March 8  2015, Sunday
editorial
7 Aditya Birla doctors get 1-year jail term
Dr KK AggarwalIn the first such action against a large corporate hospital, a total of seven doctors have been charged with violating sections of the Pre-Conception and Pre-Natal Diagnostic Technique (PC-PNDT) Act and convicted to one year’s simple imprisonment and fine of Rs 5,000 by a Judicial Magistrate First Class court, Pune.

This is the first such case when a corporate hospital has been pulled up — mainly for non-maintenance of records and slapped with a Rs 10,000 fine by a court while hospital workers too have been convicted by the JMFC court presided by Judge D B Mhalatkar. The court observed that the hospital had been given a chance in 2011 to improve but they failed to do so.

Considering that punishment is strict for flouting any section of the PC-PNDT act that deals with the offence of illegal sex determination of the foetus, the hospital should have improved its position but failed to do so, the court observed.

According to Advocate Anant Randive, legal adviser for PC-PNDT in the PCMC, Dr Anandrao Jagdale the then Appropriate Authority for implementing the PC-PNDT Act in Pimpri Chinchwad Municipal Corporation, had filed a case against Aditya Birla Hospital, its superintendent Dr Ashutosh Shrivastav, medical director Dr Ashish Pathak, Chief Operating Officer Rekha Dubey, Dr Ritu Lokhande and radiologists Dr Anup Bharsakade, Dr Deepali Ahirrao, Dr Runalaila Soofi under sections 23, 25, 26 and 29 of the PC-PNDT Act.

On 28-6-2012, Dr R N Bachchav had been authorised to conduct inspections of all sonography and medical termination of pregnancy centres in Thergaon, Kala Khadak and Pimple Nilakh area. Dr Bachchav inspected the Aditya Birla hospital on 28-6-2012 and 29-6-2012 and found irregularities in filling Form ‘F’, which records medical history of pregnant women. While the PC-PNDT booklet was not made available, the board displaying rules of the PC-PNDT Act too were not displayed at six sonography machines.

Subsequently, show cause notices were issued after sealing the sonography machines to respond to the violation of the PC-PNDT Act. The court has said that rule 9(4), 17 (1) and 17 (2) of the PC-PNDT Act were flouted. When contacted, Dr Pavan Salve, presently the Appropriate Authority for implementing the PC-PNDT Act in PCMC area, reiterated that this was the first such case that had involved a large corporate hospital and assumes importance as despite reminders the administration failed to improve. Rekha Dubey, COO, Aditya Birla Memorial Hospital, said the court judgment was “shocking news”.

“It was only the act of omission not a case of any medical negligence. We are all aware that doctors are supposed to deal with the medical emergency and that time their priorities are to treat the patients. However in this case in between the procedure they received emergency calls from nurse so whilst filling the documentation, in a hurry, they missed only putting their own signatures. (The) remaining documents were in order thoroughly, as per the PC-PNDT Act requirements. It should be noted that this was the only fault — a technical mistake aggrieved by the above judgment, the Management of Hospital is filing an appeal in the Sessions Court against the said judgement,” she added.

No sonography tests in city from Monday

By Nozia Sayyed, Pune Mirror | Mar 5, 2015, 02.30 AM IST

While a court of judicial magistrate (first class) has announced its judgment against the six doctors of the Chinchwad-based Aditya Birla Hospital for the incomplete filling of Form F, the Pune doctor's association has now called upon a cease of gynaec sonography tests from Monday in retaliation. Over 250 radiologists and sonologists have agreed to join the protest. On February 25, the court found six doctors guilty of violating the Pre- Conception and Pre-Natal Diagnostic Techniques Act, 1994. They will need to pay a fine of Rs 10,000 each and serve one-year imprisonment.
The doctor's association, which includes Association of Nursing Homes and Clinic Owners of Pune (ANHCOP) and Indian Medical Association of Pune, has claimed that the penalty is huge and the injustice is not only towards doctors, but the medical profession, too. Dr Nitin Bhagali, president of ANHCOP, told Mirror, "The court's judgment is insensitive as the punishment is same as conducting a sex determination test. It has come as a shock to us. Filling of the form is a clerical job which is done by hospital staffers. How can doctors be held responsible for a minor technical error that is not even their fault?" Urging all centres in the city to stop conducting gynaec, especially pregnancy-related sonography tests, Dr Avinash Bhondwe, past president of IMA Pune, said, "We are firm on our stand and will continue to remain so until the court changes the judgment. The act deems the same punishment for incomplete filling of forms and an illegal sex determination test. The degree of punishment needs to change. Bhondwe added that they had written to the Union health ministry, urging it to amend the Act, which was refused. However, the accused doctors seem to be not unaware of the support. Dr Anup Bhasrakade, one of the accused, said, "Although we are not aware, it will be a big relief if they are supporting us. The imprisonment has come as a huge punishment for us. We are still in a state of shock."

