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 & 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 & Hony. Visiting Professor (Clinical Research) DIPSAR

 

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos …
Nobility of medical profession Video 1 to 9 Health and Religion Video 1–7
DD Take Care Holistically Video 1–4 Chat with Dr KK On life Style Disorders
Health Update Video 1–15 Science and Spirituality
Obesity–Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

10th September 2012, Monday

Walnuts Good for Semen

The daily addition of 75 g of whole–shelled walnuts to a typical Western–style diet appears to have positive effects on the vitality, morphology and motility of sperm in healthy men, according to the findings of a randomized, parallel, 2–group, dietary intervention trial by Wendie A. Robbins, PhD, from the University of California, Los Angeles. The study is published in August 15 in Biology of Reproduction.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

 
    Constipation Update

What is the role of colonoscopy in constipation?

A colonoscopy allows for direct visualization of the colon to exclude mucosal lesions (eg, solitary rectal ulcer syndrome, inflammation, malignancy) and should be performed in patients if they have alarm symptoms and also as indicated for colorectal cancer screening.

For comments and archives

 
Dr K K Aggarwal
  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal on

Proton–pump inhibitors to carry warning about C

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

Seminar on Diet, Health & Religion

An Inter Religion Seminar on Diet, Health & Religion was organized at Bharatiya Vidya Bhavan in association with Heart Care Foundation of India

 
Dr K K Aggarwal
 
    National News

Drug trial deaths: Value of life only Rs 2.2 lakh in India

NEW DELHI: The value of life is only Rs 2.2 lakh in India if the average compensation paid for deaths during clinical trials of drugs is any yardstick. And the value is only getting cheaper going by the compensation amount paid in 2011 as against average compensation of Rs 3.2 lakh for clinical trial–related deaths paid in 2010, according to an analysis of data provided in Parliament today by the Union Health Ministry. The alarmingly low–level of compensation for lives lost during clinical trials in India can be credited to the fact that government is yet to frame rules for compensation in such cases under the existing drug regulation laws in the country. By its own admission, the government said today there were no such rules in place and it was in the process of finalising them. Health Minister Ghulam Nabi Azad said the government is in the process of finalising such guidelines and expects to do so soon. "The government expects to finalise these guidelines soon keeping in view the rights and well–being of trial subjects," Azad said in a written reply to a question in Lok Sabha. The Minister said draft guidelines for determining the quantum of financial compensation to be paid in cases of clinical trial-related injury or death have been prepared and comments from public have been sought.

Though the total number of deaths in the country in 2010 and 2011 during clinical trials were 668 and 438 respectively, the Serious Adverse Events (SAEs) of death attributed only to clinical trials of drugs were found to be in 22 and 16 cases in these respective years. In 2012, there have been 211 deaths till June during clinical trials, but the reasons of their deaths are being assessed. A perusal of financial compensation in cases of clinical trial–related deaths in 2011 indicate that a total of Rs 35.21 lakh has been paid in 16 cases by drug firms. They ranged from a paltry Rs 50,000 to a maximum of Rs 5 lakh (still under process of payment). In 2010, a total financial compensation of Rs 70.33 lakh was paid in 22 cases with the maximum amount being Rs 20 lakh by and a minimum amount being Rs 1.08 lakh. (Source: The Economic Times, 7 Sep, 2012)

For comments and archives

4th Dil Ka Darbar

September 23, 2012, 9:00 AM–6:00 PM , Tal Katora Indoor Stadium, Connaught Place, New Delhi

A non stop question answer–session between all top cardiologists of the NCR region and the public.

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

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

 
    Valvular Heart Disease Update

What is the indication of surgery in a valve patient with atrial fibrillation?

Atrial fibrillation is not an absolute indication for surgery in an asymptomatic patient with preserved left ventricular function but the burden of this arrhythmia in a patient with borderline left ventricular function (LVEF 55–60%) may be considered as an indication for surgery, especially if the risk of surgery is low and the valve appears to be amenable to repair.

(Experts: Dr Bhabha Nanda Das and Dr Ganesh K Mani, Dr. Yugal Mishra, Dr Deepak Khurana, Dr K S Dagar, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

For comments and archives

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

BRCA carriers at extra risk from radiation

Young women at high familial risk for breast cancer may see an even greater risk from diagnostic scans that expose them to chest radiation, including mammograms, researchers found. (Source: Medpage Today)

For comments and archives

Submicron NSAID data mixed

Low doses of naproxen in a fine powder provide pain relief, but not statistically better relief than standard formulations of the drug, a new study shows. The submicron particles are designed to be more bioavailable, allowing lower doses and theoretically fewer adverse reactions. (Source: Medscape)

For comments and archives

Biomarkers may refine thyroid cancer diagnosis

A three–step genetic analysis of thyroid nodule tissue, obtained by fine needle aspiration, could improve the diagnosis of cancer, researchers reported. (Source: Medpage Today)

For comments and archives

High rheumatoid factor is a red flag, even in the healthy

Elevated rheumatoid factor (RF) levels in healthy patients may be a strong predictor of future rheumatoid arthritis (RA), according to data from a prospective cohort study published online September 6 in the British Medical Journal. (Source: Medscape)

For comments and archives

 
  Twitter of the Day

@DrKKAggarwal: Dramatic Rise in Extensively Drug–Resistant Tuberculosis Almost half (43.7%) of patients with multidrug–resistant… http://fb.me/sy9YZAcL

@DrKKAggarwal: "The spirit of inquiry liberates scientific thinking from unnecessary limitations."

 
    Spiritual Update

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

What are the dietary restriction in Jainism?

The core principle of Jainism is nonviolence. Food is the main source of energy to survive. Bhagwan Mahavir talked about two types of diet – Hitkari (Beneficial) and Mitkari (Moderate). Jains are lactovegetarian and many are even vegans. Many avoid

For comments and archives

 
    4th Asia Pacific Vascular Intervention Course (APVIC)
  • 4th Asia Pacific Vascular Intervention Course–Excerpts from a Panel discussion Read More
  • The 4th Asia Pacific Vascular Interventional Course begins Read More
  • Excerpts of a talk and interview with Dr. Jacques Busquet by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Editor–in–Chief Cardiology eMedinewS Read More
  • 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • Press Conference on 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • 4th Asia pacific vascular intervention course Read More
  • 4th Asia pacific vascular intervention course paper clippings Read More
 
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What is the process of insemination?

Inseminations may be timed based on a woman’s natural cycle or in conjunction with an ovulation induction cycle and should occur close to the time of ovulation. The woman is positioned on the examination table as if in preparation for a pelvic examination. The physician or nurse then places the speculum into the vagina to visualize the cervix. The semen sample is drawn up into an insemination catheter attached to a syringe. For intracervical inseminations (ICI), the thawed semen sample is injected into the cervical opening and the sample bathes the cervix. After an ICI, the patient is instructed to lie supine for a few minutes. Some providers may choose to place a cervical cap or sponge into the vagina to hold the semen near the cervix for four to six hours after the insemination, after which time the cap or sponge may be removed. This enables a higher concentration of sperm to reach the uterine cavity and fallopian tubes where fertilization occurs.

For comments and archives

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

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

What are the functions of these components?

  • Plasma: acts as a vehicle to carry many substances like glucose, fats, and proteins, enzymes, and hormones etc., in addition to the blood cells.
  • Red blood cells: carry oxygen from lungs to various body tissues and take back carbon dioxide from the cells and tissues to be thrown out of body in the form of exhaled air.
  • White blood cells: are mainly acting as body scavengers and guards. They help in the immune system of the body and act as defense forces of the body killing the bacteria or any other organisms that enters the body.
  • Platelets: help in the clotting and coagulation of blood. We all have experienced that whenever we get injured, the bleeding stops after a few minutes. This is brought about by a mechanism called clotting of blood in which platelet plays a very vital role.

For comments and archives

 
    An Inspirational Story (Ms Ritu Sinha)

The last cab ride

A true story by Kent Nerburn

Twenty years ago, I drove a cab for a living. One time I arrived in the middle of the night for a pick up at a building that was dark except for a single light in a ground floor window.

Under these circumstances, many drivers would just honk once or twice, wait a minute, and then drive away. But I had seen too many impoverished people who depended on taxis as their only means of transportation. Unless a situation smelled of danger, I always went to the door. This passenger might be someone who needs my assistance, I reasoned to myself. So I walked to the door and knocked. "Just a minute," answered a frail, elderly voice.

I could hear something being dragged across the floor. After a long pause, the door opened. A small woman in her 80s stood before me. She was wearing a print dress and a pillbox hat with a veil pinned on it, like somebody out of a 1940s movie. By her side was a small nylon suitcase.

The apartment looked as if no one had lived in it for years. All the furniture was covered with sheets. There were no clocks on the walls, no knickknacks or utensils on the counters. In the corner was a cardboard box filled with photos and glassware.

"Would you carry my bag out to the car?" she said. I took the suitcase to the cab, then returned to assist the woman. She took my arm and we walked slowly toward the curb. She kept thanking me for my kindness. "It’s nothing," I told her. "I just try to treat my passengers the way I would want my mother treated." "Oh, you’re such a good boy," she said. When we got in the cab, she gave me an address, then asked, "Could you drive through downtown?"

"It’s not the shortest way," I answered quickly. "Oh, I don’t mind," she said. "I’m in no hurry. I’m on my way to a hospice." I looked in the rear view mirror. Her eyes were glistening. "I don’t have any family left," she continued. "The doctor says I don’t have very long." I quietly reached over and shut off the meter. "What route would you like me to take?" I asked.

For the next two hours, we drove through the city. She showed me the building where she had once worked as an elevator operator. We drove through the neighborhood where she and her husband had lived when they were newlyweds. She had me pull up in front of a furniture warehouse that had once been a ballroom where she had gone dancing as a girl.

Sometimes she’d ask me to slow in front of a particular building or corner and would sit staring into the darkness, saying nothing. As the first hint of sun was creasing the horizon, she suddenly said, "I’m tired. Let’s go now." We drove in silence to the address she had given me.

It was a low building, like a small convalescent home, with a driveway that passed under a portico. Two orderlies came out to the cab as soon as we pulled up. They were solicitous and intent, watching her every move. They must have been expecting her. I opened the trunk and took the small suitcase to the door. The woman was already seated in a wheelchair.

"How much do I owe you?" she asked, reaching into her purse. "Nothing," I said. "You have to make a living," she answered. "There are other passengers." Almost without thinking, I bent and gave her a hug. She held onto me tightly. "You gave an old woman a little moment of joy," she said. "Thank you." I squeezed her hand, then walked into the dim morning light. Behind me, a door shut. It was the sound of the closing of a life.

I didn’t pick up any more passengers that shift. I drove aimlessly, lost in thought. For the rest of that day, I could hardly talk. What if that woman had gotten an angry driver, or one who was impatient to end his shift? What if I had refused to take the run, or had honked once, then driven away? On a quick review, I don’t think that I have done anything more important in my life. We’re conditioned to think that our lives revolve around great moments. But great moments often catch us unaware—beautifully wrapped in what others may consider a small one.

For comments and archives

 
  Cardiology eMedinewS

Kids’ Sleep Problems Linked To Educational Issues Read More

Obese Parents, High Screen Time Top Child Overweight Risks Read More

 
  Pediatric eMedinewS

Cardiac Benefits Of Red Wine Not From The Alcohol Read More

Silent Heart Attacks Are Common and Predict Risk of Death, MRI Diagnosis Shows Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient with diabetic nephropathy was found to have a high homocysteine levels.
Dr Bad: Homocysteine has no correlation with nephropathy.
Dr Good: These high levels need to be controlled.
Lesson: Results of a nested case–control study suggest that hyperhomocysteinemia has an etiologic role in the pathogenesis of diabetic nephropathy. In the study, baseline plasma homocysteine concentrations and mean HbA1c levels during follow–up were significantly higher in patients who developed microalbuminuria than in those who remained normoalbuminuric. Multivariate logistic regression analysis showed that baseline plasma homocysteine level and mean HbA1c were independent predictors of microalbuminuria in type 2 diabetes.

For comments and archives

Make Sure

Situation: A diabetic patient died of flu pneumonia.
Reaction: Oh my God! Why was flu vaccine not given?
Lesson: Make sure that all diabetics are given flu vaccine every year.

