Tumor necrosis factor inhibitors in psoriatic arthritis.

INTRODUCTION: Psoriatic arthritis (PsA) is a chronic inflammatory disease that can result in significant disability. With the emergence of tumor necrosis factor inhibitors (TNFi), therapeutic outcomes in PsA have improved substantially. The clinical efficacy and the inhibition of radiographic progression demonstrated by TNFi have transformed the management of PsA. However, there is still an unmet need for a subset of patients who do not respond adequately to TNFi. Areas covered: This review provides an overview of the pharmacokinetics of TNFi, the efficacy of TNFi in PsA, and the role of immunogenicity of TNFi in the treatment of PsA. In addition, we address the use of TNFi in the setting of other medications utilized in the treatment of PsA and the potential future role of biosimilars. Expert commentary: Monoclonal antibodies exhibit complex and widely variable pharmacokinetics. The study of factors that can affect the pharmacokinetics, such as immunogenicity, is valuable to further define and understand the use of TNFi in PsA, especially in the subset of patients who do not respond adequately to these agents or lose effectiveness over time

Comparison of Clustering Techniques: PAM and SSM-PAM: Experiments and Test cases

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Clustering and Bootstrapping Based Framework for News Knowledge Base Completion

Extracting the facts, namely entities and relations, from unstructured sources is an essential step in any knowledge base construction. At the same time, it is also necessary to ensure the completeness of the knowledge base by incrementally extracting the new facts from various sources. To date, the knowledge base completion is studied as a problem of knowledge refinement where the missing facts are inferred by reasoning about the information already present in the knowledge base. However, facts missed while extracting the information from multilingual sources are ignored. Hence, this work proposed a generic framework for knowledge base completion to enrich a knowledge base of crime-related facts extracted from online news articles in the English language, with the facts extracted from low resourced Indian language Hindi news articles. Using the framework, information from any low-resourced language news articles can be extracted without using language-specific tools like POS tags and using an appropriate machine translation tool. To achieve this, a clustering algorithm is proposed, which explores the redundancy among the bilingual collection of news articles by representing the clusters with knowledge base facts unlike the existing Bag of Words representation. From each cluster, the facts extracted from English language articles are bootstrapped to extract the facts from comparable Hindi language articles. This way of bootstrapping within the cluster helps to identify the sentences from a low-resourced language that are enriched with new information related to the facts extracted from a high-resourced language like English. The empirical result shows that the proposed clustering algorithm produced more accurate and high-quality clusters for monolingual and cross-lingual facts, respectively. Experiments also proved that the proposed framework achieves a high recall rate in extracting the new facts from Hindi news articles

Flow Shop Scheduling Problem in Neutrosophic Environment Using Trapezoidal Fuzzy Numbers

In this paper, we propose to solve the flow shop scheduling problem using Branch and Bound method. This paper presents an algorithm with the help of branch and bound approach for a flow shop scheduling problems consisting of 4 jobs and 4 machines in which the processing time as Neutrosophic trapezoidal fuzzy numbers which are further converted in to crisp value using graded mean ranking method. Numerical example is given to illustrate the study of solving flow shop scheduling under Neutrosophic trapezoidal fuzzy number using branch and bound technique

Axisymmetric magneto-hydrodynamic (MHD) flow and heat transfer at a non-isothermal stretching cylinder

An investigation is made to study the effects of transverse curvature and the temperature dependent thermal conductivity on the magneto-hydrodynamic (MHD) axisymmetric flow and heat transfer characteristics of a viscous incompressible fluid induced by a non-isothermal stretching cylinder in the presence of internal heat generation/absorption. It is assumed that the cylinder is stretched in the axial direction with a linear velocity and the surface temperature of the cylinder is subjected to vary non-isothermally. Here the thermal conductivity is assumed to vary linearly with temperature. Using a similarity transformation, the governing system of partial differential equations is first transformed into coupled non-linear ordinary differential equations with variable coefficients. The resulting intricate non-linear boundary value problem is solved numerically by a second order finite difference scheme for different values of the pertinent parameters for two cases: (i) the prescribed surface temperature (PST case) and (ii) the prescribed heat flux (PHF case). Numerical results are obtained for two different cases namely, zero and non-zero values of the curvature parameter to get the effects on the velocity and temperature fields. The combined effects of the curvature parameter and the thermal conductivity parameter are examined. The physical significances of the numerical results are presented for several limiting cases. © 2012 Elsevier Inc. All rights reserved

An M/G/1 Queue with Server Breakdown and Multiple Working Vavation

This paper deals with the steady state behavior of an M=G=1 multiple working vacation queue with server breakdown. The server works with different service times rather than completely stopping service during a vacation. Both service times in a vacation period and in a regular service period are assumed to be generally distributed random variables. The system may breakdown at random and repair time is arbitrary. Further, just after completion of a customer’s service the server may take a multiple working vacation. Supplementary variable technique is employed to find the probability generating function for the number of customers in the system. The mean number of customers in the system is calculated. Some particular cases of interest are discussed. Numerical results are also presented

An M/G/1 Retrial Queue with Single Working Vacation

We consider an M=G=1 retrial queue with general retrial times and single working vacation. During the working vacation period, customers can be served at a lower rate. Both service times in a vacation period and in a service period are generally distributed random variables. Using supplementary variable method we obtain the probability generating function for the number of customers and the average number of customers in the orbit. Furthermore, we carry out the waiting time distribution and some special cases of interest are discussed. Finally, some numerical results are presented

Deep neck space infections: comparison of outcomes between diabetic and non-diabetic patients

Background: The objective of the study was to study the clinical presentation, microbiological profile, treatment protocol of deep neck space infections in diabetics and non diabetics.Methods: This was a prospective study conducted on 76 patients (diabetics and non diabetics) admitted in the Department of Otorhinolaryngology, TD Medical college, Alappuzha over a period of 18 months from January 2012 to June 2013.Results: The age distribution was 15-75 years. Male to female ratio was 2:1. Fever, pain, neck swelling and odynophagia were the common symptoms with dyspnoea and chest pain indicative of complications. The most common etiology was odontogenic (68.4%) followed by tonsillopharyngeal infection and foreign bodies. No etiological factor was found in 34.2%. The commonest site was submandibular space (64.2%) followed by parapharyngeal space (26.6%). Abscess was present in majority needing surgical drainage. The most common organism isolated was streptococcus viridans (37.5%). Preponderance of klebsiella species was noted in diabetics. Streptococcus showed susceptibility to pencillin (83.33%), ampicillin (92%), cefotaxime (60.526%). Klebsiella showed susceptibility to gentamicin (42.3%) and ciprofloxacin (28.57%). The complication rate was more in diabetics (34.21%). Contrast enhanced CT was done in cases suspected to have complication. The mean hospital stay was longer in diabetics (19.6 days) than non diabetics (6.4 days).Conclusions: Deep neck space infection still remains life threatening if not heeded promptly. Senescence and diabetes demand surgical intervention and meticulous glycemic control to prevent complications. Judicious use of antimicrobials and timely radiological and surgical interventions have come a long way in the management and in providing a cure to this dreaded condition

A Study on Clinico-Epidemiological Profile of Snake Bite in Children in a Tertiary Care Hospital, South India

OBJECTIVE : A high incidence of snake bite envenomation has been reported in rural India. This study was conducted to assess the clinico epidemiological profile of snake bite cases admitted in a tertiary care hospital in south India. MATERIALS AND METHODS : This is a descriptive type of study included snake bite cases in paediatric age group and conducted for a period of one year from July 2015 to June 2016. Data about age, sex, clinical manifestations, complications and outcome were collected and analysed. FINDINGS : The study included 54 cases of snake bite victims. The majority were boys (64.8 %). The common age group affected was 5-12 years. Lower extremities were the most common site of bite (85.2 %). Most common identified species were viper (20.4 %). The most common symptoms were cellulitis (22 %). Krait bite manifested as neurotoxic required ventilatory support. Most common non poisonous snake is rattle snake. Reactions to antisnake venom was observed in 18.5% cases. The case fatality rate was 11.1%. CONCLUSION : Snake bite remains a major public health problem. Knowledge must be imparted regarding prevention of snake bites, appropriate first aid, importance of effective treatment. Considering the magnitude of this problem a national programme for this issue is needed