purpose of the study was to determine the effectiveness of Epley's maneuver against expectant treatment and to find out if this treatment should be used more frequently than watchful waiting for the treatment of BPPV. This study was carried out at outpatient clinic, departments of ENT, Combined Military hospital Rawalpindi and PNS Shifa hospital Karachi over a three years period from Jan, 2002 to Jan, 2005. Based upon history and Dix-hallpike testing 44 patients diagnosed as benign paroxysmal positional vertigo were collected by convenient sampling from these hospital's outpatient departments and divided by non probability convenience into two groups of 22 each. The control group [group A] was given placebo and the test group [group B] received single treatment by Epley's maneuver in the OPD. The results were analyzed at the end of one and two weeks by history taking and Dix-hallpike testing. Computer software SPSS version 10 was used. At the end of week one 14 [63.63%] patients of group B were symptom free and 2 [9.1%] patients was much better as compared to the control group where only 1 [4.5%] patient reported as symptom free and another 5 [22.7%] reported as much better. At the end of second week out of those treated by Epley's maneuver 16 [72.7%] reported as symptom free and another 2 [9.1%] as much better whereas 4 [18.2%] patients reported no improvement at all. In the control group only 4 [18.2%] patients reported as symptom free, 3 [13.6%] as much better, 6 [27.3%] as better and 9 [40.9%] reported no change in the symptoms. Chi square test was applied and the value of p came out to be 0.001 and 0.002 at week one and week two respectively. It was concluded that Epley's maneuver is a much better form of management for benign paroxysmal positional vertigo