Mycobacterium tuberculosis Sonicate–Induced IFNγ, CXCL10 and IL10 can Differentiate Severity in Tuberculosis

Improved tools are required to study immunopathogenesis of tuberculosis (TB). Mycobacterium tuberculosis antigen‐stimulated T cell‐based assays can detect TB but are less effective when responses are compromised such as in severe disease. We investigated immune responses to M. tuberculosis whole sonicate (MTBs), recombinant antigens ESAT6 and CFP10 in whole blood cells of healthy endemic controls (EC, n = 42) and patients with pulmonary (PTB, n = 36) or extrapulmonary (ETB, n = 41) disease. Biomarkers of T cell activation (IFNγ) or modulation (IL10) and chemokines, CXCL9, CXCL10 and CCL2, secretion were measured. MTBs, ESAT6 and CFP10 all induced IFNγ responses in TB. ESAT6‐induced IFNγ was elevated in TB as compared with EC. MTBs stimulated the highest IFNγ levels but did not differentiate between TB and EC. However, MTBs‐induced CXCL10 (P = 0.004) was reduced, while IL10 (P < 0.001) was raised in TB as compared with EC. Between sites, MTBs‐induced CCL2 (P = 0.001) and IL10 secretion was higher in PTB than ETB (P < 0.001). In comparison of disease severity, MTBs‐induced IFNγ (P = 0.014) and CXCL10 (P = 0.022) levels were raised in moderate as compared with far advanced PTB. In ETB, MTBs‐induced IL10 levels were greater in less‐severe (L‐ETB) than in severe disseminated (D‐ETB) cases, P = 0.035. Within the L‐ETB group, MTBs‐induced IFNγ was greater in patients with tuberculous lymphadenitis than those with pleural TB (P = 0.002). As immune responses to MTBs were differentially activated in TB of different sites and severity, we propose the utility of MTBs‐induced IFNγ, CXCL10 and IL10 as biomarkers in TB.     

The effects of body mass index and age on cross‐sectional properties of the femoral neck

Research on the relationship between body mass index (BMI) and cross‐sectional geometry of long bone diaphyses demonstrates that strength properties are significantly greater in obese versus normal BMI individuals. However, articular dimensions do not differ appreciably. If femoral head size remains constant, we hypothesize that the femoral neck remodels to accommodate greater loads associated with increased BMI. High‐resolution CT scans (n = 170 males) were divided into three BMI groups (normal, overweight, and obese) and two age groups (21–50 and >50). OsiriX software was used to obtain a cross‐sectional slice at the waist of the femoral neck. Cortical area (CA), total cross‐sectional area (TA), percent cortical area (%CA), circularity index (I_max/I_min), section modulus (Z_pol), and second moment of area (J) were measured with ImageJ software. The effects of age and BMI were evaluated statistically. Pairwise comparisons in the younger group only detected significant differences between normal and obese males in the circularity index (P = 0.022). The older cohort showed significant differences in CA (P < 0.001), %CA (P = 0.004), Z_pol (P = 0.007), and J (P < 0.001) between normal and obese groups. This study shows that the effects of obesity on the cross‐sectional geometry of the femoral neck are more pronounced in older males relative to younger males. Older males with increased BMI have greater cortical area and bone strength in the femoral neck relative to younger males, thus making the femoral neck less susceptible to fractures in obese individuals. Clin. Anat. 28:1048–1057, 2015. © 2015 Wiley Periodicals, Inc.     

Cytokine polarization in miliary and pleural tuberculosis

Cytokines were measured in patients with pleural effusion and miliary tuberculosis (TB). Patients with pleural effusion had significantly higher interferon-gamma (IFN-) levels (P < 0.001) in their pleural fluid as compared to that of peripheral blood of the same patients, thus exhibiting localization of predominantly Th1-type immunity in the pleural fluid. On the contrary, patients with miliary TB had higher IFN- levels in the peripheral blood as compared to their bronchoalveolar lavage fluid. Moreover, the median IFN-:IL-4 ratio in the peripheral blood of miliary TB patients was two-fold higher as compared to bronchoalveolar lavage fluid, suggesting that the cytokine profile at the disease site is skewed toward a Th2-like bias. Further, flow cytometry data revealed a significantly higher (P < 0.001) percentage of CD4⁺ pleural fluid lymphocytes expressing IFN-, whereas in the miliary TB, a nine-fold higher percentage of lymphocytes in bronchoalveolar lavage fluid expressed IL-4 in comparison with their peripheral CD4 T cells. Our data indicate, respectively, a Th1-like and Th2-like response in tuberculous pleural effusion and miliary TB, suggesting that these clinical forms of extrapulmonary tuberculosis probably reflect the extreme ends of a Th1–Th2 spectrum of the disease.     

