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Feb27
What are vascular diseases
What are vascular diseases and Vascular Surgery

“A surgeon's skills are measured by the way he handles the blood vessels”

These prophetic words of the great American surgeon William Halstead ushered in the era of one of the most skilful surgical specialties – Peripheral Vascular Surgery. This field has rapidly evolved over the last hundred years, with major advances occurring during the II World war and the Korean war. Endovascular interventions in the form of angioplasty and stenting have added an exciting new dimension for treatment of vascular diseases in the last two decades.

Vascular bypass operations in the leg preceded “heart bypass” operations by many years!

Vascular and Endovascular Surgery is a highly specialized field that deals with all the blood vessels in the body except those in the heart and the brain. Arteries that carry oxygenated blood from the heart to various organs and veins that return deoxygenated blood back to the heart, are the two main forms of blood vessels whose diseases are addressed by vascular surgeon. They are the life-lines of various body parts.The expression of vascular problems in different parts of the body is quite variable and this makes the specialty a complex, challenging field. A vascular surgeon is truly a “vascular specialist” since his expertise encompasses not only surgery, but also newer minimally invasive endovascular procedures (angioplasty, stenting) and vascular medicines. Hence vascular surgery remains one of the few “holistic” medical fields today which delivers complete, seamless care to patients with vascular disease.

How much is the problem?

What would be the magnitude of peripheral arterial disease of the legs in India? Since there are no specific data, we could extrapolate the available data to Indian population and the numbers thus obtained are quite staggering:

• Among 42 million diabetics – about 1000 per million will develop Critical Limb Ischemia, which usually means if some vascular procedure is not done they will lose the leg, which also makes them high risk for heart attack or stroke. If untreated this amounts to 42,000 amputations per year!
• Among rest of the population – about 500 per million (about 4,85,000) will develop critical limb ischemia needing a vascular correction or amputation!!
• In rest of the population about 38,00,000 (about 380 per 1,00,000 population) will develop peripheral vascular disease – these are the patients whose future vascular events can brought down significantly if proper medical care is given.

Venous diseases are far more common and include varicose veins, venous ulcers and deep vein thrombosis. All these problems affect a person’s quality of life and deep vein thrombosis is potentially life-threatening.

Causative factors
1. Smoking
2. Diabetes mellitus
3. High cholesterol
4. Lack of exercise
5. Obesity
6. Thrombophilia: tendency for blood to clot easily.
7. Heredity
8. Aging

Symptoms of vascular disease

Majority of vascular patients have one or more of the following three symptoms:

1. Painful extremity
2. Swollen extremity
3. Ulcerated extremity
Other problems include arterial aneurysms (dilated arteries) that have a potential for rupture, renovascular hypertension that is correctible, mesenteric ischemia that reduces blood supply to the intestines and has a higher fatality that heart attack, carotid artery stenosis that affects blood supply to the brain and results in paralytic attack which is preventable!
There has been an exponential increase of vascular problems in India due to unabated smoking and rapid increase in diabetic population (42 million or 4.2 crores), crossing all economic barriers. Peripheral vascular disease affects mostly the legs, which initially causes pain in the calf muscles while walking. The walking distance progressively reduces and if ignored will result in severe pain in the toes even at rest and eventually will result in gangrene of the toes and the foot, which might necessitate amputation. This “leg attack” is more dangerous than heart attack as it can endanger the limb and life of the patient. But this can be easily treated in the initial stages with appropriate medicines and simple life style modification programs. Unfortunately, these patients rarely reach a qualified vascular surgeon at this stage. One of the main reasons being lack of awareness among the public and also among many of the doctors about the vascular diseases and the role of vascular surgeon. There are only about 50 vascular surgeons in India, which results in these patients seen by other specialists, resulting in delayed referral to a vascular surgeon. In fact majority of these patients are not seen by vascular surgeon at all resulting in unnecessary limb and life loss. Even when a patient presents relatively late to a vascular surgeon, most of the limbs can be salvaged with a high success and low complication rate by vascular bypass or minimally invasive endovascular procedures like angioplasty and stenting if needed.

Blocked arteries in the leg mirrors rest of the body. Early diagnosis by good clinical examination and simple tests in patients with risks (smokers, diabetics, those over 50 years) will detect the disease even before they become symptomatic. It is well established now decreased blood flow in the legs is the biggest indicator of future hear attacks, strokes and amputation of legs or in other words the blocked arteries in the legs indicate a wide spread vascular disease in the body. When a patient has blocked arteries in the heart (cause of heart attack) it indicates that there is 30% chance that he/she has vascular disease else where, but a blocked artery in the leg indicates 60 to70% chance of diffuse vascular disease. Hence it is recommended in these risks groups should be examined peripheral arterial disease in the legs and if they do, they should be started on good medical treatment and life style modification program, which would markedly decrease the chance of future heart attacks, stroke or amputations.


Since poorly diagnosed and untreated vascular disease can lead to major limb and life threatening problems, it is of paramount importance that public and the medical profession is aware of early symptoms and the diagnostic methods. Early diagnoses and proper therapy will not only control the disease, but will markedly decrease the future complications and results in improved quality of life.

Vascular surgeon plays a pivotal role in diagnosing and treating these diseases, as our medical education imparts very little knowledge about vascular diseases to other specialties. Hence it is mandatory that any body suspected of these problems be evaluated by a vascular surgeon.

Patients with diabetic foot problems, which are the number one cause of admission in diabetic patients in India, usually are treated by vascular surgeon. These are of epidemic proportions, causing life and limb loss, though they can be easily prevented with proper foot care. Vascular surgeon plays a pivotal role in caring for the diabetic foot problems whether they are related to vasculopathy or neuropathy.

Vascular surgeon’s field is wide since it covers major portion of the human body. The next most important disease treated is stroke prevention surgery. Majority of strokes occur because of the narrowing of a blood vessel, called carotid artery, in the neck which carries blood to the brain. If diagnosed in time and treated with a highly successful surgical procedure called “Carotid Endarterectomy”, the chances of stroke is markedly reduced. In few, highly selected patients vascular surgeon may opt to perform “angioplasty and stenting”, but these cannot be applied to all patients at present, but might change in future. Again, it important to have these patients evaluated by a vascular surgeon, for proper diagnosis and treatment.

Vascular surgeons also deals with blood vessels in the upper limbs, those inside the abdomen supplying vital organs like the kidneys, liver intestines etc. Diseases of the veins, simplest of which is the varicose veins, also come under the purview of vascular surgeon.


Dr. P C Gupta, MS, FICA
Senior Consultant & Chief,
Vascular & Endovascular Surgery

Watch this space for disease specific articles.


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Feb27
Biochemic way is the simplest way
There are many theories and practices of allopathic and alternative medicine all over the world and of all the theories in history, there are few that are as simple, appealing and rational as the treatment of ailments by means of the inorganic cell-salts that are naturally occurring in the human body. If living a healthly life is important to you, then the investigation of the cell salts is crucial.



The key function of the12 cell salts (also known as tissue salts, Biochemic salts, Schuessler Salts and inorganic salts) is to build cell substance out of organic material. They serve as the active agent for this purpose. Although often thought of as homeopathic medicines, tissue salts are also referred to as a “Biochemic Therapy” because they are used to treat “mineral deficiencies” or “mineral imbalances” in the body. In contrast, homeopathy is based on the treatment of symptoms using the “law of similars”. Tissue salts are homeopathically prepared so they are very easy for the body to assimilate.



Historically, cell salts were thought to be of little importance because they only make up about five percent of our body composition. Practitioners today, however, understand more about cell salt functionality and how they contribute to overall health and well being throughout the body.


Cell Salts can be used for everyday acute situations by rebalancing minerals throughout the deficient body parts. Effective for children, adults, and pets and depending on the situation can be used more long term for healing. Think of the tissue salts as brick layers of the body while all the organic material ingested can be considered brick. Even if you have great BRICK going into the body, without adequate brick layers, bodily functions are not optimized.


If anyone doubts the cell salt effectiveness, just think of Mag Phos for cramping. If experiencing cramps of any type Mag Phos settles the problem usually within minutes.


With my own experience which started with myself feeling the effect of Magnesia Phos for cramps, I started study in the Biochemic system and have found the results very fruitful and treated many a cases of emergency where the patient was advised to be hospitablized but the very next day the same was working normally.


