The document outlines new guidelines for TB control in India, including changes to diagnostic algorithms, case definitions, treatment regimens, and follow-up procedures. Key changes include implementing a daily drug regimen using fixed-dose combinations based on weight bands, removing the need to extend the intensive phase, and conducting long-term clinical and laboratory follow-up of patients for up to two years after completing treatment. The guidelines also provide new diagnostic and treatment approaches for drug-resistant TB, intensified case finding for vulnerable groups, and ICT-enabled adherence monitoring tools.
The 2019 Diagnostic Summit brought together diagnostic developers in academia and industry as well as end-users in the pharmaceutical and healthcare sector to gain a comprehensive picture of diagnostics in prenatal, oncology, infectious disease, point-of-care, and liquid biopsy.
This important Summit enabled delegates to learn what novel technologies, platforms and applications are emerging that will impact future healthcare delivery and pharmaceutical research.
Bringing together European leading experts via presentations, workshops and case studies the Summit was a must attend event! We explored:
Current diagnostic testing in GP surgeries and Pharmacies
How Diagnostics can be funded and funding barriers
Advances in Prenatal Molecular Diagnostics
Diagnostic Regulations
Point of care testing
Advanced Diagnostics for infectious diseases
Adapting and evaluating Innovation
Education on testing and accuracy
Patient and Clinical pathways
Key health areas examined in the Summit included:
Sexual Health
Diabetes
Cancer
Antibiotic Resistance
Sepsis
Obesity
Urinary Infections
Midterm Outcome Evaluation of Government-Led Endeavors to Eliminate Hepatitis C as a Public Health Threat by 2030 in Malaysia
Presentation Slides by Mr Chan Huan Keat, presented on the 14th National Conference for Clinical Research (NCCR) 2021 Dr Wu Lien Teh Youth Investigator Awards (YIA) on 19th August 2021
Following are the links for this presentation on Zenodo Repository:
Presentation Slides: https://zenodo.org/record/5348475
E-Poster: https://zenodo.org/record/5348564
Observational Study on 255 Mechanically Ventilated Covid Patients at the Beginning of the USA Pandemic
This article is a preprint and has not been peer-reviewed.
Twitter: @MattisVollan
The 2019 Diagnostic Summit brought together diagnostic developers in academia and industry as well as end-users in the pharmaceutical and healthcare sector to gain a comprehensive picture of diagnostics in prenatal, oncology, infectious disease, point-of-care, and liquid biopsy.
This important Summit enabled delegates to learn what novel technologies, platforms and applications are emerging that will impact future healthcare delivery and pharmaceutical research.
Bringing together European leading experts via presentations, workshops and case studies the Summit was a must attend event! We explored:
Current diagnostic testing in GP surgeries and Pharmacies
How Diagnostics can be funded and funding barriers
Advances in Prenatal Molecular Diagnostics
Diagnostic Regulations
Point of care testing
Advanced Diagnostics for infectious diseases
Adapting and evaluating Innovation
Education on testing and accuracy
Patient and Clinical pathways
Key health areas examined in the Summit included:
Sexual Health
Diabetes
Cancer
Antibiotic Resistance
Sepsis
Obesity
Urinary Infections
Midterm Outcome Evaluation of Government-Led Endeavors to Eliminate Hepatitis C as a Public Health Threat by 2030 in Malaysia
Presentation Slides by Mr Chan Huan Keat, presented on the 14th National Conference for Clinical Research (NCCR) 2021 Dr Wu Lien Teh Youth Investigator Awards (YIA) on 19th August 2021
Following are the links for this presentation on Zenodo Repository:
Presentation Slides: https://zenodo.org/record/5348475
E-Poster: https://zenodo.org/record/5348564
Observational Study on 255 Mechanically Ventilated Covid Patients at the Beginning of the USA Pandemic
This article is a preprint and has not been peer-reviewed.
Twitter: @MattisVollan
Genomics, Personalized Medicine and Electronic Medical RecordsLyle Berkowitz, MD
We are now unlocking the secrets of health at a molecular level – which includes not only why some people get diseases, but also how to prevent or cure them. However, as Osler points out, knowing this information is only valuable in the context of making it available for the right patient at the right time.
