Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have signi...Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have significantly improved.While the systemic complications of post-transplantation are well recognized,ophthalmic manifestations remain underreported.Ophthalmic complications can significantly impair visual function and increase morbidity in these patients.Prolonged immunosuppression makes the patients susceptible to the opportunistic pathogens such as Cytomegalovirus,Candida,Aspergillus,etc.Other common findings include dry eye disease,cataracts and retinal vascular complications which further contribute to the long-term morbidity in these patients.Early ophthalmic evaluation and prompt management are essential to prevent irreversible vision loss and improve post-transplant outcomes.High index of suspicion and multidisciplinary approach is essential to facilitate early diagnosis and treatment.This review highlights the range of ophthalmic complications observed in liver transplant recipients and underscores the need for future research focused on understanding the underlying pathophysiological mechanisms and refining the prophylactic protocols to improve outcomes in this unique patient population.展开更多
BACKGROUND Elderly patients with colorectal cancer(CRC)can judge the risk of postoperative complications and oncological outcomes due to visceral obesity,which can provide data reference for the early prediction of pr...BACKGROUND Elderly patients with colorectal cancer(CRC)can judge the risk of postoperative complications and oncological outcomes due to visceral obesity,which can provide data reference for the early prediction of prognosis.AIM To explore the effect of visceral obesity on postoperative complications and oncological outcomes in elderly patients with CRC.METHODS A total of 150 elderly patients who underwent radical surgery for CRC at Inner Mongolia Medical University and Inner Mongolia Autonomous Region People’s Hospital from January 2021 to June 2024 were retrospectively analyzed.Patients were divided into the abdominal[visceral fat area(VFA)≥100.00 cm^(2),n=80]and non-abdominal(VFA<100.00 cm^(2),n=70)obesity groups according to the VFA measured by preoperative computed tomography.The two groups showed no significant differences in age,sex,tumor location,tumor-node-metastasis stage,and underlying disease(P>0.05).All patients underwent standardized laparoscopic assisted surgery and received unified perioperative management.Complications,nutritional status,changes in biochemical indicators,and tumor recurrence and metastasis were evaluated postoperatively.RESULTS The overall incidence of postoperative complications was significantly higher in the abdominal obesity group than in the non-abdominal obesity group(P<0.05).The pulmonary infection on postoperative day(POD)3(P=0.038),anastomotic leakage on POD 7(P=0.042),and moderate-to-severe complications(Clavien-Dindo class III,P=0.03)were significantly different.With respect to biochemical indicators,the white blood cell count,neutrophil percentage,and C-reactive protein level in the abdominal obesity group continuously increased after surgery(P<0.05);the albumin level on POD 1 was even lower(P=0.024).Regarding tumor markers,carcinoembryonic antigen(P=0.039)and carbohydrate antigen 19-9(P=0.048)levels were significantly higher in the abdominal obesity group at 3 months after surgery,and local recurrence rates were higher than those in the non-abdominal obesity group at 30 days and 3 months after surgery(P<0.05).Abdominal obesity was an independent risk factor for postoperative complications(odds ratio:3.843,P=0.001),overall survival[hazard ratio(HR):1.937,P=0.011],and disease-free survival(HR:1.769,P=0.018).CONCLUSION Visceral obesity significantly increases the risk of postoperative complications in elderly patients with CRC and may adversely affect short-term tumor prognosis.Preoperative risk identification and interventions for abdominal obesity should be strengthened to improve perioperative safety and postoperative rehabilitation quality.展开更多
AIM: To compare the complication rate of femtosecond laser-assisted cataract surgery(FLACS) and traditional phacoemulsification for the first 18 mo of FLACS use at a private surgical center in Hawaii.METHODS: A retros...AIM: To compare the complication rate of femtosecond laser-assisted cataract surgery(FLACS) and traditional phacoemulsification for the first 18 mo of FLACS use at a private surgical center in Hawaii.METHODS: A retrospective chart review was conducted from January 2012 to June 2013. The first 273 consecutive eyes receiving FLACS and 553 eyes receiving traditional phacoemulsification were examined.All surgeries were performed at a single surgical center in Hawaii. The presence of intraoperative complications was used as the main outcome measure. Approval was obtained from the institutional review board of the University of Hawaii.RESULTS: The overall complication rate for FLACS was 1.8%, while that of the traditional procedure was5.8%(P 【0.05). A majority of the surgeons(80%) had a lower complication rate while using FLACS.CONCLUSION: FLACS is comparable in safety, if not safer, than traditional cataract surgery when performed by qualified cataract surgeons on carefully selected patients.展开更多
BACKGROUND Acute ischemic stroke(AIS)is an abrupt blood flow cessation to a specific brain region within a vascular zone,causing a subsequent decline in neurological capabilities.Stent thrombectomy is a recently estab...BACKGROUND Acute ischemic stroke(AIS)is an abrupt blood flow cessation to a specific brain region within a vascular zone,causing a subsequent decline in neurological capabilities.Stent thrombectomy is a recently established technique for treating AIS.It provides the benefits of being a relatively simple and safe procedure,capable of partially enhancing a patient’s condition.However,some patients may experience endothelial damage and recurrent thrombosis,with clinical outcomes that are not always satisfactory.Hence,the efficacy of this method remains unclear.AIM To survey the association of stent thrombectomy vs standard treatment with neurological function protection,complications,and short-term prognosis in patients diagnosed with AIS.METHODS This study assigned 90 patients with AIS to the observation and control groups(n=45 patients)from December 2020 to December 2022.Stent thrombectomy was conducted in the observation group,whereas routine treatment was provided to the control group.The study assessed the therapeutic outcomes of two groups,including a comparison of their neurological function,living ability,anxiety and depression status,plaque area,serum inflammatory factors,serum Smur100βprotein,neuron-specific enolase(NSE),homocysteine(Hcy),and vascular endo-thelial function.Additionally,the incidence of complications was calculated and analyzed for each group.RESULTS The total effective rate of treatment was 77.78%and 95.56%in the control and observation groups,respectively.After 8 weeks of treatment,the scores on the National Institutes of Health Stroke Scale,Hamilton Anxiety Scale,and Hamilton Depression Scale decreased remarkably;the Barthel index increased remarkably,with better improvement effects of the scores in the observation group(P<0.05);total cholesterol,triglyceride,C-reactive protein,and plaque area lessened remarkably,with fewer patients in the observation group(P<0.05);S-100βprotein,NSE,and Hcy levels lessened remarkably,with fewer patients in the observation group(P<0.05);serum vascular endothelial growth factor and nitric oxide synthase levels increased remarkably,whereas the endothelin-1 level decreased,with better improvement effect in the observation group(P<0.05).Complications occurred in 8.88%of patients in the observation group compared with 33.33%in the control group.CONCLUSION Stent thrombectomy appeared to provide more remarkable neuroprotective effects in patients with AIS compared to the intravenous thrombolysis regimen.Additionally,it has effectively improved the neurological function,daily activities,and vascular endothelial function of patients,while reducing the incidence of complications and improving short-term prognosis.展开更多
Aqueous humor provides the necessary nutrition for the lens and transports the metabolites in the eye.It was a liquid that can directly reflect the microenvironment in the eye'and it can be easily obtained during ...Aqueous humor provides the necessary nutrition for the lens and transports the metabolites in the eye.It was a liquid that can directly reflect the microenvironment in the eye'and it can be easily obtained during the operation.This review intended to analyze the components of aqueous humor in patients with different types of cataracts'so as to reflect the pathogenesis and development of the disease'evaluate the incidence of postoperative complications and provide reference value for the surgical design of sequential cataract surgery.The aqueous humor components of different types of cataracts showed different degrees of inflammation'oxidative stress and extracellular matrix remodeling.The biomarker of early neuropathy in diabetic cataract was neural cell adhesion molecule-1(NCAM1).Transforming growth factor-β(TGF-β)was the evaluation factor of disease development in patients with pseudoexfoliation syndrome.The relationships between postoperative complications of different types of cataracts and aqueous humor components were as follows:Macular edema after diabetic cataract surgery was associated with tumor necrosis factor-alpha;capsular contraction after high myopic cataract surgery was related to monocyte chemoattractant protein-1(MCP-1)and TGF-β2;Klotho and glutathione S-transferase P 1(GSTP1)were associated with high intraocular pressure after primary open-angle glaucoma complicated by cataract surgery;capsular contraction after retinitis pigmentosa complicated by cataract surgery was associated with matrix metalloproteinases;pro-inflammatory cytokines and fibroblast growth factor 4 in the aqueous humor of congenital cataracts were associated with posterior capsular opacification after surgery.Granulocyte colony stimulating factor 3 and MCP-1 were the main cytokines mediating the pain of the second eye in the binocular sequential cataract surgery short interval(1 wk)'while MCP-1 mediated pain in the long interval(6 wk).The second eye after binocular sequential cataract surgery had a higher level of proinflammatory factors.The components of aqueous humor in patients with different types of cataracts were related to the pathogenesis and postoperative complications of the disease.Monitoring the components of the aqueous humor could help better understand the intraocular microenvironment of different types of cataracts and provide a reference for predicting the development of the disease and implementing relevant targeted therapy.展开更多
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 phacoemulsificat...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].展开更多
AIM: To compare the incidence of intraoperative complications during primary phacoemulsification(phaco) surgery between resident surgeons(residents) and staff surgeons(specialists) and to objectively determine the dif...AIM: To compare the incidence of intraoperative complications during primary phacoemulsification(phaco) surgery between resident surgeons(residents) and staff surgeons(specialists) and to objectively determine the difficulty of stages in phaco surgery. METHODS: This retrospective study included cases of phaco cataract surgery performed between January and December 2019. There were no exclusion criteria. For each patient, demographics, clinical history, case complexity, type of surgeon, and operative details were reviewed. Primary outcomes included intraoperative complication rates and the objective measure of difficulty in the steps of the surgery performed by residents and specialists.RESULTS: A total of 3272 cases were included;7.4%(n=241) of cases were performed by residents. The overall complication rate was 5.4%(n=177). The intraoperative complication rate was significantly higher(P<0.001) in residents(n=33, 13.7%) than in specialists(n=144, 4.8%). The most frequent complications were posterior capsule tear(n=85, 2.6%), anterior capsule tear(n=50, 1.53%), zonular fiber loss(n=45, 1.38%), and dropped nucleus(n=15, 0.46%). Objectively, the most difficult steps during surgery were phaco in 66(60.0%), capsulorhexis in 21(19.1%), irrigation/aspiration in 13(11.8%), hydrodissection in 9(8.2%), and intraocular lens(IOL) implantation in 1(0.9%) case. CONCLUSION: Intraoperative complication rates are higher in residents than in specialists. The order of objective difficulty in phaco surgery steps is in line with the subjective findings of other surveys, revealing that the most challenging parts of phaco surgery are phaco and capsulorhexis.展开更多
AIM:To evaluate the visual outcomes of implantable collamer lenses(ICLs)and identify the possible risk factors for ICL axis misalignment,and consequently,repositioning,explanting,or exchanging at a specialized eye hos...AIM:To evaluate the visual outcomes of implantable collamer lenses(ICLs)and identify the possible risk factors for ICL axis misalignment,and consequently,repositioning,explanting,or exchanging at a specialized eye hospital in Saudi Arabia.METHODS:The medical records of 813 eyes with different refractive errors corrected with ICL implantation were identified and included in this single-arm retrospective cohort study.The following data were collected:demographic characteristics,primary diagnosis,preoperative refraction,anterior chamber depth(ACD),white-to-white(WTW)measurement,endothelial cell density(ECD),and axial length.Patients’satisfaction and complaints,and their postoperative refraction,vault depth,and axis alignment with the preoperative target,were reviewed during the postoperative period.Collectively,these data were correlated with symptomatic axis rotation and the need for repositioning,explantation,or exchange due to high or low ICL vaults.RESULTS:Of 813 eyes,27(3.32%),13(1.59%),and 11(1.35%)required ICL repositioning,ICL explantation only without exchange,and ICL explantation with the placement of a new ICL,respectively.The mean follow-up period was 37.5mo.The main cause of explanation or exchange was incorrect WTW measurement in seven(29.17%)eyes,followed by high vault in four(16.56%)eyes.ICL repositioning was required in 27(3.32%)eyes with considerable rotation.Only 2(0.24%)eyes developed cataracts that required ICL removal,and retinal complications were reported in 7(0.86%)eyes.Long-term glaucoma and corneal decompensation were not observed in this cohort.CONCLUSION:With a high safety profile and reversibility,ICL implantation is a good alternative to corneal-based refractive surgery in eyes unsuitable for laser vision correction.The rate of secondary procedures in our study was 6.26%.Old age is a risk factor for secondary surgical interventions in the repositioning group,whereas abnormal vault and toric ICL rotation in the explantation group necessitated subsequent surgical procedures.Overall,ICL implantation demonstrates a good efficacy index and safety profile in patients with diverse refractive errors.展开更多
Background: In children, acute bacterial rhinosinusitis (ABRS) is often complicated by ophthalmological and/or neurological involvement. These complications should be known and recognized, as they require urgent treat...Background: In children, acute bacterial rhinosinusitis (ABRS) is often complicated by ophthalmological and/or neurological involvement. These complications should be known and recognized, as they require urgent treatment with intravenous antibiotics and close in-hospital monitoring. In this study, we aimed to identify the main risk factors associated with the development of complications in children aged 2 - 17 years with ABRS. Methods: We conducted a retrospective cohort study of patients with ABRS complications in a primary hospital. Participants were divided into two groups: the control group comprising patients without complications (Group 1, n = 82) and the study group comprising patients with complications requiring hospitalization (Group 2, n = 41). We assessed the sociodemographic, clinical, and imaging data of both groups. Using multivariate logistic regression, we assessed risk factors of ABRS complications. Results: No socio-demographic characteristics were associated with ABRS complications (p ≥ 0.05). Factors associated with complications were delay in consultation (t = 5.282;p Conclusions: Intracranial and extracranial complications of ABRS in children have become rare in our setting. These complications can be serious and potentially fatal. Risk factors of these complications are delays in consultation, the presence of ophthalmological signs, and more than one affected sinus. Controlling modifiable factors would improve the treatment success of ABRS complications in children.展开更多
BACKGROUND Red blood cell distribution width(RDW)is associated with the development and progression of various diseases.AIM To explore the association between pretreatment RDW and short-term outcomes after laparoscopi...BACKGROUND Red blood cell distribution width(RDW)is associated with the development and progression of various diseases.AIM To explore the association between pretreatment RDW and short-term outcomes after laparoscopic pancreatoduodenectomy(LPD).METHODS A total of 804 consecutive patients who underwent LPD at our hospital between March 2017 and November 2021 were retrospectively analyzed.Correlations between pretreatment RDW and clinicopathological characteristics and short-term outcomes were investigated.RESULTS Patients with higher pretreatment RDW were older,had higher Eastern Cooperative Oncology Group scores and were associated with poorer short-term outcomes than those with normal RDW.High pretreatment RDW was an independent risk factor for postoperative complications(POCs)(hazard ratio=2.973,95%confidence interval:2.032-4.350,P<0.001)and severe POCs of grade IIIa or higher(hazard ratio=3.138,95%confidence interval:2.042-4.824,P<0.001)based on the Clavien-Dino classification system.Subgroup analysis showed that high pretreatment RDW was an independent risk factor for Clavien-Dino classi-fication grade IIIb or higher POCs,a comprehensive complication index score≥26.2,severe postoperative pancreatic fistula,severe bile leakage and severe hemorrhage.High pretreatment RDW was positively associated with the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and was negatively associated with albumin and the prognostic nutritional index.CONCLUSION Pretreatment RDW was a special parameter for patients who underwent LPD.It was associated with malnutrition,severe inflammatory status and poorer short-term outcomes.RDW could be a surrogate marker for nutritional and inflammatory status in identifying patients who were at high risk of developing POCs after LPD.展开更多
BACKGROUND Cauda equina syndrome(CES)is characterized by a group of symptoms that may be caused by inflammation,spinal cord compression,venous congestion,or ischemia.This syndrome is commonly an indication for surgica...BACKGROUND Cauda equina syndrome(CES)is characterized by a group of symptoms that may be caused by inflammation,spinal cord compression,venous congestion,or ischemia.This syndrome is commonly an indication for surgical intervention but has not been determined as a postoperative complication following surgery for lumbar spine disease.CASE SUMMARY To report the case of a 54-year-old male patient who had CES following spinal surgery,with no obvious compression lesions found during re-exploration,suggesting that vascular insufficiency may have contributed to the condition.Furthermore,a series of urodynamic studies on bladder recovery patterns in such complications have also been investigated.CONCLUSION Postoperative CES requires urgent imaging and exploration to rule out compression;noncompressive cases,including vascular insufficiency may performed conservative management.展开更多
Background: In developing countries, charity cleft surgical mission is always operated by sporadic surgical teams without systematic follow up and quality assurance. In the past few decades, many mission projects have...Background: In developing countries, charity cleft surgical mission is always operated by sporadic surgical teams without systematic follow up and quality assurance. In the past few decades, many mission projects have been held regularly in China. The purpose of this audit was a retrospective analysis of a 9-year cleft lip and palate charity project operated in a tertiary hospital in China Shenzhen Area to evaluate perioperative and postoperative complications. Nevertheless, understanding the risk profile is essential for establishing a sustainable in-house cleft service in Shenzhen. Methods: A detailed analysis of hospital centralized record in the The University of Hong Kong-Shenzhen Hospital (HKUSZH) was reviewed since the first charity project held in 2015. The parameters of this audit were focused on perioperative complications including anesthesia related problems, early postoperative complications in patients who underwent primary or secondary cleft surgeries. A total of 430 consecutive admitted cases of 311 non-syndromic cleft lip & palate patients were enrolled into the charity project from June 2015 to July 2024. The main anesthesia related complications that occurred during general anesthesia were respiratory tract problems, while intraoperative complication was excessive bleeding, so as wound local infection and reaction were the main early postoperative complications. Results: In our 9-year clinical audit of 430 cleft lip and palate charity surgeries in Shenzhen, we observed no mortalities and a anesthesia-related complication rate of 1.16%. Specific intraoperative complications included excessive bleeding, while early postoperative issues were dominated by wound infections. The fistula rate of 18.7% post palate repair and the average hospital stay of 3.71 days complete the profile of our surgical outcomes. These data underscore the project’s efficacy and offer a reference for international cleft missions aiming for safe and efficient surgical care. Conclusions: This study provides a thorough data review of the complications in the past 9 years charity missions for cleft lip and palate surgery in a well-structured hospital infrastructure and logistic support by local surgical team. There were no perioperative or postoperative death during the study period and the overall short-term complication rate was low. Therefore, it could be a reference model for other international cleft mission in developing country for a safe and efficient service in future.展开更多
Background and Objectives: Post-operative complications (POC) are new pathological phenomena occurring in the post-operative period and worsening the previous situation through their morbidity and mortality. Our aim w...Background and Objectives: Post-operative complications (POC) are new pathological phenomena occurring in the post-operative period and worsening the previous situation through their morbidity and mortality. Our aim was to determine the prevalence and preoperative factors associated with early POC at University Clinics of Kisangani (CUKIS). Methods: This was a cross-sectional study conducted in the CUKIS, Department of Surgery from 1 January 2014 to 31 December 2023. The target population consisted of all patients who had undergone full post-operative follow-up. A logistic regression model using RStudio version 4.4.0 software was used to determine the factors predicting early postoperative complications. Results: The prevalence of early POC was estimated at 35%, with surgical site infection the most frequent POC at 45.3%. After multivariate analysis using logistic regression, the social category of widow(er)s, transfer, previous laparotomy, acute generalised peritonitis, preoperative length of stay of more than 10 days and ASA score 2 and 5 were significant risk factors associated with the occurrence of POC in the preoperative period. Conclusion: Certain factors can predict the occurrence of POC. Knowledge of these factors can help practitioners to take useful measures before each surgical operation on a patient with these factors, with a view to preventing or managing POC.展开更多
Background: Diabetes Mellitus (DM) is a growing health issue in Bangladesh, with significant complications affecting the quality of life (QoL). This study aims to assess long-term complications, treatment patterns, an...Background: Diabetes Mellitus (DM) is a growing health issue in Bangladesh, with significant complications affecting the quality of life (QoL). This study aims to assess long-term complications, treatment patterns, and QoL of diabetic patients during COVID-19. Methods: A cross-sectional study was conducted on 385 diabetic patients (aged 18-80) from tertiary hospitals in Dhaka and Mymensingh between May and October 2022. Data were collected via a semi-structured questionnaire on sociodemographics, complications, treatment patterns, and QoL (SF-12 scale). Chi-square tests, ANOVA, and linear regression were used for inferential analysis. Results: The sample predominantly included middle-aged males (41 - 55 years) with type 2 diabetes. Diabetic retinopathy (34.5%), polyneuropathy (32.2%), and hypertension (52.3%) were the most common complications. Oral medications were used by 59.7% of patients, with 29.1% on insulin. Chi-square analysis showed a significant association between treatment adherence and complications (p β = 0.45, p Conclusion: Complications in diabetic patients significantly affect QoL in Bangladesh. Treatment adherence, especially with oral medications, positively impacts QoL. There is a need for improved access to diabetes care to manage complications and enhance the overall well-being of diabetic patients.展开更多
Diabetes is a major public health concern worldwide. Low and middle-income countries are the most affected. Diabetes self-management can significantly reduce the burden of diabetes complications and mortality. This cr...Diabetes is a major public health concern worldwide. Low and middle-income countries are the most affected. Diabetes self-management can significantly reduce the burden of diabetes complications and mortality. This cross-sectional study was conducted at the outpatient department of a county referral hospital in Kenya, from 1st August 2022 to 30th October 2022. Patients with known type II diabetes of age ≥ 20 years visiting the hospital for routine follow-up visits were included. A 7-tem Summary of Diabetes Self-care Activities (SDSAC) Questionnaire was used to assess Diabetes self-care activities. For data entry and statistical analysis, SPSS for Windows version 27.0 was used. There were 96 (39.2%) males and 149 (60.8%) females. Most of the participants were more than 61 years, 148 (60.4%). Significant association was found between the sum scale scores of dietary activities, blood glucose testing, physical activity, foot care, and neuropathy at 95% CI and (p Conclusions: Diabetes self-management activities have an impact on microvascular complications in patients with diabetes.展开更多
Liver transplantation(LT)is the most effective treatment for patients with end-stage liver disease,and maintaining vascular patency of the transplanted liver is one of the crucial prerequisites for surgical success.De...Liver transplantation(LT)is the most effective treatment for patients with end-stage liver disease,and maintaining vascular patency of the transplanted liver is one of the crucial prerequisites for surgical success.Despite hepatic vein complic-ations following LT occurring at a relatively low frequency,ranging between 2%to 11%,delayed diagnosis and treatment may lead to graft dysfunction and even patient mortality.Clinical manifestations of hepatic vein complications are often subtle and nonspecific,posing challenges for early diagnosis.Signs may initially present as mild abnormalities in liver function,delayed recovery of liver function,unexplained ascites,lower limb edema,and perineal edema.Prolonged duration of these complications can lead to hepatic sinusoidal dilatation and eventual liver failure due to prolonged hepatic congestion.Ultrasonography has become the preferred imaging modality for post-liver transplant evaluation due to its convenience and non-invasiveness.Although hepatic vein complications may manifest as disappearance or flattening of the hepatic vein spectrum on routine ultrasound imaging,these findings lack specificity.Contrast-enhanced ultrasound that visualizes the filling of contrast agent in the hepatic veins and dynamically displays blood flow perfusion information in the drainage area can,however,significantly improve diagnostic confidence and provide additional information beyond routine ultrasound examination.展开更多
Type 2 diabetes mellitus(T2DM)is a chronic metabolic disorder characterized by hyperglycemia and insulin resistance,often leading to severe complications.Hemogram markers have attracted great attention from researcher...Type 2 diabetes mellitus(T2DM)is a chronic metabolic disorder characterized by hyperglycemia and insulin resistance,often leading to severe complications.Hemogram markers have attracted great attention from researchers for their established role in inflammatory conditions.In this respect,T2DM and its mi-crovascular complications are characterized by high inflammatory burden.Hence,recent studies in the literature have reported an association between T2DM and hemogram-derived markers.Emerging evidence highlights the utility of hemo-gram-derived markers,including the neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,red cell distribution width,and mean platelet volume,as potential predictors of T2DM onset and progression.These markers,readily available from routine hemogram tests,offer valuable insights into the systemic inflammation and vascular changes associated with T2DM and its complications,such as cardiovascular disease,nephropathy,and retinopathy.This review syn-thesizes current research on the association between hemogram-derived markers and T2DM,emphasizing their prognostic value in predicting disease severity and complications.We also explore the underlying pathophysiological mechanisms linking these markers to inflammation and metabolic dysfunction.The findings suggest that hemogram-derived markers could serve as cost-effective,non-invasive tools for risk stratification and early intervention in T2DM management.Future research should focus on standardizing reference ranges and validating these markers in diverse populations to enhance their clinical utility.展开更多
AIM: To investigate the effectiveness of combinationtherapy with transzonular triamcinolone-moxifloxacin andconventional perioperative drops in reducing postoperativecomplications of cataract surgery. METHODS: Electro...AIM: To investigate the effectiveness of combinationtherapy with transzonular triamcinolone-moxifloxacin andconventional perioperative drops in reducing postoperativecomplications of cataract surgery. METHODS: Electronic medical records of cataractsurgery patients (single surgeon) were reviewed fromJanuary 2018 to September 2021. The rate of postoperativecomplications including prolonged and/or recurrentpostoperative inflammation, endophthalmitis, cystoid macularedema (CME), and intraocular pressure (IOP) was comparedbetween the patients receiving combinative therapy andpatients receiving drops only. RESULTS: Totally 596 patients and 1057 eyes(Combinative-Therapy group 493 and Drop-Only group 564)were included in this study. Using combination therapyreduced the relative risk of postoperative inflammationby 26.9% (16.6% Combinative-Therapy vs 22.7% Drop-Only, P=0.013). The incidence of endophthalmitis was 0in Combinative-Therapy group vs 0.5% in Drop-Only group(relative risk reduction 100%), although not statisticallysignificant (P=0.10). The incidence of severe IOP spikeswas not significantly different between Combinative-Therapy (2.4%) and Drop-Only (1.6%) groups (P=0.33).The relative risk of postoperative CME was 51.4% less inthree months follow up visit in Combinative-Therapy group,although not statistically significant (P=0.07). The visualoutcome 1-month postop. (best corrected visual acuity) wassignificantly better in Combinative-Therapy (logMAR 0.10)compared to Drop-Only (logMAR 0.14) groups (P=0.02) whilethe baseline visual acuity was not significantly different. CONCLUSION: The combinative approach oftranszonular triamcinolone-moxifloxacin plus perioperativeeyedrops is an effective method to minimize postoperativeinflammation, with better visual outcomes. It couldpotentially reduce the risk of postoperative endophthalmitisand CME (near-significant P-values;larger studies couldanalyze better considering low incidence).展开更多
BACKGROUND Detailed data on the relation of post-operative complications with clinical outcomes after simultaneous pancreas-kidney(SPK)transplantation is lacking.AIM To compare Clavien-Dindo classification(CDC)and com...BACKGROUND Detailed data on the relation of post-operative complications with clinical outcomes after simultaneous pancreas-kidney(SPK)transplantation is lacking.AIM To compare Clavien-Dindo classification(CDC)and comprehensive complication index(CCI)in predicting outcomes after SPK.METHODS Data for patients undergoing SPK between 1999-2019 were analyzed.Information on recipients’baseline characteristics,peri-operative management and postoperative complications were collated.Length of hospital stay(LOS)was the primary study outcome,and the associations with CDC and CCI were evaluated using Spearman’s(ρ)correlation coefficients.RESULTS In the study period,data were available for 128 patients(female n=44,34.4%).Sixty-nine patients had at least one complication with the highest CDC grade of I,II,III,and IV in 8(6.3%),22(17.2%),32(25%),and 7(5.5%)patients,respectively. The mean LOS was 21.4 ± 17.7 days. Both classification systems were correlated with LOS, yet CCI was stronger(Spearman’s ρ: 0.694 vs 0.602, P < 0.001). Female patients (P = 0.019) and patients with pre-transplant cardiovascularevents (P = 0.02) had longer LOS. After adjusted multivariable analysis, the link between LOS and both theCDC and CCI remained relevant. CCI had a superior fit compared to CDC (r2 = 0.729 vs r2 = 0.481), with every 10CCI points being associated with a 5.27 day (P < 0.001) increased LOS.CONCLUSIONThis study showed that the CCI was better linked with LOS compared to CDC and might represent a useful scoreto evaluate the overall burden of postoperative complications in patients undergoing SPK.展开更多
Perioperative morbidity of esophagectomy significantly affects the surgical outcome,like any major gastrointestinal procedure.Despite introduction of minimally invasive esophagectomy,the morbidity is still close to 30...Perioperative morbidity of esophagectomy significantly affects the surgical outcome,like any major gastrointestinal procedure.Despite introduction of minimally invasive esophagectomy,the morbidity is still close to 30%-40%.The common complications following esophagectomy are pulmonary infections,cardiac events,anastomotic leakage,bleeding,chylous leak,and recurrent laryngeal nerve palsy which in turn lead to longer hospital stay,increased treatment cost and poor quality of life.A nomographic model comprising preoperative(patient,disease and treatment related)and intraoperative factors in combination with Artificial Intelligence may accurately identify the patients at higher risk of morbidity.This will aid in optimizing the modifiable risk factors preoperatively,and closely monitor these patients post operatively for early identification of complications and to initiate early corrective measures to improve the surgical outcome.展开更多
文摘Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have significantly improved.While the systemic complications of post-transplantation are well recognized,ophthalmic manifestations remain underreported.Ophthalmic complications can significantly impair visual function and increase morbidity in these patients.Prolonged immunosuppression makes the patients susceptible to the opportunistic pathogens such as Cytomegalovirus,Candida,Aspergillus,etc.Other common findings include dry eye disease,cataracts and retinal vascular complications which further contribute to the long-term morbidity in these patients.Early ophthalmic evaluation and prompt management are essential to prevent irreversible vision loss and improve post-transplant outcomes.High index of suspicion and multidisciplinary approach is essential to facilitate early diagnosis and treatment.This review highlights the range of ophthalmic complications observed in liver transplant recipients and underscores the need for future research focused on understanding the underlying pathophysiological mechanisms and refining the prophylactic protocols to improve outcomes in this unique patient population.
文摘BACKGROUND Elderly patients with colorectal cancer(CRC)can judge the risk of postoperative complications and oncological outcomes due to visceral obesity,which can provide data reference for the early prediction of prognosis.AIM To explore the effect of visceral obesity on postoperative complications and oncological outcomes in elderly patients with CRC.METHODS A total of 150 elderly patients who underwent radical surgery for CRC at Inner Mongolia Medical University and Inner Mongolia Autonomous Region People’s Hospital from January 2021 to June 2024 were retrospectively analyzed.Patients were divided into the abdominal[visceral fat area(VFA)≥100.00 cm^(2),n=80]and non-abdominal(VFA<100.00 cm^(2),n=70)obesity groups according to the VFA measured by preoperative computed tomography.The two groups showed no significant differences in age,sex,tumor location,tumor-node-metastasis stage,and underlying disease(P>0.05).All patients underwent standardized laparoscopic assisted surgery and received unified perioperative management.Complications,nutritional status,changes in biochemical indicators,and tumor recurrence and metastasis were evaluated postoperatively.RESULTS The overall incidence of postoperative complications was significantly higher in the abdominal obesity group than in the non-abdominal obesity group(P<0.05).The pulmonary infection on postoperative day(POD)3(P=0.038),anastomotic leakage on POD 7(P=0.042),and moderate-to-severe complications(Clavien-Dindo class III,P=0.03)were significantly different.With respect to biochemical indicators,the white blood cell count,neutrophil percentage,and C-reactive protein level in the abdominal obesity group continuously increased after surgery(P<0.05);the albumin level on POD 1 was even lower(P=0.024).Regarding tumor markers,carcinoembryonic antigen(P=0.039)and carbohydrate antigen 19-9(P=0.048)levels were significantly higher in the abdominal obesity group at 3 months after surgery,and local recurrence rates were higher than those in the non-abdominal obesity group at 30 days and 3 months after surgery(P<0.05).Abdominal obesity was an independent risk factor for postoperative complications(odds ratio:3.843,P=0.001),overall survival[hazard ratio(HR):1.937,P=0.011],and disease-free survival(HR:1.769,P=0.018).CONCLUSION Visceral obesity significantly increases the risk of postoperative complications in elderly patients with CRC and may adversely affect short-term tumor prognosis.Preoperative risk identification and interventions for abdominal obesity should be strengthened to improve perioperative safety and postoperative rehabilitation quality.
文摘AIM: To compare the complication rate of femtosecond laser-assisted cataract surgery(FLACS) and traditional phacoemulsification for the first 18 mo of FLACS use at a private surgical center in Hawaii.METHODS: A retrospective chart review was conducted from January 2012 to June 2013. The first 273 consecutive eyes receiving FLACS and 553 eyes receiving traditional phacoemulsification were examined.All surgeries were performed at a single surgical center in Hawaii. The presence of intraoperative complications was used as the main outcome measure. Approval was obtained from the institutional review board of the University of Hawaii.RESULTS: The overall complication rate for FLACS was 1.8%, while that of the traditional procedure was5.8%(P 【0.05). A majority of the surgeons(80%) had a lower complication rate while using FLACS.CONCLUSION: FLACS is comparable in safety, if not safer, than traditional cataract surgery when performed by qualified cataract surgeons on carefully selected patients.
文摘BACKGROUND Acute ischemic stroke(AIS)is an abrupt blood flow cessation to a specific brain region within a vascular zone,causing a subsequent decline in neurological capabilities.Stent thrombectomy is a recently established technique for treating AIS.It provides the benefits of being a relatively simple and safe procedure,capable of partially enhancing a patient’s condition.However,some patients may experience endothelial damage and recurrent thrombosis,with clinical outcomes that are not always satisfactory.Hence,the efficacy of this method remains unclear.AIM To survey the association of stent thrombectomy vs standard treatment with neurological function protection,complications,and short-term prognosis in patients diagnosed with AIS.METHODS This study assigned 90 patients with AIS to the observation and control groups(n=45 patients)from December 2020 to December 2022.Stent thrombectomy was conducted in the observation group,whereas routine treatment was provided to the control group.The study assessed the therapeutic outcomes of two groups,including a comparison of their neurological function,living ability,anxiety and depression status,plaque area,serum inflammatory factors,serum Smur100βprotein,neuron-specific enolase(NSE),homocysteine(Hcy),and vascular endo-thelial function.Additionally,the incidence of complications was calculated and analyzed for each group.RESULTS The total effective rate of treatment was 77.78%and 95.56%in the control and observation groups,respectively.After 8 weeks of treatment,the scores on the National Institutes of Health Stroke Scale,Hamilton Anxiety Scale,and Hamilton Depression Scale decreased remarkably;the Barthel index increased remarkably,with better improvement effects of the scores in the observation group(P<0.05);total cholesterol,triglyceride,C-reactive protein,and plaque area lessened remarkably,with fewer patients in the observation group(P<0.05);S-100βprotein,NSE,and Hcy levels lessened remarkably,with fewer patients in the observation group(P<0.05);serum vascular endothelial growth factor and nitric oxide synthase levels increased remarkably,whereas the endothelin-1 level decreased,with better improvement effect in the observation group(P<0.05).Complications occurred in 8.88%of patients in the observation group compared with 33.33%in the control group.CONCLUSION Stent thrombectomy appeared to provide more remarkable neuroprotective effects in patients with AIS compared to the intravenous thrombolysis regimen.Additionally,it has effectively improved the neurological function,daily activities,and vascular endothelial function of patients,while reducing the incidence of complications and improving short-term prognosis.
文摘Aqueous humor provides the necessary nutrition for the lens and transports the metabolites in the eye.It was a liquid that can directly reflect the microenvironment in the eye'and it can be easily obtained during the operation.This review intended to analyze the components of aqueous humor in patients with different types of cataracts'so as to reflect the pathogenesis and development of the disease'evaluate the incidence of postoperative complications and provide reference value for the surgical design of sequential cataract surgery.The aqueous humor components of different types of cataracts showed different degrees of inflammation'oxidative stress and extracellular matrix remodeling.The biomarker of early neuropathy in diabetic cataract was neural cell adhesion molecule-1(NCAM1).Transforming growth factor-β(TGF-β)was the evaluation factor of disease development in patients with pseudoexfoliation syndrome.The relationships between postoperative complications of different types of cataracts and aqueous humor components were as follows:Macular edema after diabetic cataract surgery was associated with tumor necrosis factor-alpha;capsular contraction after high myopic cataract surgery was related to monocyte chemoattractant protein-1(MCP-1)and TGF-β2;Klotho and glutathione S-transferase P 1(GSTP1)were associated with high intraocular pressure after primary open-angle glaucoma complicated by cataract surgery;capsular contraction after retinitis pigmentosa complicated by cataract surgery was associated with matrix metalloproteinases;pro-inflammatory cytokines and fibroblast growth factor 4 in the aqueous humor of congenital cataracts were associated with posterior capsular opacification after surgery.Granulocyte colony stimulating factor 3 and MCP-1 were the main cytokines mediating the pain of the second eye in the binocular sequential cataract surgery short interval(1 wk)'while MCP-1 mediated pain in the long interval(6 wk).The second eye after binocular sequential cataract surgery had a higher level of proinflammatory factors.The components of aqueous humor in patients with different types of cataracts were related to the pathogenesis and postoperative complications of the disease.Monitoring the components of the aqueous humor could help better understand the intraocular microenvironment of different types of cataracts and provide a reference for predicting the development of the disease and implementing relevant targeted therapy.
文摘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].
文摘AIM: To compare the incidence of intraoperative complications during primary phacoemulsification(phaco) surgery between resident surgeons(residents) and staff surgeons(specialists) and to objectively determine the difficulty of stages in phaco surgery. METHODS: This retrospective study included cases of phaco cataract surgery performed between January and December 2019. There were no exclusion criteria. For each patient, demographics, clinical history, case complexity, type of surgeon, and operative details were reviewed. Primary outcomes included intraoperative complication rates and the objective measure of difficulty in the steps of the surgery performed by residents and specialists.RESULTS: A total of 3272 cases were included;7.4%(n=241) of cases were performed by residents. The overall complication rate was 5.4%(n=177). The intraoperative complication rate was significantly higher(P<0.001) in residents(n=33, 13.7%) than in specialists(n=144, 4.8%). The most frequent complications were posterior capsule tear(n=85, 2.6%), anterior capsule tear(n=50, 1.53%), zonular fiber loss(n=45, 1.38%), and dropped nucleus(n=15, 0.46%). Objectively, the most difficult steps during surgery were phaco in 66(60.0%), capsulorhexis in 21(19.1%), irrigation/aspiration in 13(11.8%), hydrodissection in 9(8.2%), and intraocular lens(IOL) implantation in 1(0.9%) case. CONCLUSION: Intraoperative complication rates are higher in residents than in specialists. The order of objective difficulty in phaco surgery steps is in line with the subjective findings of other surveys, revealing that the most challenging parts of phaco surgery are phaco and capsulorhexis.
文摘AIM:To evaluate the visual outcomes of implantable collamer lenses(ICLs)and identify the possible risk factors for ICL axis misalignment,and consequently,repositioning,explanting,or exchanging at a specialized eye hospital in Saudi Arabia.METHODS:The medical records of 813 eyes with different refractive errors corrected with ICL implantation were identified and included in this single-arm retrospective cohort study.The following data were collected:demographic characteristics,primary diagnosis,preoperative refraction,anterior chamber depth(ACD),white-to-white(WTW)measurement,endothelial cell density(ECD),and axial length.Patients’satisfaction and complaints,and their postoperative refraction,vault depth,and axis alignment with the preoperative target,were reviewed during the postoperative period.Collectively,these data were correlated with symptomatic axis rotation and the need for repositioning,explantation,or exchange due to high or low ICL vaults.RESULTS:Of 813 eyes,27(3.32%),13(1.59%),and 11(1.35%)required ICL repositioning,ICL explantation only without exchange,and ICL explantation with the placement of a new ICL,respectively.The mean follow-up period was 37.5mo.The main cause of explanation or exchange was incorrect WTW measurement in seven(29.17%)eyes,followed by high vault in four(16.56%)eyes.ICL repositioning was required in 27(3.32%)eyes with considerable rotation.Only 2(0.24%)eyes developed cataracts that required ICL removal,and retinal complications were reported in 7(0.86%)eyes.Long-term glaucoma and corneal decompensation were not observed in this cohort.CONCLUSION:With a high safety profile and reversibility,ICL implantation is a good alternative to corneal-based refractive surgery in eyes unsuitable for laser vision correction.The rate of secondary procedures in our study was 6.26%.Old age is a risk factor for secondary surgical interventions in the repositioning group,whereas abnormal vault and toric ICL rotation in the explantation group necessitated subsequent surgical procedures.Overall,ICL implantation demonstrates a good efficacy index and safety profile in patients with diverse refractive errors.
文摘Background: In children, acute bacterial rhinosinusitis (ABRS) is often complicated by ophthalmological and/or neurological involvement. These complications should be known and recognized, as they require urgent treatment with intravenous antibiotics and close in-hospital monitoring. In this study, we aimed to identify the main risk factors associated with the development of complications in children aged 2 - 17 years with ABRS. Methods: We conducted a retrospective cohort study of patients with ABRS complications in a primary hospital. Participants were divided into two groups: the control group comprising patients without complications (Group 1, n = 82) and the study group comprising patients with complications requiring hospitalization (Group 2, n = 41). We assessed the sociodemographic, clinical, and imaging data of both groups. Using multivariate logistic regression, we assessed risk factors of ABRS complications. Results: No socio-demographic characteristics were associated with ABRS complications (p ≥ 0.05). Factors associated with complications were delay in consultation (t = 5.282;p Conclusions: Intracranial and extracranial complications of ABRS in children have become rare in our setting. These complications can be serious and potentially fatal. Risk factors of these complications are delays in consultation, the presence of ophthalmological signs, and more than one affected sinus. Controlling modifiable factors would improve the treatment success of ABRS complications in children.
基金Supported by the National Natural Science Foundation of China,No.81302124.
文摘BACKGROUND Red blood cell distribution width(RDW)is associated with the development and progression of various diseases.AIM To explore the association between pretreatment RDW and short-term outcomes after laparoscopic pancreatoduodenectomy(LPD).METHODS A total of 804 consecutive patients who underwent LPD at our hospital between March 2017 and November 2021 were retrospectively analyzed.Correlations between pretreatment RDW and clinicopathological characteristics and short-term outcomes were investigated.RESULTS Patients with higher pretreatment RDW were older,had higher Eastern Cooperative Oncology Group scores and were associated with poorer short-term outcomes than those with normal RDW.High pretreatment RDW was an independent risk factor for postoperative complications(POCs)(hazard ratio=2.973,95%confidence interval:2.032-4.350,P<0.001)and severe POCs of grade IIIa or higher(hazard ratio=3.138,95%confidence interval:2.042-4.824,P<0.001)based on the Clavien-Dino classification system.Subgroup analysis showed that high pretreatment RDW was an independent risk factor for Clavien-Dino classi-fication grade IIIb or higher POCs,a comprehensive complication index score≥26.2,severe postoperative pancreatic fistula,severe bile leakage and severe hemorrhage.High pretreatment RDW was positively associated with the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and was negatively associated with albumin and the prognostic nutritional index.CONCLUSION Pretreatment RDW was a special parameter for patients who underwent LPD.It was associated with malnutrition,severe inflammatory status and poorer short-term outcomes.RDW could be a surrogate marker for nutritional and inflammatory status in identifying patients who were at high risk of developing POCs after LPD.
文摘BACKGROUND Cauda equina syndrome(CES)is characterized by a group of symptoms that may be caused by inflammation,spinal cord compression,venous congestion,or ischemia.This syndrome is commonly an indication for surgical intervention but has not been determined as a postoperative complication following surgery for lumbar spine disease.CASE SUMMARY To report the case of a 54-year-old male patient who had CES following spinal surgery,with no obvious compression lesions found during re-exploration,suggesting that vascular insufficiency may have contributed to the condition.Furthermore,a series of urodynamic studies on bladder recovery patterns in such complications have also been investigated.CONCLUSION Postoperative CES requires urgent imaging and exploration to rule out compression;noncompressive cases,including vascular insufficiency may performed conservative management.
文摘Background: In developing countries, charity cleft surgical mission is always operated by sporadic surgical teams without systematic follow up and quality assurance. In the past few decades, many mission projects have been held regularly in China. The purpose of this audit was a retrospective analysis of a 9-year cleft lip and palate charity project operated in a tertiary hospital in China Shenzhen Area to evaluate perioperative and postoperative complications. Nevertheless, understanding the risk profile is essential for establishing a sustainable in-house cleft service in Shenzhen. Methods: A detailed analysis of hospital centralized record in the The University of Hong Kong-Shenzhen Hospital (HKUSZH) was reviewed since the first charity project held in 2015. The parameters of this audit were focused on perioperative complications including anesthesia related problems, early postoperative complications in patients who underwent primary or secondary cleft surgeries. A total of 430 consecutive admitted cases of 311 non-syndromic cleft lip & palate patients were enrolled into the charity project from June 2015 to July 2024. The main anesthesia related complications that occurred during general anesthesia were respiratory tract problems, while intraoperative complication was excessive bleeding, so as wound local infection and reaction were the main early postoperative complications. Results: In our 9-year clinical audit of 430 cleft lip and palate charity surgeries in Shenzhen, we observed no mortalities and a anesthesia-related complication rate of 1.16%. Specific intraoperative complications included excessive bleeding, while early postoperative issues were dominated by wound infections. The fistula rate of 18.7% post palate repair and the average hospital stay of 3.71 days complete the profile of our surgical outcomes. These data underscore the project’s efficacy and offer a reference for international cleft missions aiming for safe and efficient surgical care. Conclusions: This study provides a thorough data review of the complications in the past 9 years charity missions for cleft lip and palate surgery in a well-structured hospital infrastructure and logistic support by local surgical team. There were no perioperative or postoperative death during the study period and the overall short-term complication rate was low. Therefore, it could be a reference model for other international cleft mission in developing country for a safe and efficient service in future.
文摘Background and Objectives: Post-operative complications (POC) are new pathological phenomena occurring in the post-operative period and worsening the previous situation through their morbidity and mortality. Our aim was to determine the prevalence and preoperative factors associated with early POC at University Clinics of Kisangani (CUKIS). Methods: This was a cross-sectional study conducted in the CUKIS, Department of Surgery from 1 January 2014 to 31 December 2023. The target population consisted of all patients who had undergone full post-operative follow-up. A logistic regression model using RStudio version 4.4.0 software was used to determine the factors predicting early postoperative complications. Results: The prevalence of early POC was estimated at 35%, with surgical site infection the most frequent POC at 45.3%. After multivariate analysis using logistic regression, the social category of widow(er)s, transfer, previous laparotomy, acute generalised peritonitis, preoperative length of stay of more than 10 days and ASA score 2 and 5 were significant risk factors associated with the occurrence of POC in the preoperative period. Conclusion: Certain factors can predict the occurrence of POC. Knowledge of these factors can help practitioners to take useful measures before each surgical operation on a patient with these factors, with a view to preventing or managing POC.
文摘Background: Diabetes Mellitus (DM) is a growing health issue in Bangladesh, with significant complications affecting the quality of life (QoL). This study aims to assess long-term complications, treatment patterns, and QoL of diabetic patients during COVID-19. Methods: A cross-sectional study was conducted on 385 diabetic patients (aged 18-80) from tertiary hospitals in Dhaka and Mymensingh between May and October 2022. Data were collected via a semi-structured questionnaire on sociodemographics, complications, treatment patterns, and QoL (SF-12 scale). Chi-square tests, ANOVA, and linear regression were used for inferential analysis. Results: The sample predominantly included middle-aged males (41 - 55 years) with type 2 diabetes. Diabetic retinopathy (34.5%), polyneuropathy (32.2%), and hypertension (52.3%) were the most common complications. Oral medications were used by 59.7% of patients, with 29.1% on insulin. Chi-square analysis showed a significant association between treatment adherence and complications (p β = 0.45, p Conclusion: Complications in diabetic patients significantly affect QoL in Bangladesh. Treatment adherence, especially with oral medications, positively impacts QoL. There is a need for improved access to diabetes care to manage complications and enhance the overall well-being of diabetic patients.
文摘Diabetes is a major public health concern worldwide. Low and middle-income countries are the most affected. Diabetes self-management can significantly reduce the burden of diabetes complications and mortality. This cross-sectional study was conducted at the outpatient department of a county referral hospital in Kenya, from 1st August 2022 to 30th October 2022. Patients with known type II diabetes of age ≥ 20 years visiting the hospital for routine follow-up visits were included. A 7-tem Summary of Diabetes Self-care Activities (SDSAC) Questionnaire was used to assess Diabetes self-care activities. For data entry and statistical analysis, SPSS for Windows version 27.0 was used. There were 96 (39.2%) males and 149 (60.8%) females. Most of the participants were more than 61 years, 148 (60.4%). Significant association was found between the sum scale scores of dietary activities, blood glucose testing, physical activity, foot care, and neuropathy at 95% CI and (p Conclusions: Diabetes self-management activities have an impact on microvascular complications in patients with diabetes.
基金Supported by The Shenzhen Science and Technology Research and Development Fund,No.JCYJ20220530163011026 and No.JCYJ20210324131809027Shenzhen Medical Key Discipline Project,No.G2021008 and No.G2022008.
文摘Liver transplantation(LT)is the most effective treatment for patients with end-stage liver disease,and maintaining vascular patency of the transplanted liver is one of the crucial prerequisites for surgical success.Despite hepatic vein complic-ations following LT occurring at a relatively low frequency,ranging between 2%to 11%,delayed diagnosis and treatment may lead to graft dysfunction and even patient mortality.Clinical manifestations of hepatic vein complications are often subtle and nonspecific,posing challenges for early diagnosis.Signs may initially present as mild abnormalities in liver function,delayed recovery of liver function,unexplained ascites,lower limb edema,and perineal edema.Prolonged duration of these complications can lead to hepatic sinusoidal dilatation and eventual liver failure due to prolonged hepatic congestion.Ultrasonography has become the preferred imaging modality for post-liver transplant evaluation due to its convenience and non-invasiveness.Although hepatic vein complications may manifest as disappearance or flattening of the hepatic vein spectrum on routine ultrasound imaging,these findings lack specificity.Contrast-enhanced ultrasound that visualizes the filling of contrast agent in the hepatic veins and dynamically displays blood flow perfusion information in the drainage area can,however,significantly improve diagnostic confidence and provide additional information beyond routine ultrasound examination.
文摘Type 2 diabetes mellitus(T2DM)is a chronic metabolic disorder characterized by hyperglycemia and insulin resistance,often leading to severe complications.Hemogram markers have attracted great attention from researchers for their established role in inflammatory conditions.In this respect,T2DM and its mi-crovascular complications are characterized by high inflammatory burden.Hence,recent studies in the literature have reported an association between T2DM and hemogram-derived markers.Emerging evidence highlights the utility of hemo-gram-derived markers,including the neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,red cell distribution width,and mean platelet volume,as potential predictors of T2DM onset and progression.These markers,readily available from routine hemogram tests,offer valuable insights into the systemic inflammation and vascular changes associated with T2DM and its complications,such as cardiovascular disease,nephropathy,and retinopathy.This review syn-thesizes current research on the association between hemogram-derived markers and T2DM,emphasizing their prognostic value in predicting disease severity and complications.We also explore the underlying pathophysiological mechanisms linking these markers to inflammation and metabolic dysfunction.The findings suggest that hemogram-derived markers could serve as cost-effective,non-invasive tools for risk stratification and early intervention in T2DM management.Future research should focus on standardizing reference ranges and validating these markers in diverse populations to enhance their clinical utility.
文摘AIM: To investigate the effectiveness of combinationtherapy with transzonular triamcinolone-moxifloxacin andconventional perioperative drops in reducing postoperativecomplications of cataract surgery. METHODS: Electronic medical records of cataractsurgery patients (single surgeon) were reviewed fromJanuary 2018 to September 2021. The rate of postoperativecomplications including prolonged and/or recurrentpostoperative inflammation, endophthalmitis, cystoid macularedema (CME), and intraocular pressure (IOP) was comparedbetween the patients receiving combinative therapy andpatients receiving drops only. RESULTS: Totally 596 patients and 1057 eyes(Combinative-Therapy group 493 and Drop-Only group 564)were included in this study. Using combination therapyreduced the relative risk of postoperative inflammationby 26.9% (16.6% Combinative-Therapy vs 22.7% Drop-Only, P=0.013). The incidence of endophthalmitis was 0in Combinative-Therapy group vs 0.5% in Drop-Only group(relative risk reduction 100%), although not statisticallysignificant (P=0.10). The incidence of severe IOP spikeswas not significantly different between Combinative-Therapy (2.4%) and Drop-Only (1.6%) groups (P=0.33).The relative risk of postoperative CME was 51.4% less inthree months follow up visit in Combinative-Therapy group,although not statistically significant (P=0.07). The visualoutcome 1-month postop. (best corrected visual acuity) wassignificantly better in Combinative-Therapy (logMAR 0.10)compared to Drop-Only (logMAR 0.14) groups (P=0.02) whilethe baseline visual acuity was not significantly different. CONCLUSION: The combinative approach oftranszonular triamcinolone-moxifloxacin plus perioperativeeyedrops is an effective method to minimize postoperativeinflammation, with better visual outcomes. It couldpotentially reduce the risk of postoperative endophthalmitisand CME (near-significant P-values;larger studies couldanalyze better considering low incidence).
文摘BACKGROUND Detailed data on the relation of post-operative complications with clinical outcomes after simultaneous pancreas-kidney(SPK)transplantation is lacking.AIM To compare Clavien-Dindo classification(CDC)and comprehensive complication index(CCI)in predicting outcomes after SPK.METHODS Data for patients undergoing SPK between 1999-2019 were analyzed.Information on recipients’baseline characteristics,peri-operative management and postoperative complications were collated.Length of hospital stay(LOS)was the primary study outcome,and the associations with CDC and CCI were evaluated using Spearman’s(ρ)correlation coefficients.RESULTS In the study period,data were available for 128 patients(female n=44,34.4%).Sixty-nine patients had at least one complication with the highest CDC grade of I,II,III,and IV in 8(6.3%),22(17.2%),32(25%),and 7(5.5%)patients,respectively. The mean LOS was 21.4 ± 17.7 days. Both classification systems were correlated with LOS, yet CCI was stronger(Spearman’s ρ: 0.694 vs 0.602, P < 0.001). Female patients (P = 0.019) and patients with pre-transplant cardiovascularevents (P = 0.02) had longer LOS. After adjusted multivariable analysis, the link between LOS and both theCDC and CCI remained relevant. CCI had a superior fit compared to CDC (r2 = 0.729 vs r2 = 0.481), with every 10CCI points being associated with a 5.27 day (P < 0.001) increased LOS.CONCLUSIONThis study showed that the CCI was better linked with LOS compared to CDC and might represent a useful scoreto evaluate the overall burden of postoperative complications in patients undergoing SPK.
文摘Perioperative morbidity of esophagectomy significantly affects the surgical outcome,like any major gastrointestinal procedure.Despite introduction of minimally invasive esophagectomy,the morbidity is still close to 30%-40%.The common complications following esophagectomy are pulmonary infections,cardiac events,anastomotic leakage,bleeding,chylous leak,and recurrent laryngeal nerve palsy which in turn lead to longer hospital stay,increased treatment cost and poor quality of life.A nomographic model comprising preoperative(patient,disease and treatment related)and intraoperative factors in combination with Artificial Intelligence may accurately identify the patients at higher risk of morbidity.This will aid in optimizing the modifiable risk factors preoperatively,and closely monitor these patients post operatively for early identification of complications and to initiate early corrective measures to improve the surgical outcome.
