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Background: Intravenous magnesium (IV Mg), a commonly utilized therapeutic agent in the management of atrial fibrillation (AF) with rapid ventricular response, is thought to exert its influence via its effect on cellular automaticity and prolongation of atrial and atrioventricular nodal refractoriness thus reducing ventricular rate. We sought to undertake a systematic review and meta‐analysis of the effectiveness of IV Mg versus placebo in addition to standard pharmacotherapy in the rate and rhythm control of AF in the nonpostoperative patient cohort given that randomized control trials (RCTs) have shown conflicting results. Methods: Randomized controlled trials comparing IV Mg versus placebo in addition to standard of care were identified via electronic database searches. Nine RCTs were returned with a total of 1048 patients. Primary efficacy endpoints were study‐defined rate control and rhythm control/reversion to sinus rhythm. The secondary endpoint was patient experienced side effects. Results: Our analysis found IV Mg in addition to standard care was successful in achieving rate control (odd ratio [OR] 1.87, 95% confidence interval [CI] 1.13−3.11, p =.02) and rhythm control (OR 1.45, 95% CI 1.04−2.03, p =.03). Although not well reported among studies, there was no significant difference between groups regarding the likelihood of experiencing side effects. Conclusions: IV Mg, in addition to standard‐of‐care pharmacotherapy, increases the rates of successful rate and rhythm control in nonpostoperative patients with AF with rapid ventricular response and is well tolerated. [ABSTRACT FROM AUTHOR]

ATP is a crucial molecule for every energy‐dependent process in cells. In ischemic tissues, ATP production declines, and it finally results in cell death. One of the most common strategies in burn wound management is saving the zone of ischemia. In the current study, Mg‐ATP‐containing nanoliposomes were formulated and studied in vitro and in vivo. The particle size of the vesicles was between 50 and 100 nm and the mean zeta potential was −4.05 ± 0.52 mV as evaluated by dynamic light scattering and Zeta sizer instrument, respectively. The encapsulation efficiency of ATP in the nanoliposomes was found to be 9.3%. The morphology and size of nanoliposomes were further studied by transmission electron microscopy. The standard MTT assay revealed no cytotoxicity of the nanoliposomes when tested on the rat fibroblast cells. Forty rats were randomly divided into four groups (N = 10 each). Burn wounds were created by burn comb model on the back of the rats and the zone of stasis in each group was treated every 12 h for 3 days by injecting them with the Mg‐ATP‐nanoliposomes. Control samples included empty nanoliposomes, unencapsulated Mg‐ATP and the Krebs–Henseleit buffer. Laser Doppler flowmetry results revealed that blood perfusion in the zone of ischemia in rats treated with Mg‐ATP‐nanoliposomes was more than in the other groups (p < 0.05). Histopathology revealed saving zone of stasis by Mg‐ATP‐nanoliposomes. Findings obtained in this study demonstrated that the formulated Mg‐ATP‐nanoliposome has the potential to save the stasis zone in burn wounds. [ABSTRACT FROM AUTHOR]

Phenytoin is a versatile drug with utility in neurological, dermatological, and even cardiac disease processes. Though phenytoin is widely available due to its excellent anti‐epileptic properties, it is now rarely used as an antiarrhythmic. Phenytoin has well‐studied sodium‐channel blocking abilities which can be taken advantage of to treat ventricular arrhythmias. Thus, it should remain in the arsenal of antiarrhythmics for any electrophysiologist. We present two cases of intractable ventricular arrhythmia in children that were controlled with phenytoin at supra‐therapeutic serum levels, preventing the need for heart transplantation. [ABSTRACT FROM AUTHOR]

Magnesium status and vitamin B6 intake have been linked to mental health and/or quality of life (QoL). In an 8‐week Phase IV randomised controlled study in individuals with low magnesemia and severe/extremely severe stress but who were otherwise healthy, greater stress reduction was achieved with magnesium combined with vitamin B6 than with magnesium alone. We present a previously unreported secondary analysis of the effect of magnesium, with and without vitamin B6, on depression, anxiety, and QoL. Adults with Depression Anxiety Stress Scales (DASS‐42) stress subscale score >18 were randomised 1:1 to magnesium + vitamin B6 combination (Magne B6®; daily dose 300 and 30 mg, respectively) or magnesium alone (Magnespasmyl®; daily dose 300 mg). Outcomes included changes from baseline in DASS‐42 depression and anxiety scores, and QoL (Short Form‐36 Health Survey). DASS‐42 anxiety and depression scores significantly improved from baseline to week 8 with both treatments, particularly during the first 4 weeks. Improvement in QoL continued over 8 weeks. Participants' perceived capacity for physical activity in daily life showed greater improvement with magnesium + vitamin B6 than magnesium alone (Week 4). In conclusion, magnesium supplementation, with or without vitamin B6, could provide a meaningful clinical benefit in daily life for individuals with stress and low magnesemia. [ABSTRACT FROM AUTHOR]

A 72‐year‐old man, diagnosed with advanced lung squamous cell carcinoma, was administered of cisplatin plus gemcitabine with necitumumab, a human monoclonal antibody that binds to the epidermal growth factor receptor (EGFR), as a sixth‐line treatment. Tumor shrinkage was observed, but asymptomatic grade 4 hypomagnesemia occurred on day 8 of the second cycle. He received magnesium replenishment and hypomagnesemia recovered on day 40, but tumor progression was observed during the period of magnesium correction. Hypomagnesemia is known as a major adverse event of treatment with anti‐EGFR antibodies, but there have been no case reports of severe hypomagnesemia or its clinical course. [ABSTRACT FROM AUTHOR]

