Perineural low dexamethasone dose as adjuvant in supraclavicular brachial plexus block for arteriovenous fistula creation in end stage renal disease: a randomized controlled trial

Abstract Background and aims: Dexamethasone as adjunct to local anesthetic solution improves the quality of brachial plexus block (BPB). However, evidence for its efficacy at low doses (< 4 mg) is lacking. This study was designed to evaluate the duration of analgesia attained with low dose dexamethasone as adjuvant to local anesthetic for creation of arteriovenous fistula (AVF) under BPB. Methods: Sixty-six patients scheduled for AVF creation were randomly allocated to receive either saline (control) or 2 mg dexamethasone, together with 0.5% ropivacaine and 0.2% lignocaine. The primary outcome was duration of analgesia, defined as time from performing the block to the first analgesic request. The secondary outcomes were time from injection to complete sensory block, time from injection to complete motor block, duration of motor block, postoperative analgesic consumption, and fistula patency at three months. Results: All the blocks were effective. In the group that received dexamethasone, the time to first analgesic request was significantly delayed (432 ± 43.8 minutes vs. 386.4 ± 40.2 minutes; p < 0.01). The onset of sensory and motor blockade occurred faster in dexamethasone group and overall analgesic consumption was also reduced. However, dexamethasone addition did not prolong the duration of motor block. There was no statistically significant difference in the patency of fistulas between the two groups at three months. (p = 0.34). Conclusion: Addition of low-dose perineural dexamethasone to local anesthetic solution significantly prolonged the duration of analgesia. Further trials are warranted to compare the adverse effects between dexamethasone doses of 4 mg and lower.

Prepapillary vascular loops – A new classification

Background: Prepapillary vascular loops are a type of congenital vascular anomaly seen on or around the optic disk. Patients with this condition are usually asymptomatic and are detected incidentally on routine fundus examinations. Differential diagnosis for this condition includes neovascularization of the disk and collaterals on the disk. Prepapillary capillary loops are not associated with any systemic condition. They are usually unilateral in presentation, but can rarely be bilateral. Purpose: To discuss the new proposed classification of prepapillary capillary loops. Synopsis: Prepapillary capillary loops are classified based on their location around the disk, loop characteristics such as elevation, shape, and covering, and presence of vitreoretinal traction. Highlights: The most common vascular loops are arterial in origin and rarely venous in origin. They can sometimes be associated with spontaneous and recurrent vitreous hemorrhage, branch retinal artery or vein occlusion, and subretinal hemorrhage. It is an important differential diagnosis in spontaneous vitreous hemorrhage. Treatment is symptomatic

Orbital Apex Syndrome – A Case Report

Orbital apex syndrome is characterized by vision loss and ophthalmoplegia due to the involvement of the orbital apex. The signs and symptoms vary depending upon the involvement of the structures within the orbital apex, the superior orbital fissure or the cavernous sinus. Clinical evaluation is the key to the diagnosis which is aided by neuro-imaging modalities including brain and orbital Magnetic Resonance Imaging and Computed Tomography scans. In rare instances, a biopsy may be needed to aid in diagnosis. Treatment depends on what the nature of the lesion.

A Rare Case of Posterior Ischemic Optic Neuropathy after Appendicectomy

Ischemic optic neuropathy is classified into anterior and posterior ischemic optic neuropathy depending upon the part of optic nerve involved. In anterior optic neuropathy, optic nerve head is involved and in posterior ischemic optic neuropathy(PION) retrobulbar portion is involved. There is sudden loss of vision in both the entities but there are optic disc changes in anterior optic neuropathy while in posterior ischemic optic neuropathy optic disc is normal initially. Etiologically, posterior ischemic optic neuropathy is divided into non arteritic non-surgical, arteritic and perioperative non arteritic posterior ischemic optic neuropathy.

