bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhanced Rig Safety in Well Construction and Beyond: An Intelligent Digital Controls Solution to Minimize Offshore Operational Hazards
Authors: Mahmood Azfar , Thibodeaux Robert , Angelle Jeremy
Published: April 2022

As the industry leans toward achieving higher efficiency and reliability while accomplishing its operational targets and flawless execution, the operational hazards involving personnel and equipment persist, especially on the rig floor, often referred to as the "red zone." With the implementation of a vigilant surveillance and tracking system, every movement including personnel and various machinery is detected. This intelligent and digitally controlled solution stops any unsafe activity that could prevent human injuries and asset damage.

The hazard monitoring technology tracks equipment as well as personnel movement through a unified real-time system with 10-centimeter accuracy. This solution is portable and customizable to suit any rig environment or configuration. The battery-powered sensors track personnel and equipment with respect to the set boundaries established for safe operations. The location coordinates for each object are monitored live and the ability to interfere and/or stop unsafe operations is executed from a single command and control system. In addition, audible and visual alarms and safety interlocks can be established based on various levels of moving or collision hazards in operations.

The regulatory agency of the U.S. Department of Labor, Occupational Safety and Health Administration (OSHA) has stated that one of the topmost hazards in the oil and gas industry is the collision of assets, including personnel and equipment. In addition, three of every five on-site fatalities are the consequence of struck-by/caught-in/caught-between hazards per OSHA IMIS Database.

This innovative surveillance technology was used in the field during the year 2020-21 on an offshore rig in the Asia Pacific region during casing and completions operations, and the results showed a significant added value to the customers that could lead to potential cost savings in the overall rig operational expenditure budget. Another field deployment was performed for an operator in the Gulf of Mexico. During this deployment, the safety and wellbeing of rig personnel were enhanced to avoid any recordable incidents, loss time, or remedial actions resulting from human injuries or equipment damage. This paper will provide comprehensive details on the novelty of this technology and the solution offered to the industry.
Where is the Industry Going with Offshore Carbon Capture, Storage, and Injection?
Authors: Wilson Jessie , Rousseau Joseph , Miller Mimosa , Patel Harish
Published: April 2022

With the Sustainable Development Agenda and Paris Agreement adopted, there are emerging efforts to satisfy the 17 Sustainable Development Goals (SDGs) and climate change. This paper will provide the role of offshore carbon capture, storage, and injection to achieve the goals set by the SDGs. The paper will also address industry activities, technical and operational practices, equipment safety, and status of regulations, and codes and standards.

The paper will begin with an overview of carbon capture technologies, storage options, and injection capabilities. It will provide details on the current regulatory framework and codes and standards for transportation, storage, processing, and injection of CO2 offshore using various types of structures. The paper will address the areas of additional safety and structural requirements which may be needed for this concept. Additional topics will include the use of green energy options offshore, need for associated equipment verification, and associated risks to environment, people, and assets.

This paper will provide a summary of how this application of carbon capture, storage, and injection in offshore may assist in achieving the goals stated by the regulatory drivers, Sustainable Development Agenda and Paris Agreement. CO2 transportation such as by pipeline and vessels will be discussed along with facility processing and injection including fixed platform, floating facility without storage, and floating facility with storage. Current regulations are written for hydrocarbon facilities and these need to be adjusted to address CO2 storage onboard, processing, and injection risks. Green energy options such as wind power may be utilized for offshore carbon capture operations, and these will also be analyzed to reduce the carbon footprint. The conclusion is that as the industry continues to mature, there is a need for continued efforts to develop the regulations, codes and standards, and equipment verification to provide sufficient safety guidance for these operations.

The paper provides the value of implementing carbon capture, transportation, and storage for the marine and offshore industry. This technology combination may also provide insight into offshore options for carbon reduction. The paper will also provide insight on risks associated with this operation, the call for development to the codes and standards, and marine transportation and storage of CO2 onboard.
Driving the Industry Towards Net Zero Through Pooling, Sharing and Collaboration
Authors: Coull Chris
Published: April 2022

As an industry, we have a shared commitment to reach net zero emissions by 2050. The exam question has been set and although we are beginning to see progress, in an industry that has always been good at overprovisioning, a lot of work is still to be done.

Operators have traditionally felt the need to maintain extra capacity to guarantee uninterrupted production. This may seem understandable, but in reality, will only result in more significant costs and emissions further down the line. To achieve our efficiency goals, we need to change this mindset, but how can we adapt our culture and drive the change needed to achieve that?

One way is through a much greater focus on combining what we have, through pooling or sharing, to meet the increasing expectation from the authorities for operators to demonstrate they are truly collaborating with each other. Every operator has efficiency and environmental targets, but many still seem reluctant to follow through on the need to work closely together.

We must question why this is the case and tackle head-on some of the barriers that prevent us from implementing more efficient models.
High Performance DEH-PiP: Qualification Status
Authors: Lozinguez William , Roland Paul , Hallot Raymond , Anres Stéphane , D'Huart Pierre Emmanuel
Published: April 2022

This paper presents Saipem's qualification activities on its High-Performance version of DEH PiP technology. A reminder of the technology is given as well as an insight into the modifications and improvements performed. Qualification status of the sub-systems specific to the technology is also detailed.

DEH PiP technology has now been around since its development and installation by Shell in the early 2000's. Saipem considers that this technology, provided some improvements, is a very competitive option for subsea flowline heating. As a result, qualification activities on an enhanced version of the DEH PiP were started in 2019 to verify and provide evidence that the system will properly perform the function it is designed for, while bringing risks to a minimum level. Several studies and tests have been performed with this intention and are in part presented in this paper.

An overview of the technology qualification process is given and is followed by a description of the qualification activities performed on the various sub-systems of the technology. From an electrical point of view for instance, studies and tests were performed for the qualification of an electrical insulation layer, of the global system electrical modelling, and of the system upgrade for performance enhancement. Other qualification activities, like mechanical tests on the "shear stops", are also part of the qualification to validate new conceptual designs and are presented. The activities already performed in the qualification program allowed to improve the technology readiness level of the system and increase confidence in its potential. The next steps and the associated targets for development are also presented.

This paper presents Saipem's qualification activities on its High Performance DEH PiP for the first time and hence gives an interesting overview of this technology and its qualification status.
Angola Block 17 – In-Depth Assessment for a 10 Year-Long Extension of Ageing FPSOs
Authors: Gayon Pierre-Henri , Schmitt Florent , Maimaran David
Published: April 2022

The paper presents the technical study performed for the 10 years Life Extension of Girassol FPSO, Block 17 Angola. A specific methodology has been developed, splitting the asset into packages and performing a comprehensive assessment based on equipment condition and obsolescence aspects.

Starting from the scope definition, development of obsolescence plan, execution of the sites surveys up to the consolidation of the work program for the upcoming years, the paper explores how the study has been executed, in close coordination with the affiliate operational entities, engineering companies and vendors.

It explains how a fit for purpose approach has been promoted to optimize the amount of work and expenditures with a constant focus on safety & production critical items. Some examples are detailed like the selection of refurbishment approach versus newbuilt equipment, as well as the definition of partial upgrades and the use of existing warehouse stock when possible.

The paper addresses the various digital tools which were implemented during the technical evaluation and the project scope of work consolidation. An innovative database was created to record the technical scope for easier handover to project phase and smooth execution monitoring. It covers as well the use of an innovative technique to be able to inspect the inside of the FPSO tanks within the short study schedule.
A New Approach to Assuring Well Integrity and Performance
Authors: Cully Richard , Franklin C. Mark , Lewis Kimberly , Mesa Carlos
Published: April 2022

Well barrier integrity testing is key to protecting people, environment, and a company's reputation and bottom line. However, critical well integrity testing is impacted by criteria and analysis selection in a way not typically considered which introduces significant risk to well integrity assurance.

Accepting testing of key components used to validate well integrity must be consistent for all components in a test system. A simple example is testing a BOP system to a criteria that is less stringent than a test conducted on a packer, where components of the BOP are part of the overall pressure containment system. More concerning is using varying test methodologies or methodologies lacking specific criteria assurance.
20,000-Psi API 16C Choke and Kill Flexible Line Development
Authors: Kovacs Zsolt , Gonzales Gerardo , David Attila , Grepaly Istvan , Mezo Tamas
Published: April 2022

This paper is to give a brief overview of the development process on the industrie's very first 20,000psi API 16C Temp U (-20 to 121°C) hose design. Although the design input and product requirements were clear, some aspects held a significant technical challenge in the early stages of the development. Selecting the proper materials and fine tuning the reinforcement layers to create a qualified and safe product with reasonable performance parameters were just the beginning, validating the product according toAPI 16C requirements with third party inspection marked the end of the process.

This paper is providing an example of a well defined, but challenging development, detailing the design, prototype testing and verification through dynamic analysis of the product.
Pathways to Achieve Rapid Decarbonization of ASEAN
Authors: Lau Hon Chung , Lin Xianlong
Published: April 2022

As a region, the ten countries of ASEAN emitted 1.65 Gt of CO2 in 2020 which was 4.75% of worldwide emission. The biggest CO2 emitting nations were Indonesia, Malaysia, Thailand, Vietnam and Philippines. This paper conducts a detailed analysis of total primary energy consumption (TPEC) and CO2 emission profiles from these five countries as well as Singapore and Brunei (ASEAN-7). Analyses show that in 2018, TPEC of ASEAN-7 consisted of 35% oil, 29% coal, 19% gas and 17% renewables, whereas CO2 emission came 44% from coal, 39% from oil, and 17% from gas. Seven pathways for rapid decarbonization of ASEAN are proposed. They include: (1) increasing the share of renewable energies in power generation, (2) replacing coal by gas in power generation, (3) electrification of road transport, (4) hydrogen for marine transport, (5) biofuels for aviation, (6) blue hydrogen for hard-to-decarbonize industries, and (7) establishing regional carbon capture and storage (CCS) corridors to accelerate implementation of large-scale CCS projects.
Key Technology Qualification of a Full Scale Subsea Chemical Storage and Injection System
Authors: Schroeder Art J. , Chitwood James E. , Gay Tom A. , Gillespie John , Lee Yung
Published: April 2022