Modified TB rapid test by proteinase K for rapid diagnosis of pleural tuberculosis

The diagnosis of pleural tuberculosis continues to be a challenge due to the low sensitivity of traditional diagnostic methods. Better and more rapid tests are needed for diagnosis of pleural TB. In this study, pleural fluids were tested with rapid test to determine Mycobacterium tuberculosis (MTB antigen). Affinity chromatography was used to purify specific polyclonal antibodies against MTB antigen. Pleural samples after decontamination were treated with proteinase K. Rapid test for pleural fluids was prepared by specific antibody. Rapid test was performed on 85 pleural fluid patients. The patients had a mean age of 46.55 ± 15.96 years and 38 were men. The performance of rapid test, using proteinase K, was found to be the most impressive: sensitivity 93%, specificity 94%, PPV 90%, and NPV 96% compared with adenosine deaminase test (ADA), PCR, smear, and culture. The present study did demonstrate that modified TB rapid test can substantially improve the diagnosis of extrapulmonary TB.     

Prevalence of antibodies to PPD and lipoarabinomannan of Mycobacterium tuberculosis among patients with an indication of fine needle aspiration biopsy.

Recent increase in the incidence of lung cancer often makes it difficult to differentiate between lung cancer and tuberculosis (TB), due to their radiologic similarities. Fine needle aspiration biopsy (FNAB) has been widely employed for the diagnosis of lung cancer and TB, but the diagnostic accuracy of TB is not high enough. As a rapid screening test for tuberculosis, we evaluated serological tests using Mycobacterium tuberculosis PPD and lipoarabinomannan (LAM) antigens. A total of 95 patients with indication of FNAB cytology from initial CT findings were enrolled. 25 patients had TB, 76 thoracic malignancy, and six (7.9%) of the lung cancer patients also had TB, indicating much higher prevalence of TB in thoracic tumor patients. Antibodies to PPD were elevated in 18 (72.0%) of 25 TB patients and in 22 (31.4%) of 70 patients with thoracic malignancy. In contrast, only 3 (4.7%) of 64 healthy controls aged 40 or above were seropositive to PPD antigen. The prevalence of anti-PPD antibodies in thoracic tumor patients was therefore significantly greater than that amongst the healthy controls (p<0.001, chi-square test). However, no significant difference in the prevalence of anti-LAM antibodies was found between study subjects and controls. This study demonstrates that thoracic tumor patients have significantly elevated antibodies to PPD; therefore, high anti-PPD seroreactivity in thoracic tumor patients should be cautiously interpreted. A longitudinal investigation on seropositive thoracic tumor patients is required to determine the role of the serological test for TB in lung cancer patients.     

Validity of the body mass index as an indicator of adiposity in an ethnically diverse population of youths

The primary objective was to investigate the influences of ethnicity and pubertal stage on the ability of body mass index (BMI) to rank adiposity in a cohort of 402 Asian, African, Hispanic, and White Americans, aged 9–25 years. BMI was calculated from measured weight and height. Body composition and pubertal stage were determined by dual energy x-ray absorptiometry and self-rating, respectively. Multiple linear regression models with BMI, ethnicity, puberty, and age as explanatory variables were used to determine if ethnicity and pubertal stage modify the ability of BMI to predict percent of body weight that is fat (%BF). Spearman's correlation coefficients of BMI with %BF were also estimated. Both ethnicity and pubertal stage interacted with BMI. The correlation between BMI and %BF (r) was much higher in females (r = 0.72, P < 0.001) than in males (r = 0.15, NS). Among females, correlations did not vary much by pubertal stage, but tended to be higher in Blacks. Among males, correlations tended to be low during mid-puberty. However, a high correlation between BMI and lean body mass (LBM) was consistently observed in mid-pubertal males across all ethnic groups. Stratification by quartile of BMI showed that the correlation was >0 (P < .05) only in the highest quartile. Thus, in an ethnically diverse cohort of 9–25 year olds, the correlation between BMI and %BF is poor in the lower quartiles of BMI. In comparison, LBM correlates better with BMI than %BF in the lower quartiles of BMI. © 1996 Wiley-Liss, Inc.     

