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Mizuguchi Y, Mouri H, Jo T, Hashimoto Y, Matsui H, Fushimi K, Yasunaga H, Taniguchi T. Clinical Features and Outcomes of Shoshin Beriberi. Int Heart J 2024; 65:271-278. [PMID: 38479848 DOI: 10.1536/ihj.23-459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Shoshin beriberi is a fulminant form of wet beriberi, but there are no large-scale studies detailing the clinical features of this disease. We investigated the clinical features and outcomes of Shoshin beriberi using data from a nationwide database in Japan.Using the Diagnosis Procedure Combination database, we identified patients with Shoshin beriberi between July 2010 and March 2021. We retrospectively investigated the characteristics, comorbidities, treatment, and in-hospital mortality of patients with Shoshin beriberi. The chi-square test or Fisher's exact test was used for categorical variables, and the Mann-Whitney U-test was used for continuous variables.We identified 62 patients with Shoshin beriberi. The median (interquartile range) age was 63 (48-69) years. Furthermore, 54 patients were male (87%). The most common comorbidity was alcohol-related disorder (34%). The median (interquartile range) length of hospital and intensive care unit stays were 17 (range, 10-35) and 5 (range, 1-9) days, respectively. The proportion of patients who received venoarterial extracorporeal membrane oxygenation, intra-aortic balloon pump, continuous renal replacement therapy, and mechanical ventilation was 11, 5, 29, and 63%, respectively. Among the patients with Shoshin beriberi, 53% received 2 or more catecholamines or inotropes. The in-hospital mortality was 23%. Impaired consciousness at admission was significantly related to in-hospital death (P < 0.001).The present study is the first and largest to describe the clinical features of patients with Shoshin beriberi using a nationwide database. Impaired consciousness at admission was significantly associated with in-hospital death.
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Affiliation(s)
- Yoshiki Mizuguchi
- Department of Anesthesiology and Intensive Care Medicine, Kanazawa University
| | - Hideyuki Mouri
- Department of Anesthesiology and Intensive Care Medicine, Kanazawa University
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo
- Department of Respiratory Medicine, The University of Tokyo Hospital
| | - Yohei Hashimoto
- Save Sight Institute, The University of Sydney, South Block, Sydney Eye Hospital
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine and Dental Science
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Takumi Taniguchi
- Department of Anesthesiology and Intensive Care Medicine, Kanazawa University
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2
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Nisar S, Yousuf Wani I, Altaf U, Muzaffer U, Kareem O, Tanvir M, Ganie MA. Thiamine deficiency-related neuropathy: A reversible entity from an endemic area. Eur J Neurol 2024; 31:e16155. [PMID: 38018774 DOI: 10.1111/ene.16155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 10/09/2023] [Accepted: 10/31/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND AND PURPOSE Despite thiamine deficiency being a lesser-known entity in modern times, beriberi in various forms, including thiamine deficiency-related neuropathy, remains endemic in Kashmir due to the consumption of polished rice as a staple food. This observational study investigates cases of peripheral neuropathy of unknown etiology and their potential responsiveness to thiamine administration. METHODS This prospective study enrolled adult patients presenting to the emergency department with weakness consistent with thiamine deficiency-related neuropathy and conducted a therapeutic challenge with thiamine on 41 patients. Response to thiamine therapy was monitored based on subjective and objective improvements in weakness and power. Patients were divided into thiamine responders (n = 25) and nonresponders (n = 16) based on their response to thiamine therapy and nerve conduction studies. RESULTS Most of the baseline characteristics were similar between responders and nonresponders, except the responders exhibited lower thiamine levels and higher partial pressure of oxygen and lactate levels compared to nonresponders. All patients had a history of consuming polished rice and traditional salt tea. Although weakness in the lower limbs was present in both groups, nonresponders were more likely to exhibit weakness in all four limbs. Clinical improvement was observed within 24 h, but proximal muscle weakness persisted for an extended period of time. CONCLUSIONS Thiamine deficiency-related neuropathy presents with predominant lower limb weakness, exacerbated by vomiting, poor food intake, psychiatric illness, and pregnancy. Thiamine challenge should be followed by observation of clinical and biochemical response.
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Affiliation(s)
- Sobia Nisar
- Department of Medicine, Government Medical College and Associated SMHS Hospital Srinagar, Srinagar, India
| | | | - Umair Altaf
- Department of Medicine, Government Medical College and Associated SMHS Hospital Srinagar, Srinagar, India
| | - Umar Muzaffer
- Department of Medicine, Government Medical College and Associated SMHS Hospital Srinagar, Srinagar, India
| | - Ozaifa Kareem
- Department of Pharmaceutical Sciences, University of Kashmir, Srinagar, India
| | - Masood Tanvir
- Department of Medicine, Government Medical College, Srinagar, India
| | - Mohd Ashraf Ganie
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
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3
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Qiu F, Dai W, Huang T, Li M. Extracorporeal membrane oxygenation as a bridging therapy for patients with thiamine deficiency-induced pulmonary arterial hypertension. World J Emerg Med 2024; 15:147-149. [PMID: 38476526 PMCID: PMC10925530 DOI: 10.5847/wjem.j.1920-8642.2024.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/10/2023] [Indexed: 03/14/2024] Open
Affiliation(s)
- Fangfang Qiu
- Department of Intensive Care Unit, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, China
| | - Weixing Dai
- Department of Intensive Care Unit, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, China
| | - Tengyue Huang
- Department of Intensive Care Unit, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, China
| | - Min Li
- Department of Intensive Care Unit, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, China
- Department of Intensive Care Unit, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
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4
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Cordoba Torres IT, Fouda EA, Reinhardt ME, Souki FG. Perioperative Concerns in the Patient with History of Alcohol Use. Adv Anesth 2023; 41:163-178. [PMID: 38251616 DOI: 10.1016/j.aan.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Alcohol use is common in patients presenting for surgery and can result in significant physiologic changes and postoperative complications. Anesthesia providers must be aware of the potential risks associated with alcohol consumption and take steps to minimize them. Perioperative management includes assessing patients for alcohol use, providing alcohol cessation interventions, adjusting the anesthetic plan according to the patient's alcohol use history, providing appropriate pain management strategies, and closely monitoring patients during and after surgery for signs of alcohol withdrawal.
