{"id":7303,"date":"2020-09-04T13:40:37","date_gmt":"2020-09-04T13:40:37","guid":{"rendered":"https:\/\/www.marrow.com\/blog\/?p=7303"},"modified":"2020-09-07T08:51:38","modified_gmt":"2020-09-07T08:51:38","slug":"issue-5","status":"publish","type":"post","link":"https:\/\/www.marrow.com\/blog\/issue-5\/","title":{"rendered":"QBank Fortnightly Newsletter"},"content":{"rendered":"\n<h5 class=\"wp-block-heading\"><strong> <\/strong>VOLUME: 1, ISSUE: 5<\/h5>\n\n\n\n<p class=\"wp-block-paragraph\">Hello!<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In our 5th issue, we bring some more updates from the world of Qbank based on a couple of important recent updates.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Please have a look.&nbsp;<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">1. NTEP 2020 recommendation<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">(Updated- MCQ id: MB8289. Pearl id: 1720)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">As per the latest recommendations from the National Tuberculosis Elimination Programme 2020 (NTEP 2020), the treatment of TB will be based primarily on <strong>drug susceptibility testing<\/strong>. It is irrespective of new cases, previously treated cases or recurrent TB cases.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">All cases of TB will be treated with Drug Sensitive TB Regimen, as long as the patient is sensitive to isoniazid and rifampicin.  <strong>(No classification into the category I or II)<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Type of TB Case<\/strong><\/td><td><strong>Intensive Phase<\/strong><\/td><td><strong>Continuation Phase<\/strong><\/td><\/tr><tr><td>New and previously treated cases (H and R sensitive)<\/td><td>2 H R Z E<\/td><td>4 H R E<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"has-small-font-size wp-block-paragraph\">H: Isoniazid; R: Rifampicin; E: Ethambutol; Z: Pyrazinamide<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Daily Dose Schedule for Adults (as per weight bands) <\/strong> (MCQ id: MD0983)<\/p>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table><tbody><tr><td><strong>Weight category<\/strong><\/td><td>No. of tablets<\/td><td>No. of tablets<\/td><\/tr><tr><td><\/td><td><strong>Intensive phase <\/strong><br><strong>HRZE<\/strong><br>(dose: 75\/150\/400\/275)<\/td><td><strong>Continuation phase HRE&nbsp;<\/strong><br>(dose: 75\/150\/275)<\/td><\/tr><tr><td><strong>25-34 kg<\/strong><\/td><td>2<\/td><td>2<\/td><\/tr><tr><td><strong>35-49 kg<\/strong><\/td><td>3<\/td><td>3<\/td><\/tr><tr><td><strong>50-64 kg<\/strong><\/td><td>4<\/td><td>4<\/td><\/tr><tr><td><strong>65-75 kg<\/strong><\/td><td>5<\/td><td>5<\/td><\/tr><tr><td><strong>&gt;75 kg&nbsp;<\/strong><\/td><td>6<\/td><td>6<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Classification based on drug resistance (DR)<\/strong>  (MCQ id: MA2040)<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Mono-resistant (MR):<\/strong>  Resistant to one 1st line anti-TB drug only.<\/li><li>Poly-Drug Resistant (PDR): resistant to more than one 1st line anti-TB drug, other than Rifampicin.&nbsp;<\/li><li><strong>Rifampicin Resistant (RR):<\/strong>  Resistant to <strong>rifampicin <\/strong>with or without resistance to other drugs<strong>. <\/strong>Patients, who have rifampicin resistance, should be managed as if they are an MDR TB case.<\/li><li><strong>Multi-Drug Resistant (MDR):<\/strong>  Resistant to <strong>both isoniazid and rifampicin<\/strong>.<\/li><li><strong>Extensively Drug-Resistant (XDR):<\/strong> Resistant to a fluoroquinolone (ofloxacin, levofloxacin, or moxifloxacin) and a second-line injectable anti TB drug (kanamycin, amikacin, or capreomycin).<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Standard DR TB regimen<\/strong> (MCQ id: MC7007, MB8290, MB8291)<\/p>\n\n\n\n<figure class=\"wp-block-table aligncenter is-style-regular\"><table><tbody><tr><td><strong>Regimen class<\/strong><\/td><td class=\"has-text-align-left\" data-align=\"left\"><strong>Drugs<\/strong><\/td><td><strong>Comments<\/strong><\/td><\/tr><tr><td><strong>H mono-resistant\/ poly-drug resistant TB regimen<\/strong><\/td><td class=\"has-text-align-left\" data-align=\"left\">Lfx R E Z for 6 months<\/td><td>6 months long.<br>Oral drugs only<\/td><\/tr><tr><td><strong>Shorter MDR TB regimen<\/strong><\/td><td class=\"has-text-align-left\" data-align=\"left\"><strong>Intensive Phase:<\/strong> Mfx Km\/Am Eto Cfz Z H E for 4-6 months<br><br><strong>Continuation phase<\/strong>: Mfx Cfz Z E for 5 months<\/td><td>9-11 months long. <br>Injectables used in the intensive phase.<\/td><\/tr><tr><td><strong>Longer MDR TB regimen<\/strong><\/td><td class=\"has-text-align-left\" data-align=\"left\">Bdq (6 months) Lfx Lzd Cfz Cs for 18-20 months<\/td><td>18-20 months long Oral drugs only. <br>This regimen is used for XDR TB patients for 20 months.