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Placental polyp is retained placental tissue within the endometrial cavity, which forms a nidus for inflammation and bleeding. Placental polyp is a rare entity with an incidence of less than 0.25% of all pregnancies as reported. Here, we report a case of 23-year-old P2L2 woman with complaints of intermittent vaginal bleeding since her recent normal vaginal delivery, 1.5 months back. A polypoid mass (51×41 mm) with abundant vascularity was detected as retained products of placenta (RPOC) within the endometrial cavity by imaging studies. A combination of polypoidal mass within the endometrial cavity with normal beta human chorionic gonadotropin (hCG) of

Background: Postpartum haemorrhage is a single major and leading cause of maternal morbidity and mortality. PPH is the loss of more than 500 ml blood following vaginal delivery or 1000 ml blood following caesarean section. India has a maternal mortality ratio of 167 per 1 lakh live births. The most common cause of maternal mortality is haemorrhage which accounts for 25-30% of maternal mortality of which PPH is a significant cause. Methods: 200 patients were included in this prospective observational study and divided into two groups, group A, underwent only active management of third stage of labour and group B received intra umbilical oxytocin administration in addition to AMTSL. The maternal and neonatal outcome was observed between the two and the difference was noted. Results: Mean duration of third stage of labour of group A patients was 3.89±0.89 minutes and Mean blood loss was 386±85.30 ml and that of group B patients was 1.96±0.68 minutes and 235±72.99 ml respectively. These were found to be statistically significant among all the other parameters. Conclusions: The duration of third stage of labour and the amount of postpartum blood loss was significantly less when intra umbilical injection of oxytocin was used in addition to AMTSL. So, to conclude intra umbilical vein oxytocin injection should be used routinely in addition to AMTSL in order to prevent PPH.

In order to assess the impact of power trade in the backdrop of falling Renewable Energy technology (RE) prices, we developed a power system model for each country in the South Asia BBIN sub-region (Bangladesh, Bhutan, India, and Nepal). High Trade and Low Trade scenarios are developed with unrestricted and restricted power trade possibilities respectively. Cost decline in RE increases Cross- Border Electricity Trade (CBET) from 13 TWh in 2019 to 976 TWh by 2050. The share of RE capacities in the total installed capacities for the region rises to 75% by 2050 under the High Scenario compared to 68% in the Low Scenario. Higher solar and wind mobilize more hydropower and reduce coal capacities and CO2 emissions. Thus, the electricity trade helps to reach higher utilization of power capacities and reduces costs and CO2 emissions, This material has been produced under the Climate Compatible Growth (CCG) programme. CCG brings together leading research organizations and is led out of the STEER centre, Loughborough University. CCG is funded by UK aid from the UK government. However, the views expressed herein do not necessarily reflect the UK government's official policies.

