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•Ichthyosis uteri is a rare condition describing extensive endometrial keratinization.•There may be an association with squamous cell carcinoma of the endometrium.•Endometrial extension of cervical malignancy may closely resemble ichthyosis.•A hysterectomy should be considered in patients who have completed childbearing.

The sizzling growth of e-commerce platforms, online social networking websites, and online media has led to abundant information and choices, making it challenging for users to find what they want. Recommendation systems have arisen to solve this problem, proposing customized and relevant things to users based on their previous behaviour, interests, and context. Collaborative Filtering (CF) is an important part of recommendation systems approaches and it is most widely used in implementation of personalized recommendation systems. The machine learning techniques such as Matrix Factorization (MF) is a popular technique used in collaborative filtering, which is used to extract underlying factors from the user-item rating matrix. Another technique such as Neural Network (NN) has also been widely used in recommendation systems. In this paper, the use of matrix factorization with neural network have incorporated and suggested. [ABSTRACT FROM AUTHOR]

Background: The rapid emergence of carbapenem resistant Acinetobacter baumannii (CRAB) has resulted in an alarming situation worldwide. Realizing the dearth of literature on susceptibility of CRAB in genetic context in the developing region, this study was performed to determine the susceptibility profile against standard drugs/combinations and the association of in-vitro drug synergy with the prevalent molecular determinants. Methods and findings: A total of 356 clinical isolates of A. baumannii were studied. Confirmation of the isolates was done by amplifying recA and ITS region genes. Susceptibility against standard drugs was tested by Kirby Bauer disc diffusion. Minimum inhibitory concentration (MIC), MIC50 and MIC90 values against imipenem, meropenem, doripenem, ampicillin/sulbactam, minocycline, amikacin, polymyxin B, colistin and tigecycline was tested as per guidelines. Genes encoding enzymes classes A (blaGES, blaIMI/NMC-A, blaSME, blaKPC), B (blaIMP, blaVIM, blaNDM) and D (blaOXA-51, blaOXA-23 and blaOXA-58) were detected by multiplex polymerase chain reaction. Synergy against meropenem-sulbactam and meropenem-colistin combinations was done by checkerboard MIC method. Correlation of drug synergy and carbapenemase encoding genes was statistically analyzed. Results: Of the total, resistance above 90% was noted against gentamicin, ciprofloxacin, levofloxacin, ceftazidime, cefepime, ceftriaxone, cotrimoxazole and piperacillin/tazobactam. By MIC, resistance rates from highest to lowest was seen against imipenem 89.04% (n=317), amikacin 80.33% (n=286), meropenem 79.49% (n=283), doripenem 77.80% (n=277), ampicillin/sulbactam 71.62% (n=255), tigecycline 55.61% (n=198), minocycline 14.04% (n=50), polymyxin B 10.11% (n=36), and colistin 2.52% (n=9). CRAB was 317 (89.04%), 81.46% (n=290) were multidrug resistant and 13.48% (n=48) were extensively drug resistant. All the CRAB isolates harboured blaOXA-51 gene (100%) and 94% (n=298) blaOXA-23 gene. The blaIMP gene was most prevalent 70.03% (n=222) followed by blaNDM, 59.62% (n=189). Majority (87.69%, 278) were co-producers of classes D and B carbapenemases, blaOXA-23 with blaIMP and blaNDM being the commonest. Synergy with meropenem-sulbactam and meropenem-colistin was 47% and 57% respectively. Reduced synergy (p= <0.0001) was noted for those harbouring blaOXA-51+blaOXA-23with blaNDM gene alone or co-producers. Conclusion: Presence of blaNDM gene was a significant cause of synergy loss in meropenem-sulbactam and meropenem-colistin. In blaNDM endemic regions, tigecycline, minocycline and polymyxins could be viable options against CRAB isolates with more than one carbapenemase encoding genes. [ABSTRACT FROM AUTHOR]

Objective: The excessive desire to void with discomfort in the supra-pubic region, which is experienced postoperatively by patients who underwent urinary catheterization, is known as catheter-related bladder discomfort. In this study, we evaluated duloxetine, a selective serotonin and norepinephrine reuptake inhibitor, in preventing catheter-related bladder discomfort. Material and methods: Around 64 adults (18-60 years), of either sex, with American Society of American Society of Anesthesiologists (ASA) physical status I and II, scheduled to undergo elective gastrointestinal carcinoma surgeries under general anesthesia were analyzed in the final assessment of 2 comparative groups C and D of 32 patients each. Group D received 1 ranitidine tablet of 150 mg and 1 duloxetine tablet of 60 mg, while group C patients received 2 tablets of ranitidine of 75 mg 2 hours prior to induction. A 16 F Foley catheter was used to catheterize bladder intra-operatively, and 10 mL of distilled water was used to fill the balloon. At 0, 1, 2, and 6 hours, the catheter-related bladder discomfort was evaluated, and categorized into none, mild, moderate, and severe. The study drug's adverse effects, if any, were reported. Results: At all-time intervals, group D had lower incidence and severity of catheter-related bladder discomfort than group C (P < .05). Compared to group C, patients in group D had a higher incidence of nausea, dizziness, and vomiting; nevertheless, the difference was statistically insignificant (P > .05). Conclusion: Duloxetine of 60 mg given orally 2 hours before induction decreases the incidence and severity of catheter-related bladder discomfort. [ABSTRACT FROM AUTHOR]

