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AbstractThis study was designed to study the impact of menopause on voice quality. Cross-sectional Observational study with a total of 100 subjects. All subjects underwent biochemical analysis which included thyroid function tests, estrogen levels, progesterone levels and underwent voice analysis using the VAUGHMI voice analyser software. 50 postmenopausal females as cases and 50 premenopausal females as controls were taken for the study. The females were of the age group 35–55 yrs in order to remove age as confounding factor. The primary outcome measure was Total score, calculated based on harshness, hoarseness and breathiness. The postmenopausal females had a poorer voice quality than the premenopausal females (Total score 1.62 vs 2.48, p < 0.001). There was a significant difference between the fundamental frequency and pitch and perturbation in frequency of the postmenopausal females as compared to premenopausal females. The difference in the perturbation in the intensity of the voice was not significant. No linear correlation could be established between the voice quality and oestrogen or progesterone levels but the intergroup variation of the two parameters was significant. The premenopausal females have better voice quality than postmenopausal females. The relationship between hormonal level and voice quality couldn’t be established. Further studies are required to assess the relation of hormone levels & voice quality with the possibility of exploring voice cosmesis. Level of EvidenceLevel 3.

The coastal lake Veli-Akkulam is crucial to Thiruvananthapuram's urban watershed, yet it is under threat from pollution caused by urbanization and industrialization. Conserving freshwater resources is a key part of Sustainable Development Goals, and the only way to protect the lake is by consistently monitoring its water quality. This study aims at evaluating the pollution level of the lake throughout the seasons (pre-monsoon, monsoon, and post-monsoon) of 2022–2023 using the Carlson Trophic State and Water Quality indices. The lake's pollution condition using the indexes Carlson Trophic State (CTSI) and Water Quality Index (WQI) throughout the pre-monsoon, monsoon, and post-monsoon seasons in 2022–2023. The statistical tools such as Principal Component Analysis (PCA) and Pearson Correlation Matrix were used for analysing how various factors influence water quality. The impact of several factors on water quality was examined using Principal Component Analysis and the Pearson Correlation Matrix. PCA analysis revealed that high nutrient levels, suspended particles, and oxygen depletion were identified as the main drivers of the decline in water quality, and these factors were all linked to anthropogenic activity. The study's findings clearly show the Veli-Akkulam lake is severely polluted. The CTSI consistently classified the lacustrine system as eutrophic or hypereutrophic across all seasons, with mean values of 66.74 (pre-monsoon), 67.20 (monsoon), and 63.23 (post-monsoon). Similarly, the WQI classified the water quality as \"poor,\" \"very poor,\" and \"unsuitable,\" with particularly high \"unsuitable\" values (306.6 to 398.47) recorded at multiple stations. The study concludes that human activity is the clear cause of the lake's current polluted and deteriorating state.

Differences in patient characteristics due to race or ethnicity may influence the incidence of difficult airway. Our purpose was to determine the incidence of difficult laryngoscopy and intubation, as well as the anatomical features and clinical risk factors that influence them, in the Indian population. In 330 adult patients receiving general anaesthesia with tracheal intubation, airway characteristics and clinical factors were determined and their association with difficult laryngoscopy (Cormack and Lehane grade 3 and 4) was analysed. Intubation Difficulty Scale score was used to identify degree of difficult laryngoscopy. The incidence of difficult laryngoscopy and intubation was 9.7% and 4.5%, respectively. Univariate analysis showed that increasing age and weight, male gender, modified Mallampati class (MMC) 3 and 4 in sitting and supine positions, inter-incisor distance (IID) ≤3.5 cm, thyromental (TMD) and sternomental distance, ratio of height and TMD, short neck, limited mandibular protrusion, decreased range of neck movement, history of snoring, receding mandible and cervical spondylosis were associated with difficult laryngoscopy. Multivariate analysis identified four variables that were independently associated with difficult laryngoscopy: MMC class 3 and 4, range of neck movement <80°, IID ≤ 3.5 cm and snoring. We found an incidence of 9.7% and 4.5% for difficult laryngoscopy and difficult intubation, respectively, in Indian patients with apparently normal airways. MMC class 3 and 4, range of neck movement <80°, IID ≤ 3.5 cm and snoring were independently related to difficult laryngoscopy. There was a high incidence (48.5%) of minor difficulty in intubation.

Acute kidney injury (AKI) is a serious medical condition that can have many causes, including rhabdomyolysis. Rhabdomyolysis is the breakdown of muscle tissue that can lead to the release of muscle fiber contents into the bloodstream. This can cause serious damage to the kidneys, leading to AKI. In this case, a young bodybuilder was diagnosed with rhabdomyolysis induced by AKI after consuming Ibuprofen for a casual fever. The etiology of AKI in rhabdomyolysis is complex, with multiple factors contributing to the development of the condition. These include muscle trauma, dehydration, infection, and drug toxicity. In this case, Ibuprofen may have contributed to the development of AKI, as it can cause kidney damage when taken in large doses. Additionally, the bodybuilder's physical activity may have contributed to the development of rhabdomyolysis, as intense exercise can cause muscle damage. Treatment for AKI in rhabdomyolysis patients typically involves aggressive fluid resuscitation, electrolyte replacement, and dialysis if necessary. Additionally, the underlying cause of the rhabdomyolysis must be identified and treated. In this case, the patient should be monitored closely for any signs of kidney damage, and the Ibuprofen should be discontinued. In conclusion, this is a case of a relatively common presentation with uncommon circumstances. It is crucial to have a heightened understanding of the likelihood of AKI in patients with rhabdomyolysis and the impact of drug toxicity in exacerbating the condition. Early diagnosis and treatment are essential for the successful management of AKI.

Air pollution and its deleterious public health risks are a major concern across the world. It is one of the leading health risk factors causing high mortality and disease burden in many cities. Epidemiological risk assessment studies have generated considerable evi-dence of disease burden due to air pollution. Such evi-dence proves useful as inputs for framing various air quality management and public health protection policies. Implementation of these policies also necessitates a critical insight from a perspective of differential population vulnerability to air pollution. Hence, the present study proposes a methodological approach for developing an integrated vulnerability assessment framework that focuses on multidimensional aspects adhering to vulnerability in nexus with health risk characterization. The designed framework has been applied in a pilot case study undertaken in four dis-tricts of Delhi, India. Weightage has been multiplied by a normalized score for each indicator to calculate the vulnerability score. The score reflects relative vulnerability level based on the components — emission load, exposure, land use—land cover features, sensitivity and coping capacity. Findings of the study have shown maximum score for East Delhi and minimum score for New Delhi. Hence the study throws light on the factors that are contributing towards the vulnerability of human health to air pollution.

PurposePropofol injection is known to cause distressing pain, and various methods have been used to decrease this pain. We investigated the efficacy of the lidocaine + metoclopramide and lidocaine + ketamine combinations on modulating propofol injection pain.MethodsNinety ASA I/II patients aged 20–60 years were randomly assigned to three groups to receive lidocaine 20 mg (group L), lidocaine 20 mg + metoclopramide 10 mg (group LM), or lidocaine 20 mg + ketamine 5 mg (group LK), respectively, with venous occlusion for 1 min using a forearm tourniquet. Propofol 0.5 mg/kg was subsequently administered into a dorsal hand vein, and pain was assessed during its injection using a verbal rating score. The results were analyzed statistically with analysis of variance, the chi-square test, and the Wilcoxon rank sum test, where appropriate. The significance level was set at p < 0.05.ResultsThe incidence of pain was rated to be significantly less in patients in groups LM (40 %) and LK (6.7 %) than in those in group L (83.3 %) (p = 0.001 and p < 0.001, respectively). The pain score [median (range)] was also significantly less in patients in groups LM [0 (0–3)] and LK [0 (0–2)] than in those in group L [2 (0–3)] (p = 0.001 for both groups).ConclusionThe lidocaine–ketamine combination is most effective for decreasing the pain on propofol injection.