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Feb26
Approach to Homeopath
When you approach to Homeopath for treatment should go with all your previous investigation reports , prescription which are taken before . these are important for diagnosis and prognosis of a disease.
Another thing is very important , Case taking . You should take an appointment to visit a Homeopath . In chronic case it takes up to two hour for case taking . During case taking Homeopath ask you a lot of questions to analyse you physically and mentally to make a prescription .
This would include the questions about your personality and temperament , how you react to environment factors . appetite , craving , your thirst , perspiration , sleep , dreams , past history of illness , Family history . these are very important for arriving to proper remedy .
mental symptoms are very important so you have to told in detail . your nature, anger , reaction , irritablity, any incidence in life it make hurt you . From that Homeopath analyse you mentally. It is better to come with your close relative or friend to add something regarding your nature , sometimes it helps much .
After this long history , Homeopath workout your case it takes sometime and give a medicine.
Along with medicine Homeopath advised Diet , lifestyle , exercise , asked to leave addiction .
* some precautions to take while treatment .*
1) Tongue should be clean while taking medicine , don't take 15 mints. before and after medicine.
2) Generally avoid any other medicine for acute complaints , contact to Homeopath.
3) To cut down all addictions , tobacco, alcohol , smoking, etc.
4)Medicine will taken in paper or spoon and not in the hand .
5) Medicine are to be stored in cool , dry place , away from strong odours,and especially away from camphor. camphor interfere the action of Homeopathic medicines.


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Feb22
pain relief by iontophoresis
introduction of diclofenic sodium by sp new instrument

" trans ionnic ''' for pain relief in shoulder tendinitis

results are promising.


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Feb22
CASE OF INFANTILE ECZEMA
This is the case of Baby. P.K (Patient Ref. No. PS-403), a 4YEARS old female child who was brought to the clinic by anxious parents with complains of infantile eczema since the age of 2 months. She would develop reddish eruptions over the body and these would be more severe on the cheeks. She would get severe itching and would become very irritable on account of the same. Her complaints would get worse during the winter season and at night time.

Along with these she also had history of recurrent colds since childhood. She would develop cold and cough every 2-3 weeks.

She had marked desire for sweets, cold-drinks, ice-creams, chocolate and fruits. She would sweat lesser than normal. She was comfortable in the cold climate usually. She was a chubby child by constitution.

The peculiar mental traits were that she was an obstinate child with marked fear of darkness and of loud noise. She loved music, dancing and going out. She did not like to be caressed but otherwise was of a very mixing and playful nature. Never sit one place for long time. She has excessive crying when her demand is not full filled. Lying on abdomen. She is child of working parents. Mother rejoins her job at the 2 months age of pt. she leave her in crab. This is the time when complaint was started.

He consult pediatricians, dermatologist without improvement. Grand father having allergic Asthma & Eczema, Grand Mother having hypertension.

O/H/O : LSCS, Birth wt was 3.2kg
Mental state of mother during pregnancy: Tension about work level & family
Nausea & vomiting for 3 ˝ months

Mile Stone: Teeth at the age of 6 months 13 days

Based on these features she was prescribed homoeopathic medicine named Medorrhinum. Within few days itching was gone, her tendency to develop these eczematous lesions was markedly better. She would get these lesions only occasionally and they would not even require treatment at times. Frequent attacks of cold and cough also under control. Mother left job for 4 -5 months to take care of baby.

This case shows that eczema (and similar allergic disorders) can be effectively controlled with homoeopathic medicines without the use of external applications of any kind. It cures the eczema from within and restores the deviated immunity of the individual back to normalcy.


