emedinews
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  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

 

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eMedinewS Presents Audio News of the Day

Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of Workshop on Stress Management and How to be Happy and Healthy

 
    Dr KK Aggarwal on Social Media …


DR KK Aggarwal on Doctor Bhagwan Hai ya Shaitan
ASAR-Aamir Khan And Dr KK Aggarwal on Satyamev Jayate

 

 
  Editorial …

8th June 2012, Friday

To err is human

Bad people in a good system or good people in a bad system

In US alone, over 98,000 people die in any given year from medical errors that occur in hospitals. That’s more than deaths from motor vehicle accidents, breast cancer, or AIDS, three causes that receive far more public attention. Also more people die annually from medication errors than from workplace injuries.

Two large studies, one conducted in Colorado and Utah and the other in New York, found that adverse events occurred in 2.9 and 3.7% of hospitalizations, respectively. In Colorado and Utah hospitals, 6.6% of adverse events led to death, as compared with 13.6% in New York hospitals. In both of these studies, over half of these adverse events resulted from medical errors and could have been prevented.

When extrapolated to the over 33.6 million (3.3 crores) admissions to U.S. hospitals in 1997 (population 26.7 crores), the results of the study in Colorado and Utah imply that at least 44,000 Americans die each year as a result of medical errors. This translates to about 12% people getting admitted in a year.

The results of the New York Study suggest the number may be as high as 98,000. Even when using the lower estimate, deaths due to medical errors exceed the number attributable to the 8th–leading cause of death. More people die in a given year as a result of medical errors than from motor vehicle accidents (43,458), breast cancer (42,297) or AIDS (16,516).

In India, the number will be much larger. If we apply the US statistics, then for a population of 117 crores the expected number of admissions will be 13.94 crores and the number of medical errors will be 42 lakhs (3%). With 10% of these leading to deaths, the number of deaths in India due to medical errors will be 4.2 lakhs annually. This would mean 1150 deaths per day.

India has about 9.5 million (95 lakhs) deaths a year or 26000 deaths a day. In total, 4.4% deaths could be attributed to medical errors or adverse events. (0.3% of admissions)

With only a few hundred electronic channels in the country there will be enough breaking stories every minute if the media translates every mistake as negligence, which actually is not. The channels do not project the 96% of people surviving because of medical treatments.

To Err is Human. No fingers should be pointed at caring health care professionals who make honest mistakes. Of course one needs to reduce medical errors and improve patient safety through the design of a safer health system.

To err is human asserts that the problem is not bad people in health care; it is just that good people are working in bad systems that need to be made safer.

The aim should be to raise the level of patient safety. Patients themselves can influence the quality of care that they receive once they check into the hospital.

The action is required at all levels, federal, state, and local health policy makers and regulators, health professional licensing officials, hospital administrators, medical educators and students, health caregivers, health journalists, patient advocates––as well as patients themselves.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

 
  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

To err is human

Audio PostCard
 
    Photo Feature (From HCFI Photo Gallery)

World Earth Day 2012

Students of Delhi Public School presenting a beautiful skit on the occasion of the World Earth Day celebration at DPS Mathura school premises. The Event was jointly organized by Heart Care Foundation of India, Delhi Public School and Ministry of Earth Sciences.

 
Dr K K Aggarwal
 
    National News

New norms to check bacteria presence in milk

AHMEDABAD: The Food Safety Standards Authority of India (FSSAI) has made it mandatory for the food and drugs department of every state to test for harmful bacteria like e coli in milk this year. This apart, the milk producers too will have to test for bacterial content like Staph aureus and Listeria monocytogenes before pushing it into the market. The new set of standards was first introduced across the nation in August 2011. The producers will have to declare on their packets that the milk is certified E coli, Staph aureus and Listeria monocytogenes free. The FSSAI has laid down standards for 10 types of milk that include buffalo, cow, goat or sheep, mixed, standardized, re-combined, toned, double–toned, skimmed and full–cream milk. The food and drugs department of the state will be responsible for monitoring of the milk samples for bacteria content. FSSAI will also check randomly for bacteria content once in a while. (Source: TOI, Jun 5, 2012)

For comments and archives

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 Dr Monica and Brahm Vasudev)

Three crucial factors link after–hours care to primary care

Primary care practices (PCPs) can better integrate after–hours care if they have adequate payer support and incorporate features such as shared electronic health records and systematic notification procedures to maintain continuity of care, according to a new analysis. Ann S. O’Malley, MD, MPH, from the Center for Studying Health System Change in Washington, DC, and colleagues describe their findings in a qualitative analysis published online June 1 in the Journal of General Internal Medicine. (Source: Medscape)