Introduction: Chlorpromazine belongs to the category of typical antipsychotics or neuroleptics, also known as First-Generation Antipsychotics (FGAs). It is found to be effective in hiccup management by its action as dopamine antagonist in the hypothalamus. Olanzapine act as an antagonist at postsynaptic serotonergic receptors which augment phrenic motoneuronal activity and play a role in the generation of hiccups. Aim: To compare the effectiveness of combination therapy (Olanzapine plus Chlorpromazine) with monotherapy (Chlorpromazine) in Traumatic Brain Injury (TBI) patient admitted to trauma Intensive Care Unit (ICU). Material and Methods: The present study was a control trial which was conducted between November 2020 to October 2021 on patients aged 18-65 years diagnosed with intracranial injury due to trauma. A total of 100 patients (50 in each group) were randomised into Group 1 (patients receiving chlorpromazine 25 mg thrice daily for five days) and Group 2 (patients receiving chlorpromazine 25 mg thrice daily and olanzapine 5 mg once daily for five days). The primary outcome measure was to compare cessation or reduction in the frequency of hiccups. Various laboratory parameters were investigated and compared between both the groups on day zero and day five. The secondary outcome was side-effects of the drugs. results: In the present study, the distributions of age and gender were similar in both groups with mean age of patients being 39.16±13.88 years and 43.30±12.51 years in group 1 and 2, respectively. Cessation of hiccups were found in 29 (58%) of the patients in group 2 as compared to 27 (54%) patients in group 1, which was not statistically significant. However, improvement in the status of patients was observed in 18 (36%) in group 2, as compared to 10 (20%) in group 1 (p<0.05). No serious adverse events were documented in either groups. conclusion: A better outcome was observed with combination of chlorpromazine and olanzapine than chlorpromazine alone, in treating hiccups due to TBI. The present trial has established the role of drugs for managing hiccups caused after TBI. [ABSTRACT FROM AUTHOR]

Background: Post traumatic seizures (PTS) are very common after traumatic brain injury and occur more common in severe form of injury. Prophylactic treatment with phenytoin has been found to be effective however till now no uniform internationally agreed guideline is available for the duration of anticonvulsant prophylaxis for traumatic brain injury patients. Methods: 100 patients of either sex between age group of 18–65 years who have suffered intracranial injury identified by CT scan, admitted in Trauma ICU were enrolled in this prospective randomized single blinded clinical study. Group 1 (n = 50) received 7 days prophylactic anticonvulsant therapy with phenytoin and Group 2 (n = 50) received for 21 days. The primary end point was the occurrence of seizures, which were classified as early (occurring from time of drug loading to day 7) or late (occurring on day 8 or later after loading of drug). Patients were also assessed for the possible adverse side effects of phenytoin. Result: Out of 100 patients, 90 completed the study successfully as 5 patients from each group expired during the duration of the study. On comparing the frequency of seizure from 1st to 7th day after loading dose of phenytoin between two groups, out of 45 patient, 2 (4.4%) developed seizure in group 1 and 3 (6.7%) developed seizure in group 2 and found to be statistically insignificant (P = 0.645). On comparing the frequency of seizure from 1st to 21st day after loading dose of phenytoin between two groups, out of 45 patient, 4 (8.9%) developed seizure in groups 1 and 3 (11.1%) developed seizure in group 2 and found to be statistically insignificant (P = 0.725). Conclusion: A 21-day prophylactic anticonvulsant therapy with phenytoin was not more effective than a 7-day prophylactic therapy with phenytoin to reduce the frequency of seizure in a TBI patient in trauma ICU and was also associated with more adverse side effects that were insignificant. [ABSTRACT FROM AUTHOR]

