A Comparative Study of Acromio-Axillo-Suprasternal Notch Index with Modified Mallampati Grading and Thyromental Distance in Predicting Difficult Visualization of Larynx

Vijay R — 2025-09-06

Introduction:
Difficult laryngoscopy and intubation pose significant risks in anaesthetic practice. Traditional airway assessment tools like Modified Mallampati Grading (MMG) and Thyromental Distance (TMD) show variable predictive accuracy. The Acromio-Axillo-Suprasternal Notch Index (AASI) is a newer anatomical index that evaluates upper thoracic and cervical alignment and may offer better prediction of difficult visualization of the larynx (DVL). This study compared AASI with MMG and TMD in predicting DVL.

Materials and Methods:
A prospective observational study was conducted on 60 adult patients (18–60 years), ASA I and II, undergoing elective surgeries under general anaesthesia requiring endotracheal intubation. Preoperative assessment included AASI, MMG, and TMD. Cormack-Lehane grading during laryngoscopy served as the reference standard, with Grades III and IV defined as DVL. Statistical analysis included chi-square tests, logistic regression, and ROC curve analysis using SPSS .

Results:
DVL was observed in 13.33 of patients. AASI showed significant association with and was an independent predictor AASI demonstrated sensitivity of 75, specificity of 96, accuracy of 93, and AUC . In contrast, TMD and MMG had lower sensitivities respectively) and were not statistically significant predictors.

Conclusion:
AASI outperformed MMG and TMD in predicting difficult laryngoscopy. Being simple, objective, and highly accurate, AASI should be considered for routine preoperative airway assessment.

“Madhusudana-Bharti-Uppinder” Protocol for Post-Exposure Prophylaxis (PEP) in animals in Himachal Pradesh, India saves lives and economy of rural India

Omesh Kumar Bharti — 2025-08-18

Livestock are backbone of rural economy but always a neglected area. In a survey done in Ethiopia, the estimated rabies cases incidence was 1.75 in bovines, 18 in dogs, 2.37 in equines, 2.28 in cats and 0.37 in shoats per 10,000 animals annually.[i] The annual cost of livestock losses due to rabies is also substantial: approximately US$ 12.3 million (90% CI, 11–13.7 million)[ii] in endemic Africa and Asia, disproportionately affecting the rural poor who depend upon livestock for subsistence. In 2016, 7 of 21 bovine bitten by rabid dogs died due to rabies in Shimla Municipality in Himachal Pradesh who were given only IM rabies vaccination as PEP. This scenario prompted the authors to look for a suitable protocol, based on human studies, to save animals.

Epidemiology International (E-ISSN: 2455-7048)

A Comparative Study of Acromio-Axillo-Suprasternal Notch Index with Modified Mallampati Grading and Thyromental Distance in Predicting Difficult Visualization of Larynx

“Madhusudana-Bharti-Uppinder” Protocol for Post-Exposure Prophylaxis (PEP) in animals in Himachal Pradesh, India saves lives and economy of rural India