Children surgery Panipat

Children surgery Panipat A centre for treatment of surgical diseases in children managed by an MS,MCh surgeon with more than 3

06/09/2025

Bedwetting in Children (Nocturnal Enuresis): A Pediatric Surgeon’s Viewpoint

What is Nocturnal Enuresis?

Nocturnal enuresis means involuntary passage of urine during sleep in children aged 5 years or older. It is common, and most children outgrow it with time.

Primary enuresis: Child has never achieved night-time dryness.

Secondary enuresis: Child had been dry at night for at least 6 months, but starts wetting again.

Why Does Bedwetting Happen?

From a pediatric surgeon’s perspective, the causes may be functional, developmental, or occasionally surgical:

1. Delayed bladder maturation – Bladder is not yet able to hold urine overnight.

2. Overactive bladder / small bladder capacity – The bladder contracts before it is full.

3. Increased urine production at night – Sometimes due to low levels of ADH (anti-diuretic hormone).

4. Deep sleep pattern – Child doesn’t wake up to bladder signals.

5. Constipation – A full re**um presses on the bladder, reducing its capacity.

6. Psychological stress – School, family, or emotional issues may trigger secondary enuresis.

7. Surgical / anatomical causes (rare, but important for surgeons to detect):

Posterior urethral valves in boys

Neurogenic bladder (due to spinal cord problems)

Vesicoureteric reflux

Urethral obstruction

When Should Parents Worry?

Bedwetting is usually harmless, but medical evaluation is needed if:

Daytime wetting, urgency, or dribbling is also present

Child has painful urination, poor urine stream, or recurrent UTIs

Associated with constipation, spinal deformities, or weakness in legs

Bedwetting continues beyond 10–12 years despite all measures

Diagnosis

A pediatric surgeon will start with:

Detailed history (frequency, family history, fluid intake, sleep pattern)

Physical examination (abdomen, spine, genitalia)

Urine analysis and ultrasound if indicated

Rarely, uroflowmetry or voiding cystourethrogram (VCUG) in suspected anatomical problems
Treatment Approach

Treatment depends on whether it is simple functional enuresis or due to surgical pathology.

1. Parental Reassurance & Lifestyle Changes

Do not punish the child – bedwetting is not their fault.

Restrict fluids 2 hours before bedtime.

Avoid caffeinated / fizzy drinks.

Ensure regular toilet use during the day.

2. Bowel Management

Treat constipation with diet, hydration, and stool softeners if needed.

3. Bedwetting Alarm (Enuresis Alarm)

Most effective long-term non-drug therapy.

Teaches the child to wake up when bladder is full.

4. Medications (used selectively)

Desmopressin: reduces night-time urine production.

Anticholinergics: for overactive bladder.

Imipramine: rarely used, under supervision.

5. Surgical Intervention (only if anatomical cause found)

Removal of posterior urethral valves

Correction of urethral obstruction or reflux

Management of neurogenic bladder

Prognosis

Most children outgrow bedwetting naturally as the bladder matures.

With proper evaluation and management, success rates are high.

Early identification of surgical causes prevents kidney damage and improves quality of life.

29/08/2025

A Paediatric Surgeon’s Guide for Parents for

Sudden Onset of Pain and Swelling in the Sc***um of a Child

As a paediatric surgeon, one of the emergencies I often see is a child brought in with sudden pain and swelling in the sc***um. This is a situation where every minute counts.

I am writing this guide to help you recognize the seriousness, act quickly, and understand what may be happening.

Why it is an Emergency

The sc***um contains the testicles, which are very sensitive to blood supply. If the blood flow gets cut off even for a few hours, the te**is may get permanently damaged or even lost. That is why sudden scrotal pain in a child should always be treated as a surgical emergency until proved otherwise.

Possible Causes

Several conditions can cause pain and swelling in the sc***um. Some are minor, but some are very serious:

1. Testicular Torsion

The te**is twists around its cord, cutting off blood supply.

Most dangerous cause – irreversible damage can occur within 4–6 hours.

Needs immediate surgery.

2. Torsion of Testicular Appendage

A small vestigial structure twists and causes pain.

Less dangerous, but can mimic testicular torsion.

3. Infection (Epididymo-orchitis)

Rare in small children, more common in teenagers.

Causes pain, fever, burning in urine.

