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1. Approach to Thromboprophylaxis for Prevention of Venous Thromboembolism in COVID-19: Global Updates and Clinical Insights from India

Author: Nagarajan Ramakrishnan, Suresh Ramasubban, Ashit Hegde, and Deepak Govil
Subjects: COVID-19, deep vein thrombosis, pulmonary embolism, thromboprophylaxis, venous thromboembolism, Medicine (General), R5-920
Abstract: Venous thromboembolism (VTE) frequently occurs in patients with coronavirus disease-19 (COVID-19) and is associated with increased mortality. Several global guidelines recommended prophylactic-intensity anticoagulation rather than intermediate-intensity or therapeutic-intensity anticoagulation for patients with COVID-19-related acute or critical illness without suspected or confirmed VTE. Even though standard doses of thromboprophylaxis are received, many cases of thrombotic complications are reported; hence, appropriate and adequate thromboprophylaxis is critical for the prevention of VTE in COVID-19. In spite of an increased prevalence of VTE in Indian patients, sufficient data on patient characteristics, diagnosis, and therapeutic approach for VTE in COVID is lacking. In this article, we review the available global literature (search conducted up to 31 May 2021) and provide clinical insights into our approach towards managing VTE in patients with COVID-19. Furthermore, in this review, we summarize the incidence and risk factors for VTE with emphasis on the thromboprophylaxis approach in hospitalized patients and special populations with COVID-19 and assess clinical implications in the Indian context.
Published: 2022
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2. International consensus conference recommendations on ultrasound education for undergraduate medical students

Author: Richard A. Hoppmann, Jeanette Mladenovic, Lawrence Melniker, Radu Badea, Michael Blaivas, Miguel Montorfano, Alfred Abuhamad, Vicki Noble, Arif Hussain, Gregor Prosen, Tomás Villen, Gabriele Via, Ramon Nogue, Craig Goodmurphy, Marcus Bastos, G. Stephen Nace, Giovanni Volpicelli, Richard J. Wakefield, Steve Wilson, Anjali Bhagra, Jongyeol Kim, David Bahner, Chris Fox, Ruth Riley, Peter Steinmetz, Bret P. Nelson, John Pellerito, Levon N. Nazarian, L. Britt Wilson, Irene W. Y. Ma, David Amponsah, Keith R. Barron, Renee K. Dversdal, Mike Wagner, Anthony J. Dean, David Tierney, James W. Tsung, Paula Nocera, José Pazeli, Rachel Liu, Susanna Price, Luca Neri, Barbara Piccirillo, Adi Osman, Vaughan Lee, Nitha Naqvi, Tomislav Petrovic, Paul Bornemann, Maxime Valois, Jean-Francoise Lanctot, Robert Haddad, Deepak Govil, Laura A. Hurtado, Vi Am Dinh, Robert M. DePhilip, Beatrice Hoffmann, Resa E. Lewiss, Nayana A. Parange, Akira Nishisaki, Stephanie J. Doniger, Paul Dallas, Kevin Bergman, J. Oscar Barahona, Ximena Wortsman, R. Stephen Smith, Craig A. Sisson, James Palma, Mike Mallin, Liju Ahmed, and Hassan Mustafa
Subjects: Ultrasound, Medical student, Education, Undergraduate, International consensus conference, Curriculum recommendations, Medical physics. Medical radiology. Nuclear medicine, R895-920
Abstract: Abstract Objectives The purpose of this study is to provide expert consensus recommendations to establish a global ultrasound curriculum for undergraduate medical students. Methods 64 multi-disciplinary ultrasound experts from 16 countries, 50 multi-disciplinary ultrasound consultants, and 21 medical students and residents contributed to these recommendations. A modified Delphi consensus method was used that included a systematic literature search, evaluation of the quality of literature by the GRADE system, and the RAND appropriateness method for panel judgment and consensus decisions. The process included four in-person international discussion sessions and two rounds of online voting. Results A total of 332 consensus conference statements in four curricular domains were considered: (1) curricular scope (4 statements), (2) curricular rationale (10 statements), (3) curricular characteristics (14 statements), and (4) curricular content (304 statements). Of these 332 statements, 145 were recommended, 126 were strongly recommended, and 61 were not recommended. Important aspects of an undergraduate ultrasound curriculum identified include curricular integration across the basic and clinical sciences and a competency and entrustable professional activity-based model. The curriculum should form the foundation of a life-long continuum of ultrasound education that prepares students for advanced training and patient care. In addition, the curriculum should complement and support the medical school curriculum as a whole with enhanced understanding of anatomy, physiology, pathophysiological processes and clinical practice without displacing other important undergraduate learning. The content of the curriculum should be appropriate for the medical student level of training, evidence and expert opinion based, and include ongoing collaborative research and development to ensure optimum educational value and patient care. Conclusions The international consensus conference has provided the first comprehensive document of recommendations for a basic ultrasound curriculum. The document reflects the opinion of a diverse and representative group of international expert ultrasound practitioners, educators, and learners. These recommendations can standardize undergraduate medical student ultrasound education while serving as a basis for additional research in medical education and the application of ultrasound in clinical practice.
Published: 2022
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3. Diagnostic value of different interleukins and procalcitonin in critically ill patients admitted with suspected sepsis

Author: Simmi Mehra, Aseem Kumar Tiwari, Geet Aggarwal, Swati Pabbi Mehta, Rajni Chauhan, Chhavi Rajvanshi, and Deepak Govil
Subjects: flow cytometry, interleukins, procalcitonin, sepsis, Pathology, RB1-214, Microbiology, QR1-502
Abstract: Background: Many biomarkers have now been studied such as C-reactive Protein (CRP), procalcitonin (PCT), etc., and are widely used for the diagnosis of sepsis in clinical practice which may determine the appropriate antibiotic treatment. A flowcytometric cytokine bead array (CBA) assay has now been used to determine multiple interleukins (IL), simultaneously. The aim of this study was to determine the cytokine (IL2, IL4, IL6, IL10, TNFα, INFγ, and IL17) profiles of interleukins in plasma of sepsis patients by using multiplex Flowcytometric CBA array assay. Materials and Methods: A total of 99 consecutive patients admitted with the suspected sepsis were studied. PCT concentrations were measured by using the enzyme-linked fluorescent immunoassay (ELFA) technique and flow cytometry-based BD™ CBA Cytokine Kit was used to evaluate levels of 7 cytokines [IL-2, IL-4, IL-6, IL-10, Tumour Necrosis Factor (TNF), Interferon- γ (IFN-γ), and IL-17A]. Results: Microbiologically defined infection (MDI) demonstrated a positive culture report in 79/99 (79.7%) of patients. The IL6 [1873.7 (4-5000)] and IL10 [(154.7 (0-1764)] levels were significantly higher in septic patients than those in the negative MDI IL6 [901 (4-5000)] and IL10 [110.4 (4-1372)] levels. The AUROC value of IL6 [0.66 (0.53-0.79)] was found to be the highest among all followed by IL10 [0.65 (0.51-0.79)], IFNγ [0.63 (0.51-0.77)], PCT [0.61 (0.48-0.75)], and TNFα [0.55 (0.42-0.69)]. Conclusion: Our study suggests that that IL6 is substantially more economical and can reduce the investigation cost to half as compared with the procalcitonin assay.
Published: 2022
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4. Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus

Author: Arif Hussain, Gabriele Via, Lawrence Melniker, Alberto Goffi, Guido Tavazzi, Luca Neri, Tomas Villen, Richard Hoppmann, Francesco Mojoli, Vicki Noble, Laurent Zieleskiewicz, Pablo Blanco, Irene W. Y. Ma, Mahathar Abd. Wahab, Abdulmohsen Alsaawi, Majid Al Salamah, Martin Balik, Diego Barca, Karim Bendjelid, Belaid Bouhemad, Pablo Bravo-Figueroa, Raoul Breitkreutz, Juan Calderon, Jim Connolly, Roberto Copetti, Francesco Corradi, Anthony J. Dean, André Denault, Deepak Govil, Carmela Graci, Young-Rock Ha, Laura Hurtado, Toru Kameda, Michael Lanspa, Christian B. Laursen, Francis Lee, Rachel Liu, Massimiliano Meineri, Miguel Montorfano, Peiman Nazerian, Bret P. Nelson, Aleksandar N. Neskovic, Ramon Nogue, Adi Osman, José Pazeli, Elmo Pereira-Junior, Tomislav Petrovic, Emanuele Pivetta, Jan Poelaert, Susanna Price, Gregor Prosen, Shalim Rodriguez, Philippe Rola, Colin Royse, Yale Tung Chen, Mike Wells, Adrian Wong, Wang Xiaoting, Wang Zhen, and Yaseen Arabi
Subjects: COVID-19, SARS-CoV-2, Point-of-care ultrasound (PoCUS), Focused cardiac ultrasound (FoCUS), Lung ultrasound (LUS), Echocardiography, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.
Published: 2020
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5. Malignant perforation of sigmoid colon in long-standing ulcerative colitis

Author: G K Adithya, Varun Madaan, Rigved Gupta, Satya Prakash Jindal, and Deepak Govil
Subjects: chronic ulcerative colitis, perforated colonic malignancy, steroid-dependent ulcerative colitis, Medicine
Abstract: Chronic ulcerative colitis (UC) is a risk factor for malignancy in long-term disease process. Obstruction, perforation, and hemorrhage are the possible emergency situations in colorectal malignancy. A 68-year-old male with chronic UC for 18 years with steroid-dependent disease (on 10 mg prednisolone daily) presented with acute pain abdomen with distention not passing stool or flatus for 2 days. The patient was diagnosed to have perforation of colon secondary to rectosigmoid malignancy. Following the adjuvant therapy, the patient denied any definitive surgery and opted to stay on a colorectal cancer surveillance program. At present, the patient's positron emission tomography/computed tomography shows pelvic, liver surface, and small bowel deposits, suggestive of recurrence or metastasis. This case report is discussed to emphasize the importance of aggressive surgical treatment in long-term steroid-dependent disease and poor prognosis of perforated malignancy irrespective of pathological staging.
Published: 2020
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6. Malignant perforation of sigmoid colon in long-standing ulcerative colitis

Author: G K Adithya, Varun Madaan, Rigved Gupta, Satya Prakash Jindal, and Deepak Govil
Subjects: chronic ulcerative colitis, perforated colonic malignancy, steroid-dependent ulcerative colitis, Medicine
Abstract: Chronic ulcerative colitis (UC) is a risk factor for malignancy in longterm disease process. Obstruction, perforation, and hemorrhage are the possible emergency situations in colorectal malignancy. A 68-year-old male with chronic UC for 18 years with steroiddependent disease (on 10 mg prednisolone daily) presented with acute pain abdomen with distention not passing stool or flatus for 2 days. Diagnosed to have perforated sigmoid malignancy, underwent Hartmann's procedure. Following the adjuvant therapy, the patient denied any definitive surgery and opted to stay on Colorectal Cancer Surveillance Programme. At present, patient's positron emission tomography/computed tomography shows pelvic, liver surface, and small bowel deposits, suggestive of recurrence or metastasis. This case report is discussed to emphasis the importance of aggressive surgical treatment in longterm steroiddependent disease and poor prognosis of perforated malignancy irrespective of pathological staging.
Published: 2019
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7. Long term complication of feeding jejunostomy – small bowel volvulus

Author: G K Adithya, Varun Madaan, Rigved Gupta, Satya Prakash Jindal, and Deepak Govil
Subjects: complications of feeding jejunostomy, feeding jejunostomy, small bowel volvulus, Medicine
Abstract: Introduction: Feeding jejunostomy (FJ) is a lifesaving procedure on many occasions in patients requiring long term nutritional assistance. It is associated with many short and long term complications. Small bowel perforations, small bowel volvuli with infarction, intraperitoneal leaks and intussusception are well reported complications of FJ. Here we present a case report of FJ giving rise to small bowel volvulus. Case report: An elderly male patient of 71 years with underlying systemic hypertension, diabetes mellitus, and thoracic aortic aneurysm with aortoesophageal fistula underwent feeding jejunostomy for long term feeding purpose. Feeding went on well for almost a year. He had a second intravascular procedure for type 1 endoleak. Four months following this he developed an episode of severe colicky abdominal pain associated with vomiting. He was evaluated with CECT abdomen which showed the possibility of mesenteric volvulus with small bowel obstruction at distal ileal level. Patient underwent emergency exploratory laparotomy and untwisting of mesentery with redoing of FJ distal to the previous site of FJ. There was no bowel compromise. He developed severe hypokalemia post operatively which required intra venous potassium infusion and ventilator support. With all supportive management patient continued to deteriorate and succumbed.
Published: 2020
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8. Aggressive surgical resection following neoadjuvant imatinib therapy for advanced duodenal tumor with hepatic metastasis

