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Recent prospective observational study evaluated the effectiveness of ultrasonography (USG) in predicting difficult laryngoscopies through measurements of key parameters such as the tongue-to-oral height ratio (TTOHR) and anterior neck soft tissue distances. The study, involving 120 patients undergoing elective surgery under general anesthesia, focused on assessing four USG parameters: skin-to-hyoid bone distance (SHBD), skin-to-epiglottis distance (SED), skin-to-thyrohyoid membrane distance (STHMD), and TTOHR. The primary outcome was determined using modified Cormack-Lehane (CL) grading post-laryngoscopy.

### Methodology – Patients aged 18-65 years without a known difficult airway were included, while those requiring fiberoptic intubation or with altered neck anatomy were excluded. Airway USG was conducted before anesthesia by an experienced investigator, measuring the four USG parameters in a neutral neck position. Each patient’s laryngoscopy was assessed and graded by an independent anesthesiologist. Statistical analysis included ROC curve analysis, multivariable logistic regression, and comparisons of various predictive models. A cutoff value for each parameter was established to optimize diagnostic performance.

### Results – Out of 120 patients, 11.6% experienced difficult laryngoscopy (DL) while 6.6% had difficult intubation (DI). SED exhibited the highest diagnostic performance with an area under the curve (AUC) of 0.95, 100% sensitivity, and 89% specificity at a cutoff of 1.87 cm. STHMD and TTOHR followed closely with AUCs of 0.94 and 0.92, respectively. Notably, TTOHR showed the highest diagnostic accuracy of 97%, indicating significant predictive value. Combining parameters into models enhanced predictive capabilities, with one model integrating TTOHR, SHBD, and STHMD emerging as the best predictor for DL.

### Limitations – The study’s limitations include a relatively small and homogeneous sample size, limiting generalizability to broader populations or different ethnicities. Additionally, the measurements were conducted by a single investigator, which poses a risk of variability not assessed in the study. The dynamic nature of the tongue and the lack of evaluation of DI accuracy across a larger group further constrain the findings.

### Conclusion – Results demonstrated that USG parameters, particularly SED, STHMD, and TTOHR, are effective in predicting difficult laryngoscopy, with models leveraging these parameters significantly enhancing predictive performance in unexpected difficult airway scenarios.

Key Points

– A prospective observational study evaluated the effectiveness of ultrasonography (USG) in predicting difficult laryngoscopies by measuring parameters such as the tongue-to-oral height ratio (TTOHR) and anterior neck soft tissue distances in 120 elective surgery patients under general anesthesia.

– Key USG parameters assessed included skin-to-hyoid bone distance (SHBD), skin-to-epiglottis distance (SED), skin-to-thyrohyoid membrane distance (STHMD), and TTOHR, with the primary outcome being assessed via modified Cormack-Lehane (CL) grading post-laryngoscopy.

– The study included patients aged 18-65 years without known difficult airways, while excluding those needing fiberoptic intubation or with altered neck anatomy. Measurements were taken by an experienced investigator in a neutral neck position, and laryngoscopies were graded by an independent anesthesiologist.

– Among the 120 participants, 11.6% experienced difficult laryngoscopy (DL) and 6.6% had difficult intubation (DI). SED demonstrated the best diagnostic performance with an AUC of 0.95, achieving 100% sensitivity and 89% specificity at a cutoff of 1.87 cm, while TTOHR showed a diagnostic accuracy of 97%.

– Predictive capabilities improved by combining multiple parameters into models, with a particular model incorporating TTOHR, SHBD, and STHMD identified as the best predictor for difficult laryngoscopy (DL).

– Limitations of the study include a relatively small and homogeneous sample size, the use of a single investigator for measurements, potential variability in tongue dynamics, and the lack of evaluation of DI accuracy across a larger cohort, which may restrict the generalizability of the findings.

Reference –

Nandi S, Panda A, Mishra N, Rao PB, Srinivasan A. Evaluation of the predictive value of tongue height to oral cavity height ratio and anterior neck soft tissue measurements for difficult laryngoscopy in patients with unanticipated difficult airway: A prospective observational study. Indian J Anaesth 2025;69:918-25

Chronic kidney disease (CKD) is a major health issue worldwide. Many patients end up requiring regular dialysis to avoid kidney failure and stay alive. Despite the severity of the condition, there are currently no drugs available that improve kidney function. A research group led by Tohoku University Graduate School of Medicine’s Professor Takaaki Abe has found a remarkable solution to treat patients with CKD by co-opting a drug typically used for constipation. This is the first time that this drug (lubiprostone) was shown to prevent the decline of renal function in patients with CKD.

