Prognostic value of hematological parameters in older adult patients with acute coronary syndrome undergoing coronary intervention:a single centre prospective study

BACKGROUND Cardiovascular disease is a significant contributor to the disease burden in geriatric patients.Underlying systemic inflammation is thought to be the cause of age-related changes in the bone marrow and a major risk factor for atherosclerosis.The purpose of the study was to assess the accuracy of these hematological biomarkers in predicting 30-day mortality in older patients with acute coronary syndrome(ACS).METHODS This was a prospective observational study of 601 older adult patients(age>60 years)with ACS who underwent percutaneous coronary intervention over two years(2017-2019).The relationship between baseline hematological parameters and mortality was assessed during the 30-day follow-up.Logistic regression analysis and receiver operating characteristic curve analysis were done to evaluate for diagnostic accuracy of various hematological parameters.RESULTS The mean age of presentation was 77±17 years.The mean neutrophil-lymphocyte ratio(NLR)value was 5.07±4.90 and the mean platelet-lymphocyte ratio(PLR)value was 108.65±85.82.On univariate analysis,total leucocyte count[odds ratio(OR)=0.85,P=0.021],hematocrit(OR=0.91,P=0.018),NLR(OR=1.10,P=0.001)and PLR(OR=1.05,P=0.001)were associated with mortality.On receiver operating characteristic curve analysis,NLR predicted mortality with 68.1%and PLR with 65.7%accuracy.On multivariate analysis,NLR(OR=1.096,95%CI:1.006-1.15,P=0.035)was an independent predictor of 30-day mortality.CONCLUSIONS For the risk classification of all elderly ACS patients,we highly advise using NLR rather than the total white blood cell count.

A Novel Edge-Assisted IoT-ML-Based Smart Healthcare Framework for COVID-19

The lack of modern technology in healthcare has led to the death of thousands of lives worldwide due to COVID-19 since its outbreak.The Internet of Things(IoT)along with other technologies like Machine Learning can revolutionize the traditional healthcare system.Instead of reactive healthcare systems,IoT technology combined with machine learning and edge computing can deliver proactive and preventive healthcare services.In this study,a novel healthcare edge-assisted framework has been proposed to detect and prognosticate the COVID-19 suspects in the initial phases to stop the transmission of coronavirus infection.The proposed framework is based on edge computing to provide personalized healthcare facilities with minimal latency,short response time,and optimal energy consumption.In this paper,the COVID-19 primary novel dataset has been used for experimental purposes employing various classification-based machine learning models.The proposed models were validated using kcross-validation to ensure the consistency of models.Based on the experimental results,our proposed models have recorded good accuracies with highest of 97.767%by Support Vector Machine.According to the findings of experiments,the proposed conceptual model will aid in the early detection and prediction of COVID-19 suspects,as well as continuous monitoring of the patient in order to provide emergency care in case of medical volatile situation.

Antibacterial activity of lemongrass(Cymbopogon citratus) oil against some selected pathogenic bacterias

Objective:To find the effectiveness of essential oil of lemongrass for the treatment of pathogenic organisms.Methods:Lemongrass oil was investigated for activity against Staphylococcus aureus (S.aureus),Bacillus cereus(B.cereus),Bacillus subtilis(B.subtilis),Escherichia coli(E.coli), Klebsiella pneumoniae(K.pneumoniae) and Pseudomonas aeruginosa(P.aeruginosa),using Agar Diffusion Method and Broth Dilution Method.Minimum inhibitory concentration(MIC) and minimum bactericidal concentration(MBC) were determined by the Broth Dilution Method. The antibiotic susceptibility test against the test organisms was performed by Disc Diffusion Method.Results:Lemongrass was found effective against all the test organisms except P. aeruginosa.Gram positive organisms were found more sensitive to lemon grass oil as compared to gram negative organisms.The test organisms were found inhibited by Lemon grass oil at lower concentrations in Broth Dilution Method as compared to Agar Diffusion Method.Conclusions: The tested organisms,particularly gram-negative organisms had shown high resistance towards different antibiotics whereas they were found to be inhibited by lemongrass oil even at lower concentration.Thus lemongrass oil is effective against drug resistant organisms.It can be suggested that use of lemongrass oil would be helpful in the treatment of infections caused by multidrug resistant organisms.