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Feb22
Cases of Fissure-in-ano saved from surgery
This is the case of Mr. S. P (Patient Ref. No. PS - 396), a 29 years old male patient who reported to the clinic with complaints of pain in the anal region since 5 -6years. He would get shooting pains in the anal region that would last the whole day long. The pain would get worst during stools. He would also experience increased intensity of pain while sitting, traveling, at night and early morning. Application of hot water would relieve the pain to some extent. There would also be some amount of bleeding during the passage of stools. There was no history of passage of mucus with the stools. Bowels would be chronically constipated and he would have to strain much to pass stools.
Patient was taking homoeopathic treatment without improvement then he started allopathic treatment but no improvement. At last patient was ready for operation but last moment he refused operation & again start homoeopathic treatment.
His appetite is normal and he is very fond of sault, sweets. Thirst is excessive. He would be comfortable in the cold weather and could not tolerate sun heat, warm atmosphere. Constitutionally he is stoky & average height. Recurrent apthe in mouth especially when suppressed anger. White spot in nails, profuse perspiration over upper lips, saulty in test.
Mr. S is coming from well settle nuclear family of Brahmin. He is only son of parents. His father is engineer in GEB, irritable by nature. He was often irritated over patient in matter of study. Patient also irritate in front of him. Mother is house wife, good by nature. Younger sister is also good in nature.
Good in study. He took part in sport & cultural activities. He completed Msc & doing job as a teacher in higher Secondary school. He had habit of cigarette smoking, take much spicy food & irregular in diet during the Msc. This the time when complaint started. He had iften fight in collage time. He is irritable by nature. Irritate very easily. He is can not tolerate any opposition, indignation. He is reserved kind of person. Revengeful. He is particular in work. He did not like if anybody cheat. Sentimental. Never see the pain of others. He told that now he is control his anger after death of his close friend. He wept lots when his friend dies. Still remember.


He does not like authority but working as a teacher with own principal. He never accept all the things of trusty. Many times disput occur with management.
4 weeks was all that was required to give him more than 80-90% relief in his symptoms of painful defecation and he was back to his work. He was prescribed a remedy named Nat. Mur as a constitutional remedy & Nitricum Acidum along with another one called Aesculus as a acute remedy. He continued the treatment for some more time and his symptoms were under good control now. He would not have any bleeding or pain now and his complaint of chronic constipation was also effectively taken care of with the medicines. At the end of one year the patient stated that he had completely forgotten the fissure now.
Remark: Homoeopathic medicine do miracal work in surgical cases if right medicine, right potency & frequency.


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Feb22
case of psoriasis treated with homoeo
Mrs. G.S (pt Ref. No. PS – 303) a 36 years old female came with his husband with prescription paper of dermatologist to my clinic. She was suffering from the psoriasis since 6 years. Now she was fed up with Allopathic treatment. The complaints had increased since 1 month. She had extensive scaling lesions started from the ear to elbow to leg – up to thigh. There was intense itching which would be worse during winters and during the night time. She had taken allopathic as well as Homoeopathic treatment in the past for a long time but did not benefit much from these.

The patient was of an average built with an average appetite. she liked Spicy, Sour test. She would sweat profusely especially on the face with offensive odor & stain. Sleep was sound with lots of dreams of Accident, Frightful, Death of Family members, Snakes etc. that were mostly unremembered.

Patient is coming from the middle class nuclear family. She had good relation with every one in childhood. She was average in study but likes to participate in programmed. She likes knitting. She did marriage with Mr. at the age of 22 years without interest but she could not share her choice in front of parents. There was big family of husband. FIL, MIL, two younger brothers, SIL. She had strain relation with her MIL who is irritable & dominating by nature. She felt insecurity in this environment. She had fear of MIL, never express any things in front of her. She had constant fear of quarrel. This leads to sleeplessness, thoughts which were better after weeping alone. Patient is elder in family so all responsibility is on her shoulder. She has anxiety about house since 2000. Anxiety about children future. She had constant thought in mind that how many days we will take care of BIL because they are not working. She has fear of dark, alone. Can not see the pain of others. The patient had a friendly nature but he had become withdrawn off late. She would like to have the company of her friends but since few months she had begun to feel uncomfortable in the company of others due to his skin problems. She felt more when her sister’s husband dies in accident. She would not express her feelings and would not share her grief with anyone. She had the tendency to suppress her grief and would divert his mind to something else. She would frequently brood about her problems. She was very fastidious by nature and was very particular about the way she would keep his things. She likes winter rather than summer. Headache from sun heat.

No any past history, Father having kidney stone. Based on the above history the patient was prescribed a remedy called Mag. Mur as constitutional medicine & Psorinum is inter current medicine. Within 2 months of treatment his complaints were better by more than 90%. There was no itching anymore. Overall she did very well with the treatment and that too within such a short span of time.

This case illustrates that even obstinate conditions like Psoriasis can also be effectively tackled with Homoeopathy.

Remark: The remedy prescribed in these cases is patient-specific i.e. it has been prescribed based on the symptoms specific to the patient at that point of time. It is advisable that the patient does not indulge in any self-medication.


