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Stanojević M, Djuricic N, Parezanovic M, Biorac M, Pathak D, Spasic S, Lopicic S, Kovacevic S, Nesovic Ostojic J. The Impact of Chronic Magnesium Deficiency on Excitable Tissues-Translational Aspects. Biol Trace Elem Res 2024:10.1007/s12011-024-04216-2. [PMID: 38709369 DOI: 10.1007/s12011-024-04216-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 04/28/2024] [Indexed: 05/07/2024]
Abstract
Neuromuscular excitability is a vital body function, and Mg2+ is an essential regulatory cation for the function of excitable membranes. Loss of Mg2+ homeostasis disturbs fluxes of other cations across cell membranes, leading to pathophysiological electrogenesis, which can eventually cause vital threat to the patient. Chronic subclinical Mg2+ deficiency is an increasingly prevalent condition in the general population. It is associated with an elevated risk of cardiovascular, respiratory and neurological conditions and an increased mortality. Magnesium favours bronchodilation (by antagonizing Ca2+ channels on airway smooth muscle and inhibiting the release of endogenous bronchoconstrictors). Magnesium exerts antihypertensive effects by reducing peripheral vascular resistance (increasing endothelial NO and PgI2 release and inhibiting Ca2+ influx into vascular smooth muscle). Magnesium deficiency disturbs heart impulse generation and propagation by prolonging cell depolarization (due to Na+/K+ pump and Kir channel dysfunction) and dysregulating cardiac gap junctions, causing arrhythmias, while prolonged diastolic Ca2+ release (through leaky RyRs) disturbs cardiac excitation-contraction coupling, compromising diastolic relaxation and systolic contraction. In the brain, Mg2+ regulates the function of ion channels and neurotransmitters (blocks voltage-gated Ca2+ channel-mediated transmitter release, antagonizes NMDARs, activates GABAARs, suppresses nAChR ion current and modulates gap junction channels) and blocks ACh release at neuromuscular junctions. Magnesium exerts multiple therapeutic neuroactive effects (antiepileptic, antimigraine, analgesic, neuroprotective, antidepressant, anxiolytic, etc.). This review focuses on the effects of Mg2+ on excitable tissues in health and disease. As a natural membrane stabilizer, Mg2+ opposes the development of many conditions of hyperexcitability. Its beneficial recompensation and supplementation help treat hyperexcitability and should therefore be considered wherever needed.
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Affiliation(s)
- Marija Stanojević
- University of Belgrade, Faculty of Medicine, Institute for Pathological Physiology "Ljubodrag Buba Mihailović", 9, Dr Subotića Street, 11000, Belgrade, Serbia.
| | - Nadezda Djuricic
- University of Belgrade, Faculty of Medicine, Institute for Pathological Physiology "Ljubodrag Buba Mihailović", 9, Dr Subotića Street, 11000, Belgrade, Serbia
| | - Miro Parezanovic
- University of Belgrade, Faculty of Medicine, Institute for Pathological Physiology "Ljubodrag Buba Mihailović", 9, Dr Subotića Street, 11000, Belgrade, Serbia
- Institute for Mother and Child Healthcare of Serbia "Dr Vukan Čupić", Belgrade, Serbia
| | - Marko Biorac
- University of Belgrade, Faculty of Medicine, Institute for Pathological Physiology "Ljubodrag Buba Mihailović", 9, Dr Subotića Street, 11000, Belgrade, Serbia
| | - Dhruba Pathak
- University of Belgrade, Faculty of Medicine, Institute for Pathological Physiology "Ljubodrag Buba Mihailović", 9, Dr Subotića Street, 11000, Belgrade, Serbia
| | - Svetolik Spasic
- University of Belgrade, Faculty of Medicine, Institute for Pathological Physiology "Ljubodrag Buba Mihailović", 9, Dr Subotića Street, 11000, Belgrade, Serbia
| | - Srdjan Lopicic
- University of Belgrade, Faculty of Medicine, Institute for Pathological Physiology "Ljubodrag Buba Mihailović", 9, Dr Subotića Street, 11000, Belgrade, Serbia
| | - Sanjin Kovacevic
- University of Belgrade, Faculty of Medicine, Institute for Pathological Physiology "Ljubodrag Buba Mihailović", 9, Dr Subotića Street, 11000, Belgrade, Serbia
| | - Jelena Nesovic Ostojic
- University of Belgrade, Faculty of Medicine, Institute for Pathological Physiology "Ljubodrag Buba Mihailović", 9, Dr Subotića Street, 11000, Belgrade, Serbia
