SlideShare a Scribd company logo
1 of 78
ETHICAL & REGULATORY ASPECTS
OF HUMAN SUBJECTS
LEARNING OBJECTIVES
• Become aware of the National Ethical Guidelines for
Biomedical and Health Research involving Human
participant and children (ICMR) 2017.
• Understand the essential requirements for current ethical
considerations for conducting clinical trial in India
Upon completion of this session, the trainees will:
WHAT WILL WE LEARN IN THIS SESSION?
• National ethical guidelines for biomedical and health
research on human participants and children 2017 by ICMR
• Some Related Regulations
INDIAN COUNCIL OF MEDICAL RESEARCH (ICMR)
GUIDELINES
NATIONAL ETHICAL GUIDELINES FOR BIOMEDICAL AND HEALTH
RESEARCH INVOLVING HUMAN PARTICIPANTS (2017)
SECTION 1:
STATEMENT OF GENERAL PRINCIPLES
SECTION 1: STATEMENT OF GENERAL PRINCIPLES
SECTION 2:
GENERAL ETHICAL ISSUES
SECTION 2: GENERAL ETHICAL ISSUES
BENEFIT-RISK ASSESSMENT
CATEGORISATION BASED ON RISK
INFORMED CONSENT PROCESS
INFORMED CONSENT PROCESS
DISTRIBUTIVE JUSTICE
DISTRIBUTIVE JUSTICE
PAYMENT AND COMPENSATION
PAYMENT AND COMPENSATION
PAYMENT AND COMPENSATION
CONFLICT OF INTEREST
SELECTION OF VULNERABLE AND SPECIAL GROUPS
AS RESEARCH PARTICIPANTS
OTHER GENERAL ETHICAL ISSUES
SECTION 3:
RESPONSIBLE CONDUCT OF RESEARCH
RESPONSIBLE CONDUCT OF RESEARCH
WHO REGULATES CLINICAL TRIALS FOR
NEW DRUGS IN INDIA?
DATA ACQUISITION, MANAGEMENT, SHARING &
OWNERSHIP
REVIEWING AND REPORTING RESEARCH
RESPONSIBLE AUTHORSHIP AND PUBLICATION
POLICIES FOR HANDLING RESEARCH
MISCONDUCT
Fabrication, falsification and plagiarism
REGISTRATION WITH CLINICAL TRIAL REGISTRY
OF INDIA (CTRI)
COLLABORATIVE RESEARCH
COLLABORATIVE RESEARCH
COLLABORATIVE RESEARCH
SECTION 4:
ETHICS REVIEW PROCEDURES
SECTION 4:
ETHICAL REVIEW PROCEDURES
ETHICS COMMITTEE (EC): ELEMENTS
COMPOSITION OF AN EC
SPECIAL SITUATIONS: ETHICS REVIEW
ROLE OF ETHICS COMMITTEE
TYPES OF REVIEW
DECISION MAKING
DIVISION OF RESPONSIBILITY FOR REVIEW
CONTINUING REVIEW
SITE MONITORING
RECORD KEEPING AND ARCHIVING
REGISTRATION OF EC
ACCREDITATION OF ETHICS COMMITTEE
SECTION 5:
INFORMED CONSENT PROCESS
INFORMED CONSENT PROCEDURES
TYPES OF CONSENT DOCUMENTED
AUDIO-VISUAL RECORDING OF CONSENT
SECTION 6:
VULNERABILITY
VULNERABILITY
VULNERABILITY – INCLUSION CRITERIA
SECTION 7:
CLINICAL TRIALS OF DRUGS AND OTHER INTERVENTIONS
CLINICAL TRIALS
CLINICAL TRIALS
CLINICAL TRIALS
CLINICAL TRIALS
SECTION 8:
PUBLIC HEALTH RESEARCH
SECTION 8:
PUBLIC HEALTH RESEARCH
SECTION 9:
SOCIAL AND BEHAVIOURAL SCIENCES RESEARCH
FOR HEALTH
SOCIAL AND BEHAVIOURAL SCIENCES RESEARCH
FOR HEALTH
SECTION 10:
HUMAN GENETICS TESTING AND RESEARCH
HUMAN GENETICS TESTING AND RESEARCH
SECTION 11:
BIOLOGICAL MATERIALS, BIO BANKING AND DATASETS
BIOLOGICAL MATERIALS, BIO BANKING & DATA
SETS
CONSENT OPTIONS
SECTION 12:
RESEARCH DURING HUMANITARIAN EMERGENCIES
AND DISASTERS
HUMANITARIAN EMERGENCIES & DISASTERS
RESEARCH ON CHILDREN
RESEARCH ON CHILDREN
ASSENT
CHILD’S REFUSAL
SAMPLE COLLECTION
RECAP
1. Which are the latest ethical guidelines for human research released by ICMR
and when?
National ethical guidelines for biomedical and health research involving human
participants and for children 2017
2. Is it mandatory to register the clinical trials in CTRI
As of now it is mandatory to register the regulatory clinical trials in CTRI.
3. Is it mandatory for ECs to register?
Yes, it is mandatory to seek CDSCO registration for ECs reviewing regulatory
clinical trials & DHR for others
RECAP
4. Should only written and signed informed consent form be obtained?
As the situation may require oral, audio or A/V consent may be taken.
5. Can deception be used with regard to informed consent?
Yes, occasionally in social & behavioural science research.
6. Who owns the biological material/data?
Only the donor
SUMMARY
In this session, we briefly learnt about:
DISCLAIMER
The information within this presentation is based on the presenter’s
expertise and experience and represents the views of the presenter
for the purpose of training.
THANK YOU

