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The development of sensitive and low-cost techniques for identifying valve dysfunction has become inevitable in the context of increasing death due to cardiac diseases. The present work attempts to propose a novel technique for cardiac auscultation based on graph theory. The sixty heart sound signals from normal heart (NMH) and with aortic stenosis (ASH) are subjected to Fast Fourier Transform (FFT) and complex network analyses. The murmur signals, a time-series signal, carry information about the blood flow through the heart, which gets exposed in the graph constructed and its features. The finer details of the murmur signal from the defective aortic valve and the normal aortic valve are reflected as the increased number of frequency components in FFT and as interconnected clusters without uncorrelated nodes in the graph of ASH. The distinction in graph features forms the basis of classification based on machine learning techniques (MLTs). When the unsupervised MLT-principal component analysis gives 86.8% total variance, the supervised MLTs-K nearest neighbor (KNN), support vector machine, and KNN subspace ensemble classifiers give 100%, 95.6%, and 90.9% prediction accuracy, suggesting its potential in remote auscultation in rural health centers. [ABSTRACT FROM AUTHOR]

We report the case of a young man who presented with high-spiking fever, erosive arthritis, and generalized lymphadenopathy. He was diagnosed as adult-onset Still's disease (AOSD), and his clinical course was complicated by reactive macrophage activation syndrome (MAS). The sudden precipitous drop in leukocyte and platelet counts proved a valuable clue to the diagnosis of MAS in the setting of AOSD. The new American College of Rheumatology/European League Against Rheumatism classification criteria for reactive MAS complicating systemic juvenile idiopathic arthritis were applied in this patient. When MAS is associated with AOSD, treatment could be challenging. We managed this patient successfully with a combination of systemic corticosteroids and cyclosporine in the acute phase.

Carcinomatous Polyarthritis (CP) is defined as the development of arthritis in association with a malignancy but distinct from that associated with metastasis or direct invasion. It can occur before, with, or after onset of malignancy or with treatment. CP usually affects large joints and is negative for Anti Citrullinated Protein Antibodies (ACPA). CP is rarely if ever considered in the differential diagnosis of a case of symmetric polyarthritis with ACPA positivity. Presence of autoimmune disease related antibodies further obscures the diagnosis. We present a case of a young lady with symmetrical inflammatory polyarthritis with positive ACPA who was found to have haematological malignancy. This is one of the very few cases of CP of small joints with ACPA positivity reported worldwide and highlights the need to be vigilant for red flags while evaluating any case presenting with rheumatologic symptoms.