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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 & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; 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

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

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

15th December 2012, Saturday

Red Meat and Non Hemorrhagic Strokes

Eating red meat -- including beef, pork, lamb, ham, hot dogs, sausage, and bacon -- may increase the risk of stroke, a meta-analysis published in Stroke: Journal of the American Heart Association has shown.

Each one-serving-per-day increase in fresh, processed, and total red meat intake was associated with an 11% to 13% relative increase in the risk of all strokes, driven by an increase in the risk of ischemic stroke, according to Joanna Kaluza, PhD, of the Warsaw University of Life Sciences in Poland, and colleagues.

It was not linked with hemorrhagic stroke risk.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

Osmotic laxatives create an osmotic load in the intestinal and colonic lumen, causing more water to enter the intestines. They increase stool bulk intestinal fluid volume, which stimulates intestinal movement (peristalsis). Examples are polyethylene glycol, lactulose and magnesium salts. The greatest amount of evidence exists for PEG.

Dr K K Aggarwal
  eMedinewS Audio PostCard

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

One can predict acute lung injury

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

2402 Girls Trained in Hands-only CPR 10

In a special function Heart Care Foundation of India trained 2402 girls of Dr Sampurnanand Sarvodaya Kanya Vidyalaya No.1 C Block Yamuna Vihar, East Delhi in Hands-only CPR-10.

Dr K K Aggarwal
    National News

Dear Colleague, Let’s celebrate New Year by learning CPR-10 and saving the life of a person

Watch English or Hindi Video @http://emedinews.in/videos/cpr/index.html

Dr K K Aggarwal

Dr. Rohit Bhatt nominated for Lifetime Achievement Award by FOGSI

Dr. Rohit Bhatt is Emeritus professor of Obstetrics and Gynecology at Medical College, Baroda. He is the former president of FOGSI, Perinatology Society of India and National Association of Reproductive and Child Health. He was also the vice president of Asia Oceania Federation of Obstetricians and Gynecologists (AOFOG). He is a Fellow and National Professor of National Academy of Medical Sciences. He also served as: Chairperson, Safe Motherhood Committee of FOGSI and AOFOG and as consultant to WHO and The Population Council. He is the Editor in Chief of International Journal of Gynecologists and Obstetricians (India). Dr. Bhatt has made notable contribution to maternal health. The award will be conferred in January, 2013 at the National Conference in Mumbai.

Get TB drugs at shops free, govt to pay up

NEW DELHI: In a move to curb multi-drug resistant tuberculosis cases caused mostly because of irregular medication, the government has decided that relevant medicines will be available for free at all chemist shops and corporate hospitals. The scheme will be rolled out across the country by next March. A patient, confirmed positive for TB by a qualified doctor, simply needs to register with the Revised National Tuberculosis Control Program (RNTCP). The patient will then be issued a unique ID which will have all information on medicines prescribed and the dosage. "Any hospital or chemist shop will be able to give the medicine to him/her as per the treatment schedule, which will be available online. The government will bear all costs," said Dr Jagdish Prasad, director general of health services (DGHS).

The government presently spends about Rs 250 crore on providing free medicines to TB patients. The new scheme will cost about Rs 100 crore more. "We are in talks with manufacturers of the medicines and hospital groups to finalise the modality for reimbursement," Prasad said. India reports 15 lakh new cases of TB every year. About one in six deaths among adults aged 15-49 are caused by TB. Nearly 10,000 cases of multi-drug resistant are estimated to occur annually. TB was declared a notifiable disease in May this year, making it compulsory for all private doctors, caregivers and clinics treating a patient of this air-borne disease to report the case to the government. "About 1.5 million people are registered with our DOTS (directly observed therapy centres). But data shows 10-17% of these patients tend to miss their regular dosage either because they are working or they do not want to travel to the centres to get the medicine, leaving the treatment module incomplete and ineffective and also exacerbating the risk of multi-drug resistance in them. Many cannot buy medicines due to lack of money," said the official.

