Emedinews:Insights on Medicoleagal Issues:Pre–Natal Diagnostic Techniques (PNDT) Act 1994

Determination of fetus sex is prohibited in India

The Pre–Natal Diagnostic Techniques Act 1994 provide for the regulation of the use of pre–natal diagnostic techniques for the purpose of detecting genetic or metabolic disorders or chromosomal abnormalities or certain congenital malformations or sex-linked disorders and for the prevention of the misuse of such technique for the purpose of per–natal sex determination leading to female feticide.

• No person referred to in Clause (2) of Section 3 shall conduct the pre–natal diagnostic procedures unless:
• He has explained all known side and after effects of such procedures to the pregnant woman concerned;
• He has obtained in the prescribed form her written consent to undergo such procedures in the language which she understands;
• A copy of her written consent obtained under Clause (b) is given to the pregnant woman.
• No person conducting pre–natal diagnostic procedures shall communicate to the pregnant woman concerned or her relatives the sex of the fetus by words, signs or in any other manner.
• No genetic counseling center or genetic laboratory or genetic clinic shall conduct or cause to be conducted in its centre, lab or clinic, pre–natal diagnostic techniques including ultrasonography for the purpose of determining the sex of a fetus;
• No person shall conduct or cause to be conducted any pre–natal diagnostic techniques including ultra sonography, for the purpose of determining the sex of a fetus.

Emedinews:Makesure:A 14 year–old girl suffering from dysmenorrhea wanted an analgesic for her pain.

Situation: A 14 year–old girl suffering from dysmenorrhea wanted an analgesic for her pain.
Reaction: Oh my God! Why was aspirin given!
Lesson: Make sure to remember that aspirin is contraindicated in children.

Emedinews:Inspiration:A man must constantly exceed his level

This inspiring story is about Bruce Lee, a legendary martial art master.

“Bruce had me up to three miles a day, really at a good pace. We’d run the three miles in twenty-one or twenty-two minutes. Just under eight minutes a mile [Note: when running on his own in 1968, Lee would get his time down to six-and-a half minutes per mile].

So this morning he said to me “We’re going to go five.” I said, “Bruce, I can’t go five. I’m a helluva lot older than you are, and I can’t do five.” He said, “When we get to three, we’ll shift gears and it’s only two more and you’ll do it.”

I said “Okay, hell, I’ll go for it.” So we get to three, we go into the fourth mile and I’m okay for three or four minutes, and then I really begin to give out. I’m tired, my heart’s pounding, I can’t go any more and so I say to him, “Bruce if I run anymore,” –and we’re still running-” if I run any more I’m liable to have a heart attack and die.” He said, “Then die.” It made me so mad that I went the full five miles.

Afterward I went to the shower and then I wanted to talk to him about it. I said, you know, “Why did you say that?”

He said, “Because you might as well be dead. Seriously, if you always put limits on what you can do, physical or anything else, it’ll spread over into the rest of your life. It’ll spread into your work, into your morality, into your entire being. There are no limits. There are plateaus, but you must not stay there, you must go beyond them. If it kills you, it kills you. A man must constantly exceed his level.”

Emedinews:Insights on Medicolegal Issues:How is a sample for Touch DNA collected?

Touch DNA is usually not visible and since it is often deposited in smaller amounts than the DNA found in bloodstains or other body fluids, it is more difficult to obtain DNA profiles from these samples. The key to obtaining successful Touch DNA results depends on awareness of items, which may be suitable for Touch DNA analysis and using the sampling technique or collection method that will recover the highest number of skin cells.

• Swabbing: Surface of the item is rubbed with a cotton swab to collect possible cells. This method is preferred for hard items such as glass or plastic.
• Cutting: May be used for soft items, such as clothing, in which fabric from areas of interest is cut to collect possible cells.
• In addition to the commonly used swabbing and cutting methods, latest technologies have recently started using the "Scraping" and "Tape Lift" methods, in which the surface of soft items such as clothing are either scraped with a blade, or sampled with a small piece of tape, to collect possible cells.

Emedinews:Makesure:An elderly patient with unstable angina presented with URTI and was found to be positive for Chlamydia pneumoniae infection.

Situation: An elderly patient with unstable angina presented with URTI and was found to be positive for Chlamydia pneumoniae infection.
Reaction: Remember to start macrolides immediately.
Lesson: Make sure to remember that erythromycin 2 g/day for 10–14 days reverses the increased risk of atherosclerosis.

Emedinews:Inspiration:Unique human flaws

An Inspirational Story
(Ms Ritu Sinha)

An elderly Asian woman had two large pots, each hung on the end of a pole, which she carried across her neck.

One of the pots had a crack in it while the other pot was perfect and always delivered a full portion of water. At the end of the long walk from the stream to the house, the cracked pot arrived only half full.

For two years, this went on daily with the woman bringing home only one and a half pots of water. The perfect pot was proud of its accomplishments. The poor cracked pot was ashamed of its own imperfection and miserable that it could only do half of what it had been made to do.

After 2 years of what it perceived to be bitter failure, it spoke to the woman: “I am ashamed of myself because this crack in my side causes water to leak out all the way to your house.”

The old woman smiled, “Did you notice that there are flowers on your side of the path, but not on the other pot’s side?”

“That’s because I have always known about your flaw so I planted flower seeds on your side of the path, and every day while we walk back, you water them. For two years I have been able to pick these beautiful flowers to decorate the table. Without you being just the way you are, there would not be this beauty to grace the house.”

Moral: Like the pots, we all have our own unique flaws. But it’s the cracks and flaws we each have that make our lives together so very interesting and rewarding.

Emedinews:Insights on Medicolegal issues:What is a surgical error?

The word ‘surgery’ came from 'chirurgiae', which means ‘hand work’. However today in medical specialty, the term surgery incorporates uses of operative manual, various computerized instrumental techniques along with hand work on a patient for surgical procedure. The surgical operations are performed maintaining a standard with the best of his ability and capability by the surgeon without any problems or complications and the same is true in most surgeries in various hospitals. But, every year some patients complain of unnecessary harm to health and life due to performed surgical errors. Sometimes the damage caused is repairable and does not give rise to any long–term effects side by side. In some other cases, the negligence results in permanent disability or even a fatality.

• All operations naturally carry with them a certain level of risk and there are also specific risks of each different procedure.
• Each and every case where there may be problems during or following an surgical operation, risks should be carefully explained to a patient before the procedure goes ahead
• An informed choice about having surgery and the possible complications must be explained in a language, which the patient/legal heirs fully understand. Failure to do this may constitute negligence in itself.
• The Delhi Medical Council has reiterated in many cases about informed consent.

Emedinews:Insights on Medicolegal issues:What is a surgical error?

The word ‘surgery’ came from 'chirurgiae', which means ‘hand work’. However today in medical specialty, the term surgery incorporates uses of operative manual, various computerized instrumental techniques along with hand work on a patient for surgical procedure. The surgical operations are performed maintaining a standard with the best of his ability and capability by the surgeon without any problems or complications and the same is true in most surgeries in various hospitals. But, every year some patients complain of unnecessary harm to health and life due to performed surgical errors. Sometimes the damage caused is repairable and does not give rise to any long–term effects side by side. In some other cases, the negligence results in permanent disability or even a fatality.

• All operations naturally carry with them a certain level of risk and there are also specific risks of each different procedure.
• Each and every case where there may be problems during or following an surgical operation, risks should be carefully explained to a patient before the procedure goes ahead
• An informed choice about having surgery and the possible complications must be explained in a language, which the patient/legal heirs fully understand. Failure to do this may constitute negligence in itself.
• The Delhi Medical Council has reiterated in many cases about informed consent.

Emedinews:Insights on Medicolegal issues:What is a surgical error?

The word ‘surgery’ came from 'chirurgiae', which means ‘hand work’. However today in medical specialty, the term surgery incorporates uses of operative manual, various computerized instrumental techniques along with hand work on a patient for surgical procedure. The surgical operations are performed maintaining a standard with the best of his ability and capability by the surgeon without any problems or complications and the same is true in most surgeries in various hospitals. But, every year some patients complain of unnecessary harm to health and life due to performed surgical errors. Sometimes the damage caused is repairable and does not give rise to any long–term effects side by side. In some other cases, the negligence results in permanent disability or even a fatality. All operations naturally carry with them a certain level of risk and there are also specific risks of each different procedure. Each and every case where there may be problems during or following an surgical operation, risks should be carefully explained to a patient before the procedure goes ahead An informed choice about having surgery and the possible complications must be explained in a language, which the patient/legal heirs fully understand. Failure to do this may constitute negligence in itself. The Delhi Medical Council has reiterated in many cases about informed consent.

Emedinews:Insights on Medicolegal issues:What is a surgical error?

The word ‘surgery’ came from 'chirurgiae', which means ‘hand work’. However today in medical specialty, the term surgery incorporates uses of operative manual, various computerized instrumental techniques along with hand work on a patient for surgical procedure. The surgical operations are performed maintaining a standard with the best of his ability and capability by the surgeon without any problems or complications and the same is true in most surgeries in various hospitals. But, every year some patients complain of unnecessary harm to health and life due to performed surgical errors. Sometimes the damage caused is repairable and does not give rise to any long–term effects side by side. In some other cases, the negligence results in permanent disability or even a fatality.

