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Abstract Disclosure: L.A. Robles Gomez: None. G. Gill: None. A. Vincent, DO: None. A. Mahmoud, MD: None. Introduction: Osteitis fibrosa cystica (OFC) is a pathognomonic yet uncommon finding of hyperparathyroidism seen in less than 2% of patients with primary hyperparathyroidism in Western countries. We present a case of infrequent finding of late-stage severe hyperthyroidism with asymptomatic hypercalcemia and incidental findings of osteolytic bone lesions. Clinical Case: A 28-year-old female with a history of PCOS, fatigue, and chronic abdominal pain presents to the clinic after recent work-up during an ED visit demonstrated incidental findings of osteolytic bone lesions in the setting of mild hypercalcemia. Physical examination was relatively unremarkable except for mild tenderness to palpation on the right lower quadrant. Laboratory significant calcium 10.7 mg/dl (8.6-10.2 mg/dL), albumin 3.6 g/dL, Creatinine 0.56 mg/dL, GFR 127 mL/min, Alkaline phosphatase 187 IU/L (37-127 IU/L), AST 24 IU/L, ALT 45 IU/L, Intact PTH and calcium: PTH 413 pg/mL (15-65 pg/mL), Calcium 11.5 (8.7-10.4 mg/dL), Bone Specific Alkaline Phosphatase: 54.5 mcg/L (4.7-17.8 mcg/L), Phosphorus 2.1 mg/dL (2.4-4.8 mg/dL), Magnesium 1.7 mg/dL (1.5-2.5 mg/dL), Vitamin D 25 10 mg/mL (20-100 ng/mL), TSH 2.12 uIU/mL (0.46-5.05 uIU/mL). CT abdomen pelvis w/o contrast with multiple predominantly lytic expansile bone lesions, mainly in the pelvis, with the most extensive 6.2 cm lesion in the superior, posterior right ilium, the anterior acetabulum, and the posterior right ischium. A prior CT done in 2018 showed a similar distribution of lytic lesions. The patient denied any previous personal or family history of hypercalcemia or parathyroid abnormalities despite a review of prior outside records revealed abnormal labs dating back to 2018 with intact PTH 406 pg/mL, calcium 10.3 mg/dL, Ionized calcium 10.7 mg/dl (3.30-6.0 mg/dL), albumin 3.3g/dL, alkaline phosphatase 288 IU/L. The patient denied prior symptomatology of hypercalcemia, including renal stones, or prior treatment for hypercalcemia. Further work-up was ordered, and the patient was referred to endocrine surgery for management. Conclusion: Osteitis fibrosa cystica (OFC) has become a rare manifestation of primary hyperparathyroidism (PHPT) due to early diagnosis of hypercalcemia by routine lab monitoring. Skeletal findings typically seen on PHPT can vary from bone reabsorption-acroosteolysis, subchondral bone resorption, brown tumors, salt-and-pepper skull, and osteopenia. Subchondral reabsorption around specific joints commonly affects pubic symphysis and sacroiliac joints, as seen in our patient. The mechanism is due to PTH-mediated osteoclastic absorption of bone and surrounding cartilage. Due to the rare presentation of PHPT with associated osteitis fibrosa cystica, diagnosis requires a high degree of clinical suspicion, as delayed diagnosis can lead to avoided manifestation, as described by our report. Presentation: 6/3/2024

Objectives To compare the mechanical performance of partially replaced (repaired) intra-coronal restorations to totally replaced ones in root canal-treated teeth. Methods Thirty maxillary second premolars were selected according to strict criteria, mounted on moulds, and had mesio-occluso-distal (MOD) cavities prepared. Resin composite restorative material was used to perform the initial restoration, followed by aging procedures using thermo-mechanical cycling fatigue to replicate six months of intraoral aging. The specimens were then randomly divided into two groups: a totally replaced restoration (TR) group ( n  = 15), which involved the preparation of a traditional endodontic access cavity after the complete removal of the pre-existing coronal filling; and a partially replaced restoration (PR) group ( n  = 15), which involved accessing the tooth through the pre-existing restoration without completely removing it. Root canal preparation and filling procedures were conducted, and the access cavity was sealed with a new resin composite restoration, followed by a new thermo-mechanical cycling aging procedure. Finally, the specimens were submitted to a static fracture test to measure specimen fracture strength and determine the failure mode pattern (repairable fracture or irreparable fracture). Chi-square and t -tests were used for statistical analysis. Results Significant differences between the groups regarding their mechanical resistance were found. The average failure load of the TR group was 1115.13 N and 1330.23 N in the PR group ( p  = 0.002). Regarding the failure modes, the TR group exhibited eight irreparable fractures, while the PR group had four ( p  = 0.136). Conclusions Partially replaced restorations presented higher fracture strength and led to fewer irreparable fractures when compared to totally replaced restorations in root canal-treated teeth.

Background Asthma is a globally prevalent chronic respiratory disease with rising incidence, particularly in developing countries, where underdiagnosis and poor disease control are common. In Saudi Arabia, regional disparities in asthma awareness and healthcare accessibility contribute to inconsistent disease outcomes. Al-Qunfudhah, a semi-urban coastal city in western Saudi Arabia, lacks localized data on asthma prevalence and associated comorbidities, despite its unique environmental challenges such as maritime humidity and seasonal dust storms. Objectives This study aimed to assess the level of public awareness about asthma, identify the prevalence of self-reported asthma and associated comorbidities, and evaluate demographic correlations with asthma-related knowledge among residents of Al-Qunfudhah. Methods A descriptive cross-sectional study was conducted between January and March 2025, involving 540 adult residents of Al-Qunfudhah recruited via convenience sampling through an online Google form. A prevalidated, structured Arabic and English questionnaire assessed sociodemographic data, asthma knowledge and awareness, comorbid conditions, and management practices. Statistical analyses were performed using SPSS version 26 (IBM Corp., Armonk, USA), with chi-square tests to examine associations (p < 0.05 considered significant). Results Most participants were male (64.6%), aged 46-60 years (28.9%), and held a university degree or higher (74.3%). Although 94.4% correctly identified asthma as a lung disease, only 66.9% could recognize all common symptoms, with fewer recognizing persistent cough (21.1%) and dyspnea (43.0%). Approximately 20.2% had a prior asthma diagnosis, and among them, 69.8% had been diagnosed for over five years. Notably, 74.3% were aware of preventive measures, yet only 14.6% reported regular use of asthma medications, and 50.2% had not received inhaler technique instruction. Comorbidities were prevalent: allergic rhinitis (20.2%), obesity (5.6%), and gastroesophageal reflux disease (GERD) (3.7%) were the most reported. Awareness was significantly higher among those previously diagnosed with asthma, individuals aged 46-60 years, and those with intermediate education. Conclusion While general awareness of asthma in Al-Qunfudhah is relatively high, significant gaps remain in symptom literacy, medication use, and understanding of asthma-related comorbidities. These findings highlight an urgent need for community-based asthma education programs tailored to regional demographics. Targeted public health initiatives that promote accurate symptom recognition, proper inhaler usage, and integrated management of comorbidities are essential to improving asthma outcomes in underserved areas like Al-Qunfudhah.

Fournier's gangrene is an extremely rare infection that can occur in immunocompromised patients, especially those with diabetes. Given the severity of this infection and the new associated link to sodium-glucose cotransporter-2 inhibitors, the US FDA recently issued a warning in August 2018. Few cases of Fournier's gangrene have been reported in the literature in diabetic patients taking these oral medications. We report a case of Fournier's gangrene presenting 10 days after a patient with type 2 diabetes started empagliflozin therapy.

