Magnesium Administration Research Articles

A study of the effects of intravenous magnesium sulphate on post-operative atrial fibrillation in patients undergoing off pump coronary artery bypass grafting (CABG)

Atrial fibrillation (AF) occurs in almost 30% of patients undergoing coronary artery bypass grafting (CABG). Around 80% of these patients have decreased levels of total and ionized serum magnesium postoperatively. The association between magnesium deficiency and post CABG AF is still undetermined. Therefore, a large variety of prophylactic strategies have been assessed including perioperative magnesium administration. However, the efficacy is still questionable. The aim of this study was to find out any correlation of serum magnesium levels with the incidence of post-operative atrial fibrillation in patients undergoing off pump CABG and whether magnesium supplementation modifies the incidence. One hundred fifty patients undergoing CABG were selected and divided into treatment and control groups. Perioperative serum magnesium assays were done, and patients were monitored in the postoperative period for occurrence of Atrial Fibrillation. The risk of post CABG atrial fibrillation was more among females, obese patients, patients with EF < 50% and RWMA. Post-operative AF occurred in 5 patients in the treatment group (n = 75) and 11 patients in the control group (n = 75). : The proportion of patients with post-operative atrial fibrillation among cases (6.7%) was lower than that of controls (14.7%) which may indicate an important role of magnesium in prevention of AF following cardiac surgeries. The results however didn’t reach a statistical significance which could be due to sample size, the duration and design of the study and the period of post-operative AF monitoring.

Magnesium Administration in Chronic Kidney Disease.

Awareness of the clinical relevance of magnesium in medicine has increased over the last years, especially for people with chronic kidney disease (CKD), due to magnesium's role in vascular calcification and mineral metabolism. The inverse association between serum magnesium and clinically relevant, adverse outcomes is well-established in people with CKD. Subsequent intervention studies have focused on the effect of magnesium administration, mainly in relation to cardiovascular diseases, mineral bone metabolism, and other metabolic parameters. The most commonly used routes of magnesium administration are orally and by increasing dialysate magnesium. Several oral magnesium formulations are available and the daily dosage of elemental magnesium varies highly between studies, causing considerable heterogeneity. Although data are still limited, several clinical studies demonstrated that magnesium administration could improve parameters of vascular function and calcification and mineral metabolism in people with CKD. Current clinical research has shown that magnesium administration in people with CKD is safe, without concerns for severe hypermagnesemia or negative interference with bone metabolism. It should be noted that there are several ongoing magnesium intervention studies that will contribute to the increasing knowledge on the potential of magnesium administration in people with CKD.

A Mini Review on the Various Facets Effecting Brain Delivery of Magnesium and Its Role in Neurological Disorders.

Magnesium is an essential cation present in the body that participates in the regulation of various vital body functions. Maintaining normal level of magnesium is essential for proper brain functions by regulating the activities of numerous neurotransmitters and their receptors. Various studies have been reported that magnesium level is found to be declined in both neurological and psychiatric diseases. Declined magnesium level in the brain initiates various cumbersome effects like excitotoxicity, altered blood-brain permeability, oxidative stress, and inflammation, which may further worsen the disease condition. Shreds of evidence from the experimental and clinical studies proved that exogenous administration of magnesium is useful for correcting disease-induced alterations in the brain. But one of the major limiting factors in the use of magnesium for treatment purposes is its poor blood-brain barrier permeability. Various approaches like the administration of its organic salts as pidolate and threonate forms, and the combination with polyethylene glycol or mannitol have been tried to improve its permeability to make magnesium as a suitable drug for different neurological disorders. These results have shown their experimental efficacy in diseased animal models, but studies regarding the safety and efficacy in human subjects are currently underway. We present a comprehensive review on the role of magnesium in the maintenance of normal functioning of the brain and various approaches for improving its BBB permeability.

Examining changes in clinical management and postpartum readmissions for hypertensive disorders of pregnancy over time.

In response to 2013 guidelines for hypertensive disorders of pregnancy (HDP), our study examined changes in antenatal management and postpartum readmission (PPR) over time. This is a retrospective cohort study of individuals diagnosed antenatally with HDP who delivered at a tertiary care center from 2012 to 2017. The primary outcome was postpartum readmission for HDP in 2012-2013 vs 2014-2017. Secondary outcomes included intravenous magnesium administration and prescription for oral (PO) antihypertensive medication during delivery admission. Multivariable logistic regression models assessed differences in outcomes over time, adjusted for age, race, and payer status, for HDP with and without severe features, defined by ACOG criteria. Of 5,300 eligible individuals, 73.5% had HDP without severe features and 26.5% had severe features. The PPR frequency in this cohort was 1.1% (N=59). There was no difference in PPR for individuals with HDP without severe features (aOR 0.73; 95% CI 0.28-1.88) or with severe features (aOR 1.30; 95% CI 0.50-3.39) by epoch. Magnesium administration for HDP with severe features remained below 80% over time. Magnesium administration for HDP without severe features and discharge prescriptions for PO medications for HDP with severe features were lower after 2013. Neither magnesium administration nor discharge prescriptions were associated with decreased odds of PPR. Although there was no difference in PPR for HDP after 2013, there were changes in antenatal management of HDP, including decreased magnesium administration for individuals with HDP without severe features and PO medication for individuals with severe features.

Effects of Intraoperative Magnesium and Ketorolac on Catheter-Related Bladder Discomfort after Transurethral Bladder Tumor Resection: A Prospective Randomized Study.

Transurethral resection of bladder tumor (TURBT) is a standard treatment for non-muscle invasive bladder cancer. However, catheter-related bladder discomfort (CRBD) often occurs due to bladder irritation caused by indwelling large-diameter urinary catheters and delays patient recovery. We investigated the efficacy of the intraoperative administration of magnesium and ketorolac in preventing early CRBD after TURBT. One hundred patients scheduled for TURBT were enrolled in this prospective, randomized, double-blind study from December 2021 to June 2022. During surgery, the experimental group (n = 48) received intravenous magnesium and ketorolac, and the control group (n = 50) received only intravenous ketorolac. The primary outcome was CRBD incidence immediately after surgery. CRBD severity and the postoperative recovery profiles were also evaluated. Compared to the control group, the experimental group had significantly less CRBD until 1 h after surgery (0 h: 31.3% vs. 52.0%, p = 0.037; 1 h: 54.2% vs. 74.0%, p = 0.041). However, the two groups did not differ in other postoperative findings, including CRBD severity. Co-administration of magnesium and ketorolac during surgery significantly decreased the incidence of early CRBD after TURBT compared to the single use of ketorolac.

Association of Intravenous Potassium and Magnesium Administration With Spontaneous Conversion of Atrial Fibrillation and Atrial Flutter in the Emergency Department

Whether the simultaneous intravenous administration of potassium and magnesium is associated with the probability of spontaneous conversion to sinus rhythm (SCV) in the acute treatment of atrial fibrillation (AF) and atrial flutter (AFL) is unknown. To assess potassium and magnesium administration and SCV probability in AF and AFL in the emergency department. A registry-based cohort study was conducted in the Department of Emergency Medicine of the Medical University of Vienna, Austria. All consecutive patients with AF or AFL were screened between February 6, 2009, and February 16, 2020. Intravenous administration of potassium, 24 mEq, and magnesium, 145.8 mg. The primary outcome was the probability of SCV during the patient's stay in the emergency department. Multivariable cluster-adjusted logistic regression was used to estimate the association between potassium and magnesium administration and the probability of SCV. A total of 2546 episodes of nonpermanent AF (median patient age, 68 [IQR, 58-75] years, 1411 [55.4%] men) and 573 episodes of nonpermanent AFL (median patient age, 68 [IQR, 58-75] years; 332 [57.9%] men) were observed. In AF episodes, intravenous potassium and magnesium administration vs no administration was associated with increased odds of SCV (19.2% vs 10.4%; odds ratio [OR], 1.98; 95% CI, 1.53-2.57). In AFL episodes, in contrast, no association was noted for the probability of SCV with potassium and magnesium vs no administration (13.0% vs 12.5%; OR, 1.05; 95% CI, 0.65-1.69). The findings of this registry-based cohort study on intravenous administration of potassium and magnesium suggest an increased probability of SCV in nonpermanent AF, but not AFL, during a patients' stay in the emergency department.

The Role of Hypomagnesemia in Cardiac Arrhythmias: A Clinical Perspective.

