The importance of neck circumference to Thyromental Distance Ratio (NC/TM distance ratio) as a predictor of difficult intubation in obese patients coming for elective surgery under General Anaesthesia in a Tertiary Care Hospital: A Prospective Observational study

BACKGROUND AND OBJECTIVES : This study was done to assess the ability of neck circumference to thyromental distance ratio (NC/TM distance ratio) for predicting difficult intubation among obese patients coming for surgery under general anaesthesia. It enabled us to compare NC/TM distance ratio to routinely used Mallampati score and neck circumference as reliable tests for predicting difficult intubation. This study also identified incidence of difficult intubation among obese individuals. PATIENTS AND METHODS : After approval of institutional review board and ethical committee of Christian Medical College Vellore, 250 obese patients (body mass index greater than or equal to 30) within time frame of September 2014 and March 2015 was assessed preoperatively with the help of performa after obtaining informed consent. Neck circumference / thyromental distance ratio (NC/TM distance ratio) was calculated from the performa. Validated Intubation difficulty score (IDS score) for each obese patient was assessed intra operatively by the anaesthetist who performed intubation . The entire study population were divided into easy and difficult intubation groups based on the IDS score. IDS score greater than or equal to five was considered as difficult intubation. NC/TM distance ratio greater than or equal to five was correlated with IDS score greater than or equal to five. The study assessed the statistical significance of NC/TM distance ratio and difficult intubation by univariate and multivariate logistic regression analysis and its comparison with Mallampati score and neck circumference with respect to sensitivity / specificity/ positive predictive value and negative predictive value. The study also calculated the incidence of difficult intubation among obese patients. RESULTS : Binary univariate logistic regression analysis of predictors of difficult intubation showed age greater than sixty, increased neck circumference, decreased thyromental distance, modified Mallampati test, NC/TMD ratio ≥ 5 as statistically significant variables that were associated with a difficult intubation (p ≤ 0.05). Binary multivariate logistic regression analysis showed only neck circumference (p=0.030 [odd ratio 2.519 (1.094-5.802)] and NC/TMD ratio (p <0.001 [odd ratio 23.680 (10.638-52.713)] independently predicted difficult intubation. However NC/TMD ratio had higher specificity / PPV and larger AUC on an ROC curve compared to neck circumference. The incidence of difficult intubation among obese patients was 20.8 %. INTERPRETATION AND CONCLUSIONS : Among obese patients, NC/TMD ratio can be considered as a better preoperative predictor of difficult intubation and incidence of difficult intubation among them was as high as 20.8 percent

Preexisting fractures and the formation of an iconic American landscape: Tuolumne Meadows, Yosemite National Park, USA

Tuolumne Meadows, in Yosemite National Park (USA), is a large sub-alpine meadow in the Sierra Nevada Mountains. Immediately adjacent to Tuolumne Meadows—and underlain by the same bedrock lithology (Cathedral Peak Granodiorite)—are vertical rock faces that provide exceptional opportunities to climbers. While the presence of a broad meadow suggests bedrock erodibility, the vertical rock walls indicate bedrock durability. We propose that the Tuolumne Meadows’s landscape is the result of variable glacial erosion due to the presence or absence of pre-existing bedrock fractures. The meadows and valleys formed because of concentrated tabular fracture clusters—a distinctive and locally pervasive type of fracturing—that were particularly susceptible to glacial erosion. In contrast, the vertical rock walls consist of sparsely fractured bedrock that was originally bounded by zones of pervasive tabular fracture clusters. Glacial erosion preferentially removed the highly fractured rock, forming prominent ridges in the upland surrounding Tuolumne Meadows. The orientation and spacing of the tabular fracture clusters, relative to ice flow, has exerted a fundamental control on the geomorphology of the area. The erosional variability exhibited by a single lithology indicates that the degree of fracturing can be more important than the host lithology in controlling landscape evolution

The Lifespan Extension Effects of Resveratrol are Conserved in the Honey Bee and May Be Driven by a Mechanism Related to Caloric Restriction

Our interest in healthy aging and in evolutionarily conserved mechanisms of lifespan extension prompted us to investigate whether features of age-related decline in the honey bee could be attenuated with resveratrol. Resveratrol is regarded as a caloric restriction mimetic known to extend lifespan in some but not all model species. The current, prevailing view is that resveratrol works largely by activating signaling pathways. It has also been suggested that resveratrol may act as an antioxidant and confer protection against nervous system impairment and oxidative stress. To test whether honey bee lifespan, learning performance, and food perception could be altered by resveratrol, we supplemented the diets of honey bees and measured lifespan, olfactory learning, and gustatory responsiveness to sucrose. Furthermore, to test the effects of resveratrol under metabolic challenge, we used hyperoxic environments to generate oxidative stress. Under normal oxygen conditions, two resveratrol treatments—30 and 130 μM—lengthened average lifespan in wild-type honey bees by 38% and 33%, respectively. Both resveratrol treatments also lengthened maximum and median lifespan. In contrast, hyperoxic stress abolished the resveratrol life-extension response. Furthermore, resveratrol did not affect learning performance, but did alter gustation. Honey bees that were not fed resveratrol exhibited greater responsiveness to sugar, while those supplemented with resveratrol were less responsive to sugar. We also discovered that individuals fed a high dose of resveratrol—compared to controls—ingested fewer quantities of food under ad libitum feeding conditions

