Penicilliosis-associated hemophagocytic syndrome in a human immunodeficiency virus-infected child: the first case report in children

Infection-associated hemophagocytic syndrome (IAHS) has been found in many systemic infectious conditions with a high mortality rate. Disseminated Penicillium marneffei infection is a common opportunistic condition among HIV-infected patients in many regions in Southeast Asia. We report the first case of IAHS caused by penicilliosis in an HIV-infected child who presented with cytopenias and recovered promptly after antifungal and intravenous immunoglobulin therapy.

Successful prophylaxis of intracranial hemorrhage in infants with severe congenital factor VII deficiency

During the period 1984-1992, 2 severe cases (1 male, 1 female) of congenital F VII deficiency with intracranial hemorrhage (ICH) were referred to the Department of Pediatrics, Siriraj Hospital Bangkok, Thailand at the ages of 1 and 3 months old. They both responded very well to fresh frozen plasma (FFP) transfusion therapy. Subsequently, both had repeated episodes of ICH (repeated ICH) 5 and 6 times, despite the 10-14 days of replacement therapy for each episode and eventually died at the ages of 11 and 13 months. Since September 1996, another 2 severe cases (2 females) of congenital F VII deficiency who had ICH within their first month of life were referred to us. In order to prevent repeated ICH, we started a prophylactic regime after the second episode of ICH, by giving FFP 10 ml/kg twice a week. The average duration of follow up was 21 months (at 8 and 34 months). All of them (aged 14, and 38 months old) are doing well at this time and free from repeated ICH. From this observation, if there is FFP available, this regime is an effective way to prevent repeated ICH in infants with severe congenital Factor VII deficiency.

Plasma amino acid patterns and visceral protein status in users and nonusers of monosodium glutamate

Free amino acids in plasma and total protein, albumin, transferrin and retinol-binding protein (RBP) in serum were determined in two groups of healthy adults consisting of 10 female nonusers and 10 female users of monosodium glutamate (MSG). Users or nonusers of MSG were those consuming or not consuming MSG regularly at their homes for at least 1 y. On the bases of body mass index and serum protein concentrations, each of the two groups appeared to have an adequate protein-energy status. Fasting plasma glutamate concentrations in female nonusers and users of MSG were 22.4 +/- 3.2 and 21.8 +/- 2.0 nmol/mL (means +/- SEM), respectively; these values were not significantly different. These findings indicate that there is no glutamate accumulation in the plasma of MSG users and imply the safety of long-term MSG intake.

Hemodynamic responses to captopril during splenectomy in thalassemic children

Splenectomy in beta-thalassemic children is frequently accompanied by perioperative hypertension which occasionally is followed by convulsion. The efficacy of captopril in attenuating the hypertensive response to splenectomy was investigated in 82 thalassemic children. The control group, consisting of 40 patients, received intravenous furosemide (1 mg/kg) preoperatively; whereas, 42 children were randomly allocated into 2 groups to receive oral captopril (0.7 mg/kg) or a combination of captopril (0.7 mg/kg) and furosemide (1 mg/kg) before the operation. Before anesthetic induction, both systolic and diastolic arterial pressures in the captopril and the combined groups were significantly lower than the furosemide group (P < 0.001), whereas, the heart rates in all groups were comparable. Changes in arterial pressure in response to the operation were significantly smaller in the combined group when compared with the other two groups (P < 0.001). Immediate postoperative hypertension requiring additional management occurred in 20 per cent of the furosemide group, and 14.3 per cent in the other two groups. One patient in the combined group had a convulsion in association with hypertension. The authors conclude that captopril combined with furosemide effectively controls intraoperative hypertension in thalassemic children undergoing splenectomy; however, postoperative hypertension remains common, and needs appropriate treatment immediately.

Possible thermogenesis with dexfenfluramine

Fifty obese patients with a body mass index greater than 25 kg/m2 were randomized into 3 groups: control (C = 19), placebo (P = 18) and dexfenfluramine (D = 18). A behavioral modification program which included eating habits, exercise, attitudes, social relationships and six steps to lifetime weight control was taught every week. All patients strictly followed the food manual and recorded their behavior, physical activity and food intake every day through 12 weeks. Placebo and dexfenfluramine 30 mg/day were given in a double blind placebo controlled study. The results showed that all 3 groups had significant decreases in rest times and increased activity times (p < 0.05) and significant reductions of the average total daily energy, carbohydrate and fat intake (p < 0.05). They all lost weight. Mean +/- SEM cumulative weight loss was 8.3 +/- 0.7 kg in group D, 3.3 +/- 1 kg, in group P and 2.9 +/- 0.7 kg, in group C. The mean additional weight loss of 5 kg, and 5.4 kg seen with dexfenfluramine being highly significant (p < 0.001) from group P and C most likely due to increased thermogenesis. Significant (p < 0.05) and gradual reduction of biceps, triceps skinfold and per cent body fat were constantly observed only in the dexfenfluramine group. There were no significant differences among the 3 groups regarding blood pressure, heart rate, hematologic, lipids and biochemical profiles.

Lipid disorders in transitional societies with particular reference to triglycerides and HDL-cholesterol

Like Western populations, affluent urban populations in developing countries are facing the problem of dyslipidemia, an important risk factor of coronary heart disease. Our study of 453 affluent, urban Thai women revealed that the prevalences of type IIa, IIb, IV and V hyperlipoproteinemias were 32.5, 2.2, 2.4, and 0.4%, respectively. Based on a waist-over-hip circumference ratio (WHR) of > 0.8 and body mass index (BMI) of > 25.0 kg/m2 to indicate abdominal and overall obesity, respectively, the prevalences of abdominal obesity, overall obesity, and combined abdominal and overall obesity in these women were 32.9, 5.7, and 21.2%, respectively. Both BMI and WHR in these women had significantly positive influences on their serum triglyceride (TG) and apo B levels, and significantly negative influences on their serum HDL-cholesterol levels. Only BMI had a significantly positive influence on their serum total cholesterol (TC) and LDL-cholesterol levels but a significantly negative influence on their serum apo A-I levels. A lipid-lowering effect of linoleic acid was shown in 101 dyslipidemic women receiving dietary intervention for 8 weeks, evidenced by significantly negative relationships between their serum 18:2 n-6 levels and serum TC, LDL-C, TG, and apo B levels.

Global assessment of nutrition risk factors in the elderly

Global assessment of nutrition risk factors in the elderly consists of subject's history, physical examination, and laboratory tests, which are the indispensable mode to establish definite nutritional disorders. This is illustrated in a study of 150 free-living elderly Thais participating in the Global Assessment of Nutritional Risk Factors in the Thai Elderly. They consisted of 50 men and 100 women, aged 60-86 years and were an affluent urban population. Diet-related chronic diseases including overall obesity, abdominal obesity, dyslipidemia, impaired glucose tolerance, diabetes mellitus, and hypertension were the major nutritional problems affecting their life and well-being. Thus appropriate nutritional intervention must be provided to improve their impaired health status.

Dyslipidemia in urban Thais

Serum lipid profiles were determined in 2,703 male and 792 female officials of the Electricity Generating Authority of Thailand (EGAT), aged 35-54 yrs, and 519 Ramathibodi Hospital Staff (RHS) consisting of 66 men and 453 women, aged 19-61 yrs. They are affluent-urban Thais. Mean serum total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C) and triglyceride (TG) levels in EGAT officials were higher than those in RHS with the same sex, whereas the opposite result was observed for their serum high density lipoprotein-cholesterol (HDL-C) levels. Men also showed higher serum TC, LDL-C, and TG but lower HDL-C levels than women. The major type of dyslipidemia in EGAT officials and RHS was hypercholesterolemia due to elevated serum LDL-C levels, but the elevated LDL-C level in RHS was less severe than that in EGAT officials. Besides, the prevalence of serum HDL-C level of 1.55 mmol/L, a negative risk factor for coronary heart disease, in RHS was higher than that in EGAT officials. The mean percentages of dietary fat-calories consumed by EGAT officials and RHS were 39% and 31%, respectively. Thus it is plausible that dietary fat intake influences their serum lipid levels. The beneficial effects of linoleate intake on serum lipoprotein profiles are illustrated in RHS.

