Immune markers

A Cleveland Clinic study published in JAMA Network Open showed that lymphopenia is associated with death due to heart disease, cancer and respiratory infections, including influenza and pneumonia. The strength of the association increased when it presented in combination with elevated red blood cell distribution width and CRP.

1.     Absolute lymphocyte count is used to quantitate lymphocytes in peripheral blood (rather than the percentage of lymphocytes in the WBC differential count). ALC (cells/microL) = WBC (cells/microL) x percent lymphocytes ÷ 100. Normal values for ALC generally correspond to 1000 to 4000 lymphocytes/microL.

2.      The red cell distribution width (RDW), is an indicator of the degree of variation in RBC size (ie, anisocytosis). RDW has been proposed as a tool to distinguish iron deficiency (elevated RDW) from thalassemia trait (normal RDW) in samples with low MCV.

3.     CRP: <0.3 mg/dL (3 mg/L), is normal

CRP concentrations >1 mg/dL (10 mg/L) as indicating clinically significant inflammation while concentrations between 0.3 and 1 mg/dL (3 and 10 mg/L) indicate what is commonly referred to as low-grade inflammation

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Senseless killing of Japanese doctor condemned by WMA and CMAAO

The World Medical Association and Confederation of Medical Association of Asia and Oceania have condemned as “abhorrent” the killing of a Japanese doctor in Afghanistan.

Dr. Tetsu Nadkamura 73, who had devoted his career to improving the lives of Afghans, was shot by gunmen in an attack in the city of Jalalabad in eastern Afghanistan, later he succumbed to his injuries. His three security guards, his driver and a colleague were also killed in the attack.

Dr. Nakamura, headed a Japanese charity working to improve irrigation in the country. He had spent almost 30 years in Afghanistan and in October this year he was awarded honorary citizenship from the Afghan government for his humanitarian work.

Dr. Nakamura had been in Afghanistan since 1986 helping to construct wells and irrigation in villages where many suffered from cholera and other diseases because of a lack of clean water. In 2003, he won the Ramon Magsaysay Award, widely regarded as the Asian equivalent of the Nobel Prize.

Last month at the 72nd anniversary function of the Japan Medical Association, of which he was a member, Dr. Nakamura was honoured with the Supreme Merit Award for his long term contribution to global health.

WMA President Dr. Miguel Jorge said: ‘I am appalled by this senseless attack on a man who has given his life to working for the betterment of humanity in Afghanistan. Attacks on healthcare personnel around the world are an outrage that must be stopped. Wherever they work, people delivering health care must be respected and protected. The world must speak up to condemn these atrocious acts.’

CMAAO President Dr K K Aggarwal said “all Asian countries are saddened by this act of cruelty. I was present in Japan when he was honoured last month. Attacks on doctors should be condemned jointly by all National Medical Associations and the culprits should be brought to task. ”

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Fight breathing problems due to cold and dry air in winter!

A deep breath of cold winter air can be risky for people with asthma, bronchitis, or COPD. It can trigger wheezing, coughing, and shortness of breath. It can irritate the airways, causing the upper airways to narrow and making it a little harder to breathe even in healthy individuals.

1.    Get your drugs titrated: Work with your doctor in advance to optimize medications for the winter months. Patients with asthma who are sensitive to cold air may be asked to use an inhaler; short-acting bronchodilator

2.    Moist your nose: A dry nose generally feels like a congested nose, which results in mouth breathing. Regular use of a nasal saline spray help decrease the sense of nasal congestion, which will decrease mouth breathing.

3.     Cover your nose and mouth: with a scarf when you're outside. It reduces symptoms by warming the face, warming the air you breathe, and increasing the moisture in the air you breathe

4.     Stay indoors: People with respiratory conditions should avoid spending time in the cold whenever possible

5.    Avoid exercising in cold as it will further increase the dryness of the airways and potentially increase symptoms or the risk of an asthma attack. The need to move your exercise routine indoors during the winter months is a good opportunity to take an exercise class at a gym, start a home workout program, or join a walking club at a local mall.

