QBank Fortnightly Newsletter
VOLUME: 1, ISSUE: 5
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 |
|Continuation phase HRE |
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)
|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|
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|
|C2r||Recurrent varicose veins|
|Changes in skin and subcutaneous tissues secondary to chronic venous disease: Pigmentation or eczemaLipodermatosclerosis or atrophie blanche Corona phlebectatica|
|C6||Active venous ulcer|
|C6r||Recurrent active venous ulcer|
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