Diuretics are often the cornerstone of treatment for volume overload in the emergency setting. The pharmacokinetic and pharmacodynamic properties of diuretics differ in various clinical scenarios. The choice of a diuretic, its maximum dosage, and spacing of doses are important clinical issues which every medical practitioner needs to be aware of. In this review, we discuss the pharmacokinetic and pharmacodynamic properties of diuretics, their therapeutic implications, and best strategies for use in various clinical conditions.

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Thyroid function tests are one of the most common endocrine panels in general practice because a good understanding of when to order them, interpretation of their results and indications for treatment are important for the optimal treatment of thyroid dysfunction. Thyroid-stimulating hormone (TSH) should be the first test to be performed on any patient with suspected thyroid dysfunction and in follow-up of individuals on treatment. It is useful as a first-line test because even small changes in thyroid function are sufficient to cause a significant increase in TSH secretion. Thyroxine levels may be assessed in a patient with hyperthyroidism, to determine the severity of hyperthyroxinemia. Antithyroid peroxidase measurements should be considered while evaluating patients with subclinical hypothyroidism and can facilitate the identification of autoimmune thyroiditis during the evaluation of nodular thyroid disease. The measurement of TSH receptor antibody must be considered when confirmation of Graves' disease is needed and radioactive iodine uptake cannot be done.

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Background: Polytrauma is a major cause of morbidity and mortality in developed and developing countries. This study aims to assess the prevalence and outcome of polytrauma patients, in a tertiary care hospital. Materials and Methods: This retrospective observational study was conducted in a large emergency department (ED) between January 2016 and December 2016. All patients >15 years presenting to the ED with polytrauma were included in the analysis. Results: Among 98 polytrauma patients, majority (86%) were male. The mean (standard deviation) age was 41.6 (±14.85) years. Less than one-third of the patients presented to the ED within 3 h of the time of injury. A quarter of the patients have severe traumatic brain injury. Plasma alcohol levels were sent in 22 patients and were found to be elevated in 12 (15%) patients. Majority (78%) of the patients required orthopedic evaluation and intervention. Forty-four patients required 1 unit packed cell blood, whereas 11 patients received two units packed cell blood and 4 patients needed three units packed cell for resuscitation in the ED. Focused assessment with sonography for trauma was done in 66 (85%) patients and was positive in 32 (41%) patients. The ED outcome is shown in [Figure 1]. The ED mortality rate was 15%. Conclusion: Less than one-third of the patients presented to the ED within 3 h of the time of injury which stresses the need to improve prehospital care and transport in our country. Aggressive resuscitation with crystalloids and blood products is of paramount importance in treating polytrauma victims.

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Subclinical hypothyroidism (SCH) is defined as an elevated serum thyroid-stimulating hormone level with a normal total and free thyroxine (T₄) level. There is a certain degree of debate regarding the risks associated with this condition and whether treatment is beneficial. Individuals with SCH are either asymptomatic or present with milder symptoms than those with overt hypothyroidism. Although SCH does not cause significant clinical abnormalities, there are certain long-term consequences which have been documented. The diagnosis is based purely on biochemical investigations. Treatment of this condition is not indicated in all cases since thyroid function tests tend to normalize in 6%–35% of patients. However, there are specific clinical indications for treatment and oral levothyroxine is the treatment of choice in such situations.

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Objectives: In this pilot study we aimed to study the various outcomes related to treatment, morbidity and mortality in patients presenting with acute decompensated heart failure (ADHF). Materials and Methods: In this retrospective, pilot study all patients discharged with the diagnosis of acute decompensated heart failure [ADHF] were included over a span of 6 month of the year 2016. We analysed the details of requirements of oxygen, ventilation, requirements of infusion of diuretics, inotropic agents, duration of stay, cost of treatment and outcomes for these patients. Results: Twenty eight consecutive patients with ADHF were enrolled. Mean age of the patients were 53 years and 64% of these were females. The mean ejection fraction of these patients was 39.4. Most common aetiology of heart failure was ischemia [40%]. In 93% of patients the trigger for acute worsening was identified. Respiratory tract infection was the commonest precipitator {39%]. Only 36% of patients received supplemental oxygen and almost every one received diuretics. The mean duration of hospital stay was 8 days, and the in hospital mortality was 14%. Conclusions: In conclusion this pilot study looked at the outcome details in patients admitted with acute decompensated heart failure. Our patients with ADHF were younger and ha higher prevalence of Ischaemic cardiomyopathy. Most had an identified precipitator, and the most common trigger of heart failure was respiratory infections.

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Thyroid nodule is an abnormal growth of thyroid cells that form a lump in the thyroid gland. The prevalence rate is dependent on the mode of diagnosis and increases with use of ultrasound. A thyroid nodule may be either single or multiple and the majority are asymptomatic and benign in nature. The clinical features of thyrotoxicosis are seen in those with a toxic thyroid nodule. Thyroid ultrasound is the imaging of choice for assessing the location, numbers, and size of the thyroid nodules and also the background of thyroid parenchyma. Ultrasound elastography, fine needle aspiration biopsy and molecular tests further aid in diagnosis and planning of treatment. Surgical excision is the therapeutic intervention of choice.

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There are significant changes that occur in the thyroid gland and its function during pregnancy, thus making the assessment of thyroid functions in pregnancy substantially important. Normal pregnancy is associated with an increase in renal iodine excretion, an increase in T4 binding proteins, an increase in thyroid hormone production, and thyroid stimulatory effects of human chorionic gonadotropin (hCG), and the treatment targets are different from women who are not pregnant. Both hypothyroidism and hyperthyroidism are associated with significant impact on the fetomaternal unit and pregnancy outcomes. Evidence appears to support an association between overt thyroid dysfunction and an increased risk of infertility, and there is strong evidence to recommend treatment for overt hypothyroidism in pregnancy. The recommended treatment of maternal hypothyroidism is the administration of oral LT4.

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