This document summarizes a study on hypomagnesemia (low magnesium levels) in critically ill patients in the ICU. The study found:
1. The incidence of hypomagnesemia in critically ill patients admitted to the ICU was 23.96%.
2. Patients whose hypomagnesemia was routinely corrected through IV magnesium supplementation had shorter ICU stays, shorter duration of mechanical ventilation, and lower mortality compared to a previous group of patients where magnesium levels were not routinely checked or corrected.
3. Correcting hypomagnesemia resulted in a statistically significant reduction in overall ICU mortality from 39.6% to 22.9%.
Study of serum magnesium and fasting blood glucose in hypertensioniosrjce
A study was carried out to determine the fasting blood glucose and serum magnesium levels in
patients with hypertension. A total of 80 hypertensive patients were evaluated, of which, 58 were males and 22
were females. The mean ages of male and female hypertensive subjects were 48.06±6.53 and 50.83±7.62
respectively. Hypomagnesemia was observed in 61.25% subjects and raised fasting blood glucose was identified
in 55.1% of individuals. Therefore occurrence of low serum magnesium and raised blood sugar level in patients
with hypertension was observed
This study aimed to evaluate the effects of intensive insulin therapy versus conventional insulin therapy on outcomes of patients admitted to a medical intensive care unit (ICU) who were expected to require at least 3 days of intensive care. The study found that intensive insulin therapy reduced morbidity but did not significantly reduce mortality among all 1200 patients. However, among the 386 patients who remained in the ICU for at least 3 days, intensive insulin therapy reduced morbidity and mortality by accelerating weaning from ventilation, earlier ICU and hospital discharge, and reduced mortality beyond 5 days in the ICU. Larger multicenter trials were recommended to confirm these results.
The document discusses the role of peroxisome proliferator activated receptor gamma (PPARγ) agonists in treating type 2 diabetes and reducing cardiovascular risk. PPARγ agonists like thiazolidinediones improve insulin sensitivity and have beneficial effects on lipids, inflammation, and vascular cell proliferation. They may reduce cardiovascular events in type 2 diabetes through these metabolic and anti-inflammatory mechanisms. However, PPARγ agonists can also cause side effects like fluid retention, weight gain, and congestive heart failure, so their risks and benefits must be carefully weighed.
This study investigated the effects of intensive glucose control versus conventional glucose control in critically ill patients admitted to the ICU. Over 6000 patients were randomly assigned to either a tight glucose control target of 81-108 mg/dL or a more conventional target of 180 mg/dL or less. The primary outcome was all-cause mortality within 90 days. Results showed that intensive glucose control was associated with a higher mortality rate compared to conventional control, with 27.5% of patients in the intensive group dying compared to 24.9% in the conventional group. Intensive control also significantly increased the risk of severe hypoglycemia.
This study investigated cardiovascular and gastrointestinal outcomes in clopidogrel users who were also taking proton pump inhibitors (PPIs) using a large cohort of patients in the Netherlands. The study found that clopidogrel users who were also taking PPIs had a 75% higher risk of cardiovascular events compared to clopidogrel-only users. However, the study had limitations such as channeling bias since PPI users had more risk factors, and residual confounding since important risk factors could not be adjusted for. While providing useful insights, the study's findings on the risks of PPI co-administration should be interpreted cautiously due to its limitations.
Transplantation of Autologous Bone Marrow- Derived Stromal Cells in Type 2 Di...CrimsonpublishersITERM
Type 2 Diabetes is a debilitating metabolic disorder which is also the seventh leading cause of death worldwide. Current therapeutic regimes to date have failed to achieve significant long-term glycemic control even with intensive insulin therapy as revealed by deregulated Hb1Ac and C-peptides levels. In the current study, we have evaluated the effect of regenerative cellular therapy for functional recovery from Diabetic pathophysiology. 10 patients with a median age of 51 years were selected for the study and subjected to bone marrow isolation. These samples were processed under sterile conditions for the enrichment of mononuclear cells (BM MNCs) from bone marrow. After strict quality control and characterization of cells, 2 x 106 cells/kg of BM MNCs were infused back into the patient through the anterior pancreaticoduodenal artery. We performed an evaluation of clinical parameters like Body Mass Index, Fasting Plasma Glucose, Fasting Plasma Insulin, HbA1c and C-peptide levels, and followed up the patients for 12 months. Our study showed a reduction in insulin dependency by ≥ 50%.
Erectile Dysfunction and Risk Factors in Male Peruvian Hemodialysis Patientsasclepiuspdfs
Introduction: Erectile dysfunction (ED) is a common condition in patients with renal disease, but little is known about the prevalence of ED in some specific groups of patients such as Peruvian hemodialysis (HD) patients. Materials and Methods: A cross‑sectional study was conducted to determine the frequency of ED in HD patients (n = 390) in Lima, Peru. The prevalence and severity of ED were assessed using the International Index of Erectile Function with the validated Peruvian version. The dependence of ED on independent variables was evaluated by logistic regression. P ≤ 0.05 was regarded as statistically significant.
This study examined blood levels of homocysteine, vitamin B12, and folic acid in patients with metabolic syndrome compared to controls. The study found that patients with metabolic syndrome had significantly higher levels of homocysteine (2.6 times higher) and significantly lower levels of vitamin B12 (only 53% of controls) and folic acid (only 61% of controls). Lower levels of these vitamins were also associated with higher weight, BMI, blood sugar, and lipid levels. The study concludes that Indian patients with metabolic syndrome have a strong association with abnormal levels of these metabolites, suggesting they may play a greater role in Asians with metabolic syndrome than other populations.
Study of serum magnesium and fasting blood glucose in hypertensioniosrjce
A study was carried out to determine the fasting blood glucose and serum magnesium levels in
patients with hypertension. A total of 80 hypertensive patients were evaluated, of which, 58 were males and 22
were females. The mean ages of male and female hypertensive subjects were 48.06±6.53 and 50.83±7.62
respectively. Hypomagnesemia was observed in 61.25% subjects and raised fasting blood glucose was identified
in 55.1% of individuals. Therefore occurrence of low serum magnesium and raised blood sugar level in patients
with hypertension was observed
This study aimed to evaluate the effects of intensive insulin therapy versus conventional insulin therapy on outcomes of patients admitted to a medical intensive care unit (ICU) who were expected to require at least 3 days of intensive care. The study found that intensive insulin therapy reduced morbidity but did not significantly reduce mortality among all 1200 patients. However, among the 386 patients who remained in the ICU for at least 3 days, intensive insulin therapy reduced morbidity and mortality by accelerating weaning from ventilation, earlier ICU and hospital discharge, and reduced mortality beyond 5 days in the ICU. Larger multicenter trials were recommended to confirm these results.
The document discusses the role of peroxisome proliferator activated receptor gamma (PPARγ) agonists in treating type 2 diabetes and reducing cardiovascular risk. PPARγ agonists like thiazolidinediones improve insulin sensitivity and have beneficial effects on lipids, inflammation, and vascular cell proliferation. They may reduce cardiovascular events in type 2 diabetes through these metabolic and anti-inflammatory mechanisms. However, PPARγ agonists can also cause side effects like fluid retention, weight gain, and congestive heart failure, so their risks and benefits must be carefully weighed.
This study investigated the effects of intensive glucose control versus conventional glucose control in critically ill patients admitted to the ICU. Over 6000 patients were randomly assigned to either a tight glucose control target of 81-108 mg/dL or a more conventional target of 180 mg/dL or less. The primary outcome was all-cause mortality within 90 days. Results showed that intensive glucose control was associated with a higher mortality rate compared to conventional control, with 27.5% of patients in the intensive group dying compared to 24.9% in the conventional group. Intensive control also significantly increased the risk of severe hypoglycemia.
This study investigated cardiovascular and gastrointestinal outcomes in clopidogrel users who were also taking proton pump inhibitors (PPIs) using a large cohort of patients in the Netherlands. The study found that clopidogrel users who were also taking PPIs had a 75% higher risk of cardiovascular events compared to clopidogrel-only users. However, the study had limitations such as channeling bias since PPI users had more risk factors, and residual confounding since important risk factors could not be adjusted for. While providing useful insights, the study's findings on the risks of PPI co-administration should be interpreted cautiously due to its limitations.
Transplantation of Autologous Bone Marrow- Derived Stromal Cells in Type 2 Di...CrimsonpublishersITERM
Type 2 Diabetes is a debilitating metabolic disorder which is also the seventh leading cause of death worldwide. Current therapeutic regimes to date have failed to achieve significant long-term glycemic control even with intensive insulin therapy as revealed by deregulated Hb1Ac and C-peptides levels. In the current study, we have evaluated the effect of regenerative cellular therapy for functional recovery from Diabetic pathophysiology. 10 patients with a median age of 51 years were selected for the study and subjected to bone marrow isolation. These samples were processed under sterile conditions for the enrichment of mononuclear cells (BM MNCs) from bone marrow. After strict quality control and characterization of cells, 2 x 106 cells/kg of BM MNCs were infused back into the patient through the anterior pancreaticoduodenal artery. We performed an evaluation of clinical parameters like Body Mass Index, Fasting Plasma Glucose, Fasting Plasma Insulin, HbA1c and C-peptide levels, and followed up the patients for 12 months. Our study showed a reduction in insulin dependency by ≥ 50%.
Erectile Dysfunction and Risk Factors in Male Peruvian Hemodialysis Patientsasclepiuspdfs
Introduction: Erectile dysfunction (ED) is a common condition in patients with renal disease, but little is known about the prevalence of ED in some specific groups of patients such as Peruvian hemodialysis (HD) patients. Materials and Methods: A cross‑sectional study was conducted to determine the frequency of ED in HD patients (n = 390) in Lima, Peru. The prevalence and severity of ED were assessed using the International Index of Erectile Function with the validated Peruvian version. The dependence of ED on independent variables was evaluated by logistic regression. P ≤ 0.05 was regarded as statistically significant.
This study examined blood levels of homocysteine, vitamin B12, and folic acid in patients with metabolic syndrome compared to controls. The study found that patients with metabolic syndrome had significantly higher levels of homocysteine (2.6 times higher) and significantly lower levels of vitamin B12 (only 53% of controls) and folic acid (only 61% of controls). Lower levels of these vitamins were also associated with higher weight, BMI, blood sugar, and lipid levels. The study concludes that Indian patients with metabolic syndrome have a strong association with abnormal levels of these metabolites, suggesting they may play a greater role in Asians with metabolic syndrome than other populations.
