An U pdate on B iomedical L iterature Search for B udding R esearch S cholars

Literature search can be defined as systematic review of all scientific resources, both published and unpublished. Literature search is continuous process. It provides new ideas of research. It helps us to frame new research questions and to identify the knowledge gap. There are no straightforward rules for literature search. Each researcher has its own m ethod of literature search. In this review article we shall discuss about various types and sources of literature, steps and techniques of literature search which will serve as a quick guide for budding research scholars.

A Prospective Study to Analyse the Metabolic Effect of Metformin with Glimepiride on Type 2 Diabetic Patients of North India.

Background: Diabetes Mellitus is a leading disease of developing countries and its incidence is increasing day by day. Among Oral Hypoglycemic agents, Metformin is still the best treatment choice for type 2 diabetes mellitus. Metformin is associated with improvements in lipoprotein metabolism, including decreases in LDL-C, fasting and postprandial TGs, and free fatty acids. Methods: This prospective study was carried out on Type 2 Diabetic patients attending the Diabetic clinic at Teerthanker Mahaveer Medical College & Research Center, Moradabad. Only those patients were included who were not adequately controlled with a stable dose of metformin monotherapy. A total of 125 patients were enrolled in the study taking Glimepiride plus Metformin. The patients received therapy of metformin 500mg three times daily & glimepiride 5mg twice daily. Results: Out of the 125 patients enrolled in the study, only 82 patients completed the study. Out of 82 patients, 49 were males and 33 females. There was a significant reduction (p<0.05) of FPG as compared to baseline. The (PPBS) was reduced from 275.95 ±63.599 (mg/dl) to 167.04±27.084 (mg/dl) at 12 weeks and141.36±31.064(mg/dl) at 24 weeks (mg/dl). There was a significant reduction (p<0.05) of Hb1Ac, TC, TAG, LDL, VLDL, UA, SGOT as compared to baseline but no significant rise in HDL was seen as compared to baseline. Conclusion: Significant improvement in fasting blood sugar (FBS), Postprandial blood sugar (PPBS), Lipid profile and Glycosylated hemoglobin as compared to baseline.

A Study of Prescription Pattern in the Management of COPD in a Tertiary Care Hospital.

Background: Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable condition characterized by persistent airflow obstruction that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Bronchodilators are mainstay of pharmacologic management of COPD and Inhaled corticosteroids (ICS) are the central of treatment of asthma but in management of COPD their role is controversial. Aim &Objectives: The sole aim and objective of this study is to evaluate the current prescription pattern of COPD management using data generated in a tertiary care hospital of UP India.. Methods: : In this prospective study, all patient data relevant to the study were obtained by examination of Case sheets of inpatients visiting the OPD of TB & Chest department. Results: In this prospective study, prescriptions of 74 patients were selected. Out of total patients, 60 (81.08%) were males and 14(18.9%) were females. Out of total 74 patients, 73 (98.64%) are smokers, in which 30 (40.54%) are currently smoking while 43(58.1%) are ex-smokers. Out of total patients 60(81.08%) have comorbidities. Hypertension is most common comorbidity having 36 (48.65%) of patients. Inhalational route was most common route of administration of drugs in the study. Oral route was second most common route; it was used for administration of 42.03% of drugs. Formoterol was maximum prescribed drug used in 60 (81.09%) of patients followed by Budesonide 57 (77.03%), Acebrophylline 48 (64.86%),followed by Levocetrizine 41 (51.41%), Salbutamol and Montelukast were used in equal no. of patients 40(54.06%) , followed by Ipratropium 39 (52.70%), Tiotropium which was used in 29 (39.19%) of patients, followed by Amoxicillin 16 (21.63%) followed by Theophylline and Azithromycin used in 8 (10.81%) patients ,followed by Doxophylline and Terbutaline which were also used in equal number and percent of patients that is 3 (4.05%). Conclusion: The prescribing trend observed in the study appears to be in concordance with the current GOLD guidelines for the management of COPD patients.

Amygdala pharmacology and crime behavior, dysfunctions to be considered as a disease?