Disseminated Melioidosis Presenting with Community-Acquired Pneumonia: A Presentation Not to be Missed – A Case Report

BACKGROUND: Melioidosis commonly presents with pneumonia and is associated with a high mortality rate. This case report discussed a case of confirmed disseminated melioidosis. The case focused on the chronological clinical progressions of melioidosis which initially masqueraded as community-acquired pneumonia (CAP) and subsequently developed into septicemia. This case report aims to create awareness among the primary care doctors working in a potentially endemic area for melioidosis to be vigilant of its non-specific presentation. CASE REPORT: We report a case of an 80-year-old man who was treated for CAP and presented with unresolved fever and subsequently sepsis. A contrast-enhanced computed tomography showed disseminated lesions of varying sizes in the lungs, liver, spleen, and blood cultures grew Burkholderia pseudomallei. A pigtail drainage catheter was inserted into the liver abscess. In addition, the patient received a 46-day course of intravenous ceftazidime and a 4-month maintenance regime of oral trimethoprim-sulfamethoxazole and oral doxycycline. CONCLUSION: Completion of antimicrobial treatment resulted in resolution of clinical signs and abscesses on imaging

Individually tailored client-focused reports for ubiquitous devices : an experimental analysis

We describe results of a test of a method for tailoring communications based on the recipient&rsquo;s preferred information processing style and dominant motivational attitude. Results indicate that the greater the match between the style of the report and the individual&rsquo;s attributes, the more informed the reader feels about the subject of the report. This research has been conducted as part of a study into methods to design patient-centred medical using diabetic patients as an exemplar of chronic disease. The long term aim is to use reports personalised to the recipient to better inform patients about their disease and strengthen their motivation to follow the treatment plan.<br /

Etiology of Experimental Osteoarthritis: Early Events and Potential Clinical Implications

Introduction Osteoarthritis (OA) is the most common form of arthritis and accounts for 50% of all chronic conditions in the elderly. One in two adults reported a chronic musculoskeletal condition in 2005, twice the rate of reported chronic heart or respiratory conditions(2). In addition, persons aged 45 to 64 account for an increasingly greater proportion of total musculoskeletal disease treatment costs and lost wages, a trend that will continue for the next several decades(3). Surgical treatment culminating in total joint replacement (TJR) remains the most effective therapy for late stage OA. Current treatment of pre-surgical OA consists of pain relieving medications (i.e. NSAIDs), physical therapy, and mechanical supports (i.e. braces, canes, and walkers). Despite the wealth of clinical data on OA, there is currently no cure for the disease. Our previous work in developing potential disease-modifying osteoarthritis drugs (DMOADs) had yielded promising results, showing a decrease in OA cartilage lesion areas and histological grades (Figure 1). Interestingly, we noted that animals treated for only the first 3 weeks demonstrated near 6-week levels of OA reduction. These differences in treatment responsiveness necessitate a better characterization of the specific cellular phases of OA throughout the natural disease progression. The current study was undertaken to clarify this progression of early OA events. Methods OA was induced in the right knees of 10-week-old male 129 S6/SvEv (Taconic) mice via DMM surgery. Mice receiving sham surgery with no destabilization were used as negative controls. Both groups were sacrificed at 4, 8, 12, 16, and 20-day intervals in order to evaluate OA progression. Knees were harvested, processed, and sectioned at 6um intervals. Sections were stained for cartilage composition (Safranin-O) and scored for progression and severity of OA by 3 blinded observers using a 0-5 scale (modified Mankin System)(4). Both ‘mean maximal’ scores (highest scores per knee), and ‘mean summed scores (sum of scores per knee) were generated using this scale. All scores were averaged across observers. Cartilage lesion area, subchondral bone area (sclerosis), and apoptosis (TUNEL method) were measured using a histomorphometric analysis package (ImageJ)(5). Conclusions Measurable osteoarthritic changes in articular cartilage and underlying bone following meniscal injury occur far earlier than previously described. Some changes are clearly degenerative (OA grade, stage & lesion area), however, some changes (subchondral bone thickening) could be regarded as compensatory supportive mechanisms. Cell death (apoptosis) is an acute event following relatively minor changes to knee biomechanics. Our results suggest an opportunity for intervention early on in OA before the resulting articular changes become irreversible. Specifically, consideration of anti-apoptosis based therapies could prevent much of the subsequent structural changes in articular cartilage. Future Directions Apoptosis data suggests pursuing an anti-apoptotic therapy strategy in the DMM model of OA Early bone sclerotic events suggest bone tissue as a target for anti-OA therapy. Translationally, preventing or delaying OA due to soft tissue injuries (e.g., sports injuries) may be possible with early medical treatment of OA proximal to the time of injury. References (1) International Bone and Joint Decade 2000-2010 Organization, 1999. (2) National Center for Health Statistics, National Health Interview Survey, 2005. (3) Kurtz, SM, Lau, E, et al. Future Young Patient Demand for Primary and Revision Joint Replacement: National Projections from 2010 to 2030. Clinical Orthopaedics and Related Research, April 2009. (4) Kurtz, SM, Ong, K, et. al. Projections of Primary and Revision Hip and Knee Arthroplasty in the United States from 2005 to 2030. The Journal of Bone and Joint Surgery, 2007;89:780-5. (5) http://rsbweb.nih.gov/ij