Smoking and Depression among Medical School Students: A Cross-Sectional Study from Turkey's Largest Province.

BACKGROUND: To examine the prevalence of smoking among medical faculty students in Turkey, and to explore the associations between smoking, depression, and other factors. METHODS: This cross-sectional study was carried out among medical students in Konya, Turkey, from November 2018 to February 2019. The first section included eight questions pertaining to sociodemographic details. The second comprised nine questions addressing smoking and other harmful habits. The third section involved the Fagerstrom Test for Nicotine Dependence while the fourth was the Beck Depression Inventory (BDI). RESULTS: The study was completed with a total of 1117 participants (90.2% of all students). In regard to smoking, 813 (72.78%) were non-smokers, 98 (8.77%) were ex-smokers, and 222 (19.87%) were active smokers. Notably, 16.29% of students (n = 182) had a high BDI score (≥17). Male sex, good economic status, depression diagnosis at any time in life, and alcohol use were independently associated with active smoking. Being a senior student and regular exercise were independently associated with a low (<17) BDI score, whereas depression diagnosis at any time in life and drug use were independently associated with high (≥17) BDI. CONCLUSIONS: Almost 20% of medical school students were active smokers, with about a 2.5-fold higher prevalence among males compared to females. There is a significant association between smoking frequency and symptoms of depression. Policies targeting modifiable risk factors can reduce smoking and depression among future physicians, which can have a strong impact on population-wide smoking.

The Relationship between COVID-19 Severity and Bacillus Calmette-Guérin (BCG)/ Mycobacterium tuberculosis exposure history in healthcare workers: a multi-center study.

The COVID-19 pandemic has brought countries' health services into sharp focus. It was drawn to our group's attention that healthcare workers (HCWs) had a lower mortality rate against higher COVID-19 incidence compared to the general population in Turkey. Since risk of exposure to tuberculosis bacillus among healthcare workers are higher than the population, we aimed to investigate if there is a relationship between BCG and Mycobacterium tuberculosis exposure history with COVID-19 severity in infected HCWs. This study was conducted with 465 infected HCWs from thirty-three hospitals to assess the relationship between COVID-19 severity (according to their hospitalization status and the presence of radiological pneumonia) and BCG and Mycobacterium tuberculosis exposure history. HCWs who required hospital admission had significantly higher rates of chronic diseases, radiological pneumonia, and longer working hours in the clinics. Higher rates of history of contact and care to tuberculosis patients, history of tuberculosis, and BCG vaccine were observed in hospitalized HCWs. HCWs who had radiological pneumonia had a significantly increased ratio of history of care to tuberculosis patients and a higher family history of tuberculosis. The findings from our study suggest that the lower mortality rate despite the more severe disease course seen in infected HCWs might be due to frequent exposure to tuberculosis bacillus and the mortality-reducing effects of the BCG vaccine.

Complementary and alternative medicine use amongst Turkish type 2 diabetic patients: A cross-sectional study.

BACKGROUND: There is a worldwide tendency in the use of complementary and alternative medicine (CAM). Type 2 diabetic patients' attitude towards CAM use differs depending on several patient characteristics. OBJECTIVE: To determine the awareness, knowledge and the frequency of CAM use; to determine the independent demographic characteristics making it more probable to use CAM in patients with type 2 diabetes mellitus (T2DM). METHODS: 400 patients with T2DM visiting outpatient diabetes education clinic in Turkey from September 2015 to June 2016 were included in this cross-sectional study. On the basis of patients' responses to our questionnaire interrogating the CAM use, all participants were divided into 2 groups: CAM users and non-users. The independent predictors of CAM use were determined after a multivariate analysis including the parameters with a p value <0.25 in univariate analysis. RESULTS: In our study the rate of CAM use was 36,7% (n = 147) and CAM use among female gender was significantly more frequent. HbA1c, fasting blood glucose, post-prandial blood glucose serum levels were significantly higher in CAM non-user group. (p < 0.001,p < 0.001 and p < 0.001 respectively). The independent predictive factors proved to be a determinant of CAM use were the age of 50-64 years, female gender and healthy eating habits. CONCLUSIONS: The use of CAM methods in the field of T2DM is growing. Our study reported the prevalence of CAM use, the baseline comparison of CAM users and non-users and demonstrated three independent notable predictors of CAM use among patients with T2DM.

Evaluation of quality of life and depression levels in individuals with Type 2 diabetes.

