ISSN 2415-1297 (Online)   ISSN 2415-1300 (Print)
Volume : 27 Issue : 3 Year : 2019
Med J Islamic World Acad Sci: 27 (1)
Volume: 27  Issue: 1 - 2019
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1.Role of arthroscopic surgery in patients aged 60 years and more with degenerative knee
Abuzer Uludağ
doi: 10.5505/ias.2019.25901  Pages 1 - 4
Osteoarthritis is a progressive degenerative disease of the synovial joints that causes pain and limitation of range of motion. Surgery is an effective treatment method for this when conservative treatment is ineffective. Arthroscopy is one of the surgical methods that is controversial for degenerative knees. This study aimed to find the efficacy of arthroscopy in patients aged 60 years and more with degenerative knees.
A total of 27 patients (16 women and 11 men), aged 60 years and more, operated between 2012 and 2015, in whom conservative treatment for 3 months was ineffective before surgery, were enrolled. These patients had osteoarthritis according to the American College of Rheumatology criteria and a Kellgren–Lawrence Osteoarthritis Index score of less than 4. The Visual Analog Scale (VAS) and Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index of patients before and after arthroscopy were compared by age, gender, and complications.
The average Kellgren–Lawrence Index was 2.4. The average VAS score was 8 before surgery and 4.1 after surgery, indicating an almost 50% improvement in pain. The average WOMAC Osteoarthritis Index was 40.7% before surgery and 25.5% after surgery. No complications were observed after surgery. The preoperative and postoperative VAS and WOMAC values were significant. Both the described pain and osteoarthritis of the patients were partially recovered after arthroscopic surgery.
In conclusion, arthroscopy treated functions that increased pain and mechanical symptoms and hence was beneficial in appropriately selected degenerative knees.

2.Effects of Insall-Salvati ratio and obesity on suprapatellar fat pad
Mehmet Şirik, İbrahim İnan
doi: 10.5505/ias.2019.75983  Pages 5 - 8
This study aimed to evaluate the effect of Insall-Salvati ratio and obesity on signal and shape changes in the suprapatellar fat pad and investigate their role in impingement.
A total of 124 patients who underwent magnetic resonance imaging examination of the knee between January and November 2018 were included in the study. The ratio of the length of the patellar tendon to patella was calculated for the Insall- Salvati ratio. The thickness of subcutaneous fat tissue was measured from the medial of the knee as an indicator of obesity. The relationship between suprapatellar fat pad signal and shape changes, Insall-Salvati ratio, subcutaneous fat tissue thickness, quadriceps and patellar tendon thickness, and demographic data were statistically analyzed.
Of the patients, 59 (47.6%) were women and 65 (52.4%) were men. In 56 (45.2%) patients, the suprapatellar fat pad had signal changes compatible with those of edema. Moreover, 77 (62.1%) patients had a mass effect on the adjacent joint space due to convexity in the suprapatellar fat pad posterior contour. Although the mass effect was found in 63.6% (49) of the patients with edema in the suprapatellar fat pad, it was missing in 85.1% (40) of the patients without edema in the suprapatellar fat pad (P < 0.001).
This study showed that although a significant relationship existed between the presence of edema and mass effect in the suprapatellar fat pad, the Insall-Salvati ratio and obesity had no significant effect on suprapatellar fat pad impingement.

3.Emergence of AmpC β-Lactamase– and Metallo-β-Lactamase–producing Klebsiella pneumoniae in Sebha, Libya
Khadija Mohamed Ahmad, Almahdi Ahmed Mohamed Alamen, Shamsi Abdullah Mohamd Saad, Abdelkader A Elzen
doi: 10.5505/ias.2019.93798  Pages 9 - 16
The emergence of AmpC β-lactamase– and metallo-β-lactamase–producing Gram-negative bacteria has become a global concern. In the last 2 years, the resistance to broad-spectrum β-lactam antibiotics caused by Klebsiella pneumoniae has been noted among clinical isolates in Sebha Medical Center, Libya. During a period of 2 years, 22 nonrepetitive K. pneumoniae strains were obtained from neonates and identified in the microbiology unit. This study aimed to assess the antimicrobial resistance profile and phenotype of extended-spectrum β-lactamase (ESBL)– and AmpC β-lactamase–producing K. pneumoniae isolates. The antibiotic susceptibility of all isolates was evaluated according to the Clinical Laboratory Standards Institute guideline. Further screening using boric acid and ethylenediaminetetraacetate (EDTA) were performed to study metallo-β-lactamase (MBL and AmpC enzyme production. The study found that 100% of isolates were resistant to β-lactam group, and 91% were resistant to β-lactamase inhibitors. Moreover, 23% (5/24) of all isolates exhibited ESBL phenotype, and 59% (13/22) were AmpC enzyme producers. The resistance to other broad-spectrum antibiotics, for example, aminoglycosides and quinolones, was also observed in this study. This study reported the first case of carbapenem-resistant K. pneumoniae MBL in Sebha, in the south of Libya. This carbapenemase-producing strain exhibited remarkable resistance to cephalosporins, fluoroquinolones, and aminoglycosides. This study showed that AmpC and MBL screen tests were simple and could routinely be performed in the clinical laboratory using EDTA and boric acid.

4.Effect of intestinal parasites on anaerobic performance and muscle strength in athletes
Tuğba Kocahan, Bi&775;hter Akınoğlu, Adnan Hasanoğlu
doi: 10.5505/ias.2019.89847  Pages 17 - 24
Athletes have the risk of transmitting intestinal parasites in sports environments, leading to their poor performance. This study aimed to investigate iron deficiency, iron deficiency anemia, anaerobic performance, and muscle strength in athletes with intestinal parasites. It was conducted by the Ministry of Youth and Sports, General Directorate of Sports Services, Department of Health Affairs in 2018. The stool test results of the athletes were examined. The iron deficiency, iron deficiency anemia, anaerobic performance, and muscle strength were determined by stool sample analysis (study group) and compared with those of 28 athletes who performed the same sports and had no parasites (control group). The iron deficiency and iron deficiency anemia in all athletes were evaluated using iron and ferritin levels in blood analysis. The anaerobic performance was assessed using the Wingate test. The isokinetic muscle strength was evaluated using the IsoMed 2000 isokinetic dynamometer. No statistically significant difference in blood analysis and iron and ferritin levels was found between the groups. No athlete had iron deficiency or iron deficiency anemia. On comparing the anaerobic performances of the groups, no statistically significant difference in WanT parameters was observed. A statistically significant difference was found in the strength of the dominant leg knee extensor muscles at an angular velocity of 60º/s, but no statistically significant differences were noted in other muscle strength parameters. Asymptomatic intestinal parasites did not lead to iron deficiency or iron deficiency anemia and did not affect anaerobic performance in athletes, but adversely affected the strength of dominant leg knee extensor muscles.

5.Incidence and prognostic factors of cranial and spinal choriocarcinomas
Gıyas Ayberk, Mahmut Nedim Aytekin
doi: 10.5505/ias.2018.81489  Pages 25 - 28
Choriocarcinoma is a malignant germ cell tumor. Cranial and spinal lesions of choriocarcinoma are very rare. No large population-based studies have reported on cranial and spinal choriocarcinomas. This study aimed to describe the demographic factors of choriocarcinomas using the Surveillance, Epidemiology, and End Results (SEER) database.
This study was identified from the SEER database between 1973 and 2019. Histology, age, sex, and tumor location were evaluated. The results were compared with those of the previous studies.
The study comprised 16 patients. The mean age at diagnosis was 14.5 years. Thirteen (81.25%) patients were younger than 18 years. The most common locations of the tumor were the pineal region of the brain (43.75%, 7/16) and the neuroendocrine system (50%, 8/16). No spinal choriocarcinomas were detected.
In conclusion, cranial choriocarcinoma is a rare malignancy that most commonly occurs in the pineal area. Its incidence is high for individuals younger than 18 years.

6.Age and professional experience increase the risk of encountering legal malpractice claims among emergency service physicians
Tuğba Atmaca Temrel, Şervan Gökhan
doi: 10.5505/ias.2019.90001  Pages 29 - 33
Encountering legal malpractice claims has become a part of the professional careers of emergency physicians. Various studies have investigated the risk of encountering a malpractice claim. However, the factors defining that risk still remain unclear. The present study aimed to investigate the primary causes affecting the risk of encountering malpractice claims for emergency physicians, such as their age, gender, and duration of professional experience.
This study consisted of a survey conducted in an electronic environment with emergency physicians.
A total of 212 emergency physicians volunteered to participate in the study. Of these, 61.8% were male, 49.1% had encountered malpractice allegations, and 40.1% had been subjected to an institutional investigation. A relationship was found between the status of being subjected to an institutional investigation and the average age, and the difference was statistically significant (P < 0.03). No statistically significant relationship was observed between gender and the status of being subjected to an institutional investigation (P = 0.778). The duration of professional experience in the emergency department was found to be related to the status of being subjected to an institutional investigation (P < 0.001) and a judicial investigation (P < 0.02).
For emergency physicians, the increasing duration of professional experience in the emergency department and age are two natural factors that increase the risk of encountering malpractice claims; gender does not affect that risk.

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