Principles in Critical Care Nutrition Kapil Zirpe, Subhal Dixit, Khalid Khatib, Anshu Joshi, Sadanand Kulkarni
INDEX
A
Acidosis 14
Acquired immune deficiency syndrome 224
Adrenocorticotropin releasing hormone 215
Aggravate inflammatory bowel disease 129
Airway 111
Albumin 127, 135, 284
Alcoholism 34
All-in-one
bags 48
system 47, 63
Aluminium hydroxide 35
Alzheimer's disease 213
American Diabetes Association 218, 219
American Society for Parenteral and Enteral Nutrition 51, 138, 221, 266
Amino acid 42, 54, 57, 63, 93, 94, 121, 133, 153, 203
aromatic 28
essential 57
Amyotrophic lateral sclerosis 216
Angiotensin converting enzyme 190
Anorexia 34
nervosa 224
Anthropometry 5, 136, 145
Antibiotics 175
Antioxidants 109, 113, 255, 257, 259
exogenous 256
Antiretroviral therapy 199
Aortoenteric fistula 167
Aortoesophageal fistulas 33
Appetite
loss of 97
stimulants 190
Arachidonic acid 263
Arginine 92, 170, 268, 270
Arrhythmias 59
Artificial nutrition 223, 250
support 14
Artificial tube feeding 190
Ascorbic acid 150
Aspiration 31, 33
risk of 87, 112
Azotemia 59, 125
B
Bariatric nutrition 187
Bariatric surgery 177, 178t, 187
Basal energy expenditure 135
Biochemical
complications 191, 228
monitoring 80
Biochemistry 5, 145
Bioenteric balloon insertion 180
Biotin 150
Bleeding 33, 228
Blenderized tube feeding 28
Blood
ammonia 59
glucose 64
control 115
Bloodstream infection
catheter related 45
central line-associated 68, 69
Body mass index 78, 100, 113, 145, 177, 195, 199, 223, 284
Bone markers 80
Bowel
anatomy of 169
movements 204
Brain injury, traumatic 112, 213
Branched chain amino acids 28, 57
Breathing 111
Burns 97, 211
pathophysiology of 118
C
Cachexia 34, 193, 194
Calcium 149, 150, 152, 174, 229
Calories 152
Cancer 34, 193, 194
development of 194
Candida albicans 65
Capric acid 263
Caprylic acid 263
Carbohydrates 54, 93, 121, 149, 152, 155, 173, 174, 189, 203, 207
requirements and glycemic control 121
Cardiac disease 157
Catalase 255
Catheter
misplacement of 231
thrombosis 231
Central insulin sensitivity 68
Central venous
access device, site of 45
catheter 67
lines, management of 69t
Chemoradiotherapy 234
Chemotaxis 70
Chinese Society of Clinical Oncology 236
Chloride 229
Cholestasis 231
Cholestyramine 175
Chronic obstructive pulmonary disease 157
Clinical nutrition, basics of 1
Clostridium difficile infections 32
Cobalamine 150
Collagenases 92
Complementary feeding 16
Computed tomography scan 195
Constipation 32, 228
Continuous renal replacement therapy 61, 276
Copper 95, 122, 155
Corticosteroids 127
Cortisol 11
Critical care nutrition 283
future of 289
Critical illness hyperglycemia, causes of 68
Crohn's disease 127, 128, 130, 173
Cyproheptadine 190
Cysteine 94
D
Daily estimated electrolyte requirements 229t
Daily nutrition requirements 147, 152
Dehydration 121, 228
Delayed bowel function recovery 134
Diabetes mellitus 27, 34, 94, 133, 218
Diarrhea 31, 101, 200, 228
drug induced 134
treatment of 175
Diet, components of 207
Dietary interventions, aims of 128
Disease specific
formulas 226
nutrition 209
Docosahexaenoic acid 65, 263, 266
Docosapentaenoic acid 263
Dronabinol 190
Drug nutrient interactions 216
Duodenal switch, laparoscopic 180
Dyselectrolytemia 228
Dysphagia 200, 213
E
Early enteral feeding, advantages of 123
Eicosapentaenoic acid 65, 113, 263, 264, 266
Electrolyte 42, 43, 161, 229
deficiency 60
disorders 49
disturbances 80, 101
imbalances 102
End stage liver disease 136t
Energy 6, 29, 93, 106, 107, 147, 152, 173, 188, 200, 229
and protein targets, calculation of 4, 6
intake 148, 150
requirement 155, 203, 206
calculation of 113
estimation of 120
supply 41
Enteral feeding 174
laboratory monitoring of 79
tubes, monitoring 78
Enteral formula 26, 201
Enteral nutrition 15, 25, 26, 31, 39, 51, 77, 128, 138, 163, 170, 190, 214, 219, 234, 158, 283
complications of 31, 31t
dosing of 114
metabolic complications of 36t
planning of 224
route of 225
support 19
use of 234
Enteral tube feeding 21
contraindications of 21
indications of 21
Enterocutaneous fistula 167
Enterostomy tube 228
feeding 225
Epistaxis 31, 32
Erosion 33
Esophageal ulceration 33
Esophagectomy 103
European Association for Palliative Care 236
European Society for Clinical Nutrition and Metabolism 265
European Society for Enteral and Parenteral Nutrition 3, 9, 51, 97, 138
European Society of Surgical Oncology 236
Excessive carbohydrates, adverse effects of 208
Extensive mesenteric ischemia 173
Extracorporeal membrane oxygenation 160
F
Fat 94, 121, 147, 152, 174, 188, 200, 203
malabsorption 134
requirements 122
Fatty acid 170
deficiency 65
essential 60
dietary 263t
monounsaturated 263
polyunsaturated 262264
saturated 263
Fatty liver 125
Feeding
complications of 100
initiation of 99
intolerance 216
solutions, choice of 26
Fiber 149
containing formulas 226
intake 152
Fibroblasts 85
Fistula, anatomy of 169
Fluid 14, 29, 207
balance 77
imbalance 102
intake 148
overload 85, 228
retention 59
Fluoroscopic gastrostomy 225
Folic acid 150, 152, 163
Food and Drug Administration 69
Fructo oligosaccharides 27
G
Gamma-linolenic acid 113
Gastric
banding, laparoscopic 180
distension 101
intolerance 108
residual volume 108, 116
role of 108
Gastrointestinal
complications 31
fistulae 167
function, evaluation of 26
malignancies 51, 224
tract, function of 112
Gastrostomy 21, 31, 78
percutaneous 214
surgical 225, 235
Ghrelin 11
G-linolenic acid 263
Glomerular filtration rate 146, 148, 202
Glucagon 11
Glucose 79
intolerance formulae 27
Glucosuria 121
Glutamine 54, 94, 170, 236, 266, 268
Glutathione 255
peroxidase 255
Gravity infusion 226
Growth hormone 135, 190
H
Harris-Benedict equation 162, 206
Healing, phases of 91
Heart failure, congestive 258
Hemodialysis 151
Hemostasis 92
Heparin 54
Hepatic
complications 71
encephalopathy 132, 138
failure 56, 102
formulae 28
steatosis 59, 231
HIV infection 199
Home artificial nutrition 235
Home enteral nutrition 26, 223
implementation of 226
Home nutritional support 171
Home parenteral nutrition 228
Hormones 11
Hospital malnutrition, preventing and treating 249
Hospital Nutrition Steering Committee 241
Hydration status 80
Hyperammonemia 170
Hypercapnia 59, 231
Hypercatabolic state 97, 134
Hypercatabolism 85
Hyperemesis gravidarum 209
Hyperglycemia 36, 49, 59, 68, 85, 100, 102, 125, 160, 170, 218, 219t, 222, 231
pharmacologic management of 221
post-traumatic 113
prevention of 220
Hyperinsulinemia 9, 59
Hyperkalemia 36
Hyperlipidemia 102
Hypermetabolism 85
Hypernatremia 36
Hyperphagic diet 175
Hyperphosphatemia 36, 149
Hypertonic saline 216
Hypertriglyceridemia 42
Hypoalbuminemia 168, 206
Hypocaloric feeding 106
degree of 6
Hypoglycemia 36
Hypokalemia 35, 36, 231
Hypomagnesemia 70
Hyponatremia 35, 36
Hypophosphatemia 35, 36, 231
Hypoxia 14
I
Immune
cells 85
dysfunction 59, 205
modulating formulae, role of 109
Immunonutrients 103, 161, 163, 170
Indirect calorimetry 120, 206, 207, 209
Infections 59, 88, 228
catheter related 231
