A Case of Indolent Endocarditis
Bibliographic record
Abstract
1Department of Medicine; 2Department of Pathology, McGill University, Montreal, Quebec Correspondence: Dr Hanane Benbarkat, 687 Pine Avenue, Room 10.02, Montreal, Quebec H3A 1A1. Telephone 514-843-1506, fax 514-843-1725, e-mail hanane.benbarkat@mail.mcgill.ca case presentation A 69-year-old man with aortic stenosis underwent coronary artery bypass grafting and bioprosthetic aortic valve replacement (AVR) in November 2007. His medical history was remarkable for a polypectomy in 2007, gout and chronic kidney disease (creatinine level at presentation 150 μmol/L). In September 2008, the patient presented to the hospital with fever and a right middle cerebral artery infarct. His neurological symptoms ultimately resolved. An echocardiogram demonstrated vegetation on the aortic valve bioprosthesis with a periaortic abscess. Blood cultures grew Staphylococcus epidermidis. An increase in the size of the periaortic abscess one month later, despite appropriate intravenous antibiotic therapy, required another AVR (Carpentier Edwards Magna 23 bioprosthesis, Edwards Lifesciences LLC, USA). He was then treated with antibiotics for an additional six weeks. The prosthesis culture grew Penicillium species 11 days after his surgery, and valve pathology showed fungal hyphae one month later (Figure 1). The patient was asymptomatic. He was offered amphotericin B treatment but refused. He remained asymptomatic until May 2010 when he presented with a two-week history of exertional dyspnea. He developed a cold right leg two days before this presentation. On examination, he was afebrile with normal blood pressure and heart rate. Chest examination was unremarkable. Cardiovascular examination revealed a 2/6 systolic ejection murmur at the left second intercostal space with radiation to the right supraclavicular space. There was no diastolic murmur. The jugular venous pressure was normal. The right leg was cold and peripheral pulses were nonpalpable. Laboratory investigations showed a normal white blood cell count, an erythrocyte sedimentation rate of 82 mm/h and his chest x-ray was normal. The PR interval on the electrocardiogram was 280 ms compared with 200 ms in October 2008. A repeat echocardiogram demonstrated a 27 mm × 15 mm vegetation on the aortic bioprosthesis with a periaortic mass highly suggestive of an aortic root abscess. The mean gradient across the aortic valve had increased to 43 mmHg from 14 mmHg in June 2009. The patient was empirically treated for prosthetic valve endocarditis with vancomycin, gentamycin and rifampin.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".