MedSpin

Medical Tourism: Globalization of Healthcare

netmedico@gmail.com (Dr.Bhargava) — Thu, 14 Aug 2008 19:20:00 +0000

Two good articles about Medical tourism, "Importing Competition" and "Operating Profit" have been printed in the latest Economist magazine.

The the short introductory article, "Importing Competition" has the following line:

"At the same time the best hospitals in Asia and Latin America now rival or surpass many hospitals in the rich world for safety and quality."

As I have said before, the biggest hurdle that is impeding medical tourism is the lack of confidence of foreigners in the competence of Indian doctors in the Indian health care setting to provide safe and effective treatment.

People promoting medical tourism should emphasize the quality of care and the safety record of the hospitals. More soundbites on this issue and a little less on the cost savings involved will allay a lot of fears in prospective patients.

The second article, "Operating Profit", tackles many of the issues raised by critics of medical tourism.

Unlike the dozens of articles written about medical tourism everyday, this article breaks away from the routine format and goes deeper into the issues and shows how it will impact the health care systems of the countries involved.

All in all, two good articles. As they say, read the whole thing.

Related Articles on Medical Tourism

Medical Tourism in India Ads being streamed on YouTube

Promoting Medical Tourism in India

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Profit Making Medical Colleges to Be Opened in India

netmedico@gmail.com (Dr.Bhargava) — Thu, 07 Aug 2008 21:28:00 +0000

Oh, finally the Govt may loosen its grip on medical colleges!

The Govt may allow medical colleges to be set up as profit making institutions.

Will this mean higher fees for medical students ?

Only people whose IQ is equal to their shoe size would believe that the existing medical colleges are really being run as non profit enterprises. The term 'profit making medical college' is redundant as even now all private medical colleges are making profits, albeit off the records.

All that the present rule does is to keep away people who would like to open a medical college but are not willing to take the risk of making profits off the record. (Ethics/Not worth the risk etc. )

Allowing medical colleges to legitimately make a profit will attract more people to open medical colleges. Even though the initial fees in these colleges might be on the higher side, each additional college will offer more competition to the existing ones and eventually drive down the fees.

If only a few colleges are opened, we will get ripped.

So more the medical colleges, merrier the students :-)

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Medical Tourism in India Ads being streamed on YouTube

netmedico@gmail.com (Dr.Bhargava) — Thu, 07 Aug 2008 21:03:00 +0000

A couple of videos on YouTube about patients who did not have health insurance in US and had surgeries in India.

This is about a US patient who had a liver transplant at Apollo Hospital. It also features a couple of US doctors expressing their opinion.

And this one is about Wockhardt Hospital, Bangalore.

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With Digital Pathology, No More Squinting and Peering at the Microscope and Glass Slide

netmedico@gmail.com (Dr.Bhargava) — Fri, 18 Jul 2008 19:01:00 +0000

A significant part of pathology consists of squinting your eyes and peering over microscopes, trying hard to make out patterns in the slide.

Digitizing pathology slides and displaying them on large computer screen would make the process of observing slides very convenient. Beyond convenience, there are many other advantages and applications of digitizing pathology slides.

The developments till now in the emerging filed of Digital Pathology are summed up in this talk titled "The Evolution of Digital Pathology" by the founder of Aperio.

Probably the most heartening line in the article is

" I think it’s fair to say that pathologists today acknowledge that the quality of digital slides is more than adequate for most needs."

For a fee, Aperio scans and converts glass slides into digital slides which can be viewed on the Internet. At charges ranging from $30 to $150 per slide, this service is hardly affordable for most hospitals, especially in countries like India.

But as with all things digital, the cost of this service is expected to fall steeply every few months. (Like the cost of sequencing a human genome )

A couple of weeks ago, GE Healthcare formed an independent company, 'Omnyx', to develop the technologies needed to take digital pathology mainstream.

The ensuing competition will drive the prices down to affordable levels.

Till then, keep peering at the slide under the microscope.

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For Indian Doctors, Post Graduation to be 4 Years from next year

netmedico@gmail.com (Dr.Bhargava) — Thu, 10 Jul 2008 05:53:00 +0000

A news article in Economic Times titled

"For doctors, post graduation now a long & rustic journey"

All postgraduates (private and govt colleges), all over India will have to work for one year in rural area as part of Post graduation, which will now be extended to 4 years.

Every few months the health minister comes up with a crazy idea to make our life miserable, and people in the newspapers keep wondering why doctors emigrate to other countries.

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Teleradiology and Netter's Atlas on New iPhone 3G

netmedico@gmail.com (Dr.Bhargava) — Mon, 16 Jun 2008 09:32:00 +0000

At the launch of the second generation of iPhone, called iPhone 3G, two new medical applications were demoed.

Modality is targeted at medical students who can now browse through Netter's atlas on the iPhone.

Mimvista is for radiologist who can review X-rays, CAT scans on their iPhone.

Expect a ton of such features within the next few months.

Related Articles

With Digital Pathology, No More Squinting and Peering at the Microscope and Glass Slide

$1000 Human Genome: Anticipating the Arrival of Personal Genomics

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$1000 Human Genome: Anticipating the Arrival of Personal Genomics

netmedico@gmail.com (Dr.Bhargava) — Fri, 02 May 2008 17:59:00 +0000

Here is a fun graph to keep track of the rapid fall in the costs of sequencing a human genome.

Most experts consider a price of $1000 (Rs 40,000 at present rates) to be the tipping point at which most people will start getting their genomes sequenced routinely. May be as part of screening a child at birth.

But for India the tipping point is closer to $100. We may have to for a year or two for technology to make it affordable.

Note that the Y axis is logarithmic.

I have used the following data points for this graph.

Point Zero:( Not on the graph) Human Genome Project(HGP)

In 1990, an international consortium of scientists set out to sequence the first human genome. It took 13 years and cost approximately $3 Billion (That is $3,00,000,000.)
Only one set of chromosomes, 23 out of 46, were sequenced (Haploid only)

It was a mosaic of DNA obtained from many people.

Point 1: The Celera HGP

In 1998, a private company called Celera sequenced the human genome. It took about 5 years and cost about $100 Million ($100,000,000)
Only one set of chromosomes, 23 out of 46, were sequenced (Haploid only)

It was a mosaic of DNA from 5 people, Craig Venter being the main contributor.

Point 2: Genome of Craig Venter

Around 2003, the sequencing of the genome of one individual (Craig Venter) was begun.
It took around 4 years and about $70 million.

All 46 chromosomes were sequenced (Diploid)

Point 3: Genome of James Watson

In 2007, the genome of James Watson was sequenced by '454 Life Sciences' to demonstrate its new technology.

It cost about $1.5 million (15,00,000) and took around two months to sequence.

Point 4: Launch of Knome

In Nov of 2007, Knome offers to sequence whole genomes of individuals for $3,50,000.

The price also includes consultation with genetic counselors and other benefits.

Point 5: Illumina and Applied Biosystems

In Feb 2008, researchers at Illumina, claimed that they could sequence a human genome for $1,00,000

In March 2008, researchers at a company called Applied Biosystems claim that they can sequence a human genome for about $60,000.

And many more people attempt to bring the price a few steps closer to $1000.

A few articles about sequencing the Human Genome

$350,000 Genome

Mapping the individual - cheaply

6 Billion Bits of Data About Me, Me, Me!

Illumina, Gene-Sequencing Warrior

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How (Not) to Cure a Country of Obesity

netmedico@gmail.com (Dr.Bhargava) — Wed, 23 Apr 2008 09:11:00 +0000

This reminds me that staying healthy is means to an end, not an end in itself.

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Ipsi- Tipsy

netmedico@gmail.com (Dr.Bhargava) — Mon, 21 Apr 2008 23:56:00 +0000

Q: What do you call being drunk on the same side of your body?

A: Tipsi-lateral

(Anonymous)

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Promoting Medical Tourism in India

netmedico@gmail.com (Dr.Bhargava) — Mon, 21 Apr 2008 07:36:00 +0000

Dr. Aniruddha Malpani at The Patient's Doctor asks the question

"What can the Indian Government do to promote medical tourism?"

My answer, the short version is, "Stay out of the way".

The long version is

1. Stay out of regulating who can set up a medical college and how to run a medical college.

2. Stay out of regulating who can join and how much fees is to be paid and what is to be taught.

I understand that the Government of India has a strong urge to do something to promote medical tourism. So I would suggest:

3 Negotiate with governments of foreign countries to simplify the process of recognition of Indian Medical degrees by foreign countries.
We as citizens of India cant do this easily. We can handle the rest of the things. Thank you.

