emedinews
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FIRST NATIONAL eMEDICAL NEWSPAPER OF INDIA
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 …

27th November 2012, Tuesday

Day care PCI is the future

Most adverse outcomes after percutaneous coronary intervention are seen within the first 48 hours. In an observational study of over 107,000 patients undergoing elective PCI, same-day discharge was not associated with an increased risk of death or hospitalization at 30days.

Rao SV, Kaltenbach LA, Weintraub WS, et al. Prevalence and outcomes of same-day discharge after elective percutaneous coronary intervention among older patients. JAMA 2011; 306:1461.

For Comments and archives…

Dr KK Aggarwal
Group Editor in Chief

   Constipation Update

Saline laxatives such as magnesium hydroxide have not been examined in older adults, and should be used with caution because of the risk of hypermagnesemia.

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

Day care PCI is the future

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

19th MTNL Perfect Health Mela 2012

Large number of Nursing students took active participation in the 19th MTNL Perfect Health Mela

 
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

Three-year rural healthcare course to start from next year

NEW DELHI: A three-year medical course with six months of rotational internship will be introduced from 2013. Despite strong objections from the Indian Medical Association (IMA), Union health minister Ghulam Nabi Azad has decided to go ahead and introduce the Bachelor of Science (Community Health) keeping in mind the nation's acute shortage of doctors and specialists. The new medical course will create mid-level health professionals with candidates eligible to apply being students who have studied physics, chemistry and biology in the high secondary (10+2) level. Azad said on Friday, "Admissions as well as deployment will be district based and reservations would apply as norms." According to the minister, after acquiring the degree, the graduates will be employed as Community Health Officers by state governments. "The proposed course is likely to be introduced in the states willing to adopt it from 2013. A few medical associations like IMA have not welcomed the proposal. Nonetheless, in order to address the serious concern of shortage of availability of human resources in the health sector in rural areas, the government is committed to introduce the course, with in-built safeguards," he said. The Medical Council of India (MCI) recently cleared the introduction of the three-and-a half-year course.

MCI board chairman Dr K K Talwar had said this special cadre of health workers will be trained mainly in district hospitals, then placed in sub centers or primary health centers and to be taught "some module of clinical work". The cadre can diagnose and treat basic medical cases, get involved in immunization programmes and administer extended first aid. "We intend to introduce the course from next April. This cadre will also refer patients according to their condition to other centres. We have also prepared the syllabus for the course. Now, the ministry had to take the final call," Dr Talwar had said. The Planning Commission's high-level expert group too has strongly backed the all new health cadre and had said that as a career progression incentive, they should be promoted to the level of public health officers after 10 years of service. The committee envisages that by 2022 India should actually have colleges teaching B.Sc. Community Health in all the districts that have over 5-lakh population. Health ministry has been pushing for the introduction of this cadre to tackle the menace of doctors unwilling to serve in rural areas. Only 26% of doctors in India live in rural areas, serving 72% of the population. Urban density of doctors is nearly four times than in rural areas, and that of nurses also three times higher. It's become worse in the past few decades which have seen the disappearance of certain cadre — village health guides and traditional birth attendants, first instituted in 1986. Experts said the selection of students would be based on merit in the higher secondary examination.

Azad had earlier said that he wanted an MCI stamp on the degree so that it is universally recognized. "The syllabus of the course is also ready and is need based. If MCI endorses it, students will get the confidence that the degree has a standing," he had said. The Plan panel said that the course should focus on "high quality of competence in preventive, promotive and rehabilitative services required for rural populations with focus on primary healthcare". The Commission, however, was clear that the course was not a mini-MBBS but rather a unique training programme aimed at the basic healthcare needs of its target population. Azad said, "We have tried everything to get doctors to serve in far flung and backward areas. But everyone wants to be in either the state capital or district headquarters. Nobody wants to serve in sub district and primary health centres." "Measures such as a compulsory posting of one year for all MBBS graduates immediately after internship, with 10% extra marks weight age for one year of rural service and 20% extra marks for 2 years of rural service in the postgraduate entrance examination wasn't successful. We also reserved 50% seats for post graduate diploma course doctors who serve in rural areas. But that hasn't worked too," he added. The number of allopathic doctors registered with the MCI has increased since 1974 to 6.12 lakh in 2011 - a ratio of one doctor for 1,953 or a density of 0.5 doctors per 1,000 population. (Source: TOI, Nov 24, 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

Prosthetic Valve update

What are the risk factors for calcific aortic stenosis?

