Of cial quarterly Communication from Indian Chest Society
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A Note From The President’s Desk.. Dr. S. K. Luhadia Dear Colleagues, Indian Chest Society is growing very fast in terms of Academic & Research activities. Young chest physicians are showing a great interest in becoming its members. This year we have further strengthened our democratic character as democracy is backbone of any society. We have started e -voting and more than 1200 members have used their voting right, which is more than twice as compared to previous years. There was neck to neck contest for almost every post. I congratulate our dynamic secretary Dr. Rajesh Swarnkar and our past President & returning election officer Dr. Suryakant Tripathy for completing successful electoral process & e -voting. I am also thankful to our esteemed members for participating in huge numbers in the election and hope that voting percentage will further rise in future. The society will further achieve great heights under the leadership of Dr. Sudhir Choudhary & Dr. D. J Christopher, our future president & president elect respectively. The forthcoming NAPCON - 2018 at Ahmedabad is again going to be a mega event under the able leadership of Dr. Rajesh Solanki. The academic programme prepared by Dr. S. K Katiyar along with Dr. Nikhil Sarangdhar will be excellent in terms of academics. I appeal all the members of ICS to kindly attend and participate in this conference with full enthusiasm & interest. Long live Indian Chest Society and NAPCON!!! With Regards Dr. S. K. Luhadia Secretariat Address: Dr. Rajesh Swarnakar, Secretary, Indian Chest Society, ICS Secretariat office, IMA Annexe IMA House, North Ambazari Road, Nagpur -440010, Email: icsofficeexecutive@gmail.com 1
A Note From The Secretary’s Desk.. Dr. Rajesh Swarnakar Secretary, Indian Chest Society Hello Members !!! They say there is no shortcut to success and this has proved true when all the efforts of ICS team proved successful in bringing you to vote in such huge numbers. Let me start by thanking each one of you for voting for the 2018 GB Elections and making a grand success whopping 1117 votes were registered by us which are more than two times our usual ballot. The learnings are pretty clear that ICS going digital has helped all its members with the ease and convenience of choosing their members at the touch of their mobiles in minutes. I would sincerely appreciate the efforts of all our GB Members, Dr. SuryaKant, Election Officer for e-voting, Dr. Jyoti Bajpai for her continuous efforts and last but not the least Mrs. Sakshi Deshmukh for helping me bring this remarkable possibility in our society. A more detailed experience is shared by in her article on “Every Vote does Count Indeed !!! ICS e-voting journey from Traditional to Digital... We at ICS are keen to bring, HERMES Europe Adult Respiratory exam will now be held in India and this is the first time anywhere out of Europe. Also, we have strengthened our international ties by collaborating with Lung Health Joint Fellowships with the ERS is also a great venture of ICS which our young members can avail benefits of. I am thankful to Dr. Raja Dhar for constantly putting in efforts for all these tie-ups. RESPIRE has been loved by all our members and we wish you would help us with your feedback and suggestions for our constant improvement. Do write to us at icsofficeexecutive@gmail.com for your queries, suggestions and feedbacks. I also hope you follow us digitally on our Facebook and Twitter Handles for all the latest at ICS. We have a great new team on board, after elections and I wish all of them a great tenure ahead. They have been introduced to you inside the newsletter. Happy Reading!!! Secretariat Address: Dr. Rajesh Swarnakar, Secretary, Indian Chest Society, ICS Secretariat office, IMA Annexe IMA House, North Ambazari Road, Nagpur -440010, Email: icsofficeexecutive@gmail.com 2
THE COVER STORY Dr. Ashok Mahashur, Past President & Founder Joint Secretary Of ICS Talks To Dr Amita Nene, Member ICS Dr. Ashok Mahashur was born in Khamgaon, his training and get his MD in TB & Chest Diseases near Akola, Maharashtra in December 1948. He in 1976 from the Bombay University. did his basic education in Khamgaon, nurturing a keen desire to become a doctor since a very He then immediately joined the Dept. of Chest young age. Worked hard and was academically Medicine at Seth GS Medical College and KEM inclined - doing well through his early years, and Hospital - which was probably the only Non-TB then, with the grace of God, procured an MBBS respiratory disease Dept at that time. DR. S. R. seat at the Govt. Medical College in Nagpur in Kamat, a no-nonsense man, was the HOD who 1966. Working hard through all those years, he played a major role in his development, completed his MBBS in 1971. cultivating Respiratory diseases as a Speciality. These formative years formed the base of his Due to family compulsions, he had to come to career till he retired as a Professor and Head Mumbai. Having done his MBBS in Nagpur, he from KEM Hospital, his parent institute. had to struggle a lot to get a PG seat in Mumbai but finally got his PG seat in Chest Medicine in Dr. Amita Nene - Dear Sir, We all know that you 1973 at the Grant Medical College, Mumbai. were one of the key persons responsible for It was a memorable moment for him to complete conceptualizing and creating the Indian Chest 3
Society. This was truly a great step forward for one of the first papers on non TB pulmonology our field of Pulmonology and we all and brought into light that we also diagnosed pulmonologists will always remain grateful to and treated diseases other than TB. you and to the other founder members of the Indian Chest Society for your great vision and all Dr. Amita Nene - That's truly commendable Sir !! your extraordinary efforts. What inspired the birth of ICS? Was there any stimulating factor? Our Pulmonology community is extremely interested in knowing how you did this all and Dr. Mahashur – After my paper presentation at the tremendous efforts that you and other the conference, I was surprised that very few founder members put in creating the Indian physicians were aware of the condition ILD. This Chest Society and bringing it to its current, highly motivated me to think that in our speciality, respectable position. significant progress and research was being done with respect to TB, but there was very little Can you pls tell us what was the status of chest awareness and few efforts were being made to medicine prior to the formation of the ICS? promote education in non-tuberculous respiratory medicine. It highlighted the need to Dr. Mahashur - In the 1970s chest medicine was work simultaneously to improve awareness, only tuberculosis. I passed my MD Chest and TB knowledge and research in non-TB respiratory in 1976. That was the nomenclature used for our diseases amongst clinicians by getting maximum degree at that time. Before 1973, it was called chest physicians together for this purpose and I MD TB. Everyone referred to us as TB specialists was occupied with this thought. and there was very little awareness about non- tubercular chest diseases. Incidentally, on the same evening in this Nagpur 1979 API meeting, was the general body meeting Dr. Amita Nene- That's very interesting… Pls, tell of the chest group where Dr. S R. Kamat us about your non-TB work in those days !! proposed that a new democratic nationwide Pulmonology society is created which would Dr. Mahashur - Immediately after completing my have true national representation with a MD, I joined Chest Medicine Dept at Seth GS transparent election process. Medical College and KEM Hospital with Dr S R Kamat. This dept was entirely dealing with non- This did not meet with an easy approval and so tuberculous respiratory diseases. After working he came to me and said that we must take lead in for a few years, I realized that our PG training and creating such a new National Chest Association clinical approach is TB centric. There were a lot of w h i c h i s t ra n s p a r e n t , i n c l u s i v e a n d non-tuberculous diseases which were on a rise representative of the entire country - with the and needed special attention. whole and sole intention of spreading knowledge. This very important day of 1979 API The opportunity came in 1979, while I was a Meeting in Nagpur led to the conception of lecturer in this department and was involved in Indian Chest Society the research in ILD in India. My paper on ILD was accepted for verbal presentation and discussion Dr. Amita Nene - Sounds really exciting Sir !! So in the API conference at Nagpur in January 1979. how was ICS finally formed? In those days, the number of chest physicians was small and National College of Chest Dr. Mahashur - Within 4 days of coming to Physicians (NCCP) was holding its annual chest Mumbai, I called the meeting of important chest conference under the banner of API. physicians in the seminar hall of KEM hospital Mumbai. It was attended by Dr S R Kamat, Dr. P. My paper in the API meeting in 1979 on ILD was G. Kamath, Dr. A. P. Rao, Dr. Sundari Mirchandani 4
and by me - Dr. A. A Mahashur. etc was the real task and I still have fond memories of the entire process. All of us agreed to the idea of starting a society which would encourage research in all types of We all five founder members sitting in one fiat respiratory diseases and spread of knowledge car, literally went around to Pharma companies and would function democratically by strictly one-on-one requesting for their support and adhering to the constitution formed on eventually managed to raise as much as four democratic principles. After a lot of lakh rupees – a very good amount in those deliberation, the society was named INDIAN times. CHEST SOCIETY. Dr P G Kamath wrote the original constitution of ICS. A new society was Our first meeting was held at the Hotel born in May 1979. Dr. P. G Kamath was the President in South Bombay and was very very unanimous choice for secretary's post, Dr. M P. successful Mehrotra, a senior physician from Agra was elected as President, Dr. A. P. Rao as Vice We spent about two lakh rupees for organizing President and me, Dr. Mahashur as joint this first annual meeting of Indian Chest secretary. Society and we put the remaining two lakh rupees in the association kitty. Dr. Amita Nene– That's Fantastic !! Can you pls tell us something about the early years of the This first meeting marked the rise of our Indian ICS. Did the society prosper immediately or Chest Society which soon grew nationwide. was there an inertia time for people to accept the ICS? Over time the pre-existing Association of Chest physicians of India asked to join hands with us Dr. Mahashur - The philosophy of the Indian and combine our annual meeting and we Chest Society was to have membership and readily agreed as we wanted single and true representation across the country with elected national pulmonology representation office bearers on an annual basis. Dr. Amita Nene – Truly incredible Sir !! Can you The membership drive yielded quick results pls tell us about your involvement in the day to from East, South and Central zones. The day functioning of the ICS in these early years response was growing and to reach to larger since its inception? physicians and chest physicians it was decided to start a national journal in 1980. The first Dr. Mahashur - With Dr. P. G. Kamath being the journal of ICS named LUNG INDIA was ICS secretary since inception through the late published under the editorship of Dr C V 80s, my involvement with the association as Ramakrishnan. It continues to be published the joint secretary was complete and right uninterrupted from 1980 till date. from the start. I was entrusted with handling all matters of the secretary's office including We proudly watched our ICS grow in numbers correspondence, memberships, and planning to soon become the most influential academic meetings. Society for pulmonology I continued to work for ICS in all capacities Dr. Amita Nene – That's wonderful… So when without a break and with the meticulous was the first ICS national meeting held? Can nature of Dr. P. G Kamath and constant pushing you tell us something about this meeting? from Dr. S. R Kamat, it was indeed difficult to balance both the hospital and ICS work. Dr. Mahashur - We finally decided to have our Honestly, this was the most hectic period of my first annual meeting of ICS in 1981. career. I wish to mention and give full credit to my wife Mukul and my son Nikhil who allowed Planning the meeting, the venue, the budget me to pursue my passion without complaining 5
and were always supportive and made it possible active working of ICS but continue to take for me to be what I am today. I owe a lot to them. interest in all activities of the society. The society has given me access to national exposure and Dr. Amita Nene – Hats off to you and your lovely gain in-depth knowledge from all respiratory family !! How do you think has the ICS grown in physicians in the country, interact and exchange the recent past? Are you happy with the growth academic thoughts, and encouraged me to get of ICS? involved in research, education and patient care. I could train a large no of PGs between 1977 till Dr. Mahashur - As I look back, I feel very very date and am enjoying it still. My work has been proud and as a dream come true. Respiratory recognized by ICS, International Academy of medicine has grown into an important and much Allergy and Immunology, and Maharashtra sought-after speciality. All respiratory physicians University of Health Sciences. are at same wavelength because of a large number of frequent interactive sessions, CMEs, Dr. Amita Nene - Dear Sir, the entire Indian exposure to international conferences with the Pulmonology family is extremely grateful to you opportunity to shine not only at home but also and the other 4 founder members of the ICS. Pls internationally - given awards as appreciation for let us know what your vision for ICS from hereon their work. Every year ICS is coming up with is. How would you want us to continue with the newer incentives to encourage young scientists ICS legacy?? to excel in their favourite area. The journal has achieved an international standard under able Dr. Mahashur - With the way the ICS is growing I editorship. predict it to be the topmost organization in respiratory medicine that is dedicated to the I congratulate and offer my sincere thanks to all welfare of each and every respiratory physician members of ICS and all the