PROSPECTIVE COMPARATIVE STUDY OF CONSERVATIVE VERSUS OPERATIVE MANAGEMENT AMONG PATIENT WITH CELLULITIS

INTRODUCTION: Cellulitis is a bacterial infection of the skin and subcutaneous tissuethat is more generalized than erysipelas and associated with broken skin and pre-existingulceration. Mild cases of cellulitis are generally treated with oral antibiotics, GlycerinMgSO4 dressing & affected part elevation and severe cases required admission & higherantibiotics, skin & blood culture & sensitivity & in case of systemic symptoms & abscessoperative management is required.AIMS AND OBJECTIVES:• To observe the outcome of conservative and operative patients in view ofcomorbidity and after treatment complications.• Following factors are accounting before conclusive outcome.• To understand the patients characteristics, comorbidity and mode of presentation.• To study spectrum of organism isolated from patient undergoing conservative oroperative management.• To compare treatment modality and outcome in management of cellulitis.MATERIAL & METHODS: Data consists of primary data collected by the principalinvestigator directly from the patients who were admitted from OPD in the GCS medicalcollege and hospital. It was observational study for a period of six months from April2022 to September 2022 under sample size was 50 cases.CONCLUSION: We recommended Operative management over Conservativemanagement in cellulitis because single operative incision can release toxic fluid fromaffected part and can promote faster healing and better recovery and less hospital stay.Patient has less mental trauma, less pain and more economical benefits in Operativemanagement therefore study concludes Operative management is superior Compared toConservative management. However, conservative management is preferable in earlystages of cellulitis.

Shortened versus standard post-partum maintenance therapy of magnesium sulphate in severe pre-eclampsia: a randomised control trial

Background: Pre-eclampsia is a pregnancy-associated multi-organ disorder caused by altered trophoblastic invasion and endothelial cell dysfunction. It is associated with significant maternal and perinatal morbidity and mortality, especially in developing countries. Magnesium sulphate (MgSO4) is effective in the management of severe pre-eclampsia/eclampsia. Objective of this study was to compare the effectiveness of a shortened course of MgSO4 to the Pritchard regimen in patients with severe pre-eclampsiaMethods: This study was carried out at the obstetrics and gynecology department of the Obafemi Awolowo University Teaching Hospital, Ile-Ife. It was a randomised control study of 116 patients, 58 in each group. Group A received the standard Pritchard regimen: a loading dose of MgSO4 4g slow IV bolus plus 10 g IM (5 g in each buttock), followed by maintenance dose of 5g MgSO4 IM 4-hourly into alternate buttocks until 24 hours after delivery. Group B received same loading dose, but the maintenance dose was limited to three doses of 5g MgSO4 IM four hours apart after delivery. In both regimens, 2g MgSO4 was given IV for breakthrough fit. Data were analyzed using SPSS version 20.Results: This study revealed that twelve-hour postpartum MgSO4 was as effective as the Pritchard regime with no statistically difference in occurrence of seizures (X2 = 0.341, df = 1, p = 0.514). The average total dose of magnesium sulphate used was lower in the study Group B.Conclusions: Twelve-hour postpartum MgSO4 is as effective as the standard 24-hour Pritchard regime.

Study the Effect of a Single Dose of Intravenous Magnesium Sulphate on Postoperative Pain after Lower Abdominal Surgery

Background: Uncontrolled post-operative pain may produce arange of detrimental acute and chronic effects. Relief fromsevere pain arising from deep or visceral structures, ashappens in surgical procedures, requires the use of opioids.The aim of this study to assess the degree and duration ofpostoperative pain and requirements of rescue analgesia afterIntravenous use of magnesium sulphate preoperatively in lowerabdominal surgery.Materials & Methods: This is a hospital based randomizeddouble blind interventional analytic study done on 50 patientsadmitted in surgery department for lower abdominal surgery atS.M.S. medical college and attached hospital, Jaipur. Aftertaking informed consent and confirming overnight fasting,patient was taken on the recovery room and baseline vitalslike B.P., pulse rate, respiratory rate recorded. Patients at restwas evaluated by using a 0 – 10 cm. visual analogue score(VAS) or by using a 0 - 4 verbal rating score (VRS) atemergence from anaesthesia and1/2, 1, 2, 4, 6, 12 and 24 hrs.after surgery.Results: There was no significant difference in mean age ofpatients between two groups (P > 0.05). The mean of totaldose of analgesia requested was 87.00+ 27.49 mg in MgSO4group and 240.00 + 30.00 mg in C group. It means that therewas clinically and statistically highly significant (P<.001). Themean duration of analgesia was 189.60+18.70 minutes inMgSO4 group and 24.40 + 5.16 minutes in C group. In ourstudy occurrence of nausea and vomiting were more in Cgroup then the MgSO4 group. But these adverse effects werestatistically insignificant in both the groups and did not requireany supplementary management.Conclusion: We concluded that patients receiving Magnesiumsulphate during preoperative period have better pain relief,more sedated and fewer requirements of rescue analgesics inthe postoperative period, without any major side effects.

