QBank Fortnightly Newsletter

VOLUME: 1, ISSUE: 5

Hello!

In our 5th issue, we bring some more updates from the world of Qbank based on a couple of important recent updates.

Please have a look. 

1. NTEP 2020 recommendation

(Updated- MCQ id: MB8289. Pearl id: 1720)

As per the latest recommendations from the National Tuberculosis Elimination Programme 2020 (NTEP 2020), the treatment of TB will be based primarily on drug susceptibility testing. It is irrespective of new cases, previously treated cases or recurrent TB cases. 

All cases of TB will be treated with Drug Sensitive TB Regimen, as long as the patient is sensitive to isoniazid and rifampicin. (No classification into the category I or II)

Type of TB Case	Intensive Phase	Continuation Phase
New and previously treated cases (H and R sensitive)	2 H R Z E	4 H R E

H: Isoniazid; R: Rifampicin; E: Ethambutol; Z: Pyrazinamide

Daily Dose Schedule for Adults (as per weight bands) (MCQ id: MD0983)

Weight category	No. of tablets	No. of tablets
	Intensive phase HRZE (dose: 75/150/400/275)	Continuation phase HRE  (dose: 75/150/275)
25-34 kg	2	2
35-49 kg	3	3
50-64 kg	4	4
65-75 kg	5	5
>75 kg	6	6

Classification based on drug resistance (DR) (MCQ id: MA2040)

• Mono-resistant (MR): Resistant to one 1st line anti-TB drug only.
• Poly-Drug Resistant (PDR): resistant to more than one 1st line anti-TB drug, other than Rifampicin. 
• Rifampicin Resistant (RR): Resistant to rifampicin with or without resistance to other drugs. Patients, who have rifampicin resistance, should be managed as if they are an MDR TB case.
• Multi-Drug Resistant (MDR): Resistant to both isoniazid and rifampicin.
• Extensively Drug-Resistant (XDR): Resistant to a fluoroquinolone (ofloxacin, levofloxacin, or moxifloxacin) and a second-line injectable anti TB drug (kanamycin, amikacin, or capreomycin).

Standard DR TB regimen (MCQ id: MC7007, MB8290, MB8291)

Regimen class	Drugs	Comments
H mono-resistant/ poly-drug resistant TB regimen	Lfx R E Z for 6 months	6 months long. Oral drugs only
Shorter MDR TB regimen	Intensive Phase: Mfx Km/Am Eto Cfz Z H E for 4-6 months Continuation phase: Mfx Cfz Z E for 5 months	9-11 months long. Injectables used in the intensive phase.
Longer MDR TB regimen	Bdq (6 months) Lfx Lzd Cfz Cs for 18-20 months	18-20 months long Oral drugs only. This regimen is used for XDR TB patients for 20 months.

FQ: Fluoroquinolone; SLI: Second Line Injectable; PLHIV: People Living with HIV; Lfx: Levofloxacin; H: Isoniazid; R: Rifampicin; E: Ethambutol; Z: Pyrazinamide; Mfx: Moxifloxacin; Km: Kanamycin; Am: Amikacin; Eto: Ethionamide; Cfz: Clofazimine; Bdq: Bedaquiline; Lzd: Linezolid; Cs: Cycloserine

Criteria for patients to receive standard Drug Resistant TB regimen

Standard Drug-Resistant TB regimen	Inclusion criteria	Exclusion criteria
H mono-resistant/poly-drug resistant TB regimen	Isoniazid resistant TB with rifampicin sensitive	No specific criteria
Shorter MDR TB regimen	Patient with rifampicin-resistant pulmonary or extra-pulmonary TB	Non-drug sensitivity test-based criteria: Pregnancy, Any extrapulmonary disease in PLHIV, Disseminated meningeal or central nervous system TB, Intolerance to any drug in the shorter MDR TB regimen Drug sensitivity test-based criteria: If DST/DRT result for FQ or SLI is resistant (XDR TB), the presence of InhA mutation, Resistant to Z
Longer MDR TB regimen	Patients in whom shorter MDR TB regimen cannot be considered due to any reason	None

Ref: http://www.tbcindia.nic.in/WriteReadData/NTEPTrainingModules1to4.pdf

2. CEAP Classification 2020

(MCQ id: MB7659, MC7490) (Updated pearl id: 2292,1747)

The American Venous Forum has revised the CEAP classification system for Chronic Venous Disease. The ‘C’ (Clinical class) component has new inclusions, as highlighted in the table below. The Etiology (‘E’), Anatomical distribution (‘A’) and Pathophysiology (‘P’) based classes remain the same.

Currently, the clinical categories are recognized as follows: 

C0	No visible or palpable signs of venous disease
C1	Telangiectasis or reticular veins
C2	Varicose veins
C2r	Recurrent varicose veins
C3	Edema
C4 C4aC4bC4c	Changes in skin and subcutaneous tissues secondary to chronic venous disease: Pigmentation or eczemaLipodermatosclerosis or atrophie blanche Corona phlebectatica
C5	Healed
C6	Active venous ulcer
C6r	Recurrent active venous ulcer

Ref: https://www.jvsvenous.org/article/S2213-333X(20)30063-9/fulltext

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