A lung image reconstruction from computed radiography images as a tool to tuberculosis treatment control

Background: Tuberculosis (TB) is an infectious lung disease with high worldwide incidence that severely compromises the quality of life in affected individuals. Clinical tests are currently employed to monitor pulmonary status and treatment progression. The present study aimed to apply a three-dimensional (3D) reconstruction method based on chest radiography to quantify lung-involvement volume of TB acute-phase patients before and after treatment. In addition, these results were compared with indices from conventional clinical exams to show the coincidence level. Methods: A 3D lung reconstruction method using patient chest radiography was applied to quantify lung-involvement volume using retrospective examinations of 50 patients who were diagnosed with pulmonary TB and treated with two different drugs schemes. Twenty-five patients were treated with Scheme I (rifampicin, isoniazid, and pyrazinamide), whereas twenty-five patients were treated with Scheme II (rifampicin, isoniazid, pyrazinamide, and ethambutol). Acute-phase reaction: Serum exams included C-reactive protein levels, erythrocyte sedimentation rate, and albumin levels. Pulmonary function was tested posttreatment. Results: We found strong agreement between lung involvement and serum indices pre- and posttreatment. Comparison of the functional severity degree with lung involvement based on 3D image quantification for both treatment schemes found a high correlation. Conclusions: The present 3D reconstruction method produced a satisfactory agreement with the acute-phase reaction, most notably a higher significance level with the C-reactive protein. We also found a quite reasonable coincidence between the 3D reconstruction method and the degree of functional lung impairment posttreatment. The performance of the quantification method was satisfactory when comparing the two treatment schemes. Thus, the 3D reconstruction quantification method may be useful tools for monitoring TB treatment. The association with serum indices are not only inexpensive and sensitive but also may be incorporated into the assessment of patients during TB treatment.(AU)

Efeitos da posição prona no paciente com síndrome da angústia respiratória aguda (sara): metanálise / Metanálise effects of prone position in patients with acute respiratory distress syndrome (ards): meta-analysis

Objetivo: Esta revisão teve como objetivo determinar a eficácia da posição prona sobre a PaO2, FiO2, PaO2/FiO2, PEEP, PaCO2 e mortalidade nos pacientes com Síndrome da Angústia Respiratória Aguda­ SARA, discutindo os efeitos benéficos do posicionamento em prono nos pacientes com SARA. A análise dos dados foi realizada através do teste t de Student, com nível de significância p<0,05.Método: Foram analisados revisões sistemáticas e ensaios clínicos controlados e randomizados, a maioria foi publicado nos últimos sete anos, nas línguas inglesa e portuguesa, tendo como referência as bases de dados MEDLINE (National Library of Medicine) e SCIELO (Scientific Electronic Library Online).Resultados: Após a análise e interpretação dos dados, foi observado que só houve diferença estatisticamente significante (p< 0,05) para os índices de PaO2 e PaO2/FiO2.. As demais variáveis (FiO2, PEEP, PaCO2, mortalidade) não apresentaram valores de "p" significantes.Conclusão: Mais evidências são necessárias para confirmar os reais benefícios do posicionamento em prono. Os resultados parecem ser promissores para beneficiar pacientes com SARA, uma vez que houve melhora da oxigenação com aumento da PaO2, diminuição da lesão pulmonar representada pela melhora da relação PaO2/FiO2, com conseqüente redução da mortalidade.

Objective: This review aimed to determine the effectiveness of the prone position on the PaO2, FiO2, PaO2/FiO2, PEEP, PaCO2 and mortality in patients with respiratory distress syndrome - ARDS, discussing the beneficial effects of the positioning in pronation in patients with ARDS. Data analysis was performed by Student's t test with significance set at 0.05. Methods: We analyzed and systematic reviews and randomized controlled trials, the majority was published in the last seven years, in English and Portuguese, with reference to the databases MEDLINE (National Library of Medicine) and SCIELO (Scientific Electronic Library Online). Results: After analyzing and interpreting data, it was observed that only statistically significant difference (p <0.05) for the rates of PaO2 and PaO2/FiO2 .. The other variables (FiO2, PEEP, PaCO2, mortality) showed no significant p-values. Conclusion: More evidence is needed to confirm the actual benefits in the prone position. The results seem promising to benefit patients with ARDS, since there was improvement in oxygenation with the paO2 increase, decrease in lung injury represented by the improvement of the relationship PaO2/FiO2, with a consequent reduction in mortality