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Feb21
Diabetes mellitus -Health Education
Kumar’s Hospital
( Jodhamal Road, Hoshiarpur)

DIABETES MELLITUS- How to stay healthy.

Do you know that Diabetes mellitus or commonly known as “sugar” is spreading very fast in India. According to one estimate at present rate by 2050 every Indian will be diabetic. Reasons are many but more important ones are stressful life, fast food habits, sedentary lifestyle, and may be genetic predisposition.

If you are diabetic follow these tips.
Diet modification:
Avoid;
1. Sugar in all forms, sweets, fried food,
2. Potatoes, rice, sweet potatoes, refined wheat flour (Maida)
3. Mangoes, grapes, litchi, banana,
4. Cold drinks, alcoholic drinks, smoking
5. Fast foods, deep fried foods, canned juices, canned fruits, ice creams, non veg. foods
Take;
1. Lots of salads,
2. Vegetables cooked in refined oils
3. Chapattis made from whole-wheat flour preferably mixed with gram and Soya flour.
4. Fruits: - oranges, mossumbies, papaya, plumes,
5. Nimbu paani without sugar, tea/coffee without sugar, fresh fruit juices (oranges/mossumbies) without sugar and lots of plain water.
6. Roasted or plain Nuts like almonds/ground nuts/cashew can be taken in moderation.
(For further details contact your doctor)
Life Style modification:
Since Diabetes mellitus is a life style disease it is very important to modify it.

· Do light aerobic exercise daily
§ Like walking briskly for about 5 kms daily
§ Do pranayam for one hour or yoga
§ Cycling/Swimming
· Reduce weight – attain your ideal weight i.e- 23 x Height2 (in meters)
· Don’t over work and over stretch yourself. – Find time to relax, spend time with family. Free your mind from daily tensions. Try meditation for 15-20 minutes daily
· Do get up from your chair and move around in office from time to time.
· Take a walk to neighborhood groceries or vegetable market instead of going in a car.
· Dispense with peon and do small menial jobs-like taking out / putting back files from cabinet yourself.

Medical Consultation;
§ Consult your doctor for medical check ups at regular intervals and follow the instructions.
§ Keep your blood sugar level, blood pressure and weight in control with or without medicines.
§ Always keep your drug record /blood sugar level record /contact number of your home and doctor with you.
§ Take your medicines regularly

Tips for Special Care of Body
You should take special care of your body because you know that in a diabetic wounds and infections take longer than usual to heal Some times there is loss of sensation in hands and feet due to the damage to the nerves, and any minor injury goes unnoticed until it is too late. Diabetes also leads to restricted blood supply to body parts thus causing delayed healing and infection.
Report to your doctor:
§ Any numbness or tingling sensation in hands, arms feet or legs...
§ Any blurring of vision or diminishing of vision
§ Any skin infection or injury.


Do the following:
§ Daily check your feet and hands for any minor cuts, scratches, blisters, swelling and discoloration, at the time of taking bath.

§ If you find any of above then rinses the area with clean tap water, apply some antiseptic cream or band-aid etc. Consult your doctor at the earliest. Don’t ignore it can be dangerous.
§ Wash your feet daily with lukewarm water and soap, and dry them taking special care of area between the toes. Apply some moisturizing cream to feet but don’t apply in between the toes. Keep the inter digital spaces dry or sprinkle some anti fungal powder. (Candid)
§ Choose your footwear carefully _ these should be neither tight fitting nor very loose and insides should be soft smooth and well cushioned. Don’t wear new shoes for longer periods continuously. - Always examine your feet afterwards for blisters, ulcers or discoloration
§ If your feet remain numb then be extra cautious:
o Don’t wear open shoes/sandals etc. Always wear nice fitting shoes with soft inside with cotton socks. In summers and rainy seasons, sprinkle some anti fungal talcum powder (Candid powder) on your feet before putting on socks. If possible do remove shoes and socks for some time during day so that moisture dries up and massage your feet for some time.
o Never walk bare foot even in your home. Use slippers made of soft rubber.
o Ensure that inside of your footwear is smooth and there are no sharp edges.
o Don’t sit near the heaters in winters. Never put up your feet in front of heaters. It can seriously burn your feet because you will not feel pain due to numbness. Similarly do check the temperature of water before immersing your feet in it. It will be better if you ask some one else to do it for you.
o Don’t keep hot water bottles in direct contact with your legs or feet -always wrap these in cotton sheet and keep away from your body.
o Don’t cut your nails too short – it can cause unnoticed injury to your fingers and toes.
§ Don’t smoke: it further causes decrease in blood supply to legs and feet and worsens the condition.


Some Final Tips: 5 A’s
§ Avoid unnecessary medications –
§ Always consult you doctor regularly
§ Allow yourself some relaxation in between busy schedule.
§ Adhere to the guidelines/instructions of your doctor
§ Always be happy.


Prevention: of Diabetes mellitus.

There are no definite methods to prevent the onset of Diabetes mellitus but following steps, will definitely delay its onset and decrease its severity.


§ Keep your weight in ideal range.
§ Avoid junk food/fast food
§ Take natural, healthy food with lots of fruits/ vegetables/salads. And less of oils.
§ Avoid alcoholic drinks/canned juices/canned fruits/sugary syrups.
§ Do daily exercise.
§ Follow life style and diet modification as advised earlier.

We can’t cure diabetes but can definitely help you to live a meaningful, healthy and complete life.
________________________________________________
Issued in public interest by: Dr. Rajender Kumar Sharma, Consultant surgeon, Kumar’s Hospital, Jodhamal Road, Hoshiarpur
Ph. 01882-220092,
________________________________________________


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Feb21
Sensitive Teeth
Sensitive Teeth
Do you experience pain or tingling in your teeth…..
especially when eating sweets or very hot or cold foods?
You may have sensitive teeth.
Pain from sensitive teeth is not always constant; it can come
and go. Constant pain could be a sign of a more serious
problem. It is still important, however, to discuss your
Symptoms with your dentist to determine the cause and proper
Treatment.
WHAT CAUSES TOOTH SENSITIVITY?
In healthy teeth, porous tissue called dentin is protected by your
Gums and by your teeth’s hard enamel shell. Microscopic holes
In the dentin, called tubules, connect to the nerve, triggering
Pain when irritated by certain foods and beverages.
Dentin can be exposed by:
• Receding gums caused by improper brushing or
Gum disease
• Fractured or chipped teeth
• Clenching or grinding your teeth
• Erosion
TREATING TOOTH SENSITIVITY
Depending on the diagnosis, your dentist may recommend one
Or more of the following treatments to relieve the symptoms of
Sensitive teeth:
• A soft-bristle toothbrush, to be gentle on gums or a powered brush.
• A fluoride rinse or gel for sensitive teeth, prescribed by your dentist.
• A desensitizing toothpaste.
In case the above treatment is not reducing the tooth sensitivity, than you need to consult your dentist for further treatment in the clinic.

Dr.Amjadali. Y. Budguzar.
Camp, Pune.
+91 9822000805


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Feb21
How The Tooth Pierces The Heart!!!
How The Tooth Pierces The Heart!!!



Heart Attacks:

The most common strain of bacteria in dental plaque
can cause blood clots that induce heart attacks when
they escape into the bloodstream.

Studies have found the incidences of heart disease are
about twice as high in people with periodontal (gum)
disease.

Periodontal disease is an infection that destroys the
gum surrounding your teeth and also destroys the
supporting bone that holds your teeth in place.



Incidence of Periodontal Disease: Unlike most diseases
that give us early warning signs, gum disease
progresses silently, often without pain. It may
develop slowly or progress quite rapidly. More than
half of all people over 18 have at least the early
stages of periodontal disease. Even more frightening,
after the age of 35, three out of four people are
affected to some degree.



Determining Periodontal Disease:

Early Warning Signs of Periodontal Disease are

The Gums bleed when you brush your teeth.
Gums become red, swollen, or tender.
Gums are pulled away from the teeth.
Pus oozes between teeth and gums when gums are
pressed.
Permanent teeth get loose or separate.
Persistent bad breathe.


Your dentist can help you better understand
periodontal disease and how you can prevent it. He can
quickly and painlessly check and monitor the condition
of your gums during your recare appointments.

Evidence is mounting relating gum disease to a
variety of health concerns, some that are life
threatening

Plaque bacteria threatens your teeth, gums,
restorative and cosmetic work; possibly even your life


By keeping regular re-care appointments with your
dentist, you help increase your chances for a long and
happy life.


Dr. Amjadali.Y. Budguzar
camp, pune.
+91-9822000805


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