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BACKGROUND: Succinylcholine is a commonly used muscle relaxant in anaesthesia that is associated with significant side effects, including muscle fasciculations and postoperative myalgia. Succinylcholine is used to facilitate tracheal intubation, especially in emergency situations when the risk of aspiration of gastric contents is present. AIM AND OBJECTIVE: This research paper investigates the effect of administering magnesium sulfate in conjunction with propofol induction on succinylcholine-induced fasciculations and myalgia. MATERIAL & METHODS: A total of 80 adult patients scheduled for elective surgery under general anaesthesia were divided into two groups (group I and II). The group I patients were treated with magnesium sulphate (40 mg/kg weight) in 10 ml volume while Group II patients were pretreated with normal saline (0.9% in 10 ml volume). They were given slowly intravenously over a period of 10 mim. Then Anesthesia was induced with fentanyl 1.5 mcg/kg and propofol 2 mg/kg, followed by administration of succinylcholine 2 mg/kg intravenously. Muscle fasciculation and Myalgia were observed after 24 hours of surgery. They were graded as nil, mild, moderate and severe. RESULTS: The overall incidence of muscle fasciculation in group I was 52.5% while it was 100% in group II. In group I, 22.5%,12 % mild and moderate muscle fasciculation were developed and no severe cases of fasciculation were observed. While in group II, 52.5% moderate, 40 % mild and 7.5% severe muscle fasciculation were observed. Postoperative myalgia was observed after 24 hrs, and it was observed that patients of Group I were not showing any sign and symptoms of myalgia while in group II, 12.5% were mild, 7.5% were moderate and 80% were negative for myalgia. CONCLUSION: The study found that the administration of magnesium sulfate significantly reduced both the incidence and severity of succinylcholine-induced fasciculations and myalgia, suggesting a beneficial role for magnesium sulfate in anesthesia protocols. [ABSTRACT FROM AUTHOR]

Magnesium is the second most abundant cation in the human body and plays an important role in various physiological processes of the body. Magnesium sulfate as a pharmacological form of magnesium.is a natural N-methyl-D-aspartate receptor blocker and calcium channel blocker. Previous studies have found that it can be used to prevent seizures inpatients with preeclamptic, and is also used to treat diseases such as arrhythmias and asthma, With the deepening of research its role in perioperative anesthesia is becoming more and more prominent. It can have a synergistic effect on anesthetic drugs. reduce the use of anesthetic drugs, and also has anti-inflammatory, inhibiting stress response, maintaining circulatory stabilizing and neuro protective effects. Different ways of applying magnesium sulfate may produce different effects. This article reviews the different practices of magnesium sulfate in the perioperative anesthesia process. [ABSTRACT FROM AUTHOR]

Objective: To establish the population pharmacokinetics (PPK) of magnesium sulfate (MgSO4)in women with preeclampsia (PE), and to determine the key covariates having an effect in magnesium pharmacokinetics in Chinese PE. Methods: Pregnant women with PE prescribed MgSO4 were enrolled in this prospective study from April 2021 to April 2023. On the initial day of administration, the patients were administered a loading dose of 5 g in conjunction with 10 g of magnesium sulfate as a maintenance dose. On the second day, only the maintenance dose was administration, and maternal blood samples were taken at 0, 4, 5, and 12 h after the second day's 10 g maintenance dose. The software Phoenix was used to estimate PPK parameters of MgSO4, such as clearance (CL) and volume of distribution (V), and to model PPK models with patient demographic, clinical, and laboratory covariates. Results: A total of 199 blood samples were collected from 51 women with PE and PPK profiles were analyzed. The PPK of MgSO4 is consistent with to a one-compartment model. The base model adequately described the maternal serum magnesium concentrations after magnesium administration. The population parameter estimates were as follows: CL was 2.98 L/h, V was 25.07 L. The model predictions changed significantly with covariates (BMI, creatinine clearance, and furosemide). Furosemide statistically influences V. The creatinine clearance, BMI and furosemide jointly affects CL. Monte Carlo simulation results showed that a loading dose combined with a maintenance dose would need to be administered daily to achieve the therapeutic blood magnesium concentrations. For the non-furosemide group, the optimal dosing regimen was a 5 g loading dose combined with a 10 g maintenance dose of MgSO4. For the furosemide group, the optimal dosing regimen was a 2.5 g loading dose combined with a 10 g maintenance dose of MgSO4. Conclusions: The magnesium PPK model was successfully developed and evaluated in Chinese preeclampsia population, and the dose optimization of MgSO4 was completed through Monte Carlo simulation. [ABSTRACT FROM AUTHOR]

Introduction: In low-resource settings, magnesium sulphate (MgSO4) for preeclampsia is administered majorly through an injection into the gluteal muscles 4-hourly for 24 hours. The repeated injections are very painful and may lead to infection, abscess formation, and reduced compliance. Objective: To determine the acceptability of Springfusor® pump for the administration of Magnesium Sulphate in preeclampsia and eclampsia. Design: Randomized Open Label Clinical Trial. Methods: The study was conducted at Kawempe National Referral Hospital. Eligible women had a systolic blood pressure of ≥140mmHg and or diastolic blood pressure >90mmHg, proteinuria ≥+1, and the physician's decision to start on MgSO4. Four-hundred-ninety-six participants were randomized to a Springfusor® pump group (n = 248) or control (standard of care) (n = 248) administration of MgSO4. Intervention group had a loading dose (4gm of 50% MgSO4 intravenously over 20 minutes) and maintenance therapy (1gm of 50% MgSO4 intravenously per hour for 24 hours) administered using the Springfusor®. The standard of care (SOC) group received a loading dose of 4gm of 20% MgSO4 IV over 15–20 minutes, followed by 10gm of 50% MgSO4 intramuscular (5gm in each buttock) and a maintenance dose of 5gm of 50% MgSO4 was administered IM every 4 hours for 24 hours. Both arms received the rest of the care for preeclampsia/eclampsia as per the hospital guidelines. Acceptability of the method of administration was assessed using a Likert scale (1–5; 1 and 2: acceptable and 3–5: unacceptable). Pain at the site of MgSO4 administration was assessed using a Visual Analogue Scale 1–7, (1 minimal pain and 7 worst pain). Comparisons were assessed with the Chi-square test, Mann Whitney-Wilcoxon test, and Students' t-test. Results: Intervention arm; was more acceptable than the standard of care arm, (95.3% vs70.3%; p<0.001), had a lower median pain score, (2(CI: 2–2), vs 4(CI: 4–5) p<0.001), and fewer side effects. Maternal mortality was comparable between groups (0.8% in the intervention arm vs 1.2% in the IM arm). Trial registration: Trial No PACTR201712002887266 (https://pactr.samrc.ac.za/). [ABSTRACT FROM AUTHOR]

Optimizing pain management in spinal surgery is crucial for preventing adverse events due to delayed mobilization. Magnesium sulfate has potential benefits in spinal surgery because of its analgesic properties and modulation of neurotransmitters and autonomic nervous system. Existing evidence regarding the use of magnesium sulfate is partial and controversial, necessitating a comprehensive meta-analysis to evaluate its efficacy and safety. The aim of this study was to conduct a comprehensive meta-analysis to evaluate the efficacy and safety of magnesium sulfate in spinal surgery compared to other available options. This meta-analysis adhered to the PRISMA guidelines. Patients undergoing spinal surgery were included, with the intervention group receiving intravenous magnesium sulfate (MS) at various doses or combinations, whereas the comparison group received other alternatives or a placebo. The efficacy and safety outcomes were assessed. Data were collected from multiple databases and analyzed using Review Manager version 5.4. Heterogeneity was assessed and fixed- or random-effects models were applied. The meta-analysis included eight studies (n = 541). Magnesium sulfate demonstrated significant reductions in pain at 24 h (MD −0.20, 95% CI: −0.39 to −0.02) and opioid consumption (SMD −0.66, 95% CI: −0.95 to −0.38) compared to placebo. Additionally, a decrease in the use of muscle relaxants (SMD −0.91, 95% CI: −1.65 to −0.17) and remifentanil (SMD −1.52, 95% CI: −1.98 to −1.05) was observed. In contrast, an increase in extubation time (MD 2.42, 95% CI: 1.14 to 3.71) and verbal response (MD 1.85, 95% CI: 1.13 to 2.58) was observed compared to dexmedetomidine. In conclusion, magnesium sulfate administration in spinal surgery reduced pain and opioid consumption, and prolonged orientation and verbal response. No significant differences in blood pressure or heart rate were observed between the groups. [ABSTRACT FROM AUTHOR]