governing body and helping their growth. I visualize ICS as a body members from the inception of ICS till date for that would dictate health policies for respiratory their contribution, dedication and hard work to diseases to the Government and would help in make ICS an internationally recognized body. implementing effective policies for TB control Each of You have made us - all founder members and awareness. happy and proud by helping their dream come true. I bless you all for your and Indian Chest I am highly proud of the talent and foresight of Society's continued success and academic young members of the governing body of ICS. prosperity. In the end, I earnestly request to all members to Dr. Amita Nene – Thank you very much, Sir, for continue to stick to the drafted constitution and your blessings and kind words !! Can you please stick to it in difficult situations so that no decision tell us what ICS has given back to you? would sound difficult to take. I bless the society for a bright future and pray for its success in all its Dr. Mahashur - I have now retired from the future ventures. Your feedback and suggestions are welcomed @ icsofficeexecutive@gmail.com or visit our website www.indianchestsociety.com 6
RECENT UPDATES EBUS: The journey so far and beyond… Dr. Prashant N. Chhajed Dr. Prashant N. Chhajed is a Governing Council Dr. Yasufuku and Dr. Chhajed developed the EBUS Member of the Indian Chest Society (2017 – TBNA in Chiba, Japan and presented the first 2019). He has been Chair, West Zone, Indian paper on EBUS TBNA at ATS International Chest Society (2014 – 2107). Dr. Chhajed Conference in 2003 and published the Original habilitated as Privat Dozent at University of Basel, Paper, as first large series on EBUS TBNA in Journal Switzerland (2007). He is the current Chair, CHEST in 2004. His research has received several Interventional Pulmonology Group at the awards at ERS, Swiss TB Award, Swiss Society of European Respiratory Society (2018 – 2021). Dr. Pulmonology, Charak Award, St Vincent's Chhajed has also held the following positions in Hospital, Garvan Institute, etc. He has conducted International Societies: Secretary, Interventional many workshops and lectures nationally and Pulmonology, ERS (2015 – 2018); Member of internationally on Interventional Pulmonology Program Committee, American Thoracic Society and EBUS TBNA over the last 15 years. He has (2005 – 2015); Member of Planning Committee, been on Editorial Board of CHEST (2005 – 2010) ATS (2006 -2009); Secretary, European and continues to be on Editorial Board of Association of Bronchology & Interventional RESPIRATION, Journal of Bronchology & Pulmonology (2006 – 2010); Vice President, Interventional Pulmonology, Lung India, JCRT, etc. EABIP (2005 –2006). Dr. Chhajed has 125 peer-reviewed publications on PubMed The utility of endobronchial ultrasound guided and hilar lymphnodes on a day. care setting transbronchial needle aspiration (EBUS-TBNA) under moderate sedation with high diagnostic was first reported in 2004. (1) The new ebus accuracy. Enlarged mediastinal and hilar bronchoscope with a linear probe at its tip allows lymphnodes as well as subcentimeter sized real time visualisation and sampling of lymph nodes can be sampled using EBUS-TBNA. paratracheal and peribronchial lymphnodes. It is performed using a 21 or 22 gauge dedicated The ability to sample mediastinal and hilar TBNA needle. The anaesthesia for this procedure lymphnode stations 10, 11 and 12 with EBUS- varies from conscious sedation to general TBNA, which were not accessible with anaesthesia based on the patient comfort and mediastinoscopy, has led to a paradigm shift in safety. Three to five passes per lymphnode are diagnostic pulmonology and lung cancer staging. obtained for cytology by cellblock and aspirates The availability and usage of EBUS-TBNA has for microbiological analysis. Core biopsies can grown exponentially over the last decade, both also be obtained and have been reported to clinically and geographically. The technique increase the diagnostic yield in both benign and allows safe, real time sampling of mediastinal malignant pathologies.(2) The training in 7
technique of EBUS-TBNA has been incorporated Lung cancer is the leading cause of mortality due in academic curriculum of several institutions to cancer worldwide. While the incidence has worldwide. been increasing, only around 15% of lung cancers are diagnosed at an early stage. The EBUS-TBNA has been reported to be non-inferior molecular profiling of lung cancer has become an and safe compared to other modalities for tissue important step in deciding therapy for a patient acquisition.(3) It adds to the diagnosis and with an advanced stage disease. This implies that prevents more invasive procedures in a patient the pathological subtype, stage of disease and with an inconclusive CT guided biopsy. molecular profile together constitutes the Conventional TBNA using flexible bronchoscope complete diagnosis of lung cancer to plan can be used for sampling mediastinal lymph appropriate therapy for a patient. Accurate nodes. However, there is no real time guidance mediastinal staging is required in a patient for this technique and it requires the operator to where obvious distant metastases is ruled out make a mind map of the mediastinum based on with the help of positron emission tomography the available imaging. EBUS-TBNA provides real (PET-CT) or computed tomography (CT). PET-CT time visualization of the lymph node, its size and can yield false positive results in case of the adjoining blood vessels in the Doppler mode. inflammatory or co-existent infective conditions This increases the diagnostic accuracy and along with malignancy.(3) Hence, all PET positive safety.(4) Also, core biopsies can be obtained mediastinal lymph nodes should be sampled for using EBUS-TBNA which significantly increases accurate staging with no obvious evidence the diagnostic yield.(2) Endoscopic ultrasound extrathoracic metastases. This can help in down guided fine needle aspiration (EUS-FNA) can be staging of PET-CT and help in identifying used to sample paraesophageal and lower candidates for surgery. EBUS-TBNA has the medistinal lymph nodes (stations 8 and 9) and advantage of diagnosing, staging and acquiring also detect liver and adrenal metastases. It can samples for molecular profiling of lung cancer in co m p l e m e nt E B U S - T B N A i n co m p l ete the same setting. Also, endobronchial staging mediastinal staging of lung cancer. The EBUS can be done during EBUS bronchoscopy. It can bronchoscope can be passed through the also diagnose PET positive lymph node with high esophagus by pulmonologists and used to accuracy. Intrapulmonary lesions adjacent to the sample station 8 and 9. However, the knowledge trachea or bronchi can also be sampled using of mediastinal anatomy on transesophageal EBUS-TBNA. It yields the highest tumor RNA ultrasound is necessary for the operating material when compared to CT guided core pulmonologist. Mediastinoscopy has been biopsy and bronchoscopic forceps biopsy. EBUS- considered the gold standard in staging TBNA can accurately diagnose metastatic mediastinum. However, it is a surgical procedure mediastinal and hilar lymphnodes in a done under general anesthesia requiring radiologically normal mediastinum.(5) The hospitalization. Moreover, it can sample reported diagnostic yield of EBUS-TBNA in paratracheal and subcarinal lymph nodes. EBUS- malignancy is close to 90%. Moreover, it helps in TBNA can sample N1 and N2 lymphnodes with restaging of lung cancer after surgery or high accuracy. EBUS-TBNA is now the initial chemotherapy. It is the only modality which can choice of modality in mediastinal staging and help in restaging mediastinum after lobectomy may render mediastinoscopy unnecessary in or pneumonectomy despite distortion of normal most number of cases. However, negative results mediastinal anatomy. EBUS-TBNA can accurately on EBUS-TBNA with high suspicion of diagnose and stage small cell lung cancer as well. malignancy or disease may need to be confirmed Now, with the approved CT screening for lung on mediastinoscopy . cancer in smokers, accurate mediastinal staging 8
