C677T Methylenetetrahydrofolate Reductase and Plasma Homocysteine Levels among Thai Vegans and Omnivores

Hyperhomocysteinemia among vegetarians and vegans is caused mostly by vitamin B12 deficiency. A C-to-T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene results in a thermolabile MTHFR, which may affect homocysteine (Hcy) levels. The importance of this gene mutation among populations depends on the T allele frequency. Blood Hcy, vitamin B12, folate, vitamin B6, and MTHFR C677T mutation status were determined in 109 vegans and 86 omnivores aged 30 - 50 years. The vegans had significantly higher Hcy levels than the omnivores, geometric means (95 % CI) 19.2 (17.0 - 21.7) µmol/L vs. 8.53 (8.12 - 8.95) µmol/L, p < 0.001. A C-to-T mutation in the vegans increased plasma Hcy, albeit insignificantly; geometric means 18.2 µmol/L, 20.4 µmol/L, and 30.0 µmol/L respectively in CC, CT, and TT MTHFR genotypes. There was also a significant decrease in serum folate; geometric means 12.1 ng/mL, 9.33 ng/mL, and 7.20 ng/mL respectively, in the CC, CT, and TT mutants, p = 0.006, and particularly, in the TT mutant compared with the CC wild type, 7.20 ng/mL vs. 12.1 ng/mL, p = 0.023. These findings were not seen in the omnivores. It was concluded that hyperhomocysteinemia is prevalent among Thai vegans due to vitamin B12 deficiency. C-to-T MTHFR mutation contributes only modestly to the hyperhomocysteinemia.

Late and low compliance with hepatitis B serology screening among HIV-infected patients in a resource-limited setting: an issue to improve HIV care

Although hepatitis B serology screening has been recommended for HIV care, it has not been routinely performed. We aimed to assess compliance and timing of hepatitis B serology screening among HIV-infected patients in a resource-limited setting. A cross-sectional study was conducted in Thailand. Compliance, timing of hepatitis B serology screening, and factors associated with no HBsAg screening were determined. A total of 416 HIV-infected patients with 61% males were enrolled. Median (range) age at HIV diagnosis was 34 (16-75) years and 92% had heterosexual risk. Proportion of HBsAg screening and prevalence of positive HBsAg were 69.2% and 9.0%, respectively. There was no difference in the proportion of no HBsAg screening during the period 1990-2008 (p = 0.865). Proportion of anti-HBs and anti-HBc screening were 40.9% and 21.2%, respectively. HBsAg was screened before or on the day of anti-HIV testing in 9.1% and before antiretroviral therapy (ART) initiation in 27.2%. By Kaplan-Meier analysis, median time from anti-HIV testing to HBsAg screening was 55.9 (95% confidence interval [CI] 43.9, 68.3) months. By multivariate logistic regression, duration of HIV infection (odds ratio [OR] 1.14; 95% CI 1.07, 1.21), no anti-HBs screening (OR 1.65; 95% CI 1.4-2.63), and no anti-HCV screening (OR 2.60; 95% CI 1.62, 4.17) were associated with no HBsAg screening before ART initiation. In conclusion, compliance with hepatitis B serology screening was relatively low and late. Educational program regarding hepatitis B serology screening, identification of barriers, and interventions to eliminate these barriers in resource-limited settings are crucial to improve HIV care.

Cytokine responses during exacerbation compared with stable phase in asthmatic children

Bronchial asthma is a chronic inflammatory disorder of the airways. Balancing in Th1 and Th2 response is a target in the treatment. Recent studies show that interleukin-10 (IL-10) has an important role in the regulation of Th2 and allergic responses and its amount was found to decrease in asthmatic patients. This study was to focus on cytokine responses, including interferon-gamma (IFN- gamma), IL-4 and IL-10 in asthmatic children during acute exacerbation compared to stable period. Peripheral blood mononuclear cells (PBMCs) from fourteen asthmatic children during exacerbation and stable phase were stimulated with phytohemagglutinin (PHA) and mite allergen (Der p) for 72 hours. Levels of IFN-gamma, IL-4 and IL-10 in cell culture supernatants were measured using enzyme-linked immunosorbent assay. The median level of IL-10 in PBMCs stimulated with PHA was significantly lower in acute asthma exacerbation compared with stable phase (464 vs. 859.5 pg/ml, p = 0.03). However, there was no difference in the level of IL-10 in PBMCs stimulated with Der p. The level of IFN- and IL-4 were not different between exacerbation and stable phase both in PHA and Der p-stimulated PBMCs. The decrease of IL-10 production in asthmatic children during acute exacerbation may emphasize the role of IL-10 in immune regulation in allergic disease.

Serum TGF-beta1 in atopic asthma

Asthma is a chronic inflammatory disease of the airway. Pathological repair of chronic inflammation leads to airway remodeling. Transforming growth factor-beta (TGF-beta), a profibrotic cytokine, plays an important role in promoting the structural changes of airway remodeling. TGF-beta effects on the proliferation, differentiation and extracellular matrix (ECM) metabolism of airway structural cells. This study assessed serum TGF-beta1 in different severity of atopic asthma compared to non-atopic controls. Thirty-one atopic asthmatic patients and 34 non-atopic controls, aged 7-18 years, were recruited as to the asthma severity: steroid naïve mild asthma, moderate asthma, and asthma in remission. Serum TGF-beta1 was measured by enzyme-linked immunosorbent assay. There was a significant difference between serum TGF-beta1 in asthmatic patients and that in control patients (39.59 ng/ml vs. 0.26 ng/ml, p < 0.001). Serum TGF-beta1 was highest in steroid naïve mild asthma group when compared to the moderate asthma and asthma in remission groups (47.44 ng/ml vs. 38.64 ng/ml and 47.44 ng/ml vs. 35.94 ng/ml, p = 0.013 and 0.001, respectively). There were no correlations among serum TGF-beta1 and pulmonary function test parameters, duration of asthma, and duration of inhaled corticosteroid treatment. These data support the role of TGF-beta1 in airway remodeling in asthma.

Compliance with hepatitis B and hepatitis C virus infection screening among HIV-1 infected patients in a resource-limited setting

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are important risk factors for mortality among HIV-infected patients. We assessed compliance with screening for HBV and HCV infection prior to initiation of ART in a resource-limited setting. Six hundred thirty-eight patients with a mean age of 38.4 years (53% males) were studied. Prior to initiation of antiretroviral therapy (ART) 371 patients (58%) were screened for HBV and 273 (43%) were screened for HCV infection. Of those screened, 9.7% had HBV infection and 8.8% had HCV infection. Given the relatively high prevalence of HBV and HCV infection among HIV-infected patients, screening for HBV and HCV infections prior to ART initiation should not be omitted in the resource-limited setting.

Serum ferritin levels in children with dengue infection

The purpose of this study was to evaluate the levels of ferritin, an acute-phase reactant, in predicting the risk of dengue hemorrhagic fever (DHF) in patients with dengue infection. One hundred seventy-seven Thai children (100 males, 77 females) 4-16 years old (median age 11 years) with DF (n = 44) and DHF (n = 133) were enrolled in the study. All patients had serologic confirmation of dengue infection. Each had a venous blood sample drawn daily during hospitalization and at the outpatient clinic 2-4 weeks after discharge from the hospital, to determine serum ferritin levels. The median serum ferritin levels (ng/ml) in children with DHF (Day 2, 974; Day 3, 624; Day 4, 1,136; Day 5, 1,912; Day 6, 2, 105; Day 7, 1,840; Day 8, 1,478 and Day 9, 1,144 of illness) were higher than those with DF (Day 2, 25.4; Day 3, 45.6; Day 4, 655; Day 5, 1,050; Day 6, 1,075; Day 7, 615; Day 8, 764 and Day 9, 600 of illness) with p-values of 0.013, 0.001 and 0.013 on Days 5, 6 and 7 of illness, respectively. A cutoff level of serum ferritin of 1,200 ng/ml was used to calculate sensitivity and specificity for DHF. The results reveal the sensitivities on Days 5, 6 and 7 of illness were 81.5, 84.4 and 89.9%, respectively, and the specificities were 42.4, 39.0 and 36.4%, respectively. High serum ferritin levels > or = 1,200 ng/ml may be a predictor of dengue hemorrhagic fever.

Clinical presentations of newly diagnosed HIV-infected patients at a university hospital in Bangkok, Thailand

BACKGROUND

Epidemiology and clinical features of newly diagnosed HIV-infected patients vary and depend on period of time and geographical area.

METHODS

A retrospective review was conducted in adults with positive HIV antibody testing between January and December 2006 at a university hospital setting.

RESULTS

Prevalence of HIV infection was 1.0%. There were 221 patients with a median age of 35.5 (range, 15.8-72.3) years, and 57% were males. The most common risk of HIV acquisition was heterosexual (63.8%). The most common reason for HIV testing was preoperative screening (41.2%). Of all, 52.9%, 37.1%, and 10% were diagnosed as AIDS, asymptomatic, and symptomatic patients, respectively. Median CD4 count at HIV diagnosis was 260 (range, 6-1284) cells/mm(3). AIDS-defining illnesses were found in 35.7%. Overall mortality rate was 1.8%.

CONCLUSIONS

More than half of newly diagnosed HIV-infected patients have advanced HIV disease and are unaware of their HIV status. These results reflect inadequate education of HIV risks and voluntary HIV testing in Thailand.

Clinical usefulness of a HPLC method for simultaneous quantitation of plasma homocysteine and cysteine

OBJECTIVE

Homocysteine (Hcy) is a risk for vascular occlusion. It is metabolized via remethylation to methionine and transsulfuration to cysteine which has also been related to vascular occlusion. Simultaneous determination of Hcy and cysteine has additional clinical usefulness in providing a presumptive clue to the nature of hyperhomocysteinemia.

MATERIAL AND METHOD

A manual HPLC method has been worked out for simultaneous determination of plasma Hcy and cysteine. Concentrations of Hcy were validated with the widely used automated Abbott AxSYM assay. Its usefulness was tested in 87 omnivores and 111 vegans.

RESULTS

Excellent correlation between the values of Hcy was found between the manual HPLC method and the automated Abbott assay. The vegans had significantly higher levels of Hcy but lower levels of cysteine than the omnivores (mean +/- SD, micromol/L 23.6 +/- 18.0 vs. 8.8 +/- 2.1 p < 0.001, 225 +/- 30 vs. 245 +/- 34 p < 0.001, respectively). In contrast, the vegans had significantly lower levels of serum vitamin B12 and plasma vitamin B6 than the omnivores (median values 186 vs 565 pg/ml, p < 0.001; 37.4 vs. 47.4 nmol/L, p < 0.001 respectively). These findings indicate that the hyperhomocysteinemia in the vegans results from impairment of both remethylation and transsulfuration pathways of Hcy secondary to inadequacy of vitamins B12 and B6 respectively. Thus simultaneous determination of Hcy and cysteine is more useful than determination of only Hcy in that it provides a clue to the nature of hyperhomocysteinemia.

CONCLUSION

The manual HPLC method and the Abbott assay gave comparable Hcy values, and thus can be used interchangeably. The HPLC method is economical, useful for hospitals with less demand for determination of Hcy, and capable of simultaneously determining cysteine which has implication in clinical practice.

Comparable between rapid one step immunochromatographic assay and ELISA in the detection of prostate specific antigen in vaginal specimens of raped women

BACKGROUND

Rape is a crime found in Thailand nowadays. The crime is often lacking of eyewitnesses. Therefore, examination for forensic biological evidence becomes quite important, especially investigating sperm and semen in vaginal specimens of the victim. Acid phosphatase test for semen is commonly used in Thailand but is just a presumptive test. Recently, confirmatory kit tests became available in Thailand for detecting the prostate specific antigen (PSA) from semen. This test is simpler and cheaper than ELISA.

OBJECTIVE

To compare the rapid one-step immunochromatographic assay with ELISA for the detection of prostate specific antigen in vaginal specimens of raped women.

MATERIAL AND METHOD

A diagnostic test was conducted on the vaginal specimens of raped women that were sent to the laboratory of the Pathology Department, Faculty of Medicine, Ramathibodi Hospital, Mahidol University during April-August 2006. One hundred vaginal specimens were examined for prostate specific antigen by rapid one step immunochromatographic assay and compared with ELISA.

RESULTS

There were 85% and 83% of sensitivity, 85% and 85% of specificity, 85% and 85% of accuracy, 89% and 89% of positive predictive value, and 79% and 77% of negative predictive value from rapid one-step test kit and ELISA respectively

CONCLUSION

The result showed that there was no difference on specificity, accuracy and positive predictive value between the two methods but sensitivity and negative predictive value of rapid one-step test kit was better than ELISA. The research team recommends that rapid one-step test kit for prostate specific antigen should be routine service in vaginal specimens of raped women.