Introduction Severe tricuspid valve regurgitation (TR) is associated with increased 1-year morbidity and mortality. Characterization by valve etiology (primary, secondary, and lead-associated), a classification borrowed from mitral valve disease, has not been universally shown to correlate with outcomes. Purpose Among a large, racially diverse cohort with newly identified severe TR, we aimed to 1) characterize outcomes of severe TR by etiology, and 2) assess whether unsupervised phenoclustering or supervised outcome-driven prediction trees were more effective in establishing subgroups of TR with differential clinical risk profiles. Methods We retrospectively analyzed outcomes of 5-year all-cause death and a composite of death or heart failure hospitalization (HFH) among adult patients with new severe TR identified by echocardiography between 2007 to 2018 at a large academic tertiary referral center in the United States. Patients were initially categorized by etiology of TR, including primary, secondary, and lead-associated. Second, we separately applied unsupervised hierarchical clustering to identify distinct clusters using demographics, clinical, and echo data at the time of diagnosis. Third, we applied a supervised recursive partitioning algorithm (survival trees) by each outcome to identify distinct TR subgroups. We estimated the cumulative incidence of death and composite death or HFH over 5 years by 1) etiology of TR, 2) distinct clusters, and 3) groups identified by supervised learning (prediction trees). Results Among 2,379 consecutive patients with newly identified severe TR, the median age was 70 years, 61% were female, and 40% were Black. Event rates (95% CI) were 30.9 (29.0 to 32.8) events/100 PY for death and 49.0 (45.9 to 52.2) events/100 PY for composite death or HFH over median follow-up of 1.6 years. Event rates were similarly high across TR etiology groups for both death and composite death or HFH (Figure 1). Multiple methods of unsupervised clustering did not yield distinct clusters by patient demographic and imaging characteristics. After applying supervised survival tree modeling, four phenoclusters with distinct clinical prognoses were separately identified for death and composite death or HFH (Figure 2). Variables identified to partition the cohort to discriminate both death and composite death or HFH were age, albumin, blood urea nitrogen, right ventricular contractility, and right ventricular systolic pressure (all p Conclusions Five-year cumulative incidence of adverse events among patients with newly diagnosed severe TR was 69% for death and 80% for composite death or HFH. TR etiology did not stratify prognosis, while supervised survival tree models identified phenoclusters with distinct clinical risk. The identified subgroups of severe TR with differential outcomes offer insights towards enrichment in clinical trials of TR and risk/benefit analysis in patients undergoing TR therapies. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Abbott

The present study deals with the formulation of mucoadhesive bilayered buccal film of lidocaine hydrochloride and benzydamine hydrochloride for treatment of oral ulcers (aphthous stomatitis). Eudragit-RLPO and Ethyl cellulose were used as film forming polymers and low viscosity grade hydroxyl propyl cellulose as a mucoadhesive agent. Solvent casting method was adopted for film formation. The film was evaluated for content uniformity, tensile strength, folding endurance, swelling, mucoadhesive strength, ex vivo mucoadhesive time and in vitro drug release. The films were characterized for DSC and FTIR. The film showed acceptable film properties and muco-adhesion. The formulation showed predictive drug release, i.e. 80 in 2, 4 and 6 h respectively. In-vitro drug release study revealed that a combination of Eudragit and Ethyl cellulose was required for better control of the drug release. The DSC and FTIR study confirmed drug-drug and drug–excipient compatibility. Keywords: Bilayer film, Eudragit-RLPO, Ethyl cellulose, Muco-adhesion, Extended drug release.

Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia. Catheter Ablation (CA) is considered as a first-line therapy for AF. The risk of 30-days all-cause mortality associated with CA for AF may be underestimated in clinical trials and selected-cohort studies due to selection bias. Hypothesis: We evaluated 30-days all-cause mortality associated with CA for AF in the entire country of Poland Methods: The data was collected from the Polish national healthcare service (the National Health Fund of Poland). In the Polish health system covers >99% of CA for AF for the entire country. All consecutive CA in patients >18 years of age, between Jan 2012 and Dec 2019 were included in the study. CA for AF was identified by unique codes assigned to pulmonary vein isolation and CA for AF. The mortality rate was calculated for each age group. Results: During 8-year follow-up period, 31,214 CA of AF were performed in 26,767 patients. 9315 (34.8%) patients were female. 13758 (51.4%) patients had Cryoballoon ablation. Thirty-two deaths (0.1%) within 30-days of the CA were identified. The mortality rate was low and similar in each age group except in the oldest age group (age>80). The oldest age group had significantly higher 30-days mortality than any other age group. (Figure). Conclusions: In the large, consecutive patient population in the entire country of Poland, 30- days mortality following AF ablation for past 8-years remains low. In real-world clinical practice patients over the age of 80 have higher risk of 30-day all-cause mortality than any other age group found over last seven years. Systematic review is needed to further risk-stratify these findings.