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Affiliation(s)
- Ivet T Cordoba Torres
- Department of Anesthesia, Jackson Memorial Hospital, University of Miami, 1611 Northwest 12th Avenue, DTC 318, Miami, FL, 33136, USA
| | - Eslam A Fouda
- Department of Anesthesia, Jackson Memorial Hospital, University of Miami, 1611 Northwest 12th Avenue, DTC 318, Miami, FL, 33136, USA
| | | | - Fouad G Souki
- Department of Anesthesia, Jackson Memorial Hospital, University of Miami, 1611 Northwest 12th Avenue, DTC 318, Miami, FL, 33136, USA.
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5
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Schostak T, Millan IS, Jani A, Johnson RJ. Thiamine deficiency: a commonly unrecognised but easily treatable condition. Postgrad Med J 2023; 99:844-848. [PMID: 37125640 PMCID: PMC10398819 DOI: 10.1136/pmj-2022-141972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/20/2022] [Indexed: 11/04/2022]
Abstract
Thiamine is present in many foods and is well recognised as an essential nutrient critical for energy metabolism. While thiamine deficiency is commonly recognised in alcoholism, it can present in many other settings where it is often not considered and goes unrecognised. One challenging aspect to diagnosis is that it may have varied metabolic, neurological and cardiac presentations. Here we present an overview of the disorder, focusing on the multiple causes and clinical presentations. Interestingly, thiamine deficiency is likely increasing in frequency, especially among wildlife, where it is linked with changing environments and climate change. Thiamine deficiency should be considered whenever neurological or cardiological disease of unknown aetiology presents, especially in any patient presenting with lactic acidosis.
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Affiliation(s)
- Tritia Schostak
- Division of Nephrology, Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Iňigo San Millan
- Division of Endocrinology, Department of Medicine, University of Colorado—Anschutz Medical Campus, Aurora, Colorado, USA
| | - Alkesh Jani
- Division of Nephrology, Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Richard Joseph Johnson
- Division of Nephrology, Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
- Division of Endocrinology, Department of Medicine, University of Colorado—Anschutz Medical Campus, Aurora, Colorado, USA
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Kshirsagar SJ, Kute S, Bhalerao PM. Anaesthesia and intensive care management of shoshin beriberi in perioperative period in young adult. Ann Card Anaesth 2023; 26:318-320. [PMID: 37470531 PMCID: PMC10451140 DOI: 10.4103/aca.aca_133_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/26/2022] [Accepted: 10/18/2022] [Indexed: 07/21/2023] Open
Abstract
Thiamine deficiency presents as dry and wet beriberi. Wet beriberi is a complication of the cardiovascular system. Acute form of wet beriberi known as Shoshin beriberi is an acute presentation of cardiogenic shock which is rapidly reversed with thiamine administration. Here we present successful management of intraoperative acute decompensated heart failure, probably due to thiamine deficiency.
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Affiliation(s)
- Sujit J. Kshirsagar
- Department of Anaesthesiology, B. J. Government Medical College, Pune, Maharashtra, India
| | - Shivaji Kute
- Department of Anaesthesiology, B. J. Government Medical College, Pune, Maharashtra, India
| | - Pradnya M. Bhalerao
- Department of Anaesthesiology, B. J. Government Medical College, Pune, Maharashtra, India
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Hung YH, Yu AL, Chen CK, Liao MT, Hsieh MY, Chen WJ. Pulmonary artery catheter usage in diagnosis of Shoshin beriberi presented with unexplained lactic acidosis. ESC Heart Fail 2023. [PMID: 37051632 PMCID: PMC10375197 DOI: 10.1002/ehf2.14374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/08/2023] [Accepted: 03/23/2023] [Indexed: 04/14/2023] Open
Abstract
Wet beriberi is a rare but fatal disease in modern society. The nonspecific clinical manifestations, including symptoms of heart failure and recalcitrant lactic acidosis, can prevent timely diagnosis. The use of a pulmonary artery catheter can promptly confirm a high cardiac output state and plays a crucial role in rapidly deteriorating cases. Appropriate treatment with intravenous administration of thiamine leads to dramatic recovery within hours. We present two cases of Shoshin beriberi, a fulminant variant of wet beriberi, diagnosed in 2016 and 2022 at our institute. The patients experienced haemodynamic collapse and refractory lactic acidosis, which were successfully diagnosed with the use of a pulmonary artery catheter and reversed by thiamine supplementation. We also reviewed 19 cases of wet beriberi reported between 2010 and 2022.
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Affiliation(s)
- Yi-Hsin Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - An-Li Yu
- Department of Internal Medicine, Division of Cardiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Kai Chen
- Department of Internal Medicine, Division of Cardiology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Min-Tsun Liao
- Department of Internal Medicine, Division of Cardiology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Mu-Yang Hsieh
- Department of Internal Medicine, Division of Cardiology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Wen-Jone Chen
- Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
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Ma T, Xu J, Xing W. Raise vigilance against refractory distributive shock due to severe wet beriberi. Am J Med Sci 2023; 365:396-400. [PMID: 36535540 DOI: 10.1016/j.amjms.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/05/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Differentiating the type and cause of shock is crucial for intensive care. The rapid aggravation of lactic acidosis in patients often indicates a severe impairment of oxygen uptake in tissues. Herein, we presented a rare case of refractory distributive shock with severe wet beriberi. A 40-year-old male was admitted to the emergency department (ED) with recurrent chest tightness and lower extremity edema. The condition of the patient continued to deteriorate after symptomatic treatments. After several turnovers, the medical history of the patient was requested again and finally obtained. Our emergency management team hypothesized that the thiamine-deficient diet caused an aerobic metabolism disorder in the patient. Overall, we aimed to alert clinicians to unusual causes of distributive shock and further discussed the application of thiamine supplementary therapy in critical care.
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Affiliation(s)
- Tianliang Ma
- Department of Intensive Care Medicine, Third Xiangya Hospital, Central South University, Changsha 410013, China; Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China; Hunan Engineering Research Center of Biomedical Metal and Ceramic Impants, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Jiaqi Xu
- Department of Intensive Care Medicine, Third Xiangya Hospital, Central South University, Changsha 410013, China; Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China; Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, China
| | - Wei Xing
- Department of Intensive Care Medicine, Third Xiangya Hospital, Central South University, Changsha 410013, China; Sepsis Translational Medicine Key Laboratory of Hunan Province, Central South University, Changsha, Hunan 410078, China.
