Vitamin C supplementation as adjuvant analgesic therapy in post-operative pain management in patients undergoing surgical decompression in a case of prolapsed intervertebral disc

Background: The management of postoperative pain has been a major challenge for the operating surgeons. Vitamin C has shown analgesic effects in specific clinical conditions, reducing patient suffering and improving the quality of life. The objective of this study was to evaluate the efficacy of vitamin C as an adjuvant in postoperative pain management and its effect on analgesia requirements in patients undergoing spinal decompression surgery.Methods: The present study was a prospective study of 50 patients aged 30-60 years with low back pain due to prolapsed intervertebral disc requiring surgical decompression, conducted in a tertiary care institute from 2018 to 2020. All patients underwent open discectomy. 25 patients each were randomized into two groups, those that were given vitamin c supplementation (group A) and those that weren't (group B). The patients were then followed up 1st, 2nd, 4th, and 6th week and the pain was graded at each follow-up according to the NRS scale. The total amount of diclofenac sodium consumed in the 6 weeks was calculated.Results: The mean NRS (A vs B) at 2 (2.68 vs 3.56) and 4 (0.88 vs 1.48) weeks follow-up showed a statistically significant difference between the two groups, but the difference was not significant at 6 (0.16 vs 0.36) weeks follow up. The difference in the consumption of analgesic (3.56 vs 5.46) at 6 weeks was statistically significant.Conclusions: In this clinical outcome-based study, we suggest that for postoperative pain management, vitamin C acts as an efficacious adjuvant with a dose-sparing effect on the consumption of analgesics

Intelligent Sensors and Components for On-Board ISHM

A viewgraph presentation on the development of intelligent sensors and components for on-board Integrated Systems Health Health Management (ISHM) is shown. The topics include: 1) Motivation; 2) Integrated Systems Health Management (ISHM); 3) Intelligent Components; 4) IEEE 1451; 5)Intelligent Sensors; 6) Application; and 7) Future Direction

Centrality evolution of the charged-particle pseudorapidity density over a broad pseudorapidity range in Pb-Pb collisions at root s(NN)=2.76TeV

Peer reviewe

Novel Sensor for Measuring Sodium Concentration for Dialysis Applications

One of the critical medical problems facing society today is the growing number of patients diagnosed with End-Stage Renal Disease (ESRD). Patients diagnosed with ESRD often face a problem of limited organ transplantation possibilities and time consuming, cumbersome as well as painstaking treatments that affect patients’ quality of life. This study is part of a larger effort to develop new types of dialysis treatments focused on improving the quality of life of ESRD patients. The focus of this paper is the development of a simple, yet reliable sensor that can measure the toxic ion levels in the human body so that the right type and amount of an ion absorbing material can be released in the body to absorb these ions. The sensor is based on the change in resistivity of the solution with different ion concentrations. It has been shown that that by using customized plates with different combinations of metals, the voltage readings across different terminals is unique to the concentration of the solution. By using various metal electrodes of different sizes and distances, one can develop a table of values for the ion concentration vs. voltage (actually measuring resistance by keeping track of the current). Such a look-up table can then be used to measure the ion concentration in an unknown solution. This concept will then be extended to solutions containing multiple ions. The key to the success of this approach lies in the formation of the sensing plate that has multiple electrodes of different metals, sizes and distances between them, all which contribute to a distinct and unique pattern for the current concentration of ions in the solution. The two most critical ions are sodium and potassium, and this paper presents results for only the sodium trials to show the feasibility of this approach

Management of the Lateral Breast

Summary:. Breast asymmetry is a common finding in developing adolescents. In select cases, there is maldevelopment of 1 or both breasts, which persists into adulthood and causes significant negative impact on life. Various surgical techniques (eg, breast augmentation/reduction) and nonsurgical techniques (eg, bras/gel inserts) are currently in practice to achieve breast symmetry. We describe a unique case of a young lady with Poland’s syndrome, who presented with a lateralized right breast. We have used a V-Y advancement flap, along with a breast implant, to medialize the breast and achieve symmetry in contour and volume, followed by medialization of the nipple areolar complex. Using this technique produced an excellent result on our patient. We, therefore, feel that using the V-Y advancement flap is a novel and good option for dealing with difficult cases of lateralized breast

Are Pfannenstiel scars a boon or a curse for DIEP flap breast reconstructions?

Background: Abdominal incisions and their subsequent scarring alter the vascular architecture of the abdominal pannus. This is of significance when reconstructing the breast with the deep inferior epigastric perforator (DIEP) flap. This study aimed to objectively investigate the impact of the lower abdominal Pfannenstiel scar in utilizing the DIEP flap. Methods: A retrospective study of breast reconstruction with DIEP flaps was conducted on patients who had a Pfannenstiel scar (n = 36) compared with patients who did not (n = 36). Computed tomography angiograms were analyzed for the numbers, positions, and dimensions of perforator vessels. Influence of the scar on the reconstructive outcome was assessed. Results: The number of perforators was greater in the control group (mean, 9.14) compared with the study group (mean, 8.3) but was not significant, with marginal significance (p = 0.09). The percentage of found perforators with 4 mm or greater was significantly higher in the study group than in the control group (21.7 percent compared with 14.3 percent, respectively; p = 0.04). The position of perforators was more or less the same, and complications were also comparable in both groups. Conclusions: Pfannenstiel incisions result in undermining of the lower abdominal apron and, in most cases, division of the superficial epigastric vessels. This results in "ischemic preconditioning" of the flap, as has been evidenced by the increased dimensions of the perforators. Hence, flaps raised from these abdomens are not only safe but may even be better vascularized

Optimizing the arterialized venous flap

BACKGROUND: Outcome of arterialized venous flaps is quite varied. The authors' initial experiments showed that a good vascular bed contributes significantly to survival of the flap. In continuation of these experiments, this study aimed to understand the influence of architectural variations on flap outcome. METHODS: Fasciocutaneous flaps were designed on the ears of New Zealand rabbits, and the animals were randomized into four groups having flaps that used the larger anterior marginal vein (1.3 mm) or the smaller central vein (0.6 mm) for arterial inflow, with or without isolation of the flap from its bed with a silicone sheet. Flaps were observed for area of flap survival and vasculature was assessed by microangiography. RESULTS: Using the smaller central vein for arterial inflow (n = 15), arterialized venous flaps had an excellent outcome, with good flap survival in 100 percent of the animals (survival of >85 percent of flap area), and a mean flap survival area of 99.4 +/- 1.6 percent. Even when neovascularization was prevented by isolation of the flaps (n = 14), 92 percent of central vein flaps showed good survival, with a mean flap survival area of 93.3 +/- 7.3 percent, which was significantly better than that of anterior marginal vein flaps (n = 22), which showed good flap survival in only 27 percent of the animals (mean flap survival area, 76.4 +/- 12.1 percent). CONCLUSIONS: Survival of arterialized venous flaps is optimized by using smaller-caliber veins for inflow and reserving larger-caliber veins for outflow. This regulates inflow and avoids high blood pressure, and arterialized venous flaps behave as physiologic flaps do, by not relying on neovascularization for survival

Early detection of flap failure using a new thermographic device

BACKGROUND: Early recognition of perfusion failure is critical for free flap salvage. However, most of the different methods assessing perfusion have limitations and have not gain widespread acceptance. The aim of this study was to evaluate a novel system, a combination of a highly sensitive infrared camera with dynamic infrared image processing, in an animal flap model. MATERIALS AND METHODS: Flaps based on the inferior superficial epigastric vessels were raised bilaterally in 20 rats. One pedicle artery or vein was ligated and the contralateral side served as unligated control. Thermographic measurements were performed before and after ligation yielding a color map and a temperature recording. The macroscopic evolution of the flap was photographically documented. RESULTS: All vascular occlusions were rapidly detected. In the artery ligated group, the disappearance of the hot spot, corresponding to the pedicle, was observed in absence of macroscopic changes of the flap. In animals undergoing venous ligation, changes in the thermographic image preceded clinical signs of congestion. Temperature recordings between arterial and venous ligation were not significantly different. CONCLUSIONS: Vascular compromise was rapidly and consistently identified prior to appearance of macroscopic changes. This very sensitive system allows for a precise detection of small differences of infrared emission within the flap visualized as changes in the color map with disappearance of the hot spot on the color map. This is independent of absolute temperature values that are influenced by environmental factors. In addition to postoperative monitoring, the set-up may be a promising tool for preoperative planning of perforator flaps