Family Magazine - Jeewan Mala Hospital

JMH
Family Doctor
A quarterly HEALTH JOURNAL
from one of India’s oldest hospitals
Volume 14
Lasers In Urology: What We Need To Know
July-September 2014
3
Useful Tips To Keep Your Diabetes Under Control4
Obesity and Erectile Dysfunction(ED)/ Impotency5
Imaging in Cervical Cancer – from Screening to Diagnosis6
Normal or Elective Caesarean what is better??7
Important Guidelines for Healthy Living8
News & Events9
JMH
Family Doctor
HEALTH JOURNAL
EDITORS
EDITORIAL BOARD
Dr. Glossy Sabharwal
Dr. Ankush Sabharwal
Dr. Arush Sabharwal
Dr. Anil Raheja
Dr. Latika Bhalla
Dr. Naresh Jaswal
Dr Pankaj Kumar
Dr. Pankaj Walecha
Dr. Prashant Jain
Dr. Shivani Sabharwal
Dr. Sunil Sareen
ADVISORY BOARD
Dr. Ashok Khurana
Dr. Deepak Chawla
Dr. JPS Sawhney
Dr. Malvika Sabharwal
Dr. Randhir Sood
Dr. Vinay Sabharwal
Publication Coordinators
Ms. Preeti
Ms. Sarika
Ms. Khushi
Editorial Correspondence to
Dr. Glossy Sabharwal
Family Doctor
Dept. of Imaging & Radio-Diagnosis
Jeewan Mala Hospital
New Rohtal Road, Karol Bagh
New Delhi-110005
Email: [email protected]
Published by
Printed at
Jeewan Mala Hospital Pvt. Ltd.
New Delhi, India
Gondals Press India Ltd.
New Delhi-110001, India
www.gondalspress.com
1
Dear Friends,
I wish my best to all the readers of family doctor. As
the monsoon season passes by and we enter into the
festive season I wish that all the families joy and good
health. May you spread happiness and warmth amongst
everyone.
I am delighted to present to you the 14th edition of
Jeewan Mala Hospital’s quarterly Health Magazine
“Family Doctor”. Hopefully, through this magazine we
continue to provide you with basic everyday health tips.
I thank everyone once again to have shown interest and
given significance to our small endeavor. Without your
support, this would not have been possible. As always,
we at Jeewan Mala look forward to your comments and
suggestions and are even more motivated to carry on this
task.
Dr. Vinay Sabharwal
Chairman
Jeewan Mala Hospital Pvt. Ltd.
This endeavor is intended not only to showcase all the
happenings at Jeewan Mala but also to continue to
spread awareness of everyday healthy living amongst the
people.
Director’s Desk
We at Jeewan Mala remain committed to give affordable
healthcare while not compromising on quality. Keeping
in mind this spirit and the comfort of the doctor Jeewan
Mala has made some new investments in the department
of chest and respiratory medicine details of which have
been given in the news and events section.
I once again assure you that we remain committed to our
goal of delivering the best quality healthcare at affordable
prices. We are doing everything possible to make Jeewan
Mala a continued success. Through this Magazine we
would ensure that we remain in touch in your daily lives.
I look forward for your continued support and would
not miss this opportunity to thank you for trusting in us
and having faith in our doctors.
Yours truly,
Dr. Vinay Sabharwal
Chairman
Jeewan Mala Hospital Pvt. Ltd.
2
LASERS IN UROLOGY: WHAT WE NEED TO KNOW
Dr. Prashant Jain
Consultant Urologist and Andrologist
MBBS, MS(Gen Surgery), DNB (urology) Nadiad, MNAMS (Genito-urinary surgery)
Advances in lasers and fibreoptics in recent years make them ideally suited to travel through routes in the human body
where no hand or scalpel has gone before. With its widespread use of small-diameter endoscopic instruments, urology
has been drastically and positively influenced by this technology, perhaps more than any other medical subspecialty. Still
the patient’s and the general public’s understanding regarding the correct application of laser is far from perfect, thanks
to the myths and misbelieves prevailing in the society regarding laser, considering it as “jack of all”.