The importance of magnesium (Mg2+), a micronutrient implicated in maintaining and establishing a normal heart rhythm, is still controversial. It is known that magnesium is the cofactor of 600 and the activator of another 200 enzymatic reactions in the human organism. Hypomagnesemia can be linked to many factors, causing disturbances in energy metabolism, ion channel exchanges, action potential alteration and myocardial cell instability, all mostly leading to ventricular arrhythmia. This review article focuses on identifying evidence-based implications of Mg2+ in cardiac arrhythmias. The main identified benefits of magnesemia correction are linked to controlling ventricular response in atrial fibrillation, decreasing the recurrence of ventricular ectopies and stopping episodes of the particular form of ventricular arrhythmia called torsade de pointes. Magnesium has also been described to have beneficial effects on the incidence of polymorphic ventricular tachycardia and supraventricular tachycardia. The implication of hypomagnesemia in the genesis of atrial fibrillation is well established; however, even if magnesium supplementation for rhythm control, cardioversion facility or cardioversion success/recurrence of AF after cardiac surgery and rate control during AF showed some benefit, it remains controversial. Although small randomised clinical trials showed a reduction in mortality when magnesium was administered to patients with acute myocardial infarction, the large randomised clinical trials failed to show any benefit of the administration of intravenous magnesium over placebo.

Serum Calcification Propensity Represents a Good Biomarker of Vascular Calcification: A Systematic Review.

Vascular calcification contributes to cardiovascular morbidity and mortality. A recently developed serum calcification propensity assay is based on the half-transformation time (T50) from primary calciprotein particles (CPPs) to secondary CPPs, reflecting the serum’s endogenous capacity to prevent calcium phosphate precipitation. We sought to identify and review the results of all published studies since the development of the T50-test by Pasch et al. in 2012 (whether performed in vitro, in animals or in the clinic) of serum calcification propensity. To this end, we searched PubMed, Elsevier EMBASE, the Cochrane Library and Google Scholar databases from 2012 onwards. At the end of the selection process, 57 studies were analyzed with regard to the study design, sample size, characteristics of the study population, the intervention and the main results concerning T50. In patients with primary aldosteronism, T50 is associated with the extent of vascular calcification in the abdominal aorta. In chronic kidney disease (CKD), T50 is associated with the severity and progression of coronary artery calcification. T50 is also associated with cardiovascular events and all-cause mortality in CKD patients, patients on dialysis and kidney transplant recipients and with cardiovascular mortality in patients on dialysis, kidney transplant recipients, patients with ischemic heart failure and reduced ejection fraction, and in the general population. Switching from acetate-acidified dialysate to citrate-acidified dialysate led to a longer T50, as did a higher dialysate magnesium concentration. Oral administration of magnesium (in CKD patients), phosphate binders, etelcalcetide and spironolactone (in hemodialysis patients) was associated with a lower serum calcification propensity. Serum calcification propensity is an overall marker of calcification associated with hard outcomes but is currently used in research projects only. This assay might be a valuable tool for screening serum calcification propensity in at-risk populations (such as CKD patients and hemodialyzed patients) and, in particular, for monitoring changes over time in T50.

An experimental study to characterise the role of multihole nozzle in adjuvant assisted cryospray

Cryospray is a process of skin cancer treatment in which liquid nitrogen is sprayed on the lesion to achieve necrosis. In order to achieve necrosis through cryospray, a combination of particular cooling rate and lethal temperature is required. The small aperture of single hole nozzle (SHN) and the less mass flow rate associated with it reduce the rate of heat transfer from the lesion. Moreover, the low thermal conductivity of lesion further reduces the rate of energy diffusion inside it. These limitations associated with the existing method of cryospray fail to provide complete necrosis in the lesions of size larger than 15 mm in diameter. The present study addresses these issues through the modification in the existing spraying technique, i.e. inclusion of multihole nozzle (MHN) in cryospray and administration of Magnesium Oxide (MgO) nanoparticles as an adjuvant in the lesion to increase its rate of energy diffusion. The influence of mass flow rate and the rate of evaporation of cryogen on cryoablation are analysed experimentally while changing the geometrical parameters of 6 MHNs. To quantify the necrosis, thermocouples and FLIR thermal imaging camera are used to ascertain temperature profile below and above the gel surface respectively. The crystalline nature of nanoparticles is confirmed through TEM and XRD results with a particle diameter ranging between 10 and 40 nm. A comparative study of cryoablation is carried out between nano-phantom and normal-phantom. An increase of 59%, 96% and 64% in the area of necrotic zone is observed on the surface of nano-phantom for MHNs with 5 holes and margin of 1 mm, 1.5 mm and 2 mm respectively. The radius of interacellular ice formation has increased by 5 mm at an axial depth of 2 mm for MHNs with 5 holes in the nano-phantom than that in normal-phantom due to the increase in cooling rate. It is also observed that nano-phantom achieves a lower end temperature than the normal-phantom at every thermocouple position. Among the 6 MHNs selected for the study, MHN with 5 holes and 1.5 mm margin provides the most optimised result with the ablation zone of 42 mm on the surface of gel. Thus, it can be concluded that because of the introduction of adjuvant and modification in spraying device, cryoablation outcomes have been improved both quantitatively and qualitatively. The proposed approach will increase the scope of cryospray in the treatment of larger lesions.

