Thiamine Supplementation Research Articles

Descriptive spectrum of thiamine deficiency in pregnancy: Apotentially preventable condition.

Pregnancy, a nutritionally demanding situation in terms of macro- and micronutrient supply owing to heightened maternal, placental, and fetal needs, significantly affects thiamine reserves. Thiamine deficiency during pregnancy and the postpartum period, presenting with varied manifestations and outcomes, is a relatively common condition in our population. The study aimed to understand the various manifestations and outcomes of acute thiamine deficiency in pregnant and postpartum women, emphasizing the significance of early recognition and thiamine therapy to prevent serious complications during pregnancy and after childbirth. This prospective study conducted in a tertiary care center in North India enrolled consecutive pregnant and postpartum women presenting with clinical features consistent with thiamine deficiency disorders, such as thiamine deficiency-related neuropathy, high-output heart failure, heart failure with reduced ejection fraction, Wernicke's encephalopathy, gastric beriberi, and thiamine-responsive acute pulmonary hypertension. In addition to capturing medical history including drug intake, dietary consumption, and comorbidities, women underwent brief relevant clinical examinations and laboratory assessments, including whole-blood thiamine levels. Response to intravenous thiamine supplementation was also monitored. Data of 31 women (12 pregnant, 19 postpartum) with a diagnosis of acute thiamine deficiency and a mean age of 28.88 ± 2.69 years were analyzed. The mean thiamine level was 1.28 ± 0.44 μg/dL with mean blood lactate of 3.46 ± 3.33. The most common presentation was gastric beriberi (n = 10), followed by paraparesis (n = 6), high-output heart failure (n = 6), acute pulmonary hypertension, heart failure with reduced ejection fraction (n = 3 each), and an acute confusional state (n = 2). All patients responded to thiamine challenge. In the context of borderline thiamine status, particularly in our population with endemic thiamine deficiency and heightened demand for thiamine during pregnancy and the peripartum period, the deficiency can have varied and serious manifestations of dry and wet beriberi. Early recognition of the clinical features and thiamine therapy can be life-saving. There is a need for validated clinical criteria owing to the non-availability of thiamine testing in resource-limited settings.

Summer poisoning hazards

There is a seasonal risk with some poisons and in the summer, when stinging insects and adders are more active, there is a risk of envenomation. Diagnosis of an adder bite may be missed in horses, as the biting event is rarely witnessed. Envenomation may result in local swelling and occasionally, systemic effects. Multiple bee stings are particularly hazardous as this can result in multi-organ involvement, which may be fatal. Grazing on some plants, such as ragwort or bracken, for a prolonged period can also result in poisoning as ragwort contains pyrrolizidine alkaloids which cause liver failure and bracken contains an enzyme that has an anti-thiamine effect, inducing thiamine deficiency. Photosensitisation following exposure to plants containing phototoxins and bright sunlight is also a risk in summer. Treatment of plant poisoning in horses is generally supportive and involves removing the plant, providing good quality food and supportive care. Thiamine supplementation may be required in severe cases of bracken poisoning. Animals should be protected from sunlight following exposure to a phototoxin, with supportive management of skin lesions. Management of adder bite is supportive with administration of adder antivenom. Multiple bee stings require aggressive supportive care.

OR05-02-23 Maternal Thiamine Supplementation During the Exclusive Breastfeeding Period Promotes Infants’ Cognitive Encoding and Discrimination at 24 and 52 Weeks Relative to Placebo

OR05-02-23 Maternal Thiamine Supplementation During the Exclusive Breastfeeding Period Promotes Infants’ Cognitive Encoding and Discrimination at 24 and 52 Weeks Relative to Placebo

Effects of Dietary Thiamine Supplementation on Growth Performance, Digestive Enzymes’ Activity, and Biochemical Parameters of Beluga, Huso huso, Larvae

