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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 & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; 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 to 7
DD Take Care Holistically Video 1 to 9 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial…

11th January 2013, Friday

Bharat versus India

Dr. DPS Toor is a surgeon friend of mine who always says that he practices in ‘Bharat’ and not in ‘India’. He provides all surgeries @ Rs. 6,000/- .

His concept was appreciated by me and I also started dividing my society into ‘India’ and ‘Bharat’. For me, Indians are the ones who live a western lifestyle and the Bharatiya are the ones who follow the traditional Bharatiya lifestyle observing all customs and rituals.

There are diseases linked to western lifestyle and culture and were absent in our mythology era. The examples are heart attack, diabetes, high blood pressure etc. People who observe traditional mythological fasts and do not eat cereals on the fast days do not or suffer less from lifestyle disorders.

Statement of RSS Chief Mohan Bhagwat that ‘rapes happen in India and not in Bharat’ is not acceptable to the society and, therefore, became a controversy of the country. The collective consciousness of the people rejected this statement.

Even in our mythological era, we had cases of abduction (not rape) both in Mahabharata and Ramayana.

In the period, when India was ruled by Emperors, in some cases, cases of a newly married women forcibly spending her first night with the emperor has been described in the history.

Medically, sexual urges have nothing to do with poverty or westernization. Sexual urges are universal phenomenon.

If you see the statistics of Delhi, maximum cases of pending sexual assault are seen in North East Delhi (152) and North West Delhi (154). Out of 1034 cases pending in Delhi, 25% belong to these two areas. In both these areas, we have a large number of JJ Clusters.

Also over 70% cases of sexual assault cases are reported from JJ clusters.

Whether ‘Indian’ or ‘Bharatiya’, every girl in the society has a right and has the freedom to live the way she wants and with a right to be safe.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

Register for 4th eMedinewS–revisiting 2012 conference

    Constipation Update

Stool softeners, suppositories (glycerin or bisacodyl) and enemas have limited clinical efficacy and should only be used in specific clinical scenarios.

 
Dr K K Aggarwal
  eMedinewS Audio PostCard

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

Monitoring LFT in a patient on statins

Audio PostCard
    Photo Feature (From HCFI Photo Gallery)

Dr KK Aggarwal With Gayatri from Focus tv on how to handle a sexually assaulted person

 
Dr K K Aggarwal
    National News

Dear Colleague, Let’s celebrate New Year by learning CPR-10 and saving the life of a person

Watch English or Hindi Video @http://emedinews.in/videos/cpr/index.html

Dr K K Aggarwal

Another life saved by CPR 10

The hands on hands only CPR 10 campaign was started on 1st november. On 9 th november one 16 year old student of birla vidya noketan successfuly saved the life of her uncle. And few days back a teacher Geetanjali from SD Public School Peetam Pura saved the life of her grand mother. Only a few weeks back a training camp was held ay he school. we have so far trained 25000 people on CPR 10. We can congratulate Geetanjali by sending a sms at 9899079294.

The CPR 10 mantra is within ten minutes of death, earlier the better, atleast for  the next ten minutes, longer the better, compress the center of the chest of the dead person continuously and effectively for the next 10x10 or hundred per minute.

Ayush block, Yoga centre opened at NIMHANS

Catering to an increased demand for Yoga as a therapy, the National Institute of Mental Health And Neurosciences (Nimhans) has opened an Ayurveda, Yoga, Unani, Siddha and Homeopathy (Ayush) block and Yoga centre on its premises. They were inaugurated on Wednesday and will focus on making use of Yoga as an adjunct system of medicine in the treatment of various diseases. Apart from rooms that will serve as clinics, the block will have a garden along with places of worship for all faiths and rehabilitation of patients. Union Minister of State for Health and Family Welfare Gandhiselvan, who was present on the occasion, said the initiative was a significant move by Nimhans as physical disorders are often accompanied by mental stress in patients. “We tend to neglect the problems of the mind. Lifestyle disorders are leading to depression and stress. Hence, Yoga should be an essential part of all medical treatments,” he said. “Each year, the budgetary allocation for Ayush is Rs 1,500 crore. This time, there is a proposal to increase it to Rs 2,500 crore,” Gandhiselvan said. Out of this, Rs 500 crore is planned to be kept aside just for further research in Ayush. The Ayush department last year promoted Yoga in 800 schools across the country, the minister said. The Central Board of Secondary Education has been asked by the department to make Yoga a mandatory part of the syllabus. Speaking about the newly inaugurated centre, Nimhans Director and Vice-Chancellor P Satish Chandra said the facility would be especially useful in a city like Bangalore, where suicides are increasing by the day. “The centre will not just be useful for clinically diagnosed mental disorder cases, but also for others who may feel the need to make use of Yoga therapy,” Chandra said. He requested the government to allocate Rs one crore annually for the next five years to develop infrastructure at the Ayush block and Yoga centre. (Source: Deccan Herald, Jan 9, 2013)

