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Li P, Lv T, Xu L, Yu W, Lu Y, Li Y, Hao J. Risk factors for cardio-cerebrovascular events among patients undergoing continuous ambulatory peritoneal dialysis and their association with serum magnesium. Ren Fail 2024; 46:2355354. [PMID: 38785302 PMCID: PMC11132858 DOI: 10.1080/0886022x.2024.2355354] [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: 11/07/2023] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
Serum magnesium levels exceeding 0.9 mmol/L are associated with increased survival rates in patients with CKD. This retrospective study aimed to identify risk factors for cardio-cerebrovascular events among patients receiving continuous ambulatory peritoneal dialysis (CAPD) and to examine their correlations with serum magnesium levels. Sociodemographic data, clinical physiological and biochemical indexes, and cardio-cerebrovascular event data were collected from 189 patients undergoing CAPD. Risk factors associated with cardio-cerebrovascular events were identified by univariate binary logistic regression analysis. Correlations between the risk factors and serum magnesium levels were determined by correlation analysis. Univariate regression analysis identified age, C-reactive protein (CRP), red cell volume distribution width standard deviation, red cell volume distribution width corpuscular volume, serum albumin, serum potassium, serum sodium, serum chlorine, serum magnesium, and serum uric acid as risk factors for cardio-cerebrovascular events. Among them, serum magnesium ≤0.8 mmol/L had the highest odds ratio (3.996). Multivariate regression analysis revealed that serum magnesium was an independent risk factor, while serum UA (<440 μmol/L) was an independent protective factor for cardio-cerebrovascular events. The incidence of cardio-cerebrovascular events differed significantly among patients with different grades of serum magnesium (χ2 = 12.023, p = 0.002), with the highest incidence observed in patients with a serum magnesium concentration <0.8 mmol/L. High serum magnesium levels were correlated with high levels of serum albumin (r = 0.399, p < 0.001), serum potassium (r = 0.423, p < 0.001), and serum uric acid (r = 0.411, p < 0.001), and low levels of CRP (r = -0.279, p < 0.001). In conclusion, low serum magnesium may predict cardio-cerebrovascular events in patients receiving CAPD.
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Affiliation(s)
- Penglei Li
- Department of Medicine, Division of Nephrology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Department of Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Tiegang Lv
- Department of Medicine, Division of Nephrology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Department of Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Liping Xu
- Department of Medicine, Division of Nephrology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Department of Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Wenlu Yu
- Department of Medicine, Division of Nephrology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Department of Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Yuanyuan Lu
- Department of Medicine, Division of Nephrology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Department of Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Yuanyuan Li
- Department of Medicine, Division of Nephrology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Department of Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Jian Hao
- Department of Medicine, Division of Nephrology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Department of Medicine, Inner Mongolia Medical University, Hohhot, China
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Rioux AV, Nsimba-Batomene TR, Slimani S, Bergeron NAD, Gravel MAM, Schreiber SV, Fiola MJ, Haydock L, Garneau AP, Isenring P. Navigating the multifaceted intricacies of the Na +-Cl - cotransporter, a highly regulated key effector in the control of hydromineral homeostasis. Physiol Rev 2024; 104:1147-1204. [PMID: 38329422 DOI: 10.1152/physrev.00027.2023] [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: 07/20/2023] [Revised: 01/01/2024] [Accepted: 02/03/2024] [Indexed: 02/09/2024] Open
Abstract
The Na+-Cl- cotransporter (NCC; SLC12A3) is a highly regulated integral membrane protein that is known to exist as three splice variants in primates. Its primary role in the kidney is to mediate the cosymport of Na+ and Cl- across the apical membrane of the distal convoluted tubule. Through this role and the involvement of other ion transport systems, NCC allows the systemic circulation to reclaim a fraction of the ultrafiltered Na+, K+, Cl-, and Mg+ loads in exchange for Ca2+ and [Formula: see text]. The physiological relevance of the Na+-Cl- cotransport mechanism in humans is illustrated by several abnormalities that result from NCC inactivation through the administration of thiazides or in the setting of hereditary disorders. The purpose of the present review is to discuss the molecular mechanisms and overall roles of Na+-Cl- cotransport as the main topics of interest. On reading the narrative proposed, one will realize that the knowledge gained in regard to these themes will continue to progress unrelentingly no matter how refined it has now become.
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Affiliation(s)
- A V Rioux
- Department of Medicine, Nephrology Research Group, Laval University, Quebec City, Quebec, Canada
| | - T R Nsimba-Batomene
- Department of Medicine, Nephrology Research Group, Laval University, Quebec City, Quebec, Canada
| | - S Slimani
- Department of Medicine, Nephrology Research Group, Laval University, Quebec City, Quebec, Canada
| | - N A D Bergeron
- Department of Medicine, Nephrology Research Group, Laval University, Quebec City, Quebec, Canada
| | - M A M Gravel
- Department of Medicine, Nephrology Research Group, Laval University, Quebec City, Quebec, Canada
| | - S V Schreiber
- Department of Medicine, Nephrology Research Group, Laval University, Quebec City, Quebec, Canada
| | - M J Fiola
- Department of Medicine, Nephrology Research Group, Laval University, Quebec City, Quebec, Canada
| | - L Haydock
- Department of Medicine, Nephrology Research Group, Laval University, Quebec City, Quebec, Canada
- Service de Néphrologie-Transplantation Rénale Adultes, Hôpital Necker-Enfants Malades, AP-HP, INSERM U1151, Université Paris Cité, Paris, France
| | - A P Garneau
- Department of Medicine, Nephrology Research Group, Laval University, Quebec City, Quebec, Canada
- Service de Néphrologie-Transplantation Rénale Adultes, Hôpital Necker-Enfants Malades, AP-HP, INSERM U1151, Université Paris Cité, Paris, France
| | - P Isenring
- Department of Medicine, Nephrology Research Group, Laval University, Quebec City, Quebec, Canada
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Milanković V, Tasić T, Leskovac A, Petrović S, Mitić M, Lazarević-Pašti T, Novković M, Potkonjak N. Metals on the Menu-Analyzing the Presence, Importance, and Consequences. Foods 2024; 13:1890. [PMID: 38928831 PMCID: PMC11203375 DOI: 10.3390/foods13121890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/11/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Metals are integral components of the natural environment, and their presence in the food supply is inevitable and complex. While essential metals such as sodium, potassium, magnesium, calcium, iron, zinc, and copper are crucial for various physiological functions and must be consumed through the diet, others, like lead, mercury, and cadmium, are toxic even at low concentrations and pose serious health risks. This study comprehensively analyzes the presence, importance, and consequences of metals in the food chain. We explore the pathways through which metals enter the food supply, their distribution across different food types, and the associated health implications. By examining current regulatory standards for maximum allowable levels of various metals, we highlight the importance of ensuring food safety and protecting public health. Furthermore, this research underscores the need for continuous monitoring and management of metal content in food, especially as global agricultural and food production practices evolve. Our findings aim to inform dietary recommendations, food fortification strategies, and regulatory policies, ultimately contributing to safer and more nutritionally balanced diets.
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Affiliation(s)
- Vedran Milanković
- VINČA Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, Mike Petrovica Alasa 12-14, 11000 Belgrade, Serbia; (V.M.); (T.T.); (A.L.); (S.P.); (M.M.); (T.L.-P.)
| | - Tamara Tasić
- VINČA Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, Mike Petrovica Alasa 12-14, 11000 Belgrade, Serbia; (V.M.); (T.T.); (A.L.); (S.P.); (M.M.); (T.L.-P.)
| | - Andreja Leskovac
- VINČA Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, Mike Petrovica Alasa 12-14, 11000 Belgrade, Serbia; (V.M.); (T.T.); (A.L.); (S.P.); (M.M.); (T.L.-P.)
| | - Sandra Petrović
- VINČA Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, Mike Petrovica Alasa 12-14, 11000 Belgrade, Serbia; (V.M.); (T.T.); (A.L.); (S.P.); (M.M.); (T.L.-P.)
| | - Miloš Mitić
- VINČA Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, Mike Petrovica Alasa 12-14, 11000 Belgrade, Serbia; (V.M.); (T.T.); (A.L.); (S.P.); (M.M.); (T.L.-P.)
| | - Tamara Lazarević-Pašti
- VINČA Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, Mike Petrovica Alasa 12-14, 11000 Belgrade, Serbia; (V.M.); (T.T.); (A.L.); (S.P.); (M.M.); (T.L.-P.)
| | - Mirjana Novković
- Group for Muscle Cellular and Molecular Biology, Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Vojvode Stepe 444a, 11000 Belgrade, Serbia;
| | - Nebojša Potkonjak
- VINČA Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, Mike Petrovica Alasa 12-14, 11000 Belgrade, Serbia; (V.M.); (T.T.); (A.L.); (S.P.); (M.M.); (T.L.-P.)
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Agbasi JC, Ezugwu AL, Omeka ME, Ucheana IA, Aralu CC, Abugu HO, Egbueri JC. More about making profits or providing safe drinking water? A state-of-the-art review on sachet water contamination in Nigeria. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART C, TOXICOLOGY AND CARCINOGENESIS 2024:1-43. [PMID: 38439577 DOI: 10.1080/26896583.2024.2319009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Public health concerns on surface and groundwater contamination worldwide have increased. Sachet water contamination has also raised serious concerns across many developing countries. While previous studies attempted to address this issue, this review takes a different approach by utilizing a comprehensive analysis of physicochemical parameters, heavy metals, and microbial loads tested in sachet water across Nigeria's six geopolitical zones, within the period of 2020-2023. In this review study, over 50 articles were carefully analyzed. Collected data unveiled regional variations in the quality of sachet water across Nigeria. Noteworthy concerns revolve around levels of pH, total hardness, magnesium, calcium, nickel, iron, lead, mercury, arsenic, and cadmium. Fecal contamination was also identified as a significant issue, with the prevalence of several pathogens like Escherichia coli, Salmonella typhi, Enterobacter cloacae, Staphylococcus aureus, and Enterococcus faecalis. The manufacturing, delivery, storage, and final sale of sachet water, as well as poor environmental hygiene, were identified as potential contamination sources. The intake of contaminated sachet water exposes the citizens to waterborne and carcinogenic diseases. While the sachet water industry keeps growing and making profits, it is apparent that improvement calls made by previous studies, regarding the quality of water produced, have not been paid serious attention.
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Affiliation(s)
- Johnson C Agbasi
- Department of Geology, Chukwuemeka Odumegwu Ojukwu University, Uli, Anambra State, Nigeria
| | - Arinze Longinus Ezugwu
- Department of Pure and Industrial Chemistry, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Michael Ekuru Omeka
- Department of Geology, University of Calabar, P.M.B. 1115, Calabar, Cross River State, Nigeria
| | - Ifeanyi Adolphus Ucheana
- Department of Pure and Industrial Chemistry, University of Nigeria, Nsukka, Enugu State, Nigeria
- Central Science Laboratory, University of Nigeria, Nsukka, Enugu State, Nigeria
| | | | - Hillary Onyeka Abugu
- Department of Pure and Industrial Chemistry, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Johnbosco C Egbueri
- Department of Geology, Chukwuemeka Odumegwu Ojukwu University, Uli, Anambra State, Nigeria
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Lu YH, Jeon J, Mahajan L, Yan Y, Weichman KE, Ricci JA. Postoperative Magnesium Sulfate Repletion Decreases Narcotic Use in Abdominal-Based Free Flap Breast Reconstruction. J Reconstr Microsurg 2024. [PMID: 38272058 DOI: 10.1055/a-2253-9008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
BACKGROUND Microsurgical breast reconstruction after mastectomy is now the standard of care for breast cancer patients. However, the costs and resources involved in free flap reconstruction can vary across different medical settings. To enhance patient outcomes in a cost-effective manner, we investigated the effect of intravenous magnesium sulfate (IV Mg) on postoperative opioid usage in this context. METHODS A retrospective chart review was performed on all consecutive patients who underwent abdominal-based free flap breast reconstruction in a single institute following an enhanced recovery after surgery (ERAS) protocol. Patients who received IV Mg were compared with those who did not receive supplementation. Serum magnesium levels at different time points, narcotic consumption in units of oral morphine milligram equivalents (MMEs), and other postoperative recovery parameters were compared. RESULTS Eighty-two patients were included. Those who received IV Mg on postoperative day 0 (n = 67) showed significantly lower serum magnesium levels before repletion (1.5 vs. 1.7 mg/dL, p = 0.004) and significantly higher levels on postoperative day 1 after repletion (2.2 vs. 1.7 mg/dL, p = 0.0002) compared to patients who received no magnesium repletion (n = 13). While both groups required a similar amount of narcotics on postoperative day 0 (20.2 vs. 13.2 MMEs, p = 0.2), those who received IV Mg needed significantly fewer narcotics for pain control on postoperative day 1 (12.2 MMEs for IV Mg vs. 19.8 MMEs for No Mg, p = 0.03). Recovery parameters, including maximal pain scores, postoperative mobilization, and length of hospital stay, did not significantly differ between the two groups. CONCLUSION This is the first study to describe the potential analgesic benefits of routine postoperative magnesium repletion in abdominal-based free flap reconstruction. Further research is necessary to fully understand the role of perioperative magnesium supplementation as part of an ERAS protocol.
