The predictive role of serum magnesium in prognosis of critically ill medical patients

Introduction: Magnesium deficiency is a common disorder, but easily ignored as compared to other electrolyte abnormalities. Other studies are showing varied prevalence and increased association with morbidity and mortality. Aims & Objectives: The aim of our study is to find out the prevalence of hypomagnesemia among the critically ill medical patients and to correlate the serum magnesium levels with the mortality and morbidity outcome considering the length of ICU stay, duration of ventilatory support, APACHE 2 score, SOFA score, primary medical conditions in critically ill patients in medical ICU. Methodology: This prospective observational study was conducted in Medical intensive care unit of a tertiary care hospital. After the approval from Institutional ethical committee patients admitted to the medical intensive care unit with age more than 12 years and admitted for more than 2 days were included in the study after obtaining written informed consent. Laboratory tests and radiological investigations were done. APACHE 2(acute physiology and chronic health evaluation) score, SOFA score, total ICU stay, hospital stay, need of mechanical ventilation, duration of ventilatory assistance and associated medical conditions like diabetes, sepsis and electrolyte abnormalities were followed up to assess the relation with mortality and morbidity. Results: Among total of 170 critically ill medical patients were included in the study, prevalence of hypomagnesemia was 56.8 %. The morbidity was higher in hypomagnesaemic patients (48.5% vs 23.4%), longer ICU stay (6.96 ± 3.85 vs 5.12 ± 1.31) and need of mechanical ventilation was also more (68.9% vs 40.4 % p value < 0.003). Sepsis and maximum SOFA score indicate being the predominant underlying factor for hypomagnesemia. Even though association was there between mortality and hypomagnesemia, mortality has not correlated significantly [beta -0.041, t -0.473, 95 % CI -0.219 and 0.138]. Conclusion: Hypomagnesemia is more prevalent among the critically ill medical patients. Hypomagnesemia was also associated with increased mortality, longer ICU stay, higher APACHE 2 score, SOFA score, frequent ventilatory support and significant electrolyte abnormalities also

National guidelines for cognitive assessment and rehabilitation of Iranian traumatic brain injury patients

Background: Individuals with moderate to severe traumatic brain injury (TBI) often have prolonged cognitive impairments, resulting in long-term problems with their real-life activities. Given the urgent need for evidence-based recommendations for neuropsychological management of Iranian TBI patients, the current work aimed to adapt eligible international guidelines for cognitive assessment and rehabilitation of the TBI patients in Iran. Methods: The project was led by an executive committee, under the supervision of the Iranian Ministry of Health and Medical Education (MOHME). Following a systematic literature search and selection process, four guidelines were included for adaptation. Clinical recommendations of the source guidelines were tabulated as possible clinical scenarios for 90 PICO clinical questions covering all relevant phases of care. After summing up the scenarios, our initial list of recommendations was drafted according to the Iranian patients� conditions. The final decision-making, with the contribution of a national interdisciplinary panel of 37 experts from across the country, was conducted in two rounds using online and offline survey forms (Round 1), and face-to-face and telephone meetings (Round 2). Results: A total of 63 recommendations in six sections were included in the final list of recommendations, among which 24 were considered as key recommendations. In addition, some of the recommendations were identified as fundamental, meaning that proper implementation of the other recommendations is largely dependent on their implementation. Conclusion: Iranian health policy makers and rehabilitation program managers are recommended to address some fundamental issues to provide the necessary infrastructure to set up an efficient cognitive rehabilitation service system. © 2020 Academy of Medical Sciences of I.R. Iran. All rights reserved

Evaluation Of The Results Of Surgical And Medicaltreatment In 16 Patients With Vertigo Secondary Tocervical Spondylosis

Background: In patients with cervical spondylosis, cord compression and impingement of cord vessels as well as the vertebral artery may be accompanied by vertigo. We evaluated improvement of vertigo in these patients after surgical and medical treatment. Methods: In this prospective study we reviewed 16 patients with vertigo suspected of cervical spondylosis, admitted to our hospital between 1999 and 2004. Before orthopedic examination, other causes of vertigo related to the field of ENT and neurologic problems had been ruled out. Dynamic angiography and /or Doppler sonography were performed in patients during flexion and extension and rotation of the cervical spine. Operations such as laminectomy and foraminotomy and resection of osteophytes were performed in patients who did not improve by conservative treatment. Results: There were ten males and six females, with a mean age of 62.5 years. Twelve patients had cervical canal stenosis, and four patients also had vertebral artery stenosis. In two patients angioplasty of the vertebral artery was performed. Operations were performed in twelve patients and conservative treatment was used in four patients. Surgical treatment gave good relief of symptoms and was satisfactory in eight patients and not satisfactory in four patients. Conservative treatment improved symptoms in one patient, and was not satisfactory in three patients (p <.05). Conclusion: Vertigo occurs in patients with cervical spondylosis, especially in old patients with spondylosis. In most cases we had improvement of vertigo by surgical decompression of the cervical cord and arteries

Evaluation of The Results of Surgical and Medical Treatment In 16 Patients With Vertigo Secondary to Cervical Spondylosis

Background:In patients with cervical spondylosis,cord compression and impingement of cord vessels as well as the vertebral artery may be accompanied by vertigo.We evaluated improvement of vertigo in these patients after surgical and medical treatment.Methods:In this prospective study we reviewed 16 patients with vertigo suspected of cervical spondylosis,admitted to our hospital between 1999 and 2004. Before orthopedic examination,other causes of vertigo related to the field of ENT and neurologic problems had been ruled out.Dynamic angiography and /or Doppler sonography were performed in patients during flexion and extension and rotation of the cervical spine. Operations such as laminectomy and foraminotomy and resection of osteophytes were performed in patients who did not improve by conservative treatment. Results: There were ten males and six females, with a mean age of 62.5 years. Twelve patients had cervical canal stenosis, and four patients also had vertebral artery stenosis. In two patients angioplasty of the vertebral artery was performed. Operations were performed in twelve patients and conservative treatment was used in four patients.Surgical treatment gave good relief of symptoms and was satisfactory in eight patients and not satisfactory in four patients.Conservative treatment improved symptoms in one patient,and was not satisfactory in three patients (p <.05).Conclusion:Vertigo occurs in patients with cervical spondylosis,especially in old patients with spondylosis.In most cases we had improvement of vertigo by surgical decompression of the cervical cord and arteries

THE EFFECT OF LITHIUM ON ACUTE TOXICITY OF CHLORPROMAZINE IN MICE

The effects of chronic administration of lithium, on acute toxicity of chlorpromazine (CPZ) in male albino mice was studied and the LDSO values were determined from dose-probit curves. Tfie results showed that in lithium pretrealed animals (anmials consumed drinking water containing 600mg/L lithium chloride for 10 days) the LD50 value (the dose corresponding to probit 5) of CPZ increased significantly from 27.99&amp;plusmn;0.29 to 45.5&amp;plusmn;0.47 mg/kg. It seems that concurrent administration of lithium with CPZ decreases the acute toxicity of CPZ in mice. Several interactions between phenothiazines and lithium has been described. It is concluded that concurrent use of lithium anil CPZ, decreases the acute toxicity of CPZ in mice and such interaction may reduce CPZ response. the lithium-induced reduction of CPZ lethality may be due to pharmacokinetics and pharmucrttlvnamics inleractions