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

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; 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 7 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 …

24th October 2012, Wednesday

Yash Chopra’s death should not cause treatment panic: Not all dengue is serious

The mortality of dengue is less than 1% and that too only in selected cases said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India. Dr Aggarwal said that the forthcoming MTNL Perfect Health Mela will focus on identification, prevention and treatment of severe dengue.

There are three groups of patients with dengue, who need attention.

  • Patients with coexisting medical conditions, such as pregnancy, infancy, old age, obesity, diabetes mellitus, renal failure, and chronic hemolytic diseases, may increase the risk of severe dengue and/or complicate management. Referral for hospitalization is recommended for such patients regardless of other findings. Hospitalization should also be considered for patients who may have difficulties with outpatient follow-up or with timely self-referral should complications develop (e.g., patients who live alone or who live far from a health care facility without a reliable means of transport).
  • Patients with "alarm signs” i.e. severe abdominal pain or tenderness, persistent vomiting, abrupt change from fever to hypothermia, mucosal bleeding, liver enlargement on physical exam, or abnormal mental status, such as disorientation.
  • Patients with blood pressure <90/60 mmHg or fall in blood pressure by 20, hematocrit >50% or rise in hematocrit by more than 20, difference between upper and lower blood pressure less than 20, evidence of bleeding other than petechiae, true platelet count less than 20000, rise in pulse by 20.

Not all dengue is serious

  • The current strains 1 and 3 are not serious.
  • First attack of dengue is usually not serious.
  • Dengue is not serious if one can maintain the difference between upper and lower blood pressure more than 40
  • Dengue is not serious if one can maintain blood volume and avoid intravascular dehydration.

Facts about dengue

  • Dengue is a febrile illness that is caused by any one of four serotypes of this flavivirus (DEN-1, DEN-2, DEN-3, and DEN-4).
  • It is endemic in more than 100 countries in tropical and subtropical regions of the world and causes an estimated 50 million infections annually worldwide.
  • The greatest risk factor for the development of dengue hemorrhagic fever (DHF) or dengue shock syndrome is secondary infection with a different dengue serotype from the original infecting virus. Thus, severe disease occurs primarily in patients who reside in hyperendemic areas where multiple serotypes circulate simultaneously.
  • Mosquito control is the most effective approach to the prevention of dengue transmission. There is no licensed vaccine available for preventing dengue.
  • Patients with dengue fever should be cautioned to maintain their fluid intake to avoid dehydration and to take paracetamol as needed for fevers and myalgias. Aspirin or nonsteroidal antiinflammatory agents should generally be avoided.
  • It is important to manage plasma leakage in dengue hemorrhagic fever with aggressive intravascular volume repletion to prevent or reverse hypovolemic shock. Blood transfusion is appropriate only in patients with significant bleeding. The adequacy of fluid repletion should be assessed by serial determination of hematocrit, blood pressure, pulse, and urine output.
  • Prophylactic platelet transfusion has no role.
  • Early identification of patients at higher risk for shock and other complications of dengue are important. Patients with suspected dengue who have none of the warning signs for more severe illness and can maintain their fluid intake can be managed as outpatients, but may need daily re-evaluation.
  • Duration of illness – The period of maximum risk for shock is between the third and seventh day of illness. This tends to coincide with resolution of fever. Plasma leakage generally first becomes evident between 24 hours before and 24 hours after defervescence.

Insecticide spraying does not help

  • Insecticide spraying in response to dengue outbreaks is not highly effective against A. aegypti mosquitoes, which frequently breed inside houses.
  • Community-based approaches involving education of the population in efforts to reduce breeding sites, such as discarded tires and other containers that accumulate standing water, have shown some promise.

