Classification of electrocardiogram and auscultatory blood pressure signals using machine learning models

In this paper, two real-world medical classification problems using electrocardiogram (ECG) and auscultatory blood pressure (Korotkoff) signals are examined. A total of nine machine learning models are applied to perform classification of the medical data sets. A number of useful performance metrics which include accuracy, sensitivity, specificity, as well as the area under the receiver operating characteristic curve are computed. In addition to the original data sets, noisy data sets are generated to evaluate the robustness of the classifiers against noise. The 10-fold cross validation method is used to compute the performance statistics, in order to ensure statistically reliable results pertaining to classification of the ECG and Korotkoff signals are produced. The outcomes indicate that while logistic regression models perform the best with the original data set, ensemble machine learning models achieve good accuracy rates with noisy data sets.

Progress on salt reduction in the Pacific Islands: from strategies to action

BACKGROUND: Most populations are consuming too much salt which is the main contributor of high blood pressure, a leading risk factor of cardiovascular disease and stroke. The South Pacific Office of the World Health Organization has been facilitating the development of salt reduction strategies in Pacific Island Countries and areas (PICs). The objective of this analysis was to review progress to date and identify regional actions needed to support PICs and ensure they achieve the global target to reduce population salt intake by 30% by 2025.
METHODS: Relevant available national food, health and non-communicable disease (NCD) plans from all 22 PICs were reviewed. NCD co-ordinators provided updates and relayed experiences through semi-structured interviews. All activities were systematically categorised according to an existing salt reduction framework for the development of salt reduction strategies.
RESULTS: Salt reduction consultations had been held in 14 countries and final strategies or action plans developed in nine of these, with drafts available in a further three. Three other countries had integrated salt reduction into NCD strategic plans. Baseline monitoring of salt intake had been undertaken in three countries, salt levels in foods in nine countries and salt knowledge, attitude and behaviour surveys in four countries. Most countries were at early stages of implementation and identified limited resources as a barrier to action. Planned salt reduction strategies included work with food industry or importers, implementing regional salt reduction targets, reducing salt levels in school and hospital meals, behaviour change campaigns, and monitoring and evaluation.
CONCLUSIONS: There had been good progress on salt reduction planning in PICs. The need for increased capacity to effectively implement agreed activities, supported by regional standards and the establishment of improved monitoring systems, were identified as important steps to ensure the potential cardiovascular health benefits of salt reduction could be fully realised in the region.

An enhanced stability criterion for time-delay systems via a new bounding technique

In the past few years, a great deal of effort has been devoted to improve delay-dependent conditions for stability of linear systems with an interval time-varying delay. To reduce conservatism of stability conditions, in the framework of the Lyapunov-Krasovskii functional (LKF) method, the bounding technique plays a key role. In this paper, a new bounding technique based on a new integral inequality is proposed. By employing the newly bounding technique proposed in this paper, an enhanced stability criterion for a class of linear systems with an interval time-varying delay is derived. The effectiveness and a significant improvement of the obtained results are shown by numerical examples.

Properties of HIV-1 associated cholesterol in addition to raft formation are important for virus infection

The overall HIV-1 membrane lipid contents resemble lipid rafts, and we have previously demonstrated that raft-promoting properties of virus-associated cholesterol (with modifications in either the 3β-OH group or AB rings) are important for HIV-1 infectivity. As cholesterol is present in both rafts and non-rafts domains of HIV-1 membrane, we question whether the interpretation of rafts property of virus-associated cholesterol being an absolute requirement for HIV-1 function is too simplistic. The carbon side chain of cholesterol is the third component of cholesterol that can affect the fluidity of membrane depending on its context within the lipid membrane bilayers. In this work, we have used synthetic cholesterol analogues that have different lengths of carbon side chain for our investigation. In contrast to our previous report, we have found that cholesterol side chain analogues that lack in vitro defined raft promoting-property is able to support HIV-1 replication. More specifically, cholesterol analogues with side chains of intermediate length have greater capacity to support HIV-1 infection, suggesting HIV-1 is able to maintain function using cholesterol variants that promote a range of non-rafts- to rafts-properties. Our data demonstrate cholesterol properties other than raft-promoting function also contribute to the infectivity of HIV-1.

Wage inequality and welfare in developing countries: privatization and reforms in the short and long run

The impacts of privatization on wage inequality and welfare are considered for developing countries. In the short run, privatization can narrow wage inequality but reduce output of public firms. However, the favorable effect of privatization on lowering wage inequality vanishes in the long run due to the excessive entry of public firms. Thus, a policy recommendation for privatization would be: to avoid rising wage inequality, entry regulation of public firms should be imposed in the short run, and to mitigate the output contraction, complementary structural changes or policy reforms are needed in the transitional period of privatization.

Fetuin B is a secreted hepatocyte factor linking steatosis to impaired glucose metabolism

 Liver steatosis is associated with the development of insulin resistance and the pathogenesis of type 2 diabetes. We tested the hypothesis that protein signals originating from steatotic hepatocytes communicate with other cells to modulate metabolic phenotypes. We show that the secreted factors from steatotic hepatocytes induce pro-inflammatory signaling and insulin resistance in cultured cells. Next, we identified 168 hepatokines, of which 32 were differentially secreted in steatotic versus non-steatotic hepatocytes. Targeted analysis showed that fetuin B was increased in humans with liver steatosis and patients with type 2 diabetes. Fetuin B impaired insulin action in myotubes and hepatocytes and caused glucose intolerance in mice. Silencing of fetuin B in obese mice improved glucose tolerance. We conclude that the protein secretory profile of hepatocytes is altered with steatosis and is linked to inflammation and insulin resistance. Therefore, preventing steatosis may limit the development of dysregulated glucose metabolism in settings of overnutrition. Meex et al. use proteomic approaches to identify steatosis as a factor that changes protein secretion in hepatocytes. Secreted factors from steatotic hepatocytes caused insulin resistance and inflammation. One secreted protein, fetuin B, was identified as a hepatokine that is increased in type 2 diabetes and causes impaired glucose metabolism.

Eating marshmallows reduces ileostomy output: a randomized crossover trial

AIM: Anecdotally, many ostomates believe that eating marshmallows can reduce ileostomy effluent. There is a plausible mechanism for this, as the gelatine contained in marshmallows may thicken small bowel fluid, but there is currently no evidence that this is effective. METHOD: This was a randomized crossover trial. Adult patients with well-established ileostomies were included. Ileostomy output was measured for 1 week during which three marshmallows were consumed three times daily, and for one control week where marshmallows were not eaten. There was a 2-day washout period. Patients were randomly allocated to whether the control or intervention week occurred first. In addition, a questionnaire was administered regarding patient's subjective experience of their ileostomy function. RESULTS: Thirty-one participants were recruited; 28 completed the study. There was a median reduction in ileostomy output volume of 75 ml per day during the study period (P = 0.0054, 95% confidence interval 23.4-678.3) compared with the control week. Twenty of 28 subjects (71%) experienced a reduction in their ileostomy output, two had no change and six reported an increase. During the study period, participants reported fewer ileostomy bag changes (median five per day vs six in the control period, P = 0.0255). Twenty of 28 (71%) reported that the ileostomy effluent was thicker during the study week (P = 0.023). Overall 19 (68%) participants stated they would use marshmallows in the future if they wanted to reduce or thicken their ileostomy output. CONCLUSION: Eating marshmallows leads to a small but statistically significant reduction in ileostomy output.

Relative toxicity of selective serotonin reuptake inhibitors (SSRIs) in overdose

BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) have increasingly replaced tricyclic antidepressants (TCAs) in the treatment of depression. They appear to be safer in overdose, but there is little information on their spectrum of toxicity in overdose, or relative toxicity of each agent. OBJECTIVE: To determine the effect of SSRIs in overdose, as a group, and the relative toxicity of five different SSRIs. METHODS: A review of consecutive SSRI poisoning admissions to a single toxicology unit. Outcomes examined were length of stay [LOS], intensive care [ICU] admission rate, coma, seizures, electrocardiographic [ECG] abnormalities, and presence of serotonin syndrome [SS]. Logistic regression was used to model the outcome QTc >440 msec. RESULTS: There were 469 SSRI poisoning admissions analyzed after exclusions. The median LOS for all SSRI overdose admissions was 15.3 h (IQR: 10.5-21.3) and 30 of 469 (6.4%; 95% CI 4.3-9.0%) cases were admitted to ICU. The incidence of seizures was 1.9% and coma was 2.4%. Serotonin syndrome occurred in 14% of overdoses. Comparison of median QTc intervals of the five SSRIs was significantly different (p=0.0002); citalopram (450 IQR: 436-484) was individually different to fluoxetine (p=0.045), fluvoxamine (p=0.022), paroxetine (p=0.0002), and sertraline (p=0.001). The proportion of citalopram overdoses with a QTc >440 msec was 68%, differing significantly from sertraline (adjusted OR: 5.11 95% CI 2.32-11.27). Comparison of median QT intervals of the five SSRIs was statistically different (p=0.026); citalopram (400 IQR: 380-440) was individually different from sertraline (p=0.023). CONCLUSIONS: This study shows SSRIs are relatively safe in overdose despite serotonin syndrome being common. The exception was citalopram, which was significantly associated with QTc prolongation. We believe that cardiac monitoring should be considered in citalopram overdose, particularly with large ingestions and patients with associated cardiac disease.

Patterns of brachiopod faunal and body-size changes across the Permian-Triassic boundary: Evidence from the Daoduishan section in Meishan area, South China

New analysis of Permian-Triassic brachiopod assemblages and body-size changes in South China provides insights into the process of the environmental crisis in the lead up to the end-Permian mass extinction. The recently discovered Daoduishan section of South China can be considered as an important auxiliary section for the study of brachiopods at the Meishan Section D of South China, the GSSP of the Permian-Triassic Boundary (PTB). This paper studied changes of the brachiopod assemblages and body sizes through the upper part of the Changxing Formation and basal Yinkeng Formation of Daoduishan. The results show that significant changes of brachiopod assemblages took place between Beds 24e and 26. Brachiopods?Prelissorhynchia sp. and Paracruirithyris pygmaea are the dominators in Beds 14-24e, while Tethyochonetes pigmaea and Paryphella spp. are the dominators in Beds 26-29. Body sizes of brachiopods significantly decreased between Beds 24e and 26 and then maintained smaller means in Beds 27-29. Studies of brachiopod morphological features indicate both Tethyochonetes and Paryphella had advantageous adaptations enabling them to copy with living in an anoxic/dysoxic and/or low-productivity environment during the Permian-Triassic crisis.

Graph-induced restricted Boltzmann machines for document modeling

Discovering knowledge from unstructured texts is a central theme in data mining and machine learning. We focus on fast discovery of thematic structures from a corpus. Our approach is based on a versatile probabilistic formulation – the restricted Boltzmann machine (RBM) –where the underlying graphical model is an undirected bipartite graph. Inference is efficient document representation can be computed with a single matrix projection, making RBMs suitable for massive text corpora available today. Standard RBMs, however, operate on bag-of-words assumption, ignoring the inherent underlying relational structures among words. This results in less coherent word thematic grouping. We introduce graph-based regularization schemes that exploit the linguistic structures, which in turn can be constructed from either corpus statistics or domain knowledge. We demonstrate that the proposed technique improves the group coherence, facilitates visualization, provides means for estimation of intrinsic dimensionality, reduces overfitting, and possibly leads to better classification accuracy.

Effects of commercial diets and temperature on the growth performance and stress response of hapuku (Polyprion oxygeneios)

There is a growing interest in the development of hapuku (Polyprion oxygeneios) for aquaculture in New Zealand and Australia. This is driven by the high value of this species prized for its excellent flesh quality, texture and its rapid growth capability. As a relatively new aquaculture candidate, little is currently known about their thermal tolerance and stress response. Juveniles inhabit surface waters, have a high rate of growth and move into a demersal habitat at an age between 3 and 4 years, where water temperature is cooler (7-15. °C) and more stable. The sea surface temperature in New Zealand can reach 22. °C during the summer months in more northerly locations, and captive rearing has indicated that during periods of high temperature, growth is reduced and it is possible that the physiological response is compromised. We examined the effects of two rearing temperatures (18. °C and 22. °C) and three commercial diets on the growth of P. oxygeneios during a 14 week trial. At the end of this trial, fish were exposed to a crowding stressor, and their stress response (plasma cortisol, glucose and cholesterol levels) determined. In addition, we examined the temporal stress response of P. oxygeneios acclimated to 18. °C and 22. °C subjected to a single acute handling stress. Specific growth rate and condition factor significantly increased over time in fish reared at 18. °C, but not at 22. °C. Plasma cortisol levels in hapuku prior to and after application of the stressors were within the range observed in other teleost species and the magnitude of the cortisol response was higher in hapuku subjected to crowding than handling stress. In summary, the results indicated that rearing P. oxygeneios at temperatures of 22. °C compromised their growth and that all three diets tested promoted growth in hapuku reared at 18. °C but not at 22. °C.Statement of relevanceHapuku over 1 kg had better growth rates at 18. °C than 22. °C.

Rapidly cured out-of-autoclave laminates: understanding and controlling the effect of voids on laminate fracture toughness

Voids are one of the most significant defects found within composites and have been demonstrated to reduce the performance of composite structures. The understanding of the impact of the size and distribution of voids on laminate properties is still limited because voids have proven difficult to deliberately control. This study aims to understand the mechanisms by which voids are generated within out-of-autoclave cured laminates. In this study, a process of prepreg conditioning was developed to control the level of voids within test laminates. Non-conditioned laminates highlighted signs of void growth (1.5%), while conditioned laminates showed consistently low levels of voids (<0.3%). Mass spectrometry indicated higher levels of aqueous and solvent volatiles within the non-conditioned prepreg. Finally, Mode II fracture testing revealed a 21% improvement in toughness for the non-voided laminates. A model on the effect of voids within the Mode II stress state has also been proposed.

Viability of tallow inclusion in Atlantic salmon diet, as assessed by an on-farm grow out trial

The results of a recent increase in research interest directed at the inclusion of tallow in fish feed formulations are suggesting tallow is viable as a potential substitute for other alternative lipid sources such as poultry by-product oil. Although strong growth performance data has been shown, reservations still exist regarding reduced digestibility and the potential impacts this could have on performance over the duration of a grow-out period in low temperature conditions. Also little information is yet available on the potential effect of dietary tallow inclusion on final product quality. A large scale farm based study testing the inclusion of tallow at 40% inclusion, partially replacing poultry by-product oil, in commercial diets of Atlantic salmon over a winter grow-out period in southern Tasmania, Australia was conducted. Tallow inclusion had no impact on growth performance or nutrient digestibility. Tallow resulted in a slight improvement in fillet quality exhibiting a significant reduction in n - 6 PUFA and the n6:n3 ratio, and an increased n - 3LC-PUFA tissue deposition. Consumers were unable to display any preference in liking between 3 salmon products (cold smoked, hot smoked, and cooked) as a result of tallow inclusion. This study demonstrates the viability of partial inclusion of tallow in Atlantic salmon diets over a winter grow-out period. Statement of relevance: Improved knowledge of alternative dietary energy sources (oils and fats) to be used in aquafeed, (replacing the increasingly expensive, and diminishingly available, fish oil) is a key area of research towards improved environmental sustainability and economic viability of the aquaculture sector. Following a promising laboratory based, research scale, in vivo trial aimed at assessing the viability of tallow in salmon feed, a larger and longer duration farm-based trial was implemented to validate initial findings. Consumer test of final products (fresh-cooked, hot smoked and cold smoked fillets) showed no modification of sensorial attributes. Tallow is hereto shown to be a highly viable alternative oil for the salmon aquafeed industry.

Avaliação da coloração, consistência e contaminação da dentina de dentes decíduos submetidos ao capeamento pulpar indireto com remoção parcial de tecido cariado

Este ensaio clínico randomizado, controlado, duplo-cego, em paralelo, objetivou comparar o efeito do cimento de hidróxido de cálcio (grupo HC) ao de um material inerte (grupo cera) sobre a dentina cariada de molares decíduos submetidos à remoção incompleta de tecido cariado, bem como verificar a correlação entre coloração, consistência e contaminação da dentina. A amostra foi constituída por 30 crianças, de 4 a 8 anos de idade, que apresentavam um molar decíduo com lesão de cárie ativa em dentina profunda, sem sinais clínicos e radiográficos de patologia pulpar irreversível. Após anestesia local e isolamento absoluto do campo operatório, a dentina cariada das paredes laterais da cavidade foi totalmente removida, e a da porção pulpar, parcialmente removida. Um examinador calibrado avaliou visualmente o grau de coloração e de consistência da dentina cariada remanescente. Uma amostra do tecido cariado foi coletada para avaliação ao microscópio eletrônico de varredura (MEV). Aplicou-se, aleatoriamente, um dos materiais capeadores sobre o tecido, e os dentes foram restaurados com sistema adesivo e resina composta. Passados 90 dias realizou-se o exame clínico e radiográfico, remoção da restauração e do material capeador, avaliação da coloração e consistência do tecido e coleta de amostra da dentina remanescente. Após a fixação e preparo para MEV, foi realizado um registro, em 2000x de aumento, da região central de cada amostra e o escore do grau de contaminação foi determinado. Para comparação entre os grupos dos graus de coloração, consistência e contaminação atribuídos no início e no final do estudo aplicou-se a prova U de Mann-Whitney. Através do teste de Wilcoxon, as variáveis estudadas foram comparadas entre a fase inicial e final do estudo, dentro de um mesmo grupo. O teste de correlação de Spearman foi realizado para avaliar a correlação entre as variáveis clínicas e a contaminação da dentina. O nível de significância estabelecido foi de 5%, e o indivíduo considerado a unidade analítica. Não houve diferença entre os grupos quanto à coloração (p=0,355), consistência (p=0,329) e contaminação (p=0,561) dentinária no início do estudo. Ao final, houve diferença quanto à coloração (p=0,023) e consistência (p=0,022), demonstrando que o hidróxido de cálcio promoveu endurecimento e escurecimento da dentina significativamente maior do que a cera. Quanto aos graus de contaminação, não houve diferença entre os grupos (p=0,703). Entre as fases do estudo, o hidróxido de cálcio promoveu alteração significativa nos graus de coloração (p=0,011), consistência (p=0,003) e contaminação (p=0,006) da dentina; enquanto a cera promoveu alteração nos níveis de consistência (p=0,007) e contaminação (p=0,003), não alterando os graus de coloração (p=0,564) da dentina. A coloração e contaminação iniciais apresentaram correlação positiva (rS=0,40; p=0,028), enquanto a consistência e contaminação finais apresentaram correlação negativa (rS=-0,50; p=0,005). Concluiu-se que o cimento de hidróxido de cálcio e a cera, quando utilizados como capeadores da dentina cariada, promoveram a inativação do processo carioso verificada por meio da alteração na consistência, bem como redução na contaminação do tecido.

Apresentação rediológica da tuberculose em pacientes HIV+ e HIV-

Introdução A AIDS trouxe mudanças na apresentação clínico-radiológica da tuberculose, com o surgimento de formas incomuns. Estas alterações vêm sendo discutidas na literatura internacional. Entretanto, o quadro clínico, radiológico e epidemiológico da apresentação pulmonar da tuberculose em pacientes infectados pelo vírus da imunodeficiência humana (HIV) em nosso meio não foi ainda completamente descrito. Pacientes e Métodos Foram estudadas as radiografias de tórax e coletados dados de prontuário de 231 pacientes com 37,7 ± 12,9 anos de idade, com tuberculose pulmonar comprovada por baciloscopia do escarro e sem história de tratamento prévio, internados no Hospital Sanatório Partenon no período de janeiro de 1997 a dezembro de 2001. Os pacientes foram divididos em grupos, de acordo com a presença ou não de infecção pelo HIV e de AIDS e de acordo com os valores de linfócitos (≤ 1500 ou > 1500 células/mm3) e de CD4 (≤ 200 ou > 200 células/mm3) no sangue periférico. Parâmetros clínicos e radiológicos foram comparados entre os grupos. Foram avaliados idade, sexo, cor da pele, estado geral, duração dos sintomas, alcoolismo, uso de drogas ilícitas, presença de diabetes melito, neoplasias ou adenomegalias superficiais e diagnóstico prévio ou atual de doenças oportunísticas associadas ao HIV. Pacientes que apresentaram adenomegalias superficiais foram considerados como tendo doença multifocal. Pacientes infectados pelo HIV (HIV +) que apresentaram doenças oportunísticas foram classificados como tendo o diagnóstico de síndrome da imunodeficiência adquirida (AIDS). As radiografias de tórax (póstero-ânterior e perfil) foram avaliadas para definir o tipo de tuberculose e a presença de adenomegalias intratorácicas associadas a lesões pulmonares, de cavidades e de derrame pleural. A tuberculose tipo primária, forma atípica em adultos, foi caracterizada pela presença de adenomegalias hilares e/ou mediastinais associadas a focos de consolidação peri-ganglionar ou no segmento anterior do lobo superior, segmento basal do lobo inferior, lobo médio ou língula. Resultados Os pacientes HIV+ eram mais jovens (34,3 ± 9,3 vs. 41,1 ± 15,0 anos; p<0,0001), utilizavam drogas ilícitas mais freqüentemente (61,3 vs. 12,5%; p<0,0001), apresentavam maior freqüência de doença multifocal (23,9 vs. 2,5%; p<0,0001) e contagem menor de linfócitos no sangue periférico (1590 ± 1077 vs. 2130 ± 974 células/mm3; p=0,0003) do que os pacientes não infectados pelo HIV (HIV-). A freqüência dos tipos de tuberculose foi diferente entre os pacientes HIV+ e HIV- (p<0,001), pela maior prevalência de tuberculose miliar, pneumonia tuberculosa e tuberculose tipo primária nos pacientes HIV+. A tuberculose tipo primária só ocorreu nos pacientes HIV+, sendo mais freqüente nos pacientes HIV+ com AIDS, nos pacientes com valores de linfócitos ≤ 1500 células/mm3 e naqueles com valores de CD4 ≤ 200 células/mm3. Os valores de CD4 foram mais baixos nos pacientes com tuberculose tipo primária [31 (3 – 71) células/mm3] do que nos com outros tipos de tuberculose (p<0,01), sem diferenças entre os demais tipos. Os pacientes HIV+ apresentaram menor freqüência de lesões escavadas do que os pacientes HIV- (70,8 vs. 91,5%; p<0,0001). A freqüência de cavidades foi ainda menor nos pacientes HIV+ com AIDS e naqueles com CD4 ≤ 200 células/mm3. Adenomegalias intratorácicas associadas a lesões pulmonares foram observadas em 20,4% dos pacientes HIV+ e em 0,8% dos HIV- (p<0,0001). Pacientes com adenomegalias intratorácicas apresentavam freqüências maiores de doença multifocal (45,8 vs. 9,2%; p<0,0001), contagens menores de linfócitos no sangue periférico (966 ± 480 vs. 1974 ± 1057 células/mm3; p<0,0001) e de CD4 [47 (3 – 268) vs. 266 (7 – 1288); p<0,0001], do que os pacientes com lesões pulmonares exclusivas. Na regressão logística múltipla, o HIV [RC = 11,5 (1,4 – 95,1); p=0,023], a doença multifocal [RC = 6,2 (1,7 – 22,2); p=0,005] e o tempo de sintomas [RC = 0,98 (0,96 – 0,99); p=0,025] estavam independentemente relacionados à presença de adenomegalias intratorácicas associadas a lesões pulmonares. Doença multifocal foi diagnosticada em 23,9% dos pacientes HIV+ e em 2,5% dos HIV- (p<0,0001), sendo mais freqüente nos pacientes com AIDS do que nos HIV+ sem AIDS (34,2 vs. 0%; p<0,0001). Pacientes com doença multifocal apresentavam contagens menores de linfócitos no sangue periférico (1244 ± 983 vs. 1966 ± 1038 células/mm3; p=0,001) do que os pacientes sem doença multifocal. Setenta e quatro por cento dos pacientes com doença multifocal apresentava contagem de linfócitos ≤ 1500 células/mm3. Na regressão logística múltipla, o HIV+ [RC = 10,4 (3,0 – 36,0); p<0,001] e a idade [RC = 0,94 (0,90 – 0,99); p=0,014] estavam independentemente associados à presença de doença multifocal. Os pacientes HIV+ sem AIDS não diferiram dos pacientes HIV- quanto aos tipos de tuberculose, quanto as freqüências de doença multifocal (0,0 vs. 2,9%; p=1,000), adenomegalias intratorácicas associadas a lesões pulmonares (2,9% vs. 0,8%; p=0,398) e lesões escavadas (88,2 vs. 91,5%; p=0,517), bem como quanto aos valores de linfócitos (2360 ± 1198 vs. 2130 ± 974 células/mm3; p=0,283). Conclusões Os pacientes HIV+ desta série apresentavam freqüência maior de adenomegalias intratorácicas associadas a lesões pulmonares, com o surgimento de formas atípicas, principalmente nos pacientes com maior grau de imunossupressão. Apresentavam ainda maior prevalência de adenomegalias superficiais, compatíveis com disseminação extratorácica da tuberculose. Em adultos, a tuberculose se caracterizava por ser uma doença unifocal, geralmente comprometendo o pulmão e sem adenomegalias intratorácicas associadas. Somente ocorria envolvimento de mais do que um órgão nos casos de tuberculose miliar e de tuberculose de excreção, quando os bacilos se disseminavam por via canalicular. Na presente série, observou-se proporção significativa de pacientes HIV+ com adenomegalias superficiais, o que pode corresponder à tuberculose multifocal. A maior freqüência dessas alterações nos pacientes com AIDS, bem como a freqüência aumentada de tuberculose miliar, corrobora com dados da literatura que demonstraram que as formas atípicas de tuberculose pulmonar e as formas graves são mais comuns em pacientes com imunossupressão avançada. A similaridade na freqüência dos tipos de tuberculose entre os pacientes HIV+ sem AIDS e os pacientes HIV- sugere que, em locais de alta prevalência de tuberculose, adultos HIV+ com apresentação clínico-radiológica usual de tuberculose, na ausência de história prévia ou atual de outras infecções oportunísticas, não devem ser classificados como tendo AIDS. Entretanto, é importante lembrar que com a introdução da highly active antiretrovial therapy (HAART), que reduziu a morbidade e a mortalidade causada pela AIDS, tem-se observado aumento nos valores de CD4 e diminuição na incidência de tuberculose em pacientes HIV+. Com isso, é possível que a tuberculose volte a se manifestar na sua forma clássica em pacientes com AIDS sob tratamento adequado. Com base nos achados do presente estudo os autores recomendam que, havendo suspeita clínica de tuberculose, a investigação prossiga, mesmo que as lesões radiológicas não sejam típicas. Ainda sugerem que, em casos de tuberculose tipo primária ou de doença multifocal, o teste anti-HIV seja realizado e, se positivo, que os valores de CD4 e a presença de doenças oportunísticas associadas sejam avaliados. Em locais onde a contagem de linfócitos CD4 não se encontra disponível, a contagem de linfócitos totais no sangue periférico deve ser realizada, uma vez que esta pode contribuir para o atendimento de pacientes com HIV e tuberculose.