bluuebunny/crossref_metadata_2025 huggingface dataset:
Sealing Advancements for Rotating Control Devices
Authors: Richie Aaron Paul , Dietle Lannie Laroy
Published: August 2021

Some of the most critical elements of a rotating control device (RCD) are the rotary seals that prevent a pressurized abrasive drilling fluid from destroying the rolling element bearings. The rotary seals prevent the drilling fluid from damaging the bearings by sealing the annular gap between the rotating mandrel and the stationary bearing housing. The combination of pressure causing seal material to bulge into the annular gap and the relative runout between the mandrel and housing can cause extrusion damage of the seal. The relative rotation and runout between the seal and mandrel in an abrasive environment leads to abrasive wear of the seal. Finally, the relatively high surface speed and contact pressure between the seal and mandrel leads to adhesive wear of the seal.

When the drilling fluid pressure below the RCD is low there are several suitable rotary seal designs that can provide acceptable RCD life at most rotary drilling speeds. To meet higher speed and pressure conditions for the 100 hour minimum duration, established in API 16RCD, many RCD designs employ a sealing approach that splits the sealing tasks across two seals. One seal excludes the abrasive drilling fluid at low differential pressure and another seal, capable of operating at high differential pressure, retains a clean lubricant that is at nearly the same pressure as the drilling fluid. This sealing system generally requires an external lubricant pressurization system to provide the necessary fluid and pressure environment for the seals. Some drilling sites that operate at these conditions cannot accommodate these large, complex, expensive lubricant systems due to space or access constraints, or economic considerations.

This paper describes an innovative sealing system that enables an RCD to operate at 1,500 psi and 100 RPM for 200 hours without requiring an external lubricant pressurization system. This claim is based on extensive laboratory testing of three new technologies included in this sealing system. Key results and summaries from the test program are included in this paper. The three key technologies are:

A hydrodynamic spring-loaded lip seal that can be used to exclude abrasive drilling fluid at low-differential pressure or retain a clean lubricant at high differential pressure. A direct-compression hydrodynamic seal that can retain a clean lubricant at high differential pressure. A self-actuating miniature valve that replaces the lubricant supply function of an external lubricant pressurization system.
Rams Analysis for Different XT Technologies
Authors: Glaser Markus , Winter Tobias
Published: August 2021

This paper analyses the probability of failure on demand of different subsea christmas tree actuation principles and their related control system architectures. The all-electric technology has limited or insufficient field data available. This means that the reliability and availability analysis is based on theoretical analysis from data provided in reliability handbooks for mechanical and electronic components. The analysis includes the probability of failure on demand to isolate the well and the availability of each equipment type until a first failure causes the need for repair. The following different actuator and system designs were chosen for this analysis:

– Spring based hydraulic actuator – Spring based electric actuator – Electric power screw actuator – Electric planetary roller screw actuator

All Electric Systems (except the spring based electric actuator) utilize a battery to provide the energy for the valve operation. The reliability analysis provides detailed information about the major contributors that limit the reliability of the actuators and systems. With this knowledge, qualification activities can focus on the improvement of the reliability of the critical components and the actuator elements within the system.

The power screw actuator and the corresponding system provides the best reliability and availability compared to other systems. The electric with spring design provides better results than the hydraulic with spring design. Generally, the battery-based systems provide a better reliability than spring-based designs.

The most critical elements are the mechanical springs, sealings, brakes and the spindle mechanisms.

Another aspect is the analysis of an optimized operation strategy in order to utilize the redundant components to improve the availability and reduce the number of interventions by analysis of the second and third failure in the system.
Springs® Design Optimized By Seawater Quality. Laboratory Pilot Tests
Authors: Pedenaud Pierre , Rondon Marianna , Lesage Nicolas , Tournis Eric , Giolo Riccardo , Skivington Graeme
Published: August 2021

A new seawater laboratory pilot has been installed in order to evaluate the impact of the seawater quality on the performance of nanofiltration membranes and filters. The test program implemented was designed to produce the data required to optimize the design and operating parameters of a subsea sulfate removal plant, particularly with respect to the technology developed by Total, Saipem and Veolia, co-owners of the development. The equipment qualification plan is approaching completion with the development of subsea barrier-fluidless pumps, all-electric control systems, high-cycling valves operated by electric actuators and subsea water analyzers. This presented pilot laboratory study completes this plan.

Nanofiltration membranes are commonly used to remove the sulfates found in seawater before the water is injected into wells. The principal advantages of relocating this equipment from topside to subsea are better reservoir sweep control, a substantial subsea water injection network reduction and savings on space and weight on the topsides deck. The move to subsea offers the opportunity to simplify the process due to improved deep water quality. This was previously demonstrated through a subsea test campaign. This new pilot study provides data both on the performance of a plant operating with different feed water quality and on the success of operating changes to further optimize the plant performance.