Purpose of Review Migraine and other primary headache disorders do not receive adequate research funding, medical resources, or other forms of structural support relative to their prevalence and the disability they cause. In recent research, scholars have argued that stigma associated with headache disorders explains some of this discrepancy. This review will discuss (1) the factors contributing to stigma toward migraine and other primary headache disorders, (2) how structural and enacted stigma may perpetuate individual disability, (3) the impact of internalized stigma, and (4) interventions to mitigate stigma toward headache disorders with an emphasis on outcome monitoring. The review will also propose new areas of stigma research in need of further investigation. Recent Findings Recent research shows that discrimination can exacerbate chronic pain. Summary Stigma profoundly affects everything from the allocation of federal research funds and healthcare resources to individual patients’ self-efficacy and ability to care for themselves. Understanding the stigma of migraine and learning how to develop effective interventions to mitigate this stigma will increase access to appropriate migraine care, improve healthcare providers’ ability to care for their migraine patients, and help advocates reverse policies that discriminate against those with migraine. It is important to closely monitor outcomes of anti-stigma efforts for both positive and negative consequences and take note of outcomes and “lessons learned” from anti-stigma campaigns for other diseases. Supplementary Information The online version contains supplementary material available at 10.1007/s11916-021-00982-z.

Objectives There has been increased focus nationally on limiting opioid prescriptions. National data demonstrates a decrease in annual opioid prescriptions among emergency medicine physicians. We analyzed data from 2012 to 2020 from a large academic health system in California to understand trends in opioid prescribing patterns for emergency department (ED) discharged patients and assessed the potential impact of two initiatives at limiting local opioid prescriptions. Methods In 2012-2020, monthly ED visit data was used to evaluate the total number of outpatient opioid prescriptions and percent of ED visits with opioid prescriptions (as primary outcomes). Descriptive statistics, graphic representation, and segmented regression with interrupted times series were used based on two prespecified time points associated with intensive local initiatives directed at limiting opioid prescribing1) comprehensive emergency medicine resident education and 2) electronic health record (EHR)-based intervention. Results Between March 2012 and July 2020, a total of 41,491 ED discharged patients received an opioid prescription. The three most commonly prescribed drugs were hydrocodone (84.1%), oxycodone (10.8%), and codeine (2.8%). After implementing comprehensive emergency medicine resident education, the total number of opioid prescriptions, the percentage of opioid prescriptions over total ED visit numbers and the total tablet number showed decreasing trends (p's ≤ 0.01), in addition to the natural (pre-intervention) decreasing trends. In contrast, later interventions in the EHR tended to show attenuated decreasing trends. Conclusions From 2012 to 2020, we found that total opioid prescriptions decreased significantly for discharged ED patients. This trend is seen nationally. However, our specific interventions further heightened this downward trend. Evidence-based legislation, policy changes, and educational initiatives that impact prescribing practices should guide future efforts.

Rhabdomyolysis is associated with patients presenting to the emergency department who test positive for cocaine on rapid drug screening, including those neither agitated nor restrained. The aim was...

Introduction Peyronie's Disease (PD) can coexist with erectile dysfunction (ED). International guidelines recommend that management of PD include an assessment of each patient's ability to initiate and sustain erection. PD causes significant stress to the patient and his partner; that distress may limit their ability to assess adequacy of penile rigidity. Further complicating evaluations based on history is the fact that PDE5-Inhibitor use is common. Objective The primary aim of this study is to non-invasively assess vascular erectile integrity in the setting of PD. Methods 1490 patients who underwent intracavernous injection (ICI) followed by Color Doppler Duplex Ultrasound (CDDU) at our institution were retrospectively analyzed. CDDU findings were recorded following injection of low dose alprostadil (10-20 mcg) and again after a period of privacy and visual sexual stimulation. CCDU findings including peak systolic velocities (PSV), and resistive indices (RIs) were recorded. Arterial insufficiency (AI) was defined as either a post-stimulation PSV < 25 cm/sec (severe AI) or a PSV 25-34.9, RI ≥ 0.9(mild AI). Cavernous Venous Occlusion Disease (CVOD) was defined as post-stimulation PSV ≥ 35 cm/sec with RI < 0.9. Mixed was defined as post-stimulation PSV 25-34.9 with RI < 0.9. Vascular normal was defined as post-stim PSV ≥ 35 with RI ≥ 0.9. Results Our cohort of 1490 patients included 900 (60.4%) with a complaint of both PD + ED; 461 (30.9%) with complaint of ED only and 129 (8.7%) with complaint of PD only. Following ICI with PGE1, 310 men were found to have PD and 767 were found to have PD + ED. Patients with a CDDU confirmed diagnosis of PD alone were younger (median: 56.9 vs. 60.8 y, p < 0.001), less likely to have hypertension [103/310 (33.2%) vs. 365/767 (47.6%), p < 0.001], less likely to have used PDE-5 inhibitor [219/310 (70.6%) vs. 616/767 (80.3%), p < 0.001], and less likely to have failed to a PDE-5 inhibitor [142/219 (64.8%) vs. 484/616 (78.6%, p < 0.001]. Diabetes was slightly more common in men with PD + ED compared to PD [270 (35.2%) vs. 94 (30.3%), p = 0.063], but not statistically significant. CDDU diagnoses for men with ED + PD were: AI 262/767 (34.2%), CVOD 305/767 (39.8%), mixed vascular ED 200/767 (26.1%). By definition all men with PD alone were vascular normal. Self-assessments by SHIM scores were abnormal in both groups ED + PD and PD [median(interquartile range): 10 (5 – 17) vs. 14 (8 – 20), p< 0.001]. Conclusions By history alone, patients with ED + PD vs. PD only can't reliably be identified. This is likely related to the distress caused by PD and the tendency to physicians to treat or patients to self-medicate all erectile complaints with PDE5-Inhibitors. For non-invasive treatments distinguishing between ED + PD vs. PD is not critical. Before any patient is triaged to surgical intervention an evidence-based assessment of vascular erectile integrity should be performed. In our cohort of men, Doppler analysis demonstrated that at least 6 out of 10 PD patients have some form of vascular ED. Disclosure No

This study uses 810 households data collected from two states of India-Raipur district in Chhattisgarh State and Ranchi in Jharkhand- to analyse the LPG cooking transition. Most of the available studies for the South Asia region and particularly for India had mainly focused on the access aspect of clean cooking in terms of fuel or stove. In this study, we particularly focus on the household transition to clean cooking fuel (LPG) in terms of its usage. Using the Tobit regression model for censored data the study highlights the socioeconomic and other factors that may influence LPG transition. The study finds that there could be common as well as location specific factors driving LPG transition. Income linkages with LPG usage may be weak in regions with high prevalence of home produced or collected solid fuel consumption. Duration of LPG acquisition, considered in the study as a factor of behavioural aspect, has emerged as an important variable promoting LPG transition over time. The analysis suggests that LPG capital subsidy scheme, PMUY, has provided a trigger for LPG transition among beneficiary households. Increasing the share of LPG in monthly cooking fuel may require good LPG services such as doorstep delivery.

The first cases of Coronavirus of 2019 (COVID‐19) were reported in Wuhan, China in December 20191. The literature demonstrates geographical variation with regards to estimates of infection incidence, suggesting that COVID‐19 has been underdiagnosed in certain regions2,3. The rate of asymptomatic infection has been estimated to be as high as 30.8%, which may help explain variation in incidence, particularly in regions with differing screening practices 3. Transmission of COVID‐19 by asymptomatic carriers has been reported in multiple family units, indicating that this mode of infection is important in understanding disease epidemiology and population risk4,5.

Over the past few decades, marine conservation has become a global concern due to increasing anthropogenic activities in the vicinity of coastal areas, which has led to the development of the concept of Marine Protected Areas (MPAs) for the conservation of marine ecology and its biodiversity. Conservation and acceptance of MPAs can only be achieved if coastal communities and fisherfolk are included as significant stakeholders because MPAs have direct relevance to their livelihood. To capture their acceptance towards the Gulf of Kachchh Marine National Park (MNP), Jamnagar, artisanal fisherfolk fishing in and around the MNP were surveyed to determine whether the presence of a well-managed MNP has any positive effects on the adjacent fishing communities since its establishment. The findings showed that the total fish catch was observed to increase over the years, but there has been a perceived decline in total catch in recent years. Similarly, while the total fish catch data recorded an increasing trend, discussions with the fisherfolk revealed a sharp decline in “catch per unit effort” in recent years. Fisherfolk from all sites showed interest in the development of the MNP and were keen to be involved in conservation planning and the management of the MNP.

A new class of fluorobenzimidazole derivatives (IIIa-j)was synthesized to investigate their antimicrobial potential. All the compounds were prepared by multiple step synthesis, initiating from the synthesis of 5-(difluoromethoxy)-1H-benzimidazole-2-thiol (I). The compound I was further reacted with different derivatives of 2-chloro-N-phenylacetamide (IIa-j) prepared by reacting differently substituted anilines with chloroacetylchloride and triethylamine in DMF (solvent); resulting in formation of fluorobenzimidazoles IIIa-j. The compounds IIIa-j were characterized by spectral analysis viz. 1H NMR, 13C NMR, mass spectra, elemental analysis and IR. All these compounds were screened in vitro for their antimicrobial activity against Gram-positive (S. aureus and E. faecalis) and Gram-negative bacterial (E. coli and P.aeruginosa) strains as well as fungi (A. niger and C. albicans). Some of the compounds exhibited promising results (in MIC) against Gram-negative bacterial strains.

The world of 1.5 degree C requires a global compact and action. Assuming that a fair allocation of global emissions space is made, the question arises can India live within that space? What kind of technological innovations are needed to make it possible? What would be the consequences of such a path for human welfare in India? The model has 25 goods and services and 38 alternative production activities reflecting different technologies to produce these goods or services. The model provides for social welfare measures by the government. The paper explores the consequences of different technological futures and policy regimes using a multi-sectoral inter temporal dynamic optimizing model with endogenous demand. With endogenous income distribution and 20 different consumer classes effects of heterogeneity are accounted. Reductions in costs of renewable power and batteries are stipulated based on projections by various researchers. Also targets for energy efficiency are based on past experience. The scenarios show the importance of technical progress for India can meet its human development goals within a fair emission limit.

Background and Objectives Many healthy older adults experience age-related memory changes that can impact their day-to-day functioning. Qualitative interviews have been useful in gaining insight into the experience of older adults who are facing memory difficulties. To enhance this insight, there is a need for a reliable and valid measure that quantifies the impact of normal memory changes on daily living. The primary objective of this study was to develop and validate a new instrument, the Memory Impact Questionnaire (MIQ). Research Design and Methods We examined the underlying component structure and psychometric properties of the MIQ in a sample of 205 community-dwelling older adults. Results Principal component analysis revealed three clusters: (a) Lifestyle Restrictions, (b) Positive Coping, and (c) Negative Emotion. Comparisons of the corresponding subscale scores with scores on other instruments revealed good convergent and discriminant validity. In addition, the MIQ subscales and the total score showed good test–retest reliability (rs = 0.65–0.91) and internal consistency (αs = 0.87–0.93). Discussion and Implications This novel questionnaire can be used in both clinical and research settings to better understand the impact of memory changes on the day-to-day functioning of older adults and to monitor outcomes of support programs for this population.

The present study illustrates the application of the concept of Quality by Design for development, optimization and evaluation of Lorazepam loaded microemulsion containing ion responsive In situ gelator gellan gum and carbopol 934. A novel approach involving interactions between surfactant and polymer was employed to achieve controlled drug release and reduced mucociliary clearance. Microemulsion formulated using preliminary solubility study and pseudo ternary phase diagrams showed significantly improved solubilization capacity of Lorazepam with 54.31±6.07nm droplets size. The effect of oil to surfactant/cosurfactant ratio and concentration of gelling agent on the drug release and viscosity of microemulsion gel (MEG) was evaluated using a 32 full factorial design. The gel of optimized formulation (MEG1) showed a drug release up to 6h of 97.32±1.35% of total drug loaded. The change in shear-dependent viscosity for different formulations on interaction with Simulated Nasal Fluid depicts the crucial role of surfactant-polymer interactions on the gelation properties along with calcium ions binding on the polymer chains. It is proposed that the surfactant-polymer interactions in the form of a stoichiometric hydrogen bonding between oxyethylene and carboxylic groups of the polymers used, provides exceptional ME stability and adhesion properties. Compared with the marketed formulation, optimized MEG showed improved pharmacodynamic activity. Ex vivo diffusion studies revealed significantly higher release for MEG compared to microemulsion and drug solution. MEG showed higher flux and permeation across goat nasal mucosa. According to the study, it could be concluded that formulation would successfully provide the rapid onset of action, and decrease the mucociliary clearance due to formation of in situ gelling mucoadhesive system.

Tracheal intubation is the preferred technique for mechanical ventilation. However, standard tracheal intubation via conventional direct laryngoscopy (DLS), performed by untrained medical personnel has high incidence of failure. Success rate by medical support staff, medical students and novice anaesthesia residents is stated to be between 35% and 65%.[1] Alternative approaches for improving the success rates include use of videolaryngoscopy (VLS), which provides better view of the glottis and higher success rate.[2] It does not depend on alignment of the optical axes in the pharynx and mouth.[3] It is more effective but can be time-consuming but the steepness of the learning curve may be less than that with DLS for a novice.[4] The main hurdle in DLS with Macintosh laryngoscope is the visual restriction inherent to the procedure caused by a need to get straight line of sight to visualise the glottis, blade flange, tongue and epiglottis making the procedure monocular at the level of the larynx.[5] Video laryngoscopes (VLS) represent a breakthrough in airway management. They are available in various designs and blade shapes, with specific applications in selected case groups. Most of the VLS available in market are cumbersome to use and expensive. The need of the hour is a user-friendly and economical VLS. TAScope (The Anaesthetist Society scope) is an indigenously designed VLS by a fraternity member. It is a channelled, anatomically angulated video intubation aid with an endoscopic camera which can be connected to mobile phones and tablets.[6] After satisfactory manikin trial in the institute, this preliminary human study was done to evaluate TAScope in comparison to Macintosh laryngoscope.

Author(s): Elder, Joshua W; Wu, Evan F; Chenoweth, James A; Holmes, James F; Parikh, Aman K; Moulin, Aimee K; Trevino, Tommie G; Richards, John R | Abstract: BackgroundScreening for unhealthy alcohol and drug use in the emergency department (ED) can be challenging due to crowding, lack of privacy, and overburdened staff. The objectives of this study were to determine the feasibility and utility of a brief tablet-based screening method in the ED and if patients would consider a face-to-face meeting with a certified alcohol and drug counselor (CADC) for more in-depth screening, brief intervention, and referral to treatment (SBIRT) helpful via this interface.MethodsA tablet-based questionnaire was offered to 500 patients. Inclusion criteria were age ≥18, Emergency Severity Index 2-5, and English comprehension. Subjects were excluded if they had evidence of acute intoxication and/or received sedating medication.ResultsA total of 283 (57%) subjects were enrolled over a 4-week period, which represented an increase of 183% over the monthly average of patients referred for SBIRT by the CADC prior to the study. There were 131 (46%) who screened positive for unhealthy alcohol and drug use, with 51 (39%) and 37 (28%) who screened positive for solely unhealthy alcohol use and drug use/drug use disorders, respectively. There were 43 (33%) who screened positive for combined unhealthy alcohol and drug use. Despite willingness to participate in the tablet-based questionnaire, only 20 (15%) with a positive screen indicated via the tablet that a face-to-face meeting with the CADC for further SBIRT would be helpful.ConclusionBrief tablet-based screening for unhealthy alcohol and drug use in the ED was an effective method to increase the number of adult patients identified than solely by their treating clinicians. However, only a minority of subjects screening positive using this interface believed a face-to-face meeting with the CADC for further SBIRT would be helpful.

A 65-year-old man presented with a 2-week history of worsening vertigo. The sensation of vertigo was constant and exacerbated by turning in bed, sitting, and standing. Exacerbations lasted 5–10 minutes and were intense enough to cause gait impairment. Two days prior to presentation, the vertigo had worsened in severity and was associated with one episode of nausea and vomiting. Review of systems was positive for a 3-month history of a whistling noise in the patient's left ear, a 2-week history of acute-on-chronic left-sided hearing impairment, and a recent upper respiratory infection.

The paper projects households' stock of four major electricity consuming appliances till 2030 and explores policy options to accelerate adoption of more energy efficient appliances. India's rapid economic growth has enabled the growing middle class to buy household appliances in increasing numbers. The consequent rise in energy consumption and GHG emissions can be significantly reduced if consumers are motivated by awareness and options in the market to buy energy efficient appliances. India has introduced a star rating scheme for appliances, and even without incentives consumers purchase star-rated appliances. The stock of household appliances is projected using the data of a national sample survey of household consumption, observed sale of star-rated appliances and projected consumption distribution. Estimated savings in households' electricity consumption from just four appliances, ACs, refrigerators, TVs, and ceiling fans, for which data were available, range from 52 bKwh to 145 bkwh in 2030, reductions of 10–27%. The corresponding reduction in CO2 emissions will be between 42 Mt and 116 Mt in 2030. With policies of finance and bulk procurement to reduce costs, emissions reduction can be 128 Mt in 2030, a reduction of 30%.

Although lumbar punctures (LPs) are used for diagnostic evaluation in idiopathic intracranial hypertension (IIH), they can also provide relief from IIH-associated headache. Conversely, low-pressure headache secondary to LP can be debilitating. Low-volume cerebrospinal fluid (CSF) removal to a "high-normal" closing pressure (CP), approximately 18-20 cm H2O, may result in relief of IIH-associated headache with a lowered frequency of post-LP headache.We conducted a single-center retrospective analysis from 2011 to 2016 of patients who underwent fluoroscopic LPs aiming for high-normal CPs. Inclusion criteria were as follows: 1) pre-existing diagnosis of IIH, or opening pressure (OP) and clinical findings diagnostic for IIH; 2) height and weight recorded within 1 year; 3) documented LP data parameters; and 4) one week post-LP follow-up documenting whether headache was worse, unchanged, or better.One hundred forty-six patients met the inclusion criteria. Mean age was 34.9 years ± 11.0, and mean body mass index was 39.2 kg/m ± 10.5. Mean volume removed was 9.7 mL ± 4.6. The mean CP was 17.9 cm H2O ±2.7. The mean pressure change (OP-CP) per volume removed was 1.50 cm H2O/mL ±0.6. Headache symptoms at follow-up were improved in 64% (80/125) of patients, worse in 26% (33/125), and unchanged in 10% (12/125). Eleven patients were headache-free, and 11 patients required hospital care for post-LP headache.Low-volume CSF removal to approximately 18 cm H2O resulted in relief of IIH-associated headache in most patients and a low incidence of post-LP headache. Although clinically variable, these data suggest that for every 1 mL of CSF removed, the CP decreases approximately 1.5 cm H2O.