Magnesium and Human Health: Perspectives and Research Directions

Magnesium is the fourth most abundant cation in the body. It has several functions in the human body including its role as a cofactor for more than 300 enzymatic reactions. Several studies have shown that hypomagnesemia is a common electrolyte derangement in clinical setting especially in patients admitted to intensive care unit where it has been found to be associated with increase mortality and hospital stay. Hypomagnesemia can be caused by a wide range of inherited and acquired diseases. It can also be a side effect of several medications. Many studies have reported that reduced levels of magnesium are associated with a wide range of chronic diseases. Magnesium can play important therapeutic and preventive role in several conditions such as diabetes, osteoporosis, bronchial asthma, preeclampsia, migraine, and cardiovascular diseases. This review is aimed at comprehensively collating the current available published evidence and clinical correlates of magnesium disorders.

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Enablers and challenges of caring in the Intensive Care Unit--Part 2: In relation to nurses

Journal of Nursing Education and Practice ◽

10.5430/jnep.v12n2p18 ◽

2021 ◽

Vol 12 (2) ◽

pp. 18

Author(s):

Hanan Subhi Al-Shamaly

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Quality Care ◽

Optimal Level ◽

Ethnographic Study ◽

Personal Factors ◽

Team Members ◽

Educational Backgrounds ◽

Wide Range ◽

Different Sources

The concept of caring is vague and complex, especially in critical environments such as the intensive care unit (ICU), where technological dehumanisation is a challenge for nurses. ICU nursing care includes not only patients but also extends to patients’ families, nurses, other health team members and the unit’s environment. Caring in critical care settings is affected by enabling and impeding factors. To explore these enablers and challenges factors, a focused ethnographic study was conducted in an Australian ICU. The data was collected from 35 registered nurses through various resources: participants' observations, documents reviews, interviews, and additional participants’ notes. Data were analysed inductively and thematically. The study outlines comprehensively and widely a wide range of enablers and challenges affecting caring in the ICU - which originate from different sources such as patients, families, nurses, and the ICU environment. This paper is the second in a two-part series which explores the ICU nurses’ experiences and perspectives of the enablers and challenges of caring in the ICU. Part 1 was concerned with the enablers and challenges to caring that are related to ICU patients, families, and environment. While Part 2 introduces readers to the enablers and challenges factors that are concerned with the nurses in ICU. These factors include nurses’ educational backgrounds and professional experience, employment working factors, leadership styles, relationships, and personal factors. Nurses and other stakeholders such as clinicians, educators, researchers, managers, and policymakers need to recognize these factors and their implications for providing quality care, in order to enhance and maintain the optimal level of caring in the ICU.

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Cardiovascular Diseases and COVID-19 Mortality and Intensive Care Unit Admission: A Systematic Review and Meta-analysis

10.1101/2020.04.12.20062869 ◽

2020 ◽

Cited By ~ 3

Author(s):

Amir Shamshirian ◽

Keyvan Heydari ◽

Reza Alizadeh-Navaei ◽

Mahmood Moosazadeh ◽

Saeed Abrotan ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Cardiovascular Disease ◽

Intensive Care Unit ◽

Intensive Care ◽

Cardiovascular Diseases ◽

Meta Analysis ◽

Cardiac Injury ◽

Icu Admission ◽

The World

AbstractImportanceOn 11th March, the World Health Organization declared a pandemic of COVID-19. There are over 1 million cases around the world with this disease and it continues to raise. Studies on COVID-19 patients have reported high rate of cardiovascular disease (CVD) among them and patients with CVD had higher mortality rate.ObjectivesSince there were controversies between different studies about CVD burden in COVID-19 patients, we aimed to study cardiovascular disease burden among COVID-19 patients using a systematic review and meta-analysis.Data SourcesWe have systematically searched databases including PubMed, Embase, Cochrane Library, Scopus, Web of Science as well as medRxiv pre-print database. Hand searched was also conducted in journal websites and Google Scholar.Study SelectionStudies reported cardiovascular disease among hospitalized adult COVID-19 patients with mortality or ICU admission (primary outcomes) were included into meta-analysis. In addition, all of studies which reported any cardiovascular implication were included for descriptive meta-analysis. Cohort studies, case-control, cross-sectional, case-cohort and case series studies included into the study. Finally, 16 studies met the inclusion criteria for primary outcome and 59 studies for descriptive outcome.Data Extraction and SynthesisTwo investigators have independently evaluated quality of publications and extracted data from included papers. In case of disagreement a supervisor solved the issue and made the final decision. Quality assessment of studies was done using Newcastle-Ottawa Scale tool. Heterogeneity was assessed using I-squared test and in case of high heterogeneity (>%50) random effect model was used.Main Outcomes and MeasuresMeta-analyses were carried out for Odds Ratio (OR) of mortality and Intensive Care Unit (ICU) admission for different CVDs and Standardized Mean Difference (SMD) was calculated for Cardiac Troponin I. We have also performed a descriptive meta-analysis on different CVDs.ResultsSixteen papers including 3473 patients entered into meta-analysis for ICU admission and mortality outcome and fifty-nine papers including 9509 patients for descriptive outcomes. Results of meta-analysis indicated that acute cardiac injury, (OR: 15.94, 95% CI 2.31-110.14), hypertension (OR: 1.92, 95% CI 1.92-2.74), heart Failure (OR: 11.73, 95% CI 5.17-26.60), other cardiovascular disease (OR: 1.95, 95% CI 1.17-3.24) and overall CVDs (OR: 3.37, 95% CI 2.06-5.52) were significantly associated with mortality in COVID-19 patients. Arrhythmia (OR: 22.17, 95%CI 4.47-110.04), acute cardiac injury (OR: 19.83, 95%CI 7.85-50.13), coronary heart disease (OR: 4.19, 95%CI 1.27-13.80), cardiovascular disease (OR: 4.17, 95%CI 2.52-6.88) and hypertension (OR: 2.69, 95%CI 1.55-4.67) were also significantly associated with ICU admission in COVID-19 patients.ConclusionOur findings showed a high burden of CVDs among COVID-19 patients which was significantly associated with mortality and ICU admission. Proper management of CVD patients with COVID-19 and monitoring COVID-19 patients for acute cardiac conditions is highly recommended to prevent mortality and critical situations.Key PointsQuestionAre cardiovascular disease associated with mortality and Intensive Care Unit admission (ICU) of COVID-19 patients?FindingsIn this systematic review and meta-analysis, acute cardiac injury, hypertension, heart failure and overall cardiovascular diseases were significantly associated with mortality in COVID-19 patients. Arrhythmia, coronary heart disease, hypertension, acute cardiac injury and other cardiovascular disease were significantly associated with ICU admission of COVID-19 patients.MeaningCardiovascular diseases have significant role in mortality and disease severity of COVID-19 patients. COVID-19 patients need to be carefully monitored for cardiovascular diseases and managed properly in case of acute cardiac conditions.

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Platelet-Lymphocyte Ratio as a New Predictor of In-hospital Mortality in Cardiac Intensive Care Unit Patients

10.21203/rs.3.rs-763264/v1 ◽

2021 ◽

Author(s):

Guangyao Zhai ◽

Biyang Zhang ◽

Jianlong Wang ◽

Yuyang Liu ◽

Yujie Zhou

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Cardiovascular Diseases ◽

Hospital Mortality ◽

Subgroup Analysis ◽

Cardiac Intensive Care Unit ◽

Lymphocyte Ratio ◽

Platelet Lymphocyte Ratio ◽

Cardiac Intensive Care ◽

The Relationship

Abstract Background: It has been discovered that both inflammation and platelet aggregation could cause crucial effect on the occurrence and development of cardiovascular diseases. As a combination of platelet and lymphocyte, platelet-lymphocyte ratio (PLR) was proved to be correlated with the severity as well as prognosis of cardiovascular diseases. Exploring the relationship between PLR and in-hospital mortality in cardiac intensive care unit (CICU) patients was the purpose of this study. Method: PLR was calculated by dividing platelet count by lymphocyte count. All patients were grouped by PLR quartiles and the primary outcome was in-hospital mortality. The independent effect of PLR was determined by binary logistic regression analysis. The curve in line with overall trend was drawn by local weighted regression (Lowess). Subgroup analysis was used to determine the relationship between PLR and in-hospital mortality in different subgroups. Result: We included 5577 CICU patients. As PLR quartiles increased, in-hospital mortality increased significantly (Quartile 4 vs Quartile 1: 13.9 vs 8.3, P <0.001). After adjusting for confounding variables, PLR was proved to be independently associated with increased risk of in-hospital mortality (Quartile 4 vs Quartile 1: OR, 95% CI: 1.99, 1.46-2.71, P<0.001, P for trend <0.001). The Lowess curves showed a positive relationship between PLR and in-hospital mortality. The subgroup analysis revealed that patients with low Acute Physiology and Chronic Health Evaluation IV (APACHE IV) or with less comorbidities had higher risk of mortality for PLR. Further, PLR quartiles had positive relation with length of CICU stay (Quartile 4 vs Quartile 1: 2.7, 1.6-5.2 vs 2.1, 1.3-3.9, P<0.001), and the length of hospital stay (Quartile 4 vs Quartile 1: 7.9, 4.6-13.1 vs 5.8, 3.3-9.8, P<0.001). Conclusion: PLR was independently associated with in-hospital mortality in CICU patients.

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CASE STUDY: ORGANOPHOSPHATE POISONING – ATROPINE-INDUCED PSYCHOSIS IN INTENSIVE CARE UNIT PATIENT

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2021.v14i1.39921 ◽

2021 ◽

pp. 3-4

Author(s):

VATHSALYA PORANKI

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Patient ◽

Rural Areas ◽

Postsynaptic Membrane ◽

The Body ◽

Organophosphate Poisoning ◽

Competitive Antagonist ◽

Organophosphorus Poisoning

Organophosphate compounds are used as commercial insecticides and applied as aerosols or dust. Consuming these compounds intentionally or unintentionally lead to dangerous conditions even to fatality. The most common obstacle in treating organophosphorus poisoning is the availability of sufficient medical care, equipment to provide proper emergency care observed in rural areas where there is a lot of gap between intensive care and acute care. Atropine use is as an antidote in organophosphorus poisoning. The dose of atropine mainly depends on the organophosphorus toxic doses. Atropine is a competitive antagonist of acetylcholine at the muscarinic postsynaptic membrane. Atropine blocks all the muscarinic effects in the body. This study presents a case of organophosphorus poisoning treated with atropine leading to atropine psychosis. Patient’s conditions, outcomes, and improvements are studied.

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Mitigating emotional responses to stressors: coping strategies, modifiers and support

Australasian Psychiatry ◽

10.1177/10398562211047211 ◽

2021 ◽

pp. 103985622110472

Author(s):

D. Dennis ◽

P.V van Heerden ◽

C. Knott ◽

R. Khanna

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Coping Strategies ◽

Emotional Responses ◽

Well Being ◽

Environmental Stressors ◽

Professional Help ◽

Wide Range ◽

Audio Recordings ◽

Emerging Themes

Objective: The stressful nature of the intensive care unit (ICU) environment is increasingly well characterised. The aim of this paper was to explore modifiers, coping strategies and support pathways identified by experienced Intensivists, in response to these stressors. Method: Prospective qualitative study employing interviews with Intensivists in two countries. Participants were asked how they mitigated their emotional responses to the stressors of the ICU. Audio-recordings were transcribed and analysed by all researchers who agreed upon emerging themes and subthemes. Results: A wide range of strategies were reported. Although several participants had sought professional help and all supported its utility, few disclosed accessing such help to others indicating stigma. Many felt a sense of responsibility for the well-being of other staff but identified barriers that suggest alternate support pathways are required. Further implications of these findings to training considerations are described. Conclusions: Several approaches were described as regularly employed by Intensivists to mitigate ICU environmental stressors. Intensivists perceive themselves to have limited training to provide support to others; they also perceive stigma in seeking professional help.

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The “Flipped Classroom” Model for Teaching in the Intensive Care Unit

Journal of Intensive Care Medicine ◽

10.1177/0885066616632156 ◽

2016 ◽

Vol 32 (3) ◽

pp. 187-196 ◽

Cited By ~ 24

Author(s):

