October 12   2015, Monday
Dr KK AggarwalDr KK Aggarwal
H1N1 vaccine

The Centers for Disease Control and Prevention (CDC) recommends that all persons aged six months or older should receive H1N1 influenza vaccine. A priority list of population groups (as below) for vaccine administration should be followed, if the vaccine supply is limited.

• Pregnant women

• Individuals from 6 months through 24 years of age

• Household contacts and caregivers of children younger than six months of age

• Individuals from 25 through 64 years of age with health conditions associated with increased risk of influenza complications

• Healthcare and emergency medical services personnel

Drug therapy: Recommendations

Antiviral therapy should be promptly given to

• Children, adolescents, or adults with suspected or confirmed influenza infection and any of the following features

o Illness requiring hospitalization

o Progressive, severe, or complicated illness, regardless of previous health status

• Suspected or confirmed influenza infection who were at high risk for complications including:

o Children <5 years of age, particularly those <2 years of age

o Adults ≥65 years of age

o Pregnant women and women up to two weeks postpartum (including those who have had pregnancy loss)

o Individuals with certain medical conditions

Antiviral therapy be started as soon as possible in patients who are severely immunosuppressed such as those receiving treatment for malignancies, hematopoietic or solid organ transplant recipients and present with an acute respiratory illness

Patients with morbid obesity (BMI >40) and possibly those with obesity (BMI 30 to 39) with suspected or confirmed pandemic H1N1 influenza A virus infection should be carefully evaluated for the presence of conditions that confer an increased risk of influenza complications. If any such conditions were present, treatment is recommended. (Uptodate)
Breaking news
FDA OKs Multipathogen nucleic acid test for CNS infections

The US Food and Drug Administration (FDA) has approved the first nucleic acid-based test of cerebrospinal fluid (CSF) that can simultaneously detect 14 pathogens responsible for central nervous system (CNS) infections. The FilmArray Meningitis/Encephalitis (ME) Panel (BioFire Diagnostics) is designed to test CSF specimens from patients who have signs and symptoms of these two conditions. The test can yield results in about 60 minutes. In contrast, it may take up to 3 days to identify a bacterial infection using current diagnostic technology, according to an FDA news release. The wait time for viral infections can be longer, given that specimens often must be shipped to specialized laboratories.
Dr Good Dr Bad
Specialty Updates
• A new meta-analysis published in Circulation suggested that physical activity levels at two to four times the federally recommended minimum may reduce the risk of heart failure by 20% and 35%, respectively. The review also showed that there is a linear, dose-dependent, inverse association between physical activity and heart failure risk, consistent across age, sex, and geographical region.

• Women with APOE ε4 allele associated with Alzheimer’s disease (AD) have a steeper decline in body mass index (BMI) after age 70 years than their peers without this gene variant, regardless of whether they go on to develop dementia, suggests new research published online in the Journal of Alzheimer's Disease.

• Physicians should request postvaccination serologic testing (PVST) for infants born to hepatitis B–infected mothers between 9 and 12 months of age, suggests the Centers for Disease Control and Prevention in an updated recommendation, published in the October 9 issue of the Morbidity and Mortality Weekly Report.

• Women, and especially younger women, are much less likely than men to have good relief of chronic, non-cancer pain with long-term opioid use, with only one in five women reporting low levels of pain and high levels of function with chronic opioid therapy, reported a new study published in Journal of Women's Health.

• Laparoscopic lavage for acute perforated diverticulitis in patients requiring emergency surgery was no better than primary resection in reducing severe postoperative complications and was associated with a higher rate of reoperation than resection, reported a randomized trial of 144 patients published in JAMA.

• Newly discovered blood markers may lead to improved and earlier diagnoses of kidney disease, suggests a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN).

• A new study suggests that repeating words aloud can boost verbal memory, particularly if they are repeated to another person. The findings are published in the journal Consciousness and Cognition.

• Airway narrowing in parallel airways is more heterogeneous and airway closure is greater in asthma patients than in people without the condition, suggested a small high-resolution CT study published online in Thorax.

• New research published October 8 in Cell Metabolism suggests that IL17A is an important player in hyperparathyroidism's effects on bone.