Hepatitis E: Discovery, global impact, control and cure

Hepatitis E was identified as an epidemic of non-A, non-B hepatitis from Kashmir, India in 1978. Hepatitis E virus(HEV), the etiological agent is the sole member of family Hepeviridae. The virus has marked heterogeneity and infects many animals like bats, camel, chicken, deer, boar, mongoose, pigs, rats, rabbit and cutthroat trout. Hepatitis E is a disease with a major global impact and has two distinct epidemiological patterns. Hepatitis E is an imperative health issue in developing nations, transmitted through sullied water and happens most every now in young adults. The disease is particularly severe during pregnancy and in people with underlying liver cirrhosis. Autochthonous hepatitis E is increasingly recognized in developed countries. The virus infects domestic pigs, wild boar and Sika deer in these countries. HEV infections in humans occur by eating the undercooked game flesh, raw liver from supermarkets and Figatelli sausages. Blood transfusion-associated HEV infections occur in many countries and screening of donors for HEV RNA is under consideration. Hepatitis E causes a number of extrahepatic diseases, including a wide spectrum of neurological syndromes. HEV genotype 3 causes prolonged viremia, chronic hepatitis, liver fibrosis and cirrhosis in organ transplant patients. The virus is amenable to ribavirin monotherapy and most patients clear the virus in a few weeks. Hepatitis E vaccine-239, marketed in China, has shown high efficacy with sustained protection for over four years.

Hepatobiliary and pancreatic ascariasis

Hepatobiliary and pancreatic ascariasis(HPA) was described as a clinical entity from Kashmir,India in 1985. HPA is caused by invasion and migration of nematode,Ascaris lumbricoides,in to the biliary tract and pancreatic duct. Patients present with biliary colic,cholangitis,cholecystitis,hepatic abscesses and acute pancreatitis. Ascarides traverse the ducts repeatedly,get trapped and die,leading to formation of hepatolithiasis. HPA is ubiquitous in endemic regions and in Kashmir,one such region,HPA is the etiological factor for 36.7%,23%,14.5% and 12.5% of all biliary diseases,acute pancreatitis,liver abscesses and biliary lithiasis respectively. Ultrasonography is an excellent diagnostic tool in visualizing worms in gut lumen and ductal system. The rational treatment for HPA is to give appropriate treatment for clinical syndromes along with effective anthelmintic therapy. Endotherapy in HPA is indicated if patients continue to have symptoms on medical therapy or when worms do not move out of ductal lumen by 3 wk or die within the ducts. The worms can be removed from the ductal system in most of the patients and such patients get regression of symptoms of hepatobiliary and pancreatic disease.

Portal biliopathy

Portal biliopathy refers to cholangiographic abnormalities which occur in patients with portal cavernoma. These changes occur as a result of pressure on bile ducts from bridging tortuous paracholedochal, epicholedochal and cholecystic veins. Bile duct ischemia may occur due prolonged venous pressure effect or result from insufficient blood supply. In addition, encasement of ducts may occur due fibrotic cavernoma. Majority of patients are asymptomatic. Portal biliopathy is a progressive disease and patients who have long standing disease and more severe bile duct abnormalities present with recurrent episodes of biliary pain, cholangitis and cholestasis. Serum chemistry, ultrasound with color Doppler imaging, magnetic resonance imaging with magnetic resonance cholangiopancreatography and magnetic resonance portovenography are modalities of choice for evaluation of portal biliopathy. Endoscopic retrograde cholangiography being an invasive procedure is indicated for endotherapy only. Management of portal biliopathy is done in a stepwise manner. First, endotherapy is done for dilation of biliary strictures, placement of biliary stents to facilitate drainage and removal of bile duct calculi. Next portal venous pressure is reduced by formation of surgical porto-systemic shunt or transjugular intrahepatic portosystemic shunt. This causes significant resolution of biliary changes. Patients who persist with biliary symptoms and bile duct changes may benefit from surgical biliary drainage procedures(hepaticojejunostomy or choledechoduodenostomy).

