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BACKGROUND: The evidence for whether ivermectin impacts recovery, hospital admissions, and longer-term outcomes in COVID-19 is contested. The WHO recommends its use only in the context of clinical trials. METHODS: In this multicentre, open-label, multi-arm, adaptive platform randomised controlled trial, we included participants aged \u226518 years in the community, with a positive SARS-CoV-2 test, and symptoms lasting \u226414 days. Participants were randomised to usual care, usual care plus ivermectin tablets (target 300-400 \u03bcg/kg per dose, once daily for 3 days), or usual care plus other interventions. Co-primary endpoints were time to first self-reported recovery, and COVID-19 related hospitalisation/death within 28 days, analysed using Bayesian models. Recovery at 6 months was the primary, longer term outcome. TRIAL REGISTRATION: ISRCTN86534580. FINDINGS: The primary analysis included 8811 SARS-CoV-2 positive participants (median symptom duration 5 days), randomised to ivermectin (n=2157), usual care (n=3256), and other treatments (n=3398) from June 23, 2021 to July 1, 2022. Time to self-reported recovery was shorter in the ivermectin group compared with usual care (hazard ratio 1\u00b715 [95% Bayesian credible interval, 1\u00b707 to 1\u00b723], median decrease 2.06 days [1\u00b700 to 3\u00b706]), probability of meaningful effect (pre-specified hazard ratio \u22651.2) 0\u00b7192). COVID-19-related hospitalisations/deaths (odds ratio 1\u00b702 [0\u00b763 to 1\u00b762]; estimated percentage difference 0% [-1% to 0\u00b76%]), serious adverse events (three and five respectively), and the proportion feeling fully recovered were similar in both groups at 6 months (74\u00b73% and 71\u00b72% respectively (RR = 1\u00b705, [1\u00b702 to 1\u00b708]) and also at 3 and 12 months.,. INTERPRETATION: Ivermectin for COVID-19 is unlikely to provide clinically meaningful improvement in recovery, hospital admissions, or longer-term outcomes. Further trials of ivermectin for SARS-Cov-2 infection in vaccinated community populations appear unwarranted. FUNDING: UKRI / National Institute of Health Research (MC_PC_19079).
\n \n\n \n \nBACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious hyperinflammatory complication following infection with severe acute respiratory syndrome coronavirus 2. The mechanisms underpinning the pathophysiology of MIS-C are poorly understood. Moreover, clinically distinguishing MIS-C from other childhood infectious and inflammatory conditions, such as Kawasaki disease or severe bacterial and viral infections, is challenging due to overlapping clinical and laboratory features. We aimed to determine a set of plasma protein biomarkers that could discriminate MIS-C from those other diseases. METHODS: Seven candidate protein biomarkers for MIS-C were selected based on literature and from whole blood RNA sequencing data from patients with MIS-C and other diseases. Plasma concentrations of ARG1, CCL20, CD163, CORIN, CXCL9, PCSK9 and ADAMTS2 were quantified in MIS-C (n = 22), Kawasaki disease (n = 23), definite bacterial (n = 28) and viral (n = 27) disease and healthy controls (n = 8). Logistic regression models were used to determine the discriminatory ability of individual proteins and protein combinations to identify MIS-C and association with severity of illness. RESULTS: Plasma levels of CD163, CXCL9 and PCSK9 were significantly elevated in MIS-C with a combined area under the receiver operating characteristic curve of 85.7% (95% confidence interval: 76.6%-94.8%) for discriminating MIS-C from other childhood diseases. Lower ARG1 and CORIN plasma levels were significantly associated with severe MIS-C cases requiring inotropes, pediatric intensive care unit admission or with shock. CONCLUSION: Our findings demonstrate the feasibility of a host protein biomarker signature for MIS-C and may provide new insight into its pathophysiology.
\n \n\n \n \nBackground: Immigrants are exposed to numerous risk factors that may contribute to the development of chronic musculoskeletal pain. Recent political and environmental crises in North Africa and the Middle East have led to an increase in immigration to Europe that has challenged the healthcare system and especially the management of chronic conditions. Objective: The aims of this scoping review are to investigate the burden, prevalence, and associated factors of chronic musculoskeletal pain in immigrants from North Africa and the Middle East in Europe during the last decade. The intentions of the review are to inform healthcare policymakers, to identify gaps in the literature, and aid the planning of future research. Design: Online databases Medline, Embase, PubMed and Web of Science were used to identify epidemiological studies published from2012\u20132022 examining chronic pain in populations from North Africa and the Middle East with a migration background residing in Europe. Results: In total eleven studies were identified conducted in Norway (n = 3), Denmark (n = 3), Germany (n = 1), Austria (n = 1), Sweden (n = 1), and Switzerland (n = 1). Among the identified studies, eight studies were cross-sectional (n = 8), two were prospective cohort studies (n = 2) and one was a retrospective cohort study (n = 1). Data suggested that chronic pain is more prevalent, more widespread, and more severe in people with than without a migration background. Furthermore, immigrants who have resided in the destination country for a longer period experience a higher prevalence of chronic pain compared to those in the early phases of migration. The following factors were found to be associated with chronic pain in this population: female gender, lower education, financial hardship, being underweight or obese, time in transit during migration, experience of trauma, immigration status, anxiety, depression, and post-traumatic stress disorder. Conclusion: Several gaps in the literature were identified. Research is limited in terms of quantity and quality, does not reflect actual immigration trends, and does not account for immigration factors. Prospective cohort studies with long follow-ups would aid in improving prevention and management of chronic pain in populations with a migration background. In particular, they should reflect actual immigration trajectories, account for immigration factors, and have valid comparison groups in the countries of origin, transit and destination.
