She was managed conservatively with analgesics, limb elevation, and glycerin magnesium sulfate dressing. Hallak M, Berman RF, Irtenkauf SM, Evans MI, Cotton DB. A Study conducted by Yamber [13] on 30 ICU patients in Karnataka, reported that application of Glycerin with Magnesium Sulphate is more effective than heparin-benzyl nicotinate (thrombophob) ointment at 0.05 level of significant (t = 2.301) on management of cannula induced thrombophlebitis. Epsom salt is also known as magnesium sulfate. (:PS: We have moderated comments to reduce spam. A Quasi-experimental design was used for the study. Magnesium salts, such as magnesium sulphate (MgSO4) or magnesium chloride were shown to penetrate the BBB and cause enhancement of brain intracellular free Mg2+ concentration following TBI (Heath and Vink, 1999). It's been shown to be effective for these uses: control rapid heartbeat. About 95% of the microvessels in the brain display BBB properties, and almost every neuron is estimated to be nourished by a distinct capillary vessel (Pardridge, 2005). The sodium channel blocker and glutamate release inhibitor BW1003C87 and magnesium attenuate regional cerebral edema following experimental brain injury in the rat. Altura BM, Gebrewold A, Huang QF, Altura BT. Effect of diets with different magnesium content in ischemic stroke rats. Pre-testing was performed before intervention. It is beneficial in improving the texture and pigmentation of hair growth. Lscher W, Potschka H. Blood-brain barrier active efflux transporters: ATP-binding cassette gene family. In addition, a number of molecules are transported across the BBB by other mechanisms including carrier- and receptor-mediated transport, adsorptive-mediated endocytosis and fluid phase-mediated endo- cytosis (Loscher and Potschka, 2005; Pardridge, 2007). Pharmacology of traumatic brain injury. In brain tissue, the barrier-type endothelial cells have a continuous basal membrane and do not exhibit fenestrations. The impairment of BBB integrity during sepsis has been shown in several studies, and magnesium administration in the early stages of sepsis reduced BBB permeability and brain edema (Papadopoulos et al., 2005; Esen et al., 2005). Significantly decreased extracellular magnesium in brains of gerbils subjected to cerebral ischemia. Thus it was concluded that both the applications were effective in reducing level of phlebitis. Pardridge WM. Mg2+ acts as a regulatory cation at the systemic and cellular levels, and participates in almost all anabolic and catabolic processes in the body. Regarding insertion site, the present study found that the most common location for insertion of cannula was in wrist 34% followed by Dorsum of hand 30% among both groups among them the least 14% was forearm; 22% was reported in the cubital fossa. There was homogenous distribution of age, gender, marital status and education in both experimental groups with significance p-value of 0.663, 0.258, 0.3006 and 0.978 respectively as there was no significant difference of demographic characteristics among both experimental groups (considering a P-value of 0.05). Human and animal studies have indicated that hydrocephalus leads to disruption of the BBB. However, little is known about whether any improvement in BBB integrity can be achieved by magnesium treatment in acute or chronic ethanol intake. Magnesium blocks the loss of protein kinase C, leads to a transient translocation of PKC (alpha) and PKC (epsilon), and improves recovery after anoxia in rat hippocampal slices. An equal number of participants were taken having medical and surgical problems. There was homogenous distribution of age, gender, marital status and education in both experimental groups with significance p-value of 0.663, 0.258, 0.3006 and 0.978 respectively. Worldwide hundreds of millions of patients are affected by health care-associated infections each year. Esen F, Erdem T, Aktan D, Orhan M, Kaya M, Eraksoy H, Cakar N, Telci L. Effect of magnesium sulfate administration on blood-brain barrier in a rat model of intraperitoneal sepsis: A randomized controlled experimental study. in Christian Medical College and Hospital, Ludhiana, Punjab among 60 subjects (30 with Heparinoid and 30 with Ichthammol Glycerine applications with matching age, gender and type of disease condition) reported that both the applications were effective in reducing IV induced phlebitis [11]. Tight junctions (TJs) between adjacent brain capillary endothelial cells possess occludin and claudin proteins that serve to preserve junctional integrity. Taniguchi M, Yamashita T, Kumura E, Tamatani M, Kobayashi A, Yokawa T, Maruno M, Kato A, Ohnishi T, Kohmura E, Tohyama M, Yoshimine T. Induction of aquaporin-4 water channel mRNA after focal cerebral ischemia in rat. Materials and Methods In this way, the BBB is equipped with regulating means that enable the