The pilot has been installed at the Palavas-les-Flots site in France. Raw water collected from the basin was mixed with ultra-filtered water in order to calibrate the feed water quality. The pilot includes a two stage nanofiltration configuration and single stage nanofiltration unit. The two stage configuration was used to produce data for operation across an array of feed water quality and plant operating conditions. The single stage unit was used to produce data on membrane fouling over a long operating duration. Results from these tests and discussion on how this data relates to subsea plant performance shall be presented.

This innovative approach enables a wide range of subsea water quality to be simulated and tested against different process configurations of the subsea unit. Indeed, for each industrial subsea application, the raw seawater quality is dependent on both the region and the depth of the seawater inlet. With this experimental data acquisition campaign and understanding of the seawater quality at inlet, the system design can be tailor-made for each future application case.
Aqueous Degradable Polyurethane Elastomers for Oil & Gas Applications
Authors: Burdzy Matthew Peter
Published: August 2021

A new class of patent pending aqueous degradable polyurethane elastomers have been developed that can be used in oil & gas exploration, drilling, completion and production where a degradable part is needed to provide a useful service life then quickly degrade when exposed to heat and water. This polyurethane technology eliminates the need for costly secondary operations such as milling, drilling or removing tools in downhole applications saving time and reducing cost. The degradable polyurethane is a low viscosity two-part heat cured elastomer that is easy to mold using low cost hot cast tooling techniques. The novel liquid polyurethane prepolymer can be formed into films, seals, sealing elements, tools, complex geometries or other aqueous degradable elastomeric components. The polymer is a tough tear resistant high strength elastomer with a tensile strength exceeding 5000 psi, elongation over 500%, and a 70% compression modulus greater than 13,000 psi. When integrated as a sealing element in a degradable hydraulic fracturing plug, the polyurethane is designed to be pumped down-hole, set and seal then degrade once the operation is complete. Once placed into service, the useful operating lifetime of this polyurethane chemistry is more than six hours when immersed in aqueous fluids at 80°C (176°F) (i.e. water or 3% potassium chloride). The elastomer can be compressed over 70% during its service-life providing a stable set of mechanical properties during use. The elastomer beings to fracture within two days and quickly degrades at 80°C (176°F) providing consistent and reliable results. Approximately 70% is completely water soluble while the remaining 30% fractures into small particles that can be easily removed or remain in the well. This paper reviews the development of the technology, applications, mechanical properties, service life, degradation profile and product life cycle.
Surface Treatment Strategies for Mitigating Gas Hydrate & Asphaltene Formation, Growth, and Deposition in Flowloops
Authors: Pickarts Marshall A , Delgado-Linares Jose , Brown Erika , Veedu Vinod , Koh Carolyn A.
Published: August 2021

Numerous solids including gas hydrates, waxes, and asphaltenes have the potential to form in the production lines of gas and oil fields. This creates a highly non-ideal scenario as the accumulation of said species leads to flow assurance issues, especially with long-term processes like deposition. Since an ever-increasing amount of material is deposited in place at the pipe surface, production stoppage or active mitigation efforts become inevitable. The latter production issues result in increased safety risks and operational expenditures. Therefore, a cost-effective, passive deposition mitigation technology, such as a pipeline coating or surface treatment is especially appealing. The ability to address multiple pipeline flow assurance issues simultaneously without actively disrupting production would represent a dramatic step forward in this area.

This study is part of a long-term ongoing effort that evaluates the performance and application of an omniphobic surface treatment for solids deposition prevention in industrially relevant systems. In particular, this specific work concentrates on the efficacy and robustness of the treatment under fully flowing conditions. The apparatuses utilized for this include two flowloops: a lab-scale, high-pressure flowloop for gas hydrate and surface treatment durability studies, and a bench-scale, atmospheric pressure loop for crude oil and asphaltene experiments.

Film growth in high-pressure flowloop tests corroborated previous reports of delayed gas hydrate nucleation observed in rocking cells. Without the aid of the memory effect, treated oil-dominated experiments never experienced hydrate formation, spending upwards of a week in the hydrate stability zone (at the subcooled/fluid test conditions). Subsequent tests which utilized the memory effect then revealed that the hydrate formation rate reduced in the presence of the surface treatment compared to a bare stainless-steel surface. This testing was part of a larger set of trials conducted in the flowloop, which lasted about one year. The surface treatment durability under flowing conditions was evaluated during this time. Even after experiencing ∼4000 operating hours and 2 full pressure cycles, no evidence of delamination or damage was detected. Finally, as part of an extension to previous work, corroded surface asphaltene deposition experiments were performed in a bench-top flowloop. Treated experiments displayed an order of magnitude reduction in both total oil (all fractions of crude oil) and asphaltene fraction deposited.
Optimization of Control Line Encapsulation Based on Numerical Simulations of Shock and Vibration
Authors: Nardi Luiz Fernando Bermero , Sias Daniel Fraga , Abreu Leonardo Teixeira Fernandes , Guimarães Mariana Silva , Da Silva Manoel Feliciano , Eduardo Thiago Handerson Torres
Published: August 2021

Control line integrity is fundamental to ensure operability of intelligent completion systems. Damage to control lines can normally occur during string deployment (by shock), or during productive life (by vibration-related fatigue). This work aimed to investigate how encapsulation will affect control line survivability throughout their entire life cycle.