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Mulyaningsih RD, Pratiwi R, Hasanah AN. An Update on the Use of Natural Pigments and Pigment Nanoparticle Adducts for Metal Detection Based on Colour Response. BIOSENSORS 2023; 13:bios13050554. [PMID: 37232915 DOI: 10.3390/bios13050554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/07/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
Natural pigments occur in plants as secondary metabolites and have been used as safe colourants in food. Studies have reported that their unstable colour intensity might be related to metal ion interaction, which leads to the formation of metal-pigment complexes. This underlines the need for further investigations on the use of natural pigments in metal detection using colorimetric methods, since metals are important elements and can be hazardous when present in large amounts. This review aimed to discuss the use of natural pigments (mainly betalains, anthocyanins, curcuminoids, carotenoids, and chlorophyll) as reagents for portable metal detection based on their limits of detection, to determine which pigment is best for certain metals. Colorimetric-related articles over the last decade were gathered, including those involving methodological modifications, sensor developments, and a general overview. When considering sensitivity and portability, the results revealed that betalains are best applied for copper, using a smartphone-assisted sensor; curcuminoids are best applied for lead, using a curcumin nanofiber; and anthocyanin is best applied for mercury, using anthocyanin hydrogel. This provides a new perspective on the use of colour instability for the detection of metals with modern sensor developments. In addition, a coloured sheet representing metal concentrations may be useful as a standard to support on-site detection with trials on masking agents to improve selectivity.
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Affiliation(s)
- Raspati D Mulyaningsih
- Master Program in Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang 45363, Indonesia
| | - Rimadani Pratiwi
- Department of Pharmaceutical Analysis and Medicinal Chemistry, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang 45363, Indonesia
- Drug Development Study Centre, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang 45363, Indonesia
| | - Aliya N Hasanah
- Department of Pharmaceutical Analysis and Medicinal Chemistry, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang 45363, Indonesia
- Drug Development Study Centre, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang 45363, Indonesia
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The Role of Hypomagnesemia in Cardiac Arrhythmias: A Clinical Perspective. Biomedicines 2022; 10:biomedicines10102356. [PMID: 36289616 PMCID: PMC9598104 DOI: 10.3390/biomedicines10102356] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/03/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022] Open
Abstract
The importance of magnesium (Mg2+), a micronutrient implicated in maintaining and establishing a normal heart rhythm, is still controversial. It is known that magnesium is the cofactor of 600 and the activator of another 200 enzymatic reactions in the human organism. Hypomagnesemia can be linked to many factors, causing disturbances in energy metabolism, ion channel exchanges, action potential alteration and myocardial cell instability, all mostly leading to ventricular arrhythmia. This review article focuses on identifying evidence-based implications of Mg2+ in cardiac arrhythmias. The main identified benefits of magnesemia correction are linked to controlling ventricular response in atrial fibrillation, decreasing the recurrence of ventricular ectopies and stopping episodes of the particular form of ventricular arrhythmia called torsade de pointes. Magnesium has also been described to have beneficial effects on the incidence of polymorphic ventricular tachycardia and supraventricular tachycardia. The implication of hypomagnesemia in the genesis of atrial fibrillation is well established; however, even if magnesium supplementation for rhythm control, cardioversion facility or cardioversion success/recurrence of AF after cardiac surgery and rate control during AF showed some benefit, it remains controversial. Although small randomised clinical trials showed a reduction in mortality when magnesium was administered to patients with acute myocardial infarction, the large randomised clinical trials failed to show any benefit of the administration of intravenous magnesium over placebo.
