Relationship between magnesium and lipids in patients with diabetes mellitus

Introduction: Non-communicable diseases, especially cardiovascular diseases (CVD), have become more prevalent across the world, more so in developing countries. Novel methods in the management of CVD risks in patients with diabetes mellitus, type 2 (DM2) requires constant attention and an ever-evolving approach. The role of magnesium supplementation in the management of CVD has been described, but the relationship between serum magnesium (Mg) and the lipid subsets have had conflicting results in different population groups.Methods: A cross-sectional study was performed by collecting data on patients with DM2 from a specialised diabetes clinic at Edendale Hospital, Pietermaritzburg, KwaZulu-Natal, South Africa, between July 1, 2015 and June 30, 2016. Lipid subsets (total cholesterol [TC], high-density lipoprotein cholesterol [HDL], low-density lipoprotein cholesterol [LDL] and triglycerides [TG]), age, sex and Mg were recorded for analysis.Results: A total of 495 clinical data sheets were analysed. The majority of participants were female (73.45%) with a mean age of 56.97 years. A statistically significant, positive, linear relationship was found between Mg and TC (R = 0.11; p = 0.01) as well as Mg and LDL R = 0.14; p = 0.001), but not between Mg and HDL (R = 0.02; p = 0.66) and Mg and TG (R = 0.01; p = 0.82).Discussion: The results of this study are similar to findings by a group of researchers in China and differ when compared with studies observing Caucasian patients. It is plausible that intrinsic ethnic differences in lipid metabolism and the various ways in which magnesium requiring enzymatic processes are utilised may be responsible for the results found in the present study population versus those found in Caucasian study participants in other countries. More research is required to determine the effect of magnesium supplementation and CVD outcomes in the present study population

Major depressive disorder in patients with diabetes mellitus in Pietermaritzburg, South Africa

Background. Diabetes mellitus (DM) and major depressive disorder (MDD) constitute a major burden of disease. A study found that type 2 DM (DM2) is associated with a two-fold increase in risk of developing MDD worldwide – except in Africa. The present study challenges this statement.Objectives. To determine the prevalence of MDD in a cohort of patients with DM and its effect on glycaemic control.Methods. A cross-sectional study was performed at a diabetes clinic at  Edendale Hospital, Pietermaritzburg, South Africa (1 March - 31 May 2017). A total of 176 participants were enrolled. Participants completed the Patient Health Questionnaire-9 (PHQ-9), with a score of ≥10 representing a  diagnosis of MDD. Higher PHQ-9 scores translate into more severe MDD. A surrogate for glycaemic control, glycated haemoglobin (HbA1c) blood testing, was also performed.Results. The majority of participants were female and suffered from DM2. The mean age was 54.4 years. The prevalence of MDD in the study population was 46.6%. A significantly positive linear relationship was shown between PHQ-9 score and HbA1c (p=0.018253).Conclusions. MDD appears to constitute a large burden of disease in our population of individuals with DM. A relationship between the severity of the MDD and HbA1c suggests that prompt intervention in both conditions is likely to improve health outcomes

Sulphur-substituted Pyrrolo[3,4-b]quinolines: Synthesis, Chemistry and Antimicrobial Activity

2,3-Dihydro-2-propyl-3-propylimino-9-thioxo-pyrrolo[3,4-b]quinolin-1-one reacts with an aliphatic primary, secondary or tertiary amine to forma 1:1 substrate:amine (thiolate) complex. It also readily undergoes S-alkylation (with diazomethane or with an alkyl halide), S-acetylation (with acetic anhydride), hydrogenolysis (Raney nickel) with removal of sulphur, and acid-catalysed hydrolysis (with selective replacement of the 3-propylimino function by oxygen). Two novel di-(pyrrolo[3,4-b] quinolinyl) sulphide reaction products are described and their structures established. Treatment of these ‘dimers’ and related 9-alkylthio-substituted pyrroloquinolines with an aliphatic amine provides a convenient access to ‘simple’ or ‘mixed’ 2-alkyl-9-alkylamino-3-alkylimino-pyrroloquinoline derivatives. Preliminary antimicrobial (in vitro) tests indicate that: (a) the weak antimicrobial activity of the aforementioned 9-thioxo-pyrroloquinoline substrate against three selected Gram-positive pathogens is significantly enhanced in its amine complexes, and by the presence of a 6-fluoro atom in the quinoline moiety, and (b) that substitution of the 4-oxo-function in 4-oxo- 3-quinolinecarboxylic acids by an ethylimino group leads to a marked reduction in antimicrobial properties.Keywords: 2-Alkyl-3-alkylimino-9-thioxo-2,3-dihydro-pyrrolo[3,4-b]quinolin-1-ones, pyrrolo[3,4-b]quinoline (1:1) amine complexes, 6-fluoro-derivatives, antimicrobial activities, di-[(pyrrolo[3,4-b]quinolinyl)] sulphides, 9-alkylthio-substituted pyrrolo[3,4-b] quinolines

Modelling Animal Systems Paper: Update of the Dutch protein evaluation system for ruminants: the DVE/OEB2010 system

