Critical Care - ISCCM Care TM A BI˜MONTHLY NEWSLETTER OF INDIAN SOCIETY OF CRITICAL CARE MEDICINE Editorial officE dr. Kapil Zirpe Director & HOD Neuro-Trauma Unit, Grant Medical

C O M M U N I C A T I O N SCritical Care

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w w w . i s c c m . o r g

A B I - M O N T H LY N E W S L E T T E R O F I N D I A N S O C I E T Y O F C R I T I C A L C A R E M E D I C I N E

Editorial officE

dr. Kapil ZirpeDirector & HOD Neuro-Trauma Unit, Grant Medical Foundation, Ruby Hall Clinic, Pune, Maharashtra, India.

Mobile : +91 9822844212 • emails : [email protected]

Published By :

IndIan SocIety of crItIcal care MedIcIneFor Free Circulation Amongst Medical Professionals

Unit 6, First Floor, Hind Service Industries Premises Co-operative Society, Near Chaitya Bhoomi, Off Veer Savarkar Marg, Dadar, Mumbai – 400028

Tel. 022-24444737 • Telefax :022-24460348 • email : [email protected]

We request our esteemed readers to send their valued feedback,

suggestions & views at [email protected]

Contents ISCCM News HeadlIneS1 ISCCM News Headlines

1 ISCCM Elections 2016 appeal. Please update your Email ID and register your mobile number with ISCCM

2 Editorial

2 Editorial Board 2016-2017

3 President's Desk

3 Invitation for ISCCM Day Poster Competition

3 Winners of Critiquiz 2016-2017 “Battle of the Brains” - Episode 1

4 General Secretary's Desk

4-5 New Office Bearers of ISCCM Branches

5 Quiz Second Edition & Answers to First Episode

5 ICU Radiology CME by SCCM Nagpur

6 ISCCM Activities

6 Criticare 2017, Kochi - Young Talent Hunt

7 DCCS 2016

7 Best of Brussels 2016

7 SZCCC 2016

7 Neurocriticon 2016

8-9 Journal Scan

9 IDCON 2016 by SCCM Nagpur

9 Council has decided to Amend MMC CME Credit Point Policy with effect from 01/05/2016

10-11 Critical Care Infectious Diseases e-Course - A dream come true

12 Punishment for Pharma Doctor Relationship Notified

13 Report on JCCM

14 Welcome New Members to the ISCCM family

15-16 CRITICARE 2017 Kochi

ISCCM Elections 2016 AppealPlease update your Email ID and

Register your mobile number with ISCCM

Dear MembersFree and fair elections are the foundation of any democratic society. ISCCM elections are now held online only. It is therefore, imperative that ISCCM has email ids and mobile phone nos. of all its members for registering them on the electoral rolls. You are therefore requested to please update your email ids and mobile numbers as soon as possible. Election participation has been less than 30% in ISCCM election 2015. Please visit our website www.isscm.org for downloading the membership update form. All branches have special duty for following this task. I will be in touch with all branch secretaries for continuing this important work for ISCCM election 2016.

Dr. Kapil ZirpeChairperson Election Commission • [email protected]

Dr. Anand Dongre • Dr. Abhinav Gupta • Dr. Susruta Bandyopadhyay • Dr. Babu AbhrahamMembers Election Commission

Election of Office Bearers of the Executive Committee for 2017-2018 has been declared

First E-course of ISCCM on “Critical Care Infectious Diseases” (CCIDC) was launched on 13th May 2016

INDIAN JOURNAL OF CRITICAL CARE MEDICINE (IJCCM) got selected in Thomson Reuters ESCI

Kochi 2017 National conference preparations are in full swing

Council has decided to amend MMC CME credit points policy with effect from 01/05/2016

VoluME 11.3MAy-JunE, 2016

The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer of indian soCieTy of CriTiCal Care mediCine2

Editorial Board 2016-2017

EDItor In ChIEFDr. Kapil Zirpe, Pune

[email protected]

EditorialDear Colleagues,

Welcome to the Critical Care Communication (CCC). CCC is the official news letter of ISCCM. The aim of CCC is to give a highly

readable and valuable information in the field of critical care medicine. We are pleased to publish the Second Issue of the news letter, which includes election notice, journal scan, medico legal information for all of us, information about ISCCM branches & their academic activates.

I am delighted to inform, First e-course on “Critical Care Infectious Diseases” (CCIDC) was launched on 13th May 2016 by Honorable Minister Dr Harsh Vardhan, Ministry of Science and Technology. The Critical Care Infection Disease Course has been prepared with the help of eminent intensivists & infectious disease experts. The Course has 20 (twenty) modules to run over twenty weeks.

Election of Office Bearers of the Executive Committee for 2017-2018 has been declared on 15th May. Last date to receive the nomination at ISCCM Office 15th June 2016 by 5.00 P.M. and last date for withdrawal is 30th June 2016 by 5.00 P.M.

As the Editor-in-Chief of the CCC, I take this opportunity to express my sincere gratitude to contributors who have chosen the CCC to disseminate their information.

We are more than happy to receive contributions for our next issue from ISCCM Members and branch officials to ensure the consistency and the success of the newsletter. We welcome comments and suggestions that would advance the objectives of the news letter.

dr. Kapil ZirpeEditor in Chief,

the Critical Care CommunicationsPresident-Elect, [email protected]

www.isccm.org

DEPutY EDItorS

Dr. Rahul Pandit, MuMbai Dr. Subhal Dixit, PuNE

[email protected] [email protected]

EDItorS

Dr. Susruta Bandyopadhyay, KolKata Dr. Tushar Patel, ahMEdabad Dr. Yash Zaveri, NEw dElhi Dr. Srinivas Samavedam, hydErabad Dr. Sanjay Dhanuka, iNdorE

[email protected] [email protected] [email protected] [email protected] [email protected]

The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer of indian soCieTy of CriTiCal Care mediCine 3

President's Desk

Dear ISCCM members

Greetings from Mumbai. I would like to take this opportunity

to inform you about various projects undertaken by us during the past few months. The Critical Care Infectious Diseases Course was launched on the 13th of May at Delhi by Dr Harshavardhan, the honourable minister for Science and Technology and Ministry of Earth Sciences. This is a fabulous online course conceived by Dr Rajesh Chawla, our past chancellor of Indian College of Critical Care Medicine. At the end of the course you will get a certificate from Indian College of Critical Care Medicine. I urge all members to go through the course; it will increase your knowledge tremendously. I am planning to bring out 2 more online courses on topics which are generally neglected by most of us. Dr N. Ramakrishnan has kindly agreed to lead the online course on “Administrative Aspects of Critical Care”, which will have 10-12 online modules. Dr Pradeep Rangappa and Dr Abhinav Gupta are going to lead the online module on “Medicolegal Aspects of Critical Care”. This course will also have similar number of modules. The

registrants for both modules will get a course manual which will be published by Jaypee Brothers Medical Publisher (P) LTD. At

the end of both the courses you will get a certificate from Indian College of Critical Care Medicine. On behalf of ISCCM, I am going to sign a contract with Jaypee Brothers Medical Publisher (P) LTD, for next 3 years, starting with Criticare 2017, to bring out annual congress books called

dr. atul P. KulkarniPresident, ISCCM

[email protected]

“Update in Critical Care”. This year’s book has 80 chapters and around 800 pages. The preparations for the book are in full swing.

The elections for the National Executive Committee of ISCCM are around the corner and I urge all of you to update your e-mail IDs and mobile nos. with the ISCCM office. Electronic communications is the future and therefore this updating of contact details is vitally important. The ISCCM app, envisioned by Dr Shiva Iyer, our immediate past president, is now live and fully functional and will provide all the information on the website at your fingertips. Please download it from Google playstore and try it and give us feedback. Last but not the least, the preparation for Criticare 2017 is well underway. I recommend that all of you register for the conference. The younger members of the society can become faculty if they participate in the Young Talent Hunt competition; please upload your presentations on the website isccm.org. I wish all of you a good, bountiful and a badly required monsoon!

Invitation for ISCCM Day Poster Competition

Dear ISCCM Member,

We have been celebrating ISCCM Day every year with a theme. The theme of ISCCM Day for this year is

"Patient Safety in the ICU".

Poster is a good method for making doctors and lay people aware of Patient safety in the ICU. Taking the opportunity of the ISCCM day celebration, we are announcing a Poster competition on "Patient Safety in the ICU".

Top 2 posters will receive a citation from society and prize of Rs 10,000 and Rs 7,500 respectively.

Instructions for submission of Poster on "Patient Safety in the ICU"

1. Ensure that poster is catered to Indian setup

2. It should be original and not copied from somewhere else

3. Should be in poster format

4. Words allowed-up to 100 maximum

5. Should be in English

Last day for submission is 10th September 2016 and it should be emailed to Dr Vijaya Patil, Secretary ISCCM and Chairman, ISCCM Day Committee, ISCCM at [email protected]

We welcome any other suggestions from our members.

With warm regards

dr. Kapil ZirpePresident-Elect,

ISCCM

dr. Vijaya PatilSecretary, ISCCM &

Chairman, ISCCM Day Committee

dr. Pradip Kumar BhattacharyaGeneral Secretary,

ISCCM

dr. atul KulkarniPresident, ISCCM

Winners of Critiquiz 2016-2017“Battle of the Brains” - Episode 1 dr. Gunjan chanchalani

Chief Intensivist, Nanavati Superspeciality Hospital, Mumbaidr. Y.S. Bhambhani

Porbandar, Gujrat

Winners of first episode get free registration for First ICCMID Course on 10-11 September, 2016 at Delhi.


dr. Pradip Kumar BhattacharyaGeneral Secretary, ISCCM

Dear All

Today I feel proud that I am serving a society which really cares and values each and every member of the

society. ISCCM is progressing and I am pledged to work with

highest ethical standards. The good name of ISCCM is one of the

most valuable assets for me. Good names are prone to vulnerability.

Integrity and accountability amongst us will lead us towards right

path and will prevent us from being vulnerable.

Right course of action in right time is the mantra of success.

The hard work which we put is visible to the society; Growth in

membership is an important indicator of it. Now every year we

are adding approximately thousand members to our society.

Only thing which we need is to work with commitment. Personal

interests have to be kept apart.

