bluuebunny/crossref_metadata_2025 huggingface dataset:
Through Drillpipe Formation Testing: Unlocking Bypassed Pay, A Case Study Onshore Kuwait
Authors: Tagarieva Larisa , Chacon Eduardo , Olutusin David , Sindhu Sneh
Published: April 2022

Identifying a bypassed pay is always challenging, especially for highly deviated, complex wells where well control further complicates wireline logging. This case study examines the use of a Through Drillpipe Logging (TDL) conveyed formation testing and sampling tool in addition to the conventional slim open hole logging suite. The logging program overcame the challenging well trajectory and wellbore stability complications. The resulting data provided a conclusive formation evaluation and reservoir characterization identifying bypassed oil.

The logging program targeted two formations: The primary goal was the Upper Burgan and the secondary target, a suspected bypassed pay, was the Lower Burgan. The well was highly deviated and was drilled with the oil-based mud system. In addition to the complex trajectory, a well bore stability was identified as marginal due to observed washouts. Therefore, the logging program implemented TDL for both traditional open hole logging and formation testing and sampling TDL pumps the tools down the drill pipe ID until reaching TD, where they are released into the well bore and logged back to surface. On the first acquisition run a triplecombo logging suite was run, and a complete dataset was acquired without any differential sticking. During the second run the slim formation tester was centralized to minimize sticking risk during the planned stationary acquisition of formation pressure measurements and sampling.

The TDL conveyance of slim logging tools eventually led to enhanced reservoir understanding and characterization after the data interpretation. Specifically, 22 pressure points and 2 low-contamination samples were returned to surface. The sampling series found fluid in the secondary target. The combination of pressure data, porosity, saturation, fluid mobility, and permeability data characterized the formation. This combination resulted in a deeper understanding of the storage and flow capacity of these heterogeneous reservoirs. Consequently, the well completion design was optimized by the producer.

The TDL conveyance option helped to safely log the well from TD in a complex trajectory by pumping down the slim-logging tools to avoid differential tool sticking across a major washout. Regular tool fishing operations were eliminated, and open-end drill bit usage allowed reaming during wiper trips between the logging runs. TDL significantly reduced operational risks optimizing rig utilization and minimizing overall costs in addition to reservoir and formation fluid data acquisition.

The slim formation testing of the Burgan reservoir supported completion of the primary well objectives and identified bypassed pay in the secondary objective. The field development and exploratory strategies were updated based on the logging results.
WindFloat Atlantic Project: Technology Development Towards Commercial Wind Farms
Authors: Duarte Tiago , Price Seth , Peiffer Antoine , Pinheiro José Miguel
Published: April 2022

This paper presents the main achievements of the WindFloat Atlantic project, the first pre-commercial wind farm using semi-submersible technology. The journey from initial technology development through the project execution is discussed, with the viewpoint of upcoming commercial deployments. Following the successful deployment of the WF1 prototype, the WindFloat Atlantic is a 25MW floating wind farm composed of 3 semi-submersible platforms hosting 8.4MW wind turbines. The wind farm has recently completed the first year of operation, 17km off the coast of Viana do Castelo.

Key technology requirements were developed, implemented, and demonstrated, including an extended design lifetime of 25-years, building on the knowledge of oil&gas permanent units and fixed-bottom offshore wind. The use of large commercial turbines required a quay-side assembly process, with turbines installed with the foundations a float or temporally grounded. By using an onshore crane, the project avoided the use of large offshore heavy-lift vessels, also allowing most of the commissioning works to be completed onshore. The offshore activities were greatly simplified, being designed to allow a tow-to-port O&M strategy for large component replacement. Following a multi-contract strategy, the project fostered the development of the value chain and the processes required to install multi-unit offshore wind farms.

Furthermore, the project achieved non-recourse finance from EIB, demonstrating the bankability of the technology and representing a step-change towards the readiness of floating wind technology for large commercial deployments.
Analytical Model to Effective Permeability Loss Prediction and Formation Mechanical Damage Control in Fractured Oil Wells
Authors: Fernandes Fernando Bastos , Braga Arthur Martins Barbosa , de Souza Antônio Luiz S. , Soares Antônio Cláudio
Published: April 2022

This work presents a new analytical model to evaluate the effective permeability response during the oil’s production through a fractured vertical well fully penetrating a pressure-sensitive reservoir. The nonlinear hydraulic diffusivity equation (NHDE) is solved analytically through an integro-differential model coupled to Green’s function (GF) related to a semi-infinite oil source plan that represents a hydraulic fracture. The NHDE is perturbed using a first-order asymptotic series expansion method and the solution is derived in terms of a new effective permeability pseudo-pressure function, considering the matrix and fracture permeability roles. A new hydraulic diffusivity deviator factor is also derived to represent the effective permeability loss as a function of the pore pressure throughout the well-reservoir life-cycle. For this modeling, the general solution is expressed by the sum of the linear solution (constant permeability) plus a corrective term given by the combination of the exponential function and the complementary error function erfc(yD,tD). The model calibration is performed through a porous media numerical oil flow simulator, named IMEX® and the results presented high accuracy.
Boosting Reaction Rate of Acids for Better Stimulation of Dolomite-Rich Formations
Authors: Sayed Mohammed A. , Cairns Amy J. , Chang Fakuen
Published: April 2022

Carbonate formations are often stimulated using acid systems to enhance production rates. The reaction rate between acid and dolomite is known to be much slower than that between acid and calcite. Accordingly, for some acid fracturing treatments in dolomitic formations, it has been observed that the injected acid system could not adequately react with the rock to render desirable etching patterns on the fracture faces. This can be a direct result of the slow reactivity between dolomite-rich formations and acids. Developing an acidizing fluid that can accelerate the dissolution of dolomite will be beneficial to maximize the results of stimulation treatments in dolomite-rich formations.

