Acute Abscess Research Articles

A Study of the Etiology, Clinical Profile, and Diagnosis of Various Types of Central Nervous System Infections in a Tertiary Care Center.

Introduction Infections affecting the central nervous system (CNS) can stem from various sources, including bacteria, viruses, and fungi, manifesting as conditions like meningitis, encephalitis, meningoencephalitis, and brain abscesses. Despite significant advancements in diagnosis and treatment, these infections continue to pose substantial risks to life. Several factors contribute to the causes of CNS infections. Demographic and geographic elements, the health status of individuals, their immune system's strength, the availability of diagnostic tools, and local prevention initiatives, all play pivotal roles. Consequently, the necessity of comprehensive local epidemiological data becomes undeniable as it guides the need for further studies and research. Understanding these factors is crucial for enhancing preventive measures and optimizing treatment strategies in tackling CNS infections. Aims and objectives This research aims to study the etiology and clinical features of different CNS infections among hospitalized patients and to diagnose cases of CNS infections based on laboratory and radiological investigations. Material and methods One hundred adults, seeking treatment for neurological impairments at a specialized tertiary care center in Gujarat, India, volunteered for this cross-sectional observational research. The study investigated the etiology, clinical profiles, and diagnoses of different CNS infections. It delved into the prevalence of these infections across age and sex categorieswhile also observing mortality rates. Results In our research, we observed that bacterial causes were the most prevalent among CNS infections. Tubercular meningitis accounted for 36%, tuberculoma 14%, and pyogenic bacterial infections 23%. Following this, fungal infections emerged as the second most frequent, with mucormycosis at 9% and cryptococcus at 1%. Other less common CNS infections included viral encephalitis (4%), neurocysticercosis (3%), and brain abscess (1%). Middle-aged individuals between 41 and 60 years were most commonly affected (43%), followed by those aged 21-40 years (31%). Males accounted for a higher percentage of cases at 58%. Clinical symptoms revealed fever as the predominant feature (80%), with headaches following closely at 67%. Acute presentations were prevalent, representing 83% of cases, while neck stiffness was noted in 62% of patients. Most patients exhibited normal hemoglobin levels (96%) and a majority had a normal total leukocyte count (79%). Notably, 31% of the studied patients were identified as People Living With HIV (PLHIV). Out of 100 patients, 79 survived with appropriate treatment, resulting in a mortalityof 21%. Conclusion The study identified various CNS infections, including bacterial (acute pyogenic meningitis, tubercular meningitis, tuberculoma, brain abscesses, and neurosyphilis), viral (viral meningitis and encephalitis), fungal (cryptococcal meningitis and CNS mucormycosis), and parasitic infections (neurocysticercosis and CNS toxoplasmosis). Tuberculous meningitis emerged as the most prevalent, followed by pyogenic meningitis. Clinical symptoms predominantly featured fever, headache, and altered sensorium, with less common occurrences of seizures, vomiting, weakness, and speech disturbances. Elevated CSFproteins and total leukocyte count were common findings in CSF analysiswhile consistent radiological observations included hypodensities in brain tissue and leptomeningeal enhancement.

An uncommon encounter in an unusual location – A case report on acute emphysematous suppurative thyroid abscess

Acute emphysematous suppurative thyroid abscess is a potentially life threatening uncommon disease caused most commonly by gram positive organisms. It usually occurs in immunocompromised individuals with pre-existing multinodular goiter secondary to hematogenous spread of infection. The most characteristic feature of this disease is the presence of gas within the thyroid swelling seen on imaging, even though crepitus may be absent on examination. Surgical debridement and thyroidectomy are the procedure of choice in such cases and can lead to effective cure. We present an unusual and rare case of an acute emphysematous suppurative thyroid abscess caused by a gram negative (non-clostridial) organism in an immunocompromised patient after a fine needle aspiration cytology intervention.

