Vitamin D status and latent tuberculosis infection : a preliminary study in a group of healthy Mexican agricultural workers

Vitamin D metabolites are important in the regulation of bone and calcium homeostasis, but also have a more ubiquitous role in the regulation of cell differentiation and immune function. Severely low circulating 25-dihydroxyvitamin D [25(OH)D] concentrations have been associated with the onset of active tuberculosis (TB) in immigrant populations, although the association with latent TB infection (LTBI) has not received much attention. A previous study identified the prevalence of LTBI among a sample of Mexican migrant workers enrolled in Canada's Seasonal Agricultural Workers Program (SA WP) in the Niagara Region of Ontario. The aim of the present study was to determine the vitamin D status of the same sample, and identify if a relationship existed with LTBI. Studies of vitamin D deficiency and active TB are most commonly carried out among immigrant populations to non-endemic regions, in which reactivation of LTBI has occurred. Currently, there is limited knowledge of the association between vitamin D deficiency and LTBI. Entry into Canada ensured that these individuals did not have active TB, and L TBI status was established previously by an interferon-gamma release assay (IGRA) (QuantiFERON-TB Gold In-Tube®, Cellestis Ltd., Australia). Awareness of vitamin D status may enable individuals at risk of deficiency to improve their nutritional health, and those with LTBI to be aware of this risk factor for disease. Prevalence of vitamin D insufficiency among the Mexican migrant workers was determined from serum samples collected in the summer of 2007 as part of the cross sectional LTBI study. Samples were measured for concentrations of the main circulating vitamin D metabolite, 25(OH)D, with a widely used 1251 250HD RIA (DiaSorin Inc.®, Stillwater, MN), and were categorized as deficient «37.5 nmoI/L), insufficient (>37.5 nmollL, < 80 nmol/L) or sufficient (2::80 nmoI/L). Fisher's exact tests and t tests were used to determine if vitamin D status (sufficiency or insufficiency) or 25(OH)D concentrations significantly differed by sex or age categories. Predictors of vitamin D insufficiency and 25(OH)D concentrations were taken from questionnaires carried out during the previous study, and analyzed in the present study using multiple regression prediction models. Fisher's exact test and t test was used to determine if vitamin D status or 25(OH)D concentration differed by LTBI status. Strength of the relationship between interferongamma (IFN-y) concentration (released by peripheral T cells in response to TB antigens) and 25(OH)D concentration was analyzed using a Spearman correlation. Out of 87 participants included in the study (78% male; mean age 38 years), 14 were identified as LTBI positive but none had any signs or symptoms of TB reactivation. Only 30% of the participants were vitamin D sufficient, whereas 68% were insufficient and 2% were deficient. Significant independent predictors of lower 25(OH)D concentrations were sex, number of years enrolled in the SA WP and length of stay in Canada. No significant differences were found between 25(OH)D concentrations and LTBI status. There was a significant moderate correlation between IFN-y and 25(OH)D concentrations ofLTBI-positive individuals. The majority of participants presented with Vitamin D insufficiency but none were severely deficient, indicating that 25(OH)D concentrations do not decrease dramatically in populations who temporarily reside in Canada but go back to their countries of origin during the Canadian winter. This study did not find a statistical relationship between low levels of vitamin D and LTBI which suggests that in the presence of overall good health, lower than ideal levels of 2S(OH)D, may still be exerting a protective immunological effect against LTBI reactivation. The challenge remains to determine a critical 2S(OH)D concentration at which reactivation is more likely to occur.

The Confederate Air Corps Certificate, 1958

A certificate from The Confederate Air Corps that reads, "To all who shall see these presents, greeting: Know yes, that in recognition of his having manifested an unusually high regard for black-eyed peas, turnip greens, hog jowl, sow belly, pot likkers, grits, chittlins, and good old corn squeezins, Dorothy Rungeling is, as of this date, hereby appointed to the rank of Colonel in the Confederate Air Corps. This officer will, by virtue of this appointment, therefore, be obliged to carefully and diligently discharge the duties of the office to which appointed by doing and performing all manner of things thereunto belonging. As evidence of his good faith in accepting this commission, the officer named herein will continue to praise the glories of the Deep South, consume a true gentleman's share of the fares mentioned above, pay respectful homage to our lovely Southern Belles, save his Confederate money, harass the carpetbaggers, and always remember that damnyankee is one word. As Secretary of this Corps, I strictly charge and require all officers of the air militia of the South to render such obedience and courtesies as are due an Officer of this distinguished rank and honored position. Done at the City of Montgomery, Alabama, the Cradle of the Confederacy, this Seventh day of July in the year One Thousand Nine Hundred and Fifty Eight." It is stamped with the name Thadeus P. Throckmorton - Secretary, Confederate Air Corps.

Samuel DeVeaux Woodruff, Casualty Details, Grave site information etc.

Copies (these items were copied from the internet) of Samuel DeVeaux's attestation paper, casualty details and a copy of a photo of Wailly Orchard Cemetery in which the old wooden crosses have been replaced by stones.