6.     Adjust the indoor air: Keep the air warm and moist. Don't let the indoor air temperature fall below 64 degree F and use a humidifier to keep the air from becoming too dry.

7.     Avoid lung irritants like wood-burning fireplaces

8.     Take annual flu shot

9.    Complete your pneumonia vaccine protocol

10.  Make sure you do not miss heart symptoms as lung symptoms, as both are common in winter.

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Virtual autopsy will be a reality: An IMA success story

New Delhi: AIIMS Delhi and Indian Council of Medical Research have joined hands to work on a technique for post-mortem without dissecting the body and it is likely to be functional within the next six months, Health Minister Dr Harsh Vardhan said in Rajya Sabha Tuesday. India will be the first country to start “virtual autopsy” in the South-East Asian region.

During my presidential tenure at the Indian Medical Association in 2017, we suggested and asked for virtual autopsy to be included in all post-mortems. We even suggested this to be included in the private sector to find out the unexplained cause of death, in routine cases and in all cases where the relatives are not satisfied with the treatment.

We thank Dr Harsh Vardhan for taking up this issue. Virtual autopsy includes post death whole body CT with or without post death MRI and post death genetics blood tests. I recall having discussed this with Dr Harsh Mahajan to have one CT machine dedicated for postmortems.

The virtual autopsy is cost and time effective as it takes less than 30 minutes to complete one autopsy as against two-and-half hour in normal post-mortem. The ICMR has provided INR 5 crore to AIIMS for this purpose and the process is in an advance stage for getting a CT machine.

Way back in 1979-83, we used to do mini post-mortems in every unexplained case of death in MGIMS Sewagram, that used to take less than five minutes. We used to do brain, heart, lungs, kidney, muscle, spleen and live needle biopsies in such cases.

Click the links below for more information.

http://blogs.kkaggarwal.com/2017/01/in-every-death-give-an-option-for-virtual-autopsy-ima/

https://www.business-standard.com/article/pti-stories/ima-for-virtual-autopsy-to-find-cause-in-unexplained-deaths-117010501159_1.html

https://www.indiatoday.in/pti-feed/story/ima-for-virtual-autopsy-to-find-cause-in-unexplained-deaths-851910-2017-01-05

https://drugtodayonline.tumblr.com/post/155434229723/have-option-for-virtual-autopsy-in-every

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Install AEDS at all public places and in all PCR vans

An automated external defibrillator (AED) must be installed in all public places, such as temples, schools, community centers, transportation hubs, tourist attractions, high schools, universities, assembly sites, leisure areas that attract at least 3,000 people a day, large shopping malls, hotels and hot spring areas.

Based on US and European studies, when someone collapses suddenly, their chance of survival can climb to more than 50 percent if CPR is performed and an AED device is used in time.

The AED, a portable electronic device can analyze the heart’s rhythm and, if necessary, deliver an electrical shock to help the heart re-establish an effective rhythm. Bystanders should not hesitate to perform CPR on people who suddenly collapse, and to try to acquire an AED while calling for help.

Sudden cardiac arrest is a major public health challenge and early defibrillation can improve survival among those with a ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) arrest. Successful early defibrillation using an AED, when appropriate, has been shown to significantly improve survival and survival with intact neurologic function following out-of-hospital cardiac arrest.

Nationwide dissemination of AEDs in public places in Japan from 2005 through 2013 was associated with an increase in the proportion of shocks for witnessed VF arrest administered by laypersons with AEDs from 1.1 to 16.5 percent. As public access defibrillation increased, mean time to shock was reduced (from 3.7 to 2.2 minutes), with a significant improvement in one month survival with favorable neurologic function (38.5 percent compared with 18.2 percent) for those who did not receive public access defibrillation. A 2018 report from Japan also noted increased survival and improved neurological outcomes among school-aged patients receiving public access defibrillation.

Police AED programs may be the solution; police officers can sometimes respond to cardiac arrest victims more quickly than ambulance services.

