Amyloidosis cutis dyschromica in two female siblings: cases report

<p>Abstract</p> <p>Background</p> <p>Cutaneous amyloidosis has been classified into primary cutaneous amyloidosis (PCA, OMIM #105250), secondary cutaneous amyloidosis and systemic cutaneous amyloidosis. PCA is the deposition of amyloid in previously apparent normal skin without systemic involvement. Amyloidosis cutis dyschromica (ACD) is a rare distinct type of PCA. Here, the unique clinical and histological findings of two Chinese female siblings with ACD were described.</p> <p>Cases presentations</p> <p>Patient 1 was a 34-year-old female, presented with mildly pruritic, diffuse mottled hyperpigmentation and hypopigmentation. The lesions involved all over the body since she was 10 years old. There were a few itchy blisters appearing on her arms, lower legs and truck, especially on the sun-exposed areas in summer. Some hypopigmented macules presented with slight atrophy. Patient 2 was 39-year-old, the elder sister of patient 1. She had similar skin lesions since the same age as the former. The atrophy and blisters on the skin of the patient with amyloidosis cutis dyschromica have not been described in previous literature. Histological examinations of the skin biopsies taken from both patients revealed amyloid deposits in the whole papillary dermis. Depending on the histological assessment, the two cases were diagnosed as amyloidosis cutis dyschromica.</p> <p>Conclusion</p> <p>The two cases suggest that the atrophy and blisters may be the uncommon manifestations of amyloidosis cutis dyschromica. It alerts clinicians to consider the possibility of ACD when meeting patients with cutaneous dyschromia. Skin biopsy is essential and family consultation of genetic investigation is very important in such cases.</p

Neural Models for Personalized Recommendation Systems with External Information

Personalized recommendation systems use the data generated by user-item interactions (for example, in the form of ratings) to predict different users interests in available items and recommend a set of items or products to the users. The sparsity of data, cold start, and scalability are some of the important challenges faced by the developers of recommendation systems. These problems are alleviated by using external information, which can be in the form of a social network or a heterogeneous information network, or cross-domain knowledge. This thesis develops novel neural network models for designing personalized recommendation systems using the available external information. The first part of the thesis studies the top-N item recommendation setting where the external information is available in the form of a social network or heterogeneous information network. Unlike a simple recommendation setting, capturing complex relationships amongst entities (users, items, and connected objects) becomes essential when a social and heterogeneous information network is available. In a social network, all socially connected users do not have equal influence on each other. Further, estimating the quantum of influence among entities in a user-item interaction network is important when only implicit ratings are available. We address these challenges by proposing a novel neural network model, SoRecGAT, which employs a multi-head and multi-layer graph attention mechanism. The attention mechanism helps the model learn the influence of entities on each other more accurately. Further, we exploit heterogeneous information networks (HIN) to gather multiple views for the items. A novel neural network model -- GAMMA (Graph and Multi-view Memory Attention mechanism) is proposed to extract relevant information from HINs. The proposed model is an end-to-end model which eliminates the need for learning a similarity matrix offline using some manually selected meta-paths before optimizing the desired objective function. In the second part of the thesis, we focus on top-N bundle recommendation and list continuation setting. Bundle recommendation is the task of recommending a group of products instead of individual products to users. We study two interesting challenges -- (1) how to personalize and recommend existing bundles to users and (2) how to generate personalized novel bundles targeting specific users. We propose GRAM-SMOT -- a graph attention-based framework that considers higher-order relationships among the users, items, and bundles and the relative influence of items present in the bundles. For efficiently learning the embeddings of the entities, we define a loss function based on the metric-learning approach. A strategy that leverages submodular optimization ideas is used to generate novel bundles. We also study the problem of top-N personalized list continuation where the task is to curate the next items to user-generated lists (ordered sequence of items) in a personalized way by using the sequential information of the items in the list. The main challenge in this task is understanding the ternary relationships among the users, items, and lists. We propose HyperTeNet -- a self-attention hypergraph and Transformer-based neural network architecture for the personalized list continuation task. Here, graph convolutions are used to learn the multi-hop relationship among entities of the same type. A self-attention-based hypergraph neural network is proposed to learn the ternary relationships among the interacting entities via hyperlink prediction in a 3-uniform hypergraph. Further, the entity embeddings are shared with a Transformer-based architecture and are learned through an alternating optimization procedure. The final part of the thesis focuses on the personalized rating prediction setting where external information is available in the form of cross-domain knowledge. We propose an end-to-end neural network model, NeuCDCF, that provides a way to alleviate data sparsity problems by exploiting the information from related domains. NeuCDCF is based on a wide and deep framework and learns the representations jointly using matrix factorization and deep neural networks. We study the challenges involved in handling diversity between domains and learning complex non-linear relationships among entities within and across domains. We conduct extensive experiments in each of these settings using several real-world datasets and demonstrate the efficacy of the proposed models

A Cross Sectional study of Sexually Transmitted Infections among High Risk Groups attending Sexually Transmitted Infections Clinic in a Tertiary Care Hospital

INTODUCTION: Sexually Transmitted Infections (STIs) are combination of infection and syndrome that are epidemiologically heterogeneous and often transmitted sexually. They show various trends in different parts of the country. Men who have Sex with Men (MSM) and female sex workers (FSW) must be screened for HIV and STI. FSW is a person who provides sexual service for money and material. MSM are a diverse and often hard-to-reach group, spanning all age group and socioeconomic backgrounds. MSM in India can be divided into various sub groups: self-identified MSM, behaviorally MSM with no identity and Bisexual men. STIs commonly diagnosed are Herpes Simplex Virus (HSV) infection, genital warts, balanoposthitis, syphilis, molluscum contagiosum, gonorrhoea occasionally chancroid, lymphogranuloma venereum and donovanosis. AIM OF THE STUDY: 1. To assess and provide clinical and epidemiological data of STIs among high risk groups attending STI OPD. 2. To study the Age wise distribution of STIs in high risk groups. 3. To study the sexual behaviour pattern and mode of sex among high risk groups. 4. To study the prevalence of HIV infection in high risk. MATERIALS AND METHODS: The study included 460 high risk patients who attended STI OPD from 1st January 2018 to 30th June 2019 in Tirunelveli medical college. The diagnosis of various types of STI’s were made clinically and confirmed by relevant investigations. HIV screening, HBsAg, Anti- HCV were carried out in all patients. Other investigations like Tzanck smear, KOH mount, wet mount, gram staining, Rapid Plasma Reagin tests (if positive TPHA will be done for confirmation), pus culture and sensitivity were done. CONCLUSION: High risk groups are the ― bridging population for transmission of STIs and HIV. ◈ The prevalence of STIs is seen commonly in 2nd to 4th decade of age, hence they are main target population to be focused in order to prevent STI/HIV. ◈ Men are most commonly indulged in high risk sexual practice than female so, they need to be screened regularly. ◈ The population with EMC/PMC sexual behaviour had more STI’s than MSM and most of them had unprotected intercourse. ◈ Increased prevalence is seen among married high-risk groups with unknown paid partners. ◈ Increased prevalence of STIs are seen in high risk groups with unprotected sex. ◈ Most common mode of sex in high risk groups with STI’s was vaginal route among heterosexual and ororeceptive among MSM. ◈ Most common examination findings among high risk groups was painful ulcer, fissure, and papules over genitals. ◈ Viral STIs are on the rise when compared to the bacterial infections among high risk groups. Among viral STIs HIV, Herpes genitalis and Warts is the commonest, and among bacterial infections, Latent Syphilis is the common infection and it shows increase in trend of syphilis among high risk groups. Hence consistent screening with RPR and ELISA for HIV is a must in high risk groups. ◈ Among 101 HIV reactive individual 31 persons were co-infected with other STIs. ◈ Sex education is essential for high risk groups as earlier the age of sexual activity. ◈ Discourse the stigma among FSW and TGs to increase the health care awareness among them. ◈ Partner identification treatment needs to be initiated. ◈ Vaccination for Hepatitis B should be advised. ◈ Counselling for consistent use of condom should be done especially when contact with unknown partners and during anal sex. ◈ Promoting awareness about HIV-AIDS transmission & its prevention may alert them to use condom properly during each sexual act. ◈ STIs management in high risk groups requires the expert clinician to be conversant with risk valuation, the clinical presentation, and current diagnosis of certain diseases, and to be familiar with new medications. Successful STI care can be achieved because many infections are easily identified and treatable with simple single dose therapy. ◈ The current challenges lie in effective risk reduction and enhancing preventive care in a cost-effective way. Newer diagnostic studies will offer visions into the etiology of several clinical syndromes, but the basis of care will always rely on listening and talking to patients. ◈ More work is required to govern how to help high risk group minimize sexual risk, address their mental health concerns, and engage them in disease free lives. ◈ Regular monitoring of programs and research are necessary for further success of prevention and control of HIV in this HRG