Introduction Patients with intestinal failure (IF) develop problems of malabsorption and malnutrition associated with short bowel syndrome (SBS). Home parenteral nutrition (HPN) became available to treat these patients since the 1970s. There is a paucity of qualitative research on patients’ experiences in the UK. The study aim was to generate theory that explains the experiences of adults living with HPN and complex medication regimens. Method The grounded theory methodology was used to explore the experiences and to generate theory about this health intervention. Twelve participants were interviewed. The interviews were recorded and transcribed verbatim. The joint process of data collection and analysis followed the principles of constant comparative approach. Results The core categories of stoma care and HPN treatment were supported by the subcategories of maintaining stoma output, access to toilets, maintaining HPN infusion routine, access to technical help to set up HPN infusion, and general health changes. Strategy used to manage living with loss was demonstrated by the subcategory of maintaining daily activities and social interactions. Discussion The theory of living with loss suggests that patients with a stoma receiving HPN experience the sense of loss at home and in social situations. Opportunities for professional practice development are detailed along with implications for future research. Conclusions The findings resonate with the Kubler-Ross Model of the five stages of grief (Kubler-Ross, 1970). The theory of living with loss was generated by the use of the grounded theory methodology. This study identified opportunities for changes and improvement in clinical practice.

No description available.

Background: Recent research is revealing the high rate of false-positive screening results for IEMs in the NICU population. No study published to date has specifically studied the possible relationship between nutrition and newborn screening in this population. Objective: It is suspected that NICU infants who receive PN are more likely to have abnormal newborn screening results than infants who receive EN. An understanding of the role of nutrition will assist in developing protocols for screening in the NICU and decrease false-positives. Design: Infants admitted to the NICU between January 1-June 30, 2009 were included in this retrospective chart review study (n=339). The type of nutrition and timing of its initiation was recorded and compared to newborn screening results to identify correlations with false-positives. Statistical analysis included means, percentages, Fisher's exact test, Chi-square test, and the Cochran-Mantel-Haenszel test. Results: Nutrition type was significantly associated with newborn screening (p<0.001); those who received parenteral nutrition were more likely to have a false-positive. For infants who also received PN, EN of breast milk exclusively increased risk of an abnormal screen more than formula exclusively or breast milk plus formula. The timing of parenteral nutrition had no effect on screening. Premature infants who received PN exclusively had a higher percentage of false-positives than those who received EN Conclusions: Although the hypothesis could not be statistically supported, PN appears to contribute to false-positive newborn screens. More research is needed to ascertain the role of EN and GA in newborn screening and to develop standardized protocols. / Master of Science

The number of patients who are receiving home total parenteral nutrition (TPN) is increasing. This phenomenon is a result of rising hospital costs and legislation which encourages shorter hospital stays. Previous research has not demonstrated thoroughly change in nutritional status associated with TPN given over a long period of time to patients with singular disease entities such as Crohn's disease. Therefore, this study was undertaken. Two groups of patients were obtained: a sample of five hospitalized patients from a veterans' hospital, and a sample of fifteen home patients followed by a hospital-based nutritional support team. Both groups had Crohn's disease and were receiving TPN. The following parameters were measured: serum albumin, percentage of ideal body weight, and total iron binding capacity. Mean levels and standard deviations of each parameter per time period measured were obtained. These means were plotted across time periods. For each parameter, slopes for each time period were compared using a t-test. For the hospital group, time periods consisted of 20 day periods. For the home patients, time periods were 12 months in length. Mean levels of each parameter remained within normal limits within nearly all time periods for both groups. However, significant changes in each parameter in the home group occurred at the following time periods: 60- 72 months and 72-84 months for serum albumin; and 0-48 months and 48-120 months for total iron binding capacity. (No periods of significance occurred for changes in percentage of ideal body weight.) These changes might indicate periods of significant response to TPN. Other factors which also might have influenced these results include level of compliance by patient, other major illness, iron status, hydration status, effects of sample size, and protein-losing enteropathy. / M.S.

No / Aim The aim of this review is to summarise the literature relating to patients’ experiences with home parenteral nutrition (HPN). Method This literature review is based on searches of CINAHL, PubMed, Web of Knowledge and Web of Science for articles published between 1970 and 2013. Additional studies were included from Department of Health publications, NICE clinical guidance, UK patient support group with interests in HPN or intestinal failure (IF). Results Patients with severe IF have been successfully treated with HPN since the 1970s. Early published studies evaluated clinical outcomes such as catheter-related infections, metabolic complications, thrombosis of the catheterised vein and liver impairment. Since the 1980s questionnaire studies were used to evaluate the quality of life (QoL) of patients treated with HPN. These early studies used QoL assessment tools which were not validated for patients treated with HPN. Internationally, there were published qualitative research studies which explored the experiences of patients treated with HPN. Conclusions The long-term outcome of patients treated with HPN continues to attract research interest. The review of the literature did not identify any published qualitative studies on the experiences of patients treated with HPN in the UK, suggesting a gap in the research. The UK National Health Service advocates a patient-centred approach for service design and delivery in primary and secondary care. This literature review has highlighted opportunities for qualitative research into the experiences of patients living with HPN to achieve better understanding and awareness of the rehabilitation of these patients

Yes / & aims Parenteral nutrition (PN) provides nourishment and hydration as an intravenous infusion to patients with intestinal failure (IF). The aim of the study is to generate theory that explains the experiences of adult patients living with home parenteral nutrition (HPN) and complex medication regimens. Methods A grounded theory methodology was used to explore the experiences of twelve patients receiving HPN. A semi-structured interview was conducted and recorded in each participant's home setting. Each interview was transcribed verbatim. The simultaneous process of data collection and analysis was followed reflecting the principles of the constant comparative approach. Results A total of 15 patients gave written consent, with 12 of them agreeing to be interviewed. All the participants had previously undergone surgery as a result of chronic ill health or sudden illness. Analysis revealed two core categories: stoma and HPN, and these were supported by the subcategories: maintaining stoma output, access to toilets, managing dietary changes, maintaining the HPN infusion routine, access to technical help to set up an HPN infusion, mobility with HPN equipment and general health changes. The strategy of living with loss was demonstrated by all the participants, and this was supported by the action strategies of maintaining daily activities and social interactions. Conclusions This study generates new understanding and insight into the views and experiences of patients receiving HPN in the UK. The findings from these participants have been shown to resonate with the Kubler-Ross Model [1] of the five stages of grief. The theory of living with loss was generated by the use of a grounded theory methodology. This small scale exploratory study reveals opportunities for improvements in practice to be considered by the nutrition support team (NST) and other healthcare professionals involved in the patient's hospital stay prior to discharge on HPN.

Diante da extensa utilização de fármacos associados às soluções parenterais de grande volume (SPGV) e muitas vezes da impossibilidade da administração dos mesmos em diferentes veículos de infusão, sejam pela perda da estabilidade ou por insolubilidade destes, a utilização de copolímeros como carreadores de fármacos vêm a favorecer a associação destes às SPGV. Este trabalho visa avaliar a estabilidade dos fármacos ceftazidima e aminofilina nas SPGV carreados pelo copolímero Pluronic® F68 e o estudo da GFP como potencial biossensor da estabilidade de fármacos nas SPGV. A estabilidade dos fármacos ceftazidima (320ug/mL) e aminofilina (160ug/mL) em SPGV foi avaliada, na presença e na ausência de Pluronic® F68, através da utilização de HPLC logo após preparo e após período de 24hs, usando sistema Schimadzu LC10, LC-solution software, Schimadzu C18, fluxo 0,5mL/min, detecção em &#955;=255nm (ceftazidima) e &#955;=275nm (aminofilina), volume de injeção 20uL, 25ºC. A determinação da concentração mínima inibitória (CMI) foi realizada em amostras de ceftazidima (240ug/mL) na presença e na ausência de Pluronic® em SPGV