More Related Content

What's hot

Clinical trials its types and designs
Clinical trials  its types and designsClinical trials  its types and designs
Clinical trials its types and designsDevesh Aggarwal
 
Ethics of Medical Researches
Ethics of Medical ResearchesEthics of Medical Researches
Ethics of Medical ResearchesAhmed-Refat Refat
 
Institutional review board by akshdeep sharma
Institutional review board by akshdeep sharmaInstitutional review board by akshdeep sharma
Institutional review board by akshdeep sharmaAkshdeep Sharma
 
Schedule Y by akshdeep sharma
Schedule Y by akshdeep sharmaSchedule Y by akshdeep sharma
Schedule Y by akshdeep sharmaAkshdeep Sharma
 
Regulations for drug approval in USA, E.U & India
Regulations for drug approval in USA, E.U & IndiaRegulations for drug approval in USA, E.U & India
Regulations for drug approval in USA, E.U & IndiaDr. Pankaj Bablani
 
ETHICAL GUIDELINES FOR BIOMEDICAL RESEARCH ON HUMAN PARTICIPANTS
ETHICAL GUIDELINES FOR BIOMEDICAL RESEARCH ON HUMAN PARTICIPANTSETHICAL GUIDELINES FOR BIOMEDICAL RESEARCH ON HUMAN PARTICIPANTS
ETHICAL GUIDELINES FOR BIOMEDICAL RESEARCH ON HUMAN PARTICIPANTSjyothibhat21
 
Informed consent process and procedures
Informed consent process and proceduresInformed consent process and procedures
Informed consent process and proceduresSiddu K M
 
Roles and responsibility of a CRC
Roles and responsibility of a CRCRoles and responsibility of a CRC
Roles and responsibility of a CRCJagriti Bansal
 
Informed consent process
Informed consent processInformed consent process
Informed consent processGhiath Alahmad
 
Investigational new drug (IND)
Investigational new drug (IND)Investigational new drug (IND)
Investigational new drug (IND)Manish Rajput
 
Informed consent process
Informed consent processInformed consent process
Informed consent processDeveraneniVinay
 
protocol writing in clinical research
protocol writing in clinical research protocol writing in clinical research
protocol writing in clinical research pavithra vinayak
 
Preparation of Clinical Trial Protocol of India.
Preparation of Clinical Trial Protocol of India.Preparation of Clinical Trial Protocol of India.
Preparation of Clinical Trial Protocol of India.Aakashdeep Raval
 
Active and passive survillance
Active and passive survillanceActive and passive survillance
Active and passive survillanceRamavath Aruna
 

What's hot (20)

Clinical trials its types and designs
Clinical trials  its types and designsClinical trials  its types and designs
Clinical trials its types and designs
 
Anjali icmr ppt
Anjali icmr pptAnjali icmr ppt
Anjali icmr ppt
 
Ethics of Medical Researches
Ethics of Medical ResearchesEthics of Medical Researches
Ethics of Medical Researches
 
Institutional review board by akshdeep sharma
Institutional review board by akshdeep sharmaInstitutional review board by akshdeep sharma
Institutional review board by akshdeep sharma
 
Schedule Y by akshdeep sharma
Schedule Y by akshdeep sharmaSchedule Y by akshdeep sharma
Schedule Y by akshdeep sharma
 
Regulations for drug approval in USA, E.U & India
Regulations for drug approval in USA, E.U & IndiaRegulations for drug approval in USA, E.U & India
Regulations for drug approval in USA, E.U & India
 
ETHICAL GUIDELINES FOR BIOMEDICAL RESEARCH ON HUMAN PARTICIPANTS
ETHICAL GUIDELINES FOR BIOMEDICAL RESEARCH ON HUMAN PARTICIPANTSETHICAL GUIDELINES FOR BIOMEDICAL RESEARCH ON HUMAN PARTICIPANTS
ETHICAL GUIDELINES FOR BIOMEDICAL RESEARCH ON HUMAN PARTICIPANTS
 
Informed consent process and procedures
Informed consent process and proceduresInformed consent process and procedures
Informed consent process and procedures
 
ICH GCP
ICH GCPICH GCP
ICH GCP
 
Roles and responsibility of a CRC
Roles and responsibility of a CRCRoles and responsibility of a CRC
Roles and responsibility of a CRC
 
Clinical trials
Clinical trialsClinical trials
Clinical trials
 
Informed consent process
Informed consent processInformed consent process
Informed consent process
 
Schedule y
Schedule ySchedule y
Schedule y
 
Investigational new drug (IND)
Investigational new drug (IND)Investigational new drug (IND)
Investigational new drug (IND)
 
Informed consent process
Informed consent processInformed consent process
Informed consent process
 
Inform consent , M k sharma
Inform consent , M k sharmaInform consent , M k sharma
Inform consent , M k sharma
 
protocol writing in clinical research
protocol writing in clinical research protocol writing in clinical research
protocol writing in clinical research
 
Preparation of Clinical Trial Protocol of India.
Preparation of Clinical Trial Protocol of India.Preparation of Clinical Trial Protocol of India.
Preparation of Clinical Trial Protocol of India.
 
Active and passive survillance
Active and passive survillanceActive and passive survillance
Active and passive survillance
 
ICH-GCP Guidelines
ICH-GCP GuidelinesICH-GCP Guidelines
ICH-GCP Guidelines
 

Similar to Ethical Guidelines.pptx

Research ethics in human experiment
Research   ethics  in  human experimentResearch   ethics  in  human experiment
Research ethics in human experimentSupriyaCS12
 
S1 KAVANA BB MBAT-Goos clinical Pratice.pptx
S1 KAVANA BB MBAT-Goos clinical Pratice.pptxS1 KAVANA BB MBAT-Goos clinical Pratice.pptx
S1 KAVANA BB MBAT-Goos clinical Pratice.pptxVenkatesan R - 6369851191
 
EVB-Evidence Based Practice- principles,purposes,value
EVB-Evidence Based Practice- principles,purposes,valueEVB-Evidence Based Practice- principles,purposes,value
EVB-Evidence Based Practice- principles,purposes,valuechristenashantaram
 
Good Clinical Practice By: Swapnil L. patil
Good Clinical Practice By: Swapnil L. patilGood Clinical Practice By: Swapnil L. patil
Good Clinical Practice By: Swapnil L. patilSwapnil Patil
 
The declaration of helsinki by akshdeep sharma
The declaration of helsinki by akshdeep sharmaThe declaration of helsinki by akshdeep sharma
The declaration of helsinki by akshdeep sharmaAkshdeep Sharma
 
History ethical guide lines to clinical trial
History ethical guide lines to clinical trialHistory ethical guide lines to clinical trial
History ethical guide lines to clinical trialAnju Thejkumar
 
Good clinical practice by vijay
Good clinical practice by vijayGood clinical practice by vijay
Good clinical practice by vijayvijaypv
 
Research ethics & scientific misconduct
Research ethics & scientific misconductResearch ethics & scientific misconduct
Research ethics & scientific misconductDr Ghaiath Hussein
 
Ethical issues in medical research
Ethical issues in medical researchEthical issues in medical research
Ethical issues in medical researchDr. Manoj Kumbhare
 
EMPHNET-PHE Course: Module seven ethical issues in public health research& in...
EMPHNET-PHE Course: Module seven ethical issues in public health research& in...EMPHNET-PHE Course: Module seven ethical issues in public health research& in...
EMPHNET-PHE Course: Module seven ethical issues in public health research& in...Dr Ghaiath Hussein
 
Hand book of good clinical research practice
Hand book of good clinical research practiceHand book of good clinical research practice
Hand book of good clinical research practicePTCnetwork
 
GCP and EC Training (2).ppt
GCP and EC Training (2).pptGCP and EC Training (2).ppt
GCP and EC Training (2).pptgayathrivd1
 
Healthcare Ethics
Healthcare Ethics Healthcare Ethics
Healthcare Ethics Aminu Kende
 

Similar to Ethical Guidelines.pptx (20)

Research ethics in human experiment
Research   ethics  in  human experimentResearch   ethics  in  human experiment
Research ethics in human experiment
 
S1 KAVANA BB MBAT-Goos clinical Pratice.pptx
S1 KAVANA BB MBAT-Goos clinical Pratice.pptxS1 KAVANA BB MBAT-Goos clinical Pratice.pptx
S1 KAVANA BB MBAT-Goos clinical Pratice.pptx
 
EVB-Evidence Based Practice- principles,purposes,value
EVB-Evidence Based Practice- principles,purposes,valueEVB-Evidence Based Practice- principles,purposes,value
EVB-Evidence Based Practice- principles,purposes,value
 
Principles of icmr
Principles  of icmrPrinciples  of icmr
Principles of icmr
 
HM404 Ab120916 ch14
HM404 Ab120916 ch14HM404 Ab120916 ch14
HM404 Ab120916 ch14
 
Good Clinical Practice By: Swapnil L. patil
Good Clinical Practice By: Swapnil L. patilGood Clinical Practice By: Swapnil L. patil
Good Clinical Practice By: Swapnil L. patil
 
The declaration of helsinki by akshdeep sharma
The declaration of helsinki by akshdeep sharmaThe declaration of helsinki by akshdeep sharma
The declaration of helsinki by akshdeep sharma
 
Gcp 2013
Gcp 2013Gcp 2013
Gcp 2013
 
History ethical guide lines to clinical trial
History ethical guide lines to clinical trialHistory ethical guide lines to clinical trial
History ethical guide lines to clinical trial
 
Good clinical practice by vijay
Good clinical practice by vijayGood clinical practice by vijay
Good clinical practice by vijay
 
Thalidomide tragedy
Thalidomide tragedyThalidomide tragedy
Thalidomide tragedy
 
Research ethics & scientific misconduct
Research ethics & scientific misconductResearch ethics & scientific misconduct
Research ethics & scientific misconduct
 
Research Ethics
Research EthicsResearch Ethics
Research Ethics
 
Ethical issues in medical research
Ethical issues in medical researchEthical issues in medical research
Ethical issues in medical research
 
EMPHNET-PHE Course: Module seven ethical issues in public health research& in...
EMPHNET-PHE Course: Module seven ethical issues in public health research& in...EMPHNET-PHE Course: Module seven ethical issues in public health research& in...
EMPHNET-PHE Course: Module seven ethical issues in public health research& in...
 
Medical Ethics With Research
Medical Ethics With ResearchMedical Ethics With Research
Medical Ethics With Research
 
Topic7 research ethics (1)
Topic7 research ethics (1)Topic7 research ethics (1)
Topic7 research ethics (1)
 
Hand book of good clinical research practice
Hand book of good clinical research practiceHand book of good clinical research practice
Hand book of good clinical research practice
 
GCP and EC Training (2).ppt
GCP and EC Training (2).pptGCP and EC Training (2).ppt
GCP and EC Training (2).ppt
 
Healthcare Ethics
Healthcare Ethics Healthcare Ethics
Healthcare Ethics
 

More from Dr. Sreedhar Rao

academicperformanceindicatorsapi-190123081235.pdf
academicperformanceindicatorsapi-190123081235.pdfacademicperformanceindicatorsapi-190123081235.pdf
academicperformanceindicatorsapi-190123081235.pdfDr. Sreedhar Rao
 
