bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of Self-Healing Cement Additives Based on Test Methodology Using Simulated Cement Sheath Cracks
Authors: Browning Robert , Duffy Marcus , Gaugler Drew , Jones Paul
Published: October 2012

A testing methodology was developed to examine the effectiveness of oil-swellable additives in cement slurries by evaluating the capability to shut off hydrocarbon fluid flow through a crack initiated in the cement. An open-loop testing fixture was used to investigate the effect of oil-swellable additive concentration and environmental temperature, using Kaydol mineral oil as a test fluid. Under a pressure differential of approximately 2 psi/in., test results indicated that a concentration of 10% by volume of additive relative to a 15.5 lbm/gal Class G slurry was sufficient to significantly reduce hydrocarbon flow in a crack in cement at a temperature of 160°F in an average time span of 48 hr and in shorter time spans with an increase in temperature.
A New Approach to Reserves Estimation in Shale Gas Reservoirs Using Multiple Decline Curve Analysis Models
Authors: Mishra Srikanta
Published: October 2012

Recent interest in the development of Marcellus and Utica plays has renewed attention on the problem of reliable estimation of recoverable reserves from low-permeability shale gas formations. Over-optimistic results obtained from the commonly used Arps hyperbolic model has led to the development of alternative decline curve analysis models based on empirical considerations (e.g., Duong's power law model) or mechanistic considerations (e.g., Valko's SEDM). This work addresses the practical difficulty of discriminating between such models (including a new mechanistic model proposed for decline curve analysis based on the Weibull growth curve) from limited production data. The paper also presents a new approach to aggregating estimated ultimate recovery (EUR) forecasts from multiple plausible models using the Generalized Likelihood Uncertainty Estimation (GLUE) methodology.

Two field examples are presented to demonstrate the performance of Hyperbolic, SEDM, Duong and Weibull models. Model parameters are estimated via nonlinear regression using Excel-SOLVER, from which 30-year EUR estimates are generated. The GLUE procedure is then used for determining the likelihood of each model by weighting the results with [1/RMSE^2], and computing the weighted mean and standard deviation for the 30-year EUR. For the first example (with 15 years of data), excellent visual fits are obtained for both rate and cumulative production with all four models. However, 30-year EUR estimates from the Arps and Duong models are on the high side and the SEDM and Weibull models are on the low side. The uncertainty in the mean amounts to only ~2%. For the second example (with 52 months of data), the trends are very similar, albeit with greater separation in the 30-year EUR forecasts and a higher uncertainty in the mean EUR (~7%).

These results reinforce earlier findings that multiple alternative models can provide equally good fits to limited-duration production data, but yield very different 30-year EUR forecasts. The GLUE approach provides a robust methodology for aggregating such analyses and quantifying the uncertainty of the EUR forecast.
Flow Isolation Tube for Milling and Sand Jet Perforating
Authors: Dotson Thomas , Farr Jim , Tucker Barrett
Published: October 2012

Sand jet perforating (SJP) is currently gaining acceptance in unconventional resource plays where horizontal development has shown the need for methods to perforate these formations. This paper examines a new design for a tool assembly that allows fluid to flow through the sand jet perforator while operating a PDM (Positive Displacement Motor) with a mill or cutting tool. In multi-stage fracturing operations where through tubing mills are often used for cleanout runs prior to perforating, the flow isolation tube assembly can be added to the tool string to achieve cleanout in conjunction with perforating in one trip. The design allows an operator to isolate the SJP tool, which is resident in the work string and perforate casing and formation, then restore flow to the PDM to continue operations such as milling or further well cleanout-all in a single trip.

Discussion of the assembly design process and laboratory testing results are included as a part of the paper and will analyze the effectiveness of the technology and tools as well as the economic impact of this type of program. Economics includes process costs as well as cost savings from support equipment that is gained by the combination of operations. The program’s translation to other shale plays like the Marcellus, Bakken, and Haynesville are also discussed.

Shale plays dominate domestic drilling as well as production today and being able to combine completion operations to save both time and money is of interest to all producers. Using the flow isolation tube assembly will save cost and wear for coil tubing units as well as costs for other surface support equipment. Finally, safety is increased and the quality of the perforations is improved with SJP; giving a better perforating job for a lower cost.
Computational Modeling of Drilling Fluids Dynamics in Casing Drilling
Authors: Mokhtari Mehdi , Ermila Mansur , Tutuncu Azra N. , Karimi Moji
Published: October 2012

Casing drilling is used as an alternative to conventional drilling with drillpipe in order to reduce non-productive time. The smaller annular space in casing drilling elevates the annular pressure loss considerably at similar flow rates in conventional drilling. Consequently, the Equivalent Circulating Density (ECD) is more affected by annular drilling fluid dynamics in casing drilling than the conventional drilling. The higher ECD experienced in casing drilling brings concerns about exceeding fracture gradient which can lead to induced lost circulation. However, several field observations demonstrate successful application of casing drilling in combating lost circulation and strengthening the wellbore.