Evaluation of biomarkers, genetic mutations, and epigenetic modifications in early diagnosis of pancreatic cancer

BACKGROUND Pancreatic cancer(PC)is one of the deadliest malignancies with an alarming mortality rate.Despite significant advancement in diagnostics and therapeutics,early diagnosis remains elusive causing poor prognosis,marred by mutations and epigenetic modifications in key genes which contribute to disease progression.AIM To evaluate the various biological tumor markers collectively for early diagnosis which could act as prognostic biomarkers and helps in future therapeutics of PC in Kashmir valley.METHODS A total of 50 confirmed PC cases were included in the study to evaluate the levels of carbohydrate antigen 19-9(CA 19-9),tissue polypeptide specific antigen(TPS),carcinoembryonic antigen(CEA),vascular endothelial growth factor-A(VEGF-A),and epidermal growth factor receptor(EGFR).Mutational analysis was performed to evaluate the mutations in Kirsten rat sarcoma(KRAS),Breast cancer type 2(BRCA-2),and deleted in pancreatic cancer-4(DPC-4)genes.However,epigenetic modifications(methylation of CpG islands)were performed in the promoter regions of cyclin-dependent kinase inhibitor 2A(p16;CDKN2A),MutL homolog 1(hMLH1),and Ras association domain-containing protein 1(RASSF1A)genes.RESULTS We found significantly elevated levels of biological markers CA 19-9(P≤0.05),TPS(P≤0.05),CEA(P≤0.001),and VEGF(P≤0.001).Molecular genetic analysis revealed that KRAS gene mutation is predominant in codon 12(16 subjects,P≤0.05),and 13(12 subjects,P≤0.05).However,we did not find a mutation in DPC-4(1203G>T)and BRCA-2(617delT)genes.Furthermore,epigenetic modification revealed that CpG methylation in 21(P≤0.05)and 4 subjects in the promoter regions of the p16 and hMLH1 gene,respectively.CONCLUSION In conclusion,CA 19-9,TPS,CEA,and VEGF levels were significantly elevated and collectively have potential as diagnostic and prognostic markers in PC.Global data of mutation in the KRAS gene commonly in codon 12 and rare in codon 13 could augment the predisposition towards PC.Additionally,methylation of the p16 gene could also modulate transcription of genes thereby increasing the predisposition and susceptibility towards PC.

A selective approach to the surgical management of periampullary cancer patients and its outcome

BACKGROUND： Pancreaticoduodenectomy is a high risk, complex, technically challenging operation associated with significant perioperative morbidity and mortality. This study on the surgical management of periampullary cancer patients is based on our experience in a period of nearly 13 years. METHODS： The study was conducted on two groups of patients： group A included 42 patients who were treated between January 2000 and September 2005 and group B included 134 patients who were treated between October 2005 to October 2012. Preoperative, intraoperative and postoperative details of all these patients were collected, tabulated and analyzed to assess the impact of the selective approach introduced in the department with effect from October 2005. RESULTS： Intraoperative details revealed highly significant differences in the management of the two groups of patients in respect of operative time （250.4 vs 126.6 minutes; P〈0.001）, operative blood loss （1070.2 vs 414.9 mL; P〈0.001） and intraoperative blood transfusion （1A vs 0.2 units; P〈0.001）. Variations between the two groups in the frequency of complications were found to be statistically insignificant. However, the difference between the two groups in the overall morbidity of patients （47.6% vs 26.1%; P=0.009） and the length of their hospital stay （11.8 vs 7.8 days; P〈0.001） were significant. CONCLUSION： A selective approach applied to the surgical management of periampullary cancer patients is a step in the right direction.

Connective tissue growth factor expression hints at aggressive nature of colorectal cancer

BACKGROUND Connective tissue growth factor(CTGF)is a mediator of transforming growth factor-beta signaling and plays a key role in connective tissue remodeling,inflammatory processes and fibrosis in various illnesses including cancer.AIM To investigate the role of CTGF in colorectal cancer(CRC)progression and to compare the CTGF expression with different clinicopathological parameters.METHODS Real-time polymerase chain reaction,immunohistochemistry and Western blotting was performed to evaluate the CTGF expression and the results were statistically analyzed against the clinicopathological variables of patient data using STATA software version 16.RESULTS CTGF expression levels in tumor specimens were significantly higher than their paired normal specimens.The higher protein expression levels showed a significant association with smoking,staging,tumor grade,invasion depth,necrosis of tumor tissue,and both lymphovascular and perineural invasion.As per the cox regression model and classification tree analysis,tumor-nodemetastasis stage and perineural invasion were important predictors for CTGF expression and prognosis of CRC patients.Survival analysis indicated that CTGF overexpression was associated with poorer overall and disease-free survival.CONCLUSION Expression of CTGF was increased in CRC and was linked with poor overall and disease-free survival of CRC patients.These findings support prior observations and thus CTGF may be a possible prognostic marker in CRC.

