eMedinewS20th December 2013, Friday

Dr K K AggarwalPadma 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; Editor in Chief IJCP Group, National Vice President Elect, Indian Medical Association; Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); 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);
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JNC 8: Expert Panel Want BP Cuffs Loosened

  1. The long–awaited update to guidelines for the management of hypertension, from the panel appointed to the Eighth Joint National Committee (JNC 8), raises the recommended blood pressure threshold to determine the need for drug therapy in many patients.
  2. For most hypertensive individuals aged 60 or older, pharmacologic treatment should be started when the systolic pressure is 150 mm Hg or higher or the diastolic pressure is 90 mm Hg or higher, with the goal of achieving readings below those cutoffs.
  3. For younger hypertensive patients and for those with chronic kidney disease or diabetes –– regardless of age –– treatment should be initiated when the systolic pressure is 140 or higher or the diastolic pressure is 90 or higher
  4. In the previous JNC 7 guidelines released in 2003, the target blood pressure was less than 140/90 mm Hg for most hypertensive patients and less than 130/80 mm Hg for patients with chronic kidney disease or diabetes.

For the initial choice of agent, the authors made the following recommendations:

  • For nonblack individuals, including those with diabetes, ACE inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers, and thiazide–type diuretics can all be chosen for first–line treatment
  • For black individuals, including those with diabetes, calcium channel blockers and thiazide–type diuretics are recommended as first–line therapy
  • For patients with chronic kidney disease, regardless of race or diabetes status, initial or add–on therapy should include an ACE inhibitor or an ARB to improve renal outcomes.

What Isn’t Included

  1. The current guidance had a narrow focus and did not cover several subjects included in the JNC 7 recommendations, including definitions of pre–hypertension and hypertension, measurement of blood pressure, patient evaluation, secondary hypertension, adherence to treatment regimens, resistant hypertension, and lifestyle interventions.
  2. The authors didn’t completely sidestep lifestyle, however. The included treatment algorithm has an instruction to implement lifestyle interventions and maintain them throughout management of the patient before moving on to drug therapy. And the authors stated that they endorse the recently released lifestyle recommendations of the ACC and AHA.
  3. For all persons with hypertension, the potential benefits of a healthy diet, weight control, and regular exercise cannot be overemphasized. These lifestyle treatments have the potential to improve blood pressure control and even reduce medication needs.

JNC 8 at Last! Guidelines ease up on BP thresholds, drug choices

The Eighth Joint National Committee (JNC 8) has released its new guidelines on the management of adult hypertension, which contain two key departures from JNC 7 that will simplify care.

  1. The expert writing group recommends a relaxing of the more aggressive JNC 7 target blood pressures and treatment–initiation thresholds in elderly patients and in patients under age 60 with diabetes and kidney disease.
  2. JNC 8 also backs away from the recommendation that thiazide–type diuretics should be initial therapy in most patients, suggesting an ACE inhibitor, angiotensin–receptor blocker (ARB), calcium–channel blocker (CCB), or thiazide–type diuretic are reasonable choices.

Simple message rule

  1. Treat to 150/90 mm Hg in patients over age 60 and 140/90 for everybody else.
  2. Any of these four groups of drugs are good, just get people to goal. Monitor them, track them, remonitor them. That’s a very simple message.

Nine Recommendations

  • In patients 60 years or over, start treatment in blood pressures >150 mm Hg systolic or >90 mm Hg diastolic and treat to under those thresholds.
  • In patients <60 years, treatment initiation and goals should be 140/90 mm Hg, the same threshold used in patients >18 years with either chronic kidney disease (CKD) or diabetes.
  • In nonblack patients with hypertension, initial treatment can be a thiazide–type diuretic, CCB, ACE inhibitor, or ARB, while in the general black population, initial therapy should be a thiazide–type diuretic or CCB.
  • In patients >18 years with CKD, initial or add–on therapy should be an ACE inhibitor or ARB, regardless of race or diabetes status.

