Background and Objectives: Resistance to a wide variety of common antimicrobials has made the proliferation of Extended spectrum β-lactmase (ESBL) producing strains a serious global health concern that has complicated treatment strategies. The high proportion of ESBL producers among the Enterobacteriaceae and the complex molecular epidemiology with diverse types of ESBL genes are alarming. This study was undertaken to identify ESBL production in various Gram negative bacilli isolated and to further characterize ESBL producers among Escherichia coli and Klebsiella spp by PCR, which were initially screened by phenotypic method. Materials and Methods:A total of 722 isolates of Gram negative bacilli were isolated. Presence of ESBL positivity was detected using the double disk synergy test (DDST). Their antibiogram was studied. PCR analysis for β-lactamase (bla) genes of the family TEM, SHV and CTX-M was also carried out using designed primers in 20 ESBL isolates each of Escherichia coli and Klebsiella spp.Results: Among 722 Gram negative bacilli isolated 379 (52.49%) were ESBL producers. The major source of ESBL producers were respiratory tract samples, highest ESBL production was observed in Klebsiella sp. (67.04%). Resistance to multiple classes of antibiotics was observed among ESBL producers. Among ESBL producing genes prevalence of bla-CTX-M (82.5%) was highest, followed by bla-TEM (67.5%) and bla-SHV (57.5%) in the present study. The frequency of ESBL producing strains among clinical isolates has been steadily increasing. Advance drug resistance surveillance and molecular characteristics of ESBL isolates is necessary to guide the appropriate and judicious antibiotic use.

Adult GH deficiency (AGHD) is characterized by an altered body composition, an atherogenic lipid profile, decreased exercise capacity, and diminished quality of life. We performed a randomized, double-blind, placebo-controlled, multicenter study in 166 subjects with AGHD to assess the effects of GH on these outcomes. GH was initiated at 0.0125 mg/kg.d, increased to 0.025 mg/kg.d as tolerated, or decreased to 0.00625 mg/kg.d for 12 months. Primary measures of efficacy included body composition, strength and endurance, and quality of life. Additional parameters included serum IGF-I concentrations, serum lipids, and bone mineral density. After 12 months, 79% of subjects remained on GH 0.0125 mg/kg.d, whereas 21% received 0.00625 mg/kg.d. GH-treated men and women demonstrated significant decreases in total body and trunk fat and increases in lean body mass over baseline. In GH-treated men, mean IGF-I SD scores exceeded age-adjusted normal ranges, whereas similar doses produced a smaller response in women. GH treatment was associated with significant improvements in total cholesterol and low-density lipoprotein (P < 0.05 for all). No significant treatment effects were observed in strength and endurance, quality of life, or bone mineral density. GH treatment was generally well tolerated. Subjects with AGHD should receive individualized GH therapy to maintain IGF-I between the mean value and +2 SD and improve body composition and cardiovascular risk factors.

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Although every patient must be individually considered, it appears that thymic hyperplasia can be diagnosed in most Graves' hyperthyroid patients by considering the clinical context and appropriate radiologic studies such as CT. Raising awareness of the association of thymic hyperplasia in patients with Graves' hyperthyroidism and its resolution with the reversibility of the hyperthyroid state should prevent unnecessary thymic evaluation and surgery with its attendant risks.

In recent days, aiming for power generation with less carbon emission, led to the high penetration of renewable energy into the distribution grid. To improve the intermittency caused by renewables and to increase the grid flexibility, grid integrated Energy Storage Units (ESUs) are proposed as the promising solution in the literature. However, considering the investment cost, ESUs are optimally placed by satisfying the network electrical constraints. On the other hand, consideration of environmental impacts and other practical constraints are also equally important. Therefore, in this article, on top of grid performance parameters, realistic parameters that may affect the location and its size such as (1) environmental impact, (2) land requirement & its associated cost for ESU installation and (3) renewable purchase obligation are formulated in the objective function. Decision making on ESU installation is a planning activity, which follows uncertainty. Consequently, it is essential to model the uncertainty parameters into the objective function, for better planning. In this article, optimal planning of hybrid ESUs based on realistic parameters along with uncertainty is addressed. For this study, a practical 156-bus distribution system of Dehradun district, India is considered. From the results obtained, it is evident that, formulating hybrid ESU constrained with the environmental impact has significantly decreased the emission of CO2 with maximum grid stability. INDEX TERMS Batteries, distributed power generation, environmental economics, power system planning, sustainable development.

Prompt attention to the management of thyrotoxicosis in patients with a history of significant heart disease is warranted in order to avoid potentially fatal arrhythmias.

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