maintenance of neuronal homeostasis. Marmarou A. All the ethics in research were followed and maintained strictly. This book is copyright. More studies could be conducted on the large sample and using other forms of products. Take thin layer of gauze piece and soak it in the solution just made 3. However, a variety of pathological conditions, such as sepsis, multiple sclerosis and epilepsia disrupt the BBB integrity and lead to the development of brain edema. The present study shows there is no association between socio-demographic variables which included age, gender, marital education and educational level with severity score which include after complete interventions scores (8, 16, 24, 32, 40, 48 hours) of participants in both experimental groups. Similarly few were under blood transfusion and in NPO/unconscious. On the day of cannula removal, the phlebitis was assessed using the VIP score (pretest). However this finding is contradictory to the finding of other studies. A 1999 study published in "Biology of the Neonate" found that when pregnant rats were given a magnesium-deficient diet, the mortality rate of their pups increased. Aquaporin (AQP)-4, a bidirectional transmembrane water channel expressed mainly in astrocytes and to a lesser extent in barrier type of endothelial cells and pial membranes, may play a crucial role in the pathogenesis of cytotoxic and vasogenic brain edema and aggravation/resolution of ischemic and traumatic brain edema (Amiry- Moghaddam et al., 2003; Zador et al., 2009). There is only one study in the current literature that evaluates the effects of magnesium in hydrocephalus, and a mild protection against brain damage was shown using MgSO4 therapy in a rat model of childhood-onset hydrocephalus (Khan et al., 2003). Khan OH, Enno T, Del Bigio MR. Magnesium sulfate therapy is of mild benefit to young rats with kaolin-induced hydrocephalus. All absorbent dressings maintain moist wound environment but dressings like hydrogel and glycerin magnesium sulphate provide direct moisture to the wound. Soak it completely so that no part of gauze is dry 4. Acute cytoskeletal alterations and cell death induced by experimental brain injury are attenuated by magnesium treatment and exacerbated by magnesium deciency. Peripheral venous cannulation is the insertion of a Vascular Access Device (VAD) into a peripheral vein. They identified that the higher frequency for complication was found in the age group of 30 to 60 years old [15]. Ionized magnesium (Mg2+) is a crucial cofactor that plays an essential role within the cell and regulates a variety of biochemical reactions. S. Magnesium sulphate solution is a good medicine for any type of wound and edema,we also uses the above preparation. Baseline performa, was used to assess the subjective symptoms and observation scale to observe the objective symptoms. The mean VIP score is more in MSG group as compared with that of HPA group. Imer M, Omay B, Uzunkol A, Erdem T, Sabanci PA, Karasu A, Albayrak SB, Sencer A, Hepgul K, Kaya M. Effect of magnesium, MK-801 and combination of magnesium and MK-801 on blood-brain barrier permeability and brain edema after experimental traumatic diffuse brain injury. Glycerin is an odorless, thick, sweet-tasting, syrupy liquid with a very short molecule, having the chemical formula C3H8O3. It's a chemical compound made up of magnesium, sulfur, and oxygen. It is clear from the discussion above that magnesium plays a variety of essential roles within the cell by modulating the activity of more than 325 enzymes as a cofactor. Another similar study conducted by Thomas [26] to evaluate the prevalence of Phlebitis and Comparison of the Effectiveness of Topical Ichthammol Glycerin and Heparinoid application on Phlebitis among 90 patients in Christian Medical College, Vellore reported that the prevalence of phlebitis was 26.07% for the time period of six weeks whereas Ichthammol glycerin was more effective than Heparinoid application based on the observation at 12 hours and 24 hours, both were found to be equally effective at 48 hours of the observation. Majority of 80% participants days of hospital stay was below 1 week among both MSG and HPA groups out of them 40% and 88% were in MSG group and HPA group respectively the study is inconsistent with the study by Abdul it shows that phlebitis per patient was associated with longer hospital stay [17]. A study conducted by Cicoloni33 also found first degree thrombophlebitis to be the highest (84.4%). Saatman KE, Bareyre FM, Grady MS, McIntosh TK. Table 1. Take magnesium sulphate granules and mix it with glycerine using one finger (20 gm MgSO4: 100 ml Glycerine ratio) Magnesium sulphate decreases the limb edema. However, our data did not provide sufficient statistical evidence to prove and validate this result. Table 6. Grubbs RD, Maguire ME. Fisher M. Pericyte signaling in the neurovascular