How To Do Critical Appraisal of Any Research Article

In both biomedical research and medical academia, research publications serve a critical role. There are a huge number of research publications published all around the world. However, only a small percentage of them are good and have any research or academic worth. So, properly evaluating published publica-tions has become vital in this circumstance. This article is intended with medical graduates and post-graduates in mind, in order to clarify them how to critically evaluate research publications. It may also be used to write published research articles in an indirect way. A collection of questions is supplied to cover all aspects of a published research paper. To assess the quality of an article, a score system based on the following questions can be established.

First case report of tongue squamous cell carcinoma in a neurofibromatosis type 1 patient and review of pathogenesis of carcinoma in neurofibromatosis type 1

Neurofibromatosis type 1 (NF1), also known as von Recklinghausen's disease, is a type of genodermatoses having an autosomal dominant inheritance pattern and is recently considered as a RASopathy. Such patients are very much prone to develop mesenchymal tumors. However, carcinomas are quite rare in NF1 patients. This case study is the first case of oral squamous cell carcinoma (SCC) in tongue of an NF1 patient. A 35-year-old male reported to the Department of Oral Pathology in a tertiary care center with a chief complain of a painful ulcer on tongue for last 1 month. For confirmation of diagnosis of NF1, the “Diagnostic Criteria for Neurofibromatosis Type 1” was followed. Biopsied specimen of the tongue lesion was examined under microscope and histopathological features were suggestive of infiltrating SCC. Immunohistochemistry with Pan CK and beta-catenin was positive. RASopathy, WNT–beta-catenin pathway alteration, heat shock factor 1 production, and miRNA activity are investigated to explain the pathogenesis of malignancies in NF1 patients. In this first case of tongue SCC, we have found out the altered WNT–beta-catenin pathway.

Studies on central nervous system function in diabetes mellitus.

Fifty-seven insulin dependent (IDDM) and non-insulin dependent (NIDDM) diabetic patients and 25 controls were studied. Patients with history of strokes, hypoglycaemia, hearing impairment, diabetic retinopathy, etc, were excluded. Clinical examination of central nervous system (CNS) and computerised tomography scan of brain were absolutely normal in all cases. Neuroelectrophysiological tests done were the visual evoked potential (VEP), brainstem auditory evoked response (BAER) and somatosensory evoked potential (SEP). The mean VEP latency was significantly raised in both NIDDM and IDDM compared with controls. The mean BAER and SEP latencies were both significantly raised in NIDDM but not in IDDM. The percentage of cases with abnormally raised CNS latencies were as follows: In NIDDM, VEP-16.7%, BAER-50% and SEP-26.7%; in IDDM, VEP-11.1%, BAER-14.8% and SEP-18.5%. Thus, subclinical CNS dysfunction is common in diabetes mellitus particularly in NIDDM and this can be reliably detected by measuring the CNS latencies, specially VEP.

The newer unconventional indications of permanent pacemakers.

In recent years, the indications for permanent pacemakers have expanded. The interest has focussed on hypertrophic cardiomyopathy, dilated cardiomyopathy and a new entity called hypertensive hypertrophy with cavity obliteration (HHCO). Pacemaker therapy is establishing itself for the prevention of atrial fibrillation. Pacing for neurocardiogenic syncope with newer pacing mode has encouraging datas. Pacemaker for long QT syndrome, after cardiac transplant and for haemodynamic improvement in occasional cases of first degree atrio-ventricular block is getting attention. The AHA and ACC guidelines updated in 1998 for implantation of cardiac pacemakers, now include several of these newer indications.

Anomalous bile duct injury during laparoscopic cholecystectomy.

We report a patient in whom the common hepatic duct drained into the gall bladder body and the cystic duct continued as the bile duct into the duodenum. The anomalous duct was inadvertently injured during laparoscopic cholecystectomy. The injury was repaired and end-to-end anastomosis of the hepatic and cystic ducts was done through a subcostal incision.

A study of intersectoral co-ordination in disaster management in flood prone districts of West Bengal.

