A Comprehensive Review on Exploring the Impact of Telemedicine on Healthcare Accessibility.

Telemedicine has emerged as a transformative force in healthcare delivery, particularly in improving healthcare accessibility. This comprehensive review examines the impact of telemedicine on healthcare accessibility, exploring its ability to overcome geographical, financial, sociocultural, and infrastructural barriers to healthcare access. Through remote consultations, monitoring, and diagnosis facilitated by technology, telemedicine extends healthcare reach to remote and underserved areas while enhancing temporal accessibility with round-the-clock availability. By streamlining healthcare delivery systems, telemedicine reduces costs and promotes efficiency, ultimately fostering health equity and improving health outcomes. However, technological barriers, regulatory hurdles, and patient acceptance remain. To realize telemedicine's full potential, collaboration among stakeholders in the healthcare and technology sectors is imperative. Policymakers must enact supportive regulations, healthcare providers must integrate telemedicine into their practices, and technology companies must innovate to develop user-friendly platforms. Through concerted efforts, telemedicine can catalyze advancing healthcare accessibility and enhance the health and well-being of individuals worldwide.

Commercialization potential of PET (polyethylene terephthalate) recycled nanomaterials: A review on validation parameters.

Polyethylene Terephthalate (PET) is a polymer which is considered as one of the major contaminants to the environment. The PET waste materials can be recycled to produce value-added products. PET can be converted to nanoparticles, nanofibers, nanocomposites, and nano coatings. To extend the applications of PET nanomaterials, understanding its commercialization potential is important. In addition, knowledge about the factors affecting recycling of PET based nanomaterials is essential. The presented review is focused on understanding the PET commercialization aspects, keeping in mind market analysis, growth drivers, regulatory affairs, safety considerations, issues associated with scale-up, manufacturing challenges, economic viability, and cost-effectiveness. In addition, the paper elaborates the challenges associated with the use of PET based nanomaterials. These challenges include PET contamination to water, soil, sediments, and human exposure to PET nanomaterials. Moreover, the paper discusses in detail about the factors affecting PET recycling, commercialization, and circular economy with specific emphasis on life cycle assessment (LCA) of PET recycled nanomaterials.

The role of family support in the self-rated health of older adults in eastern Nepal: findings from a cross-sectional study.

BACKGROUND: Nepal's low fertility rate and increasing life expectancy have resulted in a burgeoning older population. For millennia, filial piety shaped family cohesion and helped Nepali older adults achieve positive outcomes, but recently, it has been eroding. Furthermore, there are not enough institutional support options or alternatives to family-based care to deal with the biosocial needs of older adults. This study explored the association between family support and self-rated health among Nepali older adults. METHODS: A community-based cross-sectional survey in eastern Nepal's two districts, Sunsari and Morang, interviewed 847 older adults (≥ 60 years). The final analytical sample was 844. Participants were asked whether they received assistance with various aspects of daily life and activities of daily living from their families. Multivariable logistic regression examined the association between family support and self-rated health. RESULTS: Participants who received support with various aspects of daily life had 43% higher odds of good health, but after adjusting for control variables, the result only approached statistical significance (p = 0.087). Those who received family assistance with activities of daily living had nearly four times higher odds (OR: 3.93; 95% CI: 2.58 - 5.98) of reporting good health than participants who lacked this support. CONCLUSIONS: Given the important role of family support in Nepali older adults' health, government programs and policies should create a conducive environment to foster family-based care until more comprehensive policies for older adults' care can be put into effect. The results of this study can also help shape the global aging environment by highlighting the need for family support in older care, particularly in low-income nations with declining traditional care systems and weak social security policies.

Estimating the burden of illness caused by domestic waterborne Legionnaires' disease in Canada: 2015-2019.

