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Myxedema crisis is a severe life threatening form of decompensated hypothyroidism which is associated with a high mortality rate. Infections and discontinuation of thyroid supplements are the major precipitating factors while hypothermia may not play a major role in tropical countries. Low intracellular T3 leads to cardiogenic shock, respiratory depression, hypothermia and coma. Patients are identified on the basis of a low index of suspicion with a careful history and examination focused on features of hypothyroidism and precipitating factors. Arrythmias and coagulation disorders are increasingly being identified in myxedema crisis. Thyroid replacement should be initiated as early as possible with careful attention to hypotension, fluid replacement and steroid replacement in an intensive care facility. Studies have shown that replacement of thyroid hormone through ryles tube with a loading dose and maintenance therapy is as efficacious as intravenous therapy. In many countries T3 is not available and oral therapy with T4 can be used effectively without major significant difference in outcomes. Hypotension, bradycardia at presentation, need for mechanical ventilation, hypothermia unresponsive to treatment, sepsis, intake of sedative drugs, lower GCS and high APACHE II scores and Sequential Organ Failure Assessment (SOFA) scores more than 6 are significant predictors of mortality in myxedema crisis. Early intervention in hypothyroid patients developing sepsis and other precipitating factors and ensuring continued intake of thyroid supplements may prevent mortality and morbidity associated with myxedema crisis.

The microstructure of Alloy 625, which has undergone prolonged (ϳ 70,000 hours) service at temperatures close to but less than 600 ЊC, has been characterized by transmission electron microscopy. The precipitation of an intermetallic phase Ni 2 (Cr, Mo) with Pt 2 Mo-type structure has been observed in addition to that of the ␥" phase. Six variants of Ni 2 (Cr, Mo) precipitates have been found to occur in the austenite grains. These particles exhibit a snowflake-like morphology and are uniformly distributed in the matrix. They have been found to dissolve when the alloy is subjected to short heat treatments at 700 ЊC. The occurrence of the Ni 2 (Cr, Mo) phase has been discussed by taking the alloy chemistry into consideration. Apart from the intermetallic phases, the precipitation of a M 6 Ctype carbide phase within the matrix and the formation of near continuous films, comprising discrete M 6 C/M 23 C 6 carbide particles, at the austenite grain boundaries have been noticed in the alloy after prolonged service.

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South Asia is home to one of the largest population of people with metabolic syndrome (MetS). The prevalence of MetS in South Asians varies according to region, extent of urbanization, lifestyle patterns, and socioeconomic/cultural factors. Recent data show that about one-third of the urban population in large cities in India has the MetS. All classical risk factors comprising the MetS are prevalent in Asian Indians residing in India. The higher risk in this ethnic population necessitated a lowering of the cut-off values of the risk factors to identify and intervene for the MetS to prevent diabetes and cardiovascular disease. Some pharmacological and nonpharmacological interventions are underway in MetS to assess the efficacy in preventing the diabetes and cardiovascular disease in this ethnic population.