Papers by Shyam Sundar Balasubramanian
http://isrctn.org/>, 2014
Background: The role of injections of therapeutic substances into the back as treatment for low b... more Background: The role of injections of therapeutic substances into the back as treatment for low back pain is unclear. Facet joint injections are widely used despite the absence of evidence of sustained benefit. We hypothesise that facet joint injections might facilitate engagement with physiotherapist-led, best usual care (a combined physical and psychological programme) and is a clinically and cost-effective treatment for people with suspected low back pain of facet joint origin. Methods/Design: We present here the protocol for a randomised controlled feasibility trial for a main trial to test the above hypotheses. Patients referred to secondary care with persistent non-specific low back pain will be screened and invited to take part in the study. Those who meet the eligibility criteria will be invited for a physiotherapy assessment to confirm trial eligibility and for baseline data collection. All participants (n = 150) will be offered the best usual care package with physical and psychological components. Those randomised into the intervention arm (n = 75) will, in addition, receive intra-articular facet joint injections with local anaesthetic and steroids. Primary outcome data will be collected using daily and then weekly text messaging service for a pain score on a 0-10 scale. Questionnaire follow-up will be at 3, 6, and 12 months. Evaluation of trial processes and health economic analyses, including a value of information analysis, will be undertaken. The process evaluation will be mixed methods and will include the views of all stakeholders. Discussion: Whilst this trial is a feasibility study it is currently one of the largest trials in this area. The outcomes will provide some evidence on the use of facet joint injections for patients with clinically diagnosed facet joint pain. Trial registration: EudraCT identifier 2014-000682-50, (registered on 12 February 14). ISRCTN registry number: ISRCTN93184143
The International Journal of Advanced Manufacturing Technology
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2008
Purpose: To describe the clinical presentation of three patients with Charcot-Marie-Tooth disease... more Purpose: To describe the clinical presentation of three patients with Charcot-Marie-Tooth disease, who underwent uneventful upper limb surgery following successful peripheral nerve blockade, and to review the anesthetic implications in patients with Charcot-Marie-Tooth disease. Clinical features: In three patients with Charcot-Marie-Tooth disease presenting for surgery of the upper limb, the motor response, following nerve stimulation, was suboptimal. However, ultrasound guidance was effective in visualizing the needle-nerve interaction, and local anesthetic was injected around the nerves. Good block ensued and surgery proceeded in all patients without complications. No exacerbation of the neurological condition was observed in any patient. Conclusions: Charcot-Marie-Tooth disease is a demyelinating, hereditary, motor and sensory neuropathy characterized by abnormalities of nerve conduction. Regional anesthesia of the upper limb is feasible in these patients, and these cases show that ultrasound guidance makes peripheral nerve block possible in patients for whom traditional methods of nerve localization fail.
International Journal of Engineering Materials and Manufacture, 2020
Additive Manufacturing (AM) of metallic components shows unfavorable properties in their as-built... more Additive Manufacturing (AM) of metallic components shows unfavorable properties in their as-built state; surface roughness, anisotropy, residual stresses, and internal /surface defects are common issues that affect dynamic properties of AM metals. This paper reviews traditional fatigue testing techniques, summarizes published fatigue data for wrought and additively manufactured metals with focus on Inconel 718. Surface and volume defects of AM metals were presented and how post processing techniques could improve fatigue performance were shown. Different methods for normalizing fatigue data were explored due to varying results of different fatigue testing techniques.
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Papers by Shyam Sundar Balasubramanian