Guidelines for tuberculosis prophylaxis during anti‐tumour necrosis factor‐α treatment: Indian Rheumatology Association

India is home to a large patient population of both rheumatoid arthritis (RA) and tuberculosis (TB). As the usage of biologic agents in RA increases in India, the issue of TB reactivation and prophylaxis becomes very pertinent. The consensus view of an expert group from the Indian Rheumatology Association is presented. Tuberculin testing has limited utility in India and isoniazid prophylaxis seems to be a reasonable option. It is hoped that this report shall pave the way for formal guidelines.     

GIANT FIBROUS POLYP OF THE LOWER END OF THE URETER: CASE REPORT AND REVIEW OF THE LITERATURE

Primary benign mesodermal tumours of the ureter mostly occur in the proximal part of the ureter. A case of a large fibrous polyp of the lower end of the ureter is described. The clinical presentation, radiological findings and treatment are discussed.     

Risk assessment of intravenous dose presentation in secondary care

□ The Breckenridge report highlighted that intravenous drug additions were aseptic procedures and should be conducted under the direct control of a pharmacist □ This study attempts to determine the extent of intravenous drug preparation at ward level and apply a risk assessment model □ Observation and risk assessment of intravenous drug preparation was carried out in two clinical areas within a large hospital □ Two thirds of the intravenous drug administration events were graded as high risk □ In the absence of a centralised intravenous additive service, the use of ready to administer forms or novel reconstitution systems may significantly reduce the risks associated with intravenous administration events     

Ablation of Idiopathic Right Ventricular Outflow Tract Tachycardia: Current Perspectives

Ventricular tachycardia (VT) arising from the right ventricular outflow tract (RVOT) in the absence of overt structural heart disease is a common entity. Exclusion of occult structural disease such as arrhythmogenic right ventricular cardiomyopathy is critical as this diagnosis impacts both ablation outcomes and long-term prognosis. VT is most commonly due to triggered activity. Induction of the target arrhythmia in the laboratory is often problematic, and is frequently facilitated by catecholamine infusion. Recent data indicate that high-density three-dimensional activation mapping facilitates identification of target sites for ablation, and that the spatial resolution of pacemapping may be more limited than previously recognized. A standard 12-lead electrocardiogram is useful in providing an initial approximation of the site of origin within the outflow tract, and may contain subtle clues to potentially confounding foci on the left ventricular endocardial or epicardial surface. When sufficient arrhythmia is present to permit mapping, successful ablation can be expected in 90–95% of patients, with a recurrence risk of approximately 5%. In experienced centers, major complications are ≤1% and outcomes should approach those obtained for the common forms of supraventricular tachycardia.     

Beat-to-Beat Variability in Stroke Volume During VVI Pacing as Predictor of Hemodynamic Benefit from DDD Pacing

To determine whether the magnitude of Beat-to-Beat variability in stroke volume (SVJ during VVI pacing can predici hemodynamic benefit from DDD pacing, we undertook Doppier recordings of systolic and diastolic LV flow during VVI and DDD pacing in 20 patients (age 54 ± 9 years)with DDD pacemakers implanted due to AV block. SV increased by 19%± 10% from VVI to DDD (P < 0.01). This increase was greater (29%± 9%)in patients with a ratio of early (E)/late (A) filling < 1 compared to those with E/A > 1 (10%± 9%) (P < 0.001). Beat-to-Beat variability in SV was greater in VVI (13%± 8%)compared to DDD (4%± 1%) (P < 0.001). Patients with E/A < 1 showed greater Beat-to-Beat variability in SV during VVI pacing (19 ± 6%)compared to those with E/A > 1 (8%± 4%) (P < 0.001). Beat-to-Beat variability in SV during VVI pacing correlated with both percent change in SV from VVI to DDD (r = 0.89, P < 0.001)and E/A (r = -0.71, P < 0.001). In conclusion, patients with E/A < 1 derive greater hemodynamic benefit at rest from DDD pacing compared with E/A > 1. In addition, patients with complete AV block who show large variations in SV during VVI pacing may obtain greater hemodynamic benefit at rest from DDD pacing than patients with small variations.     

Community-based projects in rural internships: an alternative approach

Supervision of medical interns posted to various primary health centres and rural health training centres by specialists in preventive and social medicine and other clinical disciplines is becoming less and less effective for a number of unavoidable reasons. Because of lack of proper and timely guidance, interns feel that during the 6-month rural internship they do not get enough experience of rural life. In order to provide them with learning experiences in community medicine and orient them in the social dynamics of the community, a new approach involving interns in small community-based projects, probably for the first time, was tried on a pilot basis at the Rural Health Training Centre (RHTC), Sirur, a field practice area of B.J. Medical College, Pune, Maharashtra, India. Interns working at RHTC Sirur completed these community-based projects successfully. Identification of problems, study design analysis and drawing conclusions, based on observation, were all undertaken by the interns under the guidance of the staff of the Department of Preventive and Social Medicine, B.J. Medical College. The opinion poll at the end of the rural internship revealed that 76% of interns considered this experience valuable for improving their knowledge and skills, and 56% though that interaction during these projects was beneficial to the community as well. This experience with community-based projects for interns during their rural posting provides them with an opportunity for interaction with the community.