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𝙀𝙢𝙚𝙧𝙜𝙚𝙣𝙘𝙮 𝙇𝙖𝙥𝙖𝙧𝙤𝙨𝙘𝙤𝙥𝙞𝙘 𝙍𝙚𝙥𝙖𝙞𝙧 𝙤𝙛 𝙎𝙩𝙧𝙖𝙣𝙜𝙪𝙡𝙖𝙩𝙚𝙙 𝙁𝙚𝙢𝙤𝙧𝙖𝙡 𝙃𝙚𝙧𝙣𝙞𝙖 𝙬𝙞𝙩𝙝 𝙎𝙢𝙖𝙡𝙡 𝘽𝙤𝙬𝙚𝙡 𝙍𝙚𝙨𝙚𝙘𝙩𝙞𝙤𝙣 𝙖𝙣𝙙 𝙄𝘾𝙂 Surgical Approach: 🔴Reduce small bowel first ➡️Gentle abdominal pressure and squeeze ➡️Atraumatic grasper to hold bowel and gently manipulate ➡️Stretch hernia ring if needed ➡️Gentle side-to-side traction without grasping useful when bowel is fragile 🔴Perform hernia... repair ➡️Suture repair safe option in strangulated small bowel requiring resection ➡️On rare occasions a biologic mesh may be an option ➡️Synthetic mesh could be considered if no resection involved 🔴ICG to assess bowel perfusion and assist in delineating length of resection ➡️Improve trainee understanding of key concepts ➡️Reduce risk of leak or stricture ➡️"See the invisible" 🔴Advanced laparoscopic skills critical 🔴Training and development of laparoscopy in EGS should be encouraged #FOAMed #GITwitter #MedEd #Hernia #Surgery #SoMe4Surgeryshow more

Derby Pancreaticobiliary & Robotic AWR Unit

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𝗘𝗺𝗲𝗿𝗴𝗲𝗻𝗰𝘆 𝗥𝗼𝗯𝗼𝘁𝗶𝗰 𝗥𝗲𝗽𝗮𝗶𝗿 𝗼𝗳 𝗟𝗲𝗳𝘁 𝗜𝗻𝗴𝘂𝗶𝗻𝗮𝗹 𝗛𝗲𝗿𝗻𝗶𝗮 𝘄𝗶𝘁𝗵 𝗜𝗖𝗚 Surgical Approach: 🔴Initial assessment of small bowel with ICG 🔴Small bowel placed in pelvis with warm wet swabs overlying 🔴TAPP approach to hernia repair ➡️Critical view of MPO ➡️ICG to help delineate key structures ➡️Progrip mesh ➡️3-0 absorbable V-lock to close peritoneum 🔴Reassessment of small bowel after hernia repair ➡️ICG present in bruised area demonstrating viability ➡️Aided decision making to not resect or oversew Robotics in EGS: 🟢Case selection key 🟢MDT approach with anaesthetic and scrub teams to coordinate 🟢Minimally invasive approaches in EGS should be encouraged #FOAMed #GITwitter #MedEd #Surgery #Hernia #EGS

𝗘𝗺𝗲𝗿𝗴𝗲𝗻𝗰𝘆 𝗥𝗼𝗯𝗼𝘁𝗶𝗰 𝗥𝗲𝗽𝗮𝗶𝗿 𝗼𝗳 𝗟𝗲𝗳𝘁 𝗜𝗻𝗴𝘂𝗶𝗻𝗮𝗹 𝗛𝗲𝗿𝗻𝗶𝗮 𝘄𝗶𝘁𝗵 𝗜𝗖𝗚 Surgical Approach: 🔴Initial assessment of small bowel with ICG 🔴Small bowel placed in pelvis with warm wet swabs overlying 🔴TAPP approach to hernia repair ➡️Critical view of MPO ➡️ICG to help delineate key structures ➡️Progrip mesh ➡️3-0 absorbable V-lock to close peritoneum 🔴Reassessment of small bowel after hernia repair ➡️ICG present in bruised area demonstrating viability ➡️Aided decision making to not resect or oversew Robotics in EGS: 🟢Case selection key 🟢MDT approach with anaesthetic and scrub teams to coordinate 🟢Minimally invasive approaches in EGS should be encouraged #FOAMed #GITwitter #MedEd #Surgery #Hernia #EGS