“We noticed that constipation is a symptom that often accompanies CKD, and decided to investigate this link further,” explains Abe. “Essentially, constipation disrupts the intestinal microbiota, which worsens kidney function. Working backwards, we hypothesized that we could improve kidney function by treating constipation.”

To address this issue, the group conducted a multicenter Phase II clinical trial (LUBI-CKD TRIAL) at nine Japanese medical institutions, enrolling 150 patients with moderate CKD. This study evaluated the effects of lubiprostone on kidney function. The results showed that, compared to the placebo group, the decline in kidney function (defined as the estimated glomerular filtration rate: eGFR) was suppressed in a dose-dependent manner in patients treated with 8 µg or 16 µg of lubiprostone.

The researchers also investigated the mechanism underlying how this effect occurred. They found that lubiprostone increases spermidine production, which improves mitochondrial function by promoting bacterial growth in the gut. The improved mitochondrial function was seen to exert a renoprotective effect – suppressing further kidney damage.

Going forward, the research team has plans to validate the trial results in a larger population (Phase 3 clinical trial) and advance the exploration of biomarkers that predict treatment efficacy. Their goal is to provide each patient with CKD the optimal treatment plan tailored to their needs. This discovery has the potential to significantly transform the conventional approach to CKD treatment, which primarily focuses on reducing uremic toxins.

These findings suggest a new therapeutic strategy in which laxatives suppress renal function decline. This strategy is expected to contribute to the development of treatments for not only CKD, but also mitochondrial dysfunction disorders. The results of this study were published in the scientific journal Science Advances on August 30, 2025.

Reference:

Shun Watanabe et al. ,Lubiprostone in chronic kidney disease: Insights into mitochondrial function and polyamines from a randomized phase 2 clinical trial.Sci. Adv.11,eadw3934(2025).DOI:10.1126/sciadv.adw3934

Patna: The All India Institute of Medical Sciences AIIMS Patna has announced that MBBS classes for the 2025 batch will commence on 23rd September 2025.

An orientation-inaugural programme will be held the same day Registrar (Academics), AIIMS Patna on 23rd September, 2025 from 09:00 AM to 11:00 AM in the Auditorium, AIIMS Patna.

Hostel / Accommodation to the students of MBBS 2025 Batch will be allotted on 22nd September 2025 at E-classroom, Admin Building, AIIMS Patna.

Students must bring admission slip, Aadhaar copies, affidavits, and passport-size photos. The foundation course will also begin on September 23.

Students are directed to bring the following documents: 

1. Xerox copy of Admission Slip – provided by AIIMS Patna

2. Xerox copy of Aadhar Card (self + guardian)

3. Original Affidavits – in the format provided by AIIMS Patna

4. Two Passport size Photos

• Foundation course of the MBBS 2025 Batch will commence from 23rd September, 2025 (Tuesday) by the Department of Medical Education, AIIMS Patna.

• First Prof. Coordinator (MBBS) is requested to prepare the Teaching Schedule in coordination with the Departments concerned and DME as per the availability of Lecture Theatre.

AIIMS Patna is a public, multispecialty hospital and institution of national importance in Phulwarisharif, Patna, India, dedicated to providing advanced, affordable healthcare and medical education, including undergraduate and postgraduate programs. Established to improve regional healthcare access, it features 42 specialized departments, a large inpatient facility with trauma services, and a sprawling campus with diverse amenities.

The first batch of MBBS and BSc Nursing students enrolled in 2012, and outpatient and inpatient services began in mid-2013. AIIMS Patna has established itself as a national level institution since 2012, with current annual enrollment of 125 MBBS, 75 BSc Nursing, 12 MSc nursing, and MS- MD- DM- MCH students under the academic services.

To view the official notice click here: https://medicaldialogues.in/pdf_upload/commencement-of-class-of-mbbs-2025-batch-09092025-300259.pdf