Search

This case study well is in a mature onshore field, which has been under production for a long time (started in 1970) resulting in depletion of some of the reservoir units presenting challenges for optimizing drilling performance and managing risks associated with stuck-pipe incidents. Additional challenges are minimized surface footprint, 100% reservoir contact in thin targets and acquisition of accurate petrophysical data for formation evaluation. A detailed pre-well study was conducted utilizing historical field and nearby wells’ data in the planning phase with close collaboration in a multi-disciplinary team including well and Bottom Hole Assembly (BHA) design and pre-well modeling for geosteering and LWD tool string configuration taking into account the elimination of radioactive chemical sources. The pre-well study has concluded that the azimuthal deep propagation resistivity image is going to provide proactive geosteering solution to identify the approach to both top and bottom boundaries. The BHA has also included rotary steerable system (RSS) along with optimized Logging While Drilling technologies (LWD) which has included, high-resolution micro resistivity imaging, Laterolog resistivity, nuclear magnetic resonance (NMR), sonic caliper and near-bit gamma ray. Continuous real-time monitoring provided drilling performance monitoring and analysis as well as facilitating geosteering services. The 8,356 feet horizontal section was effectively geosteered with 100% reservoir contact tapping into two thin reservoir sub-layers. Real-time azimuthal deep propagation resistivity image/curves were used to geosteer the well trajectory precisely within target zones and provided 4-5 feet TVD detection to bed boundaries. Also, high-resolution microresistivity images, dip picks and near-bit azimuthal gamma ray helped in maintaining the well-bore attitude parallel to the stratigraphy within each sub-layer. This data facilitated a smooth transition from one sub-layer to the next with minimum borehole tortuosity aided by the push the-bit RSS and at-bit-inclination measurements. In addition, NMR provided real-time porosity and permeability measurements assisting in well placement and enhancing reservoir understanding as well as optimizing future well planning workflows. This paper presents a step change from the traditional field development drilling techniques in terms of horizontal length. Similar well designs are currently being implemented in an effort to benchmark drilling, well placement and petrophysical data gathering requirements for future development drilling in order to maximize asset value.

Surgical site infections (SSIs) may be reduced by following SSI prevention measures. We assessed the SSI rate following caesarean section (CS) and gynaecologic surgery after implementing a simple SSI prevention bundle including preoperative bath and hair wash.The study was carried out in two hospitals in North India (Post Graduate Institute of Medical Education and Research [PGIMER] and Civil Hospital CH) from August 2018 to July 2019. The SSI rate during intervention period (9 months) was compared with baseline rate (3 months). Womens' knowledge about SSI was assessed preoperatively and after counselling, postoperatively.The baseline SSI rate after CS (n = 165) was 11.1% at PGIMER and 8.5% at CH. After gynae surgery (n = 172), it was 13% at PGIMER and 11.5% at CH. During intervention, (CS = 585, gynae surgery = 503), SSI rate was reduced significantly at PGIMER (CS: 11.1% to 3.7%,The reduction in SSI at PGIMER was attributed to better compliance to SSI prevention measures listed above. Counselling women about simple SSI prevention method like preoperative bath with scalp hair wash increased their knowledge about these significantly.

Introduction. Diabetes has become one of the leading causes of morbidity and mortality across the world. Cardiac Autonomic Neuropathy (CAN) has increased the chances of silent myocardial infarction and thus has shortened lifespan resulting in death in 25–50% patients within 5–10 years of CAN. Further patients of Diabetic Peripheral neuropathy (DPN) often have associated Autonomic Neuropathy. Our study aims at identifying the correlation of glycemic parameters with HRV parameters in patients of DPN. Methods. 95 patients of diabetes were assessed for the inclusion and exclusion criteria. 60 patients of diabetes were included in the study who gave valid written consent. They were assessed for the signs of neuropathy by evaluating ankle reflex, pinprick, vibration sense, and monofilament testing. Patients were assessed for neuropathy by MNSI Scoring. Heart rate variability was performed by PHYSIO-PAC SOFTWARE SYSTEM. Two–lead electrocardiographic data were recorded for 5 minutes and analyzed by HRV software. The time-domain analysis was done by Fast Fourier transformation. Statistical analysis of the data was performed using SPSS version 21. Nominal variables are presented as the numbers and percentages of cases and continuous variables as means ± standard deviation (SD). The association between continuous variables was tested by linear correlation using Pearson's coefficient. P-value of Results. The mean age of T2DM with neuropathy was 49.17 ± 7.1. A correlation of Fasting Plasma Glucose (FPG), Postprandial Glucose (PPG) and HbA1C with HRV parameters (pNN50, RMSSD, HF power, and LF/HF ratio) showed the statistically significant negative association. Conclusion. Patients with uncontrolled diabetic peripheral neuropathy are more prone to CAN. We conclude that patients having autonomic dysfunction should be treated with extensive therapy, which will thereby lower mortality and morbidity. Screening by HRV should be done periodically.

