Category: Newsletter

Telemedicine, defined as the practice of healthcare delivery for patients by doctors at a distance, has been an evolving field in India since its initiation in the year 2000. Now, it stands on the cusp of its silver jubilee. The Telemedicine Society of India (TSI) was established as a non-profit professional body dedicated to promoting, expanding, and advancing telemedicine services across the nation. TSI’s membership includes a diverse range of professionals – doctors, engineers, scientists, students, paramedics, health-related research institutions, hospitals, and NGOs – all of whom collaborate to fulfill TSI’s objectives and goals. Through partnerships with Niti Aayog and the Ministry of Health & Family Welfare (MoHFW), TSI members have played a crucial role in developing India’s Telemedicine Practice Guidelines (TPG), officially notified in March 2020.

India’s government initiatives, such as Ayushman Bharat/e-Sanjeevani and the Pradhan Mantri Jan Arogya Yojana (PM-JAY), have been instrumental in supporting telemedicine’s growth, specifically targeting rural-urban health access disparities and reducing out-of-pocket expenses for patients.

TSI’s Midterm Conference, titled “TeleMed UPrise 2024,” was held on September 20-21 in Prayagraj, organized by the TSI-UP chapter. This event emphasized engaging the next generation of technical and medical students, as well as enterprises, to foster sustainable, holistic growth in the field.

The two-day conference featured discussions on the role of digital health and emerging technologies, with panel discussions covering healthcare industry innovations, remote health monitoring, tele-stroke models, tele-ophthalmology, tele-agri-medicine, and more. Delegates attended insightful talks by experts sharing practical insights into emerging applications, while keynote speakers broadened their perspectives, utilized networking opportunities, and engaged with one another on new solutions for healthcare challenges.

Day 1: Bringing Telemedicine to the Next Generation

The first day of the conference introduced a “conference at your doorstep” format, with three sessions held at different academic campuses across Prayagraj:
1. United Medical College, Prayagraj
2. MLN Medical College, Prayagraj
3. Department of Physics, University of Allahabad

Dr. Krishna Kumar, Organizing Secretary, welcomed the attendees and emphasized that this unique approach mirrors telemedicine’s goal of providing healthcare “at the doorstep.” Dr. Murthy Remilla, former TSI Honorary Secretary, highlighted the evolution of telemedicine in India and the impact of TPG issued by MoHFW. He focused on technological advances supporting telemedicine as a career and a promising start-up field. Dr. Umashankar emphasized integrating telemedicine into academic curriculums, while Ms. Anita Stalin highlighted Lean Six Sigma training and certification as an upskilling opportunity for students. Dr. Ratan Srivastava and Dr. Surya Bali discussed the practical applications of telemedicine for healthcare professionals.

Dr. Pramod Kumar (United Medical College), Dr. Vatsala Mishra (MLN Medical College), and Dr. K.N. Uttam (University of Allahabad) expressed gratitude to TSI for its outreach efforts and expressed interest in more comprehensive sessions on telemedicine for their faculty and students.

The World Health Organization (WHO) has long been a guiding force in global health initiatives, striving to ensure that every individual has access to the highest standards of healthcare. A significant step towards achieving this vision is the Federated Digital ID for Sustainable Development (FIDES), which seeks to revolutionize the way healthcare is delivered, tracked, and improved upon, using digital identity systems and health data.

WHO FIDES: A Vision for the Future

The WHO FIDES initiative is designed to support the 2030 Sustainable Development Goals (SDGs) by improving the integration of health data across borders, creating robust digital identities for individuals, and fostering more equitable access to healthcare services. FIDES aims to bridge gaps in healthcare, ensuring that marginalized and vulnerable populations are not left behind in the pursuit of universal health coverage.

The vision of WHO FIDES is clear: a world where every individual can securely access their health data, regardless of location, fostering improved health outcomes and greater trust in global health systems. This is achieved through interoperability between systems, data privacy safeguards, and a user-centered approach that empowers patients and health workers alike.

Mission: Transforming Health Systems

The mission of the WHO FIDES project is multifaceted:

1. Data Integration and Accessibility: To create an integrated and scalable digital identity system that allows health data to be securely accessed and shared across borders, improving the efficiency of care.
2. Equitable Access: To close the gap between different regions and communities, ensuring equal access to health services for all, especially those in underserved areas.
3. Sustainability: To establish systems that are not only effective in the short term but are sustainable in the long run, contributing to the health sector’s resilience in addressing global challenges, such as pandemics and health crises.
4. Interoperability: To create systems that communicate across various health platforms, ensuring that data is shared seamlessly and securely.
5. Empowerment of Individuals: To ensure individuals have control over their own health data, promoting agency and informed decision-making in healthcare.

