Infection Control & Hospital Epidemiology

BackgroundDeep margin elevation (DME) is a restorative technique that facilitates the placement of restorations in cases of subgingival margins. Although clinically reported, very few data are available on dental practitioners awareness and use of DME. ObjectivesTo evaluate awareness and clinical acceptance toward deep margin elevation (DME) use in subgingival restorative cases among dental practitioners worldwide. MethodologyA cross-sectional questionnaire-based study was conducted among practicing dentists at various dental educational institutions, private dental practices, and a combination of academic and private dental practices across multiple centers globally. The self-administered questionnaire consisted of 20 closed-ended questions to evaluate awareness and clinical acceptance. The data were entered into and analyzed using a Chi-square test and descriptive statistics in the Statistical Package for the Social Sciences (SPSS) software. ResultsOut of 450 invited participants, 349 general dental practitioners completed the survey (77.6%). The purely educational institutions response rate was 79 (23%), the strictly private dental practice response rate was 134 (39%), and the combined academic and private practice response rate was 131 (38%). Sixty-six percent of respondents agreed that predictable adhesive bonding to cervical/root dentin can be achieved in restorations with deep margins. Although a majority of respondents had heard of DME (77%), the majority reported a preference for surgical crown lengthening (75%) when favorable conditions were present. ConclusionThe study highlights moderate DME awareness among the study participants. The findings of this study revealed that the number of dentists who use the technique to restore large subgingival defects in posterior teeth with proximal caries is very small. Thus, it is recommended that dental practitioners introduce this technique in their dental clinics as an alternative to surgical crown lengthening. Although years of experience and a dentists rank may influence clinical decisions, an in-depth factorial analysis with a larger sample size is necessary.

BackgroundCanine impaction represents one of the most challenging clinical scenarios in orthodontic practice, with maxillary canines being the second most commonly impacted teeth after third molars. The management of impacted canines through orthodontic traction requires an advanced understanding of biomechanical principles, surgical techniques, and patient-specific factors. The decision to attempt traction must be informed by accurate differentiation between mechanical impaction and primary failure of eruption (PFE), as applying orthodontic force to PFE teeth results in failure and iatrogenic ankylosis. Recent systematic synthesis of eruption disorders further underscores the need to differentiate mechanical impaction from genetically mediated eruption failure prior to orthodontic traction [59]. In a companion systematic review, we have synthesized the evidence on genetic etiology and diagnostic accuracy for PFE. The present review focuses specifically on the management of confirmed mechanical impaction requiring orthodontic traction, providing a complete evidence-based framework for clinicians. ObjectiveTo provide the most comprehensive quantitative synthesis to date of orthodontic traction for impacted canines, encompassing biomechanical principles, comparative outcomes of open versus closed surgical exposure techniques, radiographic predictors of traction duration, complications, innovations, and evidence-based clinical recommendations with a practical decision algorithm. MethodsA systematic search of PubMed/MEDLINE and the Cochrane Library was conducted for studies published between January 2000 and February 2026, supplemented by citation tracking in Google Scholar. The PRISMA 2020 guidelines were followed. The protocol was prospectively registered on the Open Science Framework (DOI: 10.17605/OSF.IO/3UDH6). Eligible studies included randomized controlled trials, prospective cohort studies, retrospective cohort studies with at least 20 patients, case-control studies, systematic reviews, and meta-analyses. Risk of bias was assessed using ROBINS-I, RoB 2.0, and ROBIS tools. Meta-analyses employed random-effects models with Hartung-Knapp adjustment. Heterogeneity was assessed using I-squared and tau-squared statistics. Prediction intervals were calculated for meta-analyses with substantial heterogeneity. The GRADE framework evaluated evidence quality. Given the predominance of observational studies, pooled estimates should be interpreted as associations rather than causal effects. ResultsFrom 3,587 records, 94 studies (9,156 patients) met inclusion criteria. Optimal force magnitudes range from 50-150g, with force direction determined by the center of resistance located halfway along the root length. Meta-analyses demonstrated comparable success rates between open (91%, 95% CI: 88-94%) and closed (93%, 95% CI: 89-95%) surgical exposure techniques (9 studies; 3 RCTs, 6 observational; tau-squared = 0.00). Open exposure was associated with reduced traction duration (mean difference -4.7 months, 95% CI: -7.3 to -2.1; I-squared = 87%, tau-squared = 5.82; prediction interval -9.8 to 0.4 months) and lower ankylosis risk (OR 0.15, 95% CI: 0.03-0.83; I-squared = 0%, tau-squared = 0.00). Closed exposure was associated with reduced postoperative pain (mean difference -1.9 VAS, 95% CI: -2.6 to -1.2; I-squared = 0%, tau-squared = 0.00). Radiographic predictors include alpha-angle (beta = 0.16 months/degree), d-distance (beta = 1.20 months/mm), and sector location. Three-dimensional analysis demonstrates that cusp tip displacement explains approximately 55.4% of variance in traction duration. Complications include root resorption (23-48% of adjacent incisors; pooled MD 0.69 mm, 95% CI: 0.58-0.80 mm), alveolar bone loss (pooled MD 0.51 mm, 95% CI: 0.31-0.72 mm), and ankylosis (3.5-14.5%). GRADE evidence quality ranged from high (postoperative pain) to very low (acceleration modalities). Innovations: temporary anchorage devices (moderate-high, established); digital workflows (moderate, emerging); clear aligner-based traction (low, experimental); low-level laser therapy (low-moderate, adjunct only); vibration devices (high-quality negative evidence, not recommended). ConclusionsThis most comprehensive quantitative synthesis demonstrates that both open and closed surgical exposure techniques yield excellent success rates. Open exposure offers advantages in reduced traction duration and lower ankylosis risk, while closed exposure provides superior patient comfort. Radiographic predictors enable accurate pretreatment estimation of treatment duration. The findings of this review, combined with our companion analysis of the genetic and diagnostic basis of PFE [59], support a paradigm shift toward a genetically informed and mechanistically driven approach to all forms of failed tooth eruption. A practical clinical decision algorithm is provided to guide evidence-based management.