The peak prevalence of migraine occurs in women of reproductive age, and women experience a higher burden of migraine symptoms and disability compared to men. This increased burden of migraine in women is related to both developmental and temporally variable activational effects of female sex hormones. Changing levels of female sex hormones affect the expression of migraine during pregnancy, and, to a lesser degree, lactation, and are the mechanism underlying menstrual migraine. This review describes the evidence for sex differences in the expression of migraine across the reproductive epoch; reviews the epidemiology of migraine during pregnancy, lactation, and menses; and summarizes the available evidence for safety and efficacy of acute treatments during pregnancy and lactation and for menstrual migraine. Areas of controversy in treatment of migraine during pregnancy, including the use of magnesium, triptans vs butalbital combination medications, and onabotulinum toxin, are also explored. [ABSTRACT FROM AUTHOR]

Background: Oral administration of magnesium and boron might have a beneficial effect on headshaking behavior in horses. Objective: Evaluate the effects of oral magnesium alone or in combination with boron on headshaking behavior in affected horses. Animals: Twelve geldings (6 healthy controls and 6 affected). Methods: Prospective randomized controlled dietary trial over 42 days in 12 horses (6 horses diagnosed with trigeminal‐mediated headshaking and 6 unaffected healthy controls). All horses received a hay diet and were randomized into 3 treatment groups: pelleted feed combination (PF), pelleted feed combination with magnesium (M), and pelleted feed combination with magnesium‐boron (MB) with a week washout of hay only between treatments. Headshaking behavior and biochemical blood variables were assessed at baseline (hay only) and then after each week of supplementation. Results: All 3 diet interventions increased blood ionized and total magnesium. Groups M and MB further increased Mg2+ when compared to PF. Horses receiving treatments had a significant reduction in headshaking behavior, as measured by incidence rate ratio (IRR), when compared to unsupplemented hay diet (44% for PF, IRR, 0.558; CI, 0.44, 0.72; P < .001; 52% for M, IRR, 0.476; CI, 0.37, 0.62; P < .001; and 64% for MB, IRR, 0.358; CI, 0.27, 0.48; P < .001). Conclusions and Clinical Importance: Magnesium in combination with boron had the greatest decrease in headshaking. Oral supplementation with magnesium or magnesium in combination with boron should be considered in horses affected with headshaking. [ABSTRACT FROM AUTHOR]

The present study is focused on the development of a composition based on three pectin metal complexes (NaMg‐PG, NaZn‐PG and NaCr‐PG) at a mass ratio 7:0.3:0.001. It was evaluated by the methods of infrared spectroscopy (IR spectroscopy), atomic force microscopy (AFM), dynamic light scattering (DLS) and TEM‐EDS. The data, obtained by simultaneous thermal analysis and Fourier transform IR spectroscopy, showed that water was the main component of the gas phase at the first stage of mass loss of the specified compounds, whereas further heating led to decarboxylation and degradation. The results of Forced Swim Test (FST) showed that the specified composition at the dose of 50–100 mg/kg contributed to the stimulation of an organism's adaptive capacity under intensive physical loads and could be considered as a potential adaptogen and stimulator of erythropoiesis that could normalize metabolism. [ABSTRACT FROM AUTHOR]

The article offers information on several articles published in different medical periodical on topics such as pulmonary embolism (PE) in pregnancy, medical and surgical treatment for peritonsillar abscess (PTA) and magnesium for atrial fibrillation. It mentions diagnosis or exclusion of PE in pregnancy is a challenging area and medications may have been confounded by paracetamol concentration. It also mentions clinical trial of magnesium as beta-blockers for atrial fibrillation.

Objective: To assess the acute treatment of pregnant women presenting to a hospital with migraine. Background: Migraine is a common problem in pregnancy; however, migraine treatment is challenging in pregnant women for fears of medication teratogenicity and lack of data in this population. To date, no study has directly explored physician practices for treatment of acute migraine in pregnant women. Methods: We conducted a retrospective chart review of medication administration for pregnant women who presented to an acute care setting with a migraine attack and received neurology consultation between 2009 and 2014. Results: We identified 72 pregnant women with migraine who were treated with pain medications. Fifty‐one percent (37/72) were in the third trimester of pregnancy, 39% (28/72) in the second trimester, and 10% (7/72) in the first trimester. Thirty‐two percent (23/72) had not tried any acute medications at home before coming to the hospital, and 47% (34/72) presented in status migrainosus. Patients received treatment in the hospital for a median of 23 hours (interquartile range = 5–45 hours). The most common medications prescribed were metoclopramide in 74% (53/72) of patients (95% confidence interval [CI] 62–82%) and acetaminophen in 69% (50/72) of patients (95% CI 58–79%). Metoclopramide was administered along with diphenhydramine in 81% (44/53) of patients (95% CI 71–91%). Acetaminophen was the most frequent medicine administered first (53%, 38/72). Patients were often treated with butalbital (35%, 25/72) or opioids (30%, 22/72), which were used as second‐ or third‐line treatments in 29% of patients (20/72). Thirty‐eight percent (27/72) received an intravenous (IV) fluid bolus, 24% received IV magnesium (17/72), and 6% (4/72) had peripheral nerve blocks performed. Conclusions: While the majority of pregnant women with acute migraine received medications considered relatively safe in pregnancy, there was variation in treatment choice and sequence. Some acute medications considered potentially hazardous for fetal health and less effective for migraine (opioids and butalbital) were used frequently, whereas other treatments that may have low teratogenic risk (nerve blocks, IV fluid boluses, and triptans) were used less or not at all. These results indicate a need for developing guidelines and protocols to standardize acute treatment of migraine in pregnancy. [ABSTRACT FROM AUTHOR]

Objective: The primary objective was to systematically evaluate the existing evidence base on magnesium in migraine prophylaxis. Methods: The search for clinical trials published from 1990 to 2016 was separately conducted by AvL and FR using standard search terms as well as MeSh terms on PubMed and EMBASE. Randomized, double‐blind, placebo‐controlled trials investigating prophylactic magnesium administration in migraineurs aged 18‐65 were considered eligible. In a mutual effort, the studies found were sorted and analyzed under consideration of the guidelines for controlled trials for drugs in migraine by the International Headache Society and using predefined eligibility criteria. The resulting clinical trials were jointly analyzed by FR and AvL applying the evidence classification scheme by the American Academy of Neurology and the Cochrane bias tool to assess the evidence‐base. In accordance with the guidelines for controlled trials, the number of migraine days and number of migraine attacks were chosen as primary efficacy parameters. The present review was not registered. Results: Out of 204 search results, five clinical trials fulfilling the selection procedure were found. One out of two Class I evidence trials showed a significant reduction of the number of migraine attacks compared with placebo, while two out of three Class III trials evinced a statistically significant reduction of the primary efficacy parameters compared with placebo. Conclusion: This systematic review provides Grade C (possibly effective) evidence for prevention of migraine with magnesium. Prophylactic treatment of migraine by means of high levels of magnesium dicitrate (600 mg) seems to be a safe and cost efficient strategy in clinical use. [ABSTRACT FROM AUTHOR]

Background and Purpose: Streptococcus pneumoniae is the most common cause of bacterial meningitis in adults and is characterized by high lethality and substantial cognitive disabilities in survivors. Here, we have studied the capacity of an established therapeutic agent, magnesium, to improve survival in pneumococcal meningitis by modulating the neurological effects of the major pneumococcal pathogenic factor, pneumolysin.Experimental Approach: We used mixed primary glial and acute brain slice cultures, pneumolysin injection in infant rats, a mouse meningitis model and complementary approaches such as Western blot, a black lipid bilayer conductance assay and live imaging of primary glial cells.Key Results: Treatment with therapeutic concentrations of magnesium chloride (500 mg·kg-1 in animals and 2 mM in cultures) prevented pneumolysin-induced brain swelling and tissue remodelling both in brain slices and in animal models. In contrast to other divalent ions, which diminish the membrane binding of pneumolysin in non-therapeutic concentrations, magnesium delayed toxin-driven pore formation without affecting its membrane binding or the conductance profile of its pores. Finally, magnesium prolonged the survival and improved clinical condition of mice with pneumococcal meningitis, in the absence of antibiotic treatment.Conclusions and Implications: Magnesium is a well-established and safe therapeutic agent that has demonstrated capacity for attenuating pneumolysin-triggered pathogenic effects on the brain. The improved animal survival and clinical condition in the meningitis model identifies magnesium as a promising candidate for adjunctive treatment of pneumococcal meningitis, together with antibiotic therapy. [ABSTRACT FROM AUTHOR]

An editorial is presented where the treatment of envenoming syn dromes continues to be fraught with recommendations and guidelines being based on low-level evidence, often anecdotes and case reports. It also discusses the challenges faced by the clinicians for treating this syndrome is how to inter pret this early and low-level evidence, when to give patients the best treatment, but not expose them to unsafe, untested or exciting novel therapies with little evidence of effi cacy.

Background: Advances in diagnostic imaging of stroke include multimodal techniques such as noninvasive angiography and perfusion imaging. We aimed to characterize trends in neuroimaging utilization among acute stroke patients. Utilization of multimodal imaging for acute stroke in the community has remained largely uncharacterized despite its increased adoption at academic medical centers.Methods: We quantified neuroimaging utilization in the emergency department (ED) for 1,700 hyperacute stroke patients presenting <2 hours after symptom onset who participated in the National Institutes of Health Field Administration of Stroke Therapy-Magnesium (FAST-MAG) study throughout Los Angeles and Orange Counties. FAST-MAG provided no recommendation as to imaging utilization.Results: A total of 1,700 cases were imaged a median (interquartile range [IQR]) of 92 (74-120) minutes after last known well time and 28 (19-41) minutes after ED arrival. The initial scanner used in the ED was computed tomography (CT) in a preponderance of cases (N = 1,612, 95%), with magnetic resonance imaging (MRI) in 88 cases (5%). CT angiography (CTA) was obtained in 192 (11%) and perfusion CT (CTP) in 91 (5.4%) cases. MRI imaging was universally obtained using diffusion-weighted images, 60% with MR angiography and 33% included perfusion imaging. Rates of concomitant CTA or CTP use increased in the later years of the study from 4% in 2005-2006, 2% in 2007-2008, 8% in 2009-2010, and 26% in 2011-2012 (P for trend < .001).Conclusions: Among acute stroke patients, noncontrast CT was the most common initial imaging strategy in clinical practice in the 2005-2012 time period, though use of concomitant CTA grew to one-quarter of cases, suggestive of an upward trend. [ABSTRACT FROM AUTHOR]

