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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


eMedinewS Presents Audio News of the Day

Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

  Editorial …

11th November 2011, Friday

Two public health policies hit back in the US

Cigarette warnings up in smoke as judge blocks rule in US: Will same happen in India?

A US federal judge has blocked the rule that will require cigarette packs to be emblazoned with graphic images warning of the dangers of smoking and ruled that the tobacco companies suing the federal government are likely to win with their free speech argument.

Rules issued by FDA in June require that starting on Sept. 22, 2012, cigarettes sold in the U.S. will have to carry graphic images warning of the dangers of smoking. These images include rotting teeth, diseased lungs, and a body on an autopsy table. The images will be accompanied by dissuasive wording on cigarettes and smoking, including "cigarettes are addictive," "cigarettes cause cancer," and "smoking can kill you." They must be displayed on at least half of the front and back of cigarette packs, and 20% of the top of the pack.

Banning Soda in Schools Ineffective

US State bans on sugar–sweetened drinks in middle schools didn’t have much impact on kids’ overall consumption, said Daniel R. Taber, PhD, MPH, of the University of Illinois at Chicago, and colleagues. These results from surveys at schools across 40 states appeared online in the Archives of Pediatrics & Adolescent Medicine. Students who reported at least daily consumption actually slightly increased their intake when the drinks were banned at school, suggesting that they more than compensated with drinks purchased at convenience stores and other locations.

Simply replacing soda with sports drinks or other sugary drinks wouldn’t be expected to have much impact on obesity, because even 100% fruit juice has as many calories as other sugar–sweetened beverages.

(Source: Excerpts from Medpage Today)

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Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

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

Two public health policies hit back in the US

Audio PostCard
    Photo Feature (From HCFI Photo Gallery)

18th MTNL Perfect Health Mela 2011– Heritage – An Inter Dancing School Health Festival

Dancing is good for health and classical dance is a mix of exercise and meditation Students from different schools participated in the Heritage – An Inter Dancing School Health Festival

Dr K K Aggarwal
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook – Twitter


Study boost for elimination of kala–azar in India

NEW DELHI: Asia’s largest ever study on kala–azar – the deadly parasitic disease transmitted through the bite of a sand fly – will now help India eliminate the disease. A comprehensive four–year project, including over 10,000 patients in clinical and pharmaco–vigilance studies for diagnosis and treatment of visceral leishmaniasis (VL, also known as kala–azar) in India, has been launched by an international consortium to support the country’s elimination strategies. The consortium includes the Indian Council of Medical Research, the Drugs for Neglected Diseases initiative (DNDi), Medecins Sans Frontieres (MSF), the Bihar State Health Society and WHO’s Special Programme for Research and Training in Tropical Diseases (TDR). (Source: TOI, Nov 10, 2011)

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

Fenofibric acid may not cut cardiac risk, FDA warns

The US FDA has ordered that the label for fenofibric acid be changed to indicate that the lipid–lowering drug has not been shown to reduce the risk of heart attack or stroke

For comments and archives

Hillary Clinton says U.S. aims to wipe out AIDS

The United States will, for the first time, make it a policy goal to have an "AIDS–free generation" in the near future, Secretary of State Hillary Clinton announced. The administration’s new AIDS–free generation goal will focus on "combination prevention strategy," combining three interventions that have been proven to slow the spread of the disease: ending mother–to–child transmissions; expanding voluntary male circumcision; and making greater use of antiretroviral medications. (Source: Medpage Today)

For comments and archives

South Asians need to revisit obesity cut–offs

NEW DELHI: Substantially lower obesity cut–off points are needed in South Asians to detect an equivalent level of cardiovascular risk as observed in white Europeans. A new study says the conventional definition of obesity – a body mass index or BMI of 30 kg/m2 – should not be applied for South Asians for whom the count should be between 23–28 kg/m2. BMI, calculated as weight (kg) divided by height, is the most common method of assessing adiposity. Based on epidemiological evidence investigating associations with mortality and morbidity, BMI cut–off points of 25 kg/m2 and 30 kg/m2 are conventionally used to classify overweight and obesity, respectively. In 2004, an expert consultation by the World Health Organization (WHO) recommended revised BMI cut–off points for the classification of overweight (23 kg/m2) and obesity (27.5 kg/m2) in Asian populations. "However, further evidence suggests that these revised categorizations may still under represent the risk of cardio–metabolic disease in people originating from India, Pakistan and Bangladesh. A recent consensus statement advised that BMI cut–off points for overweight and obesity should be lowered to 23 kg/m2 and 25 kg/m2, respectively, for Indian Asians," says a latest study published in the medical journal PLoS One. (Source: TOI, Nov 10, 2011)

