Emedinews:Insights on Medicolegal Issues:What is an impulse and what is its medicolegal importance?

Impulse is a sudden and irresistible desire or force in a person, compelling him to the conscious performance of some act for which there is no motive; for example, kleptomania means an irresistible desire to steal articles which may be of small value and even, may be of no use to the person stealing the article. A sane person who has self–control and judgment capacity may not finally give shape to his impulsive or compulsive desire. But an insane person, who lacks in self–control and judgment capacity, cannot resist the impulse and may commit any offence. Thus, in connection with commission of an unlawful act, impulse is a good defense for an insane person which is not so for a sane person. Some types of impulses are:

• Dipsomania: This is found in alcoholics who have an irresistible desire to take alcoholic drinks.
• Pyromania: Here, there is an irresistible desire to set fire to things, which may be important and valuable. The person is not conscious or careful, at least temporarily, to the possible dangers of his act.
• Mutilomania: This is an irresistible desire to injure and mutilate animals, commonly the domestic pets.
• Sexual impulse: The person may feel compulsive urge to perform sexual intercourse, often in a perverted way. There may be some psychic problem concerning the sexual behavior; or the person may be a victim of mental sub normality.

Emedinews:Inspiration:Cost of a miracle

A little girl went to her bedroom and pulled a glass jelly jar from its hiding place in the closet.

She poured the change out on the floor and counted it carefully. Three times, even. The total had to be exactly perfect. No chance here for mistakes.

Carefully placing the coins back in the jar and twisting on the cap, she slipped out the back door and made her way six blocks to Rexall's Drug Store with the big Red Indian Chief sign above the door. She waited patiently for the pharmacist to give her some attention, but he was too busy at this moment. Tess twisted her feet to make a scuffing noise. Nothing. She cleared her throat with the most disgusting sound she could muster. No good. Finally she took a quarter from her jar and banged it on the glass counter. That did it!

'And what do you want?' the pharmacist asked in an annoyed tone of voice. I'm talking to my brother from Chicago whom I haven't seen in ages,' he said without waiting for a reply to his question.

'Well, I want to talk to you about my brother,' Tess answered back in the same annoyed tone. 'He's really, really sick....and I want to buy a miracle.'

'I beg your pardon?' said the pharmacist.

'His name is Andrew and he has something bad growing inside his head and my Daddy says only a miracle can save him now. So how much does a miracle cost?'

'We don't sell miracles here, little girl. I'm sorry but I can't help you,' the pharmacist said, softening a little.

'Listen, I have the money to pay for it. If it isn't enough, I will get the rest. Just tell me how much it costs.'

The pharmacist's brother was a well dressed man. He stooped down and asked the little girl, 'What kind of a miracle does your brother need?'

'I don't know, 'Tess replied with her eyes welling up I just know he's really sick and Mommy says he needs an operation. But my Daddy can't pay for it, so I want to use my money.'

'How much do you have?' asked the man from Chicago.

'One dollar and eleven cents,' Tess answered barely audible. 'And it's all the money I have, but I can get some more if I need to.'

'Well, what a coincidence,' smiled the man. 'A dollar and eleven cents-the exact price of a miracle for little brothers.'

He took her money in one hand and with the other hand he grasped her mitten and said 'Take me to where you live. I want to see your brother and meet your parents. Let's see if I have the miracle you need.'

That well-dressed man was Dr. Carlton Armstrong, a surgeon, specializing in neurosurgery. The operation was completed free of charge and it wasn't long until Andrew was home again and doing well.

Mom and Dad were happily talking about the chain of events that had led them to this place.

'That surgery,' her Mom whispered. 'was a real miracle. I wonder how much it would have cost?'

Tess smiled. She knew exactly how much a miracle cost.....one dollar and eleven cents...plus the faith of a little child.

In our lives, we never know how many miracles we will need. A miracle is not the suspension of natural law, but the operation of a higher law. I know you'll keep the ball moving!

Here it goes. Throw it back to someone who means something to you!

A ball is a circle, no beginning, no end. It keeps us together like our Circle of Friends. But the treasure inside for you to see is the treasure of friendship you've granted to me.

Today I pass the friendship ball to you.

Pass it on to someone who is a friend to you.

MY OATH TO YOU...

When you are sad.....I will dry your tears. When you are scared.......I will comfort your fears.

When you are worried......I will give you hope.

When you are confused.....I will help you cope.

And when you are lost...and can't see the light, I shall be your beacon...shining ever so bright.

This is my oath.....I pledge till the end.

Why you may ask?....Because you're my friend.

Signed: GOD

Emedinews:Insights on Medicolegal Issues:What is lucid interval?

Lucid interval is the period during which the mentally unsound person behaves very much like a normal person. During this period all the signs and symptoms of insanity are absent. The person is responsible for all his acts performed during the period of lucid interval.

Emedinews:Inspiration:The Trouble Tree

 The carpenter I hired to help me restore an old farmhouse had just finished a rough first day on the job. A flat tire made him lose an hour of work, his electric saw quit, and now his ancient pickup truck refused to start.

 While I drove him home, he sat in stony silence. On arriving, he invited me in to meet the family. As we walked toward the front door, he paused briefly at a small tree, touching the tips of the branches with both hands.

 After opening the door, he underwent an amazing transformation. His face was wreathed in smiles, and he hugged his two small children and then gave his wife a kiss.

 Afterward, he walked me to my car. We passed the tree, and my curiosity got the better of me. I asked him about what I had seen him do earlier.

 “Oh, that’s my trouble tree,” he replied. “I know I can’t help having troubles on the job, but one thing for sure, troubles don’t belong in the house with my wife and children. So I just hang them up on the tree every night when I come home. Then in the morning, I pick them up again.”

 “Funny thing is,” he smiled, “when I come out in the morning to pick them up, there aren’t nearly as many as I remember hanging up the night before.”

