Serum Magnesium Concentrations Research Articles

Machine Learning Approaches Incorporating High-Dimensional Longitudinal Data Improve the Prediction of Survival after Allogeneic Hematopoietic Cell Transplantation

Introduction: The European Society for Blood and Marrow Transplantation (EBMT) risk score and the Hematopoietic Cell Transplant Comorbidity Index (HCT-CI) remain suboptimal for predicting mortality after allogeneic hematopoietic cell transplantation (HCT) in pediatric patients. These risk scores are calculated based on a small number of variables collected before HCT. Their predictive performance is limited because of the inherent procedural uncertainties, the statistical methodologies used, and the limited number and quality of variables included. By combining multi-institutional, comprehensive, and patient-centric data, machine learning (ML)-based techniques provide an opportunity to develop more accurate risk prediction algorithms by incorporating longitudinal data collected before and after HCT. To our knowledge, no risk prediction algorithms incorporate longitudinal data collected after HCT into the prediction of overall survival (OS) for pediatric patients. We hypothesized that by including high-dimensional longitudinal data such as objective clinical and laboratory assessments from electronic health records (EHRs), models built with ML could help identify patients at high risk of mortality. To test this hypothesis, we developed an ML model incorporating such longitudinal data, which were readily available from EHRs, to predict the 1-year OS among pediatric patients undergoing allogeneic HCT, and we compared its prediction performance with that of a model involving only the baseline variables normally used in standard risk prediction models. Patients and Methods: This study included a cohort of 770 pediatric patients who underwent their first allogeneic HCT at St. Jude Children's Research Hospital between 2000 and 2020. Combining the baseline data (e.g., disease, donor, and graft characteristics) and the longitudinal evaluation data (e.g., blood cell counts, serum chemistries, measurable residual disease) collected within 30 days before or after HCT, we built a predictive model that uses penalized logistic regression to identify patients at high risk for mortality within 1 year after HCT. We compared the proposed ML model incorporating longitudinal measurements with a model trained only on baseline data and analyzed the importance of the different input features. Results: The area under the curve (AUC), either the receiver operating characteristic (ROC) curve or the precision-recall (PR) curve, measures the prediction accuracy of the estimated model. The AUC ranges from 0.0 and 1.0, with a higher AUC indicating a more accurate prediction. The proposed ML model has achieved an ROC AUC of 0.760 (95% confidence interval [CI]: 0.739-0.779), significantly outperforming the baseline model, for which the ROC AUC is 0.698 (95% CI: 0.675-0.718). This predictive advantage of the proposed ML model is also reflected in the PR AUC of 0.680 (95% CI: 0.651-0.712), as compared with 0.513 (95% CI: 0.482-0.546). The feature importance analysis suggests that in prediction modeling, the learned model relies heavily on the longitudinal evaluations, including the concentrations of serum magnesium, aspartate aminotransferase (AST), and ferritin, and the platelet count before and after HCT in addition to certain baseline variables such as the underlying diagnosis and graft type. Conclusion: Leveraging readily available longitudinal data from EHRs, we developed an ML model for 1-year OS prediction in pediatric patients undergoing allogeneic HCT. Our model shows that the results of frequently monitored laboratory and clinical tests performed within 30 days before or after HCT can potentially identify patients with a high risk of mortality after HCT. We are currently validating this model by using external datasets. Such ML models could be included in the EHR system as clinical decision support tools (see an R Shiny app created for data analysis and an illustration of the results at https://sjbiostat.shinyapps.io/pedsHCT), enabling better dynamic stratification of patient risk, optimization of clinical care, and improved therapeutic outcomes. The findings of this study reflect the fact that ML approaches are hugely augmentative and vital to efforts to transform large pools of data into valuable information as a result of their ability to extract predictive features efficiently from high-dimensional and heterogeneous data sources. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Associations of metal profiles in blood with thyroiditis: a cross-sectional study

