Recent Updates for INI-CET Nov ‘26
With INI-CET 2026 approaching, here are some important recent updates covering revised diagnostic and management guidelines, along with newly approved drugs and vaccines.
Contents:
- GTN: Revised FIGO staging and scoring (2026)
- CDSCO approves India’s 1st dengue vaccine
- Management of Paediatric Community-Acquired Pneumonia (2026)
- Risk assessment guidelines on Osteoporosis (NICE 2026)
- Centanafadine: 1st NDSRI approved by FDA for ADHD
- ACOG update on evaluation of postmenopausal bleeding (2026)
- Diagnosis and management of MASLD (NICE 2026)
GTN: Revised FIGO staging and scoring (2026)
FIGO has revised the diagnosis, imaging, staging and risk scoring of GTN.
Diagnosis:
- Potential GTN: hCG plateau (<10% rise/fall over 4 values, ≥3 weeks) or rise (>10% over 3 weekly values, ≥2 weeks).
- Definite GTN: Histopathological diagnosis of choriocarcinoma, PSTT or ETT.
Imaging:
- Suspected low risk: Pelvic USG with Doppler + chest X-ray + CT; count lung lesions ≥1 cm.
- Suspected high risk/choriocarcinoma/lung metastases ≥1 cm: Contrast MRI brain + pelvis, followed by CT chest + abdomen/pelvis.
Staging updates: Stage I now includes cervix; II includes broad ligaments; III includes infradiaphragmatic lymph nodes; IV includes supradiaphragmatic lymph nodes.
Risk score: Low: 0–6 (5–6: higher chemoresistance); high: 7–12; ultra-high: ≥13 (new; poorer prognosis, induction chemotherapy to reduce mortality).
PSTT/ETT: Contrast pelvic MRI is mandatory. Dedicated FIGO I–IV staging replaces WHO risk stratification; stage IV and pregnancy interval ≥48 months are critical prognostic factors.
CDSCO approves India’s 1st dengue vaccine
CDSCO has approved India’s 1st dengue vaccine to strengthen the prevention and control of the dengue virus in India. The vaccine has already received approval in 42 countries and has been prequalified by WHO
Key features:
- Type: Live attenuated (formed by recombinant DNA technology); tetravalent against dengue serotypes 1-4.
- Dose: 2 doses of 0.5 mL each, 3 months apart, SC administration in the upper arm.
- Benefits: Protects against all 4 serotypes and reduces dengue hospitalisation by 90%.
- Adverse effects: Injection-site pain/redness, headache, myalgia, weakness and fever; generally mild to moderate and self-resolving.
- Contraindications: Hypersensitivity to previous dose, immunocompromised individuals, pregnancy and lactation.
Management of Paediatric Community-Acquired Pneumonia (2026)
The 2026 IDSA/PIDS update provides recommendations for managing parapneumonic effusion and empyema in children >3 months.
Management of parapneumonic effusion:
- Small effusion: Observation is preferred over pleural drainage if uncomplicated.
- Moderate-to-large effusion: Chest USG is preferred over CT/MRI to assess size and complexity.
- Cases in which pleural drainage is indicated: Moderate effusions with respiratory distress, large effusions or documented purulent effusions.
Management of pneumonia-associated empyema:
- 1st-line therapy: Pleural drainage with a chest tube and intrapleural fibrinolytics.
- Chest tube: Small-bore (<12 Fr) is preferred over large-bore (>14 Fr).
- Fibrinolytic: tPA alone is preferred over tPA and DNase.
Risk assessment guidelines on Osteoporosis (NICE 2026)
NICE has updated its osteoporosis risk assessment guidelines, replacing the 2012 version, to identify people at risk of major osteoporotic fracture (MOF) earlier.
Key updates:
- 10% DEXA threshold: FRAX or QFracture for 10-year risk of MOF in percentage
- <10%: Reassess after 5 years
- ≥10%: DEXA scan
- Straight-to-DEXA: People >30 years with a previous hip/vertebral fragility fracture, a single MOF in the last 2 years or ≥ 2 fragility fractures can undergo DEXA without prior FRAX/QFracture assessment.
- Vertebral Fracture Assessment: Recommended with DEXA in women >60 years, men >70 years and younger people with additional risk factors.
Centanafadine: 1st NDSRI approved by FDA for ADHD
FDA has approved centanafadine, the first and only NDSRI for ADHD, for adults and paediatric patients aged >6 years and weighing >20 kg.
MOA: Inhibits reuptake of norepinephrine, dopamine and serotonin.
Dose: Extended-release capsule once daily. Adults: 210 mg initially; maximum 280 mg/day. Paediatric dose is weight-based.
Common side effects: Headache, decreased appetite, insomnia, nausea, dry mouth and diarrhoea.
Adverse effects: Increase in heart rate/BP, psychiatric symptoms, growth suppression, peripheral vasculopathy, serotonin syndrome and tics.
Warning: High potential for dependence, abuse and addiction.
Contraindications: MAOI use within 14 days, hypersensitivity, pheochromocytoma, cardiac disease and severe hepatic impairment.
ACOG update on evaluation of postmenopausal bleeding (2026)
ACOG now recommends TVUS + endometrial biopsy as the initial evaluation for most patients with postmenopausal bleeding, replacing the previous TVUS-focused approach.
TVUS alone may be considered if all criteria are met:
- Only single episode of bleeding
- Fully visualised endometrium ≤ 4 mm
- No risk factors of endometrial cancer
- Prompt gynaecologic follow-up available if bleeding recurs
Diagnosis and management of MASLD (NICE 2026)
NICE has published updated guidelines on metabolic dysfunction-associated steatotic liver disease (MASLD).
Key updates:
Diagnosis: Exclude alcohol-related liver disease. Routine liver blood tests cannot rule out MASLD. In children and young people, liver USG confirms steatosis; repeat after 3 years if normal.
Advanced fibrosis:
- MASLD + ELF ≥ 10.51 = definitive diagnosis of advanced liver fibrosis.
- ELF < 10.51: retest every 3 yrs (adults) or 2 yrs (children and young people).
Management:
- Advise diet, physical activity and limiting alcohol. Avoid omega-3 fatty acids. Continue statins unless liver enzymes double within 3 months.
- Advanced fibrosis: Consider pioglitazone or vitamin E in adults; vitamin E in young people, in secondary or tertiary care settings. Vitamin E for children in tertiary care settings only.
To see the complete list of updates, check out the Recent Updates section on your Marrow app.