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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

  Editorial …

12th May 2011, Thursday                                eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

eMedinewS Wishes All its readers Happy International Nurses Day

Belly fat + heart disease can be deadly: Study

Even normal–weight abdominal obesity and heart disease has an increased risk of death compared to obesity where fat is concentrated elsewhere. It is as significant a risk factor as smoking a pack of cigarettes a day or having very high blood cholesterol. And the risk is greater for men. BMI is just a measure of weight in proportion to height. What seems to be more important is how the fat is distributed on the body. The study is published in the May 10 issue of the Journal of the American College of Cardiology.

The researchers looked at data from five studies conducted around the world, involving almost 16,000 people with coronary artery disease. The risk of death was nearly doubled for people with coronary artery disease and central obesity, which was determined by waist circumference and waist–to–hip ratio.

Visceral (belly) fat has been found to be more metabolically active. It produces more changes in cholesterol, blood pressure and blood sugar. However, people who have fat mostly in other locations in the body, specifically the legs and buttocks, don’t show this increased risk.

Dr KK Aggarwal
Editor in Chief
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    Changing Practice – Resource which has changed practice in last one year

Tdap vaccination

The US Advisory Committee on Immunization Practices (ACIP) voted to recommend that a single dose of Tdap vaccine may be given in place of Td for adults aged 65 years and older who have not previously received Tdap.

  eMedinewS Audio PostCard

Rheumatoid arthritis Update

Dr Harvinder S Luthra Speaks on
‘Diagnosis of RA: RF and Anti CCP antibodies’

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)


Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal delivering a lecture at Delhi Public School, RK Puram.

Dr K K Aggarwal
    National News

Centre to curb colleges of traditional medicine

To prevent mushrooming growth of Ayurveda, Siddha, Unani ( ASU) and Homoeopathic medical colleges, the Centre has decided to raise the parameters for recognition of medical colleges and decided to stop fresh admissions in Homeopathy medical colleges for the year 2011–12 which do not fulfil the requirements of infrastructure. The AYUSH Department in the Ministry of Health and Family Welfare has come out with new norms for recognition of medical colleges. To ensure the quality education, the AYUSH Department has decided to restrict the recognition of Homoeopathic medical colleges for year–to–year basis. "The norms for recognition of medical colleges would be notified by the year–end after consultations with the state governments," AYUSH secretary Anil Kumar said. He said that the Ayurveda, Unani and Siddha colleges would need 90 percent of total requisite faculty as per the new parameters. Currently, the colleges with 80 percent faculty were getting recognition. He said that as per the new parameters, at least one teacher in all the 14 departments and 50 percent faculty availability at higher level is must for recognition of colleges. Pitching in for stringent measures to check false claims of colleges, Anil Kumar said that regular checking of the registers of OPD of the colleges would be carried out. He said that the AYUSH Department has proposed to set up ‘Centre for Unani’ at Hyderabad during the 12th five year plan period. (Source: Indian Express, May 11, 2011)

60% TB dosages in India defy treatment norms

Almost 60% of dosages being prescribed to patients suffering from Tuberculosis — the world’s most infectious disease — in India don’t correspondent with standard TB treatment guidelines. The figure is nearly twice the average of nine other countries that have a high burden of TB. Researchers have found that there were 70 different first–line TB drug dosages and combinations prevalent in India’s private sector. However, only 14 were necessary. According to a study on the private TB drug market — published in the latest edition of the medical journal PLoS ONE — TB patients being treated by private doctors in India might be facing a grave risk of developing drug–resistant TB. The study was conducted by the Global Alliance for TB Drug Development in 10 high–burden countries, including India, where an audit of 4,600 physicians was carried out. The findings said more than one–third (35%) of all TB treatment in the private sector fall outside the national and international treatment recommendations and constitute non–recommended strengths. (Source: TOI, May 6, 2011)

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 Rajat Bhatnagar, International Sports & Fitness Distribution, LLC)

To feel better, exercise harder: Study

Vigorous exercise offers more of a mood boost than less strenuous exercise, a new study finds. U.K. researchers compared 11 sedentary people who did moderate and high–intensity exercise. Their mood was assessed before, during, immediately following, and 20 minutes after they did the workouts. The participants’ moods were more negative during and immediately after high–intensity exercise, compared to when they did the less strenuous exercise or no exercise. However, their mood 20 minutes after doing the vigorous workout was much better compared to before the workout. This type of improvement did not occur after moderate or no exercise, the investigators found.