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Bhatti H, Mohmand B, Ojha N, P Carvounis C, L Carhart R. The Role of Magnesium in the Management of Atrial Fibrillation with Rapid Ventricular Rate. J Atr Fibrillation 2021; 13:2389. [PMID: 34950320 DOI: 10.4022/jafib.2389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 05/26/2020] [Accepted: 07/01/2020] [Indexed: 11/10/2022]
Abstract
Background Atrial fibrillation is currently managed with a variety of rate controlling and antiarrhythmic agents. Often, magnesium is used as adjunctive therapy, however, the benefit it provides in managing Afib with RVR has been debated. This study aimed to determine if IV MgSO4 administration in conjunction with standard therapy provides any synergistic effect in acute and prolonged control of Afib with RVR. Methods This was a retrospective study involving ninety patients with episodes of Afib with RVR during their hospitalization. The treatment group included those that had received magnesium (n=32) along with standard management and the control group (n=58) received only standard management. Heart rates at different time intervals were collected. Dose dependent effects of IV MgSO4 on heart rates were also evaluated. Results Patients that received magnesium had a lower mean heart rate (85 BPM versus 96 BPM, P<0.05) 24 hours after onset of the episode. Also, in the last 16 hours of observation, it appeared that administration of higher levels of magnesium resulted in statistically lower heart rates. In the group of patients that received 2 grams of magnesium, the mean heart rate at 8 hours was 103.4 beats/min and 84.8 beats/min at 24 hours (p<0.01). This same trend was not seen in patients that received 1 gram of magnesium or in the control group. Conclusions Overall, the use of IV MgSO4 as an adjunctive treatment permitted normalization of the heart rate progressively that continued to at least 24 hours.
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McLaine AS, Yaxley PE, Young AA, Cooper ES. Successful management of massive lamotrigine extended-release intoxication in a dog. Clin Case Rep 2021; 9:e05169. [PMID: 34963800 PMCID: PMC8677885 DOI: 10.1002/ccr3.5169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 10/14/2021] [Accepted: 11/03/2021] [Indexed: 11/12/2022] Open
Abstract
A 3-year-old spayed female Siberian Husky presented for evaluation following ingestion of approximately 429 mg/kg of lamotrigine extended-release. She demonstrated severe neurologic and cardiac signs and was treated with lipid emulsion, anticonvulsants, antiarrhythmics and aggressive decontamination and supportive care. She was successfully discharged from the hospital 5 days later.
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Affiliation(s)
- Alexis S. McLaine
- Department of Veterinary Clinical SciencesThe Ohio State UniversityColumbusOhioUSA
| | - Page E. Yaxley
- Department of Veterinary Clinical SciencesThe Ohio State UniversityColumbusOhioUSA
| | - Anda A. Young
- Department of Veterinary Clinical SciencesThe Ohio State UniversityColumbusOhioUSA
| | - Edward S. Cooper
- Department of Veterinary Clinical SciencesThe Ohio State UniversityColumbusOhioUSA
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Hizuka K, Kato T, Shiko Y, Kawasaki Y, Koyama K. Ionized Hypomagnesemia Is Associated With Increased Incidence of Postoperative Atrial Fibrillation After Esophageal Resection: A Retrospective Study. Cureus 2021; 13:e17105. [PMID: 34395148 PMCID: PMC8357411 DOI: 10.7759/cureus.17105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 01/18/2023] Open
Abstract
Introduction: Postoperative atrial fibrillation (POAF) is common after surgery for esophageal cancer and may prolong hospitalization and elevate mortality. POAF and hypomagnesemia are linked, but this is based on studies showing an association of POAF with serum total magnesium (tMg). In contrast, the relationship of POAF with ionized magnesium (iMg), which has physiological activity, has not been examined. In this study, the association between hypomagnesemia and POAF was investigated retrospectively to examine iMg as a possible predictive factor for POAF. Methods: The subjects were 151 patients who underwent right transthoracoabdominal subtotal esophagectomy at Saitama Medical Center between January 2011 and December 2020. The incidence of POAF and predictive factors were examined retrospectively. Perioperative predictive factors were subjected to univariate analysis, and items with P<0.1 were then included in multivariate analysis, along with five potential POAF predictors reported in the literature (age, gender, body mass index, hypertension, and diabetes mellitus). P<0.05 was regarded as significant in the multivariate analysis. Results: Of the 151 patients, 34 (23%) developed POAF. In univariate analysis, six factors with P<0.1 (oral statin, dyslipidemia, iMg level after anesthesia induction, maximum and minimum iMg during surgery, and iMg level immediately before admission to ICU) were identified. In multivariate analysis including these and the five literature factors as explanatory variables, iMg immediately before admission to ICU emerged as a predictive factor for POAF (iMg≥0.46 mmol/L, OR 0.32, 95%CI 0.14-0.74, p=0.01) (standard iMg range: 0.48-0.60 mmol/L). Conclusion: The iMg level immediately before admission to ICU may be associated with the development of POAF. A further study is needed to evaluate changes in iMg in the ICU and iMg at the time of onset of POAF.
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Affiliation(s)
- Kotaro Hizuka
- Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Takao Kato
- Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Yuki Shiko
- Biostatistics, Clinical Research Center, Chiba University Hospital, Chiba, JPN.,Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Yohei Kawasaki
- Emergency Medicine, Japanese Red Cross College of Nursing, Tokyo, JPN.,Biostatistics, Clinical Research Center, Chiba University Hospital, Chiba, JPN.,Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Kaoru Koyama
- Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
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Koc B, Kizildag S, Hosgorler F, Gumus H, Kandis S, Ates M, Uysal N. Magnesium Citrate Increases Pain Threshold and Reduces TLR4 Concentration in the Brain. Biol Trace Elem Res 2021; 199:1954-1966. [PMID: 32989649 DOI: 10.1007/s12011-020-02384-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
Magnesium is being investigated in various clinical conditions and has shown to be effective in some chronic pain models. However, it is not clear if oral magnesium use affects pain perception in acute pain. TLR4's (toll-like receptor) role in pain perception has emerged through its role in immune pathways and ion channels. The aim of this study is to investigate the effect of a single oral dose of magnesium citrate on pain conduction and whether with magnesium, the expression of TLR4 changes in the acute phase. Following a single dose of 66-mg/kg magnesium citrate administration to male Balb-c mice, pain perception (via hot-plate test), motor conduction (via electrophysiological recording, forelimb grip strength, rotarod and open-field tests), and emotional state (via elevated plus maze and forced swim test) were evaluated. In behavioral experiments, the control group was compared with applied magnesium for three different time groups (4, 8, 24 h). TLR4 expression was measured in four groups: control, magnesium (Mg), hot plate (HP), and Mg + HP. Hot plate latency was prolonged in the magnesium group (p < 0.0001) and electrophysiological recordings (p < 0.001) and forelimb grip strength measurement (p < 0.001) determined motor latency. Compared with the untreated hot plate group, TLR4 levels was lower in the brain (p = 0.023) and higher in the sciatic nerve (p = 0.001) in the magnesium-treated hot plate group. Consequently, the study indicated a single dose of magnesium citrate appeared to cause weakening in the transmission and perception of nociceptive pain. TLR4 may act as a regulator in magnesium's effects on pain perception.
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Affiliation(s)
- Basar Koc
- Department of Physiology, School of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Servet Kizildag
- College of Vocational School of Health Services, School of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Ferda Hosgorler
- Department of Physiology, School of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Hikmet Gumus
- Department of Sports Medicine, School of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Sevim Kandis
- Department of Physiology, School of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Mehmet Ates
- College of Vocational School of Health Services, School of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Nazan Uysal
- Department of Physiology, School of Medicine, Dokuz Eylül University, Izmir, Turkey.
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Liu M, Dudley SC. Magnesium, Oxidative Stress, Inflammation, and Cardiovascular Disease. Antioxidants (Basel) 2020; 9:E907. [PMID: 32977544 PMCID: PMC7598282 DOI: 10.3390/antiox9100907] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 12/15/2022] Open
Abstract
Hypomagnesemia is commonly observed in heart failure, diabetes mellitus, hypertension, and cardiovascular diseases. Low serum magnesium (Mg) is a predictor for cardiovascular and all-cause mortality and treating Mg deficiency may help prevent cardiovascular disease. In this review, we discuss the possible mechanisms by which Mg deficiency plays detrimental roles in cardiovascular diseases and review the results of clinical trials of Mg supplementation for heart failure, arrhythmias and other cardiovascular diseases.
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Affiliation(s)
- Man Liu
- Division of Cardiology, Department of Medicine, the Lillehei Heart Institute, University of Minnesota at Twin Cities, Minneapolis, MN 55455, USA
| | - Samuel C. Dudley
- Division of Cardiology, Department of Medicine, the Lillehei Heart Institute, University of Minnesota at Twin Cities, Minneapolis, MN 55455, USA
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Scarpati G, Baldassarre D, Oliva F, Pascale G, Piazza O. Ionized or Total Magnesium levels, what should we measure in critical ill patients? Transl Med UniSa 2020; 23:68-76. [PMID: 34447718 PMCID: PMC8370522 DOI: 10.37825/2239-9747.1015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Monitoring and measuring magnesium (Mg) values are essential to prevent the development of numerous complications in perioperative medicine and critically ill patients. Although previous studies suggest that measuring free ionized magnesium (iMg) is more useful for estimating Mg status, clinicians currently rely on measurement of total serum magnesium to determine if supplemental magnesium is needed. In this review, we analyzed the recent literature to decide whether it is better to measure ionized serum Mg or total serum Mg when assessing magnesium status, whether iMg predicts clinical outcome, and what are the difficulties in measuring serum iMg levels in intensive care patients and perioperative medicine.
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Malviya A, Kapoor M, Sivam RKN, Khan SA, Pandey R, Kumar U, Ete T, Mishra A. Ibutilide with magnesium for conversion of atrial fibrillation or flutter in rheumatic heart disease patients: Ibutilide with magnesium for chemical cardioversion of atrial fibrillation or flutter. Indian Heart J 2020; 72:283-288. [PMID: 32861384 PMCID: PMC7474117 DOI: 10.1016/j.ihj.2020.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/15/2020] [Accepted: 07/07/2020] [Indexed: 11/30/2022] Open
Abstract
Background Data on adjunctive use of magnesium with ibutilide for conversion of persistent rheumatic atrial fibrillation and flutter to sinus rhythm is lacking. Aim We aimed to study the efficacy of adjunctive supplementation of intravenous magnesium with ibutilide for conversion of persistent rheumatic atrial fibrillation and flutter to sinus rhythm and to define a definite level of serum magnesium which leads to significant increase in rates of such conversion. Methods and results This was a prospective study including 33 Rheumatic heart disease patients (13 males and 20 females) with mean age of 49.27 ± 11.4 years and persistent AF or AFl. All patients received intravenous magnesium to raise serum magnesium level in range of 4 mg/dl to 4.5 mg/dl prior to administration of Ibutilide. 25 out of 33 (76%) patients converted to sinus rhythm. Upon univariate analysis, presence of background beta blocker therapy, serum potassium and magnesium at time of Ibutilide injection were found to have significant relation with conversion to sinus rhythm. Upon multivariate analysis serum magnesium level at the time of Ibutilide injection was found to have significant contribution on post injection rhythm reversal (p-value = 0.006). The level of magnesium at 3.8 mg/dl was found to have maximum sensitivity of 96% and specificity of 62.5% for conversion to sinus rhythm by ibutilide with magnesium (p-value< 0.05). Conclusions Ibutilide is highly effective in cardioversion of persistent rheumatic atrial fibrillation/flutter patients. Raising Serum Magnesium levels above 3.8 mg/dl significantly improves efficacy of ibutilide.
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Affiliation(s)
- Amit Malviya
- Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong, Meghalaya, India
| | - Manish Kapoor
- Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong, Meghalaya, India
| | - Rondeep Kumar Nath Sivam
- Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong, Meghalaya, India
| | - Shakeel Ahamad Khan
- Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong, Meghalaya, India
| | - Ruchi Pandey
- Department of Community Medicine, Al-Falah School of Medical Science & Research Centre, Dhauj, Faridabad, Haryana, India
| | - Utpal Kumar
- Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong, Meghalaya, India
| | - Tony Ete
- Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong, Meghalaya, India
| | - Animesh Mishra
- Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong, Meghalaya, India.
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Ferdaus MZ, Mukherjee A, Nelson JW, Blatt PJ, Miller LN, Terker AS, Staub O, Lin DH, McCormick JA. Mg 2+ restriction downregulates NCC through NEDD4-2 and prevents its activation by hypokalemia. Am J Physiol Renal Physiol 2019; 317:F825-F838. [PMID: 31364380 PMCID: PMC6843039 DOI: 10.1152/ajprenal.00216.2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Hypomagnesemia is associated with reduced kidney function and life-threatening complications and sustains hypokalemia. The distal convoluted tubule (DCT) determines final urinary Mg2+ excretion and, via activity of the Na+-Cl- cotransporter (NCC), also plays a key role in K+ homeostasis by metering Na+ delivery to distal segments. Little is known about the mechanisms by which plasma Mg2+ concentration regulates NCC activity and how low-plasma Mg2+ concentration and K+ concentration interact to modulate NCC activity. To address this, we performed dietary manipulation studies in mice. Compared with normal diet, abundances of total NCC and phosphorylated NCC (pNCC) were lower after short-term (3 days) or long-term (14 days) dietary Mg2+ restriction. Altered NCC activation is unlikely to play a role, since we also observed lower total NCC abundance in mice lacking the two NCC-activating kinases, STE20/SPS-1-related proline/alanine-rich kinase and oxidative stress response kinase-1, after Mg2+ restriction. The E3 ubiquitin-protein ligase NEDD4-2 regulates NCC abundance during dietary NaCl loading or K+ restriction. Mg2+ restriction did not lower total NCC abundance in inducible nephron-specific neuronal precursor cell developmentally downregulated 4-2 (NEDD4-2) knockout mice. Total NCC and pNCC abundances were similar after short-term Mg2+ or combined Mg2+-K+ restriction but were dramatically lower compared with a low-K+ diet. Therefore, sustained NCC downregulation may serve a mechanism that enhances distal Na+ delivery during states of hypomagnesemia, maintaining hypokalemia. Similar results were obtained with long-term Mg2+-K+ restriction, but, surprisingly, NCC was not activated after long-term K+ restriction despite lower plasma K+ concentration, suggesting significant differences in distal tubule adaptation to acute or chronic K+ restriction.
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Affiliation(s)
- Mohammed Z. Ferdaus
- 1Division of Nephrology and Hypertension, Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Anindit Mukherjee
- 1Division of Nephrology and Hypertension, Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Jonathan W. Nelson
- 1Division of Nephrology and Hypertension, Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Philip J. Blatt
- 1Division of Nephrology and Hypertension, Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Lauren N. Miller
- 1Division of Nephrology and Hypertension, Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Andrew S. Terker
- 2Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Olivier Staub
- 3Department of Pharmacology and Toxicology, University of Lausanne, Lausanne, Switzerland
| | - Dao-Hong Lin
- 4Department of Pharmacology, New York Medical College, Valhalla, New York
| | - James A. McCormick
- 1Division of Nephrology and Hypertension, Department of Medicine, Oregon Health and Science University, Portland, Oregon
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Braile-Sternieri MCVB, Mustafa EM, Ferreira VRR, Braile Sabino S, Braile Sternieri G, Buffulin de Faria LA, Sbardellini BC, Vianna Queiroz CO, Braile DM, Zotarelli Filho IJ. Main Considerations of Cardiogenic Shock and Its Predictors: Systematic Review. Cardiol Res 2018; 9:75-82. [PMID: 29755623 PMCID: PMC5942235 DOI: 10.14740/cr715w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/10/2018] [Indexed: 01/17/2023] Open
Abstract
The mortality rate of post-infarction cardiogenic shock (CS) was 80.0-90.0%. Recent studies show a significant reduction of hospital mortality to approximately 50.0%. CS is defined as systemic tissue hypoperfusion resulting from systolic and/or diastolic heart dysfunction, the main cause of which is acute myocardial infarction (AMI). The main predictors are biological markers such as troponin, CKMB and lactate. A systematic literature review and meta-analysis is performed in order to present and correlate the main literary findings on CS and its evolution with possible changes in biomarkers such as troponin, lactate and CKMB. After criteria of literary search with the use of the mesh terms: cardiogenic shock; acute myocardial infarction; biomarkers; troponin; CKMB; lactate; clinical trials and use of the bouleanos "and" between the mesh terms and "or" among the historical findings. In the main databases such as Pubmed, Medline, Bireme, EBSCO, Scielo, etc., a total of 96 papers that were submitted to the eligibility analysis were collated and, after that, 41 studies were selected, following the rules of systematic review - PRISMA (Transparent reporting of systematic reviews and meta-analyzes-http://www.prisma-statement.org/). Some risk factors for its development in AMI are advanced age, female gender, anterior wall infarction, diabetes mellitus, systemic arterial hypertension, previous history of infarction and angina. The CS associated with AMI depends on its extent and its complications, being the main ones: mitral regurgitation, rupture of the interventricular septum and rupture of the free wall of the left ventricule. The diagnosis is based on the clinical manifestations, such as mental confusion, oliguria, hypotension, tachycardia, fine pulse, sweating, and cold extremities; in hemodynamic aspects: systolic blood pressure was < 90.0 mm Hg or 30 mm Hg below baseline, pulmonary capillary pressure was > 18.0 mm Hg and cardiac index was < 2.2 L/min/m2. Laboratory and imaging exams should be requested to evaluate the possible etiology of CS, its systemic repercussions and comorbidities. The treatment aims at the rapid reestablishment of the blood flow in the affected artery, to improve the patient's prognosis. The biomarkers dosage in the daily clinical practice of the different cardiological centers can facilitate the diagnosis and the conduction of the dubious cases and the best evaluation of the degree of myocardial suffering after CS.
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Affiliation(s)
| | - Eliana Migliorini Mustafa
- Domingo Braile Institute of Sao Jose do Rio Preto (SP), Rua Luiz Vaz de Camoes, 3111 - Vila Redentora, Sao Jose do Rio Preto - SP, 15015-750, Sao Paulo, Brazil
| | - Victor Rodrigues Ribeiro Ferreira
- Domingo Braile Institute of Sao Jose do Rio Preto (SP), Rua Luiz Vaz de Camoes, 3111 - Vila Redentora, Sao Jose do Rio Preto - SP, 15015-750, Sao Paulo, Brazil.,Faceres - Medical School of Sao Jose do Rio Preto, Av. Anisio Haddad, 6751 - Jardim Francisco Fernandes, Sao Jose do Rio Preto - SP, 15090-305, Sao Paulo, Brazil
| | - Sofia Braile Sabino
- Domingo Braile Institute of Sao Jose do Rio Preto (SP), Rua Luiz Vaz de Camoes, 3111 - Vila Redentora, Sao Jose do Rio Preto - SP, 15015-750, Sao Paulo, Brazil
| | - Giovanni Braile Sternieri
- Domingo Braile Institute of Sao Jose do Rio Preto (SP), Rua Luiz Vaz de Camoes, 3111 - Vila Redentora, Sao Jose do Rio Preto - SP, 15015-750, Sao Paulo, Brazil
| | - Lucia Angelica Buffulin de Faria
- Domingo Braile Institute of Sao Jose do Rio Preto (SP), Rua Luiz Vaz de Camoes, 3111 - Vila Redentora, Sao Jose do Rio Preto - SP, 15015-750, Sao Paulo, Brazil
| | - Bethina Canaroli Sbardellini
- Domingo Braile Institute of Sao Jose do Rio Preto (SP), Rua Luiz Vaz de Camoes, 3111 - Vila Redentora, Sao Jose do Rio Preto - SP, 15015-750, Sao Paulo, Brazil
| | - Cibele Olegario Vianna Queiroz
- Domingo Braile Institute of Sao Jose do Rio Preto (SP), Rua Luiz Vaz de Camoes, 3111 - Vila Redentora, Sao Jose do Rio Preto - SP, 15015-750, Sao Paulo, Brazil
| | - Domingo Marcolino Braile
