18100006001 THESIS

TITLE:

ASSESSMENT OF SERUM MAGNESIUM AND ITS OUTCOME IN ACUTE ISCHEMIC CEREBROVASCULAR ACCIDENTS.

INTRODUCTION:

Magnesium depletion in the diet is more prevalent than generally expected . In

industrialised and developing countries it remains to be most common nutritional

problems. This may be due to result of current changes in agricultural practices, food

preparation techniques and dietary changes. WHO and other health agencies states that

more than 75 to 80% of people do not consume the recommended daily intake of

magnesium (1)

Magnesium depletion is considered to be most under diagnose electrolyte

abnormality in current medicine. The prevalence of magnesium deficiency in hospital

settings has been found to be 7 to 11 %. 40% of patients deficiency also coexist with other

electrolyte abnormalities.(2)

Magnesium deficiency is more common in alcoholics, young people and people who

receive certain medications. It is associated with hypertension, diabetes, coronary heart

disease, stroke, osteoporosis due to thrombogenic and atherogenic disruption of arterial

and cardiac integrity .(3)

The National institute of Health website publishes, in human body For the correct

metabolic function more than 350 enzymes magnesium is needed. “Magnesium helps in

proper functioning of muscles and nerves maintains a strong immunity against infections,

supports bone integrity and keeps the heart work in regular rhythm It regulates blood sugar

values , keeps the blood pressure in control, has a role in protein synthesis and energy

metabolism. Interest is gaining in role of magnesium in the prevention and treatment

of diabetes, hypertension, cardiac, cerebral disorders ”. Thus deficiency is considered to

be epidemic deficiency.(4)

In acute cerebrovascular accidents, there occurs a rapid loss of brain magnesium and

potassium levels with rapid uptake of sodium and calcium channels, the lower the

magnesium and potassium concentrations the greater the magnitude of cerebral arterial

contraction.

Interruption of cerebral blood flow will lead on to ischemic cell death causing ATP

depletion and ischemic depolarisation leading to excessive calcium entry which causes

vasospasm.

Cerebral blood flow interruption causes release of excitatory glutamate through NMDA

receptors, which causes influx of calcium and sodium leading onto production of free

radicals and initiation of inflammatory response.

Magnesium exerts neuroprotection in the following ways :

1. It‟s a natures physiologic calcium blocker antagonises calcium mediated metabolic

process.

2. It decreases the release of excitatory neurotransmitter

3. It increases the release of inbitory neurotransmitter

4. It relaxes vascular smooth muscle

5. It decreases platelet aggregation.

AIMS AND OBJECTIVES OF THE STUDY:

AIM OF THE STUDY:

To Study serum Magnesium and outcome of patientsIn Acute ischemic cerebrovascular

accidents.

OBJECTIVES OF STUDY:

1. To detect the serum magnesium levels in patients of Acute ischemic cerebrovascular

Accidents.

2. To detect the outcome ofacute ischemic stroke patients in accordancewith the

magnesium levels.

VARIABLES MEASURED IN STUDY:

MODIFIED RANKIN SCALE:

The Rankin scale is named after the Scottish physician JohnRankin who made this

scale in view to access the disability of thepatient with specific reference to morbidity

of the patient. The scalewas made to access the patient who suffered from stroke to access

theglobal disability of these patients was later to be used in clinicaltrail and the name

Modified Rankin scale (mRs).

The Modified Rankin scale was used initially in a study in Great Britainfor patients suffering

from TIA. After this the scale has gainedpopularity and now it is widely used to access the

functional outcomes of patients who suffer from stroke.

Advantages of MRS scale:

1.Easy to perform

2. Takes about five minutes to perform

3. It has close correlation with other stroke scale like the NIHSS scale and theBI

4. The volume of infarct correlates well with the imaging findings of patients with

CVA

5. It has six point score which correlates well with the outcome of patients

6. As in the case of NIHSS there are various mobile phone apps, DVDs, online

certificate courses for Learning the scale

Limitations of the MRS scale:

1. As there are only six point score it is less probable to change than other stroke

scales

2. The specificity of the scale is less

3. Inter observer variability is high with respect to this scale

4. Detailed training in scripted interviews is required to improve the reliability and the

consistency of the scale

PATIENTS AND METHODS:

Methods and study design:

This was a observationl study , done in patients admitted inmedical wards of Kamineni

institute of medical sciences , Narketpally , Nalgonda, conducted from October 2018

toSeptember 2020. The study will be approved by the ethicalCommittee of Kamineni

Institute of medical sciences ,Narketpally.

INCLUSION CRITERIA :

1. Diagnosis of ischemic stroke based on history , physical. examination and initial

CT/ MRI of Brain or delayed

CT /MRI scan of brain where first scans were normal.

2. Age greater than 40 years

3. Cerebrovascular accidents occurring less than 72 hours.

EXCLUSION CRITERIA :

4. Chronic kidney disease

5. Alcoholic liver disease

6. Thyroid disorders – hypo/hyperthyroidism

7. Chronic diarrhea

8. Patients on drugs that affect serum magnesium levels like diuretics, digoxin and

drugs like amphotericin B

aminoglycosides

9. Age less than 40 years.

DATA COLLECTION AND METHODS: 

patients who have got admitted in medicine ward, in the Institute of Kamineni institute of medical sciences, Narketpally , Nalgonda in Department of General medicine, an observational study was conducted on acute cerebrovascular accident patients for a period of two years. Patients selected for clinical study as per inclusion and exclusion criteria. Informed consent was obtained from the relatives of the cases. Detailed history taking and clinical examination was done. Around 2ml of venous blood was collected from the patients. Blood was allowed to clot and serum was separated by centrifugation . Serum levels of Magnesium were estimated using calorimetric method .Neurological status of the patients suffering from cerebrovascular accidents was assessed at the time of admission and at the time of discharge was assessed using modified Rankin Scale(mRS) and Glasgow coma scale.

STATISTICAL METHODS:

Present study results were obtained by using SPSS statistics 20.0 software , following statistical methods are used in this study :

1. MEAN : It is simplest measure of central tendency and is the arithmetic average

of observations .

For a ungrounded data , mean is calculated by

MEAN : Sum of all observations

Number of observations

X = ∑X

n

For grouped data , mean is calculated by

X = ∑ fx

n

Where f is the frequency

x is mid point of class interval

n is total number of observations

2. STANDARD DEVIATION: It is a measure of the magnitude of the variation

present in set of data. It is known as root mean square deviation because it is square

root of the mean of squared deviations from arithmetic mean. It is a summary

measure of the differences of each observation from mean of all the observations.

S = d2

(n-1)

3. Level of significance : The magnitude of risk of making a wrong

conclusion of rejecting the null hypothesis that the two groups are

from same population is fixed in terms of probability level „p‟ and is

known as level of significance.

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