Mg Of Thiamine Research Articles

Thiamine deficiency as a cause of anorexia in terminally ill cancer patients: A case of possible gastrointestinal beriberi.

Anorexia in cancer patients has a variety of causes and impairs patients' quality of life. However, there have been few reports of thiamine deficiency (TD) playing a role in anorexia during palliative care. The objective of this report was to describe such a case. An 82-year-old woman with advanced cervical cancer was admitted for palliative care because of progressive disease. One month after admission, she developed myoclonus on the left side, difficulty speaking, slurred speech, and drooping of the left corner of the mouth, with no consciousness disturbance. She also developed nausea and complained of decreased dietary intake for more than 2 weeks. The patient's thiamine level, which had been measured 2 weeks earlier, was 27 ng/ml, which was below the normal range, and 100 mg of thiamine was administered intravenously. After 2 hours, the patient's neurological findings resolved, and her dietary intake improved from 30% to 40% of meals to 90% to 100%. Subsequently, the patient did not experience similar symptoms, and her clinical course was stable. Based on the patient's clinical course, gastrointestinal beriberi was diagnosed. This case shows that TD may cause anorexia. Many patients who receive palliative care have decreased dietary intake. Consequently, such patients may present with gastrointestinal beriberi, as in the present case. Appropriate diagnosis and treatment may contribute to increasing such patients' quality of life. It may be necessary to differentiate TD from other conditions as a cause of anorexia in patients receiving palliative care.

Clinical Practice Guidelines for Assessment and Management of Patients with Substance Intoxication Presenting to the Emergency Department.

Clinical Practice Guidelines for Assessment and Management of Patients with Substance Intoxication Presenting to the Emergency Department.

1219: EFFECT OF HIGH-DOSE THIAMINE INJECTION ON SHOCK REVERSAL IN SEPTIC PATIENTS

Introduction: Thiamine (TH) is a co-factor for pyruvate dehydrogenase, an enzyme necessary for pyruvate entry into the Krebs cycle, and without this enzyme, pyruvate would be converted to lactate. Elevated lactate, which is often used as a marker of perfusion, is proportionally associated with increased mortality in septic shock. The few publications on TH in septic shock are inconclusive. This study aims to ascertain if there is benefit to adding TH to standard of care (SOC) in the management of septic shock. Methods: IRB-approved, multicenter, retrospective review from 2016 to 2021. Adult patients admitted to the ICU for septic shock and receiving ≥ 400 mg a day of IV TH (in divided doses) were included. Patients < 18, pregnant, admitted for SARS-COV-2, or whom received < 400 mg of TH daily were excluded. Two matched cohorts were evaluated, SOC plus TH versus SOC alone. The primary endpoint is time to shock reversal, defined as off vasopressors for at least 12 hrs and alive. Secondary endpoints include time to lactate clearance (< 2 mmol/L), lactate trends at 6, 12, 24, 48 hrs, and end of therapy, hospital and ICU lengths of stay, new end organ dysfunction, and in-hospital mortality. Results: Data from 50 patients were analyzed: 25 in the SOC plus TH and 25 in the SOC arm. The TH arm had greater number of vasopressors (2 vs. 1, p=.019), and greater utilization of stress-dose steroids (72% vs. 8%, p<.001), however there was no difference in cumulative vasopressor dose in norepinephrine equivalents at baseline (BL) (30.1 vs. 25.8 mcg/min, p=.248). There was no difference in SOFA score at ICU admission (10 vs. 8.5, p=.106) or lactate level at ICU admission (5.9 vs. 3.9 mmol/L, p=.055). There was a longer time to shock reversal from vasopressor initiation time in the TH arm (93 vs. 37.1 hrs, p=.023). Lactate clearance was slower in the TH arm (44.75 vs. 15.8 hrs, p=.027), and there was increased in-hospital mortality in the TH arm (13 vs. 5, p=.018). Conclusions: Compared to SOC alone, TH treated patients had longer times to shock reversal. However, this outcome may have been confounded by differences at BL with regard to number of vasopressors, and stress-dose steroid utilization, which indicate these patients were sicker at BL. Larger, prospective studies are required to confirm these findings.

Comparative effect of a nutraceutical compound based on a flavonoid complex from bergamot on plasma lipids, glucose metabolism, and liver enzymes: a 3-arm, double-blind, placebo-controlled, randomized clinical trial.

Bergamot and opuntia (prickly pear cladodes) standardized extracts have been demonstrated to have positive metabolic effects in preclinical and clinical models. The aim of this study was to evaluate the metabolic effect of a combined nutraceutical containing 150 mg of Opuntia ficus Indica extract, 400 mg of plant sterols, 12.5 mg of thiamine, and 200 mg of Brumex® a phytocomplex from bergamot fruit (Citrus bergamia Risso et Poiteau, fructus) standardized 40% in total flavonoids and min 5% in 3-hydroxy-3-methylglutaryl-flavanones. Thus, we carried out a randomized, double-blind, placebo-controlled clinical trial on 75 hypercholesterolaemic subjects randomized to take the active compound (2 tablets per day), placebo (2 tablets per day), or both (1 per product per day). After 12 weeks of treatment with 1 tablet per day, we observed a significant reduction of a number of metabolic parameters: total cholesterol (TC) (-14.6%), low-density lipoprotein cholesterol (LDL-C) (-19.9%), non-high-density lipoprotein cholesterol (non-HDLC) (-22.1%), triglycerides (TG) (-13.1%), Apolipoprotein B (-16%) (all p < 0.05 both versus baseline and versus placebo), fasting plasma glucose (-5.1%), glutamate oxaloacetate transaminase (-7.8%), glutamate pyruvate transaminase (-7.3%), and γ-glutamyl transferase (-34.4%) (all p < 0.05 versus baseline). High-density lipoprotein cholesterol (HDL-C) was increased 6.9% by the use of 1 tablet per day (p < 0.05 versus baseline). All parameters were reduced to the same extent when taking the full dose (2 tablets), beyond TG. the tested nutraceutical compound based on a flavonoid complex from bergamot and opuntia showed a short-term positive impact on plasma lipids, fasting plasma glucose, and liver enzyme in overall healthy subjects affected by hypercholesterolaemia with low cardiovascular risk.

Daily supplementation of a multiple micronutrient powder improves folate but not thiamine, riboflavin, or vitamin B12 status among young Laotian children: a randomized controlled trial

PurposeTo assess the effects of intervention with a daily multiple micronutrient powder (MNP) on thiamine, riboflavin, folate, and B12 status among young Laotian children.MethodsChildren (n = 1704) aged 6–23 mo, participating in a double-blind placebo-controlled randomized trial were individually randomized to receive daily either MNP (containing 0.5 mg of thiamine, 0.5 mg riboflavin, 150 μg folic acid, and 0.9 μg vitamin B12 along with 11 other micronutrients) or placebo and followed for ~ 36 weeks. In a randomly selected sub-sample of 260 children, erythrocyte thiamine diphosphate (eThDP), plasma folate and B12 concentrations, and erythrocyte glutathione reductase activation coefficient (EGRac; riboflavin biomarker) were assessed at baseline and endline.ResultsThere was no treatment effect on endline eThDP concentrations (110.6 ± 8.9 nmol/L in MNP vs. 109.4 ± 8.9 nmol/L in placebo group; p = 0.924), EGRac (1.46 ± 0.3 vs. 1.49 ± 0.3; p = 0.184) and B12 concentrations (523.3 ± 24.6 pmol/L vs. 515.9 ± 24.8 pmol/L; p = 0.678). Likewise, the prevalence of thiamine, riboflavin, and B12 deficiencies did not differ significantly between the two groups. However, endline folate concentration was significantly higher in the MNP compared to the placebo group (28.2 ± 0.8 nmol/L vs 19.9 ± 0.8 nmol/L, respectively; p < 0.001), and correspondingly, the prevalence of folate deficiency was significantly lower in the MNP group (1.6% vs 17.4%; p = 0.015).ConclusionsCompared to a placebo, daily MNP for 9 months increased only folate but not thiamine, riboflavin, or B12 status in young Laotian children.Trial registrationThe trial was registered at www.clinicaltrials.gov (NCT02428647) on April 29 2015.