unit. In addition, magnesium treatment protects the blood-spinal cord barrier, improves clinical recovery, and preserves normal spinal cord ultrastructure in experimental spinal cord injury in rats (Kaptanoglu et al., 2003). Also, the reduction in Mg2+ concentration within the cell results in an impairment of membrane stability by promoting free radical production (Ebel and Gunther, 1980; Bara and Guiet-Bara, 1984). Pardridge WM. These data are mechanistically consistent with the observation that the treatment of the astrocytes with a PKC activator caused a rapid decrease in AQP-4 mRNA and that this effect was inhibited by a specific PKC inhibitor (Nakahama et al., 1999). The protection of the BBB by magnesium in hypoxic conditions could be multifactorial and, in addition to the above mentioned effects, may involve other factors such as decrease in the production of cytokines, increase in antioxidative products and blockade of NMDA or AMPA channels/ receptors. One of the major mechanisms responsible for the pharmacological action of Mg2+ is blockage of NMDA or alpha-amino-3-hydroxy-5-methyl isoxazole-4-proprionic acid (AMPA) channels/ receptors in cerebral vascular system as well as brain parenchyma (Huang et al., 1994). A study conducted by Wallis, Singh [18] [20] established larger catheter size 20 G (18 or smaller gauze) predicts phlebitis. The invention relates to sterilized magnesium sulfate wet dressing agent. A number of studies have provided evidence for the alterations in serum Mg2+ levels in acute and chronic ethanol treatments. It's available in a handy 100 gm jar that is both Australian-made and Australian owned and is Australian. The study was done to find out the effectiveness of Liu X, Hunter C, Weiss HR, Chi OZ. Table 9. Preeclampsia-eclampsia: Clinical and neuroradiographic correlates and insights into the pathogenesis of hypertensive encephalopathy. Musso CG. Similarly, a study conducted in KU Nepal by Singh [7] found very mild (40%) and mild (11.3%) grades were seen to the higher than moderate (3.9%) and severe (3.9%) phlebitis. Ravishankar S, Ashraf QM, Fritz K, Mishra OP, Delivoria-Papadopoulos M. Expression of Bax and Bcl-2 proteins during hypoxia in cerebral cortical neuronal nuclei of newborn piglets: effect of administration of magnesium sulfate. Table 4 depicts that majority of 16% and 80% participants had pain along the pathway in MSG and HPA groups. Under certain pathological conditions, such as traumatic brain injury (TBI), cerebral ischemia and acute hypertension, thebrain edema, which is initially cytotoxic, acquires a vasogenic character in the following stages. Correale J, Villa A. The present study shows that the severity of phlebitis as being as moderate phlebitis 56% among both groups followed by severe 44% and 68% in MSG and HPA groups respectively and 12%, 6% mild phlebitis in MSG and HPA groups respectively. Upreg- ulation of AQP-4 in brain injury leads to an increase in brain water content, resulting in brain edema (Taniguchi et al., 2000; Papadopoulos and Verkman, 2005) and treatment with magnesium causes the down-regulation of AQP-4 (Ghabriel et al., 2006) and thereby attenuates brain edema (Okiyama et al., 1995). Usually applied to boils and carbuncles, the cooling, white paste helps the skin heal so it pushes areas of infection up and out. Edema in foot and ankle. Dysfunctional cell-cell signaling in the neurovascular unit as a paradigm for central nervous system disease. Papadopoulos MC, Verkman AS. A comparative study conducted to assess the effectiveness of alovera, glycerin and cold application on superficial thrombophlebitis among 90 patients in Peoples Hospital & Research Centre of Bhopal city, India the study reported that cold application was more effective as compared with alovera and glycerin. All applications were given 3 times a day for 3 days. Magnesium ion (Mg2+), the most abundant divalent cation in living cells, exists not only in the intracellular compartment but also in circulation and cerebrospinal fluid (CSF). In this study, the instruments baseline performa and observation scale were used. Table 5. Koirala Institute of Health Sciences, Dharan, Nepal. Pathology and new players in the pathogenesis of brain edema. Susanna, Sr. Winnifred D'Souza(2014), Malarvizhi, to identify the effectiveness of fresh aloevera and glycerin magnesium sulphate application on phlebitis among children.. Similarly, majority of participants 72% and 84% in MSG group and HPA group respectively were married. However, the exact mechanism/s of action of magnesium treatment in the improvement of BBB integrity in eclampsia still remains to be elucidated. WellTell us something you know better. Place the paste on a . Glycerine is a sweet clear viscous liquid with dehydrating property. Accumulated data from animal models indicates that administration of magnesium salts into the circulation or extracellular brain compartments can provide an effective therapy for TBI (Vink and Cernak, 2000; Saatman et al., 2001; Hoane, 2007) by improving BBB integrity and decreasing brain edema (Esen et al., 2003). However the study finding is contradictory to the findings from other studies Singh [7] reported that phlebitis was higher if inserted in forearm 65.5%, followed by dorsum of hand 54.7% and wrist joint 53.3%. Apart from any fair dealing for the purposes of private study, research, criticism or Nag S, Manias JL, Stewart DJ. To find out the association between magnesium sulphate with glycerin dressing and heparinoid ointment application on management of phlebitis with selected socio-demographic variables. It absorbs the edema or liquid within the . Magnesium can modulate hypoxic-ischemic events in the cerebral cortex by blocking the action of local putative excitatory amino acid neurotransmitters and consequently, high extracellular Mg2+ has been shown to be effective in blocking the pathophysiological mechanisms of rupture and spasm in the brain microvasculature (Huang et al., 1994; Chaon et al., 2006). Most 38 (76%) of the participants were cannulated with less than and equal to 20 G cannula Frequency of cannula insertion was more than and equal to second time of nearly 90% among both groups. The blood-brain barrier (BBB) is composed mainly of brain capillary endothelial cells and represents a dynamic structure that regulates the trafficking of molecules between blood and brain tissue. Use of magnesium in traumatic brain injury. Looking at the blood-brain barrier: molecular anatomy and possible investigation approaches. Prolonged standing, Encourage rhythmic isotonic movements eg. 1. They are primarily used for therapeutic purposes such as administration of medications, fluids and/or blood products as well as blood sampling. Materials and Methods: A Quasi-experimental design was carried among admitted patients in Medical-Surgical Units of BPKIHS. Table 3. Cannula related factors of the participants (n = 50). 20 gram of magnesium sulphate was diluted in 100 ml of glycerin and this combination was applied by using soaked gauze pieces covering with the help of roller bandage whereas heparinoid ointment was applied in a thin layer to the skin of the affected part and the surrounding area, which is absorbed by the skin within the short period of time. Amiry-Moghaddam M, Otsuka T, Hurn PD, Traystman RJ, Haug FM, Froehner SC, Adams ME, Neely JD, Agre P, Ottersen OP, Bhardwaj A. Finally, alterations in endothelial cells, which are protagonists in the vascular changes during inflammation, are reversible upon magnesium supplementation (Mazur et al., 2007). There is no significant difference in effectiveness of Magnesium-sulphate with glycerin dressing and heparinoid ointment application on phlebitis. In a study involving a total of 21 patients with normal- pressure hydrocephalus, a slight plasma-like protein pattern has been demonstrated in CSF in 38% of the patients prior to surgical intervention, indicating BBB dysfunction (Wikkels and Blomstrand, 1982). Table 1 shows surprisingly 47 years was the mean age of respondents in both. Stretched or shiny skin. Blood-brain-barrier delivery. Table 2. Therefore, this lack of basic knowledge compounds the difficulty we face when interpreting the importance of efforts of increasing serum Mg2+ levels under these conditions. Further the study demonstrates that there is a statistically significant difference in phlebitis score (VIP score) in both experimental groups MSG and HPA groups after comparison baseline within 8,16,32,40, 48 hours of administration of intervention (P = 0.05). Finally, data will be preserved for at least five years. Using magnesium sulfate capsules or Epsom salts may help discourage water retention and promote elimination, decrease bloating and help to reduce edema tied to inflammation. Treatment with magnesium decreases the concentration of inflammatory cytokines and free radicals and increases antioxidant capacity and survival rate in rats (Salem et al., 1995). Temkin NR, Anderson GD, Winn HR, Ellenbogen RG, Britz GW, Schuster J, Lucas T, Newell DW, Manseld PN, Machamer JE, Barber J, Dikmen SS. While commercial manufacturers remove the glycerin for its uses in more profitable expensive lotions and creams, handcrafted soap generally retains glycerin in them. Data was entered in MS Excel with the help of concerned people, guide and co-guide. The difference between pre and post-treatment score was found to be significant. Schwartz RB, Feske SK, Polak JF, DeGirolami U, Iaia A, Beckner KM, Bravo SM, Klufas RA, Chai RY, Repke JT. Similarly, this study confirms the findings of some other studies as well Wait [18] that site of insertion of cannula influence phlebitis. Dai LJ, Quamme G A. Intracellular Mg2+ and magnesium depletion in isolated renal thick ascending limb cells. The observation that blockade of NMDA or AMPA receptors could attenuate BBB disruption in focal cerebral ischemia suggest that ionotropic glutamate receptors are involved, at least partly, in BBB disruption (Liu et al., 2010). Vink R, Cernak I. Nurses need to have adequate knowledge and skill regarding cannula induced phlebitis management and its complication prevention. Esen F, Erdem T, Aktan D, Kalayc R, Cakar N, Kaya M, Telci L. Effects of magnesium administration on brain edema and blood brain barrier breakdown after experimental traumatic brain injury in rats. Serum Mg2+ concentration normally ranges between 1.7-2.3 mEq/L in humans and may decrease during several pathological conditions (Romani and Scarpa, 2000; Musso, 2009). Keywords: Glycerin magnesium sulphate dressing, Phlebitis patients, Peripheral Intravenous infusion, Effectiveness. Experimental studies focusing on the treatment of brain edema showed beneficial effects of magnesium administered in combination with various pharmacological drugs in animal models (Royo et al., 2003; Sen and Gulati, 2010). Passive diffusion across the BBB mainly depends on the lipid solubility and molecular weight of molecules. Romani AM. Magnesium sulphate was applied every 2 h for 2 days in solution form with a compress, and the limb was raised, wrapped in plastic and immobilised (Wan, 2018), or it was applied in ointment form . . This finding is supported by study conducted in India where they found that incidence of phlebitis is lower in patients older than 60 years than below 60 years Cicolini [14] also reported equal numbers of participants 24% were from below 25 years, 46 - 65 and >65 years of age group in MSG group. The antioxidant action of magnesium has been reported in two recent studies (Ariza et al., 2005; Turkoglu et al., 2008), suggesting that it could protect against free radical surge associated with epileptic seizures. Patients who were not willing to participate and were under cytitoxic drugs were excluded in research. Prolonged standing, Encourage rhythmic isotonic movements eg. Demougeot C, Bobillier-Chaumont S, Mossiat C, Marie C, Berthelot A. K. C., A. , Parajuli, P. , Mehta, R. and Mandal, G. (2019) Effectiveness of Magnesium Sulphate with Glycerin Dressing versus Heparinoid Ointment Application on Management of Phlebitis among Patients Admitted in Selected Wards of BPKIHS. Bruises, and sprains associated with muscle and joint injuries. Treatment with magnesium and MK- 801 (dizocilpine), a noncompetitive NMDA receptor antagonist, either alone or in combination, can reduce brain edema development and help to restore BBB permeability after experimental diffuse brain injury (Feng et al., 2004; Imer et al., 2009). =DBe a good critic and correct us if something went wrong :|Go ahead. Similarly, there was no significant association between magnesium sulphate with glycerin dressing and heparinoid ointment application on management of phlebitis with selected socio-demographic variables and cannula related factors. Effectiveness of magnesium sulphate with glycerin dressing (MSG) and heparinoid ointment application (HPA) on management of phlebitis. The blood-brain barrier (BBB) is constituted primarily of brain capillary endothelial cells and is a pre- requisite for the maintenance of brain homeostasis that is essential for optimal brain function. Increase in the size of the stomach area. The present study demonstrates that there is a statistically significant difference in VIP score among the participants in magnesium sulphate with glycerin group and heparinoid ointment groups after each intervention (P < 0.05). Confidentiality and anonymity were maintained by writing code number instead of name of participants. Vink R, McIntosh T K, Demediuk P, Faden AI. The finding of the study indicated that the computed "t" value of cold application group ('t" 14 =14.33), heparinoid application group ('t' 14 Effectiveness of Magnesium Sulphate with Glycerin Dressing versus Heparinoid Ointment Application on Management of Phlebitis among Patients Admitted in Selected Wards of BPKIHS. Feeling of leg heaviness. In animal models, magnesium treatment has been shown to contribute to the protection of the BBB during eclampsia, to decrease the increased BBB permeability, and to prevent the development of brain edema in certain experimental settings, including acute hypertension and hypoglycemia- induced seizures (Kaya et al., 2001 and 2004; Euser et al., 2008). The passage of many circulating substances from the capillary bed into the brain parenchyma is tightly controlled by physical and enzymatic barriers provided by the endothelial cells of capillaries in the brain parenchyma (Abbott et al., 2010; Cardoso et al., 2010). It produces a warm sensation and irritates mucous membranes. 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