1.Anesthetic considerations for a patient with myasthenia gravis undergoing deep sedation in an outpatient oral surgery setting
Shamit S PRABHU ; Saad A KHAN ; Alexander L DOUDNIKOFF ; Uday N REEBYE
Journal of Dental Anesthesia and Pain Medicine 2019;19(1):67-72
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.
Anesthesia
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Deep Sedation
;
Fatigue
;
Humans
;
Muscle Weakness
;
Myasthenia Gravis
;
Outpatients
;
Receptors, Cholinergic
;
Surgery, Oral
2.Minimizing the risk of perioperative cardiovascular complications in homozygous familial hypercholesterolemia: a case report
Saad KHAN ; Samuel MIN ; Garrett WILLARD ; Iris LO ; Rachael D'SOUZA ; Aaron PARK
Journal of Dental Anesthesia and Pain Medicine 2020;20(1):39-44
Homozygous familial hypercholesterolemia (HoFH) is a rare inherited disorder that presents as abnormally elevated levels of low-density lipoprotein cholesterol and premature heart disease, requiring frequent intervention through lipid apheresis for management. The risk of perioperative cardiac events is higher in patients with HoFH because of its pathophysiological manifestations in the vascular system. Careful cardiac precautions and anesthetic assessments are necessary to ensure patient safety. In the following case report, we discuss the clinical course and anesthetic considerations for a 14-year-old girl with HoFH undergoing sedation for dental extractions and mandibular molar uprighting in an outpatient oral surgery clinic. Considerations included the use of heparin in the patient's weekly plasma lipid apheresis treatment. In order to reduce the risks of peri- and postoperative bleeding and perioperative cardiac events, the operation was scheduled for 4 days after apheresis. This allowed for adequate heparin clearance, while also reducing the likelihood of possible cardiac events. A literature review revealed no results for the outpatient management of patients with HoFH undergoing sedation for noncardiac procedures. Our reported case serves as a clinical example for physicians to be utilized in the future.
3.Sex‑related differences of fatty acid‑binding protein 4 and leptin levels in atrial fibrillation: an updated review
Shahab SAIDULLAH ; Binish Ayub AHMAD ; Muhammad Saad WAQAS ; Anam FATIMA ; Malik Hasnat ul Hassan KHAN ; Umer KHIYAM ; Jahanzeb MALIK
International Journal of Arrhythmia 2024;25(1):1-
Atrial fibrillation (AF) is a prevalent cardiac arrhythmia affecting millions of individuals worldwide and posing significant challenges to healthcare systems. The growing body of research has uncovered sex-related differences in AF pathophysiology, including the role of fatty acid-binding protein 4 (FABP4) and leptin as potential biomarkers. FABP4 and leptin, key adipokines involved in cardiovascular health, have been linked to inflammation, oxidative stress, and endothelial dysfunction, all of which may contribute to AF development. These adipokines exhibit sex-specific differences in their concentrations, with females generally showing higher FABP4 levels and males displaying distinct leptin profiles. Furthermore, hormonal influences, particularly estrogen, and testosterone, play significant roles in shaping AF risk and atrial remodeling. Estrogen is associated with cardioprotective effects, while testosterone may exert proarrhythmic effects. Understanding these sex-specific mechanisms could lead to more tailored and effective clinical management of AF. The future of AF research holds promise for precision medicine, novel therapeutic targets, artificial intelligence integration, and personalized care approaches. Emphasizing patient-centered care, telemedicine, and multidisciplinary collaboration can further enhance AF management and improve patient outcomes. In conclusion, recognizing and addressing sex-related factors in AF pathophysiology offer opportunities for gender-responsive interventions and advancements in AF management. Implementing these insights may pave the way for targeted therapies and improved quality of life for individuals affected by AF.
4. Wolbachia pipientis: A potential candidate for combating and eradicating dengue epidemics in Pakistan
Uruj TAHIR ; Umair Hassan KHAN ; Umair Hassan BAHAR-E-MUSTAFA ; Muhammad Saad ZUBAIR
Asian Pacific Journal of Tropical Medicine 2015;8(12):989-998
Dengue virus syndrome is an emerging global health challenge which is endemic in tropical countries like Pakistan. In recent years dengue incidences have increased considerably in different areas of Pakistan with more sever impacts on urban and peri-urban populations. This review is an effort to highlight the changing epidemiology of dengue fever, role of Government of Pakistan in disease management and control using preventive and community based approaches in the region. Moreover, there is an emphasis on application of Wolbachia as novel, inexpensive and environmentally benign candidate for control and eradication of dengue transmitting vectors.
5.Orthopaedic Practices and Surgeries during COVID-19 in Pakistan - A Survey Based Study
Saad-Ilyas M ; Zehra U ; Khan UU ; Mohammad I ; Muhammad R ; Aziz A
Malaysian Orthopaedic Journal 2021;15(No.1):72-78
Introduction: The study aimed to target the current practices
of the orthopaedic community in outpatient (OPD),
emergency (ER) and surgical services (OT) during COVID19.
Material and method: This study surveyed 303 orthopaedic
surgeons from all over Pakistan. The survey had 30 questions
targeting the setup of outpatient, emergency and operation
services in orthopaedic departments of different hospitals in
Pakistan.
Result: A total of 302 surgeons were included from 53 cities
all over Pakistan. Between 35-48% of the respondents
reported lack of availability of standard operating procedures
in OPD, ER and in OT. Majority of the respondents noted
that their OPD and surgical practice had been affected to
some degree and 69% of the surgeons were only doing
trauma surgery. This trend was higher in younger consultants
of less than 45 years of age (p<0.001). Almost two-third of
the surgeons, mostly senior (p=0.03) were using surgical
masks as the only protective measure during various
practices of OPD, ER and OT, while most of the setups were
not assessing patients even for signs and symptoms of
COVID. Almost 89% of the orthopaedic community is
facing definite to mild stress during this pandemic and this
has significantly affected the senior surgeons (p=0.01).
Conclusion: Our study highlighted that COVID-19 has
resulted in marked changes to the practices of the majority of
Pakistani orthopaedic surgeons. Despite a sharp upsurge in
the number of cases and mortality due to COVID-19,
guidelines were still lacking at most of the settings and a
substantial percentage of the orthopaedic community were
not following adequate safety measures while attending to
patients.