A program of providing AEDs to police officers and training them in their use was initially introduced in the late 1980s in Rochester, Minnesota. Police often arrived at cardiac arrest victims due to ventricular fibrillation prior to medical help and defibrillated patients an average of 5.5 minutes following collapse. Ten of 14 patients survived to hospital discharge. In a later series of 193 patients, survival from witnessed ventricular fibrillation to hospital discharge was 46 percent. Most were neurologically intact. In contrast, survival from cardiac arrest not caused by ventricular fibrillation was only 5 percent.

Similarly, implementation of police AED programs in Pittsburgh, Pennsylvania, Miami-Dade County, Florida, King County, Washington, and Zurich, Switzerland, has also been associated with greater survival.

Resources:

1.     White RD, Vukov LF, Bugliosi TF. Early defibrillation by police: initial experience with measurement of critical time intervals and patient outcome. Ann Emerg Med 1994; 23:1009.

2.     White RD, Bunch TJ, Hankins DG. Evolution of a community-wide early defibrillation programme experience over 13 years using police/fire personnel and paramedics as responders. Resuscitation 2005; 65:279.

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Ohio bill orders doctors to ‘re-implant ectopic pregnancy’ or face 'abortion murder' charges

I read an article published in the-guardian and got confused how can this US Ohio story or the law be possible. Either the guardian interpretation of the law is wrong, or the law makers have no sense in making a law which can risk the life of a pregnant women with ectopic pregnancy. I think other NNAs should respond.

Recently the Ohio governor, Mike DeWine, signed the ‘heartbeat bill’, one of the nation’s toughest abortion bans, on 11 April 2019. The bill requires doctors to “reimplant an ectopic pregnancy” into a woman’s uterus – a procedure that does not exist in medical science – or face charges of “abortion murder," a procedure that is currently medically impossible.

An ectopic pregnancy is a life-threatening condition, which can kill a woman if the embryonic tissue grows unchecked. In addition to ordering doctors to do the impossible or face criminal charges, House Bill 413 bans abortion outright and defines a fertilized egg as an “unborn child”.

It also appears to punish doctors, women and children as young as 13 with “abortion murder” if they “perform or have an abortion”. This crime is punishable by life in prison. Another new crime, “aggravated abortion murder”, is punishable by death, according to the bill.

Ohio passed a six-week abortion ban last summer. The “heartbeat bill”, as supporters called it, banned abortion before most women knew they are pregnant. 

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

CMAAO condemns criminal provisions in medical practice

 International Press Release: The confederation of Medical Associations of Asia and Oceania strongly condemn the amendments to Poisons Act 1952 in Malaysia and support the Malaysian Medical Association's (MMA) concern in this respect.

CMAAO urges the Malaysia Government to withdraw the proposed Poisons Act 1952 Amendments Bill, which may have been drawn up without meaningful consultations with medical professionals.

 The new amendment proposes possible jail term for private medical doctors, dental surgeons and veterinarians who do not comply with requests for prescriptions by patients. Such severe and harsh penalties should only be for offences that result in severe consequences.

 In every country it is the job of the medical council to handle such ethical issues. They have the power to cancel the license of doctors for unethical acts or practices. The inclusion of a jail sentence is needlessly draconian.

Good medical practice suggests that upon request of a prescription by a patient, it should be given without any hesitance by the doctor. The issue therefore concerns medical ethics rather than a criminal act.

The question is also whether the pharmacist or pharmacy should also be penalized with a jail sentence if they give medicines without a prescription.

Dr KK Aggarwal, President CMAOO said that CMAAO does not support criminalization of any professional group, including pharmacists.

The existing Poisons Act, Medical Act 1971 and the Code of Professional Conduct clearly stipulates the prescription rights of patients upon request.

CMAAO is also concerned about the wide-ranging power granted to enforcement officers, especially as there seems to be virtually no recourse available in the courts against them.

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

High-Protein Diet May not be Safe

(Excerpts from Medscape): Even a high-protein diet, often recommended to lose weight or build muscles can be harmful to normally functioning kidneys as per two separate new studies from the Netherlands and Korea, published online in Nephrology Dialysis Transplantation. Many earlier studies have shown that a high-protein diet may harm kidney function, and this is why doctors recommend kidney patients a low-protein diet. 

The high-protein culture (Atkins, Zone, South Beach, and Ketogenic diets) involve daily protein intake of 20% to 25% or more of the total daily energy intake.  As per the studies one should avoid recommending high-protein intake for weight loss in obese or diabetic patients, or those with prior cardiovascular events, or a solitary kidney if kidney health cannot be adequately protected.

1.   In the Dutch study, Kevin Esmeijer, MD, of Leiden University Medical Center, the Netherlands collected dietary data using a food frequency questionnaire from 4837 patients 60-80 years of age with a history of heart attack involved in the Alpha Omega Trial. At baseline and 41 months follow-up, serum cystatin C (cysC) and serum creatinine were measured from stored blood samples. The mean age of the cohort was 69 years and mean estimated glomerular filtration rate was 82 mL/min/1.73m². Compared with the general population, patients with a history of heart attack have double the rate of annual decline in kidney function and thus are at higher risk for chronic kidney disease. For the entire cohort, mean total protein intake was 71 g/day, of which approximately two thirds was from animal protein and the remaining third from plants.

Analyses indicated that the total amount of protein intake per day was inversely associated with the annual rate of kidney function decline. The annual change in eGFR was doubled in patients with a total daily protein intake in excess of 1.20 g/kg ideal body weight, compared with an intake less than 0.80 g/kg.

Specifically, the annual change in eGFR in those with the highest total daily protein intake was –1.60 mL/min/1.73m² compared with –0.84 mL/min/1.73m² for those with the lowest total daily protein intake.

And for each extra daily intake of animal protein of 0.1 g/kg ideal body weight, there was an additional decline in eGFR_cysC of –0.12 mL/min/1.73m² per year.

Subgroup analyses also indicated that the association between protein intake and decline in eGFR was threefold stronger in patients with diabetes compared to those without diabetes.

2.   In the Korean study, Jong Hyun Jhee, MD, of the Institute of Kidney Disease Research, Yonsei University, Seoul, and colleagues analyzed the effect that a high-protein diet had on renal hyperfiltration and declining kidney function in 9226 participants from the Korean Genome and Epidemiology Study.

Patients were classified into quartiles of daily protein intake as assessed by a food frequency questionnaire. The mean age of study participants was 52 years and the mean follow-up was 11.5 years.

Among the four quartiles of daily protein intake, the prevalence of renal hyperfiltration was significantly higher among those in the highest quartile of protein intake, at 6%, compared with 5.2% among those in the lowest protein intake quartile.

And the annual mean decline in eGFR was again highest, at –2.34 mL/min/1.73m², among those in the highest quartile of daily protein intake, compared with –2.01 mL/min/1.73m² among those in the lowest quartile of protein intake.

Rapid decline in kidney function is defined as a decrease in eGFR of > 3 mL/min/1.73m² per year. They found that those in the highest quartile of protein intake had a 32% greater risk of experiencing a rapid decline of eGFR per year compared with those in the lowest quartile.

They also found that the faster drop in renal function happened only among those with pre-existing hyperfiltration. These findings indicate that a higher intake of protein may be an independent risk factor for renal hyperfiltration that can accelerate deterioration of kidney function.

Comments

The recommended dietary allowance for protein intake is only 0.8 g/kg/day and the requirement for protein is likely even lower, at only about 0.6 g/kg/day, provided adequate essential amino acids are consumed. However, most adults in Western societies eat 1.0 to 1.4 g/kg/day of protein. Protein intake may be as high as 20% to 25% or more of the total energy source they add — considerably higher than the 10% to 15% recommended by most guidelines.

Emerging data across individuals and populations suggest that glomerular hyperfiltration associated with a high-protein diet may lead to a higher risk of de novo CKD or may accelerate progression of pre-existing CKD.

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Bhopal gas victims update

Ahead of the 35^th anniversary of the Bhopal gas tragedy, organizations representing survivors have accused the Indian Council of Medical Research (ICMR) of suppressing a crucial study depicting comparatively higher rate of birth defects in babies of mothers exposed to the methyl isocyanate gas that killed thousands and maimed lakhs in December 1984.