The use of self-medication, which includes dietary supplements and over-the-counter drugs, is still on the rise, while safety issues are not well addressed yet. This especially holds for combinations. For example, iron supplements and magnesium peroxide both produce adverse effects via the formation of reactive oxygen species ( ROS). This prompted us to investigate the effect of the combination of three different iron supplements with magnesium peroxide on ROS formation. Hydroxyl radical formation by the three iron supplements either combined with magnesium peroxide or alone was determined by performing a deoxyribose assay. Free iron content of iron supplements was determined using ferrozine assay. To determine hydrogen peroxide formation by magnesium peroxide, a ferrous thiocyanate assay was performed. Finally, electron spin resonance spectroscopy ( ESR) was performed to confirm the formation of hydroxyl radicals. Our results show that magnesium peroxide induces the formation of hydrogen peroxide. All three iron supplements induced the formation of the extremely reactive hydroxyl radical, although the amount of radicals formed by the different supplements differed. It was shown that combining iron supplements with magnesium peroxide increases radical formation. The formation of hydroxyl radicals after the combination was confirmed with ESR. All three iron supplements contained labile iron and induced the formation of hydroxyl radicals. Additionally, magnesium peroxide in water yields hydrogen peroxide, which is converted into hydroxyl radicals by iron. Hence, iron supplements and magnesium peroxide is a hazardous combination and exemplifies that more attention should be given to combinations of products used in self-medication. [ABSTRACT FROM AUTHOR]

Key Clinical Message We present a case of prominent hypocalcemia and hyperkalemia attributed to magnesium infusion in a preeclamptic patient. Iatrogenic hypermagnesemia is an underrecognized cause of hypocalcemia and hyperkalemia. Our report illustrates the effects of magnesium therapy on serum calcium and potassium, necessitating close electrolytes monitoring when used. [ABSTRACT FROM AUTHOR]

Leg cramps are common in pregnant women. Currently, there is no standard treatment for pregnancy-induced leg cramps. The objective of this study was to evaluate the therapeutic efficacy of oral magnesium in pregnant women with leg cramps. This double-blinded, randomised, placebo-controlled trial included 86 healthy pregnant women, 14-34 weeks of gestation who had leg cramps at least twice per week. The study period was 4 weeks. Eighty women completed the study. Forty-one women were assigned to magnesium bisglycinate chelate (300 mg per day) and 39 women to placebo. Details of leg cramps were recorded before beginning the treatment and the fourth week of study. Outcome measure was the reduction of cramp frequency after treatment and cramp intensity measured by 100-mm visual analogue scale. Fifty per cent reduction of cramp frequency was significantly higher in the magnesium group than the placebo group (86.0% vs. 60.5%, P = 0.007). The 50% reduction of cramp intensity was also significantly higher in the treatment group than in the placebo group (69.8% vs. 48.8%, P = 0.048). There were no significant differences between the two groups in terms of side effects such as nausea and diarrhoea. These results demonstrated that oral magnesium supplement can improve the frequency and intensity of pregnancy-induced leg cramps. Therefore, oral magnesium may be a treatment option for women suffering from pregnancy-induced leg cramps. [ABSTRACT FROM AUTHOR]

The use of magnesium as a parameter to estimate the time of death is controversial. In 32 traumatic deaths with known postmortem intervals ( PMIs), small quantities of vitreous humor ( VH) were sampled repetitively every 3 h until 24 h postmortem. The bodies were kept at the constant ambient temperature of 20°C (68°F). The concentrations of magnesium were in the range of 0.47-1.15 mM. A statistically significant correlation of the concentration of magnesium with the PMI was observed ( r = 0.453, p < 0.01), but with small predictive value-coefficient of variation for regression was 45.5%; the average of the paired differences between the estimated and actual PMIs was 5.24 + 3.19 h. Although useful results might be expected due to the large transmembrane gradient for magnesium, the results of this study strongly disprove the usefulness of measuring magnesium in VH to estimate the time of death. [ABSTRACT FROM AUTHOR]

Objective To derive a more precise estimation on the safety and efficacy of calcium and magnesium ( Ca and Mg) infusions in the prevention of oxaliplatin-induced sensory neuropathy. Methods A total of 16 studies including 1765 individuals were involved in this meta-analysis. Odds ratio ( OR) and its 95% confidence interval ( CI) were calculated. Results The difference in the incidence of oxaliplatin-induced neuropathy grade ≥ 1 was statistically significant between the Ca and Mg infusions treatment group and the untreated group (National Cancer Institute common toxicity criteria [ NCI CTC]: OR 0.44, 95% CI 0.31-0.62, P = 0.000; oxaliplatin-specific scale [ OSS]: OR 0.30, 95% CI 0.20-0.45, P = 0.000). Similar results were found in the incidences of oxaliplatin-induced neuropathy grade ≥ 2 ( NCI CTC: OR 0.60, 95% CI 0.46-0.77, P = 0.000; OSS: OR 0.45, 95% CI 0.30-0.67, P = 0.000). However, we did not detect a trend of fewer oxaliplatin-induced neuropathy grade ≥ 3 incidences in the Ca and Mg infusions treatment group than the untreated group ( NCI CTC: OR 0.67, 95% CI 0.44-1.01, P = 0.054; OSS: OR 0.66, 95% CI 0.34-1.29, P = 0.224). There was no difference in the response rate between the Ca and Mg treated group and the untreated group ( OR 0.89, 95% CI 0.67-1.17, P = 0.391). Conclusion Ca and Mg infusions do not alter the efficacy of oxaliplatin-based chemotherapy in gastrointestinal cancers, which may be reasonable to add them to lessen the incidence of neuropathy. [ABSTRACT FROM AUTHOR]

