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.     

The New Mode of Public Governance and Public Accountability in Developing Countries: An Analysis with Particular Reference to Bangladesh

Public accountability is a fundamental element of good governance. All countries all over the world strive to ensure the accountability of public officials by adopting different kinds of mechanisms. Following the liberal democratic tradition, most countries in the world have relied on the legislative instruments, executive means, judicial and quasi-judicial processes, official rules, codes of conducts, official hierarchies, public hearings, interest groups, media scrutiny and so forth for ensuring public accountability. However, in recent years, the new mode of public governance has brought new dimensions to the discourse on public accountability. This new mode focuses largely on the market- and society-centered mechanisms. This article is an attempt to assess the effectiveness of these market- and society-centered mechanisms in ensuring public accountability in Bangladesh. The article has the following objectives:

(a) to explore contemporary debates on the market- and society-centered mechanisms of public accountability;

(b) to sketch the state of public accountability in Bangladesh; and

(c) to analyze the effectiveness of the market- and society-centered mechanisms in view of the contemporary socio-economic and political dynamics of Bangladesh.     

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.     

Pesticide mortality. A Jordanian experience

During the 13-year period of 1973-1985, at least 329 deaths in Jordan resulted from poisoning by pesticides. Organophosphates were the major compounds incriminated in 93.6% of the cases. The annual mortality rate compared with that of other countries is relatively high, and was 5.97%, 17.35%, and 2.6% per 1 million people in 1973, 1979, and 1985, respectively. The annual mortality rates due to suicidal and accidental poisoning are 61% and 35.3%, respectively: 74% of the accidentally poisoned group are children less than 10 years, while 60.7% of the suicides are 15-24 years of age. To minimize such high mortality rates from pesticide poisoning, Jordan needs to adopt more protective measures by rigorous regulation.     

Sites and services schemes in Dacca: A critique

This paper presents a critical analysis of two sites and services projects in Dacca, in the light of previous studies of low income housing. The analysis demonstrates that resource limitation is not the most important factor preventing resolution of the low-income housing problem, that there is a perverse use of resources which makes the situation worse, and that this use continues because it is in the pecuniary interest of the dominant interest group. The conclusions drawn are far from optimistic: (a) without radical changes in the main direction of resource allocation, there exists little or no possibility for an improvement in the living conditions of poor families; and, (b) the provision of housing for the lowest income group is more a question of political will and social engineering than building technology.     

Empowerment at village level through a workshop method

This article describes the activities and lessons learned of a 2-day workshop held in Sheikhupura District in Punjab, Pakistan. The project aim was to strengthen primary health care and to include the community in health development. The pilot program established Village Health Committees (VHCs) to promote local participation. Villagers decided that VHCs should be representative of the community. The community elected traditional birth attendants, teachers, holy men, and village activists. Workshops were held with VHCs in order to provide basic concepts of community awareness, organization, and development. Each workshop included 3-4 VHCs. Groups were comprised of up to 6 people. Workshops were held near villages and had access to lavatories. The workshop aims were identified throughout individual sessions and linked with each other. Facilitators kept discussions relevant, objective, and interesting. Participants introduced each other, which provided an opportunity to establish comfort and trust. Initial discussions centered on health issues that were introduced as interrelated. The health system issues was related to the village situation. Participants were asked to develop a health system model. The aim of the sessions was to reinforce the importance of the role of community. An exercise was conducted to illustrate the importance of dialogue and collective work. Participants discussed the nature of community organization and means of development, threats to the village, and empowerment. The workshops created awareness of the process of community involvement in development and were ongoing.     

Implementing Change by Continuous Learning: The Public Service Reform Programs in Tanzania

The talk you hear … about adapting to change is not only stupid, it's … dangerous. The only way you can manage change is to create it. By the time you catch up to change, the competition is ahead of you.

Peter Drucker     

What determines public health expenditures in Pakistan? Role of income, urbanization and unemployment

What determines public health care expenditures at the national level is an important policy question. Since the pioneering work of Newhouse (J Hum Resour 12(1):115–125, 1977) on the relationship between health expenditures and national income, this area of economic inquiry has received much attention. This paper seeks an answer to this question by estimating the factors affecting public health expenditures at the national level in Pakistan. This paper uses annual time series data from 1972 to 2009 and employing unit root and Johansen cointegration methods estimated the determinants of public health expenditures. It is estimated that all variables are integrated of order one and are cointegrated hence in a long run relationship. The income elasticity of public health care expenditures is estimated below unity (at 0.26) indicating health care is a necessity in Pakistan contrary to most of the industrialized countries. Furthermore, it is imperative that government have a larger role in allocating and directing public resources to health care in Pakistan. Urbanization and unemployment variables have elasticity values of ?1.33 and ?0.37 respectively, implying that it is costly to provide health care to residents of remote rural areas of Pakistan.     

Mental health and fitness to plead proposals in England and Wales

Proposals to reform fitness to plead legislation have been published by the Law Commission in England and Wales; they include a new test of decision making capacity and a new psychiatric test that has yet to be fully developed. Although proposals have met with some support, there have also been detractors. The history of fitness to plead is reviewed and current case law (including the 1836 Pritchard criteria) is examined. Although existing arrangements have been criticised, this may be attributable to inconsistent practical application, rather than inherent conceptual flaws. The Pritchard test has largely stood the test of time and has emerged relatively unscathed. Fitness to plead is not a medical construct, but rather a legal entity and any new test would be likely to introduce its own difficulties. A capacity based assessment could enhance debate and disagreement and increase court time in many cases, presenting new resource implications with questionable benefit. As the existing Pritchard criteria, amended by case law, already include a five limb test that closely resembles a capacity assessment (ability to plead to the indictment, to understand the course of the proceedings, to instruct a lawyer, to challenge a juror and to understand the evidence) and given the difficulties in introducing a functional test format in other jurisdictions, the Law Commission's proposals should now be set aside, perhaps for another day: reconsideration may be possible some decades hence, pending enhanced scientific developments within psychiatry and better understanding of the mind.