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Affiliation(s)
- Yi-Hsueh Lu
- Division of Plastic Surgery, Montefiore Medical Center, Bronx, New York
| | - Jini Jeon
- Division of Plastic Surgery, Albert Einstein College of Medicine, Bronx, New York
| | - Lakshmi Mahajan
- Division of Plastic Surgery, Albert Einstein College of Medicine, Bronx, New York
| | - Yufan Yan
- Division of Plastic Surgery, Montefiore Medical Center, Bronx, New York
| | - Katie E Weichman
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
| | - Joseph A Ricci
- Department of Plastic Surgery, Northwell Health, Hofstra School of Medicine, Great Neck, New York
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Menegazzo B, Regolisti G, Greco P, Maccari C, Lieti G, Delsante M, Fiaccadori E, Di Mario F. Sustained low-efficiency dialysis with regional citrate anticoagulation is a suitable therapeutic option for refractory hypermagnesemia in critically ill patients with AKI. J Nephrol 2024:10.1007/s40620-023-01837-z. [PMID: 38319546 DOI: 10.1007/s40620-023-01837-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/18/2023] [Indexed: 02/07/2024]
Affiliation(s)
- Brenda Menegazzo
- Unità Operativa di Nefrologia, Azienda Ospedaliero-Universitaria Parma and Dipartimento di Medicina E Chirurgia, Università̀ di Parma, Via Gramsci 14, 43100, Parma, Italy
- Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Giuseppe Regolisti
- Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
- UO Clinica e Immunologia Medica, Azienda Ospedaliero-Universitaria and, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Paolo Greco
- Unità Operativa di Nefrologia, Azienda Ospedaliero-Universitaria Parma and Dipartimento di Medicina E Chirurgia, Università̀ di Parma, Via Gramsci 14, 43100, Parma, Italy
- Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Caterina Maccari
- Unità Operativa di Nefrologia, Azienda Ospedaliero-Universitaria Parma and Dipartimento di Medicina E Chirurgia, Università̀ di Parma, Via Gramsci 14, 43100, Parma, Italy
- Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Giulia Lieti
- Scuola di Specializzazione in Nefrologia, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Marco Delsante
- Unità Operativa di Nefrologia, Azienda Ospedaliero-Universitaria Parma and Dipartimento di Medicina E Chirurgia, Università̀ di Parma, Via Gramsci 14, 43100, Parma, Italy
- Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Enrico Fiaccadori
- Unità Operativa di Nefrologia, Azienda Ospedaliero-Universitaria Parma and Dipartimento di Medicina E Chirurgia, Università̀ di Parma, Via Gramsci 14, 43100, Parma, Italy
- Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Francesca Di Mario
- Unità Operativa di Nefrologia, Azienda Ospedaliero-Universitaria Parma and Dipartimento di Medicina E Chirurgia, Università̀ di Parma, Via Gramsci 14, 43100, Parma, Italy.
- Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy.
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Kim O, Kim K, Park S, Yang H, Kim H, Ro W, Lee C. Clinical relevance of serum ionized magnesium concentration in dogs with myxomatous mitral valve disease. J Vet Intern Med 2024; 38:41-50. [PMID: 38064361 PMCID: PMC10800217 DOI: 10.1111/jvim.16963] [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: 11/03/2022] [Accepted: 11/17/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Hypomagnesemia is associated with a poor prognosis in humans with congestive heart failure (CHF), but studies in veterinary medicine are limited. HYPOTHESIS Serum ionized magnesium concentration [iMg2+ ] would decrease as CHF progresses compared with the initial diagnostic levels and that lower [iMg2+ ] would be negatively associated with prognosis in dogs with CHF. ANIMALS A total of 181 client-owned dogs with myxomatous mitral valve disease (MMVD) were included. They were classified into the preclinical stage (NO-CHF, n = 108), stage C (n = 42), and stage D (n = 31) based on the American College of Veterinary Internal Medicine MMVD classification. METHODS This is a retrospective study from 2 referral centers. The [iMg2+ ] was compared among the NO-CHF, stage C, and stage D groups. Kaplan-Meier curves and the log-rank test were used to compare the incidence of death between groups. Multivariable Cox regression analysis was used to estimate the association of hypomagnesemia with the death. RESULTS In the stage D group, the [iMg2+ ] was lower than that in the NO-CHF (P < .0001) and stage C groups (P < .003). In the Kaplan-Meier survival analysis, the 1-year cumulative survival rate in hypomagnesemic dogs was 53% compared with 91.5% in normomagnesemic dogs (log-rank test, P < .0001). In the multivariable Cox analysis, lower concentration of [K+ ] and [iMg2+ ], along with higher Evel , were associated with negative prognoses. Specifically, hypomagnesemia was associated with an approximately 4-fold increased risk of death (hazard ratio = 4.015; 95% confidence interval, 1.537-10.488; P = .005). CONCLUSIONS AND CLINICAL IMPORTANCE Assessing the [iMg2+ ] might serve as a potential marker for estimating the severity and prognosis indirectly in dogs with MMVD. Combining [iMg2+ ] measurement with other diagnostic methods, such as echocardiography, could improve the prognostic evaluation of MMVD in dogs.
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Affiliation(s)
- Ock‐Kyu Kim
- Department of Veterinary Medicine, College of Veterinary Medicine and BK21 FOUR ProgramChonnam National UniversityGwangjuRepublic of Korea
| | - Keon Kim
- Department of Veterinary Medicine, College of Veterinary Medicine and BK21 FOUR ProgramChonnam National UniversityGwangjuRepublic of Korea
| | - Sinwook Park
- Department of Veterinary Medicine, College of Veterinary Medicine and BK21 FOUR ProgramChonnam National UniversityGwangjuRepublic of Korea
| | - Hayoung Yang
- Noah Animal Medical CenterGwangjuRepublic of Korea
| | - Hyunwoo Kim
- Noah Animal Medical CenterGwangjuRepublic of Korea
| | - Woong‐Bin Ro
- Department of Veterinary Medicine, College of Veterinary Medicine and BK21 FOUR ProgramChonnam National UniversityGwangjuRepublic of Korea
| | - Chang‐Min Lee
- Department of Veterinary Medicine, College of Veterinary Medicine and BK21 FOUR ProgramChonnam National UniversityGwangjuRepublic of Korea
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Souza ACR, Vasconcelos AR, Dias DD, Komoni G, Name JJ. The Integral Role of Magnesium in Muscle Integrity and Aging: A Comprehensive Review. Nutrients 2023; 15:5127. [PMID: 38140385 PMCID: PMC10745813 DOI: 10.3390/nu15245127] [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: 11/01/2023] [Revised: 12/09/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
Aging is characterized by significant physiological changes, with the degree of decline varying significantly among individuals. The preservation of intrinsic capacity over the course of an individual's lifespan is fundamental for healthy aging. Locomotion, which entails the capacity for independent movement, is intricately connected with various dimensions of human life, including cognition, vitality, sensory perception, and psychological well-being. Notably, skeletal muscle functions as a pivotal nexus within this intricate framework. Any perturbation in its functionality can manifest as compromised physical performance and an elevated susceptibility to frailty. Magnesium is an essential mineral that plays a central role in approximately 800 biochemical reactions within the human body. Its distinctive physical and chemical attributes render it an indispensable stabilizing factor in the orchestration of diverse cellular reactions and organelle functions, thereby rendering it irreplaceable in processes directly impacting muscle health. This narrative review offers a comprehensive exploration of the pivotal role played by magnesium in maintaining skeletal muscle integrity, emphasizing the critical importance of maintaining optimal magnesium levels for promoting healthy aging.
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Affiliation(s)
| | | | | | | | - José João Name
- Kilyos Assessoria, Cursos e Palestras, São Paulo 01311-100, Brazil; (A.C.R.S.); (A.R.V.); (D.D.D.); (G.K.)
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Mamun GMS, Sarmin M, Alam A, Afroze F, Shahrin L, Shahid ASMSB, Shaima SN, Sultana N, Chisti MJ, Ahmed T. Prevalence and predictors of magnesium imbalance among critically ill diarrheal children and their outcome in a developing country. PLoS One 2023; 18:e0295824. [PMID: 38100423 PMCID: PMC10723721 DOI: 10.1371/journal.pone.0295824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
Despite having essential roles in maintaining human body physiology, magnesium has gained little attention. We sought to evaluate the prevalence and predictors of magnesium imbalance in diarrheal children admitted to an intensive care unit. This retrospective data analysis was conducted among children admitted between January 2019 and December 2019. Eligible children were categorized by serum magnesium levels that were extracted from the hospital database. Among 557 participants, 29 (5.2%) had hypomagnesemia, 344 (61.8%) had normomagnesemia and 184 (33.0%) had hypermagnesemia. By multivariable multinomial logistic regression, we have identified older children (adjusted multinomial odds ratio, mOR 1.01, 95% CI: 1.004-1.018, p = 0.002) as a predictor of hypomagnesemia. Conversely, younger children (adjusted mOR 0.99, 95% CI: 0.982-0.998, p = 0.02), shorter duration of fever (adjusted mOR 0.92, 95% CI: 0.857-0.996, p = 0.04), convulsion (adjusted mOR 1.55, 95% CI: 1.005-2.380, p = 0.047), dehydration (adjusted mOR 3.27, 95% CI: 2.100-5.087, p<0.001), pneumonia (adjusted mOR 2.65, 95% CI: 1.660-4.240, p<0.001) and acute kidney injury (adjusted mOR 2.70, 95% CI: 1.735-4.200, p<0.001) as the independent predictors of hypermagnesemia. The mortality was higher among children with hypermagnesemia (adjusted mOR 2.31, 95% CI: 1.26-4.25, p = 0.007). Prompt identification and management of the magnesium imbalance among critically ill diarrheal children might have survival benefits, especially in resource-limited settings.
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Affiliation(s)
- Gazi Md. Salahuddin Mamun
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Monira Sarmin
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Aklima Alam
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farzana Afroze
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lubaba Shahrin
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Shamsun Nahar Shaima
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nadia Sultana
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Chen JY, Jiang MY, Huang YT, Hwang JC. Lower product of magnesium × potassium is associated with higher mortality in chronic hemodialysis patients: a cohort study. Sci Rep 2023; 13:22128. [PMID: 38092856 PMCID: PMC10719325 DOI: 10.1038/s41598-023-49372-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023] Open
Abstract
This study aimed to investigate the Mg × K product on the mortality risk of hemodialysis patients with concomitant hypokalemia and lower magnesium levels. This was a prospective observational study of patients in a HD center in southern Taiwan. A total of 444 HD patients were divided into 5 groups by the Mg × K product: group 1, bottom quintile, median Mg × K: 7.87, IQR: 7.03-8.12 (n = 89, age: 64 ± 13 years old); group 2, median Mg × K: 9.37, IQR: 8.97-9.86 (n = 89, age:62 ± 13 years old); group 3, median Mg × K: 10.95, IQR: 10.50-11.26 (n = 89, age:64 ± 13 years old); group 4, median Mg × K: 12.30, IQR: 11.87-12.82 (n = 89, 61 ± 12 years old); and group 5, top quintile, median Mg × K: 14.92, IQR:14.07-16.23 (n = 88, 62 ± 11 years old). The patients were followed up for 2 years to determine the risk of all-cause mortality. Patients with a lower Mg × K product had more comorbidities, malnutrition-inflammation status, and a higher mortality risk. Using multivariable Cox regression analysis, a higher Mg × K [HR, 0.89; 95%CI (0.81-0.98)] was found to be an independent predictor of better survival. HD patients with a lower Mg × K product had more comorbidities, a marked malnutrition-inflammation status, and were associated with long-term mortality. A higher Mg × K value is a favorable survival factor.
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Affiliation(s)
- Jui-Yi Chen
- Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan City, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Ming-Yan Jiang
- Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan City, Taiwan
| | - Yun-Ting Huang
- Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan City, Taiwan
| | - Jyh-Chang Hwang
- Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan City, Taiwan.
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
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11
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Ab Rahim SN, Nordin N, Wan Omar WFA, Zulkarnain S, Kumar S, Sinha S, Haque M. The Laboratory and Clinical Perspectives of Magnesium Imbalance. Cureus 2023; 15:e49835. [PMID: 38045630 PMCID: PMC10693313 DOI: 10.7759/cureus.49835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2023] [Indexed: 12/05/2023] Open
Abstract
Magnesium (Mg2+) is a predominantly intracellular cation that plays significant roles in various enzymatic, membrane, and structural body functions. As a calcium (Ca2+) antagonist, it is imperative for numerous neuromuscular activities. The imbalance of body Mg2+ concentration leads to clinical manifestations ranging from asymptomatic to severe life-threatening complications. Therefore, the contribution of Mg2+ measurement regarding various laboratory and clinical aspects cannot be ignored. Mg2+ is often described as the forgotten analyte. However, its close relationship with body potassium (K+), Ca2+, and phosphate homeostasis proves that Mg2+ imbalance could co-exist as the root cause or the consequence of other electrolyte disorders. Meanwhile, several preanalytical, analytical, and postanalytical aspects could influence Mg2+ measurement. This review highlights Mg2+ measurement's laboratory and clinical issues and some analyte disturbances associated with its imbalance. Understanding this basis could aid clinicians and laboratory professionals in Mg2+ result interpretation and patient management.
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Affiliation(s)
- Siti Nadirah Ab Rahim
- Fakulti Perubatan and Kesihatan Pertahanan, Universiti Pertahanan Nasional Malaysia, Kuala Lumpur, MYS
| | - Nani Nordin
- Pathology, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, MYS
| | | | - Sarah Zulkarnain
- Pathology, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, MYS
| | - Santosh Kumar
- Periodontology and Implantology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Susmita Sinha
- Physiology, Khulna City Medical College and Hospital, Khulna, BGD
| | - Mainul Haque
- Research, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
- Pharmacology and Therapeutics, National Defence University of Malaysia, Kuala Lumpur, MYS
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12
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Hong X, Tian G, Zhu Y, Ren T. Exogeneous metal ions as therapeutic agents in cardiovascular disease and their delivery strategies. Regen Biomater 2023; 11:rbad103. [PMID: 38173776 PMCID: PMC10761210 DOI: 10.1093/rb/rbad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/26/2023] [Accepted: 11/11/2023] [Indexed: 01/05/2024] Open
Abstract
Metal ions participate in many metabolic processes in the human body, and their homeostasis is crucial for life. In cardiovascular diseases (CVDs), the equilibriums of metal ions are frequently interrupted, which are related to a variety of disturbances of physiological processes leading to abnormal cardiac functions. Exogenous supplement of metal ions has the potential to work as therapeutic strategies for the treatment of CVDs. Compared with other therapeutic drugs, metal ions possess broad availability, good stability and safety and diverse drug delivery strategies. The delivery strategies of metal ions are important to exert their therapeutic effects and reduce the potential toxic side effects for cardiovascular applications, which are also receiving increasing attention. Controllable local delivery strategies for metal ions based on various biomaterials are constantly being designed. In this review, we comprehensively summarized the positive roles of metal ions in the treatment of CVDs from three aspects: protecting cells from oxidative stress, inducing angiogenesis, and adjusting the functions of ion channels. In addition, we introduced the transferability of metal ions in vascular reconstruction and cardiac tissue repair, as well as the currently available engineered strategies for the precise delivery of metal ions, such as integrated with nanoparticles, hydrogels and scaffolds.
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Affiliation(s)
- Xiaoqian Hong
- Department of Cardiology of the Second Affiliated Hospital and State Key Laboratory of Transvascular Implantation Devices, Cardiovascular Key Laboratory of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Geer Tian
- Department of Cardiology of the Second Affiliated Hospital and State Key Laboratory of Transvascular Implantation Devices, Cardiovascular Key Laboratory of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310009, China
- Binjiang Institute of Zhejiang University, Hangzhou 310053, China
| | - Yang Zhu
- Binjiang Institute of Zhejiang University, Hangzhou 310053, China
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China
| | - Tanchen Ren
- Department of Cardiology of the Second Affiliated Hospital and State Key Laboratory of Transvascular Implantation Devices, Cardiovascular Key Laboratory of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310009, China
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13
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Wynne Z, Falat C. Disorders of Calcium and Magnesium. Emerg Med Clin North Am 2023; 41:833-848. [PMID: 37758427 DOI: 10.1016/j.emc.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
This review will discuss the importance and homeostasis of calcium and magnesium in the human body, as well as the implications and treatment of disordered calcium and magnesium. With calcium and magnesium often considered to be the "forgotten cations" in medicine, it is our hope that this review will lead providers to evaluate for and effectively manage these electrolyte disorders in the emergency department.
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Affiliation(s)
- Zachary Wynne
- Department of Emergency Medicine, University of Maryland Medical Center, 110 South Paca Street, 6th Floor Suite 200, Baltimore, MD 21201, USA
| | - Cheyenne Falat
- Department of Emergency Medicine, University of Maryland Medical Center, 110 South Paca Street, 6th Floor Suite 200, Baltimore, MD 21201, USA.
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14
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Saglietti F, Girombelli A, Marelli S, Vetrone F, Balzanelli MG, Tabaee Damavandi P. Role of Magnesium in the Intensive Care Unit and Immunomodulation: A Literature Review. Vaccines (Basel) 2023; 11:1122. [PMID: 37376511 DOI: 10.3390/vaccines11061122] [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: 05/15/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
Both the role and the importance of magnesium in clinical practice have grown considerably in recent years. Emerging evidence suggests an association between loss of magnesium homeostasis and increased mortality in the critical care setting. The underlying mechanism is still unclear, but an increasing number of in vivo and in vitro studies on magnesium's immunomodulating capabilities may shed some light on the matter. This review aims to discuss the evidence behind magnesium homeostasis in critically ill patients, and its link with intensive care unit mortality via a likely magnesium-induced dysregulation of the immune response. The underlying pathogenetic mechanisms, and their implications for clinical outcomes, are discussed. The available evidence strongly supports the crucial role of magnesium in immune system regulation and inflammatory response. The loss of magnesium homeostasis has been associated with an elevated risk of bacterial infections, exacerbated sepsis progression, and detrimental effects on the cardiac, respiratory, neurological, and renal systems, ultimately leading to increased mortality. However, magnesium supplementation has been shown to be beneficial in these conditions, highlighting the importance of maintaining adequate magnesium levels in the intensive care setting.
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Affiliation(s)
- Francesco Saglietti
- Santa Croce and Carle Hospital, Department of Emergency and Critical Care, 12100 Cuneo, Italy
| | - Alessandro Girombelli
- Division of Anesthesiology, Department of Anesthesiology, Intensive care and Emergency Medicine, Ospedale Regionale di Lugano, 69000 Lugano, Switzerland
| | - Stefano Marelli
- Department of Medicine and Surgery, University of Milan-Bicocca, 20900 Monza, Italy
| | - Francesco Vetrone
- Department of Medicine and Surgery, University of Milan-Bicocca, 20900 Monza, Italy
| | - Mario G Balzanelli
- Department of Prehospital Emergency Medicine, ASL TA, Italian Society of Prehospital Emergency Medicine (SIS 118), 74121 Taranto, Italy
| | - Payam Tabaee Damavandi
- Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori, School of Medicine and Surgery, Milan Center for Neuroscience, University of Milano-Bicocca, 20900 Monza, Italy
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15
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Parisse S, Gianoncelli A, Isani G, Gambaro FL, Andreani G, Malucelli E, Aquilanti G, Carlomagno I, Carletti R, Mischitelli M, Ferri F, Paterna V, Lai Q, Mennini G, Melandro F, Di Gioia C, Rossi M, Iotti S, Fratini M, Ginanni Corradini S. Severity of Hepatocyte Damage and Prognosis in Cirrhotic Patients Correlate with Hepatocyte Magnesium Depletion. Nutrients 2023; 15:nu15112626. [PMID: 37299589 DOI: 10.3390/nu15112626] [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: 05/11/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
We aimed to evaluate the magnesium content in human cirrhotic liver and its correlation with serum AST levels, expression of hepatocellular injury, and MELDNa prognostic score. In liver biopsies obtained at liver transplantation, we measured the magnesium content in liver tissue in 27 cirrhotic patients (CIRs) and 16 deceased donors with healthy liver (CTRLs) by atomic absorption spectrometry and within hepatocytes of 15 CIRs using synchrotron-based X-ray fluorescence microscopy. In 31 CIRs and 10 CTRLs, we evaluated the immunohistochemical expression in hepatocytes of the transient receptor potential melastatin 7 (TRPM7), a magnesium influx chanzyme also involved in inflammation. CIRs showed a lower hepatic magnesium content (117.2 (IQR 110.5-132.9) vs. 162.8 (IQR 155.9-169.8) μg/g; p < 0.001) and a higher percentage of TRPM7 positive hepatocytes (53.0 (IQR 36.8-62.0) vs. 20.7 (10.7-32.8)%; p < 0.001) than CTRLs. In CIRs, MELDNa and serum AST at transplant correlated: (a) inversely with the magnesium content both in liver tissue and hepatocytes; and (b) directly with the percentage of hepatocytes stained intensely for TRPM7. The latter also directly correlated with the worsening of MELDNa at transplant compared to waitlisting. Magnesium depletion and overexpression of its influx chanzyme TRPM7 in hepatocytes are associated with severity of hepatocyte injury and prognosis in cirrhosis. These data represent the pathophysiological basis for a possible beneficial effect of magnesium supplementation in cirrhotic patients.
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Affiliation(s)
- Simona Parisse
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Viale dell'Università 37, 00185 Rome, Italy
| | - Alessandra Gianoncelli
- Elettra-Sincrotrone Trieste, Strada Statale 14 km 163,5 in AREA Science Park, Basovizza, 34149 Trieste, Italy
| | - Gloria Isani
- Department of Veterinary Medical Sciences, Alma Mater Studiorum-University of Bologna, Via Tolara di Sopra 50, 50055-Ozzano dell'Emilia, 40064 Bologna, Italy
| | - Francesco Luigi Gambaro
- Department of Radiological Sciences, Oncology and Pathological Anatomy, "Sapienza" University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Giulia Andreani
- Department of Veterinary Medical Sciences, Alma Mater Studiorum-University of Bologna, Via Tolara di Sopra 50, 50055-Ozzano dell'Emilia, 40064 Bologna, Italy
| | - Emil Malucelli
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy
| | - Giuliana Aquilanti
- Elettra-Sincrotrone Trieste, Strada Statale 14 km 163,5 in AREA Science Park, Basovizza, 34149 Trieste, Italy
| | - Ilaria Carlomagno
- Elettra-Sincrotrone Trieste, Strada Statale 14 km 163,5 in AREA Science Park, Basovizza, 34149 Trieste, Italy
| | - Raffaella Carletti
- Department of Radiological Sciences, Oncology and Pathological Anatomy, "Sapienza" University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Monica Mischitelli
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Viale dell'Università 37, 00185 Rome, Italy
| | - Flaminia Ferri
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Viale dell'Università 37, 00185 Rome, Italy
| | - Veronica Paterna
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Viale dell'Università 37, 00185 Rome, Italy
| | - Quirino Lai
- General Surgery and Organ Transplantation Unit, "Sapienza" University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Gianluca Mennini
- General Surgery and Organ Transplantation Unit, "Sapienza" University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Fabio Melandro
- General Surgery and Organ Transplantation Unit, "Sapienza" University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Cira Di Gioia
- Department of Radiological Sciences, Oncology and Pathological Anatomy, "Sapienza" University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Massimo Rossi
- General Surgery and Organ Transplantation Unit, "Sapienza" University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Stefano Iotti
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy
- National Institute of Biostructures and Biosystems, Via delle Medaglie d'oro, 305, 00136 Rome, Italy
| | - Michela Fratini
- CNR-Institute of Nanotechnology c/o Physics Department, Sapienza University of Rome, Piazzale Aldo Moro 7, 00185 Rome, Italy
- Laboratory of Neurophysics and Neuroimaging (NaN), IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Stefano Ginanni Corradini
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Viale dell'Università 37, 00185 Rome, Italy
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16
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Karakousis ND, Pyrgioti EE, Georgakopoulos PN, Apergi K, Papanas N. Magnesium and Diabetic Foot Ulcers: A Mini Review. INT J LOW EXTR WOUND 2023:15347346231176117. [PMID: 37229664 DOI: 10.1177/15347346231176117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
There is accumulating evidence that magnesium, an important mineral having a pivotal role in many physiological functions, may be important in development and healing of diabetic foot ulcers (DFUs). In this non-systematic mini review, we discuss the role of magnesium in DFUs, as well as the effects of magnesium administration in DFUs. Reduced Mg levels appear to be associated with DFUs. Moreover, Mg administration may be beneficial for the outcome of DFUs. Further investigation is imperative in order to shed more light on these findings.
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Affiliation(s)
- Nikolaos D Karakousis
- Second Department of Internal Medicine, Diabetes Centre-Diabetic Foot Clinic, Democritus University of Thrace, Alexandroupolis, Greece
| | | | | | - Kyriaki Apergi
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Papanas
- Second Department of Internal Medicine, Diabetes Centre-Diabetic Foot Clinic, Democritus University of Thrace, Alexandroupolis, Greece
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17
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Cheung B, Sikand G, Dineen EH, Malik S, Barseghian El-Farra A. Lipid-Lowering Nutraceuticals for an Integrative Approach to Dyslipidemia. J Clin Med 2023; 12:jcm12103414. [PMID: 37240523 DOI: 10.3390/jcm12103414] [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: 12/31/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 05/28/2023] Open
Abstract
Dyslipidemia is a treatable risk factor for atherosclerotic cardiovascular disease that can be addressed through lifestyle changes and/or lipid-lowering therapies. Adherence to statins can be a clinical challenge in some patients due to statin-associated muscle symptoms and other side effects. There is a growing interest in integrative cardiology and nutraceuticals in the management of dyslipidemia, as some patients desire or are actively seeking a more natural approach. These agents have been used in patients with and without established atherosclerotic cardiovascular disease. We provide an updated review of the evidence on many new and emerging nutraceuticals. We describe the mechanism of action, lipid-lowering effects, and side effects of many nutraceuticals, including red yeast rice, bergamot and others.
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Affiliation(s)
- Brian Cheung
- Susan Samueli Integrative Health Institute, 856 Health Sciences Road, Irvine, CA 92617, USA
- Division of Cardiology, University of California, Irvine, CA 92521, USA
| | - Geeta Sikand
- Division of Cardiology, University of California, Irvine, CA 92521, USA
| | - Elizabeth H Dineen
- Susan Samueli Integrative Health Institute, 856 Health Sciences Road, Irvine, CA 92617, USA
- Division of Cardiology, University of California, Irvine, CA 92521, USA
| | - Shaista Malik
- Susan Samueli Integrative Health Institute, 856 Health Sciences Road, Irvine, CA 92617, USA
- Division of Cardiology, University of California, Irvine, CA 92521, USA
| | - Ailin Barseghian El-Farra
- Susan Samueli Integrative Health Institute, 856 Health Sciences Road, Irvine, CA 92617, USA
- Division of Cardiology, University of California, Irvine, CA 92521, USA
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18
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Hypomagnesemia as a Risk Factor and Accelerator for Vascular Aging in Diabetes Mellitus and Chronic Kidney Disease. Metabolites 2023; 13:metabo13020306. [PMID: 36837924 PMCID: PMC9959098 DOI: 10.3390/metabo13020306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023] Open
Abstract
The age-old axiom that one is as old as his or her vessels are, calls for ongoing critical re-examination of modifiable risk factors of accelerated vascular ageing in chronic kidney diseases. Attempts to modulate vascular risk with cholesterol-lowering agents have largely failed in advanced chronic kidney disease (CKD). In addition to nitrogen waste products, many pathological biochemical processes also play a role in vascular calcification in chronic kidney damage. Magnesium, a cation vital for the body, may substantially reduce cardiovascular diseases' risk and progression. This narrative review aimed to address the relationship between hypomagnesemia and vascular calcification, which promotes further cardiovascular complications in diabetes, aging, and CKD. Articles with predefined keywords were searched for in the PubMed and Google Scholar databases with specific inclusion and exclusion criteria. We hypothesized that a decrease in serum magnesium levels contributes to increased vascular calcification and thereby increases cardiovascular mortality. In summary, based on existing evidence in the literature, it appears that simple and inexpensive oral magnesium supplementation may reduce the cardiovascular mortality of patients who are already severely affected by such diseases; in this context, the concept of 'normal' vs. 'ideal' serum magnesium levels should be carefully re-examined.
