Indexing severity of diabetic foot infection with 99mTc-WBC SPECT/CT hybrid imaging.

OBJECTIVE: Management of diabetic foot infection (DFI) has been hampered by limited means of accurately classifying disease severity. New hybrid nuclear/computed tomography (CT) imaging techniques elucidate a combination of wound infection parameters not previously evaluated as outcome prognosticators. Our aim is to determine if a novel standardized hybrid image-based scoring system, Composite Severity Index (CSI), has prognostic value in DFI. RESEARCH DESIGN AND METHODS: Masked retrospective (99m)Tc-white blood cell (WBC) single photon emission CT (SPECT)/CT image interpretation and independent chart review of 77 patients (101 feet) suspected of DFI-associated osteomyelitis at a large municipal hospital between January 2007 and July 2009. CSI scores were correlated with probability of favorable outcome (no subsequent amputation/readmission after therapeutic intervention) during median 342-day follow-up. RESULTS: CSI ranged from 0-13. Receiver operating characteristic accuracy for predicting favorable outcome was 0.79 (optimal cutoff CSI, ≤2; odds ratio of therapeutic failure for CSI >2, 15.1 [95% CI 4.4-51.5]). CSI of 0 had a 92% chance of favorable outcome, which fell progressively to 25% as indices rose to ≥7. Image-based osteomyelitis versus no osteomyelitis assessment was less accurate than CSI at predicting outcome (P = 0.016). In patients with intermediate severity (CSI 3-6), treatment failure decreased from 68 to 36% when antibiotic duration was extended to ≥42 days (P = 0.026). CONCLUSIONS: (99m)Tc-WBC SPECT/CT hybrid image-derived wound infection parameters incorporated into a standardized scoring system, CSI, has prognostic value in DFI.

Urinary tract infection in patients with acute coronary syndrome: a potential systemic inflammatory connection.

BACKGROUND: Inflammation has been linked with atherosclerotic disease development and instability. Contributors to systemic inflammation, such as subclinical infection, may trigger acute coronary syndromes (ACSs). METHODS: Using a case-control study design, we evaluated the prevalence of urinary tract infection (UTI) among 100 consecutive ACS patients, compared with a contemporary control group undergoing elective coronary artery bypass graft (CABG) surgery. Cases were excluded if ACS was not confirmed by chart review or if a urinalysis was not obtained

Brain natriuretic peptide and left ventricular dysfunction in chagasic cardiomyopathy.

Global left ventricular (LV) systolic dysfunction is the strongest predictor of morbidity and mortality in Chagas disease. Echocardiography is considered the gold standard for the detection of LV dysfunction, but not always available in endemic areas where chagasic cardiomyopathy is most common. Brain natriuretic peptide (BNP) is a neurohormone that has been recently described as a simple and inexpensive diagnostic and prognostic marker for patients with congestive heart failure. Chagasic patients (n = 63) and non-infected healthy individuals (n = 18) were recruited prospectively and underwent complete clinical examination, echocardiography and 24-h Holter monitoring. BNP was measured from thawed plasma samples using the Triage BNP test. We observed high levels of BNP in association with depression of LV ejection fraction, with increase of LV end-diastolic diameter and with LV premature complexes. An elevated concentration of BNP, defined as a concentration of 60 pg/ml or more, had a sensitivity of 91.7%, specificity of 82.8%, positive predictive value of 52.4%, and negative predictive value of 98% for detecting LV dysfunction (LV ejection fraction < 40%).BNP measurement using a simple, relatively inexpensive and rapid test has a promising role in identifying LV dysfunction associated with chagasic cardiomyopathy. Equally important, patients with Trypanosoma cruzi infection who have low levels of BNP level in plasma have a very low likelihood of severe cardiac involvement, and echocardiography is probably not necessary.

Brain natriuretic peptide and left ventricular dysfunction in chagasic cardiomyopathy

Global left ventricular (LV) systolic dysfunction is the strongest predictor of morbidity and mortality in Chagas disease. Echocardiography is considered the gold standard for the detection of LV dysfunction, but not always available in endemic areas where chagasic cardiomyopathy is most common. Brain natriuretic peptide (BNP) is a neurohormone that has been recently described as a simple and inexpensive diagnostic and prognostic marker for patients with congestive heart failure. Chagasic patients (n = 63) and non-infected healthy individuals (n = 18) were recruited prospectively and underwent complete clinical examination, echocardiography and 24-h Holter monitoring. BNP was measured from thawed plasma samples using the Triage BNP test. We observed high levels of BNP in association with depression of LV ejection fraction, with increase of LV end-diastolic diameter and with LV premature complexes. An elevated concentration of BNP, defined as a concentration of 60 pg/ml or more, had a sensitivity of 91.7 percent, specificity of 82.8 percent, positive predictive value of 52.4 percent, and negative predictive value of 98 percent for detecting LV dysfunction (LV ejection fraction < 40 percent).BNP measurement using a simple, relatively inexpensive and rapid test has a promising role in identifying LV dysfunction associated with chagasic cardiomyopathy. Equally important, patients with Trypanosoma cruzi infection who have low levels of BNP level in plasma have a very low likelihood of severe cardiac involvement, and echocardiography is probably not necessary.

Natriuretic peptide hormone measurement in acute coronary syndromes.

Cardiac Ischemia is an important trigger for the release of B-type natriuretic peptide (BNP). BNP and N-terminal pro-BNP (N-proBNP) are emerging as important biomarkers for risk stratification in patients with acute coronary syndromes. Higher levels of BNP and pro-BNP are associated with a greater risk for death and heart failure, independent of traditional clinical variables and levels of other biomarkers such as troponins and C-reactive protein. The therapeutic implications of these findings are not yet known.