Legionellosis is a disease caused by the bacterium Legionella that most commonly presents as Legionnaires' disease (LD), a severe form of pneumonia. From 2015 to 2019, an average of 438 LD cases per year were reported in Canada. However, it is believed that the actual number of cases is much higher, since LD may be underdiagnosed and underreported. The purpose of this study was to develop an estimate of the true incidence of illnesses, hospitalizations, and deaths associated with LD in Canada. Values were derived using a stochastic model, based on Canadian surveillance data from 2015 to 2019, which were scaled up to account for underdiagnosis and underreporting. Overall, there were an estimated 1,113 (90% CrI: 737-1,730) illnesses, 1,008 (90% CrI: 271-2,244) hospitalizations, and 34 (90% CrI: 4-86) deaths due to domestically acquired waterborne LD annually in Canada from 2015 to 2019. It was further estimated that only 36% of illnesses and 39% of hospitalizations and deaths were captured in surveillance, and that 22% of illnesses were caused by Legionella serogroups and species other than Legionella pneumophila serogroup 1 (non-Lp1). This study highlights the true burden and areas for improvement in Canada's surveillance and detection of LD.

Assessment of Metal Ions Levels in Blood of Dental Implant Patients.

Background: Dental implants use has significantly increased and the concentration of metal ions into blood may have detrimental effect of human body. The present study aimed to determine metal ions levels in blood of dental implants patients. Materials and Methods: 48 patients scheduled for dental implant surgery was assessed for measurement of titanium and aluminum pre-operatively and post-operatively at 6 weeks, 3 months, 6 months, and 1 year. Results: Out of 48 patients, males were 22 (45.8%), and females were 26 (54.2%). The mean ± SD titanium metal levels in blood pre-operatively was 2.34 ± 0.47 mg/dl, at 6 weeks was 2.35 ± 0.48 mg/dl, at 3 months was 2.37 ± 0.52 mg/dl, at 6 months was 2.37 ± 0.42 mg/dl, and at 1 year was 2.38 ± 0.51 mg/dl. A non-significant difference was seen (P > 0.05). The mean ± SD aluminum metal levels in blood pre-operatively was 4.4 ± 0.12 mg/dl, at 6 weeks was 4.45 ± 0.14 mg/dl, at 3 months was 4.7 ± 0.13 mg/dl, at 6 months was 4.7 ± 0.21 mg/dl, and at 1 year was 4.8 ± 0.17 mg/dl. A non-significant difference was seen (P > 0.05). Conclusion: A non- significant increase in titanium and aluminum ions level in blood of patients receiving dental implants was observed.

Assessment of Dimensional Changes in Periodontium with Immediate Replacement of Tooth by Socket-shield Technique.

Background: The reduction of alveolar bone volume following tooth extraction may interfere with the placement of implants. The present study was conducted to assess dimensional changes in periodontium with immediate replacement of tooth by socket-shield technique. Materials and Methods: Twenty fractured central incisors were enrolled, and periodontal ligament (PDL)-mediated root preservation technique was planned with simultaneous implant placement. Results: Out of 20 patients, males were 11 and females were 9. Preoperatively, buccolingual alveolar bone width was 8.1 mm and postoperatively, 9.0 mm. There was 2.1 mm bone loss preoperatively and 2.2 mm postoperatively. The difference was significant (P < 0.05). Conclusion: PDL-mediated root preservation technique with simultaneous implant placement is effective.

Acute and sub-acute oral toxicity assessment of 5-hydroxy-1,4-naphthoquinone in mice.

