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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


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eMedinewS Presents Audio News of the Day

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

Photos of Doctor’s Day Celebration

    Health Videos …

Nobility of medical profession: Aamir Khan Controversy (Video 1 to Video 9)
Health and Religion: Bharatiya Vidya Bhavan and Heart Care Foundation of India(Video 1 to Video 7)
Take Care Holistically, DD India health series, Anchor Dr KK Aggarwal (Video 1–3)
Chat with Dr KK On life Style Disorders

Health Update (Video 1 to 15)

  Editorial …

5th August 2012, Sunday

New procedure to prevent contrast nephropathy

A bed side procedure may prevent contrast-induced acute kidney injury in high-risk patients.

Ischemic preconditioning, restricting and restoring blood flow to induce a protective effect against a subsequent insult, is the method as reported in the journal Circulation. The intervention consisted of inflating a standard upper-arm blood-pressure cuff to 50mmHg above a patient's systolic blood pressure for five minutes and then deflating it for five minutes.

In the randomized study, 100 patients with impaired renal function received either the pretreatment (four cycles of alternating five-minute inflations and deflations) or a sham intervention that only inflated to 10mmHg above systolic blood pressure.

With kidney injury defined as an increase in serum creatinine of at least 25% or 0.5 mg/dL above baseline within 48 hours after angiography, 40% in the sham arm developed contrast nephropathy, vs 12% in the active arm.

Surrogate endpoint used in the study clearly suggests renal protection by ischemic preconditioning

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

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

One can predict acute lung injury

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Ek Shaam Sehat Ke Naam

A session on Obesity was held at India Habitat Centre. It was organized by Heart Care Foundation of India in association with All India Radio and India Habitat Centre to mark Doctor’s Day on July 1, 2012

Dr K K Aggarwal
    National News

16-fold increase in safe institutional deliveries in India

With 2.8 lakh women dying across the globe during child birth, Union Health Minister Ghulam Nabi Azad today said there has been a 16-fold increase in number of women having safe institutional deliveries in India in the last six years after a cash incentive scheme was introduced. Speaking at the Global Health Policy Forum Summit in London, the Minister said around 11 million pregnant women in India benefited through institutional deliveries last year after the scheme, compared to only 700,000 during 2005. Azad informed the meet that over 43 million pregnant women and children are registered under another innovative scheme of telephone-based mother and child tracking system, aimed at ensuring timely delivery of pregnant women and monitoring of services to them.

Talking about the safe motherhood incentive scheme to eliminate out-of-pocket expenses for both pregnant women and sick neonates, Azad said "institutional deliveries have increased from 47 per cent in 2007-08 to 60.5 percent in 2010." He said while free to and fro transport between home and health institution is being provided to pregnant women by the central government, free diagnostics and tests, medicines, food and cesarean section are also being provided under various schemes. He said sick newborns will be provided the same initiatives up to 30 days after birth. The ministry has also taken steps to address reproductive, sexual health and nutritional needs of adolescents as a means to improve maternal and child healthcare, Azad said. "Under a unique initiative, probably the first of its kind in the world, community health workers are promoting birth spacing through awareness and door to door distribution of contraceptives. The challenge of nutrition is being addressed at the highest levels," Azad said. "The Prime Minister's Nutrition Council is working vigorously on a multi-sectoral plan to improve overall nutritional status of women and children. Our efforts to control anaemia now encompass adolescent boys and girls in addition to children and pregnant and lactating mothers." Azad said "For India, the challenge is particularly formidable considering that, though we are the second most populous country in the world, we have the largest number of pregnancies at 27 million and an annual birth cohort of 26 million babies". (Source: Business Standard, August 01, 2012)

For comments and archives

Woman gifts her kidney to brother on Rakshabandhan

NEW DELHI: This Rakshabandhan, a woman gave her brother a priceless gift — life itself. Asha, 34, donated one of her kidneys to Sriniwas Thakur, 42, at the Asian Institute of Medical Sciences (AIMS), Faridabad, on Thursday. Thakur, a resident of Faridabad, had high blood pressure for a long time and the problem was recently diagnosed as kidney failure. When doctors advised a kidney transplant, Asha offered to donate hers, said doctors. "Both recipient and donor are doing fine and are on the road to recovery. Asha gave her elder brother a new lease of life by donating her kidney, a vital organ," said Dr Jitender Kumar, one of the operating surgeons. Kidney transplantation means replacement of the failed kidneys of a patient with a working kidney from another person, called a donor. In India, the law lays down that only relatives can donate organs. Cadaver donation is allowed but is rare. Around 1.5 lakh Indians suffer from kidney failure every year, and their survival largely depends on a successful transplant. "However, only 5,000 get a transplant due to lack of available organs," said an expert. "While Spain has 35.1 organ donors per million, Britain 27, USA 26, Canada 14, and Australia 11, India has only 0.08 donors per million population," the expert added. (Source: TOI, Aug 3, 2012)

