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Health effects by biomass combustion include acute lower respiratory infections in childhood (at least 2 million deaths annually in children under 5 years) antibiotics for acne infection discount 150mg erybros overnight delivery, respiratory symptoms (such as cough antibiotics sinusitis erybros 150mg for sale, wheeze), weakening of the respiratory infections, obstructive lung diseases, lung cancer)16. In addition, the exposure of asthmatic children to indoor carbon oxides is associated with an increased risk for wheezing attacks18 (Table 2). Building dampness increases in a variety of respiratory and asthma-related health outcomes. Epidemiological studies and meta-analyses show indoor dampness/mould to be associated with increased asthma development and exacerbations, current and ever asthma diagnosis, dyspnea, wheeze, cough, respiratory respiratory tract symptoms, regardless of atopy19. Conservative estimates show that exposure to indoor air pollution may be responsible for nearly two million deaths per year in developing countries. According to the Global Burden of Disease Study 2010, household air pollution from solid fuels accounted for about 3. House dust is composed of several organic and inorganic compounds, including fibres, mold spores, pollen grains, insects and mites and their faeces. It is commonly related to sneezing, nose/mouth/throat irritations, nasal stuffiness/runny nose and red/itchy/watery eyes. The principal domestic mite species, Dermatophagoides and Euroglyphus, are particularly abundant in mattresses, bed bases, pillows, carpets or fluffy toys and proliferate in warm (above 20°C) and humid conditions. In developed countries, homes have been insulated for energy efficiency and carpeted, heated, cooled and humidified, thus creating an ideal habitat for indoor allergens14. In children, the risk for asthma increases by 17% for each 10 µg/m3 of formaldehyde concentration26 (Table 3). Epidemiology of chronic Obstructive pulmonary disease: health effects of air pollution. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990­2010: a systematic analysis for the Global Burden of Disease Study 2010. Changes in prevalence of asthma and allergies among children and adolescents in Italy: 1994-2002. Proportional Venn diagram and determinants of allergic respiratory diseases in Italian adolescents. Maio S, Baldacci S, Carrozzi L, Polverino E, Angino A, Pistelli F, Di Pede F, Simoni M, Sherrill D, Viegi G. Urban residence is associated with bronchial hyper-responsiveness in Italian general population samples. Nuvolone D, Della Maggiore R, Maio S, Fresco R, Baldacci S, Carrozzi L, Pistelli F, Viegi G. Geographical information system and environmental epidemiology: a cross-sectional spatial analysis of the effects of traffic-related air pollution on population respiratory health. Particulate Levels Are Associated with Early Asthma Worsening in Children with Persistent Disease. Conclusion Recent epidemiological studies have shown that outdoor and indoor pollution considerably affects respiratory health worldwide. Health care providers and the general community should support public health policy to improve outdoor air quality through programs aimed at abating/reducing pollution emissions. Patient education about the importance of good indoor air quality in the home and workplace is also essential. Current and Future Needs · More research is needed about the long-term effects of outdoor/indoor environments, in order to elucidate the mechanisms by which pollutants induce damage in exposed subjects and on the cost-effectiveness of preventative and remedial measures related to air quality. Hoek G, Pattenden S, Willers S, Antova T, Fabianova E, BraunFahrlдnder C, Forastiere F, Gehring U, Luttmann-Gibson H, Grize L, Heinrich J, Houthuijs D, Janssen N, Katsnelson B, Kosheleva A, Moshammer H, Neuberger M, Privalova L, Rudnai P, Speizer F, Slachtova H, Tomaskova H, Zlotkowska R, Fletcher T. Pйnard-Morand C, Raherison C, Charpin D, Kopferschmitt C, Lavaud F, Caillaud D, Annesi-Maesano I. Long-term exposure to closeproximity air pollution and asthma and allergies in urban children. Unmet Needs · A thorough understanding of the reasons behind the increasing prevalence and severity of asthma and allergic rhinitis would be helpful for effective control. Copyright 2013 World Allergy Organization 98 Pawankar, Canonica, Holgate, Lockey and Blaiss 15. Viegi G, Simoni M, Scognamiglio A, Baldacci S, Pistelli F, Carrozzi L, Annesi-Maesano I. Current asthma and respiratory symptoms among pupils in Shanghai, China: influence of building ventilation, nitrogen dioxide, ozone, and formaldehyde in classrooms. Respiratory and allergic health effects of dampness, mold, and dampness-related agents: a review of the epidemiologic evidence.