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   Twitter of the Day

@DrKKAggarwal: Watch Padma Shri Awardee Dr KK Aggarwal on MTNL Perfect Health Mela 2011 Presents DANDIA SHOWhttp://www.youtube.com/watch?v=FpLCMNmSCSw&feature=sharevia @youtube

@DeepakChopra: #CosmicConsciousness Life recycles

    Spiritual Update

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

Spiritual significance of Kartik Purnima

  1. The Full Moon Purnima day of the Shukla paksha (waxing moon) of the Kartik month is considered very auspicious.
  2. It marks the end of Kartik month and start of Margshirsha.

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   An Inspirational Story

(Dr Anupam Sethi Malhotra)

Assert Yourself

When you trust your assertiveness, you have the Ability to express yourself and the ability to Communicate your feelings, wants and needs. You are Less dependent on others and more in control of your Own life.

When you assert yourself, you make your own Choices. You make room for your confidence to Explode. Practice confident assertion by saying, "Yes" to the things you want to do and, "No" to the Things you don’t.

Don’t be afraid or feel guilty for asserting yourself. You have nothing to lose. You will only become Stronger and more self sufficient, and in turn your Self respect and self worth will shine!

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   Cardiology eMedinewS

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


Antithrombotic therapy for patients with atrial fibrillation

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CSI Abstracts

Rotational angiography (dynact) in ablation procedures in chambers other than LA

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CSI News

TCT Update: ACEF new tool for assessment PCI Outcome

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TCT 2011 update

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    Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

Yoga helps with chronic low back pain, study says

Individuals who suffer from chronic low back pain can get relief by doing yoga, according to a study in the Archives of Internal Medicine. Small trials had suggested that yoga might improve function and reduce symptoms of chronic low back pain, but this study set out to determine if yoga was more effective than stretching and also more effective than a self–care book that doctors could give their patients that included advice on preventing and managing pain. For the study, 92 adults with chronic low back pain took 12 weekly yoga classes while 91 patients did conventional stretching exercises and 45 read the self–care book. At the end of the 12 weeks and then again at 26 weeks, the back–related functional status and pain level of the participants were measured. The yoga group had less pain and improved function over the group who read the self–care book at both times of measurement. The improvement was similar to those of the group that did conventional stretching exercises. The researchers noted in the article that the results seemed to indicate that the stretching involved in yoga was the reason for the decreased back pain, not the breathing and relaxation components.

For comments and archives

    Healthy Driving

(Conceptualized by Heart Care Foundation of India and Supported by Transport Department; Govt. of NCT of Delhi)

If you do need to use a cellular phone urgently, take the following precautions:

Avoid intense, emotional or complicated conversations.

For comments and archives

    Medicine Update

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

What is the function of endoscopic ultrasonography in diagnosis of chronic pancreatitis?

Endoscopic ultrasonography (EUS) is likely to play an important role in diagnosis and management of patients with chronic pancreatitis. High resolution (<1mm) images of pancreatic parenchyma and duct structure can be generated without the use of ionizing radiation. Presently EUS is very popular in adult population. But, pediatric EUS is available only in limited centres and will gradually gain popularity; with the development of smaller probes and experience in children.

For comments and archives

  Legal Question of the Day

(Dr M C Gupta)

Please comment upon my statement that the consumer justice system suffers from the following pitfalls:

a. If an appeal is filed against the lower court, the appellate court does not allow producing further evidence. It is ridiculous. There is no sense in appealing to a higher forum if there is no effort of rectification.
b. Surprisingly there are incidence when penalties are increased by the higher forum.
c. Consumer forums cannot be relied upon for awarding compensation. No penalty is awarded against doctors in 95–96% cases. This happens because there is no proper evidence. It is very difficult to prove medical negligence in India where system is weak and full of lacunae.