A multicenter randomized clinical trial of pharmacological vitamin B1 administration to critically ill patients who develop hypophosphatemia during enteral nutrition (The THIAMINE 4 HYPOPHOSPHATEMIA trial)

Hypophosphatemia may be a useful biomarker to identify thiamine deficiency in critically ill enterally-fed patients. The objective was to determine whether intravenous thiamine affects blood lactate, biochemical and clinical outcomes in this group. This randomized clinical trial was conducted across 5 Intensive Care Units. Ninety critically ill adult patients with a serum phosphate ≤0.65mmol/L within 72h of commencing enteral nutrition were randomized to intravenous thiamine (200mg every 12h for up to 14 doses) or usual care (control). The primary outcome was blood lactate over time and data are median [IQR] unless specified. Baseline variables were well balanced (thiamine: lactate 1.2 [1.0, 1.6] mmol/L, phosphate 0.56 [0.44, 0.64] mmol/L vs. control: lactate 1.0 [0.8, 1.3], phosphate 0.54 [0.44, 0.61]). Patients randomized to the intervention received a median of 11 [7.5, 13.5] doses for a total of 2200 [1500, 2700] mg of thiamine. Blood lactate over the entire 7 days of treatment was similar between groups (mean difference=-0.1 (95% CI -0.2 to 0.1) mmol/L; P=0.55). The percentage change from lactate pre-randomization to T=24h was not statistically different (thiamine:-32 (-39,-26) vs. control:-24 (-31,-16) percent, P=0.09). Clinical outcomes were not statistically different (days of vasopressor administration: thiamine 2 [1, 4] vs. control 2 [0, 5.5] days; P=0.37, and deaths 9 (21%) vs. 5 (11%); P=0.25). In critically ill enterally-fed patients who developed hypophosphatemia, intravenous thiamine did not cause measurable differences in blood lactate or clinical outcomes. Australian and New Zealand Clinical Trials Registry (ACTRN12619000121167).

Low-dose thiamine supplementation of lactating Cambodian mothers improves human milk thiamine concentrations: a randomized controlled trial

ABSTRACTBackgroundInfantile beriberi–related mortality is still common in South and Southeast Asia. Interventions to increase maternal thiamine intakes, and thus human milk thiamine, are warranted; however, the required dose remains unknown.ObjectivesWe sought to estimate the dose at which additional maternal intake of oral thiamine no longer meaningfully increased milk thiamine concentrations in infants at 24 wk postpartum, and to investigate the impact of 4 thiamine supplementation doses on milk and blood thiamine status biomarkers.MethodsIn this double-blind, 4–parallel arm randomized controlled dose–response trial, healthy mothers were recruited in Kampong Thom, Cambodia. At 2 wk postpartum, women were randomly assigned to consume 1 capsule, containing 0, 1.2 (estimated average requirement), 2.4, or 10 mg of thiamine daily from 2 through 24 weeks postpartum. Human milk total thiamine concentrations were measured using HPLC. An Emax curve was plotted, which was estimated using a nonlinear least squares model in an intention-to-treat analysis. Linear mixed-effects models were used to test for differences between treatment groups. Maternal and infant blood thiamine biomarkers were also assessed.ResultsIn total, each of 335 women was randomly assigned to1 of the following thiamine-dose groups: placebo (n = 83), 1.2 mg (n = 86), 2.4 mg (n = 81), and 10 mg (n = 85). The estimated dose required to reach 90% of the maximum average total thiamine concentration in human milk (191 µg/L) is 2.35 (95% CI: 0.58, 7.01) mg/d. The mean ± SD milk thiamine concentrations were significantly higher in all intervention groups (183 ± 91, 190 ± 105, and 206 ± 89 µg/L for 1.2, 2.4, and 10 mg, respectively) compared with the placebo group (153 ± 85 µg/L; P < 0.0001) and did not significantly differ from each other.ConclusionsA supplemental thiamine dose of 2.35 mg/d was required to achieve a milk total thiamine concentration of 191 µg/L. However, 1.2 mg/d for 22 wk was sufficient to increase milk thiamine concentrations to similar levels achieved by higher supplementation doses (2.4 and 10 mg/d), and comparable to those of healthy mothers in regions without beriberi. This trial was registered at clinicaltrials.gov as NCT03616288.