In the current study, advancements were made toward accelerating the reaction rate of dolomite with acids through an additive-driven chemical approach based on careful surfactant selection. Static dissolution testing of dolomite core samples in the presence of 28 wt% hydrochloric acid (HCl), both with and without additives, were performed at ambient conditions. The weight loss was calculated, and the efficiency of the added chemicals was evaluated to select the formulation for evaluation at reservoir conditions. A comprehensive reaction kinetics study was performed at a pressure of 3000 psi, across a temperature range of 175 to 350 °F. Guelph Dolomite samples were cut into 1.5" diameter by 0.5" thick disks. Powder X-Ray diffraction (PXRD) was used to determine the mineralogy and purity of the dolomite core samples. The ion concentrations in the effluent samples during the dissolution was measured by ICP in the effluent samples.

Several acid/surfactant formulations were screened and characterized in the current work where several suitable surfactants were identified. It was found that the rate of dissolution of dolomite rocks in hydrochloric acids (28 wt%) could be increased by up to 30%. These results are consistent with the kinetics data collected at both 200 and 300 °F, where the rotating disk apparatus (RDA) showed that the reaction rate of dolomite with one of the developed formulations can be improved by 30 to 50% over hydrochloric acid alone.

The acid/surfactant formulations developed in the current study are aqueous-based formulations. There were no incompatibilities observed after the fluid preparation. The developed acid systems showed an improvement in the dolomite and acid reaction rate which paved the road to apply these formulations in the field to improve the outcome of acid fracturing treatments.
Generating Value from Inspection Ground Robots on Operational Sites
Authors: Munoz Jean-Michel , Bartoli Eric , Audouin Grégoire , Collin Gildas , Mateen Khalid
Published: April 2022

Over the past few years, many communications were made by robot manufacturers showing inspection robot prototypes on production sites. As the first autonomous and explosion proof inspection robots become commercial, and even if oil & gas operators are more and more interested, many have difficulty seeing how value can be generated with this new tool. This paper will describe TotalEnergies' journey towards robot implementation on site.

TotalEnergies' use of robotics on site comes from a vision of a new operating philosophy where sites will be unattended for very long periods. Based on the activities that need to be done between human interventions, TotalEnergies engaged in the development of different types of robots. Even though robots are new tools, they must comply with existing operating procedures as much as possible to be adopted by field operations teams. Among the points that require special attention for efficient operations, are robot capabilities, mission planning, data post-processing and full integration of the robots into the company's IT systems.

The best way to get robots fit for purpose for an oil & gas operator is to be able to weigh in on the robots' specifications by providing the manufacturer challenging use cases. Doing so, features like explosion proof design, autonomy, long arm and more become obvious.

Expectations from field operators are quite high when a robot is on site. They imagine that the robot will "start doing things", not realizing that the robot is an empty shell even if it is autonomous. To prepare operations with robots, a digital model of the installation must be available, and a maintenance/operation engineering exercise must be done to highlight the step-by-step instructions that will be given to the robots. The difficulty with the data collected by the robot is that it can rarely be used directly as we do for numerical values coming from transmitters. In most cases, the interesting information like a value, a status open/close or on/off, needs to be extracted from an image, a video or another support by artificial intelligence.

Finally, the robot cannot be an independent piece of equipment on site and must be treated like any other package by the site control system.

Starting with TotalEnergies' roadmap on robotics, the paper will give feedback on various field trials from different sites, combining altogether nearly one thousand missions. Then, a focus will be made on how to prepare and integrate robotics operations on site to be able to scale up and open this new frontier for improved safety, reduced environmental footprint and costs and increased production efficiency.
Competitive System Concepts for Electrification of Subsea Structures in Co-Existence with Electro-Hydraulic Control Systems
Authors: Sommer Burkhard , Mahler Carsten , Stables Gary , Mitchell Lee
Published: April 2022

Objectives/Scope

Subsea production systems can benefit today from the application of partial electrification concepts in hybrid scenarios coexisting with electro-hydraulic (E/H) control systems. This paper is based on a real project that included a system of conventional E/H subsea production trees, manifolds, and a boosting station, together with a subsea distribution and control system. Based on this architecture, an alternative field concept optimized for partial electric actuation resulted in very competitive commercial scenarios in addition to operational benefits and increased sustainability.

Methods, Procedures, Process

Using electric actuators for valves on subsea production system structures is becoming more common but is still limited. The reason for this limitation is that the systems are often not fully optimized for these uses. There are operational and conceptual differences between traditional electro-hydraulic systems and electric actuation systems. For many years subsea engineers have applied proven field and system concepts and established work practices to field development and subsea control scenarios, which might not have been successful if applied to electric actuation without further change. Electric actuators cannot replace hydraulic actuators without also rethinking the underlying system architecture.

