Emedinews:Insights on Medicolegal issues:Cannabis is also known as marijuana

Indian hemp, hashish, ganja, pot, dope and grass, is made from the Indian hemp plant Cannabis sativa

• Cannabis is often abused and, in some countries it is used almost as much as alcohol or tobacco and considered as aphrodisiac agent. It makes people feel relaxed and makes colors and sounds seem brighter and louder. The dried plant is made into cigarettes or put in a pipe and smoked. Sometimes it is taken with food also however some people inject it too.
• Cannabis causes harm affects to the brain however it does not cause much harm to adults, unless it is injected. The signs and symptoms start within 10 minutes of smoking the drug and last for about 2-3 hours.
• When the drug is eaten, the effects start within 30-60 minutes and last for 2-5 hours. The main effects are a feeling of well-being, happiness and sleepiness, but high doses may cause fear, panic and confusion, the person cannot balance when standing up, hallucinations, drowsiness, slurred speech, coughing if the drug is breathed in, as when smoking cigarettes.
• If the drug is injected it may cause more serious problems severe headache, dizziness, irregular breathing, fever, low blood pressure, unconsciousness.
• If the patient is unconscious or drowsy, lay him or her on one side in the recovery position. Check breathing every 10 minutes. A patient who is anxious or confused should be kept in a quiet, warm room. If the cannabis was swallowed: there is no need to make the patient vomit. If the patient is fully awake, breathing normally, and not vomiting, gives activated charcoal and water to drink.
• If the patient is hallucinating or violent, give chlorpromazine, 50-100 mg an adult dose, intramuscularly.
• If cannabis has been injected, monitor breathing, pulse, blood pressure, temperature. Supportive care, including oxygen and mechanical ventilation, should be given as needed: Low blood pressure should be treated by keeping the patient lying with the feet higher than the head; intravenous fluids can be given.
(Contributed by Dr Sudhir Gupta)

Emedinews:Makesure: A patient with acute chest pain died before reaching the hospital.

Situation: A patient with acute chest pain died before reaching the hospital.
Reaction: Oh my God! Why was water–soluble aspirin not given?
Lesson: Make sure that at the onset of acute heart attack and chest pain, give the patient water-soluble aspirin to chew in order to reduce chances of sudden death.

Emedinews Inspiration:Grandmother’s Vase

One day I was lying on the bed, reading, when my mother came into the room. She held out a vase––a rather ugly vase. She asked, ‘Would you like to have this vase?’ "I replied quickly, ‘No, I don’t want it.’ "As she turned to walk away, I picked up something that said to me, ‘Wait a minute, don’t shut this off yet.’ So I asked, ‘Where did you get it?’

"She said, ‘Oh, I got it when I filled an order.’ Filled an order? I thought––no communication here. So I asked, ‘What do you mean, filled an order?’ ‘Well,’ she said, ‘when I was a little girl, the Smith Company mailed catalogs to people. I would take the catalog around the neighborhood, and I’d get people to order from it. When I filled an order and sent it in, they gave me a prize. One time, I got a porch swing for my family.’

"Now you have to understand," said Hensley, "that my mother is 81–years–old. She is one of six children in a family that her father deserted when she was quite young. Money was real hard to come by. My grandmother managed to keep the family together through the years, although I don’t know how. For my mother to win a luxury like a porch swing was a significant accomplishment. Although she no longer had the swing, she had the vase––a vase full of meaning––which she offered to me. Instantly I said, ‘Mom, I want the vase.’ Now it sits in a prominent place in my living room.

It symbolizes a precious meaning which my mother and I share. Unless you and I are sensitive to the other person and hear meaning, we may well have a communication problem.

(Contributed by Ms Ritu Sinha)

Emedinews Inspiration: Everybody has a dream

Some years ago I took on an assignment in a southern county to work with people on public welfare. What I wanted to do was show that everybody has the capacity to be self-sufficient, and all we have to do is to activate them. I asked the county to pick a group of people who were on public welfare, people from different racial groups and different family constellations. I would then see them as a group for three hours every Friday. I also asked for a little petty cash to work with as I needed it.

