Robotic-assisted versus laparoscopic incisional hernia repair: a systematic review and meta-analysis.

PURPOSE: This study aimed to perform a systematic review and meta-analysis comparing the efficacy and safety outcomes of robotic-assisted and laparoscopic techniques for incisional hernia repair. METHODS: PubMed, Embase, Scopus, Cochrane databases, and conference abstracts were systematically searched for studies that directly compared robot-assisted versus laparoscopy for incisional hernia repair and reported safety or efficacy outcomes in a follow-up of ≥ 1 month. The primary endpoints of interest were postoperative complications and the length of hospital stay. RESULTS: The search strategy yielded 2104 results, of which four studies met the inclusion criteria. The studies included 1293 patients with incisional hernia repairs, 440 (34%) of whom underwent robot-assisted repair. Study follow-up ranged from 1 to 24 months. There was no significant difference between groups in the incidence of postoperative complications (OR 0.65; 95% CI 0.35-1.21; p = 0.17). The recurrence rate of incisional hernias (OR 0.34; 95% CI 0.05-2.29; p = 0.27) was also similar between robotic and laparoscopic surgeries. Hospital length of stay (MD - 1.05 days; 95% CI - 2.06, - 0.04; p = 0.04) was significantly reduced in the robotic-assisted repair. However, the robot-assisted repair had a significantly longer operative time (MD 69.6 min; 95% CI 59.0-80.1; p < 0.001). CONCLUSION: The robotic approach for incisional hernia repair was associated with a significant difference between the two groups in complications and recurrence rates, a longer operative time than laparoscopic repair, but with a shorter length of stay.

Effectiveness of different treatments in obesity hypoventilation syndrome.

Obesity hypoventilation syndrome (OHS) is an undesirable consequence of obesity, defined as daytime hypoventilation, sleep disorder breathing and obesity; during the past few years the prevalence of extreme obesity has markedly increased worldwide consequently increasing the prevalence of OHS. Patients with OHS have a lower quality of life and a higher risk of unfavourable cardiometabolic consequences. Early diagnosis and effective treatment can lead to significant improvement in patient outcomes; therefore, such data has noticeably raised interest in the management and treatment of this sleep disorder. This paper will discuss the findings on the main current treatment modalities OHS will be discussed.

Bemiparin as a long-term treatment for venous thrombosis in cancer patients: the ELEBAMA study.

INTRODUCTION: Low-molecular-weight heparin (LMWH) is the standard treatment for cancer-associated venous thromboembolism (VTE). There have been no specific studies evaluating bemiparin for VTE in people with cancer. The aim of this study is to evaluate the effects of bemiparin for long-term treatment of VTE in routine clinical practice. METHODS/PATIENTS: Prospective observational study. Consecutive patients with active cancer and VTE, under treatment with bemiparin for at least 6 months, were recruited. RESULTS: We included 89 patients. The 6- and 9-month cumulative VTE recurrence rates were 2.4% and 5.9%, respectively. The 6-month cumulative rate of major bleeding was 1.3%, and of clinically relevant non-major bleeding, 8%. CONCLUSIONS: The incidence of events in this study is lower than that reported in randomized trials. Bemiparin is effective and safe for the long-term treatment of cancer-associated VTE in routine clinical practice.

[Pharmacological treatment compliance and a description of its associated factors in patients with myasthenia gravis]. / Adhesion al tratamiento farmacologico y descripcion de sus factores asociados en pacientes con miastenia grave.

INTRODUCTION: Medication adherence is a public health problem and this has not been previously studied in myasthenia gravis patients. AIM: To determine if patients with myasthenia gravis are adherent to treatment and to describe the clinical factors of patients who are non-adherent to treatment. PATIENTS AND METHODS: Cross-sectional study of patients with myasthenia gravis followed at Padre Hurtado Hospital, Santiago de Chile, who received their medication through the hospital and therefore were on the pharmacy's list. Patients' participation was voluntary and anonymous. Medication adherence was assessed with the Morisky-Green-Levine survey (4 items). Patients were assessed for myasthenia gravis severity with the Manual Muscle Test, and myasthenia gravis-related quality of life with the MG-QOL15. Finally, patients were screened for depression with the 12-Item General Health Questionnaire. RESULTS: 26 patients were enrolled and 15 (57.7%) were women. Only 10 (38.5%) of patients were adherent to treatment. Patients who were not adherent to medication had more weakness (p = 0.06), worse quality of life (p = 0.008), were taking a greater number of myasthenia gravis drugs (p = 0.003) and had a higher risk of depression (p = 0.03). CONCLUSIONS: In this cohort of myasthenia gravis patients, three out of five patients were not adherent to treatment. These patients tended to have more weakness, worse quality of life and higher risk of depression. Medication adherence should be assessed routinely in patients with myasthenia gravis.

TITLE: Adhesion al tratamiento farmacologico y descripcion de sus factores asociados en pacientes con miastenia grave.Introduccion. La adhesion al tratamiento farmacologico es un problema de salud publica, pero no se ha estudiado en pacientes con miastenia grave. Objetivo. Determinar la adhesion al tratamiento farmacologico en pacientes con miastenia grave y describir al grupo de pacientes no adherentes al tratamiento. Pacientes y metodos. Estudio de corte transversal, en pacientes con miastenia grave, en control y abandono del tratamiento farmacologico en el Hospital Padre Hurtado, Santiago de Chile. Los pacientes fueron invitados a participar de forma voluntaria y anonima. Se evaluo la adhesion al tratamiento con la escala Morisky-Green-Levine de cuatro items. Ademas, se evaluo la gravedad de la miastenia grave con el test manual de fuerza muscular (MMT); la calidad de vida asociada a la miastenia grave, con el 15-Item Quality Of Life Instrument for Myasthenia Gravis (MG-QOL15), y el riesgo de depresion, con el cuestionario de salud general de 12 items (GHQ-12). Resultados. Participaron 26 pacientes, de los cuales 15 (57,7%) eran mujeres. Solo 10 (38,5%) mostraron adhesion al tratamiento. Los no adherentes presentaron mayor debilidad (MMT; p = 0,06) y peor calidad de vida (MG-QOL15; p = 0,008), y tomaban mas farmacos para la miastenia grave (p = 0,003). Ademas, presentaron mayor riesgo de depresion (GHQ-12; p = 0,03) comparados con el grupo de adhesion al tratamiento. Conclusion. Tres de cada cinco pacientes con miastenia grave abandonaron el tratamiento, lo que se asocio con mayor debilidad, peor calidad de vida y mayor riesgo de depresion. Por lo tanto, deberia evaluarse la adhesion al tratamiento en los pacientes con miastenia grave.