Infantile Thiamine Deficiency: New Insights into an Old Disease

Context: The wide spectrum of clinical presentation in infantile thiamine deficiency is difficult to recognize, and the diagnosis is frequentlymissed due to the lack of widespread awareness, and non-availability of costly and technically demanding investigations. Evidenceacquisition: The topic was searched by two independent researchers using online databases of Google scholar and PubMed. Weconsidered the related studies published in the last 20 years. The terms used for the search were ‘thiamine’, ‘thiamine deficiency’, ‘beri-beri’, ‘B-vitamins’,‘micronutrients’, ‘malnutrition’, ‘infant mortality’. ‘Wernicke’s syndrome’,‘Wernicke’s encephalopathy’, and ‘lacticacidosis’. Results: In the absence of specific diagnostic tests, a low threshold for a therapeutic thiamine challenge is currently the bestapproach to diagnose infantile thiamine deficiency in severe acute conditions. The practical approach is to consider thiamine injection asa complementary resuscitation tool in infants with severe acute conditions; more so in presence of underlying risk factors, clinicallyevident malnutrition or where a dextrose-based fluid is used for resuscitation. Further, as persistent subclinical thiamine deficiency duringinfancy can have long-term neuro-developmental effects, reasonable strategy is to treat pregnant women suspected of having thedeficiency, and to supplement thiamine in both mother and the baby during breastfeeding. Conclusions: Health care professionals in thecountry need to be sensitized to adopt a high level of clinical suspicion for thiamine deficiency and a low threshold for the administration ofthiamine, particularly when infantile thiamine deficiency is suspected.

Thiamine deficiency related peripheral neuropathy in peripartum women of Kashmir, India: a hospital based study

Background: Beri Beri is still seen in Asian countries due to the large-scale consumption of thiamine depleted polished rice. Thiamine deficiency related disorders are increasingly being reported from Kashmir from last two decades. Specifically, a sensorimotor axonal neuropathy occasionally develops from thiamine deficiency and may occur even without associated Wernicke’s encephalopathy.Methods: This study is a retrospective observational study. All peripartum females referred to our departments from January 2016 to December 2017 with complaints of generalized weakness and or sensory symptoms in form of paresthesias /numbness in limbs were enrolled. Clinical features, electrophysiological features, course in hospital and response to treatment in suspected thiamine deficiency related neuropathy patients were recorded.Results: Forty-three cases were included in the study. Twenty-nine patients were suspected to have nutritional neuropathy because of thiamine deficiency at the time of admission. Out of these 27 showed improvement on treatment with thiamine.Conclusions: Thiamine responsive neuropathy is common in peripartum women of this part of world. Diagnosis is usually made clinically, in at risk individuals presenting with characteristic clinical features.

An Interesting Case of Disappearing Murmur

Cardiovascular manifestations in a patient with congestive heart failure, which disappeared in short course of time, ignited the idea to think of unusuality from common rheumatic heart disease (RHD). Cardiac events that reversed within 2 days of admission in a chronic alcoholic, whose diagnosis puzzled us, are presented here. A retrospective conclusion of wet beri-beri is made, as all the haemodynamic sequelae vanished with thiamine replacement.

History of Physical Fitness and Sports Medicine in Japan / 体力科学

Kanehiro Takaki, the founder of The Jikei University School of Medicine suggested that a nutritional factor was important for preventing beri-beri, which was a common disease in the Meiji era in Japan and Southeast Asia. He improved the rations fed to crews of the Imperial Japanese Navy to include wheat and meat. The rations he devised effectively prevented beri-beri. Some 30 years later, vitamin B₁ was discovered, and a deficiency of vitamin B₁ was found to be the cause of beri-beri. Takaki believed that nutrition and exercise were important for keeping our bodies fit. He often gave lectures on how people could keep fit to prevent diseases. Thus, his activities are considered to be the beginning of preventive medicine in Japan. The contributions of Takaki to the physical fitness of the Japanese people have been continued by the graduates of The Jikei University School of Medicine. Some of the graduates became professors of The Jikei University School of Medicine and Tokyo University of Education (now, Tsukuba University). Thus, both universities have the common basis and tradition for research and education in the fields of physical fitness and sports medicine, and have collaborated with each other in these fields. In this article, we provide a brief overview of the history of the development of research regarding physical fitness and sports medicine in Japan. We discuss the contribution of various persons including our graduates, to the health and physical fitness of the Japanese people.