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Background The overall cost of managing chronic diseases is a significant barrier to accessing complete and timely healthcare, especially in rural and geographically isolated areas. This cost disparity becomes more pronounced in the case of children and more so in under-resourced regions of the world. In the era of COVID-19, as the need for physical distancing increased, there was a transition in approach to healthcare provision to Telemedicine consultations. The cost saving using teleconsultations is evaluated in this study in a pediatric nephrology clinic. Methodology This prospective cohort study was conducted at a tertiary care center in western Rajasthan from March 2021 to October 2022. All consecutive pediatric (29 days -18 years) patients attending telemedicine services for renal-related illness were enrolled. Basic demographic details were collected. The cost analysis was done after six months, in terms of perceived cost savings by a telemedicine consultation compared to an in-person visit during six months starting from enrolment. Results One hundred twelve patients were enrolled. Two hundred sixty-six teleconsultations attended. The 109 patients who could be followed up saved INR 4,57,900 during six months of follow-up. ( 3 lost to follow-up). The average cost saving was INR -1577/patient/visit. The patients saved 4.99 % of the family income [Median of 2.16 %( IQR: 0.66-5.5 %)]. The Highest expenditure per visit was incurred for food and transport. The median distance from the residence to the clinic was 122.5 km (IQR: 30-250). Over the six-month study period, our patients have saved a travel distance of 83274 km. (743 km per patient). Conclusion The use of telemedicine as a follow-up method helps save significant costs and distances travelled by patients.

Livestock markets perform major exchange function of animals in India. These markets play a considerable share in the economic gain of farmers and act as a social and cultural migration hub for the domestic and foreign tourists also. But they are largely unorganized and dominated by informal traders. The structural base of livestock markets determines the sales pattern and the major price value of animals is bagged by middlemen. These markets are functioning under the jurisdiction of the state governments and supervision is under the control of the local bodies. The different marketing strategies in the markets and pricing are affected by qualitative and quantitative factors of animals. The major constraints regarding the livestock markets are the lack of facilities and unawareness of knowledge among the sellers and buyers. The role of livestock markets in disease transmission is also a matter of concern. Details regarding animal movement will facilitate epidemiological studies to prevent contagious diseases from outside the country. In the present COVID-19 pandemic, conventional livestock markets are closed and virtual markets based on online platforms such as Facebook, WhatsApp and E-commerce sites are coming up and these transformations are absolutely inevitable. Keywords: Livestock markets, Marketing strategies, India

Autonomic dysfunction associated with Type 2 Diabetes Mellitus is a well known entity, of which cardiac autonomic neuropathy deserves a special mention due to its propensity to cause major cardiac events in a seemingly asymptomatic individual. The incidence of Cardiac autonomic neuropathy among newly diagnosed Diabetes patients is less studied, with most of the current studies done in Western populace who have a different metabolic milieu compared to Indians. This study aims to find the prevalence of cardiac autonomic neuropathy in the Central Indian population, presenting to our center who are diagnosed to be having Diabetes Mellitus within one year.35 patients, of the age group (18-45 years), who were diagnosed to have Type 2 Diabetes Mellitus within the last one year were taken, after excluding any other chronic illness, like CKD, CLD, CVA, etc. and after getting consent. 35 healthy age and sex-matched controls were included in the study. Cardiac Autonomic Testing was done for all of them, using the measurement of Heart Rate Variability (HRV), Deep Breathing Test (DBT), Cold Pressor Test (CPT), and Lying to Standing Test (LST). The experimental data was analyzed using Labchart Software for autonomic dysfunction.On preliminary analysis, around 40% of the patients enrolled in the study had cardiac autonomic dysfunction, predominantly parasympathetic dysfunction, compared to the controls. There was no significant age-wise difference in cardiac autonomic dysfunction. There was also no statistically significant correlation with the HbA1c of the patient at presentation and their cardiac autonomic dysfunction.There is significant cardiac autonomic dysfunction among newly diagnosed Diabetes patients. This reaffirms the fact that early screening and diagnosis of this disease is paramount to prevent significant morbidity and mortality associated with the complications of the disease.

Image-guided locoregional therapies have an important role in the management of patients with hepatocellular carcinoma (HCC). Recent advances in the ablative as well as endovascular therapies have expanded the role of interventional radiologists in the treatment of HCC. Following image-guided therapy, an accurate response assessment is vital. Knowledge regarding normal postprocedure changes and subtle signs of residual or recurrent disease is important. In this review, we discuss various response evaluation criteria currently employed for HCC. We also discuss the postprocedure imaging features suggestive of residual disease or recurrence and imaging biomarkers for response assessment.

Background: Drug utilization evaluation is an important parameter for the safe, effective and rational use of medications in medical care. Alcoholism results in abundant cases of alcohol withdrawal which can prove to be life-threatening if untreated, lorazepam is a drug of choice for Alcohol Withdrawal Syndrome and requires close monitoring as its over-dosing or under-dosing is common in case of withdrawal. Objective: ensures the safe and rational use of Lorazepam in the management of Alcohol Withdrawal Syndrome. Materials and Method: This prospective, observational study was conducted among alcoholic patients admitted in the KC General Hospital, Karnataka, India. Baseline data for Clinical Institute Withdrawal Assessment for Alcohol revised scale (CIWA-Ar) was collected on the day of admission and the response to lorazepam treatment was recorded using the same with respect to the baseline data every 12th hourly after the initial administration until withdrawn. Results: Statistical analysis for 72 patients was done using ANOVA to calculate the overall progression of the syndrome with treatment. Among 72 patients 94.44% were male and 5.55% were female. The mean age of patients reported with AWS was found to be 44.90 years. A significant CIWA-Ar score reduction was observed with a p-value of

In India, majority of the small-holder farmers are depending on semi-extensive farming system. The cost-effective method of semi-extensive farming is being practised in the hilly regions of Kerala, especially the Vagamon hill ranges of Idukki district. Scientific dairy farming in such semi-extensive farming systems requires evaluation of the quality of grasses in meadows, animal preference to flora and the soil quality. The study was conducted at the Base Farm, Kolahalamedu under Kerala Veterinary and Animal Sciences University where the animals are regularly left out for grazing. The most preferred grass species by the grazing animals was Congo signal in the meadows. Cultivated fodder (Setaria sp.) was also offered to the animals while at the shed. The dry matter content of grass species favoured to meet the dry matter requirement of animals to a major extent and hence the enrichment of soil quality of the meadows will increase the nutritive quality and biomass content of grasses. It is suggested that, proper management of meadows of Vagamon hill ranges with respect to type of grasses and soil quality will favour cost-effective dairy farming

Infections are the most common cause of morbidity and mortality in renal transplant recipients; respiratory, urinary, and gastrointestinal infections are the most common. Gastrointestinal manifestations are usually associated with cytomegalovirus. Although opportunistic infections are common in solid organ transplant recipients in view of the immunosuppressed state, amoebic liver abscess is uncommon in renal transplant recipients and has not been reported in literature, to the best of our knowledge. We describe a patient with an amoebic liver abscess 3 months after renal transplantation surgery.

The vast repertoire of human skills enable nimble and graceful execution of several habitual tasks. On the contrary, despite many advances, robots are still far from matching human capabilities. Robots can be envisioned to take up the oft-touted dull, dirty and dangerous humans jobs only with breakthroughs in their energetic and dynamic characteristics. A typical bio-inspired approach that can potentially help robots achieve the aforesaid performance aspects is joint compliance. Compliant actuation technology has vastly diversified in the last decade. A survey of the various actuator methodologies hints at possible advances for series-clutched and series-parallel multi-articulated actuation. To address them, the thesis builds upon these existing actuation concepts and focuses on specifically improving their energetic and dynamic performance characteristics. Energetic benefits of series elastic actuation is often marred by gearbox friction. An instance is when friction dissipates the link energy impeding gravity-driven link motions. At such instances, clutches can help stem undesired power-flows by decoupling the link and motor. In addition, when natural link motions are to be damped while not driving the actuator, clutches can be used to actively exploit slippage to dissipate the excess mechanical energy. Such a continuous clutching action has significant implications for energy economy. Therefore, first contributions of this thesis is towards deriving an energy-based model and an optimal controller for a series clutched actuator. In addition, an optimization-based approach is sought to obtain design parameters for a physical implementation of the actuator. Parallel actuators can often augment series elastic actuators as secondary torque sources. Owing to their energy storage capabilities, they have been used to greatly enhance robot energetics. However, the joint torque resolution problem when employing dissimilar (series and parallel) actuators is difficult, more so when the parallel actuators are biarticulated. Therefore, a second contribution of the thesis is towards deriving an energetic criteria-driven, torque resolution controller. An energetic analysis of the various criteria predicts that allocation of maximum possible torque demand to the higher efficiency actuators may not necessarily be the best strategy at all times. The analysis when extended to a wider range of motion frequencies predicts progressively lesser utilization of parallel actuators can contribute to higher energy-economy. Through energy-recycling, mono and biarticulated parallel compliance can amplify jumping performance of series elastic actuated robots. While the principle augments robot performance from the mechanical domain, joint velocities powered by series actuators yet suffer from limited voltage. Field weakening is applied at the electrical level to alleviate voltage constraints. In order to maximize energetic economy during such highly dynamic motions, trajectory optimization is further employed with knowledge of actuation capabilities and novel power constraints. Therefore, the confluence of these methods is proposed and experimentally demonstrated to significantly enhance jumping performance. Finally, the efficacy of these concepts towards enhancing explosive motions are quantified through a centroidal dynamic manipulability analysis. These results lead to a third broad contribution from this thesis.

Background and Aims The southern state of India, Kerala was hit by the worst flood in the last century on 16.08.18, due to unprecedented monsoon rains. The Indian government had declared it a Level 3 Calamity. According to the Kerala government, over 483 people died, about a million people were evacuated. This paper describes the experience of the Hemodialysis (HD) unit at Aster Medcity, which was forcibly closed due to floods. The Nephrology department does over 1100 dialysis treatments per month and about 60 kidney transplants per year. Aim To study unexpected shutdown of hemodialysis unit and its effect on maintenance hemodialysis patients. Method This is a descriptive study of forced closure of HD unit due to floods. The sequence of events till shut down after the decision of closure has been retrospectively studied by reviewing the minutes of meetings with chief of medical services and memory recall of the Nephrology team involved in the process. Role of HD nurses during the period of flood was also studied. HD patients were interviewed and impact of floods on them was recorded, including, ability to find an alternate HD unit, any missed HD sessions, access to medicines and admissions in hospital. The characteristics of HD patients was recorded. After reopening of our HD unit, 30days assessment was done for clinical consequences including, hospitalization, infections, vascular access problems and seroconversion. Results The services of HD unit were suspended from midnight 17.08.18 to 27.08.18. The HD unit is at the ground floor of the hospital. The HD unit has 13 HD machines, which were used for 77 maintenance HD patients (Males: 55; Females: 22). The mean age was 61 ±14 years and the median dialysis vintage was 2 years. Vascular access was a catheter (tunnelled and non-tunnelled) in 19 patients, arterio-venous fistula in 57 patients and arterio-venous graft in 1 patient. Patients known to have Diabetes were 77.7%, Hypertension 91%, Coronary artery disease were 26 in number and chronic liver disease were 5. Hospital authorities decided to evacuate the hospital 24 hours before the floods hit the hospital premises. The Nephrology team comprised of 4 consultants, 6 residents, 33 dialysis nurses and technicians and a social worker. The HD unit was closed after draining the reverse osmosis (RO) plant at 10pm on 16.08.18. The lead consultant contacted potentially safe HD units in other parts of the state; willingness for accepting HD patients and the surge capacity of each HD unit was recorded. The HD patients were informed over telephone the centers they can approach and HD summary (includes diagnosis and HD details) was sent to them via e-mail. All HD patients were reminded to comply with diet restrictions and inform the shelter camp regarding the same. Accordingly, 77 HD patients were accommodated in 25 HD units. 12 dialysis nurses provided their services voluntarily at other HD units unaffected by floods. 15 HD patients were displaced from their homes due to floods. 19 HD patients missed one HD session; 5 HD patients missed two HD sessions; 1 patient missed three HD sessions. Our HD unit reopened on 27.08.18 after complete disinfection of the RO plant and servicing of HD machines by the manufacturer. All patients returned to our HD unit. In the first 30 days after floods, 3 patients were admitted to intensive care unit with fluid overload, 3 patients were admitted with respiratory tract infection, 2 patients had an AV fistula dysfunction, 3 patients developed catheter related blood stream infection. There was no seroconversion. There was no mortality in HD patients during and one month after flood. Conclusion The timely decision to suspend dialysis services played a crucial role in preparing for HD unit closure, arranging alternate HD places for patients and providing treatment summaries. However, the increase in adverse clinical consequences heralds the drop in the quality of healthcare services during natural disasters.

Adult-onset Still's disease (AOSD) is a rare inflammatory disorder of unknown etiology. The varied clinical presentation of the disease mimicking many other diseases makes it difficult to diagnose. Various infectious triggers in a genetically susceptible host have been described in literature. We report a case of a 25-year-old female who presented with fever, rash, and arthralgia and diagnosed to be AOSD triggered by hepatitis A infection after excluding other differentials. She was managed with corticosteroids with dramatic response and continued to be in remission even after steroid withdrawal.

Manufacturing organization experiences highly volatile market due to the technological updates, customer needs, environmental issues and competitor’s product. The ultimate objective of the manufacturing industries today is to provide the market with products of the highest quality, at reasonable prices, at the optimal time. Just-in-time (JIT) has been widely implemented in manufacturing industries as a survival strategy against global market competition as it offers various benefits, such as greater throughput, higher productivity and better quality. The aim of the paper is to discuss few strategic issues and some important rules for getting the system off the ground. The procedure for planning and implementation along with global status and pay off has been discussed critically. A designed questionnaire for self test has also been given along with evaluation criteria to identify the weakness and strength of the company for successful implementation of JITmanufacturing strategy. It also gives a methodology for computation and improvement of performance index using the principle of continuous improvement.This paper focuses on how to enhance the productivity/ performance index while applyingsystematically, scientifically basic principles of JIT approaches. The design guidelines are applied to a small scale industry as a case example.The ideas presented in the paper will be useful for those who want to implement JIT manufacturing in their organizations.

This paper investigates the energy efficiency potential of continuously controllable clutches between the motors and links of robot joints. Inspired by biological muscles, the clutch enables free, purely gravity driven robot link motion phases gradually disengaged from gear friction, not requiring motor effort. The concept combines the energetic benefits of direct drives during unforced motion phases with the high torque density of conventional and mature geared robotic drive technology during forced motion phases. The paper specifies the general functional principle of the clutch for energy saving independent of any particular clutch implementation. The feasible energy saving of up to 60 % is investigated for harmonic link motions with varying frequencies and with respect to different ratios of link weight to friction torque. The outcomes of the theoretical investigations are supported by first experimental results.

Zinc oxide (ZnO) nanoparticles (NPs) has been synthesized by precipitation method using ammonia as precipitating agent and ZnCl 2 . 4 H 2 O as starting material. Syntsesised nanoparticles (NPs) have been characterized by using XRD (X-ray diffraction), TGA/DTA (Thermo Gravimetric Analysis), IR (Infrared Spectroscopy), magnetic measurement, surface area measurement, SEM(Scanning electron microscopy) and TEM (Transmission electron microscopy). XRD studies show that zinc oxide was formed as ZnO and it has hexagonal structure. Magnetic measurements showed diamagnetic nature of synthesized zinc oxide NPs. Surface area of NPs zinc oxide was 4.3737 m2/g. The particle size of the synthesized zinc oxide was determined by TEM. TEM images show that the size of particles of ZnO varied from 27nm to 82nm with average crystallite size 50 nm.

Chromium oxide nanoparticles (NPs) have been rapidly synthesized by precipitation method using ammomia as precipitating agent and are characterized by using X-ray Diffraction (XRD), Thermo Gravimetric Analysis (TGA), UV-Visible absorption (UV), Infrared Spectoscopy (IR), Scanning Electron Microscopy (SEM) and Transmission Electron Microscopy (TEM). XRD studies show that chromium oxide NP is formed as Cr 2 O 3 and it has hexagonal structure. The shape and particle size of the synthesized Cr 2 O 3 NPs is determined by SEM and TEM. The images showed that the size of NPs of Cr 2 O 3 varied from 20 nm to 70 nm with average crystalline size 45 nm. UVVisible absorption and IR spectoscopy confirm the formation of nanosized Cr 2 O 3 . TGA verifies that the Cr 2 O 3 NPs are thermally stable upto 1000 °C.

A series of 4-methyl-2-oxo-pyranyl-phenothiazines ( IIIa - j ) followed by 4-methylpyrano-(2, 3-β)-phenothiazine-2(11 H )-one oxime ( IVa - j ) were synthesized by using 7-hydroxy-4-methylcoumarin ( I ). Further reaction of ( I ) was carried out with substituted aromatic amines ( a - j ) to convert into 7-arylamino-4-methyl-coumarin ( IIa - j ). Additionally ( IIa - j ) was treated with sulphur in presence of iodine to obtain a series of novel 4-methyl-2-oxo-pyranyl-phenothiazine ( IIIa - j ) derivatives, which on treatment with hydroxylamine hydrochloride afforded the title compounds i.e. 4-methylpyrano-(2,3-β)-phenothiazine-2(11 H )-one oxime ( IVa - j ). The structures of these compounds were confirmed by IR, NMR and Mass spectral analysis. The newly synthesized compounds were evaluated for antibacterial and antifungal activity. The results show that compound IIIa , IIIe , IIIh , IIIj, IVa , IVi and IVj exhibited moderate to good antibacterial and antifungal activity at 5-100 mcg/mL.

Condensation of ethylaceto acetate (EAA) with resorcinol in concentrated H2SO4 afforded 7-hydroxy-4-methyl coumarin (1), which on reaction with thiosemicarbazide in anhydrous pyridine yielded 7-hydroxy-4-methyl-quinolinyl [1,5-c]-mercaptotriazole (2). Reaction of 2 with formaldehyde solution and amino acid in ethanol yielded 7-hydroxy-4-methyl-8-(N-methyl-aminoacid)-quinolinyl [1,5-c]-2''-mercaptotriazole (3a-e). Interaction of 3 with o-phenylenediamine in pyridine yielded 7-hydroxy-4-methyl-8-(aminobenzimidazolyl)-quinolinyl [1,5-c]-2''-mercaptotriazole derivatives (4a-e). The latter compounds were evaluated for their antiviral and antimicrobial activities.

Melioidosis, also known as Whitmore disease, is caused by the bacterium Burkholderia pseudomallei, a motile, aerobic, non-spore-forming bacillus. The bacterium is known to thrive in tropical climates. However, the worldwide incidence of the disease appears to be increasing as a result of increased travel and epidemiological sophistication. [1] We report two patients who were diagnosed to have melioidosis, and the challenges faced in treating them.