Author: Varun Madaan, Rigved Gupta, G K Adithya, Satya Prakash Jindal, and Deepak Govil
Subjects: duodenal gastrointestinal stromal tumor, imatinib, locally advanced gastrointestinal stromal tumor, Medicine
Abstract: Duodenal gastrointestinal stromal tumors (GISTs) are rare tumors which constitute < 5% of all cases of GIST. The treatment of locally advanced/inoperable and metastatic GIST is primarily tyrosine kinase inhibitor therapy (TKI), i.e., imatinib mesylate. In some patients, initial TKI therapy may result in significant downstaging of the primary tumor and metastatic disease. The role of aggressive surgical resection in such patients remains controversial. We present a case of advanced duodenal GIST treated successfully by Whipple's procedure with liver wedge resection following neoadjuvant TKI therapy. This case shows that aggressive surgical resection for metastatic duodenal GIST following neoadjuvant imatinib seems to be a feasible treatment option.
Published: 2019
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9. Incidence of posterior wall penetration during internal jugular vein cannulation: A comparison of two techniques using real-time ultrasound

Author: Shrikanth Srinivasan, Deepak Govil, Sachin Gupta, Sweta Patel, K N Jagadeesh, and Deeksha Singh Tomar
Subjects: Jugular vein, posterior venous wall penetration, real-time ultrasound, Anesthesiology, RD78.3-87.3
Abstract: Background and Aims: The true incidence of penetration of the posterior wall (through-and-through puncture) of the internal jugular vein (IJV) during cannulation is unknown. This may have implications if there is hematoma formation, penetration and/or inadvertent cannulation of an underlying carotid artery. This study compared the incidence of posterior wall puncture during IJV cannulation using ultrasound guidance versus traditional landmarks-guided technique. Methods: One hundred and seventy adult patients admitted to a gastro-liver Intensive Care Unit who required central venous lines were randomly divided into Group A: IJV cannulation using anatomical landmark-guided technique and Group B: IJV cannulation using real-time ultrasound guidance. In both groups, a second investigator followed the needle path using real-time ultrasound. The incidence of posterior wall puncture, number of attempts for successful cannulation, incidence of inadvertent arterial punctures and occurrence of complications such as hematoma formation and pneumothorax were recorded. Results: Significantly more (37/80, 46%) patients in Group A had posterior wall puncture compared to 19/90 (21%) in Group B. Incidence of arterial puncture was 8/80 (10%) in Group A, 5/90 (5.5%) in Group B. The number of attempts for venous cannulation and hematoma formation was significantly less in Group B. Conclusion: Real-time ultrasound-guided IJV cannulation significantly reduces but does not wholly eliminate the incidence of posterior venous wall penetrations. It also significantly reduces the incidence of inadvertent arterial punctures and number of attempts for successful cannulation.
Published: 2017
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10. A rare cause of retroperitoneal mass: Castleman's disease

Author: Satyaprakash Jindal, G K Adithya, Varun Madaan, Rigved Gupta, Sandeep Vohra, Vivek Tandon, and Deepak Govil
Subjects: castleman's disease, human herpes virus-8, human immunodeficiency virus, lymphoproliferative disorder, retroperitoneal mass, Medicine
Abstract: Castleman's disease is a rare lymphoproliferative disorder. It is a pathological diagnosis and rarely diagnosed before surgery. Presentation of disease may be unicentric or multicentric. We are reporting a case of unicentric Castleman's disease presenting as an asymptomatic retroperitoneal mass. The ultrasound-guided aspiration of the lesion was inconclusive. Complete en bloc resection was done and was reported as Castleman's disease after pathological analysis. Pathogenesis of Castleman's disease is not well defined, but interleukin-6 and vascular endothelial growth factor are thought to have a significant role. Two pathological variants have been described as follows: hyaline vascular and plasma cell type. The treatment of unicentric disease is complete resection. Multicentric disease may be associated with human immunodeficiency virus and human herpes virus-8 infection and requires systemic treatment in the form of steroids, chemotherapy, radiotherapy, or immunotherapy.
Published: 2018
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11. Congenital mesenteric defect causing volvulus and intestinal obstruction in an adult

Author: Adithya GK, Satya Prakash Jindal, Varun Madaan, Vivek Tandon, and Deepak Govil
Subjects: adult volvulus, congenital, intestinal obstruction, mesenteric defect, Medicine
Abstract: A 39-year-old female presented with a history of recurrent pain abdomen for 2 years. The pain was colicky and intermittent in nature. She had been diagnosed to have right-sided nephrolithiasis based on the findings of computed tomography (CT) abdomen and was managed conservatively during each episode of pain. During the present episode, her pain started 4 days prior to presentation and was associated with vomiting and inability to pass stool and flatus. X-ray abdomen showed evidence of dilated bowel loops. On clinical examination, her abdomen was distended with tenderness and guarding in the right lower abdomen. Her CT abdomen revealed dilated ileal loops in the right lower abdomen. The distal bowel was found to be collapsed. On exploratory laparotomy, a volvulus of the distal ileum, caecum and part of ascending colon was noted. The involved bowel loops were gangrenous. A mesenteric defect of about 10 cm was noted in the root of the mesentery, which had caused an internal herniation, volvulus and gangrene. She underwent a right hemicolectomy with covering ileostomy. Congenital mesenteric defects leading to internal herniation are a well-documented condition in pediatric population. Although the same can occur in adults, it is an infrequent cause of intestinal obstruction.
Published: 2018
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12. Celiac axis stenosis in a patient undergoing pancreatoduodenectomy

Author: G K Adithya, Satya Prakash Jindal, Varun Madaan, Chitra Singh, Sandeep Vohra, Vivek Tandon, and Deepak Govil
Subjects: celiac axis stenosis, collateral pathway, pancreaticoduodenectomy, whipple procedure, Medicine
Abstract: Celiac axis (CA) stenosis is a commonly detected condition in candidates planned for upper abdominal surgery. In major abdominal surgeries, CA stenosis has its own importance. In our case, a 57-year-old female was admitted with obstructive jaundice and diagnosed to have distal cholangiocarcinoma and was planned for surgery. Computed tomography scan (done from outside centre) was discussed with our radiologist; a moderate-to-severe CA stenosis was noted with collaterals being developed between superior mesenteric and gastroduodenal arteries. Based on this, she was planned for preoperative biliary and vascular stenting before definitive surgery. Whipple procedure was done after stenting of the CA stenosis. Intraoperatively, we found a wide and good caliber hepatic artery being fed by the CA itself. Postoperatively, there was no complication related to ischemia or anastomotic leak. This case is being reported to emphasize the importance of thorough radiological evaluation before taking up any major abdominal surgery.
Published: 2018
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13. Superior mesenteric artery thrombosis: A rare complication after pancreaticoduodenectomy

Author: Satyaprakash Jindal, G K Adithya, Varun Madaan, Vivek Tandon, and Deepak Govil
Subjects: cholangiocarcinoma, pancreaticoduodenectomy, superior mesenteric artery thrombosis, Medicine
Abstract: Pancreaticoduodenectomy (PD) is the treatment of choice for malignant and some benign diseases of the pancreas and periampullary region. Common complications after PD include delayed gastric emptying, pancreatic fistula, anastomotic leak, and intra-abdominal collection. Postoperative medical complications include arrhythmia, renal failure, pulmonary complications, urinary tract infection, and deep vein thrombosis. Superior mesenteric artery (SMA) thrombosis is rarely been reported after PD. SMA thrombosis is difficult to diagnose in postoperative period due to nonspecific symptoms and associated with high mortality rate up to 80%–90%. The patient was a 68-year-old female with lower end cholangiocarcinoma without any other comorbidity. She underwent PD without any intraoperative complications. Postoperatively, she developed SMA thrombosis. Unfortunately, the patient could not be salvaged, and she succumbs to death.
Published: 2018
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14. Metachronous Pancreatic Adenocarcinoma in Patient with Renal Cell Carcinoma: A Case Report

Author: Satya Prakash Jindal, GK Adithya, Varun Madaan, Vivek Tandon, and Deepak Govil
Subjects: dual malignancy, pancreaticoduodenectomy, secondary pancreatic carcinoma, Medicine
Abstract: Multiple primary tumours in a single individual are reported in the literature with incidence which varies from 1% to 20%. Few common combinations are labelled as the syndrome and showed a common genetic association; however, sporadic cases of multiple primaries are relatively rare. Such a combination of Renal Cell Carcinoma (RCC) with pancreatic carcinoma is sparingly being reported in the literature. Here, we present a case of pancreatic carcinoma in a patient who was treated for renal cell carcinoma, 10-years-back. A few cases, which have been published before also could not establish any specific reason for this combination. We recommend considering a possibility of the second primary in any patient with unusual symptoms different from primary lesion and research for genetic association in these patients.
Published: 2018
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15. 055 CYTOKINE REMOVAL IN SEPSIS: DOES THEIR LEVELS CO-RELATE WITH OUTCOME

Author: Deepak Govil, Sachin Gupta, Shrikanth Srinivasan, Sweta J. Patel, K.N. Jagadeesh, Mozammil Shafi, Deeksha S. Tomar, Vipal Chawla, Ashish Srivastava, and Swarup Padhi
Subjects: Diseases of the genitourinary system. Urology, RC870-923
Published: 2017
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16. 054 CYTOKINE ADSORPTION IN SEPSIS: CORRECT TIMING CAN PREDICT THE FAVORABLE OUTCOME

Author: Deepak Govil, Sachin Gupta, Shrikanth Srinivasan, Sweta J. Patel, K.N. Jagadeesh, Mozammil Shafi, Deeksha S. Tomar, Vipal Chawla, and Swarup S. Padhi
Subjects: Diseases of the genitourinary system. Urology, RC870-923
Published: 2017
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17. Unexplained ascites following laparoscopic cholecystectomy: A surgeon's nightmare – A case report and review of literature

Author: Varun Madaan, G K Adithya, Satya Prakash Jindal, Rigved Gupta, Vivek Tandon, and Deepak Govil
Subjects: Ascites, idiopathic, post-lap chole, unknown cause, Surgery, RD1-811, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract: Laparoscopic cholecystectomy has many known complications which can be ascertained to a particular cause. We report a case of ascites development in a young female immediately after Laparoscopic cholecystectomy, for which a cause cannot be found. On review of medical literature, there are few similar case reports, based on them; it can be ascertained to acute allergic reaction to the material used during the procedure may be the CO2 or the electrocautery.
Published: 2019
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18. Bone Cement Implantation Syndrome: A Report of Four Cases

Author: Pradeep Govil, P N Kakar, Deep Arora, Shibani Das, Nishkarsh Gupta, Deepak Govil, Sachin Gupta, and Ashima Malohtra
Subjects: Bone cement, Complications, Joint replacement surgeries, Anesthesiology, RD78.3-87.3
Abstract: Cardiovascular collapse following use of methylmethacrylate for lower limb surgeries has been reported. How-ever there are no reports of cement reaction following shoulder arthroplasty. We report series of four patients exhibiting cement reaction. Two of our patients had cardiovascular collapse following cement insertion during hip arthroplasty. Severe hemodynamic derangement and transient hypoxemia was observed during cemented arthro-plasty of shoulder and knee respectively. Peripheral vasodilatory effects of the cement monomer, fat and marrow embolism and activation of the clotting cascade in the lungs, all contribute to cement reaction. Early and aggressive resuscitation with use of vasopressors, establishment of invasive hemodynamic monitoring and surgical modifications are the key to prevention of catastrophic outcome.
Published: 2009

19. Refractory Hypotension after Tourniquet Deflation in a Patient on Chronic Clomipramine Therapy

Author: Pradeep Govil, P. N. Kakar, Atul Kishore Kapoor, Ankit Sharma, Deepak Govil, and Deep Arora
Subjects: Tricyclic antidepressants, hypotension, clomipramine, tourniquet deflation, combined spinal epidural anaesthesia, Anesthesiology, RD78.3-87.3
Abstract: Treatment of intraoperative hypotension in a patient on chronic tricyclic antidepressant therapy(TCA) is contro-versial. Evidence based guidelines for the management of psychotropic drugs during perioperative period are lacking. We present a patient who was subjected to bilateral total knee replacement under combined spinal epidural anaesthe-sia. She developed refractory hypotension after release of tourniquet and responded only to large dosage of norepi-nephrine along with acid base correction. We believe that chronic TCA therapy led to depleted catecholamine re-serves and down regulation of its receptors. Release of tourniquet led to metabolic acidosis and subsequently in-creased free clomipramine concentration in blood leading to severe refractory hypotension.
Published: 2008

20. Transanal Minimally Invasive Surgery for Rectal Cancer

Author: Sheikh Mohammad Taha Mustafa, Deepak Govil, Vijay Arora, V.K. Malik, Shivendra Singh, Avinash Saklani, Rajesh Bhojwani, Shyam Aggarwal, Purvish Parikh, C. Selvasekar, and Saumitra Rawat
Subjects: early stage, curative treatment, cure, minimally invasive, organ preserving, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
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21. ISCCM Guidelines for Hemodynamic Monitoring in the Critically Ill

Author: Kishore Pichamuthu, Ramesh Venkataraman, Deepak Govil, Shrikanth Srinivasan, Suresh Ramasubban, Srinivas Samavedam, Sheila Nainan Myatra, Atul Kulkarni, Sameer Arvind Jog, and Jigeeshu V Divatia
Subjects: Critical Care and Intensive Care Medicine
Published: 2022
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22. Guidelines for the Use of Procalcitonin for Rational Use of Antibiotics