[Display omitted] • Preterm brain damage is still a significant and unresolved problem for neonatologists. • Knowledge of the predictors of the cord blood magnesium levels help elucidate the ideal MgSO4 regimen and timing of administration. • Efficacy of MgSO4 for fetal Neuroprotection is accepted, Optimum timing of administration in relation to delivery and Optimal dosing regimen remains unknown. • We have compared the neonatal outcomes of different duration groups in different gestations with Cord blood magnesium as a tool. • We found that the mean cord blood magnesium level was found to be 3.8 mg/dl to serve the purpose of neuroprotection. To achieve this target, the standard dosing regimen of 4gm Bolus followed by Infusion should be administered for at-least 6 h prior to delivery. The effectiveness of MgSO4 for foetal neuroprotection is acknowledged, but the best time to provide it in relation to birth is a conundrum, and dose schedule is yet unknown. Understanding the determinants of the magnesium levels in cord blood aids in determining the appropriate timing and length of administration. To assess the cord blood magnesium concentration in relation to the timing of MgSO4 and delivery. To achieve ROC in relation to optimum level of cord blood magnesium concentration in relation to neonatal outcome variables. A prospective observational study conducted in a tertiary care hospital over 2 years in women having preterm delivery from 26 weeks to 33 + 6 weeks, who received Neuroprophylaxis. Cord blood was collected for magnesium level estimation. Baby followed 24 h after delivery. ROC analysis performed for predicting an optimal cut-off for a continuous predictor predicting binary outcome. 85 recruited cases divided into bolus group, bolus + infusion group. The mean cord blood magnesium (n = 85) was 3.8 mg/dl. The AUROC for Gestational Age at Administration predicting Baby Outcome: 0.699, It was statistically significant (p = 0.034). The AUROC for Cord Blood Mg predicting Baby Outcome: 0.606, It was not statistically significant (p = 0.262). Mean cord blood magnesium levels served as a tool to determine the timing and duration of Neuroprophylaxis. Mean cord blood magnesium of 3.8 mg/dl should be achieved to serve the purpose of Neuroprotection. To achieve this, Bolus followed by Infusion should be administered for at-least 6 h prior to delivery. [ABSTRACT FROM AUTHOR]

Postoperative sore throat is one well-recognized complication, occurring most frequently following tracheal intubation. Effective prevention of postoperative sore throat has been recognized as a top priority, bringing pleasant feelings and satisfaction to patients. This study aimed to assess the efficacy of magnesium sulfate, dexmedetomidine and ondansetron gargle with lidocaine administrated prior to laryngoscopy and tracheal intubation for postoperative sore throat prevention alongside hemodynamic management. This double-blind randomized clinical trial enrolled 105 general anesthesia-administered patients who had undergone laryngoscopy and endotracheal intubation, and they were equally randomized into three groups: magnesium sulfate, dexmedetomidine, and ondansetron groups. No significant intergroup difference was seen in oxygen saturation, non-invasive blood pressure, heart rate, duration of surgery, postoperative complications, analgesic consumption, and incidence of cough and hoarseness. The results showed statistically significant intergroup differences in pain scores and average pain intensity in the dexmedetomidine group was significantly lower than the other groups. Results suggest that dexmedetomidine gargle with lidocaine before general anesthesia induction could be recommended as an option depending on the patient's general condition and the anesthesiologist's discretion. [ABSTRACT FROM AUTHOR]

Magnesium sulfate (MgSO 4) is a potential neuroprotective agent for patients with aneurysmal subarachnoid hemorrhage (SAH). We analyzed the effect of early application of intraoperative intravenous MgSO 4 and compared cerebral vasospasm (CV), delayed cerebral ischemia (DCI), and neurological outcome in 2 patient cohorts. A retrospective matched-pair analysis from patients at a single center in Germany was performed without (group A) and with (group B) MgSO 4 application <24 hours after diagnosis. Pairs were matched according to the known risk factors for DCI and CV (age, Fisher grade, smoking, severity of SAH). Incidence of CV and DCI and neurological outcome using the modified Rankin Scale score 3 and 12 months after SAH were recorded. The inclusion criteria were met by 196 patients. After risk stratification, 48 patients were included in the final analysis (age 54.2 ± 8.1 years; 30 women and 18 men) and were assigned to group A (n = 24) or group B (n = 24). CV occurred less frequently in group B (33%) than in group A (46%). Likewise, DCI was present in 13% in group B compared with 42% in group A. After 12 months, 22 patients in group B had a favorable functional outcome (modified Rankin Scale score 0–3) compared with 15 patients in group A. In this study, the incidence of CV and DCI was lower in patients receiving intravenous MgSO 4 within 24 hours after aneurysmal SAH onset. Favorable functional outcome was more likely in the MgSO 4 group after 12 months of follow-up. [ABSTRACT FROM AUTHOR]

Preterm birth remains the leading cause of mortality among under‐5's and is a major contributor to the reduction in quality‐of‐life adjusted years and reduction in human capital. Globally, there are many interventions and care bundles that aim to reduce the impact of preterm birth once preterm labor has ensued and into the neonatal period; not all of these are applicable in all settings. Here, we introduce the FIGO PremPrep‐5 initiative, which aims to disseminate key information on the most simple and effective interventions with the aim of increasing implementation globally. Before delivery, we recommend a course of antenatal corticosteroids, and intrapartum magnesium sulfate. At delivery, we recommend delayed cord clamping. Postnatally, we recommend early feeding with breast milk and immediate kangaroo care. While there are many other interventions that may improve outcomes at the time of labor and after preterm birth, these are clinically effective and relatively inexpensive options that can be practiced in most settings and supplemented with more advanced care. We include examples of a training video and infographics that will be used for dissemination. Synopsis: An introduction to simple interventions to reduce the impact of preterm birth in low‐ and middle‐income country settings. [ABSTRACT FROM AUTHOR]

Magnesium oxysulfate (MOS) cement, a building material, can be considered the result of the hydration reaction between magnesium sulfate, caustic-burned magnesia powder, and water. Despite its desirable properties, such as limited mechanical strength and water resistance, MOS cement can hinder its use in engineering applications. We employed several testing methods to assess the impact of sodium gluconate (SG) addition on the compressive strength, microstructure, moisture resistance, coagulation time, pH profile, micropore parameters, phase composition, and thermal decomposition of MOS cement's hydration products. The addition of sodium gluconate improves the stability of the hydration film surrounding active magnesium oxide in magnesium sulfate. This extension in the setting time of MOS cement is observed. Additionally, it inhibits the creation of magnesium hydroxide while facilitating the formation of numerous needlelike structures corresponding to the 5Mg(OH)2·MgSO4·7H2O (5·1·7 phase). Consequently, the mechanical strength and water resistance of MOS cement are substantially improved compared to the unmodified sample. [ABSTRACT FROM AUTHOR]

Lop Nur is located at the eastmost end of the Tarim Basin in Xinjiang, Northwestern China. This study reviews the hydrochemical characteristics and evolution of underground brine in Lop Nur, based on analytical data from 429 water samples (mainly brine). It is found that in the NE–SW direction, from the periphery to the Luobei sub‐depression, while the hydrochemical type varies from the sodium sulfate subtype (S) to the magnesium sulfate subtype (M), the corresponding brine in the phase diagram transfers from the thenardite phase (Then) area, through the bloedite phase (Blo), epsomite phase (Eps), picromerite phase (Picro), finally reaching the sylvite phase (Syl) area. As for the degree of evolution, the sequence is the periphery < Luobei horizontally and the overlying glauberite brine < the underlying clastic brine vertically. It is concluded that the oxygen and hydrogen isotopic compositions of the brine have evidently been affected through the effects of evaporation and altitude, as well as the changes in local water circulation in recent years. Boron and chloride isotopic compositions show that the glauberite brine is formed under more arid conditions than the clastic one. The strontium isotopic composition indicates that the Lop Nur brine primarily originates from surface water; however, deep recharge may also be involved in the evolution of the brine, according to previous noble gas studies. It is confirmed that the brine in Lop Nur has become enriched with potassium prior to halite precipitation over the full course of the salt lake's evolution. Based on chemical compositions of brine from drillhole LDK01 and previous lithological studies, the evolution of the salt lake can be divided into three stages and it is inferred that the brine in Lop Nur may have undergone at least two significant concentration‐dilution periods. [ABSTRACT FROM AUTHOR]

Pediatric asthma is a common condition, and its exacerbations can be associated with significant morbidity and mortality. The role of nebulised magnesium as adjunct therapy for children with asthma exacerbations is still unclear. To compare clinical and functional outcomes for children with asthma exacerbation taking either nebulised magnesium sulfate added to standard medical therapy (SMT) versus SMT alone. PubMed, Embase, and Cochrane Library were systematically searched for randomised clinical trials (RCT) comparing the use of SMT with vs. without nebulised magnesium. The outcomes were respiratory rate, heart rate, % predicted peak expiratory flow rate (PEFR), % predicted forced expiratory volume (FEV1), peripheral O2 saturation, asthma severity scores, and need for intravenous (IV) bronchodilator use. Twelve RCTs and 2484 children were included. Mean age was 5.6 (range 2–17) years old, mean baseline % predicted FEV1 was 69.6%, and 28.66% patients were male. Children treated with magnesium had a significantly higher % predicted PEFR (mean difference [MD] 5.33%; 95% confidence interval [CI] 4.75 to 5.90%; p < 0.01). Respiratory rate was significantly lower in the magnesium group (MD -0.70 respirations per minute; 95% CI -1.24 to -0.15; p < 0.01). Need for IV bronchodilators, % predicted FEV1, heart rate, asthma severity scores, and O2 saturation were not significantly different between groups. Conclusion: In children with asthma exacerbation, treatment with nebulised magnesium and SMT was associated with a statistically significant, but small improvement in predicted PEFR and respiratory rate, as compared with SMT alone. What is Known: • Magnesium sulfate has bronchodilating properties and aids in the treatment of asthma exacerbation when administered intravenously. • There is no significant evidence of benefit of nebulised magnesium as an adjunct therapy to the standard medical treatment for children with asthma exacerbations. What is New: • Our study suggests nebulised magnesium sulfate may have a statistically significant, but small benefit in respiratory rate and peak expiratory flow rate. The addition of nebulised magnesium does not seem to increase adverse events. [ABSTRACT FROM AUTHOR]

