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December 2002 for diagnosis or therapy are included in this study. After thorough history and clinical examination all patients were subjected to Tc-99m Thyroid scan and T3, T4 , TSH besides other investigations as per specific requirement. Thyroid to Parotid Ratio TPR ; was calculated after drawing Regions of Interest ROI ; over the Thyroid and both parotid glands in anterior projection. The TPR values were derived by taking ratio of activity per pixel and were compared with biochemical parameters like T3, T4, and TSH and with the results of other investigations. Results : All the 252 patients having diffuse or nodular goiter with euthyroid function had a TPR value below 2.52 mean TPR + 2 SD normal volunteers ; .Out of 578 patients having Hyperthyroidism 515 had a TPR value more than 2.52 and 63 patients had TPR less than 2.52. T3 and T4 values were high in 512 patients and normal in 66 cases. In 18 patients who were clinically hypothyroid 12 had low TPR 2.52 ; whereas 6 showed TPR more than 2.52. Five of them later found to have iodine avidity and one dyshormonogenesis. In 22 patients clinically suspected to have Thyroiditis, 14 had low TPR whereas 8 revealed higher values of TPR. All these patients had also high T3 and T4 values and in follow up found to be suffering from mild hyperthyroidism. The sensitivity and specificity of TPR has been calculated to be 93.7 % and 88.57 % respectively. Conclusions : In our experience TPR is an extremely useful parameter for speedy diagnosis of thyroid dysfunction and particularly helpful for patients coming from far off places who can not pay and also wait for results of biochemical parameters which do not provide any additional information in most of the cases. Key Words: Thyroid to Parotid Ratio TPR ; , Graves' Disease, Thyroiditis 54 RS EN Hypothyroidism in Pregnancy: Management of Mother and Effects on the Foetus. L Ravi Shankar, T Sekhri, R Sharma, G Sripathy Institute of Nuclear Medicine & Allied Sciences, Brig S. K. Mazumdar Road, Delhi 110 054 Objectives: Thyroid hormones are essential for normal growth, sexual development, and, reproductive function. Numerous hormonal changes and metabolic demands occur during pregnancy, and thus pregnancy and the postpartum period are times of marked and rapid change in the thyroid gland, that need to be recognized, carefully assessed, and, correctly managed. A project was taken up on the management of hypothyroidism in the mother during pregnancy and study the effects on the foetus and cimetidine.

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A patient at 0200 and 0248. Said patient's physician had ordered Demerol 50 mg. IM q 4 h prn pain. The RESPONDENT failed to document the wastage on the Pyxis Narcotic Sign Out Sheet. The RESPONDENT failed to document the administration of the Demerol at 0200 and 0248 in the Nurse's Notes and in the Medication Administration Record for the patient. On or about 3 1 96, he signed out Demerol 100 mg. on the Pyxis Narcotic Sign Out Sheet for a patient at 1938. Said patient's physician had ordered Demerol 50 mg. IM q 4 hr. prn pain. He documented the administration of said medication in the Nurse's Notes at 1900. The RESPONDENT failed to document the administration of said Demerol in the Medication Administration Record for the patient. The RESPONDENT failed to document the wastage of said dosage on the Pyxis Narcotic Sign Out Sheet. The RESPONDENT signed out 2 vials of Demerol for a patient, administered one vial and left the other vial by the patient's bedside as evidenced by his admission. The RESPONDENT oftentimes failed to document what medications he administered to his patients until the completion of the endof-shift narcotic count as evidenced by his own admission. ENGAGED IN CONDUCT LIKELY TO DECEIVE, DEFRAUD OR HARM THE PUBLIC On or about 2 7 96, the RESPONDENT submitted to a drug screen after being requested to do so result of strange behavior during his 7: 00 p.m. to 7: 00 a.m. shift. Said drug screen, which was collected at 7: 35 a.m. on 2 7 96, tested positive for Meperdine. FALSIFIED RECORDS On or about 7 3 96, the RESPONDENT falsified his Employment Health History by marking "No" to question that asked if he had ever been told that he had diabetes as evidenced by his own admission and eldepryl. 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Green, J. 2006 ; . Annotation: the therapeutic alliance - a significant but neglected variable in child mental health treatment studies. Journal of Child Psychology and Psychiatry and Allied Disciplines; 47 5 p. 425-435. Available online via EBSCOhost and nordette.

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