Root Abscess Research Articles

Comparing clinical outcomes in bicuspid versus trileaflet aortic valve endocarditis

Abstract Background The incidence of bicuspid aortic valve infective endocarditis (BAV-IE) has been reported at 2% in contemporary BAV cohorts with an estimated risk of developing BAV-IE 11 times that of the general population with a trileaflet aortic valve (TAV). Purpose To characterise BAV-IE from a clinical and microbiological perspective and compare clinical outcomes with a cohort of individuals with trileaflet aortic valve infective endocarditis (TAV-IE). Methods The clinical records of all patients (>16 years old) admitted to a large tertiary referral centre in the United Kingdom between 2015 and 2022 with a definitive diagnosis of native aortic valve IE by Duke’s criteria were included. Clinical, echocardiographic and microbiological data were obtained. The primary outcomes were death or surgical aortic valve intervention during the indexed hospital admission. Secondary outcomes included the incidence of cardiac complications (e.g. aortic root abscess or fistula formation, IE affecting another valve or high degree atrioventricular block requiring temporary or permanent pacing). Extra-cardiac complications included embolic phenomena and thrombotic events. Results 83 patients were included (BAV-IE 34; TAV-IE 49). BAV-IE patients were significantly younger at presentation than TAV-IE patients (Table 1). There was no difference age-adjusted mortality rate between the two groups (mortality rate BAV-IE 0.20 (95% CI 0.08-0.54) versus TAV-IE 0.29 (95% CI 0.17-0.48). The rate of cardiac complications including aortic root abscess or fistula formation, and concomitant mitral valve endocarditis was greater in the BAV group, though not reaching statistical significance. Those in the BAV-IE group were more likely to develop at least moderate aortic regurgitation and have aortic valve intervention during the admission (70.6% (24/34) BAV-IE versus 46.9% (23/49) TAV-IE, p=0.03). Conclusion Despite an estimated prevalence of 1% in the general population, BAV accounted for 41% of all native AV IE cases at our institution. This study demonstrates that even in young, otherwise healthy individuals, BAV-IE has a poor prognosis with a high proportion developing structural complications. Age-adjusted mortality rates are similar to those with TAV-IE, who are often older with more co-morbidities. Though antibiotic prophylaxis is currently only recommended for those at the highest risk, these findings reinforce the importance of mitigating sources of infection in individuals with BAV. Prompt medical attention and treatment of suspected IE cases is of utmost importance as degeneration of a BAV and other cardiac complications, particularly aortic regurgitation, can rapidly develop.

Abstract 11698: Torsades de Aortique Pustule: A Case of Aortic Abscess Leading to 2:1 AV Block and Torsades de Pointes

Introduction: Endocarditis of the aortic valve has a propensity to create A-V conduction disturbances in up to 10% of cases. Torsades de pointes (TdP) is polymorphic ventricular tachycardia in the setting of prolonged QT interval and bradycardia that is typically preceded by a short-long-short sequence of ventricular activation. We present a case of infective endocarditis with aortic root abscess leading to acute 2:1 A-V conduction and culminating in TdP. Case Summary: A 30-year-old male with history of IV drug use and bioprosthetic aortic valve repair presented with pleuritic chest pain, nausea and vomiting. He was febrile and tachycardic with a systolic murmur at the right upper sternal border. Initial electrocardiogram showed sinus rhythm with no conduction abnormalities. A Transthoracic echocardiography showed a large aortic valve vegetation with an abscess cavity. E Blood cultures grew Streptococcus oralis. Two days later, he developed VT/VF arrest requiring external defibrillation. Preceding ECGs and telemetry showed sinus tachycardia with new left bundle branch block and prolonged QTc. B This progressed to 2:1 AV block C with abrupt transition to relative bradycardia and ventricular ectopy leading to short-long-short ventricular intervals and subsequent TdP. D A temporary pacemaker was placed, and he underwent an aortic root reconstruction with valve replacement. Discussion: While both the etiology of TdP and aortic root abscesses leading to conduction system disease are well described, this case exhibits the real time progression of aortic abscess involvement. The patient presented with a normal QRS morphology. During hospitalization, he developed new LBBB, and the appropriate sinus tachycardia then deteriorated into 2:1 AV conduction leading to relative bradycardia. This abrupt transition with QTc prolongation sets up the nidus for ventricular ectopy (due to early after depolarizations) with salvos of short-long-short sequences causing TdP.

Abstract 19189: A Rare Case of Neisseria Gonorrhoeae Native Aortic Valve Infective Endocarditis With Development of Gerbode Defect

Introduction: Infective endocarditis (IE) is a devastating condition most commonly caused by gram-positive cocci ( S. aureus , S. viridans , S. gallolyticus , Enterococcus spp.) and gram-negative organisms (e.g. HACEK organisms). We present a case of Native Aortic Valve IE due to disseminated N. Gonorrhea in an immunocompetent patient. Hospital Course: The patient is a 30-year-old female who presented with a chief complaint of subacute chest pain and constitutional symptoms. Echocardiography revealed aortic valve abscess and severe aortic insufficiency with concerns of aorto-atrial fistula. The patient was treated with antibiotics and transferred to our hospital. Upon transfer, the patient was initially stable. Physical exam was notable for a pandiastolic murmur. The patient rapidly deteriorated into cardiogenic and septic shock. TTE revealed aortic root abscess, LVOT-RA fistula (Gerbode defect), and right atrial vegetation. Emergent surgical exploration revealed IE of the aortic valve with destruction of right and non-coronary cusps and vegetation eroding from the base of the aortic root through the membranous septum to the right atrium without tricuspid valve involvement. She underwent successful treatment with debridement and reconstruction. Initial blood cultures were positive for N. gonorrhoeae. The patient was negative for HIV and no gynecologic source was identified. After an extended hospital course, the patient was discharged with IV antibiotics. Discussion & Conclusion: We present a rare case of N. Gonorrhoeae aortic valve endocarditis leading to aortic valve destruction with subsequent abscess and fistulae formation. This case demonstrates a rare and severe consequence of disseminated gonococcal infections (DGI), though the patient was without other manifestations of DGI.

Machine learning in the detection of dental cyst, tumor, and abscess lesions

Background and ObjectiveDental panoramic radiographs are utilized in computer-aided image analysis, which detects abnormal tissue masses by analyzing the produced image capacity to recognize patterns of intensity fluctuations. This is done to reduce the need for invasive biopsies for arriving to a diagnosis. The aim of the current study was to examine and compare the accuracy of several texture analysis techniques, such as Grey Level Run Length Matrix (GLRLM), Grey Level Co-occurrence Matrix (GLCM), and wavelet analysis in recognizing dental cyst, tumor, and abscess lesions.Materials & MethodsThe current retrospective study retrieved a total of 172 dental panoramic radiographs with lesion including dental cysts, tumors, or abscess. Radiographs that failed to meet technical criteria for diagnostic quality (such as significant overlap of teeth, a diffuse image, or distortion) were excluded from the sample. The methodology adopted in the study comprised of five stages. At first, the radiographs are improved, and the area of interest was segmented manually. A variety of feature extraction techniques, such GLCM, GLRLM, and the wavelet analysis were used to gather information from the area of interest. Later, the lesions were classified as a cyst, tumor, abscess, or using a support vector machine (SVM) classifier. Eventually, the data was transferred into a Microsoft Excel spreadsheet and statistical package for social sciences (SPSS) (version 21) was used to conduct the statistical analysis. Initially descriptive statistics were computed. For inferential analysis, statistical significance was determined by a p value < 0.05. The sensitivity, specificity, and accuracy were used to find the significant difference between assessed and actual diagnosis.ResultsThe findings demonstrate that 98% accuracy was achieved using GLCM, 91% accuracy using Wavelet analysis & 95% accuracy using GLRLM in distinguishing between dental cyst, tumor, and abscess lesions. The area under curve (AUC) number indicates that GLCM achieves a high degree of accuracy. The results achieved excellent accuracy (98%) using GLCM.ConclusionThe GLCM features can be used for further research. After improving the performance and training, it can support routine histological diagnosis and can assist the clinicians in arriving at accurate and spontaneous treatment plans.

Contributions of increased osteopontin and hypophosphatemia to dentoalveolar defects in osteomalacic Hyp mice.

