Recent developments in restorative materials, placement techniques, preparation design, and adhesive protocols allow clinicians to predictably restore fractured teeth. Using a minimally invasive approach, treatment of the maxillary anterior region can be effortlessly completed within a single appointment. If the original tooth fragment is retained following fracture, the natural tooth structures can be reattached using adhesive protocols to ensure reliable strength, durability, and aesthetics. This article discusses the adhesive reattachment of a tooth fragment to a fractured incisor using a conservative preparation technique. It also restores function, provides a positive psychological response, and is a relatively simple procedure.

 BACKGROUND: Depression is a common mental illness found in all regions of the world. In Pakistan, depression is on top of the list among all psychiatric conditions. However, there are inconsistent findings regarding the relationship between diabetes, pregnancy and severity of depression. We aimed to identify the relationship between diabetes and depression severity in pregnant females.  

METHODS: In a cross-sectional study, 498 age matched pregnant females were recruited, and categorized as normal glycemic (controls n=300) and diabetic (cases n=198). Aga Khan University Anxiety and Depression Scale was administered to analyze depression score, and blood glucose levels were measured.  Data were presented as absolute count/ frequencies. Chi-square test, Spearman rank correlation and simple linear regression analysis were performed. P value of <0.05 was considered significant.

RESULTS: The mean age of the study subjects was 26.6±5 (years). Random blood glucose levels were 148.3±51.9 (mg/dl) for diabetic females and 123.6± 30.5(mg/dl) for non-diabetic females (p<0.001). Majority of the diabetic females answered that they usually had little or no interest in doing daily chores (52%), felt depressed (52%) and tired (39.9%) or bad (35.6%) versus healthy controls (p<0.01). About 23% diabetic females also admitted to having suicidal ideas and even giving half-hearted attempts to end their lives versus 13% healthy controls (p<0.01). When stratified by glucose levels, 64.9% (n=135) females with diabetes and 44% (n=132) without diabetes reported to be depressed (p<0.01). Logistic regression analysis revealed that females with raised blood glucose levels were more prone to be depressed (OR 1.20; CI 1.13-1.27; p=0.01) when compared to females with normal blood glucose levels. An 11.5% positive correlation was found between glycemic status and depression scores.

CONCLUSION: Depression is a common finding in pregnancy, which can be aggravated by poor glycemic control. Among other factors to relieve depression, health care physicians may also focus on a stricter glycemic control to improve maternal mental health status.

BACKGROUND: Road traffic injuries (RTIs) have emerged as a major global public health problem. However, burden of RTI is not known in Afghanistan. We aimed to estimate and characterize the burden and types of RTIs in Afghanistan.

 METHODS: Using a cross-sectional study design, 1514 road traffic injured admitted in eight regional/provincial hospitals, were enrolled in the study between June and December 2013. A structured questionnaire was used to interview injured ones or their attendants in emergency rooms to collect data on the causes of accidents.

RESULTS: We surveyed 1514 injured and 283 drivers. Mean ± standard deviation age of the patients and drivers were 25.7 ± 14.5 and 32.3 ± 10.4 years respectively. Most accidents occurred on Thursdays/weekends (16.25%). Apparently the proportion of smokers among drivers were 51% (144) while it was 16.5% (247) among injured. Similarly, hashish use was 11% (31) among driver and 1.6% (24) among injured. Cars and motorbikes were involved in 56.4% and 28.3% of cases. Of the injured, 45.3% were pedestrians, 25.7% were passengers, 18.1% were cyclists, and 10.9% were drivers. The reasons for accidents from the injured patients’ standpoint were 1.9% due to overloads, 2.8% due to failure to follow traffic signs, 71.6% due to driving over speed limits, 5.6% due to pedestrians on the street, 1.4% due to bad weathers, 7.7% due to bad roads, 8.6% due to poor driving skills and 0.5 % due to poorly maintained vehicles. Lower limb injuries were most common (39.6 %) followed by head injuries (25.1 %). Of all injured, 63.6% were hospitalized, 31.5% were discharged from emergency department, and 4.9% died in the emergency department. The average speed of the vehicles involved in accidents was 59.5 ± 22.10 km/hours. 13% vehicle occupants used seat belts or helmets, and 23.7% vehicles were right-side steering wheel.

CONCLUSION: RTIs in Afghanistan mainly involve young men and often involve pedestrians. To reduce the burden of RTIs, considerable attention of various sectors on road safety measures, human factors and vehicles are needed.

Cilnidipine is a 4th generation dihydropyridine calcium channel blocker that is used in essential hypertension. Unlike amlodipine, cilnidipine rarely causes ankle edema. Therefore, cilnidipine is often used as an alternative drug in patients with amlodipine-induced ankle edema. However, we report a case of cilnidipine induced ankle edema.

 BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the world. The simultaneous occurrence of NAFLD and type 2 diabetes is common, however, few studies on the prevalence of NAFLD in prediabetic patients have been performed. Therefore, the aim of this study was to determine the prevalence of NAFLD by sonography in prediabetic patients and to compare the prevalence of NAFLD between prediabetic patients and normal population.

 METHODS: In this cross-sectional study, 191 consecutive prediabetic patients who were referred to the internal medicine clinic in the Razi Referral Hospital of Rasht, Iran, were compared with 191 healthy controls. Diagnosis of prediabetes was based on abnormal oral glucose tolerance test or fasting plasma glucose. Both groups underwent ultrasonography for the assessment of NAFLD and data was analyzed by Student’s t test and Chi-square test.

RESULTS: Patient population was between 20 and 70 years old and the mean age of participants was 41.04±12.66 years. Prediabetic group had 71(37.1%) males while healthy group had 84(43.9%) males.  Of the 382 subjects, 142 (37.2%) had evidence of NAFLD on ultrasound examination of which 93(65.4%) were prediaibetics (P=0.001).

CONCLUSION: We show that the prevalence of NAFLD in prediabetic patients is higher than healthy individual.

BACKGROUND: Oral squamous cell carcinoma (OSCC) is the most common malignant tumor of the oral cavity, and one of the tenth most common causes of death. Although there are advances in both surgical and non-surgical treatments of oral cancer, the overall survival and mortality rates have not improved. Therefore, it is necessary to define molecular markers to allow early diagnosis, and to identify new therapeutic targets.  Epidermal growth factor receptor (EGFR) is a transmembrane protein kinase which consists of extra and intracellular domains. Activation of the EGFR pathway promotes tumor cell proliferation, angiogenesis, metastasis and decreases apoptosis. Cyclin D1 (CCND1) regulates G1 to S phase transition of cell cycle. Its overexpression may lead to disturbance in the normal cell cycle control and tumor formation.

 METHODS: Thirty formalin-fixed paraffin-embedded tissue blocks of OSCC were included in this study. Diagnostic confirmation was performed through an examination of hematoxylin and eosin (H&E) sections. Fluorescent in situ hybridization method was used to evaluate EGFR and CCND1 gene copy number.

RESULTS: Fluorescent in situ hybridization evaluation showed that the EGFR amplification was present in 70% of the cases while CCND1 amplification was present in 43% of the cases.  Statistically there was no significant correlation with clinic pathological findings.

CONCLUSION: We did not find a statistically significant relationship between clinic pathological data and gene amplification.