For comments and archives

My Profession My Concern

Should a doctor charge his professional colleagues?

Dr OP Yadava, CEO & Chief Cardiac Surgeon, National Heart Institute, New Delhi

Why must we ask this question? Is it because of fear of ‘medical ethics’ and its attendant dogmas, or of being castigated under the realm of ‘probity’ or of being labelled ‘discourteous’. Let me first start with defining these terminologies. Merriam Webster’s dictionary defines ethics as ‘principles of conduct governing an individual or a professional group’; probity as ‘adherence to the highest principles and ideals’ and courtesy as ‘consideration, cooperation and generosity in providing (as a graft or privilege) and its adjective, courteous has been defined as ‘marked by respect for a consideration of others’. Clearly this issue is not covered under medical ethics as the Hippocratic oath is silent on it, even though it clearly states that imparting knowledge should be without a fee. Some may argue that the oath states that all colleagues are brothers, but then who else but a brother can realize the true worth of his sibling! The toss up thus is between probity and courtesy.

In fact under the American Code of Ethics, this issue is discussed under ‘Courtesy’. Terms like ethics, courtesy and probity are subjective terms and there are no hard defined boundaries. They all come from inner calling and can neither be, nor should be dictated. You imbibe them right from the childhood from the example set by our superiors and role models, as also in our day to day life from our contemporaries.

Doctors have been called Gods on earth. This might have caused many of our brethren to see themselves in some hallowed light. A doctor must now come down from this pedestal of Godliness and stop considering himself as someone out of this world, but become a mortal human being. Granted our calling is definitely far removed from other professions as we purport to deal with human life. A computer engineer can hit Ctrl + Alt + Del at the end of the day & start anew, but a doctor doesn’t have that luxury. Yet we should not make undue expectations and why should we in the first place?

It is unfortunately in our psyche that we always look forward to freebies and discounts and that’s applicable right from mundane things as buying vegetables or groceries in a sale to such issues of paramount ethical importance as the case in point. If a person can afford to pay for a service, then he must insist for paying for it and reserve that charity, which a doctor or any other professional is willing to do, for such people, unfortunate as they may be of not being able to afford these kinds of services. Consequently it behoves all members of the profession, to not baulk at remunerating a colleague’s services. Who knows, one day he might find positions reversed and he may be expecting recompense for services he just rendered. Medicine is no doubt the noblest of professions, but it is precisely just that, a profession and nothing more. If other professions, unemblazoned with the “Noble” tag can claim adequate compensation for services rendered, why not this profession?

The question that begs to be asked is a corollary and in fact a contrarian one - Should a doctor, when offered complimentary service by his physician colleague, accept it? Won’t that qualify to be labelled, if not unethical, at least discourteous? Those who do expect complementary service are possibly doing it sheerly out of greed, rather than as an ethical issue. If it were entirely latter, then how many times a professional colleague rendering complementary service is reciprocated and how many times, these very professionals, who receive such deals actually dole out similar deals in their own turn, is in fact a question of much debate and consternation.

Let me wander askew for a moment yet again. I often hear a debate about doctors’ inter-personal relationship, where it is mentioned that doctor must not make his professional colleague wait. By the same token, should not the professional colleague take a formal appointment, when he walks into another doctor’s clinic and what entitles him to gain a march over any other patient, who is waiting in the que and is in fact more deserving for the doctor’s time and attention?

Another question which could arise surreptitiously is that a free service may come with some kind of scaled down quality and should certainly be discouraged. Everything subsidized, should be linked to and viewed towards financial and social empowerment, rather than to caste, creed or religion, least of them profession.

