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This case report highlights the rare association among a dental procedure, infective endocarditis, and an acute ischemic stroke. A 54-year-old woman who experienced an acute ischemic stroke 5 weeks after a tooth extraction is described. The initial symptoms of this patient included mild to moderate word-finding difficulty and right facial droop. Computed tomographic angiography revealed a left M1 segment middle cerebral artery occlusion (thrombolysis in cerebral infarction scale, 0) with reconstitution of the distal middle cerebral branches through arterial collaterals. After initial administration of tissue plasminogen activator, endovascular thrombectomy was successfully performed with thrombolysis in cerebral infarction scale 3 (complete) recanalization. After the procedure, the patient showed improvement in language and neurologic deficits. Imaging showed multifocal, bilateral, cortical, and deep brain hemorrhages. Blood cultures grew Streptococcus mitis , ultimately leading to the diagnosis of endocarditis. Echocardiographic imaging revealed moderate to severe aortic insufficiency, a mitral valve vegetation, and mild mitral valve regurgitation. After evaluation by the cardiothoracic surgery team, the patient was discharged with intravenous antibiotics and short-term outpatient follow-up with the cardiothoracic surgery team. Dental procedures, although generally safe, can introduce oral bacteria into the bloodstream, leading to bacterial seeding of cardiac valves and subsequent infective endocarditis. Recognizing infective endocarditis subsequent to a dental procedure, including a tooth extraction, as a potential cause of an acute ischemic stroke is vital so that prompt treatment can be initiated. [ABSTRACT FROM AUTHOR]

In recent years, third-party forgiveness has received renewed attention, much of it negative. While a few have undertaken important attempts to defend or expound accounts of third-party forgiveness, many suspect that it is incoherent, vicious, or both. If true, this would be bad news for Christians, for Christians rely on notions of third-party forgiveness for their accounts of salvation and pastoral authority. I think there is reason to think that some notions of third-party forgiveness can overcome the critics’ worries. In what follows, I argue that third-party forgiveness is more common, coherent, salutary, and diverse in species than many critics suppose. After considering key objections to third-party forgiveness, I offer a constructive account of it that makes sense of these objections while also defending the underlying concept and act. What emerges from this defense is a newfound appreciation for the diverse species of third-party forgiveness. Still, some of these species are more intelligible and safeguarded from declension than others, and I conclude by examining the limits of third-party forgiveness by considering its most contentious species. [ABSTRACT FROM AUTHOR]

Presents a post-1965 description of New York City's Chinatown. Demographics; Increased Chinese investment in garment factories; Economic conditions; Immigrant population; Family orientations.