Benefits of Maternal Thiamine Supplementation for Enhancing Cambodian Infants’ Social Responsiveness at 24 Weeks

ObjectivesInfants in Cambodia are at risk for thiamine deficiency, with long-term negative consequences for neuro-cognitive development. We investigated the extent to which maternal thiamine supplementation enhances infants’ responsiveness to social engagement. Such responsiveness is both indicative of neuro-cognitive development and beneficial for subsequent neuro-cognitive progress. Methods335 lactating Cambodian mothers were randomly assigned to receive a capsule containing 0, 1.2, 2.4, or 10 mg of thiamine daily from 2- until 24-weeks postnatal. We assessed infants’ social responsiveness via a new method – the Primary Engagement Task (PET) – when infants were 2-, 12-, and 24-weeks. In the PET, mothers were asked to elicit and sustain a smile from infants as they added and then removed modalities of engagement (eye-contact/facial expression, voice and touch) across six 30-second “epochs.” Subsequent behavioral coding from video-recordings determined changes in infants’ state across the epochs of the PET. ResultsPreliminary analyses based on 103 of the 335 infants in the PET at 24 weeks revealed that infants displayed significantly increased alertness as mothers introduced new modalities of engagement in the PET, and a partial decline in alertness as modalities were removed (linear contrast F(1,102) = 24.37, P = 0.000; quadratic contrast F(1,102) = 7.27, P = 0.008). Although maternal thiamine dosage did not influence these patterns overall (F’s < 1.56, P’s > 0.20), higher maternal thiamine dosage was associated with infants displaying enhanced alertness when mothers first offered eye-contact in the PET (beta-weight = 0.026; t = 2.01, P = 0.047). This pattern of alerting to maternal eye-contact was statistically significant only in the 10 mg group (paired t(25) = 3.14, P = 0.004). ConclusionsInfants whose mothers received 10 mg daily thiamine supplementation displayed increased alertness to opportunities to interact socially. These preliminary findings (a) showcase the value of the PET for assessing infants’ responsiveness to caregiver’s efforts to engage them socially, and (b) hint that maternal thiamine supplementation promotes infants’ social responsiveness, thereby underscoring the importance of infants’ early access to adequate thiamine for neuro-cognitive thriving. Funding SourcesBill & Melinda Gates Foundation & New York Academy of Sciences.

Maternal Thiamine Supplementation Promotes Infants’ Language Processing at 24 Weeks

ObjectivesIn 2005, researchers observed a link between infants’ access to thiamine (vitamin B1) and their subsequent language functioning: infants fed formula that inadvertently lacked thiamine later displayed significant delays in language and motor development. In the context of a double-blind, randomized, controlled trial, the present research provided the first experimental test of a relationship between early life thiamine exposure and infants’ early language processing. Methods335 lactating mothers were randomly assigned to receive capsules containing either 0, 1.2, 2.4, or 10 mg of thiamine daily, from 2 weeks postpartum until infants were 24 weeks. We assessed the integrity of 24-week-old infants’ developing system for language processing by measuring the extent to which they displayed attentional enhancement in response to infant-directed speech (IDS) relative to adult-directed speech (ADS). Such IDS-related attentional enhancement implies that infants can differentiate IDS from ADS, which requires underlying skills for analysis of the complex stream of sound that human speech embodies. Of the 335 infants in the study, analyzable data for the IDS preference task were available for 251. ResultsAs predicted, a greater-than-chance percentage of all infants displayed enhanced attention to IDS relative to ADS, replicating prior research (one-sample t(250) = 3.06, P = 0.002). The magnitude of the IDS-elicited attentional-enhancement increased significantly in relation to the thiamine dose that lactating mothers received (beta-weight 0.007, t = 2.57, P = 0.011). Notably, however, when supplementation groups were examined separately, only infants whose mothers received the 10 mg daily supplement displayed a statistically significant IDS-related attentional enhancement (10 mg group: one-sample t(63) = 4.14, P = 0.000; all other groups t’s < 1.41, P’s > 0.16). ConclusionsTaken together, these findings confirm a link between infants’ post-natal access to thiamine and their language processing facility at 24 weeks. The findings both showcase the value of the IDS preference task for monitoring the integrity of infants’ language processing, and underscore the importance of adequate thiamine for ensuring infants’ optimal language development. Funding SourcesBill & Melinda Gates Foundation and the New York Academy of Sciences.