For comments and archives

 
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  Quote of the Day (Dr GM Singh)

No task is more difficult than systematic hypocrisy. Edward George

 
    Legal Question of the Day (Dr MC Gupta)

Q. What is the law regarding treatment options such as fish therapy for asthma?

Ans.

  1. "Fish therapy for asthma" is not a recognised mode of treatment under AYUSH. Hence there is no question of punishing the practitioners of such therapy for quackery.
  2. If an RMP under any medical system practices "Fish therapy for asthma", he can be proceeded against by the respective medical council as per the rules of that council. However, nothing prevents an RMP from undertaking a research study to scientifically evaluate the efficacy of "Fish therapy" for treatment of asthma.
  3. The practice of "Fish therapy for asthma" does not apparently constitute cruelty under the Prevention of Cruelty to Animals Act, 1960.
  4. In general, the question of taking legal action against anything arises only when some law is broken. The practice of "Fish therapy for asthma" does not violate any Act.
 
    Stem Cell Update (Dr S K Verma, Consultant Ophthalmologist, New Delhi)

The cerebral cortex in the brain is the seat of higher functions in humans and it has several layers of neurons. Earlier it was thought that neurons of each layer of the cortex were derived from the same stem cells that produce different type of neurons at different points in time during development. Now a study has shown that there is a separate progenitor cell for the upper layer neurons. (Courtesy: Journal of Stem cell and Regenerative Medicine August 2012; Vol. 3; Issue 13)

 
    Lab Update (Dr Navin Dang and Dr Arpan Gandhi)

Magnesium

Increased: Renal failure, hypothyroidism, severe dehydration, lithium intoxication, antacids, Addison’s disease.

Decreased: Hyperthyroidism, aldosteronism, diuretics, malabsorption, hyperalimentation, nasogastric suctioning, chronic dialysis, renal tubular acidosis, drugs (aminoglycosides, cisplatin, ampho B), hungry bone syndrome, hypophosphatemia, intracellular shifts with respiratory or metabolic acidosis.

 
    Mind Teaser

Read this…………………

High uric acid levels may develop in clients who are receiving chemotherapy. This is caused by:

A. The inability of the kidneys to excrete the drug metabolites
B. Rapid cell catabolism
C. Toxic effect of the antibiotic that are given concurrently
D. The altered blood ph from the acid medium of the drugs

Yesterday’s Mind Teaser: Which statement by the client indicates to the nurse that the patient understands precautions necessary during internal radiation therapy for cancer of the cervix?

A. "I should get out of bed and walk around in my room."
B. "My 7 year old twins should not come to visit me while I’m receiving treatment."
C. "I will try not to cough, because the force might make me expel the application."
D. "I know that my primary nurse has to wear one of those badges like the people in the x–ray department, but they are not necessary for anyone else who comes in here."

Answer for Yesterday’s  Mind Teaser: B. "My 7 year old twins should not come to visit me while I’m receiving treatment."

Correct answers received from:  Dr Satya Bhooshan Sood, y. j. vasavada, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Dr Chandresh  Jardosh, Dr Kanta Jain, Muthumperumal Thirumalpillai

Answer for 8th September Mind Teaser: D. Frequently elevating the arm of the affected side above the level of the heart.
Correct answers received from: Dr Thakur Om Prakash Singh, shashi saini, gopal shinde, Satya Bhooshan Sood

Send your answer to ijcp12@gmail.com

 
    Laugh a While (Dr GM Singh)

A Horoscope for The Workplace

Middle Management/Department Management/"Team Leads" Catty, cut–throat, yet completely spineless, you are destined to remain at your current job for the rest of your life. Unable to make a single decision you tend to measure your worth by the number of meetings you can schedule for yourself. Best suited to marry other "Middle Managers," as everyone in your social circle is a "Middle Manager."

 
    Medicolegal Update

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

Medical negligence–Supreme Court decisions in the United States

The implied contract of a physician or surgeon is not to cure…but to treat the case with diligence and skill.

