Objectives: This study aims to determine the prevalence of knee osteoarthritis (OA) and associated risk factors in the contralateral limb after lower limb amputation. Methods: This cross-sectional survey included 500 lower limb amputees using prostheses for at least 1 year using convenience sampling from the Pakistan Institute of Prosthetic and Orthotic Sciences (PIPOS), Peshawar City, Pakistan rehabilitation services program (PRSP) and its satellite centers across Khyber Pakhtunkhwa. A sample included either gender aged 20 to 80 years. A basic demographic sheet and risk factors questionnaire and American College of Rheumatology (ACR) guidelines diagnostic knee OA criteria, such as using history, physical examination, and radiographic findings were used to collect data. Data were analyzed using SPSS software, version 21. T-test and analysis of variance (ANOVA) statistics were utilized to observe any relationship with P<0.05 as significant.  Results: The current study revealed the prevalence of OA in 131 people (26.2%) with a higher prevalence in 86 married men (65.5%) aged 51-80 years (99[75.6%] and 99[75.6%]) with the predominance of 87 trans-tibial amputees (TTA) (66.4%). Sustained knee bending was the most prevalent risk factor in 127 people (96.9%, 31.07), followed by the history of a painful knee injury in 117 people (89.3%, 12.00), sitting on the floor for home activities in 106 people (80.9%, 8.00) and occupation with knee use in 129 people (98.5%, 7.25). Discussion: The high prevalence of 26.2% of OA in the sound limb in lower limb amputees is more common in married men aged 51-80 years with trans-tibial amputation on the contralateral side. Common risk factors include sustained knee bending, a history of a painful knee injury, sitting on the floor for home activities, and occupations with knee use.

Background and Aim: Lower limb amputation and prosthesis use affect mobility and other aspects of amputees’ daily activities. Awareness of these effects may aid health-care and rehabilitation systems in improving quality of life and well-being of lower limb amputees. A questionnaire was used to collect data about the conditions resulting from lower limb amputation, mobility, low back pain, balance confidence in different activities, and quality of life. Methods: A survey composed of three standard questionnaires including part of Prosthesis Evaluation Questionnaire (PEQ), complete Activities-Specific Balance Confidence (ABC) Scale questionnaire, and complete Oswestry Disability Index (ODI) was designed and published online. The study’ s statistical population included lower limb amputees with any level of amputation who were aged >18 years. The questionnaire was publicised through the prosthetic clinic in the Comprehensive Rehabilitation center of Iranian Red Crescent in Tehran by colleagues working in the fields of amputee rehabilitation, social channels related to disabilities, and the social media of the “ Iranian Handicapped Society” . The questionnaire was available online in Persian. Data collection was performed over 16 months (August 2016‒ December 2017). Results: Of the 37 respondents (including 1 female and 1 bilateral amputee), many suffered from phantom limb sensation (21 participants/56. 8%), phantom limb pain (18 participants/48. 6%), stump pain (19 participants/51. 4%), intact-side pain (22 participants/59. 5%), falls during the last 12 months (22 participants/59. 5%) and worry about falling (28 participants/75. 7%), deficient balance confidence as measured by the ABC scale (26 participants/70%), and risk of future fallings (17 participants/46%). These problems negatively affected respondents’ ODI scores, ABC scores, mobility scores and quality of life (QoL) scores. However, despite the high rate of lower back pain (LBP) among respondents (22 participants/59. 5%), intensity of pain was mild and moderate for the majority. LBP was associated with lower scores of ABC scale, mobility, QoL and amputees satisfaction with prosthesis. According to the ODI, 24% and 32% of participants respectively had minimal and moderate disability due to LBP. Conclusion: Problems related to balance, pain in amputated and intact sides, and LBP were common among respondents. These issues likely impact their mobility and QoL. Accordingly, it is necessary for health care/ rehabilitation systems to include screening plans to monitor these problems and manage them appropriately.

Limb-Girdle Muscular dystrophy (LGMD) is a rare hereditary myopathy which involves pelvic and shoulder muscles. Anesthesia management could be a challenge in these patients considering the choice of technique and potential complications in perioperative period. Since it is a rare disease, clinical trials are scarce and most of the information about anesthetic considerations obtained from case reports. Here we have a short review of the disease and the report the choice of spinal anesthesia in a 28 year old lady suffering LGMD undergoing caesarian section. There was no perioperative complication.

