emedinews
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FIRST NATIONAL 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 and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR

 

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eMedinewS Presents Audio News of the Day

Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of Workshop on Stress Management and How to be Happy and Healthy

 
    Dr KK Aggarwal on Social Media …


DR KK Aggarwal on Doctor Bhagwan Hai ya Shaitan
ASAR–Aamir Khan And Dr KK Aggarwal on Satyamev Jayate

 

 
  Editorial …

12th June 2012, Tuesday

New treatment for acute asthma in children

According to a randomized controlled, double–blind study by Dorit Ater, MD, from Tel Aviv University in Israel, and colleagues published in May 21 in the journal Pediatrics, the use of hypertonic saline inhalations with albuterol (salbutamol) among preschool children with acute wheezing is associated with lower hospital admission rates and shorter hospital stays but is not linked with improved clinical scores. The use of HS treatment with albuterol given to acutely wheezing children in the emergency department comprises 4 mL of HS 5% given with albuterol twice, every 20 minutes.

This was the first study to examine HS treatment in preschool children (32 ± 17 months of age) with a wheezing episode. Most wheezing episodes causing hospitalization or emergency department visits in preschool children are associated with viral respiratory tract infections.

The most common viruses are rhinoviruses, detected in the lower airways and leading to lower airway inflammation. Hypertonic saline (HS) 5% may reverse some of the pathophysiologic abnormalities attributed to virus–induced acute wheezing episodes in small children because of promucus clearance and prohydration.

For Comments and archives…

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

Confederation of Associations of Medical Specialties of India (CAMSI)

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

World Earth Day 2012

Students of Delhi Public School presented a beautiful skit on the occasion of the World Earth Day celebration at DPS Mathura school premises. The event was jointly organized by Heart Care Foundation of India, Delhi Public School and Ministry of Earth Sciences.

 
Dr K K Aggarwal
 
    National News

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 re build the image of the medical profession.

For comments and archives

A MILESTONE IN THE SERVICE OF THE COMMUNITY BY THE ROTARY CLUB OF DELHI CHANAKYAPURI (RI DISTRICT 3010)

In the year 1978, I was given the charge of the Physically Handicapped Committee of Rotary Club of Delhi Chanakyapuri as its Chairman by the then President of the Club, Rtn. Raj Khullar.

I comprehended that the term Physically Handicapped embraces a very vast array of challenging conditions like visual, hearing, mobility etc., and therefore it would have been a futile attempt to address all of them.

Therefore, it occurred to me that a dreaded disease called Poliomyelitis was causing havoc to infants and children in Delhi resulting in large number of deaths and permanent paralytic disorders of the limbs in the surviving children.

Although, there is, even to date, no medical cure available for this awful condition, an excellent oral vaccine had been invented in Russia which offers total immunity from the disease.

As a doctor, the dictum ‘Prevention is better than the Cure’, is always in the forefront of the mind. Thus I approached the then largest children’s hospital in Delhi, the ‘Kalawati Saran Children’s Hospital’ and I was told that the Institution gets nearly 8,000 cases of Poliomyelitis every year from a nearby area in Pahargunj, New Delhi called Nabikarim.

I proposed to offer the services on behalf of the Community Service Avenue of the Rotary Club of Delhi Chanakyapuri in vaccinating the infants and children in the above mentioned area which was the hotbed of poliomyelitis. This offer was immediately accepted by the authorities of the hospital who even provided some staff to help us conduct this marathon vaccination programme by going from door to door to motivate and vaccinate the infants and children. As is the case with all new drives, we met with resistance and suspicion. This did not deter us and we completed our job in 2–3 days.

The result, a year later in 1979, the hospital reported only one case of Poliomyelitis from the same Nabikarim from where earlier thousands of cases used to come every year. On further enquiry we found that the affected baby’s mother had hidden the infant from us when we came for administering the oral vaccine as she was apprehensive that it may cause some fatal side effects.

The Rotary International District 309 in 1980 recognised the efforts and awarded ‘Outstanding Rotarian’ award to me during the District Conference held at Srinagar, Kashmir in the year 1980.

The Union Ministry of Health and Family Welfare also took cognizance of our efforts and appointed me the Honorary Advisor to the Ministry for their Polio Eradication Project for the year 1979–80.

