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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; 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

 

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

12th August 2012, Sunday

Fasting during Ramadan carries a risk of complications for diabetic patients

  • Patients with type diabetes should not fast.
  • Type 1 diabetics with history of recurrent hypoglycemia or hypoglycemia unawareness or those who are poorly-controlled are at very high risk for developing severe hypoglycemia. An excessive reduction in the insulin dosage in these patients (to prevent hypoglycemia) may place them at risk for hyperglycemia and diabetic ketoacidosis.
  • Hypo- and hyperglycemia may occur in type 2 diabetics but generally less frequently and with less severe consequences compared with type 1 diabetics.
  • A patient’s decision to fast should be made after ample discussion with his or her physician concerning the risks involved. Patients who insist on fasting should undergo pre-Ramadan assessment and receive appropriate education and instructions related to physical activity, meal planning, glucose monitoring, and dosage and timing of medications. The management plan must be highly individualized. Close follow-up is essential to reduce the risk for development of complications.
  • In type 2 diabetics well controlled with diet alone, the risk associated with fasting is quite low. But there is a potential risk for postprandial hyperglycemia after the predawn and sunset meals if patients overindulge in eating. Distributing calories over 2 to 3 smaller meals during the non-fasting interval may prevent excessive postprandial hyperglycemia.
  • Type 2 diabetics on diet control usually do so with a regular daily exercise program. The exercise program should be modified in its intensity and timing to avoid hypoglycemic episodes; the timing of the exercise could be changed to ~2 h after the sunset meal.
  • In the elderly, fluid restriction and dehydration may increase the risk of thrombotic events in the presence of hypertension and dyslipidemia.
  • The choice of oral antidiabetic drugs is individualized. Drugs that act by increasing insulin sensitivity are associated with a significantly lower risk of hypoglycemia than compounds that act by increasing insulin secretion.
  • Patients treated with metformin alone may safely fast because the possibility of hypoglycemia is minimal. However, the timing of the doses should be modified with two-thirds of the total daily dose administered immediately before the sunset meal, while the other third may be given before the predawn meal.
  • Patients on insulin sensitizers (pioglitazone) have a low risk of hypoglycemia and require no change in the dose.
  • Sulfonylureas are unsuitable for use during fasting because of the inherent risk of hypoglycemia. Hence, their use should be individualized and they should be utilized with caution.
  • Chlorpropamide is absolutely contraindicated during Ramadan because of the high possibility of prolonged and unpredictable hypoglycemia.
  • Gliclazide MR or glimepiride can be used as they have lower risk of hypoglycemia. Newer generations drugs therefore may be used but with caution.
  • Short-acting insulin secretagogues, repaglinide and nateglinide, are useful because of their short duration of action. They could be taken twice-daily before the sunset and predawn meals.
  • Problems in patients with type 2 diabetes who use insulin are similar to those with type 1 diabetes, except that the incidence of hypoglycemia is less.
  • Judicious use of intermediate- or long-acting insulin preparations + short-acting insulin administered before meals is an effective strategy.
  • Using one injection of long-acting insulin analog, such as insulin glargine, or two injections of NPH, lente, or detemir insulin before the sunset and predawn meals may provide adequate coverage as long as the dosage of each injection is appropriately individualized.
  • A single injection of intermediate-acting insulin administered before the sunset meal may be sufficient to provide acceptable glycemic control in patients with reasonable basal insulin secretion.
  • Most patients will still require short-acting insulin administered in combination with the intermediate- or long-acting insulin at the sunset meal to cover the large caloric load of Iftar. Moreover, many will need an additional dose of short-acting insulin at predawn.
  • Use of insulin lispro instead of regular insulin before meals in patients with type 2 diabetes who fast during Ramadan is associated with less hypoglycemia and smaller postprandial glucose excursions.
  • All patients should understand that they must always and immediately end their fast if hypoglycemia (blood glucose of <60 mg/dl) occurs, since there is no guarantee that their blood glucose will not drop further if they wait or delay treatment.
  • The fast should also be broken if blood glucose reaches <70 mg/dl in the first few hours after the start of the fast, especially if insulin, sulfonylurea drugs, or meglitinide are taken at predawn. Finally, the fast should be broken if blood glucose exceeds 300 mg/dl. Patients should avoid fasting on “sick days.”

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Guest Editorial

Professor Suchitra N. Pandit, Kokilaben Dhirubhai Ambani Hospital & Research Centre, Mumbai, Vice President, FOGSI (2008 -2009)

For comments and archives

  eMedinewS Audio PostCard

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

Crime Against Women - Dr Rashmi Singh part 2

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

Seminar on Health and Happiness

A seminar on Health and Happiness was organised jointly by Heart Care Foundation of India and Bharatiya Vidya Bhavan at Bharatiya Vidya Bhavan on 5th July 2012.

 
Dr K K Aggarwal
 
    National News

Fix rural health care course syllabus in six weeks, Delhi High Court tells MCI

New Delhi: The Delhi High Court has given the Medical Council of India (MCI) six weeks to finalise the curriculum for the new 3-1/2 year course, ‘Bachelor of Rural Health Care (BRHC)’. The course was proposed by the Health Ministry to meet the acute shortage of (MBBS) qualified doctors in rural areas due to which rural population was being deprived of basic, primary health care. The court issued the order on Thursday while hearing a contempt case filed by public health specialist Meenakshi Gautham. In her plea filed on February 27, she sought contempt proceedings against the Union Health Secretary and the MCI Chairperson for not having complied with the court’s November 10, 2010 order, wherein they had been asked to initiate measures to introduce the BRHC course by March 2011.

The court had served contempt notices on the Health Secretary and the MCI and had given four weeks’ time to file their responses (see The Hindu, February 28). The contemnors had filed their affidavits in March/April and Thursday’s hearing was following their submissions.

The November 2010 order was issued following several hearings on a 2009 writ petition by Ms. Gautham and the Garhwal Community and Development Society (GCDS). The plea sought speedy introduction of the short-term course for rural health care as per the resolution of the 9th Conference of the Central Council of Health and Family Welfare in November 2007 and the recommendation of the 2007 Task Force on Medical Education Reforms for National Rural Health Mission. The order had directed the MCI to finalise the syllabus by January 2011 and the Ministry to begin the course by March 2011. Their failure to comply with the order had prompted Ms. Gautham to file the contempt petition. (Source: The Hindu, August 11, 2012)

For comments and archives

My Profession My Concern

(Dr. Indrajit Khandekar, In-charge Clinical Forensic Medicine Unit (CFMU) & Associate Professor, Dept of Forensic Medicine, Kasturba Hospital & MGIMS, Sevagram)

It is a privilege to inform you all that in a unique initiative, Mahatma Gandhi Institute of Medical Sciences (MGIMS) & Kasturba Hospital, Sevagram has established Clinical Forensic Medicine Unit (CFMU) in Casualty under the Dept. of Forensic Medicine, which will work hand in hand with the Emergency Centre.

Handling of all forensic issues of the hospital including medicolegal examination and preparation of “Forensic Medical Reports’ (FMR) of the MLCs brought to the hospital will be done under the direct supervision of Faculty of Dept. of Forensic Medicine through the CFMU. CFMU will work round the clock and all the doctors posted in it will work as “Forensic Physicians”.

After just joining this institute (MGIMS) as a Lecturer (i.e., 4 ½ years back), I had submitted the proposal to the management regarding CFMU, but it was not accepted by the then management because of stiff opposition. When I submitted my suggestions regarding this unit to the MCI in May 2011 through my study report of 464 pages, the management asked me to work on this issue. Later on meetings were called by the management along with the head & faculties of Forensic medicine dept, in which I have been given responsibility by the Dean MGIMS- Dr. B. S. Garg and Medical Superintendent- Dr. S. P. Kalantri to establish “CFMU” and to develop “Forensic Medical Software” as an In-charge.

It took around 8 months strenuous efforts to develop this unit, for creation of standardized “Forensic Medical Formats” and incorporating these proformas into the “Forensic Medical Software”.

With this initiative, we hope to bring an upright and efficient medicolegal system. It aims to blend Emergency Medicine with Forensic Medical care (medicolegal care) to achieve systematic and lawful management of medicolegal cases. It also aims to provide students (UG and PG) actual practical medicolegal experience to face the real world.

I am thankful to Dr. BH Tirpude (Prof & Head Dept of FM) & other staff of the department for their constant support.

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

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

High-dose cholecalciferol prevents vitamin D insufficiency in kidney disease

High doses of cholecalciferol helped prevent vitamin D insufficiency and reduce parathyroid hormone (PTH) levels in patients with early chronic kidney disease (CKD) in a recent randomized trial. (Source: Medscape)

For comments and archives

Preventing surgeon fatigue in the OR: are micropauses the answer?