For comments and archives

ASCO: 3–drug combo may help in AML

A three–drug combination –– including one agent no longer on the market –– appeared to benefit older patients with acute myeloid leukemia (AML), a researcher said at the annual meeting of the American Society of Clinical Oncology. The combination of hydroxyurea, azacitidine (Vidaza), and gemtuzumab ozogamicin (Mylotarg) induced remission in nearly half of a group of patients ages 60 through 69, according to Sucha Nand, MD, of Loyola University Medical Center in Maywood, Ill. (Source: Medpage Today)

For comments and archives

Therapy by phone good against depression

Receiving cognitive behavioral therapy (CBT) over the phone is just as effective in primary care patients as when counseling is done face–to–face, and phone CBT may keep patients in treatment longer, researchers found. (Source: Medpage Today)

For comments and archives

Subclinical hypothyroidism increases gestational diabetes risk

Higher thyrotropin levels are associated with an increased risk of developing gestational diabetes, according to a report in the May 2012 Obstetrics & Gynecology. (Source: Medscape)

For comments and archives

 
    Prayer Meeting

Dr. Vidya Prakash Sood (13/04/1936 – 03/03/2012)

A prayer meeting will be held to pay homage to the departed soul of Dr VP Sood (Issue Editor – Asian Journal of Ear, Nose and Throat) who passed away peacefully on March 3, 2012 in USA.

Date: Sunday 10th June, 2012
Venue: Chinmaya Mission (Auditorium), 89, Lodhi Road, New Delhi.
Time: 11 AM – 12 Noon

(IJCP and eMedinews)

 
   Twitter of the Day

@DrKKAggarwal: on MEDITATION–Delhi Aaj Tak: http://youtu.be/yB85566EKVM via @youtube

@DeepakChopra: Just as a seed grows & unfolds into a glorious blossom, we grow & unfold in awareness. Let it be!

 
    Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Lust was the common reason for occurrence of Ramayana and Mahabharata

In Ramayana, Rama symbolizes with soul, Lakshman with determined mind and Sita with physical body. Dashratha represents the one who has conquered the 10 senses.

For comments and archives

 
    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What are the symptoms of hydrosalpinx?

Some women with hydrosalpinx may have constant or frequent pain in their lower belly or abdomen. A vaginal discharge can also be associated with this condition.

For comments and archives

 
    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Component Selection

Upon receipt of the blood order, the transfusion service personnel determine whether pretransfusion testing is required. Compatibility testing must be performed for transfusion of whole blood and all red cell components. Compatibility testing is not required for platelet and plasma components, but most facilities requires that the recipient’s ABO and Rh types be known before components are selected for issue.

For comments and archives

 
   An Inspirational Story

(Ms Ritu Sinha)

Portrait of a Friend

I can’t give solutions to all of life’s problems, doubts, or fears. But I can listen to you, and together we can seek answers. I can’t change your past with all its heartache and pain, or the future with its untold stories. But I can be there now when you need me to care.

I can’t keep your feet from stumbling. I can only offer my hand that you may grasp it and not fall. Your joys, triumphs, successes, and happiness’s are not mine; yet I can share in your laughter and joy. Your decisions in life are not mine to make, or to judge; I can only support you, encourage you, and help you when you ask.

I can’t give you boundaries which I have determined for you, but I can give you the room to change, room to grow, room to be yourself. I can’t keep your heart from breaking and hurting, but I can cry with you and help you pick up the pieces and put them back in place.

I can’t tell you who you are. I can only love you and be your friend.

For comments and archives

 
   Cardiology eMedinewS

Score predicts risk for death in heart failure Read More

Exercise worsens a CV risk factor in 10% of people Read More

 
   Pediatric eMedinewS

Oral drug equals subcutaneous in kids’ arthritis Read More

Child aggression guidelines provide much needed direction Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: An adolescent came with prepubertal gynecomastia of more than six months duration.
Dr Bad: It’s normal.
Dr Good: Its persistent pre pubertal gynecomastia.
Lesson: If the patient is an adolescent and has a normal general physical and genital examination, then it is quite likely that he has pubertal gynecomastia (seen in 25% cases). Re–evaluation at 6– monthly intervals will show whether the condition is persistent or not; improvement supports the initial impression of a pubertal cause.

