We recommend periodic monitoring of patients with increased INR, decreased fibrinogen, and decreased platelet count. Patients should be monitored for 10 to 14 days after envenomation to identify asymptomatic rebound coagulopathy. Prompt readministration of FabAV appears to correct the coagulopathy.

Introduction: Hypocarbia in neonates increases the risk of poor neurodevelopmental outcomes. Volume-targeted ventilation (VTV) is associated with decreased hypocarbia and other respiratory morbidities. We noticed a high incidence of hypocarbia in extremely low birth weight (ELBW; <1,000 g) neonates in our Neonatal Intensive Care Unit. Thus, we undertook a quality improvement project to decrease the incidence of hypocarbia (the occurrence of PCO 2 < 35 mm Hg) in ELBW neonates during the first week of life by 50% over 1 year. Methods: Our major interventions were employing VTV as the primary mode of mechanical ventilation in neonates less than 28 weeks of gestation or ELBW at birth and increasing staff knowledge regarding hypocarbia. The baseline period spanned May–August 2016. We implemented the interventions in October 2016 and tracked the use of VTV and the incidence of hypocarbia during the first week of life for 12 months. Results: We analyzed data on 28 and 77 patients in the baseline and postintervention periods, respectively. The use of VTV increased from 39% to 65%. However, the incidence of hypocarbia was not reduced (57% preintervention vs. 64% postintervention). In the postintervention cohort, the incidence of hypocarbia was comparable between VTV and other modes (60% vs. 70%; 95% confidence interval: −32%, 12%; P = 0.367), but we noted decreased blood gas sampling and earlier extubation in the VTV group ( P = 0.002 and P = 0.046, respectively). Conclusions: Successfully increasing VTV in our Neonatal Intensive Care Unit did not decrease hypocarbia during the first week of life. However, we observed the safety of VTV and obtained other desirable results.

Lateral epicondylitis is also known as a Tennis elbow is a common disease of middle age which is painful and functionally limiting entity affecting the upper extremity & causes decreased productivity. The rst line treatment for LE is topical and oral anti-inammatory drugs from ice st applications and brace used. If the 1 line treatment fails second line treatment generally invasive are offered and second-line therapeutic regimens include saline, corticosteroid or platelet-rich plasma injections. Dry needling is relatively new for treating the same. We hypothesized that dry needling would be as effective as second-line treatment for LE. Here we compared the outcomes of second-line treatment, local steroids and dry needling. MATERIALS AND METHODS: The study involved 50 patients having LE, dividing into 2 groups. Patients in group 1 received dry needling, where as those in group 2 received second-line treatment, consisting of local corticosteroid injections. The patients were evaluated after 2 and 4 weeks on the bases of Patients – rated tennis elbow evaluation score (PRTEE). RESULTS:Both treatment were equally effective at 2 and 4 weeks. The effectiveness of both are same and both intervals but someone dry needling has low complications rate in compare to local steroids. CONCLUSION: Because of the low complication rate, dry needling is a safe method, and it might be an effective treatment option for LE same as the second line treatment of local corticosteroid injections.