Emedinews:Insights on Medicolegal issues: Right coronary artery supplying blood to the electrical area of heart is called artery of sudden death

• The most common cause of sudden cardiac death in adults over the age of 40 has been coronary artery atheroma seen in postmortem examination in about 100 cases randomly selected by me in the mortuary of AIIMS.
• The most common finding at postmortem examination is chronic high-grade stenosis of minimum one segment of a major coronary artery, the arteries which supply the heart muscle with its blood supply. A significant number of cases also have an identifiable clot in a major coronary artery which causes transmural occlusion of that vessel.
• In 75 cases out of hundred cases, the clot was found in the right coronary artery supplying the electrical area of heart. Death in these cases is thought to result from a period of transient or prolonged lack of blood supply in the muscle of the heart wall which induces an ventricular arrhythmia/fibrillation and no changes in the myocardium is seen during postmortem examination.
• The absence of the histological signs of acute necrosis and a healed infarct are a common finding.
• Chronic high-grade stenosis causing previous episodes of ischemia and areas of focal fibrosis is seen histologically in the myocardium.
• Ventricular arrhythmias may arise from a myocardium which has been previously scarred by episodes of ischemia.

Emedinews:Makesure:A patient with pseudomonas meningitis was not responding

Situation: A patient with pseudomonas meningitis was not responding.
Reaction: Oh my God! Why was aminoglycoside not added?
Make sure that when pseudomonas meningitis is suspected, combination therapy with two antibiotics from different classes to which the isolate is susceptible are given and one antibiotic is an aminoglycoside, unless the use is precluded by nephrotoxicity. The therapy should continue for at least 21 days.

Emedinews:Inspiration: Just listen

I suspect that the most basic and powerful way to connect to another person is to listen. Just listen. Perhaps the most important thing we ever give each other is our attention. And especially if it's given from the heart. When people are talking, there's no need to do anything but receive them. Just take them in. Listen to what they're saying. Care about it. Most times caring about it is even more important than understanding it. Most of us don't value ourselves or our love enough to know this. It has taken me along time to believe in the power of simple saying, "I'm so sorry," when someone is in pain. And meaning it.

One of my patients told me that when she tried to tell her story people often interrupted to tell her that they once had something just like that happen to them. Subtly her pain became a story about themselves. Eventually she stopped talking to most people. It was just too lonely. We connect through listening. When we interrupt what someone is saying to let them know that we understand, we move the focus of attention to ourselves. When we listen, they know we care. Many people with cancer can talk about the relief of having someone just listen.

I have even learned to respond to someone crying by just listening. In the old days I used to reach for the tissues, until I realized that passing a person a tissue may be just another way to shut them down, to take them out of their experience of sadness and grief. Now I just listen. When they have cried all they need to cry, they find me there with them.

This simple thing has not been that easy to learn. It certainly went against everything I had been taught since I was very young. I thought people listened only because they were too timid to speak or did not know the answer. A loving silence often has far more power to heal and to connect than the most well intentioned words.

(Contributed by Ms Ritu Sinha)

Emedinews:Insights on Medicolegal issues: Simulated suicide by hanging

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Simulated suicide by hanging

·        The most common method of suicide all over the world is hanging because the factors deciding method of suicide are like accessibility, feasibility, credibility of method causing death and rapidity of the method.

·        As the death by hanging is being easily achieved using cheap and easily available materials resulting in fast and painless death.

·        After homicidal strangulation means homicides by hanging and the simulation of suicide by hanging a victim previously killed or made unable to resist by other means are regarded as extremely rare events, although especially in German forensic literature cases of this kind were repeatedly reported.

·         Example to the number of observations published so far: A 23-year-old student strangled his 58-year-old father with an electric cable until he ceased to show any signs of life. Then he hanged the victim at the handrail of the staircase with a running noose.

·        From the forensic point of view the following clues pointed to homicide: presence of massive signs of facial congestion in spite of the "typical" situation of hanging, horizontal ligature mark in addition to the noose mark, skin injuries at the head and the upper extremities, traces of blood near the place where the body was found.

·        The case history presented emphasizes again that for differential diagnosis the possibility of a dissimulated homicide has to be considered in all cases where a body is found suspended.

Reference InstitutfürGerichtlicheMedizin, UniversitätTübingen.

Emedinews:Makesure:A patient with diabetes shows deteriorating kidney function.

Situation: A patient with diabetes shows deteriorating kidney function.

Reaction: Oh my God! His HbA1c is very high?

Lesson: Make sure that strict glycemic control is maintained in patients with type 2 diabetes in order to delay vascular complications.

Emedinews:Inspiration: A harsh word

A woman used to buy eggs and butter from a farmer who had a fine reputation not only for the quality of his products, but also for his promptness of delivery. One fine day, when she was expecting guests, he failed to come. On the next delivery, she spoke harshly to him. At the end of her tirade he said quietly, "I'm sorry if I caused you any inconvenience, but I had the misfortune of burying my mother yesterday."

Ashamed, the woman determined never to speak harshly to anyone again until she fully understood the cause of the delay.

Often we never care for other travails and traumas. Like a frog in the well, our feelings remain confined to our milieu. Even a farmer has his own priorities. Sometimes, we do not empathize with others. Had we been stricken with some tragedy, if someone callously chastises us, then?

Emedinews:Insights on Medicolegal issues: Autopsy findings in manual strangulation

Autopsy findings in manual strangulation

• The autopsy findings fall into two groups: Local signs of violence, and the signs of the mechanism of death

• Bruising on the neck is the result of the assailant’s attack, whereas abrasions may be from either the victim or assailant. The bruises are mainly discoid, but may run together into larger areas of neck bruising. The discoid marks are from finger-pads and are about 1-2 cm in size, though, longer, irregular marks may occur where the fingers skid across the skin surface, especially along the jaw margins. The bruises tend to cluster at the sides of the neck, often high up under the angles of the jaw. Some may overlap the jaw line and trespass on the chin, but others can be lower on the neck spreading down to the inner ends of the clavicles.

