May 26  2015, Tuesday
15 Game-Changing Wireless Devices to Improve Patient Care
Dr KK Aggarwal
  1. An ECG in your pocket: The device, a one-lead ECG, attaches to a smartphone and records accurate ECGs and heart rate in 30 seconds.
  2. Monitoring inpatients when you're not in the hospital: The new device can retrieve and display a patient's temperature, blood pressure, CT scans, ultrasounds, labs, radiographs, medications, and more—including electronic health record (EHR) notes—on a doctor's tablet or smartphone.
  3. Checking all your diabetic patients at once: A new device connects over 30 nonwireless glucometers to patient smartphones, transforming them into wireless devices that enable syncing of blood glucose readings, integrate food and lifestyle data, and allow for real-time connection between patients and providers.
  4. A foolproof medication compliance monitor: A sensor, which costs less than a penny, is placed on a pill. It gets activated by stomach juices when it's ingested. A digital signal is then sent to a monitor worn on the patient's arm." This records the medication taken, ingestion time, heart rate, body temperature, body position, and rest and activity patterns.
  5. A symptom tracker for patients with asthma or COPD: A device that fits onto an inhaler and wirelessly syncs with a smartphone app to record trending data.
  6. An advance in insulin administration and glucose monitoring: A noninvasive, wireless monitoring system for people with diabetes. A pen-like skin preparation device administers insulin via pain-free transdermal skin permeation rather than a needle. A biosensor is then placed on the administration site, much like a Band-Aid; it wirelessly transmits the patient's blood glucose level every minute to a remote monitor, which tracks glucose levels and rate of glucose change. Visual and audible alarms are triggered if levels move beyond the target range.
  7. Precise monitoring of cardiac patients with frequent symptoms: The new device including a wearable peel-and-stick sensor and a wireless transmitter is designed for patients with frequent symptoms that require short-term cardiac monitoring for up to 30 days.
  8. A scale that measures much more than your weight: A Bluetooth device monitors fat mass, lean mass, and body mass index with FDA-cleared bioelectrical impedance analysis. It also monitors your pulse (with an accompanying blood pressure cuff), records your standing heart rate history, and measures temperature and carbon dioxide to assess air quality. A companion smartphone app tracks running, weight loss, activity and calorie levels, and cardiovascular fitness.
  9. A smart way to monitor cardiac patients: This wireless device has been designed to continuously monitor a patient's heart rate, R-R interval, respiration rate, ECG, activity level, position, and posture while in the hospital, in transition, or at home. A wireless module snaps into a holder held in place on a patient's chest by two disposable standard ECG electrodes, making it easy for patients to stay remotely connected to a care team without cumbersome wires or hard-to-use devices. Vital signs, updated every minute, can be monitored in a special Web portal.
  10. A wireless system to improve seniors' health and wellness: This tablet-like device improves quality of life for nursing home residents or enables elderly patients to remain at home. The simple software interface includes medication schedules and reminders, as well as lifestyle assessments and care coordination notes that wirelessly let family members and professional caregivers exchange information. The tablet mates with a variety of wireless devices available from the firm—a scale, pulse oximeter, glucometer, blood pressure cuff, thermometer, motion sensors, contact sensors (for doors and windows), and pressure sensors (for bed and chair)—with readings viewable in an online portal.
  11. An early warning system for monitoring inpatients: The device eliminates the need for cumbersome devices, replacing them with a tablet-like sensor inserted under the mattress of the patient's bed. This device wirelessly monitors heart rate, respiration, and body movement. Computer monitors placed in prominent locations and handheld devices alert nurses of a change in patient status, enabling early detection of patient deterioration.
  12. A real-life Tricorder: Physicians and nurses of a certain age will remember a hit TV series from the 1960s, Star Trek, in which the Starship Enterprise's resident physician, Dr Leonard McCoy, relied on something called a "tricorder"—a fictional scanning device—to measure the body temperature, heart rate, and just about every other physiologic function in his mostly human patients. Now a Chinese company, as created virtually the real thing.
  13. Patient-generated eyeglass prescriptions: A plastic eyepiece that clips onto a smartphone screen. A patient views the screen through the eyepiece, sees several parallel lines, and presses the phone's arrow keys until the lines overlap. This is repeated with the lines at different angles, at which point software loaded onto the phone generates the prescription data. The process takes 2 minutes.
  14. The sole of a new machine: World's first wireless sensor insole. As thin as a normal insole, it wirelessly transmits data on a patient's plantar distribution of pressure to a smartphone app. This is useful for clinical research and sports science, particularly for training analysis and optimizing rehabilitation after a foot injury.
  15. Reducing pressure ulcer risk in bedridden patients: An app-device combo automates wound assessment; simplifies wound treatment; wirelessly enables care team communication; and identifies bedridden, at-risk patients before pressure ulcers can develop.
IMA-USV Vitamin D Deficiency CME held on 24-5-2015 at IMA House, New Delhi
  • Acupuncture can reduce pain and increase quality of life in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), suggests new research published online in Prostate Cancer and Prostatic Diseases.
  • Low-dose oral tetrahydrocannabinol (THC) does not reduce behavioral disturbances in patients with dementia, but it is well tolerated, suggests a new study published online in Neurology.
  • Risk assessment for hereditary cancer is the key to identifying patients and families who may be at increased risk of developing certain types of gynecologic cancer, suggests a new committee opinion from the American College of Obstetrics and Gynecology (ACOG). The guidelines, published in the June issue of Obstetrics & Gynecology, recommend that patients be referred to a genetic specialist if the initial screening points towards a familial risk.
  • Botox may improve the pliability and elasticity of skin for up to 4 months, suggests a new study published in the journal JAMA Facial Plastic Surgery.
  • Bariatric surgery may restore sudomotor and cardiac autonomic-nerve dysfunction to near normal in obese patients with type 2 diabetes, suggest preliminary data from a new study presented at the American Association of Clinical Endocrinologists' 2015 Annual Scientific and Clinical Congress.
Dr KK Spiritual Blog
Why do We Worship the Tulsi Plant?

Yanmule sarvatirhaani
Yannagre sarvadevataa
Yanmadhye sarvavedaascha
Tulasi taam namaamyaham

"I bow to the Tulsi, At whose base are all the holy places, At whose top reside all the deities and In whose middle are all the Vedas."

The Tulsi or Sacred Basil is one of the most sacred plants. There is a saying in Sanskrit: "Tulanaa naasti athaiva tulsi" that which is incomparable in its qualities is the tulsi. It is the only pooja samagri, which can be washed and reused.

Satyabhama once weighed Lord Krishna against all her legendary wealth. The scales did not balance until a last single tulsi leaf was placed along with the wealth on the scale by Rukmini with devotion. Thus, tulsi played the vital role of demonstrating that even a small object offered with devotion is of greater value than all the wealth in the world.

The Tulsi leaf has great medicinal value and is used to cure various ailments, including the common cold. Tulsi seeds are good for male infertility and increase the viscosity of semen and sperm counts. It has detoxifying properties and is used in fasts including the Satynarayana Katha where a thousand tulsi leaves are added to the water for pooja, which is consumed later by everybody.

Tulsi also symbolizes Goddess Lakshmi. Those who wish to be righteous and have a happy family life worship the tulsi. Tulsi is ‘married’ to Lord Vishnu with pomp and show like any other wedding. This ‘marriage’ is solemnised because according to a legend, the Lord blessed her to be His consort. Tulsi is worshipped in the months of Magh and Kartik. Tulsi vivah is observed in the month of Kartik and is the symbolic marriage of Lord Vishnu in the form of a shaligram (sacred stone) and Tulsi. It indicates the importance of Tulsi for fertility. Tulsi pooja is an important component of any marriage.
Cardiology eMedinewS
  • In elderly patients with distributive shock in critical care, a higher target for mean arterial pressure leads to an increase in mortality, warns a pilot study presented at the American Thoracic Society 2015 International Conference.
  • Results of a study presented at the American Association of Clinical Endocrinologists' 2015 Annual Scientific and Clinical Congress by Zdravko Kamenov, MD, PhD, from Alexandrovska University Hospital, Sofia, Bulgaria suggest that measuring an obese patient's neck may prove to be of greater value than waist circumference in assessing cardiometabolic risk.
Pediatrics eMedinewS
  • A higher risk of multiple surgeries may offset any advantages to implanted intraocular lenses (IoLs) after cataract surgery in infants, reported a new study published online in the British Journal of Ophthalmology.
  • A new study revealed that maternal obesity weakens an infant's immune system at the time of birth, increasing their susceptibility to illness, and infants born to obese mothers had reduced immune cell response compared with infants whose mothers were lean. The findings were published in the journal Pediatric Allergy and Immunology.
Make Sure
Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why was the blood pressure of 90/80 ignored?
Lesson: Make sure that a pulse pressure of less than 20 is not ignored. It is an impending sign that the patient is going into shock.
Dr Good Dr Bad
Situation: A patient with osteoarthritis was not responding to treatment
Dr Bad: Increase the dose of the painkiller
Dr Good: Give a combination of nimesulide and colchicine
Lesson: Adding colchicine to ongoing nimesulide (NSAID) therapy may be of additional benefit. In a study, in which 36 patients with moderately severe symptomatic osteoarthritis of the knee were randomly assigned to receive nimesulide plus colchicine (0.5 mg twice daily) or nimesulide plus placebo, significantly more patients receiving the NSAID plus colchicine combination had at least 30 percent improvement in osteoarthritis scores (Arthritis Rheum. 2002 Jun 15;47(3):280-4).

(Copyright IJCP)
Can one charge for a telephonic consultation?

One should avoid giving telephonic consult.

In a Supreme Court Judgment Martin F. D'Souza vs Mohd Ishfaq (3541 of 2002) dated 17.02.2009 Justice Markandey Katju and G S Singhvi enlisted precautions which doctor/ Hospitals/ Nursing Homes should take. “54(b): No prescription should ordinarily be given without actual examination. The tendency to give prescription over the telephone, except in an acute emergency, should be avoided”. But, the above judgment does not restrict one from charging a fee if the consult has been given in an acute emergency unless the patient cannot afford treatment, in which case, if one wants, he/she can send the bill to the state government for reimbursement.
IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Video of the Day
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, CHD TOF
Press Release
Besan or gram flour has health benefits

If you are in doubt that your food may be the cause of your illness, try substituting one food each day. To begin with, its best to use besan (gram flour) in place of wheat flour said Padma Shri, Dr. B C Roy & DST National Science Communication Awardee, Dr K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General Indian Medical Association.

People suffering from celiac disease cannot digest a protein called gluten, which is found in barley and wheat flour. Gluten triggers immune system in patients to damage small intestine villi. As a result, patients cannot absorb nutrients from food and remain malnourished, which could lead to anemia, weight loss and fatigue. Celiac disease patients suffer from fat malabsorption.

A gluten-free diet is also recommended for patients with wheat allergy, dermatitis herpetiformis; multiple sclerosis, autoimmune disorders, autism spectrum disorders, ADHD, and some behavioral problems. Gluten-containing cereals are wheat, barley, rye, oats and triticale. Gluten is also present as a food additive in the form of a flavoring, stabilizing or thickening agent.

In these conditions one should switch over to gluten-free foods. The best alternative is to shift from wheat flour to gram flour (besan).
Rabies News (Dr A K Gupta)
Is there a need to alter the dose or schedule of any concomitant medication during IDRV?

There is no need to alter the dose or schedule of any concomitant medication during IDRV.

eIMA News
World No Tobacco Day
Dear IMA Colleagues,

"World No Tobacco Day" is on 31st May. It is observed every year, all over the world to draw attention of policy makers, law enforcers, public, towards the health hazards of Tobacco, and advocating for policies to reduce its consumption, be it in any form like smoking or chewing.

Every year WHO gives a theme for the World No Tobacco Day. The theme this year is “Countries to Work together to end the illicit trade on Tobacco Products”.

Tobacco is the leading cause of morbidity, mortality & impoverishment
  • Tobacco kills nearly 60 lakhs (six million) people each year, of which more than 600 000 are non-smokers dying from breathing second-hand smoke. Tobacco caused 100 million deaths in 20th century. As per current trends, it may cause one billion deaths in 21st century. If no action is taken now, tobacco related deaths will increase to more than eight million per year by 20130.Unfortunately, 80% of these deaths will be in low & middle income countries, and we are one of them.
  • Tobacco-related diseases are responsible for one in 10 adult deaths worldwide.
  • Every 6 seconds, one person dies of tobacco-related disease.
  • In India alone, it kills nearly 8 lakhs people per year.
A study has shown that every day 55,000 new children take up tobacco habits in India, whereas a mere 2% of Indian adults quit the habit, that also, often only after falling ill. ICMR has also shown that out of 100 young smokers today, nearly 50% are going to die of tobacco-related disease. People who smoking and/or chew tobacco are likely to have:
  • Fifty times more chances of getting oral cancer.
  • Twelve times more likely to die from lung cancer.
  • Ten times more likely to die from some form of lung disease.
  • Ten times more likely to die from cancer of the larynx.
  • Six times more likely to die of heart disease.
  • Twice as likely to die of a stroke.
And the list goes on & on …

There is a plethora of evidence-based information on the health hazards of tobacco, most of which are also well known to our IMA Doctors. They are also aware of its menace to the Patient, family & Society.

International Classification of Diseases (ICD-10) has notified tobacco dependence as a disease. The 5As (Ask, Advise, Assess, Assist, Arrange) if followed by doctors, help a great deal in Tobacco control and also increase the Quit rate.

IMA branches are advised to organise awareness rally, arrange symposium/lectures, give talk shows, distribute pamphlets, stickers, give interviews to media and arrange Oral Lesion detection camps etc. on World No Tobacco Day.

For readymade material, please contact

Please do send photographs of the activity to the IMA head office, along with a brief report.

Dr. A Marthanda Pillai, National President

Dr KK Aggarwal, Hon Secy General

Dr Dilip Kumar Acharya, Chairman IMA National Cancer & Tobacco Control Committee
IMA Swachch Bharat Swastha Bharat
Observe IMA Hygiene Hour Every Friday 4-5 PM. Do one hour cleanliness awareness drive.
World No Tobacco Day
Quit smoking
  • Follow 5 As (Ask, Advise, Assess, Assist, Arrange)
  • Assessing tobacco use status during healthcare visits increases the likelihood of smoking-related discussions between patients and clinicians, as well as increases smoking cessation rates.
  • All smokers should be advised to quit smoking. Even brief advice to quit has been shown to increase quit rates.
  • For smokers who are willing to quit, manage them with combination of behavioral support and pharmacologic therapy
    • Behavioral intervention generally consists of brief clinician counseling in the office, but smokers should also be referred to a free telephone quit line
    • Smokers who fail to quit on an adequate trial of first-line pharmacotherapy may benefit from second line pharmacotherapy.
    • Also attempt to intensify behavioral counseling.
    • Patients who successfully quit but experience relapse be treated with a pharmacologic agent that previously helped the patient to achieve abstinence and was tolerable
    • Enhancing treatment by adding another pharmacologic agent or more intensive behavioral support can also be considered.
    • Smokers can also be advised about the health risks of secondhand smoke exposure to their household members and urged to commit to keeping their home and car smoke-free, especially if children are present.
5As of quitting Smoking

Ask: Implement an office wide system that ensures that, for every patient at every clinic visit, tobacco-use status is queried and documented. Repeated assessment is not necessary in the case of the adult who has never used tobacco or has not used tobacco for many years, and for whom this information is clearly documented in the medical record.

Advise: Strongly urge all tobacco users to quit in a clear, strong, personalized manner. Advice should be clear - "I think it is important for you to quit smoking now and I can help you." "Cutting down while you are ill is not enough." It should be "As your clinician, I need you to know that quitting smoking is the most important thing you can do to protect your health now and in the future. The clinic staff and I will help you." and it should be personalized. Tie tobacco use to current health/illness, and/or its social and economic costs, motivation level/readiness to quit, and/or the impact of tobacco use on children and others in the household.

Access: Determine the patient's willingness to quit smoking within the next 30 days; If the patient is willing to make a quit attempt at this time, provide assistance; If the patient will participate in an intensive treatment, deliver such a treatment or refer to an intensive intervention; If the patient clearly states he or she is unwilling to make a quit attempt at this time, provide a motivational intervention and If the patient is a member of a special population (adolescent, pregnant smoker), provide additional information specific to that population.

Assist: Provide aid for the patient to quit.

Arrange: Schedule follow-up contact, either in person or by telephone. Follow-up contact should occur soon after the quit date, preferably during the first week. A second follow-up contact is recommended within the first month. Schedule further follow-up contacts as indicated.

Congratulate success during each follow-up. If tobacco use has occurred, review circumstances and elicit recommitment to total abstinence. Remind the patient that a lapse can be used as a learning experience. Identify problems already encountered and anticipate challenges in the immediate future. Assess pharmacotherapy use and problems. Consider use or referral to more intensive treatment.
Doctors clean KIMS hospital campus as part of Clean India National Movement

Bangalore, May 23rd, 2015. Today India witnessed one of the biggest cleanliness rallies by the medical fraternity, which occurred simultaneously in 135 cities across the nation. In line with the Hon’ble Prime Minister’s Swachh Bharat Abhiyan, Indian Medical Association & the medical fraternity in association with Alkem Laboratories, took up the mission of raising awareness about how a “Clean India will deliver healthy India”.

The message of the drive was short and simple, ‘More than 50% of diseases can be eliminated and health budget saved, if one’s surroundings are kept clean’. In Bangalore over hundreds of participants were seen cleaning the premises of KIMS Hospital and showcasing their support towards the cause.

During the rally throughout nation, approximately 20,000 doctors, 3 lakh concerned citizens and 900 Alkem employees came out onto the streets and cleaned the roads of their respective cities. As a part of the campaign, the Indian Medical Association also educated over 2.5 lakh of its doctor members about the importance of imparting basic health and hygiene awareness to their patients for a healthier India.

Dr. Ramamurthy Bingi, Senior Consultant – Department of Cardiology KIMS Hospital& Dr Chenna Raya, Physician KIMS Hospital who participated in the cleanliness drive said, “Recent reports declare Bangalore to be one of the most populated cities in India making its inhabitants vulnerable to a host of short-term allergies, respiratory disorders, as well as chronic illnesses. Ambient air pollution is an established cause of morbidity and mortality just like tobacco smoke and needs to be tackled with on priority. Swachh Bharat in its true sense does not just imply just cloning one’s surroundings of garbage but it also implies being a sensible citizen and adopting environment friendly practices such as proper waste disposal, recycling, using public and shared modes of transport as much as possible as well as maintaining a certain level hygiene. I congratulate Alkem on this initiative and hope that together we can make our country a healthier one.

A recent report by the United Nation mentions that over 1 lakh people in India die of water-borne diseases annually. One of the major reasons for this is that about 70 per cent of water supply here is majorly polluted with sewage effluents. In light of this, it becomes very important to cultivate clean habits amongst people.

Supporting the case, Padma Shri Awardees and the National President & Honorary Secretary General of the Indian Medical Association, Dr. Marthanda Pillai and Dr K K Aggarwal in a joint statement said, “We at Indian Medical Association believe that awareness is the first step to disease prevention and are proud to be associated with this movement. Health and cleanliness are two sides of the same coin and we sincerely believe that just by keeping environment clean, over 50% of the country’s disease burden and healthcare budget can be reduced. We urge every person to join this movement and help make India a clean and disease free nation. We are thankful to 2.5 lakh members of IMA who have supported this campaign and urge them to continue spreading the message that a “Clean India will deliver a Healthy India” in their cities.

A Medical Council of India (MCI) proposal to raise the maximum age set for retirement of the medical teachers’ fraternity in India to 75 years is being challenged by various quarters in Maharashtra where the retirement age has been raised to 64 years against the existing limit of 70.

Slamming the practice of pharma companies offering freebies and gifts to doctors, government auditor CAG said that drug makers have claimed tax benefits on such expenses despite these being prohibited by law. The Comptroller and Auditor General (CAG) said that it audited 2,868 assessment records of pharma companies and found 246 cases not in compliance with the laid-down provisions, involving total tax effect of Rs 1,348.44 crore.

There were 22 cases involving tax effect of Rs 570.59 crore where on research and development (R&D) expenses were allowed without verifying the claims by the Department of Scientific & Industrial Research (DSIR). The deduction of 200 per cent of the expenditure incurred on R&D activities is allowed provided it is approved by DSIR.

Interim guidelines from the Society of Gynecologic Oncology and the American Society for Colposcopy and Cervical Pathology are the first US guidelines to suggest primary human papillomavirus (HPV) testing as an option for cervical cancer screening in women starting at age 25 years.

The International Breast Cancer Intervention Study I (IBIS-1) assigned over 7000 high risk women to tamoxifen 20 mg daily or placebo for five years. With 16 years of follow-up, tamoxifen significantly reduced the risk of breast cancer, with risk extending beyond the first ten years of follow-up. The risk reduction was primarily seen for hormone receptor-positive breast cancer.
Inspirational Story
Temper Control

There once was a little boy who had a bad temper. His father gave him a bag of nails and told him that every time he lost his temper, he must hammer a nail into the fence.

The first day the boy had driven 37 nails into the fence. Over the next few weeks as he learned to control his anger, the number of nails hammered daily, gradually dwindled down. He discovered it was easier to hold his temper than to drive those nails into the fence. Finally the day came when the boy didn’t lose his temper at all. He told his father about it and the father suggested that the boy now pull out one nail for each day that he was able to hold his temper.

The days passed and the young boy was finally able to tell his father that all the nails were gone. The father took his son by the hand and led him to the fence. He said "you have done well, my son, but look at the holes in the fence. The fence will never be the same. When you say things in anger, they leave a scar just like this one."

You can put a knife in a man and draw it out. It won’t matter how many times you say I’m sorry, the wound is still there. Make sure you control your temper the next time you are tempted to say something you will regret later.
Quote of the Day
The best thing about dreams is that fleeting moment, when you are between asleep and awake, when you don’t know the difference between reality and fantasy, when for just that one moment you feel with your entire soul that the dream is reality, and it really happened. Johann Wolfgang von Goethe
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Reader Response
Dear Sir, Thanks for the updation. Regards: Dr Krishna
Wellness Blog
Triphala can help in reducing bronchial hyperreactivity

Triphala (TRP), a herbal extract, has been shown to affect lymphocytes and natural killer T (NKT) cell function. It has been shown to ameliorate bronchial hyperreactivity through immune–cell modulations.

In a study carried out at the Division of Allergy, Immunology and Pulmonary Medicine, Washington University in Saint Louis, Saint Louis, MO, asthma mouse models were generated through intraperitoneal (IP) injections of ovalbumin (OVA)/2 weeks followed by repeated intranasal OVA challenges.

Mice were then treated with normal saline (OVA/NS) or Triphala (OVA/TRP). Data were compared with mice treated with inhaled budesonide.

Both TRP and budesonide significantly ameliorated functional and histological OVA–induced bronchial hyperreactivity. Triphala causes a significant decrease in bronchial reactivity. It alters immune–cell distributions and show antioxidative properties. Immune–cell modulation with triphala can ameliorate lung injury.

(Ref: Horani A, Shoseyov D, Ginsburg I, et al. Triphala (PADMA) extract alleviates bronchial hyperreactivity in a mouse model through liver and spleen immune modulation and increased anti-oxidative effects. Ther Adv Respir Dis 2012 Aug;6(4):199–210).
eMedi Quiz
The substances present in the gall bladder stones or the kidney stones can be best identified by the following technique:

1. Fluorescence spectroscopy.
2. Electron microscopy.
3. Nuclear magnetic resonance.
4. X-ray diffraction.

Yesterday’s Mind Teaser: The following separation technique depends on the molecular size of the protein:

1. Chromatography on a carboxymethyl (CM) cellulose column.
2. Iso-electric focusing.
3. Gelfiltration chromatography.
4. Chromatography on a diethylaminoethly (DEAE) cellulose column.

Answer for yesterday’s Mind Teaser: 3. Gelfiltration chromatography.

Correct Answers received from: Dr Shangarpawar, Dr K Raju, Dr Poonam Chablani, Dr Avtar Krishan.

Answer for 24th May Mind Teaser: D. 30 minutes of exercise at least four times a week

Correct Answers received: Dr Avtar Krishan.
IMA Humor
Never be rude to anyone

An American tourist asked a boat guy in Zanzibar, "Do you know Biology, Psychology, Geography, Geology or Criminology?"

The boat guy said, "No. I don’t know any of these."

The tourist then said, "What the hell do you know on the face of this Earth? You will die of illiteracy!"

The boat guy said nothing. After a while the boat developed a fault and started sinking. The boatman then asked the tourist, "Do you know Swimology and Escapology from Crocodiology?"

The tourist said, "No!"

The boat guy replied, "Well, today you will Drownology and Crocodiology will eat you. I will not Helpology and you will Dieology because of your Badmouthology."
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