Robot-assisted distal pancreatectomy (RDP) was developed to overcome technical limitations of laparoscopic distal pancreatectomy (LDP), yet uncertainty persists regarding oncologic adequacy, learning-curve effects, and outcomes in high-risk subgroups. We synthesized current evidence to address these gaps. We systematically searched PubMed and EMBASE, in accordance with PRISMA guidelines, from inception to 2025 to identify comparative studies of RDP versus LDP. Using random-effects models, we calculated weighted mean differences (WMDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes, and performed subgroup analyses, including pancreatic ductal adenocarcinoma (PDAC), along with meta-regression to explore heterogeneity sources. Sixty-four studies comprising 15,790 patients (5,723 RDP; 10,067 LDP; mean age 60.5 years; BMI 26.1 kg/m²) were included. RDP resulted in lower blood loss (WMD − 52.0 mL; p < 0.00001), fewer conversions (RR 0.49; p < 0.00001), and fewer unplanned splenectomies (RR 0.59; p < 0.0001). Operative time was longer (WMD + 24.06 min; p < 0.00001). Postoperative morbidity, POPF, PPH, infection, reintervention, and mortality were comparable. Length of stay was shorter with RDP (WMD − 0.57 days; p < 0.00001). Although lymph node yield appeared higher with LDP in the overall and PDAC cohorts, this difference was no longer significant in a sensitivity analysis, and R0 resection rates remained comparable. Costs were higher with RDP, with substantial heterogeneity. RDP and LDP demonstrate comparable safety and oncologic outcomes. RDP reduces blood loss, conversions, and splenectomy but increases operative time and cost. The operative time disadvantage likely reflects learning-curve. Selective use in high-risk and complex resections is supported; cost-effectiveness warrants further study.
Parkinson's disease (PD) is a multisystem neurodegenerative disorder in which nonmotor symptoms often precede classical motor manifestations by years. Neuropsychiatric symptoms such as REM sleep behavior disorder (RBD), depression, anxiety, apathy, and mild cognitive impairment are increasingly recognized as clinically meaningful prodromal features, yet they remain underrecognized in routine practice. This narrative review summarizes literature identified through PubMed, Scopus, and Google Scholar between 2003 and 2025 using terms related to PD, prodromal symptoms, neuropsychiatric symptoms, alpha-synuclein, and body-first versus brain-first disease. Priority was given to review articles, original studies, clinical trials, Movement Disorder Society prodromal criteria, and foundational neuropathological models. Current evidence supports a dual pathway model of PD progression. In the body-first phenotype, pathology may begin in the peripheral autonomic or enteric nervous system and ascend through the brainstem, where RBD and autonomic dysfunction are prominent early markers. In the brain-first phenotype, pathology is proposed to arise in olfactory or limbic regions, where hyposmia, anxiety, and depression may precede motor disease. Prodromal neuropsychiatric symptoms are among the earliest clinically detectable features of PD. Interpreting these symptoms within the body first versus brain first framework may improve risk stratification, earlier recognition, and selection of candidates for biomarker-driven and disease-modifying studies.
INTRODUCTION:Sexually transmitted infections remain a significant concern among people living with HIV (PLHIV), with syphilis emerging as a common coinfection globally, particularly among men who have sex with men (MSM) and anti-retroviral therapy (ART)-naïve individuals. Understanding the socio-demographic and behavioural characteristics of HIV-syphilis coinfected individuals is important for guiding targeted prevention strategies. This study aimed to examine the associations between socio-demographic characteristics, sexual behaviour patterns, and treatment status among HIV-syphilis coinfected individuals, with a focus on gender differences and MSM versus non-MSM. METHODS:This secondary data analysis included 2,209 PLHIV coinfected with syphilis registered at 27 designated sexually transmitted infections/reproductive tract infection clinics (DSRCs) in Mumbai under the National AIDS and STI Control Programme from April 1, 2022, to March 31, 2025. Socio-demographic, behavioural, and clinical variables were extracted from programme records and analyzed in R, with associations assessed using chi-square or Fisher's exact tests, as applicable, and multivariable logistic regression was performed, at a significance level of p<0.05. Ethical approval was obtained from the Mumbai District AIDS Control Society, and data were anonymized before analysis. RESULTS:Among the 2,209 coinfected individuals, 1822 (82.5%) were males, 273 (12.4%) were females, and 114 (5.2%) were transgender individuals. The majority belonged to the 26-35 year age group (n = 767, 34.7%). Significant differences were observed across gender groups in education, marital status, sexual practices, partner types, condom use, and treatment status (p < 0.05). Vaginal intercourse was the most common sexual act overall (n = 1434, 76.6%), while anal and oral sexual practices were more frequently reported among males and transgender individuals (p < 0.001). Spousal partners were the most commonly reported type of partner (n = 886, 51.0%), followed by commercial (n = 808, 45.9%) and casual partners (n = 794, 44.3%). Consistent condom use was highest with casual partners (n = 377, 49.2%) but lower with regular partners (n = 71, 30.6%). Among males, 398 (21.8%) identified as MSM, who were significantly younger, more educated, and more likely to report anal sex and casual partners (p < 0.05). Overall, 60.3% (n = 1332) of participants were ART-experienced. In multivariable analysis, MSM status was independently associated with unmarried status, higher education, and anal intercourse. Increasing age, male and transgender identity were associated with higher odds of being ART-experienced, while engagement in commercial partnerships and anal intercourse were associated with lower odds. CONCLUSION:HIV-syphilis coinfection in our study appears to be sustained through overlapping sexual networks involving casual, commercial, and marital partnerships combined with inconsistent condom use. Strengthened screening for syphilis, targeted prevention interventions, and behavioural counselling for risk reduction among PLHIV are essential to reduce ongoing transmission.
Spiritual and traditional beliefs are key in how people in India describe and manage pain. In this editorial, the authors discuss that physiotherapists need to understand these cultural views to provide effective care.
