Infection Control & Hospital Epidemiology

Importance: Clinicians often look for a dental source in Staphylococcus aureus bacteremia (SAB), but how often dental disease is found, compared with other bacteremias, is unclear. Objective: To compare documented dental disease in adults with SAB, Escherichia coli bacteremia, and a general population cohort. Design, Setting, and Participants: Retrospective cohort study in the Protege database of 48 975 adults with bacteremia from January 1, 2015, through December 31, 2023, assigned by earliest in-window organism, and 81 945 general population adults. Exposures: SAB, with E coli bacteremia as the primary comparator and the general population as the secondary comparator. Main Outcomes and Measures: Documented dental disease from 7 days before through 30 days after index, defined by a qualifying dental procedure or disease-specific note text and adjusted for age, sex, race, and documentation intensity. Results: Dental disease occurred in 528 of 16 435 patients with SAB (3.21%) and 179 of 24 942 patients with E coli bacteremia (0.72%). The adjusted odds ratio was 3.86 (95% CI, 3.23 to 4.63). By the pathology-only definition, disease occurred in 517 patients with SAB (3.15%) and 399 general population patients (0.49%). The adjusted odds ratio was 3.71 (95% CI, 3.08 to 4.46). Within SAB, rates were highest with prior infective endocarditis (9.8%), opioid use disorder (6.2%), injection drug use (5.3%), and prosthetic valve (5.0%). Prevalence ranged from 0.49% in the general population to 7.98% in other streptococcal bacteremia. Of 437 patients with SAB and an assignable first finding date, 333 (76.2%) had the finding after the index date. Conclusions and Relevance: Dental disease was documented more often in SAB than in E coli bacteremia after adjustment. Most findings were first recorded after bacteremia was recognized, during SAB evaluation. These data do not show that dental disease caused the bacteremia.

Background: Privacy curtains represent a uniquely difficult infection control surface because they are frequently touched by patients, visitors, and healthcare workers, yet are difficult to disinfect using routine environmental cleaning protocols. We sought to quantify the performance of a novel automated aerosolized hydrogen peroxide system against pathogens on privacy curtains. Methods: This study was performed in an enclosed office space ({approx} 65 m^3), approximating a patient exam room. Four Bacillus atrophaeus (ATCC 9372) biological indicators (BIs) were affixed to a standard polyester privacy curtain. A single one-minute fogging phase was followed by a ten-minute contact/aeration phase (total = 11 min). Four corresponding chemical indicators measured peak airborne aerosolized hydrogen peroxide concentration, and two control BIs were placed outside of the room. Results: All four BIs demonstrated complete inactivation (no growth after seven-day incubation), representing [≥] 4-log10 spore reduction. Peak dosages reached 42 ppm nearest the aerosolized hydrogen peroxide jet outlet, with the lowest value at the near point on the back side of the curtain reaching 27 ppm (exceeding the target dosage of 25 ppm). Control exposures failed to achieve sterilization. Conclusions: A next-generation aerosolized hydrogen peroxide dry-fogging disinfection system achieved full inactivation of resistant spores on both sides of privacy curtains within a short 11-minute automated cycle.

Hard-tissue surgery requires precise spatial control, while conventional computer-assisted navigation presents guidance separately from the operative field. Augmented reality can bring navigation information closer to the surgeon, but how best to translate this information into intuitive intraoperative guidance remains underexplored. We therefore developed an augmented reality navigation system (ANS) that translates real-time deviations from the planned trajectory into co-located holographic action cues. Evaluation comprised typodont and ex vivo porcine experiments, a randomized crossover study in 40 dental trainees, and eight clinical cases. In porcine mandibles, ANS showed lower angular deviation than static and dynamic navigation (1.78 vs 6.42 and 4.02 degrees). Among trainees, accuracy was comparable with dynamic navigation, while workload was lower (29.18 vs 33.15), usability higher (73.13 vs 68.88), and visual-focus ratings improved (3.55 vs 2.28). Clinical cases supported feasibility. These findings support co-located action guidance as an alternative interface paradigm for surgical navigation.

Automated dental implant planning using artificial intelligence (AI) faces challenges in interpretability, safety assurance, and applicability beyond single-tooth cases. This paper presents a unified explainable framework for cone-beam computed tomography (CBCT) that handles both single-tooth and consecutive multiple missing teeth. The method combines nnU-Net-based anatomical segmentation with a transparent geometric optimization pipeline. Implant placement is formulated as a lexicographic multi-objective constrained optimization problem that enforces clinical safety margins while balancing bone engagement, mesiodistal spacing, and buccolingual position. For multi-tooth cases, a global coordination strategy ensures inter-implant parallelism, minimum spacing, and a common insertion path. The framework was validated on 20 single-tooth and 9 consecutive multi-tooth cases. The AI plans achieved a centroid distance of 1.60+/-1.05 mm for single-tooth cases and 1.22+/-0.32 mm for multi-tooth cases, with approximately 7 degrees axial angle difference. All plans achieved 100% compliance with predefined safety thresholds. In a Turing-style test, experts were unable to distinguish AI from human intelligence (HI) plans under blinded conditions. By decoupling perception from reasoning and embedding clinical knowledge as explicit constraints, the framework offers an interpretable and clinically trustworthy solution for computer-aided implant dentistry.

Objective Describe the profile of consumers utilising Emergency Departments (ED) across Victorian hospitals for dental conditions between financial year 2018-19 to 2022-23. Methods Dental conditions were grouped according to the diagnosis categories using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM). Presentations for non-dental conditions were classified as 'Other'. Dependent variables included age, sex, Aboriginal and Torres Strait Islander (Aboriginal) background, language other than English, interpreter required, remoteness, and socio-economic disadvantage according to the Index of Relative Socio-economic Disadvantage (IRSD). The primary outcome evaluated is the relative risk ratio (RRR) of having a hospital ED presentation for a dental condition compared to a non-dental condition and age-specific rates per 100,000 population. Multinomial logistic regression was performed following the backwards elimination method. Results Over the years 2018-19 to 2022-23, 0.55% (n=44,382) of ED presentations across Victorian hospitals by Victorian residents were due to dental conditions. Patients aged 20-44 years have the highest RRR compared to other age groups for dental-related ED presentations. Patients experiencing social inequity in terms of demographic factors such as Aboriginal background, requiring an interpreter, not living in a major city and living in areas of greater disadvantage (IRSD) have statistically significant increased RRR for dental-related ED presentations. Conclusion Patient characteristics were useful for identifying the relative risk of dental-related ED presentations between socio-economic and demographic groups to inform relevant public policy design focus on preventing dental-related ED.

