Neuropathy in rheumatoid arthritis (RA) may result secondary to entrapment, vasculitis, and drug toxicity. We aimed to study clinical and electrophysiological neuropathy and pathological changes in sural nerve in patients with RA. One hundred eight patients of RA, fulfilling American College of Rheumatology 1987 criteria (mean age, 45.83 years; M/F 1:3, 80.3% seropositive) were examined clinically and electrophysiologically for evidence of peripheral neuropathy. Sural nerve biopsies were performed in the involved cases. In all RA patient medications, disease activity, results of blood tests, and X-rays of affected joints were recorded. Twenty-three patients complained of paresthesias in the extremities. Vibration sensations were decreased in 9, and tendon reflexes were decreased or absent in 28 patients. Sixty-two (57.4%) patients had electrophysiologic evidence of neuropathy. Of these 53 (85.5%) patients had pure sensory or sensory motor axonal neuropathy (mononeuritis multiplex, n = 7), while 9 (14.5%) had demyelinating neuropathy (chronic inflammatory demyelinating polyneuropathy, n = 1). Carpal tunnel syndrome was seen in 11 (10.1%) patients (associated with neuropathy in 6). Of 23 sural nerve biopsies available, perineurial thickening (n = 5, amyloid deposits n = 4), perivascular lymphomononuclear cell infiltrate (n = 4), loss of myelin fibers (n = 2), and necrotizing vasculitis (n = 1) were found. Clinically, however, seven patients had evidence of cutaneous vasculitis. Comparing the clinical characteristics of the patients with or without electrophysiological neuropathy, absence of deep tendon jerks (p < 0.005) and presence of extra articular manifestations (p < 0.01) were conspicuous in the neuropathic group. There was no relation of neuropathy with the duration of RA, seropositivity, joint erosions, joint deformities, prior disease-modifying anti-rheumatic drugs or glucocorticoid intake, and 28-joint disease activity score. Neuropathy in RA was mostly subclinical and predominantly axonal. Pathologically, neuropathy secondary to amyloid infiltration was second only to vasculitic neuropathy. Absence of deep tendon jerks and presence of vasculitis were more commonly observed in patients with neuropathy.

PurposeThe purpose of this paper is to identify and address various wastes in the supply chain of the edible cottonseed oil industry (specifically the processing side) using a value stream mapping (VSM) approach to improve productivity and capacity utilization in an Indian context.Design/methodology/approachCritical observations and interviewing techniques were used with open‐ended questions to understand the processes involved in the value chain of the cottonseed oil industry. Different chain links/members were investigated through personal visits and discussions. VSM is applied as an approach to the industry to identify and remove non‐value‐adding (NVA) activities.FindingsMajor findings obtained from the study are as follows. There is an excess cumulative inventory of 244 days in the whole supply chain. The industry is highly fragmented with a large number of small players present, which hampers the use of economies of scale. There are NVA activities present in the supply chain such as the moving of cottonseed oil from expeller mill to refinery. The industry still uses outdated technology which hampers the productivity.Practical implicationsAttention needs to be given to boosting the productivity of the oil sector. Waste removal from the oilseed‐processing sector is one key to improving the productivity of the sector.Originality/valueThe paper addresses the various wastes in the processing side of the supply chain of the Indian cottonseed oil industry, using VSM as an approach which was hardly ever attempted before. Wastes are then individually attacked to reduce or eliminate them from the system. Suggestions to make the whole chain more productive can be generalized and can be replicated in the context of other developing countries.

Background:The aim of this study was to identify the prevalence and risk factors for hypertension in a rural community in north-east India.Materials and Methods:A door-to-door survey was conducted amongst all residents of a village in Uttarakhand province. All residents were interviewed and data were was relating to the demographics of the individuals, dietary habits, alcohol consumption, tobacco use, psychosocial stress, past medical history and drug history. Blood pressure (BP) and anthropometric data was recorded and blood samples taken.Results:We identified 1348 people living in the village. Assessment was carried out on all those aged 15 years and over (n=968, 71.8%). Hypertension, defined as BP ≥ 140/90 mmHg or cases of known hypertensive on medication, were present in 30.9% (95% CI 25.6 to 36.0) of males and 27.8% (95% CI 23.4 to 32.2) of females. Standardisation to the World Health Organization (WHO) world population gives an overall prevalence of 32.3% (95% confidence interval, CI 28.9 to 35.8). Increasing age and higher body mass index (BMI) were independent predictors of hypertension in both sexes, with psychosocial stress an additional independent predictor in males.Conclusions:Rates of hypertension in the rural community under study are similar to those seen in high-income countries and in urban India. With the exception of age, all the risk factors identified were potentially modifiable.

Local glucocorticoid injection results in long-term improvement in nerve conduction parameters, symptom severity and functional scores in patients with mild CTS.