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19
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To evaluate the relationship between serum magnesium and parathyroid hormone levels in peritoneal dialysis and hemodialysis patients. Int Urol Nephrol 2022; 55:1321-1327. [PMID: 36526918 DOI: 10.1007/s11255-022-03445-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
OBJECTS This study aimed to determine the relationship between magnesium and PTH levels in peritoneal dialysis (PD) and hemodialysis (HD) patients. METHODS This cross-sectional study was performed on HD and PD patients in Kerman, Iran. After recording demographic and clinical data, the pre-dialysis levels of hemoglobin, 25-hydroxy vitamin D, ferritin, creatinine, calcium, phosphorus, albumin, PTH, and magnesium were measured for all patients. The P value of less than 0.05 was considered statistically significant. RESULTS Magnesium levels in PD patients were significantly higher than in HD patients (P < 0.001). The median PTH level in PD patients was significantly lower than in HD patients (P = 0.046). The correlation between PTH and serum magnesium levels was not significant in PD or HD patients. In the regression model, dialysis modality (PD or HD) was the only significant variable in determining serum magnesium levels (P = 0.005). CONCLUSION Magnesium is a neglected ion in peritoneal dialysis and hemodialysis patients. In dialysis centers that use a dialysate with standard magnesium concentration (0.5 mmol/L in HD and 0.75 mmol/L in PD), special attention is necessary to hypomagnesia and its complications because magnesium levels in PD patients were significantly higher than in HD patients. As the correlation between magnesium and PTH levels in both PD and HD patients were not significant, the association of high magnesium levels with low PTH in PD patients should be considered in terms of increasing the potential for adynamic bone disease. It seems that ordering serum magnesium in the routine tests of dialysis patients is necessary.
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20
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Elasy AN, Nafea OE. Critical Hypermagnesemia in Preeclamptic Women Under a Magnesium Sulfate Regimen: Incidence and Associated Risk Factors. Biol Trace Elem Res 2022:10.1007/s12011-022-03479-x. [PMID: 36413336 DOI: 10.1007/s12011-022-03479-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 11/06/2022] [Indexed: 11/23/2022]
Abstract
Magnesium sulfate is used as prophylaxis and treatment of severe preeclampsia/eclampsia, albeit its safety and toxicity are a concern. We designed this study to estimate the incidence of critical hypermagnesemia in severely preeclamptic women under a magnesium sulfate regimen at 8 h following its administration and to identify the associated risk factors as the primary outcomes. Also, secondary outcomes were to compare baseline characteristics, laboratory findings, and maternal-neonatal complications stratified by the baseline serum magnesium (Mg2+) in those women, and to assess the degree of agreement between patellar reflex and serum Mg2+ concentration 8 h following magnesium sulfate administration. We conducted a retrospective study including severely preeclamptic women receiving magnesium sulfate from June 2016 to May 2021. We enrolled 429 women in the study. Two-hundred sixty-one (60.8%) of the included women developed critical hypermagnesemia. Preeclamptic women with high baseline serum Mg2+ concentration demonstrated significantly affected renal functions, hepatic transaminase activities, and low platelet count as well as more reported maternal complications compared to those with low baseline serum Mg2. Multivariable logistic regression revealed that a lower gestational age, a higher uric acid concentration, and a higher baseline serum Mg2+ concentration were independently associated with an increased risk of critical hypermagnesemia. The agreement between deep tendon reflex assessment and serum Mg2+ concentration was slight although not significant. The maternal-neonatal outcomes were non-significant in women with critical hypermagnesemia. More vigilant monitoring through assessment of both serum Mg2+ concentration and deep tendon reflex should be considered especially in high-risk women.
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Affiliation(s)
- Amina Nagy Elasy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
- Specialist Obstetrics and Gynecology, New Mowast Hospital, Salmiya, Kuwait
| | - Ola Elsayed Nafea
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt.
- Department of Clinical Pharmacy, College of Pharmacy, Taif University, P.O. Box 11099, Taif, 21944, Saudi Arabia.
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21
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A Clinician's View of Wernicke-Korsakoff Syndrome. J Clin Med 2022; 11:jcm11226755. [PMID: 36431232 PMCID: PMC9693280 DOI: 10.3390/jcm11226755] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/06/2022] [Accepted: 11/12/2022] [Indexed: 11/17/2022] Open
Abstract
The purpose of this article is to improve recognition and treatment of Wernicke-Korsakoff syndrome. It is well known that Korsakoff syndrome is a chronic amnesia resulting from unrecognized or undertreated Wernicke encephalopathy and is caused by thiamine (vitamin B1) deficiency. The clinical presentation of thiamine deficiency includes loss of appetite, dizziness, tachycardia, and urinary bladder retention. These symptoms can be attributed to anticholinergic autonomic dysfunction, as well as confusion or delirium, which is part of the classic triad of Wernicke encephalopathy. Severe concomitant infections including sepsis of unknown origin are common during the Wernicke phase. These infections can be prodromal signs of severe thiamine deficiency, as has been shown in select case descriptions which present infections and lactic acidosis. The clinical symptoms of Wernicke delirium commonly arise within a few days before or during hospitalization and may occur as part of a refeeding syndrome. Wernicke encephalopathy is mostly related to alcohol addiction, but can also occur in other conditions, such as bariatric surgery, hyperemesis gravidarum, and anorexia nervosa. Alcohol related Wernicke encephalopathy may be identified by the presence of a delirium in malnourished alcoholic patients who have trouble walking. The onset of non-alcohol-related Wernicke encephalopathy is often characterized by vomiting, weight loss, and symptoms such as visual complaints due to optic neuropathy in thiamine deficiency. Regarding thiamine therapy, patients with hypomagnesemia may fail to respond to thiamine. This may especially be the case in the context of alcohol withdrawal or in adverse side effects of proton pump inhibitors combined with diuretics. Clinician awareness of the clinical significance of Wernicke delirium, urinary bladder retention, comorbid infections, refeeding syndrome, and hypomagnesemia may contribute to the recognition and treatment of the Wernicke-Korsakoff syndrome.
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22
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Zhang J, Zhai B, Gao J, Li Z, Zheng Y, Ma M, Li Y, Zhang K, Guo Y, Shi X, Liu B, Gao G, Sun L. Plain metallic biomaterials: opportunities and challenges. Regen Biomater 2022; 10:rbac093. [PMID: 36683734 PMCID: PMC9847527 DOI: 10.1093/rb/rbac093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/31/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022] Open
Abstract
The 'plainification of materials' has been conceptualized to promote the sustainable development of materials. This perspective, for the first time in the field of biomaterials, proposes and defines 'plain metallic biomaterials (PMBs)' with demonstrated research and application case studies of pure titanium with high strength and toughness, and biodegradable, fine-grained and high-purity magnesium. Then, after discussing the features, benefits and opportunities of PMBs, the challenges are analyzed from both technical and regulatory aspects. Regulatory perspectives on PMB-based medical devices are also provided for the benefit of future research, development and commercialization.
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Affiliation(s)
- Jiazhen Zhang
- Correspondence address. E-mail: (J.Z.); (Y.Z.); (M.M.)
| | - Bao Zhai
- Center for Medical Device Evaluation, National Medical Product Administration, Beijing 100081, China
| | - Jintao Gao
- Guangdong-Hong Kong-Macao Greater Bay Area, Center for Medical Device Evaluation and Inspection of NMPA, Shenzhen 518045, China
| | - Zheng Li
- Center for Medical Device Evaluation, National Medical Product Administration, Beijing 100081, China
| | - Yufeng Zheng
- Correspondence address. E-mail: (J.Z.); (Y.Z.); (M.M.)
| | - Minglong Ma
- Correspondence address. E-mail: (J.Z.); (Y.Z.); (M.M.)
| | - Yongjun Li
- State Key Laboratory of Nonferrous Metals and Process, GRINM Group Corporation Limited (General Research Institute for Nonferrous Metals), Beijing 100088, China
| | - Kui Zhang
- State Key Laboratory of Nonferrous Metals and Process, GRINM Group Corporation Limited (General Research Institute for Nonferrous Metals), Beijing 100088, China
| | - Yajuan Guo
- Center for Medical Device Evaluation, National Medical Product Administration, Beijing 100081, China
| | - Xinli Shi
- Center for Medical Device Evaluation, National Medical Product Administration, Beijing 100081, China
| | - Bin Liu
- Guangdong-Hong Kong-Macao Greater Bay Area, Center for Medical Device Evaluation and Inspection of NMPA, Shenzhen 518045, China
| | - Guobiao Gao
- Center for Medical Device Evaluation, National Medical Product Administration, Beijing 100081, China
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Ashitomi Y, Konta T, Motoi F, Watanabe M, Kayama T, Ueno Y. Association between Serum Magnesium Levels and Mortality in a Community-Based Population: The Yamagata (Takahata) Study. J Nutr Sci Vitaminol (Tokyo) 2022; 68:270-275. [PMID: 36047098 DOI: 10.3177/jnsv.68.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The element magnesium (Mg) is involved in various metabolic reactions within the human body, and its deficiency is considered a risk factor for several diseases. In this study, we investigated the relationship between serum Mg levels and mortality in a community-based population. We prospectively assessed the association between serum Mg levels at enrollment and all-cause mortality in 1,314 participants who underwent a community health examination. The mean serum Mg level was 2.4 (±0.2) mg/dL. Patients with serum Mg levels ≤2.3 mg/dL constituted the low Mg group, while those with serum Mg ≥2.4 mg/dL constituted the high Mg group. Ninety-three (7.1%) patients died during the 10-y follow-up period. Kaplan-Meier analysis revealed that all-cause mortality was significantly higher in the low Mg group (log-rank p<0.05). Cox proportional hazards analysis revealed a significant association in the unadjusted model (hazard ratio [HR] 1.72, 95% confidence intervals [CI] 1.14-2.58, p<0.01) and in the fully adjusted model (HR 1.73, 95% CI 1.09-2.76, p<0.05). This association was particularly strong in males (HR 2.08, 95% CI 1.19-3.63, p<0.05). Low serum Mg levels were significantly associated with the risk of all-cause mortality among males in a community-based Japanese population.
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Affiliation(s)
- Yuya Ashitomi
- First Department of Surgery, Yamagata University Faculty of Medicine
| | - Tsuneo Konta
- Global Center of Excellence Program Study Group, Yamagata University Faculty of Medicine.,Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science
| | - Fuyuhiko Motoi
- First Department of Surgery, Yamagata University Faculty of Medicine
| | - Masahumi Watanabe
- Global Center of Excellence Program Study Group, Yamagata University Faculty of Medicine
| | - Takamasa Kayama
- Global Center of Excellence Program Study Group, Yamagata University Faculty of Medicine
| | - Yoshiyuki Ueno
- Global Center of Excellence Program Study Group, Yamagata University Faculty of Medicine
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Theisen CF, Wodschow K, Hansen B, Schullehner J, Gislason G, Ersbøll BK, Ersbøll AK. Drinking water magnesium and cardiovascular mortality: A cohort study in Denmark, 2005-2016. ENVIRONMENT INTERNATIONAL 2022; 164:107277. [PMID: 35551005 DOI: 10.1016/j.envint.2022.107277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 04/28/2022] [Accepted: 05/01/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Cardiovascular diseases are globally a major cause of death. Magnesium deficiency is associated with several diseases including cardiovascular diseases. OBJECTIVE To examine if a low concentration of magnesium in drinking water is associated with increased cardiovascular mortality and mortality due to acute myocardial infarction and stroke. METHODS A nationwide population-based cohort study using national health registries was used. A total of 4,274,132 individuals aged 30 years or more were included. Magnesium concentration in drinking water was estimated by linkage of residential addresses in the period 2005-2016 with the national drinking water quality monitoring database. The association between magnesium concentration in drinking water and cardiovascular mortality and mortality due to acute myocardial infarction and stroke was examined using a Poisson regression of number of deaths and logarithmic transformation of follow-up time as offset. The incidence rate ratio (IRR) was adjusted for differences in age, sex, calendar year, cohabitation, country of origin, and socioeconomic status. RESULTS Median magnesium concentration in drinking water at inclusion was 12.4 mg/L (range: 1.37-54.2 mg/L). The adjusted IRR for cardiovascular mortality was 0.96 (95% CI: 0.94; 0.97) for the lowest magnesium quintile (<6.5 mg/L) as compared to the highest magnesium quintile (>21.9 mg/L). The adjusted IRR for mortality due to acute myocardial infarction and stroke was 1.22 (1.17; 1.27) and 0.96 (0.93; 0.99), respectively, for the lowest magnesium quintile as compared to the highest quintile A decreasing mortality due to acute myocardial infarction was seen with an increasing magnesium concentration in a dose-response manner. CONCLUSION Low concentrations of magnesium in drinking water were associated with an increased mortality due to acute myocardial infarction. Low concentrations of magnesium in drinking water were associated with decreased cardiovascular mortality, and mortality due to stroke.
