Dr. Sampurnanand Medical College (or SNMC by its students and alumni) is a government medical college situated in the city Jodhpur of Indian state Rajasthan which was established in 1965. It celebrated the completion of its Golden Jubilee in 2015.
BACKGROUND:Colonic diverticulosis (CD) is a prevalent condition marked by small pouches (diverticula) in the colon wall, particularly in those over 50. Many studies have investigated various risk factors, but the relationship between smoking, alcohol consumption, and CD remains to be decided. This meta-analysis analyses the association between these lifestyle factors and the risk of CD and its complications. METHODS:A comprehensive literature search was conducted using PubMed, Embase, and Google Scholar to find relevant studies. Inclusion criteria were based on predefined eligibility standards, focusing on observational studies reporting smoking, alcohol consumption, and CD. Using random effect models, Mantel-Haenszel odds ratios and associated 95% confidence intervals were produced to report the overall effect size. Statistical significance was set at P < .05. Egger's regression test and Begg-Mazumdar's rank test were used to assess publication bias. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. RESULTS:Sixty-two studies encompassing 5,66,903 patients were included finally, where the mean age was 73.8 years, and 44.53% were female. Smoking increased the risk of CD (odds ratio [OR]: 1.36, 95% confidence interval [CI]: 1.24-1.48), diverticulitis (OR: 1.59, 95% CI: 1.01-2.51), and diverticular bleeding (OR: 1.51, 95% CI: 1.13-2.02). Ex-smokers also showed a higher risk of CD compared to nonsmokers (OR: 1.31, 95% CI: 1.08-1.59). Alcohol consumption was associated with an increased risk of CD (OR: 1.41, 95% CI: 1.09-1.82). However, no association was found between alcohol consumption and diverticular bleeding (OR: 1.15, 95% CI: 0.77-1.71) or diverticulitis (OR: 1.36, 95% CI: 0.98-1.88). No publication bias was clear in the analysis. CONCLUSION:This meta-analysis suggests an association between smoking, alcohol consumption, and increased risk of CD. Smoking is associated with an increased risk of CD and diverticular bleeding. The relationship between alcohol consumption and diverticular disease requires further investigation. Future research should explore the mechanisms by which these factors influence the development of CD to understand and inform public health recommendations.
BACKGROUND:Pulmonary hypertension (PH) is a progressive, life-threatening condition characterized by elevated pulmonary arterial pressure, often culminating in right heart failure. Despite existing therapies, optimizing treatment efficacy and safety remains a clinical challenge. Riociguat, a soluble guanylate cyclase stimulator, has shown promise in managing PH, particularly in pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). This meta-analysis aims to evaluate the optimal dosing of riociguat to maximize therapeutic benefits while minimizing adverse effects. METHODS:This systematic review and meta-analysis followed PRISMA guidelines. A comprehensive search of PubMed, Cochrane Central, Embase, and Google Scholar was conducted to identify randomized controlled trials (RCTs) comparing riociguat with placebo in adult PH patients. Eligible studies included double-arm RCTs with riociguat dosages ranging from 0.5 to 2.5 mg. Primary outcomes included changes in 6-minute walk distance (6-MWD), mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), and NT-proBNP levels. Secondary outcomes were adverse events and clinical worsening. Study quality was assessed using the Cochrane risk of bias tool. Statistical analysis used RevMan 5.4 with a random-effects model. Heterogeneity was evaluated using χ2 and I2 tests, and meta-regression assessed the impact of age and BMI. RESULTS:Ten RCTs involving 1109 PH patients were included. Riociguat significantly improved 6-MWD (MD: 27.23 m; 95% CI: 8.28-46.18; P = .005), reduced mPAP (MD: -2.61 mm Hg; 95% CI: -4.60 to -0.63; P = .01), lowered PVR (MD: -90.27 dynes·s·cm-5; 95% CI: -119.30 to -61.23; P < .00001), and decreased NT-proBNP levels (MD: -256.77 pg/mL; 95% CI: -491.99 to -21.55; P = .03). Meta-regression showed age and BMI significantly influenced treatment effects. CONCLUSIONS:Riociguat demonstrates dose-dependent efficacy in improving functional and hemodynamic parameters in PH, with the 2.5 mg thrice-daily dose showing consistent benefit. BMI impacted functional outcomes but not hemodynamic measures. These findings support tailored dosing strategies for optimized patient outcomes. Further research is needed to confirm dose-response effects and address residual heterogeneity.
Depressed skull fractures of the superior sagittal sinus (SSS) deserve special attention because they may lead to sinus obstruction or stenosis, resulting in venous hypertension. Here, we highlight an extremely unusual clinical presentation of a depressed skull fracture over the SSS obstructing the sinus, along with successful surgical management. A 35-year-old male patient presented with quadriplegia and intact sensations throughout the body following an alleged history of a rock falling on his head. On examination, computed tomography and magnetic resonance imaging of the brain revealed a depressed skull fracture over the SSS, with a filling defect in the SSS on magnetic resonance venography (MRV) underlying the fracture, along with venous hemorrhage and edema. The depressed fracture was elevated and managed postoperatively in the intensive care unit. At follow-up, the patient showed significant neurological improvement, and MRV demonstrated patent SSS. Radiological evidence of obstruction or thrombosis of the SSS, along with the corresponding neurological deficits in patients with midline depressed skull fractures, should be considered an indication for surgery.
Background: With HIV increasingly managed as a chronic condition under antiretroviral therapy, assessing quality of life (QOL) has become integral to patientcentered care. This study evaluated QOL across multiple domains and identified sociodemographic and clinical determinants among people living with HIV (PLHIV) in western Rajasthan. Methods: A crosssectional study was conducted (March 2024–2025) among PLHIV attending a government ART center in Jodhpur. QOL was measured using the WHOQOLHIV BREF (Hindi version, pretested for reliability). Determinants were examined using descriptive statistics and logistic regression. Results: Among 551 participants (mean age 42.8 ± 12.4 years), the mean overall QOL score was 14.1 ± 2.0. The physical domain scored highest, while social relationships scored lowest. In adjusted models, age >30 years, occupation, and symptomatic HIV status were significant predictors of poor QOL. Spousal absence showed a particularly strong association with diminished independence, underscoring the importance of social support. Viral suppression was modestly linked to better psychological QOL, though the effect size was small. Conclusion: Clinical stage, age, occupation, and spousal support emerged as key determinants of QOL among PLHIV in Jodhpur. These findings highlight the need for integrated interventions that combine medical management with psychosocial counselling and communitybased support to address the multifaceted needs of PLHIV.