44-Year-Old Woman With Altered Mental Status and Tachypnea

A 44-year-old woman was admitted to the medical intensive care unit (MICU) with suspected toxic ingestion, hyperkalemia, and metabolic acidosis. Her history is notable for previous suicidal attempts, generalized anxiety disorder, postpartum depression, and alcohol use disorder. The patient denied any current medications, although she was prescribed a daily multivitamin, 900 mg of gabapentin at bedtime and 100 mg of thiamine daily. Reportedly, last contact was with her ex-husband, who noticed acute changes in mental status after a relationship dispute.

Relapse of rare diseases during COVID-19 pandemic: bicytopenia in an adult patient with thiamine-responsive megaloblastic anaemia.

Thiamine-responsive megaloblastic anaemia (TRMA) is a syndrome associated with megaloblastic anaemia, diabetes mellitus and sensorineural deafness, due to mutations in the SLC19A2gene, which codes for a thiamine carrier protein. Oral thiamine supplementation is the main treatment. We report the case of a 19-year-old man known for TRMA, who presented in the emergency department with bicytopenia (haemoglobin 5,4 g/dL, thrombocytes 38×109/L) revealed by dyspnea and chest pain. Investigations excluded bleeding, hemolysis, coagulopathy and iron deficiencies. A recent infection and an acute coronary syndrome have also been eliminated. We later found out that thiamine treatment had been discontinued three months before, due to general confinement in Tunisia during the COVID-19 pandemic. Parenteral administration of 100 mg of thiamine daily resulted in the recovery of haematopoiesis within three weeks.

Association Between IV Thiamine and Mortality in Patients With Septic Shock: A Nationwide Observational Study.

To examine the effect of thiamine administration on mortality in patients with septic shock requiring norepinephrine. Retrospective observational cohort study from July 2010 to March 2017. More than 1,000 acute care hospitals covering approximately 90% of all tertiary care emergency hospitals in Japan. Patients with septic shock requiring norepinephrine within 2 days of admission were retrospectively reviewed. Patients who received greater than or equal to 100 mg of thiamine within 2 days of admission were included in the thiamine group and those who did not were included in the control group. We identified a total of 68,571 eligible patients, including 18,780 and 49,791 patients in the thiamine and control groups, respectively. In the thiamine group, 100 and 200 mg of thiamine per day were administered to 10,143 (54.0%) and 7,679 (40.9%) patients, respectively. The 28-day mortality were 19.2% (3,609/18,780) and 17.8% (8,845/49,791) in the thiamine and control groups, respectively. After adjusting for confounders by inverse probability of treatment weighting, no significant differences were observed between the two groups (risk difference, 0.2%; 95% CI, -0.5% to 0.9%). There were also no significant differences between the 100-mg thiamine group and the control group (risk difference, 0.6%; 95% CI, -0.3% to 1.4%) or between the 200-mg thiamine group and the control group (risk difference, -0.3%; 95% CI, -1.3% to 0.8%). The findings of this nationwide database-based observational study did not support an association between thiamine administration early after admission and the 28-day mortality in patients with septic shock.