Author: Dhruva Chaudhry, Anita Sharma, Deepak Govil, Vijay Hadda, Neetu Jain, Pawan Tiwari, Srinivas Samavedam, Subhal Dixit, Manjunath B Govindagoudar, Gopi C Khilnani, Niraj Tyagi, Kapil Gangadhar Zirpe, Atul Prabhakar Kulkarni, Simant Kumar Jha, Subhash Kumar Todi, and Madhusudan R Jaju
Subjects: Critical Care and Intensive Care Medicine
Published: 2022
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23. ISCCM Guidelines on Acute Kidney Injury and Renal Replacement Therapy

Author: Dhruva Chaudhry, Jose Chacko, Deepak Govil, Srinivas Samavedam, Yash Javeri, Arindam Kar, Nitin Arora, Palepu Gopal, Niraj Tyagi, Kanwalpreet Sodhi, Nita George, Subhal B Dixit, Rajesh C Mishra, Gunjan Chanchalani, Ruchira W Khasne, Ranajit Chatterjee, Raymond D Savio, Ahsina J Lopa, Rajeev A Annigeri, Ahsan Ahmed, Kowdle Chandrasekhar Prakash, Balasubramanian Subbarayan, Rajasekara M Chakravarthi, Akshay K Chhallani, Reshu G Khanikar, and Saravanan Margabandhu
Subjects: Critical Care and Intensive Care Medicine
Published: 2022
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24. Indian Society of Critical Care Medicine Consensus Statement for Prevention of Venous Thromboembolism in the Critical Care Unit

Author: Shirish Prayag, Deepak Govil, Rahul A Pandit, Kapil G Zirpe, Subhal B Dixit, Rajesh C Mishra, Gunjan Chanchalani, Farhad N Kapadia, Akshaykumar A Chhallani, Bharat G Jagiasi, and Rishi Kumar
Subjects: Critical Care and Intensive Care Medicine
Published: 2022
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25. Intensive Care in India in 2018–2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study

Author: Vivek Kumar, Ramesh Venkataraman, Khusrav Bajan, Yatin Mehta, Deepak Govil, Nagarajan Ramakrishnan, Kapil Zirpe, Mrinal Sircar, Sushma Gurav, Srinivas Samavedam, Samir Sahu, Subhal Dixit, Sheila Nainan Myatra, Prachee Sathe, Pradip Kumar Bhattacharya, Rahul Harne, Jigeeshu V Divatia, Carol D'Silva, Pravin R Amin, Farhad N Kapadia, Rajesh Kumar Pande, Sujata N Mehta, Leelavati Thakur, Darshana Rathod, Shaik Arif Pasha, Subhash Kumar Todi, and FNU the INDICAPS-II investigators
Subjects: Adult, Intensive care units, Patients, Practice patterns, business.industry, Process assessment, Health care, India, Critical Care and Intensive Care Medicine, Case mix index, Nursing, Intensive care, Medicine, Original Article, Mortality, business
Abstract: Background We aimed to study organizational aspects, case mix, and practices in Indian intensive care units (ICUs) from 2018 to 2019, following the Indian Intensive Care Case Mix and Practice Patterns Study (INDICAPS) of 2010–2011. Methods An observational, 4-day point prevalence study was performed between 2018 and 2019. ICU, patient characteristics, and interventions were recorded for 24 hours, and ICU outcomes till 30 days after the study day. Adherence to selected compliance measures was determined. Data were analyzed for 4,669 adult patients from 132 ICUs. Results On the study day, mean age, acute physiology and chronic health evaluation (APACHE II), and sequential organ failure assessment (SOFA) scores were 56.9 ± 17.41 years, 16.7 ± 9.8, and 4.4 ± 3.6, respectively. Moreover, 24% and 22.2% of patients received mechanical ventilation (MV) and vasopressors or inotropes (VIs), respectively. On the study days, 1,195 patients (25.6%) were infected and 1,368 patients (29.3%) had sepsis during their ICU stay. ICU mortality was 1,092 out of 4,669 (23.4%), including 737 deaths and 355 terminal discharges (TDs) from ICU. Compliance for process measures related to MV ranged between 62.7 and 85.3%, 11.2 and 47.4% for monitoring delirium, sedation, and analgesia, and 7.7 and 25.3% for inappropriate transfusion of blood products. Only 34.8% of ICUs routinely used capnography. Large hospitals with ≥500 beds, closed ICUs, the APACHE II and SOFA scores, medical admissions, the presence of cancer or cirrhosis of the liver, the presence of infection on the study day, and the need for MV or VIs were independent predictors of mortality. Conclusions Hospital size and closed ICUs are independently associated with worse outcomes. The proportion of TDs remains high. There is a scope for improvements in processes of care. Registered at clinicaltrials.gov (NCT03631927). How to cite this article Divatia JV, Mehta Y, Govil D, Zirpe K, Amin PR, Ramakrishnan N, et al. Intensive Care in India in 2018–2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study. Indian J Crit Care Med 2021;25(10):1093–1107.
Published: 2022
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26. Core outcome measures for clinical effectiveness trials of nutritional and metabolic interventions in critical illness: an international modified Delphi consensus study evaluation (CONCISE)

Author: Thomas Davies, Rob van Gassel, Marcel van de Poll, Jan Gunst, Michael Casaer, Kenneth Christopher, Jean Charles Preiser, Aileen Hill, Kursat Gundogan, Annika Reintam-Blaser, Anne-Françoise Rousseau, Carol Hodgson, Dale Needham, Melina Castro, Stefan Schaller, Thomas McClelland, Joshua Pilkington, Carla Sevin, Paul Wischmeyer, Zheng Yii Lee, Deepak Govil, Andrew Li, Lee-anne Chapple, Linda Denehy, Juan Carlos Montejo-González, Beth Taylor, Danielle Bear, Rupert Pearse, Angela McNelly, John Prowle, Zudin Puthucheary, Surgery, Intensive Care, MUMC+: MA Medische Staf IC (9), MUMC+: MA Heelkunde (9), and RS: NUTRIM - R2 - Liver and digestive health
Subjects: Adult, Delphi Technique, Outcome Assessment, SEPSIS, ILL, Critical Illness, Multiple Organ Failure, Core outcome set, CARE, Critical Care and Intensive Care Medicine, Delphi, ORGAN FAILURE ASSESSMENT, Health Care, Treatment Outcome, Metabolism, Research Design, Critical Illness/therapy, Outcome Assessment, Health Care, Activities of Daily Living, INSTRUMENTAL ACTIVITIES, INFECTION, Humans, INFLAMMATORY RESPONSE SYNDROME, Critical illness, Nutrition
Abstract: Critical care 26, 240 (2022). doi:10.1186/s13054-022-04113-x, Published by Springer, Berlin ; Heidelberg
Published: 2022
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27. Tocilizumab plus standard care versus standard care in patients in India with moderate to severe COVID-19-associated cytokine release syndrome (COVINTOC): an open-label, multicentre, randomised, controlled, phase 3 trial

Author: Arvinder S. Soin, Vipul Mishra, Suneetha Narreddy, Ashish Gupta, Dhruva Chaudhry, Narendra S. Choudhary, Rahul A Pandit, Shashikala A Sangle, Vikas Agarwal, Pawan Kumar Singh, Vikas Deswal, Sushila Kataria, Yatin Mehta, Deepak Govil, Suresh Kumar, Pooja Sharma, Rajesh Chawla, Athimalaipet V Ramanan, Kuldeep Kumar, and Manoj Goel
Subjects: Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Critical Care, Population, India, Antibodies, Monoclonal, Humanized, Severity of Illness Index, law.invention, chemistry.chemical_compound, Tocilizumab, Randomized controlled trial, law, Internal medicine, Intensive care, Severity of illness, Clinical endpoint, Humans, Immunologic Factors, Medicine, Mortality, Adverse effect, education, Respiratory Distress Syndrome, education.field_of_study, SARS-CoV-2, business.industry, COVID-19, Articles, Middle Aged, Receptors, Interleukin-6, Respiration, Artificial, Clinical trial, Treatment Outcome, chemistry, Female, Drug Monitoring, Cytokine Release Syndrome, business
Abstract: BACKGROUND: Global randomised controlled trials of the anti-IL-6 receptor antibody tocilizumab in patients admitted to hospital with COVID-19 have shown conflicting results but potential decreases in time to discharge and burden on intensive care. Tocilizumab reduced progression to mechanical ventilation and death in a trial population enriched for racial and ethnic minorities. We aimed to investigate whether tocilizumab treatment could prevent COVID-19 progression in the first multicentre randomised controlled trial of tocilizumab done entirely in a lower-middle-income country. METHODS: COVINTOC is an open-label, multicentre, randomised, controlled, phase 3 trial done at 12 public and private hospitals across India. Adults (aged ≥18 years) admitted to hospital with moderate to severe COVID-19 (Indian Ministry of Health grading) confirmed by positive SARS-CoV-2 PCR result were randomly assigned (1:1 block randomisation) to receive tocilizumab 6 mg/kg plus standard care (the tocilizumab group) or standard care alone (the standard care group). The primary endpoint was progression of COVID-19 (from moderate to severe or from severe to death) up to day 14 in the modified intention-to-treat population of all participants who had at least one post-baseline assessment for the primary endpoint. Safety was assessed in all randomly assigned patients. The trial is completed and registered with the Clinical Trials Registry India (CTRI/2020/05/025369). FINDINGS: 180 patients were recruited between May 30, 2020, and Aug 31, 2020, and randomly assigned to the tocilizumab group (n=90) or the standard care group (n=90). One patient randomly assigned to the standard care group inadvertently received tocilizumab at baseline and was included in the tocilizumab group for all analyses. One patient randomly assigned to the standard care group withdrew consent after the baseline visit and did not receive any study medication and was not included in the modified intention-to-treat population but was still included in safety analyses. 75 (82%) of 91 in the tocilizumab group and 68 (76%) of 89 in the standard care group completed 28 days of follow-up. Progression of COVID-19 up to day 14 occurred in eight (9%) of 91 patients in the tocilizumab group and 11 (13%) of 88 in the standard care group (difference -3·71 [95% CI -18·23 to 11·19]; p=0·42). 33 (36%) of 91 patients in the tocilizumab group and 22 (25%) of 89 patients in the standard care group had adverse events; 18 (20%) and 15 (17%) had serious adverse events. The most common adverse event was acute respiratory distress syndrome, reported in seven (8%) patients in each group. Grade 3 adverse events were reported in two (2%) patients in the tocilizumab group and five (6%) patients in the standard care group. There were no grade 4 adverse events. Serious adverse events were reported in 18 (20%) patients in the tocilizumab group and 15 (17%) in the standard care group; 13 (14%) and 15 (17%) patients died during the study. INTERPRETATION: Routine use of tocilizumab in patients admitted to hospital with moderate to severe COVID-19 is not supported. However, post-hoc evidence from this study suggests tocilizumab might still be effective in patients with severe COVID-19 and so should be investigated further in future studies. FUNDING: Medanta Institute of Education and Research, Roche India, Cipla India, and Action COVID-19 India.
Published: 2021
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28. Ultrasound-guided Bedside Percutaneous Transhepatic Biliary Drainage in Critically Ill: A Friend Indeed

Author: Deepak Govil and Anant Vikram Pachisia
Subjects: Critical Care and Intensive Care Medicine
Published: 2022
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29. Delirium Assessment in Intensive Care Unit: A Need for Higher Regard!

