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Creating Backup Management Resources for Spine Care during the Coronavirus Disease 2019 Pandemic
Yadav Sandeep Kumar,Kar Bikram Keshri,Banta Aditya,Kumar Awkash 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.3
During this unprecedented time of the coronavirus disease 2019 (COVID 19) pandemic, most countries are struggling to optimize their healthcare resources. Although the prevention and treatment of COVID 19 has become the priority for the majority of the population, most medical professionals are facing the challenge of balancing the management of this pandemic and treating patients with other diseases. Healthcare professionals from all specialties are facing this situation and designing guidelines and recommendations that are contributing to the literature that is crucial for disease management at the current time. We share our experience with two ends of the spectra that we currently observe in spine patients. One group of patients included the non-operative cases that presented with back pain. Further, we discuss our experience with operative precautions and digitally assisted discharge.
Sanjay Kumar,Sandeep Khuba,Anil Agarwal,Sujeet Gautam,Madhulika Yadav,Aanchal Dixit 대한마취통증의학회 2018 Korean Journal of Anesthesiology Vol.71 No.6
Background: Pain on injection is a limitation with propofol use. The effect of the Valsalva maneuver on pain during propofol injection has not been studied. This maneuver reduces pain through the sinoaortic baroreceptor reflex arc and by distraction. We aimed to assess the efficacy of the Valsalva maneuver in reducing pain during propofol injection. Methods: Eighty American Society of Anesthesiologists class I adult patients undergoing general anesthesia were enrolled and divided into two groups of 40 each. Group I (Valsalva) patients blew into a sphygmomanometer tube raising the mercury column up to 30 mmHg for 20 seconds, while Group II (Control) patients did not. Anesthesia was induced with 1% propofol immediately afterwards. Pain was assessed on a 10-point visual analog scale (VAS), where 0 represented no pain, and 10, the worst imaginable pain, and a 4-point withdrawal response score, where 0 represented no pain, and 3, the worst imaginable pain. Scores were presented as median (interquartile range). Results: We analyzed the data of 70 patients. The incidence of pain was significantly lower in the Valsalva than in the control group (53% vs. 78%, P = 0.029). The withdrawal response score was significantly lower in the Valsalva group (1.00 [0.00–1.00] vs. 2.00 [2.00–3.00], P < 0.001). The VAS score was significantly lower in the Valsalva group (1.00 [0.00–4.00] vs. 7.00 [6.25–8.00], P < 0.001). Conclusions: A prior Valsalva maneuver is effective in attenuating injection pain due to propofol; it is advantageous in being a non-pharmacological, safe, easy, and time-effective technique.
Naga Brahmendra Yadav Gorla,Sandeep Kolluri,Merlin Chai,Sanjib Kumar Panda 전력전자학회 2019 ICPE(ISPE)논문집 Vol.2019 No.5
Three-stage solid state transformer (SST) consists of a multilevel AC-DC converter in stage-1 followed by dual active bridge (DAB) isolated DC-DC converters in stage-2 and a three-phase inverter in stage-3. The output filters of stage-1 are designed to filter both switching frequency based harmonics and second harmonic ripple generated due to singlephase power processing. As a result, the use of less reliable electrolytic capacitors in stage-1 is inevitable. In this paper, a new control scheme is proposed for the SST to transfer the second harmonic ripple current from the output of stage-1 to the output of stage-2 in each phase. When the three phases are connected at the output of stage-2, the second harmonic ripple currents which are phase shifted by 2π/3 radians add to zero. As a result, the capacitive filter requirement at the medium voltage DC (MVDC) bus is reduced, which is realized using reliable film capacitors. The operating principles along with detailed mathematical analysis and simulation results are presented.