A. Rationale: Medication-related incidents are an important patient-safety concern, particularly in critical-care and inpatient settings where polypharmacy, clinical complexity, frequent therapeutic modifications, and transitions of care increase the risk of medication errors. Systematic analysis of reported incidents can help identify predominant error patterns, potential contributing factors, and priority areas for quality improvement. The present study was undertaken to characterize medication-related incidents and identify areas requiring targeted patient-safety interventions. B. Research Question What are the predominant patterns and distribution of medication-related incidents across critical-care and inpatient units, what patient-care, process, communication, documentation, and system-level factors potentially contribute to their occurrence, and how can these findings be systematically translated into prioritized, evidence-based quality-improvement interventions to strengthen medication safety and reduce preventable medication-related harm? C. Study Design and Methods A retrospective descriptive observational study was conducted to assess the pattern of medication-related errors identified through medication audits conducted in inpatient and critical-care settings. A total of 74 medication audit records were retrospectively reviewed. Each record was evaluated for the presence and type of medication-related error, including transcription, administration, documentation, and dispensing errors. The identified medication errors were categorized based on the nature of the error documented in the audit records. As individual records could contain more than one type of medication-related error, the error categories were considered non-mutually exclusive. Consequently, the total number of error occurrences could exceed the number of records reviewed. Descriptive statistical analysis was performed using frequency distributions and percentages to determine the relative occurrence of each medication-error category. Pareto analysis was subsequently performed to identify the predominant error categories and establish priorities for quality-improvement interventions. The Pareto analysis demonstrated that transcription and administration errors constituted the major contributors to the observed medication-related errors. The identified error patterns were further evaluated using a process-based patient-safety approach to determine potential failure points within the medication-use process. Poka-Yoke (error-proofing) principles were applied to identify opportunities for preventing or detecting errors at the point of occurrence. Based on the findings, potential interventions included standardization of medication-ordering and transcription processes, mandatory verification of medication details, strengthening of independent verification for high-alert medications, and incorporation of technology-enabled safeguards such as electronic medication administration records and barcode-based medication administration. The findings were used to identify priority areas for targeted quality-improvement interventions aimed at reducing medication-related errors and strengthening the safety and reliability of the medication-use process. D. Results: A total of 91 medication-related error occurrences were identified across the 74 audit records reviewed. Transcription errors constituted the predominant error category (46; 50.5%), followed by administration-related errors (41; 45.1%). Documentation-related and dispensing-related errors accounted for 3 (3.3%) and 1 (1.1%) occurrences, respectively. Pareto analysis demonstrated that transcription and administration-related errors collectively accounted for 87 of the 91 identified occurrences (95.6%), indicating a substantial concentration of medication-related errors within these two categories. The cumulative frequency increased from 50.5% for transcription errors to 95.6% following inclusion of administration-related errors, while the remaining categories contributed only 4.4% of the total error occurrences. Accordingly, transcription and administration-related errors were identified as the principal priority areas for subsequent root cause analysis and quality-improvement interventions. Interpretation: The findings demonstrate that transcription errors (50.5%) and administration-related errors (45.1%) were the predominant medication-related errors, collectively accounting for 87 of the 91 identified error occurrences (95.6%). Documentation-related errors constituted 3.3%, while dispensing-related errors accounted for 1.1% of the observed occurrences. Pareto analysis revealed a marked concentration of medication-related errors within the transcription and administration domains, indicating that these two categories represented the principal areas requiring focused quality-improvement interventions. Subsequent Root Cause Analysis (RCA) and Poka-Yoke-based error-proofing approaches were therefore directed toward identifying and mitigating process vulnerabilities within these high-frequency error domains. Keywords: Medication-related incidents, Medication errors, Patient safety, Critical care, Inpatient care, Medication transcription errors, Medication omission, Medication administration, Root Cause Analysis, Pareto analysis, Poka-Yoke, Error-proofing, Quality improvement, Medication safety, PDSA.

Predicted probabilities of antibiotic susceptibility to known or suspected pathogens can be used to support antibiotic selection. Patient demographic, clinical, and prior microbiologic history can be used to generate location-specific prediction models. For three Canadian tertiary care institutions we fit and evaluated models for predicting Gram-negative antibiotic susceptibilities to common antimicrobial agents based on previously established model structures. A web-based application was developed to permit visualization of antibiotic susceptibility predictions and support antibiotic decision-making.

Background: Pertussis has resurged in the post-COVID-19 era, yet diagnostic delay remains a barrier to timely treatment and transmission interruption, particularly among adults. Methods: Retrospective observational cohort study of 787 patients with confirmed pertussis from January 2016 through March 2026 across two South Carolina health systems. Electronic health record data from the 60 days preceding confirmation were used to characterize diagnostic timing (same-day vs. delayed), delay duration, and respiratory pathogen testing patterns including pertussis test modality. Results: Adults accounted for 48.4% of cases (median age 16 years [IQR 4-52]; 61.6% female). Same-day diagnosis was highest among children aged 1-4 years (75.4%) and lowest among adults aged 50 and older (approximately 50%). Among the 305 patients (38.8%) with delayed diagnosis, median delay ranged from 7-12 days in children to 22.5-26.5 days in adults aged 50 and older. Delay did not vary significantly by COVID-19 period, race, ethnicity, or insurance type. Testing breadth was greater in inpatient and emergency settings than outpatient. Pertussis testing was predominantly PCR-based in children but serologic in adults, potentially reflecting later clinical presentation relative to illness onset; however, the near-absence of PCR testing in older adults may contribute to missed diagnoses during the early illness window when PCR sensitivity is highest. Conclusions: Older adults experienced markedly delayed pertussis diagnoses compared with children. Earlier consideration of pertussis in adults with prolonged cough, including PCR testing early in illness before serologic conversion, may reduce diagnostic delay and facilitate timelier treatment and contact tracing.

Objectives- Among clinical methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) strains, we sought to determine the prevalence of {beta}-lactam-{beta}-lactamase inhibitor (BLBLI) susceptibility, and its association with oxacillin susceptibility, genotypic factors, and patient characteristics. Methods- Clinical MRSA BSI strains were tested for susceptibility to penicillin-clavulanate by Etest (n=117, 36% of the dataset) and to oxacillin by disk diffusion assay (n=328, 100%). Penicillin-clavulanate susceptibility was defined as MIC [≤]2mg/L and oxacillin disk susceptibility as an inhibition zone > 6mm. All strains were whole-genome sequenced, and alleles of mecA annotated. The sensitivity and specificity of the oxacillin disk to predict penicillin-clavulanate 'susceptibility' were assessed. Clinical and genomic associations with BLBLI 'susceptibility' were assessed by calculating odds-ratios (OR). Results -We found 73/117 (62%) and 205/328 (62%) strains to be 'susceptible' to penicillin-clavulanate and oxacillin disk, respectively. Oxacillin disk susceptibility and penicillin-clavulanate susceptibility were highly correlated (sensitivity 97.3% and specificity 95.5%). We therefore used oxacillin disk susceptibility as a proxy for penicillin-clavulanate susceptibility. Comparative genomics of the mecA gene uncovered 8 alleles. The oxacillin disk 'susceptible' phenotype was associated with specific mecA alleles, community-associated MRSA sequence-types (OR 72.8, 95%CI 35.4-162), community acquisition of infection (OR 2.09, 95% CI 1.03-4.27), lower Charlson Comorbidity Index (OR 0.90, 95% CI 0.82-0.98) and SOFA (sequential organ failure assessment) scores at presentation (OR 0.88, 95% CI 0.79-0.98). Conclusion - BLBLI 'susceptibility' is common among MRSA strains and is strongly associated with the strain genotype. Infections caused by BLBLI 'susceptible' strains are associated with specific patients' characteristics, namely younger age, fewer comorbidities, acquisition in the community and milder presentations.

Coal-fired power plants remain a major source of fine particulate matter (PM2.5) exposure and mortality in the United States. Announced retirement dates mark when those burdens are expected to end, but rising electricity demand, partly from data centers supporting cloud computing and artificial intelligence, has led utilities and regulators to revisit them. Of 50 coal plants scheduled in January 2024 to retire before 2035, 20 had later or removed dates by January 2026. Projecting coal PM2.5 and mortality among Medicare beneficiaries from the 20 plants for 2026-2035, we estimate the revised schedule would result in 1,256 additional deaths (1,136 to 1,376), raising mortality to 3.1 times the original burden. Eighteen plants operate in balancing authorities with hyperscale data-center demand, and federal orders and utility filings supporting several plants' operation cited data-center growth. Retirement schedules are revised faster than health consequences are assessed, and those delays carry a measurable mortality cost.

Objective: To evaluate the specimen-level performance of a multichannel electronic nose (e-nose) sensor array in classifying stool specimens into relevant Clostridioides difficile categories. Design: Retrospective single-center validation study with reference to polymerase chain reaction (PCR) and C. difficile toxin testing. Participants: A convenience sample of 31 discarded stool specimens with PCR and confirmatory toxin testing. Categorized into PCR-positive (+)/toxin+, PCR+/toxin-negative (-), and PCR-. Methods: Specimens were sampled in controlled headspace by two e-nose sensor arrays in 10-minute sessions with 5-second sampling intervals. The primary endpoint was one-versus rest classification performance (sensitivity, specificity, positive predictive value, and accuracy) into three classes: PCR+/toxin+, PCR+/toxin-, and PCR-. Data were normalized and the region of interest was extracted for training and testing. Random forests were utilized for classification of normalized data with a test-train split at the specimen-level. Results: There were 457 unique 10-minute sampling events (147 PCR+/toxin+, 183 PCR+/toxin-, 127 PCR-). Sensors 1 and 2 captured 20,331 and 23,538 unique 5-second exposures within the region of interest, respectively. Testing data classification accuracy was 0.79 [0.78, 0.81] and 0.84 [0.83, 0.85] for Sensors 1 and 2. Sensitivity for PCR+/toxin+ exposures was 0.82 [0.79, 0.84] and 0.94 [0.92, 0.95], and specificity was 0.91[0.90, 0.93] and 0.93 [0.92, 0.94] for Sensors 1 and 2. Conclusion: An e-nose sensor array partially differentiated PCR-classified C. difficile specimen classes at the exposure level under headspace-controlled conditions. Performance was strongest for PCR+/toxin+ exposures. Findings support further prospective validation in the hospital room setting.

