emedinews
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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR

 

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  Editorial …

17th September 2011, Saturday

Is sex an exercise and is it hard on the heart?

This is a piece taken from HealthBeat to share with our readers. At some time in his life, nearly every man gets exercised about sex. And as many men get older, they wonder if sex is a good form of exercise or if it’s too strenuous for the heart.

Treadmill vs. mattress

To evaluate the cardiovascular effects of sexual activity, researchers monitored volunteers while they walked on a treadmill in the lab and during private sexual activity at home. In addition to 13 women, the volunteers included 19 men with an average age of 55. About three–quarters of the men were married, and nearly 70% had some form of cardiovascular disease; 53% were taking beta blockers. Despite their cardiac histories, the men reported exercising about four times a week, and they reported having sexual activity about six times a month on average.

Researchers monitored heart rate and blood pressure during standard treadmill exercise tests and during "usual" sexual activity with a familiar partner at home. All the sex acts concluded with vaginal intercourse and male orgasm. Disappointingly perhaps, the treadmill proved more strenuous. On an intensity scale of 1 to 5, with 5 being the highest, men evaluated treadmill exercise as 4.6 and sex as 2.7. Sex was even less strenuous for women in terms of heart rate, blood pressure, and perceived intensity of exertion.

Sex as exercise

Men seem to spend more energy thinking and talking about sex than on the act itself. During sexual intercourse, a man’s heart rate rarely gets above 130 beats a minute, and his systolic blood pressure nearly always stays under 170. All in all, average sexual activity ranks as mild to moderate in terms of exercise intensity. As for oxygen consumption, it comes in at about 3.5 METS (metabolic equivalents), which is about the same as doing the foxtrot, raking leaves, or playing ping pong. Sex burns about five calories a minute; that’s four more than a man uses watching TV but it’s about the same as walking the course to play golf. If a man can walk up two or three flights of stairs without difficulty, he should be in shape for sex.

Sex as sex

Raking leaves may increase a man’s oxygen consumption, but it probably won’t get his motor running. Sex, of course, is different, and the excitement and stress might well pump out extra adrenaline. Both mental excitement and physical exercise increase adrenaline levels and can trigger heart attacks and arrhythmias, abnormalities of the heart’s pumping rhythm. Can sex do the same? In theory, it can. But in practice, it’s really very uncommon, at least during conventional sex with a familiar partner.

Careful studies show that fewer than one of every 100 heart attacks is related to sexual activity, and for fatal arrhythmias the rate is just one in 200. Put another way, for a healthy 50–year–old man, the risk of having a heart attack in any given hour is about one in a million; sex doubles the risk, but it’s still just two in a million. For men with heart disease, the risk is 10 times higher — but even for them, the chance of suffering a heart attack during sex is just 20 in a million. Those are pretty good odds.

How about Viagra?

Until recently, human biology has provided unintentional (and perhaps unwanted) protection for men with heart disease. That’s because many of the things that cause heart disease, such as smoking, diabetes, high blood pressure, and abnormal cholesterol levels, also cause erectile dysfunction. The common link is atherosclerosis, which can damage arteries in the penis as well as in the heart.

Sildenafil, vardenafil, and tadalafil have changed that. About 70% of men with erectile dysfunction (ED) respond to the ED pills well enough to enable sexual intercourse. Sex may be safe for most men with heart disease, but are ED pills a safe way to have sex?

For men with stable coronary artery disease and well–controlled hypertension, the answer is yes — with one very, very important qualification. Men who are taking nitrate medications in any form cannot use ED pills. This restriction covers all preparations of nitroglycerin, including long–acting nitrates; nitroglycerin sprays, patches, and pastes; and amyl nitrate. Fortunately, other treatments for erectile function are safe for men with heart disease, even if they are using nitrates.

Safe sex

Sex is a normal part of human life. For all men, whether they have heart disease or not, the best way to keep sex safe is to stay in shape by avoiding tobacco, exercising regularly, eating a good diet, staying lean, and avoiding too much (or too little) alcohol. Needless to say, men should not initiate sexual activity if they are not feeling well, and men who experience possible cardiac symptoms during sex should interrupt the sexual activity at once.

With these simple guidelines and precautions, sex is safe for the heart — but it should be safe for the rest of the body, too. Sexually transmitted diseases pose a greater threat than sexually induced heart problems. When it comes to sex, men should use their brains as well as their hearts.

(Source HealthBeat: Harvard)

For More editorials…

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

Is sex an exercise and is it hard on the heart?

