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1. Categorization of H1N1 Cases in India 2014-15
Category A patients: Mild fever plus cough/sore throat with or
without body ache, headache, diarrhea and vomiting Do not require
Oseltamivir Treat symptomatically Patients be monitored for their
progress and reassessed at 2448 hours No testing of the patient for
H1N1 is required
Patientsshouldconfinethemselvesathomeandavoidmixingupwithpublicandhighriskmembersinthefamily.Category
B patients: In addition to all the signs and symptoms mentioned
under Category-A, if the patient has,1.
Highgradefeverandseveresorethroat
Home isolation and Oseltamivir2. One ormore of the high risk
conditions:Childrenwithmild illness butwith predisposing risk
factors/Pregnant
women/Personsaged65yearsorolder/Patientswithlungdiseases,heartdisease,liverdisease,kidneydisease,blooddisorders,
diabetes, neurological disorders, cancer and HIV/AIDS/Patients on
long term cortisone therapy Oseltamivir No tests for H1N1 is
required
Patientsshouldconfinethemselvesathomeandavoidmixingwithpublicandhighriskmembersinthefamily.
Category C patients: In addition to the above signs and symptoms
of Category-A and B, if the patient has, 1.
Breathlessness,chestpain,drowsiness,fallinbloodpressure,sputummixedwithblood,bluishdiscolorationofnails2.
Childrenwithinfluenzalikeillnesswhohadaseverediseaseasmanifestedbytheredflagsigns(Somnolence,highand
persistentfever,inabilitytofeedwell,convulsions,shortnessofbreath,difficultyinbreathing,etc)3.
Worseningofunderlyingchronicconditions
Testing,immediatehospitalizationandtreatment.
(Source: MOHFW Guidelines, Government of India)
2. Mission Indradhanush 2014
Launch
25 December 2014Description
Indradhanush depicting seven colors of the rainbow, aims to
cover all those children by 2020 who are either unvaccinated,
orarepartiallyvaccinatedagainst7vaccinepreventablediseases(7
VPDs)
Diphtheria Pertussis Tetanus Childhood Tuberculosis
Poliomyelitis Hepatitis B Measles.
Strategy
Focusedandsystematicimmunizationdrive:Catch-upcampaignmodetocoverallthechildrenwhohavebeenleft/missedout.
4specialvaccinationcampaigns:January-June2015withintensiveplanningandmonitoring.
LearningofPolioprogram:Applyinplanningandimplementation.
Coverage:
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Firstphase:201districts Secondphase:297districts
82districtsin4statesofUP,Bihar,MadhyaPradeshandRajasthan.
(Source: Mission Indradhanush, MoHFW, Government of India)
3. New Revised Guidelines for Treatment of MDR-TB and XDR-TB
(RNTCP 2015)
I. MDR-TB Regimen
Intensive Phase: 6-9(KLCZEEt)+Continuation Phase:
18(LCEEt)(KKanamycin;LLevofloxacin;CCycloserine;ZPyrazinamide;EEthambutol;EtEthionamide).
II. XDR-TB Regimen
Intensive Phase: 6-12(HCmCzLAMP)+Continuation Phase:
18(HCzLAMP)(HHighdoseIsoniazid;CmCapreomycin;CzClofazimine;LLinezolid;AAmoxy-Clav;MMoxifloxacin;PPAS).
(Source: Resistant TB Programmatic Management Guidelines in
India, MOHFW, GOI)
4. New Revised Definitions under RNTCP (2014-15)
4 A. NEW CASE DEFINITIONS
PresumptiveTB:PatientwhopresentswithsymptomsorsignssuggestiveofTB(previouslyknownasaTBsuspect)
BacteriologicallyconfirmedTB:Abiologicalspecimenispositivebysmearmicroscopy,cultureorWRD(suchasXpert
MTB/RIF) Clinically diagnosed TB: Does not fulfil the criteria
for bacteriological confirmation but has been diagnosedwith
activeTBbyaclinicianorothermedicalpractitioner(includescasesdiagnosedonthebasisofX-rayabnormalitiesorsuggestivehistologyandextrapulmonarycaseswithoutlaboratoryconfirmation).
4 A1. Classification based on anatomical site of disease
Pulmonarytuberculosis(PTB):AnybacteriologicallyconfirmedorclinicallydiagnosedcaseofTBinvolvingthelungparenchymaorthetracheobronchialtree(E.g.MiliaryTB)
Extrapulmonary tuberculosis (EPTB):Anybacteriologically
confirmedor clinicallydiagnosed case of TB
involvingorgansotherthanthelungs(E.g.Tuberculousintra-thoraciclymphadenopathy,Tuberculouspleuraleffusion).
4 A2. Classification based on history of previous TB treatment
(Patient registration group)
Newpatients:HaveneverbeentreatedforTBorhavetakenanti-TBdrugs 1
month or more of anti-TB drugs
Relapsepatients:PreviouslybeentreatedforTB,weredeclaredcuredortreatmentcompleted,andisnowdiagnosedwith
a recurrent episode of TB
Treatment after failure patients:Whohavepreviously been treated
for TB, and treatment failed at the end oftreatment
Treatmentafterlosstofollow-uppatients:PreviouslybeentreatedforTBandweredeclaredlosttofollow-upattheendoftreatment.
4 A3. Classification based on HIV status
HIV-positiveTBpatient:AnybacteriologicallyconfirmedorclinicallydiagnosedcaseofTBwhohasapositiveresultfrom
HIV testing conducted at the time of TB diagnosis or other
documented evidence of enrolment in HIV care, such
asenrolmentinthepre-ARTregisterorintheARTregisteronceARThasbeenstarted.
HIV-negativeTBpatient:AnybacteriologicallyconfirmedorclinicallydiagnosedcaseofTBwhohasanegativeresultfromHIVtestingconductedatthetimeofTBdiagnosis.
HIVstatusunknownTBpatient:AnybacteriologicallyconfirmedorclinicallydiagnosedcaseofTBwhohasnoresultof
HIV testing and no other documented evidence of
enrolmentinHIVcare.
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4A4. Classification based on drug resistance based on drug
susceptibility testing (DST)
Monoresistance:Resistancetoonefirst-lineanti-TBdrugonly.
Polydrugresistance:Resistancetomorethanonefirst-lineanti-TBdrug(otherthanbothisoniazidandrifampicin).
Multidrugresistance:Resistancetoatleastbothisoniazidandrifampicin.
Extensivedrugresistance:Resistancetoanyfluoroquinoloneandtoatleastoneofthreesecond-lineinjectabledrugs
(capreomycin,kanamycinandamikacin),inadditiontomultidrugresistance.
Rifampicin resistance: Resistance to rifampicin detected using
phenotypic or genotypicmethods,with orwithout
resistancetootheranti-TBdrugs.
4B. Treatment outcome definitions
4B1. Treatment outcomes for TB patients (excluding patients
treated for RR-TB or MDR-TB)
Cured:PulmonaryTBpatientwithbacteriologicallyconfirmedTBatbeginningoftreatmentwhowassmear-orculture-negativeinthelastmonthoftreatmentandonatleastonepreviousoccasion.
Treatmentcompleted:TBpatientwhocompletedtreatmentwithoutevidenceoffailureBUTwithnorecordtoshowthat
sputum smear or culture results in the last month of treatment and
on at least one previous occasion were negative,
eitherbecausetestswerenotdoneorbecauseresultsareunavailable.
Treatmentfailed:TBpatientwhosesputumsmearorcultureispositiveatmonth5orlaterduringtreatment.
Died:TBpatientwhodiesforanyreasonbeforestartingorduringthecourseoftreatment.
Losttofollow-up:TBpatientwhodidnotstarttreatmentorwhosetreatmentwasinterruptedfor2consecutivemonths
ormore.
Notevaluated:TBpatientforwhomnotreatmentoutcomeisassigned(IncludesCasestransferredout,andOutcome
unknown). Treatmentsuccess:Sumofcuredandtreatmentcompleted.
4B2. Outcomes for RR-TB/MDR-TB/XDR-TB patients treated using
second-line treatment
Cured:TreatmentcompletedasrecommendedbythenationalpolicywithoutevidenceoffailureANDthreeormoreconsecutiveculturestakenatleast30daysapartarenegativeaftertheintensivephase.
Treatmentcompleted:TreatmentcompletedasrecommendedbythenationalpolicywithoutevidenceoffailureBUTnorecordthatthreeormoreconsecutiveculturestakenatleast30daysapartarenegativeaftertheintensivephase.