My Involvement
With my strong background in digital health, telemedicine, data privacy, and healthcare innovation, WHO wanted me to play a role in FIDES. And help in driving forward the project’s mission of equitable healthcare access through digital innovation.

I have always worked for health equity by advocating for vulnerable populations in global health policy forums. My membership in WHO FIDES focuses on ensuring that digital identity systems prioritize patient confidentiality, while also facilitating the efficient exchange of health data to improve patient outcomes.

WHO FIDES continues to explore innovative approaches to digital health, from telemedicine to digital health wallets, ensuring that all individuals have access to the care they need, wherever they are in the world.

Conclusion

The WHO FIDES initiative stands as a pivotal force in transforming healthcare delivery through the power of digital identity and data integration. With a mission aligned with the Sustainable Development Goals and a vision of accessible, equitable healthcare for all, FIDES is shaping the future of health systems globally.

It ensures in merging multiple powerful voices in health care into a single voice under the banner of WHO fides whom everyone can trust.

Conference on “Digital Health & Telemedicine” Overview

The conference on “Digital Health & Telemedicine” aimed to explore the evolving landscape of healthcare technology, focusing on the integration of digital health solutions and telemedicine practices. The primary objectives were to educate healthcare professionals on the latest trends, share innovative approaches in telemedicine, and discuss the challenges and opportunities associated with digital health. This event was particularly significant in the post-pandemic era, where telemedicine has become an essential component of healthcare delivery.

Venue and Organization

The conference was held in association with the Tamil Nadu Dr. MGR Medical University, where all government and private medical colleges and hospitals in Tamil Nadu are affiliated, except for some deemed universities. This collaboration ensured extensive outreach, particularly within the government sector. Special recognition goes to Dr. K. Selvakumar, Past President of TSI & Visiting Professor of the university, and Dr. Sunil Shroff, currently Vice President of TSI, who served as conveners. Their close ties with the university’s Vice Chancellor were instrumental in organizing the event.

The conference took place on Friday, August 2, 2024, at the Silver Jubilee Auditorium of The Tamil Nadu Dr. M.G.R. Medical University, Chennai. This was the third time the TSI Tamil Nadu Chapter collaborated with the university to host an event on its premises. Nodal officers in telemedicine from various medical colleges and district hospitals participated, both in-person and online. Directors from Medical Education, Rural Health, and Public Health departments also participated, chairing several sessions.

Inaugural Ceremony

The event commenced with the traditional Thamizh Thai Vazhthu and the lighting of the lamp (Kuthuvilakku), followed by a welcome address by Dr. P. Arumugam, Registrar (FAC) of the university. Dr. Sunil Shroff introduced the conference’s aims, while Dr. K. Narayanasamy, Vice-Chancellor of The Tamil Nadu Dr. M.G.R. Medical University, delivered the Inaugural Address, highlighting the university’s vision for digital health and telemedicine in Tamil Nadu.

Dr. Kim Ramasamy, President of TSI, was the Guest of Honour and delivered the Presidential Address. Dr. H. Ikramulla, President of TSI, Tamil Nadu Chapter, delivered the Keynote Address, emphasizing the importance of telemedicine in modern healthcare.

The event featured seven scientific sessions:

1. Session I: Telemedicine Application
   – Focused on the university’s vision for digital health, remote patient monitoring, and the integration of payment gateways and digital signatures in telemedicine. Esteemed speakers shared valuable insights.
2. Session II: Telemedicine Growth & Practice
   – Covered the impact of COVID-19 on telemedicine and best practices for establishing virtual clinics, with contributions from Dr. Subramaniam Swaminathan and Dr. Sunil Shroff.
3. Session III: Telemedicine Setup & Remote Monitoring Devices
   – Discussions centered on network connectivity, video conferencing, wearables, and other critical devices. Experts like Mr. Ashwin Desai and PadmaShri Dr. S. Natarajan offered their perspectives.
4. Session IV: Evaluation of Telemedicine & NMC Guidelines
   – Explored the global landscape of telemedicine, its history in India, and associated legal issues. Renowned speakers Dr. K. Ganapathy, Dr. R. Kim, and Dr. Sunil Shroff provided authoritative lectures.
5. Session V: Telemedicine in Specialties
   – Highlighted telemedicine’s application in various specialties, including Tele-Dermatology, Tele-Cardiology, and Tele-Surgery, with contributions from Dr. P. Manokar, Dr. Sanjay Sharma, and Dr. Murthy Remilla of ISRO.
6. Session VI: Tele-Dentistry & Revenue Models in Telemedicine
   – Featured discussions on Tele-Dentistry by the Dean of Sri Ramachandra Dental College and a successful revenue model in Tele-Ophthalmology presented by Dr. T. Senthil.
7. Session VII: Tele-Education
   – The final session explored telemedicine’s role in education, including tele-mentoring and mobile telemedicine vans, with insights from leaders like Dr. Chavan Kalidas, Dean of ESI Medical College, and Dr. Sheila John.

Outcomes

The conference successfully met its objectives, fostering a deeper understanding of digital health and telemedicine among participants. Key outcomes included:

– Increased awareness of telemedicine’s role in improving healthcare accessibility and efficiency.

– Identification of best practices for implementing telemedicine in various specialties.

– Enhanced collaboration among healthcare professionals, fostering an environment of innovation and shared learning.

Innovative Approaches

The conference showcased several innovative approaches, including:

– Telemedicine in Specialties: Sessions focused on telemedicine applications in cardiology, dermatology, and other specialties, providing practical insights into the specialized use of telehealth.

– Tele-Education: Discussions on using telemedicine for uniform teaching practices and examinations highlighted its potential to revolutionize medical education.

The event concluded with a group photo and a vote of thanks by Dr. S.T. Radhiga, Professor & Head of the Department of Medical Education & Curriculum Development at the university.

Conclusion

The one-day conference on “Digital Health & Telemedicine” was a resounding success, providing a platform for healthcare professionals to explore the future of healthcare through technology. The event not only met its objectives but also set the stage for ongoing innovation and collaboration within the field of telemedicine.

1968 : I entered Medical School 56 years ago. Trained in the 20th century, in the BC era my generation would today be considered to belong to the Neanderthal Age.

I injected air into the brain and dyed directly into the Carotid Artery to see if there was any displacement of ventricles or blood vessels in the brain – a surrogate marker for a possible “Space Occupying Lesion”. Tuberculoma and Cysticercosis (growths due to TB and parasites) were as common as benign and malignant brain tumors. Getting the patient’s consent for surgery was a one-sided conversation.

No questions were asked. Such was the faith and trust reposed in the surgeon. The role of the patient and the family in the decision-making process was minimal. We could not share our responsibility with anyone.

I was Amicus curiae and the Devil’s Advocate rolled into one. We entered the brains of our patients even before the surgery, trying to understand what he/she and their families would want, and took a surrogate decision on their behalf, in their interests.

2024: Tomorrow the Digital Health we will be practicing will be 5P (Predictive, Personalized, Precision, Participatory, and Preventive) medicine with AI as a major component. As 80% of the 41 Zetabytes (410 trillion GB) of digital information currently available is unstructured AI will detect patterns and trends, which our gray matter is unable to decipher.

Powerful AI techniques are unlocking clinically relevant information, hidden in massive amounts of data. Wanting to be future-ready and ahead of the curve, are we turning a Nelson’s eye and forgetting our past?

After all, it is NI (Natural, Native) Intelligence that led to the birth of AI. In a world where algorithms make diagnoses, wearables track vital signs, and robots are remotely controlled, to perform surgical procedures, will clinicians of the last century become an endangered species?

Technology today is working overtime to guarantee patient safety and quality improvement. There is already a marked shift in using technology to promote good health. In the next two decades the necessity to diagnose and treat established diseases will significantly reduce. There will be no chapter on “Complications”.

Genomics, radiomics, and specialties hardly existing today will replace many disciplines. The increasing use of a Digital Twin of a patient will enable accurate assessment and a preliminary “ in silico” trial.

We need to remind ourselves that technology is a means to an end, not an end by itself. Proactive measures need to be taken to ensure that increasing the use of technology does not lead to depersonalization and dehumanization.

