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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; 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


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    Health Videos …
Nobility of medical profession Video 1 to 9 Health and Religion Video 1–7
DD Take Care Holistically Video 1–4 Chat with Dr KK On life Style Disorders
Health Update Video 1–15 Science and Spirituality
Obesity–Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

30th August 2012, Thursday

New Guidelines: Thyroid Disease during Pregnancy

The Endocrine Society's clinical practice guideline for the management of thyroid disease during pregnancy and after birth has been updated from its 2007 version. (August issue of the Journal of Clinical Endocrinology and Metabolism)

Diagnosing and treating patients with thyroid-related medical issues before, during, and immediately after pregnancy.

  • Trimester-specific reference ranges for pregnant women, using a free T4 assay, should be established.
  • The nonpregnant total T4 range (5–12 µg/dL or 50–150 nmol/liter) can be adapted in the second and third trimesters by multiplying this range by one and a half-fold.
  • Free T4 index appears to be a reliable assay during pregnancy.
  • Propylthiouracil (PTU) should be the first-line drug for treatment of hyperthyroidism during the first trimester of pregnancy.
  • Methimazole (MMI) may also be prescribed if PTU is not available or not tolerated.
  • Clinicians should change treatment of patients from PTU to MMI after completion of the first trimester because of the potential for liver toxicity.
  • Breast-feeding women should maintain a daily intake of 250 µg iodine to ensure breast-milk provides 100 µg iodine per day to the infant.
  • Once-daily prenatal vitamins should contain from 150 to 200 µg iodine in the form of potassium iodide or iodate
  • Thyroid receptor antibodies should be measured before 22 weeks' gestational age in mothers with "1) current Graves' disease; or 2) a history of Graves' disease and treatment with 131I or thyroidectomy before pregnancy; or 3) a previous neonate with Graves' disease or 4) previously elevated (thyroid-stimulating hormone receptor antibodies (TRAb)).
  • In women with TRAb at least 2- to 3-fold the normal level and women treated with antithyroid drugs, fetal thyroid dysfunction should be screened for during the fetal anatomy ultrasound done in the 18th–22nd week and repeated every four to six weeks or as clinically indicated.
  • Evidence of fetal thyroid dysfunction could include thyroid enlargement, growth restriction, hydrops, presence of goiter, advanced bone age, tachycardia, or cardiac failure.
  • Women with nodules from 5 mm to 1 cm in size should be considered for fine-needle aspiration (FNA) if they have a high risk history or suspicious findings on ultrasound, and women with complex nodules from 1.5 to 2 cm in size should also receive an FNA. "During the last weeks of pregnancy, FNA can reasonably be delayed until after delivery. Ultrasound-guided FNA is likely to have an advantage for maximizing adequate sampling," the authors conclude. (Medscape)

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

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

FDA adds warnings to statin label

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Workshop for Teachers on Proper Hygiene in schools

Heart Care Foundation of India and DAV Public School, Kailash Hills organized a workshop on health and hygiene for teachers

Dr K K Aggarwal
    National News

Aamir offers to help Tripura govt introduce generic drugs (TNN)

Bollywood actor Aamir Khan has expressed his willingness to help the Tripura government introduce generic drugs at the community level in the state. In a letter to the chief minister, Manik Sarkar, recently, Khan stressed on the benefits of generic drugs and urged him to take appropriate steps to make them available to patients. He also said CDs of his popular television serial, Satyamev Jayate, should be distributed among them. "India exports generic medicine worth Rs 35,000 crore annually but poor Indians are not getting access to these cheap drugs," Khan wrote in his letter.

Satyamev Jayate has talked about the importance of generic drugs since a section of the pharmaceutical industry is in nexus with some doctors where business interests rule. Chief minister Manik Sarkar has also criticized this recently which prompts many physicians to prescribe expensive drugs unnecessarily. Health minister Tapas Chakraborty said, "Doctors are prescribing unnecessary and expensive medicines to patients because of an unholy alliance between a section of doctors and pharmaceutical companies. Amir Khan's show has made us look at alternatives."