During complex operations, "micropauses" - 20-second breaks every 20 minutes - will reduce surgeons' fatigue and increase their accuracy at fine motor tasks, two Canadian surgeons say. (Source: Medscape)

For comments and archives

RA oral therapy: Tofacitinib promising in 2 studies

A drug that can be taken by mouth was more effective than placebo against rheumatoid arthritis (RA) in 2 phase 3 clinical trials published in the August 9 issue of the New England Journal of Medicine. Results from one of the trials indicate the drug (tofacitinib) may be as effective as medications that are currently available only through injection. (Source: Medscape)

For comments and archives

Gonorrhea near complete drug resistance

The CDC is launching a "preemptive strike" aimed at delaying the emergence of complete drug resistance in gonorrhea. In revised guidelines, the agency says the oral cephalosporin antibiotic cefixime (Suprax) – one of two choices in earlier recommendations -- should no longer be used as first-line treatment for gonorrhea. Instead, the first choice should be the injectable cephalosporin ceftriaxone (Rocephin), coupled with either azithromycin (Zithromax, Azithrocin) or doxycycline, according to Robert Kirkcaldy, MD, of the CDC's Division of STD Prevention. Details of the revised guidelines appear in the August 10 issue of Morbidity and Mortality Weekly Report. (Source: Medpage Today)

For comments and archives

 
    Twitter of the Day

@DrKKAggarwal: When constipation may be a serious
problemhttp://blog.kkaggarwal.com/2012/08/when-constipation-may-be-a-serious-problem/

@DeepakChopra: When someone else makes a mistake, it is their responsibility to correct it, but it is your responsibility to handle how you feel about it.

 
    Spiritual Update

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

Krishna: The Messenger of Love and Happiness

Krishna teaches us the path of acquiring inner happiness. It can be understood by the four cycles of Krishna described in the Vedic literature: Krishna the Child, Krishna the Husband and Friend, Krishna the Preacher and Krishna the Sanyasi.

The childhood of Krishna describes the methodology and components of a child education. Krishna, pure consciousness, was born as the eight child of Devki representing that during pregnancy one needs to follow the eight limbs of yoga to get a child with no disease.

For comments and archives

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

Who needs ovulation medication?

Medications for inducing ovulation are used to treat women with irregular ovulation. Diagnosis of ovulatory dysfunction might be established by recording basal body temperature, monitoring urinary LH excretion, timed measurement of serum progesterone levels, timed endometrial biopsies and /or serial Transvaginal ultrasound examinations. Women might not ovulate because of polycystic ovarian syndrome (PCOS), insufficient production of LH and FSH by the pituitary, ovaries that do not respond well to normal levels of LH and FSH, thyroid disease, prolactin excess, obesity, eating disorders, or extreme weight loss or exercise. Ovulation drugs are indicated in the treatment of women with amenorrhea (absence of menstruation) or irregular menstruation (oligo-ovulatory). Ovulation drugs can also be used to stimulate the ovaries to produce more than one mature follicle per cycle, which leads to the release of multiple eggs. This controlled ovarian hyperstimulation (COH), or superovulation, may be accomplished with either oral or injectable fertility medications

For comments and archives

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

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

Irradiated Red Blood cell or Packed Red Cells/Platelet Concentrate:

Definition: Cellular blood components (red blood cells and platelets) are irradiated by Gamma rays or Cobalt 60 by the dose of 25 gy.

Shelf Life

  • RBC - 28 days from the day of irradiation or date of expiry, whichever is earlier
  • Platelet - 5 days

Indications: To prevent transfusion-associated graft versus host disease (TA-GvHD) in the following conditions:

  • Immunocompromised patients
  • Hereditary immune T-cell deficiencies
  • Fetuses and neonates
  • Pediatric malignancies (Neuroblastomas)
  • Hodgkin’s disease
  • Bone marrow transplants
  • Transfusion from all blood relatives
  • Intrauterine transfusion

Volume, dosage and administration are same as RBC/platelet concentrate except that in small children, RBCs should be irradiated just before use due to risk of hyperkalemia. In high-risk adults (for hyperkalemia), they should be irradiated just before use or the RBCs should be washed with 0.9% sterile normal saline before use.

For comments and archives

 
    An Inspirational Story (Dr GM Singh)

When without money, eats wild vegetables at home
When has money, eats same wild vegetables in fine restaurant.

When without money, rides bicycle
When has money, rides exercise machine.

When without money, walks to earn food
When has money, walks to lose the fat

Man O Man! Never fails to deceive thyself!

When without money, wishes to get married
When has money, wishes to get divorced.

When without money, wife becomes secretary
When has money, secretary becomes wife.

When without money, acts like rich man
When has money, acts like poor man.

Man, O Man, never can tell the simple truth!

Says share market is bad but keeps speculating
Says money is evil but keeps accumulating.
Says high positions are lonely but keeps wanting them.

Man O Man ! Never means what he says and never says what he means!

For comments and archives

 
    Cardiology eMedinewS

QI program can cut unneeded cardiac CT Read More

Vascular problems affect TAVI outcomes Read More

 
    Pediatric eMedinewS

Improvements in lipids observed in US adolescents Read More

Vitamin D deficiency common in critically ill children Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A 40-year-old male developed dyspnea for the first time in life.
Dr. Bad: It is an attack of asthma.
Dr. Good: Get an ECG done.
Lesson: First onset of breathlessness after the age of 40, unless proved otherwise, is cardiac in nature.

Make Sure

Situation: A patient with acute heart attack died on the way to the hospital.
Reaction: Oh my God! Why was the patient not accompanied by the doctor?
Lesson: Make sure that all heart attack patients are accompanied by the doctor to the hospital so that chest compression (CPR) can be given if the heart stops on the way.

 
    Quote of the Day (Dr GM Singh)

Always put yourself in the other’s shoes. If you feel that it hurts you, it probably hurts the person too

 
    Legal Question of the Day (Dr M C Gupta)

Q. Is the chemist liable if he supplies a drug that is defective or has less than the declared potency?

Ans.

  • This question can arise in the mind of a patient who is prescribed a generic drug and the chemist sells him a substandard drug manufactured/marketed by a dubious company.
  • The patient (or anybody else) has a right, after buying the drug, to get it tested in a laboratory and, if found defective, to file a consumer complaint for supply of defective goods.
  • The respondent parties in the complaint may be the following:
    • The seller/supplier of the drug/chemist shop concerned. The supplier will also include a government hospital/dispensary, which comes under the CPA.
    • The manufacturer.
  • In order to enable such testing, arrangements need to be made for cheap and reliable testing of drugs. This can be done by the government or by the pharmaceutical industry (as part of their CSR (Corporate social responsibility) or by both as a PPP (Public-Private Partnership).
 
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Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of Doctor’s Day Celebration

 
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    Lab Update (Dr Navin Dang and Dr Arpan Gandhi)

Categories of Anemia

Normochromic/normocytic anemia (normal MCV, normal MCHC)

The first step in laboratory workup of this broad class of anemias is a reticulocyte count. Elevated reticulocytes imply a normo–regenerative anemia, while a low or "normal" count implies a hyporegenerative anemia:

Normoregenerative normocytic anemia (appropriate reticulocyte response)

  • Immunohemolytic anemia
  • Glucose–6–phosphate dehydrogenase (G6PD) deficiency (common)
  • Hemoglobin S or C
  • Hereditary spherocytosis
  • Microangiopathic hemolytic anemia
  • Paroxysmal hemoglobinuria
 
    Mind Teaser

Read this…………………

The husband of a client asks the nurse about the protein-restricted diet ordered because of advanced liver disease. What statement by the nurse would best explain the purpose of the diet?

A. “The liver cannot rid the body of ammonia that is made by the breakdown of protein in the digestive system.”
B. “The liver heals better with a high carbohydrates diet rather than protein.”
C. “Most people have too much protein in their diets. The amount of this diet is better for liver healing.”
D. “Because of portal hyperemesis, the blood flows around the liver and ammonia made from protein collects in the brain causing hallucinations.”

Yesterday’s Mind Teaser: What instructions should the client be given before undergoing a paracentesis?

A. NPO 12 hours before procedure
B. Empty bladder before procedure
C. Strict bed rest following procedure
D. Empty bowel before procedure

Answer for Yesterday’s Mind Teaser: B. Empty bladder before procedure

Correct answers received from: Dr KV Sarma, Mvithalani, Dr PC Das, Dr (Maj. Gen.) Anil Bairaria,
Dr Kanta Jain, parimalshah, Dr Pankaj Agarwal, Dr K Raju, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Dr Thakor Hitendrsinh G, Dr Avtar Krishan
.

Answer for 10th August Mind Teaser: A. Sit upright for at least 30 minutes after meals
Correct answers received from: Dr Thakor Hitendrsinh G.

Send your answer to ijcp12@gmail.com

 
   Laugh a While (Dr GM Singh)

An elderly gentleman had serious hearing problems for a number of years. He went to the doctor and the doctor was able to have him fitted for a set of hearing aids that allowed the gentleman to hear 100%.

The elderly gentleman went back in a month to the doctor and the doctor said, 'Your hearing is perfect. Your family must be really pleased that you can hear again.'

The gentleman replied, 'Oh, I haven't told my family yet. I just sit around and listen to the conversations. I've changed my will three times!'

 
    Medicolegal Update

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

What are the legal issues in pregnancy?

  • Pregnancy is the condition resulting from the fertilized ovum.
  • The existence of the condition beginning at the time of conception and terminating with the delivery of the child.
  • Extra uterine or ectopic pregnancy is the development of the ovum outside the uterine cavity as in the fallopian tube or the ovaries.
  • Extra uterine pregnancy usually terminates with the rupture of the sac, profuse internal bleeding, and death if not relieved promptly by a surgical operation.
  • Pregnancy is most likely to occur between the age group of 14 to 45 years but has been reported much earlier and later.
  • A plea of pregnancy is a plea which a woman capitally convicted may plead in stay of execution; for this, though it is no stay of judgment, yet operates as a respite of execution until the child is delivered.
  • This position is statutorily recognized by Section 416 of the Code of Criminal Procedure, 1973 which says that if a woman sentenced to death is found pregnant, the High Court shall order the execution of the sentence to be postponed, and commute the sentence to imprisonment of life.

For comments and archives

 
    Public Forum

Public Forum (Press Release for use by the newspapers)

Do not ignore early morning chest pain

Do not ignore early morning chest pain as most fatal heart attacks occur early in the morning. In a message, Padma Shri & Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India said that most heart attacks occur in the first three hours of getting up, more during full moon period and during winter.

A heart attack can present with chest pain, discomfort, heaviness or burning in the center of the chest, which is diffuse in nature and never localized and lasts for more than 30 minutes.

A discomfort, which lasts less than 30 seconds and which can be pinpointed with a finger, can be ignored as a non-cardiac chest pain. A burning in the chest occurring at 2 O’clock in the night may be due to acidity but any acidity occurring for the first time in life after the age of 40 years, should be considered cardiac in origin unless proved otherwise. Similarly, any breathlessness appearing for the first time in life after the age of 40 years is cardiac in origin unless proved otherwise.

Chewing a tablet of aspirin at the onset of cardiac chest pain can reduce chances of cardiac death by 22%.

All patients with chest pain should be promptly taken to the nearest cardiac hospital as timely clot dissolving therapy or clot removing angioplasty can practically cure a patient. The life saving window is to reach hospital within three hours.

Elaborating further he said that the three investigations required for evaluation of a chest pain should be available in the set up of every doctor who handles such patients and these include ViScope, an audio-visual auscultation device, ECG machine to diagnose an acute heart attack and echocardiography machine for early detection of heart attack.

ECG can often detect abnormal sounds in first six hours of heart attack but with a ViScope it is always possible to detect abnormal sounds during chest pain. Angiography is the gold-standard investigation if a patient with chest pain comes within three hours as it can help removing the clot by primary angioplasty.

 
    Readers Responses
  1. IMA should seriously take up the issue of use of title 'Dr.' instead of 'Vaid' by BAMS. There should be a Court ban on their freely prescribing Allopathic drugs. If the Govt or Court fails to form laws to make public aware, the IMA should launch a program for people education to bring facts to their knowledge. Dr. Aun Gupta, Patron (AOI-Haryana)
 
    Forthcoming Events
Dr K K Aggarwal


Dr K K Aggarwal


Dr K K Aggarwal

Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001
A non stop question answer-session between all the top cardiologists of the NCR region and the public. Event will be promoted through hoardings, our publications and the press. Public health discussions
http://www.heartcarefoundation.org

 
    eMedinewS Special

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    Our Contributors

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