 What do you think about the way the carpenter chose to deal with his problems? What do you think he accomplished by leaving his troubles outside of his home?

Emedinews:Insights on MEdicolegal Issues:Should a doctor perform CPR in a patient with already injured chest?

When a person needs CPR or cardiopulmonary resuscitation, this means that he/she is unconscious, not moving and not breathing normally. If this is the case, the person is presumably in cardiac arrest or in a state that justifies cardiopulmonary resuscitation.

• If the person is awake, is breathing normally and therefore does not appear to need CPR, it would be correct that chest compressions and CPR may complicate the already damaged chest and further complicate the victim’s injuries.
• As soon as the victim becomes unconscious, is not breathing normally and now appears to need CPR, Emergency Services would be contacted and CPR would be initiated regardless of the injuries of the patient.
• If the person needs CPR, this means that they are clinically dead. If the victim does not receive CPR, they will simply graduate to permanent death.
• This is why, regardless of the chest injury, if the person is "dead" or in need of CPR, compressions are to be given per the American Heart Association (AHA) guidelines even if the complications could include those of punctured lungs, lacerated organs, or bruised/punctured heart muscle. These injuries must be recorded in clinical sheet.
• This would be based on the theory that a person in need of CPR is already dead and will not be harmed more even if there are negative side effects from providing chest compressions. If a person remains dead, surgery is not an option but if the person is resuscitated with CPR, and alive at the hospital, we have an opportunity to fix the injuries that may have been aggravated by doing CPR.

Emedinews:Inspiration:Arms and legs for others

Bob Butler lost his legs in a 1965 land mine explosion in Vietnam. He returned home a war hero. Twenty years later, he proved once again that heroism comes from the heart.

 Butler was working in his garage in a small town in Arizona, USA on a hot summer day; when he heard a woman’s screams coming from a nearby house. He began rolling his wheelchair toward the house but the dense shrubbery wouldn’t allow him access to the back door. So he got out of his chair and started to crawl through the dirt and bushes.

 “I had to get there”, he says. “It didn’t matter how much it hurt”. When Butler arrived at the pool there was a three-year-old girl named Stephanie Hanes lying at the bottom. She had been born without arms and had fallen in the water and couldn’t swim. Her mother stood over her baby screaming frantically. Butler dove to the bottom of the pool and brought little Stephanie up to the deck. Her face was blue, she had no pulse and was not breathing.

 Butler immediately went to work performing CPR to revive her while Stephanie’s mother telephoned the fire department. She was told the paramedics were already out on a call. Helplessly, she sobbed and hugged Butler’s shoulder.

 As Butler continued with his CPR, he calmly reassured her. Don’t worry, he said. “I was her arms to get out of the pool. It’ll be okay. I am now her lungs. Together we can make it”.

 Seconds later the little girl coughed, regained consciousness, and began to cry. As they hugged and rejoiced together the mother asked Butler how he knew it would be okay. The truth is, “I didn’t know”, he told her. “But when my legs were blown off in the war, I was all alone in a field. No one was there to help except a little Vietnamese girl. As she struggled to drag me into her village, she whispered in broken English, ‘It okay. You can live. I be your legs. Together we make it’.” Her kind words brought hope to my soul and I wanted to do the same for Stephanie.

 There are simply those times when we cannot stand alone. There are those times when we need someone to be our legs, our arms, our friend.

 Source: http://academictips.org/blogs/arms-and-legs-for-others/

Emedinews:Insights on Medicolegal Issues:What is the Native American Graves Protection and Repatriation Act 1990?

Doctors and scientists have long sought to understand life in early civilizations through the excavation of burial grounds and exhumation of human remains. In the United States, the attempt to understand early cultures led to the exhumation of the remains of Native Americans, many of which ended up in the nation’s museums and archaeology labs. In an attempt to prevent the desecration of Native American graves, the Native American Graves Protection and Repatriation Act was introduced in Congress in July 1990 and subsequently passed into law.

• The bill states that any human remains and objects found on federal or tribal lands after the date of enactment are to be considered owned or controlled by lineal descendants, the tribe on whose land it was found, the tribe having the closest cultural affiliation, or the tribe which aboriginals occupied the area. Anyone who discovers items covered by the bill must cease his or her activity, notify the federal land manager responsible and the appropriate tribe, and make a reasonable effort to protect the items.
• Anyone who violates the provisions of the bill may be fined, imprisoned not more than one year, or both. The penalty may increase to five years for a second violation.
• The act further states that all federal agencies and museums receiving federal funds that have control over any of the items covered in the bill are to, within five years, inventory and identify the items, notify the affected tribes, and make arrangements to return such items if the appropriate tribe made a request. If an item was acquired with the consent of the tribe or if the item was part of a scientific study which was expected to be of major benefit to the country, the request for repatriation (i.e., return) could be denied.

Emedinews:Inspiration:Moment of truth

There was a young student-archer who reached such proficiency in his art that he could shoot an arrow into a tree and then cleave that arrow into two with the next shot. He began to boast that he was a greater archer than his guru.

One day his guru, a venerable old man in his 70s, asked the youth to accompany him on a trip across the hills. The journey was uneventful until they came to a deep chasm.

A single log spanned the chasm. The guru walked down to the centre of the log, unshouldered his bow and taking an arrow shot it into a tree on the other side. His next shot cleaved the first arrow into two.

"Now it's your turn," he said, walking back to where his student was standing.

The youth stepped gingerly on the log and very slowly and carefully made his way to the middle. But his heart was in his mouth. He knew that if he lost his footing, he would plunge to his death. His hands trembled as he strung an arrow into his bow. Preoccupied with the danger he was in, he found it hard to focus on the target. Consequently when he let go of the arrow, it missed the tree altogether. Whimpering, he turned around.
"Help me!" he shouted to his guru. "I'll fall!"

The old man walked up to him, took his hand and stepping backwards led him to safety. Neither of them said a word on the return journey but the boy had much to think about.

