Despite lack of rationale for the use of a combination of quinolones and anti-protozoal agents in the management of acute diarrhea in India; it is the most common prescription. These brands have a large market share of >200 crores and there are >70 brands. This combination is a very "Indian" and does not fi gure in any standard pharmacopoeia.There is no rationale for the use of combinations of quinolones and anti-protozoal in patients with acute diarrhea due to the following reasons. Most acute diarrheas in adults are self-limiting, and require only oral rehydration therapy. Antibacterials like quinolones are required in certain specifi c situations. Anti-protozoals are not routinely indicated as giardia and ameba are uncommon causes of acute diarrhea.Studies from the CIWEC clinic in Nepal, a CDC accredited center evaluating nearly 2000 cases of acute diarrhea every year, have shown that amebic and giardial infection constitute only 1% each of all acute diarrheas. 1 Studies from Indonesia in 3875 adults with acute diarrhea also show similar results. 2,3 Black et al also showed that amongst 179 Indian children with acute diarrhea, only 2% had giardial infection and none had amebic infection. 4 Thus, acute onset diarrhea occurring within <7 days after an unhygienic food exposure, especially if associated with fever and vomiting is highly unlikely to be of protozoal etiology. Amebic or giardia infection warrant treatment for 7-10 days instead of 5 days as required for bacterial infections. Most patients, prescribed this combination, do not complete the course of treatment because of side effects of the imidazole group of drugs, thus defeating the purpose of therapy.Rational use of all drugs is a cornerstone for good clinical practice. When evidence-based medicine seems to be the order of the day, we still seem to go by "gut feelings of the doctors". It is high time we look at this issue squarely and decide what is best for our patients.Adenocarcinoma of the stomach represents more than 90% of gastric malignant tumors. The liver is the most common location of hematogenous metastasis. 1 The large intestine is an unusual site of metastasis from gastric adenocarcinoma. Although direct extension of infi ltrating gastric cancer through the gastrocolic ligament into the transverse colon appears to be the commonest type, metastases extending from the ileocecal valve to the sigmoid colon are rare. Stomach adenocarcinoma causes metastases usually within 5 years after gastrectomy. After this period, tumor recurrence is unusual and is estimated to be 6.2 %.We report a 73-year-old woman who presented with chronic diarrhea, with a history of gastric adenocarcinoma diagnosed 8 years ago. In 1999, a stage IIIb, poorly differentiated, adenocarcinoma of the stomach was diagnosed and the patient was treated with total gastrectomy, splenectomy and esophago-jejunal Roux-en-Y anastomosis followed by course of chemotherapy. Histology of the resected specimens revealed a poorly differentiated ulcerous adenocarcinoma, of mixed-type both dif...

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