This presentation provides a basic introduction to genomic or personalized medicine, and discusses how this information can and should be integrated into our electronic medical record systems.
These slides were originally presented at the HIMSS Annual Conference in February of 2007.
Transforming the NHS through genomic and personalised medicine, pop up uni, 1...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Webinar Series on Demystifying Phases in Clinical Trials & COVID-19 Updates organized by Institute for Clinical Research (ICR), NIH
Speaker: Dato Dr Chang Kian Meng, Haematologist from Sunway Medical Centre
More information, please visit: https://clinupcovid.mailerpage.com/resources/p9f2i7-introduction-to-phase-2-3-trial-s
Journal club presentation: by RxVichuZ!! ;)RxVichuZ
My 97th powerpoint... deals with the comparative study of efficacy of piperacillin-tazobactam, as compared to meropenem in the treatment of ESBL(Extended spectrum beta-lactamases) infections.
A summarized insight has been provided, using research article from JAMA.
This bulletin is a publication of the CRC networks in Perak (Hospital Raja Permaisuri Bainun Ipoh, Hospital Seri Manjung and Hospital Taiping).
This issue emcompasses various research articles written by CRC staff, a research scope write-up to emphasize on the research focus this coming year, programmes conducted in 2021 as well as upcoming events across the CRC Perak Network this year.
(e-ISSN Number: 2682-7867).
Webinar: Defeating Superbugs: Hospitals on the Front Lines Modern Healthcare
About the Webinar: Defeating Superbugs: Hospitals on the Front Lines
http://www.modernhealthcare.com/article/20140917/INFO/309179926
Hospitals across the country are facing a grim reality in which some of the most deadly healthcare-associated infections they encounter are untreatable with first- or even second-line antibiotics. These “superbugs” affect at least 2 million Americans each year and lead to 23,000 deaths. And their threat is growing, public health officials warn. This editorial webinar and “Defeating Superbugs” white paper will explore the steps providers must take to ramp up surveillance efforts, promote appropriate antibiotic use and control outbreaks. Our panel of experts will share their organizations' experiences as well as proven strategies for success.
Registration for this webinar includes Modern Healthcare's “Defeating Superbugs” white paper, with proven tips and strategies for promoting appropriate antibiotic use, improving infection surveillance, identifying drug-resistant infections and dealing with outbreaks.
KEY TAKEAWAYS
- Best practices for effective antimicrobial stewardship
- Real-world examples of effective interventions, including universal rapid testing for drug-resistant MRSA
- Tips for engaging senior leadership
- Aggressive strategies for controlling outbreaks
PANELISTS
Lance Peterson
Director of the Clinical Microbiology and Infectious Disease Research Division
NorthShore University HealthSystem, Evanston, Ill.
Anurag Malani
Medical Director for the Infection Prevention and Antimicrobial Stewardship Programs
St. Joseph Mercy Hospital, Ann Arbor, Mich.
Robert Weinstein
Chief Medical Officer for Population Health
Chairman of the Department of Medicine, Cook County Health and Hospitals System; Professor, Rush University Medical Center, Chicago
MODERATOR
Maureen McKinney
Editorial Programs Manager
Modern Healthcare
Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH
Speaker: Dr. Ong Tien Lee, neurologist in Sungai Buloh Hospital, Ministry of Health Malaysia.
Assignment on Covid 19 | Tutors India.pptxTutors India
Tutors india thesis and dissertation writing help guarantees that your dissertation is confidential, and so you do not have to worry about it.