This work is done in the context of a giant carbonate reservoir with 40 years of production/injection history. In this reservoir, the key heterogeneities that impact the production mechanisms (high permeability streaks, permeability contrast, intra dense and dual sub-zones of varying maturity) are well characterized, through major field reviews. However, in the recent years, unexpected high water saturation were encountered while drilling infill horizontal drains. An integrated multi-scale investigation was conducted to understand the potential mechanism of water movement within the lower sub-zone through an assimilation and interpretation of data and multi-disciplinary understanding. This work resulted in further optimization of remaining infill wells and the field development strategy. The observed high water saturation signatures were investigated through integration and analysis of multi-disciplinary data, using data acquired in infill wells during the last three (3) years. First, the studied wells were categorized primarily based on their water cut, water saturation encountered and then mapped along with their data. Second, the different scenarios of possible water movement were developed chronologically. Third, a multi-scale integrated analysis (well level to reservoir level) and subsequent mapping was captured on a montage. The developed scenarios were validated with recent surveillance, monitoring data and corroborated with geological/geophysical understanding. This comprehensive approach and results were corroborated with blind tests in terms of the dynamic behavior of the water. Faults and their characteristics were identified as a key element affecting this local dynamic behavior. Saturation logs showed high water saturation but were inconclusive on whether this water is mobile or not. This required integration with dynamic flow data from production logging and well tests. The dynamic data was integrated with the seismic and geological findings to ascertain whether the water presence is due to poor rock type, water migration through faults or water movement in the matrix. The findings were mapped and led to re-consider the well placements and expectations from infill wells while crossing faults. This enhancement of the reservoir understanding resulted in mitigation of risks in future producers which subsequently impacted the reservoir development strategy. This multi-scale analysis over the reservoir provided an insight into the source of the unexpected high water saturation in the undrained lower sub-zones of the reservoir. Thus, revising the understanding of the field development strategy, well placement and related contingencies.

Introduction: There is a close association between obesity and type 2 diabetes as well as its complications. Obesity related changes in nerve conduction assume paramount importance in diabetic patients where the nerve functions are already compromised by other metabolic derangements. Aim: To study any existing correlation of the Nerve Conduction Velocity (NCV) with the Total Body Fat Mass (TBFM) and Body Mass Index (BMI) and to identify which is a better predictor of NCV impairment in type 2 diabetics. Materials and Methods: A prospective, cross-sectional study was conducted during April 2018-January 2019 in 90 patients with confirmed diagnosis of Diabetes type 2 of recent onset or not more than 8 years and age between 30 to 60 years. NCV was measured in both upper and lower limbs. Median, ulnar, and posterior tibial nerves were selected for motor nerve conduction study and median, Ulnar and sural nerves were selected for sensory nerve conduction study. Bioelectric Impedance Analysis (BIA) was used to find the TBFM. The correlation of TBFM and BMI with the NCV was assessed by using Pearson’s coefficient of linear correlation. Results: Both BMI and TBFM showed negative correlation with the motor and sensory NCV of both sides of the body. BMI had a significant negative correlation with conduction velocity of two sensory nerve viz., right median (r=-0.388) and left sural (r=-0.356) and two motor nerves viz., right median (r=-0.483) and right posterior tibial (r=-0.305) only. However, the TBFM showed a significant negative correlation with the motor conduction velocity of four motor viz., right median (r=-0.602), right posterior tibial (r=-0.455), left median (r=-0.483) and left posterior tibial (r=-0.288) and four sensory nerves viz., right median (r=-0.411), right sural (r=-0.435), left median (r=-0.461) and left sural (r=-0.408). Conclusion: TBFM as assessed by BIA analysis shows a stronger correlation with the NCV as compared to the BMI and should be used clinically along with electrophysiological studies for the risk factor stratification of diabetic peripheral neuropathy in type 2 diabetes patients.

