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Article ; Online: A Cross-sectional Study to Assess the Need for Standardisation of the Modified Mallampati and Friedman’s Scoring System

Jithin Mathew Abraham / Leno Ninan Jacob / Sangeetha Merrin Varghese / Ashu Sara Mathai

Journal of Clinical and Diagnostic Research, Vol 18, Iss 01, Pp 09-

2024 Volume 12

Abstract: Introduction: The Modified Mallampati (MM) grading and Friedman’s Tongue Position (FTP) scores are two major scoring systems used to evaluate the oropharyngeal space. However, the current descriptions of performing these scores do not specify the route ... ...

Abstract	Introduction: The Modified Mallampati (MM) grading and Friedman’s Tongue Position (FTP) scores are two major scoring systems used to evaluate the oropharyngeal space. However, the current descriptions of performing these scores do not specify the route of breathing taken by the patient during the examination. The dynamic changes in the tongue and palate, in relation to the route of breathing, may contribute to the high interobserver variability in MM scoring. Aim: To explore the differences in MM scores and Friedman’s scores obtained during mouth breathing and nose breathing in order to standardise the scoring system. Materials and Methods: A community-based cross-sectional study was conducted at the Departments of Anaesthesiology and Community Medicine at Believers Church Medical College Hospital in Central Kerala, India between April 2022 and October 2022, on 702 adults. MM scores and FTP scores were recorded separately for each person during mouth breathing and nose breathing. Socio-demographic variables such as age, gender, and Body Mass Index (BMI) were also collected. The data was analysed using the Z-test for proportions. Results: The mean age of the study participants was 3.58±16.42 years. The majority of the participants were females (69.2%), and more than half (59%) were above 50 years of age. Out of the 135 participants with an MM Score-1 during mouth breathing, 99 (73.3%) had higher scores during nose breathing. For the 196 individuals with an MM Score-2 during mouth breathing, 87 (44.3%) had higher scores during nose breathing. Similarly, out of the 220 people with an MM score of -3 during mouth breathing, 106 (48.2%) had a Score-4 during nose breathing. A similar pattern was observed for the FTP scores. Conclusion: The present study demonstrates significant variability in MM and FTP scores obtained during oral and nasal breathing, highlighting the need to standardise the route of breathing during examination. The study suggests that advising patients to breathe through the mouth may relax the ...
Keywords	friedman’s tongue position ; mallampati score ; oral breathing ; nasal breathing ; Medicine ; R
Subject code	796
Language	English
Publishing date	2024-01-01T00:00:00Z
Publisher	JCDR Research and Publications Private Limited
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Modified mallampati score – Does it predict more than a difficult airway? A community-based study assessing the association between modified mallampati score and obstructive sleep apnea

Jithin Mathew Abraham / Sangeetha Merrin Varghese / Gincy Ann Lukachan / Ashu Sara Mathai

Archives of Medicine and Health Sciences, Vol 11, Iss 2, Pp 172-

2023 Volume 175

Abstract: Background and Aim: The suspicion of obstructive sleep apnea (OSA) has serious implications for an anesthesiologist perioperatively. This study examines the association between the modified Mallampati scoring (MMS) and the STOP-BANG score in a community ... ...

Abstract	Background and Aim: The suspicion of obstructive sleep apnea (OSA) has serious implications for an anesthesiologist perioperatively. This study examines the association between the modified Mallampati scoring (MMS) and the STOP-BANG score in a community setting. Materials and Methods: This was a community-based cross-sectional survey among 702 adults in a rural area in South India. Airway assessment using MMS and assessment for OSA using STOP-BANG scoring were made by junior doctors trained in the anesthesia department. The association between the Mallampati score and the STOP-BANG score was tested by the Chi-square test using the SPSS version 21. Results: Among the community-dwelling adults, 19.2% had a score of 1, 27.9% had a score of 2, 31.3% had a score of 3, and 21.5% had a score of 4 on the Mallampati scoring system. Using the STOP-BANG score for risk stratification of OSA, 29.2% had an intermediate risk and 5.8% had a high risk for OSA. Higher Mallampati Grades (3 and 4) were a significant risk factor for OSA (61.8% vs. 38.2%, P = 0.001). Conclusion: A higher Mallampati class (3 or 4) is significantly associated with an intermediate-to high risk for OSA as assessed using STOP-BANG score criteria. Therefore, we suggest using the MMS not only as an airway screening tool but also as a predictor of OSA, in view of the rising obesity rates in India.
Keywords	airway assessment ; community-based study ; modified mallampati score ; obstructive sleep apnea ; stop-bang ; Medicine ; R
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Wolters Kluwer Medknow Publications
Document type	Article ; Online
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Article: Insulin IP Calc: A smartphone application for insulin infusion protocol in Intensive Care Units.

Karippacheril, John George / Mathai, Rashmi Teresa / Abraham, Sona Susan

Indian journal of anaesthesia

2016 Volume 59, Issue 12, Page(s) 829–830

Language	English
Publishing date	2016-02-21
Publishing country	India
Document type	Journal Article
ZDB-ID	412570-8
ISSN	0019-5049
ISSN	0019-5049
DOI	10.4103/0019-5049.171607
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Article: Assessment of malnutrition and enteral feeding practices in the critically ill: A single-centre observational study.

Verghese, Prashant P / Mathai, Ashu Sara / Abraham, Valsamma / Kaur, Paramdeep

Indian journal of anaesthesia

2018 Volume 62, Issue 1, Page(s) 29–35

Abstract: Background and aims: Early identification of malnutrition among hospitalised patients is essential to institute appropriate patient-specific nutritional strategies. This study was conducted to evaluate the nutritional status of medical patients at ... ...

Abstract	Background and aims: Early identification of malnutrition among hospitalised patients is essential to institute appropriate patient-specific nutritional strategies. This study was conducted to evaluate the nutritional status of medical patients at admission to the adult intensive care unit (ICU) and to identify factors which prevent attainment of daily feeding goals in them. Methods: This was a 1 year prospective, observational study on 200 medical adult ICU patients. The study was carried out based on daily documentation. The primary outcome was the nutritional status of medical Patients at admission to the adult ICU. The tests for statistical analysis used were independent Results: Out of the 200 patients in our study, 45%, 48.5% and 9% of patients had mild, moderate and severe malnutrition, respectively, corresponding to subjective global assessment (SGA) rating A,B and C, respectively. The most common reasons for non-attainment of daily feeding goals were delayed feed procurement (17.57%), and feeds being held for procedures (16.36%). The overall mean length of ICU stay was 8.63 ± 7.26 days, and the ICU mortality rate was 47.5% (95/200). Patients with SGA rating B and C at admission had higher risk of mortality in the ICU, with an adjusted odds ratio of 3.54 (95% confidence interval [CI]- 1.71-7.33, Conclusion: Malnutrition is commonly present at admission among medical ICU patients, and is associated with higher ICU mortality.
Language	English
Publishing date	2018-02-07
Publishing country	India
Document type	Journal Article
ZDB-ID	412570-8
ISSN	0019-5049
ISSN	0019-5049
DOI	10.4103/ija.IJA_513_17
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Article ; Online: Prevalence of oral human papillomavirus infection among Indian HIV-positive men who have sex with men: a cross-sectional study.

Hernandez, Alexandra L / Karthik, Rajiv / Sivasubramanian, Murugesan / Raghavendran, Anantharam / Lensing, Shelly / Lee, Jeannette Y / Abraham, Priya / Mathai, Dilip / Palefsky, Joel M

BMC infectious diseases

2021 Volume 21, Issue 1, Page(s) 675

Abstract: Background: Oral human papillomavirus (HPV) infection has been causally linked to a subset of oropharyngeal cancers in Western populations, and both oropharyngeal cancer and oral HPV infection are increased among HIV-positive individuals. India has high ...

Abstract	Background: Oral human papillomavirus (HPV) infection has been causally linked to a subset of oropharyngeal cancers in Western populations, and both oropharyngeal cancer and oral HPV infection are increased among HIV-positive individuals. India has high incidences of oral and oropharyngeal cancers, and Indian HIV-positive men who have sex with men (MSM) may be at increased risk of developing oropharyngeal cancers. However, there is little information available on the prevalence of oral HPV in this population. Methods: We tested 302 HIV-positive Indian MSM for oral HPV infection using L1 HPV DNA PCR with probes specific for 29 types and a mixture of 10 additional types. CD4+ level and plasma HIV viral load (VL) were measured. Participants completed an interviewer-administered questionnaire including a sexual history. Results: The prevalence of oral HPV was 23.7% (95% CI: 19-29%) and 2.4% of participants had oncogenic HPV types. No participants had oral HPV type 16 (HPV-16) and the prevalence of other anogenital HPV types was low. Participants with higher CD4+ levels had reduced odds of having any oral HPV infection (OR: 3.1 [1.4-6.9]) in multivariable analyses. Conclusions: This is the first report of oral HPV among Indian HIV-positive MSM. Our results show a high prevalence of oral HPV infection consistent with studies from Western populations. However, oncogenic anogenital HPV types were relatively uncommon in our study population. It is unknown what the impact of this distribution of oral HPV will be on oropharyngeal cancers. HIV-positive MSM in India should be monitored closely for oral and oropharyngeal pre-cancer and cancer.
MeSH term(s)	Cross-Sectional Studies ; HIV Infections/complications ; HIV Seropositivity/epidemiology ; Homosexuality, Male ; Humans ; India/epidemiology ; Male ; Middle Aged ; Mouth Diseases/epidemiology ; Mouth Diseases/etiology ; Papillomavirus Infections/complications ; Papillomavirus Infections/epidemiology ; Prevalence ; Risk Factors ; Sexual and Gender Minorities
Language	English
Publishing date	2021-07-12
Publishing country	England
Document type	Journal Article
ISSN	1471-2334
ISSN (online)	1471-2334
DOI	10.1186/s12879-021-06301-6
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Article ; Online: Normal Peak Expiratory Flow Rate and Nomogram for Children (8-12 years).

