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. 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 keep the patient awake. 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.

Emedinews:Maskesure:A patient with suspected pneumonia and normal x–ray died 12 hours after admission.

Situation: A patient with suspected pneumonia and normal x–ray died 12 hours after admission.
Reaction: Oh my God! Why were antibiotics not started?
Lesson: Make sure that all patients with suspected pneumonia are given antibiotic at the first suspicion as x–ray can be normal in the first 24 hours.

Emedinews:Inspiration:Creating opportunity

An enterprising person is one who comes across a pile of scrap metal and sees the making of a wonderful sculpture. An enterprising person is one who drives through an old decrepit part of town and sees a new housing development. An enterprising person is one who sees opportunity in all areas of life.

To be enterprising is to keep your eyes open and your mind active. It's to be skilled enough, confident enough, creative enough and disciplined enough to seize opportunities that present themselves... regardless of the economy.

A person with an enterprising attitude says, "Find out what you can before action is taken." Do your homework. Do the research. Be prepared. Be resourceful. Do all you can in preparation of what's to come.

Enterprising people always see the future in the present. Enterprising people always find a way to take advantage of a situation, not be burdened by it. And enterprising people aren't lazy. They don't wait for opportunities to come to them, they go after the opportunities. Enterprise means always finding a way to keep yourself actively working toward your ambition.

Enterprise is two things. The first is creativity. You need creativity to see what's out there and to shape it to your advantage. You need creativity to look at the world a little differently. You need creativity to take a different approach, to be different.

What goes hand-in-hand with the creativity of enterprise is the second requirement: the courage to be creative. You need courage to see things differently, courage to go against the crowd, courage to take a different approach, courage to stand alone if you have to, courage to choose activity over inactivity.

And lastly, being enterprising doesn't just relate to the ability to make money. Being enterprising also means feeling good enough about yourself, having enough self worth to want to seek advantages and opportunities that will make a difference in your future. And by doing so you will increase your confidence, your courage, your creativity and your self-worth, your enterprising nature.

Low Self Esteem

Low Self Esteem

Do Not Replace Saturated Fat With Refined Carbohydrates: White Sugar, White Rice And White Maida May Be More Harmful

Do Not Replace Saturated Fat With Refined Carbohydrates: White Sugar, White Rice And White Maida May Be More Harmful

Emedinews:Insights on Medicolegal issues: Facilitate cadaver organ retrieval for transplantation

In India, certain amendments to the Human Organ Transplant Act 1994 are required to enhance cadaver organ retrieval and transplantation to bridge the huge demand–supply gap. The pool of donors, including increasing the supply of organs by widening the definition of ‘near relatives’ by allowing organ swaps among needy families, as well as, simplifying cadaver transplant procedures. The paired matching should be permitted i.e. if patient A’s donor does not match A, and likewise for patient B, then donor switch should be allowed, if it results in a match. Swaps or exchanges between families unable to fulfill the need of their family member in need of a transplant.

Emedinews:Makesure:A patient with chest pain and who had normal ECG died half an hour later.

Situation: A patient  with chest pain and who had normal ECG died half an hour later.
Reaction: Oh my God! Why was acute MI not suspected?
Lesson: Make sure all patients of chest pain are observed for 12 hours. ECG can be normal in acute heart attack for up to six hours.

Emedinews:Inspiration:Depression - clinical or self-induced?

There is one type of illness in the world that affects more people than anything else and is very deadly. If untreated this illness could affect everything you do. What is this illness? Depression. Serious depression requires professional treatment. Self-induced depression is something each of us can change.

Everyone's circumstances are different and the pressures we face from day to day vary, but really some of the causes self-induced depressions are common: low self-esteem, hurtful thinking and a bad attitude.

Although these affect people on a global scale and cause much heartache, how can we change the way we think, feel, and cultivate a cheerful attitude? Like with any obstacle there will be stumbling blocks, but they can be avoided.

First we must look at ourselves, truly and honestly examining our motives for what we do and what we wish to achieve. If you are dissatisfied because you feel you haven't or can't do anything, then one step is needed - to set goals.

Always start your goals relatively small and easy to attain. Think of them as sand; one grain may be insignificant but as a group they form the beach.

Once you have set and attained small goals for yourself, move on to slightly larger, more challenging goals. Examples might be like competing in a sporting event, studying at college or getting a part time job. And most importantly of all, talk to people about your goals. Talk to people who have reached higher goals, for they can give you much encouragement.

It takes more than just setting goals to be happy. It takes positive thinking. How can we attain this?

There are a number of factors that can make us think negatively and one of those is diet.

