Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand.

Background: Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods: Children aged <18 years initiating combination ART (≥2 nucleoside reverse transcriptase inhibitors [NRTIs] plus nonnucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of ≥1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks. Results: Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. Conclusions: One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch

Síndrome de Gradenigo y trombosis de seno cavernoso secundaria a otitis media aguda

Gradenigo�s syndrome is characterized by facial pain in the area supplied by the trigeminal nerve and a unilateral external ophthalmoplegia (paralysis of VI cranial nerve) secondary to acute apical petrositis for evolutionary complication of otitis media. This is a serious complication that requires immediate treatment to prevent permanent damage and may be associated with other intracranial complications such as thrombosis of the cavernous sinus. We report a 4 year old male who complains of fever, headache and external ocular paralysis in the course of acute otitis media.El síndrome de Gradenigo se caracteriza por dolor facial en la zona inervada por el trigémino y una oftalmoplejía externa unilateral (parálisis del VI par craneal) secundaria a petrositis apical aguda, por complicación evolutiva de una otitis media. Se trata de una complicación grave que requiere de un tratamiento inmediato para evitar secuelas permanentes y puede asociarse a otras complicaciones intracraneales como la trombosis del seno cavernoso. Presentamos el caso de un varón de 4 años que consulta por fiebre, cefalea y parálisis ocular externa en el curso de una otitis media aguda

Cross-CPP - An ecosystem for provisioning, consolidating, and analysing big data from cyber-physical products

It is expected that with the increasing number of connected sensors and actuators within mass products, the large spectrum of sensor data coming from high volume products in various industrial sectors (vehicles, smart home devices, etc.) will rise in short-term. This enormous amount of data continuously generated by CPPs will represent (1) a new information resource to create new value, allowing the improvement of existing services or the establishment of diverse new cross-sectorial services, by combining data streams from various sources, and (2) a major big data-driven business potential, not only for the manufacturers of Cyber Physical Products (CPP), but in particular also for cross-sectorial industries as well as various organisations with interdisciplinary applications. In spite of major advances in the field, several challenges still hinder the use of these data, like the lack of, or only few, CPP ecosystems that are in the best-case manufacturer specific and not open for external companies interested in using such data. We present here a solution that envisions to establish a CPP Big Data Ecosystem to bring to the outside world CPP data from various industrial sectors, brand independent, allowing for external service providers that use CPP data from this unique CPP data access point (as well as from other sources) to develop cross-sectorial services

An analysis of healthcare use and the cost associated to end-of-life care of lung cancer patients in a Spanish hospital

Despite various studies have demonstrated that the consumption of healthcare services by cancer patients, and therefore healthcare costs, increases during the end-of-life period, there are insufficient studies which focus specifically on lung cancer. Thus, we aim to study the consumption of healthcare services and its cost in end-of-life lung cancer patients attended in the Puerta de Hierro University Hospital, Spain

General Learnings from the Horizon 2020 Project BigMedilytics

Big Data, in combination with Artificial Intelligence (AI), has the potential to change and improve processes in medicine. However, these activities/technologies must be developed to promote the trust of all stakeholders: patients, healthcare professionals, private and public providers and businesses. Providing a Trustworthy AI - lawful, ethical and robust - requires significant efforts. Although technological development is moving quickly, testing, validation and integration of such innovation may take many years. The reasons which slow down this process are manifold. However, some barriers and pitfalls are foreseeable and, therefore, can be taken into account or avoided. In order to support future development and integration of AI and Big Data technologies, we present technical challenges and lessons learnt from our previous project, BigMedilytics, involving clinicians and data scientists. This chapter considers the challenges data scientists providing advanced technology in the healthcare domain may face, along with some suggestions to address any related issues.f applicabl

Epidemiological and clinical insights into the enterovirus D68 upsurge in Europe 2021/22 and the emergence of novel B3-derived lineages, ENPEN multicentre study

International audienceEnterovirus D68 (EV-D68) infections are associated with severe respiratory disease and acute flaccid myelitis (AFM). The European Non-Polio Enterovirus Network (ENPEN) aimed to investigate the epidemiological and genetic characteristics of EV-D68 and its clinical impact during the fall-winter season of 2021/22. From 19 European countries, 58 institutes reported 10,481 (6.8%) EV-positive samples of which 1,004 (9.6%) were identified as EV-D68 (852 respiratory samples). Clinical data was reported for 969 cases. 78.9% of infections were reported in children (0-5 years); 37.9% of cases were hospitalised. Acute respiratory distress was commonly noted (93.1%) followed by fever (49.4%). Neurological problems were observed in 6.4% of cases with six reported with AFM. Phylodynamic/Nextstrain and phylogenetic analyses based on 694 sequences showed the emergence of two novel B3-derived lineages, with no regional clustering. In conclusion, we describe a large-scale EV-D68 European upsurge with severe clinical impact and the emergence of B3-derived lineages

Children living with HIV in Europe: do migrants have worse treatment outcomes?

International audienceTo assess the effect of migrant status on treatment outcomes among children living with HIV in Europe

Prevalence and Clinical Outcomes of Poor Immune Response Despite Virologically Suppressive Antiretroviral Therapy Among Children and Adolescents With Human Immunodeficiency Virus in Europe and Thailand: Cohort Study

International audienceIn human immunodeficiency virus (HIV)-positive adults, low CD4 cell counts despite fully suppressed HIV-1 RNA on antiretroviral therapy (ART) have been associated with increased risk of morbidity and mortality. We assessed the prevalence and outcomes of poor immune response (PIR) in children receiving suppressive ART