Increased femoral anteversion-related biomechanical abnormalities: lower extremity function, falling frequencies, and fatigue.

BACKGROUND: Increased femoral anteversion (IFA) is defined as forwardly rotated femoral head relative to the transcondylar knee axis which may have a potential to reduce the functional quality of adolescents. Therefore, the aim of our study was to investigate the effects of IFA on lower-extremity function, falling frequency, and fatigue onset in neurologically intact children. RESEARCH QUESTION: Does increased femoral anteversion influence lower extremity function, falling frequency and fatigue on set in healthy children? METHODS: Sixty-five participants with increased femoral anteversion (IFA) and thirty-two healthy peers as control were included into the study. For the function, the lower extremity function form (LEFF) which is adapted from Lower Extremity Function Test used. Falling frequency and fatigue onset time were assessed by a Likert-type scale. In addition, the activities which cause frequently fall for the participants were questioned. RESULTS: Lower extremity function was found deteriorated (p= 0.02) and falling frequency was higher (p = 0.00) in IFA than in controls. Fatigue onset time was not different between groups, although lower extremity function was strongly correlated with fatigue onset (rho = -0.537, p < 0.001). IFA children fall four times more during running (60%), three times more during fast walking (21.42%) than their healthy peers (14.28%, 7.14% respectively). SIGNIFICANCE: IFA leads functional problems, especially in the form of high falling frequencies. According to the LEFF score, the most difficult functional parameters for these children were walking long distances, becoming tired, walking more than a mile, and standing on one spot. Also, shorter fatigue onset time may worsen the lower-extremity function secondarily. Because of the higher frequency of falling and functional problems, children with IFA may be more defenseless to injuries, especially in high-motor-skill activities such as running and soccer.

Pregnancy outcome of 149 pregnancies in women with epilepsy: Experience from a tertiary care hospital.

INTRODUCTION: Epilepsy has a prevalence of 1.65% in adults, and every 1 in 200 pregnancies encounters its complications. We aimed to present the existing condition of and our experience with epileptic pregnant women for whom the prepregnancy counseling is inadequate in Turkey. METHODS: We evaluated 149 epileptic pregnant women between March 2009 and January 2015. Demographic features of the patients, along with type and duration of epileptic seizure, time of diagnosis, date of last seizure prior to pregnancy, number and duration of seizures during pregnancy, type of AEDs, result and week of termination of pregnancy, and birth weight were registered, and also, we evaluated perinatal complications and fetal malformations. RESULTS: Mean age of the patients was 27.12 ± 5.4 years, and mean duration from the diagnosis of epilepsy to pregnancy was 9.68 ± 5.91 years. Twenty-seven (18.12%) and 101 (67.78%) patients had polytherapy and monotherapy, respectively. We observed epileptic seizures in 103 (69.12%) patients during pregnancy, and seizures mostly occurred in the first and third trimesters. Forty-one (39.80%) patients had seizures in all three trimesters. Forty-two (28.18%) patients among all patients who had seizures during pregnancy had 5 or more seizures. Major malformations, namely, cleft lip and palate, ventriculoseptal defect, and spina bifida were observed in the patients. Mean birth week was 38.43 ± 1.68 weeks, and mean birth weight was 2965.31 ± 453.94 grams. Twenty-two patients had normal spontaneous vaginal delivery whereas 118 patients had cesarean section. CONCLUSIONS: Pregnant women with epilepsy have their own risks. These women should be followed by experienced obstetricians and neurologists during their pregnancies. Appropriate management and follow-up lead to good results almost the same as general population.

The effects of a history of seizures during pregnancy on umbilical arterial blood gas values in pregnant women with epilepsy.

OBJECTIVE: The objective of this study is to investigate if the number of seizures that occur during pregnancy has any effect on umbilical arterial blood gas values at delivery. MATERIAL AND METHODS: In total, 55 women who were 37 to 41 weeks pregnant and diagnosed with generalized tonic-clonic epilepsy and 50 pregnant women with similar characteristics but not diagnosed as epileptic were included in this study. The patients diagnosed with epilepsy were divided into two groups: 27 patients with a history of at least 5 epileptic seizures during pregnancy and 28 who had no seizures during pregnancy. All patients diagnosed with epilepsy had a history of caesarean delivery or a caesarean section under general anesthesia on the advice of neurology. Pregnant women in the control group were also chosen from among patients who had a caesarean on account of a previous caesarean delivery. In the cases included in the study, umbilical arterial blood gas sampling was performed immediately after delivery. RESULTS: When the control group without epilepsy was compared with pregnant women who had no history of epileptic seizures during pregnancy, no difference was found in umbilical arterial blood gas values (p>0.05). When patients with a history of 5 or more epileptic seizures during pregnancy were compared with the control group without epilepsy and the patients with epilepsy who had no history of seizures during pregnancy, there was no statistically significant difference (p>0.05), although their umbilical arterial blood pH values were found to be lower, while partial carbon dioxide pressure (pCO2), values were higher and partial oxygen pressure (pO2) values were lower. CONCLUSION: Taking potential fetal risks into consideration, maternal generalized tonic-clonic epileptic seizures might be worrying. Tonic-clonic seizures that occur during pregnancy appear to be associated with temporary hypoxia. Therefore, monotherapy for seizures and treatment at the lowest effective dose should be administered to women with epilepsy in the preconception and prenatal term.

Sclerosing stromal tumour of the ovary: A case report and the review of literature.

Sclerosing stromal tumours are rare benign ovarian neoplasms of the sex cord stromal that occur predominantly in the second and third decades of life. To date, 208 cases have been recorded in the literature. Most patients have menstrual irregularities and pelvic pain. Infertility and virilisation have also been described. In this article, histopathological features and differential diagnosis of the benign sclerosing stromal tumour were described together with the literature data. It is imperative to consider the differential diagnosis of a sclerozing stromal tumour of the ovary in a young woman with an ovarian tumour. A combination of morphological, immunohistochemical, radiological and clinical findings is needed in differentiating the tumour from thecoma, fibroma/fibrosarcoma, lipoid tumours and Krukenberg tumour.

Recurrent massive haemoperitoneum associated with ruptured corpus luteum in women with congenital afibrinogenemia; case report.

Massive hemoperitoneum secondary to ruptured corpus luteum is a rare but serious and life-threatening complication for women with congenital bleeding disorders and may lead to surgical interventions and even oophorectomy. Congenital afibrinogenemia is a rare inherited coagulation disorder. As it can be asymptomatic, its clinical manifestations vary from minimal tendency of bleeding to life-threatening bleedings. Intraabdominal bleeding due to ovulation is very rare in these patients and only a few cases of corpus luteum rupture and hemoperitoneum in afibrinogenemic patients have been described. We report on a 28-year-old woman with congenital afibrinogenemia with recurrent massive intraabdominal bleeding due to ovulation as the presenting clinical sign. The first episode was managed with fresh frozen plasma, cryoprecipitate and blood transfusions; exploratory laparotomy and excision of the ruptured follicle was performed at the second episode; the third episode was managed with fresh frozen plasma, cryoprecipitate and blood transfusions; exploratory laparotomy and right salphingooopherectomy was performed at the fourth episode; fifth episode was managed with fresh frozen plasma, cryoprecipitate and blood transfusions. Conservative management is crucial for patients with congenital bleeding disorders. These case demonstrate that preservation of ovarian function is possible with a conservative approach and recurrent episodes may be prevented by suppression of ovulation.

Role of the cmcH-ccaR intergenic region and ccaR overexpression in cephamycin C biosynthesis in Streptomyces clavuligerus.

The effect of the CcaR regulatory protein on expression of the cephamycin C gene cluster is studied. Quantitative reverse transcription PCR (qRT-PCR) expression analysis of the cephamycin biosynthesis genes in the ccaR-disrupted strain, S. clavuligerus ccaR::aph, revealed that in the absence of CcaR, the lat and cmcI genes expression was reduced 2,200- and 1,087-fold compared with the wild type. Expression of pcbAB-pcbC-cefD-cefE-cmcJ-cmcH and blp was 225- to 359-fold lower, while expression of pcbR-pbpA-bla and orf10 was only slightly affected if at all, indicating that resistance and regulatory genes are not under CcaR control as opposed to pathway biosynthetic genes. In the intergenic cmcH-ccaR region, a small messenger RNA (mRNA) overlaps with the cmcH transcription terminator. Deletion of 688 bp of the intergenic region results in a strain, S. clavuligerus ΔRI, still able to produce cephamycin C and clavulanic acid but at levels 30-40% lower than the parental strain. Therefore, specific sequences in the intergenic region upstream of ccaR enhance the expression of ccaR but are not essential for its expression. Strains containing an additional ccaR gene integrated in the chromosome, S. clavuligerus pSET-PC, or multiple copies of ccaR expressed from the PglpF promoter, S. clavuligerus pAK23, were constructed. Fermentations of the pAK23 strain resulted in a 6.1-fold increase in specific cephamycin C production relative to the wild type. In the same experiments, qRT-PCR analysis of the cephamycin biosynthesis genes showed a 5.1-fold increase in ccaR expression and similar increases in expression of lat and cmcI, while expression of other cluster genes were increased in the order of 2- to 3-fold.

Cry3Aa11: a new Cry3Aa delta-endotoxin from a local isolate of Bacillus thuringiensis.

A local isolate of Bacillus thuringiensis Mm2 had insecticidal activity against the larvae of Melolontha melolontha, Agelastica alni, Leptinotarsa decemlineata and Amphimallon solstitiale and produced a 65 kDa protein. SDS-PAGE profile of B. thuringiensis Mm2 was compared with those of 29 different Cry3Aa producers which verified Cry3Aa biosynthesis by the isolate. The cry3Aa gene of Mm2 was cloned, sequenced and the deduced amino acid sequence was compared with the cry3Aa sequences of ten different quaternary ranks. Its identity to these sequences ranged between 97.4% and 99.2%. The gene was next cloned into E. coli-Bacillus shuttle vector pNW33N and expressed at a low level in B. subtilis 168.