Burns During Covid-19 Pandemic: Demographics, Etiological and Clinical Trends in 2021 at the National Burn Care Centre in Islamabad, Pakistan

The scarcity of data on burn-related injuries in Pakistan prompted this study. The study is specifically aimed at assessing the burn patients who were admitted to a national burn care center (BCC) in Pakistan. This single-center retrospective analysis was conducted for 12 months from January to December 2021. During this time period, 14,069 patients visited BCC with burn injuries of diverse natures while 613 of them were admitted. The patients' information was abstracted from the hospital database. This information included age, sex, diagnosis, burn depth/degree, time of arrival, circumstances of burn injury, TBSA (total burn surface area), complications, outcome, and management plan. This information was shifted to Microsoft Office Excel Worksheet 2015 and then coded into the IBM Statistical Package for the Social Sciences (SPSS) version 24.0. Armonk, NY: IBM Corp. Of 14,069 patients, 613 were admitted to the burn care center, indicating an admission rate of 4.35%. Among these 613 patients, there was a high proportion of males (58.89%) and a mean age of 20.2±12.5 years. Most patients (40.4%) visited within the first hour after being burnt and flame burns were the most common (41.10%). Most patients were burnt due to accidents (97.7%). The mean length of hospital stay was 15.5 days. Flames were the main cause of burns among our cohort of patients. Most patients had a TBSA of >10% and generally had a second-degree burn, mostly in the pediatric population. An urgent appraisal of burn policies and related legislation is needed to halt the burn burden in the country.

Analysis of Factors Affecting Burns Mortality: A National Burn Centre Experience From Pakistan 2007-2021

Burns are a public health concern burdening the healthcare delivery system across the globe. Mortality rates are significant outcome parameters after a burn injury. The objective of the current study was to analyze the characteristics of the patients admitted to our burn care center and identify the factors related to mortality in the burn patients. This was a cross-sectional single-center study involving a retrospective analysis of mortality rates in burn patients over a period of 15 years from July 2007 to December 2021. During the study period, 7,866 burn patients were admitted to the ICU of the burn care center. Patients who died [Group 1] were compared to the group of survivors (control cases [Group 2]) to ascertain the contributing factors that might forecast a high risk for mortality. The mortality rate was calculated as 23.16% (1,822/7,866). The majority of the patients (both groups) had a total body surface area (TBSA) of >50% (p 0.001). The average duration of stay at the burn care center was 15.5 days for the survivors' group (Group 2) while it was 11.4 days for the patients who died (Group 1) during the course of their treatment. About 23.16% of all admitted patients died mostly from flame burns, and sepsis was the commonest cause of death. Patients with risk factors should be classified as high risk for mortality at the time of ICU admission. It is necessary to initiate educational and awareness programs for sensitization related to the prevention of burn injuries.

Unlocking integrated waste biorefinery approach by predicting calorific value of waste biomass

The current study analyzed the high heating values (HHVs) of various waste biomass materials intending to the effective management and more sustainable consumption of waste as clean energy source. Various biomass waste samples including date leaves, date branches, coconut leaves, grass, cooked macaroni, salad, fruit and vegetable peels, vegetable scraps, cooked food waste, paper waste, tea waste, and cardboard were characterized for proximate analysis. The results revealed that all the waste biomass were rich in organic matter (OM). The total OM for all waste biomass ranged from 79.39% to 98.17%. Likewise, the results showed that all the waste biomass resulted in lower ash content and high fixed carbon content associated with high fuel quality. Based on proximate analysis, various empirical equations (HHV=28.296-0.2887(A)-656.2/VM, HHV=18.297-0.4128(A)+35.8/FC and HHV=22.3418-0.1136(FC)-0.3983(A)) have been tested to predict HHVs. It was observed that the heterogeneous nature of various biomass waste considerably affects the HHVs and hence has different fuel characteristics. Similarly, the HHVs of waste biomass were also determined experimentally using the bomb calorimeter, and it was observed that among all the selected waste biomass, the highest HHVs (21.19 MJ kg-1) resulted in cooked food waste followed by cooked macaroni (20.25 MJ kg-1). The comparison revealed that experimental HHVs for the selected waste biomass were slightly deviated from the predicted HHVs. Based on HHVs, various thermochemical and biochemical technologies were critically overviewed to assess the suitability of waste biomass to energy products. It has been emphasized that valorizing waste-to-energy technologies provides the dual benefits of sustainable management and production of cleaner energy to reduce fossil fuels dependency. However, the key bottleneck in commercializing waste-to-energy systems requires proper waste collection, sorting, and continuous feedstock supply. Moreover, related stakeholders should be involved in designing and executing the decision-making process to facilitate the global recognition of waste biorefinery concept.

Pattern of Acute Adverse Transfusion Reactions in Patients With Burn Injuries: A Novel Initiative Towards Haemovigilance at the National Burn Centre of Pakistan

The transfusion of blood and blood components is a life-saving medical procedure, however, it is linked with adverse reactions to transfusions. Information about different types of adverse transfusion reactions (ATRs) will assist in their early identification and subsequent management, as well as in devising strategies to minimize the occurrence of adverse reactions related to blood component transfusion. The current study was therefore executed to analyze the pattern of ATRs in patients with burn injuries at a national burn center. This was a cross-sectional, prospective study involving an analysis of immediate ATRs from January 2020 to June 2021 (18 months). ATRs observed during the study period were documented and analyzed. During the study period, 2,220 units of blood and blood components were transfused to 1,075 burn patients (2.06 transfusions per patient). A total of 27 ATRs were recorded (1.21%). Allergic reactions were the commonest (55.55%) followed by febrile non-haemolytic transfusion reaction (37.03%). The mean volume of blood unit transfused, when the reactions were noted, was approximately 75 ml (range: 15-230 ml). The mean time at which transfusion reactions were noted was 17 min (range: 5-220 minutes). The ATRs were more common in patients with multiple transfusions compared to those receiving a single transfusion. The common adverse reactions were allergic and febrile non-haemolytic transfusion reactions. It is vital to report all transfusion reactions to the attached blood center and hospital transfusion committee (HTC) on standardized reporting forms. Continuous medical education through seminars and sensitization workshops will support consolidating haemovigilance systems.

Detection of adaptive genetic diversity and chemical composition in date palm cultivars and their implications in controlling red palm weevil, Rhynchophorus ferrugineus Oliver

This study, about RPW and date palms, is under the scope of date palm bioecology and nutrition (nutritional ecology) which includes the integration of several areas of research such as date palm biochemistry, genetics, and RPW infestation behavior through various date palm cultivars. Date palm (Phoenix dactylifera L.; Arecaceae) production is under threat from the red palm weevil (RPW), Rhynchophorus ferrugineus Oliver. A better understanding of genetic diversity within date palm cultivars can be useful for its implementation within the insect IPM program in the future. Three indices, namely simple-sequence repeats (SSR) markers to elucidate genetic diversity, chemical components, and a natural infestation index of RPW, were used to evaluate the resistant or susceptible date palm cultivars in Qassim. Based on a field survey of RPW infestation within 79 date palm farms involving 11 cultivars at Qassim, the sensitivity and resistance cultivars were determined. The resistant date palm cultivars were Nabtat Ali, Shakrah, red Sukary, and um Kobar which had the lowest degree of RPW abundance %. Values of the essential minerals, nitrogen, phosphorus, potassium, and calcium within the date palm cultivars were also estimated. RPW abundance % was negatively correlated with the calcium content of date palm cultivars. The principal component analysis (PCA) revealed that the calcium content and RPW abundance % were highly affected by the cultivars. SSR markers of the date palm cluster tree divided genotypes into two main groups at similarity coefficients between 0.56 and 0.91. The 1st group included; Nabtet Ali, Red Sukary, Um Kobar, and Shakrah with similarity coefficients between 0.56, this group was the most resistant cultivars. Therefore, SSR markers were able to characterize and resolve genetic diversity in date palm cultivars for RPW resistance. When SSR markers coupled with higher calcium (Ca) content can efficiently replace indices in characterizing resistant date-palm genotypes with a high confidence level. Integration between date palm genetic diversity, chemical structures, and RPW infestations rates promoted the understanding of the interplay between the diversity of RPW management (short-time scale), and the resistance genes, plant nutrition, and dynamics of the diversity of RPW through domestication and diversification (long-timescale). Therefore, our results may lead to a change in RPW control strategies by switching to using safe alternative pesticide control methods (Resistant cultivars of date palm), which are underestimated and may reveal the impact of low-cost, but highly effective agricultural practices in the field of date production in the world. Understanding the genetic structure and calcium content of date palm cultivars mechanisms could help to predict date palm resistance against RPW populations in the new IPM strategy in RPW control.

Monitoring of infestation percentages of the invasive red palm weevil, Rhynchophorus ferrugineus (Coleoptera: Curculionidae), and management tactics: a six-year study

Red palm weevil (RPW), Rhynchophorus ferrugineus (Olivier) (Coleoptera, Curculionidae), is a devastating invasive pest, that invaded Saudi Arabia's date palms in 1987. Evaluation of the infestations and the efficacy of both preventative and control treatments have been studied from 2015- 2020 in Qassim. The results indicated that the number of infested date palms varied according to the years and locations. The infested date palm trees percentage was relatively high in 2016 (2.24%) and 2017 (3.19%), then gradually decreased to reach its lowest in 2020 (0.73%) due to the management protocol applied by the Ministry of Environment, Water, and Agriculture. Furthermore, the infested palm trees' percentage varied among the eight study locations, reaching the highest percentage in location G (SA7) with a general average of 4.31%. While in the other locations, the general infested percentage average was very low when compared to location G (SA7) with 1.21 and 0.47% in locations A (SA1) and H (SA8), respectively. The effectiveness of control methods increased sharply from 52.141% in 2015 to 90.0% in 2020 with a general average of 72.73%. The quarantine and management protocols of R. ferruginous applied in Qassim decreased the number of palm infestations. Contrary, the intensive use of insecticide in the last two decades promoted genetic mutations within the Rhynchophorus, which led to the emergence of a new species R. bilineatus. This leads to increase pesticide pollution, and control costs and the insect becomes more resistant to pesticides.

Production of high quality biodiesel from novel non-edible Raphnus raphanistrum L. seed oil using copper modified montmorillonite clay catalyst

This study focused on producing high quality and yield of biodiesel from novel non-edible seed oil of abundantly available wild Raphnus raphanistrum L. using an efficient, recyclable and eco-friendly copper modified montmorillonite (MMT) clay catalyst. The maximum biodiesel yield of 83% was obtained by base catalyzed transesterification process under optimum operating conditions of methanol to oil ratio of 15:1, reaction temperature of 150 °C, reaction time of 5 h and catalyst loading of 3.5%. The synthesized catalyst and biodiesel were characterized for their structural features and chemical compositions using various state-of-the-art techniques, including x-ray diffraction, scanning electron microscopy, energy dispersive x-ray spectroscopy, Fourier transform infrared spectroscopy, nuclear magnetic resonance (¹H, ¹³C) and gas chromatography-mass spectroscopy. The fuel properties of the biodiesel were estimated including kinematic viscosity (4.36 cSt), density (0.8312 kg/L), flash point (72 °C), acid value (0.172 mgKOH/g) and sulphur content (0.0002 wt.%). These properties were compared and found in good agreement with the International Biodiesel Standards of American (ASTM-951, 6751), European Committee (EN-14214) and China GB/T 20828 (2007). The catalyst was re-used in five consecutive transesterification reactions without losing much catalytic efficiency. Overall, non-edible Raphnus raphanistrum L.. seed oil and Cu doped MMT clay catalyst appeared to be highly active, stable, and cheap contenders for future biofuel industry. However, detailed life cycle assessment (LCA) studies of Raphnus raphanistrum L. seed oil biodiesel are highly recommended to assess the technical, ecological, social and economic challenges.