For comments and archives

Make Sure

Situation: An adult undergoing bronchoscopic biopsy developed infective endocarditis.
Reaction: Oh my God! Why was IE prophylaxis not given?
Lesson: Make sure, that all procedures of the respiratory tract that involve incision or biopsy of the respiratory mucosa include IE prophylaxis.

For comments and archives

 
    Legal Question of the day

(Prof. M C Gupta, Advocate & Medico–legal Consultant)

Q. What is the Hippocratic Oath and what is its relevance and importance? Is it administered to Indian Doctors? Is it binding upon us?

Ans.

  1. The Hippocratic Oath is of no importance in India except at historical level. Those who talk about the need for doctors to abide by the Hippocratic oath are probably ignorant of the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002, commonly referred, in short, as "Code of Ethics Regulations, 2002", made by the Medical Council of India under section 20A read with section 33(m) of the Indian Medical Council Act, 1956 (102 of 1956), with the previous approval of the Central Government and duly published in Part III, Section 4 of the Gazette of India, dated 6th April,2002).
  2. The Supreme Court has observed about the Hippocratic Oath in State of Punjab versus Shiv Ram & Ors., decided on 25–8–2005, as follows:
    1. Medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. The oldest expression of this basic principle comes from Hippocrates, an early Greek Physician, born in 460 B.C. who came to be known as the "Father of Medicine" and had devoted his entire life to the advancement of medical science. He formulated a code of conduct in the form of the Hippocratic Oath, as he realized that knowledge and skill were not enough for a physician without a code of standards and ideals. He coined an oath of integrity for physicians, a code of standards and ideals to which they must swear to adhere in the practice of their profession.
    2. The oath is as follows:

      "I swear by Apollo the physician, by Esculapeus, Hygeia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgement, the following Oath.

      To consider dear to me as my parents him who taught me this art; to live in common with him and if necessary to share my goods with him; to look upon his children as my own brothers, to teach them this art if they so desire without fee or written promise; to impart to my sons and the sons of the master who taught me and the disciples who have enrolled themselves and have agreed to the rules of the profession, but to these alone the precepts and the instruction. I will prescribe regimens for the good of my patients according to my ability and my judgement and never do harm to anyone. To please no one will I prescribe a deadly drug nor give advice which may cause his death.

      Nor will I give a woman a pessary to procure abortion. But I will preserve the purity of my life and my art. I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art. In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves. All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal. If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot."
    3. Many versions of Hippocratic Oath are prevalent. "Light From Many Lamps" a book edited by Lilian Eichler Watson contains a little different phraseology of that oath but certainly a beautiful commentary on the significance of the Hippocratic Oath. We would like to reproduce the oath and the commentary hereunder: (pages 181–182);

      THE OATH––

      "I do solemnly swear by that which I hold most sacred:

      That I will be loyal to the profession of medicine and just and generous to its members;

      That I will lead my life and practice my art in uprightness and honour;

      That into whatsoever house I shall enter, it shall be for the good of the sick to the utmost of my power, I holding myself aloof from wrong, from corruption, and from the temptation of others to vice;

      That I will exercise my art solely for the cure of my patients, and will give no drug, perform no operation for a criminal purpose, even if solicited, far less suggest it;

      That whatsoever I shall see or hear of the lives of men which is not fitting to be spoken, I will keep inviolably secret.

      These things I do promise, and in proportion as I am faithful to this my oath may happiness and good repute be ever mine – the opposite if I shall be forsworn."

      The Commentary

      The Hippocratic Collection, containing the best of the ancient Greek medical writings, was put together by Aristotle and has survived through the centuries. The "Hippocratic Oath" is one of the last and most inspiring passages in this Collection. There are a number of versions of the famous Oath; but the form given here is the one commonly used today; and is an adaptation of a translation from the original Greek.
    4. Many people argue that the original Hippocratic Oath is inappropriate in a society that has seen drastic socioeconomic, political and moral changes, since the time of Hippocrates. Certain parts of the original oath such as teaching the master’s sons the secrets of medicine without fees and the promise not to bring a knife to another’s body but to leave it to 'practitioners of the craft' have been rendered obsolete as the modernisation of education has led to the teaching of medical science in institutions of higher learning, and specialisation in medicine has led to physicians who specialise in a variety of fields including surgery. Similarly, the legalisation of abortion and physician–assisted suicide in certain parts of the world, has made it awkward for some medical practitioners there to carry on in the tradition of the original oath.
    5. This has led to the modification of the oath to something better suited for our times. One of the most widely used versions is The Declaration of Geneva which was adopted by the General Assembly of the World Medical Association at Geneva in 1948. Written with the medical crimes committed in Nazi Germany in view, it is a ‘declaration of physicians’ dedication to the humanitarian goals of medicine.’ It is also perhaps the only one to mention treating people equally, without regard as to race, religion, social standing and political affiliations:

      "I solemnly pledge myself to the service of humanity. I will give to my teachers the respect and gratitude which is their due. I will practice my profession with conscience and dignity. The health of my patient will be my first consideration. I will respect the secrets which are confided in me. I will maintain by all means in my power the honour and noble traditions of the medical profession. My colleagues will be my brothers and sisters. I will not permit consideration of religion, nationality, race or social standing to intervene between my duty and my patient. I will maintain the utmost respect for human life even under threat. I will not use my medical knowledge contrary to the laws of humanity. I make these promises solemnly, freely and upon my honour."
  3. As per Indian law and conventions and practice, as follows the Hippocratic Oath is not administered to doctors now–a–days. Hence the question of abiding by it does not arise.
  4. The oath as administered to doctors in India at the time of registration with the medical council is given in Appendix 1 to the 2002 regulations, which is reproduced below:

"APPENDIX – 1

DECLARATION

At the time of registration, each applicant shall be given a copy of the following declaration by the Registrar concerned and the applicant shall read and agree to abide by the same:

  1. I solemnly pledge myself to consecrate my life to service of humanity.
  2. Even under threat, I will not use my medical knowledge contrary to the laws of Humanity.
  3. I will maintain the utmost respect for human life from the time of conception.
  4. I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient.
  5. I will practice my profession with conscience and dignity.
  6. The health of my patient will be my first consideration.
  7. I will respect the secrets which are confined in me.
  8. I will give to my teachers the respect and gratitude which is their due.
  9. I will maintain by all means in my power, the honour and noble traditions of medical profession.
  10. I will treat my colleagues with all respect and dignity.
  11. I shall abide by the code of medical ethics as enunciated in the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations 2002.

    I make these promises solemnly, freely and upon my honour.

    Signature………………………………………………

    Name……………………………………………………

    Place……………………………………………………Address………………………………………………………

    Date………………………".

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  Quote of the Day

(Dr GM Singh)

We are so vain that we even care for the opinion of those we don’t care for. Marie Von Ebner–Eschenbach

 
    Lab Update

(Dr Navin Dang and Dr Arpan Gandhi)

A semen analysis is recommended following a vasectomy and when a physician thinks that the patient might have a fertility problem.

 
    Mind Teaser

Read this…………………

The nurse is aware the early indicator of hypoxia in the unconscious client is:

a. Cyanosis
b. Increased respirations
c. Hypertension
d. Restlessness

Yesterday’s Mind Teaser: Nurse Linda is preparing a client with multiple sclerosis for discharge from the hospital to home. Which of the following instruction is most appropriate?

a. Practice using the mechanical aids that you will need when future disabilities arise.
b. Follow good health habits to change the course of the disease.
c. Keep active, use stress reduction strategies, and avoid fatigue.
d. You will need to accept the necessity for a quiet and inactive lifestyle.

Answer for yesterday’s Mind Teaser: c. Hypertension

Correct answers received from: Dr Sushma Chawla, Dr Kanta Jain, Dr Chandresh Jardosh, Dr Jainendra Upadhyay, Muthumperumal Thirumalpillai, Raju Kuppusamy, Raju Kuppusamy, Dr Avtar Krishan, Dr Valluri Ramarao, Dr U Gaur, Anil Bairaria, Dr shashi saini.

Answer for 6th June Mind Teaser: Pupil size and papillary response
Correct answers received from: YJ Vasavada.

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Dr GM Singh)

Everything happens for a Reason, The hard part is finding the Reason.

 
    Medicolegal Update

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

Inevitable medical accident in healthcare delivery

An inevitable medical accident or "unavoidable medical occurrence" in health care delivery is that which could not be possibly prevented by the exercise of ordinary medical/surgical/paramedics and nursing care, caution and skill.

