Use of procalcitonin for the diagnosis of pneumonia in patients presenting with a chief complaint of dyspnoea: results from the BACH (Biomarkers in Acute Heart Failure) trial

Biomarkers have proven their ability in the evaluation of cardiopulmonary diseases.We investigated the utility of concentrations of the biomarker procalcitonin (PCT) alone and with clinical variables for the diagnosis of pneumonia in patients presenting to emergency departments (EDs) with a chief complaint of shortness of breath. The BACH trial was a prospective, international, study of 1641 patients presenting to EDs with dyspnoea. Blood samples were analysed for PCT and other biomarkers. Relevant clinical data were also captured. Patient outcomes were assessed at 90 days. The diagnosis of pneumonia was made using strictly validated guidelines. A model using PCT was more accurate [area under the curve (AUC) 72.3%] than any other individual clinical variable for the diagnosis of pneumonia in all patients, in those with obstructive lung disease, and in those with acute heart failure (AHF). Combining physician estimates of the probability of pneumonia with PCT values increased the accuracy to .86% for the diagnosis of pneumonia in all patients. Patients with a diagnosis of AHF and an elevated PCT concentration (.0.21 ng/mL) had a worse outcome if not treated with antibiotics (P ¼ 0.046), while patients with low PCT values (,0.05 ng/mL) had a better outcome if they did not receive antibiotic therapy (P ¼ 0.049). Procalcitonin may aid in the diagnosis of pneumonia, particularly in cases with high diagnostic uncertainty. Importantly, PCT may aid in the decision to administer antibiotic therapy to patients presenting with AHF in which clinical uncertainty exists regarding a superimposed bacterial infection

Ecophysiology of Eucalyptus marginata and Corymbia calophyllain decline in an urban parkland

Eucalypt trees are in decline throughout urban landscapes of south western Australia. This study investigated the cause of decline in Eucalyptus marginata and Corymbia calophylla trees in parkland and compared water and nutrient relations with healthy trees in adjacent bushland in Perth, Western Australia. It was hypothesized that: (i) trees were drought stressed through competition for soil water by the vigorous turf; (ii) excessive uptake of nitrogen, because of fertilizer application to turf, caused toxicity; and/or (iii) micronutrient (Cu, Fe, Mn and/or Zn) deficit was induced by high-pH irrigation water applied to turf around parkland trees. Leaf water potential showed aseasonal variation in the irrigated parkland trees and foliar 13C indicated that parkland trees generally had low water-use efficiency and were not drought stressed relative to bushland trees. Foliar N levels were not significantly different between parkland and bushland trees indicating that excess N uptake was not a factor in the decline. Foliar total Fe, 'metabolically active' Fe, Cu and Zn concentrations were not significantly different between parkland and bushland trees. Foliar manganese concentrations were indicative of deficiency and significantly lower in parkland trees (5-14 g g-1) relative to bushland trees (22-35 g g-1). It is concluded that application of alkaline irrigation water to the parkland site reduced the plant-availability of Mn; however, our study of only one parkland site does not allow us to generalize the results across other parklands

A 37-Year-Old Man With Pleuritic Chest Pain

Case presentationA 37-year-old man with poorly controlled type 2 diabetes presented with severe right-sided pleuritic chest pain, respiratory splinting, and cough. Two weeks earlier, he had been evaluated at an urgent care for cough and was prescribed a 5-day course of azithromycin for bronchitis. He then presented to our ED reporting mild, right-sided pleuritic chest pain. Vital signs were normal, and his chest radiograph showed a trace right pleural effusion (Fig 1A). He was discharged with naproxen for pleurisy. Three days later, he returned, reporting a dramatic increase in the severity of his pleuritic chest pain and a cough that had become productive of yellow-brown sputum. He denied fever, but endorsed chills and night sweats. His medications included atorvastatin, lisinopril, metformin, and saxagliptin. His parents were from Guam, although he was born and raised in San Diego, CA. He was employed as a social worker and denied any history of cigarette smoking, alcohol, or drug use

Mid-region pro-hormone markers for diagnosis and prognosis in acute dyspnea : results from the BACH (Biomarkers in Acute Heart Failure) trial

Our purpose was to assess the diagnostic utility of mid-regional pro-atrial natriuretic peptide (MR-proANP) for the diagnosis of acute heart failure (AHF) and the prognostic value of mid-regional pro-adrenomedullin (MR-proADM) in patients with AHF