CO2 utilization: Turning greenhouse gas into fuels and valuable products

This study critically reviews the recent developments and future opportunities pertinent to the conversion of CO₂ as a potent greenhouse gas (GHG) to fuels and valuable products. CO₂ emissions have reached an alarming level of around 410 ppm and have become the primary driver of global warming and climate change leading to devastating events such as droughts, hurricanes, torrential rains, floods, tornados and wildfires across the world. These events are responsible for thousands of deaths and have adversely affected the economic development of many countries, loss of billions of dollars, across the globe. One of the promising choices to tackle this issue is carbon sequestration by pre- and post-combustion processes and oxyfuel combustion. The captured CO₂ can be converted into fuels and valuable products, including methanol, dimethyl ether (DME), and methane (CH₄). The efficient use of the sequestered CO₂ for the desalinization might be critical in overcoming water scarcity and energy issues in developing countries. Using the sequestered CO₂ to produce algae in combination with wastewater, and producing biofuels is among the promising strategies. Many methods, like direct combustion, fermentation, transesterification, pyrolysis, anaerobic digestion (AD), and gasification, can be used for the conversion of algae into biofuel. Direct air capturing (DAC) is another productive technique for absorbing CO₂ from the atmosphere and converting it into various useful energy resources like CH₄. These methods can effectively tackle the issues of climate change, water security, and energy crises. However, future research is required to make these conversion methods cost-effective and commercially applicable.

Untapped renewable energy potential of crop residues in Pakistan: Challenges and future directions

Sustainability in power generation mainly depends on the transition from fossils to sustainable energy resources. Biomass from the crop residue has huge potential for renewable power generation, but it is still not utilized to its full potential. This study presents a comprehensive methodology to evaluate and forecast the current and future availability of selective crop residue to generate renewable energy. A forecast model incorporating historical trends in the crop yield has been developed in MATLAB and implemented for crop residue based biomass resource assessment of five primary crops (wheat straw, rice husk, rice straw, cotton straw, corn stover, and bagasse) in order to estimate the energy generation potential for Pakistan from 2018 till 2035. It was found that about 40 million tonnes of crop residue was available in Pakistan for power generation in the year 2018 considering a residue removal (availability) factor of 50%. This translates to an estimated potential of about 11,000 MW of electricity generation capacity using crop residue derived biomass for 2018. This capacity is predicted to gradually increase up to 16,000 MW by the year 2035 based on the trends in the growth of crop production since 2001. The suitability of a potential region for the installation of 100 MW biomass-fired power plants was also assessed by calculating crop residue density and an equivalent collection radius (R_e) of 50 km (km). Punjab province of Pakistan, being an agricultural province, with relatively better road infrastructure can sustain crop residue based power plants of up to 7000 MW cumulative capacity at various locations. The challenges, such as economic, logistics, regulatory and political barriers, in generating renewable energy from biomass along with their potential solutions were also discussed. The study also provides a baseline for future research to evaluate and forecast the growth in bio-power generation potential of any biomass resource in a region based on crop yield and area of the region.

Domination of Filamentous Anoxygenic Phototrophic Bacteria and Prediction of Metabolic Pathways in Microbial Mats from the Hot Springs of Al Aridhah

Microbial mats in hot springs form a dynamic ecosystem and support the growth of diverse communities with broad-ranging metabolic capacity. In this study, we used 16S rRNA gene amplicon sequencing to analyse microbial communities in mat samples from two hot springs in Al Aridhah, Saudi Arabia. Putative metabolic pathways of the microbial communities were identified using phylogenetic investigation of communities by reconstruction of unobserved states (PICRUSt). Filamentous anoxygenic phototrophic bacteria associated with phylum Chloroflexi were abundant (> 50 %) in both hot springs at 48 °C. Chloroflexi were mainly represented by taxa Chloroflexus followed by Roseiflexus. Cyanobacteria of genus Arthrospira constituted 3.4 % of microbial mats. Heterotrophic microorganisms were mainly represented by Proteobacteria, Actinobacteria, Bacteroidetes, and Firmicutes. Archaea were detected at a lower relative abundance (< 1 %). Metabolic pathways associated with membrane transport, carbon fixation, methane metabolism, amino acid biosynthesis, and degradation of aromatic compounds were commonly found in microbial mats of both hot springs. In addition, pathways for production of secondary metabolites and antimicrobial compounds were predicted to be present in microbial mats. In conclusion, microbial communities in the hot springs of Al Aridhah were composed of diverse bacteria, with taxa of Chloroflexus being dominant.

Development of novel MnO2 coated carbon felt cathode for microbial electroreduction of CO2 to biofuels

Fabrication of superior and cost-effective cathodic materials is vital in manufacturing sustainable microbial electrolysis cells (MECs) for biofuels production. In the present study, a novel manganese dioxide (MnO₂) coated felt cathode (Mn/CF) has been developed for MECs using electrodeposition method via potentiostat. MnO₂ is considered to encourage exogenous electron exchange and, in this way, improves the reduction of carbon dioxide (CO₂). MnO₂, as a cathodic catalyst, enhances the rate of biofuel production, electron transfer, and significantly reduces the cost of MECs. A maximum stabilized current density of 3.70 ± 0.5 mA/m² was obtained in case of MnO₂-coated Mn/CF based MEC, which was more than double the non-coated carbon felt (CF) cathode (1.70 ± 0.5 mA/m²). The dual chamber Mn/CF-MEC achieved the highest production rate of acetic acid (37.9 mmol/L) that was significantly higher (43.0%) in comparison to the non-coated CF-MEC. The cyclic voltammograms further verified the substantial enhancement in the electron transfer between the MnO₂ coated cathode and microbes. The obtained results demonstrate that MnO₂ interacted electrochemically with microbial cells and enhanced the extracellular electron transfer, therefore validating its potential role in biofuel production. The MnO₂ coated CF further offered higher electrode surface area and better electron transfer efficiency, suggesting its applicability in the large-scale MECs.

CO2 capture and storage: A way forward for sustainable environment

The quest for a sustainable environment and combating global warming, carbon capture, and storage (CCS) has become the primary resort. A complete shift from non-renewable resources to renewable resources is currently impossible due to its major share in energy generation; making CCS an imperative need of the time. This study, therefore, aims to examine the reckoning of carbon dioxide (CO₂), measurement methods, and its efficient capture and storage technologies with an ambition to combat global warming and achieve environmental sustainability. Conventionally, physical, geological and biological proxies are used to measure CO₂. The recent methods for CO₂ analyses are spectrometry, electrochemical gas sensors, and gas chromatography. Various procedures such as pre, post, and oxyfuel combustion, and use of algae, biochar, and charcoal are the promising ways for CO₂ sequestration. However, the efficient implementation of CCS lies in the application of nanotechnology that, in the future, could provide a better condition for the environment and economic outlooks. The captured carbon can be stored in the earth crust for trillions of years, but its leakage during storage can raise many issues including its emissions in the atmosphere and soil acidification. Therefore, global and collective efforts are required to explore, optimize and implement new techniques for CCS to achieve high environmental sustainability and combat the issues of global warming.

Waste to biodiesel: A preliminary assessment for Saudi Arabia

This study presents a preliminary assessment of biodiesel production from waste sources available in the Kingdom of Saudi Arabia (KSA) for energy generation and solution for waste disposal issues. A case study was developed under three different scenarios: (S1) KSA population only in 2017, (S2) KSA population and pilgrims in 2017, and (S3) KSA population and pilgrims by 2030 using the fat fraction of the municipal solid waste. It was estimated that S1, S2, and S3 scenarios could produce around 1.08, 1.10 and 1.41 million tons of biodiesel with the energy potential of 43423, 43949 and 56493 TJ respectively. Furthermore, annual savings of US $55.89, 56.56 and 72.71 million can be generated from landfill diversion of food waste and added to the country's economy. However, there are challenges in commercialization of waste to biodiesel facilities in KSA, including waste collection and separation, impurities, reactor design and biodiesel quality.

Plastic waste to liquid oil through catalytic pyrolysis using natural and synthetic zeolite catalysts

This study aims to examine the catalytic pyrolysis of various plastic wastes in the presence of natural and synthetic zeolite catalysts. A small pilot scale reactor was commissioned to carry out the catalytic pyrolysis of polystyrene (PS), polypropylene (PP), polyethylene (PE) and their mixtures in different ratios at 450°C and 75min. PS plastic waste resulted in the highest liquid oil yield of 54% using natural zeolite and 50% using synthetic zeolite catalysts. Mixing of PS with other plastic wastes lowered the liquid oil yield whereas all mixtures of PP and PE resulted in higher liquid oil yield than the individual plastic feedstocks using both catalysts. The GC-MS analysis revealed that the pyrolysis liquid oils from all samples mainly consisted of aromatic hydrocarbons with a few aliphatic hydrocarbon compounds. The types and amounts of different compounds present in liquid oils vary with some common compounds such as styrene, ethylbenzene, benzene, azulene, naphthalene, and toluene. The FT-IR data also confirmed that liquid oil contained mostly aromatic compounds with some alkanes, alkenes and small amounts of phenol group. The produced liquid oils have high heating values (HHV) of 40.2-45MJ/kg, which are similar to conventional diesel. The liquid oil has potential to be used as an alternative source of energy or fuel production.

Waste biorefineries: Enabling circular economies in developing countries

This paper aims to examine the potential of waste biorefineries in developing countries as a solution to current waste disposal problems and as facilities to produce fuels, power, heat, and value-added products. The waste in developing countries represents a significant source of biomass, recycled materials, chemicals, energy, and revenue if wisely managed and used as a potential feedstock in various biorefinery technologies such as fermentation, anaerobic digestion (AD), pyrolysis, incineration, and gasification. However, the selection or integration of biorefinery technologies in any developing country should be based on its waste characterization. Waste biorefineries if developed in developing countries could provide energy generation, land savings, new businesses and consequent job creation, savings of landfills costs, GHG emissions reduction, and savings of natural resources of land, soil, and groundwater. The challenges in route to successful implementation of biorefinery concept in the developing countries are also presented using life cycle assessment (LCA) studies.

Biodiesel production potential from fat fraction of municipal waste in Makkah

In the Kingdom of Saudi Arabia (KSA), millions of Muslims come to perform Pilgrimage every year. Around one million ton of municipal solid waste (MSW) is generated in Makkah city annually. The collected MSW is disposed of in the landfills without any treatment or energy recovery. As a result, greenhouse gas (GHG) emissions and contamination of the soil and water bodies along with leachate and odors are occurring in waste disposal vicinities. The composition of MSW shows that food waste is the largest waste stream (up to 51%) of the total generated MSW. About 13% of the food waste consists of fat content that is equivalent to about 64 thousand tons per year. This study aims to estimate the production potential of biodiesel first time in Makkah city from fat/oil fractions of MSW and highlight its economic and environmental benefits. It has been estimated that 62.53, 117.15 and 6.38 thousand tons of biodiesel, meat and bone meal (MBM) and glycerol respectively could be produced in 2014. A total electricity potential of 852 Gigawatt hour (GWh) from all three sources based on their energy contents, Higher Heating Value (HHV) of 40.17, 18.33 and 19 MJ/kg, was estimated for 2014 that will increase up to 1777 GWh in 2050. The cumulative net savings from landfill waste diversion (256 to 533 million Saudi Riyal (SAR)), carbon credits (46 to 96 million SAR), fuel savings (146 to 303 million SAR) and electricity generation (273 to 569 million SAR) have a potential to add a total net revenue of 611 to 1274 million SAR every year to the Saudi economy, from 2014 to 2050 respectively. However, further studies including real-time data about annual slaughtering activities and the amount of waste generation and its management are critical to decide optimum waste management practices based on life cycle assessment (LCA) and life cycle costing (LCC) methodologies.

Influence of temperature and reaction time on the conversion of polystyrene waste to pyrolysis liquid oil

This paper aims to investigate the effect of temperature and reaction time on the yield and quality of liquid oil produced from a pyrolysis process. Polystyrene (PS) type plastic waste was used as a feedstock in a small pilot scale batch pyrolysis reactor. At 400°C with a reaction time of 75min, the gas yield was 8% by mass, the char yield was 16% by mass, while the liquid oil yield was 76% by mass. Raising the temperature to 450°C increased the gas production to 13% by mass, reduced the char production to 6.2% and increased the liquid oil yield to 80.8% by mass. The optimum temperature and reaction time was found to be 450°C and 75min. The liquid oil at optimum conditions had a dynamic viscosity of 1.77mPas, kinematic viscosity of 1.92cSt, a density of 0.92g/cm³, a pour point of -60°C, a freezing point of -64°C, a flash point of 30.2°C and a high heating value (HHV) of 41.6MJ/kg this is similar to conventional diesel. The gas chromatography with mass spectrophotometry (GC-MS) analysis showed that liquid oil contains mainly styrene (48%), toluene (26%) and ethyl-benzene (21%) compounds.

EVALUATION OF DRUG ADVERTISEMENTS IN A MEDICAL JOURNALThough ideally the scientific information provided by pharmaceutical companies in drug advertisements should be for promotion of rational use of drugs, this objective is rarely achieved, as often the d

Though ideally the scientific information provided by pharmaceutical companies indrug advertisements should be for promotion of rational use of drugs, this objective israrely achieved, as often the data is incomplete and biased. Analytical studies withthe help of standard indicators on this aspect of drug advertisements are very fewfrom developing countries. We analyzed all medical drug advertisements in elevenconsecutive issues of Journal of Nepal Medical Association published between 1993and 1996 with a special emphasis on their conformity with WHO guidelines andInternational Federation of Pharmaceutical Manufacturers Association (IFPMA) codefor drug advertisement.The 78 advertisements in the Journal of Nepal Medical Association constituted 7.7%pages of the eleven issues. Of the 38 products advertised, 30 (79%) were manufacturedoutside Nepal. Antimicrobial agents were the most frequently advertised group ofdrugs (47.4%). While generic name was not mentioned in 16.7% of the advertisements,the information on indications, adverse effects and contra-indications was lacking in37%, 88.4% and 87.1% of the advertisements respectively. Only 11.5% ofadvertisements provided information on generic name, indications, dosage, adverseeffects and contra indications. However, none of the advertisement was "complete"on the basis of the indicators of WHO guidelines and IFPMA codes.Key Words: Medical drug advertisement, drug information, WHO guidelines, IFPMA code.

Selective criteria for differential diagnosis of infants with symptoms of congenital heart disease

147 case records of infants referred to the Brompton Hospital in the first year of life with a provisional diagnosis of congenital heart disease were examined. Statistical analyses were performed to evaluate selective criteria for the allocation of these infants into a group with lung disease, or into 1 of 5 major haemodynamic groups--namely, acyanotic, complete transposition of the great arteries, pulmonary outflow tract obstruction, common mixing situations, or hypoplastic left heart syndrome. Arterial PO2 in high oxygen concentration, cardiothoracic ratio, and pulmonary vascular markings on the admission chest x-ray; respiratory rate; P-wave morphology, the electrical sign of the T-wave in lead V4R, and the presence or absence of Q-waves in leads V4R and v6 on the electrocardiogram were significant. A decision tree for the differential diagnosis of infants with suspected congenital heart disease into 5 haemodynamic groups and a group with lung disease is presented, and its predictive value is assessed.