Persistent mechanical irritation of the nerve root sets up a series of events mediating sensitisation of the dorsal roots and dorsal horns in the spinal cord. Current evidence supports the role of magnesium in blocking central sensitisation through its effect on N-methyl- d-aspartate receptors. We studied the role of sequential intravenous and oral magnesium infusion in patients with chronic low back pain with a neuropathic component. We recruited a cohort of 80 patients with chronic low back pain with a Leeds Assessment of Neuropathic Signs and Symptoms pain scale score ≥ 12, who were receiving a physical therapy programme. All patients were treated with anticonvulsants, antidepressants and simple analgesics; in addition 40 patients received placebo for 6 weeks (control group), while the other 40 patients received an intravenous magnesium infusion for 2 weeks followed by oral magnesium capsules for another 4 weeks (magnesium group). Patients were asked to rate their pain using a numerical rating scale. Lumbar spine range of motion was also determined using a long-arm goniometer. In the magnesium group, the patients' numerical rating scales revealed a significant reduction in pain intensity. The mean ( SD) pre-treatment value was 7.5 (2.2) compared with 4.7 (1.8) at 6 months (p = 0.034). The reduction in pain intensity was accompanied by significant improvement in lumbar spine range of motion during the follow-up period. The mean ( SD) values of flexion, extension and lateral flexion movements before treatment and at 6-month follow up were 22.2 (8.4) vs 34.7 (11.5) (p = 0.018), 11.8 (3.4) vs 16.9 (3.5) (p = 0.039), 11.4 (3.6) vs 17.2 (4.4) (p = 0.035), respectively. Our findings show that a 2-week intravenous magnesium infusion followed by 4 weeks of oral magnesium supplementation can reduce pain intensity and improve lumbar spine mobility during a 6-month period in patients with refractory chronic low back pain with a neuropathic component. [ABSTRACT FROM AUTHOR]

The article focuses on research into drugs that could prevent noise-induced hearing loss. It states that excessive noise can stress inner-ear hair cells which convert sound waves into electrical signals and mentions research has found loud noises can result in the production of active oxygen and nitrogen species. It comments that antoxidant mimetics and precursors can combat free radicals and reduce permanent threshold shifts. It examines the role of magnesium in hearing loss prevention.

Intravenous magnesium has been reported to improve postoperative pain; however, the evidence is inconsistent. The objective of this quantitative systematic review is to evaluate whether or not the peri-operative administration of intravenous magnesium can reduce postoperative pain. Twenty-five trials comparing magnesium with placebo were identified. Independent of the mode of administration (bolus or continuous infusion), peri-operative magnesium reduced cumulative intravenous morphine consumption by 24.4% (mean difference: 7.6 mg, 95% CI −9.5 to −5.8 mg; p < 0.00001) at 24 h postoperatively. Numeric pain scores at rest and on movement at 24 h postoperatively were reduced by 4.2 (95% CI −6.3 to −2.1; p < 0.0001) and 9.2 (95% CI −16.1 to −2.3; p = 0.009) out of 100, respectively. We conclude that peri-operative intravenous magnesium reduces opioid consumption, and to a lesser extent, pain scores, in the first 24 h postoperatively, without any reported serious adverse effects. [ABSTRACT FROM AUTHOR]

Pseudoxanthoma elasticum (PXE), which demonstrates progressive build-up of calcium phosphate and proteoglycan deposits in skin, eye, and arteries, has been associated with myocardial infarctions, stroke, and blindness. In a mouse model of PXE, a magnesium-enriched diet prevents mineralization of the vibrissae capsule, an early biomarker for PXE. However, biomarkers for therapeutic responses in PXE have not been identified in humans. Because PXE patients have an increased carotid intima-media thickness (CIMT), a risk factor for cardiovascular disease and stroke, we analyzed the feasibility of CIMT as a treatment endpoint before and after magnesium supplementation in a mouse model of PXE ( Abcc6−/−). CIMT was measured in 1-year-old Abcc6−/− and Abcc6+/+ mice fed either standard rodent diet with or without magnesium oxide supplementation for 2 months. Baseline CIMT in Abcc6−/− versus Abcc6+/+ mice was increased ( p value = 0.009), whereas CIMT in magnesium-treated versus untreated Abcc6−/− mice was reduced ( p value = 0.024). CIMT is a novel treatment endpoint in this mouse model and may serve as a predictive biomarker of therapeutic response in PXE patients. In that context, magnesium oxide significantly reduced CIMT in PXE mice, and may be useful for disease prevention in PXE patients. Clin Trans Sci 2012; Volume #: 1-6 [ABSTRACT FROM AUTHOR]

Intravenous Electrolytes Increase Success Rate of Cardioversion. Background: External biphasic electrical cardioversion (CV) is a standard treatment option for patients suffering from acute symptoms of atrial fibrillation (AF). Nevertheless, CV is not always successful, and thus strategies to increase the success rate are desirable. Objective: The purpose of this study was to evaluate the effect of intravenously administered K/Mg solution on the biphasic CV energy threshold and success rate to restore sinus rhythm (SR) in patients with AF. Methods: The study consisted of 170 patients with persistent AF. The patients were randomly assigned to undergo biphasic CV either with (n = 84) or without (n = 86) pretreatment with K/Mg solution. An energy step-up protocol of 75, 100, and 150 W (J) was used. Results: Biphasic CV of AF was effective in 81 (96.4%) patients in the pretreatment and 74 (86.0%) patients in the control group (P = 0.005). The effective energy level required to achieve SR was significantly lower in the pretreated group (140.8 ± 26.9 J vs 182.5 ± 52.2 J, P = 0.02). No K/Mg-solution-associated side effects such as hypotension or bradycardia were observed. Conclusion: Administration of K/Mg solution positively influences the success rate of CV in patients with persistent AF. Furthermore, significantly less energy is required to successfully restore SR and therefore K/Mg pretreatment may facilitate SR restoration in patients undergoing CV for AF. (J Cardiovasc Electrophysiol, Vol. 23, pp. 54-59, January 2012) [ABSTRACT FROM AUTHOR]

