An Adolescent Girl with Giant Fibroadenoma - A Case Report.

Though fibroadenoma is the most common benign tumor of the breast and is more common under the age of 30, giant fibroadenoma is rare representing less than 4% of all fibroadenomas. A 12 years old girl presented with rapidly enlarging well-circumscribed firm, non-tender mass in right breast for 2 months which was painless and with no history of trauma, nipple discharge, fever, anorexia, weight loss or axillary lymphadenopathy. There was no family history of neoplasms. Clinically, the lump was about 12 × 12 cm and not fixed to skin or underlying structures with the absence of nipple retraction or discharge. There was no axillary lymphadenopathy. Fine needle aspiration cytology showed a benign proliferative breast disease. Total excision of mass was done preserving nipple and areola having weight of 535 gm with histopathological features suggestive of giant fibroadenoma. Giant fibroadenoma is a benign breast disease that may mimic rare malignant lesion. So, breast and nipple conserving surgery should always be performed irrespective of size of tumor as in this case.

A Male with Extreme Subcutaneous Insulin Resistance: A Case Report.

INTRODUCTION: Though insulin has no upper limit in dosage, we do not encounter very high dose requirements too often. The reported case is the first in Bangladesh to require more than 1000 international units (IU) of subcutaneous insulin per day. CASE PRESENTATION: A 44-year old male diabetic patient from Bangladesh presented with unusually uncontrolled diabetes mellitus due to extreme insulin resistance. Despite dramatic increase in insulin step by step up to 1110 IU of concomitant short and intermediate acting insulin per day by subcutaneous route, his blood glucose remained over 12 mmol/L persistently, in all the fasting, pre-prandial, postprandial and random samples. He was also treated with several oral hypoglycemic agents including metformin, vildagliptin, glimepiride, pioglitazone and miglitol along with insulin but blood glucose levels remained almost unchanged. However, intravenous infusion of insulin over 4 hours caused a plummet in the glucose level. His blood test for insulin autoantibody was negative. CONCLUSION: This paper provides a scope to review literatures on extreme subcutaneous insulin resistance and its management. It also reveals the limitations of management due to lack of facilities in an underdeveloped country, which hinders proper exploration to many medical issues.

Pattern of anti-diabetic drugs prescribed in a tertiary care hospital of Bangladesh.

BACKGROUND: Globally, diabetes mellitus is a common endocrine disorder. This study was conducted for collecting the demographic details of diabetic patients and determining the pattern of drugs prescribed among them in outpatient department of a tertiary healthcare center. METHODS: A descriptive type of cross-sectional study was carried out at the outpatient department of Endocrinology, Dhaka Medical College Hospital, Bangladesh from 1 May to 31 July, 2015. Diabetic patients receiving the management for at least 6 months were enrolled and interviewed by the researchers after getting informed written consent. Structured case record form was used for demographic data & prescription details. Data were analysed using computer in SPSS 22 and Microsoft Excel 2010. RESULTS: Altogether 105 patients, 40 males (38.1%) and 65 females (61.9%) were enrolled with urban predominance (69.5%) where 51 (48.6%) were in the age group 47-61 years with a mean of 53.4 (SD±10.6) years. 70 (66.7%) had diabetic history of less than 5 years and 66 (62.9%) had at least one concurrent illness. Hypertension accounted for majority (34.3%) of complications. On an average, 5.62 (SD±3.16) drugs were advised per prescription for diabetes as well as associated co-morbidities and majority (23.8%) had 4 drugs. The majority of drugs (74.3%) were from local manufacturers. Most patients (62.9%) were prescribed with oral drugs singly. Metformin alone predominated in 41% prescriptions followed by the combination of Metformin and Sitagliptin (31.4%). CONCLUSIONS: The findings can serve as a guide to choose the formulation and combination of anti-diabetic drugs in this part of the world before developing & marketing any new drug.