In medical profession, it means any medical/surgical accident that results in damage/injury/disability or death that was not avoidable by any such precautions as a reasonable qualified medical professional or hospital doing such an act then, "could be expected to take." A general/reasonable medical professional is not credited by the law with exact perfection of judgment. As observed by Greene M.R., an accident is "one out of the ordinary course of things, something so unusual as not to be looked for by a person of ordinary prudence.

During the course of treatment, an accident occurs which could not be avoided by any ordinary skill or care on the part of the doctor administering the treatment, the accident is said to be inevitable accident. The term ‘inevitable accident ‘has been defined as an accident not avoidable by any such precautions as a reasonable man can be expected to take’. In the case of (Gerber V.pines 21) the plaintiff claimed damages against the defendant alleging that during the administration of a hypodermic injection the defendant left part of a broken needle in her buttock. The defendant denied liability and said that the breakage of the needle was due to a sudden muscular spasm and that no skill or care on his part could have prevented the fracture of the needle or the retention of the broken part in the plaintiff‘s body. The judge found that there had been no negligence on the part of the defendant in so far as the fracture of the needle was concerned, he found however, that had been a breach of duty on the part of defendant in not informing the plaintiff or her husband that the needle had fractured and that a piece of it was still in her body. For this the judge awarded the plaintiff a small sum by way of damages.

In cases of inevitable medical accident, a very positive/sympathetic/grief sharing approach should be taken by the doctor towards his/her patient and all logistic medical/surgical services must be extended/provided to the patient without cost by the doctor/hospital to restore/enhance faith and trust of this profession since the service which medical professionals render to the people/society and nation is the noblest one. The patient must also be told that inevitable medical accident was due to the elementary forces of nature unconnected with the hospital/doctor and they are there to share with the patient’s suffering.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Carotid neck ultrasound the only way to check regression of heart blockages

In people with type 2 diabetes, intensive drug therapy can significantly lower bad LDL cholesterol and reduce the thickness of the neck carotid arteries supplying oxygen to the brain, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

Quoting a study published in Journal of the American College of Cardiology, Dr Aggarwal said that every effort should be made to bring down the bad LDL cholesterol to less than 80mg/dL.

The Stop Atherosclerosis in Native Diabetics Study (SANDS) trial tested the value of aggressively lowering bad LDL cholesterol to 70 mg/dL or lower and non HDL cholesterol to 100 mg/dL.

The standard treatment group had standard goals (100 mg/dL for LDL and less than 130 mg/dL for non HDL Cholesterol).

The study involved 427 type 2 diabetic Native Americans who were aged 40 or older and who had no history of heart attack or other heart–related event. There were 204 people in the standard treatment group and 223 in the aggressive treatment group. Ultrasound tests showed that neck artery thickness got worse, or progressed, in the standard treatment group and regressed in the aggressive treatment groups.

The test called intima media thickness of the carotids is the only cost–effective test to know whether or not the heart blockages are shrinking or progressing as the thickening in carotids goes hand in hand with the thickening in the heart arteries.

 
    Letter to Editor

Dear Editor, I appreciate the concern of Dr. Tara Saxena from Rewari and others, and would like to say that the presence of a few black sheep doesn’t mean that the whole society is dishonest; I know scores of doctors who have and are rendering selfless service to humanity across the country, and that a picture is never complete until its other side is also evaluated. Dr. Narendra Kumar, New Delhi

 
    Readers Response
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    Forthcoming Events
Dr K K Aggarwal

4th Asia Pacific Vascular Intervention Course (APVIC-IV)

Date: June 8-10-2012

THE OBEROI, Dr. Zakir Hussain Marg, New Delhi
In association with 'International Society of Endovascular Specialists' 'Vascular Society of India' 'Society of Cardiovascular Angiography & Interventions'

IYCNCON 2012

All are cordially invited for the 2nd National Conference of IYCF Chapter of IAP. This conference is organized by: IYCF Chapter, MOH&FW GOI, MOWCD GOI, WHO, UNICEF, IMLEA, SDHE Trust.
The theme of the conference is: "Proper Nutrition: Defeat Malnutrition – Investing in the Future"
Venue: India Habitat Centre, Lodhi Road, New Delhi – 110 003.
Date: 5th Aug 2012
For further details contact:
Conference Secretariat: Dr. Balraj Yadav, E–Mail: drbalraj@ymail.com, drvisheshkumar@gmail.com,
Ph: +91.124.2223836, Mobile: +91.9811108230

Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001
http://www.heartcarefoundation.org

A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions

 
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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 Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta, Dr Usha K Baveja