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Laparoscopic Ileocaecal Resection with Intracorporeal Anastomosis and ICG Patient Presentation: 🔴Sudden onset severe abdominal pain 🔴Tender abdomen 🔴No previous abdominal surgery 🔴High WCC 🔴Lactate ➡️5 on arrival down to 2 in 2 hours following fluid resuscitation 🔴CT abdomen/pelvis ➡️Red arrows show no small bowel perfusion with mural thickening ➡️Green arrows show perfused small and large bowel ➡️Mesenteric vessels patent Surgical Approach: 🔴Lap EGS approach ➡️Torsion of small bowel with Meckel's adhesion to abdominal wall acting as pivot point ➡️80cm ischaemic small bowel involving ileocaecal junction 🔴Specimen retrieved via extension of LUQ 12mm port

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Derby Pancreaticobiliary & Robotic AWR Unit

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𝙇𝙖𝙥𝙖𝙧𝙤𝙨𝙘𝙤𝙥𝙞𝙘 𝙍𝙚𝙥𝙖𝙞𝙧 𝙤𝙛 𝙋𝙚𝙧𝙛𝙤𝙧𝙖𝙩𝙚𝙙 𝘿𝙪𝙤𝙙𝙚𝙣𝙖𝙡 𝙐𝙡𝙘𝙚𝙧 𝙬𝙞𝙩𝙝 𝙋𝙧𝙞𝙢𝙖𝙧𝙮 𝘾𝙡𝙤𝙨𝙪𝙧𝙚 & 𝙊𝙢𝙚𝙣𝙩𝙖𝙡 𝙋𝙖𝙩𝙘𝙝 Presentation: 🔵1 day history of sever upper abdominal pain 🔵Smoker and excess ETOH 🔵CXR ➡️Pneumoperitoneum 🔵CT ➡️Perforated duodenal ulcer 🔵Time from ED➡️theatre 3 hours Operative Approach: 🔴Thorough peritoneal lavage ➡️Lap washout allows for thorough removal of intra-abdominal contamination ➡️Modern OR table tilting can provide better view then open in select cases 🔴If fragile tissue then omental patch only ➡️This approach is a modified version of Grahams patch repair ➡️When suitable, we prefer primary closure with patch after 🔴For large perforations kocherisation of duodenum may be indicated 🔴Convert to open if: ➡️Large ulcer ➡️Associated ulcer bleed 🔴H. Pylori eradication therapy on discharge 🔴OGD in 6-8 weeks to confirm healing Key Points: 🟢Timely intervention critical 🟢Lap approach in EGS should be encouraged 🟢Compared to open, advantages of lap are: ➡️Reduced pain ➡️Reduced LOS ➡️Reduced incisional hernia rate 🟢Trainees should be exposed to lap EGS early to develop skills and confidence #FOAMed #GITwitter #MedEd #SurgEd #EGS #SoMe4Surgery

