Publications by authors named "Diwan S"

Background: It is very well known that the supraclavicular nerve (SCN) which occupies the inferior part of the superficial cervical plexus basically originates from the ventral rami of C2-C4, then travels caudally into the investing layer of the deep cervical fascia (IL-DCF) alternatively termed the "prevertebral fascia."

Methods: This cadaveric study (a total of 6 soft-embalmed cadavers and bilateral dissections, i.e.

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Hemiplegic individuals often demonstrate gait abnormality causing asymmetry in lower-limb muscle activation-related (implicit) and gait-related (explicit) measures (offering complementary information on one's gait) while walking. Added to hemiplegia, such asymmetry can be aggravated while walking under varying task conditions, namely, walking without speaking (single task), walking while counting backwards (dual task), and walking while holding an object and counting backwards (multiple task). This emphasizes the need to quantify the extent of aggravated implication of multiple-task and dual-task on gait asymmetry compared to single task.

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Objective: To systematically examine the literature on the clinical consequences of inadvertent delays in scheduled onabotulinumtoxin A (OTA) therapy for chronic migraine during the COVID-19 pandemic and assess recommendations when access to OTA is limited.

Background: The coronavirus (COVID-19) pandemic was unprecedented in its impact on the global medical community. Most healthcare institutions in the United States (US) and the world had begun significantly limiting elective procedures, undermining management of many debilitating chronic conditions.

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Article Synopsis
  • * EVs and exosomes, tiny structures released by cells, show promise in treating conditions like osteoarthritis and intervertebral disc disease by reducing inflammation and promoting tissue repair in animal models.
  • * While clinical use of EVs and exosomes for chronic pain management is still developing, ongoing research and clinical trials suggest they have substantial potential for future therapies.
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Introduction: A proximal obturator nerve block has a similar block efficacy as the distal obturator nerve block. Previous cadaveric investigation injecting methylene blue dye solution and an immediate dissection proved the solution engulfing the anterior and posterior divisions of the obturator nerve as they emerge from the obturator canal. Uptake of methylene blue dye by the fascia and muscles obscures the exact delineation of the stained nerves.

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Background: Radiofrequency ablation (RFA) is a form of therapy for knee osteoarthritis (OA) pain that has become more popular in recent years. In addition to standard RF approaches, there are cooled and pulsed options. RFA could be used to treat the superolateral, superomedial, and inferomedial branches of the genicular nerves.

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Background: The lumbar plexus (LP) is a group of nerves located at the fourth lumbar vertebra level, between the anterior two-thirds and posterior one-thirds of the psoas muscle. In this study, the researchers aimed to investigate the spread of latex in injections of LP, suprainguinal fascia iliaca, and circum-psoas planes to assess the different regional techniques for blocking LP nerves (LPNs).

Methods: The study involved performing ultrasound-guided injections of three different colored latexes in six cadavers.

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Purpose: Injectable biologics have not only been described and developed to treat dermal wounds, cardiovascular disease, and cancer, but have also been reported to treat chronic pain conditions. Despite emerging evidence supporting regenerative medicine therapy for pain, many aspects remain controversial.

Methods: The American Society of Pain and Neuroscience (ASPN) identified the educational need for an evidence-based guideline on regenerative medicine therapy for chronic pain.

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Objective: This systematic scoping review aimed to map the literature on the use of various nudging strategies to influence prescriber behavior toward reducing opioid prescriptions across diverse healthcare settings.

Methods: A systematic database search was conducted using seven electronic databases. Only articles published in English were included.

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MicroRNAs (miRNAs) play crucial roles in physiological functions and disease, but the regulation of their nuclear biogenesis remains poorly understood. Here, BioID on Drosha, the catalytic subunit of the microprocessor complex, reveals its proximity to splicing factor proline- and glutamine (Q)-rich (SFPQ), a multifunctional RNA-binding protein (RBP) involved in forming paraspeckle nuclear condensates. SFPQ depletion impacts both primary and mature miRNA expression, while other paraspeckle proteins (PSPs) or the paraspeckle scaffolding RNA NEAT1 do not, indicating a paraspeckle-independent role.

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Background: The erector spinae plane block (ESP block) is frequently employed for thoracic, abdominal, and spinal surgeries, yet its precise mechanism of action remains a subject of debate. While initially postulated to influence both ventral and dorsal rami of the spinal nerve, recent studies indicate a predominant impact on the dorsal rami with limited involvement of the ventral rami. To elucidate this mechanism, we conducted an observational study to assess the distribution of ESP infiltration to the ventral rami.

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Background: The utilization of non-invasive techniques for fetal cardiac health surveillance is pivotal in evaluating fetal well-being throughout the gestational period. This process requires clean and interpretable fetal Electrocardiogram (fECG) signals.

Method: The proposed work is the novel framework for the elicitation of fECG signals from abdominal ECG (aECG) recordings of the pregnant mother.

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Background: Ultrasound (US)-guided costoclavicular block (CCB) is a promising new approach to brachial plexus (BP) block which is increasingly being utilized. Conventionally, the costoclavicular space (CCS) has been described to contain three cords. However, there may be variations in the neural pattern of the BP which is important to know to prevent inadvertent injury.

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Protein farnesylation is a post-translational modification where a 15-carbon farnesyl isoprenoid is appended to the C-terminal end of a protein by farnesyltransferase (FTase). This process often causes proteins to associate with the membrane and participate in signal transduction pathways. The most common substrates of FTase are proteins that have C-terminal tetrapeptide CaaX box sequences where the cysteine is the site of modification.

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Dermatomal analgesia achieved with quadratus lumborum blocks is site-dependent and inconsistent. Cadaveric and clinical studies reveal multiple mechanisms of action. We dissected six fresh human cadavers bilaterally and thoroughly studied their neurological linkages to the quadratus lumborum muscle (QLM) to identify neural structures and block targets.

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Article Synopsis
  • The erector spinae plane (ESP) block has become popular but its diffusion toward the paravertebral area is unpredictable; researchers evaluated dye diffusion patterns in human cadavers to clarify this.
  • In an experiment with six cadavers, different dyes were injected using an ultrasound technique at the thoracic vertebrae, with evaluations conducted to see how far the dye spread in surrounding areas.
  • Results showed that dye from the ESP injection spread only to the dorsal area and not to the paravertebral space, while the inter-ligament space injection allowed for extensive dye spread both anteriorly and posteriorly, suggesting it could be a more effective approach.
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Background: Radiofrequency ablation of genicular nerves is recommended to ameliorate the pain of osteoarthritis of the knee. However, long-term efficacy in patients with persistent pain following total knee arthroplasty remains elusive. The current study aimed to evaluate radiofrequency ablation of genicular nerves using a hybrid technique to manage severe incapacitating pain and quality of life following surgery.

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The dorsal root ganglion (DRG) serves as a pivotal site for managing chronic pain through dorsal root ganglion stimulation (DRG-S). In recent years, the DRG-S has emerged as an attractive modality in the armamentarium of neuromodulation therapy due to its accessibility and efficacy in alleviating chronic pain refractory to conventional treatments. Despite its therapeutic advantages, the precise mechanisms underlying DRG-S-induced analgesia remain elusive, attributed in part to the diverse sensory neuron population within the DRG and its modulation of both peripheral and central sensory processing pathways.

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Objectives: Total Hip Arthroplasty (THA) may be a risky proposition in patients with comorbidities, and they may require systemic analgesics for chronic hip pain (CHP). Since traditional pain medications may not provide complete pain relief or carry prohibitive adverse effects, pulsed radiofrequency (PRF) treatment of the hip articular nerves (HAN) has been proposed for effective clinical outcomes. We determined the efficacy of PRF-HAN in improvement in CHP compared to baseline pain on conventional systemic analgesics.

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Background: Vertebral compression fractures (VCFs) can affect the entire spinopelvic complex and cause unpredictable patterns of back pain due to their effects on spinal tensegrity and biomechanical compensation. They can lead to significant morbidity and mortality in the aging population and are difficult to diagnose. We aimed to establish a relationship between VCFs and sacroiliac (SI) joint pain.

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Article Synopsis
  • The article introduces a new diagnostic condition called Chronic Abdominal Discomfort Syndrome (CADS), characterized by chronic abdominal pain without clear acute causes, often accompanied by symptoms like dyspepsia and bloating.
  • The underlying cause of CADS is believed to be neurogenic, possibly involving the nerves in the abdomen, which can lead to discomfort and varying symptoms.
  • A diagnostic tool is provided for clinicians to identify CADS, aiming to help primary care physicians and gastroenterologists determine which patients may need further evaluation or treatment from a pain specialist for relief.
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