Wednesday 30 November 2011

Emedinews:Insights on Medicolegal issues: Forensic anatomy and importance of larynx in postmortem examination


• The larynx consists of a large ‘V’-shaped thyroid cartilage. Below the smaller cricoid cartilage, at the upper margin of the posterior wing of the thyroid on each side, are the superior horns or ‘cornuae’, which are connected by the thyrohyoid membrane to the greater horns of the hyoid bone, which lies immediately above.
• The hyoid bone lies at the root of the tongue. The hyoid calcifies at variable times; the body is usually calcified, but the horns may calcify irregularly, both in space and time. In teenagers and young adults they are usually cartilaginous and the joints mobile.
• In middle and later life, the hyoid and thyroid horns calcify and become more brittle.
• The cricoid cartilage is a modified upper tracheal ring but can also become partly calcified as age increases.
• No meaningful ages can be placed on any calcification, but traumatic fractures can occur at any time except in children and most teenagers.
• The pressure is mainly bilateral, so that the sides of the larynx are squeezed. Particularly vulnerable structures are the four ‘cornuae’ or horns, which protect backwards to maintain the patency of the airway around the glottis
• Lateral pressure of the fingers can displace any of the four horns inwards, either by direct pressure or by pressure on the thyrohyoid membrane, which then drags the horns medially. In young persons, the horns are so pliable that they return to their normal position on release of the pressure but, variably beyond the third decade, they may be sufficiently calcified to fracture.
• Though the hyoid bone has received most attention in publications as being the marker of violence to the larynx, in fact the thyroid horns are far more vulnerable. Simpson (1985) found that, in 25 successive deaths from manual strangulation, there were 22 fractures of thyroid horns but only one fractured hyoid.


Emedinews:Makesure:A patient with pyogenic meningitis developed complications.

Situation: A patient with pyogenic meningitis developed complications.
Reaction: Oh my God! Why were antibiotics not given when the meningitis was suspected?
Lesson: Make sure that first dose of antibiotics is given at the time meningitis is suspected.

Emedinews:Inspiration:The Challenge

It was decided that we would enter our first sports race or challenge as it was also called. The event was for a really good cause and sounded like a great idea. We would all train accordingly in preparation for the big day. A 60-mile course consisting of three paddling legs, two cycling segments and two running courses lied ahead. We decided which part of the race each of us would complete and recruited a driver for our team.

We came up with a team name, and so we had the birth of the Warren Street Rat Pack. What we might have lacked in physical ability, we would make up in enthusiasm. We arrived at the starting point adorn with our team t-shirts. We looked like true contenders. My teammates left me at the starting line to run my leg of the challenge and headed off to the next checkpoint.

When it was time for the challenge to begin, I joined the large group of runners at the starting line. I observed some of the runners stretching, some walking in circles nervously and decided to converse with a small group who chattered and laughed non-stop while waiting for the race to begin. I have never been in a race before; the excitement of taking off swept me away. People lined that streets and were cheering. I stuck with the group of runners until I realized I was completely out of breath and was running at speed that was twice as fast as I had ever gone before.

(Contributed by Ms Ritu Sinha)

I managed to finish my leg in the time that I had hoped for, with only two runners finishing behind me. My team cheered me on as if I was the first to cross the line and I felt like a champion. It was time to pass the baton to our next team member who would embark on his first kayak ride since he attended summer camp as a boy.
With the completion of each leg of the race, our team members applauded wildly and acknowledged success for the person who just finished their turn. I am sure the spirit of our team was lifted a bit higher when one our teammates took off with a giant smile while ringing the bell on her three-speed bike. We all followed her in the car for a bit, laughing as we watched her emanating joy with her smile; waving to every person she passed by.

The first place team had long since passed the finish line, the check in points were being dismantled, and the big celebration party had already kicked off when we had one last kayak route to complete. Now on his second kayak ride since attending summer camp as a boy, our finish line team member set off to complete the challenge for our team. We did our best to stay close enough to him, so that he could hear us rooting for him. Our excitement level was high, as we were about to complete our first sports race, or challenge as it was also called.
At last we helped our kayaker to pull the boat ashore after he crossed the finish line. Jumping up and down, hugging one another, offering raised hands welcoming the high-fives, we had finished. The encouragement we gave to each other, the laughter we shared and the way we embraced each part of the journey put us on a winning team, which by the way came in last.

We all agreed to enter the Greenway Challenge together again this year. Although we have considered making some changes in our strategy looking back, perhaps we shouldn't change a thing.

Tuesday 29 November 2011

Emedinews:Insights on Medicolegal issues:Medical Testimony of Doctor in the Court of law

The doctor should acquire the habit of making a careful note of all the facts observed by him. Vagueness and theory have no place in legal medicine. He should examine the facts which come to his knowledge in his special capacity, draw his conclusions logically and correctly after a detailed consideration of the pros and cons of the case, and indicate to the Court that interpretation, along with the grounds on which it is based. Presumption is not proof, and conjecture is not evidence. The Court has no special medical knowledge. It relies on medical witness for an opinion and expects him to assist it with his special knowledge and experience in perusal of truth.

Emedinews:Makesure:A foreigner with two loose motions developed sepsis.

Situation: A foreigner with two loose motions developed sepsis.
Reaction: Oh my God! Why was antibiotic not started early.
Lesson: Make sure that all cases of travelers' diarrhea (foreigners) are treated with antibiotics.

Emedinews:Inspiration:The Carpenter

Once there was an elderly carpenter who was ready to retire. He told his employer-contractor of his plans. To leave the house building business and live a more leisurely life with his wife enjoying his extended family. He would miss the paycheck, but he needed to retire. They could get by. The contractor was sorry to see his good worker go and asked if he could build just one more house as a personal favor.

The carpenter said yes, but in time it was easy to see that his heart was not in his work. He resorted to shoddy workmanship and used inferior materials. It was an unfortunate way to end his career.

When the carpenter finished his work and the builder came to inspect the house. The contractor handed the front-door key to the carpenter. "This is your house," he said, "my gift for your retirement as a token of my appreciation." What a shock! What a shame! If he had only known he was building his own house. He would have done it all so differently. Now he had to live in the home he had built none too well.

So it is with us. We build our lives in a distracted way, reacting rather than acting, willing to put up less than the best. At important points we do not give the job our best effort.

Then with a shock we look at the situation we have created and find that we are now living in the house we have built. If we had realized that we would have done it differently.

Think of yourself as the carpenter. Think about your house. Each day you hammer a nail, place a board, or erect a wall. Build wisely. It is the only life you will ever build. Even if you live it for only one day more, that day deserves to be lived graciously and with dignity.

The plaque on the wall says, "Life is a do-it-yourself project." Your life tomorrow will be the result of your attitudes and the choices you make today.


Monday 28 November 2011

Emedinews:Insights on Medicolegal issues:WMA non-therapeutic Biomedical Research guidelines Involving Human Subjects


The WMA standards have been drafted only as a guide to Doctors/physicians all over the world. Doctors are not relieved from criminal, civil and ethical responsibilities under the laws of land applicable to them.

• All precautions should be taken to respect the privacy of the subject and to minimize the impact of the study on the subject’s physical and mental integrity/health.
• In the purely scientific application of medical research carried out on a human being, it is the duty of the doctor to remain the protector of the life and health of that person on whom biomedical research is being carried out.
• The subjects should be volunteers, either healthy persons or patients for whom the experimental design is not related to the patient’s illness.
• The investigator or the investigating team should discontinue the research if in his/her or their judgment it may, if continued, be harmful to the individual.
• In research on man, the interest of science and society should never take precedence over considerations related to the wellbeing of the subject.

(Ref: 18th World Medical Assembly, Helsinki, Finland, 1964 and revised by the 29th World Medical Assembly, Tokyo, Japan, 1975)

Emedinews:Makesure:A 10-day-old neonate developed purulent conjunctival discharge. On history, it was found that mother had had repeated episodes of PID.

Situation: A 10-day-old neonate developed purulent conjunctival discharge. On history, it was found that mother had had repeated episodes of PID.
Reaction: Oh my God! You should have treated the mother with azithromycin for Chlamydia trachomatis infection.
Lesson: Make sure to remember that C. trachomatis infection is effectively treated with single dose of 1 g azithromycin.

Emedinews:Inspiration:The Bird Feeder



Last fall, I hung outside my window a bird feeder. Now not knowing the first thing about wild birds, I assumed that as soon as I hung this bird feeder outside, a multitude of beautiful birds would be swooping to my new addition. Days, weeks and months went by; NO BIRDS.
I asked so many people what to do? What was I doing wrong? "Nothing" most of them replied. "Just wait." So I waited and waited and waited trying everything possible, to attract these birds.
I cleaned off the deck, I changed the feed, I washed the feeders, I even made the cat go out the other door! But nothing seemed to work. So......I waited, "with patience and hope."
Two months later, on a Saturday afternoon, I FROZE! What to my eyes had appeared on the bird feeder but the most beautiful bird I have ever seen in my life! All of a sudden HUNDREDS UPON HUNDREDS OF BIRDS WERE APPEARING FROM EVERYWHERE!
What a beautiful lesson I learned from this little creature. "Patience and hope" and "things" will attract the beautiful things in life. I never realized how much patience I really do have and how much I do rely upon "hope" to sort out the questions in my heart.
So I keep hoping and waiting, waiting and hoping. I will try to use this "little lesson" with so many other things in my life. I guess "patience is a virtue" after all.

Saturday 26 November 2011

Emedinews:Insights on Medicolegal issues:Forceful/Artificial feeding and hunger strike-what is the role of doctor?


 

It has been observed that generally the hunger strikers do not wish to die but it cannot be ruled out that some may be prepared to do so to achieve their aims. The doctor needs to ascertain the individual's true intention, especially in collective strikes or situations where peer pressure may be a factor. An ethical dilemma for doctor arises when hunger strikers who have apparently issued clear instructions/consent not to be resuscitated or even medically intervened, reach a stage of cognitive impairment. The principle of beneficence urges physicians to resuscitate them but respect for individual autonomy restrains physicians from intervening when a valid and informed refusal has been made. An added difficulty arises in custodial settings because it is not always clear whether the hunger striker's advance instructions were made voluntarily and with appropriate information about the consequences. I too was faced with such a dilemma in the case of Medha Patekar hunger strike case at Jantar Mantar in Delhi. Such situations are resolved in India by police by arresting the hunger striker/s under Section 309 IPC for committing suicide and the doctor can treat the person to save his/her life as a legal obligation with ethical precaution that it should be restricted and limited only for life saving.

Emedinews:Makesure: A patient on 10 units of insulin developed hypoglycemia after taking light breakfast.

Situation: A patient on 10 units of insulin developed hypoglycemia after taking light breakfast.
Reaction: Oh my God! Why was the insulin dose not reduced?
Lesson: Make sure that insulin dose is correct. The formula is 500/total daily dose. The value will be the amount of sugar fluctuation with ten grams of carbohydrates.

Emedinews:Inspiration:What is it that's hard to break?

What is it that's hard to break?
Diamonds are hard to find but not hard to Break. What is the hardest thing to break then?
The answer is: HABIT!

If you break the H, you still have A BIT.
If you break the A, you still have BIT.
If you break the B, you still have IT!
Hey, after you break the T in IT, there is still the 'I'.
And that (I) is the root cause of all the problems. Isn’t it right?!
Now you know why HABIT is so hard to break….
Its destiny is in its name!

Emedinews:Insights on Medicolegal issues:Dangerous weapons

• The Section 324 of IPC states that any instrument for shooting, stabbing, cutting or any instrument used as weapons of offence is likely to cause death or by means of fire or any heated substance or by means of poison or any corrosive substance or by means of any explosive or by means of any substance which is deleterious to the human body to inhale, to swallow, or to receive into the blood or by means of any animal will be taken as dangerous weapons.
• The duty of the attending doctor is to record all the injuries, its dimension as far as possible, and the body parts where the injuries are located the nature of injury whether simple or grievous, caused by sharp/blunt object, age or duration of injury and with the vital parameters like blood pressure, pulse respiration with the mental status of the patient.
• The injuries present could be a self-inflicted or fabricated one? if yes please mention the forensic justification
• Are there any signs, symptoms or smell of alcohol or any drug intoxication? If yes, please give your opinion about the mental status due the influence of intoxication. Also, preserve blood sample.
• Please opine if the injured or intoxicated patient is fit for obtaining his statement? If no, please give due reasons and an approximate time interval for medical revaluation for his/her fitness for statement.
• Is the condition of patient is critical, severe or serious? If so, the dying declaration must be recorded by attending doctor before one or two witnesses.


Emedinews:Makesure:A patient on 10 units of insulin developed hypoglycemia after taking light breakfast.

Situation: A patient on 10 units of insulin developed hypoglycemia after taking light breakfast.
Reaction: Oh my God! Why was insulin dose not reduced?
Lesson: Make sure that insulin dose is correct. The formula is 500/total daily dose. The value will be the amount of sugar fluctuation with 10 grams of carbohydrates.

Emdinews: Inspiration:Stay true to your goals

A personal goal or personal goals are yours - they are what you want, not what others want for you. Believe in yourself - you can do anything. See what Jacquie has to say.

The key to being happy is to respect your desire to make your life better by your own choices-even if and, especially when others ridicule them. Do not let the ignorance or the short-sightedness of others redirect your life's goal.

Everyone has their own path to follow-their own map for the future. The key is to understand everyone is different and to respect their goals as well as your own.

Do not accept behavior that goes against your beliefs or wishes, and do not accept behavior from friends, family, or a spouse that you wouldn't accept from a stranger.

Be true to yourself. Stand firm. And, do not postpone your dreams or wishes to please someone else's idea of what it should be...
(Contributed by Ms Ritu Sinha)

Friday 25 November 2011

Emedinews:Insights on Medicolegal issues:Infliction of an injury on human body may precipitate a myocardial infarct

Infliction of an injury on human body may precipitate a myocardial infarct
• The emotional upset produced due to injury, or even the threat of fear of an injury can cause death due to transient hypertension or tachycardia that may precipitate arrhythmia, cerebral or sub-arachnoids bleeding resulting into death
• It has been also seen during postmortem examination that physical effort that damaged a diseased heart when the deceased was performing unaccustomed work led to accidents or other trauma and to the extra physical demands while working with defective equipment.
• A heart attack may occur while a scuffle and fight. The person may sustain simple injury and injury not sufficient to cause death in ordinary course of nature, and the person died due to heart failure.
• This happen due to unusual physical or mental strain precipitating coronary insufficiency.

(Contributed by Dr Sudhir Gupta)

Emedinews: Makesure: A chronic smoker developed cancer of lung.


Situation: A chronic smoker developed cancer of lung.
Reaction: Oh my God! Why was he not screened for the cancer of lung?
Lesson: Make sure all chronic smokers are given an option for lung cancer screening with low dose spiral CT.

Emedinews:Inspiration:Start For Yourself

Start for yourself, Face your greatest fears, and take the new step of faith, because only who can see the invisible, Can do the impossible.

God opens a door before your eyes, it’s up to you to find out. Help yourself and explore the things outside. If only you could see the genuine smile through the eyes of an innocent child that gives you different insight

Sometimes it's better to be like a child They take the challenge of life No matter what comes out You will see them playing around.

If you want to cope-up with your grief, you must help and start for yourself. Minimize your self-centeredness, Maximize your faith and strength for living. Because, you are still alive!

There are more things to explore outside. Even the air you breathed, the voice you've heard, the things you've seen, are enough to analyze, you are still fortunate to be alive! You are blessed to take another day to feel the sun's ray!

Hey, didn't you know that you are nature's greatest miracle?

Thursday 24 November 2011

Emedinews: Insights on Medicolegal issues - Drowning submersion is followed by struggle and subsides with exhaustion

• The survival rate from potentially fatal salt water submersion is about 80% whereas in fresh water it is less than 50%.
• In drowning, breath holding lasts until carbon dioxide accumulation stimulates respiration resulting in inhalation of water.
• Gulping of water, coughing and vomiting is rapidly followed by loss of consciousness. Profound unconsciousness and convulsions are associated with involuntary respiratory movements and the aspiration of water.
• Death within 2 to 3 minutes may be called “Instantaneous deaths" and the death is almost invariable when the period of submersion exceeds 10 minutes.
• There are no pathological findings that are pathognomonic of drowning. Consequently obtaining proof that the victim was alive on entering the water and excluding natural, traumatic and toxicological causes of death are critically important.
• Some pathological changes are characteristic of drowning but the diagnosis is largely one of exclusion. A fine white froth or foam is seen exuding from the mouth and nostrils. The froth is sometimes tinged with blood producing a pinkish color. If the foam is wiped away then pressure on the chest wall will cause more foam to exude from the nostrils and mouth..
• The foam is a mixture of water, air, mucus and possibly surfactant whipped up by respiratory efforts. Thus it is a vital phenomenon and indicates that the victim was alive at the time of submersion

Emedinews:Makesure:A rape victim developed HIV infection.

