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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 …

2nd February, 2011, Wednesday                                 eMedinewS Present Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

Mauni (Mauna) Amavasya

Mauni Amavasya is observed on the “No Moon day” during Magha (January – February) as the most auspicious day of Kumbh Mela to perform ritual bath.

The words Mauni and Mauna are derived from ‘muni’, which means a spiritual performer who practices silence as a part of his daily spiritual rituals.

In all religious spiritual traditions whether Christian, Hindu, Islamic or Buddhist, the voluntary act of non-speaking is an integral part of religion, being practiced in the form of silent retreats, vows of silence or silent prayer.

According to Hinduism, ‘Mauna’ (silence) is one of the most important aspects of spiritual discipline and symbolizes a state of oneness with the Self. It gives an opportunity to introspect and initiate a dialogue within oneself. Mauna has been described by Adi Shankaracharya as one of the three essential attributes of a Sanyasi along with balya or childlike state and panditya or wisdom.

Both Acharya Vinoba Bhave and Mahatma Gandhi observed periods of silence in their spiritual practice. Vinoba Bhave even observed a year-long silence in the year 1974-75. According to Ramana Maharshi, mauna is a state beyond speech and thought; it is "living without the ego-sense". He made silence the medium of spiritual instruction.

Mauna is not different from the classic definition of Yoga as given in Patanjali’s Yoga Sutras: “Yogas citta vritti nirodha” i.e. Yoga is the cessation of mental fluctuations.

However, one has to distinguish between the spiritual discipline of consciously observing silence and muteness due to indifference, shyness, anger or simply a bad mood.

Mauna is spiritually motivated silence and can be “Vak Mauna,” which is to renounce the use of the organs of speech or “kashta mauna”, which means to not only abstain from oral speech but to also avoid communication through written messages, gestures like nodding or shaking the head and so on.

In his book, The Seven Spiritual Laws of Success, Deepak Chopra writes that practicing silence means making a commitment to take a certain amount of time to simply ‘Be’ and periodically withdrawing from the activity of speech. It also involves periodically withdrawing from external stimuli such as watching television, listening to the radio, or reading the book.

“When you go into this experience of silence, initially your internal dialogue may become even more turbulent and you may feel an intense need to say things. But as you stay with the experience, the internal dialogue begins to quieten. And soon the silence becomes profound. Then, as the internal dialogue quietens, you begin to experience the stillness of the field of pure potentiality. At this time in silence one can introduce a faint impulse of intention in this field, and the creation of your desire will come about spontaneously.”

“Imagine throwing a little stone into a still pond and watching it ripple. Then, after a while, when the ripple settles down, perhaps you throw another little stone. That's exactly what you do when you go into the field of pure silence and introduce your intention. In this silence, even the faintest intention will ripple across the underlying ground of universal consciousness, which connects everything with everything else. But, if you do not experience stillness in consciousness, if your mind is like a turbulent ocean, you could throw the empire state Building into it, and you wouldn't notice a thing,” says Deepak Chopra.

Both Bhagwad Gita and Bible give importance to silence and austerity of mind. In the Bible is the expression, "Be still, and know that I am God." In Gita, Krishna also describes silence as himself and says “ 10.38: Among all means of suppressing lawlessness I am punishment, and of those who seek victory I am morality. Of secret things I am silence, and of the wise I am the wisdom."

Apart from silence, one can access the state of pure potentiality by practising meditation, non-judgment and spending time with the nature. Silence is the great teacher, and to learn its lessons you must pay attention to it.

In periods other than silence one must learn to observe austerity of speech which Krishna in Bhagvad Gita describes as “17.15: Austerity of speech consists in speaking words that are truthful, pleasing, beneficial, and not agitating to others, and also in regularly reciting Vedic literature."

5.27-28: "Shutting out all external sense objects, keeping the eyes and vision concentrated between the two eyebrows, suspending the inward and outward breaths within the nostrils, and thus controlling the mind, senses and intelligence, the transcendentalist aiming at liberation becomes free from desire, fear and anger. One who is always in this state is certainly liberated."

Dr KK Aggarwal
Editor in Chief
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  eMedinewS Audio PostCard

2nd eMedinewS revisiting 2010

Revisiting the Year 2010 with Dr KK Aggarwal
New MCI regulations – Doctor–Pharma relationship

Audio PostCard
 
  Quote of the Day

(By Dr GM Singh)

The happiest of people don’t necessarily have the best of everything they just make the most of everything that comes along their way.

 
    Photo Feature

2nd eMedinewS Revisiting 2010

Dr Ashwani Dalmia recieving 'eMedinewS Excellence Awards of the year 2010' in the 2nd eMedinewS revisiting 2010 on 9th January 2011 at Maulana Azad Medical College.

 
Dr K K Aggarwal
 
    National News

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology

Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

Mobiles to monitor govt food programme

The government intends to give the oldest child welfare programme a fresh lease of life through new technology. It proposes to use mobile phones to monitor its food programme directed at children between the years of 0-6. The ministry of women and child development (WCD) will use mobile phones to monitor the integrated child development scheme (ICDS) and spread awareness on nutrition and sanitation. The issue will be discussed in the state ministers' meeting on Friday. ICDS provides children, pregnant women and lactating mothers with supplementary nutrition. Commenting on the scheme, WCD minister Krishna Tirath said, "We intend to use new technology like mobile phones as part of a larger strategy to focus on nutrition. Mobiles will be used to monitor ICDS services and spread awareness on the issue." The move comes after the Nutrition Council, headed by the PM, in a meeting in November last year stressed on the need for restructuring and strengthening of the food programme with special attention to children under 2. Mobile phones will be put to use in some anganwadis on a pilot basis for collecting and collating information on ICDS. It is aimed at establishing effective communication with anganwadi centres and monitoring the regularity of functioning, feeding and to get regular information on key indicators. (Source: The Times of India, Jan 30, 2011)

 
    International News

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

Incidence of coronary heart disease is 150% lower among women who exercise as compared to women who don't

The important Nurse's Health Study collected data on 88,393 women aged 34-59, who were monitored for 20 years. Those who exercised more than 3.5 hours per week regularly, enjoyed enormous benefits in reduced heart disease risk compared to women who did not exercise at all.

(Dr Monica and Brahm Vasudev)

Cystatin C beats creatinine at predicting complications of kidney disease

Testing for cystatin C, a protease inhibitor made by most cells and a biomarker of renal function, more accurately identifies chronic kidney disease (CKD) patients who are at high risk for complications than creatinine testing does, according to a new study (Dec. 16, Journal of the American Society of Nephrology)

ACIP updates its recommendations for use of meningococcal conjugate vaccines

Updated ACIP recommendations for the use of meningococcal conjugate vaccines are published in the January 28 issue of the MMWR Morbidity and Mortality Weekly Report. The new recommendations include

  • Routine vaccination of adolescents, preferably at age 11 or 12 years, with a booster dose at age 16 years
  • A two–dose primary series administered 2 months apart for individuals aged 2 through 54 years with persistent complement component deficiency (e.g., C5–C9, properidin, factor H, or factor D) and functional or anatomic asplenia, and for adolescents with human immunodeficiency virus (HIV) infection.

Very late stent thrombosis after primary PCI for STEMI relatively common

According to results from a US study, very late stent thrombosis may occur more often with drug–eluting stents. Dr. Bruce Brodie, a cardiologist at the LeBauer Cardiovascular Research Foundation in Greensboro, North Carolina, who is the lead author of this study said that very late stent thrombosis occurred more frequently with drug–eluting stents, probably due to slower healing i.e., it takes longer for the stent to be covered with the inner layer of the blood vessel. The study is published in the January issue of the Journal of the American College of Cardiology Cardiovascular Interventions.

