Antimicrobial resistance pattern, clustering mechanisms and correlation matrix of drug-resistant Escherichia coli in black Bengal goats in West Bengal, India

A cross-sectional study covering four agro-climatic zones of West Bengal, India, was carried out to understand the risk-factors, antimicrobial resistance mechanism and clustering of the resistance characteristics of Escherichia coli isolated from healthy (170) and diarrhoeic (74) goats reared under intensive (52) and semi-intensive (192) farming practices. Of the 488 E. coli isolates, the majority, including the extended spectrum (n: 64, 13.11%) and AmpC β-lactamase (ACBL) (n: 86, 17.62%) producers, were resistant to tetracycline (25.2%), followed by enrofloxacin (24.5%), cefotaxime (21.5%) and amikacin (20.5%). Statistical modelling revealed that the isolates from diarrhoeic animals (p < 0.001) are likely to be more ACBL-positive than those from the healthy counterparts. Similarly, cefotaxime (p < 0.05) and enrofloxacin-resistance (p < 0.01) were significantly higher in diarrhoeic goats and in goats reared intensively. The isolates (n = 35) resistant to multiple drugs revealed the presence of β-lactamase [blaCTXM-1-(21), blaSHV-(7), blaTEM-(3), blaCMY-6-(1), blaCITM-(3)]; quinolone [qnrB-(10), qnrS-(7), aac(6’)-Ib-cr-(3)]; tetracycline [tetA-(19), tetB-(4)] and sulphonamide resistance determinants [sul1-(4)]; multiple plasmids, especially those belonging to the IncF and IncI1 replicon types; and active acrAB efflux pumps. Further, two isolates harbored the carbapenem resistance (blaNDM-5) gene and eight were strong biofilm producers. This first ever study conducted to unravel the status of AMR in goat farming reveals that not only the intensive farming practices but also certain clinical ailments such as diarrhoea can increase the shedding of the drug-resistant isolate. The emergence of multi-drug resistant (MDR) E. coli in goats, particularly those that are carbapenem resistant, is a cause for concern that indicates the spread of such pathogens even in the livestock sub-sector generally considered as naive

Hematological entities with plasmacytic differentiation: a case report

Abstract Introduction Plasmacytoma, a localized tumor of monoclonal plasma cells without any clinical, radiological or physical evidence of plasma cell neoplasm (PCN), is a rare entity that accounts for 1% of PCN. Immunoglobulin M (IgM) extramedullary plasmacytoma of mediastinal region has never been reported and is a diagnostic challenge considering other differential diagnoses. Case presentation We present the case of a 51-year-old African-American female with progressively increasing cough, dyspnea, and dysphagia for 6 months with a computed tomography (CT) scan revealing a subcarinal mass. The histopathological analysis of the mass reveals a diagnosis of lymphoma with plasma cell differentiation, with a differential of lymphoplasmacytic lymphoma and plasma cell neoplasm. The lymphoma panel via next-generation sequencing (NGS) and a myeloma-targeted fluorescent in situ hybridization (FISH) panel confirmed the diagnosis of IgM extramedullary plasmacytoma, an entity of rare occurrence. Treatment with radiation led to complete regression of the plasmacytoma with normal blood work-up. Conclusions This report describes the challenges of diagnosing IgM extramedullary plasmactyoma. Our case report highlights the importance of cytogenetics and NGS in establishing a correct diagnosis that indeed has prognostic and therapeutic implications

Additional file 1 of Hematological entities with plasmacytic differentiation: a case report

Additional file 1: Table S1. The details of physical examination of the patient at the time of admission

A case of primary cutaneous mucormycosis caused by minor trauma

We present the case of a 66-year-old neutropenic man with mantle-cell lymphoma who presented for evaluation of a rapidly expanding necrotic eschar after a minor cutaneous injury. Histopathology revealed infection with Rhizopus indicating primary cutaneous mucormycosis. Our case reviews the presentation and management of this condition as well highlights the potential for minor cutaneous injuries in the hospital to lead to this dangerous infection

A case of primary cutaneous mucormycosis caused by minor trauma

We present the case of a 66-year-old neutropenic man with mantle-cell lymphoma who presented for evaluation of a rapidly expanding necrotic eschar after a minor cutaneous injury. Histopathology revealed infection with Rhizopus indicating primary cutaneous mucormycosis. Our case reviews the presentation and management of this condition as well highlights the potential for minor cutaneous injuries in the hospital to lead to this dangerous infection

Searching exotic Higgs bosons at the LHC

We analyse in a model independent way the possibilities of digging out neutral exotic Higgs states, should they exist endowed with unconventional couplings with ordinary matter and gauge fields, at the 14 TeV run of the Large Hadron Collider (LHC), adding some comparative studies for 13.6 and 13 TeV runs. Flavor models, based on some discrete symmetry groups, with extended scalar sectors are known to yield exotic spin-0 states, both CP-even and CP-odd, with purely flavor off-diagonal Yukawa couplings. The gauge interaction of one such CP-even state is also unusual that, unlike the Standard Model Higgs boson, it does not couple to gauge boson pairs. Such unconventional properties immune these exotic states from receiving traditional collider and electroweak constraints, and hence those states could be light. Without committing to any specific model, exploiting their peculiar Yukawa and gauge properties, we explore the discovery potential of those exotic Higgs states through some interesting topologies by figuring out some specific kinematic variables that suppress the backgrounds.Comment: 1+23 pages, 8 captioned figures: v2: Discussions on scalar and pseudoscalar Yukawa couplings in the light of D-D(bar) mixing include

Rebooting Virtual Memory with Midgard

Computer systems designers are building cache hierarchies with higher capacity to capture the ever-increasing working sets of modern workloads. Cache hierarchies with higher capacity improve system performance but shift the performance bottleneck to address translation. We propose Midgard, an intermediate address space between the virtual and the physical address spaces, to mitigate address translation overheads without program-level changes. Midgard leverages the operating system concept of virtual memory areas (VMAs) to realize a single Midgard address space where VMAs of all processes can be uniquely mapped. The Midgard address space serves as the namespace for all data in a coherence domain and the cache hierarchy. Because real-world workloads use far fewer VMAs than pages to represent their virtual address space, virtual to Midgard translation is achieved with hardware structures that are much smaller than TLB hierarchies. Costlier Midgard to physical address translations are needed only on LLC misses, which become much less frequent with larger caches. As a consequence, Midgard shows that instead of amplifying address translation overheads, memory hierarchies with large caches can reduce address translation overheads. Our evaluation shows that Midgard achieves only 5% higher address translation overhead as compared to traditional TLB hierarchies for 4KB pages when using a 16MB aggregate LLC. Midgard also breaks even with traditional TLB hierarchies for 2MB pages when using a 256MB aggregate LLC. For cache hierarchies with higher capacity, Midgard's address translation overhead drops to near zero as secondary and tertiary data working sets fit in the LLC, while traditional TLBs suffer even higher degrees of address translation overhead

Prospective randomized trial to compare the outcome and tolerability of delivering the same total dose of radiation in 61/2 weeks versus 51/2 weeks time in head and neck cancers

Background: Concurrent chemoradiation is currently considered to be the standard of care in the treatment of head and neck cancer. In developing countries like ours, a good number of patients cannot tolerate chemoradiation because of the poor general condition and financial constraints. Those patients are treated with radiation alone. The optimum radiotherapy (RT) schedule for best local control and acceptable toxicity is not yet clear. We aimed to find out whether shortening of treatment time using six instead of five RT fractions per week improves the locoregional control in squamous cell carcinoma of head and neck. Materials and Methods: We conducted a prospective randomized study for a period of 2 years from September 2007 to August 2009 in 109 untreated patients of squamous cell carcinoma of head and neck with histologically confirmed diagnosis and no evidence of distant metastasis. Study group (55 patients) received accelerated RT with 6 fractions per week (66 Gy/33#/51/2 weeks). Control group (54 patients) received conventional RT with 5 fractions per week (66 Gy/33#/61/2 weeks). Tumor control, survival, acute and late toxicities were assessed. Results: At a median follow-up of 43 months, 29 patients (52.7%) in the 6 fractions group and 24 patients (44.4%) in the 5 fractions group were disease-free (P = 0.852). The benefit of shortening was higher for advanced disease control though it was not statistically significant. Grade 3 and 4 skin toxicity was significantly higher in the accelerated RT (70.9%) arm as compared to conventional (35.1%) arm (P = 0.04). Grade 3 mucositis was significantly higher in the accelerated RT arm (32.7% vs. 16.6%; P = 0.041). Those acute toxicities were managed conservatively. There was no difference in late toxicities between the two arms. Conclusion: Use of 6 fractions per week instead of 5 fractions per week is feasible, tolerable, and results in a better outcome in the patients of head and neck cancers

Oncocytic Adrenocortical Neoplasm Diagnosed after Robot-Assisted Adrenalectomy

Oncocytic tumors, composed of eosinophilic, mitochondria-rich cells, can occur in several locations throughout the body. These tumors can occur in the adrenal cortex and are rarely malignant. We report a case of a patient presenting with an incidental adrenal mass which was later diagnosed as a oncocytic adrenocortical neoplasm (OAN). The patient is a 53-year-old man found to have a 7.2 cm right adrenal mass, incidentally found by computed tomography (CT). After metabolic workup was negative, a right robotic adrenalectomy (RA) was performed. Pathologic analysis revealed clusters of large cells with abundant eosinophilic and granular cytoplasm, consistent with OAN. This pathology is rare, with only about 150 cases described in the literature. It occurs in females 2.5 times more frequently and more commonly on the left side. Diagnosis is usually made by imaging criteria, typically with CT or magnetic resonance imaging (MRI). Treatment is generally surgical, since OAN can be malignant in some cases. Differentiation between benign and malignant OAN is done based on the Lin-Weiss-Bisceglia criteria and can be difficult. If malignancy is diagnosed, recurrence is common and close surveillance should be performed