Tehran University Medical Journal

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Background: The present study designed to assess the effect of Mg+Zn, vitamin C+E, and combination of these micronutrients on glycemic control and insulin resistance in type 2 diabetic patients
Methods: In a randomized, double-blind, placebo controlled clinical trial, 69 type 2 diabetic patients were randomly divided into four groups, each group receiving one of the following daily supplement for 3 months group M: 200 mg and 30 mg Zn (n=16), group V: 200 mg vitamin C and 150 mg vitamin E (n=18), group MV: minerals plus vitamins (n=17), group P: placebo (n=18).Fasting blood glucose, fructosamine, HbA1c and serum insulin were measured at the beginning and at the end of 3 months supplementation. Insulin resistance was calculated by HOMA score. Treatment effects were analyzed by general linear modeling.
Results: After 3 months of supplementation fasting blood glucose decreased in MV group (165±46 vs 177±41 mg/dl, p=0.035). There was no significant change in fructoseamin, HbA1c, serum insulin or insulin resistance in treatment groups.
Conclusion: The results of the present study provide evidence for the effects of combination of Mg, Zn and vitamin C and E supplementations on improvement of fasting blood glucose but not fructosamine, HbA1c, serum insulin or insulin resistance in type 2 diabetic patients.

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Background: Propofol, an anesthetic noted to give rapid recovery, causes discomfort at the site of injection. A number of methods to reduce propofol-induced pain have been tried, including pretreatment with lidocaine, with varying results. Here, we evaluate the efficacy of magnesium sulfate compared to that of lidocaine and normal saline in mitigating propofol-induced pain.
Methods: One hundred ASA I and II adults, aged 20-50 years, scheduled for elective surgery requiring two IV lines with 20-gauge cannulae in the dorsum of each hand, were enrolled in this study. The patients were randomly placed into two groups of 50 patients. In each patient, one hand was the case study and other hand was the control. Group A received 10% magnesium sulfate in one hand and normal saline in the other hand. Group B received 10% magnesium sulfate in one hand and 1% lidocaine in the other hand. All injections had a volume of 2 ml. After 30 seconds, 2 cc of 1% propofol was injected simultaneously into each hand. Pain was assessed according to the VAS rating system, ranging from 0 (no pain) to 10 (the most severe pain), with a minimum interval of 3 as significant pain. Data were analyzed by chi-square and independent t tests. A P value <0.05 was considered significant.
Results: In Group A, the mean pain in the hand premedicated with magnesium was 1.46±1.07, compared to 4.54±2.15 for that of the other hand that had received normal saline (P=0.001). In group B, the mean pain in the hand that had received magnesium was 0.82±1.34, compared to 0.78±1.07 for that of the other hand, which had received lidocaine (P=0.86).
Conclusion: Intravenous magnesium and lidocaine pretreatments are equally effective in attenuating propofol-induced pain, and were better than normal saline in attenuating propofol-induced pain.

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Background: Magnesium Sulfate (MgSO4) has been used as a pharmacologic agent in different situations for many years in the treatment of tachyarrhythmias, myocardial ischemia, preeclampsia, and tocolysis among others. The analgesic effect of MgSO4 for postoperative pain has been used since the 1990s. Postoperative pain is one of the most common complications in the perioperative period and can result in serious consequences in different organs if left untreated. Inguinal herniorrhaphy is among the most common surgeries and is almost always accompanied by severe pain. The object of this study is to determine the effect of a pre-induction infusion of MgSO4 on the reduction of postsurgical pain after herniorrhaphy.
Methods: This double-blind, randomized clinical trial included 105 ASA class I and class II herniorrhaphy patients at Shariati Hospital in years 2004 and 2005. For statistical analysis, the 2 and T tests were used. The patients were divided into three groups based on block randomization. Patients in the following groups received: Group A, 200 ml of normal saline infusion (placebo) Group B, 25 mg/kg MgSO4 in 200 ml of normal saline Group C, 50 mg/kg MgSO4 in 200 ml of normal saline. All groups were infused twenty minutes before induction of anesthesia using identical methods and dosage in all three groups. Heart rate and mean arterial pressure (MAP) at pre- and postintubation and so at skin incision time were charted. Visual analog scale (VAS) pain score, nausea, vomiting and the amount of morphine used before recovery room discharge and in six, twelve and twenty-four hours after recovery discharge was recorded.
Results: The average age for the different groups was as follows: Group A: 33.6, Group B: 37.37, Group C: 32.74. Nausea and vomiting between the case and control groups were not statistically different (60% vs. 71.4%, p=0.0499), nor was the amount of Morphine used. On recovery room discharge, the VAS scores were 8.1, 7.2, and 5.5 for the first, second and third groups, respectively (P<0.001). However, no statistical significance was found for the VAS scores six hours after recovery room discharge.
Conclusion: The results in this study show that pre-induction with MgSO4 has no remarkable effect on decreasing postoperative pain or morphine use for inguinal herniorrhaphy.

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Background: Over the past two decades we have seen a marked increase in the survival of very low birth weight infants. This increase in survival has been attributed to increased use of corticosteroids, regionalization of perinatal care, improved methods of mechanical ventilation, availability of exogenous surfactant, and improved nutritional therapy. However, the reduction in mortality has not been accompanied by a reduction in neonatal morbidity or long-term handicaps. Preterm labor is a major issue in Iran. Besides various etiologies, preterm labor may be due to a biochemical alteration, such as magnesium. It is known that magnesium plasma levels fall during pregnancy. Since magnesium has an inhibitory role on myometrial contractions attention has been paid to the role of magnesium deficiency in preterm labor. Hypomagnesemia leads to neuromuscular hyperexcitability resulting in muscle cramps and uterine hyperactivity. The aim of this study was to determine the relationship between serum magnesium levels and preterm delivery in order to circumvent the high morbidity of preterm delivery by early diagnosis of this deficiency.
Methods: Serum magnesium was measured in 42 cases of preterm labor of idiopathic etiology (28-37 weeks) and 42 normal pregnancies at the same gestational age.
Results: Hypomagnesemia was variable in preterm labor cases, with only slightly low values in normal pregnant women.
Conclusion: Our study indicates that serum magnesium levels during pregnancy can be a valuable predictive tool for preterm labor. Hypomagnesemia must be considered in all pregnant women with preterm labor and supplementation must be provided effectively.

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Background: Diabetes mellitus is a common metabolic disorder accompanied with structural and functional changes in central and peripheral nervous system. Researches showed, memory disturbance were occurred in the course of diabetes. On the other hand, magnesium deficit has been described in diabetic patients. Some researches were showed that, appropriate magnesium supplementation can play a positive role in diabetic control.
Methods: Locally produced male rats were used. Diabetes was induced with intravenous injection of 40 mg/kg streptozotosin. In treatment groups, the animals were received magnesium sulfate via drinking water (10 g/l). Eight weeks after diabetes confirmation, the animals were assessed on Morris Water Maze.
Results: A significant decrease in time of platform finding (latency) and distance of swimming in all four experimental days were seen in all groups. Mean latency in diabetic group was significantly higher than the other. This weak response was almost completely prevented by magnesium sulfate administration.
Conclusion: It seems that after eight weeks magnesium sulfate administration (10g/l), spatial memory of the animals was improved in comparison to diabetic group that can suggest role of magnesium in recovery of diabetic animal memory.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Leg cramp is the painful contraction of the muscles that often occurs at night. Pregnancy is the most common cause of muscle cramps that usually occur in the second trimester of pregnancy. Although the reasons of the spasms had not been determined, the imbalance between the absorption and elimination of serum electrolytes such as Ca, Mg and potassium and also insufficiency of some vitamins and probably the changes in activities of motor neurons of spinal cord, can be the source of these problems. The aim of this study was the evaluation of frequency and predisposing factors of leg cramps.
Methods: In a cross sectional descriptive analytic study, a group of 400 women in the third trimester of pregnancy were asked to record the symptoms of leg cramp. Their education level and job recorded and their total serum level of Ca and Mg was measured in the first visit. Exclusion criteria included systemic medical conditions such as thyroid disease, diabetes, osteoporosis and prenatal disorders such as gestational diabetes mellitus and preeclampsia and patient cooperation.
Results: In our study the prevalence of leg cramp was 54.75%. There was a statistically significant relationship between leg cramp and serum level of magnesium (p=0.04). There was no relation between calcium serum level and leg cramp (p=0.294). The women's age, their nutritional habits and individual characteristics were not signify-cantly related to occurrence of leg cramp.
Conclusion: Leg cramp is a common symptom in pregnancy and in patients with low serum levels of magnesium, a magnesium supplement can be helpful.

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Background: Postpartum depression is a mood disorder that has harmful effects on mothers, infants, family and relationships. Acute decrease of progesterone after delivery has been proposed as a cause for postpartum depression. This hormone can affect neurotransmitters' function. Zinc (Zn) and magnesium (Mg) as trace elements exert their antidepressant effects through neurotransmitter pathways. On the other hand, thiamin (Vit B1) deficiency leads to depression in animal models. The aim of this study was to evaluate effects of combination of zinc, magnesium and thiamine on postpartum depression and role of nitrergic system.

Methods: One hundred ten female mice in five groups were used. Postpartum depression was conducted using progesterone injections. Combinations of Zinc chloride, magnesium chloride and thiamine HCL were administered 30 minutes before open field and forced swimming test (FST). In order to investigate role of nitrergic system, L-arginine and LNAME were administered.

Results: All treatment groups spent less immobility time than the control group (p< 0.05). Combined administration of Zn+ Mg+ Vit B1 caused the most reduction in immobility time. Administration of L-NAME in Zn+ Mg+ Vit B1 group caused reduction in immobility time while administration of L-arginine caused increase in immobility time in the same group.

Conclusion: Zinc, magnesium and thiamine can improve depressive symptoms by nitrergic pathway. These elements as supplement compounds could be alternatives for antidepressants in postpartum period.

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Background: Deposition of bilirubin in neurons causes permanent neuronal injury. Bilirubin exhibits an affinity for the phospholipids of plasma membrane like N-methyl-D-aspartate (NMDA) receptors. Magnesium is an NMDA antagonist and it acts against the neurotoxic effects of bilirubin. We compared pre- and post-phototherapy serum magnesium level of neonates with hyperbilirubinemia to find the best time of discharge and evaluate new management techniques such as magnesium supplementation.

Methods: In this semi-experimental study, we evaluated neonates admitted in Ali Asghar Children's Hospital in Tehran, Iran with signs of icter from 2009 to 2010. The inclusion criteria included age less than four weeks, no history of magnesium sulfate administration in the mother and absence of sepsis.

Results: From 106 patients with icter, 50.9% were male and 49.1% were female neonates. Their mean gestational age was 37.341.286 (33-41) weeks and the mean birth weight was 3172.12436.936 (2022-4300) grams. The frequency of underlying causes of hyperbillirubinemia included: ABO mismatch 9.34%, Rh incompatibility 4.7%, breastfeeding 16% and breast milk 44.3%. There was a significant difference (P≤0.001) between serum magnesium levels before (2.24mg/dl) and after phototherapy (2.12mg/dl). There were no significant differences between serum magnesium values in the two sexes (male=2.28, female=2.19), among different gestational age groups (<34 wks=2.35, 35-37 wks=2.27, >38 wks=2.17), between different birth weight groups (1500-2500 g=2.4 and >2500 g=2.23) or severity of hyperbilirubinemia (mild=2.23, moderate=2.21 and severe=2.29).

Conclusion: Phototherapy decreases the total magnesium concentration and magnesium administration will prevent bilirubin neurotoxicity in icteric neonates.

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Results: In this study, 100 neonates were evaluated. The mean serum magnesium level in these patients was 2.32 mg/dl. This rate was significantly higher in neonates with seizure (P=0.038), hyperbilirubinemia fever (P=0.048), and neonates with chronic encephalopathy (P=0.003). The mean serum magnesium level was significantly higher in severe hyperbilirubinemia (P<0.001). Serum Magnesium in complications of chronic encephalopathy (P=0.007), Fisting (P=0.001), retrocoli (P=0.001), hypertonia (P=0.004), hypotonia (P=0.001) and seizures (P=0.030) were significantly different. The serum magnesium levels were positively correlated with total bilirubin (r=0.443, P<0.001). The magnesium levels correlated with the chronic encephalopathy (OR: 4.15, P=0.040) and it was observed that magnesium levels above 2.15 could predict chronic encephalopathy with a sensitivity of 100%, the specificity of 47.82%, a negative predictive value of 100% and a positive predictive value of 14.28%. Conclusion: The results of this study showed that serum magnesium levels significantly correlated with serum total bilirubin and magnesium cutting points above 2.15 mg/dl in patients with jaundice could predict chronic encephalopathy.

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Background: Sore throat after surgery is the second most common cause of complications in recovery. It causes decreased patient satisfaction, and it affects patients’ well-being after surgery. The aim of this study was to compare the effects of ketamine and magnesium sulfate gargle on sore throat after laminectomy.
Methods: In this randomized clinical trial, 69 candidates for laminectomy patients in Shohade-Tajrish hospital from June 2021 to December 2022 were randomly assigned to three groups of ketamine (n=25), magnesium (n=23) and control (n=21). The Magnesium group received magnesium sulfate gargle (30 mg/kg in a total of 30 ml 5% Dextrose water), Ketamine gargle (0.5 mg/kg in a total of 30 ml 5% Dextrose water), and the control group received 30 ml 5% Dextrose water gargle. Standard similar anesthesia protocols were applied for all patients. In PACU (0) and 2, 4, 24 hours afterward sore throat was assessed using a visual analog scale (VAS) scoring. Conclusion: The preventive effect of "magnesium sulfate gargle" on sore throat after laminectomy is much better than "ketamine" or "placebo" gargle.