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Infections acquired from transfusions are rare due to antibiotic wash generic erybros 150 mg with amex improved screening methods by blood banks bacteria reproduction rate order erybros 150mg free shipping. Blood is actively screened for all these agents and discarded if contamination is even suspected. It is harbored in a dormant state in the white blood cells of previously infected persons. In this case, a blood sample is drawn from the patient and the patient is tagged with a special blood products identification bracelet which is matched to the specimen drawn and a set of labels which will be used on any blood products which might be ordered for the patient in the next few days. If blood products are required for this patient, they can be ordered from the blood bank. The blood bank will crossmatch the blood using the previously drawn and labeled specimen. Page - 427 A "type and hold", also called a "type and screen", should be ordered for a patient who has a moderate likelihood of requiring a transfusion during the hospital stay. This unit cannot be used for any other patient, so a "type and crossmatch" should only be ordered when a transfusion is highly likely. In a true emergency with a rapidly hemorrhaging and hypovolemic patient, the time required for blood typing and crossmatching (20 to 30 minutes) may not be available. There are many ethical issues which need to be considered when transfusing patients. Because of the rare possibility of morbidity and mortality from transfusions, written and informed consent must always be obtained before a transfusion is given. During the transfusion of platelets, this patient develops 3 small hives (urticarial lesions) on his back. Recipient mast cell histamine release, stimulated by donor antigen presenting cells. Is very expensive and tedious, and therefore should be used in only selected cases. Transfuse slowly at <3ml/kg/hour, with subunits from a unit split in the blood bank, and discard the remainder of each subunit after 4 hours. New strategies for prophylactic platelet transfusion in patients with hematologic diseases. Additionally, it would expose the patient to a second donor, and half of the second unit would be discarded (wasted). For just a few hives, it is not necessary to check the crossmatch of the blood, since this will detect antibodies causing hemolysis. With severe anemia, the patient is already in high output congestive heart failure. She was hospitalized three weeks ago for a pseudomonas external otitis media and neutropenia that was treated with two weeks of intravenous antibiotics. A bone marrow examination is done (mostly because of parental concern) which shows a normal cellular marrow. Case 2 this is a 2 year old male who presents with a chief complaint of recurrent skin and soft tissue infections. Referral is now being made to a hematologist during his current hospitalization for the treatment of cervical lymphadenitis and left lower lobe pneumonia with bilateral pleural effusions. Past Medical History: At 2 months of age, he developed a perianal furuncle that was incised and drained because of no response to oral antibiotics. He is placed on subcutaneous injections of gamma interferon (three times a week) and twice daily doses of oral trimethoprim-sulfamethoxazole and has not required any further hospitalizations for bacterial infections for the last 3 years. The most common problem seen by primary care physicians is neutropenia (decreased neutrophil count). When low neutrophil counts are associated with infection it must be decided whether neutropenia is secondary to the infection, or if an underlying neutropenia contributed to the risk of infection. A key point to remember is that the risk of infection with neutropenia is high when bone marrow production of neutrophils is decreased from either primary or secondary causes. Rare congenital disorders result in extremely high risks of infection and require specialized laboratory tests to correctly diagnose.

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Activities that involve rapid or profound changes in barometric pressure (scuba diving bacteria 33 000 feet generic erybros 150mg without a prescription, flying in unpressurized aircraft antibiotic for bronchitis buy discount erybros 150mg on line, etc. Pneumomediastinum and subcutaneous emphysema in the neck region are usually benign conditions if the patient is only minimally symptomatic, but they may precede a pneumothorax in some instances. Pneumopericardium is associated with cardiac tamponade and a high risk of mortality even if decompression is attempted. True/False: A primary spontaneous pneumothorax in a tall thin boy does not require further work-up other than for treatment of the pneumothorax. True/False: A chest tube is always the standard of care for the treatment of a pneumothorax. Management of Spontaneous Pneumothorax: An American College of Chest Physicians Delphi Consensus Statement. It is the second or third interspace in the midclavicular line or the fourth or fifth interspace in the midaxillary line. Tension pneumothorax is most likely to occur on ventilator patients and hose with penetrating chest trauma. Chest and extremity radiographs reveal a displaced midshaft right femur fracture and a small left pulmonary contusion. Although the majority of these children recover uneventfully, the overall mortality rate of pediatric trauma is estimated at 1. Each year, 250,000-500,000 children are hospitalized with various trauma-related injuries. Of these children who are hospitalized, 50,000-100,000 are left with some degree of permanent disability (1). Motor vehicle-related accidents are responsible for 40% of blunt pediatric trauma and are the leading cause of trauma-related fatalities in children (1). For example a subtle tachycardia may be the only clue to the possibility of early hemorrhagic shock in a child who otherwise looks stable. The spleen is the most commonly injured organ associated with blunt abdominal trauma. The larger head-to-body ratio of infants and young children makes them more susceptible to head injuries during falls. The larger head size also affects the fulcrum forces along the neck, making upper cervical spine injuries more common in infants and younger children as opposed adults who more commonly sustain injuries to their lower cervical spine. The larger head size as well as the increased body surface area in children make them more susceptible to greater heat loss and hypothermia when they are exposed during the trauma resuscitation. Injuries to the chest and abdomen also account for a fair amount of disability and death. Hypoxia and hemorrhagic shock are the final common pathways involved in pediatric trauma-related fatalities. The assessment and management of trauma patients is divided into the primary survey and secondary survey. The major components of the primary survey therefore involve the assessment, stabilization and management of all acute, lifethreatening conditions such as airway compromise, respiratory distress and hemorrhagic shock. These two caveats involve the possibility of cervical spine injury and hemorrhagic shock. The proper sequence that should always be adhered to in any resuscitation can be remembered by the mnemonic "A-I-R" (1): A=Assessment I=Interventions R=Reassessment after each intervention During the assessment and management the airway of any trauma patient, one must always consider the possibility of a neck injury and maintain cervical spine immobilization. This is extremely important if you are considering endotracheal intubation, during which time the airway should never be opened using the head-tilt maneuver. The jaw-thrust maneuver to open the airway with in-line cervical spine immobilization is the safest method to intubate any child with a potential cervical spine injury. Thus an orogastric tube may be helpful to decompress the stomach and thereby facilitate ventilatory efforts. The circulating blood volume of a child is 70-80 ml/kg as compared to the typical adult circulating blood volume of 60 ml/kg. Hypotension (systolic) in any aged child is defined via the formula: (Age X 2) + 70 mmHg. The minimum systolic blood pressures for age are: a) Newborns to 1 month old: >60 mmHg b) 1 month old-1 year old: >70 mmHg c) > 1 years old: (Age X 2) + 70 mmHg the keys to the treatment of hemorrhagic shock in the pediatric trauma patient includes recognition of the early signs of shock, controlling any external sites/sources of hemorrhage, rapid fluid resuscitation to restore the circulating blood volume, early consideration of blood replacement therapy and an early involvement of the surgical team. Rapid fluid boluses are administered as 20 ml/kg of warmed crystalloid solutions. If more than 40-60 ml/kg of crystalloid solution is required to restore adequate perfusion, blood replacement must then be considered.

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In evaluating the case above using inductive reasoning antibiotic without penicillin content generic 150mg erybros free shipping, the symptoms of crampy mid-abdominal pain amical 48 antimicrobial discount erybros 150 mg with mastercard, bilious vomiting, and history of prior abdominal surgery, suggest a hypotheses of bowel obstruction. If it is intestinal obstruction, an abdominal series should show an obstructive pattern (deduction). It could be biliary colic but this is rare in children and the pain distribution is not that of biliary pain. It could be a gynecological problem but this girl is prepubertal, and ovarian torsion frequently presents in the lower quadrant and radiates to the anterior thigh. Nerve root compression by spinal cord tumors are rare but must be suspected if no other cause for the discomfort can be found and if the pain distribution is that of a dermatome. Inflammation of the pleura from a pneumonic process in the distribution of the lower thoracic nerves is not an infrequent cause for referred abdominal pain and should be a reason for auscultation of the chest in a search for pneumonia or pleurisy. The abdominal series includes the lung bases and should be noticed when evaluating abdominal films. Lower lobe pneumonia can frequently be seen in the lung portions of an abdominal series, and it is very frequently overlooked since the clinician is usually focusing on the abdominal structures. Diabetic acidosis, lupus erythematosus, porphyria, and other systemic illnesses may cause pain and inflammation of the serous surfaces (serositis). As with most rules of thumb or generalizations there are exceptions that the clinician should keep in mind. Similarly, if it is retrocecal so that it has no contact with peritoneum, the child may not exhibit severe tenderness. The examiner of children must realize that most children wish to please, so that a child brought in the middle of the night to the hospital may feel obligated (obliged) to its adult caregivers and nighttime physicians to show cause for such concern. Thus, when asked if their tummy hurts, they may be inclined to answer affirmatively to justify the trip and trouble. A useful technique is to ask the child to cough while asking what he or she feels. This ploy will direct attention away from the abdomen but almost always elicits peritoneal discomfort if present. Sensory innervation of the intestines is via the ninth through eleventh thoracic nerve roots. Consequently pain from the intestines due to stretching is appreciated as originating from the mid-abdomen until an inflammatory process localizes it in the dermatome of the parietal peritoneum. There are several areas of referred pain which, when present, may suggest a specific entity. Radiation of flank pain into the groin and ipsilateral scrotum or labium suggests ureteral colic. They should not be a substitute for such evaluation and should not precede the clinical examination since the clinical appraisal may obviate the need for additional tests. The flat and upright plain film radiographs can be particularly useful in recognizing small bowel obstruction, ileus, abnormal calcifications and lower lung pathology. However, abdominal pain can also signal severe illness leading to serious morbidity and death if not attended to. True/False: Surgical causes of abdominal pain are much less common than non-surgical causes. He reportedly is unable to keep anything down, vomiting after every feeding, even water. His mother reports that he is not feeding well and his activity level is decreased. His capillary refill time is less than 3 seconds and his skin turgor is slightly diminished. During the first 3 years of life, a child will likely experience about 1 to 3 acute diarrheal illnesses. Information on the number, volume, and/or fluidity of stools and emesis should be obtained (1).

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Page 256 134740 121730 109590 121980 134720 164590 132250 119210 116290 100500 106970 136680 137360 163570 127590 105420 139830 September 2010 Appendix 3: Master Bibliography American Urological Association antibiotics jobs generic erybros 150 mg overnight delivery, Inc antibiotic resistance medical journals order erybros 150 mg. Determination of non-alpha1-antichymotrypsin-complexed prostate-specific antigen as an indirect measurement of free prostate-specific antigen: analytical performance and diagnostic accuracy. Incidence and severity of sexual adverse experiences in finasteride and placebo-treated men with benign prostatic hyperplasia. Transurethral collagen injections for male intrinsic sphincter deficiency: the University of Texas-Houston experience. Solitary fibrous tumor of the lower urogenital tract: a report of five cases involving the seminal vesicles, urinary bladder, and prostate. Cardiorenal effects of celecoxib as compared with the nonsteroidal anti-inflammatory drugs diclofenac and ibuprofen. Advances in the treatment of male androgenetic alopecia: a brief review of finasteride studies. Oxytocin, oxytocin-associated neurophysin and the oxytocin receptor in the human prostate. The effect of oxytocin on cell proliferation in the human prostate is modulated by gonadal steroids: implications for benign prostatic hyperplasia and carcinoma of the prostate. Prevalence and clinical correlates of glomerulopathy in children with sickle cell disease. N-acetylcysteine for preventing acute kidney injury in cardiac surgery patients with pre-existing moderate renal insufficiency. Serenoa repens extract for benign prostate hyperplasia: a randomized controlled trial. Metabolic activation of carcinogens and expression of various cytochromes P450 in human prostate tissue. A prostate-specific antigen-activated channel-forming toxin as therapy for prostatic disease. The changing practice of transurethral prostatectomy: a comparison of cases performed in 1990 and 2000. Expression of matrix metalloproteinase-2 and -9 and their inhibitors, tissue inhibitor of metalloproteinase-1 and -2, in primary cultures of human prostatic stromal and epithelial cells. Correlation of power Doppler with microvessel density in assessing prostate needle biopsy. Terazosin for treating symptomatic benign prostatic obstruction: a systematic review of efficacy and adverse effects. Tamsulosin for treating lower urinary tract symptoms compatible with benign prostatic obstruction: a systematic review of efficacy and adverse effects. Evaluation of bladder instability in children with recurrent urinary tract infections. Kidney function and use of recommended medications after myocardial infarction in elderly patients. Expression of CaT-like, a novel calcium-selective channel, correlates with the malignancy of prostate cancer. Management of lower urinary tract symptoms in men with progressive neurological disease. Altered prostate specific antigen reference range after transurethral resection of the prostate. Serum concentrations of transforming growth factorbeta 1 in patients with benign and malignant prostatic diseases. Tissue polypeptide specific antigen serum concentrations in patients with newly diagnosed prostatic diseases. Improving initial management of lower urinary tract symptoms in primary care: costs and patient outcomes. Lower urinary tract symptoms: social influence is more important than symptoms in seeking medical care.