5-hydroxy-1,4-naphthoquinone (5NQ) or juglone is a bioactive molecule found in walnuts and has shown therapeutic effects in various disease models. Limited information is available regarding the toxicity of 5NQ, thereby limiting the clinical development of this drug. In the present study, oral acute (50, 300 and 2000 mg/kg) and sub-acute toxicity (5, 15 and 50 mg/kg) was assessed in mice to evaluate the safety of 5NQ. The acute toxicity study identified 118 mg/kg as the point-of-departure dose (POD) for single oral administration of 5NQ using benchmark dose modeling (BMD). Repeated administration of 5NQ at doses of 15 and 50 mg/kg/day caused reduction in food consumption and body weight of mice along with alterations in liver and renal function. Histopathological assessment revealed significant damage to hepatic and renal tissues at all doses in the acute toxicity study, and at higher doses of 15 and 50 mg/kg in the sub-acute toxicity study. We observed dose dependent mortality in sub-acute toxicity study and the no observed adverse effect level (NOAEL) was established as < 5 mg/kg/day. Modeling the survival response in sub-acute toxicity study identified 1.74 mg/kg/day as the POD for repeated administration of 5NQ. Serum levels of aspartate aminotransferase (AST) were most sensitive to 5NQ administration with a lower limit of BMD interval (BMDL) of 1.1 × 10-3 mg/kg/day. The benchmark doses reported in the study can be further used to determine a reference dose of 5NQ for human risk assessment.

Ensem-HAR: An Ensemble Deep Learning Model for Smartphone Sensor-Based Human Activity Recognition for Measurement of Elderly Health Monitoring.

Biomedical images contain a huge number of sensor measurements that can provide disease characteristics. Computer-assisted analysis of such parameters aids in the early detection of disease, and as a result aids medical professionals in quickly selecting appropriate medications. Human Activity Recognition, abbreviated as 'HAR', is the prediction of common human measurements, which consist of movements such as walking, running, drinking, cooking, etc. It is extremely advantageous for services in the sphere of medical care, such as fitness trackers, senior care, and archiving patient information for future use. The two types of data that can be fed to the HAR system as input are, first, video sequences or images of human activities, and second, time-series data of physical movements during different activities recorded through sensors such as accelerometers, gyroscopes, etc., that are present in smart gadgets. In this paper, we have decided to work with time-series kind of data as the input. Here, we propose an ensemble of four deep learning-based classification models, namely, 'CNN-net', 'CNNLSTM-net', 'ConvLSTM-net', and 'StackedLSTM-net', which is termed as 'Ensem-HAR'. Each of the classification models used in the ensemble is based on a typical 1D Convolutional Neural Network (CNN) and Long Short-Term Memory (LSTM) network; however, they differ in terms of their architectural variations. Prediction through the proposed Ensem-HAR is carried out by stacking predictions from each of the four mentioned classification models, then training a Blender or Meta-learner on the stacked prediction, which provides the final prediction on test data. Our proposed model was evaluated over three benchmark datasets, WISDM, PAMAP2, and UCI-HAR; the proposed Ensem-HAR model for biomedical measurement achieved 98.70%, 97.45%, and 95.05% accuracy, respectively, on the mentioned datasets. The results from the experiments reveal that the suggested model performs better than the other multiple generated measurements to which it was compared.

Cardiac assessment of patients during post COVID-19 recovery phase: a prospective observational study.

Introduction: The coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It usually presents as a respiratory syndrome but also known to cause many cardiovascular complications during acute phase. However, little is documented about cardiac complications during the post COVID-19 recovery phase. Therefore, this prospective observational study was planned to evaluate cardiovascular effects of the disease in patients recovering from COVID-19. Methods: This was a prospective observational study with a total of 63 patients presenting at 6-month follow-up in post COVID-19 outpatient clinics. Patients with known cases of underlying ischemic heart disease, cardiomyopathy, or any other cardiac disorder, and patients with chronic lung disorder or severe anemia were excluded. Results: Dyspnea was the most common presenting complaint. In biochemical parameters, none of them showed any significant difference between these two groups including NT pro BNP, ferritin, CK-MB. But NT pro BNP was high in moderate/severe cases, especially those having reduced ejection fraction. On echocardiographic evaluation, LVEF was low in moderate/severe group patients (59.7% vs. 51.1%, p < 0.0001). LV diastolic dysfunction was also observed more commonly in moderate/severe group patients (55.9% vs. 86.2%, p = 0.009). There was no significant difference in RV function assessment parameters. Conclusion: Patients in the moderate/severe group during index hospitalization for COVID-19 should be followed up with NT Pro BNP and echocardiography. This may help in early recognition of heart failure during follow-up of COVID-19 patients.

Pharmacokinetic Assessment of Rottlerin from Mallotus philippensis Using a Highly Sensitive Liquid Chromatography-Tandem Mass Spectrometry-Based Bioanalytical Method.

Rottlerin is a key bioactive phytoconstituent present in the pericarp of Mallotus philippensis. It shows promising multifaceted pharmacological actions against cancer. However, there is hardly any report for the quantification of rottlerin in the biological matrix and on its pharmacokinetic behavior. Therefore, we aimed in the present study to assess selective in vitro ADME properties and in vivo pharmacokinetics of isolated and characterized rottlerin using a newly developed and validated liquid chromatography-tandem mass spectrometry-based highly sensitive bioanalytical method. The method was found to be simple (mobile phase and analytical column), sensitive (1.9 ng/mL), and rapid (run time of 2.5 min). All the validation parameters were within the acceptable criteria of the United States Food and Drug Administration's bioanalytical method validation guideline. The method was found to be very useful to assess lipophilicity, plasma stability, metabolic stability, plasma protein binding of rottlerin, as well as its oral and intravenous pharmacokinetics in mice. Rottlerin showed a number of drug-like pharmacokinetic properties (in vitro). Moreover, it displayed an excellent half-life (>2 h) and oral bioavailability (>35%) as compared to other members of natural phenolics. The present study is the first-time report of in vitro ADME properties and in vivo preclinical pharmacokinetics of rottlerin. The generated information is very much useful for its further development as a phytotherapeutics toward cancer therapy.

Epidemiological Correlates of Well Being at Work Place and Hazards Identification and Risk assessment Amongst Saw Mill Workers in Anand, Gujarat.

CONTEXT: The nature of the work in saw mills carries a huge risk as the workers are exposed to various life-threatening hazards. AIMS: This study was conducted to know the "Work place Wellbeing" of the saw mill workers, occupational Hazards identification and Risk assessment (HIRA) including hazard communication, occupational accidents, injuries and diseases. SETTINGS AND DESIGN: The study was a cross sectional study amongst workers of saw mills. METHODS AND MATERIAL: A total of 219 saw mill workers were interviewed. "Work place wellbeing", was studied by using the "Workplace Wellbeing Questionnaire - Black Dog Institute" which includes four areas of workplace wellbeing viz. (1) Work satisfaction, (2) Organizational respect for the employee, (3) Employer care, and (4) Intrusion of work into private life. Reliability analysis was done and Cronbach's alpha was found. Association was found between the work place wellbeing and other demographic and occupational variables. STATISTICAL ANALYSIS USED: Proportions and Mann-Whitney U test. RESULTS: Scores of all the participants fall in the medium scale for "work satisfaction". For "respect", 93.6% fall in the medium scale. In "employer care" 97.7% fall in medium category. All the workers scored in the medium scale for the "intrusion in private life". None of the scores were in low scale for any domain. Injury as an event was reported by 8.22%. Specific disease prevalence was highest for back ache as 72.1%. Hazard communication was done in 40% workers. CONCLUSIONS: We found poor working positions at work place and they did suffer from various medical morbidities at the work place.

Making neonatal intensive care: cost effective.