(Dr Monica and Brahm Vasudev)

ACE inhibition with ramipril may reduce rate of renal events among patients with proteinuria

ACE inhibition with ramipril reduced the rate of renal events among patients with proteinuria in all body mass index strata, but the effect was greater among obese patients, according to the results of a post hoc analysis published online April 28 in the Journal of the American Society of Nephrology.

Anti–leukotrienes as good as standard asthma therapy

In the "real world" of asthma treatment, leukotriene–receptor agonists may be just as effective as the gold standard of inhaled glucocorticoids as both a first–line and add–on therapy. Two real–life trials found the drugs were equivalent as monotherapy in symptom reduction at two months and approached equivalence at two years, according to David Price, MD, of the University of Aberdeen in Scotland, and colleagues. (May 5 issue of the New England Journal of Medicine)

(Ms Seema Wilson, Nursing Superintendent, Mool Chand MedCity, New Delhi)

History of Nurses Day

The history of Nurses Day can be traced back to 1953 when Dorothy Sutherland of the US Department of Health, Education, and Welfare sent a proposal to President Eisenhower to proclaim a "Nurse Day" in October of the following year. The proclamation was never made, but the following year National Nurses Week was observed from October 11 – 16, marking the 100th anniversary of Florence Nightingale’s mission to Crimea.

In 1974, President Nixon proclaimed a "National Nurse Week." In 1981, a resolution was initiated by nurses in New Mexico to have May 6th declared "National Recognition Day for Nurses." This proposal was promoted by the ANA Board of Directors and in 1982, with a joint resolution, the United States Congress designated May 6th to be "National Recognition Day for Nurses." The proposal was signed by President Reagan, making May 6 the official "National Recognition Day for Nurses." It was later expanded by the ANA Board of Directors in 1990 to a week–long celebration (May 6–12) known as "National Nurses Week." National Student Nurses Day is celebrated each year on May 8th. At the request of the National Student Nurses Association, the ANA Board of Directors designated May 8th as National Student Nurses Day beginning in 1998. And as of 2003, the ANA has declared that National School Nurse Day is celebrated on the Wednesday within National Nurses Week.

International Nurses Day is celebrated around the world on May 12th of each year. The International Council of Nurses (ICN) commemorates this day each year with the production and distribution of the International Nurses’ Day Kit which includes educational and public information materials for use by nurses everywhere. The ICN has celebrated International Nurses Day since 1965. National Nurses Day, also known as National RN Recognition Day, is always celebrated on May 6th and opens National Nurses Week. National Nurses Week begins each year on May 6th and ends on May 12th, the birth date of Florence Nightingale.

Activities during National Nurses Week typically include banquets and recognition dinners, state and city proclamations, continuing education seminars, and other community events. Nurses are typically honored with gifts, dinners, and flowers by friends and family members, coworkers such as doctors and administrators, and patients who want to show their appreciation. International Nurses Day is May 12, the anniversary of the birth of Florence Nightingale, who is most often considered the founder of modern nursing. The ICN (International Council of Nurses) has celebrated International Nurses Day since 1965.

"Nurses dispense comfort, compassion, and caring without even a prescription."
"Comfort provided by a Nurse is comfort provided by God himself."

On this auspicious occasion of Nurses Day, on behalf of the entire Nursing Department of MoolChand MedCity, I take this opportunity to wish all the nurses for their compassion and hard work they do.

    Spiritual Update

Hanuman Chalisa

Bhim Roop Dhari Asur Sanhare
Ramchandra Ke Kaaj Savare

Meaning: You killed the demons with a gigantic form. In this way you always serve Lord Rama and perform all his work.

Spiritual Significance: Practicing Pranayama also gives one powers to fight the demons. Demons are the negative thoughts full of desires and ego. During Chakra Pranayama one gets these powers. One also gets all the powers of soul.

    IJCP Special

Dr Good Dr Bad

Situation: A 63–year–old male with pneumonia was admitted with blood urea of 44 mg/dL.
Dr Good: You need OPD treatment.
Dr Bad: You need ICU admission.
Lesson: Patients with a CURB–65 score of 0 to 1 could probably be treated as outpatients, those with a score of 2 should be admitted to the hospital, and those with a score of 3 or more should be assessed for ICU care, particularly if the score was 4 or 5. (Thorax 2003;58:377–82)

Make Sure

Situation: A diabetic patient’s wound was not healing.
Reaction: Oh my God! Why is his A1c still more than 8.
Lesson: Make sure to control diabetes in such cases. Every 1% increase in hemoglobin A1c was associated with almost a 0.03 cm2 reduction in daily rate of wound resolution.

    An Inspirational Story

(Dr Prabha Sanghi)

Professor Ernest Brennecke of Columbia is credited with inventing a sentence that can be made to have eight different meanings by placing just ONE WORD in all possible positions in the sentence: "I hit him in the eye yesterday."

The word is "ONLY".

1. ONLY I hit him in the eye yesterday. (No one else did.)
2. I ONLY hit him in the eye yesterday. (Did not slap him.)
3. I hit ONLY him in the eye yesterday. (I did not hit others.)
4. I hit him ONLY in the eye yesterday. (I did not hit outside the eye.)
5. I hit him in ONLY the eye yesterday. (Not other organs.)
6. I hit him in the ONLY eye yesterday. (He doesn’t have another eye..)
7. I hit him in the eye ONLY yesterday. (Not today.)
8. I hit him in the eye yesterday ONLY. (Did not wait for today.)
This is the beauty and complexity of the English language.

    Pediatric Update

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

Is MMR vaccine contraindicated in a child with egg allergy?

No, with the current available vaccine of MMR, it is not a contraindication to give in a child with egg allergy.

    Infertility Update

(Dr. Kaberi Banerjee, Director Precious Baby Foundation)

What are the prerequisites of an ART centre?

A designated overall practice director, medical director, and laboratory director. One individual may fulfill more than one of these positions, but the medical director must be a licensed physician.There should be clinicians trained in Embryology, Ultrasonology as well as Nurse Practitioner and Counselor.

    Medicolegal Update

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

Should a doctor perform CPR in already injured chest patient?

When a person is in need of CPR, it means that the person is in cardiac arrest. This is to say that they are unconscious, not moving, not breathing normally. If this is the case, they are presumably in cardiac arrest or in a state that justifies Cardio Pulmonary Resuscitation.

  • If the person is awake, is breathing normally and therefore does not appear to need CPR, it would be correct that chest compressions and CPR may complicate the already damaged chest and further complicate the victim’s injuries.
  • As soon as the victim becomes unconscious, is not breathing normally and now appears to need CPR, Emergency Services would be contacted and CPR would be initiated regardless of the injuries of the patient.
  • If the person needs CPR, this means that they are clinically dead. If the victim does not receive CPR, they will simply graduate to permanent death.
  • This is why, regardless of the chest injury, if the person is "dead" or in need of CPR, compressions are to be given per the American Heart Association (AHA) guidelines even if the complications could include those of punctured lungs, lacerated organs, or bruised/punctured heart muscle. These injuries must be recorded in clinical sheet.
  • This would be based on the theory that a person in need of CPR is already dead and will not be harmed more even if there are negative side effects from providing chest compressions. If a person remains dead, surgery is not an option but if the person is resuscitated with CPR, and alive at the hospital, we have an opportunity to fix the injuries that may have been aggravated by doing CPR.
    Gyne Update

(Dr Maninder Ahuja, Secretary General IMS)

Patient is on systemic therapy for atrophic vaginitis. Can she still have symptoms of vaginitis?

Yes, as the (systemic) dose sufficient to control vasomotor symptoms may not be the right dose for vaginal atrophy.

The new trend is low dose for the shortest time. That might be sufficient for systemic issues, but very often we see that the vaginal tissue, veins, arteries, nerves and tissues need local HT to improve. So the systemic therapy might be controlling one aspect, we have to add on local estrogenic creams or tablets or rings, and if there are no more vasomotor symptoms, only local hormones should be used.

This discussion would continue. Please send your feedbacks.

    Twitter of the Day

@DrKKAggarwal: For every 100 units (2.5 mcg) of added vitamin D3, serum 25OHD concentrations increase by approximately 0.7 to 1.0 ng/mL

@DeepakChopra: The often misdiagnosed Celiac Disease is the subject of my Health Tip this week

    Obesity Update

Dr. Parveen Bhatia and Dr. Pulkit Nandwani

Obesity in Pregnancy – National Health Service Guidelines

All pregnant women with a booking BMI >30 should be provided with accurate and accessible information about the risks associated with obesity in pregnancy and how they may be minimised. Women should be given the opportunity to discuss this information.

A Swedish population–based observational study of 151,025 women examined the association of change in BMI between successive pregnancies with adverse outcomes during the second pregnancy. The risk of pre–eclampsia, gestational diabetes mellitus (GDM), large–for–gestational–age babies, caesarean section and stillbirth was linearly related to interpregnancy weight gain.

Interpregnancy weight reduction among women with obesity has been shown to significantly reduce the risk of developing GDM. A population–based cohort study of 4102 non–diabetic women with maternal obesity prior to their first singleton pregnancy found that a weight loss of at least 4.5 kg before the second pregnancy reduced the risk of developing GDM by up to 40%.

    Mind Teaser

Read this…………………

What happens only in the middle of each month, in all of the seasons, except summer and happens only in the night, never in the day?

Yesterday’s Mind Teaser: Which of the following is correct regarding Wernicke’s Encephalopathy?

a. Often develops into Korsakof’s even when treated.
b. It has a mortality rate of 70% to 80% if untreated.
c. The treatment is thiamine 100 mg. PO daily for 5 days.
d. The symptoms include nystagmus, ataxia and opisthotonus.
e. None of the above

Answer for Yesterday’s Mind Teaser: d.

Correct answers received from: Dr Shirish Singhal, Dr K Raju, Dr Muthumperumal Thirumalpillai,
Dr Manju, Dr Anupama, Dr Ketan, Dr Ratan.

Answer for 10th May Mind Teaser
: c
Correct answers received from: Dr Vijay Kansal, Dr D Chatterjee, Dr Karan, Dr Pooja.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)


As an instructor in driver education at the local area High School, I’ve learned that even the brightest students can become flustered behind the wheel. One day I had three beginners in the car, each scheduled to drive for 30 minutes.

When the first student had completed his time, I asked him to change places with one of the others. Gripping the wheel tightly and staring straight ahead, he asked in a shaky voice, "Should I stop the car first?"

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Serum calcium

Hypocalcemia (or low serum calcium level) must be interpreted in relation to serum albumin concentration (Some laboratories report a "corrected calcium" or "adjusted calcium" which relate the calcium assay to a normal albumin. The normal albumin, and hence the calculation, varies from lab to lab). True decrease in the physiologically active ionized form of Ca++ occurs in many situations:

  • Hypoparathyroidism
  • Vitamin D deficiency
  • Chronic renal failure
  • Magnesium deficiency
  • Prolonged anticonvulsant therapy
  • Acute pancreatitis
  • Massive transfusion
  • Alcoholism

Drugs producing hypocalcemia include most diuretics, estrogens, fluorides, glucose, insulin, excessive laxatives, magnesium salts, methicillin, and phosphates.

    Medi Finance Update

(Dr GM Singh)

Saving to Income Ratio

                                                                Total monthly saving
Saving to income ratio = --------------------------------------------------
                                                                Total monthly income

You should save at least 20% of your monthly income and invest.

    Drug Update

List of approved drugs from 01.01.2010 to 31.8.2010

Drug Name
DCI Approval Date
Imipenem 50mg + Cilastatin 50mg
Treatment of infection caused by susceptible bacteria for the following indication as in neonates and infants (below 3 months of age) 1. Lower respiratory tract infections 2. Urinary tract infections 3. Intra–abdominal infections 4. Bacterial septicemia 5. Bone and joint infections 6. Skin and Skin structure infections 7. Bacterial endocarditis
    IMSA Update

International Medical Science Academy (IMSA) Update

Preoperative antisepsis with chlorhexidine–alcohol is superior to providone–iodine

Chlorhexidine should be used preferentially for preoperative antisepsis in clean–contaminated surgery. In a systemic review of six studies involving more than 5000 patients, chlorhexidine reduced postoperative surgical–site infection compared with povidone–iodine (pooled odds ratio 0.68, 95 percent confidence interval 0.50 to 0.94; p = 0.019).

  Thought of the Day

(BK Sapna)

Where there is determination there is success.

Think of all that you wanted to achieve in the past few days. Now check if you have achieved it or are still trying for it. Check if you have left anything midway. Pick out one of the things that you wanted to achieve or create an aim for yourself and think, "I am the one who is victorious and I will achieve whatever I set out to. I will not leave any task unfinished."

    Readers Responses

Dear Sir, I have been enjoying your very useful, informative, educative and very regular eMedinews for the past several months. Thank you very much for the uninterrupted mailing of the same. Thank you once again. With regards: Dr. Manjesha

    Public Forum

(Press Release for use by the newspapers)

Obesity is a Disease & Needs Medical Supervision

As per the international guidelines "obesity is a disease" and needs to be treated under strict medical supervision, said Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal and President, Heart Care Foundation of India.

All patients who are overweight (BMI >27 kg/m2) or obese (BMI >30 kg/m2), should receive counseling on diet, lifestyle, and goals for weight loss.

Patients with a BMI of 25 to 29.9 kg/m2 who have an increased waist circumference (>40 inches/102 cm in men or >35 inches/88 cm in women) or those with a BMI 27 to 30 kg/m2 with co–morbidities deserve the same consideration for obesity intervention as those with BMI >30 kg/m2.

For patients who have failed to achieve weight loss goals through diet and exercise alone, one should go for pharmacologic therapy. The drug options are Metformin, Sibutramine, Orlistat and Rimonabant.

For obese patients with elevated blood pressure, cardiovascular disease, or dyslipidemia, one should use orlistat as first–line drug therapy given its excellent cardiovascular safety profile and beneficial effects on lipid profiles. For otherwise healthy obese patients, one should use sibutramine given its efficacy and easy tolerability.

For patients with type 2 diabetes, in addition to lifestyle modifications, one should use metformin both for glycemic control, and for modest weight reduction. If the diabetic patient has coexisting hypertension, one should not use Sibutramine.

Both orlistat and rimonabant can be added to diabetics. Sibutramine and orlistat should not be combined.

For patients with BMI 40 kg/m2 who have failed diet and exercise (with or without drug therapy) or for patients with BMI >35 kg/m2 and obesity–related co–morbidities (hypertension, impaired glucose tolerance, diabetes mellitus, dyslipidemia, sleep apnea), one should consider bariatric surgery.

    eMedinewS Special

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

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

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

Activities eBooks


  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

    Forthcoming Events

September 30th to October 2nd, 2011, Worldcon 2011 – XVI World Congress of Cardiology, Echocardiography & Allied Imaging Techniques at The Leela Kempinski, Gurgaon (Delhi NCR), India

A unique & highly educative Pre–Conference CME, International & national icons in the field of cardiology & echocardiography will form the teaching faculty.
• Provisional Scientific Program at http://worldcon2011.org/day1.html
• Provisional program for Pre Congress CME at http://worldcon2011.org/Pre_Conference_CME.html
• Abstract submission at http://worldcon2011.org/scientificprogram.html
• Important dates at http://worldcon2011.org/importantDates.html
• Congress website at http://www.worldcon2011.org
• Entertainment – Kingdom of Dreams at http://worldcon2011.org/Pre_Post_Tours.html

Key Contacts
Dr. (Col.) Satish Parashar, President Organizing Committee, + 91 9810146231
Dr. Rakesh Gupta, Secretary General, + 91 9811013246

Congress Secretariat: Rajat Khurana, C–1 / 16, Ashok Vihar – Phase II, Delhi 110 052, INDIA., Phone: + 91–11–2741–9505, Fax: + 91–11–2741–5646, Mobile: + 91 9560188488, 9811911800,
Email: worldcon2011@gmail.com, jrop2001@yahoo.com, worldcon2011@in.kuoni.com


Medifilmfest (1st International Health Film Festival in Delhi)

October 14–23, 2011, As part of 18th MTNL Perfect Health Mela 2011(Screening of films October 14–17, Jury Screening at Jamia Hamdarad University Auditorium October 18–19, award winning films at TalKatora Stadium October 19–23, 2011)
Organized by: Heart Care Foundation of India, World Fellowships of Religions, FACES, Bahudha Utkarsh Foundation and Dept of Health and Family Welfare Govt of NCT of Delhi.
Entries Invited: from feature films, Ad Films, Serials, Documentary Films, Cartoon Films, Animation Films, Educational films; films on Yoga, Siddha, Ayurveda, Unani, Homeopathy; Indigenous Healing, Films promoting the Bio–cultural Diversity, Medical Tourism, Visual and Medical Anthropology, Gender sensitization, awareness drive on socio–medical issues and health journalism. The films can be of variable durations (0–1 minute, upto 3 minutes, upto ten minutes, upto 45 minutes and upto an hour and beyond).
Separate entries are also invited for "factual mistakes in feature films concerning health". This can be in the form of 1–5 minutes footages.

Categories:Competitive category/ Non Competitive category/ Special screening
Sub Categories:

1. General: Documentaries, animation films, corporate films, Ad films, TV health programs/reports, health chat shows.

2. Special: Short instances of "depiction of wrong health messages" through the films.

Subjects: Health, disease, sanitation, yoga, spiritual health, environment, social issues, food, better living, Indigenous healing, medical tourism, visual & medical anthropology, gender sensitization, health journalism. Duration: 0–10 seconds; <30 minutes, 30–60 minutes, 1–3 hours. Language: English or Hindi, or sub tilled in English/Hindi. Fee: No fees from participants. Entry to the film show free. Format: Any format duly converted into DVD (compatible to the latest players/systems) Boarding, Lodging and Travel Expenses: Own, the participants may raise their own sponsorships

For details contact: Dr KK Aggarwal/Dr Kailash Kumar Mishra/Mr M Malik at


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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 Naveen Dang, Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr Rajiv Parakh, Dr Sudhir Gupta