Treatment

  • Exclude other treatable diagnoses. Patients at risk for dengue can acquire other diseases with similar clinical features, such as malaria, typhoid fever, and leptospirosis. Symptoms in patients with dengue virus infections resolve in 5 to 7 days.
  • Patients with dengue fever should be cautioned to maintain their intake of oral fluid to avoid dehydration. Fever and myalgias can be managed as needed with paracetamol. Aspirin or nonsteroidal antiinflammatory agents should generally be avoided because of the risk of bleeding complications and in children because of the potential risk of Reye's syndrome.
  • Gastrointestinal bleeding or menorrhagia in patients with DHF, and occasionally in patients with dengue fever as well, can be severe enough to require blood transfusion.
  • Platelet transfusions have not been shown to be effective at preventing or controlling hemorrhage, but may be warranted only in patients with severe thrombocytopenia (<10,000/mm3) and active bleeding.
  • Prophylactic platelet transfusions in patients with severe thrombocytopenia but without active bleeding are generally not recommended.
  • Administration of intravenous vitamin K1 is recommended for patients with severe liver dysfunction or prolonged prothrombin time.
  • Use of a histamine H2 receptor antagonist or proton pump inhibitor is reasonable in patients with gastrointestinal bleeding, although there is no evidence of benefit.
  • Plasma leakage in DHF is important to manage with aggressive intravascular volume repletion to prevent or reverse hypovolemic shock
  • In mild cases, oral rehydration may be sufficient. However, in patients with established intravascular fluid loss, intravenous fluid administration is recommended. Blood transfusion is appropriate in patients with significant bleeding; subsequent hematocrit measurements must be interpreted with caution since it is also critical to assess the adequacy of fluid repletion.
  • For patients with hypotensive shock, an initial bolus of 5% dextrose in normal saline or Ringer's lactate (20 mL per kg of body weight) infused over 15 minutes is recommended, followed by continuous infusion (10 to 20 mL/kg per hour depending on the clinical response) until vital signs and urine output normalize. For patients who improve, the infusion rate should then be gradually reduced until it matches plasma fluid losses.
  • The adequacy of fluid repletion should be assessed by serial determination of hematocrit, blood pressure, pulse and urine output. Patients with shock on presentation should initially have vital signs measured at least every 30 minutes and hematocrit measured every two to four hours.
  • Narrowing of the pulse pressure is an indication of hypovolemia in children even with a normal systolic blood pressure.
  • Normalization of the hematocrit is an important goal of early fluid repletion
  • Patients can develop shock for one to two days after initial fluid resuscitation, which represents the period of increased vascular permeability in DHF.
  • Most patients who present for medical attention before profound shock develops and who receive appropriate fluid therapy will recover quickly.
  • Usually no more than 48 hours of intravenous fluid therapy are required.
  • Discharge from the hospital is appropriate when patients have been afebrile for at least 24 hours and have normal oral intake, urine output, and hematocrit.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

A study suggests that women who exercise more regularly move their bowels more often than those who are sedentary (Am J Gastroenterol. 2003;98:1790-96).

For Comments and archives…

 
Dr K K Aggarwal
    eMedinewS Audio PostCard

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

Lifestyle change can reduce aging

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

MCD South Zone to Train its Teachers on Health & Hygiene at Perfect Health Mela

Addressing a press conference, Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Mr. Satish Upadhyay, Chairman Education Committee, MCD South Zone said that MCD South Zone in association with Heart Care Foundation of India will be organizing a training program for its teachers on 7th November, 2012, Wednesday, at Constitution Club of India.

 
Dr K K Aggarwal
    National News

Stricter pictorial warning for tobacco products

New Delhi, Oct 22 (PTI) Government has notified new, stricter pictorial warnings for smoking and smokeless forms of tobacco with April 1 next year as the deadline for their implementation. A set of three pictorial warnings each for both smoking and smokeless forms of tobacco to be displayed on tobacco product packages have been notified by the Health Ministry.