de 5% glicose usando E. coli ATCC 25922 e P.eruginosa ATCC 9721 na concentração de 106UFC/mL . Pluronic® F68 foi utilizado nas amostras para avaliação da estabilidade dos fármacos ceftazidima e aminofilina na concentração 10% m/m. Resultados mostraram uma incompatibilidade entre a associação dos fármacos em SPGV de 5% glicose, com perda de concentração de 25% do fármaco ceftazidima na ausência de Pluronic®. Nos ensaios de CMI realizados com fármaco ceftazidima em SPGV de 5% glicose observou-se uma melhora dos valores de CMI quando o fármaco foi associado ao copolímero Pluronic® para ambos os microrganismos estudados. O estudo da GFP mostrou que fatores como (i) as propriedades físico-químicas dos fármacos, (ii) valores de pH das soluções e (iii) interações entre a proteína e as SPGV, podem favorecer mudanças de intensidade de fluorescência da GFP (determinada em espectrofluorímetro &#955;ex=394nm, &#955;em=509nm), favorecendo seu potencial emprego como biossensor da estabilidade de fármacos. / Drug association administered through parenteral solutions is a common hospital practice. Copolymers as carriers in parenteral solutions may allow originally unstable or insoluble drug combinations, or even improve their action. The aim of this work was to evaluate the stability of ceftazidime and aminophylline in parenteral solutions carried by Pluronic® F68, besides the application of the green fluorescent protein as a biossensor of drug stability. To evaluate the stability of ceftazidime (320 &#181;g/mL) and aminophylline (160 &#181;g/mL) carried by Pluronic® F68 (10%) in parenteral solutions, HPLC measurements were made immediately after the drug mixture preparation and after 24 hours, detected at &#955;=255nm (ceftazidime) and &#955;=275nm (aminophylline). In addition, minimal inhibitory concentration test (MIC) was used to determine the biological activity of ceftazidime (240 &#181;g/mL) in 5% glucose parenteral solution, with or without Pluronic® F68 (10%). The strains tested by MIC were E. coli ATCC 25922 and P.aeruginosa ATCC 9721 (106UFC/mL). The HPLC experiments showed incompatibility of ceftazidime and aminophylline associated in 5% glucose parenteral solution, with 25% loss for ceftazidime without Pluronic® F68. MIC analysis for ceftazidime, with or without aminophylline, showed that lower antibiotic concentration values were required to inhibit E. coli and P.aeruginosa growth, when the copolymer Pluronic® F68 was present in the samples. It was also showed that physical chemical drugs alterations, pH values and protein-parenteral solution interactions can change GFP fluorescence intensity (detected by espectrofluorimeter &#955;ex=394nm, &#955;em=509nm). These data endorse the potential of this protein as a biosensor of drug stability in parenteral solutions.

A introdução da nutroterapia parenteral (NTP) contribuiu para redução da morbimortalidade de pacientes com contraindicação de uso do trato gastrointestinal. Porém, está relacionada a complicações clínicas, destacando-se a infecção associada ao uso de cateteres venosos centrais (CVCs) e a formação de biofilmes, que podem contribuir para piora clínica daqueles que necessita da NTP. O objetivo deste estudo foi avaliar a presença de biofilmes, a infecção sanguínea secundária ao uso de CVC utilizados em nutroterapia e os fatores de riscos associados ao processo infeccioso. Por meio de estudo clínico prospectivo, durante janeiro a junho de 2008, avaliou-se clinicamente por meio de registros médicos e de enfermagem todos pacientes em uso de parenteral internados no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, assim como os cateteres utilizados pelos mesmos, por meio de técnicas de cultura semiquantitativas e de hemoculturas. Aleatoriamente, algumas amostras dos CVCs utilizados foram enviadas para microscopia eletrônica de varredura e de alguns pacientes e de alguns profissionais da saúde foram coletados amostras se swab de pele. Foram avaliados 145 pacientes com idade média de 53±16 anos, destes 46% cursaram com infecção associada ao uso de CVC, ocorrendo óbito em 43% dos casos. A mortalidade foi associada ao maior risco de infecção (0.007),a complicações metabólicas como hiperglicemia (p <0.001) e distúrbio hidroeletrolítico (p=0.036) e à desnutrição (p=0.03). Com relação ao CVC, foram analisados um total de 179 CVCs, desses 49% estavam colonizados por micro-organismos e 34% foram relacionados à infecção sanguínea, não foram observadas diferenças clínicas quanto ao risco de colonização ou infecção sistêmica relacionada aos CVCs. Observou-se o risco de infecção cruzada em 21% do swabs auriculares coletados da equipe de saúde que assitia ao paciente. O risco da migração de micro-organismo da própria pele do paciente foi observado em 45% dos swabs coletados da mão e da região auricular do paciente. Quanto ao biofilme, foi observado a formação em 62% das amostras analisadas, sendo cocos mais comuns e Staphylococcus spp (39%) e Candida spp (19%) os micro-organismos mais frequentes. Conclui-se que a presença de biofilmes e infecção associada ao CVC utilizado para NTP é frequente e está relacionada ao aumento da mortalidade dos pacientes que necessitam desta nutroterapia / The introduction of parenteral nutrition therapy (PNT) has helped to reduce morbidity and mortality of patients with contraindications for use of the gastrointestinal tract. However, is related to clinical complications, especially infection associated with the use of central venous catheters (CVCs) and the formation of biofilms, which may contribute to clinical worsening of those who need the PNT. The aim of this study was to evaluate the presence of biofilms, the risk of infection related to the use of CVC used in parenteral nutrition, as well as risk factors associated with infection. Through a prospective study during January to June 2008 were evaluated clinically by means of medical records and nursing all patients who needed parenteral nutrition support at Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto, as well as catheters used by them, by means of semiquantitative culture techniques and blood cultures. Randomly, some samples of CVCs used were sent for scanning electron microscopy. Also, some samples of skin´s swabs were collected from, some patients and some health professionals. We evaluated 145 patients with mean age 53 ± 16 years, 46% of those presenting with infection associated with the use of CVC, death occurring in 43% of cases. Mortality was associated with increased risk of infection (0.007), hyperglycemia (p <0.001), electrolyte disturbance (p = 0.036) and malnutrition (p = 0.03). Regarding the CVC were analyzed a total of 179 CVCs, 49% of these were colonized by micro-organisms and 34% were related to bloodstream infection, there were no clinical differences between the risk of colonization or bloodstream infection related to CVCs. It was noted the risk of cross infection in 21% of ear swabs collected from the health team whom attended to the patient. The risk of migration of micro-organism of the patient\'s own skin was observed in 45% of the swabs collected from the hand and around patient´s ear. Biofilm formation was observed in 62% of samples, being more common cocci. Staphylococcus spp (39%) and Candida spp (19%) were the most frequent micro-organisms. The presence of biofilms and infection related to CVC used for NTP is frequent and is associated with increased mortality of patients who need this nutritional support.

A terapia nutricional mostra-se de grande importância no tratamento do doente crítico, por apresentar impacto favorável em seu desfecho clínico. No entanto, até 70% dos pacientes em unidade de terapia intensiva podem não receber terapia nutricional adequada. Isso ocorre, em parte, pela falta de formação e de conhecimento dos profissionais de saúde sobre princípios de nutrição clínica. O objetivo do presente estudo foi avaliar o impacto da introdução de um programa de educação médica em terapia nutricional em uma unidade de terapia intensiva sobre a qualidade da terapia nutricional e os resultados clínicos de seus pacientes. O presente estudo foi desenvolvido em três fases distintas: 1) Pré-programa educacional (PP): 50 pacientes recém-admitidos em unidade de terapia intensiva foram selecionados consecutivamente para avaliação da qualidade da terapia nutricional a eles oferecida e seus desfechos clínicos, através de visitas periódicas. 2) Programa Educacional (PE): foram criados protocolos nutricionais específicos. Um programa de educação em terapia nutricional baseado nesses protocolos (palestras, workshops e discussões à beira leito) foi introduzido nessa unidade de terapia intensiva. 3) Pós-programa educacional (PO): a qualidade da terapia nutricional e os desfechos clínicos de um segundo grupo de 50 pacientes foram avaliados, utilizando-se a mesma metodologia da fase 1 (PP). Os marcadores utilizados para avaliação da qualidade da terapia nutricional foram: avaliação nutricional, adequação da oferta de energia, tempo de jejum e introdução de nutrição enteral precoce. Tempo de permanência na unidade de terapia intensiva e tempo de internação hospitalar foram registrados e avaliados como desfechos clínicos principais. Os pacientes da fase PP e PO não diferiram em idade, APACHEII, sexo, tipo de diagnóstico na admissão e avaliação nutricional. Observou-se redução no tempo de jejum (PP 3,8 dias ± 3,1 vs PO: 2,2 dias ± 2,6; p = 0,002), melhora na adequação calórica (PP 74,2% ± 33,3 vs PO 96,2 ± 23,8%; p <0,001) e aumento da indicação de nutrição enteral precoce (PP 24% vs PO 60%; p = 0,001) nos pacientes da fase PO, em comparação com os pacientes da fase PP. Além disso, o tempo de permanência na unidade de terapia intensiva foi menor (PP: 21,9 dias ± 15,2 vs PO: 12,2 dias ± 8,0; p <0,001) nos pacientes da fase PO, em comparação com os pacientes da fase PP. Não houve alteração significativa no tempo de internação hospitalar. A introdução de um modelo de educação em terapia nutricional em uma unidade de terapia intensiva melhorou a qualidade da terapia nutricional e diminuiu o tempo de permanência de seus pacientes / In critically ill patients, nutritional therapy favorably impacts clinical outcomes. However, up to 70% of patients in the intensive care unit do not receive adequate nutritional therapy, due, partially, to the lack of training and knowledge regarding nutrition principles among healthcare providers. The aim of this study was to evaluate the impact of a medical educational program in an intensive care unit on the quality of the nutritional therapy and clinical outcomes. The study protocol was developed among three distinct phases: 1) Pre-educational program (Pre-EP): 50 patients newly admitted to the intensive care unit were consecutively selected to assess their regular performed nutritional therapy and clinical end-points. 2) Educational program (EP): specific nutritional protocols were created and an education program (lectures, workshops and bedside discussions) were implemented. 3) Post educational program (Post-EP): a second group of 50 patients was enrolled and observed using the same phase 1 (Pre-EP) methodology. Nutritional therapy practice was evaluated through the application of specific quality indicators and the evaluation of nutritional therapy-related complications, considering as main markers the nutritional assessment, adequacy of energy requirement, duration of fasting and use of early enteral nutrition. Intensive care unit length of stay and hospital length of stay were recorded and measured as primary end-points. The Pre-EP and Post-EP patients did not differ in age, APACHEII, gender, admission diagnosis (surgery x medical) and nutritional assessment. Duration of fasting decreased (Pre-EP 3.8 days ±3.1 vs. Post-EP: 2.2 days ±2.6; p=0.002), the adequacy of nutritional therapy improved (Pre-EP 74.2% ±33.3 vs. Post-EP 96.2%±23.8; p<0.001) and enteral nutrition was earlier initiated (Pre-EP 24% vs. Post-E 60%; p=0.001). Intensive care unit length of stay also decreased (Pre-EP: 21.9 days±15.2 vs Post-EP: 12.2 days ±8.0; p<0.001). No changes were observed in hospital length of stay. Conclusion: Implementing a medical nutrition educational model in an intensive care unit improved the quality of nutritional therapy and decreased the length of stay of their patients

Moléculas HLA-DR e co-estimulatórias tem papel central na função imune de leucócitos. Diferentes emulsões lipídicas (EL) podem alterar funções imunes de leucócitos. Para avaliar os efeitos de diferentes EL sobre a expressão de moléculas HLA-DR, CD80 e CD86 presentes na superfície de monócitos/macrófagos (MO/M?) e CD28 e CD152 presentes na superfície de linfócitos T auxiliares (L? CD4) humanos, células mononucleares do sangue periférico de voluntários saudáveis (n=10) foram separadas com uso de Ficoll Hypaque (d=1,007) e incubadas por 48 horas (MO/M?) e 72 horas (L?) em meio RPMI 1640 acrescidas ou não (controle negativo) de diferentes EL comerciais ou misturas experimentais na concentração de 1mg/mL. De acordo com o tipo da emulsão lipídica adicionada ao meio de cultura, as células foram divididas em seis grupos experimentais: a) Controle negativo - células mononucleares cultivadas sem o acréscimo de EL b) TCLn-6 - células mononucleares cultivadas com EL a base de óleo de soja rica em ácidos graxos poliinsaturados tipo n-6 (AGPI n-6), c) TCLn-6/TCLn-3 - células mononucleares cultivadas com mistura experimental contendo 80% da EL a base de óleo de soja e 20% de EL a base de óleo de peixe rica em AGPI tipo n-3, d) TCM/TCLn6 - células mononucleares cultivadas com EL composta por 50% óleo de coco, rico em triglicérides de cadeia média e 50% de óleo de soja, e) TCM/TCLn-3 - células mononucleares cultivadas com mistura experimental contendo 80% de EL composta por 50% óleo de coco e 50% de óleo de soja e 20% de EL a base de óleo de peixe, f) SMOF - células mononucleares cultivadas com a nova EL contendo 30% de óleo de soja, 30% de triglicérides de cadeia média, 25% de óleo de oliva e 15% de óleo de peixe. As células mononucleares foram ativadas pelo uso de 10?g/mL de fitohemaglutinina. A expressão das moléculas de superfície foi analisada por citometria de fluxo. A porcentagem de fluorescência, que indica o número de células expressando as