BACKGROUND
Polycythaemia vera and essential thrombocythaemia are chronic Philadelphia-negative myeloproliferative neoplasms that increase the risk of arterial and venous thrombosis, as well as bleeding. In addition to the different therapeutic strategies available, an antiplatelet drug is often used to reduce thrombotic risk.


OBJECTIVES
To quantify the benefit and harm of antiplatelet drugs for long-term primary and secondary prophylaxis of arterial and venous thrombotic events in patients with polycythaemia vera or essential thrombocythaemia.


SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library (Issue 1 2012), MEDLINE (1966 to 2012), and EMBASE (1980 to 2012), as well as online registers of ongoing trials and conference proceedings. The date of the last search was October 2012.


SELECTION CRITERIA
We included all randomised controlled trials (RCTs) comparing long-term (>6 months) use of an antiplatelet drug versus placebo or no treatment in participants with polycythaemia vera or essential thrombocythaemia, as diagnosed by established international criteria, with data for at least one of the selected outcomes.


DATA COLLECTION AND ANALYSIS
Using a pre-defined extraction form, two review authors independently screened results, extracted data, and assessed quality. We planned to analyse the following outcomes: mortality from arterial and venous thrombotic events (primary efficacy outcome), mortality from bleeding episodes (primary safety outcome), fatal and non-fatal arterial thrombotic events, fatal and non-fatal venous thrombotic events, micro-circulation events, transient neurological and ocular manifestations, major and minor bleeding episodes, and all-cause mortality and any adverse events. We based quantitative analysis of outcome data on an intention-to-treat principle. We used the pooled odds ratio (OR) with 95% confidence interval (CI) with a fixed-effect model (Mantel-Haenszel) to estimate the overall treatment effect.


MAIN RESULTS
We identified no new studies from the updated searches. We included in this review two RCTs for a total of 630 participants. Both RCTs included participants with an established diagnosis of polycythaemia vera and with no clear indication or contraindication to aspirin therapy. We judged both studies to be of moderate quality. Published data from both studies were insufficient for a time-to-event data analysis and for some of the primary and secondary outcomes that we planned. The use of low-dose aspirin, compared with placebo, was associated with a lower risk of fatal thrombotic events (although this benefit was not statistically significant (OR 0.20, 95% CI 0.03 to 1.14; P = 0.07). No data on mortality from bleeding episodes were available. A non-significant benefit of aspirin was shown for all-cause mortality (OR 0.46, 95% CI 0.21 to 1.01; P = 0.05). No increase in the risk of major bleeding was reported in participants taking aspirin compared with those given placebo (OR 0.99, 95% CI 0.23 to 4.36; P = 0.99), and a non-significant increase with aspirin treatment was shown for minor bleeding (OR 1.85, 95% CI 0.90 to 3.79; P = 0.09). No published studies have reported findings in participants with essential thrombocythaemia or in the study of other antiplatelet drugs.


AUTHORS' CONCLUSIONS
For patients with polycythaemia vera who have no clear indication or contraindication to aspirin therapy, available evidence suggests that the use of low-dose aspirin, when compared with no treatment, is associated with a statistically non-significant reduction in the risk of fatal thrombotic events and all-cause mortality, without an increased risk of major bleeding.

Antiplatelet drugs for polycythaemia vera and essential thrombocythaemia: a Cochrane meta-analysis.

Financial stability of Asian Nations: Governance quality and financial inclusion

This article empirically explores the impact of governance indicators (corruption, government effectiveness, and political stability) along with some other macroeconomic variables (inflation, trade openness, worker remittances, direct foreign investment, and population growth rate) on economic growth of 14 countries located in Latin American and Caribbean(LAC) region between 2002Q1 and 2018Q4. The panel autoregressive distributed lag (ARDL)/pooled mean group (P.M.G.) estimation techniques are used for empirical investigation. The P.M.G. results disclose that corruption has a significantly inverse effect on growth, while both political stability and government effectiveness have positive impacts in the long run. These results indicate that increasing corruption discourages growth, while political stability and government effectiveness encourage the process of economic growth. Empirical findings demonstrate the need of good governance, where corruption needs to be miniaturized, while government effectiveness and political stability be strengthened to boost economic growth and thereby improve social welfare. The present study is different from the erstwhile studies in three folds: (i) it focuses on 14 countries from LAC region (highest number of LAC countries investigated so far in a single study), (ii) the data covers a long time span of 16 years, and (iii) it employs relatively holistic panel data and empirical techniques for estimation purpose. Therefore, the outcomes of this study will not only contribute to the literature on LAC region but can also be extended globally with the objective to understand the significance of governance for national economic development.

Governance and Economic Growth: Evidence from 14 Latin America and Caribbean Countries

Complex interlinkages, key objectives, and nexuses among the Sustainable Development Goals and climate change: a network analysis.

This study aims to test the Malthusian and Kremer theories by exploring the relationship between population and economic growth in a low middle-income economy of India.,The autoregressive distributed lag approach is employed based on the nature of time-series data to achieve the study objectives. In this study, regressand is economic growth measured by real GDP, and the regressors are population growth rate, investment, life expectancy and inflation rate from 1980 to 2018.,Empirical results confirm the applicability of Kremer’s theory. In this theory, population growth has a significant and positive impact on economic growth in the short and long run. Moreover, investment and life expectancy variables have a positive and significant impact on economic growth, whereas inflation rate has a negative association with economic growth. Empirical results support the population-growth-driven economic growth hypothesis, which indicates that population growth stimulates economic growth and development.,Empirical findings in this study provide guides for management authorities in formulating the right and relatable policies on population growth whilst promoting economic growth and social welfare.,Achieving a desirable level of economic growth is the prime objective of every country. The role of the population in the process of economic growth and development cannot be overlooked. Malthus' and Kremer's views are opposite. Extant literature exhibits that scant research has been carried out on this significant topic in developing countries. Therefore, empirically investigating the effect of population on the growth performance of India as a developing country is necessary and will significantly contribute to the literature.,The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-08-2019-0496

Testing Malthusian's and Kremer's population theories in developing economy

The main aims of this study are to empirically evaluate the impact of foreign direct investment (FDI) along with some other control variables such as: GDP per capita, international remittances, and exports on human capital, measured by gross secondary school enrolment for 34 developing countries over the time period ranging from 1981-2013. The results of fixed-effects model reveal that the inward FDI has statistically positive impact on human capital. Therefore, this study rejects the null hypothesis that there is no significant positive relationship between inward FDI and human capital, where as it accepts the alternative one. Thus findings of the study suggest that policy makers need to devise conductive and investment friendly policy in order to enhance more FDI into the host countries. As a result, it will largely improve the social welfare of the people of these developing countries.

Foreign direct investment and human capital: evidence from developing countries

Primary polycythemia (polycythemia vera) is a hematopoeitic stem cell disorder giving rise to proliferation of a clone of hematopoietic precursors leading to an excess production of erythrocytes with thrombocytosis and leukocytosis. The optimum management of polycythemia vera remains elusive. Patients requiring surgery are at increased risk of both perioperative thrombosis and hemorrhage. On one hand, thrombosis can lead to multi organ ischemia and infarction while on the other, bleeding diathesis can lead to profuse perioperative hemorrhage; both posing considerable risk to the patient’s health and stress to the anesthesiologist concerned directly with perioperative management of the patient. Hence, management guidelines for polycythemia vera needs to be clearly understood and tailored to each patient individually and appropriate management protocols need to be de! ned accordingly.

Polycythemia vera: Essential management protocols

Objective: To determine whether a structured OPAT program supervised by an infectious disease physician and led by an OPAT nurse decreased hospital readmission rates and OPAT-related complications and whether it affected clinical cure. We also evaluated predictors of readmission while receiving OPAT. Patients: A convenience sample of 428 patients admitted to a tertiary-care hospital in Chicago, Illinois, with infections requiring intravenous antibiotic therapy after hospital discharge. Methods: In this retrospective, quasi-experimental study, we compared patients discharged on intravenous antimicrobials from an OPAT program before and after implementation of a structured ID physician and nurse-led OPAT program. The preintervention group consisted of patients discharged on OPAT managed by individual physicians without central program oversight or nurse care coordination. All-cause and OPAT-related readmissions were compared using the χ2 test. Factors associated with readmission for OPAT-related problems at a significance level of P < .10 in univariate analysis were eligible for testing in a forward, stepwise, multinomial, logistic regression to identify independent predictors of readmission. Results: In total, 428 patients were included in the study. Unplanned OPAT-related hospital readmissions decreased significantly after implementation of the structured OPAT program (17.8% vs 7%; P = .003). OPAT-related readmission reasons included infection recurrence or progression (53%), adverse drug reaction (26%), or line-associated issues (21%). Independent predictors of hospital readmission due to OPAT-related events included vancomycin administration and longer length of outpatient therapy. Clinical cure increased from 69.8% before the intervention to 94.9% after the intervention (P < .001). Conclusion: A structured ID physician and nurse-led OPAT program was associated with a decrease in OPAT-related readmissions and improved clinical cure.

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Decreased hospital readmissions after programmatic strengthening of an outpatient parenteral antimicrobial therapy (OPAT) program

Objective: To compare the stylet and the gum elastic bougie in tracheal intubation of a simulated difficult airway. Study design: Randomized control trial. Place and time period: The study was conducted in Main Operation Theatre at Rehman Medical Institute, Peshawar from June 2009 to June 2010. Method: 56 patients, ASA grades I and II, undergoing elective surgical procedures requiring tracheal intubation were randomly divided in two groups. Difficult intubation scenario was simulated by applying a rigid Philadelphia collar in both groups. Patients in Group-A were intubated with a stylet and patients in Group-B were intubated using a gum elastic bougie. Both groups were then compared in terms of overall success in intubation, and number of intubation attempts. Statistical analysis was done by applying Chi-Square test and Students’ T- test. Results: Among the patients of Group-A, only 71.4% patients were successfully intubated using a stylet while 100% patients in Group-B were successfully intubated using a bougie. Conclusion: In the simulated difficult airway, tracheal intubation using a gum-elastic bougie has a higher success rate when compared to stylet assisted intubation and should be preferred in a difficult intubation scenario.

Farah Khan

Papers

Testing Malthusian's and Kremer's population theories in developing economy

Foreign direct investment and human capital: evidence from developing countries

Polycythemia vera: Essential management protocols

Decreased hospital readmissions after programmatic strengthening of an outpatient parenteral antimicrobial therapy (OPAT) program

Comparison of the stylet and the gum elastic bougie in tracheal intubation in a simulated difficult airway