He had realized that to be a master of his art it was not enough to know how to control the bow; he had to learn how to control his mind too.

Emedinews:Insights on Medicolegal Issues:Medical fasting

• Various blood tests require a fasting of up to 12–16 hours so that a baseline normalcy of blood can be established.
• The patient is asked to remain in a fasting state for medical reasons: surgery or other procedures of diagnostic or therapeutic intervention that require anesthetic. The presence of food in a person's system can cause complications when they are anesthetized; medical personnel strongly suggest that their patients fast for several hours before the procedure.
• Some animal studies show that fasting every other day while eating double the normal amount of food on non–fasting days led to better insulin control, neuronal resistance to injury and health indicators similar to mice on calorie restricted diets.
• Patient refusal of nutrition and hydration in terminal illness: "within the contexts of adequate palliative care, the refusal of food and fluids does not contribute to suffering among the terminally ill" and might actually contribute to a comfortable passage from life: "At least for some persons, starvation does correlate with reported euphoria."
• In homeopathic medicine, fasting is seen as a way of cleansing the body of toxins, dead or diseased tissues, and giving the gastrointestinal system a rest. During fasts, water, fruit and vegetable juices are usually taken on choice.

Emedinews:Inspiration:No one will ever know

Karen, Judy and I were the last ones back in the school room after lunch. We put our metal lunch boxes on the shelf above the coat hooks, which were mostly empty. All of the other sixth graders were already outside, playing marbles or hop scotch or jumping rope, since it was a pleasant spring day.

"Look what I found this morning in the storage cupboard when I was getting out some art supplies for Mrs. Eiffler."

With a conspiratorial grin on her face, Karen held up a wooden box filled with short pieces of chalk in every color of the rainbow.

"Wow! What fun it would be to write on the chalkboard while everyone is outside." Judy's eyes twinkled with anticipation.

"But Mrs. Eiffler doesn't want us writing on the chalkboard," I responded, already feeling guilty, although we had not yet done a thing.

"Don't be such a 'fraidy cat', Janet. No one will ever know," said Karen, reaching into the box and drawing out a piece of chalk.

"Right. Everyone is outside, so we're safe. No one will tell on us." Judy was already drawing a house with sure strokes.

I reluctantly joined my friends in the artwork, wanting to be part of what was going on, but afraid of being caught. I knew well that we were breaking not one, but two class rules. The second rule was that no one was allowed to stay inside at noon without a written excuse from home if the weather was nice.

Trying various colors, we drew houses, trees and three-dimensional boxes. It was fun! All the time we were watching the clock, knowing that our fun would be over if anyone walked into the room.

Then Judy had an idea. "We're all right-handed. Let's see who can write their name best using their left hand."

Judy and Karen picked up their chalk and started writing. I chose a white piece from the box and wrote my name. The handwriting was a bit shaky, but no one would doubt that it said "Janet."

"I think Judy is the winner," said Karen. "Hers is the best."

"We'd better get this board cleaned off before Mrs. Eiffler comes back," said Judy, eying the clock. She picked up an eraser and began erasing our handiwork from the board.

Everything came off . . . but my name!

In disbelief, I looked at the chalk I held in my sweaty hand. On closer examination, it wasn't chalk at all. I had picked up a small piece of white color crayon which was mixed in with the pieces of chalk.

My stomach churned and my knees felt weak. What would Mrs. Eiffler do to me?

My mother had a saying: "Fools names and fools faces always appear in public places." I never understood fully what it meant before. Now I did! I was a fool, and there was my name in crayon to prove it. And the teacher would be returning soon.

"Quick, let's get some wet paper towels," said Judy, springing into action. After vigorous rubbing, my name still remained.

"I think I saw a can of cleanser by the sink in the coat room," I said as I raced to find it. Precious minutes were ticking away.

We rubbed and my name came off all right, but in the process of removing it, we left an abrasion on the chalkboard.

Listening for footsteps coming down the hall, we dried the scrubbed area as much as we could with more paper towels and fanned it with a book to remove every tell-tale trace of wetness.

We were just slipping into our desks as the bell rang and the other students began entering the room. The teacher walked in soon afterward.

Mrs. Eiffler never asked about abrasion and maybe never noticed it. But I did. Every time I walked past the marred surface of the chalkboard, I remembered. Oh, how I remembered.

The lesson I learned that day is one I never forgot, even though over forty years have passed since the event. "No one will ever know" is never true. Even if no one else found out, Jesus knew and I knew. Sometimes living with a guilty conscience is punishment enough.

Emedinews:Rational use of blood

Tat Tvam Asi……..and the Life Continues…..
(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Definition

Blood components are various parts of blood like red blood cells, platelets, granulocytes and plasma separated from one another by conventional blood bank method of centrifugation because of their different specific gravities.

Cellular components

• Red blood cells (RBC) or packed red cells (PCV)
• Leukocyte depleted red cells
• Platelet concentrate
• Platelet apheresis
• Leukocyte depleted platelet concentrate
• Lekocyte apheresis

Plasma components

• Fresh frozen plasma
• Cryoprecipitate
• Cryo-poor plasma

Emedinews:Be Human stop child abuse:All about child sexual abuse

Be Human Stop Child Abuse (http://behumanstopchildabuse.emedinews.in/)
(Team IMA for CMAAO)

1. Sexual abuse occurs primarily in preadolescent children.
2. It’s more often in girls. 
3. Perpetrators are usually males.
4. They are known to the victims.
5. Most of the complaints that are possible indicators of sexual abuse are nonspecific.

Emedinews:Insights on Medicolegal Issues:What is the vegetative state?

What is the vegetative state?

Complete absence of behavioral evidence for self or environmental awareness

• The capacity for spontaneous or stimulus–induced arousal is preserved, evidenced by sleep–wake cycles i.e. patients are awake, but have no awareness. This means that the patients appear awake.
• They have normal heart beat and breathing, and do not require advanced life support to preserve life and cannot produce a purposeful, co–coordinated, voluntary response in a sustained manner, although they may have primitive reflexive responses to light, sound, touch or pain.
• They cannot understand, communicate, speak, or have emotions and unaware of self and environment and have no interaction with voluntarily control passing of urine or stools. They sleep and awaken. As the centers in the brain controlling the heart and breathing are intact, there is no threat to life, and patients can survive for many years with expert nursing care.
• The following behaviors may be seen in the vegetative state: Sleep–wake cycles with eyes closed, then opened. Patient breathes on her own; Spontaneous blinking and roving eye movements; Produce sounds but no words; Visual pursuit following an object with her eyes; Grimacing to pain; changing facial expression; Yawning; chewing jaw movements Swallowing of her own spit No purposeful limb movements; arching of back; reflex withdrawal from painful stimuli; brief movements of head or eyes toward sound or movement without apparent localization or fixation; startles with a loud sound.

Almost all of these features consistent with the diagnosis of permanent vegetative state were present during the medical examination of Aruna Shaunbag. Behavior suggestive of a minimally conscious not vegetative state was observed during the examination.

emedinews:Inspiration:Keep on knocking, keep on asking, keep on seeking

 When Colonel Harland Sanders retired at the age of 65, he had little to show for himself, except an old Caddie roadster, a $105 monthly pension check, and a recipe for chicken.

Knowing he couldn't live on his pension, he took his chicken recipe in hand, got behind the wheel of his van, and set out to make his fortune. His first plan was to sell his chicken recipe to restaurant owners, who would in turn give him a residual for every piece of chicken they sold--5 cents per chicken. The first restaurateur he called on turned him down.

So did the second. So did the third.

In fact, the first 1008 sales calls Colonel Sanders made ended in rejection. Still, he continued to call on owners as he traveled across the USA, sleeping in his car to save money. Prospect number 1009 gave him his first "yes."

After two years of making daily sales he had signed up a total of five restaurants. Still the Colonel pressed on, knowing that he had a great chicken recipe and that someday the idea would catch on. Of course, you know how the story ends. The idea DID catch on. By 1963 the Colonel had 600 restaurants across the country selling his secret recipe of Kentucky Fried Chicken (with 11 herbs and spices).

 In 1964 he was bought out by future Kentucky governor John Brown. Even though the sale made him a multi-millionaire, he continued to represent and promote KFC until his death in 1990.

 Colonel Sanders' story teaches an important lesson: it’s never too late to decide to never give up.

 Earlier in his life the Colonel was involved in other business ventures--but they weren't successful. He had a gas station in the 30's, a restaurant in the 40's, and he gave up on both of them. At the age of 65, however, Harland Sanders decided his chicken idea was the right idea, and he refused to give up, even in spite of repeated rejection.

 He knew that if he kept on knocking on doors, eventually someone would say "yes." This is how Jesus has commanded to approach life. He said, "Ask and it will be given to you; seek and you will find; knock and the door will be opened to you." (Luke 11:9)

This verse follows a story Jesus told emphasizing the importance of a "never-give-up" attitude in prayer. Jesus is saying, "Ask--not just once, but as many times as is necessary. Keep on knocking till the door is opened."

If you have made half-hearted attempts at doing God's will in your life...if you have given up too easily in the past...remember: It's never too late to become persistent. It's never too late to decide to never give up. Keep on knocking. Keep on asking. Keep on seeking.

Emedinews:Whole blood

Tat Tvam Asi……..and the Life Continues…..
(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Whole blood

Definition: Whole blood contains 350 ml. of donor blood plus anticoagulants.

Volume: 350 ml.

Storage: Between 2° C to 6° C in approved Blood Bank refrigerator

Shelf Life: 35 days

Emedinews:Be Human Stop Child Abuse:All about child sexual abuse

Be Human Stop Child Abuse (http://behumanstopchildabuse.emedinews.in/)
(Team IMA for CMAAO)

1. Children victims of sexual abuse should receive a thorough evaluation.
2. Evaluation should include careful questioning and a complete physical examination. 
3. Evidence-collection procedures, and/or specialized examination techniques may be required.

Emedinews:Insights on Medicolegal Issues:How can exit and entry wounds be identified?

• Entry wound are small and neat in most cases. But, with ultra–high velocity small bullets or bomb splinters, the entrance wound may be of the ‘blowout’ type.
• Exit wound are generally big. The size of the exit wound depends upon the shape of the local track, the temporary cavitation effect at the site of the exit, the impact velocity and type of bullet. If the missile has remained stable in the tissues, or alternatively has expended most of its energy, a relatively small exit wound results.

Handgun wounds such as revolver and semiautomatic pistol bullet wounds are very important in medicolegal practice. As the wounds caused by pistol and revolver bullets are similar, and the caliber of bullets used in the weapon is roughly the same, it should be noted that the muzzle velocities of magnum revolvers are higher than those of modern pistols.

Emedinews:Inspiration:God Created The Teacher

On the 6th day, God created men and women. On the 7th day, he rested. Not so much to recuperate, but rather to prepare himself for the work he was going to do on the next day. For it was on that day – the 8th day – that God created the FIRST TEACHER.

This TEACHER, though taken from among men and women, had several significant modifications. In general, God made the TEACHER more durable than other men and women. The TEACHER was made to arise at a very early hour and to go to bed no earlier than 11 PM, with no rest in between.

The TEACHER had to be able to withstand being locked up in an air–tight classroom for six hours with thirty–five "monsters" on a rainy Monday. And the TEACHER had to be fit to correct 103 papers over Easter vacation. Yes, God made the TEACHER tough…but gentle, too. The TEACHER was equipped with soft hands to wipe away the tears of the neglected and lonely student… those of the sixteen–year old girl who was not asked to the prom.