In the current Dutch protein evaluation system (the DVE/OEB1991 system), two characteristics are calculated for each feed: true protein digested in the intestine (DVE) and the rumen degradable protein balance (OEB). Of these, DVE represents the protein value of a feed, while OEB is the difference between the potential microbial protein synthesis (MPS) on the basis of available rumen degradable protein and that on the basis of available rumen degradable energy. DVE can be separated into three components: (i) feed crude protein undegraded in the rumen but digested in the small intestine, (ii) microbial true protein synthesized in the rumen and digested in the small intestine, and (iii) endogenous protein lost in the digestive processes. Based on new research findings, the DVE/OEB1991 system has recently been updated to the DVE/OEB2010 system. More detail and differentiation is included concerning the representation of chemical components in feed, the rumen degradation characteristics of these components, the efficiency of MPS and the fractional passage rates. For each chemical component, the soluble, washout, potentially degradable and truly non-degradable fractions are defined with separate fractional degradation rates. Similarly, fractional passage rates for each of these fractions were identified and partly expressed as a function of fractional degradation rate. Efficiency of MPS is related to the various fractions of the chemical components and their associated fractional passage rates. Only minor changes were made with respect to the amount of DVE required for maintenance and production purposes of the animal. Differences from other current protein evaluation systems, viz. the Cornell Net Carbohydrate and Protein system and the Feed into Milk system, are discussed

Atypical chest pain: Needles in a haystack

A 20-year-old man presented with a 6-month history of intermittent chest pain. Initial imaging demonstrated approximately 15 sewing needles lodged in his myocardium, predominantly in the left ventricle. The patient has been referred to cardiothoracic surgery for further management. His progress will be monitored closely

The Magnesium and Glucose (MAG) Study: the prevalence and effect of hypomagnesaemia on diabetes control in a regional hospital in KwaZulu-Natal

Background: Diabetes mellitus (DM) poses a great burden of disease  worldwide. The adverse effects of hypomagnesaemia (hypoMg2+) in patients with DM have been well described, with a higher prevalence of hypoMg2+ in patients with DM than in the general population (up to 35% vs. up to 15%). No data exist for South Africa (SA).Objectives: The study aimed to determine the prevalence of hypoMg2+ in a cohort of patients visiting a specialised DM clinic and to ascertain whether there is a relationship between hypoMg2+ and glycaemic control and  hypoMg2+ and renal dysfunction.Methods: Data recorded on standardised clinical sheets from patients who attended a specialised DM clinic at Edendale Hospital, Pietermaritzburg, SA, over a period of one year (July 1, 2015 to June 30, 2016) were collected. Patient demographics, diabetes type, glycaemic control, serum magnesium (Mg2+) and renal function are presented for statistical analysis.Results: A total of 744 patients were enrolled. Most patients were female (527; 70.8%) and were diagnosed with Type 2 diabetes (DM2) (633; 85.1%) with a mean age of 52.3 (SD 15.6 years). The prevalence of  hypoMg2+ was found to be 8.44%. HypoMg2+ was associated with poor  glycaemic control (r = –0.16, p < 0.0001). A significant relationship was observed between glycaemic control and hypoMg2+ in males (r = –0.21, p = 0.0038), but not females (r = –0.011, p = 0.81). No significant relationship was evident between hypoMg2+ and renal dysfunction (r = –0.064, p = 0.11).Conclusion: HypoMg2+ in patients with DM was associated with poorer glycaemic control in the male population, potentially increasing the risk of adverse health outcomes. However, the prevalence of hypoMg2+ was not higher than in published data, but population-specific controls are required. No association could be found between hypoMg2+and renal dysfunction. The need for routine Mg2+ testing and supplementation in our population requires further assessment.Keywords: Diabetes mellitus, glycaemic control, magnesium, renal  function, types 1 and

Ruminal availability of nitrogen and carbohydrates from fresh and preserved herbage in dairy cows.

Resultaten van een studie naar de afbreekbaarheid van ruw eiwit en koolhydraten uit vers en geconserveerd ruwvoer, middels een studie met nylon zakjes in de pen

Opportunities to optimise colistin stewardship in hospitalised patients in South Africa: Results of a multisite utilisation audit

Background. Colistin is an old antibiotic that has been reintroduced as salvage therapy in hospitalised patients because it is frequently the only agent active against Gram-negative bacteria. Various guidelines for colistin administration have led to confusion in establishing the appropriate dose, which has potential for adverse consequences including treatment failure or toxicity. The emergence and spread of colistin resistance has been documented in South Africa (SA), but no local information exists on how and why colistin is used in  hospitals, and similarly, compliance with current dosing guidelines is unknown.Objectives. To evaluate the current utilisation of colistin in SA hospitals, in order to identify stewardship opportunities that could enhance the appropriate use of this antibiotic.Methods. Electronic patient records of adult patients on intravenous (IV) colistin therapy for >72 hours in four private hospitals were retrospectively audited over a 10-month period (1 September 2015 - 30 June 2016). The following data were recorded: patient demographics, culture and susceptibility profiles, diagnosis, and indication for use. Compliance with six colistin process measures was audited: obtaining a culture prior to initiation, administration of a loading dose, administration of the correct loading dose, adjustments to maintenance dose according to renal function, whether colistin was administered in combination with another antibiotic, and whether de-escalation following culture and sensitivity results  occurred. Outcome measures included effects on renal function, overall hospital mortality, intensive care unit length of stay (LoS), and hospital LoS.Results. Records of 199 patients on IV colistin were reviewed. There was 99.0% compliance with obtaining a culture prior to antibiotic therapy, 93.5% compliance with prescription of a loading dose, and 98.5% compliance regarding prescription of colistin in combination with another agent. However, overall composite compliance with the six colistin stewardship process measures was 82.0%. Non-compliance related to inappropriate loading and  maintenance doses, lack of adjustment according to renal function and lack of de-escalation following culture sensitivity was evident. Significantly shorter durations of treatment were noted in patients who received higher loading doses (p=0.040) and in those who received maintenance doses of 4.5 MU twice daily v. 3 MU three times daily (p=0.0027). In addition, compared with patients who survived, more patients who died received the 3 MU three times daily maintenance dose (p=0.0037; phi coefficient 0.26).Conclusions. The study identified multiple stewardship opportunities to optimise colistin therapy in hospitalised patients. Urgent implementation of a stewardship bundle to improve colistin utilisation is warranted.