Aim To determine the current prevalence of thyroid dysfunction in normal pregnant women and to study the impact of thyroid dysfunction on maternal and fetal outcome. Methods 400 pregnant women between 13 and 26 weeks of gestation were registered for the study. Apart from routine obstetrical investigations, TSH tests were done. Free T4 and anti-TPO antibody tests were done in patients with deranged TSH. Patients were followed up till delivery. Their obstetrical and perinatal outcomes were noted. Results The prevalence of hypothyroidism and hyperthyroidism was 12 and 1.25 %, respectively. Adverse maternal effects in overt hypothyroidism included preeclampsia (16.6 vs. 7.8 %) and placental abruption (16.6 vs. 0.8 %). Subclinical hypothyroidism was associated with preeclampsia (22.3 vs. 7.8 %) as compared to the euthyroid patients. Adverse fetal outcomes in overt hypothyroidism included spontaneous abortion (16.6 vs. 2.39 %), preterm birth (33.3 vs. 5.8 %), low birth weight (50 vs. 12.11 %), intrauterine growth retardation (25 vs. 4.9 %), and fetal death (16.6 vs. 1.7 %) as compared to the euthyroid women. Adverse fetal outcomes in subclinical hypothyroidism included spontaneous abortion (5.5 vs. 2.39 %), preterm delivery (11.2 vs. 5.8 %), low birth weight (25 vs. 12.11 %), and intrauterine growth retardation (8.4 vs. 4.9 %) as compared to the euthyroid women. Conclusions The prevalence of thyroid disorders was high in our study with associated adverse maternal and fetal outcomes. Routine screening of thyroid dysfunction is recommended to prevent adverse fetal and maternal outcome.

During pregnancy, the body goes through various anatomical and physiological changes to provide suitable environment for foetal development, to cater to the increased metabolic demands and to prepare for the childbirth. These changes have notable anaesthetic implications in determining the optimal anaesthetic technique, while also keeping in mind the gestational age, type of procedure and any coexisting medical condition. It is important to note that these changes revert to baseline (pre-pregnancy) levels at different time intervals during the postpartum period which is important while managing postpartum patients. None of the anaesthetic agents are known teratogens; however, there is concern regarding the effects of some agents on the developing brain.

Background Bloodstream infections (BSIs) are an emerging cause of significant morbidity and mortality in severe Coronavirus disease 2019 (COVID-19). We aimed to assess the prevalence, clinical profile and outcome of BSIs in critically ill COVID-19 patients. Methods This was a single-centre retrospective study conducted at a tertiary care hospital in Western India. All patients (age > 18 years) with reverse-transcription polymerase chain reaction (RT-PCR) confirmed COVID-19 admitted in the intensive care unit (ICU) were included. Hospital electronic records were searched for demographic data, time of bloodstream infection since admission, clinical profile, antimicrobial resistance pattern and clinical outcome of all patients who developed BSIs. Results Out of 750 patients admitted in COVID ICU, 8.5% developed secondary BSIs. All severe COVID-19 patients who developed BSIs succumbed to illness. A significant proportion of BSIs were Gram-negative pathogens (53/64, 82.8%). Acinetobacter baumannii was the commonest isolate, followed by Klebsiella pneumoniae (32.8% and 21.9%, respectively). Multidrug-resistance organisms (MDRO) were found in 57.8% of the cases. The majority of MDRO belonged to K. pneumoniae and Enterococcus groups. The proportion of Gram-negative bacteria resistant to carbapenems was 47.2% (25/53). On multivariate analysis, raised total leukocyte counts, mechanical ventilation and presence of comorbidities were significantly associated with the incidence of BSIs. Conclusion We found a significant prevalence of Acinetobacter baumannii in COVID-19 associated BSIs. The presence of comorbidities raised leukocyte counts and mechanical ventilation should alarm clinicians for possible BSIs. The timely initiation of empirical antibiotics and rapid de-escalation is vital to improve the outcome. At the same time, strict compliance of infection control practices should be accomplished to reduce the occurrence of MDRO.

Background:Traditionally, midazolam has been used for providing conscious sedation in endoscopic retrograde cholangiopancreatography (ERCP). Recently, dexmedetomidine has been tried, but very little evidence exists to support its use.Objective:The primary objective was to compare haemodynamic, respiratory and recovery profile of both drugs. Secondary objective was to compare the degree of comfort experienced by patients and the usefulness of the drug to endoscopist.Study Design:Open-label Randomised Controlled Trial.Methods:Subjects between 18 and 60 years of age with American Society of Anaesthesiologist Grade I-II requiring ERCP were enrolled in two groups (30 each). Both groups received fentanyl 1 μg/kg IV at the beginning of ERCP. Group M received IV midazolam (0.04 mg/kg) and additional 0.5 mg doses until Ramsay Sedation Scale (RSS) score reached 3-4. Group D received dexmedetomidine at loading dose of 1 μg/kg over 10 min followed by 0.5 μg/kg/h infusion until RSS reached 3-4. The vital parameters (heart rate (HR), blood pressure (BP), respiration rate, SpO2), time to achieve RSS 3-4 and facial pain score (FPS) were compared during and after the procedure. In the recovery room, time to reach modified Aldrete score (MAS) 9-10 and patient and surgeon's satisfaction scores was also recorded and compared. Any complication during or after the procedure were also noted.Results:In Group D, patients had lower HR and FPS at 5, 10 and 15 min following the initiation of sedation (P<0.05). There was no statistically significant difference in BP and respiratory rate. The procedure elicited a gag response in 29 (97%) and 7 (23%) subjects in Group M and Group D respectively (P<0.05). MAS of 9-10 at 5 min during recovery was achieved in 27 (90%) subjects in Group D in contrast to 5 (17%) in Group M (P<0.05). Dexmedetomidine showed higher patient and surgeon satisfaction scores (P<0.05).Conclusion:Dexmedetomidine can be a superior alternative to midazolam for conscious sedation in ERCP.

Objectives Study was conducted to determine acceptability, efficacy, safety, return of fertility with Implanon. Methods Volunteers having regular menstruation, requiring spacing formed study population. Implanon was inserted within 5 days of LMP or concurrent with MTP. Woman was asked to record bleeding pattern, side effects. Implanon duration was 3 years but Implanon was removed before, if patient wanted pregnancy/for side effects. Subjects who did not adopt family planning method after removal were followed up for return of ovulation and pregnancy. Results 200 subjects were enrolled (160 within 5 days of LMP, 40 concurrent with MTP). 74 implanon removals were done. (16 after tenure completion, 58 for other reasons.) 16% cases discontinued implanon for polymenorrhagia, 10% for irregular bleeding, 4.5% for amenorrhea. There was no failure of implanon. 40% had return of ovulation within one month, 95.8% conceived within 12 months. Conclusions Implanon is safe, effective, well accepted method of contraception.

SummaryIncreasing numbers of patients presenting for surgery are receiving concurrent medication with low-dose aspirin. We surveyed the opinions and working practices of consultant members of the Neuroanaesthesia Society regarding patients who present for elective intracranial surgery whilst taking this form of medication. Identical questionnaires were sent to 140 members of the society and proffered four main questions: (1) the adherence to any policy of stopping aspirin preoperatively, (2) the preferred method of treatment for excessive bleeding in this context, (3) personal knowledge of haemorrhagic complications in this group of patients, (4) the neurosurgical unit concerned. There were 121 responses (86.4%) of which 116 (82.9%) were valid. Of the respondents, 78 (67.2%) were unaware of a written departmental policy for the discontinuation of pre-operative aspirin treatment and had no personal policy. Thirty-two respondents (27.6%) had a personal policy but were unaware of a written departmental policy; only six respondents (5.2%) stated that a written departmental policy was in place. The mean time suggested for discontinuation of aspirin pre-operatively was 11.3 days (range: 1-42 days). Fifty-one respondents (44.0%) considered that patients taking low-dose aspirin were at increased risk of excessive perioperative haemorrhage and 15 (12.9%) anaesthetists reported having personal experience of such problems. Fifty-seven respondents (49.1%) would use a platelet infusion, alone or in association with other blood products or prohaemostatic agents, if haemorrhagic complications developed. The majority of neuroanaesthetists felt that aspirin was a risk factor for haemorrhagic complications associated with intracranial procedures, but most adopt no policy regarding its preoperative discontinuation.Keywords Surgery; neurosurgical. Analgesics; salicylates, aspirin. ...................................................................................... Correspondence to: D. N. James, Department of Anaesthesia, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK. Accepted: 18 October 1996 Aspirin is increasingly prescribed for its antithrombotic properties [1][2][3][4][5] and more patients are therefore presenting for surgery with dysfunctional circulating platelets. Aspirin is also a common constituent of many 'over the counter ' medications [6].The contribution of low-dose aspirin to increased perioperative blood loss is a contentious issue with conflicting published results from different surgical groups. Data from neurosurgical patients are sparse [7] but aspirin has been identified as an important risk factor in the development of postoperative haematomata following intracranial surgery [8].This survey examined the opinions and working practices of consultant neuroanaesthetists with regard to patients taking low-dose aspirin medication who present for elective intracranial surgery. MethodsIdentical questionnaires with stamped addressed return envelopes were sent to practising consultant members o...

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The deficiencies of trace elements and infectious diseases often coexist and exhibit complex interactions. Several trace elements such as zinc (Zn), copper (Cu) and magnesium (Mg) have immunomodulatory functions and thus influence the susceptibility to the course and outcome of a variety of viral infections. So, this present study was aimed to study relations of trace metals in association with severity and mortality in SARS-CoV-2 patients. A total of 150 individuals infected with COVID-19 and 50 healthy individuals were recruited. Cases were divided based on severity (mild, moderate and severe) and outcome (discharged or deceased). Serum Zn, Mg and Cu levels were analysed by direct colourimetric method. Both serum Cu and Zn levels were significantly decreased in cases when compared to those in controls ( p < 0.005 and p < 0.0001). Serum magnesium levels although not significant were found to be slightly decreased in controls. On comparing the trace elements between the deceased and discharged cases, a significant difference was found between serum copper and zinc levels, but for magnesium, both groups have similar levels. The receiver operating characteristic (ROC) curve results indicate that a serum Cu/Zn ratio along with the age of patient provides some reliable information on COVID-19 course and survival odds by yielding an AUC of 95.1% with a sensitivity of 93.8% and specificity of 89.8%. Therefore, we would like to emphasize that measuring the serum copper and zinc along with their ratio can be used as routine investigations for COVID-19 patients in proper identification and management of severe cases in upcoming new waves of COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s12011-022-03124-7.