Currently the rapid development of technology is taking place in the field of cloud computing. Cloud computing environment is the very demanding. It is easily accessible to provide the computer ...network service and resources using the Internet. It offers a variety of services such as Software as a Service (SAAS), Platform as a Service (PAAS) and Infrastructure as a Service (IAAS). The development of cloud computing environment primarily refers to the cloud service users and the cloud service provider. Cloud service user can utilize all kind of services provided by the provider and Cloud service provider provide cloud resources to the user. The service provider should use its resources professionally to make earnings, but in cloud environment, the difficult task for them is to improve the cloud resources. This article express the network energy reduction approach through optimizing the load using the network node and reducing the active network node by rearranging techniques.
In the rapid development of computer network technology. The cloud computing is a novel technology had become a highly demanded service due to several new challenges to all organizations the ...advantages of high computing power, cost of services, scalability, accessibility and availability. However, Cloud computing supports virtual machines system is more complex while dispatching variety of tasks to server’s applications simultaneously. That dispatching tasks to the servers is a challenge since there has a large number of applications in the heterogeneous cloud environment servers, all application services need to cooperate with each other in the cloud computing environment network. The huge number of tasks, an appropriate and effective scheduling algorithm is to allocate these tasks to appropriate servers within the minimum completion time, and to achieve the load balancing of performance workload of the cloud system. In this paper, we present a novel improved efficient dynamic load balancing scheme to organizing the virtualized resources algorithm, called Improved Efficient Scheme (IES) algorithm in the cloud computing network. The main concept of the IES algorithm is to allocate the tasks to server host by comparing all value of makespan time of the server nodes between each task. Basically, the IES algorithm can obtain better task completion time than previous works and can achieve dynamic load balancing in cloud computing environment.
Purpose
Metastatic spinal cord compression (MSCC) requires expeditious treatment. While there is no ambiguity in the literature about the urgency of care for patients with MSCC, the effect of timing ...of surgical intervention has not been investigated in detail. The objective of our study was to investigate whether or not the ‘timing of surgery’ is an important factor in survival and neurological outcome in patients with MSCC.
Methods
All patients with MSCC presenting to our unit from October 2005 to March 2010 were included in this study. Patients were divided into three groups—those who underwent surgery within 24 h (Group 1,
n
= 45), between 24 and 48 h (Group 2,
n
= 23) and after 48 h (Group 3,
n
= 53) from acute presentation of neurological symptoms. The outcome measures studied were neurological outcome (change in Frankel grade post-operatively), survival (survival rate and median survival in days), incidence of infection, length of stay and complications.
Results
Patients’ age, gender, revised Tokuhashi score, level of spinal metastasis and primary tumour type were not significantly different between the three groups. Greatest improvement in neurology was observed in Group 1, although not significantly when compared against Group 2 (24–48 h; (
p
= 0.09). When comparisons of neurological outcome were performed for all patients having surgery within 48 h (Groups 1 and 2) versus after 48 h (Group 3), the Frankel grade improvement was significant (
p
= 0.048) favouring surgery within 48 h of presentation. There was a negative correlation (−0.17) between the delay in surgery and the immediate neurological improvement, suggesting less improvement in those who had delayed surgery. There was no difference in length of hospital stay, incidence of infection, post-operative complications or survival between the groups.
Conclusions
Our results show that surgery should be performed sooner rather than later. Furthermore, earlier surgical treatment within 48 h in patients with MSCC resulted in significantly better neurological outcome. However, the timing of surgery did not influence length of hospital stay, complication rate or patient survival.
Bronchial asthma is one of the common chronic respiratory illnesses worldwide, with a global disease burden that affects approximately 300 million individuals. It affects 5-10% of the population in ...developed countries. India constitutes approximately one-tenth of the global disease burden, where an estimated 7 million children are affected by this illness. Airway hyperresponsiveness or bronchial hyperreactivity in asthma is an exaggerated response to numerous exogenous and endogenous stimuli. In India, the most important endogenous stimuli is considered to be fungal antigens from the genus, Aspergillus. Positive skin reactions to Aspergillus fumigatus among individuals with atopic asthma is 10 to 20%; however, a causal relationship is yet to be established. A separate entity, termed "severe asthma with fungal sensitivity," is often used to describe milder allergic reactions to fungal aeroallergens that has fungal sensitization as the starting point of pathogenesis than allergic bronchopulmonary aspergillosis.
A total of 57 patients with bronchial asthma were prospectively enrolled and evaluated for Aspergillus sensitization and its impact on asthma control.
Symptoms were well controlled in a majority of patients (57.89%) and partly controlled in 14.04%. Uncontrolled symptoms were observed in only 28.07% of patients. The proportion of patients with uncontrolled symptoms was higher among patients who were sensitized (45.00%) compared with patients who were not sensitized (18.92%). The proportion of patients with well-controlled symptoms was higher in individuals who were not sensitized compared with individuals who were sensitized (62.16% versus 50.00%).
The severity of asthma was associated with fungal sensitization, with sensitization to Aspergillus as a part of the pathogenesis. Aspergillus sensitization is significantly associated with bronchiectasis, even in the absence of clinical features.
Introduction: Difficult-to-control asthmatics, as defined by the Global Initiative for Management of Asthma (GINA), belong to a subset of patients whose symptoms remain uncontrolled despite adhering ...to maximal optimised therapy. Complex hypersensitivity reactions in response to airway colonization with Aspergillus fumigatus, which occurs in patients with asthma or cystic fibrosis, are established factors for a poor response to treatment and frequent exacerbations. Only limited data related to Allergic Bronchopulmonary Aspergillosis (ABPA) is available from India, particularly from Kerala. Aim: To assess the occurrence of ABPA in patients with difficultto-control asthma using the modified ISHAM criteria. Materials and Methods: This cross-sectional analysis was conducted in the Department of Pulmonary Medicine, Institute of Chest Diseases, Government Medical College, Kozhikode, Kerala, India from February 2019 to July 2020. The study population comprised asthmatics attending the Pulmonary Medicine Outpatient Services who were on regular medications, including optimal doses of inhaled corticosteroid and longacting beta-agonist combinations. Patients with two or more exacerbations per year requiring systemic steroids for symptom control and a positive skin test for Aspergillus fumigatus antigen were further analysed using the modified International Society for Human and Animal Mycology (IHAM) criteria to determine the proportion of difficult-to-control asthmatics with ABPA. A total of 185 subjects were enrolled. Twelve patients opted out of the study, and the remaining 173 patients were screened using the modified ISHAM criteria. Statistical analysis was performed using Stastistical Packages of Social Sciences (SPSS) software version 21.0. Continuous parameters were expressed as mean and median, while categorical parameters were measured as frequency and percentages. Results: It was observed that 104 (60.1%) patients belonged to the age group between 41-60 years, while approximately 60 patients (34.7%) were below 40 years of age. Among the 173 patients, 86 (49.7%) tested positive for Aspergillus fumigatus antigen. Applying the ISHAM criteria, it was found that only 17 (9.8%) of these patients satisfied the criteria for co-existent ABPA. A total of 101 patients (58.4%) required at least one hospital admission, while 4 (2.3%) patients required more than three hospital admissions per year. Total 21 (12.1%) patients had IgE specific to Aspergillus fumigatus, while total IgE levels were elevated in 46 (26.6%) cases. Thirty-six cases (20.8%) had a high peripheral eosinophil count. Conclusion: This study suggests the possibility of the treating physician overlooking 10% of asthmatics in this region who are being managed as difficult-to-control asthma, but who have co-existent ABPA. This subset should be identified early in the course and managed separately for better treatment response.
Pulmonary mucoepidermoid carcinoma (MEC) is an uncommon tumor constituting only 0.1% to 0.2% of all lung carcinoma. It is classified under "salivary gland type" tumors in the World Health ...Organization (WHO) classification of lung cancers. It generally carries a better prognosis than the more common small cell and nonsmall cell lung carcinomas. It is pathologically classified into high-grade and low-grade tumors. High-grade tumors are usually unresectable at presentation. However, surgery is the mainstay of treatment, which aims at surgically negative margins for a complete cure. In our patient, pulmonary MEC presented with intrathoracic mass with pericardial effusion. It came out to be low-grade neoplasm, which was treated with platinum-based doublet chemotherapy and responded well with near-total disappearance of tumor, like a vanishing lung tumor.
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.
Pleural effusion is a common diagnostic dilemma for the pulmonologist. A histological diagnosis would many a time steer the way to an accurate diagnosis of the aetiologies of pleural effusions. This ...study has compared two methods for obtaining histological specimens in cases of undiagnosed pleural effusions.
To compare the efficacy of closed pleural biopsy with Abrahm's needle and medical thoracoscopic biopsy in the diagnosis of undiagnosed exudative pleural effusions at a tertiary care setting.
Randomized controlled study.
November 2008-October 2010.
All patients who were admitted with pleural effusions underwent a clinical workup for pleural effusions. Light's criterion was used to differentiate between exudative and transudative pleural effusions. Those patients with exudative pleural effusions, who did not have a specific diagnosis, were included in the study. Fifty eight patients were included in the study and they were randomized into 2 Groups of 29 patients each. One group was subjected to medical thoracoscopic pleural biopsy and the other to closed pleural biopsy with Abrahm's needle. Demographic, clinical and biochemical characteristics, diagnostic yields and the complications among the two groups were compared.
Medical thoracoscopy has a diagnostic yield of 86.2% with complication rate of 10.3% compared to 62.1% and 17.2% respectively in closed pleural biopsy group.
Medical thoracoscopic pleural biopsy had a better diagnostic yield with a lower complication rate as compared to closed pleural biopsy with Abrahm's needle.
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