FDA approves rituximab as maintenance treatment for lymphoma

Rrituximab (Rituxan), a monoclonal antibody, has been approved by the FDA as maintenance therapy for advanced follicular lymphoma in patients with an initial response to induction therapy with the drug plus chemotherapy. Rituximab is already approved as induction therapy for a number of hematologic cancers, and for treating rheumatoid arthritis.

 
    Infertility Update

Dr. Kaberi Banerjee, Infertility and IVF Specialist Max Hospital; Director Precious Baby Foundation

What is a typical IVF calendar ?

The sequence of events depends on the treatment protocol that has been planned for you. Usually OPD–based injections are started on Day 20 of previous menses, further gonadotrophins with follicular monitoring and blood tests start from 2nd day of menses for about 10 days. You may need daycare admission for oocyte retrieval as you will be administered anesthesia. Two days later you will come back for Embryo transfer which is an OPD USG–guided procedure. In a different protocol, stimulation starts from Day 2/3 of period and collection is done around day 15 after 10–12 days of stimulation.

For queries contact: banerjee.kaberi@gmail.com

 
    Pediatric Update

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

What is the recommendation for post exposure prophylaxis for contacts with a known HBsAg - positive case?

Most guidelines suggest the following:

  • If the exposed person is unvaccinated :
    • Hepatitis B immunoglobulin (HBIG) 0.06 ml/kg and
    • Hepatitis B vaccine 3 doses should be given
  • Exposed patient with known response to vaccine
    • No treatment
  • Exposed patient with known failed response to vaccine
    • Patient has not yet completed second 3-dose series
      • Hepatitis B immunoglobulin (HBIG) 0.06 ml/kg and
      • Hepatitis B vaccine (complete second 3-dose series)
  • Patient has completed two prior 3-dose series:Hepatitis B immunoglobulin (HBIG) 0.06 ml/kg
  • Exposed patient with unknown response to vaccine
    • Test for antibody to HBsAg
    • Adequate antibody (HBsAg Positive): No treatment
    • Inadequate antibody (HBsAg Negative)
      • Hepatitis B immunoglobulin (HBIG) 0.06 ml/kg and Hepatitis B vaccine booster dose
 
    Medicolegal Update

Dr Sudhir Gupta, Asso Professor, Forensic Medicine & Toxicology, AIIMS

What is Sec 312 of the IPC?

Criminal and legal Abortions

Sec 312 of the IPC, 1860 under the heading "causing miscarriage" says that whoever voluntarily causes a woman with child to miscarry, shall, if such miscarriage be not caused in good faith for saving the life of the woman, be punished with imprisonment of either description of a term which may extend to three years, or with fine, or with both; and, if the woman be quick with the child, shall be punished with imprisonment of either description of a term which may extend to seven years or shall also be liable to fine. Explanation to this section: a woman who causes herself to miscarry, is also punishable therunder.

  • In Dr. Akhil Kumar v. State of M.P., 1992 LJ 2029(MP), a woman living separately from her husband for 3 to 4 years conceived as a result of illicit intercourse with her distant cousin. When her pregnancy was of 24 weeks she approached a medical practitioner who pushed Menstrogen Forte injection into her which caused her death. The literature of Menstrogen Forte clearly stated that the effect of such injection could be miscarriage. The plea of the accused physician that he had pushed that injection to determine if she was pregnant was not believed because the six month old pregnancy was writ large on her abdomen discernible from outside and the doctor was convicted for attempt to cause miscarriage.
  • The deceased mother of four children, having become pregnant was taken by her son–in–law to a quack for abortion. She was later found dead and was buried. The dead body was exhumed after about 12 days and the quack was prosecuted under Sec. 314 and convicted thereunder on circumstantial evidence. (In Maideen Sab v. State of Karnataka, 1993 Cri LJ 1430 (Kar)
 
    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

Q. Can a hospital include HIV test along with hepatitis B and C as routine pre–operative serology without the consent of the patient?

Ans.