Assessment & Accreditation Process of NAAC in Revised Accreditation Framework...
Assessment & Accreditation Process of NAAC in Revised Accreditation Framework...Assessment & Accreditation Process of NAAC in Revised Accreditation Framework...
Assessment & Accreditation Process of NAAC in Revised Accreditation Framework...Dr. Sreedhar Rao
 
CCIM Regulation 18 July 2012
CCIM Regulation 18 July 2012CCIM Regulation 18 July 2012
CCIM Regulation 18 July 2012Dr. Sreedhar Rao
 
AYUSH-Report of Steering Committee on AYUSH for 12th Five Year Plan
AYUSH-Report of Steering Committee on AYUSH for 12th Five Year PlanAYUSH-Report of Steering Committee on AYUSH for 12th Five Year Plan
AYUSH-Report of Steering Committee on AYUSH for 12th Five Year PlanDr. Sreedhar Rao
 
AYUSH Funding Opportunities
AYUSH Funding OpportunitiesAYUSH Funding Opportunities
AYUSH Funding OpportunitiesDr. Sreedhar Rao
 
Fundamentals of chest radiology
Fundamentals of chest radiologyFundamentals of chest radiology
Fundamentals of chest radiologyDr. Sreedhar Rao
 

More from Dr. Sreedhar Rao (10)

academicperformanceindicatorsapi-190123081235.pdf
academicperformanceindicatorsapi-190123081235.pdfacademicperformanceindicatorsapi-190123081235.pdf
academicperformanceindicatorsapi-190123081235.pdf
 
Assessment & Accreditation Process of NAAC in Revised Accreditation Framework...
Assessment & Accreditation Process of NAAC in Revised Accreditation Framework...Assessment & Accreditation Process of NAAC in Revised Accreditation Framework...
Assessment & Accreditation Process of NAAC in Revised Accreditation Framework...
 
CCIM Regulation 18 July 2012
CCIM Regulation 18 July 2012CCIM Regulation 18 July 2012
CCIM Regulation 18 July 2012
 
Basics of ECG
Basics of ECGBasics of ECG
Basics of ECG
 
AYUSH-Report of Steering Committee on AYUSH for 12th Five Year Plan
AYUSH-Report of Steering Committee on AYUSH for 12th Five Year PlanAYUSH-Report of Steering Committee on AYUSH for 12th Five Year Plan
AYUSH-Report of Steering Committee on AYUSH for 12th Five Year Plan
 
AYUSH Funding Opportunities
AYUSH Funding OpportunitiesAYUSH Funding Opportunities
AYUSH Funding Opportunities
 
Basics of Ultrasound
Basics of UltrasoundBasics of Ultrasound
Basics of Ultrasound
 
Basics of MRI
Basics of MRIBasics of MRI
Basics of MRI
 
Basics of CT Scan
Basics of CT ScanBasics of CT Scan
Basics of CT Scan
 
Fundamentals of chest radiology
Fundamentals of chest radiologyFundamentals of chest radiology
Fundamentals of chest radiology
 

Recently uploaded

Call Girl Bangalore Nandini 7001305949 Independent Escort Service Bangalore
Call Girl Bangalore Nandini 7001305949 Independent Escort Service BangaloreCall Girl Bangalore Nandini 7001305949 Independent Escort Service Bangalore
Call Girl Bangalore Nandini 7001305949 Independent Escort Service Bangalorenarwatsonia7
 
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...
College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...
College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...Miss joya
 
Call Girls Budhwar Peth 7001305949 All Area Service COD available Any Time
Call Girls Budhwar Peth 7001305949 All Area Service COD available Any TimeCall Girls Budhwar Peth 7001305949 All Area Service COD available Any Time
Call Girls Budhwar Peth 7001305949 All Area Service COD available Any Timevijaych2041
 
Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...
Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...
Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...narwatsonia7
 
Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...
Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...
Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...narwatsonia7
 
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...
VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...
VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...Miss joya
 
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service JaipurHigh Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipurparulsinha
 
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowSonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowRiya Pathan
 
VIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service Mumbai
VIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service MumbaiVIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service Mumbai
VIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service Mumbaisonalikaur4
 
Call Girls Service in Bommanahalli - 7001305949 with real photos and phone nu...
Call Girls Service in Bommanahalli - 7001305949 with real photos and phone nu...Call Girls Service in Bommanahalli - 7001305949 with real photos and phone nu...
Call Girls Service in Bommanahalli - 7001305949 with real photos and phone nu...narwatsonia7
 
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original Photos
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original PhotosCall Girl Service Bidadi - For 7001305949 Cheap & Best with original Photos
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original Photosnarwatsonia7
 
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...Miss joya
 
Call Girls Thane Just Call 9910780858 Get High Class Call Girls Service
Call Girls Thane Just Call 9910780858 Get High Class Call Girls ServiceCall Girls Thane Just Call 9910780858 Get High Class Call Girls Service
Call Girls Thane Just Call 9910780858 Get High Class Call Girls Servicesonalikaur4
 
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service Chennai
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service ChennaiCall Girls Service Chennai Jiya 7001305949 Independent Escort Service Chennai
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service ChennaiNehru place Escorts
 
Ahmedabad Call Girls CG Road 🔝9907093804 Short 1500 💋 Night 6000
Ahmedabad Call Girls CG Road 🔝9907093804  Short 1500  💋 Night 6000Ahmedabad Call Girls CG Road 🔝9907093804  Short 1500  💋 Night 6000
Ahmedabad Call Girls CG Road 🔝9907093804 Short 1500 💋 Night 6000aliya bhat
 
Asthma Review - GINA guidelines summary 2024
Asthma Review - GINA guidelines summary 2024Asthma Review - GINA guidelines summary 2024
Asthma Review - GINA guidelines summary 2024Gabriel Guevara MD
 

Recently uploaded (20)

Call Girl Bangalore Nandini 7001305949 Independent Escort Service Bangalore
Call Girl Bangalore Nandini 7001305949 Independent Escort Service BangaloreCall Girl Bangalore Nandini 7001305949 Independent Escort Service Bangalore
Call Girl Bangalore Nandini 7001305949 Independent Escort Service Bangalore
 
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
 
College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...
College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...
College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...
 
Call Girls Budhwar Peth 7001305949 All Area Service COD available Any Time
Call Girls Budhwar Peth 7001305949 All Area Service COD available Any TimeCall Girls Budhwar Peth 7001305949 All Area Service COD available Any Time
Call Girls Budhwar Peth 7001305949 All Area Service COD available Any Time
 
Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...
Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...
Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...
 
Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...
Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...
Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...
 
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
 
VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...
VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...
VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...
 
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service JaipurHigh Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
 
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowSonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
 
VIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service Mumbai
VIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service MumbaiVIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service Mumbai
VIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service Mumbai
 
Call Girls Service in Bommanahalli - 7001305949 with real photos and phone nu...
Call Girls Service in Bommanahalli - 7001305949 with real photos and phone nu...Call Girls Service in Bommanahalli - 7001305949 with real photos and phone nu...
Call Girls Service in Bommanahalli - 7001305949 with real photos and phone nu...
 
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original Photos
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original PhotosCall Girl Service Bidadi - For 7001305949 Cheap & Best with original Photos
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original Photos
 
Escort Service Call Girls In Sarita Vihar,, 99530°56974 Delhi NCR
Escort Service Call Girls In Sarita Vihar,, 99530°56974 Delhi NCREscort Service Call Girls In Sarita Vihar,, 99530°56974 Delhi NCR
Escort Service Call Girls In Sarita Vihar,, 99530°56974 Delhi NCR
 
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
 
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
 
Call Girls Thane Just Call 9910780858 Get High Class Call Girls Service
Call Girls Thane Just Call 9910780858 Get High Class Call Girls ServiceCall Girls Thane Just Call 9910780858 Get High Class Call Girls Service
Call Girls Thane Just Call 9910780858 Get High Class Call Girls Service
 
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service Chennai
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service ChennaiCall Girls Service Chennai Jiya 7001305949 Independent Escort Service Chennai
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service Chennai
 
Ahmedabad Call Girls CG Road 🔝9907093804 Short 1500 💋 Night 6000
Ahmedabad Call Girls CG Road 🔝9907093804  Short 1500  💋 Night 6000Ahmedabad Call Girls CG Road 🔝9907093804  Short 1500  💋 Night 6000
Ahmedabad Call Girls CG Road 🔝9907093804 Short 1500 💋 Night 6000
 
Asthma Review - GINA guidelines summary 2024
Asthma Review - GINA guidelines summary 2024Asthma Review - GINA guidelines summary 2024
Asthma Review - GINA guidelines summary 2024
 

Ethical Guidelines.pptx