1. Categorization of H1N1 Cases in India 2014-15

Category A patients: Mild fever plus cough/sore throat with or without body ache, headache, diarrhea and vomiting Do not require Oseltamivir Treat symptomatically Patients be monitored for their progress and reassessed at 2448 hours No testing of the patient for H1N1 is required Patientsshouldconfinethemselvesathomeandavoidmixingupwithpublicandhighriskmembersinthefamily.Category B patients: In addition to all the signs and symptoms mentioned under Category-A, if the patient has,1. Highgradefeverandseveresorethroat

Home isolation and Oseltamivir2. One ormore of the high risk conditions:Childrenwithmild illness butwith predisposing risk factors/Pregnant

women/Personsaged65yearsorolder/Patientswithlungdiseases,heartdisease,liverdisease,kidneydisease,blooddisorders, diabetes, neurological disorders, cancer and HIV/AIDS/Patients on long term cortisone therapy Oseltamivir No tests for H1N1 is required Patientsshouldconfinethemselvesathomeandavoidmixingwithpublicandhighriskmembersinthefamily.

Category C patients: In addition to the above signs and symptoms of Category-A and B, if the patient has, 1. Breathlessness,chestpain,drowsiness,fallinbloodpressure,sputummixedwithblood,bluishdiscolorationofnails2. Childrenwithinfluenzalikeillnesswhohadaseverediseaseasmanifestedbytheredflagsigns(Somnolence,highand

persistentfever,inabilitytofeedwell,convulsions,shortnessofbreath,difficultyinbreathing,etc)3. Worseningofunderlyingchronicconditions

Testing,immediatehospitalizationandtreatment.

(Source: MOHFW Guidelines, Government of India)

2. Mission Indradhanush 2014

Launch

25 December 2014Description

Indradhanush depicting seven colors of the rainbow, aims to cover all those children by 2020 who are either unvaccinated, orarepartiallyvaccinatedagainst7vaccinepreventablediseases(7 VPDs)

Diphtheria Pertussis Tetanus Childhood Tuberculosis Poliomyelitis Hepatitis B Measles.

Strategy

Focusedandsystematicimmunizationdrive:Catch-upcampaignmodetocoverallthechildrenwhohavebeenleft/missedout.

4specialvaccinationcampaigns:January-June2015withintensiveplanningandmonitoring. LearningofPolioprogram:Applyinplanningandimplementation. Coverage:

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Firstphase:201districts Secondphase:297districts 82districtsin4statesofUP,Bihar,MadhyaPradeshandRajasthan.

(Source: Mission Indradhanush, MoHFW, Government of India)

3. New Revised Guidelines for Treatment of MDR-TB and XDR-TB (RNTCP 2015)

I. MDR-TB Regimen

Intensive Phase: 6-9(KLCZEEt)+Continuation Phase: 18(LCEEt)(KKanamycin;LLevofloxacin;CCycloserine;ZPyrazinamide;EEthambutol;EtEthionamide).

II. XDR-TB Regimen

Intensive Phase: 6-12(HCmCzLAMP)+Continuation Phase: 18(HCzLAMP)(HHighdoseIsoniazid;CmCapreomycin;CzClofazimine;LLinezolid;AAmoxy-Clav;MMoxifloxacin;PPAS).

(Source: Resistant TB Programmatic Management Guidelines in India, MOHFW, GOI)

4. New Revised Definitions under RNTCP (2014-15)

4 A. NEW CASE DEFINITIONS

PresumptiveTB:PatientwhopresentswithsymptomsorsignssuggestiveofTB(previouslyknownasaTBsuspect) BacteriologicallyconfirmedTB:Abiologicalspecimenispositivebysmearmicroscopy,cultureorWRD(suchasXpert

MTB/RIF) Clinically diagnosed TB: Does not fulfil the criteria for bacteriological confirmation but has been diagnosedwith

activeTBbyaclinicianorothermedicalpractitioner(includescasesdiagnosedonthebasisofX-rayabnormalitiesorsuggestivehistologyandextrapulmonarycaseswithoutlaboratoryconfirmation).

