Importance of Magnesium Status in COVID-19.

A large amount of published research points to the interesting concept (hypothesis) that magnesium (Mg) status may have relevance for the outcome of COVID-19 and that Mg could be protective during the COVID disease course. As an essential element, Mg plays basic biochemical, cellular, and physiological roles required for cardiovascular, immunological, respiratory, and neurological functions. Both low serum and dietary Mg have been associated with the severity of COVID-19 outcomes, including mortality; both are also associated with COVID-19 risk factors such as older age, obesity, type 2 diabetes, kidney disease, cardiovascular disease, hypertension, and asthma. In addition, populations with high rates of COVID-19 mortality and hospitalization tend to consume diets high in modern processed foods, which are generally low in Mg. In this review, we review the research to describe and consider the possible impact of Mg and Mg status on COVID-19 showing that (1) serum Mg between 2.19 and 2.26 mg/dL and dietary Mg intakes > 329 mg/day could be protective during the disease course and (2) inhaled Mg may improve oxygenation of hypoxic COVID-19 patients. In spite of such promise, oral Mg for COVID-19 has thus far been studied only in combination with other nutrients. Mg deficiency is involved in the occurrence and aggravation of neuropsychiatric complications of COVID-19, including memory loss, cognition, loss of taste and smell, ataxia, confusion, dizziness, and headache. Potential of zinc and/or Mg as useful for increasing drug therapy effectiveness or reducing adverse effect of anti-COVID-19 drugs is reviewed. Oral Mg trials of patients with COVID-19 are warranted.

Lessons learned after one year of COVID-19 from a urologist and radiotherapist view: A German survey on prostate cancer diagnosis and treatment.

INTRODUCTION: Since the beginning of the pandemic in 2020, COVID-19 has changed the medical landscape. International recommendations for localized prostate cancer (PCa) include deferred treatment and adjusted therapeutic routines. MATERIALS AND METHODS: To longitudinally evaluate changes in PCa treatment strategies in urological and radiotherapy departments in Germany, a link to a survey was sent to 134 institutions covering two representative baseline weeks prior to the pandemic and 13 weeks from March 2020 to February 2021. The questionnaire captured the numbers of radical prostatectomies, prostate biopsies and case numbers for conventional and hypofractionation radiotherapy. The results were evaluated using descriptive analyses. RESULTS: A total of 35% of the questionnaires were completed. PCa therapy increased by 6% in 2020 compared to 2019. At baseline, a total of 69 radiotherapy series and 164 radical prostatectomies (RPs) were documented. The decrease to 60% during the first wave of COVID-19 particularly affected low-risk PCa. The recovery throughout the summer months was followed by a renewed reduction to 58% at the end of 2020. After a gradual decline to 61% until July 2020, the number of prostate biopsies remained stable (89% to 98%) during the second wave. The use of RP fluctuated after an initial decrease without apparent prioritization of risk groups. Conventional fractionation was used in 66% of patients, followed by moderate hypofractionation (30%) and ultrahypofractionation (4%). One limitation was a potential selection bias of the selected weeks and the low response rate. CONCLUSION: While the diagnosis and therapy of PCa were affected in both waves of the pandemic, the interim increase between the peaks led to a higher total number of patients in 2020 than in 2019. Recommendations regarding prioritization and fractionation routines were implemented heterogeneously, leaving unexplored potential for future pandemic challenges.

The relevance of magnesium homeostasis in COVID-19.

PURPOSE: In less than one and a half year, the COVID-19 pandemic has nearly brought to a collapse our health care and economic systems. The scientific research community has concentrated all possible efforts to understand the pathogenesis of this complex disease, and several groups have recently emphasized recommendations for nutritional support in COVID-19 patients. In this scoping review, we aim at encouraging a deeper appreciation of magnesium in clinical nutrition, in view of the vital role of magnesium and the numerous links between the pathophysiology of SARS-CoV-2 infection and magnesium-dependent functions. METHODS: By searching PubMed and Google Scholar from 1990 to date, we review existing evidence from experimental and clinical studies on the role of magnesium in chronic non-communicable diseases and infectious diseases, and we focus on recent reports of alterations of magnesium homeostasis in COVID-19 patients and their association with disease outcomes. Importantly, we conduct a census on ongoing clinical trials specifically dedicated to disclosing the role of magnesium in COVID-19. RESULTS: Despite many methodological limitations, existing data seem to corroborate an association between deranged magnesium homeostasis and COVID-19, and call for further and better studies to explore the prophylactic or therapeutic potential of magnesium supplementation. CONCLUSION: We propose to reconsider the relevance of magnesium, frequently overlooked in clinical practice. Therefore, magnesemia should be monitored and, in case of imbalanced magnesium homeostasis, an appropriate nutritional regimen or supplementation might contribute to protect against SARS-CoV-2 infection, reduce severity of COVID-19 symptoms and facilitate the recovery after the acute phase.

Serum magnesium: time for a standardized and evidence-based reference range.

Magnesium deficiency can have serious health consequences. Low magnesium intake or low serum levels are risk factors for e.g. type 2 diabetes and cardiovascular diseases. Despite its scientifically recognized importance, too little attention is paid to magnesium in clinical practice. This may be due to the fact that there is no uniform and evidence-based reference range for serum magnesium as is the case for other electrolytes such as sodium and potassium. The serum magnesium concentration is also of a limited informative value, as it is maintained for a long time by releasing magnesium from body pools. A low serum magnesium is a definite sign of magnesium deficiency; however, values within the reference range do not rule out deficiencies. Nevertheless, serum magnesium should become part of routine diagnostics in order to be able to better detect deficiency states. For serum magnesium, a reference range of 0.75 to 0.95 mmol/L (1.82 to 2.31 mg/dL) can often be found. However, according to the current data situation, serum magnesium values of less than 0.85 mmol/L are associated with increased health risks. Therefore, the lower limit of the reference range should be raised to 0.85 mmol/L (2.07 mg/dL).

Take care or "German Angst"? Lessons from cancer care during COVID-19 pandemic in spring 2020.

OBJECTIVE: While the second wave of COVID-19 has started in Europe, data are still missing on the consequences of the first one for patients with cancer. The aim of our study was to learn more about the experiences of German patients and staff in the oncology services. MATERIALS AND METHODS: An anonymous online survey was conducted among cancer patients and their therapists (physicians, medical staff, psychologists, spiritual care givers) in Germany between April and May 2020 asking about burden, fears, and perceived changes in German oncology service system. Besides answer frequencies of different stakeholders, uni- and multivariate analyses were performed for selected items to identify areas of high impact. RESULTS: In total 752 participants were included. All groups have identified high mental burden as central problem. A majority was confused about varying information policies and strategies against the pandemic. Patient reported restricted visits, isolation and delay of treatment as central fears and problems. The majority of fears could be coped by the health care workers. The patients describe processes at the oncology services during the first wave. Personal experiences with COVID-19 have had no influence on the felt burden of the patients. Physicians, medical staff, psychologists and spiritual care givers were extremely stressed but repressed their own burden. They await financial, physical and mental problems for their own future. CONCLUSIONS: The presented personal views and experiences allow focusing the discussions about heath care systems during the on-going pandemic. Support for health care workers, as much routine as possible in oncology services, and transparency in information will be the keys for good management in futural situations of crisis.

Magnesium and COVID-19 - Some Further Comments - A Commentary on Wallace TC. Combating COVID-19 and Building Immune Resilience: A Potential Role for Magnesium Nutrition? J Am Coll Nutr. 2020;1-9. doi:10.1080/07315724.2020.1785971. Cited in: PMID: 32649272.

The paper "Combating COVID-19 and Building Immune Resilience: A Potential Role for Magnesium Nutrition?" by TC Wallace, which was published in the Journal of the American College of Nutrition highlights the importance of adequate magnesium (Mg) supply in relation to COVID-19. Wallace notes that Mg deficiency is associated with low-grade chronic inflammation. Furthermore, hypokalemia and a lack of active Vitamin D are consequences of a Mg deficit. In this way, Mg deficiency may exacerbate the course of COVID-19. Therefore, in patients with Covid-19 permanent monitoring of the Mg status and, if necessary, supplementation should be carried out. The possible importance of Mg in COVID-19 was only recently discussed also by Iotti et al. and the German Society for Magnesium Research e.V. Considering the meaningful connections between Mg and COVID-19 there are relevant research topics that should be addressed: Does Mg deficiency increase the risk of infection with COVID-19 or the risk of a severe course of the disease? Is there an increased prevalence of Mg deficiency in COVID-19 patients? Could Mg supplementation alleviate the course of the disease in COVID-19 or reduce complications? Does pharmacological induction of hypermagnesemia via intravenous Mg provide clinical benefits for COVID-19 patients in the intensive care unit (for example with regard to lung function or thromboembolism)?