Fecal alpha1--antitrypsin in healthy and intestinal-disorder Thai children

OBJECTIVE

Determine the normal FA1-AT level in random wet stool of Thai children using RID and NPL, and to study the correlation between RID and NPL methods for measurement of FA1-AT.

MATERIAL AND METHOD

Random stool samples were collected from healthy children and intestinal-disorders patients. Alpha1-antitrypsin (FA1-AT) in wet stool samples was measured by nephelometry (NPL) and radial-immunodiffusion (RID) methods.

RESULTS

Newborn infants had the highest FA1-AT level during the first day of life and declined to the same level as older children on day 3-4. Median and geometric mean of FA1-AT levels by NPL from healthy children aged 1 month-15 years was 1.23 and 1.11 mg/dL respectively. FA1-AT levels by NPL from children with severe intestinal disorders, displaying median and geometric mean at 6.77 and 12.39 mg/dL respectively, were much higher than healthy children. The RID and NPL methods showed a correlation of r = 0.87 (p < 0.01) and R2 = 0.75.

CONCLUSION

Random FA1-AT assay in wet stool is a non-invasive and simple test for supporting diagnosis of protein-losing enteropathy.

Factors for predicting successful immune response to hepatitis B vaccination in HIV-1 infected patients

This study aimed to determine the predicting factors for successful hepatitis B vaccination among HIV-1 infected patients. A prospective study was conducted among HIV-1 infected patients who had negative HBV serologies. Anti-HBs antibody was evaluated one month after completing a 3-injection course of hepatitis B vaccine. Patients who had an anti-HBs antibody level >10 mlU/ml were defined as responders. There were 65 patients with a mean age of 39+/-8.5 years, 68% were females. Fifty-seven (88%) patients had received antiretroviral therapy for a mean (SD) duration of 26.1 (22.3) months and 75% of these had an HIV-1 RNA count <50 copies/ml. The mean (SD) CD4 cell count and percentage at the time of vaccination were 345 (194) cells/mm3 and 16 (7) %, respectively. Thirty patients (46%) were responders. Compared to non-responders, responders had a higher mean CD4 cell count (p = 0.047) and a trend toward a younger age (p = 0.052). On multivariate analysis, younger age (p = 0.049) and higher CD4 cell count (p = 0.048) were predictors for successful response to hepatitis B vaccination. Determination of antibody levels after vaccination in HIV-infected patients is warranted.

An autopsy report case of rape victim by the application of PSA test kit as a new innovation for sexual assault investigation in Thailand

The case of a 30 year-old Thai female found dead on the floor at the base of a small monument on Rajadumnern Road, Bangkok, Thailand with blood stains around the body and a naked bottom. The scene investigation and autopsy findings suggested a sexual assault and multiple sharp force injuries. The approach to the postmortem examination using different laboratory tests is reviewed. The specificity and sensitivity of prostate specific antigen (PSA) in specimens from rape victims is better than acid phosphatase test. The ELISA test for PSA was tested to confirm the PSA test kit. The present report suggests the PSA test kit in addition to conventional sperm smear and acid phosphatase test for sexual assault investigation in Thailand.

Homocysteine, MTHFR C677 T, vitamin B12, and folate levels in Thai children with ischemic stroke: a case-control study

Hyperhomocysteinemia has been identified as a risk factor for venous and arterial thrombosis especially in adult populations. Twenty-eight patients with an initial diagnosis of ischemic stroke and 100 controls, aged <or=18 years, were enrolled in this study. The mean plasma total homocysteine (tHcy) levels in patients and controls were significantly different with values of 8.7+/-3.6 and 7.5+/-2.4 micromol/L, respectively (P=0.01). The plasma tHcy at the 95th percentile was 11.5 micromol/L and patients whose plasma tHcy was above the 95th percentile had an odds ratio of 8.2 (95% confidence interval 1.4-47.2, P=0.02) for developing ischemic stroke. The genetic and acquired factors that could have affected plasma tHcy levels were studied and no differences were found between patients and controls. Factors that were investigated were vitamin B12, red blood cell folate, and serum folate levels as well as methylenetetrahydrofolate reductase C677T polymorphism. It is of note, however, that subjects whose plasma tHcy was above the 95th percentile had significantly lower serum folate levels (P=0.02).