John, Jomon Mathew / Mathai M, Isac / Paulose, Abraham

Indian journal of pediatrics

2017 Volume 84, Issue 6, Page(s) 477–478

MeSH term(s)	Child ; Female ; Humans ; Male ; Nomograms ; Peak Expiratory Flow Rate ; Reference Values
Language	English
Publishing date	2017-02-23
Publishing country	India
Document type	Letter
ZDB-ID	218231-2
ISSN	0973-7693 ; 0019-5456
ISSN (online)	0973-7693
ISSN	0019-5456
DOI	10.1007/s12098-017-2313-5
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Article ; Online: Clinicogenetic Profile, Treatment Modalities, and Mortality Predictors of Gaucher Disease: A 15-Year Retrospective Study.

Barney, Anitha M / Danda, Sumita / Abraham, Aby / Fouzia, N A / Gowdra, Aruna / Abraham, Suneetha Susan Cleave / Sony, Mohan / Das, Sweta / Korula, Sophy / Mathai, Sarah / Simon, Anna / Kumar, Sathish

Public health genomics

2021 Volume 24, Issue 3-4, Page(s) 139–148

Abstract: Introduction: Gaucher disease (GD) is a rare autosomal recessive lysosomal storage disorder, in which biallelic pathogenic variants in the Glucosidase beta acid (GBA) gene result in defective functioning of glucosylceramidase that causes deposition of ... ...

Abstract	Introduction: Gaucher disease (GD) is a rare autosomal recessive lysosomal storage disorder, in which biallelic pathogenic variants in the Glucosidase beta acid (GBA) gene result in defective functioning of glucosylceramidase that causes deposition of glucocerebroside in cells. GD has 3 major types namely, non-neuronopathic (type I), acute neuronopathic (type II), and chronic neuronopathic (type III). Definite treatment options are limited and expensive. They succumb early to the disease, if untreated. There is paucity of studies from the Indian subcontinent, which elicit the factors resulting in their premature mortality. Materials and methods: A retrospective study was carried out in a tertiary care setting of South India to assess the clinical profile, mutation spectrum, and various management strategies (only supportive therapy, enzyme replacement therapy [ERT], substrate reduction therapy [SRT] haematopoietic stem cell transplant [HSCT]), and mortality predictors of patients with GD from 2004 to 2019. A Kaplan-Meier survival curve was plotted. In silico predictions were performed for novel variants. Results: There were 60 patients with all types of GD seen over the study period of 15 years. Their median age at diagnosis was 2 years. The median follow-up was for 5 years (interquartile range [IQR] = 2-8). The overall mortality rate was 35%; however, it was only 10% in those receiving definite treatment. Mortality was higher (47.5%) by more than 4 folds in those only on supportive therapy. The median survival from the time of diagnosis was 6.3 years (IQR = 3.5-10.8) in the definite treatment group and 3.5 years (IQR = 1-5) in those on supportive therapy. The Kaplan-Meier survival analysis showed significant (p value 0.001) mortality difference between these groups. The multiple logistic regression analysis found the neuronopathic type (OR = 5) and only supportive therapy (OR = 6.3) to be the independent risk factors for premature mortality. Conclusion: GD is a rare disease with a high mortality rate, if left untreated. ERT and SRT are the definitive treatments which increase the survival. In resource-limited settings like India, with higher prevalence of the neuronopathic type, HSCT may be a more suitable definitive treatment option, due to its one-time intervention and cost, assuming similar efficacy to ERT. However, the efficacy and safety of HSCT in GD needs to be established further by substantial patient numbers undergoing it.
MeSH term(s)	Enzyme Replacement Therapy ; Gaucher Disease/diagnosis ; Gaucher Disease/genetics ; Gaucher Disease/therapy ; Glucosylceramidase/genetics ; Glucosylceramidase/therapeutic use ; Humans ; Mutation ; Retrospective Studies
Chemical Substances	Glucosylceramidase (EC 3.2.1.45)
Language	English
Publishing date	2021-04-06
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2457023-0
ISSN	1662-8063 ; 1662-4246
ISSN (online)	1662-8063
ISSN	1662-4246
DOI	10.1159/000514507
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Article: Wilms tumour with intracardiac extension - multimodal approach to a challenging case.

Abraham, Mallie / Samuel, Mathai / Mathew, Mohan

Indian journal of anaesthesia

2016 Volume 60, Issue 3, Page(s) 216–218

Language	English
Publishing date	2016-04-06
Publishing country	India
Document type	Journal Article
ZDB-ID	412570-8
ISSN	0019-5049
ISSN	0019-5049
DOI	10.4103/0019-5049.177884
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Article ; Online: Phenotypic variability of a TREX1 variant in Aicardi-Goutieres type 1 patients from the Indian subcontinent.

Abraham, Suneetha Susan Cleave / Yoganathan, Sangeetha / Koshy, Beena / Oommen, Samuel Philip / Simon, Anna / Mathai, Sarah / Korula, Sophy / Mathew, Lydia / Sathishkumar, Dharshini / Jasper, Anitha / George, Renu / Danda, Sumita

European journal of medical genetics

2021 Volume 64, Issue 9, Page(s) 104291

Abstract: Aicardi-Goutieres Syndrome (AGS) is a heterogeneous genetic syndrome, manifesting early as encephalopathy and is associated with abnormal neurologic findings, hepatosplenomegaly, elevated liver enzymes, thrombocytopenia and intracranial calcification. ... ...

Abstract	Aicardi-Goutieres Syndrome (AGS) is a heterogeneous genetic syndrome, manifesting early as encephalopathy and is associated with abnormal neurologic findings, hepatosplenomegaly, elevated liver enzymes, thrombocytopenia and intracranial calcification. The most severe neonatal type, AGS1, is caused by biallelic disease-causing variants in TREX1. In this study, we describe four patients with TREX1-related AGS1 whose phenotype overlaps with intra-uterine infections and neonatal lupus. Exome sequencing identified a previously reported TREX1 variant, c.223dup (NM_016381.5; p. Glu75GlyfsTer82) in all the four patients belonging to the Indian subcontinent. The functional consequence of the disease-causing variant was predicted by using a new combination of bioinformatics softwares. The recurrence of this pathogenic variant indicates a possible founder effect in TREX1 for AGS1 in this population. The phenotypic variability in those with this founder mutation can mimic intrauterine infections and neonatal lupus, thereby leading to misdiagnosis warranting a targeted genetic testing approach to be a part of the diagnostic workup to obtain a definite, early and cost-effective diagnosis in patients from Indian subcontinent with early onset encephalopathy.
MeSH term(s)	Autoimmune Diseases of the Nervous System/epidemiology ; Autoimmune Diseases of the Nervous System/genetics ; Autoimmune Diseases of the Nervous System/pathology ; Exodeoxyribonucleases/chemistry ; Exodeoxyribonucleases/genetics ; Female ; Founder Effect ; Gene Frequency ; Humans ; India ; Infant ; Male ; Mutation ; Nervous System Malformations/epidemiology ; Nervous System Malformations/genetics ; Nervous System Malformations/pathology ; Phenotype ; Phosphoproteins/chemistry ; Phosphoproteins/genetics ; Protein Domains
Chemical Substances	Phosphoproteins ; Exodeoxyribonucleases (EC 3.1.-) ; three prime repair exonuclease 1 (EC 3.1.16.-)
Language	English
Publishing date	2021-07-22
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2184135-4
ISSN	1878-0849 ; 1769-7212
ISSN (online)	1878-0849
ISSN	1769-7212
DOI	10.1016/j.ejmg.2021.104291
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Article ; Online: Wilms tumour with intracardiac extension - multimodal approach to a challenging case

Mallie Abraham / Mathai Samuel / Mohan Mathew

Indian Journal of Anaesthesia, Vol 60, Iss 3, Pp 216-

2016 Volume 218

Keywords	Anesthesiology ; RD78.3-87.3 ; Surgery ; RD1-811 ; Medicine ; R
Language	English
Publishing date	2016-01-01T00:00:00Z
Publisher	Medknow Publications
Document type	Article ; Online
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