General Secretary's Desk

Academics and education are two important empowering tools for us. Without government support we are working hard to spread the knowledge of critical care all across the country. Conferences are becoming more and more organized. Further improvements will be visible very soon. ISCCM run critical care courses are expanding every year. With the overwhelming response we are in the process of further improvement in the quality of teaching and exams.

Publication and research make us more acceptable to other people. Our Journal has gone one step ahead and now it is being cited by Thomson Reuters which will help improving its impact factor. ISCCM driven multi-centric CHITRA Study has been launched and more than 1000 registries have happened. More centers are getting attached to share their data. I thank you all, and end with a saying by “Phil Jackson” The strength of the team is each member and the strength of each member is the team.

New Office Bearers of ISCCM BranchesAurangabad

ChAIrMAn

Dr. Vyankatesh Deshpande

SECrEtArY

Dr. Prashant Walse

trEASurEr

Dr. Nahush Patel

ExECutIvE CoMMIttEE MEMbErS

Dr. Avinash TribhuvamDr. Yogesh Deogirikar

Dr. Sunil DhuleDr. Krishna DeshpandeDr. Shrikant Sahastrabudhe

Dr. Amol Kulkarni

RajkotChAIrMAn

Dr. Tejas Karamata

SECrEtArY

Dr. Milap Mashru

trEASurEr

Dr. Hetal Vadera


Dr. Tejas MotivarasDr. Bhumi DaveDr. Tushar PatelDr. Bhavin Gor

Dr. Dipak AgharaDr. Amit Patel

KaramsadChAIrMAn

Dr. Samir B. Patel

SECrEtArY

Dr. Tejash M. Parikh

trEASurEr

Dr. Archana Sinha


Dr. Jyoti MannariDr. Hemlata Kamat

Dr. Himanshu PandyaDr. A.C. Patel

Ahmedabad ChAIrMAn

Dr. Jigar Mehta

SECrEtArY

Dr. Anish Joshi

trEASurEr

Dr. Gopal Rawal


Dr. Faruk MemonDr. Harshal Thaker

Dr. Vivek DaveDr. Amrish Patel

Dr. Nirav VisavadiaDr. Jay Kothari


Pune Puducherry DehradunChAIrMAn

Dr. Subhal Dixit

SECrEtArY

Dr. Kapil Borawke

trEASurEr

Dr. Kayanoosh Kadapatti


Dr. Abhijeet DeshmukhDr. Jignesh Shah

Dr. Sunita VargheseDr. Sachin Jagdale

Dr. Urvi Shukla

ChAIrMAn

Dr. C. S. Adhi Ganesh

SECrEtArY

Dr. Sreenivaasan

trEASurEr

Dr. Sivaramakrishnan


Dr. J. SameerDr. Leo Gounalane

Dr. Hemanth KumarDr. Joseph Rajesh

Dr. Sivaguru Chandran

ChAIrMAn

Dr. Vipin Vaish

SECrEtArY

Dr. Bhupesh Uniyal

trEASurEr

Dr. Sudhir K. Singh


Dr. Sonika KatiyarDr. Rameshwar Pandey

Dr. Luv Kush PandeyDr. Vinay Kumar

Dr. Sushant Khanduri

ICu RadiologyCME by

SCCM nagpur

SCCM, Nagpur organized CME on ICU Radiology on 13th March 2016 at Hotel Tuli Imperial. The CME was attended by total 75 delegates. It covered various topics including Chest X-rays in ICU, Lung Ultrasound, FAST, role of MRI in intracranial vascular emergencies, Role of CT scans in Traumatic Brain Injury, and also CT Thorax and abdomen. Application of 2D ECHO in ICU and its use by Intensivist was also discussed. Similarly quiz on ICU Radiology was conducted by Dr. Imran Noormohammad. The other speakers were Dr. Prashant Nimbalkar, Dr. Anil Jawahirani, Dr. Parimal Fuke and Dr. Nilay Nimbalkar. MMC has granted 2 MMC Credit Hours for this CME. It was first of its kind CME in Nagpur.

Quiz Second Edition1. Trypsinogen is proposed serum

biomarker for which disease2. DAMP expansion3. Which DBO is FDA approved for

therapy. What is FDA approved indications?4. What does monkey jumping imply in

relation to oxygen therapy?5. Dose of activated charcoal in toxicology 6. Which year was Indian College of

Critical Care Medicine established?7. What does CHITRA stands for?

8. Who am I? 9. Spot On – Whats wrong

10. What is The Tiger Tube? Benefits

Answers to First Episode1. EUPHARATES: Evaluating the Use

of Polymyxin B Haemoperfusion in a Randomized controlled Trial of Adults treated for Endotoxemia and Septic shock.

EUPHARATES RIVER IN IRAQ

2. NICCOLO MACHIAVELLI

3. PETER SAFAR: Father of CPR

4. 8/7/94: Transplantation of Human Organs Act passed

5. 9/10/93: Establishment of ISCCM

6. HBP: Heparin Binding Protein Sepsis Biomarkers

7. q - SOFA: quick SOFA score for SEPSIS identification

8. Hide and Die syndrome: It is a condition seen in fatal hypothermia, particularly

in old persons. Long exposure to the severe cold produces paralysis of the thermo regulatory mechanism, which leads to the aberrant feeling of a higher body temperature and the victim may take off some or all of his clothing known as Paradoxical undressing.

9. Tacrolimus

10. If frozen at -18 deg C cryoprecipitate has shelf life of 1 year.

dr. yash Zaverinew [email protected]


ISCCM ActivitiesCritical Care Refresher Course was

held at Medanta The Medicity, Gurgaon by Dr Deepak Govila and

Dr Sachin. The course was an instant hit with a houseful show.

Sepsis Rediscovered an Open House session was organized by ISCCM Delhi at India Habitat Centre.

International Speaker Program on high flow nasal oxygen therapy was organized on 10 April at IHC. Professor J.J.Rouby was the guest speaker for the program.

IA one day CME on Critical Care – Spreading The Knowledge was held on 24th April 2016 which was jointly organized with Department of Critical Care Medicine, Fortis-Escorts Hospital, Faridabad and Society of Critical Care Medicine (Delhi-NCR)on24 April 2016, Sunday at Hotel Vivanta by Taj, Surajkund, Haryana.

Indian Association Medical Microbiologists (Delhi chapter) and ISCCM Delhi NCR organized CME “Bench to Bedside” a joint educational program on microbiology and critical care on 7 May at India Habitat Centre. The CME was specially designed for microbiologist and critical care specialist. The topics on blood culture, antimicrobial resistance, respiratory viral infection and many more discussed.

First E-course on “Critical Care Infectious Diseases” was launched on 13th May 2016 by Honorable Minister Dr Harsh Vardhan, Ministry of Science and Technology. Dr Harsh Vardhan gave a very inspirational talk. Dr Yash Javeri moderated the session. Dr Rajesh Chawla moderator CCIDC gave a brief introduction to the course. Dr Harsh Vardhan inaugurated the course. Dr Atul Kulkarni, Dr Dhruv Chaudhary, Dr Debashis Dhar and many senior colleagues were present for the launch of e course.

Indian Association of Medical Microbiologists – Delhi Chapter & Indian Society of Critical Care Medicine – Delhi

CONVERGENCE OF MINDS: PART I

BENCH TO BEDSIDE

Joint CME: 7th May 2016

India Habitat Center, New Delhi

Criticare 2017, Kochi - young Talent Hunt

Dear ISCCM members,

ISCCM is committed for giving opportunity to young and new talent in Criticare 2017. We hereby invite online

applications from our members to participate in Young Talent

Hunt and to be a part of the National Faculty at Criticare 2017,

Kochi. The members are required to upload their presentation on

ISCCM website. The webpage for uploading the presentation is

available on ISCCM website.

Criteria:

1. Member should not have spoken/delivered lecture at previous

ISCCM National Conferences.

2. Age <35 years.

3. The member can select his/her topic for the presentation.

4. The member's presentation should not be more than 12 minutes.

5. The last date of Application is 15th October 2016.

6. The eligible members may please log on to ISCCM website and upload their presentation for Young Talent Hunt.

7. The conference secretariat will bear the expenses for your stay during conference only.

8. ISCCM center will pay for travel by II A/C.

9. All the presentations uploaded on the web site will be viewed and the best will be selected. The selected members will be invited to speak at Criticare 2017, Kochi.

With warm regards

Dr. Atul KulkarniPresident, ISCCM

Dr. Kapil ZirpePresident-Elect, ISCCM

Dr. Pradip Kumar BhattacharyaGeneral Secretary, ISCCM


TM

Delhi Critical Care Symposium

14th Annual Conference of SCCM Delhi NCR&

First ICCMID CourseINTENSIVE CARE CLINICAL MICROBIOLOGY & INFECTIOUS DISEASE COURSE

10-11 September 2016India Habitat Centre, Lodhi Road, New Delhi 110003

HIGHLIGHTS Multidisciplinary ConferenceThematic Course

Criti QuizOpen House and Hot Debates

ICCMID Course Indianised Course Focus on Severe Life Threatening

Infections Resistance Trends

Perfect Amalgam of Audience and Faculty

Best Critical Care ID Case

Dr. Debasis Dhar Dr. Vinod Singh OrganisingChairperson ScientificChairperson

Dr. Yash Javeri, Organizing Secretary9818716943•[email protected]

CONFERENCE SECRETARIATSociety of Critical Care Medicine Delhi

(A Branch of Indian Society of Critical Care Medicine)805/59 Shakuntla Tower, Nehru Place, New Delhi 110019

Tel.:011-41007180•Mob.:9811895550e-mail:[email protected]

ConferenceCo-ordinator:Ms.KavitaSharma•9811895550

www.isccmdelhi.com

Abstract Submission Last Date 15th July 2016Send your abstract to [email protected]

4th International Best of Brussels Symposiumon Intensive Care & Emergency Medicine

Jointly Organised by

ISCCM, Pune Branch& Intensive Care Department of Erasme Hospital, Brussels

Workshops : 3-7 July 2016

Symposium : 8-10 July 2016

Venue : Hyatt Regency, Pune

Shirish PrayagOrganizing Chairman

[email protected]

Dr. Kapil ZirpeOrganizing Secretary

+91-9822844212•[email protected]

Dr. Subhal DixitJoint Organizing Secretary


Dr. Sameer JogChairmanScientificCommittee


For Registration Please Contact

Medvents Conferences & Events Pvt LtdOfficeNo112,AshokaPavillion,DrAmbedkarRoad, AboveMaheshLunchHome,Camp-Pune-411001.