Objectives To evaluate the impact of passive ultrasonic irrigation on the micro-tensile bond strength of two different self-etch adhesive systems, including a universal one-step adhesive and a two-step adhesive system, to pulp chamber dentine compared to conventional syringe irrigation. Methods Twenty-four extracted human mandibular first molar teeth were chosen according to strict criteria and mounted in epoxy resin blocks. Subsequently, the pulp chambers were exposed using an Isomet cutting machine. The specimens were numbered and assigned to four groups (6 teeth each) based on the canal irrigation method and the adhesive system used as follows: Conventional syringe irrigation in which a universal one-step self-etch adhesive system was applied (CSIU), conventional syringe irrigation in which a two-step self-etch adhesive system was used (CSIT), passive ultrasonic irrigation in which a universal one-step self-etch adhesive system was utilized (PUIU), and passive ultrasonic irrigation in which a two-step self-etch adhesive system was employed (PUIT). Following placement of the final restoration and submission to simultaneous thermo-mechanical cycling (artificial aging) equivalent to 6-month intra-oral aging, the teeth were sectioned and dentine/restoration beams were prepared. The micro-tensile bond strength was evaluated and the failure mode was defined, with a confirmatory evaluation of the dentine-resin interface using a scanning electron microscope. Statistical analysis was conducted using one-way ANOVA and Tukey’s post hoc tests to compare irrigation regimens for each adhesive technique independently, while failure modes of each adhesive system were represented as the frequency for each irrigation method. The significance level was set at 5%, with a confidence interval (CI) of 95%. Results The micro-tensile bond strength of composite resin restorations to pulp chamber dentine was reduced significantly with ultrasonic irrigation with more unfavorable failure modes compared to syringe irrigation ( P  < 0.0001), irrespective of the type of adhesive system used. The means of the micro-tensile strength for teeth treated with the two-step adhesive system were 26.1055 ± 4.7611 MPa and 16.0079 ± 3.7665 MPa for CSIT and PUIT, respectively. For teeth treated with the universal adhesive system, the mean for CSIU (20.1818 ± 3.8500 MPa) was significantly higher than that of PUIU (11.2090 ± 2.9928 MPa). The micro-tensile bond strength was significantly greater with the two-step adhesive system compared to the universal adhesive, regardless of the irrigation method ( p  < 0.05). An adhesive layer with varying thickness was noted in all groups, displaying distinct morphological features. Conclusions Within the limitations of the present laboratory investigation, ultrasonic irrigation may negatively affect the bond between composite resin restorations and pulp chamber dentine compared to conventional syringe irrigation. The two-step self-etch adhesive tended to achieve a stronger bond to pulp chamber dentine than the universal one-step self-etch adhesive. Clinical relevance While ultrasonic irrigation would be essential for effective root canal debridement and disinfection, it is imperative for clinicians to consider its potential adverse effects. This method may considerably impact the bond strength of composite resin restorations to the pulp chamber dentine, particularly when compared to conventional syringe irrigation. In root canal-treated teeth, a two-step self-etch adhesive system might be more effective in maximizing the bond strength to pulp chamber dentine than a universal adhesive system. However, these findings were concluded under the conditions of the present study and must be interpreted cautiously. Further research is recommended to validate these results and fully understand the clinical ramifications of ultrasonic irrigation on adhesive performance in different dental situations. Clinical trial number Non-applicable. Conducting the current experiment was limited to the approval of the local Research Ethics Committee at the Faculty of Dentistry, Minia University, Egypt (Committee No. 106, Registration No. 910, Date: April 30, 2024).

Angiotensin-converting enzyme (ACE) inhibitors are among the most common medications used to treat patients with concomitant diabetes and hypertension. They are considered the first line of treatment for hypertension in this population. Several case studies have reported that ACE inhibitors can induce hypoglycemia in patients with diabetes. To our knowledge, however, ACE inhibitors have not been found to induce hypoglycemia in patients without diabetes. This report describes a patient without diabetes experiencing recurrent severe hypoglycemia induced by the ACE inhibitor lisinopril.

Amiodarone is a class III antiarrhythmic drug, used by cardiologists to treat arrhythmia including atrial fibrillation (A fib) and ventricular fibrillation. However, amiodarone is associated with endocrine dysfunction including both hypo- and hyperthyroidism. In the literature, two types of amiodarone-induced thyrotoxicosis (AIT) were described: AIT-1 and AIT-2. Mixed AIT also called AIT type 3 (AIT-3) has been described in the literature when the cases do not have a typical presentation. In order to differentiate different types of AIT, various clinical, biochemical, and radiological tools have been proposed. The use of 99mTc-methoxy-isobutyl-isonitrile (sestaMIBI) uptake on scintigraphy (99m-STS) has been suggested in the literature in only few studies (no large retrospective or prospective studies have been established in the United States). We present a case series describing 5 patients presenting to the University of Arizona with AIT where we used 99m-STS to assess in diagnosis and treatment of different types of AIT followed by a review of the literature.

Disclosure: G. Sheth: None. M. Alsayed: None. Introduction: Primary hypoparathyroidism is commonly encountered post-surgically, however isolated cases are rarely seen without clear risk factors. Severely low calcium levels have been shown to correlate with flare ups and worsening of psoriasis. Treatment of hypocalcemia has been thought to improve and prevent the progression of this skin rash. This case highlights an interesting presentation of psoriasis in which the severity was likely related to hypocalcemia. Clinical Case: 25 y/o F with no prior past medical history presented to the emergency room with diffusely worsening skin rash and fever. She had bilateral erythematous plaques on her anterior legs for a few months that was progressively worsening. A few days prior, she started noticing erythema and scaling on her upper body and back. Her on arrival labs were remarkable for a calcium level of 4.5 mg/dL (8.8-10.4). Patient declined any symptoms at the time but did state she had noticed tingling in her face and hand/foot cramps occurring on and off over the last 6 months. Her EKG was remarkable for a mildly prolonged QT interval. She was treated with IV calcium gluconate 4 grams without improvement in her calcium. She ultimately was placed on a calcium gluconate drip and oral calcium carbonate 2 grams every 2 hours. Meanwhile, her work up revealed a PTH of <6 pg/mL, phosphate of 7 mg/dL, magnesium of 1.7 mg/dL, and vitamin D of 23 ng/mL. To elucidate the cause of her newly diagnosed primary hypoparathyroidism, iron studies were ordered to rule out hemochromatosis and ceruloplasmin to rule out Wilson’s disease, both of which returned negative. She had no history of radiation therapy or prior blood transfusions. She denied any family history of calcium disorders. Therefore, PTH antibody testing was sent to a send out lab and is currently pending. Patient was ultimately weaned off of the calcium drip with low normal calcium values around 7.5-8.5 mg/dL. She was placed on calcium carbonate 2 grams every 6 hours with plans for close outpatient labs and follow up. She was seen by dermatology in the hospital and was diagnosed with erythrodermic psoriasis. She was given an IL-17 inhibitor, Taltz, with significant improvement in her rash over her 2 day hospital stay. Conclusions: This case brings to light the importance of a thorough investigation of primary hypoparathyroidism and to recognize the rare genetic or autoimmune etiology as a possibility. Additionally, this case identifies the association of psoriasis with hypocalcemia. Studies have recognized a correlation of severity of psoriasis in patients with low calcium as was seen in this patient. Moreover, treatment with calcium supplementation may have a role in improving skin manifestations. Presentation: Saturday, June 17, 2023

In recent years, the incidence of thyroid cancer has increased dramatically, resulting in an increased demand for early thyroid nodule examination. Ultrasound (US) imaging is the modality most frequently used to image thyroid nodules; However, the low image resolution, speckle noise, and high variability make it difficult to utilize traditional image processing techniques. Recent advances in deep learning (DL) have increased research into the automated processing of thyroid US images. We review three main image processing tasks for thyroid nodule analysis: classification, segmentation, and detection. We discuss the advantages and limitations of the recently proposed DL techniques as well as the data availability and algorithmic efficacy. In addition, we investigate the remaining obstacles and future potential for automated analysis of thyroid US images.