Background: Extensive drug resistance in Klebsiella pneumoniae (K. pneumoniae) causing major outbreaks in large hospitals is an emerging challenge. We describe a near fatal outbreak of colistin resistant, carbapenem resistant K. pneumoniae (CRKp) producing metallo beta-lactamases (blaNDM) and blaOXA-48 in the neonatal intensive care unit (NICU) at the background of a larger outbreak involving multiple parts of the hospital and the challenges in its containment. Methods: Following identification of an outbreak due to colistin resistant CRKp between April to June 2017 in the NICU, a thorough surveillance of similar cases and the hospital environment was performed to trace the source. All the isolated K. pneumoniae were tested for susceptibility to standard antibiotics by disc diffusion and microbroth dilution methods. Molecular detection of extended spectrum beta lactamases (ESBLs) and carbapenemases (classes A, B, D) genes was done. Enterobacterial repetitive intergenic consensus (ERIC) PCR and multi-locus sequence typing (MLST) was done to determine the genetic relatedness of the isolates. Characteristics of different sequence types were statistically compared (Student's t-test). Results: A total of 45 K. pneumoniae isolates were studied from NICU (14 cases of neonatal sepsis), ICU (18 cases), other wards (7 cases) along with 6 isolates from hospital environment and human colonizers. The primary case was identified in the ICU. All the K. pneumoniae from NICU and 94.4% from the ICU were colistin resistant CRKp. Majority (59.37% and 56.25%) harbored blaSHV/blaCTXM and blaOXA-48 genes, respectively. Two distinct sequence types ST5235 and ST5313 were noted with colistin resistance, distribution within the NICU and mortality as significant attributes of ST5235 (p < 0.05). The outbreak was contained with strengthening of the infection control practices and unintended short duration closure of the hospital. Conclusion: Large hospital outbreaks with considerable mortality can be caused by non-dominant clones of colistin resistant CRKp harboring blaOXA-48 and blaNDM carbapenemases in endemic regions. The exact global impact of these sequence types should be further studied to prevent future fatal outbreaks. [ABSTRACT FROM AUTHOR]

Background and Aims: Ventilator-associated pneumonia (VAP) is the most common healthcare-associated infection in adult critical care units. The reason behind the different levels of severity and the outcome in different individuals is not established yet.Co-morbidities and age may be a valid reason.In an attempt to find out the reason behind the different levels of severity of VAP in different individuals, we conducted a studywith the primary objective being to assess the quantitative correlation between the colony forming units (CFU) of Acinetobacter baumannii in the endotracheal tube aspirate and the Clinical Pulmonary Infection Score (CPIS) in mechanically ventilated patients without co-morbidities. The secondary objective was to see whether the severity of VAP depends on the number of CFU(>105/ml). Methods: This observational study was conducted in a 27-bedded intensive care unit of a tertiary care hospital in northern India. Endotracheal tube aspirate was collected from patients with suspected VAP.A total of 81 patients without any prior co-morbidity and having Acinetobacter baumannii in their endotracheal tube aspirate were included in the study group. Quantification of Acinetobacter baumannii was done by counting CFU.The CPIS was calculated for all Acinetobacter baumannii positive patients. Correlation between CFU of Acinetobacter baumannii and CPIS was assessed using Spearman's Rho correlation coefficient. Results: Among 81 patients having Acinetobacter baumannii infection, only 61.9% had a CPIS >4. There was an insignificant correlation between the quantity of CFUs of Acinetobacter baumannii and CPIS (P value = 0.784). Conclusion: Number of CFU >105/ml in an endotracheal tube aspirate culture bears no relation to the severity of VAP as predicted by the CPIS. [ABSTRACT FROM AUTHOR]

Byline: Ghanshyam. Yadav, Gaurav. Jain Sir, Accomplishment of successful laryngoscopy depends upon certain key factors, including head positioning, route of blade insertion, direction of applied force and the type of [...]

Background and Aims: Various biomarkers are used for predicting outcome from sepsis and septic shock but single value doesn't give clear-cut picture. Changing trends of serum lactate and red cell distribution width (RDW) gives more accurate information of patient outcome. So, aim of this prospective observational study was to identify the correlation, for initial and changing trend of blood lactate level and RDW, with 28-day mortality in sepsis and septic shock. Material and Methods: Patient who fulfills the criteria of sepsis and septic shock, according to the consensus conference published in 2016, were included in this study. All patients were resuscitated and managed according to institutional protocol for sepsis and septic shock. Serum lactate and RDW was obtained from arterial blood gas and complete blood count, respectively. Serum lactate and RDW were recorded at 0 h, 6 h, 24 h, day 2, day 3, day 7, week 2, and week 3. Mean between two groups were compared with student t-test. Pearson and Spearman correlation coefficient was used for establishing correlation between two continuous data. P value < 0.05 indicates significant difference between two groups. Results: There is positive correlation between serum lactate and RDW at all-time point in non-survival group while negative correlation was found in survival group except on day1 and 2. Conclusion: Changing trends of serum lactate and RDW can be used as a prognostic marker in patient of sepsis and septic shock. [ABSTRACT FROM AUTHOR]

Byline: Gaurav. Jain, Pranav. Bansal, Girdhari. Garg, Dinesh. Singh, Ghanshyam. Yadav Background: To compare the efficacy and safety of local anaesthetics under cervical epidural anaesthesia (CEA) using lignocaine (1%), bupivacaine [...]

Byline: Gaurav. Jain, Pranav. Bansal, Bashir. Ahmad, Dinesh. Singh, Ghanshyam. Yadav Background: This prospective double-blind trial was undertaken to analyze the role of perioperatively administered dexmedetomidine on the occurrence of [...]

Byline: Gaurav. Jain, Dinesh. Singh, Ghanshyam. Yadav, Surender. Gupta, Santosh. Tharwani Background: The technique of anterograde over a retrograde guide is considered to be more reliable and preferable in comparison [...]