Inflammation 9, 92
Inflammatory bowel disease 102, 126, 126t, 127129, 135, 224
Insulin 11, 54
therapy 35
Intensive care
subpopulation of 102
unit 3, 4, 9, 21, 51, 69, 157, 159, 275, 278
Intermittent bolus feeding 226
Intestinal fistula 228
Intrabronchial placement 227
Intraperitoneal supplements 153
Intravenous fat emulsions 63, 266
Iron 95, 147, 150
J
Jejuno-colonic anastomosis 176
Jejuno-ileocolonic anastomosis 176
Jejunostomy 31, 235
surgical 225
K
Kidney 144
disease 144, 146
function 80
injury 56
Krebs's cycle 14
L
Lactulose 28
Laryngospasm 33
Lauric acid 263
Lean body mass, loss of 205
Leptin 11
Linoleic acid 262, 263
conjugated 263
Lipid 42, 54, 106, 149, 207, 208
adverse effects of 209
emulsion 56, 65, 65t
Lipolysis 133
Liver
disease 132, 134t, 135, 138
failure 210
transplantation 132, 140t
Long chain triglycerides 60, 65
Loperamide 175
Lymphoid tissue 87
Lysine 94
M
Macronutrients 200
Magnesium 43, 80, 95, 115, 134, 152, 174, 229
Magnetic resonance imaging scan 61, 195
Malabsorption 133, 168
syndromes 34
Maldigestion 34
Malignancy 224
Malnutrition 9, 85, 132, 193, 233
assessment of 127
cancer related 193
causes of 10t, 126, 126t
chronic 34
consequences of 127
correction of 95
effects of 158
impact of 205
management of 189
pathophysiology of 9, 215
risk of 105
screening tool 234
universal screening tool 3
Manganese 95
Medium-chain triglycerides 57, 58, 140
Megestrol acetate 190
Metabolic bone disease 71, 231
Metalloproteinases 92
Methionine 94
Micronutrient 109, 155, 174, 200, 259
deficiency 35, 134t
correction of 130
requirements 122, 204
role of 109
Mid-arm muscle circumference 145, 284
Minerals 29, 94, 149, 150, 189
Mini-nutritional assessment 105, 234
scale 189
Motor neurone diseases 213
Multi-chamber bags 48, 63, 64
Multi-lumen central venous catheters 230
Multiple bottle system 47
Multiple organ dysfunction syndrome 162, 255
Myocardial infarction, acute 157
Myristic acid 263
N
N-3 fatty acids 264266
Nasoduodenal tubes 24
Nasoenteral feeding tubes 31, 225
Nasogastric tube 31, 174, 200, 235
Nasojejunal tube 24, 235
Nausea 32, 228
Needle catheter jejunostomy 21
Nervous system 135
Neuroinflammation 112
Neuromuscular dysfunction 59
Niacin 150, 152, 200
Nicotinic acid 150
Nitrogen balance 209
N-methyl-d-aspartate 115
Non-essential amino acids 57
Non-ketotic coma 170
Non-nasogastric feeding 115
Non-protein energy 57
Nonsteroidal anti-inflammatory drugs 67
Normalized protein nitrogen appearance 145
Nucleic acid 266
Nucleosides 170
Nucleotides 170
NUTRIC score 22, 52, 52t, 120, 159t
Nutrients 14, 150
absorption 179
deficiency of 60
in wound healing 93
requirement of 173
requirements 154
Nutrition 5, 103
assessment 4
stage of 4
care process, course of 77
delivery
methods of 200
principles of 200
formula 49
goals of 205
in chronic
hemodialysis 150
kidney disease 146
in motor neuron diseases 216
in peritoneal dialysis 152
in stroke 213
in traumatic brain injury 214
intervention, monitoring of 77
monitoring of 101
provision of 3
risk score 3, 4, 159
route of 124, 128, 164
screening 3, 4, 242
status assessment 113
support 118
in nonsurgical oncology 233
route of 107, 114
team 195, 248
therapy 51, 113, 116
evaluation of 250
monitoring of 250
Nutritional
absorption 134
assessment 3, 52, 119, 233
goals of 205
care, future of 288
deficiencies 183, 183t, 228
interventions 140, 151, 169
management, rationale of 169
monitoring 77
requirements 228
assessment of 159, 284
calculation of 98
estimation of 106, 188
