Apnea, bradycardia and desaturation spells in premature infants: impact of a protocol for the duration of 'spell-free' observation on interprovider variability and readmission rates.

ObjectiveTo study the impact of implementing a protocol to standardize the duration of observation in preterm infants with apnea/bradycardia/desaturation spells before hospital discharge on length of stay (LOS) and readmission rates.Study designA protocol to standardize the duration of in-hospital observation for preterm infants with apnea, bradycardia and desaturation spells who were otherwise ready for discharge was implemented in December 2013. We evaluated the impact of this protocol on the LOS and readmission rates of very low birth weight infants (VLBW). Data on readmission for apnea and an apparent life-threatening event (ALTE) within 30 days of discharge were collected. The pre-implementation epoch (2011 to 2013) was compared to the post-implementation period (2014 to 2016).ResultsThere were 426 and 368 VLBW discharges before and after initiation of the protocol during 2011 to 2013 and 2014 to 2016, respectively. The LOS did not change with protocol implementation (66±42 vs 64±42 days before and after implementation of the protocol, respectively). Interprovider variability on the duration of observation for apneic spells (F-8.8, P=0.04) and bradycardia spells (F-17.4, P<0.001) decreased after implementation of the protocol. The readmission rate for apnea/ALTE after the protocol decreased from 12.1 to 3.4% (P=0.01).ConclusionImplementing an institutional protocol for VLBW infants to determine the duration of apnea/bradycardia/ desaturation spell-free observation period as recommended by the American Academy of Pediatrics clinical report did not prolong the LOS but effectively reduced interprovider variability and readmission rates

Myxoedemic coma: an uncommon presentation of Sheehan syndrome

This is a rare case of a 35 year old multiparous female who presented with electrolyte abnormality, hyponatremia in a setting of seizure and moderate pallor. She had a significant past history of childbirth complicated with post-partum haemorrhage after which she developed secondary amenorrhoea and lactation failure. Workup showed suppressed levels of all pituitary hormones and was treated as myxoedemic coma. A diagnosis of Sheehan’s syndrome presenting as myxoedemic coma - a rare but emergency presentation was made

Effect of Plasma Irradiation on CdI2Cd I_2 films

The effect of plasma irradiation is studied systematically on a 4H polytype (002) oriented ${\rm CdI_2}$ stoichiometric film having compressive residual stress. Plasma irradiation was found to change the orientation to (110) of the film at certain moderate irradiation distances. A linear decrease in grain size and residual stress was observed with decreasing irradiation distance (or increasing ion energy) consistent with both structural and morphological observations. The direct optical energy gap ${\rm E_g}$ was found to increase linearly at the rate ${\rm 15\mu eV/atm}$ with the compressive stress. The combined data of present compressive stress and from earlier reported tensile stress show a consistent trend of ${\rm E_g}$ change with stress. The iodine-iodine distance in the unit cell could be responsible for the observed change in ${\rm E_g}$ with stress.Comment: 13 pages and 10 fi

On the Structure of ZnI2{\rm ZnI_2}

A new structure for ${\rm ZnI_2}$ is proposed which it exists in tetragonal state. In this structure the ${\rm ZnI_2}$ molecule exists in a nonlinear array and forms the basis of the tetragonal unit cell with one basis per unit cell. The structural analysis based on the reflections listed in ASTM 30-1479 shows that the proposed structure is correct.Comment: six pages and four figures. Manuscript prepared in RevTe

Acute intermittent porphyria with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and neurological crisis, successfully treated with haemodialysis

We report a 35 years old male, a case of Acute Intermittent Porphyria (AIP) with Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) and neurological crisis for its rarity. Since specific parenteral medication (hemin) was not available, patient was empirically treated with haemodialysis with satisfactory outcome