Sequential multicomponent site-selective synthesis of 4-iodo and 5-iodopyrrole-3-carboxaldehydes from a common set of starting materials by tuning the conditions.

A simple and straightforward method for the synthesis of 4-iodo and 5-iodopyrrole-3-carboxaldehydes is developed from a common set of starting materials by tuning the reaction conditions. This sequential multicomponent protocol involves I2-mediated regioselective C4-iodination and aromatization of intermediate dihydropyrrole, generated through proline-catalyzed direct Mannich reaction-cyclization sequence between succinaldehyde and imines, to access 4-iodopyrroles. While aerobic oxidative aromatization of dihydropyrrole to pyrrole followed by NIS-mediated regioselective iodination furnished 5-iodopyrroles in a two-pot fashion. A series of site-selective C4/C5-iodopyrroles have been synthesized in good to high yields (up to 78%) and DFT calculations of these compounds were also performed.

Australian mental health care practitioners' practices and attitudes for encouraging smoking cessation and tobacco harm reduction in smokers with severe mental illness.

Reducing the burden of physical illness among people living with severe mental illnesses (SMI) is a key priority. Smoking is strongly associated with SMIs resulting in excessive smoking related morbidity and mortality in smokers with SMI. Smoking cessation advice and assistance from mental health practitioners would assist with reducing smoking and smoking-related harms in this group. This study examined the attitudes and practices of Australian mental health practitioners towards smoking cessation and tobacco harm reduction for smokers with SMI, including adherence to the 5As (ask, assess, advise, assist and arrange follow up) of smoking cessation. We surveyed 267 Australian mental health practitioners using a cross-sectional, online survey. Most practitioners (77.5%) asked their clients about smoking and provided health education (66.7%) but fewer provided direct assistance (31.1-39.7%). Most believed that tobacco harm reduction strategies are effective for reducing smoking related risks (88.4%) and that abstinence from all nicotine should not be the only goal discussed with smokers with SMI (77.9%). Many respondents were unsure about the safety (56.9%) and efficacy (39.3%) of e-cigarettes. Practitioners trained in smoking cessation were more likely (OR: 2.9, CI: 1.5-5.9) to help their clients to stop smoking. Community mental health practitioners (OR: 0.3, CI: 0.1-0.9) and practitioners who were current smokers (OR: 0.3, CI: 0.1-0.9) were less likely to adhere to the 5As of smoking cessation intervention. The results of this study emphasize the importance and need for providing smoking cessation training to mental health practitioners especially community mental health practitioners.

Virtual Reality Exposure Therapy for the Treatment of Dental Phobia: A Controlled Feasibility Study.

BACKGROUND: Virtual reality exposure therapy (VRET) has been used to treat a variety of fears and phobias. AIM: To determine the feasibility (i.e. safety and efficacy) of using VRET to treat dental phobia. METHOD: Safety was evaluated by determining any adverse events or symptom exacerbation. Efficacy of VRET was evaluated by comparing the reduction in dental anxiety scores (measured 16 times within a 14-week study period, and at 6-month follow-up), and its behavioural effects with that of an informational pamphlet (IP) on ten randomized patients with dental phobia using a controlled multiple baseline design. Participants' heart rate response during VRET, and their experience post-VRET, were indexed. RESULTS: No personal adverse events or symptom exacerbation occurred. Visual analysis and post-hoc intention-to-treat analysis showed a significantly greater decrease in dental anxiety scores [higher PND (percentage of non-overlap data) scores of 100% and lower POD (percentage of overlap data) of 0%, Modified Dental Anxiety Scale, F (1,8) = 8.61, p = 0.019, and Dental Fear Scale, F (1,8) = 10.53, p = 0.012], and behavioural avoidance in the VRET compared with the IP group [d = 4.2 and -1.4, respectively). There was no increase in average heart rate during VRET. Of the nine treatment completers, six (four from the VRET group and two from the IP group) no longer had dental phobia at 6-month follow-up. Four of the five VRET participants, but none of the IP participants, scheduled a dental treatment appointment following the intervention. CONCLUSION: VRET is a feasible alternative for patients with dental phobia.