4. Trauma

Injury from play, sports, or cycling.

May cause swelling and bruising.

5. Inguinal Hernia / Hydrocele

A loop of intestine slipping into sc***um (hernia) can also present with sudden pain.

A hydrocele (fluid collection) usually painless, but may suddenly swell.

Warning Signs Parents Should Never Ignore

Sudden, severe pain in the sc***um (child may wake up at night screaming)

Redness, swelling, or tenderness in the sc***um

Nausea, vomiting, or abdominal pain along with scrotal pain

Child refusing to walk or holding sc***um while walking

What Parents Should Do Immediately
1 .Treat it as an emergency – rush to the nearest hospital with paediatric surgical or urology services.
2. Do not give painkillers and wait to see if pain subsides. Pain relief may mask the seriousness.
3. 3.Do not apply heat packs or massage – this can worsen the condition.
4.Ensure the child avoids food or drink if surgery may be required.

Diagnosis is done by :-

Physical Examination: Paediatric surgeon checks for tenderness, swelling, and position of te**is.
Ultrasound with Doppler: To check blood flow in te**is.

But remember: if torsion is strongly suspected, surgery should not be delayed for tests.

Treatment

Testicular torsion → Emergency surgery within 4–6 hours to untwist and save the te**is.

Torsion of appendage → Pain relief, rest, sometimes minor surgery.

Infection → Antibiotics, supportive care.

Hernia → Surgery to prevent recurrence.

Trauma → Supportive treatment or surgery if severe injury.

Long-Term Outlook

If treated promptly, most children recover completely.

Delay in treatment of torsion may lead to permanent loss of the te**is, which can affect fertility and hormones later in life.

Final Word from a Paediatric Surgeon

Parents, please remember:
1 Any sudden scrotal pain in a child = surgical emergency until proven otherwise
2 Time lost in hoping or home remedies can cost the child his te**is.
3 Early consultation saves both the organ and the child from long-term problems.

15/08/2025

From a Doctor’s Desk:

Feeding Your Child from 6 Months to 2 Years

Dear Parents,

As a pediatrician, I often see parents confused about what to feed their little ones once they cross 6 months.
Here’s my simple, practical guide — based on science, experience, and a lot of love for healthy children.

Why Change at 6 Months?

Till 6 months, mother’s milk gives all the nutrition your baby needs.
After 6 months, your baby grows faster and needs extra energy, protein, iron, and vitamins.
This is why we start complementary feeding (extra foods along with breast milk).

6 to 9 Months: Gentle Introduction

Continue breastfeeding on demand.

Give semi-solid foods 2–3 times a day.

Start with soft, mashed, easy-to-swallow foods:

Mashed banana, sweet potato, or rice porridge with a little ghee.

Mashed dal (lentils) or soft khichdi.

Steamed and mashed carrot, pumpkin, spinach puree.

Mashed apple, papaya, chikoo.

For non-veg: mashed boiled egg yolk, pureed chicken/fish.

Keep food smooth and lump-free to avoid choking.

9 to 12 Months: Exploring Tastes

Breast milk + 3 meals + 1–2 small snacks.

Introduce finger foods: soft fruit pieces, cooked carrot sticks.

Include:

Soft chapati soaked in milk or dal.

Idli, dosa, upma, poha (soft cooked).

Curd, paneer, minced chicken/fish.

Mild spices (turmeric, cumin) for taste.

12 to 18 Months: Family Food, Baby Style

3 meals + 2 snacks + breast milk or cow’s milk (max 400–500 ml/day).

Offer family food, just softer and cut small:

Rice, chapati, dal, vegetables, eggs, curd, cheese.

Seasonal fruits without seeds.

Energy snacks: homemade laddoos (atta + ghee + jaggery), banana shake.

18 to 24 Months: Independence Begins

3 meals + 2–3 snacks daily.

Encourage self-feeding with a spoon or hands.

Give a variety of cereals, pulses, vegetables, fruits, dairy, eggs, fish, chicken.

Introduce light soups, smoothies, and safe salads.

Foods to Avoid Completely

Salt (before 1 year) and very little after.

Sugar (before 1 year) and keep minimal later.

Honey before 1 year (risk of botulism).

Junk food, processed snacks, chocolates.

Whole nuts, popcorn, raw carrots, whole grapes (choking risk).

