Magnesium research : official organ of the International Society for the Development of Research on Magnesium
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Magnesium (Mg) plays an important role in the prevention and treatment of central nervous system (CNS) damage. This pathology is a serious problem in patients undergoing coronary artery bypass graft surgery (CABG) with extracorporeal circulation (ECC). Its biochemical diagnosis is mainly based on S100beta protein observations. This study aims to analyse different forms of Mg supplementation on serum S100beta concentrations in patients who have undergone CABG. ⋯ 1) ECC resulted in S100beta elevation, 2) infusion of 10 mg of MgSO4 per min reduced serum S100beta concentrations, and 3) dopamine infusion resulted in the highest serum S100beta concentrations.
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The purpose of the study was to analyse the effects of different forms of magnesium supplementation on its serum concentrations and the frequency of atrial fibrillation in patients undergoing coronary artery bypass graft surgery with extracorporeal circulation (ECC). One hundred and twenty adult patients were examined. All of them received intravenous infusions of MgSO4 during surgery and the early postoperative period (18 hours). Moreover, some of them received preoperative Mg supplementation. Therefore, patients were divided into six groups: A) patients, receiving an intravenous infusion 3.33 mg of MgSO4 per min; B) those receiving preoperative, oral Mg supplementation (OPS-Mg) and intravenous 3.33 mg of MgSO4 per min; C) patients receiving intravenous 6.66 mg of MgSO4 per min; D) patients receiving OPS-Mg and 6.66 mg of MgSO4 per min; E) patients receiving intravenous 10 mg of MgSO4 per min; F) those receiving OPS-Mg and 10 mg of MgSO4 per min. Additionally, all patients were divided into three groups: O (patients, who did not receive dopamine or dobutamine infusions), DOP (those receiving dopamine infusions in doses dependent on their clinical state) and DOB (those receiving dobutamine infusions in doses dependent on their clinical state). Total serum Mg concentrations (Mg(t)) were measured at five points: 1) 10 min before anaesthesia; 2) 10 min after ECC; 3) 10 min after surgery, 4) in the morning of postoperative day 1, 5) in the morning of postoperative day 2. The data were analyzed statistically; values at the first measurement points were considered as baseline. In group A, Mg(t) decreased at time points 2, 3, 4. Similar changes were observed in group B, however, in both groups Mg(t) returned to the baseline value at time point 5. In groups C and D, Mg(t) decreased at point 2 and 3, whereas in groups E and F it was increased during all the study period. The changes in Mg(t) were slightly less in patients receiving OPS-Mg, these patients had a significantly higher Mg(t) at time point 1. Mg(t) decreased in the O, DOP and DOB groups at measurement points 2 and 3. Moreover, the lowest Mg(t) was observed in the DOP group. Atrial fibrillation (AF) was noted in 33 patients (27.5%). The highest percentage of patients with AF during the early postoperative days was observed in groups A and B (45%). In groups C, D, E and F, AF was detected in 25%, 20%, 20% and 10% of patients, respectively. The incidence of AF was significantly higher in groups A and B compared to the other groups. Moreover, episodes of AF were rarer in patients receiving preoperative, oral Mg supplementation. ⋯ 1) ECC resulted in a decrease in Mg(t); 2) Mg infusion at the dose of 3.33 mg/min had little effect for the prevention of postoperative AF; 3) the infusion of 10 mg/min of MgSO4 maintained the level of Mg(t) during CABG and most effectively reduced AF; 4) OPS-Mg played a beneficial role in Mg(t) disturbances during CABG; 5) dopamine caused the most severe disturbances in serum Mg(t) concentration.
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Randomized Controlled Trial
The effects of magnesium prophylaxis in migraine without aura.
There are inconsistent findings about the efficacy of magnesium in the prophylaxis of migraine attacks and there is no study of magnesium prophylaxis focused on migraine subtypes without aura. In this double blind, randomized, placebo controlled study; we tried to evaluate the prophylactic effects of oral magnesium in migraine patients without aura. The prophylactic effects of 600 mg/day oral magnesium citrate supplementation were assessed by means of clinical evaluation, visual evoked potential and statistical parametric mapping of brain single photon emission computerized tomography before and after a 3 month treatment period. ⋯ In a comparison of the effects of magnesium treatment with those of placebo, post/pretreatment ratios of migraine attack frequency, severity and P1 amplitude in Mg treatment group were found to be significantly lower than those in placebo treatment group (attack frequency p = 0.005, attack severity p < 0.001, P1 amplitude p < 0.05). Cortical blood flow in inferolateral frontal (p < 0.001), inferolateral temporal (p = 0.001) and insular regions (p < 0.01) increased significantly after magnesium treatment with respect to the pretreatment; while such significant changes of cortical blood flow were not observed with placebo treatment. These results have made us think that magnesium is a beneficial agent in prophylaxis of migraine without aura and might work with both vascular and neurogenic mechanisms.
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Abnormal serum sodium levels are frequently observed among patients with aneurysmal subarachnoid hemorrhage (SAH) and may worsen cerebral edema or mass effect. Low serum potassium levels (hypokalemia) are also common among patients with aneurysmal SAH and are associated with prolonged QT interval and ventricular arrhythmia. Recent meta-analysis suggests that MgSO4 infusion improves the clinical outcome in patients after aneurysmal SAH; however, MgSO4 infusion may theoretically exacerbate electrolyte disturbance. ⋯ Hyperkalemia was uncommon in both groups. There was also no statistically significant difference between the two groups when the data were re-analyzed as severe hyponatremia, severe hypokalemia and severe hyperkalemia. Magnesium sulfate infusion was safe and did not seem to exacerbate the duration of electrolyte disturbance associated with aneurysmal subarachnoid hemorrhage.
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The metabolic syndrome is a cluster of common pathologies: abdominal obesity linked to an excess of visceral fat, insulin resistance, dyslipidemia and hypertension. This syndrome is occurring at epidemic rates, with dramatic consequences for human health worldwide, and appears to have emerged largely from changes in our diet and reduced physical activity. An important but not well-appreciated dietary change has been the substantial increase in fructose intake, which appears to be an important causative factor in the metabolic syndrome. ⋯ Potential mechanisms include the priming of phagocytic cells, the opening of calcium channels, activation of N-methyl-D-aspartate (NMDA) receptors, the activation of nuclear factor-kappaB (NFkB) and activation of the renin-angiotensin system. Since magnesium deficiency has a pro-inflammatory effect, the expected consequence would be an increased risk of developing insulin resistance when magnesium deficiency is combined with a high-fructose diet. Accordingly, magnesium deficiency combined with a high-fructose diet induces insulin resistance, hypertension, dyslipidemia, endothelial activation and prothrombic changes in combination with the upregulation of markers of inflammation and oxidative stress.