Prevalence of acute periapical abscesses in head and neck cancer patients receiving radiotherapy.

Head and neck cancer is a serious condition affecting the life of patients. Radiotherapy is commonly used to treat such conditions. The aim of this study was to assess the prevalence of acute periapical abscesses (PAs) in patients who received radiotherapy for head and neck cancer. Data on acute PAs and oropharyngeal cancer (OPC) diagnosis with or without a history of radiation therapy (RAD) was retrieved by searching the appropriate query in the database. All cases were diagnosed for acute PAs by calibrated dentists for patients admitted to urgent care. The odds ratio (OR) for the prevalence of acute PAs and its association with a history of OPC with or without RAD were then calculated. Adjustment for comorbidities such as diabetes, smoking and gingival and periodontal diseases was also done. The prevalence of acute PAs in patients with a history of OPC was significantly higher as compared to the general hospital patient population (OR 2.92, 95%CI, p<.0001). Males were more affected than females and whites were more affected than African Americans and other ethnicities. The prevalence for PAs in patients with a history of OPC and RAD was higher and the difference in prevalence was statistically significant (OR 3.61, 95%CI, p<.0001). Whites were more affected than African Americans by more than 3.5-fold. Adjustment for diabetes comorbidly affected mainly the OPC + RAD group, however, the difference remained statistically significant. Adjustment for smoking and gingival and periodontal disease reduced the OR but the difference remained statistically different. The high prevalence of acute PAs in patients with a history of OPC and RAD may suggest an association between these conditions warranting a meticulous medical and dental examination.

Alternatives to β-Lactams as Agents for the Management of Dentoalveolar Abscess.

Dentoalveolar abscess are localized infections within the tooth or the surrounding alveolar bone, often resulting from untreated dental caries or dental trauma causing alveolar bone resorption or even loss. Serious consequences arising from the spread of a dental abscess can often lead to significant morbidity and mortality. The acute dentoalveolar abscess is a polymicrobial infection comprising strict anaerobes, such as anaerobic cocci i.e., Prevotella fusobacterium species, and facultative anaerobes i.e., Streptococci viridians and Streptococcus anginosus. Moreover, inappropriately managed dental infections can progress to severe submandibular space infections with associated serious complications, such as sepsis and airway obstruction. An audit of the Hull Royal Infirmary between 1999 and 2004 showed an increase in the number of patients presenting to oral and maxillofacial surgery services with dental sepsis. Thus, the scientific community is forced to focus on treatment strategies for the management of dentoalveolar abscess (DAA) and other related dental problems. The current treatment includes antibiotic therapy, including β-lactams and non-β- lactams drugs, but it leads to the development of resistant microorganisms due to improper and wide usage. Furthermore, the currently used β-lactam therapeutics is non-specific and easily hydrolyzed by the β-lactamase enzymes. Thus, the research focused on the non-β-lactams that can be the potential pharmacophore and helpful in the management of DAA, as the appropriate use and choice of antibiotics in dentistry plays an important role in antibiotic stewardship. The newer target for the choice is NLRP inflammasome, which is the major chemical mediator involved in dental problems. This review focused on pathogenesis and current therapeutics for the treatment of dentoalveolar abscesses.

Anaphylaxis and Cardiac Arrest in a Patient during the 14th Transarterial Chemo-embolization for Hepatocellular Carcinoma

Transarterial chemo-embolization (TACE) is a valid and recommended treatment for patients with Barcelona Clinic Liver Cancer (BCLC) Stage B hepatocellular carcinoma (HCC). It is considered a safe procedure and the treatment-related mortality rate is less than 1%, mostly associated with acute liver failure, sepsis, renal failure or liver abscess. We reported a rare case of anaphylaxis and cardiac arrest during TACE, followed by successful cardiopulmonary resuscitation (CPR) and the management per anaphylaxis guideline, including epinephrine injection and glucagon infusion. The patient recovered well from this event and continued his treatment for HCC. The diagnosis, management and laboratory analysis of anaphylaxis is also reviewed in discussion. To our knowledge, it is the first case report of anaphylaxis-related cardiac arrest during TACE.