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World: https://www.tutorsindia.com
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UAE: https://tutorsindia.com/ae/
Australia:https://www.tutorsindia.com/au/
Newzealand: https://www.tutorsindia.com/nz/
(UK): +44-1143520021
Mail: info@tutorsindia.com
Mail: info@tutorsuk.co.uk
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Household Catastrophic Health Expenditure From Oral Potentially Malignant Disorders And Oral Cancer In Public Healthcare Of Malaysia
Presentation Slides by Mr Sivaraj Raman, presented on the 14th National Conference for Clinical Research (NCCR) 2021 Dr Wu Lien Teh Youth Investigator Awards (YIA) on 19th August 2021
Following are the links for this presentation on Zenodo Repository:
Presentation Slides: https://zenodo.org/record/5348498
E-Poster: https://zenodo.org/record/5348963
ASTUTE: Acute Stroke Telemedicine: Utility Training and Evaluation
Implementing Telemedicine in Acute Stroke and the development of a Standardised Telemedicine Tookit
Lancashire Teaching Hsopitals NHS Foundation Trust
Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013
More information about this event can be found at
http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx
Single-dose oral ciprofloxacin prophylaxis as a meningococcal meningitis outbreak response: results of a cluster-randomized trial
https://www.meningitis.org/mrf-conference-2017
Genomics, Personalized Medicine and Electronic Medical RecordsLyle Berkowitz, MD
We are now unlocking the secrets of health at a molecular level – which includes not only why some people get diseases, but also how to prevent or cure them. However, as Osler points out, knowing this information is only valuable in the context of making it available for the right patient at the right time.
This presentation provides a basic introduction to genomic or personalized medicine, and discusses how this information can and should be integrated into our electronic medical record systems.
These slides were originally presented at the HIMSS Annual Conference in February of 2007.
Transforming the NHS through genomic and personalised medicine, pop up uni, 1...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Webinar Series on Demystifying Phases in Clinical Trials & COVID-19 Updates organized by Institute for Clinical Research (ICR), NIH
Speaker: Dato Dr Chang Kian Meng, Haematologist from Sunway Medical Centre
More information, please visit: https://clinupcovid.mailerpage.com/resources/p9f2i7-introduction-to-phase-2-3-trial-s
Journal club presentation: by RxVichuZ!! ;)RxVichuZ
My 97th powerpoint... deals with the comparative study of efficacy of piperacillin-tazobactam, as compared to meropenem in the treatment of ESBL(Extended spectrum beta-lactamases) infections.
A summarized insight has been provided, using research article from JAMA.
This bulletin is a publication of the CRC networks in Perak (Hospital Raja Permaisuri Bainun Ipoh, Hospital Seri Manjung and Hospital Taiping).
This issue emcompasses various research articles written by CRC staff, a research scope write-up to emphasize on the research focus this coming year, programmes conducted in 2021 as well as upcoming events across the CRC Perak Network this year.
(e-ISSN Number: 2682-7867).
Webinar: Defeating Superbugs: Hospitals on the Front Lines Modern Healthcare
About the Webinar: Defeating Superbugs: Hospitals on the Front Lines
http://www.modernhealthcare.com/article/20140917/INFO/309179926
Hospitals across the country are facing a grim reality in which some of the most deadly healthcare-associated infections they encounter are untreatable with first- or even second-line antibiotics. These “superbugs” affect at least 2 million Americans each year and lead to 23,000 deaths. And their threat is growing, public health officials warn. This editorial webinar and “Defeating Superbugs” white paper will explore the steps providers must take to ramp up surveillance efforts, promote appropriate antibiotic use and control outbreaks. Our panel of experts will share their organizations' experiences as well as proven strategies for success.
Registration for this webinar includes Modern Healthcare's “Defeating Superbugs” white paper, with proven tips and strategies for promoting appropriate antibiotic use, improving infection surveillance, identifying drug-resistant infections and dealing with outbreaks.
KEY TAKEAWAYS
- Best practices for effective antimicrobial stewardship
- Real-world examples of effective interventions, including universal rapid testing for drug-resistant MRSA
- Tips for engaging senior leadership
- Aggressive strategies for controlling outbreaks
PANELISTS
Lance Peterson
Director of the Clinical Microbiology and Infectious Disease Research Division
NorthShore University HealthSystem, Evanston, Ill.
Anurag Malani
Medical Director for the Infection Prevention and Antimicrobial Stewardship Programs
St. Joseph Mercy Hospital, Ann Arbor, Mich.
Robert Weinstein
Chief Medical Officer for Population Health
Chairman of the Department of Medicine, Cook County Health and Hospitals System; Professor, Rush University Medical Center, Chicago
MODERATOR
Maureen McKinney
Editorial Programs Manager
Modern Healthcare
Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH
Speaker: Dr. Ong Tien Lee, neurologist in Sungai Buloh Hospital, Ministry of Health Malaysia.
Assignment on Covid 19 | Tutors India.pptxTutors India
Tutors india thesis and dissertation writing help guarantees that your dissertation is confidential, and so you do not have to worry about it.
For #Enquiry:
World: https://www.tutorsindia.com
UK: https://www.tutorsindia.com/uk
UAE: https://tutorsindia.com/ae/
Australia:https://www.tutorsindia.com/au/
Newzealand: https://www.tutorsindia.com/nz/
(UK): +44-1143520021
Mail: info@tutorsindia.com
Mail: info@tutorsuk.co.uk
(Whatsapp): +91-8754446690
Household Catastrophic Health Expenditure From Oral Potentially Malignant Disorders And Oral Cancer In Public Healthcare Of Malaysia
Presentation Slides by Mr Sivaraj Raman, presented on the 14th National Conference for Clinical Research (NCCR) 2021 Dr Wu Lien Teh Youth Investigator Awards (YIA) on 19th August 2021
Following are the links for this presentation on Zenodo Repository:
Presentation Slides: https://zenodo.org/record/5348498
E-Poster: https://zenodo.org/record/5348963
ASTUTE: Acute Stroke Telemedicine: Utility Training and Evaluation
Implementing Telemedicine in Acute Stroke and the development of a Standardised Telemedicine Tookit
Lancashire Teaching Hsopitals NHS Foundation Trust
Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013
More information about this event can be found at
http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx
Single-dose oral ciprofloxacin prophylaxis as a meningococcal meningitis outbreak response: results of a cluster-randomized trial
https://www.meningitis.org/mrf-conference-2017
Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic of att. Tuberculosis and basic o
Drug Resistant Tuberculosis Management GuidelineNabin Bist
National Guidelines On Drug Resistant Tuberculosis Management.
National TB programme is moving forward with the vision of TB Free Nepal by 2050 in accordance
with the National Health Policy 2014 and under the strategic direction of the worldwide initiative
to end TB – the End TB Strategy.
The goal of National Strategic Plan 2016-21 is to decrease the TB Incidence rate by 20%, from
2015 to 2021 i.e. to identify additional 20,000 new TB cases by next 5 years.
RNTCP in India has gone a lot of updates in the resent times. The recent updates in RNTCP in India have been summarised in this presentation. Management of Drug sensitive and Drug Resistant TB have been included in the presentation.
Important maternal and child health parameters to evaluate quality care for the special group. Includes MMR, IMR, SBR, PMR, NMR, PNMR, U5MR. Practical class for UG 4th sem
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
RNTCP Changes in 2018
1. Technical and Operational
Guidelines for TB Control in India
2016 -
with Focus on Recent Change in the
Programme
Junior Resident: Dr. Tanveer Rehman
Faculty Moderator: Dr. Palanivel C
2. CONTENTS
1. Introduction
2. Changes/Additions in Recent Programme
3. Presumptive TB case
4. Diagnostic Tools
5. Diagnosis strategy
6. Specimen Collection & Transport
7. PMDT
8. Treatment
9. Follow up
10. Treatment support program
11. Treatment outcomes
12. Puducherry
13. Summary
229-01-2018 Dr Tanveer Rehman PSM JIPMER
3. INTRODUCTION
• Brief History of TB Control in India
The objectives of the National Strategic Plan (2012-2017) are:
1. achieve 90% notification rate for all cases
2. To achieve 90% success rate for all new and 85% for re-treatment cases
3. To improve the successful outcome of treatment for DRTB cases
4. To achieve decreased morbidity and mortality for HIV-associated TB cases
5. To improve the outcome of TB care in the private sectors
329-01-2018 Dr Tanveer Rehman PSM JIPMER