Author: Divya Pal and Deepak Govil
Subjects: Critical Care and Intensive Care Medicine
Published: 2022

30. Feasibility of Laparoscopic Intraoperative Cholangiogram in Patients with Intermediate Risk for Choledocholithiasis

Author: Vachan S. Hukkeri, Varun Madaan, Rigved Gupta, Satya Prakash Jindal, Vivek Tandon, GK Adithya, and Deepak Govil
Subjects: medicine.medical_specialty, laparoscopic intraoperative cholangiogram, business.industry, lcsh:R5-130.5, intermediate risk, Surgery, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Intraoperative cholangiogram, Medicine, 030211 gastroenterology & hepatology, In patient, business, Intermediate risk, lcsh:General works
Abstract: BACKGROUND Intra-Operative Cholangiogram (IOC) is a procedure carried out during cholecystectomy with the primary objective of clearly delineating the biliary anatomy. Over decades, routine IOC became selective IOC and now it is being overtaken by less invasive investigations like MRCP and EUS. Role of IOC remains only to intraoperatively confirm or rule out bile duct injury in difficult cases. Laparoscopic IOC is a skilful procedure which requires training and extra added time during laparoscopic cholecystectomy. Once mastered it can be used in many situations for either anatomical reasons or to detect CBD pathology. METHODS All patients getting admitted for laparoscopic cholecystectomy with intermediate risk for choledocholithiasis were enrolled in the study from 2016 to 2019. Procedure was carried out with all necessary consents and precautions. All cases were performed by an experienced GI surgeon and followed up with proper protocol. RESULTS Fifty patients with known intermediate risk for choledocholithiasis underwent laparoscopic cholecystectomy with laparoscopic IOC. Procedure was successfully done in all patients except two, where cystic duct was very thin and cannulation was not possible. Forty-one (82%) patients had deranged liver function test and 9 patients (18%) had history of acute pancreatitis in the past as indications for the procedure. Two patients had dilated CBD (>6 mm) on ultrasound along with deranged liver function tests. An average of 12 minutes was taken to perform the procedure (range: 8 - 15 min). In cases where IOC took longer time was mainly due to technical issues (operability of C-arm). No IOC related complications occurred in any of the patients. Hospital stay was not prolonged in any of the patients due to IOC. None of the patients had any filling defect in CBD. All cases followed till date are asymptomatic. CONCLUSIONS It is a technically feasible procedure that can be performed with limited addition to OT time, minimal failure rate, and complications. All patients with limited criteria for intermediate risk of choledocholithiasis had a normal IOC with no evidence of biliary obstruction in follow up. KEYWORDS Laparoscopic Intraoperative Cholangiogram, Intermediate Risk, CBD Stones
Published: 2021

31. Expert Consensus Statements on the Use of Corticosteroids in Non-severe COVID-19

Author: Vijay Hadda, Rohit Yadav, Ravi Jain, Rajesh M Shetty, Dhruva Chaudhry, Sandeep Garg, Srinivas Samavedam, Deepak Govil, Mohan Gurjar, Prashant Nasa, Sumit Ray, Rajesh C Mishra, Bharat G Jagiasi, Deven Juneja, Mradul Kumar Daga, Manish Munjal, Pradeep Rangappa, Hrishikesh Jha, Himadri S Barthakur, Sivakumar Mundilipayalam Nandakumar, Akshaykumar A Chhallani, Apoorv Krishna, Raghunath Aladakatti, and Yash Javeri
Subjects: Thorax, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, medicine.drug_class, Non-severe COVID-19, SARS-CoV-2, education, Organ dysfunction, Delphi method, Consensus Statement, Corticosteroids in moderate COVID-19, Critical Care and Intensive Care Medicine, Delphi study, Work of breathing, Radiological weapon, Internal medicine, Medicine, Corticosteroid, medicine.symptom, business, Dexamethasone, medicine.drug
Abstract: Introduction There is strong evidence for the use of corticosteroid in the management of severe coronavirus disease-2019 (COVID-19). However, there is still uncertainty about the timing of corticosteroids. We undertook a modified Delphi study to develop expert consensus statements on the early identification of a subset of patients from non-severe COVID-19 who may benefit from using corticosteroids. Methods A modified Delphi was conducted with two anonymous surveys between April 30, 2021, and May 3, 2021. An expert panel of 35 experts was selected and invited to participate through e-mail. The consensus was defined as >70% votes in multiple-choice questions (MCQ) on Likert-scale type statements, while strong consensus as >90% votes in MCQ or >50% votes for “very important” on Likert-scale questions in the final round. Results Twenty experts completed two rounds of the survey. There was strong consensus for the increased work of breathing (95%), a positive six-minute walk test (90%), thorax computed tomography severity score of >14/25 (85%), new-onset organ dysfunction (using clinical or biochemical criteria) (80%), and C-reactive protein >5 times the upper limit of normal (70%) as the criteria for patients’ selection. The experts recommended using oral or intravenous (IV) low-dose corticosteroids (the equivalent of 6 mg/day dexamethasone) for 5–10 days and monitoring of oxygen saturation, body temperature, clinical scoring system, blood sugar, and inflammatory markers for any “red-flag” signs. Conclusion The experts recommended against indiscriminate use of corticosteroids in mild to moderate COVID-19 without the signs of clinical worsening. Oral or IV low-dose corticosteroids (the equivalent of 6 mg/day dexamethasone) for 5–10 days are recommended for patients with features of disease progression based on clinical, biochemical, or radiological criteria after 5 days from symptom onset under close monitoring. How to cite this article How to cite this article: Nasa P, Chaudhry D, Govil D, Daga MK, Jain R, Chhallani AA, et al. Expert Consensus Statements on the Use of Corticosteroids in Non-severe COVID-19. Indian J Crit Care Med 2021;25(11):1280–1285.
Published: 2021

32. Basic Critical Care for Management of COVID-19 Patients: Position Paper of the Indian Society of Critical Care Medicine, Part II

Author: Deven, Juneja, Raymond D, Savio, Shrikanth, Srinivasan, Rahul A, Pandit, Suresh, Ramasubban, Pavan K, Reddy, Manoj K, Singh, Palepu Bn, Gopal, Dhruva, Chaudhry, Deepak, Govil, Subhal B, Dixit, and Srinivas, Samavedam
Subjects: 2019-20 coronavirus outbreak, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Venous thromboembolic, Guidelines, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Antibiotics, law, Sepsis, Intensive care, Pandemic, Medicine, Thromboprophylaxis, Intensive care medicine, Patients position, Acute respiratory distress syndrome, SARS-CoV-2, business.industry, COVID-19, 030208 emergency & critical care medicine, Intensive care unit, Critical care, 030228 respiratory system, Position paper, business
Abstract: With more than 23 million infections and more than 814,000 deaths worldwide, the coronavirus disease-2019 (COVID-19) pandemic is still far from over. Several classes of drugs including antivirals, antiretrovirals, anti-inflammatory, immunomodulatory, and antibiotics have been tried with varying levels of success. Still, there is lack of any specific therapy to deal with this infection. Although less than 30% of these patients require intensive care unit admission, morbidity and mortality in this subgroup of patients remain high. Hence, it becomes imperative to have general principles to guide intensivists managing these patients. However, as the literature emerges, these recommendations may change and hence, frequent updates may be required. How to cite this article: Juneja D, Savio RD, Srinivasan S, Pandit RA, Ramasubban S, Reddy PK, et al. Basic Critical Care for Management of COVID-19 Patients: Position Paper of Indian Society of Critical Care Medicine, Part-I. Indian J Crit Care Med 2020;24(Suppl 5):S244-S253.
Published: 2020
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33. Reprint: Airway Management and Related Procedures in Critically Ill COVID-19 Patients: Position Statement of the Indian Society of Critical Care Medicine

Author: Subhal Dixit, Palepu B Gopal, Deepak Govil, Srinivas Samavedam, Atul P Kulkarni, G Praveen Kumar, Kapil Zirpe, Arindam Kar, and Dhruva Chaudhry
Subjects: medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Statement (logic), business.industry, medicine.medical_treatment, COVID-19, Disease, Guidelines, Critical Care and Intensive Care Medicine, Nebulization, Videolaryngoscopy, Airway, Tracheostomy, Extubation, Pandemic, Health care, medicine, Position paper, Airway management, Intubation, Intensive care medicine, business, Aerosol, Droplets
Abstract: The coronavirus disease (COVID-19) pandemic has affected nearly all nations globally. The highly contagious nature of the disease puts the healthcare workers at high risk of acquiring infection, especially while handling airway and performing aerosol-generating procedures. The Indian Society of Critical Care Medicine, through this position paper, aims to provide guidance for safe airway management to all healthcare workers dealing with airway in COVID-19 patients. How to cite this article Praveen Kumar G, Kulkarni AP, Govil D, Dixit SB, Chaudhry D, Samavedam S, et al. Airway Management and Related Procedures in Critically Ill COVID-19 Patients: Position Statement of the Indian Society of Critical Care Medicine. Indian J Crit Care Med 2020;24(8):630–642.
Published: 2020
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34. Debunk the Myth: Percutaneous Tracheostomy in Cervical Spine Injury

Author: Deepak Govil and Anant Vikram Pachisia
Subjects: Critical Care and Intensive Care Medicine
Published: 2022
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35. Seeing is Believing: The Import of Lung Ultrasound!

Author: Deepak, Govil and Anant Vikram, Pachisia
Subjects: Critical Care and Intensive Care Medicine
Published: 2022
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36. Evolution Over Time of Ventilatory Management and Outcome of Patients With Neurologic Disease

