The growth of microorganisms in total parenteral nutrition admixtures

Total nutrient admixtures (TNAs) containing glucose, amino acids, and lipid emulsion in one container and amino acid/dextrose solutions [conventional total parenteral nutrition (TPN) formulations] were studied in a controlled laboratory experiment for their ability to support the growth of microorganisms. Both TNA and conventional TPN formulations for peripheral and central venous administration with standard additives were inoculated with microorganisms to provide 10(1)-10(2) colony-forming units/ml (CFU/ml) of Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Candida albicans. The admixtures were stored at room temperature and samples for quantitative microbiology were taken at time 0, 6, 12, 24, 48, 72, and 96 hr. K. pneumoniae, E. coli, and P. aeruginosa were able to proliferate in central TNAs, but the growth of these organisms was retarded in conventional TPN solutions. In the peripheral formulations, K. pneumoniae and E. coli proliferated in both the TNA and conventional TPN systems, whereas P. aeruginosa grew well only in the peripheral TNA. S. epidermidis was not able to grow in any admixtures tested; however, C. albicans grew well in all admixtures, but growth was slower in the conventional central TPN. In conclusion, peripheral and central TNAs supported the growth of microorganisms significantly better than conventional TPN solutions.     

Prevention of yeast translocation across the gut by a single enteral feeding after burn injury

Recently, burn injury has been shown to facilitate the ability of enteric Candida albicans (CA) to penetrate the gut epithelium and translocate to the mesenteric lymph nodes (MLN) during the first 24 hr after injury. Guinea pigs were given 3 X 10(10) CA intragastrically before inflicting a 50% burn to determine if a single enteral feeding could affect CA translocation to the MLN. A bolus infusion (20 kcal/kg, 12 ml in volume) of liquid meal, consisting of 68% carbohydrate, 20% protein, and 12% lipid, was administered either at 3-hr or 12-hr postburn. Control groups received no food or a similar amount of saline by bolus infusion. All animals were allowed water ad libitum until 24-hr postburn when their MLN and intestinal segments were harvested for enumeration of viable CA. Blood was also collected for determination of serum IgG, C3, cortisol, and albumin. Compared to nonfeed animals, those with a single enteral feeding at 12-hr postburn had reduced numbers of CA translocating to the MLN (970 +/- 220 vs 7,120 +/- 2,130 CFU/g, p less than 0.02) and colonizing in the ileum (27,000 +/- 6,770 vs 104,000 +/- 23,550 CFU/g, p less than 0.01). Bolus feeding at 12 hr was associated with a lower cortisol level (237 +/- 55% of normal controls) than bolus feeding at 3 hr (310 +/- 58, p less than 0.02) or the nonfed group (326 +/- 66, p less than 0.01). Regardless of dietary treatment, serum cortisol levels correlated positively with the extent to which CA translocated to the MLN and negatively with C3 levels.     

Microbial growth comparisons of five commercial parenteral lipid emulsions

The ability of parenteral lipid emulsions to support microbial growth was compared using commercially available brands of lipid emulsion. Both 10 and 20% concentrations of soybean and safflower oil emulsions were used. Washed cultures of six gram-negative, three gram-positive, and one yeast, in concentrations of 1 x 10(4) to 2 x 10(4) colony-forming units/ml, were inoculated into lipid emulsion aliquots and stored at room temperature. There were than subcultured at 0, 6, 12, 24 and 48 hr. After 48 hr at 37 degrees C, growth was recorded as colony-forming units/ml. Normalized growth curves were expressed as mean +/- SEM. ANOVA demonstrated no difference in growth patterns due to the nature of the oil or its concentration. Gram-negative organisms multiplied faster when compared to gram-positive (p less than 0.05 at 12 hr, p less than 0.01 at 24 hr, and p less than 0.005 at 48 hr). Yeast grew as well as bacteria. The Center for Disease Control's recommendation of a 12-hr hang time for parenteral lipid emulsions should be observed until correlation of laboratory microbial growth patterns and clinical use are studied further.     

Urea nitrogen excretion in chair-adapted primates

To evaluate the temporal pattern of urea excretion in chair-adapted primates (Macaque fascicularis) on continuous total parenteral nutrition (TPN), two groups of five animals were studied. Group I received continuous TPN (75 glucose kcal; 0.56 g nitrogen; and 100 ml fluid per kg per day) while Group II received a single morning isonitrogenous oral meal along with a continuous isovolemic intravenous infusion of 0.45% saline. Urine was collected hourly in group I for 2 days and every 4 hr in group II for 5 days and analyzed for urea content. Time series analysis revealed no periodicity of urea excretion in either group. Six animals were then studied for a total of 46 TPN days to define the relationship between the urea content of a single 3-hr morning urine aliquot and its respective content in a 24-hr collection. A significant linear relationship was found (r = +0.76, p less than 0.01). However, using this relationship, a reasonable estimate (+20%) of measured 24-hr urea output was achieved only 50% of the time using a single 3-hr urea output. Chair-adapted primates maintained on continuous TPN or a single oral meal with continuous saline infusion do not exhibit a periodic pattern of urea excretion. The variability in 3-hr urinary urea output in the chaired primate on continuous TPN does not consistently permit accurate estimation of the coincident 24-hr urinary urea output.     

Thermogenesis from intravenous medium-chain triglycerides

Eighteen hospitalized patients dependent on total parenteral nutrition (TPN) were randomly enrolled into a prospective study comparing intravenous long-chain triglycerides (LCT) with a physical mixture of 75% medium-chain triglycerides (MCT) and 25% LCT. The TPN was given continuously as amino acids and glucose over 5 days with the respective lipid emulsion given intermittently during each day for 10 hr. Indirect calorimetry was measured on each patient before the lipid emulsion was administered in the morning and again 10 hr later near the end of the lipid infusion, on days 1, 3, and 5. Resting energy expenditure, VO2, VCO2, and calculated fat oxidation were shown to increase during MCT infusion but not during LCT administration, (resting energy expenditure 899 +/- 37 to 1085 +/- 40, compared with 978 +/- 23 to 976 +/- 39, kcal/m2 body surface area [BSA]/day, respectively, p less than 0.0002; VO2: 129.9 +/- 5.2 to 157.2 +/- 5.9, compared with 140.9 +/- 3.6 to 141.2 +/- 5.9 ml O2/min/m2 BSA, respectively, p less than 0.0005; and VCO2: 110.7 +/- 4.4 to 127.5 +/- 4.3, compared with 118.3 +/- 2.8 to 118.0 +/- 5.3, ml CO2/min/m2 BSA, respectively, p less than 0.0076; calculated fat oxidation 10.7 +/- 1.5 to 19.3 +/- 2.4, compared with 20.0 +/- 2.7 to 20.0 +/- 3.6, kcal/m2 BSA/hr, respectively, p less than 0.014). Respiratory quotient tended to fall with lipid infusion but did not change statistically. Body temperatures were unaltered by either fat infusion. It is concluded that TPN consisting of MCT causes an increased thermogenesis, most likely through increased fat oxidation, reflective of MCT's property as an obligate fuel. The increased thermogenesis occurs without an increase in body temperature.     

Stability of imipenem and cilastatin sodium in total parenteral nutrient solution

The chemical stability and compatibility of imipenem-cilastatin sodium (Primaxin) in two different total parenteral nutrient (TPN) solutions was determined. TPN solutions consisted of 4.25% and 5% amino acids with 25% and 35% dextrose, respectively. Imipenem-cilastatin sodium was constituted with 10 ml of sterile water and admixed with 90 ml of TPN solution for a final concentration of 5 mg/ml of each drug. The final solutions were assayed at times 0 (immediately after admixture), 15 min, 30 min, 1, 4, 8, and 24 hr by a stability-indicating high-performance liquid chromatographic assay. Concurrently, test TPN solutions were monitored for pH changes, color changes, and precipitate formation. The potential effect of imipenem-cilastatin sodium on the stability of amino acids and other TPN additives was not evaluated. Imipenem and cilastatin sodium was stable (greater than or equal to 90% recovered) in each TPN solution at 15 min. A significant (greater than or equal to 10%) and steady decrease of imipenem recovery occurred at subsequent sampling times. Cilastatin appeared more stable than imipenem in both TPN solutions. A physical color change from colorless to dark orange appeared in each TPN solution over the 24-hr study period. Imipenem-cilastatin sodium is stable for 15 min in the TPN solutions studied; however, until the stability of the amino acids can be determined, the antibiotic should be administered through a separate line or Y-site while the TPN infusion is interrupted.     