Treatmentfailed:Treatmentterminatedorneedforpermanentregimenchangeofatleasttwoanti-TBdrugsbecauseof:
Lackofconversionbytheendoftheintensivephase,or Bacteriological
reversion in the continuation phase after conversion to negative,
or
Evidenceofadditionalacquiredresistancetofluoroquinolonesorsecond-lineinjectabledrugs,or
Adversedrugreactions(ADRs).
Died:Patientwhodiesforanyreasonduringthecourseoftreatment.
Losttofollow-up:Patientwhosetreatmentwasinterruptedfor2consecutivemonthsormore.
Not evaluated: Patient forwhomno treatment outcome is assigned
(Includes cases transferred outand outome
unknown. Treatmentsuccess:Sumofcuredandtreatmentcompleted.
(Source: Definitions and Reporting Framework for Tuberculosis
2013 Revision. updated December 2014, World Health
Organization)
5. Endorsed TB Diagnostics under RNTCP 2015
SmearmicroscopyforAFB: ZNstaining
FluorescencestainsexaminedunderMicroscopywith/withoutLED.
Culturemethods: LJmedia(Solid)
MiddleBrookmedia(Liquid)usingBactec/MGIT.
Rapiddiagnosticmoleculartests:
ConventionalPCRbasedLine-probe-assayforMTBcomplex
Real-timePCRbasedNAATforMTBcomplex(GeneXpert).
(Source: MOHFW Annual Report 2013-14, Government of India)
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6. New Indices Used in Public Health
6A. Global Hunger Index (GHI)
Description
Importance:ComprehensivetoolformeasurementandtrackingofhungerinWorldbyregionandcountry
Agency:InternationalFoodPolicyResearchInstitute.
Components
Undernourishment Child underweight Childmortality.
Calculation of GHI
GHI=%Undernourishment+%Childunderweight+%Childmortality
3 GHIScore:
Lies between 100 to 0 0best(nohunger) 100worst.
(Source: Challenge of hunger, The Global Hunger Index 2008,
2014)
6B. Gross National Happiness (GNH)
Description
GrossNationalHappiness(GNH)measuresthequalityofacountryinmoreholisticway[thanGNP]andbelievesthatthe
beneficial development of human society takes placewhenmaterial and
spiritual development occurs side by side
tocomplementandreinforceeachother.
Component domains
Domain Indicators1. Psychological well-being 42. Health 43.
Time-use 24. Education 45. Cultural diversity and resilience 46.
Good governance 47. Community vitality 48. Ecological diversity and
resilience 49. Living standards 3
Total 33
(Source: A Short Guide to Gross National Happiness Index, The
Centre for Bhutan Studies 2012)
7. New Post-Exposure Guidelines for HIV 2014-15 (Proposed)
AdolescentsandAdults: Preferredbackboneregimen:TDF+3TC(orFTC)
Preferredthirddrug:LPV/rorATV/r Alternateoptions:RAL,DLV/rorEFV
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Childrenlessthan10yearsold: Preferredbackboneregimen:AZT+3TC
Alternateregimens:ABC+3TCorTDF+3TC(orFTC) Preferredthirddrug:LPV/r
Alternateoptionsaccordingtoage-appropriateness:ATV/r,RAL,DRV,EFV,NVP).
Prescribing frequency:28dayprescription.
(Source: Guidelines on Post-Exposure Prophylaxis for HIV and Use
of Cotrimoxazole, World health Organisation 2014)
Printing errors in 7th Edition Review of PSM by Dr Vivek
Jain
Dear Students,
WiththehelpofPG-aspirants,Ihavebeenabletofindfewprinting/typingerrorsincurrent7thEditionofPSMbook.I
do not want to wait for 8th edition for corrections. I am sharing
them with you to avoid any error in the most important
examofyourlife.Pleasetakeoutfewminutesandmarkthesecorrectionsinyourbookbeforereading.
Page Correction Thanks to Doctors
48 India declared smallpox free: April 1977 July 1975 Dr
Shahshank Singh
86 Ans 119 B & C; 123 C Dr Amit Ilamkar, GMC, Nagpur
87 Ans 133 A Dr Ronak Patel, SSG Hospital, Vadodara
346 Ans 29 B Dr Amit Yadav
393 Ans 584: Cholesterol/ CHD ratio > 3.5 Dr Avishek Amar,
Patna
396 Delete table in Ans 603 (Refer to Page 298) Dr Musaib
Muhammad, GMC & SMHS, Srinagar
491 Ans 257 A, D Dr Akash Patel, SMIMER, Surat
541/674/687 BPL (