SMD Group Research Articles

Microdebrider-Assisted Turbinoplasty and Submucosal Diathermy for Inferior Turbinate Hypertrophy: A Randomized Clinical Trial

ABSTRACT 
 Background: Nasal obstruction is a common presenting problem which can lead to symptoms like sleep disturbances, mouth breathing, oral cavity dryness. Hypertrophied inferior turbinate is a common cause of nasal obstruction. Microdebrider assisted turbinoplasty and submucosal diathermy are widely used methods for patients who fail to respond to medical therapy to relieve obstruction. The aim of the study was to compare two methods in terms of relief of nasal obstruction, reduction in sneezing and post-operative complications.
 Material & Methods: This randomized clinical trial was conducted at ENT Department, Benazir Bhutto Hospital Rawalpindi, Pakistan for one year from 01-03-2018 to 28-02-2019. One hundred and twenty patients were randomized to into either MAT and SMD groups each with 60 patients. Nasal obstruction symptom evaluation score system (NOSE) was used to access relieve from obstruction and sneezing. SPSS 22, online chai square and fisher exact test calculators were used to analyze the data.
 Results:
 Two groups were comparable for age and gender. After 3 months of treatment, all patients in MAT group and 51 patients in SMD group were completely relieved from obstruction. At two weeks follow up 37(61.57%) patients in MAT group had grade 0 obstruction compared with 14 (23.33%) in SMD group and this difference was significant (p value .000). at one month follow up 55 (91.67%) patients in MAT while 46 (76.67%) had completely relieved obstruction and this difference was significant ( p value .024). Not all patients showed reduction in sneezing in both groups. 37 patients in MAT and 25 patients in SMD group had completely relieved from sneezing at third month follow up with MAT group showing significantly more patients with sneezing reduced at one month follow up. Crust formation was most seen complication in both groups, more with SMD group at two weeks follow up which responded to treatment alkaline nasal douches and crust removal.
 
 Conclusion:
 MAT gives better in terms of nasal obstruction relieved, reduction in sneezing and less complications than SMD procedure.
 KEYWORDS: Microdebrider; Diathermy; Turbinates; Nasal obstruction

Partial inferior turbinectomy versus submucosal diathermy in hypertrophied inferior turbinates

<p><strong>Background:</strong> The study aims to compare the efficacy of submucosal diathermy and partial inferior turbinectomy in terms of improvement in nasal obstruction, pain, haemorrhage, crusting and wound healing.</p><p><strong>Methods: </strong>A prospective sequentially randomized comparative study involving fifty patients, divided into two groups of 25 patients each. Group A consists of patients who underwent SMD and group B consists of patients who underwent PIT. Post-operative assessment was done at day 1, 2 weeks, 1 month, 3 months and 6 months.</p><p><strong>Results: </strong>Post-operative improvement in nasal obstruction was seen in both groups. 80% showed significant improvement in SMD and 32% in PIT group at the end of second week. By sixth month, 40% in SMD group and 80% in PIT group showed significant improvement. Mild pain was observed in 12% of PIT group at 2 weeks. In SMD group, 8% developed reactionary haemorrhage. In PIT group, 24% developed minimal soakage and 12% developed moderate soakage. Severe nasal crusting was seen in 64% of the cases in PIT group and in 40% of the cases in SMD group at second week. By 1 month, 44% in PIT group and 12% in SMD group showed severe crusting.</p><p><strong>Conclusions: </strong>Short term complications like pain, obstruction and haemorrhage was noted to be higher with PIT. On long term evaluation, PIT showed better results in terms of improvement in nasal obstruction scores.</p>

Comparison of Wound Complications Between Two Closing Techniques Following Total Hip Arthroplasty Via the Direct Anterior Approach

AbstractA higher rate of wound complications has been reported in the direct anterior approach (DAA) for total hip arthroplasty (THA), reportedly due to the location of the incision and poor surgical site exposure techniques. Therefore, the purpose of this study was to compare wound complications within the first 90 days between a zipper closing method (ZM) and subcuticular monocryl with dermabond skin closure (SMD). A total of 294 patients (352 hips) were closed using the SMD and 166 patients (206 hips) were closed via the ZM. All THAs via the DAA and postoperative care were performed based on the current standard of care for the treatment of symptomatic hip osteoarthritis, established by a single, high volume surgeon from 2016 to 2018. Any wound complications during the first 90 days were noted. Independent t-tests determined differences in descriptive variables. Additionally, a Fisher Exact test was performed to compare wound complication rate between groups (p < 0.05). Surgical time was significantly shorter for ZM (p < 0.001) for both unilateral and bilateral groups compared with SMD. Overall, there were four complications occurring in 558 cases (0.7%), with two cases (0.36%) requiring additional surgery. No wound complications were present in the SMD and four wound complications (1.9%), two requiring surgery, were reported for the ZM (χ2 [1, N = 558] = 6.884, p = 0.009). While no wound complications were reported in the SMD group, the ZM group sustained four wound complications, two of which required additional surgery. Two of these wound complications occurred within the first 14 cases following implementation of the ZM, perhaps indicating a short learning curve. The ZM is a quicker, perhaps easier closure method yet the added expense for materials and suggested increased risk for wound complications may moderate the enthusiasm of the ZM compared with the sutures following THA via the DAA.

Comparison Between the Fecal Bacterial Microbiota of Healthy and Diarrheic Captive Musk Deer

Diarrhea constitutes one of the most common diseases affecting the survival of captive musk deer and is usually caused by an imbalance in intestinal microbiota. Currently, research regarding the structure and function of intestinal microbiota in diarrheic musk deer is lacking. Therefore, in the present study, high-throughput 16S-rRNA gene sequencing was used to analyze the intestinal microbiota in feces of healthy captive musk deer (HMD) (n = 8) and musk deer with mild (MMD) (n = 8), and severe (n = 5) (SMD) diarrhea to compare the difference in intestinal microbiota of musk deer under various physiological conditions. The results showed that the diversity of HMD fecal microbiota was significantly higher than that of the two diarrhea samples. β Diversity results indicated that there were extremely significant differences in bacterial communities between the HMD sample and the MMD and SMD samples. However, no significant difference was found between the two diarrhea samples. LefSe analysis showed that the degree of intestinal physiological dysfunction in musk deer was correlated with the types of major pathogens. The main pathogen in the MMD group is Escherichia–Shigella, whereas Fusobacterium is the main pathogen in the SMD group. PICRUSt functional profile prediction indicated that the intestinal microbiota disorder could also lead to changes in the abundance of genes in metabolic pathways of the immune system. Altogether, this study provides a theoretical basis for the exploration of treatments for diarrhea in captive musk deer, which is of considerable significance to the implementation of the musk deer release into the wild program.

De las disfunciones familiares a la exclusión social: un estudio piloto

La inclusión social está relacionada con la integración, la cohesión y la justicia social. La inclusión consiste en materializar la posibilidad de participación igualitaria de todas las personas de una sociedad en todas las dimensiones social, mientras que su opuesto se actualizaría en el concepto de exclusión social. Para la mayoría de los autores, el inicio de esta problemática se encuentra en la infancia. En esa línea, en este estudio se pretende explorar cómo las condiciones disfuncionales familiares comienzan la inauguración de una alteración en el apego que favorece unas relaciones sociales e interpersonales desorganizadas. Éstas conducirán a la exclusión social en muchos casos. Para la realización de este estudio retrospectivo sobre el apego, partimos de dos muestras, una formada por personas que padecen trastornos mentales graves (TMS) y otra por individuos con un alto grado de inclusión (estudiantes universitarios). En total se contó con 284 participantes (200 pacientes con TMS de Consultas Ambulatorias del Área Sanitaria de A Coruña y 84 estudiantes de la Universidade da Coruña), siendo ambas muestras homogéneas con respecto a la variable género. Los datos se recogieron mediante un cuestionario autoadministrado. Se empleó la Escala de Experiencias Familiares en la Infancia (EFI), cuya fiabilidad total es de .86 y en la que un análisis factorial exploratorio puso de manifiesto cuatro factores sólidamente estructurados, que explican el 57% de la varianza: Apego seguro, Negligencia/ maltrato, Apego ansioso/desorganizado e Inversión de roles parentales. Para este trabajo en concreto se procedió al análisis de los seis ítems más relevantes de cada conjunto de experiencias. Los resultados mostraron un efecto principal debido al tipo de apego y una interacción significativa con el tipo de muestra, observándose que el grupo de TMS arroja puntuaciones más altas en apego alterado, maltrato e inversión de roles, mientras que los estudiantes universitarios obtienen puntuaciones más elevadas en apego seguro. En cambio, no se encontraron diferencias significativas en las experiencias familiares debidas al sexo, ni interacción entre esta variable y las restantes. Estos resultados parecen apoyar la hipótesis de que un apego seguro de base favorece las relaciones familiares y sociales y, por ende, la inclusión social, si bien podrían contradecir en parte la creencia extendida de que en el cuidado de las mujeres suele existir una mayor proporción de apego alterado, mientras que en los hombres suele predecirse una mayor proporción de maltrato. Será necesario realizar más investigación en este sentido para aclarar este punto. Teniendo en cuenta estos hallazgos se podría concluir que una herramienta útil de corrección sería la de incentivar desde el contexto educativo estrategias para promover por parte de las familias la colaboración y la participación en los distintos programas preventivos relacionados con el cuidado de los hijos, el conocimiento y uso de los recursos sociales, el vínculo padres-hijos, la cohesión y la gestión familiar, las pautas de comunicación, y el modelado de conductas.

Maternal hypomagnesemia causes placental abnormalities and fetal and postnatal mortality

IntroductionMagnesium (Mg2+) is essential for cellular growth and the maintenance of normal cellular processes. However, little is known about how maternal hypomagnesemia during pregnancy affects fetal growth and development. This study investigated the effects of maternal hypomagnesemia on the late gestation placenta and fetus, and postnatal outcomes until weaning. MethodsFemale CD1 mice consumed a control (0.2% w/w Mg2+), moderately Mg2+ deficient (MMD; 0.02% w/w Mg2+) or severely Mg2+ deficient (SMD; 0.005% w/w Mg2+) diet for 4 weeks prior to mating and throughout pregnancy. Dams were killed at E18.5 for embryonic studies or allowed to litter naturally and the offspring studied up to postnatal day 21. ResultsAt E18.5, both Mg2+ deficient diets decreased maternal plasma and bone Mg2+ but only the SMD diet decreased fetal plasma Mg2+. Maternal hypomagnesemia led to fetal loss and fetal growth restriction. Maternal Mg2+ deficiency increased placental glycogen cell area and decreased spongiotrophoblast cell area while upregulating mRNA expression of the MagT1 Mg2+ transporter in spongiotrophoblast cells. The SMD animals also displayed instances of gross placental abnormalities. After birth, pups in the SMD group had increased early postnatal mortality and failed to thrive. Pups in the MMD group underwent catch-up growth but remained shorter than controls at PN21 and were hypomagnesemic and hypoglycemic. ConclusionsThese changes suggest that maternal Mg2+ deficiency during pregnancy impairs placental development and fetal growth, which may have long-term health consequences for offspring. Collectively, these results have important implications for women who are Mg2+ deficient during pregnancy.

Primary and secondary distant metastatic breast cancer: Two sides of the same coin

ObjectivesThis study evaluated the differences between breast cancer (BC) patients who present with primary distant metastatic disease (PMD) and those who develop distant metastases during the course of their illness (secondary metastatic disease [SMD]) with regard to clinicopathological characteristics, patterns of metastatic sites, palliative therapy and survival. Patients & methodsBased on a cohort of patients with newly diagnosed BC (n = 1459), we analyzed all patients who had PMD (n = 92, 6.3%) and those who developed SMD (n = 277, 20.3%). ResultsThere were no significant differences with regard to the patient's age in which metastatic disease had been diagnosed (PMD/SMD: 64 years/66 years, p = 0.19). The SMD group had more often triple-negative carcinomas (25.5%/7.3%, p = 0.019); there were no significant differences with regard to grading (p = 0.61), HER2 status (p = 0.67) and hormonal receptor status (p = 1.00). The mean number of metastatic locations was similar (2.3/2.3, p = 0.91). While patients with PMD usually initiated systemic therapy, patients with SMD received systemic therapy after diagnosis of metastatic disease less often (16.4%/2.6%, p < 0.001). Both groups received palliative chemotherapy similarly often (PMD/SMD: 62.8%/63.3%, p = 1.00). The mean number of palliative therapy lines was similar (PMD/SMD: 2.8/3.2, p = 0.39). Compared to patients with SMD, patients who had PMD had a significantly improved metastatic disease survival (p < 0.001). The one-year, two-year and five-year survival rates were as follows: 76.9%/60.3%, 58.2%/43.0%, 23.1%/10.6%. The median survival times were 18.5 months and 32 months. ConclusionThe poorer prognosis of patients with SMD may be explained by differences in clinicopathological features of the tumor, metastatic patterns, the use palliative therapy and drug resistance of the tumor cells which occurs in therapy-naïve PMD patients at a later phase of the disease course.

