This study developed a predictive model to identify pleural tuberculosis. A consecutive cases study of patients investigating the cause of pleural effusion, in an area of high prevalence of tuberculosis (Rio de Janeiro, Brazil). Clinical and laboratory variables were compared among patients with tuberculosis (TB) and without tuberculosis (NTB), individually and using logistic regression. The performance was described as diagnostic accuracy, compared to a gold standard in a masked way. We have studied 104 TB patients, 41 with malignant, 29 transudates, 28 parapneumonic, 13 with miscellaneous diseases. After identification of individual discrimination power aided by clinical, radiological and laboratory variables, the following ones were included in a multivariate analysis: ADA, total leukocytes, percentile of lymphocytes, protein, lactate dehydrogenase, duration of disease, age and gender. A logistic regression model to predict pleural tuberculosis including the five first variables showed the best performance. A receiver operating characteristic curve identified the best cutoff at 0.7, resulting in a sensitivity and specificity of more then 95%. The predictive model improved the specificity of ADA alone, keeping its sensitivity. This model seems helpful when a microbiological or histological diagnosis of pleural tuberculosis could not be established. External validation of these results is necessary before recommendation for routine application.

Fatigue occurs in patients with MS in the absence of motor dysfunction and is associated with the disease itself, the sedentary lifestyle, and mood disorders. The 6MWT is not useful to demonstrate motor fatigue in subjects without neurological disability.

The aim of the present study was to provide new spirometry reference equations in a sample of the Brazilian population for the following parameters: forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, peak of expiratory flow (PEF), forced expiratory flow at 50% (FEF50%), 75% average vital capacity (FEF25-75%), and average forced expiratory flow time (FEFT). This was a prospective study using results from chest radiographs, electrocardiograms, and questionnaires to investigate the participants' respiratory symptoms, sedentarism, and comorbidities (Charlson comorbidity index). From December 2010 to July 2014, individuals were randomly selected from various locations in the state of Rio de Janeiro. All individuals were examined by a single technician in the morning at the laboratory, and performed the spirometry with the same spirometer. Spirometry values were tabulated for the creation of three equation models: linear regression, logarithmic regression, and logarithms through a method that incorporates the lambda, median, and coefficient of variation (LMS method). Initially, 7003 individuals from both genders were contacted, and 454 were recruited. The data from the new equations were compared with one Brazilian and eight international equations, resulting in a high correlation (r>0.9). The values derived from the LMS method and linear regression were very similar (P>0.5), and both could be used to acquire the reference values for Brazilian spirometry. Data derived from the equations of this study were different from the current Brazilian equation, which could be justified by the different method used.

Since ADA is highly sensitive, we can practically exclude TB as the cause of effusion when there are low ADA values. However, to confirm the possibility of TB we recommend that other variables, such as prevalence of lymphocytes (higher than 90%), and high protein levels (more than 4 g/dL); low age (less than 45 years) also should be considered.

INTRODUÇÃO: A tuberculose é a causa mais freqüente de derrame pleural no Brasil. Em mais de 50% dos casos o tratamento tem sido instituído sem a confirmação do diagnóstico. Nosso objetivo é identificar variáveis que possam contribuir para este diagnóstico. MÉTODO: Estudamos 215 pacientes subseqüentes com derrame pleural, 104 com tuberculose (TB) e 111 com outras causas (NTB): 41 neoplasias, 29 transudatos, 28 parapneumômicos e 13 de outras etiologias. Variáveis clínicas, radiológicas e laboratoriais foram avaliadas quanto ao poder em discriminar os dois grupos de modo isolado ou em associação. RESULTADOS: O sexo masculino e a reação ao PPD maior do que 10mm foram significantemente mais freqüentes no grupo da tuberculose. Dentre as variáveis contínuas, a adenosina desaminase (ADA), o percentual de células, a proteína e a idade mostraram melhor desempenho isolado para o diagnóstico, com uma área abaixo da curva ROC maior do que 0,7 e razão de chance superior a 5. As características radiológicas, a desidrogenase lática, os leucócitos e o tempo de doença não foram capazes, isoladamente, de diferenciar o grupo TB do NTB. A associação da ADA com qualquer uma das demais variáveis contínuas, de melhor desempenho isolado, possui uma LR+ maior do que 10 e uma LR- menor do que 0,1, o que praticamente confirma a presença ou ausência da tuberculose pleural. CONCLUSÕES: Em pacientes com ADA maior do que 39U/L, a sensibilidade foi de 95%. A especificidade pode ser aumentada, para mais de 90%, se considerarmos os derrames não purulentos ou com predomínio de linfócitos (>50%).