• Rheumatoid arthritis (RA) is associated with more-severe acute coronary syndrome and poorer outcomes, suggests a new study published online in the European Heart Journal.
Promoting peaceful death in ICUs
Having a peaceful death is a common wish. Many cultures and religious beliefs offer practical ways to enhance having a peaceful death. Dying in an intensive care unit is unnatural and oftentimes painful for the patient and their loved ones. ICU nurses can promote peaceful death through a three-dimensional process.

• Awareness of dying
• Creating a caring environment
• Promoting end-of-life care

(Source: Int Nurs Rev. 2009 Mar;56(1):116-22.)
Legal Quote
Samira Kohli vs Dr. Prabha Manchanda and Anr SCI, Civil Appeal No. 1949 of 2004, 16.01.2008

“A doctor cannot be held negligent either in regard to diagnosis or treatment or in disclosing the risks involved in a particular surgical procedure or treatment, if the doctor has acted with normal care, in accordance with recognised practices accepted as proper by a responsible body of medical men skilled in that particular field, even though there may be a body of opinion that takes a contrary view.”
TB Fact
Prior TB infection, contained as latent tuberculosis, confers protection against subsequent TB disease
Planning methodology should attempt to anticipate the timeline and amount necessary to achieve financial independence, which is defined as the date when a person’s savings (and income from savings) afford their lifestyle needs…allowing them to live the rest of their lives doing whatever they choose to do. And, by avoiding excess risk, maximizing allowable deductions and protecting their health and wealth from unexpected events, it should be the shortest course to financial independence without compromising the lifestyle to which they have grown accustomed.

(Source: IJCP)
Industry News
• A new startup to solve commuting problems: LiftO, a ridesharing venture in Mumbai, joins a raft of other startups trying to solve India's worsening issues with urban transport and daily commutes. Existing public infrastructure — including newer options such as the Delhi Metro which ferries three million passengers — are woefully inadequate for India's working population. (Economic Times - Rahul Sachitanand)

• Govt to commission study on impact of FDI in pharma:The government is likely to commission a study soon to assess the impact of foreign direct investment in existing pharmaceutical companies in view of concerns expressed on the issue by a Parliamentary panel.There are apprehensions that takeovers by MNCs have impacted the generic medicine industry of the country. (Financial Express - PTI)

• Two labs for Internet of Things:The Department of Electronics and Information Technology (DeitY) and the National Association of Software and Services Companies (Nasscom) have plans to launch labs to carry out research work on the Internet of Things (IoT). The centres would be established in Bengaluru and Chennai and preliminary work was on, said K. Purushothaman, Regional Director of Nasscom. Speaking at a conclave on Internet of Things at VIT University, Chennai campus, he said, "We are working closely with various stakeholders, including IIT-Madras, to set up this lab, which would benefit everybody. IoT is all embedded with networking, sensors and lot more. In 2013-14, people started speaking about IoT and people started exploring it, by 2020 it will be a $29-billion business." (The Hindu)

• Auto industry calls for unified emissions rules across India: India’s auto industry body called on Friday for a single set of emission norms to be introduced in the country, simplifying operations for carmakers who would be able sell the exact same car across the nation’s 29 states. A lack of clean fuel in every Indian state has forced the auto industry to follow two different emission rules in the country, tougher norms in big cities like Mumbai and Delhi, and more lenient rules in the smaller cities. (Livemint.com)
The Indian Medical Association in collaboration with the Brahma Kumaris and Heart Care Foundation of India is organizing the two-day stress and leadership meet
Inspirational Story
The House with the Golden Windows

The little girl lived in a small, very simple, poor house on a hill and as she grew she would play in the small garden and as she grew she was able to see over the garden fence and across the valley to a wonderful house high on the hill – and this house had golden windows, so golden and shining that the little girl would dream of how magic it would be to grow up and live in a house with golden windows instead of an ordinary house like hers. And although she loved her parents and her family, she yearned to live in such a golden house and dreamed all day about how wonderful and exciting it must feel to live there.

When she got to an age where she gained enough skill and sensibility to go outside her garden fence, she asked her mother if she could go for a bike ride outside the gate and down the lane. After pleading with her, her mother finally allowed her to go, insisting that she kept close to the house and didn’t wander too far. The day was beautiful and the little girl knew exactly where she was heading! Down the lane and across the valley, she rode her bike until she got to the gate of the golden house across on the other hill.

As she dismounted her bike and lent it against the gate post, she focused on the path that lead to the house and then on the house itself…and was so disappointed as she realized all the windows were plain and rather dirty, reflecting nothing other than the sad neglect of the house that stood derelict. So sad she didn’t go any further and turned, heartbroken as she remounted her bike… As she glanced up she saw a sight to amaze her…there across the way on her side of the valley was a little house and its windows glistened golden …as the sun shone on her little home.

She realized that she had been living in her golden house and all the love and care she found there was what made her home the ‘golden house’. Everything she dreamed was right there in front of her nose!
A man was complaining to a railroad engineer. What’s the use of having a train schedule if the trains are always late?

The railroad engineer replied, "How would we know they were late, if we didn’t have a schedule?"
MTNL perfect Health Mela 2015. Pls click here for details
IMA Digital TV
Press Release
One can reduce stress by changing their interpretation

The Indian Medical Association in collaboration with the Brahma Kumaris and Heart Care Foundation of India is organizing the two-day stress and leadership meet

New Delhi, October 11, 2015: A 2-day stress and detox leadership meet of the State and Local branch Presidents and Secretaries of the Indian Medical Association is ongoing at the Om Shanti Retreat Centre, Pataudi Road, Near Manesar, Gurgaon, Delhi-NCR. The aim of the workshop is to address the increasing incidence of lifestyle diseases amongst doctors due to high levels of stress.

During his address to the doctors, Padma Shri Awardee Dr. K K Aggarwal – Honorary Secretary General IMA and President Heart Care Foundation of India said, “Stress is the reaction of the body or the mind to the interpretation of a known situation. Stress management, therefore, involves either changing the situation, changing the interpretation or taming the body in such a way that stress does not affect the body. Every situation has two sides. Change of interpretation means looking at the other side of the situation. It is something like considering half a glass of water, which can be interpreted as half empty or half full.”

Research indicates that anger, hostility and aggression are the new risk factors for heart disease. It has been shown that even recall of anger can precipitate a heart attack.

Adding to this, Dr. Vinay Aggarwal, Past President, IMA said, “Various studies have shown that in front of unconscious patients in the ICU if the doctors talk positively their outcome is better than those in whose presence the doctors talk negatively.”

The best way to practice spiritual medicine is to experience silence in ones thoughts, speech and actions. Simply walking amidst nature with silence in the mind and experiencing the sounds of nature can be as effective as 20 minutes of meditation. 20 minutes of meditation provides the same physiological parameters as that of seven hours of deep sleep.

Management of stress, therefore, involves either removing the known situation or changing one’s interpretation or preparing the body in such a way that the stress does not affect the mind and the body. But, removing the known situation may not be possible all the time. For example, if you are stressful in a job, resigning may not be feasible.

The modality, therefore, is to change your interpretation towards the stressful situation for which one should start thinking positively and different and choose the resultant options within, which do not hurt the heart.

Speaking on the occasion, BK Brij Mohan, Principle Secretary Brahma Kumaris, BK Asha, Director OM Shanti Retreat Centre, BK Sapna, Centre in charge Lajpat Nagar in a joint statement said, “Apart from counseling, one can also prepare the body in such a way that stress does not bother them. This can be done by learning the art of parasympathetic breathing, relaxation, meditation and regular exercise.”

Changing of the interpretation is what in allopathic terms is described as cognitive behavior therapy, the origin of which comes from Bhagavad Gita where Lord Krishna counsels Arjuna following the principles of Cognitive Behavioral Therapy.
A Physician’s right to privacy

Smita N Deshpande
Head, Dept. of Psychiatry, De-addiction Services
PGIMER-Dr. Ram Manohar Lohia Hospital
New Delhi

The case concerns a lady who underwent hysterectomy. The surgeon used to suffer from epilepsy, which was currently well under control. While the surgery went off well and the surgeon did not have any health issues during surgery, the patient died due to an inadvertent cystotomy during surgery.

a) Should the surgeon have disclosed his health information with the patient and allowed her to choose?

b) How much privacy should a physician enjoy in disclosing health issues to the patient?

c) When a surgeon suffers from periodic health issue such as epileptic seizures or unstable diabetes, should s/he discuss them with patients, especially if the health condition is under control? Should such a surgeon undertake surgeries without disclosing his health condition?

