Palm print sign in prediction of difficult laryngoscopy in diabetes.

Sir,

The report on “palm print (PP) sign in prediction of difficult laryngoscopy in diabetes[1]” is very interesting. Hashim and Thomas reported that “the PP test appears to be the most sensitive and specific in the prediction of difficult laryngoscopy in diabetic patients.[1]” In fact, the finding partially agrees with previous reports. Good sensitivity of the PP test in diabetes can be seen in many reports including the present report and that of Vani et al.[2] and Nadal et al.[3] However, the specificity of the test is not shown to be good in the previous reports.[23] In medical statistics, the test that has both good sensitivity and specificity is rarely available. Finally, since the diabetic patients tend to have peripheral neuropathy, wounds on extremities can easily occur. This can limit the usefulness of of PP test in some some diabetic patients with the chronic wound on hands.