INTRODUCTION: Improving the quality of life in diabetic individuals is known to reduce morbidity and mortality. We aimed to investigate the quality of life and depression symptomatology situations and the related factors in patients with Type 2 diabetes mellitus (DM) in this study. MATERIALS AND METHODS: In this study, 440 adult patients with Type 2 DM and under treatment admitted to Selcuk University Family Medicine Outpatient Diabetes Education Clinic were included in the study. A questionnaire containing sociodemographic characteristics of the participants, the Short Form 36 (SF-36) quality of life questionnaire was applied with Beck depression inventory face to face interviews. RESULTS: Mean scores of females in all SF-36 subscales were statistically significantly lower than those of male patients. Physical function, physical role limitations, general health, social function, emotional role limitations, and mental health mean scores of the patients with 1-10 years duration of diabetes were found statistically significantly higher than those with 20 years and over duration of diabetes. Physical function, physical role limitations, pain, general health, and social function mean scores in patients using oral antidiabetic drug (OAD) was statistically significantly higher compared to patients using insulin + OAD. The average physical function scores of the patients with no complications were statistically significantly higher than those with two and more complications. CONCLUSION: Quality of life and depression symptomatology are worse in females, the elderly, the overweight, people with lower level of education, in the widowed or divorced, homemakers, those with low incomes, those with longer duration of diabetes, patients using insulin, and those with two or more complications. There are many medical and sociodemographic factors affecting the quality of life and depressive symptomatology in the individuals with diabetes, so both health care workers and patients should pay the necessary attention to this issue.

8-Isoprostane and Coenzyme Q10 Levels in Patients with Metabolic Syndrome.

BACKGROUND: Metabolic syndrome has become an important health problem, which involves obesity, hyperlipidemia, insulin resistance, and high blood pressure values. The components of metabolic syndrome are all suggested as independent cardiovascular disease risk factors along with high mortality and morbidity rates accompanied by many organ and system complications. OBJECTIVE: We aimed to determine 8-isoprostane (8-IsoP) and coenzyme Q10 (CoQ10) levels in patients with metabolic syndrome and healthy individuals and demonstrate whether there was any relation between these parameters and metabolic syndrome criteria. MATERIALS AND METHODS: A total of 30 patients (10 male, 20 female) with metabolic syndrome and 20 age-matched healthy individuals (9 male, 11 female) were involved in the study. Body mass index, waist and hip circumferences, systolic and diastolic blood pressures and serum glucose, triglyceride, total cholesterol, high-density lipoprotein cholesterol, insulin, HbA1c, 8-IsoP and CoQ10 levels, and homeostasis model assessment of insulin resistance indexes of all participants were determined. RESULTS: 8-IsoP levels were significantly increased in metabolic syndrome compared to healthy individuals (P = 0.003), however, there was no significant difference between groups for CoQ10 levels. 8-IsoP levels were positively correlated with waist circumference (r = 0.303, P = 0.032), diastolic blood pressure (r = 0.337, P = 0.017), systolic blood pressure (r = 0.329, P = 0.020) values and total cholesterol levels (r = 0.354, P = 0.012). CONCLUSION: We can suggest that the levels of 8-IsoP, which is an indicator of the oxidative stress, increase in metabolic syndrome and this can be associated with high blood pressure and visceral adiposity, which are the components of metabolic syndrome.

Evaluation of Netrin-1 Levels and Albuminuria in Patients With Diabetes.

BACKGROUND: Netrin-1 is a diagnostic biomarker that has been identified recently for chronic renal failure (CRF) in animal experiments. Netrin-1 levels in urine have been shown to have increased significantly at the acute kidney damage. Human studies on the relation between the CRF and plasma netrin-1 levels have not been found in the literature. This study aimed to investigate whether plasma netrin-1 levels increased in the early stages of the CRF in diabetic patients. METHODS: Plasma samples from healthy volunteers and diabetic patients with and without microalbuminuria were collected after receiving consent. Netrin-1 in plasma was quantified by enzyme-linked immunosorbent assay and the data were analyzed to determine whether plasma netrin-1 correlates significantly with disease progression. RESULT: Plasma netrin-1 level in microalbuminuric diabetic patients was significantly higher than in normoalbuminuric diabetic patients and the control group. However, no significant difference between normoalbuminuric patients and control group was determined. Plasma netrin-1 level was significantly associated with albuminuria and estimated glomerular filtration rate, independently of age and sex. CONCLUSION: This study supports that plasma netrin-1 level increases significantly when glomerular damage occurs in diabetic nephropathy.