4 A1. Classification based on anatomical site of disease

Pulmonarytuberculosis(PTB):AnybacteriologicallyconfirmedorclinicallydiagnosedcaseofTBinvolvingthelungparenchymaorthetracheobronchialtree(E.g.MiliaryTB)

Extrapulmonary tuberculosis (EPTB):Anybacteriologically confirmedor clinicallydiagnosed case of TB involvingorgansotherthanthelungs(E.g.Tuberculousintra-thoraciclymphadenopathy,Tuberculouspleuraleffusion).

4 A2. Classification based on history of previous TB treatment (Patient registration group)

Newpatients:HaveneverbeentreatedforTBorhavetakenanti-TBdrugs 1 month or more of anti-TB drugs

Relapsepatients:PreviouslybeentreatedforTB,weredeclaredcuredortreatmentcompleted,andisnowdiagnosedwith a recurrent episode of TB

Treatment after failure patients:Whohavepreviously been treated for TB, and treatment failed at the end oftreatment

Treatmentafterlosstofollow-uppatients:PreviouslybeentreatedforTBandweredeclaredlosttofollow-upattheendoftreatment.

4 A3. Classification based on HIV status

HIV-positiveTBpatient:AnybacteriologicallyconfirmedorclinicallydiagnosedcaseofTBwhohasapositiveresultfrom HIV testing conducted at the time of TB diagnosis or other documented evidence of enrolment in HIV care, such asenrolmentinthepre-ARTregisterorintheARTregisteronceARThasbeenstarted.

HIV-negativeTBpatient:AnybacteriologicallyconfirmedorclinicallydiagnosedcaseofTBwhohasanegativeresultfromHIVtestingconductedatthetimeofTBdiagnosis.

HIVstatusunknownTBpatient:AnybacteriologicallyconfirmedorclinicallydiagnosedcaseofTBwhohasnoresultof HIV testing and no other documented evidence of enrolmentinHIVcare.

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4A4. Classification based on drug resistance based on drug susceptibility testing (DST)

Monoresistance:Resistancetoonefirst-lineanti-TBdrugonly. Polydrugresistance:Resistancetomorethanonefirst-lineanti-TBdrug(otherthanbothisoniazidandrifampicin). Multidrugresistance:Resistancetoatleastbothisoniazidandrifampicin. Extensivedrugresistance:Resistancetoanyfluoroquinoloneandtoatleastoneofthreesecond-lineinjectabledrugs

(capreomycin,kanamycinandamikacin),inadditiontomultidrugresistance. Rifampicin resistance: Resistance to rifampicin detected using phenotypic or genotypicmethods,with orwithout

resistancetootheranti-TBdrugs.

4B. Treatment outcome definitions

4B1. Treatment outcomes for TB patients (excluding patients treated for RR-TB or MDR-TB)

Cured:PulmonaryTBpatientwithbacteriologicallyconfirmedTBatbeginningoftreatmentwhowassmear-orculture-negativeinthelastmonthoftreatmentandonatleastonepreviousoccasion.

Treatmentcompleted:TBpatientwhocompletedtreatmentwithoutevidenceoffailureBUTwithnorecordtoshowthat sputum smear or culture results in the last month of treatment and on at least one previous occasion were negative, eitherbecausetestswerenotdoneorbecauseresultsareunavailable.

Treatmentfailed:TBpatientwhosesputumsmearorcultureispositiveatmonth5orlaterduringtreatment. Died:TBpatientwhodiesforanyreasonbeforestartingorduringthecourseoftreatment. Losttofollow-up:TBpatientwhodidnotstarttreatmentorwhosetreatmentwasinterruptedfor2consecutivemonths

ormore. Notevaluated:TBpatientforwhomnotreatmentoutcomeisassigned(IncludesCasestransferredout,andOutcome

unknown). Treatmentsuccess:Sumofcuredandtreatmentcompleted.

4B2. Outcomes for RR-TB/MDR-TB/XDR-TB patients treated using second-line treatment

Cured:TreatmentcompletedasrecommendedbythenationalpolicywithoutevidenceoffailureANDthreeormoreconsecutiveculturestakenatleast30daysapartarenegativeaftertheintensivephase.

Treatmentcompleted:TreatmentcompletedasrecommendedbythenationalpolicywithoutevidenceoffailureBUTnorecordthatthreeormoreconsecutiveculturestakenatleast30daysapartarenegativeaftertheintensivephase.

Treatmentfailed:Treatmentterminatedorneedforpermanentregimenchangeofatleasttwoanti-TBdrugsbecauseof: Lackofconversionbytheendoftheintensivephase,or Bacteriological reversion in the continuation phase after conversion to negative, or Evidenceofadditionalacquiredresistancetofluoroquinolonesorsecond-lineinjectabledrugs,or Adversedrugreactions(ADRs).

Died:Patientwhodiesforanyreasonduringthecourseoftreatment. Losttofollow-up:Patientwhosetreatmentwasinterruptedfor2consecutivemonthsormore. Not evaluated: Patient forwhomno treatment outcome is assigned (Includes cases transferred outand outome

unknown. Treatmentsuccess:Sumofcuredandtreatmentcompleted.

(Source: Definitions and Reporting Framework for Tuberculosis 2013 Revision. updated December 2014, World Health Organization)

5. Endorsed TB Diagnostics under RNTCP 2015

SmearmicroscopyforAFB: ZNstaining FluorescencestainsexaminedunderMicroscopywith/withoutLED.

Culturemethods: LJmedia(Solid) MiddleBrookmedia(Liquid)usingBactec/MGIT.

Rapiddiagnosticmoleculartests: ConventionalPCRbasedLine-probe-assayforMTBcomplex Real-timePCRbasedNAATforMTBcomplex(GeneXpert).

(Source: MOHFW Annual Report 2013-14, Government of India)

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6. New Indices Used in Public Health

6A. Global Hunger Index (GHI)

Description

Importance:ComprehensivetoolformeasurementandtrackingofhungerinWorldbyregionandcountry Agency:InternationalFoodPolicyResearchInstitute.

Components

Undernourishment Child underweight Childmortality.

Calculation of GHI

GHI=%Undernourishment+%Childunderweight+%Childmortality

3 GHIScore:

Lies between 100 to 0 0best(nohunger) 100worst.

(Source: Challenge of hunger, The Global Hunger Index 2008, 2014)

6B. Gross National Happiness (GNH)

Description

GrossNationalHappiness(GNH)measuresthequalityofacountryinmoreholisticway[thanGNP]andbelievesthatthe beneficial development of human society takes placewhenmaterial and spiritual development occurs side by side tocomplementandreinforceeachother.

Component domains

Domain Indicators1. Psychological well-being 42. Health 43. Time-use 24. Education 45. Cultural diversity and resilience 46. Good governance 47. Community vitality 48. Ecological diversity and resilience 49. Living standards 3

Total 33

(Source: A Short Guide to Gross National Happiness Index, The Centre for Bhutan Studies 2012)

7. New Post-Exposure Guidelines for HIV 2014-15 (Proposed)

AdolescentsandAdults: Preferredbackboneregimen:TDF+3TC(orFTC) Preferredthirddrug:LPV/rorATV/r Alternateoptions:RAL,DLV/rorEFV

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Childrenlessthan10yearsold: Preferredbackboneregimen:AZT+3TC Alternateregimens:ABC+3TCorTDF+3TC(orFTC) Preferredthirddrug:LPV/r Alternateoptionsaccordingtoage-appropriateness:ATV/r,RAL,DRV,EFV,NVP).

Prescribing frequency:28dayprescription.

(Source: Guidelines on Post-Exposure Prophylaxis for HIV and Use of Cotrimoxazole, World health Organisation 2014)

Printing errors in 7th Edition Review of PSM by Dr Vivek Jain

Dear Students, WiththehelpofPG-aspirants,Ihavebeenabletofindfewprinting/typingerrorsincurrent7thEditionofPSMbook.I do not want to wait for 8th edition for corrections. I am sharing them with you to avoid any error in the most important examofyourlife.Pleasetakeoutfewminutesandmarkthesecorrectionsinyourbookbeforereading.

Page Correction Thanks to Doctors

48 India declared smallpox free: April 1977 July 1975 Dr Shahshank Singh

86 Ans 119 B & C; 123 C Dr Amit Ilamkar, GMC, Nagpur

87 Ans 133 A Dr Ronak Patel, SSG Hospital, Vadodara

346 Ans 29 B Dr Amit Yadav

393 Ans 584: Cholesterol/ CHD ratio > 3.5 Dr Avishek Amar, Patna

396 Delete table in Ans 603 (Refer to Page 298) Dr Musaib Muhammad, GMC & SMHS, Srinagar

491 Ans 257 A, D Dr Akash Patel, SMIMER, Surat

541/674/687 BPL (