Results, Observations, Conclusions

When alternative configurations were analyzed, the basic architecture was maintained. But instead of simply replacing the hydraulic actuator with electric actuators, it was important to consider how the actuators were connected to the control system in terms of distance, communication, and overall layout. Holistic optimization of the subsea distribution and control system introduces significant benefits to the whole system. However, electric actuators have different performance and diagnostics characteristics than hydraulic actuation systems. Specific sessions were held with the operator, focusing on system performance and the operational advantages of the proposed system. The subsea distribution system and its control philosophy were changed from a traditional layout to a layout taking full advantage of the benefits electric actuators are offering.

This paper uses before-and-after comparisons to show how moving from traditional subsea control methods to a "hybrid" system enables a more sustainable architecture by combining "traditional" products with newer electric actuation methods. As a result of those benefits, the end user in this case study selected the hybrid system and replaced the original base case.
Automated Subsea Pipeline Leak Detection Using Real-Time Downhole Gauges
Authors: Kadem Mohammad , Bayounis Ryyan , Jawad Mustafa , Ghamdi Tareq
Published: April 2022

In oil industry, there are several technologies used in detecting subsea pipeline leaks. These technologies are not costly only, but require extensive implementation fieldwide across hundreds of kilometers pipelines. Currently, there are few digital solutions or systems in the literature addressing the detection mechanism. In this study, an automated mechanism will be introduced to locate leaks in subsea pipeline network coupled with real-time monitoring.

Real-time downhole pressure data from wells' permanent downhole monitoring systems (PDHMSs) are used to map the pressure drop across each reservoir in water injection subsea pipeline network. The data are collected from the gauges and are fed into the model with the incorporation of reservoir properties data. Monitoring of the possibility of leakages can be done by measuring the pressure of wells. A positive pressure differential in wells represent a maintained injection pressure across the reservoir. Wells with a negative pressure differential show low injectivity which might indicate a potential leak in the subsea water injection pipeline network. A dye injection technology can be used to detect leakages and confirm the model result.

Pressure data from real-time PDHMS gauges are first validated with reservoir simulation models to ensure accuracy of the input parameters. The pressure data validation is achieved by verifying each reservoir data using its properties for reliable reservoir pressure identification. Then, the GAPTM network model can be used to validate the pressure drops. The model results can enable engineers' decision-making process easier to spot leak locations where pressure decreases drastically across the subsea water pipeline. The proposed model also shows a close match with the simulated values from GAPTM network model within an accuracy of 2%. Additionally, a dye liquid is injected into the sea near to the suspected pipelines with leaks. The dye introduces a new color and thus can confirm the leak locations based on calculated values from the automated model.

Pipeline leakages have been a problem for many oil fields with water injection mechanism. Pipeline leak detection is an integral part of pipeline risk management. The model can assist the engineers to locate the leaks proactively and prevent incidents from occurring time to time. The leaked water could damage environment and cause injection rate loss.
Reservoir Souring in Mature Offshore Field Malaysia: Root Cause, Mitigation, and Management of H2S
Authors: Mithani Aijaz Hussain , Rosland Eadie Azhar , Jamaludin M Aiman , W Ismail W Rokiah , Lajawi Maxwell Tommie , A Salam Irzie Hani
Published: April 2022

The field under study is a mature brownfield with no H2S in the fluid stream (PVT) at the time of development. However, concentrations more than 1000 ppm were recorded recently causing wells to close in (few already closed). Hence, the shut-in wells have to be brought on stream and an assessment of souring potential in the field has to be completed. This paper will share our experience in H2S mapping at reservoir-well-facilities modelling, history matching and prediction of H2S. We will highlight the workflow adopted to find the root causes of souring via sampling and modelling approach since the H2S is measured throughout the field across all the reservoirs, including those undergoing waterflood. Moreover, various options that were studied through simulation will be discussed for mitigation and management of H2S within this field to safeguard the production, and thus recovery of the field.

A systematic phased approach is adopted to mitigate and manage the unwanted sour gas (H2S). In first phase we performed the analysis on the historical development of H2S throughout the field and developed the concept for possible souring causes. In second phase, we designed and conducted a comprehensive sampling and laboratory analysis program end-to-end to fill the existence knowledge gap. In third phase, we performed 3D dynamic reservoir souring modelling where we history matched the H2S and assessed the future potential via forecasting. Finally, we developed multiple mitigation scenarios ranging from nitrate injection, sulphate reducing unit, limiting the nutrient supply for microbe growth via water mixing etc.