  1. It is a basic principal of law that the plaintiff has to be careful and vigilant when he files a complaint in the court. Similarly, the defendant is expected to be careful and vigilant when he files his reply to the plaint. The parties cannot be allowed to treat law casually and submit half–baked pleadings to the court in the hope that they will later fortify their pleadings by producing further evidence to support their case. An appeal is not meant to present new evidence to the court. The limited and specific purpose of the appeal is that the party preferring the appeal thinks that the lower court has not applied or interpreted law correctly or has not properly considered the facts on record, resulting in miscarriage of justice. The appeal has to be on points of law and not on points of fact. The purpose of the trial court is to ascertain the facts. The appellate court is not a fact finding court.
  2. If the trial court has committed an error and has given punishment/awarded compensation wrongly or inadequately, it is the duty of the appellate court to legally evaluate the judgment and to set aside or reduce or enhance the punishment/compensation in the interest of justice. It is true that it is very difficult to prove medical negligence in India. But this not because the system here is weak and full of lacunae but because the members of the medical profession are not willing to give written expert opinion against professional colleagues even when there is negligence. I also face this problem when I take up cases for patients but after requesting a few doctors, I am often able to find a doctor who is willing to give expert opinion. This is because I am a doctor myself. The same doctors would not give such opinion if approached directly by the patient or his advocate.
  3. There is a great need for establishing an impartial patients’ grievances redressal system which can impartially and neutrally assess patients’ grievances and get opinions from experts and decide/arbitrate the complaint. The best agency suited for this is the IMA. Fees can be charged from the complainants for this purpose and this mechanism can act as a significant source of income for the IMA or any other organisation concerned. Such an agency can give its decision within 3–4 months. Many complainants would prefer to go to such an agency instead of going to a consumer court if the public has confidence in such an agency acting as the mediator between the patient and the doctor. Here is the problem. The IMA is not able to get over the idea that if it holds a doctor guilty, it would be acting against the interest of doctors. It was tried in the DMA about 5–6 years ago but did not succeed because of this very reason.
  4. The medical profession must realise that:
    a. It is a fact that culpable medical negligence does occur.
    b. Such negligence brings down the faith of the public in the profession.
    c. If such negligence is exposed, doctors will learn to avoid negligence in future and thus the medical profession/system itself will be cleansed and thereby benefit from such cleansing.
    d. It is a practice in good medical institutions to undertake academic professional exercises like CPC (Clinico–pathological conference) and even a weekly or monthly "Death conference" (where an internal inquiry is held after a patient dies). The purpose of these conferences, respectively, is to find how a better diagnosis could have been made and how a better treatment could have been given. There is a need in the medical profession to extend this concept to those cases where a patient complains of negligence. This can be done by appointing a "Patient Grievance Redressal Committee" in each hospital. The purpose of the inquiry held by this committee would be:
    i) To find whether there was negligence;
    ii) To determine how such negligence could have been prevented;
    iii) To act as a mediating or arbitrating body between the complainant and the hospital so that the grievance is dealt with and settled at the inception level itself.

    I have a conviction that such a committee, if it functions properly, will result in the following benefits:

    i) It will minimise legal action against the hospital at various platforms;
    ii) It will result in better patient satisfaction and reputation;
    iii) It will result in substantial savings to the hospital in litigation cost and the compensation awarded by courts.
  5. I need to make it clear that a mediation/compromise reached at through the efforts of the above committee will be payable through the indemnity insurance policy purchased by the hospital/doctor. However, when buying an indemnity policy, the buying hospital/doctor needs to ensure that there is a specific provision in the policy that it will cover any payment made as a result of compromise/arbitration.

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emedinews revisiting 2011
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  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

A/G ratio

When daylight turns to a darkened hue, The lovely stars hinting at u, ur heartbeat tells u something true, That someone IS badly missing you.

  • Globulin is increased disproportionately to albumin (decreasing the albumin/globulin ratio) in states characterized by chronic inflammation and in B–lymphocyte neoplasms, like myeloma and Waldenström’s macroglobulinemia. More relevant information concerning increased globulin may be obtained by serum protein electrophoresis.
  • Decreased globulin may be seen in congenital or acquired hypogammaglobulinemic states. Serum and urine protein electrophoresis may help to better define the clinical problem.

