Orogenital ulcers and the Behcet’s disease

Behcet’s’s disease is a systemic vasculitis involving small to large veins and arteries. It is a sporadic disease, mostly prevalent among the ancestors of the silk route. It is characterized by recurrent oral ulcers, genital ulcers, and uveitis. It also can manifest as skin, vascular, gastrointestinal, neurological, cardiac, and renal involvement. Though overall mortality is around 5%, delay in diagnosis and treatment may lead to significant morbidity. Cardiovascular and pulmonary arterial aneurysms are dreadful complications of this disease. Being uncommon in south India it is liable to be wrongly diagnosed and treated. Delay in the diagnosis and treatment may lead to severe complications. Here we present a case of Behcet’s disease which was managed at primary health care inadequately. We also demonstrated a quick response to steroids which are the mainstay of treatment. In this case presentation we illustrated pre and post treatment scrotal and oral Behcet’s’s lesions for clinicians to memorize. We also discussed international criteria to diagnose Behcet’s disease (ICBD) in concurrence with our case. In this presentation, we briefly described the involvement of other systems and their treatment. This article also elaborated on the latest developments in the treatment of Behcet’s disease

Revision Total Shoulder Arthroplasty is Associated with Increased Thirty-Day Postoperative Complications and Wound Infections Relative to Primary Total Shoulder Arthroplasty

© 2017, Hospital for Special Surgery. Background: With an increasing volume of primary total shoulder arthroplasties (TSA), the number of revision TSA cases is expected to increase as well. However, the postoperative medical morbidity of revision TSA has not been clearly described. Questions/Purposes: The purpose of this study was to determine the rate of postoperative complications following revision TSA, relative to primary TSA. In addition, we sought to identify independent predictors of complications, as well as to compare operative time and postoperative length of stay between primary and revision TSA. Methods: Patients who underwent primary/revision TSA between 2005 and 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program. Differences in complications, readmission rates, operative time, length of stay, and predictors of complications were evaluated using bivariate and multivariate analyses. Results: A total of 10,371 primary TSA (95.4%) and 496 revision TSA cases (4.6%) were identified. The overall complication rate was 6.5% in primary and 10.7% in revision TSA patients (p \u3c 0.001). Multivariate analysis identified an increased risk of any complication (odds ratio 1.73, p \u3c 0.001), major complication (2.08, p = 0.001), and wound infection (3.45, p = 0.001) in revision TSA patients, relative to primary cases. Operative time was increased in revision cases (mean ± standard deviation, 125 ± 62.5), relative to primary (115 ± 47.7, p \u3c 0.001). Age \u3e 75, female sex, history of diabetes or chronic obstructive pulmonary disease, and American Society of Anesthesiologists classification ≥ 3 were associated with increased risk of any complication. Smoking history was the only significant predictor of wound infection. Conclusion: Revision TSA, in comparison to primary, poses an increased risk of postoperative complications, particularly wound infections. A history of smoking was an independent predictor of wound infections

Timage -- A Robust Time Series Classification Pipeline

Time series are series of values ordered by time. This kind of data can be found in many real world settings. Classifying time series is a difficult task and an active area of research. This paper investigates the use of transfer learning in Deep Neural Networks and a 2D representation of time series known as Recurrence Plots. In order to utilize the research done in the area of image classification, where Deep Neural Networks have achieved very good results, we use a Residual Neural Networks architecture known as ResNet. As preprocessing of time series is a major part of every time series classification pipeline, the method proposed simplifies this step and requires only few parameters. For the first time we propose a method for multi time series classification: Training a single network to classify all datasets in the archive with one network. We are among the first to evaluate the method on the latest 2018 release of the UCR archive, a well established time series classification benchmarking dataset.Comment: ICANN19, 28th International Conference on Artificial Neural Network

Nanocarrier-assisted sub-cellular targeting to the site of mitochondria improves the pro-apoptotic activity of paclitaxel

Many drug molecules exert their biological action on intracellular molecular targets present on or inside various cellular organelles. Consequently, it has become more evident that the efficiency and efficacy of drug action is dependent largely on how well an unaided drug molecule is able to reach its intracellular target. We hypothesized that the biological action of such drug molecules might be improved by specific delivery to the appropriate sub-cellular site by a pharmaceutical carrier designed for the purpose. To test our hypothesis, we used paclitaxel, a molecule that has recently been shown to have pro-apoptotic biological targets on the mitochondria but has a quantitative structure–activity relationship-predicted cytosolic accumulation and no affinity for mitochondria. Using a mitochondria-specific nanocarrier system (DQAsomes) prepared from the amphiphilic quinolinium derivative dequalinium chloride to deliver paclitaxel to mitochondria in cells, we report that it is possible to improve the pro-apoptotic action of paclitaxel

Increased Surgical Duration Associated With Prolonged Hospital Stay After Isolated Posterior Cruciate Ligament Reconstruction