Relevant Sections

23: Offences and penalties- (1) Any medical geneticist, gynaecologist, registered medical practitioner or any person who owns a Genetic Counselling Centre, a Genetic Laboratory or a Genetic Clinic or is employed in such a Centre, Laboratory or Clinic and renders his professional or technical services to or at such a Centre, Laboratory or Clinic, whether on an honorary basis or otherwise, and who contravenes any of the provisions of this Act or rules made there under shall be punishable with imprisonment for a term which may extend to three years and with fine which may extend to ten thousand rupees and on any subsequent conviction, with imprisonment which may extend to five years and with fine which may extend to fifty thousand rupees.

(2) The name of the registered medical practitioner who has been convicted by the court under subsection

(1), shall be reported by the Appropriate Authority to the respective State Medical Council for taking necessary action including the removal of his name from the register of the Council for a period of two years for the first offence and permanently for the subsequent offence.

(3) Any person who seeks the aid of a Genetic Counselling Centre, Genetic Laboratory or Genetic Clinic or of a medical geneticist, gynaecologist or registered medical practitioner for conducting prenatal diagnostic techniques on any pregnant woman (including such woman unless she was compelled to undergo such diagnostic techniques) for purposes other than those specified in clause

(2) of section 4, shall, be punishable with imprisonment for a term which may extend to three years and with fine which may extend to ten thousand rupees and on any subsequent conviction with imprisonment which may extend to five years and with fine which may extend to fifty thousand rupees.

25: 25. Penalty for contravention of the provisions of the Act or rules for which no specific punishment is provided.- Whoever contravenes any of the provisions of this Act or any rules made there under, for which no penalty has been elsewhere provided in this Act, shall be punishable with imprisonment for a term which may extend to three months or with fine, which may extend to one thousand rupees or with both and in the case of continuing contravention with an additional fine which may extend to five hundred rupees for every day during which such contravention continues after conviction for the first such contravention.

26: Offences by companies - (1) Where any offence, punishable under this Act has been committed by a company, every person who, at the time the offence was committed was in charge of, and was responsible to the company for the conduct of the business of the company, as well as the company, shall be deemed to be guilty of the offence and shall be liable to be proceeded against and punished accordingly:

Provided that nothing contained in this sub-section shall render any such person liable to any punishment, if he proves that the offence was committed without his knowledge or that he had exercised all due diligence to prevent the commission of such offence.

(2) Notwithstanding anything contained in sub-section (1), where any offence punishable under this Act has been committed by a company and it is proved that the offence has been committed with the consent or connivance of, or is attributable to any neglect on the part of, any director, manager, secretary or other officer of the company, such director, manager, secretary or other officer shall also be deemed to be guilty of that offence and shall be liable to be proceeded against and punished accordingly.

Explanation.--For the purposes of this section,--

(a) "company" means anybody corporate and includes a firm or other association of individuals, and

(b)"director", in relation to a firm, means a partner in the firm.

29: Maintenance of records. (1) All records, charts, forms, reports, consent letters and all other documents required to be maintained under this Act and the rules shall be preserved for a period of two years or for such period as may be prescribed:

Provided that, if any criminal or other proceedings are instituted against any Genetic Counselling Centre, Genetic Laboratory or Genetic Clinic, the records and all other documents of such Centre, Laboratory or Clinic shall be preserved till the final disposal of such proceedings.