Plasma netrin-1 levels significantly increase in smokers.

OBJECTIVES: Netrin-1 is a laminin like protein that has recently been suggested to involve in the pathophysiology of atherosclerosis and treatment targets. The relationship between netrin-1 and atherosclerosis has not been evaluated in a human research previously and the effect of smoking on plasma netrin-1 levels as well. In this study, we aimed to evaluate plasma netrin-1 levels in smokers and non-smokers and the impact of smoking on netrin-1 levels. Our second aim was to evaluate the existence of peripheral artery disease in these groups by means of ankle brachial index (ABI) measurements and the relation between plasma netrin-1 levels and peripheral artery disease. DESIGN AND METHODS: Smoker and non-smoker male patients were contributed in the study, 112 males in each group. ABI of all patients was determined with an automatic device and plasma netrin-1 levels were quantified with an enzyme-linked immunosorbent assay. Netrin-1 levels were compared between smoker and non-smoker cases, and the cases with and without peripheral arterial disease. RESULTS: Plasma netrin-1 levels of smokers (4.54±2.87pg/mL) were significantly higher than in non-smokers (3.81±1.26pg/mL) (p=0.015). Similarly, netrin-1 levels of cases with peripheral arterial disease (6.21±2.16pg/mL) were significantly higher than the ones without peripheral arterial disease (4.07±2.16pg/mL) (p=0.002). Amount of smoking (packet⋅year) and ABI were found to be significantly related with netrin-1 levels. The relationship between PAD and netrin-1 levels remained significant after adjusting for smoking status. CONCLUSION: We can conclude that plasma netrin-1 levels significantly increase in smokers and peripheral artery disease is significantly related with netrin-1 levels after adjusting for smoking status.

Assessment of atrial electromechanical delay and P-wave dispersion in patients with type 2 diabetes mellitus.

OBJECTIVES: Diabetes mellitus is an independent and strong risk factor for development of atrial fibrillation (AF). Electrophysiologic and electromechanical abnormalities are associated with a higher risk of AF. In this study we aimed to determine the correlation of atrial conduction abnormalities between the surface electrocardiographic and tissue Doppler echocardiographic measurements in type 2 diabetes mellitus (T2DM) patients. METHODS: A total of 88 consecutive T2DM patients and 49 age-, gender-, and body mass index-matched healthy volunteers were included in the present study. Baseline characteristics were recorded and 24-hour ambulatory blood pressure monitoring, transthoracic echocardiography, and 12-lead surface electrocardiography were performed for all study participants. Atrial electromechanical delay (EMD) intervals were measured. RESULTS: Maximum P-wave duration and P-wave dispersion (Pd) were significantly higher in patients with T2DM (105.7±10.2ms vs. 102.2±7.5ms, p=0.02; 40.6±7.6ms vs. 33.6±5.9ms, p<0.001, respectively). Interatrial, intraatrial, and intraleft atrial EMD were significantly higher in the T2DM patients when compared with the controls (16.5±7.8ms vs.11.2±4.4ms, p<0.001; 9.0±7.3ms vs. 6.0±3.8ms, p=0.002, and 7.4±5.2ms vs. 5.1±3.2ms, p=0.002 respectively). Correlation analysis showed a positive correlation between interatrial EMD and Pd (r=0.429, p<0.001) and left atrial volume (r=0.428, p<0.001). CONCLUSIONS: In this study, there was significant EMD and Pd in patients with T2DM as compared with healthy volunteers. Additionally, interatrial EMD was correlated with Pd and left atrial volume index.

Arterial stiffness and carotid intima-media thickness in diabetic peripheral neuropathy.

BACKGROUND: We investigated the relationship between peripheral neuropathy and parameters of arterial stiffness and carotid intima media thickness (CIMT) in patients with type 2 diabetes mellitus (T2DM). MATERIAL AND METHODS: The study included 161 patients (80 females and 81 males), 69 of whom had peripheral neuropathy. All patients underwent 24-h blood pressure monitoring, and arterial stiffness parameters were measured. The CIMT was measured using B-mode ultrasonography and patients also underwent transthoracic echocardiographic examination. RESULTS: Patients with peripheral neuropathy, compared with those without it, were older (54.68±8.35 years vs. 51.04±7.89 years; p=0.005) and had T2DM for longer periods (60 vs. 36 months; p=0.004). Glycated hemoglobin (HbA1c) values (8.55±1.85 mg/dL vs. 7.30±1.51 mg/dL; p<0.001), pulse wave velocity (PWV) (7.74±1.14 m/s vs. 7.15±1.10 m/s; p=0.001), CIMT (anterior 0.74±0.15 mm vs. 0.67±0.13 mm; p=0.01), and left ventricular mass (LVM) index (98.68±26.28 g/m2 vs. 89.71±19.70 g/m2; p=0.02) were all significantly increased in the group with peripheral neuropathy compared to the group without peripheral neuropathy. We determined that duration of diabetes, HbA1c, and LVM index were predictors of peripheral neuropathy. CONCLUSIONS: A significant relationship was found between diabetic neuropathy and increased PWV, a parameter of arterial stiffness, as well as CIMT, a marker of systemic atherosclerosis. Diabetic peripheral neuropathy may be a determinant of subclinical atherosclerosis in T2DM.

Evaluation of the levels of oxidative stress factors and ischemia modified albumin in the cord blood of smoker and non-smoker pregnant women.

OBJECTIVE: The aim of this cross-sectional study was to determine the oxidant and antioxidant status and a novel ischemia marker - ischemia modified albumin - in the cord blood of smoker and non-smoker pregnants. METHODS: This study was performed on 30 smoker and 60 non-smoker pregnant women. Malondialdehyde (MDA), vitamin A and E, total antioxidant capacity (TAC) and ischemia modified albumin (IMA) levels and superoxide dismutase activities (SOD) were determined in the cord blood of the contributors. RESULTS: In the cord blood of the smoker women compared to the non-smokers; MDA (µmol/L) levels increased (5.17 ± 0.25, 3.60 ± 0.06, p = 0.000), IMA (ABSU) levels increased (0.913 ± 0.02, 0.830 ± 0.01, p = 0.050), SOD (U/ml) activities decreased (8.22 ± 0.14, 8.63 ± 0.14, p = 0.045), Vit A(µg/L) (339.06 ± 17.52, 454.91 ± 16.56, p = 0.000) and Vit E (mg/L) levels decreased (2.8 ± 0.15, 7.58 ± 0.38, p = 0.000) and TAC (Mm Trolox) levels decreased (3.25 ± 0.15, 4.08 ± 0.09, p = 0.000), and these differences were statistically significant. We found moderate and strong positive correlations between smoking status and IMA (r = 0.325, p = 0.002) and smoking status and MDA levels (r = 0.636, p = 0.000). Smoking status presented weak, moderate and strong negative correlations with SOD activities, TAC, Vit A and Vit E levels, respectively (r = -0.237, p = 0.024), (r = -0.420, p = 0.000), (r = -0.443, p=0.000), (r = -0.795, p = 0.000). CONCLUSION: It was determined that smoking cigarette during gestation disturbed the balance between the oxidant and antioxidant system and caused oxidative stress. Increased IMA levels in cord blood of smoker pregnants suggests that smoking during pregnancy causes fetal ischemia.

Periodontitis as a risk factor for preterm low birth weight.

PURPOSE: There is growing evidence showing that a number of complex human diseases are caused or are at least influenced by periodontal diseases. Such diseases include cardiovascular diseases, respiratory diseases, diabetes mellitus and osteoporosis. The aim of study was to evaluate periodontal diseases as a risk factor for a preterm low birth weight. MATERIALS AND METHODS: A total of 48 mothers, 20 of who had a preterm low birth weight delivery, were examined in the Clinics of Periodontology, Faculty of Dentistry, Cumhuriyet University. The periodontal exams consisted of a full mouth pocket depth, a Loe and Sillness Gingival index score measurements, and a panoramic radiograph analysis. Information on any other factors that may cause a preterm low birth weight was obtained from the family physician. RESULTS: The study results indicated that periodontitis (OR: 3.6 95% CI: 1.06-12.18) together with bacterial vaginosis (OR: 11.57 95% CI: 1.26-105.7) were independent risk factors of a preterm low birth weight. According to the data obtained from this study, the paternal age, tobacco use and the mothers' height were not significant risk factors for a preterm low birth weight. CONCLUSION: Within the limits of this study, it is concluded that a poor periodontal health status of the mother may be a potential risk factor for a preterm low birth weight.

The recurrent aphthous stomatitis frequency in the smoking cessation people.

This study was aimed to evaluate the frequency of recurrent aphthous stomatitis (RAS) within the 6-week period after quitting smoking. The study group consisted of 90 subjects. Oral, medical findings and tobacco habits were recorded for all subjects. Nicotine replacement therapy (NRT) and behavioral treatment were applied to some of the subjects by a family physician. All subjects were evaluated for their RAS and periodontal measurements on baseline, 1, 3, 6 weeks by a periodontist. While the subjects were in this smoking cessation programme, 64 of the 90 smokers successfully quit smoking within the 6 weeks and 26 smokers dropped out during the third week of the study. Point prevalence of RAS among the subjects on the first day of the quitting period and at the end of the first, third and sixth week after smoking cessation was 3.3% (3/90), 18.9% (17/90), 21.1% (19/90) and 17.1 (11/64), respectively. In the following weeks, aphthous ulcer point prevalence was significantly higher than the quitting level (p < 0.05). As the time after quitting increased, the incidence of aphthous ulcer decreased. Of 64 patients, 35 (54.6%) completed the 6 weeks using NRT and 29 (45.4%) of them did not use any medication. The aphthous ulcer frequency observed in the patients taking NRT [11.4% (4/35)] was lower when compared with the subjects taking no NRT [24.1% (7/29)] (p > 0.05). The results of this study confirm that RAS is a complication of quitting smoking. Further studies are needed to identify the effects of NRT on RAS.

Smoking status and smoke-related gingival melanin pigmentation in army recruitments.

This study aimed to define the smoking status and smoke-related gingival melanin pigmentation in army recruitments and was conducted with army recruitments in Sivas. Nine hundred eight subjects were examined. The oral and dental health of those subjects was checked and recorded. The smoking status of the subjects was self-reported and recorded on questionnaires by researchers. The chi2 test and Kruskal-Wallis test were used for statistical analysis. More than one-half of the subjects (54.3%) were primary school graduates and the mean age was 20.2 +/- 0.95 years. The response rate regarding smoking was 100%. Of the respondents, 596 (65.7%) were current smokers, 12 (1.3%) were former smokers, and 300 (33.0%) were never smokers. The gingival melanin pigmentation rate was 27.5% in current smokers and 8.6% in those who never smoked (p = 0.000). Smoking five to nine cigarettes a day appeared to be sufficient to cause gingival melanin pigmentation. The proportion of smokers who had melanin pigmentation did not change after 10 cigarettes a day. A rehabilitation project on smoking prevention and smoking cessation for army recruitments is urgently needed.

Assessment of effects of pre- and post-training programme for healthcare professionals about breastfeeding.

This retrospective study assessed the effects of pre- and post-training programme for healthcare professionals about breastfeeding. The study included 3,114 mothers who had children aged 1-72 month(s). Their knowledge and behaviours relating to breastfeeding were evaluated. The mothers were randomly divided into two groups: the 'before' group included 2,000 women who were not informed about breastfeeding, and the 'after' group comprised 1,114 women who had been informed about breastfeeding. 56.2% and 66.1% of the mothers started breastfeeding within 30 minutes after delivery, respectively, in the before and the after group (chi2 = 29.31, p < 0.001). 16.7% and 36.5% gave exclusive breastfeeding for six months (chi2 = 72.85, p < 0.001), and 28.5% and 23.7% stopped breastfeeding within the first five months (chi2 = 17.20, p = 0.002). Ninety-four percent delivered in a hospital or in a primary healthcare centre. Therefore, prenatal and postnatal breastfeeding education and support courses may improve a woman's chance of starting and continuing to breastfeed her baby. In terms of the number of antenatal check-ups, since the differences between the two groups were significant (chi2 = 390.67, p = 0.000), the importance of the training programme about breastfeeding was highlighted. Follow-up interventions after training are suggested.

A case-control study on the effect of exposure to different substances on the development of COPD.

PURPOSE: The purpose of this study was to examine the effect of exposure to different substances on the development of chronic obstructive pulmonary disease (COPD). METHODS: The case group consisted of 74 housewives. These were female patients who never smoked who had a diagnosis of COPD and were seen at the Cumhuriyet University Hospital in Sivas, Turkey, between January 1, 2001, and March 31, 2002. The control group consisted of 74 housewives; this group consisted of healthy women who never smoked who came to the hospital as visitors and who did not have the diagnosis of COPD. The control group was chosen by group matching of the age distribution of the women in the case group and the regions and the neighborhoods where they lived. All of the women in the case and control groups were evaluated with a questionnaire for exposure to wood ashes, biomass, and cigarette smoke in closed areas. RESULTS: No difference was found in the groups for exposure to wood ashes (p > 0.05). Logistic regression analysis resulted in the following odds ratio of COPD estimate for women with > or = 30 years biomass exposure, 6.61 (95% Confidence interval [CI]: 2.17-20.18); for women with > or = 30 years cigarette smoke exposure, 4.96 (95% CI: 1.65-14.86). CONCLUSION: A statistically significant correlation was found between the effect of > or = 30 years of exposure to biomass and cigarette smoke exposure and the development of COPD.