“The documents they obtained from NIREH (National Institute for Research on Environmental Health) show that its parent organization ICMR decided to not publish the results of a study that found that birth defects in babies of gas-exposed mothers was several times higher compared to those of non-exposed mothers.

According to the documents, Dr Ruma Galgalekar, the principal investigator of the study conducted by NIREH, found that 9 per cent of the 1,048 babies born to gas-exposed mothers reported congenital malformations (birth defects), while in 1,247 babies born to unexposed mothers, only 1.3 per cent had congenital malformations. The study, costing little over INR 48 lakh, was carried out from January 2016 to June 2017 following approval by three successive meetings of the Scientific Advisory Committee (SAC) of the ICMR from December 2014 to January 2017.

As per the minutes of the expert group’s meeting on April 4, 2018, (obtained through RTI) the group strongly recommended that, "this data, due to its inherent flaws, should not be put in public domain and shared at any platforms.” According to the four experts, the “inherent flaws” of the study were “various methodological issues, problems of invalidated data and outcome assessment bias”.

At the eighth SAC meeting in October 2018, the members agreed that “as the said project had flaws… the results are erroneous and thus should not be brought in the public domain”.

Our thoughts: Even today the victims can be followed up to know the scientific truth.

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

HCFI Round Table Suggestions for Amendments in Delhi Health Bill.

Date: 02.12.2019

To,

Shri Satyendar Jain

Department of Health and Family Welfare, Delhi Government

9^th Level, A Wing, IP Extension, Delhi Secretariat, Delhi - 110002

Email id: dirdhs@nic.in, pshealth@nic.in

Subject: HCFI Round Table Suggestions for Amendments in Delhi Health Bill.

Dear Sir,

Heart Care Foundation of India Round Table on Health and Wellness: Building Consensus on 21^st November, 2019 passed the following suggestions for amendments in draft Delhi Health Bill:

SR. NO.	EXISITNG PROVISION IN DELHI HEALTH BILL, 2019	SUGGESTIONS OF HCFI ROUND
1.	Section 2: Definitions c) “clinical establishment” means- (i) a hospital, maternity home, nursing home, clinic, sanatorium, wellness clinic, fertility and invitro fertilization centres, hospice, de-addiction centre, medical day care centre treatment including laser or an institution by whatever name called that offers services, facilities requiring prevention, diagnosis, treatment, or care for illness, injury, deformity, abnormality, dental care or pregnancy in any recognized system of medicine established and administered or maintained by any person or body of persons, whether incorporated or not; or…..	The term “hospice” needs to be defined in the bill.
2.	Section 2: Definitions s) "to stabilize (with its grammatical variations and cognate expressions)" means, with respect to an emergency medical condition specified in clause (g), to provide such first aid medical treatment, within the staff, facilities and medical expertise available herein, as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to occur during the stay of an individual in that clinical establishment;	The latter part of the provision i.e. “to assure, within reasonable medical probability, that no material deterioration of the condition is likely to occur during the stay of an individual in that clinical establishment;” be deleted as the same will give rise to numerous multiple litigations against all clinical establishments and doctors in the State.
3.	Section 3(2): Establishment of the Council: The State Council shall consist of- (n) President from the below mentioned Associations on a rotational basis for a period of 1 year; (i) State Indian Medical Association (ii) State Association of AYUSH (iii) State Dental Association	The words “on rotational basis” to be deleted. Presidents of all these associations should be made part of Council every year.
4.	Section 4: Functions of State Council e) conduct medical, clinical and social inspection and audits of the clinical establishments and take necessary action as prescribed;	The words “clinical and social” needs to be omitted as the term “medical” includes everything.
5.	Section 9: Authority for registrations d. One representative, nominated by the State Government, from a registered professional medical association working in the State of the concerned recognized system of medicine being practiced in the clinical establishment seeking registration for a period of three years;	There should be one representative each from DMA/Dental association/ state Ayush association/Lab & Diagnostic  association
6.	Section 11: Registration for clinical establishment (4). Any clinical establishments proposed to be established after the notification of the minimum standards before commencing its functioning shall acquire permanent registration. Where a clinical establishment is offering services in more than one system of medicine, such clinical establishment shall apply for separate provisional or permanent registration for each services of the concerned system of medicine under this Act:	Registration certification should mention scope of services of the registered establishment
7.	Section 12: Condition for registration and continuation 12. For registration and continuation, every clinical establishment shall fulfil the following conditions, namely: (k) shall declare commission or incentives taken or given for patient referral to any individual or institution for any purpose within 24 hrs. of such payment in any form along with reports as may be prescribed	This point needs to be deleted.
8.	Section 14: Application for permanent registration (2) The authority may not conduct any inquiry prior to the grant of permanent registration Provided the authority has reasons to believe that the information being provided is false or incorrect may inspect or cause to be inspected the clinical establishments before grant of permanent registration Provided that all new clinical establishments which apply after the notification of minimum standards would be inspected before grant of permanent registration	The inspection needs to be done by the third party.
9.	Section 14: Application for permanent registration (3) After the clinical establishments submits the application along with the required evidence of having complied with the prescribed minimum standards, the authority shall cause to be displayed of information in the Delhi Government clinical establishment website for a period of thirty days for filing objections, supported with substantive proof, if any, before processing for grant of permanent registration in such manner, as may be prescribed.	The information which will be displayed need to be displayed in a confidential manner.
10.	Section 24: Inspection of registered clinical establishment (1) The registration authority shall have the right to cause an inspection of, or inquiry in respect of any clinical establishment, to be made by such multimember inspection or assessment team as prescribed as it may direct and to cause an inquiry to be made in respect of any other matter connected with the clinical establishment and that establishment shall be entitled to be represented there at with due notice.	The inspection to be done by the third party.
11.	Section 32: Any medical practitioner who knowingly serves in a clinical establishment which is not duly registered under this Act shall be liable to a monetary penalty which may extend to twenty-five thousand rupees	The nurses, paramedical staff, healthcare professionals should also be included.

