As the industry environment becomes more competitive, the supply chain management for multi items has become an essential part of the industries. In this paper, a multi-echelon inventory model for deteriorating multi items with imperfect production has been developed under the environment of fuzzy and inflation. In this study, a single producer, multi-supplier, and multi-retailer are considered from the integrated point of view. Here, the producer only produces the retailer's need to have a tremendous advantage and minimum loss. It is observed that the inflation rate is almost uncertain for deteriorating goods in every supply chain. In this paper, the inflation rate is taken as a triangular fuzzy number, and the centroid method is used to defuzzify the profit function. The shortage is not allowed in any part, an imperfect production process is also considered, but it is not reworkable in this supply chain. Different inflation rates are considered for additional items because inflation has strained the most vulnerable consumers (the daily wage earners), who mainly demand goods in short and small quantities. This entire model is developed based on the retailer's demand and due to which the profit potential is maximized. The central premise of this study is to get maximum benefit by creating a production model for deterioration items. Finally, a numerical example and sensitivity analysis illustrate the present study. It is also observed that if the number of shipments taken from the supplier increases during the production period, the total profit increases in crisp and fuzzy. If a positive change occurs in the number of shipments received through the producer to the retailer, then the fuzzy model has positive, but a slight negative change occurs in the crisp model. This paper shows the effect of a joint replenishment policy for multi-item compared with the independent approaches.

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Kawasaki disease is a common childhood vasculitis. Fever and lymphadenopathy, at times, are the only clinical presentation of Kawasaki disease, which mimics infectious lymphadenitis, especially, when other features are yet to evolve. In such a scenario, ultrasonography of cervical lymph nodes can help to differentiate Kawasaki disease lymphadenitis from infectious lymphadenitis. We present one such patient who was initially diagnosed as having bacterial lymphadenitis; however, ultrasonography of the neck lymph nodes showed typical imaging features described with Kawasaki disease lymphadenitis.

IntroductionAlthough most patients with NAFLD are obese or overweight, some are lean with normal BMI. Our aim was to assess differences in clinicopathological pro le and liver disease severity among lean and nonlean NAFLD. Methods Data of 1040 NAFLD patients over last 10 years was analysed. BMI <23kg/m 2 categorised lean patients. Non-invasive assessment of steatosis was done by ultrasound and controlled attenuation parameter (CAP) while brosis was assessed with FIB-4 and liver stiffness measurement (LSM). FibroScan-AST (FAST) score was used for non-invasive prediction of NASH with signi cant brosis. Histology was reported using NASH-CRN system. Results 149 (14.3%) patients were lean while 891 (85.7%) patients were non-lean. Diabetes mellitus [25 (16.7%) vs 152 (17.05%), p>0.99], elevated triglycerides [81 (54.3%) vs 525 (58.9%), p=0.33] and low HDL [71(47.6%) vs 479(53.7%),p=0.18] were observed in a similar proportion. Lean patients were less likely to have central obesity [72 (48.3%) vs 788 (88.4%),p<0.001], hypertension [16 (10.7%) vs 239(26.8%),p<0.001] and metabolic syndrome [21 (14.09%) vs 290 (32.5%),p<0.001]. No difference in steatosis assessment was noted using ultrasound (p=0.55) or CAP (0.11).