And into the TEACHER God poured a generous amount of patience. Patience when a student asks to repeat the directions the TEACHER has just repeated for someone else. Patience when the kids forget their lunch money for the fourth day in a row. Patience when one–third of the class fails the test…patience when the text books haven’t arrived yet, and the semester starts tomorrow.

And God gave the TEACHER a heart slightly bigger than the average human heart. For the Teacher’s heart had to be big enough to love the kid who screams, "I hate this class – it’s boring!" and to love the kid who runs out of the classroom at the end of the period without so much as a "goodbye," let alone a "thank you."

And lastly, God gave the TEACHER an abundant supply of HOPE. For God knew that the TEACHER would always be hoping. Hoping that the kids would someday learn how to spell… hoping not to have lunchroom duty… hoping that Friday would come… hoping for a free day… hoping for deliverance.

When God finished creating the TEACHER, he stepped back and admired the work of His hands. And God saw that the TEACHER was good. Very Good! And God smiled, for when he looked at the TEACHER, he saw into the future.

He knew that the future is in the hands of the TEACHERS. And because God loves TEACHERS so much… on the 9th day God created… SNOW DAYS!

Emedinews:Insights on Medicolegal Issues:World Medical Association (WMA) guidelines for medical doctors in biomedical research involving human subjects

• Doctors should abstain from engaging in research projects involving human subjects unless they are satisfied that the hazards involved are believed to be predictable. Doctors should cease any investigation if the hazards are found to outweigh the potential benefits.
• In publication of the results of his or research, the doctor is obliged to preserve the accuracy of the results. Reports of experimentation not in accordance with the principles laid down in this Declaration should not be accepted for publication.
• In any research on human beings, each potential subject must be adequately informed of the aims, methods, anticipated benefits and potential hazards of the study and the discomfort, it may entail. He or she should be informed that he or she is at liberty to abstain from participation in the study and that he or she is free to withdraw his or her consent to participation at any time. The doctor should then obtain the subject’s freely given informed consent, preferably in writing.
• When obtaining informed consent for the research project the doctor should be particularly cautious if the subject is in a dependent relationship to him or her or may consent under duress. In that case the informed consent should be obtained by a doctor who is not engaged in the investigation and who is completely independent of this official relationship.
• In case of legal incompetence, informed consent should be obtained from the legal guardian in accordance with national legislation. Where physical or mental incapacity makes it impossible to obtain informed consent, or when the subject is a minor, permission from the responsible relative replaces that of the subject in accordance with national legislation.
• The research protocol should always contain a statement of the ethical consideration involved and should indicate that the principles enunciated in the present Declaration are complied with.

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

Emedinews:Inspiration:Glass of milk

One day, a poor boy who was selling goods from door to door to pay his way through school, found he had only one thin dime left, and he was hungry.

He decided he would ask for a meal at the next house. However, he lost his nerve when a lovely young woman opened the door.

Instead of a meal he asked for a drink of water!  She thought he looked hungry so brought him a large glass of milk. He drank it so slowly, and then asked, “How much do I owe you?”

“You don't owe me anything,” she replied. “Mother has taught us never to accept pay for a kindness.”

He said ... “Then I thank you from my heart.”

As Howard Kelly left that house, he not only felt stronger physically, but his faith in God and man was strong also. He had been ready to give up and quit.

Many years later that same young woman became critically ill. The local doctors were baffled. They finally sent her to the big city, where they called in specialists to study her rare disease.

Dr. Howard Kelly was called in for the consultation. When he heard the name of the town she came from, a strange light filled his eyes.

Immediately he rose and went down the hall of the hospital to her room. Dressed in his doctor's gown he went in to see her. He recognized her at once.

He went back to the consultation room determined to do his best to save her life. From that day he gave special attention to her case.

After a long struggle, the battle was won.

Dr. Kelly requested the business office to pass the final bill to him for approval. He looked at it, and then wrote something on the edge, and the bill was sent to her room. She feared to open it, for she was sure it would take the rest of her life to pay for it all. Finally she looked, and something caught her attention on the side of the bill. She read these words..."Paid in full with one glass of milk"

(Signed) Dr. Howard Kelly.

Tears of joy flooded her eyes as her happy heart prayed: "Thank You, God, that Your love has spread broad through human hearts and hands."

There's a saying which goes something like this: Bread cast on the water comes back to you. The good deed you do today may benefit you or someone you love at the least expected time. If you never see the deed again at least you will have made the world a better place - And, after all, isn't that what life is all about?

Emedinews:Insights on Medicolegal Issues:What is cannabis poisoning?

Cannabis, also known as marijuana, Indian hemp, hashish, ganja, pot, dope and grass, is made from the Indian hemp plant, Cannabis sativa. Cannabis is often abused and, in some countries it is used almost as much as alcohol or tobacco.

Cannabis harms the brain; however, it does not cause much harm to adults, unless it is injected. The signs and symptoms start within 10 minutes of smoking the drug and last for about 2–3 hours. When taken orally, the effects start to appear within 30-60 minutes and last for 2–5 hours. The major effects are a feeling of well–being, happiness and sleepiness; high doses may cause fear, panic and confusion, impaired balance, hallucinations, drowsiness, slurred speech, coughing if the drug is breathed in, as when smoking cigarettes. If the drug is injected it may cause more serious problems such as severe headache, dizziness, irregular breathing, fever, low blood pressure, unconsciousness.

• If the patient is unconscious or drowsy, lay him or her on one side in the recovery position. Check breathing every 10 min. A patient who is anxious or confused should be kept in a quiet, warm room. If the cannabis was swallowed: there is no need to make the patient vomit.
• If the patient is fully awake, breathing normally, and not vomiting: Give activated charcoal and water to drink.
• If the patient is hallucinating or violent: Give chlorpromazine, 50–100 mg (adult dose), intramuscularly.
• If cannabis has been injected: Monitor breathing, pulse, blood pressure, temperature. Supportive care, including oxygen and mechanical ventilation, should be given as needed. If low BP, keep the patient lying with the feet higher than the head; intravenous fluids can be given.

Emedinews:Inspiration:If and Were Planted

An Inspirational Story

How is "if and when" planted? The short stories below are examples of planting "if and when":

Karen, one of my coworkers was stressed about where she was living. She hated the apartment she was in and complained every day about it. One day over coffee, I asked her why she didn't look for another apartment - it seemed like an easy solution to me. Karen's reply to this was, "I will look for another apartment when I come back from vacation."

Sam hated his job. He dreaded getting up in the morning. He hated the work he was doing and it started to take a toll on him. He had a love for photography and was currently taking a two-year course to obtain his certificate. Every night he complained about his work. After listening to his complaints for a month, I asked him why he didn't finish his course and start a small business doing photography on the weekends. His reply, "if only I had more time to finish my course. When I finish my course I will start a business."

Sarah had saved all her life and now was retired and living comfortably. The house she bought had a dishwasher in it; however, the dishwasher was old and didn't work. She hated doing dishes, and every time we visited with her she complained about doing the dishes. One night, I asked her, "Why don't you buy a new dishwasher Sarah." Her reply, "I have been thinking about it, if they would only come on sale I would."

Larry worked for a company that allowed early retirement. Larry had both the years of service and his age, which allowed him to retire, but at a reduced pension. He was having difficulty coping with all the changes that were being made in his work. He had a couple of mild attacks, not a heart attack but similar to one. He called me and we talked for hours. I was worried about the stress of his job and the effects it was having on his health. "Why don't you retire Harry? Do something that you have always wanted to do," I asked. Harry's reply to my question was, "If only I was older then I would get my full pension." I got bolder in my conversation with him, "But Harry, you have your house paid off, you have no bills, the kids are grown up. You could sell your house and downsize, it really is not worth your health is it? Harry then said, "When the summer comes maybe I will."

All of these stories have the same theme running through them. There is a proverb that says it all:

"If and when were planted, and nothing grew."

Now a year later,

Karen is still living in the apartment she hates!

Sam is still complaining about his job and still has not finished his course!

Sarah is still washing dishes!

Larry is still working and his health is not what it used to be!

The sad part of all of these stories is that all of these people had a lot of stress in their lives that they could have taken action to reduce. But, all of them defeated themselves by thinking "if" or "when". Life is too short for "if's and when's".

The next time you are in a stressful situation and you find yourself saying or thinking - "if or when" - remember the saying, "If and when were planted and nothing grew!" Change your thinking and take action, so that you can reduce your stress right now.

Emedinews:Inspiration:Happiness is NOW, Don't Wait

We convince ourselves that life will be better after we get married, have a baby, then another. Then we are frustrated that the kids aren't old enough and we'll be more content when they are. After that, we're frustrated that we have teenagers to deal with. We will certainly be happy when they are out of that stage.

We tell ourselves that our life will be complete when our spouse gets his or her act together, when we get a nicer car, are we able to go on a nice vacation, or when we retire. The truth is, there's no better time to be happy than right now. If not now, when? Your life will always be filled with challenges. It's best to admit this to yourself and decide to be happy anyway.

 Happiness is the way. So, treasure every moment that you have and treasure it more because you shared it with someone special, special enough to spend your time with...and remember that time waits for no one.

 So, stop waiting....

 --until your car or home is paid off

--until you get a new car or home

--until your kids leave the house

--until you go back to school

--until you finish school

--until you lose 10 lbs.

--until you gain 10 lbs.

--until you get married

--until you get a divorce

--until you have kids

--until you retire

--until summer

--until spring

--until winter

--until fall

--until you die

 There is no better time than right now to be happy. Happiness is a journey, not a destination. So -- work like you don't need money, Love like you've never been hurt, And dance like no one's watching.

Emedinews:Insights on Medicolegal issues:Exhumation of corpse – America

In America, corpses are exhumed when there is a need to identify a body or to establish cause of death, for instance, in a case of suspected homicide.

• President Zachary Taylor was exhumed in 1991 to determine whether or not he had been poisoned, and the famous outlaw Jesse James’s grave was excavated to prove that it was his body in the coffin. In addition, archaeological investigations often involve exhumation.
• Under modern law, courts usually do not allow exhumation unless there are substantial and compelling reasons to do so.
• In a landmark U.S. Supreme Court decision Justice Cardozo stated, "The dead are to rest where they have been lain unless reason of substance is brought forward for disturbing their repose."
• Three general principles govern the law of disinterment in the United States. First, it is presumed that a "decently buried" body should remain undisturbed where it was placed unless good reason is given to do so. Second, disinterment is considered the private concern of the immediate family and the cemetery. Third, if there is disagreement among the close relatives regarding a proposal for exhumation the matter is adjudicated by a court of equity. The court considers (in order of importance) the wishes and religious beliefs of the deceased (if these can be determined), the wishes of the spouse of the deceased, the opinions of other close relatives, and the policies and regulations of the cemetery when determining if exhumation should be allowed.
• California Labor Code stipulates that if it is suspected that a person has died as a result of injuries sustained in the course of his employment, the investigating appeals board may require an autopsy and, if necessary, the exhumation of the body for the purposes of autopsy. However, in accordance with the rules of equity, the close relatives can, if they wish, prevent the state (i.e., California) from either exhuming the body or performing the autopsy.

Emedinews:Insights on Medicolegal Issues:What is the 8th clause of Section 320 Indian Penal Code for doctors?

The eighth clause of Indian Penal Code 320 defines grievous hurts as "Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain, or unable to follow his ordinary pursuits."

