Background: An outbreak of Nipah virus infection was confirmed in Kerala, India in May 2018. Five out of 23 cases including the first laboratory-confirmed case were treated at Baby Memorial Hospital ...(BMH), Kozhikode. The study describes the clinical characteristics and epidemiology of the Nipah virus outbreak at Kozhikode during May 2018. Objective: To study the clinical and epidemiological profile of Nipah virus epidemic that occurred in Kerala in May 2018. Methods: A collaborative team of physicians and epidemiologists from BMH, Medical College Hospital (MCH) Kozhikode and from the Indian Medical Association (IMA) conducted this study. The clinical and exposure history and the data on outbreak response were gathered from hospital medical records and through interviewing patient relatives and health workers using questionnaires. Results: It was identified that out of the 23 patients with Nipah virus infection, 21 (91.3%) expired. Out of the 21 patients, 18 tested positive for Nipah virus by Real Time polymerase chain reaction (RT-PCR). It has been found that only the index case was infected in the community from fruit bats. Rest of the cases were due to transmission of the virus at three public hospitals. Median age was 45 years. 65% of them were males. Median incubation period was 9.5 days. Fever (100%), altered sensorium (84.2%), tachycardia (63.1%), hypertension (36.8%), segmental myoclonus (15.7%), segmental sweating (15.7%) and shortness of breath (73.6%) were common features. Mean duration of illness was 6.4 days. Conclusion: The rapid spread of infection uncovered the miserable state of health care system in implementing infection control measures. The case fatality and the socio-economic burden warrant developing appropriate treatments, vaccines and diagnostics.
The rapid growth of the cloud industry has increased challenges in the proper governance of the cloud infrastructure. Many intelligent systems have been developing, considering uncertainties in the ...cloud. Intelligent approaches with the consideration of uncertainties bring optimal management with higher profitability. Uncertainties of different levels and different types exist in various domains of cloud computing. This survey aims to discuss all types of uncertainties and their effect on different components of cloud computing. The article first presents the concept of uncertainty and its quantification. A vast number of uncertain events influence the cloud, as it is connected with the entire world through the internet. Five major uncertain parameters are identified, which are directly affected by numerous uncertain events and affect the performance of the cloud. Notable events affecting major uncertain parameters are also described. Besides, we present notable uncertainty-aware research works in cloud computing. A hype curve on uncertainty-aware approaches in the cloud is also presented to visualize current conditions and future possibilities. We expect the inauguration of numerous uncertainty-aware intelligent systems in cloud management over time. This article may provide a deeper understanding of managing cloud resources with uncertainties efficiently to future cloud researchers.
An HPLC procedure developed for the rapid and simultaneous determination of purine derivatives (PD) in ruminants’ urine was investigated, since the adoption of a single method for the simultaneous ...detection of PD and creatinine was not carried out due to elution of polar co-extractives and also due to overlapping of the peaks of allantoin and creatinine. The experimental conditions chosen in the present study avoid the presence of chemically competitive compounds and afford a good separation of the peaks of allantoin and creatinine. The recoveries of the standard compounds added to urine samples were 94–104%. This method can be proposed as a possible reference method for the estimation of allantoin, uric acid and creatinine in cattle urine.