  • No test, HIV or non–HIV can be conducted on a patient without his consent. In case of ordinary tests, consent may be taken as implied by the fact that the patient has submitted to them voluntarily. This cannot be said in case of special tests like biopsy, FNAC, MRI, tests for pregnancy or for HIV etc. Specific informed and documented consent is needed for these.
  • As per NABL and NABH guidelines, consent is mandatory. It is a must to take the patient’s consent for HIV testing. A doctor has no right to conduct a test forcibly. He also does not have a right to collect blood for some other test, say hemogram/hepatitis B and C and send a part of it for HIV testing. He even does not have the right to collect blood from the patient, telling him that the blood will be sent for hemogram and also some other test, and then get the hemogram and HIV testing done. The reason is that when the patient agrees to give blood for "hemogram and also some other test", this cannot be construed as meaning that the "some other test" means HIV test. This would not be treated in law as informed consent. If the consent is not informed consent, it is not legally valid. Please note that if HIV testing is done without the clear consent of the patient, he can legally sue and most likely win.
  • Please note that the patient has a right to refuse consent for HIV testing. He also has a right to refuse to undergo forcible testing without consent. He also has a right to sue the doctor/hospital for violation of his right.
  • Please also note that if the patient refuses consent for HIV testing, there are several possible courses of action:
    i. If the proposed treatment/procedure/surgery is not a life– saving one, the doctors would be within their right not to go ahead with the proposed treatment/procedure/surgery and to inform the patient accordingly, along with the reasons and consequences of withholding the same.

    ii. If the treatment/procedure/surgery is a life- saving one, or if it is an emergency and there is no time to wait for the HIV test report, the doctors should not withhold it but carry out the same using all proper precautions and equipment needed for safe barrier surgery. The patient should be billed later for the cost towards such equipment etc. as per hospital rules.

    iii. In the above situation, if safety equipments (gowns, gloves etc.) are not available, the doctors may refuse to treat the patient or may, depending upon the circumstances, may agree to treat the patient and, immediately afterwards, if there is confirmed or unconfirmed suspicion/ possibility of the patient being an HIV–positive person, take necessary prophylactic treatment/immunisation etc. to prevent the future development of HIV infection within their body.
  • Please note that doctors cannot be expected in law to endanger their own life in order to save that of others. However, this being a sensitive area, the doctors MUST maintain proper written records of all necessary decisions, along with the reasons thereof, duly authenticated, as far as possible, by a committee of two or more doctors. The medical superintendent of the hospital must be kept, in writing, in the picture.
 
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Our Contributors
  Docconnect Dr Veena Aggarwal
  Docconnect Dr Arpan Gandhi
  Docconnect Dr Aru Handa
  Docconnect Dr Ashish Verma
  Docconnect Dr A K Gupta
  Docconnect Dr Brahm Vasudev
  Docconnect Dr GM Singh
  Docconnect Dr Jitendra Ingole
  Docconnect Dr. Kaberi Banerjee
  Docconnect Dr Monica Vasudev
  Docconnect Dr MC Gupta
  Docconnect Dr. Neelam Mohan
  Docconnect Dr. Naveen Dang
  Docconnect Dr Prabha Sanghi
  Docconnect Dr Prachi Garg
  Docconnect Rajat Bhatnagar
  Docconnect Dr Sudhir Gupta
 
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Inorganic Phosphorus

Hyperphosphatemia may occur in myeloma, Paget’s disease of bone, osseous metastases, Addison’s disease, leukemia, sarcoidosis, milk–alkali syndrome, vitamin D excess, healing fractures, renal failure, hypoparathyroidism, diabetic ketoacidosis, acromegaly, and malignant hyperpyrexia. Drugs causing serum phosphorous elevation include androgens, furosemide, growth hormone, hydrochlorthiazide, oral contraceptives, parathormone, and phosphates.

 
    Medi Finance Update

If a doctor gives service to his family or relatives then is it taxable?

Yes, if income is generated.