ForRegistrationEnquiries:SupriyaTak:+917767834459Office:020-26069376MobileNo.:09822311519/09657746584

e-mail:[email protected]

www.isccmpune.com

2nd Annual South ZoneCritical Care Conference of ISCCM

Organized by ISCCM Hyderabad Chapter

Supported by ISCCM Chapters of Vizag, Kakinada, Rajahmundry, Vijaywada, Tirupati and Kurnool

Theme: Cardiovascular Critical Care “Man & Machine – Synergy for Optimum Outcome”

Workshops & Courses : 25-26 August 2016

Conference : 27-28 August 2016

Venue : Marriott Hyderabad Hotel & Convention Centre

Dr. T. Shyam SunderOrganizing Chairman+91-9849038265

Dr. Ganshyam JagathkarOrganizing Secretary+91-9949001344

Dr. Srinivas SamavedamChairman–ScientificCommittee

+91-9866343632

Dr. Srinivas JakkinaboinaTreasurer

+91-9652342973

For Registration Please Contact :

Medvents Conferences & Events Pvt LtdOfficeNo112,AshokaPavillion,DrAmbedkarRoad,AboveMaheshLunchHome,Camp-Pune-411001.

ForRegistrationEnquiries:SupriyaTak:+917767834459Office:020-26069376MobileNo.:09822311519/09657746584

e-mail:[email protected]&[email protected]

www.szccc2016.org

TMTM

Annual Conference on Neuro Critical Care Medicine & Pre-Conference Workshops on Neurology

Organised by Indian Society of Critical Care Medicine, Nagpur

17-19 June 2016 • Hotel Centre Point, Ramdaspeth, NagpurPre-Conference Workshops : 17 June 2016

HIGHLIGHTS Thematic Sessions on Traumatic Brain&Spinalinjuries

Transport and Care Neuropharmacology covering

Theraperatic Hypothermia Neuro Monitoring EEG Monitoring, Remote and

Tele Monitoring, Neuroscales view

Infections in Neurocritical care Neurosurgical Complications and

prevention Various Research and Updates

in Neurocritical Care Neuro Imaging Nutrition in Critically Ill Neuro

Patients

Dr. Nirmal JaiswalOrganising Chairman

SuretechHospital&ResearchCentre,Nagpur,13-A,BanerjeeMarg, Dhantoli,Nagpur12,Maharashtra,INDIA•Mobile:9890955055

e-mail:[email protected]•[email protected]. Rajan BarokarOrganising Secretary

Dr. Sanjay JainChairman,ScientificCommittee

For Registration Contact :

RajuAndulkar292,ShankarNagar,BehindWockhardtHospital,Nagpur10

9822717917•9423228161•9822675744 e-mail:[email protected]

www.neurocriticon2016.com • www.isccmnagpur.com


JOUR

NAL SCAN

dr. Srinivas Samavedamhead of the Department of Critical Care, Mediciti Institute of Medical Sciences, Shamirpet

SEPSISSurviving sepsis guidelines are set to be revised in a few months. Some established paradigms are bound to be omitted or changed. however some interesting studies have been published on this common problem in the first quarter of the year.

Heart rate reduction with esmolol is associated with improved arterial elastance in patients with septic shock: a prospective observational study: Intensive Care Medicine April 2016Systemic inflammatory response is an integral part of sepsis syndrome. While it might be a protective phenomenon, unregulated effect of SIrS on the myocardium is likely to be detrimental. Morelli et al carried out an observational study among a small (45) population of septic patients who required norepinephrine for maintaining the Mean Arterial Pressure (MAP). Enrolment started atleast 24 hours after hemodynamic optimisation. their hypothesis was that esmolol will improve the hemodynamics by improving arterial elastance, which is expected to improve ventriculo-Atrial coupling. Apart from routine hemodynamic monitoring, stroke volume and Pulmonary arterial pressures were measured invasively. the targeted MAP was 65 mm hg and heart rate < 95 bpm. the dose of esmolol used was 25mg /hr with an upper dose limit of 2000mg/hr. CvP and PAOP were used to decide fluid status optimisation. The primary outcome measured was 28 day mortality. the authors report a decrease in norepinephrine requirements at the first assessment which happened 4 hours after commencement of esmolol infusion. Stroke Volume also improved significantly. Ejection Fraction and Cardiac output did not show any negative effects. the authors concluded that esmolol infusion could be beneficial for patients with high norepinephrine requirements after adequate volume resuscitation

Reviewer’s comments: this seems to be an innovative idea for hemodynamic optimisation in patients with vasopressor dependent septic shock. however, this cannot be extrapolated to patients with sepsis associated myocardial dysfunction. the use of CVP and PAOP as end points of fluid optimisation is a questionable choice. Stroke volume optimisation could have been a better target. however, it shows a new path for hemodynamic optimisation in a select group of septic patients.

High-Dose Versus Conventional-Dose Continuous Venovenous Hemodiafiltration and Patient and Kidney Survival and Cytokine Removal in Sepsis-Associated Acute Kidney Injury: A Randomized Controlled TrialAJKD April 2016

Another area which focuses on blunting the SIrS in sepsis is attempted removal of inflammatory cytokines. Several methods have been attempted including high volume hemofiltration. Previous studies (IvoIrE) have yielded negative results. Park et al on behalf of the hICorES investigators conducted a prospective open label rCt to evaluate this approach. they included all septic patients who required rrt for AKI. they attempted to compare a high volume hemofiltration strategy (80 ml/kg/h) with a conventional strategy (40ml /kg/h). Circulating levels of cytokines were measured at randomisation pre and post filter. Baseline APACHE and SOFA scores were matched and were significantly high (> 28 and >14 respectively). There did not seem to be any significant difference in the 28 mortality between the two groups. Cytokine levels post filter showed significant gradients. Patients enrolled in the high volume arm tended to stay longer in the ICu and in the hospital. Overall high volume hemodiafiltration did not seem to make a difference to a population of sick patients with sepsis

Reviewer’s comments: Cytokine involvement in the pathogenesis is time tested. however, reducing the levels of these mediators of inflammation on the overall outcome of sepsis is not impressive. It ultimately boils down to sepsis being a more complex syndrome where no single intervention will make a big difference

Randomized, Double-Blind, Placebo-Controlled Trial of Thiamine as a Metabolic Resuscitator in Septic Shock: A Pilot StudyCrit Care Med 2016; 44:360–367

Sepsis syndrome is associated with unhinging of homeostatic mechanisms. tissue hypo perfusion is a hallmark of the disease complex. hyperlactatemia is a known accompaniment and regression of lactic acidosis has been suggested as a marker of efficacy of resuscitation. Several interventions – expensive or otherwise – have been tried to reduce the micro environmental damage. Donnino et al tried to study if addition of thiamine, which is an essential vitamin for aerobic metabolism, improves the “metabolic atmosphere” in septic patient. they used lactate clearance as an indicator. they enrolled more than 80 patients with Sepsis (by SIrS criteria) and septic shock. Patients with liver dysfunction were excluded as were “alcoholics”. Primary endpoint was reduction in lactate levels 24 hrs after drug administration. Patients randomised to intervention arm received 200 mg of Intravenous thiamine twice daily for seven days. All patients had thiamine levels measured prior to receiving the drug or placebo. APAChE scores were more than 25 in both groups with SoFA scores greater than 8, indicating a sick cohort of patients. Thiamine deficient patients were identified a priori. Overall thiamine supplementation did not have a significant effect on lactate clearance or shock reversal. however, patients with thiamine deficiency showed better lactate levels and shock reversal, with a longer time to death when treated with thiamine.

Reviewers comments: Thiamine deficiency and its consequences are well reported from the subcontinent. Prescription of thiamine containing multi vitamin preparations are common in ICus. routine administration does not seem to confer a benefit amongst general cohort of patients. But thiamine deficient patients seemed to benefit from a supplementation regimen. It is definitely an area to investigate amongst our cohort of patients

Risks and Benefits of Stress Ulcer Prophylaxis for Patients With Severe SepsisCrit Care Med 2016

Sepsis associated gastro intestinal bleeding is not uncommon. outcomes of patients who develop GI bleed while in ICu are poorer than those who do not bleed, although a direct causal relationship has not been established. Stress ulcer Prophylaxis is a standard recommendation in all guidelines for ICu patients, including those with Sepsis. however, of late the rationale in prescribing SuP for all patients has come under scrutiny, especially from the angle of nosocomial infections. Sasabuchi et al carried out a retrospective cohort study evaluating the risks and benefits of SUP among patients admitted to acute care hospitals in Japan. A database review was done to retrieve the data. At least one organ failure was needed for data of the patient to be evaluated. both proton pump inhibitors and h2 receptor antagonists were considered as SuP. Patients receiving sucralfate were excluded. need for Mechanical ventilation, rrt, blood transfusion, vasopressors and nutritional plan change were recorded. Gastro intestinal bleeding needing endoscopic hemostasis was the primary outcome measured. Close to seventy thousand patients and their outcomes were reviewed. Patients in the SuP group had lesser incidence of GI bleed but had higher mortality as well as higher rates of ventilator Associated Pneumonia. the rates of Clostridium Difficile infection were however not different among both the groups. Amongst subgroups of patients who were hemodynamically unstable and needed Mechanical ventilation, SuP conferred a mortality advantage.

Reviewer’s comments: SuP is another time tested ICu paradigm which is likely to change. Although this is a retrospective analysis, it raises certain pertinent points. SuP needs to be individualised. blanket prescriptions are not recommended. SUP can increase VAP rates. It is beneficial in a hemodynamically unstable septic patient in shock. however, prescription needs to be reviewed as soon as the clinical situation improves.

