Tuesday, August 13, 2019

How To Find Appropriate Literatue In PubMed










               Basic steps of literature search  

1.     Learning the steps of literature search process

2.     Understanding MeSH

3.     Determining the database searching techniques

4.     Conducting an advance search in PubMed

5.     Accessing the literature

     Essential terminologies for literature searches

ü Keyword: These are the words or phrases that researcher types in search engine/database. Keywords defines the questions/concepts we are searching about, and results are displayed accordingly. Narrower (specific) the keyword is, higher the chance of getting appropriate results. 
üMeSH (Medical subjects headings) is the national library of medicine-controlled vocabulary thesaurus, used for indexing articles for the MEDLINE/PubMed databases. Each article citation is associated with a set of MeSH terms that describes contents of citation. MeSH terms are organized in a tree with sixteen main branches such as anatomy, organisms, disease, publication characteristics and so on. Searching with MeSH is preferred over keyword searching.



           Stepwise methods of searching literature

1.     Break down the search topic into different steps:

ü Depending on types of data we are searching, keywords are also constructed accordingly.
ü Generally our search topics for experimental study results contain intervention, diagnosis and outcome keywords.
Eg: chemotherapeutic agents for breast carcinoma. Here four major keywords are used (chemotherapy, agents, breast and carcinoma)  


2.     Gathering keywords

üFor gathering keywords, Google, Google scholar and Wikipedia are used
ü Google search shows thousands of results for any keywords, including journals, official and personal websites, blogs and patient information sites. most of information by random searching are of no use. Results can be limited by directing googles algorithms to particular types of sources like site.gov, site.edu, site.org at the end of keyword.  Generally limiting .gov is preferred one to get more relevant results (governmental agencies provides data on .gov. country shortcut)
Here,  keyword 'peptic ulcer' is typed by applying two methods- random searching and specifying the algorithms. Former search showed large number of sites designed to provide  general information and later displayed only governmental sites with authentic results. 

ü Wikipedia is preferred to get background information, and references & external websites. But, content itself is not preferred in scientific communities.
ü Google scholar provides scholarly information like books, Journals articles and patents. One special characteristic of google scholars is it shows results in order that higher the article is sited for, higher will be the rank-older articles are prone to be ranked high.  
3.     Search the concepts separately in PubMed
ü Once we done with gathering keywords, we now search that particular keyword in PubMed search box.
ü Relevant MeSH terms (medical subjects headings) are searched. It’s the set of controlled vocabulary terms used by national library of medicines. In pubmed, articles are assigned in subject specialists who read over the article and determines the subjects contents. Applying MeSH term ensures that articles in same subjects are grouped together regardless of the vocabulary used by author. MeSH descriptors are arranged in a tree structure that allows to search the different level of specificity 
 Here, firstly the search icon was changed to MeSH, then keyword is typed, total of 15 major MeSH were displayed, Each  heading again contains subheadings arranged in a typical tree format. 



4.  Apply additional Database search techniques
   
I.  Truncation
ü Addition of symbol using an asterisk at the end of word stem to find variant of root word and this is very useful to find synonyms. Eg: incubat* (incubator, incubation, incubating, incubated, incubates)
II  Quotation Marks keep terms together and in order. Eg: cervical cancer metastasis contains three keywords which can be represented as one by “cervical cancer metastasis”.
III.Parentheses: allows users to combine the concepts. They are used in the same manner that are being used in mathematics equation and allows ordering the set of terms. Eg oesophageal carcinoma (adenocarcinoma).
IV.  Boolean operators
ü They are used to narrow the search and helps to find the relationship between the search terms when searching in electronic databases.
ü Three Boolean operators are AND, OR and NOT.
ü AND narrows the search by combining together two separate topics. Putting treatment And outcome Helps to find the article which contains both these concepts. Eg: child* AND “head injury”. Quotation marks is used to keep two words as a phrase and * to find the variants on this word.
ü Using OR Boolean operators broaden the search and this is often used with synonyms child* OR paediatrics OR infants* OR adolescence*.
ü Using NOT will narrow the search. It helps to remove the terms we want to exclude. Eg: childhood diarrhoea NOT rotavirus.