Confidence in Indian Doctors

Right now, the biggest hurdle that is impeding medical tourism is the lack of confidence of foreigners in the competence of Indian doctors in the Indian health care setting to provide safe and effective treatment.

Foreign patients are not anxious about the competence of the significant number of Indian doctors who are working in UK, US and recently Australia as these Indian doctors have been certified by the respective foreign countries.

But getting this certification is costly in terms of money and time. For example a surgeon from India will have to repeat at least 3 years training in US, spend about a million rupees to be certified to treat patients from US. If this process is simplified, there will be more foreign certified Indian doctors in Indian hospitals. Foreign patients can then more easily rely on Indian hospitals. This is one way of solving this.

India doctors are not the only ones facing this and doctors of other third world countries offering medical tourism are also facing this hurdle. Whichever country in able to solve this problem first will take a lead in medical tourism.

Price Tag of Indian Hospitals

Dr. Aniruddha Malpani has suggested that the government should provide tax exemptions to hospitals that are involved in earning foreign exchange. To its credit, the Government of India has provided 5 year tax exemptions to hospitals in Tier II and III cities in the budget of 2008.

But Indian hospitals are so cost competitive, as compared to western hospitals and competing countries in medical tourism that even after paying tax, the price tag of Indian hospitals will be lower than the nearest competitor.

Price is not the issue. Confidence is.

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After MBBS: Karnataka Medical PGCET 08 Seat Selection

netmedico@gmail.com (Dr.Bhargava) — Wed, 02 Apr 2008 07:48:00 +0000

Medical Rank 1 to 250 in the Karnataka PGET 08 will be attending seat selection round today.

All the PG seats in the four Government Medical Colleges and 33 percent of the PG seats in each private medical college in COMEDK will be offered for selection through this round.

In Karnataka PGET 07, there were a total of 178 MD seats and 126 diploma seats(clinical, para/pre clinical from Govt and private colleges) for people who had written Karnataka PGET 07. This was then further divided into general merit and other categories.

This year the number of seats is likely to be less than last year as a few of the private colleges have been granted deemed university status and will be admitting students through their own entrance exams.

Students taking up a seat in a private medical college through Karnataka PGET will get a subsidy of 33% from the Government of Karnataka.

In turn all students taking up seats, in private and government medical colleges, have to sign a bond that they are willing to work in Government hospitals for a period of 3 years(MD)/2 years(diploma) if the government so desires.

The fees for a seat in private college is

Course	Total Fee (100%)	Fee after reduction of 33%
1. Medical
a) Degree
- Clinical	Rs. 4,56,000/-	Rs. 3,05,000/-
- Para Clinical	Rs. 1,14,000/-	Rs. 76,000/-
- Pre Clinical	Rs. 57,000/-	Rs. 38,190/-
b) Diploma
- Clinical	Rs. 3,42,000/-	Rs. 2,29,000/-
- Para Clinical	Rs. 1,14,000/-	Rs. 76,000/-
2. Dental Degree
- Clinical	Rs. 2,34,000/-	Rs. 1,56,000/-
- Para Clinical	Rs. 78,000/-	Rs. 52,260/-

The fees for a seat in government college is

Course	Total Fee
1. Medical
a) Degree
- Clinical	Rs. 20,000/-
- Para Clinical	Rs. 10,000/-
- Pre Clinical	Rs. 5,000/-
b) Diploma
- Clinical	Rs. 20,000/-
- Para Clinical	Rs. 10,000/-
2. Dental Degree
- Clinical	Rs. 20,000/-
- Para Clinical	Rs. 5,000/-

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Genetics: Naming Genes

netmedico@gmail.com (Dr.Bhargava) — Sun, 23 Mar 2008 11:55:00 +0000

"...a misleading way of talking about genetics that involves tagging genes with the problem that accompanies their dysfunction - genes "for" obesity, aggression, dyslexia, and addiction, and their more obviously medical cousins, the genes "for" cancer, Alzheimer's, and high cholesterol - and you get a world where people begin to think that their genes hold road plans for their lives. That their nature controls them"

Names do matter

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Medical Advances Vs Health Insurance

netmedico@gmail.com (Dr.Bhargava) — Mon, 17 Mar 2008 00:28:00 +0000

"Since insurance depends on mutual ignorance, then any advance in medical science, which pushes back the boundaries of ignorance—whether for the insurers, the insured, or both, will weaken the basis of insurance. The more we know, the less we can insure."

This is from New York Times bestseller "The Undercover Economist" by Tim Harford.

A major part of the chapter "The Inside Story" is about the shortcomings of the US and UK health care systems. The health care system of Singapore, with out of pocket spending for regular doctor visits and health insurance covering catastrophic expenses, is held as the solution.

If you are a econo junkie like me then put this book on your must-read list.

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Patient Care: Protocol Vs Clinical Judgement

netmedico@gmail.com (Dr.Bhargava) — Fri, 14 Mar 2008 02:05:00 +0000

Commenting on the procedure to be followed by physicians in treating any patient in Columbia Hospital in Bangalore.

"It is devising an “integrated critical care pathway, a specific flow of events which needs to be followed by every physician for the treatment of a given symptom.”

If a doctor deviates from this standard for whatever reason, he has to document the reason for doing so"

This might be the sweet spot that we are looking for between the so called impersonal, rigid, inhumane, medicine-as-a-system type of standardized, protocol based management of the patients and the each-patient-is-unique type of care.

This allows for standardized and efficient management of the patient based on a protocol while allowing lee way to the physician, based on his clinical judgment, to tailor the treatment to the needs of a particular patient.

Trying to have the best of both worlds.

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Medical PG KCET 2007 Rank Cut off

netmedico@gmail.com (Dr.Bhargava) — Tue, 11 Mar 2008 08:04:00 +0000

Getting a ~~good~~ rank in any entrance exam is half the battle.

Making sense of what the rank means and what seats will be available for that rank is the other half of the battle which only the ~~fortunate~~ deserving few will get to fight.

On the RGUHS website, at this page

http://www.rguhs.ac.in/student/newcollegelist.php?fcode=01

you can find the number of seats alloted to each college , classified into subdivisions to be filled up though KCET, COMEDK, Management quota, NRI quota, All India Quota.

But the best part is that there in also information about the name of the person who took up a particular seat in 2007, his rank, the category (GM, cat II/III, SC, ST) and other details.

So you can sort of compile a list of the seats chosen by the first 100 or 200 rank holders in KCET 2007. But the list wont be complete as a few of the colleges have not put up this information (?yet). You can know the general pattern in which seats of different specialties and colleges are taken up in each round and what the likely choices that you will face during counseling.

It is cumbersome, but it can be done.

Others who are preparing for the next KCET exam can do this to get an idea about the ruthless competition that is out there to get you.

What rank do you need, to get into the seat that you want ?

Postscript: If any of you have such lists for previous entrance exams (All India, KCET) about which seat will be available for what rank under which category, please mail it to netmedico@gmail.com

Read the other posts on this blog

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Part 1: How to study ENT ?

netmedico@gmail.com (Dr.Bhargava) — Mon, 10 Mar 2008 00:07:00 +0000

Recently one of the readers of this blog asked me "How to retain what is read in ENT?".

One easy way to understand any subject and retain it is to visualize what is being read.

Knowing the anatomy and functioning of the ear is essential.

Here are few videos that might be of help.

This is a short animation to know the basics of Ear anatomy.

This is a 5 minute didactic video of ear anatomy.

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Funny Condom Song from India

netmedico@gmail.com (Dr.Bhargava) — Sun, 09 Mar 2008 17:31:00 +0000

Fake US Medical School

netmedico@gmail.com (Dr.Bhargava) — Fri, 07 Mar 2008 16:55:00 +0000

This is the weirdest this I have come across in a while.

A fake medical school in US is trying to lure students.

I had heard of fake doctors. But a whole medical college ?

Cost of Creating a Doctor in a Private College

netmedico@gmail.com (Dr.Bhargava) — Thu, 06 Mar 2008 07:52:00 +0000

Let us see how much it costs a young person in time and money to become a fully minted doctor from Kasturba Medical College, Manipal, one of the best medical colleges in India. This is a private autonomous college and the full cost is borne by the student. (i.e no subsidy by the government)

This is the college fees for a General Category student in the year 2008 .
( Does not include accommodation, food and other expenses.)
( Foreign national/NRIs/Management students have to pay more)

MBBS Degree ( Under Graduate)

First Year --- 1 year -- Rs 4,00,500

Second Year --- 1.5 years -- Rs 4,06,000

Third Year ----1 year -- Rs 4,30,000

Fourth Year ---- 1 year -- Rs 4,56,000

Internship ---- 1 Year -- Rs 2,42,000

Total Time : 5.5 Years College Fees: Rs 19,34,500

After spending 5.5 years and paying Rs 19, 34,500 you are awarded a MBBS degree. If you join a top end corporate hospital you can expect a salary between Rs 15,000 to Rs 20, 000 a month. (Roughly 8 to 11 years to earn the 19 odd lakhs paid as college fees).

But most people view a MBBS degree as inadequate to set up a private practice and treat in as a ticket to pursue specialization in some field of their interest by taking up a post graduate course.

MS/MD ( Post Graduate Degree)

A top rank in a competitive exam will grant you an entrance into any of these courses.

This is a three year course and the fees varies depending on the subject chosen.

MD Radiology (X ray, CAT Scan)-- 3 year course -- college fees: Rs 22,45,500

MD Pediatrics (Child Specialist) -- 3 year course -- college fees: Rs 18,31,500
MS Orthopedics(Bone Specialist)

MD General Medicine --- 3 year course-- college fees: Rs 16,09,500
MS General Surgery
MS Obstetrics & Gynecology (Ladies Specialist)

After spending 8.5 years, assuming you get a Post graduate seat in your first attempt, and spending a total of Rs 35,44,000 - Rs 41,80,000 you are certified as a specialist in your field and you can start a private practice and/or join a uni/multi specialty hospital.

Most people settle down at this level of specialization. But this may change in the future due to increasing competition and the demand for super specialists by patients in corporate hospitals.

The pressure to super specialize is already present to some extent in General Medicine and General Surgery.

Super Specialty Courses
Again , a top rank in a competitive exam will grant you an entrance into any of these courses.

If you want to be a Cardiologist(heart), Nephrologist (kidney), Neurologist (nerve), you have to complete a 3 year course after MD General Medicine or MD Pediatrics

Similarly if you want to become a Cardio-thoracic Surgeon, Neurosurgeon , Urologist, you have to complete a 3 year course after MS General Surgery or MD Pediatrics.

Duration: 3 years Course Fee: Rs 22,45,500

So after spending a total of 11.5 years, Rs 57,89,500 and countless exams, you are a super - specialist in your chosen field from one of the best medical colleges in India.

To put this in another way, a 18 year old student entering this end of the tunnel in 2008 will come out of the other end as 30 year old super - specialist in the year 2020.

Post Script: For the sake of simplicity, I have willfully turned a blind eye to the trend of exponentially increasing college fees. I have assumed that college fees will be frozen at the 2008 level till 2020.

I have also assumed that you will get your desired seat in the various entrance exams in your first attempt.

You will have to throw in a few more lakhs for the hostel facility based on the creature comforts you cant live without.

I have not considered Non clinical branches like Pathology, Anatomy, Biochemistry and 2 year diploma courses.

Eradicating Waves of Malaria

netmedico@gmail.com (Dr.Bhargava) — Tue, 04 Mar 2008 13:16:00 +0000

Commenting on the undulating nature of Malaria

"The best-known example of defeat snatched from the jaws of victory is Sri Lanka, which went from one million malaria cases in 1955 to a mere 18 in 1963. Spraying was cut back, and cases surged to 537,000 by 1969. By 2005, the country was again down to 1,640 cases.

The civil war’s cease-fire of 2001 has broken down, and the disease could surge again."

Bill Gates has called for the eradication of malaria. He has been investing a lot of money on this through the Bill and Melinda Gates Foundation.

Just to place this audacious goal in perspective consider this.

A vaccine, considered an essential weapon for eradication of any disease, for polio was developed more than 50 years ago.

Efforts to eradicate polio have been going on since 1985.

There were less than 800 cases of polio in the whole world in 2003.

Yet we are years away from wiping out polio from the face of earth.

In contrast, there are around 500 million malarial infections every year, spread across 107 countries.

And a vaccine for malaria is nowhere in sight.

Can we or should we even aim to eradicate malaria in the near future ?

New Indian Law: Re-registration of Doctors Every Five Years

netmedico@gmail.com (Dr.Bhargava) — Thu, 28 Feb 2008 09:44:00 +0000

Tucked away at the end of this article is this paragraph..

" The commission has also recommended converting the Medical Council of India, Nursing Council of India and Rehabilitation Council of India into a professional association with the power to conduct nationwide examinations, minister of state for health and family welfare Panabaka Lakshmi said.

The new body would also regulate the fee structure in private medical colleges and revamp continuing medical education (CME) and re-registration of doctors every five years based on evaluation of credit earned through CME."

Exams are a necessary evil..

SC/ST Quota in MBBS and BDS for All India Seats

netmedico@gmail.com (Dr.Bhargava) — Wed, 27 Feb 2008 04:43:00 +0000

Latest News

" Seats in government medical and dental colleges across the country that are under the all India quota are filled up on the basis of the all India entrance examination....

Health Ministry has issued directions to the Director General of Health Services (DGHS) to implement 15 per cent reservation for Scheduled Castes and 7.5 per cent for Scheduled Tribes in the exams conducted by the Central Board of Secondary Education (CBSE)."

Prepare to work harder..

Visible Body: Online 3D Human Anatomy Model

netmedico@gmail.com (Dr.Bhargava) — Sun, 24 Feb 2008 05:04:00 +0000

The Visible Body is the best website that I have come across to learn human anatomy by interacting with a three dimensional human model.

After the free registration, the model has to be downloaded. This is a one off thing and will take quite a while depending on your internet speed. Only Internet Explorer is supported right now.

Once the model has been loaded, you can rotate it in any direction, zoom in/ zoom out, isolate required structures, make structures transparent/invisible. You can also add or remove entire systems.

Overall a very good resource for those who are simply just not satisfied with the line diagrams in Chaurasia and need to play around to make sense of it.

Unhappy Doctors and The Great Lie

netmedico@gmail.com (Dr.Bhargava) — Sat, 23 Feb 2008 14:28:00 +0000

This is from a ongoing discussion in med blogs.

Edwin Leap, starts the discussion with the post titled "Why are doctors so unhappy?".

He says

"I believe physicians are unhappy because they believed the great lie.

.. The lie was this: ‘if you become a doctor, your profession of medicine will be all you need for happiness and fulfillment.’ In short, physicians learned to validate themselves by way of a profession.

The problem is, that will always fail. Medicine is a wonderful profession; and also a job. No job should have, or can have, the power to be everything to any of us."

He goes on to say that doctors need validation somewhere besides medicine. He says he has found it in his religion.

And Graham, a medical student, responds

"I believe my generation of physicians never grew up with a great lie.

.....We want to have free time outside of our careers. We want to have families and relationships. Sure, we’re ready to make sacrifices, but we weren’t told a lie–or maybe we just never believed it."

Did you believe ?

Rank List of Karnataka PGET - 2008 (Medical PG)

netmedico@gmail.com (Dr.Bhargava) — Sat, 16 Feb 2008 19:46:00 +0000

Today the Provisional marks list of Karnataka PGET - 2008 (Medical PG) was released. I copied the page to a spreadsheet and messed around till I got the rank list. Since these marks are provisional, the list is tentative. When two or more students score the same marks, the rank is assigned depending upon several factors like number of attempts in UG exams, marks scored in UG exams. Since I do not have these data about individual students, I have given the ranks as a interval.

Marks Scored Rank (Starts from - Ends at)

172 (Highest) 001 and 002
170-- 003 and 004
169-- 005 to 008
168-- 009 to 015
167-- 016 to 023
166-- 024 to 033
165-- 034 to 047
164-- 048 to 060
163-- 061 to 074
162-- 075 to 089
161-- 090 to 110
160-- 111 to 152
159-- 153 to 183
158-- 184 to 217
157-- 218 to 257
156-- 258 to 304
155-- 305 to 345
154-- 346 to 397
153-- 398 to 461
152-- 462 to 517
151-- 518 to 581
150-- 582 to 659

I have the whole rank list sorted till the last rank. I will upload the rest if I find the time.

ನಿದ್ದೆ ಮಾಡಬೇಕು.

Update: Click on the link below to download the whole list. It is a tentative. People who have scored the same marks has been arranged alphabetically for convenience. But in the actual official rank list it will be arranged based on the number of attempts and aggregate marks in UG Exams.

Rank List PGET - 2...

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