𝙇𝙖𝙥𝙖𝙧𝙤𝙨𝙘𝙤𝙥𝙞𝙘 𝙍𝙚𝙥𝙖𝙞𝙧 𝙤𝙛 𝙋𝙚𝙧𝙛𝙤𝙧𝙖𝙩𝙚𝙙 𝘿𝙪𝙤𝙙𝙚𝙣𝙖𝙡 𝙐𝙡𝙘𝙚𝙧 𝙬𝙞𝙩𝙝 𝙋𝙧𝙞𝙢𝙖𝙧𝙮 𝘾𝙡𝙤𝙨𝙪𝙧𝙚 & 𝙊𝙢𝙚𝙣𝙩𝙖𝙡 𝙋𝙖𝙩𝙘𝙝 Presentation: 🔵1 day history of sever upper abdominal pain 🔵Smoker and excess ETOH 🔵CXR ➡️Pneumoperitoneum 🔵CT ➡️Perforated duodenal ulcer 🔵Time from ED➡️theatre 3 hours Operative Approach: 🔴Thorough peritoneal lavage ➡️Lap washout allows for thorough removal of intra-abdominal contamination ➡️Modern OR table tilting can provide better view then open in select cases 🔴If fragile tissue then omental patch only ➡️This approach is a modified version of Grahams patch repair ➡️When suitable, we prefer primary closure with patch after 🔴For large perforations kocherisation of duodenum may be indicated 🔴Convert to open if: ➡️Large ulcer ➡️Associated ulcer bleed 🔴H. Pylori eradication therapy on discharge 🔴OGD in 6-8 weeks to confirm healing Key Points: 🟢Timely intervention critical 🟢Lap approach in EGS should be encouraged 🟢Compared to open, advantages of lap are: ➡️Reduced pain ➡️Reduced LOS ➡️Reduced incisional hernia rate 🟢Trainees should be exposed to lap EGS early to develop skills and confidence #FOAMed #GITwitter #MedEd #SurgEd #EGS #SoMe4Surgery

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Tips & Tricks for Minimally Invasive Adhesiolysis 🔴Gentle counter traction on bowel whilst scissors dissects adhesion under tension 🔴Cold scissors 🔴Divide adhesion close to abdominal wall 🔴Include tissue from abdominal wall onto bowel ➡️Shown prior to division of adhesion

Tips & Tricks for Minimally Invasive Adhesiolysis 🔴Gentle counter traction on bowel whilst scissors dissects adhesion under tension 🔴Cold scissors 🔴Divide adhesion close to abdominal wall 🔴Include tissue from abdominal wall onto bowel ➡️Shown prior to division of adhesion

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Tips for Transcystic Laparoscopic CBD Exploration 🔴3mm choledochoscope ➡️Direct visualisation of duct 🔴Cephalad retraction 🔴Incise cystic duct parallel to CBD stone 🔴If large CBD stone ➡️withdraw scope over wire and provide gentle traction 🔴Milk backwards 🔴Keep CBD in view 🔴Reduce speed of irrigation to trap CBDS What are your tips and tricks for transcystic LCBDE? #FOAMed #GITwitter #surgery #hpb #MedEd #SoMe4Surgery

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𝗘𝘅𝘁𝗲𝗻𝘀𝗶𝗼𝗻 𝗼𝗳 𝗖𝗵𝗼𝗹𝗲𝗱𝗼𝗰𝗵𝗼𝘁𝗼𝗺𝘆 𝗳𝗼𝗿 𝗟𝗮𝗿𝗴𝗲 𝗖𝗕𝗗 𝗦𝘁𝗼𝗻𝗲 🔴CBD diameter key 🔴Extend choledochotomy with choledochotome 🔴CBD stone trapped in basket under slight tension and brought to choledochotomy 🔵Other options ➡️EHL ➡️Laser Lithotripsy 🔵Caution when extending choledochotomy ➡️Experience and training critical #FOAMed #GITwitter #MedEd #Surgery #SoMe4Surgery

𝗘𝘅𝘁𝗲𝗻𝘀𝗶𝗼𝗻 𝗼𝗳 𝗖𝗵𝗼𝗹𝗲𝗱𝗼𝗰𝗵𝗼𝘁𝗼𝗺𝘆 𝗳𝗼𝗿 𝗟𝗮𝗿𝗴𝗲 𝗖𝗕𝗗 𝗦𝘁𝗼𝗻𝗲 🔴CBD diameter key 🔴Extend choledochotomy with choledochotome 🔴CBD stone trapped in basket under slight tension and brought to choledochotomy 🔵Other options ➡️EHL ➡️Laser Lithotripsy 🔵Caution when extending choledochotomy ➡️Experience and training critical #FOAMed #GITwitter #MedEd #Surgery #SoMe4Surgery

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Tips for Retrieval of CBD Stone during Transcholedochal LCBDE 🔴CBD >8mm 🔴Atraumatic graspers useful 🔴"Milking" CBDS 🔴5mm choledochoscope with 0-Tip basket ➡️Gentle "to-and-fro" motion ➡️Irrigation 🔴Withdraw choledochoscope over basket wire with trapped CBDS 🔴Extend choledochotomy #FOAMed #GITwitter #Surgery #SoMe4Surgery #HPB

Tips for Retrieval of CBD Stone during Transcholedochal LCBDE 🔴CBD >8mm 🔴Atraumatic graspers useful 🔴"Milking" CBDS 🔴5mm choledochoscope with 0-Tip basket ➡️Gentle "to-and-fro" motion ➡️Irrigation 🔴Withdraw choledochoscope over basket wire with trapped CBDS 🔴Extend choledochotomy #FOAMed #GITwitter #Surgery #SoMe4Surgery #HPB

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𝗟𝗮𝗽𝗮𝗿𝗼𝘀𝗰𝗼𝗽𝗶𝗰 𝗙𝗲𝗻𝗲𝘀𝘁𝗿𝗮𝘁𝗲𝗱 𝗦𝘂𝗯𝘁𝗼𝘁𝗮𝗹 𝗖𝗵𝗼𝗹𝗲𝗰𝘆𝘀𝘁𝗲𝗰𝘁𝗼𝗺𝘆 Patient Presentation: 🔵History of severe cholecystitis 🔵CT on index admission showed: ➡️Cholecysto-colic fistula ➡️Air locules on GB ➡️Figure 1 below 🔵Follow up CT (~4 months later): ➡️Good improvement with apparent resolution of fistula as absence of air in GB ➡️Figure 2 below 🔵Symptomatic gallstones 🔵Listed for planned biliary surgery Operative Approach: 🔴Colonic adhesion to GB fundus 🔴Fused hepatocystic triangle ➡️Decision to perform subtotal cholecystectomy 🔴Dissection plane (window) identified between GB and colon 🔴Presumed area of fistula tract detached with cuff of GB wall 🔴Stone retrieved and GB opened to identify cystic duct ostium on opening GB ➡️Closed with 2/0 Vicryl 🔴Gallbladder dissected off as far as safe to do so 🔴Detached colonic attachment with GB cuff ➡️No obvious fistula tract ➡️The area was under run to achieve haemostasis 🔴Cystic artery transfixed with figure of 8 suture 🔴Drain x 1 ➡️Removed after 24 hours 🔴Uneventful postop course #FOAMed #MedTwitter #GITwitter #SoMe4Surgery #HPB

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Robotic Longitudinal Pancreaticojejunostomy 🔵Chronic pancreatitis secondary to ETOH excess - now teetotal 🔵Multiple admissions with chronic pain 🔵Significant impairment on QoL 🔵2 emergency admissions ➡️Acute pancreatitis with side branch disruption 🔵Normal LFTs 🔵CT/MRCP ➡️Dilated PD with "chain of lakes" ➡️Non-obstructing stone at HOP 🔵MDT ➡️Decision to proceed to surgery 🔴Adjuncts such as IOUS, ICG and intraoperative pancreatoscopy ➡️Improves operative safety ➡️Promotes learning and training in complex benign PB conditions 🔴Benefit of ICG ➡️Visual confirmation of splenic artery and proximity to PD/pancreatic parenchyma #FOAMed #MedEd #surgery #hpb

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Laparoscopic Infracolic Necrosectomy and Drainage of RIF Abscess 🔴Septic patient but no organ failure 🔴Narrow window of access for EUS or IR drainage 🔴Single stage clearance of WON and drainage of RIF abscess ➡️Prevents hits of sepsis between multiple procedures ➡️Address both collections at once ➡️Select cases ➡️Benign PB MDT ➡️"One size does not fit all" Our paper on infracolic approach in Journal of Gastrointestinal Surgery (JoGS): #Surgery #HPB #Pancreatitis