Prophylactic Use of Magnesium Sulphate to Prevent Arrythmias in Patients with Rheumatic Heart Disease Undergoing Closed Mitral Valvotomy

Maintenance of sinus rhythm is superior to incidence of atrial fibrillation (AF) in patients with rheumatic heartdisease undergoing Closed Mitral Valvotomy (CMV). The present study was done to evaluate the effect ofprophylactic use of Magnesium Sulphate (MgSo4), intravenously (i.v) soon after opening the stenosed MitralValve using Tubbs dilators by Surgeon, in patients undergoing CMV. One hundred and twenty patients withMitral Stenosis (MS) (mitral valve area < 1cm2), normal mitral valvular apparatus, no mitral regurgitation,mitral score not more than 7/16 planned for CMV. These patients were divided in two groups of 60 each.Group (I) (n=60) received. MgSo4, 30 mg/kg diluted to 20 ml with normal saline soon after mitral valvotomyand Group - II (n=60) received 20 ml of normal saline. The standardized protocol for CMV was maintainedfor all the patients. Before surgery AF was observed in 56.67% of patients in group I and 48.33% of patientsin group II (p=0.46). Postoperatively in ICU, 30% of patients in group I and 70% of patients in group II hadAF(p<0.0001). A single prophylactic intra operative dose of i.v MgSO4 decreased post valvotomy arrhythmiain comparision to placebo group . Thus, a single dose of intraoperative MgSO4 can be used to decreasepostoperative arrhythmias in patients of M.S undergoing CMV

Ameliorative effects of MgSO4 on Dexamethasone – induced Histo-chemical alterations in the testes of Albino Rats.

Background: In experimental animal, Dexamethasone-induced impaired spermatogenesis, causes distortion of the normal architecture of seminiferous tubules along with alteration in male sexual hormone, testosterone. Concomitant administration of MgSO4 preserved the cytoarchitecture of testes as well as hormonal regulation in albino rats. Objective: This study was performed to observe the ameliorative effects of MgSO4 on the histology of testes and correlation with serum testosterone level during dexamethasone administration. Duration of study: twenty days (April 2012).Study design: Prospective experimental study.Place of study: Anatomy department Basic Medical Sciences Institute (BMSI), Jinnah Postgraduate Medical Centre (JPMC), Karachi. Methods: thirty healthy adult albino rats were included in this study and divided equally into three groups. Group-A served as control. Group-B received Dexamethasone (intraperitoneally) at the dose of 4.0 mg/kg body weight/24 hours. Group-C received Dexamethasone in the same dose as given in group-B and additionally received MgSO4 (intramuscularly) at the dose of 20mg/kg/24hours. Results: MgSO4 significantly preserved cytoarchitecture of the testes as well as minimized alteration in serum Testosterone level in group-C. Conclusion: This study showed that administration of MgSO4 has ameliorated both the histological and biochemical damaging effects induced by dexamethasone in rats’ testes.

Wolf-parkinson-white Syndrome-current Concepts in Anesthetic Practice.

Wolf-Parkinson-White (WPW) syndrome is a disorder of conduction system of heart caused by presence of an abnormal accessory conduction pathway between the atria and ventricles. It is associated with tachyarrhythmias diagnosed by electrocardiography (ECG). The anesthetic management of these patients is challenging as they are known to develop life threatening arrhythmias. Magnesium sulfate (MgSO4) is a good agent for control of peri-operative dysrhythmias.

Effects of dietary magnesium on testicular histology, steroidogenesis, spermatogenesis and oxidative stress markers in adult rats.

The available information on the effect of excess dietary magnesium on male reproduction is inadequate, though consumption of hard water rich in magnesium salt is not uncommon in many geographical areas. The present study has thus been undertaken to evaluate the morphological as well as cytological and functional changes in testis of magnesium administered sexually mature male Wistar rats. Significant increase in the activities of androgenic enzymes viz. Δ53β-hydroxysteroid dehydrogenase and 17β-hydroxysteroid dehydrogenase with concomitant increase in serum testosterone level, followed by progressive development in cytoarchitechture of genital organs, without any significant alteration in quantitative spermatogenesis were observed. The results were more marked in the groups treated for longer duration. The results further suggests that the changes that occurred after excessive magnesium in testis were not for the enhanced adrenocortical activities or for the generation of oxidative stress in reproductive organs, but for the direct action of excess magnesium on male gonads. Magnesium supplementation thus has an apparent beneficial effect on male gonadal system.

