Mechanical complications of weekly care and maintenance versus once every 10 days of the peripherally inserted central catheter line insertion site in newborns: A propensity score-matched cohort study in Mexico

PURPOSE

To evaluate the mechanical complications of weekly care and maintenance versus once every 10 days of the peripherally inserted central catheter (PICC) line insertion site versus once every 10 days in newborns.

DESIGN AND METHODS

Prospective propensity score matched cohort study. Care and maintenance of the PICC line insertion site were performed on days 7 and 10 during January 2018 to December 2019. To compare mechanical complications, propensity score matching was performed. Propensity scores were used to determine the relative risks and hazard ratios by using logistic regressions with log-link function and Cox regressions, respectively.

RESULTS

We included 175 newborns hospitalized in the neonatal intensive care unit (NICU) who underwent insertion of a PICC line. Ninety-six received weekly care and maintenance, and 79 received care and maintenance every 10 days. Weekly care and maintenance were associated with more breakage (RR 1.98, 95% CI 1.68-2.34); occlusions (RR 0.81, 95% CI 0.46-1.42) and accidental withdrawals (RR 1.31, 95% CI 0.93-1.84) were not different between care and maintenance every 7 and 10 days. A survival analysis was performed, showing that weekly care and maintenance are a risk factor for removal for mechanical complications (HR 7.61, 95% CI 3.05-19.01).

CONCLUSION

We concluded that care and maintenance of the PICC in newborns every 10 days have fewer complications than when performing care and maintenance every 7 days.

PRACTICE IMPLICATIONS

Newborns requiring intravenous therapy will benefit from care and maintenance every 10 days, and this practice could potentially spread to other NICUs.

Interaction of metabolic dysfunction-associated fatty liver disease and nonalcoholic fatty liver disease with advanced fibrosis in the death and intubation of patients hospitalized with coronavirus disease 2019

Patients with pre-existing liver diseases are considered to have an increased risk of morbidity and mortality from any type of infection, including viruses. The aim of this work was to explore the implications of metabolic dysfunction-associated fatty liver disease (MAFLD) and nonalcoholic fatty liver disease (NAFLD) definitions in coronavirus disease 2019 (COVID-19) and to study the interaction between advanced fibrosis (AF) and each of these diseases in the death and intubation of patients hospitalized with COVID-19. We performed a retrospective study with 359 patients hospitalized with confirmed COVID-19 infection in a tertiary referral hospital who were admitted between April and June 2020. A multivariate Cox model was performed regarding the interaction of AF with MAFLD and NAFLD in the mortality and intubation of patients with COVID-19. The death rate was statistically significantly higher in the MAFLD group compared to the control group (55% vs. 38.3%, p = 0.02). No significant difference was seen in the death rate between the NAFLD and control group. The MAFLD (44.09% vs. 20%, p = 0.001) and NAFLD (40.51% vs. 20%, p = 0.01) groups had statistically significantly higher intubation rates than the control group. A statistically significant interaction between NAFLD and AF was associated with an increase in mortality (p = 0.01), while a statistically significant interaction between MAFLD and AF was associated with an increased risk of mortality (p = 0.006) and intubation (p = 0.049). In the case of patients hospitalized with COVID-19, our results indicate that the death rate was higher in the MAFLD group but not the NAFLD group compared to that in the control group. The intubation rates were higher in the NAFLD and MAFLD groups compared to rates in the control group, suggesting that both could be associated with COVID-19 severity. In addition, we found interactions between AF with MAFLD and NAFLD.

Detection of Paragonimus mexicanus (Trematoda) metacercariae in crabs from Oaxaca, Mexico

Metacercariae of Paragonimus mexicanus were collected in crabs Tehuana guerreroensis (Rathbun, 1933) in the municipality of Putla, Oaxaca, Mexico. Metacercariae were found in 20.8% of the crabs collected, with an average of 1.9 metacercarie per crab. Stained metacercariae showed the specific characteristics of P. mexicanus by morphology and sequencing a fragment of the 28S ribosomal gene obtained by PCR. These findings reveal that T. guerreroensis is an intermediate host for P. mexicanus; this new report is relevant considering the potential risk of transmission in the states of Oaxaca and Guerrero, Mexico.