BackgroundThe rationale for use of drugs during pregnancy requires a careful assessment as in addition to the mother, the health and life of her unborn child is also at stake. Information on the use of drugs during pregnancy is not available in Pakistan. The aim of this study was to evaluate the patterns of drug prescriptions to pregnant women in tertiary care hospitals of Pakistan.MethodsThis was a cross-sectional study conducted at five tertiary care hospitals of Pakistan. Copies of outpatient medicinal prescriptions given to pregnant patients attending the antenatal clinics were collected. The drugs were classified according to the pharmacological class and their teratogenic potential.ResultsAll the pregnant women attending the antenatal clinics received a prescription containing at least one drug. A total of 3769 distinct prescriptions given to different women were collected. Majority of the women who received the prescriptions belonged to third trimester (55.4%) followed by second (33.6%) and first trimester (11.0%). On an average, each prescription contained 1.66 ± 0.14 drugs. The obstetricians at Civil Hospital, Karachi and Chandka Medical College Hospital, Larkana showed a tendency of prescribing lesser number of drugs compared to those in other hospitals. Anti-anemic drugs including iron preparations and vitamin and mineral supplements (79.4%) were the most frequently prescribed drugs followed by analgesics (6.2%) and anti-bacterials (2.2%). 739 women (19.6%) received prescriptions containing drugs other than vitamin or mineral supplements. Only 1275 (21.6%) of all the prescribed drugs (n = 6100) were outside this vitamin/mineral supplement class. Out of these 1275 drugs, 29 (2.3%) drugs were prescribed which are considered to be teratogenic. Misoprostol was the most frequently prescribed (n = 6) among the teratogenic drugs followed by carbimazole (n = 5) and methotrexate (n = 5). Twenty nine pregnant women (0.8% of all the women studied) were prescribed these teratogenic drugs.ConclusionLess than one percent of the pregnant women attending tertiary care hospitals in Pakistan are prescribed teratogenic drugs. The prescribing practices of Pakistani physicians are similar to those in western countries.

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One step green synthesis of a silver–reduced graphene oxide nanocomposite (Ag–RGO) and its application to construct a nitrite (NO2−) sensor.

Heat-exchanger fouling is a severe operational problem in steam-assisted gravity drainage (SAGD) processes. In an effort to better understand which species are prone to deposit and gain insights into means for mitigating SAGD heat-exchanger deposition, analyses were performed on a series of heat-exchanger deposit samples from an inverted SAGD operation in Canada. Deposit samples were obtained from each of five heat-exchanger banks used in the operation of the facility: exchangers heating the produced raw bitumen reverse emulsion coming from the wells (two exchanger banks in series) and exchangers cooling separated produced water leaving the high-temperature separator (HTS) (three exchanger banks in series). The separated produced water leaving the facility HTS was also analyzed. The analyses focused on determining the overall inorganic and organic elemental compositions, as well as providing general information on the type of chemical species predominately present. The analyses performed on the deposits and solids from the produced water included (1) carbon, hydrogen, and nitrogen analyses, (2) X-ray fluoresence, (3) X-ray diffraction, (4) thermogravimetric analyses, (5) chloroform/methanol/toluene solubilities, and (6) Fourier transform infrared spectroscopy. Ion chromatography and inductively coupled plasma analyses were also run on the water sample. Analyses indicated preferential deposition of particular species and potential causes of deposition in certain exchangers. For the SAGD operation, at that time, a periodic slop-tank recycle containing warm lime softener sludge was indicated as a source of a significant amount of fouling in the heat exchangers handling the produced bitumen reverse emulsion and the initial exchanger cooling separated produced water leaving the HTS. High Mg +2 and Si +4 compositions were detected in these deposits. Magnesium silicates were indicated in Fourier transform infrared spectroscopy analyses. Deposition of additional other sand/silicates was also indicated. For the organic portion of these deposits, significant concentrations of organic acids and organic acid salts were indicated within the deposit hydrocarbons. Although all deposits contained both inorganic and organic components, the deposits in the last two exchangers cooling the produced water were found to be predominately organic. Significant concentrations of organic acids and organic acid salts were also indicated in these deposits. The indications of a significant organic acid/acid salt content led to collaboration work with the National High Magnetic Field Laboratory to study these components in detail. Electrospray ionization Fourier transform ion cyclotron resonance mass spectroscopy work performed at the National High Magnetic Field Laboratory is discussed in the part 2 companion paper (

Xeroderma pigmentosum (XP) is a rare autosomal recessive inherited disorder caused by a defect in the normal repair of DNA of various cutaneous cell types damaged by exposure to ultraviolet radiation. We present our 7-year experience with 36 XP patients who either visited the Department of Dermatology or were seen in the medical camps arranged in remote areas for patients' welfare, from 1995 to 2001. For ease of discussion we classified all cases into the following subgroups on clinical grounds only: mild, those with light brown freckles on the face alone; moderate, those with dark brown freckles with burning on the face, neck, ears, chest, hands and photophobia but without other associated obvious cutaneous and ocular changes; severe, those with extensive dark brown freckles with burning on the exposed parts as well as on the unexposed parts of the body, i.e. the chest, back, abdomen and arms including other associated cutaneous and ocular changes such as ulcers and malignancy. Of 36 patients, three (8.3%) were classified as mild, nine (25%) moderate and 24 (66.7%) severe; there were 18 males and 18 females, age range 2-30 years (mean 8.9 years). Seventeen patients had cutaneous changes: actinic keratosis, keratoacanthoma, fissures and ulcerative nodules on the exposed parts of the body. Four patients had wide ulcers, along with mass formation and severe pigmentation on the face, neck and head. Twenty-nine patients developed ocular symptoms: photophobia, conjunctivitis, corneal keratitis and lid ulcer. One patient had complete loss of vision. Histopathological findings revealed that six patients had squamous cell carcinoma (SCC) on the face, head, ear or lip. More than one sibling (two to four) was affected in four families. The majority of cases (20/36, 55.6%) were from the Brohi tribe (skin type III), while the remaining cases (16/36, 44.4%) were from the Sindhi population (skin type IV). The large number of XP patients seen in those with skin type III (Brohi tribe) compared with skin type IV (Sindhi population) indicates that the skin type and the race has a considerable value in the pathogenesis of XP. Furthermore, 24 of 36 patients were in the severe group and six of these had SCC. Moreover, no neurological abnormalities were observed in our patients. All patients were treated according to disease severity by prescribing oral antibiotics, local steroids, sunscreens and/or chemotherapy followed by irradiation in malignant cases. Two patients died because of extensive SCC.