Effects of n-3 fatty acids on serum interleukin-6, tumour necrosis factor-alpha and soluble tumour necrosis factor receptor p55 in active rheumatoid arthritis.

We investigated the effects of a low n-6 fatty acid (FA) diet supplemented with fish oil on serum pro-inflammatory cytokine concentrations and clinical variables in patients with active rheumatoid arthritis (RA). Sixty patients were randomly assigned to receive a diet low in n-6 FAs and n-3 FAs supplement (fish oil group), a diet low in n-6 FAs and placebo (placebo group), or no special diet or intervention (control group). Serum cytokines and clinical and biochemical variables were evaluated at baseline and various timepoints. At week 18 the fish oil group had significant reductions in linoleic acid, C-reactive protein (CRP) and soluble tumour necrosis factor receptor p55 (sTNF-R p55), and significant elevations in eicosapentaenoic acid and docosahexaenoic acid compared with baseline. There were no significant differences in the clinical variables between the three groups. At week 24 there were significant reductions in interleukin-6 and TNF-alpha in the fish oil and placebo groups. Supplementation with n-3 FA and a low n-6 FA intake decreased serum sTNF-R p55 and CRP levels in patients with RA.

Plasma HIV-1 RNA viral load and serum vitamin A and E levels in HIV-1 infected pregnant women.

The aim of this study was to assess the correlation between plasma HIV-1 RNA viral load and serum vitamin A and E concentrations and vitamin E/cholesterol ratio in HIV-1 infected pregnant women not receiving antiretroviral therapy There were no significant correlations between plasma HIV-1 RNA viral load and serum vitamin A and E concentrations and vitamin E/cholesterol ratio. However, the presence of underlying vitamin A deficiency in these pregnant women was common.

Antioxidant nutrients and lipid peroxide levels in Thai preeclamptic pregnant women.

OBJECTIVE: To compare the antioxidant nutrients and lipid peroxide levels in preeclampsia and normal pregnant women. METHODS: Antioxidant nutrients (vitamin A and E) were measured by high-pressure liquid chromatography, vitamin C was measured by the dinitrophenyl hydrazine method, lipid peroxides were measured by the malondialdehyde method in 20 severe preeclampsia, 30 mild preeclampsia and 60 normal pregnant women as controls. RESULTS: Vitamin C levels in severe and mild preeclampsia were significantly less than those in control group. The corrected vitamin E and vitamin A levels were significantly decreased only in severe preeclampsia. While the lipid peroxide levels in both mild and severe preeclampsia were significantly increased when compared with the nomal pregnancy. CONCLUSIONS: Preeclampsia is associated with the imbalance between lipid peroxides and antioxidant nutrients (vitamin C and E). The imbalances favour lipid peroxides with the increasing severity of preeclampsia.

Maternal and umbilical cord serum vitamin A, E levels and mother-to-child transmission in the non-supplemented vitamin A, E HIV-1 infected parturients with short-course zidovudine therapy.

This study was undertaken to assess the maternal and umbilical cord serum vitamin A, E levels at delivery and mother-to-child transmission in nonsupplemented vitamin A, E HIV-1 infected parturients who received short-course zidovudine therapy. Maternal and umbilical cord serum vitamin A, E levels were quantitated by high-performance liquid chromatography in 67 HIV-1 infected parturients who received short-course zidovudine therapy. Mother-to-child transmission occurred in 13.4 per cent of HIV-1 infected parturients. There were no significant differences in the mean concentrations of vitamin A, E and vitamin E/cholesterol ratio between parturients with HIV-1 infected and non-infected infants. While maternal serum vitamin E level was adequate, nearly one-third of the parturients in the study had vitamin A deficiency. In conclusion our study has shown that there was no correlation between maternal serum vitamin A, E levels and mother-to-child HIV transmission in HIV-1 infected parturients who received short-course zidovudine therapy. However, the presence of underlying vitamin A deficiency in these parturients was common, adequate and intensive maternal-infant nutritional support should be emphasized especially in developing countries as an adjunctive measure in the reduction of mother-to-child transmission of HIV as well as the reduction in maternal and perinatal morbidity.

Serum copper and zinc levels in Thai patients with various diseases.

This study was conducted to evaluate the possible alteration of serum Cu and Zn levels in 118 medical inpatients (53 women and 65 men) in Ramathibodi Hospital. Patients were classified according to their main clinical diseases: pulmonary (n = 12), renal (14), infectious (30), malignant (9), cardiovascular (22), GI & hepatic (13) and hematological (18) diseases. Significantly increased serum Cu concentrations were found in patients with pulmonary, malignant, cardiovascular and infectious diseases; moreover, 75, 75, 50 and 37 per cent of these diseases, respectively, had serum levels greater than the normal mean + 2SD (23.6 mumol/L). Besides, 5 per cent of patients (3 in renal, 1 in infectious and 2 in GI & hepatic diseases) had low serum Cu levels suggestive of Cu depletion. By contrast, significantly decreased serum Zn concentrations were found in patients with GI & hepatic, infectious, renal, cardiovascular and malignant diseases. Serum Zn levels below the normal mean - 2SD (8.1 mumol/L) were presented in 46, 37, 29, 23 and 22 per cent of cases, respectively. It was found that serum Cu/Zn ratio in our patients not only with cancer but also with other diseases were statistically significant from the normal group. Hence, the use of serum Cu/Zn ratios as markers for the diagnosis of cancer or for staging tumors must be interpreted cautiously.

Serum vitamin A and E in pregnant women with hemoglobinopathies.