X-linked hypophosphatemia (XLH) is an inherited disorder caused by inactivating mutations in the PHEX gene leading to renal phosphate wasting, rickets and osteomalacia. XLH is also associated with dentoalveolar mineralization defects in tooth enamel, dentin and cementum, and in alveolar bone, which lead to an increased prevalence of dental abscesses, periodontal disease and tooth loss. Genetic mouse experiments, and deficiencies in XLH patient therapies where treatments do not fully ameliorate mineralization defects, suggest that other pathogenic mechanisms may exist in XLH. The mineralization-inhibiting, secreted extracellular matrix phosphoprotein osteopontin (OPN, gene Spp1) is a substrate for the PHEX enzyme whereby extensive and inactivating degradation of inhibitory OPN by PHEX facilitates mineralization. Conversely, excess OPN accumulation in skeletal and dental tissues - for example in XLH where inactivating mutations in the PHEX gene limit degradation of inhibitory OPN, or as occurs in Fgf23-null mice - contributes to mineralization defects. We hypothesized that Spp1/OPN ablation in Hyp mice (a mouse model for XLH) would reduce dentoalveolar mineralization defects. Immunostaining revealed increased OPN in Hyp vs. wild-type (WT) alveolar bone, particularly in osteocyte lacunocanalicular networks where Hyp mice have characteristic hypomineralized peri-osteocytic lesions (POLs). Micro-computed tomography and histology showed that ablation of Spp1 in Hyp mice (Hyp;Spp1-/-) on a normal diet did not ameliorate bulk defects in enamel, dentin, or alveolar bone. On a high-phosphate diet, both Hyp and Hyp;Spp1-/- mice showed improved mineralization of enamel, dentin, and alveolar bone. Silver staining indicated Spp1 ablation did not improve alveolar or mandibular bone osteocyte POLs in Hyp mice; however, they were normalized by a high-phosphate diet in both Hyp and Hyp;Spp1-/- mice, although inducing increased OPN. Collectively, these data indicate that despite changes in OPN content in the dentoalveolar mineralized tissues, there exist other compensatory mineralization mechanisms that arise from knockout of Spp1/OPN in the Hyp background.

Scurvy complicated with Capnocytophaga sputigena sepsis as a possible cause of death of king Saint-Louis of France (1270 AD)

The cause of death of Saint-Louis is not known, but recent findings indicated that he presented scurvy and inflammatory jaw disease, which has been associated with infection by oral commensals. Here, we have the exceptional opportunity to analyze the relics of the viscera of King Saint-Louis.A 4.3 g sample from the viscera relics of King Saint-Louis conserved in Versailles’ cathedral was subjected to radiocarbon dating, electronic and optic microscopy, and elementary, palynological, molecular, proteomics and microbiological analyses including specific PCR and v3v4 16 S rRNA gene amplification prior to large-scale sequencing using an Illumina MiSeq instrument.The measured radiocarbon age was Cal 1290 CE–1400, which was compatible with that of the viscera of St Louis viscera, considering the addition of lime, incense and vegetables within the human organs. Elemental and palynological analyses confirmed a medieval embalming process. Proteomics analysis identified mainly human muscle and blood proteins. Specific PCR for plague, amoebiasis, shigellosis and typhoid fever was negative. C. sputigena was identified as the main pathogenic species representing 10.8 % of all microbial sequences. In contrast, C. sputigena was found in only 0.001 % of samples sequenced in our center, and the 23 positive human samples showed a dramatically lower abundance (0.02–2.6 %). In the literature, human infections with C. sputigena included odontitis, dental abscess, sinusitis, thoracic infections and bacteremia, particularly in immunocompromised patients with oral and dental diseases consistent with recent analysis of King Saint-Louis’ jaw.C. sputigena, a commensal of the mouth that is potentially pathogenic and responsible for fatal bacteremia, may have been the cause of the king's death.

Heartbreak From Puppy Love: A Case of Pasteurella multocida Endocarditis and Review of the Literature

Background Pasteurella multocida, a gram-negative coccobacillus associated with dog, cat, and other animal contact, often causes human bite infection, cellulitis, and osteomyelitis, but infective endocarditis is rare. We present a patient with P. multocida aortic valve endocarditis whose animal exposure was contact with his dog's saliva from frequent licking of patient's skin in the perioral area. Case Presentation A 62-year-old man with successfully treated hepatitis C presented to hospital after a syncopal episode while chasing his dog. He had previously noted night sweats, fever, generalized weakness, and dyspnea on exertion. He denied bites or scratches but admitted allowing his dog to lick around his mouth. On presentation, he was in septic shock with lactic acidosis. White blood cell count was 20,000/μL. Pasteurella multocida was isolated from both admission blood cultures. The patient was treated with antimicrobial therapy and resuscitated. Transthoracic echocardiogram revealed critical bicuspid aortic valve stenosis with root abscess and ascending aortic aneurysm. Transesophageal echocardiogram showed reduced ejection fraction and severe aortic stenosis but no definitive vegetations. At surgery, there were nodular lesions on the aortic valve, left ventricular outflow tract perforation, and annular abscess of aortic valve. He had mechanical aortic valve replacement, annular reconstruction, and aortic aneurysm repair. The patient received 6 weeks of postoperative intravenous ceftriaxone and remained infection-free at 1-year follow-up visit.

Sclerostin antibody improves alveolar bone quality in the Hyp mouse model of X-linked hypophosphatemia (XLH)

X-linked hypophosphatemia (XLH) is a rare disease of elevated fibroblast growth factor 23 (FGF23) production that leads to hypophosphatemia and impaired mineralization of bone and teeth. The clinical manifestations of XLH include a high prevalence of dental abscesses and periodontal disease, likely driven by poorly formed structures of the dentoalveolar complex, including the alveolar bone, cementum, dentin, and periodontal ligament. Our previous studies have demonstrated that sclerostin antibody (Scl-Ab) treatment improves phosphate homeostasis, and increases long bone mass, strength, and mineralization in the Hyp mouse model of XLH. In the current study, we investigated whether Scl-Ab impacts the dentoalveolar structures of Hyp mice. Male and female wild-type and Hyp littermates were injected with 25 mg·kg−1 of vehicle or Scl-Ab twice weekly beginning at 12 weeks of age and euthanized at 20 weeks of age. Scl-Ab increased alveolar bone mass in both male and female mice and alveolar tissue mineral density in the male mice. The positive effects of Scl-Ab were consistent with an increase in the fraction of active (nonphosphorylated) β-catenin, dentin matrix protein 1 (DMP1) and osteopontin stained alveolar osteocytes. Scl-Ab had no effect on the mass and mineralization of dentin, enamel, acellular or cellular cementum. There was a nonsignificant trend toward increased periodontal ligament (PDL) attachment fraction within the Hyp mice. Additional PDL fiber structural parameters were not affected by Scl-Ab. The current study demonstrates that Scl-Ab can improve alveolar bone in adult Hyp mice.

THU394 Disease Burden Of X-Linked Hypophosphatemia Focused On The United States And Canada: A Targeted Literature Review

Abstract Disclosure: Z. Li: Employee; Self; Employee of Kyowa Kirin, Inc., Princeton, NJ, USA. O. Zaidi: Other; Self; Employee of OPEN Health and received funding to complete this research. C. Chukwu: Other; Self; Employee of OPEN Health and received funding to complete this research. H. Heerssen: Other; Self; Employee of Kyowa Kirin, Inc., Princeton, NJ, USA. Y. Zhao: Other; Self; Employee of Kyowa Kirin, Inc., Princeton, NJ, USA. A. Dale: Other; Self; Employee of Kyowa Kirin, Inc., Princeton, NJ, USA. M. Bernauer: Other; Self; Employee of OPEN Health and received funding to complete this research. Introduction: X-linked hypophosphatemia (XLH) is a rare genetic musculoskeletal disease and the most common form of heritable hypophosphatemic rickets. The objective of this review was to summarize the disease burden and treatment patterns of XLH in the United States (US) and Canada. Methods: Publications from January 1, 2015, to June 3, 2022, were searched using the Medline, Embase, and EconLit databases. Observational studies reporting epidemiology, humanistic burden, economic burden, and treatment patterns in the US and Canada were included. Evidence on epidemiology, humanistic burden, and treatment patterns was expanded to other countries as limited US and Canada studies were identified. Results: A total of 1,218 publications were screened; 42 publications were included (6 from US or Canada; 36 did not report location or were from other countries). Epidemiology data (i.e., incidence, prevalence, mortality) were limited for patients with XLH in the US and Canada. The estimated number of people in the US with XLH was &amp;lt;50,000 in 2021. Globally, the incidence of XLH was estimated at 3.9 per 100,000 live births, and the prevalence ranged from 1.4 per 100,000 to 4.8 per 100,000. One United Kingdom-based study estimated an XLH mortality rate of 12.1 per 1,000 person-years. Sixteen publications reported clinical manifestations of XLH, which showed a high level of heterogeneity. Among children with XLH, frequent clinical manifestations (&amp;gt;80% in 1 or more publications) included active rickets, diminished height, gait disturbance, bone or joint pain, and leg bowing. Among adults with XLH, frequent clinical manifestations (&amp;gt;80% in 1 or more publications) included short stature, leg deformity, musculoskeletal pain, fatigue, osteoarthritis, enthesophytes, gait disturbance, dental abscesses, and joint stiffness or restricted range of motion. Humanistic burden data from the US was limited to 2 non-trial publications, which used, respectively, the 36-Item Short Form Survey (SF-36) and the Knee Injury and Osteoarthritis Outcome Score-Physical Function Shortform (KOOS-PS) instruments. These 2 publications reported lower health-related quality of life for patients with XLH compared with the general population. No publication was identified on economic burden, treatment patterns, or XLH guidelines in the US or Canada. A consensus statement from a US panel of experts recommends individualization of monitoring and disease management due to clinical heterogeneity. Conclusions: There are limited published data on disease burden or treatment patterns for XLH in the US or Canada. Further research should consider the epidemiological, humanistic, and economic burden of XLH among pediatric and adult populations in these countries. Presentation: Thursday, June 15, 2023

Outcomes of double-valve surgery for infective endocarditis are improving in the modern era

BackgroundThe incidence of infective endocarditis (IE) is rapidly increasing. Contemporary outcomes following high-risk double valve surgery (DVS) for IE are not well described. MethodsBetween 2001 and 2021, 211 patients with IE underwent combined aortic and mitral valve surgery at a tertiary care referral center. Data from the Society of Thoracic Surgeons registry, including demographics, operative details, and outcomes, were collected. Risk factors for 30-day and 1-year-mortality were analyzed. Survival was analyzed using Kaplan-Meier and Cox proportional hazards modeling. ResultsThe study cohort had a male preponderance (73%), with a median age of 56 years (interquartile range [IQR], 44 to 63 years). Forty-five patients (21%) had a history of intravenous (IV) drug abuse, 50 (24%) were on preoperative dialysis, and 50 (24%) had prosthetic valve endocarditis. Thirty-day and 1-year mortality were 14% (n = 30) and 30% (n = 61), respectively. On multivariable Cox regression adjusting for age, prosthetic valve endocarditis, postoperative intra-aortic balloon pump (IABP), history of dialysis (adjusted hazard ratio [aHR], 1.9; 95% confidence interval [CI], 1.3 to 2.9; P = .002) and IV drug abuse (aHR, 2.0; 95% CI, 1.1-3.5; P = .02) were predictive of decreased survival. Undergoing surgery after 2010 was predictive of improved survival (aHR, 0.5; 95% CI, 0.3 to 0.8; P = .006). These patients were more likely to undergo urgent/emergent surgery (83% vs 29%; P < .001) and less likely to have an aortic root abscess (40% vs 58%; P = .03) or to require the commando procedure (13% vs 33%; P = .002). ConclusionsIn this large series evaluating outcomes of DVS for IE in the modern era, although the mortality risk remained elevated, improving outcomes may be associated with earlier surgical intervention before significant disease progression. Multidisciplinary evaluation for complex IE may be considered to better understand the optimal timing and repair strategy.

P25 TB or not TB? An unusual case of inflammatory arthritis in an anti-CCP positive patient

P25 TB or not TB? An unusual case of inflammatory arthritis in an anti-CCP positive patient

Assessment of Prescription Patterns and Appropriateness of Antibiotics for Prophylaxis in Dental Procedures: A Retrospective Study

There is a lack of data on dentists’ prescribing behaviors when it comes to the correct use of antibiotics in dental treatments. Antibiotic prescriptions made by dentists were analyzed from a diagnostic perspective in a countrywide study. This study retrospectively examined national health data from January 2018 through August 2019, collected through the Prescription Information System. The analysis only included prescriptions for a single illness and at least one systemic antibiotic. Antibiotic prescribing practices and the role of dental specialization and diagnosis were studied. A total of 9,214,956 prescriptions out of 9,293,410 matched the criteria for inclusion. An average course of antibiotic treatment consists of 1.01 pills. Antibiotics were prescribed most frequently for dental caries (16.2% of cases), dental examinations (20.7% of cases), and periapical abscess without sinuses (28.1% of cases). Antibiotics were prescribed for 96.6% of patients for illogical or confusing reasons, whereas just 3.4% were given based on a single, unambiguous diagnosis, such as cellulitis or a mouth abscess. The most commonly prescribed treatment for any medical issue was amoxicillin combined with an enzyme inhibitor (58.6%). Compared to unidentified dental practitioners (58.2%; p = 0.0001), dental specialists in Groups A and B significantly overprescribed amoxicillin plus an enzyme inhibitor (67.0 and 67.8%, respectively; p = 0.0001) (data not shown). The results of the study suggest that dentists routinely and arbitrarily prescribe antibiotics with questionable rationale in the contexts studied. These results emphasize the need for dentists to begin prescribing antibiotics more deliberately and evidence-based. Educational programs, awareness campaigns, and antibiotic stewardship programmes are just some of the interventions that may be implemented to improve prescribing practices and ensure the correct use of antibiotics in dental operations. The results of this countrywide study highlight problems with dentists’ procedures for prescribing dental antibiotics. The paper states that dentists should base their prescription practices on sound reasoning and empirical data. Dentists can help with global efforts to lower antibiotic resistance and improve patient care if they prescribe them in a more reasonable and responsible manner.

Sulfonamide-Resistant Nocardia Isolated from Alveolar Dental Abscesses in a Child with ALL: A Case Report

Introduction: Nocardia is a catalase-positive and gram-positive bacillus. This organism causes skin, lung, and brain infections more frequently in immunocompromised hosts. Objectives: We report a 10-year-old child with a history of lymphoma relapse undergoing chemotherapy several times. There was no improvement after a dental abscess, outpatient surgery, and oral antibiotics. The child was hospitalized with trismus and respiratory distress. In the CT scan, periodontitis and masticatory abscess were reported. Results: The culture results showed Nocardia otitidiscaviarum resistant to experimental antibiotics such as sulfonamides. Clinical symptoms improved with surgical intervention and appropriate antibiotics. The child is in good condition and is currently receiving treatment for the primary illness. Conclusions: Nocardia should be considered in patients with infectious complications following malignancy or other immunocompromised conditions, as failure to correct diagnosis results in inadequate response.

Mandibular small cell osteosarcoma: a case report and review of literature

BackgroundSmall cell osteosarcoma is an extremely rare histopathological variant of conventional osteosarcoma. Due to nonspecific symptoms, most osteosarcomas of the jaws are misdiagnosed as periapical abscesses and mistreated by teeth extraction and drainage.Case presentationWe report, to our knowledge, the seventh case of small cell osteosarcoma in gnathic sites affecting the mandible of an old female with history of a large painful swelling related to the right mandibular molar area for 2 months. Cone-beam computed tomography scan showed an osteolytic lesion related to the lower molar area with involvement of the inferior alveolar nerve. An incisional biopsy was taken, and after histopathological examination and immunohistochemical staining, a diagnosis of small cell osteosarcoma was reached. Hemi-mandibulectomy was performed by a maxillofacial surgeon. No clinical evidence for recurrence was noted until manuscript writing.ConclusionAccurate diagnosis is very important, and general practitioners should be aware of this entity considering that small cell osteosarcoma has a poor prognosis when compared to conventional osteosarcoma.

A Case of X-Linked Hypophosphatemia: Exploring the Burden in a Single Family and the Significance of a Multidisciplinary Approach

A 46-year-old lady was diagnosed clinically with X-linked hypophosphatemia (XLH) with a rare pathogenic variant detected using exome sequencing. Phosphate-regulating endopeptidase homologous X linked (PHEX) is normally expressed in osteoblasts and osteocytes, and senses phosphate regulation. More than 1000 PHEX variants have been detected to date, which are caused by missense, nonsense, and frameshift mutations in addition to splice variants and copy number changes. The aberration in the PHEX gene leads to the upregulation of fibroblastic growth factor 23 (FGF23), which leads to defects in phosphate metabolism. This results in impaired bone growth and mineralization, short and disproportionate stature, leg bowing, musculoskeletal pain, spontaneous dental abscesses, rickets, and osteomalacia in XLH patients. The spectrum of manifestations differs between pediatric and adult patients. In our case study, two of the patient’s children started showing symptoms at a younger age, unlike their mother. Timely diagnosis and the start of treatment would help in their better management and improved quality of life.

