Constituent of SBKS Medical Institute & Research Centre

DHIRAJ NEWS LETTER

Issue - 3, Nov., 2010
Qtly - S/N03/2010
Motto : Excellence in Service Education & Research
DHIRAJ HOSPITAL
Dr. (Col) S.S. Dhaliwal
(Director)
Dr. (Col) Rakesh Anand
(Medical Superintendent)
Dr. Varsha Shah
(Dept. of Pediatrics)
Dr. Vicky Ajwani (Surgery)
Dr. Arti Muley (Medicine)
Dr. Shridevi Patel (Radiology)
Dr. Prasad Muley (Paed)
Dr. Niraj Pandit
(Community Medicine)
Editorial Board
EDITOR IN CHIEF
CO-EDITOR
EDITORIAL TEAM
OUTREACH SERVICES
HIGHLIGHTS OF THIS ISSUE
1. Celebration of Breast feeding week from 1st to 7th Aug 2010. and
made it a success.
2. State level Nursing conference on EVIDENCE BASED NURSING was
held from 4th Oct to 06th Oct 2010, more than 500 delegates
attended and was a great success.
3. Establishment of digital colposcopy clinic
4. Blood donation camp and CME on Blood component banking was held on
01st Oct 2010. Students and faculty participated with full
commitment.
5. Navratri & Garba celebration.
From the editors desk..
Dear Friends,
In the midst of this festival season which began with Navratri followed by Dussehra and
Diwali which will culminate into Christmas and New Year we are once again with you with
the present issue of Dhiraj News Letter. On behalf of the entire
We must share our pleasure in receiving feedback on previous issues. Some of the readers
have highly appreciated the case gallery with its academic content. We always make an
endeavor to share usable medical information from this institution and interact fruitfully.
At Dhiraj Hospital, as always we have been busy providing OPD and IPD quality care to the
patients while making serious attempt to expand our services. The mega camp has
benefitted patients from the region in large numbers and on the public demand the
management has benevolently continued the effort.
In the field of Blood banking, our centre has expanded into providing blood components for
our valued clientele. This has enabled various dependent specialties to expand the field of
medical care.
SUMANDEEP PARIWAR
WE WISH YOU A PEACEFUL AND PROSPEROUS NEW YEAR
to all the members of the fraternity. . May the new year bring your way bright sparkles
of joy , peace , prosperity, good health , that stay with you through the days ahead.
Dhiraj News...
While most people dream of success ,those who succeed wake up & work for it.
STATE LEVEL NURSING CONFERENCE
Evidence based Nursing Education System
towards future challenges
A major conference on
was held on 04th & 05th Oct 2010. Guest of
Honour were Chancellor Dr. Mansukhbhai Shah, Pro chancellor Dr.
Dixit Shah & Vice Chancellor Dr. Jayashree Mehta. The Chief Guest
Prof. Anandiben, Principal of Civil Hospital College of Nursing,
Ahmedabad graced the occasion by her presence.
It was attended by eminent faculty members and more than 500
delegates from other institutes. CME and Workshops were held and
interactive session were conducted. This academic event was highly
appreciated for its content and conduct.
DIGITAL COLPOSCOPY CLINIC
Digital Colposcopy clinic has been established in the Gynec OPD of
Dhiraj Hospital. A state of art equipment from BORZE has been
procured and put into function. This facility has enhanced the female
genital cancer screening effort. In abnormal cytologies colposcopic
directed biopsies have helped in early and successful detection of
malignancies.
BLOOD DONATION CAMP AND CME ON BLOOD COMPONENTS
Under the dynamic leadership of our Director Dr. (Col) S S Dhaliwal
and cooperation of students and faculty, a blood donation camp was
held on 1st Oct 2010. The donors were issued certificates of
recognition and participant of CME benefitted from academic
interaction. This occasion was also important because our Director
inaugurated the brand new seminar hall equipped with most modern
teaching aids.
NAVARATRI CELEBRATION
Navaratri has been celebrated with festivities and fervor all over Gujarat. In
Vadodara, various Groups held Dandiya and Garba dances. At Sumandeep
Campus, the students and the staff held their own celebrations through the
navaratri. After dinner, Garbas and singing session were held in Hostel and
campus premises. It was very enjoyable to see the young crowd mixing up for
the happy moments. These celebrations will complete by a major get together
at the campus on Sharad Purnima.