A point to highlight, if I may call it so, is that the Rotary Club of Delhi Chanakyapuri thought of and executed the Polio Eradication years before the Rotary International Conceived the Idea. No doubt our effort was in a mini scale but it was a small beginning.

I take this opportunity to thank the authorities of the Kalawati Saran Children’s Hospital for the assistance extended to us.

PP Rtn Dr. Sandip Mukerjee, President (1985–86), Rotary Club of Delhi Chanakyapuri, RI District 3010.

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

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Miltefosine losing its edge against leishmaniasis in India

Public health authorities in India who distribute miltefosine to treat visceral leishmaniasis are misusing the drug, according to researchers from that country and Belgium. As a result, miltefosine -- the only oral first-line drug for this condition - appears to be slowly losing its effectiveness, they say. Final cure rates fell from 94% in 2000 to 90% in 2010, while relapses more than doubled to 6.8%, the research team reported online May 9th in Clinical Infectious Diseases. Miltefosine monotherapy for kala azar (leishmaniasis) was approved in India in 2002. In 2010, the World Health Organization advised that miltefosine be given only in combination with other drugs. And for patients in the Indian subcontinent with leishmaniasis, the WHO recommended liposomal amphotericin B alone in a single dose of 10 mg/kg, or liposomal amphotericin B 5mg/kg on day 1 followed either by miltefosine for 7 days or paromomycin for 10 days, or a combination of miltefosine and paromomycin for 10 days. In India, in the meantime, miltefosine monotherapy was available over the counter from 2002 to 2006, "with many incomplete dosages and poor adherence," according to the new report by Professor Shyam Sundar from the Kala Azar Medical Research Center at Benares Hindu University in Varanasi and colleagues. Currently the drug is available only at public hospitals, which dispense a one-week supply. (Source: Medscape)

For Comments and archives…

Some rapid Hep B screening tests highly accurate

Antigen-based point-of-care tests for hepatitis B infection are generally very accurate, but the sensitivity of antibody-based tests needs to be improved, according to the results of a meta-analysis of global data. In particular, Determine (Alere; Waltham, Massachusetts) and Binax NOW (Binax; Portland, Maine) had high sensitivity and specificity, the researchers found. "The result of this meta-analysis suggests that these tests could be potentially used in first-line screening initiatives for marginalized populations, and for resource limited settings," they reported in the American Journal of Gastroenterology online May 29. (Source: Medscape)

For Comments and archives…

Lifestyle vies with heredity in centenarian stakes

Genetics may be the best predictor of longevity, but lifestyle choices, including staying connected with family and friends, are key components to reaching the age of 100, according to a new poll. More than 80% of 100 men and women who have already hit the milestone said being socially active had helped them get there, and a similar number of baby boomers believe it will help them reach their 100th birthday. (Source: Medscape)

For Comments and archives…

Progression in colorectal carcinomatosis may not rule out cure

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis (PC) from colorectal cancer can be undertaken with a curative intent even if neoadjuvant systemic chemotherapy was unsuccessful, European researchers say. Some institutions consider progression despite neoadjuvant therapy to be an absolute contraindication to surgery and HIPEC, the researchers said in their May 10th online paper in the Annals of Surgery. (Source: Medscape)

For Comments and archives…

Study shows even little kids can be cutters

Children as young as 7-years-old report cutting and burning themselves in nonsuicidal self-injury (NSSI), researchers reported. (Source: Medpage Today)

For Comments and archives…

 
    Twitter of the Day

@DrKKAggarwal: 4th Asia Pacific Vascular Intervention Course–Excerpts from a Panel discussion blog.kkaggarwal.com/2012/06/10/4th…

@DeepakChopra: If love is the only reality & our biggest priority, what do I do with unrequited love?

 
    Spiritual Update

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

Bhaja Govindam Bhaj: Meaning "To Love, Adore, Enjoy, Make Love To, To Worship, To Share

Bhaja Govindam, a musical Sanskrit manual was composed by the great Hindu saint and philosopher Adi Shankaracharya. He described events as "samskara" that everyone has to go through in this life and how to escape the "life and death" by seeking Lord Govinda, the GOD. The book was written for the common man in simple verses that can be chanted by anyone.

For Comments and archives…

 
    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

How is an ART program selected?