Relapse of rare diseases during COVID-19 pandemic: bicytopenia in an adult patient with thiamine-responsive megaloblastic anaemia (TRMA)

Thiamine-responsive megaloblastic anaemia (TRMA) is a syndrome associated with megaloblastic anaemia, diabetes mellitus and sensorineural deafness, due to mutations in the SLC19A2 gene, which codes for a thiamine carrier protein. Oral thiamine supplementation is the main treatment. We report the case of a 19-year-old man known for TRMA, who presented in the emergency department with bicytopenia (haemoglobin 5,4 g/dL, thrombocytes 38×109/L) revealed by dyspnea and chest pain. Investigations excluded bleeding, hemolysis, coagulopathy and iron deficiencies. A recent infection and an acute coronary syndrome have also been eliminated. We later found out that thiamine treatment had been discontinued three months before, due to general confinement in Tunisia during the COVID-19 pandemic. Parenteral administration of 100 mg of thiamine daily resulted in the recovery of haematopoiesis within three weeks.

Ascorbic Acid, Corticosteroids and Thiamine in Sepsis (ACTS) protocol and statistical analysis plan: a prospective, multicentre, double-blind, randomised, placebo-controlled clinical trial

IntroductionSeptic shock is a common and highly morbid condition. To date, there is no specific therapy proven to attenuate organ injury in septic shock. Recent studies have suggested a role...

Sustained high-dose thiamine supplementation in high-risk cardiac patients undergoingsurgery under cardiopulmonary bypass (apply trial): a pilot study

Introduction Numerous studies showed that relative thiamine depletion in critically ill patients and in patients undergoing cardiac surgery may contribute to cardiac dysfunction and hyperlactatemia leading to adverse outcomes. Thus, in preparation for a larger trial, we performed a pilot, randomized, placebo-controlled feasibility trial of sustained thiamine supplementation in high-risk patients undergoing cardiac surgery under CPB. Methods Forty patients who underwent high-risk cardiac surgery under CPB were randomly assigned to receive either 200 mg of Thiamine or placebo intravenously after anesthesia induction; after CPB; on the evening of the day of surgery; on three postoperative days (twice a day). Primary endpoints were successful compliance with protocol and successful recruitment of patients. Secondary endpoints included: vasoinotropic score and norepinephrine equivalent dose, postoperative peak lactate and creatinine levels, incidence of acute kidney injury, daily SOFA score, rate of postoperative complications, incidence of adverse events, 7-day and 30-day mortality. Results The mean recruitment rate was 6.6 patients per month (1.6 patients per week). Compliance with protocol was excellent as all patients enrolled into the study received all assigned intervention. No patients develop allergic reactions to the study drug. All patients completed the 30-day follow-up. There were no differences in secondary endpoints. Statistical analysis performed with the Stata Statistical Software using Mann-Whitney U test, T test of Student and ANOVA. Discussion The rationale for thiamine administration in patients undergoing cardiac surgery comes from results of several studies that showed a high incidence of thiamine deficiency postoperatively. Our study implies that it is feasible to achieve an acceptable recruitment rate in a typical tertiary institution with full compliance with the protocol and it's not associated with major safety concerns in patients receiving complex cardiac surgery.

Development of a Pennywort (Centella asiatica) Ice Cream with Passion Fruit (Passiflora edulis)

Ice cream is a popular frozen dessert usually made of milk, cream, sugar, and flavoring. The goal of this study was to determine methods to enhance ice cream nutritionally through the addition of pennywort (Centella asiatica) and passion fruit (Passiflora edulis) extract. Pennywort is a nutritious leaf but not commonly utilized as food. The development of the product through laboratory experiments. The standardized ingredients and procedures were determined after five trial formulations. The pennywort leaf was dehydrated using the Multi-Commodity Heat Pump Dryer and ground using a food processor. Coconut milk was first chilled then mixed with soya milk from fresh soybeans. Sugar, vanilla, salt, pennywort and passion fruit extract were mixed using a blender. The mixture was poured into a plastic cup and frozen for 24 hours. The pennywort ice cream with passion fruit containeds 177 kcal per serving (125 ml). Each serving contained 33g of carbohydrates, 5g of protein, 2.8 g of fat, 88mg of calcium, 85mg of phosphorus, 1.1 mg of niacin, 0.9 mg of iron, 0.04 mg of thiamine, and 0.03 mg of riboflavin. The cost of one serving was ₱17. The product was evaluated by 30 individuals from both genders and was rated by the majority as like extremely in terms of odor, color, appearance, texture. Its taste was rated as like very much. This study showed that utilizing pennywort and passion fruit to enhance the taste and nutrient content of ice cream is possible.