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    IJCP Special

Dr Good Dr Bad

Situation: A patient with dengue had itchy rash.
Dr Bad: It’s an allergy.
Dr Good: This is dengue.
Lesson: Itchy rash can be present in Dengue or Chikungunya.

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Make Sure

Situation: A 62–year–old diabetic with coronary artery disease, on treatment for the same, comes for follow up.
Reaction: Oh my God! Why did not you put him on antioxidants?
Lesson: Make Sure to add antioxidants to the prescription because of their free radical scavenging and other beneficial effects.

For comments and archives

  Quote of the Day

(Dr GM Singh)

A mountain is not higher than our confidence. It will be under our feet if we reach the top.

    Mind Teaser

Read this…………………

In ulcerative colitis with toxic megacolon, the lowest rate of recurrence is seen in

a) Complete proctocolectomy and Brook’s ileostomy
b) Ileorectal anastomoses
c) Koch’s pouch
d) Ileoanal pull–through procedure

Yesterday’s Mind Teaser: Which of the following statements is true about ulcerative colitis with malignancy?

a) It has a better prognosis.
b) Is related to disease activity.
c) Is related to duration of ulcerative colitis.
d) Malignancy is more in anorectal ulcerative colitis.

Answer for yesterday’s Mind Teaser: c) Is related to duration of ulcerative colitis.

Correct answers received from: Chanchal Das, Dr Ajay Gandhi, Dr Selva Pandian, Dr AK KELA, Muthumperumal Thirumalpillai, Dr Chandresh Jardosh, Dr Jainendra Upadhyay, Dr Thakor Hitendrasinh G, Raju Kuppusamy, Dr Surendra Bahadur Mathur, Dr Mohit Sharma, Anil Bairaria, Dr Neelam Nath.

Answer for 9th November Mind Teaser: Two peas in a pod
Correct answers received from: Muthumperumal Thirumalpillai, Dr Chandresh Jardosh, Dr Jainendra Upadhyay, Dr Thakor Hitendrasinh G, Raju Kuppusamy, Dr Surendra Bahadur Mathur.

Send your answer to ijcp12@gmail.com

    Laugh a While


Smart Bird?

His mother was now living in Miami Beach and the young man didn’t see her that often. His father was no longer around and he was worried that Mom was lonely. For her birthday, he purchased a rare parrot, trained to speak seven languages. He had a courier deliver the bird to his dear mother. A few days later, he called. "Ma, what do you think of the bird?"

"The bird was good, but a little tough. I should have cooked it longer." "You ate the bird? Ma, the bird was very expensive. It spoke seven languages!"

"Oh, excuse me. But, if the bird was so smart, why didn’t it say something when I put it in the oven?"

    Medicolegal Update

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

Immediate first aid may stop serious poisoning and may save life

In cases of poisoning, if breathing and the heart stop, the person will die within a few minutes unless first aid is given at once. Here is an action list. Each step is explained in more detail below the list. Start with the first step and follow each step in the order given. Act as quickly as you can, but stay calm.

  • Check if the patient is conscious try to make the patient wake up. Shout "Are you all right?" and gently shake the shoulders, but take care not to make any injuries worse. Pinch the skin on the neck and watch the face. A patient who is just sleeping will wake up, but an unconscious patient will not.
  • Open the airway. The airway is the tube through which air passes from the mouth and nose to the lungs. If it is blocked the patient cannot breathe and air cannot get into or out of the lungs. A patient who cannot breathe will die within four minutes. In an unconscious patient the tongue may block the throat and the airway. Make sure the airway is open and air can get down the throat. Place the patient on his or her back. Tilt the head back and lift the chin up with the finger and thumb of one hand on the bony part of the chin, while pressing the forehead back with the other hand. This will open the airway and stop the tongue blocking the throat.
  • Check whether the patient is breathing after opening the airway; quickly check whether the patient is breathing. Look for the belly or the chest moving up and down. Feel the chest moving up and down. Feel the patient’s breathe on your cheek. Listen for breath sounds. Put your ear close to the patient’s mouth. Use all four checks. Remember that the chest may move up and down even when the throat is completely blocked and air cannot get to the lungs.

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    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Diabetes mainly linked to obesity

Type 2 diabetes mellitus is strongly associated with obesity said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India. More than 80 percent of cases of type 2 diabetes can be attributed to obesity.

  1. There is a curvilinear relationship between BMI and the risk of type 2 diabetes.
  2. Lowest risk is associated with a BMI below 22 kg/m2.
  3. At a BMI greater than 35 kg/m2, the relative risk for diabetes adjusted for age increases to 61. The risk may further increase by a sedentary lifestyle or decrease by exercise.
  4. Weight gain after age 18 years in women and after age 20 years in men increases the risk of type 2 diabetes.
  5. The Nurses’ Health Study, compared women with stable weight (those who gained or lost <5 kg) after the age of 18 years to women who gained weight. Those who had gained 5.0 to 7.9 kg had a relative risk of diabetes of 1.9; this risk increased to 2.7 for women who gained 8.0 to 10.9 kg.
  6. Similar findings were noted in men in the Health Professionals Study. The excess risk for diabetes with even modest weight gain is substantial.
  7. Weight gain precedes the onset of diabetes. Among Pima Indians (a group with a particularly high incidence of type 2 diabetes), body weight gradually increased 30 kg (from 60 kg to 90 kg) in the years preceding the diagnosis of diabetes. Conversely, weight loss is associated with a decreased risk of type 2 diabetes.
  8. Insulin resistance with high insulin levels is characteristic of obesity and is present before the onset of high blood sugar levels.
  9. Obesity leads to impairment in glucose removal and increased insulin resistance, which result in hyperinsulinemia. Hyperinsulinemia contribute to high lipid levels and high blood pressure.

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    Readers Responses
  1. Dear Sir, I really enjoy reading your e–medinews as soon as I wake up in the morning. thanks for your excellent task. Indragee Amarasinghe.
    Forthcoming Events

CSI 2011

63rd Annual Conference of the Cardiological Society of India

Date: December 8–11, 2011.
Venue: NCPA Complex, Nariman Point, Mumbai 400021

Organizing Committee

B. K. Goyal – Patron
Samuel Mathew – President CSI
Ashok Seth – President Elect & Chairman Scientific Committee
Lekha Adik Pathak – Chairperson
Satish Vaidya & C. V. Vanjani – Vice Chairman
N. O. Bansal – Organizing Secretary
B. R. Bansode – Treasurer
Ajit Desai , Ajay Mahajan , G. P. Ratnaparkhi – Jt. Org. Secretaries
Shantanu Deshpande , Sushil Kumbhat , Haresh Mehta – Asst. Org. Secretaries
D. B. Pahlajani, A. B. Mehta , M. J. Gandhi , G. S. Sainani, Sushil Munsi, GB Parulkar, KR Shetty – Advisory Committee

Contact: Dr. Lekha Adik Pathak, Chairperson, CSI 2011; Dr. Narender O. Bansal, Org. Secretary, CSI 2011 Tel: 91 – 22 – 2649 0261/2649 4946, Fax: 91 – 22 – 2640 5920/2649 4946.
Email: csi2011@ymail.com, csimumbai2011@gmail.com Website: www.csi2011mumbai.com

eMedinewS Events: Register at emedinews@gmail.com

3rd eMedinewS Revisiting 2011

The 3rd eMedinewS – revisiting 2011 conference will be held at Maulana Azad Medical College, New Delhi on Sunday January 22nd 2012.

The one–day conference will revisit and cover all the new advances in the year 2011. There will also be a webcast of the event. An eminent faculty is being invited to speak.

There will be no registration fee. Delegate bags, gifts, certificates, breakfast, lunch will be provided. The event will end with a live cultural evening, Doctor of the Year award, cocktails and dinner. Kindly register at www.emedinews.in

3rd eMedinewS Doctor of the Year Award

Dear Colleague, The Third eMedinews “Doctor of the Year Award “ function will be held on 22nd January, 2012 at Maulana Azad Medical College at 5 pm. It will be a part of the entertainment programme being organized at the venue. If you have any medical doctor who you feel has made significance achievement in the year 2011, send his/her biodata: emedinews@gmail.com

    eMedinewS Special

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

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

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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  Playing Cards

  Dadi Ma ke Nuskhe

  Personal Cleanliness

  Mental Diseases

  Perfect Health Mela

  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein

  How to Use

  Pesticides Safely

    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