तटवर्ती जलकृषि विकास में एम पी ई डी ए की भूमिका

कृपया पूरा लेखा पढ

Robotic versus laparoscopic distal pancreatectomy in obese patients

Background: Although robotic distal pancreatectomy (RDP) has a lower conversion rate to open surgery and causes less blood loss than laparoscopic distal pancreatectomy (LDP), clear evidence on the impact of the surgical approach on morbidity is lacking. Prior studies have shown a higher rate of complications among obese patients undergoing pancreatectomy. The primary aim of this study is to compare short-term outcomes of RDP vs. LDP in patients with a BMI ≥ 30. Methods: In this multicenter study, all obese patients who underwent RDP or LDP for any indication between 2012 and 2022 at 18 international expert centers were included. The baseline characteristics underwent inverse probability treatment weighting to minimize allocation bias. Results: Of 446 patients, 219 (50.2%) patients underwent RDP. The median age was 60 years, the median BMI was 33 (31-36), and the preoperative diagnosis was ductal adenocarcinoma in 21% of cases. The conversion rate was 19.9%, the overall complication rate was 57.8%, and the 90-day mortality rate was 0.7% (3 patients). RDP was associated with a lower complication rate (OR 0.68, 95% CI 0.52-0.89; p = 0.005), less blood loss (150 vs. 200 ml; p < 0.001), fewer blood transfusion requirements (OR 0.28, 95% CI 0.15-0.50; p < 0.001) and a lower Comprehensive Complications Index (8.7 vs. 8.9, p < 0.001) than LPD. RPD had a lower conversion rate (OR 0.27, 95% CI 0.19-0.39; p < 0.001) and achieved better spleen preservation rate (OR 1.96, 95% CI 1.13-3.39; p = 0.016) than LPD. Conclusions: In obese patients, RDP is associated with a lower conversion rate, fewer complications and better short-term outcomes than LPD

Prevalence of obesity and its association with stress levels among undergraduate medical students

The burden of obesity and its related disorders is growing to an epidemic form, particularly among young adults, both in the developing and developed countries. Pursuing medical education is considered stressful throughout the course of the training. Stress leading to disordered eating habits along with lack of physical activity tend to make medical students more prone to obesity related disorders. The present study was carried out to find out the prevalence of overweight and obesity and its association with stress among medical undergraduates.This cross-sectional study was conducted at Narayana Medical College, Nellore, Andhra Pradesh. After obtaining approval from the Institutional ethics committee, both male and female students were invited to participate. Data on age, gender, type of diet, physical activity, consumption of junk food and other habits were collected. Cohen’s perceived stress score questionnaire was used to quantify the level of stress. Among 170 students, about 18.2% (n=31) of students were obese and 8.2% (n=14) were overweight. The mean stress score was 17.2 (± 4.72) and about 78% (n=133) reported to have stress with scores &amp;#62; 13. There was a significant association between BMI and consumption of junk food and a mild positive correlation existed between BMI and perceived stress score index(PSSI) among first year medical undergraduates.Obesity and stress remain a common problem among medical undergraduates. The causality can be established with more robust study designs. Encouraging proper eating habits combined with daily physical activity, yoga and body weight management programs might help curbing the problem.</jats:p

Impact of routine nasogastric decompression <i>versus</i> no nasogastric decompression after pancreaticoduodenectomy on perioperative outcomes: meta-analysis

Abstract Background Consensus on the use of nasogastric decompression (NGD) after pancreaticoduodenectomy (PD) is lacking. This meta-analysis reviewed current evidence on the impact of routine NGD versus no NGD after PD on perioperative outcomes. Methods PubMed, Medline, Scopus, Embase and Cochrane databases were searched for studies reporting on the role of NGD after PD on perioperative outcomes. Data up to January 2021were retrieved and analysed. Results Eight studies were included, with a total of 1301 patients enrolled, of whom 668 had routine NGD. Routine NGD was associated with a higher incidence of overall delayed gastric emptying (DGE) (odds ratio (OR) 2.51, 95 per cent c.i. 1.12 to 5.63, I2 = 83 per cent; P = 0.03) and clinically relevant DGE (OR 3.64, 95 per cent c.i. 1.83 to 7.25, I2 = 54 per cent; P &amp;lt; 0.01), a higher rate of Clavien–Dindo grade II or higher complications (OR 3.12, 95 per cent c.i. 1.05 to 9.28, I2 = 88 per cent; P = 0.04) and increased length of hospital stay (mean difference 2.67, 95 per cent c.i. 0.60 to 4.75, I2 = 97 per cent; P = 0.02). There were no significant differences in overall complications (OR 1.07, 95 per cent c.i. 0.79 to 1.46, I2 = 0 per cent; P = 0.66) or postoperative pancreatic fistula (OR 1.21, 95 per cent c.i. 0.86 to 1.72, I2 = 0 per cent; P = 0.28) between patients with or those without routine NGD. Conclusion Routine NGD was associated with increased rates of DGE, major complications and longer length of stay after PD. </jats:sec

Robotic versus laparoscopic distal pancreatectomy for pancreatic adenocarcinoma in obese patients

BackgroundRobotic distal pancreatectomy (RDP) is associated with a lower conversion rate and less blood loss than laparoscopic distal pancreatectomy (LDP). LDP has similar oncological outcomes as open surgery in PDAC. The aim of this study was to compare perioperative and oncological outcomes in obese patients with RDP versus LDP for PDAC.Materials and methodsRetrospectively, all obese patients who underwent RDP or LDP for PDAC between 2012 and 2022 at 12 international expert centres were included.Resultsout of 372, 81 patients were included. All baseline features were comparable between the two groups. RDP was associated with decreased blood loss (495mlLDP vs. 188mlRDP; p = 0.003), lower conversion rate (13.5%RDP vs. 36.4%LDP; p = 0.019) and lower rate of Clavien-Dindo &gt;= 3 complications (13.5%RDP vs. 36.4%LDP; p = 0.019). Overall and disease-free survival were comparable.ConclusionsIn obese patients with left-sided PDAC, the robotic approach was associated with improved intraoperative outcomes and fewer severe complications