With the improvement in neonatal care in last two decades, the survival of very low birth weight (VLBW), extremely low birth weight (ELBW), fetus diagnosed with malformations, and congenital heart disease and severe birth asphyxia has increased significantly. These infants when admitted to the neonatal intensive care unit (NICU) need numerous interventions depending upon the severity of sickness and postnatal course like need of mechanical ventilation (MV) or noninvasive ventilation, surfactant administration, placement of central lines, total parenteral nutrition, and numerous medications. The duration of NICU and hospital stay of these high-risk infants varies from few days to few weeks to few months. Long stay in the hospital leads to high hospital bills and increase the cost of neonatal care substantially. The cost of NICU stay varies from 90 USD to 1250-2500 USD per day as per various studies, depending upon the level of care and sickness of the admitted infants. In developed countries, the burden of NICU cost is often taken care by the government or insurance companies but in many developing countries the parents bear the substantial cost of NICU admission of their infants. There are many interventions which when implemented in the NICU will lead to reduction of the cost and will make the NICU cost effective. In this review, we cover various interventions mostly from our own published work which have shown to reduce the NICU cost and make it more cost effective with equivalent and better neonatal outcomes, especially in developing countries like ours.

Assessment of Anesthesia Practice Patterns for Endovascular Therapy for Acute Ischemic Stroke: A Society for Neuroscience in Anesthesiology and Critical Care (SNACC) Member Survey.

BACKGROUND: The choice of general anesthesia (GA) or conscious sedation (CS) may impact neurological outcomes of patients undergoing endovascular therapy (EVT) for acute ischemic stroke (AIS). The aim of this survey was to describe the practice patterns of members of the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) for anesthetic management of AIS. METHODS: Following institutional review board approval, a 16-question online survey assessing anesthetic management of patients with AIS undergoing EVT was circulated to members of SNACC. RESULTS: A total of 76 SNACC members from 52 institutions and 11 countries completed the survey (12.5% response rate). Overall, 33% of institutions reported dedicated neuroanesthesia teams for EVT. Patients treated with GA ranged from 5% to 100% between centers. In total 51% and 49% of centers in the United States reported preferentially providing GA and CS, respectively, compared with 34% and 66%, respectively, in European centers. Reported anesthetic induction agents are propofol (64%), etomidate (4%) and either medication (33%). For maintenance of GA, volatile anesthetic is used more often (54%) than propofol (16%). There was wide variation in medications used for CS. Arterial catheter placement was reported by 75% and 43% of respondents for patients undergoing GA and CS, respectively. Systolic blood pressure >140 mm Hg was targeted by 35.7% of respondents, with others targeting mean arterial pressure within 10%, 20% or 30% of baseline values. Phenylephrine and norepinephrine were the most commonly used vasopressors. CONCLUSIONS: There is wide variation in anesthesia technique and hemodynamic management during EVT for AIS, and no consensus on the choice of, or preferred medications for, GA or CS, or target blood pressure and management of hypotension during the procedure.

Echocardiographic assessment of hemodynamic changes in preterm neonates with shock: a prospective pragmatic cohort study.

Shock is a state of circulatory dysfunction and its diagnosis is complex in neonates. Hemodynamic assessment using echocardiography has potential to guide better management regimes in neonates with shock. Objective of this study is to analyze changes in the echocardiographic parameters in preterm neonates with shock at presentation and after resolution. In this prospective pragmatic Cohort study, eligible neonates with shock were monitored for changes in echocardiographic parameters at onset of shock and after resolution of shock. Paired data analysis was done for observed changes in the parameters. Based on initial clinical parameters and echocardiographic parameters, infants were assigned into different types of shock. Data of 37 infants were analyzed for baseline clinical and echocardiographic parameters, and data of 31 infants were analyzed for the changes in the observed parameters after shock resolution. Statistically significant changes were observed in inferior vena cava collapsibility index (ICI), left ventricular end diastolic volume (LVEDV), isovolemic ventricular relaxation time (IVRT), left and right ventricular stroke volume, and ejection fraction (EF). There was no agreement between clinical and echocardiographic definitions of shock.Conclusion: We noticed shock has overlapping pathophysiologic features. Our study highlights the importance of baseline documentation of echocardiographic parameters of all infants who are at risk of shock and repeat echocardiography at onset of shock to observe the changes in ICI, LVEDV, IVRT, stroke volume, and EF. This would guide pathophysiological management of shock in neonates. What is Known: • In neonates pathophysiology of shock is overlapping. • Echocardiography can help in better understanding and management of shock. What is New: • Study gives median changes in major echocardiographic parameters in neonatal shock. • These changes can guide for selection of volume and inotropes in management.