Virtual Reality Exposure Therapy for Treatment of Dental Phobia.

popularity as an effective treatment for anxiety disorders. The purpose of this article is to determine the applicability of VRET in the treatment of dental phobia of two patients. Two case examples of female dental patients, aged 56 and 24 years, who met the criteria for dental phobia according to the Phobia Checklist, illustrate the use of VRET in the dental setting. VRET that is used as a psychological treatment for dental fear and dental phobia can potentially be given by a non-specialist (for example dental assistant), thereby making it a cost-effective therapy for the treatment of dental phobia. Clinical relevance: This article is the first of its kind to demonstrate Virtual Reality Exposure Therapy (VRET) in the treatment of dental anxiety.

An appraisal of practice guidelines for smoking cessation in people with severe mental illness.

OBJECTIVE: To review the quality of current smoking cessation guidelines that include recommendations for people with severe mental illness. METHODS: A systematic search of scientific databases, central government health authority websites, psychiatry peak bodies, guideline clearing houses and Google was undertaken for relevant smoking cessation guidelines. Three reviewers independently assessed guideline quality using the AGREE II (Appraisal of Guidelines for REsearch and Evaluation II) instrument. Two reviewers extracted recommendations specific to smokers with severe mental illness. RESULTS: Thirteen guidelines met the inclusion criteria. Seven guidelines scored ⩾60% in at least four domains. Median scores for 'Editorial independence', 'Rigour of development', 'Stakeholder Involvement' and 'Applicability' were less than 60%. The highest median scores were for 'Scope and purpose' (87%, 69-96%) and 'Clarity of presentation' (87%, 56-98%). 'Editorial independence' (33.3%, 0-86%) and 'Rigour of development' (54%, 11-92%) had the lowest median domain scores. The guidelines varied greatly in their recommendations but the majority recommended nicotine replacement therapy, bupropion or varenicline as first-line pharmacotherapy, along with behavioural support. CONCLUSION: Many guidelines did not adequately report their methods or the competing interests of the authors. Future guidelines development may benefit from more specifically addressing AGREE II criteria and the needs of smokers with severe mental illness.

Synthesis of methanesulphonamido-benzimidazole derivatives as gastro-sparing antiinflammatory agents with antioxidant effect.

A series of 5-methanesulphonamido benzimidazole derivatives were designed by combining the structural features of clinically useful anti-inflammatory drugs (nimesulide and rofecoxib) and antiulcer drugs (lansoprazole, omeprazole, etc.) based on physicochemical and 3D similarity studies. The compounds were evaluated for their anti-inflammatory activity in carrageenan induced rat paw edema model taking rofecoxib and indomethacin as standard drugs. In vitro antioxidant activity of the compounds was assessed by potassium ferricyanide reducing power (PFRAP) assay. The compounds 9, 10 and 11 showed anti-inflammatory activity comparable to the standard group and were also non-ulcerogenic at the test doses. Compounds 6-11 exhibited good antioxidant effect in the concentration range (1.0-50.0µmol/ml. Preliminary theoretical ADME profiling of the compounds based on computation of selected physicochemical properties showed an excellent compliance with Lipinski's rule.

Motivations and Limitations Associated with Vaping among People with Mental Illness: A Qualitative Analysis of Reddit Discussions.

