Background:The relationship between chronotypes and sleeping problems is not clear. The objective of the study was to identify the relative occurrence of chronotypes among college students and to explore adult psychological morbidity and childhood sleeping problems across chronotypes.Materials and Methods:One hundred and fifty undergraduate medical students were assigned into different chronotypes by Morningness–Eveningness Questionnaire and they were further assessed using Self-Reporting Questionnaire, Parasomnia Questionnaire (adapted from the Adult Sleep Disorders Questionnaire), and Pittsburgh Sleep Quality Index.Results:Intermediate chronotype was the most common, seen in 87 (58%) students, followed by evening type in 34 (22.7%). Evening types have more difficulties in making a decision, becoming exhausted more easily and feeling worthless than other chronotypes. Evening-oriented students showed a significantly higher frequency of initial insomnia and poorer overall sleep quality than the other groups. The current bedwetting was more in evening types; there was no difference in any other current and childhood parasomnias.Conclusions:Evening chronotypes had greater difficulty in decision-making, and they were more vulnerable to feel worthless. No significant association was found between childhood parasomnias and chronotypes except persistent bedwetting during adulthood in evening types.

Multiple primary malignancies especially in the head and neck region is no longer a rare occurrence and the prevalence is increasing. They were described as synchronous when the malignancies present within 6 months of another or metachronous tumors if the subsequent malignancy presents 6 months later. Many etiologies had been hypothesised including similar carcinogens exposure, genetic susceptibility and mutation, immunodeficiency or treatment of the index tumor. Among the hypotheses, the most accepted theory was field cancerisation in which the occurrence of multiple primaries in the aerodigestive tract was due to persistent exposure of similar carcinogens through inhalation or oral intake . However the co-incidence of thyroid and aerodigestive malignancies is relatively low. Hereby we would like to report a case of a 74 years old lady with known esophageal squamous cell carcinoma presented with metachronous laryngeal squamous cell carcinoma and papillary micro carcinoma of thyroid.

Tracheo-Oesophageal Puncture (TEP) with voice prosthesis insertion is considered as a gold standard among various voice rehabilitation procedures in laryngectomized patients. It is easily reversible with a high success rate, and the speech, which closely resembles laryngeal speech, develops faster than esophageal speech. However the prosthesis has to be cleaned regularly to ensure proper function as well as longevity of the voice prosthesis valve system. There are not many incidents of the voice prosthesis cleaning brush reported, as the cleaning brush is made to be durable and able to withstand repetitive usage. Hereby we describe an unusual case of a laryngectomized patient who had aspirated a broken tip of a cleaning brush while cleaning his voice prosthesis. The delay in removal of the aspirated foreign body due to technical diffi culty had led to lung collapse subjecting the patient to partial lobectomy. We would like to highlight several aspects in this case report, fi rstly patients should be counselled regarding the proper techniques to clean the voice prosthesis and they should be vigilant during the cleaning process to prevent aspiration in case of accidental broken of cleaning brush. Secondly the incident should be reported to the manufacturer so that the durability of the cleaning brush is reviewed and improvised. Lastly, prompt management of foreign body aspiration should be implied to prevent complications.