In my opinion, a person who eats a lot of take out and fast food is feeding their body junk which mostly consists of fat, saturated fat, cholesterol, sugar and is generally low in vitamins and minerals. Start by eating better foods, more fruit and veggies, meat products and high fiber meals which give the body much-needed minerals. If your physical body is happy, it's much easier for your mental body or "thinking ability" to be happy.

Next, exercise. A half-hour a day is recommended for positive well-being. Why is exercise so important?

Because it gets oxygen running around the body more easily which helps us think better and helps us sleep better. If you are having difficulties sleeping, a little more physical work or exercise during the day may be needed.

Thinking is also linked to what we do. For example: if you do something that you hate doing everyday, it will show in your attitude. This probably explains why so many people are angry in the work place. If you don't like what you do, but have no choice in doing it, try to give yourself some hobbies or activities you really enjoy doing (Lego is always a good one for me).

Hobbies are just like lifelong invisible friends. If all else fails, you can turn to them.

If thinking positive becomes that difficult, think back to a time in your life when you were happier, or think about good memories you had, or generally think of things that make you smile.

Remember, everything you wear costs money but to wear a smile is free. A smile can be the difference between an average day and a great day and also offers you some brief exercise (smiling requires the movement of certain facial muscles).

If you follow these steps, positive change is inevitable.

To be happy depends not only on good health mentally, how we think and feel, but also on how healthy we are physically. So start making positive goals, treating your body to healthier foods, and stay motivated in life by doing things you love or think is fun, and thus you can enjoy the precious life you have.

Emedinews:Insights on medicolegal issues:What are resuscitative injuries?

Doctor should always document in detail the resuscitative injury in case of death

The injuries produced in human body during resuscitation pose difficulty in interpretation of injuries noted at postmortem examination or in inquest paper by the investigating law enforcement agency. Before proceeding to make an interpretation, the doctor conducting the autopsy should know if there has been an attempt for resuscitation and who did it and for how long. He should also know about the methods used in a particular case and whether all these have been documented in the clinical sheets or not. Resuscitative attempts may lead to skeletal, cardiac and abdominal viscera injuries. The investigating police officer should make a note on the basis of statements taken from the relative and doctors who attended the deceased and the same should be enclosed in inquest paper before handing them over to the autopsy surgeons.

• The method generally used for life saving attempts by non–medical persons who are near the critical patient is mouth–to–mouth respiration and manual chest massage may causes contusions.
• Resuscitation in hospitals includes bag and mask intubations, endotracheal tube, obdurate airways used for respiratory ventilation.
• Mechanical methods like Thumper, active compression–decompression device, and defibrillators are used in resuscitation. Closed chest cardiac massage along or with interspersed abdominal compression is also used for resuscitation.
• The injections and closed–chest cardiac massage and other resuscitation procedures to the patients may result in the fracture of a chest vertebra, serial fractures of ribs resulting in an unstable thorax, bilateral hemothorax, tension pneumothorax, rupture of kidney and of spleen.
• Fractures of ribs and/or sternum were found in 40% of cases, the frequency increasing with age. The number of fractured ribs ranged up to 16, mainly 3–8 ribs was fractured. Fractures of the 1^st and 8^th to 12^th ribs were very rare.
• The common site of rib fractures after heavy blunt thoracic injuries was found in the dorsal region.
• The injuries which are received/inflicted on body prior to death are called mortem injuries and may or may not be a contributing factor in causing the death or they may have occurred due to much other reason like resuscitation/transport of sick/ill person for medical care called artifacts.

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

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

Emedinews:Inspiration:Just a Mom

A woman, renewing her driver’s license at the County Clerk’s office was asked by the woman recorder to state her occupation. She hesitated, uncertain how to classify herself. ”What I mean is,” explained the recorder, “do you have a job or are you just a……?”

“Of course I have a job,” snapped the woman. ”I’m a Mom.” “We don’t list ‘Mom’ as an occupation, ‘housewife’ covers it,” said the recorder emphatically.

I forgot all about her story until one day I found myself in the same situation, this time at our own Town Hall.

The Clerk was obviously a career woman, poised, efficient and possessed of a high sounding title like, “Official Interrogator” or “Town Registrar.” ”What is your occupation?” she probed. What made me say it? I do not know. The words simply popped out.

“I’m a Research Associate in the field of Child Development and Human Relations.” The clerk paused, ball-point pen frozen in midair and looked up as though she had not heard right. I repeated the title slowly emphasizing the most significant words.

Then I stared with wonder as my pronouncement was written, in bold, black ink on the official questionnaire. ”Might I ask,” said the clerk with new interest, “just what you do in your field?”