Usefulness of MgSO4 in the Field of Anesthesia and Pain Medicine

Perioperative hypomagnesemia is common in major surgical patients. MgSO4 infusion may be useful in the treatment of arrhythmia, asthma and postoperative shivering and in the prevention of hemodynamic stimulation associated with endotracheal intubation and surgery of pheochromocytoma. It may also enhance muscular relaxation and improve postoperative analgesia. It can be an ideal adjunct to propofol-remifentanil-based total intravenous anesthesia.

Rocuronium-induced Neuromuscular Block after Long Pretreatment of Magnesium Sulfate in Rabbits / 대한마취과학회지

BACKGROUND: Magnesium sulfate (MgSO4) has been used in the treatment of pre-eclampsia, hypertension and arrhythmia. This study was been conducted to evaluate the potency and time course of rocuronium-induced neuromuscular block after prolonged pretreatment with MgSO4 in rabbits. METHODS: Forty rabbits were randomly assigned to two groups; the control group: normal saline 0.1 ml/kg sq for 6 weeks; and the study group: 50% MgSO4 60 mg/kg sq for 6 weeks. The dose-response relationships of rocuronium were studied during thiopental anesthesia in twenty rabbits. Each group received rocuronium 40, 60 and 80microgram/kg rocuronium, respectively, and the time course of rocuronium, at 0.6 mg/kg, evaluated in the twenty rabbits in each group. RESULTS: The mean serum magnesium concentration were 2.3-2.6 and 3.3-3.9 mEq/L in the control and study groups, respectively (P < 0.001). The calculated ED50s for rocuronium were 52.7 and 61.2microgram/kg in the control and study groups, respectively (P < 0.05). The times after rocuronium administration until the 95% twitch recovery were 49.3 and 34.8 min in the control and study groups, respectively (P < 0.05). CONCLUSIONS: Rocuronium, following prolonged MgSO4 pretreatment had a decreased effect and short duration of action compared with the control, for which increased doses of nondepolarizing muscle relaxants would be required to obtain a similar effect.

Biocompatibility of chitosan-Mg membranes with PC12 cells in vitro / 基础医学与临床

Objective To prepare the chitosan-Mg membranes and to explore the biocompatibility of membranes with PC12 cells and its usage as biomaterials in tissue engineering.Methods The appearance of the chitosan-Mg membranes (CM) was observed under scanning electromicroscope (SEM) and the element of the membranes was analyzed by x-ray energy spectromete. PC12 cells were co-cultured with CM in vitro,the morphological changes of PC12 cells on membranes were observed under scanning electron microscope (SEM) and light microscope (LM),the cell vitality was detected by MTT assay. Results The surface of chitosan membranes (CS) was smoother than that of CM;but the CM groups were full of pore observed under SEM;The content of Mg element was related with the dosage of MgSO4 added into chitosan solution. Morphology observation showed that PC12 cells grew well on CM as compared with CS group. The cells were rich of microvilli and long processes on 7th day,and synapses-like structure was formed in many PC12 cells. In addition,the cell viability of experiment group was higher than that of control group(P

Essai clinique du sulfate de magnésium dans la pré-éclampsie sévère et l'éclampsie en milieu africain à Cotonou

