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To compile a central audit database, conducted by different multidisciplinary team members on a mixed medical and surgical critical care unit, in order to improve both record-keeping and trainee awareness of current and past audit projects. Data on audits conducted on the unit over the last 2 years (2012–13) were collected by interviewing key staff members from the various …

Magnesium, Mg2+, is the second most abundant intracellular cation after potassium and the fourth most abundant in the body. It was first isolated in 1808 by the English chemist, Sir Humphrey Davy. Magnesium is essential to numerous biochemical reactions. It modulates key physiological processes such as metabolic biochemistry, nucleic acid synthesis, receptor-binding and ion flux. The western diet falls short of the recommended daily allowance of 4.5 mg/Kg/day and important dietary sources are seeds, grains, nuts and green vegetables. It is used as a therapeutic agent in a broad range of pathologies: neurological, cardiovascular, respiratory, gastrointestinal and obstetric. The pharmacokinetics and pharmacodynamics of magnesium, as a drug, are not well understood. Despite its fundamental importance to human physiology, it remains an electrolyte that is not routinely measured as part of the “urea & electrolytes” test and is the most overlooked electrolyte deficiency in hospital inpatients. This review will summarise the importance of magnesium homeostasis, its pharmacological effects and clinical applications.

BackgroundAortic stenosis is the most common age-related valvular pathology. Patients with aortic stenosis and myocardial fibrosis have worse outcome but the underlying mechanism is unclear. Lipoprotein(a) is associated with adverse cardiovascular risk and is elevated in patients with aortic stenosis. Although mechanistic pathways could link Lipoprotein(a) with myocardial fibrosis, whether the two are related has not been previously explored. In this study, we investigated whether elevated Lipoprotein(a) was associated with the presence of myocardial replacement fibrosis.MethodsA total of 110 patients with mild, moderate and severe aortic stenosis were assessed by late gadolinium enhancement (LGE) cardiovascular magnetic resonance to identify fibrosis. Mann Whitney U tests were used to assess for evidence of an association between Lp(a) and the presence or absence of myocardial fibrosis and aortic stenosis severity and compared to controls. Univariable and multivariable linear regression analysis were undertaken to identify possible predictors of Lp(a).ResultsThirty-six patients (32.7%) had no LGE enhancement, 38 (34.6%) had midwall enhancement suggestive of midwall fibrosis and 36 (32.7%) patients had subendocardial myocardial fibrosis, typical of infarction. The aortic stenosis patients had higher Lp(a) values than controls, however, there was no significant difference between the Lp(a) level in mild, moderate or severe aortic stenosis. No association was observed between midwall or infarction pattern fibrosis and Lipoprotein(a), in the mild/moderate stenosis (p = 0.91) or severe stenosis patients (p = 0.42).ConclusionThere is no evidence to suggest that higher Lipoprotein(a) leads to increased myocardial midwall or infarction pattern fibrosis in patients with aortic stenosis.

Objectives: Skin graft failure is a recognised complication in the treatment of major burns. Little research to date has analysed the impact of the complex physiological management of burns patients on the success of skin grafting. We analysed surgical and anaesthetic variables to identify factors contributing to graft failure. Methods: Inclusion criteria were admission to our Burns Intensive Care Unit (BICU) between January 2009 and October 2013 with a major burn. After exclusion for death before hospital discharge or prior skin graft at a different hospital, 35 patients remained and were divided into those with successful autografts (n=16) and those with a failed autograft (n=19). For the purposes of this study, we defined poor autograft viability as requiring at least one additional skin graft to the same site. Logistic regression of variables was performed using SPSS (Version 22.0 IBMTM). Results: Age, Sex, %Total Burn Surface Area or Belgian Outcome Burns Injury score did not significantly differ between groups. No differences were found in any surgical factor at logistic regression (graft site, harvest site, infection etc.). When all operations were analysed, the use of colloids was found to be significantly associated with graft failure (p=0.035, CI 95%) and this remained significant when only split thickness skin grafts (STSGs) and debridement operations were included (p=0.034, CI 95%). No differences were found in crystalloid use, intraoperative temperature, pre-operative haemoglobin and blood products or vasopressor use. Conclusions: This analysis highlights an independent association between colloids and graft failure which has not been previously documented., Lay Summary After large burns injuries, patients require fluid to be given via an IV drip. This is often very large volumes of fluid, much higher than would normally be required in other medical conditions. When the area of burn is very large multiple operations are often required and during these operations, IV fluids are again used to keep the blood pressure normal and keep the patient hydrated. We looked at the hospital records of 35 patients to see if there was any link between the drugs and fluids given during these operations and the success of the skin grafts performed in these operations. We found that using a particular type of fluid called a colloid fluid, which allows smaller volumes to be given for the same effect on blood pressure and hydration, was more common in patients whose skin grafts subsequently required further surgery due to poor healing. A larger study would now be required to see if this type of fluid is causing poor healing or whether it is a coincidental finding only.

We present a rare case of severe corticosteroid-induced ocular hypertension (OHT) after prolonged systemic corticosteroid use in a young woman with Takayasu’s arteritis. As she did not sufficiently respond to ocular antihypertensive therapies, bilateral enhanced trabeculectomies were required to normalize her intraocular pressures. The systemic side effects of corticosteroids are well known, yet steroid-induced OHT and glaucoma remain silent causes of ocular morbidity. This case highlights the importance of IOP-monitoring in visually asymptomatic patients on systemic corticosteroids. It further emphasizes the need to raise awareness of the potential ocular side effects of steroids amongst physicians, in particular those looking after patients with autoimmune and inflammatory diseases.

Normal serum magnesium (Mg2+) reference range is 0.7–1.1 mmol/L, of which 65–80 % is ionised and considered to be the physiologically useful portion in serum [1–4].

Methods 15 healthy volunteers (31±5 years, 8 males) with no known medical conditions, on no medication, underwent CMR scans (Avanto, Siemens, 1.5T) on two separate attendances with an 11 heart beat MOLLI 5(3)3. Following frequency adjustment, native T1 maps were obtained twice on a basal and a mid-ventricular slice respectively. 15 mins following GBCA administration (0.1 mmol/kg, Gadobutrol, Bayer, Germany) both image planes were acquired again twice. Pixel-wise T1 maps were analyzed offline by 2 independent blinded operators. A Region Of Interest was manually drawn in the septum for myocardium and blood in native and post gad images as shown in fig 1.