February 1 2015, Sunday
Pediatrics Update
Dr KK Aggarwal Taper desmopressin rather than abrupt discontinuation

In a multicenter trial involving patients diagnosed with nocturnal enuresis and responding to desmopressin, structured withdrawal of desmopressin (giving one-half the usual dose each day or by giving the usual dose every other day) for two weeks before discontinuation) reduced relapse rates as compared to abrupt withdrawal of the drug. Structured withdrawal was also an independent factor associated with lower initial effective dose and number of wet nights per week.1

Public smoking ban also benefits perinatal and child health

A systematic review and meta-analysis of 11 quasi-experimental observational studies published between 2008-13, involving more than 2•5 million births and 247,168 asthma exacerbations found that smoke-free legislation is associated with considerable decrease in preterm births and hospital admissions for asthma.2

Avoid helmets for infants with positional skull flattening

A randomised controlled trial (HEADS, HElmet therapy Assessment in Deformed Skulls) which randomly assigned infants aged 5-6 months with moderate to severe skull deformation to helmet therapy vs observation found both to be comparable in terms of effectiveness. Because of high prevalence of side effects, and high costs associated with helmet therapy, the authors discourage the use of a helmet as a standard treatment for healthy infants with moderate to severe skull deformation.3

  1. Gökçe MI, Hajiyev P, Süer E, et al. Does structured withdrawal of desmopressin improve relapse rates in patients with monosymptomatic enuresis? J Urol 2014;192(2):530-4.
  2. Been JV, Nurmatov UB, Cox B, et al. Effect of smoke-free legislation on perinatal and child health: a systematic review and meta-analysis. Lancet 2014;383(9928):1549-60.
  3. van Wijk RM, van Vlimmeren LA, Groothuis-Oudshoorn CG, et al. Helmet therapy in infants with positional skull deformation: randomised controlled trial. BMJ 2014;348:g2741.
Health Check Up and CPR 10 Camp at G B S.S. School, Varun Marg, Defence Colony, New Delhi on 22nd December 2014
News Around the Globe
  • Although a net-clinical-benefit analysis was not performed, these data suggest that omeprazole and clopidogrel can be safely coadministered, according to lead investigator Dr Chiara Melloni (Duke University Medical Center, Durham, NC) and colleagues. These findings, all based on randomized trials, call into question the Food and Drug Administration warning against the concomitant use of clopidogrel and omeprazole.
  • Patients receiving methadone for noncancer pain had a 46% increased risk for death compared with patients receiving morphine sustained release (SR), suggests a new study published online in JAMA Internal Medicine.
  • Drinking more than two alcoholic beverages a day in middle age increases stroke risk in early old age more than do traditional risk factors, such as high blood pressure and diabetes, suggests a new study published online January 29 in Stroke.
  • Mobile devices equipped with cameras can effectively enable patients to monitor atypical nevi and send images to their healthcare providers, reports an article published online January 28 in JAMA Dermatology. The technology may help reduce the increased patient load in dermatology.
  • Eating processed foods with added sweeteners is possibly contributing to the growing incidence of type 2 diabetes, suggests a new review, published online January 29 in the Mayo Clinic Proceedings.
Dr KK Spiritual Blog
What is the importance of life force?

A physical body becomes useless once the life force is gone. The same body, which was lovable to everyone, becomes a liability after death. Everyone wants to dispose it as early as possible as keeping a dead body at home is considered a bad omen.

During the transfer of dead body from one place to another nobody wants to keep the body in a vehicle other than a hearse van, meant to transport dead bodies. No family would be willing to carry the dead body of a person in a car in which the deceased person had been traveling or driving for years.

Once you touch a dead body you are required to take a bath, for any reason, health or ritual, before you commence your daily routine.

Within a matter of hours in absence of life force, the physical body starts disintegrating and in a matter of days, it shows signs of self-destruction and putrefaction.

This vital force is nothing but the soul, atma, brahma, spirit or consciousness described in different Vedic texts.

Adi Shankaracharya in his book Bhaja Govindam shloka 6 says:

Yávat-pavano nivasati dehe
Távat-pøcchati kuùalam gehe,
Gatavati váyau dehápáye
Bháryá bibhyati tasmin káye.(6)

“Till the life force remains in the body, people come and enquire about your welfare. But, the moment the life force goes out, even your wife is afraid of coming anywhere near your body”.