• Local MgSO4 administration alleviates postincisional pain. • MgSO4 post-treatment suppresses inflammation and phosphorylation of the NMDA receptor in injured tissue. • MgSO4 post-treatment attenuates astrocytic and microglial activation in ipsilateral lumbar spinal cord dorsal horn. Postoperative pain remains one of the most common complaints after surgery, and appropriate treatments are limited. We therefore investigated the effect of the anti-nociceptive properties of magnesium sulfate (MgSO 4), an N-methyl-D-aspartate (NMDA) receptor antagonist, on incision-induced postoperative pain and peripheral and central nervous system inflammation. We found that local MgSO 4 administration dose-dependently increases paw withdrawal latency, indicating reduced peripheral postoperative pain. Furthermore, MgSO 4 inhibited the expression of interleukin-1β (IL-1β) and inducible nitric oxide synthase (iNOS) and phosphorylation of the NMDA receptor NR1 subunit in injured paw tissue and significantly attenuated microglial and astrocytic activation in the ipsilateral lumbar spinal cord dorsal horn. Locally administered MgSO 4 has potential for development as an adjunctive therapy for preventing central nociceptive sensitization. [ABSTRACT FROM AUTHOR]

Sorption technologies are essential for various industries because they provide product quality and process efficiency. New encapsulated microspherical composite sorbents have been developed for resource-saving contact drying of thermolabile materials, particularly grain and seeds of crops. Magnesium sulfate, known for its high water capacity, fast sorption kinetics, and easy regeneration, was used as an active moisture sorption component. To localize the active component, porous carriers with an accessible internal volume and a perforated glass–crystalline shell were used. These carriers were created by acid etching of cenospheres with different structures isolated from fly ash. The amount of magnesium sulfate included in the internal volume of the microspherical carrier was 38 wt % for cenospheres with ring structures and 26 wt % for cenospheres with network structures. Studies of the moisture sorption properties of composite sorbents on wheat seeds have shown that after 4 h of contact drying the moisture content of wheat decreases from 22.5 to 14.9–15.5 wt %. Wheat seed germination after sorption drying was 95 ± 2%. The advantage of composite sorbents is the encapsulation of the desiccant in the inner volume of perforated cenospheres, which prevents its entrainment and contamination and provides easy separation and stable sorption capacity in several cycles. [ABSTRACT FROM AUTHOR]

Aim and background: Searching is ongoing to find an alternative prophylactic magnesium sulphate regimen for severe preeclampsia despite 24 hours recommendation of the World Health Organization (WHO). This review finds the provision of any such substitute prophylactic instead of the recommended ones searching through the recently published trials. Objectives: To endorse any alternative prophylactic magnesium sulphate regimen effective for severe preeclampsia. Methods: Data sources: Studies are retrieved from the bibliographic databases of PubMed, Scopus, and Cochrane Library. Eligibility Criteria, Participants, and Interventions: Included studies are recently published trials intended to compare the efficacy of different modified regimens of magnesium sulphate prophylaxis for women with severe preeclampsia in contrast to the standard regimen. Results: Out of a total of fifteen, eight studies evaluated different abbreviated regimens of magnesium sulphate prophylaxis. A lower maintenance dose of magnesium sulphate as preeclampsia-prophylaxis was assessed by two. In addition, four studies evaluated the efficacy of only loading doses of magnesium sulphate as prophylaxis. Finally, one study estimated a placebo in the postpartum period compared to the standard regimen. No incidence of eclampsia was reported in any group of eight studies. Even in the rest seven studies, eclampsia incidences did not appear significantly higher in the study group allocated for either abbreviated or low dose or loading-dose regimens. However, a statistically significant number of women in the study groups needed extension/reinstitution of prophylaxis. Low-dose and loading dose prophylaxis are found unsuitable for a recommendation. Apart from the established safety potential, abbreviated/short-course prophylaxes of magnesium sulphate have been found to generate different secondary benefits. Conclusions: The abbreviated postpartum regimen of magnesium sulphate can be recommended as prophylaxis for severe preeclampsia instead of recommended schedule if applied judicially. [ABSTRACT FROM AUTHOR]

Magnesium sulfate has been widely detected on the surface of Mars. The occurrence of magnesium sulfate and mixed cationic sulfates preserves clues regarding the sedimentary environment, hydrological processes, and climate history of ancient Mars. In this study, seven magnesium sulfate double salts were synthesized in the laboratory using a high-temperature solid phase reaction or slow evaporation of aqueous solutions. The samples were analyzed using X-ray diffraction to confirm their phase and homogeneity. Subsequently, the Raman, mid-infrared spectra, and visible near-infrared spectra of these samples were collected and analyzed. Our results showed that the spectra of the analyzed magnesium sulfate double salts exhibited distinctive spectral features. These laboratory results may provide new insights for the identification of various magnesium sulfate double salts on Mars during the interpretation of in situ data collected by Scanning Habitable Environments with Raman and Luminescence for Organics and Chemicals (SHERLOC), SuperCam, and the ExoMars Raman Laser Spectrometer (RLS). In addition, the MIR and VNIR spectra features obtained in this study provide an improved reference and spectra library for decipherment of data sourced from the Thermal Emission Spectrometer (TES), Thermal Emission Imaging System (THEMIS), and Mars Mineralogical Spectrometer (MMS). [ABSTRACT FROM AUTHOR]

Background: Among hypertensive disorders of pregnancy (HDP), eclampsia is a rare but serious event, often considered avoidable. Detailed assessment of the adequacy of care for the women who have eclampsia can help identify opportunities for improvement and for prevention of the associated adverse maternal and neonatal outcomes. Objective: 1/ To estimate the incidence and describe the characteristics of women with eclampsia and to compare them with those of women with non-eclamptic hypertensive disorders of pregnancy (HDP)-related severe maternal morbidity (SMM) and of control women without SMM 2/ To analyse the quality of management in women who had eclampsia, at various stages of their care pathway. Methods: It was a planned ancillary analysis of the EPIMOMS population-based study, conducted in six French regions in 2012–2013. Among the 182,309 maternities of the source population, all women with eclampsia (n = 51), with non-eclamptic HDP-related SMM (n = 351) and a 2% representative sample of women without SMM (n = 3,651) were included. Main outcome was the quality of care for eclampsia assessed by an independent expert panel at three different stages of management: antenatal care, care for pre-eclampsia and care for eclampsia. Results: The eclampsia incidence was 2.8 per 10,000 (95%CI 2.0–4.0). Antenatal care was considered completely inadequate or substandard in 39% of women, as was pre-eclampsia care in 76%. Care for eclampsia was judged completely inadequate or substandard in 50% (21/42), mainly due to inadequate use of magnesium sulphate. Conclusion: The high proportion of inadequate quality of care underlines the need for an evidence-based standardisation of care for HDP. [ABSTRACT FROM AUTHOR]

Introduction: Intrathecal adjuvants have gained favour in recent years with the goal of extending the duration of a block. Among these, Dexamethasone possesses anti-inflammatory and analgesic action and can be given as an adjuvant to local anaesthetics to enhance the efficacy of regional anaesthesia, as well as to decrease the intensity of shivering. The addition of Magnesium sulphate (MgSO4) to spinal anaesthesia helps in improving postoperative analgesia in an orthopaedic setting. Aim: To compare the effects of Intravenously (i.v.) MgSO4 and i.v. dexamethasone on intraoperative haemodynamics, the time to achieve dermatome T10 intraoperatively, and to compare postoperative Visual Analogue Scale (VAS) scores between the two groups at 1, 3, 6, 12, and 24 hours after surgery. Materials and Methods: This randomised clinical trial was conducted, and patients were randomly divided into two groups. Group M (n=40): MgSO4 40 mg/kg given 15 minutes before spinal anaesthesia in 100 mL normal saline infusion i.v. Group D (n=40): Dexamethasone 8 mg given 15 minutes before spinal anaesthesia in 100 mL normal saline infusion i.v. The parameters assessed included haemodynamic parameters, time to achieve dermatome T10 intraoperatively, postoperative VAS score at 1, 3, 6, 12, and 24 hours after surgery, and any side-effects like sedation, respiratory depression, nausea, vomiting, pruritus, urinary retention, bradycardia, and hypotension. Statistical testing was conducted using the statistical software Statistical Package for Social Sciences (SPSS) 28.0. Results: There was no significant difference in demographic variables (age and gender) between the two groups (p-value>0.05). However, the decrease in mean heart rate, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Mean Arterial Blood Pressure (MAP) was greater in group D compared to group M at different time intervals (p-value<0.05). Additionally, dermatome level T10 was achieved earlier in group D by approximately two minutes compared to group M (6.95±0.39 minutes versus 5.03±0.16 minutes, respectively, p-value<0.001). Conclusion: An i.v. infusion of 8 mg dexamethasone in 100 mL normal saline was more effective compared to an i.v. infusion of 40 mg/kg MgSO4 in terms of achieving more stable haemodynamics intraoperatively and achieving the T10 dermatome level earlier. [ABSTRACT FROM AUTHOR]

Introduction: Laparoscopic surgeries currently represent the mainstay of surgical modalities. Pneumoperitoneum imposes significant intraoperative haemodynamic alterations, which are more pronounced in elderly patients and those with co-morbid conditions. Inadequate pain relief in the perioperative period may result in various physiological and psychological traumas. Aim: To investigate the effects of magnesium sulphate, dexmedetomidine, and lignocaine on the haemodynamic responses and postoperative analgesia in patients undergoing laparoscopic abdominal surgeries. Materials and Methods: This double-blinded, randomised clinical study was conducted in the general surgery operation theatre, Post-anaesthetic Care Unit (PACU), and the male and female surgery ward of RG Kar Medical College and Hospital, Kolkata, West Bengal, India from March 1, 2021, to March 1, 2022. The study involved 105 subjects assigned to Group-L, who received an injection of lignocaine as a loading dose of 1.5 mg/kg intravenously over 2-4 minutes before induction, followed by a continuous infusion of 2 mg/kg/hour throughout the surgery. Group-M received a loading dose of MgSO4 at 30 mg/kg over 15 minutes before induction, followed by 15 mg/kg/hour throughout the surgery, and Group-D received a loading dose of dexmedetomidine at 1 mcg/kg over 10 minutes before induction, followed by a continuous infusion of 0.5 mcg/kg/min throughout the surgery. Data on Heart Rate (HR), Mean Arterial Pressure (MAP), and the total dose of rescue analgesic administered in the postoperative 24 hours were recorded and analysed using Analysis of Variance (ANOVA) and Tukey's Honestly Significant Difference (HSD) test, as well as the Chi-square test where applicable. A p-value of less than 0.05 was considered statistically significant. Results: The groups were comparable in terms of demographic variables and baseline haemodynamic status. The average age in Group-D was 39.13±9.48 years, in Group-M was 37.30±8.14 years, and in Group-L was 36.5±7.2 years (p=0.26). Group-D had 60% males, Group-M had 57% males, and Group-L had 60% males. The mean Body Mass Index (BMI) of Group-D was 25.9±2.03 (kg/m2), Group-L (Lignocaine) was 24.7±2.7, and Group-M (Magnesium Sulphate) was 23.8±3.2. Dexmedetomidine was found to be superior in maintaining haemodynamic stability throughout the perioperative period (Preinduction HR: Group-D=79.43, Group-L=79.06, Group-M=82.09; Postinduction HR: Group-D=86.49, Group-M=65.91, Group-L=72.69). There was a significant decrease in postintubation MAP, most pronounced in the Magnesium Sulphate and Dexmedetomidine groups. Post-pneumoperitoneum, the surge in MAP was most effectively prevented by Dexmedetomidine. The lowest amount of rescue analgesic (injection Diclofenac in mg) was used in the Dexmedetomidine group (55.86±5.05), followed by the Lignocaine group (126.43±17.69). Patients in the Magnesium group required the highest amount of rescue analgesic (156.43±7.91). The number of patients receiving rescue analgesia was significantly higher in the Lignocaine and Magnesium Sulphate groups (Group-D: 6.5±3.14565, Group-L: 14.75±7.36, Group-M: 18.25±8.057). Conclusion: Dexmedetomidine was more effective in maintaining haemodynamic stability throughout the perioperative period and exhibited superior postoperative analgesic properties. Magnesium Sulphate and lignocaine were more effective in preventing postintubation surges. [ABSTRACT FROM AUTHOR]

Background: Junctional ectopic tachycardia (JET) is a serious tachyarrhythmia following pediatric cardiac surgery. It isn't easy to treat and better to be prevented. This study aimed to examine the prophylactic effects of dexmedetomidine, MgSO4, or their combination in reducing JET following pediatric open cardiac surgery. Methods: Hundred and twenty children under 5 years, weighing more than 5 kg, who were scheduled for corrective acyanotic cardiac surgeries were randomized into three groups. Group MD (Dexmedetomidine–MgSO4 group): received dexmedetomidine 0.5 μg/kg IV over 20 min after induction, then infusion 0.5 μg/kg/h for 72 h, and 50 mg/kg bolus of MgSO4 with aortic cross‐clamp release, then continued administration for 72 h postoperatively at a dose of 30 mg/kg/day. Group D (the dexmedetomidine group) received the same dexmedetomidine as the MD group in addition to normal saline instead of MgSO4. Group C (control group): received normal saline instead of dexmedetomidine and MgSO4. The primary outcome was the detection of JET incidence; the secondary outcomes were hemodynamic parameters, ionized Mg, vasoactive‐inotropic score, extubation time, PCCU and hospital stay, and perioperative complications. Results: The incidence of JET was significantly reduced in Group MD and Group D (p =.007) compared to Group C. Ionized Mg was significantly higher in Group MD than in Groups D and C during rewarming and in the ICU (p <.001). Better hemodynamic profile in Group MD compared to Group D and Group C throughout surgery and in the ICU, the predictive indexes were significantly better in Group MD than in Groups D and C (p <.001). Including the extubation time, PCCU, and hospital stay. Conclusion: Dexmedetomidine alone or combined with MgSO4 had a therapeutic role in the prevention of JET in children after congenital heart surgery. [ABSTRACT FROM AUTHOR]

Introduction: For many surgical diseases, laparoscopic surgery has become the conventional treatment. The physiological repercussions of pneumoperitoneum, on the other hand, are cause for concern. The formation of pneumoperitoneum with carbon dioxide (CO2) presents a unique haemodynamic problem for patient anaesthesia management. The increased intra-abdominal pressure caused by pneumoperitoneum, combined with the head-up tilt, causes changes in cardiovascular, respiratory, stress, and acid-base physiology. Pneumoperitoneum causes alterations in the cardiovascular system such as an increase in mean arterial pressure, a decrease in cardiac output, and an increase in systemic vascular resistance, which can lead to altered tissue perfusion. Materials and methods: In the haemodynamic changes, the most important outcome measure is systolic blood pressure. Thus, expecting a 15 mmHg difference in systolic blood pressure between the Intervention and Control groups, a 95% confidence interval, power 85% and population variance 500, the sample size calculated for each arm was 80. All adult male patients aged 18-50 years, American Society of Anaesthesiologists Grade I/II with informed written consent and Mallampati score of up to Class II undergoing elective laparoscopic abdominal surgery under general anaesthesia were included. Patients with systemic disorders, on calcium channel blockers and in whom the surgery could not be completed laparoscopically were excluded. Results: Two groups of 80 each were labelled as Group A (magnesium sulfate 50 mg/kg)- Intervention group and Group B (Normal Saline 50 mL)- Control group. The mean of patients' age, weight and height were calculated between the two groups and were tabulated as shown below. Thus, it was concluded on the basis of the p value that the distribution of age, weight and height among the two groups were comparable and these factors did not have any influence on outcome. Conclusion: In our study, we conclude that IV magnesium sulfate, when given before pneumoperitoneum attenuates arterial pressure increase during elective laparoscopic abdominal surgeries. This attenuation is apparently related to reductions in the release of catecholamine, vasopressin or both by magnesium sulfate. We also found that there is no adverse effect of magnesium like sedation or prolonged neuromuscular blockade at the dose we used. [ABSTRACT FROM AUTHOR]

Objective: To observe the treatment of severe preeclampsia in newborns with enoxaparin sodium combined with magnesium sulfate. Methods: A retrospective analysis was conducted on the clinical data of 80 patients with severe preeclampsia admitted to Hefei Second People's Hospital, China from January 2019 to December 2020. Treatment records showed that 40 cases received magnesium sulfate treatment (single group), and 40 cases received enoxaparin sodium combined with magnesium sulfate treatment (combination group). Levels of D-dimer, soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PLGF), Apgar scores of newborns delivered before and after treatment were compared. Gestation weeks and incidence of adverse reactions were analyzed. Results: After treatment, levels of D-dimer, sfit-1 and adverse reactions in the combination group were significantly lower than those in the single group (P<0.05), and the level of PLGF, newborn Apgar score and length of gestation were significantly higher than those in the single group (P<0.05). Conclusion: Compared to magnesium sulfate alone, the combination of enoxaparin sodium and magnesium sulfate in the treatment of pregnant women with severe preeclampsia can more effectively regulate the cytokine level of patients, improve pregnancy outcome, and improve neonatal Apgar score. The incidence of adverse reactions is low, making it a safe and efficient treatment modality. [ABSTRACT FROM AUTHOR]

Objectives: To compare the response between different doses of nebulized magnesium sulphate along with Salbutamol in children between two to 12 years of age with status asthmaticus. Methods: This single blinded, randomized clinical trial was carried out at the Department of Pediatrics, Dr. Ziauddin University Hospital, Karachi, Pakistan during October 2021 to September 2022. A total of 104 children aged between 2-12 years, with the diagnosis of asthma having "Pediatric Rapid Assessment Measure (PRAM)" score>4 and with reactive airways were included. Children either received three back-to-back nebulization with salbutamol solution only (n=50) or salbutamol and MgSO4 with three different doses (250mg, 500mg or 750mg) after every 20 minutes for 60 minutes. The PRAM score was used as an assessment tool to clinically score asthma. Results: In a total of 104 children, 53 (51.0%) were girls. The mean age was 5.25±2.86 years. No statistically significant difference was found in PRAM scores at baseline (p=0.448) and at 20-minutes (p=0.072) but significant differences were observed at 40-minutes (p=0.009), 60-minutes (p=0.011), 120-minutes (p=0.010), 6-hours (=0.034), 12-hours (p=0.018), 18-hours (p=0.033) and at 24-hours (p=0.029). The reduction in PRAM scores from baseline to 24-hours following treatment among Salbutamol, Salbutamol+ MgSo4 250mg, Salbutamol+ MgSo4 500mg and Salbutamol+ MgSo4 750mg group were 6.53±1.09, 7.22±1.09, 6.85±1.43 and 7.57±1.06 respectively (p=0.007). Conclusion: While children with status asthmaticus managed using salbutamol, with or without nebulized MgSO4, showed improved clinical outcomes, combining salbutamol with higher dosages of nebulized MgSO4 resulted in even greater clinical improvement. [ABSTRACT FROM AUTHOR]