Smearing effect theory backed by smaller cuttings at the shale shaker, eccentric casing wear, and discrepancy between analytical and field measurements are three main evidences for potential significant eccentricity in casing drilling operations. This paper demonstrates the inherent eccentricity of casing drilling as one of the parameters that controls the annular pressure losses. Eccentricity reduces the velocity in the narrow section of annulus. Similarly, it reduces the annular pressure losses considerably. In addition, controlling the fluid rheological properties as well as the flow rate are recommended to manage the casing drilling hydraulics. This comprehensive study of pressure loss and velocity profile at various annular sizes can help analyzing several field observations and designing the hydraulics of drilling operations.
Method of Using KUTT Radiometric Data to Prospect for Oil and Gas
Authors: Mulkern Mark E.
Published: October 2012

A method of using surface acquired radiation data has proven successful in Kentucky's shallow oil reservoirs of the southern Illinois Basin. The theory adhered to is that measured surface radiation shows characteristic low activity above petroleum deposits when compared to surrounding areas. Mapping measured potassium data layered with total radiation data can aid in identifying pooled hydrocarbon deposits as well as the area and extent of these deposits.

An overview of proper field acquisition operations is given as well as an analysis of three radiometric surveys taken in Kentucky.
Short Bit-To-Bend Motors and Horizontal Drilling
Authors: Greer John , Ide Russell
Published: October 2012

Thrust bearings used in mud lubricated drilling motors have to handle high loads, abrasive drilling mud, and large impacts, all of which reduce bearing life. In bent housing motors used for directional drilling, these adverse operating conditions are amplified and generally result in severely shortened bearing life and reliability. When drilling the lateral section with a bent housing motor a shorter "bit-to-bend" length is a great advantage because it reduces the loads on many of the motor components. Through the use of a resiliently-mounted stacked ceramic bearing design, the thrust bearing length can be reduced while retaining the capability to handle the increasing thrust and impact loads and withstand the erosion from abrasive drilling muds, thus increasing life expectancy and reliability.

The patented ceramic stack bearing has been designed to replace ball and PDC bearings in mud lubricated drilling motors. Although the bearing can be used in any drilling motor, a significant advantage is realized from using the shorter bearing design for short bit-to-bend motors. The increasing demand for short bit-to-bend motors has led manufacturers to reduce the length of their bearing section, and thus the life and load capacity of the thrust bearing. A shorter conventional thrust bearing stack means the load is carried by fewer bearing components and thus the load-per-bearing stage is increased, reducing the life expectancy of the bearing and, in turn, limiting the drilling hours a motor can continuously operate.

With the increasing number of directional wells being drilled, short bit-to-bend motors have become more desireable; more drilling companies are requesting them and more motor manufacturers are designing them. Using the improved bearing technology, combined with short bit-to-bend mud motors, directional drillers are able to drill curved and lateral sections of wells with one motor. This eliminates tripping out of the well to change the motor / BHA (Bottom Hole Assembly). Deep wells in the Eagleford formation have saved days of drilling time by operating motors in excess of 280 hours continuously with this resiliently mounted ceramic thrust bearing assembly.
An Investigation of Ancient Geological Events and Localized Fracturing on Current Bakken Trends
Authors: Borglum Scyller J. , Todd Burt J.
Published: October 2012

To date the most prolifically producing geologic structure in Montana's Bakken formation is the Elm Coulee Field. While the first wells drilled into this structure 35 years ago had some success, significant production did not occur until horizontal wells were drilled starting in 2000. The Bakken Petroleum System consists of three members, the Upper Bakken, shale, the Middle Bakken, silty dolostone, and the lower Bakken, siltstone. Production of the Bakken Petroleum System is extremely difficult to predict with standard reservoir models. Thus, the decision to understand initial production through geologic drivers was made. An investigation of the implications of ancient geology on what is believed to be specific areas of micro-flexures in and around the major geologic structures in Montana's Bakken three-member formation will form the basis for a Bakken production model.

The challenge in modeling the Bakken's production, both initial and subsequent, stems from the unusual history matching problem of either extremely high initial production with an unpredictably low subsequent production or surprisingly low production to begin with. The authors believe this phenomenon is due to broaching a series of micro-flexures and draining them, resulting in high initial production and unsustained subsequent production, or missing these structural flexures all together resulting in low production. This paper will investigate the genesis of Montana's Bakken micro and macro fractures with the ultimate goal of simulating and thus predicting production for wells currently producing in the area.
The Impact of Multistage Fracturing on the Production Performance of the Horizontal Wells in Shale Formations
Authors: Ayers K. L. , Aminian K. , Ameri S.
Published: October 2012

The interest in exploitation of ultra-low permeability formations, such as the Marcellus Shale, has increased in the recent years. Shale formations require massive stimulation treatments to achieve economic production. The recent advances in horizontal drilling and multistage hydraulic fracturing have proved successful in achieving commercial production. However, the parameters that directly affect lifetime production of the wells have not been well established.