Background and Aim: The lower limb amputees, due to the loss of limb, generally use hip strategy to control balance instead of ankle strategy. The present study aimed to evaluate the effect of a lower limb training protocol consisting of core stabilization exercises with and without augmented visual feedback on balance control strategies of prosthetic leg and the sound leg in below knee amputees.Materials and Methods: Based on the inclusion criteria, 21 amputees were invited to voluntarily take part in the current quasi-experimental study with pretest-posttest protocol. They were randomly divided into three groups of control, core stabilization exercises, and core stabilization exercises using augmented visual feedback. Involvement of hip strategy in the balance control of the groups, in the intact limb, and prosthetic limb were determined using Dynamic Computer Posturography.Results: The results of analysis of variances using repeated measures showed significant differences (p=0.001) between the hip strategy scores of intact limb and prosthetic limp after training interventions. Bonferroni post hoc test indicated higher average scores in both training groups compared with that for control group. Between two training groups, the group with augmented visual feedback showed even a better score (p=0.001) using hip strategies to control balance. The strategy in both legs for core stabilization exercise group with visual feedback was more efficient compared with core stability exercise group without feedback.Conclusion: The results showed that core stabilization exercises can improve pelvic control strategy to maintain balance in the intact leg and prosthetic leg of thr amputee. Using augmented feedback will improve the strategy application even more.

Retaliation is a punishment which it has been in humanity society and its first and most important property is that the guilty person is punished whit the same crime that he/she has committed. Also in Islamic punishment if someone kills or hurt another will be commanded to his retaliation. But in a case, this condition hasn,t observed, and that is the amputation of the hand of a criminal who for some reasons has no hand at all, by the complainant. If so, how the amputation of the hand punishment is done? What should we done? The jurisprudences have disagreement among themselves about this case. If so some deem the amputation of the criminal foot instead of his/her hand necessary, and some others also command to be reduced the retaliation and turned into bloodmoney. Islamic republic legislator also in article number 275 has been commanded to the limb equality necessity and in article note number of it has ordered to amputate the criminal,s foot. In this article after searche about limb retaliation and equality of the limbs, the amputation of foot instead of hand had researched. after observig two jurisprudence,s teoreis and the pros and con-proofs of criminal amputation of the foot is concluded that pros proofs failed to prove this claimer about the criminal retaliation and the necessity of his/her amputation of the foot. Then the note of article number 275 is needed to reviewing.

Background and Objectives: The main objective of the present study was to evaluate the efficacy of second trimester screening for Down syndrome and trisomy 18 in a population of pregnant women in east Azerbaijan province.Materials and Methods: The study involved 300 consecutive women who attended the screening between the 15th and 20th weeks of pregnanc. A blood sample was obtained to measure alpha feto protein (AFP), intact human chorionic gonadotropin (hCG) and unconjugated estriol 3 (UE3). The combined risk assessment including maternal age, AFP, hCG and UE3 was performed in each individual using a computerized risk figure program. The positive screen results were referred to prenatal diagnosis to prenatal diagnosis clinic for further molecular and cytogenetic studies.Results: The mean age in study population was 25.11±5.47 years. Twenty one positive screen results (7%) were detected for Down syndrome and 9 positive screen results were detected for Edward syndrome (3%). The mean age in these groups were 30.62±7.88 and 30±4.26 years respectively. The remaining 270 individuals had negative screen results and the mean age in this group was 24.75±5.45 years. Prenatal diagnosis using interphase Fluorescence in Situ Hybridisation and standard cytogenetic techniques revealed Down syndrome in 3 positive screen results (7%). Two positive screen pregnancies for Down syndrome were terminated due to fetal death. In none of the positives screen results for trisomy 18, Edward syndrome was confirmed through the aforementioned techniques.Conclusion: The results of this study were comparable to the previous studies. These showed that second trimester study of pregnant mothers is a useful screening model for detection of Down syndrome.

Phocomelia, ie the absence or severe hypoplasia of the long tubular bones with more or less intact hands and or feet, is widely known to be the most spectacular finding of thalidomide embryopathy. It may be complete in the form that proximal and distal bones of limb are absent or may be incomplete when either proximal or distal bones are missing. It is known to occur in some familial syndromes such as Roberts’s syndrome, the DK Phocomelia syndrome and in a few other extremely rare syndromes.Phocomelia syndromes are multiple malformations syndrome that includes skeletal, genitourinary such as renal agenesis, gastrointestinal system, eye abnormalties eg cloudy corneas, craniofacial abnormalities including silvery blonde hair, extensive hemangiomas and hypoplastic nasal cartilage. These syndromes include autosomal recessive form of VACTERL hydrocephaly syndrome (David-O’Callaghan syndrome), X-linked recessive form (Hunter Mac Murray) syndrome, DK-phocomelia (von Voss-Cherstvoy) syndrome and Laurin-Sandrow Syndrome (LSS).