Coolly, without any trace of fluster in my voice, I heard myself reply, “I have a continuing program of research, (what mother doesn’t) in the laboratory and in the field, (normally I would have said indoors and out). I’m working for my Masters (first the Lord and then the whole family) and already have four credits (all daughters). Of course, the job is one of the most demanding in the humanities, (any mother care to disagree?) and I often work 14 hours a day, (24 is more like it).

But the job is more challenging than most run-of-the-mill careers and the rewards are more of a satisfaction rather than just money.” There was an increasing note of respect in the clerk’s voice as she completed the form, stood up and personally ushered me to the door.

As I drove into our driveway, buoyed up by my glamorous new career, I was greeted by my lab assistants — ages 13, 7, and 3. Upstairs I could hear our new experimental model, (a 6 month old baby) in the child development program, testing out a new vocal pattern.

I felt I had scored a beat on bureaucracy! And I had gone on the official records as someone more distinguished and indispensable to mankind than “just another Mom.” Motherhood!

Dilemmas in legal inquiry over antemortem and a postmortem injury

Injuries, other than antemortem in nature, may appear due to various other reasons and sources such as deliberate mutilation of a body by a murderer, predation by wild animals, or handling in transportation leading to cause confusion over the manner and cause of death. It is important to distinguish between antemortem, perimortem and postmortem injuries.

• 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 e.g. when a person drowns, the body usually floats face downwards resulting in the head becoming congested with blood. If the cadaver receives a head injury by being buffeted around in the water and colliding with boats or propellers, 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 (cuts or scrapes) to the head and scalp which may be very hard to interpret.
• After death, the blood stays liquid in the vessels and no longer clots. Careless handling of a cadaver may produce some postmortem bruising, which may need to be distinguished from antemortem bruising. Blood also tends to pool under gravity after death, causing a bruised appearance in the lower limbs, arms, hands, and feet known as lividity. Some of the smaller vessels may even hemorrhage under the pressure of this pooled blood. These bruises could be confused with ante–mortem bruising.

Recent research has focused on improved techniques for distinguishing between an antemortem and a postmortem injury by analyzing damaged tissue. Antemortem injuries show signs of inflammation, while postmortem injuries do not. Chinese scientists have found that tissue from antemortem injuries contains a chemical involved in inflammation leukotriene B4 (LTB4). Postmortem injuries were found to have no LTB4. This could help the pathologist classify injuries more accurately.

The Secret Ears

“Can I see my baby?” the happy new mother asked. When the bundle was nestled in her arms and she moved the fold of cloth to look upon his tiny face, she gasped.

The doctor turned quickly and looked out the tall hospital window. The baby had been born without ears. Time proved that the baby’s hearing was perfect. It was only his appearance that was marred.

When he rushed home from school one day and flung himself into his mother’s arms, she sighed, knowing that his life was to be a succession of heartbreaks. He blurted out the tragedy. “A boy, a big boy… called me a freak.”

He grew up, handsome for his misfortune. A favorite with his fellow students, he might have been class president, but for that. He developed a gift, a talent for literature and music.

“But, you might mingle with other young people,” his mother reproved him, but felt a kindness in her heart. The boy’s father had a session with the family physician. Could nothing be done? “I believe I could graft on a pair of outer ears, if they could be procured,” the doctor decided.

Whereupon, the search began for a person who would make such a sacrifice for a young man. Two years went by. Then his father said, “You are going to the hospital, son. Mother and I have someone who will donate the ears you need. But, it’s a secret who it is.”

The operation was a brilliant success, and a new person emerged. His talents blossomed into genius, and school and college became a series of triumphs. Later, he married and entered the diplomatic service.

“But, I must know!” He urged his father, “Who gave so much for me? I could never do enough for him.” “I do not believe you could,” said the father, “but, the agreement was that you are not to know… not yet.”

The years kept their profound secret, but the day did come. It was one of the darkest days that ever pass through a son. He stood with his father over his mother’s casket. Slowly, tenderly, the father stretched forth a hand and raised the thick, reddish-brown hair to reveal that the mother had no outer ears.

“Mother said she was glad she never let her hair be cut,” he whispered gently, “and nobody ever thought mother less beautiful, did they?”

Real beauty lies not in the physical appearance, but in the heart. Real treasure lies not in what can be seen, but in what cannot be seen. Real love lies not in what is done and known, but in what is done and not known.

How is death finally certified?