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Vitamin B1 Deficiency and Perimyocarditis Fulminans: A Case Study of Shoshin Syndrome in a Woman Following an Unbalanced Dietary Pattern Followed by a Literature Review. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010205. [PMID: 36676154 PMCID: PMC9864204 DOI: 10.3390/life13010205] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/07/2023] [Accepted: 01/08/2023] [Indexed: 01/12/2023]
Abstract
(1) Background: vitamin B1 level depletion, known as a beriberi syndrome, can lead to severe cardiovascular complications, from which perimyocarditis fulminans is one of the most severe. (2) Methods: this is a retrospective case study that includes an adult patient with clinical presentations of acute heart failure (HF) symptoms following perimyocarditis on the grounds of thiamine deficiency. (3) Results: A 49-year-old woman presented with acute HF symptoms due to perimyocarditis. The patient suddenly developed refractory cardiogenic shock with metabolic acidosis requiring maximal medical management, including an intra-aortic balloon pump and extracorporeal membrane oxygenation. Due to additional peripheral polyneuropathy, beriberi disease was suspected after excluding other possible causes of the patient's condition. After administration of vitamin B1, clinical improvement in the patient's condition and the resolution of metabolic abnormalities were observed, which ultimately confirmed the diagnosis of Shoshin syndrome caused by the implementation of a gluten-free diet without indications for its adherence. (4) Conclusions: Fulminant beriberi disease, although considered rare, is a life-threatening condition and should always be included in the differential diagnosis of critically ill patients, notably those with malnutrition. An unbalanced diet can be detrimental and have severe consequences, i.e., perimyocarditis fulminans. However, treatment with thiamine can significantly improve the patient's cardiac function and restore hemodynamic and metabolic parameters.
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10
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Shetye B, Hamilton FR, Bays HE. Bariatric surgery, gastrointestinal hormones, and the microbiome: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. OBESITY PILLARS (ONLINE) 2022; 2:100015. [PMID: 37990718 PMCID: PMC10661999 DOI: 10.1016/j.obpill.2022.100015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 03/26/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians an overview of bariatric surgery (i.e., bariatric procedures that improve metabolic disease are often termed "metabolic and bariatric surgery"), gastrointestinal hormones, and the microbiome as they relate to patients with obesity. Methods The scientific information for this CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results This CPS includes the pros and cons of the most common types of bariatric procedures; the roles of gastrointestinal (GI) hormones in regulating hunger, digestion, and postabsorptive nutrient metabolism; and the microbiome's function and relationship with body weight. This CPS also describes patient screening for bariatric surgery, patient care after bariatric surgery, and treatment of potential nutrient deficiencies before and after bariatric surgery. Finally, this CPS explores the interactions between bariatric surgery, GI hormones, and the microbiome. Conclusions This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) regarding bariatric surgery, gastrointestinal hormones, and the microbiome is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity. Implementation of appropriate care before and after bariatric surgery, as well as an awareness of GI hormones and the microbiome, may improve the health of patients with obesity, especially patients with adverse fat mass and adiposopathic metabolic consequences.
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Affiliation(s)
- Bharti Shetye
- Diplomate American Board of Obesity Medicine, Medical Director, Dr. Abby's Weight Management Clinic, 6101 Webb Road, Suite 207, Tampa, FL, 33615, USA
| | - Franchell Richard Hamilton
- Diplomate American Board of Obesity Medicine, A Better Weigh Center, 8865 Davis Blvd Ste 100, Keller, TX, 76248, USA
| | - Harold Edward Bays
- Diplomate American Board of Obesity Medicine, Louisville Metabolic and Atherosclerosis Research Center, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville, KY, 40213, USA
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11
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Skok H, Jabour J, Betcher J. Wernicke Korsakoff syndrome in a teenage female as a complication of COVID‐19. J Am Coll Emerg Physicians Open 2022; 3:e12735. [PMID: 35505931 PMCID: PMC9051863 DOI: 10.1002/emp2.12735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/09/2022] [Accepted: 04/14/2022] [Indexed: 12/13/2022] Open
Abstract
Wernicke encephalitis (WE) is usually associated with alcohol use disorder and caused by a deficiency in thiamine. Classic findings include confusion, ataxia, and ophthalmoplegia. This case is a unique presentation of WE in a 14‐year‐old female related to prior coronavirus disease infection. She had persistent dysgeusia and developed thiamine deficiency. She presented with confusion, ataxia, and changes in speech. She had a prolonged hospitalization but was discharged to an inpatient rehab facility with persistent symptoms. It is prudent to include thiamine deficiency in the differential for patients with any symptoms of WE and a history of nutritional deficiency.
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Affiliation(s)
- Hannah Skok
- Department of Emergency Medicine Trinity Health West Michigan Muskegon Michigan USA
| | - Joseph Jabour
- Department of Emergency Medicine Henry Ford Health System Detroit Michigan USA
| | - Joseph Betcher
- Department of Emergency Medicine Trinity Health West Michigan Muskegon Michigan USA
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12
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Morton A. Letter to the Editor: Thiamine deficiency and bariatric surgery. Obstet Med 2022; 15:71. [PMID: 35444732 PMCID: PMC9014546 DOI: 10.1177/1753495x211063379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Adam Morton
- Obstetric Medicine, Mater Health, Australia,University of Queensland, Australia,Adam Morton, Obstetric Medicine, Mater Health,
Raymond Terrace, South Brisbane 4101, Australia.
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13
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Pawar RD, Balaji L, Grossestreuer AV, Thompson G, Holmberg MJ, Issa MS, Patel PV, Kronen R, Berg KM, Moskowitz A, Donnino MW. Thiamine Supplementation in Patients With Alcohol Use Disorder Presenting With Acute Critical Illness : A Nationwide Retrospective Observational Study. Ann Intern Med 2022; 175:191-197. [PMID: 34871057 PMCID: PMC9169677 DOI: 10.7326/m21-2103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Thiamine supplementation is recommended for patients with alcohol use disorder (AUD). The authors hypothesize that critically ill patients with AUD are commonly not given thiamine supplementation. OBJECTIVE To describe thiamine supplementation incidence in patients with AUD and various critical illnesses (alcohol withdrawal, septic shock, traumatic brain injury [TBI], and diabetic ketoacidosis [DKA]) in the United States. DESIGN Retrospective observational study. SETTING Cerner Health Facts database. PATIENTS Adult patients with a diagnosis of AUD who were admitted to the intensive care unit with alcohol withdrawal, septic shock, TBI, or DKA between 2010 and 2017. MEASUREMENTS Incidence and predicted probability of thiamine supplementation in alcohol withdrawal and other critical illnesses. RESULTS The study included 14 998 patients with AUD. Mean age was 52.2 years, 77% of participants were male, and in-hospital mortality was 9%. Overall, 7689 patients (51%) received thiamine supplementation. The incidence of thiamine supplementation was 59% for alcohol withdrawal, 26% for septic shock, 41% for TBI, and 24% for DKA. Most of those receiving thiamine (n = 3957 [52%]) received it within 12 hours of presentation in the emergency department. The predominant route of thiamine administration was enteral (n = 3119 [41%]). LIMITATION Specific dosing and duration were not completely captured. CONCLUSION Thiamine supplementation was not provided to almost half of all patients with AUD, raising a quality-of-care issue for this cohort. Supplementation was numerically less frequent in patients with septic shock, DKA, or TBI than in those with alcohol withdrawal. These data will be important for the design of quality improvement studies in critically ill patients with AUD. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Rahul D Pawar
- Division of Hospital Medicine, Department of Medicine, and Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts (R.D.P.)