For comments and archives

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

Valvular sclerosis in end stage renal disease is associated with progressive stenosis and increased cardiovascular mortality.

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

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

The heart has both the plumbing pipes and the electrical wires

Interventional cardiologists can be equated to plumbers and electrophysiologists like an electrician. The job of plumbing, interventional cardiologists is to debulk the cholesterol-filled plaque and the job of the electrocardiologist is to either repair the wires or put an external wire along with an external generator or an inverter.

NSAID, BP med combo tied to kidney risk

Adding a nonsteroidal anti-inflammatory drug (NSAID) to an antihypertensive regimen that includes a diuretic and either an ACE inhibitor or an angiotensin receptor blocker may increase the risk of acute kidney injury, researchers found. (Source: Medpage Today)

Intervention boosts thrombolytic use in community hospitals

Identifying and addressing barriers to alteplase use in patients with acute ischemic stroke led to a modest increase in thrombolytic use in nonspecialty acute care community hospitals in Michigan, researchers report. (Source: Medscape)

Arthritis drugs may trigger shingles

Patients with rheumatoid arthritis (RA) undergoing treatment with agents such as Enbrel (etanercept), Remicade (infliximab) or Humira (adalimumab) appear to have a significantly increased risk for developing shingles. (Source: Medpage Today)

Gonorrhea resistant to cefixime found in North America

Growing global resistance by Neisseria gonorrhoeae to cefixime, the last oral antibiotic used against it, has been documented in North America with a Canadian study that showed a nearly 7% treatment failure rate, according to research published in the January 8 issue of JAMA. (Source: Medscape)

Synthetic stool stymies stubborn C. difficile

Fake feces may fight Clostridium difficile infection just as well as the real thing, researchers found. In a small proof-of-concept trial, two patients with refractory C. difficile infection got back to regular bowel movements within 2 or 3 days of receiving a substitute stool mixture, and remained symptom-free at 6 months, Elaine Petrof, MD, of Kingston General Hospital in Ontario, and colleagues reported online in Microbiome. (Source: Medpage Today)

 
   Twitter of the Day

@DrKKAggarwal: Do not take pain killers if you are on drugs for high blood pressure. Taking two anti blood pressure drugs-a (cont) http://tl.gd/klmigu

@DeepakChopra: Please take a look at the season preview of Holy Factshttp://tinyurl.com/aegnv2j

 
    Spiritual Update

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

The remarks of Spiritual Leader Asa Ram Ji Bapu not unexpected

Tyaga, Vairagya and Sanyasa are the three terms used in spirituality. Tyaga is at the level of physical body, Vairagya at the level of mind and Sanyasa at the level of spirit.

For comments and archives

 
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What is endometriosis?

Endometriosis is a common condition that affects women during the reproductive years. It occurs when normal tissue from the uterine lining, the endometrium, attaches to organs in the pelvis and begins to grow. This displaced endometrial tissue causes irritation in the pelvis that may lead to pain and infertility.

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

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

Blood Grouping systems & Principles, Blood Group Discrepancies & their possible solutions

Genetic

  • Blood group genes are inherited in pairs.
  • Blood group systems have 2 (three) major genes:
    • 2 identical Genes homozygous: (Lea+Leb-)
    • 2 different Genes heterozygous: (Lea+Leb+)

For comments and archives

 
   An Inspirational Story

Always remember those who serve

In the days when an ice cream sundae cost much less, a 10 year old boy entered a hotel coffee shop and sat at a table. A waitress put a glass of water in front of him.

"How much is an ice cream sundae?" "Fifty cents," replied the waitress.

The little boy pulled his hand out of his pocket and studied a number of coins in it. "How much is a dish of plain ice cream?" he inquired. Some people were now waiting for a table and the waitress was a bit impatient.

"Thirty-five cents," she said brusquely. The little boy again counted the coins. "I'll have the plain ice cream," he said.

The waitress brought the ice cream, put the bill on the table and walked away. The boy finished the ice cream, paid the cashier and departed.

When the waitress came back, she began wiping down the table and then swallowed hard at what she saw. There, placed neatly beside the empty dish, were two nickels and five pennies - her tip.

For comments and archives

 
   Cardiology eMedinewS

Score may predict LVAD survival Read More

Aging is easier with endurance exercise Read More

 
   Pediatric eMedinewS

Outcome of kid's concussion hard to predict Read More

Bullying common in kids with food allergies, weight problems Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A 45–year–old came with first-onset diabetes.
Dr Bad: Start pioglitazone.
Dr Good: Start metformin.
Lesson: In the absence of contraindications, metformin is considered the first choice for oral treatment of type 2 diabetes (Diabetes Care 2009;32:193).

Make Sure

Situation: A patient with suspected MI died after receiving sublingual nitrate.
Reaction: Oh my God! Why was a history of intake of Viagra drug not taken?
Lesson: Make sure to take a history of Viagra drug intake before giving nitrates, because co–administration of the two drugs can cause a fatal fall in blood pressure.

 
  Quote of the Day (Dr GM Singh)

The willingness to accept responsibility for one's own life is the source from which self-respect springs. Joan Didion

 
    Legal Question of the Day (M C Gupta)

Q. What are the main provisions of the WB-CEA, 2010? How does this Act differ from the central CEA, 2010?

Ans.

  • West Bengal was the first state to come out with a WB Clinical Establishments Act, 1950. It has been repealed by the WB Clinical Establishments Act, 2010, which can be viewed at— http://www.wbhealth.gov.in/download/wbc.pdf
  • In contrast to the central CEA, 2010, the WB Act has the following features:
    • Government establishments are exempted.
    • There is a three tier mechanism for dealing with violations under the Act:
      • Complaints will be made by the District Licencing Authority to the District Adjudicatory Authority (established under section 34) against violation of the Act.
      • The decision of the District Adjudicatory Authority will be appealable to the CE Tribunal (established under section 35).
      • The decision of the CE Tribunal will be appealable to the HC.
    • Maximum penalty for violation of the Act is Rs. 50,000/- (compared to Rs. 5 lakh under the central CEA)
    • The constitution of the District Adjudicatory Authority and the CE Tribunal refers to a person with a judicial/legal background.
    • Section 7(3)(k) says that the CE has the right to recover the cost of treatment.
    • The Act provides for grant of compensation by the CEA in case of negligence. Minimum compensation awardable in case of death is 5 lakh.

      (NOTE—This is likely to lead to conflict since compensation is also awardable under CPA, 1986).
  • In general, it seems to be a better Act than the central CEA, 2010. Other states which might be contemplating adopting the central CEA, 2010, would do well to rely more upon the WB Act than on the central Act.

For comments and archives

 
    Mind Teaser

Read this…………………

An intravenous pyelogram reveals that Paulo, age 35, has a renal calculus. He is believed to have a small stone that will pass spontaneously. To increase the chance of the stone passing, the nurse would instruct the client to force fluids and to

A. Strain all urine.
B. Ambulate.
C. Remain on bed rest.
D. Ask for medications to relax him.

Yesterday’s Mind Teaser: Helen is diagnosed with myasthenia gravis and pyridostigmine bromide (Mestinon) therapy is started. Mestinon dosage is frequently changed during the first week. While the dosage is being adjusted, the nurse’s priority intervention is to:

A. Administer the medication exactly on time
B. Administer the medication with food or mild
C. Evaluate the client’s muscle strength hourly after medication
D. Evaluate the client’s emotional side effects between doses

Answer for yesterday’s Mind Teaser: C. Evaluate the client’s muscle strength hourly after medication

Correct answers received from: Dr Arpan Gandhi, Dr KV Sarma, Dr PC Das, Dr (Maj. Gen.) Anil Bairaria, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Muthumperumal Thirumalpillai, Dr Chandresh Jardosh, Dr Thakor Hitendrsinh G, Dr Jella, Dr Kanat Jain, Dr Avtar Krishan, Dr BK Agarwal.