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

18th MTNL Perfect Health Mela to Focus on Science behind Rituals: Ghaziabad to Benefit

Addressing a press conference, Padma Shri and Dr B C Roy National Awardee Dr. K K Aggarwal, President, Heart Care Foundation of India and MTNL Perfect Health Mela said that the main theme this year will be science behind mythology.

 
Dr K K Aggarwal
 
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook & Twitter

http://blogs.kkaggarwal.com/?p=1134
http://twitter.com/#!/search/medicolegal
https://www.facebook.com/pages/Insight–on–Medicolegal–Issues/247091668637671

Doctors’ meeting to find ways for fighting big ‘C’

NAGPUR: Cancer has emerged as a killer disease globally. The World Health Organisation has predicted that the number of people affected by the disease in the developing countries would triple in another two decades. Doctors say that lifestyle and socio–economic scenario affects the kind and incidence of cancer commonly observed in any country. Most of the world’s cancer burden is borne by developing countries so it becomes necessary to find ingenious solutions suited to local needs. With this aim, the Indian Co–operative Oncology Network (ICON) has organised a three–day cancer conference in the city starting from Friday. Doctors from the US, Europe and South Korea, and several oncologists from all over India would discuss international medical technologies available to fight the menace and the ways to implement them in India. (Source: TOI, Sep 16, 2011)

For comments and archives

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

(Dr Monica and Brahm Vasudev)

Period of obesity may increase diabetes risk

Obesity increases diabetes risk, but the amount of excess weight someone carries –– and how long it’s carried –– can make that risk even higher. In a study investigators examined information on roughly 8,000 teens and young adults and calculated how far above a certain body mass index (or BMI, a calculation based on weight and height) they were and for how long. They "found those with a BMI of 25 or higher (overweight) or 35 and higher (30 and up is obese) for a greater length of time had a higher risk of diabetes.

For comments and archives

New drug allows shorter hepatitis therapy for some

Response–guided therapy with the protease inhibitor telaprevir (Incivek) can cut the treatment period for hepatitis C (HCV) in half, researchers reported. In an open–label randomized trial, 24 and 48 weeks of standard therapy – each combined with telaprevir for the first 12 weeks – had equivalent efficacy among patients who responded early and strongly, according to Kenneth Sherman, MD, PhD, of the University of Cincinnati College of Medicine, and colleagues. (Source: Medpage Today)

For Comments and archives

Eyelid lipid plaques predict CV disease

The presence of the lipid–containing yellow plaques known as xanthelasmata on the eyelids is an independent predictor of cardiovascular disease, a large prospective study found.
During a mean follow–up of 22 years, adults participating in a long–term Danish heart study who had xanthelasmata at baseline had an adjusted hazard ratio for myocardial infarction of 1.48 (95% CI 1.23 to 1.79), according to Anne Tybjærg–Hansen, MD, of Rigshospitalet in Copenhagen, and colleagues. Participants with these plaques also were at increased risk of ischemic heart disease (HR 1.39, 95% CI 1.20 to 1.60) and death (HR 1.14, 95% CI 1.04 to 1.26), the researchers reported online in BMJ. (Source: Medpage Today)

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  Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

Nurses who exercise encourage their patients to do the same

There are many news articles and research reports encouraging physicians to become more active and set an example for their patients. Now, new research published in the International Journal of Nursing Practice shows that nurses who exercise are more likely to promote it to their patients (the article gives some additional motivation for nurses to exercise, too!). Researchers at the Case Western Reserve University School of Nursing administered a survey to 112 New York area nurses to find out more about their exercise habits, and whether they encouraged their patients to engage in exercise and other healthy behaviors. Unfortunately, the study found that half of nurses were overweight, and almost 40% did not have time to exercise. However, those nurses who do exercise almost always promote healthy lifestyle changes to their patients, and those who do not exercise tend not to encourage their patients to do the same. The authors conclude that more patients would be motivated to exercise, or learn more about active lifestyles, if nurses became more active.

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  Twitter of the Day

@DrKKAggarwal: The direction of firing is determined from the bullet track *Burning, blackening and tattooing around a firearm... http://fb.me/ZJ3DmDDf

@DeepakChopra: It was amazing RT @DanaStorm: RT @EricaFordNYC: @50centjust had an amazing discussion!!! I #Inspired @UncleRUSHhttp://twitpic.com/6lh4u0

 
    Dr KK Answers

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

How to handle patients on nitrates who wants to take Viagra group of drugs?