Parenteral infusion of long- and medium-chain triglycerides and reticuloendothelial system function in man

Previous study demonstrated that patients who received total parenteral nutrition (TPN) with standard intermittent infusion of long chain triglyceride (LCT) at 0.13 g kg-1hr-1 over 10 hr for each of three days showed a significant decline in 99Tc-sulfur colloid (TSC) clearance rate by the reticuloendothelial system (RES). The present studies evaluated eight patients who received the same total lipid dose of LCT infused continuously as in a three-in-one admixture, and another nine patients receiving the same amount of fat as a medium chain triglyceride (MCT)/LCT (75%/25%) emulsion intermittently over 10 hr at 0.13 g kg-1hr-1 for three consecutive days. Patients were given continuous total parenteral nutrition (TPN) comprised of protein, 1.5 g kg-1day-1, and dextrose, 4.5 g kg-1day-1. RES function was examined by measuring the clearance rates of intravenously injected TSC while receiving TPN containing only protein and dextrose, and again after three days of fat infusion. Mean (+/- SEM) clearance rate constants before and after continuous LCT infusion were 0.38 +/- 0.09 and 0.41 +/- 0.08 min-1, respectively, while those before and after intermittent MCT/LCT infusion were 0.50 +/- 0.18 and 0.73 +/- 0.24 min-1, respectively. In contrast to intermittent LCT infusion, the administration of continuous LCT or an intermittent MCT/LCT mixture does not impair TSC clearance by the RES. These findings suggest that condensing the daily period of LCT infusion at standard dosage may exceed the rate of metabolic utilization, resulting in increased fat removal and diminished TSC uptake by the RES.(ABSTRACT TRUNCATED AT 250 WORDS)     

Acute inhibition of lipid transport in rat intestinal lymph by ethanol administration.

To observe the effect of acute ethanol ingestion on stable lipid transport in intestinal lymph, three groups of mesenteric lymph fistula rats were prepared. In group A rats, lipid emulsion containing 120 mumol/hr of oleate (control meal) was infused intraduodenally for 8 hr. Group B rats were infused with another lipid emulsion, which had the same basic composition as the control meal but included 0.75 g/kg body weight/hr of ethanol (alcohol meal), for 8 hr. In group C, rats were infused with the control meal for the first 4 hr, then with the alcohol meal for the next 4 hr. Lymph flow increased just after the infusion of ethanol, that is, lymph flow in group B was significantly higher than that of group A at 1 and 2 hr, and lymph flow in group C was significantly higher than that of group A at 5 hr. In group A, lymphatic triglyceride (TG) output reached a plateau of more than 30 mumol/hr after 3-hr infusion. TG output in group B was significantly lower than that in group A from 2 hr to 8 hr and was two-thirds that of group A at the plateau level. In group C, TG output was the same as in group A until 5 hr, but decreased to two-thirds of that in group A at 6 hr, 2 hr after replacing the control meal with the alcohol meal. Lymphatic phospholipid output exhibited a tendency similar to that of TG output. Comparisons of group A vs. B and A vs. C clearly demonstrated an inhibitory effect of ethanol on stable lipid transport in intestinal lymph. A 2-hr infusion was enough for ethanol to exhibit its inhibitory effect. In conclusion, stable lymphatic transport of intestinal absorbed lipid was suppressed by acute ethanol ingestion.     

Effect of structured lipids as energy substrate after hepatectomy in rats with streptozocin-induced diabetes.