Having said all this, it certainly would be desirable, and in some way reminiscent of the proverbial Ram Rajya – a utopian situation, that the treating physician should offer to waive off his fees and yet the recipient, if solvent, must with due courtesies refuse to accept the offer and in fact insist to pay for them. I wonder if I will live to see that day.

Food for Thought!

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

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Aflibercept approved for colorectal cancer in the US

Aflibercept (Zaltrap, Regeneron/Sanofi) has been approved by the US Food and Drug Administration (FDA) for use in the treatment of metastatic colorectal cancer. The indication is for use in combination with the conventional FOLFIRI regimen (leucovorin, irinotecan, 5-fluorouracil) for the second-line treatment of patients who have progressed on an oxaliplatin-containing regimen. The same indication is awaiting approval in Europe and elsewhere in the world. (Source: Medscape)

For comments and archives

Doxorubicin-eluting beads improve HCC outcomes

Unresectable hepatocellular carcinoma (HCC) responded more often to transarterial chemoembolization (TACE) when doxorubicin-eluting beads were used, in a recent retrospective study. The product, called DC Beads by manufacturer Biocompatibles International Ltd, is available in Europe, Canada, Taiwan and elsewhere, but not in the U.S. (Source: Medscape)

For comments and archives

Spray-on skin cells heal wounds fast

Spray-on skin cells significantly improved wound healing versus standard care in patients with venous leg ulcers, results of a randomized trial showed. (Source: Medpage Today)

For comments and archives

Outreach helps reengage out-of-care HIV patients in care

Tens of thousands of people diagnosed with HIV and ever linked to care in New York City were not retained in care in 2010. These out-of-care (OOC) people living with HIV (PLWH) are at risk for HIV-related morbidity and mortality, as well as of transmitting the virus to uninfected sexual partners. However, Chi-Chi Udeagu, MPH, director of the HIV Epidemiology and Field Services Program of the New York City Department of Health and Mental Hygiene in Queens, presented evidence here at AIDS 2012: XIX International AIDS Conference that those PLWH who accepted assistance from public health workers for linkage to care were more likely than those who refused assistance to reengage in HIV medical care. (Source: Medscape)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: Try Flute Yoga To Beat Stress.

@DeepakChopra: Love is the ultimate truth at the heart of the universe and transcends all boundaries.

    Spiritual Update

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

Fasting during Ramadan for diabetic patients carries a risk of complications

  1. Type 1 diabetics should not fast
  2. Type 1 diabetics with recurrent episodes of low blood sugar or low blood sugar unawareness or who are poorly controlled are at very high risk for developing severe episodes of low blood sugar. An excessive reduction in the insulin dosage in these patients (to prevent low blood sugar) may place them at risk for very high blood sugar and diabetic ketoacidosis.

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 can multiple pregnancies be prevented?

When a triplet or higher order multiple pregnancy occurs, multifetal pregnancy reduction may be considered for the health of the mother and also to improve survival of the pregnancy. While multifetal pregnancy reduction carries some risk of a complete miscarriage, it also reduces the chances of extreme premature birth.

For comments and archives

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

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

Rational use of blood


Blood components are various parts of blood like red blood cells, platelets, granulocytes and plasma separated from one another by conventional blood bank method of centrifugation because of their different specific gravities.

Cellular components

  • Red blood cells (RBC) or packed red cells (PCV)
  • Leukocyte depleted red cells
  • Platelet concentrate
  • Platelet apheresis
  • Leukocyte depleted platelet concentrate
  • Lekocyte apheresis

Plasma components

  • Fresh frozen plasma
  • Cryoprecipitate
  • Cryo-poor plasma

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

Give your best to relationships

A boy and a girl were playing together. The boy had a collection of marbles. The girl had some sweets with her.

The boy told the girl that he would give her all his marbles in exchange for her sweets. The girl agreed. The boy kept the biggest and the most beautiful marble aside and gave the rest to the girl. The girl gave him all her sweets as she had promised.

That night, the girl slept peacefully. But the boy couldn’t sleep as he kept wondering if the girl had hidden some sweets from him the way he had hidden his best marble.

Moral of the story: If you don’t give your 100% in a relationship, you’ll always keep doubting if the other person has given his/her hundred percent.

This is applicable for any relationship like love, employer-employee relationship etc. Give your hundred percent to everything you do and sleep peacefully.

For comments and archives

    Cardiology eMedinewS

Exercise training improves depressive symptoms in heart failure: HF-ACTION Read More

    Pediatric eMedinewS

Blood test predicts response to therapy for orthostatic tachycardia
Read More

Nasopharyngeal specimens allow pulmonary TB diagnosis in children
Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient with fever and joint pain came with rash.
Dr Bad: It’s a drug allergy.
Dr Good: This looks like Chikungunya.
Lesson: Rash is present in 30% of cases with Chikungunya.

For comments and archives

Make Sure

Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why was the blood pressure 90/80 ignored?
Lesson: Make sure that a pulse pressure of less than 20 is not ignored; it is an impending sign that the patient is going into shock.

For comments and archives

    Quote of the Day

(Dr GM Singh)

Life is just like a sea, we are moving without an end.
Nothing stays with us, what remains is just the memories of some people who touched us as Waves..

    Lab Update

(Dr Navin Dang and Dr Arpan Gandhi)

Tests for celiac disease

  • The best initial laboratory test for diagnosis of celiac disease is anti–tissue transglutaminase antibody (anti–tTG), IgA. If this test is positive, it is likely that the patient has celiac disease.
  • Intestinal biopsy to determine whether there is damage to the intestinal villi.
  • CBC (complete blood count) to look for anemia
  • ESR (erythrocyte sedimentation rate) and CRP (C–reactive protein) to evaluate inflammation.
  • CMP (complete metabolic panel) to determine electrolyte, protein, and calcium levels and to verify the status of the kidney and liver.
  • Vitamin D, E, and B12 to measure vitamin deficiencies
  • Stool fat to help evaluate malabsorption.
    Legal Question of the Day

(Dr. M C Gupta)

Q. Are the following two legally on the same footing?

  • An MBBS who gets an MD degree from a foreign university not recognised by the MCI.
  • An MBBS who gets an MD degree after having been allotted the MD seat as a result of counselling after the PG entrance exam conducted by the state government, even though such seat is not recognised by the MCI. (200 PG seats in UP are included for state counselling out of state quota but are not included for All–India level counselling because these are not recognised by the MCI).


  • It is unfortunate that young doctors planning their career are subjected to such unnecessary controversies because of confusion created by the politicians and others.
  • The two are not on the same footing. ‘A’ lacks legal validity. ‘B’ is valid in law.
  • If a student is a registered medical practitioner by virtue of the MBBS degree recognised by the MCI, nobody can legally question his status as a holder of valid MD degree given through a government mechanism simply because the MCI does not recognise the degree. A student cannot be made to suffer because of differences between the state government and the MCI.
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    Mind Teaser

Read this…………………

Included in the plan of care for the immediate post-gastroscopy period will be:

A. Maintain NGT to intermittent suction
B. Assess gag reflex prior to administration of fluids
C. Assess for pain and medicate as ordered
D. Measure abdominal girth every 4 hours

Yesterday’s Mind Teaser: On discharge, the nurse teaches the patient to observe for signs of surgically induced hypothyroidism. The nurse would know that the patient understands the teaching when she states she should notify the MD if she develops:

A. Intolerance to heat
B. Dry skin and fatigue
C. Progressive weight gain
D. Insomnia and excitability

Answer for Yesterday’s Mind Teaser: C. Progressive weight gain

Correct answers received from: Dr Prabha, Dr PC Das, Dr KV Sarma, Dr Pankaj Agarwal, Dr K Raju, Muthumperumal Thirumalpillai, Dr Chandresh Jardosh, Dr Avtar Krishan, Dr Jainendra Upadhyay.

Answer for 3rd August Mind Teaser: C. Keep legs elevated on 2 pillows while sleeping
Correct answers received from: Dr Chandresh Jardosh, Dr Avtar Krishan, Dr Jainendra Upadhyay.

Send your answer to ijcp12@gmail.com

   Laugh a While

(Dr GM Singh)

There is a good news for u. U r going to USA soon. Some scientist will take you there. Because they want to test that how can you live without your brain.

    Medicolegal Update

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

What is the vegetative state?

