Drug utilization pattern in type II diabetes mellitus patients attending non-communicable disease clinic in a tertiary care hospital

Background: Diabetes mellitus is a metabolic disorder. Early institution of treatment is necessary to prevent complications. Since treatment of diabetes requires lifetime therapy; this study is designed to understand the prescription trends at Non Communicable Disease clinic set up and to provide rationale.Methods: This cross-sectional, observational study was conducted over a period of 2 months (May 2017- June 2017). Details of demographic data, duration and family history of diabetes, antidiabetic medications prescribed, history of comorbid diseases and drugs prescribed by physician for the treatment of comorbid diseases were collected in a structured format. Height and weight were recorded, and body mass index was calculated.Results: Study population included 294 patients and patients in the age groups of 40-59 years formed the bulk. 39% patients were overweight and 19.39% were obese. 93.20% patients were prescribed with metformin. 37 patients received insulin injection. 64.29% received more than one antidiabetic drug. Hypertension (82.05%) was the most common comorbid disease. Amlodipine was the most commonly prescribed antihypertensive drug.Conclusions: Metformin was the most commonly prescribed antidiabetic drug. Utilization of newer antidiabetic drug is inferior. Use of rationale fixed dose combination improves patient compliance

Primary Adenosquamous Carcinoma of Ascending Colon – A Rare Entity

Colorectal cancers (CRC) are on the rise globally with increased incidence rate 5.7/100000 cases in developing countries like India. 1 Majority (90%) of CRC are adenocarcinoma. The primary adenosquamous carcinoma (ASC) of the colon is exceedingly rare variant of adenocarcinoma with incidence of 0.025% and accounts for 0.1% of colonic epithelial malignancies. 2 The squamous differentiation accounts for its aggressiveness and poor prognosis. Here we report a rare case of primary ASC in 80year old male who presented with large bowel obstruction and peritonitis. A 80-year-old male brought to causality with history of fever, vomiting, pain in abdomen, altered sensorium since three days. The clinical examination revealed intestinal obstruction and peritonitis. Patient was immediately subjected for radiological and hematology investigations which showed signs of bowel obstruction and perforation. On emergency exploratory laparotomy, colonic perforation was identified along with an ulcer proliferative mass in ascending colon. Gross examination of right hemicolectomy revealed 9x6x3cm ulcero proliferative mass in ascending colon. The microscopic examination showed an infiltrating tumor composed of adenocarcinoma component and areas of squamous differentiation (60%) noted. Tumor was invading through muscularis propria and serosa. Final diagnosis of primary ASC was made. Colonic ASC is rare and associated with poorer prognosis. The squamous cell differentiation has greater metastatic potential than adenocarcinoma. Compared to adenocarcinoma, ASC is more likely to manifest with advanced disease and complications. Keywords: Adenosquamous, Carcinoma, Colo