Situation: A rape victim developed HIV infection.
Reaction: Oh my God! Why was she not given post exposure ART prophylaxis?
Lesson: Make sure all rape victims are counseled for HIV post exposure ART prophylaxis.

Emedinews:Inspiration:Some thing you keep

Some things you keep; like good teeth, warm coats and bald husbands. They're good for you, reliable and practical and so sublime that to throw them away would make the garbage man a thief. So you hang on, because something old is sometimes better than something new, and what you know often better than a stranger.
These are my thoughts. They make me sound old; old and tame and dull at a time when everybody else is risky and racy and flashing all that's new and improved in their lives. New spouses, new careers, new thighs, new lips.
The world is dizzy with trade-ins. I could keep track, but I don't think I want to. I grew up in the fifties with practical parents - a mother, God bless her who washed aluminum foil after she cooked in it, then re-used it- and still does. A father who was happier getting old shoes fixed than buying new ones.
They weren't poor, my parents, they were just satisfied. Their marriage was good, their dreams focused. Their best friends lived barely a wave away.
I can see them now; Fifties couples in Bermuda shorts and Banlon sweaters, lawn mower in one hand, tools in the other. The tools were for fixing things - a curtain rod, the kitchen radio, screen door, the oven door, the hem in a dress. Things you keep.
It was a way of life, and sometimes it made me crazy. All that re-fixing, re-heating, renewing, I wanted just once to be wasteful. Waste meant affluence. Throwing things away meant there'd always be more.
But then my father died, and on that clear autumn night, in the chill of the hospital room, I was struck with the pain of learning that sometimes there isn't any 'more'. Sometimes what you care about most gets all used up and goes away, never to return.
So, while you have it, it's best to love it and care for it and fix it when it's broken and heal it when it's sick. That's true for marriage and old cars and children with bad report cards and dogs with bad hips.
You keep them because they're worth it, because you're worth it. Some things you keep.

Wednesday 23 November 2011

Emedinews:Makesure: A patient with acid peptic disease was denied any painkiller for his distressing illness.

Situation: A patient with acid peptic disease was denied any painkiller for his distressing illness.
Reaction: Oh my God! Why did you not give him nimesulide?
Lesson: Make sure to prescribe nimesulide as it is safe in acid peptic disease.

Emedinews:Inspiration:Peace of mind


Once Buddha was walking from one town to another town with a few of his followers. This was in the initial days. While they were traveling, they happened to pass a lake. They stopped there and Buddha told one of his disciples, I am thirsty. Do get me some water from that lake there.

The disciple walked up to the lake. When he reached it, he noticed that some people were washing clothes in the water and, right at that moment, a bullock cart started crossing through the lake. As a result, the water became very muddy, very turbid. The disciple thought, How can I give this muddy water to Buddha to drink! So he came back and told Buddha, The water in there is very muddy. I don’t think it is fit to drink.

After about half an hour, again Buddha asked the same disciple to go back to the lake and get him some water to drink. The disciple obediently went back to the lake. This time he found that the lake had absolutely clear water in it. The mud had settled down and the water above it looked fit to be had. So he collected some water in a pot and brought it to Buddha.

Buddha looked at the water, and then he looked up at the disciple and said, See what you did to make the water clean. You let it be … and the mud settled down on its own and you got clear water… Your mind is also like that. When it is disturbed, just let it be. Give it a little time. It will settle down on its own. You don’t have to put in any effort to calm it down. It will happen. It is effortless.

What did Buddha emphasize here? He said, It is effortless. Having ‘peace of mind’ is not a strenuous job; it is an effortless process. When there is peace inside you, that peace permeates to the outside. It spreads around you and in the environment, such that people around start feeling that peace and grace.


Tuesday 22 November 2011

Emedinews:Insights on Medicolegal issues:Human body dies in bits and pieces-The clinical death implies the failure of the body as an integrated system.


• After death the life continues in the separate tissues, which constitute the body. These only die after varying periods depending upon the ability of the tissue to function without blood supply.
• This is called molecular or cellular death. The nervous tissue dies rapidly and the vital centers die in about 5 minutes. The muscle live longer and they will constrict to direct electrical stimuli up to 3 hours. The corneal reflex and papillary reflex disappear at the time of death.
• The pupil reacts to the drugs like atropine that causes dilatation up to 1 hour. The cornea can be removed for transfused for up to 6 hours and blood can be transfused for up to 6 hours of death. Therefore, we die in bits and pieces.
• The legal definition of death depends upon the diagnosis of somatic death. The distinction between somatic and molecular death becomes important because in order to remove essential tissues and organs for transplantation there is a relatively short time for the biological properties of living matter to persist after somatic death. With somatic death, there is complete generalized anoxia of the tissue and consequently stoppage of metabolic process carried out by the tissue cells.
• The metabolic process of the ganglionic cells stops in minutes, which are most sensitive whereas that of connective tissue stops in hours, which are the least sensitive.
(Reference Dr. PC Dikshit Head (MAMC) MD LLB, Textbook of forensic medicine, Peepe Publisher)

(Contributed by Dr Sudhir Gupta)

Emedinews:Makesure: A patient died after consuming six pegs of alcohol.

Situation: A patient died after consuming six pegs of alcohol.
Reaction: Oh my God! why was he allowed to consume six pegs?
Lesson: Make sure that no patient is allowed binge alcohol i.e. consuming more than six pegs in a day or five pegs at a time.

Emedinews:Inspiration:Small victories

Standing in the noisy cafeteria of the old school, I was watching the students line up for lunch. Having wearied of trying to "cut" in line on each other, they were intently moving toward the food. As I continued to watch their progress, I began to remember scenes from my own grade school days. This old school building was somewhat similar to mine.
I could still remember coming into the warm building with the funny smells of furnace heat and cleaning liquids. I visualized the rooms, heated with old-fashioned steam pipe radiators and the hand-turn heat regulators. I could picture the Spartan desks in long straight rows, with scratched and scared surfaces, and the small cloak closets with wood doors folding in along the back of the room. “Teacher," a small hand tugged my wrist, "I can't eat my lunch," complained a small Asian American boy, standing behind me. My thoughts abruptly returned to the present in the cafeteria of the old school where I was substitute teaching. “What’s wrong?" I replied as I watched the last of the lunch line disappear into the kitchen. "Why not?" I asked as I turned to face the cafeteria at large.
"Jamal and Anthony keep poking at my food. I don't want to eat it!” Making my way to his lunch table, I took up Lee's cause. I admonished the children, "Keep your hands to yourselves and eat properly!"
My repeated warnings went unheeded, and I began to move the children to different spots at the table. To no avail--as soon as Lee sat down, the pestering began again. As the hearty children began finishing their food, I urged Lee to go back to the kitchen to get a second lunch, promising I would speak to the cooks for him. When I went out to playground duty, he was still sitting in front of his second tray, picking at the food. I tried not to worry about the thin child because I remembered that I had not always eaten my cafeteria lunches and I survived. I substituted frequently at this school, and in a few weeks, I was back in Lee's small class. Both the teacher and the assistant were absent. The children in this room had some learning difficulties, and each child had different instructions and activities. I soon realized that Lee had a problem with staying on task and with anger. As I moved through the room, I stopped by each child to check on progress and to help with work. Lee was working with educational coloring sheets, and I let him work on his pictures in sequence rather than finishing one at a time. Doing a part of each until all were completed seemed to suit his temperament. He began to smile as if he and I shared a huge joke. This time, I did not have lunch duty, so I lined the children up and led them to the cafeteria where another teacher took charge of their progress through the line. I went back to the room to check each child's work again and eat a quick sandwich. In fifteen minutes, Lee was back in the room, unable to eat lunch again, having left the cafeteria without permission. I gave him some money, the cost of an alternate lunch, and walked him down to the cafeteria. At the end of lunch, Lee was back in the room with the young man assigned to the room as psychological counselor. Evidently, a cafeteria supervisor sent him to be counseled about his difficulties with eating.
Slowly, with shyness and pride, he handed me my money back and told me what he and the counselor had rehearsed. "Thank you, Mrs. Grishan (his pronunciation), but my mom and dad will not let me accept money. They provide my food." I smiled, accepted the money, and watched Lee go with the counselor for further discussion. When he returned, the counselor stayed with him to keep him sweet and on task.
Later in the year, I was back at the same school to substitute with a large fourth grade class for a week. The day I had lunch duty, I noticed as I glanced quickly around the cafeteria that Lee's table was at peace. They were eating quietly and were not teasing each other. Lee was eating too, and as he looked at me intensely, I glanced away because I did not want to interfere with his concentration on his food. I know, though, that I was smiling, and my heart was singing. I thought of the phrase, "all the little children of the world, brown and yellow, black and white," and these precious children were all getting along just fine. I knew that major work by persistent teachers, a dedicated counselor, fine administrators, and parents willing to partner with the school had wrought a change in the life of these troubled children.
(Contributed by Ms Ritu Sinha)