Numerical simulations were carried out using geometrical arrangements of control lines typically found in completion valves and tubings. For installation loads, lines were submitted to shock simulations, both inside and outside of protection clamps. The role of flatpack material was studied, as to which kind of material would better absorb impact energy. For productive life loads, the flow-induced vibration was taken into account for high-rate injector wells. Vibration loads were based on force results obtained by Computational Fluid Dynamics (CFD). Structural Finite Element Analysis (FEA) was performed to obtain local tensions to estimate productive life of lines.
Technologies for Advancing Offshore Enhanced Oil Recovery Capabilities
Authors: Melchert Elena Subia , Long Roy Clayton
Published: August 2021

Last year the Department of Energy (DOE) presented a description of the expansion of its research portfolio from one focused on research primarily for onshore applications to one that includes projects specifically for offshore application. That paper (OTC - 30469-MS) also included key research results for the portfolio beginning with projects initiated in 2007. This paper follows on that theme and presents an overview of the Department's current research portfolio focusing on recent-past learnings, current learnings, and research gaps identified from the projects in the current research portfolio 2017-2023.

Discussion includes projects that are sponsored by the Department as part of its public-private partnerships with principal investigators from industry and academia, and those projects sponsored by the Department at its National Laboratories. The discussion also includes an overview of activities and projects jointly pursued by DOE and the Department of the Interior's Bureau of Safety and Environmental Enforcement (BSEE) pursuant to the July 2020 Memorandum of Collaboration signed by both agencies.

Major insights presented in this paper focus on innovative mid-Technology Readiness Level (mid-TRL) technologies that will enable cost-effective enhanced oil recovery in deepwater and ultra-deepwater including insights for cement and wellbore integrity, flow assurance, life extension of offshore platforms and risers, sensors and telecommunications, early kick detection, chemical delivery, data analytics involving big data sets and modeling, and advanced sensors for EOR operations.

Many of the projects reviewed in this paper are part of the portfolio of projects that are sponsored by the Department at the National Laboratories while at the same time includes projects that are cost-shared with private sector and research partners in academia. The breadth of the portfolio illustrates the overall approach of the offshore research portfolio especially for enhanced oil recovery.

Recently the National Petroleum Council completed a study for the Secretary of Energy titled Meeting the Dual Challenge: A roadmap to at-scale deployment of carbon capture, use, and storage in which the potential for the use and potential long-term storage of CO2 used in enhanced oil recovery is considered for both onshore and offshore settings (NPC 2019).
Corrosion Experience with Low Carbon Steel R4 Grade Mooring Chain
Authors: Gabrielsen Øystein , Liengen Turid , Rørvik Gisle , Molid Solfrid , Stavang Terje
Published: August 2021

Equinor owns and operates a fleet of floating installations on the Norwegian Continental Shelf (NCS). As the installations are getting older, the importance of knowing the actual condition of the mooring systems has increased, and continuous mooring system integrity evaluation is important for the safekeeping of the assets. As a part of the mooring system integrity management, seabed chains have been replaced for condition evaluation, as in situ inspection techniques so far has not been able to determine the actual conditions of longer lengths of seabed chain. Thorough onshore inspection and full-scale fatigue and break load tests has been performed on retrieved chains, to map the actual condition and effect to integrity.

After retrieving seabed chains from approximately half of the floating installations, Equinor now has collected experience on chain degrading mechanisms and corrosion on different locations, water depths and different chain deliveries. The inspections have revealed several corrosion phenomena, where microbiologically influenced corrosion (MIC) due activity of sulphate reducing bacteria (SRB), is observed to have a significant effect on fatigue capacity. An important finding is also that corrosion mechanisms and severity change along the seabed chains.

In the Equinor fleet mooring chain grade R4 has usually been used. In total four different vendors have supplied chains, but the vast majority is supplied by two vendors. One of the mooring chain vendors have supplied low carbon (LC) steel chains for the larger chain diameters (larger than 114mm). A significant difference in corrosion is found between the low carbon steel R4 grade chains and other chains. Differences are found both for general corrosion, light surface corrosion and MIC/SRB corrosion.

