Hybrid switching : converging packet and TDM flows in a single platform

Optical fibers have brought fast and reliable data transmission to today’s network. The immense fiber build-out over the last few years has generated a wide array of new access technologies, transport and network protocols, and next-generation services in the Local Area Network (LAN), Metropolitan Area Network (MAN), and Wide Area Network (WAN). All these different technologies, protocols, and services were introduced to address particular telecommunication needs. To remain competitive in the market, the service providers must offer most of these services, while maintaining their own profitability. However, offering a large variety of equipment, protocols, and services posses a big challenge for service carriers because it requires a huge investment in different technology platforms, lots of training of staff, and the management of all these networks. In today’s network, service providers use SONET (Synchronous Optical NETwork) as a basic TDM (Time Division Multiplexing) transport network. SONET was primarily designed to carry voice traffic from telephone networks. However, with the explosion of traffic in the Internet, the same SONET based TDM network is optimized to support increasing demand for packet based Internet network services (data, voice, video, teleconference etc.) at access networks and LANs. Therefore the service providers need to support their Internet Protocol (IP) infrastructure as well as in the legacy telephony infrastructure. Supporting both TDM and packet services in the present condition needs multilayer operations which is complex, expensive, and difficult to manage. A hybrid switch is a novel architecture that combines packets (IP) and TDM switching in a unified access platform and provides seamless integration of access networks and LANs with MAN/WAN networks. The ability to fully integrate these two capabilities in a single chassis will allow service providers to deploy a more cost effective and flexible architecture that can support a variety of different services. This thesis develops a hybrid switch which is capable of offering bundled services for TDM switching and packet routing. This is done by dividing the switch’s bandwidth into VT1.5 (Virtual Tributary -1.5) channels and providing SONET based signaling for routing the data and controlling the switch’s resources. The switch is a TDM based architecture which allows each switch’s port to be independently configured for any mixture of packet and TDM traffic, including 100% packet and 100% TDM. This switch allows service providers to simplify their edge networks by consolidating the number of separate boxes needed to provide fast and reliable access. This switch also reduces the number of network management systems needed, and decreases the resources needed to install, provision and maintain the network because of its ability to “collapse” two network layers into one platform. The scope of this thesis includes system architecture, logic implementation, and verification testing, and performance evaluation of the hybrid switch. The architecture consists of ingress/egress ports, an arbiter and a crossbar. Data from ingress ports is carried to the egress ports via VT1.5 channels which are switched at the cross point of the crossbar. The crossbar setup and channel assignments at ingress port are done by the arbiter. The design was tested by simulation and the hardware cost was estimated. The performance results showed that the switch is non-blocking, provide differentiated service, and has an overall effective throughput of 80%. This result is a significant step towards the goal of building a switch that can support multiprotocol and provide different network capabilities into one platform. The long-term goal of this project is to develop a prototype of the hybrid switch with broadband capability

Evaluating the Trends of Bloodstream Infections among Pediatric and Adult Patients at a Teaching Hospital of Kathmandu, Nepal: Role of Drug Resistant Pathogens

Bloodstream infections (BSIs) are among the significant causes of morbidity and mortality for patients of all age groups. However, very little is known about the trends of bacterial bloodstream infections and antimicrobial susceptibilities among pediatric and adult population from Nepal. In this study, we have investigated the different etiological agents responsible for bloodstream infections among pediatric and adult patients and the role of drug resistant organisms in these infections at a tertiary care teaching hospital of Kathmandu, Nepal. A total of 3,088 blood culture specimens obtained from pediatric and adult patients suspected to have bloodstream infections were processed by standard microbiological methods. Significant bacterial pathogens were identified by morphological, biochemical, and serological methods as suggested by American Society for Microbiology. In vitro antimicrobial susceptibility testing was performed by Kirby-Bauer disk diffusion method and interpreted according to the guidelines of Clinical and Laboratory Standards Institute. Overall, incidence of bloodstream infections among the suspected patients was 7.48%. Pediatric patients (n=90, 9.37%) were the significant subgroup of patients affected with bloodstream infections compared to adults (p<0.05, CI-95%). Gram positive (n=49, 54.4%) bacteria in pediatric and gram negative bacteria (n=141, 78.7%) in adult patients were the most common isolates for BSI. Staphylococcus aureus (n=41, 45.6%) in pediatric patients and Salmonella enterica (n=40, 28.3%) in adult patients were the leading pathogens. Trends of antimicrobial resistance among isolated bacterial strains were significantly high in adults compared to pediatric patients. Methicillin resistant Staphylococcus aureus (MRSA) (31.4%), extended spectrum beta-lactamase (ESBL) (12.5%), and metallo-beta-lactamase (MBL) (3.9%) producing gram negatives were major resistant strains. Our study shows higher rates of bloodstream infections in pediatric patients compared to adult patients. Alarming rates of antimicrobial resistance among blood culture isolates is a serious issue. Prompt and accurate diagnosis and rational antimicrobial therapy are extremely needed

Copanlisib in non-Hodgkin’s lymphoma and solid tumors: An efficacy and safety analysis

Introduction: Copanlisib is an intravenous pan-class I PI3K inhibitor with predominant activity against the α and δ isoforms. We conducted this review to assess the efficacy and safety of copanlisib in patients with relapsed or refractory non-Hodgkin’s lymphoma (NHL) and other solid tumors. Methods: A systematic search of the electronic database (PubMed, Cochrane, Clinicaltrials.gov, Google scholar, and China National Knowledge Infrastructure) was conducted for relevant studies. Any clinical trial with clear outcome measures on the efficacy or safety of copanlisib in NHL or other solid tumors were eligible for inclusion. The objective response rate (ORR) and the complete response (CR) rate were used to assess the efficacy. Incidence of all grade and grade 3-4 treatment-emergent adverse events (TEAE) were calculated to evaluate the safety profile. Results: We analyzed seven single-arm prospective clinical trials. The pooled ORR was 39.1% (95% CI: 21.0-60.7%) for NHL cohort. The pooled CR rate for NHL was 10.9% (95% CI: 6.9-16.8%). Indolent NHL had a higher rate of response than aggressive NHL (ORR 56.9% vs. 22.8%; CR rate 15.8% vs. 7.6%). The pooled incidence rate of grade 3-4 TEAE was 73.9% (95% CI: 66.4-80.3%). Most common grade 3-4 TEAE were: hyperglycemia (31.4%), hypertension (29.8%), neutropenia (18.3%), anemia (7.4%), and pneumonia (6.8%). Conclusions: Copanlisib is effective in the treatment of relapsed or refractory NHL, with a higher rate of response in indolent NHL than aggressive NHL. Hyperglycemia and hypertension were the most common adverse event

Extended-Spectrum β-Lactamase (ESBL) Genotypes among Multidrug-Resistant Uropathogenic Escherichia coli Clinical Isolates from a Teaching Hospital of Nepal

Urinary tract infections (UTI) represent the most common bacterial infections among patients visiting outpatient clinics of healthcare centers in Nepal. However, treatment of such infections is compounded by emergence and spread of multidrug-resistant uropathogens associated with extended-spectrum β-lactamases (ESBLs). In this study, we aimed to investigate the burden of antimicrobial resistance and occurrence of ESBL genes among clinical isolates of uropathogenic Escherichia coli at a tertiary care teaching hospital of Nepal. During the study period, we processed a total of 1,626 urinary tract specimens, isolated significant bacterial pathogens, and investigated their antimicrobial susceptibilities. Escherichia coli (n = 154), the predominant pathogen associated with UTI, was further investigated for the existence of ESBL enzymes by using conventional phenotypic as well as molecular approaches. Among suspected cases of UTI, we found that 15.2% were having UTI and female patients of the reproductive age group were more affected (p<0.05). Escherichia coli (154, 62.1%) was the key uropathogen, and majority (∼64.9%) of them were multidrug resistant (MDR). Among MDR E. coli isolates, 40.3% were producing extended-spectrum β-lactamases (ESBLs). bla-TEM (83.8%), bla-CTX-M (66.1%), and bla-SHV (4.8%) were common ESBL genotypes. Nitrofurantoin, gentamycin, and imipenem were the most effective antibiotics for ESBL-producing Escherichia coli isolates. It indicates that the high rates of multidrug-resistant Escherichia coli are frequent causes of UTI in our hospital. Nitrofurantoin and aminoglycosides are the most useful first-line drugs to be used in the cases of UTI. We recommend the regular investigation of drug resistance among all isolates and develop a useful antibiotic prescription policy in our country

AmpC and extended spectrum beta-lactamases production among urinary isolates from a tertiary care hospital in Lalitpur, Nepal

Abstract Background Production of AmpC and extended spectrum beta-lactamases among urinary isolates has created a serious problem to the successful management of the urinary tract infection. The main purpose of this study was to determine the rates of the extended spectrum beta-lactamase (ESBL) production and AmpC beta-lactamase (ABL) production among urinary isolates. Results Among total 564 urinary isolates, 514 (91.1%) were gram negative bacilli and 50 (8.9%) were gram positive cocci. E. coli (76.1%) was the most common bacteria isolated. Staphylococcus aureus (6.7%) was the predominant gram positive bacteria isolated. 35 (6.8%) of the 514 gram negative bacilli were ESBL producers. Similarly, 14 (2.7%) of the gram negative bacilli were ABL producers. Only one isolate was ESBL and ABL co-producer. Highest rate of susceptibility of gram negative bacteria was seen toward amikacin (97.3%) followed by imipenem (94.4%). Similarly, highest rate of susceptibility among gram positive cocci was seen toward vancomycin (100%) followed by amikacin (93.5%). Conclusions Low rates of AmpC and extended spectrum beta-lactamases production in comparison to other previous studies were reported. On the basis of the antimicrobial susceptibility patterns of the bacteria we reported in our study, amikacin, imipenem and nitrofurantoin can be used for the preliminary treatment of urinary tract infections caused by gram negative bacteria and vancomycin and amikacin for treatment of urinary tract infections caused by gram positive bacteria

Shigellosis Caused by CTX-M Type ESBL Producing Shigella flexneri in Two Siblings of Rural Nepal: First Case Report from the Country

Shigellosis is an acute infectious disease characterized as severe bloody diarrhea (dysentery) and is accountable for a significant burden of morbidity and mortality especially in children under the age of 5 years. Antimicrobial therapy is required in the cases of severe dysentery associated with Shigella. However, emergence of multidrug resistant (MDR) strains of Shigella spp. over the last two decades has restricted the use of common therapeutic antimicrobials. In MDR strains, the third-generation cephalosporins have been used for the treatment, but, unfortunately, emerging reports of enzyme mediated β-lactam resistance among Shigella isolates from various parts of the world have greatly compromised the therapy of pediatric dysentery. In Nepal, drug resistant strains of Shigella spp. have been reported, but MDR and extended spectrum β-lactamase (ESBL) producing strains were previously unknown. Here, we report two Shigella flexneri isolates harboring ESBL genotype-CTX-M associated with acute dysentery in two siblings which were presented and treated in a tertiary care teaching hospital of Kathmandu, Nepal