Progression of clinical tuberculosis is associated with a Th2 immune response signature in combination with elevated levels of SOCS3

In this study, we explored the local cytokine/chemokine profiles in patients with active pulmonary or pleural tuberculosis (TB) using multiplex protein analysis of bronchoalveolar lavage and pleural fluid samples. Despite increased pro-inflammation compared to the uninfected controls; there was no up-regulation of IFN-γ or the T cell chemoattractant CCL5 in the lung of patients with pulmonary TB. Instead, elevated levels of IL-4 and CCL4 were associated with high mycobacteria-specific IgG titres as well as SOCS3 (suppressors of cytokine signaling) mRNA and progression of moderate-to-severe disease. Contrary, IL-4, CCL4 and SOCS3 remained low in patients with extrapulmonary pleural TB, while IFN-γ, CCL5 and SOCS1 were up-regulated. Both SOCS molecules were induced in human macrophages infected with Mycobacterium tuberculosis in vitro. The Th2 immune response signature found in patients with progressive pulmonary TB could result from inappropriate cytokine/chemokine responses and excessive SOCS3 expression that may represent potential targets for clinical TB management.     

Internal rib structure can be predicted using mathematical models: An anatomic study comparing the chest to a shell dome with application to understanding fractures

The human rib cage resembles a masonry dome in shape. Masonry domes have a particular construction that mimics stress distribution. Rib cortical thickness and bone density were analyzed to determine whether the morphology of the rib cage is sufficiently similar to a shell dome for internal rib structure to be predicted mathematically. A finite element analysis (FEA) simulation was used to measure stresses on the internal and external surfaces of a chest‐shaped dome. Inner and outer rib cortical thickness and bone density were measured in the mid‐axillary lines of seven cadaveric rib cages using computerized tomography scanning. Paired t tests and Pearson correlation were used to relate cortical thickness and bone density to stress. FEA modeling showed that the stress was 82% higher on the internal than the external surface, with a gradual decrease in internal and external wall stresses from the base to the apex. The inner cortex was more radio‐dense, P < 0.001, and thicker, P < 0.001, than the outer cortex. Inner cortical thickness was related to internal stress, r = 0.94, P < 0.001, inner cortical bone density to internal stress, r = 0.87, P = 0.003, and outer cortical thickness to external stress, r = 0.65, P = 0.035. Mathematical models were developed relating internal and external cortical thicknesses and bone densities to rib level. The internal anatomical features of ribs, including the inner and outer cortical thicknesses and bone densities, are similar to the stress distribution in dome‐shaped structures modeled using FEA computer simulations of a thick‐walled dome pressure vessel. Fixation of rib fractures should include the stronger internal cortex. Clin. Anat. 28:1008–1016, 2015. © 2015 Wiley Periodicals, Inc.     

T regulatory cells and immune activation in Mycobacterium tuberculosis infection and the effect of preventive therapy

Mycobacterium tuberculosis (TB) often causes persistent infection and many immune cell subsets and regulatory mechanisms may operate throughout the various stages of infection. We have studied dendritic cell (DC) subsets, regulatory T cells (Treg) and the expression of activation and apoptosis markers on CD4⁺ and CD8⁺ T cells in blood from patients with active TB (n = 20), subjects with positive QuantiFERON‐TB GOLD (QFT) test (LTBI, latent TB infection) (n = 20) before and after 3 months of preventive anti‐tuberculous therapy and from QFT‐negative controls (n = 28). The frequency of CD4⁺CD25⁺CD127^? Treg was highest in the group with active TB (P = 0.001), but also increased in the LTBI group (P = 0.006) compared to controls. The highest level of activated T cells, defined as CD38⁺HLA‐DR⁺ cells, was found in the active TB group, for the CD4⁺ T cell subset positively correlated to the level of CD25⁺CD127^? Treg (P < 0.001, r = 0.4268). After 3 months of preventive therapy, there was an increase in the fraction of foxp3⁺ Treg, but no differences in markers of activation or apoptosis. In conclusion, there seems to be an increased level of immune activation and Treg in both latent and active TB infection that is only modestly influenced by preventive therapy.     