We don’t have today drugs specifically registered for amygdala dysfunctions as preventable agents towards some kind of crime behavior. This Neuro psychiatric condition or organ state are to be considered and treated in preventive way as common disease. There is an amygdala physio-pathological Level of activation.  Still we are not sure to call this dysfunctions status as disease and drugs are needed or efficacy to control it. A neuro-pharmacology research of amygdala can give the response also using imaging Techniques. Studies demonstrated that Amygdala activation is involved in aggressive behavior. The aim of this work is to investigate in this relationship and to find if there is a level of activation.

Role of Clinical Pharmacologist in Healthcare- Present Scenario

The endeavour of a Clinical Pharmacologist is to develop methods and strategies that improve the quality of drug use in individual patients and patient populations. In the first WHO report on clinical pharmacology in 1970,[4] the section on research emphasized the need for studies that explored the mechanisms of action of drugs and identified their pharmacokinetics in humans.

To study the hypotensive and hypolipidemic effects of garlic in smokers in the North Indian population.

Background: Garlic, latin name Allium Sativum, belongs to the onion family Alliaceae, have been widely recognized as agents for prevention and treatment of cardiovascular and other metabolic diseases like atherosclerosis, hyperlipidemia, thrombosis, hypertension and diabetes. Methods: This prospective study conducted on male smokers (n=40) in the department of physiology of Teerthanker Mahaveer Medical College & Research Centre. Selected smokers were further evaluated before and after giving raw fresh garlic weighing about 5-6gm daily for a month. Sample 1:- Before taking garlic parameters. Sample 2:- After taking garlic parameters. After one month all the parameters were analyzed and compared with the baseline parameters. Results: Garlic has a significant hypotensive effect by lowering DBP, SBP also lowered but it was not statistically significant. Also hypolipidemic effects of garlic were found to be statically significant in cases of triglyceride, HDL & LDL, but changes in cases of cholesterol and VLDL are not statically significant. Conclusions: Garlic being hypotensive and hypolipidemic in nature as shown in our study, therefore it can be concluded that garlic is beneficial for human beings. Its main beneficial effect for decreasing the lipid levels as well as the blood pressure in smokers.

Assessment of hearing loss in multi-drug resistant tuberculosis (MDR-TB) patients undergoing Aminoglycoside treatment.

Background: Incomplete treatments and treatment failures has led to Multi-drug resistant tuberculosis, which has emerged as a significant problem in treating tuberculosis and thus the second line drugs are used with the concomitant increase in the incidence of adverse effects. Methods: This prospective study was carried out from June 2009 to May 2014 in the department of ENT in collaboration with TB & Chest at Teerthanker Mahaveer Medical College & Research Centre. Out of 104, only 84 patients were included in our study. Patients were divided into three groups: group I (n=27) patients using Amikacin, group II (n=40) patients using kanamycin and group III (n=17) patients using streptomycin. Baseline pre-treatment pure tone audiometry was performed on all the patients and repeated every three months until completion of therapy. Results: Patients included were 15 to 55 years age with higher number of males (65%, n=55) than females (35%, n =29). Only 22.7% (n=19) of patients were found to be suffered from Hearing Loss. At the end of the study (at 12 month), Overall incidence of HFL was 58.0% (n=11) while incidence of Dead ear was 31.5% (n=6) and LFL was 10.5% (n=2). Amikacin was found to be more Ototoxic than Kanamycin and streptomycin. Conclusion: Aminoglycosides in MDR-TB patients may cause irreversible hearing loss involving higher frequencies and can become a hearing handicap as speech frequencies are too implied in more or less of the patients, thus underlining the need for regular audiologic evaluation in patients of MDR-TB during the treatment.

A prospective study on sleep disorders related to antidepressant drugs use in a tertiary care teaching hospital.