here, I searched for Tamsulosin and 'benign prostatic hyperplasia', by applying AND & OR. former showed 838 results where both the terms are being used, and later showed 14359 results where either of these two terms are used. 
use of NOT is dependent on knowledge & understanding of researcher.
5. Apply filter:
Filtering article according to our wish is available in pubmed, on the left hand side of the result. Applying filter reduces the number of articles significantly and increases the accuracy. 
also, literatures can be filtered by author name. After entering keyword/MeSH, authors short name in this bracket […] will show exact literature you are searching for..
                                                                    Thank You !!!


References: 










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Saturday, August 3, 2019

GENERIC DRUGS: NEEDS AND REGULATION



Tylenol is brand name drugs produced by Johnson & Johnson containing acetaminophen. The cost of Tylenol (extra strength, 100 tablets) is $9.49 whereas acetaminophen (extra strength, 100 tablets) is $2.39. Similarly, the price of Allegra (180 mg, 30 tablets) is $17.99 whereas Fexofenadine (180 mg, 30 tablets) costs $11.99. This is an example of significant change in price for brand drug and its generic counterpart. With the availability of generic drugs, the price drops in 'scalloped curve' fashion. According to Food and Drugs Administration (FDA), Generic drugs are typically 80 -85 % cheaper. This is the reason, countries promotes generic drugs. At the same time, a number of evidences are suggesting that qualities of Generics is being compromised significantly because of aggressive marketing.  

             What are Generic Drugs  

Generic drugs are carbon copy of marketed brand drugs. These are manufactured by any pharmaceutical company by  ensuring that the drug has same chemical constituent, dose & dosage, therapeutic indications, pharmaceutical characteristics, side effects and safety profile with the marketed patent/brand name drugs. Even before getting approval for marketing, generic manufacturer should submit Bio-equivalence study report with the branded one to the regulatory authority of respective country. Many countries including US and India are promoting and regulating production of generic drugs within their own country, to make healthcare affordable to public. Adopting generic drugs for healthcare system might be more important to developing countries with growing health economy.

Global Market for Generics is in Boom



According to BCC Research report 2017, the global market for generic drugs is going to be $474 billion by 2023 from $315 billion (2016), with annual growth rate of 6.8 % during 2018-2023.
Increase in healthcare cost is global burden. Members of OECD (organization for economic co-operation and development) expenses 1.5 % of total GDP only in pharmaceutical products. Till now, generic substitution is found one better method to reduce this cost globally. 
The spectrum of therapeutics covered by generic drugs will be antibacterial, antidepressant, anticancer agents, antiarthritics, cardiovascular drugs and drugs for respiratory diseases. Cardiovascular medications particularly has highest market share because of increasing cardiovascular diseases secondary to changes in lifestyle and eating habit.
Generally pharmaceutical companies spent huge amount of money (in millions) to conduct innovation, discovery, experiments and humans to trials during its development. Also they have to go through vigorous regulatory procedure to get approval for marketing for future use. On contrary, generic drugs are exempt form research and human trial since, they are copied of already marketed one. Regulatory process is also undemanding for them. Food and drugs administrations (FDA) has developed ANDA (abbreviated new drugs application ) in place of NDA, abbreviated because no safety data are need to be submitted.
In 2018 only, the food and drug’s administration of united states approved more than a 1,000  new generic drugs products. Nearby 40 % of all generic drugs available in US market are imported from India, 80 % of active ingredients for both brand and generic drugs come from abroad, India and china majorly.
America makes almost none of its own antibiotics anymore.
They are less expensive, easily available and aggressively marketed. So, people form marginalized community and low socioeconomic status also can afford it.
Generic drugs by competing with branded counterparts, helps to reduce the overall healthcare cost through the globe.
Positive outlook for drugs manufacturer in terms of economic return is catalyzed by increase in prevalence of chronic diseases like: diabetes, hypertension, Alzimer  disease, depression etc. in developed as well as developing countries.

