Internet Traffic Flow Analysis using Hadoop

The internet traffic analysis elucidates the network administrator for monitoring the ongoing operation in the network and to understand the network so that the behavior could be examined and large problem can be examined. Flow analysis assists in traffic management, allocation of resources and fault tolerance. Due to the fast increase in internet user simultaneously the network usage has also escalated rapidly. The major problem of this fast growth in network is the traffic management, storing of traffic data and analysis this enormous amount of data in a single machine. To resolve this issue hadoop has been implemented to scan multiple input data and produce output for traffic identification and clustering flow. In this paper internet traffic flow analysis has been done using hadoop. In this proposed method system accepts packet data as input from network and this input is appended to hadoop distributed file system (HDFS) and at last processing is done through MapReduce. Once the output has been generated the network administrator analyses the internet traffic and troubleshoot any problem if necessary

Using Bedside Ultrasound to Rapidly Differentiate Shock

History of present illness: A 62-year-old female presented from a nursing home for altered mental status. She had an initial Glascow coma score of 9. Her blood pressure was 70/44, temperature 36.8 C, heart rate 82, respiratory rate 23, and oxygen saturation 88% on room air. The patient’s initial lactate was 3.1 mmol/L. A rapid ultrasound for shock and hypotension (RUSH) exam demonstrated the need for fluid resuscitation. 2 liters of normal saline was given, resulting in the improvement of her blood pressure to 93/53. Ultimately, the patient required intubation because of the severity of her pneumonia. A subsequent lactate of 0.8 mmol/L demonstrated adequate resuscitation. Significant findings: A RUSH exam demonstrated hyperdynamic cardiac contractility and collapse of the inferior vena cava (IVC) with probe compression more than 50% suggesting hypovolemia likely secondary to sepsis. Incidentally, Morrison’s pouch revealed a large right renal cyst but no signs of free fluid. A computed tomography of abdomen/pelvis showed a 10.8 x 9.5 cm right renal cyst and left lower lobe pneumonia. Discussion: Sepsis is defined as organ dysfunction in a patient with a known source of infection. Signs of sepsis include hypotension, tachypnea, and altered mental status.1 Although not a standard of care yet, the RUSH exam proves to be a valuable and rapid instrument to evaluate the cause of shock and hypotension in critically ill patients in the emergency department (ED). The components of the RUSH exam can be remembered by the mnemonic HI-MAP: Heart, IVC, Morrison’s/FAST abdominal views, Aorta, and Pneumothorax scanning.2 Ultrasound can be used to quickly differentiate cardiogenic, distributive, and hypovolemic shock. RUSH has a sensitivity of 72.7% and specificity of 100% for shock with distributive etiology.3 Measurement of the IVC diameter can be used to estimate CVP and thus a patient’s likelihood to respond to fluid resuscitation. A maximum IVC diameter of 50 % collapsibility, such as in our patient, was found to correlate with a low central venous pressure (CVP) (<5 mm Hg).4 There are several instances in which IVC measurement does not correlate to CVP, such as mechanical ventilation, valvular abnormalities, pulmonary hypertension, congestive heart failure, liver cirrhosis, elevated intra-abdominal pressures, and many other pathologies that affect flow to the right heart.5 Therefore, the RUSH exam should be interpreted with the patient’s entire clinical presentation

Factors associated with hospitalization due to streptococcal infection in Houston, Texas 2015-2016