Academic activities and Faculty achievements
Knowledge is not to dissect your past but to construct your future
4. On the Occasion of World Suicide prevention day on 10th Sep 2010, an awareness campaign was
held at Sumandeep Vidyapeeth. A poster competition was conducted and a topic
Was adopted as theme of the
year.
i. Case Report of Pitutary macroadenoma presenting with superior orbital fissure syndrome
by
ii. Head & Neck Surgery at Dhiraj Hospital, a study of 128 cases
iii. Basics of RNTCP
iv. Lumber Canal Stenosis our experience at Dhitaj Hospital
v. Evaluation of Joint Replacement surgeries at Dhiraj Hospital
and , Dept
of Medicine, participated in the international conference of
th th th
at S.S.G. Hospital on 8 , 9 and 10 Oct, 2010. The conference was attended by
well-known clinicians and academicians from across the globe including U.S., Canada, Australia,
S. Africa. They also presented a free poster on Sickle cell anemia cases in Emergency-Room.
Associate Professor of ENT Department Paper title
has been accepted in International
Journal of Case Reports and Images.
is elected as for 2011-12 for Indian
Society of Anesthesiology.
MANY FACES,
MANY PLACES: SUICIDE PREVENTION ACROSS THE WORLD .
MONTHLY CLINICAL MEETING
Dr. Tapan Nagpal
Dr. Tapan Nagpal
Dr. Mayur Adalja
Dr. Paresh Golwala
Dr. Prakash Parekh
We are proud of
1. Dr. J.D. Lakhani (Prof & Head) , Dr. Arti Muley (Asst Prof) Dr. Maulik Parekh (R-2)
Indo - US Emergency Medicine
Summit
2. Dr. Tapan Nagpal, Pituitary
Macroadenoma with Superior Orbital Fissure Syndrome
3. Dr. M.H. Parmar of Anesthesia Department President
1. Dyslipidemias and Hypertension
(Basic & Advanced)
(31/07/2010)
2. Corneal surface diseases
(18/09/2010)
Dr. J.C. Mohan
Dr. Paras Mehta
MD, DM MNAMS
Professor of Cardiology, New Delhi,
delivered masterly talks on the sub
jects. He also interacted with the
residents and the faculty in the form
of workshop. The content of the
interaction is very educative.
Eminent Corneal Transtlant
Surgeon from Vadodara delivered talk on this
subject in a very detailed manner.
The interactive session was very enlightening
for the attending faculty & students.
-Cipla foundation held an interdepartment
seminar on ASTHMA involving Pediatric,
medicine & pulmonary medicine department.
The speakers brought out the recent advances
in management of ASTHMA into focus.
3. An interdepartmental seminar
CME, Lectures and Workshops
Dhiraj Case Gallery...
The young physician starts life with 20 drugs for each disease , and the old physician uses one drug for 20 diseasesWilliam Osler
Patient was treated with Pulse therapy of I/V methyl prednisolone 1gm for 3
days. She was given 3 units of whole blood, analgesics and other supportive
therapy. Patient improved significantly with treatment and was discharged on
high dose oral steroids with other supportive treatment.
Hemolytic anemia is a rare presentation of SLE. Only around 10% of SLE
patients present with hemolytic anemia. It can be rapid in onset and severe,
requiring high dose of glucocorticoid therapy, as with our patient.
DEPARTMENT OF MEDICINE
Dr. Hetal Pandya, Dr. Arti Muley, Dr. Preeti Kaushik
Severe Hemolytic anemia a rare presentation of Systemic Lupus Erythematosus
A 24 years old female patient was admitted with chief complaints of severe generalized weakness, myalgia
and arthralgia involving major joints. She had past history of similar complaints in mild form with history of
weight loss, loss of hair, generalized abdominal pain, amenorrhea since 6 months. H/O 1 episode of jaundice
with blood transfusion was present
Physical examination revealed pulse 92/min, BP 108/70mmHg, severe pallor & bilateral cervical
lymphadenopathy .Systemic examination was unremarkable. No signs of local inflammation were seen. Her
Hb was 3.4gm%, TC 9600, DC P-72, L-20, M-2, E-1, ESR 60,platelet count 2.43 lacs/cub.mm,
peripheral smear - microcytic normocytic anemia, retic count 2.8%, S.bilirubin total 1.7, Direct - 1.3,
Indirect 0.6, SGPT 56, S. Creatinine 0.9, USG Abdomen Mild hepato-splenomegaly with few para-
aortic lymph nodes. Cervical lymph node FNAC showed chronic inflammation. Her ANA test was strongly
positive. dsDNA, anti-Sm and anti-Ro antibodies were strongly positive suggestive of diagnosis of Systemic
lupus erythematosus.
DEPARTMENT OF OBSTERICS & GYNAECOLOGY
Dr. (Col) Rakesh Anand, Dr. Rozy Ahya, Dr. Dushyant Naik
CASE OF CONCURRENT MULTIPLE GYNECOLOGICAL MALIGNANCIES
Investigations:
An extremely emaciated and severely anaemic patient aged 35 years and Para
2+0 was admitted in with bleeding per vaginum since 8 months progressively
increasing abdominal distention and weakness.
Patient had severe pallor, oedema and ascites with abdominopelvic lump up to
umbilicus ( 24 weeks size). Mobility of the mass was not restricted. Uterus was
parous size with persistant small blood discharge.
Hb 2.8 gm%, Total count 3200/cumm, Peripheral smear severe hypochromic,
microcytic, anisopoikilocytosis, target cells & tear drop cells +, few ovalocytes &
macroovalocytes, leucopenia, thrombocytopenia +.RBS 78, B. Urea 19, S. Cret
0.7, BT 1 min 15 sec, CT 2 min 25 sec, HIV & HBsAg ve. USG Abdo & Pelvis on
21-7-10 Ut AV, N Size, ET-17 mm. Rt. Ovary-Echogenic well defined mass of
size 18 x 15 x 12 cm with small cystic areas with minimal vascularity.
Left Ovary N. Liver & Spleen N. Chest X-ray N. Tumour markers- Alpha Feto Protein, Ca-125 & B-HCG
were N. CT confirmed ultrasonic findings & no metastasis.
Anaemia was corrected . standard staging laparotomy was performed. Uterus, both adnexae, Infracolic
omentum were removed after taking biopsies.
Abdominal viscera & lymphnodes did not reveal any metastasis. Histopath showed stage 1A1 solid ovarian
Germ Cell malignancy( Well differentiated GRANULOSA CELL TUMOUR ) and uterus had well diff.
ENDOMETROID ADENOCARCINOMA stage 1A1( G 1). In view of early staged well differentiated
malignancy surgical management was considered adequate. Patient made good recovery & has been placed on
follow up protocol.
Management:
Dhiraj Case Gallery.
The load of tomorrow added to that of yesterday ,carried today ,makes the strongest falter. Shut off the future as tightly as the past .Willliam Osler
DEPARTMENT OF ORTHOPAEDICS
Dr. Prakash Parekh, Dr Shiv Chocksey & Dr Abhishek Darji
BILATERAL TOTAL KNEE REPLACEMENT IN GROSS GENU
VALGUS-FLEXION DEFORMITY
Male aged 28 years had gross genu Valgus deformity of 40 degrees of left
side and 20 degrees on right knee joint. Both knees had 20 degrees of fixed
flexion deformity. Patient was unable to stand on both feet and had not
walked for several years. The only possible movement for him was crawling.
He is a known case of sero-positive Rheumatoid Arthritis, with burnt out
knee joints. Xrays showed gross destruction of lateral tibial condyles on
both sides, left knee more than right knee joint.
Both knee joint replacement surgery was done SIMULTANEOUSLY
at a single siting. On operation table, lateral tibial condyle was
grossly escavated and partly deficient. A chunk of bone block was
fixed with a screw to augment lateral tibial condyle to normal height.
At the end of operation, all knee deformities were fully corrected
and joints were fairly stable.
Post-operatively, patient recovered uneventfully and had fully
straight legs with good functional range of 100 flexion bending. He
th
could stand-up and walk on 4 post operative day as seen above.
(Pre-operative Clinical)
(Pre-operative X-ray)
TH
4 POST-OPERATIVE DAY
Dhiraj Case Gallery.
A doctor who cannot take a good history and a patient who cannot give one are in danger of giving and receiving bad treatment.~Author Unknown
DEPARTMENT OF ENT
Dr. Jayesh Rakholia, Dr. Nirali Chauhan
CASE OF BASAL CELL CARCINOMA OF THE NOSE
70 yrs old female patient from Badvani (MP) working as a farm
labourer presented with c/o nodular swelling over nose since last
8-10 months gradually increasing to present size. Pre operative
histopathological report was Basal cell carcinoma. Wide excision
was done & reconstruction with midline forehead flap was
completed, which was released after 21 days. final histopathology
report demonstrated nodular variety of basal cell carcinoma stage
II disease (T2N0Mx)
Nose is the frequent site of basal cell carcinoma and is most
prevalent in the age group of 65 to 75 yrs Exposure to sunlight is
commonest pre-disposing factor and metastasis are rare. Tissue
conserving surgery with wide excision is the best method of
management.