Clinical Profile and Quality of Life of Incident Hemodialysis Patients

Hemodialysis is the most commonly used treatment modality for end stage renal disease. A 6 months observational study was conducted in the Dialysis unit of Kasturba Hospital, Manipal to study the clinical profile, quality of life with the help of KDQoL SF 36 questionnaire and factors affecting quality of life of hemodialysis patients. A total of 45 participants were included who initiated dialysis in the year 2018 and 2019 and were receiving dialysis in our hospital. Out of 45 participant 77.8% were males and 22.2% were females, the mean age was 55.29 (11.29) years. 23 patient-initiated dialysis in the year 2018 22 patients-initiated dialysis in the year 2019. The prevalence of hypertension, diabetes mellitus and cardiovascular diseases in this population were found to be 95.2%, 35.6% and 8.9% respectively. The mean scores of the sub scales were analyzed with the help of scoring manual and descriptive statistics. In the result it was found the hemoglobin, intradialytic weight gain were found to be positively correlated with the Physical component summary (PCS) and Mental component summary (MCS). Effects of kidney disease was found to be very strongly and positively correlated with dialysis vintage. In the result of the study due to its smaller population we cannot determine more factors which were affecting the Quality of life scores.

Coagulation abnormalities and their relationship with bleeding manifestations in patients with dengue-A single center observational study

Objective: To evaluate coagulation abnormalities and their relationship with bleeding manifestations among patients with dengue. Methods: This observational study was conducted on 292 adult dengue patients who were admitted to a tertiary care hospital of Western India from July 2021 to June 2022. Coagulation tests including prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen, and D-dimer were performed. Patients were monitored for bleeding manifestations. Results: Coagulation abnormalities were reported in 42.8% of the patients. Overall, prolonged aPTT was the most common coagulation abnormality (40.8%), followed by low fibrinogen (38.7%), raised D-dimer (31.2%), raised INR (26.0%) and prolonged PT (19.2%). Bleeding manifestations were present in 19.9% patients. PT, INR, aPTT and D-dimer levels were significantly higher (P<0.01) and fibrinogen level was significantly lower (P<0.001) in patients with bleeding compared to patients without bleeding. Patients with bleeding had a significantly higher rate of all coagulation abnormalities than patients without bleeding (P<0.01). Conclusions: Patients with bleeding showed a significantly higher frequency of coagulation abnormalities compared to patients without bleeding. Patients with dengue should be assessed for coagulation abnormalities.

Florid Osseous Dysplasia in Edentulous Maxilla and Mandible: A Rare Case Report

Introduction: Florid osseous dysplasia (FOD) has been described as a reactive fibro-osseous lesion affecting the jaw bones especially the tooth bearing areas. Usually, this lesion is asymptomatic unless accidentally detected during radiographic examination for any other purpose. Although the etiology is unclear, several theories suggests that its origin was related to reactive or dysplastic changes within the periodontal ligament. Case Presentation: Presenting a case of Florid Osseous Dysplasia within the edentulous maxilla and mandible of 65-year-old female patient. Patient reported with a diffuse swelling in the edentulous maxillary and mandibular posterior regions intraorally. Radiographically, multiple radiopaque lesions were noted bilaterally in the posterior mandible and also in the right posterior side of the maxilla. On microscopic examination, the lesion was composed of spicules of bony trabeculae with osteocytes in lacunae and intervening fibro-fatty connective tissue with plump fibroblasts. Management and prognosis: After the incisional biopsy, surgical recontouring was done along with further regular follow up and observation. Conclusion: Diagnosis of the jaw lesions is based on clinical findings, radiographic features, and histological picture, whereas FOD can be diagnosed based on its clinical and radiographical features. Even though the surgical approach may lead to many complications like osteomyelitis, infection, fracture etc., a biopsy may be done to confirm the diagnosis.

Contribution of Kashyapa Samhita or Vrddha Jivakiya Tantra in Panchakarma

Ayurveda is one of the most renowned traditional systems of medicine that has survived and flourished from ages till date. There are many avenues still to be explored by the researchers, practitioners and experts in the field who carry the responsibility of keeping the traditional systems of medicine alive and contributing to their growth in the future. Panchakarma is a fivefold treatment modality in Ayurveda used for detoxification of the body in preventive, curative as well as rejuvenative aspect. It includes Vamana (emesis), Virechana (purgation), Nirooha vasti (decoction enema), Nasya (instillation of medicine through nostrils), and Anuvasana vasti (oil enema). Kashyapa Samhita is a renowned book in Ayurveda especially in the field of Kaumarabritya. It elaborates Panchakarma procedures along with its indications, contraindications and doses for children. It contains many points explained in Brihat trayi along with some unique contributions in the field of Panchakarma. The present article reviews the original text and critically analyses the contribution of Kashyapa Samhita in the field of Panchakarma.

