Recurrent miscarriage and associated factors

The incidence of recurrent pregnancy loss in women of reproductive age group is 0.5%-3%, And idiopathic causes accounts for 50%-60% of recurrent pregnancy losses. Approximately 30%-50% of conceptions end in spontaneous miscarriage before the completion of first trimester. Miscarriages mostly occur at the time of implantation. The causes of recurrent pregnancy loss are many including parental chromosomal abnormalities, maternal thrombophilias, immunologic causes and endocrine disorders. Recurrent pregnancy loss is an extremely distressing clinical problem for women as well as health professinals. According to current studies the decidualized endometrium act as a biosensor of good quality embyos, if it is faulty ,may lead to implantation of embryos resulting in miscarriage. Other factors implicated in the pathophysiology of miscarriage are Systemic and placental oxidative stress. Vascular endothelial damage, abnormal vascularity of placenta and immunologic reactions have been proposed to play some role in causing recurrent miscarriage. The objective of this review is to discuss the causes of recurrent miscarriage, based on the published research articles

pattern of peripheral nerve injuries among Pakistani soldiers in the War against terror

To determine the pattern of peripheral nerve injuries in Pakistani soldiers in the War against terror. Case series. Department of Electrodiagnosis at Armed Forces Institute of Rehabilitation Medicine [AFIRM], Rawalpindi, Pakistan, from June 2008 to June 2011. All new cases of war wounded soldiers with peripheral nerve injuries were consecutively enrolled. Physical examination and electrodiagnostic study was carried out by experienced physiatrists. Data was entered in pretested especially designed questionnaire which was analysed using SPSS version 17.0. Seddon's classification system was used to assess the severity of injury. There were 418 cases of peripheral nerve injuries with 504 different nerve segments. Mean age was 29.41 +/- 8 years. Blast was the main cause of nerve injury in 244 [48.5%] cases followed by gunshot in 215 [42.7%] and 45 [8.9%] cases had nerve injuries secondary to fall, burial under debris and motor vehicle accidents. Eighty six [17%] cases had multiple nerve injuries. Most commonly injured nerve was ulnar [20.6%] followed by sciatic [16.7%], median [16.5%], radial [16.3%], peroneal [8.7%], brachial plexus [8.5%], axillary [4.8%], tibial [2%], femoral [1.8%], long thoracic [0.4%] and others [3.8%]. Axonotmesis was seen in 459 [91.1%] cases, 44 [8.7%] cases revealed neurotmesis and 1 [0.2%] case had neuropraxia. Peripheral nerve injuries are a major component of war related injuries mainly involving the upper limbs. Electrodiagnostic studies help in assessing severity and determining prognosis. Precise documentation of severity of nerve injuries is important to estimate the burden on our resources and to extend rehabilitation services

role of intraarticular platelet rich plasma [PRP] injection in patients with internal knee derangements

Platelet Rich Plasma [PRP] is an emerging biotechnology which uses patient's own blood components to create healing effect to their own injured tissues. This study was carried out to evaluate the clinical effects, adverse reactions and patient satisfaction after intraarticular injection of platelet rich plasma in a small group of patients with internal derangements of knee at Combined Military Hospital, Panoaqil, Pakistan. In this single center, open study, 10 patients with internal derangements of knee fulfilling the inclusion criteria received two doses of 3 ml of platelet rich plasma as intraarticular knee injection at two weeks interval. All patients were evaluated at 0, 4 and 12 weeks after treatment using IKDC, TEGNER, KOOS and VAS. Adverse events and patient's satisfaction was recorded. There was significant improvement in all scores. Intraarticular PRP injection is safe and effective method in the conservative treatment of internal knee derangements

Medical management with vaginal misoprostol versus surgical management for first trimester pregnancy failure

Background: The incidence of clinically recognized miscarriages remains around 10-20%.The most common type of early pregnancy failure include spontaneous abortion, anembryonic gestation and embryonic or fetal death [missed miscarriage].In this study we compared the effectiveness of vaginal misoprostol for the management of first trimester pregnancy loss in obtaining adequate evacuation of uterus as an alternative to surgical evacuation in a tertiary care hospital

Methods: This was a Quasi experimental trial conducted at Ziauddin University Hospital and the study participants were 180 women who presented with first trimester miscarriage upto 12 weeks of gestation. The women were divided into two groups according to their choice [90 women in each]. Group one named Misoprostol group who received tablet Misoprostol 800mcg vaginally, two dose 6 hours apart. Group two named surgical evacuation group, who underwent surgical evacuation under general anesthesia

Results: The success rate in achieving complete evacuation of uterus was 82.8% in misoprostol group in the current study while in surgical evacuation group it was 100%.No serious side effects were encountered in misoprostol group

Causes of root canal failure noted in AFID

The aim of the study was to determine the most common causes of root canal failure in patients who reported to the operative department of AFID [Armed forces institute of dentistry] for retreatment. This was a cross sectional study carried out at the operative department of ARID Rawalpindi from January 2011 to December 2012. Among 200 patients included in the study, 112 [56%] were male and 88[44%] were female with mean age of 31.24 years [SD +/- 10.1]. In the present study the most common cause of root canal failure was found to be underfilled [42%] followed by poor lateral condensation [22%] and unfilled / untreated [20%], overfilled [6%], fractured instruments [4%] and inadequate coronal restorations [3%]. The patients presented with different symptoms The most common symptom being the tenderness [74%] followed by pain [20%], swelling [15%], loss of restoration [13%], sinus formation [6%], mobility [4%], fractured crown [4%] and split tooth [1%]

Functional outcomes following lower extremity amputation at the armed forces institute of rehabilitation medicine using lower extremity functional scale

To assess improvement in functional outcomes following prosthetic fitting after lower limb amputation using a lower extremity functional scale in a cohort of the Pakistani population. Quasi experimental Study. Amputee rehabilitation ward [indoor] / OPD [out patient department] at Armed Forces Institute of Rehabilitation Medicine Rawalpindi. From August 2009 to August 2010. Study was carried out in the amputee rehabilitation ward of the Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan. Fifty two consenting lower limb amputees fulfilling the inclusion criteria were enrolled. All patients were provided with modular prosthesis followed by gait training and integrated amputee rehabilitation program. An assessment was done at 0, 4 and 12 weeks after the provision of prosthesis. Results were analyzed by SPSS Version 15. Most of the patients were males [98.1%]. Mean age was 30.17 +/- 9 years. Trauma was the main etiology [99%] followed by tumor [in only 1 patient who had osteosarcoma]. Transtibial amputation level was the commonest [53.8%] followed by transfemoral in 32.7% patients and Syme's [7.7%]. Lower extremity functional scale [LEFS] mean score in the first week was 35.56 [44.5% of maximum function], which improved to 49.40 [61.8% of maximum function] at week 4, and 59.27 [74.09% of maximum function] at the end of week 12. The p-value for each was 0.000. Early and multidisciplinary amputee rehabilitation improves the functional ambulation level, quality of life and satisfaction level of the individual

Status of glycemic control in patients of type 2 diabetes mellitus

To determine the status of glycemic control in patients of type 2 diabetes mellitus. Cross sectional descriptive study. Medical out-patient/ in -patient departments at Military Hospital Rawalpindi from January 2011 to December 2012. Six hundred and fifty patients of type 2 DM fulfilling the required criteria were included in the study. Glycemic control of these patients was determined by estimation of blood glucose [fasting and random] and glycosylated haemoglobin [HbA1c]. The patients were grouped in three categories good, fair and poor diabetic control having their HbA1c values of being 6-7%, 7.1-8% and more than 8.1% respectively. Statistical package for social sciences [SPSS] version 15 was used for analysis. Out of 650 patients 377 [58%] had poor glycemic control with mean HbA1c of 9.5% +/- 0.95, 78 [12%] patients had fair control of glycemic control with mean HbA1c of 7.8 +/- 0.25, and 195 [30%] patients had good glycemic control with mean HbA1c of 6.4 +/- 0.17. Majority of patients had poor control of their glycemic status which is an important indicator and predictor of both micro and macrovascular complications

Oral aspects and complications in type 2 diabetes mellitus - a study

Type 2 diabetes mellitus comprises an array of dysfunctions resulting in several soft tissue abnormalities in the oral cavity. These include gingivitis periodontitis, salivary dysfunction, taste dysfunction, oral fungal and bacterial infections, geographic tongue, benign migratory glossitis, fissured tongue, traumatic ulcer, lichen planus, angular cheilitis, delayed mucosal healing, dental root caries, tooth loss, mucosal neurosensory disorders, and oral mucosal lesions. This article aims to determine the frequency of different oral manifestations and complications in patients of Type 2 Diabetes Mellitus. This will not only increase the awareness of oral manifestations and complications of diabetes mellitus but also help in expediting the research on the subject. It was a descriptive study and was carried out at the Operative Dentistry Department of Armed Forces Institute of Dentistry from January 2010 to January 2011. 200 patients fulfilling the inclusion criteria [diagnosed cases of type 2 diabetes mellitus of >35 years of age] were included in the study. 70 [35%] were female and 130 [65%] were male patients. The frequency of different oral manifestations and complications seen in these patients in descending order were; gingivitis [45%], periodontitis [36%], dental root caries [22%], taste dysfunction [7%], neurosensory dysesthesias [5%], xerostomia [4%] and oral candidiasis [2%]. It was concluded that diabetic patients are more prone to get oral complications so health education, timely diagnosis and effective treatment should be carried out to prevent these complications

Evaluation of tooth brushing technique and oral hygiene knowledge at Afid, Rawalpindi

The aim of the present study was to evaluate tooth-brushing technique and oral hygiene knowledge in Rawalpindi population. This study was a single centre, descriptive study which was carried out at the Department of Operative Dentistry, AFID, Rawalpindi from January 2010 to January 2011. 500 individuals fulfilling the inclusion criteria were included in the study. They were asked about their tooth brushing technique and oral hygiene knowledge using a questionnaire. The data obtained were analyzed using Statistical Package for Social Sciences [SPSS] version 15. Out of 500 adult participants, 140 [28%] were females and 360 [72%] males. 425 [85%] brushed their teeth regularly, 87% twice a day, 10% once a day and only 3% thrice a day. The study subjects demonstrated the brushing technique in front of the researcher. The result showed that only 4% knew proper technique. Only 7% used the brush for 2 minutes, 67% for one minute and 36% for less than one minute. 45% used fluoride tooth pastes and 24% which did not contain fluoride. 31% did not know about fluoride. The overall awareness about oral hygiene knowledge was not satisfactory

Frequency of different grades of retinopathy in type-2 diabetes mellitus patients at military hospital Rawalpindi

To analyse the various types of retinopathy in individuals with type 2 DM. Descriptive study. Military Hospital Rawalpindi from January 2010 to July 2010. One hundred and fifty patients with type 2 DM were studied into for different types of retinopathy, based on history, clinical examination [ophthalmological] and laboratory investigations. Out of 150 patients who fulfilled the criteria for study, 93[62%] were male and 57[38%] were female patients, frequency of retinopathy was 28.67%. The duration of diabetes ranged from 5 to 30 years. The frequency of retinopathy was higher in males as compared to females. The mean age of the patients was 51.10 +/- 8.33 years with range 36-77 years. Proliferative retinopathy was seen more in those diabetic patients whose duration of disease was more than 10 years. They also showed poor glycaemic control in the form of raised blood glucose and HbA1C levels. About twenty eight percent of our diabetic patients are suffering from diabetic retinopathy. This can be controlled by early detection and effective treatment both in terms of strict glycemic control and laser photocoagulation, thus decreasing the morbidity and mortality due to this chronic disease

Frequency determination of aetiological factors in teeth treated endodontically

To study the effect of morphine on in vitro production of testicular T from un-stimulated or LH stimulated Leydig cells. Experimental study. Biological and Biomedical Sciences Department, Aga Khan University Karachi. De-capsulated testes from two rats were subjected to enzymatic dispersion for each experiment. Cells were pre-incubated in the incubation medium to remove endogenous Testosterone Thereafter, 80K cells were used for each treatment in 2001 of suspension. Incubation medium contained either no treatment [control] or different concentrations of morphine [5x10-5 -10-9 M]. Leydig cells were also incubated with different doses of LH [16-500 ?IU] and morphine. Naloxone, an opioid receptor antagonist [10-6 M], was used to determine if morphine induced effects on the Leydig cells could be reversed. Incubations were carried out for three hours in a shaking water bath at 340C. Reaction was stopped by placing the tubes in a water bath at 600C, and thereafter the tubes were transferred to a tray containing ice before freezing. Testosterone was measured directly in the incubation medium by radioimmunoassay. Morphine reduced Testosterone production from Leydig cells at all concentrations tested [p<0.01]. There was a dose dependent response to LH stimulation by the Leydig cells and testosterone levels were significantly different from control [p<0.01] and incubation with morphine in the presence of LH significantly reduced T levels [p<0.01]. Inhibition of opioid receptors with naloxone significantly attenuated morphine induced inhibition of T [p<0.01]. These in vitro results show that the morphine inhibits T secretion directly at the testis level

Diabetic patients; level of awareness about oral health knowledge, attitude and practices

Diabetes Mellitus [DM], the commonest endocrine disorder is associated with 2-4 times increased risk of coronary artery disease and other macro and microvascular complications in the body. Oral diseases are also more common in diabetics as compared to normoglycemic individuals. The aim of this study was to gather baseline information on knowledge, attitude, and practices of diabetic patients regarding their oral health with the view of enhancing dental health education for them, which will help in updating their knowledge about the diasese and its associated systemic and various oral complications. This study was a cross sectional descriptive survey of 300 diabetic patients visiting the Operative Department of Armed Foreces Institute Of Dentistry Rawalpindi, Pakistan from January 2010 to January 2011. Out of total 300 patients 195 [65%] were males and 105 [35%] were females. 36 [12%] were suffering from Type 1 Diabetes Mellitus and 264 [88%] were suffering from Type 2 Diabetes Mellitus. 64% of the patients had knowledge about the oral complications of diabetes. 35% of this group knew about this issue from their treating physicians and 65% from dentists. 13% did not know that diabetes predisposed them to oral disease, and 23% denied any existence of a link between diabetes and oral health. The level of awareness end dental health knowledge in diabetic patients are good in our army set up which is comparable to previous studies carried out locally and abroad but it still needs to be improved by health education

Determination of various precipitating factors of hepatic encephalopathy in patients of chronic liver disease at military hospital Rawalpindi

To analyse the various precipitating factors of hepatic encephalopathy. A single centre, retrospective study. Military Hospital Rawalpindi from July 2009 to April 2010 One hundred and fifty admitted patients with hepatic encephalopathy were probed into for different precipitating factors, based on history, clinical examination and laboratory methods. Sixty two percent were female and 38% were male patients. The mean age of the patients was 57 years, with a range of 30-85 years. Evidence of Hepatitis C virus was detected in 141[94%] patients while in 9[6%] patients HBV was detected. Constipation was present in 42.7%, gastrointestinal bleeding in 37.3%, infections in 12%, use of sedatives 2.7%, surgery 2.7%, while hypokalemia and excess protein diet were seen in 1.3% of the total patients. Constipation is the most common precipitating factor followed by upper gastrointestinal bleeding and infections

Frequency of dyslipidemia in type-2 diabetes mellitus patients

To determine the frequency of dyslipdemias in patients of type -2 diabetes mellitus. Descriptive study. Combined Military Hospital Rawalpindi from January to July 2010. A total of 150 patients of DM fulfilling the required criteria were selected and subjected to fasting blood glucose, fasting lipid profile including total cholesterol, HDL- cholesterol, LDL- cholesterol and Triglyceride [TG] levels. The data obtained was analyzed using Statistical Package for Social Sciences [SPSS] version 10. Out of 150 patients 38% were female and 62% were male. The mean age of the patients was 57.63 years [SD +/- 8.09]. Minimum age was 36 years and maximum age was 77 years. Out of 150 patients dyslipidemia was present in 120[80%] patients. Hypertriglyceridemia was present in 120[80%] patients, raised LDL-cholesterol in 94 [62.7%] patients, decreased HDL-cholesterol in 88 [58.7%] patients, and raised levels of total cholesterol in 60 [40%] patients. Diabetic patients have a high frequency of dyslipidemias especially raised Triglycerides, therefore lipid profile is to be checked routinely and its management be given equal importance in addition to glycemic control

Frequency of peripheral polyneuropathy in a cohort of diabetic patients having symptoms of polyneuropathy using electrodiagnostic procedure

To determine the frequency of peripheral polyneuropathy in patients having diabetes mellitus with symptoms of polyneuropathy using electrodiagnostic procedure. Observational descriptive study. Armed Forces Institute of Rehabilitation Medicine [AFIRM], Rawalpindi. June 2008 to June 2009 [one year]. Sixty three patients of diabetes mellitus having symptoms of peripheral polyneuropathy fulfilling the inclusion criteria were sampled by purposive sampling. Informed consent was taken. Their demographic data and common symptoms were recorded. All patients underwent Electrodiagnostic procedures for the presence or absence of polyneuropathy, using nerve conduction studies by recording amplitudes, velocities and latencies of minimal two [sural, peroneal] and maximum six nerves. Electromyography was performed only in patients with abnormalities in nerve conduction findings or conditions other than polyneuropathy. Frequencies as percentages were calculated for the presence or absence of polyneuropathy, type of polyneuropathy, associated symptoms and other related diagnosis [if any]. There were thirty three males [52.4%] and thirty female [47.6%]. Forty one [65%] patients had confirmed polyneuropathy on electrodiagnosis, out of which forty patients [97.6%] had axonal polyneuropathy, only one patient [2.4%] had demyelinating polyneuropathy. Twenty two had no polyneuropathy [35%], out of which 65% had other diagnosis like Carpal Tunnel Syndrome [CTS], Radiculopathy and other Compression neuropathies. Majority of symptomatic diabetic patients actually had polyneuropathy. Electrodiagnostic studies are a sensitive tool for early detection of peripheral polyneuropathy, its types and extent