A workshop involving top researchers and TB experts is being held to develop the standard model for TB treatment. "There is disparity in prescription of drugs among the private practitioners and the DOTS module, which is WHO approved. We need to address that too," Prasad said. Dr Sarman Singh, professor of clinical microbiology at AIIMS, said while the idea of free distribution of medicines is welcome, strict monitoring will be required to ensure that needy patients get it and it is not misused. (Source: TOI, Dec 13, 2012)

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

    Valvular Heart Disease Update

Aortic regurgitation (AR) is less common in elderly adults than aortic stenosis (AS) and mitral regurgitation (MR). In the Helsinki Aging Study, AR mostly mild was present in 29 percent of patients. In the Framingham Study, AR that was at least mild was present in 13 percent of subjects.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Climate change deaths up 5-fold since 1970

NEW DELHI: Even as one in four deaths worldwide in 2010 was caused by heart disease or stroke the top two killers that have remained constant for the past 40 years human mortality caused by climate change has shown the most dangerous spurt over the last four decades. The Global Burden of Disease Study, 2010, published by the British medical journal, The Lancet, on Thursday shows that there has been a 523% increase in mortality due to "exposure to forces of nature" the highest across 235 causes of death. Alzheimer's disease and other forms of dementia, thanks to ageing populations across the world, also saw a massive increase since 1970 by almost 245%. Mortality due to Parkinson's disease rose by over 107%. Men died the most of cardiovascular disease (12.8%), with road injuries and HIV being the second biggest killers at 10.7%. Interestingly, HIV became the biggest killer of women at 14.4% in 2010, with cardiovascular diseases accounting for nearly 11% of all deaths. The study, which has taken more than five years, involving 486 authors in 50 countries found that chronic obstructive pulmonary disease, lower respiratory infections and lung cancer make up the top five killers for 2010. (Source: TOI, Dec 14, 2012)

Visual impairment rise tied to increased diabetes prevalence

The prevalence of nonrefractive visual impairment in the United States has increased 21% overall and 40% among non-Hispanic whites aged 20 to 39 years, according to a study published in the December 12 issue of JAMA. (Source: Medscape)

Obese women may benefit from fewer, larger meals

Contrary to popular belief, eating fewer, larger meals per day may reduce the risk for cardiovascular disease in obese women compared with eating more smaller meals per day, according to a study published online July 26 in Obesity. (Source: Medscape)

Contact precautions may have unintended consequences

Contact precautions, including gloves, gowns, and isolated rooms, have helped stem the transmission of hospital pathogens but have also had some negative consequences, according to findings from a new study. Healthcare worker (HCWs) visited patients on contact precautions less frequently than other patients and spent less time with those patients when they did visit, report Daniel J. Morgan, MD, from the University of Maryland School of Medicine and the Veterans Affairs (VA) Maryland Health Care System, Baltimore, and colleagues. Moreover, patients on contact precautions also received fewer outside visitors. (Source: Medscape)

Bad habits may imperil progress on CV outcomes

Although rates of heart disease and stroke continue to fall, a rising tide of unhealthy behaviors may start to reverse those improvements, according to an American Heart Association report. (Source: Medpage Today)

    Twitter of the Day

@DrKKAggarwal: I uploaded a @YouTube video http://youtu.be/9dzWbDBmLCo?a Veeraraghavan Keynote.mp4

@DeepakChopra: If you have challenges meditating or can’t easily get into the ‘zone’ consider trying the Dream Weaver

    Spiritual Update

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

The very purpose of life is to face sufferings

As per Hinduism, the very fact we are born means that in our last life, we did not get liberation or Moksha. It also means that there were some of the sufferings, which were left in our last birth. Therefore, the purpose of this birth is to face those sufferings.

For comments and archives

    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

Is D&C safe?

Most of the times, D&C is safe. Occasionally, complications do occur during or right after surgery. The possible complications include:

  • Uterine perforation is when a hole is accidentally made in the uterus by a surgical instrument. The uterine perforation is not always obvious at the time of the D&C, and then you may need additional surgery to look inside the lower belly. The laparoscope is a small instrument attached to a camera that is placed through small incisions in your abdomen or belly to see if the organs around your uterus, such as intestines, bladder, or blood vessels, are injured. If any of these organs are injured, they must be repaired with surgery.
  • Infections can occur after a D&C. It may be related to a sexually-transmitted infection, such as chlamydia or gonorrhea, or due to normal bacteria that pass from the vagina into the uterus during or after the procedure. The symptoms can consist of vaginal discharge, uterine cramping and pain, and fever.
  • Scar tissue formation in the uterus is an uncommon complication in women who have had a D&C. This is referred to as "Asherman’s syndrome." You are at greater risk of scar tissue formation when a D&C is performed after a miscarriage, during pregnancy, or shortly after delivery of a baby. The most common symptom is very light or missed periods. To treat this condition, scar tissue is surgically removed. This type of surgery is performed with a hysteroscope.
  • Other rare complications of a D&C include tears in the cervix, uterine bleeding, and reactions to anesthesia. These complications usually occur at the time of surgery.
    Tat Tvam Asi………and the Life Continues……

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

Blood Grouping systems & Principles, Blood Group Discrepancies & their possible solutions

ABO system and pregnancy

  • Majorities of hemolytic diseases are due to ABO incompatibility
  • The fetus inherits one gene from each parent: O + O = O, O + A= O or A, O + B= O or B, O + AB= A or B.
  • There is a 20% chance of ABO incompatibility of mother and fetus
  • There is a 5% chance of developing hemolytic disease only in type A & B infants of type O mothers, that too only of milder form
  • In fetus and newborns, the RBCs have a decreased number of H, A and B reactive sites
  • The fetal immunoglobulin production is low, so the plasma contains very little of anti–A and B agglutinins
  • Anti–A and B produced in the mother being natural are IgM molecules and so do not cross placenta.
  • In some type O adults, much of the anti–A and B and anti–AB (a cross reacting antibody, also called anti–C) isoagglutinins are of IgG class.
  • There is no adequate method of antenatal diagnosis.
  • Direct Coomb’s antiglobulin test may be negative in ABO hemolytic disease.
  • ABO hemolytic disease is frequently seen in infants of primigravidae and the chance of recurrence is 87%.
  • The risk of stillbirth is not increased and no antenatal treatment is necessary.
  • Only 67% of affected infants will need any treatment.

For comments and archives

    An Inspirational Story

A place to stand

If you have ever gone through a toll booth, you know that your relationship to the person in the booth is not the most intimate you’ll ever have. It is one of life’s frequent non–encounters: You hand over some money; you might get change; you drive off. I have been through every one of the 17 toll booths on the Oakland–San Francisco Bay Bridge on thousands of occasions, and never had an exchange worth remembering with anybody.

Late one morning in 1984, headed for lunch in San Francisco, I drove toward one of the booths. I heard loud music. It sounded like a party, or a Michael Jackson concert. I looked around. No other cars with their windows open. No sound trucks. I looked at the toll booth. Inside it, the man was dancing.

"What are you doing?" I asked. "I’m having a party," he said. "What about the rest of these people?" I looked over at other booths; nothing moving there. "They’re not invited."

I had a dozen other questions for him, but somebody in a big hurry to get somewhere started punching his horn behind me and I drove off. But I made a note to myself: Find this guy again. There’s something in his eye that says there’s magic in his toll booth. Months later I did find him again, still with the loud music, still having a party.

Again I asked, "What are you doing?" He said, "I remember you from the last time. I’m still dancing. I’m having the same party." I said, "Look. What about the rest of the people." He said. "Stop. What do those look like to you?" He pointed down the row of toll booths. "They look like toll booths." "Noooo imagination!"

I said, "Okay, I give up. What do they look like to you?" He said, "Vertical coffins." "What are you talking about?"

"I can prove it. At 8:30 every morning, live people get in. Then they die for eight hours. At 4:30, like Lazarus from the dead, they reemerge and go home. For eight hours, brain is on hold, dead on the job. Going through the motions."

I was amazed. This guy had developed a philosophy, a mythology about his job. I could not help asking the next question: "Why is it different for you? You're having a good time."

He looked at me. "I knew you were going to ask that," he said. "I’m going to be a dancer someday." He pointed to the administration building. "My bosses are in there, and they're paying for my training."

Sixteen people dead on the job, and the seventeenth, in precisely the same situation, figures out a way to live. That man was having a party where you and I would probably not last three days. The boredom! He and I did have lunch later, and he said, "I don’t understand why anybody would think my job is boring. I have a corner office, glass on all sides. I can see the Golden Gate, San Francisco, the Berkeley hills; half the Western world vacations here and I just stroll in every day and practice dancing.

Abraham Lincoln said, "Most people are about as happy as they make up their minds to be." I would tend to agree.

For comments and archives

    Cardiology eMedinewS

Chantix may up heart risk, FDA warns Read More

Smokers' risk of sudden death drops after quitting Read More

    Pediatric eMedinewS

Binge eating: Stepping stone to drug use? Read More

Premature birth 'should be new risk factor' for cardiovascular disease
Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient came with subclinical hypothyroid state.
Dr. Bad: No treatment is required.
Dr. Good: You need treatment.
Lesson: Treatment of subclinical hypothyroidism with thyroid extract is associated with fewer coronary heart disease events.

Make Sure

Situation: A patient missed his second dose of Hepatitis B vaccine and developed Hepatitis B.
Reaction: Oh my God! Why was the vaccine not given between 1–2 months?
Lesson: Make sure that all patients who missed their second dose of vaccine at one month are given the same up to second month (1–2 months).

    Legal Question of the Day

Q. Can a person who has a Diploma in Clinical Pathology do the following without any legal objection?

a. Report histopathology specimens
b. Open a path lab and sign reports
c. Operate and head a blood bank


  1. The person in question has to abide by the rules set by the employer who, in turn, may like to follow the guidelines of the quality control organisations.
  2. A DCP is an expert in clinical pathology which is different from histopathology. There may be problems with his reporting of histopathology slides etc.
  3. A DCP is certainly competent to open a path lab and sign reports.
  4. The Drugs and Cosmetics Rules, 1945, do not lay down any qualifications for running a blood bank but the person concerned will have to abide by any regulations or instructions or requirements that may be laid down for this purpose by the licencing authority under the Drugs and Cosmetics and Rules.
  Quote of the Day (Dr GM Singh)

Do not spoil what you have by desiring what you have not; remember that what you now have was once among the things you only hoped for. Epicurus

    Mind Teaser

Read this…………………

In dealing with a dying client who is in the denial stage of grief, the best nursing approach is to:

A. Agree with and encourage the client’s denial
B. Reassure the client that everything will be okay
C. Allow the denial but be available to discuss death
D. Leave the client alone to discuss the loss

Yesterday’s Mind Teaser: A client has been in a coma for 2 months. The nurse understands that to prevent the effects of shearing force on the skin, the head of the bed should be at an angle of:

A. 30 degrees
B. 45 degrees
C. 60 degrees
D. 90 degrees

Answer for Yesterday’s Mind Teaser: (A) 30 degrees

Correct answers received from: Dr Bharat Bhushan Aggarwal, Dr BK Agarwal, Dr Kanta Jain, Dr PC Das, Dr KV Sarma,, Dr (Maj. Gen.) Anil Bairaria, Dr Arpan Gandhi, Dr Pankaj Agarwal Muthumperumal Thirumalpillai, Dr Jainendra Upadhyay, Dr Avtar Krishan, Dr PC Das, Dr Jella, Dr KP Chandra, Dr KV Sarma, Dr Thakor Hitendrsinh G.

Answer for 13th December Mind Teaser: C. Maintaining the ordered hydration

Correct answers received from: Muthumperumal Thirumalpillai, Dr Jainendra Upadhyay, Dr PC Das, Dr Jella, Dr KP Chandra, Dr KV Sarma, Dr Thakor Hitendrsinh G.

Send your answer to ijcp12@gmail.com

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

Photos of Doctor’s Day Celebration

eMedinewS Apps
    Laugh a While (Dr GM Singh)

The Birth Order


1st baby: You take your infant to Baby Gymnastics, Baby Swing, and Baby Story Hour.

2nd baby: You take your infant to Baby Gymnastics.

3rd baby: You take your infant to the supermarket and the dry cleaner.

    Medicolegal Update

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

What is any hurt which causes the victim to be in severe bodily pain or unable to follow his ordinary pursuits for a period of 20 days?

A grievous injury

The 8th clause of Indian Penal Code 320 defines such hurts, which cause the victim to be in severe bodily pain for a period of 20 days as

  • Any hurt which prevents the victim from following his ordinary pursuits for a period of 20 days
  • Ordinary pursuits means the patient is not able to go to the toilet, to brush the mouth, bathe, cannot eat himself, cannot walk and to carry on such daily pursuits require mandatory help of other person for 20 days
  • The length of time during which an injured person is in pain, disease or is not able to pursue his ordinary daily routine work must be meticulously and satisfactorily observed by the doctor himself before certifying the injury as a grievous injury.
  • It is employed not only in cases where violence has been used but also in cases where hurt has been caused without any assault, e.g., by administration of drugs, the digging of pitfalls. The setting of traps etc. the extent of hurt and the intention of the offender are considered for giving punishment.
  • It is difficult for a doctor to prove that an injured person was in severe bodily pain for 20 days but it is easier to prove that he was unable to follow his ordinary profession/pursuits due to the hurt.
  • A mere stay of 20 days in the hospital doesn’t make an injury grievous unless the person was in severe bodily pain or unable to follow his ordinary pursuits for a period of 20 days. Certifying doctor must rule out and document the feigned illness in medicolegal report.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Heart patients should avoid stress in winter

All heart patients should have their cardiac and mental stress levels check up done in winter. A heart attack can come with irregular meals, late nights, missing of regular dose of medicines and indulgence in smoking and drinking, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India.

Acute stress-related events are common during winters, especially close to full moon in the early morning hours. The circadian variation in event frequency suggests that cardiac events may be triggered by external activities, particularly those activating the sympathetic nervous system.

Data from the Multicenter Investigation of the Limitation of Infarct Size (MILIS) indicated that among 849 patients with acute heart attack, 48 percent described one or more possible triggers, the most common of which was emotional upset (14 percent).

There are several mechanisms by which emotional stress might trigger an acute heart attack.

The physiologic changes that have been described in the morning period of enhanced cardiovascular risk — increase in blood pressure, heart rate, vascular tone, and platelet agreeability — also may result from mental stress. These factors may all be related to abnormalities in autonomic tone and activation of sympathetic nervous system activity, which may enhance platelet aggregation and increase the susceptibility to serious ventricular arrhythmias.

A Guide for heart patients

  • Keep BP <120/80 mm hg
  • Maintain blood sugar levels <90 mg%
  • Not to miss their regular dose of cardiac drugs, if prescribed. The morning pulse and BP should be normal.
  • Ask your doctor for a beta-blocker, if not contraindicated, to keep the stress under control
  • Say no to smoking
  • Say no to alcohol
  • Get a flu vaccine.
  • Avoid heavy eating.
  • Not to ignore any suicidal thoughts.
  • Have a complete medical check up done including a treadmill.
    Readers Responses
  1. Dear Sir, Your thoughts are worthy to bring into practice as Integrative medicine is a comprehensive therapy for patients. In almost all developed countries such treatment strategy is already in practice and in developing countries, it has been initiated. For effective practical application of Integrative medicine to reach the masses there is a need of an Integrative medical course. Best regards: Gandhidas Laveka
    Forthcoming Events

4th eMedinews Revisiting 2012

(a day long single hall medical conference on 2012 happenings, followed by doctors of the year 2012 awards)

Sunday 20th January 2013, Maulana Azad Medical College Auditorium

Dilli Gate Delhi


Dr KK Aggarwal
Padmashri and Dr B C ROY National Awardee President

Dr Veena Aggarwal
Executive Editor IJCP Group
Organizing Chairman

Dr Pawan Gupta
Past President IMA Haryana
Organizing Secretary

4th eMedinewS Revisiting 2012

The 4th eMedinewS–revisiting 2012 conference is being held at Maulana Azad Medical College, New Delhi on Sunday January 20th 2013.

The one–day conference will revisit and discuss all the major advances in medicine in the year 2012. There will also be a live webcast of the event. An eminent faculty will speak at the conference.

There is no registration fee. All delegates will get Registration Kit, Attractive gifts, Certificates. Morning snacks and lunch will be provided.

Register at: www.emedinews.in/


4th eMedinewS Doctor of the Year Awards

Nominations invited for 4th eMedinewS Doctor of the year Award in plain paper. Nominated by 2 professional colleagues along with details of your contributions in the year 2012.

pls send his/her Biodata at: emedinews@gmail.com

    eMedinewS Special

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

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

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

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

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

    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