A team-based multidisciplinary approach to managing peripherally inserted central catheter complications in high-risk haematological patients: a prospective study.

PURPOSE: Use of peripherally inserted central catheters (PICCs) has markedly increased during the last decade. However, there are few studies on use of PICCs in patients with haematological malignancies (HM) receiving intensive chemotherapy. Preliminary data suggest a higher rate of PICC-related complications in these high-risk patients. This prospective observational single-centre study aimed to investigate PICC-related complications after implementation of a multidisciplinary approach to PICC care and compared it with previous literature. METHODS: A total of 44 PICCs were inserted in 36 patients (27.3%, thrombocytopenia <50 × 10(9)/L at insertion) over 5045 PICC days (median duration, 114.5 days). RESULTS: No major insertion-related complications were observed. Major late complications were obstruction in 13.6% (1.19/1000 PICC days) of patients, catheter-related bloodstream infection in 6.8% (0.59/1000 PICC days), and catheter-related thrombosis in 4.5% (0.39/1000 PICC days). Premature PICC removal occurred in 34% (2.97/1000 PICC days) of patients. The overall rate of potentially major dangerous complications was particularly low (11.36%, 0.99/1000 PICC days) compared with previous studies. CONCLUSIONS: This study highlights the utility of a multidisciplinary approach for PICC care in adults with HM receiving intensive chemotherapy. We provide further data to support use of PICCs in such patient populations.

Cooking and Fe fortification have different effects on Fe bioavailability of bread and tortillas.

OBJECTIVE: To identify iron sources for wheat- (WF) and corn-flour (CF) fortification taking into account the effect of cooking. METHODS: Sixty-six Fe-depleted rats were replete with various Fe sources. Fe bioavailability and utilization in wheat bread (WB) and corn tortillas (CT) fortified with various Fe sources was assessed after the depletion and repletion periods. RESULTS: Baking decreased the phytates content of WF by 97%. Improvements in Hb and FeHb were greater in rats fed unfortified WB than in those fed unfortified WF. Fe fortification had no benefit. In contrast, phytates content was unchanged by tortilla preparation, but fortification improved iron availability. Iron bioavailability indicators were best in rats fed CT fortified with ferrous sulfate and NaFe(III)EDTA than in those fed unfortified CT or CT plus reduced Fe. CONCLUSION: We concluded that baking WF bread improved the bioavailability of native Fe with no further effect of fortification. Pan-cooking of lime-treated CF did not improve Fe bioavailability, but addition of Ferrous sulfate or NaFe(III)EDTA did it, despite the high phytate and calcium content of tortillas.

Frequency and determinants of vitamin A deficiency in children under 5 years of age with pneumonia.

BACKGROUND: Vitamin A deficiency (VAD) has been closely related to acute respiratory infections (ARI), although information is still incomplete; for example, the frequency of VAD in children <5 years of age with pneumonia is not known, and the conditions associated with VAD have not been identified. This study was conducted to gain insight into the status of vitamin A in children with pneumonia. A secondary objective was to identify the sociodemographic, individual, and nutritional factors associated with VAD in these children. METHODS: A cross-sectional study was conducted in the Mexican state of Hidalgo, one of the poorest in the country. Children with community-acquired pneumonia treated at nine public hospitals were included. Information was obtained by interviewing mothers, and ascertainment of vitamin A status was performed with relative-dose-response (RDR) test. RESULTS: A total of 422 cases were included. VAD was identified in 17.8% of children; 50.3% showed normal results, 24.6% had liver reserve depletion, and 7.3% showed results attributable to the infectious process. Variables associated with VAD were as follows: age <2 months (OR 3.44, 95% CI: 1.84-9.24); children >6 months of age fed with formula (OR 0.37, 95% CI: 0.15-0.91), and affiliation with the Mexican Social Security Institute (IMSS) health system (OR 0.40, 95% CI: 0.22-0.72). CONCLUSIONS: The frequency of VAD in children with community-acquired pneumonia confirms that the problem of deficiency persists in Mexico. The associated factors for VAD found in this study can be taken into account when planning and evaluating vitamin A supplementation activities in populations with high risk for deficiency.