Intensive glycemic control aimed at maintaining blood glucose between 80-110 mg/dl in adult ICU patients does not reduce mortality and significantly increases the risk of hypoglycemia compared to conventional control between 140-180 mg/dl. Multiple large randomized controlled trials found no benefit to intensive control and post-hoc analyses determined hypoglycemia independently increases mortality. Current guidelines recommend insulin therapy only for blood glucose over 180 mg/dl and targeting 140-180 mg/dl range to minimize hypoglycemia risk while avoiding hyperglycemia's harmful effects.
Strict Glycemic Control in Critically ill patients: The Demise of another ver...Prof. Mridul Panditrao
Prof. Mridul M. Panditrao tries to explain the pros and cons about the good strategy, whcih became controversial and almost obsolete. He also tries to tract the whole aspect of the phenomenon and reviews/ RCTs/
Strict (Tight) Glycemic control (SGC/TGC), as it is called, was and still is a good strategy. It can be defined as maintenance of the blood glucose level in the range of 80-110 mg /dl. with help of dose variable and intensive insulin therapy (IIT). Since its introduction, there have been conflicting reports of its efficacy and complications. This resulted in slow but steady neglect of this very good idea leading to its almost complete demise.
An effort has been made in this review, to impartially analyze all the available evidence and try to find the reasons for the negative publicity which led to the neglect or worse still, the wrong use of this protocol. Some suggestions for fair and proper implementation of the strategy are put forward.
etc/
The study aimed to determine the prevalence of hypomagnesemia in critically ill medical patients and relate serum magnesium levels to patient outcomes. The prevalence of hypomagnesemia was found to be 53%. Patients with hypomagnesemia had higher mortality, longer ICU and hospital stays, higher APACHE and SOFA scores, more frequent need for mechanical ventilation, and longer ventilation duration. Hypomagnesemia was also associated with higher rates of sepsis, diabetes, and other electrolyte abnormalities. While mortality was associated with hypomagnesemia, regression analysis found that sepsis and maximum SOFA score best predicted low magnesium levels rather than mortality alone.
The DANISH trial investigated whether implanting an ICD in patients with non-ischemic heart failure reduced mortality. Over 67 months of follow-up:
1) ICD implantation did not provide an overall survival benefit compared to usual care.
2) The risk of sudden cardiac death was halved with an ICD.
3) Younger patients and those receiving CRT may benefit more from an ICD.
4) ICDs were associated with device-related complications but reduced inappropriate shocks compared to earlier studies. The trial adds to understanding ICD benefits in non-ischemic heart failure.
Nice Sugar Study - Glycemic control in the ICUshivabirdi
The NICE-SUGAR study was a large randomized controlled trial that compared intensive glucose control (80-108 mg/dL) to conventional glucose control (≤180 mg/dL) in over 6,000 critically ill patients. The study found that intensive control was associated with a higher mortality rate (27.5% vs 24.9%) and more episodes of severe hypoglycemia. No differences were seen in other outcomes like length of stay. This significant study challenged prior evidence supporting tight glucose control in the ICU and suggests current practice of more moderate control is safest.
The ACCORD study investigated whether intensive glucose lowering therapy targeting an A1C below 6% would reduce cardiovascular events more than standard therapy targeting an A1C of 7-7.9% in patients with type 2 diabetes who had existing cardiovascular disease or were at high risk. Over 10,000 patients were randomized to either intensive or standard therapy and followed for an average of 3.5 years. The intensive therapy group saw lower A1C levels but higher rates of hypoglycemia, weight gain, and fluid retention. Additionally, the intensive group had higher mortality and no reduction in major cardiovascular events compared to standard therapy. The study found that intensively lowering glucose did not provide benefit and actually increased the risk of death.
This study analyzed the prescription patterns of antihypertensive drugs prescribed to 137 patients in India to determine adherence to JNC 7 guidelines. The most frequently prescribed classes of drugs were diuretics, followed by calcium channel blockers, beta blockers, ACE inhibitors, and ARBs. Combination drug therapy was prescribed to 72% of patients, most commonly a combination of a calcium channel blocker and beta blocker. The prescription patterns were found to adhere to JNC 7 guidelines, which recommend diuretics as first-line treatment and combination therapy including a diuretic for stage 2 hypertension.
The biomarker of choice in association of dyslipidemia with osteoporosis: A c...SriramNagarajan17
This case study describes a 55-year-old male patient who presented with pain in his lower limb and was diagnosed with both dyslipidemia and osteoporosis based on his medical history and laboratory tests. He had a family history of metabolic diseases and consumed excessive alcohol. His dyslipidemia was diagnosed based on genetic predisposition and lipid profile showing low HDL and high LDL levels. His osteoporosis was diagnosed a year and a half later when he fractured his femur during a walk and was found to have low bone mineral density. The conclusion is that low HDL and high LDL levels in the lipid profile are the biomarker of choice for associating dyslipidemia with osteoporosis as these
This clinical practice guideline from the Endocrine Society provides recommendations for the diagnosis and treatment of functional hypothalamic amenorrhea (FHA). FHA is a form of chronic anovulation caused by stress, weight loss, excessive exercise or a combination thereof, rather than identifiable organic causes. The guideline recommends excluding other causes through medical history, examination and laboratory tests before diagnosing FHA. Treatment involves correcting energy imbalance through increased caloric intake and/or decreased exercise, as well as psychological support. Short-term hormone therapy may be considered if menses do not return with lifestyle changes alone.
This study investigated the effects of omega-3 fatty acids, vitamin C, and zinc supplementation individually and combined on asthma control in children. 76 children with moderate persistent asthma were randomly assigned to receive normal diet plus placebo, omega-3, zinc, vitamin C, or a combination of all three supplements over 5 phases. Asthma control was assessed using ACT scores, pulmonary function tests, and sputum inflammation markers. The combination phase showed the greatest improvement in ACT scores, lung function, and reduction of inflammatory markers compared to placebo or single supplements. This study suggests children with asthma may benefit from dietary supplementation with omega-3s, vitamin C, and zinc.
The document discusses the importance of glycemic control for hospitalized patients with diabetes or hyperglycemia. It notes that hyperglycemia is common in hospitalized patients and associated with worse outcomes. The document reviews evidence that intensive insulin therapy to maintain tight glycemic control can reduce mortality, infection rates, and length of stay in intensive care units and improve outcomes for patients with acute myocardial infarction. It discusses guidelines developed for recommended glycemic targets in hospitals.
Hyperglycemia occurs in up to 50% of ICU patients due to underlying conditions like diabetes or stress-related illnesses and steroids. Early studies found decreased mortality with intensive glucose control, but later larger trials were stopped due to lack of benefit and increased risk of hypoglycemia. While hyperglycemia can have ill effects, hypoglycemia can cause brain damage or death within minutes. Current consensus recommends liberalizing glucose control to a range of 140-180 mg/dL due to weak evidence of benefit from intensive control and risk of harm from hypoglycemia and glucose fluctuations.
This document provides guidelines for using insulin infusion to manage hyperglycemia in critically ill patients. It conducted a literature review using the GRADE methodology to evaluate the impact of insulin infusion on outcomes. The literature mostly provided weak recommendations due to unclear benefits versus risks. The guidelines suggest a target blood glucose of ≤150 mg/dL that triggers insulin treatment, and <180 mg/dL. Insulin infusion may provide a slight reduction in mortality and reductions in morbidity for certain patient groups. The guidelines provide suggestions for insulin regimens, monitoring, and processes to safely achieve glycemic control while avoiding hypoglycemia.
Journal of Schizophrenia Research is a peer-reviewed, open access journal published by Austin Publishers. It provides easy access to high quality Manuscripts in all related aspects of a mental disorder often characterized by abnormal social behavior and failure to recognize what is real with common symptoms including false beliefs, auditory hallucinations, confused or unclear thinking, inactivity, and reduced social engagement and emotional expression. The journal focuses upon the latest research in finding causes, understanding mechanisms, diagnosis, prevention, management, prognosis, epidemiology, ancestral history and treatment of schizophrenia.
Austin Publishing Group is a successful host of more than hundred peer reviewed, open access journals in various fields of science and medicine with intent to bridge the gap between academia and research access.
Journal of Schizophrenia Research accepts original research articles, review articles, case reports, mini reviews, rapid communication, opinions and editorials on all related aspects of schizophrenia including, finding causes, understanding mechanisms, diagnosis, prevention, management, prognosis, epidemiology, ancestral history and its treatment.
Basal bolus insulin therapy resulted in improved glycemic control compared to sliding scale insulin therapy for hospitalized patients with type 2 diabetes, according to the RABBIT 2 trial. The mean daily blood glucose was 27 mg/dL lower in patients receiving basal glargine plus prandial glulisine compared to those receiving sliding scale regular insulin. Both regimens resulted in a similar rate of hypoglycemia and length of hospital stay. Basal bolus insulin provided better glycemic control and achieved target blood glucose levels under 140 mg/dL in more patients than sliding scale insulin alone.
Thyroid Abnormalities in Correlation with Stage of CKD in Tribal Population o...ijtsrd
Chronic Kidney Disease is a worldwide health problem with an increasing incidence and prevalence. Abnormalities in the structure and function of the thyroid gland and in the metabolism and plasma concentration of thyroid hormones are common in patients with CKD. In view of variability of thyroid profile in CKD patients in previous studies, a prospective study of various thyroid function has been undertaken to establish a correlation if any between thyroid dysfunction and severity of renal diseases . Total number of 50 patients with Chronic Kidney Disease on conservative management fulfilling the criteria for CKD who were admitted in Department of Medicine under nephrology unit, Dr. Bhimrao Ambedkar Hospital Raipur C.G. , during the period of February 2018-March 2018 were selected in this prospective study. The result showed that out of the 50 patients with CKD 29 patients had low T3 syndrome 0.2-2.0ng ml, mean 0.67 which accounts for 58 of the patients, 12 patients had low T4 syndrome 0.5-8.5µg ml, mean 5.65 which accounts for 24 of the patients and 4 patients had primary hypothyroidism TSH 20µIU ml. Excluding Primary Hypothyroidism, analysis of serum T3, T4 and TSH in the study subjects shows very high significance, p 0.001. Thyroid Dysfunction occurred in 66 of the patients with chronic kidney disease in our study, it does not indicate a state of hypothyroidism, but a reflection of the state of chronic illness malnutrition. The low T3 state of CKD can be viewed as being protective, promoting conservation of protein. The number of patients with low T3 syndrome progressively increases with the severity of renal failure. Priya Banjare "Thyroid Abnormalities in Correlation with Stage of CKD in Tribal Population of Chhattisgarh" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-2 , February 2019, URL: https://www.ijtsrd.com/papers/ijtsrd21418.pdf
Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/21418/thyroid-abnormalities-in-correlation-with-stage-of-ckd-in-tribal-population-of-chhattisgarh/priya-banjare
This document provides guidelines for website design and content at Real Life churches. It outlines standards for pages, blogs, events, landing pages and navigation. All content must be approved by the Communications Team and adhere to branding guidelines. Stock images and templates are available to support ministry teams, and the Communications Team can be contacted for assistance or with questions.
