tbuckley/cabot-search huggingface dataset:
Acute kidney injury induced by hypothyroidism myopathy: a clinical analysis of 24 cases
Authors: Ting Liu, Jing'ai Fang, Xiaodong Zhang
Journal: BMJ (2019)

Clinical data of 24 patients with acute kidney injury (AKI) induced by hypothyroidism myopathy admitted in our hospital from January 2014 to December 2016 were analyzed retrospectively. There were 9 patients classified as AKI stage Ⅰ and 15 patients as AKI stage Ⅱ according to the Kidney Disease Improving Global Outcomes (KDIGO), 21 hypothyroidism myopathy patients without AKI were selected as control group. ANOVA and chi-square test were used to compare the general data and laboratory results among three groups; artificial neural network analysis and multi-factor stepwise regression method were used to analyze the factors related to AKI. There were significant differences in serum creatinine (Scr) (F=34.3, P<0.01), BUN(F=29.1, P<0.01), ALB(F=5.27, P=0.01), CK (F=8.61, P=0.01) , creatin kinase isoenzyme(CK-MB)(F=33.1, P<0.01), LDH(F=7.78, P=0.01),ALT(F=34.3, P<0.01) and AST (F=28.1, P<0.01) among three groups. Artificial neural network analysis showed that myoglobin was closely related to serum creatinine, suggesting its importance for AKI in patients with primary hypothyroidism myopathy. Multivariate regression analysis showed that serum creatinine was correlated with CK-MB(B=2.10, SE=0.38, β=0.96, t=5.52), LDH(B=0.18, SE=0.06, β=0.34, t=3.00) and AST (B=0.16, SE=0.09, β=0.32, t=2.62). This study indicates that hypothyroidism myopathy may be one of the causes of AKI, and the severity of AKI might be closely related to the severity of hypothyroidism myopathy.


Key words: 
Hypothyroidism; Muscular diseases; Kidney injury, acute
乙型肝炎病毒感染并非随时皆宜抗病毒治疗
Authors: 杨秉辉
Journal: BMJ (2008)

我国医务界对慢性乙型肝炎(乙肝)的治疗,多年来主要采取保肝治疗.从循证医学的观点看来,其价值尚难确定.我国肝病、传染病专家多方呼吁对有适应证的病例应采用抗病毒治疗.目前经批准用于乙肝抗病毒治疗药物有干扰素与核苷类似物两大类.前者应用较久,不过对我国以B型、C型基因型为主的乙肝病毒而言,疗效並不满意,不良反应较多,价格也较昂贵,应用并不普遍。
Cytokine status in the omentum and peritoneum in metastatic gastric cancer.
Authors: Elena Yu. Zlatnik, Oleg I. Kit, Aleksandr B. Sagakyants, Ekaterina I. Zolotareva, Oksana G. Shulgina, Inna A. Novikova, Nikolay S. Samoylenko, Natalya V. Soldatkina, Yuriy A. Gevorkyan, Elena A. Dzhenkova, Dmitry A. Kharagezov, Andrey V. Dashkov, Vladimir E. Kolesnikov, Sergey I. Poluektov, Dmitry O. Kaymakchi, Vladimir A. Dontsov, Alexander V. Shaposhnikov, Dmitry S. Petrov, Yuriy A. Fomenko
Journal: Journal of Clinical Oncology (2020)

e16557 Background: Gastric cancer (GC) is one of the most common malignant tumors and the second most common cause of cancer deaths in Russia. Many researchers note the ambiguous role of cytokines in the pathogenesis of tumor processes. The purpose of the study was to determine characteristics of the cytokine status in the omentum and peritoneum of patients with metastatic GC. Methods: The main group (Mgr) included 23 patients with T2-4N0-3M1 GC with metastases to the peritoneum and greater omentum, the mean age 58.9±9.7 years. The comparison group (Cgr) included 20 non-cancer patients, the mean age 55.9±9.7 years. Tissues of the omentum (OT) and peritoneum (PT) were obtained from all patients during cytoreductive and diagnostic surgeries. Ex tempore tissues were disintegrated using BD Medimachine (USA) with 0.9% NaCl; the cell suspension was centrifuged, and the supernatant was collected and aliquoted. Levels of cytokines IL-1β, IL-2, IL-6, IL-8, IL-18, TNF-α, IL-10 (Vektor-Best, Russia) and IL-1RA (eBioscience, Austria) were determined by ELISA. The results were expressed as the specific content per 1 g of protein evaluated by the biuret method (pg/mL/g of protein). Statisical analysis of the results was performed with the Statistica 10 program (StatSoft Inc., USA). Significance of differences was evaluated using the Mann-Whitney and Wilkinson tests; differences were considered significant at p &lt; 0.05. Results: In Cgr, levels of IL-6, IL-8, IL-18 and IL-1β in OT were 4.1±1.1, 3.4±0.7, 21.2±5.5 and 10.8±2.1, while in Mgr – 55.3±24.4, 32.5±13.8, 144.9±48.4 and 21.01±5.4 pg/mL/g of protein, i.e. 13.7, 9.5, 6.9 and 1.9 times (p≤0.05) higher than in Cgr, respectively. The specific content of IL-1RA in OT was 12.6 times higher, p≤0.05 (215.7±69.8 vs. 2723.1±730.1), and the IL-10 concentration did not differ significantly. In PT of Cgr, levels of IL-8, IL-18 and IL-6 were 9.8±7.3, 35.2±21.7, 7.5±3.7, and in Mgr – 250.7±21.4, 322.9±16.9, 61.1±27.6 pg/mL/g, i.e. 25.7, 9.2 and 8.2 times (p≤0.05) higher than in Cgr. IL-1RA in PT of Mgr was 24.4 times higher than in Cgr, p≤0.05 (7656.2±3160.3 vs. 357.69±180.86). Conclusions: A certain microenvironment is formed in OT and PT affected by metastases, with specific features in the ratio and concentrations of various cytokines, which undoubtedly contribute to the formation of a secondary tumor.
Effects of nutritional status in patients of systemic inflammatory response syndrome on its prognosis
Authors: Bao-lan Yuan, Chun-sheng Li, Shuo Wang
Journal: BMJ (2011)

Objective To investigate influence of nutritional status on prognosis in patients with systemic inflammatory response syndrome (SIRS). Methods Retrospective analysis for clinical data of 533 patients who hospitalized at the Internal Medicine Department of Beijing Social Welfare Hospital and the Emergency Department of Chaoyang Hospital, Beijing during 2005 to 2010 were performed. All the patients were divided into SIRS (323 cases) and non-SIRS (210 cases) groups based on diagnostic criteria of SIRS and pyemia, and groups of the survival (431 cases) and the dead ( 102 cases) based on their end outcomes.Patients of SIRS were further divided into sub-groups of pyemia (287 cases) and non-pyemia (36 cases)based on their infection status. The Acute Physiology and Chronic Health Evaluation Ⅱ ( APACHE Ⅱ ),serum levels of prealbumin ( PAB), albumin ( ALB), total cholesterol (CHOL) and C-creative protein (CRP) were measured for all the patients on the 1st, 3rd, 7th days after admission, before discharge and prior to death, respectively. Results Scores of APACHE Ⅱ were significantly higher in SIRS and the dead groups than those in non-SIRS and the survival groups (P ＜0. 05 ). Serum level of albumin was significantly lower in SIRS and the dead groups than that in non-SIRS and the survival groups on the 7th day after admission (SIRS vs. non-SIRS: F=9.812, P=0.035; the dead vs. the survival: F =45.285, P=0. 003). Change in serum level of prealbumin was the same as the level of albumin, with significant difference between various groups since the 3rd day after admission ( P ＜ 0. 05 ). Significant time effects could be found in the dead and survival groups (for the dead group: F = 19. 188, P = 0. 000; and for the survival group: F = 47. 250, P ＜ 0. 01 ). Multiple regression analysis showed that serum levels of prealbumin and total cholesterol correlated with scores of APACHE Ⅱ[with a regression formula of scores of APACHE Ⅱ = 52.032-21.407 PAB-8.971 CHOL (R2 =0.801, F=48.016, P =0.023)]. Logistic regression analysis showed that low level of prealbumin and high scores of APACHE Ⅱ both were predictors for survival of SIRS patients, with an overall accuracy of 77. 1 percent, 73.5 percent for survival and 79. 5 percent for death prediction. Conclusions Severe malnutrition can be found in patients with SIRS and serum level of prealbumin can be used to evaluate their nutritional status and severity of the disease. High scores of APACHE Ⅱ combined with low serum level of prealbumin can predict prognosis of the patients.

Key words: 
Sepsis;  Systemic inflammatory response syndrome;  Prognosis
Clinical analysis of 46 cases with systemic lupus-associated pancreatitis
Authors: Qiang Wang, Yan Li, Min Shen, Xiaomei Leng, Xiaofeng Zeng, Fengchun Zhang
Journal: BMJ (2014)

Objective
To determine the clinical features of systemic lupus erythematosus (SLE) patients with pancreatitis.


Methods
The medical records of 46 patients with pancreatitis among 5 233 SLE patients admitted into Peking Union Medical College Hospital from January 1983 to January 2012 were reviewed for retrospective analyses of clinical manifestations, laboratory tests, radiological findings, treatments and prognosis.


Results
The prevalence of pancreatitis was 0.88% (46/5 233) in SLE patients. There were 7 males and 39 females with an average age of (33±13) years. Acute pancreatitis (n=40) occurred more frequently than chronic pancreatitis (n=6). It appeared mostly in active course of SLE with an involvement of more organs. Hypertriglyceridemia was found in 81.0% (17/21) lupus-associated acute pancreatitis patients. The average level of triglycerides in severe acute pancreatitis was higher than that in mild acute pancreatitis (P=0.023). The mortality rate of lupus-associated acute pancreatitis was 37.5% (15/40). Most patients received high-dose glucocorticoid and immunosuppressants. Acute pancreatitis appeared in only 5 patients during the course of steroids pulse therapy and most symptoms were mild. Concomitant infections were correlated with poor prognosis (P<0.01). The most common manifestations of lupus-associated chronic pancreatitis were abdominal pain, jaundice and pancreatic enlargement. Autoimmune pancreatitis could be the initial manifestation of lupus.


Conclusions
Pancreatitis with SLE includes acute and chronic pancreatitis. Among them, acute pancreatitis is more common and severe and it usually occurs in patients with active SLE with a high mortality. Hypertriglyceridemia may induce and aggravate lupus-associated acute pancreatitis. Early aggressive management with high-dose steroids and immunosuppressants is recommended. Concomitant infection is a risk factor of poor prognosis.


Key words: 
Lupus erythematosus, systemic; Acute pancreatitis, necrotizing; Pancreatitis, chronic
Metabolic Alkalosis and Cystic Fibrosis: A Case Report
Authors: Sudip Ghimire, Himabindu Yerneni, Tomonori A. Oyadomari, Martin Sedlacek
Journal: Annals of Internal Medicine (2020)

Letters18 August 2020Metabolic Alkalosis and Cystic Fibrosis: A Case ReportSudip Ghimire, MD, Himabindu Yerneni, MD, Tomonori A. Oyadomari, MD, and Martin Sedlacek, MDSudip Ghimire, MDDartmouth Hitchcock Medical Center, Lebanon, New Hampshire (S.G., M.S.), Himabindu Yerneni, MDCase Western Reserve University, Cleveland, Ohio (H.Y.), Tomonori A. Oyadomari, MDMosaic Life Care, St. Joseph, Missouri (T.A.O.), and Martin Sedlacek, MDDartmouth Hitchcock Medical Center, Lebanon, New Hampshire (S.G., M.S.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-0038 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Chloride-deficient metabolic alkalosis usually has an obvious cause, but the situation can be more complicated in patients with cystic fibrosis.Objective: To illustrate a rare cause of metabolic alkalosis in a patient with cystic fibrosis.Case Report: We took care of a 32-year-old man with known cystic fibrosis who presented with generalized weakness, fatigue, and failure to thrive for several days. On examination, we found him to be severely volume-depleted, with hypotension and orthostatic blood pressure changes, subjective weight loss, and decreased skin turgor. Laboratory testing showed severe metabolic alkalosis with the following levels: CO2, 50 mmol/L; chloride, 70 ...References1. Bates CM, Baum M, Quigley R. Cystic fibrosis presenting with hypokalemia and metabolic alkalosis in a previously healthy adolescent. J Am Soc Nephrol. 1997;8:352-5. [PMID: 9048354] CrossrefMedlineGoogle Scholar2. Varasteh Kia M, Barone S, McDonough AA, et al. Downregulation of the Cl−/HCO3 − exchanger pendrin in kidneys of mice with cystic fibrosis: role in the pathogenesis of metabolic alkalosis. Cell Physiol Biochem. 2018;45:1551-1565. [PMID: 29482189] doi:10.1159/000487691 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (S.G., M.S.)Case Western Reserve University, Cleveland, Ohio (H.Y.)Mosaic Life Care, St. Joseph, Missouri (T.A.O.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L20-0038.Corresponding Author: Sudip Ghimire, MD, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756; e-mail, Sudip.[email protected]org.This article was published at Annals.org on 2 June 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 18 August 2020Volume 173, Issue 4Page: 315KeywordsBicarbonatesCellsChloridesCystic fibrosisKidneysPotassiumSaltsSodiumSweatUrine ePublished: 2 June 2020 Issue Published: 18 August 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Correlation of personality characteristics and quality-of-life in patients with chronic urticaria
Authors: Yu Fu, Yingqiu Bao, Xiaofeng Wei, Min Yang, Wen Su, Jianmin Chang
Journal: BMJ (2015)

WHO quality-of-life scales (WHOQOL-BREF) and Eysenck personality questionnaire (EPQ) were used for evaluating the quality-of-life and personality characteristics of 60 outpatients with chronic urticaria. According to statistical correlation analysis, a positive correlation existed between education level and psychological field (P<0.05). And there were negative correlations between N scale, P scale and psychological field (P<0.05, P<0.01). The incidence and incurability of chronic urticaria was more correlated with anxiety and depression. The patients with chronic urticaria were more likely to have a worse quality-of-life than normal population.


Key words: 
Urticaria; Qualify of life; Questionnaires
Impact of continuing medical education on chronic obstructive pulmonary disease knowledge of medical doctors practicing at the grassroots
Authors: Rong-bao Zhang, Quan-ying He
Journal: BMJ (2009)

Objective To understand knowledge level about chronic obstructive pulmonary disease (COPD)of medical doctors practising at district hospitals and community health service and impact of different models of continuing medical education on their knowledge level.Methods Knowledge of COPD was investigated with a close-book examination in 372 medical doctors working at the grassroots of 10 urban copies of finished examination papers were returned in this investigation.with an average score of 50.1 and pass rate of 42.5%.About 67.7%and 67.5%of medical doctors passed the examination of knowledge on definition,risk factors and non.pharmacological treatment for COPD.respectively,and 19.9%of them passed the examination on pharmacological treatment for COPD.Different modes of continuing medical education made varied impacts on their acquisition of COPD knowledge.with an average score of 67 and pass rate of 73.3%in the intensified education group,respectively,significantly higher than those in general education group and non-education group.Conclusions Clinical knowledge and skills of COPD for medical doctors working at the grassroots in Beijing Was not so satisfactory and education should be strengthened urgently to raise their knowledge on COPD prevention and control.

Key words: 
Pulmonary disease,chronic obstructive;  Questionnaire; Education,continuing
2007年青州市城区部分中青年体检人群代谢综合征情况调查
Authors: 徐军, 杨和爱, 陈国明
Journal: BMJ (2008)

近年来,代谢综合征(MS)越来越受到人们关注,为了解青州地区人群MS情况,以便采取科学的生活方式与合理膳食,减少MS发生率,本研究对2007年1月至8月青州市城区部分18～59岁体检人群进行调查。
Hepatic arterial infusion oxaliplatin plus oral S-1 chemotherapy to improve prognosis for gastric cancer with multiple liver metastases.
Authors: Kangxin Wang, Yang Yang
Journal: Journal of Clinical Oncology (2020)

e16508 Background: Gastric cancer with multiple liver metastases (GCLM) is associated with a high disease burden with synchronous or metachronous tumour invasions of other organs. In order to improve patient outcome, this study combined hepatic artery infusion (HAI) oxaliplatin with oral S-1 chemotherapy as a first-line palliative therapy. The aim is to assess efficacy and safety of this combination mode. Methods: We reviewed the records of ten patients with GCLM who received HAI oxaliplatin (70-80 mg/m 2 2h d1,15) administered via a port-catheter system and S-1 with oral (35-40 mg/m 2 twice daily for d1-14, 28 days for one cycle). Follow-up examination and efficacy evaluation were executed periodically. Results: Until the 4th cycle response evaluation, the local effective rate and control rate was 60% and 90% respectively, only one patient developed progression. HAI oxaliplatin plus oral S-1 chemotherapy had a better local control against hepatic metastases (median progression-free survival: hepatic, 9.0 months vs. extrahepatic, 6.5 months), which showed potential benefit of the combination regimen in gaining local tumour control, maintaining function and improving life quality. Conclusions: HAI oxaliplatin plus oral S-1 chemotherapy can be regarded as an optimized treatment strategy for GCLM, which is also a crucial way for controlling of extrahepatic lesions without much systemic toxicity.
Macrophage determines immnophenotype and predicts anti-PD-L1 response of urothelial cancer: Results from phase II clinical trial.
Authors: Dongqiang Zeng, Zilan Ye, Gaofeng Wang, Xinxiang Fan, Jiani Wu, Yiqiang Huang, Nailin Li, Min Shi, Wangjun Liao
Journal: Journal of Clinical Oncology (2020)

e15093 Background: Immune-checkpoint blockades (ICBs) are revolutionizing treatment of advanced or metastatic urothelial cancer (mUC) whereas the promising response merely occurred in a subset of patients. To dig into underlying determinants, we investigated the comprehensive tumor microenvironment (TME) of 348 tumor samples derived from a large phase II trial (IMvigor210: NCT#02108652). Methods: Based on the 348 pre-treatment samples, the LASSO-Bootstraping algorithm were applied to figure out the optimal predictive biomarker. Assessment of immune-cell proportions, pathway activity, and tumor purity used CIBERSORT algorithm, ssGSEA methodology, and ESTIMATE algorithm, respectively. Unsupervised clustering methods were applied to identify TME infiltrating patterns. Moreover, the predictive value of M1 infiltration in mUC were systematically explored, as well as its correlation to integrative molecular subtypes, tumor intrinsic mutation and metabolic pathways. An additional TCGA dataset was applied to validate the results. Results: Bootstrapping and ROC curve analysis indicated that M1 was non-inferior to TMB in predicting ICBs response (M1: AUC = 0.706; TMB: AUC = 0.728; Delong test: P = 0.333), but surpassed more-than-10,000 counterparts covering TME-infiltrating cells, metabolic pathways, tumor intrinsic pathways and hallmarks of cancer. Kaplan-Meier survival analysis (M1: P &lt; 0.0001, Hazard Ratio = 0.25, 95% CI: 0.14 − 0.44) supported its promising prognostic value. Moreover, study into TME patterns demonstrated its role in determining immunophenotypes (AUC = 0.785). M1 frequency is positively correlated with CD8+ T cells fraction (P = 7e-04), whereas the Treg cell, neutrophil and monocyte infiltration which refer to suppressive immune microenvironment were negatively correlated (P = 0.0066, P = 7e-04, P = 2e-04, respectively). Furthermore, significant correlation was observed between M1 and tumor intrinsic characteristics, including TMB, neoantigen and PD-L1 level of tumor (P = 3.83e-5, P = 1.69e-7, and P = 0.0018, respectively). The TCGA data reproductively supported the majority of aforementioned results. Conclusions: Our study lend statistical power to the notion that Macrophage independently contribute to anti-tumor immune function in the context of ICB therapy. Nonetheless, these findings provide important insight into the role of M1-Macrophage, macrophage polarization and innate immune machinery in therapeutic responses to ICB. Clinical trial information: NCT02951767 .
Clinical study of intrapleural cycle hyperthermic perfusion chemotherapy in the treatment of malignant pleural effusion
Authors: Lijuan Wang, Hongqiao Zhang, Nan Ba, Peili Li, Xixiu Ye, Jianyuan Li
Journal: BMJ (2014)

Malignant pleural effusion is a common complication of advanced cancer. The present study employed chest circulating hot infusion chemotherapy for 55 cases of malignant pleural effusion. The outcomes were complete remission (n=23, 41.8%), partial remission (n=25, 45.5%), stable disease (n=4, 7.3 %) and progressive disease (n=3, 5.5%). And the effective rate was 87.3%. After treatment, the levels of interleukin-10 (IL-10) and interleukin-6 (IL-6) were significantly lower than those before treatment (P<0.05). And the levels of interleukin-2 (IL-2) and interferon-gamma (IFN-γ) were significantly higher than those before treatment (P<0.05). Pleural circulation perfusion chemotherapy is both safe and effective in the treatment of malignant pleural effusion. And it helps to enhance immune functions and improve the quality-of-life of patients.


Key words: 
Iung neoplasms; Treatment outcome
A survey on topical medication compliance in patients with glaucoma
Authors: Chun-ling Hu, Shuai Wang, Li-ping Wu, Xin Ding, Qing Chang
Journal: BMJ (2010)

A survey on compliance with topical medication and the relevant factors were conducted in 190 patients with glaucoma in Miaohang Township, Baoshan County of Shanghai. All patients used 1 or more topical ocular hypotensive medications for at least 6 months and a special questionnaire was designed for the survey. The survey revealed that the overall non-compliance rate was 54. 7% (104/190) in this group of patients; which was closely correlated with age, medication application time and the extent of visual defect ( OR = 2. 550, 0. 225 and 0. 342, P ＜ 0. 05 ). Education levels, gender of patients, glaucoma type, number of daily medication, medication types and the stability of diseases were not correlated with the compliance.

Key words: 
Glaucoma;  Patients compliance
Cultivation of doctor-patient communication ability for general practitioners based on iceberg theory
Authors: Xiayuan Zhu, Hao Wu, Caiying Ge, Xiaoxia Li, Zhili Li, Min Kong, Xiumei Liu, Junxing Liu
Journal: BMJ (2017)

An iceberg model for better understanding the patients was developed. In this model the seeking for consultation is visible part of illness behavior, but the thoughts, concerns and expectations toward his or her illness are the hidden parts. Through detailed history taking, using appropriate language skill (Leichester Assessment Package) and nonverbal communication skill (space distance, eye contact, listening, pronunciation, appropriate silence), physicians can acquaint comprehensive knowledge about the hidden thoughts, concern and expectation of patients about their illness. This model would help general practitioners to raise communication and consultation ability and skills in their practice.


Key words: 
Physician patient relationship; Communication; General practitioner
Risk factors and treatment of cervicocerebral artery dissection
Authors: 道文欣, 刘煜敏, 朱江, 孔朝红
Journal: BMJ (2010)

动脉夹层(artery dissection,AD)是指动脉壁层内撕裂导致血液成分通过破损的血管内膜进入血管壁,使血管壁分层,造成血管狭窄、闭塞或形成假性动脉瘤.脑动脉夹层是青年卒中的主要因素[1-2]。
Community diagnosis of dental caries in an urban community of Beijing
Authors: Yan Si, Min Liu, Zheng Li, Xiao-chi Chen, Wen-hui Wang, Bo-xue Zhang, Ling Zhu
Journal: BMJ (2009)

Total 1188 subjects aged 35-74 in an urban community of Beijing were recruited by a multistage stratified random sampling procedure. Dental caries were examined by three dentists independently. The prevalence of dental crown caries was 79. 6% (DF), that of DMFS was 24. 39% and the root caries index (RCI) was 3.5% in this group. 22. 3% of the examinees required treatment for the crown caries and 26. 0% for root caries. Bivariate correlation analysis showed that DMFS was significantly correlated with RCI (P <0. 01 ), and there was no significant difference of DMFS and RCI between males and females. The study indicates that dental caries is a common health problem in adults and elderly population of urban Beijing, and the development of community oral health service system is necessary.

Key words: 
Community dentistry; Dental caries