While the world was focused on covid 19, WHO has made and issued consolidated guidelines making changes in how to prevent, diagnose and treat tuberculosis.
CME Lecture on "COVID-19 Presentation and Diagnosis"
Presented at the Scientific Seminar of Philippine American Medical Association in Chicago on March 6th, 2021.
PATTERN OF HOSPITAL-ACQUIRED PNEUMONIA IN INTENSIVE CARE UNIT OF SUEZ CANAL U...Khaled Mohamed
Hospital-acquired pneumonia occurs more than 48 h after hospital admission and was not present at the time of admission, while ventilator-associated pneumonia occurs
after 48–72 h of endotracheal intubation or within 48 h of extubation. HAP is the second most common nosocomial infection and accounts for approximately 25% of all infections in the Intensive
Care Unit worldwide.
Catridge based nucleic acid amplification test(CBNAAT) / RIF assay gene xpert POWER PONT. other normal tests versus CBNAAT. issues for cbnaat by WHO & CONCLUSION.
To Present an up-to-date summary of the best microbiology practice related to malaria diagnostics
PGY-3, IAU Clinical Microbiology Residency
Dammam, KSA
COVID 19- Basics beyond Basics by Dr. Brij Teli doc2rock
COVID-19: Basics Beyond Basics, is a concise presentation on Some Salient aspects and facts about Management of COVID-19 as per the Evidence based information on the day of Webinar.
Video of Webinar available at:
https://youtu.be/fjlgVzvwhM4
Can Join Telegram Group for Discussion: https://t.me/covindia
Target Audience being- Resident Doctors of Medicine, Pulmonary Medicine, Anesthesia, Pharmacology as well as Undergraduate Medical Students, Interns and HealthCare Workers from Various States of India as well as Outside India.
Covers aspects Like- Maskology, COVID-19 Antigen Detection Test, X-Ray & CT Findings of COVID-19, Cytokine Storm, Tocilizumab, Steroids & Recovery Trial, Covid Associated Coagulopathy(CAC), Hydroxychloroquine & the Controversies, Remdesivir, Convalescent Plasma, Awake Non-Intubated Prone Positioning, Thromboprophylaxis in COVID-19 including calculating SIC Score, Newer Trials and Publications, COVID-19 Vaccine Status, Favipiravir.
The bacteria that cause tuberculosis (TB) can develop resistance to the antimicrobial drugs used to cure the disease. Multidrug-resistant TB (MDR-TB) is TB that does not respond to at least isoniazid and rifampicin, the 2 most powerful anti-TB drugs.
The 2 reasons why multidrug resistance continues to emerge and spread are mismanagement of TB treatment and person-to-person transmission. Most people with TB are cured by a strictly followed, 6-month drug regimen that is provided to patients with support and supervision. Inappropriate or incorrect use of antimicrobial drugs, or use of ineffective formulations of drugs (such as use of single drugs, poor quality medicines or bad storage conditions), and premature treatment interruption can cause drug resistance, which can then be transmitted, especially in crowded settings such as prisons and hospitals.
In some countries, it is becoming increasingly difficult to treat MDR-TB. Treatment options are limited and expensive, recommended medicines are not always available, and patients experience many adverse effects from the drugs. In some cases even more severe drug-resistant TB may develop. Extensively drug-resistant TB, XDR-TB, is a form of multidrug-resistant TB with additional resistance to more anti-TB drugs that therefore responds to even fewer available medicines. It has been reported in 117 countries worldwide.
Drug resistance can be detected using special laboratory tests which test the bacteria for sensitivity to the drugs or detect resistance patterns. These tests can be molecular in type (such as Xpert MTB/RIF) or else culture-based. Molecular techniques can provide results within hours and have been successfully implemented even in low resource settings.
New WHO recommendations aim to speed up detection and improve treatment outcomes for MDR-TB through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen. At less than US$ 1000 per patient, the new treatment regimen can be completed in 9–12 months. Not only is it less expensive than current regimens, but it is also expected to improve outcomes and potentially decrease deaths due to better adherence to treatment and reduced loss to follow-up.
Solutions to control drug-resistant TB are to:
cure the TB patient the first time around
provide access to diagnosis
ensure adequate infection control in facilities where patients are treated
ensure the appropriate use of recommended second-line drugs.
In 2015, an estimated 480 000 people worldwide developed MDR-TB, and an additional 100 000 people with rifampicin-resistant TB were also newly eligible for MDR-TB treatment. India, China, and the Russian Federation accounted for 45% of the 580 000 cases. It is estimated that about 9.5% of these cases were XDR-TB.
CME Lecture on "COVID-19 Presentation and Diagnosis"
Presented at the Scientific Seminar of Philippine American Medical Association in Chicago on March 6th, 2021.
PATTERN OF HOSPITAL-ACQUIRED PNEUMONIA IN INTENSIVE CARE UNIT OF SUEZ CANAL U...Khaled Mohamed
Hospital-acquired pneumonia occurs more than 48 h after hospital admission and was not present at the time of admission, while ventilator-associated pneumonia occurs
after 48–72 h of endotracheal intubation or within 48 h of extubation. HAP is the second most common nosocomial infection and accounts for approximately 25% of all infections in the Intensive
Care Unit worldwide.
Catridge based nucleic acid amplification test(CBNAAT) / RIF assay gene xpert POWER PONT. other normal tests versus CBNAAT. issues for cbnaat by WHO & CONCLUSION.
To Present an up-to-date summary of the best microbiology practice related to malaria diagnostics
PGY-3, IAU Clinical Microbiology Residency
Dammam, KSA
COVID 19- Basics beyond Basics by Dr. Brij Teli doc2rock
COVID-19: Basics Beyond Basics, is a concise presentation on Some Salient aspects and facts about Management of COVID-19 as per the Evidence based information on the day of Webinar.
Video of Webinar available at:
https://youtu.be/fjlgVzvwhM4
Can Join Telegram Group for Discussion: https://t.me/covindia
Target Audience being- Resident Doctors of Medicine, Pulmonary Medicine, Anesthesia, Pharmacology as well as Undergraduate Medical Students, Interns and HealthCare Workers from Various States of India as well as Outside India.
Covers aspects Like- Maskology, COVID-19 Antigen Detection Test, X-Ray & CT Findings of COVID-19, Cytokine Storm, Tocilizumab, Steroids & Recovery Trial, Covid Associated Coagulopathy(CAC), Hydroxychloroquine & the Controversies, Remdesivir, Convalescent Plasma, Awake Non-Intubated Prone Positioning, Thromboprophylaxis in COVID-19 including calculating SIC Score, Newer Trials and Publications, COVID-19 Vaccine Status, Favipiravir.
The bacteria that cause tuberculosis (TB) can develop resistance to the antimicrobial drugs used to cure the disease. Multidrug-resistant TB (MDR-TB) is TB that does not respond to at least isoniazid and rifampicin, the 2 most powerful anti-TB drugs.
The 2 reasons why multidrug resistance continues to emerge and spread are mismanagement of TB treatment and person-to-person transmission. Most people with TB are cured by a strictly followed, 6-month drug regimen that is provided to patients with support and supervision. Inappropriate or incorrect use of antimicrobial drugs, or use of ineffective formulations of drugs (such as use of single drugs, poor quality medicines or bad storage conditions), and premature treatment interruption can cause drug resistance, which can then be transmitted, especially in crowded settings such as prisons and hospitals.
In some countries, it is becoming increasingly difficult to treat MDR-TB. Treatment options are limited and expensive, recommended medicines are not always available, and patients experience many adverse effects from the drugs. In some cases even more severe drug-resistant TB may develop. Extensively drug-resistant TB, XDR-TB, is a form of multidrug-resistant TB with additional resistance to more anti-TB drugs that therefore responds to even fewer available medicines. It has been reported in 117 countries worldwide.
Drug resistance can be detected using special laboratory tests which test the bacteria for sensitivity to the drugs or detect resistance patterns. These tests can be molecular in type (such as Xpert MTB/RIF) or else culture-based. Molecular techniques can provide results within hours and have been successfully implemented even in low resource settings.
New WHO recommendations aim to speed up detection and improve treatment outcomes for MDR-TB through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen. At less than US$ 1000 per patient, the new treatment regimen can be completed in 9–12 months. Not only is it less expensive than current regimens, but it is also expected to improve outcomes and potentially decrease deaths due to better adherence to treatment and reduced loss to follow-up.
Solutions to control drug-resistant TB are to:
cure the TB patient the first time around
provide access to diagnosis
ensure adequate infection control in facilities where patients are treated
ensure the appropriate use of recommended second-line drugs.
In 2015, an estimated 480 000 people worldwide developed MDR-TB, and an additional 100 000 people with rifampicin-resistant TB were also newly eligible for MDR-TB treatment. India, China, and the Russian Federation accounted for 45% of the 580 000 cases. It is estimated that about 9.5% of these cases were XDR-TB.
Constance A. Benson, MD, director of the UC San Diego AntiViral Research Center, presents "New Drugs and Novel Approaches to Treatment Shortening for Drug-Susceptible and Drug-Resistant TB" for AIDS Clinical Rounds at UC San Diego
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
clinical standards for ds tb treatment 2022 (1).pptxPathKind Labs
To diagnose and treat drug susceptible pulmonary tuberculosis is of paramount importance in our efforts to eliminate tuberculosis. This describes seven clincal standards which should be practiced to obtain optimum results
ISO 15189 2022 standards for laboratory quality and competencePathKind Labs
The fourth edition of standards for laboratory quality and competence are available. Labs need to perform gap analysis to identify areas that need to be developed to fulfill the new requirements.
recently the fourth edition of ISO 15189 2022 have been released. It has aligned itself to its parent document ISO 17025 and focused on risk assessment
management of childhood tuberculosis in 2023.pptxPathKind Labs
diagnosis of childhood TB is a challange, but if we follow a system of screening and then appropriate diagnostic tests following contact tracing, we are likely to identify children with infection or disease and put them on appropriate treatment.
Recently ISO 15189:2022 have become available. This would help laboratories set up processes which would yield reproducible results and improve the quality of work.
viral markers in diagnosis monitoring and treatment of hepatitis b and c.pptxPathKind Labs
Hepatitis B Virus and Hepatitis C Virus infections are transmitted by parentral route. Early diagnosis and treatment can prevent cirrhosis of liver in HCV cases as drugs which can cure the infection are now available.
Covid-19 pandemic has caused over 6 million deaths and has been acknowledged as one of the worst pandemic in living memory. But antimicrobial resistance as invisble pandemic may clain more deaths every year if suitable action is not taken soon.
While MIC is a good measure of antibiotic activity, it is static and reflects in vitro activity. PK and PD of the drug needs to be considered together with MIC if we wish to obtain an in vivo prediction of drug action and success.
what is new in prevention, diagnosis and treatment of tuberculosis tb short.pptxPathKind Labs
Many changes have been made recently in Tuberculosis. The first important change is that instead of control now the focus is on eradication. for that to happen we need to change the way we detect, diagnose and treat tuberculosis.
Procalcitonin is an excellent biomarker for antibiotic use in bacterial infections alone. POCT guided PCT levels can help decide whether to add antibiotics or not in opd settings for respiratory tract infection.
Understanding and implementing quality management system in medical laboratoriesPathKind Labs
QMS is essential to run a good laboratory, but the various requirements pose a big challenge. Once you understand the reason for these requirements compliance may be easier.
RT PCR is too slow for effective control of spread of cov 2 infection, rapid antigen test by giving results in less than 30 minutes can help identify infected persons leading to quick isolation.Lack of sensitivity can be compensated by repeating RAT after a day or so.
investigation of infertility with focus on genetic basis of infertilityPathKind Labs
Infertility if quite common. Understanding genetic basis of infertility can help in making the right decision on what diseases can be transmitted to the offspring and which IVF technique would be most helpful in overcoming infertility.
Diagnosis of tuberculosis by direct demonstration of the pathogen or by indirect demonstration of cell mediated immunity through activation of CD 4 and / or CD 8 T lymphocytes.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
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!
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.
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
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
what is new in tuberculosis
1. Tuberculosis is a disease of great antiquity
What is new in TB diagnosis, Treatment & Prevention
2.
3.
4.
5.
6.
7. THE PRINCIPLES OF THE STRATEGY
• Government stewardship and accountability with monitoring and
evaluation
• Strong coalition with civil society organizations and communities
• Protection and promotion of human rights, ethics and equity
• Adaptation of the strategy and targets at country level, with global
collaboration
• Pillar 1. INTEGRATED, PATIENT-CENTRED CARE AND PREVENTION
• Pillar 2. BOLD POLICIES AND SUPPORTIVE SYSTEMS
• Pillar 3. INTENSIFIED RESEARCH AND INNOVATION
15. What is new in TB ?
Change in classification of anti TB drugs
• Evidence has been accumulating that second line drug regimen
containing injectable aminoglycosides: kanamycin &/or Capreomycin
• Higher treatment failure
• Higher relapse rate
• Higher mortality & toxicity
• Success of BpaL & its registration with USA FDA indicated that it was
possible to have all oral treatment for DR TB
16. Group A Group B Group C
Include all three if possible Include one or both Make up depending upon resistance
Levofloxacin Lfx or Clofazimine Cfz Ethambutol E
Moxifloxacin Mfx Cycloserine Cs or Delamanid Dlm
Bedaquiline Bdq Terizidone Trd Pyrazinamide Z
Linezolid Lzd Imipenem-cilastatin Ipm- Cln or
Meropenem Mpm
Amikacin Am or
Streptomycin S
Ethionamide Eto or
Prothionamide Pto
Para amino salicyclic acid PAS
What is new in TB ?
Change in classification of anti TB drugs
Second Line
18. Grouping of
medicines
Medicine CB E2E LPA tNGS WGS pDST pBMD
First Line Drugs RIF x z x z z x z
INH z z x z z x z
EMB z z x z
PZA z z z x z
Group A Lfx / Mfx z x z z x z
BDQ x z z x z
LZD z z x z
Group B Cfz z z x z
CS
Group C Dlm z z x z
IMP Cln/MPM
Amk/ S z x z z x z
Eto / Pto z z x z
What is new in TB ?
Spectrum of diagnostics endorsed by WHO
X = endorsed; Z = in process
19. What is new in TB ?
Definition of pre XDR & Updated definition of XDR-TB
• Pre-XDR-TB: TB caused by Mycobacterium tuberculosis (M. tuberculosis)
strains that fulfil the definition of MDR/RR-TB and that are also resistant to
any fluoroquinolone
• XDR-TB: TB caused by Mycobacterium tuberculosis (M. tuberculosis)
strains that fulfil the definition of MDR/RR-TB and that are also resistant to
any fluoroquinolone and at least one additional Group A drug
20. • Key findings: High diagnostic accuracy and improved patient outcomes confirmed
for Xpert MTB/RIF as initial test to diagnose pulmonary TB (i.e. replacing smear
microscopy) and to simultaneously detect rifampicin resistance
• Intervention: Xpert MTB/RIF as replacement for sputum smear microscopy
(bacteriological culture as reference standard)
• Results also showed improved patient-important outcomes (cure rates, reduced
mortality and reduced pre-treatment loss) when Xpert MTB/RIF replaced
microscopy as the initial diagnostic test.
• Sensitivity 85% (smear + or --); specificity 98%
• Sensitivity for HIV infected persons 81%, specificity 98 %
• RR Detection: High overall sensitivity (96%) and specificity (98%) when compared
to phenotypic drug susceptibility testing.
21. High diagnostic accuracy of Xpert Ultra as initial test to
diagnose pulmonary TB (i.e. replacing smear microscopy)
and to simultaneously detect rifampicin resistance
• Intervention: Xpert Ultra as replacement for sputum smear microscopy
(bacteriological culture as reference standard)
• Results: High diagnostic accuracy of Xpert Ultra in adults with pulmonary TB:
Overall sensitivity (including ‘trace’ calls as positive) was 90% in all specimens
(smear-positive and smear-negative).. Excluding ‘trace’ calls resulted in a slight
increase in specificity to 98%. Sensitivity in sputum specimens from HIV co-
infected participants was 88% while specificity was retained at 95%.
• Intervention: Xpert Ultra for simultaneous detection of rifampicin resistance
(phenotypic drug susceptibility testing as reference standard)
• Results: High overall sensitivity (94%) and specificity (99%) when compared to
phenotypic drug susceptibility testing.
22. Use of Xpert MTB/RIF and Xpert Ultra to diagnose TB and
detect rifampicin resistance in children from sputum, stool,
nasopharyngeal and gastric specimens
• Intervention: Xpert MTB/RIF or Xpert Ultra as initial diagnostic test
for TB in children (bacteriological culture as reference standard)
• Results: Sensitivity varied by specimen type (46% for nasopharyngeal
specimens; 61% for stool; 65% for sputum; and 73% for gastric
specimens). Specificity for all specimens varied from 98% to 100%.
• Intervention: Xpert MTB/RIF to detect rifampicin resistance in
children (phenotypic drug susceptibility as reference standard)
• Results: High overall sensitivity (90%) and specificity (98%) when
compared to phenotypic drug susceptibility testing.
23. Use of Xpert MTB/RIF and Xpert Ultra to diagnose TB and detect
rifampicin resistance in adults with extra-pulmonary TB
• Intervention: Xpert MTB/RIF as initial diagnostic test in adults with extra-
pulmonary TB (bacteriological culture as reference standard)
• Results: Sensitivity of Xpert MTB/RIF varied by specimen type (from 50% for
pleural fluid up to 97% for synovial fluid). The specificity of Xpert MTB/RIF also
varied by specimen type (from 79% for lymph node biopsy up to 99% for pleural
fluid).
• Intervention: Xpert Ultra as initial diagnostic test in adults with extra-pulmonary
TB (bacteriological culture as reference standard)
• Results: Sensitivity of Xpert Ultra varied by specimen type (from 71% for pleural
fluid up to 100% for lymph node biopsy). The specificity of Xpert Ultra also
varied by specimen type (from 71% for pleural fluid up to 100% for urine).
• Detection of Rif Resistance: Data showed overall high performance of both
assay for detection of rifampicin resistance: sensitivity 96-97% and specificity
99%.
24. High diagnostic accuracy of Truenat as initial test to
diagnose TB (i.e. replacing sputum smear microscopy) and to
sequentially detect rifampicin resistance
• Intervention: Truenat MTB and MTB Plus as replacement for sputum smear
microscopy (bacteriological culture as reference standard)
• Results: Overall sensitivity of the Truenat MTB assay was 83% and that of the
MTBPlus assay 89%. Specificity was 99% for the MTB and 98% for the MTBPlus
assay.
• Intervention: Truenat MTB-Rif Dx for sequential detection of rifampicin
resistance (phenotypic drug susceptibility testing as reference standard)
• Results: Sensitivity of the Truenat MTB-Rif Dx assay was 93% and specificity
was 95%.
25. • Key Changes Recommended: Shorter, all-oral, bedaquiline-containing
regimen for eligible MDR/RR-TB patients
• Replacing the injectable with bedaquiline resulted in significantly better
treatment success and a considerable reduction in loss-to-follow up in
MDR/RR-TB patients without previous exposure to second-line drugs and
with confirmed fluoroquinolone susceptible disease. The outcomes were
similar irrespective of HIV status.
• The evidence assessment showed that in eligible MDR/RR-TB patients a
shorter, all-oral, bedaquiline-containing regimen may be used instead of the
standardized shorter regimen with an injectable
26. Novel treatment regimen - BPaL
• The BPaL regimen showed high treatment success when used in XDR-TB
patients in South Africa.
• Limitations in study design and the small number of participants (108),
• observed adverse events (including blood disorders, liver toxicity, peripheral
and optic neuropathy) preclude programmatic implementation of the regimen
worldwide until additional evidence has been generated.
• However, BPaL regimen may be used under operational research conditions
conforming to WHO standards
• (patient-centered care and support,
• proper patient inclusion,
• principles of good clinical practice,
• active drug safety monitoring and management, treatment monitoring,
• outcome evaluation and comprehensive,
• standardized data collection).
27. • In individual patients for whom design of an effective regimen based on
existing recommendations is not possible,
• the BPaL regimen may offer benefits despite potential harms and may be
considered under prevailing ethical standards.
BPaL : Bedaquiline 400 mg QID 2 wks &
200 mg TDS 24 wks
Pretomanid 200 mg QID 26 wks
Linezolid 1200 mg OD 26 wks
• In such patients the use of BPaL should be accompanied by
• individual consent,
• adequate counselling on potential benefits and harms and
• active monitoring and management of adverse events.
• Patients should also be advised that reproductive toxicities have been observed in animal
studies and that the potential effects on human male fertility have not been adequately
evaluated at this point in time.
28. Summary of key changes to Treatment
• MDR/RR-TB patients with extensive TB disease, severe forms of extra-pulmonary TB,
those with resistance to fluoroquinolones or
• who have been exposed to treatment with second-line drugs
• will benefit from an individualized longer regimen designed using the WHO priority
grouping of medicines
• For MDR/RR-TB patients without previous exposure to second-line treatment
(including bedaquiline), without fluoroquinolone resistance and no extensive TB
disease or severe extra-pulmonary TB,
• the preferred treatment option is a shorter, all-oral, bedaquiline-containing regimen.
In this group of patients, national TB programmes are advised to phase out use of the
injectable-containing shorter regimen.
• Access to rapid drug susceptibility testing, especially for ruling out fluoroquinolone
resistance, is required before starting the shorter, all-oral, bedaquiline-containing
MDR-TB regimen
29. • BPaL regimen may be used under operational research conditions in
patients with XDR-TB who have not had previous exposure to bedaquiline
and linezolid (defined as less than two weeks).
• This regimen may not be considered for programmatic use worldwide until
additional evidence on efficacy and safety has been generated.
• However, in individual patients for whom design of an effective regimen
based on existing recommendations is not possible, BPal regimen may be
considered as a last resort under prevailing ethical standards.
• Decisions made according to patient preference and clinical judgement, also
considering the results of susceptibility testing, patient treatment history
and severity and site of the disease.
• All treatment should be delivered under WHO-recommended standards,
• including patient-centered care and support,
• informed consent where necessary,
• principles of good clinical practice,
• active drug safety monitoring and management, and
• regular patient monitoring to assess regimen effectiveness
30. Rapid Communication
on forthcoming changes to the programmatic
management of tuberculosis preventive treatment
• Requires programmatic coordination at several key steps
• identifying individuals at highest risk,
• testing them for infection,
• excluding active TB disease,
• choosing the treatment option that is best suited to an individual,
• managing adverse drug reactions,
• supporting medication adherence and monitoring programmatic performance.
• one month of daily rifapentine plus isoniazid (“1HP”) and
• another regimen of four months of daily rifampicin (“4R”) are now proposed as TPT
options for both high- and low- TB incidence settings.
• aligning the durations of certain regimens to the ones most often used; and merging
the four previous algorithms into one
• Will be released in WHO Consolidated TB guidelines