Author: Tejerina E. E., Pelosi P., Robba C., Penuelas O., Muriel A., Barrios D., Frutos-Vivar F., Raymondos K., Du B., Thille A. W., Rios F., Gonzalez M., Del-Sorbo L., Marin M. D. C., Valle Pinheiro B., Soares M. A., Nin N., Maggiore S. M., Bersten A., Amin P., Cakar N., Young Suh G., Abroug F., Jibaja M., Matamis D., Ali Zeggwagh A., Sutherasan Y., Anzueto A., Esteban A, Fernando Ríos, Damian Violi, Marisol Rodríguez-Goñi, Roger Lamoglie, Fernando Villarejo, Norberto Tiribelli, Santiago Ilutovich, Matías Brizuela, Mariana Monllau, Fernando Saldarini, Silvina Borello, Alberto Marino, Mauricio Vinzio, Karina Bonasegla, Julián Hernández, María Belén Yapur, María Eugenia González, Sebastián E Mare, Judith Sagardía, Marco Bezzi, Cecilia Pereyra, Julian Strati, Daniel Vargas, Claudia Diaz, Pablo Gómez, Marcelo Palavecino, Graciela Elizabeth, Aguilera García, M Eugenia, Luis Pablo Cardonnet, Lisandro Betttini, Hernán Nuñez, Lucas Vallejo, Fernando Fernández, Jorge Arroyo, Daniel Duarte, Gerardo Filippa, Cayetano Galetti, Hernan Nunia, Fernando Lambert, Elisa Estenssoro, Marina Busico, Javier Horacio Álvarez, Alejandro Raimondi, Gustavo Badariotti, Martín Lugaro, Fernando Lipovestky, Alan Javier Zazu, Hugo Capponcelli, Patricia Vogl, Cristina Orlandi, Alejandro Gómez, Gustavo Jannello, Alejandro Risso, Leticia Rapetti, Guillermo Chiappero, Juan Domingo Fernández, Rodrigo E Gómez-Paz, Marcos Juan Zec, Pascual Valdez, Jorgelina Guyon, Ariel Chena, Sergio Lasdica, Martin Deheza, Schimdt Alejandra, Francisco Criado, Norma Beatriz Márquez, Pablo Desmery, José Luis Scapellato, Gonzalo Javier Ríos, Cristian Casabella, Jasmin Board, Andrew Davies, Andrew Bersten, Elisha Matheson, Amy Waters, John Santamaria, Jennifer Holmes, Cartan Costello, Manoj K Saxena, John Myburgh, Ellen Kinkel, Forbes McGain, Claire Cattigan, Allison Bone, Ian Seppelt, Leonie Weisbrodt, Cheryl Cuzner, Christopher MacIsaac, Deborah Barge, Tania Caf, Cameron Knott, Graeme Duke, Imogen Mitchell, Helen Rodgers, Rachel Whyte, Elisha Fulton, Alistair Nichol, Hergen Buscher, Priya Nair, Claire Reynolds, Simon J G Hockley, Ian Moore, Katherine Davidson, David Milliss, Raju Pusapati, Helen Wong, Jason Fletcher, Julie Smith, Paul Goldrick, Dianne Stephens, Jane Thomas, Anders Aneman, Sutrisno Gunawan, Tom Cowlam, George Lukas, Rick McAllister, Minka Springham, Joanne Sutton, Jeff Presneill, Tony Sutherland, Dianne Hill, Howard Connor, Jenny Dennett, Tim Coles, Freddy Sandy, Sando Chavarria, Marcelo Choque, Ronald Pairumani, Juan Guerra, Marco Antônio Soares Reis, José Carlos Versiani, Eduardo Fonseca Sad, Maria Aparecida Braga, Dinalva Aparecida Gomes, Fernando Antônio Botoni, Maurício Meireles Góes, Frederico Costa Val Barros, Rogério de Castro Pereira, Hugo Urbano, Valéria de Carvalho Magela, Aline Camile Yehia, Bruno Bonaccorsi Fernandino, Marco Antônio Ribeiro Leão, Rovílson Lara, Rubens Altair Amaral de Pádua, Janine Dias Alves, Aloísio Marques do Nascimento, Bruno do Valle Pinheiro, Carlos Alberto Studart Gomes, Marcelo Alcântara Holanda, Frederico Rodrigues Anselmo, Niall Ferguson, Neill Adhikari, Robert Fowler, Cheromi Sittambalam, Mehar-Un-Nisa Raja, Nicole Marinoff, Lauralyn McIntryre, Shawna Reddie, Laura Jones, Irene Watpool, Jeffrey Singh, Madison Dennis, Andrea Matte, Marc Lipkus, Ryan Albert, Andrew Steel, Emily Stern, Michael Miletin, Antonio Raso, Robyn Klages, Jan Friedrich, Orla Smith, Laura Wilson, Deborah Cook, Mark Bailey, Sangeeta Mehta, Stephen Lapinsky, Hannah Mathers, Cheryl Ethier, Stephanie Lubchansky, Samer Haj-Bakri, Dietrich Henzler, Lisa Julien, Luis Soto-Román, Juan Carlos Maurelia, César Antonio Maquilon, Luis Soto-Germani, Bin Du, Yan Kang, Bo Wang, Fachun Zhou, Fang Xu, Haibo Qiu, Yi Yang, Qingyuan Zhan, Bing Sun, Zhenjie Hu, Bin Yu, Xi Zhu, Yu Bai, Gang Li, Yi Li, Geng Zhang, Jianbiao Meng, Xiaobo Huang, Hong Pu, Daxing Yu, Chuanyun Qian, Wei Zhang, Yongjie Yin, Debiao Song, Yunxuan Yue, Zhengxuan Lv, Chengmin Yu, Qunmei Yao, Xue Wang, Yuan Xu, Wei He, Mian Chen, Zhihua Hu, Dongpo Jiang, Jian Huang, Wei Yu, Juanxian Gu, Yangong Chao, Zhixiang Li, Zhicheng Zhang, Wanxia Li, Zhenyang He, Jianguo Li, Chang Liu, Tiehe Qin, Shouhong Wang, Feng Li, Jun Jin, Jianhong Fu, Hongyang Xu, Hongyuan Lin, Jianying Guo, Yalin Liu, Jinghua Wang, Maoqin Li, Jiaqiong Li, Lei Chen, Qing Song, Liang Pan, Xianyao Wan, Jiuzhi Zhang, Weihai Yao, Yuhong Guo, Pang Wing Yan, Kelly Choy, Kwan Ming Chit, Patricia Leung, Chau Chin Man, Marco González, Ricardo Buitrago, Marcela Granados, Guillermo Ortiz, Cesar Enciso, Mario Gómez, Bladimir Alejandro Gil, Juan Pablo Sedano, Luis Fernando Castro Castro, Carlo Alberto Acosta, Marco Gonzalez, Francisco Molina, Camilo Pizarro, Mario Villabon, Carmelo Dueñas, Carlos Andrés Díaz, Nelson Fonseca, Rubén Camargo, Juan David Uribe, Hans-Henrik Bülow, Simona Beniczky, Jens Brushoj, Mikkel Præst, Birgitte Viebaek, Sine Wichman, Anette Mortensen, Susanne Andi Iversen, Bo Broberg, Edgard Luna, Manuel Jibaja, Leonardo Pazmiño, Katty Trelles, Fabricio Picoita, Gustavo Paredes, Vanesa Ramírez, Guillermo Falconí, Cristian Cevallos, Boris Villamagua, Marco Escobar, Freddy Sánchez, Miguel Llano, Miguel Lazcano, Ramiro Puetate, José Miguel Guerrero, Mijail Játiva, Myriam Montalvo, Franklin Villegas, Luis González Zambrano, Ronnie Mantilla, Gina Quinde, Andrea Gimenez, Luis Gonzalez Mosquera, Henry Caballero, María Fernanda García, Marcelo Ochoa, Soraya Puertas, Jackeline Coello, Mario Acosta, Medhat Soliman, Arnaud W Thille, Achille Kouatchet, Alain Mercat, Laurent Brochard, François Collet, Guillaume Marcotte, Pascal Beuret, Jean-Christophe M Richard, Gaëtan Bedunaeu, Pierre-Gildas Guitard, Fabien Soulis, Frédéric Bellec, Philippe Berger, Dorothée Carpentier, Benoit Veber, Salem Ould Zein, Géraldine Dessertaine, C Canevet, Fabien Grelon, Konstantinos Raymondos, Rolf Dembinski, Rolf Rossaint, Steffen Weber-Carstens, Christian Putensen, Maximillian Ragaller, Michael Quintel, Winfried Schubert, Thomas Bein, Heinrich Paulus, Walter Brandt, Lutz Pfeiffer, Silke Frenzel, Thoralf Kerner, P Kruska, Leila Eckholt, Joachim Hartung, Harald Fritz, Monika Holler, Johannes Busch, Andreas Viehöfer, Jens Buettner, Jörn Schlechtweg, Achim Lunkeit, Roland Schneider, Maria Wussow, Nils Marquardt, Christian Frenkel, Falk Hildebrandt, Tumbass Volker, Thomas Lipp, Cezar Mihailescu, Thomas Moellhoff, Thomas Steinke, Oliver Franke, Marcus Ruecker, Markus Schappacher, Steffen Appel, Heinz Kerger, Andreas Schwartz, Jan Dittmann, Jörg Haberkorn, Wolfgang Baier, Walter Seyde, Dimitros Matamis, Eleni Antoniadou, Pertsas Evangelos, Maria Giannakou, Zoltan Szentkereszty, Zsolt Molnar, Pravin Amin, Farhad N Kapadia, Nagarajan Ramakrishnan, Deepak Govil, Anitha Shenoy, Umesh G, Samir Sahu, Sheila Nainan Myatra, Subhash Kumar Todi, Sanjay Dhanuka, Mayur Patel, P Samaddar, Dhruva Chaudhry, Vivek Joshi, Srinivas Samavedam, Ankur Devendra Bhavsar, Prachee Sathe, Sujoy Mukherjee, Salvatore Maurizio Maggiore, Francesco Idone, Federica Antonicelli, Paolo Navalesi, Rosanna Vaschetto, Arianna Boggero, Rosalba Tufano, Michele Iannuzzi, Edoardo De Robertis, Romano Tetamo, Andrea Neville Cracchiolo, Antonio Braschi, Francesco Mojoli, Ilaria Curro', Mirko Belliato, Chiara Verga, Marta Ferrari, Erika Mannelli, Valerio Mangani, Giorgio Tulli, Francesca Frigieri, Armando Pedulla', Monica Rocco, Giorgia Citterio, Di Russo, Gaetano Perchiazzi, Loredana Pitagora, Antonio Pesenti, Michela Bombino, Davide Chiumello, Federica Tallarini, Serena Azzari, Antonina Pigna, Ivano Aprile, Marco Adversi, Antonio Corcione, Marianna Esposito, Annunziata Mattei, Vito Marco Ranieri, Rosario Urbino, Ilaria Maria Mastromauro, Antonino Giarratano, Maurizio Raineri Santi, Ambrogio Sansone, Younsuck Koh, Moo Suk Park, Je Hyeong Kim, Kyung Chan Kim, Hye Sook Choi, Yun Seong Kim, Jin Hwa Lee, Myung-Goo Lee, Won-Yeon Lee, Jin Young An, Gee Young Suh, Ki-Suck Jung, Asisclo J Villagómez Ortiz, César Cruz Lozano, Zalatiel Maycotte Luna, José Francisco López Baca, José Elizalde, Guillermo Cueto Robledo, Mario Alonso Treviño Salinas, Ricardo Martinez Zubieta, Claudia Olvera-Guzman, Marco Montes De Oca, Silvio A Ñamendys-Silva, José Salvador Martínez Cano, Jose Angel Baltazar Torres, Gustavo Morales Muñoz, Antonio Villa Delgado, Javier Ladape Martinez, Amine Ali Zeggwagh, Tarek Dendane, Abderrahim Azzouzi, Ahmed Sbihi, Wajdi Maazouzi, Mourad Amor, Charki Haimeur, Michael A Kuiper, Matty Koopmans, Uli Strauch, Dennis Bergmans, Serge Heines, Sylvia den Boer, Bas M Kors, Peter van der Voort, Paul J Dennesen, Bert Beishuizen, Ingrid van den Hul, Erna Alberts, Harry P P M Gelissen, Eduard Bootsma, Auke Reidinga, Kim Heus, Diane Mackle, Paul Young, Rachael Parke, Eileen Gilder, Jodi Brown, Lynette Newby, Catherine Simmonds, Jan Mehrtens, Seton Henderson, Tony Williams, Judi Tai, Chantal Hogan, Mary La Pine, John Durning, Sheree Gare, Troy Browne, Shirley Nelson, Jennifer Goodson, Julio Osorio, Chabu Coronado, Rollin Roldán Mori, Rosa Luz López Martínez, Adam Mikstacki, Barbara Tamowicz, Rui Moreno, Eduardo Almeida, Joana Silvestre, Heloisa Castro, Irene Aragão, Susana Alves Ferreira, Nelson Barros, Filomena Faria, Carlos André Correia Casado, Fausto Fialho Moura, Paulo Marcal, Ricardo Matos, Edward Nicolayenko, Mikhail Kirov, Andrey Yaroshetskiy, Andrei Piontek, Valery Subbotin, Yaseen Arabi, Olivia Dulfo, Chafrina Marie Olay, Edgardo E Tabhan, Nicolas Nin, Alfonso Muñoz, César Aragón, Ana Villagrá, Ainhoa Rosselló, Joan Maria Raurich, María Garitacelaya, Miguel Ángel González-Gallego, Francisco Ortuño, Miguel Fernández-Vivas, David Freire, Francisco Guerrero, Francisco Manzano, Juan Carlos, Alfredo Padrón, Pedro Rosa, Rafael Morales, Liliana Caipe, Maurizio Bottiroli, José María Nicolás, Marta Ugalde, Javier Ruiz, Lucia Capilla, Guillermo Muñiz, Jesús Sánchez-Ruiz, Javier Cebrián, Begoña Balerdi, Elena Parreño, Alvaro van Bommel, César Pérez-Calvo, Irene Dot, Javier Blanco, Raquel Manzanedo, José J Blanco, Daniel Fontaneda, Raúl González, Javier Díaz Domínguez, Alfonso Moreno, Antonio Reyes, Ian Carrasco, Itziar Mintegui, Rosa Sebastián, Javier García-Alonso, Carolina Lorencio, Josep Maria Sirvent, Patricia Jimeno, Miguel León, Pedro Galdos, Nuria Alonso, Julia López-Díaz, María Victoria de la Torre, Jorge Vidal Hernández, Nicolás Zamboschi, Francisco Lucena, Gemma Rialp, Raquel Montoiro, Victoria Goñi, María Ángeles Pena, Antonio Maestre, Marc Fabra, Jacinto Baena, Eva Benveniste, Susana Temprano, Jesús Sánchez, Carmen Campos, Sara Cabañes, María Elena Pérez-Losada, José Claudio Leo, Enrique Piacentini, María Del Carmen de la Torre, Laura Álvarez-Montero, Fernando Sánchez, Antonio Viñuales, Bernabé Álvarez, Javier Castañeda, Ángela Alonso, María Isabel Ruiz, Pedro Jesús Domínguez, Marcos Delgado, Eugenio Palazón, Antonio García-Jiménez, Rosa Álvaro, Clara Laplaza Eva Regidor, Enrique Maraví, José María Quiroga, Amalia Martínez de la Gandara, Cecilia Carbayo, María Luisa Navarrete, Manuel Valledor, Raquel Yano, José María Gutiérrez, Javier González-Robledo, Amparo Ferrandiz, Alberto Belenguer, Lidón Mateu, Laura Sayagues, María José Tolón, Nieves Franco, Elena Gallego, Félix Lacoma, Patricia Albert, Vicente Arraez, Mar Gobernado, Susana Moradillo, Carolina Gímenez-Esparza, Teresa Sánchez de Dios, Carlos Marian Crespo, Cecilia Hermosa, Federico Gordo, Genis Carrasco, María Ángeles Alonso, Alejandro Algora, Raúl de Pablo, Sofía García, Ana Carolina Caballero, José María Montón, Teresa Mut, Eva Manteiga, Alejandro de la Serna, Ana Esther Trujillo, Rafael Blancas, Inmaculada Vallverdú, José Manuel Serrano, Miquel Ferrer, Juan Diego Jiménez, Carlos Gallego, Dolores Vila, Luis Marina, Valentín Parra, Juan Ramón Cortés, Chen Chin-Ming, Ai-Chin Cheng, Fekri Abroug, Besbes Mohamed, Imed Chouchene, Mounir Bouaziz, Stambouli Neji, Islem Ouanes, Ayed Samia, Nahit Cakar, Ismail Kati, Ali Aydım Altunkan, Remzi Iscimen, Zafer Dogan, Bilge Çetin, Tayfun Adanir, Sabriye Guvenc, Unase Büyükkoçak, Antonio Anzueto, Ashley Ellis, Gary Kinasewitz, Allan Walkey, Phil Alkana, Gregory A Schmidt, Susan Gillen, Kathleen Lilli, Jennifer Twombley, Denice Wells, Larry Welder, Alejandro Arroliga, Alfredo Vasquez-Sandoval, Vincent John Scott, Craig Cernosek, Christopher Spradley, Dimple Tejwani, Sindhaghatta Venkatram, Gilda Diaz-Fuentes, Amber Monson, Anthony Saleh, Madhav Gudi, George Liziamma, Mohamed A Saad, Crissie De Spirito, Bryan Beatty, Samir Vermani, Crissie Despirito, Zaza Cohen, Amee Patrawalla, Samir Abdelhadi, Rupesh Vakil, Steven Y Chang, Brian Sherman, Rosanna Del Giudice, John Oropell, Timothy D Girard, Cayce Strength, Joyce Okahashi, Leanne Boehm, Matthew Kirchner, Erwin J Oei, Sebastian Circo, Nelson Medina, Mohammed Al-Jagbeer, V J Cardenas Jr, Smyth Smith, Shelby Sutton, Marcela Canola-Mazo, Tim Houlihan, Yogeet Kaur, Travis Parry, Craig A Piquette, Kerry Canady, Rahul Nanchal, Dana K Soetaert, Maria Del Mar Torres-Perez, Carlos Robles-Arias, William Rodriguez-Cintron, Mark Tidswell, Jennifer Germain, Lori-Ann Kozikowski, Erin Braden, Geneva Tatem, Javier Hurtado, Alberto Deicas, Daniel Weiss, Marta Beron, Román Garrido, Cristina Santos, Mario Cancela, Raúl 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Yao, Yuhong Guo, Pang Wing Yan, Kelly Choy, Kwan Ming Chit, Patricia Leung, Chau Chin Man, Marco González, Ricardo Buitrago, Marcela Granados, Guillermo Ortiz, Cesar Enciso, Mario Gómez, Bladimir Alejandro Gil, Juan Pablo Sedano, Luis Fernando Castro Castro, Carlo Alberto Acosta, Marco Gonzalez, Francisco Molina, Camilo Pizarro, Mario Villabon, Carmelo Dueñas, Carlos Andrés Díaz, Nelson Fonseca, Rubén Camargo, Juan David Uribe, Hans-Henrik Bülow, Simona Beniczky, Jens Brushoj, Mikkel Præst, Birgitte Viebaek, Sine Wichman, Anette Mortensen, Susanne Andi Iversen, Bo Broberg, Edgard Luna, Manuel Jibaja, Leonardo Pazmiño, Katty Trelles, Fabricio Picoita, Gustavo Paredes, Vanesa Ramírez, Guillermo Falconí, Cristian Cevallos, Boris Villamagua, Marco Escobar, Freddy Sánchez, Miguel Llano, Miguel Lazcano, Ramiro Puetate, José Miguel Guerrero, Mijail Játiva, Myriam Montalvo, Franklin Villegas, Luis González Zambrano, Ronnie Mantilla, Gina Quinde, Andrea Gimenez, Luis Gonzalez Mosquera, Henry Caballero, María Fernanda García, Marcelo Ochoa, Soraya Puertas, Jackeline Coello, Mario Acosta, Medhat Soliman, Arnaud W Thille, Achille Kouatchet, Alain Mercat, Laurent Brochard, François Collet, Guillaume Marcotte, Pascal Beuret, Jean-Christophe M Richard, Gaëtan Bedunaeu, Pierre-Gildas Guitard, Fabien Soulis, Frédéric Bellec, Philippe Berger, Dorothée Carpentier, Benoit Veber, Salem Ould Zein, Géraldine Dessertaine, C Canevet, Fabien Grelon, Konstantinos Raymondos, Rolf Dembinski, Rolf Rossaint, Steffen Weber-Carstens, Christian Putensen, Maximillian Ragaller, Michael Quintel, Winfried Schubert, Thomas Bein, Heinrich Paulus, Walter Brandt, Lutz Pfeiffer, Silke Frenzel, Thoralf Kerner, P Kruska, Leila Eckholt, Joachim Hartung, Harald Fritz, Monika Holler, Johannes Busch, Andreas Viehöfer, Jens Buettner, Jörn Schlechtweg, Achim Lunkeit, Roland Schneider, Maria Wussow, Nils Marquardt, Christian Frenkel, Falk Hildebrandt, Tumbass Volker, Thomas Lipp, Cezar Mihailescu, Thomas Moellhoff, Thomas Steinke, Oliver Franke, Marcus Ruecker, Markus Schappacher, Steffen Appel, Heinz Kerger, Andreas Schwartz, Jan Dittmann, Jörg Haberkorn, Wolfgang Baier, Walter Seyde, Dimitros Matamis, Eleni Antoniadou, Pertsas Evangelos, Maria Giannakou, Zoltan Szentkereszty, Zsolt Molnar, Pravin Amin, Farhad N Kapadia, Nagarajan Ramakrishnan, Deepak Govil, Anitha Shenoy, Umesh G, Samir Sahu, Sheila Nainan Myatra, Subhash Kumar Todi, Sanjay Dhanuka, Mayur Patel, P Samaddar, Dhruva Chaudhry, Vivek Joshi, Srinivas Samavedam, Ankur Devendra Bhavsar, Prachee Sathe, Sujoy Mukherjee, Salvatore Maurizio Maggiore, Francesco Idone, Federica Antonicelli, Paolo Navalesi, Rosanna Vaschetto, Arianna Boggero, Rosalba Tufano, Michele Iannuzzi, Edoardo De Robertis, Romano Tetamo, Andrea Neville Cracchiolo, Antonio Braschi, Francesco Mojoli, Ilaria Curro', Mirko Belliato, Chiara Verga, Marta Ferrari, Erika Mannelli, Valerio Mangani, Giorgio Tulli, Francesca Frigieri, Armando Pedulla', Monica Rocco, Giorgia Citterio, Di Russo, Gaetano Perchiazzi, Loredana Pitagora, Antonio Pesenti, Michela Bombino, Davide Chiumello, Federica Tallarini, Serena Azzari, Antonina Pigna, Ivano Aprile, Marco Adversi, Antonio Corcione, Marianna Esposito, Annunziata Mattei, Vito Marco Ranieri, Rosario Urbino, Ilaria Maria Mastromauro, Antonino Giarratano, Maurizio Raineri Santi, Ambrogio Sansone, Younsuck Koh, Moo Suk Park, Je Hyeong Kim, Kyung Chan Kim, Hye Sook Choi, Yun Seong Kim, Jin Hwa Lee, Myung-Goo Lee, Won-Yeon Lee, Jin Young An, Gee Young Suh, Ki-Suck Jung, Asisclo J Villagómez Ortiz, César Cruz Lozano, Zalatiel Maycotte Luna, José Francisco López Baca, José Elizalde, Guillermo Cueto Robledo, Mario Alonso Treviño Salinas, Ricardo Martinez Zubieta, Claudia Olvera-Guzman, Marco Montes De Oca, Silvio A Ñamendys-Silva, José Salvador Martínez Cano, Jose Angel Baltazar Torres, Gustavo Morales Muñoz, Antonio Villa Delgado, Javier Ladape Martinez, Amine Ali Zeggwagh, Tarek Dendane, Abderrahim Azzouzi, Ahmed Sbihi, Wajdi Maazouzi, Mourad Amor, Charki Haimeur, Michael A Kuiper, Matty Koopmans, Uli Strauch, Dennis Bergmans, Serge Heines, Sylvia den Boer, Bas M Kors, Peter van der Voort, Paul J Dennesen, Bert Beishuizen, Ingrid van den Hul, Erna Alberts, Harry P P M Gelissen, Eduard Bootsma, Auke Reidinga, Jasmin Board, Andrew Davies, Kim Heus, Diane Mackle, Paul Young, Rachael Parke, Eileen Gilder, Jodi Brown, Lynette Newby, Catherine Simmonds, Jan Mehrtens, Seton Henderson, Tony Williams, Judi Tai, Chantal Hogan, Mary La Pine, John Durning, Sheree Gare, Troy Browne, Shirley Nelson, Jennifer Goodson, Julio Osorio, Chabu Coronado, Rollin Roldán Mori, Rosa Luz López Martínez, Adam Mikstacki, Barbara Tamowicz, Rui Moreno, Eduardo Almeida, Joana Silvestre, Heloisa Castro, Irene Aragão, Susana Alves Ferreira, Nelson Barros, Filomena Faria, Carlos André Correia Casado, Fausto Fialho Moura, Paulo Marcal, Ricardo Matos, Edward Nicolayenko, Mikhail Kirov, Andrey Yaroshetskiy, Andrei Piontek, Valery Subbotin, Yaseen Arabi, Olivia Dulfo, Chafrina Marie Olay, Edgardo E Tabhan, Nicolas Nin, Alfonso Muñoz, César Aragón, Ana Villagrá, Ainhoa Rosselló, Joan Maria Raurich, María Garitacelaya, Miguel Ángel González-Gallego, Francisco Ortuño, Miguel Fernández-Vivas, David Freire, Francisco Guerrero, Francisco Manzano, Juan Carlos, Alfredo Padrón, Pedro Rosa, Rafael Morales, Liliana Caipe, Maurizio Bottiroli, José María Nicolás, Marta Ugalde, Javier Ruiz, Lucia Capilla, Guillermo Muñiz, Jesús Sánchez-Ruiz, Javier Cebrián, Begoña Balerdi, Elena Parreño, Alvaro van Bommel, César Pérez-Calvo, Irene Dot, Javier Blanco, Raquel Manzanedo, José J Blanco, Daniel Fontaneda, Raúl González, Javier Díaz Domínguez, Alfonso Moreno, Antonio Reyes, Ian Carrasco, Itziar Mintegui, Rosa Sebastián, Javier García-Alonso, Carolina Lorencio, Josep Maria Sirvent, Patricia Jimeno, Miguel León, Pedro Galdos, Nuria Alonso, Julia López-Díaz, María Victoria de la Torre, Jorge Vidal Hernández, Nicolás Zamboschi, Francisco Lucena, Gemma Rialp, Raquel Montoiro, Victoria Goñi, María Ángeles Pena, Antonio Maestre, Marc Fabra, Jacinto Baena, Eva Benveniste, Susana Temprano, Jesús Sánchez, Carmen Campos, Sara Cabañes, María Elena Pérez-Losada, José Claudio Leo, Enrique Piacentini, María Del Carmen de la Torre, Laura Álvarez-Montero, Fernando Sánchez, Antonio Viñuales, Bernabé Álvarez, Javier Castañeda, Ángela Alonso, María Isabel Ruiz, Pedro Jesús Domínguez, Marcos Delgado, Eugenio Palazón, Antonio García-Jiménez, Rosa Álvaro, Clara Laplaza Eva Regidor, Enrique Maraví, José María Quiroga, Amalia Martínez de la Gandara, Cecilia Carbayo, María Luisa Navarrete, Manuel Valledor, Raquel Yano, José María Gutiérrez, Javier González-Robledo, Amparo Ferrandiz, Alberto Belenguer, Lidón Mateu, Laura Sayagues, María José Tolón, Nieves Franco, Elena Gallego, Félix Lacoma, Patricia Albert, Vicente Arraez, Mar Gobernado, Susana Moradillo, Carolina Gímenez-Esparza, Teresa Sánchez de Dios, Carlos Marian Crespo, Cecilia Hermosa, Federico Gordo, Genis Carrasco, María Ángeles Alonso, Alejandro Algora, Raúl de Pablo, Sofía García, Ana Carolina Caballero, José María Montón, Teresa Mut, Eva Manteiga, Alejandro de la Serna, Ana Esther Trujillo, Rafael Blancas, Inmaculada Vallverdú, José Manuel Serrano, Miquel Ferrer, Juan Diego Jiménez, Carlos Gallego, Dolores Vila, Luis Marina, Valentín Parra, Juan Ramón Cortés, Chen Chin-Ming, Ai-Chin Cheng, Fekri Abroug, Besbes Mohamed, Imed Chouchene, Mounir Bouaziz, Stambouli Neji, Islem Ouanes, Ayed Samia, Nahit Cakar, Ismail Kati, Ali Aydım Altunkan, Remzi Iscimen, Zafer Dogan, Bilge Çetin, Tayfun Adanir, Sabriye Guvenc, Unase Büyükkoçak, Antonio Anzueto, Ashley Ellis, Gary Kinasewitz, Allan Walkey, Phil Alkana, Gregory A Schmidt, Susan Gillen, Kathleen Lilli, Jennifer Twombley, Denice Wells, Larry Welder, Alejandro Arroliga, Alfredo Vasquez-Sandoval, Vincent John Scott, Craig Cernosek, Christopher Spradley, Dimple Tejwani, Sindhaghatta Venkatram, Gilda Diaz-Fuentes, Amber Monson, Anthony Saleh, Madhav Gudi, George Liziamma, Mohamed A Saad, Crissie De Spirito, Bryan Beatty, Samir Vermani, Crissie Despirito, Zaza Cohen, Amee Patrawalla, Samir Abdelhadi, Rupesh Vakil, Steven Y Chang, Brian Sherman, Rosanna Del Giudice, John Oropell, Timothy D Girard, Cayce Strength, Joyce Okahashi, Leanne Boehm, Matthew Kirchner, Ashley Ellis, Gary Kinasewitz, Erwin J Oei, Sebastian Circo, Nelson Medina, Mohammed Al-Jagbeer, V J Cardenas Jr, Smyth Smith, Shelby Sutton, Marcela Canola-Mazo, Tim Houlihan, Yogeet Kaur, Travis Parry, Craig A Piquette, Kerry Canady, Rahul Nanchal, Dana K Soetaert, Maria Del Mar Torres-Perez, Carlos Robles-Arias, William Rodriguez-Cintron, Mark Tidswell, Jennifer Germain, Lori-Ann Kozikowski, Erin Braden, Geneva Tatem, Javier Hurtado, Alberto Deicas, Daniel Weiss, Marta Beron, Román Garrido, Cristina Santos, Mario Cancela, Raúl Lombardi, Pedro Alzugaray, Jorge Gerez, Silvia Mareque, Graciela Franca, Oscar Cluzet, Edgardo Nuñez, Julio Pontet, Sergio Cáceres, Elias Caragna, Alberto Soler, Frank Torres, Gastón Pittini, Gabriel D Empaire, Stevens Salva, Fernando Pérez, Clara Pacheco, Zoraida Parra, Ingrid Von der Osten, Luis Williams, José Salinas, Do Danh Quynh, Pham Thi Van Anh, Nguyen Huu Hoang, Nghuyen Ba Tuan
Subjects: Male, medicine.medical_treatment, pulmonary complications, RESPIRATORY-DISTRESS-SYNDROME, Critical Care and Intensive Care Medicine, CASE-FATALITY, 0302 clinical medicine, Risk Factors, Brain Injuries, Traumatic, Multicenter Studies as Topic, Hospital Mortality, Prospective Studies, Simplified Acute Physiology Score, Stroke, POPULATION, Age Factors, ANEURYSMAL SUBARACHNOID HEMORRHAGE, Middle Aged, Hemorrhagic Stroke, Intensive Care Units, Observational Studies as Topic, Anesthesia, Breathing, Female, medicine.symptom, Ventilator Weaning, Cohort study, Adult, TRAUMATIC BRAIN-INJURY, Pressure support ventilation, mechanical ventilation, prognosis factors, ACUTE LUNG INJURY, 03 medical and health sciences, medicine, Humans, Aged, Ischemic Stroke, Mechanical ventilation, Noninvasive Ventilation, business.industry, MORTALITY, neurologic patients, Organ dysfunction, 030208 emergency & critical care medicine, Length of Stay, medicine.disease, TRENDS, Respiration, Artificial, 030228 respiratory system, Etiology, NEUROCRITICAL CARE, Nervous System Diseases, Tracheotomy, business
Abstract: OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease.
Published: 2021
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37. Indocyanine green enhanced near-infrared fluorescence imaging for perfusion assessment of colonic conduit for esophageal replacement: Utility of a novel technique