BackgroundFebrile neutropenia requires rapid empirical antibiotic therapy, with regimen selection shaped by local prescribing practice and pathogen patterns. We described starting treatment, later drug changes, microbiological findings, and inpatient outcomes. MethodsThis ambispective cohort comprised 96 episodes from 90 patients admitted to a tertiary-level teaching hospital. Treatment and outcome analyses used each episode as the unit of observation. Recorded variables included the starting antibiotics, later regimen modification, microbiology, hospitalization length, invasive fungal infection (IFI) as captured in study records, and disposition. Comparisons based on escalation status were exploratory. ResultCefoperazone-sulbactam appeared in 62/96 initial regimens (64.6%), amikacin in 42 (43.8%), teicoplanin in 28 (29.2%), and meropenem in 14 (14.6%). Eighteen episodes (18.8%) required a change that broadened or substituted antibacterial therapy. Among 31 microbiologically documented infections, 22 (71.0%) yielded Gram-negative organisms and 9 (29.0%) were polymicrobial. Median length of admission was 18.5 days in the escalation group and 9 days in the remainder (p<0.001). Mortality was 27.8% (5/18) with escalation and 5.1% (4/78) without it (p=0.011), with nine inhospital deaths overall (9.4%). ConclusionAntibacterial management differed within this cohort, with treatment escalation required in 18 of 96 episodes. Gram-negative organisms comprised most microbiologically confirmed infections. Escalation marked a clinically complex course with prolonged hospitalization and greater observed mortality; the observational design does not establish comparative efficacy or causation.

In 2024, Chicago experienced a measles virus outbreak. Air samples collected as part of routine respiratory virus surveillance from three hospitals that received measles patients were retrospectively analyzed. Measles virus was detected in air samples from one emergency department across five weeks when measles patients were present and another when no known cases were present. Two of three viral sequences derived from air samples were identical to measles patients. The source of one diverging sequence could not be identified and may represent a case not identified by traditional surveillance methods. Air sampling may supplement measles investigation, surveillance and response.

Purpose: To compare the performance of three large language models (LLMs), ChatGPT-o1, Grok 3, and Gemini 2.0 Pro, on the American College of Prosthodontists' National Prosthodontic Resident Examination (NPRE). Materials and Methods: Official NPRE examinations from years 2015-2024 were retrieved from the American College of Prosthodontists website and used to prompt each LLM. Paid access tiers and advanced reasoning were enabled. Responses from LLMs were recorded and compared against the official answer keys for accuracy, variability across years, and consistency of responses. Duplicate questions were retained for the primary analysis and removed in a sensitivity analysis. Accuracy (percent correct) was compared using generalized estimating equations binary logistic regression (primary); Cochran's Q with Bonferroni-adjusted McNemar tests (sensitivity). Year-to-year variability (SD of annual accuracy) was compared using weighted Levene tests. Consistency across duplicate items was quantified as the percentage of perfect matches and compared using Cochran's Q with Bonferroni-adjusted McNemar tests. Results: Across 1,487 questions, overall accuracy differed among models (global P < 0.001). ChatGPT-o1 achieved 78.4% correct, Grok 3 76.4%, and Gemini 2.0 Pro 73.2%; ChatGPT-o1 and Grok 3's accuracy significantly exceeded Gemini 2.0 Pro (both P [&le;] 0.016), with no significant difference between ChatGPT-o1 and Grok 3 (P = 0.099). After removing duplicates (n = 1,200), results were similar: ChatGPT-o1, Grok 3, and Gemini 2.0 Pro were 77.1%, 76.6%, and 71.5% correct, respectively; ChatGPT-o1 and Grok 3's accuracy was significantly higher than Gemini 2.0 Pro (both P < 0.001). Variability across years did not differ significantly (P [&ge;] 0.097). Grok 3 showed significantly higher perfect-match consistency (79.2%) than ChatGPT-o1 (69.4%) and Gemini 2.0 Pro (64.5%) (P [&le;] 0.010). Conclusions: Contemporary LLMs showed 70-80% accuracy on postgraduate prosthodontic multiple-choice content. While promising for educational support, residual error and inconsistency warrant human oversight and transparent methods reporting before curricular adoption.

Lines, drains, and airway devices are commonly used in surgical and inpatient care to support treatment and patient monitoring. While these devices are essential, prolonged device retention is associated with complications such as infection, tissue injury, thrombosis, and extended hospital stay. Understanding how long devices remain in place and how duration varies across device types is important for improving patient safety and guiding device management practices. This study analyzes device duration patterns using Patient Lines, Drains, and Airways (LDA) data containing information on device type, placement time, and removal time across multiple patient encounters. Exploratory data analysis and machine learning approaches are used to examine duration distributions, distinguish short and prolonged device retention, and identify structural patterns across device categories. The findings indicate notable variation in device duration patterns across categories, with identifiable differences in device retention behavior across device groups. This study highlights the value of observational electronic health record data for characterizing device exposure patterns and provides a foundation for future data-driven device management and risk assessment.

Morganella morganii is an opportunistic pathogen with intrinsic and acquired antimicrobial resistance, but its genomic epidemiology remains poorly characterized in Bangladesh. We sequenced and compared genomes of 47 stool-derived M. morganii isolates from hospital (n = 29) and community (n = 18) participants in urban Dhaka. Susceptibility testing showed frequent resistance to imipenem (70.2%) and cefuroxime (97.9%), while all isolates were resistant to colistin. Resistance to meropenem (6.4%) and ertapenem (2.1%) was uncommon. Based on acquired non-susceptibility across tested antimicrobial categories, 18/47 (38.3%) isolates were multidrug-resistant, including 15/29 (51.7%) hospital-derived and 3/18 (16.7%) community-derived isolates. Genomic analysis identified 17 {beta}-lactamase alleles including Morganella-associated chromosomal {beta}-lactamases and acquired resistance determinants, with blaOXA-1, blaDHA-21, blaCTX-M-15, and blaTEM-1 predominating. However, no recognized acquired carbapenemase genes were detected. Among 44 non-{beta}-lactam resistance genes, tetB was most frequent. Phylogenomic and average nucleotide identity analyses classified 31 isolates as M. morganii subsp. morganii and 16 as the subsp. intermedius lineage. Considerable population diversity was observed, with 33 distinct sequence types among the 47 isolates and no clear clustering by hospital or community origin. The subsp. intermedius isolates showed greater genomic heterogeneity than subsp. morganii, with a minimum within-group average nucleotide identity of 94.2%. Single nucleotide variant (SNV) analysis identified several closely related isolate groups, including an ST1 pair differing by 10 SNVs and collected three days apart within the same hospital, although direct transmission could not be established. Virulence-associated gene profiles differed between subspecies, with hemolysin- and toxin-associated genes predominantly detected among subsp. morganii isolates and largely absent from subsp. intermedius. Overall, these findings reveal substantial genomic diversity, a considerable burden of multidrug resistance, and subspecies-associated differences in virulence gene content among M. morganii circulating in Dhaka, while the frequent imipenem-non-susceptible but carbapenemase-negative phenotype highlights the need to investigate alternative carbapenem resistance mechanisms.

Background: Nicotine pouches (NPs) are increasingly popular tobacco-free nicotine products, particularly among young people. Despite growing use, evidence regarding their oral health effects remains limited. Methods: We employed a mixed-methods approach comprising: (1) a national cross-sectional survey of NP users, (2) a survey of UK dental professionals, and (3) in-person clinical assessments of NP users. Survey data explored patterns of NP use, oral and dental side effects, and perceptions of risk. Clinical assessments included comprehensive oral examinations, periodontal assessments, and histopathological investigation of lesions where indicated. Results: A total of 3,659 NP users completed the public survey. Participants were predominantly male (89%) and aged 16-22 years (78%). Overall, 45% reported at least one oral or dental side effect. The most commonly reported effects were gingival recession (60%), burning sensations (41%), white patches (30%), and dry mouth (29%). Higher nicotine exposure was associated with increasing numbers of reported side effects. Among 126 dental professionals, oral lesions associated with NP use were commonly observed clinically, while only 17% reported seeing no oral or dental effects. Thirty-three NP users underwent in-person assessment. Ten lesions were biopsied; six demonstrated hyperkeratosis and four showed oral epithelial dysplasia (three mild, one moderate). All dysplastic lesions occurred at pouch placement sites. In two cases, clinical follow-up demonstrated partial or complete resolution of lesions following cessation of NP use. Periodontal assessments demonstrated generally low levels of periodontal disease and gingival recession across the cohort. Conclusions: Oral and dental side effects associated with NP use were commonly reported by users and observed by dental professionals. Histopathological assessment identified biopsy-confirmed oral epithelial dysplasia in lesions occurring at pouch placement sites, representing, to our knowledge, the first such report associated with NP use. Evidence of lesion improvement following discontinuation of use suggests that at least some NP-associated oral changes may be reversible. Although causality cannot be established, these findings highlight the need for vigilance among dental professionals and urgent longitudinal research to determine the incidence, progression, and reversibility of NP-associated oral lesions.

Background: Indwelling urinary catheters can cause pain, urethral irritation and trauma and provide surfaces for microbial colonisation and biofilm formation. The LubriShield(R) Foley catheter incorporates a covalently bonded, superhydrophilic antifouling hydrogel designed to reduce surface friction and limit biofilm accumulation without releasing an antimicrobial agent. This study evaluated its safety and clinical performance compared with an uncoated silicone Foley catheter, including usability and patient comfort, and explored catheter-associated microbial colonisation and biofilm formation. Methods: This prospective, randomised, single-blind, single-centre controlled clinical investigation enrolled 33 adults requiring indwelling urinary catheterisation for 72 hours to 14 days. Participants received either the LubriShield(R) Foley catheter (n = 16) or an uncoated Sterimed all-silicone Foley catheter (n = 17). The primary endpoint was safety based on adverse-event reporting; the prespecified safety criterion was the absence of a serious adverse device effect in the LubriShield(R) group. Secondary endpoints included investigator-rated ease and functionality of catheter insertion and removal and participant-reported pain and irritation/discomfort assessed using 0-10 numerical rating scales. Urine microbiology, catheter colonisation and catheter-level biofilm measurements were exploratory endpoints. Analyses were performed in the as-treated population. Numerical rating scale outcomes were compared using two-sided Mann-Whitney U tests; exploratory biofilm analyses used permutation tests with bootstrap confidence intervals. Results: No serious adverse events or serious adverse device effects occurred. Nine non-serious adverse events were reported and resolved completely. At least one adverse event occurred in 4/16 (25.0%) participants in the LubriShield(R) group and 4/17 (23.5%) participants in the control group. The prespecified safety criterion, defined as the absence of a SADE in the LubriShield(R) group, was met. LubriShield(R) was rated more favourably for ease of insertion (p = 0.0096), functionality during insertion (p = 0.0051), ease of removal (p = 0.0037) and functionality during removal (p = 0.0085). Participants reported significantly less pain and irritation/discomfort during insertion, while the catheter was indwelling and during removal (all p < 0.05). Outcomes 7 {+/-} 1 days after catheter removal were similar between groups. Absolute biofilm biomass and bacterial and fungal loads did not differ significantly. In a post hoc exploratory normalised analysis, the biofilm-to-bacterial-load ratio was lower with LubriShield(R) (median 0.052 vs 0.080; permutation p = 0.043), although the bootstrap 95% confidence interval for the between-group difference included zero. Conclusions: The LubriShield(R) Foley catheter demonstrated a favourable short-term safety profile and was associated with improved investigator-rated usability and participant-reported comfort compared with an uncoated silicone Foley catheter. A post hoc exploratory analysis was compatible with reduced biofilm accumulation relative to bacterial load, but this finding is hypothesis-generating only and requires confirmation in larger, adequately powered studies with prespecified biofilm endpoints.

OBJECTIVE To assess associations of ambient UV with cardiovascular and cancer mortality across US Health Service Areas (HSAs), prioritise outcomes by signal and attributable burden, assess racial and ethnic variation, with UK Biobank corroboration. DESIGN Ecological analysis of HSAs using linear regression of crude mortality on ambient UV and social vulnerability, with correction for multiple comparisons. SETTING US HSAs and UK Biobank. DATA SOURCES Publicly available US data and UK Biobank data accessed under Application 82526. PARTICIPANTS 704 808 annual cardiovascular deaths (aged [&ge;]65) and 565 287 annual cancer deaths (aged [&ge;]50) from populations of 52.8 and 115.2 million; UK Biobank analyses included 412 665 individuals. MAIN OUTCOME MEASURES Cardiovascular, all-cancer, and body-site-specific cancer mortality; regression slope per interquartile-range increase in UV ({beta} UV/IQR), modelled attributable burden for US data, and hazard ratios for the UK Biobank data. RESULTS Higher UV was associated with lower cardiovascular ({beta}UV/IQR -68.3 deaths/100 000; P<0.001) and all-cancer mortality (-43.2; P<0.001), corresponding to 36 043 (5.1%) and 49 789 (8.8%) fewer US deaths annually, respectively. Associations varied by race and ethnicity. Cardiovascular findings were directionally consistent between US and UK datasets. All-cancer mortality and 10 of 18 cancers were inversely associated with UV in the US; UK analyses found inverse associations for all-cancer and two individual body-site-specific cancers. Twelve cancers showed directionally concordant associations across the datasets, of which ten were inverse. Lung cancer showed the strongest inverse association in each dataset. CONCLUSIONS Higher UV was associated with lower cardiovascular and cancer mortality across US HSAs, with modelled attributable burdens exceeding 5%; UK Biobank findings provided partial corroboration. Twelve of 18 site-specific cancers were directionally concordant between datasets. US race-stratified heterogeneity did not follow a skin-colour gradient, suggesting residual confounding.

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) is one the most common cause of post-surgical infections in Malawi and poses a significant public health challenge due to resistance to commonly used antibiotics. We isolated and evaluated the stability and lytic activity of a MRSA-specific bacteriophage (Staphylophage) from Mzuzu Central hospital (MZCH) sewage against MRSA strains isolated from surgical wards. MethodsA prospective in vitro experimental study was conducted using 56 pus swabs collected from post-surgical patients at Mzuzu Central Hospital (MZCH), Malawi. Standard microbiological methods and VITEK analysis were used for bacterial isolation, identification and antimicrobial susceptibility testing of Staphylococcus aureus and MRSA according to the 2024 EUCAST guidelines. A lytic Staphylophage was isolated and purified from sewage wastewater using filtration, enrichment, and double-layer agar techniques. The purified Staphylophage was evaluated for its lytic activity through host range testing and stability under ultraviolet (UV) exposure (up to 60 minutes), different pH levels (2-12), and temperatures (4{degrees}C, -20{degrees}C, and -80{degrees}C). ResultsOut of 56 bacterial isolates, 18 (32.1%) were S. aureus, of which 11 (61.1%) were MRSA. The isolated Staphylophage showed lytic activity against 87% of Staphylococcus species tested. The phage remained stable at temperatures between -80{degrees}C and 4{degrees}C and across a pH range of 2- 12. It also retained viability after UV exposure for up to 15 minutes, although a reduction in phage titre was observed after 30 minutes. ConclusionsA lytic Staphylophage isolated from hospital sewage at MZCH demonstrated activity against Staphylococcus species, including MRSA strains from post-surgical wound infections. These findings illustrate the feasibility of generating candidate phages for alternative therapeutic approaches in a central hospital setting in Malawi.