Autoimmune thyroiditis (AIT) is increasingly common, and serological markers include thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb). To determine if selected metals influence thyroiditis antibody positivity, this cross-sectional study investigated associations between metals and thyroiditis antibody status. Healthy individuals (n = 1104) completed a questionnaire and underwent checkups of anthropometric parameters, thyroid function status, and levels of seven metals in blood (magnesium, iron, calcium, copper, zinc, manganese, and lead). Associated profiles of glyco- and lipid metabolism were also established. Logistic regression and restricted cubic spline (RCS) regression analysis were applied to adjudge associations between metals and TPOAb and TgAb status. It was found that, after adjusting for likely cofounding factors, participants with antibody positivity had significantly lower serum concentrations of magnesium and iron. When serum magnesium levels were analyzed in quartiles, the odds ratios of quartile 4 were 0.329–fold (95% confidence interval (CI): 0.167–0647) and 0.259-fold (95% CI 0.177–0.574) that of quartile 1 regarding TPOAb and TgAb positivity (P = 0.004, 0.003). After adjustment, the RCS analysis detected nonlinear associations between iron and TPOAb and TgAb positivity (P < 0.01, both). In stratified analyses, these associations regarding magnesium and iron remained for women of reproductive age, but not for postmenopausal women and men. We conclude that lower serum levels of magnesium and iron are associated with incremental positivity of thyroiditis antibodies and may be among the most important metals contributing to AIT in women of reproductive age.

Correlation of serum magnesium with HbA1c in patients with diabetes mellitus

Background and objectives: Diabetes mellitus (DM) is a leading cause of death and disability world wide. Magnesium acts as a cofactor in glucose metabolism and its decreased level causes insulin resistance and many complications in diabetic patients. The present study evaluated the correlation of serum magnesium with HbA1c in DM patients. Materials and methods: This cross sectional study was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka from July 2016 to June 2017. A total number of 100 individuals with and without diabetes mellitus were included in the study. HbA1c was measured by high performance liquid chromatography and estimation of serum magnesium was done by automatic biochemistry analyzer. Results: Out of 100 enrolled participants, 50 were diagnosed patients of DM (Group-A) and 50 were age and sex matched apparently healthy individuals (Group-B). The mean age of Group-A and B individuals was 50.5 ± 6.0 and 50.4 ± 5.1 years respectively. Group-A had significantly (p &lt; 0.001) lower serum magnesium concentration compared to Group-B (1.5 ± 0.6 mg/dl vs 2.3 ± 0.5 mg/dl). Serum magnesium levels showed significant negative correlations with HbA1c (r = -0.511, p &lt; 0.001). Conclusion: DM patients showed significant negative correlation of serum magnesium with HbA1c level. Routine screening for serum magnesium status would be helpful for the better management of diabetic cases. IMC J Med Sci. 2023. 17(1): 005. DOI: https://doi.org/10.55010/imcjms.17.005 *Correspondence: Farzana Ahmed, Department of Biochemistry, Ibrahim Medical College, 1/A Ibrahim Sarani, Shegunbagicha, Dhaka, Bangladesh. Email: tanvy1108@gmail.com

ASSESSMENT OF MAGNESIUM (MG) AND ZINC (ZN) IN CARCINOMA BREAST PATIENTS

Objectives: The objectives of the study were to determine and compare serum magnesium (Mg) and zinc (Zn) concentrations between breast carcinoma patients and healthy controls. Methods: Determination and comparison of serum Mg and Zn was done between 50 breast carcinoma patients and 50 healthy controls. Determination and comparison of LFT in between 50 breast cancer patient during different course of chemotherapy. Trace element analysis was done using atomic absorption spectrophotometry. Statistical comparison was done, results were expressed as Mean±SD, p&lt;0.05 was considered to be statistically significant. Results: All groups were statistically matched in age, sex, and p&gt;0.05. Serum Mg concentrations in cases and controls (0.9920±0.38 mg/dL) and (1.49±0.58 mg/dL) respectively, p≤0.0001* serum Zn concentrations in cases and controls were (66.74±12.58 μg/dL) and (90.88±14.51 μg/dL), respectively, p≤0.0001*. Conclusion: Both serum (Zn) and (Mg) showed significant decreases in breast carcinoma patients as compare to healthy controls.

Neuromuscular blockade characteristics of cisatracurium in patients receiving chemotherapy: A preliminary study in breast cancer patients.