Adapted and shortened from: UNESCO, 2011. Casebook on Human Dignity and Human Rights, Bioethics Core Curriculum Casebook Series, No. 1, UNESCO: Paris, 144 pp.

Do write in with views and your solutions!
Breaking news
E-gazette to save Rs 40cr, 90 tonnes of paper annually

TNN | Oct 10, 2015

New Delhi: Government estimates it will save 90 tonnes of paper (worth Rs 40 crore) annually which is used to print 3.5 crore pages of gazette notifications every year, as it stops their physical printing and introduces e-publishing. The move will also save power, chemicals, colour and dyes, which is a major environment-friendly initiative. Following an order issued by the Union urban development minister M Venkaiah Naidu, the physical printing of these notifications has stopped from October 1. "The e-publishing also puts an end to the long wait for the important documents, which used to take weeks and months in many cases," said an urban development ministry spokesperson.

Gazette notification is an important legal requirement to validate, authenticate and to make effective various kinds of laws, Acts, rules, orders and government decisions. "Seeking to end delays, UD ministry has directed the department of publication to stop physical printing and switch over to e-publishing of all gazette notifications on its official website within five days of receipt of the same from respective ministries and departments. The records for the gazette will be maintained by the department for all future references," an official release said. User groups and citizens can download and print all gazette notifications free of charge. As per the IT Act, downloaded and printed gazette copies are sufficient for all official and legal purposes. The decision is also being seen as another step towards Digital India target as set by the Prime Minister…(TOI)
Oct 11 2015 : The Times of India (Ahmedabad)

With the World Medical Association (WMA) annual council meeting scheduled in Moscow on October 14-17, Ahmedabad-based Dr Ketan Desai, former MCI chief and WMA's president-elect for 2016, is prepared to face opposition from a western lobby which is questioning his past. Dr Desai tells Bharat Yagnik about his determination to head the global body of doctors.

Q Why this controversy surrounding your election as president of WMA?

A This is the first time an Indian would take over as President of WMA since its inception in 1947. I was elected as president in 2009 and it has taken so many years of struggle to finally come to the finishing line. Yet, a small section of western lobby in the medical profession, that has perpetual malice and bias against non-whites, is coming in my way. They are making all attempts to prevent a duly elected Indian from eading WMA. They are also using the western media to scuttle what is inevitable. But I am not worried really as doctors world over would see through the game. Eventually, truth will prevail. Indian Medical Association and myself are fully prepared for Moscow.

Q What is your objective behind getting the presidency of WMA?

A World Medical Association, which was set up in 1947, has 109 national medical associations as its members. This includes the US, Germany, Japan, UK, European Union, Russia, China, India, Brazil etc. It stands for the community of physicians and uniformity of their medical practice in the larger interest of mankind. It lays down ethical standards for medical practice all over the world. It also advises doctors through associations on standardization of practice techniques and treatment of different diseases prevalent globally and locally. Through discussions by its work-groups, council meetings and the general assembly, WMA issues appropriate statements on global health problems. The advocacy of WMA on all these vital aspects and issues is taken note of by the World Health Organization for their appropriate amalgamation in formulation of policies. As president of WMA, I will have to preside over all its functions and act as its ambassador in different international fora like WHO, UNICEF, WHPA etc.

Q But you are controversial because of legal cases against you.

A For a period of two months since April 22, 2010, seven cases came to be registered against me at various places on counts of disproportionate assets and corruption. After detailed investigation, the CBI has filed closure report in five cases and recently, in the sixth case of Lucknow, charges of corruption and conspiracy were dropped by the competent court. Contrary to the stories about my amassing wealth which was being fed to the media, only Rs 53,640 in cash was recovered from me and this was not seized. Every penny was found accounted for. The Supreme Court has stayed all proceedings in the 7th and the last case.

Q You are blaming the western lobby now but who was after you in 2010?

A Some vested interests with the support of government machinery wished to dismantle the elected Medical Council of India (MCI) and so they targeted me. After I was taken into custody on April 22, 2010, within 3 weeks an ordinance was promulgated on May 15, to supersede the elected MCI without waiting for a report from the investigating agency with a board of governors comprising six retired government officials and private practitioners who were hand-picked by the then government. Various lobbies were opposed to the pragmatic initiatives undertaken by the MCI under me, like common entrance test at the national level for all medical admissions, screening test for all foreign graduates, code of ethics for doctor-pharma company nexus, crackdown on faculty with fake documents and many alike. These were hurting vested interests.

Q How exactly can WMA help India and other countries raise their human development index?

A The core issue that I would like to address is the self-evident `inequity' in healthcare in different parts of the world. This inequity needs to be bridged, without which the wish to realize millennium development goals for global citizens would be utopian.Further, on the lines UN's `peace keeping force', we would strive to form a global `health keeping force'. There are plenty more initiatives, which I would disclose later. With limitation of resources and huge populations, the challenges before developing countries are substantial. Bridging the inequity and prompting the developed world to play the role of an elder brother in terms of liberal extension of technology, pharmaceuticals, instrumentation, manpower, training and orientation would have good consequences. The developed world needs to believe that `contingent approach' needs to be replaced by a `planned approach', executed through a concrete action plan and actualized in a time-bound manner.

Q If you were elected in 2009 as WMA president, why this delay in assuming office?

A I was taken into custody on April 22, 2010 and subsequently released. A day before I was supposed to leave for Canada on October 9, 2010, to take over as WMA president, the MCI received a sketchy one-page complaint on fax from one Dr Kunal Saha, an NRI from USA. In great haste, the board of governors, ignoring the objections raised by some members of the MCI's Ethics Committee, decided to suspend my registration and a communication was promptly sent to the WMA and Gujarat Medical Council. The MCI also asked the CBI to prevent my leaving the country. All this was completed in less than 24 hours without following any statutory procedures. Interestingly, the communication to WMA suggested that the new chairman of the MCI be invited to be installed as president of WMA. This ridiculous suggestion was of course turned down flatly by WMA because I was an elected president and the position could not have been transferred to any new person heading the MCI. Since things didn't work out after the 2009 elections, WMA decided to install me as president for the term starting 2016. However my registration was never suspended by Gujarat Medical Council where I am primarily registered
IMA Digital TV
Every fourth person in country suffers from mental illness

People with severe depression, according to mental health experts, are mostly likely to commit suicide within a week of suffering from the disease. AIIMS mental health experts also said that 80 per cent of patients who survived their suicide attempts accepted that they had committed a mistake by trying to end their life. Talking on the eve of World Mental Health Day, AIIMS professor of psychiatry Dr Rakesh Chadda said every fourth person in the country suffers from mental illness. “Some 90 per cent of patients with common mental disorders do not receive treatment and around 50 per cent with severe mental disorders not receive treatment for illness,” added Dr Chadda. “Most of the persons with severe depression commit suicide within first week of disease and those who survive felt guilty that they had tried to do something wrong. A study conducted in India shows that after proper treatment and counselling, about 80 per cent felt what they had done is not right. It was also found that most of the people who had taken the extreme step were suffering from severe depression for only one week,” said assistant professor of psychiatry, AIIMS, Dr Siddharth Sarkar. The experts also warned that sensationalisation of suicides by mass media also encourages other mentally-ill persons to end their lives in the same way. “Mentally-ill patients copy previous suicide incidents which were sensationalised. In recent years, the national capital has witnessed a lot of people attempting suicide at Janakpuri District Centre or now we hear about people jumping in front of Delhi Metro trains. Such copycat suicides can be brought down by stopping sensationalisation of suicides,” said Dr Pratap Sharan. The experts also stressed that there are many types of depression. One way to classify would be endogenous and reactive depression. Endogenous depression is considered mostly biological and reactive depression can be caused by life events. “There are some patients with depression who require more than just medication and may require various psychological and physical therapies,” they said. (Source: Asian Age)
LG launches TB Seal Sale drive
New Delhi, | 10 October, 2015

Lieutenant Governor Najeeb Jung on Friday launched the 66th statelevel TB Seal Sale Campaign of the Delhi Tuberculosis Association. He appealed to the citizens of Delhi to come forward and join the campaign for prevention and control of tuberculosis and make contributions to the campaign. "Citizens of Delhi are known to support causes which are in public interest. I know they will come forward and support the TB Seal Sale Campaign which can help patients, especially from disadvantaged sections, fight this debilitating disease" Jung said. The LG said in spite of best efforts, tuberculosis continues to be a major public health challenge. There is a greater need to disseminate information about prevention and cure of TB, particularly raising awareness about the importance of early detection and diagnosis in curing the disease, he added. Representatives of the Delhi Tuberculosis Association said the sale proceeds of the TB Seal Sale Campaign go towards running awareness campaigns about tuberculosis, as also for providing financial assistance to TB patients from disadvantaged sections. (The Statesman)
Continued use of beta-blockers for HT during noncardiac surgery may increase CV risk

Continued use of beta-blockers for hypertension during noncardiac surgery can raise the risk of major adverse cardiac events (MACE) and all-cause mortality within 30 days in a relatively low-risk population, suggests new research that is in line with earlier studies that generally included higher-risk patients. A Danish cohort of more than 55,000 low-risk hypertension patients showed that those who were taking a beta-blocker plus another type of antihypertensive medication before noncardiac surgery had significantly increased 30-day postoperative risk of MACE and all-cause mortality compared with those who took non–beta-blocker antihypertensive drugs. The findings were published online October 5, 2015 in JAMA Internal Medicine.
MCI Code of Ethics Regulations, 2002

2.3 Prognosis: The physician should neither exaggerate nor minimize the gravity of a patient’s condition. He should ensure himself that the patient, his relatives or his responsible friends have such knowledge of the patient’s condition as will serve the best interests of the patient and the family.
Keep Your Mouth Healthy (NIH)

• Drink fluoridated water and use fluoride toothpaste. Fluoride protects against dental decay at all ages.

• Floss and brush teeth daily. (If you’re a caregiver for someone who can’t brush or floss his/her own teeth, you’ll need to help.)

• Visit your dentist regularly, even if you have no natural teeth and have dentures.

• Avoid tobacco and alcohol. They can raise the risk for oral and throat cancers.

• If medicines lead to a dry mouth, ask your doctor if other drugs might be used instead. If dry mouth continues, drink plenty of water, chew sugarless gum, and avoid tobacco and alcohol.
GP Tip: Heat stroke or heat exhaustion

The only difference between heat exhaustion and head stroke is that in heat stroke, the person does not sweat.
Establishing capacity for Ebola testing, isolation & treatment at the onset is critical to control

Establishment of Ebola treatment units and laboratories at the onset of an Ebola outbreak, in conjunction with other well-established control measures, might prevent rapid escalation of Ebola cases and contribute to outbreak control. Bombali district was among the hardest hit districts in Sierra Leone in the ongoing Ebola epidemic, but outbreak control was achieved. Improvements in timeliness of Ebola control measures were seen after the establishment of an Ebola Treatment Unit (ETU) and laboratory in Bombali; however, these facilities were not available until five months after the outbreak began there. Data from the Viral Hemorrhagic Fever database revealed that after the establishment of the ETU and laboratory in Bombali, the processes for initiating case investigations and determining laboratory results for Ebola patients occurred more rapidly, which coincided with outbreak control. These findings support that establishing capacity for Ebola testing, isolation, and treatment at the onset of an outbreak, is a critical component of outbreak control. Gleason B, et al. MMWR Morb Mortal Wkly Rep. 2015 Oct 9;64(39):1108-11.
Decreased Glycolytic activity impairs oxygen transport by hemoglobin due to:

1. Reduced energy production.
2. Decreased production of 2,3-bisphosphoglycerate.
3. Reduced synthesis of hemoglobin.
4. Low levels of oxygen.

Yesterday’s Mind Teaser: The primary defect which leads to sickle cell anemia is:

1. An abnormality in porphyrin part of hemoglobin.
2. Replacement of glutamate by valine in B-chain of HbA.
3. A nonsense mutation in the B-chain of HbA.
4. Substitution of valine by glutamate in the a-chain of Hba.
Answer for Yesterday’s Mind Teaser: 2.Replacement of glutamate by valine in B-chain of HbA.

Answers received from:Daivadheenam Jella, Dr Jainendra Upadhyay, Raju Kuppusamy, Dr Avtar Krishan

Answer for 10th October Mind Teaser: 3. NADPH cytochrome P-450-reductase.

Correct Answers received from: Dr Jainendra Upadhyay, Raju Kuppusamy, Dr A R Krishan
Readers column
Respected IMA Leaders, Why can’t we assemble in Delhi in large numbers and sensitize the whole nation through media about the plight of allopathy doctors in India. This event if planned properly will be taken attention nationwide and international media will also cover it. Thanks, Regards: Dr Sanjay Deshpande.
Digital IMA