Comparison of complication rates between femtosecond laser-assisted cataract surgery and conventional phacoemulsification cataract surgery

Dear Editor,We read with interest the Meta-analysis conducted by Chen et al[1]on the clinical outcomes and complication rates between femtosecond laser-assisted cataract surgery(FLACS)and conventional phacoemulsification cataract surgery(CPCS).The authors reported no statistical difference between both methods for all measured complications except posterior capsular tear,with CPCS displaying a higher rate of posterior capsular tear.Since its inception in 2011[2].

Prognostic value of ultrasound in early arterial complications post liver transplant

Liver transplantation is the primary therapeutic intervention for end-stage liver disease.However,vascular complications,particularly those involving the hepatic artery,pose significant risks to patients.The clinical manifestations associated with early arterial complications following liver transplantation are often non-specific.Without timely intervention,these complications can result in graft fai-lure or patient mortality.Therefore,early diagnosis and the formulation of an op-timal treatment plan are imperative.Ultrasound examination remains the pre-dominant imaging modality for detecting complications post liver transplan-tation.This article comprehensively reviews common causes and clinical present-ations of early hepatic artery complications in the post-transplantation period and delineates abnormal sonographic findings for accurate diagnosis of these con-ditions.Overall,ultrasound offers the advantages of convenience,safety,effect-iveness,and non-invasiveness.It enables real-time,dynamic,and precise evalua-tion,making it the preferred diagnostic method for post-liver transplantation assessments.INTRODUCTION Liver transplantation stands as the primary therapeutic approach for end-stage liver disease.Continuous advancements in surgical techniques and the application of novel immunosuppressive agents contribute to ongoing improvements in the success rate and overall survival in patients undergoing liver transplantation procedures.Despite these advan-cements,vascular complications,particularly those involving the hepatic artery,pose significant risks to patients.During the early stages following liver transplantation(within the first 30 d),proper hepatic artery function is crucial for hepatic arterial blood flow.During later stages,collateral circulation,including arteries such as the phrenic artery,right gastric artery,and gastroduodenal artery,becomes important for maintaining hepatic blood supply.It is now understood that the establishment of effective collateral circulation is pivotal for determining the prognosis of hepatic artery complic-ations.The clinical manifestations of these complications are closely linked to factors such as timing,severity,and the specific type of onset.Insufficient hepatic arterial blood flow can lead to abnormal liver function,hepatic infarction,and the formation of hepatic abscesses.Additionally,since the hepatic artery is the sole blood supply to the biliary tract,hepatic artery-related ischemia may result in biliary stricture,obstruction,and the formation of bile ducts.Ultrasound examination remains the primary imaging modality for diagnosing complications post liver transplantation.This article comprehensively reviews common causes and clinical presentations of early hepatic artery complications in the post-transplantation period and outlines abnormal sonographic findings for accurately diagnosing these conditions.NORMAL HEPATIC ARTERY During the intraoperative phase,an ultrasound examination is typically conducted to evaluate the hepatic artery anas-tomosis.The normal internal diameter of the hepatic artery typically ranges from 2 to 5 mm.Two strong echo points are typically identified near the anastomosis.To assess blood flow dynamics,peak systolic velocity,end-diastolic velocity,and resistance index are measured at the donor and recipient sides of the anastomosis following angle correction.Anastomotic stenosis presence and severity can be evaluated by comparing the velocity at the anastomotic site with that at the recipient side.Postoperatively,direct visualization of the anastomosis site through gray ultrasound scans is often challenging.The surgical approach has a significant impact on the proper hepatic artery’s position,resulting in a lower overall success rate of continuous visualization.Color Doppler ultrasound is primarily employed to trace the artery’s path,and spectral measurements are taken at the brightest position of the Color Doppler blood flow signal,primarily used to identify the presence of high-speed turbulence.Hepatic artery spectrum examination plays a crucial role,as a favorable arterial spectral waveform and appropriate hepatic artery flow velocity typically indicate a successful anastomosis,even in cases where the hepatic artery anastomosis cannot be directly visualized by ultrasound.The hepatic artery runs alongside the portal vein,often selected as a reference due to its larger inner diameter.A normal hepatic artery spectrum displays a regular pulsation pattern with a rapid rise in systole and a slow decline in diastole.Parameters for assessing hepatic artery resistance include a resistance index between 0.5 to 0.8 and an artery systolic acceleration of less than 80 ms.Instantaneous increases in the resistance index(RI>0.8)often occur within 2 d after surgery,followed by a subsequent return to normal hepatic arterial parameters.It has been established that the maximum blood flow velocity during systole in the hepatic artery should not exceed 200 cm/s[1].

Comparison of different preoperative objective nutritional indices for evaluating 30-d mortality and complications after liver transplantation

BACKGROUND The nutritional status is closely related to the prognosis of liver transplant re-cipients,but few studies have reported the role of preoperative objective nutri-tional indices in predicting liver transplant outcomes.AIM To compare the predictive value of various preoperative objective nutritional indicators for determining 30-d mortality and complications following liver transplantation(LT).METHODS A retrospective analysis was conducted on 162 recipients who underwent LT at our institution from December 2019 to June 2022.RESULTS This study identified several independent risk factors associated with 30-d mor-tality,including blood loss,the prognostic nutritional index(PNI),the nutritional risk index(NRI),and the control nutritional status.The 30-d mortality rate was 8.6%.Blood loss,the NRI,and the PNI were found to be independent risk factors for the occurrence of severe postoperative complications.The NRI achieved the highest prediction values for 30-d mortality[area under the curve(AUC)=0.861,P<0.001]and severe complications(AUC=0.643,P=0.011).Compared to those in the high NRI group,the low patients in the NRI group had lower preoperative body mass index and prealbumin and albumin levels,as well as higher alanine aminotransferase and total bilirubin levels,Model for End-stage Liver Disease scores and prothrombin time(P<0.05).Furthermore,the group with a low NRI exhibited significantly greater incidences of intraabdominal bleeding,primary graft nonfunction,and mortality.CONCLUSION The NRI has good predictive value for 30-d mortality and severe complications following LT.The NRI could be an effective tool for transplant surgeons to evaluate perioperative nutritional risk and develop relevant nutritional therapy.

Clinical nursing value of predictive nursing in reducing complications of pregnant women undergoing short-term massive blood transfusion during cesarean section

BACKGROUND Cesarean hemorrhage is one of the serious complications,and short-term massive blood transfusion can easily cause postoperative infection and physical stress response.However,predictive nursing intervention has important clinical significance for it.AIM To explore the effect of predictive nursing intervention on the stress response and complications of women undergoing short-term mass blood transfusion during cesarean section(CS).METHODS A clinical medical record of 100 pregnant women undergoing rapid mass blood transfusion during sections from June 2019 to June 2021.According to the different nursing methods,patients divided into control group(n=50)and observation group(n=50).Among them,the control group implemented routine nursing,and the observation group implemented predictive nursing intervention based on the control group.Moreover,compared the differences in stress res-ponse,complications,and pain scores before and after the nursing of pregnant women undergoing rapid mass blood transfusion during CS.RESULTS The anxiety and depression scores of pregnant women in the two groups were significantly improved after nursing,and the psychological stress response of the observation group was significantly lower than that of the control group(P<0.05).The heart rate and mean arterial pressure(MAP)of the observation group during delivery were lower than those of the control group,and the MAP at the end of delivery was lower than that of the control group(P<0.05).Moreover,different pain scores improved significantly in both groups,with the observation group considerably less than the control group(P<0.05).After nursing,complications such as skin rash,urinary retention,chills,diarrhea,and anaphylactic shock in the observation group were 18%,which significantly higher than in the control group(4%)(P<0.05).CONCLUSION Predictive nursing intervention can effectively relieve the pain,reduce the incidence of complications,improve mood and stress response,and serve as a reference value for the nursing of women undergoing rapid mass transfusion during CS.

Predicting short-term major postoperative complications in intestinal resection for Crohn’s disease:A machine learning-based study

BACKGROUND Due to the complexity and numerous comorbidities associated with Crohn’s disease(CD),the incidence of postoperative complications is high,significantly impacting the recovery and prognosis of patients.Consequently,additional stu-dies are required to precisely predict short-term major complications following intestinal resection(IR),aiding surgical decision-making and optimizing patient care.AIM To construct novel models based on machine learning(ML)to predict short-term major postoperative complications in patients with CD following IR.METHODS A retrospective analysis was performed on clinical data derived from a patient cohort that underwent IR for CD from January 2017 to December 2022.The study participants were randomly allocated to either a training cohort or a validation cohort.The logistic regression and random forest(RF)were applied to construct models in the training cohort,with model discrimination evaluated using the area under the curves(AUC).The validation cohort assessed the performance of the constructed models.RESULTS Out of the 259 patients encompassed in the study,5.0%encountered major postoperative complications(Clavien-Dindo≥III)within 30 d following IR for CD.The AUC for the logistic model was 0.916,significantly lower than the AUC of 0.965 for the RF model.The logistic model incorporated a preoperative CD activity index(CDAI)of≥220,a diminished preoperative serum albumin level,conversion to laparotomy surgery,and an extended operation time.A nomogram for the logistic model was plotted.Except for the surgical approach,the other three variables ranked among the top four important variables in the novel ML model.CONCLUSION Both the nomogram and RF exhibited good performance in predicting short-term major postoperative complic-ations in patients with CD,with the RF model showing more superiority.A preoperative CDAI of≥220,a di-minished preoperative serum albumin level,and an extended operation time might be the most crucial variables.The findings of this study can assist clinicians in identifying patients at a higher risk for complications and offering personalized perioperative management to enhance patient outcomes.

Utility of real-time 3D visualization system in the early stage of phacoemulsification training

●AIM:To determine the teaching effects of a real-time three dimensional(3D)visualization system in the operating room for early-stage phacoemulsification training.●METHODS:A total of 10 ophthalmology residents of the first-year postgraduate were included.All the residents were novices to cataract surgery.Real-time cataract surgical observations were performed using a custom-built 3D visualization system.The training lasted 4wk(32h)in all.A modified International Council of Ophthalmology’s Ophthalmology Surgical Competency Assessment Rubric(ICO-OSCAR)containing 4 specific steps of cataract surgery was applied.The self-assessment(self)and expert-assessment(expert)were performed through the microsurgical attempts in the wet lab for each participant.●RESULTS:Compared with pre-training assessments(self 3.2±0.8,expert 2.5±0.6),the overall mean scores of posttraining(self 5.2±0.4,expert 4.7±0.6)were significantly improved after real-time observation training of 3D visualization system(P<0.05).Scores of 4 surgical items were significantly improved both self and expert assessment after training(P<0.05).●CONCLUSION:The 3D observation training provides novice ophthalmic residents with a better understanding of intraocular microsurgical techniques.It is a useful tool to improve teaching efficiency of surgical education.

Pain perception enhancement in consecutive secondeye phacoemulsification cataract surgeries under topical anesthesia

Cataract is the main cause of visual impairment and blindness worldwide while the only effective cure for cataract is still surgery.Consecutive phacoemulsification under topical anesthesia has been the routine procedure for cataract surgery.However,patients often grumbled that they felt more painful during the second-eye surgery compared to the first-eye surgery.The intraoperative pain experience has negative influence on satisfaction and willingness for second-eye cataract surgery of patients with bilateral cataracts.Intraoperative ocular pain is a complicated process induced by the nociceptors activation in the peripheral nervous system.Immunological,neuropsychological,and pharmacological factors work together in the enhancement of intraoperative pain.Accumulating published literatures have focused on the pain enhancement during the secondeye phacoemulsification surgeries.In this review,we searched PubMed database for articles associated with pain perception differences between consecutive cataract surgeries published up to Feb.1,2024.We summarized the recent research progress in mechanisms and interventions for pain perception enhancement in consecutive secondeye phacoemulsification cataract surgeries.This review aimed to provide novel insights into strategies for improving patients’intraoperative experience in second-eye cataract surgeries.

Defining the association between the prolonged operative time and 90-day complications in patients undergoing radical cystectomy

Objective:Radical cystectomy is a complex lengthy procedure associated with postoperative morbidity.We aimed to assess the operative time(OT)in patients undergoing radical cystectomy and its impact on 90-day postoperative complications and readmission rates.Methods:The retrospective cohort study included 296 patients undergoing radical cystectomy and urinary diversion from May 2010 to December 2018 in our institution.The OT of 369 min was set as a cutoff value between short and long OT groups.The primary outcome was 90-day postoperative complication rates.Secondary outcomes were gastrointestinal recovery time,length of hospital stay,and 90-day readmission rates.Results:The overall incidence of 90-day postoperative complications was 79.7%where 43.2%representing low-grade complications according to the ClavieneDindo classification(Grade 1 and Grade 2),and 36.5%representing high-grade complications(Grade3).Gastrointestinal tract and infectious complications are the most common complications in our data set(45.9%and 45.6%,respectively).On multivariable analysis,prolonged OT was significantly associated with odds of high-grade complications(odds ratio 2.340,95%confidence interval 1.288e4.250,p=0.005).After propensity score-matched analysis,a higher incidence of major complications was identified in the long OT group 55(51.4%)compared to 35(32.7%)in the short OT group(p=0.006).A shorter gastrointestinal tract recovery time was noticed in the short OT group(p=0.009).Prolonged OT was associated with a higher 90-day readmission rate on univariate and multivariate analyses(p<0.001,p=0.001,respectively).

Mechanical Complications after Myocardial Infarction: A Comprehensive Review

Mechanical complications of myocardial infarction are potentially fatal events that can occur after an acute myocardial infarction. While the introduction of primary percutaneous reperfusion and fibrinolysis has reduced the incidence of these complications to less than 1%. These complications pose significant hemodynamic consequences and necessitate prompt diagnosis. Echocardiography, cardiac magnetic resonance imaging, and computed tomography are valuable tools for establishing an accurate and expedited diagnosis. Consequently, it is imperative to conduct further scientific research to enhance hemodynamic stabilization techniques such as intra-aortic balloon counterpulsation and extracorporeal membrane oxygenation, in addition to exploring new surgical procedures that can reduce mortality resulting from mechanical complications. This article aims to provide a comprehensive review of mechanical complications following myocardial infarction and their correlation with multi-imaging, facilitating a better understanding of these complications.

Transepithelial photorefractive keratectomy without mitomycin-C for irregular astigmatism after femtosecond laser-assisted in situ keratomileusisflap complications

Dear Editor,W e write to present a case report of transepithelial photorefractive keratectomy(TPRK)without mitomycin-C(MMC)for irregular astigmatism after femtosecond laser-assisted in situ keratomileusis(FS-LASIK)flap complications.Written informed consent was obtained from the patient to allow the publication of this case and associated accompanying images.The study was conducted in accordance with the Helsinki Declaration.TPRK is a surgical procedure which uses an excimer laser to ablation of both the corneal epithelium and stroma,which is widely used in clinic[1-2].The procedure may be conducted in cases where there is notable topographic irregularity or scarring following complications with the LASIK flap.Corneal haze is a potential complication following TPRK,and the use of MMC as a prophylactic agent against postoperative corneal haze has been demonstrated to significantly reduce its formation after TPRK/photorefractive keratectomy(PRK).

Tenosynovitis of hand: Causes and complications

Tenosynovitis represents a common clinical condition characterized by inflam-mation of the synovium that encases the tendon sheath.Although tenosynovities may be noted in any tendon in the body,extremities such as hand,and foot remain the sites of high predilection to acquire this condition.The predominant cause of this predilection rests in the intricate tendon arrangements in these extremities that permit fine motor actions.This editorial explores the common causes and the complications associated with this condition to improve the understanding of the readers of this common condition encountered in our everyday clinical practice.

Can we predict the incidence of high-grade Clavien-Dindo complications in patients with forgotten encrusted stents undergoing endourologic management?

Objective:Ureteral stents are customarily inserted to facilitate urinary drainage,but they come with their own glitches of being forgotten and/or encrusted leading to serious consequences.The present study aimed to report the complications in patients with forgotten and encrusted stents according to the Clavien-Dindo system specific to urological procedures and identify the factors leading to high-grade(Clavien-Dindo Grade 4A or above)complications.Methods:The hospital records of patients with forgotten encrusted double-J stents over a period of 8 years were reviewed.The parameters recorded included patient demographics,indwelling time,need for percutaneous nephrostomy,hemodialysis,urine culture,blood culture,total blood counts,serum creatinine,radiologic findings,management techniques,number of surgical interventions,modified Clavien-Dindo complications,follow-up,and mortality,if any.Results:Forty patients were included in the study.The median age was 52(range 6-85)years.Of the total,25(62.5%)patients had a“significant”stent load;31(77.5%)had renal failure or acute kidney injury on presentation;19(47.5%)patients had sepsis at presentation.Among the patients presented with sepsis,11(57.9%)patients demonstrated a positive urine culture;and 7/11(63.6%)patients exhibited pan-resistant organisms.Twelve out of 40(30.0%)patients in our series developed high-grade Clavien-Dindo complications.On univariate analysis,sepsis at presentation(p=0.007),stent load(p=0.031),diabetes(p=0.023),positive urine culture(p=0.007),and stent indwelling time of more than 1 year(p=0.031)were found to be significant.On multivariate logistic regression analysis,sepsis at presentation(p=0.017)and positive urine culture(p=0.016)were significant predictors for high-grade complications.Conclusion:It is prudent to identify specific risk factors,namely sepsis at presentation and positive urine culture to triage and optimize these patients before surgical management.

Complications of Corticosteroid Therapy in Rheumatological Practice in Guinea

Introduction: Corticosteroid therapy used in rheumatology is effective but can lead to complications. The objective was to describe the complications of corticosteroid therapy in rheumatological practice at Ignace Deen University Hospital (Conakry). Methods: Cross-sectional study from July 1, 2022 to March 31, 2023. All patients who had been diagnosed with a rheumatological disease and who had received corticosteroid therapy were included. Results: Of the 1489 patients suffering from rheumatological diseases, 238 (15.9%) had received corticosteroid therapy. The average age of the patients was 48.5 ± 17.16 years with a female predominance (70.5%). The main indications for corticosteroid therapy were lower back pain due to probable disco-radicular impingement (35.8%) followed by rheumatoid arthritis (21.9%). The predominant method of administration was infiltration (56.9%). The average dosage was 24.2 ± 13.5 mg prednisone equivalent (range: 5 mg and 40 mg). Complications were present in 26 patients (10.9%) such as muscle cramps (3.8%), hypocalcemia (3.4%), edema of the lower limbs (3%), stimulation of appetite and weight gain (3%), high blood pressure (2.5%), hyperglycemia (2.5%). The occurrence of complications was associated with the high dose of corticosteroid (p = 0.014) and long-term use (p = 0.000). Conclusion: Corticosteroid therapy used in 15.9% of consultations in the rheumatology department of Ignace Deen University Hospital led to 10.9% of complications. These complications were related to the dose and duration of corticosteroid therapy.

Mechanical Complications of Osteosynthesis: Frequency and Management at the Orthopedics-Traumatology Department of CHU Ignace DEEN

Introduction: Mechanical complications after osteosynthesis are spontaneous and harmful modifications of the joint compromising the consolidation process. The aim of this study is to report on the frequency of these complications and their management in the Orthopaedic-Traumatology Department of CHU Ignace Deen. Patients and Methods: we conducted a retrospective descriptive and analytical cross-sectional study from January 2017 to December 2022. It focused on the records of patients hospitalized and treated in the department for a mechanical complication after osteosynthesis. Results: The frequency of mechanical complications was 1.2%, with an average age of 44.2 years and a sex ratio of 3.2 in favor of men. Non-compliance with postoperative instructions, non-compliance with surgical technique, postoperative infection and early loading were the main contributing factors. Disassembly of the screw-plate was the most common cause in 6 cases (35.5%), with a mean delay of 4.1 months. Revision osteosynthesis was carried out using screw plates in 8 cases (47.1%). Conclusion: Mechanical complications of osteosynthesis are less frequent traumatic conditions in our department. Several factors contribute to their occurrence.

Prevention of complications in endourological management of stones:What are the basic measures needed before,during,and after interventions?

Objective:This narrative review aims to describe measures to minimise the risk of complications during percutaneous nephrolithotomy(PCNL),ureteroscopy,and retrograde intrarenal surgery.Methods:A literature search was conducted from the PubMed/PMC database for papers published within the last 10 years(January 2012 to December 2022).Search terms included“ureteroscopy”,“retrograde intrarenal surgery”,“PCNL”,“percutaneous nephrolithotomy”,“complications”,“sepsis”,“infection”,“bleed”,“haemorrhage”,and“hemorrhage”.Key papers were identified and included meta-analyses,systematic reviews,guidelines,and primary research.The references of these papers were searched to identify any further relevant papers not included above.Results:The evidence is assimilated with the opinions of the authors to provide recommendations.Best practice pathways for patient care in the pre-operative,intra-operative,and post-operative periods are described,including the identification and management of residual stones.Key complications(sepsis and stent issues)that are relevant for any endourological procedure are then be discussed.Operation-specific considerations are then explored.Key measures for PCNL include optimising access to minimise the chance of bleeding or visceral injury.The role of endoscopic combined intrarenal surgery in this regard is discussed.Key measures for ureteroscopy and retrograde intrarenal surgery include planning and technique to minimise the risk of ureteric injury.The role of anaesthetic assessment is discussed.The importance of specific comorbidities on each step of the pathway is highlighted as examples.Conclusion:This review demonstrates that the principles of meticulous planning,interdisciplinary teamworking,and good operative technique can minimise the risk of complications in endourology.

Clinical efficacy of femtosecond laser-assisted phacoemulsification in diabetic cataract patients

BACKGROUND Diabetic patients with cataracts encounter specific difficulties during cataract surgery due to alterations in microcirculation,blood supply,metabolism,and the microenvironment.Traditional phacoemulsification may not fully tackle these issues,especially in instances with substantial preoperative astigmatism.The utilization of femtosecond laser-assisted phacoemulsification,in conjunction with Toric intraocular lens(IOL)implantation,offers a potentially more efficient strategy.This research seeks to evaluate the efficacy and possible complications of this approach in diabetic cataract patients.AIM To investigate the clinical efficacy and complications of femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation in diabetic cataract patients,comparing it with traditional phacoemulsification methods.METHODS This retrospective study enrolled 120 patients with diabetes cataract from May 2019 to May 2021.The patients were divided into two groups:the control group underwent traditional phacoemulsification and Toric IOL implantation,while the treatment group received Len Sx femtosecond laser-assisted treatment.Outcome measures included naked eye vision,astigmatism,high-level ocular phase difference detection,clinical efficacy,and complication.RESULTS There were no significant preoperative differences in astigmatism or naked eyesight between the two groups.However,postoperative improvements were observed in both groups,with the treatment group showing greater enhancements in naked eye vision and astigmatism six months after the procedure.High-level corneal phase difference tests also indicated significant differences in favor of the treatment group.CONCLUSION This study suggests that femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation appears to be more effective in enhancing postoperative vision in diabetic cataract patients compared to traditional methods offering valuable insights for clinical practice.

Utero-Cutaneous Fistula after Caesarean Section Delivery: Diagnosis and Management of a Rare Complication

Utero-cutaneous fistula following cesarean section is a rare occurrence. We present the case of a 34-year-old woman who presented to our department four years after her second cesarean section with a history of pain and blood discharge from a previous Pfannenstiel incision, during menstruation, with an absence of vaginal menstrual flow. Despite a prior surgical repair operation, her symptoms persisted. A pelvic MRI was done to confirm the diagnosis of utero-cutaneous fistula, and surgical management was pursued. This case report aims to contribute to the existing literature on utero-cutaneous fistula and provide insights into the diagnostic considerations and management strategies for this rare complication.

Predictors and Complications of Prematurity in Two Health Facilities in Fako Division, Southwest Region, Cameroon

Background: Prematurity is the leading cause of neonatal mortality. Most preterm births can be associated to an identifiable risk factor. In Cameroon, especially in the Southwest Region, there is limited data regarding prematurity associated risk factors. The aim of this study was to evaluate the risk factors and complications of prematurity in two health facilities in the Fako division, the BRH and RHL. Methods: A hospital based retrospective case control study was done from the 1st of January 2021 to 28th of February 2022. We assessed the gestational ages at which preterm birth occurred and their short-term outcome using a structured pretested questionnaire to collect data from files. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 26. Results: The minimum sample size was 137 preterms. 45.5% of cases were born between 34 and increased the risk of having a preterm birth meanwhile being married (AOR: 0.410;95% CI: 0.217 - 0.773;p = 0.006) decreased the risk. Hospital complications were neonatal infection 103 (51.5%), respiratory distress 79 (39.5%) and neonatal jaundice 61 (30.50%). Among the cases, 97 (48.50%) stayed in the hospital for 2 to 4 weeks and 177 (88.5%) were discharged alive. Conclusions: Modifiable factors that increased the risk of prematurity were advanced maternal age, secondary level of education, rural residence, and prenatal alcohol consumption. Being married decreased the risk. The most common hospital complications in both the cases and controls were neonatal infection, respiratory distress syndrome and neonatal jaundice.

Effects of vitamin family members on insulin resistance and diabetes complications

The following letter to the editor highlights the article“Effects of vitamin D supplementation on glucose and lipid metabolism in patients with type 2 diabetes mellitus and risk factors for insulin resistance”in World J Diabetes 2023 Oct 15;14(10):1514-1523.It is necessary to explore the role of vitamin family members in insulin resistance and diabetes complications.

Effect of capsule treatment on visual acuity and quality after phacoemulsification lens implantation in myopic patients with cataract

BACKGROUND Cataracts pose a significant clinical burden due to their complex pathogenesis.In recent years,an increase in cataracts coexisting with myopia has heightened the incidence of retinopathy and posterior vitreous detachment.Additionally,symptoms of ocular axis elongation,lens nucleus hardening,and vitreous liquefaction have become more prevalent.While conventional extracapsular cataract extraction is commonly employed,it often yields suboptimal visual outcomes.Subsequent advancements in cataract phacoemulsification and lens implantation surgeries have gained widespread acceptance for their ability to improve refraction and significantly improve uncorrected visual acuity.AIM To investigate the effect of capsular treatment after phacoemulsification lens implantation in myopic patients with cataract.METHODS We selected 110 patients(with 134 eyes)with myopia and cataracts treated.These patients were categorized into two groups:an observation group(57 patients with 70 eyes)and a control group(53 patients with 64 eyes).The control group underwent cataract phacoemulsification and lens implantation,while the observation group received a refined capsular treatment based on the control group’s procedure.We assessed the differences in visual acuity and quality between the two groups before and after surgery.RESULTS At six months post-operation,the observation group exhibited significantly improved far vision,intermediate vision,near vision,lower objective scattering index,higher Modulation transfer function cut-off frequency,and overall vision metrics at different contrast levels(100%,20%and 9%)compared to the control group(P<0.05).The total score of the National Eye Institute Visual Function Questionnaire in the observation group at 6 months after operation was significantly higher than that in the control group(P<0.05).No significant difference in the incidence of adverse reactions was observed between the observation group and control group(P>0.05).CONCLUSION Capsular treatment demonstrates efficacy in improving visual acuity and quality after phacoemulsification lens implantation in myopic patients with cataracts,warranting its clinical application.