  1. Men treated with PDE–5 inhibitors (Viagra group of drugs) and nitrates are at risk for severe hypotension and syncope (loss of consciousness).
  2. Co–administration of Viagra group of drugs (sildenafil) with isosorbide mononitrate or sublingual nitroglycerin lowers blood pressure (52/29 mmHg with isosorbide mononitrate and 36/21 mmHg with sublingual nitroglycerin).
  3. In men on Viagra group of drugs with chest pain, nitrates should not be administered for 24 hours (or longer in patients with renal or hepatic dysfunction) of sildenafil, 24 hours of vardenafil, or up to 48 hours of tadalafil.

For comments and archives

 
    Spiritual Update

Seva, Simran & Satsang: The Basic Spiritual Prescription

Most spiritual movements today follow the path of Seva, Satsang and Simran to achieve inner happiness. It forms the basis for both, Nirankari movement as well as Sikhism. It was earlier propagated by Adi Shankaracharya in his book Bhaj Govindam, where he described all three in one path: Satnaam (Simran), Satsang and Seva: Shlokas 28.

For comments and archives

 
    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

A young man died in a hospital. The police has requested the hospital for the following investigations so as to ascertain the cause of death: MRI scan CT scan, Bone scan, Chemical test and Pathological test of the body to ascertain the cause of death. My queries are:

  • Has the police any authority to do so?
  • Is the hospital bound to do as asked by the police (especially when the value/rationale of bone scan in such situation may be questionable)?
  • Who will pay for the tests that can be done in the hospital?
  • What should be done as regards the tests that cannot be done in the hospital?
  • Can the CT and MRI facility of a private diagnostic centre be used for this purpose?

My combined opinion for the above five queries is as follows:

The police has no authority over the hospital and cannot dictate that the tests should be done. The hospital’s job is to treat patients, including MLC cases; to carry out MLC examination/autopsy and prepare an MLC report/autopsy report and give the original of such report to the police, along with any specimens preserved for further examination; to appear in the court when asked by the court/police. The expertise for treatment and MLC examination/autopsy lies with the hospital/FTM specialist and not with the police. Such FTM specialist is expected to advise the police for any need for any further tests on the body. After death in an MLC case, the custody of the dead body lies with the police till the police releases the body to the relatives for cremation. The police is expected to have its own arrangements for doing any further necessary tests before releasing the body. All such tests are the duty and responsibility, including financial responsibility of the police department/state. They cannot transfer, by police orders, any such responsibility to others, including the relatives. However, everybody is expected to help the police in investigation of crime. If the hospital is a government hospital, and if the hospital does not mind doing the tests asked for, it may do so after getting a written request from the police. If the govt. hospital concerned has reservations regarding doing certain tests, it is not bound to do the same but should record in writing the reasons/reservations. If the govt. hospital does not have facility for doing a certain test, it has no responsibility to get it done from anywhere else. If it is a private hospital, it has no duty to carry out the tests free and has no duty to perform these tests even otherwise, even if payment is offered, if there is no request from a doctor/FTM specialist. If the police feels that the tests must be done, it is for them to approach senior police officers who may ask the District Collector etc. for necessary help/instructions.

For comments and archives

 
    An Inspirational Story

(Ms Ritu Sinha)

Happiness

The King asked an old wise monk to write down something that could encourage the prosperity of his family for years to come. It would be something that the family could cherish for generations. On a large piece of paper, the old monk wrote. "Your majesty dies, the queen dies, and the prince dies, the prince’s son dies."

The King man became angry when he saw the monk’s work. "I asked you to write something down that could bring happiness and prosperity to my family," the King yelled. "Why do you give me something depressing like this?"

"If your son should die before you," the monk answered, "this would bring unbearable grief to your family.

If your grandson should die before your son, this also would bring great sorrow. If your family, generation after generation, disappears in the order I have described, it will be the natural course of life. This is true happiness and prosperity."

For comments and archives

 
    Medicine Update

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

What is the treatment of febrile seizures?

A spinal tap may be done to be sure your child does not have a serious infection like meningitis, especially if your child is younger than 1 year of age.

In general, physicians do not recommend treatment of a simple febrile seizure with preventive medications. Diazepam and Clobazam for intermittent prophylaxis. Anti–fever drugs like acetaminophen and ibuprofen can help lower a fever, as can hydrotherapy but they do not prevent febrile seizures.

If your child has had a febrile seizure, do not fear the worst. These types of seizures are not dangerous to the child and do not cause long–term health problems. If you have concerns about this issue or anything related to the child's health.

Remember: While febrile seizures may be very scary, they are harmless to the child. Febrile seizures do not cause brain damage, nervous system problems, paralysis, mental retardation, or death.