Derby Pancreaticobiliary & Robotic AWR Unit

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𝗥𝗼𝗯𝗼𝘁𝗶𝗰 𝗧𝗔𝗥𝗨𝗣 𝘃𝘀. 𝗟𝗮𝗽𝗮𝗿𝗼𝘀𝗰𝗼𝗽𝗶𝗰 𝗜𝗣𝗢𝗠 𝗥𝗲𝗽𝗮𝗶𝗿 𝗼𝗳 𝗩𝗲𝗻𝘁𝗿𝗮𝗹 𝗛𝗲𝗿𝗻𝗶𝗮 Defect closure: 🔵Standard of care in both approaches 🔵Robot facilitates closure of larger defect up to a maximum size of 5cm for TARUP repair Comparison: 🔴Retromuscular (rTARUP) vs. Intraperitoneal (IPOM) mesh placement 🔴No tacks (rTARUP) vs. Use of tacks (IPOM) 🔴Minimal risk of bowel adhesions (rTARUP) vs. Possibility of bowel adhesions (IPOM) 🔴Extensive dissection (rTARUP) vs. Minimal dissection (IPOM) 🔴LOS and analgesic requirements less for rTARUP Less pain in rTARUP due to: 🟢Better and precise haemostasis in dissection plane facilitated by robotic platform 🟢No use of tacks 🟢Robotic port remote centre technology with less muscle trauma at port sites #FOAMed #SoMe4Surgery #hernia #surgery #robotics

𝗥𝗼𝗯𝗼𝘁𝗶𝗰 𝗧𝗔𝗥𝗨𝗣 𝘃𝘀. 𝗟𝗮𝗽𝗮𝗿𝗼𝘀𝗰𝗼𝗽𝗶𝗰 𝗜𝗣𝗢𝗠 𝗥𝗲𝗽𝗮𝗶𝗿 𝗼𝗳 𝗩𝗲𝗻𝘁𝗿𝗮𝗹 𝗛𝗲𝗿𝗻𝗶𝗮 Defect closure: 🔵Standard of care in both approaches 🔵Robot facilitates closure of larger defect up to a maximum size of 5cm for TARUP repair Comparison: 🔴Retromuscular (rTARUP) vs. Intraperitoneal (IPOM) mesh placement 🔴No tacks (rTARUP) vs. Use of tacks (IPOM) 🔴Minimal risk of bowel adhesions (rTARUP) vs. Possibility of bowel adhesions (IPOM) 🔴Extensive dissection (rTARUP) vs. Minimal dissection (IPOM) 🔴LOS and analgesic requirements less for rTARUP Less pain in rTARUP due to: 🟢Better and precise haemostasis in dissection plane facilitated by robotic platform 🟢No use of tacks 🟢Robotic port remote centre technology with less muscle trauma at port sites #FOAMed #SoMe4Surgery #hernia #surgery #robotics

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11,606 Aufrufe • vor 2 Jahren

𝗦𝘁𝗼𝗻𝗲 𝗥𝗲𝘁𝗿𝗶𝗲𝘃𝗮𝗹 𝗳𝗿𝗼𝗺 𝗡𝗮𝗿𝗿𝗼𝘄 𝗖𝗵𝗼𝗹𝗲𝗱𝗼𝗰𝗵𝗼𝘁𝗼𝗺𝘆 🔴Bring CBD stone trapped in basket to choledochotomy site 🔴Remove scope over wire 🔴Keep tension on basket wire with trapped CBD stone 🔴Introduce choledochotome (or laparoscopic scissors) and minimally extend choledochotomy over large CBD stone ➡️Prevents large choledochotomy #FOAMed #GITwitter #MedEd #SoMe4Surgery #Surgery