Evaluation of Risk Related to MTHFR 677C>T Gene Polymorphism in Migraine Patients in Kashmiri Population

Objective: Migraine, a common chronic neurological disorder involves a pathophysiology having both multiple genetic and environmental factors. 5, 10-Methylenetetrahydrofolate reductase (MTHFR) involved in folate metabolism has an important role in a cell for folate availability which is critical for DNA integrity. Methods: This case-control study conducted in Srinagar, Kashmir (North India) between 2013 and 2015 was designed to evaluate risk induced due to MTH-FR 677C>T gene polymorphisms to contribute in susceptibility for migraine in Kashmir population (North India). Using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method, we tested the genotype distribution of 100 migraine patients in comparison with 120 healthy migraine-free controls from the same geographical region. Results: The genotypic frequencies of the patients and controls were not significantly associated (p > 0.05). Higher distribution of TT mutant genotype was found in controls as against the cases (5% versus 1%) but association was not significant (p > 0.05). Per copy frequency of T allele (Val) was found to be 0.14 in cases versus 0.19 in controls (p 0.05). Similar scenario was observed when migraine without aura was compared with controls where variant genotype (16% cases versus 39.0% controls: p > 0.05) as well as allele frequency was found to be less in cases (cases 0.15 versus 0.19 controls: p > 0.05). Conclusions: We conclude that MTHFR gene C677T polymorphism has no role in predisposition to the migraine in our population and cannot serve as a predictive factor for the risk of migraine.

Unit cost of CT scan and MRI at a large tertiary care teaching hospital in North India

Imaging department is an important department of a hospital contributing directly to patient care, providing diagnostic support to all specialties which cannot practice efficiently without their support. Hospital administrators are looking for newer tools to control costs without affecting the quality of patient care. It is well known that the escalation of costs for advanced technology has been dramatic and it has been labeled as one of the culprits for great increase in healthcare costs. A prospective study for a period of six months was carried out for calculation of unit cost of radiological investigations CT head, CT chest, CT abdomen and MRI. Unit costs were computed under direct and indirect costs. The actual cost incurred by the hospital on CT head was Rupees 581.40 (US $10.89), CT abdomen Rupees 2339.20 (US $43.83), CT chest Rupees 2339.20 (US $43.83), and MRI Rupees 4497.50 (US $84.28). However, in the hospital patients are charged Rupees 900 (US $16.86) for CT head, Rupees 1200 (US $22.48) for CT abdomen, Rupees 1200 (US $22.48) for CT chest and Rupees 2500 (US $46.85) for MRI. There is a substantial loss of revenue because of subsidies provided to patients in a tertiary care teaching hospital which needs revision of charges.

Tackling SARS-CoV-2 Pandemic: The Way Forward

The world is engaged in containing the COVID Pandemic and controlling further spread and deaths. The global spread of the virus has overwhelmed health systems, and caused widespread social and economic disruption. Some nations have done a better job than rest of the world. The global spread of the virus has overwhelmed health systems, and caused widespread social and economic disruption. There is a strong case that COVID-19 could be with us in one way or another until a vaccine comes on the market or herd immunity is achieved. A long crisis, could stretch the international order to its breaking point. The virus has succeeded in confining almost all human beings in their homes. Balancing act between public health crisis and complex societal implications is an inescapable necessity. The pandemic will alter the world forever. An economic slowdown, severe recession, plummeting revenue, increased expenditure, and mental health issues could be the emerging challenges. There will be increased confidence in technology and nations will invest more in public health. We are passing through fragile and critical times in history. People around the world can prevail in response to this extraordinary challenge. Investing in public health, preparedness, and relying on science will bring a better future. Think of one world, one humanity to shape and secure our future.

