Correlative study between modified mallampati score with Cormack Lehane and POGO scoring

Background: Assessing the difficulty level of the airway for intubation is extremely important in anaesthetic practice to avoid delays in intubation and resulting adverse consequences. Multiple grading systems are used by anaesthesiologists across the globe to aid in classifying the airways, but the number of studies assessing the level of agreement between various methods is scarce. Hence, the current study was conducted with an objective of assessing the level of agreement of Modified Mallampatti score (MMS) with Cormack –Lehane scoring and POGO Scoring. Materials and methods: The study was a cross sectional study, conducted in the Department of Anesthesiology, Government Mohan Kumaramangalam Medical College and Hospital, Salem, Tamil Nadu on adults aged between 18 to 65 years, belonging to ASA grade 1 and 2, scheduled for elective and emergency surgery under general anaesthesia. Patients with apparent restriction of mouth opening due to pain, with fresh facial injuries and dental abnormalities were excluded from the study. The airway of each subject was assessed by the trained anesthetist, in charge of the procedure. The agreement between the different methods of grading was assessed by kappa Statistic along with its standard error and P value. P value < 0.05 was considered as statistically significant. Results: A total of 236 subjects were included in the study. Among the study population, 74 (31.36%) had mallampatti grade I. The number of mallampatti grade II, III, and IV was 140 (59.32%), 21 (8.90%) and 1 (0.42%) respectively. Among the study population, 143 (60.59%) had Cormack Lehane grade I. The number of Cormack Lehane grade II, and III was 84 (35.59%), and 9 (3.81%) respectively. Among the study population, 170 (72.03%) had POGO grade 1. The number of POGO grade 2, 3 and 4 was 42 (17.80%), 15 (6.36%), and 9 (3.81%) respectively. The measure of agreement was very poor between Mallampatti grading with Cormack Lehane grading. (kappa statistics value - K. Murugesan, Arunachalam R, Rajarajan N. Correlative study between modified mallampati score with Cormack Lehane and POGO scoring. IAIM, 2018; 5(4): 119-125. Page 120 0.103, P value 0.032). The measure of agreement was also very poor between Mallampatti grading and POGO grade. (kappa statistics value was 0.105, P value 0.004). The measure of agreement was fair between Cormack Lehane grading and Mallampatti grading. (kappa statistics value was 0.327, P value <0.001). Conclusions: When compared to POGO score, Cormack Lehane grading had shown a better level of agreement with Mallampatti grading. But the level of agreement between any of the two methods was too low to rely on them interchangeably in clinical practice.

Comparison of the roles of serratiopeptidase and dexamethasone in the control of inflammation and trismus following impacted third molar surgery.

Introduction: Surgical extraction of lower 3 rd molar is the most frequent intervention in oral surgery. This procedure is often associated with significant post operative swelling that may have both biological and social implications. Various studies have been done using different anti inflammatory drugs to study their impact on inflammation. Material and Methods: This study was conducted on 110 patients who had undergone surgical removal of mandibular third molar. The subjects were divided into two groups by double blind method. In addition to post operative swelling and pain , trismus was evaluated using two different groups of drugs. Results: One group was administered 1 mg of dexamethazone every 8 hours for 3 days post operatively. The other group was administered 10 mg of serratiopaptidase every 8 hours for 3 days post operatively. Swelling, pain and trismus were assessed on the 1 st , 3 rd , 5 th and 7 th post operative days. The results of the studies were statistically analysed. Conclusion: The results showed dexamethazone was more effective in reduction of swelling and pain in comparison with serratiopaptidase. Both dexamethazone and serratiopaptidase had the same effect on trismus.

The effect of implant design on the stress distribution in a three-unit implant-supported distal cantilever fixed partial denture: A three-dimensional finite-element analysis.

Context: Implant design influences the stress distribution in an implant-supported distal cantilever fixed partial denture and supporting bone tissue. Aim: The purpose of this study was to investigate the effect of implant design on the stress distribution in the framework, implant, and surrounding bone, using a three-dimensional finite-element analysis. Materials and Methods: A three-dimensional finite-element model of a mandibular section of bone with implants placed in the first and second premolar region was created to support a distal cantilever fixed partial denture. A one-piece and two-piece implant and its suprastructure were simulated into wire frame models using Pro engineer (Pro E) program. Four models were created in this study. Results: Comparative analysis of all models showed that the maximum stress overall was in the cervical portion of the secondary abutment. When used in combination, the maximum stress was when the two-piece implant was used as secondary abutment. The one-piece implant showed less stress compared to its counterpart when used as secondary abutment. The maximum stress distribution in the bone was around the neck region of the secondary implant. Conclusion: Within the limitations of this study, it can be concluded that stress distribution is better in a one-piece implant design when compared with the two-piece implant design, with stress concentration being more at the junction of the abutment and the implant fixture in the two-piece implant. When implants are used as abutments (either primary or secondary), irrespective of their position and design, the secondary implant shows the maximum amount of stresses.