LASER TYPES AND CLINICAL APPLICATIONS :
LASER is a powerful technology which has made its specific place in the urologist’s armamentarium due to its unique
qualities. Still its just one technology amongst many and has specific indications for its use. The general and widespread
myths “that everything is possible through LASER”, and that “LASER is applied without touching/entering in the
body” and: does not need any cut in the body or need to enter in the body” are wrong perceptions.
Lasers used in urology are applied through the endo-urological instruments passed in the body via Natural passages
(eg. Urethra, ureters) to reach the target organ (eg. Urinary bladder, kidney) and destroy the pathology (eg. Stones,
tumors, enlarged prostate etc.).
Depending upon the wavelength and medium specificity in which they work best, Lasers are of mainly of
following types :
1.
2.
3.
4.
5.
CO2 laser
Neodymium:yttrium-aluminium-garnet(Nd:YAG) laser
Potassium-titanyl phosphate (KTP) crystal laser
Diode lasers
Holmium:YAG laser
Holmium:YAG (Ho:YAG) is a more recent addition and the most commonly applied laser in urology currently. This
laser energy is delivered most commonly in a pulsatile manner, using a thermo-mechanical mechanism of action. This is
ideal for the management of all stone types to pulverize and break them. As The absorption depth in tissue is 1–2 mm
in a water-based medium,it is widely used in the prostate surgery (eg. HoLEP, HoLAP,HoLARP) and other soft tissue
cutting surgeries.
Other laser varieties mainly used in prostate and soft tissue surgeries are KTP Green Light Laser and Diode Laser which
are applicable in high risk patients with severe cardiovascular co-morbidities.
SUMMARY OF LASER IN UROLOGY:
1.
2.
3.
4.
5.
6.
A great surgical modality but has its own specific indications
Applied inside the body via endoscopes and LASER fiber
Very safe if used correctly but has severe adverse consequences if applied wrongly
Should be applied only by the surgeons specially trained to use LASER
LASER is not to replace the established modalities of urologic surgery but to join hands to give better result to the
patient and the surgeon
As myths are not to believed unless proved with the facts, so is with LASER !
SUMMARY OF CURRENT CLINICAL APPLICATIONS OF LASER IN UROLOGY :
• For soft tissue incisions (e.g. urethral strictures, posterior urethral valves, endopyelotomy, bladder neck contractures)
• For resection and ablation (e.g. benign prostatic hyperplasia [BPH], bladder tumor, penile carcinoma, bladder
haemangiomata
• For stone lithotripsy (renal pelvis, ureter and bladder stones
• For tissue welding (e.g. vasovasotomy; urethral reconstruction for hypospadias, strictures, diverticula, or fistulas;
pyeloplasty, bladder augmentation, and continent urinary diversion)
Jeewan Mala Health Journal Vol. 14, 2014
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USEFUL TIPS TO KEEP YOUR DIABETES UNDER CONTROL
Dr Rakesh Sharma
MD (MED), FCCP, Chief, Department of Medicine
Dr Vishal Garg
MBBS, MD, Internal Medicine, FAG Consultant Physician
Dr Vipul Mohan
MBBS, MD Internal Medicine
Physical activity
• Exercise promotes cardiovascular fitness and weight loss, lowers high blood pressure, improves lipid profiles, improves
blood sugar control, and leads to an overall sense of well-being. A 30 minute brisk walk does the trick.
Weight loss
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•
•
Moderate weight loss (5% of body weight) can improve insulin action, decrease fasting blood glucose concentrations, and
reduce the need for diabetes medications.
Crash Dieting/ starvation is not a healthy way of losing weight
Aim to lose weight gradually until a healthy BMI is achieved which is between 18.5 and 22.9
Dietary changes
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•
•
•
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Decrease intake of fat and increase intake of protein & dietary fibre
Amount of fibre in the diet can be increased by including wholegrain foods in the diet and consuming more vegetables,
fruits, beans and lentils.
Reduce overall fat intake, and particularly to reduce intake of saturated fat like desi ghee and butter
Grilling and steaming food will cut down on fat intake in comparison
Frequent (5-6 times /day) small meals is health way of losing weight.
Non vegetarian diet may include fish & skinless chicken Stress
• Stress hormones increase blood pressure and surge in blood glucose.
• Constant stress can make blood glucose control very difficult, particularly if an individual is unaware of when they are
getting stressed.
• Yoga is a best stress buster. 20 minutes of Yoga each day would really help
• Stress also increases chances of developing diabetes related complications such as heart disease, stroke, hypertension and
mental health conditions including depression and anxiety
Alcohol & Smoking
•
•
•
Drinking moderate amount of alcohol (up to one serving per day for women, up to two servings per day for men) with
food does not affect blood sugar levels significantly.
People who take oral diabetes medications do not usually need to adjust their medication, as long as the alcohol is
consumed in moderation with food.
Quitting smoking is one of the most important practices that a patient can do to improve their health.
Menstruation and menopause
•
•
Changes in hormone levels the week before and during menstruation can result in significant fluctuations in blood sugar
Hormone changes may result in unpredictable variations in blood sugar levels that complicate diabetes management.
Keep careful track of your blood sugar readings from month to month. You may be able to predict fluctuations related to
your menstrual cycle and adjust your diabetes treatment plan as needed.
4
Obesity and Erectile Dysfunction(ED)/ Impotency
Dr. Vinay Sabharwal
Chief, Laparoscopy and Gen. Surgery
Dr. Arush Sabharwal
Bariatric & Laparoscopic Surgeon
Dr. Nikunj Bansal
Bariatric & Laparoscopic Surgeon
Obesity is a condition that is reaching epidemic proportions in both the developed and the developing world.
‘Metabolic Syndrome’ Includes:
•
•
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Central Obesity (Abdominal obesity, also known as belly fat or clinically as central obesity, is excessive abdominal fat
around the stomach and abdomen ),
High Blood Pressure,
High Triglycerides,
Low HDL (Cholestrol),
Insulin Resistance (Diabetes)
ED has been defined by a consensus panel at the National Institute of Health (NIH) as “ The inability to obtain or maintain
the erection for satisfactory sexual performance”.
Causes of ED: It is more common in people suffering from Metabolic Syndrome. Other Causes of ED are also other obesity
related diseases like:
Hypogonadism (medical term which describes a decreased functional activity of the gonads – the testes and ovaries in males
and females, respectively),
Heart Disease (Often it may be without any Symptoms),
Depression,
Smoking (mostly due to depression from being Obese)
Testosterone (Testosterone is a steroid hormone and plays a key role in the development of male reproductive tissues such
as the testis and prostate as well as promoting secondary sexual characteristics such as increased muscle, bone mass, and the
growth of body hair.) Deficiency etc.
Men with obesity, the metabolic syndrome, and type 2 diabetes have low total and free testosterone and low sex hormone–
binding globulin (SHBG). Conversely, the presence of low testosterone and/or SHBG predicts the development of metabolic
syndrome and type 2 diabetes
Excess body fat makes a man look more curvaceous than cut and, if he’s really unlucky, gives him a lovely pair of manbreasts to admire in the mirror. But that’s not all. Body fat contains aromatase, an enzyme that converts testosterone into
estrogens, the main sex hormones in women. Having extra estrogens floating around your system triggers your body to slow
its production of testosterone. And the less testosterone you make, the more belly fat you accumulate and the more estrogens
you spew. It’s a vicious, emasculating cycle—and not a sorority you want to party with.
Watch that muscle drain, because it also contributes to an age-related metabolic slowdown that can pad your body with a
pound of fat a year. This metabolic remodelling is a change most men never see coming.
Even if you maintain your weight over the years, you could be saying goodbye to what you want to keep (muscle) and hello
to what you don’t need (body fat). That fateful swap could be lowering your testosterone levels even further.
According to Dr. Arush Sabharwal: The good news is: You can reverse the tide and turn on your body’s testosterone spigot by
losing weight, especially belly weight. Kick start your Teststerone production with us at Jeewan Mala Hospital at the lowest
cost in the country, making it a most affordable and patient friendly hospital since 5 generations.
Belly fat, my friend, is a testosterone buster. And it’s secretly turning you into a chick.
“It’s time to LOOSE WEIGHT and Re-Establish your Man Hood”
Jeewan Mala Health Journal Vol. 14, 2014
5
IMAGING IN CERVICAL CANCER – FROM SCREENING TO DIAGNOSIS
Dr. Glossy Sabharwal
Consultant, MD Radio-diagnosis
Dr. Shalini Verma
Consultant, DMRD Radio-diagnosis
Dr. Bimalpreet
Consultant, MD Radio-diagnosis
Cervical cancer is the third most common malignancy affecting the female genital tract in middle age group between 45 and
55 years. Its incidence is increasing rapidly in developing countries like India. In fact it is the no. 1 cancer amongst Indian
women, yet very few are aware of it.
Cervical cancer is a common gynecological malignancy and a frequent cause of death. Human papillomavirus (HPV) is now
recognized as the most important causative agent in cervical carcinogenesis . As many as 5% of cervical cancers may not be
associated with HPV. First intercourse at an early age, sexual promiscuity, high parity, race, and low socioeconomic status are
presently thought to increase the risk for cervical cancer because these factors are linked to sexual behavior that increases the
likelihood of exposure to HPV and/or because they are cofactors that modify the risk in women who are infected with HPV.
Tobacco smoking is also a significant independent risk factor.
However it is largely a preventable disease. There is also a vaccine available for preventing the cervical cancer. According to
the WHO guidelines, the vaccine is intended to be administered before the exposure of HPV. It is best to be given to teenage
girls.
Precancerous lesions slowly progress into advanced cancer.The disease process is almost certainly curable if it is identified
before its spreading into other organs.Patient outcome depends on tumor stage, size, nodal status, and histological grade.
Correct tumor staging is important to decide the treatment strategy. Cancer of the cervix in its early stages is readily managed
with surgery. Radiation or chemoradiation therapies are reserved for high-risk early stages or advanced disease.
•
•
•
•
physical examination
chest radiography
Ultrasonography- Pelvis with transvaginal scan
Cross-sectional imaging (computed tomography [CT] scanning or magnetic resonance imaging [MRI])
In early stage disease with a small tumor confined to the cervix, cross-sectional imaging are not routinely performed because
of their relatively low yield. Magnetic Resonance Imaging is accepted as a preferred imaging modality to assess the prognostic
factors.
Here we present a case of a middle aged female patient who came for routine checkup (seeing the health camp for women
pamphlet in the newspaper) and on screening for uterus and ovaries, incidental finding was a cm large mass in the cervix
which was very painful and showed this appearance on ultrasound scan through the vagina (fig.)
The patient was scheduled for CECT whole abdomen and that further confirmed the ultrasound and revealed that it is stage
1 cervical cancer which means that it has not spread to other organs.
The patient was not willing for an MRI scan so we scheduled her for biopsy which proved the mass in the cervix to be a
cancer.
It not only emphasis the importance of transvaginal scan in the detection of the disease but also the early treatment and cure
of this condition.
We at Jeewan Mala Hospital offer complete comprehensive women imaging which includes•
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Ultrasound scan whole abdomen and pelvis (also 3D-4D pelvis scan, color Doppler study etc)
Mammography- breast
Ultrasound scan breast
CT scan- whole body
DEXA scan for bones
For Further queries please feel free to email us at [email protected]
6
NORMAL OR ELECTIVE CAESAREAN
WHAT IS BETTER??
Dr. Malvika Sabharwal
Chief Gynae Endoscopy & Laparoscopy Surgery
Dr. Shivani Sabharwal
Consultant, Gynae Endoscopy & Laparoscopy Surgery
Dr. Nivedita Mishra
Junior Consultant, Gynae Endoscopy and Laproscopy Surgery
Since the dawn of time, labour and birth through the vaginal passage has been an inevitable consequence of pregnancy. But
in the 21th century, the rate of caesarean (L.S.C.S) has increased. Since caesarean is perceived as a quick, scheduled, painfree,
clean and a modern procedure to suit today’s lifestyle “Maternal request” is the number cause of this increased rate.
After going through medical guidelines let’s compare the advantages and disadvantages of both procedures.
Advantage
Vaginal Delivery
L. S. C. S
Natural way
Scheduled
Feeling of complete motherhood
No risk of pelvic floor injury
Early recovery & short hospital stay
Early feeding
Lower respiratory problem to baby
Disadvantage
Vaginal Delivery (in a small percentage of cases)
L. S. C. S
Risk of perineal tear (3rd-4th fetus)
Delayed contact with baby & delayed feeding
Increased risk of cord compression of fetus,
And hence fetal distress (decreased heart rate of fetus)
Increase admission of newborn in nursery
(Respiratory problems)
Brachial pelvis injury (in difficult delivery) i.e difficulty
to raise arm of baby, It is usually mild & recovers.
Anesthesia Risk-Severe headache, vomiting.
Urinary incontinence (Dribbling of urine)
Wound infection
Prolapse desend of uterus
Bowel movements are delayed
Wound infection
Longer stay in hospital
Numbness/pain at scar site
Chance of post partum depression
More chance of Asthma, Type-I diabetic,
obesity, food allergy, allergic rhinitis in
adulthood
Increased adhesion in next surgery (Surgery
more complicated with increasing number of
scar)
Risk of caesarean though out weighs natural vaginal birth, but in certain situation caesarean it is a life saving option for
both mother & baby. Eg very small/large fetus, extreme prematurity, breech baby, severe hypertension, heart problems,
abnormal shape of mother pelvis, sexually trammitted diseases of mother.
Women should formally have the right to choose to give birth vaginally or L.S.C.S but the clinician should individualize
every women and offer her complete counseling and explain the relative risk of the same.
Jeewan Mala Health Journal Vol. 14, 2014
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Important guidelines for healthy living
Mr. M.L Arya
Financial Advisor
Jeewan Mala Hospital Pvt. Ltd.
There is an old proverb “God helps those who help themselves” We all desire to lead a healthy & disease-free life. My
personal experience is that strong will power, determination & absolute faith in God give us immense strength to overcome
horrible diseases. I was operated upon for Gall Bladder Cancer. Although surgeons were reluctant to operate me at the
age of 78 & warned me of dire consequences, I, however, gave any consent for operation. Ultimately my inner strength
conquered & the operation was successful & now by the grace of god I am free from the dreaded disease.
I extend my gratitude’s to the Director & team of expert Doctors of JMH & other Hospital who imparted unprecedented
treatment & gave me new life. Nothing is impossible in this universe. We have got unlimited inner-power bestowed by the
almighty god. We must explore & utilize the same with a view to achieve our desired goals.
I have further experimented & experienced that disciplined life style is absolutely necessary for maintaining sound health.
Our body is a living machine which has got auto healing system inside the body itself. The root cause of all the diseases
is the deposit of toxic materials inside the body which occur due to polluted environments & unbalanced & adulterated
food etc.
The undernoted few suggestive & preventive measures can go a long way in maintaining a diseased free healthy life:Physical Exercise
Morning walk clubbed with light exercises/yogas/pranayam keep body free from commonly occurring diseases. Fresh air /
sunshine are essential pre-requisites for healthy living. We should inculcate regular habit of getting up early before sunrise,
go out for walk & enjoy nature’s great blessings. Our body will appreciate calm & peaceful atmosphere & will lead us to
the path of healthy & happy living.
Balanced Diet
We should eat only healthy food. Fresh seasonal fruits, green leafy vegetables, sprouts, juice, salad etc contain protective
substances which help to combat many diseases. We should finish our meals at least two hours before sleep. Simultaneously
we should avoid food during the course of anxiety, worry, and fear. Smoking, alcohol, drugs, sweets, spices etc should be
avoided, as far as possible. We should take plenty of water every day. Taking 2-3 glass of water in the morning in empty
stomach helps a lot in flushing out toxic matters from the body & eradicate constipation problem also.
Sound Night Sleep
Constant sleep-less-ness can lead us to memory losses, depression & adversely affect our immune, digestive system. Sound
sleep gives us nourishment & fresh energy. Sleep should not be sacrificed for the sake of late night events. Time management
is essential feature in all the phases of life. Meditation, thought less-ness work as wonderful antidotes in this regard.
Positive Attitude
This will help to face life-set-backs. Accept situations & persons around you as they are. Always live in present. Past is gone,
future is uncertain. Therefore enjoy the present & make your life a pleasant journey throughout.
Avoid Stress
Do not make stress your companion or else be prepared to confront manifold diseases. Adverse situations are bound
to come in life. Face them boldly as a challenge. Hobbies like music, gardening etc are excellent stress reliever. Besides
meditation is another major factor for relieving stress. Social circles like laughing clubs, gymkhana etc boost our body &
mind & thereby manifest peace, health, happiness in life.
To end up, as exercise is food for body, likewise positive thinking is food for mind. As such we ought to be optimistic in life
throughout by putting our unshakable trust in god & at the same time be cautioned about our physical, mental, emotional
health. Integrated approach will tend to enhance tremendous peace, happiness & ever-lasting health.
8
News and Events
Addition of new equipment: Bronchoscope
With the aim of developing the department of chest and respiratory medicine Jeewan Mala hospital added an Olympus
Bronchoscope to its list of latest equipment. Bronchoscopy is a procedure that allows your doctor to look inside your lungs
airways, called the bronchi and bronchioles. The airways carry air from the trachea, or windpipe, to the lungs.
Bronchoscopy can help find the cause of a lung problem. For example, during the procedure, your doctor may see a tumor,
signs of infection, excess mucus in the airways, the site of bleeding, a blockage (such as a piece of food) in your airway
Your doctor also may take samples of mucus or tissue from your lungs to test in a laboratory.
Sometimes doctors use bronchoscopy to treat lung problems. For example, the procedure might be done to insert a stent
in an airway. An airway stent is a small tube that holds the airway open. It might be used if a tumor or other condition
blocks the airway.
In children, bronchoscopy most often is used to remove an object blocking an airway. Sometimes it’s used to find out
what’s causing a cough that has lasted for at least a few weeks.
Now our expert doctors at Jeewan Mala hospital would be able to diagnose even the smallest lesions of the airways of the
lung.
Obesity Camp
The Surgical center for obesity and diabetes control along with Jeewan Mala Hospital organized an obesity camp followed
by a round table obesity support group meeting at Starbucks in Connaught place.
The camp was organized in Jeewan mala hospital in which there were more than 150 registrations. Free Obesity counseling
which included Nutrition advice from expert nutritionist, physician check up and whole body composition were included
in the camp.
At the support group previous patients that had undergone surgical treatment along with prospective surgical candidates
discussed life pre and post operatively. These forums give an opportunity to discuss many issues like diet, exercise etc that
patients face in day-to-day routine post operatively.
Jeewan Mala Health Journal Vol. 14, 2014
9
Services offered at
Jeewan Mala Hospital
Emergency 24 hrs – 4th generation critical care beds
Laparoscpic and General Surgery
24 Hours Laboratory and Diagnostics
Obesity & Bariatric Surgery
CT Scan & Digital X-Ray
Gynae endoscopy and Laparoscopy
3 D & 4D Ultra Sound with colour doppler
Obstetrics
Bone Dexa scan
Pediatrics with neonatology
Mammography
Joint replacement center and Orthopedic Surgery
24 hrs fully equipped ICU Ambulance
Pediatric Surgery
4 generation fully equipped ICU
Cosmetic and Plastic Surgery
Departments-
Neurosurgery
Internal Medicine
Cancer Surgery
Respiratory Medicine
Eye & ENT
Non Invasive Cardiology
Urology
Medical Gastroenterology and endoscopy
Nephrology and 24hr. Dialysis
Neurology
Dermatology
th
Jeewan Mala Hospital
67/1, New Rohtak Road, Karol Bagh
New Delhi- 110005. Ph - 47774141
Fax - 011-47774242, 23670347
E-mail - [email protected]
Jeewan Mala Clinic
E 87 Paschimi Marg, Vasant Vihar
(Next to Vasant Vihar club)
New Delhi – 110057. Ph - 9212526855
Website: www.jmh.in
www.gynaeendoscopy.in
www.scod.in
Jeevan Mala Hospital Doctor Health Journal
Dr. Naresh Jaswal (CEO)
9212200575
JMH Direct Line
Dr. Pankaj Srivastav (Operations Head)
9873978081
Pharmacy011-23672645
Emergency9212200553
ICU9212027954
Gynae & Obs
9212150586/ 9212526855
Surgery (Ms. Pinki)
9212150577
Surgical Centre of obesity and
Diabetes Control (SCOD) (Ms. Pinki)
9873927874
now accredited with NABH
AF
ET
Y & QUAL
IT
Y
O
S
T
011-47774129, 011-47774132
9871233766/ 011-47774121
F
CA
EN
Admission & Reception
Radiology (Mrs. Sarika)
RE
PAT I
General Information
011-47774141
[email protected]
9212167895
NAB H

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