An Age of Emerging and Reemerging Pandemic Threats

Today, we are confronted with an unprecedented crisis this world has never experienced before. Infectious diseases remain among the leading causes of death and disability worldwide. Epidemics of new and old infectious diseases periodically emerge, greatly magnifying the global burden of infections. Humans are constantly exposed to a huge diversity of viruses, though those of others mammals are of greatest importance. Persistence of SARS-CoV-2 as an endemic virus may be fueled by pockets of susceptible individuals and waning immunity after infection or vaccination, changes in the virus through antigenic drift that diminish protection and re-entries from zoonotic reservoirs. Moreover, these viruses are very genetically diverse and new genotypes, strains and species evolve rapidly. The emergence of new human viruses is a long-standing and ongoing biological process. We must anticipate the emergence and/or discovery of more new human viruses in the coming years and decades. The spillover of viruses from animals to humans is the major source of pandemic risk. Life threatening situations demand extraordinary response and more stringent measures to contain the pandemic. The first line of defence against emerging viruses is effective surveillance. Rapid detection and identification of emerging pathogen leading to the rapid introduction of preventive measures can prove highly effective in combating outbreaks of novel diseases. A coordinated, global surveillance network is essential if we are to ensure rapid detection of novel viruses. Improving the situation will require both political will and considerable investment in infrastructure, human capacity and new tools. To ensure global preparedness, newer vaccines, diagnostics and antiviral agents are being developed. Infectious diseases can be prevented at a variety of points, depending on the infectious cycle for the particular disease. Disease prevention, health promotion, strengthening public health systems, translational research, focus on drug discovery, tailored therapies by personalized precision medicine, developing newer effective and affordable vaccines are crucial to prevent and control emerging pandemics. The need of the day is to prioritize diagnostic tests and strengthen laboratory response network. Effective communication is an indispensable tool. In a world of 7.8 billion people, countries have to be in a state of emergency preparedness to tackle emerging infectious diseases. There is a need to stop pandemics before they start.

India’s COVID-19 Catastrophe: Cause, Effect &Future Trends

The COVID crisis in India shows no sign of abating. The country of 1.4 billion has passed 30.5 million COVID-19 infections and over 402,000 deaths. Even government figures are likely underestimated due to problems with testing and reporting in the country. Reasonable estimates due to under reporting and lack of testing put these figures at three times higher. The new cases and deaths are predicted to rise by September 2021. The situation is bad in the main cities, but also that it is worse in the poorer and rural areas where lack of healthcare resources has made those populations most vulnerable to the disease. There is an urgent need for rapid tests for quantification of infectiousness to triage patients. In traumatised India, saving lives has become the highest priority to be achieved by vaccinating 70 per cent of the adult population. Over 200 million population have been vaccinated. India’s monthly COVID vaccine manufacturing capacity is about 60 - 65 million doses against the final requirement of 1.45 billion doses to cover 70 per cent adults. Even though the second surge is on a decline in most of the states, mucormycosis continues to be a public health concern. There are 41,000 mucormycosis cases reported during the second wave. Daily increase in Delta plus variant cases should alert the Policy-makers. It has a very high transmissibility. Genomic testing & surveillance of mutations to limit fresh twist of pandemic is a necessity. Only a few drugs have emerged as approved COVID-19 treatments. Where are we with drug treatment? Over 30 billion USD have been spent on vaccine development because it has a market. Very little is spent on research on drug discovery. There has not been any significant antibiotic molecule for the last two decades. Politics has played and continues to play a big part in the spread of the virus but it is a situation that needs a global approach. Tiding over a pandemic requires detailed preparation at multiple levels on the part of the State. New ways to prevent, detect, track and treat SARS-CoV-2 infections are crucial keeping in view the rise of more-transmissible viral mutants like Delta plus.

Lumbar Hernia: An Unusual Presentation of Bear Maul

Introduction: Typical lumbar hernias are very rare surgical conditions. Lumbar hernias can be congenital or acquired. About 25% of all lumbar hernias have a traumatic etiology. Case-Report: We here reported a case of a 55-year-old male who was mauled by a bear. The patient developed an atypical lumbar hernia after 6 months of sustaining craniofacial and abdominal trauma. Open hernioplasty, which was a very challenging job, was done in this patient. Conclusion: Post traumatic lumbar hernias have been reported but till today no case of lumbar hernia following an attack by a bear has been reported in literature. Both acute and long-standing post-traumatic lumbar hernias are rare but challenging conditions. The corrective surgical procedure becomes more complex as hernial defect enlarges. Reconstruction is a challenging aspect of lumbar hernia surgery.