Striking the right immunological balance prevents progression of tuberculosis

Introduction

Tuberculosis (TB) caused by infection with Mycobacterium tuberculosis (Mtb) is a major burden for human health worldwide. Current standard treatments for TB require prolonged administration of antimycobacterial drugs leading to exaggerated inflammation and tissue damage. This can result in the reactivation of latent TB culminating in TB progression. Thus, there is an unmet need to develop therapies that would shorten the duration of anti-TB treatment and to induce optimal protective immune responses to control the spread of mycobacterial infection with minimal lung pathology.

Findings

Granulomata is the hallmark structure formed by the organized accumulation of immune cells including macrophages, natural killer cells, dendritic cells, neutrophils, T cells, and B cells to the site of Mtb infection. It safeguards the host by containing Mtb in latent form. However, granulomata can undergo caseation and contribute to the reactivation of latent TB, if the immune responses developed to fight mycobacterial infection are not properly controlled. Thus, an optimal balance between innate and adaptive immune cells might play a vital role in containing mycobacteria in latent form for prolonged periods and prevent the spread of Mtb infection from one individual to another.

Conclusion

Optimal and well-regulated immune responses against Mycobacterium tuberculosis may help to prevent the reactivation of latent TB. Moreover, therapies targeting balanced immune responses could help to improve treatment outcomes among latently infected TB patients and thereby limit the dissemination of mycobacterial infection.

     

Immunological diagnosis of tuberculosis based on recombinant antigens ESAT-6 and CFP-10 in children from an endemic area in northeast Brazil

Diagnostic tests for tuberculosis (TB) using interferon gamma (IFN‐γ) responses produced by T lymphocytes after stimulation by early secretory antigen target 6 (ESAT‐6), culture filtrate protein 10 (CFP‐10) or purified protein derivate (PPD) were carried out using ELISA (enzyme‐linked immunosorbent assay) in whole blood culture supernatants from children with suspected TB disease (n = 21), latent TB infection (LTBI; n = 17) and negative controls (NC; n = 21) from Recife, Pernambuco, Brazil. The results were analysed using the ROC (receiver operating characteristic) curves and the areas under the curve (AUC) generated varied from 0.5 to 1.0 with higher values indicating increased discriminatory ability. Comparisons of AUCs were made using non‐parametric assumptions, and the differences were considered significant if P < 0.05. The ROC curve showed a statistical difference (P = 0.015) between the LTBI and NC groups with an AUC of 0.731, TB disease and NC (AUC = 0.780; P = 0.002) and a group with TB (latent infection + disease, n = 38) and NC (AUC = 0.758; P = 0.001) when the antigen used was ESAT‐6. No statistical difference was found between the groups when CFP‐10 or PPD was used. In conclusion, the ESAT‐6 test may be the most appropriate for diagnosis of childhood TB, both LTBI and TB disease, when associated with epidemiological and clinical data, especially in endemic areas such as Brazil.     

Diagnostic utility of pleural fluid IFN-gamma in tuberculosis pleural effusion.

Pleural fluid interferon-gamma (IFN-gamma) levels are increased in patients with tuberculosis (TB) pleural effusion. Recent studies from the west have found that estimation of pleural fluid IFN-gamma levels is an excellent diagnostic strategy for these patients. The diagnostic utility of pleural effusion IFN-gamma level estimation has not been evaluated in patients from developing countries, however. This work was carried out to study the diagnostic utility of IFN-gamma level estimation in patients with TB pleural effusion and to define the best cutoff of IFN-gamma for diagnosis TB pleural effusion. We studied 101 patients with pleural effusion. Of these, 64 were found to have a TB etiology, established by means of various conventional modalities. Measurement of pleural fluid IFN-gamma levels was done by ELISA technique. The median value of pleural fluid IFN-gamma levels in patients with TB (1480 pg/ml, range 3-14,000 pg/ml) was significantly higher (p < 0.001) compared with the non-TB group (3 pg/ml, range 0-900 pg/ml). The receiver operator characteristic (ROC) curve for IFN-gamma showed an area under the curve (AUC) value of 0.954, and the best cutoff was computed to be 138 pg/ml. Using this cutoff for IFN-gamma levels in pleural fluid for the diagnosis of TB, sensitivity, specificity, negative predictive value, and positive predictive value were found to be 90.2%, 97.3%, 85.7%, and 98.3%, respectively. Estimation of IFN-gamma levels in pleural fluid is a useful diagnostic modality for TB pleural effusion. A cutoff of 138 pg/ml provides the best sensitivity and specificity for diagnosis of TB.     