(2) All such records shall, at all reasonable times, be made available for inspection

Rules

9(4): The record to be maintained by every Genetic Clinic, in respect of each man or woman subjected to any pre-natal diagnostic procedure/technique/test, shall be as specified in Form F.

17 (1): Every Genetic Counselling Centre, Genetic Laboratory, Genetic Clinic, Ultrasound Clinic and Imaging Centre shall prominently display on its premises a notice in English and in the local language or languages for the information of the public, to effect that disclosure of the sex of the foetus is prohibited under law.

17 (2): At least one copy each of the Act and these rules shall be available on the premises of every Genetic Counselling Centre, Genetic Laboratory, Genetic Clinic, Ultrasound Clinic and Imaging Centre, and shall be made available to the clientele on demand for perusal.

(Penalties: Case may be launched in the court of JMIC u/s 25 of the Act. Punishment may extend to 3 months or with fine, which may extend to Rs. 1,000/-for first offence. Additional fine upto Rs. 500/- per day for the period of contravention for subsequent offence. Or Show cause notice u/s 20(1),(2) for temporary suspension of registration. Or Under Section 20(3))

Section 4 of the Act:

4. Regulation of pre-natal diagnostic techniques- On and from the commencement of this Act,--

(1) no place including a registered Genetic Counselling Centre or Genetic Laboratory or Genetic Clinic shall be used or caused to be used by any person for conducting pre-natal diagnostic techniques except for the purposes specified in clause (2) and after satisfying any of the conditions specified in clause (3);

(2) no pre-natal diagnostic techniques shall be conducted except for the purposes of detection of any of the following abnormalities, namely:--

(i) chromosomal abnormalities;
(ii) genetic metabolic diseases;
(iii) haemoglobinopathies;
(iv) sex-linked genetic diseases;
(v) congenital anomalies;
(vi) any other abnormalities or diseases as may be specified by the Central Supervisory Board;

(3) no pre-natal diagnostic techniques shall be used or conducted unless the person qualified to do so is satisfied for reasons to be recorded in writing that any of the following conditions are fulfilled, namely:--

(i) age of the pregnant woman is above thirty-five years;
(ii) the pregnant woman has undergone of two or more spontaneous abortions or foetal loss;
(iii) the pregnant woman had been exposed to potentially teratogenic agents such as drugs, radiation, infection or chemicals;
(iv) the pregnant woman or her spouse has a family history of mental retardation or physical deformities such as, spasticity or any other genetic disease;
(v) any other condition as may be specified by the Central Supervisory Board;
Provided that the person conducting ultrasonography on a pregnant woman shall keep complete record thereof in the clinic in such manner, as may be prescribed, and any deficiency or inaccuracy found therein shall amount to contravention of provisions of section 5 or section 6 unless contrary is proved by the person conducting such ultrasonography;

(4) no person including a relative or husband of the pregnant woman shall seek or encourage the conduct of any pre-natal diagnostic techniques on her except for the purposes specified in clause (2).

(5) no person including a relative or husband of a woman shall seek or encourage the conduct of any sex-selection technique on her or him or both.

5. Written consent of pregnant woman and prohibition of communicating the sex of foetus. (1) No person referred to in clause (2) of section 3 shall conduct the pre-natal diagnostic procedures unless—