• All operations naturally carry with them a certain level of risk and there are also specific risks of each different procedure.
• Each and every case where there may be problems during or following an surgical operation, risks should be carefully explained to a patient before the procedure goes ahead
• An informed choice about having surgery and the possible complications must be explained in a language, which the patient/legal heirs fully understand. Failure to do this may constitute negligence in itself.
• The Delhi Medical Council has reiterated in many cases about informed consent.

Emedinews:Insights on Medicolegal issues:What is a surgical error?

The word ‘surgery’ came from 'chirurgiae', which means ‘hand work’. However today in medical specialty, the term surgery incorporates uses of operative manual, various computerized instrumental techniques along with hand work on a patient for surgical procedure. The surgical operations are performed maintaining a standard with the best of his ability and capability by the surgeon without any problems or complications and the same is true in most surgeries in various hospitals. But, every year some patients complain of unnecessary harm to health and life due to performed surgical errors. Sometimes the damage caused is repairable and does not give rise to any long–term effects side by side. In some other cases, the negligence results in permanent disability or even a fatality.

• All operations naturally carry with them a certain level of risk and there are also specific risks of each different procedure.
• Each and every case where there may be problems during or following an surgical operation, risks should be carefully explained to a patient before the procedure goes ahead
• An informed choice about having surgery and the possible complications must be explained in a language, which the patient/legal heirs fully understand. Failure to do this may constitute negligence in itself.
• The Delhi Medical Council has reiterated in many cases about informed consent.

Emedinews:Makesure:A patient of jaundice with fever developed complications.

Situation: A patient of jaundice with fever developed complications.
Reaction: Oh my God! Why were other causes of jaundice not suspected?
Lesson: Make sure that in a patient with jaundice and fever, causes other than viral hepatitis are looked into. In viral hepatitis, jaundice appears after the fever subsides.

Emedinews:Inspiration:The baby without 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, “You are going to the hospital, Son. Mother and I have someone who will donate the ears you need. But it’s a secret,” said the father.

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 … one of the darkest days that a son must endure. 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 what cannot be seen. Real love lies not in what is done and known, but in what that is done but not known.

Emedinews:Insights on Medicolegal Issues:What is Somatic Death?

For many years it was accepted that death occurred if respiration and circulation ceased for more than 10 minutes. Now it is possible to stop the heart and respiration for an hour or longer and restart them again at will by methods such as cooling the whole body to 15°C or 59°F or less. During this period, ECG and EEG show no electrical activity and body looks like a corpse. This leads to the view that it is not the cessation of the respiration or circulation but it is their failure to return that indicates death. Thus we are driven from a positive to negative approach. Therefore, the doctor while taking decision must satisfy himself that not only respiration and circulation has stopped, but their failure has persisted to such a period that under no circumstances it is possible for the person to come to life again.

• Death is said to have occurred when a final expiration is followed by continuous immobility of the chest, loss of pulse and alteration of the features. These changes indicate that respiration and circulation have been stopped and the brain will stop functioning if it has not been so.
• Residual heart movement is not of practical importance as they are insufficient to maintain the circulation.
• Somatic death can be detected by ECG that will stop within minutes.

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

Emedinews:Makesure:A patient with rheumatoid arthritis was not responding.

Situation: A patient with rheumatoid arthritis was not responding.
Reaction: Oh my God! Why was smoking not stopped?
Lesson: Make sure that all patients of RA stop smoking. It is a major preventable factor contributing to the development of antibody–positive rheumatoid arthritis in genetically susceptible individuals.

Emedinews:Inspiration:Human value

An Inspirational Story
(Ms Ritu Sinha)

Life is full of ups and downs. It is easy to lose hope and confidence. This little story helps us to realize that no matter what happens, we remain valuable as individuals.

A well known speaker started off his seminar by holding up a $20 bill. In the room of 200, he asked, “Who would like this $20 bill?” Hands started going up.

He said, “I am going to give this $20 to one of you but first, let me do this.” He proceeded to crumple the dollar bill up. He then asked, “Who still wants it?” Still the hands were up in the air.

“Well,” he replied, “What if I do this?” And he dropped it on the ground and started to grind it into the floor with his shoe. He picked it up, now all crumpled and dirty. “Now who still wants it?” Still the hands went into the air.

“My friends, no matter what I did to the money, you still wanted it because it did not decrease in value. It was still worth $20.

Many times in our lives, we are dropped, crumpled, and ground into the dirt by the decisions we make and the circumstances that come our way.

We feel as though we are worthless. But no matter what has happened or what will happen, you will never lose your value. You are special – Don’t ever forget it!”

Emedinews:Insights on Medicolegal Issues:Sudden death – Autopsy

Left ventricular hypertrophy is the second leading cause of sudden cardiac death in adults in India

• Longstanding raised high blood pressure causes secondary damage to the wall of the left ventricle, the main pumping chamber of the heart. Hypertrophy is associated with cardiac arrhythmias.
• The mechanism of death in a majority of patients dying of sudden cardiac death is ventricular fibrillation and as a consequence there may be no prodromal symptoms associated with the death. These patients may be going about their daily business and suddenly collapse without the typical features of myocardial infarction such as chest pain and shortness of breath. There are a number of cases in which patients feel the effect of myocardial ischemia. (Myocardial ischemia is associated with referred pain, classically to the front of the chest, the left arm and the jaw. Patients may feel generally unwell, with nausea, dizziness and vomiting).
• These symptoms may precede the death for any length of time between a few minutes and several hours.

I have conducted the postmortem examination of four cases who were found dead in toilet during daily pursuits; these were cases of left ventricular hypertrophy that led to sudden death.

Emedinews:Makesure:A patient with renal failure came to a doctor.

Situation: A patient with renal failure came to a doctor.
Reaction: Oh, my God! Why was he given painkillers?
Lesson: Make sure to avoid painkillers in renal failure as most painkillers (barring nimesulide, paracetamol) are not kidney–friendly drugs.

Emedinews:Inspiration:Have lunch with God – bring chips

An Inspirational Story
(Dr GM Singh)

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 cola and started his journey. When he had gone about three blocks, he met an old woman. She was sitting in the park, staring at some pigeons. The boy sat down next to her and opened his suitcase.

He was about to take a drink from his cola 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 cola . 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!

Emedinews:Insights on MEdicolegal Issues:Places where pregnancy may be terminated

Places where pregnancy may be terminated

No termination of pregnancy shall be made in accordance with this act at any place other than:

• a hospital established or maintained by the Government, or
• a place for the time being approved for the purpose of this Act by Government or a District Level Committee constituted by that government with the Chief Medical Officer or District Health Officer as the Chairperson of the said Committee:
• The District Level Committee shall consist of not less than three and not more than five members including the Chairperson, as the Government shall specify from time to time.
• Under section4, before its substitution by the present section by the Medical Termination of Pregnancy (Amendment) Act, 2002, no termination of pregnancy could be made in accordance with the act at any place other than a hospital established or maintained by the government, or
• a place for being approved for the purpose of the Act by the government.

(Ref: MTP Act 1971)

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

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

Emedinews:Inspiration:Akbar’s Gold Coins

The wisdom of Birbal was unparalleled during the reign of Emperor Akbar. But Akbar’s brother in law was extremely jealous of him. He asked the Emperor to dispense with Birbal’s services and appoint him in his place. He gave ample assurance that he would prove to be more efficient and capable than Birbal. Before Akbar could take a decision on this matter, this news reached Birbal. Birbal resigned and left. Akbar’s brother–in–law was made the minister in place of Birbal. Akbar decided to test the new minister. He gave three hundred gold coins to him and said, "Spend these gold coins such that, I get a hundred gold coins here in this life; a hundred gold coins in the other world and another hundred gold coins neither here nor there."

The minister found the entire situation to be a maze of confusion and hopelessness. He spent sleepless nights worrying over how he would get himself out of this mess. Thinking in circles was making him go crazy. Eventually, on the advice of his wife he sought Birbal’s help. Birbal said, just give me the gold coins. I shall handle the rest. Birbal walked the streets of the city holding the bag of gold coins in his hand. He noticed a rich merchant celebrating his son’s wedding. Birbal gave a hundred gold coins to him and bowed courteously saying, "The Emperor Akbar sends you his good wishes and blessings for the wedding of your son. Please accept the gift he has sent. The merchant felt honored that the king had sent a special messenger with such a precious gift. He honored Birbal and gave him a large number of expensive gifts and a bag of gold coins as a return gift for the king.

Next, Birbal went to the area of the city were the poor people lived. There he bought food and clothing in exchange for a hundred gold coins and distributed them in the name of the Emperor. When he came back to town he organized a concert of music and dance. He spent a hundred gold coins on it. The next day Birbal entered Akbar’s darbar and announced that he had done all that the king had asked his brother–in–law to do. The Emperor waited to know how he had done it. Birbal repeated the sequences of all the events and then said, The money I gave to the merchant for the wedding of his son – you have got back while on this earth. The money I spent on buying food and clothing for the poor "you will get it in the other world". The money I spent on the musical concert" you will get neither here nor there."

This is true even today. The money you spend on friends is returned or reciprocated in some form or the other. Money spent on charity gets converted into blessings from God which becomes your eternal property. Money spent on pleasures is just frittered away!

Emedinews:Insights on Medicolegal Issues:What are the viscera samples to be taken for chemical analysis by the doctor conducting the autopsy?

What are the viscera samples to be taken for chemical analysis by the doctor conducting the autopsy?

The majority of poisons are taken orally and the poison due to water content/liquids is likely to be present in the stomach and intestinal contents and their walls. After absorption all poison pass through the liver, which is the major detoxifying organ in the body and has the power of concentrating many poisons and making them identifiable when the blood and urine concentrations may have declined to very low levels. The kidney, being the organ of excretion, contains large amounts of poison, which is excreted into the urine. The following viscera are preserved in case of any suspected or evident case of death due to poisoning.

• Stomach and its contents. If the stomach is empty the wall should be preserved.
• Upper part of small intestine about 30 cm long with its contents
• Liver about 500 grams.
• One kidney or half of each kidney
• Brain in case of alcohol death
• Blood 100 ml/minimum 10 ml
• Urine 100 ml

Emedinews:Makesure: A patient missed her last dose of hepatitis B vaccine as she was out of station at 6th month

Situation: A patient missed her last dose of hepatitis B vaccine as she was out of station at 6th month.
Reaction: Oh my God! Why was the vaccine not given between 4–6 months?
Lesson: Make sure that all patients are given the complete vaccine regimen. The correct regimen is 0, 1–2 months and 4–months.

Emedinews:Inspiration:How elite people think?

Have you ever wondered how elite people think? Through a short, inspiring speech below, Jim Rohn leads us into the spirit world of highly successful entrepreneurs. Here to strengthen our spirit! Yes we can!! 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.

Emedinews:Insights on Medicolegal Issues:What is Touch DNA

Locard’s Exchange Principle states that with contact between two items, there will always be an exchange. So, when a crime is committed, if the perpetrator deposits a sufficient number of skin cells on an item at the scene, and that item is collected as possible evidence.

• It is the DNA in skin cells that is left at a crime scene and may be sampled from a variety of items including gun grips, steering wheels, eating utensils, luggage handles and clothing.
• Humans shed tens of thousands of skin cells each day, and these cells are transferred to every surface with which human skin comes into contact.
• Touch DNA is not Low Copy Number DNA (LCN DNA).
• LCN DNA profiling allows a very small amount of DNA to be analyzed, from as few as 10 to 30 cells.
• Touch DNA samples are processed exactly in the same way as blood, semen, saliva etc, and can stand up to scrutiny in court much better than LCN DNA.
• Touch DNA analysis may be able to link the perpetrator to the crime scene, by collecting the skin cells and analyzing them.

Emedinews:Makesure:An elderly patient with unstable angina presented with URTI and was found to be positive for Chlamydia pneumoniae infection.

Situation: An elderly patient with unstable angina presented with URTI and was found to be positive for Chlamydia pneumoniae infection.
Reaction: Remember to start macrolides immediately.
Lesson: Make sure to remember that erythromycin 2 g/day for 10–14 days reverses the increased risk of atherosclerosis.

Emedinews:Inspiration:MBA and the fisherman

An American businessman was at a pier in a small coastal Mexican village when a small boat with just one fisherman docked. Inside the small boat were several large yellow-fin tuna. The American complimented the Mexican on the quality of his fish and asked how long it took to catch them.

The Mexican replied only a little while.

The American then asked why didn't he stay out longer and catch more fish?

The Mexican said he had enough to support his family's immediate needs.

The American then asked the Mexican how he spent the rest of his time.

The Mexican fisherman said, "I sleep late, fish a little, play with my children, take siesta with my wife, Maria, stroll into the village each evening where I sip wine and play guitar with my amigos. I have a full and busy life, senor."

The American scoffed, "I am a Harvard MBA and could help you. You should spend more time fishing and with the proceeds, buy a bigger boat. With the proceeds from the bigger boat, you could buy several boats, eventually you would have a fleet of fishing boats. Instead of selling your catch to a middleman you would sell directly to the processor, eventually opening your own cannery. You would control the product, processing and distribution. "You would need to leave this small coastal fishing village and move to Mexico City, then LA and eventually NYC where you will run your expanding enterprise."

The Mexican fisherman asked, "But senor, how long will this all take?"

To which the American replied, "15-20 years."

"But what then, senor?" asked the Mexican.

The American laughed, and said, "That's the best part! When the time is right, you would announce an IPO and sell your company stock to the public. You'll become very rich, you would make millions!"

"Millions, senor?" replied the Mexican. "Then what?"

The American said, "Then you would retire. Move to a small coastal fishing village where you would sleep late, fish a little, play with your kids, take siesta with your wife, stroll to the village in the evenings where you could sip wine and play your guitar with your amigos."

Then the Mexican Fisherman says: THEN WHAT AM I DOING NOW?

Emedinews:Insights on Medioclegal Issues:What is obsession?

• In obsession, the sufferer constantly entertains an idea, without cause, in spite of all his efforts to drive the idea out of his mind. Obsession is a type of compulsive phenomenon. The classical example of this condition is, a person while going to bed at night, bolts the door of the room from inside, but after going to the bed he feels the necessity to verify and does so to see if he has bolted the door or not. He repeats this act again and again, in spite of his consciousness and in spite of his desire and efforts to stop the act.
• Obsession is considered a borderline state between sanity and insanity. In the above case, a sane person will stop after repeating the act of verification for a few times. But an insane person may continue the act all throughout the night without sleeping.

Emedinews:Insights on Medioclegal Issues:What is obsession

• In obsession, the sufferer constantly entertains an idea, without cause, in spite of all his efforts to drive the idea out of his mind. Obsession is a type of compulsive phenomenon. The classical example of this condition is, a person while going to bed at night, bolts the door of the room from inside, but after going to the bed he feels the necessity to verify and does so to see if he has bolted the door or not. He repeats this act again and again, in spite of his consciousness and in spite of his desire and efforts to stop the act.
• Obsession is considered a borderline state between sanity and insanity. In the above case, a sane person will stop after repeating the act of verification for a few times. But an insane person may continue the act all throughout the night without sleeping.

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

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

Emedinews:Inspiration:Learn from mistakes

Thomas Edison tried two thousand different materials in search of a filament for the light bulb. When none worked satisfactorily, his assistant complained, “All our work is in vain. We have learned nothing.”

Edison replied very confidently, “Oh, we have come a long way and we have learned a lot. We know that there are two thousand elements which we cannot use to make a good light bulb.”

Emedinews:Insights on Medicolegal Issues:What is murder?

Murder is the act of killing another human being with malice, traditionally called "malice aforethought." Malice is defined as the intent to kill or to inflict bodily injury, either express or implied. If a deadly weapon is used, intent to kill will necessarily be implied by a court of law. The presumption is that if the assailant brought a deadly weapon with him/her there was intent to use the weapon. If the assailant picked up a weapon at the scene of the crime in an act of defense or in a provoked fit of rage, there might not be malice.

Murder, as defined in common law countries, is the unlawful killing of another human being with intent or malice aforethought and generally this state of mind distinguishes murder from other forms of unlawful homicide.

• Such a manslaughter means unlawful premeditated killing of a human being by a human being
• In the United States, the principle of dual sovereignty applies to homicide, as to other crimes. If murder is committed within the borders of a state, that state has jurisdiction.
• In Sweden, Murder (Mord) is defined as a planned taking a life of another and punishable with imprisonment between 10 to 18 years or life.
• However, according to the Romanian Penal Code, a person can face a penalty ranging from 10 to 25 years or life imprisonment for murder.
• In Norway, an act of murder (mord or drap) may be either planned murder, intentional murder or murder as a result of neglect.
• Murder is defined in the New South Wales Crimes Act 1900 as follows:
• Under NSW law, the maximum penalty for murder is life imprisonment with a standard non–parole period of 20 years, or
• 25 years for the murder of a child under the age of 18 years, or police official
• In Finland, murder is defined as homicide with at least one of four aggravating factors: deliberate intent/exceptional brutality or cruelty significantly endangering public safety Committed against a public official engaged in enforcing the law.

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

Situation: A diabetic patient died of flu pneumonia.
Reaction: Oh my God! Why was flu vaccine not given?
Lesson: Make sure that all diabetics are given flu vaccine every year.

Emedinews:Insights on MEdicolegal Issues:What is the August 5, 2005 Supreme Court judgment on medical negligence?

Cases of doctors being subjected to criminal prosecution are on an increase. Sometimes such prosecutions are filed by private complainants and sometimes by police on an FIR being lodged and cognizance taken.

o   The investigating officer and the private complainant cannot always be supposed to have knowledge of medical science so as to determine whether the act of the accused medical professional amounts to rash or negligent act within the domain of criminal law under Section 304–A of IPC.

o   The criminal process once initiated subjects the medical professional to serious embarrassment and sometimes harassment.

o   He has to seek bail to escape arrest, which may or may not be granted to him.

o   At the end he may be exonerated by acquittal or discharge but the loss which he has suffered in his reputation cannot be compensated by any standards.

o   We may not be understood as holding that doctors can never be prosecuted for an offence of which rashness or negligence is an essential ingredient.

o   All that we are doing is emphasizing the need for care and caution in the interest of society; for, the service which the medical profession renders to human beings is probably the noblest of all, and hence there is a need for protecting doctors from frivolous or unjust prosecutions.

• Many a complainant prefer recourse to criminal process as a tool for pressurizing the medical professional for extracting uncalled for or unjust compensation. Such malicious proceedings have to be guarded against.

Emedinews:Make Sure:A patient with dengue died.

Situation: A patient with dengue died.
Reaction: Oh my God, why was he not given adequate fluids?
Lesson: Make Sure that all patients with dengue are given fluids to correct intravascular dehydration.

Emedinews:Inspiration:Value and Invest in Yourself

Author: Warren Buffet

 If you are into financial investment, you’re probably very familiar with Mr. Warren Buffet (1951–present). He is the most successful investor in the world. His investment strategies are legendary and many people seek to learn from him. Even more respectable, he pledged to give away 99% of his wealth (more than $30 billion at the time of the pledge in 2006) to non-profit foundations, mostly to Bill Gates’ Foundation. Mr. Buffet often travels to universities to give speeches to educate and motivate students. Here is one of his speeches to teach us the value of our body, to invest in ourselves, in education for a great future. Imagine that a Genie offers you any car in the world. The catch is that it is the only car you will ever own. What would you do? You would read the manual 10 times, change the oil twice as often as required, and you would take fastidious care so that that car remained the car of your dreams forever. Think about what this tells you about your body. You get only one mind and one body–the same ones you will have at 20, 40, 60, etc. Take care of them and maximize their potential. It will be too late to take care of your body and mind (and car) later on. You can maintain them, but it is hard or impossible to undo big mistakes or negligence later on. You do not want to end up with a wreck on your hands. Your main asset in life is yourself. Treat yourself as a valuable asset. I often explain to students that I would be willing to pay today for a percentage of the future earnings of good students. If you value yourself, and invest in yourself, you will be worth a great deal throughout your lifetime, both to yourself and to your community.

What is Sec 312 of the IPC?

What is Sec 312 of the IPC?

Criminal and legal Abortions

Sec 312 of the IPC, 1860 under the heading "causing miscarriage" says that whoever voluntarily causes a woman with child to miscarry, shall, if such miscarriage be not caused in good faith for saving the life of the woman, be punished with imprisonment of either description of a term which may extend to three years, or with fine, or with both; and, if the woman be quick with the child, shall be punished with imprisonment of either description of a term which may extend to seven years or shall also be liable to fine. Explanation to this section: a woman who causes herself to miscarry, is also punishable thereunder.

• In Dr. Akhil Kumar v. State of M.P., 1992 LJ 2029(MP), a woman living separately from her husband for 3 to 4 years conceived as a result of illicit intercourse with her distant cousin. When her pregnancy was of 24 weeks she approached a medical practitioner who pushed Menstrogen Forte injection into her which caused her death. The literature of Menstrogen Forte clearly stated that the effect of such injection could be miscarriage. The plea of the accused physician that he had pushed that injection to determine if she was pregnant was not believed because the six month old pregnancy was writ large on her abdomen discernible from outside and the doctor was convicted for attempt to cause miscarriage.
• The deceased mother of four children, having become pregnant was taken by her son–in–law to a quack for abortion. She was later found dead and was buried. The dead body was exhumed after about 12 days and the quack was prosecuted under Sec. 314 and convicted thereunder on circumstantial evidence. (In Maideen Sab v. State of Karnataka, 1993 Cri LJ 1430 (Kar)

Emedinews:Makesure:A diabetic patient with BP of 130/90 developed acute heart pain.

Situation:  A diabetic patient with BP of 130/90 developed acute heart pain.  
Reaction: Oh my God! Why was his BP not kept below 120/80.
Lesson: Make sure that all patients with diabetes should have a goal BP of less than 120/80.

Emedinews:Inspiration:Value and invest in yourself

An Inspirational Story
(Ms Ritu Sinha)

If you are into financial investment, you’re probably very familiar with Mr. Warren Buffet (1951–present). He is the most successful investor in the world. His investment strategies are legendary and many people seek to learn after him. Even more respectable, he pledged to give away 99% of his wealth (more than $30 billion at the time of the pledge in 2006) to non-profit foundations, mostly to Bill Gates Foundation.

Mr. Buffet often travels to universities to give speeches to educate and motivate students. Here is one of his speeches to teach us the value of our body, to invest in ourselves, in education for a great future. Imagine that a Genie offers you any car in the world. The catch is that it is the only car you will ever own. What would you do?

You would read the manual ten times, change the oil twice as often as required, and you would take fastidious care so that that car remained the car of your dreams forever. Think about what this tells you about your body.

You get only one mind and one body–the same ones you will have at 20, 40, 60, etc.

Take care of them and maximize their potential. It will be too late to take care of your body and mind (and car) later on. You can maintain them, but it is hard or impossible to undo big mistakes or negligence later on. You do not want to end up with a wreck on your hands.

Your main asset in life is yourself.

Treat yourself as a valuable asset. I often explain to students that I would be willing to pay today for a percentage of the future earnings of good students. If you value yourself, and invest in yourself, you will be worth a great deal throughout your lifetime, both to yourself and to your community.

Emedinews:Insights on Medicolegal Issues:Medical negligence–Supreme Court decisions in the United States

The implied contract of a physician or surgeon is not to cure…but to treat the case with diligence and skill.

• In 1832 Connecticut court focused on the word "ordinary". A physician and surgeon, in the performance of his professional duties, is liable for injuries resulting from the want of ordinary diligence, care and skill…"Ordinary" means usual, common…If in the performance of any operation there was a want of ordinary diligence, care, and skill, or if there was carelessness, then the defendant–physician is liable.
• Twenty–one years later, the Pennsylvania Supreme Court ruled similarly, emphasizing the word "reasonable," in addition to "ordinary."
• The implied contract of a physician or surgeon is not to cure…but to treat the case with diligence and skill. The question is...whether the doctor had employed such skill and diligence as are ordinarily exercised in his profession… The rule (is) to be reasonable…The law demands…not extraordinary skill such as belongs only to a few men of rare genius and endowments, but that degree which ordinarily characterizes the profession.
• In 1860, the Supreme Court of Illinois issued its first decision on what constitutes the standard of care of a medical physician. The lawsuit claimed that a physician, who incidentally was represented by a then–practicing attorney named Abraham Lincoln, had been negligent for improperly applying a cast to treat a wrist fracture that had been sustained by the plaintiff.
• When a person assumes the profession of physician and surgeon, he must be held to employ a reasonable amount of skill and care. For anything short of that degree of skill in his practice, the law will hold him responsible for any injury which may result from its absence. While he is not required to possess the highest order of qualification, to which men attain, still he must possess and exercise that degree of skill which is ordinarily possessed by members of the profession. And whether the injury results from a want of skill or the want of its application, he will, in either case, be equally liable.

Emedinews:Makesure:A patient with LDL cholesterol 100 mg% and hsCRP 3 developed MI.

Situation: A patient with LDL cholesterol 100 mg% and hsCRP 3 developed MI.
Reaction: Oh my God! Why was he not put on a statin?
Lesson: Make sure all patients with even normal cholesterol are considered for statins if the CRP is high.

Emedinews:Inspiration:Success depends upon maturity

Maturity is many things. It is the ability to base a judgment on the big picture, the long haul. It means being able to resist the urge for immediate gratification and opt for the course of action that will pay off later.

One of the characteristics of the young is “I want it now.” Grown-up people can wait.

Maturity is perseverance–the ability to sweat out a project or a situation, in spite of heavy opposition and discouraging setbacks, and stick with it until it is finished. The adult who is constantly changing friends and changing mates is immature. He/she cannot stick it out because he/she has not grown up.

Maturity is the ability to control anger and settle differences without violence or destruction. The mature person can face unpleasantness, frustration, discomfort and defeat without collapsing or complaining. He/she knows he cannot have everything his/her own way every time. He/she is able to defer to circumstances, to other people-and to time. He/she knows when to compromise and is not too proud to do so.

Maturity is humility. It is being big enough to say, “I was wrong.” And, when he/she is right, the mature person need not experience the satisfaction of saying, “I told you so.”

Maturity is the ability to live up to your responsibilities, and this means being dependable. It means keeping your word. Dependability is the hallmark of integrity. Do you mean what you say-and do you say what you mean? Unfortunately, the world is filled with people who cannot be counted on. When you need them most, they are among the missing. They never seem to come through in the clutches. They break promises and substitute alibis for performance. They show up late or not at all. They are confused and disorganized. Their lives are a chaotic maze of broken promises, former friends, unfinished business and good intentions that somehow never materialize. They are always a day late and a dollar short.

Maturity is the ability to make a decision and stand by it. Immature people spend their lives exploring endless possibilities and then doing nothing. Action requires courage. Without courage, little is accomplished.

Maturity is the ability to harness your abilities and your energies and do more than is expected. The mature person refuses to settle for mediocrity. He/she would rather aim high and miss the mark than low-and make it.

Maturity is the art of living in peace with that which cannot be changed, the courage to change that which should be changed, no matter what it takes, and the wisdom to know the difference.

Emedinews:Insights on Medicolegal Issues:Contravention of PNDT Act may lead to imprisonment up to 3 years

• The name of the registered medical practitioner who has been convicted by the court under sub–section (1), shall be reported by the Appropriate Authority to the respective State Medical Council for taking necessary action including the removal of his name from the register of the Council for a period of two years for the first offence and permanently for the subsequent offence.
• Any person who seeks the aid of a genetic counseling center or genetic laboratory or genetic clinic or of a medical geneticist, medical gynecologist or registered medical practitioner for conducting pre–natal diagnostic techniques on any pregnant woman (including the woman unless she was compelled to undergo such diagnostic technique) for purposes other than those specified in clause(2) of section 4, shall be punishable with imprisonment for a term which may extend to 3years and with a fine which may extend up to ten thousand rupees and on any subsequent conviction with imprisonment which may extend to five years and with fine which may extend up to fifty thousand rupees.