Sri Adichunchanagiri Shikshana Trust [R]
Adichunchanagiri Institute of Medical Sciences
Department of Community Medicine
Chief Patron:
Paramapoojya Sri Sri Sri
Nirmalanandanatha
Mahaswamiji
Chief Advisor
Dr Shivaramu M.G
Principal A.I.M.S
Editor in Chief
Dr Basavaraj Ingalgeri
Professor and Head
Dept. of Community Medicine
Editor
Dr Shashikiran M
Dr Radha R
Associate Professor(s)
Dept. of Community Medicine
Assistant Editors
Dr Shashikanth S K
Dr Sheethal M P
Dr Shashank K J
Dr Gagan S
Dr Chethan T K
Dr Raghavendra S K
Dr Ranjini N
Mrs Veena N H
Dr Chandrasekar C J
Dr Srividya J
Mr. Prakash S N
Mr. Yateesh B R
Cohort Biannual Departmental Newsletter
Contents:
1. Editorial (Page 1)
2. World AIDS day 2016 - Report
(Page 3)
3. World Health Day History
(Page 5)
4. RNTCP 2016 Update (Page 10) 5. Exercise and Physical activity
(Page 27)
AIMS/Dept.of CM/Newsletter/2016/Jul-Dec
1
EDITORIAL
A feel honoured and privileged in addressing you. With immense
pleasure I am handing over volume 6 issued to of the Dept of Community
Medicine to you all.
With a wholehearted cooperation and support, it is my humble
endeavour to strengthen community medicine at all levels. In my opinion, we
should work as an academic body to update the faculty members’ knowledge
and being community medicine people, to full fill social responsibilities.
We would like to thank the management, the Principal colleagues and
our Post Graduate and Under Graduate students for their constant support and
feedback in the activities. And endeavours planned and executed by the
department. We are the pleased to inform that UG and PG students who took
up the final exam by the University in the month of June 2016 have passed with
flying colors.
Dr. Shashank Asst. Professor joined the Govt. Medical College,
Chamarajanagara in the month of November 2016. Dr. Ranjini N Asst.
Professor and Dr. Pruthvi tutor joined the department in the month of
December 2016.
Department has organized on the occasion of World AIDS Day – 2016.
Essay competition, Quiz, Poster presentation in the college for Under
Graduates. The department also organized Jatha by UG, PG and Inters at Bellur
town on the occasion of World AIDS Day – 2016.
This issue of the “Cohort”, our biannual newsletter starts of with a brief
report on world AIDS day celebration and goes on to indroduce you, the reader
trough the timeline of world Health Day and the challenges identified for
addressing since inception. The RNTCP update of 2016 is expected to bring you
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up to date on the recent activities of RNTCP and culminating with the
presentations done from our department between Jul-Dec 2016 and a note on
Exercise and Physical activity.
The previous edition was well received and appreciated. We welcome
feedback, both positive and also negative, if any to improve the quality of our
future newsletters. We hope you enjoy reading this newsletter as much we
enjoyed preparing it
Dr Basavaraj M Ingalgeri
Professor and Head
Department of Community Medicine
AIMS/Dept.of CM/Newsletter/2016/Jul-Dec
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WORLD AIDS DAY 2016 -
REPORT
As a part of World AIDS day 2016, the following events were organized
at the Department of Community Medicine, AIMS for a period of 5 days
between 3rd & 7th Dec 2106.
1. Essay competition – on 3rd December, for I year MBBS students., a total
of 95 students appeared for the event, the topic was Stigma & HIV/AIDS &
Hands up for AIDS control (WHO theme for the year). The event was co-
ordinated by Dr Chethan TK & Dr Srividya B.
2. Quiz competition – for II year MBBS students. The event was held in two
stages, a preliminary written round attended by 130 students individually (on
5th Dec) & a final round of 5 teams of three students each on 7th December.
The event was co-ordinated by Dr Gagan S, Dr Shashikanth SK, Dr
Raghavendra SK & Dr Chandrasekar CJ. Dr Shashikanth SK was the quiz
master.