Disaster management is essentially a multi-sectoral and multidisciplinary endeavor. The status of disaster preparedness, coordination among different sectors and its impact on disaster management performance were studied and compared in two flood prone comparable districts viz. Midnapore and Murshidabad of West Bengal. The perception of state level officers about important job responsibilities of other departments in relation to disaster management and its intersectoral co-ordination was found mostly satisfactory; but this desired status did not prevail at district level. Lack of co-ordination among some sectors at district levels persisted in Murshidabad district, indicating comparatively better intersectoral co-ordination in Midnapore district. Thus, 'early response following flood' the most important indicator of adequacy of pre-disaster preparedness was found significantly better in Midnapore district. On the contrary, due to liberal use of Radio transmission set for flood warning, a significantly higher proportion of affected families in Murshidabad district received early flood warning compared to Midnapore. Organisational aspects of disaster management need to be improvised with role clarity of different departments in relation to other sectors involved in this endeavor.

Clinical significance of carcinoembryonic antigen in colorectal malignancy.

Carcinoembryonic antigen (CEA) assay was performed in 40 patients of histologically proven colorectal carcinoma. The overall incidence of positivity was 72.5%. The incidence increased from 40% in Duke's A stage to 84.6% in Duke's C stage. Similarly the mean CEa levels also increased as the disease advanced i.e. 4.96 ng/ml, 8.07 ng/ml and 12.7 ng/ml in Duke's A, B and C respectively. Cancer with poor prognosis i.e. poorly differentiated and colloid carcinoma, had significantly less rise in CEA values (P < 0.05) as compared to well differentiated carcinoma. There was no relation of CEA values with the gross appearance of the tumour and lymph node involvement. CEA level came down in all the patients after surgery. Based on the postoperative CEA estimation, complete tumour clearance had been achieved in 86.2% of patients.

Patient education programme in bronchial asthma in India: why, how, what and where to communicate?

Judicious and prolonged use of 'protector' metered dose inhalers of steroid aerosol, sodium cromoglycate, both orally and nasally, and 'reliever' drugs like beta 2-agonists etc can induce a state of controlled asthma in many cases. Continued patient education programme (PEP) in a well-staffed asthma clinic is needed to achieve this state. Various aspects of PEP programme should be discussed during each visit. Presence of superstition, misconceptions, ignorance and strong bias against the use of metered-dose inhalers should be removed during PEP. Poor level of literacy, language-barrier, poverty and inadequate contingency fund for prolonged treatment in most families, poor medical infrastructure, inadequate health care facilities, overcrowding in all hospitals, insufficient para-medical staff-pattern (even in private hospitals), high cost of inhalers, tendency for early discontinuation of protector drugs, dislike for prolonged supervision and follow-up investigations, distrust for doctors, fear of social stigma, lure for homeopathy and indigenous branch of medicine for children, etc., are some of the many problems, peculiar to our country, to be faced during PEP. Because of the presence of adequate medical and primary health care services, PEP in developed and affluent Western countries is liable to differ from what is advised here.

Multiple dermoid cysts of omentum.

Dermoid cyst of the omentum is an extremely rare condition. We report a case of multiple dermoid cysts of omentum in a 50 years old woman. The aetiopathogenesis, clinical presentation and relevant literature is briefly reviewed.

Antimicrobial potentiality of a new beta-lactum antibiotic fosfomycin.

Antimicrobial action of penicillin and some of its derivatives including fosfomycin was studied with respect to 225 strains of Gram-positive and Gram negative bacteria. Fosfomycin was found to possess somewhat less activity against Staphylococcus aureus compared with other penicillins; however, it showed powerful activity towards Escherichia coli, Klebsiella spp. and Proteus mirabilis.

Effect of hydroxyurea on foetal haemoglobin in myeloproliferative & myelodysplastic syndromes.

The effect of hydroxyurea on foetal haemoglobin (HbF) levels was evaluated in 36 patients of myeloproliferative and myelodysplastic disorders. In 17 (47.2%) patients, HbF levels increased from 1.40 +/- 1.17 to 3.03 +/- 1.97 per cent after 4 wk therapy with hydroxyurea. In the responders this increase was highly significant (P less than 0.001). The rise in the HbF levels after hydroxyurea therapy was significant in patients with chronic myeloid leukaemia but not in the other groups.