\n \n\n \n \nCognitive models of insomnia highlight internal and external cognitive-biases for sleep-related \"threat\" in maintaining the disorder. This systematic review of the sleep-related attentional and interpretive-bias literature includes meta-analytic calculations of each construct. Searches identified N\u00a0=\u00a021 attentional-bias and N\u00a0=\u00a08 interpretive-bias studies meeting the inclusion/exclusion criteria. Seventeen attentional-bias studies compared normal-sleepers and poor-sleepers/insomnia patients. Using a random effects model, meta-analytic data based on standardized mean differences of attentional-bias studies determined the weighted pooled effect size to be moderate at 0.60 (95%CI:0.26-0.93). Likewise, seven of eight interpretive-bias studies involved group comparisons. Meta-analytic data determined the weighted pooled effect size as moderate at .44 (95%CI:0.19-0.69). Considering these outcomes, disorder congruent cognitive-biases appear to be a key feature of insomnia. Despite statistical support, absence of longitudinal data limits causal inference concerning the relative role cognitive-biases in the development and maintenance of insomnia. Methodological factors pertaining to task design, sample and stimuli are discussed in relation to outcome variation. Finally, we discuss the next steps in advancing the understanding of sleep-related biases in insomnia.
\n \n\n \n \nSpecific noises (e.g., traffic or wind turbines) can disrupt sleep and potentially cause a mismatch between subjective sleep and objective sleep (i.e., \u201csleep misperception\u201d). Some individuals are likely to be more vulnerable than others to noise-related sleep disturbances, potentially as a result of increased pre-sleep cognitive arousal. The aim of the present study was to examine the relationships between pre-sleep cognitive arousal and sleep misperception. Sixteen healthy sleepers participated in this naturalistic, observational study. Three nights of sleep were measured using actigraphy, and each 15-s epoch was classified as sleep or wake. Bedside noise was recorded, and each 15-s segment was classified as containing noise or no noise and matched to actigraphy. Participants completed measures of habitual pre-sleep cognitive and somatic arousal and noise sensitivity. Pre-sleep cognitive and somatic arousal levels were negatively associated with subjective\u2212objective total sleep time discrepancy (p < 0.01). There was an association between sleep/wake and noise presence/absence in the first and last 90 min of sleep (p < 0.001). These results indicate that higher levels of habitual pre-sleep arousal are associated with a greater degree of sleep misperception, and even in healthy sleepers, objective sleep is vulnerable to habitual bedside noise.
\n \n\n \n \nThis chapter focuses on intimate partner violence (IPV) and sleep disturbances. A comprehensive understanding of sleep disturbances in IPV survivors has been somewhat elusive and has received relatively less attention than mental or physical consequences; however, the evidence suggests robust associations do exist. Sleep disturbances and psychopathology often co-occur following IPV experiences, suggesting some degree of shared variance and/or interaction. These sleep disturbances are often linked to IPV-related post-traumatic stress disorder (PTSD) or PTSD-like symptoms. There is sufficient evidence to indicate that sleep should be investigated just as routinely as common mental health problems associated with IPV. This chapter is divided into two parts. Part 1 presents an overview of the relationships between IPV and sleep, including: (i) the basic physiology of normal sleep, (ii) the effects of IPV on sleep from a neurobiological perspective, (iii) common sleep disturbances associated with IPV, and (iv) the role of sleep in moderating or mediating the psychopathological manifestations of IPV. Part 1 therefore allows the reader to scaffold their knowledge on sleep and IPV - from basic sleep science to how sleep fragmentation and changes in sleep architecture may differentially affect mental health following IPV. Building on the understanding of sleep and IPV in Part 1, Part 2 provides an overview of salient non-pharmacological, psychological interventions for sleep disturbances associated with IPV, including insomnia, nightmares, and other sleep disturbances. There is a growing body of evidence suggesting that treating sleep disturbances associated with IPV may be critical for overall recovery and well-being. Clinicians and researchers would therefore benefit from understanding the associations between IPV and sleep disturbances, along with evidence-based interventions.
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