For comments and archives

India to run out of phone numbers by next year

CHENNAI: It was inevitable, but it is now closer than ever. All the phone numbers series currently in use, like the ones beginning with 98 or 99, are quickly getting used up with the subscriber base in the country expected to reach a billion and beyond by next year. "There might be a serious problem if a new series of numbers are not brought in by the middle of next year. We are theoretically reaching the limit of existing number sets with a subscriber base of one billion," said Rajan Mathews, director general of Cellular Operators Association of India (COAI). The solution may lie in 11-digit phone numbers but Department of Telecom (DoT) is also looking at alternatives. Mathews said allocation of numbers to operators is done in batches, depending on factors like the size of subscriber base and efficiency in utilizing existing number sets, among other things. A batch system is followed to avoid chaos due to all kinds of phone numbers flooding the market. Since a particular range of numbers is given to an operator, it generally has an identifier like the first two digits, for example 98 or 99, which come to be associated with that operator. "None of these number ranges can be used to their full extent due to the way in which they are allotted. Only a certain portion of these numbers are used as phone numbers. This is called percentage of numbering system utilization and it hovers around 50%, meaning only around half or more of the potential numbers are used as phone numbers," said Sandip Biswas, director at consultancy firm Deloitte. "The numbers will have to be increased by at least one digit to accommodate new devices. However, to ensure there's absolutely no scope for any problem, we may even see the introduction of 12 digit numbers," said Biswas. (Source: TOI, Oct 22, 2012)

For comments and archives

My Profession My Concern

Recommendations of the Expert Advisory Group Meeting on the 14th Oct, 2004

Administration of IV infusions to treat shock

  • It was universally felt that the administration of IV infusions was a lifesaving procedure. As hemorrhage was the commonest cause of maternal mortality, the administration of 3ml of fluid for every ml of blood lost could keep the woman alive during the time it took to transport her to the nearest CHC/FRU where blood transfusion facility was available
  • As of now, the ANMs are neither trained nor allowed by the regulatory authorities to establish an IV line. After the discussion, it was decided that:
  • If the ANM is trained to give IV infusion, she should administer wherever feasible, even at home.
  • The ANM should start infusion with Ringer Lactate or Dextrose Saline.
  • If an IV infusion was being started in cases of PPH, it was recommended the IV fluid should be augmented with 20U of Oxytocin for every 500 ml bottle of fluid. This could be continued throughout transportation.
  • However, the logistics and feasibility of the ANM being able to carry IV infusion sets and IV fluids to homes need to be explored, and ensured.

For comments and archives

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

 
    Valvular Heart Disease Update

Mitral stenosis in the elderly

Mitral stenosis remains a valvular disease of predominantly young people, and rheumatic fever remains the leading cause of mitral stenosis in all age groups.

(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)

For comments and archives

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

COPD can't be treated alone in older patients

Most elderly patients with chronic obstructive pulmonary disease (COPD) also have other illnesses that require a combined treatment approach, researchers said at the American College of Chest Physicians annual meeting. (Source: Medpage Today)

For comments and archives

Sleep disorders common in cystic fibrosis

Children with cystic fibrosis (CF) who are in stable clinical condition have high rates of obstructive sleep apnea, which holds implications for their overall well-being, Italian researchers reported. (Source: Medpage Today)

For comments and archives

Antibiotic misuse worries infection control personnel

In an online survey, 9 of 10 hospital infection control personnel report inappropriate use or misuse of antibiotics and raise concerns about delay in sensitivity results affecting treatment decisions. (Source: Medscape)

For comments and archives

Getting physical ups seniors' brain volume

Older individuals who engage in regular physical activity are less likely to experience loss of brain volume and other changes in brain structure, Scottish researchers found. (Source: Medpage Today)

For comments and archives

 
    Twitter of the Day

@DrKKAggarwal: B12 deficiency can present with recent memory loss If you are forgetting things instead of worrying that... http://fb.me/1JGsYwzz0

@DeepakChopra: Compassion is the feeling of shared suffering. When you feel someone else's suffering, there is the birth of understanding. Interoman.ws

 
    Spiritual Update

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

On the 7th Navratri, enjoy a mind devoid of inner darkness

Kalaratri is worshipped on the Seventh Day of Navratri. She is dark and black like the night. Her hairs are unlocked. SHE has three eyes and four hands.

For comments and archives

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

How does contraception work?

Contraceptive agents are usually divided into those that are either hormonal or non hormonal. Most of the hormonal contraceptives work by changing a woman's hormone levels to mimic a pregnancy, therefore preventing eggs from being able to be released from the ovary. In contrast, non hormonal contraceptive agents or devices work by preventing a man's sperm from joining a woman's egg.

For comments and archives

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

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

Blood transfusion

Blood transfusion is a broadly based discipline that overlaps and intersects many other medical, scientific and managerial fields, including hematology, immunology, genetics, histocompatibility, cellular function and metabolism protein structure and function, cryobiology, disposable equipment, bioengineering, statistics, data-processing, public relations, logistics and standardization.

For comments and archives

 
    An Inspirational Story

The rose

A certain man planted a rose and watered it faithfully, and before it blossomed, he examined it. He saw the bud that would soon blossom and also the thorns. And he thought, "How can any beautiful flower come from a plant burdened with so many sharp thorns?" Saddened by this thought, he neglected to water the rose, and before it was ready to bloom, it died.

So it is with many people. Within every soul there is a rose. The God-like qualities planted in us at birth grow amid the thorns of our faults. Many of us look at ourselves and see only the thorns, the defects. We despair, thinking that nothing good can possibly come from us. We neglect to water the good within us, and eventually it dies. We never realize our potential.

Some people do not see the rose within themselves; someone else must show it to them. One of the greatest gifts a person can possess is to be able to reach past the thorns and find the rose within others. This is the characteristic of love, to look at a person, and knowing his faults, recognize the nobility in his soul, and help him realize that he can overcome his faults. If we show him the rose, he will conquer the thorns. Then will he blossom, blooming forth thirty, sixty, a hundred-fold as it is given to him.

Our duty in this world is to help others by showing them their roses and not their thorns. Only then can we achieve the love we should feel for each other; only then can we bloom in our own garden.

For comments and archives

 
    Cardiology eMedinewS

Cell-based strategy for treating vascular disorders Read More

Robotic-assisted cardiac stent system enhances control and improves visualization Read More

 
    Pediatric eMedinewS

Govt to liberalise norms for setting up new medical college Read More

Urine culture still the standard for UTI in neonates Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient came for counseling for a high risk sexual behavior.
Dr. Bad: Use condoms.
Dr. Good: Use condoms and take a pre–exposure prophylaxis pill for 7 days.
Lesson: Pre exposure prophylaxis for 7 days is now a reality.

For comments and archives

Make Sure

Situation: A diabetic patient died of flu pneumonia.
Reaction: Oh my God! Why was flu vaccine not given?
Lesson: Make sure that all diabetics are given flu vaccine every year.

For comments and archives

 
  Legal Question of the Day (Dr MC Gupta)

Q. A lawyer underwent a cholecystectomy 20 years ago. Recently he underwent a health check-up during which sonography was also performed. The sonography report mentioned erroneously that the gall bladder was normal. The sonologist has apologized to the patient and offered to correct the report. The patient/lawyer have threatened the sonologist that they would approach the consumer court. What should the sonologist do?

Ans.

  1. It is unlikely that the court will award any compensation because no damage has occurred.
  2. The sonologist should introspect and analyse the procedures in his clinic that lead to such mistake and should take necessary action to avoid the same in future.
  3. The sonologist should do nothing further at this stage. If the patient sends a legal notice or files a consumer complaint, he should engage a lawyer and reply to the notice/complaint.
 
  Lab Update (Dr Navin Dang and Dr Arpan Gandhi)

Vitamin B1, Plasma

Thiamine, or thiamin, sometimes called aneurin, is a water–soluble vitamin of the B complex (vitamin B1), whose phosphate derivatives are involved in many cellular processes. The best characterized form is thiamine diphosphate (ThDP), a coenzyme in the catabolism of sugars and amino acids.

Thiamine deficiency can lead to many problems including neurodegeneration, wasting and death. A lack of thiamine can be caused by malnutrition, a diet high in thiaminase–rich foods (raw freshwater fish, raw shellfish, ferns) and/or foods high in anti–thiamine factors (tea, coffee, betel nuts) and by grossly impaired nutritional status associated with chronic diseases, such as alcoholism, gastrointestinal diseases, HIV–AIDS, and persistent vomiting.

 
  Quote of the Day (Dr GM Singh)

Egotism is the anesthetic that dulls the pain of stupidity. Frank Leahy

 
    Mind Teaser

Read this…………………

Joey is a 46 year-old radio technician who is admitted because of mild chest pain. He is 5 feet, 8 inches tall and weighs 190 pounds. He is diagnosed with a myocardial infarct. Morphine sulfate, Diazepam (Valium) and Lidocaine are prescribed.

The physician orders 8 mg of Morphine Sulfate to be given IV. The vial on hand is labeled 1 ml/10 mg. The nurse should administer:


A. 8 minims
B. 10 minims
C. 12 minims
D. 15 minims

Yesterday’s Mind Teaser: A glass of water with a single ice cube sits on a table. When the ice has completely melted, will the level of the water have increased, decreased or remain unchanged?

Answer for yesterday’s Mind Teaser: remain unchanged

Correct answers received from: Dr Amit Kochar, Dr Anurag Julka, Drjella,
Dr BB Aggarwal, Dr (Maj. Gen.) Anil Bairaria, Dr Jainendra Upadhyay, Dr Pankaj Agarwal, Dr KV Sarma, Dr K Raju, Muthumperumal Thirumalpillai, Dr Kanta Jain, Dr Archna Parwani, Dr Avtar Krishan.

Answer for 22nd October Mind Teaser: Father of the man

Correct answers received from: Sandeep Yadav, Dr Kanta Jain, Dr Mohan.

Send your answer to ijcp12@gmail.com

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    Laugh a While (Dr GM Singh)

A man tells his doctor he is suffering from memory loss.
How long are you suffering from that, the doctor ask?
Suffering from what?

 
    Medicolegal Update

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

What is murder?

Murder is the act of killing another human being with malice, traditionally called "malice aforethought." Malice is defined as the intent to kill or to inflict bodily injury, either express or implied. If a deadly weapon is used, intent to kill will necessarily be implied by a court of law. The presumption is that if the assailant brought a deadly weapon with him/her there was intent to use the weapon. If the assailant picked up a weapon at the scene of the crime in an act of defense or in a provoked fit of rage, there might not be malice.

Murder, as defined in common law countries, is the unlawful killing of another human being with intent or malice aforethought and generally this state of mind distinguishes murder from other forms of unlawful homicide

  • Manslaughter means unlawful premeditated killing of a human being by a human being.
  • In the United States, the principle of dual sovereignty applies to homicide, as to other crimes. If murder is committed within the borders of a state, that state has jurisdiction.
  • According to the modern Russian Criminal Code, only intentional killing of another human considered as a murder.
  • In Sweden, Murder (Mord) is defined as a planned taking of life of another and is punishable with imprisonment between 10 to 18 years or life imprisonment.
  • However, according to the Romanian Penal Code, a person can face a penalty ranging from 10 to 25 years or life imprisonment for murder.
  • In Norway, an act of murder (mord or drap) may be either planned murder, intentional murder or murder as a result of neglect.
  • Murder is defined in the New South Wales Crimes Act 1900 as follows:
    • Under NSW law, the maximum penalty for murder is life imprisonment with a standard non–parole period of 20 years, or
    • 25 years for the murder of a child under the age of 18 years, or police official
  • In Finland, murder is defined as homicide with at least one of four aggravating factors: deliberate intent/Exceptional brutality or cruelty significantly endangering public safety Committed against a public official engaged in enforcing the law.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Driving fitness awareness for commercial drivers in the forthcoming Perfect Health Mela

When appointing a driver, look for his medical fitness. Commercial vehicle driver should be completely medically fit as they risk multiple lives while driving, said Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal, President Heart Care Foundation of India.

Patients suffering from diabetes on insulin should not be allowed to drive commercial vehicles. People who snore in the night should have a medical fitness before they can become commercial drivers.

People who snore and have more than five episodes of stopped breathing per hour of sleep are four times more likely to get road accident. People with 15 or more episodes of stopped breathing per hour of sleep are seven times more likely to get road accidents. People with uncontrolled blood pressure, preexisting heart diseases, visions disturbances and dementia should not drive commercial vehicles.

 
    Readers Responses
  1. Your information regarding knowledge of modern concepts is praiseworthy. Dr. Malhan
 
    Forthcoming Events


19th MTNL Perfect Health Mela 2012 Programme

Dr K K Aggarwal
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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