KNOWLEDGE, ATTITUDE & PRACTICE REGARDING EYE DONATION AMONG MEDICAL, NURSING AND ALLIED HEALTH SCIENCES STUDENTS

Purpose: Corneal diseases constitute a signi?cant cause of visual impairment. There is considerable backlog for corneal transplantation due to lack of awareness. Aim of this study was to assess the knowledge, attitude, and practice regarding eye donation among Medical, Nursing and Allied health sciences students of a medical college in Kerala. A cross-sectional descriptive Methods: study was conducted among all first year Medical, Nursing and Allied health sciences students of a medical college in Kerala. A standard predesigned questionnaire was given after obtaining informed consent, to assess their knowledge, attitude and practice regarding eye donation. The data was analysed using statistical package SPSS version 21.0 IBM corp. Results: Out of the 285 first year students , 268 responded (94.03%) and majority were females (73.5%). Participants were well aware of eye donation (98.9%). Media was the major source of information for their knowledge (79.5%). Although 94.3% of the students considered eye donation as a service to mankind, only 69.8% were willing to pledge their eyes. Objection by family members (58.6%) was the major reason for not pledging their eyes. 92.1 % were willing to give awareness regarding eye donation to others. Awareness about eye donation was high and knowledge wa Conclusion: s fair. However, the attitude and practice showed mixed responses. Thus strategies and programmes have to be devised to increase the knowledge , attitude and practice regarding eye donation among students in medical colleges so that they can act as good motivators for the general public .

Lung ultrasonography as a tool to guide perioperative atelectasis treatment bundle in head and neck cancer patients undergoing free flap reconstructive surgeries: a preliminary observational study / Ultrassonografia pulmonar como ferramenta para orientar o tratamento perioperatório de atelectasia em pacientes com câncer de cabeça e pescoço submetidos a cirurgia reconstrutiva com retalho livre: um estudo observacional preliminar

Abstract Introduction: General anesthesia causes pulmonary atelectasis within few minutes of induction. This can have significant impact on postoperative outcome of cancer patients undergoing prolonged reconstructive surgeries. Objective: The purpose of this study was to evaluate the impact of sonographically detected perioperative atelectasis on the need for postoperative oxygen supplementation, bronchodilator therapy and assisted chest physiotherapy in patients undergoing free flap surgeries for head and neck carcinoma. Methods: Twenty eight head and neck cancer patients underwent bilateral pulmonary ultrasonographic assessments before and after lung surgery. Lung ultrasound scores, serum lactate, and PaO2/FiO2 ratio were measured both at the beginning and at end of the surgery. Patients were scanned in the supine position and the number of single and confluent B lines was noted. These values were correlated with the need for oxygen therapy, requirement of bronchodilators and total weaning time to predict the postoperative outcome. Other factors affecting weaning were also studied. Results: Among twenty eight patients, seven had mean lung ultrasound score of ≥10.5 which correlated with prolonged weaning time (144.56±33.5min vs. 66.7±15.7min; p = 0.005). The change in lung ultrasound score significantly correlated with change in PaO2/FiO2 ratio (r = −0.56, p = 0.03). Elevated total leukocyte count >8200 ΜL and serum lactate >2.1 mmoL/L also predicted prolonged postoperative mechanical ventilation. Conclusion: This preliminary study detected significant levels of perioperative atelectasis using point of care lung ultrasonography in head and neck cancer patients undergoing long duration surgical reconstructions. Higher lung ultrasound scores highlighted the need for frequent bronchodilator nebulizations as well as assisted chest physiotherapy and were associated with delayed weaning. We propose more frequent point of care lung ultrasonographic evaluations and use of recruitment maneuvers to reduce the impact of perioperative pulmonary atelectasis.

Resumo Introdução: A anestesia geral causa atelectasia pulmonar poucos minutos após sua indução. Isso pode ter um impacto significativo no resultado pós-operatório de pacientes com câncer submetidos a cirurgias reconstrutivas prolongadas. Objetivo: Avaliar o impacto das atelectasias perioperatórias detectadas por ultrassonografia na necessidade de suplementação pós-operatória de oxigênio, terapia broncodilatadora e fisioterapia respiratória assistida em pacientes com carcinoma de cabeça e pescoço submetidos a cirurgias com uso de retalho livre. Método: Foram submetidos a avaliações ultrassonográficas pulmonares bilaterais antes e após a cirurgia 28 pacientes com câncer de cabeça e pescoço. Os escores de ultrassonografia pulmonar, lactato sérico, razão PaO2/FiO2 foram medidos no início e no fim da cirurgia. Os pacientes foram avaliados na posição supina e o número de linhas B confluentes e únicas foi observado. Esses valores foram correlacionados com a necessidade de oxigenoterapia, necessidade de broncodilatadores e tempo total de desmame para predizer o resultado pós-operatório. Outros fatores que afetam o desmame também foram estudados. Resultados: Entre os 28 pacientes, sete apresentaram escore médio de ultrassonografia pulmonar ≥ 10,5, que se correlacionou com o tempo de desmame prolongado (144,56 ± 33,5 minutos vs. 66,7 ± 15,7 minutos; p = 0,005). A mudança no escore de ultrassonografia pulmonar correlacionou-se significantemente com a mudança na razão PaO2/FiO2 (r = −0,56, p = 0,03). A contagem total elevada de leucócitos > 8200 uLe o nível de lactato sérico >2,1 mmoL/L também previram ventilação mecânica pós-operatória prolongada. Conclusão: Este estudo preliminar detectou um nível significante de atelectasia perioperatória com ultrassonografia pulmonar no local de atendimento em pacientes com câncer de cabeça e pescoço submetidos a reconstruções cirúrgicas de longa duração. Escores mais altos de ultrassonografia pulmonar enfatizaram a necessidade de nebulizações broncodilatadoras frequentes e fisioterapia respiratória assistida e foram associados a desmame tardio. Propomos avaliações ultrassonográficas pulmonares mais frequentes no local de atendimento e o uso de manobras de recrutamento para reduzir o impacto das atelectasias pulmonares perioperatórias.

Role of serum microRNAs as biomarkers for endometriosis, endometrioid carcinoma of ovary & endometrioid endometrial cancer

Background & objectives: Accurate and early diagnosis is imperial in the management of endometriosis, endometrioid carcinoma of ovary (ECO) and endometrioid endometrial cancer (EC), yet there are no definitive diagnostic methods available for these diseases. Therefore, the present study was aimed to evaluate the diagnostic potential of differentially expressed miRNAs in serum samples of women with endometriosis, ECO and EC to establish them as diagnostic biomarkers. Methods: Blood samples (5 ml) were obtained from 40 patients (n=10/study group) undergoing laparoscopy/laparotomy/hysterectomy. miRNA-rich RNA was extracted from the serum samples, and quantitative real-time (qRT)-PCR was performed to check the expression levels of miR-16, miR-99b, miR-20a, miR-145, miR-143 and miR-125a in all the samples. Receiver operating characteristic (ROC) curve analysis was done to check the diagnostic potential. Results: In endometriosis, miR-16 was downregulated (P<0.05) whereas miR-99b, miR-125a, miR-143 and miR-145 were upregulated (P<0.05). In ECO group, downregulated expression of miR-16 and miR-125a (P<0.05) was observed, whereas miR-99b, miR-143 and miR-145 were upregulated (P<0.05). In endometrioid EC, miR-16, miR-99b, miR-125 and miR-145 were downregulated (P<0.05), whereas miR-143 was upregulated (P<0.05). ROC curve analysis showed that, for endometriosis, miR-99b, miR-125a, miR-143 and miR-145 served as diagnostic markers. miR-145 showed diagnostic power for ECO, and for endometrioid EC, miR-16, miR-99b, miR-125a and miR-145 showed diagnostic potential. Interpretation & conclusions: The present findings suggested that certain circulating miRNAs (miB99b, miR-16, miR-125a, miR-145) might act as indicators and discriminators of endometriosis and endometrioid subtypes of EC and ovarian cancer and might serve as potential biomarkers for early diagnosis and management of these debilitating diseases.

A Mini Review: Mucormycosis in Coronavirus Disease-19, Host-Iron Assimilation, and Probiotics as Novel Therapy

Mucormycosis is an acute fungal infection with 90% of cases in the form of rhino-orbito-cerebellar. It is an aggressive and life-threatening fungal infection causing 50% mortality in people with coronavirus disease 2019 (COVID-19). In COVID-infected patients due to, diabetic ketoacidosis, epithelial damage, ciliary dysfunction, dysfunctional phagocytic mechanism, and immunosuppression, there is impaired chemotaxis and defective intracellular killing leads to fungal spores to invade, germinate and penetrate in surrounding tissues. The use of broad-spectrum antibiotics disrupts the normal microbiomes and increases the probability of growth of Rhizopus spp. Commercially available probiotics such as Lactobacillus, Bifidobacterium, Enterococcus, Streptococcus, and Saccharomyces when administered in adequate quantities form siderophores which induces iron stress in fungus and inhibits spore germination.