Intensive glycemic control aimed at maintaining blood glucose between 80-110 mg/dl in adult ICU patients does not reduce mortality and significantly increases the risk of hypoglycemia compared to conventional control between 140-180 mg/dl. Multiple large randomized controlled trials found no benefit to intensive control and post-hoc analyses determined hypoglycemia independently increases mortality. Current guidelines recommend insulin therapy only for blood glucose over 180 mg/dl and targeting 140-180 mg/dl range to minimize hypoglycemia risk while avoiding hyperglycemia's harmful effects.
Strict Glycemic Control in Critically ill patients: The Demise of another ver...Prof. Mridul Panditrao
Prof. Mridul M. Panditrao tries to explain the pros and cons about the good strategy, whcih became controversial and almost obsolete. He also tries to tract the whole aspect of the phenomenon and reviews/ RCTs/
Strict (Tight) Glycemic control (SGC/TGC), as it is called, was and still is a good strategy. It can be defined as maintenance of the blood glucose level in the range of 80-110 mg /dl. with help of dose variable and intensive insulin therapy (IIT). Since its introduction, there have been conflicting reports of its efficacy and complications. This resulted in slow but steady neglect of this very good idea leading to its almost complete demise.
An effort has been made in this review, to impartially analyze all the available evidence and try to find the reasons for the negative publicity which led to the neglect or worse still, the wrong use of this protocol. Some suggestions for fair and proper implementation of the strategy are put forward.
etc/
The study aimed to determine the prevalence of hypomagnesemia in critically ill medical patients and relate serum magnesium levels to patient outcomes. The prevalence of hypomagnesemia was found to be 53%. Patients with hypomagnesemia had higher mortality, longer ICU and hospital stays, higher APACHE and SOFA scores, more frequent need for mechanical ventilation, and longer ventilation duration. Hypomagnesemia was also associated with higher rates of sepsis, diabetes, and other electrolyte abnormalities. While mortality was associated with hypomagnesemia, regression analysis found that sepsis and maximum SOFA score best predicted low magnesium levels rather than mortality alone.
The DANISH trial investigated whether implanting an ICD in patients with non-ischemic heart failure reduced mortality. Over 67 months of follow-up:
1) ICD implantation did not provide an overall survival benefit compared to usual care.
2) The risk of sudden cardiac death was halved with an ICD.
3) Younger patients and those receiving CRT may benefit more from an ICD.
4) ICDs were associated with device-related complications but reduced inappropriate shocks compared to earlier studies. The trial adds to understanding ICD benefits in non-ischemic heart failure.
Nice Sugar Study - Glycemic control in the ICUshivabirdi
The NICE-SUGAR study was a large randomized controlled trial that compared intensive glucose control (80-108 mg/dL) to conventional glucose control (≤180 mg/dL) in over 6,000 critically ill patients. The study found that intensive control was associated with a higher mortality rate (27.5% vs 24.9%) and more episodes of severe hypoglycemia. No differences were seen in other outcomes like length of stay. This significant study challenged prior evidence supporting tight glucose control in the ICU and suggests current practice of more moderate control is safest.
The ACCORD study investigated whether intensive glucose lowering therapy targeting an A1C below 6% would reduce cardiovascular events more than standard therapy targeting an A1C of 7-7.9% in patients with type 2 diabetes who had existing cardiovascular disease or were at high risk. Over 10,000 patients were randomized to either intensive or standard therapy and followed for an average of 3.5 years. The intensive therapy group saw lower A1C levels but higher rates of hypoglycemia, weight gain, and fluid retention. Additionally, the intensive group had higher mortality and no reduction in major cardiovascular events compared to standard therapy. The study found that intensively lowering glucose did not provide benefit and actually increased the risk of death.
This study analyzed the prescription patterns of antihypertensive drugs prescribed to 137 patients in India to determine adherence to JNC 7 guidelines. The most frequently prescribed classes of drugs were diuretics, followed by calcium channel blockers, beta blockers, ACE inhibitors, and ARBs. Combination drug therapy was prescribed to 72% of patients, most commonly a combination of a calcium channel blocker and beta blocker. The prescription patterns were found to adhere to JNC 7 guidelines, which recommend diuretics as first-line treatment and combination therapy including a diuretic for stage 2 hypertension.
The biomarker of choice in association of dyslipidemia with osteoporosis: A c...SriramNagarajan17
This case study describes a 55-year-old male patient who presented with pain in his lower limb and was diagnosed with both dyslipidemia and osteoporosis based on his medical history and laboratory tests. He had a family history of metabolic diseases and consumed excessive alcohol. His dyslipidemia was diagnosed based on genetic predisposition and lipid profile showing low HDL and high LDL levels. His osteoporosis was diagnosed a year and a half later when he fractured his femur during a walk and was found to have low bone mineral density. The conclusion is that low HDL and high LDL levels in the lipid profile are the biomarker of choice for associating dyslipidemia with osteoporosis as these
This clinical practice guideline from the Endocrine Society provides recommendations for the diagnosis and treatment of functional hypothalamic amenorrhea (FHA). FHA is a form of chronic anovulation caused by stress, weight loss, excessive exercise or a combination thereof, rather than identifiable organic causes. The guideline recommends excluding other causes through medical history, examination and laboratory tests before diagnosing FHA. Treatment involves correcting energy imbalance through increased caloric intake and/or decreased exercise, as well as psychological support. Short-term hormone therapy may be considered if menses do not return with lifestyle changes alone.
This study investigated the effects of omega-3 fatty acids, vitamin C, and zinc supplementation individually and combined on asthma control in children. 76 children with moderate persistent asthma were randomly assigned to receive normal diet plus placebo, omega-3, zinc, vitamin C, or a combination of all three supplements over 5 phases. Asthma control was assessed using ACT scores, pulmonary function tests, and sputum inflammation markers. The combination phase showed the greatest improvement in ACT scores, lung function, and reduction of inflammatory markers compared to placebo or single supplements. This study suggests children with asthma may benefit from dietary supplementation with omega-3s, vitamin C, and zinc.
The document discusses the importance of glycemic control for hospitalized patients with diabetes or hyperglycemia. It notes that hyperglycemia is common in hospitalized patients and associated with worse outcomes. The document reviews evidence that intensive insulin therapy to maintain tight glycemic control can reduce mortality, infection rates, and length of stay in intensive care units and improve outcomes for patients with acute myocardial infarction. It discusses guidelines developed for recommended glycemic targets in hospitals.
Hyperglycemia occurs in up to 50% of ICU patients due to underlying conditions like diabetes or stress-related illnesses and steroids. Early studies found decreased mortality with intensive glucose control, but later larger trials were stopped due to lack of benefit and increased risk of hypoglycemia. While hyperglycemia can have ill effects, hypoglycemia can cause brain damage or death within minutes. Current consensus recommends liberalizing glucose control to a range of 140-180 mg/dL due to weak evidence of benefit from intensive control and risk of harm from hypoglycemia and glucose fluctuations.
This document provides guidelines for using insulin infusion to manage hyperglycemia in critically ill patients. It conducted a literature review using the GRADE methodology to evaluate the impact of insulin infusion on outcomes. The literature mostly provided weak recommendations due to unclear benefits versus risks. The guidelines suggest a target blood glucose of ≤150 mg/dL that triggers insulin treatment, and <180 mg/dL. Insulin infusion may provide a slight reduction in mortality and reductions in morbidity for certain patient groups. The guidelines provide suggestions for insulin regimens, monitoring, and processes to safely achieve glycemic control while avoiding hypoglycemia.
Journal of Schizophrenia Research is a peer-reviewed, open access journal published by Austin Publishers. It provides easy access to high quality Manuscripts in all related aspects of a mental disorder often characterized by abnormal social behavior and failure to recognize what is real with common symptoms including false beliefs, auditory hallucinations, confused or unclear thinking, inactivity, and reduced social engagement and emotional expression. The journal focuses upon the latest research in finding causes, understanding mechanisms, diagnosis, prevention, management, prognosis, epidemiology, ancestral history and treatment of schizophrenia.
Austin Publishing Group is a successful host of more than hundred peer reviewed, open access journals in various fields of science and medicine with intent to bridge the gap between academia and research access.
Journal of Schizophrenia Research accepts original research articles, review articles, case reports, mini reviews, rapid communication, opinions and editorials on all related aspects of schizophrenia including, finding causes, understanding mechanisms, diagnosis, prevention, management, prognosis, epidemiology, ancestral history and its treatment.
Basal bolus insulin therapy resulted in improved glycemic control compared to sliding scale insulin therapy for hospitalized patients with type 2 diabetes, according to the RABBIT 2 trial. The mean daily blood glucose was 27 mg/dL lower in patients receiving basal glargine plus prandial glulisine compared to those receiving sliding scale regular insulin. Both regimens resulted in a similar rate of hypoglycemia and length of hospital stay. Basal bolus insulin provided better glycemic control and achieved target blood glucose levels under 140 mg/dL in more patients than sliding scale insulin alone.
Thyroid Abnormalities in Correlation with Stage of CKD in Tribal Population o...ijtsrd
Chronic Kidney Disease is a worldwide health problem with an increasing incidence and prevalence. Abnormalities in the structure and function of the thyroid gland and in the metabolism and plasma concentration of thyroid hormones are common in patients with CKD. In view of variability of thyroid profile in CKD patients in previous studies, a prospective study of various thyroid function has been undertaken to establish a correlation if any between thyroid dysfunction and severity of renal diseases . Total number of 50 patients with Chronic Kidney Disease on conservative management fulfilling the criteria for CKD who were admitted in Department of Medicine under nephrology unit, Dr. Bhimrao Ambedkar Hospital Raipur C.G. , during the period of February 2018-March 2018 were selected in this prospective study. The result showed that out of the 50 patients with CKD 29 patients had low T3 syndrome 0.2-2.0ng ml, mean 0.67 which accounts for 58 of the patients, 12 patients had low T4 syndrome 0.5-8.5µg ml, mean 5.65 which accounts for 24 of the patients and 4 patients had primary hypothyroidism TSH 20µIU ml. Excluding Primary Hypothyroidism, analysis of serum T3, T4 and TSH in the study subjects shows very high significance, p 0.001. Thyroid Dysfunction occurred in 66 of the patients with chronic kidney disease in our study, it does not indicate a state of hypothyroidism, but a reflection of the state of chronic illness malnutrition. The low T3 state of CKD can be viewed as being protective, promoting conservation of protein. The number of patients with low T3 syndrome progressively increases with the severity of renal failure. Priya Banjare "Thyroid Abnormalities in Correlation with Stage of CKD in Tribal Population of Chhattisgarh" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-2 , February 2019, URL: https://www.ijtsrd.com/papers/ijtsrd21418.pdf
Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/21418/thyroid-abnormalities-in-correlation-with-stage-of-ckd-in-tribal-population-of-chhattisgarh/priya-banjare
This document provides guidelines for website design and content at Real Life churches. It outlines standards for pages, blogs, events, landing pages and navigation. All content must be approved by the Communications Team and adhere to branding guidelines. Stock images and templates are available to support ministry teams, and the Communications Team can be contacted for assistance or with questions.