Branded drugs are patented only for certain time limit (generally for 20 years). The space for future marketing for generics has already been established; no need of investment on extensive marketing research. 

Promotional strategy for Generic Uses

Governmental healthcare centers and community hospitals can adopt certain promotional strategies to adopt generic drugs (for both in-patient as well as outpatient), which will help to increase the usage percentage as well as decrease in hospital cost. Study conducted in Gifu municipal hospital, Japan shows that adoption of generic drugs by Hospital increases its use by 9.4% within 1 year time period, The same study found that the dispensing rate as well as price percentage of generic drugs were increased significantly after the adoption. 
The price is variable upon countries to countries, but follows the same pattern while comparing developed versus developing world. The number of factors affect the price determination but, medicine supply chain system and Taxation of that particular country plays the major role. 

Generic manufacturers are misleading scientific and Regulatory community


Although generic manufacturers show Bio-equivalence study report with the patented drugs and get approval, only Bio-equivalence study can’t conform therapeutic range and safety. Specially for drugs with narrow therapeutic index, more evidences are required.
In contrary to general belief of reducing health care price with generic drugs, systematic review on impact of generic substitution on health outcome and economics shows 64% of comparison of economic outcomes suggesting cost to be lower when using original drug. Same study shows 67 % of clinical outcome being similar with the original one.
There is paucity of evidence on effects of generic drugs as de novo therapy for treatment, rather most of uses are confined on substitution therapy from original drugs.

With the massive increase in monetary value, the risk of falsification on data and compromising the quality is also high. This not only jeopardizes the health of consumers but also company’s own market get toppled, once exposed. According to NEW YORK TIMES opinion article by Eban Cathrine published on 11of may 2019, most of generic manufacturers of India supplying drugs to US do not follow industry standard “GOOD MANUFACTURING PRACTICE” and quality is severely compromised. But the regulators are fooled with the falsified and fraud data. Here I have attached small fraction of article as it was

Here I have attached small fraction of article as it was:
Six months into his stint, Mr. Baker visited a plant in Aurangabad run by the Indian company Wockhardt, which made about 110 generic-drug products for the American market. He had one week at the plant to ensure that it complied with the F.D.A. regulations known as “current good manufacturing practices.” Generating and preserving data at each manufacturing step is crucial to those regulations.
On his second day at the Wockhardt plant, Mr. Baker and a colleague caught an employee trying to smuggle out a garbage bag of documents. The documents led Mr. Baker to discover that the plant had knowingly released into Indian and other foreign markets vials of insulin containing metallic fragments. These had apparently come from a defective sterilizing machine. He learned that the company had been using the same defective equipment to make a sterile injectable cardiac drug for the American market. The willful deception there and at other plants so shocked him that he overhauled his inspection methods, with significant results.
Two months after Mr. Baker’s Wockhardt inspection, the F.D.A. banned the import of drugs from that plant into the United States, a potential $100 million loss in sales for the company. Company officials declined to comment on the fallout from the inspection.
Mr. Baker kept digging. Over the next five years, first in India and then in China, he uncovered fraud or deceptive practices in almost four-fifths of the drug plants he inspected. Some of the plants used hidden laboratories, secretly repeated tests and altered results to produce fake data that fundamentally misrepresented drug quality, then submitted that data to regulators.
In some instances, deceptions and other practices have contributed to generic drugs with toxic impurities, unapproved ingredients and dangerous particulates reaching American patients. Some doctors have struggled to stabilize patients who became sicker after they were switched from a brand-name to a generic, or between generic versions. A low-cost drug is not a bargain if it doesn’t work... (for full article, link is attached below)
 This above mentioned fraudulent issue is not only because of lack of professionalism in Indian pharmaceutics but also due to poor regulatory practices of both India and US. Arousal of  The conflict of interest trading and market  sectors is unavoidable, but with proper regulations, adverse impact on public domain is definitely preventable. 

Finally,

In spite of having number of shortcomings, Generic drugs need to be used all over the world. In order to make healthcare cost affordable to every citizen, adopting Generic drugs is one major options available to us till now. At the same time, regulators should be cautious about conflict of interest, vigorous policy and required and meticulous observation of regulations only can insure this  highly economic market. Good quality of drug is what we need not good quality of data.

                                                    THANK YOU !!!





References: 











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Wednesday, July 10, 2019

Placebo Effect - A Secret Servant Of Medical Practice



                               What is placebo effect ?? 

Image result for placebo drugs
Placebo effects are beneficial effects that are attributable to the brain-mind response to the context in which a treatment is delivered rather than to specific action of the drug. mediated by the diverse process including learning, expectation and social cognition and can influence various clinical and physiological outcomes related to health. commonly used terms for placebo are  "sugar pills", "dummy drugs", "fake drugs", "sham treatment". 
Though placebo was introduced in 18th was century, has been featured in medical treatment since 1995, when Henry k. Beecher published an influential paper entitled powerful placebo by enlightening the clinically important aspects of placebo treatment. 



modern medicines in spite of its overwhelming success over disease by altering physiology and pathological mechanism, couldn't succeed over pain and psychological distress that are integral to many diseases and to treat disorders like depression, chronic pain, anxiety and fatigue. In such spectrum placebo is dragging more attentions. 

    Where is placebo being Used ?

  • A placebo is used in clinical trials to test the effectiveness of treatments and is most often used in drug studies. For instance, people in one group get the tested drug, while the others receive a fake drug, or placebo, that they think is the real thing. This way, the researchers can measure if the drug works by comparing how both groups react. If they both have the same reaction — improvement or not — the drug is deemed not to work.
  • Actual potency of drug can be determined by eliminating psychological factors by using appropriate statistical methods of analysis
  • Placebo  as an anonymous therapy during any intervention of established treatment  which includes emotional, cognitive and social aspects of clinical practice. 

     Psycho-physiology behind placebo effect !!!

Image result for placebo drugsPlacebo works through a complicated and holistic psycho-physiological system. psychological and physiological components of the placebo phenomenon are connected in a way which is analogous to the connection between thermal imagery and skin blood flow and skin temperature. By analogy, the physiological effects of placebo treatment depends on content of patients treatment related  imagery
  • The long term effect of placebo in a specific disease depends on duration and repetition of single placebo effects. Therefore, its effects is more long-lasting than the effects of more specific agents
  • Unlike disease pathology, pain and distress are rooted in complex brain functions and influenced by internal thought, brain pathology, brain states and conception of social and environmental context. Moreover visual perception, memory, decision making , athletic and cognitive performances also share context effects. 
  • Emerging neuroscience implicates multiple brain systems and neurochemical mediators including opioids, cannabinoids and dopamine . Certain relevant brain areas involved are: prefrontal cortex, anterior insula, rostral anterior singulate cortex and amygdala in analgesia)
  • Humans are endowed with uniquely powerful system for representing context, which help to tailor our response to the needs of given situations. clinical context particularly denotes certain psychological element like learned associations between cues and positiveness/Negative experiences, conceptual knowledge based on verbal suggestion, expectation about treatment outcome and social interactions, patient-care provider relationship, emotional and cognitive interaction with clinicians etc. 

Moreover, recent clinical research into placebo effects has provided compelling evidence that these effects are genuine biopsychosocial phenomena that represent more than simply spontaneous remission, normal symptom fluctuations, and regression to the mean.

Potential and Identified benefits of placebo treatment:


 potency and magnitude of placebo effect is under appreciate in terms of clinical practice. Both psychology and physiology are affected equally sometimes effects of placebo have been found to be stronger than the effects of medication itself. 
  • Improves the quality of life
  • Mitigates burdens of disability and decrease mortality. in ones study, patients with congestive heart failure who adhere to taking  placebo regularly were 50% less likely to die than medication group.
  • Similar results on stroke and heart attack
  • Placebo have been found to influence the activity of the autonomic nervous system such as heart rate , GI activity and respiration
  • Endocrine secretions, specially level of cortisol is found to be decreased based on expectation only. 
  • Immune system activities were found to be greatly affected by placebo mechanism.  Immunosupression was seen by placebo-induced response and in another  study, watching advertisement of the antihistamine drug  "claritin" led to the drug being more effective than others who didn't receive any pro-drug messages. 
Sometimes, clinicians and pharmaceutical products are being appreciated beyond scientifically proven efficacy, which might have been associated with placebo effects. 

            How Neurobilogy is linked to  ???

  • Despite numerous experiments, neurobiological system are yet to learn. As of now, it might be different according to type of stimulus or expectation.
  • For neuroscientist, placebo studies provides a way to investigate how the brain system that process contextual information influence physiological and clinically relevant outcomes
  • Neuroimaging studies on pain modules shows decrease in activity of thalamus, somatosensory cortex (processing center), insula (mediates emotional response) and anterior cingulate cortex (emotional response).
  • larger the placebo effects greater the reduction of activity on these areas.
  • Other than pain centers, placebo also activates pathways between brain stem to spinal cord to inhibit pain response.
In mid-brain, an area called periaqueductal grey gets activated, which inhibits variety of cortical areas, and leads to increased secretions of natural painkillers (endogenous opioids). 
  • Some studies shows activity in periaqueductal grey is associated with degree of placebo in analgesia. Same mechanism works in anti-anxiety placebo medications
  • Higher brain regions like prefrontal cortex, amygdala and striatums also affected by placebo.
  • Other than mitigating pain, placebo has also been found to  affect experiences ranging from emotions to movements in Parkinson's diseases. Studies in PD has shown to increase the level of dopamine in striatum, which is associated with improved movements /mobility.
The full neural circuitry of brain might be more complex than collection of particular regions as outlined above, which might includes more intricate neurological basis than just endogenous opioids and dopamines. recent examples: cholecystokinin and oxytocin.
  • Same brain regions ( lets say prefrontal cortex) can be acting differently in different diseases (pain and anxiety). thus it's uncertain if this shareds neurall circuitary is actually working in the same manner in different placebo situations. 

Why one can't rely on placebo as treatment strategy? 

    Image result for confusion
First, though placebos may provide relief, they rarely cure. The evidence to date suggests that the therapeutic benefits associated with placebo effects do not alter the Pathophysiology of diseases beyond their symptomatic manifestations. Several experiments demonstrated that common symptoms of cancer and side effects of treatment (nausea, vomiting, fatigue, hot flashes etc.) are greatly improved with placebo but there is no evidence that placebos can shrink tumors. 
  • Similarly,  in patients with asthma, symptoms like breathlessness, chest tightness have been greatly improved without affecting FEV1 (forced expiratory volume in 1 second ). 
  • The psycho social factors that promote therapeutic placebo effects also have the potential to cause adverse consequences, known as nocebo effects. generally anticipation of the negative symptoms of drug therapy leads to presentation of actual symptoms. Such nocebo effect has been demonstrated in Benign Prostatic Hyperplasia with "finsteride". Those patients informed of sexual side effects reported such effects three times more than those uninformed. similar finding with anti-migraine therapy on cognitive effects. 
Although relief of symptoms is one aspects of treatment, on which placebo has been succeeded, core truth of medicine lies in cure and control disease. there are paucity of evidence where placebo actually cured disease by changing the pathophysiology. 




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Wednesday, May 8, 2019

PREVALENCE OF HERBAL MEDICINE USES AND DEMONSTRATED SAFETY CONCERNS





Image result for ayurveda

Use of plants product and plant derived medication with the purpose of disease prevention and treatment are called herbal medicines. Those plants with medicinal potency on certain parts or whole plant are used since quite long. Those system of medicines whose primary ingredients are plants and other natural derivatives are called complementary and alternative medicines (CAM). Since these medications are used from ancient time to till date and somehow incorporated in human culture, are considered as autonomous treatment system. Alternative in the sense that medicines which are primarily used first line as conventional treatment all over the world are allopathic. 

                                                                                                   

          Historical perspective and current use of herbal medicines:

India being the country with high biodiversity, thousands of medicinal plants are identified and used since ancient time. The oldest medical system i.e. Ayurveda was originated from India almost 4000 years back. Ayurveda is the mainly related to use of herbal medicines as treatment and preventive aspects. Ayurveda describes 2000 medicinal herbs with thousands of formulations from medicinal herbs.  Now government of India AYUSH ministry, oversees homeopathy, Ayurveda, yoga, siddha and UNANI under complementary and alternative medicine (CAM), are . theses systems are considered to be Indian system of medicine. Other than India, use of herbal medicine as primary care is in practice worldwide with different nomenclature.
   

  1. The history of the use of herbs as medication is as old as history itself. First recorded use of herbs for medical treatment began over 4000 years ago. The origin of this type of medical treatment began in China and India.
  2. A World Health Organisation survey indicated that about 70-80% of the world populations rely on non-conventional medicine mainly of herbal sources in their primary healthcare. according to few studies, more than 70 % of German populations is using herbal medicine in any form for minor diseases.
  3. In one study conducted in Delhi with 200 doctors working on tertiary care center shows that 58% of them uses CAM for their own health issues. mostly practiced were homeopathy and Ayurveda. Many doctors view CAM therapies as not part of legitimate medical practice, but  many have a positive attitude towards it. This shows how cultural practice is deeply rooted in human mind.
  4. In recent years, it is witnessed that the increasing growth in popularity of over-the-counter (OTC) health foods, nutraceuticals, and medicinal products from plants or other natural sources in developed countries. This indirectly indicates that the public is not satisfied with their orthodox medical (OM) treatment.
  5.  A 2012 report by the American Botanical Council disclosed that herbal products sales exceeded US$5.3 billion in the United States in 2011, a 4% growth compared to 2010 . In 2013, sales increased by 8%, reaching a total of approximately US$6 billion .
  6. Traditional Chinese medicine centers on interactions between the body and the environment. A mixture of treatments, including herbs, acupuncture, and massage, is then prescribed
  7.  More than 60 to 70% of modern medicines in the world market are directly or indirectly derived from plant products. 

Few examples that demonstrate safety concerns of herbal medicines:

  1. Some herbal products were found to contain 0.1 to 0.3 mg of betamethasone per capsule aftersome patients developed corticosteroid-like side effects.
  2. Owing to misidentification of the medicinal plant species, plant materials containing aristolochic acid were used for manufacturing herbal products, which caused severe kidney failure in patients in several countries. In Europe it was being used for weight reduction. It was
  3.  Kava kava is An herb native to islands in the South Pacific. This was being used to relieve   stress, anxiety, tension, sleeplessness, and problems of menopause. The U.S. Food and Drug Administration advises users that kava kava may cause severe liver damage
  4.  Reports have been received by drug safety monitoring agencies of prolonged prothrombin times, increased coagulation time, subcutaneous hematomas, and intracranial hemorrhage associated with the use of Ginkgo biloba. It also retards absorption of aspirin when used conjointly.
  5. A number of women in Belgium attending a slimming clinic developed kidney failure after being given a herbal medicine containing the wrong botanical herb, the toxic Aristolochia fangchi in 1990. Since then safety of herbal medicine became social issue.
  6. Aconitum kusnezoffii Reichb. and Aconitum japonicum Thunb, which is used in TCM (traditional Chinese medicine) for a wide range of indications, including many chronic conditions caused the cardio- and neurotoxicity by improper use in China, India, Japan and some other countries has led to a high risk of severe intoxication.
  7.  Ephedra when used with caffeine, stimulant and decongestant is found to be addictive.
  8. Psyllium, cosmopolitan herb for digestive disorder when used with coumarins derivatives decrease the absorption.
                                                                                             THANK YOU !!!

