Introduction. Diabetic peripheral neuropathy (DPN) is the most common but least recognised and understood long term complication of type 2 diabetic patients (T2DM). There is a close association between obesity and type 2 diabetes as well as its complications. Nerve conduction study is an important non-invasive diagnostic modality used in the detection of diabetic peripheral neuropathy. Obesity is associated with increased oxidative stress and lipid peroxidation is thought to play a crucial role in the development of diabetic neuropathy. The aim of this study is to see the correlation of nerve conduction velocity parameters viz nerve conduction velocity and nerve conduction amplitude with the total body fat mass and oxidative stress markers. Methods. The study included 90 type 2 diabetes patients with clinically suggestible symptoms of diabetic peripheral neuropathy (DPN). 50 type 2 diabetic subjects without peripheral neuropathy served as control. Total body fat mass was measured using bioelectric impedance analysis. Oxidative stress markers viz total antioxidant capacity and malondialdehyde were measured using elisa kit. Nerve conduction study both motor and sensory was carried out in relevant nerves. Results. Serum levels of total antioxidant capacity and super oxide dismutase were significantly decreased in type 2 diabetic with neuropathy as compared to the ones without neuropathy. Serum levels of malondialdehyde, on the other hand, was significantly elevated. Motor nerve conduction velocity (MNCV) of ulnar and common peroneal nerve and sensory nerve conduction velocity of ulnar and sural showed a significantly decreased conduction velocity as compared to control. The total body fat mass showed a significant negative correlation with the motor conduction velocity of median, posterior tibial and sensory conduction velocity of median and sural nerve. Conclusion. The nerve conduction velocity test and total body fat mass evaluation is a cost- effective tool for earlier detection of neuropathy in type 2 diabetes patient.

Aims Diabetes mellitus (DM) is considered to be one of the important risk factors for cardiac diseases. Frank diabetes is usually preceded by long term abnormality in glucose homeostasis which is called pre-diabetes. The hypothesis that diabetic patients have greater risk and worse prognosis of Acute Myocardial Infarction (AMI) than pre-diabetics is controversial. Considering that India has been declared as a diabetic capital of the world, the study aimed to assess the load of pre diabetics, diabetics and non-diabetics landing in myocardial infarction. Materials and methods The study consisted of through physiological and biochemical evaluation of 200 patients of newly diagnosed AMI and evaluating the load of non-diabetics, pre-diabetics and diabetics among them. Result It was found that the total non-diabetic population (normoglycaemic and pre-diabetic) formed the bulk of AMI patient (69%) in our study. The degree of biochemical alterations seen among the three groups suggests that abnormal glucose homeostasis is not the sole determinant of the severity of AMI. The study data also suggests that glycaemic status, which poses a risk for AMI, differs in male and female individuals. Males even with normal glucose level are at increased risk to develop MI. Conclusion The study concludes that both males and females with their blood glucose in pre-diabetic range are seen to be vulnerable to develop AMI. Thus all individuals irrespective of their glycaemic status around the age of forty should be screened and individuals with fasting sugar in pre-diabetic range should take extra precaution in terms of healthy diet, life style and regular check up

Background: Obesity is an epidemic in 21st century especially rising among young population of developing nations is measured in terms of BMI (Body Mass Index). It affects almost every system. In present study we aim to investigate any correlation between NCV & BMI among professionals of mechanized jobs involving repeated wrist movements. Method: BMI and median nerve NCV is measured in dominant and non-dominant hand of young active professionals. Results: One way ANOVA is applied and MNCV of median nerve in dominant hand and SNCV of dominant as well as non-dominant hand is found to be significantly decreased but MNCV of non-dominant shows no significant difference. Conclusion: Early changes in nerve conduction due to increased carpal tunnel pressure are more pronounced in dominant hand and SNCV of median nerve could be used as an early screening and diagnostic tool for median neuropathy

