Thiamine Levels Research Articles

Fluorouracil-induced leukoencephalopathy mimicking neuroleptic malignant syndrome: a case report

BackgroundFluorouracil-induced leukoencephalopathy is a rare complication and has been reported to present as confusion, oculomotor abnormality, ataxia, and parkinsonism; however, there is no previous report of a presentation mimicking neuroleptic malignant syndrome. Acute cerebellar syndrome may occur, which can be explained by the extremely high accumulation of the drug in the cerebellum. However, presentation mimicking neuroleptic malignant syndrome similar to our case has never been reported.Case presentationHere, we describe a 68-year-old Thai male presenting with advanced-stage cecal adenocarcinoma, as well as symptoms and signs indicative of neuroleptic malignant syndrome. He received two doses of intravenous metoclopramide 10 mg 6 hours before his symptoms occurred. Magnetic resonance imaging scan revealed signal hyperintensity within the bilateral white matter. Further evaluation showed that his thiamine level was extremely low. Thus, he was diagnosed with fluorouracil-induced leukoencephalopathy mimicking neuroleptic malignant syndrome. The concomitant fluorouracil-induced thiamine deficiency eventually leads to rapid depletion of thiamine and was considered a risk factor for fluorouracil-induced leukoencephalopathy.ConclusionFluorouracil-induced leukoencephalopathy is believed to be caused by insult causing mitochondrial dysfunction. However, the exact mechanism remains unknown, but our finding suggests that thiamine deficiency plays a crucial role in fluorouracil-induced leukoencephalopathy. Diagnosis is usually delayed due to a lack of clinical suspicion and results in significant morbidity requiring unnecessary investigations.

The Thiamine-Dependent Hysteretic Behavior of Human Transketolase: Implications for Thiamine Deficiency

We have investigated the hysteretic properties of human transketolase with emphasis on its dependency on thiamine pyrophosphate concentration. As demonstrated previously, the reaction progress curves revealed a slow transition from an initial low velocity to a faster final steady-state velocity, characterized by the rate constant τ-1. The rate of the transition was dependent on the concentration of the thiamine pyrophosphate cofactor, with progressively longer transition times found as the concentration of thiamine pyrophosphate was decreased. At physiological thiamine pyrophosphate concentrations, the inverse rate constant was in the range of 10 to 20 min for fibroblast-derived transketolase and increased dramatically with only small decreases from these levels of thiamine pyrophosphate. Variation in the lag was found when transketolase from different individuals was examined. Moreover, at low levels of thiamine, the rate of the transition was different between fibroblast- and lymphoblast-derived transketolase. The substantial lag in formation of active holoenzyme and the findings of interindividual variation and cell type variation in the lag period suggest mechanisms for the loss of transketolase activity during thiamine deficiency and may explain, at least in part, the differential sensitivity to deficiency demonstrated by tissues and individuals.

Anorexia nervosa and Wernicke-Korsakoff syndrome: case report an literature review

