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

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

A loxoscelism case received therapeutic apheresis and hyperbaric oxygen therapy.

Loxosceles reclusa (L.reclusa) is known to bite humans, and its venom includes several enzymes that cause clinical symptoms. Loxoscelism, a condition due to being bitten by Loxosceles spiders, commonly known as recluses, can involve a range of clinical conditions, from local cutaneous lesions to severe systemic involvement. The diagnosis of loxoscelism is usually made by anamnesis and clinical findings. Magnetic resonance imaging is recommended for patients at high risk of necrotizing fasciitis. Treatment modalities are still controversial and there is no standardized treatment approach. Reported here, our case of loxoscelism involved a 24-year-old man presenting with a Loxosceles spider bite, dermonecrotic lesion, vomiting, diarrhea, acute renal injury, and rhabdomyolysis, who was successfully treated with hyperbaric oxygen therapy, therapeutic apheresis, hemodialysis, wound debridement, and cutaneous autografting. Early diagnosis and multidisciplinary approach can be life-saving in spider bites that can cause systemic involvement. Loxoscelism should be considered in patients with skin necrosis, acute renal injury, and rhabdomyolysis.

Mechanical evaluation of calcium-zirconium-silicate (baghdadite) obtained by a direct solid-state synthesis route.

Ca3ZrSi2O9 (baghdadite) has become a major research focus within the biomaterial community due to its remarkable in-vitro and in-vivo bioactivity. Although baghdadite seems to exhibit interesting biological properties, as yet there has been no data published concerning its mechanical properties. This lack of knowledge hinders targeting this novel bioactive material towards potential applications. In this study we prepare dense Ca3ZrSi2O9 bulk ceramics for the first time, allowing the evaluation of its mechanical properties including hardness, bending strength, Young׳s modulus, and fracture toughness. The preparation of baghdadite has been accomplished by a direct solid-state synthesis in combination with conventional sintering at 1350-1450°C for 3h. Our results show that samples sintered at 1400°C exhibit the best mechanical properties, resulting in a bending strength, fracture toughness, and hardness of 98±16MPa, 1.3±0.1MPam(0.5), and 7.9±0.2GPa. With a comparable mechanical strength to hydroxyapatite, but with an increased fracture toughness by 30% and hardness by 13% baghdadite is highly suitable for potential applications in non-load bearing areas (e.g. coatings or filler materials).