2. Sunum Planı
4. Rekabet
1. Blefarit nedir?
5. Projeler
6. Referanslar
2. Tedavi Yaklasimlari
3. Urun Bilgileri
3. Blefarit
Blefarit; gozde kizariklik kabuklanma,
sulanma, yanma, batma, kuruluk ve
kasinti ile seyredebilen goz kapagi
kenarinin inflamasyonudur. (1)
1. Lindsley K, Matsumura S, Hatef E, Akpek EK. Interventions for chronic blepharitis. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD005556.
2. Edwards.RS. Ophthalmic emergencies in a district general hospital casual department. Br J Ophthalmol 1987; 71:938.
3. Lemp MA, Nichols KK. Blepharitis in the United States 2009: a survey-based perspective on prevalence and treatment. Ocul Surf. 2009;7(2 Suppl):S1-S14.
4. Driver PJ, Lemp MA. Seborrhea and meibomian gland dysfunction. Cornea. 2nd Edition. Philadelphia: Elsevier Mosby, 2005:485–91
4. Blefarit
• Acile goz problemi ile basvuran hastalarin
%70’inde blefarit ya da konjunktivit gorulur. (2)
• Poliklinik muayenelerinde %47 oraninda rastlanir.
(3)
• Her yasta gorulebilmekle birlikte, sikligi yas ile
beraber artmaktadir. (4)
• Grafikler? Hekimlerin karsilastigi???
1. Lindsley K, Matsumura S, Hatef E, Akpek EK. Interventions for chronic blepharitis. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD005556.
2. Edwards.RS. Ophthalmic emergencies in a district general hospital casual department. Br J Ophthalmol 1987; 71:938.
3. Lemp MA, Nichols KK. Blepharitis in the United States 2009: a survey-based perspective on prevalence and treatment. Ocul Surf. 2009;7(2 Suppl):S1-S14.
4. Driver PJ, Lemp MA. Seborrhea and meibomian gland dysfunction. Cornea. 2nd Edition. Philadelphia: Elsevier Mosby, 2005:485–91
7. Presentation Title Here Slide 7
Blefarit
Blefarit Siniflamasi
1. Stafilokokkal blefarit
2. Seboreik blefarit
3. Stafilokokkal ve seboreik karısımı
4. Seboreik blefarit ve meibomian
sebore varlığı
5. Seboreik blefarit ve sekonder
meibominit
6. Primer meibominit (oküler
rozasea ile birlikte)
17. Obesity in major gastrointestinal surgery: multicenter international observational prospective study Slide 17
EuroSurg Collaborative
To provide useful research skills to students and
trainees
To develop international research networks
To improve patient care
European medical students and surgeons network
International student-led and trainee-led cohort studies
19. Obesity in major gastrointestinal surgery: multicenter international observational prospective study Slide 19
Trends in adult prevalence of obesity – percentage of the adult
population
Butland B et al.
London:
Government
Office for Science,
2007
20. Obesity in major gastrointestinal surgery: multicenter international observational prospective study Slide 20
Association between BMI and postoperative complication rate
Yasunaga H et al.
Br J Surg, 2013
21. Obesity in major gastrointestinal surgery: multicenter international observational prospective study Slide 21
Previous Studies
Most previous studies are limited by a lack
of statistical power due to:
Retrospective design
Single institution
Small sample size
Inclusion-Exclusion criterias
Heterogeneity in definitions
Limited patient follow-up
22. Aim
To determine whether obesity is associated with excess risk of major post-operative
(Clavien-Dindo grade III-V) complications in a European cohort.
24. Obesity in major gastrointestinal surgery: multicenter international observational prospective study Slide 24
Materials & Method
• 13 weeks of inclusion window totally
• Each team (6 totally), collected data for their 2
weeks
• 30 days of follow-up for each patient
25. Obesity in major gastrointestinal surgery: multicenter international observational prospective study Slide 25
Timeline
Dec
2015
Feb
2016
May
2016
June
2016
Past Future
Study protocol released to
collaborators at their centers.
Patient inclusion window
started.
Patient inclusion window
ended.
End of follow-up window for
patients.
26. Obesity in major gastrointestinal surgery: multicenter international observational prospective study Slide 26
Materials & Method
• Age > 18
• Any one of the following:
• Any gastrointestinal resection
• Reversal of ileostomy or colostomy
• Formation of defunctioning stoma
• Age < 18
• Appendicectomy
• Transanal surgery
• Bariatric surgery
• Primarily hepatobiliary procedure
• Primarily urological procedure
• Primarily gynecological procedure
• Primarily vascular procedure
Inclusion Criteria Exclusion Criteria
27. Obesity in major gastrointestinal surgery: multicenter international observational prospective study Slide 27
Materials & Method
Outcome Measure:
• Overall 30-day major
adverse event rate,
defined as Clavien-
Dindo grade III-V
complications
III
•Complication requiring surgical,
endoscopic or radiological
intervention
IV
•Life-threatening complications
requiring intensive care unit
management
V
•Death of the patient
28. Obesity in major gastrointestinal surgery: multicenter international observational prospective study Slide 28
Materials & Method
29. Obesity in major gastrointestinal surgery: multicenter international observational prospective study Slide 29
Participation in Eurosurg-1
• 7 countries/127 centers
• 550 students/305 doctors
• 3529 patients
30. Obesity in major gastrointestinal surgery: multicenter international observational prospective study Slide 30
Participation in Eurosurg-1
• 7 countries/127 centers
• 550 students/305 doctors
• 3529 patients
32. Obesity in major gastrointestinal surgery: multicenter international observational prospective study Slide 32
Results
• 3529 records submitted on REDCap online database
• 2519 patients included for data analysis
560 patients Obese (mean BMI: 34)
915 patients Overweight (mean BMI: 27.1)
1044 patients Normal weight (mean BMI: 22.4)
33. Obesity in major gastrointestinal surgery: multicenter international observational prospective study Slide 33
Patient Demographics
Normal BMI (n=1044) Overweight (n=915) Obese (n=560)
Age (mean) 62.1 65.0 63.9
Male gender 53.7% 63.1% 53.2%
ASA grade I-II 69.9% 68.7% 59.6%
ASA grade III-V 30.1% 31.3% 40.4%
Elective surgery 83% 84.8% 87.5%
Emergency surgery 17% 15.2% 12.5%
Open Approach 59.5% 54.3% 58.0%
Laparoscopic Approach 40.5% 45.7% 41.6%
Elective:
85%
Emergency:
15%
Open:
57%
Laparoscopic
or Robotic:
43%
34. Obesity in major gastrointestinal surgery: multicenter international observational prospective study Slide 34
Procedures
Normal BMI Overweight Obese
Oesophageal resection 58 49 31
Gastric resection 45 37 20
Small bowel resection 108 69 40
Colonic resection 411 427 243
Rectal resection 167 158 115
Reversal of stoma 82 49 31
Other 126 94 58
Cancer
65%
IBD
9%
Other
26%
Colorectal
60%
Other
40%
35. Obesity in major gastrointestinal surgery: multicenter international observational prospective study Slide 35
Results
• 22% of patients with gastrointestinal procedures are obese.
• 14.5% of patients had major complications.
• 2.38% was 30-day mortality rate.
Normal BMI
(n=1044)
Overweight
(n=915)
Obese
(n=560)
P value
Major
Complications
169 (16.2%) 123 (13.4%) 73 (13.0%) 0.123
30 Day
Mortality
23 (2.2%) 29 (3.2%) 8 (1.4%) 0.092
36. Obesity in major gastrointestinal surgery: multicenter international observational prospective study Slide 36
Results
Undergoing surgery
for benign conditions:
OR: 0.59
95% CI 0.46-0.75,
P < 0.001
Undergoing surgery
for malign conditions:
OR: 2.10
95% CI 1.49-2.96,
P < 0.001
38. Obesity in major gastrointestinal surgery: multicenter international observational prospective study Slide 38
Summary
No significant association
was found between BMI and major
complications in this cohort.
39. Obesity in major gastrointestinal surgery: multicenter international observational prospective study Slide 39
Summary
Malignant
disease
Benign
disease
Complications
Complications
40. Ebubekir Ucar
on behalf of the EuroSurg Collaborative
EuroSurg
The European Student Research Network
www.eurosurg.org
@EuroSurg
Editor's Notes
Genellikle iki tarafli ve simetrik olarak gorulur. (1)
Genellikle iki tarafli ve simetrik olarak gorulur. (1)
Anterior posterior
A enfeksiyon stafilokok
Posterior enfeksyion dogrudan sebep olmayabilir, genellikle lipid yapisinin bozulmasi
Anterior posterior
Evoporatif goz kurulugu
Why we did this study? To determine whether obesity is associated with excess risk of major post-operative complications in European cohort. So, why obesity is important?
Obesity is a condition that is associated with having excess body fat. In other words, if BMI is greater than 30.
As you can see in this graphic, obesity has reached epidemic levels in high income and developing countries, with its prevalence expected to increase further over the coming decades. One-third of patients undergoing gastrointestinal surgery in the United Kingdom are obese. While it is a recognized risk factor for cardiovascular and metabolic disease, there is conflicting evidence on its impact on postoperative complications. Understanding the relationship between obesity and surgical outcomes is needed to optimize preoperative assessment and perioperative care.
There is wide variation on the impact of obesity after gastrointestinal surgery in published reports.
In some patient groups, no association is identified between obesity and postoperative complications, whereas other studies have identified obesity as a risk factor for increased postoperative complications
Most previous studies are limited by a lack of statistical power given their small sample sizes, their single-institution, retrospective designs with a risk of bias, and with limited follow-up periods. Additionally, there is heterogeneity in their definitions of obesity, types of surgical procedures included, and the outcomes studied.
Taking this into consideration, Eurosurg, which is a European multicenter study group involving researchers and students from England, Ireland, The Netherlands, Italy, Spain, the Czech Republic and Turkey, embarked on a large prospective comparative clinical study investigating the effects of obesity on the outcome of major gastrointestinal surgery to overcome these limitations. Department of General Surgery of Istanbul Faculty of Medicine was selected as a participating center. The aim of the study was to determine whether obesity is associated with excess risk of major post-operative complications in a European cohort.
We have total 13 weeks inclusion window, each team collected data for 2 weeks. Each patient was followed up for 30 days.
Study protocol was released in December 2015. Patient inclusion window started in Feb 2016 and ended in May 2016. Follow-up ended in June 2016.
Our inclusion criteria were; adult patients undergoing elective or emergent gastrointestinal surgery including any gastrointestinal resection, reversal of ileostomy or colostomy, formation of defuncitoning stoma when it were performed as main procedure. The other abdominal procedures were excluded.
What are our outcome measures, what we follow primarily?
Overall 30-day major adverse events rate.
Here you can see: Complication requiring surgical, endoscopic or radiological intervention, OR life-threatening complications requiring ICU management, OR death of the patient.
Here you can see our data collection sheet for each patient.
7 countries, 127 centers participated, and 3529 patients included in this study.
Here we see the number of patients contributed by each country
What did we find?
3529 records were submitted on REDCap, from these 2519 patients were eligible for final data analysis.
Patients were stratified by BMI (main explanatory variable) into these three groups.
Obese, overweight, normal weight.
You can see patient demographics.
Most operations included were elective and an open approach was done in 57.3% of the cases.
Here you can see which procedures had been performed.
As a result of our research,
Overall major complication rate is 14.5 per cent of all patients across Europe. 30-day mortality was 2.38%
And there is NO significant difference between patients who are normal, overweight or obese.
Another finding was that there was an inverse relationship between obesity and postoperative complications in benign disease, yet this did not hold true for malignancies in which the complication rates increased.
Obesity, in general, is a serious problem in the world. Obesity is associated with heart disease, stroke, type 2 diabetes, certain types of cancer. And make worse too many medical conditions. The estimated annual health care costs of obesity-related illness are 190 billion or nearly 21% of annual medical spending in the US. Well, does obesity effects the outcomes of surgical procedures? According to our international study, it does not.
No significant association was found between BMI and major complications.
On the other hand, if surgical procedure include malignancy, major complications were increased. Inversely, if there is a benign disease, complications were decreased. Further research is required the understand underlying pathophysiology of these effect, in order to improve management of patients undergoing surgery.
