ANALYSIS OF PSYCHO-SOCIAL RISK FACTORS IN PATIENTS WITH RECENT ACUTE CORONARY SYNDROME: A CASE-CONTROL STUDY

ABSTRACTObjective: Although psycho-social factors are reported to be independently associated with myocardial ischemia in many studies, the majority ofthese were done in the western population. This was conducted in India to determine the impact of psycho-social factors in subjects with the recentacute coronary syndrome (ACS).Methods: Patients with the first episode of ACS within 4 weeks of onset at LPS Institute of Cardiology, Kanpur, India between 2013 and 2015 wereenrolled as cases. Control was community-based individuals without coronary artery disease. Both were compared for demographic variables,the psycho-social profile including annual income, education status, depression, stressful life events (using presumptive stressful life events scale,i.e. PSLES), and independent predictors were determined using multiple logistic regression analysis and were computed as odds ratio (OR).Results: Between 200 cases and 200 controls, respectively, statistically significant difference was observed in mean annual income (2.74±1.95 vs.2.23±1.22 lac rupees; p<0.05), smoking exposure (13.93±16.17 vs. 4.88±3.10 pack years; p<0.05), mean number of stressful life events (8.18±2.57 vs.4.14±1.63; p<0.05). Depression (48% vs. 27%; p<0.05) while education status was comparable. Further, odds of having myocardial infarction werehigher for subjects with mild-to-moderate depression (OR: 2.45), family history of heart disease (OR: 2.25), hypertensive males (OR: 1.43), anddiabetic females (OR: 1.22).Conclusion: Psycho-social factors, particularly depression may have a significant role in the prognosis of ACS. Further systematic studies arewarranted to provide more important insights regarding the magnitude of the association between psycho-social factors and the onset of ACS.Keywords: Coronary artery disease, Depression, Psycho-social factors, Presumptive stressful life events scale, Stressful life events

Learning in Partially Observable Markov Decision processes

Learning in Partially Observable Markov Decision process (POMDP) is motivated by the essential need to address a number of realistic problems. A number of methods exist for learning in POMDPs, but learning with limited amount of information about the model of POMDP remains a highly anticipated feature. Learning with minimal information is desirable in complex systems as methods requiring complete information among decision makers are impractical in complex systems due to increase of problem dimensionality. In this thesis we address the problem of decentralized control of POMDPs with unknown transition probabilities and reward. We suggest learning in POMDP using a tree based approach. States of the POMDP are guessed using this tree. Each node in the tree has an automaton in it and acts as a decentralized decision maker for the POMDP. The start state of POMDP is known as the landmark state. Each automaton in the tree uses a simple learning scheme to update its action choice and requires minimal information. The principal result derived is that, without proper knowledge of transition probabilities and rewards, the automata tree of decision makers will converge to a set of actions that maximizes the long term expected reward per unit time obtained by the system. The analysis is based on learning in sequential stochastic games and properties of ergodic Markov chains. Simulation results are presented to compare the long term rewards of the system under different decision control algorithms

Recurrent hemorrhagic pericardial effusion and tamponade due to filariasis successfully treated with ivermectin and albendazole

Filariasis presenting with pericardial effusion with tamponade is rare. We report a case of a 30-year-old female who was admitted with severe dyspnea and chest pain since 2 days. Echocardiogram showed massive pericardial effusion with tamponade. Pericardial fluid aspiration drained 1.2 L of hemorrhagic fluid. Cytology examination revealed microfilaria of Wuchereria bancrofti. She was treated with diethyl carbamazine and discharged. Six weeks later, she presented again with massive pericardial effusion with cardiac tamponade. Pericardiocentesis was done. Cytology examination revealed microfilaria of W. bancrofti. This time she was treated with ivermectin and albendazole and cured. Hemorrhagic effusion resolved completely. Though relatively uncommon, tropical diseases must always be considered in the etiological diagnosis of recurrent pericardial effusion

Effect of Tillage Practices and Fertility Levels on Growth, Yield Attributes and Yield of Wheat in Rice- Wheat Cropping System

This study was conducted at Agronomy Research Farm, CSAUAT, during rabi 2021-22 and 2022-23. The experiment was laid out into Split plot design with3 replication. Two levels of tillage viz. (1) Conventional tillage Two ploughing followed by sowing), (2) Reduce tillage (one ploughing followed by sowing were randomly allotted to main plot while ten 10 fertility levels. Basis on the pooled data the results of the study revealed that in case of tillage practices among the growth parameters; maximum plant height at 30, 60, 90 DAT and at harvest is 26.25, 46.26, 87.43, and 92.38 cm respectively, number of leaves plant-1 at 30, 60, 90 DAT and at harvest is 5.47, 16.51, 19.34 and 20.18 respectively, leaf area index at 30, 60, 90 DAT and at harvest is 0.553, 3.13, 4.48 and 5.05 respectively, relative growth rate at 30, 60, 90 DAT is 24.33, 14.48 and 3.82 g day-1 respectively, among the yield attributing characters maximum ear length (11.07 cm) , number of grain ear-1 (41.08), grain weight ear-1 (1.54 g) and 1000 grain weight (36.93 g) and among the productivity parameters; maximum grain yield (51.31 q ha-1), straw yield (67.21 q ha-1), biological yield (118.52 q ha-1) and harvest index (43.22 %) were recorded under the conventional tillage. Similarly in case of fertility levels growth parameters, yield attributing characters and productivity parameters were associated with 125 % RDF + chloromequate chloride

Accura balloon tamponade to successfully treat right common iliac vein perforation — an unconventional use

Percutaneous mitral valvotomy is effective alternative for management of patients with symptomatic mitral stenosis in pregnant women. Gravid uterus may compress and distort inferior vena cava. Patients will have their abdomen shielded with lead sheets to limit fetal radiation exposure. We report a case of six month pregnant women with critical mitral stenosis suitable for PMV. During introduction of Mullins sheath into innominate vein, little resistance was encountered. We could not exactly ascertain the cause as abdomen shielded was there. Mullins sheath was reintroduced and procedure was completed. At the end sudden hypotension was detected with patient complaining of right hip pain. Venogram showed contrast extravasations from the right common iliac vein confirming iliac vein disruption. Accura balloon was placed across the perforated segment and inflated twice for 4 mints, sealing the perforation. This case shows that immediate treatment with balloon tamponade can result in a successful outcome

Acute myocardial infarction in very young adults: A clinical presentation, risk factors, hospital outcome index, and their angiographic characteristics in North India - AMIYA Study

BACKGROUND: India is currently in the fourth stage of epidemiological transitions where cardiovascular disease is the leading cause of mortality and morbidity. Purpose of the present study was to assess the risk factors, clinical presentation, angiographic profile including severity, and in-hospital outcome of very young adults (aged &le; 30 years) with first acute myocardial infarction (AMI). METHODS: Total of 1,116 consecutive patients with ST-segment elevation acute myocardial infarction (STEMI) were studied between March 2013 and February 2015 at LPS Institute of Cardiology, Kanpur, Uttar Pradesh, India. RESULTS: Mean age of the patients was 26.3 years. Risk factors were smoking (78.5%), family history of premature coronary artery disease (CAD) (46.8%), obesity (39.1%), physical inactivity (38.7%) and stressful life events (29.6%). The most common symptom and presentation was chest pain and anterior wall MI (AWMI) in 94.8% and 58.8%, respectively. About 80.6% of patients had obstructive CAD with single vessel disease (57.6%), double-vessel disease (12.9%) and left main involvement (3.2%). Left anterior descending (LAD) was commonest culprit artery (58.1%) followed by right coronary artery in 28.2%. In-hospital mortality was 2.8%. Percutaneous coronary intervention was performed in 71.6% of patients. Median number and length of stent were 1.18 and 28 &plusmn; 16 mm, respectively. CONCLUSION: AMI in very young adult occurred most commonly in male. Smoking was the most common risk factor. AWMI owing to LAD artery involvement was the most common presentation. Mean time of presentation after symptom onset was 16.9 hours. In contrast to western population, it is characterised by earlier onset, delayed presentation, more severity, diffuse disease, and more morbidity but with favourable in-hospital mortality&nbsp;</p