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The incidence of bariatric surgery is increasing due to obesity being one of our top public health challenges. As such, bariatric-related ophthalmic changes are a potentially new clinical area of knowledge, with increasing published evidence on post-bariatric complications experienced by patients and identified by clinicians. We reviewed the available literature and summarised the different complications and potential recommendations. A search strategy was conducted with PubMed, Cochrane, Medline, Embase, Allied and Complementary Medicine and DH-DATA databases to look for papers answering our research question: "What are the ophthalmological complications for patients after bariatric surgery?". Our search gave a total of 59 relevant papers. Bariatric surgery, particularly subtypes that cause direct bypass of nutrients from the stomach, lead to nutritional deficiencies. Vitamin A, crucial for proper functioning of body systems and specialised cells, manifests ophthalmologically as corneal ulceration, nyctalopia, conjunctival xerosis and more. Thiamine levels are also depleted, leading to Wernicke's Encephalopathy. Pre-existing diabetic retinopathy is also noted to worsen sub acutely, although evidence is conflicting. Patients undergoing surgery to treat idiopathic intracranial hypertension would have reduced IOP and resolving papilloedema. Other comorbidities of obesity like HB摘要: 肥胖是我们最大的公共卫生挑战之一, 减肥手术的实施率正在增加。随着关于减肥后并发症报道越来越多, 且这些都是由患者亲身经历或者经临床医生确认的, 因此与肥胖相关的眼部变化是一个潜在的新的临床知识领域。我们回顾了现有的文献, 总结了不同的并发症和潜在的建议。我们通过PubMed、Cochrane、Medline、Embase、联合和补充医学以及DH-DATA数据库进行了搜索, 以寻找能够回答我们关于““减肥手术后患者的眼科并发症是什么? ”问题的论文。我们共搜索到59篇相关论文。减肥手术, 特别是导致直接从胃中摄取营养的亚型手术, 会导致营养不足。维生素A对维持身体系统和特殊细胞的正常功能至关重要, 当维生素A缺乏时在眼部的表现为角膜溃疡、夜视、结膜干燥等。硫胺素水平也会下降, 并导致韦尼克脑病。术前存在的糖尿病视网膜病变也会亚急性恶化, 尽管目前的论文证据还存在相互矛盾。特发性颅内高压的患者在接受手术治疗后眼压会降低并缓解视乳头水肿。其它与肥胖的共患疾病如高糖化血红蛋白水平、阻塞性睡眠呼吸暂停综合症和代谢综合征也会在术后得到解决。病史记录仍然是医学实践的基石。根据证据, 我们建议考虑术前进行眼科病理筛查和术后的疾病进展监测。我们需要不断分析真实世界数据, 创建明确的管理途径, 帮助临床医生尽早识别眼部并发症, 改善患者预后。.

Erythroderma (exfoliative dermatitis) associates with important metabolic changes that include an enhancement in energy expenditure. The key components to total energy expenditure (TEE) include basal metabolic rate (~68% of TEE), physical activity (~22% of TEE) and thermic effect of food (~10% of TEE). In the erythrodermic state, there are likely multiple contributors to the increase in basal metabolic rate such as ‘caloric drain’ resulting from increased evaporation of water from enhanced transepidermal water loss, increased activity of the cardiovascular system (including high‐output cardiac failure), increased non‐shivering thermogenesis and hormonal changes (such as hypercortisolaemia). A change to patient’s level of physical activity and appetite as a result of ill health status may further impact on their total energy expenditure and energy consumption. In part two of this two part concise review, we explore the key constituents of energy homeostasis, the potential mechanisms impacting on energy homeostasis in erythroderma and suggest much needed dietetic management strategies for this important condition.\ud \ud

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Actinic keratoses (AK) are keratotic lesions presenting on chronically ultraviolet-exposed skin. The rate of malignant progression of a single AK to squamous cell carcinoma (SCC) remains uncertain, with reports ranging from 0.025%–20%.1,2 Patients receiving long-term immunosuppressive medications are at higher risk of developing AK.3 The estimated prevalence of AK is 19%–24% of individuals aged >60 years in the UK.3 Research suggests between 25%–70% of AK may spontaneously regress in a 1–4 year period.3 A Dutch qualitative study highlighted that some primary care clinicians’ principal approach to managing AK was treatment with cryosurgery, or referral to secondary care with patient-driven follow-up care.4 This article aims to inform GPs on the management of AK based on the British Association of Dermatologists (BAD) guidelines, the authors’ opinions on effective virtual consultations on AK, and when to refer patients to secondary care.