| | - Lakshman Balaji
- Center for Resuscitation Science and Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (L.B., A.V.G., G.T., P.V.P.)
| | - Anne V Grossestreuer
- Center for Resuscitation Science and Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (L.B., A.V.G., G.T., P.V.P.)
| | - Garrett Thompson
- Center for Resuscitation Science and Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (L.B., A.V.G., G.T., P.V.P.)
| | - Mathias J Holmberg
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, and Department of Anesthesiology and Intensive Care, Randers Regional Hospital, Randers, Denmark (M.J.H.)
| | - Mahmoud S Issa
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts (M.S.I.)
| | - Parth V Patel
- Center for Resuscitation Science and Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (L.B., A.V.G., G.T., P.V.P.)
| | - Ryan Kronen
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (R.K.)
| | - Katherine M Berg
- Center for Resuscitation Science and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (K.M.B.)
| | - Ari Moskowitz
- Center for Resuscitation Science and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and Division of Critical Care Medicine, Montefiore Medical Center, Bronx, New York (A.M.)
| | - Michael W Donnino
- Center for Resuscitation Science, Department of Emergency Medicine, and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (M.W.D.)
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14
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Vitamin B1, eye and brain. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh210929019b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Vitamin B1 (aneurin, thiamine) is a water-soluble vitamin necessary for the
normal function of the nervous system, visual system and heart and is part
of important enzymes in the body. Thiamine enables the normal use of
glucose, other carbohydrates and proteins, and enables the supply of energy
to the organism. The main sources of thiamine are exogenous and small
amounts are synthesized by microorganisms of the human intestinal
microbiome. Vitamin B1 cannot accumulate in the body, so signs of
deficiency are quickly manifested. Hypovitaminosis B1 is seen in chronic
ethyl abuse, persistent vomiting (as in some pregnant women) or after
bariatric surgical procedures, but in a mild form it is present in the
general population. Normal daily needs for vitamin B1 depend on calorie
intake, and 0.4 mg should be ingested for every 1000 kcal.
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15
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Guarneri AM, Hoffman RP. Non-glycemic Adverse Effects of Insulin. Curr Diabetes Rev 2022; 18:e012821190877. [PMID: 33511950 DOI: 10.2174/1573399817666210129104420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 11/22/2022]
Abstract
Insulin is primarily considered for its glycemic effects in patients with diabetes. There are, however, non-glycemic adverse effects of insulin that may significantly impact patient health and interfere with glycemic control. Insulinogenic edema primarily occurs with rapid improvement in glycemic control either in patients with newly discovered diabetes or in patients with poorly-controlled diabetes. Insulin-induced sympathetic activation, vasodilation, changes in vascular permeability, and most importantly, sodium retention play significant etiologic roles in the development of edema. Clinically, it is usually self-limited, but significant complications can develop. Allergic reactions to all insulin preparations and various compounds used in insulin formulations with a wide range of severity have been reported. Frequently, changing the type of insulin or delivery method is sufficient, but more advanced treatments such as insulin desensitization and anti-IgE antibody treatment may be needed. Lipohypertrophy and lipoatrophy frequently develop with the overuse of injection sites. Lipohypertrophy can affect tissue insulin absorption and glycemic control.
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Affiliation(s)
- Alissa M Guarneri
- Department of Pediatrics Division of Endocrinology and Diabetes UPMC Children's Hospital of Pittsburgh University of Pittsburgh School of Medicine Pittsburgh, Pittsburgh, PA 15224, USA
| | - Robert P Hoffman
- Department of Pediatrics Division of Endocrinology Nationwide Children\'s Hospital The Ohio State University College of Medicine Columbus, OH 43205, USA
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16
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The Effect of a Single Dose of Thiamine on Oxygen Consumption in Patients Requiring Mechanical Ventilation for Acute Illness: A Phase II, Randomized, Double-Blind, Placebo-Controlled Trial. Crit Care Explor 2021; 3:e0579. [PMID: 34806022 PMCID: PMC8601368 DOI: 10.1097/cce.0000000000000579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Lower oxygen consumption is associated with worse survival in septic shock and in other forms of critical illness. No treatment that increases oxygen extraction, a key determinant of oxygen consumption, has been found. Thiamine is required for aerobic metabolism, and deficiency is common in the critically ill. OBJECTIVES We evaluated the effect of thiamine on oxygen consumption in patients requiring mechanical ventilation for an acute illness. DESIGN Phase II, randomized, double-blind, and placebo-controlled trial. SETTING AND PARTICIPANTS ICUs in a tertiary care hospital in the United States. Patients admitted to the ICU and requiring mechanical ventilation were screened for enrollment. INTERVENTIONS After enrollment, baseline measurement of oxygen consumption and baseline laboratories including lactate, central venous oxygen saturation, and pyruvate dehydrogenase, a single dose of 200 mg IV thiamine or placebo was administered. Oxygen consumption was then monitored for 6 additional hours and repeat laboratories were drawn at the end of the protocol. MAIN OUTCOMES AND MEASURES The primary outcome was the change in oxygen consumption. Analysis was done using linear regression with a first-order autoregressive variance-covariance structure to account for repeated measures within subjects. Secondary outcomes included change in lactate, central venous oxygen saturation, and pyruvate dehydrogenase quantity and activity. RESULTS Sixty-seven patients were enrolled. After excluding 11 patients due to inadequate quantity or quality of oxygen consumption data, 56 patients were included. There was no difference in change in oxygen consumption in the 6 hours after study drug. Results for secondary outcomes were similarly negative. In the prespecified subgroup of 18 thiamine deficient patients, there was a difference in the two oxygen consumption curves (p = 0.006), although no difference in median oxygen consumption or area under the curve. CONCLUSIONS AND RELEVANCE A single dose of IV thiamine did not alter oxygen consumption in patients requiring mechanical ventilation for acute illness.