Author: Varun Madaan, Supreet Kumar, Deepak Govil, and Rigved Gupta
Subjects: icg fluorescence imaging, Fluorescence-lifetime imaging microscopy, medicine.medical_specialty, Leak, Near-Infrared Fluorescence Imaging, indocyanine green, medicine.medical_treatment, Case Report, Anastomosis, colonic interposition, chemistry.chemical_compound, Medicine, cardiovascular diseases, colonic conduit, health care economics and organizations, perfusion assessment, business.industry, General Medicine, Perioperative, surgical procedures, operative, chemistry, Esophagectomy, cardiovascular system, esophagectomy, Radiology, business, Indocyanine green, Perfusion
Abstract: Esophagectomy, followed by esophageal replacement using gastric/colonic conduits, is a complex surgical procedure with significant perioperative morbidity. The most significant and potentially life-threatening complication associated with esophageal replacement is conduit ischaemia, resulting in anastomotic leak and conduit necrosis. Ensuring adequate perfusion of the conduit remains the key to preventing conduit ischaemia. Indocyanine green (ICG) enhanced near-infrared fluorescence imaging is a novel technique which has been used for assessing bowel perfusion. While numerous studies have focused on ICG fluorescence imaging for assessment of gastric conduit perfusion after esophagectomy, data regarding its use for colonic conduits is limited to case reports. ICG fluorescence imaging can help in resolving intraoperative issues by predicting the adequacy of colonic conduit perfusion, thereby preventing postoperative morbidity. To the best of our knowledge, this is the first report in Indian literature describing the utility of ICG fluorescence imaging for assessment of perfusion of colonic interposition.
Published: 2021

38. The Seventh Organ—Gastrointestinal Tract: Neglect at Your Own Peril!

Author: Deepak Govil, Sachin Gupta, and Atul P Kulkarni
Subjects: medicine.medical_specialty, Gastrointestinal tract, business.industry, media_common.quotation_subject, Acute intestinal failure, Gastric residual volume, 030208 emergency & critical care medicine, Paralytic ileus, Critical Care and Intensive Care Medicine, Gastroenterology, Neglect, 03 medical and health sciences, Gastrointestinal complications, Editorial, Acute upper gastrointestinal bleed, 0302 clinical medicine, 030228 respiratory system, Internal medicine, medicine, business, Gastrointestinal dysmotility, media_common
Abstract: How to cite this article: Kulkarni AP, Govil D, Gupta S. The Seventh Organ—Gastrointestinal Tract: Neglect at Your Own Peril!. Indian J Crit Care Med 2020;24(Suppl 4):S143–S145.
Published: 2020
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39. Current Approaches to COVID-19: Therapy and Prevention

Author: Om Shrivastav, Atul P Kulkarni, Yatin Mehta, Srinivas Samavedam, Subhal Dixit, Pradeep Rangappa, Dhruva Chaudhry, Kapil Zirpe, Rahul A Pandit, Ujwala Mhatre, Khalid I Khatib, Sameer Jog, Susruta Bandopadhyay, and Deepak Govil
Subjects: medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Hospitalized patients, Review Article, Disease, Critical Care and Intensive Care Medicine, Azithromycin, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Tocilizumab, Pandemic, Medicine, Intensive care medicine, Heparin, SARS-CoV-2, business.industry, Critically ill, 030208 emergency & critical care medicine, Hydroxychloroquine, Coronavirus, 030228 respiratory system, chemistry, Coronavirus disease-2019, Remdesvir, business, medicine.drug
Abstract: The coronavirus disease-2019 (COVID-19) pandemic has affected millions of people worldwide. As our understanding of the disease is evolving, our approach to the patient management is also changing swiftly. Available new evidence is helping us take radical decisions in COVID-19 management. We searched for inclusion of the published literature on treatment of COVID-19 from around the globe. All relevant evidences available till the time of submission of this article were briefly discussed. Once advised as blanket therapy for all patients, recent reports of hydroxychloroquine with or without azithromycin indicated no potential benefit and use of such combination may increase the risk of arrhythmias. Clinical evidence with newer antivirals such as remdesivir and favipiravir is promising that can hasten the patient recovery and reduce the mortality. With steroids, evidence is much clear in that it should be used in low dose and for short period not extending beyond 7 days in moderate to severe hospitalized patients. Low-molecular-weight heparin should be initiated in all hospitalized COVID-19 patients and dose should be based on the coagulation profile and risk of thromboembolism. Immunomodulatory drugs such tocilizumab may be considered for severe and critically ill patients to improve the outcomes. Though ulinastatin can be a potential alternative immunomodulator, there is lack of clinical evidence on its usage in COVID-19. Convalescent plasma therapy can be potentially lifesaving in critically ill patients. However, there is need to generate further evidence with various such therapies. Though availability of a potent vaccine is awaited, current treatment of COVID-19 is based on available therapies, which is guided by the evidence. In this review, we discuss the potential treatments available around the globe with current evidence on each of such treatments. How to cite this article: Dixit SB, Zirpe KG, Kulkarni AP, Chaudhry D, Govil D, Mehta Y, et al. Current Approaches to COVID-19: Therapy and Prevention. Indian J Crit Care Med 2020;24(9):838–846.
Published: 2020
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40. Systemic Involvement of Novel Coronavirus (COVID-19): A Review of Literature

Author: Nilay Chatterjee, Deepak Govil, Manish Munjal, Adarsh Eshappa Setra, and Samaresh Das
Subjects: Peacetime, Face (sociological concept), Globe, Review Article, Multisystemic involvement of COVID-19, Criminology, Critical Care and Intensive Care Medicine, Elevation of cardiac troponins (cTnI), Respiratory system, 03 medical and health sciences, 0302 clinical medicine, Neurological signs, Pandemic, medicine, Food security, Acute respiratory distress syndrome, Novel coronavirus, business.industry, Social distance, Respiratory infection, COVID-19, 030208 emergency & critical care medicine, medicine.anatomical_structure, 030228 respiratory system, Scale (social sciences), High rate of transmission, COVID pneumonia, business, Bilateral predominant ground-glass opacities
Abstract: COVID-19 outbreak has caused a pandemonium in modern world. As the virus has spread its tentacles across nations, territories, and continents, the civilized society has been compelled to face an unprecedented situation, never experienced before during peacetime. We are being introduced to an ever-growing new terminologies: “social distancing,” “lockdown,” “stay safe,” “key workers,” “self-quarantine,” “work-from-home,” and so on. Many countries across the globe have closed their borders, airlines have been grounded, movement of public transports has come to a grinding halt, and personal vehicular movements have been restricted or barred. In the past couple of months, we have witnessed mayhem in an unprecedented scale: social, economic, food security, education, business, travel, and freedom of movements are all casualties of this pandemic. Our experience about this virus and its epidemiology is limited, and mostly the treatment for symptomatic patients is supportive. However, it has been observed that COVID-19 not only attacks the respiratory system; rather it may involve other systems also from the beginning of infection or subsequent to respiratory infection. In this article, we attempt to describe the systemic involvement of COVID-19 based on the currently available experiences. This description is up to date as of now, but as more experiences are pouring from different corners of the world, almost every day, newer knowledge and information will crop up by the time this article is published. How to cite this article Munjal M, Das S, Chatterjee N, Setra AE, Govil D. Systemic Involvement of Novel Coronavirus (COVID-19): A Review of Literature. Indian J Crit Care Med 2020;24(7):565–569.
Published: 2020

41. Dilatational Percutaneous vs Surgical TracheoStomy in IntEnsive Care UniT: A Practice Pattern Observational Multicenter Study (DISSECT)

Author: Sachin Gupta, Dhruva Choudhry, Sushma K Gurav, Subhal Dixit, Nilanchal Chakrabortty, Deeksha S Tomar, Deepak Govil, Kanchi Vv Gupta, Jaya Wanchoo, Kapil Zirpe, and Zubair Umer Mohamed
Subjects: medicine.medical_specialty, Percutaneous, Complications, Cost, Forceps, Intensivist, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Tracheostomy, law, Surgical, medicine, Percutaneous dilatational, business.industry, Incidence (epidemiology), 030208 emergency & critical care medicine, Intensive care unit, Surgery, Platelet transfusion, 030228 respiratory system, Dilator, Observational study, Original Article, business
Abstract: Introduction Tracheostomy is among the common procedures performed in the intensive care unit (ICU), with percutaneous dilatational tracheostomy (PDT) being the preferred technique. We sought to understand the current practice of tracheostomy in Indian ICUs. Materials and methods A pan-India multicenter prospective observational study, endorsed and peer-reviewed by the Indian Society of Critical Care Medicine (ISCCM), on various aspects of tracheostomy performed in critically ill patients was conducted between September 1, 2019 and December 31, 2019. The SPSS software was used for the statistical analysis. Cross tables were generated and the chi-square test was used for testing of association. The p value < 0.05 was considered statistically significant. Results Out of 67 ICUs that participated, 88.1% were from private sector hospitals. A total of 923 tracheostomies were performed during the study period; out of which, 666 were PDT and 257 were surgical tracheostomy (ST). Coagulopathic patients received more platelet transfusion [p = 0.037 with platelet count (PC) < 50 × 109, p = 0.021 with PC 50–100 × 109] and fresh frozen plasma transfusion in the ST group (p = 0.0001). The performance of PDT vs ST by day 7 of admission was 28.4% vs 21% (p = 0.023). The single dilator technique (60.4%) was the preferred technique for PDT followed by the Grigg's forceps and then the multiple dilator technique. Fiberoptic bronchoscope (FOB) and ultrasonography (USG) were used in 29.3% and 16.8%, respectively, for guidance during tracheostomy. Most of the PDTs were performed by a trained intensivist (74.2%), whereas ST was mostly done by an ENT surgeon (56.8%). Percutaneous dilatational tracheostomy resulted in less hemorrhagic (2.6% vs 7%, p = 0.002) and desaturation complications (2.3% vs 6.6%, p = 0.001) as compared to ST. The duration of procedure was shorter in the PDT group (average shortening by 9.2 minutes) and the ventilator-free days (VFD) were higher in the PDT group. The cost was less in PDT by approximately Rs. 13,104. Conclusion Percutaneous dilatational tracheostomy, especially the single dilator technique, is preferred by clinicians in Indian ICUs. The incidence of minor complications like hemorrhagic episodes is lower with PDT. Percutaneous dilatational tracheostomy was found to be cheaper on cost per patient basis as compared to ST (with or without complications). How to cite this article Gupta S, Tomar DS, Dixit S, Zirpe K, Choudhry D, Govil D, et al. Dilatational Percutaneous vs Surgical TracheoStomy in IntEnsive Care UniT: A Practice Pattern Observational Multicenter Study (DISSECT). Indian J Crit Care Med 2020;24(7):514–526.
Published: 2020

