622 results match your criteria: "Medical Research Council Clinical Trials Unit[Affiliation]"

Background: HIV prevention trials usually require that women of childbearing potential use an effective method of contraception. This is because the effect of most investigational products on unborn babies is unknown. We assessed contraceptive use, prevalence and incidence of pregnancy and associated factors among women in a HIV vaccine preparedness study in Masaka, Uganda.

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A Meta-Analysis of Levofloxacin for Contacts of Multidrug-Resistant Tuberculosis.

NEJM Evid

January 2025

Sydney Infectious Diseases Institute and the WHO Collaborating Centre in Tuberculosis, Faculty of Medicine and Health, The University of Sydney.

Background: Data from randomized trials evaluating the effectiveness of tuberculosis (TB) preventive treatment for contacts of multidrug-resistant (MDR)-TB are lacking. Two recently published randomized trials that did not achieve statistical significance provide the opportunity for a meta-analysis.

Methods: We conducted combined analyses of two phase 3 trials of levofloxacin MDR-TB preventive treatment - Levofloxacin for the Prevention of Multidrug-Resistant Tuberculosis (VQUIN) trial and the Levofloxacin preventive treatment in children exposed to MDR-TB (TB-CHAMP) trial.

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Levofloxacin Preventive Treatment in Children Exposed to MDR Tuberculosis.

N Engl J Med

December 2024

From the Department of Pediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Stellenbosch (A.C.H., S.E.P., H.S.S., A.G.-P., E.B., A.-M.D., S.N., J.A.S., L. Frigati), the Perinatal HIV Research Unit (N.A.M.) and the Faculty of Health Sciences, Wits Research Health Institute (L. Fairlie), University of the Witwatersrand, and Isango Lethemba TB Research Unit, Port Elizabeth, Wits Health Consortium (F.C.), Johannesburg, and the Tuberculosis and HIV Investigative Network, Durban (S.S.) - all in South Africa; the Johns Hopkins Center for TB Research, Baltimore (N.A.M.); the Medical Research Council Clinical Trials Unit at University College London (J.B., D.M.G., C.M., C.L., R.T., T.D.) and the Department of Infectious Disease, Imperial College London (J.A.S.) - both in London; the Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison (A.G.P.); and the Division of Microbiology, Department of Laboratory Medicine, Centre Hospitalier Universitaire Sainte-Justine, and the Department of Microbiology, Immunology, and Infectious Diseases, Faculty of Medicine, University of Montreal - both in Montreal (A.-M.D.).

Background: Worldwide, approximately 2 million children younger than 15 years of age are infected with multidrug-resistant (MDR) , with MDR tuberculosis developing in approximately 30,000 annually. Evidence from randomized, controlled trials on tuberculosis preventive treatment in persons exposed to MDR tuberculosis is lacking.

Methods: In this community-based, multisite, double-blind, cluster-randomized, placebo-controlled trial in South Africa, we assessed the efficacy and safety of levofloxacin as preventive treatment in children with household exposure to an adult with bacteriologically confirmed MDR pulmonary tuberculosis.

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Effect and safety of intravenous iron compared to oral iron for treatment of iron deficiency anaemia in pregnancy.

Cochrane Database Syst Rev

December 2024

Medical Research Council Clinical Trials Unit, Institute for Clinical Trials and Methodology, University College London, London, UK.

Rationale: Intravenous iron is increasingly used to treat iron-deficient anaemia (IDA) in pregnancy. A previous network meta-analysis suggested that intravenous irons have a greater effect on haematological parameters than oral irons; however, the impact on serious pregnancy complications such as postpartum haemorrhage (PPH) or the need for blood transfusion was unclear. Since then, several new randomised controlled trials (RCTs) have been conducted.

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Objectives: To provide globally representative data on hospitalisation and death in recently SARS-CoV-2-positive ambulatory populations.

Methods: We enrolled SARS-CoV-2-positive ambulatory adults in the cohort studies, ICOS (47 sites, 5 continents), and PCOS (Liberia) and followed for 28-days. Kaplan-Meier estimates of percentage of those hospitalised or died were derived.

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Therapeutics of neuroinflammatory disorders including multiple sclerosis is one of the fastest growing areas in neurology. However, pressures on higher specialty training in neurology together with an expanding curriculum have led to challenges in adequately preparing trainees for a subspecialist career. In this study we set out to understand current perceptions and barriers to training in neuroinflammatory disorders among neurology trainees in the UK.

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Accelerating COVID-19 Treatment Interventions and Vaccines (ACTIV) was initiated by the US government to rapidly develop and test vaccines and therapeutics against COVID-19 in 2020. The ACTIV Therapeutics-Clinical Working Group selected ACTIV trial teams and clinical networks to expeditiously develop and launch master protocols based on therapeutic targets and patient populations. The suite of clinical trials was designed to collectively inform therapeutic care for COVID-19 outpatient, inpatient, and intensive care populations globally.

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Background: HIV self-testing (HIVST) may facilitate marginalised populations' uptake of HIV testing, but whether the extent of marginalisation challenges individual uptake of HIVST remains under-researched. We aim to explore the perspectives of multiply marginalised cis-gender gay, bisexual and other men who have sex with men (GBMSM) and trans women on whether HIVST might increase their uptake of HIV testing.

Methods: We reanalysed qualitative interview data from SELPHI (the UK's largest HIVST randomised trial) collected between 2017 and 2020 from marginalised populations, defined as people self-identifying as non-heterosexual, transgender, non-White ethnicity and/or with low educational attainment.

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Approaches and processes for paediatric chest X-ray classification used in the SHINE TB treatment-shortening trial.

Int J Tuberc Lung Dis

November 2024

Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.

INTRODUCTIONSHINE (Shorter Treatment for Minimal Tuberculosis in Children) was the first Phase 3 paediatric TB treatment-shortening trial. Robust chest X-ray (CXR) classification methods were integral to excluding severe disease for trial eligibility and to retrospectively adjudicating TB status at baseline. We describe and critically evaluate the CXR classification approaches and processes used in the SHINE trial.

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Treatment options for children living with HIV have historically been less effective, less practical and more difficult to implement compared with those for adults, as the research and development of new drugs for children has lagged behind. Significant progress has been achieved in response to the paediatric HIV epidemic over the last decade. Several optimised paediatric antiretroviral formulations are currently available or in development, including fixed-dose combination tablets containing a complete World Health Organization-recommended regimen.

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Background: Epidemiological and clinical studies often have missing data, frequently analysed using multiple imputation (MI). In general, MI estimates will be biased if data are missing not at random (MNAR). Bias due to data MNAR can be reduced by including other variables ("auxiliary variables") in imputation models, in addition to those required for the substantive analysis.

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Advancing the chemotherapy of tuberculous meningitis: a consensus view.

Lancet Infect Dis

September 2024

Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa; The Francis Crick Institute, London, UK; Department of Infectious Diseases, Imperial College London, London, UK. Electronic address:

Article Synopsis
  • Tuberculous meningitis is a serious disease that can cause death or long-term problems for about half of the people it affects.
  • Current treatment methods are based on how we treat lung tuberculosis, but they don't work as well for the brain.
  • Researchers are calling for new global trials with better drugs to improve treatment and help patients with this dangerous infection.
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Background: Deep grey matter pathology is a key driver of disability worsening in people with multiple sclerosis. Quantitative susceptibility mapping (QSM) is an advanced magnetic resonance imaging (MRI) technique which quantifies local magnetic susceptibility from variations in phase produced by changes in the local magnetic field. In the deep grey matter, susceptibility has previously been validated against tissue iron concentration.

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Pharmacokinetics of once-daily darunavir/ritonavir in second-line treatment in African children with HIV.

J Antimicrob Chemother

November 2024

Department of Pharmacy, Radboudumc Research Institute for Medical Innovation (RIMI), Radboud University Medical Center, Nijmegen, The Netherlands.

Background: Darunavir is a potent HIV protease inhibitor with a high barrier to resistance. We conducted a nested pharmacokinetic sub-study within CHAPAS-4 to evaluate darunavir exposure in African children with HIV, taking once-daily darunavir/ritonavir for second-line treatment.

Methods: We used data from the CHAPAS-4 pharmacokinetic sub-study treating children with once-daily darunavir/ritonavir (600/100 mg if 14-24.

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Background: Extrapulmonary complications (EPCs) are common in patients hospitalized for coronavirus disease 2019 (COVID-19), but data on their clinical consequences and association with viral replication and systemic viral dissemination are lacking.

Methods: Patients hospitalized for COVID-19 and enrolled in the Therapeutics for Inpatients with COVID-19 (TICO) platform trial at 114 international sites between August 2020 and November 2021 were included in a prospective cohort study. We categorized EPCs into 39 event types within 9 categories and estimated their frequency through day 28 and their association with clinical outcomes through day 90.

