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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

 
  Editorial …

10th May 2012, Thursday

Excerpts from a CME talk by Dr KK Aggarwal held at Moolchand Medcity, New Delhi

  • Parasympathetic dysautonomia can occur in hypertension.
  • Hypertension as a disease is not mentioned in Ayurveda.
  • It is a lifestyle disorder of new era.
  • Stress cannot cause hypertension. It can only trigger it.
  • Hypertension = stroke volume × heart rate × peripheral resistance.
  • Ankle brachial index (ABI) > 1.4 indicates arteriosclerosis of leg arteries (calcification/hardening)
  • Pseudohypertension is when blood pressure measurements are elevated but the BP is actually normal. As people get older, the walls of the arteries sometimes get very thick, and calcium may be deposited in the arterial wall. This makes the arteries very stiff and difficult to compress. One can suspect pseudohypertension in cases where: The blood pressure reading is very high over time, but the patient has no signs of organ damage or other complications and attempting to treat the measured high blood pressure causes symptoms of low blood pressure (dizziness, confusion, decreased urine output). Osler maneuver can be used to diagnose them. This is done by assessing the palpability of the pulseless radial or brachial artery distal to a point of occlusion of the artery manually or by cuff pressure. When the artery remains palpable (despite being pulseless), the patient is described as "Osler–positive." In contrast, when the artery either collapses and becomes impalpable, the patient is "Osler–negative.
  • Measuring intima media thickness (IMT) is a reliable test for calculating the vascular age of a patient.
  • Endothelial dysfunction is linked to presence of microalbumin in the urine and exudates in the eye.
  • Flow mediated dilatation of brachial artery is the test for endothelial dysfunction. Occlude the brachial artery by inflating BP measuring cuff above 170 mm of mercury for 5 minutes. Post release, the artery should dilate > 10%; if not, this is a sign of endothelial dysfunction.
  • A/E ratio on echo defines the cardiac age of a person.
  • Smoking, stress, hypercholesterolemia, alcohol alone cannot cause hypertension but they are triggering factors.
  • Migraine is a vascular disease and is related to hypertension. One should check for presence of endothelial dysfunction.
  • In Ayurveda, only 2.5 gram of salt is advisable, that too black/rock salt. In allopathy, it is 6 gram. However, we take on an average 18 gram of salt per day. Restriction of salt intake is highly recommended to control hypertension.
  • Increase intake of potassium improves endothelial dysfunction. It is present in good amount among oranges, lemon, mausami (sweet lime), bananas and amla (Indian gooseberry). One should consume these in sufficient quantities.
  • Use of refined carbohydrates increases C–reactive protein in the body. It is a cause of endothelial inflammation.
  • Oxygen liberates free radicals, which damages the vascular walls leading to endothelial dysfunction. To neutralize free radicals, free radical scavengers are required. One of them is superoxide dismutase (SOD).
  • Along with dietary food (amla), love and compassion also increases SOD in the body thus controlling hypertension. To a large extent, refined carbohydrates are responsible for hypertension.
  • Around 40% of anti hypertensive medicines can be reduced at the end of 1 week by reducing the diet to half with no refined carbohydrates taken during this period.

(Compiled by Dr OP Jain and Dr Pawan Gupta)

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

Excerpts from a CME talk by Dr KK Aggarwal held at Moolchand Medcity, New Delhi

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

World Earth Day organized at DPS Mathura Road

World Earth Day was celebrated by Heart Care Foundation of India jointly with Delhi Public School

 
Dr K K Aggarwal
 
    National News

Finally, tuberculosis declared a notifiable disease

NEW DELHI: India has finally declared tuberculosis (TB) a notifiable disease. The announcement signifies that with immediate effect, all private doctors, caregivers and clinics treating a patient suffering from TB will have to report every single case of the air–borne disease to the government. The notification was sent to all states on May 7. Till now, doctors in the private sector were free to treat TB patients, and weren’t required to keep a record. The notification said, "In order to ensure proper TB diagnosis and case management, reduce TB transmission and fight emergence of drug resistant TB, it is essential to have complete information of all TB cases. Therefore the healthcare providers shall notify every TB case to local authorities – district health officer/chief medical officer of a district and municipal health officer of a municipal corporation, every month." (Source: TOI, May 9, 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)

HCV independently raises risk of premature death in AIDS patients

Despite competing risks, chronic hepatitis C virus (HCV) infection is independently associated with a 50% increase in mortality among patients with a diagnosis of AIDS, new research suggests. "Effective HCV treatment may benefit HIV/HCV co–infected patients with AIDS," according to a report online April 24 in Clinical Infectious Diseases by Dr. Andrea D. Branch at Mount Sinai School of Medicine in New York City and colleagues. (Source: Medscape)

For comments and archives

EUROACTION PLUS: Varenicline aids in smoking cessation

A nurse–led, family–based preventive cardiology program in high–risk patients that included the use of varenicline (Chantix, Pfizer) cut smoking rates in half when compared with usual care, according to the results of a new study. In addition, patients also improved their diet, exercised more, and did not gain any weight when treated with varenicline on top of usual care. The study, known as EUROACTION PLUS, is a follow–up to a similar study known as EUROACTION, with the exception that the patients from the 20 general practices enrolled in the newest study had the option of receiving varenicline at the discretion of the treating physician. In all, 95% of those in the intervention arm received the smoking–cessation medication. (Source: Medscape)

For comments and archives

New earlier, noninvasive paternity test developed

Experts say the test has important medical, legal applications – Researchers say they’ve found a way to identify the father of a baby as early as the eighth week of pregnancy. The new method, reported in the New England Journal of Medicine, uses fetal DNA isolated from the mother's blood. (Source: Medscape)

For comments and archives

U.S. ranks 131st in preterm births

Preterm birth rates are higher in the United States than in 130 other countries, including many poorer nations, according to a new report from the March of Dimes Foundation, the World Health Organization, and other leading health agencies. The report, which provides the first–ever estimates of preterm birth rates by country, ranks the U.S. 131st out of 184 countries — ranking between the Congo and Nigeria — with a preterm birth rate of 12.0 per 100 live births. Each year in the U.S., nearly half a million babies are born before 37 weeks’ gestation. The March of Dimes has set a U.S. goal of a 9.6% preterm birth rate by 2020. (Source: Medscape)

For comments and archives

 
    Twitter of the Day

@DrKKAggarwal: How to Avoid Craving When Leaving Smoking?
http://blog.kkaggarwal.com/2012/05/02/how–to–avoid–craving–when–leaving–smoking/

@DeepakChopra: Karma: What you give is what you get

 
    Spiritual Update

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

Rama Vs Krishna

I happened to listen to Shri Vijay Kaushal who was narrating Rama Katha at Sirifort Auditorium. He was trying to differentiate between Lord Rama and Lord Krishna. He said that Rama was blessed with 12 Kalaas and Krishna with 16 Kalaas (arts).

For comments and archives

 
    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

How do the androgens effect our hair growth?

Androgens are present in both men and women, but men have much higher levels. In men, androgens are produced primarily by the testes and the adrenal glands. In women, androgens are produced by the ovaries and the adrenal glands. To some degree, estrogen reduces the effect of androgens in women. If your hair follicles are sensitive, androgens may cause some vellus hairs to change to terminal hairs and cause the terminal hairs to grow faster and thicker. Once a vellus hair has changed to a terminal hair, it usually does not change back. Androgens increase sebum production, which results in oily skin and acne. Excess androgens can cause irregular or absent ovulation and menstruation. Extremely high androgen levels, such as when a tumor is present, may cause male–like balding, deepening of the voice, increased muscle mass, enlargement of the clitoris and decreased breast size

For comments and archives

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

(Dr. Sujay Shad, Senior Consultant Cardiac Surgeon and Director of Heart–Lung Transplantation, Sir Ganga Ram Hospital, Delhi)

Heart: Failure, Therapies & Transplantation

When humanity must take over from medicine (Part 3)

Option 2: The surgical miracle. A heart suddenly is donated which magically matches with the very sick patient. The patient is on a ventilator, not yet septic. His renal functions have deteriorated completely, but nothing that shall not recover once the heart recovers.

Mr. Dass is transplanted. The heart functions beautifully, the lungs get offloaded and start excellent oxygen exchange within a few hours of the transplant. The patient’s circulatory overload due to a combination of hear and kidney failure needs urgent treatment. A large volume hemofiltration is performed by the Heart–Lung Machine during the transplant procedure. A day later a slow trickle of 5mls of urine per hour starts, which becomes 20 and then 100 ml hour.

Patient is well and home in all the health that he never enjoyed.

Such miracles do happen and often do, however, surgery is not the art of miracles. It is an art of hard, grueling scientific work. Breaking backs when they can take no further loads, giving blood transfusions when blood bank is going dry, treating hypotension when the whole vascular tree is paralyzed, feeding patients when they do not want food, turning them about when a bed sore has to be prevented and so on and so forth.

(To be contd.)

For comments and archives

 
    An Inspirational Story

(Ms Ritu Sinha)

The only constant in LIFE is CHANGE…

There once lived a great mathematician in a village outside Ujjain. He was often called by the local king to advice on matters related to the economy. His reputation had spread as far as Taxila in the North and Kanchi in the South. So it hurt him very much when the village headman told him, "You may be a great mathematician who advises the king on economic matters but your son does not know the value of gold or silver. The mathematician called his son and asked, "What is more valuable – gold or silver?" "Gold," said the son. "That is correct. Why is it then that the village headman makes fun of you, claims you do not know the value of gold or silver? He teases me every day. He mocks me before other village elders as a father who neglects his son. This hurts me. I feel everyone in the village is laughing behind my back because you do not know what is more valuable, gold or silver. Explain this to me, son."

So the son of the mathematician told his father the reason why the village headman carried this impression. "Every day on my way to school, the village headman calls me to his house. There, in front of all village elders, he holds out a silver coin in one hand and a gold coin in other. He asks me to pick up the more valuable coin. I pick the silver coin. He laughs, the elders jeer, and everyone makes fun of me. And then I go to school. This happens every day. That is why they tell you I do not know the value of gold or silver."

The father was confused. His son knew the value of gold and silver, and yet when asked to choose between a gold coin and silver coin always picked the silver coin. "Why don’t you pick up the gold coin?" he asked. In response, the son took the father to his room and showed him a box. In the box were at least a hundred silver coins. Turning to his father, he said, "The day I pick up the gold coin the game will stop. They will stop having fun and I will stop making money."

The bottom line is… Sometimes in life, we have to play the fool’s role because our seniors and our peers, and sometimes even our juniors like it. That does not mean we lose in the game of life. It just means allowing others to win in one arena of the game, while we win in the other arena of the game. We have to choose which arena matters to us and which arenas do not.

For comments and archives

 
    Cardiology eMedinewS

Omega–3–Rich Diet May Protect Against Alzheimer’s Disease Read More

Two Drugs Better Than 1 For Children With Diabetes Read More

Endovascular Stents Help Some Babies with Hypoplastic Left Heart Syndrome Read More

 
    Pediatric eMedinewS

Mandates Boost Vaccine Coverage In ‘Tweens’ Read More

Babies Conceived With Help More Prone To Birth Defects Read More

Long Pregnancy Tied To Kids’ Behavior Issues Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: An asymptomatic patient with no obvious underlying cardiac disease shows ventricular premature contractions (VPCs).
Dr Bad: Anti–arrhythmics should be given.
Dr Good: No treatment is needed.
Lesson: In the absence of cardiac disease, isolated asymptomatic VPCs regardless of configuration and frequency need no treatment.

For comments and archives

Make Sure

Situation: A patient with fever developed melena.
Reaction: Oh my God! why was platelet count not done?
Lesson: Make sure in all patients with fever platelet counts are done.

For comments and archives

 
    Legal Question of the day

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

Q. The clinic of a doctor colleague of mine is registered as an ultrasound centre under the PNDT Act. He also has an IVF lab. The civil surgeon wants him to get his lab registered under the PNDT Act. Is there such a requirement?

Ans.

  • For a centre to be registered under the PNDT Act, Form A has to be filled, which is titled—"Form of application for registration or renewal of registration of a genetic counselling centre/genetic laboratory/genetic clinic/ultrasound clinic/imaging centre"
  • Your friend would do well to remember that the requirement for registration depends not on the name or title of the centre but upon what is done there. He needs to check whether his centre is covered by the definition of a "genetic counselling centre/genetic laboratory/genetic clinic" as defined in subsections (c), (d) and (e) of section 2 of the Act, reproduced below:
    • "Genetic Counseling Centre" means an institute, hospital, nursing home or any place, by whatever name called, which provides for genetic counselling to patients;
    • "Genetic Clinic" means a clinic, institute, hospital, nursing home or any place, by whatever name called, which is used for conducting pre–natal diagnostic procedures. Explanation–For the purposes of this clause, ‘Genetic Clinic’ includes a vehicle, where ultrasound machine or imaging machine or scanner or other equipment capable of determining sex of the foetus or a portable equipment which has the potential for detection of sex during pregnancy or selection of sex before conception, is used.
    • "Genetic Laboratory" means a laboratory and includes a place where facilities are provided for conducting analysis or tests of samples received from Genetic Clinic for pre-natal diagnostic test.

      Explanation– For the purposes of this clause, ‘Genetic Laboratory’ includes a place where ultrasound machine or imaging machine or scanner or other equipment capable of determining sex of the foetus or a portable equipment which has the potential for detection of sex during pregnancy or selection of sex before conception, is used."
  • Whether your friend’s "IVF lab" needs to be registered under the PNDT Act will depend upon what procedures or techniques are carried out in the lab.
  • It would be useful to review the procedures described in subsections (i), (j) and (k) of section 2 of the PNDT Act. These are reproduced below:
    • "pre–natal diagnostic procedures" means all gynaecological or obstetrical or medical procedures such as ultrasonography, foetoscopy, taking or removing samples of amniotic fluid, chorionic villi, blood or any other tissue or fluid of a man, or of a woman for being sent to a Genetic Laboratory or Genetic Clinic for conducting any type of analysis or pre–natal diagnostic tests for selection of sex before or after conception;
    • "pre–natal diagnostic techniques" includes all pre–natal diagnostic procedures and pre–natal diagnostic tests;
    • "pre–natal diagnostic test" means ultrasonography or any test or analysis of amniotic fluid, chorionic villi, blood or any tissue or fluid of a pregnant woman or conceptus conducted to detect genetic or metabolic disorders or chromosomal abnormalities or congenital anomalies or haemoglobinopathies or sex-linked diseases;
  • It is for your friend to determine whether his lab is covered by any of the above definitions. If he is covered, he will need to be registered. If he is not covered, there is no question of registration.

For comments and archives

 
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  Quote of the Day

(Dr GM Singh)

All human power is a compound of time and patience. Honor de Balzac

 
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Fructosamine

  • To help monitor your over time, especially if it is not possible to monitor using the A1c test
  • To help determine the effectiveness of changes to your diabetic treatment plan
 
  Microbial World: The Good and the Bad They Do

(Dr Usha K Baveja, Prof. and Senior Consultant Microbiology, Medanta – The Medicity, Gurgaon)

Post exposure prophylaxis for Hepatitis B and C viruses

In case the HCW has a needle stick or any other kind of accidental exposure to HBV positive blood or body fluid, manage the local site as already described and proceed to give PEP against HBV as detailed below. Normally the HCW should have been vaccinated against HBV and should have the protective titer of anti HBs antibody.

Treatment according to the status of source material

Exposed person

HBsAg positive

HBsAg negative

Source not tested or unknown

Unvaccinated

HBIG × 1*, Initiate HBV vaccine

Initiate HBV vaccine

Initiate HBV vaccine

Previously vaccinated, known responder

Test exposed HCW for anti HBsAb, if adequate (>10 units/mL; preferably around 100 units/mL), no treatment.

If inadequate (<10 units), HBV vaccine booster dose is given

No treatment

No treatment

If inadequate (<10 units), HBV vaccine booster dose is given

Previously vaccinated, known non–responder

HBIG × 2 or

HBIG × 1 plus 1 dose HBV vaccine

No treatment

If source high risk for Hepatitis B, manage as if source is positive

Response unknown

Test exposed HCW for anti HBs Ab, if adequate as above, no treatment required, if inadequate HBIG × 1*, initiate HBV vaccine

No treatment

Test exposed for HBsAb, if adequate, no treatment. If inadequate, HB vaccine booster

*HBIG dose 0.06 ml/kg IM

 
    Mind Teaser

Read this…………………

Nurse Maureen is aware that a client who has been diagnosed with chronic renal failure recognizes an adequate amount of high–biologic–value protein when the food the client selected from the menu was:

a. Raw carrots
b. Apple juice
c. Whole wheat bread
d. Cottage cheese

Yesterday’s Mind Teaser: Nurse Maureen knows that the positive diagnosis for HIV infection is made based on which of the following:

a. A history of high risk sexual behaviors.
b. Positive ELISA and western blot tests
c. Identification of an associated opportunistic infection
d. Evidence of extreme weight loss and high fever

Answer for Yesterday’s Mind Teaser: b. Positive ELISA and western blot tests

Correct answers received from: Dr Sushma Chawla, Rajiv Kohli, Dr Hitendrasinh Thakor, Yogindra Vasavada, Dr BB Aggarwal, Dr Sanjana Sikri, Dr Chandresh Jardosh, Raju Kuppusamy, Dr Avtar Krishan,
Dr Gopal M Shinde, Dr LC Dhoka, Dr Jainendra Upadhyay.

Answer for 8th May Mind Teaser: A. The blood must be stopped at once, and then normal saline should be infused to keep the line patent and maintain blood volume

Correct answers received from:
Dr Shivam

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Dr GM Singh)

Law of Cat Composition

A cat is composed of Matter + Anti–Matter + It Doesn’t Matter.

 
    Newly Issued Alcohol Warnings

(Dr GM Singh)

The American Board of Health has proposed that warning signs be placed on all alcohol bottles to tip off drinkers about the possible perils of drinking a pint or two of any alcoholic beverage.

  1. WARNING: Consumption of alcohol may cause you to wake up with a breath that could knock a buzzard off a wreaking dead animal that is one hundred yards away.
  2. WARNING: Consumption of alcohol is a major factor in dancing like an idiot.
  3. WARNING: Consumption of alcohol may cause you to tell the same boring story over and over again until your friends want to assault you
  4. WARNING: Consumption of alcohol may cause you to thay shings like thish.
  5. WARNING: Consumption of alcohol may cause you to tell the boss what you really think of him.
  6. WARNING: Consumption of alcohol is the leading cause of inexplicable rug burn on the forehead.
  7. WARNING: Consumption of alcohol may create the illusion that you are tougher, handsomer and smarter than some really, really big guy named Psycho Bob.
 
    Medicolegal Update

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

Private Doctors can treat and report in MLC Cases: High Court

MLCs has been extended to the private doctors also

The foremost legal and ethical duty of doctor is to attend and treat the injuries and health of the patient/person produced before him. His primary effort should always be to save the life of the patient and then inform the police; but, all the injuries/findings observed by him must be documented clearly in medicolegal cases (MLCs). This means that the duty of the doctor to provide medical aid, even in MLCs, has been extended to the private doctors and has also authenticated in many government orders and honorable courts.

The private doctors should not hesitate to entertain MLC. But, after the completion of medical examination/treatment a medicolegal report should be prepared as early as possible to avoid afterthought allegation. They should be prepared in duplicate, preferably with a ballpoint pen, in a clear and legible hand. Cutting/overwriting, etc. should be avoided as much as possible and all corrections should be properly initialed. Abbreviations of any sort should be avoided. A medicolegal register should be maintained in the casualty of every hospital and details of all MLCs should be entered in this register, including the time and date of examination and the name of the doctor who is dealing with the case. This would be of immense help for future reference, when the patient through the court/the police, requests for a copy of the legal report.

(Ref: Pattipati Venkaiah Vs State of Andhra Pradesh 1985)

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Natural fast food is good for health

"Natural fast food is good for health", said Padmashri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwa, President Heart Care Foundation of India while interacting with public in a programme organized by Zee Manthan.

Dr. Aggarwal said that natural fast food consists of eating fruits, vegetables, milk products, sprouts and sattu. On the contrary, unnatural fast food, also called as junk food, is bad for the heart’s health as it consists of items like refined bad carbohydrates and either animal bad fat or transfats.

Dr. Aggarwal further said that Sattu is a grounded roasted powder of soaked pulses and cereals. It is consumed along with fruit slices, gur or milk. Green chili, lemon juice and salt can be added to add flavor.

The commonest form of sattu is grounded roasted black gram or chana. Other common variety is grounded roasted black gram with barley.

Originally, sattu was made of seven Anaja (7 cereals, millets and pulses). The seven ingredients are maze and barley (cereals), black gram, pigeon gram or Arhar, green pea, khesari daal, kultha daal (pulses).

Sattu is a high fiber diet with low sugar producing properties. It is a cooling ad refreshing fast food with anti diabetic and anti– obesity properties.

It is a full breakfast, mid day or lunch meal and has minerals and vitamins. It is both energy drink and energy food. So called energy drinks available in the market are harmful as they contain three times the caffeine content of coffee or tea.

Sattu drink can be made sweet by adding gur or honey, sour by adding lemon and salted by adding black or rock salt.

Roasting is one of the best forms of cooking.

Sattu is both a fast food and a summer fast soft drink but healthy.

 
    Readers Responses
  1. Dr KK is right; punish the doctor doing sex selection or aborting the female; above all; the family – mother–in–law; father–in-law; husband should be punished and published at large so that society will be afraid. This is a very important step in stopping this menace. Dr VK Goyal.
 
    Forthcoming Events
Dr K K Aggarwal


Dr K K Aggarwal

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