Answer for 9th January Mind Teaser: a) Complete proctocolectomy and Brook's ileostomy

Correct answers received from: Dr Jainendra Upadhyay, Muthumperumal Thirumalpillai, Dr Thakor Hitendrsinh G, Dr Kanat Jain, Dr Avtar Krishan.

Send your answer to ijcp12@gmail.com

 
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    Laugh a While (Dr GM Singh)

Women Gossip

A lot of ladies used to sit together every evening in a park and talk non stop. One day they were sitting very very quietly. A gentleman who would walk past the noisy group every day was surprised to see them all so quiet. He inquired about this to which they replied, "You see, today we are ALL present, so we don't know who to gossip about."

 
    Medicolegal Update

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

Hotson v East Berkshire Health Authority case– (1987) 2 All ER 909

This was a case of alleged medical negligence and compensation where the extent of the hip injuries to a 13 year–old boy was not diagnosed for five days. At the age of 20 years, there was deformity of the hip joint, restricted mobility and permanent disability. The judge found that even if the diagnosis had been made correctly, there was still a 75% risk of the plaintiff's disability developing, but that the medical staff’s breach of duty had turned that risk into inevitability, thereby denying the plaintiff a 25% chance of a good recovery.

Damages included an amount of £11,500 representing 25% of the full value of the damages awardable for the plaintiff's disability. On appeal to the Lords, the question was whether the cause of the injury was the fall or the negligence of the health authority in delaying treatment, since if the fall had caused the injury the negligence of the authority was irrelevant in regard to the plaintiff’s disability. Because the judge had held that on the balance of probabilities, even correct diagnosis and treatment would not have prevented the disability from occurring, it followed that the plaintiff had failed on the issue of causation. It was therefore irrelevant to consider the question of damages.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Lohri: Adieu to Winters: "TIL TADAKE; DIN JHATAKE"

Means 'Good bye to Til or Sesame', (which is used excessively in winters) and 'welcome to longer days' (which signify the dawn of summer) said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India & Vice President Elect IMA.

Lohri, the festival of bonfire falls on 13th January. The earth, farthest from the sun at this point of time, starts its journey towards the sun, thus ending the coldest month of the year, Paush, and announcing the start of the month of Magh and the auspicious period of Uttarayan - January 14 to July 14 ("Uttar" North and "ayan" movement towards). Uttarayana is considered to be the holiest half of the year. In Bhagavad Gita, the Lord says, "I am Uttarayana among the ayanas."

Unlike other Indian festivals, Lohri reflects less of religion than culture. It is more a heritage of the agrarian Indian society than a felicitation of some Indian God.

Lohri is also the time to say good bye to winter foods. The lohri ritual starts at sunset when people circle around (parikrama) the bonfire and throw puffed rice, popcorn and other munchies into the fire, shouting "Aadar aye dilather jaye" (May honor come and poverty vanish!). This slogan coincides with the start of the harvesting season in North India.

After the parikrama, people exchange greetings and gifts, and distribute prasad comprising of five items: til, gajak, jaggery, peanuts, and popcorn followed by the traditional dinner of makki-ki-roti (multi-millet hand-rolled bread) and sarson-ka-saag (cooked mustard leaves). Eating of til (sesame of seeds) and rorhi (jaggery) is considered to be essential on this day.

Lohri therefore is the last day of eating heat producing winter foods. This is what the ritual of throwing these items in the bonfire is. It also signifies that from the day of lohri these items are for worship and to be taken in small amount like a prasadam and not as major part of the meals.

The bonfire or the artificial source of heat, to many, is embarked with festivity and supposedly the last need for heat for the season after which the warmth would come from the sun most naturally.

As per Ayurveda the six months of Uttarayana( Adana –Dry Season) consists of Shishira, Vasanta and Grishma periods (Late winter, spring, summer). Bitter, pungent and astringent tastes are dominant in the soil. During the late winter chances of asthmatic attacks, vata imbalance, dryness of the body etc. are more. Maximum chances of vata emergencies liken heart attacks and stroke occur during full moon in this period.

The Daksinayana (6 months, Visarga – Wet Season) consists of Varsha, Sharad, Hemanta (Rainy, autumn, early winter). Sweet, sour, salt tastes are dominant in the soil.

Early (Wet) vs late (Dry) winter

Winter therefore can be divided into wet and dry winter. Wet winter is characterized by fall in temperature along with high humidity. Environmentally, we see fog and smog during this season. Dry or late winter on the other hand is characterized by absence of fog, smog and presence of chilly airy winds.

Most hypothermia illnesses occur in dry late winter. The transition phase between wet and dry winter is on Lohri. In terms of Ayurveda, it means shifting from Kapha to Vata atmosphere. The onset of dry winter is also the time for accelerated movement disorders in the body. Accelerated hypertension, arrhythmias, paroxysmal atrial tachycardia (PAT), brain hemorrhage, heart attack etc. all occur at the start of dry late winter.

Unpublished compilation of data has also shown that maximum temporary pacemakers are also put during this season.

The correct lifestyle in this season has been defined in Ayurveda and it involves reducing consumption of stringent, bitter and pungent foods.

 
    Readers Response
  1. The recommendations to Justice Verma are well thought out & timely. I adore you for your service-minded and pro-active actions in the spirit of a karmyogi. Warmest regards: Madanmohan Trakroo
 
    Forthcoming Events

4th eMedinews Revisiting 2012

The 4th eMedinewS–revisiting 2012 conference is being held at Maulana Azad Medical College, New Delhi on Sunday January 20th 2013 (8 AM to 8 PM).

The one–day conference will revisit and discuss all the major advances in medicine in the year 2012. An eminent faculty will speak at the conference.

There is no registration fee. All delegates will get Registration Kit, Attractive gifts, Certificates. Morning snacks and lunch will be provided.

Eminent Faculty:

Dr Praveen Chandra (Cardiology)
Dr NK Bhatia (Transfusion Medicine)
Dr Ambrish Mithal (Diabetes)
Dr Kaberi Banerjee (Infertility)
Dr Yougal Mishra, Dr Manju Gupta, Dr Somesh Juneja, Dr Deepak Khurana (Valve Surgery)
Dr Rajnish Malhotra (Cardiology)
Dr Vivek Bhatia (GI)
Dr Ashish Jain (Ortho)
Dr Kailash Singla (GI)
Dr IM Chugh (Pulmonoagy)
Dr AK Dhar (Hemato oncology)
Dr Neeraj Jain (Pain Management)

Register at: www.emedinews.in/

rawat.vandana89@gmail.com/drpawangupta2006@yahoo.com

Dr Pawan Gupta, Past President IMA Haryana, Organizing Secretary

4th eMedinewS Doctor of the Year Awards

Nominations invited for 4th eMedinewS Doctor of the year Award in plain paper. Nominated by 2 professional colleagues along with details of your contributions in the year 2012.

pls send his/her Biodata at: emedinews@gmail.com

4th eMedinewS Revisiting 2012
Dr KK Aggarwal Revisiting 2012
Dr Ashish Jain eMedinewS Oration Orthopedics in 2012
Dr Vivek Bhatia eMedinews Distinguished Lecture GI in 2012
Mr B N S Ratnakar IJCP Oration Financial Health
Dr N K Bhatia Dr Col K L Chopra eMedinewS Oration Transfusion Medicine 2012
Dr Ambrish Mithal AJD Oration Diabetes 2012
LIC India eMedinews Distinguished Lecture Life Insurance Schemes
Dr Praveen Bhatia G L Sanghi eMedinewS Oration Surgery in diabetes
Dr Kaberi Banerjee AJOG Oration Infertility Update
Dr Yugal Mishra, Dr Manju Gupta, Dr Saurabh Juneja,
Dr Deepak Khurana
AJCC Oration 2012 Valve Update
Dr Rajnish Malhotra Dr J J Sood eMedinewS Oration Cardiac Surgery 2012
Rajiv Gandhi Cancer Institute Dr K B Sharma eMedinewS Oration Oncology Update
Dr Ganesh mani eMedinews Distinguished Lecture Valve in 2012
Dr Brig A K Dhar eMedinews Distinguished Lecture Hematooncology Update
Dr I M Chugh eMedinews Distinguished Lecture Chest Update
Dr Kailash Singla eMedinews Distinguished Lecture Gastro Update
Dr Neeraj Jain eMedinews Distinguished Lecture Pian Management
Dr S K Parashar eMedinews Distinguished Lecture Echo 2012
Dr K K Aggarwal Take Home messages
Cultural Evenning and Doctor of the Year Award
 
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3. eMedinewS audio lectures (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