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17
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Jahngir MU, Nabizadeh-Eraghi P. Use of Right Ventricular Assisted Device for Right Heart Failure in a Patient With Acute Respiratory Distress Syndrome. Cureus 2021; 13:e17671. [PMID: 34650850 PMCID: PMC8489537 DOI: 10.7759/cureus.17671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/05/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) is one of the common etiologies of acute right ventricular dysfunction (RVD) with or without right heart failure (RHF). We present a case of a 40-year-old patient who developed severe ARDS due to massive aspiration of gastric content, secondary to predisposing anatomy of his post-surgical upper gastrointestinal tract. He subsequently developed right ventricular failure. He was treated with a right ventricular mechanical device. Despite all heroic measures, the young patient lost the battle of his life.
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18
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Hurtado-Torres GF. Thiamin deficiency secondary to loop diuretics, an overlooked cause of multiorgan failure. Nutr Clin Pract 2021; 36:1086-1087. [PMID: 34468033 DOI: 10.1002/ncp.10767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Gilberto Fabian Hurtado-Torres
- Internal Medicine and Clinical Nutrition Department, Faculty of Medicine, Autonomous University of San Luis Potosi, San Luis Potosi, Mexico
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19
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Derespina KR, Kaushik S, Mahadeo K, McCabe M. Response to "Thiamin deficiency secondary to loop diuretics, an overlooked cause of multiorgan failure". Nutr Clin Pract 2021; 36:1088-1089. [PMID: 34462961 DOI: 10.1002/ncp.10766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kim R Derespina
- Pediatric Critical Care, Kravis Children's Hospital at Mount Sinai, Icahn School of Medicine, New York, New York, USA.,Children's Hospital at Montefiore, Bronx, New York, USA
| | - Shubhi Kaushik
- Pediatric Critical Care, Kravis Children's Hospital at Mount Sinai, Icahn School of Medicine, New York, New York, USA.,Children's Hospital at Montefiore, Bronx, New York, USA
| | - Kris Mahadeo
- Children's Hospital at Montefiore, Bronx, New York, USA.,University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Megan McCabe
- Children's Hospital at Montefiore, Bronx, New York, USA
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20
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Piechocka J, Gramza-Michałowska A, Szymandera-Buszka K. The Changes in Antioxidant Activity of Selected Flavonoids and Caffeine Depending on the Dosage and Form of Thiamine. Molecules 2021; 26:molecules26154702. [PMID: 34361853 PMCID: PMC8347205 DOI: 10.3390/molecules26154702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/24/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022] Open
Abstract
Phenolic compounds and thiamine may serve as therapies against oxidative stress-related neurodegenerative diseases. However, it is important to note that these components show high instability under changing conditions. The study’s aim was to determine the impact of the thiamine concentration (hydrochloride—TH and pyrophosphate—TP; in the range 0.02 to 20 mg/100 g on the indices of the chelating properties and reducing power, and free radicals scavenging indices of EGCG, EGC, ECG and caffeine added from 0.04 to 6.0 mg/100 g. Our research confirmed that higher concentrations of TH and TP can exhibit significant activity against the test antioxidant indices of all components. When above 5.0 mg/100 g of thiamine was used, the radical scavenging abilities of the compound decreased in the following order: EGCG > ECG > EGC > caffeine. The highest correlation was found for the concentration of thiamine pyrophosphate to 20.0 mg/100 g and EGCG. Knowledge of the impact of factors associated with the concentration of both EGCG, EGC, ECG or caffeine and thiamine on their activity could carry weight in regulating the quality supplemented foods, especially of nutrition support for people of all ages were oral, enteral tube feeding and parenteral nutrition).
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21
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Thota V, Paravathaneni M, Konduru S, Buragamadagu BC, Thota M, Lerman G. Treatment of Refractory Lactic Acidosis With Thiamine Administration in a Non-alcoholic Patient. Cureus 2021; 13:e16267. [PMID: 34373820 PMCID: PMC8346261 DOI: 10.7759/cureus.16267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/05/2022] Open
Abstract
Lactate, or lactic acid, is an end-product of anaerobic metabolism. The build-up of lactate in the body is commonly due to type A lactic acidosis, resulting from an inability to meet the body's oxygen delivery demands. When lactic acidosis persists, other causes need to be ruled out. Here, we describe the case of a 63-year-old female who initially presented with hypoglycemia and was found to have significant lactic acidosis. Her blood sugar levels improved with dextrose supplementation; however, lactic acidosis persisted despite fluid hydration and empiric antibiotics. After excluding other causes of lactic acidosis, she was started on intravenous thiamine due to suspicion of thiamine deficiency secondary to poor nutrition. Lactic acid levels improved drastically after starting thiamine supplementation. Thiamine is a water-soluble vitamin that plays an essential role as a cofactor in several biochemical reactions. Thiamine deficiency is a rare, underdiagnosed cause of type B lactic acidosis, with early diagnosis and intervention playing crucial roles in preventing severe cardiac and neurological impairment.
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Affiliation(s)
- Vihitha Thota
- Internal Medicine, Mercy Catholic Medical Center, Darby, USA
| | | | - Sudheer Konduru
- Internal Medicine, Mercy Catholic Medical Center, Darby, USA
| | | | - Manaswitha Thota
- Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Gabriel Lerman
- Critical Care, Mercy Catholic Medical Center, Darby, USA
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22
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The conundrum of Thiamine Responsive Acute Pulmonary Hypertension (TRAPH) syndrome in the Emergency Department. Am J Emerg Med 2021; 49:185-188. [PMID: 34126563 DOI: 10.1016/j.ajem.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/04/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Management of acute pulmonary hypertension in the Emergency Department(ED) can be challenging. The treatment is specialised, requires rapid identification and correction of the precipitating cause; failing which the patient enters a vortex of deterioration. We describe a lesser-known cause for the same, Thiamine responsive acute pulmonary hypertension (TRAPH) syndrome where timely appropriate treatment can result in dramatic improvement. METHODOLOGY Medical records with ICD code E51.12 (Wet Beriberi) from Mar 2018 to Mar 2020 were screened. The data regarding presenting symptoms, initial vitals, lab and radiological investigations, and treatment received were retrieved from patient files and the Hospital Informatics System, entered into an MS Excel sheet and compared. RESULTS The study includes eight cases, which we believe to be TRAPH syndrome. Majority were young adult males, ethanol users. All patients presented with acute shortness of breath with tachypnea and shock index more than 0.9. Gross right atrioventricular dilatation, tricuspid regurgitation and mild to moderate pulmonary arterial hypertension was identified in echocardiography. The initial blood gas revealed median pH 6.98 (IQR 6.81-7.09), Bicarbonate 3.4 meq/L (IQR 2.5-5) and lactate 172 mg/dL (IQR 132-200) which improved within 12-16 h of admission. Patients received median 400 mg IV Thiamine. The mean duration of ICU stay was 2.5 days and total hospital stay was 7 days. CONCLUSION Thiamine Responsive Acute Pulmonary Hypertension (TRAPH) Syndrome is an under-recognised entity which should be included in differentials for acute right ventricular dysfunction in the ED. Early diagnosis and rapid protocolised management of the same can cause quick recovery of patients.
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23
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Elagizi A, Lavie CJ, O’Keefe E, Marshall K, O’Keefe JH, Milani RV. An Update on Omega-3 Polyunsaturated Fatty Acids and Cardiovascular Health. Nutrients 2021; 13:nu13010204. [PMID: 33445534 PMCID: PMC7827286 DOI: 10.3390/nu13010204] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 12/19/2022] Open
Abstract
Interest in the potential cardiovascular (CV) benefits of omega-3 polyunsaturated fatty acids (Ω-3) began in the 1940s and was amplified by a subsequent landmark trial showing reduced CV disease (CVD) risk following acute myocardial infarction. Since that time, however, much controversy has circulated due to discordant results among several studies and even meta-analyses. Then, in 2018, three more large, randomized trials were released—these too with discordant findings regarding the overall benefits of Ω-3 therapy. Interestingly, the trial that used a higher dose (4 g/day highly purified eicosapentaenoic acid (EPA)) found a remarkable, statistically significant reduction in CVD events. It was proposed that insufficient Ω-3 dosing (<1 g/day EPA and docosahexaenoic acid (DHA)), as well as patients aggressively treated with multiple other effective medical therapies, may explain the conflicting results of Ω-3 therapy in controlled trials. We have thus reviewed the current evidence regarding Ω-3 and CV health, put forth potential reasoning for discrepant results in the literature, highlighted critical concepts such as measuring blood levels of Ω-3 with a dedicated Ω-3 index and addressed current recommendations as suggested by health care professional societies and recent significant scientific data.
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Affiliation(s)
- Andrew Elagizi
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA 70121, USA; (A.E.); (R.V.M.)
| | - Carl J. Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA 70121, USA; (A.E.); (R.V.M.)
- Correspondence: ; Tel.: +1-504-842-1281; Fax: +1-504-842-5875
| | - Evan O’Keefe
- Tulane Medical Center, New Orleans, LA 70112, USA;
| | - Keri Marshall
- Director Medical and Scientific Communications, Pharmavite LLC., West Hills, CA 91304, USA;
| | - James H. O’Keefe
- Saint Luke’s of Kansas City, Mid America Heart Institute, University of Missouri, Kansas City, MO 64111, USA;
| | - Richard V. Milani
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA 70121, USA; (A.E.); (R.V.M.)
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24
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Hayek A, Djabou M, Mewton N, Bonnefoy-Cudraz E, Bochaton T. Thiamine Deficiency as a Cause for Acute Circulatory Failure: An Overlooked Association in Western Countries. CJC Open 2020; 2:716-718. [PMID: 33305236 PMCID: PMC7710995 DOI: 10.1016/j.cjco.2020.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022] Open
Abstract
A 42 year-old patient presented with circulatory failure and lactic acidosis. Clinical features, later coupled with biological tests, led to the diagnosis of wet beriberi syndrome and scurvy. Echocardiography showed a pattern of thiamine deficiency with high cardiac output and low vascular resistance. The patient's condition and biological parameters immediately improved after treatment injections of thiamine. Wet BeriBeri is often overlooked in western countries and is a diagnosis that must be considered based on history, and clinical and echocardiographical findings.
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Affiliation(s)
- Ahmad Hayek
- Cardiac Intensive Care Unit, Louis Pradel Hospital, Bron, France
- Claude Bernard University Lyon 1, Lyon, France
- Corresponding author: Dr Ahmad Hayek, Hôpital cardiologique Louis Pradel, Unité d'urgence et soins intensifs cardiologiques, 28 avenue Doyen Lépine, 69677 Bron, France. Tel.: 0472357549.
| | - Mourad Djabou
- Cardiac Intensive Care Unit, Louis Pradel Hospital, Bron, France
- Claude Bernard University Lyon 1, Lyon, France
| | - Nathan Mewton
- Claude Bernard University Lyon 1, Lyon, France
- Investigation Clinical Center, Louis Pradel Hospital, Bron, France
| | - Eric Bonnefoy-Cudraz
- Cardiac Intensive Care Unit, Louis Pradel Hospital, Bron, France
- Claude Bernard University Lyon 1, Lyon, France
| | - Thomas Bochaton
- Cardiac Intensive Care Unit, Louis Pradel Hospital, Bron, France
- Claude Bernard University Lyon 1, Lyon, France
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25
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Thiamine-Responsive Acute Pulmonary Hypertension of Early Infancy (TRAPHEI)-A Case Series and Clinical Review. CHILDREN-BASEL 2020; 7:children7110199. [PMID: 33126440 PMCID: PMC7693669 DOI: 10.3390/children7110199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/30/2020] [Accepted: 10/16/2020] [Indexed: 11/17/2022]
Abstract
Persistent pulmonary hypertension of the newborn (PPHN) is a syndrome of high pulmonary vascular resistance (PVR) commonly seen all over the world in the immediate newborn period. Several case reports from India have recently described severe pulmonary hypertension among infants in the postneonatal period. These cases typically present with respiratory distress in 1–6-month-old infants, breastfed by mothers on a polished rice-based diet. Predisposing factors include respiratory tract infection such as acute laryngotracheobronchitis with change in voice, leading to pulmonary hypertension, right atrial and ventricular dilation, pulmonary edema and hepatomegaly. Mortality is high without specific therapy. Respiratory support, pulmonary vasodilator therapy, inotropes, diuretics and thiamine infusion have improved the outcome of these infants. This review outlines four typical patients with thiamine-responsive acute pulmonary hypertension of early infancy (TRAPHEI) due to thiamine deficiency and discusses pathophysiology, clinical features, diagnostic criteria and therapeutic options.