Sir William Osler’s observations 150 years ago “ — the good physician treats the disease, the great physician treats the patient who has the disease”

“—–Patients don’t care how much you know until they know how much you care”

“—Listen, listen, listen he is telling you the diagnosis” is even more relevant today. The world has turned upside down. Very soon a clinician who does not use AI in his/ her armamentarium would appear to have come from another planet!

Terms such as “ trust” and TLC (Tender Loving Care) espoused by my teachers, may soon disappear. Once new technologies roll over you, if you are not part of the steamroller, you are part of the road. The writing is on the wall!

The ultimate disruption will be when what today is termed AI will become ANI, not perhaps in my lifetime but certainly in the lifetime of my children.

The A in AI after all stands for Augmenting, Amplifying, Accelerating, Assisting, and Analyzing in an Ambient milieu.

A smart empathetic clinician using ANI will become smarter. A mediocre clinician using ANI will not necessarily become smarter. The Hippocratic Oath may have to be replaced with a Robocratic Oath.

After all “To err is ChatGPT, to forgive is human !!”

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The Telemedicine Society of India, Himachal Chapter, proudly hosted a Continuing Medical Education (CME) event focused on “Telemedicine in Himalayas: Bridging Gaps and Creating Opportunities.” This event aimed to explore the transformative impact of telemedicine in remote Himalayan regions, addressing challenges and unlocking new possibilities in healthcare delivery.

We delved into the intricacies of how telemedicine can revolutionize healthcare in one of the most remote and challenging terrains on earth. We discussed the remarkable potential of telemedicine to bridge geographical gaps, enhance access to medical expertise, and ultimately improve health outcomes for the communities in these remote areas.

Our discussions reinforced the importance of collaboration, innovation, and unwavering commitment to this cause.

Let us continue to work together, leveraging the insights and strategies we have shared, to bring about a healthcare revolution in the Himalayas. By doing so, we can ensure that even the most remote communities receive the care they need and deserve.

I thank all the participants for your dedication, and your passion for advancing healthcare through telemedicine. Together, we can bridge the gaps and create new opportunities for a healthier, more connected Himalayan region.

It is often forgotten that instant access to healthcare is critical in remote isolated locations and areas. Interestingly a phenomenal amount of money and resources are being spent to keep humans on board the ISS (International Space Station) orbiting 400 km above the earth. Health issues of all the 280 humans from 23 countries who have been living in the ISS for the last 24 years ( periods varying from few weeks to several months ) have been addressed and managed.

Air travel today is no longer a luxury. In India, 4.17 lakh passengers board 2891 flights every day. No doubt In Flight Medical Emergencies occur rarely – 7 per 10,000 passengers leading to unscheduled landing (1 for 1 million passengers). Unnecessary diversion causes flight hazards, inconveniences, ↑fuel ↑costs.

Provision of In Flight Emergency Medical Services could therefore be a tremendous value addition. 15 years ago in my enthusiasm as a Telemedicine evangelist I made presentations to the CMO’s of three airlines including the then progressive Jet Airways and even the Director General of Civil Aviation. Perhaps the credibility of the institution which I was associated with and my personal credentials enabled a hearing!! Permission could not be obtained to include Telemedicine equipment in aircrafts for pilot studies. Attempts to do pilot projects on ships also did not materialise then.

It was therefore gratifying to learn that today much water has flown under the bridge (pun intended!). International Labour Organisation (ILO) & Maritime Labour Convention states “—–provide seafarers with medical care as nearly as possible equivalent to care on shore, and to ensure that medical advice by radio or satellite communication to ships at sea is available at any hour of the day or night”. Every ILO signatory nation is bound to have a prearranged system for wireless medical advice available to ships of all nationalities, round the clock and free of charge, also known as Telemedical Assistance Services(TMAS). This network ensures communication through marine radio, email, telephone or fax and in more recent times, via real-time video calls.

The author thanks the Tamilnadu Chapter of the TSI and Amet University for the opportunity given to revive an important topic, not in the main stream of Telehealth.

SNOMED CT stands for Systematized Medical Nomenclature for Medicine–Clinical Terminology and is a clinical terminology system that provides a standardized and scientifically validated way of representing clinical information captured by clinicians.

SNOMED CT is a special type of medical coding system called terminology system where the meaning of a term is coded instead of the term itself. It is a controlled medical vocabulary containing standard terms and that codes the concept definition (meaning) of a term. This definition is a formal logical representation of the information that is always necessarily true about its meaning.

This information representing the meaning is modelled as a set of interrelated triples, which encodes it in a structured format thereby making it machine-interpretable. Being always necessarily true under all circumstances, the meaning is interpreted exactly the same way everywhere each and every time.

The information model is made up of the three entities: subject, predicate and object (hence called semantic triples) that are represent the concept’s relationships.

The SNOMED concept model mandates that at least one of the triples must have the concept as the subject, the relationship “is a” as the predicate, and another concept as the object which represents a broader definition.

This makes the subject concept a finer representation or subtype of the object concept. There can be any number of additional triples that are either subtype relationships or attribute relationships, which have different relationship types as predicates.

Example: Appendicitis is coded by its concept definition. Note the three distinct components of each line – together they form the “triple”.

1. “Appendicitis” “Is a” “Disorder of appendix”

2. “Appendicitis” “Is a” “Inflammation of large intestine”

3. “Appendicitis” “Finding site” “Appendix”

4. “Appendicitis” “Associated morphology” “Inflammatory morphology”

This makes the concept of “Appendicitis” to be a finer version of the “Disorder of appendix” concept (there can be other subtype finer concepts of this like “Appendicular abscess”, “Intussusception of appendix”, “Appendicular neoplasm”, etc.) and of “Inflammation of large intestine” concept (whose other subtype finer concepts would be “Colitis”, “Crohn’s disease”, “Proctitis”, etc.). Incidentally, “Appendicitis” concept has several subtype finer concepts such as “Acute appendicitis”, “Chronic appendicitis”, “Atypical appendicitis”, and more.

As is clearly evident from above, all of the four assertions are always necessarily true of the meaning of “Appendicitis” irrespective of any other consideration.

Combining the above, as per SNOMED CT Expression Constraint Language (ECL), the unique language used to express the concept definition is as follows:

=== 18526009 |Disorder of appendix (disorder)| + 302168000 |Inflammation of large intestine (disorder)| : { 363698007 |Finding site (attribute)| = 66754008 |Appendix structure (body structure)|, 116676008 |Associated morphology (attribute)| = 409774005 |Inflammatory morphology (morphologic abnormality)| }

From the above it is evident that the individual components of the triples are in codes making the entire definition machine-interpretable.

Every concept definition is assigned a unique machine-processable identifier.

Example: Code for Appendicitis is 74400008.

Every concept is assigned a unique human-readable official name that explains the concept in a non-vague manner, which is called Fully Specified Name, or FSN, that has the concept’s domain enclosed in parentheses as a suffix to help disambiguate it.

Example: FSN for Appendicitis is Appendicitis (disorder).

All terms synonymous with a concept’s definition is assigned the same concept code.

Example: Inflamación aguda del apéndice [Spanish], Appendicite [French], blindedarmontsteking [Dutch], Appendicit [Swedish] – all have the same code 74400008.

SNOMED CT also permits the coding of terms without matching concept definitions in a standardised manner, post-facto, for machine-processability and machine-interpretability of user specific or local terms.

The concepts can be constrained, extended, or mapped to other code systems as required. All of the resultant codes will be standards-compliant, making the code system very flexible and customisable.

Example:

1. Myalgia relieved by analgesic === 706955002 |Pain relieved by analgesic (finding)| : 363698007 |Finding site (attribute)| = 127954009 |Skeletal muscle structure (body structure)|

2. operable tumour === 128303001 |Surgical removal (procedure)| : 363700003 |Direct morphology| = 108369006 |Neoplasm (morphologic abnormality)|

3. GC fair === 162669003 |Patient’s condition satisfactory (finding)|

The relationships of the concept definition can be used for in-depth query and its machine-interpretability makes all SNOMED coded information Artificial Intelligence (AI) and Machine Learning (ML) ready – imparts “intelligence”.

Example: Appendicitis has many “is a subtypes” of its own and it itself “is a subtype” of others. These relationships as well as its attribute relationships (assertions # 3 & 4 in the above example) can be used to do semantic search or to generate custom cohorts on-demand or trigger automated follow on action using preset rules like “for all concepts having inflammatory morphology as associated morphology prescribe antibiotics”. Since the code is sufficient for this, on user entry, the required action can be performed by the machine without any further action by the user.

In conclusion, SNOMED CT can be said to be a dictionary of healthcare for machines to “understand” human understandable terms.

Artificial Intelligence (AI) is revolutionizing the way we live, work, and interact with the world. From voice-activated assistants to self-driving cars, AI technologies are increasingly becoming a part of our daily lives. But as AI becomes more prevalent, so does the jargon surrounding it. To bridge the gap between complex AI concepts and everyday understanding, here’s a guide to some of the most common AI terms. This list will help demystify the language of AI, making it more accessible to everyone curious about how these technologies work and their impact on our future.

AI Terms

1. Artificial Intelligence (AI): AI is like a computer brain that can think, learn, and make decisions similar to humans. It can solve problems, recognize speech, and even drive cars without human help.

2. Machine Learning (ML): A subset of AI, machine learning is when computers learn from data without being explicitly programmed. It’s like teaching a computer to improve at a task by learning from its mistakes and successes.

3. Deep Learning: This is a more advanced type of machine learning involving neural networks with many layers. It’s akin to teaching a computer to think and understand the world in a way that mimics the human brain.

4. Neural Network: Inspired by the human brain, a neural network is a series of algorithms that tries to recognize underlying relationships in a set of data through a process that mimics the way the human brain operates.

5. Natural Language Processing (NLP): This technology helps computers understand, interpret, and respond to human language in a valuable way. It’s what powers chatbots and virtual assistants to understand and reply to your questions.

6. Algorithm: In AI, an algorithm is a set of rules or instructions given to an AI system to help it learn from data. It’s like a recipe that the computer follows to make decisions or predictions.

7. Data Mining: This process involves exploring and analyzing large blocks of information to glean meaningful patterns, trends, and relationships. It’s like sifting through a mountain of data to find valuable nuggets of information.

8. Supervised Learning: A type of machine learning where the computer is taught using data that is already labeled. It’s similar to learning with a teacher who provides you with the correct answers for study examples.

9. Unsupervised Learning: Unlike supervised learning, unsupervised learning involves training a machine using information that is neither classified nor labeled. The machine tries to identify patterns and relationships in the data on its own, like learning without a teacher to guide you.

10. Token: In the context of AI, especially in natural language processing, a token is typically a word or piece of text that the machine uses to understand and generate language. It’s like breaking down a sentence into individual pieces to better understand its meaning.

Just as a calf likes to suckle, so too does the cow like to be suckled !! The greatest incentive for conference organisers to persist in their efforts, is the attendance and the feedback. 13 years ago when Dr Sangita Reddy mooted the idea of a conference on “ Transforming Healthcare with IT” we realised that we were too far ahead of the time. A conference on a then non existing subject required considerable conviction ! 200 hundred years ago Victor Hugo had remarked “ Nothing can stop an idea whose time has come”. THIT 2024 has proved that. Last week we reached that critical mass essential for a successful take off. 1667 registrants – young and old, converted and to be converted had an opportunity to directly listen to 67 speakers https://www.transformhealth-it.org/wp-content/uploads/2021/05/11thTHIT-2024_-Agenda.pdf (combined experience of more than 1600 years !!) from 8 different countries.

Cutting Edge topics discussed included Climate change &Telehealth, panel discussions on Bench to Bedside, Healthcare in Outer space, Digital Personal Data Protection Bill, AI deployment, changing trends in technology, Innovations in Digital health etc. It was wonderful to see national and global authorities adhere to the 720 seconds given to them – after all when you have mastered your subject you can communicate the essence as a Take Home Message. Time management was incredible. More than 1000 virtual attendees logged in to partake in 20 hours of unadulterated wisdom. We deliberately had no parallel sessions. Opportunity to display ePosters was also available.

Visits to 31 stalls enabled the attendees to see, touch, feel and understand that what appeared like science fiction, was indeed a cost effective customised available reality ! In keeping with the times everything was App based including a Quiz program and Treasure Hunt . Of course a QR code was essential for plates for lunch !. Large number of contestants for the 8 awards and for the 36 hour Solvathon marathon held in conjunction with IITACB indicates that THIT has truly arrived. This would not have been possible but for a fantabulous set of volunteers who did not want to follow high standards. They believed in setting them ! We no longer strive to achieve world class. We want the world to strive to achieve India class !! A big thank you again to the core committee of Dr Sangita Reddy, Vikram Thaploo. Dr Sujoy kar, Dr Sai Praveen Haranath, Ashokkan and Aashish Kumar Jain.