emedinews
Head Office: E–219, Greater Kailash, Part 1, New Delhi–110 048, India. e–mail: emedinews@gmail.com, Website: www.ijcpgroup.com
FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
eMedinewS is now available online on www.emedinews.in or www.emedinews.org 
  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR

 
  Editorial …

7th May 2011, Saturday                                eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

Breaking News: Person revived after 96 minutes of CPR

A 54–year–old man with post MI ventricular fibrillation regained spontaneous circulation after a dozen defibrillator shocks and continuous CPR for 96 minutes with full physical and neurological recovery reports Dr Roger D. White at the Mayo Clinic in Rochester, Minn in a case report published online April 20 in the Mayo Clinic Proceedings.

The patient was resuscitated for initial 31 minutes by the emergency staff along with DC shocks. At the 31st minute a helicopter transport crew arrived and continued applying defibrillator shocks to the man who did not have a pulse, yet showed signs of systemic blood flow as measured by an end–tidal carbon dioxide sensor. The team administered a total of 12 defibrillator shocks and kept the patient’s blood flowing with continuous chest compressions.

A key piece of technology on the scene was capnography, which measures how much blood is flowing through the lungs and subsequently to other organs. Capnography has been used to monitor patients in operating rooms but is not often used by ER when treating cardiac arrest. As the measurement remained sufficiently high, the rescuers were encouraged to continue resuscitation efforts.

At the hospital, he was stabilized and taken to the cath lab and was stented for 100% occlusion in the mid–left anterior descending coronary artery. The persistent low blood pressure was stabilized with an intra–aortic balloon pump. The patient was discharged after 10 days with no neuro damage.

Lessons learned

  1. It’s the only case where a person has been revived after 96 minutes of clinical death
  2. We had a similar case where CPR was continued for 45 minutes
  3. GB Pant reports a similar case with revival after an hour and with stenting (Dr Vijay Trehan)
  4. Medicolegal implications: Do not stop resuscitation for up to 100 minutes and make sure you measure E tube CO2 levels
  5. Transport the patient to nearest cardiac hospital for possible angiography and IABP (intra aortic balloon pump), if required.

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
Blogs.kkaggarwal.com Dr K K Aggarwal on blogs
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook

 
  Changing Practice – Evidence which has changed practice in last one year

Artesunate for severe malaria

For treatment of nonpregnant adults and children with severe falciparum malaria, start intravenous artesunate (in areas where intravenous artesunate of reliable quality is readily available), rather than intravenous quinine.

 
  eMedinewS Audio PostCard

 CKD Update

Dr KK Aggarwal Speaks on
‘Evaluation of patient with CKD’

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

World Earth Day 2011

Students of Delhi Public School, Mathura Road took part in a painting competition organized on 21st April to earmark World Earth Day.

 
Dr K K Aggarwal
 
    National News

NDM-1 in Pune: Researchers

Superbug gene detected in 20 patients

Researchers from the government-run B J Medical College (BJMC) and the National Centre for Cell Science (NCCS), in preliminary findings of a study to find the New Delhi metallobeta lactamase-1 (NDM-1) incidence in Pune, reported the strain in the city in 20 cases.

In Pune, clinical microbiologists at the government-run BJMC and Sassoon General Hospital and the NCCS collected samples of blood, urine and pus from 3,172 patients at Sassoon General Hospital in the last two months and found that 885 had gram negative bacilli (bacteria which causes a majority of infections). Of these 885 as many as 181 patients were resistant to the carbapenem family of drugs while 20 were detected with the NDM-1 gene.

NDM-1 is an enzyme that makes bacteria resistant to a broad range of beta-lactam antibiotics including antibiotics of the carbapenem family, a mainstay for treatment of antibiotic-resistant bacteria. The gene for NDM-1 is a member of a large gene family that encodes beta-lactamase enzymes called carbapenemases. Infections with these bacteria are hard to treat successfully, say microbiologists.

Data from well-known medical journals across the world document emergence of similar metallo-ß-lactamases bacteria from at least 28 countries including South Korea, Japan, China, Greece, Brazil, Australia, Italy, Portugal and Spain.

Detection of NDM-1 is important as it shows an increasing presence of drug-resistant bacteria. (Indian Express)

At India’s insistence, mental health included as non–communicable disease

India achieved a major success on the global platform by pushing for inclusion of mental health in the list of non–communicable diseases. India fought alone to get mental disorders included in the non–communicable diseases (NCDs) list at the just–concluded first Ministerial Conference on Healthy Lifestyles and Non–communicable Disease Control in Moscow. Mental health as a NCD was adopted in the Moscow Declaration on April 29 which reads: "Other NCDs such as mental disorders also significantly contribute to the global disease burden." Union Health and Family Welfare Minister Ghulam Nabi Azad led the Indian delegation to Moscow where the World Health Organisation organised the two–day conference on April 28 and 29. The principal non–communicable diseases are cardiovascular diseases, diabetes, cancers and chronic respiratory diseases, which are the leading causes of preventable morbidity and disability, and currently cause over 60 per cent of global deaths, 80 per cent of which occur in developing countries. By 2030, the NCDs are estimated to contribute to 75 per cent of global deaths. Pleading for its case, India argued that "like all non–communicable diseases, mental disorders required long term treatment and affected the quality of life."
(Source: http://www.thehindu.com/health/article1991279.ece, May 4, 2011)

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology: Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

 
    International News

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC)

WHO warns of enormous burden of chronic disease

Chronic illnesses like cancer, heart disease and diabetes have reached global epidemic proportions and now cause more deaths than all other diseases combined, the World Health Organization (WHO) said on Wednesday. In its first worldwide report on so–called non–communicable diseases, or NCDs, the United Nations health body said the conditions caused more than half of all deaths in 2008 and pose a greater threat than infectious diseases such as malaria, HIV and tuberculosis (TB) –– even in many poorer countries. NCDs, which include heart disease, lung diseases, cancer and diabetes, accounted for 36 million, or 63 percent, of the 57 million deaths worldwide in 2008. Millions of lives could be saved and much suffering avoided if people did more to avoid risk factors like smoking, drinking and being overweight, the WHO said.

(Dr Monica and Brahm Vasudev)

First autologous organ

The race is on to build the first complex organ. Describing what it will take to achieve this momentous milestone was Doris Taylor, PhD, Director of the Center for Cardiovascular Repair, Medtronic Bakken Professor of Integrative Biology and Physiology, and Professor of Medicine at the University of Minnesota, during Monday’s State–of–the–Art Address, "Rebuilding Autologous Organs: Cells, Scaffold, Organ." Rebuilding an organ involves collecting appropriate types and numbers of cells, selecting the right scaffold, decellularizing the scaffold and seeding the scaffold with the cells. When this concept works, the end result is an organ that performs its appropriate function (American Transplant Congress 2100)

Neglect, under treatment ails headache disorders

Three in every four adults, aged between 18 and 65, suffered from some form of headache disorder, including migraine and tension–type headaches, last year. The World Health Organization (WHO) says headaches are the most common health disorders across the world, but they are often neglected and under–treated. According to the world's first "Atlas of Headache Disorders 2011" brought out by the WHO, 50% suffering from headaches opt for self–medication, oblivious to bouts of pain. Neurologists examine only 10% headache patients, and the rate is even lower in Africa and South–East Asia. The report says, over 10% of those suffering frequent headaches have migraine, and 1.7– 4% of the adult population is affected by headache for 15 or more days every month. Information on the societal impact of headache exists in only 18% of countries that responded for the report. Three types of headache disorders have been underlined as most frequent — migraine, tension–type and those caused by medication–overuse. (Source: TOI, May 5, 2011)

Secondhand tobacco smoke associated with higher blood pressure

Exposure to secondhand tobacco smoke appears to be associated with higher blood pressure in boys, researchers found. Among boys ages 8 to 17, those who lived with a smoker had an average systolic blood pressure that was 1.6 mm Hg higher than in those who did not live with a smoker (P<0.001), according to Jill Baumgartner, PhD, a research fellow at the University of Minnesota’s Institute on the Environment in St. Paul.

 
    Spiritual Update

Hanuman Chalisa

Hath Bajra Aur Dhvaja Biraje
Kandhe Moonj Janeu Saaje


Meaning: "In one hand you hold the divine Vajra weapon, in the other you have the flag with your emblem. Your shoulder is decorated with the holy thread.

Spiritual Significance: It indicates the power or Pranayama and Bhakti, the two main paths for being in touch with the self. Vajra represents acquiring the power to destroy the evil and the flag with the emblem represents victory over the evil.

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient of dengue hemorrhagic fever with minor GI bleed came for evaluation.
Dr Bad: Sister, give him platelet transfusion.
Dr Good: Sister, admit him for observation.
Lesson: Platelet transfusion are not indicated for minor bleeds unless the bleeding is profuse and hematocrit is high. No blood transfusion is needed.

Make Sure

Situation: A patient of asthma worsened on aspirin.
Reaction: Oh my God! Why was history of allergy not taken?
Lesson: Make Sure that patients with asthma are not given aspirin without asking history of allergy.

 
    An Inspirational Story

(Dr Prachi Garg)

Footprints

One night a man had a dream. He dreamed he was walking along the beach with the Lord. Across the sky flashed scenes from his life. For each scene, he noticed two sets of footprints in the sand; one belonging to him, and the other to the Lord.

When the last scene of his life flashed before him he looked back at the footprints in the sand. He noticed that many times along the path of his life there was only one set of footprints. He also noticed that it happened at the very lowest and saddest times in his life.

This really bothered him and he questioned the Lord about it. "Lord, you said that once I decided to follow you, you’d walk with me all the way. But I have noticed that during the most troublesome times in my life, there is only one set of footprints. I don’t understand why when I needed you most you would leave me."

The Lord replied, "My precious, precious child, I love you and I would never leave you. During your times of trial and suffering, when you see only one set of footprints, it was then that I carried you."

 
    Pediatric Update

(Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta – The Medicity)

What is candida score?

In non–neutropenic critically ill patient

  • Multifocal colonization      1 point
  • Surgery                         1 point
  • TPN                              1 point
  • Severe sepsis                 2 points

Cut off value 2.5
Sensitivity 81%, specificity 74%
Score >2.5 – sensitive indication of proven infection (7.75 times more likely to have infection)
 

 
ijcpgroup
ijcpgroup
Docconnect
 
    Medicolegal Update

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

What is Contributory medical Negligence?

The pregnant woman delivered a child with spina bifida however she failed to attend regularly advised dates for antenatal ultrasounds that would have identified this problem. The patient was found to be 100% at fault."

  • In a medical malpractice/maloccurrence case, medical negligence is the foremost ingredient to establish the liability of damage and dereliction in provided medical care. However, it is important to establish the difference between malpractice and contributory negligence when determining liability.
  • Contributory negligence means the patient/legal heirs/parties are partially to blame for the maloccurrence or medical untoward incident. For e.g., a patient is admitted to the emergency room for treatment and they fail to inform the doctor about a pre–existing condition e.g. any allergy to a drug. The patient is guilty of contributing to the negative outcome/damage of the treatment.
  • If the victim is found to be even one percent at fault, they will be unable to recover compensation for their injuries. However, comparative negligence is used to determine degree of liability of the doctor/medical care provider.
  • Contributory negligence will determine who will receive compensation for their losses and how much they may be entitled to receive in compensation for their injuries. Pure comparative negligence means that in case of an aggrieved patient, damages will be calculated and then reduced to reflect his or her contribution to the injury.

In India, the doctors take the defense against malpractice cases when determining how the parties involved are responsible. In US, 4 categories applied in compensation cases in many of its states: Pure Comparative Negligence/Pure Contributory Negligence/Modified Comparative Negligence—50% Bar Rule and Modified Comparative Negligence—51% Bar Rule. Twenty–one states that recognize the 51% bar rule which means that the party who is less than 51% liable can seek compensation; only 11 US states use the 50% bar rule, which means that if the damaged party is less than 50% responsible, they can collect damages.

 
  Twitter of the Day

@DrKKAggarwal:OTC drug Paracetamol will not be available in concentrated infant drops. Liquid preperation will be in a 160 mg/5 mL concentration.

@PritishNandy:Osama should have been brought to justice, not killed. it would have made a serious difference.

 
    Obesity Update

Dr. Parveen Bhatia and Dr. Pulkit Nandwani

Life after Bariatric surgery

Post operative (Stage I)

Full liquids: Once clear liquids are tolerated, a full liquid diet is started. This will last for one week. Foods in this stage should be smooth (no lumps or seeds). Thicker foods such as plain or "lite" yogurt, sugar free pudding, or baby food in small frequent meals (i.e. 1/4 cup of low fat milk). are usually tolerated. Protein supplement is crucial at this point.

 
    Mind Teaser

Read this…………………

Eskimos are very good hunters, but they never hunt penguins. Why not?

Yesterday’s Mind Teaser: Which is heavier: a ton of gold or a ton of feathers?

Answer for Yesterday’s Mind Teaser: Both would weigh the same, a ton!

Correct answers received from: Dr BB Aggarwal, Dr Rajshree Aggarwal, Dr Manjesha, Dr Sunil Sekhri, Dr Doraisami Sundaram, Dr Muthumperumal Thirumalpillai, Dr Anil Bairaria, Dr Chandresh Jardosh, Dr
U Gaur, Dr Rahul Sharma.

Answer for 5th May Mind Teaser: d.
Correct answers received from: Dr Pawan Sulaniya, Dr Jainendra Upadhyay, Dr K Raju.

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Dr. GM Singh)

Bank Name

Mother decided that 10–year–old Cathy should get something ‘practical’ for her birthday."Suppose we open a savings account for you?" mother suggested. Cathy was delighted. "It’s your account, darling," mother said as they arrived at the bank, "so you fill out the application."

Cathy was doing fine until she came to the space for ‘Name of your former bank.’ After a slight hesitation, she put down ‘Piggy.’

 
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Complete blood count (CBC)

CBC measures the amount of various types of blood cells in a sample of your blood. Blood cancers like AML, ALL, CML, CLL may be detected using this test if too many or too few of a type of blood cell or abnormal cells are found.

 
    Medi Finance Update

Investment tips

An investment in bank’s fixed deposits (FDs) has low risk but minimum gain. A bank gives 6% interest with inflation of 5%; the yield is only 1%. Company FDs can be invested in only after thorough analysis of the company.

 
    Drug Update

List of Approved Drug From 01.01.2010 TO 31.8.2010

Drug Name

Indication

DCI Approval Date

HPMC 0.3% + Dextran 0.1% + Glycerin 0.2%

For the temporary relief of burning and irritation due to dryness of the eye and for use as a protection against further irritation. For the temporary relief of discomfort due to minor irritations of the eyes or to exposure to wind or sun

06/07/10

 
    IMSA Update

International Medical Science Academy (IMSA) Update

Screening for colorectal cancer

A UK randomized trial found that one–time screening by sigmoidoscopy in individuals aged 55 to 64 years decreased the incidence of colorectal cancer (CRC) and overall mortality at 11 year follow–up.

 
  Quote of the Day

(Dr GM Singh)

Talking and eloquence are not the same: to speak and to speak well are two things. A fool may talk, but a wise man speaks. Heinrich Heine

 
    Readers Response
  1. Dear Dr Aggarwal, thanks for enlightening me on the subject of visits to Badri and Kedar. I am of the opinion that a true doctor is a friend, philospher, and a spiritual guide to the patients. Yesteryear doctors like my teachers imparted lot of moral values to us rather than incentive and percentages of referral system. It is a shame to call a healthcare industry as a noble profession. In the industry you do not expect empathy, sympathy and humaneness but productivity, loss or gain and also strike and lay off. With love, Dr R Mani, Psychiatrist, Chennai.
 
    Public Forum

(Press Release for use by the newspapers)

Drugs that help reduce cholesterol may also prevent nerve damage

Drugs that help reduce cholesterol might prevent nerve damage brought on by diabetes.

Australian researchers said that in an eight–year study of statins and fibrates (atorvastatin and fenofibrate), the two classes of cholesterol medications, significantly cut the risk of developing peripheral sensory diabetic neuropathy, said Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal and President, Heart Care Foundation of India.

Neuropathy that affects half of all diabetics can cause stinging or burning sensations, tingling, pain, numbness or weakness in the hands and feet and is a major cause of amputations, one in every 50 seconds.

Statins, reduce levels of LDL, or "bad" cholesterol, thus decreasing the risk of heart attacks and stroke. Fibrates are drugs that have been shown to raise levels of good HDL cholesterol, and reduce triglycerides.

Both drugs are already highly recommended for people with type 2 diabetes to help prevent heart attacks.

Now they appear to help this type of nerve damage, as per the study done by Dr. Timothy Davis, of the University of Western Australia.

Statin drugs reduced the risk of developing peripheral neuropathy by 35 percent, and fibrates cut the risk by 48 percent.

 
    eMedinewS Special

1. eMedinewS audio PPT (This may take a few minutes to download)

2. eMedinewS audio lectures (This may take a few minutes to open)

3. eMedinewS ebooks (This may take a few minutes to open)

HCFI
Activities eBooks

  HCFI

  Playing Cards

  Dadi Ma ke Nuskhe

  Personal Cleanliness

  Mental Diseases

  Perfect Health Mela

  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein

  How to Use

  Pesticides Safely

  Towards Well Being

 
    Forthcoming Events

May 7–8, 2011, National Seminar On Stress Prevention

A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris.
Organized by: Brahma Kumaris and Heart Care Foundation of India
Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.
Timings: Saturday 7th May (2 pm onwards) and Sunday 8th May (7 am–4 pm). There will be no registration charges, limited rooms, kindly book in advance; stay and food (satvik) will be provided. Voluntary contributions welcome. For booking e–mail and SMS to Dr KK Aggarwal: 9899974439, emedinews@gmail.com, rekhapapola@gmail.com; BK Sapna: 9811796962, bksapna@hotmail.com.

Programme

Saturday 7th May 2011

2.00 pm – 4.00 pm : Registration
4.00 pm – 4.30 pm : Tea
4.30 pm – 5.30 pm : Dr K K Aggarwal
5.30 pm – 6.30 pm : Inauguration
6.30 pm – 8.00 pm : Session by Brahma Kumaris
8.00 pm – 8.30 pm : Dinner
8.30 pm – 10.00 pm : Dr K K Aggarwal

Sunday 8th May 2011
7.00 am – 8.30 am : Meditation Session
8.30 am – 9.00 am : Breakfast
9.00 am – 10.30 am : Dr K K Aggarwal
10.30 am – 11.00 am : Tea Break
11.00 am – 12.30 pm : Session by Brahma Kumaris
12.30 pm – 01.30 pm : Dr K K Aggarwal
1.30 pm – 2.00 pm : Prasad and Blessings
02.00 : Lunch

Farewell for a New Beginning

………………………………………………………………

September 30th to October 2nd, 2011, Worldcon 2011 – XVI World Congress of Cardiology, Echocardiography & Allied Imaging Techniques at The Leela Kempinski, Gurgaon (Delhi NCR), INDIA

from Sept 29, 2011: A unique & highly educative Pre–Conference CME, International & national icons in the field of cardiology & echocardiography will form the teaching faculty.
• Provisional Scientific Program at http://worldcon2011.org/day1.html
• Provisional program for Pre Congress CME at http://worldcon2011.org/Pre_Conference_CME.html
• Abstract submission at http://worldcon2011.org/scientificprogram.html
• Important dates at http://worldcon2011.org/importantDates.html
• Congress website at http://www.worldcon2011.org
• Entertainment – Kingdom of Dreams at http://worldcon2011.org/Pre_Post_Tours.html

Key Contacts
Dr. (Col.) Satish Parashar, President Organizing Committee, + 91 9810146231
Dr. Rakesh Gupta, Secretary General, + 91 9811013246

Congress Secretariat: Rajat Khurana, C–1 / 16, Ashok Vihar – Phase II, Delhi 110 052, INDIA., Phone: + 91–11–2741–9505, Fax: + 91–11–2741–5646, Mobile: + 91 9560188488, 9811911800,
Email: worldcon2011@gmail.com, jrop2001@yahoo.com, worldcon2011@in.kuoni.com

………………………………………………………………

Medifilmfest (1st International Health Film Festival in Delhi)

October 14–23, 2011, As part of 18th MTNL Perfect Health Mela 2011(Screening of films October 14–17, Jury Screening at Jamia Hamdarad University Auditorium October 18–19, award winning films at TalKatora Stadium October 19–23, 2011)
Organized by: Heart Care Foundation of India, World Fellowships of Religions, FACES, Bahudha Utkarsh Foundation and Dept of Health and Family Welfare Govt of NCT of Delhi.
Entries Invited: from feature films, Ad Films, Serials, Documentary Films, Cartoon Films, Animation Films, Educational films; films on Yoga, Siddha, Ayurveda, Unani, Homeopathy; Indigenous Healing, Films promoting the Bio–cultural Diversity, Medical Tourism, Visual and Medical Anthropology, Gender sensitization, awareness drive on socio–medical issues and health journalism. The films can be of variable durations (0–1 minute, upto 3 minutes, upto ten minutes, upto 45 minutes and upto an hour and beyond).
Separate entries are also invited for "factual mistakes in feature films concerning health". This can be in the form of 1–5 minutes footages.

Categories:Competitive category/ Non Competitive category/ Special screening
Sub Categories:

1. General: Documentaries, animation films, corporate films, Ad films, TV health programs/reports, health chat shows.

2. Special: Short instances of "depiction of wrong health messages" through the films.

Subjects: Health, disease, sanitation, yoga, spiritual health, environment, social issues, food, better living, Indigenous healing, medical tourism, visual & medical anthropology, gender sensitization, health journalism. Duration: 0–10 seconds; <30 minutes, 30–60 minutes, 1–3 hours. Language: English or Hindi, or sub tilled in English/Hindi. Fee: No fees from participants. Entry to the film show free. Format: Any format duly converted into DVD (compatible to the latest players/systems) Boarding, Lodging and Travel Expenses: Own, the participants may raise their own sponsorships

For details contact: Dr KK Aggarwal/Dr Kailash Kumar Mishra/Mr M Malik at
medifilmfestinhealthmela@gmail.com

………………………………………………………………

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    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Naveen Dang, Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta