Cefepime/tazobactam as a new treatment option for multidrug resistant gram negative bacilli

Background: Every time an antibiotic is used, whether appropriately or not, the probability of the development and spread of antibiotic resistant bacteria is increased. Thus, multidrug resistant bacteria particularly ESBL (Extended spectrum β­lactamase), Amp C and carbapenemases producing gram negative bacilli have emerged as a major health problem all over the world. Considering new treatment options as a carbapenems sparing and resistance prevention modality, this study was aimed to know the in vitro susceptibility pattern of Cefepime/Tazobactam (CPM/TZ) in comparison to other β-Lactam/ β-Lactamase inhibitors (BL/BLI) and carbapenems against GNB.Methods: A prospective study was conducted on all clinical samples received for a period of about 1 year. Identification and susceptibility of all isolates was done by Vitek 2 Compact system. Susceptibility of CPM/ TZ was done by disc diffusion method on the basis of CLSI guidelines. Both fermenters (E. coli and Klebsiella pneumoniae) and non-fermenters (Acintobacter baumanii and Pseudomonas aeruginosa) were included in the study.Results: Out of 550 GNB isolates the most common was E. coli (61.8%), Acintobacter baumanii (16%), Klebsiella pneumoniae (14.9%) and Pseudomonas aeruginosa (7.3%). Cefepime/tazobactam had a much higher susceptibility of 68% compared to cefepime (28%). Among the BL/BLI combinations tested cefepime/tazobactam (68%) showed the maximum percentage of susceptibility followed by cefoperazone/sulbactam (61.5%) and piperacillin/tazobactam (57.6%). Amongst all GNB isolates cefepime/tazobactam (68%) sensitivity was very much comparable to imipenem (71.8%) and meropenem (69.6%).Conclusions: CPM/TZ exhibited the best in vitro activity in comparison to the other BL/BLI. This new combination of cefepime/tazobactam appears to be a promising alternative therapeutic option to carbapenems. Clinical studies are needed to confirm this in vitro study result

A unified approach for fault-tolerance in communication protocols

Aims to provide a unified approach to fault-tolerance in communications systems under a model of transient failures by formally incorporating the states and transitions for fault-tolerance into the specification and design phases of the communication software development life cycle

Immunologic glomerulopathies-diagnostic role of immunofluorescence study of renal biopsies

Background: The kidney is a structurally complex organ that has evolved to subserve a number of important functions: excretion of the waste products of metabolism, regulation of body water and salt, maintenance of appropriate acid balance, and secretion of a variety of hormones and autacoids. Some clinical disorders affect more than one structure. In addition, the anatomic interdependence of structures in the kidney implies that damage to one almost always secondarily affects the others. Thus, severe glomerular damage impairs the flow through the peritubular vascular system, conversely, tubular destruction, by increasing interglomerular pressure, may induce glomerular atrophy. Thus, whatever the origin, there is a tendency for all forms of chronic renal disease ultimately to destroy all four components of the kidney, culminating in chronic renal failure and what has been called end-stage contracted kidneys. The functional reserve of the kidney is large, and much damage may occur before functional impairment is evident. The circulating immune complexes play a very major role in various types of glomerular nephropathies.Methods: The present study was conducted on renal biopsies referred to Pathology Department of G.S.V.M. Medical College, Kanpur and Regency Hospital Ltd., Kanpur. Frozen section of renal biopsy was taken for IF studies. Renal biopsy tissue was received in IF fluid containing Ammonium sulphate, N-ethyl malcimide, Magnesium sulphate.Results: The lgG class of immunoglobulins was found to be most fatal to the G13M, the 1gM and IgA were also found to cause glomerular damage. This mechanism was seen responsible for most cases of ICGN. In the present study, fluorescent study of renal biopsy tissue was also done using Hollande’s fixative and it was observed that a better diagnosis could be done when used with routine H & E and immunofluorescent studies.Conclusions: The immunofluorescence microscopy proved to be very useful and essential, for proper diagnosis and therapy of a renal disease. IFM comes out to be a very good indicator of the deposition site and class of immunoglobulin involved in the Immune-complex deposit

Optimizing end user QoS in heterogeneous network environments using reputation and prediction

Telecommunication consumers are fueling a demand for mobile devices that are rapidly increasing in their capability to provide a wider range of services. These services in turn are consuming more bandwidth and require richer quality of service (QoS) in order to ensure a good end user experience when performing activities such as streaming video content or facilitating voice over IP. As a result, network providers are expanding and improving their coverage area while technology to establish Wi-Fi hotspots is becoming more accessible to every day users. This combination of increase in demand and accessibility, coupled with users' ever-increasing expectations for high quality service presents a growing need to seamlessly optimize the use of the overlaid heterogeneous networks in urban areas to maximize the end user experience via the use of a vertical handover mechanism (VHO). Grey systems theory has been used in a wide range of systems including economic, financial, transportation, and military to accurately forecast time series based on limited information. In this paper, we build on a novel reputation-based VHO decision rating system by proposing the use of the grey model first-order one variable, GM(1,1), in the handover decision making progress. The low complexity of the GM(1,1) model allows for a quick and efficient prediction of the future reputation score for a given network, providing deeper insight into the current state of the target network. Furthermore, simulations show that the proposed model, in comparison with the original reputation model, improves the decision capability of a mobile node and helps balance the load across the heterogeneous networks employing its strategy

Optimizing Spectrum Trading in Cognitive Mesh Network Using Machine Learning

In a cognitive wireless mesh network, licensed users (primary users, PUs) may rent surplus spectrum to unlicensed users (secondary users, SUs) for getting some revenue. For such spectrum sharing paradigm, maximizing the revenue is the key objective of the PUs while that of the SUs is to meet their requirements. These complex contradicting objectives are embedded in our reinforcement learning (RL) model that is developed and implemented as shown in this paper. The objective function is defined as the net revenue gained by PUs from renting some of their spectrum. RL is used to extract the optimal control policy that maximizes the PUs’ profit continuously over time. The extracted policy is used by PUs to manage renting the spectrum to SUs and it helps PUs to adapt to the changing network conditions. Performance evaluation of the proposed spectrum trading approach shows that it is able to find the optimal size and price of spectrum for each primary user under different conditions. Moreover, the approach constitutes a framework for studying, synthesizing and optimizing other schemes. Another contribution is proposing a new distributed algorithm to manage spectrum sharing among PUs. In our scheme, PUs exchange channels dynamically based on the availability of neighbor’s idle channels. In our cooperative scheme, the objective of spectrum sharing is to maximize the total revenue and utilize spectrum efficiently. Compared to the poverty-line heuristic that does not consider the availability of unused spectrum, our scheme has the advantage of utilizing spectrum efficiently

A Secure and Efficient Authentication Mechanism Applied to Cognitive Radio Networks

Cognitive radio (CR) has been introduced to accommodate the steady increment in the spectrum demand. Wireless security in cognitive radio network (CRN) is a challenging technical area due to the dynamic and unique characteristics of CRNs. As a cognitive node can dynamically join or leave the spectrum, providing secure communication becomes problematic and requires more investigation. Authentication is a primary security property in wireless networks wherein the identity of a cognitive node is verified before providing access to available resources. In this paper, a two-level authentication scheme for communication in CRN is proposed. Before joining the network, a CR node is validated by obtaining security credentials from an authorized point. The proposed scheme relies on public- and symmetric-key cryptography, instead of using a digital signaturebased approach. It encrypts data between the communicating nodes in order to improve network security in terms of resource availability and accessibility.This mitigates attacks such as Reflection attack, Denial of Service attack and Man-in-the-Middle attack. The scheme has been evaluated and verified in terms of security functionality, its correctness and the performance, which shows less computation and communication requirements

Obstetrical outcome of pregnancy complicated with first trimester bleeding and subchorionic hematoma

Background: First trimester bleeding complicates around 20-27% of pregnancy. Objective of this study was to evaluate and compare the feto-maternal and pregnancy outcome in patients presenting with live pregnancy complicated with first trimester bleeding and subchorionic hematoma with those without subchorionic hematoma.Methods: In this prospective observational study, based on ultrasonography, live pregnancies were categorized into two groups, first group having first trimester bleeding with subchorionic hematoma and second with first trimester bleeding only without any hematoma. They were evaluated for the end outcome of pregnancy in terms of abortion and continuation. Continued pregnancies were evaluated for antenatal complications, delivery and intrapartum events along with fetal outcomes.Results: Outcome of pregnancies presenting with first trimester bleeding in terms of abortion was similar in both the groups, 22.8% and 21.5% with hematoma and without hematoma respectively. Incidence of preeclampsia was 11.4% and Fetal growth restriction was 7% in pregnancies with first trimester bleeding with hematoma and was significantly higher than those without hematoma which was 3.07% for preeclampsia and 3% for fetal growth restriction. Incidence of antepartum haemorrhage was higher in hematoma group but the result was not statistically significant. 20% pregnancies with first trimester bleeding with hematoma had preterm deliveries, while it was 7.7% in pregnancies without hematoma and the difference was statistically significant. Low birth weight had occurred in 20% of babies in first group of patients while 4.6% in second group, difference being statistically significant.Conclusions: We found that live pregnancies with first trimester bleeding and subchorionic hematoma were associated with similar risk of miscarriage and antepartum haemorrhage while increased risk of preeclampsia, fetal growth restrictions, preterm birth, non-reassuring fetal heart pattern, caesarean delivery and low birth weight baby when compared to patients with first trimester bleeding without subchorionic hematoma. There was no difference in 5 minutes Apgar score and the NICU admission in both the groups

Endometrial histopathology patterns in women with abnormal uterine bleeding

Background: Abnormal uterine bleeding is the most common gynaecological condition for which many women seek medical opinion. Evaluation of these women requires careful investigation into the cause and nature of bleeding with a main focus to exclude organic pathology, especially genital malignancies. Endometrial biopsy is one such intervention which is of immense value in categorizing the conditions. Aims and objectives of current study were to analyse endometrial histology patterns in women with AUB.Methods: This was a retrospective study conducted on women with AUB who presented in the gynae OPD during the study period of one year and had endometrial biopsy as part of evaluation. Women between with AUB were included in the study after excluding pregnancy related bleeding. Detailed clinical history, examination findings, investigations and endometrial histopathology was noted.Results: A total of 97 women with AUB who had undergone dilatation and curettage with endometrial biopsy were studied. Majority of women were in age group of 40-45 years and heavy menstrual bleeding was the commonest complaint, AUB (P) 17% and AUB (L) 39%, accounted for most of the clinical presentations. Endometrial histology showed varied patterns 27 % had secretory endometrium, 11% proliferative endometrium. There were 7 cases of endometrial hyperplasia without atypia and three cases of endometrial malignancy. Conclusions: Histopathological evaluation of endometrium is the cornerstone of management of abnormal uterine bleeding. Endometrial patterns obtained can be useful in ruling out malignancy and help in formulating further management