Advanced stage breast cancer is associated with catheter-tip thrombus formation following implantable central venous port placement.

PURPOSE: Catheter-tip associated thrombosis is not uncommon in patients with implantable central venous ports; however, the prevalence and clinical impact of this complication on patient management is unclear. This study aims to identify risk factors for thrombus formation in a large population receiving serial echocardiograms (echo) following port placement. METHODS: A total of 396 female breast cancer patients underwent internal jugular vein chest port placement between 2007 and 2013 and received echo studies every third month. Catheter tip position was measured from chest radiography and catheter associated thrombus was identified by echo. RESULTS: Sixteen out of 396 patients (4%) had catheter-tip thrombus. No patients were symptomatic or prophylactically anticoagulated. Patients with thrombus were significantly younger than those without (46.4 years versus 53.4 years, respectively, p = 0.02) and had higher stage breast cancer with 75% versus 44.7% having stage III or IV cancer ( p = 0.017). Thrombus was identified after a median of 91 days. No significant difference was identified in anatomic ( p = 0.1) or measured ( p = 0.15) tip position, port laterality ( p = 0.86), or number of port lumens ( p = 0.65). CONCLUSIONS: In this large cohort, younger patients and those with more advanced stage breast cancer were more associated with catheter-tip-related thrombus after port placement.

Low-cost diagnostic test for susceptible and drug-resistant tuberculosis in rural Malawi.

BACKGROUND: Rural settings where molecular tuberculosis diagnostics are not currently available need easy-to-use tests that do not require additional processing or equipment. While acid-fast bacilli (AFB) smear is the most common and often only tuberculosis diagnosis test performed in rural settings, it is labour intensive, has less-than-ideal sensitivity, and cannot assess tuberculosis drug susceptibility patterns. OBJECTIVE: The objective of this study was to determine the feasibility of a multidrug-resistant (MDR) or extensively drug-resistant (XDR)-tuberculosis coloured agar-based culture test (tuberculosis CX-test), which can detect Mycobacterium tuberculosis growth and evaluate for drug susceptibility to isoniazid, rifampicin and a fluoroquinolone (i.e. ciprofloxacin) in approximately 14 days. METHOD: In this study, 101 participants were enrolled who presented to a rural health clinic in central Malawi. They were suspected of having active pulmonary tuberculosis. Participants provided demographic and clinical data and submitted sputum samples for tuberculosis testing using the AFB smear and tuberculosis CX-test. RESULTS: The results showed a high level of concordance between the AFB smear (12 positive) and tuberculosis CX-test (13 positive); only one sample presented discordant results, with the molecular GeneXpert MTB/RIF® test confirming the tuberculosis CX-test results. The average time to a positive tuberculosis CX-test was 10 days. Of the positive samples, the tuberculosis CX-test detected no cases of drug resistance, which was later confirmed by the GeneXpert MTB/RIF®. CONCLUSION: These findings demonstrate that the tuberculosis CX-test could be a reliable low-cost diagnostic method for active pulmonary tuberculosis in high tuberculosis burden rural areas.