3. Poster competition – for III year MBBS students, in all 24 posters were
prepared & presented by students of IV term & VI term, the posters were
judged by a panel of 4 faculty members including Professors from
Microbiology and Obstetrics & Gynecology. The event was co-ordinated by Dr
Shashikanth SK & Mr.Yateesh BR.
Winners were announced and will be distributed on talents day for all the
events.
A rally was also organized on 19th Dec by Bellur Community Health
Centre at Bellur town in which our students, Interns & staff (around 100 in
number) participated with placards about HIV/AIDS prevention.
AIMS/Dept.of CM/Newsletter/2016/Jul-Dec
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Dr Shashikantha S K,
Assistant Professor
Department of Community Medicine
AIMS/Dept.of CM/Newsletter/2016/Jul-Dec
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World Health Day
The World Health Day is a global health awareness day celebrated every
year on 7 April, under the sponsorship of the World Health Organization
(WHO).
In 1948, the WHO held the First World Health Assembly. The Assembly
decided to celebrate 7 April of each year, with effect from 1950, as the World
Health Day. The World Health Day is held to mark WHO's founding, and is
seen as an opportunity by the organization to draw worldwide attention to a
subject of major importance to global health each year.
The WHO organizes international, regional and local events on the Day
related to a particular theme. World Health Day is acknowledged by various
governments and non-governmental organizations with interests in public
health issues, who also organize activities and highlight their support in media
reports, such as the Global Health Council.
World Health Day is one of eight official global health campaigns
marked by WHO, along with World Tuberculosis Day, World Immunization
Week, World Malaria Day, World No Tobacco Day, World AIDS Day, World
Blood Donor Day, and World Hepatitis Day.
A particular theme is chosen to run the celebration and take care of the
health for whole year. Global Polio Eradication was also one of the special
themes of the year 1995 of world health day. From then, most of the countries
have become free of this fatal disease whereas in other parts of the world its
awareness level has increased.
World Health Day targets all the health issues on global basis for which
the WHO organizes several programs yearly and other related health
organizations at various places like schools, colleges and other crowd places. It
AIMS/Dept.of CM/Newsletter/2016/Jul-Dec
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is celebrated to remember the establishment of the World health Organization
as well as draw the attention of people towards the major health issues in the
world.
WHO is a vast health organization working under UN for addressing
the health issues on a global basis. Since its establishment, it has addressed
serious health issues including chickenpox, polio, smallpox, TB, leprosy and etc
from various developing countries. It has played a significant role aiming to
make the world a healthy world. It has all the statistics about global health
reports.
How World Health Day is Celebrated
World Health Day is celebrated worldwide by the government, non-
government, NGOs including various health organizations at many places by
organizing programmes relating to the public health issues and awareness.
Participated organizations highlight their activities and supports through the
media reports by means of press releases, news and etc.
Health authorities from different country take part in the celebration
with their pledges in order to support on the health issues worldwide.
Varieties of activities are done in the conference of health workers to encourage
people to maintain their health in the presence of media coverage. Debates on
the related topics, art exhibitions, essay writing, competitions and award
ceremony are organized to fulfill the aim of world health day.
Why World Health Day is Celebrated
World Health Day celebration focuses on increasing the life expectancy
by adding good health to the lives of people and promoting healthier living
habits. Youths of the new era are also targeted by this event to prevent and
make them healthy to make the world healthy and free from AIDS and HIV.
AIMS/Dept.of CM/Newsletter/2016/Jul-Dec
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Disease spreading vectors like mosquitoes (malaria, dengue fever, filaria,
chikungunya, yellow fever and etc), ticks, bugs, sand flies, snails and etc are
also spotlighted by the WHO to make the world free from a wide range of
diseases caused by parasites and pathogens. It provides better prevention and
cure from the vector-borne diseases spread by vectors and travelers from one
country to other. WHO supports various health authorities on global basis to
make their own efforts for the public health problems to enhance better life
without any diseases.
World Health Day Themes
1950. “Know your Health Services”.
1951. “Health for your Child and World’s Children”.
1952. “Healthy surroundings make Healthy people”.
1953. “Health is Wealth”.
1954. “The Nurse: Pioneer of Health”.
1955. “Clean water means better Health”.