Thiamine is a crucial nutrient in larval stage of fish, and thus, the present study aimed at evaluating the effects of dietary thiamine supplementation on survival, growth performance, and biochemical parameters of beluga, Huso huso, larvae. The fish larvae (50 ± 4.5 mg) were fed diets containing 0 (control), 5, 10, and 20 mg/kg thiamine for 26 days from 18 days after hatching to 44 days after hatching. Thiamine significantly increased the larvae survival, growth rate, digestive enzymes activity, and whole body protein and ash but decreased the whole body lipid and moisture P < 0.001 ). Also, alanine amino transferase (ALT) and alkaline phosphatase (ALP) were decreased significantly in thiamine-treated groups ( P < 0.05 ). The highest survival and whole body ash were observed in 20 mg/kg thiamine treatment; the highest whole body protein and lipase activity were observed in 10 mg/kg thiamine treatment. The highest growth rate, amylase, and lowest whole body lipid, alanine amino transferase (ALT), and alkaline phosphatase (ALP) were observed in 10 and 20 mg/kg thiamine treatments. All thiamine-treated fish exhibited similar pepsin and chymotrypsin activities, all above the control fish. There were no significant effects of dietary thiamine supplementation on trypsin, whole body lysozyme, alternative complement (ACH50), lactate dehydrogenase (LDH) activities, and IgM levels. According to the results, 10–20 mg/kg dietary thiamine supplementation can increase the performance of beluga larvae by improving the health of liver and the activity of digestive system.

Roger’s syndrome presenting with stroke

Rogers syndrome (Thiamine responsive megaloblastic anaemia-TRMA) occurs due to defect in the SLC19A2 gene. SLC19A2 and SLC19A3 genes encode THTR1 and 2 respectively, which are thiamine transporter proteins. The SLC19A2 gene is expressed in the inner ear cells, β-islet cells, and hematopoietic stem cells; consequently, the typical clinical trial of TRMA is diabetes, TRMA, and sensorineural hearing loss. This syndrome, eponymously called Roger’s syndrome is rare. Mode of inheritance of TRMA is autosomal recessive. Clinical presentation as recurrent stroke is extremely rare. We present a case of a five-year-old boy who had recurrent large artery territory cerebral infarcts, with no other identifiable underlying cause of stroke. During current admission, no underlying etiology could be identified for cerebral infarct. On workup, a preliminary diagnosis of TRMA was made and thiamine supplementation was instituted. Gene analysis confirmed the diagnosis. The child was a product of non-consanguineous marriage. There was history of early childhood demise of two older siblings within five years of age due to diabetic ketoacidosis (DKA). TRMA is a rare autosomal recessive syndrome that manifests as a typical triad with diabetes, hearing loss and megaloblastic anaemia. The treatment is with high dose thiamine supplementation that can alleviate symptoms of diabetes and megaloblastic anaemia. Onset and progression of hearing loss may be delayed with treatment. Some cases may present with recurrent stroke as in the proband.

The relationship between micronutrient status, frailty, systemic inflammation, and clinical outcomes in patients admitted to hospital with COVID-19

BackgroundMicronutrients have been associated with disease severity and poorer clinical outcomes in patients with COVID-19. However, there is a paucity of studies examining if the relationship with micronutrient status and clinical outcomes is independent of recognised prognostic factors, specifically frailty and the systemic inflammatory response (SIR). The aim of the present study was to examine the relationship between micronutrient status, frailty, systemic inflammation, and clinical outcomes in patients admitted with COVID-19.MethodsRetrospective analysis of prospectively collected data was performed on patients with confirmed COVID-19, admitted to hospital between the 1st April 2020–6th July 2020. Clinicopathological characteristics, frailty assessment, biochemical and micronutrient laboratory results were recorded. Frailty status was determined using the Clinical Frailty scale. SIR was determined using serum CRP. Clinical outcomes of interest were oxygen requirement, ITU admission and 30-day mortality. Categorical variables were analysed using chi-square test and binary logistics regression analysis. Continuous variables were analysed using the Mann–Whitney U or Kruskal Wallis tests.Results281 patients were included. 55% (n = 155) were aged ≥ 70 years and 39% (n = 109) were male. 49% (n = 138) of patients were frail (CFS > 3). 86% (n = 242) of patients had a serum CRP > 10 mg/L. On univariate analysis, frailty was significantly associated with thirty-day mortality (p < 0.001). On univariate analysis, serum CRP was found to be significantly associated with an oxygen requirement on admission in non-frail patients (p = 0.004). Over a third (36%) of non-frail patients had a low vitamin B1, despite having normal reference range values of red cell B2, B6 and selenium. Furthermore, serum CRP was found to be significantly associated with a lower median red cell vitamin B1 (p = 0.029).ConclusionVitamin B1 stores may be depleted in COVID-19 patients experiencing a significant SIR and providing rationale for thiamine supplementation. Further longitudinal studies are warranted to delineate the trend in thiamine status following COVID-19.

