Anesthetic considerations for a patient with myasthenia gravis undergoing deep sedation in an outpatient oral surgery setting

Myasthenia gravis (MG) is a neuromuscular autoimmune disorder which clinically presents as muscular weakness and fatigue due to autoantibody formation against acetylcholine receptors (AChR), leading to their subsequent destruction. Due to the neuromuscular implications of MG, certain considerations must be taken into account when providing anesthesia to MG patients. In the following case report, we have outlined procedural considerations for the anesthetic management of a patient with MG undergoing deep sedation for an elective oral surgery in an outpatient setting, as well as a discussion of relevant literature.

levels of cytokines - the effect of betel quid/areca nut on oral epithelium

The objectives of this study were to investigate the in vitro effect of betel quid and its components on a stratified epithelium and to evaluate whether there was evidence of a site specific response to their effect. The reconstituted human buccal epithelium model and human gingival epithelium model used in the study which was prepared and supplied by Skin ethic Laboratories, Nice, France. It is a three-dimensional tissue culture model obtained by culturing transformed oral keratinocytes [TR146] derived from a buccal carcinoma and oral keratinocytes derived from healthy gingival. 50 micro ml of freshly prepared aqueous extract of paan, areca, lime, areca/lime mixture, tobacco and PBS [as control] was applied to the surface of the epithelium and the tissue incubated for upto 48 hours at 37 [degree sign] C in 5%. CO[2] in a humidified atmosphere. The tissue was used to access the viability by MTT assay. The culture medium was also collected at 4 and 48 hours and used for the measurement of cytokines /chemokines release using ELISA technique. In this study application of paan and its components caused up-regulation of cytokines and chemokines. On the buccal epithelium model after 4 hours of treatment lime caused increased release of IL-1 alpha [26.9 +/- 14.3 pg/ml] compared to PBS Control [9.5 +/- 4.5 pg/ml], IL-6 [24.9 +/- 8.4 pg/ml] compared to PBS control [8.2 +/- 1.8 pg/ml], IL-8 [437.5 +/- 227.8 pg/ml] compared to PBS control [194 +/- 58.1pg/ml] and TGF-beta after 24 hours [71.3 +/- 10.8 pg/ml] compared to PBS control [49.3 +/- 2.7 pg/ml]. In gingival epithelial model only paan caused increased IL-8 release [305.5 +/- 221.1 pg/ml] compared to PBS control [48.3 +/- 19.4] after 48 hours of treatment. Areca caused increased of IL-1 alpha [81.2 +/- 11.3 pg/ml] compared to PBS control [11.2 +/- 5.9 pg/ml] after 48 hours of treatment, whereas paan caused increased release of IL-6 [16.3 +/- 4.3 pg/ml] compared to PBS control [8.2 +/- 1.7 pg/ml], IL-8 [2333.7 +/- 1252.3 pg/ml] compared to PBS control [294.8 +/- 126.5pg/ml] and TGF-beta [35.8 +/- 0.9, 41.4 +/- 1.4 pg/ml] compared to PBS control [62 +/- 4.2] after 48 hours of treatment. Areca inhibited the viability of buccal epithelial cells. This study has confirmed that lime, areca and paan caused significant changes in cytokine release, viability and histology of the tissue. The release of pro-inflammatory cytokines may suggest that in the initial event of OSF these cytokines can act as a constant source of irritation to underlying tissue. The increase in TGF-beta release suggests that it may act on the underlying fibroblasts and result in increased collagen synthesis, a feature of OSF

prevalence of tobacco consumption in youth of Karachi, Pakistan - a pilot study

The aim of this study is to explore the prevalence of tobacco consumption in young people and observe its association with second hand smoking. It is a pilot study conducted in Karachi, Pakistan. Following are the objectives of this study: This pilot study will help to proceed with conducting validated Global Youth Tobacco Survey [GYTS] in Karachi using standard methodology in future. It will also establish current and life time prevalence of smoking in young people of Karachi, Pakistan. To study correlation between young people consuming tobacco and the effect of environmental tobacco smoke [second hand smoking]. A cross sectional study was conducted in a private school in Karachi. School was selected through convenience sampling. The sample consisted of 76 students both boys and girls had equal opportunity to participate in the survey. A Validated GYTS questionnaire was used. The current prevalence of smoking is 16% while the students who ever smoked is 41% which is comparatively high to other Global Youth Tobacco Survey [GYTS] conducted in other cities in Pakistan, The results matched with GYTS Eastern Mediterranean Regions which reports 15.3% as current smokers. Environmental tobacco smoke or second hand smoking reported was statistically significant. In this study environmental tobacco smoke [ETS] second hand smoking has been considered as an associated factor and has correlation with tobacco consumption in young people in Karachi. Further research is needed by conducting GYTS using the standard methodology and tobacco awareness programmes need to be integrated in health promoting schools to reduce the ETS