(a) he has explained all known side and after effects of such procedures to the pregnant woman concerned;
(b) he has obtained in the prescribed form her written consent to undergo such procedures in the language which she understands; and
(c) a copy of her written consent obtained under clause (b) is given to the pregnant woman
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  • Higher levels of fluoride in drinking water appear to be associated with an increased risk for hypothyroidism in a new study from England in the Journal of Epidemiology and Community Health, raising concerns about the validity of community fluoridation of water as a safe public-health measure. In particular, when a comparison was drawn between the West Midlands, a completely fluoridated area (0.7 mg/L or more) and Greater Manchester, a nonfluoridated area (0.3 mg/L or less), nearly twice the risk for hypothyroidism was detected in the West Midlands.
  • Chronic kidney disease (CKD) rates are estimated to rise substantially during the next 20 years, with more than half of individuals aged 30 to 64 years likely to be affected, reports a simulation study published in the March 2015 issue of the American Journal of Kidney Disease.
  • The first biosimilar product in the United States has been approved by the US Food and Drug Administration. The product approved is the recombinant colony-stimulating factor filgrastim-sndz which has several clinical uses, including aiding recovery from neutropenia in cancer patients undergoing chemotherapy.
  • A new study suggests that concussion is associated with reduced cerebral blood flow, which recovers in most individuals within a few weeks. The findings were published online in JAMA Neurology on March 2.
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Facts about Soul and the Spirit
  1. Energy is the raw material of the universe.
  2. Information is the organization of energy into reproducible patterns.
  3. Consciousness is living information and energy (living energized information)
  4. Consciousness is, therefore, intelligence.
  5. Intelligence is information and energy that has self–referral or the ability to learn through experiences and the ability to reinterpret and influence one’s own information and energy states.
  6. Consciousness is live, advanced, software–driven energized information.
Nearest example: Advanced computer software which can type, correct, interpret, edit and store spoken or read information.
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  • In three large cohorts of 40- to 79-year-old mostly low-income men and women, those who ate more peanuts had a lower risk of dying from CVD or all causes in a median follow-up of 5 to 12 years. The report is published online in JAMA Internal Medicine.
  • Patients with MI treated with a high-dose of omega-3 fatty acids besides standard care had significant improvements in cardiac function and structure compared with individuals who received standard medical care alone, reported a new study presented at the American College of Cardiology 2015 Scientific Sessions.
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  • Long-term improvements in air quality are linked to clinically significant improvements in pediatric lung development and function, suggests a longitudinal cohort study published in the March 5 issue of the New England Journal of Medicine.
  • A cross-sectional study of more than 400 adolescents demonstrated that hopelessness and nonproductive coping were significant risk factors for depression for the girls. On the other hand, positive thinking was a protective factor for girls, whereas self-discovery was protective for boys. Researchers noted that significant risk factors for suicidal behavior for the entire group included depression, hopelessness, or coping problems. The study is published in the Canadian Journal of Psychiatry.
Make Sure
Situation: A patient on binasal oxygen developed nasal mucosal damage.
Reaction: Oh my God! Why was the oxygen given at the rate of 4 liters per minute?
Lesson: Make sure that oxygen via nasal catheter, is not given at a rate of >3 liters per minute.
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Situation: A patient with severe migraine wanted to know if xylocaine drops would help.
Dr. Bad: They have no role.
Dr. Good: You can try them.
Lesson: As an intranasal spray, 2% xylocaine drops can help migraine patients.

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HC stays suspensions of docs
The Free press journal: March 04, 2015: Indore: In a setback to Medical Council of India (MCI), Indore bench of Madhya Pradesh High Court stayed its orders pertaining to registration suspension of six doctors from Indore who had allegedly gone on foreign trips sponsored by a pharma company.

Hearing separate petitions filed by the doctors, three different benches of Justice S Waghmare, Justice SC Sharma and Justice Prakash Srivastava stayed the suspension orders giving interim relief to the petitioners including Dr Shrikant Rege, Dr Jaishree Tapadia, Dr Atul Tapadia, Dr Rajesh Mulay, Dr Swati Mulay and Dr Vrishali Nadkarni.

Earlier on Monday, the high court granted a stay on the ban against Dr Shrikant Rege on the similar grounds. The ban would have restricted the doctors from practicing for a period of six months for violation of MCI rules.

Counsel of the petitioners, Pankaj Bagadia said, “The doctors had challenged the orders of the MIC on different grounds and sought stay which was granted by the court.”

Last month, the MCI had issued orders regarding suspension of registration for six months of 15 doctors of the city, including six from the city, for accepting sponsored foreign trips.

A complaint against them for accepting offer of Intas Pharma for UK trip was lodged in 2012.

The MCI had found the complaint true. The doctors were found guilty of misconduct under the Clause 6.81-B of MCI Ethics Regulations by the Ethics Committee.

On receiving MCI orders, Madhya Pradesh Medical Council (MPMC) also issued the suspension orders of the beleaguered doctors.

The MCI has also recommended to the Drug Controller General of India and Director General of Health Services for appropriate action against Intas Pharma, Ahmedabad.
MPMC suspends six doctors
TNN | Mar 1, 2015, 07.27PM IST

BHOPAL: In a major action against erring doctors, Madhya Pradesh Medical Council (MPMC) on Saturday suspended six medical practitioners and banned four of them from practice for a year while two for six months.

MPMC president Dr KK Thassu and registrar Dr SAS Qazmi said complaints were received against 12 doctors, of which six have been barred for practice from six months to a year.

According to sources, Ratlam-based doctor at district hospital Dr Pushpendra Sharma was suspended after he was charged by a local gynaecologist Dr Manju Singh for carrying out a hysterectomy. Rules permit only gynaecologists to perform the procedure. Interestingly, complainant Dr Singh was also suspended for trying to interfere with council's process.

A Khargone-based ophthalmologist, Dr Santosh Gupta was suspended after MPMC investigation found a patient suffered from complications after an operation conducted by him. Dr Seema Shivhare from Nascot hospital (Gwalior) was penalised after a patient complained that she withhold and did not provide her medical records.

Rajendra Kumar Jain, medical specialist in Khajuraho was found guilty of issuing a fraudulent medical certificate while Dr Umesh Sinha of Chirayu hospital, Bhopal was suspended for giving out a medical certificate not following the appropriate format.
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Inspirational Story
The Old Man and the Rose

During the mid 1950s when I was a kid, my dad worked in a furniture shop at Spadina and Queen in downtown Toronto. Sometimes, I got to go to the shop with him and I made a bit of pocket change running to the restaurant and getting coffee for everybody. I would pass the rest of the day away just hanging around the store, not doing much of anything and not paying much attention to all the hustle and bustle of people and things that were all around me.

One day, as my dad and I were driving to the shop, I looked out the passenger window of the car and I saw an old man standing at the street corner. For some reason, our eyes met and held for about twenty seconds as we went by the corner. There was nothing fearful about this man but it was a significant encounter for me. Up to that point in my life, I had given no thought to anyone I saw on the street, in stores or anywhere else. My life was my family and my friends on the block and that was it. I had no interest in anyone beyond that circle.

But I was intrigued by that old man. For the first time I had an empathy and an interest in what that person was all about. What kind of life had he lived? Where had he been in his time? How had he come to this corner just at the moment I was going by?

Over the years I had long forgotten about this old man, but he came to mind for me recently and I remembered those twenty seconds or so that I looked into the eyes of a stranger and wondered what he was all about.

It seems we are all so busy these days. There are so many details, so many calls to make and so many things to look after that we barely have time for sincere and genuine interest in others.

We are inundated by warnings from great thinkers in our society encouraging us to 'stop and smell the roses'. But I'm afraid it has taken me decades to really appreciate the wisdom of these words.

If I ever have the opportunity to speak to a young person today, I do my best to convey this message. But unfortunately, young people are too busy to heed good advice. Much like I was so many years ago. Youth indeed is so often wasted on the young.

If I had the chance, I would tell young people to stop what they are doing and look around. I would tell them to try as hard as they could to fully understand what is right in their line of sight, what is in the range of their hearing at the moment, what is in their immediate reach and grasp.

I would like so much to tell people, especially young people, that if you are thoughtless and indifferent to others on your road in life, then you are missing life itself. Do not be intrusive or tactless, for heaven’s sake, but take a moment and ask someone, how did you come here or how did you get into this business?

No matter what that person tells you, their answer will make you richer. You can grow emotionally, you can excel as a person and you can be wealthy by every measure if you just appreciate the gifts that people and life all around you are ready to give right at this moment just by their simple presence.

We should appreciate that great symphonies were written from only seven simple notes that God gave the entire universe. We should know that great works of art are measured by the emotions they evoke, not just how they look next to the plant stand.

We should never forget that heartache cannot be cured but can be eased by someone willing to give genuine sympathy. The true greatness of joy can only be known when it is shared with others.