Isolation and characterization of bioactive and antibacterial compound from Helianthus annuus linn.

A bioactive compound with antibacterial activity was isolated and purified from the extract of leaves of sunflower, Helianthus annuus. The bioactive compound was characterized using 1H and 13C NMR. The compound induced auxin, gibberellins and cytokinin in Oryza sativa and Phaseolus mungo. It also showed activity against Xanthomonas oryzae pv. oryzae.

Pharyngeal airway changes following mandibular setback surgery.

Treatment of dentofacial deformities with jaw osteotomies has an effect on airway anatomy and therefore mandibular setback surgery has the potential to diminish airway size. The purpose of this study was to evaluate the effect of mandibular setback surgery on airway size. 8 consecutive patients were examined prospectively. All patients underwent mandibular setback surgery. Cephalometric analysis was performed preoperatively and 3 months post operatively with particular attention to pharyngeal airway changes. Pharyngeal airway size decreased considerably in all, patients thus predisposing to development of obstructive sleep apnea. Therefore, large anteroposterior discrepancies should be corrected by combined maxillary and mandibular osteotomies.

Bioremediation of paper and pulp mill effluents.

Pulp and paper mill effluents pollute water, air and soil, causing a major threat to the environment. Several methods have been attempted by various researchers throughout the world for the removal of colour from pulp and paper mill effluents. The biological colour removal process uses several classes of microorganisms--bacteria, algae and fungi--to degrade the polymeric lignin derived chromophoric material. White rot fungi such as Phanerochaete chrysosporium, Corius versicolor, Trametes versicolor etc., are efficient in decolourizing paper and pulp mill effluents. Gliocladium virens, a saprophytic soil fungus decolourised paper and pulp mill effluents by 42% due to the production of hemicellulase, lignin peroxidase, manganese peroxidase and laccase.

Synthetic dye decolourization by white rot fungi.

Synthetic dyes are integral part of many industrial products. The effluents generated from textile dyeing units create major environmental problems and issues both in public and textile units. Industrial wastewater treatment is one of the major problems in the present scenario. Though, the physical and chemical methods offer some solutions to the problems, it is not affordable by the unit operators. Biological degradation is recognized as the most effective method for degrading the dye present in the waste. Research over a period of two decades had provided insight into the various aspects of biological degradation of dyes. It is observed that the white rot fungi have a non-specific enzyme system, which oxidizes the recalcitrant dyes. Detailed and extensive studies have been made and process developed for treatment of dye containing wastewaters by white rot fungi and their enzyme systems. An attempt is made to summarize the detailed research contributions on these lines.

Xylanase production by Ganoderma lucidum on liquid and solid state fermentation.

Ganoderma lucidum, a white rot fungus, was exploited for its potentials to produce xylanase employing shake and solid-state culture conditions. Different culture conditions such as pH, temperature, carbon and nitrogen requirements for its growth and production of xylanase were optimized. The culture media pH 6.0-7.0 and temperatures 30 degrees-35 degrees C significantly promoted the growth as well as xylanase secretion into the media. Xylan and peptone were found to be the suitable carbon and nitrogen sources. Among the different agrowastes used, wheat bran was found to be the best substrate for the test fungus for the production of xylanase than sugarcane bagasse and rice bran in solid-state fermentation.

Influence of culture parameters on paper mill effluent decolourization by a white rot fungus Ganoderma lucidum.

Efficacy of a white rot fungus G. lucidum for reduction of colour of paper mill effluent under various growth conditions was evaluated. G. lucidum cultured in IBME medium supported maximum colour reduction on 18th day of fungal growth. The optimization of growth parameters further improved colour reduction. The 18 day old culture at 4 g/l inoculum concentration resulted in maximum decolourization (89%) of the effluent with pH adjusted to 6.5 at 35 degrees C along with maximum reduction in biological oxygen demand and chemical oxygen demand. Relative contribution of lignin peroxidase and laccase to the decolourization of paper mill effluent by G. lucidum was also observed.

Tamoxifen increases the proliferation of human endometrial stromal cells in in vitro. A model for evaluation of endometrial hyperplasia.

Tamoxifen given for breast cancer therapy, has a complex and an unclear action on the endometrium. A large number of literatures has attributed the proliferous changes in the endometrium caused by tamoxifen (Tam). No report has appeared on the endometrial cellular changes induced by Tam. The present study shows a significant (P < 0.001) increase in the proliferative activity due to Tam in endometrial stromal cells over control and estradiol (E2). This in vitro model is useful for the study of the hyperplasic effect of Tam at the cellular level.

Effect of tamoxifen, estradiol 17 beta on coenzymes NAD, NADPH and the metabolism of estradiol and estrone in rabbit uterus in vivo.