Commercially available disposable products such as cell culture utensils and catheters do not necessarily possess sufficient quality for in vitro fertilization (IVF), from the perspective of pyrogen contamination. We aimed to comprehensively analyze the pyrogen contamination status, including bacterial endotoxins, of the products used for IVF in assisted reproductive technology (ART) and improve their cleanliness using a new sterilization technology. Pyrogen contamination levels were evaluated using a direct human cell-based pyrogen test that is not affected by the recovery ratio, unlike bacterial endotoxin tests. Pyrogen inactivation tests were performed using low-temperature ozone/hydrogen peroxide gas treatment. The residual hydrogen peroxide was colorimetrically quantified, and the effectiveness of its removal by drying treatment was evaluated using germ cell viability as an indicator. Significant amounts of pyrogen, from 0.014 to 1.110 EU/product, were detected in seven of the twenty products. Pyrogen contamination levels were reduced below the detection limit by ozone/hydrogen peroxide gas sterilization. Hydrogen peroxide remained on the surface of the GPS dish but was reduced to a level that did not affect human sperm viability and embryo development after drying at 80{degrees}C for 24 h following sterilization. These products may carry a potential risk of reducing ART success rates, and pyrogen contamination levels may exceed the previously reported allowable level of 0.01-0.02 EU/mL in human IVF during actual use. Our study suggests that the manufacturing of products free from pyrogens and without adverse effects on germ cells is possible using ozone/hydrogen peroxide gas sterilization and subsequent drying technologies.

Background The microbial aetiology of early childhood caries (ECC) in sub-Saharan African populations remains poorly characterised, with most studies focusing on conventional cariogenic pathogens like Streptococcus mutans. This study aimed to characterise the salivary microbial profile of children with ECC in urban Kano, northern Nigeria. Methods In this cross-sectional study of 162 children aged 3-5 years in urban Kano, unstimulated saliva samples were collected and analysed using standard bacteriological culture methods. Caries status was assessed using decayed, missing, and filled teeth (dmft) index and International Caries Detection and Assessment System (ICDAS). Microbial isolates were identified through Gram staining, colony morphology, and biochemical tests (catalase, coagulase, oxidase). Results Of 32 microbial isolates obtained, Staphylococcus aureus was the most prevalent (43.8%, n=14), followed by Streptococcus species (28.1%, n=9), Klebsiella species (12.5%, n=4), non-aureus staphylococci (6.3%, n=2), yeast (6.3%, n=2), and Pseudomonas species (3.1%, n=1). Only one isolate demonstrated direct association with dmft-detectable caries. Polymicrobial colonisation occurred in four cases (12.5%), predominantly featuring S. aureus-yeast combinations (n=2). White spot lesions (ICDAS 1-2) were associated with S. aureus and Klebsiella species in two separate cases. Conclusion This study reveals an unexpected predominance of S. aureus in the salivary microbiome of children in northern Nigeria, challenging conventional paradigms of ECC microbiology. The low correlation between microbial isolates and clinical caries suggests complex, multifactorial aetiology. These findings highlight the need for molecular characterisation of oral microbiomes in African populations and reconsideration of caries pathogenesis models in this unique epidemiological context.

ObjectiveCommunity service-learning (CSL) placements engage with equity-deserving groups. They receive oral health care and students can critically reflect on their experiences. This study aimed to thematically explore the reflections of senior dental students providing oral health services to equity-deserving communities in British Columbia, Canada. MethodsSemi-structured written reflections were collected cross-sectionally from three consecutive graduating cohorts of fourth-year dental students (2022-23, 2023-24, and 2024-25). Reflections were a mandatory component of a community placement course, were approximately 500 words in length, and were prompted as follows: "Describe your personal experience at the assigned community clinic, noting moments of revelation, valuable learning, and/or disappointment for you." An exploratory thematic analysis was conducted using an iterative coding process to identify and interpret categories and themes. ResultsFrom all the three years, 764 reflections were collected (191-625 words each) from 171 students. Of these, 124 reflections were excluded because they consisted solely of descriptions of procedures. Data saturation was reached after in-depth analysis of 205 reflections, yielding four overarching themes, including learning across differences; and pause-breathe-refine. These themes were informed by categories highlighting that detrimental impact of overly controlling mentorship styles and observation-only experiences on students learning. ConclusionTransformative experiences were observed, while students also reflected on less positive practices. Students emphasized the importance of CSL placements for their education, professional growth, and understanding of underserved populations, while also highlighting implementation challenges. Future research should examine the long-term impact of CSL activities once these challenges are addressed.

IntroductionDigital technologies are reshaping how health professionals are trained, and extended reality (XR) has gained attention as a tool for skills development in dental education. Yet, successful integration depends largely on educators perceptions, readiness, and working conditions. This study aimed to explore dental educators views of the educational value of XR, what barriers they experience, and how familiarity with immersive technologies relates to their use in teaching. Materials and MethodsA cross-sectional, web-based survey was conducted among dental educators. The questionnaire included items on demographics, familiarity and frequency of XR use, and perceptions of educational value, barriers, and curricular integration. Descriptive statistics were calculated, and Spearman correlation analyses were performed to explore associations between familiarity, use, and perceived benefits of XR. ResultsRespondents reported positive attitudes toward XR, particularly for improving students understanding of complex anatomy (mean = 6.02/7), skill development (5.68/7), and confidence and preparedness for clinical practice (5.08-5.20/7). XR was mainly viewed as a complement to traditional teaching rather than a replacement (mean = 3.77/7). Strong correlations were observed between perceived improvements in confidence, skills, and clinical readiness (r = 0.71 - 0.89, P < 0.0001). High costs, limited technical support, and time constraints were the most prominent barriers to usage. ConclusionOverall, dental educators appear open to XR but constrained by structural and organizational factors rather than a lack of interest. Faculty development, hands-on training opportunities, and institutional support may therefore be essential to translating positive perceptions into meaningful and sustained integration of immersive technologies in dental curricula.

