Magnesium

Magnesium is needed for more than 300 biochemical reactions in the body. It helps to maintain normal nerve and muscle function, supports a healthy immune system, keeps the heart beat steady, and helps bones remain strong. It also helps regulate blood glucose levels and aid in the production of energy and protein.

Oxygen, carbon, hydrogen and nitrogen form the basis of compounds found in all living matter. Beyond compounds built from these four most common elements, the rest of the body’s contents is made up of minerals.

Magnesium is a macro-mineral, which, unlike trace minerals, is needed by the body in large amounts.  Calcium, sodium, and potassium are also macro-minerals.  The average human body contains about 25 grams of magnesium, one of the six essential minerals that must be supplied in the diet.

Once magnesium enters the body through food, supplements, or topical applications, it is broken down and released to form independent magnesium atoms, or “ions”. In its ionic form, magnesium has a positive charge, commonly noted as Mg^2+.

Magnesium cations function as a part of the structure of the body through their presence in bone. But arguably more important is their function as cell regulators in hundreds of chemical reactions throughout the body.

Diet rich in Magnesium:

Dark leafy greens (e.g. spinach), Fish, Beans and peas, Whole grains, Dried fruits and nuts, Avocados, Yogurt.

Deficiency Symptoms: 

magnesium defieciency can occur in conjunction with calcium and potassium deficiency, the latter should be kept in mind while assessing the symptoms. Muscle cramps and spasms, Irregular heart-beats (arrhythmia), Weakness, Seizures, Confusion, Anxiety &Twitching.

Diagnosis:

Magnesium testing should be considered when the levels of calcium and potassium are persistently low, or when there are deficiency symptoms. A test result indicating low magnesium level signifies either inadequate dietary intake or excessive excretion. Therefore, the corresponding diseases impacting these parameters should be kept in mind in the differential diagnosis. 

Treatment:

Magnesium supplementation remains the mainstay of treatment. Magnesium salts of oxalate or gluconate can be administered orally. In case of severe deficiency, parenteral route may be considered with regular monitoring.

Iron

iron is an essential mineral that is a component of hemoglobin, the red pigment of red blood cells (RBC), responsible for the transport of oxygen in the blood.

It is also involved in cellular respiration as a component of the enzyme complex cytochrome P450.Iron deficiency is characterized by a sharp fall in hemoglobin levels.

Diet rich in Iron:
Dark green leafy vegetables, Red meat, Organ meat – liver, Dry fruits and nuts, Breakfast cereals fortified with iron

Deficiency Symptoms:

anemia, Exhaustion, Shortness of breath, Restless leg syndrome, Headache, Anxiety, Hair loss.

Diagnosis:

Clinical examination can give indications that the patient is suffering from iron deficiency. A complete blood count (CBC) revealing sub-optimal levels of hemoglobin (<7-8 g/dl) is a confirmatory test. The level of iron stores can be assessed by a ferritin test. The total iron-binding capacity (TIBC) indirectly measures the levels of transferrin, a protein that iron attaches itself to help in moving around in the blood.

Treatment:

The standard treatment for iron deficiency is oral supplementation with iron. This should be taken on an empty stomach. As vitamin C increases the absorption of iron, the iron tablet can be taken with a glass of orange or lime juice. 

Iodine

Iodine is a mineral found in some foods. The body needs iodine to make thyroid hormones. These hormones control the body’s metabolism and many other important functions. The body also needs thyroid hormones for proper bone and brain development during pregnancy and infancy. Getting enough iodine is important for everyone, especially infants and women who are pregnant. Iodine is an essential trace element in the diet responsible for the production thyroid hormones.

Natural source of Iodine: Iodized table salt, Cow’s milk, Cheese, Eggs, Salt water fish, Seaweed, Soy milk / sauce, Yogurt

Deficiency Symptoms: 

Hypothyrodism, Goitre, Mental retardation (in infants and children whose mothers were iodine deficient during pregnancy)

Diagnosis: The iodine concentration  is generally not measured in individual patients, but only in case of population-based studies. Indirect diagnosis is made based on its effect on thyroid function. Clinical observation of any enlargement of the thyroid gland (goiter) is indicative of iodine deficiency. A definitive diagnosis of hypothyroidism can be made by laboratory tests that measure the levels of thyroxine (T4), triiodothyronine (T3) and thyroid stimulating hormone (TSH).