Background: Nerve Conduction Velocity is affected by various factors like age gender & temperature. Various studies have been done regarding development of brain and dominance of right or left side, some studies have found differences between left and right hand for nerve conduction. Our aim is to compare NCV of dominant limb to nondominant limb in right hand dominant subjects and to find out if different normal values should be considered in right and left hand. Methods: The Median and Common Peroneal Nerve (CPN) of dominant as well as Non- dominant limb were used for measuring Motor & Sensory Nerve Conduction Velocity (MNCV & SNCV) in age groups of 31-35 and 3640 years using Medicaid system. Results: We found p value was insignificant using unpaired t-test for MNCV & SNCV of Median and Common Peroneal Nerve of left and right side. Similarly, the MNCV & SNCV of dominant and nondominant limb for median and CPN were insignificant. Conclusion: Consideration of right or left side dominance is not necessary while measuring NCV in asymptomatic subjects and different set of normal values are not required for right and left hand.

Background: IUGR is a most common and complex problem in modern obstetrics. Most commonly use methods to assess fetal condition are BPP and NST which are not sensitive for predicting better perinatal outcome. Present study was an effort to evaluate the role of ratio of pulsatility index (PI) of middle cerebral artery and umbilical artery which is called cerebro placental ratio as the most sensitive, specific and accurate predictor of adverse perinatal outcome in clinically suspected IUGR Pregnancies.Methods: 50 clinically suspected IUGR Pregnancies attending antenatal clinics Muzaffarnagar Medical College and Hospital, Muzaffarnagar were subjected to Doppler ultrasound evaluation Doppler velocity wave form of umbilical artery and fetal middle cerebral artery were obtained. Pulsatility index ratio of MCA and umbilical artery (cerebro placental ratio) was evaluated in each case. Abnormal ratio is defined as CPR

Perinatal asphyxia refers to an impairment of the normal oxygenation during parturition and the ensuing adverse effects on the fetus/neonate. It is one of the major causes of early neonatal mortality in India. Among the institutional births, incidence is 5% and accounts for 24.3% of neonatal deaths. It is an insult to fetus or newborn due to lack of oxygen (hypoxia) or lack of perfusion (ischemia) to various organs of sufficient magnitude and duration. The aim of the study was to observe the urinary uric acid to creatnine ratio in patients with perinatal birth asphyxia in a hospital setting. It was concluded that UUA/Cr concentration increase considerably after birth asphyxia, and the increase is associated with severity of HIE with a poorer outcome. Hence, UUA/Cr might have an important role in diagnosing and predicting the outcome of perinatal asphyxia.

Abstarct Aims To correlate serum levels of TGF-β1 with motor and sensory nerve conduction velocities in patients of type 2 diabetes mellitus Materials and methods The study was conducted in diagnosed type 2 diabetes mellitus patients which were divided in patients with clinically detectable peripheral neuropathy of shorter duration ( n = 37) and longer duration ( n = 27). They were compared with patients without clinical neuropathy ( n = 22). Clinical diagnosis was based on neuropathy symptom score (NSS) and Neuropathy disability score (NDS) for signs. Blood samples were collected for baseline investigations and estimation of serum TGF-β1. Nerve conduction velocity was measured in both upper and lower limbs. Median, Ulnar, Common Peroneal and Posterior Tibial nerves were selected for motor nerve conduction study and Median and Sural nerves were selected for sensory nerve conduction study Results In patients of type 2 diabetes mellitus with clinically detectable and serum TGF-β1 showed positive correlation with nerve conduction velocities Conclusion High level of TGF-β1 in serum of T2DM patients with neuropathy show possible contribution in development of neuropathy. Due to its independent association this cytokine might be used as biomarker for diabetic peripheral neuropathy

Background: Different scoring systems based on neurological and physical examination are used in the neonatal units for assessment of gestational age. Assessment of gestational age is very much helpful in labelling the newborn to be preterm, term or post – term and to assess the further outcome of the newborn infants. Present study was performed to test the accuracy and reliability of the Ballard scoring system as compared to Dubowitz scoring system on 250 newborn infants and their correlation with the gestational age as calculated from first day of mother’s last menstrual period. In infants of 38 weeks onwards correlation of gestational age was done with the extension of plantar creases over sole.Methods: Infants studied were selected from infants born in Muzaffarnagar Medical College and Hospital Muzaffarnagar and those infants admitted to the neonatal intensive care unit. First of all methods of eliciting different criteria were experienced by examining several newborn infants and then Dubowitz and Ballard scoring system were performed separately and gestational age assessed. crease was measured, using metallic scale from base of great toe after stretching the sole.Results: Gestational ages estimated by Ballard scoring system and Dubowitz system strongly correlated with the gestational ages computed from the date of mother’s last menstrual period. The coefficient of correlation calculated between Ballard and Dubowitz scoring system showed perfect positive correlation on the regression line. Association of gestational age with the length of sole crease was also very significant.Conclusions: The clinical test of maturation described by Ballard et al and which is evaluated in the present study, takes a balanced look at physical and neurological maturation and included those items found to be most useful regardless of the presence or absence of diseased state.