Monday 21 November 2011

Emedinews:Insights on Medicolegal issues:Embalming


• Embalming is the process of chemically treating a dead body, developed by the ancient Egyptians, to preserve a person's body after death.
• Embalming delays decomposition of the body, restores it to an acceptable physical appearance and reduces presence and growth of bacteria to prevent foul smell and adds fragrance to the corpse.
• Embalming is done by injecting chemicals directly into the bloodstream, chest cavity and abdominal cavity to preserve the corpse's appearance.
• The most commonly used chemicals for embalming are formaldehyde and ethanol. A combination of these two chemicals is sufficient to preserve the body for a short time i.e. up to a week.
• To keep the corpse in good condition for a longer period i.e. up to a month, a solution made up almost entirely of formaldehyde is used.
• There are several steps involved in modern embalming. First, the embalming fluid is injected directly into the deceased’s blood vessels, and pushed through the body with a mechanical pump. Next, the internal organs are hollowed of their contents and filled with embalming fluid. The chemicals are then injected beneath the skin wherever necessary, followed by a final surface embalming on injured areas of the body.
• Embalming certificate is required by law in certain circumstances like air/rail transportation.


Emedinews: Makesure:A patient on amlodipine developed severe gum hypertrophy

Situation: A patient on amlodipine developed severe gum hypertrophy
Reaction: Oh my God! Why was amlodipine not stopped.
Lesson: Make sure that all patients on amlodipine are watched for gum hypertrophy as its side effect.


Emdinews:Inspiration:Selfishness


A Sufi mystic lived in a wild and dangerous dark forest in a very small hut along with his wife. It was a very thick forest with spooky noises. One day there was torrential rain throughout the day, which continued in the night also. In the middle of the night somebody knocked at the door. The wife was sleeping near the door. There was not much space inside, just enough for two persons to sleep.

The husband said, “The night is dark, the forest has many wild animals. Somebody might have lost his way. Open the door. He certainly needs refuge.” “But there is no space inside our hut, only for two of us to sleep” retorted his wife. Laughing over it, the mystic said, “It is not a palace of a king, however big the palace may be, it is always smaller than a poor mystic’s hut. If two can sleep, three can sit perfectly well. We will sit, talk and tell stories, and sing songs. It is a beautiful night. Even the rain is creating certain music. Open the door!”

When the wife opened the door, there entered a visitor drenched with water and said, “I am sorry to disturb you. I got lost, and there is no light except in this hut. I know it is small, but there was no other way. Outside life is full of danger as the wild animals are roaming everywhere.” The mystic heartily said, “No problem, two can sleep, three can sit. You are welcome. We will know many things from you about the world; and we will offer you our songs, and the night will pass this way. Please close the doors and be at ease. You have graced us; you have given us a chance to welcome a guest; you have made us richer.”

All of them sat together, while the mystic sang a melodious song. Just then there was again a knock at the door. The mystic said, “You are close to the door, please open it. Somebody needs refuge.” But the man, who was asking for refuge just a few minutes before, became angry. He said, “What do you mean? There is no space.”
The mystic replied, “It is not a palace of a king, which is always short of space. It is a small hut of a mystic. We three can sit comfortably, but four will have to sit a little tight, more close to each other. And it is really a joy to feel each other’s warmth and love, and anyhow the cold night is almost half way through. So you open the doors! And remember, a few minutes before you were in the same position.”

Now as there was no alternative left, the man opened the door. Another man who had lost his way in the forest said, “Excuse me, I am absolutely helpless; otherwise I would not have given you trouble. I can see that such a small space is already overcrowded.”
The mystic said, “No problem. We will sit a little close to each other. The gaps between the three can be adjusted to accommodate the four. You are welcome. Sit down and close the door.” Now the hut was completely packed. The mystic started singing another song, while there was another knock on the door, this time it was a different one.

Everyone was shocked. They now knew very well that whoever was outside the hut would be accommodated by the mystic. “Open the door,” said the mystic, “he is one of my friends, a wild donkey.” All the guests and the wife were irritated as they said, “This is beyond tolerance. Do you want to bring in a donkey in this place where there is no space left even for sitting comfortably?”

The mystic said, “How many times do I have to remind you that this is a poor mystic’s hut. There is always space. One has just to find it. Now we are sitting; it’s just a matter of time that the last quarter of this night will also pass. Soon there will be sunrise, open the door!” The last man who came in was nearest to the door, reluctantly opened it, and a donkey drenched with water entered.

The mystic said, “Remember perfectly well – you were in the same state just a few minutes before.”

Selfishness blinds you of other's needs!

Saturday 19 November 2011

Padma Shri Awardee Dr KK Aggarwal on Children & adolscents with congenit...

Emedinews:Insights on Medicolegal issues:Phenol poisoning is known as carbolism



·         Dettol is a chlorinated phenol and it is nontoxic to adults even in higher concentrations; some fatalities have occurred in children.
·         Poisoning by phenol or Dettol is known as carbolism because of the carbolic acid.
·         The acid in a concentrated form acts as a corrosive and remotely as a narcotic poison.
·         It coagulates proteins but does not form a firm chemical combination with them. Applied to the skin, it causes a burning sensation followed by tingling, numbness and anesthesia due to its effect on sensory nerve endings.
·         Dangerous symptoms may be caused by 0.3 to 0.42 g of carbolic acid; about 2g is the average fatal dose. A quarter of a teaspoon full dissolved in glycerin killed a six month old child.
·         Carbolic acid is largely used as an antiseptic, as a disinfectant and as a preservative. It is used in the preparation of many disinfecting powders.
·         Carbolic soaps should not be used for enemas. Being easily procurable several cases of accidental and suicidal poisoning by carbolic acid have occurred.
·         On account of its powerful odor and taste, it is rarely used for homicidal purposes though it has been sometimes used for murdering children and infants.

Emedinews:Makesure:In an STD clinic, a 23-year-old heterosexual male presenting with dysuria, and uretheral discharge was prescribed azithromycin to cover suspected Chlamydia trachomatis infection.

Situation: In an STD clinic, a 23-year-old heterosexual male presenting with dysuria, and uretheral discharge was prescribed azithromycin to cover suspected Chlamydia trachomatis infection.
Reaction: Oh my God! Why didn’t you advise the same treatment for his partner also?
Lesson: Make sure to remember that in such cases, it is essential that both the partners are treated.

Emedinews:Inspiration:Sometimes you just have to cry


There are a lot of things about parenthood that could make one cry... the cost of formula, sleepless nights, or diaper messes just to name a few. However, for me the absolute worst had to be - immunization shots.
At about two months into parenthood, I learned the true meaning of the word "heartbreak". There could not have been anything worse than watching helplessly as he received his first round of immunization shots. I would rather have been run over by a truck than have to sit there and watch him go through that. While listening to his screams, I kept thinking that surely medical science could have come up with a better way of doing this by now. As far as any solace from the doctor, all he could say was, "Ah, look at those healthy tears." As we left the office, I whispered into my son's ear, "Its okay, Sam. Sometimes you just have to cry."

In a way I guess it was only a matter of time before Sam was introduced to pain in his life. I remembered losing my father to a sudden car accident a number of years ago. I tried to remain strong through it all. One day, when a song came on the radio that reminded me of your grandpa, I completely lost it. It was the first time since the funeral that I just let go and cried. It felt good to not hold back anymore.

The earliest memory I have of my father is one of me as a young boy holding his hand by his two last fingers as we walked together. His hands seemed so large that his fingers were all I could actually grip. He always took me with him to basketball games even at my young age. I will never forget that.