4. Changes/Additions in Recent Programme
1. Sub District Level 2. Presumptive TB & DR-TB case
3. Diagnostic algorithm 4. Case definitions
5. Principle of TB Treatment 6. Enhanced enables and incentives
7. Introduction of BDQ 8. New treatment Card
9. ICT enabled adherence support 10. Follow up
11. Treatment outcomes 12. Special situations
29-01-2018 4Dr Tanveer Rehman PSM JIPMER
5. Presumptive TB case: Previous guideline
1. An individual having persistent cough for 2 weeks or more, with or without - fever, weight
loss, night sweat, haemoptysis
2. Cough of any duration for special groups like
1. Contacts of smear-positive TB patients
2. Suspected/confirmed extra-pulmonary TB
3. HIV-positive patient
29-01-2018 5Dr Tanveer Rehman PSM JIPMER
6. Presumptive TB case
• New Guideline (any of the following)
1. Cough >2 weeks, or
2. Fever >2 weeks, or
3. Significant weight loss, or
4. Haemoptysis, or
5. Any abnormalities in chest radiography, or
6. Contact of microbiologically confirmed TB patients, PL HIV, diabetics, malnourished,
cancer patients, patients on immunosuppressive therapy or steroid should be regularly
screened for signs and symptoms of TB
29-01-2018 6Dr Tanveer Rehman PSM JIPMER
7. Diagnostic Tools available in the program
1. Sputum Smear Microscopy (for AFB) : ZN, Fluorescence
2. Culture :
Solid (LJ) media
Automated Liquid culture systems eg. BACTEC MGIT 960, BactiAlert
Drug Sensitivity Testing (DST)
3. Rapid molecular diagnostic testing:
Line Probe Assay for MTB complex and detection of RIF & INH Resistance
NAAT Xpert MTB/Rif testing using the GeneXpert system
29-01-2018 7Dr Tanveer Rehman PSM JIPMER
10. DIAGNOSIS STRATEGY
1. Diagnostic algorithm of TB has been completely changed from the
previous guideline
2. All TB cases diagnosed must be offered testing for HIV
3. All key population (PLHIV, children, EPTB, etc.) will preferentially get a
CBNAAT : upfront CBNAAT
4. “order to DO” – “order of consideration”
1029-01-2018 Dr Tanveer Rehman PSM JIPMER
11. Case scenario 1
A patient with H/O cough for >2 weeks is unwilling to come to give sputum
sample next day morning as he lives far away from the PHC. How to collect
his sputum ?
29-01-2018 11Dr Tanveer Rehman PSM JIPMER
12. Case scenario 2
If the first sputum smear is positive of a patient with H/O significant weight
loss, and the second smear not available; how to diagnose TB in this
patient?
29-01-2018 12Dr Tanveer Rehman PSM JIPMER
13. Case scenario 3
If the first sputum smear is negative and the CXR (done a week back)
suggestive of TB, what is the next step?
29-01-2018 13Dr Tanveer Rehman PSM JIPMER
14. Case scenario 3: Answer
1. 2nd sample – smear and CBNAAT both
2. If both positive – diagnosed
3. If both negative – physician call
4. If CBNAAT positive, smear negative – MTB +/-
5. If CBNAAT negative, smear positive – physician call
29-01-2018 14Dr Tanveer Rehman PSM JIPMER
15. Pooled sensitivity and specificity of different screening
tools for TB, using culture-confirmed pulmonary TB as
the gold standard
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16. Specimen Collection & Transport
A good quality sputum specimen:
1. Open air room
2. Rinse
3. Inhale
4. Cough out bronchial secretions
5. Volume 3-5 mL
• Result within a day (if delay: 1 week - refrigerate)
• Disinfect – 5% phenol
29-01-2018 16Dr Tanveer Rehman PSM JIPMER
17. Programmatic Management of Drug Resistant TB
(PMDT)
1. DOTS Plus
2. Once the MO PHI confirms presumptive DR-TB – 2 sputum specimen
3. Presumptive DR-TB:
• TB patients who have failed treatment with first-line ATD
• Paediatric TB non-responder
• TB patients who are contacts of DRTB
• TB patients who are found positive on any follow-up sputum smear examination
• Previously treated TB cases
• TB patients with HIV co-infection
29-01-2018 17Dr Tanveer Rehman PSM JIPMER
19. Case scenario 4
4.2 Patient X had taken TB treatment three years back in RNTCP and declared
cured. Now he is having cough with sputum for three weeks duration? As per the
new guideline, what steps to be followed for management of TB?