• As a result of the shifting grip, often caused by the struggles of the victim, bruising can occur anywhere, even at the posterolateral sides of the neck, and on the upper chest over the sternum and collar bones. Some may be seen in the grooves on either side of the larynx, over the anterior edge of the stern mastoid. They are also common over the prominence of the larynx and at the level of the cricoid.

• Abrasions on the neck: scratches may be caused by the assailant or the victim, usually from fingernails. As with bruising, rough finger pads, especially from a male hand on the delicate skin of a female neck, may abrade the epidermis and underlying bruises may be overlain by diffuse abrasions, again often seen along the margin of the jaw line.

• Linear scratches are the hallmark of fingernails and when a woman strangles a child, the often longer nails of the woman may leave obvious marks. Whether male or female, the scratches are of two types: when the pressure is static, straight or curved marks up to a centimeter in length are made; when the nails skid down the skin, linear lines may result, sometimes several centimeters in length.

• The alleged assailant should always be examined medically to correlate any injuries that may have been inflicted on him by the fingernails of the victim such as facial or hand scratches by the fingernails of the victim. If he/she is examined soon after the offence, his own fingernail scrapings should be taken, especially if the victim has neck abrasions, so that comparison studies can be made between any debris found and the tissue types of the victim.

(Ref: Bernard Knight Forensic Pathology 3^rd edition)

EMddinews:Makesure:A patient with dengue developed acute lung injury after platelet transfusion

Situation: A patient with dengue developed acute lung injury after platelet transfusion
Reaction: Oh my God! Why were platelets transfused?
Lesson: Make sure that no platelets are transfused unless there is significant spontaneous bleeding.

Emedinews:Inspiration:Wisdom and kindness make a person attractive

A little boy wanted to meet God. He knew it was a long trip to where God lived, so he packed his suitcase with a bag of potato chips and a six-pack of root beer and started his journey.

When he had gone about three blocks, he met an old woman. She was sitting in the park, just staring at some pigeons. The boy sat down next to her and opened his suitcase. He was about to take a drink from his root beer when he noticed that the old lady looked hungry, so he offered her some chips. She gratefully accepted it and smiled at him.

Her smile was so pretty that the boy wanted to see it again, so he offered her a root beer. Again, she smiled at him. The boy was delighted! They sat there all afternoon eating and smiling, but they never said a word.

As twilight approached, the boy realized how tired he was and he got up to leave. But before he had gone more than a few steps, he turned around, ran back to the old woman, and gave her a hug. She gave him her biggest smile ever. When the boy opened the door to his own house a short time later, his mother was surprised by the look of joy on his face. She asked him, "What did you do today that made you so happy?" He replied, "I had lunch with God." But before his mother could respond, he added, "You know what? She's got the most beautiful smile I've ever seen!"

Meanwhile, the old woman, also radiant with joy, returned to her home. Her son was stunned by the look of peace on her face and he asked, "Mother, what did you do today that made you so happy?" She replied! "I ate potato chips in the park with God." However, before her son responded, she added, "You know, he's much younger than I expected."

Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around. People come into our lives for a reason, a season, or a lifetime! Embrace all equally!

Have lunch with God.......bring chips. Send this to people who have touched your life in a special way. Let them know how important they are.

God still sits on the throne. You may be going through a tough time right now but God is getting ready to bless you in a way that only He can. Keep the faith. My instructions were to pick four people that I wanted God to bless, and I picked you.

P.S.: Wisdom and kindness make a person attractive.

Emedinews:Insights on Medicolegal issues: Simulated suicide by hanging

Simulated suicide by hanging

• The most common method of suicide all over the world is hanging. The factors deciding using this method of suicide are accessibility, feasibility, credibility of method causing death and rapidity of the method.

• Fast and painless death by hanging is easily achieved by using cheap and easily available materials.

• Cases of homicidal strangulation and the simulation of suicide by hanging a victim previously killed or made unable to resist by other means are regarded as extremely rare events, but have been reported. Example: A 23-year-old student strangled his 58-year-old father with an electric cable until he ceased to show any signs of life. Then he hanged the victim at the handrail of the staircase with a running noose.

• From the forensic point of view the following clues pointed to homicide: presence of massive signs of facial congestion in spite of the "typical" situation of hanging, horizontal ligature mark in addition to the noose mark, skin injuries at the head and the upper extremities, traces of blood near the place where the body was found.

• The case history presented emphasizes again that for differential diagnosis the possibility of a dissimulated homicide has to be considered in all cases where a body is found suspended.

(Ref: Institut für Gerichtliche Medizin der Universität Tübingen, Germany).

Emedinews:Makesure:A 13-year-old girl complained of epigastric pain, fatigue and anorexia. Elevated serum gastrin level (900 mIU/l) raised the suspicion of gastrinoma.

Situation: A 13-year-old girl complained of epigastric pain, fatigue and anorexia. Elevated serum gastrin level (900 mIU/l) raised the suspicion of gastrinoma.
Reaction: Oh my God! Why did you not put her on triple therapy for H. pylori infection?
Lesson: Make sure to remember that H. pylori infection is the most important cause of hypergastrinemia other than gastrinoma in childhood.

Emedinews:Inspiration: Success is 99% Failure: The Story of Soichiro Honda

  

Who is a true winner? We may be very familiar with Honda Motors. They’re everywhere, from cars to motorcycles. But do you know the real story of how challenging it was for Mr. Soichiro Honda to establish Honda Motors?

Like most other countries, Japan was badly hit by the Great Depression of the 1930s. In 1938, Soichiro Honda was still in school, when he started a little workshop, developing the concept of the piston ring. His plan was to sell the idea to Toyota. He labored night and day, even slept in the workshop, always believing he could perfect his design and produce a worthy product. He was married by now, and pawned his wife’s jewelry for working capital.

Finally, came the day he completed his piston ring and was able to take a working sample to Toyota, only to be told that the rings did not meet their standards! Soichiro went back to school and suffered ridicule when the engineers laughed at his design.

He refused to give up. Rather than focus on his failure, he continued working towards his goal. Then, after two more years of struggle and redesign, he won a contract with Toyota.

By now, the Japanese government was gearing up for war! With the contract in hand, Soichiro Honda needed to build a factory to supply Toyota, but building materials were in short supply. Still he would not quit! He invented a new concrete-making process that enabled him to build the factory.

With the factory now built, he was ready for production, but the factory was bombed twice and steel became unavailable, too. Was this the end of the road for Honda? No!

He started collecting surplus gasoline cans discarded by US fighters – “Gifts from President Truman,” he called them, which became the new raw materials for his rebuilt manufacturing process. Finally, an earthquake destroyed the factory.

After the war, an extreme gasoline shortage forced people to walk or use bicycles. Honda built a tiny engine and attached it to his bicycle. His neighbors wanted one, and although he tried, materials could not be found and he was unable to supply the demand.

Was he ready to give up now? No! Soichiro Honda wrote to 18,000 bicycles shop owners and, in an inspiring letter, asked them to help him revitalize Japan. 5,000 responded and advanced him what little money they could to build his tiny bicycle engines. Unfortunately, the first models were too bulky to work well, so he continued to develop and adapt, until finally, the small engine ‘The Super Cub’ became a reality and was a success. With success in Japan, Honda began exporting his bicycle engines to Europe and America.

End of story? No! In the 1970s there was another gas shortage, this time in America and automotive fashion turned to small cars. Honda was quick to pick up on the trend. Experts now in small engine design, the company started making tiny cars, smaller than anyone had seen before, and rode another wave of success.

Today, Honda Corporation employs over 100,000 people in the USA and Japan, and is one of the world’s largest automobile companies. Honda succeeded because one man made a truly committed decision, acted upon it, and made adjustments on a continuous basis. Failure was simply not considered a possibility.

Emedinews:Insights on Medicolegal issues: Doctor and care of the terminally ill

Doctor and care of the terminally ill

The duty of the physician is to heal and, where possible, relieve suffering and act to protect the best interests of his patients. There shall be no exception to this principle even in the case of incurable disease or malformation.

This principle does not preclude application of the following rules:

• The physician may relieve suffering of a terminally ill patient by withholding treatment with the consent of the patient or his immediate family if unable to express his will.
• Withholding of treatment does not free the physician from his obligation to assist the dying person and give him the necessary medicaments to mitigate the terminal phase of his illness.
• The physician shall refrain from employing any extraordinary means, which would prove of no benefit for the patient.
• The physician may, when the patient cannot reverse the final process of cessation of vital functions, apply such artificial means as are necessary to keep organs active for transplantation provided he acts in accordance with the laws of the country or by virtue of a formal consent given by the responsible person and provided the certification of death or the irreversibility of vital activity had been made by physicians unconnected with the transplantation and the patient receiving treatment.
• These artificial means shall not be paid for by the donor or his relatives. Physicians treating the donor shall be totally independent of those treating the recipient and of the recipient himself.

Emedinews:Makesure:A foreigner with a single loose stool developed sepsis.

Situation: A foreigner with a single loose stool developed sepsis.
Reaction: Oh my God! Why were antibiotics not started in time?
Lesson: Make sure that all foreigners are diagnosed to be suffering from Travelers’ diarrhea even if there is one single loose motion.

Emedinews:Inspiration:Is the Cross you wear too heavy to bear?

Complainingly I told myself, "This cross is too heavy to wear"

And I wondered discontentedly why God gave it to me to bear. And I looked with envy at others whose crosses seemed lighter than mine and wished that I could change my cross for one of a lighter design.

And then, in a dream, I beheld the cross I impulsively wanted to wear, It was fashioned of pearls and diamonds and gems that were precious and rare.

And when I hung it around my neck the weight of the jewels and the gold was much too heavy and cumbersome for my small, slender neck to hold So I tossed it aside and before my eyes was a cross of rose-red flowers And I said with delight as I put it on, "this cross I can wear for hours" For it was so dainty and fragile, so lovely and light and thin, But I had forgotten about the thorns that started to pierce my skin And then in my dream I saw "my cross," rugged and old and plain, that clumsy old cross I had looked upon with discontented disdain.

And at last I knew that God had made this "special cross for me," For God in His great wisdom knew what I before could not see, that often the loveliest crosses are the heaviest crosses to bear. For only God is wise enough to choose the cross we can wear. So never complain about Your Cross, for your cross has been blest, God made it Just For You to wear and remember, God knows best!!!!

Emedinews:Insights on Medicolegal issues: If the cadaver receives a head injury by colliding with blunt object there will be bleeding

If the cadaver receives a head injury by colliding with blunt object there will be bleeding

After death, the blood stays liquid in the vessels and no longer clots. Careless handling of a cadaver may produce some post-mortem bruising which may need to be distinguished from ante mortem bruising. Blood also tends to pool under gravity after death, causing a bruised appearance in the lower limbs, arms, hands, and feet known as discoloration. Some of the smaller vessels may even hemorrhage under the pressure of this pooled blood. These bruises could be confused with ante-mortem bruising

·        The injuries which are received in the body prior or before death is called the ante mortem injury in medicine. These injuries may be a contributing factor in the death or even its cause however on the other hand, they may have occurred many days/months or years ago too.

·        During the autopsy surgeon assesses the age of ante mortem injuries, as well as distinguishing them from postmortem injuries—that is, injuries occurring after death. Postmortem injury can come from various sources such as deliberate mutilation of a body by a murderer following a homicide, predation by wild animals, or careless handling in the mortuary. Postmortem injuries can cause confusion over the manner and cause of death.

·        One major difference between an ante mortem and a postmortem injury is the presence of signs of bleeding. While the person is still alive, the blood is circulating and any injuries such as cuts or stabs will bleed. After death, the body usually does not bleed. However, there are exceptions. For instance, when a person drowns, their body usually floats face down and these results in the head becoming congested with blood.

·        If the cadaver receives a head injury by colliding with blunt object/force, then there could be some evidence of bleeding. Scalp wounds sustained after death may also leak some blood. It can be especially difficult to distinguish between injuries inflicted in the very last few minutes of life and those caused postmortem. If the person collapses, there may be areas of laceration to the head and scalp which may be very hard to interpret.