Biotransformation of estradiol (E2) and estrone (E1) and the concentrations of NAD, NADPH and 17 beta-estradiol dehydrogenase (E2DH) were measured in the uterus of rabbits treated with tamoxifen (Tam) in two doses; 100 micrograms/day, (Tam 100) and 500 micrograms/day, (Tam 500), E2 (10 micrograms/day) and combination of E2 + Tam 500 for 4 days. The concentration of NAD in Tam 500 treated group was significantly higher than E2, low dose Tam and E2 + Tam 500 treated groups (P < 0.01). The concentration of NAD in E2+ Tam 500 uteri was also significantly higher than E2 treated uteri. The concentration of NADPH was not significantly different from each other amongst the various treatment groups. The studies have shown that E2DH in E2 treated uteri was less than control and Tam 500 treated groups. A significant rise in the enzyme estradiol oxidoreductase (E2OR) activity (P < 0.02) was observed in E2 + Tam 500 treated uteri over control and other treated groups whereas high dose Tam decreased the E2OR activity significantly over the E2 treated group. The rate of conversion of E1 to E2 in Tam 500 treated group was significantly less than the other treatment groups except E2 + Tam 500 treated group (P < 0.04). This study showed that E2 decreases the uterine biosynthesis of NAD and E2DH and the biotransformation of E2 to E1, while high dose Tam increases uterine NAD, E2DH activity and E2 to E1 conversion.

Short term treatment of tamoxifen and estradiol on estradiol and progesterone receptors in rabbit uterus.

Effects of tamoxifen (Tam) on cytosolic estradiol (E2) receptors (ERc), progesterone (P4) receptors (PRc), nuclear estradiol (ERn) and progesterone receptors (PRn) were studied in adult normal rabbit uterine tissue. The ratio of cytosol: nuclear estradiol receptors (ER) was greater in rabbits treated with Tam than E2 or control uterine tissues. Rabbit uterine progesterone receptors (PR) in E2 treated animal were greater than Tam-treated animals. Tam caused nuclear accumulation of estradiol receptor, and simultaneous administration of E2 + Tam 500, estradiol could not revert Tam mediated accumulation of ER. The results suggest that Tam has an essentially antagonist action in the rabbit uterine tissue.

Evaluation of direct gas-liquid chromatography of CSF in rapid diagnosis of acute bacterial meningitis.

A comparison of culture and lactic acid level from 50 patients suffering from bacterial meningitis and 25 controls was done to evaluate the role of direct GLC analysis of CSF for early diagnosis of bacterial meningitis. The study revealed that the CSF lactic acid level was higher in 48 out of 50 cases. Only in 30 patients the causative agent of the disease could be established by conventional techniques. Quantitative estimation of lactic acid was found to be useful.

DDT levels in human body fat & milk samples from Delhi.

A study of 45 human fat samples from autopsy and surgery specimens from Delhi showed a mean total DDT level of 6.37 micrograms/g (SE +/- 0.36; range 3.34-9.12 micrograms/g). While these values compare well with those reported from India and abroad, they are much lower than those obtained from other areas of Delhi, confirming wide variation in the quantity of DDT sprayed in different pockets of this city. Twenty one human milk samples from Delhi showed a mean total DDT level of 0.144 ppm (micrograms/ml). Thus, many infants in Delhi appear to be consuming 3 to 5 times the permissible 5 micrograms/kg/day quantity of DDT. This study too indicates the need of continuous monitoring of DDT and other insecticides commonly used in India.

Standardisation of quantitative direct gas liquid chromatography for early detection of bacteria in blood cultures.

Blood cultures with strains of aerobic, facultative and obligate anaerobic bacteria were studied by quantitative direct gas liquid chromatography for early diagnosis of bacteraemias. Small amounts of volatile and nonvolatile fatty acids were detected in uninoculated blood cultures. Bacteroides fragilis produced acetic (27.6 mumol/ml), propionic (1.0 mumol/ml), isovaleric, (0.6 mumol/ml), lactic (4.5 mumol/ml) and succinic (2.7 mumol/ml) acids after 48 h. Blood cultures inoculated with Clostridium perfringens and Fusobacterium nucleatum produced large amount of butyric acid (2.5 and 18.8 mumol/ml respectively) along with acetic, propionic, lactic and succinic acids on day 2 of incubation. Blood cultures with Escherichia coli, Salmonella typhi, Staphylococcus aureus, beta-haemolytic streptococci (group A) produced only acetic, lactic and succinic acids. Pseudomonas aeruginosa produced only small amounts of succinic (0.6 mumol/ml) and acetic acids (2.4 mumol/ml) on day 5 of incubation. Blood cultures inoculated with anaerobic bacteria produced multiple volatile fatty acids within 24 to 48 h of incubation. Since these acids could be detected earlier than the organism in cultures, they may be useful in the early diagnosis of anaerobic bacteraemias/septicaemias.