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p style=\"font-size:14px\" class=\"has-text-color has-very-dark-gray-color wp-block-paragraph\"> 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<\/p>\n\n\n\n<h5 class=\"wp-block-heading\">Criteria for patients to receive standard Drug Resistant TB regimen<\/h5>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Standard Drug-Resistant TB regimen<\/strong><\/td><td><strong>Inclusion criteria<\/strong><\/td><td><strong>Exclusion criteria<\/strong><\/td><\/tr><tr><td><strong>H mono-resistant\/<\/strong><strong>poly-drug resistant TB regimen<\/strong><\/td><td><strong>Isoniazid resistant<\/strong> TB with <strong>rifampicin sensitive<\/strong><\/td><td>No specific criteria<\/td><\/tr><tr><td><strong>Shorter MDR TB regimen<\/strong><\/td><td>Patient with <strong>rifampicin-resistant<\/strong> pulmonary or extra-pulmonary TB<\/td><td><span style=\"text-decoration: underline;\">Non-drug sensitivity test-based criteria<\/span>:<br>Pregnancy, Any extrapulmonary disease in PLHIV, Disseminated meningeal or central nervous system TB, Intolerance to any drug in the shorter MDR TB regimen<br><span style=\"text-decoration: underline;\">Drug sensitivity test-based criteria<\/span>: <br>If DST\/DRT result for FQ or SLI is resistant (XDR TB), the presence of InhA mutation, Resistant to Z&nbsp;<\/td><\/tr><tr><td><strong>Longer MDR TB regimen<\/strong><\/td><td>Patients in whom shorter <strong>MDR TB regimen cannot be considered<\/strong> due to any reason<\/td><td>None<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"has-small-font-size wp-block-paragraph\">Ref: <a href=\"http:\/\/www.tbcindia.nic.in\/WriteReadData\/NTEPTrainingModules1to4.pdf\">http:\/\/www.tbcindia.nic.in\/WriteReadData\/NTEPTrainingModules1to4.pdf<\/a><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">2. <strong>CEAP Classification 2020<\/strong>  <\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">(MCQ id: MB7659, MC7490)  (Updated pearl id: 2292,1747)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The American Venous Forum has revised the CEAP classification system for Chronic Venous Disease. The &#8216;C&#8217; (Clinical class) component has new inclusions, as highlighted in the table below. The Etiology (&#8216;E&#8217;), Anatomical distribution (&#8216;A&#8217;) and Pathophysiology (&#8216;P&#8217;) based classes remain the same.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Currently, the clinical categories are recognized as follows:&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td>C0<\/td><td>No visible or palpable signs of venous disease<\/td><\/tr><tr><td>C1<\/td><td>Telangiectasis or reticular veins<\/td><\/tr><tr><td>C2<\/td><td>Varicose veins<\/td><\/tr><tr><td><strong>C2r<\/strong><\/td><td><strong>Recurrent varicose veins<\/strong><\/td><\/tr><tr><td>C3<\/td><td>Edema<\/td><\/tr><tr><td>C4<br>C4aC4b<strong>C4c<\/strong><\/td><td>Changes in skin and subcutaneous tissues secondary to chronic venous disease: Pigmentation or eczemaLipodermatosclerosis or atrophie blanche <strong>Corona phlebectatica<\/strong><\/td><\/tr><tr><td>C5<\/td><td>Healed<\/td><\/tr><tr><td>C6<\/td><td>Active venous ulcer<\/td><\/tr><tr><td><strong>C6r<\/strong><\/td><td><strong>Recurrent active venous ulcer&nbsp;<\/strong><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"has-small-font-size wp-block-paragraph\">Ref: <a aria-label=\"undefined (opens in a new tab)\" href=\"https:\/\/www.jvsvenous.org\/article\/S2213-333X(20)30063-9\/fulltext\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.jvsvenous.org\/article\/S2213-333X(20)30063-9\/fulltext<\/a><\/p>\n\n\n\n<p style=\"font-size:14px\" class=\"has-text-align-left wp-block-paragraph\"><span style=\"text-decoration: underline;\">Click <a href=\"https:\/\/www.marrow.com\/blog\/category\/qbank-fortnightly-newsletters-recent-updates\/\" target=\"_blank\" aria-label=\"undefined (opens in a new tab)\" rel=\"noreferrer noopener\">here<\/a> to check out the previous issues of the newsletters: <\/span>       <\/p>\n","protected":false},"excerpt":{"rendered":"<p>VOLUME: 1, ISSUE: 5 Hello! In our 5th issue, we bring some more updates from the world of Qbank based&#46;&#46;&#46;<\/p>\n","protected":false},"author":27,"featured_media":7312,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_uag_custom_page_level_css":"","_exactmetrics_skip_tracking":false,"_monsterinsights_skip_tracking":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[595],"tags":[],"class_list":["post-7303","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-qbank-fortnightly-newsletters-recent-updates"],"yoast_head":"<!-- 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