Breast Cancer Survivorship and Level of Institutional Involvement Utilizing Integrative Oncology.

OBJECTIVE: Integrative oncology is widely used by patients with breast cancer. This study aims to investigate the relationship between the survival outcomes of breast cancer patients and the level of involvement in integrative oncology at the institutions treating them. METHODS: Claims-based data were used to find 4,815 newly diagnosed breast cancer patients treated between January 2013 and December 2014 for survival analysis. A scoring system was developed by asking oncologists about their institutions' efforts to educate, support, and provide funding for 12 complementary and lifestyle approaches. Cohort analysis using two-tailed chi-square and a separate multivariate model using SMOTE and lasso regression were used. Nine variables across patient and institutional profiles were included. The model coefficients were exponentiated and presented as odds ratios. RESULTS: 173 patients mapped to 103 institutions and 103 oncologists. The median patient age was 51, and 8% were metastatic. Institutions were scored for integrative oncology involvement and placed into four cohorts. Low-scoring institutions showed less effort to educate, support, and provide integrative therapies compared to others. The 5-year survival of patients in the low cohort was directionally but not significantly lower than others. In the multivariate model, a composite integrative oncology score was shown to increase 5-year survival odds three times for institutions in the low-mid cohort and 48% in the mid-high, compared to the low. CONCLUSION: Crossing the threshold beyond 'low' involvement in integrative oncology represents a new path to incremental survival benefit for many cancer patients. Entities invested in the survival of breast cancer patients should increase education, access, and funding for a core set of six therapies: nutrition counselling, exercise counselling, patient support groups, spiritual services, meditation, and psycho-oncology support.

Exploring the Role of Aminocatalysis in the Dearomatization and Regioselectivity of Heteroaromatic Aldehydes.

Heteroaromatic aldehydes have recently received a lot of attention as a scaffold for aminocatalytic functionalization as they allow for the construction of remote stereocenters and highly complex heterocyclic compounds. In this paper, we employ computational methods (M06-2X/cc-pVTZ//M06-2X/6-31 + G(d,p) and MP2/cc-pVTZ//M06-2X/6-31 + G(d,p)) to examine the abilities of secondary amines to activate several model heteroaromatic aldehydes by promoting loss of aromaticity and formation of the reactive trienamine intermediate. The hyperhomodesmotic equations used to assess the energy penalty for dearomatization show that the formation of the iminium ion decreases the energy cost for dearomatization, especially when X = O and S. Furthermore, we also investigated the role that the catalyst and heteroatom may have on the orbital coefficients of the various positions of the trienamine intermediary in order to better understand and/or predict the regioselectivity these systems may showcase. Synergistic effects between the catalyst and the heteroatom of the aromatic ring were observed to increase electron density at the most remote positions of several of the model systems studied.

Assessment of Effect of Implant Angulation and Implant Number on the Dimensional Accuracy of Definitive Casts.

AIM: To analyze the impact of implant angulation and implant number on the dimensional accuracy of definitive casts. MATERIALS AND METHODS: Seven definitive casts with implant analogs placed in a triangular pattern were made from dental stone. The groups were as follows: group 1 (control group) all implant analogs perpendicular to the plane of the cast; the center implant analog (implant 2) being at 90° to the plane of the cast in all groups and implant analogs number 1 and 3 arranged in 5°, 10°, or 15° divergence from or convergence to the center implant (implant number 2). Three open-tray impressions of definitive casts were made in each group. Impressions were poured in type IV dental stone. Coordinates in the three planes were measured at the implant analog top surface and the base of the cast using a fine tip measuring stylus. The data were aligned and the angular differences between implant analog vectors from definitive and duplicate casts were calculated in degrees. RESULTS: The impact of implant number on the dimensional accuracy of definitive casts was significant whereas for implant angulation it was nonsignificant. The correlation of angulation and the number of the implant did not show an interpretable pattern. The precision of duplicate casts (compared to definitive casts) is not affected by the combined interaction of implant number and implant angulation. CONCLUSION: The close proximity of implant angulation toward a right-angled direction results in higher precision of implant. In the impression, there is direct picking from the impression copings which decreases the discrepancies in implant angulation on impression and master cast. The interaction of implant angulation and the number shows a noninterpretable pattern. CLINICAL SIGNIFICANCE: Dimensionally accurate implant impressions can be made by using an open tray technique for three implants angled up to 15°.