This study aims to understand the nature and significance of online lay discussions about e-cigarettes and mental illness. We systematically searched the website Reddit.com using keywords related to e-cigarettes and mental illness. We coded relevant posts into themes under the framework of motivations for and limitations of vaping for people with mental illness. The thematic analysis included 3263 comments from 133 discussion threads. Six themes were classified as motivations to vape for people with mental illness: Self-medication; Quitting smoking; Freedom and control; Hobby; Social connectedness; and Motivation from caregivers and online communities. The limitations of vaping included: Unsatisfactory substitute for cigarettes and psychiatric medicines; Drug interactions; Nicotine addiction; Risks of e-liquid; Practical difficulties and Cost. People with mental illness; and their carers; use online discussion boards like Reddit to discuss the benefits and limitations of e-cigarettes for people with mental illness. Both positive and negative views exist. Media platforms like Reddit may shape the opinions of stakeholders and generate lay expertise about contentious health topics such as e-cigarettes. These findings have implications for policy and practice concerning assisting smokers with mental illness to reduce their health risk through switching to e-cigarettes.

Views and Preferences for Nicotine Products as an Alternative to Smoking: A Focus Group Study of People Living with Mental Disorders.

Aims and Background: People living with mental disorders experience a disproportionately higher burden of tobacco-related disease than the general population. Long-term substitution with less harmful nicotine products could reduce the tobacco-related harm among this population. This study investigated the views and preferences of people with mental health disorders about different nicotine products and their use as long-term substitutes for cigarettes. Methods: Semi-structured focus group discussion followed by a brief questionnaire. The discussion transcripts were analysed for content and themes and quantitative data summarised with descriptive statistics. Results: Twenty-nine participants took part in four focus groups. Vaping devices were the most acceptable nicotine products discussed; however preferences for nicotine products were individual and varied along aesthetic, pragmatic, sensory and symbolic dimensions. The concept of tobacco harm reduction was unfamiliar to participants, however they generally agreed with the logic of replacing cigarettes with less harmful nicotine products. Barriers to activating tobacco harm reduction included the symbolism of smoking and quitting; the importance placed on health; the consumer appeal of alternatives; and cost implications. Discussion and Conclusions: Engaging this population in tobacco harm reduction options will require communication that challenges black and white thinking (a conceptual framework in which smoking cigarettes or quitting all nicotine are the only legitimate options) as in practice this serves to support the continuance of smoking. Consumers should be encouraged to trial a range of nicotine products to find the most acceptable alternative to smoking that reduces health harms. Providing incentives to switch to nicotine products could help overcome barriers to using less harmful nicotine products among mental health consumers.

The challenge of reducing smoking in people with serious mental illness.

The high prevalence of smoking in people with serious mental illness contributes substantially to the disproportionately high morbidity and premature mortality in this population. There is an urgent need to help people with serious mental illness to quit smoking. We discuss competing explanations for the high prevalence of smoking in people with serious mental illness and the effectiveness of available smoking cessation interventions. We propose trials of harm reduction options, such as nicotine replacement therapy and electronic cigarettes (e-cigarettes), as long-term substitutes for cigarettes in smokers with serious mental illness who are unable to quit smoking. We also propose that smoke-free psychiatric units provide smoking cessation support on patient admission to the hospital and after discharge.

YouTube as a source of quit smoking information for people living with mental illness.

BACKGROUND: YouTube is the most popular video sharing website, and is increasingly used to broadcast health information including smoking cessation advice. This study examines the quality and quantity of YouTube quit smoking videos targeted at people living with mental illness (MI). METHODS: We systematically searched YouTube using selected relevant search terms. The first 50 videos obtained for each search term were screened for relevance and further videos screened through snowball sampling. Forty unique, English language videos focussing on people with MI were included in the assessment and evaluated for general video characteristics, themes, format, targeted smoking cessation and harm reduction information. RESULTS: Most videos either discussed the problem of high smoking rates among people with MI (n=12) or smoking cessation programmes and policies at an institutional level (n=13). Only nine videos were aimed at providing quit smoking advice to this population. One video recommended higher doses of nicotine replacement therapy (NRT) for people with MI while six videos referred to possible changes in medication dosage on quitting smoking. Four videos suggested cutting down smoking for harm reduction. CONCLUSIONS: Very few YouTube videos specifically focus on the problem of high smoking rates among people with MI and even fewer provide targeted smoking cessation and harm reduction advice for this priority population. There is a need to develop comprehensive, evidence based, quit smoking video resources for smokers with a MI.