Kindly consider the above-mentioned suggestions of HCFI Round Table and inform the undersigned any decision taken.

Thanking You,

Yours truly,

  

Dr KK Aggarwal

Recipient of four National Awards (Padma Shri, Vishwa Hindi Samman, Dr B C Roy National Award and National Science Communication Award)

President Heart Care Foundation of India

President – Confederation of Medical Associations of Asia and Oceania

Ira Gupta, Advocate

About HCFI Round Table on Health and Wellness: Building Consensus

The mission of this Round Table is to build consensus on issues of National; importance.

Following are the members of HCFI Round Table:

Name	Designation
Dr. KK Aggarwal	President of Heart Care Foundation of India
Ms. Meenakshi Datta Ghosh	IAS, Former Special Secretary Ministry of Health, GOI
Mr. Bejon Kumar Misra	Consumer Activist
Mr. Anil Khaitan	Former President PHD
Dr N V Kamat	Former DGHS Delhi
Dr KK Kalra	Former CEO NABH
Dr A C Dhariwal	Former Director NCDC
Mr. Amod Kanth	Retired IPS
Dr N K Ganguly	Former ICMR Chief
Dr Narottam Puri	Head of Department, Medical Advisor & Eminent Consultant Fortis Hospital.
Mr Nikhil Rohatgi, Advocate	Supreme Court Lawyer
Dr Ganesh Mani	President IMA New Delhi Branch
Mr R C Juneja	CMD Mankind Pharmaceuticals
Mr Rakesh Mehta	Former Chief Secretary
Mr. Rajiv Nath	President AIMED
Mrs. Balbir Verma	Former Principle Director General Income Tax
Mr. P Sharma	Former Deputy Director DCGI
Dr. Girdhar Gyani	Former CEO NABH
Mr. B R Sikri	Vice President of Bulk Drug Manufacturers Association
Mr. Prafulla D Sheth	Former Vice President of Indian Pharmaceutical Association
Mr R K Srivastava	Former DGHS
Ms. Ira Gupta, Advocate	Legal Advisor HCFI
Mr. Saurabh Aggarwal	Strategic Director HCFI

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA