April 7  2015, Tuesday
Reimbursement Income Tax Rules
Dr KK Aggarwal
  • No transaction is allowed of more than Rs. 20,000 in cash in one day with one vendor.
  • Payments of more than Rs.2,000/- should be made in Cheque as far as possible.
  • Put a revenue stamp on every cash receipt.
  • If a vendor is charging service tax, the bill must carry service tax number
  • If the vendor is charging VAT or sales tax, TIN number should be on the bill.
  • Always hire audiovisual equipment and run it yourself. If you hire a person for operating the system, service tax will be applicable.
  • If you hire a car and run it yourself, service tax is not applicable. But if you hire a car with the driver, service tax is applicable.
  • In Hotel and Restaurants, Service Tax is not applicable if the total turnover of the hotel/restaurant is less than 10 lakh per annum, if the Hotel/Restaurant is not air-conditioned or if the room rent in the hotel is less than 1000 Rs per day per room.
  • All Bills should contain the word “Service Tax not applicable” if it is not charge
  • Best way to take a bill is “inclusive of all applicable taxes"
  • If the vendor has only given a bill than a stamp of 'cash paid" should be there on the bill or a separate receipt should be procured. Remember both receipt and bill are needed.
  • In TB Project, Every bill should be in the name of IMA-GFATM-RNTCP-PPM Project (........name of IMA branch).
This World Health Day, the Indian Medical Association commits to making food safety a priority within its Swachh Bharat Swasth Bharat program
  • Consuming herring, mackerel and certain fish oils may heighten the risk of cancer patients becoming resistant to chemotherapy, suggests a new study published in JAMA Oncology.
  • Alcohol-dependent hospital patients die from multiple morbidities 7.6 years earlier than patients without a history of alcohol addiction, suggests new research published in European Psychiatry.
  • In a study of the sleeping habits and metabolism, people who stayed up late, regardless of lifestyle factors, had a higher risk of diabetes or reduced muscle mass than those who were early risers. The findings are published in the Journal of Clinical Endocrinology and Metabolism.
  • The American Academy of Otolaryngology–Head and Neck Surgery Foundation has presented an updated clinical practice guideline on adult sinusitis, with a greater focus on patient education and patient preference. The guidelines are published April 1 in Otolaryngology–Head and Neck Surgery.
  • An investigational, first-in-class antipsychotic has shown promise as an effective agent in the treatment of schizophrenia, with an improved side effect profile, suggests a phase 2 study presented at the 15th International Congress on Schizophrenia Research (ICOSR).
Dr KK Spiritual Blog
The Skill Of Controlling Anger

Cynicism is a recognized major risk factor for coronary artery disease (blockages in the channels supplying blood to the heart). And, anger, jealousy and irritability form the triad responsible for this.

Anger is the enemy of peace, knowledge and devotion. According to Ayurveda, anger is a manifestation of Pitta (metabolism) imbalance and is a predisposing risk factor for causation of heart attack, paralysis, gall bladder stone, kidney stone, acidity, ulcer and cancer.

In Bhagavad Gita, Lord Krishna describes the pathway of anger leading to destruction in Chapter 2 Sloka 62 and 63. According to Lord Krishna, when a man’s desires are not fulfilled or expectations are not met one becomes angry. When one is under the influence of anger, he does all types of sinful activities. One loses the distinction between good and bad, loses one’s memory, understanding becomes clouded and the intellect gets perverted. Loss of intellect leads to animal-like behavior, and ultimately to destruction of oneself.

Many kinds of repercussions can occur with anger such as injustice, rashness, persecution, jealousy, taking possession of others property, killing, speaking harsh words and cruelty. The degree of anger may vary from irritation, frowning, resentment, indignation, rage, fury and wrath.

Anger is not always bad. It is only when the anger is an outcome of greed or selfish motives, is it bad.

Righteous or spiritual anger is a type of anger caused with good intentions. This anger passes off the next moment as a wave subsides in the sea. The classical example of righteous anger is when you become angry in a situation where you see a person doing something wrong to check that person.

The root cause of anger is ignorance, egoism, and passion (strong desires), with passion being the root cause. To control anger, therefore, passion should be controlled first.

In Vedic language, both anger and passion are Rajo-Vriti disorders and get exaggerated with any Rajas-increasing lifestyle. Living a life with less of Rajas characteristics will reduce the chances of getting into passion and anger.

Rajas-increasing foods are eggs, fish, onion, garlic, fermented foods, etc. Modern fashion, night clubs, reading novels with stories of violence, living in the company of bad people, indulging in sexual talks, use of tobacco, alcohol and drugs are all Rajas-increasing life styles. A typical Rajasik person is one who indulges in eating, drinking and procreating.

Controlling anger and passion is a procedure involving effort. As a fish swims upstream against the current in a river to breathe, a person has to work against the disturbing thoughts. To balance and stabilize the mind, consuming ‘satvik’ foods like fresh food, vegetables, milk, and barley bread will help. Many exercises can also help to control anger. For example, observing silence for 20 to 30 minutes in a day, walking regularly, practicing speaking kind words, doing regular meditation, practicing non violent communication daily and learning to think differently.

During an episode of anger one can try left nostril pranayama, a short deep breathing exercise, taking a walk, drinking cold or simple water or chanting AUM or I AM. With inspiration one chants “I” and with expiration “AM” reminding one who I AM. That I am the expression of pure spirit and my purpose of life is not to become angry. Remember the person who gets angry will have high blood pressure. The person who you are angry with may not have any change in the blood pressure.

One should realize that during anger, the power of discrimination is lost along with intellectual impairment. Therefore, anger has to be controlled much before it becomes full blown. The initial stage of anger is irritability, and therefore, with the onset of irritability, one should try to control it at the earliest.

One should never judge an individual with his own level of perception. One should realize that if a servant starts working with your level of expectations, he or she will not be working with you as a servant.

One should also make sure that one is not hungry at the time of feeling angry or irritable. Regular meals prevent development of anger.

Anger can be expressive or suppressive. Expressive anger presents with aggressive behavior and the outbursts of anger can cause social unhealthiness. It can cause sudden rise in upper blood pressure or cause rupture of a plaque in the artery supplying blood to the heart precipitating a heart attack.

Suppressive anger can lead to acidity, asthma, formation of plaques in the heart arteries etc. In the long run, suppressed anger, if not expressed, may end up with depression, despondency, guilt etc.

Therefore anger should neither be passed on to others (expressive) nor taken within (suppressed or repressed). Anger, therefore, should be altered, neutralized, or modified. This can be done by temporarily holding it for some time and then taking timely action. Temporary holding can be achieved by using the above exercises. Remember both passion and anger are energies which should be conserved and not wasted.

The mythological explanation of Shiva, the Neelkanth is also the same. One should neither throw the poison (anger), nor drink it but keep it in the throat for some time and take the right action after the anger manifestations are over.

From Vedic text point of view, every thought arises from the silent potential web of energized information or consciousness. This thought from the mind is then analyzed by the intellect and the modified by the ego. At this stage it leads to an action. An action lead so memory and memory leads to desire for the action again.

If this desire is fulfilled, it leads to action again and then desire again. Repeated fulfillment of desires leads to habits formation, addictions and development of a particular personality.

If the desire is not fulfilled it leads to irritability and irritability leads to anger which then can be expressive or suppressive.
The answer therefore lies in changing the perception at the level of the thought or controlling the desires and or the expectation.
Cardiology eMedinewS
  • A new study has suggested that at levels found in typical urban environments, ultrafine airborne particles can alter heart function within minutes of being breathed in. The findings are published in Particle and Fibre Toxicology.
  • Early inflammation and disease activity may predict future elevations in arterial stiffness in ankylosing spondylitis (AS), suggests new research published in the Annals of the Rheumatic Diseases.
Pediatrics eMedinewS
  • Researchers have found that a simple eye test in first grade could predict the onset of nearsightedness by eight grade. The study was published recently in JAMA Ophthalmology.
  • Passive exposure to bleach in the home could increase the frequency of respiratory and other infections among school-age children, suggests a new study published in Occupational & Environmental Medicine.
Wellness Blog
Have Leg Artery Blockages? Walk on a Treadmill

A planned program of walking is good for people with blockage of leg blood vessels called peripheral arterial disease (PAD).

Normally when there is pain in the calf muscles in the leg on walking, the usual tendency is to rest and not walk. A study of 156 people with PAD published in JAMA showed that regular six–minute walks on a treadmill improved their endurance and quality of life. The study examined patients with symptoms and without symptoms. Over the six months of the study, the participants who did their regular six–minute treadmill walks increased their walking distance by about 69 feet, while those who did not walk regularly saw a decrease of 49 feet.

There is the potential for greater oxygen extraction from the blood under maximum exercise conditions. The muscles can make better use of blood flow and the oxygen release that comes from it.

Such exercise leads to improvement in "collateral circulation" –– growth in the number of blood vessels supplying the legs. Clinicians should urge all PAD patients, whether or not they have symptoms, to engage in a regular, supervised exercise program.

Walking is a standard recommendation for people with PAD. A recommended regimen is a 40–minute walk three times a week for at least six months.

Persistent leg pain is an indication that help is needed. In the absence of that symptom, physicians can test for PAD by measuring the difference in blood pressure between an ankle and an arm.
Make Sure
Situation: An elderly patient with unstable angina presented with URTI and was found to be positive for C. pneumoniae infection.
Reaction: Remember to start macrolides immediately.
Lesson: Make sure to remember that erythromycin 2 g/day for 10–14 days reverses the increased risk of atherosclerosis. Seroepidemiological studies have shown a strong association between C. pneumoniae infection and atherosclerosis in patients with cardiovascular disease.
Dr Good Dr Bad
Situation: A patient came for counseling for a high risk sexual behavior. 

Dr. Bad: Use condoms. 

Dr. Good: Use condoms and take a pre–exposure prophylaxis pill for seven days. 

Lesson: Pre exposure prophylaxis for seven days is now a reality

(Copyright IJCP)
IJCP Book of Medical Records
IJCP’s ejournals
Quote of the Day
Just for today don’t be angry. Just for today don’t worry. Just for today be grateful and humble. Just for today be honest. Just for today be kind to others.
Rabies News (Dr A K Gupta)
How to approach a case of irregularities in treatment schedule, e.g., if patients missed the doses as per the due dates, i.e. dose schedule is broken?

The first three doses of modern rabies vaccine must be very timely and for the fourth and fifth, one or two days of variation is permissible.
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
Sonal Namaste
Hand washing is like a "do-it-yourself" vaccine—it involves five simple and effective steps (Wet, Lather, Scrub, Rinse, Dry) you can take to reduce the spread of diarrheal and respiratory illness so you can stay healthy.
Facts about Tuberculosis (TB)
What does ‘Patient wise box’ mean?
  • In RNTCP, drugs for treatment are supplied as ‘Patient Wise Boxes’, which contain the entire full course of treatment for one patient. 
  • There are separate boxes for new patients, re-treatment patients and children.
  • One such box is earmarked for every patient registered ensuring the availability of the full course of treatment to the patient. Hence, in RNTCP the treatment never fails on account of non-availability of medicines.
  • For the convenience of DOT Providers and patients, each box contains 2 pouches- one for Intensive phase and one for Continuation phase.
  • The drugs are packed in blisters. For the intensive phase, each blister pack contains one day’s medication. For the continuation phase, each blister pack contains one week’s supply of medication with clearly marked daily doses for the convenience of the patient and the DOT provider.
Pharmacist to answer patients' queries for free
NEW DELHI, April 3, 2015, DHNS:

If you want extra information on the medicines prescribed to you by a doctor, you can now consult a pharmacist for free at the Indian Medical Association headquarters in ITO here.

The Indian Medical Association has started free consultation for patients. A pharmacist will be available for eight hours every day who can advise patients on when the medicine needs to be taken or on drug reaction in individual cases.

The pharmacist will also be able to guide patients on duration of the treatment. Patients can also discuss the possible side effects of the medicines and how to report these to doctors in future.

“Currently, one pharmacist is available at the headquarters. The idea is to give patients more information about medicines prescribed by doctors. The pharmacist can respond to queries like how the patient is reacting to the drug,” said Dr K K Aggarwal, Honourary, Secretary General, IMA.

The IMA will expand the project at a later stage so that more patients can be accommodated.

In government hospitals, patients are often at loss to understand how to go about the medicines with doctors having little time during rush hours. The IMA is now planning to send circulars to government hospitals so that doctors can send patients here for free consultation.

Hoardings will also be put to make people aware of the consultation available at the IMA House, said Dr Aggarwal.

Meanwhile, the IMA is also likely to start free OPD in the headquarters in a month. Besides free consultation, needy patients will also be provided medicines at a subsidised rates.
World Health Day message: Make food safety a public health priority

NEW DELHI 3April 2015

Food safety, nutrition and food security are inextricably linked. Unsafe food creates a vicious cycle of disease and malnutrition; hence, food safety should be made a public health priority through a multi-sectoral effort.

This was observed by medical experts while speaking on the theme of this year’s World Health Day on April 7 as “Food Safety: From farm to plate, make food safe.”

According to the World Health Organisation (WHO) guidelines on food safety, “diarrhoeal diseases alone kill an estimated 1.5 million children annually, and most of these illnesses are attributed to contaminated food or drinking water”.

Dr KK Aggarwal, Honorary Secretary General of Indian Medical Association, said, “If you suspect a food to be cause of reaction, avoid it, consult your doctor and get it investigated. If you know you have a food allergy, always avoid that specific food trigger.”

According to a WHO report, every day, 3,561 children under 5 die in India and 1.3 million die a year. What is frustrating is that most of these deaths are caused by preventable and treatable conditions such as diarrhoea, respiratory infections and fever. Diarrhoea can be effectively tackled if food is cooked and consumed in a hygienic manner.

Over 200 diseases are caused by unsafe food contaminated with harmful bacteria, parasites, viruses and chemical substances.

As a leader in Reproductive and Child Health (RCH) projects, Hindustan Latex Family Planning Promotion Trust (HLFPPT) has been working closely to reduce under-5 mortality, infant mortality and maternal mortality at grassroots level across 23 states.

The objective of the campaign was to reduce diarrhoeal deaths among children by advocating the use of ORS-Zinc combination. This was done not only at community level but also through door-to-door campaigns. It also seeks to inculcate in pregnant women and lactating mothers about the benefits of preparing and consuming hygienic food.

The project is credited for devising an innovative model of social franchisee hospitals and clinics under the brand name of Merrygold Health Network that offers quality RCH services at affordable rates.

Pregnant/lactating women are told about the imperatives of hygienic food to prevent anaemia. It goes without saying that undernourishment is one of the prime contributors to high maternal mortality rate (MMR) and infant mortality rate (IMR).
Inspirational Story
Waiting is a Mystery

Waiting is a mystery - a natural sacrament of life - there is a meaning hidden in all the times we have to wait. It must be an important mystery because there is so much waiting in our lives. Every day is filled with those little moments of waiting (testing our patience and our nerves, schooling us in self-control.)

We wait for meals to be served, for a letter to arrive, for a friend to call or show up for a date. We wait in line at cinemas and theaters. Our airline terminals, railway stations and bus depots are great temples of waiting filled with men and women who wait in joy for the arrival of a loved one - or wait in sadness to say goodbye. And we wait for ourselves to grow from childhood to maturity. We wait for those inner voices that tell us when we are ready for the next stop. We wait for graduation, for our first job, our first promotion. We wait for success and recognition. We wait to grow up - to reach the stage where we make our own decisions.

We cannot remove this waiting from our lives. It is a part of the tapestry of living - the fabric in which the threads are woven to tell the story of our lives. Yet current philosophies would have us forget the need to wait - Instant pleasure, instant transcendence. Do not wait for anything. Life is short - eat, drink and be merry because tomorrow you will die.

 And so they rationalize us into accepting unlicensed and irresponsible freedom- they warn against attachments and commitments - against expecting anything of anybody, or allowing them to expect anything of us - against dropping any anchors in the currents of our life that will cause us to hold and wait. This may be the correct prescription for pleasure - but even that is fleeting and doubtful.

 If we wish to be real human beings, spirit as well as flesh, soul as well as heart, we have to learn to wait, for if we never learn to wait, we will never learn to love someone other than ourselves. But most of all, waiting means waiting for someone else; it is a mystery, brushing by our face everyday like a stray leaf falling from a tree.

 Anyone who has loved knows how much waiting goes into it - how much waiting is important for love to grow, to flourish through a lifetime.

 Why is this? Why can't we have it right now, what we so desperately want and need? Why must we wait - two years, three years - and seemingly waste so much time? You might as well ask why a tree should take so long to bear fruits - the seed to flower - carbon to change to diamond.

 There is no simple answer - no more than there is to life's other demands - having to say goodbye to someone you love because either you or they have made other commitments or because they have to grow and find the meaning of their own lives - you having to leave home and loved ones to find your own path. Good-byes, like waiting, are also sacraments of our lives.

 All we know is that growth - the budding, the flowering of love needs patient waiting. We have to give each other a time to grow. There is no way we can make someone else truly love us or we them, except through time. So we give each other that mysterious gift of waiting - of being present without asking demands and rewards. There is nothing harder to do than this. It truly tests the depth and sincerity of our love. But there is life in the gift we give.

So lovers wait for each other - until they can see things the same way - or let each other freely see things in quite different ways. There are times when lovers hurt each other and cannot regain the balance of intimacy of the way they were. They have to wait - in silence - but still present to each other - until the pain subsides to an ache and then only a memory and the threads of the tapestry can be woven together again in a single love story.

What do we lose when we refuse to wait, when we try to find shortcuts through life - when we try to incubate love and rush blindly and foolishly into a commitment we are neither mature nor responsible enough to assume? We lose the hope of truly loving or of being loved. Think of all the great love stories of history and literature - isn't it of their very essence that they are filled with this strange but common mystery - that waiting is part of the substance - the basic fabric against which the story of that true love is written.

How can we ever find either life or true love if we are too impatient to wait for it? Waiting is a good thing only if something is worth waiting for. How will you know if it's worth it? Gut feel. What if you don't trust your gut? Pray. You will be enlightened. Trust me.

Is it wrong to expect while waiting? It's not wrong, but it will increase your chances of heartbreak and disappointment if things don't work out in the end. Is it good to expect while waiting? It is better to HOPE.

 What's the difference between hoping and expecting? HOPING means you're open to either side of the coin landing though you're more inclined to believe that things will turn out well. EXPECTING means you're thinking single-track, which won't do you much good at all.

What's the difference between waiting and expecting? EXPECTING is waiting for something TO DEFINITELY HAPPEN. WAITING is staying where you are, but not necessarily expecting something to happen definitely.

Do you need assurance from someone you're waiting for while you're waiting? Ideally, yes. But realistically, do you really want assurance from this person? It's so easy to just point at something and make that the reason why you're waiting ("Because she said..." "Because he told me that...").
 With WAITING, all you really can rely on are 3 things: your gut feel, your heart and your mind. Just YOURSELF, not anyone else.

 So should you wait? What does your gut say? How does your heart feel? What does your mind think? If they're saying different things, keep asking yourself these 3 questions (and pray!) until you get a solid answer. THEN you'll know if he or she is worth waiting for.
Reader Response
Dear Sir, emedinews is very informative and educative. Regards: Dr Sapna
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As an English professor

As an English professor, my father would often write little notes on student essays. Often he worked late, and as the hours passed, his handwriting deteriorated. One day a student came to him after class with an essay that had been returned.

"Mr. McDonald," he said, "I can’t make out this comment you wrote on my paper."

My father took the paper and, after studying it, sheepishly replied, "It says that you should write more legibly."
eMedi Quiz
Which of the following is not a post transcriptional modification of RNA?

1. Splicing.
2. 5' Capping.
 3' polyadenylation.

Yesterday’s Mind Teaser: Which of the following is present intracellularly in muscle cells?

1. Insulin.
2. Corticosteroid.
3. Epinephrine.
4. Glucagon.

Answer for yesterday’s Mind Teaser: 2. Corticosteroid.

Correct Answers received from: Daivadheenam Jella, Arvind Diwaker, Dr Avtar Krishan, Dr Poonam Chablani

Answer for 5th April Mind Teaser:2. pKa

Correct Answers receives:Dr Poonam Chablani, Raju Kuppusamy, Dr Kala Sarma
Press Release of the Day
This World Health Day, the Indian Medical Association commits to making food safety a priority within its Swachh Bharat Swasth Bharat program

Announces day long ‘World Health Day 2015 Celebrations’ in association with the Heart Care Foundation of India, Delhi Medical Association and NDMC

The current budget of Shri Narendra Modi’s Government if managed effictively can take care of lakhs of people dying from food and water borne illnesses. It is estimated that over three lakh children in India alone die before the age of 3 due to diarrheal illnesses every year. Addressing a press conference on the occasion of the upcoming World Health Day, Padma Shri Awardee and Honorary Secretary General of the Indian Medical Association, President Heart Care Foundation of India, Dr KK Aggarwal said, “We at Indian Medical Association would like to invite all the ministries to join hands with us to make India a country free of diarrhoeal deaths. In our endevor to raise awareness about food safety and prevent food and water bourne illness we will be organizing a day long awareness program tomorrow at the Talkatora Indoor Stadium from 8am to 5pm. This is being organized in association with the Heart Care Foundation of India, Delhi Medical Association and NDMC with special support from Indian Oil and the Lions Club”.  

The activities of the World Health Day celebrations on April 7th, 2015 will include a Perfect Health Parade, CPR training camp, panel discussion open to the public consisting of leading influencers and doctors including pediatrician Dr Anupam Sachdeva, dietician Dr Shikha Sharma, renowned dancers Nalini and Kamilini, surgeon Dr RN Tandon amongst others.

Gobally there are estimated 58 crore cases of 22 different food borne enteric diseases and 351000 associated deaths. The enteric disease agents responsible for most deaths are Salmonella Typhi (52,000 deaths), enteropathogenic E. coli (37,000) and norovirus (35,000). Over 40% people suffering from enteric diseases caused by contaminated food are children aged under 5 years.
Addressing the cause, Padma Shri Awardee and President of the Indian Medical Association – Dr Marthanda Pillai said, “Indian Medical Association will write to health ministry; commerce ministry, consumer ministry and agriculture ministry, to join hands with IMA to get rid of diarrheal deaths in the country”.

Adding to this Dr KK Aggarwal said, “At present the government has earmarked a budget worth 33,152 crores for health. A separate budget for the Swachh Bharat campaign with six crore toilets will bring hygiene and cleanliness; 6 crore new houses with a toilet each under Amrut Mahotsav (75th year of independence), 68968 crores for education and mid-day meals; 5,300 crores for micro-irrigation, service tax exemption in cold storage services and transportation of food stuff by rail/road; and thousands of crores for agriculture ministry if properly utilized can make India a country free of food and water borne diseases.”

Sharing his views Dr. Ajay Lekhi, President, Delhi Medical Association and Dr. P.K. Sharma, MOH, New Delhi Municipal Council in a joint statement said, “The way to good health is through proper education of the masses. For example, people should know that cut open fruits and vegetables are banned and one should not eat them. Through various public health activities we hope that the message of food safety would reach to one and all and they would be better equipped to deal with each and every aspect of it. We are proud to be associated with this noble initiative of Heart Care Foundation of India and Indian Medical Association.” 

The following facts on food safety were released by IMA on the occasion:
  1. Ideal temperature for food to remain safe is between 5 to 60 degrees
  2. Water has to be roll boiled for a minimum one minute to kill all the organisms
  3. Remember when in doubt follow "Heat it, roll boil it, cook it, peel it or forget it"
  4. Wash vegetables in running water and not in a utensil
  5. Keep cooked and uncooked food separately
  6. Do not pick up multiple glasses containing drinking water with one hand using multiple fingers to support them
  7. Give all your food handlers one tablet of de-worming every 3-6 months
  8. If you allergic to any food, avoid it. Next allergic reaction may be more severe
  9. Food poisoning can occur within 6 hours of food consumption (vomiting predominant) or after 24 hours of food consumption (diarrohea predominant)
  10. Frozen things do not mean they are sterilized. Ice should always be made out of pure safe water.
  11. All food handlers must wear gloves while preparing food
  12. Always give food handlers a space for toilet with facilities of soap if they are going to stay overnight
  13. Bottled water does not mean it is safe, it can be recycled one.
  14. Do not eat leftover food for more than 2 hours at room temperature
  15. Cheaper fruits and vegetables brought in morning from abundant stock will always be fresh locally grown and seasonal
  16. Do not buy vegetables if all of them are of the same size
  17. Avoid buying vegetables which look very bright in color with the same brightness
  18. Food of plant in origin has no cholesterol
  19. Combine all seven colures and six taste when buying vegetables and fruits
  20. Food offered to the gods will always be satvik.