This paper describes the Bárány Society Classification OverSight Committee (COSC) position on Cervical Dizziness sometimes referred to as Cervical Vertigo. This involved an initial review by a group of experts across a broad range of fields, and then subsequent review by the Bárány Society COSC. Based upon the so far published literature, the Bárány Society COSC takes the view that the evidence supporting a mechanistic link between an illusory sensation of self-motion (spinning or otherwise) and neck pathology and/or symptoms of neck pain - either by affecting the cervical vertebra, soft tissue structures or cervical nerve roots - is lacking. When a combined head and neck movement triggers an illusory sensation of spinning, there is either an underlying common vestibular condition such as migraine or BPPV or less commonly a central vestibular condition including, when acute in onset, dangerous conditions such as a dissection of the vertebral artery with posterior circulation stroke and, exceedingly rarely, a vertebral artery compression syndrome. The Committee notes however, that migraine, including vestibular migraine, is by far, the commonest cause for the combination of neck pain and vestibular symptoms. The committee notes that since head movement aggravates symptoms in almost any vestibular condition, the common finding of increased neck muscle tension in vestibular patients, may be linked as both cause and effect, to reduced head movements. Additionally, there are theoretical mechanisms, which have never been explored, whereby cervical pain may promote vaso-vagal, cardio-inhibitory reflexes and hence by presyncopal mechanisms, elicit transient disorientation and/or imbalance. The committee accepts that further research is required to answer the question as to whether those rare cases in which neck muscle spasm is associated with a vague sense of spatial disorientation and/or imbalance, is indeed linked to impaired neck proprioception. Future studies should ideally be placebo controlled and double-blinded where possible, with strict inclusion and exclusion criteria that aim for high specificity at the cost of sensitivity. To facilitate further studies in “cervical dizziness/vertigo”, we provide a narrative view of the important confounds investigators should consider when designing controlled mechanistic and therapeutic studies. Hence, currently, the Bárány COSC, refrains from proposing any preliminary diagnostic criteria for clinical use outside a research study. This position may change as new research evidence is provided.
Introduction: Soluble Suppression of Tumourigenicity 2 (sST2) represents a clinically relevant biomarker and has predictive evidence in acute Myocardial Infarction (MI) and predicts cardiovascular death and risk of heart failure development in these patients. The data about the correlation of sST2, N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) and high-sensitivity C-reactive protein (hsCRP)in the Indian population is lacking. Aim: To find a correlation of ST2 level at the time of admission with NT-proBNP, hsCRP and Left Ventricular Ejection Fraction (LVEF) in patients with MI, and the association of ST2 levels with mortality. Materials and Methods: This longitudinal observational study was conducted at Poona Hospital and Research Centre, Pune, Maharashtra, India, between June 2018 and August 2019, among 75 myocardial infarction patients above 18 years of age. ST2, NT-proBNP and hsCRP levels were checked within 6 hour of hospitalisation. The primary outcome measures were to study the correlation of ST2 levels at the time of admission with hsCRP, NT-proBNP and LVEF. The secondary outcome measures were to study the association of ST2 levels with in-hospital and onemonth mortality. The medians of continuous variables of two groups and three groups were-tested using the Mann-Whitney U test and Kruskal-Wallis H test respectively. The correlation analysis was performed using Spearman’s method. Results: The mean age of the study population was 57.8±7.2 years. The mortality rate was 60% (12/75). ST2 levels showed a statistically significant positive correlation with NT-proBNP (r =0.703, p-value=0.001) and hsCRP (r=0.873, p-value=0.001), whereas, ST2 levels showed a negative correlation with LVEF (r=- 0.711, p-value=0.001) in MI patients. The median ST2 levels were significantly higher in-hospital (215.3 ng/dL vs 94 ng/dL) and one month (219.5 ng/dL vs 92.0 ng/dL) mortality as compared to survived MI patients. Conclusion: ST2 levels showed a statistically significant positive correlation with NT-proBNP and hsCRP and were associated with in-hospital and one month mortality in MI patients.