Clinical and epidemiological analysis of odontogenic inflammatory diseases of the maxillo-facial area in children

Children of the Karaganda region have a high prevalence of odontogenic inflammatory diseases of the maxillofacial region. For this purpose, epidemiological material was collected and analyzed from 426 children aged 1 to 17 years inclusive; distribution of medical records of an inpatient was carried out depending on the nosological form of the inflammatory process and covered the period from 2018 to 2022. in the SOE «Multiprofile hospital named after Kh. M. Makazhanov» (Karaganda city), nosological forms: acute purulent periostitis; acute odontogenic osteomyelitis, abscess and phlegmon. In the comparative structure of odontogenic inflammatory diseases of the maxillofacial region, acute odontogenic osteomyelitis of the jaw predominates – 41.8 %, the second place is occupied by odontogenic phlegmon – 36.6 %, followed by acute purulent periostitis – 15 %, odontogenic abscess – 6.6 %.Studies on the level, structure and prevalence of odontogenic inflammatory diseases of the maxillofacial region in children, depending on the place of residence, revealed that in children of urban areas the highest incidence rate was found for acute odontogenic osteomyelitis. Whereas in rural children odontogenic phlegmon and odontogenic abscess occurred on average 2.2 times more often than in urban children, which indicates the severity of the development of odontogenic inflammatory diseases of the maxillofacial region in them.Thus, in our studies, a relationship was found in the prevalence of odontogenic inflammatory diseases of the maxillofacial region between the age characteristics of children and their place of residence.

Management of acute perianal abscess: is surgeon specialization associated with improved outcomes?

Acute surgical units (ASU) are increasingly being adopted and in our system are staffed by colorectal and non-colorectal general surgeons. This study aims to evaluate whether surgeon specialization was associated with improved outcomes in perianal abscess. Patients with perianal abscess admitted to the ASU between 2016 and 2020 were identified from a prospective database and their medical records reviewed. Patients with IBD, treatment for fistula-in-ano within the preceding year, or perianal sepsis of non-cryptoglandular origin were excluded. Patients admitted under an ASU colorectal (CR) consultant were compared with those under a non-CR general surgeon in a retrospective cohort study. Primary outcome was perianal abscess recurrence. For those without initial fistula, hazard of recurrent abscess or fistula was analysed. Multivariable Cox PH regression analysis was performed. Four-hundred and eight patients were included (150 CR, 258 non-CR). The CR group more frequently had a fistula identified at index operation (34.0% versus 10.9%, P < 0.0001). However, Cox multivariable analysis found no difference in hazard of recurrent abscess between groups (HR 1.12, 95% CI 0.65-1.95, P = 0.681)). Abscess recurred in 18.7% CR and 15.5% non-CR. Subsequent fistula developed in 14.7% in both groups. For patients without initial fistula, there was no difference between groups in hazard of recurrent abscess or fistula (HR 1.18, 95% CI 0.69-2.01, P = 0.539). Surgeon specialization was not associated with improved outcomes for ASU patients with perianal abscess, albeit with potential selection bias. CR surgeons were more proactive identifying fistulas; this raises the possibility that drainage alone may be adequate treatment.

Sinus pilonidalis—elastic ligature as an optimal outpatient treatment

Abstract Background The incidence of pilonidal sinus shows a steadily rising tendency, especially in the patient age group of up to 40 years. Treatment of this condition is often protracted involving lengthy sick leave and an increased risk of recurrence. The optimal treatment of pilonidal sinus remains open to debate, but it should focus on decreasing the length of hospitalization, promoting a rapid return to daily life, maintaining low pain levels, and keeping costs at a minimum. Materials and methods In our study conducted between 2017 and 2021, we focused on treatment of pilonidal sinus. We performed 50 elastic ligature procedures with a median observation time of 30 months. The patients were divided into three groups according to the characteristics of pilonidal sinus: (1) acute primary abscess; (2) acute recurrent abscess; and (3) chronic fistula. Results Out of a total of 50 patients with a subsequent 30-month follow-up, we observed complete recovery in 47 patients and recurrence in three patients. Return to work was possible immediately after the operation, with an average total treatment time of 1 month for complete healing of the defect. Conclusion The current results suggest that the technique of elastic ligature is a desirable solution for pilonidal sinus, because of the initial low costs, no need for hospitalization, and good patient tolerance.

The Global Impact on Health of Dental Infections and Antibiotic Resistance:A mini Reveiw

Dental abscesses are a common infectious process that medical professionals are aware of. The aggressiveness of the bacteria, host resistance mechanisms, and local anatomy all influence how the infection turns out. A dental abscess that spreads can have serious implications that result in a high rate of morbidity and death. Acute dental abscesses are composed of a variety of microorganisms, including facultative anaerobes like _Streptococcus anginosus_ group and _viridans_ group _streptococci_, as well as stringent anaerobes such anaerobic _cocci_, _Prevotella_, and _Fusobacterium_ species. Antibiotics are commonly prescribed to treat dental infections. The benefits of antibiotics are that they can help resolve symptoms quickly, reduce pain, and prevent systemic infections. However, antibiotics can also have negative impacts on health, such as promoting antibiotic resistance. Antibiotic resistance refers to the phenomenon where bacteria evolve to become immune to antibiotics, making them harder to treat. Bacteria can develop resistance through mutations or by acquiring resistance genes from other bacteria. The overuse and misuse of antibiotics are one of the primary causes of antibiotic resistance. Inappropriate prescribing of antibiotics for illnesses such as the common cold and flu has led to the development of antibiotic resistance. In addition, patients who do not finish a full course of antibiotics can also contribute to the evolution of resistant bacteria. This has resulted in health risks that are not just confined to treating dental infections, but also pose a significant threat to global health. MATERIALS AND METHODS: This review is based on a thorough analysis of freely accessible literature from reputable sources such as Google, Google Scholar, and PubMed. The terms used in this review include dental, oral, maxillofacial infection, resistance pattern, epidemiology, common microorganisms, nutrition components, biofilm formation, morbidity, mortality, and increased healthcare costs. Overall, this review highlights the significant impact of dental infections and resistance on global health, including increased morbidity and mortality rates and rising healthcare costs. By understanding the epidemiology and resistance patterns of common microorganisms, as well as the role of nutrition and biofilm formation in infection prevention, we can work towards developing effective strategies for managing and preventing dental infections. In CONCLUSION, the epidemiology of dental infections is an important area of study that helps us understand the prevalence, incidence, and risk factors associated with these infections. By understanding these factors, we can develop effective prevention and treatment strategies to improve oral health and overall well-being.

Use of Vacuum in The Treatment of Acute Lung Abscess in Patients with Diabetes

Abstract of acute lung diseases. This problem is of particular importance when considering the growth of patients with diabetes. It should be noted that the emergence of antibiotics is a result of not using antibacterial drugs. Since the implementation. According to various authors, the number of complications in patients remains high, regardless of the rapid development of modern technologies used in the treatment of modern technologies requires the purchase of expensive specialized costs, the economic sector of the lung is also important for diabetes. In the background of appropriate surgical methods, use vacuum therapy in the treatment of acute diabetes and help early decontamination and cleaning of fibrin tissue and fibrin, accelerate the last necrotic tissue and fibrin This allows us to reduce the time of patients

Parotid gland abscess in an underweight infant: A comprehensive analysis

We report a case of a 7-month-old underweight male infant who developed a unilateral parotid abscess due to Staphylococcus aureus infection and was managed with surgical intervention. An acute parotid abscess is uncommon in paediatric patients but can occur in neonates and premature infants with certain risk factors. Parotitis, the most common inflammatory condition of the parotid gland, usually responds well to medical management but can occasionally progress to a parotid abscess. Conservative management with hydration, oral hygiene, and antibiotics is recommended, but if the disease worsens, suppurative parotitis or parotid abscess can develop. S. aureus and anaerobic bacteria are the most common pathogens, with streptococci and candida also reported. Ductal stones are rare in children and parotid abscesses are usually non-obstructive. Differential diagnosis should consider other conditions such as trauma, lymphadenitis, and neoplasia. Computed tomography scans are preferred for complications or suspected neoplastic lesions. Incision and drainage in paediatric patients can have good outcomes, but there is a risk of facial nerve damage.

Abstract 147: Utilization and Application of Transcranial Doppler Emboli Monitoring for Infective Endocarditis

Introduction The rapid growth of the elderly population, an increase in cardiac disease, and notable use of intracardiac prosthetic devices has led to an increased prevalence of infective endocarditis (IE). Among the sequelae observed with an IE diagnosis, acute ischemic stroke (AIS), subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), vasculitis, septic emboli, cerebral abscess, and infectious intracranial aneurysms (IIA) continue to complicate overall management of this disease. Current literature on neurological complications of IE includes limited data on the defined role of neuroimaging in dictating inpatient management. Transcranial doppler (TCD) emboli monitoring with high intensity signals (HITS) offers a real time, radiation‐free, relatively low cost, non‐invasive imaging option to potentially risk stratify and identify candidates for earlier intervention to prevent further cerebrovascular (CV) complications. Methods We conducted an observational study of infective endocarditis cases admitted to our institution from April 2022 to May 2023 who had TCD with HITS completed. Baseline clinical characteristics (age, sex, date and timing of TCD with HITS study, date of last positive blood culture, organism of infection, other neuroimaging utilized) were recorded. Observations recorded included the results of the TCD with HITS studies, the overall incidence and timing of neurological complications (AIS, SAH, ICH, IIA, septic emboli, cerebral abscess), timing of valve surgery, and inpatient mortality rates. A positive HITS was defined as detection of cerebral microembolism during ultrasound monitoring of bilateral middle cerebral arteries (MCA) for 30 minutes using a TCD machine (VIASONIX Dolphin IQ). Results Between April 2022 to July 2023, we identified 22 patients with confirmed left‐sided infective endocarditis who underwent TCD with HITS. Mean age was 66 years (SD, 10), and 82% were men. Leading pathogen types were Enterococcus Faecalis (27%) and Staphylococcus Epidermidis (18%). CV complications were noted in 19/22 patients (86%), the most common being AIS (82%) and IPH (18%). Two patients (9%) were found to have a positive HITS study, both of which developed septic emboli that caused ischemic stroke in one case, and hemorrhagic stroke in the other case. Average days from admission to timing of TCD with HITS study was 8.5 days. 14/22 patients underwent valve surgery (64%) during the admission on average 9.2 days after TCD with HITS study in the negative HITS group versus 5 days in the positive HITS group. Of the positive HITS cases, one of them died inpatient. Conclusion The association between neurological complications in patients with IE and cerebral microemboli detected with TCD monitoring has yet to be elucidated. While our observational study was limited by our sample size, both of our IE patients who had positive TCD with HITS studies developed more severe CV complications, and aggressive care was sought out more urgently to further minimize complications. Future directions include pursuing a prospective study incorporating TCD with HITS monitoring for patients with IE in order to risk‐stratify neurological complications and safety of valve surgery.

Knowledge Regarding Prescription of Antibiotic for Endodontic Treatment among House Officers of Multan

OBJECTIVE: To evaluate the knowledge regarding the prescription of antibiotic for treatment of endodontic disease and errors made by the house officers at Multan Dental College. Since the discovery of antibiotics, they have been in use broadly for the treatment of odontogenic infections. Prescription is a dynamic, customized clinical process, which is set owing to the necessities of patient &amp; the acquaintance of the practitioner. METHODOLOGY: This survey-based study was conducted among 40 house officers working at Multan Dental College. A survey form was designed, about the pattern of antibiotics prescription and the situations for which they were recommended by the House officers. RESULTS: The medication of choice was mostly Amoxicillin + clavulanic acid (52.6%) and Amoxicillin alone (47.3%). The most incidence of antibiotic prescription was reported for acute abscess of periapical area of the tooth (62.8%) and patient having fever with malaise (62%). Chronic apical abscess with sinus tract (58%). Overall, 12% of part takers were used to suggest p antibiotics for root canal treatment. CONCLUSION: We conclude that here is deficiency of information &amp; knowledge for the proper indication, kind, and antibiotics dose. Different educational activity like symposium or lectures should be practiced to teach the practitioner to prescribe antibiotics. Curriculum &amp; syllabus should offer great emphasis on prescribing. KEYWORDS: Antibiotics, Endodontics, Prescription, prophylaxis, Root canal treatment (RCT)

Changing the Surgical Approach to Breast Diseases During the COVID-19 Pandemic Period.

Background Postponing elective surgeries during the COVID-19 pandemic has also affected the approach to both malignant and benign breast diseases. This paper aims to share how the COVID-19 pandemic affects our approach to breast cancer, benign breast cases, and the procedures' results. Methodology A cross-sectional study was conducted in a tertiary-level public hospital in Istanbul, Turkey. We retrospectively analyzed our treatment options for patients diagnosed with breast cancer and benign breast disease in the general surgery clinic of a tertiary hospital that declared a pandemic status between March 11, 2020, and June 1, 2020. Results The number of patients who visited the breast outpatient clinic and received a diagnosis of breast cancer was 23. Among the benign diseases, no intervention was made except for abscess (eight patients, 40%) and mastitis (12 patients, 60%). Conclusions Patients with acute abscesses and mastitis were treated for both diagnostic and therapeutic purposes. Chemotherapy and hormone therapy were chosen for those diagnosed with cancer. Priority was given to oncology protocols rather than surgical approaches during the pandemic. We think that different approaches will be defined as the pandemic continues.

Complications after partial nephrectomy: robotics overcomes open surgery and laparoscopy: the PMSI French national database

PurposeTo evaluate three partial nephrectomies (PN) procedures: open (OPN), standard laparoscopy (LPN), and robot-assisted laparoscopy (RAPN), for the risk of initial complications and rehospitalization for two years after the surgery.Materials and methodsFrom the French national hospital database (PMSI-MCO), every hospitalization in French hospitals for renal tumor PN in 2016–2017 were extracted. Complications were documented from the initial hospitalization and any rehospitalization over two years. Chi-square and ANOVA tests compared the frequency of complications and length of initial hospitalization between the three surgical procedures. Relative risks (RR) and 95% confidence intervals were computed.ResultsThe 9119 initial hospitalizations included 4035 OPN, 1709 LPN, and 1900 RAPN; 1475 were excluded as the laparoscopic procedure performed was not determined. The average length of hospitalization was 8.1, 6.2, and 4.5 days for OPN, LPN, and RAPN, respectively. Compared to OPN, there were fewer complications at the time of initial hospitalization for the mini-invasive procedures: 29% for OPN vs. 20% for LPN (0.70 [0.63;0.78]) and 12% for RAPN (RR=0.43, 95%CI [0.38;0.49]). For RAPN compared to LPN, there were fewer haemorrhages (RR=0.55 [0.43;0.72]), anemia (0.69 {0.48;0.98]), and sepsis (0.51 [0.36;0.71]); during follow up, there were fewer urinary tract infections (0.64 [0.45;0.91]) but more infectious lung diseases (1.69 [1.03;2.76]). Over the two-year postoperative period, RAPN was associated with fewer acute renal failures (RR=0.73 [0.55;0.98]), renal abscesses (0.41 [0.23;0.74]), parietal complications (0.69 [0.52;0.92]) and urinary tract infections (0.54 [0.40;0.73]) than for OPN.ConclusionsConservative renal surgery is associated with postoperative morbidity related to the surgical procedure fashion. Mini-invasive procedures, especially robot-assisted surgery, had fewer complications and shorter hospital lengths of stay