will be the need of the hour. The utility of EBUS- processed for cartridge based nucleic acid TBNA in these situations will expand further. Oral amplification test (Genexpert for MTB/Rif) and tyrosine kinase inhibitors individualised for liquid based TB cultures. (7) It can help in treating advanced lung cancers with particular detection of MDR and XDR TB in patients with genetic mutations has helped in improving the mediastinal tuberculous lymphadenitis. A case quality of life and survival. The commonest highlighting role of EBUS-TBNA in diagnosis of mutations in non-small cell lung cancer are MDR-TB in patients with meningitis is reported epidermal growth factor receptor (EGFR), in the literature. Sarcoidosis poses a diagnostic anaplastic lymphoma kinase (ALK) and Kirsten dilemma in patients with mediastinal rat sarcoma (Kras). The success rate of multiple lymphadenopathy in a TB endemic region. EBUS- genome analysing techniques for the above TBNA diagnosis sarcoidosis with high accuracy mutations on samples acquired by EBUS-TBNA is and the accuracy increases when it is clubbed reported to be over 90%. EBUS-TBNA samples with transbronchial lung biopsy in the same when made into cell blocks returned an setting.(8) The characteristics of lymph nodes on adequacy rate of around 97% when processed endobronchial ultrasound may help in for various immunohistochemical stains.(3) differentiating the causative pathologies. EBUS-TBNA has a place in tissue acquisition for Heterogeneous echotexture of the lymph node research settings as well due to the high quality and coagulation necrosis sign on EBUS are more genetic material obtained in malignancy. specific for a diagnosis of TB.(9) Mediastinal lymphadenopathy in patients with EBUS-TBNA has a complication rate of 1%.(10) It malignancy can be due to metastasis, infection can be safely performed in patients who are or a sarcoid reaction to malignancy. These need elderly, with superior vena cava syndrome or a to be subtyped accurately even in the space occupying lesion in the brain. However, management of extra-thoracic malignancy. It infective and fatal complications like massive can help in down staging PET-CT and also bleeding, bacterial pericarditis and mediastinitis accurately diagnose granulomatous or have been reported. The role of EBUS-TBNA in metastatic mediastinal lymph nodes during patients receiving clopidogrel is still post-therapy PET-CT. EBUS-TBNA can thus controversial. Transvascular EBUS-TBNA through impact management even in extra thoracic the aorta and pulmonary artery have been malignancies. It can yield estrogen receptor and reported by expert operators. Endobronchial progesterone receptor status in patients with ultrasound with elastography is an emerging and mediastinal lymphadenopathy with carcinoma promising tool to differentiate benign versus of breast.(6) The role of EBUS-TBNA in malignant lymph nodes. Recently, EBUS-TBNA diagnosing lymphomas is emerging. has been reported to provide diagnosis in people living with HIV and mediastinal lympha- In tuberculosis endemic region, mediastinal denopathy. (11) The ability of EBUS-TBNA to lymphadenopathy and fever often pose a provide diagnosis in a low lymphocytic situation diagnostic challenge to the clinicians. The is promising. EBUS-TBNA has certainly emergence of multidrug resistant (MDR) and penetrated and established itself as the standard extensively drug resistant (XDR) tuberculosis of care in diagnostic pulmonology. The past (TB) has led to acquiring the microbiological fifteen years definitely set the path for the rise and rise of EBUS-TBNA in the clinical applications evidence necessary during diagnosis. Accurate of the technique for maximum patient benefit! drug susceptibility pattern can prevent a delay in References: appropriate therapy and improve outcomes. The 1. Yasufuku K, Chiyo M, Sekine Y, Chhajed PN, Shibuya K, samples acquired by EBUS-TBNA can be Iizasa T, et al. Real-time endobronchial ultrasound-guided 9
transbronchial needle aspiration of mediastinal and hilar 2018;29(1):35-40. lymph nodes. Chest. 2004;126(1):122-8. 7. Dhasmana DJ, Ross C, Bradley CJ, Connell DW, George PM, 2. Vaidya PJ, Saha A, Kate AH, Pandey K, Chavhan VB, Leuppi Singanayagam A, et al. Performance of Xpert MTB/RIF in the JD, et al. Diagnostic value of core biopsy histology and diagnosis of tuberculous mediastinal lymphadenopathy by cytology sampling of mediastinal lymph nodes using 21- endobronchial ultrasound. Annals of the American Thoracic gauge EBUS-TBNA needle. Journal of cancer research and Society. 2014;11(3):392-6. therapeutics. 2016;12(3):1172-7. 8. Gupta D, Dadhwal DS, Agarwal R, Gupta N, Bal A, 3. Vaidya PJ, Kate AH, Yasufuku K, Chhajed PN. Aggarwal AN. Endobronchial ultrasound-guided Endobronchial ultrasound-guided transbronchial needle transbronchial needle aspiration vs conventional aspiration in lung cancer diagnosis and staging. Expert transbronchial needle aspiration in the diagnosis of review of respiratory medicine. 2015;9(1):45-53. sarcoidosis. Chest. 2014;146(3):547-56. 4. Chhajed PN, Odermatt R, von Garnier C, Chaudhari P, 9. Dhooria S, Agarwal R, Aggarwal AN, Bal A, Gupta N, Gupta Leuppi JD, Stolz D, et al. Endobronchial ultrasound in hilar D. Differentiating tuberculosis from sarcoidosis by and conventional TBNA-negative/inconclusive mediastinal sonographic characteristics of lymph nodes on lymphadenopathy. Journal of cancer research and endobronchial ultrasonography: a study of 165 patients. therapeutics. 2011;7(2):148-51. The Journal of thoracic and cardiovascular surgery. 5. Herth FJ, Eberhardt R, Krasnik M, Ernst A. Endobronchial 2014;148(2):662-7. ultrasound-guided transbronchial needle aspiration of 10. Vaidya PJ, Munavvar M, Leuppi JD, Mehta AC, Chhajed lymph nodes in the radiologically and positron emission PN. Endobronchial ultrasound-guided transbronchial tomography-normal mediastinum in patients with lung needle aspiration: Safe as it sounds. Respirology. cancer. Chest. 2008;133(4):887-91. 2017;22(6):1093-101. 6. Serra P, Sanz-Santos J, Castella E, Cirauqui B, Andreo 11. Prasad KT, Muthu V, Sehgal IS, Dhooria S, Sharma A, F, Llatjos M, et al. Identification of oestrogen, progesterone Gupta N, et al. Utility of endobronchial ultrasound-guided receptor and human epidermal growth factor receptor 2 transbronchial needle aspiration in HIV-infected patients expression in mediastinal metastases of breast cancer with undiagnosed intrathoracic lymphadenopathy. Lung obtained by endobronchial ultrasound-guided India :official organ of Indian Chest Society. 2018;35(5):379- transbronchial needle aspiration. Cytopathology : official 83. journal of the British Society for Clinical Cytology. Your feedback and suggestions are welcomed @ icsofficeexecutive@gmail.com or visit our website www.indianchestsociety.com 10