There are many studies in India that have compared direct laryngoscopy and video laryngoscopy in adults but the published data regarding paediatric population which needs special consideration is limited. The present study was aimed to compare the efficacy of video laryngoscopy and direct laryngoscopy in endotracheal intubation in paediatric patients. The present randomised controlled research was done in 64 children of one to five years that underwent pre-planned surgery. Children were divided into direct laryngoscopy and video laryngoscopy groups by randomization. The comparison of the time required for the best visualisation of glottis was the primary outcome measure. The comparison of the time to intubation and number of attempts were the secondary outcome measures. An unpaired student’s t-test and the Chi-square/ Fisher’s exact tests were used to compare the quantitative and qualitative variables respectively. Mean time required for the best visualisation of video laryngoscopy and direct laryngoscopy was 6.1 sec and 5.3 sec respectively (p-value = 0.010). The mean time to intubation of video laryngoscopy was 15.3 sec while that of direct laryngoscopy was 13.1 sec (p-value = 0.001). The first attempt success rate was 29/32 (90.6%) in the video laryngoscopy group whereas it was 28/32 (87.5%) in the direct laryngoscopy group (p-value = 0.580). Time required for the best visualisation of glottis and time to intubation were significantly higher in video laryngoscopy as compared to direct laryngoscopy group.
Purpose: WHO recommends dolutegravir (DTG) based regimens as first-line treatment for HIV-1 infection. However, few studies have been conducted in Indian population. Hence, our study evaluated the safety, tolerability, and efficacy of DTG 50 mg with Tenofovir and Lamivudine (300/300mg) fixed dose combination in treatment naïve adult Indian patients. Methods: This was an open label, multicenter, prospective, interventional, phase IV study conducted across 14 sites between February 2019 and July 2020. 24 weeks was the treatment duration for each subject. The primary end point was to assess the incidence of adverse events (AEs) and secondary end points were to assess the proportion of patients achieving plasma HIV-1 RNA levels <50 copies/mL at week 24 and change in CD4+ cell count from the baseline. Safety analysis was conducted using Safety Analysis Set and efficacy analysis was carried out using Full Analysis Set and Per protocol set. Results: A total of 288 patients were screened; 250 were enrolled; and 229 completed the study. 389 AEs were reported from 58% of patients. Of these, 61 were related to study treatment. One event of decreased creatinine clearance led to study discontinuation. One serious event of pyrexia was reported, which was unrelated to the study drug. The most common AEs were headache (18%), pyrexia (14%), vomiting (6.4%) and upper respiratory tract infections (6%). No deaths were reported. At week 24, 86.8% of the patients achieved plasma HIV-1 RNA levels <50 copies/mL and the mean CD4 cell count increased from 350.2 (SD, 239.73) at baseline to 494.6 (SD, 261.40) with an average increase of 143.2 (SD, 226.14) cells. Conclusion: This study demonstrated the safety and efficacy of DTG based regimen in treatment naïve HIV-1 patients in Indian population and support use of DTG as first-line treatment regimen.
Background: An association between increased incidence of acute myocardial infarction (AMI) and elevated levels of stored iron concentration was recently reported. The data in India regarding association between AMI and levels of serum ferritin are lacking. Objectives: To study the association between serum ferritin level and risk of AMI. Materials and methods: The present case-control study was conducted from May 2016 to October 2017 on 64 patients aged ≥30 years of either sex who were diagnosed with AMI (group I) and 60 controls (group II). Patients who attended outpatient department of hospital for minor illnesses, routine health checkups, and persons accompanying patients were selected randomly as controls. The controls had no signs of AMI or coronary heart disease (CHD) on clinical examination and had normal electrocardiogram (ECG). Quantitative measurement of serum ferritin was done in all subjects. The Chi-square or Fisher's exact test and unpaired t-test were used to compare the categorical and quantitative variables, respectively. The independent association of serum ferritin with AMI was tested using multivariate logistic regression analysis. Results: The mean serum ferritin level was significantly higher in group I (203.5 µg/L) as compared to group II (111.8 µg/L). In group I, 82.9% patients had serum ferritin ≥150 µg/L as compared to group II (15.0%) with p-value = 0.001. Multivariate analysis showed history of smoking, body mass index (BMI) >25 kg/m2 , serum ferritin levels >200 µg/L, and high-density lipoprotein (HDL) cholesterol level <35mg/dL were independent and significant determinants of AMI. Conclusions: There was an association between elevated serum ferritin levels with AMI.
