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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

  Editorial …

28th March, 2011, Monday                                eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

What is evidence–based medicine?

I was recently called to attend an Ayurvedic Workshop on Arishta Vigyan (science which deals with sign and symptoms of sure future death). One of the points that come up was ‘What is the definition of evidence-based medicine?’

In terms of medicine, to put it simply, anything which is published in Medline is evidence–based. But when we talk in a more strict sense, an authentic evidence–based medicine means either a meta–analysis or the results of a randomized control trial. Eighty percent of the medical literature today will not be based on either of the two. A large number of medical literature will be based on observational studies and observational data. In fact, no research is possible unless there is some observational data available. An observation, therefore, is the basic necessary background material for any research.

When it comes to Ayurveda, in those times when Ayurveda texts were written, there was no concept of meta–analyses or randomized control trials. Most of the texts were based on scientific observations with or without valid explanation.

Even in Allopathy, we have drugs whose actions can be scientifically validated but there are many uses of drugs where we find no scientific explanation. The empirical use of drugs falls in this category. The use of these drugs is justified by looking at the results of the observational studies. Every fact of Ayurveda written in standard text can be traced back to an observation by the Ayurvedic physicians of that era which has been validated by others with observations in their practice, and therefore, cannot be challenged.

These observations should be studied by Allopathic doctors and if found correct, should be adopted in the modern methodology. Most of these observations relate to prognosis and diagnosis of a disease. These aspects of Ayurveda with consensus can be incorporated in the modern therapeutic systems.

Dr KK Aggarwal
Editor in Chief
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  eMedinewS Audio PostCard

 CKD Update

Dr KK Aggarwal speaks on
‘CKD – Definition & Diagnosis’

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Parampara, 8th World Fellowship of Religion to be held on April 3, 2011

Mr. Amit Mishra, Famous Indian Cricketer, Captain of Haryana team was felicitated by Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal and Acharya Dr. Sadhvi Sadhna Ji Maharaj, Chairperson, World Fellowship of Religions at a press conference

Dr K K Aggarwal
    National News

Sunderban tigers will make it to this census, says Jairam

Sunderban — the largest tiger habitat in India — is to figure for the first time in the All India Tiger Census report, to be released on Monday. The last census in 2008, projecting 1,411 big cats in the country, could not include the mangrove tigers from this World Heritage Site for reasons, among others, like tough terrains making estimation work difficult. Environment Minister Jairam Ramesh confirmed this to The Pioneer, "Fairly complete results of tiger estimation will figure from Sunderbans in the upcoming census". While fingers are kept crossed over the numbers, Wildlife Institute of India (WII) officials said even though work is still in progress they should be able to come out with a broad estimation of tiger presence in the estuarine sanctuary. However, amidst controversies and question marks on the number of felines in the reserve, Pradeep Vyas, Director Sunderban Biosphere Reserve pointed out, "I am not in the number game– what is important is the management of the eco–system, protection trend, threats, counter threats, monitoring and relationship with the local villagers, all of which has improved during the last ten years." As per the accepted methodology of the WII, the department has so far been able to radio collar six tigers and camera trap 120 sq kms of the area, which apart from the National Park West in Sunderban Tiger Reserve (STR) core area, also includes parts of Sajnekhali Wildlife Sanctuary and other adjoining forest areas. Ten adults with two cubs have been spotted in the process. (Source: The Pioneer, March 26, 2011)

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

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC)

Aerobic exercise is beneficial to asthma sufferers

There is good news for asthma sufferers! While it is sometimes thought that it is safer for asthmatics to refrain from exercise, the truth is that leading a sedentary lifestyle is far worse. In fact, new research published in Medicine & Science in Sports & Exercise reports that exercising actually helps reduce asthma symptoms, even in people with severe asthma. The study conclusion even suggests that aerobic exercise should be prescribed in addition to medical treatment for people who suffer from asthma, as it can enhance the beneficial effects of an inhaler or other prescription drugs for asthma. The study consisted of 68 subjects with moderate to severe asthma. Both groups went through an educational program and performed regular breathing exercises for a three–month period. However, one group performed aerobic exercise three times per week, while the other group did not. After three months, the group that exercised experienced a significantly higher number of asthma symptom–free days and had significantly lower levels of markers of respiratory inflammation.

(Dr Monica and Brahm Vasudev)

Do vitamins stop cancer, heart attacks? Study says 'No'

In a study of more than 180,000 people, scientists observed the same number of deaths from cancer and heart disease among multivitamin–takers and those who did not take the supplements. National Institutes of Health advise that doctors should prescribe multivitamins only "for patients who need extra vitamins, who cannot eat enough food to obtain the required vitamins, or who cannot receive the full benefit of the vitamins contained in the food they eat."

