Possible role of pseudoephedrine and other over-the-counter cold medications in the deaths of very young children

The Philadelphia Medical Examiners Office has reported a series of 15 deaths between February 1999 and June 2005 of infants and toddlers 16 months and younger in which drugs commonly found in over-the-counter (OTC) cold medications were present. A total of 10 different drugs were detected: pseudoephedrine, dextromethorphan, acetaminophen, brompheniramine, carbinoxamine, chlorpheniramine, ethanol, doxylamine and the anticonvulsants, phenobarbital, and phenytoin. The drugs were confirmed and quantified by gas chromatography (GC)-mass spectrometry, with the exception of ethanol, which was analyzed by headspace GC and of phenobarbital and phenytoin that were quantified by GC with a nitrogen phosphorus detector. The most predominant drug was pseudoephedrine, which was found in all of the cases (blood concentration, n=14, range=0.10-17.0 mg/L, mean=3.34 mg/L) and was the sole drug detected in three cases. Acetaminophen was detected in blood from each of the five cases with sufficient sample. Other drugs (with frequency of detection) were dextromethorphan (five cases), carbinoxamine (four cases), chlorpheniramine (two cases) and brompheniramine, doxylamine, and ethanol (one case each). In the majority of the cases, toxicity from drugs found in easily available OTC medications was listed either as the direct cause of death or as a contributory factor. The manner of death was determined to be natural in only two of the cases. This postmortem study supports previous evidence that the administration of OTC cold medications to infants may, under some circumstances, be an unsafe practice and in some cases may even be fatal. The treating physicians and the general public need to be made more aware of the dangers of using OTC cold medications to treat very young children so that these types of tragedies might be avoided.     

Government survival in semi‐presidential regimes

As semi‐presidentialism has become increasingly common in European democracies, so have the debates about the consequences of several of its political and institutional features. In particular, in those regimes, cohabitation between presidents and cabinets of different parties and cabinet dismissal powers on the part of presidents are thought to be a source of inter‐branch conflict and government instability. However, so far, most empirical work on government survival has failed to confirm any of these expectations. This article addresses this disjuncture between theory and empirical results by making a twofold contribution. First, it takes into account the internal diversity within semi‐presidentialism, modeling the implications for government survival of different configurations between presidential powers’ of cabinet dismissal, parliament dissolution and cohabitation in European semi‐presidential systems. Second, it reconsiders traditional government survival using the competing risks framework by adding a distinction between two different types of non‐electoral replacement: those where replacements imply a change in the party of the prime minister and those where they do not. Once such an approach is adopted, that presidential powers of parliamentary dissolution and cabinet dismissal indeed emerge as highly relevant for explaining government survival in these regimes.