ABSTRACT
Background: Cholelithiasis is one of the most common surgical diseases. About 1-15% adult population have gallstones. The present study is done to compare the frequency and intensity of post-operative shoulder tip pain (VAS) score in standard pressure v/s low pressure cholecystectomy.Methods: The Comparative, Randomized and Prospective study is conducted on 100patients’ under-going Laparoscopic Cholecystectomy for Cholelithiasis with 50 patients in each group: Group A- Low pressure pneumoperitoneum at 7 to 10mm Hg, Group B- Standard pressure pneumoperitoneum at 12 to14mm Hg in the Department of General Surgery, Muzaffarnagar Medical College and hospital. Postoperative pain was measured at 6, 12, 24, 48 hours using a Visual Analogue Scale (VAS). Statistical analysis was carried out using the chi square and independent student t tests with the help of SPSS (statistical package for social sciences, version 17.0). A p value < 0.05 was taken as statistically significant. Results: Low insufflation pressure reduced pain frequency as well as pain intensity after laparoscopic cholecystectomy. Analgesic requirement is also less in low pressure.Conclusion: Low pressurepneumoperitoneum is ideal for laparoscopic cholecystectomy for decrease frequency and intensity of postoperative shoulder tip pain.
ABSTRACT
Background: In 2010, a study estimated the number of smokeless tobacco (SLT) users in 70 countries at 302.4 million. These countries represented 70% of the global population. We aimed to update this information and widen the scope to estimate the global prevalence of SLT use by including a larger number of countries. Methods: Data on the prevalence of current SLT use in 121 countries were obtained from various sources. Country-wise and gender-wise breakdown of the adult population in these countries was derived from the UN World Population for 2015. To translate prevalence rates into an estimate of the number of adult SLT users, we multiplied the adult male and female SLT prevalence rates by the corresponding male and female adult population in the respective countries. We then added the estimated number of male and female SLT users to get an overall estimate of SLT use. Results: There were 352 million SLT users (351.9 million) in 121 countries. Of these, 67% were men (232.7 million) and 33% were women (119.2 million). Nearly 95% (333.1 million) of global SLT users lived in developing countries and only 5% (918.8 million) lived in developed countries; 82.7% of global SLT users lived in the World Health Organization (WHO) South-East Asia Region. Globally, 90.4% of SLT users live in 11 countries of the world: India (237.4 million, 67.5%), Bangladesh (30.9 million), Myanmar (12.6 million), Pakistan (10.1 million), USA (9.6 million), China (4.1 million), Indonesia (3.2 million), Nepal (2.7 million), Madagascar (2.6 million), Germany and Uzbekistan (2.4 million each). Conclusion: Smokeless tobacco use is a global epidemic affecting 121 countries. All 180 countries that have ratified the WHO Framework Convention on Tobacco Control (WHO FCTC) are obliged to monitor SLT use. Parties to the Convention should collect information periodically using standard protocols for national and international comparability. To prevent health and economic losses attributable to SLT use, countries, especially developing countries, should formulate strategies specific to SLT control.