• Ordinary pursuits means the patient is unable to visit the toilet, to bathe or brush his teeth, eat himself, walk or carry on such daily pursuits and requires mandatory help of other person for 20 days
• The length of time during which an injured person is in pain, disease or is not able to pursue his ordinary daily routine work must be meticulously and satisfactorily observed by the doctor himself before certifying the injury as a grievous injury.
• It is employed not only in cases where violence has been used but also in cases where hurt has been caused without any assault, e.g., by administration of drugs, setting of traps etc. The extent of hurt and the intention of the offender are considered for giving punishment.
• It is difficult for a doctor to prove that an injured person was in severe bodily pain for 20 days but it is easier to prove that he was unable to follow his ordinary profession/pursuits due to the hurt.
• A mere stay of 20 days in the hospital doesn’t make injury grievous. The certifying doctor must rule out and document the feigned illness in medicolegal report.

Emedinews:Inspiration:Don't be afraid to fail

You've failed many times, although you may not remember. You fell down the first time you tried to walk. You almost drowned the first time you tried to swim, didn't you? Did you hit the ball the first time you swung a bat? Heavy hitters, the ones who hit the most home runs, also strike out a lot.

R.H. Macy failed seven times before his store in New York caught on. English novelist John Creasey got 753 rejection slips before he published 564 books. Babe Ruth struck out 1,330 times, but he also hit 714 home runs.

Don't worry about failure. Worry about the chances you miss when you don't even try.

Emedinews:Insights on Medicolegal Isues: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.

Emedinews:Inspiration:The three fishes

There were three big fishes living in a lake who were very close friends. All three of them were very different from one another. The first one believed in fate. He thought things cannot be changed and what had to happen will happen no matter what. The second one was intelligent. He thought he knew how to solve a problem if he had one, with his intelligence. The third one was the wise one. It thought long and hard before acting.

So one day, the wise fish was happily playing around in the water, when it over heard a fishermen talking to another. "Look at that one, what a big fish... This lake is full of big fishes like this one. Let us come tomorrow and catch them."

It hurriedly swam to its friends to tell the news. "Let us get out of this lake before those fishermen come back. A canal I know can take us to another lake," the wise one said.

The intelligent fish said, “I know what to do if the fishermen come and catch me."

The fish which believed in fate said, "Whatever to happen will happen, I was born in this lake and I am not going to leave it."

The wise fish didn't want to risk its life, so he took the canal and went to another lake.

The fishermen came back the next morning and cast their net. The rest of the two friends were caught in it along with many other fishes.

The intelligent fish thought of a way to escape, it acted as if it were dead. The fishermen threw him along with other dead fish back into the lake. But the other fish which believed in fate was still jumping in the net and the fishermen struck him dead.

Story moral: Intelligence wins over might.

Emedinews:Insights on MEdicolegal Issues:What is the approach to acute ethanol and isopropanol poisoning?

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

• Do a full medical examination to exclude other causes of the patient’s condition, such as head injury
• Correct fluid and electrolyte imbalance.
• Hypoglycemia should be treated with oral or intravenous glucose.

Emedinews:Inspiration:The complaint

 "The sea was much better," the traveler complained. "Whenever I got tired it at least had its currents to push me forward on my journey but you," he looked at the vast desert surrounding him, "you are of no help."

 He went down on his knees, dead tired. When his breaths restored back to normalcy, a while later, he heard the desert's voice.

 "I agree. I am of no help like the sea and thus I often depress people. But do you really think people will remember you for crossing the sea? Never! For the sea doesn't allow you to leave any mark. I, on the contrary, do. Thus, if you cross me, I swear, you will in turn immortalize yourself with the imprints you leave over me!"

 The traveler got the essence and got up to walk on. "It's always about the imprints," his heart echoed.

Emedinews:Insights on Medicolegal Issues:Antemortem vs postmortem injury

• The injuries which are received in the body prior or before death is called the antemortem injury in medicine. These injuries may be a contributing factor in the death or even its cause however on the other hand, they may have occurred many days/months or years ago too.
• During the autopsy, surgeon assesses the age of antemortem injuries, as well as distinguishes them from postmortem injuries, which occur after death. Postmortem injury can be from various sources such as deliberate mutilation of a body by a murderer following a homicide, predation by wild animals, or careless handling in the mortuary. Postmortem injuries can cause confusion over the manner and cause of death.
• One major difference between an antemortem and a postmortem injury is the presence of signs of bleeding. While the person is still alive, the blood is circulating and any injuries such as cuts or stabs will bleed. After death, the body usually does not bleed. However, there are exceptions. For instance, when a person drowns, their body usually floats face down and these results in the head becoming congested with blood.
• Careless handling of a cadaver may produce some post-mortem bruising which may need to be distinguished from ante mortem bruising. Blood also tends to pool under gravity after death, causing a bruised appearance in the lower limbs, arms, hands, and feet known as discoloration. Some of the smaller vessels may even hemorrhage under the pressure of this pooled blood. These bruises could be confused with antemortem bruising.
• If the cadaver receives a head injury by colliding with blunt object/force, then there could be some evidence of bleeding. Scalp wounds sustained after death may also leak some blood. It can be especially difficult to distinguish between injuries inflicted in the very last few minutes of life and those caused postmortem. If the person collapses, there may be areas of laceration to the head and scalp which may be very hard to interpret.
• Recent research has focused on improved techniques for distinguishing between an ante mortem and a postmortem injury by analyzing damaged tissue. Antemortem injuries show signs of inflammation, while postmortem injuries do not. Some research suggests that tissue from ante mortem injuries contains a chemical involved in inflammation leukotriene B4 (LTB4). Postmortem injuries were found to have no LTB4. This could help in more accurate assessment of injuries.

Emedinews:Inspiration:When my fingers grow back?

An Inspirational Story

 A man came out of his home to admire his new truck. To his puzzlement, his three-year-old son was happily hammering dents into the shiny paint. The man ran to his son, knocked him away, and hammered the little boy's hands into a pulp as punishment. When the father calmed down, he rushed his son to the hospital.

