Effects of treating subclinical hypothyroidism in pregnancy in India: Are we treating too many for little gain? A retrospective cohort study.

OBJECTIVE: To assess the impact of treatment of subclinical hypothyroidism (SCH) on short-term pregnancy outcomes. METHOD: Data from 4526 consecutive women with singleton pregnancies who delivered between January 2015 and December 2017 were analyzed. SCH was defined as a thyroid-stimulating hormone (TSH) level between 2.5 and 10 mU/mL with normal free thyroxine. Of those with SCH, some were treated but others were not. These two groups were compared using χ2 and Student t tests for categorical and continuous variables, respectively. Multiple logistic regression models, adjusted for maternal age, body mass index, parity, gestation at TSH measurement, and gestational diabetes mellitus status, were used to investigate the effect of treatment on pregnancy and neonatal outcomes. RESULTS: In all, 1227 (27.1%) of 4526 women had SCH, of whom 393 (32.0%) were treated. The mean age and body mass index were similar in both groups. The mean gestation at measuring of TSH was 11.7 ± 6.5 weeks. There was no significant difference in pregnancy or neonatal outcomes between the two groups. A sub-group analysis when SCH was defined as TSH 4.0 mU/mL or greater showed a higher rate of large for gestational age and lower rates of low birth weight and small for gestational age in the treated group. CONCLUSIONS: The prevalence of SCH based on the international guidelines threshold is high in India. Treatment of SCH did not show any difference in pregnancy and neonatal outcomes in this study.

Effects of Intravenous Dexmedetomidine on Hemodynamic Responses to Pneumoperitoneum During Laparoscopic Cholecystectomy.

BACKGROUND: Dexmedetomidine is a potent α_2 agonist which has been used for blunting the stress responses during critical events such as laryngoscopy, endotracheal intubation, pneumoperitoneum creation, and extubation. The purpose of this study was to see the efficacy of intravenously administered dexmedetomidine at a dose of 0.5 mcg/kg in attenuating the hemodynamic responses due to pneumoperitoneum during laparoscopic cholecystectomy under general anesthesia. METHODS: Sixty patients, ASA-PS class I (American Society of Anesthesiologist physical status class I), aged between 18 and 60 years, of either sex with weight ranging from 50 to 80 kg, scheduled for laparoscopic cholecystectomy were randomized into two groups (groups A and B) in a double-blinded fashion. Both groups were pre-medicated with an injection glycopyrrolate. Group A received 100 mL normal saline (NS) over 10 minutes while group B received dexmedetomidine 0.5 mcg/kg diluted in 100 mL NS over 10 minutes before induction of general anesthesia. Heart rate, systolic, diastolic, and mean arterial pressures were noted. RESULTS: Following pneumoperitoneum, there was no statistically significant difference in the hemodynamic parameters between the two groups (P > 0.05). CONCLUSION: Administration of dexmedetomidine at a dose of 0.5 mcg/kg before induction did not blunt the hemodynamic responses to pneumoperitoneum during laparoscopic cholecystectomy.

Postoperative Acute Submandibular Sialadenitis: A Case Report.

Acute postoperative sialadenitis is a rare complication usually after surgery involving extreme head and neck rotation, such as posterior fossa surgery. It is characterized by the development of swelling in the submandibular region, usually contralateral to the surgical side, either immediately or within hours post-operatively. We report a case of a 43-year-old woman who developed sialadenitis leading to upper airway obstruction in the postoperative period. Further, she developed bilateral neck and face swelling. Dexmedetomidine used as an infusion throughout the surgery could be an additional cause. Swelling without signs of inflammation is rapidly progressive and may cause airway obstruction. Therefore, awareness and recognition are important, as a delay in airway securement can cause a complete collapse of the airway. Keywords: airway obstruction; case reports; sialadenitis.

Free-Will Arbitrary Time Consensus for Multiagent Systems.

In this article, the free-will arbitrary time consensus is formulated for multiagent systems. This consensus protocol is independent of initial conditions and any other system parameters. With such a protocol, the multiagent system is shown to attain consensus as well as average consensus within the prespecified arbitrary time. Agents rendezvous can also be accomplished with the given protocol. Communication imperfections are easily handled with the designed protocol. Robust free-will arbitrary time consensus protocol is also designed. The stability of such nonlinear nonautonomous protocols is established using suitable Lyapunov functions. Simulation examples confirm the theoretical findings.

Microbial phytase: Impact of advances in genetic engineering in revolutionizing its properties and applications.

Phytases are enzymes that increase the availability of phosphorous in monogastric diet and reduces the anti-nutrition effect of phytate. This review highlights contributions of recombinant technology to phytase research during the last decade with specific emphasis on new generation phytases. Application of modern molecular tools and genetic engineering have aided the discovery of novel phytase genes, facilitated its commercial production and expanded its applications. In future, by adopting most recent gene improvement techniques, more efficient next generation phytases can be developed for specific applications.

