RESUMO

OBJECTIVE: To develop a predictive model for thiamine responsive disorders (TRDs) among infants and young children hospitalized with signs or symptoms suggestive of thiamine deficiency disorders (TDDs) based on response to therapeutic thiamine in a high-risk setting. STUDY DESIGN: Children aged 21 days to <18 months hospitalized with signs or symptoms suggestive of TDD in northern Lao People's Democratic Republic were treated with parenteral thiamine (100 mg daily) for ≥3 days in addition to routine care. Physical examinations and recovery assessments were conducted frequently for 72 hours after thiamine was initiated. Individual case reports were independently reviewed by three pediatricians who assigned a TRD status (TRD or non-TRD), which served as the dependent variable in logistic regression models to identify predictors of TRD. Model performance was quantified by empirical area under the receiver operating characteristic curve. RESULTS: A total of 449 children (median [Q1, Q3] 2.9 [1.7, 5.7] months old; 70.3% exclusively/predominantly breastfed) were enrolled; 60.8% had a TRD. Among 52 candidate variables, those most predictive of TRD were exclusive/predominant breastfeeding, hoarse voice/loss of voice, cyanosis, no eye contact, and no diarrhea in the previous 2 weeks. The area under the receiver operating characteristic curve (95% CI) was 0.82 (0.78, 0.86). CONCLUSIONS: In this study, the majority of children with signs or symptoms of TDD responded favorably to thiamine. While five specific features were predictive of TRD, the high prevalence of TRD suggests that thiamine should be administered to all infants and children presenting with any signs or symptoms consistent with TDD in similar high-risk settings. The usefulness of the predictive model in other contexts warrants further exploration and refinement. TRIAL REGISTRATION: Clinicaltrials.gov NCT03626337.

Assuntos

Assuntos

RESUMO

A 19-month-old, white, Pennsylvanian boy, with an unremarkable medical history, presented to our hospital with a 3-week history of nonbloody, nonbilious emesis up to 5 times a day and nonbloody diarrhea. Ten days before admission, his gait became progressively unsteady, until he finally refused to walk. A day before admission, he found it difficult to move his eyes. The patient was hypoactive. History, physical and neurologic examination, blood and cerebrospinal (CSF) fluid studies, and neuroimaging studies ruled out the most frequent causes of acute ataxia. The etiology of bilateral, complete ophthalmoplegia was also taken into consideration. Magnetic resonance imaging (MRI) findings of bilateral thalami and mammillary bodies provided diagnostic clues. Additional history and specific tests established the final diagnosis and treatment plan. The patient improved to a normal neurologic state. This case provides important practical information about an unusual malnutrition cause of acute ataxia, particularly in young children of developing countries.

Assuntos

RESUMO

OBJECTIVES: To test the hypothesis that heavy metal toxicity and consumption of thiaminase-containing foods predispose to symptomatic thiamine deficiency. STUDY DESIGN: In a case-control study, thiamine diphosphate (TDP) blood concentrations were measured in 27 infants diagnosed with beriberi at a rural clinic, as well as their mothers and healthy Cambodian and American controls. Blood and urine levels of lead, arsenic, cadmium, mercury, and thallium were measured. Local food samples were analyzed for thiaminase activity. RESULTS: Mean TDP level among cases and Cambodian controls was 48 and 56 nmol/L, respectively (P = .08) and was 132 nmol/L in American controls (P < .0001 compared with both Cambodian groups). Mean TDP level of mothers of cases and Cambodian controls was 57 and 57 nmol/L (P = .92), and was 126 nmol/L in American mothers (P < .0001 compared with both Cambodian groups). Cases (but not controls) had lower blood TDP levels than their mothers (P = .02). Infant TDP level decreased with infant age and was positively associated with maternal TDP level. Specific diagnostic criteria for beriberi did not correlate with TDP level. There was no correlation between heavy metal levels and either TDP level or case/control status. No thiaminase activity was observed in food samples. CONCLUSIONS: Thiamine deficiency is endemic among infants and nursing mothers in rural southeastern Cambodia and is often clinically inapparent. Neither heavy metal toxicity nor consumption of thiaminase-containing foods account for thiamine deficiency in this region.

Assuntos

RESUMO

1. Vitamina B1 é essencial para o metabolismo dos hidratos de carbono. 2. O homem depende da ingestão de alimentos para suprir suas necessidades de tiamina. 3. Pequenas deficiências de vitamina B1 podem ser repostas através de alimentação adequada. 4. Grandes deficiências de tiamina ocorrem no alcoolismo e grandes déficits nutricionais.5. Carência crônica de tiamina pode levar a insuficiência cardíaco-congestiva.

Assuntos

RESUMO

Polioencephalomalacia (PEM) of ruminants is a complex disease. The term indicates a morphological diagnosis where severe cortical neuronal necrosis results in softening of cerebral grey matter. Initially though as a single disease caused by thiamine deficiency, it is currently believed that PEM is caused by different etiological agents through different pathogenic mechanisms or trough a single pathogenic mechanism triggered by different agents. In this paper the putative cases and pathogenesis of PEM in ruminants are critically reviewed and discussed. Also reviewed are the epidemiology, clinical signs, gross and histological findings and methods of diagnosis of cases of PEM described in ruminants in Brazil(AU)

Assuntos

RESUMO

Polioencephalomalacia (PEM) of ruminants is a complex disease. The term indicates a morphological diagnosis where severe cortical neuronal necrosis results in softening of cerebral grey matter. Initially though as a single disease caused by thiamine deficiency, it is currently believed that PEM is caused by different etiological agents through different pathogenic mechanisms or trough a single pathogenic mechanism triggered by different agents. In this paper the putative cases and pathogenesis of PEM in ruminants are critically reviewed and discussed. Also reviewed are the epidemiology, clinical signs, gross and histological findings and methods of diagnosis of cases of PEM described in ruminants in Brazil

Assuntos

RESUMO

BACKGROUND: The nonpharmacological management of heart failure (HF) has been understudied. The importance of micronutrients such as thiamine has long been known since its deficiency is associated with the development of high-output HF. OBJECTIVE: We studied the relationship between adding to ACE inhibition further aldosterone suppression with spironolactone and thiamine blood levels (pmol/ml). METHODS: A total of 22 patients (pts) with HF (NYHA III/IV) were divided in two groups [group I-spironolactone 25mg/qd (n=11) and group II - no spironolactone (n=11)]. Thiamine levels were determined using the erythrocyte transketolase activity. The groups were compared regarding food intake, demographics, furosemide doses and thiamine blood levels using Mann-Whitney and student's T-test. The proportions were analyzed with Chi-square and Kruskal-Wallis tests to associate thiamine with demographics and furosemide doses as dependent variables. RESULTS: Group I and II were similar regarding food intake, daily furosemide doses (110.9+/-30.2 and 105.5+/-26.9 mg, respectively; p>0.05), demographics (etiology, age, hypertension, diabetes, smoking, alcohol abuse, dyslipidemia and adjuvant drug HF treatment). Pts in group I showed significantly higher thiamine levels when compared to pts in group II (277.2+/-89.8 and 154.7+/-35.7, respectively) (p<0.001). None of the dependent variables cited above were associated with thiamine. CONCLUSION: In a cohort of ambulatory HF patients on high dose of loop diuretics, the use of spironolactone is associated with higher thiamine blood levels. The significance of this finding remains to be established by future studies with prospective design and larger sample sizes.

Assuntos

RESUMO

FUNDAMENTO: Estudos do manejo não-farmacológico da insuficiência cardíaca (IC) têm sido muito escassos. A importância de micronutrientes como tiamina há muito é conhecida, uma vez que sua deficiência está associada com o desenvolvimento de IC de alto débito. OBJETIVO: Nós estudamos a relação entre adicionar à inibição da ECA uma supressão adicional da aldosterona com espironolactona e níveis sangüíneos de tiamina (pmol/ml). MÉTODOS: Um total de 22 pacientes (pc) com IC (classes III/IV da NYHA) foi dividido em dois grupos [grupo I - espironolactona 25mg/dia (n=11) e grupo II - sem espironolactona (n=11)]. Determinamos os níveis de tiamina pelo uso da atividade da transcetolase eritrocitária. Os grupos foram comparados com relação à ingesta alimentar, demografia, doses de furosemida e níveis sangüíneos de tiamina, usando os testes de Mann-Whitney e t de Student. Analisamos as proporções com testes de qui-quadrado e de Kruskal-Wallis para associarmos a tiamina com fatores demográficos e usamos as doses de furosemida como variáveis dependentes. RESULTADOS: Os grupos I e II eram similares em relação à ingesta alimentar, doses diárias de furosemida (110,9±30,2 e 105,5±26,9 mg, respectivamente; p>0,05), demografia (etiologia, idade, hipertensão, diabete, tabagismo, abuso de álcool, dislipidemia e tratamento adjuvante da IC com drogas). Os pacientes do grupo I mostraram níveis de tiamina significativamente superiores, comparados com aqueles do grupo II (277,2±89,8 e 154,7±35,7, respectivamente) (p<0,001). Nenhuma das variáveis dependentes citadas acima estava associada com a tiamina. CONCLUSÃO: Em uma coorte de pacientes ambulatoriais com IC tratados com alta dose de diuréticos de alça, o uso de espironolactona está associado com níveis sangüíneos superiores de tiamina. A importância deste achado ainda deverá ser estabelecida por estudos futuros com desenho prospectivo e amostras maiores.

BACKGROUND: The nonpharmacological management of heart failure (HF) has been understudied. The importance of micronutrients such as thiamine has long been known since its deficiency is associated with the development of high-output HF. OBJECTIVE: We studied the relationship between adding to ACE inhibition further aldosterone suppression with spironolactone and thiamine blood levels (pmol/ml). METHODS: A total of 22 patients (pts) with HF (NYHA III/IV) were divided in two groups [group I-spironolactone 25mg/qd (n=11) and group II - no spironolactone (n=11)]. Thiamine levels were determined using the erythrocyte transketolase activity. The groups were compared regarding food intake, demographics, furosemide doses and thiamine blood levels using Mann-Whitney and student's T-test. The proportions were analyzed with Chi-square and Kruskal-Wallis tests to associate thiamine with demographics and furosemide doses as dependent variables. RESULTS: Group I and II were similar regarding food intake, daily furosemide doses (110.9±30.2 and 105.5±26.9 mg, respectively; p>0.05), demographics (etiology, age, hypertension, diabetes, smoking, alcohol abuse, dyslipidemia and adjuvant drug HF treatment). Pts in group I showed significantly higher thiamine levels when compared to pts in group II (277.2±89.8 and 154.7±35.7, respectively) (p<0.001). None of the dependent variables cited above were associated with thiamine. CONCLUSION: In a cohort of ambulatory HF patients on high dose of loop diuretics, the use of spironolactone is associated with higher thiamine blood levels. The significance of this finding remains to be established by future studies with prospective design and larger sample sizes.

Assuntos

RESUMO

BACKGROUND: Chronic administration of furosemide may induce thiamine deficiency and cause or aggravate myocardial dysfunction. METHODS AND RESULTS: Wistar rats were divided into four groups according to food and treatment: (1) thiamine standard chow with intraperitoneal furosemide administration; (2) thiamine standard chow with intraperitoneal saline administration; (3) thiamine-deficient chow with intraperitoneal furosemide administration; and (4) thiamine-deficient chow with intraperitoneal saline administration. Thiamine status was evaluated by high-performance liquid chromatography determination in plasma, erythrocytes, and myocardium, and by erythrocyte transketolase activity and the thiamine pyrophosphate effect to recover transketolase activity. Left ventricular mass index, intramyocardial arteries-to-cardiomyocyte ratio, cardiomyocyte cross-sectional area, and cardiomyocyte nuclei number were estimated. Myocardial structure was also studied by transmission electronic microscopy. Group 3 showed significantly lower blood and myocardial thiamine levels, which was not observed in group 1. Left ventricular mass index, cardiomyocyte cross-sectional area, and intramyocardial arteries-to-cardiomyocyte ratio were smaller in thiamine-deficient and furosemide-treated rats. However, no significant variation was found in the number of cardiomyocyte nuclei among the groups. Transmission electronic microscopy showed mitochondrial alterations in the thiamine-deficient groups. CONCLUSION: The present results indicate that furosemide administration is not the primary cause of thiamine deficiency in rats with adequate thiamine intake. Furosemide aggravates thiamine deficiency only in situations associated with insufficient thiamine intake, causing cardiac structural alterations, such as myocardial fiber hypotrophy, poor microvascularization, and mitochondrial degeneration.

Assuntos

RESUMO

Descrevem-se 7 surtos de polioencefalomalacia em caprinos e 3 surtos em ovinos no semi-árido nordestino. Foram afetados animais de diversas idades em diferentes épocas do ano. Em 5 surtos os animais eram suplementados com concentrados e em 5 consumiam somente pastagem. Em um dos surtos os ovinos estavam recebendo à vontade uma mistura múltipla contendo 1,3 por cento de flor de enxofre. Os sinais clínicos caracterizaram-se por cegueira, depressão, pressão da cabeça contra objetos, andar em círculos, ranger de dentes, incoordenação, paralisia espástica, ataxia, diminuição dos reflexos palpebral e pupilar, estrabismo lateral, nistagmo e pupilas dilatadas. De 9 animais tratados com tiamina e dexametasona, 7 se recuperaram e 2 morreram. O diagnóstico foi feito com base na recuperação após o tratamento e/ou a presença de alterações histológicas características. O curso clínico variou de 2 a 15 dias. Três animais foram necropsiados. Um animal apresentou herniação do cerebelo em direção ao Forame magno e amolecimento das circunvoluções cerebrais e, ao corte, coloração amarelada e cavitação da substância cinzenta do córtex. Outro animal apresentou somente herniação do cerebelo. No terceiro animal não foram observadas lesões macroscópicas. As alterações histológicas caracterizaram-se por necrose laminar do córtex cerebral e, em dois animais, por lesões de malácia no tálamo e colículo rostral. Desconhece-se a etiologia em 9 dos surtos estudados. Em outro se sugere que tenha sido causado por intoxicação por enxofre, contido principalmente na mistura múltipla constituída por com 1,3 por cento de flor de enxofre (96 por cento de enxofre) e 30 por cento de cama de galinha (0,39 por cento de enxofre).

Assuntos

RESUMO

Descrevem-se 7 surtos de polioencefalomalacia em caprinos e 3 surtos em ovinos no semi-árido nordestino. Foram afetados animais de diversas idades em diferentes épocas do ano. Em 5 surtos os animais eram suplementados com concentrados e em 5 consumiam somente pastagem. Em um dos surtos os ovinos estavam recebendo à vontade uma mistura múltipla contendo 1,3% de flor de enxofre. Os sinais clínicos caracterizaram-se por cegueira, depressão, pressão da cabeça contra objetos, andar em círculos, ranger de dentes, incoordenação, paralisia espástica, ataxia, diminuição dos reflexos palpebral e pupilar, estrabismo lateral, nistagmo e pupilas dilatadas. De 9 animais tratados com tiamina e dexametasona, 7 se recuperaram e 2 morreram. O diagnóstico foi feito com base na recuperação após o tratamento e/ou a presença de alterações histológicas características. O curso clínico variou de 2 a 15 dias. Três animais foram necropsiados. Um animal apresentou herniação do cerebelo em direção ao Forame magno e amolecimento das circunvoluções cerebrais e, ao corte, coloração amarelada e cavitação da substância cinzenta do córtex. Outro animal apresentou somente herniação do cerebelo. No terceiro animal não foram observadas lesões macroscópicas. As alterações histológicas caracterizaram-se por necrose laminar do córtex cerebral e, em dois animais, por lesões de malácia no tálamo e colículo rostral. Desconhece-se a etiologia em 9 dos surtos estudados. Em outro se sugere que tenha sido causado por intoxicação por enxofre, contido principalmente na mistura múltipla constituída por com 1,3% de flor de enxofre (96% de enxofre) e 30% de cama de galinha (0,39% de enxofre).(AU)

Seven outbreaks of polioencephalomalacia in goats and 3 in sheep are reported from the semiarid region of northeastern Brazil. Animals of different ages were affected in various seasons of the year. In 5 outbreaks the animals were supplemented with concentrate ration and in 5 others they were only grazing on pastures. In one outbreak sheep were supplemented with an energy-protein-mineral mixture containing 1.3% of sulfur flower. Clinical signs were characterized by blindness, depression, head pressing, circling, grinding of the teeth, incoordination, spastic paralysis, ataxia, depression of the palpebral and pupillary reflexes, lateral strabismus, nystagmus, and dilated pupils. Nine affected animals were treated with thiamine and dexamethasone; 7 of them recovered but 2 died. The diagnosis of the disease was based on the recovered animals after treatment and/or on the histologic lesions. The clinical course varied from 2 to 15 days. On three animals post-mortem examination was made. One had herniation of the cerebellum through the Foramen magnum and softening of the cerebral cortex. The cut surface of the cerebral cortex showed cavitation and yellowish discoloration. Another animal had only cerebellar herniation. In a third animal no gross lesions were observed. Histological changes in the 3 animals were laminar necrosis of the cerebral cortex, and in 2 malacia of the thalamus and the rostral colliculi was also observed. In 9 outbreaks the cause of the disease was not determined, but one was probably due to sulfur toxicosis caused by the high sulfur content of the energy-protein-mineral mixture containing 1.3% of sulfur flower (96% sulfur) and 30% chicken litter (0.39% sulfur).(AU)

Assuntos

RESUMO

Wernicke encephalopathy is considered a complication of dialytic therapy, but there are few reports of this complication. We report a 57 years old man a 45 years old woman, with grade IV renal failure, who after acute peritoneodialysis and chronic hemodialysis respectively, had a confusional syndrome that responded to the administration of thiamine. CT scans in both patients discarded abnormal blood collections or new cerebrovascular episodes. The man had two previous cerebrovascular episodes, a severe anemia that was corrected, angina and an episode of arrhythmia during the dialytic procedure previous to the confusional episode. The woman had an acute uremic syndrome and a concomitant urinary tract infection during the confusional episode. Wernicke encephalopathy must be suspected in patients in dialysis with confusional episodes

Assuntos

RESUMO

The unexpected autopsy finding of Wernicke encephalopathy in three children who died after prolonged enteral feeding prompted us to examine the incidence of thiamine deficiency in three high-risk pediatric populations. We also measured riboflavin and pyridoxine activity in the same groups. We used activated enzyme assays (erythrocyte transketolase, glutathione reductase, aspartate aminotransferase) to assess tissue stores of the dependent vitamin cofactors (thiamine (vitamin B1), riboflavin (vitamin B2), and pyridoxine (vitamin B6), respectively). Using our own reference ranges based on data from 80 healthy adults and children, we prospectively investigated the B vitamin status of three groups of children: (1) 27 patients who were fed solely by nasogastric tube for more than 6 months, (2) 80 children admitted to a pediatric intensive care unit for more than 2 weeks, and (3) 6 children receiving intensive chemotherapy. The upper limits for stimulated enzyme activity in control subjects were unaffected by age or gender (16% for transketolase, 63% for glutathione reductase, 123% for aspartate aminotransferase). Using these limits, 10 (12.5%) of 80 patients receiving intensive care and 4 of 6 patients receiving chemotherapy were thiamine deficient. Elevated levels returned to normal after thiamine supplementation. No patients were pyridoxine deficient, but 3 (3.8%) of the 80 patients receiving intensive care and 1 of the 6 patients receiving chemotherapy were also riboflavin deficient. We conclude that unrecognized thiamine deficiency is common in our pediatric intensive care and oncology groups. This potentially fatal but treatable disease can occur in malnourished patients of any age and is probably underdiagnosed among chronically ill children. Our findings may be applicable to other high-risk pediatric groups.

Assuntos

Assuntos

RESUMO

There is indirect evidence that Jamaican children with protein energy malnutrition and adult alcoholics with cirrhosis may be thiamine deficient because of sudden death of some malnourished children during rehabilitation and observation of a good clinical response to thiamine supplements by the alcoholic patients with cirrhosis. The aim of this study is to examine the thiamine status of severely malnourished children aged 6-24 months and in adult patients with alcoholic liver disease. Erythrocyte transketolase activity (ETLA) was determined in 25 children (14 boys, 11 girls) aged 7 weeks to 27 months, consecutively admitted to hospital for the treatment of severe protein energy malnutrition, before any vitamin supplementation and twice during rehabilitation. ETKA determinations were carried out upon 9 adult alcoholics with liver disease (8males, 1 female) aged 32 and 73 years, before and after thiamine supplementation, as well as 28 normal healthy control children attending child well-baby clinic and 22 normal healthy adult blood donors. In 36 percent of the malnourished children, the thiamine pyrophosphate stimulation effect (TPP-E) was greater than 15 percent (mean TPP-E percent 23.6ñ6.2 SD) with moderate thiamine deficiency in 4 and severe deficiency in 5. All survived. Of the 16 with normal thiamine status on admission, 5 died subsequently. In two of these, TPP-E percent of 21 and 103 was found in ante-mortem specimen. Specific clinical features were associated with biochemical thiamine deficiency in only one child. Of the 9 adult alcoholics, 3 were found to be thiamine deficient (mean TPP-E percent 20.6ñ7.3 SD), 1 marginally and 2 severely. Although all appeared to improve with thiamine therapy, responses were slow. Unlike the malnourished children the adults' clinical features appeared to validate the biochemical findings. It was concluded that (1) thiamine deficiency is present in 7 percent of control children, 14 percent control adults, 36 percent severely malnourished children and 33 percent adult alcoholics: this may represent a public health problem in Jamaica; (2) thiamine status improves with the standard therapeutic regime in most infants and adult alcoholics, but slow response was seen with pharmacological doses; (3) there are no specific features associated with the deficiency; and (4) in very sick children, a masked thiamine deficiency on admission may become overt on the standard therapeutic regimen (AU)

Assuntos

Assuntos

Assuntos

Assuntos

Assuntos