Magnesium plays an important physiological role as an intracellular and extracellular cation. It is involved in many metabolic processes and acts as a physiological antagonist to calcium. Hypomagnesemia can occur due to inadequate intake, excess renal losses, or redistribution. It can manifest as cardiovascular, neuromuscular, or psychiatric symptoms. Magnesium sulfate is used to treat and prevent eclampsia and preeclampsia by reducing cerebral vasospasm. It is also used for cardiovascular indications such as arrhythmias. Magnesium can impact anesthesia by potentiating neuromuscular blockade and decreasing acetylcholine release.
Anaesthesia in Cardiac Patients for Non-cardiac SurgeryRashad Siddiqi
The reader should be able to:
(1) identify factors which will lead to increased cardiovascular risk for patients undergoing non-cardiac surgery
(2) decide which patients require further cardiovascular testing
(3) make optimization plan for such patients
(4) understand the principles of anaesthesia for patients with cardiac disease
PERIOPERATIVE RENAL PROTECTION : WHAT IS THE EVIDENCE?Dr Jayashree Patki
PERIOPERATIVE RENAL PROTECTION : WHAT IS THE EVIDENCE?-
Dr. JAYASHREE PATKI
MBBS, MD, PGDHHM
Sr. Consultant
Krishna Institute of Medical Sciences
Hyderabad
Intro to Hypoxic pulmonary vasoconstriction Arun Shetty
Hypoxic pulmonary vasoconstriction, a seldom heard phenomenon but very effective physiologic property which helps lungs utilise ventilation to the maximum
Anaesthesia in Cardiac Patients for Non-cardiac SurgeryRashad Siddiqi
The reader should be able to:
(1) identify factors which will lead to increased cardiovascular risk for patients undergoing non-cardiac surgery
(2) decide which patients require further cardiovascular testing
(3) make optimization plan for such patients
(4) understand the principles of anaesthesia for patients with cardiac disease
PERIOPERATIVE RENAL PROTECTION : WHAT IS THE EVIDENCE?Dr Jayashree Patki
PERIOPERATIVE RENAL PROTECTION : WHAT IS THE EVIDENCE?-
Dr. JAYASHREE PATKI
MBBS, MD, PGDHHM
Sr. Consultant
Krishna Institute of Medical Sciences
Hyderabad
Intro to Hypoxic pulmonary vasoconstriction Arun Shetty
Hypoxic pulmonary vasoconstriction, a seldom heard phenomenon but very effective physiologic property which helps lungs utilise ventilation to the maximum
Magnesium is a very important ion in the body, crucial to over 300 reactions.
Its disorders are underdiagnosed and can help improve healthcare if appropriately treated
Magnesium deficiency can cause a wide variety of features including hypocalcaemia, hypokalaemia and cardiac and neurological manifestations. Chronic low magnesium state has been associated with a number of chronic diseases including diabetes, hypertension, coronary heart disease, and osteoporosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
2. Introduction
4th most plentiful cation in humans (after Na, K, and Ca)
2nd most important intracellular cation (after K)
Distribution- bones(53%), muscles(27%), soft tissues(19%) and
in serum and RBCs(less than 1%)
S. Mg – 3 forms- ionised(62%), protein bound( 33%), complexed
to anions such as citrate, PO4( 5%)
Ionised fraction is physiologically active
4. Physiological role
Physiological antagonist of Ca
Involvement of Mg in Na K ATPase- essential in maintaining
transmembrane Na and K gradients and normal K conc.
Determinant of electric potential across cell membranes
Generation of C-AMP is Mg dependant
Activation of many enzyme systems, including those involved in
energy metabolism
Essential role in production of ATP
Synthesis of DNA, RNA and protein
5. Physiological role
Direct effect on myocardium and vascular smooth muscle- depress
contractility, block catecholamine receptors, inhibits release of
catecholamines from adrenal medulla, peripheral adrenergic receptors
Blunts response of vascular tissue to vasoconstrictors
Bronchodilator, decreases PVR
Decreases release of acetylcholine at neuromuscular junction
Decreases excitability of nerves and muscles, involved in contraction
and relaxation of muscles
Suppress epileptic foci and reverse cerebral vasospasm
Tocolytic
Inhibits platelet activity, increases bleeding time
6. Mg homeostasis
Body stores regulated by hormonal and metabolic effects on
gi absorption and renal excretion
Normal levels- 0.7- 1.05mmol/l
GI absorption- ileum and colon, inversely proportional to intake
Absorbed Mg excreted primarily by kidney
Majority of reabsorption in ascending limb of Henle’s loop
Aldosterone increses renal excretion
PTH enhances gut absorption, reduces renal excretion of Mg
8. Pharmacology
2ml, 5ml and 10 ml ampoules, clear solution for infusion
Not to be stored above 25 degrees celsius
Active substance - Magnesium sulphate heptahydrate
2ml= 1g MgSO4= 4mmols= 8 meq= 98 milligram elemental Mg
Too rapid administration- hypotension and even asystole
Reduced dose in elderly and in renal failure- use with caution
Use with caution in Myasthenia gravis, muscular dystrophy
Contraindications- Heartblock, obstetrics- within 2 hours of delivery
Drug interactions- Digoxin , Beta blocker and CCB, NDMR
Antidote- resp depression or HB- iv calcium
hypotension- calcium/ dopamine
9. Hypomagnesemia
Plasma Conc < 0.7mmol/l
Plasma Mg is less than 1% of total body Mg
Overall deficiency may exist even with normal plasma levels
Low serum Mg generally indicates low total body Mg, exceptions-
following massive crystalloid infusion, hypoalbuminemia
Suggestions that hypomagnesemia may be the most
underdiagnosed electrolyte deficiency
Relatively common disorder
10. Hypomagnesemia - causes
Decreased intake- elderly, chronic alcoholics, pancreatic
insufficiency, short bowel syndrome, TPN with insufficient Mg
Excessive renal loss- loop diuretics, ACEI, Gentamicin, interstitial
nephritis, diuretic phase of ATN, hyperaldosteronism
Extra renal losses- prolonged diarrhoea, long term NG drainage
Redistribution- treatment of DKA with insulin dextrose, massive
transfusion with citrated blood
11. Hypomagnesemia-Clinical manifestations
CVS- HTN, Angina, Arrythmias, digoxin toxicity, ECG changes
Neuromuscular- myoclonus, cramps, stridor, Chovstek’s and
Trousseau’s signs, convulsions and coma
Psychiatric disturbances- confusion, psychosis including
Wernicke’s encephalopathy
Co existing electrolyte disturbances- hypokalemia, hypocalcemia
12. Hypomagnesemia- Treatment
Normal homeostasis of Mg requires daily intake of 10-20 mmol
Mg replacement therapy particularly important in critically ill
Emergency- 10-20 mmol in 50 ml 5% D iv over 15-30mins,
followed by 40 mmol over 4 hrs iv
Critically ill(c/c deficiency)- 40 mmol iv on day 1 and
10-20 mmols on days 2-5
Less severely ill- 15 mmols/day, NG/PO
Renal function should be adequte before Mg administration
IV administration should be stopped if hypotension/ bradycardia,
if plasma conc. > 2.5 mmol/l or if DTR disappear
13. Hypermagnesemia
Iatrogenic- overdose in treatment of preeclampsia/eclampsia
End stage renal disease
High intake of antacids and use of purgatives
Adverse effects enhanced by hypocalcimea
GI- Nausea, vomiting, diarrhoea
CVS- Prolongation of PR interval, QRS complex and QT interval,
hypotension and bradycardia, Complete HB and cardiac arrest
(10-12.5mmol/l) can also occur
CNS- Disappearance of DTR (levels> 4-5 mmol/l), depressed
respiration and apnoea due to paralysis of voluntary muscles
(5-7.5mmol/l)
Treatment-
Stop medications
iv calcium gluconate 2.5-5mmol bolus
Diuretics/ dialysis
14. PIH and Eclampsia
Major cause of maternal mortality and fetal loss
Uteroplacental ischaemia
Multisystem disorder affecting CVS, resp, hepatic, renal,
haemostatic and CNS
Control BP and abnormal haemodynamic state, prevent
convulsions, ensure safe delivery
MgSO4 is the most widely used anti convulsant
15. MgSO4 in Preeclampsia
Magpie Trial- Lancet 2002- “ MgSO4 halves the risk of eclampsia
and probably reduces the risk of maternal death with no
substantive harmful effects to mother or baby in short term”
Intense cerebral vasospasm with increased sensitivity to pressor
agents
Reduction in cerebral blood flow causing convulsions
MgSO4 in PIH- reduces intracerebral vasospasm, as measured by
Doppler examination of MCA
16. MgSO4 in Eclampsia
Collaborative Eclampsia trial ( Lancet,1995)– superiority of MgSO4
over Diazepam & Phenytoin in prevention of reccurent convulsions in
eclampsia
Reduction in incidence of eclamptic convulsions in women with PIH
Alters cardiovascular response to endotracheal intubation(40mk/kg
after induction agent, 30mg/kg in a patient on Magnesium therapy)
Less foetal depression than Alfentanil
For very severe preeclampsia- combination of MgSO4 and Alfentanil
superior to MgSO4 alone
17. MgSO4 in PIH
MgSO4 is the DOC for prevention and treatment of eclamptic
seizures
Loading dose of 4 g( some centres use 5g) iv over 5 mins
followed by iv infusion at 1-2g/hr for 24 hrs after last convulsion
If further convulsion occurs, another 2-4 g given iv over 5 mins
Therapeutic range of 2-3.5mmol/l recommended
IM route- painful, less predictable plasma concentrations
5 g im, then 2.5g im every 4 hrs until 24 hrs after last seizure
Plasma conc of 2-4 mmol/l usually acceptable
18. MgSO4 in cardiovascular anaesthesia
Hypomagnesemia is common after CPB- Mg widely accepted in
treatment and prophylaxis of arrythmias after CPB
Anti arrythmic agent- post MI, torsades de pointes, intractable VT/
VF, digoxin induced arrythmias, multifocal atrial tachycardia
Component of some cardioplegic solutions- protects ischemic
myocardium especially during reperfusion
Aortic cross clamping- NMDA antagonsit- protection to spinal
cord during repair of supra renal anuerysms
Control of hypertensive responses to laryngoscopy and intubation-
suppress stress response at a dose of 40mg/kg
19. Mg and anaesthesia
Both hypo and hyper magnesemia- anaesthetic implications
Frequently accompanied by other electrolyte disturbances
If not urgent, postpone procedure
Increased risk of perioperative arrythmias
High chances of stridor provoked by airway stimulation, upon
induction of hypomagnesemic patients
Avoid hyperventilation, as it further lowers Mg levels
Vasodilation produced by volatile agents, narcotics may be
exacerbated by Mg leading to hypotension
20. Mg and anaesthesia
It decreases presynaptic release of acetylcholine and reduces
sensitivity of post junctional membrane
NDMR potentiated by Mg
MgSO4 causes dose related depression of acetylcholine release
Mg decreases twitch response without TOF fade, unlike NDMR
Pancuronium, rocuronium and vecuronium are potentiated by Mg
Reduced dose of muscle relaxant
Use peripheral nerve stimulator
21. Other clinical uses of Magnesium
Phaeochromocytoma crisis -bolus dose of 2-4 g followed by infusion at 1g/hr-
marked anti adrenergic effect, inhibition of release of catecholamines and calcium
channel blocking property allied to its effect on release of acetylcholine
Anaesthetic management of phaeochromocytoma resection
Asthma- bronchodilator- calcium antagonism, inhibitory action on smooth muscle
contraction, on Histamine release from mast cells and Acetylcholine release from
cholinergic nerve terminals. IgE stimulation increases calcium conc intracellularly,
leading to Histamine release
Tetanus- MgSO4 in conjunction with sedation eg: clonidine, reduce cardiovascular
(autonomic) instability and inhibits release of catecholamines, reduces spasms
Sub arachnoid haemorrhage- neuroprotective mechanisms- inhibition of release
of excitatory aminoacids, blockade of NMDA glutamate receptors, non competitive
antagonist of voltage dependant Ca channel, cerebrovascular dilatory activity
22. From the journals
MgSo4 attenuates arterial pressure increase during lap
cholecystectomy - BJA (2009)103(4)
MgSO4 as an adjuvant to intrathecal bupivacaine in mild pre
eclampsia undergoing CS- reduces post op analgesic requirements-
IJOA 2010;19
MgSO4 in severe tetanus improves muscle spasm and cardiovascular
stability- Anaesthesia 2008;63
Intra articular inj of MgSO4 enhances analgesic effect of intra
articular Bupivacaine- Anaesth Analg 2008;106
23. References
Cations- Pottasium, Calcium, Magnesium BJA CEACCP 2012 Vol 12,No 4
Magnesium: an emerging drug in anaesthesia- Editorial, BJA (2009)103(4)
Magnesium and the anaesthetist BJA CEACCP 2001,Vol 1 No 1
Magnesium- Physiology and pharmacology, BJA 1999;83:302-20
Clinical uses of Magnesium infusions in Anaesthesia,
Anaesth Analgesia 1992;74:129-136