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Since bicarb is the dominant cellular and extracellular buffer antibiotics given for sinus infection purchase erybros 150 mg fast delivery, the bicarb will decline as metabolic acid levels increase antibiotics for uti without penicillin cheap erybros 150 mg. Thus, since the respiratory factor should cause an alkalosis, but the pH shows an acidosis, this must be a metabolic acidosis, with secondary respiratory compensation. But since the degree of acidosis is generally more severe, the degree of tachypnea is generally more exaggerated (Kussmaul respirations). A respiratory alkalosis could only be caused by increasing the minute ventilation. Since metabolic compensation does not occur acutely, one would have to hyperventilate for a long time for metabolic compensation to occur. However, in a patient on a mechanical ventilator set such that the patient is deliberately hyperventilated for a prolonged period, the kidneys may sense the alkalosis and thus, excrete bicarb to partially compensate for this. This would be an unusual case of a respiratory alkalosis with metabolic compensation. There are only a few possibilities: 1) the patient would have to take a drug which excretes chloride or retains bicarbonate. All that can be said about a capillary pO2 is that it lies somewhere between the venous pO2 and the arterial pO2. The arterial pO2 is frequently described as the paO2 to denote that this is an arterial sample, as opposed to a venous or capillary pO2. Gases travel rapidly, so that the partial pressures of gases tend to be identical in samples that are next to each other for at least 5 seconds. Gas pressure or gas tension is measured in mmHg or Torr, which are exactly the same thing. If I replaced my blood with coffee, my brain and other tissues would not be happy since although the pO2 of the coffee may be 160, it does not contain much oxygen. One ml of coffee contains only a few oxygen molecules, while one ml of blood contains many, many more oxygen molecules. While many fluids may have reasonably good pO2s, only blood has a satisfactory oxygen content. The pO2 and the SaO2 are related to each other by the oxygen hemoglobin dissociation curve, which students learn in physiology. This curve plots the oxygen saturation (in %) on the vertical axis and pO2 on the horizontal axis. The oxygen saturation % steadily increases as the pO2 increases up to about a pO2 of 100 mmHg at which point the oxygen saturation is 99% to 100%. So the typical appearance of an oxygen hemoglobin dissociation curve, has a steep rise at pO2s below 100 mmHg, at which point it becomes a plateau since the oxygen saturation cannot increase above 100%. Oxygen saturation (SaO2) is a measurement of the percentage of oxygen binding sites that contain oxygen. If all the oxygen binding sites contain oxygen, then the oxygen saturation is 100%. This curve plots the oxygen saturation (in %) on the vertical axis and pO2 on the Page - 294 horizontal access. The oxygen saturation % steadily increases as the pO2 increases up to about a pO2 nearing 90 to 100 mmHg at which point the oxygen saturation is 99% to 100%. If the patient breathes supplemental oxygen, the inspired pO2 increases to 200 mmHg, 400 mmHg or higher depending on how much oxygen is inhaled. Pulse oximetry uses light absorption through a pulsing capillary bed usually in a toe or finger, but it will also pick up in the nose, ear, palm, side of the foot, etc. The probe looks red, but it actually uses two light sources; one is red and the other is invisible infrared. Absorption using these two wave lengths measures oxygen saturation for hemoglobin A. Oxygen saturation can be measured by co-oximetry but this requires a blood sample Co-oximetry is capable of determining the true oxygen saturation for methemoglobin and carboxyhemoglobin. The oxygen content is determined by the oxygen saturation percentage and the hemoglobin concentration. A patient with a hemoglobin of 14 has twice as much oxygen per ml of blood compared to a patient with a hemoglobin of 7, assuming that they both have 100% oxygen saturations. Thus, a patient with a hemoglobin of 7 at 80% saturation has a deoxygenated hemoglobin concentration of 1. Additionally, a patient with a hemoglobin of 14 at 80% saturation will look more cyanotic than a patient with a hemoglobin of 7 at 80% saturation.