Hypertension guidelines recommend measuring blood pressure (BP) in both arms at least once. However, this is seldom done due to uncertainties regarding measurement procedure and the implications of finding a clinically important inter‐arm BP difference (IAD). This study aimed to provide insight into the prevalence of clinically important IADs in a large Indian primary care cohort. A number of 134 678 (37% female) unselected Indian primary care participants, mean age 45.2 (SD 11.9) years, had BP measured in both arms using a standardized, triplicate, automated simultaneous measurement method (Microlife WatchBP Office Afib). On average, there were clinically minor differences in right and left arm BP values: systolic BP 134.4 vs 134.2 mmHg (p < .01) and diastolic BP 82.7 vs 82.6 mmHg (p < .01), respectively. Prevalence of significant mean systolic IAD between 10 and 15 mmHg was 7,813 (5.8%). Systolic IAD ≥ 15 mmHg 2,980 (2.2%) and diastolic IAD ≥ 10 mmHg 7,151 (5.3%). In total, there were 7,595 (5.6%) and 8,548 (6.3%) participants with BP above the 140/90 mmHg threshold in only the left or right arm, respectively. Prevalence of participants with elevated BP on one arm only was highest in patients with a systolic IAD ≥ 15 mmHg; 19.1% and 13.7%, for left and right arm, respectively. This study shows that a substantial prevalence of IAD exists in Indian primary care patients. BP is above the diagnostic threshold for hypertension in one arm only for 6% of participants. These findings emphasize the importance of undertaking bilateral BP measurement in routine clinical practice.
Background: Many studies found that only hypomagnesemia, but not hypermagnesemia is linked with increased mortality. However, reports of mortality due to magnesium dysregulation in the critical care setting are controversial. Objectives: To study serum magnesium levels in critically ill patients on admission in intensive care unit (ICU) and its correlation with patient's need and duration for ventilator support, duration of ICU stay, incidence of cardiac arrhythmias and mortality Methods: Two hundred forty six critically ill patients admitted in ICU with Acute Physiology and Chronic Health Evaluation (APACHE) II scores>10, were included for this prospective observational study. Serum total magnesium level was measured at the time of admission to ICU. Primary outcome measure was ICU mortality whereas, secondary outcome measures were patient's need and duration for ventilator support, duration of ICU stay, and incidence of cardiac arrhythmias. Categorical and continuous variables were tested using Chi-square/Fisher's exact test and analysis of variance respectively. Multivariate logistic regression analysis was carried out to determine association of serum magnesium levels with ICU mortality. Results: Incidence of ICU mortality was significantly higher in group of patients with hypomagnesemia compared to those with normal magnesium levels. Hypomagnesemia was associated with need and longer duration of ventilator support, longer duration of ICU stay, higher APACHE II score, QTc prolongation, higher incidence of cardiac arrhythmias compared to patients with normal magnesium levels. Hypomagnesemia was an independent and statistically significant determinant of ICU mortality. Conclusions: Hypomagnesemia was associated with higher mortality rate, longer duration of ventilator support and ICU stay, and higher APACHE II score in critically ill patients.