Generation and trapping of electron-deficient 1,2-cyclohexadienes. Unexpected hetero-Diels-Alder reactivity.

Keto-substituted 1,2-cyclohexadienes were generated by base-mediated (KOt-Bu) elimination, and found to dimerize via an unprecedented formal hetero-Diels-Alder process, followed by hydration. These highly reactive cyclic allene intermediates were also trapped in Diels-Alder reactions by furan, 2,5-dimethylfuran, or diphenylisobenzofuran to afford cycloadducts with high regio- and diastereoselectivity, and could also be intercepted in a hetero-Diels-Alder process with enamine dienophiles. Endo/exo stereochemistry was unambiguously determined via X-ray crystallography in the case of nitrile-substituted 1,2-cyclohexadiene. DFT calculations indicate that the novel hetero-Diels-Alder processes observed with these allenes occur via a concerted asynchronous cycloaddition mechanism.

Route of Drug Abuse and its Impact on Oral Health-Related Quality of Life among Drug Addicts.

BACKGROUND: Various studies have tested quality of life (QOL) among drug addicts, however very few have reported any association between oral health-related quality of life (OHRQOL) and mode of drug administration among drug addicts. Hence, the present study was conducted aiming to evaluate the impact of mode of administration of drugs on OHRQOL among drug addicts. METHODS: Data was collected using respondent-driven sampling (RDS) method among 313 male drug addicts in Sri Ganganagar, Rajasthan, India, using self-administered questionnaires on oral hygiene aids and drug addiction history. OHRQOL was recorded using Oral Health Impact Profile (OHIP-14) questionnaire. The chi-square test, t-test, and Kruskal-Wallis test were used for statistical analysis. FINDINGS: In this study, 56.2% of the drug addicts reported practicing oral hygiene aids. The main drugs abused were heroin, cocaine, and amphetamines as 51.4%, 35.1%, and 13.4%, respectively. Most of the drug addicts were employed (82.4%) and studied up to primary education (46.3%). The highest mean values of community periodontal index (CPI) and decayed, missing, filled surface (DMFS) were found among the cocaine addicts and amphetamine abusers with rates of 3.11 ± 0.98 and 6.69 ± 8.52, respectively. Poor OHRQOL was observed among addicts who consumed drugs in inhalation since a long time irrespective of the type of the drug, but among them heroin addicted subjects had the poorest OHRQOL. CONCLUSION: OHRQOL was poor among the drug addicts in comparison to general population. Preventive strategies on oral health and other health promotion programs for this vulnerable group can be unified.

Traumatic Dental Injuries Prevalence and their Impact on Self-esteem among Adolescents in India: A Comparative Study.

INTRODUCTION: Adolescents are mostly injured during sport activities, traffic accidents and some forms of violence which may lead to traumatic injuries. Traumatic injuries not only pose a health risk worldwide but are also regarded among serious social problems. Poor oral health has been related to poor social relationships that affect the ability to learn and grow which may lead to reduced self-esteem. AIM: This study was conducted to compare self-esteem of adolescents with and without anterior Traumatic Dental Injury (TDI). MATERIALS AND METHODS: A population based comparative study was conducted among 10 to 17 years old adolescents from November 2014 to January 2016. The study sample comprised of 424 controls and 212 cases with 2:1 control-to-case ratio that were selected by four examiners along with a gold standard examiner. TDI was recorded using Ellis classification and self-esteem was recorded using Rosenberg's Self-Esteem Scale (RSES). For comparing self-esteem of cases and controls according to RSES questions, t-test is used. Odds ratio (OR) was utilized to assess and compare the self-esteem according to high and low esteem in cases and controls. RESULTS: Ellis Class I, Ellis Class II and Ellis Class III fractures were observed in 53.3%, 33.49% and 13.20% of cases, respectively. The maxillary arch was the most affected (72.48%) and on the hierarchy of causes, this study found that on most occasions dental injuries were caused by sports (40.09%). The total mean score of RSES in cases (23.16) and in controls (24.43) was also statistically significant (p<0.001). CONCLUSION: Improving oral health in schools may contribute considerably to increase the self-esteem of adolescents in a positive direction and help them in becoming socially competent adults.