ICS - ATS Travel Grant Reciepient Interview Dr. Deepak Muthreja Dr. Mark Weir, (MD) from Chicago Reviewing The Poster Of Dr. Deepak Muthreja Q1. Please tell ICS Members about your background and how did you come to know about the travel grant? I am Dr. Deepak Muthreja (L-1827) an Interventional Pulmonologist based in Nagpur. I did my MD Chest Diseases from Government Medical College, Rajkot and currently pursuing European Respiratory Society's EBUS course having passed Part II assessment. I have also passed HERMES Adult Respiratory Examination held in paris 2018. Our abstract titled “Removal of Endobronchial Endodontic Equipments with help of Flexible Video bronchoscope: Single centre experience” was accepted for presentation at ATS International conference 2018. I became an ICS member in 2015 and was aware of the travel grant through letters and continuous emails from ICS office. Their frequency is very appropriate and also the apt timings which young members especially new ones to get every information required. Q2. What was the process and how were you selected? The procedure for applying for a grant is pretty simple. I sent my abstract and the acceptance of it which I received from ATS to the ICS team via email; I received the approval of my grant once all my documents were thoroughly verified by ICS Office and the reviewing committee. Q3. How did the travel grant help you and was there competition for it at ICS? The travel grant immensely helped me in easing out my financial crunch as travelling to the USA is very expensive. Although, I did have a hard time competing with other eligible Doctors who had also applied for the grant. ICS thoroughly verifies all the documents and provides the grant to the most deserving one with a scrutinising committee overlooking the selection in the most transparent way. So my advice to all my fellow ICS Members applying for grants would be to make your paper or poster very sound in all matters and submit required documents correctly and on time. 11
Q4. How was experience and what would you say to other young doctors of ICS? I think ICS is providing a very good opportunity for young doctors to grow by supporting doctors who require financial assistance. Early career members seldom get the opportunity to attend such conferences. These kinds of travel grants help them not only for attending the conference but also to present their work at an international platform. I suggest all young ICS Members to regularly visit the ICS Website, follow them on social media platforms like their facebook and twitter handles and read all ICS emails sent to them to know about various travel grants available time to time from various international societies with which ICS forges tie-ups. Q5. After your return, how many days did it take to get the grant and what is the process? The travel grant is issued after submitting the proof of travel along with a certificate of attendance and presentation. You also need to submit all original bills paid by you like your travel tickets. These are all verified at the Treasurer's office. Treasurer's office took around two to four weeks for the release of funds. Q6. How do you feel as a receipt on the grant and on being an ICS Member? This grant has helped me to a large extent to make ends meet and given me an opportunity to present my work at an International forum. I am very thankful to ICS for giving me this opportunity. I would encourage the young members of ICS to participate and make the most of the opportunities provided by ICS. I would request Leadership of ICS to further increase the grant in view of depreciating rupee. Your feedback and suggestions are welcomed at icsofficeexecutive@gmail.com or visit our website www.indianchestsociety.com 12
ERS Paris Report 2018 Conference of ERS is an important venue for ICS leadership to have meetings with international societies. This meeting helped ICS to forge new relationships and bring various benefits in terms of international grants, academic activities, Joint membership plans etc. This time too ICS had its stall at the ERS Congress, Paris 2018 held from 15-19th September. ICS leadership was represented by Dr. Rajesh Swarnakar, Hon Secretary, Dr. Raja Dhar, National Representative of ICS for ERS, Dr. Prashant Chhajed, Member GB, Prof Surya Kant, Ex-President of ICS and Dr.Sundeep Salvi. Meetings were held with office bearers of ERS, Lung Health Workshop and American College of Chest Physicians ACCP-Chest to explore possibilities of new ventures with them. ICS in association with ERS is keen to bring HERMES European Adult Respiratory Examination in India from next year along with its preparatory course. This will be the first time this exam will be held outside Europe. Another possibility being actively pursued is Joint Membership with ACCP, discussions on which are underway. ICS has collaborated with Lung Health in its conference is at NICE from 17th-19th January 2019 giving three travel grants for accepted abstracts of ICS Members & also the opportunity of being a “Rising Star”.Keep visiting our website www.indianchestsociety.com for recent updates and detail information, also follow us on social media platforms like Facebook, Twitter and Youtube for all latest at ICS. ICS Lung Health Meeting at ERS Congress Paris 2018 ICS - ERS Meeting at the ERS Congress at Paris 201 13
ICS-ACCP meeting at the ERS Congress at Paris 2018 Dr. Raja Dhar, interacting with ICS members at ERS Congress Paris 2018 Dr Rajesh Swarnakar interacting with ICS members at ERS Congress Paris 2018 Dr. Surya Kant Tripathi interacting with ICS members at ERS Congress Paris 2018 Your feedback and suggestions are welcomed at icsofficeexecutive@gmail.com or visit our website www.indianchestsociety.com 14
ICS e-voting journey from Traditional to Digital... Mrs.Sakshi Deshmukh, B.E,M.B.A (Mktg), Office Executive ,Indian Chest Society, Nagpur Dear Friends, An active member of the college committee since her early college days she has won several awards Let me introduce you all to our ICS Executive who for her communications and management skills. must have interacted with you all through her Organizing guest lectures, taking part in various local mailers, phone, SMS etc from our ICS office. competitions and workshops include her interest A firm Believer of “Attitude is Everything”...Mrs. while dancing and yoga being her hobbies. With Sakshi Deshmukh has been working with the her husband Ajinkya Deshmukh, Captain in the Indian Chest Society as an Office Executive at the Indian Army attending the call of National Duty Secretary office in Nagpur for 1.5 years. Post posted remotely Sakshi chose to quit her lucrative completing her MBA from the ICFAI University job to look after her widowed mother in law in (IBS Hyderabad) in Marketing and Operations, Nagpur and agreed to work in Nagpur ICS office. Mrs. Sakshi Deshmukh was working as a Business Analyst with Genpact India, a subsidiary of G.E She was the backbone of our maiden ICS e-voting (USA) in Bengaluru. She has also worked with an endeavour and pens her thought about her e-commerce firm for almost 2 years, post experience during e-voting in this article. completing her Engineering in Electronics and Telecommunication. Dr. Rajesh Swarnakar, Secretary, ICS It all began with a thought of making the He was surprised to know that without involving elections at Indian Chest Society more Human Interference at all this process was now transparent and simultaneously increasing the possible. Without wasting time I contacted some participation of voters that e-Voting as a vendors and I kept the final list in front of Dr. resolution was passed in Annual General Swarnakar, the same was discussed in the GB Meeting of ICS Members at Kolkata NAPCON meeting and CDSL was the clear winner. CDSL e- 2017. Our mandate was to hold ICS Election this Voting System was approved by the Ministry of year by only electronic voting. Dr. Rajesh Corporate Affairs (MCA) vide its circular no. Swarnakar, Hon. Secretary of the Indian Chest 21/2011 dated 2nd May 2011. The Society generally asked me about the e-voting Standardization Testing and Quality Certification process, how is it conducted and what would be (STQC) has also been taken for the e-Voting the expenses etc. I am an engineering graduate website. Additionally, the e-Voting system is also in electronics and telecommunication although ISO 9001:2015 certified. After a detailed we engineers do not have every answer at our presentation and exhaustive discussion with tips, I explained some technical aspects about it Governing Body of Indian Chest Society in its to Dr. Swarnakar. meeting, CDSL was finalized. 15
The next big challenge was to have as much made the officer in charge of this election who correct email ID as possible; this would help us himself received. involve most of our Life Members. As it was the One to one training in e-voting process in an first time, Governing Body of ICS instructed exclusive exhaustive session with CDSL trainers. Two months in advance Email reminders, CDSL to send postal information of their user ID Facebook posts, videos and SMS were used to & e-voting password to all members without spread awareness before the e-voting actually emails registered with us. But it was decided that began. This helped us spread the word and once they received these instructions by post helped us gain the maximum votes possible. they will also have to go online and vote on the CDSL E-VOTING PORTAL. I made a state-wise list From day one I could feel tremendous of missing email ID and it was worked upon until enthusiasm not only in the nominees but also in we had retrieved many emails and mobile life members. We were overwhelmed to receive numbers from fellow members, pharma help hundreds of emails and phone calls every day at etc. These were then cross-checked, verified and our secretary office. The same was the case with then included in the final list of 1917 emails in all. the election office at Lucknow of Dr. Suryakant sir. All these revelations made me understand I personally made almost 200-250 phone calls that doctors were a little less tech-savvy as just to ensure we had the correct email ID on a presumed earlier or/ and indeed very busy in life regular basis. Some marketing applications like to have time to read through our instructive MailChimp helped me to understand the bounce emails and fish out the CDSL email from their emails and cleaned them as well. This exercise respective registered accounts with I C S. also helped us clean our data and make it Members most common complaint was they had accurate. I really thank all our GB members for not received the user id and password required their kind support during the retrieval exercise of to perform e-voting. Actually, our emails privacy emails. and server settings are the players here and a lot depended on them. The CDSL emails would end A trial e-voting was also conducted a month up in spam, junk or any other section which was prior with all GB Members to accrue faith in the not visible immediately and needed to be dug system. The motive here was to understand the out among so many other emails received on a system well so that there were no glitches during daily basis which led to panic in some members. the actual process. Feedbacks and suggestions from the esteemed GB members were noted The whole process was just three simple steps: and implemented in the final e-voting 1.Click on Shareholders/Members on the accordingly. www.evotingindia.in 2.Enter Userid and Password along with captcha The final e-voting was held from 1st Aug 12 am to code whenever required 20th Aug 11.59 pm. There were in all 21 nominees 3.Choose among the nominees , Vote and submit fighting for the Post of President, Vice-President and Member, GB. To help members know the But this sadly seemed to be very confusing nominees well and to make them take an initially with members copy pasting their informed decision we had a one-pager designed credentials and putting passwords in the place of for all nominees which would be displayed on Captcha codes. The captcha basically checks if the website along with their names. The data the person using the system is a robot/malware was given to the CDSL team with Dr. Suryakant, thereby ensuring that the whole e-voting Election officer and Past President of ICS being process is safe, secured not succumbing to any 16
deceptive intent. And hence system does not laws of ICS can't vote. Many of them then take copy paste of user IDs and password. promptly sent their degrees that they had forgotten to submit to let their associate Based on queries and difficulties the voters faced membership be converted to life membership. we promptly compiled a FAQs (Frequently Asked ICS Membership almost doubled of average per Questions) and mailed them to all our members. month with 46 new life members in the month of The frequency of doubts reduced after that but A u g u st a n d t h ey a l l wa nte d to e -vo te until the end, we continued to help the e- immediately since life-members only till 30th voters..! Also, our nominees who were also very June were allowed to vote we had to ask our actively campaigning themselves as allowed in members to wait for the next year elections ….! democratic election process cleared many Correct Address, emails phone numbers and doubts of members and really helped us majorly new life members were all a result of the during the election process in getting huge enthusiasm that ensued during e-voting. numbers in e-voting. We sincerely acknowledge nominees & voter's cooperation, patience and Out of all the successful emails delivered and enthusiasm but at the same time seek seen by the Life Members, we were happy that forgiveness if they had to face some 94% people voted while the overall voting was inconveniences. 