Introduction: multimodal analgesia promotes the combined use of medications to produce a synergistic effect, thereby reducing the doses used and adverse effects, including opioids and other drugs. Currently, there are no guidelines recommending the safety framework for hospitals in which these drugs should be prescribed outside the operating room area. Material and methods: searches were conducted in academic databases, websites specializing in clinical practice guidelines, and clinical practice guidelines from multiple hospital institutions up to 15 years old. Recommendations based on the collected information were created, reviewed by experts, and adapted to the local regulations of Médica Sur Hospital. Results: in-hospital recommendations for the prescription of opioid analgesics and other drugs for the treatment of acute pain in Médica Sur hospitalization; 11 recommendations for the prescription of opioids, 10 for lidocaine, and 9 for ketamine, alpha-2 agonists, and magnesium sulfate, each. Conclusions: we recognize that any guideline development process has limitations, including evidence and contrasting opinions. Creating recommendations for prescription provides a framework to limit unjustified variation in the prescription of opioids and other drugs in the management of acute pain. [ABSTRACT FROM AUTHOR]

Sulfate plays a critical role in portland cement. The internal gypsum (CaSO4·2H2O) incorporating with clinker controls the hydration of cement, while the external gypsum can attack the hydration products. Magnesium sulfate is renowned for sulfate attack on concrete. This study aims to investigate the impact of the internal Mg2+ addition on the composition and microstructure of hardened portland cement paste. Notably, the test results demonstrate that internal Mg2+ does not show the same aggressive effect as external Mg2+ on the destabilization of portland cement. Instead, internal Mg2+ infiltrates into the calcium-silicate-hydrate (C-S-H) gels, displacing the Al-O tetrahedra on the Si chain, forming C-(A, M)-S-H gels by converting Ca octahedra to Mg octahedra or Al-O tetrahedra to Mg-O tetrahedra. This process contributes to a decrease in the Al/Si ratio and mean chain length of the C-S-H gels. Additionally, the displaced Al-O tetrahedra from the C-S-H gels react with AFt, resulting in the AFm formation. Consequently, these structural changes in the C-S-H gels, along with additional pore filling through AFm precipitation, play a significant role in refining the pore structure. [ABSTRACT FROM AUTHOR]

More than 70% of the potash fertilizer globally is produced by the froth flotation process, in which 4-dodecylmorpholine (DMP) serves as a reverse flotation agent. As the potash fertilizer production rapidly rises, the increased DMP levels in discharged brine pose a threat to the production of high-value chemicals. In this paper, composite particles of basic magnesium sulfate@TiO2 (BMS@TiO2) were prepared using a simple and mild loading method. These particles were utilized for the adsorption and photocatalytic degradation of DMP in brine. Compared with normal powdered materials, the granular BMS@TiO2 in this study can be easily separated from liquid, and the degradation intermediates will not enter the brine without causing secondary pollution. BMS@TiO2 consists of 5·1·7 phase (5Mg(OH)2·MgSO4·7H2O) whisker clusters embedding 2.3% TiO2. The adsorption equilibrium of DMP on BMS@TiO2 particles was achieved through hydrogen bonding and pore interception with the adsorption capacity of approximately 5 mg g−1 after 6 h. The photodegradation efficiency of DMP adsorbed on BMS@TiO2 reached about 92% within 16 h, which is compared with that of pure TiO2 nanoparticles. Additionally, excellent stability and recyclability of BMS@TiO2 were also observed in five cycle tests of adsorption and photocatalytic degradation of DMP, and the possible photocatalytic degradation pathways and mechanism of DMP are proposed following molecular electrostatic potential analysis. This work provides a sustainable and environmentally friendly approach for eliminating organic micropollutants from water environments. [ABSTRACT FROM AUTHOR]

Calcium sulfate bone cement (CSC) is extensively used as a bone repair material due to its ability to self-solidify, degradability, and osteogenic ability. However, the fast degradation, low mechanical strength, and insufficient biological activity limit its application. This study used magnesium polyphosphate (MPP) and constructed a composite bone cement composed of calcium sulfate (CS), MPP, tricalcium silicate (C3S), and plasticizer hydroxypropyl methylcellulose (HPMC). The optimized CS/MPP/C3S composite bone cement has a suitable setting time of approximately 15.0 min, a compressive strength of 26.6 MPa, and an injectability of about 93%. The CS/MPP/C3S composite bone cement has excellent biocompatibility and osteogenic capabilities; our results showed that cell proliferation is up to 114% compared with the control after 5 days. After 14 days, the expression levels of osteogenic-related genes, including Runx2, BMP2, OCN, OPN, and COL-1, are about 1.8, 2.8, 2.5, 2.2, and 2.2 times higher than those of the control, respectively, while the alkaline phosphatase activity is about 1.7 times higher. Therefore, the CS/MPP/C3S composite bone cement overcomes the limitations of CSC and has more effective potential in bone repair. [ABSTRACT FROM AUTHOR]

This study presents a comprehensive investigation into the mechanical properties of Basic Magnesium Sulfate Cement Concrete (BMSC) in comparison to Ordinary Portland Cement Concrete (OPC) within reinforced concrete components. The main objective is to evaluate BMSC's applicability for practical engineering purposes, with a focus on its with early high strength, improved toughness, and superior crack resistance compared to conventional concrete. Experimental procedures involved fabricating beam specimens using OPC concrete with a C40 strength grade, alongside BMSC beams with varying strength grades (C30, C40, and C50). These specimens underwent bending resistance tests to analyze crack patterns and mechanical characteristics. The findings reveal that BMSC beams demonstrate enhanced bending and tensile properties at equivalent strength grades compared to OPC beams. Particularly, cracking mainly occurred at the mid-span region of BMSC beams, characterized by narrower cracks, indicating superior crack resistance. However, it was noted that the toughness of BMSC beams decreases as the strength grade increases. The maximum mid-span deflection of the BMSC test beam was smaller than that of the OPC test beam, which was 3.8 mm and 2.6 mm, respectively. The maximum crack width of the OPC beam was 4.7 times that of the BMSC beam. To facilitate practical implementation, the study developed calculation models for estimating the crack bending distance and ultimate bending distance in BMSC beams, offering valuable tools for engineering design and optimization. Overall, this research provides significant insights into the mechanical behavior of BMSC, presenting potential advantages for structural engineering applications. [ABSTRACT FROM AUTHOR]

Objective In the setting of a growing obese obstetric population, we sought to determine whether differences in body mass index (BMI) and obesity class influenced both serum magnesium levels and the likelihood of achieving therapeutic levels for eclampsia prophylaxis after standard boluses of magnesium sulfate. Study Design This is a retrospective cohort study of patients treated with magnesium sulfate in the setting of either preeclampsia with severe features or preterm labor between 2010 and 2016. Subjects were categorized by BMI: Normal (BMI < 30 kg/m 2), Class 1 (BMI 30–34.9 kg/m 2), Class 2 (BMI 35–39.9 kg/m 2), and Class 3 (BMI ≥ 40 kg/m 2). Study participants' demographics, intrapartum characteristics, and adverse reactions were compared among the groups. Logistic regression models were used to calculate unadjusted and adjusted odds ratios comparing the likelihood of each BMI class reaching therapeutic eclamptic prophylactic levels. Linear regression models were also evaluated to determine the relationship between BMI and post-bolus serum magnesium levels. Results Of the 760 people who met the inclusion criteria, 313 (41.1%) had normal BMI, 190 (25.0%) had Class 1 obesity, 135 (17.8%) had Class 2 obesity, and 122 (16.1%) had Class 3 obesity. When adjusted for confounders, those with Class 1 obesity were 54% less likely to achieve serum levels deemed therapeutic for seizure prophylaxis compared with normal BMI counterparts. Meanwhile, those with Class 2 or 3 obesity were 90% less likely. Linear regression models also demonstrated an inverse association between BMI and post-bolus serum magnesium levels. Conclusion Increasing BMI has a significant effect on post-bolus serum magnesium levels regardless of standard loading dose used. Immediately after bolus administration, obese gravidas are significantly less likely to reach levels effective for eclamptic seizure prophylaxis. When considering which bolus to administer in an obese gravida, it may be more beneficial to choose a 6 g load. Key Points BMI has an inverse relationship with post-bolus serum magnesium levels. Obese gravidas were less likely to reach eclampsia prophylaxis levels regardless of bolus type. Obesity class, not just the presence or absence of obesity, plays a role in serum magnesium levels. [ABSTRACT FROM AUTHOR]