Evaluation of the mini-mental state examination among the elderly people in Konya, Turkey.

OBJECTIVE: To evaluate cognitive function by using the Mini-Mental State Examination (MMSE) among the elderly people in Konya, Turkey, and to examine the acceptance, and screening efficacy of the MMSE in the family medicine practice setting. METHODS: A descriptive and cross-sectional study was carried out between 15th December 2004 and 15th February 2005, in Konya, Turkey. Two hundred elderly people were included in the study. Participants were selected from the cases who were at least 65 years of age and older. Cognitive levels were assessed with the MMSE. Two different MMSE forms for educated and uneducated individuals were applied. Socio-demographic characteristics, orientation, registry memory, attention and calculation, recall, and language status were determined. The data were evaluated with SPSS 10.0 software. RESULTS: Participants of 65 years of age and older (36.5% women, n=73 and 63.5% men, n=127) were included in this study. The age interval of participants was 65 and 85, and the mean age was 71.02 (SD=4.569). Of the participants, 66% (n=132) were uneducated, and 34% (n=68) were educated. The mean score of MMSE was 23.33 (SD=4.799). The score of MMSE was considered as normal when the value was 24 and over. Of the participants, 57% (n=114) were evaluated as normal score and 43% (n=86) as abnormal score. The female mean MMSE score was 21.808 (SD=5.352). The male mean MMSE score was 24.204 (SD= 4.230). It was observed that cognitive impairment was higher among women than men (p=0.002). When we compared the cognitive status, there was no significant difference between uneducated and educated people (p>0.05). The cognitive function of participants with a dominant left hand was significantly lower than those with a dominant right hand (p=0.027). CONCLUSION: Family physicians should be able to competently diagnose, evaluate, and initiate treatment in most patients with dementia. Physicians should be familiar with psychometric instruments such as the MMSE. These instruments are useful both to diagnose Alzheimer`s dementia and follow patients on therapy. The MSSE should be used by family physicians of elderly patients, as early diagnosis and treatment will enable patients to retain the greatest possible functional capacity, and may allow families to care for the patient successfully for a longer period. Consequently, early diagnosis and aggressive treatment are crucial for people with dementia.

Anencephalic infant with cleft palate and natal teeth: a case report.

OBJECTIVE: Natal/neonatal teeth are very common in children with complete unilateral and bilateral cleft lip and palate. This article outlines a patient with intrauterine growth retardation, anencephaly, atrial septal defect, ventricular septal defect, two maxillary first natal incisor teeth, cleft palate, short neck, low-set ears, hypertelorism, retrognathia, and simian-line on the right hand. There is no conclusive evidence of a correlation between these findings and a known syndrome, suggesting that this case may be a hitherto undefined clinical combination with neonatal teeth.

Phenytoin-induced gingival overgrowth in un-cooperated epilepsy patients.

Phenytoin-induced gingival overgrowth is a well-known and frequently reported gingival lesion, which was first detected in 1939. However, there are conflicts in the literature about the agents which affect the severity of the lesion. Un-cooperative dental patients are one of the most unsuccessfully treated periodontal patient groups because of the difficulty in maintaining their oral hygiene. This case report consists of two cases with the same characteristics: phenytoin usage, comprehension and speech defects and poor oral hygiene, but each case differs in the duration of the phenytoin therapy. Both of the cases received scaling, root planning and a gingivectomy.

Congenital epulis: report of a case.

Congenital epulis of the new-born is a rare tumour, also known as Neumann's tumour described for the first time in 1871. Epulis usually present at birth and it has marked female preponderance of 10:1. Histiogenesis is uncertain, recommended treatment is excision. However as recurrence or damage to future dentition have not been reported, radical excision is not warranted. We reported a case of congenital epulis in a new-born female, with clinic investigations, surgical excision were not performed as it was not indicated for this case.