62%. On an average 54-56 people voted daily which was not a bad number for the first time e- Some members who were really understanding voters of ICS. We are also happy that 1117 votes and were tech-savvy could finish the process in were registered in all which were more than two one go. All in all, since this was the first time we times of what we recorded earlier the previous at the Election Office expected some problems high through ballot paper election voting being and were ready always to help the members in only 526. casting their e-votes. I am happy to share that we could successfully resolve 98% queries coming Just to make ICS Members more tech savvy I through all modes in our offices very promptly have some information on email use and although we could not help some of them who technology, had not even updated their old postal addresses leave alone email and mobile numbers. But the 1. Always log out from your email account when e-voting prompted them to at least contact us and let us correct their contacts. The you have finished your emails, as open emails combination of Emails, SMS and Voice Prompts can be hacked easily. helped us to a great extent in reminding the busy 2. Never copy-paste any user id and password for doctors about ICS Elections throughout the logging in. process. A special contest to promote and 3. Keep all your junk and spam folders clean. motivate voters to e-vote was thought of SELFIE 4. Check emails in all the sections of your email with the device used for e-voting was conducted account. as well and our ICS Facebook page filled with 5. Keep updating your passwords regularly as members selfies pouring in. So much was the they also carry important information like bank enthusiasm that enquiries came from Associate account details. Members to enable them to vote which as per By 17
Kindly see that you always update your email and Dr. Jyoti working hard in the election back office at mobile numbers whenever you change them and Lucknow for her prompt actions and all GB prompt others including your colleagues to do so. members for trusting me motivating me Re s o l v e t o e n c o u ra g e m o r e a n d m o r e throughout the election journey. I humbly Pulmonologists to become members of Indian apologize for any mistakes that inadvertently Chest Society. And yes just one day before the e- might have happened. voting had begun I met with an accident and had Concluding I congratulate all the winners and also compound fractures in my left toes, but since we the nominees for participating in this historic e- were striving hard to make this maiden e-voting elections of ICS. effort a resounding success I could not rest at all They say all's well that ends well and this was hence proved true... and my enthusiasm which was matched in equal amount by our revered members made me forget Best Regards, my pain. I am sincerely thankful to Dr. Rajesh By Mrs. Sakshi Deshmukh, B.E,M.B.A (Mktg), Swarnakar for his vision, Dr. Suryakant for his Office Executive, Indian Chest Society, Nagpur supervisory skills, Your feedback and suggestions are welcomed @ icsofficeexecutive@gmail.com or visit our website www.indianchestsociety.com 18
Congratulations To The Winners Of ICS GB Elections 2018. On behalf of the Indian Chest Society, we welcome all our newly elected GB members and wish them all the best for their tenure. Here is their introduction and vision for ICS Dr. D. J. Christopher, President-Elect MBBS, CMC (Vellore), PG MMC(Chennai), advanced training UK and Australia Past Professional Experiences: Fellow of ICS, Royal college(UK), ACCP, Asia Pacific Society Research awards Grand challenges, RePORT India(TB)- NIH & DBT & others. Coveted Ida-Scudder research chair(CMC, Vellore) 130 publications, 12 chapters, 200 invited lectures HOD CMC, Vellore- ranked 3rd Nationally - the Week Neilson survey. Set up MD, Postdoc fellowships in Pulmonology & Allergy and BSc (respiratory therapy). Annual workshops in Allergy, bronchoscopy, thoracoscopy and ultrasonography Admin Experience: Deputy MS & Assoc Director 2 terms ICS South zonal chair – Several workshops, new initiatives & state societies Founder- former president Indian association of respiratory care (IARC) Vision For ICS : ICS a vibrant organization will be made stronger and richer. Reciprocal membership with ERS be extended to APSR, ACCP etc. and efforts to elevate ICS to their status. ICS resources will be used wisely to further its objectives - Educational activities and filling the National need of quality research. A scientific committee will scrutinize appropriate research projects for funding. Advocacy role of ICS with the government and the civil society will increase. Focus on young trainees and fresh postgraduates, the future of ICS - offer academic input in Napcon, workshops, CME & conferences regionally. 19
Dr. Sundeep Salvi, Vice President MD, DTCD, DNB, PhD(UK), FCCP(USA), FICS, Hon FRCP (Lon) Past Professional Experience Director, Chest Research Foundation Lecturer, BJ Medical College Pune and Sassoon General Hospitals, Pune (1991 – 1994) Clinical Research Fellow, Asthma Research Unit, University of Southampton, UK (1994 – 2002) Director, Chest Research Foundation, Pune (2002 onwards) Elected Member of the Governing Council of Indian Chest Society for 2 terms, with one term serving as Chairman, West Zone Chapter Member, Board of Directors, GOLD (Global Initiative for Chronic Obstructive Lung Disease) Member, Advisory Board, Air Pollution and Health, Ministry of Health and Family Welfare International Advisory Board Member, Lancet Respiratory Medicin Chairman, Chronic Respiratory Disease Group, Global Burden of Disease, India Editorial Board of several national and international journals Highly cited Clinician Scientist, more than 250 published papers (Google Scholar Total Citation: 6287, H-index 33) Vision for ICS: 1. To build Indian Chest Society as a valuable knowledge generating society through promoting research in the field of respiratory medicine by developing research networks, research capacity and addressing simple, yet highly applicable and relevant research questions that will improve clinical practice. 2. To develop Indian Chest Society as the prime driver of advocacy for Respiratory Medicine in India by working with the State and Central Governments to facilitate preventative and disease control healthcare policies. 3. To develop Indian Chest Society as a premier knowledge dissemination society for Respiratory Medicine, through the conduct of educational activities for postgraduate students of Respiratory Medicine and clinicians to upgrade their knowledge and skills in order to relieve the suffering or people with respiratory diseases. 20
Dr. Raja Dhar, ICS Governing Body Member MD (Respiratory Medicine), MRCP (UK) CCST (UK), FCCP (USA) Past Professional Experiences Working in Fortis Kolkata as the Director of Pulmonology. I set up the Department of Pulmonology here and it has been acclaimed as a Center of Excellence in Pulmonology amongst all Fortis hospitals in India. We have a robust academic structure with our DNB and Fellowship Programs. I completed my MD in Respiratory Medicine in the year 2000 and thereafter went for further training to the UK. Completed MRCP (UK) and then their structured training Program in Respiratory Medicine and Intensive Care. I also completed an MSc in Evidence-Based Medicine from Teeside University which has facilitated my Clinical Research work in India. I then worked as a Respiratory Consultant at St James' Hospital in Leeds. I came back to India in 2009 and started working as a Respiratory Consultant in Apollo before taking on my current mantle. Vision for ICS: I envision the Indian Chest Society leading the Academics and Research in India We have taken giant strides in building bridges with other International Society (like ERS) but there is much more to achieve. These bridges should facilitate training of the bright young brigade in the best of centres in the world. I also want to build up robust training, fellowship and preceptorship programs in the country to train Pulmonologists in Centers of Excellence. We have made some progress in furthering collaborative Research under the umbrella of the ICS but this needs to be greatly enhanced to include Pulmonologists from Tier 2 and 3 cities. I want to promote the concept of Electronic record keeping in every Pulmonologists OPD so that building up robust Disease Registries becomes feasible. The ICS has to become the mouthpiece for every Pulmonologist in the country. 21