Cancer chemotherapeutic agents cause alteration in the response to neuromuscular blocking drugs, which can have serious perioperative implications. Magnesium, commonly found to be deficient in these patients, plays an indispensable role in neuromuscular transmission. This study aimed to understand the effect of neoadjuvant chemotherapy on the neuromuscular blocking properties of cisatracurium. One hundred female patients scheduled for breast cancer surgery were divided into two groups (n = 50 each). Group B received neoadjuvant chemotherapy with taxane, adriamycin, and cyclophosphamide, and Group A did not receive neoadjuvant chemotherapy. Neuromuscular block following cisatracurium 0.15 mg/kg was measured using peripheral nerve stimulator at the ulnar nerve. Onset time, duration of intense block, clinical duration of action, time to TOF4 after the last dose of cisatracurium, along with preoperative serum magnesium concentration were measured. Correlation and multiple regression were run to analyze the relationship between history of neoadjuvant chemotherapy, preoperative magnesium, and the abovementioned time points. Mediation analysis was done to ascertain if magnesium was mediating the observed effects. Onset time was prolonged by nearly 18% in Group B compared to Group A (P = 0.001). The duration of intense block was 35.27 ± 8.9 min in Group B and 42.07 ± 10.99 min in Group A (P < 0.001). The clinical duration of action of cisatracurium was significantly shorter in Group B (46.06 ± 8.68 min) compared to Group A (55.87 ± 11.04 min, P < 0.001). The time to TOF4 was 32.86 ± 5.66 min in Group B and 36.57 ± 8.49 min in Group A (P < 0.05). Preoperative serum magnesium levels were significantly lower in Group B (P < 0.001). Patients who had received neoadjuvant chemotherapy had a delayed onset, shorter duration of action, and faster recovery for cisatracurium. Although preoperative magnesium levels were lower in Group B, it was found to be an independent predictor rather than a mediator of these effects.

Nutritional Imbalances in Polish Children with Coeliac Disease on a Strict Gluten-Free Diet.

Currently, the only treatment for coeliac disease (CD) is a strict, lifelong gluten-free diet (GFD); however, their completeness with regard to energy and macro- and micronutrients remains poorly understood. Paediatric studies are often limited by a low quality and a lack of controls, and their findings should be interpreted with caution. The aim of the present study was to evaluate nutritional imbalances in children with CD on a strict GFD. Methods: A single-centre prospective cohort study was conducted. A total of 48 children with CD (33 girls, mean age 11.8 ± 3.68 years) on a strict GFD (mean duration 5.02 ± 3.87 years) were compared with 50 non-coeliac subjects (26 girls, mean age 10.2 ± 3.97 years). In both groups, anthropometric measurements (body height, weight and BMI) and laboratory tests (haemoglobin level, calcium and magnesium serum concentration, folic acid, vitamin B1, B2, B6 and B12 level) were checked. Additionally, in coeliac subjects, a 3-day food record for energy and macro- and micronutrient intake assessment were determined, and the values were compared to those in non-CD participants and the dietary reference intake (DRI) standards. Results: The CD children were more likely to demonstrate significantly lower serum vitamin B1 and folic acid levels compared to controls (p = 0.01 and p = 0.002, respectively). Although mean serum calcium values were within normal ranges, they were significantly lower in CD subjects than controls (p = 0.01). Mean calcium, folic acid and vitamin D intake was below the dietary recommendations in the CD group (69.9%, 71.2% and 68.9% DRI, respectively) but did not differ significantly between CD and non-coeliac subjects. In turn, the mean supply of proteins and carbohydrates in the CD group substantially exceeded the recommended levels (190.3% and 189.4% DRI, respectively) but was similar to controls. A significantly higher number of CD children were classified as underweight, and a significantly lower number as overweight or obese, compared with controls (p < 0.001). Conclusion: Although children with CD receive nutritional education at diagnosis, a GFD often does not provide a balanced set of macro- and micronutrients. This is mainly due to unhealthy dietary habits, as commonly observed in the general population. Children with CD should be informed that while their diet should be free of gluten, it should nevertheless cover all their nutrition requirements in the long term.

Reduced serum magnesium is associated with the occurrence of diabetic macular edema in patients with diabetic retinopathy: A retrospective study.