It was evident that a) increased injection water contributed to souring wells, b) link between souring wells and nutrient availability, c) increased negative fractioning of Sulphur isotope as H2S concentration increases, d) and mesophilic SRBs detected in some souring wells. This evidence suggested that BSR is the predominant cause of souring. It was also seen based on water chemistry that injection water was rich in sulphate while formation water rich in volatile fatty acids. Results indicate that the nitrate injection (up to 200ppm) alone may not be an attractive option to mitigate the H2S within this field. However, the combination of SRU and nitrate injection of 150ppm could be a technically feasible options to mitigate such higher concentration of H2S within allowable facilities limits of H2S.
Building primary health care teams for universal health coverage in Africa
Authors: Moosa Shabir
Published: April 2022

No abstract available.
Community’s knowledge, attitude and practices towards inclusive home based early childhood education in Uganda: Lessons for scaling deep
Authors: Ejuu Godfrey , Locoro Victor , Nandera Miria , Omoding Martin , Mafabi Lenard W. , Kutosi George W. , Kharono Irene
Published: April 2022

Background: Most innovations that would help to provide inclusive home-based early learning for children in marginalised communities sometimes collapse when the funders pull out. One of the reasons for this has been lack of information on the dynamics in such communities that can help to sustain such innovations.Aim: This study aimed to provide information on what communities in the study area know, their attitude and practices that can sustain home-based early learning initiatives.Setting: The study setting was in rural districts with marginalised communities, two in eastern and the other two in central Uganda.Methods: This study uses an exploratory approach to collect data through interviews and focus group discussions in the selected Ugandan communities. Data were collected from 120 purposively sampled parents, caregivers and teachers using in-depth interviews.Results: (1) Participants support the establishment of inclusive home learning centres and already have learning expectations of their children by the age of 6 years. (2) While women are more available for early childhood care services, men are supportive of inclusive education. (3) Cases of children with special needs are more prevalent in the study area, suggesting that many more could be found than currently known.Conclusion: The study concludes that communities have preferences for some activities carried out in the centres if established. This study provides an advance information that is useful for planning by agencies and government departments that may want to support establishment of such centres in marginalised communities.
Clinical Signs in Neuro-Ophthalmology
Authors: Wong Sui Hsien
Published: April 2022

A hallmark of myasthenia gravis (MG) is the variability and fatigability of striated muscles. The majority of people with MG have eye symptoms of ptosis and diplopia. This paper outlines the eye signs in MG, including practical tips on the examination technique relevant to MG, and pitfalls to avoid.
Sacrococcygeal teratoma Type IV presenting as anal canal duplication
Authors: Gupta Rahul , Saini Girish , Gupta Arun
Published: April 2022

We present an extremely rare association of anal canal duplication with sacrococcygeal teratoma Altman's Type IV. A 3-year-old female child presented with anal discharge, itching, and vague perineal pain. On examination, a small second opening of 5 mm in size and 2.5 cm in length was located just posterior to the normal anus at 6 'o'clock position. The lumen ended blindly without connection to the normal anorectum. Ultrasound and radiological investigations were normal. During excision of the duplicated tract, it was seen arising from a presacral mass which was completely excised along with coccygectomy. Biopsy was confirmed mature teratoma and anal canal duplication.
Colonic perforation due to advanced prostate cancer in prostate-specific antigen era
Authors: Kumar Manoj , Sahu Reva Shankar , Sinha Ruchi , Priyadarshi Rajeev Nayan
Published: April 2022

Prostate cancer presentation with perforation peritonitis due to rectal infiltration is quite rare. We report a 53-year-old man who presented with rectal growth resulting in bowel obstruction and transverse colon perforation, for which emergent exploration was performed. Postoperative evaluation with imaging, serum tumor markers, and histopathological examination including immunohistochemistry revealed it to be prostate cancer infiltrating to surrounding structures including the rectum. It is rare to observe such advanced cases in the era of serum prostate-specific antigen screening, but a high index of suspicion is necessary for adequate diagnosis and treatment, eventually benefitting the patient.
Clinical Profile of Addison’s Disease in a Tertiary Care Institute, Southern India – The Changing Landscape
Authors: Sridhar Subbiah , Balachandran Karthik , Nazirudeen Roshan , Natarajan Vasanthiy , Sangumani Jayaraman
Published: April 2022

Aims and Objectives:

Clinical, biochemical, and radiological profiles of Addison’s disease and to assess the various etiological spectrum of primary adrenal insufficiency (PAI) in adults.

Materials and Methods:

A retrospective cohort study was carried out in the Department of Endocrinology, Madurai Medical College, Madurai between January 2014 and January 2021 over a 7-year period.

Inclusion Criteria:

All the patients with clinical symptoms and or signs of suspected PAI, such as hyperpigmentation, weight loss, persistent nausea or vomiting, fatigue, and hypotension, were recruited. All suspected cases underwent measurement of 8-AM plasma ACTH and cortisol levels. In possible cases and equivocal cortisol levels, patients underwent Co-syntropin/ACTH stimulation test. To know the underlying etiology of PAI, 21-hydroxylase autoantibodies (21OHAb), thyroid function test, Anti TPO, calcium, parathyroid hormone (PTH), LH and FSH, CT of chest and abdomen, and sputum AFB based on the clinical pattern of involvement were performed.

Exclusion Criteria:

Patients with onset of PAI at infancy and childhood, secondary adrenal insufficiency or exogenous Cushing’s syndrome, and central hypocortisolism, including Sheehan’s syndrome, were excluded.