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26
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Nouira N, Mansouri R, Tlili R, Bhouri I, Sfaxi S, Chtourou D, cheikh MB. Relapse of rare diseases during COVID-19 pandemic: bicytopenia in an adult patient with thiamine-responsive megaloblastic anaemia. Pan Afr Med J 2020; 35:139. [PMID: 33193954 PMCID: PMC7608766 DOI: 10.11604/pamj.supp.2020.35.139.25368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 11/11/2022] Open
Abstract
Thiamine-responsive megaloblastic anaemia (TRMA) is a syndrome associated with megaloblastic anaemia, diabetes mellitus and sensorineural deafness, due to mutations in the SLC19A2gene, which codes for a thiamine carrier protein. Oral thiamine supplementation is the main treatment. We report the case of a 19-year-old man known for TRMA, who presented in the emergency department with bicytopenia (haemoglobin 5,4 g/dL, thrombocytes 38×109/L) revealed by dyspnea and chest pain. Investigations excluded bleeding, hemolysis, coagulopathy and iron deficiencies. A recent infection and an acute coronary syndrome have also been eliminated. We later found out that thiamine treatment had been discontinued three months before, due to general confinement in Tunisia during the COVID-19 pandemic. Parenteral administration of 100 mg of thiamine daily resulted in the recovery of haematopoiesis within three weeks.
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Affiliation(s)
- Nourelhouda Nouira
- Mongi Slim Academic Hospital, Emergency Department, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia,,Corresponding author: Nourelhouda Nouira, Mongi Slim Academic Hospital, Emergency Department, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
| | - Rawdha Mansouri
- Aziza Othmana Academic Hospital, Hematology Department, Tunisia
| | - Rami Tlili
- Cardiology Department, Mongi Slim Academic Hospital, Tunisia
| | - Ines Bhouri
- Mongi Slim Academic Hospital, Emergency Department, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Souha Sfaxi
- Mongi Slim Academic Hospital, Emergency Department, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Dorra Chtourou
- Mongi Slim Academic Hospital, Emergency Department, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Maamoun Ben cheikh
- Mongi Slim Academic Hospital, Emergency Department, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
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27
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Bloxham CJ, Foster SR, Thomas WG. A Bitter Taste in Your Heart. Front Physiol 2020; 11:431. [PMID: 32457649 PMCID: PMC7225360 DOI: 10.3389/fphys.2020.00431] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/08/2020] [Indexed: 12/11/2022] Open
Abstract
The human genome contains ∼29 bitter taste receptors (T2Rs), which are responsible for detecting thousands of bitter ligands, including toxic and aversive compounds. This sentinel function varies between individuals and is underpinned by naturally occurring T2R polymorphisms, which have also been associated with disease. Recent studies have reported the expression of T2Rs and their downstream signaling components within non-gustatory tissues, including the heart. Though the precise role of T2Rs in the heart remains unclear, evidence points toward a role in cardiac contractility and overall vascular tone. In this review, we summarize the extra-oral expression of T2Rs, focusing on evidence for expression in heart; we speculate on the range of potential ligands that may activate them; we define the possible signaling pathways they activate; and we argue that their discovery in heart predicts an, as yet, unappreciated cardiac physiology.
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Affiliation(s)
- Conor J Bloxham
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - Simon R Foster
- Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Walter G Thomas
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
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28
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Heming N, Salah A, Meng P, Sivanandamoorthy S, Bounab R, Chevret S, Annane D. Thiamine status and lactate concentration in sepsis: A prospective observational study. Medicine (Baltimore) 2020; 99:e18894. [PMID: 32049788 PMCID: PMC7035069 DOI: 10.1097/md.0000000000018894] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Thiamine is an essential co-factor for aerobic metabolism. Both thiamine deficiency and sepsis may be associated with hyperlactatemia and hypotension. We assessed the relationship between thiamine compounds, lactate concentrations and clinical outcomes in septic patients.We undertook a prospective observational single-center study. Erythrocyte levels of total thiamine, free thiamine, thiamine mono, di and triphosphate (TMP, TDP, and TTP respectively), the erythrocyte transketolase activity (ETKA) and the effect of thiamine diphosphate on ETKA were measured in septic patients by high performance liquid chromatography and correlated with arterial lactate. Vital status at the end of intensive care unit stay was recorded.Overall, 28 patients suffering from sepsis were included. Median (interquartile range [IQR]) age was 60 [44-77.3] years, 15 (53.6%) patients were male, median [IQR] simplified acute physiology score II was 40 [27-50]. There was no correlation between total thiamine and lactate levels (P = .33). There was no correlation between free thiamine (P = .81), TMP (P = .71), TDP (P = .31), TTP (P = .86), and lactate levels in our population. There was no correlation between ETKA (P = .58) or the effect of TDP on ETKA (P = .40) and lactate concentration. Total thiamine and TDP concentration were significantly higher in intensive care unit (ICU) survivors than in nonsurvivors (P = .03 and P = .03). The effect of TDP on ETKA was significantly higher in nonsurvivors compared to survivors (P = .04).We found no correlation between thiamine compounds and lactate concentration in sepsis. Thiamine deficiency in sepsis may be associated with ICU-mortality.
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Affiliation(s)
- Nicholas Heming
- General Intensive Care Unit, Raymond Poincaré Hospital, Garches, France and U1173 Lab Inflammation & Infection, University of Versailles SQY-Paris Saclay - INSERM, Montigny-Le-Bretonneux
| | - Amor Salah
- General Intensive Care Unit, Raymond Poincaré Hospital, Garches
| | - Paris Meng
- General Intensive Care Unit, Raymond Poincaré Hospital, Garches
| | | | - Rania Bounab
- General Intensive Care Unit, Raymond Poincaré Hospital, Garches
| | - Sylvie Chevret
- Biostatistical Unit, Saint Louis Hospital, Paris, France
| | - Djillali Annane
- General Intensive Care Unit, Raymond Poincaré Hospital, Garches, France and U1173 Lab Inflammation & Infection, University of Versailles SQY-Paris Saclay - INSERM, Montigny-Le-Bretonneux
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29
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Kotoulas SC, Manika K, Pilianidis G, Tsikouriadis P, Kalopitas G, Petridis N, Apsemidou A, Iakovos A, Kioumis I. A rare pulmonary pathology complicated with an unusual condition. Breathe (Sheff) 2019; 15:121-127. [PMID: 31191723 PMCID: PMC6544794 DOI: 10.1183/20734735.0117-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A 73-year-old male presented to the emergency department complaining about fatigue, night sweats, lack of appetite and weight loss for the past 2 months. His baseline weight was 47 kg and his height was 1.78 m (body mass index of 14.83 kg·m−2), while at presentation he weighed 39 kg. From his history, he underwent gastrectomy 31 years ago for stomach cancer. He was a smoker (55 pack-years), with no history of alcohol consumption or any other known pathological condition. Despite his gastrectomy, he did not suffer from symptoms suggesting reflux disease. 2 years ago, his daughter suffered from pulmonary tuberculosis, but he was not checked at that time with either a Mantoux test or chest radiograph. Physical examination revealed crackles in both lungs. His heart rate and blood pressure were normal. Because of his gastrectomy, he was on treatment with B12 and folic acid supplements and on presentation he did not reveal megaloblastic anaemia. From his laboratory examinations, his white blood cells were normal (9780 cells·μL−1 (68.4% neutrophils, 21.7% lymphocytes)) while his C-reactive protein was elevated (8.87 mg·dL−1). Despite his obviously impaired nutritional status his serum albumin was slightly above the lower normal level (3.67 g·dL−1). His chest computed tomography (CT) revealed infiltrations bilaterally, signs of incipient pulmonary fibrosis with thickened interlobular septa, centrilobular nodules and loss of volume of the left lower lobe (figure 1). His blood gas analysis revealed hypoxaemia; therefore, he was admitted to hospital and initiated intravenous antibiotic treatment with ampicillin/sulbactam plus azithromycin. Differential diagnosis should never be limited to the obvious diagnoseshttp://ow.ly/ybTM30obh6H
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Affiliation(s)
| | - Katerina Manika
- Medical School, Aristotle University of Thessaloniki, Pulmonary Dept, G. Papanikolaou Hospital, Thessaloniki, Greece
| | | | | | - Georgios Kalopitas
- Dept of Internal Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Nikolaos Petridis
- Dept of Internal Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | | | - Avramidis Iakovos
- Dept of Internal Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Ioannis Kioumis
- Medical School, Aristotle University of Thessaloniki, Pulmonary Dept, G. Papanikolaou Hospital, Thessaloniki, Greece
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30
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Hammoudi N, Lionnet F, Redheuil A, Montalescot G. Cardiovascular manifestations of sickle cell disease. Eur Heart J 2019; 41:1365-1373. [DOI: 10.1093/eurheartj/ehz217] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 03/04/2019] [Accepted: 03/27/2019] [Indexed: 02/06/2023] Open
Abstract
Abstract
Sickle cell disease (SCD) is the most frequent genetic haemoglobinopathy worldwide. Early childhood mortality has dramatically decreased in high-income countries, and most patients now survive beyond the 5th decade. However, in the aging SCD population, the morbidity related to chronic organ damage, especially kidney and heart, has become a major concern. While pulmonary hypertension has attracted most attention, it appears that this condition is frequently linked to left heart failure (HF). Accordingly, SCD-associated cardiomyopathy is emerging as a major cause of reduced quality of life and early mortality in these patients. The diagnosis of this particular phenotype of high-output HF is challenging. Exercise intolerance and dyspnoea in SCD patients are linked to multiple causes including chronic anaemia. Moreover, echocardiographic features are unusual and can be misinterpreted. The classical diagnosis algorithm for HF is generally not suitable in SCD patients, and HF is poorly recognized and mostly diagnosed at a late congestive stage in routine practice. Such patients need to be identified at an earlier stage of myocardial dysfunction via improved phenotyping. This constitutes the first step towards further investigations in SCD needed to improve the prognosis and the quality of life. This article provides an updated review of the recent advances in the pathophysiology and diagnosis, and in addition, perspectives of new therapeutic approaches in SCD-related cardiac manifestations.
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Affiliation(s)
- Nadjib Hammoudi
- Sorbonne Université, Inserm, Institute of Cardiometabolism and Nutrition (ICAN), ACTION Study Group and Department of Cardiology, Institute of Cardiology (AP-HP), Hôpital Pitié- Salpêtrière, Boulevard de l'hôpital, Paris F-75013, France
| | - François Lionnet
- Sorbonne Université, Department of Internal Medicine, centre de référence de la drépanocytose (AP-HP), Centre Hospitalier Universitaire Tenon, rue de la Chine, 75020 Paris, France
| | - Alban Redheuil
- Department of Cardiovascular Imaging, Interventional and Thoracic Radiology (DICVRIT), Hôpital Pitié- Salpêtrière, Boulevard de l'hôpital, Sorbonne Université, Inserm, CNRS 7371, Laboratoire d'Imagerie Biomédicale, Institute of Cardiometabolism and Nutrition (ICAN), Institute of Cardiology (AP-HP), Paris F-75013, France
| | - Gilles Montalescot
- Sorbonne Université, Inserm, Institute of Cardiometabolism and Nutrition (ICAN), ACTION Study Group and Department of Cardiology, Institute of Cardiology (AP-HP), Hôpital Pitié- Salpêtrière, Boulevard de l'hôpital, Paris F-75013, France
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Polegato BF, Pereira AG, Azevedo PS, Costa NA, Zornoff LAM, Paiva SAR, Minicucci MF. Role of Thiamin in Health and Disease. Nutr Clin Pract 2019; 34:558-564. [DOI: 10.1002/ncp.10234] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Bertha F. Polegato
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Amanda G. Pereira
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Paula S. Azevedo
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Nara A. Costa
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Leonardo A. M. Zornoff
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Sergio A. R. Paiva
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Marcos F. Minicucci
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
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Lei Y, Jiang Z, Chen J, Wang D, Hong G, Chen S. Type A aortic dissection in pregnant patients with fibrillin-1 gene mutations: Two case reports and a literature review. Exp Ther Med 2018; 16:4407-4414. [PMID: 30542390 PMCID: PMC6257332 DOI: 10.3892/etm.2018.6761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/20/2018] [Indexed: 01/03/2023] Open
Abstract
In acute aortic dissection (AD) in pregnancy, increased cardiovascular stress due to pregnancy is an important factor leading to an emergent aortic event. It is rare but often results in a devastating event for both the pregnant patient and the foetus. Two cases of acute AD (Stanford type A) in pregnant females are presented in the present study. The patients were diagnosed via echocardiography, and the diagnosis was confirmed with computed tomography angiography prior to aortic surgery. Up to 50% of ADs in pregnancy occur in patients with fibrillin-1 (FBN1) gene mutations. The FBN1 gene was sequenced in both patients, and notable, novel pathogenic mutations of FBN1 were identified in both patients. A literature review was also performed on available diagnostic imaging and other measurements regarding AD during pregnancy. The authors suggest that the relevant content may have important clinical implications in raising disease awareness, arranging test rationally and choosing an intervention method.
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Affiliation(s)
- Yuanli Lei
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Zhelong Jiang
- Department of Emergency Medicine, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, Zhejiang 310000, P.R. China
| | - Jiaozhen Chen
- Department of Electrocardiogram, Wenzhou People's Hospital, Wenzhou, Zhejiang 325000, P.R. China
| | - Dongsheng Wang
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Guangliang Hong
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Shouquan Chen
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
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