This study describes the establishment of the National Dental Center Singapore Oral Disease Registry (NDCS-ODR), a large-scale, electronic health records registry designed to capture real-world data on oral diseases. The NDCS-ODR was developed to standardize and integrate oral health data within Singapore Health Services, the countrys largest healthcare cluster. Its development, governance, and data architecture are described, with an overview of individuals with oral diseases recorded in the registry. Data collection from 2013 to June 2025 has been completed. As of June 2025, the NDCS-ODR comprises 229,249 unique patients, with a mean (SD) age of 49.1 (19.5) years and an approximately equal sex distribution. Most were of Chinese ethnicity (77.6%), and Singapore citizens (92.5%). Clinical variables indicated substantial disease and treatment burden, with a mean of 7.9 (7.7) missing teeth, 4.8 (6.2) restored surfaces, and 2.8 (3.4) restored teeth per patient. Among 108,517 recorded periodontal diagnoses, Stage III periodontitis (2018 EFP/AAP Classification) and severe chronic periodontitis (1999 Classification of Periodontal Diseases and Conditions) were most common. The NDCS-ODR represents Singapores first large-scale, real-world oral disease registry embedded within a national specialty center, demonstrating the feasibility of leveraging electronic health record data for research and service evaluation.

Aim and ObjectivesThe study aimed to evaluate the effectiveness of titanium inserts for interdental papilla reconstruction, comparing it with the Han and Takei technique using subepithelial connective tissue grafts. The objectives included assessing the black triangle height, papilla height and papilla presence index (PPI) at baseline, 1 month and 3 months postoperatively along with the evaluation of Early Wound Healing Score (EHS) during the first week of post operative healing period. Patients and MethodsThis single-blind randomized clinical trial included systemically healthy individuals aged 18-35 years with Nordland and Tarnows Class I-III papillary loss. A total of 18 participants were randomly assigned to either test group or control group. Clinical parameters were measured pre- and post-operatively at specified intervals. Both groups received standard presurgical care and postoperative follow-up. The surgical protocol for the test group involved titanium insert placement in the interdental bone, while the control group received a connective tissue graft using the Han and Takei method. ResultsBoth groups showed significant intragroup improvements in all parameters from baseline to 1 and 3 months (p<0.05). However, intergroup comparisons showed no significant differences at most time points, except at 3 months for PPI, where the control group showed significantly better results (p=0.04). EHS scores were not significant between the groups. ConclusionTitanium inserts and CTG both demonstrated clinical effectiveness in enhancing interdental papilla dimensions. These findings support the titanium insert as a viable, less invasive alternative, offering clinicians a practical option for esthetic papilla reconstruction.

ObjectiveThe rapid availability of phenotypic antimicrobial susceptibility results is crucial for the timely detection of multidrug-resistant Gram-negative organisms and for guiding optimized treatment strategies. Recently, novel methods have been introduced that enable direct antimicrobial susceptibility testing (AST) from positive blood cultures. However, their performance has not yet been systematically compared in head-to-head evaluations. This study aimed to assess the analytical performance of two rapid AST approaches--the agar diffusion-based EUCAST rapid AST (RAST) method and the automated QuickMIC system--using a challenging collection of highly resistant Gram-negative organisms. MethodsA total of 101 Gram-negative bacteria (Escherichia coli, n = 24; Klebsiella pneumoniae, n = 22; Acinetobacter baumannii, n = 30; Pseudomonas aeruginosa, n = 25) were spiked into blood cultures and processed according to the respective AST workflows. Broth microdilution (BMD) was performed from pure cultures as the reference method. Time to result (TTR), categorical agreement (CA), and essential agreement (EA) with BMD were evaluated. Boruta analysis was applied to identify genetic determinants associated with AST errors. ResultsOverall TTR for QuickMIC was 3 h 44 min with a CA of 86.2%, an EA of 92.3 % for Enterobacteriaceae and 97.0 % for non-fermenters. Overall CA of RAST ranged from 90.7%-93.7% across reading time points. Overall, very major discrepancy rates were low (QuickMIC n=0.7%, RAST n=0.1%). Presence of NDM-5 and KPC was most frequently associated with errors for QuickMIC and EUCAST RAST, respectively. ConclusionsBoth rapid AST approaches yielded robust results in this diverse and highly resistant bacterial study population, directly from positive blood cultures, with a short turnaround time. These findings underscore the potential of rapid AST methods to facilitate timely optimization of antimicrobial therapy in bloodstream infections, even in the context of extensively drug-resistant pathogens. ImportanceAccurate antimicrobial susceptibility testing (AST) is essential for stewardship and effective therapy, especially as rising antimicrobial resistance increases the risk of empiric treatment failure. Traditional AST methods are limited by slow turnaround times, creating a need for rapid alternatives. This study evaluated the diagnostic accuracy of two rapid AST methods--EUCAST RAST and QuickMIC--using 101 genetically characterized, carbapenem-resistant Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii tested directly from positive blood cultures. Broth microdilution served as the reference. Both rapid assays provided results within 3.5-6 hours and demonstrated high categorical and essential agreement with few very major discrepancies. Incorrect results were more common in isolates harboring NDM-5 and KPC carbapenemases. Overall, the findings support EUCAST RAST and QuickMIC as reliable tools for challenging resistant pathogens and highlight their potential to enable earlier detection of carbapenem-resistant phenotypes and more timely initiation of appropriate, last-resort antimicrobial therapy.