While the targets have been loosened, the new guidelines do not mean that physicians should ease up on treatment in a patient who is doing very well based on JNC 7 guidance.

  1. "I do think there’s always a concern about people not following the recommended targets; however, we have to start somewhere, and our panel’s opinion is that we should start where the evidence leads us," Dr Paul A James (University of Iowa, Iowa City) lead author on the new guidelines, said. "In one sense, you’re fooling people by saying, ‘Let’s pretend it’s 140 mm Hg so we have a little leeway,’ and that doesn’t feel exactly right."

cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

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Ringtone – CPR 10 Mantra Hindi
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More about Debts

sprritual blog

Hindu scriptures have talked about three types of Hrin (debts) – Dev Hrin, Pitra Hrin and Rishi Hrin.

God or the devtas gave us the consciousness, parents gave us our body and teachers gave us the knowledge or intellect.

In Vedic language, our body is a mix of mind, body and soul which can be equated to three Hrins of mind (teachers), body (parents) and soul (Rishi & Gods). In computer language, it can be equated to operational software (God), application software (teachers) and computer hardware (parents).

cardiology news

The Seed of Honesty

A successful business man was growing old and knew it was time to choose a successor to take over the business. Instead of choosing one of his Directors or his children, he decided to do something different. He called all the young executives in his company together. He said, "It is time for me to step down and choose the next CEO. I have decided to choose one of you."

The young executives were shocked, but the boss continued. "I am going to give each one of you a SEED today – one very special SEED. I want you to plant the seed, water it, and come back here one year from today with what you have grown from the seed I have given you. I will then judge the plants that you bring, and the one I choose will be the next CEO."

One man, named Jim, was there that day and he, like the others, received a seed. He went home and excitedly, told his wife the story. She helped him get a pot, soil and compost and he planted the seed.

Every day, he would water it and watch to see if it had grown. After about three weeks, some of the other executives began to talk about their seeds and the plants that were beginning to grow.

Jim kept checking his seed, but nothing ever grew. Three weeks, four weeks, five weeks went by, still nothing. By now, others were talking about their plants, but Jim didn’t have a plant and he felt like a failure.

Six months went by – still nothing in Jim’s pot. He just knew he had killed his seed. Everyone else had trees and tall plants, but he had nothing. Jim didn’t say anything to his colleagues, however… He just kept watering and fertilizing the soil – He so wanted the seed to grow.

A year finally went by and all the young executives of the company brought their plants to the CEO for inspection.

Jim told his wife that he wasn’t going to take an empty pot. But she asked him to be honest about what happened. Jim felt sick to his stomach, it was going to be the most embarrassing moment of his life, but he knew his wife was right.

He took his empty pot to the board room. When Jim arrived, he was amazed at the variety of plants grown by the other executives. They were beautiful — in all shapes and sizes. Jim put his empty pot on the floor and many of his colleagues laughed, a few felt sorry for him! When the CEO arrived, he surveyed the room and greeted his young executives.

Jim just tried to hide in the back. "My, what great plants, trees, and flowers you have grown," said the CEO. "Today one of you will be appointed the next CEO!" All of a sudden, the CEO spotted Jim at the back of the room with his empty pot. He ordered the Financial Director to bring him to the front.

Jim was terrified. He thought, "The CEO knows I’m a failure! Maybe he will have me fired!" When Jim got to the front, the CEO asked him what had happened to his seed – Jim told him the story.

The CEO asked everyone to sit down except Jim. He looked at Jim, and then announced to the young executives, "Behold your next Chief Executive Officer! His name is Jim!" Jim couldn’t believe it. Jim couldn’t even grow his seed. "How could he be the new CEO?" the others said.

