Prevalence of Fever in Patients Undergoing Left Atrial Ablation of Atrial Fibrillation Guided by Barium Esophagraphy

Background: Real-time esophageal imaging is critical in avoiding esophageal injury. However, the safety of esophageal imaging with barium has not been specifically explored.
Methods: Three hundred seventy consecutive patients underwent left atrial (LA) ablation of atrial fibrillation (AF) under conscious sedation. One hundred eighty-five patients (50%) underwent the ablation procedure with, and 185 patients (50%) underwent the procedure without administration of barium. Fever, as a surrogate for aspiration, was defined as a maximal temperature ≥100°F within the first 24 hours following the ablation procedure.
Results: Thirty of the 370 patients (8%) developed fever within 24 hours after LA ablation. The prevalence of fever was 9% (17/185) among patients who received barium and 7% (13/185) among those who did not receive barium (P = 0.6). Evaluation revealed the following causes of fever in 14 of the 30 patients (47%) with no difference in prevalence between the 2 groups: pericarditis, venous thromboembolism, hematoma, and infiltrate on chest radiography. Multivariate analysis failed to reveal any factors associated with development of fever. None of the patients experienced serious complications such as respiratory failure or atrioesophageal fistula.
Conclusions: Fever may occur in approximately 10% of patients undergoing LA ablation of AF. Administration of barium is not associated with fever or other complications such as aspiration pneumonia. Real-time imaging of the esophagus with barium administration in conjunction with conscious sedation appears to be safe.     

Variations in antenatal corticosteroid therapy: a persistent problem despite 30 years of evidence

OBJECTIVE:To document current use of antenatal corticosteroid therapy in a large cohort of Canadian preterm infants admitted to neonatal intensive care units, and to assess the impact of variations in use on neonatal outcomes. METHODS: The study subjects included 11,440 infants less than 38 weeks' gestation who were admitted to 17 Canadian Neonatal Network intensive care units from January 1996 to October 1997. Data analyses were conducted separately for infants less than 24 weeks' gestation, 24-34 weeks' gestation, and over 34 weeks' gestation. Logistic regression analysis was used to model the examined relationships, controlling for patient characteristics. RESULTS: The incidence of antenatal corticosteroid treatment was 42% for infants less than 24 weeks' gestation, 59% for infants 24-34 weeks' gestation, and 10% for infants over 34 weeks' gestation. Antenatal corticosteroid treatment was associated with reduced risk for neonatal mortality and respiratory distress syndrome, but not for infants over 34 weeks' gestation. Significant institutional variations in antenatal corticosteroid use were present among both inborn and outborn infants. Increased antenatal corticosteroid treatment for infants 24-34 weeks' gestation can potentially reduce the number of neonatal deaths by 41 cases (10%) and respiratory distress syndrome by 90 cases (3%) among participating hospitals. CONCLUSION: Wide institutional differences persist in the incidence of antenatal corticosteroid treatment for women expected to give birth preterm. Increased use of antenatal corticosteroids for preterm deliveries can reduce neonatal mortality in Canada by up to 10%.     

Non epileptic motor phenomena in the newborn

<正>新生儿易出现各种非癎样运动如颤动、惊跳和良性新生儿睡眠性肌阵挛。而其他的异常运动如新生儿惊跳病就较为少见。然而这些运动的大多数预后良好,不会影响新生儿远期的神经发育。但临床医生对新生儿出现的一些惊跳现象仍需高度警惕,     

加拿大新生儿重症监护室院内感染及其变化趋势对胎龄<33周早产儿预后的影响

败血症是新生儿重症监护室(NICU)的危重病症及造成新生儿死亡的重要原因之一,根据其发病时间,可分为早发(生后2 d 内)和晚发(生后2 d 后)。其中晚发的新生儿败血症,一般考虑为院内感染(NI)。胎龄越小,出生体重越低,NI 的发生率越高。NI 的发生率在加拿大各 NICU 之间差别较大,与各中心医护人员的相关诊疗行为密切相关。在国家卫生研究院"基于循证医学的医疗质量改进项目" 的推动下,2003~2009 年间加拿大全国 NICU 总的NI 率明显下降,但不同中心各自感染率的变化趋势仍极为不同。本研究纳入了加拿大全国共24 家 NICU 在2008~2012 年间所有收入院的胎龄<33 周的早产儿共18 961 名,探讨NI 率的变化趋势以及其与早产儿预后的关系。     

Nonepileptic motor phenomena in the neonate

The newborn infant is prone to clinical motor phenomena that are not epileptic in nature. These include tremors, jitteriness, various forms of myoclonus and brainstem release phenomena. They are frequently misdiagnosed as seizures, resulting in unnecessary investigations and treatment with anticonvulsants, which have potentially harmful side effects. Unfortunately, there is a paucity of literature about many of these phenomena in the newborn, and some of the major textbooks refer to these events as nonepileptic seizures, leading to further confusion for the practitioner. The present paper aims to review these phenomena with special emphasis on differentiating them from epileptic seizures, and offers information on treatment and prognosis wherever possible.     

Malayalam cinema and mental health

There is a tradition of using films to teach various aspects of psychiatry and we feel that Malayalam cinema can also be used suitably to teach effectively. These films can be an invaluable resource in cultural competency training as they depict the effects of culture on psychopathology and cultural and regional influences on attitudes to mental illness and stigma. We also note that the portrayal is often far from reality but this is not a barrier for using the films as an effective alternative to traditional and didactic teaching methods. This method of teaching can stimulate interest and discussion and demystify the myths of novice students and others about mental health.     

Cue-based feeding for preterm infants: a prospective trial

We set out to test whether premature infants were able to be fed orally on feeding cues and be discharged home earlier than infants fed by traditional feeding regimens. Attainment of adequate growth, adverse events, and nursing time to provide care were also assessed. After screening, the recruited premature infants (< 36 wks post-conceptual age [PCA]) were divided into two feeding regimens. A control group of 40 infants was fed using an initial combination of scheduled gavage and bottle feeding and then graduating to demand feeds. The intervention group comprised 39 neonates who had gavage feeds discontinued at study entrance and fed orally on cues. Outcomes measured were: weight gain in grams/kg/day, length of stay (in days) after enrollment, PCA on entrance and at discharge, adverse events during feeding, number of cues per feed in the intervention group, and resource utilization using nurse/patient ratios. Differences between groups were evaluated using Mann-Whitney U test, Fisher's exact test, and regression analysis. Two-tailed P values of < 0.05 were considered significant. There was no difference between groups in the mean weight gain; in the control group mean weight gain was 12.5 gm/kg/day and in the intervention group 12.1 gm/kg/day ( P = 0.83). The average length of stay in the control group of 14.5 days was significantly longer than the 10.0 days in the intervention group ( P = 0.009). This difference remained significant after adjusting for gestational age at birth in regression analysis. The average total number of adverse events in the control group (12.5 events) was significantly greater than in the intervention group (3.5 events; P = 0.007). The mean PCA on study entry was 34.4 wks in both groups and on exit 36.5 wks in the control group and 35.8 wks in the intervention group, a significant difference ( P = 0.02), The intervention group elicited 2.8 cues/feed. The nurse to patient ratios was equal in both groups throughout the study period. Cue-based feeding was possible for premature infants with similar weight gain as traditional feeding without affecting workload. Hospitalization and adverse events were decreased.