Metabolic and immune effects of dietary arginine, glutamine and omega-3 fatty acids supplementation in immunocompromised patients.

To evaluate the nutritional, metabolic and immune effects of dietary arginine, glutamine and omega-3 fatty acids (fish oil) supplementation in immunocompromised patients, we performed a prospective study on the effect of immune formula administered to 11 severe trauma patients (average ISS = 24), 10 burn patients (average % TBSA = 48) and 5 cancer patients. Daily calorie and protein administration were based on the patient's severity (Stress factor with the range of 35-50 kcal/kg/day and 1.5-2.5 g/kg/day, respectively) Starting with half concentration liquid immune formula through nasogastric tube by continuous drip at 30 ml/h and increasing to maximum level within 4 days. The additional energy and protein requirement will be given either by parenteral or oral nutritional support. Various nutritional, metabolic, immunologic and clinical parameters were observed on day 0 (baseline), day 3, 7, and 14. Analysis was performed by paired student-t test. Initial mean serum albumin and transferrin showed mild (trauma) to moderate (burn and cancer) degree of malnutrition. Significant improvement of nutritional parameters was seen at day 7 and 14 in trauma and burn patients. Significant increase of total lymphocyte count (day 7, P < 0.01), CD4 + count (day 7, p < 0.01), CD8 + count (day 7, p < 0.0005 & day 14, p < 0.05), complement C3 (day 7, p < 0.005 day 14, p < 0.01), IgG (day 7, and 14, p < 0.0005), IgA (day 7, p < 0.0005 & day 14, p < 0.05), in all patients. C-reactive protein decreased significantly on day 7 (p < 0.0005) and day 14 (p < 0.005). 3 cases of burn wound infection, one case of UTI and one case of sepsis were observed. Two cases of hyperglycemia in burn, 3 cases of hyperbilirubinemia in trauma, 10 cases of elevated LFT (5 trauma/5 burn), and one case of hyponatremia in cancer patients were observed. Two cases of nausea, 4 cases of vomiting, 5 cases of diarrhea (< 3 times/day), 2 cases of abdominal cramp, 1 case of distension were observed. The feeding of IMMUNE FORMULA was well tolerated and significant improvement was observed in nutritional and immunologic parameters as in other immunoenhancing diets. Further clinical trials of prospective double-blind randomized design are necessary to address the so that the necessity of using immunonutrition in critically ill patients will be clarified.

Indirect immunoperoxidase staining of Crithidia luciliae for detecting anti-dsDNA: comparison with other serodiagnostic tests.

The indirect immunoperoxidase (IIP) method was modified and improved for detecting anti-dsDNA. Using fetal calf serum to block the non-specific antibodies and staining with chromatic substrate solution at pH 6.2, the performance time is substantially decreased and the patterns of positive and negative staining are easily distinguished. IIP was compared with indirect hemagglutination (IHA), latex agglutination (LA) and the standard method indirect immunofluorescent technique (IFT). The sensitivities and specificities of the three methods were studied in 507 sera from various sources. Using IFT as the gold standard, sensitivities of IIP, IHA, LA were 98.18%, 88.18% and 50.91% respectively, and the corresponding specificities were 99.5%, 98.24% and 100%. There was a good correlation between titers of IFT and IIP (Spearman correlation coefficient = 0.77, p < 0.001) with no significant difference between the titer of both tests (Wilcoxon Matched-Pairs Signed-Rank test, p = 0.143). These results indicate that the modified IIP method is both highly sensitive and specific and only needs a light microscope to perform it.

Toxoplasma infection in healthy persons and in patients with HIV or ocular disease.

Toxoplasma infection is associated with acquired immune deficiency syndrome (AIDS), pregnancy, chorioretinitis, etc. Since the number of AIDS patients is increasing rapidly in Thailand and there are few reports about T. gondii immune status in this country. Toxoplasma-specific IgG and IgM antibodies (Ab) were determined in healthy persons and patients with different symptoms who were suspected of toxoplasmosis. Specific IgG Ab were detected in 3.2% of healthy persons, 12.5% of patients with ocular disease and in 42.5% in HIV positive patients. Only 3.1% of patients with ocular disease were positive for specific IgM Ab. No specific IgM Ab were found in the other samples studied.

Antistreptolysin O titers in school age children and in adults.

A study of ASO titers by latex agglutination was carried out in 176 healthy. Thais were ranging in age from 6 to 59 years. The peak ASO titer was reached with subjects of 11-15 years of age. Titer at 6-10 years of age was also high but slightly lower than that at 11-15 years. The level gradually decreased from age 16 to 59 years. In this study, 72.16% of all ASO titers were below 200 IU/ml, 20.45% were between 200-400 IU/ml, the remainders, 7.39%, were equal to or above 400 IU/ml. An upper limit of no more than 400 IU/ml. can be given to the group of 6-35 years of age. Above 35, the upper limit is not more than 200 IU/ml. However, latex ASO test is good for screening because it is simple and rapid. Semiquantitative titers can also be determined by serial dilution of the serum. Confirmation of the elevated latex ASO titers can be done by a haemolytic test.

VDRL and TPHA tests in pregnant women and biological false positive for VDRL.

In 1980, 1981, 1982, 1983 and 1984, the author and colleagues performed serological tests for syphilis in 25,860, 27,971, 26,655 and 25,348 pregnant women respectively. The results obtained showed reactive VDRL at the rate 3,952, 3,800, 3,741, 3,500 and 3,156 cases in 1980, 1981, 1982, 1983 and 1984 respectively per 100,000 population,. When TPHA test, which is more specific for syphilis, was performed in the same groups of subjects, positive results was obtained at the rate of 2,394, 2,535, 2,416, 2,328 and 2,320 case per 100,000 populations respectively. The results of both tests performed during different years showed no statistically significant difference. False positive for VDRL in these pregnant women was obtained in 1.56, 1.26, 1.32, 1.17 and 0.84 percent of the studied cases in the testing years respectively; and such false positive VDRL in pregnant women is significant when VDRL is the only test available in the laboratory.

Manual and automatic leucocyte counts.

A total of 2012 venous blood samples of healthy individuals were determined for leucocyte counts. The samples were taken between 9.00 to 12.00 a.m. Samples of 503 males and 504 females were examined by manual method, while another 502 males and 503 females were counted by electronic or automatic machine. The results were evaluated by Student’s t-test. The mean + standard deviation of ages in the manual group was 30.9 + 8.6 years for males and 27.4 + 7.7 years for females. They had a mean + standard deviation of total leucocyte counts 7003.78 + 785.76 cells per cu.mm. for males and 7028.83 + 778.09 cells per cu.mm. for females. There was no significant statistical difference (p=0.98981). The mean + standard deviation of ages in the automatic group was 29.5 + 7.4 years for males and 29.3 + 7 years for females. The mean + standard deviation of total leucocyte counts was 6482.68 + 1267.98 and 6819.89 + 1252.55 cells per cu.mm. for males and females respectively. the difference was not significant (p=0.98194). There was no significant statisfical difference in total leucocyte counts 1. between manual and automatic method 2. between males and females The average + standard deviation of total leucocyte counts of 2012 healthy individuals was 6924 + 1053 cells per cu.mm. The small variation of leucocyte counts among subjects aged 10 to 50 years was also observed.