Group B Streptococcus tricuspid valve endocarditis with subsequent septic embolization to the pulmonary artery: A case report following elective abortion.

BACKGROUND: Tricuspid valve endocarditis caused by Group B streptococcus is a rare clinical entity with poor prognosis and has been previously reported following gynecologic procedures. CASE SUMMARY: We report a case of an 18-year-old female diagnosed with Group B streptococcus tricuspid valve endocarditis with septic emboli following an elective therapeutic abortion. After six weeks of treatment with ceftriaxone, she returned with recurrent symptoms and was found to have embolized a sizable vegetation to the pulmonary artery with probable lung infarction. She underwent surgical embolectomy and was treated with antibiotics and anticoagulation and was subsequently discharged in stable condition. CONCLUSION: Group B streptococcus endocarditis is a serious complication of gynecologic procedures. The role of preoperative antibiotics, postoperative clinical suspicion of endocarditis based on respiratory symptoms and a multidisciplinary approach may lead to enhanced patient outcomes.

Population-Based Evaluation of Major Adverse Events After Catheter Ablation for Atrial Fibrillation.

OBJECTIVES: The purpose of this study was to evaluate the safety and incidence of periprocedural adverse events (AEs) among patients who underwent catheter ablation (CA) for atrial fibrillation (AF) in Quebec and Ontario, Canada. BACKGROUND: CA is evolving into the mainstay therapy for patients with symptomatic AF refractory to antiarrhythmic medication. However, the safety of CA at the population level over time requires further evaluation. METHODS: A population-based cohort was constructed using administrative databases of all patients who underwent CA between 1999 and 2014 in Quebec and Ontario, Canada. Incidence and predictors of AEs were assessed within 30 days of CA. Major AEs included all-cause mortality, cerebrovascular accident (CVA) including transient ischemic attack, pericardial effusion requiring drainage (PERD), vascular AEs, hemorrhage/hematoma, and pulmonary embolism. RESULTS: Of 6,388 patients who had a CA (mean age 57.3 years; mean CHA2DS2-VASc 1.1 ± 1.4; 27.6% female), 221 (3.5%) patients developed major AEs within 30 days of index CA. Hemorrhage/hematoma was the most frequent (1.4%), followed by PERD (1.0%) and CVA (0.6%). PERD was more likely to occur post-discharge than during the index CA (p < 0.05). CVA decreased by more than 50% in patients with recent compared with remote CA (p < 0.05). Compared with index CA, the incidence of PERD and hemorrhage/hematoma was greater at first repeat CA (p < 0.05 for both). CONCLUSIONS: CA is a relatively safe procedure with low incidence of major AEs. The incidence of procedure-related CVA appeared to decline significantly over time. Incidence of PERD remained relatively stable and was more likely to be diagnosed after discharge and following repeat CA.

Outcome Reporting in Cardiac Surgery Trials: Systematic Review and Critical Appraisal.

BACKGROUND: There is currently no accepted standard for reporting outcomes following cardiac surgery. The objective of this paper was to systematically review the literature to evaluate the current use and definition of perioperative outcomes reported in cardiac surgery trials. METHODS AND RESULTS: We reviewed 5 prominent medical and surgical journals on Medline from January 1, 2010, to June 30, 2014, for randomized controlled trials involving coronary artery bypass grafting and/or valve surgery. We identified 34 trials meeting inclusion criteria. Sample sizes ranged from 57 to 4752 participants (median 351). Composite end points were used as a primary outcome in 56% (n=19) of the randomized controlled trials and as a secondary outcome in 12% (n=4). There were 14 different composite end points. Mortality at any time (all-cause and/or cardiovascular) was reported as an individual end point or as part of a combined end point in 82% (n=28), myocardial infarction was reported in 68% (n=23), and bleeding was reported in 24% (n=8). Patient-centered outcomes, such as quality of life and functional classification, were reported in 29% (n=10). Definition of clinical events such as myocardial infarction, stroke, renal failure, and bleeding varied considerably among trials, particularly for postoperative myocardial infarction and bleeding, for which 8 different definitions were used for each. CONCLUSIONS: Outcome reporting in the cardiac surgery literature is heterogeneous, and efforts should be made to standardize the outcomes reported and the definitions used to ascertain them. The development of standardizing outcome reporting is an essential step toward strengthening the process of evidence-based care in cardiac surgery.

Impact of scaling and root planing with adjunct essential-oil-based mouthwash usage on whole salivary IgG levels in patients with periodontal inflammation.

OBJECTIVE: The aim was to assess the effect of scaling and root planing (SRP) with and without adjunct use of an essential-oil-based-mouthwash (EOBM) on whole salivary immunoglobulin G (IgG) levels in patients with periodontal inflammation. METHODS: Fifty patients with periodontal inflammation were included. Treatment wise, these patients were randomly divided into two groups. In group 1, patients underwent SRP and were instructed to rinse with 10 mL of an EOBM twice daily for 30 days, whereas those in group 2 underwent SRP and were instructed to rinse with 10 mL of water twice daily for 30 days. Whole saliva samples were collected at baseline and after 40 days of treatment. P-values < 0.05 were considered statistically significant. RESULTS: At baseline, whole salivary IgG levels were comparable among patients in groups 1 (60.5 ± 5.5 mg/dL) and 2 (57.3 ± 2.4 mg/dL). After 40 days of follow-up, there is a significant decrease in whole salivary IgG levels among patients in group 1 (7.2 ± 2.4 mg/dL) as compared to those in group 2 (26.6 ± 4.6 mg/dL) (P < 0.001). CONCLUSIONS: SRP, when performed with adjunct use of an EOBM, is more effective in reducing whole salivary IgG levels as compared to when SRP is performed without adjunct use of an EOBM.

Causes and patterns of spine trauma in children and adolescents in Saudi Arabia: implications for injury prevention.

BACKGROUND AND OBJECTIVES: Knowledge regarding traumatic spine injuries (TSIs) is essential for effective prevention strategies, particularly in the developing world, where majority of the population is younger and organized prevention programs are scarce. Therefore, our objective was to describe TSI mechanisms, demographics, patterns, and outcomes in children and adolescents. DESIGN AND SETTINGS: Retrospective chart review in a major trauma center from May 2001 to May 2009 in Riyadh, Saudi Arabia. PATIENTS AND METHODS: Detailed chart reviews were done for all consecutive TSI patients ≤18 years old.Cases were identified through the trauma database registry that included admitted patients. RESULTS: Of the 3796 cases identified, 120 cases (3.2%) sustained 141 TSIs (mean age: 13.5 years; males:83.8%). TSI was most common among children from 16 to 18 years old. Overall, motor vehicle collision (MVC)was the most common injury mechanism (60.8%). However, younger patients (<12 years) sustained more pedestrian injuries (40.6%). Among MVC cases with known seat belt statuses (43.8%), 90.6% were not wearing seat belts. The cervical spine level was the most commonly affected (55.8%) region, especially in children <12 years old (88%). More than 1 affected spinal level was found in 23.3% cases. Spinal cord injuries were found in 19.2% cases. Overall, mortality was 8.3%, and half of these mortalities were secondary to pedestrian injuries. A total of 22.7% of cases were discharged with neurological deficits. CONCLUSION: The high frequency and severity of MVC and pedestrian injuries observed in the present study raise significant concerns regarding the safety of children on the roads. Spine involvement was age specific;younger patients tended to have more cervical injuries, and older patients exhibited more thoracic spine involvement.