Cytokine- and chemokine-induced inflammatory colorectal tumor microenvironment: Emerging avenue for targeted therapy

Colorectal cancer(CRC)is a predominant life-threatening cancer,with liver and peritoneal metastases as the primary causes of death.Intestinal inflammation,a known CRC risk factor,nurtures a local inflammatory environment enriched with tumor cells,endothelial cells,immune cells,cancer-associated fibroblasts,immunosuppressive cells,and secretory growth factors.The complex interactions of aberrantly expressed cytokines,chemokines,growth factors,and matrix-remodeling enzymes promote CRC pathogenesis and evoke systemic responses that affect disease outcomes.Mounting evidence suggests that these cytokines and chemokines play a role in the progression of CRC through immunosuppression and modulation of the tumor microenvironment,which is partly achieved by the recruitment of immunosuppressive cells.These cells impart features such as cancer stem cell-like properties,drug resistance,invasion,and formation of the premetastatic niche in distant organs,promoting metastasis and aggressive CRC growth.A deeper understanding of the cytokineand chemokine-mediated signaling networks that link tumor progression and metastasis will provide insights into the mechanistic details of disease aggressiveness and facilitate the development of novel therapeutics for CRC.Here,we summarized the current knowledge of cytokine-and chemokine-mediated crosstalk in the inflammatory tumor microenvironment,which drives immunosuppression,resistance to therapeutics,and metastasis during CRC progression.We also outlined the potential of this crosstalk as a novel therapeutic target for CRC.The major cytokine/chemokine pathways involved in cancer immunotherapy are also discussed in this review.

Wernicke's encephalopathy in exclusive breastfed infants

Background:Kashmir has a population that largely consumes polished rice which is deficient in thiamine.Furthermore,lactating women in this region are prone to severe thiamine deficiency because of their traditional food avoidance practices.Infantile beriberi is common in exclusively breastfed infants of thiamine deficient mothers in Kashmir.Methods:This was a one year prospective hospitalbased study.We included 50 exclusively breastfed infants in our study.AH patients were evaluated as per unit protocol including complete septic workup and metabolic workup.Most of our patients belonged to low and middle income group families,and mothers were on customary dietary restriction.Demographic and anthropometric data were collected from all the study participants.In addition,data regarding the treatments received by the study population and overall mortality were collected.Results:The mean age,male:female ratio,and mean weight of the study population were 3.15±0.97 months,1.5∶1,and 5.1±1.1 kg,respectively.Traditional food avoidance practices were followed by 80% of the mothers.Irritability was observed in 40 (80%) patients.Blepharoptosis was observed in 30 (60%).Septic workup including cerebro spinal fluid analysis was normal in all patients.Predominant magnetic resonance imaging finding was bilateral basal ganglia hyperintensity.Whole blood thiamine diphosphate levels showed a drastic decrease (10-49 nmol/L).Ten percent of the study infants died.Conclusion:In exclusively breasffed infants,we observed acute infantile encephalopathy with epidemiological,clinical,biochemical,and radiological features suggestive of infantile Wernicke's encephalopathy and a favourable therapeutic response to thiamine supplementation during the acute stage.

Malignant eccrine acrospiroma with nodal and bone metastasis

Acrospiromas are cutaneous tumors of sweat duct differentiation.Although various eccrine sweat gland tumours including benign acrospiroma are widely reviewed,malignant acrospiroma is rarely reported.Clinically,they resemble other cutaneous lesions and the primary treatment is wide local excision with or without lymph node dissection.The efficacy of adjuvant chemotherapy and radiation therapy requires further investigation.

Effect of fluoroscopy frame rate on radiation exposure and in-hospital outcomes in cardiovascular implantable electronic device implantation procedures

Objective:To assess the radiation exposure in cardiovascular implantable electronic device(CIED)implantation procedures,the effect of fluoroscopy frame rate on various radiation exposure indices,and in-hospital outcomes.Methods:Data of CIED implantation procedures from September 2015 to December 2019 of all the CIED implantation procedures performed at our institute were retrospectively analyzed.The procedural data were divided into two groups:a)pre-group:procedures that were performed under fluoroscopy frame rate of 7.5 frames per second(fps);b)post-group:procedures that were performed under fluoroscopy frame rate of 3.75 fps.We compared procedure time,fluoroscopy time,Kerma air product,effective dose,and in-hospital outcomes between the two groups.Results:A total of 2,225 procedures were included in the analysis with mean age of(62±15)years.The procedures consisted of the implantation of single-chamber(n=1,436),double chamber(n=656),and biventricular devices(n=133).Procedure time and radiation indices showed a significant reduction over the study period(P<0.001).Reduction in the fluoroscopy frame rate was associated with a significant reduction in radiation exposure indices(P<0.001).In-hospital outcomes did not differ between the two groups.Conclusions:Reduction in the fluoroscopy frame rate from 7.5 to 3.75 fps significantly decreased the radiation exposure in CIED implantation procedures.A framerate lower than 3.75 fps should be the default setting during such procedures.