Accuracy of Bilistick (a Point-of-Care Device) to Detect Neonatal Hyperbilirubinemia.

INTRODUCTION: Early diagnosis and appropriate management of neonatal jaundice is crucial in avoiding severe hyperbilirubinemia and brain injury. A low-cost, minimally invasive, point-of-care (PoC) tool for total bilirubin (TB) estimation which can be useful across all ranges of bilirubin values and all settings is the need of the hour. OBJECTIVE: To assess the accuracy of Bilistick system, a PoC device, for measurement of TB in comparison with estimation by spectrophotometry. DESIGN/METHODS: In this cross-sectional clinical study, in infants who required TB estimation, blood samples in 25-µl sample transfer pipettes were collected at the same time from venous blood obtained for laboratory bilirubin estimation. The accuracy of Bilistick in estimating TB within ±2 mg/dl of bilirubin estimation by spectrophotometry was the primary outcome. RESULTS: Among the enrolled infants, 198 infants were eligible for study analysis with the mean gestation of 36 ± 2.3 weeks and the mean birth weight of 2368 ± 623 g. The median age at enrollment was 68.5 h (interquartile range: 48-92). Bilistick was accurate only in 54.5% infants in measuring TB within ±2 mg/dl difference of TB measured by spectrophotometry. There was a moderate degree of correlation between the two methods (r = 0.457; 95% CI: 0.339-0.561, p value < 0.001). Bland-Altman analysis showed a mean difference of 0.5 mg/dl (SD ± 4.4) with limits of agreement between -8.2 and +9.1 mg/dl. CONCLUSION: Bilistick as a PoC device is not accurate to estimate TB within the clinically acceptable difference (±2 mg/dl) of TB estimation by spectrophotometry and needs further improvement to make it more accurate.

Assessment of sickness severity of illness in neonates: review of various neonatal illness scoring systems.

Sickness severity scores are widely used for neonates admitted to neonatal intensive care units to predict severity of illness and risk of mortality and long-term outcome. These scores are also used frequently for quality assessment among various neonatal intensive care unit and hospital. Accurate and reliable measures of severity of illness are required for unbiased and reliable comparisons especially for benchmarking or comparative quality improvement care studies. These scores also serve to control for population differences when performing studies such as clinical trials, outcome evaluations, and evaluation of resource utilisation. Although presently there are multiple scores designed for neonates' sickness assessment but none of the score is ideal. Each score has its own advantages and disadvantages. We did literature search for identifying all neonatal sickness severity score and in this review article, we discuss these scores along with their merits and demerits.

Study comparing "Kangaroo Ward Care" with "Intermediate Intensive Care" for improving the growth outcome and cost effectiveness: randomized control trial.

AIMS: The aim of this study was to compare growth outcome and cost effectiveness of "Kangaroo ward care" (KWC) with "Intermediate intensive care" (IIC) in stable infants with birth weight 1000 g to <1100 g. MATERIAL AND METHODS: In this secondary analysis, we included 79 infants, with birth weight 1000 g to <1100 g. Thirty-eight were randomized to KWC and 41 to IIC group once the infant reached a weight of 1150 g. Infants in the KWC group were shifted to Kangaroo ward immediately after randomization and in the IIC group received IIC care till they attained a weight of 1250 g before shifting to Kangaroo Ward. After shifting to Kangaroo ward, infants in the IIC group received equivalent care to KWC group infants. RESULTS: There was significant better weight gain post-randomization during hospital stay and better length gain till 40 weeks of gestational age in intervention arm. There was reduction of post-randomization hospital stay by 2 d in the KWC group. The infants in the KWC group were shifted 6 d earlier to Kangaroo ward from IIC when compared with the IIC group. The cost-effective analysis that used "top-down" and "bottom-up" accounting method showed significant reduction of hospital and parents expenditure in the KWC group (p < .001) with saving of 570 USD per patient in the KWC group. CONCLUSION: Early shifting of infants to Kangaroo ward with birth weight 1000 g to <1100 g leads to better growth and is cost effective (CTRI/2014/05/004625). CLINICAL TRIAL REGISTRATION: Clinical trial registry of India CTRI/2014/05/004625.

To compare growth outcomes and cost-effectiveness of "Kangaroo ward care" with "intermediate intensive care" in stable extremely low birth weight infants: randomized control trial.

AIMS: To compare growth outcome and cost-effectiveness of "Kangaroo ward care" (KWC) with "Intermediate intensive care" (IIC) in stable extremely low birth weight (ELBW) infants. MATERIALS AND METHODS: This is secondary analysis of the study and we analyzed 62 ELBW infants, 33 were randomized to KWC and 29 to IIC once the infant reached a weight of 1150 g. Infants in the KWC group were shifted to the Kangaroo ward immediately after randomization and in the IIC group received IIC care till they attain a weight of 1250 g before shifting to Kangaroo ward. RESULTS: The gain in weight (g/day), length (cm/week), and head circumference (cm/week) were comparable between the two groups. The mean weight, length, and head circumference were comparable at term gestational age. The infants in KWC group were shifted five days earlier to Kangaroo ward when compared to IIC group. The cost-effective analysis using "top-down" and "bottom-up" accounting method showed that there was significant reduction of hospital and parents expenditure in KWC group (p < 0.001) with approximate saving of 452 USD for each patient in the KWC group. CONCLUSION: Early shifting of ELBW infants for KWC is very efficacious and cost-effective intervention when compared to IIC. (CTRI/2014/05/004625).

To compare cost effectiveness of 'Kangaroo Ward Care' with 'Intermediate intensive care' in stable very low birth weight infants (birth weight < 1100 grams): a randomized control trial.

BACKGROUND: To compare cost effectiveness of 'Kangaroo Ward Care' with 'Intermediate Intensive Care' in stable very low birth weight infants (birth weight < 1100 g). METHODS: This is the secondary analysis of the study in which we have analysed the cost effectiveness of 'Kangaroo ward care' (KWC) with 'Intermediate Intensive Care' (IIC). In this randomized control trial 141 infants (less than 1100 g and ≤ 32 weeks at birth) were enrolled, 71 were randomized to KWC group and 70 to IIC group, once the infant reached a weight of 1150 g. Infants randomized to KWC group were shifted to the Kangaroo ward immediately after randomization. Infants randomized to IIC group were shifted to the Kangaroo ward once the infant reached 1250 g. RESULTS: Cost incurred by the patient in both the groups from the time of randomization to hospital discharge was calculated. The hospital costs were determined by "top-down" accounting methods and out of pocket expenditure of parents from standard "bottom-up" cost-accounting methods. There was significant reduction in neonatal charges in KWC group post-randomization {41591.9 ± 21712.8 INR vs 75388.8 ± 25532.2 INR; p < 0.001}). The separate "top-down" and "bottom-up" cost analysis showed that there was significant reduction of hospital and parents expenditure in KWC group when compared to IIC group (p < 0.001). There was significant saving of around 33800 INR (USD) in the KWC group for each patient. CONCLUSION: Initiating early shifting to Kangaroo ward is cost effective intervention and have huge monetary implication in resource poor countries. (CTRI/2014/05/004625, retrospectively registered, Registered on: 26/05/2014). CLINICAL TRIAL REGISTRATION: Clinical trial registry of India CTRI/2014/05/004625 ( http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=7640&EncHid=&userName=CTRI/2014/05/004625 ) Registered on: 26/05/2014. Date of enrolment of the first participant to the trial: 13/11/2013.