Human cytokine responses to meso-endemic malaria on the Pacific Coast of Colombia.

Studies of naturally-acquired immunity to malaria in endemic regions provide the potential for a greater understanding of the regulation of human immune responses to the malarial parasite. However, little is known about the acquisition of malaria-specific immunity in regions of unstable, meso-endemic or hypo-endemic transmission. Cytokine profiles - patterns in the expression of interleukin-4 (IL-4), interleukin-10, interleukin-12, interferon-gamma (IFN-gamma) and tumour necrosis factor-alpha (TNF-alpha) - were therefore studied during the natural acquisition of immunity to Plasmodium falciparum and P. vivax among individuals from Buenaventura, a meso-endemic region on the Pacific Coast of Colombia. In general, specific type-1 immune responses, characterized by IFN-gamma expression, were more likely to develop during P. falciparum infection, whereas pro-inflammatory cytokine profiles (with TNF-alpha expression) were observed more frequently among the P. vivax infections. Type-2 cytokine profiles, characterized by dominant IL-4 expression, were infrequent. Expression of IL-4 probably occurs primarily after prolonged exposure to parasites (which would, by definition, not be common in a meso-endemic region).

Echocardiography in cystic fibrosis: A proposed scoring system.

An echocardiographic scoring system was developed on the basis of an observed sequence of echo abnormalities, beginning with RV hypertrophy, through RV dilation, to abnormal RV systolic time intervals, noted to be associated with the progressive pulmonary disease of cystic fibrosis. This score correlated significantly with both the Shwachman-Kulczycki (r = 0.87, P < 0.001) and Taussig-NIH (r = 0.86, P < 0.001) clinical scoring systems, the Brasfield chest roentgenogram score (r = 0.86, P < 0.001), and pulmonary function test results. The scoring of echos appears to be useful for the early detection and systematic quantitation of the cardiac effects of the progressive pulmonary disease. Preliminary sequential echo studies suggest that this system provides a method for assessing the progression of cardiac disease and evaluating prognosis in individual patients, and may prove to be useful in monitoring therapeutic interventions for cor pulmonale.