monitoring of 284
screening and assessment 86
status 10, 11t
assessment of 97, 135, 136t, 158, 189
monitoring 205
optimization of 168
supplementation 129
support 78, 144, 160
during cancer surgery 197
in acute pancreatitis 162
in AIDS 199
in bariatric surgery 177
in burns 118
in cancer 193
in cardiac disease 157
in chronic pancreatitis 162
in extensive gut resection 173
in gastrointestinal fistulas 167
in kidney transplant recipients 153
in liver disease 132
in liver transplant 132
in neurological disorders 213
in pregnancy 202
in pulmonary disease 157
in renal disease 144
in sepsis 105
in trauma 111
in wound healing 91
modes of 19, 37
monitoring of 75, 77, 125
team 232, 248, 249
timing of 123
therapy 137, 174, 175
in liver transplant 138
Nutritious foods 9
O
Obesity 102, 210
Oleic acid 263
Omega-3 fatty acids 262, 265, 268
Oral nutritional
supplements 15, 86, 108, 190, 200, 234, 265
support 219
Organ function, derangement of 97
Overfeeding 124
complications of 125t
Oxygen consumption 85
P
Pain, abdominal 101
Palmitic acid 263
Palmitoleic acid 263
Pancreas 162
Pancreatitis 102, 162, 210
Pantothenic acid 95, 150, 152
Parathyroid hormone 231
Parenteral fluid balance 77
Parenteral micronutrients 275, 278
Parenteral nutrition 37, 39, 40, 47, 54, 59, 60, 60t, 67, 77, 80, 101, 111, 128, 163, 170, 191, 195, 196, 200, 220, 221, 230, 258, 277
administering 41
central 44
complications of 58, 59t, 67, 124t
components of 56t
compounding 63
contraindications of 39
formulae 63
implementation of 230
indications of 39, 235
planning of 51
preparation of 230
solutions 65
use of 235
Parkinson's disease 213
People living with HIV 199, 201
Percutaneous endoscopic gastrostomy 190, 216, 225
Perioperative nutritional
components of 86t
interventions 86
support 85
Perioperative parenteral nutrition 86, 88
Peripheral parenteral nutrition 15, 44
Peripheral veins 44, 49
Peripherally inserted central catheter 230, 235
Phagocytosis 70
Pharmaconutrients 161
Phosphate 42, 229
Phosphorus 79, 149, 150, 152
Pneumonia 111
Pneumothorax 227
Polymeric formulae 27
Polytrauma 97
Polyuria 121
Post bariatric surgery 182t
Post pyloric tube 24, 31, 225
Post-liver transplantation period 140
Postoperative nutritional supplementation 181
Postpyloric feeding 108
Potassium 43, 49, 79, 80, 149, 150, 152, 229
Pre-albumin 135, 189
micronutrients 284
Pre-liver transplantation period 140
Preoperative carbohydrate loading 86, 87
Preoperative metabolic optimization 86, 87
Prokinetics 109
administration of 101
Proline 94
Prostaglandins 264
Protein 6, 93, 106, 107, 147, 152, 153, 173, 188, 200, 204, 207, 208
adverse effects of 208
energy malnutrition 132
diagnosis of 132
intake 148, 151
dietary 145
requirement 121, 155, 229
restriction 148
Proton pump inhibitors 175
Pump controlled techniques 226
Pyridoxine 152
hydrochloride 150
R
Radiation enteritis 224
Radiotherapy 237
Randomized controlled trials 21
Reactive oxygen species 255
Recommended daily allowance 93, 257
Refeeding syndrome 5, 12, 14, 34, 34t, 70, 228
risk of 80, 119
Renal disease 144
Renal failure 101, 210
Renal replacement therapy 56, 144
Respiratory distress syndrome, acute 157, 266
Respiratory failure 157, 101, 210
Retinol 134, 150
Riboflavin 95, 150, 152, 204
Ribonucleic acid 258
Roux-en-y gastric bypass 179
laparoscopic 180
S
Selenium 109, 122, 134, 150, 155, 256, 257
supplementation 256
Sensory stimuli 116
Sepsis 80, 102, 211
acute phase of 106, 107
control 168
shock, severe 105, 108, 109
Septic
complications 54
shock, severe 105, 108, 109
Sequential organ failure assessment 52, 159
Serum
albumin 145, 189
lactate 14
levels 79
potassium 49
Short bowel syndrome 16, 173, 224, 228
Short nutritional assessment questionnaire 159
Simple starvation 9
Single bottle system 47
Sinusitis 31, 32
Skin 167
fold thickness 145
Sleeve gastrectomy, laparoscopic 180
Small intestinal bacterial overgrowth, risk of 130
Society of Critical Care Medicine 28, 221, 266
Sodium 80, 85, 147, 149, 150, 152, 229
levels of 70
Standard parenteral nutrition 47
Standard polymeric formulas 225
Staphylococcus aureus 64
Starvation, pathophysiology of 9
Stearic acid 263
Stearidonic acid 262, 263
Steatosis 102
Stress starvation malnutrition 9
Stroke 213
Sucralfate 35
Superoxide dismutase 255
Supplemental enteral nutrition 129
Surgery 265
Surgical intensive care unit 266
Swallowing, assessment of 116
Systemic inflammatory response syndrome 162, 255
T
Teduglutide 175
Theophylline 35
Thiamine 95, 109, 152, 163, 204
deficiency 70
hydrochloride 150
Thioredoxin 255
Three-chamber bags 48
Thrombophlebitis 44
Thyroid 11
stimulating hormone 11
Tiger tube 225
Total parenteral nutrition 15, 258
Total protein 284
Trace elements 42, 54, 61t, 115, 150, 151, 155, 230
deficiency 60, 168
requirements 122t
Tracheoesophageal fistula 227
Trans-fatty acids 263
Transitional feeding 227
Transnasal access 21
Transthyretin 189
Trauma 211
index 78
Triceps skinfold thickness 284
Tube
blockage 227
clogging 31, 34
displacement 31
malposition 31, 33
Tumor 94
necrosis factor 111, 195
Tunneled central venous catheter 230
Two-chamber bags 48
U
Ulceration 33
V
Vaccenic acid 263
Venous access devices 45
Visceral protein 284
Vision 249
Vitamin 19, 42, 54, 56, 94, 109, 149, 150, 151, 155, 168, 169, 230
A 94, 95, 122, 152, 155, 174, 204, 256258
B complex 155
B1 79
C 94, 95, 109, 122, 152, 155, 189, 204, 256, 258, 259
D 109, 134, 147, 152, 174, 189, 204
requirement 230
E 95, 122, 152, 174, 256, 258, 259
supplementation 259
K 134, 150, 152, 174
requirements 122t, 204
role of 109
Vocal cord dysfunction 33
Vomiting 32, 101, 228
W
Weak respiratory muscles 205
Weight loss, causes of 194
Wound
acute 91
care 169
chronic 91, 92
healing 91, 94, 94t, 95t
surgical 91
types of 91
Z
Zinc 95, 109, 115, 122, 134, 150, 152, 155, 256, 257
deficiencies 163
supplementation 258
×
Chapter Notes

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Principles in Critical Care Nutrition
Principles in Critical Care Nutrition
Editors Subhal Dixit MBBS MD FICCM FCCM FICP Consultant Critical Care and Director ICU Sanjeevan and Manohar Joshi Memorial Hospitals Pune, Maharashtra, India Kapil Zirpe MBBS MD (Chest) FICCM FCCM Director Neurotrauma Unit Ruby Hall Clinic Pune, Maharashtra, India Khalid Khatib MD (Medicine) Professor Department of Medicine Smt Kashibai Navale Medical College Pune, Maharashtra, India Section Editors Anshu Joshi MBBS PGDGM PGDM Regional Manager Medical Affairs Abbott Nutrition International – India Chittorgarh, Rajasthan, India Sadanand Kulkarni MBBS MD (Clinical Microbiology) Vice President Medical Affairs and Clinical Research Fresenius Kabi India Pvt Ltd. Pune, Maharashtra, India Foreword Shirish Prayag
Jaypee Brothers Medical Publishers (P) Ltd
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Principles in Critical Care Nutrition
First Edition: 2019
9789386261021
Printed at
Contributors Foreword
It is with a great degree of pleasure and pride that I am writing this foreword.