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Affiliation(s)
- C F Theisen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; DTU Compute, Technical University of Denmark, Kgs Lyngby, Denmark
| | - K Wodschow
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - B Hansen
- Geological Survey of Denmark and Greenland, GEUS, Aarhus, Denmark
| | - J Schullehner
- Geological Survey of Denmark and Greenland, GEUS, Aarhus, Denmark; Department of Public Health, Research Unit for Environment, Work and Health, Aarhus University, Aarhus, Denmark
| | - G Gislason
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; Department of Cardiology, The Cardiovascular Research Centre, Copenhagen University Hospital Herlev and Gentofte, Gentofte, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark
| | - B K Ersbøll
- DTU Compute, Technical University of Denmark, Kgs Lyngby, Denmark
| | - A K Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
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25
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Kaneko S, Ookawara S, Morishita Y. Clinical Factors Associated with Serum Magnesium Concentration in Patients Undergoing Peritoneal Dialysis: A Single-Center Observational Study. Int J Nephrol Renovasc Dis 2022; 15:185-195. [PMID: 35637657 PMCID: PMC9148175 DOI: 10.2147/ijnrd.s357130] [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] [Received: 01/05/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Magnesium (Mg) is an essential element that is associated with various physiological functions, such as maintenance of blood pressure, muscle contraction, and nerve function. In patients undergoing hemodialysis, hypomagnesemia is associated with cardiovascular and all-cause mortality. However, in patients undergoing peritoneal dialysis (PD), clinical factors associated with Mg have not been fully investigated. Patients and Methods Clinical factors including anthropometric data, comorbidities, laboratory data, medications, and dialysis methods were collected from the medical records of patients undergoing PD. The associations of these factors with the serum Mg concentration were investigated by univariate and multivariate analyses. Results Sixty patients undergoing PD were investigated. The univariate analysis showed that the serum Mg concentration was significantly associated with treatment by hybrid PD (daily PD + once-weekly hemodialysis) (β = 0.264, P = 0.04), administration of phosphate binders (β = 0.294, P = 0.02), the serum C-reactive protein concentration (β = -0.318, P = 0.01), the serum potassium (K) concentration (β = 0.451, P < 0.01), and the serum intact parathormone concentration (β = -0.333, P = 0.01). The multivariate analysis using these factors showed an independent association between the serum Mg and K concentrations (β = 0.333, P = 0.01). Conclusion The serum Mg concentration was independently associated with the serum K concentration in patients undergoing PD.
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Affiliation(s)
- Shohei Kaneko
- Department of Nephrology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Susumu Ookawara
- Department of Nephrology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yoshiyuki Morishita
- Department of Nephrology, Jichi Medical University Saitama Medical Center, Saitama, Japan
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Park JW, Kim EK, Lee J, Chung SH, Boo G, Do SH. Effect of Intraoperative Magnesium Sulfate Administration on Blood Glucose Control following Total Joint Arthroplasty in Patients with Diabetes. J Clin Med 2022; 11:jcm11113040. [PMID: 35683428 PMCID: PMC9181658 DOI: 10.3390/jcm11113040] [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] [Received: 02/11/2022] [Revised: 04/19/2022] [Accepted: 05/26/2022] [Indexed: 11/25/2022] Open
Abstract
Magnesium deficiency, which is known to be highly prevalent among patients with diabetes, has been associated with insulin resistance and poor glucose control. Here, we aimed to investigate the effects of intraoperative magnesium administration on postoperative glucose control in patients with diabetes. We retrospectively reviewed the medical records of patients with type 2 diabetes who had undergone total joint arthroplasty at a tertiary hospital, where intraoperative magnesium sulfate injections were frequently performed for postoperative analgesia. The patients were grouped based on whether treated with magnesium or not (magnesium vs. control groups). We investigated postoperative blood glucose levels and sliding scale insulin requirements. After propensity matching, 170 patients were allotted to each group. Both the mean glucose level and the incidence of a mean glucose level of >200mg/dL were significantly lower in the magnesium group than in the control group (p = 0.040 and 0.013, respectively). There was also a lower insulin requirement in the magnesium group (p = 0.043). Multivariate logistic regression revealed that magnesium treatment was significantly related to a less frequent incidence of a mean blood glucose level of >200 mg/dL (p = 0.047). This study demonstrated that magnesium sulfate infusion was associated with an improved postoperative blood glucose profile in patients with diabetes.
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Affiliation(s)
- Jin-Woo Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (J.-W.P.); (J.L.); (G.B.)
| | - Eun-Kyoung Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul 03080, Korea;
| | - Jiyoun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (J.-W.P.); (J.L.); (G.B.)
| | - Seung Hyun Chung
- Department of Anesthesiology and Pain Medicine, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu 11759, Korea;
| | - Gihong Boo
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (J.-W.P.); (J.L.); (G.B.)
| | - Sang-Hwan Do
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (J.-W.P.); (J.L.); (G.B.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul 03080, Korea;
- Correspondence: ; Tel.: +82-31-787-7501
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Hypermagnesaemia, but Not Hypomagnesaemia, Is a Predictor of Inpatient Mortality in Critically Ill Children with Sepsis. DISEASE MARKERS 2022; 2022:3893653. [PMID: 35126786 PMCID: PMC8814719 DOI: 10.1155/2022/3893653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/25/2021] [Accepted: 01/05/2022] [Indexed: 12/20/2022]
Abstract
Objective The effect of serum magnesium on the prognosis of children with sepsis in the pediatric intensive care unit (PICU) is unclear. This study was designed to assess the risk of inpatient mortality for children with sepsis in the PICU based on serum magnesium levels at admission. Methods We collected patients' clinical information from the Pediatric Intensive Care database and then performed locally weighted scatterplot smoothing (LOWESS) analysis, Kaplan–Meier analysis, and multivariate logistic regression to determine the relationship between admission serum magnesium and inpatient mortality in children with sepsis. Results A total of 974 critically ill children with sepsis were included, with 246 patients in the hypomagnesemia group, 666 in the normal group, and 62 in the hypermagnesemia group. The chi-square test suggested that the hypermagnesemia group had higher in-hospital mortality than the normal group (14.5% vs. 2.4%, P < 0.001). Kaplan–Meier curves revealed that the 30-day overall survival rate was lower in the hypermagnesaemia group than in the normal group (P < 0.001). The multivariate logistic regression model revealed that hypermagnesaemia was a risk factor related to inpatient mortality (odds ratio 4.22, 95% CI 1.55-11.50), while hypomagnesaemia was not a significant factor for inpatient mortality (odds ratio 0.78, 95% CI 0.26-2.32). Conclusion Hypermagnesaemia, but not hypomagnesaemia, is a predictor of inpatient mortality in critically ill children with sepsis.
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Wodschow K, Villanueva CM, Larsen ML, Gislason G, Schullehner J, Hansen B, Ersbøll AK. Association between magnesium in drinking water and atrial fibrillation incidence: a nationwide population-based cohort study, 2002-2015. Environ Health 2021; 20:126. [PMID: 34906160 PMCID: PMC8672465 DOI: 10.1186/s12940-021-00813-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is a common heart rhythm disorder and a risk factor of adverse cardiovascular diseases. Established causes do not fully explain the risk of AF and unexplained risk factors might be related to the environment, e.g. magnesium in drinking water. Low magnesium levels in drinking water might be associated with higher risk of cardiovascular diseases including AF. With detailed individual data from nationwide registries and long-term magnesium exposure time series, we had a unique opportunity to investigate the association between magnesium in drinking water and AF. OBJECTIVE We evaluated the association between magnesium concentration in drinking water and AF risk. METHODS A nationwide register-based cohort study (2002-2015) was used including individuals aged ≥30 years. Addresses were linked with water supply areas (n = 2418) to obtain time-varying drinking water magnesium exposure at each address. Five exposure groups were defined based on a 5-year rolling time-weighted average magnesium concentration. AF incidence rate ratios (IRRs) between exposure groups were calculated using a Poisson regression of incidence rates, adjusted for sex, age, and socioeconomic position. Robustness of results was investigated with different exposure definitions. RESULTS The study included 4,264,809 individuals (44,731,694 person-years) whereof 222,998 experienced an incident AF. Magnesium exposure ranged from 0.5 to 62.0 mg/L (mean = 13.9 mg/L). Estimated IRR (95% CI) compared to the referent exposure group (< 5 mg/L) was 0.98 (0.97-1.00) for the second lowest exposure group (5-10 mg/L), and 1.07 (1.05-1.08) for the two highest exposure groups (15-62 mg/L). Strongest positive associations were observed among those aged ≥80 years and with lowest education group. An inverse association was found among individuals with highest education group. CONCLUSION There might be a small beneficial effect on AF of an increase in magnesium level in drinking water up to 10 mg/L, though an overall positive association was observed. The unexpected positive association and different associations observed for subgroups suggest a potential influence of unaccounted factors, particularly in vulnerable populations. Future research on magnesium in drinking water and cardiovascular diseases needs to focus on contextual risk factors, especially those potentially correlating with magnesium in drinking water.
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Affiliation(s)
- Kirstine Wodschow
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen C, Denmark
| | - Cristina M. Villanueva
- ISGlobal, Campus Mar, Dr. Aiguader, 88, 08003 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain
- Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10-12, 08002 Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Dr. Aiguader, 88, 08003 Barcelona, Spain
| | - Mogens Lytken Larsen
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej15, 9000 Aalborg, Denmark
| | - Gunnar Gislason
- Department of Cardiology, The Cardiovascular Research Centre, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
- The Danish Heart Foundation, Vognmagergade 7, 3. sal, 1120 Copenhagen C, Denmark
| | - Jörg Schullehner
- Geological Survey of Denmark and Greenland, GEUS Department of Groundwater and Quaternary Geology Mapping, C.F. Moellers Allé 8, Bygning 1110, 8000 Aarhus C, Denmark
- Department of Public Health –Research Unit for Environment, Work and Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Birgitte Hansen
- Geological Survey of Denmark and Greenland, GEUS Department of Groundwater and Quaternary Geology Mapping, C.F. Moellers Allé 8, Bygning 1110, 8000 Aarhus C, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen C, Denmark
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Lozada-Martinez ID, Padilla-Durán TJ, González-Monterroza JJ, Aguilar-Espinosa DA, Molina-Perea KN, Camargo-Martinez W, Llamas-Medrano L, Hurtado-Pinillos M, Guerrero-Mejía A, Janjua T, Moscote-Salazar LR. Basic considerations on magnesium in the management of neurocritical patients. JOURNAL OF NEUROCRITICAL CARE 2021. [DOI: 10.18700/jnc.210018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Magnesium is an essential chemical element in human life. In the brain, it is physiologically responsible for a large number of processes involved in intracellular homeostasis, blood-brain barrier integrity, protein synthesis, neuronal proliferation, aging, and apoptosis. Considering that neurocritical care is a relatively new discipline in certain regions of the world and is an independent protective factor of neurological diseases in critical care, it is essential to disseminate basic concepts and utilities of tools that can positively impact the neurological disease burden. Magnesium and its use in neurocritical care are poorly understood. Therefore, this study aimed to review basic concepts regarding the physiology of magnesium in neurological dynamics, its role in the pathophysiology of neurological disorders, and the outcome of its use in the management of neurocritical illnesses.
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Machine Learning Consensus Clustering Approach for Hospitalized Patients with Dysmagnesemia. Diagnostics (Basel) 2021; 11:diagnostics11112119. [PMID: 34829467 PMCID: PMC8619519 DOI: 10.3390/diagnostics11112119] [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] [Received: 09/23/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The objectives of this study were to classify patients with serum magnesium derangement on hospital admission into clusters using unsupervised machine learning approach and to evaluate the mortality risks among these distinct clusters. METHODS Consensus cluster analysis was performed based on demographic information, principal diagnoses, comorbidities, and laboratory data in hypomagnesemia (serum magnesium ≤ 1.6 mg/dL) and hypermagnesemia cohorts (serum magnesium ≥ 2.4 mg/dL). Each cluster's key features were determined using the standardized mean difference. The associations of the clusters with hospital mortality and one-year mortality were assessed. RESULTS In hypomagnesemia cohort (n = 13,320), consensus cluster analysis identified three clusters. Cluster 1 patients had the highest comorbidity burden and lowest serum magnesium. Cluster 2 patients had the youngest age, lowest comorbidity burden, and highest kidney function. Cluster 3 patients had the oldest age and lowest kidney function. Cluster 1 and cluster 3 were associated with higher hospital and one-year mortality compared to cluster 2. In hypermagnesemia cohort (n = 4671), the analysis identified two clusters. Compared to cluster 1, the key features of cluster 2 included older age, higher comorbidity burden, more hospital admissions primarily due to kidney disease, more acute kidney injury, and lower kidney function. Compared to cluster 1, cluster 2 was associated with higher hospital mortality and one-year mortality. CONCLUSION Our cluster analysis identified clinically distinct phenotypes with differing mortality risks in hospitalized patients with dysmagnesemia. Future studies are required to assess the application of this ML consensus clustering approach to care for hospitalized patients with dysmagnesemia.
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Canei DH, Pereira ME, de Freitas MN, Trevisan YPA, Zorzo C, Bortolini J, Mendonça AJ, Sousa VRF, Ferreira de Almeida ADBP. Biochemical, electrolytic, and cardiovascular evaluations in cats with urethral obstruction. Vet World 2021; 14:2002-2008. [PMID: 34566314 PMCID: PMC8448651 DOI: 10.14202/vetworld.2021.2002-2008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background and Aim: Urethral obstruction (UO) is a common condition in feline medicine. Severe acid-base and electrolyte disorders promote relevant electrocardiographic changes in these animals. Cardiac biomarkers such as cardiac troponin I have been shown to be useful in identifying cats with myocardial disease, but it has not been investigated whether UO leads to myocardial damages. This study aimed to evaluate biochemical changes, electrocardiographic findings, troponin I measurements, and electrolyte disturbances for 7 days in cats with UO. Materials and Methods: This follow-up prospective study included 33 cats diagnosed with UO for 7 days. For all cats, clinical examination, serum biochemistry, electrolyte analyses, blood pressure, and electrocardiography were performed. Cardiac troponin I was measured in the serum in 16 cats at 3 different times. Results: The mean age of the feline population was 1.83±1.58 years (mean±standard deviation). Creatinine, urea, blood urea nitrogen, glucose, phosphorus, base excess, bicarbonate, and serum potassium decreased significantly (p≤0.05), while ionic calcium and blood pH increased significantly (p≤0.05) at different times. Electrocardiographic abnormalities were observed in 21/33 (63.63%) of the felines on admission day. The electrocardiographic abnormalities were no longer observed on the subsequent days. Only one feline showed changes in troponin I cardiac concentrations. Conclusion: This study suggests the sum and severity of electrolyte abnormalities aggravate the clinical and cardiovascular status of these patients. However, cTnI, blood pressure, and heart rate within the reference range do not exclude the presence of major cardiovascular and metabolic abnormalities. The hyperglycemia in felines with UO appears to be associated with decreased renal clearance, which may reflect the severity of hyperkalemia and azotemia. The metabolic and cardiovascular changes of these felines are minimized by the establishment of appropriate intensive care; however, cardiac and blood gas monitoring is essential to assess the severity of the disease.
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Affiliation(s)
- Darlan Henrique Canei
- Program of Postgraduate in Veterinary Sciences, Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá - Mato Grosso, Brazil
| | - Mariana Elisa Pereira
- Program of Postgraduate in Veterinary Sciences, Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá - Mato Grosso, Brazil
| | - Maria Natália de Freitas
- Scientific Initiation Volunteer (CNPq), Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá - Mato Grosso, Brazil
| | - Yolanda Paim Arruda Trevisan
- Program of Postgraduate in Veterinary Sciences, Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá - Mato Grosso, Brazil
| | - Carolina Zorzo
- Program of Postgraduate in Veterinary Sciences, Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá - Mato Grosso, Brazil
| | - Juliano Bortolini
- Department of Statistics, Federal University of Mato Grosso, Cuiabá - MT, Brazil
| | - Adriane Jorge Mendonça
- Veterinary Hospital, Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá - Mato Grosso, Brazil
| | - Valéria Régia Franco Sousa
- Veterinary Hospital, Faculty of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá - Mato Grosso, Brazil
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Dysmagnesemia Is the Most Common Disturbance of the Calcium-Magnesium-Phosphorous Balance among Older Hospitalized People in Warsaw. Nutrients 2021; 13:nu13103395. [PMID: 34684395 PMCID: PMC8540856 DOI: 10.3390/nu13103395] [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] [Received: 08/18/2021] [Revised: 09/17/2021] [Accepted: 09/24/2021] [Indexed: 11/24/2022] Open
Abstract
The elderly are at great risk of developing life-threatening disturbances in calcium–magnesium–phosphate homeostasis because of comorbidities, long-term medication use, and dietary deficiencies, but it is still not known how often they occur in this group of patients. This study aimed to assess the prevalence of these disturbances in a group of hospitalized patients over 65 years of age according to age and sex. The study was conducted between January 2018 and September 2020 at the Central Clinical Hospital in Warsaw. A total of 66,450 calcium, magnesium, phosphate, and vitamin D concentration results were included in the analysis. Dysmagnesemia was present in 33% of the calcium results, dyscalcemia, dysphosphatemia, and dysvitaminosis D—in 23.5%, 26%, and 70% of the results, respectively. The magnesium concentration was found to be age-dependent, and older people were found to be at higher risk of developing abnormal magnesium concentrations (p < 0.001). Sex influenced the occurrence of abnormal magnesium (p < 0.001), vitamin D (p < 0.001), and calcium (p < 0.00001) concentrations, with hypercalcemia and hypervitaminosis D disorders being significantly more common in women (p < 0.0001). In conclusion, disorders of the calcium–magnesium–phosphate metabolism are common in hospitalized patients over 65 years of age, and the concentrations of these substances should be routinely monitored in this group.
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Barros GAMD, Módolo NSP. Magnesium: the underestimated ion. Braz J Anesthesiol 2021; 71:481. [PMID: 34389344 PMCID: PMC9373482 DOI: 10.1016/j.bjane.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Guilherme Antonio Moreira de Barros
- Departamento de Especialidades Cirúrgica e Anestesiologia, Faculdade de Medicina de Botucatu (FMB), Universidade Estadual Paulista (UNESP), Brazil.
| | - Norma Sueli Pinheiro Módolo
- Departamento de Especialidades Cirúrgica e Anestesiologia, Faculdade de Medicina de Botucatu (FMB), Universidade Estadual Paulista (UNESP), Brazil
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Baracaldo-Santamaría D, Llinás-Caballero K, Corso-Ramirez JM, Restrepo CM, Dominguez-Dominguez CA, Fonseca-Mendoza DJ, Calderon-Ospina CA. Genetic and Molecular Aspects of Drug-Induced QT Interval Prolongation. Int J Mol Sci 2021; 22:8090. [PMID: 34360853 PMCID: PMC8347245 DOI: 10.3390/ijms22158090] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 12/22/2022] Open
Abstract
Long QT syndromes can be either acquired or congenital. Drugs are one of the many etiologies that may induce acquired long QT syndrome. In fact, many drugs frequently used in the clinical setting are a known risk factor for a prolonged QT interval, thus increasing the chances of developing torsade de pointes. The molecular mechanisms involved in the prolongation of the QT interval are common to most medications. However, there is considerable inter-individual variability in drug response, thus making the application of personalized medicine a relevant aspect in long QT syndrome, in order to evaluate the risk of every individual from a pharmacogenetic standpoint.
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Affiliation(s)
- Daniela Baracaldo-Santamaría
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (D.B.-S.); (J.M.C.-R.); (C.A.D.-D.)
| | - Kevin Llinás-Caballero
- GENIUROS Research Group, Center for Research in Genetics and Genomics (CIGGUR), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (K.L.-C.); (C.M.R.); (D.J.F.-M.)
- Institute for Immunological Research, University of Cartagena, Cartagena 130014, Colombia
| | - Julián Miguel Corso-Ramirez
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (D.B.-S.); (J.M.C.-R.); (C.A.D.-D.)
| | - Carlos Martín Restrepo
- GENIUROS Research Group, Center for Research in Genetics and Genomics (CIGGUR), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (K.L.-C.); (C.M.R.); (D.J.F.-M.)
| | | | - Dora Janeth Fonseca-Mendoza
- GENIUROS Research Group, Center for Research in Genetics and Genomics (CIGGUR), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (K.L.-C.); (C.M.R.); (D.J.F.-M.)
| | - Carlos Alberto Calderon-Ospina
- GENIUROS Research Group, Center for Research in Genetics and Genomics (CIGGUR), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (K.L.-C.); (C.M.R.); (D.J.F.-M.)
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Warda AEA, Tammam M, El-Gazar RA, Sarhan RM, Gaber S. Hydroxychloroquine and Azithromycin Combination in The Management of COVID-19 Infection: Safety and Effectiveness Challenges. Curr Drug Saf 2021; 17:143-151. [PMID: 34315385 DOI: 10.2174/1574886316666210727152609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/15/2021] [Accepted: 04/27/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The treatment of COVID-19 disease remains a dilemma so far because there is no approved therapy for it. This study aimed to evaluate the use of hydroxychloroquine and azithromycin combination in treatment. OBJECTIVE This study was carried out to determine the safety and effectiveness of hydroxychloroquine and azithromycin combination in COVID 19 patients. METHODS This study included 90 adult COVID 19 patients. Treatment of all patients followed Egyptian Ministry of Health COVID-19 protocols, receiving a combination of hydroxychloroquine 400mg twice on day 1, then 200 mg twice daily in addition to azithromycin 500mg/day for 5 days. ECG findings especially the QTc interval was assessed before and after 5 days from the administration. RESULTS All patients showed a statistically significant higher post-treatment QTc readings (433.6 ± 37.2) compared to baseline QTc (402.4 ± 31.3) at p<0.005 with a median QTc prolongation by 26 mSec and IQR (17.8-41.3), but without serious clinical complications. Only 5.6% of patients showed QTc more than 500 mSec and no torsade de points or cardiac arrest. Geriatric patients were at higher risk for QTc prolongation compared to patients aged less than 65 years but without a significant difference as regards the median max QTc difference p˂0.65. The expected therapeutic effectiveness was 82.5% for moderate patients compared to 26% in severe patients (P<0.005). CONCLUSION In a modest safety profile, we support the evidence that HQ/AZ therapy can be used to treat Covid-19 infection with more effectiveness in moderate rather than severe cases, which might be a reflection to the time of administration in the disease course.
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Affiliation(s)
| | | | - Rabab Ahmed El-Gazar
- Clinical Pharmacy Department, Faculty of Pharmacy, October 6 University, Giza, Egypt
| | - Rania Mohammad Sarhan
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni Suef University, Beni Suef, Egypt
| | - Sayed Gaber
- Critical Care Medicine Department, Faculty of Medicine, Cairo University, Giza, Egypt
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Grigoryan R, Costas-Rodríguez M, Van Wonterghem E, Vandenbroucke RE, Vanhaecke F. Effect of Endotoxemia Induced by Intraperitoneal Injection of Lipopolysaccharide on the Mg isotopic Composition of Biofluids and Tissues in Mice. Front Med (Lausanne) 2021; 8:664666. [PMID: 34368182 PMCID: PMC8342922 DOI: 10.3389/fmed.2021.664666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/22/2021] [Indexed: 12/02/2022] Open
Abstract
Endotoxemia induced in vivo in mice by intraperitoneal injection of lipopolysaccharide (LPS) leads to (neuro)inflammation and sepsis. Also the homeostasis of mineral elements can be altered through mechanisms that still are poorly understood. The isotopic composition of Mg and the concentrations of the minor elements Ca, K, Mg, Na, P, and S were determined in biological fluids and tissues of young (14–28 weeks) and aged (40–65 weeks) LPS-injected mice and age-matched controls to reveal potential effects of the LPS-induced infection. Blood plasma of young and aged LPS-injected mice showed a heavy Mg isotopic composition, as well as elevated Mg and P concentrations, compared to matched controls. The plasma Mg isotopic composition was correlated with the P concentration in aged mice. Also the liver Mg isotopic composition was strongly affected in the young and aged LPS-injected mice, while for aged mice, an additional effect on the urine Mg isotopic composition was established. These observations were hypothetically associated with liver inflammation and/or hepatotoxicity, and reduced urinary Mg excretion, respectively. Also a regional endotoxin-induced difference was observed in the brain Mg isotopic composition for the aged mice only, and was attributed to potential disruption of the blood-brain barrier.
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Affiliation(s)
- Rosa Grigoryan
- Atomic & Mass Spectrometry - A&MS Research Unit, Department of Chemistry, Ghent University, Ghent, Belgium
| | - Marta Costas-Rodríguez
- Atomic & Mass Spectrometry - A&MS Research Unit, Department of Chemistry, Ghent University, Ghent, Belgium
| | - Elien Van Wonterghem
- Atomic & Mass Spectrometry - A&MS Research Unit, Department of Chemistry, Ghent University, Ghent, Belgium
| | - Roosmarijn E Vandenbroucke
- Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Ghent, Belgium.,Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
| | - Frank Vanhaecke
- Atomic & Mass Spectrometry - A&MS Research Unit, Department of Chemistry, Ghent University, Ghent, Belgium
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Fiorentini D, Cappadone C, Farruggia G, Prata C. Magnesium: Biochemistry, Nutrition, Detection, and Social Impact of Diseases Linked to Its Deficiency. Nutrients 2021; 13:1136. [PMID: 33808247 PMCID: PMC8065437 DOI: 10.3390/nu13041136] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 12/11/2022] Open
Abstract
Magnesium plays an important role in many physiological functions. Habitually low intakes of magnesium and in general the deficiency of this micronutrient induce changes in biochemical pathways that can increase the risk of illness and, in particular, chronic degenerative diseases. The assessment of magnesium status is consequently of great importance, however, its evaluation is difficult. The measurement of serum magnesium concentration is the most commonly used and readily available method for assessing magnesium status, even if serum levels have no reliable correlation with total body magnesium levels or concentrations in specific tissues. Therefore, this review offers an overview of recent insights into magnesium from multiple perspectives. Starting from a biochemical point of view, it aims at highlighting the risk due to insufficient uptake (frequently due to the low content of magnesium in the modern western diet), at suggesting strategies to reach the recommended dietary reference values, and at focusing on the importance of detecting physiological or pathological levels of magnesium in various body districts, in order to counteract the social impact of diseases linked to magnesium deficiency.
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Affiliation(s)
| | | | - Giovanna Farruggia
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy; (D.F.); (C.C.); (C.P.)
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Magnesium level correlation with clinical status and quality of life in women with hormone related conditions and pregnancy based on real world data. Sci Rep 2021; 11:5734. [PMID: 33707700 PMCID: PMC7952720 DOI: 10.1038/s41598-021-85156-y] [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] [Received: 08/04/2020] [Accepted: 02/22/2021] [Indexed: 11/21/2022] Open
Abstract
This study was aimed to assess the effectiveness of magnesium (Mg)-vitamin B 6 replenishment and its correlation with clinical status in pregnant women (PW), and quality of life in women with hormone-related conditions (HRCW) and hypomagnesemia (HME). Data collected in four observational studies were pooled and analysed. All women received Mg supplementation for 4 weeks. The proportion of women with normalized Mg level, and the correlation between serum Mg dynamics and number of symptoms/complaints (PW) or changes in World Health Organization quality of life questionnaire scores (WHOQOL; HRCW) were evaluated. 869 PW and 957 HRCW were included in the study. Normalization of serum Mg level to ≥ 0.66 mmol/L occurred in 92.1% of PW and 78.4% of HRCW, and to ≥ 0.8 mmol/L in 73.8% and 58.9%, respectively. Mg normalization was accompanied by a median decrease of 1 symptom and 1 complaint in PW. Serum Mg level increase by 0.1 mmol/L was associated to significant changes in the WHOQOL scores in HRCW. Treatment of HME with the Mg for approximately 4 weeks provided a high response rate of Mg serum level, was associated with an improvement in symptom severity and complaints in PW, and WHOQOL score in HRCW. A 0.8 mmol/L cut-off appeared to be more relevant in terms of patient-reported outcomes.
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Neuroprotective effect of magnesium supplementation on cerebral ischemic diseases. Life Sci 2021; 272:119257. [PMID: 33631176 DOI: 10.1016/j.lfs.2021.119257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 01/31/2021] [Accepted: 02/19/2021] [Indexed: 02/07/2023]
Abstract
Ischemic encephalopathy is associated with a high mortality and rate of disability. The most common type of ischemic encephalopathy, ischemic stroke, is the second leading cause of death in the world. At present, the main treatment for ischemic stroke is to reopen blocked blood vessels. However, despite revascularization, many patients are not able to achieve good functional results. At the same time, the strict time window (<4.5 h) of thrombolytic therapy limits clinical application. Therefore, it is important to explore effective neuroprotective drugs for the treatment of ischemic stroke. Magnesium is a natural calcium antagonist, which exerts neuroprotective effects through various mechanisms. However, while most basic studies have shown that magnesium supplementation can help treat cerebral ischemia, intravenous magnesium supplementation in large clinical trials has failed to improve prognosis of ischemic patients. Therefore, we review the basic and clinical studies of magnesium supplementation for cerebral ischemia. According to the route of administration, treatment can be divided into intraperitoneal magnesium supplementation, intravenous magnesium supplementation, arterial magnesium supplementation and intracranial magnesium supplementation. We also summarized the potential influencing factors of magnesium ion intervention in cerebral ischemia injury. Finally, in combination with influencing factors derived from basic research, this article proposes three future research directions, including magnesium supplementation into the circulatory system combined with magnesium supplementation in the lateral ventricle, magnesium supplementation in the lateral ventricle combined with hypothermia therapy, and lateral ventricle magnesium supplementation combined with intracarotid magnesium supplementation combined with selective hypothermia.
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Degirmenci H, Bakirci EM. The CHA2DS2-VASc Score and Acute Stent Thrombosis After Primary Percutaneous Coronary Intervention. Angiology 2021; 72:492. [PMID: 33412901 DOI: 10.1177/0003319720985635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Husnu Degirmenci
- Faculty of Medicine, Department of Cardiology, 162315Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Eftal Murat Bakirci
- Faculty of Medicine, Department of Cardiology, 162315Erzincan Binali Yildirim University, Erzincan, Turkey
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Zhang H, Wu Y, Jiang Y. CNNM2-Related Disorders: Phenotype and Its Severity Were Associated With the Mode of Inheritance. Front Pediatr 2021; 9:699568. [PMID: 34604137 PMCID: PMC8481361 DOI: 10.3389/fped.2021.699568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/17/2021] [Indexed: 12/14/2022] Open
Abstract
CNNM2 (Cystathionine-β-synthase-pair Domain Divalent Metal Cation Transport Mediator 2) pathogenic variants have been reported to cause hypomagnesemia, epilepsy, and intellectual disability/developmental delay (ID/DD). We identified two new cases with CNNM2 novel de novo pathogenic variants, c.814T>C and c.976G>C. They both presented with infantile-onset epilepsy with DD and hypomagnesemia refractory to magnesium supplementation. To date, 21 cases with CNNM2-related disorders have been reported. We combined all 23 cases to analyze the features of CNNM2-related disorders. The phenotypes can be classified into three types: type 1, autosomal dominant (AD) inherited simple hypomagnesemia; type 2, AD inherited hypomagnesemia with epilepsy and ID/DD; and type 3, autosomal recessive (AR) inherited hypomagnesemia with epilepsy and ID/DD. All five type 1 cases had no epilepsy or ID/DD; they all had hypomagnesemia, and three of them presented with symptoms secondary to hypomagnesemia. Fifteen type 2 patients could have ID/DD and seizures, which can be controlled with antiseizure medications (ASMs); their variations clustered in the DUF21 domain of CNNM2. All three type 3 patients had seizures from 1 to 6 days after birth; the seizures were refractory, and 1/3 had status epilepticus; ID/DD in these AR-inherited cases was more severe than that of AD-inherited cases; they all had abnormalities of brain magnetic resonance imaging (MRI). Except for one patient whose serum magnesium was the lower limit of normal, others had definite hypomagnesemia. Hypomagnesemia could be improved after magnesium supplement but could not return to the normal level. Variations in the CBS2 domain may be related to lower serum magnesium. However, there was no significant difference in the level of serum magnesium among the patients with three different types of CNNM2-related disorders. The severity of different phenotypes was therefore not explained by decreased serum magnesium. We expanded the spectrum of CNNM2 variants and classified the phenotypes of CNNM2-related disorders into three types. We found that DUF21 domain variations were most associated with CNNM2-related central nervous system phenotypes, whereas hypomagnesemia was more pronounced in patients with CBS2 domain variations, and AR-inherited CNNM2-related disorders had the most severe phenotype. These results provide important clues for further functional studies of CNNM2 and provide basic foundations for more accurate genetic counseling.
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Affiliation(s)
- Han Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Ye Wu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yuwu Jiang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
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Sankova MV, Kytko OV, Meylanova RD, Vasil’ev YL, Nelipa MV. Possible prospects for using modern magnesium preparations for increasing stress resistance during COVID-19 pandemic. RESEARCH RESULTS IN PHARMACOLOGY 2020. [DOI: 10.3897/rrpharmacology.6.59407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The relevance of the issue of increasing stress resistance is due to a significant deterioration in the mental health of the population caused by the special conditions of the disease control and prevention during the COVID-19 pandemic. Recently, the decisive role in the severity of clinico-physiological manifestations of maladjustment to stress is assigned to magnesium ions.
The aim of the work was to study the magnesium importance in the body coping mechanisms under stress for the pathogenetic substantiation of the magnesium correction in an unfavorable situation of disease control and prevention during the COVID-19 pandemic.
Materials and methods: The theoretical basis of this scientific and analytical review was an analysis of modern Russian and foreign literature data posted on the electronic portals MEDLINE, PubMed-NCBI, Scientific Electronic Library eLIBRARY.RU, Google Academy, and CyberLeninka.
Results and discussion: It was shown that the total magnesium level in the body plays the indicator role of the body functional reserves. Acute and chronic stresses significantly increase the magnesium consumption and cause a decrease in its body content. Magnesium deficiency is one of the main pathogenetic mechanisms of reducing stress resistance and adaptive body reserves. Arising during the COVID-19 pandemic, increased nervous and emotional tension, the lack of emotional comfort and balance can lead to the onset or deterioration of magnesium deficiency, which manifests itself in mental burnout and depletion of adaptive capacities. The inability to synthesize magnesium in the body necessitates including foodstuffs high in magnesium in the population diet during this period. The appointment of magnesium preparations is pathogenetically justified with moderate and severe magnesium deficiency. This therapy should take into account the major concomitant diseases, severity of magnesium deficiency, and a patient’s age.
Conclusion: magnesium correction, carried out during the COVID-19 pandemic, will contribute to increasing stress resistance, preventing mental diseases and improving the population’s life quality.
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Aly J, Engmann O. The Way to a Human's Brain Goes Through Their Stomach: Dietary Factors in Major Depressive Disorder. Front Neurosci 2020; 14:582853. [PMID: 33364919 PMCID: PMC7750481 DOI: 10.3389/fnins.2020.582853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/09/2020] [Indexed: 12/12/2022] Open
Abstract
Globally, more than 250 million people are affected by depression (major depressive disorder; MDD), a serious and debilitating mental disorder. Currently available treatment options can have substantial side effects and take weeks to be fully effective. Therefore, it is important to find safe alternatives, which act more rapidly and in a larger number of patients. While much research on MDD focuses on chronic stress as a main risk factor, we here make a point of exploring dietary factors as a somewhat overlooked, yet highly promising approach towards novel antidepressant pathways. Deficiencies in various groups of nutrients often occur in patients with mental disorders. These include vitamins, especially members of the B-complex (B6, B9, B12). Moreover, an imbalance of fatty acids, such as omega-3 and omega-6, or an insufficient supply with minerals, including magnesium and zinc, are related to MDD. While some of them are relevant for the synthesis of monoamines, others play a crucial role in inflammation, neuroprotection and the synthesis of growth factors. Evidence suggests that when deficiencies return to normal, changes in mood and behavior can be, at least in some cases, achieved. Furthermore, supplementation with dietary factors (so called “nutraceuticals”) may improve MDD symptoms even in the absence of a deficiency. Non-vital dietary factors may affect MDD symptoms as well. For instance, the most commonly consumed psychostimulant caffeine may improve behavioral and molecular markers of MDD. The molecular structure of most dietary factors is well known. Hence, dietary factors may provide important molecular tools to study and potentially help treat MDD symptoms. Within this review, we will discuss the role of dietary factors in MDD risk and symptomology, and critically discuss how they might serve as auxiliary treatments or preventative options for MDD.
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Affiliation(s)
- Janine Aly
- Faculty of Medicine, Friedrich Schiller Universität, Jena, Germany
| | - Olivia Engmann
- Institute for Human Genetics, Jena University Hospital, Jena, Germany
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Thongprayoon C, Cheungpasitporn W, Hansrivijit P, Thirunavukkarasu S, Chewcharat A, Medaura J, Mao MA, Kashani KB. Association of serum magnesium level change with in-hospital mortality. BMJ Evid Based Med 2020; 25:206-212. [PMID: 31980468 DOI: 10.1136/bmjebm-2019-111322] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2020] [Indexed: 11/03/2022]
Abstract
The objective of this study was to assess the association of in-hospital mortality risk based on change in serum magnesium levels in hospitalised patients. All adult patients admitted to our hospital from years 2009 to 2013 with at least two serum magnesium measurements during hospitalisation were included. Serum magnesium change, defined as the absolute difference between the highest and lowest serum magnesium, was categorised into six groups: 0-0.2, 0.3-0.4, 0.5-0.6, 0.7-0.8, 0.9-1.0, ≥1.1 mg/dL. In-hospital mortality was the outcome of interest. Logistic regression was used to assess the association between serum magnesium change and in-hospital mortality, using serum magnesium change of 0.0-0.2 mg/dL as the reference group. A total of 42 141 patients, with the median serum magnesium change during hospital stay of 0.3 (IQR 0.2-0.6) mg/dL, were studied. In-hospital mortality based on serum magnesium change of 0-0.2, 0.3-0.4, 0.5-0.6, 0.7-0.8, 0.9-1.0, ≥1.1 mg/dL was 1.3%, 2.3%, 3.1%, 5.0%, 6.5%, and 8.8%, respectively (p<0.001). After adjustment for potential confounders, increased serum magnesium change was significantly associated with higher in-hospital mortality with adjusted OR of 1.39 (95% 1.14-1.69) in serum magnesium change of 0.3-0.4, 1.48 (95% CI 1.21 to 1.81) in 0.5-0.6, 1.89 (95% CI 1.53 to 2.34) in 0.7-0.8, 1.85 (95% CI 1.45 to 2.37) in 0.9-1.0 and 1.89 (95% CI 1.48 to 2.41) in ≥1.1 mg/dL when compared with serum magnesium change group of 0-0.2 mg/dL. Increased in-hospital mortality was associated with both downward and upward trends of serum magnesium change during hospitalisation. The greater extent of change in serum magnesium levels was progressively associated with increased in-hospital mortality.
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Affiliation(s)
| | - Wisit Cheungpasitporn
- Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | | | - Api Chewcharat
- Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan Medaura
- Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Michael A Mao
- Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida, USA
| | - Kianoush B Kashani
- Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Micke O, Vormann J, Classen HG, Kisters K. [Magnesium: Relevance for general practitioners - a position paper of the Society for Magnesium Research e. V.]. Dtsch Med Wochenschr 2020; 145:1628-1634. [PMID: 33142330 PMCID: PMC7749760 DOI: 10.1055/a-1166-7229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Magnesium deficiency is to be expected in the population and particularly among risk groups. Magnesium deficiency can cause numerous symptoms, is per se pathological and thus requires treatment. Diagnostics is based on clinical symptoms in conjunction with anamnestic criteria and laboratory parameters. Insufficient magnesium supply is associated with an increased risk for many diseases, e. g. metabolic syndrome, type 2 diabetes and cardiovascular diseases. Magnesium deficiency often appears as comorbidity and may exacerbate diseases. Physicians should pay more attention to magnesium in order to avoid deficits as a cause for multiple symptoms and risk factor for diseases. Optimisation of magnesium status may make an important contribution to the prevention of diseases. Oral magnesium therapy is safe and cost effective.
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Affiliation(s)
- Oliver Micke
- Klinik für Strahlentherapie und Radioonkologie, Franziskus Hospital Bielefeld
| | | | - Hans-Georg Classen
- Ehemals FG Pharmakologie und Toxikologie der Ernährung, Universität Stuttgart-Hohenheim
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Pagano P, Marra A, Shinabarger D, Pillar C. In vitro activity of omadacycline and levofloxacin against Escherichia coli, Klebsiella pneumoniae and Staphylococcus saprophyticus in human urine supplemented with calcium and magnesium. J Antimicrob Chemother 2020; 75:2160-2163. [PMID: 32428235 PMCID: PMC7366199 DOI: 10.1093/jac/dkaa138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Omadacycline, an aminomethylcycline, was approved in 2018 for the treatment of acute bacterial skin and skin structure infections and community-acquired bacterial pneumonia. In a Phase Ib study, around 34% of the absorbed dose of omadacycline was shown to be excreted in urine-an important property for urinary tract infection (UTI) treatment. Therefore, omadacycline has been studied in two Phase II trials for the treatment of uncomplicated UTIs and acute pyelonephritis. The activity of omadacycline against UTI pathogens in human urine is important to understand in this context. OBJECTIVES To study the in vitro activity of omadacycline against UTI pathogens in human urine supplemented with calcium and magnesium. METHODS Omadacycline activity was compared with that of levofloxacin against the urinary pathogens Escherichia coli, Klebsiella pneumoniae and Staphylococcus saprophyticus in standard medium, pooled normal human urine and neutral pH-adjusted pooled normal human urine spiked with calcium or magnesium at concentrations consistent with hypercalcaemia and hypermagnesaemia. RESULTS The activities of omadacycline and levofloxacin against these urinary pathogens were lower in urine relative to standard medium; addition of Mg2+ to broth and urine had a further negative impact on omadacycline activity, whereas the addition of Ca2+ had less of an impact. Levofloxacin activity was not substantially reduced in either broth or urine by the addition of divalent cations. CONCLUSIONS The activity of omadacycline against UTI organisms was lower in urine relative to standard medium and was negatively impacted by magnesium. Omadacycline displayed slightly reduced activity when excess calcium was present, but, overall, the differences were ≤2-fold. These observations should be considered along with the pharmacokinetics of the agent for clinical context.