FDA on Weight–Loss Drugs

Three weight–loss drugs or drug combinations were recently shot down by the FDA: bupropion and naltrexone (Contrave), phentermine and topiramate (Qnexa), and lorcaserin hydrochloride (Lorqess). In the cases of Qnexa and Lorqess, the FDA’s Endocrine and Metabolic Drugs Advisory Committee voted against recommending approval. In the case of Contrave, the advisory panel actually endorsed the drug, but the FDA decided it needed to see more cardiovascular data on the drug before it could be approved.

FDA currently requires companies seeking approval for their diet drugs to show in clinical trials that at least 30% of people who took the drug lost at least 5% of their body weight, and that, after one year, the difference in mean weight loss between the active and control groups is at least 5%. But even if a trial did meet both those endpoints, 5% weight loss may not be enough to convince the FDA to approve a drug that could be used by the 27 million Americans who are obese. That’s because every drug carries risks, and when a drug is used by so many people, that risk is magnified. In addition, obesity drugs could then be approved for smaller subgroups of obese people in whom they’ve been shown to have a measurable impact on weight–related comorbidities e.g. sleep apnea.

Early ART may reduce AIDS–related mortality risk in HIV patients coinfected with TB

The latest findings from the Starting Antiretroviral Therapy at Three Points in Tuberculosis (SAPIT) trial, presented at the Retroviruses and Opportunistic Infections conference, contribute to evidence that antiretroviral therapy (ART) should begin as soon as possible for patients coinfected with tuberculosis (TB) and HIV.

    IJCP Special

Dr Good Dr Bad

Situation: A patient with albumin in the urine was to go for bypass surgery.
Dr Bad: There is no risk.
Dr Good: There is a risk of kidney injury.
Lesson: A simple urine test for presence of proteins before heart surgery can predict which patients may develop kidney–related complications, according to a study published early online and to appear in an upcoming issue of the Journal of the American Society of Nephrology.

Make Sure

Situation: A child with sore throat and the large lymph nodes developed fever.
Reaction: Oh my God! Why were antibiotics not given in time?
Lesson: Make Sure, that all children with sore throat and enlarged lymph nodes are given antibiotics as such sore throats are Streptococcal unless proved otherwise.

    An Inspirational Story

(Dr Prachi Garg)

The Magical tree

There was once a weary traveler who sat down to rest in the shade of a tree. He did not know that the tree he rested upon was a magic tree. It was called "The Wish–Granting Tree." Seated on the hard ground, he thought how pleasant it would be if he could sleep in a soft bed. Instantly, a bed appeared before him. Astonished, the man immediately climbed onto the bed. Then, he thought that it would be nice if there would be a beautiful young girl beside him who would massage his sore legs. At that moment, a young girl appeared before him and began massaging him. "I’m so hungry," the man said to himself. "Having something to eat now would be a great pleasure." Instantly, a table appeared with delicious foods. The man rejoiced and began eating and drinking to his heart’s content. His head spun a little and his eyelids grew heavy as the wine took effect. He stretched himself and was thinking about the wonderful events that took place on that extraordinary day. "I’ll sleep for an hour or two," he thought. "The worst that could happen would be if a tiger wandered by while I’m asleep." Instantly a tiger appeared and devoured the poor man.

You have a magic tree inside you, waiting to grant your wishes. But be careful! The same tree can also make your negative thoughts and fears come true.

At the very least it will be influenced by your negative thoughts, so that the good things you wish for do not happen. That’s what worrying can do. I wish with all my heart that you live a life free of worry, negative thoughts and fear, in the shade and comfort of your personal Wish–Granting Tree.

    Infertility Update

(Dr. Kaberi Banerjee, Director Precious Baby Foundation)

What are the pros and cons of single vs multiple embryo transfer in IVF? What is the usual practice in Delhi fertility centers regarding the same?

The initial practice of IVF and Embryo Transfer involved the transfer of multiple embryos, usually 3–5. It was soon realized that the number of multiple pregnancies especially higher order i.e. > 3 was increasing. This was associated with pre–term delivery which led to premature babies and developmental delays with occasional mental handicap in the long run. This leads to enormous psychological and financial burden to the person and society in general. A drive was therefore started in the West in those countries where the government is responsible for healthcare, especially the Nordic countries and UK to limit the number of embryos to be transferred. They have in fact suggested transferring a single embryo to further reduce the chance of twin pregnancy. The following steps should be adopted in patients who need anticoagulants and have conceived. This would hold good for a system where:

  • The cryopreservation systems are excellent.
  • The government is funding at least partially for the IVF treatment, as the patients would need multiple attempts at transfer to get a viable pregnancy. In India, where the patient has to pay for each cycle, it becomes difficult to justify single embryo transfer. I usually practice transferring between 2–3 embryos. This gives me a good pregnancy rate of 40% vs 25% of single embryo transfer. If the lady has triplets we then offer fetal reduction.
    Hepatology Update

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

Management of GERD

Lifestyle changes

Thickened Feedings and other dietary modifications: Thickening the child’s food (e.g., rice cereal in formula) to reduce the clinical symptoms of children with GER has long been an accepted practice. This assumption has been tested with pH probe data, and thickened feedings (e.g., apple juice thickened with rice cereal) were found to have no effect on reflux time unless the child was in a head–elevated prone position after the feeding. However, although infants with GER who are given thickened feedings might not have significantly reduced reflux time as measured by a pH probe, other criteria, such as episodes of emesis, time spent crying, and time spent awake, may be reduced. In addition, their effects may often result in the therapeutic success of thickened feedings.

    Medicolegal Update

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

What is the right to refuse medical interventions? Nancy Vehicle Accident Case

The US Supreme Court declared that artificial hydration or nutrition is no different from medicines

Nancy Cruzan a 31–year–old women suffered severe brain damage in a vehicular accident that placed her in a persistent vegetative state, dependent upon a feeding tube.

  • After four years without improvement in her cognitive function, her family asked to have her artificial feeding and hydration stopped.
  • In its decision, the United States Supreme Court recognized that competent patients have a constitutional right to refuse medical care.
  • Using the Fifth Amendment’s guarantee that no person shall "be deprived of life, liberty, or property, without due process of law" the Supreme Court affirmed patients’ rights to refuse medical treatments. The Court declared that artificial hydration or nutrition is no different from other medical interventions. Although mentally incapacitated patients have the same right, the Supreme Court allowed states to impose restrictions on how explicit and specific the patient’s prior wishes had to be.
  • After this court ruling, some of Cruzan’s friends provided evidence that she had previously expressed wishes that she would want artificial feedings discontinued in such a scenario. As a result of this testimony, her feedings were terminated.
  • Mentally competent patients need not be terminally ill to exercise this right to refuse interventions they have the right regardless of health status.
  • The right applies equally to withholding proposed treatments and to discontinuing initiated treatments.
  • The right to refuse medical care does not imply a correlative right to demand treatment.
    Obesity Update

Dr. Parveen Bhatia and Dr. Pulkit Nandwani

Infants of overweight mothers

Neonatal parameters

Low Apgar scores are slightly more frequent in infants of obese mothers than in infants of normal–weight mothers. Prepregnancy BMI is a strong predictor of birth weight, and obese mothers deliver large–for–gestational–age infants 1.4 to 18 times more frequently than do lean mothers. Neonatal skinfold thickness is also higher in infants born to obese mothers, suggesting that the excess weight in the newborn is due to a larger fat mass. Macrosomia increases the risk for shoulder dystocia, birth injury, depression of Apgar scores, and perinatal death. High gestational weight gain enhances the risk of delivering large–for–gestational–age infants in overweight women. Gestational diabetes also affects fetal growth.

    Mind Teaser

Read this………………… 

r clock c

Yesterday’s Mind Teaser: ATfrankfrankRA

Answer for Yesterday’s Mind Teaser: Frank Sinatra

Correct answers received from: Dr Sudipto Samaddar, Dr Neelam Nath, Dr Rajiv Rattan

Answer for 26th March Mind Teaser: Turned inside out
Correct answers received from: Dr Vijay Kansal, Dr. Rajshree Aggarwal,  Dr K P Rajalakshmi, Dr Y J Vasavada, Dr. Manjesha, Dr. Amit Kochar, Dr. Rajiv

Send your answer to ijcp12@gmail.com

    Lighter Side of Reading

Laugh a While
(Dr G M Singh)


Fresh out of high school, I found a job cleaning the elegant home of an older couple. Among other duties, I had to dust their many imported carvings and petrified collectibles as well as pick up after their pets. One day I was astonished to find two ivory fossils lying on the floor beside the bookcase. I quickly picked them up and put them back on the shelf. The next week the same thing happened. That afternoon my employer came into the parlor, her faithful canine behind her. Looking around, she eyed the bookcase.

"Tippy," she asked the dog, "how do your bones keep getting up there?"

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Anion gap

  • Increased serum anion gap reflects the presence of unmeasured anions, as in uremia (phosphate, sulfate), diabetic ketoacidosis (acetoacetate, beta–hydroxybutyrate), shock, exercise–induced physiologic anaerobic glycolysis, fructose and phenformin administration (lactate), and poisoning by methanol (formate), ethylene glycol (oxalate), paraldehyde, and salicylates. Therapy with diuretics, penicillin, and carbenicillin may also elevate the anion gap.
  • Decreased serum anion gap is seen in dilutional states and hyperviscosity syndromes associated with paraproteinemias. Because bromide is not distinguished from chloride in some methodologies, bromide intoxication may appear to produce a decreased anion gap.
    Medi Finance Update

(Dr GM Singh)

What are the consequences of not deducting tax at source?

You are required to withhold taxes at appropriate rates while making certain payment of expenses such as advertisement expenses, payment of salary to employees, etc. Failure to do so will result in the entire expenditure being disallowed as your business expenditure resulting in higher profits will be charged to income tax.

    Drug Update

List of approved drugs from 01.01.2010 to 31.8.2010

Drug Name
DCI Approval Date
Timolol Maleate Long acting Ophthalmic Solution 5mg/ml
For the treatment of elevated intraocular pressure in patient with ocular hypertension or open angle glaucoma.
    IMSA Update

International Medical Science Academy (IMSA) Update

Cancer prevention

EPIC study, a cohort study of nearly 500,000 European men and women followed for nine years, found only a weak association between increased intake of fruits and vegetables with overall risk of cancer.

    Readers Responses

Dear Sir, I am really glad that at least one of us has the courage to criticise the news reports published in the media. I congratulate you for that, Sir. Your answer was really to the point and diplomatic and I really appreciate that. Sir, recently In the Times of India, few months back on 29th March 2010, there were allegations on the pediatricians for overcharging for the vaccines; they tried to give the costs of all the vaccines and the MRP etc. at which the doctors give the vaccine. The news was totally baseless and irrelevant. You can read the report on the net. I had raised this issue with the IAP. There was a lot of support on its Adolescent site but nothing was done by our beloved leaders, to even correct the wrong facts written in the news item. I myself tried writing to the editors of the TOI & its rival newspaper but to no avail. A single voice cannot make a din. Your diplomatic way of dealing with the present issue, is what gave me a little hope, so I wrote to you. Thanks for your time. Regards, Dr. Sonia S. Kanitkar, Consultant Adolescent Specialist, Director, Kinder Clinic, Bangalore, ECM Pedicon 2009, DRP Science of Vaccinology, National Trainer Adolescent off. prac.

    Public Forum

(Press Release for use by the newspapers)

Can’t avoid anger: take aspirin

Emotionally stressful events, and more specifically, anger, immediately precede and appear to trigger the onset of acute heart attack.

Episodes of anger are capable of triggering the onset of acute heart attack and aspirin can reduce this risk said Dr. K K Aggarwal Padma Shri and Dr BC Roy National Awardee and President, Heart Care Foundation of India.

Angry people who cannot control their anger should ask their doctors to consider taking aspirin. Harvard doctors at the Deaconess Hospital interviewed 1623 patients (501 women) an average of 4 days after a heart attack. The Onset Anger Scale identified 39 patients with episodes of anger in the 2 hours before the onset of heart attack. The relative risk of heart attack in the 2 hours after an episode of anger was 2.3. Regular users of aspirin had a significantly lower relative risk (1.4) than nonusers (2.9).

Anger in response to stress is also of particular importance for the development of premature heart attack in young men. An episode of anger may also trigger an acute heart attack in the next 2 hours. Not only anger but even recall of anger can precipitate acute heart attack both in day time and during sleep. It can act as trigger of acute cardiac events in susceptible individuals, with a vulnerable period of a few hours. Recall of anger practically produces the same biochemistry as if the person is in rage or fit of anger.

Proneness to recall of anger can be tested by the cardiologist either by doing six–minute mental arithmetic stress test or by six–minute irritating recall of anger. During angiography, recall of anger has been shown to cause temporary increase in blockages.

    eMedinewS Special

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Activities eBooks


  Playing Cards

  Dadi Ma ke Nuskhe

  Personal Cleanliness

  Mental Diseases

  Perfect Health Mela

  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein
    Situation Vacant

Vacancy for a post of Consultant in Pediatric ICU at Medanta – The Medicity Hospital, Sector –38, Gurgaon.
Interested candidates may please contact: drneelam@yahoo.com/9811043475.
*Eligibility: Post M/DNB/DCH

    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

Sunday 3rd April, 2011, World Fellowships of Religions and Perfect Health Parade First ever Conference which will talk about science behind all Religions, Dharmas and Pathies under one roof on Global Warming, Ethnic Crises, How to be Healthy
Venue: Maulana Azad Medical College Auditorium, New Delhi;Time: 8 AM – 4 PM.
Parade through tableaus to be flagged off at 10 am from outside MAMC to move till 5 pm on different predefined routes in Delhi to create awareness about health matters.
Parade Route: Vikas Marg – Shahdara – Seemapuri – Guru Tegh Bahadur Hospital – Seelampur Pusta – Gandhinagar, to ISBT Kashmiri Gate – Civil Lines – Delhi University North Campus – Azadpur – Punjabi Bagh – Mayapuri – Raja Garden – Janakpuri – Tilak Nagar – Tihar Jail Road – Delhi Cantt. – R.K Puram – Munirka – IIT Gate – Panchsheel Park – Chirag Delhi Flyover – Nehru Place – Modi Mill Flyover – Ashram – Nizamuddin – Sunder Nagar – Pragati Maidan – ITO – finally culminate at Maulana Azad Medical College at 4pm. Full day conference on ethnic crisis and global warming. Pre lunch session to be addressed by religious representatives who would talk on what each religion has to say. Post lunch to be addressed by doctors from all streams of medicinal practice (allopathy, ISM)
Register: rekhapapola@gmail.com


April 16–17, 2011, National Conference on Gynae–Endocrinology–2011 under aegis of FOGSI, ICOG and AOGD , Focus on newer advances in management of endocrinal problems in gynaecology with emphasis on PCOS, hyperprolactinemia, amenorrhoea, hormonal contraception. Gyne– endocrinology is a topic of high importance especially for practitioner. Detailed programme http://www.aiims.edu and http://www.aiims.ac.in
For details please contact: Prof Alka Kriplani, Organizing Chairperson, 9810828717 kriplanialka@gmail.com/Dr Nutan Agarwal, organizing Secretary, 9810107464/9868397310 nutan.agarwal1@gmail.com


May 7–8, 2011, National Seminar On Stress Prevention
A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris.
Co–organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, IMA New Delhi Branch and IMA Janak Puri Branch, IMSA (Delhi Chapter)
Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.
Timings: Saturday 7th May (2 pm onwards) and Sunday 8th May (7 am–4 pm). There will be no registration charges, limited rooms, kindly book in advance; stay and food (satvik) will be provided. Voluntary contributions welcome. For booking e–mail and SMS to Dr KK Aggarwal: 9899974439, emedinews@gmail.com, rekhapapola@gmail.com; BK Sapna: 9811796962, bksapna@hotmail.com


September 30 – October 02, 2011;XVIth World Congress on Cardiology, Echocardiography & Allied Imaging Techniques Venue: The Leela Kempinski, Delhi (NCR), September 29, 2011: A unique & highly educative Pre–Conference CME, International & national icons in the field of cardiology & echocardiography will form the teaching faculty.
Highlights of Pre – Conference CME: Case based learning experience & audience interaction, Maximum 250 delegates for CME will be accepted, who will be divided in 5 batches and will rotate to different halls every 90 minutes. The topics are:(A) Right heart pressures & functions (From basics to newer methods (RV anatomy, echo views, echo assessment of RV function, prognostic impact of RV function) (B) Carotid Doppler: How do I assess and interpret in my daily practice.: Technical tips (Anatomy of the vessel, views of ultrasound scanning, Normal & abnormal Doppler hemodynamics, how to measure IMT) (C) Valvular stenosis: Assessment, limitations and their solution: (Anatomy of the valves, 2–D findings of stenotic lesions, quantitation of lesion, limitations) (D) How do I assess and report ventricular dyssynchrony in my lab. (What is ventricular dyssynchrony, what are the types of dyssynchrony, in whom, when & why do we assess it, various echo methods to assess it ) (E) Live 3–D Echo: Protocol for acquisition. How to slice and get full information. Aim is that by end of the day, every participant is well conversant with all the topics.
Dr (Col) S.K. Parashar, President, e–mail: drparashar@yahoo.com, Mob:09810146231/Dr Rakesh Gupta, Secretary General, email:jrop2001@yahoo.com, Mob:09811013246
worldcon2011@in.kyoni.com, www.worldcon2011.org


ICC Cricket World Cup 2011

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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 Naveen Dang, Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta