Fatal Intoxications Due to Administration of Isosorbide Tablets Contaminated with Pyrimethamine

In January 2012, 664 cases of pyrimethamine toxicity and 151 deaths were reported among cardiac patients that had recently received free medicines from pharmacy of Punjab Institute of Cardiology, Lahore, Pakistan. These patients, ages ranged from 58 to 75 years, were prescribed simvastatin, clopidogrel, aspirin soluble, isosorbide mononitrate, and amlodipine. On examination of medications being given to them, it was found that a particular batch of isosorbide mononitrate tablets was contaminated with 50 mg pyrimethamine. Cardiac patients were taking isosorbide contaminated with pyrimethamine twice daily (100 mg pyrimethamine/day), whereas therapeutic dose of pyrimethamine for malaria is 25 mg/week. Postmortem urine, cardiac blood, and femoral blood specimens of three deceased males were submitted to author's laboratory for analysis. Postmortem toxicological analysis revealed that pyrimethamine concentration fell within the range of 1–10 μg/mL by liquid chromatography. Clinical, autopsy, histopathological, and toxicological findings strongly suggested toxicity due to pyrimethamine accumulation that resulted in deaths of these cardiac patients.     

Development of Rapid and Economical Colorimetric Screening Method for p‐Phenylenediamine in Variety of Biological Matrices and its Application to Eleven Fatal Cases of p‐Phenylenediamine Poisoning

A rapid colorimetric method for detection of p‐phenylenediamine (PPD) in various biological samples is developed. The o‐cresol test for acetaminophen detection has been modified to detect PPD in blood, urine, gastric contents, and liver. After precipitating protein with trichloroacetic acid solution (2 mL, 10% w/v), biological specimens were required to convert PPD metabolites to PPD by acid hydrolysis. Finally, o‐cresol solution (1 mL, 1% w/v), hydrogen peroxide (200 μL, 3%v/v), and concentrated ammonium hydroxide (0.5 mL) were added in the biological samples. The presence of PPD was indicated by formation of violet color which was turned to bluish green color within 10–15 min. The limit of detection was found to be 2 mg/L in blood, urine, and gastric contents and 2 mg/Kg in liver. This method is also free from any potential interference by p‐aminophenol, acetaminophen, and other amine drugs under test conditions. This method was successfully employed to thirteen fatal cases of PPD poisoning.     

Conciliation Ethics in the Qurʾan

The concept of Conciliation Ethics in the Qur?an is a crucial aspect of Islamic Law: Conciliation features notably in the Qur?anic text which gives rise to Islamic rules and regulations, Conciliation is an important dispute resolution method in an Islamic legal system, and Conciliation-related Qur?anic textual analysis reveals a broad range of legal language and concepts. Traditional studies of Conciliation in the Qur?an have often focussed on the process of ?ul? (Reconciliation) through intermediaries, particularly in marriage and between groups of Muslims, whilst there is a dearth of Western scholarship in this area. Using Classical Arabic tafsīr (exegesis) and Western literature on Conciliation as a general concept, this paper examines holistically and analytically the concept of Conciliation Ethics in the Qur?an, investigating its scope, constituent elements, emphasis and purpose. This paper argues, based on a manual survey of the entire Qur?an, that Conciliation is not limited to isolated contexts or verses where ?ul? is mentioned explicitly. The paper finds that Conciliation is a pervasive concept throughout the hierarchy of social relationships. It is achieved through behaviours such as good conduct (i?sān), attitudes such as ‘Differentiation’ and ‘Externalisation’ and preventative strategies of dispute avoidance, and sometimes includes a contract or Reconciliation process. It is emphasised in the Qur?an through a range of stylistic features and is of fundamental importance in maintaining the fabric of society.