42. Percutaneous Tracheostomy under Real-time Ultrasound Guidance in Coagulopathic Patients: A Single-center Experience

Author: Deeksha S Tomar, Sachin Gupta, Vipal Chawla, K.N. Jagadeesh, Mozammil Shafi, Praveen G Kumar, Rahul Harne, Sweta J. Patel, Deepak Govil, Divya Pal, Shrikanth Srinivasan, and Srinivas Monanga
Subjects: medicine.medical_specialty, business.industry, Incidence (epidemiology), Ultrasound, 030208 emergency & critical care medicine, Real time ultrasound, Subgroup analysis, Critical Care and Intensive Care Medicine, medicine.disease, Single Center, Surgery, 03 medical and health sciences, Airway, Percutaneous tracheostomy, 0302 clinical medicine, 030228 respiratory system, Coagulopathy, medicine, business, Research Article
Abstract: Objective To examine the safety and complications associated with percutaneous tracheostomy (PT) in critically ill coagulopathic patients under real-time ultrasound guidance. Materials and methods Coagulopathy was defined as international normalized ratio (INR) ≥1.5 or thrombocytopenia (platelet count ≤50,000/mm3). Neck anatomy was assessed for all patients before the procedure and was characterized as excellent, good, satisfactory, and unsatisfactory based on the number of vessels in the path of needle. Percutaneous tracheostomy was performed under real-time ultrasound (USG) guidance, with certain modifications to the technique, and patients in both groups were assessed for immediate complications including bleeding. Results Six hundred and fifty-two patients underwent USG-guided PT. Three hundred and forty-five (52.9%) were coagulopathic before the procedure. Ninety-nine patients (15.2%) had an excellent neck anatomy on USG scan, and 112 patients (62 in coagulopathy group vs 50 in noncoagulopathy group, p value 0.386) had an unsatisfactory neck anatomy for tracheostomy. A total of 42 events of immediate complications were noted in 37 patients (5.7%). No difference was seen in the rate of immediate complications in both groups (5.8% in coagulopathy group vs 5.5% in noncoagulopathy group, p value 0.886). The incidence of minor bleeding in coagulopathic patients was 14 patients (4.1%) and 7 (2.3%) in those without coagulopathy, and this difference was not statistically different (p value-0.199). In the subgroup analysis of patients with significant coagulopathy and unsatisfactory anatomy, no difference was observed in the incidence of immediate complications. Conclusion This study shows the efficacy and safety of real-time ultrasound-guided PT, even in patients with coagulopathy. How to cite this article Kumar P, Govil D, Patel SJ, Jagadeesh KN, Gupta S, Srinivasan S, et al. Percutaneous Tracheostomy under Real-time Ultrasound Guidance in Coagulopathic Patients: A Single-center Experience. Indian J Crit Care Med 2020;24(2):122-127.
Published: 2020

43. ISCCM Guidelines for the Use of Non-invasive Ventilation in Acute Respiratory Failure in Adult ICUs

Author: Sachin Gupta, Srinivas Samavedam, Inder Sehgal, Yatin Mehta, Kapil Zirpe, Rajesh C Mishra, Suresh Ramasubban, Gopi C Khilnani, Vikas Marwah, Khalid I Khatib, Rajesh Chawla, Sameer Jog, Shirish Prayag, Dhruva Chaudhry, Deepak Govil, Atul P Kulkarni, Subhal Dixit, Gunjan Chanchalani, Jayesh Dobariya, and Bharat G Jagiasi
Subjects: medicine.medical_specialty, ARDS, Palliative care, Exacerbation, medicine.medical_treatment, Guidelines, Acute respiratory failure, Critical Care and Intensive Care Medicine, 03 medical and health sciences, Mechanical ventilation, 0302 clinical medicine, Oxygen therapy, medicine, Obesity hypoventilation syndrome, COPD, Respiratory distress, business.industry, Chronic obstructive pulmonary disease, Non invasive ventilation, 030208 emergency & critical care medicine, Guidelines/Position Statements, medicine.disease, 030228 respiratory system, ICU, Emergency medicine, business
Abstract: A. ACUTE HYPERCAPNIC RESPIRATORY FAILURE A1. Acute Exacerbation of COPD: Recommendations: NIV should be used in management of acute exacerbation of COPD in patients with acute or acute-on-chronic respiratory acidosis (pH = 7.25-7.35). (1A) NIV should be attempted in patients with acute exacerbation of COPD (pH 7.35). (2B) A2. NIV in ARF due to Chest wall deformities/Neuromuscular diseases: Recommendations: NIV may be used in patients of ARF due to chest wall deformity/Neuromuscular diseases. (PaCO2 ≥ 45) (UPP) A3. NIV in ARF due to Obesity hypoventilation syndrome (OHS): Recommendations: NIV may be used in AHRF in OHS patients when they present with acute hypercapnic or acute on chronic respiratory failure (pH 45). (3B) NIV/CPAP may be used in obese, hypercapnic patients with OHS and/or right heart failure in the absence of acidosis. (UPP) B. NIV IN ACUTE HYPOXEMIC RESPIRATORY FAILURE: B1. NIV in Acute Cardiogenic Pulmonary Oedema: Recommendations: NIV is recommended in hospital patients with ARF, due to Cardiogenic pulmonary edema. (1A). NIV should be used in patients with acute heart failure/ cardiogenic pulmonary edema, right from emergency department itself. (1B) Both CPAP and BiPAP modes are safe and effective in patients with cardiogenic pulmonary edema. (1A). However, BPAP (NIV-PS) should be preferred in cardiogenic pulmonary edema with hypercapnia. (3A) B2. NIV in acute hypoxemic respiratory failure: Recommendations: NIV may be used over conventional oxygen therapy in mild early acute hypoxemic respiratory failure (P/F ratio 200 mmHg), under close supervision. (2B) We strongly recommend against a trial of NIV in patients with acute hypoxemic failure with P/F ratio
Published: 2019
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44. Early CT in COVID-19: Should I or Should I Not?

Author: Deepak Govil and G Praveen Kumar
Subjects: 2019-20 coronavirus outbreak, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, Ground-glass opacification, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19, 030208 emergency & critical care medicine, Critical Care and Intensive Care Medicine, Gastroenterology, Hypoxemia, 03 medical and health sciences, 0302 clinical medicine, Editorial, 030228 respiratory system, Role of general physicians, Internal medicine, Lung CT, medicine, medicine.symptom, business
Abstract: How to cite this article: Govil D, Kumar GP. Early CT in COVID-19: Should I or Should I Not? Indian J Crit Care Med 2021;25(3):251-252.
Published: 2021

45. Procedures in COVID-19 Patients: Part-II

Author: Rajesh K, Pande, Ashish, Bhalla, Sheila N, Myatra, Lakshmi N, Yaddanpuddi, Sachin, Gupta, Tapas K, Sahoo, Ravi, Prakash, Tarun A, Sahu, Akansha, Jain, Palepu Bn, Gopal, Dhruva, Chaudhry, Deepak, Govil, Subhal, Dixit, and Srinivas, Samavedam
Subjects: CT scan, Airway, Continuous renal replacement therapy, SARS-CoV-2, Hemodialysis, COVID-19, Ultrasonography interventional, Guidelines, Critical Care and Intensive Care Medicine, Ambulance, Acute kidney injury
Abstract: Critical care in the era of novel coronavirus disease-2019 (COVID-19) infection has multiple challenges including management of the patient, underlying comorbidities, and the complications. With no end in sight to the pandemic, intensive care unit (ICU) practitioners and hospital administrators have to join hands to prepare for the long battle ahead. Critically ill COVID-19 patients need imaging or image-guided interventions in one form or the other including X-rays, ultrasonography (USG), echocardiography (ECHO), and CT scan. These patients often require renal replacement therapy (RRT) for either the preexisting chronic renal insufficiency or acutely developing kidney injury. Another important component of care is transfer of the patient to and fro from the ICU or to higher care centers. Most of the ICUs are equipped with modern facilities but with increasing number of patients a large number of makeshift arrangements are being made for managing these patients. This position paper outlines important tips to formulate protocols and procedures for critically ill patients, who are managed in the ICU. How to cite this article: Pande RK, Bhalla A, Myatra SN, Yaddanpuddi LN, Gupta S, Sahoo TK, et al. Procedures in COVID-19 Patients: Part-II. Indian J Crit Care Med 2020;24(Suppl 5):S272–S279.
Published: 2020

46. Gastrointestinal Motility Disorders in Critically Ill

Author: Divya Pal and Deepak Govil
Subjects: medicine.medical_specialty, Gastroparesis, Ileus, medicine.medical_treatment, Critical Care and Intensive Care Medicine, law.invention, Targeted therapy, Sepsis, 03 medical and health sciences, 0302 clinical medicine, law, Intensive care, medicine, Intensive care medicine, Mechanical ventilation, Invited Review, business.industry, 030208 emergency & critical care medicine, medicine.disease, Intensive care unit, Malnutrition, 030228 respiratory system, Motility disorder, business, Pseudo-obstruction
Abstract: Gastrointestinal (GI) motility disorders are a common problem in the intensive care unit (ICU) and are associated with increased morbidity, complications like feeding intolerance, malnutrition, bacterial translocation, sepsis, multiple organ failure, prolonged hospital stay and increased risk of mortality. Several risk factors in intensive care setting that contribute to GI dysmotility include mechanical ventilation, vasopressor support, use of opioids, etc. Degree of GI motility dysfunction correlates with severity of critical illness. So, it is important to identify the dysfunction early so that targeted therapy could be prescribed to prevent worsening of clinical outcomes. How to cite this article: Govil D, Pal D. Gastrointestinal Motility Disorders in Critically Ill. Indian J Crit Care Med 2020;24(Suppl 4):S179–S182.
Published: 2020

47. Critical Care for COVID-19 Affected Patients: Updated Position Statement of the Indian Society of Critical Care Medicine

Author: Jigeeshu V Divatia, Chand Wattal, Arindam Kar, Deepak Govil, Subhal Dixit, Srinivas Samavedam, Raj Kumar Mani, Gopi C Khilnani, Yatin Mehta, Sanjeev Singh, Prashant Kumar, Bhuvana Krishna, Ooriyapadickal Cherian Abraham, Jose Chacko, Bharat G Jagiasi, Pawan Kumar Singh, Pavan Tiwary, Dhruva Chaudhry, and BK Rao
Subjects: Position statement, medicine.medical_specialty, Patients position, Convalescent plasma, Coronavirus disease 2019 (COVID-19), business.industry, Statement (logic), SARS-CoV-2, Psychological intervention, COVID-19, 030208 emergency & critical care medicine, Disease, Guidelines, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Randomized controlled trial, law, Pandemic, medicine, Intensive care medicine, business
Abstract: The management of coronavirus disease-2019 (COVID-19) is witnessing a change as we learn more about the pathophysiology and the severity of the disease. Several randomized controlled trials (RCTs) and meta-analysis have been published over the last few months. Several interventions and therapies which showed promise in the initial days of the pandemic have subsequently failed to show benefit in well-designed trials. Understanding of the methods of oxygen delivery and ventilation have also evolved over the past few months. The Indian Society of Critical Care Medicine (ISCCM) has reviewed the evidence that has emerged since the publication of its position statement in May and has put together an addendum of updated evidence. How to cite this article: Mehta Y, Chaudhry D, Abraham OC, Chacko J, Divatia J, Jagiasi B, et al. Critical Care for COVID-19 Affected Patients: Position Statement of the Indian Society of Critical Care Medicine. Indian J Crit Care Med 2020;24(Suppl 5):S225–S230.
Published: 2020

48. Basic Critical Care for Management of COVID-19 Patients: Position Paper of Indian Society of Critical Care Medicine, Part-I

Author: Deven, Juneja, Raymond D, Savio, Shrikanth, Srinivasan, Rahul A, Pandit, Suresh, Ramasubban, Pavan K, Reddy, Manoj, Singh, Palepu Bn, Gopal, Dhruva, Chaudhry, Deepak, Govil, Shubhal, Dixit, and Srinivas, Samavedam
Subjects: Critical care, SARS-CoV-2, Intensive care, Corticosteroids, COVID-19, Guidelines, Critical Care and Intensive Care Medicine, Antivirals
Abstract: With more than 23 million infections and more than 814,000 deaths worldwide, the coronavirus disease-2019 (COVID-19) pandemic is still far from over. Several classes of drugs including antivirals, antiretrovirals, anti-inflammatory, immunomodulatory, and antibiotics have been tried with varying levels of success. Still, there is lack of any specific therapy to deal with this infection. Although less than 30% of these patients require intensive care unit admission, morbidity and mortality in this subgroup of patients remain high. Hence, it becomes imperative to have general principles to guide intensivists managing these patients. However, as the literature emerges, these recommendations may change and hence, frequent updates may be required. How to cite this article: Juneja D, Savio RD, Srinivasan S, Pandit RA, Ramasubban S, Reddy PK, et al. Basic Critical Care for Management of COVID-19 Patients: Position Paper of Indian Society of Critical Care Medicine, Part-I. Indian J Crit Care Med 2020;24(Suppl 5):S244–S253.
Published: 2020

49. Robotic Colonic Cancer Surgery

Author: Supreet Kumar, Deepak Govil, Varun Madaan, and Rigved Gupta
Subjects: medicine.medical_specialty, Colonic cancer, business.industry, medicine, business, Surgery
Published: 2020
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50. Laparoscopic Conventional Abdominoperineal (CAPE) and Extra-Levator Abdominoperineal Resection (ELAPE)

Author: Sanjiv Haribhakti and Deepak Govil
Subjects: medicine.medical_specialty, Abdominoperineal resection, business.industry, Medicine, business, Surgery
Published: 2020
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