Life force can be equated to the network of information in computer, radio, television or mobile phone. All these gadgets without data are useless and are thrown away. This silent data retrievable by operational and application software represent the life force or soul of these electronic gadgets.

Just as one does not give importance to a computer without data, one should not give importance to the physical body. It is the life force within the body which is respected and cared for and that is what real “I” or “We” are. All glories of the body are only until the life force remains in it. In Bhagavad-Gita, Lord Krishna in Chapter 2 (2.23) says about this life force or ataman “fire cannot burn it, weapon cannot cut it, water cannot wet it, air cannot dry it, it is immortal”.

The most defined relationship in Vedic text is between husband and wife. The very fact even a wife after death does not want to touch the husband signifies the importance of life force.

The life force has no dimensions: height, weight, color or image. It is immortal, omnipotent, omniscient and omnipresent. The weight of a live and a dead body immediately after the death is the same.

It is the same life force, which dwells in everybody and during life is modified by the action, memory and desire cycle. If one gets attached to any of the three, then one starts getting detached from the soul or the life force. People who are in touch with their life force all the time attain peace and happiness and die young in old age.

Most Vedic mahavakyas talk about, that it is the same spirit, which dwells in everybody and hence every person in the society should be welcomed and treated with equal importance. Aham brahmasami, tatwam asi, vasudeva kutumbakam, etc. are a few of the examples.

According to Adi Shankaracharya, one can achieve non-duality only by seeing God in everyone. Athithi-devo-bhava is also based on the same principle.
Cardiology eMedinewS
  • Patients admitted to the emergency department with chest pain who are ruled out for an MI tend to have low risk for having an MI in the short- and longer-term follow-up even if they receive no further diagnostic testing, suggests a new study published in the JAMA: Internal Medicine.
  • Patients who receive red blood cell transfusions during coronary artery bypass grafting (CABG) surgery are at an increased risk of developing pneumonia, suggested a study presented at the 51st Annual Meeting of The Society of Thoracic Surgeons.
Pediatrics eMedinewS
  • Results from a study published online in the Journal of Pediatrics show that developmental salivary biomarkers are associated with feeding success in newborns. These markers could lead to development of objective assessment tools for caregivers.
  • Clonidine may be a good alternative to morphine for babies with neonatal abstinence syndrome (NAS), suggests a new study published online in Pediatrics.
Make Sure
Situation: A patient on ACE inhibitor developed angioedema.
Reaction: Oh my God! Why was ACE inhibitor continued?
Lesson: Make sure that patients on ACE inhibitors are advised to watch for symptoms of urticaria and stop the drug immediately in case swelling of lip, face or tongue develops (Br J Clin Pharmacol 1999;48(6):861–5).
Has the MCI set a cap on consultation fees?

There is no such restriction by the Medical Council of India as long as the fee is reasonable and is disclosed to the patients beforehand. This is true for non-emergent conditions. Fee cannot be a consideration in an emergency situation.

In a case decided by Delhi Medical Council dated February 15, 2001, DMC/14/2/2001, the Council observed the following: Dr RSV charged an amount of Rs.5,000.00 from Mr. M.M. P day after initially asking for Rs.200.00 only for his professional services. This is a violation of MCI Code of Medical Ethics which states “remuneration received for such services should be in the form and amount specifically announced to the patient at the time the service is rendered.”

MCI Regulation 3.7.1 states: “A physician shall clearly display his fees and other charges on the board of his chamber and/or the hospitals he is visiting. Prescription should also make clear if the Physician himself dispensed any medicine.”
Dr Good Dr Bad
Situation: A patient with heart failure came for cardiac evaluation.
Dr. Bad: Go for Echo test.
Dr. Good: Go for Tissue Doppler Echo test.
Lesson: A patient with heart failure must go for Tissue Doppler Echo Test for evaluation of diastolic function.

(Copyright IJCP)
IJCP Book of Medical Records
IJCP’s ejournals
eMedinewS Humor
During their silver anniversary, a wife reminded her husband: Do you remember when you proposed to me, I was so overwhelmed that I didn’t talk for an hour?" The hubby replied: "Yes, honey, that was the happiest hour of my life."
Twitter of the Day
Dr KK Aggarwal: Give your child deworming now By Dr k k Aggarwal http://bit.ly/15QdVeB #Health

Dr Deepak Chopra: #Science is a creation of the mind in order to understand reality. The mind itself is an expression of consciousness http://bit.ly/15QdVeB #Health
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Rabies News (Dr A K Gupta)
What is IM pre–exposure vaccination schedule?