90 Breast Abscess Management: What Is Best for Breast?

Abstract Aim To assess the speed of resolution of breast abscesses presenting to the unit. There is significant variation in the management of breast abscesses between units at a national level. Whilst the MAMMA study results are awaited, we wished to understand our unit’s outcomes in order to improve the patient journey. Method A single centre retrospective service evaluation of acute breast abscesses. The project was approved on the hospitals online QSIS system. The data was collected by interrogating the health records database using the following criteria: female, minimum age 16, presenting between 01/01/2017 - 31/12/2021. ICD codes for; breast abscess and/or breast infection were analysed with Excel (v16.40). Results 298 notes were reviewed as a representative sample of outcomes (n = 700). 73 patients (24.5%) were correctly coded to have a breast abscess. The median age was 41 years (IQR 50-29.5). All received an USS scan within 24 hours. The cohort was stratified along smokers (32%) and lactational (23%) risk factors. Smokers were most likely to require I&amp;D (39%) and had the longest duration of antibiotics (24 days). The median time for resolution was similar between those treated with serial aspirations (40 days) and those who needed I&amp;D (42 days). Conclusions The study demonstrated prompt access to USS and aspirations. Each abscess presentation took approximately 1 month to resolve and needed 4 visits to the unit. This aspect of care is an area for improvement so that we can streamline the process and take pressure off valuable clinic slots.

SP8.2 Management of Acute Surgical Abscesses (MAGIC): National prospective audit

Abstract Aim Subcutaneous abscesses are common, accounting for 2% of all emergency attendances. The aim of this project was to describe the management and outcomes associated with the management of subcutaneous abscesses in surgical practice. Method A national, prospective audit was undertaken. Adult patients presenting to an acute general surgical service with a subcutaneous (non-perianal) abscess between September and December 2022 were included. Data relating to their presentation, management, and outcomes were collected. Outcomes of interest included rates of recurrence, readmission, and complications within 60 days of treatment. A centre-level survey was administered to gather data on clinical resource use and sustainable practices. Results A total of 1247 patients were included across 55 centres. The most common abscess locations were pilonidal (18.8%), posterior thorax (14.5%), and buttock (11.7%). The majority (84.4%) were treated with incision and drainage and half (51.9%) of these also received antibiotics. Surgery was mostly performed with general (65.2%) or local (33.0%) anaesthesia. The rates of recurrence (5.7% vs. 6.7%) and readmission (14.0 vs. 10.3%) were broadly similar, respectively. A quarter (26.6%) of hospitals incorporated dedicated abscess management pathways. The majority of hospitals used single-use items for abscesses drained in ambulatory/ward areas (90.2%) but not in the operating room (13.7%). Conclusions Wide variation exists in the management of subcutaneous abscesses. These data, along with other preparatory work, may justify a trial of general and local anaesthesia in appropriately selected patients.

Impact of COVID-19 Vaccination on General Surgical Emergencies in Al-Qassim Region, Saudi Arabia: A Single-Center Retrospective Chart Review.

Background This study sought to determine the COVID-19 pandemic and vaccination's effects on the number of patients presenting with emergent surgical illnesses or requiring emergency general surgical procedures. We compared the number of presenting cases and surgical emergencies before the pandemic, in 2019, and during the pandemic, before and after the COVID-19 vaccination's introduction. Method This observational retrospective chart review was conducted at a tertiary hospital in Al-Qassim, Saudi Arabia. The data were retrospectively collected for three periods (July 1 to September 30) in 2019, 2020, and 2021 using a data collection sheet for demographic data, visit date, comorbidities, emergency procedure type, COVID-19 test result, length of hospitalization, ICU admission status, and surgical case mortality. Results The study included 152 participants with a mean age of 36.1 (SD: 16) years, and 69.7% of them were male. Common surgical conditions were identified as acute appendicitis (49.3%), skin abscesses and pilonidal sinus (21.7%), and diabetic foot (9.2%) across all three years. The most frequent (48.7%) surgical procedure was appendectomy. A decrease in surgical emergencies rate was observed during the year 2020, as compared to 2019 and 2021. The general surgery emergency rate was highest in 2021 among patients admitted for procedures post-vaccination (38.8%). Conclusion Common surgical emergencies were most frequent in 2021, after the COVID-19 vaccine's introduction. Future research areas include the impact of the pandemic on delays or the severity and complication of surgical or medical cases.

Biocompatible Gallium Nanodots against Drug-Resistant Bacterial Pneumonia and Liver Abscess.

Resistant bacterial infection remains a severe public health threat, and conventional antibiotic drugs work poorly in effectively treating infectious diseases. Here, we developed gallium-based nanodots (Ga NDs), consisting of specific disruption of bacterial iron ability, to treat multidrug-resistant (MDR) Gram-negative bacteria-infected diseases. The Ga NDs significantly suppress the proliferation of two typical MDR bacteria strains (P. aeruginosa and ESBL E. coli) compared with clinically used antibacterial drugs, including penicillin and levofloxacin. Ga NDs could also disrupt the biofilms of these two bacterial strains. In P. aeruginosa infected pneumonia and ESBL E. coli infected acute liver abscess models, the Ga NDs enable substantial inhibition of bacterial growth and reduce the organs' inflammation that resulted in significant improvement of survival. Further, the Ga NDs demonstrated excellent biocompatibility and biosafety characteristics. Together, we believe that our gallium containing nanotherapeutics are expected to be developed into promising alternative therapies to combat drug-resistant bacterial infection.

Radiographic evaluation of preoperative periapical status in teeth with apical abscess

Background: The presence of preoperative periapical lesion is a significant prognostic factor that influences the outcome of endodontic treatment. Radiographic evaluation of periapical status is important for diagnosis, treatment, and prognosis of periapical lesion. Objectives: To radiographically compare and evaluate the preoperative periapical status using periapical index (PAI) in teeth with acute and chronic apical abscess. Methods: An analytical cross-sectional study was conducted in Chitwan Medical College, between 2022 February to 2022 May using nonprobability convenience sampling technique. Forty-eight periapical radiographs with a diagnosis of apical abscess {24 acute apical abscess (AAA) = Group 1; 24 chronic apical abscess (CAA) = Group 2)} were included for evaluation. Four observers (Three endodontists and one oral radiologist) evaluated the periapical status on radiographs and scored them according to PAI scoring system. Statistical analysis was done using the Mann-Whitney U test and SPSS v.22. Results: The most common PAI score for teeth in Group 1 was three (13, 54.20%) with mean PAI score = 3.21 and in Group 2 the score was four (13, 54.20%) with mean PAI score = 3.79. Analysis of PAI scores found significant differences (p = 0.009, p &lt;0.05) between groups. The distribution of PAI varied according to apical diagnosis (p &lt;0.05). Intraobserver and Interobserver agreement values demonstrated good self-agreement and interobserver agreement. Conclusion: Teeth with CAA were more likely to have higher PAI scores and therefore, periapical radiograph and PAI scoring system can be used effectively for the evaluation of preoperative periapical status in teeth with apical abscess.