Extending all support to the Tripura government, Khan said if the government desires he will request Samit Sharma, the prime generic drug promoter, to provide all possible help to make generic drugs available to the poor. Khan said during investigation it came to the fore that most Indian pharmaceutical companies produce both generic and branded drugs; but generic drugs are not often prescribed though they are no way inferior. On the contrary, generic drugs assure 10-50 per cent profit in many cases.

The Tripura government has decided to send state medical advisor Siddhartha Majumder and director, medical education, Basudev Bhattacharjee, to Rajasthan and a few places in Tamil Nadu and West Bengal to see how generic drugs are being successfully used there. For starters, the state government is exploring the possibility of introducing generic drugs in at least a few selected hospitals on a pilot basis.

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

From today we are starting a new column on valvular heart disease. The experts Cardiovascular & Thoracic Surgeons will be Dr Bhabha Nanda Das and Dr Ganesh K Mani from Indraprastha Apollo Hospital, Dr. Yugal Mishra from Escorts Heart Institute & Research Centre, Dr Deepak Khurana , Dr I S Virdi, Dr K S Dagar and Dr Rajesh Kaushish from Max Devki Devi Heart & Vascular Centre

Q: Which heart diseases are common in the elderly?
Ans: Aortic stenosis and mitral regurgitation are the most common valvular disorders in the elderly.

    International News

(Contributed by Dr Monica and Brahm Vasudev)

When metformin fails, which second-line type 2 diabetes therapy is superior?

In three trials, researchers assess options for second-line diabetes therapy.

Metformin is accepted widely as first-line treatment for patients with type 2 diabetes, but no clear guidelines exist on how to proceed when metformin monotherapy fails. In three new industry-supported studies, researchers compared available second-line treatments.

In an open-label study, 1029 adults with glycosylated hemoglobin (HbA1c) levels between 6.5% and 9.0% while taking metformin were randomized to add either the glucagon-type peptide-receptor agonist exenatide (Byetta; 5–10 µg subcutaneously twice daily) or the sulfonylurea glimepiride (titrated to maximum tolerated daily dose). During 4 years of follow-up, significantly fewer exenatide recipients than glimepiride recipients (41% vs. 54%) reached the primary endpoint of treatment failure (HbA1c level >9% after 3 months of treatment, or HbA1c level >7% at two consecutive readings after 6 months of treatment). Significantly more patients in the exenatide group than in the glimepiride group reached a target HbA1c level of <7% (44% vs. 31%). Patients who received exenatide lost a mean of 3.3 kg, whereas those who received glimepiride gained a mean of 1.2 kg — a significant difference. Hypoglycemia occurred significantly more often in patients taking glimepiride.

In another open-label trial, researchers randomized 515 adults with HbA1c levels between 7% and 11% while taking metformin to add either once-daily insulin glargine (Lantus; titrated to a fasting glucose level of 72–99 mg/dL) or the dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin (Januvia; 100 mg once daily). After 24 weeks, patients who received insulin glargine had a significantly greater reduction in mean HbA1c level than did those who received sitagliptin (–1.7% vs. –1.1%), and more patients who received insulin glargine reached the HbA1c target of 7% (68% vs. 42%). Mean body weight increased slightly in the insulin glargine group and decreased slightly in the sitagliptin group, and significantly more hypoglycemic events occurred in the insulin glargine group (4.2 vs. 0.5 per patient-year).

In the third trial, researchers randomized 1551 patients with HbA1c levels between 6.5% and 10.0% who were taking metformin alone to the DPP-4 inhibitor linagliptin (Tradjenta; 5 mg daily) or to glimepiride (1–4 mg daily, titrated to fasting plasma glucose =110 mg/dL). After 2 years, average HbA1c level was –0.16% in the linagliptin group and –0.36% in the glimepiride group. Thirty percent of patients taking linagliptin and 35% of those taking glimepiride reached HbA1c levels <7%. Average body weight decreased slightly with linagliptin and rose slightly with glimepiride; hypoglycemic events occurred in 7% of patients taking linagliptin and in 36% of those taking glimepiride.

Comment: The choice of diabetes therapies is complex, involving patient acceptance, efficacy, and safety. These trials were limited to surrogate endpoints, and all were industry-sponsored (by the makers of exenatide, insulin glargine, and linagliptin, respectively); also, the insulin glargine–sitagliptin trial was very brief. Nevertheless, these trials highlight some of the strengths and weaknesses of the various options for second-line diabetes therapy; the long-term effects of these therapies on glucose metabolism and clinical endpoints remain to be elucidated.

— Bruce Soloway, MD (Published in Journal Watch General Medicine July 10, 2012)

For comments and archives

Prasugrel fails to top clopidogrel in ACS

Compared with clopidogrel (Plavix), prasugrel (Effient) did not improve outcomes among medically treated patients with acute coronary syndrome, according to the TRILOGY-ACS investigators reported in a paper published online August 26 by the New England Journal of Medicine.

For comments and archives

Waiting to treat CMV may benefit kidney transplant patients

Waiting to treat cytomegalovirus (CMV) in kidney transplant patients may deliver better long-term outcomes than blanket preventive drugs, according to a study published online in the Journal of the American Society of Nephrology.

For comments and archives

    Twitter of the Day

@DrKKAggarwal: #AJD Debunking Diabetes Myths If you’ve just been diagnosed with diabetes, it may be difficult to separate fact... http://fb.me/1BMnzpqXd

@DeepakChopra: Pursue excellence, ignore success.

    Spiritual Update

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

Music Therapy

  1. 1. Music therapy can ameliorate physical and emotional distress.
  2. It can improve distress caused by pain, decrease muscle tension and promote relaxation, decrease anxiety, improve chemotherapy-related nausea and emesis and improve overall mood (1,2).

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 is the recipient prepared for the embryo transfer?

In order for embryos to implant into the recipient’s uterus, the endometrium (uterine lining) must be appropriately prepared and synchronized with the donor reproductive cycle. When the donor starts her hormonal medications to stimulate her ovaries, the recipient is given estradiol to stimulate the endometrium to develop. Estradiol may be given in the form of an oral pill, transdermal patch, or injection. Ultrasound assessment of the endometrium and blood tests may occur during this time. The recipient begins progesterone on the day after the donor receives hCG. Progesterone causes specific maturational changes within the endometrium that enable the embryo to implant. Embryos are transferred into the recipient’s uterus usually within three to five days after the eggs are fertilized in the laboratory. The embryo transfer is performed by placing a small catheter with the embryos through the cervix and into the uterus.

For comments and archives

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

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

Massive Transfusion

  • Massive transfusion is usually defined as the replacement of one or more blood volume(s) within 24 hours or replacement of more than 50% of the blood volume in 3 hours in an adult.
  • Blood should never be warmed in a bowl of hot water, microwave or in an incubator as this could lead to hemolysis of the red cells which could be life-threatening.
  • It is not necessary to warm the blood before transfusion when rate of infusion is slow.

For comments and archives

    An Inspirational Story (Ms Ritu Sinha)

The baby without ears

“Can I see my baby?” the happy new mother asked.

When the bundle was nestled in her arms and she moved the fold of cloth to look upon his tiny face, she gasped. The doctor turned quickly and looked out the tall hospital window. The baby had been born without ears.

Time proved that the baby’s hearing was perfect. It was only his appearance that was marred. When he rushed home from school one day and flung himself into his mother’s arms, she sighed, knowing that his life was to be a succession of heartbreaks. He blurted out the tragedy: “A boy, a big boy… called me a freak.”

He grew up, handsome for his misfortune. A favorite with his fellow students, he might have been class president, but for that. He developed a gift, a talent for literature and music. “But you might mingle with other young people,” his mother reproved him, but felt a kindness in her heart. The boy’s father had a session with the family physician. Could nothing be done? “I believe I could graft on a pair of outer ears, if they could be procured,” the doctor decided.

Whereupon the search began for a person who would make such a sacrifice for a young man. Two years went by. Then, “You are going to the hospital, Son. Mother and I have someone who will donate the ears you need. But it’s a secret,” said the father.