The suitability of energy substrates for use by the remnant liver after 70% hepatectomy was studied in relation to the hepatic energy status in diabetic rats. Rats with streptozocin-induced diabetes underwent 70% hepatectomy and were divided into five groups receiving total parenteral nutrition (TPN) for 24 h. One group received standard TPN without fat, and four groups respectively received standard TPN with long-chain triglycerides (LCTs), medium-chain triglycerides (MCTs), mixed triglycerides (MIX), or structured lipids (SLs) as a 10% lipid emulsion. The latter groups received 60% of nonprotein calories per day with fat emulsion (LCT, MCT, MIX, or SL), and the remaining 40% with glucose. The group that received 100% of nonprotein calories per day with glucose was defined as the TPN group. All rats in the TPN group died from nonketotic hyperosmolarity within 24 h. The blood ketone body ratio (acetoacetate/beta-hydroxybutyrate), the energy charge level of the remnant liver, and the cumulative excretion of 14CO2 in expired breath during 6 h after [14C]glucose administration were all significantly higher in the SL group than in the other groups 24 h after hepatectomy. These findings suggest that SL may be a superior energy substrate to other triglyceride preparations during the immediate posthepatectomy phase in diabetic patients.     

Effects of long-chain triglyceride emulsions on reticuloendothelial system function in humans

Parenteral administration of long-chain triglyceride emulsions has been shown to have deleterious effects on reticuloendothelial system function in animal models. It is unknown whether this interference occurs in humans with clinically relevant doses of intravenous fat. Two studies were done. Eighteen patients were prospectively enrolled for study. Patients received full feeding by continuous total parenteral nutrition (amino acids 1.5 g/kg/day and dextrose 4.5 g/kg/day) with 33.1 kcal/kg/day. Forty-three % of the nonprotein calories were provided as soybean oil emulsion (Travamulsion 20%) and was administered intravenously over 10 hr (0.130 g/kg/hr). Reticuloendothelial system function was determined by measuring the change in the clearance rate of intravenously injected 99mTc-sulfur colloid (TSC) in each patient. In study 1 (n = 10), one day of lipid (10 hr) was infused, with the clearance of 99mTc-sulfur colloid measured before the lipid was infused and then during the last hour of the 10-hr infusion. In study 2 (n = 8), the clearance rates were measured before the lipid emulsion was begun, and then during the last hour of the infusion on the 3rd day. Clearance rates for TSC after 10 hr of lipid infusion in study 1 did not differ (0.27 +/- 1/min to 0.26 +/- 0.1/min, p greater than 0.10). However, after 3 days of lipid infusion (10 hr/day), a statistically significant reduction in TSC was seen (0.46 +/- 0.08/min-0.27 +/- 0.03/min, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Options available for the infusion of lipid emulsion in home parenteral nutrition (HPN): a questionnaire survey for hospitals in Japan where HPN is practiced

OBJECTIVE: To understand the status of total parenteral nutritional (TPN) composition and the TPN line used for home parenteral nutrition (HPN) in Japan and to investigate how adequate nutritional support should be in HPN, we conducted a questionnaire survey. METHODS: From February to March 2004, questionnaires were sent by mail to the members of the Japan Society for Home Therapy Research. With the content of the questionnaire, we surveyed 1) the types of medical staff who are involved in HPN, 2) the status of the preparation of TPN fluid and its place of preparation, 3) use of the TPN line and final filter, and 4) administration of lipid emulsion and All-in-One. RESULTS: The major survey results from 66 respondents were that the 50% of the medical staff who are involved in HPN have more than 10 y of experience; however, the number of patients who used HPN and were treated by 78% of the medical staff was fewer than 50. With regard to TPN fluid, 50% was prepared in-house and 12% was prepared by home care service providers. In addition, 58% of institutions were infusing lipid emulsion from the side port of the TPN line or through a peripheral route because they used a final filter and closed system infusion line. CONCLUSIONS: Because the final filter and closed system infusion line for HPN management is standard practice, lipid emulsion is not adequately used in Japan. Therefore, the All-in-One system including lipid emulsion is not used.     