1956. “Destroy disease carrying Insects”.
1957. “Food for All”.
1958. “Ten years of Health progress”.
1959. “Mental illness and Mental Health in the World of today”.
1960. “Malaria eradication – A world challenge”.
1961. “Accidents and their prevention”.
1962. “Preserve sight- prevent Blindness”.
1963. “Hunger= Disease of millions”.
1964. “No Truce for Tuberculosis”.
1965. “Smallpox – constant alert”.
1966. “Man and his Cities”.
1967. “Partners in Health”.
1968. “Health in the World of Tomorrow”.
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1969. “Health, Labor and Productivity”.
1970. “Early detection of Cancer saves Life”.
1971. “A full life despite Diabetes”.
1972. “Your Heart is your Health”.
1973. “Health begins at Home”.
1974. “Better food for a healthier World”.
1975. “Smallpox: Point of no return”.
1976. “Foresight Prevents Blindness”.
1977. “Immunize and protects your Child”.
1978. “Down with High Blood pressure”.
1979. “A healthy Child: A sure future”.
1980. “Smoking or Health: Choice is yours”.
1981. “Health for all by year 2000 AD”.
1982. “Add life to years”.
1983. “Health for all by year 2000 AD: Countdown has begun”.
1984. “Children’s Health: Tomorrow’s Wealth”.
1985. “Healthy Youth- Our best Resource”.
1986. “Healthy living: Everyone a winner”.
1987. “Immunization: A chance for every Child”.
1988. “Health for All: All for Health”.
1989. “Let’s talk Health”.
1990. “Our Planet our Earth: Think Globally Act Locally”.
1991. “Should Disaster Strike, be prepared”.
1992. “Heart beat: A rhythm of Health”.
1993. “Handle life with care: Prevent violence and Negligence”.
1994. “Oral Health for a Healthy Life”.
1995. “Global Polio Eradication”.
1996. “Healthy Cities for better life”.
AIMS/Dept.of CM/Newsletter/2016/Jul-Dec
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1997. “Emerging infectious diseases”.
1998. “Safe motherhood”.
1999. “Active aging makes the difference”.
2000. “Safe Blood starts with me”.
2001. “Mental Health: stop exclusion, dare to care”.
2002. “Move for health”.
2003. “Shape the future of life: healthy environments for children”.
2004. “Road safety”.
2005. “Make every mother and child count”.
2006. “Working together for health”.
2007. “International health security”.
2008. “Protecting health from the adverse effects of climate change”.
2009. “Save lives, make hospitals safe in emergencies”.
2010. “Urbanization and health: make cities healthier”.
2011. “Anti-microbial resistance: no action today, no cure tomorrow”.
2012. “Good health adds life to years”.
2013. “Healthy heart beat, Healthy blood pressure”.
2014. “Vector-borne diseases”.
2015. “Food safety”
2016. “Beat diabetes”
2017. “Depression: Let's Talk”
Dr Chethan T K,
Dr Gagan S,
Assistant Professor,
Department of Community Medicine
AIMS/Dept.of CM/Newsletter/2016/Jul-Dec
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RNTCP 2016 Update
Case Finding and Diagnosis Strategy
• Early case detection is vital to interrupt the transmission of TB disease
as highlighted in the 12th five-year plan for TB control in India.
• Early identification of people with a high probability of having active TB
(Presumptive TB) is the most important activity of the case finding
strategy.
• Passive case finding alone can lead to missed cases or delayed diagnosis.
Definitions of Presumptive TB
• Presumptive Pulmonary TB: Refers to a person with any of the
symptoms and signs suggestive of TB including cough >2 weeks, fever
> 2 weeks, significant weight loss, haemoptysis, any abnormality in chest
radiograph.
• Contacts of microbiologically confirmed TB Patients, PLHIV, diabetics,
malnourished, cancer patients, patients on immune-suppressants or
steroid should be regularly screened for sign and symptoms of TB.
• Presumptive Extra Pulmonary TB: To the presence of organ specific
symptoms and signs like swelling of lymph node, pain and swelling in
joints, neck stiffness, disorientation, etc and/or constitutional symptoms
like significant weight loss, persistent fever for >2 weeks, night sweats.
• Presumptive DR TB: Refers to those TB patients who have failed
treatment with first line drugs, paediatric TB non responders, TB
patients who are contacts of DR-TB , TB patients who are found positive
on any follow-up sputum smear examination during treatment with
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first line drugs, previously treated TB cases, TB patients with HIV co-
infection.
Tools for Microbiological Confirmation of TB
• Sputum Smear Microscopy (for AFB): Zeihl-Neelson Staining and
Fluorescence staining.
• Culture: Solid (Lowenstein Jensen) media, Automated Liquid culture
systems.
• Drug Sensitivity Testing: Modified DST for MGIT 960 system (for both
first and second line drugs).
• Rapid molecular diagnostic testing: Line Probe Assay for MTB complex and
detection of RIF& INH resistance
• Nucleic Acid Amplification Test (NAAT) Xpert MTB/Rif testing using the
GeneXpert system.
• Radiology, TST, IGRA are other tools for diagnosis of tuberculosis.
Two samples are collected within a day or two consecutive days. One
sample is collected on the spot under supervision and other is collected
early in the morning.
Sputum should be at least 2 ml in quantity.
Results of sputum tests should be reported within a day.
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Diagnosis of Extra-pulmonary TB
• All efforts should be made to establish microbiological confirmation in
case of presumptive EPTB. Appropriate specimens from the presumed
sites of involvement must be obtained from all presumptive EPTB
patients for CBNAAT, Smear Microscopy Culture & DST for M.
tuberculosis, histo-pathological examination, based on type of specimen
and availability of facilities.
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Diagnosis of Drug Resistant TB
• Drug resistant TB is a laboratory based diagnosis.
• Both genotypic and phenotypic testing are available, genotypic testing
being the rapid way of diagnosing.
• Wherever the facilities are available, efforts should be made to obtain
DST results of all the drugs intended to be used in regimen.
• The programme has introduced Bedaquiline through conditional access
programme.
• If Rifampicin Resistance is confirmed by CBNAAT or LPA, start
Standardized Regimen for MDR TB and perform Liquid Culture DST at
base line to Levofloxacin, Moxifloxacin, Kanamycin, Capreomycin,
Ethambutol, Ethionamide, Linezolid and Pyrazinamide along with LPA
for lsoniazid on sample /culture isolate.
• If lsoniazid resistance is detected by LPA, report of result must also
mention Kat G or INH-A mutation.
• If resistance is detected to second line injectable and/or
fluoroquinolones, perform DST for remaining second line drugs. Initiate
or modify treatment as per Drug susceptibility test results.
Treatment of Tuberculosis (Goals)
• To decrease case fatality and morbidity by ensuring relapse free cure.
• To minimize and prevent development of drug resistance.
• To render patient non-infectious, break the chain of transmission and to
decrease the pool of infection.
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Case definitions
• Microbiologically confirmed TB case refers to a presumptive TB
patient with biological specimen positive for acid fast bacilli, or positive
for Mycobacterium tuberculosis on culture, or positive for tuberculosis
through Quality Assured Rapid Diagnostic molecular test.
• Clinically diagnosed TB case refers to a presumptive TB patient
who is not microbiologically confirmed, but has been diagnosed with
active TB by a clinician on the basis of X-ray abnormalities,
histopathology or clinical signs with a decision to treat the patient with
a full course of Anti-TB treatment.
• Microbiologically or clinically diagnosed TB can be divided according
to:
a) Anatomical site of disease: Pulmonary /Extra pulmonary (Miliary
TB considered as pulmonary TB as lungs are also involved)
b) History of previous treatment:
• New case -A TB patient who has never had treatment for TB or has
taken anti-TB drugs for less than one month is considered as a new
case.
• Previously treated patients who have received 1 month or more of
anti-TB drugs in the past.
• Recurrent TB case- A TB Patient previously declared as
successfully treated and is subsequently found to be
microbiologically confirmed TB case is a recurrent TB case.
• Treatment After failure patients, are those who have previously
been treated for TB and whose treatment failed at the end of their
most recent course of treatment.