Results:

Thirty-six patients were diagnosed with PAI in this study; 19 (53%) were females and 17 were males (47%). The median age of diagnosis was 35 years. Patients were divided into acute presentation and subacute presentation. Twenty-six patients presented with acute presentation and ten were presented with progressive evolved symptoms. Non-tuberculous etiology was the predominant finding noted in our cohort study (87%, 31 out of 36 patients). The other causes of Addison disease included isolated auto-immune PAI, polyglandular autoimmune syndrome type 1 and II, APLA Syndrome, and adrenal metastasis.

Conclusion:

Non-tuberculous causes of PAI are the leading etiology in our retrospective study. Autoimmune PAI and Polyglandular autoimmune syndromes are increasingly being recognized as the cause of Addison’s disease. PAI individuals require lifelong surveillance for possible development of coexisting autoimmune syndromes and need for glucocorticoid/mineralocorticoid therapy.
A Practitioner’s Toolkit for Polycystic Ovary Syndrome Counselling
Authors: Lathia Tejal , Joshi Ameya , Behl Arti , Dhingra Atul , Kalra Bharti , Dua Charu , Bajaj Kiran , Verma Komal , Malhotra Neharika , Galagali Preeti , Sahay Rakesh , Mittal Samta , Bajaj Sarita , Moorthy Smitha , Sharma Suresh , Kalra Sanjay
Published: April 2022

Polycystic ovary syndrome (PCOS), a frequently occurring health issue, has a significant effect on the cosmetic, metabolic, psychosocial and fertility aspects of women. A multidisciplinary team approach based on the core pillars of screening, assessment and counselling to detect, prevent and treat physiological and psychological issues in PCOS is very essential. Women are treated medically, but the psychosocial part is often forsaken. Hence, counselling forms an integral part of PCOS management that enables enhanced clinical outcomes and patient satisfaction. Digital tools and PCOS support groups have built an opportunity for physicians to create awareness, help timely diagnosis and overcome PCOS symptoms. The absence of clear guidelines to tackle the often less discussed aspects of PCOS warrants the need for consensus on PCOS counselling. This review summarizes the biopsychosocial health, clinical assessment and treatment strategies of PCOS and associated co-morbidities. The review article will discuss the clinician’s role in patient education with the special focus on counselling of females with PCOS regardless of age group.
Genetic Heterogeneity and Challenges in the Management of Permanent Neonatal Diabetes Mellitus: A Single-Centre Study from South India
Authors: Korula Sophy , Ravichandran Lavanya , Paul Praveen G. , Johnson Jabasteen , Chapla Aaron , Santhanam Sridhar , Simon Anna , Mathai Sarah
Published: April 2022

Aim and Objectives:

1. To study the clinical outcome, growth and glycaemic control, 2. To study the frequency and type of genetic mutations.

Methods:

This is a retrospective study with a review of data of medical records from 2008 till date.

Results:

Twelve patients (six males) with neonatal diabetes mellitus (NDM) were identified. Median (interquartile range – (IQR)) age at diagnosis was 72 (31–95) days with a history of consanguinity in 75%. The median birth weight (range) was 2345 (900–3300) g. Follow-up data were available for eight patients with a median age at (IQR) follow-up of 3.3 (3–5.3) years. At follow-up, the mean annual HbA1c was 8.2% at a mean insulin dose of 1.1 U/kg/d. One patient with Wolcott-Rallison syndrome (WRS) and 21α-hydroxylase deficiency had poor growth and intellectual difficulty. The rest demonstrated satisfactory growth with an increase of mean weight centile from 2ndto 13th, height centile from 6.5thto 20thand normal neuro-cognitive development. Eleven patients underwent genetic testing with a molecular diagnosis in 54% (6/11):EIF2AK3(n= 2) and one each inINS,PDX1,IL2RAandFOXP3. None had variants inABCC8orKCNJ11. One with immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome underwent haematopoietic stem cell transplant (HSCT) and later succumbed.

Conclusion:

Our study demonstrates good clinical outcomes among NDM patients without immune dysfunction. Molecular diagnosis was attained only in around half of the patients (54%) with a great genetic heterogeneity.
Developing Clinical Decision Support System using Machine Learning Methods for Type 2 Diabetes Drug Management
Authors: Singla Rajiv , Aggarwal Shivam , Bindra Jatin , Garg Arpan , Singla Ankush
Published: April 2022

Background and Objectives:

Application of artificial intelligence/machine learning (AI/ML) for automation of diabetes management can enhance equitable access to care and ensure delivery of minimum standards of care. Objective of the current study was to create a clinical decision support system using machine learning approach for diabetes drug management in people living with Type 2 diabetes.

Methodology:

Study was conducted at an Endocrinology clinic and data collected from the electronic clinic management system. 15485 diabetes prescriptions of 4974 patients were accessed. A data subset of 1671 diabetes prescriptions of 940 patients with information on diabetes drugs, demographics (age, gender, body mass index), biochemical parameters (HbA1c, fasting blood glucose, creatinine) and patient clinical parameters (diabetes duration, compliance to diet/exercise/medications, hypoglycemia, contraindication to any drug, summary of patient self monitoring of blood glucose data, diabetes complications) was used in analysis. An input of patient variables were used to predict all diabetes drug classes to be prescribed. Random forest algorithms were used to create decision trees for all diabetes drugs.

Results and Conclusion:

Accuracy for predicting use of each individual drug class varied from 85% to 99.4%. Multi-drug accuracy, indicating that all drug predictions in a prescription are correct, stands at 72%. Multi drug class accuracy in clinical application may be higher than this result, as in a lot of clinical scenarios, two or more diabetes drugs may be used interchangeably. This report presents a first positive step in developing a robust clinical decision support system to transform access and quality of diabetes care.
Long-acting Porcine Sequence ACTH (Acton Prolongatum) Stimulation Test is a Reliable Alternative Test as Compared to the Gold Standard Insulin Tolerance Test for the Diagnosis of Adrenal Insufficiency
Authors: Atluri Sridevi , Sarathi Vijaya , Goel Amit , Channabasappa Shivaprasad , Alapaty Shailaja , Dhananjaya Melkunte S. , Barure Ramdas , Kolla Gautam
Published: April 2022

Context:

As synacthen use is not licensed in India and there are concerns about the safety of the insulin tolerance test (ITT), an alternative dynamic test to diagnose adrenal insufficiency (AI) is required.

Objective:

The study aimed to evaluate the diagnostic performance of the Acton Prolongatum stimulation test (APST) with a standard ITT for the diagnosis of AI.

Design:

Prospective study comparing two diagnostic tests.

Participants:

Six healthy volunteers and 53 suspected or known AI patients.

Measurements:

Serum cortisol response to ITT and APST.

Results:

The median (95% confidence interval [CI]) peak cortisol levels among healthy volunteers in ITT and APST were 17 (14.58–19.08) and 30.5 (22.57–34.5) μg/dL. Of the 53 patients (age: 39.6 ± 9.38 years; females: 38 [71.1%]), 34 had AI (peak ITT serum cortisol < 14.5 μg/dL) whereas 19 had a normal hypothalamic-pituitary-adrenocortical (HPA) axis. In the receiver operator characteristic curve analysis, 60-min APST cortisol had an area under the curve of 0.984 (95% CI: 0.904–1.00, P < 0.0001). The best accuracy was obtained at a cut-off of 16.42 μg/dL (sensitivity: 97.7% [95% CI: 87.7–99.9%]; specificity: 100% [69.2-100%]). Forty-three of the 53 patients with suspected AI had hypoglycemic symptoms during ITT and two of them required intravenous dextrose, whereas, none had adverse events during APST. The ITT was incomplete in two patients whereas all completed APST.

Conclusions:

APST is a simple, safe, and reliable alternative to ITT for the diagnosis of AI; 60-min serum cortisol of 16.42 μg/dL in APST best distinguishes the AI patients from those with adequate cortisol response.
Role of Serum Irisin During Early Pregnancy to Predict The Development of Gestational Diabetes Mellitus at 24–28 Weeks of Pregnancy in high-risk patients
Authors: Sahoo Devadarshini , Pattanaik Sudhi Ranjan , Kumar Padala Ravi , Gandhi Ronak
Published: April 2022

Aims:

The aim of this prospective study was to investigate the role of serum irisin during early pregnancy to predict the development of GDM at 24–28 weeks in high-risk patients.

Methodology:

This study was conducted among the pregnant women attending the Department of Endocrinology and antenatal clinic of Department of Obstetrics and Gynecology of MKCG Medical College for a period of one year with at least one risk factor for the development of gestational diabetes mellitus (GDM). Blood samples were collected for measurement of fasting plasma glucose, serum insulin, serum irisin, lipids (TC, LDL, HDL, TG), and HbA1c. Oral glucose tolerance test was performed using 75 g of glucose during the first trimester and between 24–28 weeks of pregnancy. Patients were diagnosed as GDM based upon IADPSG criteria at 24–28 weeks. Serum irisin, glycemic parameters, and homeostatic model assessment of insulin resistance during first trimester were analyzed for predicting GDM between 24–28 weeks.

Results:

Sixty-five patients were included in the study, out of which 20 (30.8%) patients developed GDM and the rest 45 patients had normal glucose tolerance (NGT). The first trimester mean serum irisin concentration was significantly lower in women who later developed GDM compared with women who had NGT (111.65 ± 25.43 μg/L vs 185.89 ± 28.89 μg/L). Serum irisin concentration was the best predictor with an optimal threshold value of 149 μg/L, which had sensitivity, specificity, positive predictive value, and negative predictive value of 90%, 91.1%, 81.8%, 95.3%, respectively, for predicting GDM at 24–28 weeks of pregnancy.

Conclusion:

We suggest the utility of serum irisin as an early biomarker to predict the development of GDM later in pregnancy in high-risk patients.
Complex Regional Pain Syndrome Associated with Henoch-Schonlein Purpura
Authors: Kumar Sanjay , Khuba Sandeep , Awal Shikha , Gautam Sujeet , Agarwal Anil
Published: April 2022

Introduction:

Henochschonlein purpura (HSP) is an acute, systemic, immune complex-mediated, leukocytoclastic vasculitis, most commonly affecting children. It is a small-vessel vasculitis which is characterized by a tetrad of palpable purpura (without thrombocytopenia), abdominal pain, arthritis, and renal impairment. Although most commonly affecting the skin, joints, gastrointestinal tract, and kidneys, other organs may also be affected. Association of HSP with complex regional pain syndrome (CRPS) has not been reported in the literature. In the present case report, we are describing the successful management of CRPS of the upper limb in a diagnosed case of HSP.