Development of Power Vegan Cupcake

The objective of this study was to develop a healthy eating on the go for busy people. The Power Vegan Cupcake is a plant-based, nutrient-dense product, and is made from local plant-based ingredients. Saluyot and soymilk were used as replacements for egg and milk. Brown rice flour, muscuvado, banana, raisins, and peanuts made the cupcake a complete food. The dry ingredients were sifted and mixed. Saluyot and pandan leaves were boiled for 15 minutes and then cooled, blended, and strained. The saluyot puree and pandan juice were then mixed with the dry ingredients, soy milk, and vanilla. The batter was mixed, and raisins and banana were added. The batter was baked in an oven for 25 minutes at 200°C. Each Power Vegan Cupcake (70g) contained 41.7g of carbohydrates, 4.7g of protein, and 3.12g of fat for a total calorie content of 198.4kcal. It also contained 28.75ug of Vitamin A, 2.4mg of Vitamin C, 50.6mg of calcium, 1.5mg of iron, 0.17mg of thiamin, 0.19mg of riboflavin, 2.93mg of niacin, and 98.7mg of phosphorus. The product was found to contain a higher amount of carbohydrates, protein, and micronutrients compared to regular cupcakes on the market. Thirty respondents, ages 18-29, evaluated the product. The results showed a rating of like very much from 63%, 53%, and 50% of the evaluators in terms of appearance, texture, and taste, respectively. Advance development of saluyot as egg substitute for strict vegetarian foods is recommended.

The problem of central fever in victims with a combined trauma and one of the ways to resolve it in intensive care

Abstract . In 60 patients with a combined trauma, one of the components of which was a severe traumatic brain injury, within 10 days, the effectiveness of eliminating central fever with the help of three correction schemes has investigated. Patients of the first group, 20 in number, received 3000 mg of paracetamol per day. Patients of the second group, also number 20, used a combined preparation containing succinic acid, nicotinamide, inosine and riboflavin. The drugs administered intravenously in an amount of 25 ml per day. Together with him, patients received 250 mg of thiamine per day. Patients of the third group, 20, in addition to these measures to improve tissue respiration received on the day 600 mg of the antioxidant N-acetylcysteine. A significant advantage of eliminating central fever with the help of means for improving tissue respiration was found. The most effective treatment regimen, which contained N-acetylcysteine.

THE USE OF THIAMINE IN INTENSIVE THERAPY OF PATIENTS IN CRITICAL CONDITION

The clinical cases of treatment of two patients in critical conditions by intravenous thiamine are described. In the first clinical case, in addition to intensive therapy, the patient was administered 300 mg of thiamine by intravenous titration for 10 hours, followed by a daily titration of 100 mg of thiamine and the administration of a complex of fat-soluble vitamin “Vitalipid N.” The basis for the appointment of thiamine was an increase in the level of lactate (19.0 mmol/l), with clear consciousness, effective breathing, adequate oxygenation, stable hemodynamics. Intravenous use of thiamine led to the stabilization of the patient’s homeostasis, normalization of clinical and some laboratory indicators (2.0 mmol/l), reflecting the presence of thiamine deficiency. In the second clinical case, there was a lack of evacuation of gastric contents into the intestine, an increase in the level of lactate (3.3 mmol/l) in the patient in the critical condition, in the postoperative period with clear consciousness, effective independent breathing, adequate oxygenation, stable hemodynamics, good peristalsis. After excluding the main possible causes of increased lactate levels (hypoxia, liver failure), the patient was prescribed 100 mg of thiamine intravenously by titration within an hour. The introduction of thiamine, the subsequent recovery of enteral nutrition led to the cessation of parenteral nutrition, rapid positive dynamics of the general condition, the normalization of the lactate level (0.9 mmol/l).

66-Year-Old Woman With Falls and Confusion

66-Year-Old Woman With Falls and Confusion