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Influence of age and co-medication on dolutegravir glucuronidation in paediatric patients.

Br J Clin Pharmacol

November 2024

Department of Pharmacy, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands.

Article Synopsis
  • Dolutegravir (DTG) is metabolized in the body, producing an inactive form called DTG glucuronide (DTG-gluc), and the study focused on its metabolic ratio (DTG-MR) among 85 HIV-positive children aged 3 months to 18 years.
  • The research found that the overall DTG-MR in children was similar to that in adults and was primarily influenced by the use of rifampicin, which significantly increased the DTG-MR.
  • These results suggest that factors like age, body weight, and type of NRTI treatment do not affect the DTG-MR in children, paving the way for better pharmacokinetic modeling for pediatric patients based on adult data
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Most phase III trials in drug-resistant tuberculosis have either been underpowered to quantify differences in microbiological endpoints or have taken up to a decade to complete. Composite primary endpoints, dominated by differences in treatment discontinuation and regimen changes, may mask important differences in treatment failure and relapse. Although new regimens for drug-resistant tuberculosis appear very effective, resistance to new drugs is emerging rapidly.

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Background: African children with cerebral malaria and seizures caused are at greater risk of poor outcomes including death and neurological sequelae. The agonal events are severe hypoventilation and respiratory arrest often triggered by seizures. We hypothesised that prophylactic anti-seizure medication (ASM) could avert 'spikes' of intracranial pressure during or following seizures and that adequate ventilation could be supported by biphasic Cuirass Ventilation (BCV) which requires no intubation.

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Why Was the Azithromycin "for Life" Trial Necessary?

N Engl J Med

August 2024

From the Department of Infectious Disease and Institute of Global Health and Innovation, Division of Medicine, Imperial College (K.M.), and the Medical Research Council Clinical Trials Unit, University College London (A.S.W.) - both in London.

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Importance: The prognosis of patients with adenocarcinoma of the esophagus and esophagogastric junction (AEG) is poor. From current evidence, it remains unclear to what extent preoperative chemoradiotherapy (CRT) or preoperative and/or perioperative chemotherapy achieve better outcomes than surgery alone.

Objective: To assess the association of preoperative CRT and preoperative and/or perioperative chemotherapy in patients with AEG with overall survival and other outcomes.

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Population Pharmacokinetics of Dolutegravir in African Children: Results From the CHAPAS-4 Trial.

J Pediatric Infect Dis Soc

September 2024

Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.

We characterized population pharmacokinetics in 42 African children receiving once-daily 25 mg (14 to <20 kg) or 50 mg (>20 kg) dolutegravir. Coadministration with emtricitabine and tenofovir alafenamide reduced dolutegravir bioavailability by 19.6% (95% confidence interval: 8.

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Article Synopsis
  • This study looks at how HIV self-testing can help gay, bisexual men, and trans people based on their social connections.
  • It analyzed interviews from 2015 to 2020 to see what support these individuals need for HIV testing.
  • Four groups were identified based on their needs and support: those needing help, those wanting privacy, those with support, and those confident in managing risks on their own.
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Attributable mortality of candidemia - Results from the ECMM Candida III multinational European Observational Cohort Study.

J Infect

September 2024

University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.

Introduction: Despite antifungal advancements, candidaemia still has a high mortality rate of up to 40%. The ECMM Candida III study in Europe investigated the changing epidemiology and outcomes of candidaemia for better understanding and management of these infections.

Methods: In this observational cohort study, participating hospitals enrolled the first ten consecutive adults with blood culture-proven candidemia.

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Background: Children who are HIV-exposed and uninfected (HEU) are at risk for early neurodevelopmental impairment. Smaller basal ganglia nuclei have been reported in neonates who are HEU compared to HIV-unexposed (HU); however, neuroimaging studies outside infancy are scarce. We examined subcortical brain structures and associations with neurocognition in children who are HEU.

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Article Synopsis
  • The study investigates the effects of antiretroviral therapy (ART) interruption on neuro-axonal injury, specifically measuring levels of neurofilament light protein (NfL) in individuals during primary HIV-1 infection.
  • Findings show that NfL decreased after 48 weeks of ART, indicating reduced neuronal injury, and remained stable despite viral rebound after ART interruption.
  • Additionally, baseline NfL levels correlated with higher plasma HIV-1 RNA and older age but showed no significant relationship with inflammation markers like IL-6 or total HIV-1 DNA.
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