This document provides an overview of the history, epidemiology, and prevention of tuberculosis (TB). It discusses how TB was historically known by other names and was a common fatal disease until scientific discoveries in the 1800s proved it was caused by the bacterium Mycobacterium tuberculosis and was contagious. It also outlines the global burden of TB, how it is transmitted between people, diagnostic methods, treatment approaches including drug-resistant TB, and newer diagnostics.
Tuberculosis infection is very common in the world and the disease manifest when ever either the virulence of the organism increases or the resistance of the host goes down.it can affect any part of the body.the best method of control of tuberculosis is early diagnosis and treatment.despite international cooperation the problem of resistance in tuberculosis is increasing and great efforts are being made to tackle this problem both in diagnostic tools as well as in treatment modalities. the social factors also play a big role in the causation as well as emergence of resistance is concerned . a participatory approach is required to combat the problem.
www.slideshare.ne www.slideshare.ne Tuberculosis (TB) is fatal
contagious disease that affects the lungs and other part of body which is a public health problem but curable and preventable disease .
Caused organism : bacteria (Mycobacterium tuberculosis
Human : Mycobacterium tuberculosis
Pulmonary TB
Extra pulmonary TB
Animals : Mycobacterium Bovis
Bovine tuberculosis (TB) is a chronic disease of animals caused by a bacteria called Mycobacterium bovis, (M.bovis) which is closely related to the bacteria that cause human
Tuberculosis infection is very common in the world and the disease manifest when ever either the virulence of the organism increases or the resistance of the host goes down.it can affect any part of the body.the best method of control of tuberculosis is early diagnosis and treatment.despite international cooperation the problem of resistance in tuberculosis is increasing and great efforts are being made to tackle this problem both in diagnostic tools as well as in treatment modalities. the social factors also play a big role in the causation as well as emergence of resistance is concerned . a participatory approach is required to combat the problem.
www.slideshare.ne www.slideshare.ne Tuberculosis (TB) is fatal
contagious disease that affects the lungs and other part of body which is a public health problem but curable and preventable disease .
Caused organism : bacteria (Mycobacterium tuberculosis
Human : Mycobacterium tuberculosis
Pulmonary TB
Extra pulmonary TB
Animals : Mycobacterium Bovis
Bovine tuberculosis (TB) is a chronic disease of animals caused by a bacteria called Mycobacterium bovis, (M.bovis) which is closely related to the bacteria that cause human
measles is a important vaccine preventable disease in children and carries a high mortality in undernourishment children.it is also a candidate for eradication. proper diagnosis will go a long way in the control and eradication of measles
At the end of the session, the students shall be able to
Describe the HIV AIDS introduction, epidemiology of HIV AIDS, diagnosis of HIV AIDS, treatment of HIV AIDS and prevention control of HIV AIDS.
India is the highest TB burden country in the world & accounts for nearly 1/5th (20 per cent) of global burden of tuberculosis, 2/3rd of cases in SEAR. Every year approximately 1.8 million persons develop tuberculosis, of which about 0.8 million are new smear positive highly'- infectious cases.Annual risk of becoming infected with TB is 1.5 % and once infected there is 10 % life-time risk of developing TB disease
It gives all the important definitions used in infectious disease epidemiology and continues to elaborate on dynamics of disease transmission followed by prevention and control of infectious diseases.
measles is a important vaccine preventable disease in children and carries a high mortality in undernourishment children.it is also a candidate for eradication. proper diagnosis will go a long way in the control and eradication of measles
At the end of the session, the students shall be able to
Describe the HIV AIDS introduction, epidemiology of HIV AIDS, diagnosis of HIV AIDS, treatment of HIV AIDS and prevention control of HIV AIDS.
India is the highest TB burden country in the world & accounts for nearly 1/5th (20 per cent) of global burden of tuberculosis, 2/3rd of cases in SEAR. Every year approximately 1.8 million persons develop tuberculosis, of which about 0.8 million are new smear positive highly'- infectious cases.Annual risk of becoming infected with TB is 1.5 % and once infected there is 10 % life-time risk of developing TB disease
It gives all the important definitions used in infectious disease epidemiology and continues to elaborate on dynamics of disease transmission followed by prevention and control of infectious diseases.
Explore the intricate world of Tuberculosis with this comprehensive PowerPoint presentation. Uncover its origins, transmission, symptoms, diagnosis, treatment, and preventive measures. Engage your audience with informative visuals and charts, shedding light on the global impact of TB. Equip your audience with knowledge to raise awareness and foster a proactive approach towards combating this infectious disease.
MDR in Mycobacterium species by Parth AgarwalParth Agarwal
Introduction to MDR and MDR-TB. Types of MDR, History and Diagnostic methods, Antibiotics used and their Mechanism, Mechanism of resistance towards Antibiotics by the bacteria and Future Technologies
Intro to TB
epidemiology of TB
Structure of Mycobacterium TB
pathogenesis of TB
Immunosuppression by Mycobacterium TB
types of TB
Clinical manifestation
Diagnosis
Treatment
Bio303 Lecture 2 Two Old Enemies, TB and LeprosyMark Pallen
In this lecture I will focusing on another of the most serious infectious threats to humanity, tuberculosis, outlining its evolutionary origins, impact on human health and wealth and the steps taken to control and treat this infection. I will also discuss a related mycobacterial infection, leprosy and recent progress in its control.
Epidemiological Exercise for Undergraduate Medical Students. The exercise is based on Cohort Study, Case control study, Horrock's apparatus, Vital Indices.
It is an acute viral infection caused by an RNA virus belonging to Picornaviridae family under enterovirus genera.
It primarily infects human alimentary tract but may infect the CNS resulting in varying degrees of paralysis & possibly death.
It is discussed in the following headings:
1. Epidemiology of Poliomyelitis in children
2. Clinical spectrum of poliomyelitis
3. Clinical features/presentation of poliomyelitis in children
4. Treatment of Poliomyelitis in children
5. Prevention of Poliomyelitis in children
6. Eradication strategy of Poliomyelitis in children
A study design is a specific plan or protocol for conducting the study, which allows the investigator to translate the conceptual hypothesis into an operational one
Obesity is defined as an abnormal growth of the adipose tissue and or enlargement of fat cell size (hypertrophic obesity) or increase in fat cell number (hyperplastic obesity).
Obesity is often expressed in terms of body mass index (BMI)
Dengue is a self limited acute febrile condition and sometimes
haemorrhagic, primarily transmitted to the humans from
infected Aedes species ( Ae. aegypti or Ae. albopictus ).
Dengue Syndrome will be discussed in following headings
1.Epidemiology
2. Manifestation
3. Clinical presentation,
4. Diagnosis
5. Treatment
6. Prevention & Control
Infection caused by three closely related nematodes (W. bancrofti, B. malayi & B. timori) & transmitted to man by bite of infective mosquitos & clinically characterized by-
Lymphangitis, lymphadenitis, elephantiasis of genitals, legs & arms or
Pulmonary esonophilia or Filaria arthritis
CLINIC PRESENTATION
MANAGEMENT
PREVENTIVE MEASURES
FILARIALSURVEY
Malaria epidemiology, clinical features & treatmentDr. Animesh Gupta
Malaria is a protozoal disease caused by infection with
parasites of the genus Plasmodium and transmitted by
certain species of infected female Anopheles mosquito.
Experimental Epidemiology
1st Clinical trial
Basic steps in RCT
Randomization & its method
Manipulation/ Intervention
Types of RCT
Phases in Clinical trial
Hierarchy of epidemiological study
Concept of Association, Causation and Correlation
Association - Spurious, Indirect & Direct
Multi-factorial causation
Guidelines for Judging causality
Additional Criteria for Judging causality
What is Cohort?
Indication and Elements of Cohort Study.
What is Relative risk and Attributable risk, and its interpretation?
Advantages & disadvantages of Cohort study.
Difference between Case control & Cohort study.
Different types of epidemiological methods
Salient features of case control study
Steps for conducting case control study
Matching
Odds ratio
Bias in case control study
Advantages & disadvantages in case control study
Descriptive Epidemiology (including Measurement in epidemiology)Dr. Animesh Gupta
Basic measurement in epidemiology
Incidence & Prevalence
Tools of measurement in epidemiology
Epidemiological methods
Descriptive epidemiology.
Distribution of disease in term of Time, Place and Person
Epidemiology - Definition, History, Aims, Approach, Uses/Purpose.
"The study of the distribution and determinants of
health related states in specified populations , and
the application of this study to control of health
problems."
Screening is defined as the search for unrecognized disease or defect by means of rapidly applied tests , examinations or other procedures in apparently healthy individuals
Rheumatic Heart Disease (RHD) is one of the major causes of cardiovascular disease, accounting for nearly 25-45% of the acquired heart disease.
Rheumatic Fever (RF) is a febrile disease affecting connective tissue (heart) & joints. It is caused due to infection of the throat by group-A beta hemolytic streptococci.
It is NOT a communicable disease but results from communicable disease(streptococcal pharyngitis).
RF is the common cause of acquired heart disease in childhood and adolescence.
IMNCI (Integrated Management of Neonatal and Childhood illness) is an integrated approach to child health that focuses on the well-being of the whole child.
IMNCI strategy is one of the main interventions under RCH-II/NRHM, that focuses on Preventive, Promotive and Curative aspects of program.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
1. TUBERCULOSIS – History,
Epidemiology & Prevention
Dr. Animesh Gupta
MBBS, MD, FDM, FAGE
Assistant Professor
Dept. Of Community Medicine, SIMS & RC, Mangalore
1
Dr. Animesh Gupta Tuberculosis
2. History of TB
Historically known by a variety
of names, including:
Consumption
Wasting disease
White plague
TB was a death sentence for
many
2
Vintage image circa 1919
Image credit: National Library of Medicine
Dr. Animesh Gupta Tuberculosis
3. History of TB
Scientific Discoveries in 1800s
3
Until mid-1800s, many
believed TB was hereditary
1865- Jean Antoine-Villemin
proved TB was contagious
1882- Robert Koch discovered
M. tuberculosis, the bacterium
that causes TB
Mycobacterium tuberculosis
Image credit: Janice Haney Carr
Dr. Animesh Gupta Tuberculosis
4. History of TB
SANATORIUMS
Before TB antibiotics, many
patients were sent to
sanatoriums
Patients followed a
regimen of bed rest, open
air, and sunshine
TB patients who could not
afford sanatoriums often
died at home
4
Sanatorium patients resting outside
Dr. Animesh Gupta Tuberculosis
5. TB Management Early 19th Century5
Pre-antibiotic era: before 1940s (e.g., cod liver oils, bed rest, fresh air)Dr. Animesh Gupta Tuberculosis
6. TB History Timeline
6
1840 19201860 1900 1940 1960 1980 20001880
1993: TB cases decline due to
increased funding and
enhanced TB control efforts
Mid-1970s: Most TB
sanatoriums in U.S.
closed
1884:
First TB
sanatorium
established
in U.S.
1865:
Jean-Antoine
Villemin
proved TB is
contagious
1943:
Streptomycin
(SM) a drug
used to treat TB
is discovered
1882:
Robert Koch discovers
M. tuberculosis
Mid-1980s:
Unexpected rise in
TB cases
1943-1952:
Two more drugs are
discovered to treat
TB: INH and PAS
Dr. Animesh Gupta Tuberculosis
7. Introduction
Tuberculosis (TB) is an infectious bacterial
disease caused by Mycobacterium tuberculosis,
which most commonly affects the lungs.
It is transmitted from person to person via
droplets
7
Dr. Animesh Gupta Tuberculosis
9. Global burden of TB
In 2016
10.4 million – New TB cases
1.8 million died from the disease (0.4 million – HIV +ve)
4,80,000 people developed MDR-TB
1,73,000 deaths from MDR-TB.
60% of the new TB cases: India, Indonesia, China,
Nigeria, Pakistan, and South Africa.
9
Source: GLOBAL TUBERCULOSIS REPORT 2017 - WHO
Dr. Animesh Gupta Tuberculosis
11. Estimated burden of TB in India
Number (Lakhs)
Incidence 28
Mortality 4.8
HIV among estimated incident TB patients 1.1
Mortality of HIV- TB Patients 0.37
MDR-TB among notified pulmonary TB patients 1.3
11
Source : Annual TB 2017 Report, SEARO- WHO (www.tbcindia.gov.in)Dr. Animesh Gupta Tuberculosis
12. Epidemiological Factors
Agent factors
a. Agent
✓ M. tuberculosis
- Faculative intracellular
- Strains – Human & bovine
✓ Atypical myobacteria
- Photochromogens – M. kansasii
- Scotochromogens – M. scrofulaceum
- Non photochromogens – M. intercellulare
- Rapid growers – M.fortuitum
12
Dr. Animesh Gupta Tuberculosis
13. Epidemiological Factors….
b) Source of infection
▪ Human source – Sputum +ve case
▪ Bovine source – infected milk
c) Communicability
▪ Person is infective as long as they remain
untreated
▪ Effective treatment – reduces infectivity – 48 hrs
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Dr. Animesh Gupta Tuberculosis
14. Host Factors
Age-
All ages
Sex-
Male>Female, No heredity
Nutrition-
Malnutrition predispose to TB
Immunity-
CMI
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Dr. Animesh Gupta Tuberculosis
15. Social Factors
➢ Poor quality of life
➢ Poor housing
➢ Overcrowding
➢ Population explosion
➢ Large families
➢ Poverty, Illiteracy, Ignorance
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Dr. Animesh Gupta Tuberculosis
16. Mode of transmission
TB is spread person to person
through the air via droplet nuclei
M. tuberculosis may be expelled
when an infectious person:
Coughs
Sneezes
Speaks
Sings
Transmission occurs when another
person inhales droplet nuclei
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Dr. Animesh Gupta Tuberculosis
17. TB Transmission
17
Dots in air represent droplet nuclei containing
M. tuberculosis
Dr. Animesh Gupta Tuberculosis
18. TB Transmission
Probability that TB will be transmitted depends on:
Infectiousness of person with TB disease
Environment in which exposure occurred
Length of exposure
Virulence (strength) of the tubercle bacilli
The best way to stop transmission is to:
Isolate infectious persons
Provide effective treatment to infectious persons as
soon as possible
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Dr. Animesh Gupta Tuberculosis
19. Incubation Period
▪ 3-6 weeks
▪ Depends upon- closeness of contact, extent
of disease, sputum positivity, immunity of the
individual
19
Pathogenesis
▪ Primary TB
▪ Ghon’s focus
▪ Primary complex
▪ Secondary TB
Dr. Animesh Gupta Tuberculosis
20. Epidemiological indices
To measure the problem in a community
Planning and evaluation of control measures
Required for international comparisons
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Dr. Animesh Gupta Tuberculosis
21. Epidemiological indices……
a) Prevalence of infection
Percentage of individuals who show a positive
reaction to the standard tuberculin test.
b) Incidence of infection
Percentage of population under study who will
be newly infected by Mycobacterium
tuberculosis among the non infected of the
preceding survey during the course of one
year.
c) Prevalence of disease or case rate
Percentage of individuals whose is positive for
tubercle bacilli on microscopic examination
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Dr. Animesh Gupta Tuberculosis
22. Epidemiological indices……
d) Incidence of new cases
Percentage of new cases (confirmed by
bacteriological examination)Per 1,000
population occurring in one year
e) Prevalence of drug resistant cases
Those patients excreting tubercle bacilli
resistant to anti tubercular drugs
f) Mortality rate
Number of deaths from TB every year
per1000 or 100000 population
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Dr. Animesh Gupta Tuberculosis
23. Clinical Features
▪ Cough with expectoration > 2 weeks
▪ Evening rise temperature
▪ Loss of weight
▪ Hemoptysis
▪ Chest pain
▪ Failure to thrive
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Dr. Animesh Gupta Tuberculosis
30. Treatment
Anti-tuberculosis drugs should be
✓ highly effective
✓ free from side effects
✓ easy to administer
✓ reasonably cheap
Classification-
Bactericidal drugs
Rifampicin, INH, Streptomycin, Pyrazinamide
Bacteriostatic drugs
Ethambutol, Thioacetazone
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Dr. Animesh Gupta Tuberculosis
31. Treatment (DOTS Regimens)
Category of
Treatment
Type of Patient Regimen*
Category I All new pulmonary (smear-positive
and negative), extra pulmonary and
‘others’ TB patients.
2H3R3Z3E3+
4H3R3
Category II TB patients who have had more than
one month anti-tuberculosis
treatment previously
Relapse , Failure, Treatment After Default,
Others
2H3R3Z3E3S3 +
1H3R3Z3E3 +
5H3R3E3
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Dr. Animesh Gupta Tuberculosis
32. Childhood TB
The newer weight bands are 6-8 kg, 9-12 kg, 13-16 kg, 17-
20 kg, 21-24 kg and 25-30 kg.
Chemoprophylaxis for children under 6 years: isoniazid
(5mg/kg) for 6 months
32
Rifampicin 10-12 mg/kg (max 600 mg/day)
Isoniazid 10 mg/kg (max 300 mg/day)
Ethambutol 20-25mg/kg (max 1500
mg/day)
Pyrazinamide 30-35mg/kg (max 2000
mg/day)
Streptomycin 15 mg/kg (max 1gm/day)Dr. Animesh Gupta Tuberculosis
34. Drug-Resistant TB
Caused by M. tuberculosis
organisms resistant to at least
one TB treatment drug
Isoniazid (INH)
Rifampin (RIF)
Pyrazinamide (PZA)
Ethambutol (EMB)
Resistant means drugs can no
longer kill the bacteria
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Dr. Animesh Gupta Tuberculosis
35. Drug-Resistant TB…
Primary
Resistance
Caused by person-to-person
transmission of drug-resistant
organisms
Secondary
Resistance
Develops during TB treatment:
• Patient was not
given appropriate
treatment regimen
OR
• Patient did not
follow treatment regimen as
prescribed
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Dr. Animesh Gupta Tuberculosis
36. Drug-Resistant TB….
Mono-resistant Resistant to any one TB treatment
drug
Poly-resistant Resistant to at least any 2 TB drugs
(but not both isoniazid and rifampin)
Multidrug
resistant
(MDR TB)
Resistant to at least isoniazid and
rifampin, the 2 best first-line TB
treatment drugs
Extensively
drug resistant
(XDR TB)
Resistant to isoniazid and rifampin,
PLUS resistant to any fluoroquinolone
AND at least 1 of the 3 injectable
second-line drugs (e.g., amikacin,
kanamycin, or capreomycin)
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Dr. Animesh Gupta Tuberculosis
37. Drug Resistant TB Treatment
For MDR-TB : Daily DOT includes (6-9m) Kanamycin,
Levofloxacin, Cycloserine, Ethionamide,
Pyrazinamide, and Ethambutol. (18m) Levofloxacin,
Cycloserine, Ethionamide, Ethambutol
For XDR-TB : (6-12m) Capreomycin, PAS (Para-
Aminosalicylate Sodium), Moxifloxacin, High dose
INH, Clofazimine, Linezolid, and Amoxy- Clavulanic
Acid. (18m) all the above drugs except
Capreomycin
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Dr. Animesh Gupta Tuberculosis
43. Recent advances in Treatment
Daily drug treatment – 5 states- Maharashtra,
Bihar, Kerala, Himachal Pradesh and Sikkim -
February 2016.
Introduction of new anti TB drug under RNTCP-
Bedaquiline
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Dr. Animesh Gupta Tuberculosis
44. Bedaquiline
Introduction of new anti TB drug under RNTCP
highly bound to plasma proteins and hepatically
metabolized.
Extended half-life : present in the plasma up to 5.5
months post stopping BDQ.
No cross-resistance with existing first- and second-line
anti-TB drugs
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Dr. Animesh Gupta Tuberculosis
45. Criteria For Patients To Receive
Bedaquiline
Adults aged > 18 years having pulmonary MDR-TB.
MDR TB with resistance to Second line injectable drugs or
Fluroquinolones.
XDR TB
Treatment failures of MDR/XDR TB or MDR TB
Females should not be pregnant, or should be using
effective non-hormone-based birth control methods.
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Dr. Animesh Gupta Tuberculosis
46. Bedaquiline
Dosage:
400 mg daily – 2 weeks followed by
200mg 3 times a week – 3 to 24 weeks
All patients would be counselled and managed indoor
for a mandatory period of 2 weeks to complete the
initial 2 weeks of BDQ doses.
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Dr. Animesh Gupta Tuberculosis
47. References
1. A brief history of tuberculosis control in India. Geneva, Switzerland: World Health
Organisation; 2010.
2. Revised National TB Control Program : Annual Status Report 2016. New Delhi:
Central TB Division, 2017.
3. Global Tuberculosis Report 2016, WHO
4. http://www.who.int/tb/strategy/stop_tb_strategy/en/
5. http://www.who.int/topics/tuberculosis/en
6. Park Textbook of Preventive & Social Medicine, 23rd Edition
7. Tuberculosis: Current Situation, Challenges and Overview of its Control Programs in
India: Journal of Global Infectious Disease 2011 Apr-Jun; 3(2): 143–150
8. TB INDIA 2017, Revised National TB Control Programme, Annual Status Report 2017
(Available from: http://www.tbcindia.nic.in/Pdfs/TB%20INDIA%202014.pdf)
9. TB EliminationTreatment of Multidrug-Resistant Tuberculosis: Bedaquiline.
(Available from :
https://www.cdc.gov/tb/publications/factsheets/treatment/multidrug-resistant-
tuberculosis-bedaquiline )
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Dr. Animesh Gupta Tuberculosis
48. World TB Day – 24th March 2017
THANK YOU
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Dr. Animesh Gupta Tuberculosis