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• Treatment after loss to follow-up: A TB patient previously
treated for TB for 1 month or more and was declared lost to
follow-up in their most recent course of treatment and
subsequently found microbiologically confirmed TB case.
c) Drug resistance: Mono, Poly, Multi drug and Extensive Drug
Resistant TB.
Drug Regimen for Drug Sensitive TB:
• The programme is now introducing daily regimen for treatment of drug
sensitive Tuberculosis among PLHIV and Pediatric TB patients in the
entire country and for all TB patients in 104 districts initially.
• For new TB cases, the treatment in intensive phase (IP) will consist of
eight weeks of lsoniazid, Rifampicin, Pyrazinamide and Ethambutol in
daily dosages.
• There will be no need for extension of IP.
• Only Pyrazinamide will be stopped in the Continuation Phase (CP), while the
other three drugs will be continued for another 16 weeks as daily
dosages.
• For previously treated cases of TB, the IP will be of 12 weeks, where
injection Streptomycin will be stopped after 8-weeks.
• INH, Rifampicin, Pyrazinamide and Ethambutol in daily dosages as per
weight will be continued for another 4-weeks.
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• At the start of CP, Pyrazinamide will be stopped while the rest of the
drugs - Rifampicin, INH and Ethambutol will be continued for another
20 weeks as daily dosages in the CP.
• The CP in both new and previously treated cases may be extended by
12-24 weeks in certain forms of TB like CNS TB, Skeletal TB,
Disseminated TB etc.
Drug Regimen for MD R/RR-TB cases (without additional resistance):
• These patients are to be treated with standard treatment regimen for
MDR-TB that contains 6 to 9 months of IP with Kanamycin,
Levofloxacin, Ethambutol, Pyrazinamide, Ethionamide and Cycloserine
and 18 months of CP with Levofloxacin, Ethambutol, Ethionamide and
Cycloserine.
• All MDR-TB isolates would be subjected to LC DST at baseline for
Kanamycin and Levofloxacin, the results of which would be received
after 6-8 weeks. Appropriate modifications of the treatment regimens
can be done in the presence of additional resistance.
Drug Regimen for XDR-TB
• XDR TB cases are treated with Injection Capreomycin, Moxifloxacin,
Linezolid, PAS, Clofazimine High Dose INH & Amoxyclav.
• The duration of IP will be for 6-12 months. Only the injectables will be
stopped in CP and the remaining medicines will continue for another 18
months in CP.
• All DR-TB treatment regimen are to be given on daily basis under
supervision
AIMS/Dept.of CM/Newsletter/2016/Jul-Dec
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Drug Regimen for Mono /Poly Drug resistant TB
• Repeat rifampicin DST is to be done in case, result of mono or poly drug
resistant TB is available after 6-8 weeks.
• Mono Drug Resistant TB -The treatment regimen is consisting of
Injectable SLD + FQ + Rifampicin + two out of the first line drugs (from
H, E & Z) to which the patient is sensitive to make a total of 5 effective
drugs regimen given daily.
• In case of reported baseline additional resistance to other FLDs, the
regimen is lnj SLD + FQ + Rifampicin + any FLD to which patient is
sensitive+ one of the remaining Group 4 drugs (Ethionamide,
cycloserine ,PAS).
• In addition, High Dose INH is added to the regimen if LPA shows inhA
mutation or culture reports show low level INH resistance.
• The total duration of treatment will be 9 to 12 months. The Intensive
Phase (IP) is for 3 months with scope for extension to a maximum of 6
months. The Continuation phase (CP) is for a fixed duration of 6 months.
Drug Regimen for MDR/RR-TB cases (with additional resistance)
• In case of resistance to Ethambutol, it is to be omitted.
• In case of resistance to Pyrazinamide, it is to be omitted.
• In case of resistance to both Ethambutol and PZA, PAS to be added in IP
and CP.
• In case of resistance to Levofloxacin or Moxifloxacin, the sensitive one is
to be used along with PAS and clofazimine.
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• In case of resistance to all second line injectable, replace them with
Clofazimine, Linezolid and PAS in IP and CP. The duration of IP will
be from 6 to 12 months.