Apical plug technique in a calcified immature tooth: a case report.

Traumatic injury to an immature tooth may result in pulpal necrosis secondary to pulp canal obliteration, which makes the management of the tooth a clinical challenge for dentists. The present case report describes an innovative apical plug technique with mineral trioxide aggregate in a calcified immature tooth using an ultrasonic tip and long, thin, tapered fissure burs. The technique was proven to be successful clinically and radiographically at 2 years postobturation.

Effect of two herbal mouthwashes on gingival health of school children.

This study aimed at determining the effect of indigenously prepared neem and mango chewing stick mouthwashes on plaque and gingival indices. A sample of 105 children aged 12-15 years was randomized into three groups, namely neem, mango, and chlorhexidine mouthwash groups. All the children were examined at baseline and gingival and plaque indices were recorded. Baseline scores for plaque and gingivitis were fair and moderate, respectively, in all the three groups and there existed no statistically significant difference among them. Ten millilitres each of herbal and chlorhexidine mouthwashes (0.2%) were administered according to the group allocation twice daily for 21 days. Indices were reassessed at 21 days (immediately after intervention) and at 1 month, 2 months, and 3 months after discontinuing the mouthwashes. Statistically significant reduction (P < 0.001) in plaque index was found in all the three mouthwash groups at 21 days and at 1 month from discontinuing the mouthwash. Chlorhexidine additionally showed statistically significant reduction in plaque index at 2 months from discontinuing the mouthwash. Statistically significant reduction (P < 0.001) in gingival index was found in all the three mouthwash groups at 21 days (immediately after discontinuing the mouthwash) and at 1 and 2 months from discontinuing the mouthwash. To conclude, all the three mouthwashes were effective antiplaque and antigingivitis agents. Chlorhexidine and neem possess equivalent efficacy in reducing plaque, while chlorhexidine has superior antigingivitis properties.

The impact of incinerators on human health and environment.

Of the total wastes generated by health-care organizations, 10%-25% are biomedical wastes, which are hazardous to humans and the environment and requires specific treatment and management. For decades, incineration was the method of choice for the treatment of such infectious wastes. Incinerator releases a wide variety of pollutants depending on the composition of the waste, which leads to health deterioration and environmental degradation. The significant pollutants emitted are particulate matter, metals, acid gases, oxides of nitrogen, and sulfur, aside from the release of innumerable substances of unknown toxicity. This process of waste incineration poses a significant threat to public health and the environment. The major impact on health is the higher incidence of cancer and respiratory symptoms; other potential effects are congenital abnormalities, hormonal defects, and increase in sex ratio. The effect on the environmental is in the form of global warming, acidification, photochemical ozone or smog formation, eutrophication, and human and animal toxicity. Thus, there is a need to skip to newer, widely accepted, economical, and environment-friendly technologies. The use of hydroclaves and plasma pyrolysis for the incineration of biomedical wastes leads to lesser environmental degradation, negligible health impacts, safe handling of treated wastes, lesser running and maintenance costs, more effective reduction of microorganisms, and safer disposal.

Indian dental students' attitudes and practices regarding tobacco cessation counseling.

Tobacco cessation counseling (TCC) has been proven to be very effective in helping tobacco users to quit. Dentists can play a vital role in helping patients to quit tobacco use. The aim of this study was to examine five groups of Indian dental students' attitudes and practices regarding TCC. Out of 514 fifth-year students in five colleges of Karnataka, India, 456 students voluntarily participated. The thirty-five-item questionnaire consisted of four sections: demographic characteristics, practices in the institution, attitudes toward tobacco cessation programs in the dental setting, knowledge of tobacco counseling, and perceived barriers in counseling. To test the reliability of the survey items, Cronbach's alpha coefficient was used. Frequency distributions and percentages were examined for each item, and chi-square tests were used to analyze differences based on tobacco usage status. The sample consisted of 317 female and 139 male students. The majority of the students (n=429, 94 percent) reported that they give anti-tobacco usage advice to patients who smoke and planned to advise patients about tobacco cessation throughout their careers. Fewer students (n=314, 68.9 percent) indicated that such counseling would assist patients to quit. The major barriers were reported to be patients' resistance, inadequate skills, and poor knowledge about nicotine replacement therapy. This study found that these students had a positive attitude about TCC, along with adequate knowledge regarding the ill effects of tobacco. However, this study concludes that tobacco cessation should be given greater emphasis in the curriculum of Indian dental schools in order to expand the use of TCC in dental practices.

Traumatic dental injuries in primary school children of South India--a report from district-wide oral health survey.

AIM: The aim of this study was to investigate the prevalence of dental trauma among primary school children aged 6-11 years in Belgaum, India. MATERIALS AND METHODS: A sample of 13,200 children from primary schools of Belgaum district was examined for dental trauma. WHO classification of dental trauma was used. RESULTS: Total number of children suffering from dental trauma was found to be 1946 (14.74%). A significant gender influence on the occurrence of dental trauma was observed, with more boys (17.26%) experiencing dental trauma than girls (12.29%). More than 3 mm overjet and incompetent lips were also significantly associated with dental trauma in children. CONCLUSION: The findings of this study show that dental trauma has a moderately high prevalence among Indian primary school children. Community, especially parents and school teachers, should be educated about prevention and early management of dental trauma in children.

Effectiveness of herbal and fluoridated toothpaste on plaque and gingival scores among residents of a working women's hostel - a randomised controlled trial.

PURPOSE: To determine the effectiveness of herbal and fluoridated toothpastes on plaque and gingival scores among 18- to 25-year-old female participants residing in a working women's hostel. MATERIALS AND METHODS: Sixty participants residing in a working women's hostel in Belgaum city, aged between 18 and 25 years, comprised the study population. The 60 participants were randomly allocated to the experimental and control groups. The experimental group was asked to use a herbal toothpaste (Himalaya Herbal Healthcare) and the control group a fluoridated toothpaste (Colgate Dental Cream) twice a day for 6 weeks. The plaque and gingival indices were recorded according to Silness and Löe (1964) and Löe and Silness (1963), respectively, at baseline, 3 weeks and 6 weeks of usage of the toothpastes. RESULTS: Baseline plaque and gingival scores were 1.53 ± 0.9 and 1.22 ± 0.13 for the control group and 1.30 ± 0.15 and 1.19 ± 0.12 for the experimental group, respectively. At 6 weeks, plaque and gingival scores were 0.86 ± 0.18 and 0.80 ± 0.2 for the control group and 0.99 ± 0.14 and 0.9 ± 0.21 for the experimental group, respectively. Statistically significant differences were obtained before and after the intervention in both groups (P < 0.001). CONCLUSION: The herbal toothpaste was as effective as the conventionally formulated dentifrice in controlling plaque and gingivitis.

Mobile-phone text messaging (SMS) for providing oral health education to mothers of preschool children in Belgaum City.

We compared the effectiveness of two media (text messages and pamphlets) in imparting health education to mothers of preschool children. Mothers and their children were randomized into two groups. There were 72 mothers and their children in the pamphlet group and 71 in the text message group. The mothers were given health education by one of the two modes for four weeks. Knowledge, attitude and practices of the mothers were assessed by a questionnaire pre- and post-intervention. Visible plaque scores of their children were also recorded pre- and post-intervention. There were significant improvements in knowledge (P < 0.001), attitude (P < 0.001) and practices (P < 0.001) in both groups. There was also a significant reduction in visible plaque scores (P < 0.001) in both groups. Text messaging was more effective than pamphlets in improving knowledge, attitude and practices of mothers, but the comparative reduction in plaque score between groups was not significant. Text messaging appears to be an effective means of imparting oral health education.