There is paucity of Indian data regarding the use of sedation for endobronchial ultrasound. We compared the efficacy of etomidate and propofol in patients undergoing endoscopic bronchial ultrasound for the achievement of satisfactory sedation. Seventy patients aged more than 18 years posted for endoscopic bronchial ultrasound under sedation for diagnostic and therapeutic purpose were included in this randomised double- blind controlled study. Patients were randomly allocated to propofol and etomidate group. Comparison of cardiovascular adverse events and haemodynamic parameters were the primary objectives. Comparison of gag reflex, visual analogue scale score and recovery from sedation using Modified Aldrete Score were the secondary objectives. Patient satisfaction in terms of visual analogue scale score was the same in both propofol and etomidate groups. Endoscopist’s satisfaction was significantly higher in etomidate group as compared to propofol group. The post-operative hypotension was significantly lower in etomidate group as compared to propofol group. The post-operative bradycardia was significantly lower in etomidate group as compared to propofol group. Endoscopist’s satisfaction and the haemodynamic control was better in etomidate group as compared to propofol group during endobronchial ultrasound.
Objective The aim of the present study was to find a correlation of serum Suppression of tumorigenicity 2 (ST2) levels with severity of diastolic dysfunction on echocardiography and cardiac magnetic resonance imaging (CMRI) in heart failure with preserved ejection fraction (HFpEF) patients. Methods Fifty patients aged ≥ 18 years fulfilling diagnostic criteria for HFpEF were included. ST2 levels, 2D echocardiography and CMRI were performed. Left ventricular ejection fraction, E/A, Septal E/E’, left atrial volume index (LAVI), tricuspid regurgitation (TR), assessment of diastolic dysfunction, T1 mapping in milliseconds and late gadolinium enhancement (LGE) in percentage were noted. The primary outcome measure was to study correlation of ST2 levels with severity of diastolic dysfunction, whereas the secondary outcome measures were to study correlation of ST2 levels with native T1 mapping and LGE on CMRI. Results ST2 levels showed statistically significant and positive correlation with E/E’ (r = 0.837), peak TR velocity (r = 0.373), LAVI (r = 0.74), E/A (r = 0.420), and T1 values in milliseconds (r = 0.619). There was no statistically significant correlation between ST2 level and LGE in % (r = 0.145). The median ST2 levels in patients with E/E’ > 14 and E/E’ ≤ 14 were 110.8 and 36.1 respectively (p-value < 0.05). The mean ST2 levels were significantly higher in patients who had diastolic dysfunction grade III (126.4) and New York Heart Association class IV (133.3). Conclusions Evaluation of ST2 adds important information to support the diagnosis of left ventricular diastolic dysfunction in patients with HFpEF.
The incidence of a post-operative sore throat (POST) varied from 21%–100% in intubated patients. Numerous non-pharmacological and pharmacological measures have been used for attenuating POST with variable success. The aim of the present study was to compare the efficacy of amyl meta cresol-2,4-dichlorobenzyl alcohol (AMC-2,4-DCBA) lozenges against warm normal saline (0.9%) gargles versus control in preventing and treating POST after extubation of the patients who have undergone surgical procedures under general anaesthesia. This single-blind randomised controlled study was conducted in 120 patients. Group S patients received one honey and lemon-flavoured AMC-2,4-DCBA lozenge. Group G and Group C patients received warm normal saline and distilled water for gargling respectively. Assessment of POST was carried out at 1 h, 12 h and 24 h. The primary outcome measure was to compare the degree of sore throat whereas secondary outcome measure was to compare patient comfort in terms of relief of symptoms. Comparison of quantitative and qualitative variables was done using analysis of variance test and chi-square test/Fisher’s exact test respectively. There was no statistically significant difference between Group S, Group G and Group C in relation to Ramsay sedation score, supplemental analgesics given, three-point assessment score at 1 h, 12 h, and 24 h. AMC-2,4-DCBA lozenges offered the maximum benefit in terms of patient comfort of POST symptoms at the end of 24 h post-surgically. Amyl meta cresol-2,4-dichlorobenzyl alcohol lozenges and warm normal saline gargles did not show a significant benefit in relieving post-operative sore throat in the post-surgical period as compared to the placebo.
BACKGROUND Displaced odontoid fractures that are irreducible with traction and have cervicomedullary compression by the displaced distal fracture fragment or deformity caused by facetal malalignment require early realignment and stabilization. Realignment with ultimate solid fracture fusion and atlantoaxial joint fusion, in some situations, are the aims of surgery. Fifteen such patients were treated with direct anterior extrapharyngeal open reduction and realignment of displaced fracture fragments with realignment of the atlantoaxial facets, followed by a variable screw placement (VSP) plate in compression mode across the fracture or anterior atlantoaxial fixation (transarticular screws or atlantoaxial plate screw construct) or both. OBSERVATIONS Anatomical realignment with rigid fixation was achieved in all patients. Fracture fusion without implant failure was observed in 100% of the patients at 6 months, with 1 unrelated mortality. Minimum follow-up has been 6 months in 14 patients and a maximum of 3 years in 4 patients, with 1 unrelated mortality. LESSONS Most irreducible unstable odontoid fractures can be anatomically realigned by anterior extrapharyngeal approach by facet joint manipulation. Plate (VSP) and screws permit rigid fixation in compression mode with 100% fusion. Any associated atlantoaxial instability can be treated from the same exposure.
Objective Large data on the clinical characteristics and outcome of COVID-19 in the Indian population are scarce. We analysed the factors associated with mortality in a cohort of moderately and severely ill patients with COVID-19 enrolled in a randomised trial on convalescent plasma. Design Secondary analysis of data from a Phase II, Open Label, Randomized Controlled Trial to Assess the Safety and Efficacy of Convalescent Plasma to Limit COVID-19 Associated Complications in Moderate Disease. Setting 39 public and private hospitals across India during the study period from 22 April to 14 July 2020. Participants Of the 464 patients recruited, two were lost to follow-up, nine withdrew consent and two patients did not receive the intervention after randomisation. The cohort of 451 participants with known outcome at 28 days was analysed. Primary outcome measure Factors associated with all-cause mortality at 28 days after enrolment. Results The mean (SD) age was 51±12.4 years; 76.7% were males. Admission Sequential Organ Failure Assessment score was 2.4±1.1. Non-invasive ventilation, invasive ventilation and vasopressor therapy were required in 98.9%, 8.4% and 4.0%, respectively. The 28-day mortality was 14.4%. Median time from symptom onset to hospital admission was similar in survivors (4 days; IQR 3–7) and non-survivors (4 days; IQR 3–6). Patients with two or more comorbidities had 2.25 (95% CI 1.18 to 4.29, p=0.014) times risk of death. When compared with survivors, admission interleukin-6 levels were higher (p<0.001) in non-survivors and increased further on day 3. On multivariable Fine and Gray model, severity of illness (subdistribution HR 1.22, 95% CI 1.11 to 1.35, p<0.001), PaO 2 /FiO 2 ratio <100 (3.47, 1.64–7.37, p=0.001), neutrophil lymphocyte ratio >10 (9.97, 3.65–27.13, p<0.001), D-dimer >1.0 mg/L (2.50, 1.14–5.48, p=0.022), ferritin ≥500 ng/mL (2.67, 1.44–4.96, p=0.002) and lactate dehydrogenase ≥450 IU/L (2.96, 1.60–5.45, p=0.001) were significantly associated with death. Conclusion In this cohort of moderately and severely ill patients with COVID-19, severity of illness, underlying comorbidities and elevated levels of inflammatory markers were significantly associated with death. Trial registration number CTRI/2020/04/024775.
Ticagrelor is a potent, oral P2Y12 inhibitor used as a part of dual antiplatelet therapy (DAPT) in acute coronary syndromes (ACS). New evidence has emerged for its use in ACS, which may be crucial for the Indian context. This brought together nearly 150 experts in ACS management across the country who reviewed the current evidence and discussed the same through a series of 10 meetings on an online platform. With all experts' agreement, the key expert opinions for the P2Y12 inhibitors use in ACS management were finalized. These include the following. In ACS patients aged <75 years, with diabetes, a history of stroke/transient ischemic attack, and chronic kidney disease, ticagrelor may be preferred over other P2Y12 inhibitors. It may also be preferred in the elderly above 75 years with clopidogrel is a suitable alternative in patients at high-risk of bleeding. Rates of stent thrombosis are lower with ticagrelor than clopidogrel. In patients managed with fibrinolysis, use ticagrelor after 48 hours if streptokinase was the fibrinolytic agent or it can be used after 12 to 24 hours if fibrin-specific fibrinolytic was used. Rates of major bleeding in patients treated with fibrinolysis are similar to clopidogrel. Prehospital administration may be preferred over in-hospital administration with expected bleeding rates similar to clopidogrel. Switching among P2Y12 inhibitors should be done with due consideration of their pharmacodynamics. At present, DAPT should be continued for 12 months with discontinuation after three to six months in patients with high bleeding risk. The use of low dose ticagrelor may be considered in cases with high-bleeding risk. DAPT or ticagrelor continuation beyond one year should be individualized considering ischemic and bleeding risks. Dyspnea is a common, mild, and transient and does not necessitate ticagrelor discontinuation. Severe dyspnea should be investigated thoroughly. In conclusion, ticagrelor (180 mg, 90 mg, and 60 mg doses), a potent antiplatelet is expected to reshape the antiplatelet use in the management of ACS.
Percutaneous coronary intervention (PCI) in very small vessel coronary arteriesis challenging due to adverse short-term as well as long-term outcomes. This single-arm, open-label, observational study assessed 1-year clinical outcomes of drug-eluting stents (DES) in Indian patients undergoing PCI for symptomatic very small-calibre coronary artery disease. It enrolled 66 Indian patients with 74 very small coronary artery lesions (reference vessel diameter: ≥2.0 and ≤2.25mm); eligible for implantation with 2.25 mm DES. The primary endpoint of major adverse cardiovascular events (MACE) was 3.0% indicating favourable 1-year clinical outcomes of DES in very small coronary artery lesions in Indian patients.
Objective Determining the lateralizing value of lying-down nystagmus (LDN) in horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV). Methods The authors prospectively investigated LDN in 35 consecutive patients of HSC-BPPV (28 geotropic and 7 apogeotropic variants) attending an Otoneurology Centre in South Rajasthan India over a period of 20 months. Results LDN was present in 45.7% (16/35) patients of HSC-BPPV; 50% in those with geo-HSC-BPPV (14/28), and 28.6% (2/7) with apo-HSC-BPPV. When present, LDN directs contralaterally in 93% of geo-HSC-BPPV (13/14) and ipsilaterally in 100% of apo-HSC-BPPV (2/2). Only in 1 out of the 35 patients (2.9%), LDN was solitarily decisive in lateralizing the affected canal as the supine roll test elicited nystagmus of symmetric strength on the lateral head roll to either side. Conclusion LDN is an important secondary sign of lateralization (SSL) in patients with HSC-BPPV (both geotropic and apogeotropic variants). LDN direction is mainly corroborative, but rarely when the lateral head rolls to either side elicits LDN of symmetric strength to either side, it can be solitarily relied on for lateralization.
Introduction: Anterior retropharyngeal realignment, distraction, and atlantoaxial fixation are an option for the treatment of symptomatic basilar invagination (BI). The anterior implants for distraction and fixation for atlantoaxial joints are still evolving. We share our experience using a novel implant which can easily, safely, and rigidly fix both lateral masses to the body of the axis. Methods: After exposing both the atlantoaxial joints anteriorly, the joints were prepared, distracted with wedge shaped autologous tricorticate bone grafts and realigned to correct the cervicomedullary strain. The atlantoaxial joints were fixed using a novel titanium plate by passing screws upwards and laterally into the lateral masses of the atlas and centrally into the body of the axis. Post-operative imaging showed effective correction of BI and atlantoaxial dislocation. Post-operative dynamic X-ray images confirmed maintenance of rigid fixation at 6 months. Conclusion: This new plate screw construct is safe, easy, cost-efficient, and biomechanically appealing option for the treatment of symptomatic BI.
