---

NTPC Limited

---

Key Facts

---

Business Overview

• Core Business: Generation and sale of bulk power to state electricity boards and distribution companies (DISCOMs)
• Presence: 70+ power stations across India
• Subsidiaries & JVs: NTPC Vidyut Vyapar Nigam (NVVN), NTPC Renewable Energy Ltd (NREL), Ratnagiri Gas & Power, Meja Urja Nigam, etc.

---

Strategic Focus (2024–2032)

• Renewable Energy Target: 60 GW of renewable capacity by 2032
• Expanding into solar parks, green hydrogen, and battery storage
• Pursuing coal mine development for fuel security
• International projects in Bangladesh, Sri Lanka, and Nepal

---

Financial Snapshot (FY2024 approx.)

• Revenue: ~₹1.8 lakh crore
• Net Profit: ~₹17,000–18,000 crore
• Dividend: Consistent dividend-paying PSU (Navratna status)
• Market Cap: ~₹3–4 lakh crore (fluctuates with market)

---

Stock & Investor Notes

• Classified as a Navratna PSU
• Part of Nifty 50, Nifty 100, and S&P BSE Sensex (periodically)
• Considered a dividend yield + growth play given its renewable expansion pipeline
• Debt-heavy but backed by sovereign guarantee perception

---

---

National Tuberculosis Control Programme (NTCP)

1. Background & History

---

2. Burden of TB in India

• India accounts for ~26% of global TB burden (highest in the world)
• Incidence: ~210 per 1,00,000 population
• Mortality: ~23 per 1,00,000 (excluding HIV-TB)
• HIV-TB co-infection is a major challenge
• India has highest burden of MDR-TB and XDR-TB globally

---

3. Causative Agent & Transmission

• Agent: Mycobacterium tuberculosis (Koch's bacillus) — aerobic, acid-fast bacillus (AFB)
• Source: Open/infectious cases of pulmonary TB
• Mode: Droplet nuclei (airborne) — primary mode
• Incubation: 4–12 weeks (primary infection to tuberculin conversion)
• Infectivity: One untreated sputum-positive case can infect 10–15 persons/year

---

4. Goals & Objectives of NTEP (formerly RNTCP)

1. Detect — universal access to early, accurate diagnosis
2. Treat — universal access to high-quality treatment
3. Prevent — reduce transmission, preventive therapy
4. Build — enabling environment (financing, HR, logistics)

• Reduce TB incidence by 80% (from 2015 levels) by 2025
• Reduce TB mortality by 90% by 2025
• Zero catastrophic costs for TB-affected families

---

5. DOTS Strategy (WHO/RNTCP Cornerstone)

1. Government commitment to sustained TB control
2. Case detection by sputum smear microscopy
3. Standardized short-course chemotherapy under direct observation
4. Regular uninterrupted supply of drugs
5. Standardized recording & reporting system

---

6. Case Definitions

---

7. Classification of TB

By Site

• Pulmonary TB (PTB): Involves lung parenchyma
• Extra-pulmonary TB (EPTB): Lymph nodes, pleura, bones, CNS, abdomen, genitourinary, etc.

By Drug Sensitivity

• DS-TB: Drug-susceptible TB
• MDR-TB: Resistant to at least Isoniazid (H) + Rifampicin (R)
• Pre-XDR TB: MDR + resistant to any fluoroquinolone
• XDR-TB: MDR + resistant to fluoroquinolone + at least one Group A drug (Bedaquiline/Linezolid)

---

8. Diagnosis

Sputum Smear Microscopy (ZN Stain)

• Cheapest, quickest
• Detects AFB if ≥10,000 bacilli/mL
• 2 samples: spot + morning (or 2 spot samples)

CB-NAAT (Cartridge-Based Nucleic Acid Amplification Test)

• TrueNat / GeneXpert MTB/RIF
• Detects M. tuberculosis AND rifampicin resistance simultaneously
• Now the preferred initial test in India under NTEP
• Sensitivity ~88%, Specificity ~99%

Culture (Gold standard)

• Löwenstein-Jensen (LJ) medium — 6–8 weeks
• MGIT (Mycobacteria Growth Indicator Tube) — 2–3 weeks
• Used for DST (drug sensitivity testing)

Chest X-Ray

• Supportive, not confirmatory
• Findings: upper lobe cavities, infiltrates, nodules, fibrosis

Tuberculin Skin Test (Mantoux)

• Intradermal injection of 5 TU PPD
• Read at 48–72 hours
• Induration ≥10 mm = positive in general population (≥5 mm in immunocompromised)
• Indicates infection, NOT necessarily active disease

IGRA (Interferon Gamma Release Assay)

• QuantiFERON-TB Gold, T-SPOT.TB
• Better specificity than Mantoux (not affected by BCG)

---

9. Treatment Regimens Under NTEP

Treatment Categories (Revised)

New DS-TB Cases (Pulmonary & EPTB)

2HRZE / 4HR

• Intensive Phase (IP): 2 months — Isoniazid (H) + Rifampicin (R) + Pyrazinamide (Z) + Ethambutol (E)
• Continuation Phase (CP): 4 months — Isoniazid (H) + Rifampicin (R)

Previously Treated DS-TB

2HRZES / 1HRZE / 5HRE (older regimen) Now re-evaluated with DST before treatment

MDR-TB Regimen

• Shorter oral BPaL regimen (BPaLM): Bedaquiline + Pretomanid + Linezolid ± Moxifloxacin — 6 months
• Older longer regimen: 18–20 months with injectable (being phased out)

Drug Abbreviations

---

10. Treatment Outcomes (WHO Definitions)

---

11. NIKSHAY — Digital Platform

• NIKSHAY = Digital case-based web-based system for TB notification and management
• All TB cases (public + private sector) must be mandatorily notified
• NIKSHAY Poshan Yojana: Direct benefit transfer of ₹500/month to TB patients for nutritional support during treatment

---

12. TB Preventive Therapy (TPT)

• Household contacts of bacteriologically confirmed TB cases
• HIV-positive individuals
• Children <5 years in contact with TB case

---

13. BCG Vaccination

• BCG (Bacille Calmette-Guérin): Live attenuated M. bovis
• Given at birth under Universal Immunization Programme (UIP)
• Protects against severe childhood TB (miliary TB, TB meningitis) — 80% efficacy
• Less effective against adult pulmonary TB
• Given intradermally — left deltoid region
• Dose: 0.05 mL (neonates), 0.1 mL (older children)

---

14. Organizational Structure of NTEP

Central TB Division (CTD) — MoHFW, New Delhi
        ↓
State TB Cell (STC) — State level
        ↓
District TB Centre (DTC) — District level
        ↓
Tuberculosis Unit (TBU) — Covers 1,00,000 population (urban) / 5,00,000 (rural)
        ↓
Designated Microscopy Centre (DMC) — Covers 1,00,000 population

• Medical Officer — TB Control (MO-TC): In charge of DTC
• Senior Treatment Supervisor (STS): Field supervision at TBU level
• Senior TB Laboratory Supervisor (STLS): Laboratory supervision

---

15. Contact Tracing & Social Measures

• All household contacts of smear-positive cases should be screened
• Children <5 years get isoniazid prophylaxis
• HIV testing of all TB patients
• Nutritional support via Nikshay Poshan Yojana
• Ni-kshay Mitra: Volunteer/corporate support program for TB patients (food, diagnostics, vocation)

---

16. Important Mnemonic

Government commitment | Case detection (smear) | Standardized treatment | Drug supply | Recording & Reporting

Happy Rats Zip Everywhere

---

17. Key Differences: NTP vs RNTCP vs NTEP

---