Then the CEO said, "One year ago today, I gave everyone in this room a seed. I told you to take the seed, plant it, water it, and bring it back to me today. But I gave you all boiled seeds; they were dead – it was not possible for them to grow. All of you, except Jim, have brought me trees and plants and flowers. When you found that the seed would not grow, you substituted another seed for the one I gave you. Jim was the only one with the courage and honesty to bring me a pot with my seed in it. Therefore, he is the one who will be the new Chief Executive Officer!"

  • If you plant honesty, you will reap trust.
  • If you plant goodness, you will reap friends.
  • If you plant humility, you will reap greatness.
  • If you plant perseverance, you will reap contentment.
  • If you plant consideration, you will reap perspective.
  • If you plant hard work, you will reap success.
  • If you plant forgiveness, you will reap reconciliation.
  • If you plant faith in God, you will reap a harvest.

So, be careful what you plant now; it will determine what you will reap later. "Whatever You Give To Life, Life Gives You Back"

News Around The Globe

News

Indian scientists invent insulin pills for diabetics

LONDON: In a big breakthrough, Indian scientists have done what medical science has been trying to achieve since 1930 - an insulin pill for diabetics.Since insulin’s crucial discovery nearly a century ago, countless diabetes patients have had to inject themselves with the life-saving medicine. Now Indian scientists have reported a new development toward a long-sought insulin pill that could save millions the pain of daily shots. Published in the American Chemical Society journal, the advance could someday not only eliminate the "ouch" factor but also get needle-wary — and weary — patients to take their medicine when they should.

For years, researchers have sought a way to transform delivery of this therapy from a shot to a pill, but it has been a challenge. The body’s digestive enzymes that are so good at breaking down food also break down insulin before it can get to work. In addition, insulin doesn’t get easily absorbed through the gut into the bloodstream. To overcome these hurdles, Sanyog Jain from India's National Institute of Pharmaceutical Education and Research combined two approaches to shield insulin from the digestive enzymes and then get it into the blood. They packaged insulin in tiny sacs made of lipids, or fats called liposomes, which are already used in some treatments. Then, they wrapped the liposomes in layers of protective molecules called polyelectrolytes. To help these "layersomes" get absorbed into the bloodstream, they attached folic acid, a kind of vitamin B that has been shown to help transport liposomes across the intestinal wall into the blood.

In rats, the delivery system lowered blood glucose levels almost as much as injected insulin, though the effects of the "layersomes" lasted longer than that of injected insulin. Diabetes inhibits the production or use of insulin, which is a hormone that helps blood glucose or blood sugar become absorbed into cells and give them energy. Diabetes is one of India's biggest health challenges. By 2030, India’s diabetes burden is expected to cross the 100 million mark, against 87 million estimated earlier. Type 1 diabetes occurs when the body doesn't make enough insulin, and type 2 diabetes occurs when the body doesn't make or use insulin very well, causing glucose to remain in the blood, which can lead to serious problems.

Libby Dowling, care advisor at Diabetes UK, said "Oral insulin could make a big difference to the lives of people with diabetes. Children, elderly people and those with a phobia of needles would benefit particularly if and when insulin capsules become a safe and effective treatment for the condition. Although more research is needed, Diabetes UK would very much like to see insulin capsules one day become a reality."

She added, "Many people with Type 2 diabetes take diabetes tablets. They are not the same as insulin. As yet insulin cannot be taken in tablet form because it would be broken down in the stomach before it could work. Diabetes tablets work in different ways to lower blood glucose levels - for example by stimulating the pancreas to produce more insulin, or by helping the body to use the insulin that it does produce more effectively"

(Source: Kounteya Sinha, TNN, Dec 19, 2013)

3 doctors, nurses get jail term

Additional District and Sessions Judge S. Santosh Kumar sentenced three doctors and as many nurses attached to a private hospital at Punalur to one–year jail term each after they were found guilty of medical negligence which caused the death of a 37–year–old woman on September 26, 2009.

S. Balachandran, 62, an anaesthetist; Laila Ashok, 58, gynecologist; and Vinu Balakrishnan, 49, a surgeon; and nurses Anila Kumari, 35; Shyamala Devi, 54; and Sujatha Kumari, 39; obtained bail soon after the verdict. They would go in appeal against the verdict.

All six were sentenced under Section 304(A) of the Indian Penal Code (IPC) for causing the death of a person through rash or negligent act not amounting to culpable homicide.

They were also sentenced to an additional three months imprisonment under Section 201 of the IPC for destruction of evidence and Section 34 of the IPC for jointly committing an offence.

The deceased, Mini Philip got admitted to the Deen Hospital in Punalur for a procedure on September 25, 2006 after her second delivery. But without subjecting her to any pre–surgery tests, a surgery was conducted in haste the same evening.

Following the surgery, the patient went unconscious. She was taken to a nearby hospital the same night and then to a private hospital in Thiruvananthapuram the next day as her condition worsened. She was declared dead the same day.

The prosecution said a police investigation was carried out as per the guidelines laid down by the Supreme Court in 2005 governing cases related to deaths caused due to medical negligence. The conclusion was that medical negligence had caused the woman’s death.

1. 304A. Causing death by negligence.––Whoever causes the death of any person by doing any rash or negligent act not amounting to culpable homicide shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both.

201. Causing disappearance of evidence of offence, or giving false information to screen offender.–– Whoever, knowing or having reason to believe that an offence has been committed, causes any evidence of the commission of that offence to disappear, with the intention of screening the offender from legal punishment, or with that intention gives any information respecting the offence which he knows or believes to be false, if a capital offence; if a capital offence.–– shall, if the offence which he knows or believes to have been committed is punishable with death, be punished with imprisonment of either description for a term which may extend to seven years, and shall also be liable to fine; if punishable with imprisonment for life; if punishable with imprisonment for life.–– and if the offence is punishable with 1 (imprisonment for life), or with imprisonment which may extend to ten years, shall be punished with imprisonment of either description for a term which may extend to three years, and shall also be liable to fine; if punishable with less than ten years’ imprisonment. if punishable with less than ten years’ imprisonment –– and if the offence is punishable with imprisonment for any term not extending to ten years, shall be punished with imprisonment of the description provided for the offence, for a term which may extend to one– fourth part of the longest term of the imprisonment provided for the offence, or with fine, or with both. Illustration A, knowing that B has murdered Z, assists B to hide the body with the intention of screening B from punishment. A is liable to imprisonment of either description for seven years, and also to fine.

34. Acts done by several persons in furtherance of common intention.–– When a criminal act is done by several persons in furtherance of the common intention of all, each of such persons is liable for that act in the same manner as if it were done by him alone.

Diagnosis of PCOD in postmenopausal women

The diagnosis of polycystic ovary syndrome (PCOS) is almost always made during adolescence or early adulthood based upon two out of three of the following criteria: oligomenorrhea, hyperandrogenism, and polycystic ovaries on ultrasound. The 2013 practice guidelines from the Endocrine Society state that a presumptive diagnosis of PCOS in a postmenopausal woman can be based upon a "well–documented long–term history of oligomenorrhea and hyperandrogenism during the reproductive years". Finding polycystic ovary morphology on pelvic ultrasound would provide additional support, although ovarian volume and follicle number decrease with age in women with or without PCOS.

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Rabies News (Dr. A K Gupta)

What does humanizing your dog means?

  • Talking to your dog like he/she is a person.
  • Treating your dog like he/she is a person.
  • Allowing dogs to do what they want because it will hurt their "feelings."
  • Dressing them up in little doggie clothes.