As I grew older I remember dad and I listening to high school basketball games together on an old transistor radio. I would make a list of player’s names on a piece of paper and keep track of how many points each would score as the game went on. Too small to stay awake for the whole game, I always fell asleep before the game ended. When I would wake up in the morning I would find the score sheet lying next to me. The score sheet would be filled out with the final score on it completed by my father before he carried me to bed.

I remember the times when my father would stop by the house in the early morning on those cold days when I was home from school over Christmas break. I used to ride on the floor of that bread truck as he delivered the bread to the stores. I don't know if those old trucks even had heaters but it didn't matter. The smell and warmth from the bread that had just come from the bakery ovens would make my mouth water and keep me warm both at the same time.

In high school I became very interested in athletics. My father would attend all my games. My senior year our football team qualified to play in the state championship game. It was the first time in the history of our school that any team had advanced that far. The night before the game my father came to me and sadly announced that he would not be able to attend. He had to deliver the bread to the stores and the site of the games was a three hour drive from his route. He vowed to listen to every play on the transistor radio. Consumed with the anticipation of the game, I acknowledged his comments without fully noticing his regret.

The next day as game time approached I couldn't help thinking about my dad. For some reason as I lined up for the second half kickoff I happened to look across the field into the parking lot. There I saw his blue and white bread truck pulling into the stadium. He had delivered the bread and made the long drive in time to at least see part of the game in which we won the state championship.

Years later I had become a teacher and coach. Early one morning I was awakened by the sound of the telephone ringing at 5:30 A.M. As I struggled to answer the phone I'll never forget the sound of the sheriff's voice on the other end telling me that my dad had just been killed in an automobile accident on his way to work. Cattle from a nearby farm had broken through a fence and wandered onto the highway. Being a dark, rainy morning my father never saw them as he came over a ridge. The impact spun the car sideways in the highway before a semi-trailer collided with it. He was killed instantly. As I listened to the story I could hear my heart beat in my ears. I hung up the phone devastated.

For a long time after that things really didn't matter to me. I went about my life but I really didn't care. It felt as if my heart had been torn away and in a sense it had. I went to work. I still taught school but I was just going through the motions.

One day I was on the school playground supervising a first grade recess. A little boy walked up to me and grabbed my hand by my last two fingers. Just like I use to do to my dad. In that moment my father came back to me. In that instant I realized that even though my father was gone he had left me something behind. He had left me his smile. He had left me his compassion. He had left me his heart. When that little boy touched my hand I realized that all these wonderful gifts that I had loved so much about my father could be passed on to others.

From that moment on I started. In that moment I understood the meaning of the word heritage.
Like his father, there will be times in my son's life when he will feel pain. When that happens, I hope I am there for him. If I am not, I hope he remembers the words I whispered in his ear that day as we left the doctor's office. "It's okay, Sam. Sometimes you just have to cry."

Emedinews:Insights on Medicolegal issues:How is the age of a scar determined by doctor?

• A scar is produced from the healing of wound made of fibrous tissue covered by epithelium without hair follicles, pigment.
• The scars are bluish and reddish in the first week and look like angry face of an extremely fair complexion boy; they are also called angry scars.
• In the second week, the scar is soft and sensitive on touch and looks pale. It remains so for about two months however its softness and sensitivity decrease.
• After approximately two months and up to six months, the scar looks white and glistening; however, the softness changes to harder and harder and finally wrinkled
• The shape of scar almost remains permanent and indicates the nature of weapon that caused the injury in majority of cases
• As per IPC if a person is disfigured due to scar it becomes a grievous injury.
• Bullet injuries causes mostly circular depressed scar seen in medicolegal cases.


Emedinews:Makesure:A 20-year-old college student complained of dysuria, frequency and pyuria.

Situation: A 20-year-old college student complained of dysuria, frequency and pyuria.
Reaction: Oh my God! Why did you not advise macrolide?
Lesson: Make sure to remember that macrolide are very effective against E. coli, S. saprophyticus and C. trachomatis infection.

Emedinews:Inspiration:Some Kind of Miracle

Everything comes gradually at its appointed hour-Ovid.

My mother had been in a deep sleep for three days, taking in no food at all, and a minimum of forced liquid. A "Do Not Resuscitate" sign hung over her bed. Every time I looked at the sign, I shuddered. The finality of the words chilled me, even though the heat in her bedroom was way too high.

She was 88 years old and had reached the end of a long illness. She was still in her own apartment, but I had arranged for round-the-clock nursing care for her; I did not leave her side during those three days.

On the fourth morning, a Sunday, I called my husband and asked him to pick me up and drive me home (some forty minutes from my mother's apartment) so that I could get clean clothes. I had been wearing the same pair of jeans and blouse for four days, having had no idea when I arrived that the end was so near.

As we drove home that Sunday, my husband and I decided that before we went back to my mother's apartment, we would stop at the funeral home to make arrangements. The doctor had said that she would not last more than a few days at most, and the previous evening, the visiting nurse agreed with his prognosis. We felt it would be better to make the funeral arrangements while we were still relatively calm, rather than after the emotional trauma of death had set in.

I also wanted to stop at the grocery store so there would be some food in the refrigerator for the nurses and myself.

Once at my house, I quickly showered and dressed, then threw a few clothes into a shopping bag. We got back into the car. Suddenly, I told my husband that I had changed my mind about stopping off at the funeral home. And I did not want to take time to buy groceries, either. Something inside me told me that we had to get back to my mother in a hurry-before it was too late.

I rang the bell in the lobby and the daytime nurse, Callie, buzzed me in. After the elevator ride up to the 22nd floor, I saw Callie at the end of the hall, a look of amazement on her face. "It's some kind of miracle!" she exclaimed. "Your mother's eyes are open!"

Hurrying into my mother's bedroom, I was shocked to see that her eyes were open. She was propped up in the rented hospital bed, staring straight ahead. At first, I thought she was dead, and my heart started racing. But then she shifted her gaze and looked straight at me. She had a puzzled, questioning look on her face, as if to ask, "Where am I?" Or, perhaps, "Where am I going?" Then a grimace passed over her face-a grimace that I have replayed in my mind over and over again. Was it a grimace of physical pain? Of fear? Of sadness? I think by then, she felt no more pain, so it must have been a combination of fear and sadness-deep sadness at leaving, and fear of the unknown. She needed the comfort of being in my arms when she began her journey.
I held her frail body gently, and spoke to her softly, telling her how much I loved her. And then I could feel, and see, that she was gone.

I asked Callie how long my mother's eyes had been open before I arrived. "Only a few minutes," she said. "When I heard you ring the bell downstairs, I said to your mother, 'There's your daughter. Now you just hold on there. Don't you die before she gets here?' And she did hold on. She waited for you."

Thinking about the fact that something told me not to stop for anything on the way back to my mother's apartment, but to hurry as fast as I could; thinking about the fact that my mother opened her eyes when I rang the bell, and kept them open until I got there, so that I was able to say goodbye to her, I suspect that Callie was right. It was some kind of miracle. It was the Hand of Fate.


Friday 18 November 2011

Emedinews:Insights on Medicolegal issues:Is it necessary for treating hospital to disclose all the information to patient?

The patient has a legitimate right to determine what medical/surgical, diagnostic or therapeutic intervention has to be done with his/her own body and the doctor has to obtain a valid consent after giving full information of medical procedure to be done to the patient. When two or more persons agree upon the same thing in the same sense, it is a valid consent as per the definition of the consent given in section 13 of the Indian Contract Act. The Doctor who performs an intervention without the patient’s consent commits an offence for which he is liable as per law.

Consent may be express or implied.

