Presse Med
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Shoshin beriberi, a uncommon cause of hemodynamic instability (or cardiac shock) and acute heart failure may go undiagnosed in Western countries where prevalence is low. This severe heart condition due to thiamine deficiency is rapidly fatal unless specific therapy is given. The most frequent cause in France is chronic alcoholism. ⋯ Blood tests (red cell transacetolase activity, measurement of effect of pyrophosphatase, plasma and intraerythrocyte thiamine) confirm the diagnosis a posteriori. Clinical improvement is rapid after intravenous infusion of vitamin B1. The danger of fulminant beriberi heart failure in undernourished alcoholic patients emphasizes the need for regular prescription of vitamin B1.
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Mortality among bacteremic adults ranges between 14 and 35%, and there is no biological clue to identify such patients a priori. As C-reactive protein (CRP) blood level rises in children during bacteremia, we investigated its accuracy to identify bacteremic patients among febrile adults who were admitted to our hospital either for study or treatment. ⋯ According to our findings CRP determination can not be used alone or associated to identify patients with positive blood cultures among the febrile ones. CRP blood determination should not be considered before 24 hours from disease onset as this time is required for CRP to stabilize. Patients with CRP levels higher than 20 mg% on admission have a higher risk of dying during hospitalization.