Permanent and irreversible stoppage of respiration, circulation and brain function so called the ‘Tripod of life’

• Generally the practicing doctor diagnoses death by auscultation; but, this can be difficult in cases of excessive fat, emphysema, apex beat below the rib, poorly beating heart and shallow diaphragmatic respiration. All these conditions dampen the conduction of heart sound with body wall.
• Diagnosis of recent death is also very difficult whenever the death of the person has not been observed. When a doctor is called to certify a patient ‘as dead’ that is brought by ambulance, he must insist that the body be removed to a well lit room where he can carry out his examination.
• Even though the condition is satisfactory, there can be error during examination. The signs of life can be detected by special methods like oscilloscope, ECG, and EEG etc.
• It can never be assumed that attempted resuscitation is pointless. On the other hand, resuscitative measures should always be continued for half an hour.
• In cases of electric shock, asphyxia particularly drowning and drug overdose, resuscitative measures should always be done
• There is segmentation of blood in retinal blood vessels in ophthalmoscopic examination. If still there is little doubt, the patient should be taken to intensive care unit for further investigation of heart and brain function.

(Ref: Dr. PC Dikshit Head (MAMC) MD LLB, Textbook of Forensic Medicine, Peepee Publisher)

Emedinews:Insights on Medicoleagl issues:A patient with acid peptic disease was denied any painkiller for his distressing illness.

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

Emedinews:Inspiration:Knowledge-Absolute, Bliss-Absolute

An Inspirational Story
(Dr Anil Kumar Jain)

There was a good-natured millionaire in the town. Three beggars thought of approaching him for help. The first man went to the millionaire and said: "O Lord! I want five rupees. Please give me." The millionaire was taken aback at this man's impudence. "What! You demand five rupees from me as though I owe you the money! How dare you? How can I afford to give five rupees to a single beggar? Here, take these two rupees and get away," he said. The man went away with the two rupees.

The next beggar went to the millionaire and said: "Oh Lord! I have not taken a square meal for the past ten days. Please help me."

"How much do you want?" asked the millionaire. "Whatever you give me, Maharaj," replied the beggar.

"Here, take this ten rupee note. You can have some good food for at least three days." The beggar walked away with the ten rupee note.

The third beggar came. "Oh Lord, I have heard about your noble qualities. Therefore, I have come to see you. Men of such charitable disposition are the manifestations of God on earth," he said. "Please sit down," said the millionaire. "You appear to be tired. Please take this food," he said, and offered food to the beggar.

"Now please tell me what I can do for you."

"Oh Lord," replied the beggar. "I merely came to meet such a  noble personage that you are. You have given me this rich food already. What more do I need from you? You have already shown extraordinary kindness towards me. May God bless you!"

But the millionaire, struck by the beggar's spirit, begged of the beggar to remain with him, built a decent house for him in his own compound, and looked after him for the rest of his life.

God is like this good millionaire. Three classes of people approach Him, with three different desires and prayers. There is the greedy man full of vanity, full of arrogance, full of desires. He demands the objects of worldly enjoyment from God. Since this man, whatever be his vile desires, has had the good sense to approach God, He grants him some part of the desired objects (even these very soon pass away, just as the two rupees the first beggar got are spent before nightfall).

The other type of devotee prays to the Lord for relief from the sufferings of the world, but is better than the first one, in as much as he is ready to abide by His Will. To him the Lord grants full relief from suffering, and bestows on him much wealth and property.

The third type  he merely prays to the Lord: "O Lord, Thou art Existence-Absolute, Knowledge-Absolute, Bliss-Absolute, etc., etc." What does he want? Nothing. But the Lord is highly pleased with his spirit of renunciation, of desirelessness and of self-surrender. Therefore, He makes him eat His own food, i.e., He grants this man Supreme Devotion to Himself. Over and above this, He makes the devotee to live in His own House For ever afterwards this devotee dwells in the Lord's Abode as a Liberated Sage.

What is the right to refuse medical interventions?

Theresa Marie "Terri" Schiavo case of the United States

The consistent refusal to intervene on behalf of Schiavo’s parents’ desire to continue nutrition and hydration is a reaffirmation of the right to refuse medical care even for mentally incapacitated patients and that artificial nutrition and hydration are medical treatments. In theory, the right of patients to refuse medical therapy can be limited by four state interests in: Preservation of life, Prevention of suicide, Protection of third parties such as children and Preserving the integrity of the medical profession. In practice, these interests almost never override the right of competent patients and incompetent terminally ill patients who have left explicit advance directives.

Emedinews:Makesure:A patient with rheumatoid arthritis developed deformity.

Situation: A patient with rheumatoid arthritis developed deformity.
Reaction: Oh my God! why was treatment not started early?
Lesson: Make sure all patients with rheumatoid arthritis are started with specific treatments within 3 months of diagnosis.

Emedinews:Inspiration:The seed

An Inspirational Story
(Ms Ritu Sinha)

The seed

Once upon a time, there was a seed and because it was only a seed, nobody cared to notice it. Thus, gripped by a sense of inferiority, the seed gave no importance to his existence.

Then one day, a wind picked him up - randomly or otherwise he didn't know - and threw him mercilessly on an open field under the sweltering sun. He was confused. Why would anything do such a thing? But instead of any copasetic answers, he was provided with rain (in addition to sunlight); sometimes in drizzles and sometimes in torrents.

Meanwhile time flew and years later he saw a traveler sitting by his side. "Thank you God for this. I really needed some rest," he heard the traveler say.

"What are you talking about?" The seed promptly asked. He thought the man was making fun of him. Sure, he had witnessed many people sitting by his side - more so in recent years - but no one ever spoke to him like that.

"Who is this?" The man was startled. "This is me. The seed." "The seed?" The man looked at the giant tree. "Are you kidding me? You are no seed. You are a tree. A goliath of a tree!" "Really?" "Yes! Why else do you think people come here?" "What do they come here for anyways?" "To feel your shade! Don't tell me you didn't know you had grown over time."

A moment passed before the traveler's words struck the chord of realization within him. The seed, now a prolix tree, thought and smiled for the first time in his life. The years of relentless tortures by the sun and the rain finally made sense to him.

"Oh! That means I'm not a tiny-flimsy seed anymore! I wasn't destined to die unnoticed but was actually born to strip people of their lassitude. Wow! Now that's a life worth a thousand gems!"

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.

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 was he not put on antioxidants?
Lesson: Make Sure to add antioxidants to the prescription because of their free radical scavenging and other beneficial effects.

Emedinews:Inspiration:The Perfect Heart

An Inspirational Story (Ms Ritu Sinha) The Perfect Heart One day a young man was standing in the middle of the town proclaiming that he had the most beautiful heart in the whole valley. A large crowd gathered and they all admired his heart for it was perfect. There was not a mark or a flaw in it. Yes, they all agreed it truly was the most beautiful heart they had ever seen. The young man was very proud and boasted more loudly about his beautiful heart. Suddenly, an old man appeared at the front of the crowd and said “Why your heart is not nearly as beautiful as mine.” The crowd and the young man looked at the old man’s heart. It was beating strongly, but full of scars, it had places where pieces had been removed and other pieces put in, but they didn’t fit quite right and there were several jagged edges. In fact, in some places there were deep gouges where whole pieces were missing. The people stared - how could he say that his heart was more beautiful, they thought? The young man looked at the old man’s heart and saw its state and laughed. “You must be joking,” he said. “Compare your heart with mine, mine is perfect and yours is a mess of scars and tears.” “Yes,” said the old man, “Yours is perfect looking but I would never trade with you. You see, every scar represents a person to whom I have given my love - I tear out a piece of my heart and give it to them, and often they give me a piece of their heart which fits into the empty place in my heart, but because the pieces aren’t exact, I have some rough edges, which I cherish, because they remind me of the love we shared. Sometimes I have given pieces of my heart away, and the other person hasn’t returned a piece of his heart to me. These are the empty gouges - giving love is taking a chance. Although these gouges are painful, they stay open, reminding me of the love I have for these people too, and I hope someday they may return and fill the space I have waiting. So now do you see what true beauty is?” The young man stood silently with tears running down his cheeks. He walked up to the old man, reached into his perfect young and beautiful heart, and ripped a piece out. He offered it to the old man with trembling hands. The old man took his offering, placed it in his heart and then took a piece from his old scarred heart and placed it in the wound in the young man’s heart. It fit, but not perfectly, as there were some jagged edges. The young man looked at his heart, not perfect anymore but more beautiful than ever, since love from the old man’s heart flowed into his. They embraced and walked away side by side. How sad it must be to go through life with a whole untouched heart.

Emedinews:Insight on Medicolegal Issues

Thanatology is the branch of science that deals with death in all its aspects. Shapiro, a well-known thanatologist defined death as the irreversible loss of the properties of living matter. However, it is difficult to appreciate his claim that this definition satisfies the practical requirements for death certification.
• Black’s law dictionary (Black 1951) in United States defines death as "The Cessation of life, the ceasing to exit", defined by physicians as total stoppage of circulation and cessation of vital functions, thereupon such as respiration and pulsation
• Section 46 IPC states that death denotes the death of a human being unless the contrary appears from the context.
• Section 2 (b) of the Registration of Births and Deaths Act defines death as Permanent disappearance of all evidence of life at any time after live birth gas taken place.
(Ref: Dr. PC Dikshit, Head (MAMC) MD LLB, Concise Textbook of Forensic Medicine & Toxicology, Peepee Publishers)

Emedinews:Makesure:A patient of gross ascites presents with complaints of difficulty in breathing on lying down.

Situation: A patient of gross ascites presents with complaints of difficulty in breathing on lying down.
Reaction: Oh my God! Why did you drain so much ascitic fluid?
Lesson: Make sure to only moderately tap ascitic fluid as overenthusiastic tapping can be life–threatening.

Emedinews:Inspiration

A young man was getting ready to graduate from college. For many months he had admired a beautiful sports car in a dealer's showroom, and knowing his father could well afford it, he told him that was all he wanted. As Graduation Day approached, the young man awaited signs that his father had purchased the car. Finally, on the morning of his graduation his father called him into his private study.

His father told him how proud he was to have such a fine son, and told him how much he loved him. He handed his son a beautifully wrapped gift box. Curious, but somewhat disappointed the young man opened the box and found a lovely, leather-bound Bible. Angrily, he raised his voice at his father and said, "With all your money you give me a Bible?" and stormed out of the house, leaving the Holy Book.

Many years passed and the young man was very successful in business. He had a beautiful home and wonderful family, but realized his father was very old, and thought perhaps he should go to him. He had not seen him since that graduation day. Before he could make arrangements, he received a telegram telling him his father had passed away, and willed all of his possessions to his son. He needed to come home immediately and take care of things.

When he arrived at his father's house, sudden sadness and regret filled his heart. He began to search his father's important papers and saw the still new Bible, just as he had left it years ago. With tears, he opened the Bible and began to turn the pages. As he read those words, a car key dropped from an envelope taped behind the Bible.

It had a tag with the dealer's name, the same dealer who had the sports car he had desired. On the tag was the date of his graduation, and the words...PAID IN FULL.

How many times do we miss God's blessings because they are not packaged as we expected?

Emedinews:Insights on Medicolegal issues:What is poisoning from misuse of chemical products or medicines?

People who take someone else’s medicine may suffer harm if they take a medicine that is not meant for treating their condition or take the wrong dose. Women who take medicine to try to end a pregnancy are misusing the medicine, and may poison themselves. Poisoning accidents can happen when safety warnings are ignored and chemicals are used in the wrong way. The following are illustrative:
• Bleach containers usually contain a warning that bleach should not be mixed with any other cleaner. If people ignore the warning and use bleach with another household cleaner, they may be poisoned by the gases given off.
• Insecticides that meant to be used on plants or buildings, if are used to kill insects living on people, in their hair or on their bodies may cause accidental poisoning.
• Sometimes people poison themselves by misusing medicines. They may take more than the doctor prescribed because they think, wrongly, that a larger dose will make them better more quickly.
• Taking someone else's medicine is also a kind of misuse.

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: Nobel Prize

Alfred Bernhard Nobel (21 October 1833 – 10 December 1896) was a Swedish chemist, engineer, innovator, and armaments manufacturer. He is the inventor of dynamite. Nobel also owned Bofors, which he had redirected from its previous role as primarily an iron and steel producer to a major manufacturer of cannon and other armaments.

Nobel held 355 different patents, dynamite being the most famous. In his last will, he used his enormous fortune to institute the Nobel prize. The synthetic element nobelium was named after him. His name also survives in modern-day companies such as Dynamit Nobel and Akzo Nobel, which are descendents of the companies Nobel himself established.

'The one personal trait of Nobel that helped him to sharpen his creativity include his talent for information access, via his multilingual skills. Despite the lack of formal secondary and tertiary level education, Nobel gained proficiency in six languages: Swedish, French, Russian, English, German and Italian.

He also developed literary skills to write poetry in English.' His Nemesis’, a prose tragedy in four acts about Beatrice Cenci, partly inspired by Percy Bysshe Shelley's The Cenci, was printed while he was dying. The entire stock except for three copies was destroyed immediately after his death, being regarded as scandalous and blasphemous. The first surviving edition (bilingual Swedish–Esperanto) was published in Sweden in 2003. The play has been translated to Slovenian via the Esperanto version and to French. In 2010 it was published in Russia as another bilingual (Russian-Esperanto) edition.

One day, Noble, while looking at the morning newspaper, to his surprise and horror, read his name in the obituary column. The newspapers had reported the death of the wrong person by mistake. His first response was shock. Am I here or there?

When he regained his composure, his second thought was to find out what people had said about him.

The obituary read, "Dynamite King Dies." And also "He was the merchant of death."

When he read the words "merchant of death," he asked himself a question, "Is this how I am going to be remembered?" He got in touch with his feelings and decided that this was not the way he wanted to be remembered. From that day on, he started working toward peace.

Thus the foundations of the Nobel Prize were laid in 1895 when Alfred Nobel wrote his last will, leaving much of his wealth for its establishment. Since 1901, the prize has honored men and women for outstanding achievements in physics, chemistry, medicine, literature and for work in peace.

Emedinews:Insights on Medicolegal issues: How can snake bites be avoided?

Snake venom is a very complex mixture of proteins and toxins. Snakes use their venom to immobilize, and in some cases, digest their prey.

Snakes bite only when they are surprised by a sudden movement and cannot get away. Cobras and the Russel viper are responsible for as many as 20,000 snake bite deaths in India every year. Inland Taipan is the world’s most venomous land snake. Its bite is synonymous with death. Maximum survival time recorded after the bite of a Taipan snake is not more than few hours. Without prompt medical assistance its victim has rarest chance of recovery.

To avoid snake bite:
• Do not sleep on the ground. You might roll over onto a snake while asleep, or a snake may move next to you to get warm.
• Do wear shoes when walking outdoors. Tall leather boots give the best protection for walking in long grass or undergrowth.
• Do learn about the poisonous snakes in your area. Learn what they look like and where they live. Most snakes live on the ground but some live in trees or bushes. Find out if there are any snakes that spit venom and how they attack.
• Do take care at night because this is when many snakes are active. Tell children to wear shoes and use a torch when walking around at night. Teach them to leave snakes alone.
• Do not go near snakes. Run away if you can. If you cannot run away, do not make sudden movements.
• Do not touch a snake even if it looks dead. Some snakes pretend to be dead to avoid attack.
• Do not turn over stones or logs, or put your hand or foot into a hole in the ground. Before stepping over a log look for snakes on the other side.

Emedinews:Makesure:A 28–year–old pregnant woman was advised erythromycin estolate for her upper respiratory tract infection. A week later she developed jaundice.

Situation: A 28–year–old pregnant woman was advised erythromycin estolate for her upper respiratory tract infection. A week later she developed jaundice.
Reaction: Oh my God! You should have prescribed erythromycin stearate instead of estolate.
Lesson: Make sure to remember that higher incidence of hepatitis with cholestatic jaundice occur in pregnancy with erythromycin estolate.

Emedinews:Inspiration:Insanity ???

It was a Sports Stadium. Eight children were standing on the track to participate in a running event.

Ready! Steady! Bang !!!

With the sound of toy pistol, all eight girls started running. Hardly had they covered 10 to 15 steps, when one of the smaller girls slipped and fell down. Due to bruises and pain she started crying. When the other seven girls heard the little girl cry they stopped running, stood for a while and turned back. Seeing the girl on the track they all ran to help. One among them bent down, picked her up and kissed her gently And enquired as to how she was..

They then lifted the fallen girl pacifying her.

Two of them held her firmly while all seven joined hands together and walked together towards the winning post........ ..There was pin drop silence at the spectators stand.

Officials were shocked.

Slow claps multiplied to thousands as the spectators stood up in appreciation. Many eyes were filled with tears
And perhaps even God's!

YES.!! This happened in Hyderabad, India, recently! The sport was conducted by National Institute of Mental Health. All these special girls had come to participate in this event They were spastic children.

Yes, they were Mentally Challenged. What did they teach the WORLD?
Teamwork? Humanity? Equality among all?

Successful people help others who are slow in learning so that they are not left far behind.

We never do this because we have brains !!!!

Emedinews:Insights on Medicolegal issues:Antiquity of Indian medicine & medical education: Charak Samhita

The effect of a dose of ethanol depends on how much alcohol a person regularly drinks

The effect of a dose of ethanol depends on how much alcohol a person regularly drinks. Someone who does not usually drink much alcohol may be badly affected by an amount that would otherwise have very little effect on a person who regularly drinks large amounts. Children may suffer severe poisoning after drinking just a mouthful of aftershave, mouthwash or perfume. Isopropanol is more poisonous than ethanol. Serious poisoning can be caused by using isopropanol as rubbing alcohol, if large amounts are rubbed on the skin and absorbed into the body. Both ethanol and isopropanol slow down the brain, causing unconsciousness and shallow breathing. Isopropanol vapor is irritant to eyes, nose and throat and poisonous, if inhaled. Regularly drinking large amounts of ethanol causes chronic poisoning, resulting in many changes in the body, particularly in the brain, the liver, and the heart.