ObjectiveTo study the factors associated with streptococcal infection that led to hospitalization in Houston, Texas for years 2015-2016IntroductionDifferent studies have shown that Streptococcal infections in adults are more common among older age, blacks, and underlying chronic medical conditions like diabetes, cardiovascular and kidney diseases.In specific, other studies have demonstrated that streptococcal pyogenes can cause severe illnesses and dramatic hospital outbreaks.Furthermore, community-acquired pneumonia studies had also suggested that cardiovascular disease, severe renal disease, chronic lung disease and diabetes were associated with increased odds of hospitalization.MethodsData were extracted from Houston Electronic Disease Surveillance System (HEDSS) beginning January 1, 2015 to December 31, 2016. A total of 512 confirmed cases were investigated and analyzed during the study period. Frequencies and percentages were calculated and chi square test was used to examine the association between hospitalization and other risk factors. Odds ratio was calculated using unconditional logistic regression to determine the association of risk factors with hospitalization in streptococcal patients.ResultsA total of 414 patients (81 %) of the confirmed cases were hospitalized.Age, race, fever, sepsis, diabetes, cardiovascular and kidney diseases were significantly associated with hospitalization in the bivariate analysis.Logistic regression analysis adjusted for confounding factors demonstrated that among clinical characteristics, fever (OR 2.9; 95% CI 1.66-5.38) was three times more prevalent among hospitalized patients with streptococcal infection.Patients with diabetes (OR 7.92; 95% CI 3.08-20.36) were almost eight times more likely to be hospitalized than patients without diabetes among streptococcal patients, followed by cardiovascular disease (OR 2.84; CI 1.32-6.10) which was three times more likely to be present.ConclusionsCommon clinical sign like fever was associated with hospitalization among streptococcal patient. Similarly, risk factors like diabetes and cardiovascular diseases were significantly associated with hospitalization in streptococcal patients.Prevention strategies need to be focused on streptococcal patients with chronic risk factors like diabetes, and cardiovascular disease.ReferencesParks t, Barret L, Jones N. Invasive streptococcal disease: a review for clinicians. British Med Bulletin, 2015; 115 (7): 77-89.Skoff TH, Farley MM, Petit S, et al. Increasing Burden of Invasive Group B Streptococcal Disease in Nonpregnant Adults, 1990-2007. CID 2009; 49 (7): 85-92

Epidemiological trends of Reported Legionnaires’ disease in Houston, Texas, 2014-2017

OnjectiveTo study trends and patterns in legionnaires’ disease cases in Houston, Texas, from 2014-2017.IntroductionLegionellosis is a respiratory illness that is mostly (80-90%) caused by the bacterium Legionella pneumophila. It is associated with a mild febrile illness, Pontiac fever, or Legionnaires’ disease (1), a source of severe, community-acquired pneumonia. Legionella bacteria mostly affect elderly persons specifically those with underlying debilitating illnesses and with lowered immune systems. Water is the major natural reservoir for Legionella, and the pathogen is found in many different natural and artificial aquatic environments such as cooling towers or water systems in buildings, including hospitals. An abrupt increase in the incidence of Legionnaires’ has been noted since 2003 throughout the nation. According to CDC, about 6,000 cases of Legionnaires’ disease were reported in the United State in 2015 (1). Incidence rates of Legionnaires for the year 2015 were 1.06 and 1.90 (ref) for Texas and the United States respectively (2). Increased number of reported cases might be due to the fact of an older population, more at risk individuals, aging plumbing infrastructure, and increased testing for Legionnaires’ disease by various hospitals and laboratories.MethodsData were extracted from Houston’s Electronic Disease Surveillance System (HEDSS) from January 1, 2014, to December 07, 2018. Confirmed cases were analyzed to examine the epidemiologic trends across years 2014 to 2018. Demographic characteristics such as age, race, and gender were also analyzed. Incidence rates, case fatality and time lapse from date of diagnosis to date of reporting to the health department were also studied. Data were analyzed using SAS statistical software, version 9.4. Only Houston residents were included in the analysis. To be considered confirmed, a case must be clinically compatible and fulfill at least one of the confirmatory laboratory criteria.ResultsThere were 218 cases of LD reported to the City of Huston from 2014 to 2018. Only 116 cases (53%) were classified as confirmed. Reported cases may have been not confirmed due to the lack of fulfilling the case criteria for the case. Providers may have ordered a non-confirmative test, or the case may not have satisfied the clinical compatibility due to loss to follow-up or for other reasons.Most of the confirmed cases were reported from larger for-profit hospitals (500+beds) in the area. The majority of cases were diagnosed by urinary antigen test (95, 82%). There were four deaths due to legionnaires disease during this period giving a case fatality rate of 3.4%. Death rates were inaccurate, though, and could be higher than reported since cases were not followed up after being reported to the state. From 2014 to 2018, legionnaires’ disease incidence rates increased from 0.71 to 1.36 per 100,000, an average annual increase of 17%.In 2014–2018, the incidence of LD was higher among men compared with women. 67 cases (58%) were male, and 49 (42%) were female. Female cases remained stable throughout the years while male cases increased from 6 to 23, an increase of approximately four folds. The median age was 60 years with a range of 21 to 96 years. LD incidence increased with age; it was highest among residents 65 years and older (42,36%). African Americans had the highest incidence of LD (40, 35%) followed by Hispanics (29, 25%). African Americans cases had more than doubled through years 2014-2018 from 6 to 13. Cases were higher in warmer months specifically in July (14) an August (13).ConclusionsCases were higher in the warmer months and the highest among the elderly, men, and those of African American race. ELR was the prime source of initial case reporting to the health department. The number of legionnaire’s cases observed were increasing with each passing year. The ratio of confirmed cases to those reported were only 53% thus raising awareness and appropriate education to the investigators and providers are highly advised. It is critical to the control of LD that enhanced surveillance is maintained at a high level. Consequently, more consideration should be given for the more widespread use of Legionnaires confirming test when a patient presents with pneumonia.Hospitals and other healthcare facilities often have large, complex water systems, making them potentially high-risk settings for transmission of legionellosis to vulnerable patients or residents. We recommend all healthcare facilities have a water management program to control Legionella.References1. Centers for Disease Control and Prevention. (2018). Infection Control Assessment Tools. Retrieved October 5, 2018, from https://www.cdc.gov/legionella/2. Texas Health and Human Services. (2018). Legionellosis. Retrieved October,5, 2018, from https://www.dshs.texas.gov/idcu/disease/legionnaires

Epidemiological Distribution of Reported Cryptosporidiosis cases in Houston, Texas, 2013-2016

ObjectiveTo demonstrate the demographic and clinical distribution of reported Cryptosporidiosis cases in Houston, Texas, from 2013-2016IntroductionCryptosporidiosis is a diarrheal disease caused by microscopic parasite Cryptosporidium. Modes of transmission include eating undercooked food contaminated with the parasite, swallowing something that has come into contact with human or animal feces, or swallowing pool water contaminated with the parasite. The disease is clinically manifested usually with chronic diarrhea and abdominal cramps. It is found to be more prevalent in immunocompromised patients like HIV and AIDS. Cryptosporidiosis usually causes potentially life-threatening disease in people with AIDS.MethodsData were extracted from the Houston Electronic Disease Surveillance System (HEDSS) from January 1, 2013 to December 31, 2016. A total of 170 confirmed cases received during the study period were analyzed and crossed check against national Enhanced HIV/AIDS Reporting System (eHARS) database to examine epidemiological distribution. SAS 9.4 was used to analyze demographics, clinical characteristics as well as transmission factors.ResultsApproximately, 72% of the cases were males and 28% were females. The 35-44 year old age group (37%) had the highest prevalence. African Americans (49%) and Hispanics (30%) had the highest number of confirmed Cryptosporidiosis cases.133 of the 170 cases, 78% were previously reported to the eHARS national database as HIV/AIDS cases. Among the cases reported to eHARS, 90% had AIDS. 10% of the reported cases were found to be deceased in eHARS database. Among the 170 reported cases, 30% were hospitalized. Clinical presentations were diarrhea (44%), followed by abdominal cramps (23%), and nausea and vomiting (18%). Most common transmission factors among cryptosporidiosis cases were found to be men who have sex with men (MSM) (34%), followed by heterosexual contact with HIV/AIDS patients (14%), and MSM with Intravenous/Injection drug user (IDU) (5%). Among the reported cases, 70% were receiving ongoing medical services for their HIV/AIDS status.ConclusionsCryptosporidiosis in patients with HIV/AIDS diagnosis is mostly prevalent in males, African American adults and those between 35-44 years of age, with common clinical presentations of diarrhea and abdominal cramps. The prevalence of cryptosporidiosis is found to be more common in AIDS patients.Prevention strategies should be focused on raising awareness among immunocompromised patients with HIV and symptoms of cryptosporidiosis so they get evaluated and treated quickly to prevent conversion to AIDS disease.References1. Caccio SM, Pozio E. Advances in the epidemiology, diagnosis and treatment of cryptosptidiosis. Expert Review of Anti-infective Therapy. 2006; 4(3): 429-443.2. Hunter PR, Nichols G. Epidemiology ad clinical features of cryptosporidium infection in immunocompromised patients. Clinical Microbiology Reviews. 2002 Jan; 15(1): 145-154.3. http://www.cdc.gov/parasites/crypyo/gen_info/infect.htm