Assessment of hysteroscopic role in management of women with recurrent pregnancy loss

OBJECTIVES

To assess the hysteroscopic value in the management of intrauterine lesion in women with recurrent pregnancy loss.

METHODS

This study was done in Ain Shams Maternity Hospital after the approval of the research Ethics Committee, during the period between August 2014 and December 2015 where 200 nonpregnant women with a history of three or more consecutive unexplained first and second trimester miscarriages before 20 weeks were recruited from recurrent miscarriage clinic. A written informed consent was obtained from all women before participation.

RESULTS

This current study was conducted in Ain Shams University Maternity Hospital during the period between August 2014 to May 2015 a total of 200 women with history of recurrent miscarriage were included in the study. Regarding the results of this study the mean age was 30.5(5.7), the mean number of previous abortion 3(3-5) the mean number of the first trimesteric abortion was 2 with range (2-2) the mean number of second trimesteric abortion was 2 with range (1-2). In this study, 88% of patients were nullipara. It was also found that hysteroscopic findings were found in 58.5%. Uterine anomalies was present in 21%, including septate uterus and intrauterine adhesion (IUAs) were present in 12.5%. Endometrial polyps were present in 8.5%, bicornute uterus in 4.5%, unicornuate uterus in 4.5% while submucous myomas were present in 7.5%. It was found that 48.5% need hysteroscopic intervention including 21% need septectomy 12.5% need adhesiolysis, 6.5% need myomectomy while 8.5% need polypectomy. The study found that no statistically significant difference between patients with normal hysteroscopic finding and patients with abnormal hysteroscopic finding as regard age, time of previous abortion and number of previous abortion. But there was statistically significant difference as regard number of previous delivery and abnormal HSG.

CONCLUSIONS

It appears that hysteroscopy is a useful tool in the diagnosis and treatment of the causes of recurrent miscarriage that can be performed safely without anesthesia in most cases. The prevalence of uterine anomalies in patients with recurrent miscarriages is 54.5%, septate uterus is the most common anomaly and for this reason uterine anomalies should be systematically assessed in patients with recurrent miscarriage.

Emulsions and rectal formulations containing myrrh essential oil for better patient compliance

Myrrh has long been used for its circulatory, disinfectant, analgesic, antirheumatic, antidiabetic, and schistosomicidal properties. Myrrh essential oil (MEO) was extracted from the oleo-gum resin of Commiphora molmol and formulated into emulsions and suppositories to mask/avoid its bitter taste. Three oil-in-water emulsions (E1-E3) were formulated and taste was evaluated by 10 volunteers. Particle size distribution was measured and correlated with excipients and the method of preparation. Physical and chemical stability testing was carried out for the optimum formulation (E2). Seven suppository formulations were investigated (F1-F7). Suppocire AML (F1) and Suppocire CM (F2) were chosen as fatty bases, and polyethylene glycol (PEG) 1500 (F3), PEG 4000 (F4), and a PEG blend (50% PEG 6000 + 30% PEG 1500 + 20% PEG 400) (F5) were chosen as water-soluble bases. A blend of PEG 1500 and Suppocire CM was also used (F7). Camphor (5%) was added to PEG 1500 (F6). Disintegration time, release rate, DSC, fracture points, and weight uniformity were evaluated. The overall average bitterness for formulations E1, E2, and E3 was 6.44, 4.15, and 3.45, respectively. Suppositories containing Suppocire AML had the fastest disintegration time (1.5 min) with dissolution efficiency (DE) of 56.8%. F3 containing PEG 1500 had a fast disintegration time of 2.5 min and maximum DE of 93.5%. The PEG blend had satisfactory release: (DE = 90.9%). A mixed fatty and water-soluble base (F7) had a disintegration time of 5 min and low DE (33.4%). A stable MEO emulsion with acceptable taste was formulated to improve patient acceptance and compliance. F3 suppositories yielded satisfactory results, while formulations containing fatsoluble bases exhibited poor release.

Confocal and multi-photon microscopy of dental hard tissues and biomaterials

Confocal microscopy is a technique that can be used both in the clinic and the high-resolution microscopy suite. This form of optical microscopy enables high-resolution images to be made of samples with minimum requirements for specimen preparation. Images may be made of either reflections from the sample surface or, if an immersion medium is used to optically couple the objective lens, then sub-surface images can be produced of reflective or fluorescent structures within semi transparent materials such as cells and dental hard tissues. These images are like optical sections, giving thin (> 0.35 microm) slices up to 200 microm below the surface of a mineralized tissue. The technique generates significant improvements in resolution, lying somewhere between that of conventional light microscopy and TEM/SEM. Instruments that work at video-rate allow high-speed events to be examined, such as in vivo clinical studies, cutting of dental tissues and fracture of adhesive interfaces. New dyes offer many exciting prospects for labeling changes in chemical composition in materials or biological tissues, while new imaging techniques such as multi-photon laser excitation of dyes give the potential of greater depth penetration and improved resolution. As with all new techniques the inexperienced should be aware of some of the artifacts inherent to the system. However, the widespread availability of conventional confocal microscopes should give ample opportunity for dental researchers to capitalize on this new technology.