Hasani W Swindell,1 Venkat Boddapati,1 Julian J Sonnenfeld,1 David P Trofa,1 James E Fleischli,2 Christopher S Ahmad,1 Charles A Popkin1 1Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA; 2Shoulder and Elbow Center, OrthoCarolina Sports Medicine Center, Charlotte, NC, USACorrespondence: Charles A PopkinDepartment of Orthopedic Surgery, Columbia University Medical Center, 622 West 168th Street, PH – 11, New York, New York 10032, USATel +1 212-305-4787Email [email protected]: Although often performed using a variety of reconstructive techniques and strategies, no clinically significant differences presently exist between the approaches available for isolated PCL reconstructions. Given the operatively challenging nature of these procedures, there lies a potentially increased risk of postoperative complications and healthcare expenditures. Our investigation sought to identify patient and surgical risk factors associated with prolonged hospital stays following isolated PCL reconstruction and determine the incidence of 30-day complications after PCL reconstruction using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.Method: Patients undergoing isolated PCL reconstructions between 2005 and 2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database using Current Procedural Terminology codes. Baseline patient and operative characteristics were evaluated as possible risk factors for overnight hospital admissions following PCL reconstruction and analyzed using multivariate analyses.Results: A total of 249 patients were identified. Multivariate analyses demonstrated that increased operative duration >120 mins (OR 5.04, CI 2.44–10.40; p <0.001) was associated with an increased risk of overnight hospital stay. Major complications occurred in 0.4% (N=1), and minor complications occurred in 0.8% (N=2) with overall complications occurring in 1.2% (N=3) of all patients. Wound dehiscence was the only major complication while superficial surgical site infection and deep vein thrombosis were the only minor complications. 34.1% (N=85) of patients required an overnight hospital stay postoperatively.Conclusion: Surgical duration >120 mins carried an increased risk of overnight hospital stay after isolated PCL reconstructions. As there are presently minimal significant clinical differences between current PCL reconstruction techniques, improved surgeon familiarity and comfort with a single technique is recommended to decrease operative time and avoid prolonged hospital stays and healthcare expenditures.Level of evidence: III, retrospective comparative study.Keywords: operative time, overnight hospital stays, healthcare expenditures, American College of Surgeons National Surgical Quality Improvement Program, NSQI

Continued Inpatient Care After Primary Total Shoulder Arthroplasty Is Associated With Increased Short-term Postdischarge Morbidity: A Propensity Score-Adjusted Analysis.

Advances in surgical technique and implant design during the past several decades have resulted in annual increases in shoulder arthroplasty procedures performed in the United States. The purpose of this investigation was to use the National Surgical Quality Improvement Program database to analyze the rates of morbidity following shoulder arthroplasty. The authors hypothesized that, independent of predischarge patient factors, discharge to inpatient facilities is associated with increased short-term morbidity. Patient demographics, intraoperative variables, and information about postoperative complications/readmissions up to 30 days after the operative event were collected from the National Surgical Quality Improvement Program database for the period 2005 to 2015. Patients were divided into 2 cohorts based on discharge to home vs non-home facilities. Unadjusted baseline patient characteristics were compared using Pearson\u27s chi-square test, and a propensity score-adjusted comparison was also performed. Overall, 9058 patients were included. Of these, 7996 (88.3%) were discharged to home and 1062 (11.7%) were discharged to a non-home facility. On propensity-adjusted analysis, complications determined to be statistically significantly associated with non-home discharge included cardiac (odds ratio, 4.19; 95% confidence interval, 1.75-10.04; P=.001), respiratory (odds ratio, 2.63; 95% confidence interval, 1.47-4.70; P=.001), urinary tract infection (odds ratio, 2.66; 95% confidence interval, 1.52-4.67; P=.001), and death (odds ratio, 7.51; 95% confidence interval, 2.42-23.27;

Increased Shoulder Arthroscopy Time Is Associated With Overnight Hospital Stay and Surgical Site Infection.

PURPOSE: The purpose of this study was to characterize the rates of short-term postoperative complications, readmissions, and overnight hospital stays as a function of shoulder arthroscopy procedure time. A secondary aim of this current study was to identify baseline patient risk factors for adverse outcomes. METHODS: This study used the American College of Surgeons National Surgical Quality Improvement Program registry from 2012 to 2015. Shoulder arthroscopy cases were categorized based on operative time, either \u3c45 \u3eminutes, between 45 and 90 minutes, or \u3e90 minutes. The rates of 30-day postoperative complications, readmissions, and overnight hospital stays were compared with bivariate and multivariate analysis. RESULTS: In total, 33,095 shoulder arthroscopy procedures were identified. Of these, 7,027 (21.2%) were \u3c45 \u3eminutes, 16,610 (50.2%) were between 45 and 90 minutes, and 9,458 (28.6%) were \u3e90 minutes. Multivariate analysis identified increased the risk of superficial surgical site infections (SSIs) for procedures lasting between 45 and 90 minutes (odds ratio [OR] = 3.63; P = .036) and for procedures \u3e90 minutes (OR = 4.40; P = .019), compared with proceduresFurthermore, there was an increased risk of overnight hospital stay for patients who had a shoulder arthroscopy lasting between 45 and 90 minutes (OR = 1.33) and \u3e90 minutes (OR = 2.14), compared with procedures30 kg/m CONCLUSIONS: Increased shoulder arthroscopy procedure time is associated with adverse short-term outcomes, particularly superficial SSI and overnight hospital stay. This information may be useful for patient counseling and postoperative risk stratification, as operative time is an easily measured surrogate for surgical complexity or difficulty. LEVEL OF EVIDENCE: Retrospective cohort study, Level III