OBJECTIVE: To evaluate the relationship between the status of serum vitamin A, E and hemoglobinopathies among Thai pregnant women. METHODS: This was a cross-sectional study in which serum vitamin A and E were assessed in 323 pregnant women with normal hemoglobin and 73 with hemoglobinopathies (47 with hemoglobin E and 26 with thalassemia) during the first trimester. RESULTS: There were no significant differences in the mean serum vitamin A, E concentrations and vitamin E/cholesterol ratio between pregnant women with normal hemoglobin and hemoglobinopathies, while confounding variables that might affect serum vitamin levels i.e. maternal age, gravida, BMI, gestational age, hematocrit, hemoglobin, mean corpuscular hemoglobin concentration and blood group were not different. CONCLUSION: The results of this study suggest that antenatal care in terms of micronutrients-vitamin A, E in Thai pregnant women with hemoglobinopathies should not be different from normal pregnant women.

Thiamin and riboflavin status of medical inpatients.

Thiamin status was assessed by erythrocyte transketolase activity (ETKA) and thiamin pyrophosphate effect (TPPE) and riboflavin status by erythrocyte glutathione reductase activity (EGRA) and activity coefficient (AC) in 165 medical inpatients in Ramathibodi Hospital. Based on TPPE > 15 per cent, 9 per cent of the medical inpatients had thiamin depletion. Most of them were patients with renal, cardiovascular, hematological and infectious diseases. Based on AC > or = 1.2, 17 per cent of these inpatients had riboflavin depletion. Most of them were patients with pulmonary, cardiovascular and hematological diseases. Only one patient with pulmonary disease had both thiamin and riboflavin depletion. The proportion of thiamin depletion (2/37) in subjects with thiamin supplementation (mean 32.4, median 6, mode 2 md/d) tended to be less than those without (9/98). But, subjects with riboflavin supplementation (mean 3.3, median 4, mode 1 md/d) had the proportion of riboflavin depletion (0/31) significantly (Z-test, p < 0.005) lower than without supplementation (23/104). The data suggested that although the usual dose of vitamin supplementation in medical inpatients is beneficial thiamin depletion can still be present in catabolic patients.

Effects of dietary counseling on vitamin A, B-1, B-2 and zinc status of chronic hemodialysis patients.

Twenty-one chronic hemodialysis patients underwent nutritional evaluation and regular dietary counseling to improve the protein and energy intake for 8 weeks. As a result, the mean serum potassium and phosphorus concentrations were increased but were still within the normal ranges. After counseling, the frequency of abnormal TPPE and EGRAC were decreased (9.5 to 4.8 per cent and 19 to 14.3 per cent, respectively) while the frequency of hypervitaminosis A was increased from 67 to 81 per cent. Though the evidence of zinc deficiency was decreased from 81 to 62 per cent after counseling, mean serum zinc levels were low in both periods and inadequate vitamin B status cannot be totally eradicated due to the limitation of food selection. Therefore, regular supplementation of vitamin B complex is required, whereas, vitamin A supplementation must be prohibited in chronic HD patients. Small daily doses of potassium chelator and phosphate binder are mandatory if improvement of nutritional status is aimed to be one of the therapeutic goals.

Nutritional status in chronic hemodialysis patients.

Hitherto, there has been no systematic evaluation of the nutritional status of HD patients in Thailand. 27 patients awaiting renal transplantation, 19 M 8 F, age 47.2 +/- 8.6 y (mean +/- SD), underwent HD at Ramathibodi Hospital. Dietary assessment revealed the average daily intake of men and women to be respectively 1571 +/- 314 and 1379 +/- 403 kcal, 47 +/- 11 and 42 +/- 14 g protein. Anthropometric data showed that mean of BMI, percent ideal body weight (%IBW), percent standard triceps skinfold thickness (%TSF) and percent arm muscle circumference (%std MUAMC) to be 20.5 +/- 2.6 kg/m2, 90 +/- 12, 75 +/- 30 and 100 +/- 13, respectively. However, 37%, 56% and 70% of these patients had BMI, BW and MUAC less than the minimal cut-off levels. These data reflect the importance of energy depletion in these patients. The average serum albumin was 39 +/- 6 g/L while 52% suffered from low albumin levels. TC, LDL-C, HDL-C and TG were 4.34 +/- 1.34, 2.9 +/- 1.06, 0.89 +/- 0.33 and 1.10 +/- 0.67 mmol/L while 15% had high TC, LDL-C and 58% had low HDL-C levels. Only one patient was suffered from hypertriglyceridemia. Whereas inadequate thiamine, riboflavin, ascorbic acid and alpha-tocopherol status were present in 4-30%, toxic levels of serum retinol were seen in almost all patients. Low serum zinc and copper levels were also present. This study disclosed a wide spectrum of nutritional problems usually overlooked in CRF patients undergoing chronic hemodialysis. Whereas zinc supplementation may be needed, vitamin A supplementation in these patients should be discouraged.

Hydrocortisone, heparin, and peripheral intravenous infusion.

We studied the effect of low-dose hydrocortisone and heparin added to peripheral intravenous fluid on episodes and severity of thrombophlebitis. Osmolal solutions of 860 mOsm/kg H2O with heparin and hydrocortisone (feed A) and without heparin and hydrocortisone (feed B) were infused into surgical and ear, nose, and throat patients for peripheral intravenous nutrition. The addition of heparin (500 U/L) and hydrocortisone (10 mg/L) in 10% dextrose in half-strength normal saline and 500 ml 5% crystalline amino acid solution infused simultaneously via a Y line significantly reduced the episodes and severity of thrombophlebitis. Thus, the administration of low-dose hydrocortisone and heparin with peripheral fluids is beneficial in preventing thrombophlebitis.