·        Recent research has focused on improved techniques for distinguishing between an ante mortem and a postmortem injury by analyzing damaged tissue. Ante mortem injuries show signs of inflammation, while postmortem injuries do not. Some research suggests that tissue from ante mortem injuries contains a chemical involved in inflammation leukotriene B4 (LTB4).

·         Postmortem injuries were found to have no LTB4. This could help the doctor for assessment of the injuries more accurately.

Emedinews:Makesure:A patient on gentamicin developed polyuria on 7th day. He developed renal failure on 9th day

Situation: A patient on gentamicin developed polyuria on 7th day. He developed renal failure on 9th day.
Reaction: Oh my God! Why was gentamicin toxicity not suspected when the urine output increased?
Lesson: Make sure that all patients on gentamicin are examined for toxicity. The first indication is increased output.

Emedinews:Inspiration:I Refuse to be Discouraged

I refuse to be discouraged, to be sad, or to cry; I refuse to be downhearted, and here's the reason why: I have a God Who's mighty, Who's sovereign and supreme; I have a God who loves me, and by grace I'm on His team.

He is all-wise and powerful. Jesus is His name; though everything is changeable, My God remains the same. My God knows all that's happening; Beginning to the end; His presence is my comfort; He is my dearest Friend.

When sickness comes to weaken me, to bring my head down low, I call upon my mighty God; Into His arms I go. When circumstances threaten to rob me of my peace; He draws me close unto His breast, where all my strivings cease.

When my heart melts within me, and weakness takes control; He gathers me into His arms, He soothes my heart and soul. The great "I AM" is with me. My life is in His hand. The "Son of the Lord" is my hope. It's in His strength I stand.

I refuse to be defeated. My eyes are on my God; He has promised to be with me, as through this life I trod. I'm looking past all my circumstances, To Heaven's throne above; my prayers have reached the heart of God I'm resting in His love.

I give God thanks in everything. My eyes are on His face; the battle's His, the victory mine; He'll help me win the race. I can do all things through Christ who strengthens me!!!!

Emedinews:Insights on Medicolegal issues: Antemortem vs postmortem injury

• The injuries which are received in the body prior or before death is called the antemortem injury in medicine. These injuries may be a contributing factor in the death or even its cause however on the other hand, they may have occurred many days/months or years ago too.

• During the autopsy, surgeon assesses the age of antemortem injuries, as well as distinguishes them from postmortem injuries, which occur after death. Postmortem injury can be from various sources such as deliberate mutilation of a body by a murderer following a homicide, predation by wild animals, or careless handling in the mortuary. Postmortem injuries can cause confusion over the manner and cause of death.

• One major difference between an antemortem and a postmortem injury is the presence of signs of bleeding. While the person is still alive, the blood is circulating and any injuries such as cuts or stabs will bleed. After death, the body usually does not bleed. However, there are exceptions. For instance, when a person drowns, their body usually floats face down and these results in the head becoming congested with blood.

• Careless handling of a cadaver may produce some post-mortem bruising which may need to be distinguished from ante mortem bruising. Blood also tends to pool under gravity after death, causing a bruised appearance in the lower limbs, arms, hands, and feet known as discoloration. Some of the smaller vessels may even hemorrhage under the pressure of this pooled blood. These bruises could be confused with antemortem bruising.

• If the cadaver receives a head injury by colliding with blunt object/force, then there could be some evidence of bleeding. Scalp wounds sustained after death may also leak some blood. It can be especially difficult to distinguish between injuries inflicted in the very last few minutes of life and those caused postmortem. If the person collapses, there may be areas of laceration to the head and scalp which may be very hard to interpret.

• Recent research has focused on improved techniques for distinguishing between an ante mortem and a postmortem injury by analyzing damaged tissue. Antemortem injuries show signs of inflammation, while postmortem injuries do not. Some research suggests that tissue from ante mortem injuries contains a chemical involved in inflammation leukotriene B4 (LTB4). Postmortem injuries were found to have no LTB4. This could help in more accurate assessment of injuries.

Emedinews:Makesure: patient developed fainting attack after sublingual nitrate.

Situation: A patient developed fainting attack after sublingual nitrate.
Reaction: Oh my God! Why was the systolic murmur missed on auscultation?
Lesson: Make sure that patient with LVOT obstruction are not given sublingual nitrates.

Emedinews:Inspiration:How to Pray with God's Way

Please teach me; Lord...I want to know exactly how to pray. I need some words, which ones are right? Please tell me what to say. I've bowed my head I have knelt down, but... should I be upright? I've closed my eyes, I've raised my hands, or... should I fold them tight?

Do I stand up? Should I sit down? Dear Lord... what do you like? Are lights turned on or are they off? Maybe... candle light? Wear my glasses? Take them off? Be at my desk or table? Should I whisper? Speak out loud?

Do I quote the Bible? What do you think about the time? Do you prefer the dawn? Should I pray fast, or keep it slow? Better short... or long? I'm new at this what are the rules? I want to do it right.

How do I know you’ll even hear that I am in your sight? And while I sat there quietly, waiting for some sign, I heard a gentle voice say, "Oh, dearest child of mine... Do you think I really care about the time of day, or whether you are standing up, or kneeling when you pray?"

"I don't care about your posture, or about the place you choose; just open up your soul to me, I have no other rules. Tell me what is in your heart, and tell me what you seek; tell me of your sorrows, And of those things that made you weak." "Speak to me in private about what concerns you most; I know about your good deeds... You have no need to boast.

My child, you don't need lessons, Just talk to me each day; Tell me anything you want, dear child, anyone can pray."

Emedinews:Inspiration: Laughing Buddha

In actuality he was named Hotei or Pu-Tai is best known as the jolly Laughing Buddha. In China, he is known as the Loving or Friendly One. He is based on an eccentric Chinese Ch'an (Zen) monk who lived over 1,000 years ago and has become a significant part of Buddhist and Shinto culture. Because of this monk's benevolent nature, he came to be regarded as an incarnation of the Bodhisattva who will be Maitreya (the Future Buddha).  His large protruding stomach and jolly smile have given him the common designation "Laughing Buddha.". 