- Domingo Braile Institute of Sao Jose do Rio Preto (SP), Rua Luiz Vaz de Camoes, 3111 - Vila Redentora, Sao Jose do Rio Preto - SP, 15015-750, Sao Paulo, Brazil
| | - Idiberto Jose Zotarelli Filho
- Domingo Braile Institute of Sao Jose do Rio Preto (SP), Rua Luiz Vaz de Camoes, 3111 - Vila Redentora, Sao Jose do Rio Preto - SP, 15015-750, Sao Paulo, Brazil
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Forget P, Cata J. Stable anesthesia with alternative to opioids: Are ketamine and magnesium helpful in stabilizing hemodynamics during surgery? A systematic review and meta-analyses of randomized controlled trials. Best Pract Res Clin Anaesthesiol 2017; 31:523-531. [DOI: 10.1016/j.bpa.2017.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 05/18/2017] [Accepted: 07/03/2017] [Indexed: 11/29/2022]
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Karagueuzian HS, Pezhouman A, Angelini M, Olcese R. Enhanced Late Na and Ca Currents as Effective Antiarrhythmic Drug Targets. Front Pharmacol 2017; 8:36. [PMID: 28220073 PMCID: PMC5292429 DOI: 10.3389/fphar.2017.00036] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/18/2017] [Indexed: 11/30/2022] Open
Abstract
While recent advances clarified the molecular and cellular modes of action of antiarrhythmic drugs (AADs), their link to suppression of dynamical arrhythmia mechanisms remains only partially understood. The current classifications of AADs (Classes I, III, and IV) rely on blocking peak Na, K and L-type calcium currents (ICa,L), with Class II with dominant beta receptor blocking activity and Class V including drugs with diverse classes of actions. The discovery that the calcium and redox sensor, cardiac Ca/calmodulin-dependent protein kinase II (CaMKII) enhances both the late Na (INa-L) and the late ICa,L in patients at high risk of VT/VF provided a new and a rational AAD target. Pathological rise of either or both of INa-L and late ICa,L are demonstrated to promote cellular early afterdepolarizations (EADs) and EAD-mediated triggered activity that can initiate VT/VF in remodeled hearts. Selective inhibition of the INa-L without affecting their peak transients with the highly specific prototype drug, GS-967 suppresses these EAD-mediated VT/VFs. As in the case of INa-L, selective inhibition of the late ICa,L without affecting its peak with the prototype drug, roscovitine suppressed oxidative EAD-mediated VT/VF. These findings indicate that specific blockers of the late inward currents without affecting their peaks (gating modifiers), offer a new and effective AAD class action i.e., “Class VI.” The development of safe drugs with selective Class VI actions provides a rational and effective approach to treat VT/VF particularly in cardiac conditions associated with enhanced CaMKII activity such as heart failure.
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Affiliation(s)
- Hrayr S Karagueuzian
- Translational Arrhythmia Section, David Geffen School of Medicine, University of California, Los AngelesLos Angeles, CA, USA; Cardiovascular Research Laboratory, Departments of Medicine (Cardiology), David Geffen School of Medicine, University of California, Los AngelesLos Angeles, CA, USA
| | - Arash Pezhouman
- Translational Arrhythmia Section, David Geffen School of Medicine, University of California, Los AngelesLos Angeles, CA, USA; Cardiovascular Research Laboratory, Departments of Medicine (Cardiology), David Geffen School of Medicine, University of California, Los AngelesLos Angeles, CA, USA
| | - Marina Angelini
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles Los Angeles, CA, USA
| | - Riccardo Olcese
- Cardiovascular Research Laboratory, Departments of Medicine (Cardiology), David Geffen School of Medicine, University of California, Los AngelesLos Angeles, CA, USA; Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los AngelesLos Angeles, CA, USA; Department of Physiology, David Geffen School of Medicine, University of California, Los AngelesLos Angeles, CA, USA
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