Objective To assess whether neonatal morbidities evident by the time of hospital discharge are associated with subsequent cerebral palsy (CP) or death. Study Design This is a secondary analysis of data from a multicenter placebo-controlled trial of magnesium sulfate for the prevention of CP. The association between prespecified intermediate neonatal outcomes (n = 11) and demographic and clinical factors (n = 10) evident by the time of discharge among surviving infants (n = 1889) and the primary outcome of death or moderate/severe CP at age 2 (n = 73) was estimated, and a prediction model was created. Results Gestational age in weeks at delivery (odds ratio [OR]: 0.74, 95% confidence interval [CI]: 0.67–0.83), grade III or IV intraventricular hemorrhage (IVH) (OR: 5.3, CI: 2.1–13.1), periventricular leukomalacia (PVL) (OR: 46.4, CI: 20.6–104.6), and male gender (OR: 2.5, CI: 1.4–4.5) were associated with death or moderate/severe CP by age 2. Outcomes not significantly associated with the primary outcome included respiratory distress syndrome, bronchopulmonary dysplasia, seizure, necrotizing enterocolitis, neonatal hypotension, 5-minute Apgar score, sepsis, and retinopathy of prematurity. Using all patients, the receiver operating characteristic curve for the final prediction model had an area under the curve of 0.84 (CI: 0.78–0.89). Using these data, the risk of death or developing CP by age 2 can be calculated for individual surviving infants. Conclusion IVH and PVL were the only neonatal complications evident at discharge that contributed to an individual infant's risk of the long-term outcomes of death or CP by age 2. A model that includes these morbidities, gestational age at delivery, and gender is predictive of subsequent neurologic sequelae. Key Points Factors known at hospital discharge are identified which are independently associated with death or CP by age 2. A model was created and validated using these findings to counsel parents. The risk of death or CP can be calculated at the time of hospital discharge. [ABSTRACT FROM AUTHOR]

In our earlier paper, authors have been reported that Ni(II) resistant Saccharomyces cerevisiae AJ208 was developed to remove the elevated level of Ni(II) concentration, and 70% removal was observed concerning the initial Ni(II) concentration of 3000 mg/L. This article aims to screen the facilitated Ni(II) removal after optimizing carbon-nitrogen and macro-micro elements as nutritional supplements into fermentation media from an aqueous solution. In the fermentation media, the synthetic carbon-nitrogen sources and macro-micro elements were added and optimized to obtain better Ni(II) percentage removal from the aqueous solution by using the Ni(II) resistant strain of S. cerevisiae AJ208. As newly optimized carbon-nitrogen sources, sucrose, and ammonium chloride collectively provide 75% Ni(II) removal. The macro-micro elements, magnesium sulfate, potassium dihydrogen phosphate, potassium chloride, calcium chloride, ferric sulfate, and zinc sulfate, positively impacted S. cerevisiae AJ208 growth and fermentation. After optimization, it provided 85% Ni(II) removal. The adsorbent was also characterized with SEM-EDAX, Raman, and FTIR analysis. The adsorption study shows a striking enhancement in Ni(II) removal after adding mentioned nutritive elements. The genetic algorithm is also successfully applied using the data acquired from the experiment. [ABSTRACT FROM AUTHOR]

Pregnancy in patients with end-stage renal disease (ESRD) is considered a very high-risk and is not recommended as it might cause fatal consequences for both the mother and the fetus. Even though chronic kidney disease affects the physiological components of fertility, decreasing the possibility of spontaneous conceptions, unwanted pregnancies still happen, and a small percentage of women with ESRD become pregnant. All women with kidney disease should have access to specialists in renal disease and pregnancy who can support, care for, and monitor them during their pregnancy. We reported a case of a 37-year-old primigravida who has ESRD on hemodialysis. The pregnancy journey was uneasy, but eventually she successfully passed through it. The most challenging issues to treat and manage throughout this pregnancy are anemia, the risks of eclampsia, and uncontrolled hypertension. The management of this patient requires multidisciplinary and shared care monitoring by the nephrologist, obstetrician, and primary care doctor. [ABSTRACT FROM AUTHOR]

Background: In this study, the effect of magnesium sulfate and labetalol in treating pregnancy-induced hypertension (PIH) and its influence on anxiety and depression in patients are observed, and new ideas for treating anxiety and depression in PIH are introduced. Methods: A retrospective cohort study was conducted to select patients with PlH diagnosed from July 2020 to July 2023 from Affiliated Hospital of Electronic Science and Technology University and Chengdu Women’ s and Children’s Central Hospital in Chengdu of Sichuan Province. The changes in blood pressure, Edinburgh Postnatal Depression Scale (EPDS), and generalized anxiety disorder 7 (GAD-7) in patients with hypertensive pregnancy were collected and analyzed. Results: In our investigation, 219 patients completed the study, and 36.1% (79/219) of them developed anxiety and depression. According to whether the patients were treated with magnesium sulfate and labetalol, 49 cases were assigned to the magnesium sulfate and labetalol treatment (MSLT) group, and 30 cases were assigned to the conventional treatment (CT) group. Edinburgh Postnatal Depression Scale scores and GAD-7 scores in the MSLT group were significantly lower than those in the CT group, indicating that magnesium sulfate and labetalol can improve anxiety and depression in hypertensive patients during pregnancy. The difference was statistically significant (P < .05). According to the changes in systolic blood pressure, the clinical efficacy of patients was evaluated, and no significant difference in efficacy existed between the MSLT and CT groups. Conclusion: Magnesium sulfate and labetalol can control the blood pressure of patients with PIH and indirectly improve anxiety and depression in patients with PIH, thereby introducing new ideas for the treatment of PIH accompanied by anxiety and depression. [ABSTRACT FROM AUTHOR]

In this paper, the mechanical properties and durability performance of polyvinyl alcohol fibers reinforced lightweight engineered geopolymer composites (EGC) with different fly ash and slag contents exposed to 5% magnesium sulfate solution for up to 120 days were investigated. The results were also compared to lightweight engineered cementitious composites (ECC). Instead of silica sand, recycled glass was employed as a lightweight aggregate to reduce the density of EGC and ECC composites. A combination of NaOH and water glass (Na2SiO3) solutions with a Na2SiO3/NaOH ratio 2.5 was chosen to produce lightweight EGC specimens. The relative slump, density, ultrasonic pulse velocity, visual inspection, weight change, compressive stress–strain diagram, load–deflection responses, and scanning electron microscopy were examined to investigate the normal and sulfate environments of EGC and ECC specimens. The obtained results confirmed that the EGC composites had significant multiple-cracking characteristics, strain-hardening behavior, and high deformation capacity after 120 days of exposure to sulfate environments. Moreover, the results showed that the EGC specimens had higher residual compressive and flexural strengths in normal and sulfate environments than ECC specimens. Including 50% slag and 50% fly ash into the EGC mixture exhibited the optimal deflection capacity; however, the deflection of EGC specimens substantially reduced from 6.97 to 2.52 mm when the slag amount increased from 50 to 100%. Despite all studied samples preserving their multiple-cracking and tight crack width control and deflection-hardening behavior when exposed to sulfate environments for up to 120 days, the reduction in deflection capacity of EGC specimens ranged from 8 to 22%. [ABSTRACT FROM AUTHOR]

With an aim of producing commercially important tannase enzyme using cheap and readily available agro-residues, leaves of Indian Gooseberry (Phyllanthus emblica) and Jamun (Syzygium cumini), peels of Lemon (Citrus limon), and Pomegranate (Punica granatum) were screened. Newly isolated Geotrichum cucujoidarum was utilized for the study. Preliminary studies indicated that tannase titer obtained is not proportional to the tannin content of the agro-residues and solid state fermentation superior compared to submerged fermentation. Jamun mixed with lemon peel in equal proportion supplemented with minerals under solid-state fermentation gave a tannase titer of 15.46 U/g dry solids. Through successful implantation of Plackett–Burman design, yeast extract concentration, inoculum volume, and amount of substrate were found to be the most significant factors. Further optimization of these three factors through Response Surface Methodology resulted in the 1.7-fold increase in tannase titer. Validation experiments using 3.97 g of Jamun leaves + lemon peel powder mixed with a nutrient solution having (w/v) yeast extract − 1.1%, dextrose − 3%, Urea − 1.125%, potassium chloride − 0.1%, magnesium sulfate heptahydrate − 0.1% with the initial pH of 5, inoculated with 2.48 ml of inoculum gave a tannase titer of 26.43 U/g dry solids after 6 days of solid-state fermentation. [ABSTRACT FROM AUTHOR]

Introduction: Tetanus is a rather rare disease in the Western countries thanks to widespread vaccination programs and the availability of prophylactics for patients with tetanus-prone injuries. The few cases that do occur are promptly managed in intensive care units (ICUs). However, tetanus is not so rare in developing countries, where access to a suitable level of care is limited. An unstable political situation can be a significant factor influencing patient outcomes. Case report: A ten-year-old boy presented at the EMERGENCY hospital in Lashkar-Gah (southern Afghanistan) with generalized tetanus after falling off his bicycle. In response to his rapidly deteriorating general conditions -- respiratory failure and hemodynamic instability -- the patient was urgently transferred by ambulance to the ICU at the EMERGENCY hospital in Kabul (northern Afghanistan). The patient was placed on mechanical ventilation while receiving intravenous sedation and pharmacologic paralysis for almost four weeks. A prolonged infusion of a high dose of magnesium sulphate and labetalol was also given to counteract autonomic dysfunction. Multiple complications related to the long stay in the ICU were observed and promptly addressed. During this period, several mass casualties took place in Kabul, which stretched the hospital's surge capacity. The patient was discharged and accompanied back to Lashkar-Gah three months after his admission to the hospital. Conclusions: This case report shows some of the many difficulties that arise when managing a patient with severe tetanus in a war zone where resources are limited. [ABSTRACT FROM AUTHOR]

Few studies have examined the use of ibutilide in noncardiac surgical populations. Our study considered the effectiveness and safety of ibutilide in cardioversion of atrial fibrillation (AF) in medical and surgical intensive care patients. A retrospective chart review was performed for patients with a confirmed diagnosis of AF who were hemodynamically stable and received ibutilide after the initial diagnosis. Patients were administered 1 mg of ibutilide fumarate intravenous for 10 min with a second dose administered if AF persisted after 30 min. Patients were pretreated with intravenous magnesium sulfate if their blood magnesium level was <2 mg/dL. Fifty seven total female patients and 99 male patients received ibutilide. Females had an 88% conversion rate to normal sinus rhythm (NSR) compared to 68% in males (P = 0.008). A 70% successful return to NSR was observed in patients from all groups pretreated with magnesium sulfate (P = 0.045). One year after discharge, 74% of the patients stayed in the NSR. Within our population, pretreatment with magnesium sulfate followed by ibutilide was associated with increased conversion to NSR. Additionally, we noted that females had a higher conversion rate to NSR compared to males, regardless of whether they were pretreated with magnesium sulfate. [ABSTRACT FROM AUTHOR]

In this study, we investigated the effect of local injection of ropivacaine and bupivacaine with magnesium sulfate on postoperative pain in vertebral laminectomy surgery. This randomized double-blind prospective study was conducted among 60 patients aged 18–65 years old with ASA class I and II. Group RM: (30 people) received 70 mg ropivacaine (14 ml) plus 1 ml magnesium sulfate (500 mg) volume up to 20 ml with normal saline. Group BM: (30 people) received 70 mg bupivacaine (14 ml) plus 1 ml magnesium sulfate (500 mg) volume up to 20 ml with normal saline. The results were analyzed by SPSS 23 software, and statistical analysis consisted of χ2 test and t-test, and a p value less than.05 was considered significant. Mean pain score based on VAS in 6 and 12 h after surgery in the RM group was lower in the BM group (p < 0.05). The analgesic request frequency in the RM group was lower than the BM group (p = 0.01). The mean morphine consumption in the RM group was 185 mg and in the BM group was 220 mg. According to the T-test, there was a significant difference between the two groups (p = 0.03). there was no significant difference between the mean arterial blood pressure and mean heart rate between the two groups at 6, 12, 24 and 24 h after surgery (p > 0.05). This study showed that wound infiltration with ropivacaine and magnesium sulfate compared to bupivacaine and magnesium sulfate provided better postoperative analgesia and significantly reduced postoperative opioid consumption in patients undergoing lumbar laminectomy. [ABSTRACT FROM AUTHOR]

Environmental pollution caused by microplastics has evolved into a global concern; however, limited knowledge exists about microplastics in soils due to the absence of standardized extraction methods. This research aimed to develop an inexpensive, rapid method with user-friendly and environmentally sustainable outcomes for microplastics retrieval. Three salt solutions (Sodium Chloride, Magnesium Sulfate, Sodium Hexametaphosphate) and an oil solution (canola oil) underwent evaluation for microplastics extraction through the flotation process due to the density and oleophilic properties of plastics. Four widely used plastic types, obtained through fragmentation using a grinding mill from clean new plastic containers or membranes, were subjected to analysis. The experimental procedures for microplastics retrieval varied among the evaluated solutions. Through a comprehensive multicriteria analysis, the saturated Sodium Chloride solution emerged as the optimal scenario for microplastics extraction, followed closely by the canola oil scenario. The recovery method utilizing Sodium Chloride demonstrated economic feasibility, safety, and reliability. This study provides valuable insights into an effective and sustainable approach for mitigating microplastic pollution in soil, offering a promising avenue for future environmental conservation efforts. [ABSTRACT FROM AUTHOR]

Background and Aims: Intraoperative regional analgesia and enhanced recovery are standard care models aimed at reducing perioperative opioid use following spine surgeries. This study aimed to examine the analgesic effect of retrolaminar block in promoting recovery and pain relief after posterior lumbar discectomy. Methods: The patients undergoing elective posterior lumbar discectomy were randomised into the retrolaminar group (n = 36) (received an intra-operative bilateral retrolaminar block with 15 mL of bupivacaine 0.25%, 2 mL (8 mg) of dexamethasone, and 2 mL of magnesium sulphate 10% (200 mg) on each side) and control group (n = 36) (received standard general anaesthesia). Primary outcomes were recovery time (time from isoflurane discontinuation to the first response to verbal command) and time to discharge (time from admission to the post-anaesthesia care unit (PACU) to discharge from the PACU, when Aldrete score was ≥9). P values < 0.05 were considered statistically significant. Results: The extubation, recovery, and discharge times were significantly shorter in the retrolaminar group compared to the control group (P < 0.001). Postoperative pain scores were significantly lower in the retrolaminar group for up to 8 h compared to only 2 h in the control group (P < 0.001). The time to first administration of ketorolac post-operatively was significantly longer in the retrolaminar group compared to the control group (P < 0.001). The total consumption of ketorolac post-operatively was significantly reduced in the retrolaminar group compared to the control group (P < 0.001). Conclusion: Intra-operative retrolaminar block is an easy and effective opioid-free regional anaesthesia technique that improves recovery after posterior lumbar discectomy. [ABSTRACT FROM AUTHOR]

Introduction: Peripheral nerve blocks have recently proven to be extremely promising in terms of patient satisfaction. In upper limb procedures, rapid and deep anaesthesia can be achieved with supraclavicular ultrasound-guided access to the brachial plexus. To improve the quality of local anaesthesia, adjuvants such as magnesium sulfate and dexmedetomidine have been added to the local anaesthetic. Aim: To evaluate the efficacy of magnesium sulfate and dexmedetomidine as adjuvants to ropivacaine in supraclavicular Brachial Plexus Blockade (BPB). Materials and Methods: A prospective randomised doubleblind study was conducted in the Department of Anaesthesiology from June 2016 to November 2017 (1 year and 6 months) at King George's Medical University, Lucknow, Uttar Pradesh, India. A total of 60 patients were divided into two groups using a computer-generated random number for upper limb surgeries (below the mid-humerus) under supraclavicular brachial plexus block. Group A (n=30) received ropivacaine 0.5% (30 mL) plus dexmedetomidine 50 μg for the supraclavicular block, and Group B received ropivacaine 0.5% (30 mL) plus magnesium sulfate 150 mg in 1 mL Normal Saline (NS) 0.9% for the same block. A comparison of these two groups was conducted for the time of onset, duration of sensory and motor block, haemodynamic stability, postoperative analgesia, and complications. Statistical analyses such as Student's t-test, Chi-square test, and Mann-Whitney U-test were used. Results: The mean age of Group A was 28.03±5.86 years and Group B was 31.07±7.06 years. The sensory block and motor block onset were significantly faster among patients of Group A (6.47±1.43 min and 8.50±1.46 min) compared to Group B (9.57±1.22 min and 11.77±1.19 min). The mean duration of analgesia was significantly longer (p<0.001) in Group A (1034.10±61.07 min) compared to Group B (460.00±35.82 min). The duration of sensory block and motor block was also significantly higher (p<0.001) in Group A compared to Group B. Both groups were haemodynamically stable, but sedation was significantly higher in Group A. Conclusion: Dexmedetomidine 50 μg is a superior adjuvant compared to magnesium sulfate 150 mg with ropivacaine 0.5% in supraclavicular brachial plexus block as it significantly hastens onset time and prolongs the duration of sensory and motor blocks and the duration of analgesia. [ABSTRACT FROM AUTHOR]

Purpose: Magnesium sulfate (MgSO4) has been widely used in obstetrics as a mean to help decrease maternal and neonatal morbidity in various antenatal pathology. As a factor, it seems to regulate immunity and can, thus, predispose to infectious morbidity. To date, it remains unknown if its administration can increase the risk of chorioamnionitis. In the present meta-analysis, we sought to accumulate the available evidence. Methods: We systematically searched Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL, and Google Scholar databases in our primary search along with the reference lists of electronically retrieved full-text papers. Results: Eight studies were included that investigated the incidence of chorioamnionitis among parturient that received MgSO4 and control patients. Magnesium sulfate was administered in 3229 women and 3330 women served as controls as they did not receive MgSO4. The meta-analysis of data revealed that there was no association between the administration of magnesium sulfate and the incidence of chorioamnionitis (OR 0.98, 95% CI 0.73, 1.32). Rucker's analysis revealed that small studies did not significantly influence the statistical significance of this finding (OR 1.12, 95% CI 0.82, 1.53). Trial sequential analysis revealed that the required number to safely interpret the primary outcome was not reached. Two studies evaluated the impact of MgSO4 in neonates delivered in the setting of chorioamnionitis. Neither of these indicated the presence of a beneficial effect in neonatal morbidity, including the risk of cerebral palsy, intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, stillbirth, or neonatal death. Conclusion: Current evidence indicates that magnesium sulfate is not associated with an increased risk of maternal chorioamnionitis. However, it should be noted that its effect on neonatal outcomes of offspring born in the setting of chorioamnionitis might be subtle if any, although the available evidence is very limited. [ABSTRACT FROM AUTHOR]

The article focuses on a fourth-year medical student's journey toward becoming a neonatologist, highlighting experiences with pediatric neurology and caring for a 14-month-old with cerebral palsy, while also discussing cerebral palsy as the most common motor disability in children and its risk factors.