Just supplement Thiamine! A simple yet dramatic solution! (P9-4.004)

<h3>Objective:</h3> We present a case showing how while the diagnostic process in neuropathy may be long and cumbersome, the solution is usually simple, dramatic and life changing. <h3>Background:</h3> 55-year-old female with acute-on-chronic, rapidly progressive numbness and weakness. She first noted numbness and tingling in her feet over 8 years ago, but with rapid progression over the past year up to her trunk and hands. She presented to the ER after falling in the house, laying on the floor for hours, unable to be lifted by her husband. Examination revealed several bruises, symmetric wasting of upper and lower extremity muscles, proximal greater than distal weakness, loss of pinprick, vibration and temperature sensation from toes up to the thighs. She was areflexic with bowel and bladder incontinence and urine retention of 1L on arrival. She gave a history of excessive alcohol intake since her teenage years, with a heavy increase in intake over the COVID pandemic due to loss of employment and depression. Low folic acid, ESR 72, CT abdomen notable for steatohepatitis, fecal loading and urine retention. CSF analysis showed no albumino-cytological dissociation. Autoimmune workup, RPR, B12, serum copper, CSF paraneoplastic panel, CT chest, MRI brain and complete spine were unremarkable. EMG/NCV showed moderate, length dependent, sensory-motor axonal polyneuropathy. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> She was started on high dose thiamine and folic acid supplementation in hospital. Initially, she was unable to feed herself, turn in bed or sit without support. She slowly recovered, regained continence and can ambulate independently with a walker now. She can play the piano. <h3>Conclusions:</h3> Thiamine associated neuropathy or Dry Beri-Beri can present with axonal predominant sensorimotor polyneuropathy that can mimic Guillain Barre Syndrome. While workup for other etiologies of neuropathy should be simultaneously pursued in alcoholics, thiamine supplementation is a simple treatment that can lead to satisfying and dramatic results. <b>Disclosure:</b> Dr. Bhende has nothing to disclose. Dr. Zafar has nothing to disclose. Dr. Prabhu has nothing to disclose. Dr. Undavia has nothing to disclose.

A Rare Case of Bilateral Globus Pallidus Enhancement in a Patient with Clinical Wernicke Encephalopathy (P4-4.003)

<h3>Objective:</h3> To describe a case of Wernicke encephalopathy with atypical MRI findings showing enhancement involving bilateral globi pallidi. <h3>Background:</h3> Thiamine deficiency, commonly as a result of malnourishment associated with alcohol dependence, can cause Wernicke encephalopathy, a neuropsychiatric syndrome that presents with a triad of ophthalmoplegia, altered mental status, and ataxia. Brain MRI typically shows contrast enhancement of the thalamus and mammillary bodies. <h3>Design/Methods:</h3> Case Study <h3>Results:</h3> In March 2022, a 55-year-old man with a history of alcohol dependence, hypertension, atrial fibrillation, kidney failure, sleep apnea, and obesity presented to our neurology clinic for initial evaluation and follow-up of a previous hospitalization in October 2021 for symptoms of Wernicke encephalopathy. Brain MRI obtained at his hospitalization showed edema and contrast enhancement with restricted diffusion involving the bilateral globi pallidi. He had been drinking 750 mL of bourbon every other day for about 10 years. He noted that his symptoms had improved with thiamine supplementation but still endorsed left unilateral gait instability. He denied carbon monoxide poisoning, exposure to insecticides/pesticides or other toxins. Lab results confirmed this and showed no evidence of exposure to toxins that are known to be associated with insults involving the globus pallidus. His review of systems was positive for weakness and confusion. Physical examination was notable for some impairment of finger-to-nose test, difficulty in sustaining rapid alternating movements, and a broad-based but stable gait. We recommended that the patient continues thiamine supplementation and physical therapy. <h3>Conclusions:</h3> Wernicke encephalopathy is associated with atrophic changes involving the mammillary bodies and thalamus, but current literature does not show evidence of changes involving the globus pallidus. The atypical involvement of the bilateral globi pallidi seen in this case demonstrates a need for further research into the role of globus pallidus in the pathogenesis of Wernicke encephalopathy. <b>Disclosure:</b> Miss Karim has nothing to disclose. Mr. Jin has nothing to disclose. Dr. Bagga has nothing to disclose. Dr. Mehrizi has nothing to disclose.

Metronidazole Induced Encephalopathy Responsive to High Dose Thiamine (P4-12.006)

<h3>Objective:</h3> NA <h3>Background:</h3> Metronidazole induced encephalopathy (MIE) is a complication of prolonged metronidazole use whose clinical and radiographic signs are well-documented. Metronidazole is generally a well-tolerated antibiotic but can rarely cause neurotoxicity in susceptible individuals. We report on a patient who developed MIE that did not initially resolve with metronidazole discontinuation, but which responded dramatically to high dose intravenous (IV) thiamine supplementation. <h3>Design/Methods:</h3> A 60-year-old woman developed confusion and gait disturbance two weeks prior to admission. She had presented to an outside hospital with colitis one month prior and was treated with a 28-day course of IV ciprofloxacin and metronidazole, along with TPN. She had developed confusion and dystaxia after initiation of IV antibiotics that persisted after metronidazole discontinuation, and which led her to return to hospital. Neurologic exam revealed confusion and dystaxia. Given the recent TPN use, a thiamine level was drawn, and she was treated empirically with thiamine 500mg IV daily. MRI brain revealed restricted diffusion of the splenium of corpus collosum and increased T2-signal of the bilateral dentate nuclei. After two doses of IV thiamine, her dystaxia and confusion improved, and she regained her neurologic baseline. The diagnosis of MIE complicated by thiamine deficiency was made. Her thiamine level in serum resulted as normal. <h3>Results:</h3> na <h3>Conclusions:</h3> The patient’s MRI brain revealed classic changes of MIE yet she did not improve after cessation of metronidazole as described in previously reported cases. Rather, she improved after treatment with high dose thiamine. Metronidazole acts as a thiamine analogue and inhibits the absorption of thiamine leading to a functional deficiency state. We hypothesize that metronidazole, in the context of the patient’s suspected malnutrition, led to a severe functional thiamine deficiency, despite having a normal thiamine serum level. This case highlights the importance of thiamine repletion in addition to metronidazole discontinuation when MIE is suspected. <b>Disclosure:</b> Dr. Matta has nothing to disclose. Dr. Reza has nothing to disclose. Dr. Bagert has nothing to disclose.

A Case of Neural Integrator Failure in Vitamin B1 Deficiency. (P1-9.004)

<h3>Objective:</h3> Case Report <h3>Background:</h3> The nucleus prepositus hypoglossi (NPH) and medial vestibular nuclei (MVN) are two closely related neural integrators situated in the brainstem responsible for horizontal conjugate eye movement. Thiamine deficiency, a hallmark of Wernicke’s encephalopathy, affects the MVN to a greater extent. We report a case of impaired horizontal gaze holding post-sleeve gastrectomy secondary to Vitamin B1 deficiency. <h3>Design/Methods:</h3> A 24-year-old female presented with new onset diplopia on lateral gaze, dizziness, and lower limb distal paraesthesia eight weeks post-sleeve gastrectomy. Examination revealed conjugate eye movements and horizontal gaze-holding failure bilaterally, with intact convergence and vertical gaze. Normal discs were observed on fundoscopy with no retinal haemorrhages, and visual acuity preserved. She had a normal mental state with mild sensory ataxia. Reflexes were present and symmetrical. <h3>Results:</h3> Cerebrospinal fluid analysis was normal, and MRI Brain showed no acute infarction, haemorrhage, or brainstem lesions. Folate, Vitamin B6, B12, and HbA1c levels were within normal range, with a negative infective screen. Vitamin B1 level was found to be low at 44.3nmol/L (normal range: 66.5–200nmol/L). She was commenced on high-dose intravenous thiamine for one week with symptomatic improvement in diplopia and subsequently discharged on long-term thiamine supplementation. <h3>Conclusions:</h3> The high metabolic requirements of MVN neurons responsible for high acceleration horizontal vestibulo-ocular reflex (VOR) is postulated to account for the selective vulnerability to thiamine deprivation. This case highlights an unusual presentation of disruption in horizontal gaze-holding mechanisms through failure of neural integrators, particularly the MVN, in the setting of Vitamin B1 deficiency with preservation of vertical gaze. <b>Disclosure:</b> Dr. Chen has nothing to disclose. Dr. Warfield has nothing to disclose. Dr. Nannery has nothing to disclose. Dr. Togher has nothing to disclose. Dr. Yacoob has nothing to disclose.

Atypical Clinical Presentations and Neuroimaging Findings of Wernicke Encephalopathy (P4-4.004)

<h3>Objective:</h3> Wernicke encephalopathy is an acute neurological disorder secondary to thiamine deficiency with a clinical triad of confusion, eye disorders, and ataxia. Typical MRI Findings show symmetric hyperintensities in T2-weighted sequences predominantly affecting medial thalami, periaqueductal area, mammillary body, and the tectal plate. We describe two atypical cases of Wernicke encephalopathy. <h3>Background:</h3> N/A <h3>Design/Methods:</h3> Retrospective chart review. <h3>Results:</h3> <h3>First Case:</h3> 50-year-old female with history of endometrial cancer presented with altered mental status (AMS), truncal ataxia, neck titubation, and incomplete external ophthalmoplegia, progressing rapidly to stupor. She had recently undergone chemoradiation, complicated by chronic radiation enteritis causing poor oral intake, recurrent emesis, and weight loss. After an extensive negative infectious workup, MRI Brain with contrast was performed, which revealed restricted diffusion and T2-FLAIR sequence hyperintensities of bilateral cerebella, bilateral dorsomedial thalami, fornix with contrast enhancement of mammillary bodies concerning for Wernicke Syndrome. Thiamine levels were confirmed to be 70 nmol/l. <h3>Second Case:</h3> 22-year-old female with history of Autism Spectrum Disorder presented with AMS and seizure-like activity after experiencing severe nausea and vomiting for one week. Infectious workup including CSF analysis was unremarkable. No seizures or epileptiform changes were captured on vEEG. MRI Brain showed T2 FLAIR hyperintensities with restricted diffusion throughout the posterior brainstem, bilateral thalami, caudate nuclei, left medial lentiform nucleus, bilateral periventricular basal ganglia, bilateral frontal and parietal lobes raising concerns for Wernicke encephalopathy. Serum thiamine level was less than 20, corroborating with the diagnosis. Both patients had significant clinical and radiographic improvement with high-dose thiamine supplementation. <h3>Conclusions:</h3> The classic triad of symptoms of Wernicke encephalopathy is usually present in only 16% of patients. Atypical MRI Brain findings include involvement of the cerebral cortex and cerebellum which are more commonly seen in non-alcoholic patients. Mortality rate ranges from 10–20% so prompt recognition of the condition and early treatment is vital especially in atypical cases. <b>Disclosure:</b> Dr. Biyani has nothing to disclose. Dr. Verma has nothing to disclose. Dr. Arulprakash has nothing to disclose. Dr. Shah has nothing to disclose. Dr. Patrice has nothing to disclose.

