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      The relevance of magnesium homeostasis in COVID-19

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          Abstract

          Purpose

          In less than one and a half year, the COVID-19 pandemic has nearly brought to a collapse our health care and economic systems. The scientific research community has concentrated all possible efforts to understand the pathogenesis of this complex disease, and several groups have recently emphasized recommendations for nutritional support in COVID-19 patients. In this scoping review, we aim at encouraging a deeper appreciation of magnesium in clinical nutrition, in view of the vital role of magnesium and the numerous links between the pathophysiology of SARS-CoV-2 infection and magnesium-dependent functions.

          Methods

          By searching PubMed and Google Scholar from 1990 to date, we review existing evidence from experimental and clinical studies on the role of magnesium in chronic non-communicable diseases and infectious diseases, and we focus on recent reports of alterations of magnesium homeostasis in COVID-19 patients and their association with disease outcomes. Importantly, we conduct a census on ongoing clinical trials specifically dedicated to disclosing the role of magnesium in COVID-19.

          Results

          Despite many methodological limitations, existing data seem to corroborate an association between deranged magnesium homeostasis and COVID-19, and call for further and better studies to explore the prophylactic or therapeutic potential of magnesium supplementation.

          Conclusion

          We propose to reconsider the relevance of magnesium, frequently overlooked in clinical practice. Therefore, magnesemia should be monitored and, in case of imbalanced magnesium homeostasis, an appropriate nutritional regimen or supplementation might contribute to protect against SARS-CoV-2 infection, reduce severity of COVID-19 symptoms and facilitate the recovery after the acute phase.

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          Most cited references90

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          Post-acute COVID-19 syndrome

          Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in global healthcare crises and strained health resources. As the population of patients recovering from COVID-19 grows, it is paramount to establish an understanding of the healthcare issues surrounding them. COVID-19 is now recognized as a multi-organ disease with a broad spectrum of manifestations. Similarly to post-acute viral syndromes described in survivors of other virulent coronavirus epidemics, there are increasing reports of persistent and prolonged effects after acute COVID-19. Patient advocacy groups, many members of which identify themselves as long haulers, have helped contribute to the recognition of post-acute COVID-19, a syndrome characterized by persistent symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms. Here, we provide a comprehensive review of the current literature on post-acute COVID-19, its pathophysiology and its organ-specific sequelae. Finally, we discuss relevant considerations for the multidisciplinary care of COVID-19 survivors and propose a framework for the identification of those at high risk for post-acute COVID-19 and their coordinated management through dedicated COVID-19 clinics.
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            Characteristics of SARS-CoV-2 and COVID-19

            Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly transmissible and pathogenic coronavirus that emerged in late 2019 and has caused a pandemic of acute respiratory disease, named ‘coronavirus disease 2019’ (COVID-19), which threatens human health and public safety. In this Review, we describe the basic virology of SARS-CoV-2, including genomic characteristics and receptor use, highlighting its key difference from previously known coronaviruses. We summarize current knowledge of clinical, epidemiological and pathological features of COVID-19, as well as recent progress in animal models and antiviral treatment approaches for SARS-CoV-2 infection. We also discuss the potential wildlife hosts and zoonotic origin of this emerging virus in detail.
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              Extrapulmonary manifestations of COVID-19

              Although COVID-19 is most well known for causing substantial respiratory pathology, it can also result in several extrapulmonary manifestations. These conditions include thrombotic complications, myocardial dysfunction and arrhythmia, acute coronary syndromes, acute kidney injury, gastrointestinal symptoms, hepatocellular injury, hyperglycemia and ketosis, neurologic illnesses, ocular symptoms, and dermatologic complications. Given that ACE2, the entry receptor for the causative coronavirus SARS-CoV-2, is expressed in multiple extrapulmonary tissues, direct viral tissue damage is a plausible mechanism of injury. In addition, endothelial damage and thromboinflammation, dysregulation of immune responses, and maladaptation of ACE2-related pathways might all contribute to these extrapulmonary manifestations of COVID-19. Here we review the extrapulmonary organ-specific pathophysiology, presentations and management considerations for patients with COVID-19 to aid clinicians and scientists in recognizing and monitoring the spectrum of manifestations, and in developing research priorities and therapeutic strategies for all organ systems involved.
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                Author and article information

                Contributors
                federica.wolf@unicatt.it
                jeanette.maier@unimi.it
                Journal
                Eur J Nutr
                Eur J Nutr
                European Journal of Nutrition
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1436-6207
                1436-6215
                23 October 2021
                23 October 2021
                : 1-12
                Affiliations
                [1 ]GRID grid.8142.f, ISNI 0000 0001 0941 3192, Sezione di Patologia Generale, Dipartimento di Medicina e Chirurgia Traslazionale, , Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, ; Largo F. Vito 1, 00168 Rome, Italy
                [2 ]GRID grid.432053.3, Alleanza Contro Il Cancro, ; Rome, Italy
                [3 ]CMER Center for Magnesium Education and Research, Pahoa, Hawaii USA
                [4 ]GRID grid.411600.2, Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), , Shahid Beheshti University of Medical Sciences, ; Tehran, Islamic Republic of Iran
                [5 ]GRID grid.10776.37, ISNI 0000 0004 1762 5517, Geriatric Unit, Department of Medicine, , University of Palermo, ; Palermo, Italy
                [6 ]GRID grid.4708.b, ISNI 0000 0004 1757 2822, Dipartimento di Scienze Biomediche e Cliniche L. Sacco, , Università di Milano, ; Via G.B. Grassi 74, 20157 Milan, Italy
                [7 ]Biomedical Research Unit of Mexican Social Security Institute, Durango, Mexico
                [8 ]GRID grid.6292.f, ISNI 0000 0004 1757 1758, Department of Pharmacy and Biotechnology (FaBit) National Institute of Biostructures and Biosystems, , Università di Bologna, ; Bologna, Italy
                [9 ]GRID grid.494717.8, ISNI 0000000115480420, Unité de Nutrition Humaine, INRAE, UNH, , Université Clermont Auvergne, ; Clermont-Ferrand, France
                [10 ]GRID grid.415033.0, ISNI 0000 0004 0558 1086, Department of Radiotherapy and Radiation Oncology, , Franziskus Hospital, ; Bielefeld, Germany
                [11 ]GRID grid.411600.2, Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), , Shahid Beheshti University of Medical Sciences, ; Tehran, Islamic Republic of Iran
                [12 ]GRID grid.11780.3f, ISNI 0000 0004 1937 0335, Anestesiologia e Rianimazione, Dipartimento di Medicina e Chirurgia, , Università Degli Studi di Salerno, ; Fisciano, Italy
                Author information
                http://orcid.org/0000-0002-0259-6624
                Article
                2704
                10.1007/s00394-021-02704-y
                8540865
                34687321
                7a5ee33d-04af-424c-bb22-7e3530aef236
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 21 June 2021
                : 6 October 2021
                Categories
                Review

                Nutrition & Dietetics
                aging,chronic non-communicable diseases,immune response,long covid,magnesemia,sars-cov-2

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