The operation was a brilliant success, and a new person emerged. His talents blossomed into genius, and school and college became a series of triumphs. Later he married and entered the diplomatic service. “But I must know!” He urged his father, “Who gave so much for me? I could never do enough for him.” “I do not believe you could,” said the father, “but the agreement was that you are not to know … not yet.”

The years kept their profound secret, but the day did come … one of the darkest days that a son must endure. He stood with his father over his mother’s casket. Slowly, tenderly, the father stretched forth a hand and raised the thick, reddish-brown hair to reveal that the mother — had no outer ears.

“Mother said she was glad she never let her hair be cut,” he whispered gently, “and nobody ever thought Mother less beautiful, did they?”

Real beauty lies not in the physical appearance, but in the heart. Real treasure lies not in what can be seen, but what cannot be seen. Real love lies not in what is done and known, but in what that is done but not known.

For comments and archives

    Cardiology eMedinewS

'Triple Therapy' may be OK in high-risk PCI Read More

PROTECT: No difference in stent thrombosis with endeavor and Cypher stents Read More

    Pediatric eMedinewS

AAP: Check kids for sleep apnea Read More

Breastfeeding, early milk not tied to puberty timing Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient came with A1c of 6.5%.
Dr Bad: Start a combination of Glimepiride and Metformin.
Dr Good: Start Metformin monotherapy.
Lesson: Metformin typically lowers fasting blood glucose concentrations by approximately 20% and A1c by 1.5%, a response similar to that achieved with a sulfonylurea. (Diabetes Care 1992;5:755 & N Engl J Med 1996;334:574)

For comments and archives

Make Sure

Situation: A patient of jaundice with fever developed complications.
Reaction: Oh my God! Why were other causes of jaundice not suspected?
Lesson: Make sure that in a patient with jaundice and fever, causes other than viral hepatitis are looked into. In viral hepatitis, jaundice appears after the fever subsides.

For comments and archives

  Quote of the Day (Dr GM Singh)

Anger is a Wide ball – Leave it
Fear is a No ball – Let it
Smile is a Sixer – Hit it
Friendship is a Wicket – Get it
Failure is Bouncer – Forget it
Problem is a Yorker – Face it
Success is a Century – Make it
Luck is a Free hit – Use it
Then u can rock the World Cup of Life…

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Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of Doctor’s Day Celebration

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    Legal Question of the Day (Dr MC Gupta)

Q. Should a medical officer in the hospital casualty inform the police about a patient only when the patient consents for such reporting? Should the reporting be confined to those cases listed in Section 39 CrPC?


  • A doctor does not act as per the dictates of the patient. He uses his own discretion.
    • If the doctor feels that a police report should be made, he should go ahead and make the police report. He does not need any permission from the patient before doing so.
    • If the doctor does not deem it necessary to make a police complaint, he need not make such complaint merely because the patient so wants. The patient is free to make the complaint himself or on his own initiative.
  • The discretion has to be exercised by the physician keeping in mind the following:
    • What are the rules/guidelines/conventions prevalent in the state and provided by the state laws/police/courts/other expert bodies etc.
    • What are the chances of the doctor being questioned later as to why no police complaint was made?
    • What are the chances of the patient/relatives stating later that they wanted a police complaint but the doctor got them to write that they did not want so?
    • What are the chances of foul play (criminal law)?
    • What are the chances that there may be litigation of civil nature related to the injury where medical records may be asked for by the courts?
  • Section 39 CrPC is titled--"Public to give information about certain offences". It is not labelled --"Situations when a physician should make a complaint to the police". A physician is an expert and is not to be equated to public in general.

For comments and archives

    Lab Update (Dr Navin Dang and Dr Arpan Gandhi)

What is the complete blood count test?

The complete blood count or CBC is one of the most commonly ordered blood tests. It calculates the cellular elements of blood. These calculations are generally determined by special machines that analyze the different components of blood in less than a minute.

A major portion of the CBC is the measure of the concentration of white blood cells, red blood cells and platelets in the blood. We recommend screening slides for all abnormal CBC parameters.

    Mind Teaser

Read this…………………

Nursing care planning is based on the knowledge that the first 24-48 hours post-burn are characterized by:

A. An increase in the total volume of intracranial plasma
B. Excessive renal perfusion with diuresis
C. Fluid shift from interstitial space
D. Fluid shift from intravascular space to the interstitial space

Yesterday’s Mind Teaser: A 30-year-old homemaker fell asleep while smoking a cigarette. She sustained severe burns of the face, neck, anterior chest, and both arms and hands. Using the rule of nines, which is the best estimate of total body-surface area burned?

A. 18%
B. 22%
C. 31%
D. 40%

Answer for Yesterday’s Mind Teaser: C. 31%

Correct answers received from: Dr KV Sarma, A K Jalewa, Dr Sushma Chawla, YJ Vasavada, Dr (Maj. Gen.) Anil Bairaria, Dr PC Das, Dr BB Aggarwal, Dr Avtar Krishan, Dr Jainendra Upadhyay, Dr Pankaj Agarwal, Dr Thakor Hitendrsinh G.

Answer for 28th August Mind Teaser: A. Telling him to avoid heavy lifting for 4 to 6 weeks

Correct answers received from:
Dr Parimal Shah, Dr K Raju, Dr Anita M Thakar, Dr Ajay Gandhi
Dr Thakor Hitendrsinh G

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

The Leave Application

A leave letter to the headmaster: "As I am studying in this school I am suffering from headache. I request you to leave me today".

    Medicolegal Update

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

What is a surgical error?

The word ‘surgery’ came from 'chirurgiae', which means ‘hand work’. However today in medical specialty, the term surgery incorporates uses of operative manual, various computerized instrumental techniques along with hand work on a patient for surgical procedure. The surgical operations are performed maintaining a standard with the best of his ability and capability by the surgeon without any problems or complications and the same is true in most surgeries in various hospitals. But, every year some patients complain of unnecessary harm to health and life due to performed surgical errors. Sometimes the damage caused is repairable and does not give rise to any long–term effects side by side. In some other cases, the negligence results in permanent disability or even a fatality.

  • All operations naturally carry with them a certain level of risk and there are also specific risks of each different procedure.
  • Each and every case where there may be problems during or following an surgical operation, risks should be carefully explained to a patient before the procedure goes ahead
  • An informed choice about having surgery and the possible complications must be explained in a language, which the patient/legal heirs fully understand. Failure to do this may constitute negligence in itself.
  • The Delhi Medical Council has reiterated in many cases about informed consent.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Kiran Walia: NGOs should concentrate on non communicable diseases

In her message to Heart Care Foundation of India, Prof. Kiran Walia, Minister of Social Welfare, Women & Child Development and Languages Government of NCT Delhi, said that NGOs and private sector as part of their Corporate Social Responsibility (CSR) activities should concentrate on non-communicable diseases.

She also said that in the forthcoming unique Dil Ka Darbar being organised by Heart Care Foundation of India at Talkatora Stadium on Sunday, 23rd September, 2012, thousands of heart patients will avail facilities like free checkup, telecardiology consultations and non-stop interactions with top cardiologists of the city.

Giving the details about the Dil Ka Darbar, Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India said that the Darbar will have not only free cardiology checkup facilities but will also have sessions on ‘How to reduce the cases of cardiac interventions’.

A special session on Cardiac First Aid will be organised by the Heart Care Foundation of India in the Darbar in association with MCD South.

A large number of doctors and nurses will also be participating in the event to understand patient-doctor interaction.

A special session will be organized on ‘Sex after 65’ and ‘Sex for patients with heart diseases’.

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    Forthcoming Events
Dr K K Aggarwal

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Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001
A non stop question answer-session between all the top cardiologists of the NCR region and the public. Event will be promoted through hoardings, our publications and the press. Public health discussions



Weekend Retreat for Doctors on
Mind – Body – Medicine

8 (Sat) – 9 (Sun) September 2012 At Brahma Kumaris Om Shanti Retreat Centre NH–8, Bhorakalan, Pataudi Road, Bilaspur Chowk, Distt.-Gurgaon

Visit us at: www.togetherwecan.in
Contact: BK Sister Sapna – M – 9650692204
E–mail: bksapna108@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