Remember, humanizing your dog is fulfilling your own human needs, not your dogs. Humanizing dogs does more harm than good.

cardiology news

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

Look AHEAD for intensive lifestyle modification in diabetes

In the Look AHEAD trial, 5145 individuals with type 2 diabetes and BMI >25 kg/m2, after a median follow–up of 9.6 years, the composite primary outcome (death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, and hospitalization for angina) occurred in a similar number of patients in the intervention and control groups. Non–cardiac benefits of the lifestyle intervention included reductions in urinary incontinence, sleep apnea, and depression, and improvements in quality of life, physical functioning, and mobility.

  1. Look AHEAD Research Group, Pi–Sunyer X, Blackburn G, et al. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one–year results of the look AHEAD trial. Diabetes Care 2007; 30:1374.
  2. Look AHEAD Research Group, Wing RR, Bolin P, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013; 369:145.
cardiology news

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

Obesity increases the risk of spontaneous preterm birth

Obesity is a well–established risk factor for medically–indicated preterm delivery. A population–based cohort study from Sweden including over 1.5 million singleton deliveries confirmed that overweight and obese women were not only at increased risk for medically–indicated preterm deliveries at all gestational ages, but also observed a significant dose–response relationship between severity of obesity and risk of spontaneous extremely preterm birth (22 to 27 weeks). The data support the importance of preconceptional weight loss for obese women.

  1. Cnattingius S, Villamor E, Johansson S, et al. Maternal obesity and risk of preterm delivery. JAMA 2013; 309:2362.
cardiology news

Snorers at Risk of Sudden Death

The interrupted night time breathing of sleep apnea increases the risk of dying. Sleep apnea is a common problem in which one has pauses in breathing or shallow breaths during sleep.

Studies have linked sleep apnea during snoring to increased risk for death. Most studies were done in sleep centers rather than in the general community. A study published in the journal Sleep has suggested that the risk is present among all people with obstructive sleep apnea. The size of the increased mortality risk was found to be surprisingly large.

The study showed a six–fold increase, which means that having significant sleep apnea at age 40 gives you about the same mortality risk as somebody aged 57 who does not have sleep apnea.

For the study, the researchers collected data on 380 men and women, 40 to 65 years old, who participated in the Busselton Health Study. Among these people, three had severe obstructive sleep apnea, 18 had moderate sleep apnea, and 77 had mild sleep apnea. The remaining 285 people did not suffer from the condition. During 14 years of follow–up, about 33 percent of those with moderate to severe sleep apnea died, compared with 6.5 percent of those with mild sleep apnea and 7.7 percent of those without the condition. For patients with mild sleep apnea, the risk of death was not significant and could not be directly tied to the condition.

People who have, or suspect that they have, sleep apnea should consult their physicians about diagnosis and treatment options.

Another study by researchers from the University of Wisconsin has also shown that severe sleep apnea was associated with a three–fold increased risk of dying. In addition, for those with moderate to mild sleep apnea, the risk of death was increased 50 percent compared with people without sleep apnea. Sleep apnea is also linked to future heart attacks and with thickened wall thickness of the neck artery.

cardiology news

Total CPR since 1st November 2012 – 80967 trained

Media advocacy through Web Media

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press release

Beware of air pollution in Delhi

As per DPCC website findings, in R K Puram area, the levels of NO2 in the air today are four times the normal and the levels of particulate matter PM10 (less than 10 microgram) are 8 times and particulate matter PM2.5 (less than 2.5 microgram) are up to 10 times higher.

High NO2 levels can cause elderly asthma or chronic bronchitis, high PM-10 levels can cause asthma and high PM 2.5 level can cause high BP, heart attack and irregular heart rhythm said Padma Shri and Dr. B. C. Roy National Awardee Dr. K K Aggarwal, President Heart Care Foundation of India

A recent US study has also shown that high levels of NO2 and PM 2.5 can trigger atrial fibrillation with two hours of exposure.

About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National Commemorative stamps and one cancellation stamp, and who has conducted one to one training on" Hands only CPR" of 80967 people since 1st November 2012.