Collection of cord blood stem cells for transplantation in thalassemic patients

Thalassemia is widely distributed throughout the world and is one of the major public health problems. The use of bone marrow transplantation, the only curative therapy for thalassemia, is limited because less than 30% of the patients have unaffected and HLA-identical siblings as donors. Cord blood stem cells, an alternative source of stem cells for transplantation, have been successfully transplanted into patients with several diseases after myeloablative therapy. Twenty cord blood samples from unaffected neonates whose siblings had severe thalassemia were collected. The median volume was 80 ml. The median number of cells and colony forming units-granulocyte-macrophage in cord blood was 9.2 x 10(8) and 3.4 x 10(5), respectively. Four of 20 cord blood samples had HLA-matched to the affected siblings. One patient underwent cord blood transplantation with success; one patient is waiting for transplantation.

Influence of body composition on risk factors for coronary heart disease in Thai women

Height, body weight, body mass index (BMI), waist-to-hip circumference ratio (WHR), and body fat (BF were determined in 453 female Ramathibodi Hospital Staff, aged 19-61 years. These mean (±SEM) anthropometric parameters were 1.55+0.002 m, 55.1±0.4 kg, 23.0±0.2 kg/m2, 0.82±0.003, and 21.2±0.2 kg, respectively. The prevalences of overall obesity (BMI >= 25 kg/m2) and abdominal obesity (WHR>0.8) were 27.0 and 54.1 %, respectively. Their serum TC, LDL-C, TG, TC/HDL-C, LDL-C/HDL-C, apo B and FBG increased with overall obesity based on BMI or BF whereas opposite results were observed for serum HDLC and apo A-l levels. Except serum TC, LDL-C, and apo A-l levels, other biochemical parameters were also influenced by abdominal obesity based on WHR.

Causes of inadequate protein-energy status in thalassemic children

Height-for-age, weight-for-age, triceps skinfold thickness (TST), mid upper arm circumference (MUAC), and mid upper arm muscle circumference (UAMC) were determined in 47 thalassemic children, ages ranging from 4- 5 years. Their mean (± SEM) height-for-age, weight-for age, TST, MUAC, and UAMC were 90.51± 0.98, 79.91± 2.33, 88.01± 1.26, 83.02± 1.37 and 80.09± 1.59% of standard values. Based on height-forage of less than 95% of standard values and weight-for-age, TST, MUAC, and UAMC of less than 90% of standard values, the prevalences of protein-energy malnutrition (PEM) in these thalassemic children were 72.3,74.5,53.7,75.6 and 82.9%, respectively. The causes of their inadequate protein-energy status were due to: (a) chronic hypoxia evidenced by the significantly positive correlations between haemoglobin levels and height-for-age (r=0.65, P<0.001), weight-for-age (r=0.58, P<0.001), MUAC (r=0.67, P<0.001) and UAMC (r=0.63, P<0.001); (b) zinc deficiency evidenced by significantly positive correlations between plasma zinc levels and height-for-age (r=0.26, P<0.05), MUAC (r=0.41, P<0.005), and UAMC (r=0.41, P<0.005) and significantly negative correlation between urinary zinc levels and UAMC (r=0.34, P<0.02); and (c) low energy intake, ie 65% of the mean recommended energy intake.

Clinical needs and opportunities in assessing body composition

Protein-energy malnutrition (PEM) and obesity are hazardous to health with high morbidity and mortality rates. The assessment of body composition is essential to prevent, diagnose and determine the severity of these disorders as well as their response to therapy. Body weight is the sum of fat and fat-free mass (FFM) whereas its chemical model consists of triglyceride, protein, water, and minerals. Thus one must recognize the appropriate method to assess each compartment of body composition. In clinical practice, the method must be simple, accurate, noninvasive and inexpensive. Body mass index (BMI) is a practical anthropometric parameter to assess protein-energy status in adults because it can easily be calculated from weight in kg divided by (height in meter), and correlates with fatness and mortality. Total body fat can be estimated by measuring the amount of subcutaneous fat by measuring the thickness of the subcutaneous fat layer at different sites of the body by a skinfold caliper or near-infrared interactance. A high waist-over-hip circumference ratio (WHR) can be used to diagnose abdominal obesity. Upper arm muscle circumference can be employed to measure muscle mass. However, whenever these methods are used to assess body composition their limitations should be recognized.

Nocturnal physiological and biochemical changes in sudden unexplained death syndrome: a preliminary report of a case control study

Sudden nocturnal deaths among "healthy" workers in Southeast Asia have been termed "sudden unexplained nocturnal death syndrome (SUNDS)" or "sudden unexplained death syndrome (SUDS)". The pathogenesis is still unknown. The paucity of publications on nocturnal monitoring and scientific data stimulated us to perform this study, which included biochemical tests and physiological monitoring during the night in 11 males north-eastern Thai workers. Group 1 (G1) consisted of 5 subjects with neither a previous history of near-SUDS (NSUDS) nor a familial history of SUDS (FHSUDS). Group 2 (G2) consisted of 6 subjects with a family history of either SUDS or NSUDS. Two subjects in G2 presented with NSUDS. Two-day nocturnal monitoring included blood sugar, electrolytes, and respiratory parameters. 24-hour Holter ECGs were monitored for 2 days. The subjects underwent exercise stress tests on the 2nd day of this study. Significant nocturnal hypoxia was more common in G2 than G1 and this abnormality was aggravated by exercise. There were no significant findings in sleep apnea (apnea indices) or in nocturnal biochemical changes, eg blood sugar, electrolytes, thiamine. The recordings of the Holter-ECGs were within normal limits in both groups. We conclude that nocturnal hypoxia might be the primary abnormality in SUDS, and this abnormality was aggravated by the day-time exercise. The cause of nocturnal hypoxia requires further studies.

Carnitine metabolism and human carnitine deficiency

Carnitine in the human body is derived from the intake of preformed dietary carnitine and biosynthesized carnitine, stemming from the metabolism of lysine and methionine. Carnitine is synthesized in liver and kidney, stored in skeletal muscle, and excreted mainly in urine. Carnitine has two main functions, i.e., transporting long-chain fatty acids into the mitochondrial matrix for beta-oxidation to provide cellular energy and modulating the rise in intramitochondrial acyl-CoA/CoA ratio, which relieves the inhibition of many intramitochondrial enzymes involving glucose and amino acid catabolism. Thus, the main consequence of carnitine deficiency is impaired energy metabolism. Human carnitine deficiency can be either hereditary or acquired. Hereditary carnitine deficiency can be grouped into three clinical entities: myopathic carnitine deficiency, systemic carnitine deficiency, and organic acidurias. Acquired carnitine deficiency is due to inadequate intake, increased requirement, and increased loss of carnitine. The definite diagnosis of carnitine deficiency is based on the determination of free- and acylcarnitine levels in serum, urine, and/or tissues. The estimated safe and adequate daily carnitine intake for adults is 150-500 mumol/day whereas pharmacological doses of carnitine are required for the treatment of hereditary carnitine deficiency.

The effects of soluble dietary fibre from the Thai herb, sweet basil seed, on human body composition

Twenty obese patients, two males and 18 females, with a mean (± SEM) age of 41.7± 3.2 years and body mass index (BMI) of 31.8± 3.8 kg/m2, were enrolled in a 16-week study to evaluate the usefulness and limitations of treatment with a sweet basil seed (Ocimum canum, Sims) extract. For 16-week (wk0-wk16), they were instructed to reduce their usual energy intake. After baseline observations for 4 weeks, for 12 wk (wk4-wkl6), patients were asked to ingest 2 g of sweet basil seed extract, swollen with 240 ml of water, before lunch and supper (4 g/day). Sixteen patients commenced extract use at wk4. On the basis of their ability to ingest more or less than 50% of the extract, they were categorized into high dose (n= 10) and low dose (n=6) users. In high dose users, there were a significant decrease in BMI by the 4th week of treatment which was maintained at the 8th and 12th weeks of treatment, but skinfold thickness measurements for fat did not decrease. There may, therefore, have been a reduction in total body water. Further support for this view was provided by an observed increase in serum total protein concentration at the 12th week of intervention. That the distribution of water may have changed was suggested by an increase in upper arm muscle circumference (UAMC). For low dose users, on the other hand, their body fat increased at wk8 as indicated by both BMI and skinfold thickness measurements, suggesting that supplement use gave a sense of false security. Apart from the change in serum total protein in the high dose group, no significant effect was observed on lipid, renal or electrolyte status, although fasting glucose rose within the normal range. This investigation demonstrated the importance of direct measures of body fatness, as opposed to those implied from weight-height relationships in the evaluation of management strategies for obesity.

Effect of vegetable oil intake on erythrocyte physical properties and hemorheology

Effects of vegetable oil intake on red cell physical properties and blood flow condition were evaluated. The study was done on two groups of volunteers taking either soybean oil (6 volunteers) or palm oil (another 6 subjects) for a period of eight weeks. The continuous effects were followed up after continuing the vegetable oil intake for another four weeks. Significant reduction in red cell deformability was demonstrated by laser diffractometry in both groups. The palm oil had greater extent in causing reduced red cell deformability as early as four weeks after the oil intake, whereas, such effect was shown in eight weeks after the soybean oil intake. The reducing effect of red cell deformability by palm oil intake was more obvious than that by the soybean oil intake as indicated by the fall of deformability index from the control by 47.6 per cent in palm oil and 21.9 per cent in the soybean oil group. The decrease still persisted and could be investigated on the four weeks' followup. The hematologic parameters measured by the laser-based instrument, the H*1 analyser were all within the normal ranges in both groups. However, the group taking soybean oil showed decreasing hemoglobin levels, which may be a physiological response to facilitate blood flow condition. The platelet volume was increased in both groups, indicating the possibility of adjustment of thrombopoiesis in the subjects although no clinical indication related to this finding was shown. In conclusion, intake of vegetable oil had an effect on red cell deformability. Soybean oil had an advantage over palm oil in having less effect on reducing the red cell deformability.

Postprandial glucose and insulin responses to various tropical fruits of equivalent carbohydrate content in non-insulin-dependent diabetes mellitus

The plasma glucose and insulin responses were determined in 10 NIDDM female patients following the ingestion of tropical fruit containing 25 g of carbohydrate. The five tropical fruits were pineapple, mango, banana, durian and rambutan. Blood was drawn at 0, 30, 60, 120 and 180 min, respectively. The results showed that the glucose-response curves to mango and banana were significantly less than those to rambutan, durian and pineapple (P less than 0.05). Only the glucose area after mango ingestion was significantly less than the glucose areas of the other fruits (P less than 0.05). The insulin response curve and insulin area after durian ingestion was statistically greater than after ingestion of the others. We concluded that after mango ingestion, the glucose area was lower than it had been after rambutan, durian and pineapple ingestion and the insulin area was lower than that after durian ingestion of equivalent carbohydrate content in type 2 (NIDDM) diabetes.

Essential fatty acid status in southern Thai preschool children

Essential fatty acid (EFA) status was assessed in 15 Southern Thai preschool children. The mean (+/- SD) serum linoleate (18:2 n-6), arachidonate (20:4 n-6), linolenate (18:3 n-3), eicosapentaenoate (20:5 n-3), and docosahexaenoate (22:6 n-3) percentages in the preschool children were 21.7 +/- 4.0, 6.0 +/- 1.2, 0.4 +/- 0.1, 1.2 +/- 0.8, and 4.4 +/- 1.3, respectively. Since EFA composition of total serum lipids in healthy children are not available and age and sex do not largely influence these parameters, the results of the preschool children were compared with those of 10 healthy Bangkok adults. The corresponding figures of the aforementioned fatty acids in adults were 34.9 +/- 8.5, 4.6 +/- 1.5, 0.8 +/- 0.4, 0.5 +/- 0.4, and 1.6 +/- 0.8, respectively. The data indicate linoleate and linolenate depletion in the preschool children. This was due to their low fat intake and lack of consumption of vegetable oil rich in linoleic and linolenic acids. Their high serum arachidonate percentage was probably due to the increased conversion of 18:2 n-6 to 20:4 n-6 in the presence of linolenate depletion. The significantly higher serum 20:5 n-3 and 22:6 n-3 percentages in the preschool children should be due to direct consumption of these two n-3 fatty acids from fish intake.

Renal tubular acidosis with simultaneous lactic and keto acidoses: unusual manifestations of acute myelomonoblastic leukemia

A 16-year-old male with severe metabolic acidosis required huge doses of sodium bicarbonate to alleviate his symptoms. Subsequent investigation showed that his bone marrow and kidneys were infiltrated with myelomonoblasts. His clinical course showed a temporal relationship between acute myelomonoblastic leukemia and metabolic acidosis. The literature on various etiologies of metabolic acidosis is reviewed. This is probably the first documented case of acute leukemia with the simultaneous occurrence of renal tubular, lactic and ketoacidoses.

Urinary carnitine excretion in surgical patients on total parenteral nutrition

Urinary free and total carnitine excretions were measured in 41 normal adults and seven surgical patients on fat-free total parenteral nutrition for 8 to 45 days. The means (+/-SEM) of urinary free and total carnitine excretion in normal adults were 162 +/- 19 and 328 +/- 28 micrometers/days, respectively. All of the patients exhibited protein-calorie malnutrition with a mean carnitine intake of 11.6 +/- 1.5 micrometers/day. Under this stringent carnitine economy with the adequate supply of lysine and methionine, urinary total carnitine excretion significantly reduced to 127 to 162 micrometers/day. This probably reflects the carnitine biosynthetic rate. However, during the periods of operation and/or infection, urinary total carnitine excretion significantly increased 2- to 7-fold that of normal levels. Significant positive correlation was found between the two forms of urinary carnitine and total nitrogen excretions. Serum free and total carnitine levels in patients were significantly higher than normal adults. Such findings can be explained by the endocrine responses to the stress phenomenon and indicate a catabolic response of skeletal muscle in which most of the body carnitine resides. This can impair their carnitine status.

Essential fatty acid status in adult patients receiving soybean-base formula

Essential fatty acid (EFA) status was assessed in 48 normal Thai adults and 6 patients who required tube feeding ro 2-4 wk with commercial soybean-base formula (Sobel, Mead Johnson). Each 1000 kcal of this formula provided 40.2 g protein, 32.8 g fat, 136 g carbohydrate, 13.9 g linoleic acid, 2.9 g linolenic acid, and 0 g arachidonic acid. The linoleic acid status in these patients before receiving soybean-base formula was inadequate, as evidenced by the significantly lower serum 18:2-W6 percentage but higher serum 16:1-W7 and 18:1-W9 percentages than those in normal adults. These changes were reversed while receiving soybean-base formula. A significant positive correlation between linoleic acid intake and its serum level was demonstrated. There was a significant decrease in serum 20:4-W6 percentage while receiving soybean-base formula. This could be related to the absence of this EFA in the formula and suppression of biotransformation of 18:2-W6 to 20:4-W6 in the presence of a significant amount of 18:3-W3. None of the patients had 20:3-W9 in the serum or developed scaly dermatitis throughout the study.

Carnitine status in Thai adults

Plasma carnitine and urinary carnitine levels were measured in Thai adults living in Bangkok city and Ubol villages. The mean plasma carnitine and urinary carnitine levels expressed in micromoles per liter in Bangkok adults were higher than those in Ubol adults. Their mean plasma carnitine levels were 56.6 +/- 1.8 and 50.3 +/- 1.7 whereas urinary carnitine levels were 161 +/- 19 and 127 +/- 18 micromole/liter, respectively. The nutritional status in Ubol adults was inadequate. This was evidenced by the significant decrease in urinary creatinine excretion, serum albumin, and hematocrit levels. The dietary assessment agreed with the biochemical findings. Since rice, limiting in carnitine, was the main protein and energy source consumed by Ubol adults their inadequate carnitine status could be due to the low carnitine intake. Sex affects plasma carnitine levels in Bangkok adults and urinary carnitine excretion in both groups. This could be related to the lean body mass in which most of the body carnitine resides. This is supported by the higher urinary creatinine excretion in males and the significant positive correlation between carnitine excretion and creatinine-height index.

Assessment of nutritional status in adult hospitalized patients

140 adult hospitalized Thai patients were assessed for their nutritional status. The prevalence of protein-calorie malnutrition in these patients based on various parameters was as follows: 73.2% according to weight-height, 80.0% accroding to triceps skinfold thickness, 60.7% according to upper arm muscle circumference, 50.4% according to hair root morphology and 66.2% according to serum albumin level. These data reflected the disproportionate loss of the patients' body tissues. Severity of protein-calorie malnutrition was also detected by physical signs. Anemia and vitamin deficiencies were present in some of the patients. This study signifies that intensive nutritional management should be done to combat hospital malnutrition.

Levels of L-carnitine and L-O-acetylcarnitine in normal and infertile human semen: a lower level of L-O-acetycarnitine in infertile semen

The level of total L-carnitine was determined in normal human seminal plasma and sperm. Most of the L-carnitine is concentrated in the seminal plasma and its level is about 10 times higher than that in blood plasma. About 50% of total L-carnitine in normal human seminal plasma exists in the form of acetylcarnitine. Similar studies were also carried out in oligospermic and azoospermic human seminal plasma. The level of L-O-acetylcarnitine in both types of infertile samples is significantly lower than that in normal samples. On the other hand, the level of free L-carnitine is the same in fertile and infertile seminal plasma.

Dietary lysine and carnitine: relation to growth and fatty livers in rats

Male weanling rats were fed a 72% rice diet containing no detectable carnitine and limiting in threonine and lysine. Such dietary conditions may simulate protein malnutrition in man. Under these conditions growth impairment, anemia, hypoproteinemia, and fatty liver developed. The study focused principally on the fatty liver syndrome which was corrected to varying extents depending on degrees of supplementation with carnitine, lysine, threonine, and appropriate combinations of these nutrients. Such reduction in fatty liver accumulation was accounted for principally by the lowering of triglycerides, but also in part of total cholesterol levels. All the data, which also included monitoring carnitine uptake by the tissues and measurement of plasma triglycerides, were consistent with the view that fatty liver accumulation occurs in amino acid deficient diets because (a) of an impairment in the synthesis of the lipoprotein complex mandatory for triglyceride secretion from the liver and (b) from a deficiency of carnitine needed for the intramitochondrial transport of fatty acids prerequisite for their oxidation.