Testing the Limits of the BOPHY Platform: Preparation, Characterization, and Theoretical Modeling of BOPHYs and Organometallic BOPHYs with Electron-Withdrawing Groups at ß-Pyrrolic and Bridging Positions.

Several BOPHY derivatives with and without ferrocene fragments, and with electron-withdrawing ester groups appended to the ß-pyrrolic positions have been prepared and characterized by NMR, UV/Vis near-infrared (NIR), high-resolution mass spectrometry, and fluorescence spectroscopy, as well as X-ray crystallography. The redox properties of new BOPHYs were probed by electrochemical (cyclic and differential pulse voltammetry) and spectroelectrochemical methods. In an attempt to prepare BOPHY derivatives with a cyano group at the bridging position using a similar approach for BODIPY cyanation, adducts from the nucleophilic attack of the cyanide anion on the bridging position in BOPHY have been isolated and characterized by spectroscopic methods. Oxidation of such adducts, however, resulted in formation of either the starting BOPHYs, or partial extrusion of the BF2 fragment from the BOPHY core, which was confirmed by spectroscopy and X-ray crystallography. DFT and TDDFT calculations on all target materials correlate well with the experimental data, and suggest the dramatic reduction of the nitrogen atom basicity at the hydrazine bridge of the BOPHY upon introduction of the cyano group at the bridging-carbon atom.

Impact of Dental Disorders and its Influence on Self Esteem Levels among Adolescents.

INTRODUCTION: Self esteem is more of a psychological concept therefore, even the common dental disorders like dental trauma, tooth loss and untreated carious lesions may affect the self esteem thus influencing the quality of life. AIM: This study aims to assess the impact of dental disorders among the adolescents on their self esteem level. MATERIALS AND METHODS: The present cross-sectional study was conducted among 10 to 17 years adolescents. In order to obtain a representative sample, multistage sampling technique was used and sample was selected based on Probability Proportional to Enrolment size (PPE). Oral health assessment was carried out using WHO type III examination and self esteem was estimated using the Rosenberg Self Esteem Scale score (RSES). The descriptive and inferential analysis of the data was done by using IBM SPSS software. Logistic and linear regression analysis was executed to test the individual association of different independent clinical variables with self esteem. RESULTS: Total sample of 1140 adolescents with mean age of 14.95 ±2.08 and RSES of 27.09 ±3.12 were considered. Stepwise multiple linear regression analysis was applied and best predictors in relation to RSES in the descending order were Dental Health Component (DHC), Aesthetic Component (AC), dental decay {(aesthetic zone), (masticatory zone)}, tooth loss {(aesthetic zone), (masticatory zone)} and anterior fracture of tooth. CONCLUSION: It was found that various dental disorders like malocclusion, anterior traumatic tooth, tooth loss and untreated decay causes a profound impact on aesthetics and psychosocial behaviour of adolescents, thus affecting their self esteem.

Easy and Inexpensive Technique for Removal of Round Headed, Jammed Locking Screws in Distal Tibial Interlocking Plate.

