Re: Doctor at J.J.HOSPITAL needs counseling about talking with PLHA

[Guest guest]

Dear FORUM,

Re: /message/9819

It's very sad situation.padmasree awarded doctor dont know how to counsell and

how to treat a patient. As a doctor she can treat any patient either PLHA 'r'

any one. Patient means patient.that doctor knows the cause of infecting what

she\he will do? Minimum common sence they dont have.

Counselling part we need not to ask " why,when,what " .Ithink she dont know the

basic principles of counsellig.

PLHA means he\she not a specimens no they also human being like us. But in thier

body they have HIV virus, we dont have. Every thing they know very well. Why

they are treating like that.

They know thier status they feel shy and stigmatized and they are thinking aout

thier family and community. If my status was revield community can accept? at

that movement health care providers behave like this psychologically they feel

bad and thier life span will decresess.

This is my honurble request to some doctors please treat PLHA like patient.

 

With Regards,

Sudha.Kalangi,

SHIP Positive net work,

Socialworker,

Guntur,

# 9989676699.

e-mail: <kalangi_budigi@...>

[Guest guest]

Dear FORUM,

Re: /message/9819

I do agree that Medical fraternity need proper training and capacity building in

all the feilds of HIV. Only giving medical treatment is not going to control

this pandemic.

When are our doctors  going to understand all the three faces of this pandemic

- HIV epidemic, AIDS epidemic and High Risk Behaviour epidemic? Unless all these

three aspects are tageted and attacked simultaneousely, ultimate goal cannot be

achieved.

Most of the organizations training the doctors concentrate more on the medical

part of the training and the social aspect is neglected.

Further more, in all the doctors' scientific and academic meets, doctors pefer

to withdraw from attending the sessions on HIV - that too in particular if they

are socially based. I strongly feel all the topics included in counsellors

training should be included in the training programmes of doctors.

Further more I have noticed the extreme thinking of some social scientists

mentioning that medical science has no place in controlling HIV epidemic. Let's

keep these egoes aside and work together to achieve the goal of HIV control.

Will NACO sincerely take the cognizance of training the doctors about the social

aspect of HIV/AIDS pandemic and its management?

Dr. Nishikant Shrotri

e-mail: <nishikant@...>

[Guest guest]

Dear All,

Re: /message/9819

Without knowing the exact situation and the exact version of the

doctor and the doctor's statement, one should not pointing the finger

towards a senior doctor, that too who was awarded 'Padmasree' the

title which is awarded after careful scrutinization and a prestigious

one.

Especially a doctor opt for HIV service is mostly dedicated and

service oriented only and that too in a pioneer institution on

HIV/AIDS like JJ Hospital, Mumbai would not have intendly wound any

HIV positive individual unless or otherwise that individual was

irregular or irritating.

Morevoer before AIDS era, we doctors are handling those people had STDs so many

years and decades which were also having same epidemiological situations.

I quite agree that some doctors are not enough competant to tackle or move with

those STD/HIV/AIDS patients. But mostly, many trained for this profession.

The history of high risk behaviour elicitation is also equally

important enough to more about the epidemiolgy of the disease such as

routes of transmission, modes of transmission and its prevalence.

Certain OIs are common with certain type of modes of transmission and

type of practice. For example, Kaposi's Sarcoma is more common with

Intravenous drug users and homosexuals rather than hetrosexuals and

infections transmitted thru blood transfusion.

Ofcourse training in this regards will be of immense use for fresh

doctors to this field.

Some patients also would be more sensitive for such and some questions and they

should also to be informed about the same and to be desensitized.

Thanking you.

Dr S.Murugan

I/C, Peace CCC,

(Former HOD , Dept.of STD, in Govt. Medical Colleges)

CONSULTANT HIV PHYSICIAN,

Shifa Hospitals ,

Tirunelveli Tamilnadu-627002

e-mail: <muruganyes@...>

[Guest guest]

Friends,

Re: /message/9819

The doctor could be forgiven for thinking that 95% of HIV in India is from sex

workers. Most official HIV/AIDS experts spread such confusions.

 

But let's not be so quick to excuse UNAIDS, WHO, foreign donors, and NACO for

spreading the message that most HIV in India is from women in sex work,

clients, and high risk heterosexual behavior. With so many authorities spreading

such stigmatizing messages, of course people are confused!

Anyone who listens to HIV-positive people in India knows: An HIV infection is

not a sign of sexual behavior. It can come from sex, but it can also come from

traces of blood on skin-piercing instruments in dental clinics, medical

injection, tattoos, etc.

 

The virus lives for hours on dry surfaces, and for weeks when it is kept in a

wet place (such as inside a used syringe).

We can see (from India's NFHS3) that 39% of HIV+ married women have HIV-

husbands. Are they all prostitutes, or having extramarital lovers, like so many

official experts would have us believe?

 

It is far past time to challenge and silence experts who spread their

stigmatizing sexual fantasies. Ask them to tell the truth --that they do not

have evidence to show that almost all HIV comes from sex. On the other hand,

they do have evidence to show that health care infects many patients, but they

are silent about that.

Why? Is there a conflict of interest? Would medical experts prefer to stigmatize

(blame) HIV+ wives and/or husbands for bringing HIV into the home through sex

rather than to take responsibility for medical errors and carelessness that

infect patients with HIV?

Best regards,

Gisselquist

e-mail: <david_gisselquist@...>

[Guest guest]

Friends,

Dr Saag tells AIDS-India readers that HIV survives less than an hour in dry

conditions, and not more than several hours in wet conditions.

The published record of peer reviewed research rebuts his views. How long does

HIV survive on blades, in syringes, etc? This is a life and death question. A

wrong answer misleads people to accept deathly risks, and feeds stigma.

Dr Saag also seems to confuse the very real and dangerous risk to contract HIV

from blood-to-blood contact on contaminated skin-piercing instruments with the

virtually non-existent risk to contract HIV through sharing bathrooms, etc.

Casual contact is safe. Blood-to-blood contact is very dangerous.

Here's the evidence Dr Saag presents to support his misleading message:

Work done by Markham, Salahuddin, Papovik, and others in

Gallo¹s lab in 1984-85 evaluated the survival of HIV on surfaces ...wet and dry.

Dried fluid had very short times before the virus lost its ability to be

cultured (less than an hour, I recall)...while wet surfaces could sustain

culturability for a few hours.

Please note, Dr Saag does not cite any journal article. These results -- from

his memory -- have not been published in peer-reviewed medical journals. What

really happened? We don't know.

But we do know the results of many other experiments which have been reported in

peer-reviewed medical journals. These results uniformly show that HIV lives dry

for hours, and wet for weeks.

Here are some details with references, and I attach some references as well.

Kramer et al. recently reviewed the survival of nosocomial pathogens on

surfaces. They report that HIV can survive longer than one week.

Since they published their review in an open access journal, I attach the

article, (Attached file is removed. Editor) You can also get it from this web

link: http://www.biomedcentral.com/bmcinfectdis/mostviewed/

(Reference: Kramer et al, How long do nosocomial pathogens persist on inanimate

surfaces? A systematic review. BMC Infect Dis 2006; 6: 130.)

In an experiment reported in 1994, Van Bueren and colleagues placed solutions of

cell-free HIV on glass slides. After drying, which took about 2.5 hours, at

least 10% of the HIV remained viable. Once it was dry, the amount of viable HIV

that survived fell at the rate of 90% per 5 days (ie, to 10% in 5 days, to 1% in

10 days, etc). (Reference: van Bueren J et al. Survival of human

immunodeficiency virus in suspension and dried onto surfaces. J Clin

Microbiology 1994; 32: 571-574.)

See also: Terpstra FG, et al. Resistance of surface-dried virus to common

disinfection procedures. J Hosp Infect 2007; 66: 332-338.

Summary It is believed that surface-dried viruses can remain infectious and may

therefore pose a threat to public health. To help address this issue, we studied

0.1 N NaOH and 0.1% hypochlorite for their capacity to inactivate surface-dried

lipid-enveloped (LE) [human immunodeficiency virus (HIV), bovine viral diarrhoea

virus (BVDV) and pseudorabies virus (PRV)] and non-lipid-enveloped [NLE; canine

parvovirus (CPV) and hepatitis A virus (HAV)] viruses in a background of either

plasma or culturemedium. In addition, 80% ethanol was tested on surface-dried LE

viruses. Without treatment, surface-dried LE viruses remained infectious for at

least one week and NLE viruses for more than one month.

Irrespective of the disinfectant, inactivation decreased for viruses dried in

plasma, which is more representative of viral contaminated blood than virus in

culture medium.

This is the first comprehensive study of five important (model) viruses in a

surface-dried state showing persistence of infectivity, resistance to three

commonly used disinfectants and restoration of susceptibility after rehydration.

Our results may have implications

for hygiene measurements in the prevention of virus transmission.

HIV's survival in wet conditions is also well-studied, and well-reported in

medical journals. Research published in 1999 reported that infectious HIV could

be recovered after more than 4 weeks from 2-20 microliters of blood in syringes

and needles stored at room temperature. Here's the reference with abstract:

Abdala et al. Survival of HIV-1 in syringes, J Acquir Immune Defic Syndr 1999;

20: 73-80.

Abstract Summary: We performed a study to determine the duration of survival of

HIV-1 in syringes typically used by injectors of illicit drugs (IDUs). We

describe the effectiveness of a microculture assay in detecting viable virus in

volumes of blood typical of those commonly found inside used syringes. Using

this assay and modeling the worse-case situation for syringe sharing, we have

recovered viable, proliferating HIV-1 from syringes that have been maintained at

room temperature for periods in excess of 4 weeks. The percentage of syringes

with viable virus varied with the volume of residual blood and the titer of

HIV-1 in the blood. These experiments provide a scientific basis for needle

exchange schemes, harm reduction, and other interventions among IDUs that

support the nonsharing and removal of used syringes from circulation.

I also attach an abstract by Heimer with information on HIV survival wet and

dry.(Sorry, the attached files are removed. Editor)

I hope this will help to bring some clarity. HIV survives hours dry and weeks

wet -- that's a CONSERVATIVE statement. There is a lot of evidence from

scientific experiments reported in peer-reviewed journals, but so many, many

people simply ignore it or don't know it.

Best regards,

Gisselquist

e-mail: <david_gisselquist@...

[Guest guest]

Friends,

Re: /message/9819

Commenting without knowing the exact version is foolish, silly and not

worthy. Having said that I still feel majority of medical community

behaves still in a way it should not. We forget our father of nations

words " hate the disease and not the sufferer " .

I think we all should be more sensitive and humane in dealing with all

ailments and HIV is no exception.

Re chanting this mantra always and repeatedly is the only way of

success for medical fraternity

Hopefully better sense will keep prevailing

--

Dr. Rakesh Bharti MD,AAHIVS,

BDC Research center,

27-D,Sant Avenue,The Mall,Amritsar.

Punjab,INDIA143001.

TEl-91-183-2277822;91-183-2278522

e-mail: <rakesh.bharti1@...>

[Guest guest]

Dear FORUM,

Re: /message/9819

I am not surprised by the inconsiderate approach of JJ Hospital Doctor. Many

PLHIV take such behavior as " common thing " .

Unfortunately even the most prestigious " Padmashree " award failed to infuse

sensitiveness in this JJ doctor, to carry out his /her duties as doctor/care

giver.

However I know many wonderful doctors and health workers who are working

diligently and brining solace to the many PLHIV and serving happily. Anyway I

still like to hope and believe that things will change for the better.

However, through this incidence we all got the message that if the doctors from

Mumbai can ask such distressing questions to PLHIV on 2nd line then one can

imagine the situation in the smaller towns and rural areas.

And finally it is also suggestive of that lot is not done yet.

 

Samir Shinde

Nagpur

www.accept-india.org

e-mail: <samir_71@...>

[Guest guest]

Dear Forum members,

Re: /message/9831

This is in regards to Dr 's response with doctor at JJ Hospital.

As far as our country is concerned , more than 85% of HIV cases are

transmitted thru sexual routes.

The other modes of transmission can easily be addressed to anybody and also can

be tackled with measures like laws and rules on blood safety, uniterrupted

supply of disposable syringes and needles for hospitals and drug abusers.

PPTC programmes and educating health personnels about universal work

precautions and their supply are all possibe with our effotrs and

money power.

But sexual needs and attitudes are not able to be freely discussed and able to

be followed in our country as it is related with our culture and it is a deicate

subject and also it is linked

with human natural instinct.

Because of these reasons HIV/AIDS is give top priority and only education,

awareness and BCC activities (safe sex practices,we can overcome the HIV/AIDS

menace from our country.

So please try to understand the importace of sexual transmission of

HIV/AIDS.

LET US JOIN HANDS and HAVE A CONTROL OVER THE EPIDEMIC.

Dr S.Murugan

former HOD, Dept of STD , CONSULTANT HIV and SExual Medicine,

Tirunelveli

e-mail: <muruganyes@...>

[Guest guest]

Dear FORUM,

Re: /message/9831

It is unfortunate that we so readily believe the 'data' that 85% of

people living with HIV in India have got their infections through sexual routes.

This data has been arrived at through methods which are flawed,

inadequate and completely subjective - based on moral judgements and

preconceived notions about the epidemic in our country. In fact, some

routes of unsafe health care transmission are not even considered when

collecting data on HIV transmission routes.

For a more detailed critique on the surveillance systems based on which this

data is generated, please look at:

http://www.hivaidsonline.in/index.php/Debates/transmission-is-it-just-about-sex-\

and-drugs.html

Doesn't it seem strange that in our country where it is well known that much of

health care is unsafe, our surveillance systems do not address this issue (apart

from blood transfusion safety) when looking at how HIV is spread in the country?

A 2005 nation-wide AIIMS study showed that around 23% of medical

injections were a risk for transmission of bloodborne infections. WHO

estimated that unsterile medical injections accounted for 24% of HIV

transmission in India in their global study in 2000. These are just some of the

evidences that much of HIV is coming from routes other than sexual. When are we

going to take some of these studies seriously? What can we do to address these

'other' routes of transmission?

Regards,

Mariette

--

Mariette Correa

1016, Muddo

P.O. Carona

Bardez, Goa - 403523

India

Tel: 91-832-2293766

Mobile: 9423889397

email: mariettec@...

[Guest guest]

Dear Forum

Re: /message/9831

 

History taking is an art and it needs to be learnt. The curriculum that trains

doctor is very clinically oriented and focus on non -clinical  aspect like

communication skill is  not stressed during the internship or even in the post

graduate  training period in medical colleges.

 

Secondly,  whether  getting Padmashree is a matter of  appropriate connection 

or performance is case specific. So someone getting  Padamshree award cannnot be

flawless person. Every human being is subject to error.

 

Thirdly HIV transmission  chances can be reduced  not by Government but by

people by using their power to say " NO " .

If we are all so intelligent and know that major rout of transmission is Sexual

then be little more  generous and say " NO " to multipartner sex. Demand

faithfulness in relationship  by developing your self esteem. Make sexual

expression as an integral part of permanent relationship rather than

self-expression by saying " NO " .

Globally the role of training is  recognised and ther fore a lot of money is

spent on training Doctors and other health care provider.

Round 4 under GFATM is all about training  people in Access to Care and

Treatment.

 

 

Minal Mehta

State coordinator

Round 4 GFATM ACT

Engender Healtath Society

e-mail: <meenalmehta@...>

[Guest guest]

Dear Forum,

Re: /message/9819

I do agree with many respondents in this discussion that health care

providers including need to be sensitized on PLHIV and vulnerable

communities issues. Evidences from many community based studies

suggest this action. I think policy makers and program managers need

to consider this seriously and put in to action for providing better

non-discriminatory services to the community for which we work.

This incident recalls my bitter experience as a male sex worker that I

had with a STI physician. I do not want to justify why I opt sex

work?. I do this work because I just love it. Immoral Trafficking

Prevention Act (ITPA) says sex work is immoral but not illegal. Right

to choose my occupation is my basic rights as well. We know very well

that, right based approach is a guiding principle of NACP III. Let us

respect the rights of the community.

Thanks,

D. Dinesh Kumar

(Community Consultant)

e-mail: <ethics.justice@...>

[Guest guest]

Dear Forum Members,

Re: /message/9832

 

This is in regards to Dr Murugan's assertion that more than 85% of HIV

infections in India come from sex. That is a stigmatizing statistic; it pins HIV

to sex, and sex to HIV.

Because of such statistics which have been repeated for years, if you have HIV,

your spouse, in-laws, friends, and neighbors blame you for sexual misconduct (if

they know you are infected). So does NACO, your doctor, your HIV counsellor,

foreign-funded HIV prevention programs, and most NGOs.

Are more than 85% of India's HIV infections from sex? Look at evidence from

NFHS3, available at:

http://www.nfhsindia.org/chapters.html

(a) HIV prevalence in virgin adults was 0.09%, almost 1/3 as high as in all

adults (table 12.5)

( Only 2% of men reported paying for sex in the last year, and these men

accounted for only 4% of HIV among men (table 12.6)

© Almost 100% of women and 98% of men reported 0-1 sexual partners in the past

year; these adults had 98% of the HIV infections; on the other hand, adults who

reported more than 1 sexual partner in the past year had only 2% of all HIV

infections in adults (table 12.6)

(d) For married women who are HIV-positive, 39% of their husbands are

HIV-negative (table 12.10).

Now you might say people lie about their sexual behavior. That happens. But

consider this: We have to work with the evidence we have. If you reject

evidence, and basically sit under a tree and make up evidence that fits your

views, that's not very scientific, is it?

Moreover, asserting that HIV-positive people lie about sexual behavior doubly

stigmatizes HIV-positive people. They have unwise sex -- and they are liars.

If an HIV-positive wife says she had no outside partners, should we encourage

her husband and inlaws to assume that she lied? The assertion that more than 85%

of India's HIV infections are from sex is based on disbelieving people who have

AIDS.

It is based, in other words, on lack of respect for (stigma against) people with

HIV.

If we are against stigma, then put it into practice. Proclaim that an HIV

infection is not a reliable indicator of sexual contact. Ensure that people hear

repeatedly and specifically -- with personal stories -- about non-sexual risks.

There are many children in India who are HIV-positive with HIV-negative mothers,

and who have not had transfusions. The AIDS industry ignores them. No aid, no

investigations to find out where it came from, no spreading their stories so

that others hear that its not all sex.

There are similarly many men and women with HIV but without sexual risks. Again,

the AIDS community rejects them. Counsellors accuse them of denialism. They are

victims once for having been infected by health care workers, and victims twice

by being accused of lying about their sexual behavior by AIDS experts.

Only a few percent of Indians die from being hit by a car. We don't find it

necessary to say that cars kill more than 85% of Indians in order to encourage

people to look before crossing a road. Similarly, to warn people to avoid HIV

from heterosexual partners, it is not necessary to say that sex accounts for

more than 85% of HIV in India.

It is enough to say that heterosexual transmission one of several important

risks.

 

Dr Murugan asserts that stopping nosocomial transmission is easy. Is it? It's

easy to tell doctors and nurses to  " be safe, " but that's not enough. No one in

India has done what is required to ensure that is so -- no one has investigated

unexplained infections to see if they are part of large nosocomial HIV outbreaks

as in Kazakhstan (140 infections through 3 hospitals in 2006), Libya (over 400

infections through 1 hospital in 1995-99), etc.

Why does no one investigate? Why do health experts keep their heads in the sand

on this issue?

Finally, can we stop repeating the claim that it's hard to talk about sex and

HIV? Does anyone really believe that? Sex and HIV is everywhere -- on TV, on

billboards, etc.

There is public ignorance and expert silence about nosocomial HIV, but not

about sex and HIV.

Best regards,

Gisselquist

e-mail: <david_gisselquist@...>

[Guest guest]

Dear All,

 

The infectivity of HIV through infected needles is not very high.

All the available data generated through myriad studies corroborates about the

sexual route as the predominant route of transmission of HIV.

 

Hepatitis B and C are much more transmissible  through pricks by infected

needles vis-a-vis HIV.

Howevver that should never connote that we do not have to sustain our continued

efforts for all the infection control measures (including proper bio-medical

waste management) and prevention and management of needle stick injuries through

Post Exposure Prophylaxix of HIV using anti-retroviral drugs.

 

Best wishes for a sustained collective action for all the

prevention,care,support and treatment activities,

 

Yours truly,

Dr.Rajesh Gopal.

Dr. Rajesh  Gopal,MD

Joint  Director,

Gujarat  State  AIDS  Control  Society (GSACS),

O/1 Block, New  Mental Hospital  Complex,

Meghaninagar,Ahmedabad, Gujarat.

PIN 380016 Phone (O) 079-22680211--12--13,22685210 Fax 079-22680214

e-mail: <dr_rajeshg@...>

[Guest guest]

Dear Forum,

Re: /message/9852

This is in response to Meenal Mehta's reply about safety concerns in

sex work. I do agree with him that the rights of individuals should

not damage others safety. Even for me, safety comes first then rights.

But, it is important to consider or explore the alternative

explanations before jumping in to any conclusion.

Practicing safe sex is the responsibility of both sex workers and

clients as well. There are some sex workers living with HIV knowingly

practice unsafe sex. Also, there are some tough clients force sex

workers to practice unsafe sex by offering more money. And, many sex

workers living with HIV are being raped by ruffians and local goons.

Additionally, many studies proved the influence of alcohol in

practicing unsafe sex. Thus, sex workers alone donot necessarily

accountable for safety concerns in flesh trade.

Positive prevention is important for all people living with HIV

whether they are sex worker or not. More often both individual level

and structural or contextual factors breach positive prevention.

Let us not pass the bug on sex workers or similarly marginalized groups alone

for spreading HIV and stigmatize them further.

D. Dinesh Kumar

e-mail: <ethics.justice@...>

[Guest guest]

Re: /message/9856

Dear Dr Gopal,

 

I'd like to follow up on your assertion that " all the available data generated

through myriad studies corroborates about the sexual route as the predominant

route of transmission of HIV. "

 

Please provide data from 2-3 studies among the general population in India which

shows that most HIV is from sex. I don't think you can find even one such study.

 

What about the rest? Disposing biomedical waste and post exposure prophylaxis

for health care workers after needlestick accidents is far from all that is

required.

 

What about investigating unexplained infections? What about warning the

public about HIV from blood exposures, and teaching the public how to ensure

that skin-piercing instruments are safe?

 

Best regards,

Gisselquist

E-MAIL: <david_gisselquist@...>

[Guest guest]

Re: /message/9862

Dear Mr.,

 

Thanks for your message.

 

With more than 99% of the general population not being infected ,the source of

data would be from the sentinel sites,health care delivery settings,reported

needle stick injuries,behavioural mappings,behavioural annd biological

assessments,data from ICTCs,ART centres,link ART centres, network of positive

people and what have you.

All the reports of the country specific and state specific studies are in public

domain and obviously there is no dearth of the same.

 

Incidentally it is the practice of use of shared needles in injecting drug

use(abuse) rather than the allegedly infected neddles in clinical practice which

,for obvious reasons ,is responsible for the transmission of HIV through that

route.

 

Sexual route, as a matter of fact ,is the weakest route of transmission

contributing effectively in transmission in a proportion from 0.1% to

1%(assumedly in the spectrum varying from unprotected vaginal to unptrotected

anal route).

Infected blood is the most potent route of transmission because of the quantity

transmitted with the infective load of viruses given in one unit of bloood

transfused to a recipient.Inspite of the efficacy of near 100% of this route of

transmission ,the overall contribution now is less than 2% as very few people in

the general population are transfused blood in a frequency which is not

comparable to the frequency of sexual encounters of the individual adult person.

It is definitely not to undermine the importance of the need for effective

biomedical waste management and robust and strringent infection control measures

in all the settings as they are a significant deterrants of different infections

especially HBV and HCV.All efforts must be strengthened on a topmost priority

for the same. 

The number of viral/infectious units and the transmissibilty of infection are

the main determinanats of the potential infection by a pathogen.Mere presence of

a few viral units in saliva cannot let us conclude about infectivity through

exchange of oral fluids as the amount of saliva needed for such a transmission

would be in litres.

Any digression with emphasis being shifted to cuts by barbers,'possibility' of

acquisition by tattooing may reduce the concerted collective focus with a shared

vision of making every sexual encounter safe.

This is definitely not, deliberately or inadvertently' to stigmatize the HIV

epidemic or the PLHIV with any undue emphasis on sexual route of transmission.

Condom is and must remain our most effective weapon in the entire armamentarium

of the right type of information which must include 'the social vaccine' of

cutting down all the other three routes of transmission also.

Kindly pardon me for being too didactic or simplistic.The entire extant

evidence establishes that we need to continue our sustained endeavours for the

containment of the pandemic.

Yours in camaraderie,

Rajesh Gopal.

Dr. Rajesh  Gopal,MD

Joint  Director,

Gujarat  State  AIDS  Control  Society (GSACS),

O/1 Block, New  Mental Hospital  Complex,

Meghaninagar,Ahmedabad, Gujarat.

PIN 380016 Phone (O) 079-22680211--12--13,22685210 Fax 079-22680214

e-mail: <dr_rajeshg (DOT) com>