• Express consent in an oral or written authority by the patient to render the proposed medical/surgical treatment.
• Consent may be implied to conduct medical examination from the conduct of the patient who voluntarily submits to treatment under circumstances which would indicate awareness of the planned treatment impliedly authorizes the treatment, even without express consent. A patient who presents himself or herself at the doctor’s clinic/hospital after appointment/purchasing OPD Card/paying doctor’s fee for consultation/routine medical procedure/examination by way of palpation/auscultation implies his/ her consent to treatment by the doctor/hospital
• It is now recognized that the patient has the right to full information in patient as consumer terms, concerning his diagnosis, treatment and prognosis. He/she should also be informed about the alternative treatments/methods and its possible complications.
• Informed means the consent of a patient to the performance of the health care services provided by a registered medical practitioner, that prior to be the consent having be given, the doctor/team of/hospital authority has informed the patient of the nature of the purposed procedure or treatment of those risks and alternative treatment or diagnosis that a reasonable patient would consider material to the decision whether or not to undergo treatment or diagnosis.
• In standard ethical/prudent practice of medicine the doctor’s duty to disclose the information/complete information is subject to the two exceptions: No disclosure is required, if the patient indicates a preference not to be informed; or If the physician or surgeon believes in the exercise of sound medical judgment, that the patient personality is so anxiety prone or disturbed that the information would not be processed rationally or that it would probably cause significant psychological harm/not in the interest of his/her mental and physical health or it will cause adverse effect on good prognosis of patient health of the patient.
• This exception to the legal duty of full disclosure to patient as informed consent in medical care delivery is called the ‘therapeutic privilege’ of a doctor. Consultation or sharing the information with legal heirs by another physician familiar with the patient/family doctor, with a close relative or friend of patient, or all is advisable for a treating doctor in good faith and must be documented as an extended informed consent under heading of therapeutic privilege


Emedinews:Makesure: A patient on ACE inhibitor developed angioneurotic edema.

Situation: A patient on ACE inhibitor developed angioneurotic edema.
Reaction: Oh my God! Why was ACE inhibitor continued?
Lesson: Make sure that patients on ACE inhibitors are advised to watch for symptoms of urticaria and stop the drug immediately in case swelling of lip, face or tongue develop (Br J Clin Pharmacol 1999;48(6):861–5).

Emedinews:Inspiration:Share Your Time


A man came home from work late again, tired and irritated, to find his 5-year-old son waiting for him at the door. "Daddy, may I ask you a question?"
"Yeah, sure, what is it?" replied the man. "Daddy, how much money do you make an hour?
"That's none of your business! What makes you ask such a thing?" the man said angrily. "I just want to know. Please tell me, how much do you make an hour?" pleaded the little boy.
"If you must know, I make $20.00 an hour." "Oh," the little boy replied, head bowed. Looking up, he said, "Daddy, may I borrow $10.00 please?"
The father was furious. "If the only reason you wanted to know how much money I make is just so you can borrow some to buy a silly toy or some other nonsense, then you march yourself straight to your room and go to bed. Think about why you're being so selfish. I work long, hard hours every day and don't have time for such childish games."
The little boy quietly went to his room and shut the door. The man sat down and started to get even madder about the little boy's questioning. How did he dare to ask such questions only to get some money.
After an hour or so, the man had calmed down, and started to think he may have been a little hard on his son. Maybe there was something he really needed to buy with that $10.00, and he really didn't ask for money very often. The man went to the door of the little boy's room and opened the door. "Are you asleep son?" he asked.
"No daddy, I'm awake," replied the boy. "I've been thinking, maybe I was too hard on you earlier," said the man. "It's been a long day and I took my aggravation out on you. Here's that $10.00 you asked for."
The little boy sat straight up, beaming. "Oh, thank you daddy!" he yelled. Then, reaching under his pillow, he pulled out some more crumpled up bills. The man, seeing that the boy already had money, started to get angry again. The little boy slowly counted out his money, then looked up at the man.
"Why did you want more money if you already had some?" the father grumbled. "Because I didn't have enough, but now I do," the little boy replied. "Daddy, I have $20.00 now. Can I buy an hour of your time?"
Share some time with those who need you. They need our time more then we will ever know.

Thursday 17 November 2011

Emedinews:Insights on Medicolegal issues:The legal duty of a doctor to exercise due skill and care only when there is a doctor/patient relationship

Gratuitously advices shall not be considered liable when the actions are within the established medical procedures

• Any doctor who is qualified by medical council and renders emergency care or treatment to a person suffering or appearing to suffer from cardiac arrest, which may include the use of an automated external defibrillator, in good faith and without compensation, shall be immune from civil liability for any personal injury as a result of care or treatment or as a result of any act or failure to act in providing or arranging further medical treatment where the person acts as an ordinary prudent person would have acted under the same or similar circumstances, except damages that may result for the gross negligence of the person rendering emergency care. This immunity shall extend to the licensed physician.
• If a doctor passes the scene of an accident in which some person has been injured and is in need of urgent medical attention he would not be held to have been negligent if he does not render assistance, as no doctor / patient relationship has been established and in consequences the doctor owes the patient no legal duty.
• If, however, the doctor goes to the assistance of a person who is injured in an accident, a doctor /patient relationship is at once established. When any physician gratuitously advises medical personnel at the scene of an emergency episode by direct voice contact, to render medical assistance based upon information received by voice or biotelemetry equipment, the actions ordered taken by the physician to sustain life or reduce disability shall not be considered liable when the actions are within the established medical procedures.
• A Doctor has a duty to exercise reasonable skill and care regardless of whether or not his services are being given gratuitously. A national health policy is required to be formulated to render emergency treatment to a person.
• If such a practitioner fails to attend an emergency call and a complaint is made against him it may well be that some disciplinary action will be taken against him by the health authority/ medical council


Emedinews:Makesure:A patient on amlodipine developed severe gum hypertrophy.

Situation: A patient on amlodipine developed severe gum hypertrophy.
Reaction: Oh my God! Why was amlodipine not stopped?
Lesson: Make sure that all patients on amlodipine are watched for gum hypertrophy as its side effect.

Emedinews:Inspiration:Shake It Off and Step Up

A parable is told of a farmer who owned an old mule. The mule fell into the farmer's well. The farmer heard the mule 'braying' - or whatever mules do when they fall into wells. After carefully assessing the situation, the farmer felt sorry for the mule, but decided that neither the mule nor the well was worth saving. Instead, he called his neighbors together and told them what had happened and asked them to help haul dirt to bury the old mule in the well and put him out of his misery.

Initially, the old mule was hysterical! But as the farmer and his neighbors continued shoveling and the dirt hit his back, a thought struck him. It suddenly dawned on him that every time a shovel load of dirt landed on his back: he should shake it off and step up! This is what the old mule did, blow after blow.

"Shake it off and step up... shake it off and step up... shake it off and step up!" he repeated to encourage himself. No matter how painful the blows, or distressing the situation seemed, the old mule fought "panic" and just kept right on shaking it off and stepping up!

You guessed it! It wasn't long before the old mule, battered and exhausted, stepped triumphantly over the wall of that well! What seemed like it would bury him, actually end up blessing him. All because of the manner in which he handled his adversity.

In addition to "shaking it off and step up," we Christians have our heavenly Father to help get us through rough times. When the going gets rough, keep looking up, and trust him.

Wednesday 16 November 2011

Emedinews:Insights on Medicolegal issues:Alcohol and Isopropanol poisoning

• The effect of ethanol depends on how much alcohol a person regularly drinks. Someone who does not usually drink much alcohol may be badly affected by an amount that would have very little effect on a person who regularly drinks large amounts.
• Children may get severe poisoning after drinking just a mouthful of aftershave, mouthwash or perfume. Isopropanol is more poisonous than ethanol. Serious poisoning can be caused by using isopropanol as rubbing alcohol, if large amounts are rubbed on the skin and absorbed into the body.
• Both ethanol and isopropanol slow down the brain, causing unconsciousness and shallow breathing. Isopropanol vapor is irritant to eyes, nose and throat and poisonous if breathed in. Isopropanol can cause poisoning if absorbed through the skin.
• Slurred speech, difficulty in performing simple tasks, staggering walk, nausea, vomiting, and abdominal pain with blurred or double vision, unconsciousness, fits are more severe after isopropanol intoxication.
• If breathing stops, open the airway and give mouth-to-mouth respiration. If the patient is unconscious or drowsy, lay him or her on one side in the recovery position. Check breathing every 10 minutes and keep the patient warm. Take the patient to hospital as soon as possible if the patient is a child, the patient has severe poisoning, the patient has swallowed isopropanol.
• Doctor must check for blood glucose which may be low and there may be metabolic acidosis and electrolyte imbalance. Do a full medical examination to exclude other causes of the patient's condition, such as head injury. Ensure the airway is clear and the patient remains in the recovery position. Monitor breathing, blood pressure, pulse, and blood glucose. Supportive care, including oxygen and ventilation, should be given as needed:
• Fluid and electrolyte balance should be corrected and hypoglycemia should be treated with oral or intravenous glucose.

(Contributed by Dr Sudhir Gupta)

Emedinews:Makesure:A 42–year–old male developed acute heart attack after playing squash.


Situation: A 42–year–old male developed acute heart attack after playing squash.
Reaction: Oh my God! Why hadn’t he got a cardiac check up done yet?
Lesson: Make sure that after the age of 40 anybody going for anaerobic games should first get a cardiac clearance.