Background: Conflicting data are demonstrating the superiority between Clonidine and Magnesium Sulphate in attenuating hemodynamic response to pneumoperitoneum. Methods and Methodology: This was a prospective randomized blinded trial comparing the efficacy of injection Clonidine 1.5 µg/kg (group A) and Magnesium Sulphate (MgSO4 ) 50 mg/kg (group B) done over six. Results: Sixty‑eighty patients were included and assigned randomly to two groups of 34 (50.0%) patients. The mean (SD) age in groups A and B was 34.32 (11.35) and 37.20 (10.17) years respectively. Comparison of systolic blood pressure and mean arterial pressure were similar in both groups. The heart rate (HR) of patients in group A with group B, was almost the same at pre‑induction and the end of infusion while HR was noted to be higher in group B, compared to group A at 5 minutes. Comparisons of EtCO2 (mm Hg) and SpO2 (%) between group A and group B were comparable in both the groups at pre‑induction, at 5 min, 10 min, 15 min, 20 min, 25 min, 30 min, 35 min and 40 min. However, at the end of the infusion SpO2 levels were higher in Group A (p = 0.004). According to Modified Ramsay Sedation Score, half of the patients (50.0%) from group A were cooperative, oriented, and tranquil. In Group B, about one‑third (38.2%) were cooperative, oriented, and tranquil. Immediate postoperative complications included nausea (8.8%) and vomiting (2.9%) which were comparable between both groups. Conclusion: Overall observations suggested that Clonidine (1.5 μg/kg) was equally effective as MgSO4 (50 mg/kg) in attenuating hemodynamic responses during pneumoperitoneum in laparoscopic cholecystectomy. [ABSTRACT FROM AUTHOR]

Dexmedetomidine can be used as an adjuvant in epidurals with local anesthetic sparing effects. Its use during nerve blocks results in reduced postoperative pain. Also, local infiltration of IV dexmedetomidine is associated with earlier discharge from PACU. Similarly, magnesium the blockade of N-methyl-D-aspartate (NMDA) receptor and calcium channel has an important meaning to anesthesia. However, side effects could be cardiac or respiratory complications. Therefore, we compared the intrathecal dexmedetomidine and magnesium sulphate for post-operative analgesia requirement reduction in patients undergoing spinal anaesthesia and analysing hemodynamic changes. All three drugs (dexmedetomidine, magnesium sulphate and hyperbaric bupivacaine) proved to be haemodynamically stable as clinically significant bradycardia and hypotension were not observed in any of the groups. The incidences of side effects were negligible in all the three groups. In conclusion, although longer duration of effect can be obtained by the addition of either dexmedetomidine or magnesium to intrathecal hyperbaric bupivacaine, dexmedetomidine showed a significantly prolonged effect and a faster onset with fewer side effects. [ABSTRACT FROM AUTHOR]

Objective: To determine if opioid-free analgesia is as effective and safe as opioid-based analgesia for post-cesarean section pain. Material and Methods: Non-inferiority, assessor-blinded randomized controlled trial. One hundred cesarean section patients were randomized into 2 arms. Opioid-free analgesia arm had 1 gram intravenous paracetamol infusion and bolus 4 grams intravenous 20% magnesium sulfate preoperatively, then 1 gram/hour infusion of 20% magnesium sulfate intraoperatively until 2 hours post-operation. Postoperatively, they had 100 milligrams of rectal diclofenac 12-hourly and continued paracetamol 6-hourly for 24 hours. Opioid-based analgesia arm had 100 milligrams of rectal diclofenac 12-hourly, 30 milligrams of intramuscular pentazocine 6-hourly, and 1 gram of intravenous paracetamol 6-hourly, postoperatively for 24 hours. Both arms were allowed rescue analgesia with intramuscular pentazocine. Primary outcomes were pain intensity at 4, 8, and 24 hours post-operation and postoperative pentazocine use. Non-inferiority limit was a mean difference in pain score <1.3. Results: Postoperative pain scores at 4, 8, and 24 hours were lower in the opioid-free analgesia arm; mean difference -0.18; 95% confidence interval (CI): -0.70-0.34; p=0.499, -0.10; 95% CI: -0.78-0.59; p=0.782 and -0.31; 95% CI: -0.89-0.29; p=0.308 respectively. Mean pentazocine use was lower in the opioid-free analgesia arm (52.83±21.85 mg/164.40±28.59 mg; p=0.001). Serious adverse event occurred in one (2.0%) participant in the opioid-free analgesia arm and none in the opioid-based analgesia arm, p=0.315. There was no significant difference in the 5th-minute Apgar score (p=0.315). Conclusion: Opioid-free analgesia using perioperative intravenous magnesium sulfate, intravenous paracetamol, and postoperative rectal diclofenac is non-inferior to and as safe as the opioid-based analgesia and it reduced pentazocine consumption. [ABSTRACT FROM AUTHOR]

Fungal chitosan (FCH) is superior to crustacean chitosan (CH) sources and is of immense interest to the scientific community while having a high demand at the global market. Industrial scale fermentation technologies of FCH production are associated with considerable challenges that frequently restrict their economic production and feasibility. The production of high quality FCH using an underexplored fungal strain Cunninghamella echinulata NCIM 691 that is hoped to mitigate potential future large-scale production was investigated. The one-factor-at-a-time (OFAT) method was implemented to examine the effect of the medium components (i.e. carbon and nitrogen) on the FCH yield. Among these variables, the optimal condition for increased FCH yield was carbon (glucose) and nitrogen (yeast extract) source. A total of 11 factors affected FCH yield among which, the best factors were screened by Plackett–Burman design (PBD). The optimization process was carried out using the response surface methodology (RSM) via Box-Behnken design (BBD). The three-level Box– Behnken factorial design facilitated optimum values for 3 parameters—glucose (2% w/v), yeast extract (1.5% w/v) and magnesium sulphate (0.1% w/v) at 30˚C and pH of 4.5. The optimization resulted in a 2.2-fold higher FCH yield. The produced FCH was confirmed using XRD, 1H NMR, TGA and DSC techniques. The degree of deacetylation (DDA) of the extracted FCH was 88.3%. This optimization process provided a significant improvement of FCH yields and product quality for future potential scale-up processes. This research represents the first report on achieving high FCH yield using a reasonably unfamiliar fungus C. echinulata NCIM 691 through optimised submerged fermentation conditions. [ABSTRACT FROM AUTHOR]

Magnesium sulfate (MagSul) is used clinically to prevent eclamptic seizures during pregnancy and as a tocolytic for preterm labor. More recently, it has been implicated as offering neural protection in utero for at-risk infants. However, evidence is mixed. Some studies found that MagSul reduced the incidence of cerebral palsy (CP) but did not improve other measures of neurologic function. Others did not find any improvement in outcomes. Inconsistencies in the literature may reflect the fact that sex effects are largely ignored, despite evidence that MagSul shows sex effects in animal models of neonatal brain injury. The current study used retrospective infant data to assess differences in developmental outcomes as a function of sex and MagSul treatment. We found that on 18-month neurodevelopmental cognitive and language measures, preterm males treated with MagSul (n = 209) had significantly worse scores than their untreated counterparts (n = 135; p < 0.05). Female preterm infants treated with MagSul (n = 220), on the other hand, showed a cognitive benefit relative to untreated females (n = 123; p < 0.05). No significant effects of MagSul were seen among females on language (p > 0.05). These results have tremendous implications for risk–benefit considerations in the ongoing use of MagSul and may explain why benefits have been hard to identify in clinical trials when sex is not considered. [ABSTRACT FROM AUTHOR]

Objective: To compare two quality improvement (QI) interventions to improve antenatal magnesium sulphate (MgSO4) uptake in preterm births for the prevention of cerebral palsy. Design: Unblinded cluster randomised controlled trial. Setting: Academic Health Sciences Network, England, 2018. Sample: Maternity units with ≥10 preterm deliveries annually and MgSO4 uptake of ≤70%; 40 (27 NPP, 13 enhanced support) were included (randomisation stratified by MgSO4 uptake). Methods: The National PReCePT Programme (NPP) gave maternity units QI materials (clinical guidance, training), regional support, and midwife backfill funding. Enhanced support units received this plus extra backfill funding and unit‐level QI coaching. Main outcome measures: MgSO4 uptake was compared using routine data and multivariable linear regression. Net monetary benefit was estimated, based on implementation costs, lifetime quality‐adjusted life‐years and societal costs. The implementation process was assessed through qualitative interviews. Results: MgSO4 uptake increased in all units, with no evidence of any difference between groups (0.84 percentage points lower uptake in the enhanced group, 95% CI −5.03 to 3.35). The probability of enhanced support being cost‐effective was <30%. NPP midwives gave more than their funded hours for implementation. Units varied in their support needs. Enhanced support units reported better understanding, engagement and perinatal teamwork. Conclusions: PReCePT improved MgSO4 uptake in all maternity units. Enhanced support did not further improve uptake but may improve teamwork, and more accurately represented the time needed for implementation. Targeted enhanced support, sustainability of improvements and the possible indirect benefits of stronger teamwork associated with enhanced support should be explored further. [ABSTRACT FROM AUTHOR]

The aim of the present study was to assess the efficacy of intravenous (IV) magnesium sulfate (MgSO4) for children with bronchiolitis. A retrospective cohort study was performed at a pediatric emergency department. Aged between 1 and 24 months, children with moderate/severe bronchiolitis according to the Modified Respiratory Distress Assessment Instrument (mRDAI) score were included. Patients who received 40 mg/kg/dose of IV MgSO4 (group 1, n: 74) or not (group 2, n: 33) were compared. Respiratory rate and mRDAI score significantly decreased at the second hour of MgSO4 treatment and the decrease was observed for 4th, 8th, and 12th hours, compared with group 2. Patients in group 2 had a higher rate of requirement and an earlier start high-flow nasal cannula oxygen therapy and a longer hospital stay than group 1. Intravenous MgSO4 provided significant improvement on clinical severity, need for respiratory support, length of hospital stay, and outcomes. [ABSTRACT FROM AUTHOR]