INTRODUCTION: The advent of locking plates has brought new problems in implant removal. Difficulty in removing screws from a locking plate is well-known. These difficulties include cold welding between the screw head and locking screw hole, stripping of the recess of the screw head for the screwdriver, and cross-threading between threads in the screw head and screw hole. However, there are cases in which removal is difficult. We describe a new technique for removing a round headed, jammed locking screws from a locking plate. CASE REPORT: 55 years old male patient received a locking distal tibial plate along with distal fibular plate 3years back from UAE. Now patient came with complaint of non-healing ulcer over medial aspect of lower 1/3rd of right leg from past 1 year. Non operative management did not improve the symptoms. The patient consented to implant removal, with the express understanding that implant removal might be impossible because already one failed attempt had been performed at some other hospital six months back. We then decided to proceed with the new technique. The rest of the proximal screws were removed using a technique not previously described. We used stainless steel metal cutting blades that are used to cut door locks or pad locks to cut the remaining stripped headed screws. CONCLUSION: This technique is very quick, easy to perform and inexpensive because the metal cutting blades which are used to cut the screws are very cheap. Yet it is very effective technique to remove the stripped headed or jammed locking screws. It is also very less destructive because of very less heat production during the procedure there is no problem of thermal necrosis to the bone or the surrounding soft tissue.

Oral health: How much do you know? - A study on knowledge, attitude and practices of patients visiting a North Indian dental school.

OBJECTIVE: This study was carried out to assess the knowledge, attitude and behavior among patients visiting the out-patient department (OPD) of Gian Sagar Dental College and Hospital, Rajpura. MATERIALS AND METHODS: A cross-sectional study was conducted on 642 subjects who visited the OPD of Gian Sagar Dental College and Hospital. A self-constructed questionnaire was given to each of the participant. Responses from the subjects were calculated in terms of numbers and percentages. RESULT: Three hundred six (48%) of the subjects had never visited a dentist before. 304 (47%) of the subjects still prefer other cleaning aids over toothbrush. 207 (32%) subjects were of the view that dental health has no effect on general health, whereas 219 (34%) subjects were of the opinion that tooth loss is a natural sequel of the aging process. CONCLUSION: There is a dearth of knowledge and careless attitude among people in regard to dental health. People need to be motivated and their concepts regarding the importance of dental health should be made clear through various campaigns and personal counseling.

Informed consent: corner stone in ethical medical and dental practice.

Progress in health care technologies has enabled patients to be better informed about all aspects of health care. Patients' informed consent is a legal regulation and a moral principle which represents patients' rights to take part in the clinical decisions concerning their treatment. With increasing awareness among the patients, the concept of informed consent is also evolving in developing countries like India. It is important for the medical and dental practitioners to have a written and signed informed consent from their patients before performing any invasive or irreversible procedures. Informed consent is also needed when providing medical care to children, foreign patients, and incorporating images of the patients while conducting medical and dental research. The present review addresses some of the vital issues regarding informed consent when providing medical and dental care with current review of the literature.

Knowledge and awareness of the Consumer Protection Act among dental professionals in India: A systematic review.

BACKGROUND: The medical profession has been included in the Consumer Protection Act (CPA), to protect the interests of the patients in case of any unethical treatment rendered by the doctor. The present systematic review was conducted to assess the knowledge and awareness of CPA among dental professionals in India. MATERIALS AND METHODS: A systematic review of relevant cross-sectional observational studies was conducted regarding the level of knowledge and awareness of CPA among dental professionals in India. Five studies out of 44 were finally included in the present review, after conducting both an electronic and manual search of scientific databases. The potential biases were reported and appropriate data was extracted by the concerned investigators. RESULTS: More than 90% of the study subjects in one of the studies were aware of the CPA, as compared to other studies. In two studies, when queried about the correct time period during which a patient can sue a doctor, very few subjects (18 and 23.2%) answered correctly. Almost 90% of the subjects were taking some form of consent in one of the studies. Private practitioners had more awareness as compared to academicians and combined practitioners. CONCLUSION: The results of the present review showed that a majority of the subjects were aware of the existence of CPA, but knowledge about the basic rules and regulations was lacking in a few studies. Therefore, dental professionals need to keep themselves updated on the various rules and latest amendments to save themselves from any litigation.

Knowledge, awareness and practice regarding needle stick injuries in dental profession in India: A systematic review.

BACKGROUND: Hundreds of thousands of healthcare workers remain susceptible to deadly viruses throughout the year, including blood-borne pathogens. Needle stick injuries (NSI) constitute one of the most common occupational health hazards in healthcare profession. Dental professionals are at more risk of acquiring NSI due to their limited and restricted working area. The present systematic review was carried out to determine knowledge, awareness and practice regarding NSI in dental professionals and students in India. MATERIALS AND METHODS: A systematic review of cross-sectional studies available in the literature on the knowledge, attitude and practice among dental professionals and students in India was carried out. We identified relevant articles through electronic and manual search such as Pubmed and MEDLINE. Two investigators independently identified studies that were included in the review. RESULTS: Four articles were finally selected for inclusion in the review. All the studies were done involving dental students; 89.23% of the students had correct knowledge about NSI and 91.55% of the students had adequate level of awareness regarding its management in one of the studies. Also, 89% of students in one of the studies were aware of taking post-exposure prophylaxis after accidental NSI. In another study, 44% of the students destroyed the needles using a needle destroyer and 15% destroyed them in puncture-resistant containers. CONCLUSION: The knowledge and awareness of the dental students is adequate, although there is considerable variation in practice and management of NSI among different studies. There is a need for more studies involving dental professionals.

Awareness of biomedical waste management among dental professionals and auxiliary staff in Amritsar, India.

AIM: The aim of this study was to determine awareness of biomedical waste (BMW) management policies and practices among dental professionals and auxiliary staff in a dental hospital/clinics in Amritsar, India, to inform the development of future policies for effective implementation of BMW rules. METHOD: The study involved 160 staff members at the Amritsar hospital/clinics (80 dentists and 80 auxiliary staff) to whom a questionnaire was distributed regarding policies, practices and awareness relating to BMW. The questionnaire was first piloted. Completed questionnaires were returned anonymously. The resulting data were statistically tested using the chi-square test for differences between the dentists and auxiliary staff. RESULTS: In respect of BMW management policies, there was a highly significant difference in the responses of the dentists, whose answers suggested far greater knowledge than that of the auxiliaries (P<0.001). Regarding BMW management practices, the dentists were significantly more aware (P<0.001) of the method of waste collection in the hospital and the disposal of various items into different colour-coded bags. As for employee education/awareness, there was a significant difference (P<0.05) between the dentists and the auxiliaries on the question regarding records of BMW maintained in the hospital and the other responses to questions on these topics had a highly significant (P<0.001) difference between the two groups in favour of the dentists. CONCLUSION: The results of this study have demonstrated a lack of awareness of most aspects of BMW management among dental auxiliary staff in the dental hospital/clinics in Amritsar and a lack of awareness of some aspects among dentists who work in the hospital/clinics. The results provide the hospital authorities with data upon which they can develop a strategy for improving BMW management.

Noise levels in a dental teaching institute - A matter of concern!

OBJECTIVE: To measure and assess the noise levels produced by various dental equipments in different areas of a dental institution and to recommend improvements if noise levels are not within permissible limits. MATERIAL AND METHODS: Sound levels were measured at three different areas of a dental institution where learning and teaching activities are organized. The sound level was measured using a sound level meter known as 'decibulolmeter'. In each area the noise level was assessed at two positions-one, at 6 inches from the operators ear and second, at the chairside instrument trolley. Noise levels were also assessed from a central location of the clinic area when multiple equipments were in operation simultaneously. RESULTS: Dental laboratory machine, dental hand-piece, ultrasonic scalers, amalgamators, high speed evacuation, and other items produce noise at different sound levels which is appreciable. The noise levels generated varied between 72.6 dB in pre-clinics and 87.2 dB in prosthesis laboratory. The results are comparable to the results of other studies which are conducted elsewhere. Although the risk to the dentists is lesser, but damage to the hearing is possible over prolonged periods. CONCLUSION: Higher noise levels are potentially hazardous to the persons working in such environments especially in the laboratory areas where noise levels are exceeding the permissible limits. Key words:Noise level, equipment, hearing loss, risk, working areas.