Important points that should be considered when selecting an ART program for consideration include the qualifications and experience of the personnel, types of patients being treated, support services available, cost, convenience, live birth rates per ART cycle started, and multiple pregnancy rates.

For Comments and archives…

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

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

Equipment for Transfusion

It is desirable for the medical staff of the transfusion service to participate in the assessment and selection of transfusion equipment and ensure that such items are included in the facility’s quality assurance program. Devices such as blood warmers, infusion pumps, or special filters should be evaluated for performance specifications before being used and should be monitored regularly throughout the facility to identify malfunctions or unapproved use. This characteristically requires cooperation among personnel of several hospital departments, including transfusion medicine, nursing, quality assurance and clinical engineering.

For Comments and archives…

 
    An Inspirational Story

(Ms Ritu Sinha)

Just Listen

I suspect that the most basic and powerful way to connect to another person is to listen. Just listen. Perhaps the most important thing we ever give each other is our attention. And especially if it’s given from the heart. When people are talking, there’s no need to do anything but receive them. Just take them in. Listen to what they’re saying. Care about it. Most times caring about it is even more important than understanding it. Most of us don’t value ourselves or our love enough to know this. It has taken me along time to believe in the power of simple saying, "I’m so sorry," when someone is in pain. And meaning it.

One of my patients told me that when she tried to tell her story people often interrupted to tell her that they once had something just like that happen to them. Subtly her pain became a story about themselves. Eventually she stopped talking to most people. It was just too lonely. We connect through listening. When we interrupt what someone is saying to let them know that we understand, we move the focus of attention to ourselves. When we listen, they know we care. Many people with cancer can talk about the relief of having someone just listen.

I have even learned to respond to someone crying by just listening. In the old days I used to reach for the tissues, until I realized that passing a person a tissue may be just another way to shut them down, to take them out of their experience of sadness and grief. Now I just listen. When they have cried all they need to cry, they find me there with them.

This simple thing has not been that easy to learn. It certainly went against everything I had been taught since I was very young. I thought people listened only because they were too timid to speak or did not know the answer. A loving silence often has far more power to heal and to connect than the most well intentioned words.

For Comments and archives…

 
   Cardiology eMedinewS

Targeted lifestyle changes may lower future diabetes burden Read More

ACC President Comments on Congress’s Vote Passing FDA User Fee Bill
Read More

Is type 2 diabetes different in kids? Read More

 
   Pediatric eMedinewS

CT scan on kids triples risk of developing cancer Read More

Efficacy of teen alcohol screening tool unclear Read More

Gains in social skills have ‘spillover’ effects on language Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A diabetic with cancer came for chemotherapy.
Dr Bad: Diabetics have good response to chemotherapy.
Dr Good: Diabetics respond poorly to chemotherapy.
Lesson: Diabetes is associated with an increase in mortality and poor response rates to cancer chemotherapy (Int J Diab Dev Ctries 2007;27:122–8).

For comments and archives

Make Sure

Situation: A patient on gentamicin developed polyuria on 7th day. He developed renal failure on 9th day.
Reaction: Oh my God! Why was gentamicin toxicity not suspected when the urine output increased?
Lesson: Make sure that all patients on gentamicin are observed for renal toxicity. The first indication is increased urinary output.

For comments and archives

 
  Legal Question of the day

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

Q. Is it legal for a hospital to have a path lab where tests are done and reports are signed by technicians?

Ans.

  • No. It is not legal because of the following reasons:
    • As per the IMC Act, 1956, and the affidavits submitted to HCs by the MCI and relied by the HCs, running a path lab amounts to practice of pathology, which is a specialist discipline and can be practiced only by a person having a specialist qualification in pathology.
    • Certain states, including Maharashtra and Madhya Pradesh, have in the past passed orders asking the state machinery to seal path labs run by technicians.
  • Court judgment:
    • The leading judgment in this connection is titled as Association of Pathologist & Ors v. Secretary Health & Ors., delivered by a two judge bench of the Gujarat HC on 17 September 2010.
    • The main writ petition was filed in 1998 by the Association of Pathologists for prohibiting the 5th respondent United Clinical Laboratory, Kalanala, Bhavnagar and other persons from running laboratory of pathology in the State of Gujarat with further prayer to direct other respondent Officers of the State to take legal and criminal action against the persons who are running laboratory of pathology without requisite qualifications. Thus, a prayer was made to ensure that no such laboratory is allowed to operate without qualified pathologists. Subsequently, North Gujarat Pathologists Association, North Gujarat Pathologists Association and Gujarat Association of Pathologist and Microbiologist also filed separate writ petitions on similar grounds. Two petitioners filed separate petitions in favour of the lab technicians.
    • The judgment is summarized in para 33 as follows:

      "33. We accordingly hold that the Laboratory Technicians being not Pathologists cannot run any laboratory independently. They cannot directly give any report to any patient or any other individual, or to any institution or practicing doctor, without the authentication of the same by the pathologist registered with the Medical Council. Though it is open to any person or institute to run a pathology laboratory, but no report can be issued without the signature or counter signature of the practicing pathologist recognized by the Medical Council of India. The respondents are directed to ensure that no pathology laboratory is run by any unqualified person or institute having no recognized pathologists registered with the Medical Council. However, if such pathological laboratory is run by a pathologist registered with the Medical Council, or if such pathological laboratory engages a pathologist registered with the Medical Council, the respondents may allow such laboratory to run. Individual Laboratory Technician cannot be allowed to run pathological laboratory independently without engaging a pathologist registered with the Medical Council."
    • The counsel for the Gujarat medical Council relied upon and the Gujarat High Court noted with approval the following from a judgment of a division bench of the Madhya Pradesh High Court in the case of Smt. Kamla Patel vs. State of MP, reported in AIR 2007 MP 1925, wherein the Court decided the issue in question and held as follows:–

      "13. The aforesaid analysis of the provisions of the law prescribing the profession or technical qualifications necessary for the practice of medicine and the law prescribing the qualifications for running a pathology laboratory would show that laboratory technicians registered as a paramedical practitioner under the Adhiniyam, 2000, cannot sign or authenticate any pathological test/report or certificate and he can only assist the pathologist registered in the State Medical Register as a medical practitioner in carrying out the technical tests in the pathology laboratory. In other words, a laboratory technician registered as a paramedical practitioner under the Adhiniyam, 2000 can only assist the pathologist in the technical tests in a pathology laboratory in the State of Madhya Pradesh, but he cannot sign or authenticate any certificate or test report relating to pathology and such certificate or test report can only be signed and authenticated by a pathologist having the required qualification such as MBBS, MD or other degrees as mentioned in the Act, 1956, and also registered as a medical practitioner in the State Medical Register under the Adhiniyam, 1987."
    • The Gujarat High Court allowed the writ petition filed by the Association of Pathologists, along with similar other petitions, and dismissed the others. In doing so, the court did not lay new ground. The judgment was on the same lines as the MP High Court judgment. The importance of this judgment lies in the fact that various High Courts (MP, Bombay, Nagpur, Gujarat) have deliberated on the issue and given consistently similar judgments. However, the MP HC judgment has been appealed in the SC. The SC judgment is likely to be on similar lines.
    • It is interesting to note that the lab technicians advanced the argument that the National Accreditation Board for Testing and Calibration Laboratories recognizes persons who are not pathologists as persons competent to sign report of tests done in laboratory. For instance, the qualification norms for authorized signatories provides that a person with qualification M.Sc. in Medical Biochemistry with 5 years’ experience or M.Sc. in Biochemistry with 7 years’ experience in Medical Laboratory shall be authorized signatory for the disciplines Clinical Biochemistry, Clinical Pathology, Routine Hematology, Routine Microbiology and Serology. Similarly, persons with M.Sc. (Microbiology) and B.Sc. (Biochemistry) have been recognized as authorized signatory for microbiology and serology. Such argument failed to impress the Court.

For comments and archives

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  Quote of the Day

(Dr GM Singh)

Spectacular achievement is always preceded by spectacular preparation. Robert H. Schuller

 
  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Pediatric Allergy Screen, Serum

Testing for IgE antibodies may be useful to establish the diagnosis of an allergic disease and to define the allergens responsible for eliciting signs and symptoms, to confirm sensitization to particular allergens prior to beginning immunotherapy, and to investigate the specificity of allergic reactions to insect venom allergens, drugs, or chemical allergens.

 
    Mind Teaser

Read this…………………

Which of the following is true about ulcerative colitis with malignancy?

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

Yesterday’s Mind Teaser: Which of these drugs has been shown to improve labyrinthine blood flow and to re–equilibrate central vestibular imbalance and is considered useful in treatment of patients with vascular disease of the vestibular system?

a. Propranolol
b. Amitriptyline
c. Cinnarizine
d. None of above

Answer for Yesterday’s Mind Teaser: a. Propranolol

Correct answers received from: Dr BB Aggarwal, Dr LC Dhoka, Dr CP Mishra, Dr Hari.

Answer for 10th June Mind Teaser: a. Progression stage
Correct answers received from: Dr Farhaan, Dr Rashmi.

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Dr GM Singh)

Law of Bag/Box Occupancy

All bags and boxes in a given room must contain a cat within the earliest possible nanosecond.

 
  Medicolegal Update

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

What is a medicolegal case?

A medicolegal case is a case of injury, ailment, hurt or illness or death due to evident criminal cause or where the attending doctor, on examining the patient, concludes that criminal force/weapon has been used against human body and an inquiry/investigation by law agencies is required in accordance with the prevailing law of the land. It is a legal duty of the treating doctor to inform a medicolegal case to the nearest police station immediately after completing primary lifesaving medical care. In accordance with Section 39 of Criminal Procedure Code of India, the treating doctor is duty bound to inform the nearest police station as soon as he/she completes his primary medical care. Phones/mobile phones can be used for informing the police in this era of modern advancement in telecommunication. An acknowledgement of receipt of such a message should be taken for future reference. If the intimation is given orally or on phone, the diary number (DD or the Daily Docket number/name and designation of police officer) should be taken down as proof of intimation and should be properly documented in the patient’s records. The idea is to initiate legal proceeding at the earliest so that the maximum evidence can be collected by the police officer with minimum destruction of evidences, site of occurrence, knowingly or unknowingly by any party. There is a quote in Bernard Knight Text Book of Forensic Medicine that ‘the doctor dealing with medico–legal cases should not act /behave like a detective; equally the doctor should never act like curtain between police and patient involved in crime.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Pay attention to prehypertension in young people

We should pay attention to prehypertension in young people. Young adults with the borderline high blood pressure i.e. slightly above normal, termed prehypertension, are more likely to have calcium deposits in their coronary arteries and heart blockages later in life, said Padma Shri and Dr B C Roy Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Quoting a study published in the journal Annals of Internal Medicine, Dr Aggarwal said that of the 3,560 participants whose ages were 18 to 30 when the study started, almost 20 percent developed prehypertension –– which is blood pressure higher than 120/80 but below 140/80 reading of treatable high blood pressure –– before the age of 35. Coronary scans showed accumulation of calcium deposits in their arteries of the heart during the 20–year study. These low-level elevations, above 120/80, are associated with atherosclerosis later in life and probably with heart attacks and stroke.

Earlier reports have shown an association between prehypertension in early adulthood and abnormalities of the heart muscles. Prehypertension early in life is associated not only with development of atherosclerosis, the formation of plaques that can eventually block arteries, but also with arteriosclerosis, stiffening of the arteries. Drug treatment is not a real option for prehypertension in young people. Hence, preventive measures should be recommended if it is found.

The preventive measures include modification of lifestyle, which includes increasing physical activity, eating a low fat diet, maintaining a healthy body weight, avoid smoking and alcohol.

 
    Readers Response
  1. Dear Sir, emedinews is really very informative: Regards Dr Shri
 
    Forthcoming Events

IYCNCON 2012

All are cordially invited for the 2nd National Conference of IYCF Chapter of IAP. This conference is organized by: IYCF Chapter, MOH&FW GOI, MOWCD GOI, WHO, UNICEF, IMLEA, SDHE Trust.
The theme of the conference is: "Proper Nutrition: Defeat Malnutrition – Investing in the Future"
Venue: India Habitat Centre, Lodhi Road, New Delhi – 110 003.
Date: 5th Aug 2012
For further details contact:
Conference Secretariat: Dr. Balraj Yadav, E–Mail: drbalraj@ymail.com, drvisheshkumar@gmail.com,
Ph: +91.124.2223836, Mobile: +91.9811108230

Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001
http://www.heartcarefoundation.org

A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions

 
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    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta