Guntur Medical College

BACKGROUND:Minimally invasive liver resection is increasingly used for hepatic malignancies, with laparoscopic liver resection (LLR) achieving outcomes similar to open surgery. Limitations of laparoscopy in complex resections have led to the growing adoption of robotic liver resection (RLR). This meta-analysis compares peri-operative outcomes between laparoscopic and robotic approaches in hepatic resections. PATIENTS AND METHODS:This Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant meta-analysis was conducted with a comprehensive search in February 2025 across PubMed, Cochrane, Scopus, CINAHL and Google Scholar for studies comparing RLR and LLR in adults undergoing hepatic resection. Primary outcomes included R0 resection rate, major complications (Clavien-Dindo ≥III), and conversion to open surgery. Secondary outcomes included operative time, blood loss and length of stay. RESULTS:Twenty-nine studies comprising 7678 patients (LLR: 5025 and RLR: 2653) were included. R0 resection and post-operative complications were comparable between approaches LLR was associated with a higher risk of conversion to open surgery (risk ratio: 1.83; 95% confidence interval [CI], 1.28-2.61) and shorter operative time (mean difference: -20.95 min; 95% CI, -40.53 to -1.38). RLR demonstrated lower intra-operative blood loss (mean difference: 68.22 mL; 95% CI, 38.05-98.38), while the length of hospital stay was similar between groups. CONCLUSION:Robotic and LLRs yield comparable oncologic and peri-operative outcomes, with robotics showing lower conversion rates and less blood loss but longer operative times.

Latent autoimmune diabetes in adults (LADA) is a slowly progressive form of autoimmune diabetes that is frequently misclassified as type 2 diabetes mellitus (T2DM) because of its gradual onset and initial responsiveness to oral hypoglycemic agents. This misclassification may delay appropriate insulin therapy and expose patients to medications that increase the risk of metabolic complications. Sodium glucose cotransporter-2 (SGLT2) inhibitors have been increasingly associated with euglycemic diabetic ketoacidosis (DKA), particularly in individuals with underlying insulin deficiency. Several reports describe euglycemic DKA as the presenting manifestation of previously unrecognized LADA. We report a case of a 55-year-old man with a nine-year history of presumed T2DM treated with metformin and canagliflozin who presented with vomiting, dehydration, and metabolic acidosis. Laboratory evaluation revealed high anion gap metabolic acidosis and marked ketosis despite only modest hyperglycemia, consistent with euglycemic DKA. The patient was successfully treated with intravenous fluids, insulin infusion, and electrolyte replacement. Further evaluation demonstrated markedly elevated anti-glutamic acid decarboxylase (GAD65) antibodies and reduced C-peptide levels, confirming autoimmune β-cell failure consistent with LADA. The SGLT2 inhibitor was discontinued, and the patient was transitioned to a basal-bolus insulin regimen with structured diabetes education. This case highlights how slowly progressive autoimmune diabetes may remain unrecognized for years and may be unmasked by metabolic stressors or SGLT2 inhibitor therapy. Clinicians should consider autoimmune diabetes in adults with atypical diabetes phenotypes or unexpected ketoacidosis and use antibody testing and C-peptide measurement to guide diagnosis and management.

Abstract Purpose Extraintestinal manifestations of inflammatory bowel disease (IBD) include anxiety and depression, with estimates varying across IBD types. We conducted a review and meta-analysis to estimate prevalence and incidence of anxiety and depression in IBD, compare psychiatric burden in Crohn’s disease (CD) and ulcerative colitis (UC), and identify heterogeneity. Methods MEDLINE (PubMed) and Embase were searched for anxiety/depression in IBD until May 2026. Random-effects meta-analyses calculated pooled prevalence/risk; heterogeneity was evaluated through Cochran’s Q, I², τ², and meta-regression. PROSPERO ID CRD420261297050. Results Twenty-two studies were included in the analysis. Thirteen studies ( n = 5,616) reported an anxiety prevalence of 24% (95% CI, 19–30%), and 15 studies ( n = 5,956) reported a depression prevalence of 24% (95% CI, 20–28%). Six cohort studies showed that IBD was associated with increased anxiety (HR 1.36, 95% CI, 1.17–1.59) and depression risk (HR 1.44, 95% CI, 1.35–1.54) versus non-IBD controls. No differences were observed between CD and UC for anxiety (OR 1.05, 95% CI, 0.64–1.73) or depression (OR 1.13, 95% CI, 0.86–1.48). Region explained heterogeneity, and instruments did not influence the estimates. The findings were robust, and no publication bias was identified. Conclusions One in four with inflammatory bowel disease (IBD) experiences anxiety or depression, and Crohn’s disease (CD) and ulcerative colitis (UC) burden suggest inflammation underlies this risk. Findings support assessment, clarify gut-brain links, and identify beneficiaries.

Fahr’s syndrome is a rare neurological disorder characterized by bilateral intracranial calcifications, most commonly affecting the basal ganglia, dentate nucleus, and thalamus. Unlike primary familial brain calcification, which is genetic, Fahr’s syndrome occurs secondary to identifiable metabolic or endocrine abnormalities, most commonly hypoparathyroidism. We report a case of a 36-year-old female who presented with signs of hypocalcemia and who had a history of thyroidectomy, with imaging showing extensive bilateral basal ganglia and white matter calcifications. Fahr’s syndrome should be considered a potential complication of thyroidectomy. Early diagnosis using computed tomography imaging to identify calcifications, along with calcium and Vitamin D supplementation, is associated with improved outcomes. A multidisciplinary approach is important to monitor clinical features and manage the condition effectively.