Treatment: Regular use of iodized table salt. Administration of multivitamin tablets containing at least 250 µg of iodine to pregnant women. In case of hypothyroidism, Thyroxin daily oral administration.

Calcium

Calcium is the most abundant mineral in the human body and helps in the formation and maintenance of strong bones and teeth. Blood calcium level is regulated by vitamin D and several hormones, including parathyroid hormone, thyrocalcitonin, and cortisol that control absorption, excretion and bone turnover of calcium. Old age and inadequate calcium in the diet can lead to calcium deficiency, also known as hypocalcemia.

Natural source of calcium:

Milk, Cottage cheese / Paneer, Goat cheese, Whey protein, Kidney beans, White beans, Mustard greens, Lady’s finger (Bhindi), Almonds.

Function:

Calcium is one of the most important minerals for the human body. It helps form and maintain healthy teeth and bones. A proper level of calcium in the body over a lifetime can help prevent osteoporosis.

Calcium helps your body with:

a)  Building strong bones and teeth

b)  Clotting blood

c)  Sending and receiving nerve signals

d)  Squeezing and relaxing muscles

e)  Releasing hormones and other chemicals

f)    Keeping a normal heartbeat

Deficiency Symptoms:

Muscle pain, spasms and twitching, Tingling in fingers, toes and face, Fragile bones prone to fractures, Brittle nails, Coarse hair, Pale and dry scaly skin, Tooth decay, Loss of memory, Confusion & Insomnia.

Diagnosis:
Diagnosis is carried out by blood testing. The test is designed to measure total calcium. Abnormal levels of total calcium indicate an underlying problem, in which case other tests including ionized calcium and urine calcium may also be required. 

Treatment:
Calcium carbonate supplements at a dose of 600 mg/day for adults.

Montelukast drug for asthma

Montelukast is used to prevent wheezing, difficulty breathing, chest tightness, and coughing caused by asthma. Montelukast is also used to prevent bronchospasm (breathing difficulties) during exercise. Montelukast is also used to treat the symptoms of seasonal (occurs only at certain times of the year), and perennial (occurs all year round) allergic rhinitis (a condition associated with sneezing and stuffy, runny or itchy nose). Montelukast is in a class of medications called leukotriene receptor antagonists (LTRAs). It works by blocking the action of substances in the body that cause the symptoms of asthma and allergic rhinitis.

Mechanism Of Action of Montelukast

The cysteinyl leukotrienes (LTC4, LTD4, LTE4) are products of arachidonic acid metabolism and are released from various cells, including mast cells and eosinophils. These eicosanoids bind to cysteinyl leukotriene (CysLT) receptors. The CysLT type-1 (CysLT1) receptor is found in the human airway (including airway smooth muscle cells and airway macrophages) and on other pro-inflammatory cells (including eosinophils and certain myeloid stem cells). CysLTs have been correlated with the pathophysiology of asthma and allergic rhinitis. In asthma, leukotriene-mediated effects include airway edema, smooth muscle contraction, and altered cellular activity associated with the inflammatory process. In allergic rhinitis, CysLTs are released from the nasal mucosa after allergen exposure during both earlyand late-phase reactions and are associated with symptoms of allergic rhinitis.

Montelukast is an orally active compound that binds with high affinity and selectivity to the CysLT1 receptor (in preference to other pharmacologically important airway receptors, such as the prostanoid, cholinergic, or β-adrenergic receptor). Montelukast inhibits physiologic actions of LTD4 at the CysLT1 receptor without any agonist activity.

Montelukast is more than 99% bound to plasma proteins. The steady state volume of distribution of montelukast averages 8 to 11 liters. Studies in rats with radiolabeled montelukast indicate minimal distribution across the blood-brain barrier. In addition, concentrations of radiolabeled material at 24 hours postdose were minimal in all other tissues.

Metabolism of Montelukast drug for asthma

Montelukast is extensively metabolized. In studies with therapeutic doses, plasma concentrations of metabolites of montelukast are undetectable at steady state in adults and pediatric patients.

In vitro studies using human liver microsomes indicate that CYP3A4, 2C8, and 2C9 are involved in the metabolism of montelukast. At clinically relevant concentrations, 2C8 appears to play a major role in the metabolism of montelukast.