Wernicke’s Encephalopathy Complicating Hypermesis Gravidarum: a Rare Case Report

Introduction: Wernicke’s Encephalopathy (WE) is an uncommon neurological disorder due to thiamine deficiency. Its clinical findings are variable steering its high incidence postmortem. Seldom, thiamine deficiency is present in a clinical triad consisting of cognitive disorder, ocular abnormalities and gait ataxia. Most commonly, the clinical picture is not specific leading to late or misdiagnosis. In pregnant woman with Hyperemesis Gravidarum, incoercible vomiting and poor intake paves the path to thiamine deficiency by depleting B1 storage affecting cerebral energy homeostasis. Ergo, HG leads to neurological complications affecting maternal mortality and morbidity. Case Report: We hereby present the uncommon case of WE complicate HG in 18 weeks’ gestation primigravidae. Diagnosis relied on clinical findings as the clinical picture was typical: confusion, disorientation and memory impairment besides static and kinetic cerebellar syndrome and ophthalmological abnormalities such as unequal pupils and horizontal nystagmus. Biological findings were out of normal range as it showed electrolytes imbalance, dehydration and elevated liver and pancreatic enzymes. Imaging investigations were normal. Treatment was based on intravenous thiamine supplementation and vomiting management. Conclusion: We are a preventable neurological disorder. Prompt treatment and correct dosage in light of the appropriate guidelines enlighten the prognosis and may even lead to remission. Whereas late or non-diagnosis leads to dramatic complications such as Korsakoff’s syndrome. This article aims to raise clinician’s suspicion of WE and emphasizes the importance of preventive thiamine supplementation during pregnancies and prophylactic intravenous thiamine administration in pregnancy with Hyperemesis Gravidarum.

Association of thiamine administration and prognosis in critically ill patients with heart failure.

Background: Thiamine deficiency is common in patients with heart failure, and thiamine supplement can benefit these patients. However, the association between thiamine administration and prognosis among critically ill patients with heart failure remains unclear. Thus, this study aims to prove the survival benefit of thiamine use in critically ill patients with heart failure. Methods: A retrospective cohort analysis was performed on the basis of the Medical Information Mart of Intensive Care-Ⅳ database. Critically ill patients with heart failure were divided into the thiamine and non-thiamine groups depending on whether they had received thiamine therapy or not during hospitalization. The association between thiamine supplement and in-hospital mortality was assessed by using the Kaplan-Meier (KM) method and Cox proportional hazard models. A 1:1 nearest propensity-score matching (PSM) and propensity score-based inverse probability of treatment weighting (IPW) were also performed to ensure the robustness of the findings. Results: A total of 7,021 patients were included in this study, with 685 and 6,336 in the thiamine and non-thiamine groups, respectively. The kaplan-meier survival curves indicated that the thiamine group had a lower in-hospital mortality than the none-thiamine group. After adjusting for various confounders, the Cox regression models showed significant beneficial effects of thiamine administration on in-hospital mortality among critically ill patients with heart failure with a hazard ratio of 0.78 (95% confidence interval: 0.67-0.89) in the fully adjusted model. propensity-score matching and probability of treatment weighting analyses also achieved consistent results. Conclusion: Thiamine supplement is associated with a decreased risk of in-hospital mortality in critically ill patients with heart failure who are admitted to the ICU. Further multicenter and well-designed randomized controlled trials with large sample sizes are necessary to validate this finding.

Thiamine Supplementation Improves Survival and Body Condition of Hatchery-Reared Steelhead (Oncorhynchus mykiss) in Oregon.

Early rearing of steelhead (Oncorhynchus mykiss) in Oregon hatcheries is often problematic; fry can become emaciated and die during the period between hatch and first feed. Thiamine (vitamin B1) deficiency has caused early mortality in salmonids; however, the thiamine status of Oregon's steelhead populations is unknown, to date. Of the 26 egg samples from three Oregon hatcheries in 2019, 20 (77%) had thiamine levels < 10 nmol/g, and 13 of those samples (50%) had levels <6.5 nmol/g, suggesting the thiamine deficiency of adult, female steelhead. To investigate if thiamine deficiency was causally related to fry survival, females were injected with buffered thiamine HCl 50 mg/kg prior to spawning; additionally, a subset of eggs were supplemented via bath treatment with thiamine mononitrate (1000 ppm) at spawning. Cumulative fry mortality at 8 weeks post-hatch from thiamine-injected females was 2.9% compared to 13.8% mortality of fry without thiamine supplementation. Fry treated only with the thiamine via bath as eggs had a mortality rate of 6.9%. There were no additional improvements for the survival of fry from injected females that also received a thiamine bath. Furthermore, condition factors were greater in thiamine-supplemented fry than in those that received no thiamine. These data identify thiamine deficiency in Oregon steelhead and suggest supplementation with thiamine can mitigate early rearing mortality.