Assessment of response to endocrine therapy using FDG PET/CT in metastatic breast cancer: a pilot study

The purpose of this pilot study was to assess whether outcome in metastatic or recurrent breast cancer patients is related to metabolic response to endocrine therapy determined by (18)F-FDG PET/CT. The study group comprised 22 patients with breast cancer (age 58 ± 11 years, mean ± SD) who were scheduled to receive endocrine therapy. They were systematically assessed by PET/CT at baseline and after a mean of 10 ± 4 weeks for evaluation of response after induction. All patients demonstrated FDG-avid lesions on the baseline PET/CT scan. The metabolic response was assessed according to EORTC criteria and based on the mean difference in SUV(max) between the two PET/CT scans, and the patients were classified into four groups: complete or partial metabolic response, or stable or progressive metabolic disease (CMR, PMR, SMD and PMD, respectively). All patients were followed in our institution. Metastatic sites were localized in bone (n = 15), lymph nodes (n = 11), chest wall (n = 3), breast (n = 5), lung (n = 3), soft tissue (n = 1) and liver (n = 1). PMR was observed in 11 patients (50%), SMD in 5 (23%) and PMD in 6 (27%). The median progression-free survival (PFS) times were 20, 27 and 6 months in the PMR, SMD and PMD groups, respectively. PFS in the SMD group differed from that in the PMR and SMD groups (p < 0.0001). Metabolic response assessed by FDG PET/CT imaging in patients with metastatic breast cancer treated with endocrine therapy is predictive of the patients' PFS.

Low dimensional temporal organization of spontaneous eye blinks in adults with developmental disabilities and stereotyped movement disorder

This study investigated the mean rate and time-dependent sequential organization of spontaneous eye blinks in adults with intellectual and developmental disability (IDD) and individuals from this group who were additionally categorized with stereotypic movement disorder (IDD + SMD). The mean blink rate was lower in the IDD + SMD group than the IDD group and both of these groups had a lower blink rate than a contrast group of healthy adults. In the IDD group the n to n + 1 sequential organization over time of the eye-blink durations showed a stronger compensatory organization than the contrast group suggesting decreased complexity/dimensionality of eye-blink behavior. Very low blink rate (and thus insufficient time series data) precluded analysis of time-dependent sequential properties in the IDD + SMD group. These findings support the hypothesis that both IDD and SMD are associated with a reduction in the dimension and adaptability of movement behavior and that this may serve as a risk factor for the expression of abnormal movements.

Cognitive Flexibility in Phenotypes of Pediatric Bipolar Disorder

Clinicians and researchers debate whether children with chronic, nonepisodic irritability should receive the diagnosis of bipolar disorder (BD). To address this debate, we evaluated cognitive flexibility, or the ability to adapt to changing contingencies, in three groups of children: narrow-phenotype BD (NP-BD; full-duration manic episodes of elevated/expansive mood; N = 50; 13.1 +/- 2.9 years), severe mood dysregulation (SMD; chronic, nonepisodic irritability; N = 44; 12.2 +/- 2.1 years), and healthy controls (N = 43; 13.6 +/- 2.4 years). Cognitive flexibility is relevant to symptoms of BD involving dysfunctional reward systems (e.g., excessive goal-directed activity and pleasure-seeking in mania; anhedonia in depression). We studied simple and compound reversal stages of the intra-/extradimensional shift task and change task that involves inhibiting a prepotent response and substituting a novel response. On the simple reversal, NP-BD youths were significantly more impaired than both the SMD group and controls. On the compound reversal, NP-BD and SMD youths performed worse than controls. On the change task, NP-BD youths were slower to adapt than SMD subjects. Phenotypic differences in cognitive flexibility may reflect different brain/behavior mechanisms in these two patient populations.