Population change in adult obesity and blood lipids in American Samoa from 1976–1978 to 1990

Obesity in American Samoan adults in 1990 was compared to that in 1976–1978 to evaluate population changes concomitant with modernization. Body weight, stature, the body mass index (BMI), and two skinfolds were measured in 1990 in 830 males and females 25–74 years old, and were compared to corresponding data from 1976 and 1978 for 1,621 adults. Mean BMI and skinfold thicknesses increased markedly from 1976–1978 to 1990 in males at all ages. Mean BMI for 45–54 year old males was approximately 3.6 kg/m² higher (P < 0.0001) in 1990 than in 1976–1978, but was only 0.6 kg/m² higher in females of the same age. The prevalence of overweight increased significantly from 66% in 1976–1978 to 85% in 1990 (P < 0.001) in 35–44 year old males, but remained about the same, 91%, in females of that age. Similar sex differences in temporal change were found in skinfolds. Fasting serum total and high density lipoprotein (HDL) cholesterol and triglycerides were obtained for a random subsample of 67 males 40–49 years old and were compared to lipid levels in a 1978 sample of American Samoan males of similar age and residence. Both total and HDL cholesterol were significantly different between 1978 and 1990, 178 vs. 205 mg/dl (P < 0.02), and 43 vs. 37 mg/dl (P < 0.01), respectively. Triglycerides were higher in 1990 than in 1978, 169 vs. 128 mg/dl. The results suggest that obesity and adiposity increased more over 12–14 years among adult males than among females, who in 1976–1978 were already massively overweight. © 1993 Wiley-Liss, Inc.     

Change in body mass index is a stronger predictor of change in fat mass than lean mass in elderly black and white women

The aim of this study was to determine the relation between change in body mass index (BMI) and changes in fat mass (FM), lean soft tissue (LST), and percentage body fat (%Fat) in elderly (67.6 ± 6.0 years) women varying in race (53 black, 144 white) who underwent measurements of BMI, FM, LST, and %Fat at baseline and after 2 years. The group did not markedly change body composition over 2 years (BMI = ?0.1 ± 1.5 kg/m², P = 0.53; FM = 0.0 ± 2.8 kg, P = 0.95; LST = ?0.4 ± 1.7 kg, P < 0.001; %Fat = 0.3 ± 2.0%, P = 0.06). Change in BMI predicted change in FM (r = 0.90, SEE = 1.19 kg FM, P < 0.001) but was less predictive of change in %Fat (r = 0.64, SEE = 1.54%Fat, P < 0.001). Change in BMI was curvilinearly related to change in LST adjusted for change in height (R = 0.76, SEE = 1.10 kg LST, P < 0.001). Change in BMI more strongly predicts change in FM than LST and could be used to monitor change in FM in community‐dwelling women. Am. J. Hum. Biol., 2009. © 2008 Wiley‐Liss, Inc.     

Influence of diabetes mellitus on immunity to human tuberculosis

Type 2 diabetes mellitus(DM) is a major risk factor for the development of active pulmonary tuberculosis (TB), with development of DM pandemic in countries where TB is also endemic. Understanding the impact of DM on TB and the determinants of co‐morbidity is essential in responding to this growing public health problem with improved therapeutic approaches. Despite the clinical and public health significance posed by the dual burden of TB and DM, little is known about the immunological and biochemical mechanisms of susceptibility. One possible mechanism is that an impaired immune response in patients with DM facilitates either primary infection with Mycobacterium tuberculosis or reactivation of latent TB. Diabetes is associated with immune dysfunction and alterations in the components of the immune system, including altered levels of specific cytokines and chemokines. Some effects of DM on adaptive immunity that are potentially relevant to TB defence have been identified in humans. In this review, we summarize current findings regarding the alterations in the innate and adaptive immune responses and immunological mechanisms of susceptibility of patients with DM to M. tuberculosis infection and disease.     

Revisiting thoracic surface anatomy in an adult population: A computed tomography evaluation of vertebral level

To compare key thoracic anatomical surface landmarks between healthy and patient adult populations using Computed Tomography (CT). Sixteen slice CT images of 250 age and gender matched healthy individuals and 99 patients with lung parenchymal disease were analyzed to determine the relationship of 17 thoracic structures and their vertebral levels using a 32‐bit Radiant DICOM viewer. The structures studied were: aortic hiatus, azygos vein, brachiocephalic artery, gastroesophageal junction (GEJ), left and right common carotid arteries, left and right subclavian arteries, pulmonary trunk bifurcation, superior vena cava junction with the right atrium, carina, cardiac apex, manubriosternal junction, xiphisternal joint, inferior vena cava (IVC) crossing the diaphragm, aortic arch and junction of brachiocephalic veins. The surface anatomy of all structures varied among individuals with no significant effect of age. Binary logistic regression analysis showed a significant association between individual health status and vertebral level for brachiocephalic artery (P = 0.049), GEJ (P = 0.020), right common carotid (P = 0.009) and subclavian arteries (P = 0.009), pulmonary trunk bifurcation (P = 0.049), carina (P = 0.004), and IVC crossing the diaphragm (P = 0.025). These observations differ from those reported in a healthy white Caucasian population and from the vertebral levels of the IVC, esophagus, and aorta crossing the diaphragm in an Iranian population. The differences observed in this study provide insight into the effect of lung pathology on specific thoracic structures and their vertebral levels. Further studies are needed to determine whether these are general changes or pathology‐specific. Clin. Anat. 30:227–236, 2017. © 2017 Wiley Periodicals, Inc.     

An observational study on the incidence of tuberculosis among a cohort of HIV infected adults in a setting with low prevalence of tuberculosis

Background: Tuberculosis (TB) remains a main cause of morbidity and mortality among individuals infected with HIV. We investigated the incidence of TB among a cohort of HIV infected patients attending a setting with low TB burden where screening for latent TB infection is not routinely carried out.

Methods: an observational cohort study on HIV-infected adults attending the HIV clinic at Queen Elizabeth Hospital Birmingham, UK between 1 January 2011 and 30 September 2015. Patients with culture-proven TB after HIV diagnosis, or those treated for clinical diagnosis of the infection, were classified as having “active TB”.

Results: 1824 patients were included in the study (5347 patient years of follow up), of whom 21 patients developed TB (16 microbiology confirmed). Of the 666 new HIV diagnoses, six patients developed TB within one month, giving a TB prevalence at the time of HIV diagnosis of 0.9%. The total TB incidence for the remaining 1818 patients was 2.81 cases per 1000 patient years (95% CI: 1.63–4.53). TB incidence was significantly more common among patients with CD4 ≤ 200 cells/mm³ compared to those with CD4 > 500 cells/mm³ (28.2 vs. 1.22 per 1000 patient years, p < 0.001), and in patients with VL ≥ 40 copies/mL compared to <40 copies/mL (8.30 vs. 1.42, p < 0.001).

Conclusion: In settings with low TB prevalence, early start of combined antiretroviral therapy and intensified TB case finding protocols may significantly reduce the incidence of TB.     

Body mass index,overweight and obesity in married and never married men and women in Poland