Effectiveness of management interventions on forest carbon stock in planted forests in Nepal.

Nepal has successfully established more than 370,000 ha of plantations, mostly with Pinus patula, in the last three and a half decades. However, intensive management of these planted forests is very limited. Despite the fact that the Kyoto Convention in 1997 recognized the role of plantations for forest-carbon sequestration, there is still limited knowledge on the effects of management practices and stand density on carbon-sequestration of popular plantation species (i.e. Pinus patula) in Nepal. We carried out case studies in four community forests planted between 1976 and 1990 to assess the impacts of management on forest carbon stocks. The study found that the average carbon stock in the pine plantations was 217 Mg C ha-1, and was lower in forests with intensively managed plantations (214.3 Mg C ha-1) than in traditionally managed plantations (219 Mg C ha-1). However, it was the reverse in case of soil carbon, which was higher (78.65 Mg C ha-1) in the forests with intensive management. Though stand density was positively correlated with carbon stock, the proportionate increment in carbon stock was lower with increasing stand density, as carbon stock increased by less than 25% with a doubling of stand density (300-600). The total carbon stock was higher in plantations aged between 25 and 30 years compared to those aged between 30 and 35 years.

Hypothyroidism in diabetes mellitus patients in Eastern Nepal.

CONTEXT: The coexistence of diabetes mellitus (DM) with hypothyroidism is a known clinical observation. AIMS: To estimate prevalence and co-relate that of hypothyroidism in patients with DM in relation to the age and sex, the lipid profile, body mass index visiting diabetes clinic and inpatients in B. P. Koirala Institute of Health Sciences. SETTINGS AND DESIGN: The hospital-based descriptive study. MATERIALS AND METHODS: Two hundred and seventy-one known or newly detected cases of DM aged more than 15 years were selected randomly from September 2012 to September 2013 and subjected to evaluation for thyroid function - clinically and biochemically and other relevant investigations were done. STATISTICAL ANALYSIS USED: For descriptive statistics mean, standard deviation, percentage, proportion were calculated. For inferential statistics following test were carried out at the level of significant 0.05 where confidence interval is 95%. The statistical operations were done through Statistical Package for the Social Sciences version 10. RESULTS: Of 271 subjects, the prevalence of hypothyroidism (clinical and subclinical) in diabetics was, 4.05% (11/271) with females preponderance, of which 7 (30.4%) were clinically hypothyroid and 4 (17.4%) were subclinical hypothyroid. One (4.3%) patient had subclinical hyperthyroidism. The mean age at diagnosis of type 2 DM was 51-60 years. 8.69% of diabetics with primary hypothyroids were having morbid obesity. High-density lipoprotein among different thyroid status were statistically significant (P = 0.042). CONCLUSIONS: Hypothyroidism is not uncommon in diabetes, and we found body mass index, mean triglyceride and cholesterol levels were more in those diabetic patients having coexisting hypothyroidism.

I-gel for positive pressure ventilation.

INTRODUCTION: I-gel is a relatively new supra-glotitc airway device which is claimed to be superior to laryngeal mask airway. It can be used ingeneral anesthesia with spontaneous ventilation as well as with positive pressure ventilation.This study was designed to assess whether I-gel creates adequate laryngeal seal during positive pressure ventilation in patients undergoing laparoscopic surgery. METHODS: A prospective randomized study was made among the 60 patients who underwent laparoscopic cholecystectomy under general anesthesia. Airway was managed with either I-gel insertion or endotracheal intubation and positive pressure ventilation in 30 patients each. Airway pressure, end-tidal CO2and oxygen saturation were monitored and compared between two groups. Inhaled and exhaled tidal volume, minute volume were recorded and leak volume and leak fraction was calculated and compared between two groups. RESULTS: Oxygenation and ventilation (oxygen saturation and end-tidal carbon dioxide pressure) was within normal limit in both groups and comparable. Leak volume in tracheal tube group was 25.33±12.41 ml and in I-gel group it was 26.43±13.19 ml. Leak fraction was 0.0487±0.023 and 0.0417±0.022 in tracheal group and I-gel group respectively. The airway pressure during C02 pneumoperitoneumwas 20.55±3.25 cm H20 in tracheal tube group and 20.21± 3.97 cm H20 in I-gel group and there was no significant leak in either group. Statistically, there was no significant difference in leak volume, leak fraction and airway pressure between the two groups. CONCLUSIONS: I- gel may be an alternate to tracheal tube during general anesthesia with positive pressure ventilation in patients with normal airway pressure with acceptable leak, adequate oxygenation and ventilation.