The COVID-19 pandemic has highlighted the need to upgrade systems for infectious disease surveillance and forecasting and modeling of the spread of infection, both of which inform evidence-based ...public health guidance and policies. Here, we discuss requirements for an effective surveillance system to support decision making during a pandemic, drawing on the lessons of COVID-19 in the U.S., while looking to jurisdictions in the U.S. and beyond to learn lessons about the value of specific data types. In this report, we define the range of decisions for which surveillance data are required, the data elements needed to inform these decisions and to calibrate inputs and outputs of transmission-dynamic models, and the types of data needed to inform decisions by state, territorial, local, and tribal health authorities. We define actions needed to ensure that such data will be available and consider the contribution of such efforts to improving health equity.
Abstract
Myeloproliferative neoplasms (MPNs) are clonal disorders, derived from abnormal hematopoietic stem cells and result in an excessive production of blood cells. This MPN group of conditions ...encompasses different diseases with overlapping clinical and biologic similarities. The majority of the conventional therapies of MPN are palliative in nature. However, with the discovery of Janus Kinase 2 (JAK2) mutation and development of targeted JAK1/2 inhibition therapy, the therapeutic options in treatment landscape have changed dramatically. This article presents the revised Indian MPNs Working Group consensus recommendations. It highlights and brings into attention about the recent findings that have defined the state of the art of the diagnosis and therapy in the MPN area, including identification of the new driver and prognostic mutations, treatment goals in the management of myelofibrosis and polycythemia vera (PV), role of the recently approved, targeted tyrosine kinase inhibitor ruxolitinib in PV, and special issues such MPN consideration in patients with splenic vein thrombosis and the management of the disease in pregnancy.
INTRODUCTION:
Considering its inflammatory potential Endoscopic retrograde cholangiopancreatography (ERCP) can prompt myocardial infarction in patients with preexisting coronary artery disease (CAD). ...However, the data regarding the impact of previous MI/revascularization procedures are non-existent. We aimed to compare the outcomes of adult patients undergoing ERCP with vs. without any such prior history.
METHODS:
Using the ICD-9 CM codes in the National Inpatient Sample (2007 -2014) we identified adult patients undergoing ERCP who had a prior history of MI, PCI or CABG. Primary endpoints- inpatient mortality and post-ERCP complications. Secondary endpoints- discharge disposition, mean length of stay and total hospital charges. SPSS version 22 (IBM Corp, NY, USA) was used for all analyses. Categorical and continuous variables were compared using the Chi-square test and Student’s t-test, respectively. A two-tailed
P
value ≤ 0.05 was set as the cutoff for the statistical significance.
RESULTS:
Of total 1,374,773 ERCP procedures performed between 2007 to 2014, 120,418 (8.8%) were performed in patients who had a prior history of MI, PCI or CABG (study cohort) and the rest were considered the control cohort. The study-cohort had older (mean age 74y vs. 58y) population and more males (63.9% vs. 37.6%), who were admitted non-electively (88.1% vs. 87.3%) as compared to the control cohort (
P
< 0.001) Figure 1. compares baseline characteristics between both cohorts. There is an increasing trend of performing ERCP in study group between 2007 to 2014 (7.5% to 9.5%;
P
trend
= 0.022) with a decrease in inpatient mortality from 1.8 to 1.4% (Figure 1). All-cause inpatient mortality was also higher (1.7% vs. 1.5%,
P
< 0.001) in the study cohort (Figure 1). Post-ERCP cardiopulmonary complications, sepsis, and haemorrhage were all higher in the study group (
P
< 0.001) (Table 2). However, post-ERCP pancreatitis (14.1% vs. 15.4%,
P
< 0.001) was lower in the study group without any difference in cholecystitis (0.4% vs. 0.4%,
P
= 0.180). The mean length of stay (6.8 days vs 6.6 days) was marginally higher in the study cohort without any difference in the hospitalization charges.
CONCLUSION:
In this nationwide retrospective study, we determined higher inpatient mortality and cardiopulmonary complications, sepsis, and haemorrhage in adult patients undergoing ERCP with a prior history of MI, PCI or CABG. Future prospective studies are warranted to delineate the impact of prior infarction or revascularization on the outcomes of ERCP.
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