A retrospective cohort study was conducted to assess clinical characteristics and outcomes of COVID-19 amongst People Living with HIV (PLHIV) in Western India. Out of 86 PLHIV with COVID-19 illness, 19.7% had severe/critical illness and 6 (6.9%) individuals died. Median (IQR) age was 51 (47-56) years and 77.6% were male. Eighty-five PLHIV were on antiretroviral treatment with 98% having a Viral load < 200 copies/ml. Hypertension (38.3%) and Diabetes mellitus (17.4%) were commonest co-morbidities. Fifty-eight percent PLHIV were hospitalized while 6.9% individuals needed Intensive care. Presence of medical co-morbidity was significantly associated with severe/critical COVID-19, while Hypertension was significantly associated with mortality. Recovery from COVID-19 was documented in 93% PLHIV. In conclusion, PLHIV in Western India have similar COVID-19 clinical outcomes as compared to that reported historically amongst general population. Presence of medical co-morbidities rather than HIV related disease characteristics are associated with severe COVID-19 illness.
The reported incidence of shoulder tip pain after laparoscopic cholecystectomy was 30%–50%. The aim of the present randomized controlled study was to compare the effects of low-pressure (08–10 mm Hg) vs. standard-pressure (13–15 mm Hg) pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. One hundred patients between 18 and 70 years undergoing laparoscopic cholecystectomy were included. Group A and group B patients underwent low-pressure and standard-pressure pneumoperitoneum laparoscopic cholecystectomy respectively. Post-operative shoulder tip pain and post-operative abdominal pain were measured using visual analogue scale score at 2 h, 8 h, 24 h and 48 h after surgery. The primary outcome measures were the incidence and severity of post-operative shoulder tip pain, whereas secondary outcome measures were the incidence and severity of abdominal pain. Intergroup comparison of categorical and continuous variables was done using the chi-square test/Fisher’s exact test and unpaired ‘t’ test respectively. The incidence and severity of post-operative shoulder tip pain at 2 h, 8 h, 24 h and 48 h was significantly higher in group B as compared to group A. The incidence of post-operative abdominal pain at 48 h was significantly higher in group B as compared to group A. The severity of post-operative abdominal pain at 24 h and 48 h was significantly higher in group B as compared to group A. Low-pressure laparoscopic cholecystectomy significantly decreases the incidence and severity of post-operative shoulder tip and abdominal pain. Routine use of low-pressure pneumoperitoneum for the alleviation of post-operative pain following laparoscopic cholecystectomy is recommended.
Objectives The direct correlation between Echocardiographic non-coronary calcium score (ECS) and lesion severity on invasive coronary angiography (ICA) is not reported. The aim of the present study was to find the correlation between ECS and Gensini score. Methods One hundred seventy patients aged ≥ 18 years posted for clinically indicated ICA were included. All the patients underwent standard transthoracic echocardiography. ECS and Gensisni scores were calculated. The primary outcome measure was to find a correlation of ECS with Gensini score, whereas the secondary outcome measure was to correlate ECS with traditional risk factors for coronary artery disease. The Chi-square/Fisher exact test was used to compare qualitative variables. Spearman's correlation analysis was used for assessing the correlation between ECS score and the Gensini score. Receiver-operating characteristic curve analysis was performed to detect the cut-off value of the ECS score. Results The correlation of total ECS with Gensini score was positive and statistically significant (r = 0.550, p-value < 0.0001). As ECS increased, the Gensini score increased. ECS value of > 1 detected CAD with 56.5% sensitivity, 79.5% specificity. Eight-nine percent of patients who had ECS > 1, had Gensini score ≥ 18, whereas 44.3 % of patients who had ECS ≤ 1, had Gensini score ≥ 18. The patients with ECS > 1 had significantly higher Gensini scores than the patients with ECS ≤ 1. Conclusions The correlation of total ECS with Gensini score was positive and statistically significant.
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