Emedinews:Inspiration:Life is ten percent what you make it and ninety percent how you take it

One day I hopped in a taxi and we took off for the airport. We were driving in the right lane when suddenly a car jumped out of a parking space right in front of us. My taxi driver slammed on his brakes, skidded, and missed the other car by just inches! The driver of the other car whipped his head around and started yelling at us. My taxi driver just smiled and waved at the guy. And I mean he was really friendly.

So I asked, 'Why did you just do that? This guy almost ruined your car and sent us to the hospital!'

This is when my taxi driver taught me what I now call 'The Law of the Garbage Truck.'

He explained that many people are like garbage trucks. They run around full of garbage, full of frustration, full of anger, and full of disappointment. As their garbage piles up, they need a place to dump it and sometimes they'll dump it on you. Don't take it personally. Just smile, wave, wish them well, and move on. Don't take their garbage and spread it to other people at work, at home, or on the streets.

The bottom line is that successful people do not let garbage trucks take over their day. Life's too short to wake up in the morning with regrets, so..... 'Love the people who treat you right. Forgive the ones who don't.'

Life is ten percent what you make it and ninety percent how you take it!

Tuesday 15 November 2011

Emedinews:Insights on Medicolegal issues:Most notorious and famous murder case in British history


• Dr. Hawley Crippen was hanged in London in one of the most notorious and famous murder cases in British history for murdering his wife Cora Crippen in 1910 on the basis of forensic evidence.


• Now forensic science at Michigan State University is producing evidence that his execution was a mistake.

David Foran, a forensic expert and director of MSU’s forensic science program, partnering with clinical and forensic toxicologist John Harris Trestrail the managing director of the regional poison center in Grand Rapids, is combining state-of-the-art DNA analysis with solid sleuthing to show the remains buried in Crippen’s basement couldn’t have been his wife. For nearly a century, Crippen, a doctor, was thought to have poisoned his wife with an obscure toxin, and buried. Crippen was labeled “one of the most dangerous and remarkable men who have lived in this century.”Michigan’sForan’s laboratory has devised methods to extract and isolate mitochondrial DNA.Foran’s laboratory specializes in ancient and forensic DNA evidence, often working with human remains that are thousands of years old. The nearly 100-year-old microscope slide, sent to Michigan State from the Royal London Hospital Archives and Museum, is the same one the pathologist Bernard Spilsbury used to help hang Crippen in 1910. At that time forensic medicine/ pathology was more primitive; Spilsbury’s testimony, identifying what he claimed was an abdominal scar consistent with Cora’s medical history, convinced the jury that these were Cora’s remains. 



• Crippen went to the gallows insisting he was innocent.



• The present-day challenge: getting past the pine sap that sealed the slide and the formaldehyde used to preserve the tissue in order to examine the mitochondrial DNA that could identify Cora Crippen based on the genetic history of her maternal relatives.



• Mitochondrial DNA is the genetic blueprint that is passed down in the egg from mother to daughter. Unlike regular DNA, which comes from the cell’s nucleus, 



• Foran explained that mitochondrial DNA remains more stable in aged tissue and is easier to retrieve. Also, mitochondrial DNA remains relatively undiluted through generations, offering a reliable familial match
.


• Crippen was not convicted just of murder – but the murder of Cora Crippen,Body was not of Cora proving after 100 years?



• Foran’s laboratory has devised methods to extract and isolate mitochondrial DNA. Unable to break through the sap seal, he chipped away at the slide’s glass cover slip to get at the tissue sample. One of his graduate students recently studied ways to work around formaldehyde fixation to isolate DNA. 



• The goal: compare the mitochondrial DNA in the slide that convicted Crippen with Wills’ assignment – finding a maternal relative of Cora Crippen. 


If Hawley Crippen indeed killed his wife and buried some of her remains in the cellar, those remains would share specific DNA characteristics with Cora Crippen’s current day relatives. To paraphrase the famed attorney in the O.J. Simpson murder trial, Johnnie Cochran, if the DNA doesn’t fit, you can’t convict. Wills spent some seven years pouring through genealogical records and taking on the somewhat nontraditional task of finding living female relatives of Cora Crippen’s mother. Usually, in genealogy, you work backwards, but in this case, we went forward,” she said. As she traced through the family line, she found elderly relatives who remembered talk of a family scandal, one where a woman had been murdered by her husband in London. She ultimately located three grandnieces. “We took a lot of precautions when doing this testing,” Foran said. “We just didn’t stop. We went back and started from scratch and tested it again. The DNA in the sample is different from the known relatives of Cora Crippen.” “Crippen was not convicted just of murder – but the murder of Cora Crippen,” Trestrail said that body is not of Cora?

Emedinews:Makesure: A 20–year–old college student complained of dysuria, frequency and pyuria.

Situation: A 20–year–old college student complained of dysuria, frequency and pyuria.
Reaction: Oh my God! Why did you not advise macrolide?
Lesson: Make sure to remember that macrolide are very effective against E. coli, S. saprophyticus and C. trachomatis infection.

Emedinews:Inspiration:Self Motivation

My profession is running a dance school for the past 17 years. In doing so, I have learned many things about children; one being that self motivation is really not an inherited character. It is a learned behavior.

In the corporate world that we live in now where it's a race to keep up, some of our children are losing their battle before it ever begins. At times, I feel like my job requires more than just a dance instructor. I encounter children who cannot even fathom the thought of self motivation.

Why? Because their parents are probably too busy in their own corporate climb up the ladder that they've forgotten to notice their own offspring. They've forgotten that it's just as necessary to teach their own children how to be successful and to succeed -- how to be creative and to create.

In my own effort to be successful at what I do, there is one point I push every day that I walk into my studio: "You only get what you give". It may not look like much right off the bat, but if you look at the words really careful and read between the lines, it really says a lot. I have one other quote that I use in teaching expression: "You are like a paint brush on canvas. You "the dancer" are the paint brush and your canvas is the stage."

Monday 14 November 2011

Emedinews:Insights on Medicolegal issues:Issuance of death Certificate by Doctor

Coma is a clinical symptom and not a cause of death

The certificate of death is always issued by doctor as an honor/respect to the deceased person without any fee. In accordance with the Registration of Births and Deaths Act 1969, the registration of deaths is now compulsory throughout India. The doctor must write his registration number in Death Certificate and a register for such information should be maintained with his clinic/hospital and a copy/information of death must/mandatorily be sent immediately to the birth and death registration office. It is essential that the cause of death must be documented/ determined before lawful disposal of the deceased body by the doctor. The death certificate also provides the exact cause of death for statistical purposes. The cause of death is recorded according to international conventions; the sequence being that adopted by the World Health Organization. Thus, the international medical Certificate of the Cause of Death consists of two parts:

• Part I: Records (a) the immediate cause, and (b) the morbid conditions, if any, giving rise to the immediate cause. Thus (a) must be due to (b). When (b) is due to other causes, it should be mentioned in (c). The basic pathological condition is that on the lower-most line and this is the one that is used for statistical purposes.
• Part II: records any other significant condition contributing to death, but not related to the immediate cause of death. The underlying cause of death is defined as the disease, which initiated the train of morbid events leading directly to death for instance; a patient may die primarily from myocardial infraction due to coronary artery disease. These should be placed in parts (a) and (b) of part I as the myocardial infraction due to coronary artery disease (or coronary insufficiency). Similarly, it can be certified that the patient died of cerebral hemorrhage due to hypertension.

However, if the patient also suffers from diabetes, it should be entered in part II as it does not have a direct contributing role to the immediate cause of death. It is incorrect to write ‘heart failure ‘ or ‘cardiac failure’ or’ cardiopulmonary arrest’ without mentioning the underlying pathological cause, which might be’ coronary artery disease’ or ‘rheumatic valve lesions’ or’ senile myocardial degeneration’. It should be remembered that everyone dies of cardiopulmonary arrest’ or’ heart failure’ or ‘cardiac failure’ which simply means cessation of circulation and respiration leading to somatic death.

The modes of death, e.g., cardiorespiratory failure, or asphyxia should not be recorded as the cause of death, unless qualified as explained here, for instance, ‘coma’ is a clinical symptom and not a cause of death. It should be used with proper cause such as crush injury of head or meningitis etc.

The terms like angina, cancer, tumor apoplexy congestion’,’ debility’, ‘asthenia,’ organic disease toxemia, sepsis and hemorrhage are sign/symptoms of the disease and not a pathological condition. It is pertinent for medical professional to note that a death certificate requires the underlying pathological cause and not clinical manifestations or modes of death.

Emedinews:Makesure: A patient with asymptomatic second degree Mobitz 1 block after PPI developed lead infection.

Situation: A patient with asymptomatic second degree Mobitz 1 block after PPI developed lead infection.
Reaction: Oh my God! Why was PPI (Permanent pace maker implantation) done?
Lesson: Make sure that PPI is not implanted in patients with asymptomatic second–degree Mobitz I (Wenckebach) AV block.

Emedinews:Inspiration:Reminiscing

Alas. It is good to reminisce. But how come when you reminisce, you can't help but to remember the not so good ones? How can you prevent the feeling from even entering your mind? You can never tell...
To reminisce is to understand. When you reminisce, you understand things you never understood before. To understand different thoughts and ideas, to understand the value of friendship and especially to understand the value of loyalty.
I have experienced reminiscing.. Now I ask myself, WHY? Does it have to do anything about me? Maybe God wants me to change something. To change things that is wrong. Quoted from Lion King III: "You won't change the past, so why worry?"
Again, why worry? Because it is our responsibility to change things we feel wrong. We have to make sure that everything is right in order to have a beautiful and peaceful life. But on the other side, we cannot remove the obstacles and trials in our lives. It is part of the tapestry of living and cannot be broken and scratched out by any means at all.
To reminisce is to remember good times. To remember the unforgettable days and wished you were back in time. Again, I say to myself over and over again, I cannot turn back time. I just can't. I also say to myself that it is not good to dwell in those memories forever because you have to move on. There is a big world waiting for you out there-waiting for you to change it, waiting for you to unfold and reveal its mysteries.
But then again, it is not good to reminisce forever. You must face and take the world in your hands and with the help of our Lord; you must overcome any trials and obstacles ahead for you to be worry-free in your life.
(Contributed by Ms Ritu Sinha)

Saturday 12 November 2011

Emedinews:Insights on Medicolegal issues:Reasons for false negative chemical analysis report of viscera

If the doctor conducting the autopsy has formed a conclusive opinion that the death is due to poisoning based on clinical evidence and after excluding other causes, he has all the authority to inform the investigating officer and mention his conclusive opinion in the postmortem report even if he is preserving the viscera for chemical analysis. A false negative test report may be due to:

• Delay in chemical analysis
• Improper preservation
• Use of wrong analytical technique
• Early disintegration of poison
• Complete metabolism
• Lack of suitable test for certain poison

In accordance with a judicial pronouncement, the doctor who has conducted the postmortem examination can give his opinion as to the cause of death (due to poisoning) despite negative viscera report.

(Contributed By Dr Sudhir Gupta)

Emedinews:Makesure: A patient with asymptomatic sinus bradycardia after PPI developed lead infection.

Situation: A patient with asymptomatic sinus bradycardia after PPI developed lead infection.
Reaction: Oh my God! Why was PPI (Permanent pace maker implantation) done?
Lesson: Make sure that PPI is not done in patients with sinus bradycardia without significant symptoms; sinoatrial block or sinus arrest without significant symptoms; asymptomatic prolonged RR intervals with atrial fibrillation or other causes of transient ventricular pause and asymptomatic bradycardia during sleep.

Emedinews:Inspiration:Remember the small things

Some of my sisters work in Australia. On a reservation, among the Aborigines, there was an elderly man. I can assure you that you have never seen a situation as difficult as that of the poor old man. He was completely ignored by everyone. His home was disordered and dirty. I told him, "Please, let me clean your house, wash your clothes, and make your bed."
He answered, "I'm okay like this. Let it be." I said again, "You will be still better if you allow me to do it."
He finally agreed. So I was able to clean his house and wash his clothes. I discovered a beautiful lamp, covered with dust. Only God knows how many years had passed since he last lit it. I said to him, "Don't you light your lamp? Don't you ever use it?" He answered, "No. No one comes to see me. I have no need to light it. Who would I light it for?"
I asked, "Would you light it every night if the sisters came?" He replied, "Of course."
From that day on the sisters committed themselves to visiting him every evening. We cleaned the lamp and the sisters would light it every evening. Two years passed. I had completely forgotten that man. He sent this message: "Tell my friend that the light she lit in my life continues to shine still."
I thought it was a very small thing. We often neglect small things.
(Contributed by Ms Ritu Sinha)

Emedinews:Insights on Medicolegal issues:A Criminal Investigative model of FBI for lust murders

On the basis of various literature and experience of two decades, I endorse/feel that the dead bodies do tell tales as to ‘how he/she has been killed/died”; what is required is a meticulous autopsy surgeon to hear/understand its language.
• Lust murder may be organized or disorganized depending on the psychopathology of the offender and the same is manifested in the crime scene of the killings.
• It is determined by very close observation/examination of the scene and corpse. In the case of a disorganized offender the victim will be immediately rendered unconscious or dead by a “blitz–style” of attack and there will be evidence of symbolic and postmortem sexual activities.
• In both instances, however, the cutting, mutilation and overkill type wound structures will be directed towards those parts of the body that the offender finds significant to him as per his fantasy and serve as a sexual stimulus.
• The disorganized offender usually depersonalizes his victim by facial destruction or overkill type of wounds and it became a signature forensic component for crime detection.
• Any sexually sadistic acts are performed postmortem. Mutilation to the genitalia in females, neck, throat and buttocks are performed because these parts of the body contain a strong sexual significance to him. Most cases of lust murder usually involve male perpetrators. However, accounts of female lust murderers do exist also.

(Contributed by Dr Sudhir Gupta)

Emedinews:Makesure: A patient with severe obstructive sleep apnea (OSA) developed acute coronary syndrome (ACS).

Situation: A patient with severe obstructive sleep apnea (OSA) developed acute coronary syndrome (ACS).
Reaction: Oh my God! Why was CAD not ruled out in this case?
Lesson: Make sure that all patients with OSA are investigated for underlying CAD.

Friday 11 November 2011

Emedinews:Inspiration:Our Time in History

The paradox of our time in history is that we have taller buildings, but shorter tempers; wider freeways, but narrower viewpoints.

We spend more, but have less; we buy more, but enjoy it less. We have bigger houses and smaller families; more conveniences, but less time.

We have more degrees, but less sense; more knowledge, but less judgment; more experts, but less solutions; more medicine, but less wellness.

We have multiplied our possessions, but reduced our values. We talk too much, love too seldom, and hate too often.

We've learned how to make a living, but not a life. We've added years to life, not life to years.

We've been all the way to the moon and back, but have trouble crossing the street to meet the new neighbor.

We've conquered outer space, but not inner space.
We've cleaned up the air, but polluted the soul. We've split the atom, but not our prejudice.

We have higher incomes, but lower morals. We've become long on quantity, but short on quality.

These are the times of tall men, and short character; steep profits, and shallow relationships. These are the times of world peace, but domestic warfare; more leisure, but less fun; more kinds of food, but less nutrition.
These are days of two incomes, but more divorces; of fancier houses, but broken homes. It is a time when there is much in the show window and nothing in the stockroom.

Emedinews:Insights on Medicolegal issues:The forensic analyst/doctor has a legal responsibility to retain untested biological specimen in legal cases so that another person can test it for an independent conclusion

• When crimes like injury, sexual offences, and murder are reported to a police station, the investigating officers are assigned to examine and investigate the case and collect the related evidences. The observation of scenes of crime, collection of human body fluids, weapons of the offence and medical examination of victim, accused, or both are required in any investigation of crime against human body.
• The medical examination is carried out in emergency ward of hospitals and the doctor’s main attention should be the treatment of injured and dying patient. However, in cases of crime against human body, medical examination and collection of biological sample, its recognition, documentation, packaging and analysis has an important role and are required to be done by doctor very meticulously with the high standards of science and the law in mind.
• The biological materials which are frequently required to be collected /recovered by doctor during medical examination as evidence in crime against human body are blood, seminal stains, vaginal smears/slides, gastric lavage, chemical substances, poison, hair, fiber, broken glasses, knives, blunt instruments / objects, fire arms, bullet, live and empty cartridge cases, wads, clothing etc..
• This scientific biological evidence becomes legal evidence in prosecution/acquittal of a case, if collected properly by maintaining the scientific sanctity and analyzed by a competent expert.

(Contributed by Dr Sudhir Gupta)