𝗦𝘁𝗼𝗻𝗲 𝗥𝗲𝘁𝗿𝗶𝗲𝘃𝗮𝗹 𝗳𝗿𝗼𝗺 𝗡𝗮𝗿𝗿𝗼𝘄 𝗖𝗵𝗼𝗹𝗲𝗱𝗼𝗰𝗵𝗼𝘁𝗼𝗺𝘆 🔴Bring CBD stone trapped in basket to choledochotomy site 🔴Remove scope over wire 🔴Keep tension on basket wire with trapped CBD stone 🔴Introduce choledochotome (or laparoscopic scissors) and minimally extend choledochotomy over large CBD stone ➡️Prevents large choledochotomy #FOAMed #GITwitter #MedEd #SoMe4Surgery #Surgery

Derby Pancreaticobiliary & Robotic AWR Unit

38,724 Aufrufe • vor 6 Monaten

$Laparoscopic Infracolic Necrosectomy and Drainage of RIF Abscess 🔴Septic patient but no organ failure 🔴Narrow window of access for EUS or IR drainage 🔴Single stage clearance of WON and drainage of RIF abscess ➡️Prevents hits of sepsis between multiple procedures ➡️Address both collections at once ➡️Select cases ➡️Benign PB MDT ➡️"One size does not fit all" Our paper on infracolic approach in JOGS: Our collaboration with BehindTheKnife on MIS for complicated SAP: #Surgery #HPB #Pancreatitis$

Laparoscopic Infracolic Necrosectomy and Drainage of RIF Abscess 🔴Septic patient but no organ failure 🔴Narrow window of access for EUS or IR drainage 🔴Single stage clearance of WON and drainage of RIF abscess ➡️Prevents hits of sepsis between multiple procedures ➡️Address both collections at once ➡️Select cases ➡️Benign PB MDT ➡️"One size does not fit all" Our paper on infracolic approach in JOGS: Our collaboration with BehindTheKnife on MIS for complicated SAP: #Surgery #HPB #Pancreatitis

Derby Pancreaticobiliary & Robotic AWR Unit

17,219 Aufrufe • vor 1 Jahr

Boyes ➡️ Newby ➡️🥅 We could get used to this... 😄 #YCFC 🔴🔵

Boyes ➡️ Newby ➡️🥅 We could get used to this... 😄 #YCFC 🔴🔵

York City FC

18,736 Aufrufe • vor 2 Monaten

🔴 WATCH: Sakeliga's Russell Lamberti in discussion with investor and philosopher, Nick Hudson. Nick Hudson ➡️ How BEE kills growth ➡️ The perils of DEI, ESG and 'stakeholder capitalism' ➡️ Resisting the attack on creativity and problem-solving Full video below ⬇️

🔴 WATCH: Sakeliga's Russell Lamberti in discussion with investor and philosopher, Nick Hudson. Nick Hudson ➡️ How BEE kills growth ➡️ The perils of DEI, ESG and 'stakeholder capitalism' ➡️ Resisting the attack on creativity and problem-solving Full video below ⬇️

Sakeliga

43,882 Aufrufe • vor 1 Jahr

TMC means THE MIYAAN MULLA CAUCUS ₹5713 cr for Madrassa in Bengal And Less than ₹1000 cr for entire North Bengal 🕌 🌙 Minority Affairs and Madrasah Education: 5713.61 (an increase of 1111.02% since 2011-12) ➡️ Power: 5343.59 ➡️ Irrigation and Waterways: 4214.1 ➡️ Disaster Management & Civil Defence: 3119.99 ➡️ Backward Classes Welfare: 2533.39 ➡️ Transport: 2307.3 ➡️ Judiciary: 1788.57 ➡️ Water Resources Investigation & Development: 1674.22 ➡️ Land & Land Reforms and Refugee Relief & Rehabilitation: 1532.29 ➡️ Industry, Commerce & Enterprises: 1483.97 ➡️ Technical Education, Training and Skill Development: 1464.19 ➡️ Animal Resources Development: 1327.33 ➡️ Labour: 1268.26 ➡️ Micro, Small & Medium Enterprises and Textiles: 1250.15 ➡️ Tribal Development: 1234.78 ➡️ Forests: 1105.65 ➡️ Information & Cultural Affairs: 1006.05 ➡️ North Bengal Development: 920.13 ➡️ Youth Services and Sports: 881.89 ➡️ Self Help Group & Self Employment: 821.92 ➡️ Paschimanchal Unnayan Affairs: 810.04 ➡️ Sunderban Affairs: 641.74 ➡️ Co-operation: 637.4 ➡️ Planning and Statistics: 618.68 ➡️ Fire and Emergency Services: 541.59 ➡️ Fisheries: 539.3 ➡️ Tourism: 525.92 ➡️ Correctional Administration: 455.47 ➡️ Personnel & Administrative Reforms: 447.89 ➡️ Agriculture Marketing: 434.05 ➡️ Mass Education Extension and Library Services: 318.09 ➡️ Housing: 295.37 ➡️ Food Processing Industries and Horticulture: 258.35 ➡️ Information Technology & Electronics: 217.16 ➡️ Consumer Affairs: 147.63 ➡️ Environment: 108.62 ➡️ Non-conventional & Renewable Energy Sources: 105.27 ➡️ Science and Technology and Biotechnology: 82.34 ➡️ Public Enterprises & Industrial Reconstruction: 73.45 ➡️ Law: 23.22

TMC means THE MIYAAN MULLA CAUCUS ₹5713 cr for Madrassa in Bengal And Less than ₹1000 cr for entire North Bengal 🕌 🌙 Minority Affairs and Madrasah Education: 5713.61 (an increase of 1111.02% since 2011-12) ➡️ Power: 5343.59 ➡️ Irrigation and Waterways: 4214.1 ➡️ Disaster Management & Civil Defence: 3119.99 ➡️ Backward Classes Welfare: 2533.39 ➡️ Transport: 2307.3 ➡️ Judiciary: 1788.57 ➡️ Water Resources Investigation & Development: 1674.22 ➡️ Land & Land Reforms and Refugee Relief & Rehabilitation: 1532.29 ➡️ Industry, Commerce & Enterprises: 1483.97 ➡️ Technical Education, Training and Skill Development: 1464.19 ➡️ Animal Resources Development: 1327.33 ➡️ Labour: 1268.26 ➡️ Micro, Small & Medium Enterprises and Textiles: 1250.15 ➡️ Tribal Development: 1234.78 ➡️ Forests: 1105.65 ➡️ Information & Cultural Affairs: 1006.05 ➡️ North Bengal Development: 920.13 ➡️ Youth Services and Sports: 881.89 ➡️ Self Help Group & Self Employment: 821.92 ➡️ Paschimanchal Unnayan Affairs: 810.04 ➡️ Sunderban Affairs: 641.74 ➡️ Co-operation: 637.4 ➡️ Planning and Statistics: 618.68 ➡️ Fire and Emergency Services: 541.59 ➡️ Fisheries: 539.3 ➡️ Tourism: 525.92 ➡️ Correctional Administration: 455.47 ➡️ Personnel & Administrative Reforms: 447.89 ➡️ Agriculture Marketing: 434.05 ➡️ Mass Education Extension and Library Services: 318.09 ➡️ Housing: 295.37 ➡️ Food Processing Industries and Horticulture: 258.35 ➡️ Information Technology & Electronics: 217.16 ➡️ Consumer Affairs: 147.63 ➡️ Environment: 108.62 ➡️ Non-conventional & Renewable Energy Sources: 105.27 ➡️ Science and Technology and Biotechnology: 82.34 ➡️ Public Enterprises & Industrial Reconstruction: 73.45 ➡️ Law: 23.22

Shehzad Jai Hind (Chowkidar as per INC ecosystem)

13,830 Aufrufe • vor 7 Monaten