Butyrophilin (BTN1A1) gene is located in the neighborhood of a quantitative trait loci for milk production in bovine autosome 23. We verified the genetic variability of exon-3 in BTN1A1 and its ...association with milk production traits in Holstein Friesian crossbreds of Kerala. Genomic DNA was isolated and 94 bp fragment enclosing exon-3 was amplified by primers designed using PRIMER 3 based on reference sequence (GenBank NC_037350). Pooled amplicons were sequenced by Sanger's method and a novel single nucleotide polymorphism due to a transversion of guanine to adenine at position 21 of amplicon (G21A) leading to amino acid change arginine to glutamine was detected. The study population was genotyped by high-resolution melt curve analysis and revealed two genotypes with frequencies GG/0.84 and GA/0.14. The allele G was found to be the major one (G/0.93 and A/0.07). Moreover, association analysis of G21A with milk production traits was done using the General linear model-Analysis of Variance considering herd, season, and parity as non-genetic factors and milk production trait as a dependent variable. In analysis, animals with GA genotype were found to be having significantly higher (p ≤ 0.01) 305 day milk (GG:2720.74 ± 122.92 kg; GA:3250.20 ± 183.24 kg), fat (GG:106.55 ± 4.32 kg; GA:126.30 ± 13.35 kg), and SNF yield (GG: 211.52 ± 9.20 kg; GA: 246.90 ± 13.70 kg). However, GG (7.80 ± 0.04) genotype has significantly higher (p ≤ 0.05) SNF percent than GA (7.65 ± 0.07). Butyrophilin gene polymorphism G21A can be suggested as a molecular marker for future breeding programmes of cattle.
•Correlation of colistin concentration with clinical efficacy and nephrotoxicity was studied in an Indian population.•Decreased mean steady-state levels Cssavg correlated with lower ...efficacy.•Colistin concentration decreased with an increase in creatinine clearance, even with a standard dosing regimen, leading to therapeutic failure.•There is a role for personalized therapeutic drug monitoring in guiding safe and appropriate dosages of colistin.
Safe and effective use of colistin requires robust pharmacokinetic (PK) and pharmacodynamic (PD) data to guide dosing.
To evaluate the pharmacokinetics of colistimethate sodium and colistin in critically ill patients and correlate with clinical efficacy and renal function.
Twenty critically ill adult patients with colistin-susceptible multidrug-resistant (MDR) infections and normal renal function treated with intravenous colistimethate sodium – at a 9 million units (270 mg CBA) loading dose followed by maintenance (MD) of 3 million units t.i.d, 24 hours later – were evaluated for clinical cure (CC) at the end of therapy. Patient characteristics and plasma colistin levels at 0, 0.5, 1, 2, 4, 8 and 12 hours after the loading dose and at 1, 2 and 8 hours after the eighth and ninth infusion of MD were evaluated. Colistimethate sodium and colistin levels were measured by high-performance liquid chromatography and tandem mass spectrometry (HPLC-MS/MS).
Among the 20 patients who were evaluated, 60% had pneumonia. Predominant pathogens were Klebsiella pneumoniae and Acinetobacter spp. Clinical cure was 50% (10/20). Mean peak loading dose concentrations were 3 ± 1.1 mg/L (1.75–5.14) and 2.37 ± 1.2 mg/L (1.52–5.54) for ‘cure’ and ‘failure’ groups, respectively (p = 0.13), while mean steady-state (Cssavg) concentrations were 2.25 ± 1.3 mg/L and 1.78 ± 1.1 mg/L in ‘cure’ and ‘failure’ groups, respectively (p = 0.19). Nephrotoxicity was 5% on day 7 of therapy. However, bacteriological cure could not be correlated with PK/PD.
Subtherapeutic Cssavg with clinical failure and lower efficacy without significant nephrotoxicity highlights the need for therapeutic drug monitoring to guide colistin dosing.
We present results from sun/sky radiometer measurements of aerosol optical characteristics carried out in New Delhi during March–June, 2006, as part of the Indian Space Research Organization's ...Integrated Campaign for Aerosol Radiation Budget. For the first time at this site, derived are parameters such as aerosol optical depth (AOD), single scattering albedo (SSA), asymmetry parameter, Ångstrom exponent, and real and imaginary refractive indices in five spectral channels. During the campaign, a consistent increase in aerosol loading from March to June with monthly average AOD values at 0.5μm of 0.55, 0.75, 1.22 and 1.18, respectively, was observed. Ångstrom exponent gradually decreases from 1.28 (March) to 0.47 (June), indicating an increased abundance of coarse particles due to dust storms that transport desert dust from the Thar desert and adjoining regions. SSA at 0.5 μm is found to be in the range of 0.84 to 0.74 from March to June, indicating an increasing contribution from the mixture of anthropogenic and desert dust absorbing aerosols. Optical properties derived during the campaign are used in a radiative‐transfer model to estimate aerosol radiative forcing at the surface and at the top‐of‐the atmosphere. A consistent increase in surface cooling is evident, ranging from −39 W m−2 (March) to −99 W m−2 (June) and an increase in heating of the atmosphere from 27 W m−2 (March) to 123 W m−2 (June). Heating rates in the lower atmosphere (up to 5 km) are 0.6, 1.3, 2.1, and 2.5K/d from March, April, May, and June 2006, respectively. Higher aerosol induced heating in the premonsoon period has been shown to have an impact on the regional monsoon climate.
Atmospheric aerosols alter the radiation balance by absorption/scattering of solar radiation, and indirectly by modifying the cloud microphysical properties. Observations during the Cloud Aerosol ...Interaction and Precipitation Enhancement Experiment (CAIPEEX) provide a unique opportunity to investigate the aerosol–cloud interaction in a dry to wet transition phase prior to the onset of southwest monsoon. It is observed that aerosol loading increased over the central Indian region in spite of the increase in surface rainfall. This aerosol loading was observed mainly in the 2–5 km level above surface. The origin and influence of elevated aerosol layer have been investigated with the help of WRF-Chem simulations by conducting sensitivity experiments for dust emissions, modified based on the satellite observations. To enhance the dust emissions, the erodible fraction over the Thar Desert region is enhanced to an average factor of 1.7 based on TOMS aerosol index (AI) and USGS land use category, which contributed to enhanced dust emissions by a factor of 1.25 over the study region. This enhancement of dust emission from Thar Desert can result in an increased radiative heating due to elevated aerosol layers, which leads to an increase in the ice mixing ratio and ice water content in the regions of dry to wet transition. It is shown that even natural dust emissions (without changes in anthropogenic emissions) may also influence the spatial and temporal distribution of cloud and precipitation and the hydrological cycle.
► Elevated aerosol layer (2–5 km) was caused by increased dust emission from Thar Desert. ► Interaction of aerosol via radiation parameterization is investigated with WRF-Chem. ► Enhanced dust emission leads to increased heating in the elevated aerosol layers. ► Enhanced dust emissions may influence cloud distribution and precipitation patterns.
Antimicrobial resistance is a major public health threat internationally but, particularly in India. A primary contributing factor to this rise in resistance includes unregulated access to ...antimicrobials. Implementing antimicrobial stewardship programs (ASPs) in the acute hospital setting will help curb inappropriate antibiotic use in India. Currently, ASPs are rare in India but are gaining momentum. This study describes ASP implementation in a large, academic, private, tertiary care center in India.
An ASP was established in February 2016 consisting of an administrative champion, hospitalist, microbiologist, intensivist, and pharmacists. Antimicrobial stewardship program interventions included postprescriptive audit and establishment of institutional guidelines. The ASP tracked appropriate drug selection including loading dose, maintenance dose, frequency, route, duration of therapy, de-escalation, and compliance with ASP recommendations. Defined daily dose (DDD) of drugs and cost of antimicrobials were compared between the pre-implementation phase (February 2015-January 2016) and post-implementation phase (February 2016-January 2017).
Of 48 555 patients admitted during the post-implementation phase, 1020 received 1326 prescriptions for restricted antibiotics. Antibiotic therapy was appropriate in 56% (742) of the total patient prescriptions. A total of 2776 instances of "inappropriate" antimicrobial prescriptions were intervened upon by the ASP. Duration (806, 29%) was the most common reason for inappropriate therapy. Compliance with ASP recommendations was 54% (318). For all major restricted drugs, the DDD/1000 patient days declined, and there was a significant reduction in mean monthly cost by 14.4% in the post-implementation phase.
Implementation of a multidisciplinary antibiotic stewardship program in this academic, large, Indian hospital demonstrated feasibility and economic benefits.
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