Serum magnesium levels have been reported to reflect the risk of diabetic retinopathy (DR); however, the effect of serum magnesium level on diabetic macular edema (DME) remains unclear. Here, we investigated the association between the serum magnesium levels and DME in patients with DR. Patients with DR were recruited between January 2018 and June 2021. A total of 519 such patients were included in this study. All patients underwent a standardized clinical ophthalmic examination by an experienced ophthalmologist, and an assay was conducted to determine the serum magnesium concentration. Compared with the non-DME group, the DME group had a higher proportion of insulin use and a higher level of serum ischemia-modified albumin and fasting plasma glucose. The serum magnesium and calcium levels were lower in the DME group than in the non-DME group (P < 0.05). Higher magnesium levels were negatively associated with DME after adjustment for relevant covariates. Compared with the participants in the lowest magnesium quartile, those in the fourth quartile showed a significantly lower risk of DME after adjustment [odds ratio (OR), 0.294; 95% confidence interval, 0.153–0.566; P < 0.0001]. Considering the potentially different effects of serum magnesium on the development of DME in patients with DR based on age, DR staging and insulin use, stratified analysis was performed by considering these factors. Among insulin-using patients with non-proliferative DR who were < 66 years of age, those in the third and fourth quartile of serum magnesium were less likely to develop DME than those in the lowest quartile of serum magnesium [OR (95% CI), 0.095 (0.014–0.620), 0.057 (0.011–0.305); P = 0.014, 0.001]. Overall, a higher serum magnesium level was associated with a lower risk of DME in patients with DR. Furthermore, patients with DR who used insulin were more likely to develop DME. Long-term studies on oral magnesium supplements are needed to determine whether maintaining the serum magnesium levels in a higher physiological range can reduce the risk of DME in patients with DR.

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.

Inflammatory-Metal Profile as a Hallmark for COVID-19 Severity During Pregnancy.

Pregnancy makes women more susceptible to infectious agents; however, available data on the effect of SARS-CoV-2 on pregnant women are limited. To date, inflammatory responses and changes in serum metal concentration have been reported in COVID-19 patients, but few associations between metal ions and cytokines have been described. The aim of this study was to evaluate correlations between inflammatory markers and serum metal ions in third-trimester pregnant women with varying COVID-19 disease severity. Patients with severe symptoms had increased concentrations of serum magnesium, copper, and calcium ions and decreased concentrations of iron, zinc, and sodium ions. Potassium ions were unaffected. Pro-inflammatory cytokines IL-6, TNF-α, IL-8, IL-1α, anti-inflammatory cytokine IL-4, and the IP-10 chemokine were induced in the severe presentation of COVID-19 during pregnancy. Robust negative correlations between iron/magnesium and zinc/IL-6, and a positive correlation between copper/IP-10 were observed in pregnant women with the severe form of the disease. Thus, coordinated alterations of serum metal ions and inflammatory markers – suggestive of underlying pathophysiological interactions—occur during SARS-CoV-2 infection in pregnancy.

MODERN ASPECTS OF THE ETIOPATHOGENESIS OF ISTMIC-CERVICAL INSUFFICIENCY

Isthmic-cervical insufficiency (ICI), which results in the failure of the circular muscles of the internal os, isthmus and cervix of the uterus is important in the pathogenesis of preterm birth. The existing types are anatomical, functional and congenital ICI. ICI is a pathological condition of the cervix and the isthmus, in which they are unable to withstand the intrauterine pressure and keep a fertilized egg in the uterine cavity until birth. ICI is a serious complication of pregnancy. Genetic, hormonal, inflammatory-infectious, immunological, traumatic factors play a role in the occurrence of ICI. The aim of the study is to study the peculiarities of reproductive health and gestational process of pregnant women with ICI, according to the literature. For the study, we analyzed domestic and foreign publications on this topic in professional journals, as well as data from Internet resources. Results of the research show that ICI plays a special role among many causes that lead to preterm termination of pregnancy and premature birth in the II-III trimesters. The properties of the cervix depend on the ratio of connective and muscle tissue. Today, most authors distinguish between congenital, acquired, organic and functional isthmic-cervical insufficiency.Organic (post-traumatic, secondary) ICI occurs due to mechanical damage to the cervix. Functional ICI is the result of a violation of the relationship between the muscular and connective tissues of the cervix, as well as the result of changes in the response of its structural elements to neurohumoral stimuli. Functional ICI most often occurs as a consequence of a violation of the hormonal background of women (ovarian hypofunction, hyperandrogenism). Congenital ICI occurs in malformations of the uterus, genital infantilism. Histological examination of cervical tissue in women with ICI reveals an increase in muscle tissue up to 50%, which leads to early softening of the cervix of the uterus and development of its functional insufficiency. According to Kaufman KP (2021), the role of connective tissue in the development of ICI is confirmed by the fact, that this pathological condition of the cervix is found in women with Marfan syndrome and Ehlers-Danlos syndrome. The role of undifferentiated connective tissue dysplasia (UCTD) as a risk factor for complicated pregnancy, including ICI.Research of Huang J and co-authors (2021) found the presence of nutritional imbalance in patients with UCTD, which was manifested by changes in serum concentrations of magnesium, calcium, zinc, iron, copper, selenium, inorganic phosphorus. The relationship between changes in the microcirculation system, tissue perfusion and cervical condition is currently being actively discussed and confirmed in numerous studies.Fettweis JM (2019) believes that the mechanism of abortion at different stages of gestation is not the same in pregnant women with ICI. At the same time, all pregnant women with ICI at all stages of gestation have increased cytokine levels. However, an important factor in the premature termination of pregnancy in ICI is assigned to the infectious factor. The results of the study of the pathogenetic role of local immune responses in women with habitual miscarriage are often contradictory and dictate the need for further researches.Eventually, isthmic-cervical insufficiency is a multifactorial complication of pregnancy, in which genetic, hormonal, inflammatory-infectious, immunological or traumatic factors play a role.