Risk factors associated with calcific aortic stenosis in elderly adults are similar to those for atherosclerosis.

(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)

Walk test on par with exercise in heart failure

Six-minute walk distance and exercise testing had similar prognostic value for hospitalization and mortality in outpatients with chronic heart failure, according to a head-to-head comparison study. (Source: Medpage Today)

MR colonography pinpoints larger lesions

MR colonography successfully detected larger colon polyps in high-risk patients when the imaging modality was paired with iodine-tagged limited bowel preparation and automated carbon dioxide insufflation, researchers said at the annual meeting of the Radiological Society of North America. (Source: Medpage Today)

Worse outcomes seen in resistant hypertension

Among hypertensive patients with atherothrombotic disease, resistant hypertension is relatively common and identifies a higher-risk subgroup, researchers found.

Mild head injury upsets brain's resting state

Mild traumatic brain injury (TBI) disrupts the brain's "default mode" in a way that shows up on functional MRI and correlates with symptoms, researchers found. (Source: Medpage Today)

FDA OKs Hep C indication for Promacta

The FDA has approved eltrombopag (Promacta) for the additional indication of treating low blood platelet counts in patients with chronic hepatitis C. The treatment will allow those patients who are otherwise poor candidates because of their platelet counts to undergo interferon-based therapy for the liver disease. The drug was approved in November 2008 to treat low platelet counts -- idiopathic thrombocytopenia purpura -- in chronic sufferers who have had insufficient response to other drugs. However, eltrombopag should not be used to normalize platelet counts in hepatitis C patients, its manufacturer, GlaxoSmithKline (GSK), said Monday. It should only be used in patients with chronic hepatitis C whose condition prevents them from starting interferon therapy. (Source: Medpage Today)

 
    Twitter of the Day

@DrKKAggarwal: I discussed climate change & social action with David Gershon, founder of the Empowerment Institute. http://tinyurl.com/chgt4vw

@DeepakChopra: Winter Exercise Tips for Asthmatics Exercise is a common trigger for asthma and may cause symptoms in 80-90% of... http://fb.me/1JC9ATvhg

 
    Spiritual Update

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

Soul Does Not depart the Body Immediately after the Death

According to Prashna Upanishad, at the time of death, the Prana Vayu (life force and respiration) merges with Udana Vayu (brain stem reflexes) and leaves the body.

But this does not happen immediately after clinical death which is defined as stoppage of heart and respiration. Medically the term used for clinically dead patients is sudden cardiac arrest.

For Comments and archives…

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

What are the characteristics of a normal sperm?

A normal sperm has:

  • a smooth, oval shaped head that is 5-6 micrometers long and 2.5-3.5 micrometers around (less than the size of a needle point)
  • a well defined cap (acrosome) that covers 40% to 70% of the sperm head
  • no visible defect of neck, midpiece, or tail
  • no fluid droplets in the sperm head that are bigger than one-half of the sperm head size.
 
    Tat Tvam Asi………and the Life Continues……

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

The H antigen is a precursor to A & B

 
    An Inspirational Story

Who Named the Curiosity Mars Rover?

The Curiosity Mars rover was named by an 11 year old girl in Lenexa, Kansas, USA. Her name is Clara Ma and below is her inspiring story.

On Aug. 5 at 10:31 p.m. PST, a rover named Curiosity touched down safely on the surface of Mars, and I was lucky enough to have a front-row seat.

My name is Clara, and when I was in 6th grade, I won the essay contest NASA held to name its next Mars rover. The essay I wrote was not even 250 words long, but somehow it was enough to change my life.

I still remember that chilly December day, sitting in science class. I’d finished a worksheet early and decided to get a TIME for Kids magazine off of Mrs. Estevez’s bookshelf. It was the 2008 Invention Issue, but that wasn’t the only thing that caught my eye. In the magazine, there was an article about a girl who named the Mars Exploration Rovers, Spirit and Opportunity.

The article also talked about the essay contest NASA was holding to name its next Mars rover. Before I even knew anything else about it, a single word flooded my 11-year-old mind: Curiosity.

I couldn’t wait for the bell to ring so I could get started on my essay. That afternoon, I raced home from the bus stop, sat down at the computer, and typed until my fingers ached. It turns out I was just in time. A few days later, and the contest would have closed.

Five months later, shortly after I had turned 12, I was watching a National Geographic special on mammoths when the phone rang. My mom answered, and immediately, a wide smile spread across her face.

When she told me that I had won, I was happier than I could ever remember being. I screamed and ran up and down the stairs and all around the house. I completely forgot about the mammoths and did not even remember to turn off the TV until it was really late.

Curiosity is such an important part of who I am. I have always been fascinated by the stars, the planets, the sky and the universe. I remember as a little girl, my grandmother and I would sit together in the backyard for hours. She’d tell me stories and point out constellations.

Here in the heart of the country, my grandmother would say, there were no bright city lights to compete with the brilliance of the stars.

There was just the chirping of the cicadas and the soft summer breeze.

My grandmother lived in China, thousands of miles away from my home in Kansas. I loved the stars because they kept us together even when we were apart. They were always there, yet there was so much I didn’t know about them. That’s what I love so much about space. No matter how much we learn, it will always possess a certain degree of mystery.

In the past, space exploration may have been a competition to see who got somewhere first or the fastest. But now, it is one of the few things that bring people together. Science is a language that needs no translation. It doesn’t matter where you’re from or what you look like — you just have to have a thirst for knowledge and a passion for learning in order to succeed.

People often ask me why we go to faraway places like Mars. Why do we explore? My answer to that is simple: because we can. Because we’re curious. Because we as human beings do not just stay holed up in one place. We are constantly wondering and trying to find out what’s over the hill and beyond the horizon.

The Curiosity rover is more than just a robot. It is more than just a titanium body and aluminum wheels. Curiosity represents the hard work, passion, love and commitment of thousands of people from all over the world who were brought together by science.

Science is so awesome. It is breathtaking and mind-blowing, intertwining and unifying; and sometimes, it’s just a little bit crazy. The discoveries we make about our world are incredibly humbling. They move us forward and have the potential to benefit all of mankind.

This December it will be four years of my life that have been tied to Curiosity in some way. I’ve met so many amazing people through this experience, from scientists to engineers to administrators to volunteers. Their dedication and fervor inspire me immensely. My journey with Curiosity and the MSL mission team has shaped the person that I am today, as well as the person I would one day like to become.

I am deeply grateful to everyone who made it possible for me to have this amazing adventure. And to you, I hope your curiosity takes you far.

By Clara Ma

Source: http://academictips.org/blogs/who-named-the-curiosity-mars-rover/

For comments and archives

 
   Cardiology eMedinewS

Low-Energy ICDs Not as Shocking Read More

Losing Job in Last One Year Ups Heart Attack Risk Read More

 
   Pediatric eMedinewS

Psoriasis Linked To Weight In Kids Read More

Ema Recommends Approval For Prevenar 13 Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient with community–acquired pneumonia was put on 750 mg levofloxacin.
Dr Bad: Take 500 mg for 10 days.
Dr Good: Take it for 5 days.
Lesson: The anti–pneumococcal fluoroquinolones (e.g., levofloxacin, moxifloxacin, gemifloxacin) have been used for 5 to 14 days in inpatients and outpatients with community–acquired pneumonia with most patients having a good clinical response within 2 to 3 days. Using a higher dose of a levofloxacin may decrease the duration of therapy; 750 mg for five days was as effective as 500 mg for 10 days and was associated with a more rapid resolution of fever (Clin Infect Dis 2003;37:752–60).

Make Sure

Situation: A chronic smoker developed cancer of lung.
Reaction: Oh my God!! Why was he not screened earlier for cancer of lung?
Lesson: Make sure that all chronic smokers are given an option for lung cancer screening with low dose spiral CT.

 
  Legal Question of the Day (Dr MC Gupta)

Will not the BSc (Community health) graduates start acting as “registered quacks”?

Q. I am afraid the graduates of the newly proposed 3-year BSc (Community health) course followed by 6 months internship will be given prescription rights and would then act as “registered quacks” and would compete with MBBS doctors. What are your comments?

Ans.

  • Nobody can practice medicine unless he is registered with the medical council. A BSc cannot be so registered. Hence there is no question that they may be given rights to practice medicine and may act as “registered quacks”.
  • It is possible that such graduates, if in government service, may be given service assignments to be carried out under the supervision and control of a physician. There would be nothing wrong in it. Examples of such assignments may be:
    • Assisting in life saving emergencies and first aid measures.
    • Assisting in national health programs aimed at diarrhea, diarrhea, anemia, AIDS, goitre, family planning, malaria, filaria etc.

      There would be nothing illegal in such assignments being given to them.
  • If, in future, attempts are made to extend limited prescription rights into general prescription rights, the medical professionals and the profession, including the IMA, must, as a sacred duty, act as alert watchdogs for the same and must resist and challenge such attempts most vigorously in legal and other manners. If the IMA fails in its duty and keeps quiet, I would blame the IMA and not the government forpromoting quackery.
  • Regarding the banti-quackery efforts of the IMA, I am surprised that the physiotherapist who, pretending to be a false degree holder, treated a famous cricketer like a physician is still going scot free. The IMA should have gone all out to ensure that he is punished. This should have been a test case for the IMA and would have given it much needed publicity and would have sent a message against quackery across the nation. These things cannot be done by an individual doctor and should be done by the association. It is lamentable that the IMA can take crores for sponsoring Pepsi and Dabur products and Dettol and Aquaguard etc. and can spend those crores on membership of the WMA and concerned foreign visits, but cannot engage advocates to plan and implement effective anti-quackery strategies.
  • I wish the IMA had used the existing provisions in the IMC Act, 1956, and the Punjab Medical Registration Act, 1916, which are quite stringent and provide for jail, to curb quackery. Had the IMA not been sleeping / goofing, quackery would be a thing of the past today. Quackery can’t be eradicated by the annual rituals of declarations at IMA conferences and anti-quackery marches from IMA HQ / DMA HQ to Rahghat every 2nd October. It is shameful that the DMA and the DMC have done nothing to get amended the foolishly drafted section 27 of the DMC Act, 1997. Tjey should get this section replaced by section 23 of the Punjab Medical Registration Act, 1916.
  • Had the IMA been vigilant about physicians’ rights, it would have done the following:
    • Filed WPs against the CEA Act, 2010
    • Filed WPs against the Indian Medical Council (Amendment) Act, 2010
    • Filed WP/legal representation against the NCHRH bill.
    • Got the Medicare Protection Act made in all states (more than half the states still don't have it.)
    • Got impleaded in the case (Dr.) Haniraj L. Chulani Versus Bar Council of Maharashtra and Goa, SC, decided on . 8.4.1996 by A.M. Ahmadi, CJI, S.B. Majmudar and Mrs. Sujata
    • Manohar, JJ. --(This judgment barred enrollment of doctors with LLB degree into the ba unless they give up medical practice--There is no such rule in USA, UK etc.). After the judgment, at least, it should have filed a review petition.
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  Quote of the Day (Dr GM Singh)

Man’s troubles are rooted in extreme attention to senses, thoughts, and imagination. Attention should be focused internally to experience a quiet body and a calm mind. Buddha

 
    Mind Teaser

Read this…………………

Dennis receives a blood transfusion and develops flank pain, chills, fever and hematuria. The nurse recognizes that Dennis is probably experiencing:

A. An anaphylactic transfusion reaction
B. An allergic transfusion reaction
C. A hemolytic transfusion reaction
D. A pyrogenic transfusion reaction

Yesterday’s Mind Teaser: What is the typical legal BAC content? A) 0.12%. B) 0.10%. C) 0.15% D) 0.13%

Answer for Yesterday’s Mind Teaser: B) 0.10%

Correct answers received from: Dr.K.V.Sarma, Dr Kanta jain, Dr. P. C. Das, Dr Pankaj Agarwal, Dr.K.Raju, Dr.a.k.kela, Dr Jainendra Upadhyay, Dr. Thakor Hitendrsinh G, Dr Chandresh jardosh, Muthumperumal Thirumalpillai, Dr Avtar Krishan, Sunil Parwani

Answer for 25th November Mind Teaser: D) Pork

Correct answers received from: DR.SHAGUFTA MOIN, Dr Jainendra Upadhyay, Dr.K.Raju, dr ajay gandhi

Send your answer to ijcp12@gmail.com

 
    Laugh a While (Dr GM Singh)

Funny defination:

Cardiovascular: "The three kinds of blood vessels are arteries, veins, and caterpillars."

 
  Medicolegal Update

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

What are the organo phosphorous poisons?

They are derived from phosphoric acids and form two series of compounds known as alkyl phosphates, and aryl phosphates

  • These are basically chemical insecticides and used to prevent agricultural products but when ingested by humans adversely affect health or may become life–threatening.
  • Fatal dose: TEPP 50 mg IM or 100 mg orally/OMPA 80 mg IM or 175 mg orally/Parathion 80 mg IM or 175 mg orally/HETP 60 mg IM or 350 mg orally/Malathion and diazinon 1g orally
  • The fatal period is usually within 24 hours in untreated cases and within 10 days in those treated cases when treatment is not successful. In non–fatal cases, the acute effect lasts for 6 to 30 hours which disappear in 2 to 3 days but may sometime persist for 2 weeks. Complete recovery occurs in 10 days in patients treated early.
  • Atropine is the antidote.
  • Cause of death is by paralysis of respiratory muscles, respiratory arrests due to failure of respiratory centre or intense bronchi constriction resulting in respiratory failure.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Heart Attack Symptoms in Women and elderly are Different

Winter is the month for heart attacks and the symptoms in women and the elderly may be different, warns Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

  • Chest pain is still the most common sign of a heart attack for most women but women are more likely than men to have symptoms other than chest pain or discomfort when experiencing a heart pain. In a study published in Archives of Internal Medicine researchers examined 35 years of research that yielded 69 studies and found that, between 30 and 37 percent of women did not have chest discomfort during a heart attack. In contrast, 17 to 27 percent of men did not experience chest discomfort.
  • Older people are also more likely to have heart attack without chest discomfort. Absence of chest discomfort is a strong predictor for missed diagnosis and treatment delays.
  • Women are also more likely than men to experience other forms of cardiac chest pain syndromes, such as unstable angina, and they appear to report a wider range of symptoms associated with acute coronary syndrome (ACS). They are more likely to report pain in the middle or upper back, neck, or jaw; shortness of breath; nausea or vomiting; indigestion; loss of appetite; weakness or fatigue; cough; dizziness; and palpitations.
  • Women are, on an average, nearly a decade older than men at the time of their initial heart attack. Coronary heart disease is the leading cause of death among U.S. women, and affects one in 10 women over the age of 18.
 
    Readers Response
  1. .Dear Sir, emedinews is really very informative and full of education. Regards: Rashi
 
    Forthcoming Events

Seminar on "Mind and Body in Health and Harmony in Asian Systems of Medicine"

Date: December 11-13, 2012
Venue: India International Centre, New Delhi
Themes of the Workshop: Anatomy, Philosophy, Diagnostics and imbalances, Therapeutics and treatments, Understanding Mind-Body relationships and Preventive and Promotive aspects in the traditional systems of medicine

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

8am-8pm

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/

rawat.vandana89@gmail.com/drpawangupta2006@yahoo.com

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

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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