moléculas em estudo e a intensidade de fluorescência, que indica de forma indireta o número de moléculas expressas por células, foram medidas. Os resultados obtidos foram submetidos à teste estatístico Friedman e pós-teste Student-Newman-Keuls, adotando-se nível de significância de p<0,05. Devido às diferenças na expressão basal dos doadores, os resultados de intensidade de fluorescência foram transformados em porcentagem relativa ao controle basal (Basal=100). Nos grupos TCLn-6, TCLn-6/TCLn-3, TCM/TCLn-6, TCM/TCLn-3 e SMOF, a intensidade de fluorescência de moléculas HLA-DR expressas na superfície de monócitos/macrófagos diminuiu (medianas = 87,6; 84,0; 81,0; 85,0 e 80,0 respectivamente) em relação ao controle negativo (CN) (mediana=100,0) p=0,01. Todos os grupos tratados com EL aumentaram o número de linfócitos T auxiliares expressando moléculas CD28 (medianas = 90,9; 90,4; 91,5; 92,6 e 90,1 respectivamente) em relação ao CN (mediana=82,8) p=0,001 e também o número de moléculas CD152 expressas por células na superfície de linfócitos T auxiliares (medianas = 120,6; 108,8; 127,7; 114,6 e 121,3 respectivamente) em relação ao CN (mediana=100,0), p=0,03. Não foram encontradas diferenças estatísticas na expressão de moléculas CD80 e CD86 na superfície de monócitos/macrófagos cultivados com diferentes EL. Ainda não foram encontradas diferenças no número de linfócitos T auxiliares expressando CD152. Finalmente a expressão por células de moléculas CD28 na superfície de linfócitos T auxiliares também não mostrou alteração significante com as diferentes emulsões lipídicas. Conclusão: Emulsões lipídicas parenterais in vitro, diminuem a expressão de moléculas HLA-DR na superfície de monócitos/macrófagos e aumentam a expressão de moléculas CD28 e CD152 na superfície de linfócitos T auxiliares humanos. Estas alterações podem ser um dos mecanismos pelos quais as EL modulam funções de células imunes / HLA-DR and co-stimulatory molecules play a central role on leucocytes immune function. Different lipid emulsions (LE) may change leucocytes immune function. It is of interest to study the effect of different LE on HLA-DR and costimulatory molecules expression. To access the effect of LE on the HLA-DR, CD80 and CD86 expression on monocytes/macrophages (MO/MØ) surface and CD28 and CD152 (CD80/CD86 co-stimulatory molecules receptor) expression on human T helper lymphocytes (LØ CD4) surface we obtained mononuclear cells from peripheral blood of healthy volunteers (n=10) by using ficoll hypaque (d=1.077). The cells were cultured for 48 hours (MOMØ) and 72 hours (LØ CD4) and incubated with RPMI 1640 medium without (negative control) or added with 1mg/mL of commercial or experimental mixtures of five LE. Groups: a) NC - negative control without LE, b) LCTn-6 - n-6 polyunsaturated fatty acids (PUFA) rich LE ( soybean oil), c) LCTFO - 80% of LCT and 20% of n-3 PUFA rich LE (FO) (fish oil), d) MCT/LCT - LE containing 50% of medium chain triglycerides and 50% of n-6 PUFA rich LE, e) MCT/LCTFO - 80% of MCT/LCT LE and 20% of FO LE and f) SMOF - a new LE containing 30% of soybean oil, 30% of medium chain triglycerides, 25% of olive oil and 15% of fish oil. Mononuclear cells were activated by using 10?g/mL of phytohemagglutinin. Surface molecules expression was measured by flow cytometry. Percentage and intensity of fluorescence were recorded and the data were submitted to Friedman statistical test and Student-Newman-Keuls post test (p<0,05). Due the differences in basal expression between donors, prior to statistical tests, data from intensity of fluorescence were transformed of percentage relative of basal expression (where basal=100). All LE groups LCT, LCTFO, MCT/LCT, MCT/LCTFO and SMOF decreased HLA-DR intensity of fluorescence on monocytes/macrophages (mean= 87.6, 84.0, 81.0, 85.0, and 80.0 respectively) in relation to negative control (NC) (mean=100.0) cultured without LE (p=0,01). All LE groups increased the percentage of lymphocytes expressing CD28 (means=90.9, 90.4, 91.5, 92.6 and 90.1 respectively) in relation to control (mean=82.8) p=0,001 and CD152 intensity of fluorescence on lymphocytes cultured with all different LE (mean=120,6; 108,8; 127,7; 114,6 and 121,3 respectively) in relation to NC (mean=100,0), p=0,03. No significant differences were found on CD80 and CD86 expression on monocytes/macrophages surface, CD28 intensity of fluorescence and the percentage of lymphocytes expressing CD152 on lymphocytes cultured with the different studied LE. Conclusion: In vitro parenteral LE decreased HLA-DR expression on human monocytes/macrophages surface and increase co-stimulatory molecules receptor expression on human lymphocytes surface. These changes could be one of the mechanisms of LE modulation of immune cells functions