The primary objective of this study is to examine the effects of basic stimulation parameters used in hydraulic fracturing of Marcellus Shale wells on production performance. Historical production data and stimulation treatment information have been collected and analyzed for a number of horizontal wells both in West Virginia and Pennsylvania. A commercial reservoir simulator which utilizes a dual porosity model and accounts for adsorbed gas was utilized for history matching and predicting the long term production performance. The impact of the stimulation parameters including number of stages, stage spacing, the volume of water used, and the volume of sand used on production performance was investigated. An understanding of the impact of each stimulation parameter to overall production of a well can be used for the optimization of stimulation treatments.
Impact of Hydraulic Fracture and Subsequent Increased Production Due to In-Situ Stress Changes in the Marcellus Shale
Authors: Wade Adam , Bilgesu H. Ilkin
Published: October 2012

Shale gas reservoirs are quickly becoming an important source for natural gas. Historically, the shale basins were not looked at for economic production because of their very low permeability values. However, with the use of hydraulic fracturing combined with horizontal well completions, shale plays have become economically producible, especially the Marcellus shale. In order for these wells to produce, hydraulic fracturing must be employed. This technique makes production viable, but it also changes the in-situ stress field, through the fracture itself and the increased production that occurs. This change in the stress field can damage the wellbore and compromise the integrity of the casing.

In this study, geomechanic and reservoir models were constructed using commercially available software to study the change of the stress field in the formation. The parameters of the hydraulic fracture were varied to study the effects of the hydraulic fracture half length and the fracture permeability on the stress field, specifically near the wellbore.
Proppant Selection for Hydraulic Fracture Production Optimization in Shale Plays
Authors: Yang Mei , Economides Michael J.
Published: October 2012

Proppants are essential to the success of most hydraulic fractures and often account for the overwhelming cost of the treatment. Both the mass of proppant and the selection of the right type of proppant are important elements in gaining the highest Net Present Value (NPV).

It has been generally believed that in the lower closure stress environment (below 6,000 psi, i.e., shallow reservoirs), natural sands such as Brady and Ottawa are appropriate as proppants and, for the same mesh size, they provide essentially the same permeability. A commonly accepted notion is that manmade proppants (such as ceramics) should be applied at higher closure stress environments, invariably, deeper reservoirs.

The characteristics of most shale plays are very different, mainly as regards to the rock stiffness, exemplified by the Young’s Modulus, stress anisotropy/isotropy and the existence of natural fracture network. Fracture strategies in shale formations are very different. This study presents fracture designs based on three types of proppants for shale formations: Brady sand, Ottawa sand and ceramic. Permeability tests and crush tests under certain pressure range are done to determine experimentally the dimensioned fracture conductivity. A fracture optimization p-3D model is used to maximize well performance by optimizing fracture geometry, including fracture half length, width and height. Reduced proppant pack permeability is compensated by larger width. Non-Darcy effects in the fracture are also considered for gas reservoirs. Post-treatment well performance is then estimated, using the optimized well geometry, leading to cumulative production over the well life. NPV analysis is employed as the criterion to select the best proppant for the job. Finally, the completion and production data from example wells will be analyzed for comparison purpose.

In this work, we try to correct the prejudice that natural sand proppants cannot be applied to deeper reservoirs by showing NPV study results that are superior to those of manmade proppants. Keeping stimulation costs down, natural sands proppants have a much larger range of applicability than previously thought.
Integration of Shale Gas Production Data and Microseismic for Fracture and Reservoir Properties Using Fast Marching Method
Authors: Xie Jiang , Yang Changdong , Gupta Neha , King Michael J. , Datta-Gupta Akhil
Published: October 2012

We present a novel approach to calculate drainage volume and well performance in shale gas reservoirs using a Fast Marching Method (FMM) combined with a geometric pressure approximation. Our approach can fully account for complex fracture network geometries associated with multistage hydraulic fractures and their impact on the well pressure and rates. The major advantages of our proposed approach are its simplicity, intuitive appeal and computational efficiency. For example, we can compute and visualize the time evolution of the well drainage volume for multimillion cell geologic models in seconds without resorting to reservoir simulation. A geometric approximation of the drainage volume is then used to compute the well rates and the reservoir pressure.

The speed and versatility of our proposed approach makes it ideally suited for parameter estimation via inverse modeling of shale gas performance data. We utilize experimental design to perform the sensitivity analysis to identify the ‘heavy hitters’ and a genetic algorithm to calibrate the relevant fracture and matrix parameters in shale gas reservoirs by history matching of production data. In addition to the production data, microseismic information is utilized to help us constrain the fracture extent and orientation and to estimate the stimulated reservoir volume (SRV). The proposed approach is applied to a fractured shale gas well. The results clearly show reduced uncertainty in the estimated fracture parameters and SRV, leading to improved forecasting and reserve estimation.
Realism and anti-realism in the philosophy of psychiatry
Authors: Govedarica Milanko
Published: October 2012

This paper invalidates the anti-realist point of view on the existence of
mental illness by reviewing the anti-psychiatry challenge to official
psychiatry. We present the anti-realist ideas of Thomas Szasz as the most
radical anti-psychiatric author followed by the more moderate thoughts of
Cooper and Laing. We then present the criticism of all these authors, most
notably by the Canadian philosopher of psychiatry L. Reznek. We argue that
some forms of schizophrenic experience can be non-pathological and
emancipatory, but that this does not negate the existence of schizophrenia as
a mental illness. After the invalidation of the anti-psychiatric point of
view that insanity is just a political construct, mental illness is defined
as not only a biomedical, but also a semiotic reality. Finally, we
differentiate the object-level and the meta-level of the problem of
anti-realism in psychiatry and conclude that anti-realism is only acceptable
on the former level, as a characterization of the lack of reality testing by
psychiatric patients.
Knowledge and foretelling: On imagining future
Authors: Krstic Predrag
Published: October 2012