Objective To compare serum levels of TNF-α in patients of peripheral neuropathy and patients without neuropathy in type 2 diabetes mellitus. Material and methods This cross sectional study was conducted in diagnosed type 2 diabetes mellitus patients. They were divided in groups, Group I ( n = 37) with clinically detectable diabetic peripheral neuropathy of shorter duration and Group II ( n = 27) with clinically detectable diabetic peripheral neuropathy of longer duration. They were compared with patients without clinical neuropathy ( n = 22), clinical diagnosis was based on neuropathy symptom score (NSS) and neuropathy disability score (NDS) for signs. Blood samples were collected for baseline investigations and estimation of serum TNF-α. Nerve conduction velocity was measured in both upper and lower limbs. Median, Ulnar, Common Peroneal and Posterior Tibial nerves were selected for motor nerve conduction study and Median and Sural nerves were selected for sensory nerve conduction study. Results The comparisons were done between various clinical and biochemical parameters in clinically detectable and undetectable peripheral neuropathy groups of type 2 diabetes mellitus. The study showed raised serum levels of TNF-α in peripheral neuropathy patients and significant correlation with nerve conduction velocity. Conclusion High level of TNF-α in serum of T2DM patients with neuropathy shows possible contribution in development of neuropathy. Due to its independent association this cytokine might be used as biomarker for diabetic peripheral neuropathy.

Background: Tobacco smoking has been known to affect the human physiology and among the various damaging effects of tobacco, it has been linked with its effect on the sense of hearing. Aim and Objective: This study was designed with the aim of finding the relationship between smoking and hearing loss in various age groups. Materials and Methods: This study included 148 subjects among which 108 were smokers and 40 were age matched non smokers. The smoking history of all the subjects whose ages ranged from 20 to 60 years was taken in detail and their audiometric thresholds were recorded in a sound proof room by a professional audiometrist. The data was analyzed by using appropriate statistical tests. Observation and Results: Smoking was found to be signifi- cantly associated with hearing loss. Also, the hearing loss was mainly of the sensorineural type, with the mild type (26-40 dB) of hearing loss being the most common among the smokers.

Acute torsion of the fallopian tube is a rare event, which has been reported with both normal and pathologic fallopian tubes. Tubal torsion usually accompanies torsion of the ovary as they have a common vascular pedicle. But, isolated torsion as seen in this case is a very rare event.

Objective To study the nerve conduction velocity in clinically undetectable and detectable peripheral neuropathy in type 2 diabetes mellitus with variable duration. Material and methods This cross sectional study was conducted in diagnosed type 2 diabetes mellitus patients. They were divided in groups: Group I ( n = 37) with clinically detectable diabetic peripheral neuropathy of shorter duration and Group II ( n = 27) with clinically detectable diabetic peripheral neuropathy of longer duration. They were compared with T2DM patients ( n = 22) without clinical neuropathy. Clinical diagnosis was based on neuropathy symptom score (NSS) and neuropathy disability score (NDS) for signs. Nerve conduction velocity was measured in both upper and lower limbs. Median, ulnar, common peroneal and posterior tibial nerves were selected for motor nerve conduction study and median and sural nerves were selected for sensory nerve conduction study. Results The comparisons were done between nerve conduction velocities of motor and sensory nerves in patients of clinically detectable neuropathy and patients without neuropathy in type 2 diabetes mellitus population. This study showed significant electrophysiological changes with duration of disease. Nerve conduction velocities in lower limbs were significantly reduced even in patients of shorter duration with normal upper limb nerve conduction velocities. Conclusion Diabetic neuropathy symptom score (NSS) and neuropathy disability score (NDS) can help in evaluation of diabetic sensorimotor polyneuropathy though nerve conduction study is more powerful test and can help in diagnosing cases of neuropathy.