Prophylactic Administration of Magnesium Oxide Prevents Dextran Sulfate Sodium-Induced Colonic Injury in Mice.

We previously demonstrated that per os administration and ad libitum ingestion of a magnesium chloride (MgCl2) solution had a prophylactic effect on dextran sulfate sodium (DSS)-induced colitis in mice, magnesium being considered to play a role in this preferable action. Magnesium oxide (MgO) is a commercially available magnesium formulation, but whether or not it prevents development of colitis is unknown. In this study, we investigated the effect of MgO administration on development of colitis in DSS-treated male C57BL/6J mice. Experimental colitis was induced by ad libitum ingestion of 1% (w/v) DSS, and the colitis severity was evaluated by disease activity index (DAI) scores, histological assessment and colonic expression of inflammatory cytokines. A 1 mg/mL MgO solution was administered to mice through ad libitum ingestion from a day before DSS treatment to the end of the experimental period of 12 d. In addition, the effects of DSS, MgO and their combination on the gut microbiota were investigated by 16S ribosomal RNA metagenome analysis. DSS-induced elevation of DAI scores was partially but significantly decreased by MgO administration, while MgO administration had no apparent effect on the shortened colonic length, elevated mRNA expression of colonic interleukin-1β and tumor necrosis factor-α, increased accumulation of colonic mast cells, or altered features of the gut microbiota in DSS-treated mice. Overall, we demonstrated that MgO had a prophylactic effect on the development of colitis in DSS-treated mice by preventing histological colonic damage, but not colonic inflammation or alteration of the gut microbiota.

Evidence-Based Guideline on Prevention and Management of Shivering After Spinal Anesthesia in Resource-Limited Settings: Review Article

BackgroundPerioperative shivering is a common problem faced in anesthesia practice. Unless it is properly managed and prevented, it causes discomfort and devastating problems, especially in patients with cardiorespiratory problems. Surgery, anesthesia, exposure of skin in a cool operating theater, and administration of unwarmed fluids are some of the major causes for the development of shivering among surgical patients. Currently, a variety of non-pharmacological and pharmacological techniques are available to prevent and manage this problem. The available options to prevent and treat shivering include but are not limited to pre-warming the patient for 15 minutes before anesthesia administration, administration of low dose ketamine, dexamethasone, pethidine, clonidine, dexmedetomidine, tramadol, and magnesium sulfate.ObjectiveTo develop evidence-based recommendations for the prevention and management of shivering after spinal anesthesia in a resource-limited settings.MethodsThe kinds of literature are searched from Google Scholar, PubMed, Cochrane library, and HINARI databases to get access to current and update evidence on the prevention and management of shivering after spinal anesthesia. The keywords for the literature search were (shivering or prevention) AND (shivering or management) AND (anesthesia or shivering).ConclusionPre-warming the patient with cotton, blanket, gown warming, and administering warm IV fluid 15 minutes before spinal anesthesia are possible non-pharmacologic options for the prevention of shivering. Furthermore, pharmacological medications like low dose ketamine, dexamethasone, magnesium sulfate, ad tramadol can be used as alternative options for the prevention and management strategies for shivering of different degrees in resource-limited areas.

A systematic review on considering the role of Magnesium in preventing post-anesthesia shivering.

Shivering following anesthesia is caused by disturbed regulation of body temperature and causes an increase in tissue oxygen consumption and cardio-pulmonary activity. Choosing the right medicine to reduce shivering with the most negligible side effects in surgery is essential. Magnesium is prescribed intravenously, epidurally, or intra-peritoneally. Each of these methods can have different effects in different surgical operations. In this review, we are looking for randomized clinical trials that compared preoperative magnesium administration with a control group and included studies that evaluated the degree of shivering as a primary outcome variable. This study aimed to evaluate pre-operative magnesium's effect in preventing shivering after surgery. This article was a systematic review type, in which all quality articles published until the end of 2021 were searched with the keywords magnesium, shivering, surgery, and prevention via different databases, including PubMed, Cochrane Central Register of Tested Controlled, EMBASE and Web of Science. In the initial search, 3294 publications were identified. 64 articles were included in this study. The results indicated that shivering in the magnesium group with IV epidural injection inside the peritoneum was significantly reduced compared to the control group. It was also identified in the examination of symptoms. Variants such as extubation time, length of stay in PACU, magnesium serum concentration, spinal c-fos mRNA expression, nausea or vomiting, sedation, itching, pressure drop, and bradycardia were significantly less reported than the control group. In general, the results showed that the preventive use of magnesium could decrease the intensity and number of post-anesthesia shivering and other post-anesthesia symptoms.

Effects of Magnesium Sulfate on Intraoperative Blood Loss and Anesthetic Requirement in Meningioma Patients Undergoing Craniotomy with Tumor Removal: A Prospective Randomized Study

Abstract Background Meningioma brain tumor is associated with significant blood loss. Magnesium (Mg), a calcium blocker, can facilitate blood pressure control during surgery. This study aimed to evaluate effects of magnesium on blood loss, anesthetic requirement, and its neuroprotective effect in meningioma patients undergoing craniotomy. Methods Eighty patients aged between 18 and 70, American Society of Anesthesiologists physical status I and II, diagnosed with meningioma and scheduled for craniotomy tumor removal were randomized into two groups. Group M (Mg) received intravenous magnesium sulfate 40 mg/kg over 30 minutes initiated at skin incision and followed by continuous infusion of 10 mg/kg/h until dura closure. Group N (NSS) received 0.9% NaCl as placebo. Anesthesiologists in charge, surgeons, and patients were all blinded. The assessed outcomes were perioperative blood loss, anesthetic requirement, and pre- and postoperative neurocognitive functions assessed by Montreal Cognitive Assessment (MoCA). Results Thirty-eight patients in each group were analyzed. In group M, the intraoperative blood losses were 500 (70, 2300) mL, and 510 (100, 1600) mL in group N (p = 0.315). Patients who received blood within 24 hours were 39.5% in group M and 47.4% in group N (p = 0.644). No differences were observed in anesthetic requirement, intraoperative mean arterial pressure, hypotensive episodes, and vasopressor usages. There were no significant differences in postoperative MoCA score. Magnesium levels did not exceed acceptable levels. Conclusions Magnesium administration in meningioma patients had no significant effects on blood loss, anesthetic requirement, and postoperative cognitive function.

Effect of Intraoperative Magnesium Sulfate Administration on Blood Glucose Control following Total Joint Arthroplasty in Patients with Diabetes.

Magnesium deficiency, which is known to be highly prevalent among patients with diabetes, has been associated with insulin resistance and poor glucose control. Here, we aimed to investigate the effects of intraoperative magnesium administration on postoperative glucose control in patients with diabetes. We retrospectively reviewed the medical records of patients with type 2 diabetes who had undergone total joint arthroplasty at a tertiary hospital, where intraoperative magnesium sulfate injections were frequently performed for postoperative analgesia. The patients were grouped based on whether treated with magnesium or not (magnesium vs. control groups). We investigated postoperative blood glucose levels and sliding scale insulin requirements. After propensity matching, 170 patients were allotted to each group. Both the mean glucose level and the incidence of a mean glucose level of >200mg/dL were significantly lower in the magnesium group than in the control group (p = 0.040 and 0.013, respectively). There was also a lower insulin requirement in the magnesium group (p = 0.043). Multivariate logistic regression revealed that magnesium treatment was significantly related to a less frequent incidence of a mean blood glucose level of >200 mg/dL (p = 0.047). This study demonstrated that magnesium sulfate infusion was associated with an improved postoperative blood glucose profile in patients with diabetes.

MO1006: Cni-Induced Hypomagnesemia in Kidney Transplantation: A Comparative Monocentric Study Between Sucrosomial Magnesium and Magnesium Pidolate

Abstract BACKGROUND AND AIMS Magnesium (Mg) is the second cation in the intracellular space and the fourth prevalent cation in the body. It contributes to DNA and protein synthesis, infiammatory processes and cardiac excitability, while Mg deficiency leads to increased cardiovascular risk, atherosclerosis and diabetes [1]. In addition to gastrointestinal losses, loop or thiazide diuretics induce renal wasting, volume expansion and nephrotoxins including antibiotics Hypomagnesemia (HypoMg) is observed early after kidney transplantation and is associated with a faster decline of allograft function. Main determinants are calcineurin inhibitors (CNIs), protonic pump inhibitors (PPI), low Mg intake and diuretics. CNIs, in particular, induce HypoMg with mechanisms not fully understood, likely via downregulation of the Mg channel TRPM6 in the distal collecting tubule [2]. HypoMg should be corrected with oral supplements. Recently, in order to increase magnesium bioavailability and tolerance not shown by convetional oral magnesium supplements, a new sucrosomial magnesium formulation has been developed. Its innovative preparation encapsulates magnesium oxide in a phospholipid membrane covered by a sucrester matrix, which enhances Mg passage through the gastric and intestinal environment without any interaction with the intestinal mucosa [3]. This study evaluates magnesium bioavailability, tolerance and effectiveness after administration of sucrosomial magnesium compared with magnesium pidolate. METHOD We recruited 32 adult single, double or combined kidney-pancreas transplant recipients within 1 year from transplantation, who developed CNI-induced hypomagnesemia. Exclusion criteria include: HypoMg due to PPI or gastrointestinal losses. A total of 13 patients received magnesium pidolate, and 19 patients received sucrosomial magnesium. Venous blood samples were taken at baseline (T0) and after 10 days of magnesium supplement (T1). RESULTS Sucrosomial magnesium increased Mg bioavailability and tolerance: 0.60 ± 0.02 T0 mmoL/L versus 0.69 ± 0.05 T1; P < .0001 versus magnesium pidolate: 0.61 ± 0.05 T0 versus 0.64 ± 0.05 T1; P = .72 N.S. (Fig. 1A). Sucrosomial magnesium provided an increase of Mg over magnesium pidolate in terms of $\Delta \% $ increase: 12.4% for sucrosomial Mg versus 5.4%, P = .04 (Fig. 1B). CONCLUSION Our data, although obtained by a small cohort of transplant patients, shows that sucrosomial Mg is more efficient and better tolerated compared with magnesium pidolate. On the one hand, the fact that our study is the first in transplant patients to evaluate the impact of sucrosomial Mg for the correction of HypoMg might justify the limited number of patients enrolled and the short observation time; on the other hand, our results could serve as a working hypothesis for further studies with a larger number of transplant patients and for extended study duration to confirm the benefit of sucrosomial Mg.

Immunohistochemical and Histochemical Studies of Β-Cells Insulin Up-Regulation in Pancreatic Tissues of Streptozotocin-Induced Diabetic Albino Rats Treated with Melatonin and Magnesium