This paper presents and discusses findings on MIC/SRB for seabed chains, in connection with the type of steel used in the mooring chain, demonstrating limited corrosion on low carbon steel chains. Also, special corrosion phenomena found only on low carbon steel chain is presented. These are found to have no or limited effect to integrity of the chains.
Consistency Under Applied Pressure Test CAPT - A Novel Method for Evaluating Pressure Effect on the Gel Time of Thermosetting Resin
Authors: Zhu Dingwei , Normann Svein , Xie Minli , Haugen Jonny
Published: August 2021

Thermosetting resin is gaining more acceptances in Plug and Abandonment due to its excellent mechanical properties after set and ability for placement in locations cement cannot reach. A thorough understanding of its curing behavior such as gel time is essential to ensure safe placement and a good seal. This paper investigates the pressure-sensitive gelation behavior of polymer resin under in-situ conditions, and the pressure effect on the gel time of thermosetting resin was evaluated.

An innovative assessment methodology named CAPT (Consistency under Applied Pressure Test) was created to assess the curing process of thermoset resins in a pressurized consistometer. A series of resin samples were tested at temperatures ranging from ambient to 120°C with applied pressures up to 10,000 psi. The consistency was initially used to indicate the gel structure development of the resin while it was gelling. Based on the consistency data, the relationship between applied pressure and gel time of resins was studied and a new approach of modeling the curing process with the influence factor of pressure was proposed.

The primary observation was the confirmation that the gelation process of thermosetting resin under applied pressure was faster than that under atmospheric pressure. However, the gel time had big variations. The pressure sensitivity mainly depended on the initiators and it was only partly dependent on the temperature. There was a threshold value for the pressure effect on the gel time. Below the threshold, the gel time only decreased by around 5%. Above the threshold, the pressure effect was much larger where the gel time decreased by 20% - 30%. This could be mainly attributed to the thermodynamic effect caused by pressure accelerating the polymerization process, resulting in a shorter gel time. Meanwhile, these results help explain why the curing behavior of thermosetting resin placed underground where high pressure is encountered often differs from the laboratory-predicted performance. Besides indicating the relative strength development, consistency analysis could also be used to assess the pressure effect on the gelation process of a resin sample in down-hole operations with applied pressures. Thus, CAPT would be more suitable than a conventional reactivity test to propose a new approach of modeling the gel time of thermosetting resin systems with the influence factor of pressure.

CAPT is a novel method to accurately evaluate the curing process of thermosetting resin and indicate its relative strength development. This helps engineers reach a good balance between designing proper operations and preserving mechanical properties in the plug and abandonment process.
Cost Effective, Digital, Fail-Safe Production Tree and Wellhead Actuator System
Authors: Johansen Espen Sten , Fredheim Dag Ketil , Volkers Richard , Hansen Dag Almar , Petersen Christian
Published: August 2021

E&P companies are challenged with the cost-effective development of smaller and marginal fields, while ensuring safety for its crew and facing increasing regulatory requirements for further reducing emissions and environmental impact. Key enablers to achieve profitable development of smaller fields and maintaining safe production in remote locations is digitizing and automating the production chain and limit the need for on-site personnel.

There are a number of safety critical valves on wellheads and production trees that have historically been manually or hydraulically operated and thus not suited for fully remote operations. In 2017, Equinor, Baker Hughes and TECHNI formed a Joint Industry Project (JIP) to develop a new electric actuator control system. The actuator system is designed for fail-safe, critical operations offshore and is subject to stringent safety design requirements. The key driver is reducing CAPEX and OPEX and environmental impact for offshore installations, while increasing availability of wells while providing improved monitoring and condition based, predictive maintenance.

The electric actuator system developed in the JIP has a patent pending fail-safe mechanism with extremely fast closing time to ensure well containment during critical situations. It is designed to be a drop-in replacement for existing hydraulic actuator solutions and is suitable for most standard wellhead and tree designs, sizes, and pressure ratings. The all-electric solution contains a multitude of sensors, that, in combination with an integrated digital interface, enables data-driven insights from the systems in operation.

The actuator development is currently at Technology Readiness Level (TRL) 4 on the API 17N, 0 to 7 scale. In 2020, the JIP consortium was awarded NOK 8.2 million (USD 950 000) by the Norwegian Research Council DEMO 2000 program to support the test and qualification program. TRL 5 testing is planned in first half of 2021 yielding it ready for field installation.
Novel Design Approach to Create Deep Water Metallic Buoyancy Modules
Authors: Loentgen Vincent , Maach Nouhaila , Brouard Yann , Verdeil Julien , Germanetto Florian , Lodeho Olivier
Published: August 2021

Buoyancy modules are widely used ancillary equipment aiming to shape riser systems to resist harsh offshore environments. Due to their thermoset polymeric nature, they are sensitive to the manufacturing parameters as well as subject to water absorption along their service life. To overcome the challenges of polymer-based buoyancy module, this paper explores the design of metallic buoyancy modules that can be 3-D metal printed.

An initial material selection is performed to identify suitable material candidates for the optimization algorithm. Steel and aluminum materials are considered and evaluated on a representative case combining density, mechanical stress and buckling criterion.