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Malinowska J, Małecka M, Ciepiela O. Variations in Magnesium Concentration Are Associated with Increased Mortality: Study in an Unselected Population of Hospitalized Patients. Nutrients 2020; 12:nu12061836. [PMID: 32575600 PMCID: PMC7353204 DOI: 10.3390/nu12061836] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 01/10/2023] Open
Abstract
Dysmagnesemia is a serious disturbance of microelement homeostasis. The aim of this study was to analyze the distribution of serum magnesium concentrations in hospitalized patients according to gender, age, and result of hospitalization. The study was conducted from February 2018 to January 2019 at the Central Clinical Hospital in Warsaw. Laboratory test results from 20,438 patients were included in this retrospective analysis. When a lower reference value 0.65 mmol/L was applied, hypermagnesemia occurred in 196 patients (1%), hypomagnesemia in 1505 patients (7%), and normomagnesemia in 18,711 patients (92%). At a lower reference value of 0.75 mmol/L, hypomagnesemia was found in 25% and normomagnesemia in 74% of patients. At a lower reference value of 0.85 mmol/L, hypomagnesemia was found in 60% and normomagnesemia in 39% of patients. Either hypo- or hyper-magnesemia was associated with increased risk of in-hospital mortality. This risk is the highest in patients with hypermagnesemia (40.1% of deaths), but also increases inversely with magnesium concentration below 0.85 mmol/L. Serum magnesium concentration was not gender-dependent, and there was a slight positive correlation with age (p < 0.0001, r = 0.07). Large fluctuations in serum magnesium level were associated with increased mortality (p = 0.0017). The results indicate that dysmagnesemia is associated with severe diseases and generally severe conditions. To avoid misdiagnosis, an increase of a lower cut-off for serum magnesium concentration to at least 0.75 mmol/L is suggested.
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Affiliation(s)
- Justyna Malinowska
- Students Scientific Group of Laboratory Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Milena Małecka
- Department of Laboratory Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Olga Ciepiela
- Department of Laboratory Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland;
- Correspondence: ; Tel.: +48-22-599-24-05
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Saleh M, Gabriels J, Chang D, Soo Kim B, Mansoor A, Mahmood E, Makker P, Ismail H, Goldner B, Willner J, Beldner S, Mitra R, John R, Chinitz J, Skipitaris N, Mountantonakis S, Epstein LM. Effect of Chloroquine, Hydroxychloroquine, and Azithromycin on the Corrected QT Interval in Patients With SARS-CoV-2 Infection. Circ Arrhythm Electrophysiol 2020; 13:e008662. [PMID: 32347743 PMCID: PMC7299095 DOI: 10.1161/circep.120.008662] [Citation(s) in RCA: 220] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The novel SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is responsible for the global coronavirus disease 2019 pandemic. Small studies have shown a potential benefit of chloroquine/hydroxychloroquine±azithromycin for the treatment of coronavirus disease 2019. Use of these medications alone, or in combination, can lead to a prolongation of the QT interval, possibly increasing the risk of Torsade de pointes and sudden cardiac death. METHODS Hospitalized patients treated with chloroquine/hydroxychloroquine±azithromycin from March 1 to the 23 at 3 hospitals within the Northwell Health system were included in this prospective, observational study. Serial assessments of the QT interval were performed. The primary outcome was QT prolongation resulting in Torsade de pointes. Secondary outcomes included QT prolongation, the need to prematurely discontinue any of the medications due to QT prolongation, and arrhythmogenic death. RESULTS Two hundred one patients were treated for coronavirus disease 2019 with chloroquine/hydroxychloroquine. Ten patients (5.0%) received chloroquine, 191 (95.0%) received hydroxychloroquine, and 119 (59.2%) also received azithromycin. The primary outcome of torsade de pointes was not observed in the entire population. Baseline corrected QT interval intervals did not differ between patients treated with chloroquine/hydroxychloroquine (monotherapy group) versus those treated with combination group (chloroquine/hydroxychloroquine and azithromycin; 440.6±24.9 versus 439.9±24.7 ms, P=0.834). The maximum corrected QT interval during treatment was significantly longer in the combination group versus the monotherapy group (470.4±45.0 ms versus 453.3±37.0 ms, P=0.004). Seven patients (3.5%) required discontinuation of these medications due to corrected QT interval prolongation. No arrhythmogenic deaths were reported. CONCLUSIONS In the largest reported cohort of coronavirus disease 2019 patients to date treated with chloroquine/hydroxychloroquine±azithromycin, no instances of Torsade de pointes, or arrhythmogenic death were reported. Although use of these medications resulted in QT prolongation, clinicians seldomly needed to discontinue therapy. Further study of the need for QT interval monitoring is needed before final recommendations can be made.
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Affiliation(s)
- Moussa Saleh
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
- Division of Electrophysiology, Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY (M.S., P.M., N.S., S.M.)
| | - James Gabriels
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
| | - David Chang
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
| | - Beom Soo Kim
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
| | - Amtul Mansoor
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
| | - Eitezaz Mahmood
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
| | - Parth Makker
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
- Division of Electrophysiology, Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY (M.S., P.M., N.S., S.M.)
| | - Haisam Ismail
- Division of Electrophysiology, Department of Cardiology, Long Island Jewish Medical Center, Northwell Health, New Hyde Park (H.I., B.G.)
| | - Bruce Goldner
- Division of Electrophysiology, Department of Cardiology, Long Island Jewish Medical Center, Northwell Health, New Hyde Park (H.I., B.G.)
| | - Jonathan Willner
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
| | - Stuart Beldner
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
| | - Raman Mitra
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
| | - Roy John
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
| | - Jason Chinitz
- Division of Electrophysiology, Department of Cardiology, Southside Hospital, Northwell Health, Bay Shore (J.C.)
| | - Nicholas Skipitaris
- Division of Electrophysiology, Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY (M.S., P.M., N.S., S.M.)
| | - Stavros Mountantonakis
- Division of Electrophysiology, Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY (M.S., P.M., N.S., S.M.)
| | - Laurence M. Epstein
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY (M.S., J.G., D.C., B.S.K., A.M., E.M., P.M., J.W., S.B., R.M., R.J., L.M.E.)
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Cheungpasitporn W, Thongprayoon C, Bathini T, Hansrivijit P, Vaitla P, Medaura J, Vallabhajosyula S, Chewcharat A, Mao MA, Erickson SB. Impact of admission serum magnesium levels on long-term mortality in hospitalized patients. Hosp Pract (1995) 2020; 48:80-85. [PMID: 32005074 DOI: 10.1080/21548331.2020.1724723] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 01/30/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND The impact of admission serum magnesium on long-term mortality in hospitalized patients was unclear. This study aimed to assess the long-term mortality risk based on admission of serum magnesium in hospitalized patients. METHODS This was a retrospective cohort study conducted at a tertiary referral hospital. We included all adult patients admitted to Mayo Clinic Hospital, Minnesota, between 1 January 2009 and 31 December 2013, who had available admission serum magnesium. We categorized serum magnesium into ≤1.4, 1.5-1.6, 1.7-1.8, 1.9-2.0, 2.1-2.2, ≥2.3 mg/dL. We estimated the 1-year mortality risk based on various admission serum magnesium levels using Kaplan-Meier plot and assessed the association of admission serum magnesium with 1-year mortality using Cox proportional hazard analysis. We selected serum magnesium of 1.7-1.8 mg/dL as the reference group for mortality comparison. RESULTS We included a total of 65,974 patients, with a mean admission serum magnesium of 1.9 ± 0.3 mg/dL in this study. The 1-year mortality was 15.7%, 15.8%, 15.5%, 16.7%, 19.0%, and 25.6% in admission serum magnesium of ≤1.4, 1.5-1.6, 1.7-1.8, 1.9-2.0, 2.1-2.2, ≥2.3 mg/dL, respectively (p < 0.001). After adjustment for confounders, admission serum magnesium of 1.9-2.0, 2.1-2.2, and ≥2.3 mg/dL were significantly associated with increased 1-year mortality compared with magnesium of 1.7-1.8 mg/dL with adjusted HR of 1.09 (95% CI 1.02-1.15), 1.22 (95% CI 1.14-1.30), and 1.55 (95% CI 1.45-1.55), respectively. There was no significant difference in 1-year mortality risk between low serum magnesium ≤1.6 mg/dL and magnesium of 1.7-1.8 mg/dL. CONCLUSION Hypermagnesemia, but not hypomagnesemia, at the time of hospital admission was associated with increased 1-year mortality among hospitalized patients.
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Affiliation(s)
- Wisit Cheungpasitporn
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center , Jackson, MS, USA
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic , Rochester, MN, USA
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic , Rochester, MN, USA
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona , Tucson, AZ, USA
| | - Panupong Hansrivijit
- Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle , Harrisburg, PA, USA
| | - Pradeep Vaitla
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center , Jackson, MS, USA
| | - Juan Medaura
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center , Jackson, MS, USA
| | | | - Api Chewcharat
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic , Rochester, MN, USA
| | - Michael A Mao
- Division of Nephrology and Hypertension, Mayo Clinic , Jacksonville, FL, USA
| | - Stephen B Erickson
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic , Rochester, MN, USA
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50
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Shepherd E, Salam RA, Manhas D, Synnes A, Middleton P, Makrides M, Crowther CA. Antenatal magnesium sulphate and adverse neonatal outcomes: A systematic review and meta-analysis. PLoS Med 2019; 16:e1002988. [PMID: 31809499 PMCID: PMC6897495 DOI: 10.1371/journal.pmed.1002988] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/06/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is widespread, increasing use of magnesium sulphate in obstetric practice for pre-eclampsia, eclampsia, and preterm fetal neuroprotection; benefit for preventing preterm labour and birth (tocolysis) is unproven. We conducted a systematic review and meta-analysis to assess whether antenatal magnesium sulphate is associated with unintended adverse neonatal outcomes. METHODS AND FINDINGS CINAHL, Cochrane Library, LILACS, MEDLINE, Embase, TOXLINE, and Web of Science, were searched (inceptions to 3 September 2019). Randomised, quasi-randomised, and non-randomised trials, cohort and case-control studies, and case reports assessing antenatal magnesium sulphate for pre-eclampsia, eclampsia, fetal neuroprotection, or tocolysis, compared with placebo/no treatment or a different magnesium sulphate regimen, were included. The primary outcome was perinatal death. Secondary outcomes included pre-specified and non-pre-specified adverse neonatal outcomes. Two reviewers screened 5,890 articles, extracted data, and assessed risk of bias following Cochrane Handbook and RTI Item Bank guidance. For randomised trials, pooled risk ratios (RRs) or mean differences, with 95% confidence intervals (CIs), were calculated using fixed- or random-effects meta-analysis. Non-randomised data were tabulated and narratively summarised. We included 197 studies (40 randomised trials, 138 non-randomised studies, and 19 case reports), of mixed quality. The 40 trials (randomising 19,265 women and their babies) were conducted from 1987 to 2018 across high- (16 trials) and low/middle-income countries (23 trials) (1 mixed). Indications included pre-eclampsia/eclampsia (24 trials), fetal neuroprotection (7 trials), and tocolysis (9 trials); 18 trials compared magnesium sulphate with placebo/no treatment, and 22 compared different regimens. For perinatal death, no clear difference in randomised trials was observed between magnesium sulphate and placebo/no treatment (RR 1.01; 95% CI 0.92 to 1.10; 8 trials, 13,654 babies), nor between regimens. Eleven of 138 non-randomised studies reported on perinatal death. Only 1 cohort (127 babies; moderate to high risk of bias) observed an increased risk of perinatal death with >48 versus ≤48 grams magnesium sulphate exposure for tocolysis. No clear secondary adverse neonatal outcomes were observed in randomised trials, and a very limited number of possible adverse outcomes warranting further consideration were identified in non-randomised studies. Where non-randomised studies observed possible harms, often no or few confounders were controlled for (moderate to high risk of bias), samples were small (200 babies or fewer), and/or results were from subgroup analyses. Limitations include missing data for important outcomes across most studies, heterogeneity of included studies, and inclusion of published data only. CONCLUSIONS Our findings do not support clear associations between antenatal magnesium sulphate for beneficial indications and adverse neonatal outcomes. Further large, high-quality studies (prospective cohorts or individual participant data meta-analyses) assessing specific outcomes, or the impact of regimen, pregnancy, or birth characteristics on these outcomes, would further inform safety recommendations. PROSPERO: CRD42013004451.
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Affiliation(s)
- Emily Shepherd
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology,
Adelaide Medical School, University of Adelaide, Adelaide, South Australia,
Australia
- South Australian Health and Medical Research Institute, Adelaide, South
Australia, Australia
| | - Rehana A. Salam
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology,
Adelaide Medical School, University of Adelaide, Adelaide, South Australia,
Australia
- South Australian Health and Medical Research Institute, Adelaide, South
Australia, Australia
| | - Deepak Manhas
- University of British Columbia, Vancouver, British Columbia,
Canada
| | - Anne Synnes
- University of British Columbia, Vancouver, British Columbia,
Canada
| | - Philippa Middleton
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology,
Adelaide Medical School, University of Adelaide, Adelaide, South Australia,
Australia
- South Australian Health and Medical Research Institute, Adelaide, South
Australia, Australia
| | - Maria Makrides
- South Australian Health and Medical Research Institute, Adelaide, South
Australia, Australia
| | - Caroline A. Crowther
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology,
Adelaide Medical School, University of Adelaide, Adelaide, South Australia,
Australia
- Liggins Institute, University of Auckland, Auckland, New
Zealand
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