Heart Block as a Rare Complication of Tricuspid Valve Endocarditis: Awareness is the Key.

Infective endocarditis (IE) occurs when bacterial or fungal pathogens enter the blood and attach to the endocardium. Right-sided endocarditis is usually associated with intravenous drug use (IVDU), intracardiac devices, and central venous catheters. There is more data published about left-side endocarditis when compared to right-sided endocarditis. Tricuspid valve infective endocarditis (TVIE) accounts for 5%-10% of IE, and of those cases, roughly 10% are complicated by conduction deficits due to inflammatory edema, myocarditis, and abscess formation. Tricuspid valve (TV) surgical repair carries its own risks, one of which includes the development of conduction abnormalities. Here, we review the current data of TVIE complicated by heart block after tricuspid valve replacement. Also, we present a case of a 21-year-old IVDU female who presented with tricuspid valve endocarditis, subsequently underwent tricuspid valve replacement, and developed a heart block.

N95 respirator and surgical mask effectiveness against respiratory viral illnesses in the healthcare setting: A systematic review and meta-analysis.

OBJECTIVE: To examine the results, level of evidence, and methodologic quality of original studies regarding surgical mask effectiveness in minimizing viral respiratory illness transmission, and, in particular, the performance of the N95 respirator versus surgical mask. METHODS: Meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with use of PubMed, MEDLINE, and the Cochrane Library databases. RESULTS: Eight studies (9164 participants) were included after screening 153 articles. Analyses showed statistically significant differences between N95 respirator versus surgical mask use to prevent influenza-like-illness (risk ratio [RR] = 0.81, 95% confidence interval [CI] = 0.68-0.94, P < 0.05), non-influenza respiratory viral infection (RR = 0.62, 95% CI = 0.52-0.74, P < 0.05), respiratory viral infection (RR = 0.73, 95% CI = 0.65-0.82, P < 0.05), severe acute respiratory syndrome coronavirus (SARS-CoV) 1 and 2 virus infection (RR = 0.17, 95% CI = 0.06-0.49, P < 0.05), and laboratory-confirmed respiratory viral infection (RR = 0.75, 95% CI = 0.66-0.84, P < 0.05). Analyses did not indicate statistically significant results against laboratory-confirmed influenza (RR = 0.87, CI = 0.74-1.03, P > 0.05). CONCLUSIONS: N95 respirator use was associated with fewer viral infectious episodes for healthcare workers compared with surgical masks. The N95 respirator was most effective in reducing the risk of a viral infection in the hospital setting from the SARS-CoV 1 and 2 viruses compared to the other viruses included in this investigation. Methodologic quality, risk of biases, and small number of original studies indicate the necessity for further research to be performed, especially in front-line healthcare delivery settings.

A comparison of disease burden and symptoms with age among CoVid-19 patients from data in a Florida clinic.

Our knowledge of the disease burden and symptoms with age in COVID-19 patients is limited. Therefore, it is of interest to document the clinical aspect of this association with respect to the disease. We used the data of 3363 patients enrolled with an urgent care clinic in Volusia county, Florida for this study. Data shows difference in age among COVID-19 antibody (Ab) - positive patients (48.3 years, 95% CI = 46.9,49.7 years) and Ab-negative patients (46.1 years, 95% CI = 45.4, 46.8 years). However, disease burden by age is not significant on average. Nonetheless, COVID-19 positive patients between 40-69-years of age experienced the highest burden of disease and highest average number of symptoms. Thus, COVID-19 disease burden and number of symptoms experienced were highest among the 40-69-year-old patients. Those above the populations mean age of 46.4 years old were more likely to test positive for COVID-19.

Malignant Ameloblastoma with Hepatic Metastasis in a 38-Year-Old Haitian Woman.

BACKGROUND Primary malignant ameloblastoma is a very rare tumor of the dental lamina epithelium. Similar to the benign ameloblastoma, the mass is without significant histological atypia, but the malignant type may present with metastases, most commonly to the lungs. The average age of diagnosis is 34 years, and the malignancy affects men and women equally. The tumors often present with an insidious growth and have a median survival from time of diagnosis of 17.6 years. Due to the rarity of this lesion, a standard of care has not yet been established. CASE REPORT A 38-year-old Haitian woman, who initially presented with a large primary malignant ameloblastoma of the angle of the mandible, experienced a recurrence in the floor of the mouth 30 months after surgical resection. In 2018, 2 years after the removal of the recurrent tumor, the patient presented with ascites, right-sided abdominal pain, weight loss, and a palpable liver mass. Laparoscopic exploration demonstrated a complex lateral right liver lobe cyst, suspicious for parasitic infection. Cytological analysis showed positive staining for cytokeratin 5/6, P63, and CD56, indicative of metastatic ameloblastoma of the liver. Consistent cell morphology from the primary tumor and liver cyst was also noted. Following drainage of the cyst, the patient returned to Haiti, where she died in 2020. In Haiti, she lacked appropriate local medical care, leading to the severe progression of her initial primary ameloblastoma and disease recurrence. CONCLUSIONS Malignant ameloblastoma accounts for less than 2% of all odontogenic tumors, as the benign variant is much more common. Distant metastases of these lesions are rare; to date, few cases have presented with hepatic metastases.