For comments and archives

 
    Infertility Update

(Dr. Kaberi Banerjee, Infertility and IVF Specialist)

Infertility is still an enigma to us.

The most advanced technique gives a pregnancy rate of at best 50–60% per attempt. Definitely there is lot more to be understood. We are hosting a Conference on 8th – 9th of October at Le’ Meridian, New Delhi on Current Practices and Recent Advances in ART (CUPART 2011). We have invited a very respectable panel of International and National faculty whose experiences will be a wealth of knowledge to us.

Under the aegis on AOGD

Organizing Chairperson – Dr Kaberi Banerjee

Day 1: Interesting Highlights

Session 2 – An IVF Cycle – All that you needed to know


All basics and important steps of an IVF cycle will be covered in this session.

Speakers: Dr Sonia Malik (New Delhi), Dr Shweta Mittal (New Delhi), Dr Brigadiar Sharma (Pune), Dr Sandeep Talwar (New Delhi)

Inauguration & Welcome Address by Chief ICMR New Delhi at 7.00pm followed by Shaan–e–Hindustan – Sufi Night with Adil Hussaini, Hyderabad & Fellowship Dinner

For Registration Contact: Address: E –23 Ayurvigyan Nagar New Delhi – 110049, For details contact +91 9871250235

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    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Acetaminophen

  • To determine if an overdose has occurred
  • To determine risk of liver damage
  • To help determine if treatment with an antidote is required

For comments and archives

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient was put on six per week dialysis program.
Dr Bad: It is unethical.
Dr Good: Go ahead with it.
Lesson: Increasing hemodialysis frequency from three to six sessions a week significantly reduced the risk of mortality and adverse cardiovascular outcomes but increased vascular access problems, according to results of a multicenter clinical trial. More frequent hemodialysis was associated with a 40% reduction in the risk of death or increased left ventricular mass and a 30% decrease in the risk of death or a decrease in physical–health score. Moreover, six weekly sessions resulted in significantly greater urea clearance (Kt/Vurea). However, more frequent hemodialysis was associated with a 71% increase in interventions related to vascular access (The FHN Trial Group. In–center hemodialysis six times per week versus three times per week. N Engl J Med 2010 Dec 9;363(24):2287-300)

For comments and archives

Make Sure

Situation: A patient with LBBB in ECG developed acute pulmonary edema.
Reaction: Oh my God! Why was underlying low cardiac functions not suspected?
Lesson: Make sure all patients with LBB undergo echo to rule out ejection fraction. This may not be true for RBBB.

For comments and archives

 
  Rabies Update

(Dr.A.K.Gupta, Author of "RABIES – the worst death")

Should a dog bite wound be allowed to bleed, bandaged, or stitched?

Do not bandage the wound as far as possible. If unavoidable, apply non–adherent, absorbent dressings (paraffin gauze and Melolin) to absorb the discharge from the wound. Do not use tincture iodine.

Avoid suturing the bite wound as a rule since it may risk inoculation of the virus deeply into the wound. However, if the wound has to be sutured, it should be delayed as much as possible, from several hours to 3 days and after infiltration of RIG. If RIG is not available, then, as a last resort, the wound must be flushed with povidone iodine before suturing. The suture should be loose and not interfere with free bleeding and drainage.

Human and animal bite wounds are best closed by secondary sutures after one week and after proper cleansing and daily wound care. Primary surgical intervention must be avoided if possible.

For comments and archives

 
  Quote of the Day

(Dr. GM Singh)

The eyes can perceive forms, adorn the face. They are the source of direct knowledge and a guide to avoid wrong deeds; hence, the eyes are the most important of all sense organs.

 
    Medicolegal Update

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

Death from respiratory failure in surgery

Hypoxia.

  • Text mentions that the cardiac arrest is mainly neurogenic and any irritation of the respiratory tract, such as laryngoscope or intubations may cause a lightly anesthetized patient to have a cardiac arrest.
  • Hypoxia is a potent precipitating factor in cardiac arrest, either from faults in the apparatus or more commonly due to inexperienced anesthetist, especially in handling the equipments with which he is not familiar. An overdose of the anesthetic agent depresses the respiratory centre and begins a descending spell of hypoxia.
  • Airway obstruction is another danger which may be blood, teeth, and dentures inside the tract or faults in the connecting tube, laryngeal spasm, swabs and an abnormal posture of neck.
  • Regurgitation of gastric contents is a real danger and I have seen this in many cases.
  • From the autopsy surgeon’s point of view, the finding of gastric contents in the airways must be backed up some clinical evidence of its ante–mortem origins before making any conclusion because many bodies has some gastric contents in some part of the air passage at the time of autopsy, mostly as a result of postmortem transfer that is a consequence of the dying process and not a cause of death.
  • Some physical faults in the anesthetic equipment such as faults in the connecting tube which may be internal delamination not seen from outside, may cause death.
  • Flowmeter errors occur, but confusion of bottled or pipe gas supplies or the connection of an empty cylinder are more common.
  • Any electric appliance is potentially dangerous and defective cauteries, defibrillators and diathermy equipments have all caused death.
  • Explosion from inflammable gases and vapors during intervention have also caused death

For comments and archives

 
    Mind Teaser

Read this…………………

Which of the following is least to occur as gallbladder primary?

a. Adenocarcinoma
b. Squamous cell carcinoma
c. Lymphoma
d. Carcinoid tumour

Yesterday’s Mind Teaser: Incidence of gallbladder cancer is highest in

a. Chile
b. India
c. United Kingdom
d. South Africa

Answer for Yesterday’s Mind Teaser: a. Chile

Correct answers received from: Dr AK Kela, Dr Ragavan Moudgalya, Dr Neelam Nath, Dr Jainendra Upadhyay, Dr Anil Bairaria, Dr Valluri Ramarao, Dr Prachi, Dr Anupam, Dr Rajiv, Dr Shagun.

Answer for 14th September Mind Teaser: d. Fludarabine + ATG
Correct answers received from:Dr K Raju, Dr Chandresh Jardosh, Dr Ragavan Moudgalya, Dr Seema,
Dr Ratan, Dr Tapan, Dr Shonal.

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Ms Prabha Sanghi)

Morris, an 82 year–old man, went to the doctor to get a physical. A few days later, the doctor saw Morris walking down the street with a gorgeous young woman on his arm. A couple of days later, the doctor spoke to Morris and said, ‘You’re really doing great, aren’t you?’ Morris replied, ‘Just doing what you said, Doc: "Get a hot mamma and be cheerful."

The doctor said, ‘I didn’t say that… I said, ‘You’ve got a heart murmur, be careful.’

 
    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name

Indication

DCI Approval Date

Each bowel preparatory kit contains:

One enteric coated tablet Bisacodyl IP 5mg &

One sachet of powder for reconstitution contains: Polyethylene glycol 3350NF: 210gm + Sodium Bicarbonate IP 2.86gm + Sodium Chloride IP 5.6gm + Potassium Chloride IP 0.74gm

For bowel cleansing prior to colonoscopy in adult patients only

11.02.11

 
    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Weekdays inadequate sleep can impair health

Around one–third people sleep less than seven hours per night on weekdays or workdays said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India and MTNL Perfect Health Mela.

Quoting a study published by National Health and Nutrition Examination Survey by CDC in 2011, Dr Aggarwal said that this is most common among individuals 20 to 59 years of age. Those who report sleeping less than seven hours per night are more likely to report difficulty concentrating than those who sleep seven to nine hours per night.

The message is clear: All days should be considered same and inadequate sleep in week days can impair health.

For comments and archives

 
    Readers Response
  1. Dear Dr Aggarwal, thanks for ur update on the spiritual aspects of shrads. it is very unfortunate to tell the people by the so called pundits that ur forefathers will curse your next generation if u do not observe the rituals and thereby resort to emotional blackmail.our forefathers who have become immortals in heaven will bless and not curse us.whatever u do in this janma u will get with compound interest like citi bank in the next birth. Dr. R. Mani.
 
    Forthcoming Events

International Heart Protection Summit (IHPS–2011)

Organized by Ministry of Health & Family Welfare Govt. of India & ASSOCHAM September 28th, 2011 at Hotel Ashok, Chanakyapuri, New Delhi
President: Dr. H.K. Chopra, Intl. President: Dr. Navin C. Nanda, Scientific Chairman: Dr. S.K. Parashar, Org. Secretary: Dr. O.S. Tyagi,
For Registration & Details: Contact – Mob. 9971622546, 8010222883,
E–mail: agnideep.mukherjee@assocham.com; sandeep.kochhar@assocham.com,
Website:www.assocham.org/ihps2011

……………………………………………………………………

18th MTNL Perfect Health Mela

Date: 14th–18th October
Different locations in Delhi
19th–23rd October
Venue: NDMC Ground, Opp. Indira Nari Niketan Working Girls Hostel
Near Philanji Village, Laxmibai Nagar, New Delhi
Theme: Science Behind Rituals

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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