He was truly a great Zen master and legend has a great story which is so inspirational for all of us.

The jolly good saint that he was used to go from one place to the other. He went to the Town Square and soon people gathered around him. He was so funny looking and always smiling that people used to crowd around him. He would then distribute sweets and small toys to all children who had gathered around him. Then keep his bag down, look to the sky and just start laughing. He used to laugh madly and he was not interested whether other laughed or not. Soon his laughter used to be contagious and all who had gathered would start to laugh.

The whole town used to laugh and laugh. After sometime he would pick the bag, which he had kept down, smile to all, and go to the next town. All his life he did only this action and it was said that many people attained Nirvana, enlightenment just through this process. Hence he was called as the laughing Buddha because Buddha is someone who is enlightened and laughter was his unique method. Never before him or never after him such a simple aspect was used to achieve what all humans strive for - moksha or enlightenment.

He would rarely speak and once when he was asked to describe his method he told, that he gave sweets to children to symbolically that the more you give, the more comes to you. Thereby, he unveiled the secret of "Giving with joy". Children are said to be GOD because they represent the GOD Nature, which is always, be in Present time, smiling and joyful, ego less, and most important is without judge mental mind.

The bag represented problems that all humans encounter. We are mistaken that when we have problems, that GOD only gave you a problem and the rest are so happy. The problems appear big because we are associated with it- calling it as "My Problem". Look at a funny phenomenon, if anyone comes to you with any problem of theirs and seek solutions or advice, what you do. You tell them so many solutions so easily as though you are an expert in all the fields in the Universe. However big the others problems are you can solve it so easily, you are a master solver of problems. But then what happens to your own problems. Hmm Hmm it is impossible to find any solution.

This happens only because of your attachment and association with the problem. So laughing Buddha said, simple keep your problem down (symbolically keeping the bag down) means "Disassociate with your Problem", "Separate form it" and yes just Laugh. What else can one do? Think and thank GOD that you only have such a small problem as compared to so many others. Whether you laugh or cry the problem is going to be there right. So why not laugh at it. Therein is the magic and mind you no small magic, it is huge, apply it to realize about the power of laughter.

On laughing your whole internal chemistry changes and thereby the body produces certain enzymes that are only released in a state of laughter. The problem now looks too tiny and as you pick it (symbolically he picks back the bag before going to the next place) the problem is solved.

Such a great Zen master was Hotei or Laughing Buddha. So next time you look at the statue of "laughing Buddha" associate with that great teaching he gave all of us, the power of laughter. Each time you see the Laughing Buddha and if it reminds you to laugh, a great work has been done.

Whole life Hotei lived in Laughter. And when the time came to pass away, he knew he had to give up his life at an appropriate time. He called his disciples and said that after he passes away, they should immediately burn his body. The disciples were surprised because there was no tradition of burning in Zen. But they followed the master wishes. And as they lit fire to his body, "Fire Works and Crackers" started flying all over.

Hotei was so great that just before he died he hid a lot of crackers and rockets in his clothes. So there also he created such laughter by the suddenness of the situation. So Hotei not only lived in laughter all through his life, he also died in laughter.

Let us all learn from the great Zen master that "It is our birth right to laugh" and "No matter what happens we should come back to laughter". 

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

Medical literature/document produced as evidence in the court of law must be a published one. For a document to serve as legitimate evidence in a trial/debate, it must exist in the public domain i.e. the document must potentially be available to any debater researching the topic or lawyer/interested party of cross examining side. Unpublished documents are privileged information, and using such information gives the doctor an unfair advantage. Academic debate does not have a discovery rule. The only opportunity your opponents have to examine your documents prior to a trial/debate is to have found the documents during their own research. That they may not have taken the opportunity to do so, or did not discover a document, does not obviate the rule. The advent of the Internet has created a new form of publication – electronic documents like this e–medinews. Electronic documents are accepted as published if they are accessible by the general public. Thus, electronic files to which other debaters would be denied access are not published. However, files and documents which other debaters may access, even if they have no subscription to a commercial service to do so, satisfy the publication rule. 

Emedinews:Makesure:A patient with hypertension developed bleeding at the puncture site while on intergrilin therapy

Situation: A patient with hypertension developed bleeding at the puncture site while on intergrilin therapy.
Reaction: Oh my God! Why was the anti–platelet agent started?
Lasson: Make Sure that before starting intergrilin the BP is checked. Severe hypertension i.e., systolic BP ≥ 200 mmHg or diastolic BP >110 mmHg not adequately controlled on antihypertensive therapy is a contraindication for intergrilin therapy.

Emedinews :Inspiration:A peaceful mind can think better than a worked up mind

There once was a farmer who discovered that he had lost his watch in the barn. It was no ordinary watch because it had sentimental value for him. After searching high and low among the hay for a long while; he gave up and enlisted the help of a group of children playing outside the barn.

He promised them that the person who found it would be rewarded.  Hearing this, the children hurried inside the barn, went through and around the entire stack of hay but still could not find the watch. Just when the
farmer was about to give up looking for his watch, a little boy went up to him and asked to be given another chance.

The farmer looked at him and thought, "Why not? After all, this kid looks sincere enough." So the farmer sent the little boy back in the barn. After a while the little boy came out with the watch in his hand! The farmer was both happy and surprised and so he asked the boy how he succeeded where the rest had
failed.

The boy replied, "I did nothing but sit on the ground and listen. In the silence, I heard the ticking of the watch and just looked for it in that direction."

Moral: A peaceful mind can think better than a worked up mind. Allow a few minutes of silence to your mind every day, and see, how sharply it helps you to set your life the way you expect it to be...!

Emedinews: Insights on Medicolegal Issues:How should biological samples and medical evidences be collected in a medicolegal case?

The analyst/doctor has a legal responsibility to retain untested biological specimen in legal cases so that another person can test it and come to an independent conclusion as to its origin.

The observation of scenes of crime, collection of human body fluids, weapons of the offence and medical examination of victim, accused, or both is required in any investigation of crime against human body such as injury, rape, murder.