Le sulfate de magnesium (MgSO4) previent et traite les manifestations neurologiques notamment les crises convulsives induites par les syndromes vasculo- renaux severes. L'objectif de notre etude etait d'evaluer son efficacite et sa tolerance.Nous avons mene une etude a la fois retrospective et prospective sur 30 mois a l'Hopital de la Mere et Enfant Lagune (HOMEL) de Cotonou chez 211 patientes souffrant de pre- eclampsie severe et d'eclampsie. Le sulfate de magnesium (MgSO4) etait utilisee a la dose d'attaque de 4g d'une concentration a 20par voie intra- veineuse lente (IVL) sur une duree de 15 a 20 mn associee a 10g intra- musculaire (IM) d'une concentration a 50(repartis pour 5g dans chaque muscle fessier) ; la dose d'entretien etait de 5g a 50IM (2;5g dans chaque muscle fessier) toutes les 4 heures. La surveillance des reflexes osteo- tendineux; de la frequence respiratoire et de la diurese etait assuree toutes les heures.760 cas etaient colliges sur 17.753 accouchements(4;28) dont 211cas traites par le MgSO4 ( 74 et 134 cas respectivement de pre- eclampsie severe et d'eclampsie; soit 1;27et 3;01des accouchements) ; l'age moyen des patientes etait de 24;74 ans. Les pressions arterielles systolique(PAS) et diastolique(PAD) etaient respectivement de 160 et compris entre 110- 120 mm Hg dans 91;94 et 86des cas; accompagnees notamment de crises convulsives(65) et de coma(12). L'efficacite du MgSO4 etait nette des la 24eme heure a la seule dose d'attaque avec amendement des convulsions dans 53;68des cas sans recidives. Le pronostic neonatal etait satisfaisant ; la morbidite maternelle etait amelioree et la letalite de 0;94etait tres en deca du taux (8;05) rapporte a l'HOMEL de Cotonou en 2001 avant l'utilisation du MgSO4

Apoptotic Change in Response to Magnesium Therapy after Moderate Diffuse Axonal Injury in Rats

The biochemical factors related to moderation of secondary or delayed damage to the central nervous system (CNS) remain undefined. We have recently demonstrated that the weight- drop induced moderate diffuse axonal injury (mDAI) in rats causes a rapid decline in serum ionized magnesium (Mg2+) and a significant increase in the amount of serum ionized calcium (Ca2+) relative to Mg2+ (Ca2+/ Mg2+). For three hours, serum Mg2+ levels remained significantly depressed at 76% of preinjury values (p 0.05). Head trauma resulted in a small decrease of Ca2+ (about 10%), but a significant increase in the amount of Ca2+/Mg2+ (mean value in control group: in injured group for 3 hours after trauma =4.65 +/-0.012 : 5.69 +/-0.015, p< 0.05) was observed. In order to further investigate the relationship between Mg2+ and brain injury, the effect of Mg2+ treatment on posttraumatic histological changes (apoptotic changes) was examined following the weight-drop induced brain injury. At 30 min postinjury, animals treated with MgSO4 (750micro Ml/kg) showed significant improvements of apoptotic changes when compared to the control group (54.8 +/- 1.7, 51.5 +/- 3.2 at 12, 24 h in control group, 24.8 +/- 2.6, 20.5 +/- 1.4 at 12, 24 h in treated group, p< 0.05). The early decline in serum Mg2+ and the increase in the amount of Ca2+/Mg2+ immediately following brain trauma uncovered by these findings suggest that they may be a critical factor in the development of irreversible tissue injury. If this proves to be the case, treatment with MgSO4 may be effective in improving histological findings following experimental traumatic brain injury in rats.

The Hemodynamic Effects of MgSO4 during Coronary Artery Bypass Surgery with Cardiopulmonary Bypass / 대한마취과학회지

BACKGROUND: Reperfusion injury often develops after cardiopulmonary bypass (CPB) during coronary artery bypass grafting (CABG), and MgSO4 is known to be related to such injury. The goal of this study was to determine the hemodynamic and oxygen metabolic effects of administering MgSO4 after cessating cardiopulmonary bypass during coronary bypass surgery in control and nicardipine infusion groups. METHODS: After obtaining hospital ethics committee clearance, we studied 29 patients with coronary artery disease scheduled for CABG, who were randomly assigned to receive nicardipine (0.5 microgram/kg/min, n = 11) or placebo (n = 18). All patients were administered MgSO4 (60 mg/kg) after the cessation of CPB. The hemodynamic variables and oxygen parameters were recorded and calculated by continuous cardiac output and mixed venous oxygen saturation monitoring, through a thermodilution Swan-Ganz catheter before and 20 minutes after MgSO4 administration. RESULTS: Heart rate was reduced after administering MgSO4 in both groups, and the mean arterial pressure was also reduced in the nicardipine group. The cardiac index, systemic vascular resistance index, pulmonary vascular resistance index, right and left stroke work indices were well-maintained after administering MgSO4. Mixed venous oxygen saturation and other oxygen parameters were maintained without change after MgSO4 administration. CONCLUSIONS: The present study shows that MgSO4 can be used without inducing any significant oxygen metabolism or hemodynamic derangements during CABG. But further work is needed to elucidate the myocardial protective effects of MgSO4.

