Effects of lithium carbonate on the microanatomy of thyroid gland of albino rats

Background: Lithium is routinely used to treat mania and other psychiatric disorders. It prevents the mood swing changes in bipolar disorders and the treatment is usually prolonged. Aim of current study was to observe histological changes in the thyroid gland of lithium carbonate treated albino rats.Methods: Sixty albino rats were taken and divided into two groups, group A (control group) of 15 animals, were fed with normal diet and group B of 45 animals, were fed normal diet along with lithium carbonate at the dose of 30mg/kg body weight daily. The animals were sacrificed at four, eight and twelve week’s interval, 5µm sections prepared and stained with haematoxylin and eosin stain.Results: Microscopic changes in thyroid gland of albino rats were evident after 8 weeks of drug administration which include marked pleomorphism, shrinkage in size of thyroid follicles, excess of colloid and marked vacuolations in acini. At 12th week of study, follicles were found both macro and micro follicular, with variable lining epithelium and hyperchromatic nuclei. Lining epithelium of some follicles was disrupted. The stroma was infiltrated with lymphocytes and eosinophils and there were some interfollicular hemorrhages. Conclusions: Lithium given over prolonged period will cause macro and micro follicular goiter with hyperplastic epithelium and hyper chromatic nuclei, hyperplasia of stroma with increased vascularity, sometimes hemorrhages and finally may lead to thyroiditis like picture. So, it is advised that patients on lithium therapy should be periodically evaluated for thyroid dysfunction.

An Enhanced Energy Balanced Data Transmission Protocol for Underwater Acoustic Sensor Networks.

This paper presents two new energy balanced routing protocols for Underwater Acoustic Sensor Networks (UASNs); Efficient and Balanced Energy consumption Technique (EBET) and Enhanced EBET (EEBET). The first proposed protocol avoids direct transmission over long distance to save sufficient amount of energy consumed in the routing process. The second protocol overcomes the deficiencies in both Balanced Transmission Mechanism (BTM) and EBET techniques. EBET selects relay node on the basis of optimal distance threshold which leads to network lifetime prolongation. The initial energy of each sensor node is divided into energy levels for balanced energy consumption. Selection of high energy level node within transmission range avoids long distance direct data transmission. The EEBET incorporates depth threshold to minimize the number of hops between source node and sink while eradicating backward data transmissions. The EBET technique balances energy consumption within successive ring sectors, while, EEBET balances energy consumption of the entire network. In EEBET, optimum number of energy levels are also calculated to further enhance the network lifetime. Effectiveness of the proposed schemes is validated through simulations where these are compared with two existing routing protocols in terms of network lifetime, transmission loss, and throughput. The simulations are conducted under different network radii and varied number of nodes

Fiscal Decentralization and Macroeconomic Performance in Pakistan

The study plans to analyze the part of fiscal decentralization and macroeconomic execution of Pakistan. The major goal of study was to investigate the effect of fiscal decentralization on macroeconomic performance and fiscal resource distribution system of Pakistan. The study employed secondary data comprising from 1972 to 2014 for examination. The distribution of resources among federal and provincial governments never remained simple and always recognized much complicated problem. This study categorized a number of problems in the system of fiscal division of resources of Pakistan. To examine the effect of fiscal decentralization on macroeconomic performance in Pakistan, the study evaluated a brief history of distribution of resources among the provinces. The commission reviewed the NFC awards since 1991 to improve the procedure of resource allotment among the provinces in Pakistan. Direct transfers of finances and grants have been increased for all the provinces due to these awards. The effectiveness, self-sufficiency and resource generation of Provinces get inducement to improve because of identical grants and in turn attain financial autonomy. The economic divergence of provinces can be removed through appropriate transfer of resources. The experimental results demonstrate that the fiscal decentralization prove to a valuable device to improve the economic stability, encourage the better allocation of resources and promote the economic development in Pakistan

Zooplankton community of two typical wetlands of Kashmir Himalaya.

The distribution pattern of organisms in an aquatic ecosystems varies from minute plankton to the huge predators which is governed by the behavior and adaptability with regard to particular system in which they survive (McManus and Woodson, 2012). Generally the term plankton comprises of phytoplankton and zooplankton. Zooplankton has been derived from two Greek words “zoon” means animal and “planktos” meaning wandering. These are group of animals remaining suspended, wandering with water currents and possessing little degree of locomotion. They are microscopic animals, ranging from unicelled to multicelled; size varies from a few microns to a millimeter or even more. Besides size variations, there are differences regarding their morphological characteristic and taxonomic status as well. In aquatic ecosystems zooplankton plays a vital role in studying the faunal biodiversity. They feed on micro-algae, thereby converting the autotrophic material into animal tissue which in turn comprises the fundamental food for higher trophic levels including fishes, particularly their larvae (Pandit, 1999). Zooplankton is an important component of freshwater ecosystems (Gannon and Stemberger, 1978; Sladecek, 1983; Huys and Boxshall, 1991; Devi and Ramanibai, 2012). They regulate algal and microbial production by grazing and help in transport of energy to higher trophic levels (Pandit, 1980, 99; Dejen et al., 2004). Zooplankton are extremely receptive to changing environmental conditions, as most species have short generation time, resulting in changing their abundance, species diversity or community composition (Sharma et al., 2008).Therefore, zooplankton are considered as indicators of water quality (Pinto-Coelho et al., 2005; Rajashekhar et al., 2009; Joshi, 2011). Further, these plankters improve water quality by grazing on micro-algae and even some bacteria (Kumar et al., 2009). Freshwater zooplankton is comprised of two major groups of invertebrate animals: Rotifera and Crustacea.Digital copy of Thesis.University of Kashmri

Molecular detection of Brucella melitensis in sheep from district Budgam, Jammu and Kashmir

Farmers reported abortions and stillbirths in 600 sheep including 471 pregnant ewes. A complete investigation including physical examination of livestock, postmortem examination of stillbirths, serological examination of ewes and molecular study of abomasal contents, peritoneal fluid, liver and kidney tissue collected from still born lambs was done to ascertain the cause of mortality at Disease Investigation Laboratory, Nowshera, Srinagar. Also, on spot heat fixed tissue smears were prepared for Gram’s staining and accordingly observed for presence of organism. Extraction of bacterial genomic DNA from samples from still born lambs was performed and obtained DNA extracts were checked by agarose gel electrophoresis and stored at -20°C till further use. The PCR conducted on the abomasal, peritoneal contents and liver and kidney tissues revealed 731 bp band after the gel electrophoresis, confirming Brucella melitensis as cause of stillbirths in the flock. The investigation revealed that Brucella melitensis was cause of stillbirths and abortions in sheep flocks

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial

Background Tranexamic acid reduces surgical bleeding and decreases mortality in patients with traumatic extracranial bleeding. Intracranial bleeding is common after traumatic brain injury (TBI) and can cause brain herniation and death. We aimed to assess the effects of tranexamic acid in patients with TBI. Methods This randomised, placebo-controlled trial was done in 175 hospitals in 29 countries. Adults with TBI who were within 3 h of injury, had a Glasgow Coma Scale (GCS) score of 12 or lower or any intracranial bleeding on CT scan, and no major extracranial bleeding were eligible. The time window for eligibility was originally 8 h but in 2016 the protocol was changed to limit recruitment to patients within 3 h of injury. This change was made blind to the trial data, in response to external evidence suggesting that delayed treatment is unlikely to be effective. We randomly assigned (1:1) patients to receive tranexamic acid (loading dose 1 g over 10 min then infusion of 1 g over 8 h) or matching placebo. Patients were assigned by selecting a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was head injury-related death in hospital within 28 days of injury in patients treated within 3 h of injury. We prespecified a sensitivity analysis that excluded patients with a GCS score of 3 and those with bilateral unreactive pupils at baseline. All analyses were done by intention to treat. This trial was registered with ISRCTN (ISRCTN15088122), ClinicalTrials.gov (NCT01402882), EudraCT (2011-003669-14), and the Pan African Clinical Trial Registry (PACTR20121000441277). Results Between July 20, 2012, and Jan 31, 2019, we randomly allocated 12 737 patients with TBI to receive tranexamic acid (6406 [50·3%] or placebo [6331 [49·7%], of whom 9202 (72·2%) patients were treated within 3 h of injury. Among patients treated within 3 h of injury, the risk of head injury-related death was 18·5% in the tranexamic acid group versus 19·8% in the placebo group (855 vs 892 events; risk ratio [RR] 0·94 [95% CI 0·86-1·02]). In the prespecified sensitivity analysis that excluded patients with a GCS score of 3 or bilateral unreactive pupils at baseline, the risk of head injury-related death was 12·5% in the tranexamic acid group versus 14·0% in the placebo group (485 vs 525 events; RR 0·89 [95% CI 0·80-1·00]). The risk of head injury-related death reduced with tranexamic acid in patients with mild-to-moderate head injury (RR 0·78 [95% CI 0·64-0·95]) but not in patients with severe head injury (0·99 [95% CI 0·91-1·07]; p value for heterogeneity 0·030). Early treatment was more effective than was later treatment in patients with mild and moderate head injury (p=0·005) but time to treatment had no obvious effect in patients with severe head injury (p=0·73). The risk of vascular occlusive events was similar in the tranexamic acid and placebo groups (RR 0·98 (0·74-1·28). The risk of seizures was also similar between groups (1·09 [95% CI 0·90-1·33]). Interpretation Our results show that tranexamic acid is safe in patients with TBI and that treatment within 3 h of injury reduces head injury-related death. Patients should be treated as soon as possible after injury. Funding National Institute for Health Research Health Technology Assessment, JP Moulton Charitable Trust, Department of Health and Social Care, Department for International Development, Global Challenges Research Fund, Medical Research Council, and Wellcome Trust (Joint Global Health Trials scheme)

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes