The effect of Valsalva maneuver in attenuating skin puncture pain during spinal anesthesia: a randomized controlled trial

Sanjay Kumar,Sujeet Kumar Singh Gautam,Devendra Gupta,Anil Agarwal,Sanjay Dhirraj,Sandeep Khuba 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.1

Background: Valsalva maneuver reduces pain by activating sinoaortic baroreceptor reflex arc. We planned this study to evaluate the role of valsalva in attenuating spinal needle-puncture pain. Methods: Ninety American Society of Anesthesiologists (ASA) grade I and II enrolled patients undergoing elective surgery were randomized into 3 groups of 30 each. Group I (Control): didn’t blow; group II (Distraction): patients blew into rubber tube; Group III (Valsalva): blew into sphygmomanometer tube and raise mercury column up to 30 mmHg for at least 20 seconds. During above procedures, spinal puncture was performed with 25-gauge spinal needle. Results: Eighty-two patient data were analyzed. Incidence of spinal puncture pain was reduced to 10% (3 of 27) in Valsalva group as compared to 100% (28 of 28 in control group and 27 of 27 in Distraction group) observed in other two groups (P < 0.05). Severity of lumbar puncture pain as assessed by visual analog scale (0−10; where 0 is no pain and 10 is the worst imaginable pain) presented as Median (Interquartile range) were significantly reduced in the Valsalva group (0.0 [0.0] as compared to other 2 groups 2.0 [0.0] in the Distraction group and 3.0 [0.8] in Control group) (P < 0.05). Regarding time taken by CSF to fill spinal needle hub, there was no difference among the three groups (P > 0.05). None patient of all groups had post dural puncture headache (P > 0.05). Conclusions: Valsalva can be performed routinely in ASA I and II patients undergoing spinal anesthesia as it is safe, painless and non-pharmacological method of pain attenuation.

Surgical approaches to hepatic hydatidosis ranging from partial cystectomy to liver transplantation

Sanjay Goja,Sujeet Kumar Saha,Sanjay Kumar Yadav,Anisha Tiwari,Arvinder Singh Soin 한국간담췌외과학회 2018 Annals of hepato-biliary-pancreatic surgery Vol.22 No.3

Backgrounds/Aims: A wide range of surgical approaches has been described for hepatic hydatidosis aiming primarily at the reduction of disease recurrence and minimization of postoperative morbidity. Methods: A database analysis of patients with liver hydatidosis who underwent different surgical procedures between March 2010 and May 2016 was performed. Results: A total of 21 patients with cystic echinococcosis (CE) and four cases of alveolar echinococcosis (AED) were detected. Nine patients manifested recurrent disease at presentation. Among CE cases, 5 underwent partial cystectomy (2 laparoscopic and 3 open), 9 cysto-pericystectomy (7 open and 2 robotic) and 7 hepatectomies (1 central, 4 right, 1 left and 1 right trisectionectomy). Living donor liver transplantation was performed in 3 patients with AED and the fourth patient underwent right trisectionectomy with en bloc resection of hepatic flexure and right diaphragm. Seven developed Clavien grade II and three grade III complications. The mean follow-up of CE was 34.19±19.75 months. One patient of laparoscopic partial cystectomy developed disease recurrence at 14 months. No recurrence was detected at a mean follow-up of 34±4.58 months following LDLT and at 24 months following multivisceral resection for AED. Conclusions: The whole spectrum of tailored surgical approaches ranging from minimally invasive to open and extended liver resections represents safe, effective and recurrence-free treatment of hepatic hydatidosis.

Study of Patients with Bilateral Knee Osteoarthritis Undergoing Total Knee Replacement Procedure with Coexisting Lumbar Spondylosis Symptoms

Londhe Sanjay Bhalchandra,Shah Ravi Vinod,Patwardhan Meghana,Doshi Amit Pankaj,Londhe Shubhankar Sanjay,Subhedar Kavita,Kundnani Vishal G.,Patel Jwalant Y. 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.6

Study Design: This is a prospective cohort study involving patients who were followed for 2 years after total knee replacement (TKR) to determine changes in lumbar spine and knee symptoms. Purpose: The objectives of this study were to determine the percentage of patients undergoing bilateral TKR who present with coexisting lumbar spine problems and determine if TKR relieves lumbar spine symptoms. Overview of Literature: No studies quantify the percentage of TKR patients who experience relief of lumbar spine symptoms after TKR surgery. Methods: The study included 200 patients (164 females, 36 males) undergoing primary TKR. Follow-up was performed at 4 weeks, 3, 6, 12, and 24 months. Lumbar spine and knee symptom improvements were assessed using the Oswestry Disability Index (ODI) and Oxford Knee Score, respectively. Results: All 200 patients undergoing bilateral TKR presented with radiographic lumbar spine degenerative pathology; 60% (n=120) of the patients presented with moderate to severe clinical symptoms of lumbar spondylosis, including 54% (n=108) with degenerative lumbar spondylosis and lumbar canal stenosis and 6% (n=12) with degenerative spondylolisthesis. Of the 120 patients who presented with lumbar spine problems, 90% (n=108) reported improvement in their symptoms; the ODI score improved from 42.5%±4.1% preoperative score to 15.6%±2.3% postoperative score (p-value<0.001). Of the 12 patients with no improvement, 10 patients underwent percutaneous procedures for their lumbar spine pathology with good results, one patient underwent surgery, and one declined any intervention. Conclusions: A significant number of patients (60%) undergoing bilateral TKR also present with symptomatic lumbar spine problems. Patients with mild to moderate lumbar spine degenerative symptoms and no associated severe radiating pain on activity are more likely to experience relief of their symptoms post-TKR.

Evidence for Erythrocyte Aggregational Pathology

Sanjay Jayavanth,Bock Choon Pak 한국유체기계학회 2006 유체기계 연구개발 발표회 논문집 Vol.- No.-

Erythrocyte aggregation is a physiological assemblage of red blood cells into neat stack like structure as though cells were placed one over / beside another like coins. Such stack of RBC interconnects to form three-dimensional networks often referred to as rouleaux in presence of plasma proteins aided by low flow. These neatly looking erythrocyte aggregates can turn into ugly, haphazard clump of cells under pathological conditions. Aggregational pathology can thus hamper blood flow, increase flow resistance and some times cause occlusion of blood vessels afflicting the microcirculatory rheology. This paper presents recent research report evidencing aggregational pathology in disease condition obtained through an in-vitro microhemofludic visualization system (μHVS). In a study conducted on normal and malaria infected subjects, erythrocyte aggregation showed irregular shapes and compactness aggregates when compared to the normal ones. Specific erythrocyte aggregates were rolling about themselves showing little or no deformation. While the aggregates of normal samples showed porous rouleaux network changing shape and orientation. Such deformation of rouleaux network was not seen among the clumped cells of parasitized samples. Erythrocytes were found adhering to each other and formed clumps tending toward agglutination. These results showed the extent to which microrheologic dysfunction could occur in severe cases of a specific disease.

Integration from Retail Banking to Non-Financial Corporations in EMU

( Sanjay Sehgal ),( Priyanshi Gupta ),( Florent Deisting ) 세종대학교 경제통합연구소 2016 Journal of Economic Integration Vol.31 No.3

This paper investigates the integration process within the European Economic and Monetary Union’s retail banking industry by analyzing deposit and lending rates to nonfinancial corporations. The investigation covers the 2003~2014 period, examining the normal period, the global crisis period, and the European debt crisis period. The paper classifies sampled countries into three groups on the basis of their Gross Domestic Product to investigate the relationship between economic size and degree of integration. We employ five different indicators to assess various dimensions of integration: beta convergence, sigma convergence, variance ratio, asymmetric dynamic conditional correlation, and dynamic co-integration. The results point toward a weak degree of integration, which was worsened by the twin crises. In addition, results indicate that more heterogeneity exists in the credit market than in the deposits market. Furthermore, short-term maturity products are observed to be more converged than longer-term maturity products. We also observe a positive relationship between economic size of sampled countries and the degree of retail banking integration.

Latency Aware IEEE 802.11ax for Industrial Wireless Networks

Sanjay Bhardwaj,Chang Bae Moon,Dong-Seong Kim 한국통신학회 2019 한국통신학회 학술대회논문집 Vol.2019 No.6

Use of an insulated tip knife in the management of a common foreign body in a child

Sanjay Rajput,Pratin Bhatt,Vatsal Bachkaniwala,Chaiti Gandhi,Rushi Pipavat,Varun Tadkalkar,Ravi Bokarvadia 소화기인터벤션의학회 2022 Gastrointestinal Intervention Vol.11 No.2

A 2-year-old child presented with button battery (BB) ingestion that had taken place 5 months previously. The BB was impacted within the post-cricoid esophageal wall without an obvious perforation or communication with the trachea. In view of the high surgical risk, we attempted to remove the BB endoscopically. BB removal was not possible with conventional devices due to the post-cricoid location and the invagination of the BB into the esophageal wall. We dissected the BB from the surrounding esophageal wall using an insulated tip (IT) knife and successfully extracted the BB. The use of an IT knife prevented inadvertent injury or perforation while dissecting the BB, and surgery was avoided.

Intraosseous ameloblastoma masquerading as exophytic growth: a case report

Sanjay CJ,Chaya M David,Rachna Kaul,Ramnarayan BK,Prashanth Ramachandra 대한구강악안면방사선학회 2011 Imaging Science in Dentistry Vol.41 No.2

Intraosseous ameloblastoma is the most common and simple type of ameloblastoma prevalent among odontogenic tumors. Clinico-radiographically intraosseous ameloblastoma presents as slow, painless swelling or expansion of the jaws and described as multilocular expansile radiolucency that occurs most frequently in mandibular molar/ramus area. This article describes a case of follicular ameloblastoma involving 45 year old male which is different from the usual presentation, which includes-exophytic growth, different location and without expansion of the cortex.

IEEE 802.11ax: Throughput Challenges in Industrial Wireless Network

Sanjay Bhardwaj,Jae-Min Lee,Dong-Seong Kim 한국통신학회 2019 한국통신학회 학술대회논문집 Vol.2019 No.1

Pulse Multiplication in Autotransformer Based AC-DC Converters using a Zigzag Connection

Sanjay Gairola,Bhim Singh 전력전자학회 2007 JOURNAL OF POWER ELECTRONICS Vol.7 No.3

This paper deals with pulse multiplication in zigzag connected autotransformer based 12-pulse AC-DC converters feeding vector controlled induction motor drives (VCIMD) for improving the power quality at the point of common coupling (PCC) without using a Zero-Sequence-Blocking-Transformer (ZSBT). The proposed 24-pulse AC-DC converter is based on the principle of DC ripple re-injection technique for pulse multiplication and harmonic mitigation. The design of the autotransformer is carried out for the proposed AC-DC converter and the effect of load variation on VCIMD is also studied to demonstrate the effectiveness of the proposed AC-DC converter. Test results from a laboratory developed prototype, along with simulated results, are presented to validate the design and model of the proposed 24-pulse AC-DC converter.