The regimen is three IM injections on days 0, 7 and 28.
Video of the Day
Press Release of the Day
Every pharmacist must know certain MCI Rules: IMA

Not only doctors, Pharmacists too have a role in ethical dispensing of prescription medicines. Safe and effective use of medicines is a complementary effort.

Releasing a white paper in a joint statement Padma Shri Awardee Dr A Marthanda Pillai National President and Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General Indian Medical Association said that the MCI Code of Medical Ethics has some provisions in it that are of relevance to the pharmacists. They should be familiar with these and try to comply with them.
  • Regulation 5.3 states that physicians should recognize and promote the practice of pharmacy and should seek their cooperation wherever required.
  • According to Regulation 3.7.1, a doctor’s prescription should also make clear if he/she has himself or herself dispensed any medicine to the patient.
  • Regulation 7.10 states that a registered medical practitioner shall not issue certificates of efficiency in modern medicine to any unqualified or non-medical person but he/she can issue such certificates to dispensers only after proper training.
  • No physician, as per Regulation 6.3, can run an open shop for sale of medicine for dispensing prescriptions prescribed by other doctors or for sale of medical or surgical appliances. Drugs prescribed by a physician or brought from the market for a patient should explicitly state the proprietary formulae as well as generic name of the drug.
  • Regulation 1.5 stipulates that as far as possible, drugs should be prescribed with generic names. Every doctor should make sure that there is a rational prescription and use of drugs.
  • A Pharmacist should be aware that it is improper for a doctor to affix his/her signboard at a pharmacist’s shop. This is as per Regulation 7.13.
  • Regulation 7.19 does not allow doctors to use touts or agents for procuring patients. So, a pharmacist should not indulge in such activities.
  • A pharmacist should know that according to Regulation 1.1.3, no person other than a doctor who holds qualification/s that are duly recognized by MCI and is registered with MCI or State Medical Council can practice allopathic medicine. A practitioner of other systems of medicine cannot practice allopathic medicine. A pharmacist cannot practice and prescribe drugs.
  • Regulation 1.4.1 requires that every prescription should carry the registration number of the prescribing doctor. The pharmacist should check every prescription he comes across while dispensing medicines.
  • A pharmacist should also know that according to Regulation 1.4.2, doctors can add as suffixes only those degrees/ certificates/diplomas that are recognized by the regulatory bodies or those memberships/honours which confer professional knowledge or recognizes any exemplary qualification/achievements.
  • Regulation 1.9 requires all doctors to abide by the laws of country that regulate the practice of medicine and also follow the provisions of State Acts like Drugs and Cosmetics Act, 1940; Pharmacy Act, 1948; Narcotic Drugs and Psychotropic substances Act, 1985; Drugs and Magic Remedies (Objectionable Advertisement) Act, 1954. Neither the doctor nor the pharmacist should be a party to helping others evade these laws.
  • A pharmacist should check that all the drugs prescribed by a physician are carrying a proprietary formula and clear name. Regulation 6.5 prohibits dispensing of secret remedial agents by doctors whose composition they do not know. This regulation also considers their manufacture or promotion of their use as unethical.
  • According to Regulation 6.7, practicing euthanasia is regarded as unethical conduct for the doctor. The pharmacist has a responsibility to check if the prescription is ethical.
  • According to Regulation 7.3, if the doctor’s prescription does not display the registration number that has been assigned to him/her by MCI or State Medical Council, it is considered as violation of Regulation 1.4.2.
  • A doctor is expected to follow the provisions of the Drugs and Cosmetics Act and regulations. If a doctor sells Schedule ‘H’, or H1 & ‘L’ drugs and poisons to the public except to his patient or prescribes steroids or psychotropic drugs with no absolute medication indication, it is regarded as breach of the above Act and provisions and will constitute gross professional misconduct on the part of the physician.
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.
Madan Singh,
SM Heart Care Foundation Fund, Post CAG
Kishan, SM Heart Care Foundation Fund,
Post CHD Repair

Deepak, SM Heart Care Foundation Fund,
IMA & Child Sexual Abuse

According to ACE (Adverse Childhood Experiences) Study in America, a powerful relationship has been established between emotional experiences during childhood & physical and mental health during adulthood. Sexual abuse suffered in childhood is associated with a broad range of behavioral, psychosocial and physical problems that persist into adulthood – these include Anxiety, Depression, Post-Traumatic Stress Disorder, Self Destructive Behavior, Dissociation, Substance Abuse, Sexual Maladjustment and tendency towards re-victimization in subsequent relationships.