Important Nutrients

Nutrient Why Needed Food Sources

Iron Prevents anemia, helps brain growth Dal, green veg, egg yolk, meat
Calcium & Vitamin D Strong bones Milk, curd, cheese, sunlight
Protein Growth & immunity Eggs, dal, milk, fish, chicken
Healthy fats Brain development Ghee, powdered nuts, seeds
Vitamin A Eyes, immunity Carrot, pumpkin, papaya

Doctor’s Tips

Be patient — children may take 8–10 tries to accept new foods.

Never force-feed — let the child decide how much to eat.

Offer small portions and refill if needed.

Eat together as a family — children copy adults.

Track growth during every pediatric visit.

— remember, healthy food in the first two years builds the foundation for your child’s future health, learning ability, and immunity.
Feed with love, patience, and variety

10/08/2025

Recurrent Fever in Children – What Parents Should Know

(From the desk of a Paediatric Surgeon)

1. What is “Recurrent Fever”?

If your child develops fever again and again, with short or no fever-free periods in between, it is called recurrent fever.
Sometimes these fevers are due to common colds or seasonal infections, but in a few children, the cause may be a hidden structural problem in the body that might need surgical treatment.

2. Why Should Parents Be Concerned?

Most fevers go away with rest and medicines, but repeated fevers over weeks or months can mean:

A hidden infection that keeps coming back.

Damage to important organs like kidneys, lungs, or bones if not treated early.

A condition that can be permanently cured with surgery if found in time.

3. Surgical Causes of Recurrent Fever

While many causes are medical, some children have problems in body structures that make infections return.
A paediatric surgeon looks for:

A. Urinary Tract Problems

Urine flowing backward to kidneys (Vesicoureteric Reflux – VUR) causes repeated kidney infections.

Blockage in urine flow in boys (Posterior Urethral Valves) makes urine stay in the bladder and get infected. Clues for parents: High fever with chills, pain while passing urine, very smelly urine, poor urine flow.

B. Nose, Throat, and Airway

Enlarged tonsils/adenoids → frequent throat infection, fever, snoring, mouth breathing.

Small cysts or fistulas in the neck that keep getting infected.

C. Abdomen

Chronic appendicitis → belly pain on and off, mild fever, loss of appetite.

Liver or spleen abscess after infections.

D. Bones and Joints

Chronic bone infection (osteomyelitis) causes repeated swelling, pain, and fever.

E. Chest

Recurrent pneumonia in same lung area → may be due to blockage or congenital malformations.

4. Warning Signs for Parents

Seek a paediatric surgeon’s opinion if your child has:

Fever that always returns to the same body part (e.g., urinary tract, throat, chest, belly, bone).

Fever with a lump or swelling that doesn’t go away.

Fever with difficulty passing urine or poor urine flow.

Recurrent pneumonia in the same lung.

Poor growth or weight loss along with repeated fever.

5. How Doctors Find the Cause

Detailed history and physical examination.

Urine test and culture to look for infection.

Ultrasound of abdomen/kidneys.

Chest X-ray if lung infection suspected.

Special scans like VCUG (to check urine reflux), CT, or MRI if needed.

6. Can Surgery Help?

Yes — if a structural defect is found.
Examples:

Correcting urine reflux to protect kidneys.

Removing infected tonsils/adenoids.

Removing an infected cyst or draining abscess.

Removing an inflamed appendix.

Surgery to clear airway or lung blockage.

7. Take-Home Message for Parents

Not all recurrent fevers are harmless.

If fever keeps coming back in the same pattern or with the same symptoms, it could be a sign of a surgically treatable problem.

Early detection can save your child from long-term damage.

Don’t just keep changing antibiotics — find the root cause.

Simple Prevention Tips

Encourage your child to drink enough water.

Maintain good hygiene (handwashing, clean toilets).

Treat throat and urinary infections promptly.

Go for regular follow-ups if your child had a past structural problems

09/08/2025

Green or Yellow Vomiting in Babies and Children

A Guide from a Paediatric Surgeon

Most vomiting in children is harmless—due to minor infections or overfeeding.
But green or bright yellow vomit can be a sign of a serious emergency.
Sometimes, this means the intestine is blocked and needs urgent surgery to save the child’s life.

In newborns, one episode of green vomit can mean danger.

Understanding Vomit Colours

White / Milky / Cream-coloured → Common after feeds, usually harmless.

Clear / Slightly Yellow after feeding → Often due to mild stomach upset.

Bright Yellow or Green (like spinach water) → Contains bile from the intestine → may mean blockage beyond the stomach.

Tip: Parents often confuse yellow with green. If unsure, take a photo in daylight for the doctor.

Why Green or Yellow Vomit Is a Red Flag

Inside the intestine, bile mixes with food after it leaves the stomach.
If there’s a blockage beyond the stomach, bile backs up and comes out as green or yellow vomit.

This can happen in:

Newborns → Conditions present from birth.

Infants and older children → Blockages from twisting, telescoping, or trapped intestine.

Common Surgical Causes by Age

In Newborns

Duodenal Atresia – A blockage in the first part of the intestine; often seen in babies with Down’s syndrome.

Malrotation with Midgut Volvulus – Intestine is twisted; can cut off blood supply within hours.

Jejunal / Ileal Atresia – Blockage in the small intestine.

Meconium Ileus – Thick meconium blocking the bowel.

Annular Pancreas – Pancreas encircles the intestine, causing blockage.

In Infants & Older Children

Intussusception – Bowel slides into itself like a telescope; common at 6–18 months.

Incarcerated Hernia – Intestine trapped in a groin swelling.

Adhesions – Scar tissue from previous surgery.

Gallbladder or Pancreatic Problems – Rare but possible.

Symptoms to Watch For

If your child has green or bright yellow vomiting, look for:

Refusal to feed

Swollen or hard belly

Crying a lot, inconsolable

Passing no stool or gas

Blood in stool (“red jelly” appearance in intussusception)

Unusual sleepiness or weakness

Immediate Steps for Parents / Caregivers

1. Stop feeding – No milk, water, or food until a doctor checks the child.

2. Keep the child upright – Reduces the risk of vomit entering the lungs.

3. Do NOT give home remedies – Gripe water, herbal mixtures, or over-the-counter medicines can delay proper treatment.

4. Go to the nearest hospital with paediatric surgical facilities – Time lost in transfer can cost the child’s intestine.

5. Take vomit sample or photo – Helps the doctor judge the colour.

6. Inform the doctor about all symptoms – Even if they seem small.

What Will Happen at the Hospital

Doctors may:

Place a tube in the stomach (nasogastric tube) to drain fluid and relieve pressure.

Give intravenous fluids to correct dehydration.

Order urgent X-ray or ultrasound to locate the blockage.

Call a paediatric surgeon immediately.

If surgery is needed, it will be done as soon as the child is stable—delaying surgery in certain cases (like midgut volvulus) can cause bowel death in hours.

Why Speed Matters

Midgut volvulus: Can kill the intestine in 4–6 hours.

Intussusception: Early treatment may avoid surgery, but delay can require bowel removal.

Atresia in newborns: Delay increases risk of infection and complications.

What NOT to Do

Don’t assume it’s “just colic”.

Don’t wait for your regular clinic to open—go to the emergency department.

Don’t give oral fluids once green vomit appears.

Don’t try to treat with home massage or pressure on the tummy.

Don’t stop in a small clinic without surgical facilities unless it’s only for stabilisation before transfer.

Preventing Tragedy: Awareness Saves Lives

Parents and relatives:

Learn to recognise green vomit.

Keep emergency hospital numbers handy.

Demand urgent referral if green vomit is present—don’t be told to “wait and watch”.

Health workers:

Any baby with green vomiting = urgent surgical evaluation.

Do NOT send home without investigation.

Initiate IV fluids and stomach tube before transfer.

Special Note on Newborns

In the first days of life:

If a newborn vomits green before passing stool, think intestinal blockage.

Many of these conditions are diagnosed before birth with ultrasound showing polyhydramnios (too much amniotic fluid).

Such babies should be delivered in or quickly transferred to a centre with paediatric surgical services.

Frequently Asked Questions (FAQ)

Q1: Is yellow spit-up after feeds dangerous?
A1: If it’s pale yellow and the baby is otherwise well, it may be reflux. But bright yellow or green vomit—especially if frequent—needs immediate evaluation.

Q2: Can this happen in older children?
A2: Yes. Twists, intussusception, or trapped hernias can cause green vomiting in toddlers and older kids.