Then a topology optimization algorithm called ‘Adaptative Bone Mineralization’ is applied on the best candidate material, adapting their modulus of elasticity at each iteration according to the current stress distribution, load case definition and boundary conditions. The optimized design incorporates additional requirements related to additive manufacturing processes.

Results of the optimization algorithm are presented in a progressive order of complexity starting from the optimization of an angular section of 11.25 degrees opening with symmetrical boundary conditions up to a quarter of half-shell buoyancy module fully optimized in 3D. The optimization process log, capturing the volume fraction and the maximum stress at each iteration, is presented and compared with the selected set of criteria. Impact of the manual reconstruction process of the buoyancy module is assessed and the buckling stability is evaluated as a post-treatment. Two-dimensional and three-dimensional topologically optimized buoyancy modules are presented and comply with the strict mass requirement, stress criterion and buckling stability achieving deep water depth.

This novel design approach to create deep water metallic buoyancy modules achieves the tailoring of the buoyancy module's internal structure to maximize the buoyancy performance while ensuring its structural integrity.
Design Challenge of the West Nile Delta Gas Development: The Rosetta Channel Crossing
Authors: Gitahy Leonardo , Manso Daniel , Carvalho Guilherme , Lewis Mark , Migliaresi Dario
Published: August 2021

Raven is the third stage of the West Nile Delta development (following Taurus / Libra and Giza / Fayoum) from two BP-operated offshore concession blocks, North Alexandria and West Mediterranean Deepwater. The Raven project included the design of various rigid pipelines, of which one specifically is the subject of this paper. The 16" RSM to RP in-field flowline is approximately 4.8 km long, connecting a manifold (RSM) to a PLEM (RP) through a route that crosses a prominent geological feature identified as the Rosetta Channel, a submerged canyon that extends for about 30 km. The Rosetta Channel is about 2.5 km wide at the location of the 16" flowline route crossing, with steep slopes going down for approx. 40m (in height) on the RSM side, and then climbing up approx. 150m (in height) towards the RP side.

Although it is typically preferred to avoid very rough geophysical features, this is not always possible or practicable and it is not uncommon to come across challenging seabed features that demand complex engineering solutions in order to minimise risks and associated costs.

This paper addresses the numerous technical challenges involved in the design of the 16" flowline that crosses the Rosetta Channel. Following close collaboration between all involved stakeholders, a robust, reliable and cost-effective solution was achieved after a detailed engineering process, where the final design required a unique combination of mitigations including seabed excavation, pre-lay rock carpets, post-lay rock berms, cable jetting, curve bollards and sleepers.
Flow Assurance in Buzios Field: Key Challenges and Implemented Solutions
Authors: Noville Ivan , Maciel Milena da Silva , de Mattos Anna Luiza de Moraes y blanco , de Siqueira João Gabriel Carvalho
Published: August 2021

This article's goal is to present some of the main flow assurance challenges faced by PETROBRAS in the Buzios oil field, from its early design stages to full operation, up to this day. These challenges include: hydrate formation in WAG (Water Alternating Gas) operations; reliability of the chemical injection system to prevent scale deposition; increasing GLR (Gas Liquid Ratio) management and operations with extremely high flowrates.

Flow assurance experience amassed in Buzios and in other pre-salt oil fields, regarding all these presented issues, is particularly relevant for the development of future projects with similar characteristics, such as high liquid flow rate, high CO2 content and high scaling potential.
Advances in Offshore Structural Analysis Using Response-Based Time-Domain Approach
Authors: Kyoung Johyun , Samaria Sagar , O’Donnell Jeffrey , Tallavajhula Sudhakar
Published: August 2021

Demand for life extension assessments of floating offshore platforms continues to grow worldwide. Conventional structural analysis methods have limited ability to accurately capture non-linear environmental loading, non-linear loading by the mooring and riser systems, and resulting higher order hull responses. The uncertainties are typically managed by the factors of safety applied in the structural analysis. Time domain structural analyses have long promised to improve analysis accuracy and reduce these uncertainties. This paper describes a comprehensive and practical time domain structural analysis methodology applied to a deep-water semi-submersible-type floating platform including results for structural strength and fatigue. In addition, the time domain structural analysis was extended for use in fracture mechanics and the assessment of notional weld flaws to facilitate specification of impactful non-destructive examination (NDE).

Present time domain structural analysis methodology employs a response-based finite element analysis (FEA) conducted in the time domain. All external environmental loads and inertial forces are converted to a response-based stress-time history. Previously, conventional time domain structural analysis involves massive computation resources to resolve solutions at every time interval. Present methodology significantly improves computational efficiency to be practical in real-world problems. The improvement is achieved by decomposing the structural response into a set of multiple load components selected on the bases of function for hull motion response and environmental loadings. Structural response in time domain is directly obtained by synthesizing the load components. An actual time domain structural response is captured effectively and efficiently to simulate the strength and fatigue criterion for the structure with consistent environmental loads and hull responses.