ALTEO is a global company that provides business advisory, corporate finance, innovation, and assets management services. It has operations in West Africa, the Middle East, Europe, and India. ALTEO is transitioning from a business advisory model to an innovative assets management model. The company's founder, Franck Berthod, has over 25 years of international experience in strategic advisory, corporate restructuring, innovation, and entrepreneurship mentoring.
ТВОРЧЕСКИЙ ПРОЕКТ КО ДНЮ 8 МАРТА
В подготовительной к школе группе.
Данный проект представлен в форме презентации, которая будет интересна педагогам-дошкольникам и учителям начальных классов, руководителям творческих кружков и родителям.
Всё в саду шумит, поёт,
Мамин праздник настаёт!
Нужно нам обговорить,
Мамам будем что дарить?
Не секрет, что все мамы больше всего на свете любят своих детей! А ещё они любят цветы! Поэтому долго придумывать, «что бы такое подарить нашим мамам» нам не пришлось!
Мы изготовили для них яркие картинки-открытки.
В презентации обозначены цель и основные задачи проекта, представлен подробный мастер-класс изготовления необычной открытки, а так же самые яркие моменты творческого процесса и конечный результат нашей деятельности. Все участники получили эмоциональный заряд радости и хорошего настроения, а подарок, выполненный с теплом и добрыми чувствами обязательно должен понравиться нашим мамам!
Salajit Salajitt A Presentation By Mr Allah Dad Khan Former Director General...Mr.Allah Dad Khan
Salajit Salajitt A Presentation By Mr Allah Dad Khan Former Director General Agriculture Extension KPK Province and Visiting Professor the University of Agriculture Peshawar Pakistan
1) Facials provide several skin benefits such as increasing blood flow, making the skin more flexible, tightening muscles, removing blackheads and whiteheads, and creating cleaner, softer skin.
2) When giving a facial, the first steps are to have the recipient wear a gown and scarf, and place towels under the neck. Apply cleansing cream and clean the face with cotton wool.
3) Apply cold cream and massage in upward motions from the bottom of the face to the forehead, nose, and cheeks using fingers in specific sequences as shown in pictures for a thorough facial.
Specialty crops for high tunnel production A Presentation By Mr Allah Dad Kha...Mr.Allah Dad Khan
Specialty crops for high tunnel production A Presentation By Mr Allah Dad Khan Former Director General Agriculture Extension KPK Province and Visiting Professor the University of Agriculture Peshawar Pakistan
This document appears to be in a language other than English. As an AI system, I do not have the capability to understand or summarize text in other languages. I can only summarize documents written in English.
[FW Invest Février] Plus de 118 millions d’euros investis dans la Tech frança...FrenchWeb.fr
Après un mois de janvier marqué par des opérations exceptionnelles, les investissements dans la Tech française ne tarissent pas en février, selon l'indicateur FrenchWeb Invest. Au total, 118,3 millions d'euros ont en effet été investis dans le secteur, soit 12% de plus qu'en février 2016. Si les montants investis sont en hausse, le nombre d'opérations recensées (41 au total, contre 49 en février 2016) est quant à lui en baisse de 16%. Le ticket moyen, à 2,9 millions d'euros, augmente mécaniquement.
Garlic is very beneficial vegetable Garlic benefits in details vegetables with reference of the researches on vegetables foods you can get many information from this slide about garlic
This randomized controlled trial evaluated glycemic durability of rosiglitazone, metformin, and glyburide monotherapy in patients with recently diagnosed type 2 diabetes over 4 years. The primary outcome was time to treatment failure defined as fasting plasma glucose >180 mg/dL. Rosiglitazone showed a lower risk of treatment failure compared to metformin (32% lower) and glyburide (63% lower). Glyburide was associated with a lower risk of cardiovascular events than rosiglitazone, while metformin had a similar risk profile to rosiglitazone. All drugs showed differing adverse event profiles.
Anaemia in Chronic Renal Failure Patients Undergoing Haemodialysis: A across ...Neeleshkumar Maurya
ABSTRACT Chronic renal failure disease is frequently associated with anaemia and the level of anaemia correlates with the stage of chronic kidney disease (CKD). A cross-sectional study was conducted in 44 chronic kidney disease patients in the department of medicine, M.L.B. Medical College, Jhansi during the period January to June, 2018. The study was evaluating the profile of anaemia and to find the association between the severity of anaemia and ckd-5 patients time period of taking on haemodialysis. Haemoglobin, blood urea, serum albumin, serum creatinine levels were examined using standard techniques. There was a significant difference in the haemoglobin of CKD patients taking 30 days regular interval 3 times values (P <0.05). All 44 patients (100%) were anaemic there was no significant correlation between the severity of anaemia and serum creatinine levels (P > 0.82) the most frequent anaemia in chronic kidney disease patients was a malnourished type of a moderate degree anaemic (7 10mg/dl). A significant correlation was not found between the severity of anomie and serum creatinine levels 30 day interval of CKD of patients on haemodialysis. Keywords: - haemodialysis, anomie, serum creatinine, haemoglobin, malnutrition.
This journal club discussion summarizes a randomized controlled trial that compared the glucose-lowering drug rosiglitazone to metformin and glyburide in patients with recently diagnosed type 2 diabetes. The study was well-designed, experimental in nature, and included over 4,000 patients followed for a median of 4 years. The primary outcome was time to monotherapy failure based on fasting glucose levels. The results showed that rosiglitazone delayed monotherapy failure better than the other drugs and had a lower incidence of progression to higher fasting glucose levels. However, the study also reported some safety concerns with rosiglitazone like increased risk of heart failure. Overall, the discussant found the study to be valid and that the
ABSTRACT- Background: Esophageal and Lung carcinoma are the leading cause of years of life lost because of cancer and is associated with the highest economic burden relative to other tumor types. Epidemiological studies identify magnesium deficiency as a risk factor for these types of human cancers. The present studies were performed to concerning the contribution of magnesium to tumorigenesis and investigate the concentration of magnesium in esophageal and lung carcinoma.
Aims and Objective: The aim of this study was to compare the serum magnesium levels of patients with carcinoma of lung and esophagus patients and apparently healthy people.
Material and methods: Study group consisted of 50 clinically diagnosed subjects (Biopsy confirmed 25 cases with Esophageal carcinoma and 25 cases with Lung carcinoma). The control group consisted of 50 healthy subjects were included in the study. Venous blood samples of each lung and esophagus cancer were obtained and serum magnesium level was measured by Atomic Absorption Spectrophotometer measurements.
Results: In the study group, we were found mean concentration of serum magnesium was decreased in esophageal (1.40±0.13 mg %) and lung carcinoma (1.23±0.12 mg %) in comparison to controls (2.08 ± 0.45 mg %).
Conclusions: Serum magnesium was found statistically significantly lower in study group when compared with control (P<0.0001).
Key-words- Lung and Esophagus Carcinoma, Magnesium, Atomic absorption spectrophotometer
Obesity and hyperlipidemia is international /worldwide problem causing heart disease leading to major predisposing factor for morbidity and death. Conventional medicine used in allopathy include statins, fibrates, niacin and resins but are going to defame due to their adverse effects. Herbal medicine ginger has proved itself as one of the potent anti hyperlipidemic and anti obesity herb with least adverse effects. We did try to compare its hypolipidemic effects with placebo effects when used in mild to moderate hyperlipidemic patients. It was placebo-controlled single blind research study. Research was conducted at National hospital, Lahore, from July to November 2016. Consent was taken from sixty hyperlipidemic patients age range from 25 to 60 years. Both gender male and female patients were enrolled. Patients were randomly divided in two groups, 30 patients were on drug ginger pasted-powder advised to take 5 grams in divided doses with their normal diet for the period of three months. Thirty patients were on placebo pasted-wheat powder, with same color as of ginger powder, advised to take 5 grams in divided doses with their normal diet for the period of three months. Their base line lipid profile and body weight was recorded at start of treatment and were advised to come for check-up, fortnightly.
International Journal of Medical Science in Clinical Research and Review Vol 03, Issue 02,April – 2020 Page |
229
When duration of study was over, their lipid profile and body weight was measured and compared statistically with pre-treatment values. Three months treatment with 5 grams of ginger decreased total cholesterol from 233.11±1.53 mg/dl to 198.44±1.23 mg/dl, LDL cholesterol reduced from 202.21±1.88 mg/dl to 187.72± 1.98 mg/dl, reduced body weight from 76.01±2.66 kg to 72.80±1.87 kg. Both plasma total cholesterol and LDL cholesterol reduction was statistically significant, but body weight decrease was non-significant when analyzed biostatistically.
Thyroid dysfunction and insulin resistance journal ppt.pptxSyedFurqan30
This study examined the relationship between thyroid dysfunction and insulin resistance by comparing insulin resistance levels in hyperthyroid, hypothyroid, and euthyroid patients. The results showed that hypothyroid patients had the highest levels of insulin and insulin resistance as measured by HOMA-IR. Hyperthyroid patients also had higher levels than euthyroid patients. Specifically, hypothyroid patients showed a positive correlation between TSH levels and insulin resistance, while hyperthyroid patients showed a correlation between FT3 levels and insulin resistance. The study concluded that thyroid disorders are associated with greater insulin resistance and risk of cardiovascular and metabolic abnormalities.
