Comparing catheter related bloodstream infection rate between cuffed tunnelled and non-cuffed tunnelled peripherally inserted central catheter.

OBJECTIVE: To compare catheter related blood stream infection (CRBSI) rate between cuffed tunnelled and non-cuffed tunnelled PICC. METHODS: We prospectively followed 100 patients (50:50 cuffed and non-cuffed PICC) and compared CRBSI rate between these groups. Daily review and similar catheter care were performed until a PICC-related complication, completion of therapy, death or defined end-of-study date necessitate removal. CRBSI was confirmed in each case by demonstrating concordance between isolates colonizing the PICC at the time of infection and from peripheral blood cultures. RESULTS: A total of 50 cuffed PICC were placed for 1864 catheter-days. Of these, 12 patients (24%) developed infection, for which 5 patients (10%) had a CRBSI for a rate of 2.7 per 1000 catheter-days. Another 50 tunnelled non-cuffed PICCs were placed for 2057 catheter-days. Of these, 7 patients (14%) developed infection, for which 3 patients (6%) had a CRBSI. for a rate of 1.5 per 1000 catheter-days. The mean time to development of infection is 24 days in cuffed and 19 days in non-cuffed groups. The mean duration of utilization was significantly longer in non-cuffed than in cuffed group (43 days in non-cuffed vs 37 days in cuffed group, p = 0.008). CONCLUSIONS: Cuffed PICC does not further reduce the rate of local or bloodstream infection. Tunnelled non-cuffed PICC is shown to be as effective if not better at reducing risk of CRBSI and providing longer catheter dwell time compared to cuffed PICC.

Idiopathic Thyroid Abscess - A Rare Occurrence.

Thyroid abscesses are rare as the gland has a rich blood supply, well-developed capsule and is high in iodine. However, clinicians must be aware of this fact and make an early diagnosis as it can lead to serious morbidity if left untreated. Infection may involve one or both lobes of the thyroid gland, although the left lobe is more often affected and is successfully treated with surgery and antibiotics. This case study involves a 22-year-old woman with a history of painful swelling over the neck accompanied by low-grade fever without any underlying cause. Both the ultrasound and computed tomography revealed a heterogeneous mass within the left lobe of the thyroid gland. Fine needle aspiration revealed an abscess collection and culture Staphylococcus aureus had grown. She was successfully treated with intravenous and oral amoxicillin clavulanate and no surgical treatment was carried out. In conclusion, thyroid abscesses are rare as the gland is resistant to infection and must be differentiated from an infected branchial cleft cyst or sinus, infected thyroid tumour or lymphadenitis in the region of the thyroid in order to avoid serious morbidity if left untreated.

Performance of transient elastography (TE) and factors associated with discordance in non-alcoholic fatty liver disease.

OBJECTIVE: To determine the accuracy of transient elastography (TE) and factors associated with discordance between TE and liver histology in patients with non-alcoholic fatty liver disease (NAFLD). METHODS: The accuracy of TE was assessed and compared with the aspartate aminotransferase-to-platelet ratio index (APRI) in patients with histologically proven NAFLD. Factors associated with discordance between liver histology and TE were analyzed. RESULTS: Altogether 131 patients with a mean age of 49.9 years, including 69 men and 62 women, with NAFLD underwent liver stiffness measurement (LSM) by TE. Among all patients, 120 (91.6%) had a successful LSM with an interquartile to median ratio of 0.15. The accuracy of TE in detecting ≥F3 and F4 fibrosis, assessed by the area under the receiver operating characteristic curve, were 0.77 and 0.95, respectively. The sensitivity and specificity of the optimal LSM cut-off values for detecting ≥F3 fibrosis (sensitivity 70.4% and specificity 66.6%) and F4 (sensitivity 87.5% and specificity 89.3%) were modest, but better than those of APRI. Discordance between TE and histology for fibrosis grading was observed in 22.5% of patients, but it could not be explained by body mass index, alanine aminotransferase level, the length of the biopsied specimens or the grade of steatosis. CONCLUSION: TE plays an important role in the detection of advanced fibrosis and cirrhosis in patients with NAFLD and its accuracy does not appear to be influenced by components of the disease.