Microbial keratitis is a sight-threatening corneal infection with varying etiological agents, primarily bacteria and fungi. Assessing and contrasting the virulence factors of microorganisms isolated from a non-contact lens-associated keratitis (NCLAK) and contact lens-associated keratitis (CLAK) is the goal of the current investigation. Samples were collected from over 60 patients and analysed using standard microbiological techniques, including culture, Gram staining, KOH mount, biochemical tests, antimicrobial susceptibility testing, and biofilm assays. The results demonstrated that CLAK isolates were predominantly bacterial, especially Pseudomonas aeruginosa, known for strong biofilm production and high multidrug resistance. In contrast, NCLAK showed a higher incidence of fungal infections, particularly Candida albicans. The results highlight the significance of early diagnosis, tailored and improved awareness regarding contact lens hygiene to prevent complications associated with keratitis.

BackgroundAntibiotic stewardship during stem cell transplantation (SCT) is challenging.. Procalcitonin (PCT) has been employed successfully in critical care patients to safely guide stewardship. However, procalcitonin guided stewardship has not been robustly assessed in SCT recipients. We sought to evaluate the potential utility of PCT to guide antimicrobial de-escalation during engraftment. Methods100 SCT patients were prospectively enrolled in a "strategy trial" and had infectious complications documented. Lab parameters - CBC, BMP, CRP were obtained daily as standard of care (SOC) while PCT was obtained for research purposes. Providers were blinded to PCT results. We compared duration of antimicrobial escalation between actual events (SOC model) and a proposed PCT model. In this hypothetical PCT model, antibiotic de-escalation would occur if CRP remained <100 mg/dl and PCT <0.25 ng/ml after 3 days of escalation. Escalation events were defined as a substitution or addition of an antimicrobial agent after initiation of prophylactic antimicrobials. Results77 patients had escalation events and of these, 33 had bacterial infections. A total of 136 antimicrobial escalations events were identified, and of these only 39(28.7%) were associated with documented infections. The standard of care model had a mean duration (+SD) of 9.08 (+ 6.08) antibiotic days. If the PCT model were employed, the mean duration (+SD) would be 4.44 (+ 6.16) days (p<0.001). The PCT model, however, would have missed 11 infections\ ConclusionProcalcitonin-guided antimicrobial stewardship during autologous stem cell transplantation is feasible however optimization is necessitated for utilization as a tool to guide antibiotic prophylaxis during SCT.

ImportanceHospital capacity constraints and rising healthcare costs necessitate innovative models for delivering acute care. While various hospital-substitution models exist, challenges in scalability and long-term viability persist. ObjectiveTo evaluate the feasibility and safety of a novel, high-acuity Next Day Clinic (NDC) as an alternative to hospitalization for select acutely ill emergency department (ED) patients. Design, Setting, and ParticipantsRetrospective matched cohort study of patients referred to the NDC between July 1, 2023-July 31, 2024, matched to patients seen in the ED during the year prior to NDC launch, within a large academic safety-net hospital. InterventionHigh-acuity outpatient therapy for one or more consecutive days in the NDC, consisting of daily IV antibiotics or diuretics, STAT labs, and rapid turnaround imaging and cardiodiagnostics. Main Outcomes and MeasuresDays alive and out of hospital (DAOH) in the 30 days following the index ED visit. Secondary outcomes were the number of hospital bed-days avoided, as well as 30- day ED revisits, hospital readmissions, and mortality. ResultsThe NDC had 1009 encounters (mean age, 54.4 years [SD 14.6]; 448 female [44%]) during the study period, 420 (42%) of which were referred from the ED. Of these, 298 (71%) matched to 4666 ED visits (mean age, 53.3 years [SD 15.2]; 2019 female [43%]) in the year prior to NDC launch on age, sex, the first set of laboratory and vital sign data obtained in the ED (i.e., presenting illness severity), and an exact match on primary diagnosis group. Unadjusted mean DAOH in the NDC cohort was 29.5 days (SD 2.3) compared to 24.9 days (SD 5.5) in the control cohort. Adjusting for the same features in the matching algorithm showed NDC treatment was associated with an average of 3.85 (SD 0.20) more DAOH compared to hospitalization (p<0.001), translating to 358-1294 hospital bed-days saved over the study period. NDC patients had significantly higher rates of 30-day ED revisits per 100 encounters (20.5 versus 13.0, p<0.001), but significantly lower rates of 30-day hospital readmissions per 100 encounters (5.7 versus 11.0, p<0.001) and morality (0% versus 0.9%, p<0.001). Conclusions and RelevanceThe NDC is a feasible and safe alternative to hospitalization, and promising strategy for managing ED and hospital capacity and reducing healthcare expenditures. KEY POINTSO_ST_ABSOuestionC_ST_ABSIs a high-acuity Next Day Clinic (NDC) a feasible and safe alternative to hospitalization for acutely ill emergency department (ED) patients? FindingsIn this matched cohort study of 1009 NDC encounters, 298 hospital admission avoidance referrals were matched with 4666 historical controls. Each avoided hospitalization through the NDC was associated with an average of 3.85 more days alive and out of the hospital over 30 days, lower readmissions and mortality, and a total of 358-1294 hospital bed-days saved. MeaningA centralized, high-acuity outpatient clinic may safely substitute for hospitalization, reducing hospital capacity strain and healthcare expenditures.

From 2021 to 2025, MRSA emerged as a major multidrug-resistant pathogen in the study area. Among 545 S. aureus isolates, 67.2% were MRSA, disproportionately affecting children under five (26.5%) and males (55.5%). Case incidence more than doubled by 2025, suggesting rising transmission or resistance. Most isolates were hospital-associated (85.2%), predominantly from outpatients (88.5%), with middle ear discharge as the main source (67%). Gentamicin showed the highest susceptibility (72.1%), while penicillin G resistance was nearly universal (96.7%). The majority (93.4%) were multidrug-resistant, with high MARI values indicating widespread and likely inappropriate antibiotic use. These findings reflect a complex interplay between pathogen behavior, antimicrobial use, and healthcare practices. Increasing MRSA burden may stem from inadequate infection control, poor stewardship, or enhanced community transmission. Incorporating molecular typing could deepen understanding of strain diversity and resistance mechanisms to guide targeted interventions

BackgroundHealthcare-associated carbapenemase-producing Enterobacterales (CPE) outbreaks are a major healthcare challenge. Epidemiological studies have identified patient-level risk factors for CPE transmission, and genomic studies have highlighted high-risk lineages or mobile genetic elements (MGEs); however, a unified dissemination risk-prediction framework is lacking. ObjectivesTo synthesise available data on epidemiological, microbiological and genomic risk factors to quantify healthcare-associated CPE outbreak potential. MethodsO_ST_ABSDataC_ST_ABSSix bibliographic databases and other sources were searched ( carbapenemase AND outbreak AND MGE; [&le;]31/01/24). Data were extracted on primary (patients infected/colonised) and secondary (outbreak duration/resolution, mortality) outcomes, and risk/protective factors including epidemiological, microbiological/genomic and infection control measures. Study eligibilityStudies reporting healthcare-associated CPE outbreaks involving MGE-associated IMP/KPC/NDM/OXA-48-like/VIM carbapenemases confirmed by whole-genome sequencing. Study qualityReporting quality was assessed against the ORION checklist (random subset). Data synthesisAfter descriptive summaries, multivariable linear mixed effect modelling was used to estimate associations between risk/protective factors and outbreak size. Results179 records (272 outbreaks) were included from 3,188 screened (41 countries, 2004-2023), affecting median 10 patients (IQR=5-27, range=2-223), and lasting 12 months (IQR=5-30, range=1 day-16 years). Data on outbreak size (primary outcome) was 99.6% complete (271/272) but more limited for secondary outcomes (29-97% complete) and risk/protective factors (70/91 factors had [&ge;]10% missingness). 39% (107/272) of outbreaks involved MGE-mediated transmission, which is a potential underestimate as 66% (104/157) of reports used clonal outbreak definitions. The involvement of more institutions (adjusted relative outbreak size: 1.10 per institution [95% CI: 1.04-1.16];p=0.001), and more Enterobacterales sequence types (1.04 per sequence type [1.01-1.08];p=0.011), were associated with larger outbreaks. Reporting quality assessment (n=98 studies) revealed adequate reporting on median 11/19 relevant ORION items (IQR=8-13; range=1-18). ConclusionsHeterogenous/incomplete reporting of CPE outbreaks precludes integrated risk evaluation based on epidemiological, microbiological, and genomic factors. Systematic sampling, sequencing and epidemiological metadata reporting may strengthen data quality for quantifying healthcare-associated CPE dissemination risk.

Statement of problemDental implant failure remains a significant clinical concern, with early loss often attributed to impaired osseointegration. Recent research has considered the role of serum vitamin D in implant integration, yet the precise relationship between vitamin D status and implant loss, particularly when distinguishing early and late failures, is not fully established. PurposeThe objective of this analysis was to evaluate the association between explicit serum vitamin D cut-off values and clinically confirmed dental implant failure, with a particular focus on differentiating early (pre-loading) from late (post-loading) failures. The review also sought to determine whether primary studies used multivariate adjustment for potential confounders. Material and methodsThe draft of this revision was registered in PROSPERO (CRD420251049631, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251049631). A comprehensive literature search was conducted using AI-assisted tools to identify primary research studies, including randomized controlled trials and cohort studies, published in English, Spanish, French, German, or Italian. Eligible studies required explicit vitamin D threshold categorization, clinically verified implant loss, and clear differentiation of early and late failures. Data extraction included study design, vitamin D categorization, analytical methods, and outcomes. ResultsIdentified studies predominantly consisted of retrospective and prospective cohorts examining early implant failures, frequently using cut-offs such as >30 ng/mL, 10-30 ng/mL, and <10 ng/mL for serum vitamin D. Results suggested a higher frequency of early failures in individuals with severe vitamin D deficiency; however, all studies relied on univariate analyses without multivariate adjustment for confounders. Late implant failures were rarely addressed. ConclusionsCurrent evidence indicates a possible association between low serum vitamin D and early dental implant failure, but the lack of robust statistical adjustment prevents definitive conclusions. High-quality studies with rigorous confounder control and explicit early versus late failure analysis are needed.

Dental impressions are a routine component of prosthodontic care, yet the patient experience may vary depending on the technique used. This study compared dental anxiety and satisfaction among patients undergoing digital versus conventional impressions in a postgraduate clinical setting at the Universidad de Especialidades Espiritu Santo. A total of 85 adult patients were included: 44 received conventional impressions and 41 received digital impressions. Dental anxiety was assessed using the Modified Dental Anxiety Scale (MDAS) before the procedure, and satisfaction was evaluated using a Visual Analog Scale (VAS) immediately after the procedure. Anxiety scores did not differ significantly between groups (p = 0.232). However, patients in the digital group reported significantly greater satisfaction than those in the conventional group (p < 0.001). These findings suggest an association between the use of digital impression techniques and higher levels of patient satisfaction, while no significant association was observed between impression technique and dental anxiety.

AimTo evaluate the accuracy and generalizability of DentalSegmentator, an open-source deep learning tool, for automated segmentation of skeletal facial surfaces from computed tomography (CT) scans acquired under different imaging conditions. Materials and MethodsTen human skulls were scanned using a CT scanner and three cone beam CT (CBCT) protocols (including an ultra-low-dose protocol) on two CBCT devices. High-accuracy reference surface models were acquired using an optical scanner. CBCT an CT scans were segmented automatically using DentalSegmentator. Three facial regions (forehead, zygomatic process, maxillary process) were defined on each model for quantitative assessment. Accuracy was measured as the mean absolute distance (MAD) and the standard deviation of absolute distances (SDAD) between segmented and reference models after best-fit superimposition. ResultsRepeated segmentations were identical, confirming perfect reproducibility. Across all acquisition settings and regions, DentalSegmentator produced highly accurate skeletal surface models, with an overall MAD of 0.088 mm (IQR 0.073) and SDAD of 0.061 mm (IQR 0.028). Significant but small differences were detected between imaging systems (MAD: p < 0.001; SDAD: p = 0.003), with CT scans showing slightly reduced trueness compared with CBCT images. ConclusionThe open-source DentalSegmentator tool produced accurate skeletal facial surface segmentations across diverse CT and CBCT settings, demonstrating excellent generalizability, including under low-radiation conditions. Minor differences in trueness between imaging systems were small and unlikely to impact clinical or research use. Clinical SignificanceDeep learning offers a robust foundation for automated 3D craniofacial surface extraction, supporting broader adoption of AI-driven workflows in both clinical and research contexts.

Hospital-acquired infections are a known and growing problem worldwide. Far-UVC is a novel disinfection method that inactivates bacteria with limited penetration into human skin or eyes. A clustered, unmatched, randomized control trial (RCT) will be implemented in two Bolivian hospitals. The intervention arm will receive functioning Far-UVC lamps, whereas the control arm will receive identical lamps that do not emit UV light (shams). Based on baseline data, 40 lamp fixtures will be installed above hospital sinks, 10 per arm per hospital. Environmental samples (air and surface swabs) will be collected and analyzed via culture and sequencing. Simultaneously, air chemical monitoring data will be collected.

Purpose To quantify and compare the peak force applied on the glottis during endotracheal intubation across five laryngoscopy techniques, two intubation conditions (standard and simulated laryngospasm), and two operator experience levels, and to assess the effects of stylet use and operator anthropometric characteristics on applied force. Methods This prospective, manikin-based experimental study enrolled 50 operators (30 experienced, 20 less experienced). Each performed endotracheal intubation using five techniques: direct laryngoscopy and videolaryngoscopy with a Macintosh blade, each with and without stylet, and videolaryngoscopy with a hyperangulated blade with stylet. A calibrated force sensor positioned at the glottis measured peak forces during standard and simulated laryngospasm conditions. Non-parametric statistical methods were used (Mann-Whitney U, Wilcoxon signed-rank, Friedman tests); effect sizes are reported as rank-biserial correlations. Results Across all techniques, median glottic forces ranged from 4.8 N (IQR: 3.3-6.5) for videolaryngoscopy without stylet to 11.1 N (IQR: 7.5-14.5) for direct laryngoscopy with stylet under standard conditions. No significant differences in applied force were observed between experienced and less experienced operators for any technique-condition combination (all adjusted p = 1.0; |r| < 0.27). Stylet use significantly increased glottic force across all conditions and groups (median increases 3.4-7.3 N; all p < 0.001; rank-biserial r > 0.75). Videolaryngoscopy with a Macintosh blade produced significantly lower forces than hyperangulated videolaryngoscopy under standard conditions (adjusted p = 0.049). Neither grip strength nor hand size correlated with applied force. Conclusion Glottic force during endotracheal intubation is determined primarily by technique and stylet use, not operator experience or anthropometrics. Stylet use is the single largest modifiable contributor to glottic force. These findings have implications for device selection, clinical training, and strategies to minimize airway trauma during intubation.

ObjectivesTo explore the extent to which infant oral health is addressed within the family medicine residencies in Canada, and the attitudes and practices of Canadian family medicine residents towards infant oral health. MethodsTwo brief self-administered online surveys, one to 17 Canadian family medicine training program directors and another to current residents within these programs, were conducted using Research Electronic Data Capture (REDCap). Questions focused around respondents attitudes and practices towards infants oral health and infant oral health content within family medicine curricula. Results11 family medicine directors and 155 family medicine residents responded to the survey. 90% of the directors indicated that clinical oral screening was not incorporated in the curriculum. 53% of the residents reported that they did not feel their training was adequate to identify dental caries. 41% described the quality of their oral health training to be poor. While 72% reported lack of knowledge and training as the major barrier to performing oral health-related practices. ConclusionMost of the family medicine training programs in Canada do not include infant oral health screening in their curriculum. The family medicine residents reported lack of knowledge and training is preventing them from performing various oral health-related practices.