MDR-TB with Mixed Patterns of Resistance
For lsoniazid resistance, decision on use of lsoniazid in the regimen depends
on following
• If High level resistance detected by Liquid culture - omit INH.
• If low level resistance detected by Liquid culture - add high dose INH.
• If LPA reports INH resistance by Kat G mutation- Omit INH.
• If LPA reports INH resistance by INH A mutation- Use High dose INH.
• Ethionamide in the treatment regimen will be replaced with PAS.
• If RR by CBNAAT, add INH in the standard doses to the treatment
regimen till results of LPA or Liquid culture DST are known.
• For new patients diagnosed as TB and RR by CBNAAT, put up both a
repeat CBNAAT & send sample for liquid culture. If second CBNAAT
also shows RR - start standard MDR-TB treatment regimen with INH
till the results from culture DST are known.
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• For mixed resistance pattern, consider oral drugs in following sequence
of preference Pyrazinamide (If Sensitive), Ethambutol, Ethionamide,
Cycloserine, PAS, Clofazimine,Linezolid, Co-Amoxyclav, High Dose
INH& Clarithromycin.
• Surgery in M/XDR-TB patients:
All patients of M/XDR-TB should be evaluated for surgery at the initiation
of treatment and/or during follow up.
Bedaquiline Conditional Access Programme: Introduction of new anti TB
drug under RNTCP
• The drug has a high volume of distribution, with extensive tissue
distribution, highly bound to plasma proteins and hepatically
metabolized.
• The drug has an extended half-life, which means that it is still present in
the plasma up to 5.5 months’ post stopping BDQ.
• BDQ demonstrates no cross-resistance with existing first- and second-
line anti-TB drugs and has shown significant benefits in improving the
time to culture conversion in MDR-TB patients.
Criteria for Patients to Receive Bedaquiline
• Adults aged > 18 years having pulmonary MDR-TB.
• Females should not be pregnant, or should be using effective non-
hormone-based birth control methods.
• Patients with controlled stable arrhythmia can be considered after
obtaining cardiac consultation.
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• Once the results of baseline SLDST are available, the patients eligible
and consented to be treated with BDQ containing regimen will be
identified and an appropriate regimen will be designed.
All patients would be counseled and managed indoor for a mandatory period
of 2 weeks to complete the initial 2 weeks of BDQ doses.
Bedaquiline used in
• MDR TB with SLI and FQ resistance
• XDR TB.
• Treatment failures of MDR/XDR TB.
• Dosage of 400 mg daily during week ( 0-2) followed by 200mg 3 times a
week during week 3-24, after IP of 6 months BDQ is omitted.
Major Side effects are:
• Hepatotoxicity.
• Causes QT prolongation.
• Myalgia.
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• All close contacts of DR-TB cases should be identified through contact
tracing and evaluated for active TB disease as per RNTCP guidelines. If
the contact is found to be suffering from pulmonary TB disease
irrespective of the smear results, he/she will be identified as an
"Presumptive MDR-TB".
• The patient will be initiated on regimen for new or previously treated
case based on their history of previous anti-TB treatment.
Isoniazid Preventive Therapy
• Children < 6 years of age, who are close contacts of a TB patient, should
be evaluated for active TB.
• He/She should be given INH preventive therapy irrespective of their
BCG or nutritional status.
• The dose of INH for preventive therapy is 10 mg/kg body weight
administered daily for a minimum period of six months.
• INH preventive therapy should be considered in following situation: -
• For all HIV infected children who either had a known exposure to an
infectious TB case or are Tuberculin skin test (TST) positive (>=5mm
induration) but have no active TB disease.
• All TST positive children who are receiving immunosuppressive
therapy
• A child born to mother who was diagnosed to have TB in pregnancy
should receive prophylaxis for 6 months, provided congenital TB has
AIMS/Dept.of CM/Newsletter/2016/Jul-Dec
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been ruled out. BCG vaccination can be given at birth even if INH
preventive therapy is planned.
Treatment outcomes for drug-susceptible TB patients
• Cured: Microbiologically confirmed TB patients at the beginning of
treatment who was smear or culture negative at the end of the complete
treatment.
• Treatment completed: A TB patient who completed treatment without
evidence of failure or clinical deterioration BUT with no record to show
that the smear or culture results of biological specimen in the last month
of treatment was negative, either because test was not done or because
result is unavailable.
• Failure: A TB patient whose biological specimen is positive by smear or
culture at end of treatment.
• Lost to follow up: A TB patient whose treatment was interrupted for 1
consecutive month or more.
• Not Evaluated: A TB Patient for whom no treatment outcome is
assigned.
Outcomes for RR-/MDR-TB and/ or XDR-TB patients
• Cure: Treatment completed as recommended by the national policy
without evidence of failure AND three or more consecutive cultures
taken at least 30 days apart are negative after the intensive phase.
• Treatment completed: Treatment completed as recommended by the
national policy without evidence of failure BUT no record that three or
more consecutive cultures taken at least 30 days apart are negative after
the intensive phase.
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• Treatment success: The sum of cured and treatment completed.
• Treatment failed: Treatment terminated or need for permanent regimen
change of at least two or more anti-TB drugs in CP because of
i. Lack of microbiological conversion by the end of the intensive phase.
ii. Microbiological reversion in the continuation phase after conversion
to negative, or
iii. Evidence of additional acquired resistance to fluoroquinolones or
second line injectable drugs or Adverse drug reactions.
• Conversion and reversion: Conversion (to negative): culture is
considered to have converted to negative when two consecutive
cultures, taken at least 30 days apart, are found to be negative.
• Reversion (to positive): culture is considered to have reverted to
positive when, after an initial conversion, two consecutive cultures,
taken at least 30 days apart, are found to be positive.
Dr Raghavendra S K,
Assistant Professor,
Department of Community Medicine
AIMS/Dept.of CM/Newsletter/2016/Jul-Dec
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PUBLICATIONS BY STAFF &
PG STUDENTS
1. Shashikantha SK, Sheethal MP. Prevalence of low birth weight and its
associated factors: a community based cross sectional study in a rural area of
Rohtak, Haryana, India. Int J Community Med Public Health 2016;3:1544-6.
2. Vishma BK, Shashikantha SK, Sheethal MP, Muniyal AS. Awareness
of oral cancer and its risk factors in a rural community in Mandya, Karnataka,
India. Int J Community Med Public Health 2016;3:347-52.
3. Shashikantha SK, Sheethal MP, Vishma BK. Dietary diversity among
women in the reproductive age group in a rural field practice area of a medical
college in Mandya district, Karnataka, India. Int J Community Med Public
Health 2016;3:746-9.
4. Shashikantha S K, Sheethal M P. Prevalence of depression among post
graduate residents in a tertiary health care institute, Haryana. Int J Med Sci
Public Health 2016;5:2139-2142.
5. Sheethal MP, Shashikantha SK. A cross-sectional study on the
coverage and utilization of sanitary latrine in rural field practice area of a
tertiary care hospital in Southern Karnataka. Int J Community Med Public
Health 2016;3:1540-3.
6. Ratnaprabha GK, Gagan S. Commentary on “Ebola Haemorrhagic
fever in Sudan, 1976”. Annals of Community Health. 2016 Jul 1;4(2):14-6.
7. Gagan S, Ramadurg UY, Anjum W. Blood donors profile and
seroprevalence among them-A record based case series study in Bagalkot blood
bank. Annals of Community Health. 2016 Jul 1;4(2):22-5.
8. Gagan S, Anjum W, Mendagudali R, Ramadurg UY. A Community
Based Study to find the selfawareness of Type II Diabetes Mellitus status and
AIMS/Dept.of CM/Newsletter/2016/Jul-Dec
25
compliance in its treatment in Shirur, A Rural Field Practice Area of S. N.
Medical College, Bagalkot. Annals of Community Health. 2016 Oct 1;4(3):25-8.
9. Gagan S, Ghattargi C H, Anjum W, Mendagudali R. Co-Relation Of
Body Mass Index and Waist Hip Ratio with the Prevalence of Diabetes in a
Rural population of Bagalkot. Annals of Community Health. 2016 Oct 1;4(3):37-
9.
10. Sudarshan BP, Chethan TK. A study to assess the prevalence of anemia
and activities of daily living among elderly population residing in a South
Indian rural community. Int J Community Med Public Health 2016;3:437-41.
11. Sudarshan BP, Chethan TK.Morbidity pattern among the elderly
population in the rural area of Pondicherry: a cross sectional study. Int J
Community Med Public Health 2016;3:414-8.
12. Avin Alva BR, Chethan TK. A Study to Assess the Average Age of
Menopause and Menopause Associated Symptoms among Rural Women in
Mangalore, Karnataka. Ntl J Community Med 2016; 7(5):404-408.
13. Chethan TK, Venugopal K. Trends of lipid abnormalities among newly
detected type-2 diabetes mellitus in a tertiary care hospital in Karnataka, India.
Int J Community Med Public Health 2016; 3:750-3.
14. Chethan TK, Shashank KJ. Diabetes Mellitus: Current Challenges and
Barriers in the Delivery and Utilization of Health Care in a Coastal District of
Karnataka. Ntl J Community Med 2015; 7(1):54-59.
15. Chethan T K, Shashank K J. Assessment of Nutritional Status of Under
Five Children Residing in Rural Area of Kerala State - A Cross sectional study.
National Journal of Research in Community Medicine. Vol.5. Issue 1. Jan.-Mar.
2016(056-059).
16. Shashank KJ, Chethan TK. A Study on Breastfeeding Practices among
Mothers in Rural Area of Mangalore District: A Cross-sectional Study. Ntl J
Community Med 2016; 7(2):134-137.
AIMS/Dept.of CM/Newsletter/2016/Jul-Dec
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17. Shashank K J, Chethan T K. HIV/AIDS stigma and knowledge among
high school students in a rural area of Karnataka. National Journal of Research
in Community Medicine. Vol.5. Issue 1. Jan.-Mar. 2016(069-075).
18. Shashank KJ, Chethan TK. Nutritional Status of School Going Children
between the Age Group of 6-12 Yrs in Rural Area of Bijpaur District. Ntl J
Community Med 2016; 7(5):409-412.
19. Navinkumar Angadi, Shubha Davalgi, Raghavendra S K.
“Determinants of Utilization of Maternity Benefit Schemes Among Mothers in
Urban Slums Of Davangere City.” Int J Community Med Public Health. 2016;
3:651-7.
AIMS/Dept.of CM/Newsletter/2016/Jul-Dec
27
Exercise and
Physical activity
Adults over the age of 20 years should undertake a minimum of 30-45
minutes of physical activity of moderate intensity (such as brisk walking 5-6
kms/hr) 5-6 days of the week. Greater health benefits can be obtained by
engaging in physical activity of longer duration or more vigorous intensity
such as jogging, running, cycling and swimming.
Sedentary people embarking on a physical activity programme should
undertake a moderate intensity activity of short duration to start and gradually
increasethe duration or intensity. Other day to day activities like walking,
housework, gardening , will be beneficial not only in weight reduction but also
for lowering blood pressure, serum triglycerides. It also elevates HDL
cholesterol in blood. Simple modification in lifestyle like deliberately climbing
up the stairs instead of using the lift and walking for short distance instead of
using a vehicle could also immensely help in increasing our physical activity.
Exercise program should include “warm up” and “cool down” periods
each lasting for 5 minutes. During exercise, the intensity of exercise should
ensure 60-70% increase in heart rate.
Energy expenditure on various physical activities (kcal/min):
Activities Energy (Kcal/min)
Sleeping, Resting, Relaxing 1.0
Sitting, eating, reading, writing, listening, talking 1.5
Standing, washing face, shaving, combing, watering
plants
2.3
Walking, driving, dusting, bathing, dressing 2.8
Sweeping, cleaning utensils, washing clothes, other
house chores
3.3
Warm up & recreational activities, walking up/down
stairs, cycling
4.8
AIMS/Dept.of CM/Newsletter/2016/Jul-Dec
28
Carpentry, plumbing, loding/unloading 5.6
Gymnastics, Swimming, digging 6.0
Dr Srividya J,
Post Graduate,
Department of Community Medicine
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