The first thing I said after I shook hands with everybody was, "I would like to know what your dreams are." Everyone looked at me as if I were kind of wacky. "Dreams? We don't have dreams." I said, "Well, when you were a kid what happened? Wasn't there something you wanted to do?"

One woman said to me, "I don't know what you can do with dreams. The rats are eating up my kids."Oh," I said. “That’s terrible. No, of course, you are very much involved with the rats and your kids. How can that be helped?"

"Well, I could use a new screen door because there are holes in my screen door." I asked, "Is there anybody around here who knows how to fix a screen door?" There was a man in the group, and he said, "A long time ago I used to do things like that, but now I have a terribly bad back, but I'll try."

I told him I had some money if he would go to the store, buy some screening, and go and fix the lady's screen door. "Do you think you can do that?" "Yes, I'll try. “The next week, when the group was seated, I said to the woman, "Well is your screen door fixed?"

"Oh, yes," she said. "Then we can start dreaming, can't we?" She sort of smiled at me. I said to the man, who did the work, “How do you feel? He said, "Well, you know, it's a very funny thing. I'm beginning to feel a lot better." That helped the group to begin to dream. These seemingly small successes allowed the group to see that dreams were not insane. These small steps began to get people to see and feel that something really could happen.

I began to ask other people about their dreams. One woman shared that she always wanted to be a secretary. I said, "Well, what stands in your way?" (That's always my next question). She said, "I have six kids, and I don't have anyone to take care of them while I'm away." "Let's find out," I said. "Is there anybody in this group who would take care of six kids for a day or two a week while this woman gets some training here at the community college?” One woman said, "I got kids, too, but I could do that."

"Let's do it," I said. A plan was created and the woman went to school. Everyone found something. The man who put in the screen door became a handyman. The woman who took in the children became a licensed foster care person.

In 12 weeks I had all these people off public welfare. I've not only done that once, I've done it many times.

Emedinews:Makesure:A diabetic patient died of flu pneumonia.

Situation: A diabetic patient died of flu pneumonia.

Reaction: Oh my God! Why was flu vaccine not given?
Lesson: Make sure that all diabetics are given flu vaccine every year. 

Emedinews:Insights on Medicolegal issues: Immediate first aid may stop serious poisoning and may save life

If breathing and the heart stop, the person will die within a few minutes unless first aid is administered at once. Here is an action list. Each step is explained in more detail below the list. Start with the first step and follow each step in the order given. Act as quickly as you can, but stay calm.

• Check if the patient is conscious try to make the patient wake up. Shout "Are you all right?" and gently shake the shoulders, but take care not to make any injuries worse. Pinch the skin on the neck and watch the face. A patient who is just sleeping will wake up, but an unconscious patient will not.
• Open the airway. The airway is the tube through which air passes from the mouth and nose to the lungs. If it is blocked the patient cannot breathe and air cannot get into or out of the lungs. A patient who cannot breathe will die within 4 minutes. In an unconscious patient, the tongue may block the throat and the airway.
• Make sure the airway is open and air can get down the throat. Place the patient on his/her back. Tilt the head back and lift the chin up with the finger and thumb of one hand on the bony part of the chin, while pressing the forehead back with the other hand. This will open the airway and stop the tongue blocking the throat.
• Check whether the patient is breathing after opening the airway; quickly check whether the patient is breathing. Look for the belly or the chest moving up and down. Feel the chest moving up and down. Feel the patient's breathe on your cheek. Listen for breath sounds. Put your ear close to the patient's mouth.

Use all four checks. Remember that the chest may move up and down even when the throat is completely blocked and air cannot get to the lungs.

(Contributed by Dr Sudhir Gupta)

Emedinews:Insights on Medicolegal issues:Keep chemicals safely, Use it safely and get rid of left-over chemicals and empty containers

It is important to handle all chemicals safely, not just the ones that you know are poisons. Many chemicals that you might not think are poisonous could make someone ill or cause burns. It is very important to protect children, because they cannot protect themselves and they do not understand that some things can be poisonous. Many poisonings could be prevented if chemicals were kept safely, used safely and got rid of safely.

• Do keep medicines, cleaners and pesticides where children cannot see or reach them.
• Do not keep chemicals you no longer need.
• Do not put chemicals in containers that once contained food or drink; people may eat or drink the chemicals by mistake.
• Do use medicines, cleaners, pesticides and other chemicals in the right way, and use the right amount neither more nor less. Read the label and follow carefully the instructions for use. A person who cannot read it should find someone who can. It may be dangerous to use chemicals from unlabeled containers. Ask the supplier for another container with a label.
• Do find out whether it is better to bury or burn the chemicals you want to get rid of. Choose a place to bury or burn chemical waste where there will be as little danger as possible to the people living nearby or to the environment.
• Do find out from environmental health officers or community leaders the local arrangements for getting rid of chemical waste. Seek professional advice about how to get rid of large amounts of unwanted chemicals.
• Do not use empty bottles, cans or other containers that have been used for storing chemicals to store or cook food or drink. Do not give them to children to play with.
• Do not leave left-over chemicals or empty containers where children might find them.

(Contributed by Dr Sudhir Gupta)
• Do not throw left-over chemicals or empty containers near a river, pond or spring. Chemicals might get into the water and poison fish, or poison people or animals that drink the water or wash in it. This may also happen if chemical waste is poured into drains that empty into waterways.

Emedinews Inspiration: Admitting Flaws

In the mid–1980’s researchers at Cleveland State University made a startling discovery. They conducted an experiment by creating two fictitious job candidates David and John. The candidates had identical resumes and letters of reference. The only difference was that John’s letter included the sentence "Sometimes, John can be difficult to get along with". They showed the resumes to a number of personnel directors. Which candidate did the personnel directors overwhelmingly prefer? Difficult to get along with, John.

The researchers concluded the criticism of John made praise of John more believable. Admitting John’s wart actually helped sell John. Admitting flaws gives you more credibility. A key to selling.

(Contributed by Ms Ritu Sinha)

Emedinews Inspiration: Don't let Fear Hold you Back

A man once went to a fortune teller, curious to know what she would say about his future. The fortune teller looked into her magic ball and then her facial expression said it all. The man would die, she said, involved in a bus accident. This would happen within two to three months time, but she couldn't say exactly when. The man went home, depressed and worried telling himself how he never really believed in fortune tellers. Why should he now?

When two months passed, he had thought about what she said, day in and day out. Now he decided to lock himself in his house where he wouldn't come close to any buses for the next month.

Another 3 weeks went by when the man came down the stairs from his bedroom to make some coffee. His little son had left his toys on the floor of which one was a little toy bus. The man stepped on the bus, after his last step down the stairs, slipped and knocked his head against the stairway railing and died instantly.

Moral of the story: "Live life on the edge, don't lock yourself away."

(Contributed by Ms Ritu Sinha)

Emedinews:Insights on Medicolegal issues:Postmortem examination in a case of pneumothorax

The occurrence of sudden death presents a challenge in legal autopsy
• In cases of sudden death after pneumothorax, pneumoperitoneum, intravenous infusions, childbirth, operations, or sharp instrument injuries to the neck and thorax, it is important to check for air embolism to the heart.
• A postmortem chest x-ray should be taken and inspected for larger quantities of air in the heart and great vessels.
• Postmortem examination accuracy of observation, completeness of detail, and sound conclusions can be obtained only when the postmortem examination is made according to some definite and systematic plan so that regions and organs are successively examined without disturbing the relations and appearances yet to be investigated.
• Chest radiographs provide the most reliable method for determining the extent of pneumothoraces and whether or not a pneumothorax has resulted in mediastinal shift.
• Detection of a pneumothorax is easily done by holding the dissected skin and subcutaneous tissues of the chest to form a pocket adjacent to the ribcage in postmortem examination.
• The pocket is filled with water, and a scalpel is used to incise the thoracic cavity. The presence of air bubbles indicates a pneumothorax.
• In the cases of neonates and small infants during the autopsy, the thorax may be submerged in a bucket of water.
• The apparatuses described previously for detection of air emboli work equally well for detecting pneumothoraces

(Contributed by Dr Sudhir Gupta)

Emedinews Inspiration: Dealing with depression

The dictionary describes depression as a condition of general emotional dejection and withdrawal, sadness greater and more prolonged than that warranted by any objective reason. The question here is why does one get depressed? Is it the inability to cope with the situation or the high stress levels that come with success or failure? Life is full of twists and turns, some pleasant others not so pleasant or at times dreadful. No one is devoid of problems in their lives. Everyone has their own personal set of problems. Even the people who have a smile constantly on their face have problems. The only difference is they know how to tackle the problems of their life and smile about the fact that they can overcome those problems, similar to Mother Nature.

Someone compared the changes in Mother Nature with depression so aptly. He said each year nature sheds all its charm and the vibrant colors but then again it blooms to its optimum capacity to smile and teach us the most valuable lesson of life. Seasonal changes are the main reason for depression in nature. Change is inevitable, be it in nature or in our life, but what are the changes is subjective. They may differ person to person, and so will the approach towards them.

Getting into depression is a normal phenomenon, but letting it over take us completely is not the best thing. There are no specific rules or concepts to deal with it, whatever way one feels is the best way, and one should adopt to tackle it.

Here are some really easy ways to tackle this "blown out of proportion problem".

1. Lead your life on the basis of fundamental values of what is right and what's wrong.

2. Avoid hurting others and yourself too.

3. It's easier to change and adapt ourselves to new circumstances, than to expect vice a versa.

4. Don't make any decisions when angry or sad.

5. Fight it. If you can't, then get help.

6. Enjoy nature; it's free.

7. Spend time with our own self to introspect and retrospect daily.

8. Yell, scream or punch the bag if you feel like doing it.

9. Be joyful genuinely and not just put up the mask of happiness.

10. Last, but not the least, do not underestimate the power of Prayers.

(Contributed by Ms Ritu Sinha)

Emedinews:Insights on Medicolegal issues:Failure to detect poison in chemical analysis by forensic lab

In some cases no trace of poison is found on analysis although from other circumstances it is quite certain that poison was the cause of illness or death. The possible explanations of a negative finding are:

• The poison may have been eliminated due to vomiting, stomach wash or diarrhea
• The whole of the poison may have disappeared from the lungs by evaporation or oxidation
• The poison after absorption may have been detoxified, conjugated and eliminated from the system
• Some drugs are rapidly metabolized, making extraction difficult.
• Some biological toxins and venoms, which are protein in nature cannot be separated from body tissues.
• Some organic poisons especially alkaloids may, by oxidation during life, or due to faulty preservation, or a long interval of time, or from decomposition of the body, deteriorate and cannot be detected.
• If the poison act slowly and death is delayed following production of irreversible organic changes, the poison may be completely metabolized and excreted.
• Many drugs may be present in very small amounts and these may require considerable amount of viscera for their identification.
• When the wrong or insufficient material has been sent for analysis.

(Contributed by Dr Sudhir Gupta)

Emedinews Inspiration: Cure for Sorrow

There is an old Chinese tale about a woman whose only son died. In her grief, she went to the holy man and said, "What prayers, what magical incantations do you have to bring my son back to life?"

Instead of sending her away or reasoning with her, he said to her, "Fetch me a mustard seed from a home that has never known sorrow. We will use it to drive the sorrow out of your life." The woman went off at once in search of that magical mustard seed.

She came first to a splendid mansion, knocked at the door, and said, "I am looking for a home that has never known sorrow. Is this a place? It is very important to me."

They told her, "You've certainly come to the wrong place," and began to describe all the tragic things that recently had befallen them.

The woman said to herself, "Who is better able to help these poor, unfortunate people that I, who have had misfortune of my own?" She stayed to comfort them, then went on in search of a home that had never known sorrow. But wherever she turned, in hovels and in other places, she found one tale after another of sadness and misfortune. She became so involved in ministering to other people's grief that ultimately she forgot about her quest for the magical mustard seed, never realizing that it had, in fact, driven the sorrow out of her life.

(Contributed by Ms Ritu Sinha)

HCFI Update: Anmol – School Festival for Children with Special Needs

Anmol - Interschool Festival for Children with Special Needs will be organized on Monday, 17th October, 2011 as part of 18th MTNL Perfect Health Mela.

The festival will be organized by Heart Care Foundation of India, Department of Health, Government of Delhi, NDMC, MCD and World Fellowship of Religions in association with Balwant Rai Mehta School at the school premises at Kalkaji. Over 30 NCR schools will be participating in the event.

Giving the details, Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal President of Heart Care Foundation of India and MTNL Perfect Health Mela said that this unique event is organized every year to spread the message in the community that these children are not disabled or handicapped, they are only differently abled. If they lose one of the faculties in the body, they compensate it by cultivating some other faculty.

This year theme for the competition is Science behind rituals. The competition will include painting, cartoon making, collage making, rangoli making, dance etc.

Emedinews: Insights on Medicolegal issues - The implied duty of doctor is not the guarantee of cure but to treat the case with diligence and skill

The Connecticut court focused on the word "ordinary”…A physician and surgeon, in the performance of his professional duties, is liable for injuries resulting from the want of ordinary diligence, care and skill...."Ordinary" means usual, common....If in the performance of any operation there was a want of ordinary diligence, care, and skill, or if there was carelessness, then the defendant-physician is liable.

• The implied contract of a physician or surgeon is not to cure...but to treat the case with diligence and skill. The question is...whether the doctor had employed such skill and diligence as are ordinarily exercised in his profession.... The rule [is] to be reasonable....The law demands...not extraordinary skill such as belongs only to a few men of rare genius and endowments, but that degree which ordinarily characterizes the profession.

• In 1860, the Supreme Court of Illinois issued its first decision on what constitutes the standard of care of a medical physician. The lawsuit claimed that a physician, who incidentally was represented by a then-practicing attorney named Abraham Lincoln, had been negligent for improperly applying a cast to treat a wrist fracture that had been sustained by the plaintiff. The court declared

• When a person assumes the profession of physician and surgeon, he must...be held to employ a reasonable amount of skill and care. For anything short of that degree of skill in his practice, the law will hold him responsible for any injury which may result from its absence.

• While he is not required to possess the highest order of qualification, to which men attain, still he must possess and exercise that degree of skill which is ordinarily possessed by members of the profession. And whether the injury results from a want of skill or the want of its application, he will, in either case, be equally liable.

(Contributed by Dr Sudhir Gupta)

Insights on Medicolegal Issues: Blood samples in a medicolegal case

Clean the injection site with a saline swab and not a spirit swab if the sample of blood is to be collected for alcohol estimation.
• About 3-4 ml of blood is drawn as sample in chemically clean evacuated tubes of 5ml.
• The tubes used should be waterproof and not vulnerable to freezing. Labels with identification codes should be used.
• EDTA should be used as anticoagulant. Tubes with liquid EDTA /fluoride reduce the risk of hemolysis that may alter results.
• 2ml of 5% aqueous solution of sodium citrate containing 0.2% w/v of formaldehyde or 0.5% w/v of formalin solution must be added to prevent decomposition, which alters results.
• Plastic vacuum tubes/ Plastic vacuum gel tubes are preferred to glass tubes. If vacuum tubes are not available or tubes are opened for freely flowing samples, stoppers that do not react with blood constituents should be available.
• Special boxes for tube transfer and storage, earmarked refrigerator/ freezer must be available in the hospital conducting medicolegal cases
• About 3-4 ml of blood is taken in a sterile 5ml injection vial (properly sealed and labeled) containing about 2ml of 5% aqueous solution of sodium citrate containing 0.2% w/v of formaldehyde (or 0.5% w/v of formalin solution).
• Two blood stains, about 1cm x 1cm size, are formed on clean cotton cloth/gauze piece. After drying, they are transferred to a sterile 10ml injection vial. They should be properly dried, before packing to avoid decomposition and then sealed and labeled.
• Bloodstains located on the body of an uninjured person are taken by rubbing with moistened clean cotton cloth pieces. The same should be properly dried, before packing to avoid decomposition and then sealed and labeled.

(Contributed by Dr Sudhir Gupta)

Emedinews Inspiration: Determination and Persistence

This is a real life story of engineer John Roebling who built the Brooklyn Bridge in New York, USA back in 1870. The bridge was completed in 1883, after 13 years.

In 1883, a creative engineer named John Roebling was inspired by an idea to build a spectacular bridge connecting New York with the Long Island. However bridge building experts throughout the world thought that this was an impossible feat and told Roebling to forget the idea. It just could not be done. It was not practical. It had never been done before. Roebling could not ignore the vision he had in his mind of this bridge. He thought about it all the time and he knew deep in his heart that it could be done. He just had to share the dream with someone else. After much discussion and persuasion he managed to convince his son Washington, an up and coming engineer, that the bridge in fact could be built.

Working together for the first time, the father and son developed concepts of how it could be accomplished and how the obstacles could be overcome. With great excitement and inspiration, and the headiness of a wild challenge before them, they hired their crew and began to build their dream bridge. The project started well, but when it was only a few months underway a tragic accident on the site took the life of John Roebling. Washington was also injured and left with a certain amount of brain damage, which resulted in him not being able to talk or walk.

“We told them so.” “Crazy men and their crazy dreams.” “It’s foolish to chase wild visions.” Everyone had a negative comment to make and felt that the project should be scrapped since the Roebling’s were the only ones who knew how the bridge could be built.

In spite of his handicap Washington was never discouraged and still had a burning desire to complete the bridge and his mind was still as sharp as ever. He tried to inspire and pass on his enthusiasm to some of his friends, but they were too daunted by the task. As he lay on his bed in his hospital room, with the sunlight streaming through the windows, a gentle breeze blew the flimsy white curtains apart and he was able to see the sky and the tops of the trees outside for just a moment.

It seemed that there was a message for him not to give up. Suddenly an idea hit him. All he could do was move one finger and he decided to make the best use of it. By moving this, he slowly developed a code of communication with his wife. He touched his wife’s arm with that finger, indicating to her that he wanted her to call the engineers again. Then he used the same method of tapping her arm to tell the engineers what to do. It seemed foolish but the project was under way again.

For 13 years Washington tapped out his instructions with his finger on his wife’s arm, until the bridge was finally completed. Today the spectacular Brooklyn Bridge stands in all its glory as a tribute to the triumph of one man’s indomitable spirit and his determination not to be defeated by circumstances. It is also a tribute to the engineers and their team work, and to their faith in a man who was considered mad by half the world. It stands too as a tangible monument to the love and devotion of his wife who for 13 long years patiently decoded the messages of her husband and told the engineers what to do.

Perhaps this is one of the best examples of a never-say-die attitude that overcomes a terrible physical handicap and achieves an impossible goal. Often when we face obstacles in our day-to-day life, our hurdles seem very small in comparison to what many others have to face. The Brooklyn Bridge shows us that dreams that seem impossible can be realized with determination and persistence, no matter what the odds are.

(Contributed by Ms Ritu Sinha)

Emedinews: Insights on Medicolegal issues - In MLC cases, the direction of the shelving of margins of a lacerated wound indicates the direction of the blow applied to cause the wound.

• Lacerations are tears or splits of skin, mucous membranes, muscle or internal organs produced by application of blunt force to a broad area of the body that has crushed or stretched tissues beyond the limits of their elasticity.
• Crush injury from a direct blow may produce an irregular or stellate laceration with a variable degree of devitalized tissue, abrasion and visible contamination.
• Do not close a laceration if there is visible contamination, debris, non-viable tissue or signs of infection. Wounds may involve vascular areas of the face and scalp where the risk of infection is low or extremities where infection becomes a greater risk, along with the possibility of tendon and nerve damage. The elderly and patients on chronic steroid therapy may present with "wet tissue paper" skin tears following relatively minor trauma.
• When produced by a blunt weapon, such as club, crowbar, stone, brick etc., a lacerated wound is usually accompanied by a considerable amount of bruising of the surrounding and underlying tissues, and has inverted and irregular edges. The direction of the shelving of margins of a lacerated wound indicates the direction of the blow applied to cause the wound.
• When a heavy weight like a wheel of a heavy cart or a truck passes over an extremity, by its shearing and grinding force, it tears the skin from the underlying tissue and crushes the muscles and soft part lying beneath it realizing considerable blood and fat in them.
• Crush injury syndrome or fat emboli may follow a lacerated wound. The tear, avulsion, split are types of laceration.

(Contributed by Dr Sudhir Gupta)

Emedinews: Inspiration: The Cookie Thief

A woman was waiting at an airport one night, with several long hours before her flight. She hunted for a book in the airport shops, bought a bag of cookies and found a place to drop. She was engrossed in her book but happened to see, that the man sitting beside her, as bold as could be. . .grabbed a cookie or two from the bag in between, which she tried to ignore to avoid a scene. So she munched the cookies and watched the clock, as the gutsy cookie thief diminished her stock. She was getting more irritated as the minutes ticked by, thinking, “If I wasn’t so nice, I would blacken his eye.” With each cookie she took, he took one too, when only one was left; she wondered what he would do. With a smile on his face, and a nervous laugh, he took the last cookie and broke it in half.

He offered her half, as he ate the other; she snatched it from him and thought… oooh, brother. This guy has some nerve and he’s also rude, why he didn’t even show any gratitude!

She had never known when she had been so galled and sighed with relief when her flight was called. She gathered her belongings and headed to the gate, refusing to look back at the thieving ingrate. She boarded the plane, and sank in her seat, then she sought her book, which was almost complete. As she reached in her baggage, she gasped with surprise, there was her bag of cookies, in front of her eyes. If mine are here, she moaned in despair, the others were his, and he tried to share. Too late to apologize, she realized with grief, that she was the rude one, the ingrate, the thief.

(Contributed by Ms Ritu Sinha)

Emedinews:Insights on Medicolegal issues:What is the difference between antemortem and postmortem bruises?

A bruise is also called a contusion.

• Some people bruise easily, whereas others may have tougher skin tissue. Apply a cold compress to the bruise for at least 10 minutes to reduce swelling or the amount of bruising after an injury.

• In some cases of brought dead or dead in arrival, the doctor attending the case in emergency may get confused or may not be able to differentiate between antemortem bruise and postmortem artifacts and the postmortem bruise is entered in MLC as injury. I have seen many such cases in AIIMS while conducting an autopsy.

• But, it is possible to differentiate on close examination because in antemortem bruises there is swelling and damage to epithelium, coagulation and infiltration of the tissues blood and color changes. These signs are always remain absent in postmortem bruises.

• It is seen that contusions and abrasions produced immediately after death show a very low degree of changes.

• Appreciable bruising does not occur after 2-3 minutes of death due to arrest of heart and blood circulation, but by using great violence small bruises can be produced up to 3 hours after death where the tissue can be forcibly compressed against the bone or if the body is dropped on the ground from a height or from transport trolleys or running vehicle.

• Some of the evidences of bleeding are seen without history of trauma due to tearing of small veins in the skin when the body is lifted from the scene of death and transportation handling and the same is called postmortem artifact.

(Contributed by Dr Sudhir Gupta)