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R A Forse

Publications and source records attributed to R A Forse.

119 records · Page 7Linked to original sources
PubMedDate not supplied

Dietary fish oil and cytokine and eicosanoid production during human immunodeficiency virus infection.

BACKGROUND: Dietary fish oil (FO) has been shown to modulate the immune system. The purpose of this study was to explore the effects of FO supplementation on the production of dienoic eicosanoids and cytokines in patients with human immunodeficiency virus (HIV) infection. METHODS: This was a randomized, prospective, double-blind study that included homosexual males with HIV infection. Patients were asked to consume voluntarily five food bars daily containing FO (n = 10) or safflower oil (SO) (n = 9) for 6 weeks. At baseline and week 6, plasma was obtained to measure incorporation of omega-3 fatty acids. At baseline, week 3, and week 6, measurements were made of changes in dienoic eicosanoids and cytokines from lipopolysaccharide (LPS)-stimulated peripheral blood mononuclear cells (PBMC) or spontaneously releasing cells. RESULTS: In the FO group but not the SO group, there was increased incorporation of the omega-3 fatty acid docosahexaenoic acid (DHA) into the phospholipids of the fatty acids of the plasma. In the FO group, there was a significant decrease (p = .01) in 6-keto prostaglandin (PG) F1 alpha released from PBMC. There was a significant increase (p = .01) in interleukin (IL)-6 released from the PBMC in the FO group between baseline and week 3 and between week 3 and week 6. At week 6, there was significantly more IL-6 (p = .01) released from the PBMC in the FO group compared with the SO group. There was no change in CD4 cell counts by analysis of variance. CONCLUSIONS: The FO-containing food bars were well tolerated and allowed incorporation of omega-3 fatty acids to occur. Despite evidence of significant metabolic effects on eicosanoid and cytokine production, widespread clinical use of FO for HIV-infected patients is not warranted without further study, particularly given the trend toward a decline in CD4 cell numbers at this dose and with this type of fish oil.

Adolescent↗
PubMedDate not supplied

Effect of a fish oil structured lipid-based diet on prostaglandin release from mononuclear cells in cancer patients after surgery.

BACKGROUND: The authors compared the effect on eicosanoid production (prostaglandin E2 [PGE2], 6-keto PGF 1 alpha, and thromboxane B2) from peripheral blood mononuclear cells (PBMC) of feeding an enteral diet containing a fish oil/medium-chain triglyceride structured lipid (FOSL-HN) vs an isonitrogenous, isocaloric formula (O-HN) in patients undergoing major abdominal surgery for upper gastrointestinal malignancies. A previous study, which used the same formulas and experimental design, suggested improved renal and liver function as well as a reduced number of gastrointestinal and infectious complications with the use of fish oil structured lipids. This study sought to investigate the potential mechanism for these effects by assessing eicosanoid production from PBMC with the two diets. METHODS: This prospective, blinded, randomized trial was conducted in 20 patients who were jejunally fed either FOSL-HN or O-HN for 7 days. Serum chemistries, hematology, urinalysis, gastrointestinal complications, liver and renal function, and eicosanoid production from isolated PBMC, either unstimulated or stimulated with endotoxin, were measured at endotoxin baseline and on day 7. Comparisons were made in 10 and 8 evaluable patients based a priori on the ability to reach a tube feeding rate of > 40 mL/h. RESULTS: Patients receiving FOSL-HN experienced no untoward side effects compared with patients given O-HN and demonstrated the same general trend toward improved hepatic, renal and immune function found in the previous study. There was a significant reduction in PGE2 (p < .03) and 6-keto PGF 1 alpha (p < .01) production from PBMC with endotoxin stimulation in patients receiving FOSL-HN. CONCLUSIONS: The results of early enteral feeding with FOSL-HN after surgery in this follow-up study provide further support to claims of safety, tolerance, and improved physiologic function. There was an associated reduction in eicosanoid production from PBMCs, which is presumed to be the principal mechanism for these effects.

6-Ketoprostaglandin F1 alpha↗
PubMedDate not supplied

Early postoperative glucose control predicts nosocomial infection rate in diabetic patients.

OBJECTIVES: To determined the relationship between perioperative glucose control and postoperative nosocomial infection rate is 100 consecutive diabetic patients undergoing elective surgery. DESIGN AND PATIENTS: One hundred initially uninfected diabetic patients undergoing elective surgery were prospectively monitored for perioperative glucose control and postoperative nosocomial infection rate. Glucose control was determined by the attending surgeon or diabetologist. SETTING: A large tertiary care hospital that serves as the in-patient facility for a local diabetes center. MAIN OUTCOME MEASURES: All patients were screened for infection preoperatively. Only initially uninfected patients were enrolled, and all patients received perioperative antibiotic coverage. Perioperative glucose control and postoperative nosocomial infection rate were monitored prospectively. APACHE II scores were determined on all patients. Patients were stratified into two groups: those with relatively "good" perioperative glucose control (all values < or = 220 mg/dL) and those with "poor" control (at least one value > 220 mg/dL). Contingency tables were generated, comparing nosocomial infection rates vs perioperative glucose control. Correlation coefficients between APACHE II score and maximum and mean glucose values were also determined. RESULTS: A serum glucose > 220 mg/dL on postoperative day one (POD 1) was a sensitive (87.5%) but relatively nonspecific (33.3%) predictor of the later development of postoperative nosocomial infection. In patients with hyperglycemia (> 220 mg/dL) on POD 1, the infection rate was 2.7 times that observed (31.3% vs 11.5%) in diabetic patients with all serum glucose values < 220 mg/dL. When minor infection of the urinary tract was excluded, the relative risk for "serious" postoperative infection increased to 5.7 when any POD 1 blood glucose level was > 220 mg/dL. On the basis of correlation coefficients between serum glucose values and APACHE II score, only 18% of the variance in the highest serum glucose could be explained by disease severity alone. CONCLUSIONS: We conclude that diabetic patients undergoing major cardiovascular or abdominal surgery have an increased risk of infection that is further exacerbated by early postoperative hyperglycemia. The high rate of nosocomial infection observed in diabetic patients with poor glucose control suggests that hyperglycemia itself may be an independent risk factor for the development of infection. Efforts to improve perioperative glucose homeostasis in diabetic patients may reduce the incidence of nosocomial infection and thereby improve outcome.

APACHE↗
PubMedDate not supplied

Relationship between obesity and uterine leiomyomata.

Obesity is associated with many comorbid disease states including neoplasia. The increased risk of developing endometrial cancer is thought to be due to the higher level of circulating estrogens in obese women. Uterine leiomyomata (fibroids) are also thought to be influenced by estrogens. To determine whether patients presenting with symptomatic uterine fibroids were more obese than the general population, we retrospectively reviewed the hospital records of 144 women who underwent either hysterectomy or myomectomy for uterine fibroids. Obesity was defined as preoperative weight greater than 120% of desirable body weight (DBW) for the patient's height. In our investigation, 51% of the study population were obese. Moreover, 16% were severely obese (defined as greater than 150% DBW). When compared with the general population of women in the United States matched for height and age, the study population was significantly heavier. (p less than 0.0002). Patient age, parity, menopausal status, and degree of obesity did not correlate with the number of fibroids within the uterus. Fibroid size was significantly larger in nulliparous women (p less than 0.005). These results suggest that symptomatic uterine fibroids may be another comorbid disease state associated with obesity.

Adult↗
PubMedDate not supplied

Fish-oil-containing diet and platelet aggregation.

Current research suggests that a diet high in fish oil may be useful for immunomodulation in hospitalized patients. However, one of the side effects of fish oil is a prolongation of the bleeding time, specifically by reducing platelet aggregability. Although this effect might be beneficial for patients with cardiovascular disease, it would be a potential concern in certain critically ill patients. To address this concern, we conducted a prospective study of platelet aggregation in 16 surgical patients who were randomly assigned to receive either a diet containing 16.5 g of fish oil in 1500 ml (Impact) or usual care (standard enteral formulas devoid of fish oil). Feeding was successfully accomplished in the patient group receiving a diet that provided approximately 14.2 g of fish oil/day for 1 wk without significantly affecting platelet aggregability. Thus, it appears that, over the short term, this dose of fish oil does not alter platelet function in hospitalized surgical patients.

Adult↗
PubMedDate not supplied

Symptomatic hyperlipasemia after cardiopulmonary bypass: implications for enteral nutritional support.

The incidence of pancreatitis after cardiopulmonary bypass is reported as < 0.1%. We report a milder form of pancreatitis characterized by hyperlipasemia and early intolerance to enteral nutrition without overt signs of clinical pancreatitis. A retrospective study was conducted in 72 patients who had received tube feeding. A statistically (p = 0.01) greater incidence of symptomatic hyperlipasemia was noted in post-cardiopulmonary bypass (PCPB) patients (42%, 5 of 12) than in non-PCPB patients (0%, 0 of 60). Four of the 5 PCPB patients who developed symptomatic hyperlipasemia received tube feeding into the stomach or duodenum before onset of their symptoms. The overall incidence of PCPB symptomatic hyperlipasemia during the study period was 1.3% (5 of 375). A prospective study was then carried out in 54 PCPB patients. Five patients became critically ill, and 4 of these developed symptomatic hyperlipasemia. Three of the 4 patients had received tube feeding into the stomach or duodenum before the onset of symptoms. In all cases, the symptoms of tube-feeding intolerance were mild and resolved with termination of feeding. This study suggests that critically ill cardiopulmonary bypass patients may be more susceptible to developing symptomatic hyperlipasemia, which is characterized by early intolerance to enteral nutritional support.

Cardiopulmonary Bypass↗