Aerodynamic measurement-Maximum Phonation Time in young patients with benign vocal fold lesions and with normal voice: a comparative analysis

Background: Clinicians use Maximum Phonatory Time (MPT) as one of tool to verify the glottic efficiency objectively. Impairment of vocal fold mucosa integrity due to lesions results in alteration in MPT. The aim of current study was to compare MPT in young adults with vocal fold lesions and age and sex matched normal subjects.Methods: This study was conducted in the Department of ENT & Head and Neck surgery of Government Medical College Srinagar on 41 adult patients with benign vocal fold lesions and 41 healthy subjects matched for age and sex for a period of 2 years from April 2017- April 2019. The aerodynamic measure was measured as maximum phonation time in seconds and the results were analysed statistically. Both patients and controls were explained the procedure. Results: Mean MPT in seconds in males with vocal fold lesion was 14.42 seconds with SD of 5.62 seconds and in females was 10.81 seconds with SD of 3.44 seconds. Coefficients of variation (CV) was 0.35 and 0.21 respectively. In control group it was 18.15 seconds with SD of 5.88 in males and in females it was 15.72 seconds with a SD of 6.21. Mean difference between patients and controls in males and females was 3.8 and 4.9 respectively. P-Value in males and females was 0.053 and 0.003 respectively.Conclusion: Vocal cord lesions decrease MPT in both sexes even in young adults.

Residency educational climate in a pakistani postgraduate medical institute

Objective: To determine the postgraduate residents perception of their educational environment. Study Design: Descriptive cross-sectional study

Place and Duration of Study: Armed Forces Post Graduate Medical Institute [AFPGMI] Rawalpindi, in October 2014. The postgraduate training [residency] is being imparted in two military teaching hospitals and nine armed forces clinical institutes affiliated with AFPGMI

Material and Methods: Fifty-six residents enrolled with AFPGMI in various postgraduate training programs were included in this study. Twenty-nine residents were from medical and allied [general medicine, psychiatry, dermatology, rehabilitation medicine, military medicine] and twenty-seven from surgical and allied [general surgery, gynecology, ophthalmology, ENT, pathology, radiology] disciplines. An established instrument Dutch Residency Educational Climate Test [D-RECT] was administered to determine residents' perspective on their learning environment. The survey form of each resident was analyzed to determine overall perception of educational climate addition to detailed analyses of perceptions regarding supervision, coaching and assessment, feedback, teamwork, peer collaboration, professional relation between consultants, adaptation of work to residents' competence, role of consultants, formal education, role of specialty tutor/supervisor and patient sign-out. Descriptive and inferential statistics were applied on the data to draw interpretations using SPSS Version 20.0

Results: Overall 64% of residents had positive perception of learning environment. Except 'feedback that was perceived more negative [50%] than positive [32%], other elements perceived positively but having notable negative perception [mean score of less than 3.6 on Likert scale] included work adaptation to residents' competence [25%], coaching and assessment [23%], role of specialty tutor/supervisor [23%] and patients' sign-out [21%]

Educational climate perception by residents in [medical and allied] versus [surgical and allied] disciplines did not reveal any statistically significant difference [p-value > 0.05]

Conclusion: The study highlights an overall positive learning climate at Armed Forces Post Graduate Medical Institute, but finds a need to provide regular structured feedback to residents during their training. To accomplish this end, periodic use of workplace based assessment tools is suggested

Clinico-epidemiological study of sexually transmitted infections in a tertiary centre at Aligarh

Objective: To highlight the pattern of sexually transmitted infections [STIs] and the profile of patients with HIV infection in STI patients as seen at our hospital

Methods: A retrospective analysis of records of patients attending the STD clinic during the period of September 2013 till August 2014 was done