IntroductionWenicke-Korsakoff syndrome (WKS) is a neurological disorder caused by thiamine deficiency. Wernicke Encephalopathy (WE) is the acute phase and the chronic phase is called Korsakoff-syndrome (KS).ObjectivesTo review the current literature on the management of WKS in a patient with anorexia nervosa.MethodsWe report the case of a 63-year-old woman admitted to the Psychiatry Unit after weight loss in the last 3 months (from 39 kg to 33,500 kg). She only made one meal a day. By exploration and analysis, neoplastic disease is ruled out (thoraco-abdomino-pelvic CT without pathological findings). She has maintained restrictive intakes for more than 30 years. A long-term anorexia nervosa (AN) is suspected, with a worsening of restrictive behavior in recent months. Upon admission, she has a weight of 33,500 kg and a BMI of 14,10. She has a left palpebral ptosis and an alteration of the anterograde memory as well as affectation of executive functions. Progressive oral diet is started, and due to the suspicion of a WKS, thiamine ev is started for a week and then continued with oral thiamine. Thiamine levels are extracted once the ev treatment has begun, so we do not have previous levels to know if they were decreased. Brain MRI shows bilateral hyperintensities in white matter and at supratentorial level in T2 and FLAIR. After a month and a half of admission, the patient has progressively regained weight, has managed to make adequate intakes and has improvement in memory.ResultsAn adverse consequence of severe malnutrition in AN due to severe food restriction and purging behavior is thiamine deficiency, and also global cerebral atrophy and concomitant cognitive deficits can be found. Thiamine deficiency occurs in 38% of individuals with AN and is often unrecognized. WKS is caused by thiamine deficiency, and WE is the acute phase of this syndrome (presentation of triad can vary). The chronic phase is KS and consists in amnesia with confabulations. WKS typically develops after malnourishment in alcoholic patients but can be associated in nonalcoholic such as prolonged intravenous feeding, hyperemesis, anorexia nervosa, refeeding after starvation, thyrotoxicosis, malabsorption syndromes; hemodialysis; peritoneal dialysis; AIDS; malignancy. WKS is a clinical diagnosis, and no specific abnormalities have been found in cerebrospinal fluid, brain imaging or electroencephalograms. MRI has a sensitivity of 53%, but high specificity of 93%, and shows an increased signal in T2 and FLAIR sequences, bilaterally symmetrical in the paraventricular regions of the thalamus, the hypothalamus, mamillary bodies, the periaquedutal region, the floor of the fourth ventricle and midline cerebellum.ConclusionsIf the disorder is suspected, thiamine should be initiated immediately in order to prevent irreversible brain damage, with an estimated mortality rate of about 20%, or to the chronic form of the WE in up to 85% of survivorsDisclosure of InterestNone Declared

Clinical spectrum of infants with thiamine responsive pulmonary arterial hypertension

Pulmonary arterial hypertension (PAH) is a progressive disorder caused by hypertension in blood vessels from heart to lungs. Exclusively breastfed infants are at the highest risk due to their high metabolic demand and low thiamine level in mothers. Symptoms are observed to be sometimes precipitated with the presence of co morbidity such as sepsis and lower respiratory tract infections. This study explains 10 cases with varied clinical presentation and response to management of different grades of infantile pulmonary arterial hypertension.

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.

Maternal Blood, Egg and Larval Thiamin Levels Correlate with Larval Survival in Landlocked Atlantic Salmon (Salmo salar)

A link was previously established between the Cayuga syndrome, a condition causing 100% mortality in larval landlocked Atlantic salmon, Salmo salar, in several of New York’s Finger Lakes, and a maternal diet of alewife, Alosa pseudoharengus, a non-native thiaminase-rich Clupeid fish. We evaluated salmon larvae viability relative to maternal thiamin status, and investigated the putative link of the Cayuga syndrome to an alewife diet in fish from the geographic regions outside the Finger Lakes/lower Great Lakes watersheds. We identified Cayuga syndrome in Atlantic salmon from Otsego Lake in the Susquehanna River watershed and from Green Pond in New York’s Adirondack Mountains. In both systems alewife represent the major component of the diet for the salmon. Thiamin levels in the maternal blood of Otsego salmon with syndrome-negative progeny were three- to four-fold greater than those Otsego females whose progeny exhibited 100% mortality. Thiamin levels in eggs and larvae were directly related to thiamin levels in maternal blood in both syndrome-positive and syndrome-negative stocks. Thiamin bath treatments of syndrome-afflicted larvae eliminated mortality regardless of their lake stock of origin. Maternal blood levels of approximately 0.31 nmol thiamin pyrophosphate/g or 0.44 nmol total thiamin/g appear necessary to achieve egg threshold levels of approximately 0.8 and 1.1 nmol/g unphosphorylated and total thiamin, respectively; these egg thiamin levels should prevent significant syndrome-related mortality in landlocked Atlantic salmon larvae. These results confirm the role of thiamin in the etiology of the Cayuga syndrome and support the dietary link of this naturally occurring thiamin deficiency to the thiaminase-rich alewife.

Maternal preconception circulating blood biomarker mixtures, child behavioural symptom scores and the potential mediating role of neonatal brain microstructure: the S-PRESTO cohort

Human brain development starts in the embryonic period. Maternal preconception nutrition and nutrient availability to the embryo may influence brain development at this critical period following conception and early cellular differentiation, thereby affecting offspring neurodevelopmental and behavioural disorder risk. However, studying this is challenging due to difficulties in characterizing preconception nutritional status and few studies have objective neurodevelopmental imaging measures in children. We investigated the associations of maternal preconception circulating blood nutrient-related biomarker mixtures (~15 weeks before conception) with child behavioural symptoms (Child Behaviour Checklist (CBCL), aged 3 years) within the Singapore Preconception Study of Long-Term Maternal and Child Outcomes (S-PRESTO) study. The CBCL preschool form evaluates child behaviours based on syndrome scales and Diagnostic and Statistical Manual of Mental Disorders (DSM) oriented scales. These scales consist of internalizing problems, externalizing problems, anxiety problems, pervasive developmental problems, oppositional defiant, etc. We applied data-driven clustering and a method for modelling mixtures (Bayesian kernel machine regression, BKMR) to account for complex, non-linear dependencies between 67 biomarkers. We used effect decomposition analyses to explore the potential mediating role of neonatal (week 1) brain microstructure, specifically orientation dispersion indices (ODI) of 49 cortical and subcortical grey matter regions. We found that higher levels of a nutrient cluster including thiamine, thiamine monophosphate (TMP), pyridoxal phosphate, pyridoxic acid, and pyridoxal were associated with a higher CBCL score for internalizing problems (posterior inclusion probability (PIP) = 0.768). Specifically, thiamine independently influenced CBCL (Conditional PIP = 0.775). Higher maternal preconception thiamine level was also associated with a lower right subthalamic nucleus ODI (P-value = 0.01) while a lower right subthalamic nucleus ODI was associated with higher CBCL scores for multiple domains (P-value < 0.05). One potential mechanism is the suboptimal metabolism of free thiamine to active vitamin B1, but additional follow-up and replication studies in other cohorts are needed.

Correlation between Oral Thiamine as an Opioid Adjuvant and Cathecol-O-Methyltransferase Enzyme Levels in Cervical Cancer Patients

BACKGROUND: The high prevalence of cancer pain shows that a lot of the patients are undertreatment. Vitamin B is one of the additional alternative substances studied in cancer pain management. Thiamine is believed to modulate pain mechanisms in lowering the Cathecol-O-Methyltransferase (COMT) enzyme level. AIM: The aim of the study was to assess the correlation between Oral Thiamine as an Opioid Adjuvant and COMT Enzyme Levels in Cervical Cancer Patients METHODS: This research is a quasi-experimental study with a pre-test and post-test control group design. Patients in this study were 32 cervical cancer patients who experienced cancer pain, divided into two groups (treatment and control groups). The treatment group received morphine plus thiamine 500 mg/8 h/oral, and the control group received morphine alone. Measurement and evaluation of pain scores were carried out after 72 h of thiamine administration and blood collection was carried out again 4 h after the last thiamine administration to check thiamine levels and COMT. Then, data collection and analysis is being evaluated. RESULTS: From 32 cervical cancer patients studied, there were differences in changes in numeric rating scale (NRS) levels and COMT levels in the thiamine treatment group. CONCLUSIONS: The administration of thiamine can reduce COMT enzyme levels and clinically reduce NRS in cervical cancer patients. If it confirmed by other findings, thiamine might be considered for its use in the treatment of cancer pain.

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.

Impacts of vitamin premix and/or yeast ingredient inclusion in a canned cat food on thiamin retention during 6 months of storage.

Low thiamin levels in thermally processed canned cat foods are concerning for the pet food industry. However, there is little information on storage stability of thiamin in this food format or if inclusion of select ingredients, such as dried yeasts, has an effect. Therefore, the objective was to evaluate the storage stability of thiamin when a vitamin premix and/or yeasts ingredients were included in a canned cat food. The factorial treatment arrangement consisted of 2 levels of vitamin premix (with or without) and 4 inclusions of yeast (NY = none, LBV = Lalmin B Complex Vitamins, BY = product #1064B, or EA = BGYADVANTAGE). Diets were stored for 6 months and analyzed every month for thiamin. Data were analyzed as a mixed model (SAS v. 9.4; SAS Institute, Cary, NC) with fixed effects (vitamin premix, yeast, time, and their two-way and three-way interactions) and random effects (production day and the interaction of production day, vitamin premix, and yeast). Significance was set at P < 0.05 and Fisher's LSD was used to separate means. Diets including the vitamin premix [average 55.1 mg/kg dry matter basis (DMB)] contained more (P < 0.05) thiamin than diets that did not (average 7.5 mg/kg DMB). Inclusion of LBV (average 40.3 mg/kg DMB) resulted in the highest (P < 0.05) levels of thiamin, followed by BY (P < 0.05; average 26.9 mg/kg DMB). Diets with NY and EA contained the lowest (P < 0.05) levels of thiamin and were not different from each other (P > 0.05; average 19.3 mg/kg DMB). The diet containing vitamin premix without yeast lost (P < 0.05) 17.8% thiamin while diets containing a yeast ingredient maintained thiamin levels better during storage. This suggested that thiamin from yeast ingredients was more resistant to degradation during storage and should be considered when designing new canned cat foods.

Thiamine status during treatment of diabetic ketoacidosis in children- tertiary care centre experience.

There is a lack of information regarding thiamine status in children with diabetic ketoacidosis (DKA). This study was designed to assess the thiamine status upon admission and 24h after treatment initiation of DKA, whether newly diagnosed children or with established T1DM diagnosis, who presented with DKA. We enrolled 90 children (mean age, 9.8±2.6 years; 58 females and 32 males) with type 1 diabetes mellitus (T1DM), whether newly diagnosed or with an established T1DM diagnosis (from 1 to 5.2 years ago), who presented with DKA. We observed the initial Glasgow Coma Scale (GCS) and recovery time. The whole blood thiamine diphosphate levels were measured upon admission (baseline point) and 24h after initiation of the DKA treatment (second-time point). The mean blood thiamine levels at the second-time point (90.11±15.76nmol/L) significantly decreased compared with their levels at baseline (108.8±17.6nmol/L) (p<0.001). We compared thiamine levels with the initial GCS, patient's age, and recovery time. Thiamine levels at the second-time point were positively correlated with baseline thiamine levels (r=0.86, p=0.0001) and the initial GCS (r=0.68, p=0.001) but were negatively correlated with patient's age (r=-0.61, p=0.001) and recovery time (r=-0.724, p=0.001). Based on multiple regression analysis, thiamine levels at the second-time point were directly related to the initial GCS and inversely related to the patient's age. The current study indicates that blood thiamine diphosphate levels significantly decreased after 24h of DKA treatment initiation compared to pre-treatment levels. After 24h of treatment initiation, blood thiamine levels are directly related to the initial GCS and inversely related to the patient's age.

Furosemide-related thiamine deficiency in hospitalized hypervolemic patients with renal failure and heart failure

BackgroundWe aimed to describe the thiamine status in hospitalized hypervolemic heart failure (HF) and/or renal failure (RF) patients treated with furosemide and to investigate whether there was a difference in furosemide-related thiamine deficiency between patients with RF and HF. MethodsPatients who were diagnosed as hypervolemia and treated with intravenous furosemide (at least 40mg/day) were included in this prospective observational study. Whole blood thiamine concentrations were measured 3 times during hospital follow-up of patients. ResultsWe evaluated 61 hospitalized hypervolemic patients, of which 22 (36%) were men and 39 (64%) were women, with a mean age of 69.00±10.39 (45–90) years. The baseline and post–hospital admission days 2 and 4 mean thiamine levels were 51.71±20.66ng/ml, 47.64±15.43ng/ml and 43.78±16.20ng/ml, respectively. Thiamine levels of the hypervolemic patients decreased significantly during the hospital stay while furosemide treatment was continuing (p=0.029). There was a significant decrease in thiamine levels in patients who had HF (p=0.026) and also, thiamine was significantly lower in HF patients who had previously used oral furosemide before hospitalization. However, these findings were not present in patients with RF. ConclusionsThiamine substantially decreases in most hypervolemic patients receiving intravenous furosemide treatment during the hospital stay. Thiamine levels were significantly decreased with furosemide treatment in especially HF patients, but the decrease in thiamine levels did not detected at the same rate in RF patients. Diuretic-induced thiamine loss may be less likely in RF patients, probably due to a reduction in excretion.

Traditional Colombian cuisine corn dough: Characterization and evaluation of the effect of heat treatment on selected water-soluble vitamins and minerals

Corn is one of the most abundant cereals used for human nutrition and is widely used in Colombian gastronomy as a dough. This article characterizes hydrated white corn dough and evaluates the effects on its content of selected water-soluble vitamins and minerals of cooking it in water or frying it in vegetable oil according to traditional methods used in Colombian gastronomy. Basic physicochemical and microbiological parameters were analyzed, and vitamin and mineral content were determined using HPLC-DAD and atomic absorption spectrometry, respectively. The results showed that the dough was a source of protein(4.82 %), fat(1.48 %), and dietary fiber(5.29 %) and that its microbiological quality was acceptable for human consumption. Heat treatment had no significant effect (p > 0.05) on the levels of thiamine, niacin, and pyridoxine, but ascorbic acid was not detected in the cooked and fried dough. Thiamine, niacin, and pyridoxine content were constant across the treatments. The effects on the levels of minerals present were significant (p < 0.05), with increased levels of calcium and zinc in the fried dough and increased levels of iron in the cooked dough. Finally, traditional cooking and frying methods used in Colombian gastronomy do not lower the nutrient profile of corn dough in terms of the evaluated nutrients.

Safety and Efficacy of Fedratinib in Patients with Primary (P), Post-Polycythemia Vera (Post-PV), and Post-Essential Thrombocythemia (Post-ET) Myelofibrosis (MF) Previously Treated with Ruxolitinib: Primary Analysis of the FREEDOM Trial

Introduction: Fedratinib is an oral selective Janus kinase (JAK) 2 inhibitor approved for treatment (tx) of patients (pts) with MF, including those previously treated with ruxolitinib (RUX). In the single-arm phase 2 JAKARTA2 trial (NCT01523171), fedratinib 400 mg once daily improved spleen volume and MF symptom burden in pts with MF resistant/intolerant to prior RUX (Harrison et al. Am J Hematol 2020). Long-term data are lacking due to early termination. The ongoing, single-arm, phase 3b FREEDOM trial (NCT03755518) further evaluates the safety and efficacy of fedratinib in pts with MF previously treated with RUX and includes proactive strategies to mitigate gastrointestinal (GI) adverse events (AEs), thiamine level decreases, and potential encephalopathy (including Wernicke's encephalopathy [WE]). Methods: Eligible pts aged ≥ 18 years with PMF, post-PV MF, or post-ET MF with ≥ 3 months prior tx with RUX were enrolled in the study. Pts were required to have Dynamic International Prognostic Scoring System (DIPSS) intermediate- or high-risk MF, Eastern Cooperative Oncology Group performance status ≤ 2 and baseline platelet count ≥ 50 x 109/L. Pts were treated with fedratinib 400 mg once daily in continuous 28-day cycles until lack of efficacy, intolerance, or disease progression, and followed for 12 months after end of tx (EOT). AE mitigation strategies included prophylactic use of antiemetics and symptomatic use of antidiarrheals, thiamine supplementation, surveillance for encephalopathy, and adjusting preferred time of day for fedratinib administration. Results: Thirty-eight pts were enrolled and treated. Due to accrual challenges during the COVID-19 pandemic, the study was capped early, and data lost statistical power due to reduced sample size. At the database cutoff (November 29, 2021), median tx duration was 38 weeks, 13 pts had tx ongoing, and 25 pts had discontinued tx. At baseline, median age was 68.5 years, 23 (60.5%) pts had a diagnosis of PMF, 9 (23.7%) post-PV MF, and 6 (15.8%) post-ET MF, with DIPSS assessment of intermediate-1 risk in 13 (34.2%) pts, intermediate-2 risk in 18 (47.4%) pts, and high risk in 7 (18.4%) pts. Baseline median spleen volume was 1831.6 mL. A total of 9/35 (25.7%) evaluable pts met the primary endpoint of ≥ 35% spleen volume reduction (SVR) by magnetic resonance imaging/computed tomography at end of cycle (EOC) 6; 13 (37.1%) pts had ≥ 35% SVR when missing EOC6 assessments were imputed with last observation carried forward (LOCF) method (Table). In addition, 9 (25.7%) pts achieved a ≥ 35% SVR before or after EOC6, for a best overall response of ≥ 35% SVR in 22 (62.9%) pts up to end of tx. With a ≥ 25% SVR threshold, 24 (68.6%) pts had a response with LOCF at EOC6. Of ≥ 35% SVR responders, 19/22 (86.4%) maintained durable response at data cutoff (Figure). In secondary endpoints, 21/36 (58.3%) and 16/36 (44.4%) evaluable pts showed ≥ 50% reduction in total symptom score (TSS) at EOC3 and EOC6, respectively. A total of 34/38 (89.5%) pts had 1 tx-emergent AE related to study medication; 3 (7.9%) were serious AEs. Anemia and thrombocytopenia were reported in 23 (60.5%) and 13 (34.2%) pts, respectively. GI AEs were reported in 34 (89.5%) pts, with nausea, vomiting, and diarrhea reported in 15 (39.5%), 7 (18.4%), and 15 (39.5%) pts, respectively. Most GI AEs were grade 1/2 and occurred during cycle 1, and decreased in the subsequent cycles. Grade 1/2 decreases in thiamine levels were reported in 6 pts after initial tx; all instances were treated and resolved at next assessment. No pts required tx discontinuation due to low thiamine levels. There were no cases of WE reported. There were 2 deaths during tx and 7 during follow-up; none were related to study medication. Conclusions: Clinically relevant and durable spleen and symptom responses were observed in FREEDOM study participants, with a majority of responders showing durable SVR at data cutoff. This supports the use of fedratinib in pts with MF previously treated with RUX. One limitation of the study was small pt sample size. In this first fedratinib study proactively assessing a GI mitigation strategy and thiamine monitoring, results showed GI AEs were easily mitigated and no WE was reported. Study support: This study was supported by Bristol Myers Squibb. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Maternal Liver and Egg Thiamine Concentrations in Walleye from Lake Oahe, South Dakota

Thiamine, vitamin B1, cannot be synthesized by fish. Therefore, developing embryos are reliant on thiamine stores deposited during oogenesis. Thiaminase, which breaks down thiamine in predatory fish, has been suggested as the probable reason for the poor reproductive success in salmonids. Similarly, walleye Sander vitreus reproduction may also be hampered by thiaminase-containing diets. This study documented maternal liver and egg thiamine concentrations of walleye populations from the Cheyenne, Moreau, and Grand rivers of Lake Oahe, South Dakota, USA in 2000, 2001, 2002, and 2004. Thiamine concentrations were generally lowest in the eggs from the Cheyenne River. Free thiamine, thiamine monophosphate, and total thiamine were all significantly lower in eggs from the Cheyenne River compared to the Moreau and Grand Rivers. Maternal liver thiamine pyrophosphate and total thiamine followed a similar pattern. Egg survival to hatch varied significantly between locations, at 30.5%, 41.4%, and 56.8% in the Cheyenne, Moreau, and Grand Rivers, respectively, but was not significantly correlated with any form of egg thiamine. Considerable year-to-year variation was observed when data from the locations were pooled; egg free thiamine, thiamine monophosphate, and total thiamine were significantly higher in 2002. The lowest mean egg total thiamine level of 2.6 nmol/g was recorded in 2000. Liver free thiamine and thiamine monophosphate were weakly, but significantly negatively correlated with egg survival to hatch to hatch. Egg survival to hatch was significantly negatively correlated with maternal length. The results were likely impacted by the unexpected catastrophic loss of walleye forage because of flooding in 2003.

Cerebellar restricted diffusion in Wernicke's encephalopathy.

A 50-year-old woman presented to an outside hospital for acute onset bilateral lower limb pain. She was diagnosed with aortoiliac stenosis and underwent stent placement. Post-procedure, she was noted to have altered mental status, truncal ataxia, neck titubation, and incomplete external ophthalmoplegia. She rapidly declined to a stuporous state. She had a history of uterine cancer treated with chemoradiation which was complicated by chronic radiation enteritis. She was also reported to have poor oral intake, recurrent emesis, and weight loss for a month before her presentation. After an extensive work up, she arrived at our facility where an MRI of the brain showed restricted diffusion and T2-FLAIR sequence showed hyperintensities of bilateral cerebellum. T2-FLAIR hyperintensities of bilateral dorsomedial thalami, fornix, and post-contrast-enhancement of mammillary bodies were also noted. The clinical picture with imaging findings was concerning for possible thiamine deficiency. In Wernicke's encephalopathy, restricted diffusion, T2-FLAIR hyperintensities, and contrast enhancement may be seen in mammillary bodies, dorsomedial thalami, tectal plate, periaqueductal grey matter, and rarely in the cerebellum as well. Her thiamine level was 70 nmol/l (reference range: 70-180 nmol/l). Thiamine levels can be falsely elevated in patients who are on enteral feeds, which was the case in our patient. She was started on high dose thiamine replacement. At time of discharge, repeat MRI brain revealed resolution of cerebellar changes with mild atrophy and patient had subtle neurological improvement including consistent eye opening, tracking, and attending to examiner, as well as mumbling words.

A Comparative Study on Proximate and Micronutrient Composition of Various Varieties of Rice Produced in Punjab, Pakistan

&#x0D; &#x0D; The present work aims to assess and compare the nutritional composition of the indigenously produced samples of Basmati Pak, Basmati KS 282, Super Basmati, Organic Brown Rice, 1121 Kainat Sella Rice (parboiled), Super Kernel (parboiled).The proximate analysis of macronutrients and micronutrients (Thiamine, Riboflavin Niacin, Fe, Ca, and Zn) was conducted according to AOAC, 2005 and AOAC, 2008 official methods respectively. The results showed that protein (N×5.7), crude fiber and ash contents were found to be highest in the Organic Brown rice, while the fat content was similar in all rice types. The highest moisture and protein content was found in Super Kernel Rice. Basmati Pak had the lowest percentage of moisture and ash, Super White Basmati had the least amount of protein and crude dietary fiber while the lowest percentage of fat was found in Basmati KS 282. In terms of micro-nutrients, Super Kernel Rice showed to have a higher content of Thiamin, Riboflavin, and Niacin as compared to the rest of the varieties. 1121 Kainat Sella Rice had the highest contents of Ca. Organic Brown Rice was found to have the highest level of Fe and Zn. The significantly lower levels of Thiamin and Riboflavin were found in Basmati Pak and lowest level of Niacin was found in Super Basmati. Similarly Basmati Pak had the lowest level of Ca and Zn while Kainat Sella Rice (parboiled) had the lowest levels of Fe content. The nutritional composition data suggests that some nutrients are present in one variety of rice while others are present in another variety. Basmati Pak variety had least amount of nutrients. The information obtained from this research may be of interest to food manufacturers and consumers for acknowledging the compositional variation in indigenous rice varieties.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Thiamine Deficiency in the Pathophysiology and Diagnosis of Wernicke-Korsakoff Syndrome: Case Report and Literature Review

Thiamine deficiency is associated with life-threatening pathologies, as Wernicke syndrome (WS), Korsakoff syndrome (KS), Marchiafava-Bignami (MB) disease, and wet or dry beri-beri (BB). Among the etiological factors, the thiamine deficiency may be suspected in subjects at risk for malnutrition (decreased nutrient intake, increased nutrient losses, or impaired nutrient absorption). Computed tomography (CT) but especially magnetic resonance imaging (MRI) is the best method to detect diencephalic and mesencephalic cytotoxic edematous lesions in patients with acute WS, with hyperintense on long-TR spin-echo MRI imaging and low-density signal abnormalities on CT scans. We report a case of WS in an 82-year-old woman with the history of cancer and eating disorder, who presented a neurological worsening during recovery, associated with low serum thiamine levels and the presence of symmetrical areas of hyperintense signal in the long-TR sequences of MRI. After parenteral thiamine supplementation, we observed a rapid improvement of ocular and language disorders occurred, with a low and incomplete improvement of peripheral neuropathy, supporting the WS diagnosis. Our case report presented the clinical picture of WS and KS and the diagnosis was confirmed by both the laboratory tests and the brain imaging techniques. The dosage of the vitamin was useful and accurate when performed before the beginning of the supplementation therapy. This case is important in bringing to light a clinical picture often observed in many medical recovery units.

Evolution of hydrosoluble vitamins and sugars contents of nine traditional plantain cultivars (Musa sp.) during boiling

Plantain is a great consumption foodstuff whose knowledge of the nutritional potential of all the cultivars is a necessity. The following research aims to highlight the nutritional value of nine local plantain cultivars grown in Côte d'Ivoire. Vitamins and ethanosoluble sugars were determined using standard methods. The outcomes indicated the existence of vitamins B1, B2, B3, B5 and C whose levels decrease during boiling. The highest thiamine levels after each cooking time (10, 15 and 20 min) were 0.071 (Banablé), 0.045 (Banakpa) and 0.023 mg/100 g DM (Ataplègnon). The highest riboflavin levels were observed in Banablé cultivars (0.051, 0.037 and 0.024 mg/100 g DM), after 10; 15 and 20 min of boiling respectively. Banakpa cultivar recorded the highest levels of nicotinamide at each of these three boiling times with respective values of 0.69, 0.55 and 0.33 mg/100 g DM. Pantothenic acid levels were highest in the Banaboi cultivar after boiling (0.048; 0.035 and 0.029 mg/100 g DM). Vitamin C levels were higher after boiling in N’glétia (10.02 and 8.56 mg/100 g DM) and Banadié (8.06 mg/100 g DM) cultivars. In addition, boiling increased the levels of total sugars and reducing sugars during cooking, thus reaching the maximum values at 15 min of cooking beyond which they decreased. The pulp being almost cooked after 15 min of boiling, it would be desirable to keep this cooking time.

The Relationship Between Thiamine Intake and Long Sleep Duration: Results From the Korea National Health and Nutrition Examination Survey.

Thiamine is thought to modify sleeping patterns, while alcohol use diminishes internal thiamine levels. We investigated the association between thiamine intake and sleep duration and explored possible heterogeneity in the effect according to alcohol use. In total, 15 384 participants aged 19-64 were obtained from the Korea National Health and Nutrition Examination Survey 2012-2016. Nutrient intake, including thiamine, was measured using a food frequency questionnaire. Sleep duration was measured by a self-reported questionnaire. The highest thiamine intake quartile was set as the reference group. Participants were divided into 3 groups, with 7-8 hours of daily sleep as a reference group and those who slept more or less than that as "oversleeping" and "insufficient sleeping," respectively. Multivariate logistic regression was used, adjusting for socioeconomic, medical, and nutritional factors. Additionally, participants were stratified according to high-risk alcohol use defined by the World Health Organization standards on alcohol use. Low thiamine intake was associated with oversleeping (Q3: odds ratio [OR], 1.06; 95% confidence interval [CI], 0.86 to 1.32; Q2: OR, 1.24; 95% CI, 0.99 to 1.55; Q1: OR, 1.49; 95% CI, 1.16 to 1.91) and showed a significant trend for higher ORs at lower intake levels (p-trend&lt;0.001). The effect was stronger in the high-risk alcohol use group (Q1: OR, 1.78; 95% CI, 1.28 to 2.49). Low thiamine intake was associated with oversleeping, and alcohol use intensified that association. These results were found in a context where overt clinical symptoms due to thiamine deficiency are considered rare. More awareness of the potential relationship of thiamine intake with oversleeping and its related risks should be considered.