Hypomagnesemia in the ICU - Does Correction Matter?

BACKGROUND: Magnesium is a cation that is constantly being rediscovered. A number of studies have linked low magnesium levels to poor outcome of critically ill patients. Despite this hypomagnesemia continues to be under-recognized and uncorrected. There are no studies, in our knowledge, that have assessed the impact of correction of hypomagnesaemia on the outcome of the ICU patient. AIMS AND OBJECTIVE: To determine the standard Mg levels in a healthy population sample and to correlate it with western data. To estimate the admission Mg levels in critically ill patients admitted to the ICU and to determine if routine correction of hypomagnesaemia altered their outcomes as compared with the retrospectively collected data of a similar group of patients admitted to the same ICU prior to the routine testing of Mg levels. This was an observational study carried out in the intensive care unit of a tertiary hospital in south India. RESULTS: The mean serum magnesium in a sample of healthy Indian population was noted to be 2.112 mg/dl, which is consistent with that of the western data. Among the critically ill admitted to the medical ICU, the incidence of Hypomagnesemia (defined as serum Mg+2 of ≤1.7mg/dl on admission), was 23.96%. The study group in whom serum Magnesium was routinely corrected, showed a decrease in the mean total duration of icu stay (94.265 vs. 99.443 hours with p=0.78); the need for mechanical ventilation (52.08% vs. 65.625%) and the duration of Mechanical Ventilation (36.64 vs. 58.75 hours with p=0.04). Mortality was significantly higher in the comparison group (p=0.01) (39.6% vs. 22.9%). CONCLUSIONS: The range of Magnesium levels in a healthy Indian population matches that of the west despite variations in diet and lifestyle. Routine screening and replacement of magnesium in critically ill patients with hypomagnesaemia resulted in reduction of morbidity and statistically significant reduction in overall ICU mortality.

Randomised controlled trial for efficacy of unfractionated heparin (UFH) versus low molecular weight heparin (LMWH) in thrombo-prophylaxis.

OBJECTIVE: To study if low dose Unfractionated heparin (UFH) is as effective and safe as Low-molecular weight heparin (LMWH) and also economical as a prophylactic agent for venous thromboembolism in medically ill patients. METHODOLOGY: A prospective double blind randomised controlled trial consisting of 92 patients fulfilling the inclusion criteria who were admitted to Bangalore Baptist Hospital, Bengaluru, between March 2008 and July 2009 were randomised to receive Unfractionated heparin (UFH) or Low-molecular weight heparin (LMWH). RESULTS: The result based on intention to treat (ITT)analysis with best outcome scenario: in the UFH arm there were 47 (97.9%) patients who had not developed DVT/PE as compared to 42 (95.5%) in the LMWH arm. The difference in proportion of patients who had not developed DVT/PE between UFH and LMWH was 2.4% (-5.0, 9.8). The results based on per protocol analysis: In the UFH arm there were 44 (97.8%) patients who had not developed DVT/PE as compared to 39 (95.1%) in the LMWH arm. The difference in proportion of patients who had not developed DVT/PE between the UFH and LMWH arm was 2.7% (-5.2, 10.5). Patients on UFH had higher major bleeding complications 4 (8.9%) as compared to 0 in LMWH arm. But with respect to other complications like thrombocytopenia (HIT) and mild or minimal bleeding both arms were comparable. CONCLUSION: This study has demonstrated that low dose UFH is as effective as LMWH as a prophylactic agent for venous thromboembolism in medically ill patients and economical also.

High or low- a trial of low dose anti snake venom in the treatment of poisonous snakebites.

OBJECTIVE: To demonstrate that use of lower doses of anti-snake venom is as effective as high doses and is associated with less complications and lower mortality especially in the wake of rising cost of medical treatment, the people most affected by snakebites being the poor farmers. METHODOLOGY: A prospective descriptive study consisting of 54 snakebite patients fulfilling the inclusion criteria who were admitted to Bangalore Baptist Hospital, Bengaluru, between November 2006 and November 2008 and were treated with a low dose ASV regime. The patients were initially given 2 vials of ASV followed later with 1 vial at a time according to clotting time. Any other supportive measures were undertaken as necessary. RESULTS: In this study the average dose of ASV required was only 6.70 +/- 3.24 vials. The complications--12.9% patients had ARF, and another 12.9% patients had neuropraralysis severe enough to require ventilatory support. There were 2 deaths (mortality of 3.7%) in the study. CONCLUSION: Low dose ASV regime in poisonous snakebites along with supportive treatment as necessary is as good as high dose regime, and has lesser adverse effects while reducing the cost of treatment too. Hence low dose regime can be used with beneficial results in poisonous snakebites.

Inhibition of a protein tyrosine phosphatase using mesoporous oxides.

The feasibility of utilizing mesoporous matrices of alumina and silica for the inhibition of enzymatic activity is presented here. These studies were performed on a protein tyrosine phosphatase by the name chick retinal tyrosine phosphotase-2 (CRYP-2), a protein that is identical in sequence to the human glomerular epithelial protein-1 and involved in hepatic carcinoma. The inhibition of CRYP-2 is of tremendous therapeutic importance. Inhibition of catalytic activity was examined using the sustained delivery of p-nitrocatechol sulfate (pNCS) from bare and amine functionalized mesoporous silica (MCM-48) and mesoporous alumina (Al(2)O(3)). Among the various mesoporous matrices employed, amine functionalized MCM-48 exhibited the best release of pNCS and also inhibition of CRYP-2. The maximum speed of reaction v(max) (=160 +/- 10 micromol/mnt/mg) and inhibition constant K(i) (=85.0 +/- 5.0 micromol) estimated using a competitive inhibition model were found to be very similar to inhibition activities of protein tyrosine phosphatases using other methods.

Crystallization and preliminary X-ray diffraction studies on the catalytic domain of the chick retinal neurite-inhibitory factor CRYP-2.

The receptor protein tyrosine phosphatase CRYP-2 has been shown to be an inhibitory factor for the growth of retinal axons in the chick. The extracellular receptor domain of CRYP-2 contains eight fibronectin repeats and studies using the extracellular domain alone demonstrated the chemorepulsive effect on retinal neurons. The precise role of the intracellular catalytic domain and the mechanism by which its activity is regulated is not known. Determination of the structure of the catalytic domain of CRYP-2 was proposed in an effort to understand the downstream signal transduction mechanism in this system. The cloning, expression, purification and crystallization of the catalytic domain of CRYP-2 are now reported. Preliminary crystallographic studies were performed on the diamond-shaped crystals, which grew under oil using the microbatch method at 298 K. Native X-ray diffraction data were collected to 2.9 A resolution on a home source. The crystals belong to the trigonal space group P3(1)21, with unit-cell parameters a = b = 68.26, c = 244.95 A. Assuming the presence of two molecules per asymmetric unit, the VM value was 2.7 A3 Da(-1) and the solvent content was 54.8%.