Background Interpretation of thyroid function tests during pregnancy needs trimester-related reference intervals from pregnant populations with minimal risk for thyroid dysfunction. While India has become iodine sufficient after two decades of salt iodisation, there is no normative data for thyroid function from healthy pregnant women of this country.Aims and objectives To determine trimester-specific reference ranges for free triiodothyronine (FT 3 ), free thyroxine (FT 4 ) and thyrotropin (TSH) from healthy pregnant Indian women.Design Cross-sectional study in a reference population of pregnant women.Setting Primary care level obstetric department in India.Population Women with uncomplicated pregnancy in any trimester.Methods Five hundred and forty-one apparently healthy pregnant women with uncomplicated single intrauterine gestations reporting to the Armed Forces Clinic in any trimester were consecutively recruited. Clinical examination, thyroid ultrasound for echogenicity and nodularity and estimation of FT 3 , FT 4 , TSH and antithyroid antibodies (antithyroperoxidase [anti-TPO] and antithyroglobulin [anti-Tg]) using electrochemiluminescence technique were carried out. From this entire sample, a disease-and risk-free reference population was obtained by excluding those with any known factor that could affect thyroid function or those who were being treated for thyroid dysfunction.Main outcome measure None.Results Of the 541 consecutive pregnant women in different trimesters enrolled for the study, 210 women were excluded. The composition of reference population comprising 331 women was 107 in first trimester, 137 in second trimester and 87 in third trimester. The 5th and 95th percentiles values were used to determine the reference ranges for FT 3 , FT 4 and TSH. The trimester-wise values in the first, second and third trimesters were: FT 3 (1.92-5.86, 3.2-5.73 and 3.3-5.18 pM/l), FT 4 (12-19.45, 9.48-19.58 and 11.32-17.7 pM/l) and TSH (0.6-5.0, 0.44-5.78 and 0.74-5.7 iu/ml), respectively. Analysis of mean, median values for FT 3 , FT 4 and TSH between each trimester showed no significant difference in FT 3 and TSH values (95% CI). However, FT 4 showed significant variation between trimesters with values decreasing with advancing gestational age (P value: first versus second = 0.015, first versus third = 0.003 and second versus third = not significant). Women with antibody positivity and hypoechogenicity of thyroid gland had significantly higher TSH values when compared with women with antibody negativity and normoechogenicity.Conclusions Reference ranges of FT 3 , FT 4 and TSH have been established for pregnant Indian women using 5th and 95th percentiles.

Thrombocytopenia is a common finding in septic shock patients in the intensive care unit (ICU). Various mechanisms have been attributed to explain the occurrence of thrombocytopenia, including disseminated intravascular coagulation (DIC) 1-3 , cytokine-driven haemophagocytosis of platelets 4,5 , immune-mechanisms, such as elevated plateletassociated IgG 1,6 , invasive catheters, especially pulmonary artery catheters 7,8 , and medications, such as heparin and pencillin analogues. Thrombocytopenia in critically ill patients, including trauma patients and surgical patients, has been found to be an independent marker for poor prognosis, increased bleeding, longer ICU stay and increased mortality 7-11. Most studies so far have explored the risk factors and clinical outcomes in critically ill medical, surgical, trauma or cardiac patients with thrombocytopenia. In this study, we looked at thrombocytopenic septic shock patients in a medical ICU. The objectives of the study were to study, 1) incidence of various degrees of severity of thrombocytopenia in septic shock, 2) risk factors for its development and 3) the correlation of thrombocytopenia with organ dysfunction, length of ICU stay and clinical outcome including mortality.

The present cross-sectional study was conducted to determine the vitamin D status of pregnant Indian women and their breast-fed infants. Subjects were recruited from the Department of Obstetrics, Armed Forces Clinic and Army Hospital (Research and Referral), Delhi. A total of 541 apparently healthy women with uncomplicated, single, intra-uterine gestation reporting in any trimester were consecutively recruited. Of these 541 women, 299 (first trimester, ninety-seven; second trimester, 125; third trimester, seventy-seven) were recruited in summer (April -October) and 242 (first trimester, fifty-nine, second trimester, ninety-three; third trimester, ninety) were recruited in winter (November -March) to study seasonal variations in vitamin D status. Clinical, dietary, biochemical and hormonal evaluations for the Ca -vitamin D-parathormone axis were performed. A subset of 342 mother -infant pairs was re-evaluated 6 weeks postpartum. Mean serum 25-hydroxyvitamin D (25(OH)D) of pregnant women was 23·2 (SD 12·2) nmol/l. Hypovitaminosis D (25(OH)D ,50 nmol/l) was observed in 96·3 % of the subjects. Serum 25(OH)D levels were significantly lower in winter in the second and third trimesters, while serum intact parathormone (iPTH) and alkaline phosphatase levels were significantly higher in winter in all three trimesters. A significant negative correlation was found between serum 25(OH)D and iPTH in mothers (r 20·367, P¼0·0001) and infants (r 2 0·56, P¼ 0·0001). A strong positive correlation was observed between 25(OH)D levels of mother -infant pairs (r 0·779, P¼ 0·0001). A high prevalence of hypovitaminosis D was observed in pregnancy, lactation and infancy with no significant inter-trimester differences in serum 25(OH)D levels.

Two types of generalizations of Chaundy and McLeod's functional equation have beenproposed in the paper. One generalization includes parameters and leads to a new measure of entropy, which includes Daroczy's entropy of type 3 as a particular case. Such a generalization for functions of two variables leads to new quantities whose particular cases are Kullback's information and Kerridge's inaccuracy.The second generalization is obtained by adding a symmetric term multiplied by a constant and gives alternative characterizations of quantities studied earlier.