Effect of Supply Chain Disruption in Dental Practice During Covid-19 Pandemic: An Indian Perspective

Disruption during Covid-19 pandemic highlighted the need of healthcare supply chain management in order to achieve effective delivery of health services. Though, considerable efforts have been undertaken on managing the healthcare supply chain disruptions in India but there is paucity of literature which documented the effect of supply chain disruptions in dental practices during covid-19 pandemic. During pandemic, the disruptions in production and distribution of dental products were seen in India. Indian dental market is largely dependent on imports and there is scarcity of local production units. The main dental companies reported significant decline in production during the first wave of Covid-19. The in-crease in demand for dental supplies was seen with shutdown, shortage of labour and scarcity of raw materials. Disruption rippled through the supply chain and this was caused by large distortion in de-mand. This phenomenon led to bullwhip effect. This bullwhip effect crisis led to increased cost in dental practices. Covid19 has shown significant lack of resilience in Indian dental healthcare supply chain. This study identified few loopholes in dental supply chain and suggested the way forward for managing the supply chain disruptions. It seems that there is need of more comprehensive research on dental supply chain resilience from Indian perspective to prevent disruptions particularly in emergent situations.

Impact Of Screen Time Exposure On Sleeping Habits Amongst Young Adults

Background:Lack of adequate sleep affects the mental health, emotional balance, immune function and reaction times. The alarming sedentary habit which would affect the sleep quality in the recent time is screen media exposure or increased screen time. Moderate use of ST (4hours/day) associated with lower psychological well-being. Objective: Tostudy the association between ST usage and sleep quality amongst young adults. Material And Methods:The study was conducted among medical students at Physiology department, Government medical college, Vadodara. Google form was created, which consisted of basic information. Self-reported ST usage per day. PSQI scale assessed 7components of sleep scaling from 0 to 3, and higher global score (>5) means lower sleep quality. The Google form was sent to participants who were given informed consent and the results were computed. Result:Among 204 participants, 78 males and 126 females, the median age was 19 years, the mean duration of screen time was 5.3 Hrs.(SD=2.7). ST > 5Hrs. in 57.8% and PSQI ?5 in 52.9% was seen. Chi Square test analysis for ST& PSQI, the p-value came out to be 0.094(p-value > 0.005), and was not statistically significant. Conclusion:This study shows more than half of participants had poor sleep quality and increased screen time usage. Though the results came out statistically insignificant we cannot exclude the association without further research. However,exposure to high screen time may negatively impact sleep outcome.

HbA1c: A Marker for Severity of Acute Myocardial Infarction

Introduction: Diabetes mellitus is considered a disease with a major impact on the vascular tree with both microvascular and macrovascular complications. Hyperglycaemia is independent risk factor for cardiovascular diseases. HbA1c could be considered as a good marker for glycemic control. Recent reports have found that elevated HbA1c levels are also predictive for cardiovascular disease and mortality. Present study was undertaken to find out the correlation between HbA1c levels and complications and outcome in patients of acute myocardial infarction. Materials and methods: Present prospective observational study was conducted on 200 patients admitted to the medical wards in hospital with acute myocardial infarction with or without diabetes mellitus. After a detailed history and physical examination, HbA1c, lipid profile, cardiac enzymes, ECG and echocardiogram were performed in all patients. The patients were then divided into two groups based on the HbA1c levels i.e. good glycemic control (HbA1c< 7%) and poor glycemic control (HbA1c>/= 7%).Data was analysed using SPSS software ver. 21 using appropriate statistical tests. P-value of less than 0.05 was taken as level of significance Results: Poor glycemic control was seen in 52.5% patients. No difference was observed between the groups with respect to gender distribution, duration of hospital stay and patient’s outcome. Past history of MI was found to be significantly associated with poor glycemic control (53.3% vs 38.9%). On comparing the association of outcome in high risk groups as per glycemic control, we observed that poor outcome in MI was significantly associated with elderly population (16.9% vs 3.5%; p< 0.05). Conclusions: In patients with age greater than 60 years, the occurrence of higher HbA1c levels is found to be associated with increased incidence of mortality. So, high HbA1c in elderly population should be considered a risk factor for mortality and hence active management should be done to keep HbA1c level strictly below 7 in this population.

Prevalence and risk factors associated with worm infestation in pre-school children (6-23 months) in selected blocks of Uttar Pradesh and Jharkhand, India.

BACKGROUND: Intestinal worm infestation is widely prevalent in developing countries and can result in impaired nutrition and development. AIMS: To estimate prevalence of and risk factors for intestinal geohelminths and other intestinal parasites in children aged 6 to 23 months. SETTINGS AND DESIGN: Cross sectional study in rural India. MATERIALS AND METHODS: Proportionate population size sampling method was used to randomly select 15 villages per block. Thereafter, house-to-house survey was done to recruit eligible children and obtain fecal sample for microbiological examination. STATISTICAL ANALYSIS: Univariate distribution of variables was assessed and comparison between categorical variables and continuous variables was done using a Chi-square test and student's t-test, respectively. Odds ratio was calculated to assess associations. RESULTS: Overall 926 children were recruited and 909 fecal samples examined. Combined prevalence of infestation with intestinal geohelminths treatable by albendazole and other intestinal parasites non-treatable by albendazole was 50.3% (457/909) and 51.6% (469/909), respectively. Exclusive use of hand pump water (OR = 1.79, CI = 1.36-2.35, P CONCLUSION: Since almost half the children are infected with intestinal geohelminths treatable by albendazole, targeted deworming of population in this age group should be considered.

Treatment seeking behaviour of malaria patients in desert part of Rajasthan, India.

Malaria remains to be the most important cause of morbidity and mortality in India and in many other tropical countries with approximately 2 to 3 million new cases arising every year. In spite of arid conditions prevailing in desert part of Rajasthan, malaria is a major public health problem. A longitudinal study on social determinants of malaria has been undertaken in different villages of Ramgarh PHC of Jaisalmer district, Rajasthan. The study aims to know treatment seeking behabiour of malaria patients in the desert communities which is significantly different than the non-desert part of India. Out of 60 villages, 12 villages and 573 malaria patients were selected randomly. Interview technique was used for data collection. Information was recorded on pre-tested schedules. Self diagnosis 423 (73.8%) was more common among the respondents and 443 (77.3%) had taken treatment at home with local herbal remedies as the first treatment action. Desert population was not used to laboratory test for the malaria diagnosis. Symptoms based treatment was practised. They used private and government health facilities for the treatment of malaria. Self diagnosis for malaria was common but practised more by the poorer households. A large part of the population did not complete the full course of malaria treatment as a result drug resistance was more common. They did not use the government health facility as a first step of malaria treatment. There is need for health education with campaign emphasizing the role of mosquitoes in malaria transmission and the need for prompt medical intervention. The use of Government health services for the diagnosis and treatment of malaria by the poor should be encouraged through appropriate information, education and communication (IEC) which on the long run will be more cost effective for desert population under the national malaria control programme.

Comparison of analgesic efficacy of fentanyl and sufentanil for chest tube removal after cardiac surgery.

Chest tube removal in the postcardiac surgical patients is a painful and distressful event. Fentanyl and sufentanil have not been used for pain control during chest tube removal in the postoperative period. We compared efficacy offentanyl and sufentanil in controlling pain due to chest tube removal. One hundred and forty one adult patients undergoing cardiac surgery were recruited in a prospective, randomized, double blind, placebo controlled study. Patients were randomized to receive either 2 microg/Kg fentanyl IV or 0.2 microg/Kg sufentanil IV or 2 ml isotonic normal saline, 10 min before removing chest tubes. Pain intensity was assessed by measuring visual analog scale pain score 10 minutes before removing chest tubes and 5 min and 20 min after removing chest tubes. Level of sedation, heart rate, arterial pressure, oxygen saturation, and respiratory rate were recorded by a blinded observer at the same time intervals. Mean pain intensity scores 10 minutes before removal of chest tubes infentanyl, sufentanil and control groups were 23.88+/-5.2, 25.10+/-5.39 and 23.64+/-6.10 respectively. The pain scores 5 minutes after chest tube removal were reduced to 20.11+/-6.9 (p<0.05) in the fentanyl group and 13.60+/-6.60 (p<0.05) in the sufentanil group, whereas in control group pain scores increased to 27.97+/-8.39 (p<O.05). The pain scores in sufentanil group were significantly lower compared with fentanyl or control group. Sedation scores remained low in all groups and patients remained alert and none of the patients showed any adverse effects of opioids. Heart rate, arterial pressure and respiratory rate had least variations in sufentanil group than fentanyl or control group.

Paget's disease of the bone: a report of three cases.

Paget's disease is uncommon in Asians. We present 3 patients with varying manifestations. A 50 years old lady was detected to have raised alkaline phosphatase at a routine health check-up. Isoenzyme studies confirmed its bony origin. Bone scan revealed polyostotic disease. A 65 years old male patient with known Paget's disease of 6 years duration presented with pelvic girdle pain, progressive increase in alkaline phosphatase levels and worsening bone scan. A 45 years old male was admitted with chest pain. Cardiac evaluation was normal. Bone scan picked up a cough fracture in the left 7th rib and an incidental Paget's disease of the skull. All three had elevated markers of bone metabolism in the serum and urine. With monthly intravenous pamidronate there was significant improvement in the bone markers and follow-up bone scans.

Mass poisoning with jatropha curcas - A case report.

In India, accidental poisoning due to ingestion of plant seeds is common among children, especially under 12 years of age. It varies from relatively mild poisoning to fatal poisoning. Since unripe fruits of Yellow Oleander (Cerbera thevetia; Thevetia peruviana) resemble the fruits of Jatropha curcas, and symptoms such as vomiting, diarrhoea, and abdominal pain are common to both when ingested, differentiating the two is occasionally difficult. In this paper, the authors share their experience of a mass poisoning with Jatropha curcas that was initially mistaken to be due to Cerbera thevetia.

NSAIDs and kidney.

NSAIDs are commonly used drugs. Even with the advent of selective COX-2 inhibitors, nephrotoxicity still remains a concern. The adverse effects of NSAIDs are mediated via inhibition of prostaglandin synthesis from arachidonic acid by non-specific blocking of the enzyme cyclooxygenase leading to vasoconstriction and reversible mild renal impairment in volume contracted states. When unopposed, this may lead to acute tubular necrosis and acute renal failure. NSAIDs also produce interstitial nephritis with or without nephrotic syndrome secondary to minimal change disease. Although this presents as acute renal failure, it can progress in some cases to chronic renal failure. Papillary necrosis has been incriminated in the development of chronic renal failure secondary to NSAIDs. In patients on long term NSAIDs without acute or chronic renal failure, subclinical renal dysfunction such as reduced creatinine clearance and impaired urine concentrating ability has been shown to be present. Although this sub-clinical dysfunction is reversible on withdrawal of NSAIDs, some reports have suggested a persistent residual dysfunction. Even with a wide range of NSAIDs at our disposal, a renal safe NSAID is yet to be discovered.

Rheumatoid arthritis and the kidney.

It is clear that kidney is involved in rheumatoid arthritis (RA) with both glomerular and tubular damage. Renal disease in RA however is usually asymptomatic and is detected only on laboratory investigations. It is often difficult to differentiate between damage due to disease activity and that due to drugs used to treat RA. Although there are a number of parameters to study renal function, these cannot be applied to day to day practice and still remain research tools. In such a scenario, it is important to periodically monitor serum creatinine and carry out urine examination so as to pick up the earliest signs of renal dysfunction.

Myelodysplasia and acute myeloid leukaemia in a case of rheumatoid arthritis with secondary amyloidosis treated with chlorambucil.

Immunosuppressive therapy related secondary haematologic malignancy is well reported. A 52 years lady with established rheumatoid arthritis developed reactive amyloidosis. This was initially treated with colchicine and cyclophosphamide and later with chlorambucil. Ten months after stopping chlorambucil she developed pancytopenia and vitamin B12 deficient megaloblastic anaemia. The pancytopenia was refractory to vitamin B12 supplements and a repeat bone marrow confirmed myelodysplasia (FABI RAEB-T). Within three weeks of this diagnosis she evolved into acute myeloid leukaemia and expired due to refractory thrombocytopenia and uncontrolled bleeding. This case stresses the need for long term follow up of RA patients treated with alkylating agents.

A longitudinal study of serum creatinine levels in patients of rheumatoid arthritis on long term NSAID therapy.

AIM: Primary: To study the effect of long term NSAID therapy on serum creatinine in patients of rheumatoid arthritis. Secondary: To study the effect of discontinuation, reduction in the dose or continuation of NSAID and of rechallenge. MATERIAL AND METHODS: Case records of RA patients with a minimum two years of follow up were analysed. Age, sex, duration of RA, type, dose and duration of NSAID and DMARD therapy, co-morbid conditions and serial serum creatinine levels were charted. RESULTS: Ninety nine case records were studied. Incidence of abnormal creatinine level (renal insufficiency) defined as rise in creatinine equal to or above the upper limit of normal was 27.7%. This rise was asymptomatic in all patients. No NSAID was particularly associated with an increased risk in renal insufficiency. The rise of serum creatinine was reversible in most patients irrespective of discontinuation or continuation of NSAID but settled at a higher level. Rechallenge resulted in rise of serum creatinine in 50% patients. Hypertension, DM, IHD and diuretics carried a higher but not statistically significant risk of renal insufficiency. CONCLUSION: NSAID-induced asymptomatic rise of creatinine in patients of RA on long term NSAIDs is common. It is mostly reversible. Regular monitoring of serum creatinine is essential.

Postoperative wound infection in patients undergoing coronary artery bypass graft surgery: A prospective study with evaluation of risk factors.

PURPOSE: Wound infection is an important cause of morbidity and occasional mortality after coronary artery bypass graft surgery (CABG). The aim of this study was to report postoperative wound infection in CABG surgery patients. METHODS: Consecutive patients undergoing CABG surgery between January 1998 and October 1999 have been studied. The exclusion criteria included, age less than 30 years, penicillin / cephalosporin allergy and associated other cardiac pathologies. The parameters studied were age, sex, obesity, hypertension, diabetes, myocardial infarction, chronic renal failure, previous surgeries, alcohol consumption, smoking, length of pre and postoperative hospital stay, antibiotic prophylaxis, MRSA screening, and duration of surgery. Wounds were classified as per modified CDC's NNIS criteria. Suspected sites of infection were cultured and antibiotic susceptibility of cultured organisms was tested. Postoperative follow up was for two months. RESULTS: Six hundred and fifteen patients were studied. Of these 116 (18.86%) developed SSI, involving sternum 75%, leg 21.3%, and forearm sites 3.44%. Organisms isolated at sternum site were MSSE, MRSA, and MRSE, at leg site E. coli and MSSE, and at forearm site MSSE and MSSA. Sternal site, obesity, diabetes mellitus and female sex were associated with significantly higher infection rates (p= 0.001). No antibiotic protocol proved more effective. SSI increased the postoperative hospital stay and the total treatment cost. CONCLUSIONS: Post CABG surgery SSI rate is high. Sternum and leg are the common infection sites. Obesity, uncontrolled diabetes mellitus and female sex are associated with higher infection rates. "Higher" antibiotics do not lower postoperative infection rates.