Q3: If my baby vomits green once but is fine after, should I still go to the hospital?
A3: Yes—some surgical problems can have temporary relief before worsening suddenly.

Q4: Will my child definitely need surgery?
A4: Not always—some conditions like intussusception may be treated without surgery if caught early. But only hospital evaluation can decide this.

Golden Rules

Green = Emergency.

Every minute counts—hours can make the difference between saving and losing intestine.

Early treatment means shorter recovery, fewer complications, and better results.

Final Message from a Paediatric Surgeon

I have seen far too many babies lose large parts of their intestine because green vomiting was ignored, mistaken for harmless spit-up, or treated with home remedies.
When it comes to green or bright yellow vomiting in children—don’t gamble.
Get to a surgical hospital immediately.
You may be saving not just the bowel, but your child

09/08/2025

Undescended Te**is – A Paediatric Surgeon’s Perspective

As a paediatric surgeon, I frequently encounter undescended te**is (UDT), a condition where one or both te**es fail to reach the sc***um by birth. While common in premature babies, it is not rare in full-term infants either. The te**es, ideally, should descend naturally in the first few months of life; if not, timely surgical intervention is crucial.

Timing of Surgery
From a surgical standpoint, the ideal window for orchidopexy is between 6 and 12 months of age. Operating within this period optimizes fertility potential and significantly reduces future risks. Delaying beyond 18 months is rarely advisable, as irreversible damage may occur.

Consequences of Delayed Surgery or No Surgery
Late surgery or non-intervention exposes the child to multiple risks:

Infertility – Prolonged exposure to higher abdominal temperatures damages germ cells, reducing s***m count and quality in adulthood.

Cancer Risk – The likelihood of developing testicular cancer, particularly seminoma, increases if the te**is remains undescended.

Hernia & Torsion – Many cases have associated inguinal hernia, and an undescended te**is is more prone to torsion.

Atrophy – Long-standing UDT can lead to irreversible shrinkage of the te**is.

Diagnostic Difficulty – Abdominal or inguinal te**es are harder to examine, delaying detection of abnormalities.

Psychological Considerations
Beyond medical concerns, I have seen older boys suffer embarrassment, anxiety, and self-consciousness over an empty sc***um. Peer remarks can scar confidence, and in adolescence, concerns about masculinity and fertility may become profound.

Final Word
From my professional experience, early orchidopexy is not merely a technical correction — it is an investment in the child’s future physical and emotional well-being. Prompt parental action ensures the best possible outcome for both body and mind.

08/08/2025

Hazards of Drinking and Smoking: A Doctor’s Perspective

As a medical professional, I witness daily the devastating consequences of alcohol and to***co use on individuals, families, and society. Despite widespread awareness, many people underestimate the cumulative and often irreversible damage caused by drinking and smoking. These substances do not merely affect isolated organs — they deteriorate the human body as a whole and erode the fabric of family and community life.

Liver:
Alcohol is a direct hepatotoxin. Chronic drinking leads to a spectrum of liver diseases — starting with fatty liver, progressing to alcoholic hepatitis, and eventually culminating in cirrhosis and liver failure. Cirrhosis, characterized by irreversible scarring, impairs the liver's ability to detoxify the blood, produce essential proteins, and regulate metabolism. In advanced stages, it leads to jaundice, ascites, hepatic encephalopathy, and an increased risk of liver cancer. No effective treatment can reverse cirrhosis, making prevention through alcohol cessation vital.

Lungs:
Smoking introduces more than 7,000 harmful chemicals into the lungs. These substances damage lung tissue, reduce lung capacity, and trigger chronic inflammation. Over time, smokers develop Chronic Obstructive Pulmonary Disease (COPD), emphysema, and chronic bronchitis, severely impairing breathing. Furthermore, smoking is the leading cause of lung cancer — an aggressive and often fatal malignancy. Passive smokers (especially children and the elderly) also suffer similar lung damage, making smoking hazardous not only for the user but for everyone around them.

Heart:
Both smoking and heavy drinking significantly increase the risk of cardiovascular disease. To***co damages the lining of blood vessels, promotes atherosclerosis (hardening of the arteries), and raises blood pressure. Smoking increases the risk of heart attack, stroke, and peripheral artery disease. Alcohol, in excess, contributes to high blood pressure, arrhythmias (irregular heartbeat), and cardiomyopathy (weakening of the heart muscle). Together, these habits act synergistically to shorten life expectancy by increasing the likelihood of fatal cardiac events.

Pancreas:
Alcohol is a major cause of pancreatitis — both acute and chronic. Acute pancreatitis can cause severe abdominal pain, infection, and even multi-organ failure. Chronic pancreatitis, often caused by repeated alcohol insults, leads to permanent pancreatic damage, digestive issues, and diabetes due to loss of insulin-producing cells. Pancreatic cancer, among the deadliest forms of cancer, is strongly linked with chronic smoking and drinking.

Family and Society:
The harm caused by drinking and smoking extends beyond physical health. Families suffer emotional, psychological, and financial distress due to the addict’s behavior. Alcohol and to***co-related illnesses lead to absenteeism, reduced productivity, increased healthcare costs, and premature death. Alcohol often fuels domestic violence, marital discord, and child neglect. Smoking in the home exposes family members to second-hand smoke, increasing their risk of cancer and respiratory diseases. From a societal standpoint, billions are spent annually on treating preventable diseases caused by these addictions.

Conclusion:
From a doctor's standpoint, the evidence is unequivocal — smoking and drinking are silent killers that destroy organs, shorten lives, and fracture families. Prevention through education, early intervention, and strong social support is essential. Choosing a life free from to***co and alcohol is not merely a personal choice; it is a commitment to health, family well-being, and societal progress.

07/08/2025

Public Awareness Message on Prevention of Birth Defects
By a Concerned Paediatric Surgeon

Every child deserves a healthy start to life. As a paediatric surgeon, I have had the privilege of caring for many children, but I have also seen the pain and challenges families face when a baby is born with a birth defect. The good news is — many birth defects can be prevented. With awareness and timely action, we can protect future generations.

What Are Birth Defects?
Birth defects are problems that develop in a baby before birth. These may affect how a baby’s body looks, works, or grows. Some common examples include cleft lip and palate, heart defects, abnormalities in limbs or the spine (like spina bifida), or problems with the digestive system. Some defects are mild and can be corrected easily, while others can be serious and life-changing.

Can Birth Defects Be Prevented?
Not all birth defects can be prevented, but many can be avoided with proper care before and during pregnancy. Here are a few important steps every woman and family should know:

1. Take Folic Acid Daily
Women planning to become pregnant should take 400 micrograms of folic acid daily — at least one month before conception and during early pregnancy. Folic acid is a type of vitamin (B9) that helps prevent major defects in the baby’s brain and spine.

2. Avoid Harmful Substances
Pregnant women should avoid alcohol, smoking, and drugs. These substances can interfere with the baby’s development and increase the risk of birth defects and other complications.

3. Manage Health Conditions
Women with diabetes, high blood pressure, thyroid problems, or epilepsy must consult their doctors before and during pregnancy. Proper management of these conditions reduces the risk to the unborn child.

4. Get Vaccinated
Infections during pregnancy, like rubella (German measles), can cause serious birth defects. Make sure you are vaccinated before becoming pregnant. This protects both mother and baby.

5. Go for Regular Check-ups
Prenatal care is very important. Regular doctor visits during pregnancy help detect early signs of problems. Doctors can also give advice on proper nutrition, supplements, and lifestyle changes.

6. Avoid Exposure to Harmful Chemicals
Pregnant women should stay away from pesticides, certain cleaning agents, and unnecessary medications. Always consult a doctor before taking any medicine during pregnancy.

7. Know Your Family History
Some birth defects are genetic. If there is a history of birth defects in your family, genetic counselling before pregnancy can help understand the risks and plan accordingly.

8. Ensure Good Nutrition
A balanced diet with enough iron, calcium, iodine, and other essential nutrients supports healthy baby development.

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In Conclusion
Birth defects not only affect a child physically but also emotionally and financially impact the entire family. But with awareness, timely medical care, and healthy habits, many of these conditions can be prevented. As a paediatric surgeon, I urge every parent-to-be to take these simple steps seriously. A few precautions today can lead to a lifetime of happiness for your child tomorrow.

Let’s work together to give every child the healthy start they deserve.

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31/10/2024

Dipawali greetings to all friends and all well wishers

GOI must take note of this and make it a law.This should be applicable to all ,with a cut off date
01/03/2024

GOI must take note of this and make it a law.This should be applicable to all ,with a cut off date

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