Background: Improve insulin secretion and cellular availability to reduced blood glucose levels in diabetic subjects by bioactive compound especially antioxidants are the new focus to ameliorate the complication with diabetes mellitus. Aims and objectives: The aim of this study was to evaluate the effects of administration of melatonin and magnesium on the cytoarchitecture of the pancreatic tissue and to access immunohistochemically insulin release in streptozotocin-induced diabetic Albino rats. Materials and methods: To achieve this aim six normoglycaemic rats and fourty eight Streptozotocin (STZ) induced diabetic rats was used in the study after two weeks acclimatization period. The animals were assigned into nine groups as follows, Normal control group (NC), Diabetic control (DC) group, Melatonin at 10 mg/kgb (MLD), magnesium dose group of 240 mg/kgbw (MgLD), melatonin and magnesium combined group of 10mg/kgbw+240mg/kgbw (MMgLD), melatonin group of 20mg/kgbw (MHD), melatonin and magnesium high dose combined group of 20mg/kgbw+480mg/kgbw (MMgHD) and insulin at 500mg/kgbw group (IN). Melatonin and insulin were administered through intraperitoneal injections (IP) while magnesium was by oral administration. The control groups were given placebo and all groups’ treatment was for twenty-one days. At the end of the study, the animals were aestheticized and euthanized to harvest pancreatic organ. The organs were fixed in neutral buffered formaldehyde (NBF). They were histologically prepared and stained using haematoxylin and eosin and immunohistochemically stained using insulin antibody to access insulin release. Results: Melatonin treatment at 10mg/kgbw and at 20 mg/kgbw showed histological improvement in histological tissues and insulin release while when combined with magnesium at dose of 10mg/kgbw and at 240 mg/kgbw showed better results. The administration of magnesium at 240 mg/kgbw, 480 mg/kgbw and when combined with melatonin at high doses does not show significant improvement in islet β-cell proliferation and insulin release. Conclusion: The administration of melatonin and magnesium at low doses regenerates pancreatic islet histoarchitecture and augments insulin release from treated diabetic albino rats.

Abstract TMP100: The Effect Of Prehospital Treatment With Magnesium On Symptomatic Hemorrhagic Transformation In Cerebral Ischemia

Introduction: Symptomatic hemorrhagic transformation (sHT) is a known complication of acute ischemic stroke and is associated with worse outcomes. Previously, low serum magnesium levels have been associated with higher rates of sHT. This study evaluated the effect of prehospital treatment with intravenous magnesium on rates of sHT. Methods: Subjects were participating in the NIH Field Administration of Stroke Therapy Magnesium (FAST-MAG) clinical trial. A total of 20 grams of magnesium or matching placebo was administered via 4 gram bolus in the field followed by 16 gram infusion over 24 hours. All subjects with cerebral ischemia were evaluated for the presence of symptomatic hemorrhagic transformation defined as an increase in NIHSS >=4 points in the setting of imaging showing new hemorrhage within the ischemia territory. Results: A total of 1245 cases of cerebral ischemia were evaluated by paramedics on average 40 (SD 85) minutes and treated with magnesium or placebo on average 63 (SD 85) minutes after last known well time. Study population was age 71 (SD 18), 45% female, 78% white, 14% black, 8% Asian, 20% Hispanic ethnicity, 36% were treated with intravenous TPA, 78% hypertensive and 23% diabetic. Median NIHSS at ED arrival was 7 [IQR2-15]. There were 187 cases of clinical deterioration of which 43 were due to hemorrhagic transformation (3.4%). Rates of sHT were not statistically different in those who received magnesium vs. placebo (17/632 [2.7%] vs 26/613 [4.2%], p=0.134). Although HT was more common in TPA cases (6% vs 2%, p<0.001), magnesium had no effect on sHT in this subgroup 5.3% vs 7.3%, p-0.399 Conclusions: Hyper-acute high-dose intravenous magnesium did not lead to a significant decrease in rates of sHT following acute ischemic stroke. It is possible that a subgroup with low baseline magnesium levels could have benefited.

Abstract TP5: Early Intubation Of Hyperacute Stroke Patients In The Emergency

Background: Stroke patients at times will present to the emergency department in unstable condition necessitating early intubation. Given the time-sensitive nature of thrombolysis for ischemic stroke, we sought to characterize the rates and predictors of intubation on ED arrival for hyperacute stroke patients transported by paramedics. Methods: Subjects were participating in the NIH Field Administration of Stroke Therapy Magnesium (FAST-MAG) clinical trial. Subjects were enrolled in the field ambulance within 2 hours of last known well and taken to their usual care emergency department. Early intubation was noted by study nurses on their initial NIHSS after ED arrival. Results: A total of 1700 cases were included, aged 69±13 years, 42.6% were women, median NIHSS on ED arrival was 9 [IQR 3-17], final diagnosis was cerebral ischemia in 73.3%, intracranial hemorrhage (ICH) in 22.8%, and a stroke-mimicking condition in 3.9%. The median time form last known to ED arrival was 59 minutes. Early ED intubation was more common in ICH compared to CI or mimic (18% vs. 1% vs. 3%, p<0.001). Early intubation was associated with higher NIHSS [32 v 9]. The final diagnosis for both stroke mimic cases with early intubation was seizure. Among the 88 cases intubated early in the ED, there were 71 (81%) ICH, 15 (17%) ischemia and 2 (3%) mimics. Rates of TPA utilization in cerebral ischemia cases were 53% in the intubated group and 36% in the non-intubated group. Conclusion: Early intubation in the ED was more common in the ICH cases and occurred in only 1% of cerebral ischemia cases.

Investigation of the Effects of L-carnitine and magnesium on Oxidative Stress and Cytokines in the Tissue of Experimental diabetic rats

Abstract The aim of this study was to determine the effects of L-carnitine and magnesium on the levels of tissue malondialdehyde, 8-hydroxy-2’-deoxyguanosine, and cytokines (tumor necrosis factor alpha, interleukin-6) in streptozotocin-induced experimental diabetes in rats. Eighty male Wistar albino rats (200-250 g) were divided into 8 groups with 10 rats in each group. The groups received the following treatments: Control group; 2 ml distilled water (by gavage); Group 2: 50 mg/kg (b.w.) i.p. streptozotocin; Group 3: 125 mg/kg (b.w.) magnesium; Group 4: 300 mg/kg (b.w.) L-carnitine; Group 5: 125 mg/kg (b.w.) magnesium +300 mg/kg (b.w.) L-carnitine; Group 6: 50 mg/kg (b.w.) streptozotocin +125 mg/kg (b.w.) magnesium; Group 7: 50 mg/kg (b.w.) streptozotocin +300 mg/kg (b.w.) L-carnitine and Group 8: 50 mg/kg (b.w.) streptozotocin +125 mg/ kg (b.w.) magnesium+300 mg/kg (b.w.) L-carnitine administered for 4 weeks. Liver and kidney malondialdehyde, 8-hydroxy-2’-deoxyguanosine, tumor necrosis factor alpha and interleukin-6 levels did not change in the magnesium, L-carnitine, and magnesium + L-carnitine groups compared to the control. The highest levels of malondialdehyde, 8-hydroxy-2’-deoxyguanosine, tumor necrosis factor alpha and interleukin-6 were determined only in the group with diabetes (Group 2). Lipid peroxidation, DNA damage, and cytokine levels were significantly reduced in diabetic animals with the administration of magnesium and L-carnitine separately or in combination. Based on the obtained results it can be concluded that magnesium and L-carnitine may have antidiabetic effects, especially in combination.

Prediction of Postoperative Day 1 Hemoglobin Level after Cesarean Delivery.

To create a prediction model for postoperative hemoglobin levels after cesarean delivery, which could reduce routine use of postoperative laboratory test. This was a secondary analysis of a retrospective cohort study of all women who underwent cesarean delivery (primary or repeat) at or more than 23 weeks' gestation at a single academic center. The cohort was randomly divided into a training cohort to develop a prediction model and a validation cohort to test the model in a 2:1 ratio. Variables with p-value <0.10 were considered for the mixed multivariable linear regression model in a backward stepwise fashion. We obtained the best cut-off point of the predicted hemoglobin level to detect severe anemia (postoperative hemoglobin level less than 7.0 g/dL) in the training cohort. A receiver operating characteristic curve with the area under a curve was created. We calculated the sensitivity and specificity of the model in the validation cohort using the best cut-off point obtained in the training cohort as well as postoperative hemoglobin of 10.0 g/dL. Of 2,930 women, 1,954 (66.6%) and 976 (33.3%) were randomly allocated to training and validation cohorts. The final model included preoperative hemoglobin level, preoperative platelet level, quantitative blood loss, height, weight, magnesium administration, labor, and general anesthesia. The best cut-off to predict severe anemia was predicted hemoglobin level of 8.57 g/dL in the training cohort. Using this cut-off, the sensitivity and specificity in the validation cohort were 77% (95% confidence interval [CI]: 56-91%) and 87% (95% CI: 85-89%), respectively. The use of postpartum hemorrhage yielded the sensitivity of 58% (95% CI: 37-77%) and specificity 79% (95% CI: 76-81%), respectively. We developed a validated model to predict the postoperative day 1 hemoglobin levels after cesarean delivery that could assist with identifying women who may not need postoperative laboratory tests. · Postoperative laboratory tests are routine.. · A prediction model may allow reduce routine tests.. · We developed an accurate mathematical model..