    
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Sunday, April 7, 2019

SCENARIO OF BIOMEDICAL RESEARCH IN NEPAL AND INDIA

What does biomedical research means?
Biomedical Research is the broad area of science that looks for ways to prevent and  treat diseases that caused illness and  death in people and  in animals. This general field of  research includes many areas of both the life and  physical sciences. Biomedical Research is an evolutionary process requiring careful experimentation by many scientists, Including Biologists and Chemists. Discovery of new medicines and therapies requires careful scientific experimentation, development and evaluation. 

Biomedical Research in Nepal:
  • Unlike other countries in South Asia, research in the health sector in Nepal has a relatively recent history
  • Health research in Nepal has its origin in aid from the United States started in 1951. USOM (United States Operations Mission, later renamed as USAID) undertook Nepal's first systematic research activity, a survey on malaria, in 1952, designed within the context of the country's Malaria control interventions
  • Over the last 60 years, health related research conducted in Nepal has been varied. It ranges across more pure biomedical research, into arenas where evidence is being generated for programmatic interventions into the health field more generally. This generation of evidence around programmatic interventions has been sustained by assemblages of local and international organizations and universities, and supported and funded by aid institutions
  • Data from Nepal Health Research Council shows that, officially, 1,212 health research activities have been carried out between 1991 and 2014
  •  Established in 1991, the Ethical Review Board of the Nepal Health Research Council (NHRC) is the central body that has the formal regulating authority of all the health research activities in country, granted through an act of parliament.
  •  evidence says, Much of the scholarship focusing on health sector research in low‐income countries has focused on pharmaceutical development and direct research on human subjects within the field of clinical trials and health experimentation
Currently Ongoing Research Program In Nepal: 

Nepal health research council is governing body of  biomedical researches including clinical trial and population based observational studies throughout the country.  Following research activities are being registered and being conducted according to official website of NHRC .
  • Population based screening of Sickle Cell anemia in Tharu community of Bardiaya district of Nepal, 2018.
  • Population based cancer registry in Kathmandu, Lalitpur, Bhaktapur, Sarlahi, Saptari, Mahottari and Rukum district in Nepal, 2018.
  • Descriptive study of Scrub typhus in Nepal, 2018. 
  • Unknown Disease Outbreak Investigation In Sundarharicah Foklan Tapu Morang District, 2017. 
  • Non communicable risk factors STEPS survey in Nepal 2018.
  • Global school based student health survey in Nepal, 2017.
  • Population based intervention for  prevention and control of NCD risk factors in Nepal, 2017. 
  • Prevalence study of selected chronic disease ( chronic kidney disease, chronic obstructive pulmonary disease, Diabetes mellitus, Coronary Artery disease)  in Nepal, 2017. 
  • Assessing the trends of Heat waves and perception of  people on health risk of  heat wave in Nepal, 2018.
  • Effect of climatic factor in Diarrhea disease prevalence at National and sub- National levels in Nepal, 2017. 
  • Evaluation of Introduction of Electronic Medical Record system in District Trishuli Hospital Nuwakot, 2018.
  • Estimating burden of disease in Nepal using Globally used method, 2018.
  • Disbursement Linked Indicator, 2018.
  • Study on quality of drugs and drugs used pattern in different healthcare settings in Nepal, 2018.
  • Review of social Health Insurance scheme in selected districts of Nepal, 2018.
  • Quality of essential medicine in public Health care facility of Nepal, 2018.
  • National mental health survey of Nepal, 2018.
  • Assessment of suicide and related factors in Illam districts of Nepal, 2018.
  • Institutional mapping of traditional and complementary medicine service outlet and human resource in Kathmandu valley, 2018.
  • Effectiveness of selected Yoga practice among hypertensive  patients, 2017.
  • Evaluation of Ayurvedic treatment in Hepatitis B, 2017.
  • Asparagus distribution programme for Breastfeeding promotion: perspectives from mother and health service providers, 2017. 
Challenges of conducting clinical trials in Developing countries 
  • Inadequate protocol: The application of protocols and techniques for research into human subjects is now increasingly criticized as inappropriate or inadequate for research into more complex health systems related issues in low‐income countries
  • Dependency: since health care system in developing  countries is mainly dependent on developed one in terms of medication, medical devices, subject matter experts,  Research funding and even heath statistics sometimes. it is hard to reflect need of land of particular country in such cases.
  • Lack of data: inadequacy of health statistics can't demand competent research protocol. Recently, Nepal Health research council has taken initiative in finding prevalence of different disease in different geographic regions of country to combat such issues. 
  • Funding : local Research grant or any philanthropist organization conduct only for particular type and time. In order to conduct sustained research activities, federal funding should be in adequate amount. 
  • Only few hospital are conducting biomedical researches. although number of hospital is very high, only Patan hospital, Teaching hospital and Anandaban hospital comes in list for conducting clinical studies.
  • Registration: It is, however, impossible to trace all the research activities in Nepal, especially those that are designed to generate evidence around programmatic interventions. This is mainly because not all research activities are registered with Nepal Health Research Council (NHRC), there is no standard database and no clear definition as to what is regarded as health research Without knowing how many and what research activities are taking place in the health sector. as for example: Oxford University Clinical Research Unit (OUCRU) is conducting clinical trials in Patan hospital as a daughter branch of Hospital of Tropical Disease Vietnam, in collaboration with NHRC since 2003., but official website of  NHRC doesn't show any evidence. 
  • Inadequate distribution of resources: specially in rural part of  countries, not only diversity in diagnosis is there but also  availability of research subject is easy. problem to conduct research activities is inadequacy of resources and its distribution.  
  • Political economy is not visionary for long term planning and execution.  
Analysis of South Asian countries in reference to India:

India is considered as hub for clinical research. interests  of foreign and local sponsors, government, public and health care professional makes India the most valuable country for drug development. According to official site of  Clinical Trial Registry on India (CTRI), 13,345 intervention studies are being conducted all over the country. Number will be more than double, if we consider observational and post marketing surveillance study. researches shows that even this number is not enough to justify adequacy of clinical study in a country such high diversity and population. Taking into consideration of  Global scenario, India lags behind US, European Union, Japan and Canada. These are few factors which make India to stand in Global scenario of clinical Research: 
  • Increasing number of Non- transmittable diseases like DM, HTN, dyslipidemia ( previously known to be Western disease)
  • Diversity of Medical diagnosis because of socioeconomic, geographical and cultural reason
  • Aggressive increasing in number of health care centers in different geographic locations
  • Financial interest of Public and professional ( Since participants in clinical trial are provided with free health care facility) 
  • Proper Governmental agency to regulate, register and controlling research activities eg: Indian ICH GCP guideline, CTRI ( clinical trial registry of India), ICMR (Indian council of  medical Research), CDSCO ( central drugs standard control organization), DCGI ( director general of India). 
  • Rapid population growth
How Can we Take Rapid Growth In Research Activities: 
  • Attracting more sponsor: In order to conduct large Multicentric international study, sponsors also need spend millions of  money. International investors will only work here if they find security of investments. To insure safety and yield robust data, all Governmental regulatory activities should meet perfection. since from entry and Registration in country, finding feasible site for  study, getting ethical approval, maintaining supply chains up to completing and approving drugs for  marketing. 
  • Management of conflicts of  interest: only meticulous follow of guidelines and law enforcement can manages conflicts of interest, no matter from where it aroused. 
  • Increasing federal fund
  • Strengthening of Institutions, national and international collaborating centers.
  • Empowering local, traditional treatment system, to collect scientific evidences, which are suitable to this environment. 


                                                                                                 Thank you !!!

References: 

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Location: Chamrajpet, Bengaluru, Karnataka, India
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