Evaluation of the endotoxin retention capabilities of inline intravenous filters

The capabilities of inline filters to retain bacteria and endotoxin were examined during simulated extended infusions for up to 168 hr. The tested inline filters were the ELD96 (Pall Biomedical Corp) and the IVEX 2 (Millipore Corp). Approximately 1 x 10(8) total cells of Escherichia coli B. were challenged to the upstream site of the filter. The test solution of 5% dextrose in water, 0.9% saline, Paremental A (A basic solution for total parenteral nutrition (TPN), a TPN solution in use in our clinic were infused continuously up to 168 hr and flow rate was maintained at 83 ml/hr. The effluents were analyzed using the Limulus Amebocyte Lysate (LAL) test to detect endotoxin and also passage of the challenged bacteria was tested at 24-hr intervals over 168 hr. The results were as follows: (1) The viability control culture showed the presence of viable bacteria throughout the 168-hr period of the experiment. (2) During the experiments, all filters produced sterile effluents. (3) LAL assay indicated that only the effluents from the ELD96 contained no detectable endotoxin for 168 hr.     

Comparison of the effects of continuous and cyclic nocturnal parenteral nutrition on energy expenditure and protein metabolism

Although cyclic nocturnal total parenteral nutrition is a widely used technique, its metabolic consequences have not been fully investigated. During two successive 7-day periods, 12 patients received randomly either standard continuous (infusion 24 hr/day) or cyclic (infusion between 5 pm and 9 am) total parenteral nutrition (TPN). Calorie and nitrogen intakes were identical during both periods. Energy expenditure was investigated by indirect calorimetry and showed practically no difference between continuous standard (1383 +/- 41 kcal/day-1) and cyclic total parenteral nutrition (1428 +/- 46 kcal/day-1). However, in the cyclic regimen, when compared with continuous infusion, energy expenditure was higher between 5 pm and 9 am and lower between 9 am and 5 pm. At the end of the noninfusion period, the 24-hr profile of the nonprotein respiratory quotient showed a slight decrease in patients receiving the cyclic infusion, in contrast with the stability of the quotient in the standard regimen. However, the nitrogen balance and variations in nutritional status did not differ significantly. In conclusion cyclic TPN is efficient for achieving a positive energy and nitrogen balance and in addition it induces a metabolic profile closer to physiological conditions.     

Availability of insulin from total parenteral nutrition solutions

Insulin is frequently required in total parenteral nutrition (TPN) solutions to control hyperglycemia. The purpose of this study was to evaluate the recovery of human insulin from standard TPN solutions with and without lipids and from TPN solutions with specialized amino acid formulations and to compare it to the insulin recovery from normal saline. All solutions were mixed in currently utilized PVC-free bags (ethylene vinyl acetate) and drained through PVC-containing tubing. Human insulin (Humulin-R) was spiked with 125I-labeled insulin and then added in concentrations of 10, 25, and 50 units to 1-liter bags containing 39-g amino acids (10% Freamine-III; or 6.9% Freamine HBC; or 8% Hepatamine), 257-g dextrose, electrolytes (Hyperlyte-R), 1000 units of heparin, MVI-12, and MTE-5 Concentrate. Alternate sets of bags contained 125 ml of 20% Intralipid and an appropriate amount of sterile water to keep the final volume at 1 liter. Actual clinical conditions of preparation, storage, and administration were simulated in this in vitro experiment. Multiple samples were collected during the 8-hr infusion period directly in gamma counter vials. All experiments and assays were done in triplicate. Our findings indicate that human insulin availability in TPN solutions is much higher (90%-95%) than the 50% suggested in the literature. Insulin recovery was not appreciably altered by adding lipids or by using Freamine HBC. Insulin recovery from TPN solutions was significantly reduced if they contained Hepatamine (87% and 88%, p less than 0.05) as compared to Freamine (90% and 94%).(ABSTRACT TRUNCATED AT 250 WORDS)     

The growth of micro-organisms in intravenous fluids

The growth of four micro-organisms in 12 different intravenous fluids at room temperature was studied. Gram-negative organisms grew better than Gram-positive, and lipid solutions were most favourable to microbial growth. Microbial growth was inhibited in solutions with osmolalities over 500 mosmol/l; Staphylococcus epidermidis was inhibited by inocula with Gram-negative bacilli, while the growth of Gram-negative bacilli generally was not affected. Candida albicans was inhibited by Gram-negative bacilli in lipid and 5% dextrose solutions.     

Immediate stimulation of protein metabolism in burned rats by total parenteral nutrition enriched in branched-chain amino acids

The effects of two kinds of total parenteral nutrition (TPN) on energy and protein metabolism were examined in rats subjected to 15% full-thickness scald burns in the absence of septic complications. One type of TPN was enriched in branched-chain amino acids (BCAAs), especially leucine (45% BCAA content), and the other was conventional TPN (21% BCAA content). Burned rats received isocaloric and isonitrogeneous TPN solutions for 48 hr after resuscitation by saline infusion for 24 hr. Liver and rectus abdominis muscle were removed from the rats at 7, 24, 48, and 72 hr. The concentrations of adenine nucleotides, RNA, protein, glucose-6-phosphate, hepatic glycogen, muscle phosphocreatine, and 3-methylhistidine were determined. Metabolic alterations occurred during the period of saline resuscitation (0-24 hr). At 48 hr the RNA and protein levels were significantly more improved in the BCAA-TPN group than in the conventional TPN group. At 72 hr, however, the results for the two groups were similar in most metabolite levels. Thus, BCAA-TPN enriched in leucine rapidly stimulated protein synthesis in the liver and muscle. This rapid effect may make it useful during the initial nutritional management of severe trauma patients.     

The Henry M. Vars Award. The effect of lipid emulsions on reticuloendothelial system function in the injured animal

Use of intravenous lipid emulsions in trauma and sepsis still remains controversial. In order to examine the impact lipid emulsions have on host defense against bacterial infection during total parenteral nutrition (TPN), 56 male Sprague-Dawley rats underwent jugular cannulation and were randomly divided into three groups, each receiving one of three TPN regimens. All regimens delivered approximately 250 kcal/kg X body weight/day, of which 12.5 g were as amino acids. Group 1 received 100% of the nonprotein calories as glucose (AA + G). Group 2 was given 50% of the nonprotein calories as a longchain triglyceride emulsion (100% LCT). Group 3 received 50% of nonprotein calories as a mixed lipid system, composed of medium- and long-chain triglycerides (75% MCT/25% LCT). After 24 hr on intravenous nutrition, all animals received bilateral septic femur fractures and were continued on TPN for 3 days. On the last day, the level of bacteremia and the in vivo response to an intravenous challenge of 59Fe-labeled Escherichia coli were examined. Three days following the septic injury, animals given MCT as part of their lipid calories were not bacteremic, whereas the other groups had greater than 10(2) cfu/ml of blood. Animals receiving TPN with MCT sequestered a greater percentage of exogenously administered bacteria in the liver and sequestered less in the lung compared to animals given 100% LCT (p less than 0.05). From these data, we conclude that parenteral nutrition formulas where LCT has been partially replaced with MCT may better support host bactericidal capacity than similar regimens comprised of LCT as the sole lipid source.     

Lipid and lipid-free total parenteral nutrition: differential effects on macrophage phagocytosis in rats

Lipid emulsions provided with total parenteral nutrition (TPN) have been associated with mononuclear phagocytic system functional changes. The aim of the present investigation was to assess the influence of TPN with added lipid emulsions on macrophage (M phi) phagocytosis. Wistar rats (n = 70) with external jugular vein cannulation were randomized into seven groups. The rats received an oral diet or six different isocaloric (1.16 kcal/mL), isonitrogenous (1.5 g/mL), and isolipidic (30% non-protein calories) TPN regimens: (a) an oral diet with intravenous infusion of saline (OS); (b) non-lipid TPN (glucose); (c) TPN with 10% long chain triacylglycerol emulsions (LCT); (d) TPN with 90% LCT and 10% fish oil (FO) emulsion; (e) TPN with 50% LCT and 50% FO; (f) TPN with 10% lipid emulsion with 50% medium chain triacylglycerol (MCT) and 50% LCT; and (g) TPN with 45% MCT, 45% LCT, and 10% FO. After 96 h of TPN or saline infusion, colloidal carbon (Pelikan, Germany) was injected intravenously at 1.0 mL/kg body weight, and the rats were killed after 3 h. Liver, spleen, and lung were weighed and prepared by immunohistochemistry analyses with the HAM-56 anti-M phi antibody. Under light microscopy, the total M phi number (MT) and the colloidal carbon phagocytic M phi number (MP) were established, and the phagocytic index was calculated as MP/MT x 100. There were no statistical (P < 0.05) differences in liver, spleen, or lung weights among the seven groups in comparison with the OS group. Non-lipid TPN inhibited spleen and lung M phi phagocytosis when compared with the OS and lipid-TPN groups. Lipid TPN supplemented with fish oil emulsion increased total liver and lung M phi number and phagocytosis. These results indicate that TPN supplemented with fish oil increases M phi phagocytosis in rats.     

Microbiological profile of raw Nile water

With the increase of population on the Nile banks, a remarkable increase in industrial, agricultural, human activities, and recreational activities have also occurred. The effluents of such activities are discharged directly into the Nile or through some agricultural drains which finally discharge their wastes into the Nile. Thus, the microbiological monitoring is one of the main objectives to protect the river Nile. This study was conducted to determine the microbiological profile of river Nile at Cairo segment. Eight sites were chosen along the distance (60 Km) from El-Shobak to El-Kanater and tested for two successive years (summer 1994-spring 1996). To achieve this goal, microbiological parameters (total bacterial counts at both 22 degrees C and 37 degrees C, total coliforms, faecal coliforms, faecal streptococci, total yeasts, Candida albicans, Aeromonas hydrophila, salmonellae, total staphylococci, total vibrios and Listeria group) were evaluated. The results showed that the count of the previous parameters ranged between 1.0x10(3)-7.8x10(5) CFU/ml, 5.0x10(2)-6.4x10(5) CFU/ml, 4.9x10-1.6x10(4) MPN/100 ml, 2.0-5.2x0(3) MPN/100 ml, 2.0x10-1.4x10(3) MPN/100 ml, 1.7x10(3)-2.6x10(5) CFU/100 ml, 1.5x10(2)-1.7x10(5) CFU/100 ml, 1.0x10(3)-2.4x10(5) CFU/100 ml, 1.3x10(2)-5.1x10(3) CFU/100 ml, 1.0x10(2)-3.3x10(3) CFU/100 ml, 1.0x10(2)-3.8x10(4) CFU/100 ml and 1.0x10(2)-1.4x10(5) CFU/100 ml, respectively. The total bacterial counts and bacterial indicators (total coliforms, faecal coliforms and faecal streptococci) were detected in all samples during the period of study, and the count increased in samples collected during summer than other seasons. Also total yeasts, A. hydrophila and total staphylococci were detected in all samples with differences in count between the sites. In contrast, other microbial parameters, Candida albicans, salmonellae, total vibrios and Listeria group were not detected in some samples at some sites. According to our results it can be concluded that the river Nile is categorized as an intermediately polluted river.     

Influences of an infusion of lipid emulsion on phagocytotic activity of cultured Kupffer's cells in septic rats

An experimental study was undertaken to study the influences of an infusion of lipid emulsion on phagocytosis of Kupffer's cells in septic rats. Sepsis was induced in 13 rats by ligating the cecum. Five of them received glucose as the sole nonprotein calorie (septic-glucose group), four of the rats received 25% of the nonprotein calorie with lipid emulsion, Intralipid (septic-lipid group), and the remaining four rats did not receive any intravenous solution and were allowed access to water (septic-fasted group). Another four rats which received neither intravenous solution nor ligation of the cecum served as the control group. The intravenous infusion was carried out for 72 hr. The phagocytotic activity of Kupffer's cells was determined by the ability to engulf latex particles with a size of 1.09 micron, in vitro. The phagocytotic activity was enhanced by the presence of sepsis but it was inhibited by starvation. The difference in the phagocytotic activity between the septic-glucose group and the septic-lipid group was not significant. These results suggest that, insofar as an in vitro study is concerned, a 72-hr infusion of lipid emulsion at a rate of 25% of the total nonprotein calorie does not influence the phagocytotic activity of cultured Kupffer's cell obtained from septic rats.