my-tech-reddit-acct | 3 points
Not a study, but by a researcher: "Extrapolating outcomes from international RCTs to Strongyloides non-endemic regions may have a large unmeasured confounder that randomization cannot solve."[-] my-tech-reddit-acct | 3 points
This is raised by David Boulware, Strongyloides are parasites that exist in parts of the world. We have heard the stories of areas of the world where ivermectin is routinely given to the population to treat parasites, and those areas have lower Covid-19.
Boulware seems to suggest the possibilty that in regions where strongyloides are endemic, ivermectin is working not by fighting the virus, but by fighting the parasites. If true, this would raise a huge question mark over the use of ivermectin in areas where the parasites are not endemic.
Boulware continues in the next tweet:
Thus should #ivermectin be studied in RCTs? Yes. Should IVM be used routinely in USA? No. Should IVM be used in the USA among immigrants with eosinophilia 400 eos/mcL? Yes. Is checking one stool sample (or 3 O&Ps) adequate to exclude Strongyloides? No.
Thank you for this thread. I have been having the same question about widespread parasitic infection being a potentially massive confounder after the single clinical update episode of TWiV where Dr. Daniel Griffin addresses IVM.
Dr. Griffin notes that in the countries with first IVM studies showing efficacy (Egypt, Bangladesh, Peru, etc), treatment with dexamethasone can cause such severe escalation of latent Strongyloides infection that the worms perforate the intestines. Treating such patients with IVM would help, but only because of the latent infections with Strongyloides. Hopefully this can be clarified soon...
Here's a link to the episode:
https://www.youtube.com/watch?v=lbenQxveEm0
[-] my-tech-reddit-acct | 2 points
Dr. Griffin seemed very u-impressed with ivermectin. He's like "Those guys at FLCCC are all smart, good doctors, BUT...."
[-] my-tech-reddit-acct | 1 points
The guys doing those studies in those countries ought to know about this, don't you think? Also, this doesn't invalidate the experience of the front line doctors here.
[-] twitterInfo_bot | 2 points
Extrapolating outcomes from international RCTs to Strongyloides non-endemic regions may have a large unmeasured confounder that randomization cannot solve. Even endogenous cortisol can cause Strongyloides hyperinfection. MN hyperinfection case series at:
posted by @boulware_dr
^(Github) ^| ^(What's new)
[-] my-tech-reddit-acct | 2 points
I found this worldwide study of Strongyloides prevalence: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3708837/
Including these tables:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3708837/table/pntd-0002288-t001/?report=objectonly
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3708837/table/pntd-0002288-t002/?report=objectonly
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3708837/table/pntd-0002288-t003/?report=objectonly
These damn things are all over the place.
[-] my-tech-reddit-acct | 4 points | Jan 04 2021 08:13:04
Ok, after more thoughy, I'm not as bothered about this - the concern is about a confounfer that might pccur when dexamethazone is used - but that's late in the show. I'm much more concerned about prophylaxis and early treatment, and studies of same.
Also I noticed that I'm the only one up in here, other than some bot.
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