  • In 1832 Connecticut court focused on the word "ordinary "A physician and surgeon, in the performance of his professional duties, is liable for injuries resulting from the want of ordinary diligence, care and skill…"Ordinary" means usual, common…If in the performance of any operation there was a want of ordinary diligence, care, and skill, or if there was carelessness, then the defendant–physician is liable.
  • Twenty–one years later, the Pennsylvania Supreme Court ruled similarly, emphasizing the word "reasonable," in addition to "ordinary."
  • The implied contract of a physician or surgeon is not to cure…but to treat the case with diligence and skill. The question is…whether the doctor had employed such skill and diligence as are ordinarily exercised in his profession… The rule (is) to be reasonable…The law demands…not extraordinary skill such as belongs only to a few men of rare genius and endowments, but that degree which ordinarily characterizes the profession.
  • In 1860, the Supreme Court of Illinois issued its first decision on what constitutes the standard of care of a medical physician. The lawsuit claimed that a physician, who incidentally was represented by a then–practicing attorney named Abraham Lincoln, had been negligent for improperly applying a cast to treat a wrist fracture that had been sustained by the plaintiff. The court declared
  • When a person assumes the profession of physician and surgeon, he must…be held to employ a reasonable amount of skill and care. For anything short of that degree of skill in his practice, the law will hold him responsible for any injury which may result from its absence. While he is not required to possess the highest order of qualification, to which men attain, still he must possess and exercise that degree of skill which is ordinarily possessed by members of the profession. And whether the injury results from a want of skill or the want of its application, he will, in either case, be equally liable.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Monsoon and Dengue on the Door

Bed netting is of little use since the dengue mosquitoes are most active during the daytime said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India.

Remaining in well–screened or air-conditioned buildings during the day can reduce the risk of exposure. When outside during the day, one should wear clothing that reduces the amount of exposed skin and should use an effective mosquito repellent, such as N, N–diethyl–metatoluamide (DEET).

Because dramatic plasma leakage can develop suddenly, substantial attention has been placed upon the early identification of patients at higher risk for shock and other complications. The following clinical features are of help in this regard.

Duration of illness: The period of maximum risk for shock is between the third and seventh day of illness. This tends to coincide with resolution of fever. Plasma leakage generally first becomes evident between 24 hours before and 24 hours after fever is over.

Alarm signs: Severe abdominal pain, persistent vomiting, abrupt change from fever to hypothermia, or abnormal mental status, such as disorientation, are noted in a minority of patients.

Hematocrit: An elevation of the hematocrit is an indication that plasma leakage has already occurred and that fluid repletion is urgently required.

Platelet count: Severe thrombocytopenia (<100,000/mm3) is one of the clinical criteria for dengue hemorrhagic fever and usually precedes overt plasma leakage.

Serum aspartate transaminase (SGOT): Mild elevations in serum transaminases are common in both dengue fever and dengue hemorrhagic fever. However, levels are significantly higher in patients with dengue hemorrhagic fever, and elevated SGOT levels are noted earlier in illness.

Patients with suspected dengue who do not have any of the above indicators can be safely managed as outpatients as long as close clinical observation is assured. Daily outpatient visits may be needed to permit serial assessment of blood pressure, hematocrit, and platelet count.

A patient should be hospitalized when:

  • Blood pressure <90/60 mmHg
  • Hematocrit >50 percent
  • Platelet count <50,000/mm3
  • Evidence of bleeding other than petechiae
 
    Readers Response
  1. Dear Sir in movie Amar Akbar Anthony : The three brothers are  donating blood to their mother Blood is shown getting collected in a single bottle simultaneously from the sons & transfused to mother from the same hanging bottle. How imaginative!! send by :Dr Savita Mehendale Faridabad.
 
    Forthcoming Events
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
A non stop question answer-session between all the top cardiologists of the NCR region and the public. Event will be promoted through hoardings, our publications and the press. Public health discussions
http://www.heartcarefoundation.org

TOGETHER WE CAN

RELAX *RECREATE* REJUVENATE

Weekend Retreat for Doctors on
Mind – Body – Medicine

8 (Sat) – 9 (Sun) September 2012 At Brahma Kumaris Om Shanti Retreat Centre NH–8, Bhorakalan, Pataudi Road, Bilaspur Chowk, Distt.-Gurgaon

There is NO REGISTRATION FEE but REGISTRATION is MUST
Visit us at: www.togetherwecan.in
Contact: BK Sister Sapna – M – 9650692204
E–mail: bksapna108@gmail.com

 
    eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes to open)

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

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

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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