Thiamine responsive Pulmonary Hypertension among exclusively breastfed babies –A Hospital based prospective study from southern India

Pulmonary hypertension remains leading cause of mortality despite many advances in its management. Thiaminedeficiency is identified as a reversible cause of pulmonary hypertension in exclusively breastfed infants whosemothers are thiamine defecient. The present study is planned to find out the reversible pulmonary hypertensionin association with thiamine deficiency.Objectives: To study the pattern of pulmonary hypertension and its associated factors due to thiamine deficiency.Methodology: It is hospital based study in a tertiary care hospital of tumkur. Pretested and pre designedquestionnaire was used to collect patients socio demographic data, clinical data and the data regardinginvestigations and treatment and prognosis.Results: Total of 300 babies were included in the present study after taking into consideration of all inclusionand exclusion criteria. All the babies, 300 (100) belonged to Hindhu community. 234 (79.3%) belonged to class3 socio economic status according to modified kuppuswamy classification. Majority 212 (70.6%) had onlyprimary education and 32 (10.6%) were illiterates. 88(29.3%) had come with severe gasping. 287(95.6%) of babieshad hepatomegaly and oliguria was present in 144 (48%) of babies. The majority of the infants were presentedwith shock 256 (85.3%), which was managed. Repeat echo was done serially and the difference in reduction ofpulmonary pressure after administration of thiamine was statistically significant (p value &lt;0.005) Conclusion:Thiamine responsive pulmonary hypertension presents as an acute condition with severe respiratory distress,vomiting in a previously well and exclusively breast fed baby. Hence clinical suspicion to recognise the symptomsearly and diagnose and mere thiamine administration is life saving and which reverses the fatal condition. Healtheducation to mothers and family members about food taboos related to use of polished rice to prevent deficiencyof thiamine is also important and supplementation of thiamine as prophylaxis can also be considered in theprogrammes related to antenatal and postnatal 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.

Thiamine-responsive pyruvate dehydrogenase complex deficiency presenting as recurrent muscle weakness: Identification of a novel mutation (p.T111I) in the PDHA1 gene.

Thiamine-responsive pyruvate dehydrogenase complex deficiency presenting as recurrent muscle weakness: Identification of a novel mutation (p.T111I) in the PDHA1 gene.

Pregnancy thiamine and riboflavin intake and the risk of gestational diabetes mellitus: A prospective cohort study

BackgroundThiamine and riboflavin deficiencies exist to varying degrees worldwide, especially in developing countries. Evidence regarding the association between thiamine and riboflavin intake and gestational diabetes mellitus (GDM) is scarce. ObjectivesWe aimed to evaluate the association of thiamine and riboflavin intake during pregnancy, including dietary source and supplementation, with GDM risk in a prospective cohort study. MethodsWe included 3036 pregnant women (923 in the first trimester and 2113 in the second trimester) from the Tongji Birth Cohort. A validated semi-quantitative food frequency questionnaire and a lifestyle questionnaire were used to assess thiamine and riboflavin intake from dietary source and supplementation, respectively. GDM was diagnosed using the 75 g 2-h oral glucose tolerance test at 24–28 weeks of gestation. A modified Poisson regression or logistic regression model was used to evaluate the association between thiamine and riboflavin intake and GDM risk. ResultsDietary intake of thiamine and riboflavin was at low levels during pregnancy. In the fully adjusted model, compared with participants in quartile 1 (Q1), those who had more total thiamine and riboflavin intake had a lower risk of GDM during the first trimester [thiamine: Q2: RR: 0.58 (95% CI: 0.34, 0.98); Q3: RR: 0.45 (95% CI: 0.24, 0.84); Q4: RR: 0.35 (95% CI: 0.17, 0.72), P for trend = 0.002; riboflavin: Q2: RR: 0.63 (95% CI: 0.37, 1.09); Q3: RR: 0.45 (95% CI: 0.24, 0.87); Q4: RR: 0.39 (95% CI: 0.19, 0.79), P for trend = 0.006]. This association was also observed during the second trimester. Similar results were observed for the association between thiamine and riboflavin supplement use but not dietary intake and GDM risk. ConclusionsHigher intake of thiamine and riboflavin during pregnancy is associated with a lower incidence of GDM.This trial was registered at http://www.chictr.org.cn as ChiCTR1800016908.

Is Thiamine Administration Effective in Sepsis or Not? A Randomized Controlled Trial

Background: Sepsis is the first leading cause of death in Myanmar and complications are also difficult to solve. This study aimed to detect the effect of thiamine on lactate clearance and mortality in patients with sepsis. Method: A randomized controlled trial done in No.(1) Defence Services General Hospital, Yangon from October 2020 to June 2022. All patients &gt; 18 years old admitted with suspected or documented infection and qSOFA score 2 or 3 were included but alcohol related cases were excluded. Total 80 patients were assigned 1:1 by block randomization. Intervention group was given IV thiamine 100 mg 6 hourly for 3 days. Primary outcome was lactate clearance and secondary outcomes, mSOFA score (both were assessed in day 1, day 3 and day 7), and mortality within 7 days. Intention to treat analysis with worst data imputation in missing value for expired cases. Results: Significant lactate clearance was seen in intervention group compared with control group, in day 3, [23.53% (34.37) vs 16.67% (43.30), z = -2.353, p = 0.019] and day 7, [53.85% (28.90) vs 30.22% (38.61), z = -3.186, p = 0.001]. Lactate clearance over time was well observed in the intervention group, [X2 (2) = 29.356, p &lt; 0.001] but not in the control group, [X2 (2) = 3.152, p = 0.207]. Significant mSOFA score reduction over time was also observed in the intervention group, [X2 (3) = 39.330, p &lt; 0.001]. All-cause mortality within 7 days was not different, [X2 (1) = 0.949, p = 0.330, OR 0.949, 95% CI (0.51 – 7.12)]. Conclusion: Thiamine supplementation in sepsis patient was benefit in lactate clearance starting from day 3 and reduction of mSOFA score starting from day 7. But it did not show the mortality benefit within 7 days period.

Effectiveness of Thiamine Supplementation Plus Optimal Medical Therapy as an Adjunct Treatment in Improving Cardiac Function Among Patients With Heart Failure With Reduced Ejection Fraction: A Meta analysis

BACKGROUND: Thiamine plays a crucial role for normal cardiac function, as severe vitamin B1 (thiamine) deficiency leads to congestive heart failure. Thus, patients undergoing diuretic treatment might have compromised heart function. Several small-scale studies were conducted with conflicting results”. OBJECTIVE: The aim of this study was to determine the effects of thiamine supplementation on cardiac function among patients with heart failure with reduced ejection fraction receiving optimal medical therapy versus optimum medical therapy alone. DESIGN: This was a meta-analysis of randomized, double-blind, placebo-controlled trials. METHODS: Studies for inclusion were searched using PubMed, Google Scholar, Cochrane, EMBASE, and other databases. Gray literature was also explored. Review Manager version 5.3 was used to analyze data. The mean difference and 95% confidence interval were estimated using random-effects model. χ2 and I2 were computed to assess heterogeneity. RESULTS: After the analysis of the combined effects of five studies with 218 subjects, the pooled results showed no significant effect on the left ventricular ejection fraction in heart failure patients when given thiamine supplementation with a P value of 0.04. CONCLUSION: Based on this limited group of studies, there is insufficient information to suggest that thiamine supplementation has a positive effect on left ventricular ejection fraction in heart failure patients. Further large-scale clinical trials are needed to determine the optimum dose, duration, and route of thiamine in patients with heart failure. KEYWORDS: thiamine supplementation, vitamin B, heart failure, HFrEF, reduced ejection fraction