Peripheral neuropathy after viral eradication with direct-acting antivirals in chronic HCV hepatitis: A prospective study

BACKGROUND: HCV‐related extra‐hepatic complications include peripheral neuropathies, with important prevalence and impact. A recent metanalysis of previous intervention trials concluded for insufficient data to support evidence‐based treatments for this complication. In this longitudinal study, we assessed for the first time prevalence and outcome of neuropathy in a cohort of patients with chronic HCV, before and after direct‐acting antiviral agent (DAA) treatment. METHOD: Ninety‐four patients (mean age 58.5 ± 9.9, infection duration 22.2 ± 6.3 years) without systemic and metabolic diseases, underwent neurological examination and electroneurography studies before (T0) and 10.4 ± 1.7 months after the end of DAA therapy (T1), and cryoglobulins (CG) assessment. Muscle strength was evaluated by Medical Research Council (MRC) score; neuropathic pain, sensory function, disability, quality of life were assessed by validated questionnaires (DN4, NPSI, SSS, INCAT and Euro‐QoL). RESULTS: At T0, sensory‐motor neuropathy was detected in 22 patients (23%), reflexes were depressed in 32 (34%) with no association with infection duration, viral load, age, CG. Neuropathic pain (DN4 ≥4) was present in 37 patients (39%). At T1, out of the 22 patients with altered electroneurography, 3 had died or developed HCC, 4 showed normal electroneurography, and nerve amplitude parameters tended to improve in the whole group. Only 11 patients (12%) had depressed reflexes and 10 (11%) DN4 ≥4 (P < .05 compared to T0). Scores for MRC, questionnaires and Euro‐QoL improved significantly (P < .05). CONCLUSION: Our study confirms the high prevalence of clinical and subclinical peripheral sensory‐motor neuropathy in patients with HCV infection and indicates improvement after eradication by DAA. These results support the need for larger intervention studies

What is new in the 'borderlands'? : the influence of EU external policy-making on security in Tunisia and Morocco after the uprisings

The struggle between the contradictory objectives of security and democratic governance has dominated EU discourse, policies and practices when it comes to the southern bank of the Mediterranean since 1995. Ultimately, there is a scholarly consensus on the substantial failure of what had been the normative drive for setting up the partnership: no shared area of prosperity and democracy exists today because security concerns prevailed. As reliable partners for the EU on security issues, Tunisia and Morocco were crucial in entrenching the securitisation of the relationship. This holds true also after the uprisings, as encouraging premises quickly turned into considerable instability in the Middle East and North Africa. This study employs a borderlands approach to analysing the ways in which the EU outsources the management of key ‘border functions’ while attempting to connect the periphery in other issue-areas. More specifically, it examines the implications of the EU’s post-2011 revision of its security ‘cooperation’ with Tunisia and Morocco for two aspects of the relationship. First, it looks at the way in which domestic political reconfigurations have occurred and how these reconfigurations have influenced relations with the EU. Second, it explores the asymmetries of power between the two parties and the degree of ‘leverage’ Tunisia and Morocco have vis-à-vis the EU. Our main contention is that the soul-searching and reflective mode of EU officials was short-lived, and that the rhetoric about past mistakes and new beginnings in the early days of the uprisings has not been matched over time. As enthusiasm for the Arab Spring faded on both sides of the Mediterranean, the EU reverted to a business as usual approach, demanding and obtaining the cooperation of both Tunisia and Morocco, irrespective of the diverging post-uprising trajectories of the two countries.Funded by the European Research Council (ERC) within the 7th Framework Programme, the BORDERLANDS project is hosted at the Robert Schuman Centre for Advanced Studies, European University Institute, and directed by Professor Raffaella A. Del Sarto

EU-Algeria (non)cooperation on migration: A tale of two fortresses

Despite the bilateral commitment to engage in \u2018regular dialogue on issues related to mobility, migration and asylum\u2019, EU incentives have failed in leveraging Algeria to secure cooperation notwithstanding seemingly converging interests. What explains the Algerian endless resistance to the EU\u2019s pressure and incentives? This paper claims that a focus on the historical development of the Algerian security regime improves the understanding of its non-cooperative approach vis-\ue0-vis the EU

Migration categories and the politics of labeling

Published online: 12 January 2024The chapter examines the complex and dynamic nature of migration categories and their role in shaping international migration governance. Categories are not easily changed and are often codified in laws and norms, perpetuating asymmetric power relations and certain ideas about categorized migrant groups. The chapter highlights that categories are central to migration debates, as they establish which types of migration are justified and constitute the distinction between unwanted and wanted migrants or legitimate and illegitimate forms of international mobility. The chapter provides a discussion of selected migrant categories, including high skilled/low skilled, regular/irregular, forced/voluntary, and vulnerable/non-vulnerable migrants, and assesses their analytical value in understanding migration governance. The chapter concludes by making a plea for the need for a reflexive approach to migration studies that recognizes the ambiguity and fuzziness of categories and their contested nature in shaping policy and practice

Adapting to Crisis: The Governance of Public Services for Migrants and Refugees during COVID-19 in Four European Cities

The lack of access to basic services played a big part among the key effects of COVID-19 on migrants and refugees. This paper examines the governance dynamics behind public services for migrants and refugees to understand how COVID-19 has impacted them and what accounts for different levels of adaptive capacity. It employs a mixed methods approach, using egocentric network analysis and qualitative interviews to compare the service ecosystems in four European cities from 2020 to 2022 (Birmingham, Larissa, Malaga, and Palermo). The paper explores the impact of two conditions on the service ecosystems’ ability to adapt to the pandemic: the structure of governance and the presence of dynamic capabilities. We argue that the ability of local governments to manage pandemic challenges is highly dependent on the formal distribution of comprehensive competences across various levels (the structure of governance), and the quality of network cooperation between different administrations and civil society (dynamic capabilities). Our analysis reveals that while both conditions are critical for the level of adaptive capacity in public services’ provision, the structure of governance is more likely to act as a constraint or trigger for coping strategies