Multicenter evaluation of a new 4th generation HIV screening assay Elecsys HIV combi

Fourth-generation screening assays which permit a simultaneous detection of human immunodeficiency virus (HIV) antigen and antibody reduce the diagnostic window on average by four days in comparison to third-generation antibody assays. Recently, the new automated Elecsys HIV combi was compared in a multicenter study to alternative fourth- and third-generation assays, p24 antigen test and HIV-1 RNA RT-PCR. A total of 104 serocon-version panels, samples of the acute phase of infection after seroconversion (n = 33), anti-HIV-1 positive specimens (n = 572) from patients in different stages of the disease, 535 subtyped samples from different geographical locations, including group M (subtypes A-J) and group O, anti-HIV-2 positive sera (n = 364), dilutions of cell culture supernatants (n = 60) infected with different HIV-1 subtypes, selected performance panels, 8406 unselected samples from blood donors originating from different blood transfusion centers, 3810 unselected sera from daily routine and from hospitalized patients, 9927 unselected samples from South Africa and 1943 potentially interfering samples were tested with the Elecsys HIV combi. Elecsys HIV combi showed a comparable sensitivity to HIV-1 Ag stand-alone assays for early detection of HIV infection in seroconversion panels. The mean time delay of Elecsys HIV combi (last negative sample + 1 day) in comparison to HIV-1 RT-PCR for 92 panels tested with both methods was 3.23 days. The diagnostic window was reduced with Elecsys HIV combi between 1.56 and 5.32 days in comparison to third-generation assays. The specificity of Elecsys HIV combi in blood donors was 99.80% after repeated testing. Our results show that a fourth-generation assay with improved specificity and sensitivity like the Elecsys HIV combi is suitable for blood donor screening due to its low number of false positives and since it detects HIV p24 antigen with a comparable sensitivity to single antigen assays.

Prevalence of hepatitis B virus and hepatitis C virus co-infection with human immunodeficiency virus in Thai patients: a tertiary-care-based study

BACKGROUND

Hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV share the route of transmission. HBV or HCV co-infection with HIV has been associated with a reduced survival rate, an increased risk of progression to severe liver disease, and an increased risk of hepatotoxicity associated with active antiretroviral therapy. Information regarding prevalence of HBV and HCV co-infection with HIV in Thailand is limited.

PATIENTS AND METHOD

A cross-sectional study of prevalence and risk factors of HBV and HCV co-infection in HIV-infected patients was conducted. All HIV-infected patients who were cared for in March 2003 at Ramathibodi Hospital were included.

RESULTS

There were 529 HIV-infected patients with a mean age of 36.7 years and 56.5% males. Of these, 58.8% lived in Bangkok, whereas, the others were from provincial areas. Heterosexual contact were the acquisition of HIV infection in 98.1% of all patients. The prevalence of HBV infection was 8.7%, and HCV infection was 7.8%. There was no difference between the prevalence of these infections in Bangkok and provincial areas (p = 0.115). History of intravenous drug use was associated with both HBV and HCV co-infection (p < 0.001). HCV co-infection group was also associated with male gender (p = 0.002) and elevated serum alanine transaminase (ALT) level (p = 0.0003).

CONCLUSIONS

The prevalence of HBV and HCV co-infection with HIV in Thai patients is significant. In the author s resources-limited setting, history of intravenous drug use is a major indicator to screen for both HBV and HCV co-infection. Male gender and elevated serum ALT level are also suggestive of HCV co-infection.

Effect of immediate neonatal zidovudine on prevention of vertical transmission of human immunodeficiency virus type 1

OBJECTIVE

To describe the effects of various short zidovudine (ZDV) prophylactic regimens on vertical transmission of human immunodeficiency virus type 1 (HIV-I) infection, especially the effect of immediate neonatal ZDV prophylaxis.

MATERIALS AND METHODS

The study included children of HIV-1-infected mothers who were born at a teaching hospital in Bangkok. The ZDV prophylaxis regimens varied by time periods that included: (1) no ZDV (1991-1996); (2) antenatal oral ZDV, 250 mg given twice a day starting at 34 to 36 weeks gestation and continued until labor (1995-1998); (3) antenatal oral ZDV plus immediate neonatal oral ZDV, 6 mg/0.6 mL/dose started within the first 2 hours after birth and continued at 6-hour intervals for 4 to 6 weeks (1997-1998); and (4) intrapartum intravenous ZDV given in addition to regimen 3 (1998-1999). Neonatal ZDV was administered within 2 hours after birth in 95% of the neonates.

RESULTS

In a cohort of 136 children born at least 9 months before the analysis date, the HIV-1 vertical infection rates were: (1) no ZDV, 11 of 48 (22.9%, 95% confidence interval [CI] = 12.0-37.3); (2) late antenatal ZDV, 10 of 47 (21.3%, 95% CI = 10.7-35.7); (3) late antenatal ZDV plus immediate neonatal ZDV, 0 of 28 (0%, 95% CI = 0-12.3); (4) late antenatal, intrapartum intravenous ZDV, plus immediate neonatal ZDV, 0 of 13 (0%, 95% CI = 0-24.7). An estimated 0% (95% CI = 0-8.6) of the infants who received immediate neonatal ZDV with or without intrapartum ZDV were infected, as compared with 22.1% (95% CI = 14.2-31.8 ) of those who received no ZDV or only late antenatal ZDV (P < 0.001).

CONCLUSIONS

The results of this study suggests high protective effect of immediate administration of neonatal ZDV. Perinatal components of antiretroviral prophylaxis provided the best results for protecting against vertical HIV-1 transmission.

Semiquantitative human immunodeficiency virus antibody tests in diagnosis of vertical infection

OBJECTIVE

This study evaluated the roles of semiquantitative anti-HIV antibody tests for early diagnosis of vertical HIV-1 infection in infants.

METHODS

The study included 0- to 18-month-old children of HIV-1-infected mothers. They were regularly followed up, and blood was obtained for semiquantitative anti-HIV tests using a particle agglutination (PA) test and a microparticle enzyme immunoassay (MEIA).

RESULTS

One hundred forty-six children of HIV-1-infected mothers, including 104 infected and 42 uninfected infants, were studied. Using anti-HIV titer of < or = 1:100 by PA and optical values of < or = -3 by MEIA for diagnosis of not being infected, approximately 69 and 53% of the uninfected cases at age 7 to 8 months, 76 and 67% at age 9 months and 100% at age 12 months could be diagnosed. By comparison with the diagnosis by qualitative tests the figures were 16%, 8 and 11%, 70 and 74% at the same ages. All asymptomatic HIV-infected cases had persistently high PA titers and MEIA values of at least 1:5000 and 6, respectively, but 7 cases with AIDS-related manifestation at the time of tests had low anti-HIV titers. One severely ill, HIV-infected infant had a transient negative anti-HIV test at the age of 7 months. Two asymptomatic infected children, who had been breast-fed, had transient decrease in anti-HIV titers after the age of 6 months, and transient seroreversion occurred in one. CONCLUSION. Semiquantitative anti-HIV tests between the age of 6 to 12 months were very useful in diagnosis of HIV-1 infection in infants born of HIV-1-infected mothers. Interpretation must be accompanied by information about AIDS-related manifestation and history of breast-feeding.

Serum C-reactive protein level in postsplenectomized thalassemic patients

C-reactive protein is an established marker for the detection of acute and chronic inflammatory processes. The most potent stimulator for the hepatic synthesis of this protein is interleukin 6. Previous studies have shown that inflammatory cells and inflammatory cytokines, such as interleukin 6, interferon gamma, etc were elevated in postsplenectomized thalassemic patients. The aim of this study was to determine serum C-reactive protein concentration in postsplenectomized beta thalassemic patients (beta thal/HbE postsplenec), and to compare them with those in nonsplenectomized beta thalassemic patients (beta thal/HbE), postsplenectomized non thalassemic patients (postsplenec), reactive thrombocytosis (RT), chronic myeloproliferative disorders (MPD) and normal adult volunteers. Serum C-reactive protein concentration as determined by an automatic Behring Nephelometer was carried out in 28 beta thal/HbE postsplenec, 22 beta thal/HbE, 12 postsplenec, 23 RT, 21 MPD, and 26 healthy adult volunteers. The values of CRP in beta thal/HbE postsplenec were significantly higher when compared with beta thal/HbE, and normal volunteers (4.1 +/- 0.7 vs 1.6 +/- 0.4 mg/L P = 0.006, and 4.1 +/- 0.7 vs 0.45 +/- 0.09 mg/L, P < 0.001). CRP levels in beta thal/HbE postsplenec were also higher than the postsplenec group (4.1 +/- 0.7 vs 0.19 +/- 0.7 mg/L P = 0.095). On the contrary, they were significantly lower than those in RT (4.1 +/- 0.7 vs 55.4 +/- 14.8 mg/L, P = 0.002). However, when compared to those with MPD, the values were not statistically different (4.1 +/- 0.7 vs 17.1 +/- 12.3 mg/L, P = 0.871). Interestingly, there was a trend towards increasing C-reactive protein levels in beta thal/HbE postsplenec patients with higher platelet count, although no correlation was observed. Besides the inflammatory process, platelet and/or factor(s) that control(s) thrombopoiesis seem(s) to play a role in the high serum C-reactive protein levels in the studied population.

Iron stores in autologous blood donors

Depletion of body iron stores is a major factor limiting regular blood donation in volunteer donors. Autologous blood donors are requested to donate more frequently. To determine iron stores in autologous donors, 9 men and 10 women studied gave a total of 24 donations before their elective surgery (range 1-2 donations). All donors were tested for serum ferritin (SF) and hemoglobin (Hb) level. Iron supplements were taken by 88.89 per cent of men and 90 per cent of women. Mean SF before donations was 147.75 ng/mL in men and 53.19 ng/mL in women. After donations, mean SF decreased to 124.26 ng/mL in men and 38.81 ng/mL in women. None of them had depleted iron stores (SF < or = 15 ng/mL). In conclusion, iron supplementation was beneficial in maintaining body iron stores in autologous blood donors.

Iron stores in Thai blood donors

A high number of blood donations may cause iron depletion. In order to evaluate iron stores in volunteer Thai blood donors, 82 male and 72 female donors were studied. All were tested for serum ferritin (SF), hemoglobin (Hb) level and asked for detailed histories of donations and iron supplementation. Mean SF in first-time donors was 161.12 ng/mL in men (n = 16) and 53.92 ng/mL in women (n = 23). Mean SF in multiple-time donors was 52.72 ng/mL in men (n = 66) and 25.72 ng/mL in women (n = 49). Depleted iron stores (SF < or = 15 ng/mL) were found in 8.7 per cent of first-time female donors, 21.21 per cent and 32.65 per cent of multiple-time male and female donors, respectively. The mean numbers of total donation were 51.42 +/- 30.8 in men and 8.22 +/- 6.97 in women. The estimation of depleted iron stores from Hb level could be determined in 57.14 per cent of male and 88.89 per cent of female donors. In conclusion, iron supplementation will benefit female donors and multiple-time male donors. The frequency of donations per year was more predictive of decreased iron stores than the number of total donations.

Effect of dialyzer membranes on beta-2 microglobulin production in Thai hemodialysis patients

Responses to different types of dialyzer membranes in an Asian population may differ from those of a Caucasian population. Comparative studies on the effects of different dialyzer membranes on beta-2 microglobulin production are also limited. Therefore, we conducted this study to determine the effects of different dialyzer membranes on in vitro mononuclear cell production of beta-2 microglobulin in 9 Thai hemodialysis patients. Each patient was dialysed with 4 different types of dialyzer, including cuprophane (CUP), cellulose diacetate (CD), polysulphone (PS), and polyacrylonitrile membrane (PAN), each for a 1-month period in a randomized sequence. Mononuclear cell culture was done by taking an immediate post-dialysis blood sample at the end of the 1-month period. Beta-2 microglobulin production from cell culture was determined 24 hours later. Mononuclear cell culture and determination of beta-2 microglobulin production from the culture were also done in 10 normal controls and 10 predialysis ESRD patients. The beta-2 microglobulin productions (microgram/L) were shown as follows; Control CUP CD PS PAN [table: see text] (*p < 0.05 compared to cuprophane membrane).

CONCLUSION

polysulphone and polyacrylonitrile membrane induced significantly less beta-2 microglobulin production compared to cuprophane and slightly less compared to cellulose diacetate membrane.