 
    Drug Update

List of approved drugs from 01.01.2010 to 31.8.2010

Drug Name
Indication
DCI Approval Date
Sodium chloride 6.80gm + Potassium chloride 0.30 gm + Calcium chloride dihydrate 0.37gm + Magnesium chloride hexahydrate 0.20gm + Sodium acetate trihydrate 3.27gm + L–malic acid 0.67gm in 1000ml solution for infusion
Replacement of extracellular fluid losses in case of isotonic dehydration, especially if acidosis is being imminent or present
11/02/2010
 
    IMSA Update

International Medical Science Academy (IMSA) Update

Lipid therapy in type 2 diabetes mellitus

The ACCORD Lipid trial in high–risk patients with diabetes showed no decrease in a composite cardiovascular endpoint in patients treated with fenofibrate plus simvastatin compared with simvastatin alone.

(Reference: Ginsberg HN, et al. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med 2010;362:1563)

 
    IJCP Special

Dr Good Dr Bad

Situation: A heart patient wanted to know if he could meditate under a pyramid.
Dr Bad: You cannot do it.
Dr Good: Go ahead.
Lesson: The effect of meditation under a pyramid as twice as strong as meditating outside the pyramid.

Make Sure

Situation: A diabetic patient with BP of 130/90 developed acute heart pain.
Reaction: Oh my God! Why was his BP not kept below 120/80.
Lesson: Make sure that all patients with diabetes should have a goal BP of less than 120/80.

 
    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Prachi Garg)

Burden of My Own

A Monarch of long ago had twin sons. As they grew to young manhood, the king sought a fair way to designate one of them as crown prince. All who knew the young men thought them equal in intelligence, wit, personal charm, health, and physical strength. Being a keenly observant king, he thought he detected a trait in one which was not shared by the other. Calling them to his council chamber one day, he said, "My sons, the day will come when one of you must succeed me as king. The weight of sovereignty is very heavy. To find out which of you is better able to bear them cheerfully, I am sending you together to a far corner of the kingdom. One of my advisors there will place equal burdens on your shoulders. My crown will one day go to the one who first returns bearing his yoke like a king should."

In a spirit of friendly competition, the brothers set out together. Soon they overtook an aged woman struggling under a burden that seemed far too heavy for her frail body. One of the boys suggested that they stop to help her. The other protested: "We have a saddle of our own to worry about. Let us be on our way." The objector hurried on while the other stayed behind to give aid to the aged woman. Along the road, from day to day, he found others who also needed help. A blind man took him miles out of his way, and a lame man slowed him to a cripple's walk. Eventually he did reach his father’s advisor, where he secured his own yoke and started home with it safely on his shoulders. When he arrived at the palace, his brother met him at the gate, and greeted him with dismay. He said," I don’t understand. I told our father the weight was too heavy to carry. However did you do it?"

The future king replied thoughtfully, "I suppose when I helped others carry their yoke, I found the strength to carry my own."

Heaven grant that the burden you carry may have as easy an exit as it had an entrance.

………………………………

eQuiz

Read this…………………

A 54–year–old male presents to your office with complaints of intermittent pain and discoloration of his fingers during the months of December/January. He has had regurgitation of food for years. Patient has no other significant past medical history and is a non-smoker. He sometimes takes Ibuprofen for the pain with no relief. His physical examination is unremarkable. Appropriate rheumatological workup is ordered.

Q. Which of the following is the most likely diagnosis and appropriate treatment option for this patient?

A. Primary Raynaud, oral prednisone therapy
B. Secondary Raynaud, stay warm and wear gloves in cold weather
C. Systemic Scleroderma, amlodipine
D. Limited Cutaneous Scleroderma, topical nitrate therapy

Contributed by Ashish Verma MD

Yesterday’s Mind Teaser: H ijklmn O
Answer for Yesterday’s Mind Teaser: H to O (H2O, or water)

Correct answers received from: Dr.B.N.Ganagdhar, Dr. Riyazul Qamar Khan, Dr Rakesh Bhasin, Dr.K.Raju, Dr Chandresh Jardosh, Dr Rajalakshmai Krishnamoorthy, Dr. H.L. Kapoor, Dr Anil Bairaria, Dr. T. Samraj, Dr Anil Kumar

Answer for 31st January Mind Teaser: More harm than good
Correct answers received from: Dr Rashmi Chhibber, Dr Vijay Kansal, Dr.Satyoban Ghosh

Send your answer to ijcp12@gmail.com

………………………………

Laugh a While

I have come to the conclusion that Google must be female, as she has the answer to everything!!!

………………………………

Knowledge is amusing

MOPED is the short term for ‘Motorized Pedaling’.

 
    Readers Responses
  1. Very nice and informative endeavour. Dr Varsha Gupta, MD, Professor, Department of Microbiology, Govt. Medical College Hospital, Chandigarh.
 
    Public Forum

(Press Release for use by the newspapers)

Neck artery thickness campaign

Neck artery wall plaques suggest proneness to heart attacks

Presence of plaques in the neck artery wall is highly suggestive of underlying plaques and blockages in the heart arteries. A patient with acute coronary syndrome, who presents with chest pain, if in the emergency room is found to have an ultrasound detected echolucent neck artery plaque it is highly suggestive of a high risk patient with increased chances of heart attack and sudden death said Senior Consultant Moolchand Medcity, President Heart Care Foundation of India, Dr. KK Aggarwal, Padma Shri & Dr. B.C. Roy National Awardee.

A calcification in the plaque is highly predictive of underlying heart diseases compared to a plaque with no calcification.

An artery thickness of more than 1 mm is called as a plaque. Some define a plaque as to when the thickness is more than 1.5 mm. In a patient with diffuse neck artery thickness, any focal additional thickening of 0.5 mm or more than 50% of the neck artery thickness is classified as a plaque. If a patient has plaque in both neck and the leg arteries, he/she will invariably also have plaque in the heart artery.

Patients who demonstrate a plaque of more than 1.5mm have a very high history of premature heart-related deaths in the family. In the presence of plaques, risk of acute coronary syndrome is 6.7 times more than in a person with no plaques in the neck artery.

Moolchand Medcity is running a special campaign in the month of February on detecting heart disease before the symptoms arise.

 
    Forthcoming Events

Maulana Azad Medical College SPIC-MACAY chapter is organizing a festival of music & dance

Date: 2nd to 5th February, 2011. 
All are invited

"MAMC SPIC MACAY VIRASAT 2011"

2nd February, Wednesday   3:00 pm- 4:00 pm    Panchavadyam by Vidwans - Auditorium Inauguration - Dr Sonal Mansingh (Odissi Dance) Pandit Hariprasad Chaurasia (Flute)
3rd February, Thursday, 10:00 am - Madhubani Painting Workshop  -Old Girl's by Smt. Shanti Devi Hostel
4th February, Friday, 4:00 pm -Qawwalli by Qadir Niazi and troupe- Auditorium
5th February, Saturday, 9:00 am -Heritage walk by Dr. Ramji Narayan  -(Ferozshah Kotla)
Meeting point college fountain

We look forward to having you with us during this festival.

*Please be seated 15 minutes before the event,
*We request you to switch off your cellphones during the programmes.
*No flash photography and videography allowed during the programme.

Maulana Azad Medical College has been organizing such programmes for students, staff, faculty and doctors. The aim being to experience the beauty of our culture and enrich lives with beautiful moments.  The programmes are extremely relaxing for all. Such programmes are important as they help decrease stress, something which all doctors experience in routine.
 

eMedinewS Events: Register at emedinews@gmail.com

Conference Column

Workshop on Fetal and Paedatric Echocardiography Pre and perinatal management of heart disease

13th February 2011, Sunday, Moolchand Medcity

  1. Fetal Echocardiography–How to get it right: Dr Vandana Chaddha
  2. Fetal Cardiac Spectrum– abnormal cases with interactive session: Dr Vandana Chaddha
  3. Neonatal Cardiac Cases– Hits and misses inetractive session: Dr Savitri Srivastava
  4. Intima Media Thickness and Plaque Volume, New Marker for Atherosclerosis Regression: Dr KK Aggarwal

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