Does post-cardiac surgery magnesium supplementation improve outcome?

Hypomagnesemia has been linked with increased morbidity and mortality in critically ill patients. Since the condition is common after cardiopulmonary bypass surgery, the objective of this study was to determine whether magnesium supplementation in the immediate postoperative period may improve outcomes of patients undergoing cardiac surgery with cardiopulmonary bypass. This prospective, randomized, double-blind, placebo-controlled study was conducted in a third-level, cardiac surgery intensive care unit (ICU) at a university hospital. Two hundred and sixteen patients undergoing elective cardiac surgery with cardiopulmonary bypass were randomized to receive either an intravenous bolus of 1.5 g of magnesium sulphate followed by an infusion of 12 g of the same salt in 24 h (105 patients), or placebo (111 patients) administered according to the same schedule as the treatment group. No significant differences were found either in the primary end point (hours of intubation) or in the secondary end points (length of inotropic support, new atrial fibrillation, ventricular tachycardia or ventricular fibrillation, length of intensive care unit stay, or ICU or hospital mortality). Hypomagnesemia was present in 12% of patients on admission to the intensive care unit. The magnesium group had a greater need for pacemaker stimulation. In conclusion, under the conditions of the present study, magnesium supplementation after cardiac surgery with cardiopulmonary bypass does not favourably affect clinical outcomes.

Intravitreal infliximab in patients with macular degeneration who are nonresponders to antivascular endothelial growth factor therapy.

PURPOSE: The purpose of this study was to determine the efficacy and safety of intravitreal infliximab in the treatment of choroidal neovascularization secondary to age-related macular degeneration in patients who are nonresponders to antivascular endothelial growth factor therapy. METHODS: Prospective, noncomparative, interventional case series. The primary inclusion criteria for patients consisted of previous treatment with five or more intravitreal injections of bevacizumab and/or ranibizumab, visual loss, angiographic leakage, and intraretinal and/or subretinal fluid on spectral domain optical coherence tomography. At Day 0, a single intravitreal injection of infliximab (2 mg/0.05 mL) was administered. Best-corrected visual acuity testing measured with Early Treatment Diabetic Retinopathy Study charts and spectral domain optical coherence tomography scans were performed on Days 0, 3, 7, 30, 60, and 90. Fluorescein angiography was performed at days 0 and 90. The development of systemic antibodies against infliximab (human antichimeric antibodies) was not sought. Main outcome measures were changes in best-corrected visual acuity, foveal thickness, and lesion size. RESULTS: We included four patients. At Day 90, the best-corrected visual acuity change was -18, +3, +4, and -4 letters, respectively. Intraretinal and/or subretinal fluid on spectral domain optical coherence tomography scans was not significantly reduced in any case. Lesion size was not reduced in any case. Two patients developed intraocular inflammation with high intraocular pressure 3 and 5 weeks after the infliximab injection, respectively. One case was controlled with topical medication, and one case required posterior vitrectomy. CONCLUSION: Intravitreal infliximab showed no significant visual or anatomical benefit for the treatment of choroidal neovascularization secondary to age-related macular degeneration in patients who were nonresponders to antivascular endothelial growth factor therapy. In addition, half of the cases developed intraocular inflammation.