The study examined the relationship between marital status and the body mass index (BMI) and the prevalence of overweight and obesity in the Polish population. The sample included 2,266 men and 4,122 women, 25–60 years of age, who were occupationally active inhabitants of Wroclaw, in southwestern Poland. Marital status was defined by two categories: never married and presently married, and two groups in each category were established on the basis of educational level: well‐educated (12 or more years in school) and poorly educated (less than 12 years in school). The subjects were also divided into four age groups: 25–30, 31–40, 41–50, and 51–60 years. Height and weight were measured and the BMI was calculated. Three categories of the BMI were established: normal, BMI < 25.0 kg/m², overweight, BMI ≥ 25 < 30 kg/m², and obese, BMI ≥ 30 kg/m². In each age and educational group, married individuals had a higher BMI than those who were never married. With the exception of well‐educated males 51–60 years, differences in the BMI between married and never married individuals increased with age. In general, married men and women were more likely to be overweight and obese than never married individuals. The results indicated a significant association (P < 0.001) between marital status and the BMI in both sexes. After age, marital status was the most important predictor of overweight/obesity among men (P < 0.001), whereas educational level did not have a significant role. Among women, age, marital status, and education were significantly (P < 0.001) related to the BMI. Am. J. Hum. Biol. 14:468–475, 2002.© 2002 Wiley‐Liss, Inc.     

BMI in the Trois‐Rivières study: Child–adult and child–parent relationships

This study evaluated intraindividual child–adult and interindividual child–parent relationships of body mass index (BMI) using data from the Trois‐Rivières semilongitudinal study of growth and development. Intraindividual correlations between age 12 and 35 years were substantial (r² = 36% of variance in women, 30% of variance in men). Interindividual child–parent correlations for mothers and fathers age 36.6 ± 0.4 and 39.5 ± 0.4 years, respectively, were very low to low for daughters age 12 years (r = 0.09, NS and 0.34, P < 0.001 vs. father and mother, respectively) but all very low for sons age 12 years (r = 0.07, NS and 0.16, NS vs. father and mother, respectively). A multiple regression analysis predicted adult BMI from the individual's BMI at 10, 11, 12 years plus the maternal and paternal BMIs as calculated from self‐reported heights and weights. The BMI at age 12 years was a better predictor of adult BMI than the parental BMI in both men and women (P < 0.001) and multivariate analysis revealed that this index at age 12 years was the sole significant predictor of adult BMI for both men and women. The results from our study do not support the hypothesis that parental BMI is a stronger predictor of adult BMI than childhood BMI. However, useful information for the prediction and prevention of adult overweight can be obtained from the BMI at age 12 years. Our results suggest that environmental influences may be the major factor in the present obesity epidemic. Am. J. Hum. Biol. 15:187–191, 2003. © 2003 Wiley‐Liss, Inc.     

Clinical and laboratory parameters in the differential diagnosis of pleural effusion secondary to tuberculosis or cancer

PURPOSE: To evaluate the clinical and laboratory characteristics of pleural effusions secondary to tuberculosis (TB) or cancer (CA). METHODS: A total of 326 patients with pleural effusion due to TB (n=182) or CA (n=144) were studied. The following parameters were analyzed: patient gender, age and pleural effusion characteristics (size, location, macroscopic fluid aspect, protein concentration, lactate dehydrogenase (DHL) and adenosine deaminase activity (ADA) and nucleated cell counts). RESULTS: Young male patients predominated in the tuberculosis group. The effusions were generally moderate in size and unilateral in both groups. Yellow-citrine fluid with higher protein (p < 0.001) levels predominated in effusions from the tuberculosis group (5.3 + 0.8 g/dL) when compared to the CA group (4.2 +/- 1.0 g/dL), whereas DHL levels were more elevated in CA (1,177 +/- 675 x 1,030 +/- 788 IU; p = 0.003) than in TB. As expected, ADA activity was higher in the TB group (107.6 +/- 44.2 x 30.6 +/- 57.5 U/L; p < 0.001). Both types of effusions presented with high nucleated cell counts, which were more pronounced in the malignant group (p < 0.001). TB effusion was characterized by a larger percentage of leukocytes and lymphocytes (p < 0.001) and a smaller number of mesothelial cells (p = 0.005). Lymphocytes and macrophages were the predominant nucleated cell in neoplastic effusions. CONCLUSION: Our results demonstrate that in lymphocytic pleural exudate obtained from patients with clinical and radiological evidence of tuberculosis, protein and ADA were the parameters that better characterize these effusions. In the same way, when the clinical suspicion is malignancy, serous-hemorrhagic lymphocytic fluid should be submitted to oncotic cytology once this easy and inexpensive exam reaches a high diagnostic performance (approximately equal 80%). In this context, we suggest thoracocentesis with fluid biochemical and cytological examination as the first diagnostic approach for these patients.