Results: A total of 90 patients attended the STD clinic, out of which 63 were males and 27 were females with the male: female ratio of 2.3: 1. Maximum patients belonged to the age group of 20-30 years. Herpes genitalis was the most common ulcerative STI, 19 [21.1%] out of 90 patients had herpes genitalis. Genital warts were the most common non-ulcerative STI, 25 [27.8%] out of 90 patients had genital warts. HIV seropositivity was seen in 7 patients

Conclusion: Herpes genitalis was the most common ulcerative STI, while genital warts was the most common nonulcerative STI in our study. The prevalence of HIV among STI clients in India has been on the rise, which was also seen in our study

Alopecia areata: an update

Alopecia areata [AA] is a nonscarring, autoimmune hair loss on the scalp, and/or body. Etiology and pathogenesis are still unknown. The most common site affected is the scalp in the form of solitary or multiple patches of alopecia. Histopathology is characterized by an increased number of telogen follicles and presence of inflammatory lymphocytic infiltrate in the peribulbar region. Corticosteroids are the most popular drugs for the treatment of this disease. This review precisely outlines the etiologic and pathogenic mechanisms, clinical features, diagnosis and management of alopecia areata

Minimally invasive plate osteosynthesis [MIPO] for comminuted fractures of distal tibia

To report experience with minimally invasive plate osteosynthesis [MIPO] for comminuted distal tibia fractures with specific reference to fracture union, complications encountered and functional outcome. Descriptive case series using purposive non-probability convenient sampling. Study was conducted in the Department of Orthopaedic Surgery at Combined Military Hospital Multan and Muzaffarabad from March 2006 to October 2010. Twenty three patients underwent MIPO for comminuted distal tibial fractures. Fractures were classified according to AO system. Open fractures were graded using Gustilo and Anderson classification. A 4.5mm Narrow Dynamic Compression Plate [DCP] was used for fixation in 16 cases whereas 7 fractures were fixed with 4.5mm Narrow Locking Compression Plate [LCP]. Post-operative clinical and radiological assessment was done at monthly interval until radiological union and three monthly thereafter. The minimum follow-up period was eight months with a mean of 18 +/- 4.1 months. Functional outcome was assessed in each case at final follow-up. There were 16 males and 7 females with mean age of 30.3 +/- 9.2 years. Radiological and clinical union was achieved in all cases. Twenty one cases [91.3%] achieved union [primary] at mean of 17.5 +/- 2.6 weeks whereas two cases [8.7%] required augmentation cancellous bone grafting before achieving union [secondary] at mean of 33 +/- 2.8 weeks. Unsatisfactory radiological alignment [Coronal > 5[degree]/ Sagittal > 5[degree]] was observed in one [4.3%] case. There was one [4.3%] case of infection treated successfully with antibiotics. Single screw breakage was seen in 2 cases where conventional DCP had been used for fixation but neither led to loss of position nor affected the outcome adversely. Functional results were "excellent to good" in 91.3% cases and fair in two cases. MIPO may be used successfully for treatment of high-energy peri-articular distal tibial fractures. The approach aims to preserve bone biology and minimize surgical soft tissue trauma. The technique certainly provides an answer to treat this challenging group of fractures.

Free non-vascularized fibular graft in treatment of bone defects

To determine the usefulness of free non-vascularized fibular graft in the treatment of nonunions and bone defects. Design: Prospective descriptive study. Place and Duration of Study: The study was conducted at Combined Military Hospital/Military Hospital Rawalpindi from September 1997 to June 2000. Subjects and A total of twenty-one cases where free non-vascularized fibular graft was used were included in the study. The indications were varied and included nonunited femoral neck fractures, post-infective and post-traumatic bone defects and bone tumour/cyst resection defects. Overall union was achieved in 76.2% of cases [85.7% in upper limb and 71.4% in lower limb]. Stress fracture occurred in two [9.5%] cases in lower limb. Infection was the cause in all five [23.8%] cases with failure of union and graft resorption. Use of free non-vascularized bone graft in selected patients with suitable recipient bed is a simple and costeffective procedure still valid to bridge bone defects in our setup