The changing survival scenario in gangrenous sigmoid volvulus: a four-decade study.

There is a suspicion that mortality in gangrenous sigmoid volvulus has considerably declined over the recent years. This study was aimed to assess if this is a genuine trend, applicable to the patients, of this study too, and to identify factors responsible for the change, if any. Seventy-eight patients operated for gangrenous sigmoid volvulus, in the last four decades of the just gone century, were analysed. Nine clinical parameters were studied to identify factors responsible for mortality and to see if there was a change in clinical presentation in the later decades. Mortality in the 4 studied decades varied between 15.4% and 65%. Differences were significant (p<0.05) only between the decades of the seventies and eighties and between bunched pre 1980 (48%) and post 1980 (20%) decades. A sea change in survival scene occurred at the end of the decade of the seventies. The change was not accompanied by a concomitant improvement in clinical presentation (p>0.05). Two facts which could explain improved survivals in the post. 1980 period were, the increased recognition of gangrene extending beyond the area of constriction and improved survival after primary anastomoses (p<0.05). These indicated a more accurate assessment of viability and the distance between the cut bowel ends, a stricter selection of cases for primary anastomosis and using Hartmann operation in doubtful situations. Mortality in gangrenous sigmoid volvulus, without knotting in the Indian population has genuinely declined from over 50% in an earlier time to 20% in the later 20 years of the last century, the watershed in the changed scenario being the year 1980.

The Knowledge, Attitude and Practices regarding HBV Infection of Married Women in the Reproductive Age Group living in Cantonment Area, Sunjawan, Jammu

The present study was conducted to know the knowledge, attitude and practices of 300 married women in the reproductive age group living in the cantonment area Sunjawan, Jammu regarding HBV infection. Only 20% of the women were found aware of the mode of transmission of HBV. However, 50% of the women were having the misconceptions regarding mode of transmission of HBV. 4% of women, 30% of children up to 5 years and 15% of children above 5 years were fully immunized with hepatitis B vaccine. 80% of children up to 5 years and 75% of children above 5 years were fully immunized as per universal immunization programme. Hence, the results of the study clearly indicated the low immunization rate with vaccine against HBV than that under universal immunization programme and further potentiated the need for implementation of the recommendations in 9th five year plan of India regarding introduction of immunization against HBV in universal immunization programme at the earliest .

Glaucoma Therapy: Prescribing Pattern and Cost Analysis

In the present study out of total 200 prescriptions of POAG (primary open angle glaucoma) studied 66% were found to be of monotherapy including timolol, brimonidine, pilocarpine, betaxolol, levobunolol, latanoprost and apraclonidine in 30%, 15 %, 6%, 8% , 4%, 1% and 2% of the prescriptions respectively and 34% were found to be of polypharmacy with timolol+pilocarpine, timolol+acetazolamide, timolol+ brimonidine and betaxolol+brimonidine in 13%, 4%, 8% and 9% of the prescriptions respectively. 10% drugs were prescribed by generic name. Written instruction to the patients regarding dose and dosing interval was mentioned in 100% prescriptions, but the proper method of instillation was mentioned only in 15% of the prescriptions. Results of the present study clearly indicated urgent need for prescribers to improve their communication skills, to give proper instructions to the patient regarding instillation of drug, as little bit of caution like instillation from the side of the eye in the supine position followed by rolling of the eyeball can decrease the wastage, decrease cost and improve compliance. However, in the present scenario cost of the traditional medications like betablockers, pilocarpine etc. is found to be much less than newer medications (prostaglandin analogues, brimonidine). Moreover, in presence of wide cost variation among various brands of the same drug our study could help the opthalmologist to use all possible measures of pharmacoeconomics while prescribing an antiglaucoma drug.

Double gall bladder with two disease processes.

A double gall bladder is a rare congenital anomaly which is usually diagnosed by preoperative ultrasonography. Either one, or both lobes, of the double gall bladder, may be diseased. We report a patient in whom the two lobes were affected by different disease processes, namely, cholesterosis, and cholelithiasis with mucocele.