Signs and symptoms of acute poisoning
• The patient’s clothes and breath may smell of alcohol; patients who have swallowed isopropanol smell of acetone
• Slurred speech – difficulty in performing simple tasks, staggering walk, – nausea, vomiting, and abdominal pain which are more severe after swallowing isopropanol – drowsiness– blurred or double vision– unconsciousness – fits

Emedinews:Makesure:A patient died after receiving penicillin injection.

Situation: A patient died after receiving penicillin injection.
Reaction: Oh my God! Why was anaphylaxis not suspected?
Lesson: Make sure that every time a patient is given penicillin injection, anti anaphylaxis measures are available.

Emedinews:Inspiration:The Three Races

A fable retells the story of the young athletic boy hungry for success, for whom winning was everything and success was measured by such a result.
One day, the boy was preparing himself for a running competition in his small native village, himself and two other young boys to compete. A large crowd had congregated to witness the sporting spectacle and a wise old man, upon hearing of the little boy, had travelled far to bear witness also.
The race commenced, looking like a level heat at the finishing line, but sure enough the boy dug deep and called on his determination, strength and power... he took the winning line and was first. The crowd was ecstatic and cheered and waved at the boy. The wise man remained still and calm, expressing no sentiment. The little boy however felt proud and important.
A second race was called, and two new young, fit, challengers came forward, to run with the little boy. The race was started and sure enough the little boy came through and finished first once again. The crowd was ecstatic again and cheered and waved at the boy. The wise man remained still and calm, again expressing no sentiment. The little boy, however, felt proud and important.
"Another race, another race!" pleaded the little boy. The wise old man stepped forward and presented the little boy with two new challengers, an elderly frail lady and a blind man. "What is this?” quizzed the little boy. "This is no race" he exclaimed. "Race!” said the wise man. The race was started and the boy was the only finisher, the other two challengers left standing at the starting line. The little boy was ecstatic; he raised his arms in delight. The crowd, however, was silent showing no sentiment toward the little boy.
"What has happened? Why not do the people join in my success?" he asked the wise old man. "Race again", replied the wise man, "...this time, finish together, all three of you, finish together" continued the wise man. The little boy thought a little, stood in the middle of the blind man and the frail old lady, and then took the two challengers by the hand. The race began and the little boy walked slowly, ever so slowly, to the finishing line and crossed it. The crowd was ecstatic and cheered and waved at the boy. The wise man smiled, gently nodding his head. The little boy felt proud and important.
"Old man, I understand not! Who are the crowds cheering for? Which one of us three?” asked the little boy. The wise old man looked into the little boy's eyes, placing his hands on the boy's shoulders, and replied softly... "Little boy, for this race you have won much more than in any race you have ever ran before, and for this race the crowd cheer not for any winner!"

Emedinews:Insights on Medicolegal issues:What is the first aid for poisonous bites and stings?

People often panic if they have been bitten or stung. You should tell the patient that many snakes, spiders, insects and sea creatures are harmless and that even the bites and stings of dangerous animals often do not cause poisoning.

Keep the patient calm and still. Moving the bitten or stung limb speeds up the spread of venom to the rest of the body. Fear and excitement also make the patient worse. The patient should be told not to use the limb and to keep it still and below the level of the heart. The limb may swell after a while, so take off the patient’s rings, watch, bracelets, anklets and shoes as soon as possible. A splint and a sling may help to keep the limb still.

Avoid doing the following:
• Do not cut into the wound or cut it out.
• Do not suck venom out of the wound.
• Do not use a tourniquet or tight bandage.
• Do not put chemicals or medicines on the wound or inject them into the wound (for e.g., potassium permanganate crystals).
• Do not put ice packs on the wound.
• Do not use proprietary snake bite kits.
• The patient should lie on one side in the recovery position so that the airway is clear, in case or vomiting or fainting.
• Do not give the patient anything by mouth - no food, alcohol, medicines or drinks. However, if it is likely to be a long time before the patient gets medical care, give the patient water to drink to stop dehydration.
• Try to identify the animal, but do not try to catch it or keep it if this will put you, the patient or others at risk. If the animal is dead take it to hospital with the patient, but handle it very carefully, because even dead animals can sometimes inject venom.
• As soon as possible, take the patient to a hospital, medical dispensary, or clinic where medical care can be given. The patient should not walk but should keep as still as possible. If there is no ambulance or car, carry the patient on a stretcher or trestle, or on the crossbar of a bicycle.
• Antivenom should only be given in a hospital or medical Centre where resuscitation can be given, because the patient may have an allergic reaction. If available, antivenom should be used if there is evidence of severe poisoning. It should not be used when there are no signs of poisoning.