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[...]after hypodermic injection of adrenaline, the pant relieved and the PaCO2 decreased (PaCO2 66 mmHg) gradually. [...]persistent bronchial spasm is the fatal attack in acute status asthmaticus, spasmolysis is the most important therapeutics for improving gas exchange.

Throughout American history, the fundamental purpose of marriage has shifted from (a) helping spouses meet their basic economic and political needs to (b) helping them meet their intimacy and passion needs to (c) helping them meet their autonomy and personal-growth needs. According to the suffocation model of marriage in America, these changes have had two major consequences for marital quality, one negative and one positive. The negative consequence is that, as Americans have increasingly looked to their marriage to help them meet idiosyncratic, self-expressive needs, the proportion of marriages that fall short of their expectations has grown, which has increased rates of marital dissatisfaction. The positive consequence is that those marriages that succeed in meeting these needs are particularly fulfilling, more so than the best marriages in earlier eras. In tandem, these two consequences have pushed marriage toward an all-or-nothing state.

INTRODUCTION:The association of bilirubin with cardiovascular disease (CVD) is controversial. We sought to explore the association of total bilirubin levels with QT interval in a multiracial cohort.METHODS:A total of 6,627 participants (59.0 ± 13.3 years; 52.6%% women, 49.7% Non-Hispanic Whites) without cardiovascular disease (CVD) from the Third National Health and Nutrition Examination Survey (NHANES-III) were included in this analysis. QT was automatically measured from digital 12-lead electrocardiogram in a central reading center. A multivariable logistic regression model was used to examine cross-sectional association between tertiles of total bilirubin and prolonged QT interval (≥450 ms in men, ≥460 ms in women).RESULTS:The prevalence of prolonged QT was higher among those with higher levels of total bilirubin (prolonged QT prevalence was 4.7%, 6.8%, and 7.0% across total bilirubin lower (0-0.4 mg/dl), middle (0.5-1.6 mg/dl) and higher (0.70-4.30 mg/dl) tertiles respectively). In a model adjusted for potential confounders, participants within the highest total bilirubin tertile had significantly greater odds of prolonged QT interval (OR (95% CI): 1.53 (1.16-2.02) compared to those with bilirubin levels in the first tertile. Each 0.29 mg/dl increase in total bilirubin levels was associated with a 12% (P-value < .0001) increase in the prevalence of prolonged QT interval (Table 1). This association was stronger in men than women (interaction P-value = 0.04).CONCLUSION::Recent evidence suggests worse cardiovascular (CV) outcomes with high levels of bilirubin but the mechanism behind worse CV events remains to be elucidated. Our study showed that elevated bilirubin levels are associated with prolonged QT interval. QT interval has been consistently associated with increased risk of all-cause and CV death. Thus, finding an association between total bilirubin levels and prolonged QT interval in our study extends our current knowledge on the relationship between serum bilirubin and CVD by demonstrating a link between higher total bilirubin and abnormal cardiac repolarization. To the best of our knowledge, this is the first study to demonstrate the association between bilirubin and prolonged QT. This association was stronger in men than women. Future studies are needed to establish the causal relationship between bilirubin and QT prolongation and how this association between bilirubin and QT interval could be harnessed to improve CVD risk estimation.

Aim: To determine the demographic characteristics of cases followed up with a diagnosis of perinatal asphyxia and to examine the risk factors in these cases. Material and Method: This retrospective study included 81 cases diagnosed with perinatal asphyxia and applied with hypothermia therapy in the neonatal intensive care unit of a tertiary level hospital between June 2018 and January 2020. The demographic characteristics of the cases and data related to perinatal risk factors were collected from the patient files and were analyzed using SPSS software. Results: When the pregnancy follow-up of the mothers was examined, 43.2% had attended antenatal examinations and 56.8% had not had regular follow-up. Delivery was by caesarean section in 24 (29.6%) cases and the normal spontaneous vaginal route in 57 (70.4%) cases. Risk factors determined before the birth were fetal bradycardia in 10 (10.1%) cases, pre-eclampsia in 5 (5.1%) cases, and gestational diabetes mellitus in 7 (7.1%) cases. Birth complications were recorded as prolonged difficult labour in 42 (42.4%) cases, cord prolapse in 7 (7.1%), abruptio placentae in 6 (6.1%) and amniotic fluid with meconium in 7 (7.1%) cases. No risk factors for perinatal asphyxia were determined in 4 (4.0%) cases. Conclusion: Perinatal asphyxia was observed at a higher rate in male gender infants and perinatal asphyxia was determined to develop more often in the infants of mothers who had not had antenatal follow-up. Of the known risk factors in the antenatal period and during the birth, difficult labour was observed at the highest rate.

Necrotizing enterocolitis (NEC) is a gastrointestinal emergency causing inflammation and necrosis of the intestine, most commonly in premature formula-fed infants. There exists limited conflicting data on the pathophysiology behind NEC development and the underlying intestinal bacteria behind the disease. We report a case of a two-week-old female patient who was born full term. During her birth hospitalization, she was transferred to the neonatal intensive care unit for late-onset tachypnea and apnea, where she received ampicillin and gentamicin intravenously through a peripheral line for a total of 36 hours. The newborn presented to the emergency department (ED) with bloody stool at two weeks of life. Her abdominal X-ray showed possible intramural air with concern for pneumatosis, and the patient was admitted to the pediatric ward with suspected NEC. Stool investigations were positive for occult blood, lactoferrin, and ( ) DNA amplification but negative for toxins. The patient was started on intravenous vancomycin, cefepime, and metronidazole as empirical antibiotic coverage. Oral feeds were held for bowel rest. Over the course of the next six days, repeat X-rays were taken daily, and the patient's symptoms resolved with complete resolution of the X-ray's abnormalities. The patient was gradually restarted on oral feeds, which were well tolerated by the time of hospital discharge. Our case demonstrates a unique presentation of late-onset NEC in a term infant. This patient case reflects modified Bell criteria stage IIA, including bloody stool with intestinal dilation, ileus, and pneumatosis intestinalis. The concomitant positive test for in this case could be a causative relationship or just incidental, as it could also be bacterial colonization; therefore, further study is recommended to further investigate the relationship between NEC and infection (formerly called ), especially in full-term infants.