rishi patel

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Dermatology Online Journal, 2011

Progressive pigmentary purpura (we will call it PPP) is a group of similar conditions (Schamberg'... more Progressive pigmentary purpura (we will call it PPP) is a group of similar conditions (Schamberg's disease, Lichenoid dermatitis of Gourgerot-Blum, purpura annularis telangiectodes of Majocchi and Lichen aureus). Schamberg's type is the most common, but many experts believe that dividing them into subgroups is artificial. PPP results in a rusty brown skin discoloration. The brownish patches are unevenly scattered on both sides and may be few or many. Within the patches are tiny red dots that look as if someone lightly sprinkled cayenne pepper on the area. The area is flat, smooth and not scaly. There are no internal symptoms or effects. PPP usually starts in adult life, is more common in men and may occur in children rarely. In its most common form it first appears on the lower legs, then will often spread slowly up the legs eventually often going a little on the body and even the palms (hence the name progressive). PPP really is a group of conditions, and the actually experience of any one patient is unique. PPP usually is only a cosmetic problem, but some people has severe itching, PPP can go away on its own within a few weeks, persist for years, or disappear only to recur again from time to time. No one knows what causes it, but if a biopsy is done, inflammation is seen around the tiny capillaries in the skin. The blood leaking through the damaged walls forms the little red dots. The iron from the blood "rusts" (turns into hemosiderin) giving the distinct color. A biopsy may be done to confirm the diagnosis. Occasionally PPP is caused by a reaction to a prescription drug, allergy to clothing dye and rubber, food preservatives and artificial coloring agents, or another skin disease. When it is limited to a few small patches, it may be due to an abnormal veins or arteries underneath. This may need support stockings or surgery to clear it up. Treatment is not always needed. Itching can usually be controlled with prescription steroid creams. In some cases, especially if fairly potent steroids are used, they may actually clear the PPP completely. More extensive cases can be treated with oral Trental (pentoxifylline). This takes several months, and does not always work. Trental improves circulation, and aside from rare stomach upset, it is a very safe medication. Vitamins have been said to help also (Vitamin C 500mg twice daily and Bioflavonoid Complex with Rutin).

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Erythrodermic lichen planus

Dermatology Online Journal, 2011

Lichen planus (LP) is a relatively common papulosquamous disorder that is characterized by prurit... more Lichen planus (LP) is a relatively common papulosquamous disorder that is characterized by pruritic, polygonal papules in a characteristic distribution. We present a case of a 71-year-old man with erythroderma, who was ultimately diagnosed with severe, generalized LP. Treatment of severe LP is challenging, and there are few, robust, clinical trials in the literature to guide the selection of appropriate treatment. We discuss the treatment options for generalized LP and the evidence in support of these agents.

Keratitis-ichthyosis-deafness (KID) syndrome

Dermatology Online Journal, 2009

A 21-year-old man presented with a life-long history of diffusely thickened skin with a grainy-to... more A 21-year-old man presented with a life-long history of diffusely thickened skin with a grainy-to-ridged surface, verrucous perioral plaques with radial fissures, and diffuse palmoplantar keratoderma with a stippled appearance. These skin findings were accompanied by sensorineural hearing loss and keratoconjunctivitis, a clinical triad diagnostic of keratitis-ichthyosis-deafness (KID) syndrome. The patient also had a history of recurrent infections and cysts on the scalp. This report draws attention to inflammatory nodules (representing ruptured folliculitis), cysts, and recurrent infections on the scalp as manifestations of KID syndrome and reviews the increasingly recognized risk of follicular tumors and squamous-cell carcinomas in patients with this conditions.

A deep neural network to search for new long-lived particles decaying to jets

Machine Learning: Science and Technology, 2020

A tagging algorithm to identify jets that are significantly displaced from the proton-proton (pp)... more A tagging algorithm to identify jets that are significantly displaced from the proton-proton (pp) collision region in the CMS detector at the LHC is presented. Displaced jets can arise from the decays of long-lived particles (LLPs), which are predicted by several theoretical extensions of the standard model. The tagger is a multiclass classifier based on a deep neural network, which is parameterised according to the proper decay length cτ 0 of the LLP. A novel scheme is defined to reliably label jets from LLP decays for supervised learning. Samples of pp collision data, recorded by the CMS detector at a centre-of-mass energy of 13 TeV, and simulated events are used to train the neural network. Domain adaptation by backward propagation is performed to improve the simulation modelling of the jet class probability distributions observed in pp collision data. The potential performance of the tagger is demonstrated with a search for long-lived gluinos, a manifestation of split supersymmetric models. The tagger provides a rejection factor of 10 000 for jets from standard model processes, while maintaining an LLP jet tagging efficiency of 30%-80% for gluinos with 1 mm≤cτ 0 ≤ 10 m. The expected coverage of the parameter space for split supersymmetry is presented.

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Recurrent localized primary cutaneous marginal-zone B-cell lymphoma

Dermatology Online Journal, 2011

A 36-year-old man with a prior diagnosis of primary cutaneous marginal-zone B cell lymphoma prese... more A 36-year-old man with a prior diagnosis of primary cutaneous marginal-zone B cell lymphoma presented with newly-developed, small, erythematous papules and nodules on his upper left arm and pink-to-skin-colored, clustered papules on his left forearm. A biopsy specimen and immunohistochemical analysis of the left arm lesions showed a lymphocytic infiltrate which stained positively for CD20 and Bcl-2 and negatively for CD10. A PET-CT scan was negative for any extra-cutaneous manifestations of disease. These clinicopathologic findings are indicative of recurrent localized primary cutaneous marginal-zone B cell lymphoma.

Multiple human papillomavirus-16 associated digital squamous-cell carcinomas in an immunocompetent woman with prior human papillomavirus-related genital carcinoma

Dermatology Online Journal, 2011

High-risk subtype human papillomavirus (HPV) infection, which is known to contribute to the oncog... more High-risk subtype human papillomavirus (HPV) infection, which is known to contribute to the oncogenesis of anogenital squamous-cell carcinoma (SCC), is detected in the majority of digital SCCs. Evidence suggests a genital-digital route of transmission of high-risk HPV, and most HPV-related digital SCCs occur near the nail unit in immunocompetent adults. As early HPV-related SCC commonly appears as a verrucous periungual papule, a biopsy should be considered if such a lesion persists or occurs in an individual who is likely to inoculate their digits with high-risk HPV from digital-genital contact with themselves or sexual partners. We present a 60-year-old woman, who has a personal history of vulvar and cervical SCC and an appreciable disease burden from SCCs that involved five digits of her hands.

Acquired plate-like osteoma cutis

Dermatology Online Journal, 2011

Plate-like osteoma cutis is a rare disorder that has been historically classified as a congenital... more Plate-like osteoma cutis is a rare disorder that has been historically classified as a congenital syndrome. It has a possible relationship to a mutation in the gene (GNAS1) that encodes the α-subunit of the stimulatory G protein, which regulates adenyl cyclase activity. We report a case of extensive plaque-like masses on the scalp and face with no abnormalities in calcium or phosphate metabolism and no preceding inflammatory cutaneous conditions. With less than ten reported cases, to our knowledge, this is one the few cases of acquired plate-like osteoma cutis described in the literature.

Mycosis fungoides stage IB progressing to cutaneous tumors

Dermatology Online Journal, 2011

A 44-year-old African American woman presented with well-demarcated, pruritic and intermittently ... more A 44-year-old African American woman presented with well-demarcated, pruritic and intermittently painful plaques and subsequently a diagnosis of mycosis fungoides stage IB was made. Six months after diagnosis, cutaneous tumors developed despite treatment with narrow-band ultraviolet B phototherapy. The patient failed low-dose methotrexate treatment and is now slowly improving on combination therapy with subcutaneous interferon alfa and oral bexarotene. This patient demonstrates the progression of patch/plaque stage disease to cutaneous tumors. Her case highlights the use of interferon and combination therapies in more advanced mycosis fungoides and demonstrates potential difficulties encountered in treating skin of color.

Erythroderma of unknown etiology

Dermatology Online Journal, 2011

We present a 46-year-old man with a greater than 15-year history of erythroderma. A definitive di... more

Benchmarking the cost-effectiveness of interventions delaying diabetes: a simulation study based on NAVIGATOR data

Objective: To estimate using the United Kingdom Prospective Diabetes Study Outcomes Model Version... more Objective: To estimate using the United Kingdom Prospective Diabetes Study Outcomes Model Version 2 (UKPDS-OM2) the impact of delaying type 2 diabetes onset on costs and quality-adjusted life expectancy using trial participants who developed diabetes in the NAVIGATOR study. Research design and methods: We simulated the impact of delaying diabetes onset by one to nine years, utilising data from the 3058 of 9306 NAVIGATOR trial participants who developed type 2 diabetes. Costs and utility weights associated with diabetes and diabetes-related complications were obtained for US and UK settings, with costs expressed in 2017 values. We estimated discounted lifetime costs and quality-adjusted life years (QALYs) with 95% confidence intervals. Results: Gains in QALYs increased from 0.02 (95% CI: 0.01, 0.03; US setting) to 0.15 (95% CI: 0.11, 0.20; US setting) as the imposed time to diabetes onset was increased from one to nine years, respectively. Savings in complication costs increased from...

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Combination of CMS searches for heavy resonances decaying to pairs of bosons or leptons

Physics Letters B, 2019

A statistical combination of searches for heavy resonances decaying to pairs of bosons or leptons... more A statistical combination of searches for heavy resonances decaying to pairs of bosons or leptons is presented. The data correspond to an integrated luminosity of 35.9 fb -1 collected during 2016 by the CMS experiment at the LHC in proton-proton collisions at a center-of-mass energy of 13 TeV. The data are found to be consistent with expectations from the standard model background. Exclusion limits are set in the context of models of spin-1 heavy vector triplets and of spin-2 bulk gravitons. For massdegenerate W and Z resonances that predominantly couple to the standard model gauge bosons, the mass exclusion at 95% confidence level of heavy vector bosons is extended to 4.5 TeV as compared to 3.8 TeV determined from the best individual channel. This excluded mass increases to 5.0 TeV if the resonances couple predominantly to fermions.

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$Research paper thumbnail of Measurement of the Splitting Function in pp and Pb-Pb Collisions at sqrt[s_{NN}]=5.02 TeV$

Measurement of the Splitting Function in pp and Pb-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

Physical review letters, Jan 6, 2018

Data from heavy ion collisions suggest that the evolution of a parton shower is modified by inter... more Data from heavy ion collisions suggest that the evolution of a parton shower is modified by interactions with the color charges in the dense partonic medium created in these collisions, but it is not known where in the shower evolution the modifications occur. The momentum ratio of the two leading partons, resolved as subjets, provides information about the parton shower evolution. This substructure observable, known as the splitting function, reflects the process of a parton splitting into two other partons and has been measured for jets with transverse momentum between 140 and 500 GeV, in pp and PbPb collisions at a center-of-mass energy of 5.02 TeV per nucleon pair. In central PbPb collisions, the splitting function indicates a more unbalanced momentum ratio, compared to peripheral PbPb and pp collisions.. The measurements are compared to various predictions from event generators and analytical calculations.

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Search for a W' boson decaying to a bottom quark and a top quark in pp collisions at s=7TeV

Physics Letters B, 2013

Results are presented from a search for a W boson using a dataset corresponding to 5.0 fb -1 of i... more Results are presented from a search for a W boson using a dataset corresponding to 5.0 fb -1 of integrated luminosity collected during 2011 by the CMS experiment at the LHC in pp collisions at √ s = 7 TeV. The W boson is modeled as a heavy W boson, but different scenarios for the couplings to fermions are considered, involving both lefthanded and right-handed chiral projections of the fermions, as well as an arbitrary mixture of the two. The search is performed in the decay channel W → tb, leading to a final state signature with a single electron or muon, missing transverse energy, and jets, at least one of which is identified as a b-jet. A W boson that couples to the right-handed (left-handed) chiral projections of the fermions with the same coupling constants as the W is excluded for masses below 1.85 (1.51) TeV at the 95% confidence level. For the first time using LHC data, constraints on the W gauge couplings for a set of left-and right-handed coupling combinations have been placed. These results represent a significant improvement over previously published limits.

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Serratia marcescens folliculitis and concomitant acne vulgaris

Dermatology online journal, Jan 15, 2012

We present a unique case of S. marcescens folliculitis of the trunk in a 46-year-old woman with a... more We present a unique case of S. marcescens folliculitis of the trunk in a 46-year-old woman with a history of facial acne vulgaris during her teen years. Her eruption occurred at the time of elective ambulatory surgery when she was treated with pre and post-operative antibiotics. The diagnosis of S. marcescens folliculitis was made on the basis of histopathologic features and tissue culture of a skin biopsy specimen of a pustule after her eruption was unresponsive to conventional treatment for inflammatory acne vulgaris. The history and pathophysiology of gram-negative folliculitis in the setting of acne vulgaris is reviewed.

$Research paper thumbnail of Suppression of non-prompt J/ψ, prompt J/ψ, and $ \Upsilon $(1S) in PbPb collisions at $ \sqrt {{{s_{\text{NN}}}}} = 2.76 $ TeV$

Suppression of non-prompt J/ψ, prompt J/ψ, and $ \Upsilon $(1S) in PbPb collisions at $ \sqrt {{{s_{\text{NN}}}}} = 2.76 $ TeV

Journal of High Energy Physics, 2012

Yields of prompt and non-prompt J/ψ, as well as $ \Upsilon $ (1S) mesons, are measured by the CMS... more

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Search for Pair Production of First-Generation Scalar Leptoquarks inppCollisions ats=7 TeV

Physical Review Letters, 2011

A search for pair production of first-generation scalar leptoquarks is performed in the final sta... more A search for pair production of first-generation scalar leptoquarks is performed in the final state containing two electrons and two jets using proton-proton collision data at √s = 7 TeV. The data sample used corresponds to an integrated luminosity of 33 pb⁻¹ collected with the CMS detector at the CERN LHC. The number of observed events is in good agreement with the predictions for the standard model background processes, and an upper limit is set on the leptoquark pair production cross section times β² as a function of the leptoquark mass, where β is the branching fraction of the leptoquark decay to an electron and a quark. A 95% confidence level lower limit is set on the mass of a first-generation scalar leptoquark at 384 GeV for β = 1, which is the most stringent direct limit to date.

Measurement of Dijet Angular Distributions and Search for Quark Compositeness

Physical Review Letters, 1998

We have measured the dijet angular distribution in p s 1.8 TeV p p collisions using the D0 detect... more

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Measurement of inclusive jet and dijet cross sections in proton-proton collisions at 7 TeV centre-of-mass energy with the ATLAS detector

The European Physical Journal C, 2011

Jet cross sections have been measured for the first time in proton-proton collisions at a centre-... more Jet cross sections have been measured for the first time in proton-proton collisions at a centre-of-mass energy of 7 TeV using the ATLAS detector. The measurement uses an integrated luminosity of 17 nb -1 recorded at the Large Hadron Collider. The anti-k t algorithm is used to identify jets, with two jet resolution parameters, R = 0.4 and 0.6. The dominant uncertainty comes from the jet energy scale, which is determined to within 7% for central jets above 60 GeV transverse momentum. Inclusive single-jet differential cross sections are presented as functions of jet transverse momentum and rapidity. Dijet cross sections are presented as functions of dijet mass and the angular variable χ. The results are compared to expectations based on next-toleading-order QCD, which agree with the data, providing a validation of the theory in a new kinematic regime.

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Graphitic structure formation in ion implanted polyetheretherketone

Applied Surface Science, 2013

ABSTRACT Ion implantation is a technique that is used to change the electrical, optical, hardness... more ABSTRACT Ion implantation is a technique that is used to change the electrical, optical, hardness and biocompatibility of a wide range of inorganic materials. This technique also imparts similar changes to organic or polymer based materials. With polymers, ion implantation can produce a carbon enriched volume. Knowledge as to the nature of this enrichment and its relative concentration is necessary to produce accurate models of the physical properties of the modified material. One technique that can achieve this is X-ray photoelectron spectroscopy. In this study the formation of graphite like structures in the near surface of polyetheretherketone by ion implantation has been elucidated from detailed analysis of the C 1s and valence band peak structures generated by X-ray photoelectron spectroscopy. Further evidence is given by both Rutherford backscatter spectroscopy and elastic recoil detection.

Thyroid lobectomy for indeterminate FNA: not without consequences

Journal of Surgical Research, 2013

Thyroid nodules are exceedingly common, and the cytologic interpretation of fine needle aspiratio... more Thyroid nodules are exceedingly common, and the cytologic interpretation of fine needle aspiration (FNA) findings has been the reference standard for diagnosing nodules as benign, atypia or a follicular lesion of undetermined significance, suspicious for follicular or Hürthle cell neoplasm, suspicious for malignancy, or malignant. Many patients undergo thyroid lobectomy for indeterminate FNA findings (atypia or a follicular lesion of undetermined significance or suspicious for follicular or Hürthle cell neoplasm), although the risk of malignancy is low. The general data have quoted a 20% risk of hypothyroidism after lobectomy. The purpose of the present study was to determine the risk of hypothyroidism after lobectomy in our diverse population. The pathology records from a large county hospital were reviewed to identify patients with indeterminate FNA findings. The incidence of hypothyroidism was determined by the need for thyroid hormone replacement therapy. Categorical variables were compared using the chi-square and continuous variables using the Mann-Whitney U test. A total of 655 FNAs were performed during the study period, and 60 resulted in indeterminate cases. Of these 60 patients, 17 subsequently underwent diagnostic lobectomy. The mean age was 52.8 ± 16.5 years, 88% were women, and 67% were Hispanic and 22% were African American. Only 6% had a final diagnosis of cancer, and eight patients (47%) became hypothyroid postoperatively. The incidence of hypothyroidism after diagnostic thyroid lobectomy in our patient population was much higher than previously reported. It is necessary to preoperatively counsel patients about this increased risk, in addition to the usual risks of nerve palsy and bleeding, with thyroid lobectomy. As testing of thyroid nodules evolves, the expense of preoperative testing should be weighed against the increased incidence for lifelong thyroid hormone replacement.

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