Quantification of Pulmonary Inflammatory Processes Using Chest Radiography: Tuberculosis as the Motivating Application.

The purpose of this work was to develop a quantitative method for evaluating the pulmonary inflammatory process (PIP) through the computational analysis of chest radiography exams in posteroanterior (PA) and lateral views. The quantification procedure was applied to patients with tuberculosis (TB) as the motivating application.A study of high-resolution computed tomography (HRCT) examinations of patients with TB was developed to establish a relation between the inflammatory process and the signal difference-to-noise ratio (SDNR) measured in the PA projection. A phantom essay was used to validate this relation, which was implemented using an algorithm that is able to estimate the volume of the inflammatory region based solely on SDNR values in the chest radiographs of patients.The PIP volumes that were quantified for 30 patients with TB were used for comparisons with direct HRCT analysis for the same patient. The Bland-Altman statistical analyses showed no significant differences between the 2 quantification methods. The linear regression line had a correlation coefficient of R = 0.97 and P < 0.001, showing a strong association between the volume that was determined by our evaluation method and the results obtained by direct HRCT scan analysis.Since the diagnosis and follow-up of patients with TB is commonly performed using X-rays exams, the method developed herein can be considered an adequate tool for quantifying the PIP with a lower patient radiation dose and lower institutional cost. Although we used patients with TB for the application of the method, this method may be used for other pulmonary diseases characterized by a PIP.

Production of pro- and anti-inflammatory cytokines by monocytes from patients with paracoccidioidomycosis.

Monocytes and macrophages can produce a large repertoire of cytokines and participate in the pathogenesis of granulomatous diseases. We investigated the production of pro- and anti-inflammatory cytokines by monocytes from patients with active paracoccidioidomycosis. Peripheral blood monocytes from 37 patients and 29 healthy controls were cultivated with or without 10 microg/ml of lipopolysaccharide (LPS) for 18 h at 37 degrees C, and the cytokine levels were determined in the culture supernatants by enzyme immunoassay. The results showed that the endogenous levels of tumor necrosis factor alpha (TNF-alpha), interleukin-1beta (IL-1beta), IL-6, IL-8, IL-10 and transforming growth factor beta detected in the supernatant of patient monocytes cultivated without stimulus were significantly higher than those produced by healthy controls. These data demonstrated that monocytes from patients with active paracoccidioidomycosis produce high levels of cytokines with both inflammatory and anti-inflammatory activities. However, patient monocytes produced significantly lower TNF-alpha and IL-6 levels in response to LPS when compared to normal subjects, suggesting an impairment in their capacity to produce these cytokines after LPS stimulation. Concentrations of IL-1beta, IL-8 and IL-10 in cultures stimulated with LPS were higher in patients than in controls. These results suggest that an imbalance in the production of pro- and anti-inflammatory cytokines might be associated with the pathogenesis of paracoccidioidomycosis.

The malarial impact on the nutritional status of amazonian adult subjects

A avaliacao antropometrica (peso, altura, circunferencia braquial, prega cutanea tricipital, prega cutanea subescapular, indice de Quetelet e circunferencia muscular do braco) e bioquimica (proteinas e lipides) foi realizado em 120 individuos (93 masculinos e 27 do sexo feminino), de 17 a 72 anos de idade, moradores de area endemica de malaria (Humaita - AM). De acordo com a historia da doenca (malaria) eles foram divididos em grupos: G1 - controle (n = 30), sem historia de malaria; G2 - controle (n = 40), com historia de malaria, mas sem manisfetacao de doenca atual; G - doentes com Plasmodium vivax (n = 31). O diagnostico de malaria foi estabelecido por manifestacoes clinicas e confirmado laboratorialmente (gota espessa e esfregaco). No global as medidas antropometricas e bioquimicas discriminaram os grupos diferentemente. As medidas antropometricas do peso, altura, reservas caloricas e estoque proteicos somaticos, apresentaram pouca sensibilidade, discriminado apenas os grupos extremos (G1 > G4). As medidas bioquimicas, no geral diferenciaram dois grandes grupos, os sadios e os doentes (G1+G2) e G3+G4). Os doentes com Plasmodium falciparum (G4) foram os que se apresentaram em pior estado nutricional para a maioria das variaveis, sem entretanto, nenhuma variavel individual que os discriminasse significativamente do G3. Estes dados permitem concluir que a malaria resulta em desnutricao do hospedeiro, cuja gravidade esta relacionada ao tipo e estagio da doenca.