Background: Prescription of antidepressants has been increased from the last decade and responsible for producing sleep disorders as adverse drug reactions (ADRs). Sleep disorders can be divided into 3 large groups: (1) insomnia, (2) primary complaint of daytime sleepiness, and (3) Association of disruptive behaviours during sleep, the disorders of arousal. So active surveillance is needed to access these ADRs. Aims and Objective: To analyze the sleep disturbances as ADRs of various antidepressants prescribed to the patients attending psychiatry outpatient department (OPD). Methods: This prospective study was conducted on patients aged ≤74 years attending Department of Psychiatry OPD and were prescribed Antidepressants for the duration of 8 months (December, 2013-July, 2014). The ADRs reported were confirmed by WHO UMC Causality Assessment Scale. Results: Total number of patients enrolled on the basis of inclusion and exclusion criteria (n=50). Total number of ADRs related to drugs prescribed were found to be n=69. Total number of patients with sleep disturbances as ADRs were found to be n=28. Conclusion: The drug, most frequently implicated to cause sleep disturbances, was mirtazapine. Increased sleep was the most common ADR, found to occur. Unusual ADRs such as sleep talking was also seen.

Role of Topical Acetic Acid in Comparison to Gentamicin for the Management of Chronic Suppurative Otitis Media

Introduction: Chronic Suppurative Otitis Media (CSOM) is one of the diseases resistant to current antibiotics; persisting for more than two week; and capable of causing severe discharge, tympanic membrane perforation and deafness. This may cause distress and affect their quality of life and productivity. Aims: To assess the role of topical Acetic Acid in comparison to Gentamycin for management of CSOM. Methods: It was a Randomized, open label study. Patients diagnosed as CSOM (safe type) were randomly divided into two groups, group I - topical 1.5% Acetic acid and group II - topical 0.3% Gentamicin sulphate in a dose of three otic drops thrice daily. Follow up was done every week for two weeks and was compared on the basis of otological symptoms score. Results: The mean difference of otological symptom score at day 7 and day 14 from baseline in Group I was 1.90±1.01 and 3.40±1.08; and in Group II 1.96±0.57 and 3.12±0.74; p<0.05. Among the study groups, reduction of otological symptom scores at day 7 (Group I =3.22±1, Group II=2.66±1.76; p=0.14) and at day 14 (Group I = 1.72±1.76, Group II= 1.50±1.79; p=0.56) respectively. Also, “Treatment success” seen in 46 (92%) patients in the Acetic acid group and 44 (88%) patients in Gentamicin sulphate group. Moreover, cost of the treatment for Acetic acid was 102.94 and for Gentamicin sulphate was Rs.160.25 per person. Conclusion: Topical Acetic acid was found to be equally effective to Gentamicin sulphate for the treatment of CSOM.

A prospective study on prevalence of adverse drug reactions due to antibiotics usage in otolaryngology department of a tertiary care hospital in North India.

Background: Polypharmacy, advancing age and longer duration of hospital stay are the factors responsible for adverse drug reactions (ADRs). This study has attempted to analyze the pattern of antimicrobial prescription in OPD & IPD of the Otolaryngology department and to detect, document, assess and report the suspected ADRs due to antibiotic use and preparation of guidelines to minimize the incidence of ADRs. Methods: A prospective study conducted at the TMMC&RC on patients aged >40 years, who visited the Otolaryngology department over a period of 5 months. Suspected ADRs were assessed for causality and severity using Naranjo’s probability scale and modified Hartwig’s criteria, respectively. Results: Out of 1200, 925 prescriptions were analyzed. Most patients were from 41-60 age (59.45%) followed by 61-80 age (37.29%) and least from >80 yr (3.24%). But the incidence of ADRs were found to be higher in patients of >80 yr age group n=8 (26.66%). The most commonly prescribed antibacterials were β-Lactams (64.61%). Out of 925 prescriptions studied, only 94 were found to have 154 ADRs. The most commonly identified ADRs were Gastrointestinal 47.40%, followed by Neurotoxicity 24.67%, cutaneous reactions 20.12%, Hepatic 4.54% and Kidney 3.24%. 74.67% of the ADRs were probable and 20.77% were possible type and only 4.54% were definite. 74.67% ADRs were found to be type A, and 25.32% type B. Conclusions: Our study showed that prevalence of ADRs was highest in elder age group and diarrhea was the most common ADR found. Therefore elderly patients should be given special attention when prescribing medications to avoid clinically significant harmful consequences. Minimizing unnecessary antibiotic use by even a small percentage could significantly reduce the immediate and direct risks of drug-related adverse events in individual patients.