QBank Fortnightly Newsletter (VOLUME: 1, ISSUE: 6)

Updates from Robbins & Cotran latest edition and MOHFW.

Hello!

We are back with the next issue of our newsletter. As always, we have brought you a few more new and updated MCQs (and pearls) from the world of Qbank. 

In this issue, we talk about some fascinating topics, from rabies vaccination to ninja stars! 

Have a look. 

1. Rabies vaccination:

MCQ IDs: MD0180, MA7901, MB8304, MC7168. Pearl id: 1725.

Pre-exposure prophylaxis:

• Pre-exposure rabies vaccination consists of three intramuscular (IM) or intradermal (ID) doses given on days 0, 7, and 21 or 28. 
• For adults, the vaccine should always be administered in the deltoid region of the arm; for children less than one year of age, the anterolateral area of the thigh is recommended.

Note: Rabies vaccine should never be administered in the gluteal area. Administration in this manner will result in lower neutralizing antibody titers.

• A booster is recommended if rabies virus neutralizing antibody titers have dropped to less than 0.5 IU/ml.

Post-exposure prophylaxis:

Intramuscular regimen:

• The five-dose (Essen) regimen (1-1-1-1-1) is administered on days 0, 3, 7, 14, and 28, IM, into the deltoid muscle (adults) or anterolateral part of the thigh (children).

Intradermal regimen: 

• The Updated Thai Red Cross Regimen (2-2-2-0-2) is administered on days 0, 3, 7, and 28, ID, on two sites (one on each deltoid area).

Rabies Immunoglobulin (RIG):

RIG should be administered to all category three III exposures (along with category II and III exposures in immunocompromised individuals).  

Note: For exposed or re-exposed patients who can document previous complete PrEP or PEP, the following guidelines would be applicable:

• Proper wound management should be done.
• There is no need for the administration of RIG.
• One site ID or IM vaccine administration on days 0 and 3.

Only adequate wound washing would be required in case of re-exposure where the animal bite victim has documented proof of complete PEP or PrEP within the last three months.

People who have previously received full post-exposure treatment with neural tissue vaccines (NTV) or vaccine of unproven potency or cannot document complete PEP or PrEP treatment should be treated as a new case and given full PEP.

Last updated on October 2nd, 2020.

Reference:https://ncdc.gov.in/WriteReadData/linkimages/GuidelinesforRabiesProphylaxis.pdf

 2. Prevention of vertical transmission of Hepatitis B Virus (HBV) (MCQ id: MC0967)

Elimination of HBV infection as a public health threat requires a reduction in the prevalence of hepatitis B surface antigen (HBsAg) to below 0.1% in children five years of age. To achieve this goal, WHO has recently issued guidelines on antiviral prophylaxis in pregnancy to prevent mother-to-child transmission of HBV. 

• Tenofovir prophylaxis should be started in all pregnant women who are testing positive for HBV infection (HBsAg positive) with an HBV DNA ≥ 200,000 IU/mL (≥ 5.3 log10 IU/mL) from the 28th week of pregnancy until birth. This should be in addition to three-dose hepatitis B vaccination in all infants, including a timely birth dose. 

• HBeAg testing should be used where HBV DNA testing is not available, to determine treatment eligibility for tenofovir prophylaxis to prevent mother-to-child transmission of HBV.

Reference: https://apps.who.int/iris/bitstream/handle/10665/333391/9789240002708-eng.pdf?sequence=1&isAllowed=y

3. Efferocytosis (MCQ id- MD5037)

Efferocytosis is a new term introduced in the Robbins and Cotran 10th edition. It is a specialized type of phagocytosis of apoptotic bodies. Here, various ligands bind to the apoptotic bodies and generate an ‘eat me’ signal. These signals are recognized by the receptors of phagocytes, which bind and engulf the bodies.

It is carried out mainly by conventional phagocytes like macrophages and dendritic cells. However, many fibroblast and epithelial cells can also take part in efferocytosis.

Reference- Robbins and Cotran 10th edition, page no 46

 4. Kruppel like factor 2 (KLF 2) and atherosclerosis (MCQ- MD5038)

According to the 10th edition of Robbins and Cotran, production of transcription factors particularly Kruppel like factor 2 (KLF 2) is increased by laminar non-turbulent blood flow. KLF 2, in turn, activates the atheroprotective gene and inactivates the inflammatory gene transcription. This suggests that elevating KLF2 expression may be a novel strategy for the prevention and treatment of atherosclerosis.

Reference -Robbins and Cotran 10th edition, page no 498

As per the recent edition of Robbins and Cotran. In most patients with dilated cardiomyopathy caused by Titin truncating mutation show the histologic appearance like ‘ninja-star’- an enlarged, bizarre, hyperchromatic nuclei.

• 

Reference- Robbins and Cotran 10th edition, Page no 571

——————————————————————————————————————–

Click here to check out the previous issues of newsletters.