Objective.- To review and analyze published reports on the acute treatment of migraine headache with triptans, dihydroergotamine (DHE), and magnesium in emergency department, urgent care, and headache clinic settings. Methods.- MEDLINE was searched using the terms 'migraine' and 'emergency,' and 'therapy' or 'treatment.' Reports from emergency department and urgent care settings that involved all routes of medication delivery were included. Reports from headache clinic settings were included only if medications were delivered by a parenteral route. Results.- Acute rescue treatment studies involving the triptans were available for injectable and nasal sumatriptan, as well as rizatriptan. Effectiveness varied widely, even when the pain-free and pain-relief statistics were evaluated separately. As these medications are known to work best early in the migraine, part of this variability may be attributed to the timing of triptan administration. Multiple studies compared triptans with anti-emetics, dopamine antagonists, and non-steroidal anti-inflammatory drugs. The overall percentage of patients with pain relief after taking sumatriptan was roughly equivalent to that recorded with droperidol and prochlorperazine. Sumatriptan was equivalent to DHE when only paired comparisons were performed. While the data extracted suggest that magnesium may be effective in treating all symptoms in patients experiencing migraine with aura across all migraine patients, its effectiveness seems to be limited to treating only photophobia and phonophobia. Conclusions.- Although there are relatively few studies involving health-care provider-administered triptans or DHE for acute rescue, they appear to be equivalent to the dopamine antagonists for migraine pain relief. The relatively rare inclusion of a placebo arm and the frequent use of combination medications in active treatment arms complicate the comparison of single agents with each other. [ABSTRACT FROM AUTHOR]

The article reports on guidelines on medications and fluids which can be used in pediatric advanced life support which were developed in 2010 by the Australian Resuscitation Council and the New Zealand Resuscitation Council. A discussion of factors which should be considered before administering medications and fluids during pediatric advanced life support is presented.

The article discusses methods, including defibrillation, oxygenation, ventilation and external cardiac compression, which can improve the chances for long term survival in cardiac arrest patients. A discussion of guidelines on the use of medications in cardiac arrest which were established in 2010 by the Australian Resuscitation Council and the New Zealand Resuscitation Council is presented.

In a phase-II multi-centre double-blinded trial, we evaluated haematological effects of oral hydroxycarbamide (HC) and magnesium (Mg) in patients with HbSC, aged 5-53 years old. Subjects were randomized to HC + placebo, Mg + placebo, HC + Mg, or placebo + placebo. The primary endpoint was the proportion of hyperdense red blood cells after 8 weeks. Thirty-six subjects were evaluable, but the study was terminated early because of slow enrollment. In the combined HC groups, mean cell volume and HbF were increased, but differences were not seen in hyperdense red cells or vaso-occlusive events. Mg had no effects. Further investigation of hydroxycarbamide as monotherapy in HbSC disease is warranted. [ABSTRACT FROM AUTHOR]

Background: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a familial arrhythmic syndrome caused by mutations in genes encoding the calciumregulation proteins cardiac ryanodine receptor (RyR2) or calsequestrin-2 (CASQ2). Mechanistic studies indicate that CPVT is mediated by diastolic Ca2+ overload and increased Ca2+ leak through the RyR2 channel, implying that treatment targeting these defects might be efficacious in CPVT. Method and results: CPVT mouse models that lack CASQ2 were treated with Ca2+-channel inhibitors, β-adrenergic inhibitors, or Mg2+. Treatment effects on ventricular arrhythmia, sarcoplasmic reticulum (SR) protein expression and Ca2+ transients of isolated myocytes were assessed. Each study agent reduced the frequency of stress-induced ventricular arrhythmia in mutant mice. The Ca2+ channel blocker verapamil was most efficacious and completely prevented arrhythmia in 85% of mice. Verapamil significantly increased the SR Ca2+ content in mutant myocytes, diminished diastolic Ca2+ overload, increased systolic Ca2+ amplitude, and prevented Ca2+ oscillations in stressed mutant myocytes. Conclusions: Ca2+ channel inhibition by verapamil rectified abnormal calcium handling in CPVT myocytes and prevented ventricular arrhythmias.Verapamil-induced partial normalization of SRCa2+ content in mutant myocytes implicates CASQ2 as modulator of RyR2 activity, rather than or in addition to, Ca2+ buffer protein. Agents such as verapamil that attenuate cardiomyocyte calcium overload are appropriate for assessing clinical efficacy in human CPVT. [ABSTRACT FROM AUTHOR]

Nutrition must affect the structure and functioning of the brain. Since the brain has very high metabolic activity, what we consume throughout the day is likely to dramatically influence both its structure and moment to moment function. It follows that nutritional approaches to all neurological disorders are being researched and entering medical practice, while nutraceutical use is a mainstay of public habits. This review discusses the biological basis for non-conventional or non-mainstream approaches to the treatment of migraine. This requires at least limited discussion of current migraine pathophysiologic theory. How nutrients and other chemicals and approaches are mechanistically involved within migraine pathways is the focus of this article. The nutraceuticals reviewed in detail are: magnesium, riboflavin, coenzyme Q10, petasites, and feverfew with additional comments on marijuana and oxygen/hyperbaric oxygen. This article reviews the science when known related to the potential genetic susceptibility and sensitivity to these treatments. As we know, the basic science in this field is very preliminary, so whether to combine approaches and presumably mechanisms or use them alone or with or without conventional therapies is far from clear. Nonetheless, as more patients and providers participate in patient-centered approaches to care, knowledge of the science underpinning nutritional, nutraceutical, and complementary approaches to treatment for migraine will certainly benefit this interaction. [ABSTRACT FROM AUTHOR]

There is a growing body of evidence supporting the efficacy of various complementary and alternative medicine approaches in the management of headache disorders. These treatment modalities include nutraceutical, physical and behavioral therapies. Nutraceutical options comprise vitamins and supplements (magnesium, riboflavin, coenzyme Q, and alpha lipoic acid) and herbal preparations (feverfew, and butterbur). Although controversial, there are some reports demonstrating the benefit of recreational drugs such as marijuana, lysergic acid diethylamide and psilocybin in headache treatment. Behavioral treatments generally refer to cognitive behavioral therapy and biobehavioral training (biofeedback, relaxation training). Physical treatments in headache management are not as well defined but usually include acupuncture, oxygen therapy, transcutaneous electrical nerve stimulation, occlusal adjustment, cervical manipulation, physical therapy, massage, chiropractic therapy, and osteopathic manipulation. In this review, the available evidence for all these treatments will be discussed. [ABSTRACT FROM AUTHOR]

We describe a case of prolonged severe hypercapnia with respiratory acidosis occurring during an episode of near-fatal asthma in an 8-year-old boy, followed by complete recovery. After admission to the intensive care unit, despite treatment with maximal conventional bronchodilatative therapy, the clinical picture deteriorated with evident signs of respiratory muscle fatigue. The child was sedated, intubated and mechanically ventilated. Magnesium sulphate, ketamine and sevoflurane were gradually introduced together with deep sedation, curarization and continuous bronchodilatative therapy. Ten hours after admission, arterial pCO2 reached 39 kPa (293 mmHg), pH was 6.77 and pO2 8.6 kPa (65 mmHg). Chest radiograph showed severe neck subcutaneous emphysema, with signs of mediastinal emphysema. No episode of haemodynamic instability was seen despite severe prolonged hypercapnia lasting more than 14 h. Oxygenation was maintained and successful recovery followed without neurological or cardiovascular sequelae. This case shows the cardiovascular and neurological tolerance of a prolonged period of supercarbia in a paediatric patient. The most important lesson to be learned is the extreme importance of maintaining adequate tissue perfusion and oxygenation during an asthma attack. The second lesson is that when conventional bronchodilators fail, the intensivist may resort to the use of drugs such as ketamine, magnesium sulphate and inhalation anaesthesia. In this context deep sedation and curarization are important not only to improve oxygenation, but also to reduce cerebral metabolic requirements. [ABSTRACT FROM AUTHOR]

Focuses on the therapeutic uses of magnesium. Application in the emergency department setting; Role in the treatment of acute migraine; Controversy in the use of intravenous magnesium sulphate in myocardial infarction.

Examines the effect of magnesium oral therapy on spasticity in a patient with multiple sclerosis. Impact of acetylcholine on muscle fiber membrane; Role of magnesium in regulating enzymatic reactions and phosphorylation-dependent process; Analysis of the excitability of the muscle fiber membrane.

Abstract Slow-release potassium overdose is rare and often fatal. Recommended treatment is derived from that of other, more common, causes of hyperkalaemia and from the general principles of overdose management. We present a patient who survived after a massive slow-release potassium (Slow-K®) ingestion resulting in a peak potassium concentration of 12 mmol/L, the highest yet reported. A review of previously reported cases of potassium overdose and a summary of recommended therapies for the treatment of hyperkalaemia are presented. Laboratory and current clinical evidence support the addition of magnesium to standard therapy for potassium overdose, particularly where there is concern about increasing doses of calcium; this suggestion requires further clinical research. [ABSTRACT FROM AUTHOR]

The article offers some evidence-based integrative treatments for headache. Topics discussed include Magnesium is an abundant mineral in the body, and is important for protein synthesis, energy production; mentions Feverfew is a daisy-like plant used by the Greeks in the first century for inflammatory disorders; and also mentions Chiropractic manipulation seeks to realign the physical body to improve healing.

A letter to the editor is presented in response to the article related to the use of magnesium sulphate for management of eclampsia by J. Villar and colleagues in the June, 2011 issue.

Summary: Background: Type 2 diabetes mellitus (T2DM) is a common disease; the total number of diabetes patients is expected to reach 366 million by 2030. Magnesium has received considerable attention for its potential role in improving insulin sensitivity and preventing diabetes and its cardiovascular complications. Hypomagnesaemia is linked to poor control of type 2 diabetes mellitus, and depletion of serum magnesium occurs exponentially with duration of disease. The aim of this study was to measure serum magnesium level and the correlation of magnesium level with HbA1c in type 2 diabetes mellitus. Methods: In this cross‐sectional study, we included 100 diabetic patients; blood is taken for measurement of both magnesium and HbA1c levels. Patients with risk factors of magnesium deficiency were not included. Results: Of the total 100 patients recruited in our study, majority had diabetes for 8.0 years duration. The mean age of the patients was 53.97 ± 10.65 years, most of them were on oral hypoglycaemic agents (84.9%) followed by combination of oral hypoglycaemic agents and insulin (10.5%), and a small percentage were on insulin alone (4.7%). The mean of serum magnesium and HbA1c levels was 1.88 ± 0.25 mg/dL and 8.38% ± 1.53%, respectively. The majority of the patients had a normal level of magnesium (95.0%); however, most of them had uncontrolled blood glucose (82.0%). The study showed that the serum magnesium level and HbA1c are not significantly correlated (P = 0.462). Conclusion: Normal magnesium levels were observed in majority of patients, there is no significant correlation between serum magnesium and HbA1c levels in patients with T2DM, but larger‐scale clinical trials are needed in future. Hypomagnesaemia is linked to poor control of type 2 diabetes mellitus. The aim of this study was to measure serum magnesium level and the correlation of magnesium level with HbA1c. The majority of the patients had a normal level of magnesium (95.0%); however, most of them had uncontrolled blood glucose (82.0%). The study showed that the serum magnesium level and HbA1c are not significantly correlated (P = 0.462). [ABSTRACT FROM AUTHOR]

The article offers various research related to hemodialysis including a randomized trial of patients with fistula stenosis and a blood flow associated with a lower risk of access thrombosis. A Japanese registry-based study suggests serum magnesium associated with increase in adjusted risk of death. A study suggests the low levels of serum testosterone on initiation of chronic hemodialysis associated with an increased adjusted death risk and decreased health related quality of life.

The article focuses on the use of magnesium for the prevention of migraine. It mentions that the magnesium oxide at 400-500 milligrams (mg) per day is used in the form of pill and can be used by pregnant women. It adds that the wave of brain signaling known as cortical spreading depression is prevented by magnesium. Moreover, the menstrually related migraine can also be prevented by daily oral magnesium.

The article reports that a controlled trial is used to examine effect of intravenous (IV) magnesium in alleviating pain in children admitted with sickle cell crises and states that large difference in number of children who correctly identified their presence in the magnesium and placebo group.

Background: Osteoporosis is the most common chronic metabolic disease of bone and affects over 200 million people worldwide. It is characterized by reduction of bone density and disturbance of bone architecture and it may potentially interfere with osseointegration. As the number of osteoporotic patients requiring dental and orthopaedic implants is constantly increasing, the development of biomaterials that would provide successful osseointegration in such compromised situations is of great interest in the field. Bisphosphonates (BP) are commonly used in orthopaedics to improve bone implant fixation, however, in dentistry, there has been reports that BP can cause osteonecrosis of the jaw. Thus alternative substances that can strengthen bone with osteoporosis are desirable. Magnesium (Mg) has a crucial role in bone metabolism and health, and its systemic supplementation has been listed as fundamental in osteoporosis protection. Additionally, Mg-based materials have shown to stimulate rapid osseointegration. Aim/Hypothesis: To investigate the effect of local magnesium release from mesoporous TiO2 coatings on the early healing events that lead to implant fixation in osteoporotic bone. In particular, the molecular pathways elicited by the presence of magnesium ions in the peri-implant site were elucidated using gene expression profiling with a superarray technique. It was hypothesized that the local release of magnesium in osteoporotic bone significantly improves osseointegration at the early stages of healing. Material and Methods: One-hundred titanium grade IV mini screws were coated with thin mesoporous titania films, capable of incorporating and sustainably drugs and inorganic ions. Fifty of the implants were loaded with physically adsorbed magnesium ions by soaking in MgCl2 solution (Mg2+ group) and 50 were left as native mesoporous (MP group). Osteoporosis was induced in 24 six-month old female Sprague Dawley rats by means of ovariectomy and low-calcium diet. 90 days after ovariectomy, one screw of each group were implanted in the tibia and femur of the rats. The animals were euthanized 1, 2 and 7 days after implantation and the boneimplants explants were prepared for non-decalcified histology. Ground sections stained with toluidine blue were histomorphometrically analysed for new bone formation. Additionally, mRNA was extracted from the cells attached to the surfaces of the implants retrieved from femurs at day 7. cDNA was synthetized for each sample with RT2 First Strand Kit (SABiosciences) and it was used for real-time qPCR with pathway-specific superarrays (Rat Osteogenesis, RT2 Profiler, SABiosciences). This osteogenesis array allows for the simultaneous quantification of the expression of 84 genes belonging to the same pathway. The fold-changes in the gene expression were calculated using the DDCq method, through the normalization against 4 reference genes. Statistical analyses were performed with Wilcoxon Signed Rank test for histomorphometrical values and Student t-test for qPCR values. Results: The histologic observation revealed that cells and tissues suggestive of hematoma and blood clot surrounded the implants at day 1 and 2. An organized network of fibrin was deposited onto the implant surfaces and adherent cells, with flattened aspects, were found on the surfaces. New bone formation was visible already at day 7 and it was significantly higher for the Mg2+ group (P = 0.028). The qPCR arrays showed that 6 osteogenesis related genes (Bmp6, Col14a1, Col2a1, Csf3, Vcam1, Vegfa) were up-regulated more than 3-folds for the Mg2+ samples. In particular, Bmp6, a gene of the BMPs family which expression is regulated to oestrogens and which is known to have anabolic effects on osteoporotic bone, was 3.8-folds significantly up-regulated in the test group (P = 0.027). Three genes (Sox9, Smad3, Tgfbr3) were down-regulated in the test samples, but none of these genes reached a statistical level of significance in the average difference in regulation. Conclusions and clinical implications: The obtained results suggest that the magnesium release from mesoporous coatings promotes rapid bone formation in sites of osteoporotic bone. The activation of osteogenesis related signals in the vicinity of the Mg2+ implants suggests that Mg-doping may be a relative affordable and safe strategy to stimulate an anabolic response around implants placed in osteoporotic sites. The rapid implant fixation may reduce the risk of excessive micromotion and implant failure in patients with osteoporosis. [ABSTRACT FROM AUTHOR]

The author comments on an article within the issue about use of magnesium sulphate in the prevention of eclampsia. Topics discussed include lack of information about pharmacological properties of magnesium therapy, review of the numerous dosing regimens, and analysis of serum magnesium concentrations.

Presents a letter to the editor highlighting an example of the use of intravenous magnesium in a woman with severe asthma undergoing elective lower segment Cesarean section under combined spinal-epidural anesthesia.