Effects of Magnesium sulfate on the expression of caspase-3 and caspase-9 of cytotrophoblasts under hypoxic condition / 대한산부인과학회잡지

OBJECTIVE: To determine the effect of magnesium sulfate (MgSO4) on the expression of caspase-3 and caspase-9 of cytotrophoblasts in vitro under normal and hypoxic condition as assessed immunoblot analyses. METHODS: Normal cytotrophoblasts were isolated from second trimester placentas and cultured in several physiologically relevant concentrations of MgSO4 under standard tissue culture condition (20% O2) or hypoxic condition (1-2% O2). Cytotrophoblasts apoptosis was estimated by TUNEL staining and by immunoblotting for Caspase-9 and Caspase-3. RESULTS: The apoptotic index was highest in cytotrophoblasts cultured under hypoxic conditions for 36 hour in the absence of MgSO4 and was showed decreasing tendency by the addition of MgSO4 under the same condition. The expression of Caspase-9 did not change under both standard condition and hypoxic condition with increasing MgSO4 concentrations, but the expression of Caspase-3 decreased under hypoxic condition with increasing of MgSO4 concentrations. CONCLUSION: MgSO4 might protect cytotrophoblasts from apoptosis under hypoxic condition.

Effects of Magnesium Sulfate on the Apoptosis and Invasion of Cytotrophoblasts under Hypoxic Condition / 대한산부인과학회잡지

OBJECTIVE: To determine the effect of magnesium sulfate (MgSO4) on the apoptosis and invasion of cytotrophoblasts in vitro under normal and hypoxic condition as assessed immunoblot analyses of Bcl-2/Bax, invasion assay and immunohistochemical staining of integrin alpha1. METHODS: Normal cytotrophoblasts were isolated from second trimester placentas and cultured in several physiologically relevant concentrations of MgSO4 under control tissue culture condition (20% O2) or hypoxic condition (1-2% O2). Apoptosis of cytotrophoblasts was estimated by immunoblotting for Bcl-2/Bax, invasiveness was estimated by invasion assay and immunohistochemical staining of Integrin alpha1. RESULTS: The expression of Bcl-2 did not change under standard condition, but it decreased under hypoxic condition with increasing of MgSO4 concentrations. The expression of Bax did not change under both standard condition and hypoxic condition with increasing MgSO4 concentrations. The invasiveness of cytotrophoblasts significantly decreased under both control and hypoxic conditions with increasing of MgSO4 concentrations. The expression of Integrin alpha1 immumohistochemical staining significantly decreased under control condition and showed decreasing tendency under hypoxic condition with increasing of MgSO4 concentrations. CONCLUSION: MgSO4 might induce cytotrophoblasts to the apoptosis and inhibit invasion of cytotrophoblasts under hypoxic condition.

Effects of MgSO4 on Cerebral Infarction after Permanent Middle Cerebral Artery Occlusion in Rat

OBJECTIVE: This study is aimed to prove the neuroprotective effect of magnesium ion, which is known to have competitive action against calcium influx in the process of neuronal damage. METHODS: One hundred twenty five male Sprague-Dawley rats weighing 300-350gm were divided into control and MgSO4 injected groups. Middle cerebral artery occlusion was induced by nylon insertion near internal carotid artery bifurcation via external carotid artery. Forty rats which were alive for 48 hours after the induction of cerebral infarction were drawn from each group. Thirty minutes after the induction of cerebral infarction, 750mumol/Kg of MgSO4 was intramuscullary injected for the experimental group and same amount of normal saline was injected for the control group. Each group was subdivided into groups of 20 rats 48 hours after the cerebral infarction. Brain-sections of a subgroup were obtained after transcardially perfusion of 2% 2', 3', 5'-triphenyl-tetrazolium chloride and infarction volume was measured using imaging analysis program. Brain-sections of the other subgroup were stained with terminal deoxynucleotidyl-transferase-mediated biotin dUTP nick end labeling(TUNEL) and apoptotic index(AI) was estimated. RESULTS: The volume of cerebral infarction of the control and MgSO4 injected groups were 52.44+/-5.68% and 38.38+/-9.02% respectively, and the infarction volume was significantly reduced in MgSO4 injected group(p<0.001). Brain edema volume were 209.01+/-75.41mm3 in control group and 140.7+/-81.89mm3 in MgSO4 injected group that was a significant reduction in MgSO4 injected group(p<0.001). AI of 53.68+/-6.38 for control group and 29.80+/-6.77 for MgSO4 injected group were estimated and MgSO4 injected groups showed a significant reduction(p<0.001). CONCLUSION: Magnesium ion has neuroprotective effect in reduction of cerebral infarction volume, brain edema volume and AI. In the future, various attempts to prove protecting mechanism of magnesium ion should be made and TUNEL stain is thought to be an effective comparison method in such studies.