This paper provides an overview and summary of development, testing, and qualification of a full-scale prototype subsea chemical storage and injection unit. Successful deployment of this new technology in brownfield applications will provide a very attractive alternative to an umbilical replacement that might be required late in field life when production rates and percent oil tend to be much lower, and where economics may all together preclude installing a new umbilical, resulting in pre-mature field abandonment. Additionally, transferring chemical storage and injection equipment from a host facility deck to subsea frees up space and weight and eliminates interaction of on-deck personnel with hazardous chemicals and can help achieve de-manning industry objectives. In greenfield applications, subsea chemical storage and injection can facilitate the development of hundreds of smaller deepwater resources and billions of barrels of oil equivalent (BOE) by enabling safe, cost-effective long-distance tie-backs to existing infrastructure out of traditional reach of umbilicals.
ISO Standardization as an Enabler for Production Efficiency in the Operating Phase
Authors: Hamran Harald , Østebø Runar , Smith Andrew , Alhanati Francisco
Published: April 2022

Consistent feedback on factors affecting production loss is key to monitoring production performance and drive improvements in production efficiency of upstream (E&P) installations. However, operators have used different frameworks for calculating and reporting production efficiency, and this has hampered communication among stakeholders and improvement efforts. The new ISO/TS 3250 "Calculation and reporting of production efficiency in the operating phase" has been developed to provide requirements and guidance for calculation and reporting production performance data, and production loss data, during the operating phase. This paper describes the background and how this new ISO/TS can assist in achieving consistency in determining the production potential and classifying production loss.

Calculation of the achieved production efficiency is in principle a simple exercise of calculating the ratio of actual production and production potential. However, changes in reservoir conditions, equipment failure and maintenance events, and external factors (such as weather), as well as economics, affect actual production or production potential to various degrees, and it is not always obvious how these events should be considered when calculating and reporting production efficiency. While ISO 20815:2018 already includes production loss categories for reporting production loss, the new technical specification extends these categories and provides requirements and additional guidance. For the allocation of production loss to different systems and equipment classes, the technical specification provides the important relationship to the classification provided by ISO 14224:2016, which is being used by operators in their computerized maintenance management information systems.

In an industry where continuous improvement is essential, keeping track of performance measures is key. Improving production performance or optimizing production efficiency in a life cycle perspective within HSE and sustainability frameworks, requires knowledge of such performance and identification of the most important contributors to production loss. The technical specification also provides a framework that enables consistency for benchmarking between an operator's own production facilities or across the industry.

This paper introduces all participants in the process – operators, contractors and other stakeholders, to this new international standard approach as described in this new technical specification.
XPak De Double Expansion Liner Hanger Replaces Wellhead Sub Mudline Adapter and Hanger - Qualification and Field Trial Results
Authors: Rice James Kevin
Published: April 2022

Objectives/Scope

This paper discusses the qualification testing and field trials of a large-bore expandable liner hanger, which can serve as an alternative to wellhead sub-mudline supplemental casing hanger systems. Development of the first double expansion liner hanger, the Dril-Quip® XPak De™, allows for the elimination of contingency sub-mudline equipment, improves well integrity, simplifies liner installation, and reduces well costs. Detailed results from two field trial well installations are provided.
Integrated Operation Performance and Optimization Analysis Based on Technical Limit and Invisible Lost Time
Authors: Márquez Freddy José , Sandrea Ranses Guillermo
Published: April 2022

Technical Limit (TL) and invisible lost time (ILT) are concepts that have contributed to the success of several oil and gas projects around the world since late 90s, many of them documented and presented in international conferences. The TL represents the optimum time for a given operation, based on statistical analysis or operation team commitment. Defining TL could be challenging when unique activities are programmed or there is a lack of offset data, on these situations the TL estimated may be biased. The objective of this paper is to describe a methodology that allows to define a TL based on specific conditions of the well, to identify not only the ILT from operational performance, but also identify imprecisions on the daily operation reports (DOR), the program and well design.

ILT is the difference between the productive time and TL, this value allows to estimate efficiency. Identified invisible lost time (IILT) is the ILT portion that can be measured with real time data and/or DOR. The other portion is defined as unidentified ILT (UILT). IILT and UILT were estimated to productive and non- productive time (NPT). Geological correlation was used to estimate ILT derived from drilling performance.
Novelties in the Design of Low-Voltage Subsea Wet-Mate Connectors, Demonstrating Enhanced Electrical Performance and Cost Reduction
Authors: Wyatt Rob
Published: April 2022

A new subsea wet-mate low-voltage connector is presented, showing product strategies and designs to enhance electrical performance and reliability, while reducing cost and lead-time. Also reducing the environmental impact of such a product is discussed. Connectors with reduced environmental impact, reduced cost and enhanced reliability are needed to contribute to the economic and environmental viability of new applications such as ‘all electric’ subsea production systems, as well as new offshore markets such as wind, tidal energy, CO2 storage and fish farming.

Key methods to achieve this are redesign of the electrical insulation system, solderless cable terminations, and physical layout of the pin pattern. The effect of rationalising and standardising the product range on part count reduction for increased economies of scale is discussed, both for the connectors and for flying leads.

Conclusions of the Life Cycle Assessment conducted (embodied CO2) within the product are presented and how this is reduced with new product design.

New design features are shown which allow for components to have reduced dimensions and a reduction in overall quantity of component parts can be observed. Both contributing to reduced raw material content, lowering costs and environmental impact.

Finally, electrical test results performed in accordance with API-17F are shown.
Advancing Geothermal Energy Exploration
Authors: Pinnoo Seth Michael , Hart-Wagoner Nicole Rita , Pollett Buford , Pilko Robert , Chen Jingyi
Published: April 2022

Geothermal energy is a renewable energy source that is coming into more widespread use. Given the recent advancements in geothermal energy, it is an energy source that should be given serious consideration as new policies and regulations are set in place to reduce greenhouse gas emissions. While there are long-standing projects around the world utilizing geothermal resources, many places are still investigating geothermal resource potential, including several states within the United States. One state that has had limited geothermal exploration in recent years is Oklahoma. This paper compounds research efforts for Oklahoma geothermal resource evaluation and potential use and additionally provides information and background for potential sedimentary reservoirs that can be further evaluated for carbon sequestration pore space use. Three regions of Oklahoma were analyzed for geothermal resource potential: the Anadarko Basin, Arkoma Basin, and Osage County. Well logs from 105 wells were identified to analyze geothermal potential and subsurface temperature variations based on bottom hole temperatures (BHT). Results indicate that the Anadarko Basin has low potential for geothermal energy production, as temperatures >100°C (212°F) are not reached until a depth of ~4,000 m (~13,000 ft). The Arkoma Basin wells reached temperatures of 100°C (212°F) at a depth of ~2,000 m (~6,500 ft), indicating potentially higher temperature resources at relatively shallower depths. The areas of higher temperatures appear to be dispersed, so more localized studies should be conducted in this region. The Osage County wells were only drilled to depths of <~1,000 m (~3,300 ft), but some had BHT of >40°C (~100°F) at these depths, indicating possible higher potential at depth. These results indicate that direct use of low-to-medium geothermal resources in Oklahoma can be exploitable further and that this preliminary investigation of geothermal resources in Oklahomashould be used as a basis for further exploration to target geothermal energy sources in the state.
A Novel Approach Using a Resin-Blended Cement System for Remedial Tieback Operations in a Highly Corrosive Environment: Case History from Iraq
Authors: Campana Barbosa Lucio Felipe , Iqbal Javaid , Bhaisora Devesh
Published: April 2022

Multiple heritage wells in Iraq have experienced sulfur water corrosion impacting the intermediate and production casing strings; if left untreated, the wells could be lost. Typically, costly workover operations to address this issue requires running a tieback casing and cementing it to the surface to isolate the production path from the corrosive formation fluids. Thus, well integrity is regained, and corrosion to the well casing is prevented.

To achieve long-term zonal isolation in corrosive environments, various slurry systems were studied, and a resin-blended cement system was selected to isolate the annulus between the tieback pipe and the outer intermediate casing. Reduced permeability of the set cement, resistance to fluid channeling, and increased shear bond strength, which protects the casing from H2S environments, are some of the salient features of this system. A premium grade external sleeve stage tool has been used for some of the strings to provide improved isolation.

Details of the design methodology, laboratory testing, job execution, and results from various wells wherein this cement system was applied are discussed. Some of the cementing operations have differences in terms of execution, such as the use of single or multiple plug systems or use of a perforated joint or stage tool as a means of circulation. However, all operations used the resin cement system. All tieback casings were cemented with zero non-productive time (NPT) and passed a pressure integrity test. This resin-blend cement system's reliability has proven effective for isolating zones where corrosive fluids have created severe and recurring issues in the past. Therefore, this new approach has become the primary choice for the operator.

A resin-blend cement system exhibits multiple desirable properties for isolation of the well's lifecycle and, if used as a primary option, can greatly reduce workover interventions in the future, leading to significant savings for the operator and increased well life, particularly in such corrosive environments.
Maximizing Value from Mature Assets in Deepwater Gulf of Mexico
Authors: Thompson Clay , Jegannathan Manoj , Jeansonne Natasha
Published: April 2022

This paper describes the challenges and opportunities facing operators with mature assets in the deepwater Gulf of Mexico. Oxy has a large deepwater asset base that, although mature, continues to provide the company value through robustness coupled with enhanced recovery techniques.

The deepwater Gulf of Mexico has transitioned from a reasonably steady pace of greenfield developments with standalone facilities into large brownfield projects with subsea tiebacks. As our mature deepwater fields have depleted, Oxy has leveraged the most up-to-date analytical methods and inspection techniques to extend the productive life of our floating and subsea infrastructure. Additionally, Oxy continues to apply a multitude of enhanced recovery technologies to maximize the recoverable reserves.

One of the key challenges for mature deepwater infrastructure is to institute an aggressive and robust integrity management program to achieve approval for continued service in hurricane-prone waters. The second key challenge is to boost the declining production of the aging reservoirs using a variety of enhanced recovery technologies rather than decommissioning the facilities because they are no longer economic to keep in operation.
Enabling All-Electric Subsea Control Systems without Compromising Safety - A Case Study Comparing Functional Safety Systems Using Springs or Batteries
Authors: Orth Alexandre , Placido Neto Amadeu , Hendrix Gottfried
Published: April 2022

The electrification of subsea control and production systems is essential to achieve the low carbon emission and high productivity targets that the offshore industry is facing now. But how to electrify these controls without compromising safety?

This paper provides a comparison of the design strategies using mechanical springs or electric batteries to implement safety functions in control systems, considering as a case study the development of the new subsea electric actuator for small-bore valves SVA R2 from Bosch Rexroth.

Traditionally, to control process valves with safety functions, hydraulic actuators have been applied with field-proven springs to bring the valve to a specific position (open or closed, depending on the application) in case of a safety-related failure such as a loss of power supply. However, the first electric subsea actuators developed with fail-safe springs turned out to be too large, heavy, inefficient, and costly due to their complex electro-mechanic system for broad adoption by the subsea industry. Thus, new electric subsea actuators [2] were developed using electric batteries to reduce overall size, but this added new risks: now the safety control has to detect a dangerous situation by itself and actively drive the system to the safe position. But, at the OTC 2021, a new electric subsea actuator for small bore valves was presented which achieves Safety Integrity Level SIL 3 using field-proven springs as compact as a hydraulic actuator (OTC-31083-MS) [17].

Following the functional safety methodology acc. to the IEC 61508, IEC 61511 and ISO 13849, this work provides a comparison between a control architecture with mechanical springs and another with electric batteries, considering the whole product life cycle (design, manufacture, installation, commissioning, and operation). An evaluation of the failure modes and failure mechanisms of existing subsea equipment, from field data available in the OREDA@Cloud, gives a proper assessment of the risks associated with implementing the new functional safety architecture. Costs of engineering, production and operation are taken into account to find out the most technical and economically feasible solution.

This case study is a reference for the design and qualification of new subsea electric actuators with functional safety requirements using mechanical springs or electric batteries. It provides technical guidelines and risk assessment for designers and users of subsea control systems such as machine builders, EPCI companies, operators, service providers or certification bodies.

If electrification is a prerequisite for a low carbon future, safety is a prerequisite for the adoption of all-electric control systems. This paper shows how to electrify subsea production and process systems by using mechanical springs or electric batteries without compromising safety.
Using Asset Performance Management APM to Deliver a Reliability Centered Maintenance RCM Approach in an Offshore Production Environment
Authors: Koutsoyiannis Loukas
Published: April 2022

In recent years, Asset Performance Management (APM) solutions have garnered increased attention from oil and gas process facility operators employing digitalization strategies. However, despite the growing interest, there is still confusion among industry professionals about what APM is and how it can be leveraged to reduce operating costs (OPEX), improve asset reliability, and contribute to de-manning objectives.

This paper aims to answer these questions by defining the framework for an effective APM program and outlining considerations for implementation. Multipleoffshore production facility uses cases are presented which demonstrate how an APM approach can be applied to enable a reliability centered maintenance (RCM) approach, whilst ensuring that equipment and systems perform their expected function within a specificoperating and business context.
Prevalence and associated risk factors for anaemia amongst pregnant women attending three antenatal clinics in Eswatini
Authors: Dodzo Rumbidzai C. , Ogunsakin Ropo E. , Ginindza Themba G.
Published: April 2022

Background: Anaemia is a global health problem affecting about a third of the world’s population. In pregnancy, it is a public health concern with consequences for mothers and infants, including maternal death and infant mortality. In low-income countries (LICs), 25% indirect maternal mortality and 30% neonatal deaths are due to anaemia in pregnancy.Aim: This study aimed to determine the prevalence and risks associated with anaemia amongst pregnant women attending antenatal clinic (ANC) in three health facilities in Eswatini.Setting: This study was conducted in three health facilities in Eswatini, namely Mankayane, Raleigh Fitkin Memorial (RFM) and Mbabane Hospital.Methods: This cross-sectional study used non-probability sampling in three hospitals of Eswatini, to select 550 pregnant women, aged 15–49 years. Data were collected from January to March 2021, using face-to-face interviews with a structured questionnaire. Logistic regression was used for statistical analysis.Results: A total of 550 pregnant women were included in the study. Anaemia prevalence amongst pregnant women was 43.1% with mild, moderate and severe cases of 21.3%; 21.1% and 0.7%, respectively. Prevalence was high amongst women aged 15–19 years (53.3%). Factors associated with anaemia included living in urban areas (odds ratio [OR]: 1.8; confidence interval [CI]: 1.19–2.72), having anaemia 6 months before pregnancy (OR: 4.64; CI: 1.15–18.71), and gestational age at first ANC: third trimester (OR = 10.42; CI: 4.27–25.4) and second trimester (OR: 1.62; CI: 1.02–2.60).Conclusion: Anaemia remains prevalent amongst pregnant women in Eswatini. A comprehensive anaemia prevention programme would be justified and could lower the country’s burden of anaemia.
Traumatic hand injury management and outcomes: A case report
Authors: Keller Monique M. , Jordaan Pieter W.
Published: April 2022

Acute hand injuries are routinely managed by family medicine and primary care physicians. An appropriate initial assessment and treatment, early referral to a hand surgeon when indicated, and timeous referral to a hand therapist are imperative. A patient case report is presented reporting on the initial and subsequent assessment, treatment and outcomes at 3, 6, 7 and 9 months for a patient who sustained an acute finger injury. Finger range of motion (ROM), sensation, pain, time of wound closure, hand function measured with the standardised disability of the shoulder, arm and hand (DASH) questionnaire were the outcomes used. Pain, crepitus, decreased sensation, decreased ROM right index finger proximal interphalangeal joint (PIPJ) and dense scarring was measured at 9 months. Missed injuries or lack of recognition of injury severity leads to delayed referral to specialist hand surgeons and therapists, which lengthens recovery time and leads to sub-optimal outcomes. This article aims to provide the primary care practitioner with the initial management of a patient who sustained a traumatic hand injury whilst using a power tool.
Mathematics declaring the glory of God
Authors: Kessler Volker
Published: April 2022

This article discussed the question ‘Does God speak through the language of mathematics?’ For centuries, mathematicians with different religious backgrounds would have answered this question in the affirmative. Due to changes in mathematics from the 19th century onwards, this question cannot be answered as easily as it used to be. If one regards mathematical concepts as creations of the human mind, it is difficult to argue that mathematical formulae exist in a divine mind. The article argued that there were traces of the divine in mathematics. Six kinds of traces were explained: (1) the existence of indisputable truth, (2) the existence of beauty, (3) the importance of community, (4) rational speaking about infinity, (5) the discovery that speaking about unseen and abstract objects is reasonable and (6) the unreasonable effectiveness of mathematics. In practice, traces (1), (2) and (6) are probably the most convincing.Intradisciplinary and/or interdisciplinary implications: This article is very much interdisciplinary as it combines mathematics and theology, especially the philosophy of mathematics and systematic theology.
Comparing Bridging Thrombolysis with Direct Thrombectomy in Stroke due to Large Vessel Occlusion- Indian Experience (LVO-Direct)
Authors: Prajapati Chintan , Huded Vikram , Mahajan Niranjan , Kulkarni Anirudh , Manual Delitia
Published: April 2022

Objectives:

Intravenous thrombolysis alone has poor recanalization rates in large vessel occlusion strokes. Bridging thrombolysis has evolved as a standard treatment approach in emergent large vessel occlusions. Patients who undergo thrombectomy have a higher probability of favorable outcomes irrespective of the use of prior intravenous thrombolysis. Our aim was to compare bridging thrombolysis with direct thrombectomy in ischemic stroke due to large vessel occlusion.

Methods:

We included patients from our stroke registry, with large vessel occlusion strokes, presenting <4.5 hr from onset. Bridging thrombolysis was the standard approach. Direct thrombectomy was done in patients with contraindications to intravenous thrombolysis. The primary outcome was the modified Rankin scale at 3 months. Secondary outcomes were National Institute of Health Stroke Scale at 24 hr post-procedure, door to puncture time, puncture to recanalization time, the extent of recanalization, and the number of passes required. Safety outcomes were any occurrence of intracranial hemorrhage or other complications related to procedure or death. Logistic regression analysis was used to find the factors affecting the outcome.

Results:

Total 76 patients were included, 29 underwent bridging thrombolysis and 47 underwent direct thrombectomy. A favorable outcome (mRS 0-2) was achieved in 19 (65.5%) patients in the bridging group and 25 (58.1%) patients in the direct group (P = 0.4, Chi-square test). There was no significant difference in any of the secondary outcomes as well. Symptomatic intracranial hemorrhage occurred in 2 (2.6%) patients and a total of 10 (13.9%) were dead at 3-month follow-up, comparable in both groups.

Conclusion:

Direct thrombectomy has comparable outcomes to bridging thrombolysis in emergent large vessel occlusions.
Robotic pancreaticoduodenectomy in a patient with situs inversus totalis and variant celiacomesenteric trunk
Authors: Shyr Bor-Shiuan , Shyr Bor-Uei , Chen Shih-Chin , Shyr Yi-Ming , Wang Shin-E
Published: April 2022

Situs inversus totalis (SIT) is a rare congenital anomaly characterized by right–left reversal of visceral organs and dextrocardia; the use of robotic pancreaticoduodenectomy (RPD) may be challenging in these patients. A male patient presented with jaundice; imaging studies revealed a bile duct tumor and SIT with variant celiacomesenteric trunk and multiple vascular anomalies. RPD was carried out cautiously and successfully. The trocar port design mirrored that of a normal patient. Pathological examination revealed extrahepatic bile duct adenocarcinoma, classified as pT3N1M0, stage IIB. The patient recovered uneventfully. Although difficult, RPD is technically feasible in an SIT patient with cholangiocarcinoma.
Steroid Stewardship
Authors: Kalra Sanjay , Kumar Ashok , Sahay Rakesh
Published: April 2022

Steroid stewardship is the systematic effort to prescribe and monitor glucocorticoids in a rational manner, while balancing benefit and potential risk, in patients who require this therapy. Steroid stewardship includes pre-prescription screening, rational prescription, medical care during corticosteroid use, and appropriate monitoring after corticosteroid use has been discontinued. The current usage of this class of drugs has highlighted the need to focus on this collective responsibility, and ensure effective prescription, while minimizing adverse events.
Utility of TSH Receptor Antibodies in the Differential Diagnosis of Hyperthyroidism in Clinical Practice
Authors: John Mathew , Jagesh Rejitha , Unnikrishnan Hima , Jalaja Manju Manoharan Nair , Oommen Tittu , Gopinath Deepa
Published: April 2022

Graves’ disease (GD) is the most common cause of hyperthyroidism in iodine-sufficient areas. It is important to distinguish GD from other causes of hyperthyroidism for optimal management. Thyroid stimulating hormone receptor antibody (TRAb) test is a commonly used test for this purpose. However, the sensitivity for this test in routine clinical practice may be affected by various factors leading to fallacies in diagnosis.

Materials and Methods:

A retrospective study was performed to assess the utility of an automated electrochemiluminescence TRAb immunoassay (Roche) in differentiating GD from non-Graves’ disease (NGD) in routine clinical practice.

Results:

In 227 subjects, 146 had GD and 81 had NGD. Total T3, Total T4, Free T4, and TRAb were significantly higher in people with GD in comparison to NGD. The area under the receiver operating characteristics (ROC) curve for the assay was 0.96 (95% CI: 0.926 to 0.984, P < 0.0001). The optimal threshold for the test derived from the ROC was 3.37 IU/L, which is more than the cut-off of 1.75 IU/L suggested by the manufacturer. The sensitivity/specificity of TRAb in the diagnosis of GD at presentation was 98.4%/62.9% at 1.75 IU/L and 91.2%/90.12% at 3.37 IU/L, respectively.

Conclusion:

The TRAb test is a sensitive test to differentiate between subjects with GD and NGD presenting with hyperthyroidism. However, the cutoff (1.75 IU/L) as per the kit manufacturer may lead to a lower specificity for diagnosis. A modified cut-off of 3.37 IU/L should be considered for optimizing the diagnostic efficacy of the test.
Pre-Operative Selective vs Non-Selective α-Blockade in Pheochromocytoma–Paraganglioma Patients Undergoing Surgery: A Meta-Analysis
Authors: Yadav Sanjay K. , Johri Goonj , Jha Chandan K. , Jaiswal Sanjeet Kumar , Shekhar Saket , Kumar Vivek V. , Mishra Saroj K.
Published: April 2022

The main objective of this systematic review and meta-analysis was to review, assess and report on the studies that have evaluated selective alpha blockade (SAB) vs. non-selective alpha blockade (NSAB) therapy in patients undergoing surgery for pheochromocytomas and paragangliomas (PPGL). We performed a systematic search of electronic databases. A meta-analysis was conducted to examine the effectiveness of the two blockades. RevMan 5.3 was used for the meta-analysis. Of the eight articles that met the inclusion criteria, there was only one randomized control trial. Meta-analysis showed that there was no significant difference between the groups SAB and NSAB with regard to intra-operative systolic blood pressure (SBP) >160 mm Hg (relative risk (RR) 0.95 [95% CI 0.57, 1.56]P= 0·83) and intra-operative vasopressor requirement (RR 1.10 [95% CI 0.96, 1.26]P= 0·16). Meta-analysis revealed that there was a significant difference between the groups (SAB vs NSAB) with respect to post-operative vasopressor requirement (RR 1.66 [95% CI 1.0, 2.74]P= 0·05). There was no significant difference between the groups with respect to post-operative complications (RR 0.84 [95% CI 0.58, 1.22]P= 0·36). In conclusion, as patients blocked selectively may have a higher incidence of vasodilator requirement intra-operatively, NSAB offers some haemodynamic advantage over SAB. However, NSAB’s real clinical benefit cannot be ascertained with the current studies as this difference did not result in any significant advantage over SAB with regard to morbidity or mortality.
Newer Techniques for the Ultrasonographic Evaluation of the Elbow Structures
Authors: Sharma Kanchan , Das Gautam , Roy Chinmoy , Dutta Debjyoti , Chandran Shalina , Naz Syeda Shaista , Hota Smruti Rekha , Basavarajaiah Sarvesh
Published: April 2022

Context:

Ultrasound is an excellent modality for the evaluation of the soft tissue structures as well as articular pathologies of the elbow joint. Higher resolution transducers along with the superficial location of the elbow structures make them amenable for easy visualisation However, the long learning curve and the operator dependency can limit its use.

Aims:

The aim of this article is to describe and demonstrate novel techniques to image distal biceps tendon, lateral ulnar collateral ligament and radial nerve at elbow joint with ease.

Design:

Technical advancement.

Methods:

The elbow joint ultrasound examination was performed on ten asymptomatic volunteers, 20–40 years old, using a linear probe of 3–13 MHz frequency. The scanning was started from the anterior elbow, the distal biceps tendon was visualised first with anterior to the medial approach followed by the lateral ulnar collateral ligament with one finger technique and radial nerve with first bone technique respectively.

Conclusion:

We consider our techniques as an easy approach to identify the distal biceps tendon, lateral ulnar collateral ligament and radial nerve.
Effect of Intramuscular Electrical Stimulation of Articularis Genu Muscle with Mirror Therapy on Anterior Knee Pain in a Patient with Knee Osteoarthritis
Authors: Chaudhary Sarik , Sharma Manoj Kumar
Published: April 2022

Knee osteoarthritis (OA) is a degenerative condition that can develop in people who have quadriceps muscle weakness. Knee OA is more likely to develop in people who have weak quadriceps muscles, which extend the knee. Dysfunction of articularis genu muscle (AGM) is thought to be a cause of anterior knee pain in patients having OA of the knee joint. Herein, we report a case of anterior knee pain caused due to the dysfunction of AGM in a 41-year male who was initially treated with physical therapy, and it failed to ease the patient's problems completely. Intramuscular electrical stimulation (IMES) along with mirror therapy relieved his symptoms with no recurrence till 2 months of follow-up. IMES of the AGM combined with mirror therapy can be a viable therapeutic option for muscle reeducation and anterior knee pain.
Continuous Intrathecal Infusion for Refractory Pain Management in an Oncologic Patient in Intensive Care
Authors: Cittadini Alessio , Sica Andrea , Bellantonio Daniele , Russo Emanuele , Agnoletti Vanni
Published: April 2022

Adult patients in the intensive care unit (ICU) often experience pain resulting from acute and chronic illness, as well as from standard positioning and maneuverers in the ICU. In recent years, the need for effective pain control in intensive care has emerged strongly. Partial or ineffective control is associated with multiple complications, such as agitation, delirium, inability to adapt to mechanical ventilation, increased length of stay, and post-traumatic stress disorder. Recent guidelines and studies suggest multimodal strategies for effective pain control, also re-evaluating the use of locoregional anesthesiological techniques. Oncological pain in critically ill patients represents a particular challenge for medical staff, being closely linked to the concept of palliative care. We present a case of refractory pain and agitation in an oncologic patient following an emergency exploratory laparotomy. Through the use of an intrathecal catheter, we provided effective analgesia to control pain and agitation, allowing weaning from mechanical ventilation before, and once the terminal state of the tumor was established, providing palliative care to ensure dignity and satisfaction of the patient.
Cooled Radiofrequency Ablation of Cervical Medial Branches for Treatment of Facetogenic Pain
Authors: Dinesh Nithya , Gupta Rajat , Lall Deep Divanshu , Jain Ashu Kumar
Published: April 2022

In cervical spine, the anatomical course of medial branch in significantly different and thermal radiofrequency ablation (RFA) of the cervical median branch though proven effective is technically challenging. Cooled RFA (CRFA) is a newer revolutionary technique that creates a larger spherical lesion and thus compensates for the anatomical variability of the medial branches in the cervical spine. Our case report is aimed to discuss the technique of CRFA for the treatment of cervical facetogenic pain. Right C2–C5 medial branch CRFA was done under fluoroscopic guidance under monitored anesthesia care using 17G with 75 mm length and 2 mm active tip cooled radiofrequency cannula. After 8 weeks of follow-up, the patient reported 80% pain relief.
Postamputation Pain
Authors: Nanda Samridhi , Bhoi Debesh , Mohan Virender Kumar
Published: April 2022

Postamputation phenomenon is commonly encountered in more than 80% of amputees. Due to the increasing burden of trauma and associated amputations, disability due to postamputation pain becomes rampant. In this review, we aim to describe the history, epidemiology, types and mechanisms of postamputation phenomenon, factors affecting its development, and the currently available treatment modalities – both pharmacological and nonpharmacological.