Magnesium metabolism and its assessment

Magnesium is the fourth most abundant cation in the body. It has several functions in the human body including its role as a cofactor for more than 300 enzymatic reactions. Magnesium balance in the body is controlled by a dynamic interplay among intestinal absorption, exchange with bone, and renal excretion. Intestinal magnesium absorption proceeds in both a passive paracellular and an active transcellular manner. Regulation of serum magnesium concentrations is achieved mainly by control of renal magnesium reabsorption. In the kidney passive paracellular transport via claudins facilitates bulk magnesium absorption, whereas active transcellular pathways mediate the fine-tuning of magnesium absorption. There are no readily available and easy methods to assess magnesium status. Serum magnesium and the magnesium tolerance test are the most widely used. Measurement of ionized magnesium may become more widely available with the development of ion selective electrode analyzers.​

Alterations of Serum Magnesium Concentration in Animal Models of Seizures and Epilepsy-The Effects of Treatment with a GPR39 Agonist and Knockout of the Gpr39 Gene.

Several ligands have been proposed for the GPR39 receptor, including the element zinc. The relationship between GPR39 and magnesium homeostasis has not yet been examined, nor has such a relationship in the context of seizures/epilepsy. We used samples from mice that were treated with an agonist of the GPR39 receptor (TC-G 1008) and underwent acute seizures (maximal electroshock (MES)- or 6-hertz-induced seizures) or a chronic, pentylenetetrazole (PTZ)-induced kindling model of epilepsy. MES seizures and PTZ kindling, unlike 6 Hz seizures, increased serum magnesium concentration. In turn, Gpr39-KO mice that underwent PTZ kindling displayed decreased concentrations of this element in serum, compared to WT mice subjected to this procedure. However, the levels of expression of TRPM7 and SlC41A1 proteins—which are responsible for magnesium transport into and out of cells, respectively—did not differ in the hippocampus between Gpr39-KO and WT mice. Furthermore, laser ablation inductively coupled plasma mass spectrometry applied to hippocampal slices did not reveal differences in magnesium levels between the groups. These data show the relationship between magnesium homeostasis and certain types of acute or chronic seizures (MES seizures or PTZ kindling, respectively), but do not explicitly support the role of GPR39 in mediating magnesium balance in the hippocampus in the latter model. However, decreased expression of TRPM7 and increased expression of SLC41A1—which were observed in the hippocampi of Gpr39-KO mice treated with TC-G 1008, in comparison to WT mice that received the same treatment—implicitly support the link between GPR39 and hippocampal magnesium homeostasis.

SERUM AND IONIZED MAGNESIUM IN ELDERLY HYPERTENSIVES

Objective: Magnesium is involved in about 600 enzymatic and metabolic reactions. In patients at risk, e.g. elderly, a magnesium deficiency has to be taken into account. This can result in a variety of diseases, e.g. cardiovascular disorder and hypertension. Diagnosis can be made by laboratory, anamnesis (drugs) or clinical symptoms. Especially elderly (up to 30 %) or hypertensives are risk patients for a magnesium deficiency. In these patients a magnesium supplementation is then often of benefit. Design and method: In our study 45 elderly hypertensives with normal renal function were investigated (serum creatinine was 1.1+/-0.1 mg/dL). All patients were older than 60 years. None of our patients took magnesium supplements. All patients had an essential hypertension grade 1 and 2 according to ESH guidelines classification. Anti-hypertensive treatment was performed using usual drugs (e.g. betablockers, calcium antagonists or Renin-Angiotensin-Aldosterone System (RAAS) blockers), no diuretics for at least 4 weeks before start of the study. Serum magnesium concentrations were measured by a Cobas Apparatus, Roche, Germany. The analysis of the measurements of ionized magnesium concentrations was carried out with a Prime Plus system from NOVA Medical Devices Corp., Rödermark, Germany. This is a point-of-care unit device with a high precision standard. The tests use either capillary blood or about 1 mL of whole blood and the complete measurement process takes about only 1 minute. Results: In serum magnesium content only 1 patient was below normal range of 1.7 md/dl. Mean+/- s.d. was 1.96+/- 0.16 mg/dl. In contrast in 12 of 45 patients ionized magnesium was significantly below the normal range (27%, 0.54+/-0.06 mmol/l). There was no correlation between serum or ionized magnesium concentrations (n.s., Pearson’ s or Spesrmann rank test, p value 0.91 and 0.41). Bood pressure was controlled. Conclusions: In conclusion normal serum magnesium values do not exclude a magnesium deficiency in elderly hypertensive patients. The determination of ionized magnesium might be a better tool in this context. A magnesium deficiency is often observed in elderly and has to be substituted in a sufficient amount to avoid cardiovascular and other diseases.

COMPARATIVE STUDY OF SERUM CALCIUM AND MAGNESIUM LEVELS IN WOMEN WITH PRE ECLAMPSIA AND NORMOTENSIVE PREGNANT WOMEN

Objectives: The objective of the study is to establish a relation between serum calcium and magnesium levels with severity of pre-eclampsia and to compare the levels with normotensive pregnant women. Materials And Methods: 200 women with pre-eclampsia and 200 normotensive pregnant women were included in this hospital based, cross sectional study; serum calcium and magnesium levels were measured and data was analysed. The serum calcium concentration wasResults: signicantly lower in pre-eclamptic cases as compared to normotensive controls. (7.903±0.292 Vs 9.227±0.598 mg/dl, p &lt; 0.001). Serum magnesium concentration was signicantly lower in severe preeclampsia cases as compared to mild preeclampsia. (7.67±0.32 Vs 7.991±0.22 mg/dl, p&lt;0.001). Measurements of serum calcium and magnesium among women at risk may be used toConclusion: predict onset and severity of pre-eclampsia.

A STUDY OF THE LEVELS OF SERUM MAGNESIUM AND SERUM ZINC IN PATIENTS OF SUBCLINICAL HYPOTHYROIDISM

Background: Subclinical Hypothyroidism (SCH), according to the endocrine web is defined as an elevationin in Thyroid Stimulating Hormone (TSH) level (4.6-10 m I U/L) with thyroid hormone levels in the normal range. Magnesium (Mg2+) is an essential macro-mineral in human body, which acts as a cofactor for more than 300 enzymes. Zinc (Zn+2) is required for proper functioning of 5-deiodinase &amp; it is a cofactor for Thyrotropin -Releasing Hormone (TRH). Transcription factorsbind to thyroid hormones which are fundamental for modulation expression of gene, also contain Zn2+ bound to cysteine residues. Aim and objectives: This study aim to estimate the levels of serum magnesium and zinc in patients of SCH. Material and methods: The serum TSH, Total Triiodothyronine (T3)&amp; Thyroxine (T4) levels were estimated by ELISA method to identify the cases of SCH. The concentration of serum magnesium was analyzed using semiautomated analyzerbyspectrophotometry. Serum zinc was analyzed by fully automated analyzer (Vitros 5600) in patients of SCH. Results:In SCH, both T3, T4 were within the normal range and TSH in the range of 4.6-10 m I U/L, there was a statistically significant (p&lt;0.001) decrease in serum zinc levels and not significantly decrease in serum magnesium levels in subclinical hypothyroidism patients.

The Relationship Between Plasma Magnesium Concentration and Hepatic Encephalopathy in Liver Cirrhosis Patients: A Preliminary Result of a Referral Center in Iran

Background: The present study aimed to assess the relationship between hepatic encephalopathy (HE) and serum magnesium concentration in patients with liver cirrhosis. Methods: The study population consisted of 90 cirrhotic patients admitted to the internal ward of Shariati Hospital, Isfahan, Iran. The patients were divided into two groups: with or without HE. Demographic data, cirrhosis aetiology, plasma concentration of magnesium, model end-stage liver disease (MELD) score, and Child-Pugh-Turcotte (CTP) class were recorded. Results: Thirty-one patients (34.4%) had hypomagnesaemia. Age and sex had no significant effects on plasma magnesium concentration (P-value = 0.134 and 0.212, respectively). The distribution of cirrhosis aetiologies was significantly different between patients with and without hypomagnesaemia (P-value = 0.005). Most patients with hypomagnesaemia were in groups B and C of CTP class (P = 0.027) and had a mean MELD score of 16.5 ± 5.8 versus 14.3 ± 5.4 in patients without hypomagnesaemia (P-value = 0.08). Hepatic encephalopathy was diagnosed in 45 (50.0%) patients. Mean serum levels of magnesium in patients with or without HE were 1.6 ± 0.2 and 1.9 ± 0.2 mEq/L, respectively (P-value &lt; 0.001). There was no significant association between encephalopathy grade and serum magnesium concentration (P-value = 0.377). Conclusions: We demonstrated a relatively high prevalence of hypomagnesaemia among cirrhotic patients with HE. Hypomagnesaemia was associated with the severity of liver cirrhosis based on the Child-Pugh score. Prescription of magnesium supplements in cirrhotic patients may be helpful in preventing disease progression; however, further studies are needed.

Hypomagnesemia in intestinal lymphangiectasia: a case report and review of the literature

BackgroundIntestinal lymphangiectasia (IL) is a rare disease characterized by dilation of lymphatic vessels and leakage of lymphatic fluids into the intestinal lumen, causing depletion of lymphocytes, protein, lipids, fat-soluble vitamins, and electrolytes. Hypomagnesemia can occur in IL patients but is seldom discussed.Case presentationA 30-year-old Tibetan woman who had chronic diarrhea, edema, tetany, and tingling was diagnosed with IL. Prominent hypomagnesemia was noticed. She was treated with a medium-chain triglyceride (MCT) diet and nutrient supplementation with satisfactory results. We also present a systematic review of hypomagnesemia in IL cases from the published literature.ConclusionsHypomagnesemia may be an overlooked complication of IL, thus monitoring serum magnesium concentrations in IL patients is crucial.

Maternal and fetal serum concentrations of magnesium after administration of a 6-g bolus dose of magnesium sulfate (MgSO4 ) to women with imminent preterm delivery.

Magnesium sulfate is used world-wide to treat pregnant women at imminent risk of preterm delivery in order to protect the brain of the premature infant. Previous research has shown that magnesium sulfate decreases the risk of cerebral palsy by ~30% in infants born preterm. Despite this, the dosage required for optimal neuroprotection remains unknown. We aimed to investigate whether 6 g magnesium sulfate given as a single bolus dose was tolerable for the women and infants and whether the desired target concentration in the mother's blood was reached and non-toxic level in the infant could be ensured. In total, 49 women who were at risk of delivery prior to 32 weeks of gestation were recruited. They received a bolus dose of 6 g magnesium sulfate intravenously between 1 and 24h prior to giving birth and were closely monitored during and after infusion. Blood samples from the patients were analyzed at different time-points (20-30min after start of infusion, 1, 2, 6 and 24h) post-administration. Blood samples from the umbilical cord were also taken directly after birth to assess the concentration of magnesium in the infant. None of the women who received magnesium sulfate reached serum magnesium concentrations >3.3 mmol/L. In all, 72% of the women showed serum magnesium levels within the therapeutic interval (2.0-3.5 mmol/L) and no adverse events were observed during the infusion. The serum magnesium levels in the mothers declined to pre-bolus-levels within 24h after delivery. Serum magnesium levels in the umbilical cord samples ranged from 0.87 to 1.4 mmol/L, which means that all but two were within the normal expected range for a newborn premature infant. A bolus dose of 6 g magnesium sulfate was well tolerated and without any serious side effects in either mother or infant. Most of our women reached the targeted concentration range of serum magnesium levels after infusion was completed. Their infants had magnesium levels within acceptable levels, regardless of gestational week or mother's body mass index.

Associations between Genetically Proxied Inhibition of Lipid-Lowering Drug Targets and Serum Micronutrients among Individuals of European Descent: A Mendelian Randomization Study

BackgroundLimited and inconclusive data exist concerning the associations between lipid-lowering drugs and serum micronutrient concentrations. MethodsWe conducted Mendelian randomization (MR) analyses to explore the associations between lipid-lowering drug targets and serum micronutrients. Single-nucleotide polymorphisms in genes encoding molecular targets of LDL cholesterol-lowering therapies were selected as instrumental variables for 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR; target of statins), proprotein convertase subtilisin/kexin type 9 (PCSK9; target of PCSK9 inhibitors), and Niemann-Pick C1-Like 1 (NPC1L1; target of ezetimibe). Exposure data were extracted from a published genome-wide association study (GWAS) of lipids in 188,577 European individuals, with outcome data obtained from the Integrative Epidemiology Unit (IEU) GWAS database (https://gwas.mrcieu.ac.uk). Overall, age and sex information were not calculable from the summary-level GWAS data. MR analyses were performed using the inverse-variance weighted method and MR sensitivity analysis methods. ResultsWe found genetically proxied inhibition of HMGCR to lower iron (effect, –0.16; 95% CI: –0.27, –0.06; P value = 0.003), zinc (effect, –0.83; 95% CI: –1.36, –0.31; P value = 0.002), magnesium (effect, –0.17; 95% CI: –0.27, –0.06; P value = 0.003), potassium (effect, –0.17; 95% CI: –0.27, –0.06; P value = 0.002), genetically proxied inhibition of NPC1L1 to increase calcium (effect, 0.28; 95% CI: 0.10, 0.46; P value = 0.003), retinol (effect, 0.25; 95% CI: 0.07, 0.44; P value = 0.01), and genetically proxied inhibition of PCSK9 to increase vitamin D (effect, 0.10; 95% CI: 0.07, 0.12; P value = 1.8 × 10–19). These associations were robust in MR sensitivity analyses. However, the associations between genetically proxied inhibition of HMGCR and NPC1L1 and the micronutrients were not consistent in multiple comparisons. ConclusionsOur results provide evidence that statin use may lower serum concentrations of iron, zinc, magnesium, and potassium, PCSK9 inhibitors may increase serum vitamin D, and ezetimibe may increase serum calcium and retinol concentrations.

Evaluation of Serum Biochemical Profile in Heifer and Adult Sahiwal Cows Reared in Maharashtra

Background: The Sahiwal cattle, one of the best dairy breeds of Zebu cattle in India and Pakistan, originated from the Montgomery district of Pakistan. The performance of this breed in the tropical environment is also better than other cattle breeds. Now a day Sahiwal is choice of farmers in Maharashtra as it is a milch type breed mostly preferred for Deshi cow milk production and for organic farming. Blood profile of an individual is an important indicator of an individual’s well-being. Normal blood levels of various biochemical components are essential for normal function of various systems in the body including reproductive system. Hence, the current study was aimed to evaluate of serum biochemical profile of Sahiwal cows reared in Pune district of Maharashtra. Pune district of Maharashtra comes under western Maharashtra plain zone with Grayish black soils. The annual rainfall ranges from 150 to 700 mm. Soils formed from trap rock are grayish black in colour and varying texture. The natural vegetation is of shrub. The area mostly grows paddy, sugarcane, pearl millet, sorghum and groundnut. Methods: Serum biochemical profile of Sahiwal heifers and cows were evaluated at different stages i.e. below 1 year heifer, above 1 year heifer, early lactating cow, mid lactating cow, late lactating cow, dry pregnant cow and dry non pregnant cows. Total seventy (70) animals was selected i.e. ten (10) animals from each group stage. All animals were maintained under standard feeding and management conditions. The blood samples of selected cows were collected by puncturing in jugular vein in heparinized vacationer tubes. Analysis of serum profile of 70 blood samples were carried out by using automatic blood analyzer machine (Miura 200 I.S.E. group, Italy). Result: The concentrations of serum cholesterol, glucose, triglyceride, uric acid, calcium, phosphorus, copper, zinc, total protein, globulin, A: G ratio ALP, ALT and AST were significant in different stages of Sahiwal cows. The non-significant difference was observed in different stages of Sahiwal cows in regards to serum concentration of amylase, bilirubin direct, bilirubin total, creatinine, urea, albumin, magnesium, iron and GGT.