Case Presentation:

A 14-year-old female patient, who was a diagnosed case of HSP, presented with features characteristic of CRPS in the right hand and forearm, based on the Budapest Diagnostic Criteria. Bone scintigraphy showed increased tracer uptake in joints of the right hand, also suggestive of CRPS. The pain was severe visual analog scale-90/100 and not controlled with conservative management. Patient was administered a series of 3 stellate ganglion minimally invasive pain and spine interventions (MIPSI) over the course of 2 weeks, which led to the resolution of her symptoms.

Conclusion:

HSP is a small-vessel vasculitis and may lead to peripheral nerve vasculitis. As reported in other cases, small-vessel vasculitis has led to the development of CRPS and thus may influence the development of CRPS in patients with HSP. CRPS as a complication of HSP has not been reported in the literature to date. Thus in a patient with HSP, CRPS could present as a rare complication and early intervention with the MIPSI of the affected region may lead to resolution of symptoms.
Immersive Virtual Reality in Pain Management of Burn Injury – A Review
Authors: Khurram Fahud , Hussain Aftab , Subramaniyam Bala , Usmani Hammad
Published: April 2022

Burns are one of the most severe forms of trauma to skin and tissue which results due to contact with hot substances (liquid or solid), radiation, radioactivity, electricity, friction, or contact with chemicals. Every year, nine million people are injured due to fire, heat, and hot substances worldwide, out of which 120,632 die (1.34%). In India, with a population of over 1.3 billion, the registered annual burn admissions are 7,00, 000–8,00, 000. This review is to identify studies on virtual reality (VR) therapy in the management of burn patients in terms of their pain, anxiety, and stress during treatment and rehabilitation, in the context of the scientific world of literature. Literatures from web-based scientific databases, PubMed, Cochrane, MEDLINE, and Clarivate, National Science Library, were searched to identify the studies conducted on the use of VR in the management of pain related to burns and their dressings. Randomized controlled trials and case series were included in this review. All these studies were organized and tabulated according to the methodology and type of interventions done. Few of the studies were also analyzed to present the highlighted current trends in VR and pain management. A brief overview of the observations at this center with the use of VR technology and its role in alleviating pain during the procedures for burn management has also been included. VR is a nonpharmacological complementary strategy with proven benefits in the management of burn patients. The findings of this literature review and analysis demonstrate that the use of VR in burn patients significantly reduces pain during treatment and rehabilitation and averts its consequences. VR can be easily used in the hospital setting and offers a safe, nonpharmacologic adjunctive therapy in the management of burn patients.
A Comparative Study of Ultrasound-Guided Serratus Anterior Plane Block with Pectoral Nerve Block Type II in Breast Surgeries
Authors: Amir Syed Hussain , Sheikh Kulsum , Ali Qazi Ehsan , Siddiqui Obaid Ahmed , Arman S. M.
Published: April 2022

Background:

The use of ultrasonography (USG) to identify fascial layers has led to the development of several newer interfascial techniques for analgesia of the chest and abdominal wall. Two such modalities are the Pectoral nerve block (PEC) and Serratus Anterior Plane (SAP) block.

Objective:

To compare the duration and quality of analgesia provided by ultrasound-guided SAP block with PEC block II in patients undergoing breast surgeries after induction of general anesthesia.

Design:

Randomized, double-blinded, prospective study.

Methods:

Sixty female patients were divided into two groups of 30 each. Patients in Group P received USG guided PEC II block, whereas patients in Group S received USG-guided SAP block after induction.

Outcome Measure:

The primary objective was to compare the duration of pain relief, whereas the secondary objectives were to compare the degree of pain relief, postoperative analgesic requirement within 24 h after the completion of the surgery, patient satisfaction score and complications if any.

Results:

The mean time of the first dose of analgesic given was 826 ± 405.24 min. in Group P and 1280 ± 264.29 min. in Group S (P < 0.001). The mean numeric rating scale score at rest at 6 h, on movement at 2 h and 6 h and satisfaction scores in Group P were significantly more than Group S.

Conclusion:

Ultrasound-guided SAP block provides better postoperative analgesia both in quality and duration over PEC II block.
Postoperative Analgesic Efficacy of Quadratus Lumborum Block in Patients Undergoing Laparoscopic Cholecystectomy
Authors: Kulhari Sunita , Shamshery Chetna , Ambasta Suruchi , Agarwal Anil , Singh Rajneesh Kumar , Srivastava Monalisa
Published: April 2022

Background:

Patients undergoing laparoscopic cholecystectomy (LC) often complain of pain in the postoperative period despite intravenous analgesic administration. Systemic analgesia is also associated with side effects such as postoperative nausea and vomiting, thus adding to patient's discomfort. Posterior quadratus lumborum (QL) block has been studied to provide adequate analgesia in this set of patients. We retrospectively studied the efficacy of posterior QL block in LC patients and assessed them for chronic pain.

Methods:

Records of patients meeting inclusion criteria were taken. Standard multimodal analgesia as per the institute protocol was performed in all patients. Posterior QL block was performed under ultrasound guidance in test group, while control group received parenteral analgesia alone.

Measurements:

Static and dynamic Numeric Rating Scale (NRS) were measured at different time intervals during the first 24 postoperative h and time to rescue analgesia was noted. Assessment of chronic pain was done at the same time for all the patients. Side effect profile of both the groups was compared.

Results:

Static and dynamic pain scores were compared between block and control groups at immediate postoperative time period, 3 h, 12 h, and 24 h and statistically significant difference was noted with lower scores in test group as compared to control group at all four time points (P < 0.05). None of the patients in test group suffered chronic pain, while 33.3% patients in control group had chronic pain.

Conclusion:

Posterior QL block is an effective analgesia option for LC patients with less incidence of side effects. It should be performed more frequently as it is effective in reducing acute and probably chronic pain too in LC patients.
Acute myeloid leukemia patients with variant or unusual translocations involving chromosomes 8 and 21 – A comprehensive cytogenetic profiling of three cases with review of literature
Authors: Akhila Raj T. V. , Gopinath Preethi , Geetha Raj J. A. , Narayanan Geetha , Nair Sreejith G. , Joy Philip Deepa Susan , Raveendran Suresh , Geetha Priya , Sreedharan Hariharan
Published: April 2022

Background:

t(8;21)(q22;q22) is the most frequent recurrent translocation in acute myeloid leukemia (AML) resulting in an in-frame fusion of RUNX1/RUNX1T1 that regulates various genes involved in the signaling pathways. This leukemogenic alteration is usually associated with a favorable clinical outcome. Variants of t(8;21) can be formed involving a third or fourth chromosome in ~3-4% of t(8;21)-AML. Due to the rarity of variant t(8;21), its clinicopathological features and prognostic significance are still unclear. Here we present three AML cases with cryptic rearrangements of chromosomes 8 and 21 without standard RUNX1/RUNX1T1.

Materials and Methods:

Conventional karyotyping and fluorescence in situ hybridization and/or spectral karyotyping of the pretreatment bone marrow aspirate of de novo AML patients were performed to delineate chromosomal abnormalities.

Results:

We identified three cases with novel variants of t(8;21); der(13)t(8;21;13), isodicentric derivative 8 with chromosome 21[,+idicder(8)(q11.1)t(8;21)(q22;q11.1)] and der(21)t(8;12;21)(q22;q?;q22).

Conclusion:

AML with t(8;21)(q22;q22);RUNX1-RUNX1T1 forms a distinct WHO subcategory and hence the identification of variants or unusual translocations associated with t(8;21) deserves more attention. Contribution to the variant/ unusual t(8;21) database will further refine the risk stratification and may help to significantly advance the current treatment regimen.
Galois module structure of square power classes for biquadratic extensions
Authors: Chemotti Frank , Mináč Ján , Schultz Andrew , Swallow John
Published: April 2022

For a Galois extension
$K/F$
with
$\text {char}(K)\neq 2$
and
$\mathrm {Gal}(K/F) \simeq \mathbb {Z}/2\mathbb {Z}\oplus \mathbb {Z}/2\mathbb {Z}$
, we determine the
$\mathbb {F}_{2}[\mathrm {Gal}(K/F)]$
-module structure of
$K^{\times }/K^{\times 2}$
. Although there are an infinite number of (pairwise nonisomorphic) indecomposable
$\mathbb {F}_{2}[\mathbb {Z}/2\mathbb {Z}\oplus \mathbb {Z}/2\mathbb {Z}]$
-modules, our decomposition includes at most nine indecomposable types. This paper marks the first time that the Galois module structure of power classes of a field has been fully determined when the modular representation theory allows for an infinite number of indecomposable types.
О тензорных дробях и тензорных произведениях в категории стереотипных пространств
Authors: Akbarov Sergei Saidmuzafarovich
Published: April 2022

Доказываются два тождества, связывающие некоторые естественные тензорные произведения в категории $\operatorname{LCS}$ локально выпуклых пространств с тензорными произведениями в категории $\operatorname{Ste}$ стереотипных пространств, а именно, приводятся условия, при которых выполняется тождество
$$
X^\vartriangle\odot Y^\vartriangle\cong (X^\vartriangle\cdot Y^\vartriangle)^\vartriangle\cong (X\cdot Y)^\vartriangle,
$$
в котором $\odot$ - инъективное тензорное произведение в категории $\operatorname{Ste}$, $\cdot$ - первичное тензорное произведение в категории $\operatorname{LCS}$, а $\vartriangle$ - операция псевдонасыщения в категории $\operatorname{LCS}$. Изучение соотношений этого типа оправдывается тем, что они оказываются важными инструментами при построении теорий двойственности, основанных на понятии оболочки. В частности, с их помощью строится обобщение голоморфной теории двойственности на класс (не обязательно абелевых) счетных дискретных групп.
Библиография: 15 названий.
Об универсальности дзета-функций некоторых параболических форм
Authors: Laurinčikas Antanas
Published: April 2022

Рассматривается абсолютно сходящийся в правой стороне критической полосы ряд Дирихле, связанный с дзета-функцией нормированной параболической формы Гекке. Для этого ряда получены теоремы универсальности о приближении широкого класса аналитических функций сдвигами упомянутого ряда.
Библиография: 9 названий.