This paper presents and validates opposing notions regarding possibility of
knowing the future. The medium for this enquiry is science fiction production
in the literature, television and film. It finds that potential for knowing
(in this production) demonstrate, illustrate, provokes, but also encounters
the same epistemological, ethical and metaphysical quandaries that modern and
contemporary philosophy deals with.
Experimental studies on radiation heat transfer enhancement on a standard muffle furnace
Authors: Minea Alina , Manca Oronzio
Published: October 2012

One of the sources of increased industrial energy consumption is the heating
equipment, e.g., furnaces. Their domain of use is very wide and due to its
abundance of applications it is key equipment in modern civilization. The
present experimental investigations are related to reducing energy
consumptions and started from the geometry of a classic manufactured furnace.
During this experimental study, different cases have been carefully chosen in
order to compare and measure the effects of applying different enhancement
methods of the radiation heat transfer processes. The main objective work was
to evaluate the behavior of a heated enclosure, when different radiant panels
were introduced. The experimental investigation showed that their efficiency
was influenced by their position inside the heating area. In conclusion,
changing the inner geometry by introducing radiant panels inside the heated
chamber leads to important time savings in the heating process.
Numerical study of flame/vortex interactions in 2-D Trapped Vortex Combustor
Authors: Mishra Prasad , Sudharshan Renganathan , Ezhil Kumar
Published: October 2012

The interactions between flame and vortex in a 2-D Trapped Vortex Combustor
are investigated by simulating the Reynolds Averaged Navier Stokes (RANS)
equations, for the following five cases namely (i) non-reacting (base) case,
(ii) post-vortex ignition without premixing, (iii) post-vortex ignition with
premixing, (iv) pre-vortex ignition without premixing and (v) pre-vortex
ignition with premixing. For the post-vortex ignition without premixing
case, the reactants are mixed well in the cavity resulting in a stable ?C?
shaped flame along the vortex edge. Further, there is insignificant change
in the vorticity due to chemical reactions. In contrast, for the pre-vortex
ignition case (no premixing); the flame gets stabilized at the interface of
two counter rotating vortices resulting in reduced reaction rates. There is
a noticeable change in the location and size of the primary vortex as
compared to case (ii). When the mainstream air is premixed with fuel, there
is a further reduction in the reaction rates and thus structure of cavity
flame gets altered significantly for case (v). Pilot flame established for
cases (ii) and (iii) are well shielded from main flow and hence the flame
structure and reaction rates do not change appreciably. Hence, it is
expected that cases (ii) and (iii) can perform well over a wide range of
operating conditions.
The Effect of the Timing and Direction of Capital Gain Tax Changes on Investment in Risky Assets
Authors: Falsetta Diana , Rupert Timothy J. , Wright Arnold M.
Published: October 2012

This study examines the effect of timing (gradual versus immediate) and direction (tax increase or decrease) of a tax change on taxpayer behavior. Specifically, we focus on capital gain tax changes and preferences for investment in riskier assets. We run an experiment with 117 participants who allocate investment dollars between two funds of differing risk. Drawing on mental accounting and hedonic editing (Thaler 1985; Thaler and Johnson 1990), we posit that a tax decrease (a “gain”) implemented gradually over several years will result in a greater increase in risky investment once the decrease is fully implemented than when the tax change is implemented all at once. In contrast, once a tax increase (a “loss”) is fully implemented, a smaller decrease in risky investment will result when the change occurs all at once rather than gradually. Our findings support these expectations, suggesting that the manner of implementing a tax law change may impact decisions.

Data Availability: Contact the authors.
Economic Consequences of Mandated Accounting Disclosures: Evidence from Pension Accounting Standards
Authors: Chuk Elizabeth C.
Published: October 2012

I examine whether firms alter their behavior in response to changes in accounting standards that mandate new financial statement disclosures. While prior research suggests that new recognition rules lead to changes in firm behavior, there is limited evidence that disclosure rules can impact firm behavior. This study helps to fill this void in the literature by examining the economic consequences of the mandated disclosures of pension asset composition required under SFAS 132R. Under pension accounting rules, the composition of pension assets is a key determinant of the assumed expected rate of return (ERR) on pension assets. I find that when firms disclose asset composition for the first time under SFAS 132R, firms that were previously using upward-biased ERRs respond by increasing asset allocation to high-risk securities and/or reducing the ERR assumption. While disclosure requirements arguably create less powerful incentives to alter firm decisions than recognition requirements, these findings offer evidence that firms alter behavior in response to disclosure standards.

Data Availability: The data used in this study are publicly available from the sources indicated in the text.
Cystic Hygroma of Wrist
Authors: Wani I , Bhat AR , Amin A , Wani S , Malik R
Published: October 2012

Cystic hygroma is the rare congenital lesion. This is a cystic variety of lymphangioma. Cystic hygroma arising outside of the cervicofacial, thoracic, and abdominal areas are extremely rare. Wrist is a very rare site for occurrence of cystic hygroma. Presentation depends on site of location of cystic hygroma. A case of cystic hygroma of wrist in a child is reported. This child presented with painless swelling of left wrist. Excision of cyst was done. This is first case report of literature reporting occurrence of cystic hygroma on wrist. J Nepal Paediatr Soc 2012;32(2):166-168 doi: http://dx.doi.org/10.3126/jnps.v32i2.5465
Staphylococcal Scalded Skin Syndrome in an Infant
Authors: Taksande A , Vilhekar K
Published: October 2012

Staphylococcal scalded skin syndrome is a bullous disease of the skin caused by toxins (exfoliatins) secreted by certain types of Staphylococcus aureus. These toxins may act as superantigens, stimulating the proliferation of T lymphocytes, with a massive release of cytokines and consequent epidermal damage. In neonates, the lesions are mostly found on the perineum or periumbilically, while the extremities are more commonly affected in older children. The disease begins with erythema and fever, followed by formation of large fluid filled bullae which quickly rupture on slightest pressure to leave extensive areas of denuded skin. We present a case of staphylococcal scalded skin syndrome in infant. J Nepal Paediatr Soc 2012;32(2):178-180 doi: http://dx.doi.org/10.3126/jnps.v32i2.5494
Evaluation of physical growth and sexual maturation rating of Adolescent boys
Authors: Gedam DS , Waseem M , Chansoria M
Published: October 2012

Introduction: The present study is an attempt to evaluate the incidence of malnutrition as well as obesity. We have evaluated physical growth and sexual maturity rating of 10-18 years adolescent boys–overweight Vs Normal Vs Underweight. Material and Methods: A random sample of 530 adolescent boys (one private English Medium and one Govt. Hindi Medium School) between the ages of 10-18 years during the period of August 2008 to August 2009 constituted the material for this study. Weight, Height and BMI and Sexual maturation rating (SMR) were calculated. Results: Nearly 39% of the adolescent boys studied were either underweight (31%) or overweight (8%). All overweight adolescent boys have their mean weight more as compared to WHO 50th centile. Normal weight and underweight adolescent boys have lesser mean weight as compared to WHO 50th centile. All overweight and normal weight adolescent boys have their mean height lesser as compared to WHO 50th centile. All underweight adolescent boys except for age group of 12 yr have their mean height lesser as compared to WHO 50th centile. Underweight boys achieved different stages of genital growth prior to normal weight and overweight boys but lag behind as compared to Tanner. It was obvious that underweight boys achieved different stages of pubic hair growth prior to normal weight and overweight boys. Conclusion: Present study indicates that incidence of overweight children is also increasing significantly. Adolescent psychological need should be assessed and they should be given knowledge regarding their normal sexual growth pattern to decrease their anxiety. J. Nepal Paediatr. Soc. 32(2) 2012 117-123 doi: http://dx.doi.org/10.3126/jnps.v32i2.5601
Pattern of Ear Diseases among Paediatric ENT Patient: An Experience from Tertiary Care Centre, Pokhara, Nepal
Authors: Sigdel B , Nepali R
Published: October 2012

Introduction: Ear diseases are common in children mainly due to altered anatomy of Eustachian tube which is straighter in children as compared to that in adults. However, the cause of hearing loss in children is more varied, including the etiologies. This study was done to find out the pattern of ear diseases in paediatric age group attending ear, nose and throat OPD in a tertiary care centre in Pokhara, Nepal. Materials and Methods: This is a prospective study done in paediatric patients attending ENT OPD over a period of one year from January 2010 to January 2011. The diagnoses were made on the basis of history and clinical examination. Results were expressed in numbers and percentages. Results: Out of 1632 Pediatric ENT patients, 944 had ear diseases, 59.2% were males and 40.8% females. Wax (33.4%) was the commonest diagnosis followed by Chronic suppurative otitis media (24.3%) and Acute ottitis media (13%). Conclusion: Ear diseases are most common condition in ENT OPD among paediatric age group. Wax, CSOM and ASOM were the three most common ear diseases. J. Nepal Paediatr. Soc. 32(2) 2012 142-145 doi: http://dx.doi.org/10.3126/jnps.v32i2.5673
Transcranial Doppler Study Among Children with Sickle Cell Anaemia Vs Normal Children
Authors: Lakhkar BB , Lakhkar BN , Vaswani P
Published: October 2012

Introduction: Role of transcranial Doppler in prevention of stroke in sickle cell children has been well appreciated. Studies are being done to develop the protocol in children. Since we don’t find stroke very commonly in this part of the world, this study was done in order to see the prevalence of abnormal flow velocity in sickle children attending sickle cell clinic. The aims of this study were to measure mean flow velocity in different vessels in homozygous sickle cell patients using transcranial Doppler study, to compare the mean velocity in sickle children with age and sex matched controls and to correlate mean velocity with headache or stroke if any and also to correlate mean velocity with number of transfusions. Materials and Methods: The study was done in Paediatric wards. It was a prospective crosssectional comparative study. Twenty six children below 14yrs of age with homozygous sickle cell disease attending the Sickle cell clinic were selected as the cases. Forty cases of similar age and sex were recruited as normal control group. Transcranial Doppler was done in six different vessels in both the groups and mean flow velocity was measured. Mean flow velocity was correlated with symptoms and number of transfusions. Velocity was classified as normal (<170cm/sec), conditional (170-199cm/sec) or abnormal (>200cm/sec). Statistical analysis was done using SPSS 10 software. Results: In normal age and sex matched controls mean blood flow velocity was 50cm/sec where as in the cases of sickle cell disease was 180cm/sec. Maximum mean velocity was observed in middle and posterior cerebral artery. In two Sickle cell cases (8%) blood flow velocity was abnormal, these children had headache though received 5-10 transfusions/year. In only 4% sickle cell children flow velocity was normal and rest had conditional velocity. Among these children 39% received less than 5 and rest received 5-9 transfusions /yr and had no symptoms of stroke. Conclusions: Flow velocity measured by Transcranial Doppler is highest in middle cerebral artery and Posterior cerebral artery which appear to be the best arteries for this test in this region. Flow velocity was significantly high in children with sickle cell disease as compared to normal children. Prevalence of abnormal flow velocity in our children was 8% and children with abnormal mean flow velocity presented with headache. J. Nepal Paediatr. Soc. 32(2) 2012 146-149 doi: http://dx.doi.org/10.3126/jnps.v32i2.5681
Evaluation of Nutritional Status by Mid-Upper Arm Circumference Amongst Affluent Children
Authors: Maiti S , De D , Ali KM , Ghosh A , Ghosh Debidas , Paul S
Published: October 2012

Introduction: Anthropometry is widely accepted as low-cost technique for defining the nutritional status of children. The mid upper arm circumference (MUAC) is a fast screening method in detecting acute malnutrition and it is also a predictor of childhood mortality. Materials and Methods: This is the retrospective study to evaluate the nutritional status based on mid upper arm circumference (MUAC) among urban, pre-school age children. A total of 1060 children, aged 1 to 3 years, attending the vaccination clinic of the Indian Red Cross Society Paschim Medinipur Hospital over a two years period, were enrolled in the study. The measurement of MUAC (in centimetres) was taken by the standard technique. Undernutrition was defined based on age and sex-specific MUAC cut-off values as recommended by the World Health Organization (WHO). Results: Boys were higher level of mean MUAC than girls at all ages and there was no significant sex differences. The age-combined rate of overall undernutrition was 18.96% and it was slightly higher among the boys (19.38%) than girls (18.46%). The age-combined moderate undernutrition was higher among the boys (16.08% vs 14.11%) but girls’ value was higher in case of severe undernutrition (3.28% vs 4.35%). Conclusion: The present study showed that a remarkable number of pre-schooler was undernourished based on MUAC. J. Nepal Paediatr. Soc. 32(2) 2012 113-116 doi: http://dx.doi.org/10.3126/jnps.v32i2.5689
Unilateral lower motor neuron-type of facial palsy following snake bite presumably due to Krait (Bungarus Caeruleus)
Authors: Verma S , Kumar K , Arvind S , Khadwal A
Published: October 2012

We describe an unusual case of snake bite presumably due to Krait (Bungarus Caeruleus) in a 12-year-old child from Mohali, Punjab. He presented with a history of bite behind his left ear, while he was sleeping at night on floor. He had bilateral ptosis, dysphonia initially, which progressed gradually to cause respiratory paralysis. Child was managed with antisnake venom, ventilation and other supportive measures. He recovered gradually, but persisted to have lower motor neuron paralysis of left facial nerve, which was noted post extubation. This uncommon presentation could be because of exposure of the facial muscles to the venom, spreading directly from the injection site and destroying the nerve terminals of facial nerve in the muscle tissue. At three months follow-up, child showed complete recovery. Facial nerve involvement following snake bite, which usually has a good prognosis, remain an uncommon presentation in paediatric age group. J Nepal Paediatr Soc 2012;32(2):184-186 doi: http://dx.doi.org/10.3126/jnps.v32i2.5824
Tuberous Sclerosis in a Child
Authors: Baghel B
Published: October 2012

A female child presented with the complaints of seizure and learning difficulties. On examination various types of skin lesion were found, including adenoma sebacum, hypomelanic macules ("ash leaf spots"), Shagreen patches. On investigation, CT scan of brain showed subepedymal nodule in walls of ventricle. B scan of eyes revealed multiple tiny nodular lesions in posterior chamber of eyes called astrocytic hamartomas (or "phakomas"). Antiepileptic drugs started, now patient is seizure free. J Nepal Paediatr Soc 2012;32(2):181-183 doi: http://dx.doi.org/10.3126/jnps.v32i2.5829
A Rare Case of Idiopathic Congenital Complete Heart Block in a Neonate
Authors: Sinha R , Negi V , Dalal SS
Published: October 2012

Congenital complete heart block in utero has become diagnosed more frequently with the clinical use of fetal echocardiography. Autoimmune-associated congenital complete heart block (CHB) is a rare but important disease that can now be diagnosed in utero using fetal echocardiography1,2,3,4. The overall incidence of isolated CHB has been reported to be approximately 1:15,000 to 20,000 live births5. Several reviews have shown that children diagnosed prenatally have an increased mortality compared to those diagnosed immediately after birth or later in childhood1,2,3,4. At birth, some neonate with complete heart block may remain asymptomatic and may not require a pacemaker but majority require pacemaker to increase the heart rate. We report a rare case of idiopathic congenital complete heart block in a newborn male. J Nepal Paediatr Soc 2012;32(2):163-165 doi: http://dx.doi.org/10.3126/jnps.v32i2.5992
Clinopathological Profile of Acute Leukemia in Children
Authors: Harpani PT , Parmar BJ , Makwana AM
Published: October 2012

Introduction: Acute leukemia is the most common malignancy in children of which acute lymphoblastic leukemia accounts for majority of the cases. The objective of this study was to see the clinical profile, hematological parameters and assessment of response to chemotherapeutic agents in acute leukemia. This was an observational prospective study involving 58 children conducted over a period of two years from September 2005 to August 2007 at the department of paediatrics, B.J. Medical College, Ahmedabad. Materials and Methods: Leukemia was suspected in children presenting with history of prolonged fever, pallor, hepatosplenomegaly, lymphadenopathy, abnormal bleeding or history of repeated blood transfusion. A complete history, clinical examination and relevant investigations were done to diagnose leukemia. After confirmation of diagnosis, patients were treated, followed up to first remission after receiving chemotherapy. Follow up bone marrow examination was done after induction phase to confirm remission. Complete blood count and CSF cytology were done periodically during intrathecal chemotherapy. Results: Out of total 58 patients, 49 (84.5%) were ALL and 9 (15.5%) were AML. Pallor (87.9%), fever (82.7%) and fatigue (86.2%) were most common presenting symptoms. Pallor (86.2%), splenomegaly (89.6%) and hepatomegaly (84.5%) were the most common clinical signs. Forty two patients (74.2%) presented with moderate anemia. Remission was achieved in 51 cases (87.9%) after intrathecal chemotherapy. Conclusion: ALL is more common than AML in children. With detailed history and clinical examination, timely diagnosis and initiation of appropriate chemotherapy commonly leads to remission in childhood acute leukemias. J. Nepal Paediatr. Soc. 32(2) 2012 95-98 doi: http://dx.doi.org/10.3126/jnps.v32i2.6038
Impact of Family Conflict on the Psychosocial Behaviour in Male Adolescents
Authors: Chhabra GS , Sodhi MK
Published: October 2012

Introduction: Accepting and supportive family relationships during childhood and adolescence may have long-term associations with psychosocial functioning into adulthood. Cross-sectional studies provide evidence by which positive family relationships promote adolescent health by increasing the likelihood of positive outcomes including higher educational and occupational attainment and reducing the risk for negative outcomes including suicidal behaviour and poor health. Materials and Methods: The sample consisted of 500 male adolescents from the urban and rural field practice areas in the vicinity of Sri Guru Ram Das Medical College Amritsar. Cross sectional study was conducted to examine the relation between familial conflict problems and psychosocial/behavioural disorders in adolescents. Results: Almost one third (33%) adolescents were having parental and family dispute problems. These problems were significantly higher in middle adolescence (14-16 years), adolescents of large extended families (>8 members) and in lower socioeconomic status. Residence had no significant relation to family problems in the adolescents. On correlation, poor and unhealthy family atmosphere had more chances in adolescents of having greater academic problems, depression, suicidal thoughts, substance abuse and more sexual activity. Conclusion: Family involvement, family structure, parental values, parental monitoring and parent-child communication are important factors influencing critical life choices in teens. The family support and communication should be improved through these education programs to develop healthy psychosocial and sexual attitudes and counteract unsafe behaviours in the adolescents. Future research is needed to identify additional pathways underlying this association, and the extent to which these factors are modifiable.J. Nepal Paediatr. Soc. 32(2) 2012 124-131 doi: http://dx.doi.org/10.3126/jnps.v32i2.6147
Prognostic Value of Rapid Test for Diagnosis of Dengue in Nepalese Patients during 2010 Epidemic
Authors: Pun R , Shah Y , Gupta GP , Sherchand SP , Pandey BD
Published: October 2012

Background Dengue is an emerging vector borne disease in Nepal and rapid diagnostic test is important for early diagnosis of the disease. Objectives The aim of the study was to evaluate the diagnostic accuracy of commonly used rapid immunochromatographic test kit in Nepal during 2010 dengue epidemic and to assess disease burden of dengue. Methods A total of 131 acute and nonacute serum samples were collected during recent epidemic of dengue in 2010 from clinically suspected Nepalese patients of different hospitals. Rapid immunochromatographic test kit was used for early diagnosis and enzyme immunosorbent was chosen as a reference assay. Results The sensitivity and specificity of rapid test was 70% and 76.54% respectively whereas the prevalence of the disease was 38.17%. The odds ratio for males was 1.8 however; the association with the disease was statistically not significant. Conclusion The diagnostic accuracy of rapid immunochromatographic test for dengue diagnosis was low (k=0.46). So, it should be substituted by highly sensitive test device for prompt diagnosis and health personnel should consider appropriate timing of sample collection for better performance of rapid test. KATHMANDU UNIVERSITY MEDICAL JOURNAL  VOL.10 | NO. 1 | ISSUE 37 | JAN - MAR 2012 | 7-10DOI: http://dx.doi.org/10.3126/kumj.v10i1.6905
Estimation of Stature from Foot Length in Adult Nepalese Population and its Clinical Relevance
Authors: Mansur DI , Haque MK , Sharma K , Karki RK , Khanal K , Karna R
Published: October 2012

Background Stature is the height of the person in the upright posture. It is an important measure of physical identity. Interrelationships among different body measurements may be used to estimate one from another in case of missing body parts. Objective Stature is an important indicator for identification. There are numerous means to establish stature and their significance lies in the simplicity of measurement, applicability and accuracy in prediction. The current study dealt with developing a regression equation for stature estimation from foot length and to find out the correlation between body height and foot length of Nepalese people. Methods The present study was carried out to establish the regression equation and correlation coefficient between individual’s height and mean foot length. It was conducted on 440 students of age group 17 to 25 years studying in Kathmandu University School of Medical Sciences, Dhulikhel, Nepal. Body height and foot length were measured in centimeter. Results There was significant correlation between height and foot length (r = 0. 703, p < 0.01).The regression equation for height and foot length was found to be Y = 3.179 X + 87.65, where X is the foot length and Y the height. Conclusions This study will help in medico-legal cases in establishing identity of an individual and this would be useful for Anatomists and Anthropologists to calculate stature of adult Nepalese based on foot length. KATHMANDU UNIVERSITY MEDICAL JOURNAL  VOL.10 | NO. 1 | ISSUE 37 | JAN - MAR 2012 | 16-19DOI: http://dx.doi.org/10.3126/kumj.v10i1.6907
Is Ethnicity an Important Determinant of High Blood Pressure in Nepalese Population? A community-Based Cross- Sectional Study in Duwakot, Nepal
Authors: Vaidya A
Published: October 2012

Background Hypertension is a rising public health problem in Nepal. Most of the upsurge is attributed to the behavioural and lifestyle transitions. However, the hereditary component such as ethnicity, which may also be an important determinant, has not been studied. Objective This study aims to investigate if ethnicity is a key determinant of having a high blood pressure in the Nepalese population. Methods A population-based cross sectional study was conducted in the Duwakot village of Bhaktapur District, Nepal. Systematic random sampling of the adults was done in all the nine wards. A total of 641 adults of both sexes, of age 35 years or more were included in the analysis. Results Most of the life-style related risk factors were comparable in the broad two ethnic groups- Tibeto-Burmans and Indo-Aryans. The prevalence of hypertension was 25.3% in the Tibeto-Burmans compared to the 14.0% in the Indo-Aryans. Crude odds ratio (95% CI) of being hypertensive for the Tibeto-Burmans compared to the Indo-Aryans was 2.07 (1.36-3.15) (p=0.01). After adjusting for the different factors the adjusted odds ratio (95% CI) for the same was found to be 1.78 (1.12-2.81) (p=0.014). Conclusion There is an ethnic variation in the blood pressure distribution in the Nepalese population, which might be acting independent of the different life-style factors. More elaborate studies, including longitudinal and migration studies, and probably genetic analyses, can provide a more definite answer. KATHMANDU UNIVERSITY MEDICAL JOURNAL  VOL.10 | NO. 1 | ISSUE 37 | JAN - MAR 2012 | 20-23DOI: http://dx.doi.org/10.3126/kumj.v10i1.6908
Current Fluoroquinolone Susceptibility Criteria for Salmonella Needs Re-evaluation
Authors: Acharya D , Malla S , Bhatta DR , Adhikari N , Dumre SP
Published: October 2012

Background Disc diffusion technique is the routine susceptibility testing procedure for isolates of enteric fever, the most common clinical diagnosis among febrile patients in Nepal. Objective To evaluated the current fluoroquinolones (FQs) susceptibility criteria and nalidixic acid screening test in Salmonella enterica serovar Typhi and Paratyphi A. Methods S. Typhi and Paratyphi A strains isolated from 443 suspected enteric fever patients visiting National Public Health Laboratory (NPHL) during April through October 2008 were analyzed. All isolates were confirmed by standard microbiological procedures including serotyping. Antibiotic susceptibility testing was performed by using Kirby Bauer disc diffusion method and Clinical and Laboratory Standards Institute (CLSI) approved interpretive criteria. Agar dilution method was used to determine Minimum Inhibitory Concentration (MIC) of ciprofloxacin, ofloxacin and nalidixic acid. Result Out of 41 Salmonella isolates, 80.49% were nalidixic acid resistant, with S. Paratyphi A showing higher resistance rate (88.23%) compared to S. Typhi (75%). The difference in both MIC and zone diameter in nalidixic acid susceptible and nalidixic acid resistant isolates was found to be significant (P < 0.001) and decreased susceptibility to FQs was strongly correlated (sensitivity and specificity of 100%) with resistance to nalidixic acid. Regression analysis of MIC against zone diameter based on the current CLSI recommended guidelines suggests that accommodation of current susceptible and resistant MIC requires increase in the zone diameter of ciprofloxacin and ofloxacin. Conclusion Before using these drugs for management of enteric fever, appropriate identification of Salmonella isolates with reduced susceptibility to FQs is essential to limit the possible treatment failure and development of highly resistant strains. The current FQs susceptibility break point criteria for Salmonella need re-evaluation. KATHMANDU UNIVERSITY MEDICAL JOURNAL  VOL.10 | NO. 1 | ISSUE 37 | JAN - MAR 2012 | 24-29DOI: http://dx.doi.org/10.3126/kumj.v10i1.6909