The CPR 10 Mantra is – "Within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

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CPR 10 Utsav was organized by Heart Care Foundation of India in association with NDMC on 15th December 2013 at Talkatora Stadium.

press release

Lifestyle change can reduce aging

vedio of day

today video of the day20th MTNL Perfect Health Mela Press Conference with Marwadi Yuva Manch, Faridabad

20th MTNL Perfect Health Mela Press Conference at Marwah Studio, Noida

Cultural Evening at IMA

eMedi Quiz

The syndromic management of urethral discharge includes treatment of:

1. Neisseria gonorrhoeae and Herpes genitalis.
2. Chlamydia trachomatis and Herpes genitalis.
3. Neisseria gonorrhoeae and Chlamydia trachomatis.
4. Syphilis and chancroid.

Yesterday’s Mind Teaser: The Vitamin A supplement administered in Prevention of nutritional blindness in children programme" contain:

1. 25,000 IU/ml.
2. 1 lakh IU/ml.
3. 3 lakh IU/ml.
4. 5 lakh IU/ml.

Answer for yesterday’s Mind Teaser: 2. 1 lakh IU/ml.

Correct answers received from: Dr Manjit Mohi, Dr ajay Gandhi, Dr Jainendra Upadhyay,Dr.Dinesh Narain Saksena, Dr.Bitaan Sen & Dr.Jayashree Sen, Dr.Bitaan Sen & Dr.Jayashree Sen, Dr. P. C. Das, Dr.Pawan Mehta , Dr Avtar Krishan, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, daivadheenam

Answer for 18th December Mind Teaser: 4. Agreement between two observations

Correct answers received from: Dr. P. C. Das, Dr.Pawan Mehta, Dr.K.V.Sarma

Send your answer to ijcp12@gmail.com

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lic
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medicolegal update

Click on the image to enlarge

medical querymedical query

medicolegal update

will I live longer?

patient: doctor, if i give up wine, women, and song , will i live longer?

doctor: not really, it will just seem longer.

medicolegal update
medicolegal update

Click on the image to enlarge

medicolegal updatemedicolegal update

medicolegal update

Situation: A patient with acid peptic disease was denied any painkiller for his distressing illness.
Reaction: Oh, my God! Why did you not give him nimesulide?
Lesson: Make sure to prescribe nimesulide as it is safe in acid peptic disease.

medicolegal update

In the space age the most important space is between our ears. Thomas J Borlow

medicolegal update

Dr KK Aggarwal: Some Alcohol Terms Dr K K Aggarwal 1. Do not start if you do not drink Limit if you take and can not stop 3. (cont) http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: with stress in a better way is the key to breaking the cycle of stress eating. #CosmicConsciousness

Forthcoming events

5th eMedinews Revisiting 2013

(a day long single hall medical conference on 2013 happenings, followed by doctors of the year 2013 awards)

Sunday 19th January 2014, Maulana Azad Medical College Auditorium

Dilli Gate Delhi, 10 am-6 pm


Dr KK Aggarwal
Padma Shri 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

5th eMedinewS Revisiting 2013
The 5th eMedinewS–revisiting 2013 conference is being held at Maulana Azad Medical College, New Delhi on Sunday January 19th 2014.

The one–day conference will revisit and discuss all the major advances in medicine in the year 2013. There will also be a live webcast of the event. An eminent faculty will speak at the conference.

There is no registration fee. Lunch will be provided.

Register at: rawat.vandana89@gmail.com/drpawangupta2006@yahoo.com

5th eMedinewS Doctor of the Year Awards
Nominations invited for 5th eMedinewS Doctor of the year Award in plain paper. Nominated by 2 professional colleagues along with details of your contributions in the year 2013.

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

medicolegal update
  1. Dr KK Aggarwal creates another Indian Record on CPR10 well done well doing congratulations, Dear Dr KK. Regards: Vinod.

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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, Prof.(Dr).C V Raghuveer

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