 Although the doctor tried desperately to save the crushed bones, he finally had to amputate the fingers from both the boy's hands. When the boy woke up from the surgery & saw his bandaged stubs, he innocently said, "Daddy, I'm sorry about your truck." Then he asked, "but when are my fingers going to grow back?"

 The father went home and committed suicide.

 Think about the story the next time you see someone spill milk at a dinner table or hear a baby crying. Think first before you lose your patience with someone u love. Trucks can be repaired. Broken bones & hurt feelings often can't. Too often we fail to recognize the difference between the person and the performance. People make mistakes. We are allowed to make mistakes. But the actions we take while in a rage will haunt us forever.

 Pause and ponder. Think before you act. Be patient. Understand and love.

Emedinews:Insights on Medicolegal Isssues:Medical Testimony of Doctor in the Court of Law

Do not misrepresent documents/medical literature in the Court of Law

When evidence is read into the record of a trial, only that portion of the document, which validates the information being discussed needs to be read aloud. One paragraph or even one part of a paragraph may be all that is necessary to substantiate the point you are making. Documents must be presented in the words of the author. When you paraphrase evidence, you argue in a circle. Reading the remainder of the document, even if it establishes a context for the evidence, is unnecessary and time–consuming. When a document is cut in a manner, which lends the quoted passage a meaning other than what would be derived from a more complete reading, you are misrepresenting the document. This does not mean, however, that you are responsible for drawing the same conclusions from information as the author of the document.

Drawing a contrary conclusion from passages accurately interpreted does not constitute misrepresentation. The fact that the author of the document reached a different conclusion from the information argues perhaps persuasively against your conclusion. However, you have not misused the evidence.

Emedinews:Inspiration:It only takes a second

An Inspirational Story

A few days ago I got a call from my old college mate whom I haven't seen for a very long time. The topic, which was about all the good old times that we had and about his recent graduation, changed to a touching story when he started talking about his father.

 His father's declining health made him to stay at the hospital. Because of his illness, his father suffered from insomnia and often talked to himself. My friend, who had not been able to sleep for a few days as he had to keep watch of his father's condition, became irritated and told his father to keep silence and try to get some sleep. His father said that he really wanted to sleep well because he was very tired and told my friend to leave him alone in the hospital if he did not want to keep him company.

 After his father finished talking he fell unconscious and had to be rushed to the Intensive Care Unit (ICU). My friend was very sorry for he had spoken ill words towards his father.

 My friend, whom I knew as a tough person, cried like a baby on the other end of the telephone. He said that from that moment on he prayed every day asking God to let his father woke up from his coma. He promised himself that whatever words came out from his father's mouth after he regained his conscious would be gladly taken. His only hope was for God to give him a chance to rectify his past mistake, a mistake that he might not forget for the rest of his life...

 Often we complain when we have to accompany or to watch over our parents for years, months, days, hours or even minutes. But do we realize that our parents keep us companied and watch over us for as long as we (or they) live? Since the day we were born to our adulthood, and even when death comes to greet us, they are always at our side. When it's time for them to return to God, their memory lingers for the rest of our life.

 Imagine how broken-hearted our parents will be to a seemingly innocent word of "no" which comes out from our mouth when they try to embrace us in their tender loving care, but which we often consider as something that bind us and hold us from flying the blue sky. What other words will replace the word "crying" when there are no more tears to shed from their eyes as the tears are wasted to shower our days so that our life would grow and produce fruits and flowers to liven up the dark days of the rotating wheel of life.

 We can make promises to ourselves that from now on there will be no more complaints come out from our mouths when we have to watch and accompany our parents. No more complaints come out from our mouths when we feel that our parents have treated us like little children. Have faith, out there are so many unlucky ones who have neither fathers nor mothers, who long to have the things that we most complain about, but never have them.

 Actually, it takes only a second to contemplate and light the lamp that will bring us to where peace is dwelling. Now it's all up to us whether we want to spare our short time for a great and meaningful life ahead of our lives.

Emedinews:Insights on Medico legal issues:What is a minimally conscious state?

A minimally conscious state is distinguished from vegetative state by the partial preservation of conscious awareness.

• Some patients with severe alteration in consciousness have neurological findings that do not meet criteria for vegetative state (VS).
• These patients demonstrate some behavioral evidence of conscious awareness but remain unable to reproduce this behavior consistently; the condition referred here is the minimally conscious state (MCS).
• To make the diagnosis of MCS, limited but clearly discernible evidence of self or environmental awareness must be demonstrated on a reproducible or sustained basis by one or more of behaviors like verbal yes/no responses regardless of accuracy, purposeful behavior, including movements or emotional behaviors that occur in relation to relevant environmental stimuli and are not due to reflexive activity.
• Some examples of qualifying purposeful behavior include: appropriate smiling or crying in response to the emotional but not to neutral topics, vocalizations or gestures that occur in direct response to the linguistic content, reaching for objects.

Emedinews:Inspiration:One step

Foolish people with all their other thoughts, have this one too: They are always getting ready to live, but never living.

Your success will start when you begin to pursue it. To reach your goal or to attain success, you don’t need to know all of the answers in advance. You just need to have a clear idea of what your goal is. Don’t procrastinate when faced with difficult problems. Break your problems into parts, and handle one part at a time.

Develop tendencies toward taking action. You can make something happen right now. Divide your big plan into small steps and take that first step right away. Everyone who ever got where they are had to begin where they were. Your big opportunity is where you are right now.

A journey of a thousand miles begins with one step. Take it.

Emedinews:Insights on Medicolegal Issues:Indian pharmacopoeia in British India

In British India, even after establishment of two English medical schools, the noted British John Forbes Royale wrote a very famous essay on "Antiquity of Hindu Medicine" in 1837 demonstrating the deep British interest/faith and undisputed acceptance of efficacy in Indian pharmacopoeia. But it did not survive long and an English pharmacopoeia in the name of Bengal Pharmacopoeia 1844 came into force in British India. European doctors and English medicine started dominating over Indian herbs and medicines.