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Background: The irrational use of antibiotics has led to the emergence of multi drug resistant pathogens. The phenomenon of MIC creeps occurs when organisms start showing raised MIC but within susceptible range giving an indication of the prevalence of rise in resistant pathogens in an area., Methods: A cross sectional study in a large tertiary care hospital in North India to observe the susceptibility pattern among uropathogens and the possibility of MIC creeps. The Antimicrobial Susceptibility Testing (AST) and Minimum Inhibitory Concentration (MIC) were conducted by Vitek Compact 2. The identification of Extended Spectrum Beta Lactamase (ESBL) producers and Carbapenem Resistant Enterobacteriaceae (CRE) among Escherichia coli were noted. The MIC 50 and MIC 90 for Nitrofurantoin, the most widely used antibiotic for lower UTI, was calculated to investigate the phenomenon of MIC creep., Results: In our study, a total of 2522 urine samples were analyzed: 1538 (61%) were positive with the commonest isolate being E. coli (n=736, 47.8%) followed by Klebsiella spp. (n=178, 11%). Less than 10% of resistance was observed for Fosfomycin, Amikacin, Nitrofurantoin, Imipenem, Meropenem and Colistin. ESBL producers and CRE E. coli were 528 (72% of 736) and 79 (11% of 736) respectively. Overall, 119/736 samples had an MIC ≥128. Amongst the ESBL producers, 96/528 had MIC ≥128 and amongst the CRE, 13/79 had MIC ≥128., Discussion: E. coli can be used to reflect the trends in development of resistance. In the current study, it was observed that E. coli showed a reduced susceptibility for Nitrofurantoin indicated by a creeping increase in MIC albeit within normal range., Conclusions: Trends in rising MIC should alert prescribers to use drugs such as Nitrofurantoin judiciously. Antimicrobial stewardship practices should be strongly implemented in hospitals to curb rising resistance and obtain better treatment outcomes for patients with infectious diseases.

A miniaturized four-element antenna of 20 mm × 20 mm with edge-to-edge distance of 4.9 mm between the array antennas operating from 4.6−8.6 GHz is investigated in this article. The antenna consists of 4 × integrated dipole driven elements, and complementary split ring resonator (CSRR) metacells are loaded on the both sides of each dipole arms. The loaded meta-couplers magnetically couple to dipole drivers, and the induced resonance effect improves the 10-dB impedance bandwidth (IBW) to 60.6%. To improvise the isolation between antenna elements, metallic vias are implemented that trap electromagnetic (EM)-surface waves to condense into the ground. So, the meta-couplers induce electromagnetic (EM)-propagation as surface wave trapments for radiation and decouple near-field condensed currents, acting as couplers/decouplers. The maximum isolation achieved is >−22.5 dB without any external decoupling network. The diversity parameters indicate good attributes in isotropic, indoor, and outdoor channel environments with an envelope correlation coefficient (ECC) < 0.165 and realized gain of 5.5 dBi with average radiation efficiency of 80−90% in the desired operating bands. An equivalent circuit model using lumped components is designed for the proposed four-element antenna. For validation, a prototype antenna is fabricated and measured to be implemented in 5G applications, which shows good correlation with the full-wave simulated results.

Ludwig's angina is a rapidly spreading, potentially fatal infection of deep fascial spaces of the neck leading to airway oedema and death. This, in recent times when associated with COVID-19 infection, possess treatment challenges making the patient susceptible to opportunistic infections with reduced healing potential. Owing to the multifactorial aetiology in our case and addressing them at the earliest, it is important to achieve favourable outcomes. The space infection that seeded with untreated trivial dental caries progressed to necrotising fasciitis of neck with mycobacterial growth on cartridge-based nucleic acid amplification test for tuberculosis testing. The presence of Mycobacterium organisms should be speculated in patients with pulmonary signs of tuberculosis (TB) because a suppurative TB lymphadenitis of neck could also have the same presentation. The decisive moment in successful outcome was identification of mycobacteria in COVID-19 infected patient, thereby allowing to initiate the antitubercular therapy along with surgical debridement. Thus, medical management of patient with cohabiting infections is difficult task and needs appropriate addressal., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Dengue fever is a common mosquito-borne viral disease which has reached alarming size in the past few years. It is endemic in more than 100 countries and significant differences were found in clinical profile and atypical manifestation., Aim of the Study: A retrospective observational study of clinical profile and atypical manifestations in patients with dengue fever., Materials and Methods: Serum samples were collected from clinically suspected cases of dengue fever and it was confirmed by NS1 antigen, IgM, and IgG antibody by ELISA. Clinical details and atypical manifestations were recorded., Observation: During the study period, a total of 2502 patients were suspected to have dengue infection, of which 464 (18.5%) samples were found to be positive for dengue viral infection. A majority of the cases were males [268 (57%)] when compared with females [196 (42%)]. Fever was the most common clinical presentation seen in all the patients, followed by headache (78.4%), myalgia (61%), body pain (49.3%), vomiting (40%), joint pain (31.5%), dry cough (19%), nausea (14%), abdominal pain (8%), diarrhea (5.6%), retro-orbital pain (04%), burning micturition (2.4%), and rashes (0.6%). Among atypical manifestations, hepatomegaly [32 (7%)] was the most common, followed by splenomegaly [23 (5%)], bradycardia [18 (4%)], meningitis [6 (1.2%)], hemoptysis [5 (1%)], acalculous cholecystitis [4 (0.8%)], and acute pancreatitis [2 (0.4%)]. The study of hematological parameters showed thrombocytopenia was present in 179 (38.5%) patients, followed by leukopenia [77 (17%)] and raised hematocrit [29 (6.2%)]., Conclusion: During ongoing epidemics, the clinical profile and atypical manifestations in clinically suspected dengue patients should be investigated early so that severe forms can be treated promptly., Competing Interests: There are no conflicts of interest., (Copyright: © Journal of Family Medicine and Primary Care.)

In this paper, viability of low-cost off-the-shelf Piezoelectric ceramic disc elements is explored for an insole-based gait monitoring system, `PI-Sole' (Piezo In-Sole). Piezoelectric elements can sense dynamic changes in pressure in a closed-loop environment with good sensitivity and a wide measurement range. In this paper, method to enable these elements to continuously sense plantar pressure while walking is proposed, making them a very cost-efficient alternative to the widely used Force Sensing Resistors (FSR) and pressure plates for monitoring human gait. However, piezoelectric elements show hysteresis in their force response, inducing a drift in calculated pressure which increases with time. A novel and effective method to perform detrending of the signal is also presented utilizing stride contexts from a 6-DoF Inertial Measurement Unit (IMU) and the same is utilized to perform zero-correction in the pressure data. 3-D trajectories of strides are calculated using the IMU, and parameters like stride length, stride height etc. are further derived. In order to test the validity of our proposed methods, important kinetic parameters like Vertical Ground Reaction Force (VGRF) and Center of Pressure (CoP) are calculated using PI-Sole and compared to the ones calculated using FSR's in multiple prior works. Applicability of PI-Sole is demonstrated further by depicting and analysing characteristic differences between a heel-strike toe-off stance type, and a flat-strike stance type, the latter being one of the primary symptoms in many cases of pathological gait, including Parkinsonian gait. Important artefacts from foot's height profile while walking are analysed for both stance types in context of standard gait events. We report a mean error of 2.8cm in stride length calculation, and a mean accuracy of 94.5% in calculating swing/stance duration of gait cycles.