Christopher R. Tainter ◽

Nelson L. Wong ◽

Gaston A. Cudemus-Deseda ◽

Edward A. Bittner

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Learning Environment ◽

Flipped Classroom ◽

Point Of Care ◽

Perceived Usefulness ◽

Successful Implementation ◽

Education Curriculum ◽

Patient Acuity ◽

Wide Range

Introduction: The intensive care unit (ICU) is a dynamic and complex learning environment. The wide range in trainee’s experience, specialty training, fluctuations in patient acuity and volume, limitations in trainee duty hours, and additional responsibilities of the faculty contribute to the challenge in providing a consistent experience with traditional educational strategies. The “flipped classroom” is an educational model with the potential to improve the learning environment. In this paradigm, students gain exposure to new material outside class and then use class time to assimilate the knowledge through problem-solving exercises or discussion. The rationale and pedagogical foundations for the flipped classroom are reviewed, practical considerations are discussed, and an example of successful implementation is provided. Methods: An education curriculum was devised and evaluated prospectively for teaching point-of-care echocardiography to residents rotating in the surgical ICU. Results: Preintervention and postintervention scores of knowledge, confidence, perceived usefulness, and likelihood of use the skills improved for each module. The quality of the experience was rated highly for each of the sessions. Conclusion: The flipped classroom education curriculum has many advantages. This pilot study was well received, and learners showed improvement in all areas evaluated, across several demographic subgroups and self-identified learning styles.

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Epidemiological Study of Mortality Caused by Road Accidents in the Intensive Care Unit of Besat Educational-medical Hospital in Hamadan

Journal of Biostatistics and Epidemiology ◽

10.18502/jbe.v6i3.5104 ◽

2021 ◽

Author(s):

Hiva Azami ◽

Mehrdad Maleki Jamasbi ◽

Mina Mohammadpour Bayati ◽

Zahra Bakhtiari ◽

Shiva Mohammadpour Bayati ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Health Planning ◽

Night Shift ◽

Education Level ◽

P Value ◽

Road Accidents ◽

Cross Sectional ◽

Wide Range ◽

Single Men

Introduction: Road accidents are one of the causes of death and it's important to investigate the epidemiological indicators in this context. In this regard, this study aimed to determine the epidemiological causes of road accident mortality in the intensive care unit of Besat Educational-medical Hospital in Hamadan during Nowruz Holidays 2018. Material and Methods: In this descriptive cross-sectional study, data of the patients died for 13 days in Nowruz Holidays in the intensive care unit of Besat Hospital in Hamadan, by census method, was extracted from the medical records of patients by using a checklist from a researcher-made questionnaire. Data were analyzed by Fisher's exact test and SPSS 21 software. Results: Of the 28 Patient admitted to the intensive care unit,16 patients died. Most deaths were in the third decade of life, among single men, with a self-employment job, with diploma education level or cycle education level, with more than 10 days of hospitalization and in the night shift. Based on the results, most of the dead persons were rider (81.25%), suffered head trauma (50%), with head surgery (56.25%), without any underlying illness (93.75%) and without successful experience of cardiopulmonary resuscitation (87.5%). There were no statistically significant differences between the variables and mortality rate (P value > 0/05). Conclusion: Young single men with low level of education are a wide range of road accidents victims. Therefore, it seems it's necessary to reduce mortality from these accidents, health planning such as traffic culture training and driving rules, by using social media, should focus on learning and improving the level of community awareness, especially in this group of people.

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Platelet-lymphocyte ratio as a new predictor of in-hospital mortality in cardiac intensive care unit patients

Scientific Reports ◽

10.1038/s41598-021-02686-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Guangyao Zhai ◽

Jianlong Wang ◽

Yuyang Liu ◽

Yujie Zhou

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Cardiovascular Diseases ◽

Hospital Mortality ◽

Subgroup Analysis ◽

Cardiac Intensive Care Unit ◽

Lymphocyte Ratio ◽

Platelet Lymphocyte Ratio ◽

Cardiac Intensive Care ◽

The Relationship

AbstractIt has been discovered that both inflammation and platelet aggregation could cause crucial effect on the occurrence and development of cardiovascular diseases. As a combination of platelet and lymphocyte, platelet-lymphocyte ratio (PLR) was proved to be correlated with the severity as well as prognosis of cardiovascular diseases. Exploring the relationship between PLR and in-hospital mortality in cardiac intensive care unit (CICU) patients was the purpose of this study. PLR was calculated by dividing platelet count by lymphocyte count. All patients were grouped by PLR quartiles and the primary outcome was in-hospital mortality. The independent effect of PLR was determined by binary logistic regression analysis. The curve in line with overall trend was drawn by local weighted regression (Lowess). Subgroup analysis was used to determine the relationship between PLR and in-hospital mortality in different subgroups. We included 5577 CICU patients. As PLR quartiles increased, in-hospital mortality increased significantly (Quartile 4 vs. Quartile 1: 13.9 vs. 8.3, P < 0.001). After adjusting for confounding variables, PLR was proved to be independently associated with increased risk of in-hospital mortality (Quartile 4 vs. Quartile 1: OR 95% CI 1.55, 1.08–2.21, P = 0.016, P for trend < 0.001). The Lowess curves showed a positive relationship between PLR and in-hospital mortality. The subgroup analysis revealed that patients with low Acute Physiology and Chronic Health Evaluation IV (APACHE IV) or with less comorbidities had higher risk of mortality for PLR. Further, PLR quartiles had positive relation with length of CICU stay (Quartile 4 vs. Quartile 1: 2.7, 1.6–5.2 vs. 2.1, 1.3–3.9, P < 0.001), and the length of hospital stay (Quartile 4 vs. Quartile 1: 7.9, 4.6–13.1 vs. 5.8, 3.3–9.8, P < 0.001). PLR was independently associated with in-hospital mortality in CICU patients.

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Monitoring Approach of Fatality Risk Factors for Patients with Severe Acute Pancreatitis Admitted to the Intensive Care Unit. A Retrospective, Monocentric Study

Diagnostics ◽

10.3390/diagnostics11112013 ◽

2021 ◽

Vol 11 (11) ◽

pp. 2013

Author(s):

Tudorel Mihoc ◽

Cristi Tarta ◽

Ciprian Duta ◽

Raluca Lupusoru ◽

Greta Dancu ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Acute Pancreatitis ◽

Intensive Care ◽

Severe Acute Pancreatitis ◽

Fatal Outcome ◽

Factors Associated ◽

Reactive Protein ◽

Wide Range ◽

Secondary Objective

Acute pancreatitis is an unpredictable disease affecting the pancreas and it is characterized by a wide range of symptoms and modified lab tests, thus there is a continuing struggle to classify this disease and to find risk factors associated with a worse outcome. The main objective of this study was to identify the risk factors associated with the fatal outcome of the intensive care unit’s patients diagnosed and admitted for severe acute pancreatitis, the secondary objective was to investigate the prediction value for the death of different inflammatory markers at the time of their admission to the hospital. This retrospective study included all the patients with a diagnosis of acute pancreatitis admitted to the Intensive Care Unit of the Emergency County Hospital Timisoara between 1 January 2016 and 31 May 2021. The study included 53 patients diagnosed with severe acute pancreatitis, out of which 21 (39.6%) survived and 32 (60.4%) died. For the neutrophils/lymphocytes ratio, a cut-off value of 12.4 was found. When analyzing age, we found out that age above 52 years old can predict mortality, and for the platelets/lymphocytes ratio, a cut-off value of 127 was found. Combining the three factors we get a new model for predicting mortality, with an increased performance, AUROC = 0.95, p < 0.001. Multiple persistent organ failure, age over 50, higher values of C reactive protein, and surgery were risk factors for death in the patients with severe acute pancreatitis admitted to the intensive care unit. The model design from the neutrophils/lymphocytes ratio, platelets/lymphocytes ratio, and age proved to be the best in predicting mortality in severe acute pancreatitis.

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Pembrolizumab-induced autoimmune haemolytic anaemia and cholangitis

BMJ Case Reports ◽

10.1136/bcr-2019-232505 ◽

2019 ◽

Vol 12 (12) ◽

pp. e232505 ◽

Cited By ~ 1

Author(s):

Harriet Williams ◽

Robin Aitchison

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Haemolytic Anaemia ◽

De Novo ◽

Checkpoint Inhibitors ◽

Autoimmune Haemolytic Anaemia ◽

Dermatological Disease ◽

Wide Range ◽

Life Threatening ◽

Life Threatening Complication

Increasing numbers of patients are now offered immunotherapy as part of their cancer treatment. These treatments, while often very effective, have a wide range of adverse effects that are distinct from those of traditional chemotherapy regimens. Thyroid disease, dermatological disease, colitis and pneumonitis are some of the most commonly reported immune side effects. We present a case of life-threatening de novo autoimmune haemolytic anaemia (AIHA) complicated by immune cholangitis induced by pembrolizumab. An 81-year-old woman with metastatic melanoma completed a two-year course of pembrolizumab in August 2018 and six weeks later presented to hospital with jaundice. Admission haemoglobin (Hb) was 91 g/L, rapidly decreasing to 31 g/L, at which point she required admission to the intensive care unit. AIHA is a rare but potentially life-threatening complication of checkpoint inhibitors and should be considered in patients presenting with anaemia during or after immunotherapy treatment.

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