29-01-2018 19
4.1 Patient X is having cough with sputum for three weeks duration. He is coming
from a high MDR-TB setting (MDR TB rate > 5% among new case or >20 % among
re-treatment cases). As per the new guideline, what steps to be followed for
management of TB?
Dr Tanveer Rehman PSM JIPMER
22. TREATMENT
Case definition : significant changes
1. Microbiologically confirmed TB case
2. Clinically diagnosed TB case
3. Microbiologically confirmed or clinically diagnosed cases of TB are
classified according to
i. Anatomical site of disease
ii. History of previous TB
iii. Drug resistance
2229-01-2018 Dr Tanveer Rehman PSM JIPMER
23. CASE DEFINITION
Previous guidelines New guidelines
New case: Never had treatment, or
has taken ATD for <1 month
New case: No change
Relapse Recurrent TB case: Declared as successfully treated -
subsequently found to be
microbiologically confirmed TB case
2329-01-2018 Dr Tanveer Rehman PSM JIPMER
24. CASE DEFINITION
Previous guidelines New guidelines
Failure: Previously received one month/more
ATD - sputum-positive at 5 months or more
Treatment after failure: Previously received
one month/more ATD - treatment failed at the
end of treatment
Default : Received treatment for TB for a
month/more - not taking ATD consecutively
for
2 months or more and found to have
smear-positive
Treatment after loss to follow-up: Previously
treated for TB for one month/more -
declared lost to follow-up in treatment and
subsequently found microbiologically
confirmed TB
29-01-2018 24Dr Tanveer Rehman PSM JIPMER
25. TREATMENT
Case definition : significant changes
Drug resistance
1. Mono resistance (MR)
2. Poly resistance (PDR)
3. Multi-drug resistance (MDR)
4. Rifampicin resistance (RR)
5. Extensive drug resistance (XDR)
2529-01-2018 Dr Tanveer Rehman PSM JIPMER
26. TREATMENT
Principle of treatment of TB has been shifted
1. Daily regimen
2. Fixed dose combination
3. Weight bands for adult: (Y,B,G,P)
4. No need for extension of IP
5. In the previous guidelines, extension of ATD in case of CNS and skeletal
TB was maximum 3 months
2629-01-2018 Dr Tanveer Rehman PSM JIPMER
27. TREATMENT REGIMEN
Type Intensive Phase Continuation Phase
CAT I (2) HRZE (4) HR
CAT II (2) HRZES + (1) HRZE (5) HRE
New Guidelines
CAT I (8 weeks) 4FDC (16 weeks) 3FDC
CAT II (8 weeks) 4FDC + S + (4 weeks) 4FDC (20 weeks) 3FDC
29-01-2018 27Dr Tanveer Rehman PSM JIPMER
33. Additions in the Treatment Card
FRONT BACK
1. NIKSHAY ID 1. Frequency
2. Aadhar No. 2. Formulation
3. Treatment adherence 3. Packaging
4. Source of treatment 4. Weight Bands
5. Number Screened 5. Height
6. Addiction 6. Adverse events
7. Follow up & findings
8. Nutrition support
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34. Drug Resistant TB in Pregnancy
29-01-2018 34Dr Tanveer Rehman PSM JIPMER
35. Intensified TB Case Finding (ICF)
1. Provider initiated activity
2. Early identification - high probability of having active TB
3. Screening & diagnosing – appropriate tests and strategies
4. Vulnerable groups to be offered upfront CBNAAT
5. Vulnerable group is any group of people in which the prevalence or incidence of TB is
significantly higher than in the general population.
6. Enhanced outreach – detect more cases
7. Passive screening – missed or delayed diagnosis
29-01-2018 35Dr Tanveer Rehman PSM JIPMER
37. ICT enabled adherence support - 99DOTS
1. Low-cost approach for monitoring and improving TB medication
adherence
2. First used under RNTCP - 2015 in high-burden ART TB-HIV – FDC
3. In 2016 - expanded to all ART Centres in India
4. Registered over 75,408 patients all over India. In Puducherry : IGMC&RI
5. Three key benefits: It reduces patients’ burden - improves the efficiency
of care providers - enables differentiated care
29-01-2018 37Dr Tanveer Rehman PSM JIPMER
38. Each ATD pack is wrapped in a custom envelope, which includes hidden
phone numbers that are visible only when doses are dispensed
29-01-2018 38Dr Tanveer Rehman PSM JIPMER
39. After taking daily medication, patients make a free call to the hidden toll-free
phone number, yielding high confidence that the dose was “in-hand” and has
been taken
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40. Program staff can login into www.99dots.org from their computer / mobile
(using Nikshay username and password) to see the patient adherence
29-01-2018 40Dr Tanveer Rehman PSM JIPMER
41. Treatment support program
1. Principle of direct observation
2. Short messaging service (SMS) gateway: Patient can report events like
pill consumption, S/E – incoming services in pre-recorded Interactive
voice response (IVR)
3. Innovatively designed cards: Doctors will give these - patient SMS to
CCC- reminders medication - incentives - follow up calls health tips
4. Patient compliance toolkit: Mobile app for reporting compliance using
audio/video/SMS
4129-01-2018 Dr Tanveer Rehman PSM JIPMER
42. FOLLOW UP
Clinical Long-term
1. Should be at least monthly
2. Patient may visit the clinical facility, or
3. The medical officer may conduct the
review when she/he visits the house of
the patient
4. To observe improvement of chest
symptoms, weight gain, control the
co-morbid conditions such as HIV and
diabetes and to monitor any adverse
reaction to ATD
1. After completion of treatment, the patient
should be followed up at the end of 6,
12, 18 and 24 months
2. Any clinical symptoms and/or cough,
sputum microscopy and/or culture
should be considered
29-01-2018 42Dr Tanveer Rehman PSM JIPMER
43. Treatment outcomes for drug susceptible TB patients
1. Cured : A microbiologically confirmed TB – smear or culture negative at the end of
complete treatment (Changed)
2. Treatment completed
3. Treatment success: TB patients either cured or treatment completed are accounted in
the treatment success (New addition)
4. Failure: A TB patient whose biological specimen is positive by smear or culture at the
end of the treatment (Changed)
5. Lost to follow-up: Treatment interrupted for one consecutive month or more
(New addition)
4329-01-2018 Dr Tanveer Rehman PSM JIPMER
44. Treatment outcomes for drug susceptible TB patients
6. Failure to respond: Paediatric TB – fails microbiological conversion / response clinically/
deteriorates after 12 weeks of compliant intensive phase; alternate diagnosis ruled out
(New addition)
7. Not evaluated : No treatment outcome is assigned (Former transfer out)
8. Treatment regimen changed : Previously, it was called as switched over to MDR
treatment
9. Died
4429-01-2018 Dr Tanveer Rehman PSM JIPMER
47. PUDUCHERRY
1. TU: Total 7 - 4 in Pondicherry, Rest 3 districts
2. DMC: Total 28 - Puducherry 22, Karaikal 3, Mahe 2, Yanam 1
3. Daily Dose started
4. Other than GHCD, JIPMER also performs CBNAAT/LPA
5. 1421 TB patients notified
6. ICT : Only ‘99 DOTS’ started : IGMC&RI
7. Incentives not given
8. BDQ not started
29-01-2018 47Dr Tanveer Rehman PSM JIPMER
48. SUMMARY
New guidelines
1. Daily regimen
2. Ethambutol in CP of both
categories I and II regimen
3. Fixed dose combination as per
weight band
4. No need of extension of IP
5. Follow-up-clinical, laboratory
investigation
6. Long-term follow-up up to 2
years
Previous guidelines
1. Intermittent regimen
2. Ethambutol in CP of category II
regimen only
3. No fixed dose, limited weight
band
4. Extension of IP for 1 month if
sputum is positive at the end of
IP
5. Follow-up-laboratory only
6. No long-term follow-up
4829-01-2018 Dr Tanveer Rehman PSM JIPMER