Complete absence of behavioral evidence for self or environmental awareness

  • There is preserved capacity for spontaneous or stimulus–induced arousal, evidenced by sleep–wake cycles i.e. patients are awake, but have no awareness. This means that the patients appear awake.
  • They have normal heart beat and breathing, and do not require advanced life support to preserve life and cannot produce a purposeful, co–coordinated, voluntary response in a sustained manner, although they may have primitive reflexive responses to light, sound, touch or pain.
  • They cannot understand, communicate, speak, or have emotions and unaware of self and environment and have no interaction with voluntarily control passing of urine or stools. They sleep and awaken. As the centers in the brain controlling the heart and breathing are intact, there is no threat to life, and patients can survive for many years with expert nursing care.
  • The following behaviors may be seen in the vegetative state:
    • Sleep–wake cycles with eyes closed, then opened. Patient breathes on her own; Spontaneous blinking and roving eye movements; Produce sounds but no words; Visual pursuit following an object with her eyes; Grimacing to pain; changing facial expression; Yawning; chewing jaw movements Swallowing of her own spit No purposeful limb movements; arching of back; reflex withdrawal from painful stimuli; brief movements of head or eyes toward sound or movement without apparent localization or fixation; startles with a loud sound.

Almost all of these features consistent with the diagnosis of permanent vegetative state were present during the medical examination of Aruna Shaunbag. Behavior suggestive of a minimally conscious not vegetative state observed during the examination.

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Frequent urination in night: Look for snoring

Frequent urination during night, a condition doctors call nocturia, is common among snorers (men with obstructive sleep apnea) said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India. Nocturia was defined as needing to void two or more times each night.

In obstructive sleep apnea, soft tissues in the back of throat temporarily collapse during sleep causing brief moments in which the patient stops breathing. The disorder can cause daytime sleepiness, and can be effectively treated with a breathing device that pushes air into the throat to prevent the tissues from collapsing called CPAP.

Quoting a Japanese study published in the journal Urology by Dr. Yoji Moriyama, Dr Aggarwal said that nocturia was present in 41% of patients with sleep apnea. The risk of nocturia was directly related to the severity of sleep apnea and the association was particularly strong in patients younger than 50 years of age.

Snorers at risk of sudden death

Dr Aggarwal said that the interrupted nighttime breathing of sleep apnea increases the risk of dying. Sleep apnea is a common problem in which one has pauses in breathing or shallow breaths during sleep.

Studies have linked sleep apnea during snoring to increased risk for death. Most studies were done in sleep centers rather than in the general community. A study published in the edition of Sleep, suggests that the risk is present among all people with obstructive sleep apnea. The study researcher Nathaniel Marshall, from Woolcock Institute of Medical Research in Sydney, said that the size of the increased mortality risk is surprisingly large. The study showed a six fold increase means that having significant sleep apnea at age 40 gives you about the same mortality risk as somebody aged 57 who don’t have sleep apnea.

For the study, Marshall's team collected data on 380 men and women, 40 to 65 years old, who participated in the Busselton Health Study. Among these people, three had severe obstructive sleep apnea, 18 had moderate sleep apnea, and 77 had mild sleep apnea. The remaining 285 people did not suffer from the condition. During 14 years of follow-up, about 33 percent of those with moderate to severe sleep apnea died, compared with 6.5 percent of those with mild sleep apnea and 7.7 percent of those without the condition. For patients with mild sleep apnea, the risk of death was not significant and could not be directly tied to the condition. People who have, or suspect that they have sleep apnea should consult their physicians about diagnosis and treatment options.

Another study by researchers from the University of Wisconsin has also shown that severe sleep apnea was associated with a three-fold increased risk of dying. In addition, for those with moderate to mild sleep apnea, the risk of death was increased 50 percent compared with people without sleep apnea.

    Readers Responses
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    Forthcoming Events
Dr K K Aggarwal

Dr K K Aggarwal

Dr K K Aggarwal


All are cordially invited for the 2nd National Conference of IYCF Chapter of IAP. This conference is organized by: IYCF Chapter, MOH&FW GOI, MOWCD GOI, WHO, UNICEF, IMLEA, SDHE Trust.
The theme of the conference is: "Proper Nutrition: Defeat Malnutrition – Investing in the Future"
Venue: India Habitat Centre, Lodhi Road, New Delhi – 110 003.
Date: 5th Aug 2012
For further details contact:
Conference Secretariat: Dr. Balraj Yadav, E–Mail: drbalraj@ymail.com, drvisheshkumar@gmail.com,
Ph: +91.124.2223836, Mobile: +91.9811108230

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 mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions

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