Surgical treatment of aortic root abscess: 10-year single center experience

The issue of optimal surgical scope in patients with aortic root abscess due to infective endocarditis remains open, since there are different strategies and interventional methods. In addition, the guidelines do not give preference to any particular type of surgical intervention and recommend an individual approach to each situation. The study included 25 patients with aortic root abscess due to aortic valve infective endocarditis. The most frequently performed surgical intervention in patients was the Ross procedure (n=12, 48%). Eight (32%) patients of the center underwent aortic homograft root replacement. Combined surgery was performed in 7 (28%) patients as follows: 3 (12%) patients — interventions on the mitral valve (all patients underwent mitral valve repair due to mitral valve involvement in abscess), 3 (12%) — coronary artery bypass grafting, 1 (4%) — ascending aortic replacement due to dilatation. Five- and ten-year survival after surgical treatment of patients with aortic root abscess was 86,9% and 78,6%, respectively. There was no reintervention and recurrence of infective endocarditis in the long-term period.

Surgical treatment of aortic root abscess: 10-year single center experience

The issue of optimal surgical scope in patients with aortic root abscess due to infective endocarditis remains open, since there are different strategies and interventional methods. In addition, the guidelines do not give preference to any particular type of surgical intervention and recommend an individual approach to each situation. The study included 25 patients with aortic root abscess due to aortic valve infective endocarditis. The most frequently performed surgical intervention in patients was the Ross procedure (n=12, 48%). Eight (32%) patients of the center underwent aortic homograft root replacement. Combined surgery was performed in 7 (28%) patients as follows: 3 (12%) patients — interventions on the mitral valve (all patients underwent mitral valve repair due to mitral valve involvement in abscess), 3 (12%) — coronary artery bypass grafting, 1 (4%) — ascending aortic replacement due to dilatation. Five- and ten-year survival after surgical treatment of patients with aortic root abscess was 86,9% and 78,6%, respectively. There was no reintervention and recurrence of infective endocarditis in the long-term period.

Analysis of Dental Antibiotic Prescriptions for Children and Adolescents in South Korea

Antibiotics are used for the prevention and treatment of infections. This study aimed to investigate the patterns of dental antibiotic prescription in children and adolescents. The Health Insurance Review and Assessment Service provided data on patients who visited medical institutions. It was categorized according to year, sex, age, insurance type, dental institution, and region. Chi-square tests, Fisher’s exact tests, and one-way analyses of variance were performed. Statistical analyses were performed using SAS software (ver. 9.2; SAS Institute, Cary, NC, USA). Amoxicillin and cephalosporins, the most commonly used antibiotics, accounted for approximately 96% of the prescriptions. The younger the child, the more antibiotics were prescribed for trauma, pulpitis, and dental abscesses. However, closer to adolescence, the antibiotics were primarily prescribed to manage impacted teeth and periodontal problems. Antibiotics were prescribed for 3.13 days on average. There were significant differences in the prescription rates according to age, sex, type of insurance, type of medical institution, and region (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). This study suggested that antibiotic prescriptions should be closely monitored to ensure appropriate usage of antibiotics.

Enterococcal Prosthetic Valve Infective Endocarditis Presenting as Complete Heart Block with Intramyocardial Abscess Causing Asystolic Cardiac Arrest

The extension of an intracardiac abscess causing complete heart block is a rare complication of infective endocarditis that is associated with a high mortality. Early identification of conduction abnormalities and a low threshold for suspecting infective endocarditis is crucial to provide prompt management to prevent intracardial extension of infection. We report a case of a patient presenting with complete heart block in the setting of profound hyperkalemia, and was then found to have enterococcal prosthetic valve endocarditis, which was complicated by an intracardiac aortic root abscess which led to asystolic cardiac arrest. The development of heart block in endocarditis serves as a marker for poor prognosis and can signify progression of infection. Management therefore requires immediate pacing, antibiotic delivery to lessen infectious burden, and evaluation for consideration of surgical options such as valve replacement. It is therefore recommended for patients with endocarditis complicated by conduction abnormalities or intracardial abscesses to be treated by a multi-disciplinary team consisting of cardiologists, cardiothoracic surgeons, and infectious disease specialists.

Dens Invaginatus of Mandibular Premolars and Maxillary Anterior Teeth: A Case Report in Three Brothers

Dens invaginatus (DI), also known as dens in dente, is a developmental anomaly of teeth with enamel and dentin layers folded into the pulp cavity. This case report is about three brothers without any systemic diseases or syndromes. They all have DI on the permanent mandibular premolars and permanent maxillary anterior teeth. Several teeth needed root canal treatment due to this dental anomaly. Some DI can be difficult to detect and can progress to severe cavities and periapical abscesses without notice. Most of these diseases were detected unexpectedly through radiographic examination.