Dileep Kumar Rohra

Drug-prescribing patterns during pregnancy in the tertiary care hospitals of Pakistan: a cross sectional study

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.

Prevalence of Byssinosis in Spinning and Textile Workers of Karachi, Pakistan

The authors measured prevalence of byssinosis in spinning and textile workers of Karachi, Pakistan, and examined association of the disease with demographic and environmental factors. This was a cross-sectional study conducted in 3 spinning and textile mills and 3 colonies inhabited by spinning and textile workers. A precoded questionnaire was administered to the workers and followed by physical and clinical examination. Among 362 textile workers, the authors found the prevalence of byssinosis to be 35.6%. Educational status of the workers and section of the mill were significantly associated with prevalence of the disease. The authors conclude that there is a high prevalence of byssinosis in spinning and textile workers of Karachi. Furthermore, low education level and work in the spinning section of the mill appear to contribute significantly to the high prevalence of the disease in Pakistan.

Critical appraisal of apparently evidence-based written advertising in Pakistan

Objectives The objective of the study was to critically assess references cited in support of claims in drug advertisements. Methods Drug advertising brochures were collected from privately practicing General Practitioners from different parts of Karachi. Three blinded reviewers then categorized each reference in the brochure according to the sources viz: journals (both Medline indexed and non-indexed), medical reference books, web addresses, personal communications or testimonials, abstracts presented at symposia/conferences, WHO and National Health Guidelines, ‘data on file’ and ‘others’ (which included a diverse set of references). Each reviewer then assessed and analyzed the references further into 2 broad categories: traceable and non-traceable. Traceable references were appraised and, depending upon the claim with which the reference was attached, were classified into justifiable, inaccurate/false, exaggerated and ambiguous. Results We collected a total of 175 different brochures. Thirty-nine (22.3%) brochures did not cite any references and were not subjected to further analysis. The remaining 136 (77.7%) contained a total of 559 references. 305 (54.6%) of these references were from Medline-indexed journals; 67 (12.0%) were from non-indexed journals; 55 (9.8%) references quoted medical reference books; 27 (4.8%) references cited web addresses; 12 (2.1%) references were personal communications/testimonials; 11 (2.0%) references referred to abstracts presented at symposia/conferences; 12 (2.1%) references were from WHO and National Health Guidelines; 8 (1.4%) references were listed as ‘data on file’, while the remainder that could not be defined were classified as ‘others’ (13.1%). Out of a total of 559 references, 249 (44.5%) could not be traced. After critically analyzing the 310 traceable references, 197 (63.5%) were adjudged justifiable, 30 (9.7%) inaccurate/false, 79 (25.5%) exaggerated and 15 (4.8%) ambiguous. Conclusion Results of this study show for the first time that the claims substantiated with references in the pharmaceutical advertisements in Pakistan are highly unreliable.

Reasons of refusal and drop out in a follow up study involving primigravidae in Pakistan

Objective. To determine the reasons underlying the refusals to participate and drop outs from a follow up study involving primigravidae. Design. A descriptive study. Methods. Aga Khan University and Aga Khan Hospital for Women, Karachi, jointly initiated a nested case‐control study on primigravidae for determining the predictability of preeclampsia using various biochemical markers in blood. The protocol‐eligible study subjects were counseled along with their accompanying family members to participate in the study. All women recruited in this study were followed up throughout their pregnancy till delivery. Results. One thousand six hundred and sixty‐five primigravidae were identified as the potential study subjects. Out of which, 1,307 (78.5%) consented and 358 (21.5%) refused to participate in the study. The most common reason underlying the refusal was inability to get permission from the family members (n = 84; 34.4%) followed by fear of prick (n = 51; 20.9%). For 114 refusals, either the reason was not mentioned by the counseled women (n = 60) or the data was missing (n = 54). Out of 1,307 women recruited in the research, only 611 (46.7%) women completed the study according to the prescribed protocol. Among the rest, 102 (7.8%) subsequently withdrew from the research, 503 (38.5%) were dropped out, and 91 (7.0%) were lost to follow up. Conclusions. Refusal to participate and drop out from the research program are two significant factors hindering the smooth flow of a study. In Pakistan, the major reason for the refusal by the protocol‐eligible pregnant women for participating in a research program is the unwillingness of the family members.

Reliability of Rodent Models

Despite the discrepancies observed between data generated from humans and animals, it is common practice to extrapolate data from animal models to humans. This chapter discusses the usefulness of animal models in research and development, but also stresses the need to exercise caution in interpreting the results. Complete reliance on the results from animal experiments can be dangerously misleading, resulting in damage to human health as well as loss of valuable time and resources. Furthermore, we will elaborate on the validity and reliability of rodent models, the role of confounding factors in using animal models, and precautionary advice when extrapolating data obtained from rodent models to a larger, heterogeneous human population.

Regulation of Human Coronary Vascular Tone: Further Evidence Must Be Sought Before Ruling Out the Direct Role of ATP-Sensitive Potassium Channels in Regulation of Coronary Vasculature

To the Editor: The study by Kakkar et al in Circulation Research established that spontaneous coronary vasospasm in ATP-sensitive potassium channels (K+ ATP channels) mutant mice arises from a smooth-muscle extrinsic process.1 We congratulate the investigators for successfully accomplishing such meticulous research. The concluding hypothesis, which points toward a multiorgan involvement or a paracrine cross-talk effect of neuronal or endothelial K+ ATP channels to vascular smooth muscle (VSM) in the event of coronary vasospasm, is very novel and appealing. The elucidated finding, which negates a direct role of VSM K+ ATP channels in tone regulation of coronary vasculature, is very striking as a direct implication of the VSM K+ ATP channels is well established in extracoronary vasculatures.2–4 We recommend a scrupulous exploration into the matter before any direct, or indirect, conclusions can be made. In our study on isolated …