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.

Congenital atresia of left main coronary artery.

We report a rare case of congenital atresia of left main coronary artery in an elderly male presenting with angina and positive stress thallium test. Coronary angiogram showed absence of left main coronary artery in the left aortic sinus. Collaterals from right coronary artery supplied left anterior descending artery and left circumflex artery territories. Despite collaterals, the left anterior descending and left circumflex arteries were rudimentary. Poor size of left-sided arteries precluded any surgical revascularization which is the treatment of choice in this rare entity.

Impedance plethysmography of thoracic region: impedance cardiography.

Impedance plethysmograms were recorded from thoracic region in 254 normal subjects, 183 patients with coronary artery disease, 391 patients with valvular heart disease and 107 patients with congenital septal disorder. The data in 18 normal subjects and 55 patients showed that basal impedance decreases markedly during exercise in patients with ischaemic heart disease. Estimation of cardiac index by this technique in a group of 99 normal subjects has been observed to be more consistent than that of the stroke volume. Estimation of systolic time index from impedance plethysmograms in 34 normal subjects has been shown to be as reliable as that from electrocardiogram, phonocardiogram and carotid pulse tracing. Changes in the shape of plethysmographic waveform produced by valvular and congenital heart diseases are briefly described and the role of this technique in screening cardiac patients has been highlighted.