Although isolated foci of excellence in critical care existed in India in individual centers 25 years ago, there was no organized professional activity. Training in this evolving field was nonexistent. It is then in 1992, that organized platform for discussions in small group was started in Pune, under the banner of Critical Care Society. In 1993, the Indian Society of Critical Care Medicine [ISCCM] was born, and this local activity in Pune merged with ISCCM as its first city branch.
Over the past 25 years of activity, Pune branch of ISCCM has remained in the forefront of academic activities of ISCCM and the critical care world in India. There have been innumerable activities, and all this has led to Pune being awarded the Best Branch award for many consecutive years.
We have always believed in giving something different, unique and enriching to the world of critical care in India. The workbooks for various workshops are therefore a part of this continuing process of dynamic output from this branch.
The field of nutrition symbolizes the robust growth as well as the dilemmas of the field of critical care medicine. Initially, we spent a significant period of time trying to understand the necessity and importance of nutritional supplementation. The pendulum then swung in the direction of “Total” parenteral nutrition. We then moved towards the rightful importance of enteral nutrition, and appropriate support from other components in appropriate situations.
All this and much more is discussed in this important workbook. The contributions have come from many international and national specialists of repute. The topics that are discussed are extremely practical, relevant and important for day-to-day practice to all those who spend majority of their time with clinical work.
The book fulfils an important lacuna in the field of critical care medicine in India. That void was due to the need of a practical workbook in the field of clinical nutrition for critically- ill patients. I am sure that practicing Intensivists will find it a worthwhile addition.
I look forward to ISCCM Pune Branch continuing to make many such praiseworthy contributions.
Shirish Prayag MD FCCM
Director, Critical Care
Prayag Hospital
Pune, Maharashtra, India
Preface
We are delighted to write the preface for the first ever book on Principles in Critical Care Nutrition under the umbrella of Indian Society of Critical Care Medicine (ISCCM), Pune Branch.
For long, the need of a book that covers the foundation of nutrition science and discusses various aspects of nutrition care has been identified. What was needed was a compilation of information gathered from experts on nutrition, various technology involved and new approaches to nutritional care in medicine to be put on a common platform.
Modern medicine accepts the role of nutrition in a healthy person's life and particularly highlights the nutrition management of critically-ill patients as much as its important in planning antibiotics and ventilator strategies.
Nutrition support helps to shorten the stay of critically-ill patients but also reduces mortality and morbidity.
With this in mind, the Silver Jubilee Year Celebration of ISCCM-Pune was an appropriate occasion to bring out such a book that can be useful for medical practitioners, nutritionists, intensivists and other fields of medicine.
This book has been written keeping in mind the Indian medical care scenario and covers wide range of aspects right from the planning and monitoring, delivery of nutrition and covers all major clinical conditions requiring nutrition support.
The book has been divided into eight sections comprising of 43 chapters. Each section contains evidence-based information emphasizing the science behind it, and is intended for professionals who already possesses a basic understanding of the principles of nutrition in wellness and disease. The layout of the chapter includes illustrations, figures, tables and an exhaustive reference list for further information.
The authors of the chapters are national and international experts in their subjects. It has been a challenging task to select and compile the relevant information.
In the words of Confucius, “The essence of knowledge is that, having acquired it, one must apply it.” In spite of research-based evidence that nutrition has tremendous potential to improve human well-being, in India there yet exists a gap between nutrition knowledge and its full exploitation for human betterment. The goal of the book is to bridge this gap.
We received wide encouragement and support from all our contributors, editorial board, committee members, M/s Jaypee Brothers Medical Publishers, and ISCCM office in putting tremendous effort to compile the chapters in due time.
It is our hope and expectation that this book will provide an effective learning experience and serve as a reference resource for all health professionals leading to improved patient care.
Subhal Dixit
Kapil Zirpe
Khalid Khatib
Acknowledgments
On behalf of the Indian Society of Critical Care Medicine (ISCCM), Pune branch, we sincerely appreciate the contribution of each and every author for timely completing their chapters. Everyone's contribution has added more credibility to Principles in Critical Care Nutrition.
We thank you for your continued trust on us and look forward to doing such activity in the future.
We appreciate the contribution of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for tireless follow-up and finishing the book within the timeline.