Utilizing the level of detail provided by the time domain structural analysis methodology, a fracture mechanics evaluation of notional initial flaws (engineering criticality assessments – ECAs) can be conducted providing meaningful technical basis for in-service NDE and life extension assessments. The procedures for fatigue crack growth and fracture documented in BS 7910 were employed to derive the smallest initial flaws (critical initial flaws) that may result in structural failure during a facility's lifetime.

A comparison indicates that conventional structural analysis methods provide conservative results for both structural strength and fatigue damage calculations resulting from the linear assumption of environmental loads and hull responses. Present time domain structural analysis methodology provides an innovative, cutting-edge approach providing accuracy and fewer uncertainties, which can be pragmatically used during a typical project.
Postprandial Free Fatty Acids at Mid-Pregnancy Increase the Risk of Large-for-Gestational-Age Newborns in Women with Gestational Diabetes Mellitus
Authors: Kim So-Yeon , Song Young Shin , Kim Soo-Kyung , Cho Yong-Wook , Kim Kyung-Soo
Published: August 2021

Background: To investigate the association between free fatty acid (FFA) level at mid-pregnancy and large-for-gestational-age (LGA) newborns in women with gestational diabetes mellitus (GDM).Methods: We enrolled 710 pregnant women diagnosed with GDM from February 2009 to October 2016. GDM was diagnosed by a ‘two-step’ approach with Carpenter and Coustan criteria. We measured plasma lipid profiles including fasting and 2-hour postprandial FFA (2h-FFA) levels at mid-pregnancy. LGA was defined if birthweights of newborns were above the 90th percentile for their gestational age.Results: Mean age of pregnant women in this study was 33.1 years. Mean pre-pregnancy body mass index (BMI) was 22.4 kg/m2. The prevalence of LGA was 8.3% (n=59). Levels of 2h-FFA were higher in women who delivered LGA newborns than in those who delivered non-LGA newborns (416.7 μEq/L vs. 352.5 μEq/L, P=0.006). However, fasting FFA was not significantly different between the two groups. The prevalence of delivering LGA newborns was increased with increasing tertile of 2h-FFA (T1, 4.3%; T2, 9.8%; T3, 10.7%; P for trend <0.05). After adjustment for maternal age, pre-pregnancy BMI, and fasting plasma glucose, the highest tertile of 2h-FFA was 2.38 times (95% confidence interval, 1.11 to 5.13) more likely to have LGA newborns than the lowest tertile. However, there was no significant difference between groups according to fasting FFA tertiles.Conclusion: In women with GDM, a high 2h-FFA level (but not fasting FFA) at mid-pregnancy is associated with an increasing risk of delivering LGA newborns.
Video laryngoscopy vs. direct laryngoscopy for nasotracheal intubation in oromaxillofacial surgery: a systematic review and meta-analysis of randomized controlled trials
Authors: Gupta Nishkarsh , Gupta Anju , Sarma Riniki , Batra Atul , Madan Karan
Published: August 2021

Background: Nasotracheal intubation (NTI) is commonly performed in oromaxillofacial surgeries. We did this metanalysis to ascertain whether use of video laryngoscopy (VL) provided better NTI characteristics as compared to direct laryngoscopy (DL) in patients undergoing oromaxillofacial surgeries.Methods: We performed a systematic search to identify randomized controlled trials comparing VL with DL for NTI in adults undergoing elective oromaxillofacial surgery. The primary outcome was time to intubation. Secondary outcomes included the first attempt success, overall success, incidence of nasal bleeding, Cormack and Lehane grade, and maneuvers required. Results: Of the 456 studies identified following a systematic search, 10 were included. Meta-analysis showed a significantly lower time to tracheal intubation favoring VL (mean difference: –9.04, 95% CI [–12.71, –5.36], P < 0.001; I2 = 59%). VL was also associated with a greater first attempt success (relative risk [RR]: 1.10, 95% CI [1.04, 1.16], P = 0.001). Maneuvers to facilitate intubation were less with VL (RR: 0.22, 95% CI [0.10, 0.51], P < 0.001). There was no difference in overall intubation success (RR: 1.04, 95% CI [0.98, 1.10], P = 0.17). The incidence of bleeding did not differ between the DL and VL groups (RR: 0.59, 95% CI [0.32, 1.08], P = 0.09).Conclusions: Evidence as per this meta-analysis suggests VL leads to a shorter time to NTI, a greater first attempt success rate, and reduced need for maneuvers when compared to DL. The present study supports use of VL as a first line device for NTI in oral-maxillofacial surgeries in experienced hands.
A case of Idiopathic Hypertrophic Cranial Pachymeningitis Masquerading as Tolosa–Hunt Syndrome in an Elderly Female
Authors: Parate Tilottama , Tony Kizhakkemuriyil S. , Chavan Sonali , Khatri Ankita
Published: August 2021

Idiopathic hypertrophic cranial pachymeningitis (IHCP) is an extremely rare clinical entity of unknown etiology, characterized by a chronic inflammation causing thickening of the dura mater.[1] ICHP can produce similar presentation to Tolosa–Hunt syndrome (THS) if it involves cavernous sinus.[2] THS might represent a focal manifestation of IHCP.[2] The THS is a rare syndrome with an estimated annual incidence of one case per million per year.[3] It typically presents with orbital pain associated with palsy of the third, fourth, or sixth cranial nerve. We present an interesting case of a patient with IHCP associated with THS in an elderly female who responded well to high-dose steroids and in a few days had significant improvement in her retro-orbital pain and ocular movements. The importance of appropriate neuroimaging and serological investigation in patients with suspected THS, role of erythrocyte sedimentation rate in follow-up of these patients, and the relationship between IHCP and THS are discussed.
Evaluation of Appropriate Usage of Ppe Among Healthcare Providers During Covid-19 Pandemic
Authors: Sabbella Sree Maneesha Ratnam , Suvvari Tarun Kumar , Naraayan Purnima
Published: August 2021

Background:

Shortage of personal protective equipment (PPE), inadequate staff training regarding PPE usage, and confused PPE guidance led to infections and deaths among healthcare workers in many countries. Protection of healthcare workers is needed as they are delivering essential services during the pandemic time. So, the main aim of our study is to evaluate the appropriate use of PPE among healthcare providers (HCPs) during COVID-19 pandemic.

MATERIALS AND METHODS:

An observational cross-sectional study was conducted among the HCPs of India during September and October. A 15-item self-administered questionnaire was used, and Excel 2019 and SPPS 24 were used for statistical analysis. A χ2 test was performed to determine the role of sociodemographic characteristics on appropriate usage of PPE.

RESULTS:

One hundred and eighteen HCPs have participated in our study. About 44.9% of the study participants know the proper way of donning the PPE, and 38.9% of the study participants know the proper way of doffing the PPE. About 40.6% of the study participants were aware of place for PPE removal and how to dispose a PPE; 69.49% of the study participants were aware of guidelines of donning and doffing of PPE recommended by the Centers for Disease Control and Prevention and World Health Organization.

CONCLUSION:

The prevalence of breathing difficulty, headaches, suffocation, dehydration, hair problems, and skin irritation/maceration among frontline healthcare personnel using PPE during pandemic was seen. Appropriate usage of PPE is vital in safeguarding the HCPs and restriction of the spread of viral infection in the hospital setting.
Tracheal Intubation Using a Videolaryngoscope Assisted by Transtracheal Illumination with an LED Vein Finder
Authors: Shah Kinna G , Thakkar Jayshree
Published: August 2021

Introduction:

Retrograde illumination of the glottis using an LED vein finder placed over the cricothyroid membrane produces a red-orange glow of light inside the airway that can be used to assist the intubator during videolaryngoscopy. The endotracheal tube can be guided through this red-orange glow illuminating the glottis and trachea.

Patients and Methods:

In this prospective, randomised, single-blinded study, a total of 200 patients posted for elective head and neck cancer surgeries were included. Patients were placed supine with their heads in a neutral position without a pillow. Intubation was done with The Anesthetist Scope videolaryngoscope in Group TI (transillumination) with an assistant holding the LED vein finder over the cricothyroid membrane. The glottic opening was identified by a red-orange glow within the airway and the intubation was performed. In Group C (conventional direct laryngoscopy), transillumination was not done during intubation. Exposure time was taken from the time when the patient's mouth was opened to the time when the best glottic view was obtained. Intubation time was noted from the introduction of the videolaryngoscope or conventional laryngoscope into the mouth, through successful intubation and identification of 3 complete capnographic waveforms. A total of three attempts were allowed for each patient.

Results:

The success rate was better in Group TI. Exposure time and intubation time were shorter in Group TI as compared to Group C. In three patients with carcinoma of the vocal cords, the glottic opening was identified only by retrograde light transmission from the vein finder.

Conclusion:

A combination of videolaryngoscopy and LED vein finder is an effective method to achieve a better success rate of tracheal intubation.
Evaluation of Difficult Airway in Trauma Patients from Lateral Cervical Radiographs
Authors: Gultekin Aysenur , Korkut Mustafa , Soyuncu Secgin , Bedel Cihan
Published: August 2021

Background:

Many tests have been developed that are used either singly or in combination to identify a difficult airway. However, airway patency may not be adequately evaluated in some patients despite these tests. Lateral cervical radiography can be an auxiliary technique to evaluate difficult airway in patients of trauma due to its bedside applicability, cost-efficiency and rapidity. The aim of this study was to investigate the usefulness of lateral cervical radiographic measurements in predicting difficult laryngoscopy in trauma patients.

Patients and Methods:

The study consisted of patients of trauma who were admitted to the emergency department between July 2017 and March 2018. All patients underwent bedside cervical radiography and seven measurements were obtained. The anterior and posterior mandibular depths, effective mandibular length, atlanto-occipital distance, mandibulohyoid distance, thyromental distance and distance between the superior temporomandibular joint and the inferior edge of the fourth cervical vertebra (C4) were measured on the radiographs. Patients were divided into two groups as difficult and easy laryngoscopy groups, and the parameters were compared between the groups.

Results:

A total of 97 patients were included in our study. Of these patients, 54 (55.6%) were in the difficult laryngoscopy group, while 43 (44.4%) were in the easy laryngoscopy group. The interincisor, hyomental and thyrohyoid distances were significantly lower in the difficult laryngoscopy group compared to the easy laryngoscopy group.

Conclusion:

Bedside lateral cervical radiography is not a useful imaging method to demonstrate difficulty in laryngoscopy in patients of trauma.
Anaesthetic Management for Removal of Intratracheal Precarinal Tumour
Authors: Kabra Naresh R , Wagh Harshal D
Published: August 2021

We present successful management of a case of intratracheal tumour situated just above the carina in a 46-year-old male without any adverse outcome or the need for cardiopulmonary bypass. The tumour was originating from the right lateral wall of trachea just proximal to the carina and partially obstructing the right main bronchus. A reinforced endotracheal tube was guided over a fibreoptic bronchoscope into the left main bronchus and the patient provided one-lung ventilation till the trachea was opened. During tracheal resection and closure, the first reinforced tube was withdrawn till mid-trachea and a second reinforced tube was placed in the left main bronchus under direct vision by the surgeon and used for ventilation. Towards the end of procedure, the first reinforced tube (which had been withdrawn till mid-trachea before the surgeon passed the second tube) was advanced beyond the tracheal opening and used for ventilation. At the end of the procedure, the patient was extubated on table and was subsequently discharged without any complication. Our case illustrates the paramount importance of extensive planning, preparation of the operation theatre, good communication and coordination between all team members while dealing with these difficult cases.
Correlation of parathyroid hormone level with left ventricular mass in patients with end-stage kidney disease on hemodialysis
Authors: Shaltout Asmaa H. , Samir Sameh , Lashin Fayza I. , Sherif Mohammed H. , Aboelnasr Mohamed S.
Published: August 2021

Background

Patients with end-stage kidney disease (ESKD) on hemodialysis (HD) have a high prevalence of left ventricular hypertrophy (LVH), which is associated with increased cardiovascular risk. Hyperparathyroidism in these patients plays a key role in the development of LVH. The aim of this study was to evaluate the correlation of parathyroid hormone (PTH) level with left ventricular mass in patients with ESKD on HD. Other factors that contribute to the development of LVH were also included.

Patients and methods

This study included 40 patients with ESKD at our dialysis unit. Patients were classified into two groups: group I included 20 patients with LVH and group II included 20 patients without LVH. Patients were defined as having LVH if they had left ventricular mass index more than 95 g/m2 in women and more than 115 g/m2 in men.

Results

There was a statistically significant increase in PTH in patients in group I than group II (P=0.009). Hemoglobin % was significantly lower in patients in group I than group II (P=0.042). Left ventricular mass index showed a significant positive correlation with PTH and a significant negative correlation with hemoglobin %.

Conclusion

Hyperparathyroidism and anemia are the two major contributors to the development of LVH in patients with ESKD on HD.
Successful kidney transplantation of a patient with thalassemia major
Authors: Emam Mohamed , Moneem Mohamed A. , Gheith Osama , Mahmoud Tarek , Nagib Ayman M. , Abdultawab Khalid , Elsayed Zakaria , Nair Prasad , Al-otaibi Torki
Published: August 2021

Thalassemia minor has a good prognosis, whereas thalassemia major (TM) is a severe disease, and the long-term prognosis depends on the treatment adherence to transfusion and iron chelation therapies. To our knowledge, there are no reported thalassemia cases that underwent kidney transplant. We aimed to highlight a successful kidney transplant in a patient with TM with stable graft function after 16 months of follow-up. In our case, repeated blood transfusions were inevitably associated with iron overload despite iron chelating agents. Moreover, she developed anti-HLA antibodies, but fortunately, there were no donor-specific antibodies, which facilitated the procedure of renal transplant that was performed on 17/3/2019. After 6 weeks of transplant, she started follow-up in the clinic and resumed iron chelation using deferasirox along with much less frequent blood transfusion. After more than 20 months of follow-up, she is enjoying stable graft function, hemoglobin around 9.2 g/dl, and with occasional trace proteinuria. This is a case report showing a β-TM case can undergo renal transplant with no contraindications under special circumstances, and it is the first case in the literature.