The medical examination is carried out in emergency ward of hospitals and treatment of injured and dying patient remains the major focus of the treating doctor. But, in cases of crime against the human body, the medical examination and collection of biological sample/s, its documentation, packaging, and analysis have an important role and should be done by the doctor very meticulously with the high standards of science and the law in mind. These biological materials include: 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 case if collected correctly.

Emedinews:Makesure:A patient with diabetes shows deteriorating kidney function.

Situation: A patient with diabetes shows deteriorating kidney function.
Reaction: Oh my God! His HbA1c is very high?
Lesson: Make sure that strict glycemic control is maintained in patients with type 2 diabetes in order to delay vascular complications.

Emedinews: Inspiration:The Empty Soap Box

One of the most memorable case studies on Japanese management was the case of the empty soap box, which happened in one of Japan's biggest cosmetics companies. The company received a complaint that a consumer had bought a soap box that was empty.

Immediately the authorities isolated the problem to the assembly line, which transported all the packaged boxes of soap to the delivery department. For some reason, one soap box went through the assembly line empty.

Management asked its engineers to solve the problem. Post-haste, the engineers worked hard to devise an X-ray machine with high- resolution monitors manned by two people to watch all the soap boxes that passed through the line to make sure they were not empty.

No doubt, they worked hard and they worked fast but they spent whoopee amount to do so. But when a workman was posed with the same problem, did not get into complications of X-rays, etc but instead came out with another solution.

He bought a strong industrial electric fan and pointed it at the assembly line. He switched the fan on, and as each soap box passed the fan, it simply blew the empty boxes out of the line.

Moral of the story: Always look for simple solutions. Devise the simplest possible solution that solves the problem. So, learn to focus on solutions not on problems. "If you look at what you do not have in life, you don't have anything; if you look at what you have in life, you have everything.

Emedinews:Insights on Medicolegal issues:How death was defined by scientist in past?

In the fatal automobile accident of Smith v/s Smith both husband and wife sustained injury. Husband died on the spot and the wife was taken to the hospital where she remained unconscious for 17 days and then died. The petitioner argued that the deaths were simultaneous, since there was no evidence of brain activity after accident. The Inference was that resuscitative efforts were maintaining the body in a state of animation although it could not be shown that life existed. The court did not accept the contention. They quoted Black’s definition of death and stated that "one breathing, though unconsciousness is not dead." The living body depends upon the integrity of three principal interdependent systems circulation, respiration and enervation. Failure of one of them will cause failure of the other two. This leads to the death of the individual. There are two phases of death: (i) Extinction of the personality is immediate sign of vital process: This is Somatic death. (ii) Progressive disintegration of the body tissue: This is molecular death or cellular death that occurs sometimes later.

Calne, in 1970, gave a more practical definition that states when destruction of the brain has been established, the individual has died no matter what the state of the rest of his body, giving four signs for such a diagnosis: (i) Deep, irreversible coma with fixed, dilated pupils and absent cranial nerve reflexes (ii) No spontaneous respiration (iii) absence of electrical brain activity (iv) Cessation of circulation in the retinal vessels.

Rantoul and Smith in 1973 defined death as complete and persistent cessation of respiration and circulation.

(Ref: Dr. PC Dikshit Head (MAMC) MD LLB, Textbook of forensic medicine, Peepe Publisher)

Emedinews:Makesure: A patient with hypertension developed bleeding at the puncture site while on intergrilin therapy.

Situation:A patient with hypertension developed bleeding at the puncture site while on intergrilin therapy.
Reaction: Oh my God! Why was the Anti-Platelet Agent Started?
Make Sure before starting intergrilin the BP is checked. Severe hypertension (Systolic blood pressure>/ 200 mmHg or diastolic blood pressure >110 mmHg not adequately controlled on antihypertensive therapy is a contraindication for intergrilin therapy.

Emedinews:Inspiration:God Is Good

There were two men having a trip together. They brought a donkey to carry their things, a torch to brighten the road at night and a chicken, which was a donkey's friend. The chicken sat on the donkey's head during the trip.

One of the two men was very religious, while the other one was the unbeliever. Along the way, they were having conversation about God. "God is so good," said the first one. "Well, we'll see if you still think the same during this trip," said the second.

When the nightfall, they reached a small village and they were looking for a place to sleep. They have been looking everywhere yet no one would want to take them in. So they had to continue their trip out of the village and decided to sleep there. "I thought you said that God is good," said the second one cynically. "God has decided that this is the best place for us to sleep," explained the first one.

They put their tent under a big tree, beside the road to the village and tied the donkey five metres away from their tent. When they were going to light the torch, they heard some noise. A lion attacked the donkey, dragged and ate it. They promptly climbed the tree to survive. "You still think that God is good?" asked the second man angrily. "Hadn't the lion killed the donkey, we would have been eaten. God is good," said the first.

A second later, they heard the sound of their chicken. From the tree, they could see that a big cat attacked the chicken and dragged it everywhere. Before the second man said anything, the first man said, "The sound of the chicken saved us once again. God is good." A few minutes later, a big wind blew off their torch which was the only thing that kept them warm. Once again, the second one mocked his friend.

"Apparently, God's kindness has been working on us all night," he said. The first man said nothing. The next morning, the two men went back to the village for food. Soon they found out that there were some robbers attacked the village and robbed the whole village.

Knowing that, the first man said, "Now it's clear. God is really good. Had we spent the night here, we would have been robbed along with other people. Had the wind not blown our torch, the robbers, who passed the street near us, would have seen us and robbed us too. It is so clear that God is good."

Emedinews:Makesure:A patient with fever and cough develops complications after he was given antibiotics.

Situation: A patient with fever and cough develops complications after he was given antibiotics.
Reaction: Oh my God! What was the need of giving the antibiotics?
Lesson: Make sure that a patient with fever and cough is not given antibiotics as presence of cough mostly signifies viral infection.

Emedinews:Inspiration: A story to live by

There was a blind girl who hated herself because she was blind. She hated everyone, except her loving friend. He was always there for her. She told her friend, 'If I could only see the world, I will marry you.'  One day, someone donated a pair of eyes to her. When the bandages came off, she was able to see everything, including her friend. 

He asked her, "Now that you can see the world, will you marry me?” The girl looked at her friend and saw that he was blind. The sight of his closed eyelids shocked her. She hadn't expected that. The thought of looking at them the rest of her life led her to refuse to marry him. 

Her friend left in tears and days later wrote a note to her saying: 'Take good care of your eyes, my dear, for before they were yours, they were mine.' 

This is how the human brain often works when our status changes. Only a very few remember what life was like before, and who was always by their side in the most painful situations. 

Life is a divine gift 

Emedinews:Insights on Medicolegal issues: What is blast lung?

• When a bomb explodes, it causes disruptive effect due to burns, air blast, flying missiles injuries, falling masonry, fumes and incendiary bombs
• A bomb explosion create a pressure of 1000 to 1500 tons per square inch; but, a pressure of 200 kg per square inch is enough to cause destructive injuries to human tissues
• The injuries to the pulmonary tissues and alveoli tissues that occur due to air blast effect are called blast lung injuries. The lungs air blast victims show pleural patchy bleeding on scans. The reactive pulmonary swelling converts into bronchopneumonia and may prove fatal in these cases.

Emedinews:Makesure: Doctor, this patient has developed acute renal failure (ARF).

Situation: Doctor, this patient has developed acute renal failure (ARF).
Reaction: Oh my God, I forgot that he was on frusemide. I gave him full dose of amikacin.
Lesson: Make sure, before calculating the dose of aminoglycoside (amikacin) that frusemide and other loop diuretics, which enhance its nephrotoxicity are not being given.

Emedinews:Inspiration:God's Wings

An article in National Geographic several years ago provided a penetrating picture of GOD'S wings. After a forest fire in Yellowstone National Park, forest rangers began their trek up a mountain to assess the inferno's damage.

One ranger found a bird literally petrified in ashes, perched statuesquely on the ground at the base of a tree. Somewhat sickened by the sight, he knocked over the bird with a stick. When he struck it, three chicks scurried from under their dead mother's wings.

The loving mother, keenly aware of impending disaster, had carried her offspring to the base of the tree and had gathered it under her wings, instinctively knowing that the toxic smoke would rise. She could have flown to safety but had refused to abandon her babies. When the blaze had arrived and the heat had singed her small body, the mother had remained steadfast. Because she had been willing to die, so those under the cover of her wings would live.

"He shall cover thee with his feathers, and under his wings shall thou trust" (Psalms 91:4)

Emedinews:Insights on Medicolegal issues: Obscure autopsy

• Post mortem examination of a dead body is carried out to gain insight of anatomy and pathology of corpse and close examination of the injuries, marks of weapon or disease process and it’s significant for forensic application of medical knowledge. Whether it is a clinical/pathological or forensic, autopsy is nothing but medical study of a dead body and is carried out for enhancing clinical findings and its correlation with patient clinical manifestations during the treatment or understanding some unrevealed aspect of disease or diagnose the disease which has caused the mortality. These findings may be simultaneously used for  medico-legal purpose
• The procedure of both the autopsies is same;  autopsy conducted  by a forensic expert in cases of sudden/unexpected/unexplained death is nothing but a purely clinical autopsy
• When in a postmortem examination all efforts means macro/gross, microscopic chemical and toxicological result couldn’t  be concluding enough into cause ,manner or other required medico-legal aspect of death then the obscure or negative autopsy work for logical conclusion
• Negative autopsy is very useful in cases where there is no adequate history of death and death from fear/fright or shock/Cases of post fracture air embolism. Death due to lesion in neck as diphtheria, laryngeal bronchitis/swelling of glottis or chocking on food, Cases like brown atrophy of heart associated with starvation, asthma or cancer, Sickle cell disease/Lesion of adrenal gland/hemorrhage or destruction by tumor, The negative autopsy is also very informative seen by me in death due to distal coronary artery occlusion or coronary arteries spasm.
• The opinion expressed on the basis of a clinical autopsy is examined or cross examined in departmental/institutional peer review as the findings and opinion after a forensic autopsy has to withstand the acid test of cross examination by the defense lawyer/prosecutor and judges on circumstantial evidences available before honorable court both clinical and forensic autopsies have a complimentary role towards each other.

A 62-year-old diabetic with coronary artery disease, on treatment for the same, comes for follow up.

Situation: A 62-year-old diabetic with coronary artery disease, on treatment for the same, comes for follow up.
Reaction: Oh My God! Why didn’t you put him on antioxidants?
Lesson: Make Sure to add antioxidants to the prescription because of their free radical scavenging and other beneficial effects. 

Emedinews:Inspiration:Fireworks

A few weeks before Independence Day, I noticed a fireworks stand in a parking lot in our city. It reminded me of the many wonderful fireworks shows I've attended with my family. There's something magical about those brilliant colors exploding against the dark sky.

But there's a problem with fireworks. They don't last. The same is true of many of the "fireworks" experiences in our lives. We fight and struggle for things that seem beautiful and alluring, but after we get them, their appeal disappears, just like fireworks. Maybe it's a shiny new car or speedboat. Maybe it's a big, impressive house. It might even be a promotion at work or a prestigious career. So many of the things of this world are like fireworks. They promise happiness and fulfillment but can't deliver. TV commercials play on our emotions, making us believe that if we drive a certain kind of SUV or clean our floors with their super-efficient mop, we'll be happy at last. More often than not, all we feel is disillusioned.

If you've had enough of these "fireworks" experiences and the letdowns that follow, I challenge you to pursue the only thing in life that doesn't disappoint: a personal relationship with Jesus Christ. The astounding thing about loving God is that it actually gets better every day. Once you give your heart to Jesus, you'll have happiness and fulfillment that lasts into eternity and you'll never want to go back to "fireworks" experiences again.

Emedinews:Insights on Medicolegal issues: What is the product liability in medical care delivery?

What is the product liability in medical care delivery?

• A person who alleges an injury caused by a defective product used in medical care the three principles of products liability theories: negligence, warranty, or strict liability considered in criminal, civil, or consumer case proceeding for product liability in the court of law.
• The manufacturer becomes responsible for injury or death in such case. The patient must prove that the defendant manufacturer departed from standards of due care, with respect to negligent design, manufacture, assembly, packaging, failure to test and inspect for defects or failure to warn or give adequate instructions.
• The injury or death of the patient may result unexpectedly by faulty, defective or negligently designed medical or surgical instruments or inadequate operating instructions.
• The proceeding on a negligence theory in a products liability case requires an injured party to show that a specific defendant failed to exercise proper care in designing, testing, manufacturing, or marketing the allegedly defective medical product and that, as a reasonably foreseeable and proximate result of such negligence, the patient suffered the injury.
• Many countries have evolved basis for liability on the part of the manufacturer of a defective product. This is known as “strict liability in tort”.
• The theory behind strict liability is that is better social policy for manufacturers, rather than injured consumers, to bear the economic burdens, through products liability insurance or otherwise, for any injuries caused by defective products. Under the strict liability theory, an injured party need not prove negligence or any breach of warranty, but rather must establish only that the product causing the injury was defective when it left the control of the manufacturer or the seller

Emedinews:Makesure:A 14–day–old neonate presented with pneumonia. On history, it was found that mother had complains of dysuria, mucopurulent cervical discharge, episodes of sometimes cervical bleeding and lower abdominal

Situation: A 14–day–old neonate presented with pneumonia. On history, it was found that mother had complains of dysuria, mucopurulent cervical discharge, episodes of sometimes cervical bleeding and lower abdominal.
Reaction: Oh my God! You should have treated the mother with azithromycin.
Lesson: Make sure to remember that pneumonia in neonates can be prevented by treating mother, having Chlamydia trachomatis infection, with azithromycin.

Emedinews:Inspiration:Fill me, Lord

Fill me with the fruits of your Spirit, Lord.

Fill me with love, so that I seek to understand and appreciate the rich variety and diversity of life that surrounds me.

Fill me with joy, so that I celebrate your presence in each and every moment I am on this earth.

Fill me with peace, so that I know how to ease those angry and sometimes violent urges that well up inside of me.

Fill me with patience, so that I stop rushing long enough to witness your miraculous work taking place all around me (and within me!)

Fill me with kindness, so that I take the extra time to help the one in need, even when it isn't convenient for me.

Fill me with faithfulness, so that I place my mind, heart and all that I do in the service of your Gospel.

Fill me with gentleness, so that others know that I believe in a God who loves and cares for all people.

Fill me with self-control, so that I act not on my impulses and urges, but rather on my beliefs and values, which are rooted in you.

Fill me with these fruits of your spirit, Lord!

Emedinews:Insights on Medicolegal issues:Tissue pathological examination in postmortem cases

Morgan say that those who have dissected or inspected many dead bodies have at least learned to doubt, while those who are ignorant of anatomy and do not take the trouble to attend autopsy, are in no doubt at all…

• Forensic histopathology is the application of pathological principles to the investigation of the medicolegal aspects of death.
• Forensic pathologists are medically qualified doctors who perform autopsies/ postmortem examinations on cases of sudden or unexpected death, or death as a result of trauma or poisoning.
• The forensic investigation of death is a multidisciplinary activity, involving the collaboration between pathologists, crime scene investigators, forensic scientists, and other specialists, such as anthropologists, entomologists, dentists and many other experts.
• Autopsy findings are combined with the results of other investigations, including the microscopic examination of organs and tissues removed at autopsy, toxicological analyses of blood and urine, for example and correlated with the available clinical or medical history of the deceased, as well as the circumstances of their death, in order to answer questions relating to their death.
• The issues raised by a death may include, identification of the deceased, the medical cause of death, the interpretation of injuries, and the manner of death i.e. accident, suicide, homicide or natural and required histology examination in many cases to conclude the legal autopsy report
• Forensic histopathology include the changes in cells due to drug abuse, wound age determination, adverse drug reactions, histopathology of the sudden death syndrome, and age determination of myocardial infarction. 

Emedinews:Makesure: A child with sore throat and enlarged lymph nodes developed fever.

Situation: A child with sore throat and enlarged lymph nodes developed fever.
Reaction: Oh my God! Why were antibiotics not given in time?
Lesson: Make Sure, that all children with sore throat and enlarged lymph nodes are given antibiotics as such sore throats are Streptococcal unless proved otherwise.

Emedinews:Inspiration:never, never, never give up

 If you think you are beaten, you are

If you think you dare not, you don't

If you like to win, but think you can't, it's almost a clinch you won't

If you think you will lose, you're lost

for out in the world we find.................

Success begins with a fellow's will

It's all in a state of mind

Life's battles don't always go to the stronger or faster man

but sooner or later the man who wins is the one who thinks he can

So, never, never, never give up................

Emedinews:Insights on Medicolegal issues: Medical examination of rape victim and MLR

·         When the doctor prepares a medicolegal report of a rape victim he should not forget to mention the presence of bodily injuries like bite marks, nail marks etc. on the body of the victim/accused prove that the exchange of offered resistance. Genital injuries can be serious if the act is done on a virgin or a young girl; but it is seen that the genital injuries are minimal or absent in a woman used to sexual act.

·         Trivial general injuries can be seen on the victim as well as the accused in a violent sexual act. 

·         Usually if there are signs of general and genital violence, it can be assumed that the sexual act was done against the will and without the consent of the victim and its interpretation should be left on the law.  Doctor should not comment on commission or non-commission of rape. 

·         Rape is a legal definition and not a medical diagnosis since the necessary and required constituents for law to charge a person in offence of rape, is penetration/touching of penis within vulva (leaps of vagina) however slight/little it may be, or even this act may be only for a fraction of second is sufficient to constitute the offence of rape

·         Neither complete penetration of male genital organ nor rupture of hymen nor complete sexual act or emission of seminal fluid are necessary to amount to the offence of rape.

·         The doctor conducting the medical examination of a rape victim and is also requested for age estimation she is empowered and may give the opinion regarding the age of victim on the basis of the radiological report, findings of secondary sexual characters and dental status or even the bone age as per report of radiologist

·        In cases where the examining doctor is not confident in certifying the age of victim it should be referred to CMO/higher administrator of hospital concerned.