Recently, I attended a trade show at the convention centre in downtown Toronto. During the lunch break I went to a book sale along the trendy Queen West area. I was thinking about returning to the show or carrying on my walk when I realized I was standing at the corner of Spadina and Queen. At that moment a car went by and I caught the eye of a young boy looking at me from the passenger window. We looked at each other for about twenty seconds before the car disappeared around the corner. I wondered if that boy was thinking about what sort of person I was.

And I realized that I was now an old man. Like the man I saw so many years ago. I wondered if 50 years had just simply flashed by or whether that boy and I had just simply changed places in the span of 20 seconds.

Before I returned to the trade show, I stopped at a florist. I bought a rose and put it in the lapel of my jacket. For some reason, I felt it was the most important thing I would do for the rest of the day.
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Vitamin D intake associated with reduced risk for Crohn’s disease

Increased intake of vitamin D may significantly reduce the risk for Crohn’s disease (CD) in women, according to an article published online December 12 and in the March issue of the journal Gastroenterology.
  • This study involved 72,719 women who returned the 1986 questionnaire. They had data on both vitamin D intake and physical activity and did not have a history of CD or UC.
  • Diagnosis of CD was based on a typical history of 4 weeks or longer and was confirmed by radiologic, endoscopic, or surgical evaluation.
  • The diagnosis of ulcerative colitis (UC) was based on typical clinical presentation of 4 weeks or more and endoscopic, radiologic, or surgical evaluation.
  • Mean age of the participants at baseline was 53 years, mean body mass index (BMI) was 25.4 kg/m2, mean physical activity was 13.2 metabolic hours per week, 94.5% were white and 36.6% never smoked.
  • A documented 122 cases of CD and 123 cases of UC were recorded during 1,492,811 person–years of follow–up. The median predicted 25(OH) D level was 27.6 ng/mL.
  • Women in the lowest quartile of predicted 25(OH)D level compared with those in the highest quartile had a higher body mass index, were less active, tended to reside in the Northern or Midwestern regions of the United States, and had lower intake levels of dietary or supplemental vitamin D. The median age of diagnosis of CD was 64.0 years; for UC, it was 63.5 years.
  • The median interval between assessment of plasma 25(OH) D levels and disease diagnosis was 12 years for UC and 10 years for CD.
  • For every 1 ng/mL increase in predicted 25(OH) D level, the risk for CD was reduced by 6%.
  • For UC, there was also a reduction in risk, but it was non–significant at 4%.
  • Women in the highest two quartiles of 25(OH)D levels had multivariate HRs of 0.50 and 0.55, respectively, for CD
  • Each 100 IU/day increase in total intake resulted in a 10% reduction in UC risk and a 7% reduction in CD risk.
  • For vitamin D intake from diet and supplements based on quartile distribution, there was a significant linear inverse trend for vitamin D intake and UC risk, but this trend was weaker for CD.
  • Intakes of 800 IU/day or higher resulted in greater reductions in the risks for UC and CD
  • Vitamin D intake was inversely associated with the risks for CD and UC, vitamin D insufficiency or deficiency was an important mediator in the pathogenesis of UC and CD, and assessment of vitamin D status should be a part of the assessment of inflammatory bowel diseases.
Quote of the Day
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The Amazing Kitchen Logic

Joe was a housekeeper who had this habit of drinking from his boss' wine bottle and replacing it with water. The boss, James, did suspect him but tolerated it for a while. But when this became a daily routine, James decided to do something to trap Joe.

Accordingly, James replaced his drink with a French wine which changed colour when water is added to it. Joe, not aware of the trap, took a few swigs and added water as usual. The wine changed colour from red to milky white. Joe realized he was in for trouble but was determined to get out of it.

James told his wife about Joe's misdoings and that he would make Joe accept his follies.

So he shouted, "Joe!!!" Joe answered from the kitchen, "Yes boss?"

James, "Who drank my wine and added water in the bottle?"

There was no answer from the kitchen. The boss repeated the question, still no answer. The angry boss marched to the kitchen and threatened Joe, "What the hell is going on? When I call your name you respond with 'Yes Boss' and when I ask you a question, you remain silent. What impertinence!!!"

Joe said, "It is like this. In the kitchen, you can hear only your name being called. You don"t hear anything else that is said, I swear."

James, "How is that possible? All right, I will prove you wrong. You stay right here in the hall with Madam, I will go to the kitchen and you ask me a question, OK?"

So the boss went to the kitchen.

Joe shouted, "Boss!!!"

Boss, "Yes Joe?"

Joe, "Who becomes intimate with the maid in Madam's absence?"

Silence - no reply. Joe again, "Who made the maid pregnant?"

No reply. Joe, yet again, "And who arranged for her abortion?"

James came running from the kitchen and said, "You are right Joe. When one is in kitchen, one can't hear anything but one's name. That's bloody strange.
eMedi Quiz

A self practicing dermatologist needs

a. Videoconference
b. Mobile teledermatology
c. Store and forward teledermatology
d. A combination of store and forward, online discussion group, and author-based second opinion teledermatology

Yesterday’s Mind Teaser: L E cell is a

a. Neutrophil
b. Macrophage
c. Histiocyte
d. Dendritic cell

Answer for yesterday’s Mind Teaser: a. Neutrophil
Correct Answers received from: Dr Shangarpawar.
Answer for 6th March Mind Teaser: b. Procaine.
Correct Answers receives: Dr Jainendra Upadhyay, Daivadheenam Jella, Dr Avtar Krishan, Raju Kuppusamy, Dr Shangar Pawar.

8th February is International Woman's Day
Respect the young woman: IMA

As per the POCSO Act, the definition of a female child is one who is below 18 years of age and it is mandatory to report any sexual abuse to them, said Dr A M Pillai National President and Padma Shri Awardee, Dr K K Aggarwal, Hony. Secretary General, IMA and President Heart Care Foundation of India

Doctors have a very important role to play in limiting the short-term and long-term effect of child sexual abuse.

These can be feeling of powerlessness; anger; anxiety; fear; phobias; nightmares; difficulty concentrating; flashbacks of the events; fear of confronting the offender, loss of self esteem and confidence and feelings of guilt If childhood sexual abuse is not treated, long-term symptoms can go on through adulthood and may include: PTSD and anxiety; depression and thoughts of suicide; sexual anxiety and disorders, including having too many or unsafe sexual partners; difficulty setting safe limits with others (e.g., saying no to people) and relationship problems; poor body image and low self-esteem; unhealthy behaviors, such as alcohol, drugs, self-harm, or eating problems.

These behaviors are often used to try to hide painful emotions related to the abuse and issues in maintaining relationships

All doctors must know indicators of sexual abuse, which can be both behavioral and physical.

Behavioral Indicators include abrupt changes in behavior such as self harm, talks of suicide or attempt to suicide, poor impulse control etc; reluctance to go home; sexualized behavior or acting out sexually; low self-esteem; wearing many layers of clothing regardless of the weather; recurrent nightmares or disturbed sleep patterns and fear of the dark; regression to more infantile behavior like bed-wetting, thumb-sucking or excessive crying; poor peer relationships; eating disturbances; negative coping skills, such as substance abuse and/or self-harm; an increase in irritability or temper tantrums; fears of a particular person or object; aggression towards others; poor school performance; knowing more about sexual behavior than is expected of a child of that age; child may hate own genitals or demand privacy in an aggressive manner; child may think of all relationships in a sexual manner; child may dislike being his/her own gender; child may use inappropriate language continuously in his or her vocabulary or may use socially unacceptable slang; child may carry out sexualized play (simulating sex with other children); unwarranted curiosity towards sexual act like visiting adult sites or watching adult images or content.

Physical Indicators can be sexually transmitted diseases, pregnancy, complaints of pain or itching in the genital area, difficulty in walking or sitting, repeated unusual injuries, pain during elimination, and frequent yeast infections.
Rabies News (Dr A K Gupta)
A previously immunized person is bitten again. What is the re–exposure immunization schedule?

Only two doses of vaccine at Days 0 and 3 are required. RIGs are not required (WHO 2007). However, in laboratory confirmed rabies exposures, irrespective of past rabies immunization, full course of PEP and RIGs is recommended. In rabies, it is safer to over treat than under treat.