Dr. Deepak Talwar ICS Governing Body Member, DM (Respiratory & Critical Care) Past Professional Experiences 1. V. P. Chest Institute Delhi worked as Resident medical officer w.e.f. July 1983 till March 1986. This was a three-year residency in Respiratory Diseases while doing Diploma and MD post-graduation. 2. R. M. L. Hospital Delhi worked ad Medical officer Incharge Respiratory Labs and Senior Resident Medicine for three years W. e. f. April 1986 till June 1989. 3. PGI Chandigarh worked as Post Doctoral Fellow in Pulmonary & Critical Care Medicine for two years w. e. f. July 1989 till June 1991. 4. L. N. J. P. N. Hospital Delhi worked as Senior Medical officer cum Incharge Respiratory Division for one year w. e. f. July 1991 till April 1992. 5. Assir Central Hospital KSA, worked as Consultant Pulmonologist for six years w. e. f. June 1992 till July 1998. 6. Metro Group of Hospital, worked as Director & Chair Metro Centre for Respiratory Disease w. e. f. August 1998 till date. I am working in Metro group of Hospitals for last 20 years as Director & Chair of Pulmonary & Critical care, which is the academic centre and has DNB training program in Pulmonary Medicine since 2008 with 3+3 PG seats every year. We run Fellowship programs in Interventional Pulmonology, Critical Care, Sleep Medicine and Allergy & Immunology. We run one of the best Pulmonary Rehabilitation Program in the country. I have a deep interest in research and teaching activities in which I'm engaged for last 30 years ever since doing my Post Doctoral Fellowship in Pulmonary Medicine from PGIMER Chandigarh in 1991. I intend to work for better training and providing research opportunities to our young and fresh colleagues in all aspects of Pulmonology so that they are future ready in this ever expanding and developing the field. Vision for ICS: I would work for bringing new research projects under ICS banner, which would fill the gaps in the existing knowledge of Pulmonary Diseases in India e.g. Sarcoidosis, Exposure-related diseases and phenotyping of Pulmonary Hypertension and Severe airway diseases. I would also work to create newer opportunities to learn new and innovative interventions for our younger colleagues e.g. in interventions and in critical care. 22
Dr. Shubhankar Kandi, ICS Governing Body Member MD, FAGE, FICS FCCP (USA) Past Professional Experiences Chair International Council of Global Governors & Board of Regent - American College of Chest Physicians (CHEST) Membership Committee-CHEST Member – Community service awards- Chest Foundation Zonal Task Force Chairman RNTCP- SouthZone-1 Central Council Member IMA Member – Technical Committee of TB Association of Andhra Pradesh. Air Born Infection Control Committee Technical Committee for guidelines on first line Anti-TB drugs (Daily regimen) Technical Committee- Indian standards of TB care. National Operational Research committee- RNTCPA vision for this ICS post State Coordinator for Swine flu - Andhra Pradesh President IMA - Hyderabad North-2013-2014 State Task force Chairman RNTCP Andhra Pradesh-2006-2010 Honorary Secretary IMA -Hyderabad North2006-2010 Treasurer AP Government Doctors Osmania Unit II - 2005 President AP Junior doctors Association-1985 Vision this ICS: tion to the cause of Indian Chest Society. I wish to retain and further strengthen the role of ICS as a premier organization representing professionals who promote pulmonary health throughout India. I desire to build and strengthen the membership with innovative leadership and unflagging energy. My vision is to involve ICS in identifying the current and future educational needs of the doctors practising pulmonary medicine and provide quality CME initiatives towards changing clinical practice, thus making it a vibrant organization. I will explore the opportunities to conduct multicentric research projects under ICS banner. 23
Dr. Indranil Halder, Zonal-Chairperson East MBBS, DCH, MD, FCCP, FICP Past Professional Experiences Served as a specialist medical officer in ESI Hospital of West Bengal since 1997. Conducted various works in occupational health under the ESI. Joined medical education as Assistant Professor in College of Medicine and JNM Hospital, Kalyani, under the West Bengal University of Health Sciences. Conducted various research works in Asthma, Allergic Rhinitis, COPD and Tuberculosis. Conducted various scientific seminar in District, State and National level. Vision for ICS: I will work with commitment and dedication to the cuse of Indian Chest Society. I do solemnly affirm that I would do the best of my ability to preserve, protect and defend the integrity of ICS and carry forward the untiring efforts of the previous chairpersons to uphold the responsibility of the ICS. My focus of action would be to conduct training programmes both for the postgraduates and regular updating programmes for practising pulmonologists, in newer aspects of research methodology, FOB, Critical Care, Thoracic Imaging, Sleep Medicine and its application in broader aspects for the benefit of our society at large. It is a heavy responsibility and if elected I would do my best to discharge my duties faithfully in the best interest of ICS. 24
Dr. Rakesh Chawla, Zonal-Chairperson North MBBS, MD, FCCP (USA) Past Professional Experiences Sr. Consultant, Respiratory Medicine, Critical Care and Sleep Disorders Delhi. He is one of the topmost Interventional Pulmonologist with 30 + years of experience. He is a pioneer in the endobronchial placement of glue in cases of hemoptysis. He has been conferred with appreciation award by Honorary Dr. A. P. J. Abdul Kalam (Honourable former President of India). He was chair (head) of the rare lung, airway and pleura disorder (USA), WABIP. He is the recipient of prestigious OA Sarma Oration of ICS at NAPCON 2015. He is member Governing Council ICS. I am an Interventional Pulmonologist in Delhi. I have invested my 2 years working as member governing council and is trying to take ICS forward. During my tenure, I have done basic bronchoscopy workshops for budding chest physician at Delhi, Dehradun, Bhiwani and Guwahati. I have done CME under the aegis of ICS with our annual conference of Replicon India. Vision for ICS: My all efforts are to have academic excellence and spread education through ICS. You can have faith in me and write me what more should be done, I should try to have those changes. 25
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