Intensive glucose control in critically ill patients offers no benefit and increases risk of harm. A meta-analysis of 27 randomized trials involving over 17,000 critically ill adults found that intensive glucose control, aimed at tightly regulating blood glucose levels between 80-110 mg/dL, provided no reduction in mortality or other clinical benefits compared to conventional control between 140-180 mg/dL. However, intensive control was associated with a 8.3% higher risk of severe hypoglycemia. Current guidelines recommend conventional glucose control for critically ill patients experiencing persistent hyperglycemia based on the lack of benefit and risk of harm from intensive control.
Rice bran is fabricated from the rice milling enterprise and contains about 10% of the entire weight of rough rice. It is especially composed of aleurone, pericarp, subaleurone layer, and germ. Rice bran is a fertile supply of nutrients, minerals, vital fatty acids, dietary fiber, and different sterols. The quantification of γ-oryzanol in rice bran can be conducted by many methods that require drawing out of rice bran oil (RBO) from the bran, accompanied by way of evaluation of the quantity of γ-oryzanol in the RBO with the aid of high-performance liquid chromatography. RBO is the oil drain out of the outer rigid surface of rice called chaff (rice husk). It is identified for its excessive smoke factor of 232°C (450°F) and soft taste, making it pleasant for excessive-temperature cooking strategies such as blend and deep frying. It is healthy for human expenditure, which is employed in the system of vegetable ghee. Wax was drawn out of RBO and palpanese extract, which is employed for carnauba wax in makeup, confectionery, shoe lotions, and sharpening compounds. It is accepted as a food preparation oil in numerous Asian countries, along with Bangladesh, Japan, India, and China. Regarding the importance of RBO, this overview intends to pay attention at the phytochemistry and therapeutic functions of RBO.
Journal club solid organ transplant (New Onset Diabetes)Daniel Le
This study compared the risk of new onset diabetes after transplantation (NODAT) in kidney transplant recipients receiving either early corticosteroid withdrawal (CSWD) or chronic corticosteroid (CCS) therapy. Over 5 years of follow up:
- There was no difference in patient survival or graft loss between the CSWD and CCS groups.
- Rates of death and graft loss were also not different for those with or without NODAT.
- However, insulin use was significantly higher at 5 years in the CCS group (11.1%) compared to the CSWD group (6.3%).
- For the other 8 definitions of NODAT, there were no significant differences
Tirzepatide versus Semiglutide Once Weekly in Patients with Type 2 Diabetes.pdfHaramaya University
This randomized controlled trial compared the efficacy and safety of three doses of tirzepatide (5 mg, 10 mg, and 15 mg), a dual GLP-1 and GIP receptor agonist, to semaglutide (1 mg), a GLP-1 receptor agonist, in 1879 patients with type 2 diabetes inadequately controlled with metformin alone. The primary outcome was the change in HbA1c from baseline to 40 weeks. Key secondary outcomes included changes in body weight and achievement of HbA1c targets. Tirzepatide at all doses resulted in greater reductions in HbA1c and body weight compared to semaglutide and was found to be noninferior and
This randomized, double-blind, placebo-controlled crossover clinical trial studied the effects of coenzyme Q10 supplementation on oxidative stress and antioxidant enzyme activity in glazers occupationally exposed to cadmium. 40 male glazers were randomly assigned to receive either coenzyme Q10 (60 mg twice daily) or placebo for 2 months, with a 1-month washout period in between. The study measured markers of oxidative stress and antioxidant enzyme activity at baseline and after each treatment period. The results showed that coenzyme Q10 supplementation significantly reduced oxidative stress markers and improved antioxidant enzyme activity compared to placebo.
The DCCT trial showed that intensive diabetes management reduced the risk of eye, kidney, and nerve complications compared to standard management. Intensive therapy aimed for blood glucose levels between 70-120 mg/dl, while standard therapy aimed to avoid symptoms of high or low blood glucose. The risks of intensive therapy were increased hypoglycemia and weight gain. The follow up EDIC study found metabolic memory effects, with long term benefits of early intensive control.
1) The study measured blood levels of anandamide, an endogenous cannabinoid, in patients undergoing general anesthesia with either sevoflurane or propofol.
2) Anandamide levels significantly declined over time in patients who received sevoflurane, but remained stable in patients who received propofol.
3) This suggests that general anesthesia influences the endocannabinoid system in a drug-dependent manner, which may explain differences in side effects between volatile and intravenous anesthetics.
This document summarizes landmark trials in the treatment of lupus nephritis over 50 years. Early trials in the 1960s established the benefit of high-dose steroids over low-dose. The 1986 NIH trial showed intravenous cyclophosphamide reduced end-stage renal failure compared to oral steroids alone. Subsequent trials tested maintenance therapies like mycophenolate mofetil versus azathioprine, and induction therapies like belimumab and voclosporin. Recent trials explored rituximab and found benefits without oral steroids. While treatment has improved over decades of research, heterogeneity remains a challenge in lupus nephritis clinical trials.
Early Goal-Directed Therapy in Septic Shockshivabirdi
Early goal directed therapy (EGDT) aims to balance oxygen delivery and demand through manipulating cardiac preload, afterload and contractility using measures like lactate, base deficit and ScvO2. A study of 263 patients with severe sepsis or septic shock found that those receiving EGDT in the emergency department for at least 6 hours had significantly lower in-hospital, 28-day and 60-day mortality compared to standard therapy. EGDT also resulted in fewer organ dysfunctions, less coagulation abnormalities and cardiovascular collapse.
This study analyzed prescription claims data from 238,402 patients with type 2 diabetes to identify predictors of changes in adherence to oral antidiabetes medications between years. The study found that about one third of patients changed adherence status from one year to the next, with about 22% becoming nonadherent after being adherent previously. For those who became nonadherent, the strongest predictors were the number of 90-day prescriptions filled, diabetes medication burden, longest gap in filling prescriptions, number of antidiabetes drug classes used, and copay for last drug. For those who became adherent after being nonadherent, the top predictors were medication burden, prescription gaps, fluctuating adherence, 90-day prescript
Background: One of the commonest complications of poorly controlled Type 2 diabetes mellitus (T2DM) is Diabetic nephropathy (DN), which occurs in 30-40% of DM cases. It is important to identify the high-risk group who are likely to develop DN with the modifiable and non-modifiable risk factors. This study had the objectives to estimate and correlate the levels of the urine albumin creatinine ratio (UACR) with age, anthropometric measures, glycaemic control markers, lipids, and renal function. To estimate each variable as independent and multivariate risk factors.
Materials and Methods: It was an observational and cross-sectional study conducted in a tertiary care center in Eastern India. Totally, 221 consecutive ambulatory T2DM subjects were recruited after obtaining their written consent.
Results: The diabetics were classified as having diabetic nephropathy by the urine albumin creatinine ratio (ACR) of >30 mg/gm. 53.4% of our study group had DN. There was a significant risk associated with PPBS with p=0.043 (<0.05), serum creatinine with p=0.032 (<0.05), and urine albumin with p=0.0001 (<0.001). In the multivariate regression analysis of all these variables, there was a highly significant likelihood ratio for predicting DN with p=0.0001 (<0.001) with a predictive value of 74.5% in females and 75% in males.
Conclusion: The additive factors contributed by the risk factors in the prediction of DN will benefit the DM in the prevention of DN.
Keywords: diabetic nephropathy, risk factors, diabetic kidney disease, Asian Indian
Microalbuminuria in Saudi Adults with Type 1 Diabetes Mellitus_Crimson Publis...CrimsonPublishersIOD
Background: Diabetes mellitus is among the most common chronic non-communicable diseases. The development of microalbuminuria in type 1 diabetes increases the risk for renal and cardiovascular disease.
Methods: A cross sectional study was conducted at the Primary Health Care Clinics at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. A total of 334 Saudi with type 1 diabetes were randomly selected.
Results: Total of 334 patients with T2DM included in this study; 102 (30.5%) male and 232 (69.5%) female with mean age 25.8±3.4. MA was present in 99 (29.6%). MA was not significantly more prevalent in female (69.4%) with female predominance (sex ratio male: female) 1:2.3. HTN with MA was significantly more prevalent in 51(51.5%) of MA group with odd ratio 1.7 (1.2-2.4), p=0.001 with no siginificant difference between both gender. Patients with MA have significant higher HbA1c than patients with normal buminuria and there was a significant difference between gender (p< 0.0001) and when compared to HbA1c groups (p=0.002).
Conclusion: The frequency of microalbuminuria in patients with type 1 diabetes in this study is high. It is mandatory to have adequate diagnostic, therapeutic and educational resources in addition to competent physicians who can manage microalbuminuria in diabetic patients by using a continuing, comprehensive and coordinated approach.
Rivaroxaban with or without aspirin in patients with stable peripheral or car...Bhargav Kiran
Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial
Vitamin D plays an important role in cardiovascular health beyond just calcium and bone metabolism. It has three main cardiovascular effects: 1) it maintains a balance between pro- and anti-inflammatory cytokines, 2) it decreases endothelial cell apoptosis and promotes proliferation, and 3) it is associated with the renin-angiotensin-aldosterone system. While observational studies show associations between low vitamin D levels and cardiovascular risk factors like dyslipidemia, randomized controlled trials findings have been contradictory. Both deficiency and excess of vitamin D can lead to vascular calcification and atherosclerosis. Low vitamin D has also been associated with higher rates of hypertension, heart failure, and diabetes; however, supplementation trials have not clearly shown cardiovascular benefits.
Nejm Effects of Aspirin for Primary Prevention in Persons with Diabetes MellitusBhargav Kiran
This document summarizes the results of the ASCEND trial, which investigated the effects of low-dose aspirin (100 mg daily) for primary prevention of cardiovascular events in 15,480 adults with diabetes but no history of cardiovascular disease. Over a mean follow-up of 7.4 years:
- Serious vascular events were lower in the aspirin group (8.5%) compared to placebo (9.6%), but major bleeding events were higher with aspirin (4.1% vs 3.2%).
- There was no significant difference in gastrointestinal cancer rates between groups.
- Aspirin prevented some vascular events but increased bleeding, largely offsetting the benefits. The absolute risks and benefits were closely balanced
This document summarizes a randomized controlled trial that investigated whether stable patients with infective endocarditis could be safely treated with oral antibiotics rather than continued intravenous antibiotics. The trial involved 400 patients across multiple centers in Denmark who had infective endocarditis of the left heart caused by common bacterial species. Patients received either continued intravenous antibiotics according to guidelines or a partial oral antibiotic treatment regimen. The primary outcome was to show non-inferiority of oral treatment. Results showed that oral antibiotic treatment was found to be non-inferior to continued intravenous treatment for stable patients.
This document provides information on cardiovascular symptoms, signs, and disease evaluation and management. It discusses:
1) Common cardiac symptoms like chest pain, palpitations, and dyspnea and what conditions they can indicate.
2) A comprehensive cardiac examination involves assessing the patient's general appearance, skin, head and neck, chest, abdomen, and extremities as well as measuring vital signs like jugular venous pressure and blood pressure.
3) Establishing a cardiac diagnosis involves considering etiology, anatomical abnormalities, physiological disturbances, and functional disability based on history, physical exam, ECG, imaging, and other tests. Management depends on whether heart disease is present and its severity.
The document discusses various focal cerebral disorders related to language and memory. It describes the left perisylvian network that is critical for language abilities. Key areas include Broca's area in the inferior frontal gyrus and Wernicke's area in the posterior temporal lobe. Damage to this network can cause different types of aphasias, depending on the location of the lesion. It also discusses networks related to spatial orientation, object recognition, memory, and executive function. Assessment of language abilities including naming, speech, comprehension, repetition, reading, and writing is described. Various aphasia types such as Wernicke's, Broca's, conduction, and anomic aphasia are summarized. Other disorders
This document discusses various symptoms related to cardiovascular and respiratory systems. It defines palpitations as a sensation of irregular heartbeat and lists potential cardiac, psychiatric and miscellaneous causes. Dyspnea is defined as subjective breathing discomfort that can vary in intensity. Cough is described as an essential protective function, with excessive coughing having potential complications. The mechanism of cough and types based on duration are outlined. Hypoxia and its effects on cells, cardiovascular system and central nervous system are summarized. Various causes of hypoxia including respiratory, anemic, carbon monoxide poisoning and more are listed with brief descriptions.
Balanced crystalloids were compared to saline for intravenous fluid administration in critically ill adults. The study involved over 15,000 patients randomized to receive either balanced crystalloids or saline. The primary outcome was a composite of death, new renal replacement therapy, or persistent renal dysfunction within 30 days. Fewer patients who received balanced crystalloids developed hyperchloremia or acidosis. The use of balanced crystalloids resulted in a 1.1 percentage point lower rate of reaching the primary outcome compared to saline.
This document summarizes a randomized controlled trial that investigated whether stable patients with infective endocarditis on the left side of the heart could be safely treated with oral antibiotics instead of continued intravenous antibiotics. The trial involved 400 patients randomized to either continued intravenous or oral antibiotic treatment according to predefined regimens. The primary outcome was a composite of death, embolic events, or recurrence of infection. The results showed that oral antibiotic treatment was noninferior to continued intravenous treatment.
This document discusses acute encephalitis in India. It defines acute encephalitis and acute encephalitis syndrome. Japanese encephalitis virus is a major cause of AES in India, transmitted via Culex mosquitoes between pigs, birds and humans. The document outlines the epidemiology, clinical features, diagnosis and management of AES. It emphasizes the importance of vaccination and vector control in prevention and control of AES in India.
This document discusses the approach to fever of unknown origin (FUO). It defines FUO as a fever over 101°F for at least 3 weeks without a confirmed diagnosis after initial tests. The differential diagnosis is extensive and includes infections, cancers, and non-infectious inflammatory diseases. The diagnostic approach focuses on finding potentially diagnostic clues by thorough history, exam, initial tests, and more specialized tests like PET scans and biopsies if needed. Treatment depends on the suspected cause but generally avoids antibiotics until a source is found to avoid obscuring the diagnosis. Prognosis has improved over time but malignancies remain a significant cause of mortality in FUO cases.
1) ATT induced hepatitis refers to drug-induced liver injury caused by anti-tuberculosis treatment medications like isoniazid, rifampin, and pyrazinamide.
2) These drugs can cause a spectrum of liver damage from asymptomatic transaminase elevations to acute liver failure via both idiosyncratic and dose-dependent mechanisms including intracellular calcium disruption and apoptosis.
3) Risk factors for tuberculosis drug-induced liver injury include older age, female sex, extra-pulmonary or meningeal tuberculosis, malnutrition, alcohol use, viral hepatitis coinfection, and certain genetic factors. Careful monitoring of liver enzymes is recommended during treatment.
Recent changes in behavior of plasmodiumBhargav Kiran
Recent Changes in Behavior of Plasmodium
This document discusses recent changes observed in the behavior of the Plasmodium parasite, which causes malaria. It notes that Plasmodium vivax, previously considered a benign infection, has shown a new potential for severe and life-threatening disease. The document also reviews the epidemiology and pathophysiology of malaria, including clinical manifestations like anemia, renal failure, pulmonary edema, and complications in pregnancy. It discusses investigations, treatment approaches for uncomplicated and severe malaria, drug prophylaxis, emerging drug resistance, and strategies for controlling the mosquito vector.
This case presentation describes a 54-year-old female patient who presented with fever, easy fatigability, breathlessness, and abdominal pain for 7-10 days. Clinical examination revealed pallor, icterus, bilateral pedal edema, tachycardia, tachypnea, hepatomegaly, and splenomegaly. Investigations showed anemia, leukocytosis, reticulocytosis, spherocytes, decreased haptoglobin and complement levels, indirect hyperbilirubinemia, and a positive Coombs test. The patient was diagnosed with autoimmune mixed hemolytic anemia associated with systemic lupus erythematosus. She was treated with steroids and supportive
This document provides an overview of atrial myxoma, including its history, pathology, clinical presentation, diagnosis, and surgical management. Some key points:
- Atrial myxoma is the most common primary cardiac tumor, usually located in the left atrium and arising from the interatrial septum.
- Clinical presentation varies depending on location and size of the tumor but can include signs of heart failure, murmurs, arrhythmias, and embolic events.
- Echocardiography is the primary diagnostic tool to determine tumor location, size, and attachment site.
- Surgical resection is the only effective treatment due to risk of embolization and hemodynamic complications.
This document provides an overview of how to approach heart murmurs. It discusses the basics of heart sounds and cardiac cycle timing. It describes the locations used to auscultate heart sounds. Murmurs are defined as audible vibrations caused by increased turbulence in blood flow. Pathological murmurs have distinguishing characteristics like timing within the cardiac cycle. The document outlines how to describe murmurs and provides examples of different types of murmurs heard in various locations based on their timing within the cardiac cycle. It also discusses classifications of murmurs and potential causes.
Insulin analogues are genetically engineered versions of human insulin that are designed to more closely mimic the body's natural insulin secretion. Short-acting analogues like lispro and aspart have a faster onset of action than regular insulin, allowing for more flexibility in dosing around meals. Long-acting analogues like glargine and degludec aim to provide a steady basal insulin level throughout the day without peaks, reducing the risk of nocturnal hypoglycemia. While insulin analogues provide benefits over regular insulin in terms of better glycemic control and reduced side effects, their higher cost is still a limitation to their use.
This document discusses the normal metabolism of water and sodium in the body. It covers topics such as the distribution and composition of body fluids, osmotic pressure, and the regulation of water and sodium levels. Water intake and loss must be balanced to maintain homeostasis. The kidneys play an important role in regulating sodium balance by excreting more or less sodium depending on intake levels. Hormones like ADH and aldosterone also help regulate water and sodium metabolism in the body.
This document presents a case study of a 50-year-old female patient who presented with loose stools for 2 days. Her condition did not improve with initial treatment and her diarrhea increased to 20-30 episodes per day. Laboratory tests found Entamoeba histolytica cysts in her stool. Despite treatment with antibiotics, antiamoebic medications, and loperamide, her condition continued to worsen with increased diarrhea episodes. A CT scan showed a simple liver cyst but no other abnormalities. The case is presented for discussion as the patient's condition has not responded to treatment.
This document discusses bradyarrhythmias and approach to treatment. It defines various types of sinus node dysfunction and AV conduction blocks including sick sinus syndrome, sinus pause, sinus arrest, tachy-brady syndrome, and different degrees of AV block. It describes evaluation of sinus node function including intrinsic heart rate, sinus node recovery time and SA conduction time. It discusses reversible and irreversible causes of bradyarrhythmias and guidelines for pacemaker implantation for sinus node and AV node dysfunction. Treatment options including medications and permanent pacing are outlined.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
1. Journal of The Association of Physicians of India ■ Vol. 64 ■ November 2016 15
Hypomagnesemia in the ICU –
Does Correction Matter?
B Sheba Charles1
, Indira Menon2
, TS Girish3
, AM Cherian4
1
Post Graduate, 2
Consultant and Head of the ICU, 3
Consultant, 4
Professor and Head of the Dept. of General
Medicine, Bangalore Baptist Hospital, Bangalore, Karnataka
Received: 25.08.2015; Revised: 09.06.2016; Accepted: 08.08.2016
O r i g i n a l A r t i c l e
Abstract
Background: Magnesium is a cation that is constantly being rediscovered.
A number of studies have linked low magnesium levels to poor outcome of
critically ill patients. Despite this hypomagnesemia continues to be under-
recognized and uncorrected. There are no studies, in our knowledge, that
have assessed the impact of correction of hypomagnesaemia on the
outcome of the ICU patient.
Aims and Objectives:
To determine the standard Mg levels in a healthy population sample and
to correlate it with western data.
To estimate the admission Mg levels in critically ill patients admitted
to the ICU and to determine if routine correction of hypomagnesaemia
altered their outcomes as compared with the retrospectively collected
data of a similar group of patients admitted to the same ICU prior to the
routine testing of Mg levels.
This was an observational study carried out in the intensive care unit of
a tertiary hospital in south India
Results: The mean serum magnesium in a sample of healthy Indian
population was noted to be 2.112 mg/dl, which is consistent with that
of the western data. Among the critically ill admitted to the medical ICU,
the incidence of Hypomagnesemia (defined as serum Mg+2
of ≤1.7mg/dl
on admission), was 23.96%. The study group in whom serum Magnesium
was routinely corrected, showed a decrease in the mean total duration of
icu stay (94.265 vs. 99.443 hours with p=0.78); the need for mechanical
ventilation (52.08% vs. 65.625%) and the duration of Mechanical
Ventilation (36.64 vs. 58.75 hours with p=0.04). Mortality was significantly
higher in the comparison group (p=0.01) (39.6% vs. 22.9%).