Airway Issues: Complication Rates of Open Surgical Versus Percutaneous Tracheostomy in Critically Ill PatientsLaryngoscope, March, 2016

Percutaneous tracheostomy has become a standard ICu procedure. Some intrinsic advantages have been identified for the percutaneous procedure. there are however proponents of the surgical open method, who are concerned about the safety of the percutaneous procedure. Johnson-obaseki et al carried out an updated meta analysis to answer the question of safety of the percutaneous procedure. A time analysis was also done comparing both the techniques. Intra and Post operative haemorrhage as well as infections were the primary results

analysed along with infections. their analysis suggested that no major differences exist in terms of haemorrhage or infection between percutaneous and surgical tracheostomy techniques. Percutaneous techniques took shorter time.

Reviewer’s Comments: the debate about percutaneous versus surgical tracheostomy should be laid to rest. the technique has less to do with outcomes when compared to the experience of the operator. In trained hands both techniques are equally good. the focus therefore should be on acquiring that experience

Video Laryngoscopy versus direct laryngoscopy – Which should be chosen for endotracheal intubation during cardiopulmonary resuscitation? A prospective randomised controlled study of experienced intubators Resuscitation March 2016

Endotracheal intubation is usually a part of CPr. Conventionally Direct Laryngoscopy is used in this situation. there is some concern that Endotracheal intubation could interrupt chest compressions, diluting the efficacy of CPR.

Kim et al carried out a prospective randomised study comparing the effect of direct laryngoscopy and video laryngoscopy on the airway access among patients undergoing CPr. All the persons who intubated these patients had performed at least 50 intubations. A total of 140 intubations were analysed. the speed and success of intubation was the same irrespective of which method was used. however, direct laryngoscopy took longer than video laryngoscopy. Interruptions of CPR > 10 seconds happened more often with direct laryngoscopy. this delay was also seen in highly experienced intubators ie those who had done > 80 intubations

Reviewer’s Comments: Endotracheal intubation has significant impact on the outcome of CPR. It is worth considering using videolaryngoscopy to minimise the interruptions to CPr, which is a quality indicator.

Neuro Critical Care: Hypertonic saline in severe traumatic brain injury: a systematic review and meta-analysis of randomized controlled trialsCJEM 2016;18(2):112-120

the management of raised Intra Cranial Pressure in the context of traumatic brain Injury is a core area of neuro Critical Care. the gold standard for ICP management is the osmotic diuretic Mannitol. of late some concerns have emerged about the adverse effects of Mannitol and the use of alternatives like hypertonic Saline has been advocated. berger – Pelleiter et al performed a meta analysis of literature to evaluate the potential benefits or harm associated with the use of hS in the management of tbI associated raised ICP. the a results from analysis included 11 studies enrolling a little over eighteen hundred patients. Point to note is that one particular study enrolled 1200 patients. The authors could not find any benefit in terms of ICP control or survival with the use of HS when compared to other fluids. The authors therefore do not recommend HS over other fluids for ICP management

Reviewer’s Comments: this meta analysis attempts to answer a common question in neuro critical care. however, including pre hospital resuscitation with hS is a confounding factor. More data needs to emerge before mannitol is completely taken off the shelf in neuro ICus.

Impact of Intracranial Pressure Monitoring on Prognosis of Patients With Severe Traumatic Brain InjuryMedicine Volume 95, Number 7, February 2016

Another area in neuro intensive care which is drawing attention is whether ICP monitoring results in better outcomes. Several studies have emerged in the recent past which have questioned the wisdom of measuring or evaluating ICP to tailor therapy. han et al performed a meta analysis evaluating the role of ICP monitoring in influencing outcomes among patients with severe TBI. Eighteen studies satisfied the screening criteria laid down by the authors. the authors did not find any difference in the mortality or need for mechanical ventilation or ICu stay when therapy was guided by ICP monitoring. however, softer outcome parameters like need for RRT and electrolyte abnormalities had a better profile when therapy was ICP guided.

Reviewer’s Comments: ICP monitoring seems to be going the PA catheter way. the tool is seen as equal to the result. however, ICP monitoring in non tbI settings needs to be evaluated separately before the paradigm change is recommended across all patients in neuro ICu.


Endovascular thrombectomy after large vessel ischaemic stroke – a meta-analysis of individual patient data from five randomised trialsThe Lancet 387 (10029)1723-1731

One of the areas where a definite change of practice is imminent is in the management of large vessel ischaemic infarcts. Last year saw the publication of atleast five RCTs on this subject. Goyal et al attempted to analyse the patient data from these five RCTs to come to a more comprehensive conclusion. Reduced disability on the modified Rankin score was taken as the primary end point for this analysis. Data of more than twelve hundred patients was evaluated. Endovascular thrombectomy was associated with lesser disability at 90 days across the data base. the number needed to treat for atleast one point improvement in the outcome score was 2.6. Elderly population and those who had contraindications for thrombolysis seemed to benefit equally well. Severe clinical deficit also was not a contraindication for thrombectomy.

Reviewer’s Comments: While thrombolytic therapy offered a ray of hope for patients with Ischemic Stroke, thrombectomy brightens the scene with inclusion of those in whom thrombolysis is contraindicated. A definite paradigm shift is in place here.

Mechanical Ventilation: Diastolic dysfunction as a predictor of weaning failure: A systematic review and meta-analysisJournal of Critical Care Mar (2016)

Weaning from mechanical ventilation is intricately linked to cardiac function. Decompensation of systolic function is known to be a determinant of weaning failure. Diastolic dysfunction and its association with outcomes among critically ill patients is increasingly being investigated. Almeida et al performed a meta analysis to identify the relationship between diastolic function and weaning from mechanical ventilation. one of the screening criteria for studies included in this meta analysis is the need for an Echocardiograph soon after as Sbt. the analysis suggested that a prolonged E/e’ ratio predicts weaning failure especially if the assessment is done after an Sbt. however the duration and patterns of Sbts were highly variable.

Reviewer’s Comments: the Sbt has been a good tool to assess weaning from mechanical ventilation. till date only surrogate markers have been used to suggest hemodynamic intolerance of the Sbt. this meta analysis suggests a more practical and replicable method of assessing the consequences of an Sbt

Mechanical Ventilation and Diaphragmatic Atrophy in Critically Ill Patients: An Ultrasound StudyCrit Care Med 2016

the diaphragm is a crucial participant in the process of weaning from ventilator support. Atrophy of the diaphragm is known to happen very early among patients ventilated in a controlled mode. Identification of dysfunction of the diaphragm is therefore of prime importance when the process of liberation from mechanical ventilation begins. Zambon et al conducted a prospective single centre observational study on the effect of mechanical ventilation on diaphragmatic thickness. the

diaphragm was assessed at the zone of apposition. the authors found that the thinning of the diaphragm is seen more often with controlled ventilation than with spontaneous breathing or CPAP. ultrasound seems to be very useful in identifying this thinning. A decrease in thickness of1.5% - 6% per day was noted by the authors.

Reviewer’s Comments: ultrasonographic assessment of cardio respiratory function has become standard of care. the report of measurable decay in diaphragmatic thickness is yet another parameter we can easily asses during patient evaluation.

Other articles: BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adultsDavidson AC, et al. Thorax 2016;71:ii1–ii35

ArDS is very well reviewed in the March issue of the ICM.

IDCon 2016 by SCCM nagpur

The SCCM Nagpur chapter organized a conference on Infectious Diseases. It was held on 23rd and 24th January 2016

at Chitnavis Convention Center, Nagpur. The conference covered various topics starting from malaria, tuberculosis, MDR tuberculosis, and other tropical illnesses to many complicated nosocomial infections including management of complex MDRO. The faculty for the conference included Dr. Atul Kulkarni, noted Critical Care Consultant from TATA Memorial Hospital, Dr. Ashit Hegde and Dr. Rajeev Soman from Hinduja Hospital, Dr. Tanu Singhal, Kokilaben Ambani Hospital, Dr.

Abdul Gafoor, Dr. Ram Gopalkrishnan and Dr. Ram Subramaniam from Apollo Hospital Chennai, Dr. Narvekar from Lilavati Hospital, Mumbai, Dr. Sandhya

Joshi, Manimal Hospital, Bangalore and Dr. George Vergese from CMC, Vellore. In all 360 delegates registered and attended the conference. Dr. Ram Subramanian delivered an oration on 10 Commandments of ID while Dr. Ashit Hegde spoke on various topics including New onset Fever in ICU and Colistin vs Polymixin B. This was first major conference on Infectious Diseases covering especially Critical Care ID related topics. MMC has granted 4 credit hours for this conference.

Council has decided to Amend MMC CME Credit Point Policy with effect from 01/05/2016

1. CME credit hours exemption to be granted on the request of the RMP considering the official age for senior citizen to lower the age required to 65 from 70 years. This will be applicable who have completed 65 years of age. Till the age of 65 years they will have to get 6 credit points per year, exemption is only from credit points and not for renewal of registration.

2. For the purpose of smooth function of CME credit hours certification the council should authorize members to certify the credit hours only and other certificates after verification of original CME certificate of the RMP with their signature/seal. One copy should be preserved by them. Members should be careful while authenticating any document.

3. For the purpose of decentralization and streamline the work for the

benefit of the RMPs of renewal of Registration CME credit hours certification the Council should authorize to President of accredited organization, Dean of Govt. Medical Colleges/Principal of Private Medical Colleges, Civil Surgeons, Director, Joint Director, Deputy Director of Medical Education and Research and Director, Joint Director, Deputy Director and DHO of Health Services and President, Indian Medical Associations all branches to certify the original credit hours certificate of the RMP with their signature/seal. They should mention the accredited number given by MMC under signature and seal. Further the affidavit in this regard should also be obtained from the President of respective regional Indian Medical Associations and organisations.

4. It was discussed to relax the norms of 6 Credit Hours per year and 30 credit hours every 5 years to 30 credit hours every 5 years preferably 6 credit hours per year. This is in conjunction to Chapter 1 clause 1.2.3 of Indian Medical Council (Professional Conduct Etiquette and Ethic) Regulation, 2002.

5. Indian Medical Council (Professional Conduct Etiquette And Ethic) Regulation, 2002 Chapter 1 clause 1.2.2 states that- "For the advancement of his professional, a physician should affiliate with associations and societies of allopathic medical profession and involve actively in the function of such bodies." Hence all the RMPs applying for the Registration / Renewal of Registration should be advice to become the members of associations/societies of Allopathic Medicine.


Critical Care Infectious Diseases e-Course - A dream come true

www.isccm.org • www.isccmcourses.org

The resistant bug has troubled all of us in the ICU for as long as we can remember. Now it’s getting smarter

& smarter and more skilful in surviving what we hit it with. The problem of drug resistant bacteria in the ICU is as old as the ICU itself and we are slowly getting to a point where we might lose this war completely. Although we have potent antibiotics but they are slowly but surely beginning to fail. Newer antibiotics are slow in coming and no new antibiotic class is expected any time soon! We have to do with what we have and it is in both, the patient’s and our best interests that we treat with caution and wisdom, based on the current best practices.

There are many risk factors in ICUs which predispose patients to infections. Despite the availability of potent antimicrobial therapy and advances in supportive care, infections in critical care units remain a major cause of morbidity and mortality. It is well known that Gram negative bacteria are most commonly responsible for nosocomial infections in the ICUs in the Asia-Pacific region and frequently lead to sepsis and septic shock while in the western world Gram positive infections play a major role. Nosocomial infections with sepsis and septic shock have a mortality of 12 - 38% and the outcome depends in part on the time of institution of antimicrobial therapy. Therefore a broad spectrum antibiotic cover is started early, even before the receipt of microbiological data, which is later modified, depending on sensitivity patterns. Nosocomial Gram negative organisms, however, pose serious therapeutic problems because of the increasing incidence of multidrug resistance. The situation is alarming because there are not many antibiotics in the pipeline for Gram negative infections.

We are also well aware of the problems of antibiotic overuse and misuse, both inside and outside the ICU. There is also often a delay in initiating antimicrobial treatment in critically ill patients. Then there are

issues with dosing of antibiotics as well as the duration of treatment with physicians often erring on one side or the other. They also sometimes fail to review antibiotic treatment once microbiological culture data becomes available. It is important not only to prescribe appropriate antibiotics as early as possible, but more important is not to prescribe and to discontinue antibiotics when not required or not indicated. One also needs to know how to distinguish between infection and colonization as also between community acquired and nosocomial infections because the later portend a much greater threat to life than the former. It is also important to know the appropriate microbiological tests required to reach a diagnosis and to correctly interpret them. It is therefore important to understand these and other principles that govern antibiotic prescription in infections in the critical care unit in order to achieve favourable outcomes. With these issues in mind we at Indian College of Critical Care Medicine (ICCM) of Indian Society of Critical Care Medicine(ISCCM) decided to start its first online course on infections prevalent in ICU - Critical Care Infectious Diseases eCourse (CCIDC),

Critical Care Infectious Diseases eCourse (CCIDC), the first e-course by ISCCM was launched by Honourable Dr. Harsh Vardhan, Minister of Science & Technology and Earth Sciences, Govt. of India, on 13th May at The Claridges Hotel, New Delhi. The function was attended by Dr Atul Kulkarni, President ISCCM; Dr. Pradip Bhattacharya, General Secretary

ISCCM; Dr. Dhruva Chaudhary, Vice-chancellor, Indian College of Critical Care Medicine; Dr. Yatin Mehta, Dr. Prakash Shastri, Dr. Rajesh Pande, Dr. D. K. Singh, Dr. Deepak Govil, Dr. Yash Javeri, Dr. Krishan Chugh, Dr. Rahiv Uttam, Dr. Rupak Singla, Dr. Avdhesh Bansal, Dr. Sudha Kansal, Dr Vivek Nangia, Dr. Debshish Dhar, Dr. Supradip Ghosh, Dr. Anirban and many others. This is the first structured e-course started by any critical care society in the world at such a low enrolment fee.

As I am writing ,more than 250 delegates have already registered and the feedback is very encouraging.

Making of the course

Conceptualization:

Over the last 2 decades so much has changed the way we communicate. Communication has become extremely easy. Most of the medical teaching is done physically in classes. We all will agree that the standard of teaching is not the same everywhere and at different points in time. Over the years I have felt that in the ICU there is a great need of updating the knowledge of care givers.

I have always been thinking as to why we don’t have virtual e-class room in critical care and the best and most experienced person in the country takes this class on a particular subject which is available to everyone who wants to learn. I shared this with many IT personals over the years, but nothing materialized. About a year ago a pharma company approached us with a particular person with whom I had discussed this idea earlier. The idea got a real push when they sounded serious to support Critical Care Infectious Diseases Course. I was chancellor for the college at that time and we jumped at the idea which

Dr Rajesh ChawlaChief Co-ordinator & Moderator


Critical Care Infectious Diseases eCourse (CCIDC)

Enrolment has started Course Fee :

ISCCM members Rs. 2000/-Non ISCCM members Rs. 3000/-

Logon to enrol atwww.isccm.org or www.isccmcourses.org

was fully supported by the college board and executive body of the ISCCM. That is how we started working for Critical Care Infectious Diseases Course (CCIDC) as the society’s first e-course.

Subsequently I told the pharma to find out the cost of making such a program. After three months they told me that there are vendors who make such a program like BMJ but they are asking for 80 lakhs & another famous company who is asking for 40 lakhs. We had a budget of only about 15 lakhs. After seeking more competent and innovative organizations to execute the project we approached Kamyab infotech Pvt. Ltd. (eLearning Services Division) who understood the concept and suggested the execution be done, using Lean Six Sigma concepts which helped bring the cost down without compromising the production quality and time.

Selection of topics & facility:

We discussed the possibilities of a lot of topics to be covered in this course. I talked to infectious disease specialists in India and abroad, office bearers, intensivists and short listed topics. Then I asked Dr. V. Ramasubraminan, ID Specialist, Apollo Hospital, Chennai and Dr. Subhash Todi for help in making a final list of topics. We then finalized 20 topics for 20 modules to be covered in the course.

The faculty for the Master Classes was selected from the eminent ID specialist, microbiologists and intensivists with special interest and competency in infectious diseases. Out of them we named six co-ordinators, Dr. Camilla Rodrigues, Dr. Subhash Todi, Dr. V. Ramesh, Dr. Shiva Iyer, Dr. N. Ramakrishnan & Dr. Rajesh Chawla (chief coordinator).

We divided the topics into five groups. Each co-ordinator was given the task of looking after each group. Each coordinator was asked to co-ordinate among 4-5 faculty members. After receiving the presentation from the speaker the group co-ordinator sent it to all the other members of the group for their inputs. Subsequently we organized contact meetings at Mumbai on 25th October 2015 to discuss the presentations, contents and knowledge transfer possibilities of various topics. The meeting was attended by Dr. Camilla Rodrigues, Dr. Subhash Todi, Dr. V. Ramesh, Dr. Shiva Iyer, Dr. N. Ramakrishnan, Dr. Rajesh Chawla, Dr. V. Ramasubraminan, Dr. Atul Patel, Dr. Rajiv Soman, Dr. Kunal Lahiri, Dr. Pravin Amin and Dr. Dhruva Chaudhary. The content & presentation material was discussed in each group and then after correction they were presented in front of all the groups together. The inputs were collated and incorporated and the final presentation & course material set was sent for formatting and designing.The faculty included are not only the eminent in the field but are also very busy. I must say that they all co-operated & gave us the content in record time. The faculty for the Master Classes and Expert Interview included Dr. Camilla Rodrigues, Dr. Subhash todi, Dr. Ramesh Venkatraman, Dr. Shiva Iyer, Dr. N. Ramakrishnan, Dr. Rajesh Chawla, Dr V. Ramasubraminan, Dr. Arunaloke Chakrabarti, Dr. Atul Patel, Dr. Rajiv Soman, Dr. Shirish Prayag, Dr. Pravin Amin, Dr. Ram E Rajagopalan, Dr Ram Gopalakrishnan, Prof. Kunal Lahiri, Dr. Atul Kulkarni, Dr. J. Divatia, Dr. Abdul Ghafur, Dr. Dhruva Chaudhary, Dr. Vivek Nangia, Dr. J. C. Suri, Dr. G. C. Khilnani, Dr. Pradip

Bhattacharya, Dr. Suresh Ramasubban, Dr. Krishan Chugh, Dr. Avdhesh Bansal, Dr. Sheila Myatra, Dr. Sudha Kansal, Dr. Rajiv Uttam, Dr Yash Javeri and Dr. Rupak Singla, Dr Prashant Nasa and Dr. Deven Juneja helped in preparing MCQs of few modules.Initially we had thought of only a couple of Master Classes and Self Evaluation Quiz (Case Based MCQs) in each module. But later, on Dr. Todi’s suggestion we gave links for articles which are free on the internet. He also suggested the Take Home Points Section which one must know at the end of each class. So each module now includes Master Class(es), Take Home Points, Suggested Reading, Expert Interview , Self Evaluation Quiz (MCQs) with explanations and Feedback. Presentation on the platformWe were initially not very sure how the presentation would look on the web. I visited many online courses, medical & nonmedical and youtube video. I did not find what I was looking for. I discussed the challenge with Ankit, Systems Architect & Analyst at Kamyab Infotech Pvt. Ltd., along with their production team including Dharmender Berry and after several trials we could make the Production we were looking for.The shoots and production was carried out at multiple places: Post Graduate Institue, Chandigarh; Hinduja Hospital, Mumbai; Apollo Hospitals Chennai; Indraprastha Apollo Hospitals, Delhi; J. P. Hotels, Agra and The Claridges Hotel, DelhiThen these video productions were edited several times to get the refined perfect video.I would like to thank everyone especially Dr Shiva Iyer, Dr Atul Kulkarni, Dr Kapil Zirpe, Dr Subhal Dixit, Dr Dhruva Chaudhary, Dr Pradip Bhattacharya college board, executive committee of ISCCM for giving me the freedom and supporting me at every step. I would like to thank Abbott Healthcare Pvt Ltd for supporting this endevour. I would like to thank Kamyab Infotech PVT Ltd and their team for making this dream a reality. I am sure we will have many such courses in future.Visit www.isccmcourses.org or www.isccm.org for enrolment.Happy learning!


Punishment for Pharma Doctor Relationship notified

Medical Council of India NotificationPublished from I.M.A.G.S.B. News Bulletin, April 2016 issue

New Delhi, the 28th January, 2016 No. MCI - 211 (1) / 2010 (Ethics) / 163013:- In exercise of the powers conferred by Section 33 of the Indian Medical Council Act, 1956 (102 of 1956), the Medical Council of India with the previous sanction of the Central Government, hereby makes the following Regulations to amend the “Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002:-1. i. These Regulations may be called the “Indian

Medical Council (Professional Conduct, Etiquette and Ethics) (Amendment) Regulations, 2015.” (ii) They shall come into force from the date of their publication in the Official Gazette.

2. In the “Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002”, the following additions/modification/ deletions/substitutions, shall be, as indicated therein:-

3. i. The title of Section 6.8, as amended vide notification dated 10/12/2009, shall be further amended by deleting the words “and professional association of doctors” as under:- “6.8 Code of Conduct for doctors in their relationship with pharmaceutical and allied health sector industry”

ii. Section 6.8.1. (b), as amended vide notification dated 10/12/2009, shall be substituted as under:—

b. Travel Facilities: A medical practitioner shall not accept any travel Facility inside the country or outside, including rail, road, air, ship, cruise tickets, paid vacation, etc. from any pharmaceutical or allied healthcare industry or their representatives for self and family members for vacation or for attending conferences, seminars, workshops, CME Programme, etc. as a delegate.

iii. Action to be taken by the Council for violation of Section 6.8, as amended vide notification dated 10/12/2009, shall be prescribed by further amending the Section 6.8.1 as under:-

6.8.1 In dealing with Pharmaceutical and allied health sector industry, a medical practitioner shall follow and adhere to the stipulations given below:-

a. Gifts: A medical practitioner shall not receive any gift from any pharmaceutical or allied healthcare industry and their sales people or representatives.

Action: Gifts more than Rs. 1,000/- up to Rs. 5,000/. : Censure

Gifts more than Rs. 5,000/- up to Rs.10,000/: Removal from Indian Medical Register or State Medical Register for 3 (three) months.

Gifts more than Rs. 10,000/- to Rs.50,000/- : Removal from Indian Medical Register or State Medical Register for 6 (six) months.

Gifts more than Rs. 50,000/- to Rs. 1,00,000/-: Removal from Indian Medical Register or State Medical Register for 1 (one) year.

Gifts more than Rs.1, 00,000/-: Removal for a period of more than 1 (one) year from Indian Medical Register or State Medical Register.

b. Travel facilities: A medical practitioner shall not accept any travel facility inside the country or outside, including rail, road, air, ship, cruise tickets, paid vacations etc. from any pharmaceutical or allied healthcare industry or their representatives for self and family members for vacation or for attending conferences, seminars, workshops, CME programme etc. as a delegate.

Action: Expenses for travel facilities more than Rs. 1,000/- up to Rs. 5,000/-: Censure

Expenses for travel facilities more than Rs. 5,000/- up to Rs. 10,000/-: Removal from

Indian Medical Register or State Medical Register for 3 (three) months.

Expenses for travel facilities more than Rs. 10,000/- to Rs. 50,000/-: Removal from Indian Medical Register or State medical Register for 6 (six) months.

Expenses for travel facilities more than Rs. 50,000/- to Rs. 1,00,000/-: Removal from Indian Medical Register or State Medical Register for 1 (one) year.

Expenses for travel facilities more than Rs. 1, 00,000/: Removal for a period of more than 1 (one) year from Indian Medical Register or State Medical Register.

c. Hospitality: A medical practitioner shall not accept individually any hospitality like hotel accommodation for self and family members under any pretext.

Action: Expenses for Hospitality more than Rs. 1,000/-up to Rs. 5,000/-: Censure

Expenses for Hospitality more than Rs. 5,000/- up to Rs. 10,000/-: Removal from Indian Medical Register or State Medical Register for 3 (three) months.

Expenses for Hospitality more than Rs. 10,000/- to Rs. 50,000/-: Removal from Indian Medical Register or State Medical Register for 6 (six) months.

Expenses for Hospitality more than more than Rs. 50,000/- to Rs. 1,00,000/: Removal from Indian Medical Register or State Medical Register for 1 (one) year.

Expenses for Hospitality more than Rs. 1,00,000/-: Removal for a period of more than 1 (one) year from Indian Medical Register or State Medical Register.

d. Cash or monetary grants: A medical practitioner shall not receive any cash or monetary grants from any pharmaceutical and allied healthcare industry for individual purpose in individual capacity under any pretext. Funding for medical research, study etc. can only be received through approved institutions by modalities laid down by law/rules/guidelines adopted by such approved institutions, in a transparent manner. It shall always be fully disclosed.

Action: Cash or monetary grants more than Rs. 1,000/- up to Rs. 5,000/-: Censure

Cash or monetary grants more than Rs. 5,000/, up to Rs. 10,000/-: Removal from Indian Medical Register or State Medical Register for 3 (three) months.

Cash or monetary grants more than Rs. 10,000/- to Rs. 50,000/-: Removal from Indian Medical Register or State Medical Register for 6 (six) months.

Cash or monetary grants more than Rs. 50,000/- to Rs. 1, 00,000/-: Removal from Indian Medical Register or State Medical Register for 1 (one) year.

Cash or monetary grants more than Rs. 1,00,000/-: Removal for a period of more than 1 (one) year from Indian Medical Register or State Medical Register.

e. Medical Research: A medical practitioner may carry out, participate in, work in research projects funded by pharmaceutical and allied healthcare industries. A medical practitioner is obliged to know that the fulfilment of the following items (i) to (vii) will be an imperative for undertaking any research assignment/project funded by industry-for being proper and ethical. Thus, in accepting such a position a medical practitioner shall :-

i. Ensure that the particular research proposal(s) has the due permission from the competent concerned authorities.

ii. Ensure that such a research project(s)

has the clearance of national/state/institutional ethics committees/bodies.

iii. Ensure that it fulfils all the legal requirements prescribed for medical research.

iv. Ensure that the source and amount of funding is publicly disclosed at the beginning itself.

v. Ensure that proper care and facilities are provided to human volunteers, if they are necessary for the research project(s).

vi. Ensure that undue animal experimentations are not done and when these are necessary they are done in a scientific and a humane way.

vii. Ensure that while accepting such an assignment a medical practitioner shall have the freedom to publish the results of the research in the greater interest of the society by inserting such a clause in the MoU or any other documents/agreement for any such assignment.

Action: First time censure, and thereafter removal of name from Indian Medical Register or State Medical Register for a period depending upon the violation of the clause.

f. Maintaining Professional Autonomy: In dealing with pharmaceutical and allied healthcare industry a medical practitioner shall always ensure that there shall never be any compromise either with his/her own professional autonomy and/or with the autonomy and freedom of the medical institution.

Action: First time censure, and thereafter removal of name from Indian Medical Register or State Medical Register.

g. Affiliation: A medical practitioner may work for pharmaceutical and allied healthcare industries in advisory capacities, as consultants, as researchers, as treating doctors or in any other professional capacity. In doing so, a medical practitioner shall always:—

i. Ensure that his professional integrity and freedom are maintained.

ii. Ensure that patients interest are not compromised in any way.

iii. Ensure that such affiliations are within the law.

iv. Ensure that such affiliations/employments are fully transparent and disclosed.

Action: First time censure, and thereafter removal of name from Indian Medical Register or State Medical Register for a period depending upon the violation of the clause.

h. Endorsement: A medical practitioner shall not endorse any drug or product of the industry publically. Any study conducted on the efficacy or otherwise of such products shall be presented to and/ or through appropriate scientific bodies or published in appropriate scientific journals in a proper way.

Action: First time censure, and thereafter removal of name from Indian Medical Register or State Medical Register.

Dr. Reena Nayyar, Secy. I/c. (ADVT.-III/4/Exty./100/347) The Principal Regulations namely, “Indian

Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002” were published in Part - III, Section (4) of the Gazette of India on the 6th April, 2002, and amended vide MCI notification dated 22/02/2003, 26/05/2004 & 10/12/2009

Courtesy : IMA NEWS


Report on JCCM

Friends

I am happy to share with you that IJCCM, the scientific mouthpiece

of the ISCCM has been recognized by Thomson Reuters for the Emerging sources citation index. This would mean that the journal will have greater visibility in the Web of Science. IJCCM will also be monitored for eligibility for an Impact Factor, the hallmark of a quality journal. Letters from Thomson Reuters and our Publishers Wolters Kluver are proudly enclosed!

We have a long way to go for the coveted Impact Factor, but it is clearly possible for

Respected Dr. Mani;

Hope this email finds you well. We are very pleased to inform you that

IJCCM got selected in Thomson Reuters ESCI. Your journal will now be available in Web of Science and will get a new logo at your website soon.

Now your focus should be publishing mainly those articles which you think can

us. We have had so far 2696 authors, 1472 reviewers and more than 600 manuscript submissions a year. IJCCM has been a monthly since January 2014 with 200 articles a year. Nearly 20% are overseas submissions. Our acceptance rate, however is still high at 35%.

The way to ensure that we make the cut for an Impact Factor is to raise the quality of our articles. We need more Original Research, meta analyses and systematic reviews. These submissions will receive top priority. In an effort to enhance quality the rejection rates may go up.

I would urge you all to conduct well

designed studies with robust methodology addressing original questions. Please submit to the IJCCM as the preferred journal as the visibility in PubMed and ESCI will greatly add value to your work. Please bear with the review process which will be stricter, but I assure you every effort will be made to help you improve your work. For the above category of articles, publication would be fast-tracked to within 6 months.

But this moment of our recognition is a moment to savour.

Warm regards

dr. r. K. ManiChief Editor, [email protected]

Thomson Reuters1500 Spring Garden St. 4th FloorPhiladelphia PA 19130Tel (215)386-0100 (800)336-4474Fax (215)823-6635

Thomson Reuters™

May 17, 2016

Dr. Sunny DuttaguptaSenior Managing EditorWolters Kluwer Health - Medknow

Dear Dr. Sunny Duttagupta,

I am pleased to inform you that Indian Journal of Critical Care Medicine has been selected for coverage in Thomson Reuter’s products and services. Beginning with 2016, this publication will be indexed and abstracted in:

♦ Emerging Sources Citation Index

If possible, please mention in the first few pages of the journal that it is covered in these Thomson Reuters services.

Would you be interested in electronic delivery of your content? If so, we have attached our Journal Information Sheet for your review and completion.

In the future Indian Journal of Critical Care Medicine may be evaluated and included in additional Thomson Reuters products to meet the needs of the scientific and scholarly research community.

Thank you very much.

Sincerely,

Marian HollingsworthDirector, Publisher Relations

letter from Wolters Kluwerbring good citations, because your citation metrics will be monitored by Thomson Reuters and when they find it suitable for SCIe, they will upgrade your journal and provide an impact factor.

It is however time to celebrate the fantastic achievement. Our Editorial team will continue to help you further achieve higher indexing status.

The letter of selection is enclosed.

Sincere Regards

Dr. Sunny DuttaguptaSenior Managing EditorEditorial Quality Management Health Learning, Research & PracticeWolters Kluwer, India


Welcome New Members to the ISCCM family1 Venkateswaran Ramanthan, Puducherry LM-16/R-5032 Sarvesh Kumar, Moradabad LM-16/K-8143 Banshi Saboo, Ahmedabad LM-16/S-13354 Vinod Kumar, Muzaffarpur LM-16/K-8245 Guruprasad Narayana, Gadag LM-16/N-2556 Harpreet Sandhu, Mumbai LM-16/S-13687 Anand Srivastava, Navi Mumbai LM-16/S-13318 Bharat Sharma, Dist Alwar ALM-16/S-13329 Jobby James, Kannur Dist ALM-16/J-39710 Shubhendu Bajpai, Mumbai LM-16/B-60611 Akash Nayak, Dist - Mehsana LM-16/N-24912 John Joseph, Kottayam LM-16/J-39813 Roshan Santosham, Chennai LM-16/S-133314 Sabarish Shanmugam, Dharmapuri (Dist) LM-16/S-133415 MD.Jawed Akhter, Dist Muzaffarpur ALM-16/A-49616 Bhakti Bhalavat, Mumbai LM-16/B-60717 Michael Noronha, Guntur ALM-16/N-25018 Aditya Kabra, Hyderabad LM-16/K-81019 Pradeep Sharma, Ghaziabad LM-16/S-133620 Bharat Kumar, New Delhi LM-16/K-81121 Aharnish Shah, Ahmedabad LM-16/S-133722 Deepak Giri, Osmanabad LM-16/G-61723 Srinivasarao Gorle, Chennai LM-16/G-61824 Ziyana Liyakath, Alappuzha (Dist) LM-16/L-8625 Venkata Yakkanti, Dist Prakasham LM-16/Y-5326 Parul Jain, Hyderabad ALM-16/J-39927 Amin Sanjaybhai, Modasa LM-16/S-133828 Shyam Karia, Surendranagar LM-16/K-81229 Amit Bawkar, Mumbai LM-16/B-60830 Apu Adhikary, Darjeeling LM-16/A-49731 Elangho Muthusamy, Coimbatore LM-16/M-70732 Utkarsh Utkarsh, Agra LM-16/U-5433 Anand Mittal, Sonipat LM-16/M-70834 Meenakshi Dhanu, Mumbai ALM-16/D-48935 Nikul Patel, Ahmedabad LM-16/P-76336 Uzair Shaikh, Ahmedabad LM-16/S-133937 Rajesh Chaudhary, Jaipur LM-16/C-38738 Kuldeep Chittora, Jaipur LM-16/C-38839 Mahesh Kota, Nellore Dist LM-16/K-81340 Milankumar Modi, Surat LM-16/M-70941 Dilip Sawale, Pune LM-16/S-134042 Surabhi Chandra, Allahabad LM-16/C-38943 Achal Gaidhar, Akola ALM-16/G-61944 Saurabh Nande, Bilaspur ALM-16/N-25145 Siddharth Bandla, Hyderabad LM-16/B-60946 Mrugank Bhavsar, Mehsana LM-16/B-61047 Vivekanandan Senthamilpari, Chennai LM-16/S-134148 Akshat Jain, Navi Mumbai ALM-16/J-40049 Vikrant Pawar, Navi Mumbai LM-16/P-76450 Ajinkya Bhosle, Mumbai LM-16/B-61151 Bindu Minhas, Jaipur ALM-16/M-71052 Maunik Gajjar, Ahmedabad ALM-16/G-62053 Babhanaji Adkine, Nanded LM-16/A-49854 Niraj Bannore, Dist - Washim LM-16/B-61255 Ajay Gawri, Mumbai LM-16/G-62156 Sivaraj Patchaiappan, Pondicherry LM-16/P-76557 Hemil Jasani, Mumbai LM-16/J-40158 Pragnesh Patel, Mehsana LM-16/P-76659 Ankit Deshwal, Haridwar LM-16/D-49060 Seema Sharma, Gurgaon LM-16/S-134261 Ravikumar Vaviya, Surat LM-16/V-27162 Khushbu Vaghasiya, Surat ALM-16/V-27263 Dinesh Sharda, Ahmedabad ALM-16/S-134364 Rahul Garg, Ghaziabad ALM-16/G-62265 Haresh Wagh, Mumbai ALM-16/W-6066 Beauty Hati Baruah, New Delhi ALM-16/H-10567 Komal Gurjar, New Delhi LM-16/G-63768 Shailendra Singh, New Delhi LM-16/S-134469 Manohar K, Bangalore LM-16/K-81570 Shailesh Patil, Nashik LM-16/P-76771 Shashidhar Ramaiah, Bangalore ALM-16/R-50472 Aarti Varshney, New Delhi LM-16/V-27373 Shashank Prakash, Bangalore LM-16/P-76874 Praveen K.M, Bangalore LM-16/K-81675 Ankit Bhatia, Ghaziabad LM-16/B-61376 Jisha George, Jaipur ALM-16/G-62377 Vikas Patel, New Delhi ALM-16/P-76978 Pratik Dhumal, Dist Raigad ALM-16/D-49179 Kaustav Das, Guwahati LM-16/D-49280 Neeraj Kumar, Varanasi LM-16/K-81781 Vipin Singh, Lucknow LM-16/S-134582 Yuvraj Arora, New Delhi ALM-16/A-49983 Ashok Pathak, Purnia LM-16/P-77084 Sanjay Saxena, Agra LM-16/S-134685 Zubin Vaid, Mumbai LM-16/V-27486 Pramod Korani Ratnam, Hyderabad LM-16/K-81887 Pramesh Shrestha, Mauaraj Gunj LM(SAARC)-16/S-134788 Subhash Acharya, Kathmandu LM(SAARC)-16/A-50089 Shankar Vallapu, Secunderabad LM-16/V-27590 Ajay Shukla, Gorakhpur ALM-16/S-134891 Prakash Doraiswamy, Bangalore LM-16/D-49392 Virendra Kuwar, Mumbai ALM-16/K-81993 Vishal Sharma, Dholpur LM-16/S-134994 Anand Londhe, Ahmednagar LM-16/L-8795 Nasir Sheikh, Jammu LM-16/S-135096 Potukuri Priyadarshini, Visakhapatnam LM-16/P-77197 Dharmic Suresh, Salem LM-16/S-135198 Ashish Verma, Bhopal LM-16/V-27699 Nilendu Gupta, Kolkata ALM-16/G-624

100 Prabha N, Bangalore ALM-16/N-252101 Kalyan Nath, Dist South 24 Parganas LM-16/N-253102 Shachi Pandit, Nagpur LM-16/P-772103 Archana Dash, P/O Mancheswar ALM-16/D-494104 Ronak Modi, Mumbai LM-16/M-711105 Manidipam Chatterjee, Howrah LM-16/C-390106 Darshan Pandit, Rajkot ALM-16/P-773107 Susmita Patra, Bhubaneshwar ALM-16/P-774108 Debasish Panda, Jamshedpur LM-16/P-775109 Sasank Mallick, Cuttack LM-16/M-712110 Radhika H, Kadma LM-16/H-106111 Rajeshree Nandy, Bhubaneshwar ALM-16/N-254112 Sadaf Sharif, Mumbai LM-16/S-1352113 Tejashwini Tejashwini, Gulbarga LM-16/T-286114 Reshma Kaushik, Dehradun LM-16/K-820115 Sampat Dash, Cuttack LM-16/D-495116 Mamillapalli Priyanka, Hyderabad ALM-16/P-776117 Aditya Bang, Kolkata ALM-16/B-614118 Sabyasachi Roy, Burdwan ALM-16/R-505119 Seema Gupta, Bhopal LM-16/G-625120 Vamshikrishna Johnalagedda, Hyderabad LM-16/J-402121 Divyang Vyas , Junagadh LM-16/V-277122 Sushant Muley, Akola LM-16/M-713123 Shristi Tambake, Bidar LM-16/T-287124 Hiteshkumar Hathila, Dist Dahod LM-16/H-107125 Krutik Shah, Bayad LM-16/S-1353126 Gauravkumar Prajapati, Palanpur LM-16/P-777127 Arpan Sashankar, Mumbai LM-16/S-1354128 Manjri Gupta, Noida ALM-16/G-626129 Ambika Devi S, Anthiyur ALM-16/S-1355130 Ramniwas Shriram, Faridabad ALM-16/S-1356131 Dadavali Shaik, Kurnool ALM-16/S-1357132 Nikhil Bansal, Yamuna Nagar LM-16/B-615133 Srinivas Mannava, Guntur LM-16/M-714134 Harsimran Walia, Chandigarh LM-16/W-61135 Prasad Chavan, Pune ALM-16/C-391136 Hassan Mubarak, Mangalore LM-16/M-715137 Kangchai Chaudhuri, Mohali LM-16/C-392138 Mukteshwar Shete, Pune ALM-16/S-1358139 Gopala Ravi, Bangalore LM-16/R-506140 Jyoti Sridhar, Bangalore LM-16/S-1359141 Nagendrababu Mopdevi, Guntur LM-16/M-716142 Bilavath Vinay, Nandyal ALM-16/V-278143 Durgesh Padole, Raipur LM-16/P-778144 Neeraj Gupta, New Delhi LM-16/G-627145 Ranjitha C, Chitradurga Dist LM-16/C-393146 Amit Kumar, Rohtak LM-16/K-821147 Rukmini Melo, Gurgaon LM-16/M-717148 Venkata Kintali, Hyderabad ALM-16/K-822149 Pavankumar M.M, Hyderabad ALM-16/M-718150 Sangitanjan Dutta, Guwahati LM-16/D-496151 Spandan Rajyaguru, Rajkot LM-16/R-507152 Rinoy Chandran, Calicut LM-16/C-394153 Syed Umar Quadri, Aurangabad LM-16/Q-6154 Haragopal Allapuram, Hyderabad LM-16/A-501155 Anupam Mohapatra, Dist - Balasore LM-16/M-719156 Sana Sana, Jaipur LM-16/S-1360157 Mamatha Prasad, Jaipur ALM-16/P-779158 Mukesh Limbachiya, Ahmedabad ALM-16/L-88159 Pramila Soni, New Delhi LM-16/S-1361160 Sri Ramamoorthy, Coimbatore LM-16/R-508161 Abhishek Anand, Jamshedpur ALM-16/A-502162 Jina Bhattacharyya, Guwahati LM-16/B-616163 Irshad Mir, New Delhi ALM-16/M-720164 Sonali Waghamare, Pune LM-16/W-62165 Dhaval Panakhaniya, Junagadh ALM-16/P-780166 Varun Giri, Ahmednagar LM-16/G-628167 Arpit Garg, Pune LM-16/G-629168 Raj Jupally, Secunderabad LM-16/J-403169 Ravi Patel, Deesa LM-16/P-781170 Shishir Gandhi, Anand LM-16/G-630171 Mohammed Khan, Hyderabad LM-16/K-823172 Neha Bhatia, Banga LM-16/B-617173 Manish Jha, New Delhi LM-16/J-404174 M Afzal Sheikh, New Delhi LM-16/S-1362175 Divyansh Gupta, Kota LM-16/G-631176 Rohit Amale, Solapur LM-16/A-503177 Piyush Girdhar, Palwal LM-16/G-632178 Priyesh Rahulgade, Pune LM-16/R-509179 Dhanuk Razdan, Gurgaon ALM-16/R-510180 Jimmy Hajariwala, Anand LM-16/H-108181 Rahul Verma, Indore LM-16/V-279182 Deviram Barange, Amravati LM-16/B-618183 Ramesh Kumar, Gandhinagar ALM-16/K-825184 Nandkishor Panchal, Anand LM-16/P-782185 Minesh Patel, Anand LM-16/P-783186 Nana Kunjir, Pune LM-16/K-826187 Bamathy Balasingam, Chennai ALM-16/B-619188 Gopal Sharma, Jaipur ALM-16/S-1363189 Sanjeev R, Bangalore ALM-16/R-511190 Bhagirath Chole, Aurangabad ALM-16/C-395191 Munesh Meena, Jaipur LM-16/M-722192 Sadik Mohammed, Jodhpur LM-16/M-723193 Monica Chhikara, Coimbatore LM-16/C-396194 Sachin Kunder, Bangalore ALM-16/K-827195 Bhagwan Mantri, New Delhi LM-16/M-724196 Gokul Ramanathan, Chennai LM-16/R-512197 Nitin Manwani, Chennai LM-16/M-725198 Mukesh Patel, Anand LM-16/P-784199 Kanwal Singh, Patiala LM-16/S-1364200 Nikhil Kedia, New Delhi LM-16/K-828

201 Smita Srivastava, New Delhi ALM-16/S-1365202 Lata Minz, New Delhi ALM-16/M-726203 Dhavalkumar Prajapati, Anand LM-16/P-785204 Amandeep Kaur, Ludhiana LM-16/K-829205 Arun Kumar, New Delhi LM-16/K-830206 Bikram Jyoti, New Delhi LM-16/J-405207 Chinmay Joshi, Chennai LM-16/J-406208 Mahliqa Shah, New Delhi ALM-16/S-1366209 Mahendrakumar Rawal, Surat ALM-16/R-513210 Ravikumar Krupanandan, Chennai LM-16/K-831211 Sujeet Singh, Ghaziabad ALM-16/S-1367212 Manish Badkur, Vellore LM-16/B-620213 Gaurav Gupta, Mohali LM-16/G-633214 Deepak Jha, Faridabad ALM-16/J-407215 Mukundkumar Patel, Ahmedabad LM-16/P-786216 Rajesh Joseph, Thiruvallur LM-16/J-408217 Yesha Chauhan, Vadodara ALM-16/C-397218 Georgy Panicker, Kollam LM-16/P-787219 Indumathi Dhayalan, Ariyankuppam LM-16/D-497220 Tarundeep Bhatia, Patiala LM-16/B-621221 Abdulwadood Ahmadzai, Nangarhar LM(SAARC)-16/A-504222 Afsal Mohammed, Kozhikode LM-16/M-727223 Ratul Roy, Kolkata ALM-16/R-514224 Satadru Mahapatra, Kolkata ALM-16/M-728225 Pritam Kundu, Jalpaiguri ALM-16/K-832226 Sheth Abdulaziz, Ahmedabad LM-16/A-505227 Vinod Ban, Ernakulam LM-16/B-622228 Preetam Sil, Kolkata LM-16/S-1369229 Farah Ingale, Navi Mumbai LM-16/I-44230 Harshil Mehta, Ahmedabad LM-16/M-729231 Kopalle Murthy, Mancherial LM-16/M-730232 Sudhanshu Sant, New Delhi LM-16/S-1370233 Shruti Deshpande, Bangalore LM-16/D-498234 Sunil Kedia, Dist - Purulia LM-16/K-833235 Ranjeet Patil, Pune LM-16/P-788236 Sivakumar Lakkireddigari, Hyderabad LM-16/L-89237 Sundaram Alagesan, Tirunelveli LM-16/A-506238 Jaywant Deshpande, Pune LM-16/D-499239 M.V Jothikrishnan, Chennai LM-16/J-409240 Shyam Chaudhary, Lucknow LM-16/C-398241 Deepali Mohanty, Lucknow LM-16/M-731242 Shekhar Babu, Dehradun LM-16/B-623243 Hiren Dholakia, Ahmedabad LM-16/D-500244 Kaustabh Chaudhuri, Kolkata LM-16/C-399245 Bharath Cherukuri, Vijayawada LM-16/C-400246 Shreepad Bhat, Pune LM-16/B-624247 Harshad Dongare, Sinhagad Road LM-16/D-501248 Sameer Kulkarni, Pune LM-16/K-834249 Nirmaldutt Thakur, Mumbai LM-16/T-288250 Gour Chattopadhyay, Kolkata LM-16/C-401251 Suma Kumar, Bangalore LM-16/K-835252 Hanamant Mali, Gadag LM-16/M-732253 Alok Swain, Raipur LM-16/S-1371254 Renuka Binnal, Gadag LM-16/B-625255 Swetha Gouda, Gadag LM-16/G-634256 Birenroy Chauhan, Baroda LM-16/C-402257 Swapnil Parab, Mumbai LM-16/P-789258 Rajesh Prabhu Chandrasekaran, Pondicherry LM-16/C-403259 Sai Devi, Pedawaltair LM-16/D-502260 Arun Andappan, Raipur LM-16/A-507261 Neelam Mohanty, Bhubaneswar ALM-16/M-736262 Brijesh Modia, Rajkot LM-16/M-721263 Abhilasha Motghare, Nagpur LM-16/M-733264 Tushar Mantri, Washim LM-16/M-734265 Bharatkumar Prajapati, Gandhinagar LM-16/P-790266 Ketan Gadre, Sangli LM-16/G-635267 Manasi Kolhe, Jalgaon LM-16/K-836268 Vipindas Dasan, Surat ALM-16/D-503269 Pavankumar V S, Hyderabad LM-16/S-1372270 Amandeep Singh, Chandigarh LM-16/S-1373271 Meniga Ramakrishna, Ongole LM-16/R-515272 Narinder Kanwal, Mohali LM-16/K-837273 Feroz Sayyed, Solapur LM-16/S-1374274 Abhijit Mondal, Kolkata LM-16/M-735275 Soma Sarkar (PAN), Kolkata LM-16/S-1375276 Paramita Dey, Kolkata LM-16/D-504277 Sujit Saha, Kolkata LM-16/S-1376278 Mohammad Nawaz, Mangalore LM-16/N-256279 Ravi K, Nileshwar LM-16/K-838280 Ashton Dsouza, Mangalore LM-16/D-505281 Vaijanti Bhavsar, Navi Mumbai LM-16/B-626282 Pavan Donakonda, Kurnool LM-16/D-506283 Sreebhushan Devaraju, Hyderabad LM-16/D-508284 Subrat Jena, Cuttack LM-16/J-410285 Maya Gantayet, Cuttack LM-16/G-636286 Mullai A.R, Chandigarh LM-16/A-508287 Vijayalakshmi Sivapurapu, Pondicherry LM-16/S-1377288 Sangeeta Dhanger, Pondicherry LM-16/D-507289 Krishna Mall, Lucknow LM-16/M-737290 Venugopal Jaganathan, Coimbatore LM-16/J-413291 Prakash Nadagouda, Hubli LM-16/N-257292 Avinash Karekal, Hubli LM-16/K-839293 Shobha Mudaraddi, Hubli LM-16/M-738294 Vipul Desai, Baroda LM-16/D-509295 Sara Thomas, Thiruvalla LM-16/T-289296 Sairam Commi, Hubli LM-16/C-404297 Goolappa Chikkanargund, Hubli LM-16/C-405298 Mohd Ansari, Bhopal ALM-16/A-509299 Dinesh Sardana, Chandigarh LM-16/S-1378300 Kalaiselvan S, Chennai LM-16/S-1379301 Hardik Modi, Ahmedabad LM-16/M-739


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dr. Kapil ZirpeGrant Medical Foundation, Ruby Hall Clinic, Pune, Maharashtra, India.

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Critical Care - ISCCM Care TM A BI˜MONTHLY NEWSLETTER OF INDIAN SOCIETY OF CRITICAL CARE MEDICINE Editorial officE dr. Kapil Zirpe Director & HOD Neuro-Trauma Unit, Grant Medical