New evidence suggests that adult survivors of childhood physical, emotional or sexual abuse are not only at increased risk for depression and other mental health problems; they are increasingly more likely to suffer from heart disease, obesity and other potentially fatal physical conditions…To continue….Dr DS Bhullar

Sterilisation deaths: SC notice to Chhattisgarh

Terming the deaths of over 10 women who underwent sterilisation procedure at government camps in Bilaspur district of Chhattisgarh as a “tragedy”, the Supreme Court on Friday directed the State government to reveal steps taken to indemnify the victims and compensate them. The Social Justice Bench of the Supreme Court led by Justice Madan B. Lokur said the sterilisation deaths remained “fresh” in public memory, and steps have to be taken by both Centre and the State to disburse funds to the victims.

Besides the deaths, over 30 persons were reported critical after undergoing “faulty” sterilisation surgeries at a government-organised family planning camp in Bilaspur. Eighty-three women allegedly underwent the procedure in five hours at free sterilisation camps organised by the health department on November 8.

The Bench noted that the Bilaspur deaths occurred despite specific directives laid down by the apex court in 2005 in Ramakant Rai versus Union of India, to ensure uniform norms, safety and quality assurance in sterilisation procedures... (The Hindu)

NABH Update

Kindly note that QCI recommendation regarding particular hospital/ diagnostic centre does not mean automatic empanelment by CGHS.

10 Worst Medical Treatment Dangers 2015

IV Infusion Lines Mix-up

Medication errors caused by infusion pump programming mistakes are far too common. ECRI focuses this year not on the pump itself but on "the tangle of tubing that exists when multiple IV infusions need to be administered to a single patient." Potentially dangerous mistakes occur when the infusion line is connected to the wrong fluid container, wrong pump or pump channel, and the patient end of the infusion line is to be connected to the wrong administration route. In one reported incident, liquid intended for IV delivery was instead delivered into an epidural catheter (Source: Medscape)

Medscape Family Physician Lifestyle Report 2015

What are the causes of family Physicians Burnout?

Bureaucracy and loss of autonomy are known causes of stress. This report provides more evidence of the importance of these factors, with bureaucratic tasks and spending too many hours at work rated as the most frequent causes of burnout, with scores of 5.14 and 4.23, respectively, based on a scale of 1 ("not at all important") to 7 ("extremely important"). In fact, being able to control work hours is increasingly found to play an important role in reducing stress and, therefore, burnout among family physicians. This year, computerization (3.99) and insufficient income (3.85) were also found to be important causes of burnout. One study found that PCPs with the highest number of electronic medical record functions also experienced the highest amount of stress.

Launch of IMA Rise and Shine Web Lecture Series
Date of webcast
8th February 2015
Time of webcast
11:00 AM - 11.30 AM
Live webcast http://www.ima-india.org/ima/
Opening remarks:
Dr K K Aggarwal, Honorary Secretary General, IMA - 2 minutes
Introduction of President IMA and Chairman Apollo Hospitals Group
Dr. Anupam Sibal, Group Medical Director, Apollo Hospitals - 3 minutes
Presidential Address
Dr. Marthanda Pillai, National President – IMA - 7 minutes
Leadership Qualities: My personal Journey and Healthcare challenges
Dr. Prathap C Reddy, Chairman Apollo Hospitals Group - 15 minutes
Concluding Remarks and Thanks
Dr. K K Aggarwal - 3 minutes
Inspirational Story

The Greatest Gift is LOVE

A woman came out of her house and saw three old men with long white beards sitting in her front yard. She did not recognize them.

She said, "I don’t think I know you, but you must be hungry. Please come in and have something to eat." "Is the man of the house home?" they asked. "No", she said. "He’s out." "Then we cannot come in", they replied. In the evening when her husband came home, she told him what had happened. "Go tell them I am home and invite them in!" The woman went out and invited the men in. “We do not go into a House together," they replied.

"Why is that?" she wanted to know. One of the old men explained: "His name is Wealth," he said pointing to one of his friends, and said pointing to another one, "He is Success, and I am Love." Then he added, "Now go in and discuss with your husband which one of us you want in your home."

The woman went in and told her husband what was said. Her husband was overjoyed. "How nice!!" he said. "Since that is the case, let us invite Wealth. Let him come and fill our home with wealth!" His wife disagreed. "My dear, why don't we invite Success?"

Their daughter–in–law was listening from the other corner of the house. She jumped in with her own suggestion: "Would it not be better to invite Love? Our home will then be filled with love!" "Let us heed our daughter–in–law’s advice," said the husband to his wife. "Go out and invite Love to be our guest."

The woman went out and asked the 3 old men, "Which one of you is Love? Please come in and be our guest." Love got up and started walking toward the house. The other 2 also got up and followed him. Surprised, the lady asked Wealth and Success: "I only invited Love, Why are you coming in?"

The old men replied together: "If you had invited Wealth or Success, the other two of us would’ve stayed out, but since you invited Love, wherever He goes, we go with him. Wherever there is Love, there is also Wealth and Success!"
Quote of the Day
The weak can never forgive. Forgiveness is the attribute of the strong. Mahatma Gandhi
IMA in the News
Dear IMA Colleagues,

WORLD CANCER DAY is on 4th Feb.2015.

Cancer is a complex group of 100 plus diseases. Cancer is a major public health problem that affects people in every nook & corner of every country of the world regardless of caste, creed, economic or social status. The disease has impact not only, on, the patient, but the whole family also suffers with him, and more so economically too. Unfortunately, most Indians have the pessimism that “Cancer means Death”, which is definitely, not true.

The Union for International Cancer Control (UICC) started the World Cancer Day to help save millions of preventable deaths each year by raising awareness and education about cancer, and pressing governments and individuals across the world to take action against the disease. It is observed on 4th Feb. every year, in almost the whole world.

There were 14.1 million new cancer cases, 8.2 million cancer deaths and 32.6 million people living with cancer (within 5 years of diagnosis) in 2012 worldwide. While in India 1 Million new cases occurred in 2012 with 6.8 lakh deaths. We have 17.9 million people living with Cancer (within 5 years of diagnosis). A WHO report shows that Cancer mortality in India has been growing by 11percent annually. Breast Cancer is becoming more common in 30’s & 40’s, and the rates are also increasing in India.

World Cancer Day 2015 :-Taking place under the tagline ‘NOT BEYOND US’, World Cancer Day 2015 will take a positive and proactive approach to the fight against cancer, highlighting that solutions do exist across the continuum of cancer, and that they are within our reach. World Cancer Day is a unique opportunity to raise awareness that there is much that can be done at an individual, community and governmental level, to harness and mobilise these solutions and catalyse positive change. By moving forward together we have the potential to show: Cancer. It is not beyond us.

Prevention of Cancer

Ensuring the availability of, and access to, early detection programs for cancer can significantly reduce the cancer burden in all countries.Life style modifications namely abstinence from Tobacco, limited consumption of alcohol, regular exercises, healthy diet with good food habits, safe environment, maintaining healthy weight-avoiding obesity & vaccination against Hepatitis B have always been stressed to prevent Cancer.

40% of cancers can be prevented, and one-third of cancers can be cured through early diagnosis and treatment. The economic cost of lost life years due to cancer exceed that of any other disease.

All branches are advised to observe WORLD CANCER DAY -arrange exhibitions, distribute pamphlets , take out rallies, hold Press conference, organize Cancer Detection Camps etc.

Pl. do email a report of the activity along with photographs to IMA HQ with a copy to dilipacharya@gmail.com.

Dr Marthenda Pillai
National President, IMA

Dr K K Aggarwal
Hony. Secretary General, IMA

Dr Dilip Kumar Acharya
Chairman-IMA National Cancer
& Tobacco Control Committee.
IMA in Social Media
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Reader Response
  1. Dear Sir, Very informative newspaper. Regards: Dr Kasha
Wellness Blog
Food poisoning with rice dishes

Staph and Bacillus cereus can cause acute food poisoning within 6 hours of ingestion of food. B. cereus is likely when rice is the culprit
  • B. cereus is able to persist in food processing environments due to its ability to survive at extreme temperatures as well as its ability to form biofilms and spores.
  • B. cereus has been recovered from a wide range of foods, including rice, dairy products, spices, bean sprouts and other vegetables.
  • Fried rice is an important cause of emetic–type food poisoning associated with B. cereus
  • The organism is frequently present in uncooked rice, and heat–resistant spores may survive cooking.
  • Cooked rice subsequently at room temperature can allow vegetative forms to multiply, and the heat–stable toxin that is produced can survive brief heating such as stir frying
  • Two distinct types of toxin–mediated food poisoning are caused by B. cereus, characterized by either diarrhea or vomiting, depending on which toxin is involved. The diarrheal toxin is produced by vegetative cells in the small intestine after ingestion of either bacilli or spores. The emetic toxin is ingested directly from contaminated food. Both toxins cause disease within 24 hours of ingestion.
  • The emetic syndrome is caused by direct ingestion of the toxin.
  • The number of viable spores and vegetative bacteria that produce diarrheal toxin is reduced by heating, although spores associated with emetic toxin are capable of surviving heat processing.
  • Cereulide is heat stable and resistant to gastric conditions.
  • The ingested toxin itself may therefore cause disease despite sufficient heating to kill B. cereus.
  • The emetic syndrome is characterized by abdominal cramps, nausea, and vomiting. Diarrhea also occurs in about one–third of individuals. Symptom onset is usually within 1 to 5 hours of ingestion, but it can also occur within half an hour and up to six hours after ingestion of contaminated food.
  • Symptoms usually resolve in 6 to 24 hours.
  • Rice-based dishes in particular have been implicated in emetic toxin mediated disease, usually as a result of cooling fried rice dishes overnight at room temperature followed by reheating the next day.
  • The infective dose of cereulide required to cause symptoms is 8 to 10 mcg per kg of body weight.
eMedi Quiz
The correct sequence of cell cycle is:

1. G0-G1-S-G2-M.
2 .G0-G1-G2-S-M.
3 .G0-M-G2-S-G1.
4 .G0-G1-S-M-G2.

Yesterday’s Mind Teaser: All of the following are the electrocardiographic features of severe hyperkalemia except:

1. Peaked T waves.
2. Presence of U waves.
3. Sine wave pattern.
4. Loss of P waves.

Answer for yesterday’s Mind Teaser: 2. Presence of U waves.
Correct Answers received from: Daivadheenam Jella, Dr KV Sarma, Dr Avtar Krishan.
Answer for 30th Jan Mind Teaser: 1. Clostridium tetani.
Correct Answers receives: Dr KV Sarma, Dr Avtar Krishan, Daivadheenam Jella.
IMA Videos
News on Maps
The Year in Medicine 2014: News That Made a Difference
Major Drug and Device Approvals

Two drug and two device approvals made headlines this year: The FDA approved the inhaled human insulin product Afrezza (MannKind, above) to improve glycemic control in adults with type 1 and type 2 diabetes, making needles no longer necessary. The FDA also approved a first-in-class insomnia drug called suvorexant (Belsomra, Merck). The agency also granted clearance of the first device to help improve quality of sleep in patients with restless legs syndrome (Relaxis, Sensory Medical Inc). The FDA approved Cologuard (Exact Sciences Corporation), a stool-based colorectal cancer (CRC) in vitro diagnostic device intended for the detection of colorectal neoplasia–associated DNA markers and for the presence of occult hemoglobin in human stool (Source: Medscape)
eMedinewS Humor
A Friendly Honest Neighbor

A man received the following text from his neighbor:
I am so sorry Bob. I’ve been riddled with guilt and I have to confess.
I have been tapping your wife, day and night when you’re not around.
In fact, more than you.
I’m not getting it at home, but that’s no excuse.
I can no longer live with the guilt and I hope you will accept my sincerest apology with my promise that it won’t happen again.
Bob, anguished and betrayed, went into his bedroom, grabbed his gun, and without a word, shot his wife and killed her.
A few moments later, a second text came in: Damn autocorrect. I meant "wifi", not "wife".
About the Editor

Padma Shri, National Science Communication and Dr B C Roy National Awardee, Honorary Secretary General IMA, Immediate Past Senior National Vice President IMA, Professor of Bioethics SRM University, Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand, President Heart Care Foundation of India, Chairman Legal Cell Indian Academy of Echocardiography, Editor in Chief IJCP Group of Publications & eMedinewS, Member Ethics Committee Medical Council of India (2013-14), Chairman Ethical Committee Delhi Medical Council (2009-14), Elected Member Delhi Medical Council (2004-2009), Chairman IMSA Delhi Chapter (March 10- March13), Director IMA AKN Sinha Institute (08-09), Finance Secretary IMA (07-08), Chairman IMAAMS (06-07), President Delhi Medical Association (05-06)