Association of Serum Bilirubin with Acute Ischemic Stroke – An Observational Study

@#Introduction: Stroke is a common cause of mortality and morbidity and has an increasing prevalence across the world.1 Bilirubin is now being considered an antioxidant which increases in response to diseases associated with increased oxidative stress. Hence the present observational study was undertaken to assess the bilirubin levels with the outcome of acute ischemic stroke. Methods: This observational study was conducted from January 2018 to December 2018 on 64 ischemic stroke patients admitted at KLE’S Dr. Prabhakar kore hospital at Belagavi, Karnataka. All adult patients above 18 years of age presenting with cerebrovascular accident and proved as ischemic stroke on CT scan or MRI scan were included. The patients were empirically divided into different Groups based on the bilirubin level. They were then analysed with their NIHSS scores for assessing stroke severity. Results: A total of 64 patients were included in the final analysis. The mean total bilirubin level in the patients was 0.68±0.34 mg/dl ( mean±SD). 34.3% (22) of ischemic stroke patients in the study had serum total bilirubin levels 0.7 mg/dl or more. Mean NIHSS Score for Group 1(Low) total bilirubin group was 9.37 and for Group 2(High) bilirubin group was 10.9, which was statistically not significant. This indicates that there was no significant correlation between total bilirubin and severity of symptoms at the time of admission.There was no statistically significant correlation between NIHSS and direct bilirubin levels Conclusion: The current study has documented no association between the bilirubin levels and stroke severity and prognosis.

Study of Intrauterine Foetal Death in Government Medical College in Tribal Area of Bastar.

IUFD is a major obstetrical complication and is an important indicator of perinatal health in a given population. Literally, intrauterine foetal death (IUFD) is considered as all foetal deaths weighing 500 g or more occurring both during pregnancy and during labour. We wanted to asses maternal and foetal factors associated with intrauterine death, and formulate effective strategies for prevention of IUFD. MethodsThis was a prospective study carried out in a GMC Jagdalpur from July 2019 to mid-November 2019. All the admitted patients of our department with gestational age >28 weeks (confirmed by LMP or by USG) diagnosed as having IUFD (confirmed by USG) were included in the study. ResultsTotal number of deliveries during the study was 1455 and total number of IUFD was 109. Incidence of intrauterine death was 7.49%. Majority of the cases were of age group 26-30 years that is 39.44% (43/109) while teenager (16-20 years) pregnancies were only 11.92%. Most of the cases were preterm (67/109) around 61.46% and only 2.75% cases were post term. In 22.01% (24/109) cases, causes were not identified while in 77.99% cases (85/109) causes were identified. Hypertensive disorder was the major cause of IUFD (27.5%) followed by unknown aetiology (22.01%), infection (14.67%) and rupture uterus (10.09%). Rural population was 66.97% and urban population was only 33.02%. Most of the cases were primipara 43.11% (47/109) while least number of cases 8.25% (9/109) was of grand multipara. ConclusionsDespite being a tertiary center, incidence of IUFD is much higher than other areas of our country. Cause may be attributed to lack of awareness, illiteracy, and poor infrastructure in periphery, and this being a referral centre for a large area.

Accidental multiple magnet ingestion by an adult: a case report

Accidental multiple magnetic foreign body ingestion although common in children is rare in adults. Multiple magnetic foreign body ingestion possess a definitive risk of causing intestinal perforation, volvulus or fistulas and requires early surgical intervention even in apparently asymptomatic individuals to prevent catastrophic complications. We report a case of an 18 year old male with a history of accidental simultaneous ingestion of two semi-circular shaped magnets along with a nail. The peculiarity of the case being that despite the magnets being simultaneously ingested, one was in the stomach and the other in the jejunum adhered to each other through the transverse colon mesentery causing pressure necrosis of the adjoining wall with the patient being asymptomatic.

Recurrent ectopic pregnancies with secondary infertility: a case report

Infertility is defined as 1 year of unprotected sexual intercourse without pregnancy. It is further classified as primary and secondary. Secondary infertility is one in which prior pregnancy not necessarily live birth has occurred. Pelvic infections as a cause for infertility are seen in 12% cases while genital tuberculosis contribute 10-15%. Various studies have well established a relationship between subclinical infection and infertility with the two most potential pathogens being: Chlamydia trachomatis and mycoplasma species. Authors are presenting two cases one of a 30yr female, P0+5, with class 2 obesity with previous three ectopic pregnancies with LSO done 1 year back i/v/o left ruptured ectopic now presenting with secondary infertility for 1 year and another case of a 21 years female, P0+2, with previous two ectopic with LSO done 2 years back now presenting with infertility. These cases emphasize that infections are important causes for recurrent ectopic pregnancies and infertility.

Opioid sparing anaesthesia using dexmedetomidine in a morbidly obese patient with mandibular tumor requiring free fibular graft reconstruction surgery

A 45 year old male diagnosed as a case of Ameloblastoma mandible, requiring mandibular reconstruction with a Free Fibular Flap graft was planned under general anaesthesia (GA).

A rare case of caesarean scar ectopic pregnancy: a case report

Scar ectopic pregnancy is a condition where the gestational sac implants into the previous caesarean scar site. Although it is a rare entity, its incidence is increasing due to rising rates of caesarean deliveries. Here authors report a case of caesarean scar ectopic pregnancy managed by laparotomy with caesarean scar ectopic excision following failed medical management. The patient recovered without any intraoperative or postoperative complications. An early diagnosis and management are vital in preventing maternal morbidity and mortality.

Comparative study of sublingual versus vaginal misoprostol for induction of labor

Background: Induction of labor done, when the benefits to either mother or fetus outweighs those of continuing pregnancy. Pharmacological methods used for induction includes oxytocin, prostaglandin (E1, E2) and mifepristone. However the ideal dose, route and frequency of administration of misoprostol are still under investigation. Hence we plan to do a comparative study between sublingual and vaginal misoprostol for inducing labor.Methods: A prospective randomized interventional study was conducted on seventy pregnant women who met the inclusion criteria. They were explained about the study on admission and were randomized into two groups: Group I (sublingual) and Group II (vaginal). Bishop score at start of induction, number of pelvic examinations, doses required, mode of delivery, induction to delivery interval, duration of different stages of labor and perinatal outcome of the women were recorded followed by statistical analysis.Results: Patients in both the groups were comparable with respect to demographic data, period of gestation, gravidity and parity. There was no significant difference with regard to number of doses, p/v examinations and number of patients required augmentation. Mean induction to delivery interval, average duration of first, second and third stage was almost comparable. Out of 35 women in each group, 29 women (82.8%) in both groups had normal vaginal delivery, one woman in Group I and three women in Group II had instrumental delivery. Emergency LSCS was done in 5 women (14.28%) in Group I and 3 women (8.57%) in Group II.Conclusions: Sublingual misoprostol seems as effective as vaginal misoprostol for induction of labor at term. Sublingual route represents a valid alternative to vaginal route with the advantage of convenience of administration. In view of limited sample size, we cannot reach definitive conclusions in regard to the preference of sublingual or vaginal route of misoprostol for induction of labor.

Assessment of the contributing risk factors in adult diabetic patients attending the diabetic clinic in Bankura Sammilani Medical College, Bankura

Background: Diabetes affects all segments of the population and is one of the leading causes of premature morbidity and mortality and requires life-long healthcare services. The National Rural Health Mission launched in 2005 and the new pilot National Programme for Prevention and Control of Diabetes, Cardiovascular diseases and Stroke offer opportunities for improving care for diabetes and other non-communicable diseases through service provision at the primary and secondary levels of care. This article describes the health services related factors and ascertains the physical status of adult diabetic patients.Methods: It is an institution based, cross-sectional, descriptive study. Complete enumeration of all patients attending diabetic clinic of Bankura Sammilani Medical College and hospital, Bankura, West Bengal was done. Eligible consenting adult patients, who were diagnosed as a case of diabetes and on treatment were interviewed with review of medical record. The study was preceded after obtaining ethical clearance. Data were entered in MS Excel spread sheet. Calculation was done with the help of software SPSS 22.0 free version.Results: Only 5.3% of study subjects had drug supply from hospital fully but rest of them had to buy from the shop. 79.3% of study subjects skipped the drug when it was finished. Diabetic complication was found to be more when distance of home from hospital was more.Conclusions: Antidiabetic drug were not regularly available in hospital so all most all had to purchase drug from the shop when not available at hospital.