DEPARTMENT OF RADIOLOGY
Dr. Shreedevi Patel, Dr. Mayur
A Case of Cerebral Hydatid Cyst
CT & MRI Findings
Discussion
Imaging
The 45 yr old female patient, farmer by occupation, presented to casualty with
historyof convulsions 2 episodes in last three days and headache. There was no
historyof vomiting, fever, trauma, paralysis and tuberculosis. CNS examination
was normal.
CT scan brain study showed a very well defined lobulated sharply marginated cystic
hypodense fluid containing lesion at right fronto-temporo-parietal lobe. The lesion
contained septae and multiple daughter cysts in it. No evidence of calcification was
seen in it. The lesion was seen in continuity with extradural space on right side.There
was mass effect on right lateral ventricle which was displaced to left side with
contralateral dilatation of left lateral ventricle. MRI study showed well defined
cystic lesion which appeared hypointense on T1WI and hyperintense on T2WI with
internal daughter cysts.
Hydatid cyst disease or Echinococcosis is caused by Echinococcus Granulosus. Human
infection occurrs by ingestion of food contaminated with dog feces containing ova of
dog tapeworm. The disease is endemic in sheep raising and cattle-raising countries.
It frequently involves liver and lung. CNS involvement is rare.
In CT and MRI studies they appear as large intra-parenchymal cystic lesion with
sharp margins. Cystic fluid is of CSF density with lack of surrounding edema.
contrast enhancement may be partially or completely involving the wall. Calcification
of the wall may be seen. Recurrent disease presents with intense enhancement of
the cyst wall and surrounding edema. Extradural cyst have been reported.
Post Op day 10.
Dhiraj Case Gallery...
The two underlying principles of dermatology : if it is wet then dry it , if it is dry then wet it. Anonymous
DEPARTMENT OF SKIN & VD
Freny Bilimoria, Sejal Shah, Amit Nagar.
Cutaneous manifestation of diabetes mellitus
Case history:

Reactive perforating collagenosis (RPC) is a rare skin disorder characterized by the transepidermal
elimination of altered collagen through the epidermis. The 2 distinct forms are an inherited form that
manifests in childhood and an acquired sporadic form that occurs in adulthood. Inherited reactive perforating
collagenosis is a rare disorder. Fewer than 50 cases of inherited reactive perforating collagenosis have been
reported. The acquired form of reactive perforating collagenosis is more common, occurring in as many as
10% of patients receiving maintenance hemodialysis , it is also associated with Diabetes Mellitus, chronic
renal Failure, hepatic dysfunction, hypothyroidism, hypoparathyroidism, lymphomas and malignancy.
The major abnormality in reactive perforating collagenosis is focal damage to collagen and the elimination of
the disrupted collagen through the epidermis. A frequent association with pruritus, the tendency to the
Koebner phenomenon and the distribution of lesions on trauma-prone areas provides evidence that superficial
trauma (eg, scratching) may play a part in the etiology of reactive perforating collagenosis. Cold may
precipitate the lesions, especially in the inherited form.
61 year old male, diabetic on oral anti diabetic drugs presented with multiple, pruritic, perforated,
keratotic, papular lesions on scalp, face, trunk and on all extremities for past 2 yrs (Figure-1,2,3). Lesions
had started from face and increased in number in last 2 months. Differential diagnosis of reactive
perforating collagenosis, Kyrles disease, perforating folliculitis were considered.
Laboratory findings revealed: Anemia, Normal Blood Sugar and normal hepatic and renal function tests. Skin
biopsy was suggestive of Reactive Perforating Collagenosis(Figure-4).
Treatment with antihistaminics, doxycycline and topical emollients was started and showed good response.
The ARPC occurs in patients with multiple medical problems, but whether the development of lesions implies a
poor prognosis is unclear.
Mr. Joshi Ph. No. 0265-2515620
INNOVATIVE ORTHO SURGICALS PVT. LTD.
Ortho Implants
Plot. No. 41, Road No. 5, Sardar Estate, Vadodara 390019, Gujarat, India
email : info@iosplortho.com www.iosplortho.com,
Dhiraj Case Gallery.
When you were born you were gifted to this world & this world was gifted to you. Your birthday is your biggest day. If you live well, it will also become a big day for this world.
DEPARTMENT OF PAEDIATRICS
Dr. Manish Rasania, Dr. Ajay Damor, , Dr. Bhupeshwari.
Urea Cycle Defect in a Neonate
A 4 day old male weighing 3.65 kg , born to G6P6L4D2 mother ( 2 babies expired due to unknown cause in
early neonatal period ) by emergency LSCS due to non progress of labour was admitted withsevere
respiratory distress , grunting , lethargy , poor feeding of one day duration. Initial sepsis screen was
negative ( Hb 14.2 , TC 1406 , DC 42,56,01,01 , BC 01% , I/T 0.1 , Blood culture Negative ) , Baby
developed convulsion on 4th day of life, CSF was normal, ABG showed metabolic acidosis. Child was in acute
oliguric renal failure with high s.creatinin (1.6mg%) but low blood urea (14mg%). Treatment was started in
the form of oxygen, IV fluid, vasopressor support(dopamine & dobutamine ), antibiotics, and antiepileptics (
phenobarbitone & phenytoin ). In context with the situation metabolic disorder was suspected and serum
ammonia on 5th day of life was 2468mol/L(normal values <35 mol/L). Baby was diagnosed to have
hyperammonemia due to urea cycle defect. Ventilatory support continued. For treatment of acute severe
th
hyperammonemia peritoneal dialysis was done. Despite all supportive effort baby expired on8 day of
admission.
Catabolism of amino acids results in the production of free ammonia, which is highly toxic to the CNS.
Common causes of hyperammonemia is deficiency of the urea cycle enzymes, Ornithine transcarbamoylase
(OTC) deficiency is the commonest urea cycle defect with an incidence of 1 case in 14,000 persons. The
affected infant is normal at birth but becomes symptomatic within a few days of protein feeding. Refusal to
eat, vomiting, tachypnea, convulsion and lethargy quickly progress to a deep coma. Newborn infants with
hyperammonemia are often misdiagnosed as having sepsis. main criterion for diagnosis is hyperammonemia in
plasma>1000 mole/L.
For treatment of acute hyperammonemia in infant, adequate calories, fluid, and electrolytes intravenously
are provided with minimal amounts of protein preferably as a mixture of essential amino acids. Sodium
benzoate , Sodium phenylacetate, Arginine hydrochloride are also given in initial therapy. When
hyperammonemia is extreme, direct removal of ammonia, usually using hemodialysis or hemofiltration, is more
effective than exchange transfusion or peritoneal dialysis. Early liver transplantation has increased survival
rate.
Approximately half of affected neonates still succumb to hyperammonemic coma. Survival is better in
partial defects but they still remain at risk for inter current life threatening hyperammonic crises.
Although mortality has improved , morbidity remains high.
DISCUSSION :
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M. 9824038767
Laboratory Chemical & Glass ware
Complete solution for
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chandracorporation@yahoo.co.in
Mr. Ajay Parikh
M. 9898037591/ 9374639994/0265-6538384
Dhiraj News Letter....
RIDDHI TRADERS
Mr. Sandip Shah
M. 9824346480
Laboratory Chemical & Glass ware
Authorised Dealer of Future India Ltd.
Necter Life Science / Medicit/Nirlife
MEDI CAL & SURGI CAL I TEMS
Mr. Ashutosh Shah
M. 9825040712 / 9429829696
Siyapura, Raopura, Vadodra.
nd
1,2 Floor, Xitij Complex, Pulbari Naka, Salatwada, Vadodara 390001
Dhiraj News Letter....
X-ray Film &
Kodak System
Kodak X-Ray /
Bracco Contrast
RAJESH
ENTERPRISE
Mr. Rutwik Contractor
M. 9824340323
SHREE PANDEY
MAT HOUSE
General suppliers in
All kind of Industrial Brushes, Khus,
Coir Mats & Cleaning items
Krishnalila Shopping Centre,
Harni Varsia Ring Road, Vadodara
M. 9879804156 / 0265-2530179
SHREE HARI
G R A P H I C S
Mr. Manubhai
M. 9825894656
830, Vaikunth Society,
Vadodara.
Waghodia Road,
Printing Press
SURYA
E N T E R P R I S E
Mr. Ramesh Vachani
M. 9825017704
Orthopedic Implant
& Instrument
201/SF, Devanshi Complex,
Govt. Press Anandpura,
Kothi, Vadodara 390001
Nr.
1000 BEDDED SUPER SPECIALITY HOSPITAL
Serving Humanity
At & Post. Piparia, Ta. Waghodia, Dist. Vadodara - 391760.
Ph. 02668 245264, 245265, 245266, 9601151034/35
SUPER SPECIALITIES
?Uro Surgery
?Plastic Surgery & cleft Lip Palate Centre
?Pediatric Surgery
?Laparoscopic Surgery
?Neuro Surgery
?Nephrology, Urology & Dialysis
?Joint Replacement Centre
?Neurology
?Gastro Euterology
?Arthroscopy
?Spine & Deformity Clinic
?Pulmonology & Bronchoscopy
?Neonatology
?Audiology & Speech Therapy
?Neurology & Sleep Study Centre
?Retinal Centre
?Epilepsy Clinic
CRITICAL CARE SERVICES
VALUE ADDED SERVICES
?One of its kind 26 bedded ICU and ICCU
?NICU, PICU with round the clock Neonatologist
?14 Operation Theaters and Surgical ICU
?Fully equipped (Ventilators, Invasive monitoring, Dialysis)
with 24 hrs qualified Doctors.
?Cozy CARE Deluxe, Special & Semi Special rooms
?Insurance, Mediclaim & TPA Facilities
?Preventive Health check up packages
?24 hrs Pharmacy Services
?24 hrs Blood Bank &
Component available
?24 hrs Ambulance Services
24 Hrs. HELPLINE
Launching Soon
Cardiac Centre with
Cathlab (PHILIPS
FD - 10 FLAT PANEL
AND CEILING
MOUNTED)
FREE SERVICES
?OPD and Consultation
?Free Stay and Food
?All Investigations cost
50 % Less than other Hospital
Constituent of S.B.K.S. Medical College, SUMANDEEP VIDYAPEETH
DIAGNOSTIC SERVICES
?24 Hrs Radiology (CT, MRI, Digital X-ray,
Mammography, Colour Doppler & Ultra Sound)
?24 Hrs Laboratory Services
?Neurology, EEG, EMG, NCV, BERA, Audiometry,
PFT, ENG, Perimetry, TMT, Echo.
Our Associates.
Published by :
At & Post. Piparia, Ta. Waghodia, Dist. Vadodara, Gujarat391760
E-mail : dhirajnl@sumandeepuniversity.co.in
On line Access : www.sumandeepuniversity.co.in
(For private circulation only)
Sumandeep Vidyapeeth
Academic Programmes at Sumandeep Vidyapeeth at a Glance
Institute
Degree / Diploma
Seats
K.M. Shah Dental College
& Hospital
B.D.S.
M.D.S. (All 9 Branches)
Dental Mechanics
M.B.B.S.
M.S. / M.D. /
P.G. Diploma
M.Sc. (Medical)
1. Anatomy
2. Physiology
3. Microbiology
4. Biochemistry
5. Pharmacology
B. P. T. Physiotherapy
P.G. Diploma
M. P. T. Physiotherapy (5 Branches)
B.Sc (Nursing)
M.Sc (Nursing) (All 5 Branches)
B. Pharm
M. Pharm (6 Branches)
M.B.A. (Health Care Management)
100
23
10
150
94
10
10
10
10
10
80
24
30
60
25
60
50
60
S.B.K.S. Medical Institute &
Research Center
College of Physiotherapy
Sumandeep College of Nursing
College of Pharmacy
School of Management
Tution Fees
2010-11
2,55,000/-
4,00,000/-
30,000/-
3,95,000/-
5,00,000/-
4,00,000/-
25,000/-
25,000/-
25,000/-
25,000/-
25,000/-
63,000/-
80,000/-
1,00,000/-
80,000/-
1,75,000/-
48,000/-
2,50,000/-
50,000/-
p.a.
p.a.
p.a.
p.a.
p.a.
p.a.
per Sem.
per Sem.
per Sem.
per Sem.
per Sem.
p.a.
p.a.
p.a.
p.a.
p.a.
p.a.
p.a.
p.a.
(All 20 Branches)
For
K.M. Shah Dental College & Hospital
S.B.K.S. Medical Institute &
Research Center