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If it remains intact and no inflammation is detected bacteria mod 147 generic 150 mg erybros with mastercard, the condition can be monitored indefinitely bacteria helpful to humans cheap erybros 150mg visa. Complete spontaneous crystalline lens dislocation into the anterior chamber with severe corneal endothelial cell loss. Spontaneous dislocation of a transparent lens to the anterior chamber-a case report. Bilateral spontaneous crystalline lens dislocation to the anterior chamber: a case report. Argon laser iridotomy as a possible cause of anterior dislocation of a crystalline lens. Occult lens subluxation related to laser peripheral iridotomy: A case report and literature review. Spontaneous posterior capsular rupture with lens dislocation in pseudoexfoliation syndrome. Anterior axial lens subluxation, progressive myopia, and angle-closure glaucoma: recognition and treatment of atypical presentation of ectopia lentis. Weill-Marchesani syndrome and secondary glaucoma associated with ectopia lentis Clin Exp Optom. Weill-Marchesani syndrome with advanced glaucoma and corneal endothelial dysfunction: a case report and literature review. Intracapsular lens extraction for the treatment of pupillary block glaucoma associated with anterior subluxation of the crystalline lens. Clinical Pearls · Patients with so-called "congenital" lens subluxation are rarely born with displaced lenses. Rather, the phenomenon typically develops during life due to predisposing systemic conditions, such as Marfan syndrome. Bilateral posterior dislocation of the crystalline lens after a head injury sustained during a seizure. Post-traumatic iridodialysis, crystalline dislocation and vitreous haemorrhage: how to manage. Management of crystalline lens dislocation into the anterior chamber in a victim of domestic violence. The eye as a window to a rare disease: ectopia lentis and homocystinuria, a Pakistani perspective. Evaluation of the modified capsular tension ring in cases of traumatic lens subluxation. The onset is often unilateral or asymmetric, usually developing during middle age, often beginning in the 40s and 50s. Males are often more affected than females, and patients are typically moderately to highly myopic. Monocular diplopia occurs, although most patients will describe it as blurred vision. Pinhole testing relieves monocular diplopia and may significantly improve vision, although the patient may not see similar improvement with subsequent refraction. Patients will commonly have a myopic shift that can be relatively dramatic, accounting for up to 1D to 2D per year. As the myopia is refractively corrected, best visual acuity declines to a point where the patient cannot tolerate the spectacle imbalance, visual acuity or both. Comparison with the fellow eye in unilateral or asymmetric cases is often helpful in making the diagnosis. Also in contrast to other types of cataracts, patients can present with significantly reduced vision, yet the funduscopic view is minimally altered; that is, practitioners will have a clear view into the eye, yet the patient reports poor visual acuity but no afferent pupil defect. When this occurs, diagnosing cataract is not intuitive, and the patient may go through additional testing and referral needlessly. The "view-in-equals-the-viewout" philosophy does not apply to milky nuclear sclerosis. Patients with this type of lens opacity will complain that visual acuity and nighttime driving are affected daily-living activities. The impact of cataract, cataract types, and cataract grades on vision-specific functioning using Rasch analysis. Comparative evaluation of femtosecond laser-assisted cataract surgery and conventional phacoemulsification in white cataract. Cataracts are described from generalized nuclear sclerosis, cortical changes, anterior and posterior subcapsular cataracts, and polar cataracts, among others.

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