Conclusions: The range of Magnesium levels in a healthy Indian
population matches that of the west despite variations in diet and
lifestyle. Routine screening and replacement of magnesium in critically
ill patients with hypomagnesaemia resulted in reduction of morbidity
and statistically significant reduction in overall ICU mortality.
metabolic acidosis, hypocalcemia
a n d h y p o m a g n e s e m i a e t c .
apart from many other nonfatal
complications which increase the
morbidity.1
Magnesium is also
used commonly in treatment of
hypertension in pregnancy, acute
asthma, muscle spasticity and
constipation. Yet, hypomagnesemia
often remains unrecognized in
the critically ill patients,3
hence
magnesium has been called the
“forgotten cation.”4
Magnesium is the second-most
abundant intracellular cation
and, overall, the fourth-most
abundant. It plays a fundamental
role in many functions of the cell,
including energy transfer, storage
and metabolism; maintenance of
normal cell membrane function;
and the regulation of parathyroid
hormone secretion. Systemically,
m a g n e s i u m l o w e r s b l o o d
pressure and alters peripheral
Introduction
Hypomagnesemia can result
in well-known complications
like ventricular arrhythmias1,2
including Torsades de pointes,
widened QT interval,2
coronary
artery vasospasm, convulsions,
neuromuscular weakness, inability
to wean off the ventilator and several
metabolic abnormalities including
Editorial Viewpoint
• H y p o m a g n e s e m i a
continues to be under-
r e c o g n i z e d a n d
uncorrected.
• Thisstudyshowsincidence
of hypomagnesemia of
24% in critically ill.
• C o r r e c t i o n o f h y p o -
magnesemia reduces the
duration of ICU stay and
mechanical ventilation
and mortality as well.
2. Journal of The Association of Physicians of India ■ Vol. 64 ■ November 201616
vascular resistance. Magnesium is
involved in nearly every aspect of
biochemical metabolism, activates
almost all enzymes involved in
phosphorus reactions and acts as a
molecular stabilizer of ribonucleic
acids. Because it is bound to
adenosine triphosphate inside
the cell, shifts in it’s intracellular
c o n c e n t r a t i o n m a y h e l p t o
regulate cellular bioenergetics,
such as mitochondrial respiration.
Extracellularly, Mg+2
ions block
neurosynaptic transmission by
interfering with the release of
acetylcholine. Mg+2
ions also
may interfere with the release of
catecholamines from the adrenal
medulla and has been proposed
as an endogenous endocrine
modulator of the catecholamine
component of the physiologic stress
response.5
Methodology
A descriptive observational
study was carried out in two phases
in a tertiary care hospital in south
India, which provides service to a
population that is both urban and
rural, between Jan 2012 and Jun
2012.
The initial phase estimated
the serum magnesium levels in a
sample of the normal population.
We randomly selected 50 hospital
job applicants and tested their
serum magnesium levels. All the
persons were >18years of age
and medically fit with no known
co-morbidities. The mean serum
magnesium of this group was
calculated.
The second phase was conducted
in the medical ICU where we
prospectively recruited 96 critically
ill patients into the study sample
from 6th
March 2012 to 5th
Jun 2012.
Critically ill patients who included
men and non-pregnant women
admitted in the MICU >18 years
with an APCHE II score > 10 were
included. Terminally ill patients,
those with end stage renal failure
with oliguria and non-medical
patients were excluded. The total
serum magnesium levels were
measured in all these patients
using the colorimetric method with
Xylidyl blue. Normal magnesium
levels were taken between 1.7mg/
dl –2.4mg/dl.
The patients whose serum
magnesium levels were below
1.7mg/dl were identified and given
intravenous replacement therapy
as per the ICU protocol. The target
post correction serum Mg was 1.7
mg/dl. The study did not interfere
with the management of these
patients in the ICU. The correction
was done using I.V Magnesium
sulphate (8-32 milli equivalents as
infusion over 4-12 hours, depending
on the severity). Patients were
monitored throughout the infusion
for possible side effects like
sweating, flushing, bradycardia
and hypotension. The patient’s
vitals including the blood pressure,
pulse rate, respiratory rate, deep
tendon reflexes, mental status and
urine output were monitored and
serum Mg levels were monitored till
normal level was achieved to avoid
hypermagnesemia. Serum Mg levels
were not repeatedly checked once
the desired value was achieved post
correction. None of the patients
developed any side effects during
the magnesium infusion. The
outcomes documented in the study
group were:
1. Duration of ICU stay
2. Need for mechanical ventilator
support
3. D u r a t i o n o f m e c h a n i c a l
ventilation
4. Overall ICU mortality.
This outcome data was compared
w i t h t h a t o f d a t a c o l l e c t e d
retrospectively from a comparison
group of 96 ICU patients, with
similar inclusion and exclusion
criteria who had been admitted
to the same facility prior to the
initiation of routine screening of
serum Magnesium levels (from
1st
Jan 2012 to 6th
March 2012). A
randomized controlled study was
not done as it would have been
unethical, given the evidence
regarding low Mg levels and poor
outcome. This can therefore be
considered a “before and after
study”.
Statistical Analysis
Descriptive statistical analysis
was carried out for the study.
The study and the comparison
group were noted to be statistically
comparable with respect to the age
distribution with a p=0.061, sex
distribution with a p=0.104 and the
diagnostic frequency distribution
with a p=0.181 (Table 1). The average
APACHE score was also statistically
comparable (approximately 14.5 in
the control group versus 15.1 in
the study group). All the patients
included in the study had an
APACHE score of >10. Analysis
of variance (ANOVA) has been
used to find the significance of the
study parameters between the test
group and the comparison group.
Chi square test has been used to
find the significance of the study
parameters on categorical scale
between the two groups. All data
analysis was performed with a SPSS
statistical package (SPSS 16.0, SPSS
Inc. Chicago II. USA). Microsoft
word and Excel have been used to
generate graphics, tables etc.
Results
Estimation of Serum Magnesium
In Normal Population. The average
serum magnesium in the normal
population sample was noted to
be 2.112 mg/dl. The maximum
value noted was 2.6mg/dl and the
minimum was 1.8mg/dl. Our study
group consisted of predominantly
young females less than 35 years
of age belonging to middle class.
Hence age and sex related bias
may be expected. However even
in this small group, the serum
Mg+2
was noted to be within
the published normal range for
general population as mentioned
in all the previous studies; which
were mostly done on the Western
population whose diet and life
style vary significantly from that of
Indian population. Further studies
3. Journal of The Association of Physicians of India ■ Vol. 64 ■ November 2016 17
Table 1: Comparison of the two
groups with respect to age,
sex and diagnosis
Group Study
group
Control
group
Total
Age:
18-30 19 12 28
31-40 8 3 11
41-50 7 14 21
51-60 24 17 41
≥60 38 50 88
Total 96 96 189
Sex:
Male 64 53 117
Female 32 43 75
Total 96 96 192
Diagnostic frequency:
Cerebrovascular
accident
10 10 20
Acute coronary
event
8 10 18
Sepsis 21 23 44
Poisoning 11 7 18
Seizures 4 1 5
Acute on
chronic
respiratory dis.
10 9 19
Diabetic
ketoacidosis
0 1 1
Snake bite 6 0 6
Miscellaneous 26 35 61
Total 96 96 192
Apache score:
Average 14.5 15.1
with higher number of recruits with
a wider range of age group are
however necessary. There was no
significant difference in the serum
magnesium level between the
younger and the older age groups
as well as between the male and
female sex, in our study.
I n c i d e n c e o f l o w s e r u m
magnesium at admission to the
ICU: The average age of the patients
in the study group was 54±19.25
years with a maximum of 90 years
and a minimum of 18 years. (61/96)
63.54% were males. 36.46% (35/96)
were females. The average age
of the patients in the comparison
(control) group were 58.48±18.54
years with a maximum of 96 years
and a minimum was 19 years.
55.21% (53/96) were males and
44.79% (43/96) were females. The
frequency of different diagnoses
was found to be similar in both the
Table 2: Comparison of the outcomes between the study and control groups
Results of the present study Study group Control group Significance
Incidence of hypomagnesemia 23.96% Not known
Duration of ICU stay (hrs) 94.27 99.44 No (P=0.78)
Duration of mechanical ventilation (hrs) 36.64 58.75 Yes (P=0.04)
No. of cases ventilated 50 63 No (P=0.16)
Mortality rate 22.9% 39.6% Yes (P=0.01)
groups. The average APACHE score
was also statistically comparable
(14.5 in the control group versus
15.1 in the study group). The basic
characteristics of the study and the
control groups were statistically
comparable with respect to the age
distribution with a p=0.061 and
sex distribution with a p=0.104 as
well as the diagnostic frequency
distribution with a p=0.181.
The serum magnesium level was
estimated in the study group and
the incidence of hypomagnesemia
(≤ 1.7mg/dl) was 23.95% (23/96).
The lowest serum Mg value
recorded was 0.9mg/dl while the
highest was 5mg/dl. The average
pre correction serum magnesium
in these hypomagnesemic patients
was 1.522 mg/dl. 16 patients
had a serum Mg ≥2.5mg/dl and
only one had >4mg/dl and none
above 5mg/dl. Normal and High
Magnesium were taken together
as a set in our study. Clinically
significant Hypermagnesemia is
>5 mg/dl3,4
according to various
studies done earlier. Studies show
that Hypermagnesemia4
which is
most of the time either iatrogenic
or secondary to renal failure;
is found less commonly than
hypomagnesaemia.
Comparison of parameters before
and after the routine screening and
correction of serum magnesium:
As shown in Table 2, the mean
duration of ICU stay in the in the
study group was 94.265 hours as
compared to 99.443 hours in the
comparison group. The duration
of ICU stay was relatively less (by
5.178 hours) in the study group.
(p = 0.78). The number of cases
requiring mechanical ventilation
in the study group was lower
than in the control group. Only
52.083% (n=50) required ventilator
support after routine magnesium
correction was initiated as against
65.625% (n=63) in the control
group (p=0.08). The duration
for mechanical ventilation was
36.64 hours in the study group as
compared to 58.75 hours in the
control group. The difference is
statistically significant (p=0.04).
The study group required 22.11
hours less duration of mechanical
ventilation (Table 1). The mortality
rate was 22% in the study group
where as it was 38% in the control
group; hence 16.7% lower after
routine screening and correction
of serum Mg+2
was introduced
in the ICU. This was statistically
significant with a p=0.01.
Comparison of parameters
“within” the study group – with
respect to serum magnesium:
The mean duration of ICU stay
(difference of 48.837 hours) (p=0.189)
as well as the Mean Duration of
Mechanical Ventilation (difference
of 13.667 hours) (p=0.349) were
found to be higher in patients
with low serum magnesium level
as compared with those with
normal serum magnesium (Table
3). Within the study group, total 50
out of the 96 required mechanical
ventilation. Of these, 15 had low
serum magnesium i.e, 30% of
the total of ventilated cases were
hypomagnesemic. 65% of the total
cases with hypomagnesemia in the
study group required ventilation
as compared to 47.94% of the cases
having normal levels of serum
magnesium (p=0.16). There was no
statistically significant difference
in the final mortality rate between
patients with hypomagnesemia
(21.73%) as compared to those
of normomagnesemia (23.28%).
This finding is very important to
be noted, as routine correction
4. Journal of The Association of Physicians of India ■ Vol. 64 ■ November 201618
done after screening in the study
group might have improved the
final mortality rate among the
hypomagnesemics.
Discussion
How to Measure Hypomagnesemia
The method of measuring
Mg levels has been a subject
o f d e b a t e a s r e s e a r c h e r s
f e e l t h a t m a g n e s i u m b e i n g
a predominantly intracellular ion
, estimating total serum Mg levels
may not be accurate. Toffaletti6
in
1995, noted a substantial increase
in requests for serum Mg estimation
and the interest has only been
rising since then. Huijgen et al7
found that normal or high levels
of total magnesium were always
associated with normal ionized
Mg levels. However the positive
predictive value of a low total Mg
was only 29%. The RBC magnesium
and ionized Mg are considered
better measures of intracellular
Mg but they cannot be easily
estimated. Most studies still use
total serum Mg.5,8,9
On review of
literature, the “gold standard” for
establishing hypomagnesaemia is
probably the magnesium loading
test, where the level of absorption
of administered Mg indicates the
magnesium depletion in the body.
This test needs further evaluation
in the ICU patients. In our study
we measured total Magnesium in
the study group.
Prevalence of Hypomagnesemia and
the Impact of routine Mg Replacement
T h e p r e v a l e n c e o f
hypomagnesemia in various
studies5
carried out in the critically
ill patients was in the range of
14-70%. In our study; 23% had
hypomagnesemia on admission
(defined as estimated total serum
Mg+2
of ≤1.7mg/dl). Studies that
measured ionized magnesium
reported lower prevalence of
hypomagnesaemia (Huijigen 14%
, Soliman 18%)7,9
than those that
had estimated total Mg or RBC Mg ,
where the prevalence was 20 -70% .
Hypermagnesemia has been
found to be less common10
and
ranges from 4% - 14%. Interestingly,
it has been associated with higher
mortality in some studies. We
found hypermagnesemia prevalent
in 17.7% patients but the levels
did not exceed the critical level of
5mg% and no change in clinical
outcome was noted. Hence these
patients have been taken into the
normomagnesemic group.
On analyzing ‘within’ the study
group, hypomagnesemia cases were
noted to have higher mean duration
of total ICU stay (difference of
48.837 hours) (p=0.189) as well
as mean duration of Mechanical
Ve n t i l a t i o n ( d i f f e r e n c e o f
13.667 hours) (p=0.349). 65% of
hypomagnesemia cases in the study
group required ventilator support
as against 47.9% in those with
normal magnesium levels. Similar
findings were also documented in
another prospective observational
s t u d y d o n e b y C S L i m a y e
et al.5
Safavi et al8
described a
‘retrospective observational study’
which was done on 100 patients
≥16 years old, admitted to the ICU
at a University Hospital over 2
years period. Hypomagnesemic
patients were observed to have
higher APACHE II and SOFA scores
at admission (p < 0.01 for both),
a higher maximum SOFA score
during their ICU stay, a more need
to ventilator (p < 0.05), longer stay
in the ICU and longer duration of
mechanical ventilation (p < 0.01) as
well as higher mortality rate (55%
vs. 35%) when compared with the
normomagnesemic patients.
In the current study, there was no
statistically significant difference
in the final mortality rate between
patients with hypomagnesemia
(21.73%) as compared to those
of normomagnesemia (23.28%)
‘ w i t h i n ’ t h e s t u d y g r o u p .
This is important to be noted
as a probable consequence of
routine correction of low serum
magnesium post admission. A
higher mortality rate8,9
can be
explained by greater incidence
of electrolyte abnormalities
especially hypokalemia11
and
cardiac arrhythmias2,12
and a strong
association with sepsis5
and septic
shock.
When these parameters were
compared before and after the
introduction of routine screening
and correction at admission to the
ICU, the total mean duration of
ICU stay was found to be relatively
less (by 5.177 hours) in the study
group, as compared to the control
group. However this was not
statistically significant (p=0.78).
But the mean difference of Duration
of Mechanical Ventilation in
MICU was statistically significant
(p=0.04). Post routine magnesium
correction, there was 22.11 hours
less requirement of mechanical
ventilation. The overall ICU
mortality was higher without
routine correction of serum
magnesium i.e, in the control group
(39.6%) as against 22.9% in the
study group and the difference was
noted to be statistically significant
(p=0.01).
Many factors contribute to
hypomagnesaemia in a patient
admitted to ICU like impaired GI
absorption, nasogastric suction,
poor content of Mg in the feeding
formulae or total parenteral
nutrition solutions, use of Proton
pump inhibitors routinely and
administration of drugs like
diuretics, amino glycosides,
Amphotericin B which cause
renal wasting.(11)
Even patients
with “normal” Magnesium at
admission level may even develop
low serum Mg after a few days of
ICU stay – hence we opine further
Table 3: Comparison of the outcomes‘within’the study group – according to the
magnesium status
Magnesium status
(within the study group)
Duration of
stay (hours)
Duration of mechanical
ventilation (hours)
Need for mechanical
ventilation
Normal 82.57 33.37 35/73 (47.94%)
Low 131.40 47.03 15/23 (65.21%)
5. Journal of The Association of Physicians of India ■ Vol. 64 ■ November 2016 19
that routine screening of serum
magnesium should be done at least
intermittently during the stay in
ICU; not just at admission.
We also observed that 56.52% of
hypomagnesemics were Diabetics.
31.7% of Diabetics included in
the study group (70% in a study
by CS Limaye et al5
) had low
serum Mg. Hypomagnesemia has
been known to be associated with
Diabetes mellitus, due to increased
r e n a l l o s s e s o f m a g n e s i u m
that accompany glycosuria.11
Magnesium supplementation is
associated with decreased insulin
resistance.
30.43% of the hypomagnesemic
study subjects were noted to be
alcohol dependent and 43.7%
of the alcohol dependents had
hypomagnesemia. These findings
are comparable to all the earlier
studies.5,9
Chronic alcoholism is
one of the predisposing factors for
magnesium deficiency,11
reported
in 30% of hospital admissions
with alcohol abuse and in 85% of
admissions for delirium tremens.
This is due to a number of
factors including poor nutrition,
alcohol-induced renal tubular
dysfunction leading to renal
magnesium wasting, pancreatitis
and intracellular shift in alcohol
withdrawal syndrome.
Of all the complications of
low serum Mg+2
noted in this
study, generalized weakness,
gastrointestinal manifestations
of anorexia and vomiting were
p r e d o m i n a n t f o l l o w e d b y
neuromuscular manifestations i.e
muscle weakness and depression.
Metabolic abnormalities such as
hypocalcemia and hypokalemia
were also frequently associated.
Conclusion
M a g n e s i u m r e m a i n s a n
important but often sidelined
cation in the critically ill patient.
Average serum Magnesium levels
in the Indian Population are similar
to that in the West. However
further studies with larger numbers
are required in this regard. Low
Mg levels on admission were
noted in 23% in our study group.
Correction of these levels improved
patient outcome by reducing the
length of ICU stay, the need and
duration of mechanical ventilation.
The overall ICU mortality reduction
was statistically significant.
T h e r e f o r e we r e c o m m e n d
routine screening at admission,
followed by regular monitoring
o f m a g n e s i u m l e v e l s , a s
hypomagnesaemia could develop
later too. We could not repeat the
serum magnesium repeatedly,
after initial correction, due to cost
constraints. The other limitations
of our study are the sample size,
and the optimization of the dose of
Magnesium supplementation.
References
1. Bringhurst FR, Demay MB, Krane SM,
Kronenberg HM. Bone and Mineral
Metabolism in Health and Disease.
Harrison’s Principles of Internal Medicine,
(vol. 2 of 18th
edition, page 3089-3090).
2. K a g i m a , J a c q u e l i n e W a n j i k u :
Hypomagnesemia in critically ill patients
onadmissiontothecriticalcareunitsatthe
Kenyatta national hospital: A Prospective
Observational Cohort Study. Clinicalmed.
uonbi.ac.ke/node/897
3. Whang R, Ryder KW. Frequency of
hypomagnesemia and hypermagnesemia.
Requested vs. routine. JAMA 1990;
263:3063-4.
4. Konrad M. Disorders of magnesium
metabolism. In: Geary D, Shaefer
F. Comprehensive Pediatric Nephrology.
Philadelphia PA: Mosby Elsevier; 2008:461-
475.
5. Limaye CS, Londhey VA, Nadkar MY,
Borges NE. Hypomagnesemia in critically
ill medical patients. J Assoc Physicians
India 2011; 59:19–22.
6. Toffaletti J. Physiology and regulation
ionized calcium, magnesium and lactate
measurements in critical care settings. Am
J Clin Pathol 1995; 104 (suppl1):S88-S94
7. Huijgen HJ, van Ingen HE, Sanders
R, et al. Precision of the magnesium
determination in mononuclear blood
cells and erythrocytes. Clin Biochem 1997;
30:203-208.
8. Safavi M, Honarmand A: Admission
hypomagnesemia- impact on mortality
and morbidity in critically ill patients.
MiddleEastJAnaesthesiol 2007; 19:645-60.
9. SolimanHM,MercanDetal:Development
of ionized hypomagnesemia is associated
with higher mortality rates. Crit Care Med
2003; 31:1082-7.
10. James W. Van Hook: Hypermagnesemia.
Critical Care Clinics 1991; 7:215-223.
11. Marino PL, Sutin KM. Fluid and Electrolyte
disorders – Magnesium. The ICU Book, 2nd
ed., Philadelphia, Lippincott, Williams and
Wilkins 2004; 660-672.
12. Khan AM, Lubitz SA, Sullivan LM, Sun JX,
Levy D, Vasan RS. Low serum magnesium
and the development of atrial fibrillation
in the community: the Framingham Heart
Study. Circulation 2013; 127:33-8.
Referees for JAPI
API Members with minimum ten years experience of clinical practice and who are interested to contribute for JAPI as Referee
may please send your details as listed below.
Name, Years of experience, Current designation and Affiliations, Area of interest, List of publications, e-mail id and Mobile
number.
Kindly send above information at the earliest to: onlinejapi@gmail.com
Prof. Milind Y. Nadkar
Editor-in-Chief, JAPI