Post 2004 tsunami and earthquake, the landmass of Andaman and Nicobar Islands (ANI's) experienced uplift (North Andaman and Mayabunder) and subsidence (South Andaman & Nicobar Islands). The altered geomorphology modified the tidal regime, which resulted in mangrove degradation in their current locations and the formation of new intertidal zones potential for mangrove colonization. Avicennia species; a pioneer in mangrove succession was expected to colonize such new intertidal zones. Therefore, to understand the colonization pattern of Avicennia species in these new intertidal zones and their distribution in the old forests, we surveyed 79 sites across ANI's (55 Andaman and 24 Nicobar Islands). Our survey confirms the presence of three Avicennia species namely A. marina, A. officinalis, and A. alba – a new distribution record to the ANI's. Further, A. marina was found to be the most widely distributed, and abundant among three Avicennia species (Relative Abundance (RA) – 97.92%; Relative Frequency (RF) – 68.75%). In contrast, A. officinalis (RA – 1.93%; RF – 26.25%) and A. alba (RA – 0.16%; RF – 5%) were found limited in their distribution and abundance. As per the IUCN Red List, the Avicennia population is decreasing globally, whereas, its population may increase significantly across ANI's due to the availability of vast new intertidal zones. Hence, Avicennia spp. can be utilized in the plantation programs to facilitate rapid colonization in the unvegetated potential mangrove habitats across ANI's. Such an effort will improve the mangrove ecosystem services that were hampered due to mangrove degradation by the 2004 tsunami.

Ramsay hunt syndrome[1] is a varicella zoster virus infection of the geniculate ganglion of the facial nerve. It is typically associated with a red rash and blister (inflamed vesicles or tiny water filled sacks in the skin) in or around the ear and eardrum and sometimes on the roof of the mouth or tongue. Corticosteroid, oral acyclovir, and anticonvulsant are used for treatment of this. In addition to this sympathetic neural blockade via stellate ganglion block is used to prevent facial nerve damage and relieve symptoms. We present a case of Ramsay hunt syndrome in which pain and symptoms are not relieved by oral medication but by daily sittings of stellate ganglion block with local anesthetic and steroid, pain, and other symptoms are relieved, and facial nerve damage is prevented.

An 18-year-old ASA-I patient who underwent elective left shoulder arthroscopy developed severe airway obstruction post-extubation due to fluid extravasation from the shoulder joint into the neck and airway tissue. Re-intubation for relief of obstruction resulted in negative-pressure pulmonary oedema. The patient was electively ventilated in the intensive care unit and recovered uneventfully. A high index of suspicion along with monitoring of neck circumference can prevent this kind of complication.

Background: Several morphometric airway measurements have been used to predict difficult laryngoscopy (DL). This study evaluated sternomental distance (SMD) and sternomental displacement (SMDD, difference between SMD measured in neutral and extended head position), as predictors of DL and difficult intubation (DI). Materials and Methods: We studied 610 adult patients scheduled to receive general anesthesia with tracheal intubation. SMD, SMDD, physical, and airway characteristics were measured. DL (Cormack-Lehane grade 3/4) and DI (assessed by Intubation Difficulty Scale) were evaluated. The optimal cut-off points for SMD and SMDD were identified by using receiver operating characteristic (ROC) analysis. Multivariate logistic regression was used to predict DL and ROC curve was used to assess accuracy on developed regression model. Results: The incidence of DL and DI was 15.4% and 8.3%, respectively. The cut-off values for SMD and SMDD were ≤14.75 cm (sensitivity 66%, specificity 60%) and ≤5.25 cm (sensitivity 70%, specificity 53%), respectively, for predicting DL. The area under the curve (AUC) with 95% confidence interval (CI) for SMD was 0.66 (0.60-0.72) and that for SMDD was 0.687 (0.63-0.74). Multivariate analysis with logistic regression identified inter-incisor distance, neck movement <80°, SMD, SMDD, short neck and history of snoring as predictors and the predictive model so obtained exhibited a higher diagnostic accuracy (AUC: 0.82; 95% CI 0.77-0.86). SMDD, but not SMD, correlated with DI. Conclusions: Both SMD and SMDD provide a rapid, simple, objective test that may help identifying patients at risk of DL. Their predictive value improves considerably when combined with the other predictors identified by logistic regression.