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Ramadan M, Stewart V, Elsherif N, Milligan R, Beresford A, Marley J. Infective endocarditis and oral surgery input before cardiac surgery: time to prick the paradigm of pre-cardiac surgery assessments? Br Dent J 2023; 234:678-681. [PMID: 37173494 PMCID: PMC10177729 DOI: 10.1038/s41415-023-5796-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/22/2022] [Accepted: 01/17/2023] [Indexed: 05/15/2023]
Abstract
Purpose To review current practice regarding oral surgery input for patients awaiting cardiac valvular surgery and who are at risk of infective endocarditis (IE) in the context of the COVID-19 pandemic, and to stimulate debate around the indications for pre-operative oral surgery assessment. It also opens the way to developing a new research-based approach which is patient-centred, safe, effective and efficient.Methods A desk-top based patient review was undertaken between 27 March 2020 and 1 July 2022 to record the outcome of patients undergoing cardiac valvular surgery in Northern Ireland, following the revision of the referral guidelines for oral surgery intervention. Data were collected for all cardiac referrals to the oral surgery on-call service in the Royal Victoria Hospital, Belfast. Complications were recorded at two weeks, two months, and six months post-surgery, using Northern Ireland Electronic Care Records.Results In total, 67 cardiac patients were identified between 27 March 2020 and 1 July 2022: 65.7% of patients were male and had an average age of 68, while the female patients had an average age of 61. The mean interval of date of cardiology referral to surgery date was 9.7 working days, with 36% of patients referred within five days of the planned surgery date. Moreover, 39% had valvular surgery in combination with another type of cardiac surgery. No complications linked to dental aetiology were noted.Conclusions This paper raises questions about the advisability of oral surgery input before cardiac surgery for anything other than pain relief, management of acute dental sepsis, or IE whose source has been identified as an oral commensal. The COVID-19 pandemic has presented an opportunity to review current practice and open the way to developing a new approach which is patient-centred, safe, effective and efficient.
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Affiliation(s)
- Marwa Ramadan
- General Dental Practitioner and Postgraduate Student, Queen´s University Belfast, Belfast, United Kingdom.
| | - Victoria Stewart
- Speciality Dentist, School of Dentistry, Belfast Health and Social Care Trust, United Kingdom
| | - Nusaybah Elsherif
- Department of Oral Medicine, Guy´s and St. Thomas´ NHS Foundation Trust, London, United Kingdom
| | - Rebekah Milligan
- Dental Core Trainee, School of Dentistry, Belfast Health and Social Care Trust, United Kingdom
| | - Amanda Beresford
- Consultant and Honorary Senior Lecturer, School of Dentistry, Belfast Health and Social Care Trust, United Kingdom
| | - John Marley
- Consultant and Honorary Professor, School of Dentistry, Belfast Health and Social Care Trust, United Kingdom
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Enezate T, Alkhatib D, Raja J, Chinta V, Patel M, Omran J. AngioVac for Minimally Invasive Removal of Intravascular and Intracardiac Masses: a Systematic Review. Curr Cardiol Rep 2022; 24:377-382. [PMID: 35129741 DOI: 10.1007/s11886-022-01658-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Management of intracardiac masses, such as right heart thrombi and catheter-related vegetations, can be challenging. Many patients are high-risk candidates for surgical extraction due to multiple comorbidities and risk of distal embolization. In this review, we highlight the advancements in percutaneous approaches for treatment of intracardiac masses utilizing AngioVac (AngioDynamic, Latham, NY). RECENT FINDINGS With the Food and Drug Administration (FDA) approval of the AngioVac System in 2009, a growing body of evidence has proven it to be a feasible and effective tool to extract thrombi and masses from the iliocaval system and the right heart. In this review, we highlight the feasibility of AngioVac System (AngioDynamic, Latham, NY) based on the published cases series and registries. Future randomized controlled trials are needed to establish an algorithmic approach in treating intracardiac masses.
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Affiliation(s)
- Tariq Enezate
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA.,Division of Cardiovascular Diseases, Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | - Deya Alkhatib
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Joel Raja
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Viswanatha Chinta
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mitul Patel
- Sulpizio Cardiovascular Center, University of California San Diego, San Diego, CA, USA
| | - Jad Omran
- Sharp HealthCare System, 5555 Grossmont Center Dr. La Mesa, San Diego, CA, 91942, USA.
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Ryalat S, Hassona Y, Al-Shayyab M, Abo-Ghosh M, Sawair F. Dentists' knowledge and practice regarding prevention of infective endocarditis. Eur J Dent 2019; 10:480-485. [PMID: 28042262 PMCID: PMC5166303 DOI: 10.4103/1305-7456.195158] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Objectives: The objective of this study is to assess the knowledge and practice of dentists from Jordan, regarding prevention of infective endocarditis (IE) in dental practice. Materials and Methods: A sample of Jordanian dentists was interviewed regarding their IE knowledge and practice using a validated and pretested survey instrument. Results: Most of the dentists have encountered a patient with IE who needed prophylactic antibiotic (PA) and have prescribed antibiotics to prevent IE. Jordanian dentists’ approach to patients in need for PA varied between the National Institute for Health and Clinical Excellence recommendations and the American Heart Association to a lesser degree, but still a relatively high percent (39%) did not know any guidelines to follow although 74% have encountered patients who needed endocarditis prophylaxis. Patients with prosthetic heart valve were ranked on top of medical conditions that required PA (87.4%), and most dentists (94.5%) thought that dental extractions need PA followed by periodontal surgery (88.2%). Conclusion: There is a lack of consistency in the knowledge and practice of Jordanian dentists with regard to IE. There is a need to take actions to improve dentist's knowledge regarding this topic.
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Affiliation(s)
- Soukaina Ryalat
- Department of Oral and Maxillofacial Surgery, Oral Medicine, and Periodontics, Faculty of Dentistry, The University of Jordan, Amman, Jordan
| | - Yazan Hassona
- Department of Oral and Maxillofacial Surgery, Oral Medicine, and Periodontics, Faculty of Dentistry, The University of Jordan, Amman, Jordan
| | - Mohammad Al-Shayyab
- Department of Oral and Maxillofacial Surgery, Oral Medicine, and Periodontics, Faculty of Dentistry, The University of Jordan, Amman, Jordan
| | - Mais Abo-Ghosh
- Internist at the Department of Oral and Maxillofascial Surgery, Faculty of Dentistry, The University of Jordan, Amman, Jordan
| | - Faleh Sawair
- Department of Oral and Maxillofacial Surgery, Oral Medicine, and Periodontics, Faculty of Dentistry, The University of Jordan, Amman, Jordan
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Hassona Y, Kasabreh N, Hammoudeh H, Scully C. Oral healthcare management in Bardet Biedl syndrome. SPECIAL CARE IN DENTISTRY 2016; 37:47-50. [PMID: 27571505 DOI: 10.1111/scd.12198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Bardet Biedl syndrome is a rare autosomal recessive disorder with variable clinical presentation and challenging diagnosis. Recognition of orofacial features might help in the diagnosis. Dental management of affected patients might be complicated by renal, cardiac, metabolic, neurosensory, and cognitive defects.
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Affiliation(s)
- Yazan Hassona
- Assistant Professor, Department of Oral Surgery, Oral Medicine and Periodontology, School of Dentistry, The University of Jordan, Amman
| | - Najla Kasabreh
- Teaching Assistant, School of Dentistry, The University of Jordan, Amman
| | - Hanin Hammoudeh
- Teaching Assistant, School of Dentistry, The University of Jordan, Amman
| | - Crispian Scully
- Codirector WHO Collaborating Centre for Oral Health-General Health and Professor Emeritus, University College London, UK
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Khan O, Shafi AMA, Timmis A. International guideline changes and the incidence of infective endocarditis: a systematic review. Open Heart 2016; 3:e000498. [PMID: 27621836 PMCID: PMC5013500 DOI: 10.1136/openhrt-2016-000498] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 07/21/2016] [Accepted: 08/02/2016] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to determine the impact on incident infective endocarditis (IE) of guideline recommendations to restrict indications for antibiotic prophylaxis. We conducted a systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline. PubMed and EMBASE databases were searched for articles published between 2007 and 2015 using mesh terms relevant to the research question. Included were English language articles published after 2009 that provided estimates of IE incidence before-and-after major international guideline changes. Seven studies were identified: 1 conducted in France, 4 in the USA and 2 in the UK. Only 1 study reported an increase in the rate of incident IE following guideline modification, and the remainder showed no change in upward (2 studies) or downward (4 studies) incidence trends. Study quality was generally poor for answering the question posed in this review, with serious risk of bias related to diagnostic ascertainment and unavailability of population risk data to adjust the incidence estimates. Moreover, the studies were often small, and relevant bacteriological data were not always available. Only 2 reported changes in antibiotic prescriptions, but these data were not linked to health records making it impossible to determine causal relations to changes in incident IE. The studies in this review were heterogenous in their design and variably limited by study size, duration of follow-up, diagnostic ascertainment, and absence of relevant prescription and bacteriological data. The studies were inconsistent in their conclusions and it remains uncertain what, if any, has been the impact of antibiotic prophylaxis guideline changes on the incidence of IE.
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Avilés-Reyes A, Miller JH, Lemos JA, Abranches J. Collagen-binding proteins of Streptococcus mutans and related streptococci. Mol Oral Microbiol 2016; 32:89-106. [PMID: 26991416 DOI: 10.1111/omi.12158] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2016] [Indexed: 12/13/2022]
Abstract
The ability of Streptococcus mutans to interact with collagen through the expression of collagen-binding proteins (CBPs) bestows this oral pathogen with an alternative to the sucrose-dependent mechanism of colonization classically attributed to caries development. Based on the abundance and distribution of collagen throughout the human body, stringent adherence to this molecule grants S. mutans with the opportunity to establish infection at different host sites. Surface proteins, such as SpaP, WapA, Cnm and Cbm, have been shown to bind collagen in vitro, and it has been suggested that these molecules play a role in colonization of oral and extra-oral tissues. However, robust collagen binding is not achieved by all strains of S. mutans, particularly those that lack Cnm or Cbm. These observations merit careful dissection of the contribution from these different CBPs towards tissue colonization and virulence. In this review, we will discuss the current understanding of mechanisms used by S. mutans and related streptococci to colonize collagenous tissues, and the possible contribution of CBPs to infections in different sites of the host.
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Affiliation(s)
- A Avilés-Reyes
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - J H Miller
- Department of Anesthesiology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - J A Lemos
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - J Abranches
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, FL, USA
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Hassona Y, Hamdan M, Shqaidef A, Abu Karaky A, Scully C. Ellis-Van Creveld syndrome: dental management considerations and description of a new oral finding. SPECIAL CARE IN DENTISTRY 2015; 35:312-5. [PMID: 25939880 DOI: 10.1111/scd.12116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ellis-Van Creveld is a rare syndrome with characteristic dental and orofacial findings. Dental management of patients with Ellis-Van Creveld syndrome can be complicated by the associated skeletal and cardiac abnormalities. Here, we present the dental and orofacial findings in a patient with Ellis-Van Creveld syndrome, describe a new oral finding, and discuss the dental management considerations.
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Affiliation(s)
- Y Hassona
- Assistant Professor, Department of Oral Surgery, Oral Medicine and Periodontology, Faculty of Dentistry, The University of Jordan, Amman
| | - M Hamdan
- Dental Student, Faculty of Dentistry, The University of Jordan, Amman
| | - A Shqaidef
- Assistant Professor, Department of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, The University of Jordan, Amman
| | - A Abu Karaky
- Associate Professor, Department of Oral Surgery, Oral Medicine and Periodontology, Faculty of Dentistry, The University of Jordan, Amman
| | - C Scully
- Professor Emeritus, University College of London, United Kingdom
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