Highlights for the 9th International Workshop on Pediatrics, 22–23 July 2017, Paris, France

The 9th International Workshop on Pediatrics was held in Paris, France on the 21–22 July, 2017. It was co-chaired by Lynne Mofenson (EGPAF, USA), Albert Faye (University Paris Diderot, Paris, France) and Valériane Leroy (INSERM, France). Over 300 participants attended the workshop. The abstracts included 20 oral presentations, 87 posters and 45 abstract book-only abstracts

Brief Report: Surveillance of Congenital Anomalies After Exposure to Raltegravir or Elvitegravir During Pregnancy in the United Kingdom and Ireland, 2008–2018

BACKGROUND: The indisputable benefits of antiretroviral therapy (ART) in the reduction of mother-to-child-transmission of HIV (MTCT) have to be carefully balanced with the risks of embryo-foetal toxicities due to foetal exposure to maternal ART.The recent report of a potential safety signal with Dolutegravir use in pregnancy and potential increased rate of neural tube defects (NTDs), has raised the question of a potential class effect for Integrase Strand Inhibitors. To contribute real-world evidence we evaluated data on pregnant women receiving Raltegravir (RAL) or Elvitegravir (EVG) in the UK and Ireland. METHODS: The National Study of HIV in Pregnancy and Childhood (NSHPC) is a comprehensive population-based surveillance study collecting data on all HIV-positive pregnant women and their children. We collected data on all pregnancies exposed to an ART regimen containing RAL or EVG resulting in livebirth, stillbirth and induced abortion with an expected date of delivery between September 2008 and April 2018. Pregnancies were stratified into three groups of earliest exposure. RESULTS: A total of 908 pregnancies were exposed to a RAL or EVG-based regimen (875 to RAL and 33 to EVG). There were 886 live-born infants exposed to RAL, eight pregnancies ended in stillbirth and nine in induced abortions. Among the 886 live-born infants there were 23 (2.59% 95% CI 1.65, 3.86) reported congenital anomalies, two nervous system defects but no reported NTDs. Of the 33 pregnancies exposed to EVG, 31 resulted in live-born infants with no congenital anomaly and the remaining two pregnancies ended in induced abortion. CONCLUSIONS: The prevalence of congenital anomalies is consistent with national population estimates for 2008-2016 in the UK. More data are needed on safety of RAL and EVG in pregnancy

Patient safety culture in hospitals of Iran: A systematic review and meta-analysis

Background: Nowadays, for quality improvement, measuring patient safety culture (PSC) in healthcare organizations is being increasingly used. The aim of this study was to clarify PSC status in Iranian hospitals using a meta-analysis method. Methods: Six databases were searched: PubMed, Scopus, Google Scholar, Cochrane Library, Magiran, SID and IranMedex using the search terms including patient safety, patient safety culture, patient safety climate and combined with hospital (such as "hospital survey on patient safety culture"), measurement, assessment, survey and Iran. A total of 11 articles which conducted using Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire initially were reviewed. To estimate overall PSC status and perform the meta-analyses, Comprehensive Meta-Analysis (CMA) software v. 2 was employed. Results: The overall PSC score based on the random model was 50.1. "Teamwork within hospital units" dimension received the highest score of PSC (67.4) and "Non-punitive response to error" the lowest score (32.4). About 41 of participants in reviewed articles evaluate their hospitals' performance in PSC as 'excellent/very good'. Approximately 52.7 of participants did not report any adverse event in the past 12 months. Conclusion: The results of this study show that Iranian hospitals' performances in PSC were poor. Among the 12 dimensions of HSOPSC questionnaire, the "Non-punitive response to error" achieved the lowest score and could be a priority for future interventions. In this regard, hospitals staff should be encouraged to report adverse event without fear of punitive action

HIV treatment in pregnancy

Almost 25 years since antiretroviral therapy (ART) was first shown to prevent mother-to-child transmission of HIV, 76% of pregnant women living with HIV (over 1 million women) receive ART annually. This number is the result of successes in universal ART scale-up in low-income and middle-income countries. Despite unprecedented ART-related benefits to maternal and child health, challenges remain related to ART adherence, retention in care, and unequal access to ART. Implementation research is ongoing to understand and to address obstacles that lead to loss to follow-up. The biological mechanisms that underlie observed associations between antenatal ART and adverse outcomes in pregnancy and birth are not completely understood, with further research needed as well as strengthening of the systems to assess safety of antiretroviral drugs for the mother and HIV-exposed child. In the treat-all era, as duration of treatment and options for ART expand, pregnant women will remain a priority population for treatment optimisation to promote their health and that of their ART-exposed children

The Swiss STAR trial - an evaluation of target groups for sexually transmitted infection screening in the sub-sample of men.

OBJECTIVES In Switzerland, universal health insurance does not cover any routine testing for sexually transmitted infections (STIs), not even in individuals at high risk, and extra-genital swabbing is not standard of care. We determined the prevalence and incidence of human immunodeficiency virus (HIV), viral hepatitis and non-viral STIs in a multicentre prospective observational cohort of multi-partner men who have sex with men (MSM) and other men. MATERIALS AND METHODS Between January 2016 and June 2017, we offered free STI testing to all men with multiple  sexual partners (three or more in the previous 12 months), with follow-up examinations every 6 months. We used multiplex polymerase chain-reaction testing (for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma genitalium) on pooled swabs (pharynx, urethra/vagina, anus), and antibody tests for HIV and Treponema pallidum at every visit, and for hepatitis B/C at baseline. RESULTS We screened 779 multi-partner MSM and 92 other men. Previously undiagnosed HIV was found in 0.5% vs 0.0%, respectively and T. pallidum antibodies in 15.3% vs 1.1%. STIs requiring antibiotic treatment comprised: active syphilis 1.7% vs 0.0%; N. gonorrhoeae 10.3% vs 0.0%; C. trachomatis 8.7% vs 1.1%. One in four MSM versus 1 in 100 other multi-partner men had any of these three STIs at baseline. 10.4% vs 1.3% had a history of hepatitis B, 31.9% vs 47.3% had no immunity (HBs-AB <10 IU/l). Ten MSM had HCV antibodies (1.4%), with 8 out of the 10 being MSM with HIV; HCV seroprevalence was 0.3% among HIV-negative MSM. In MSM, incidence of the three bacterial STIs was 25.5 per year over 333 person years of follow-up, HIV incidence was 0.3%. Non-condom-use (in the last 3 months) for anal/vaginal sex was not associated with STIs. Independent risk factors were sex with men (adjusted odds ratio [aOR] 16.4) and the number of sexual partners (aOR 2.3 for >20). CONCLUSION Among MSM, but not among other multi-partner men, STIs, mostly asymptomatic, are common. Given the high risk of onward transmission, low-cost or free routine screening of multi-partner MSM is a public health priority

Systematically missing confounders in individual participant data meta-analysis of observational cohort studies.

One difficulty in performing meta-analyses of observational cohort studies is that the availability of confounders may vary between cohorts, so that some cohorts provide fully adjusted analyses while others only provide partially adjusted analyses. Commonly, analyses of the association between an exposure and disease either are restricted to cohorts with full confounder information, or use all cohorts but do not fully adjust for confounding. We propose using a bivariate random-effects meta-analysis model to use information from all available cohorts while still adjusting for all the potential confounders. Our method uses both the fully adjusted and the partially adjusted estimated effects in the cohorts with full confounder information, together with an estimate of their within-cohort correlation. The method is applied to estimate the association between fibrinogen level and coronary heart disease incidence using data from 154,012 participants in 31 cohort

Structural stability and magnetic properties of Mn2FeAl alloy with a β-Mn structure

The synthesized Mn2FeAl alloys crystallize in a geometrically frustrated cubic β-Mn structure (space group: P4132) with an antiferromagnetic ordering whereas the previous theoretical findings suggest for a Heusler structure (L21: regular and X: inverse). The experimental stability of the structure is verified by electronic structure calculations performed for various arrangements of Mn, Fe and Al atoms in the β-Mn-type crystal structure. When compared the energy of the β-Mn structure with the energy of L21 and X type structures, it is found that for an expansion of the lattice volume β-Mn structure becomes more preferable in total energy than L21 and X-type structures. The calculated theoretical equilibrium lattice parameter value for the β-Mn2FeAl is within the accuracy of the experimental value obtained in this work. Additional DFT + U calculations for the optimized crystal structure of the β-Mn2FeAl revealed that the electronic correlations in the Mn ions result in the increased total magnetic moment. In the X type structure, Mn2FeAl is a half metal, whereas the disordered arrangement of atoms in the β-Mn structure leads to the closure of the semiconductor gap. The β- Mn2FeAl alloys exhibit antiferromagnetic ordering (TN ≈ 42 K), which is in excellent agreement with our electronic structure calculations. The detailed analysis of the magnetic and heat capacity measurements suggests a short-range magnetic ordering in the Mn2FeAl alloys. Owing to the strong antiferromagnetic spin fluctuation caused by the geometric frustration in β-Mn, a large enhancement in the electronic heat capacity is noticed. Mn2FeAl shows the characteristic features of spin glass as verified from the frequency dependent AC susceptibility analysis using critical power law and Vogel-Fulcher law. To the best of our knowledge, this is the first ever report on the theoretically predicted lowest ground state configuration for Mn2FeAl with a β-Mn structure and the experimental realization of spin glass features in this geometrically frustrated antiferromagnet. © 2020 Elsevier B.V.Department of Science and Technology, Ministry of Science and Technology, India, डीएसटी: - SB-FTP/PS097/2014, no-INT/ RUS / RFBR /379; University Grants Committee, UGC: F.30-49/2014; Science and Engineering Research Board, SERB; Russian Foundation for Basic Research, РФФИ: 19-52-45008, 20-02-00234; Inter-University Accelerator Centre, IUAC: UFR 57318; AAAA-A18-118020190098-5This work is financially supported by SERB -DST, New Delhi, India (Grant no - SB-FTP/PS097/2014 ) and DST New Delhi, India (Grant no-INT/ RUS / RFBR /379). The financial assistance provided by IUAC, New Delhi, India through Grant No. UFR 57318 and UGC, India Grant No. F. 30-49/2014 (BSR) is also acknowledged. Theoretical studies of β-Mn 2 FeAl are supported by the Russian Foundation for Basic Research (project nos. 19-52-45008 and 20-02-00234 ), theoretical studies of L2 1 , X-Mn 2 FeAl are supported by the state assignment of Minobrnauki of Russia (theme “Electron” No. AAAA-A18-118020190098-5).This work is financially supported by SERB-DST, New Delhi, India (Grant no- SB-FTP/PS097/2014) and DST New Delhi, India (Grant no-INT/RUS/RFBR/379). The financial assistance provided by IUAC, New Delhi, India through Grant No. UFR 57318 and UGC, India Grant No. F.30-49/2014(BSR) is also acknowledged. Theoretical studies of ?-Mn2FeAl are supported by the Russian Foundation for Basic Research (project nos. 19-52-45008 and 20-02-00234), theoretical studies of L21, X-Mn2FeAl are supported by the state assignment of Minobrnauki of Russia (theme ?Electron? No. AAAA-A18-118020190098-5)

The Swiss STAR trial – an evaluation of target groups for sexually transmitted infection screening in the sub-sample of women

OBJECTIVES: In Switzerland, universal health insurance does not cover any routine testing for sexually transmitted infections (STIs), not even in individuals at high risk, and extra-genital swabbing is not standard of care. We compared STI prevalence in a multicentre prospective observational cohort of multi-partner women with/without sex work and evaluated associated risk factors. MATERIALS AND METHODS: Between January 2016 and June 2017, we offered free STI testing to women with multiple sexual partners (three or more in the previous 12 months), with follow-up examinations every 6 months. We used multiplex polymerase chain-reaction testing (for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma genitalium) for pooled swabs (pharynx, urethra/vagina, anus), and antibody tests for human immunodeficiency virus (HIV) and Treponema pallidum at every visit, and for hepatitis B and C at baseline. RESULTS: We screened 490 female sex workers (FSWs), including 17 trans women, and 92 other multi-partner women. More than half reported a steady partner. Previously undiagnosed HIV was found in 0.2% vs 0.0%, respectively, and T. pallidum antibodies in 5.9% vs 0.0%. STIs requiring antibiotic treatment comprised: active syphilis 1.2% vs 0.0%; N. gonorrhoeae 4.9% vs 0.0%; C. trachomatis 6.3% vs 5.4%, T. vaginalis 10.4% vs 0.0%; M. genitalium 6.7% vs 6.5%. One in four FSWs vs one in nine other women had one or more of these STIs at baseline. 15.8% vs 3.8% had a history of hepatitis B, 45.5% vs 22.8% had no immunity (HBs-AB <10 IU/l). Two FSWs had hepatitis C virus antibodies (0.4%) without concurrent HIV infection. Non-condom-use (last three months) for anal/vaginal sex was not associated with STIs. Independent risk factors were group sex (adjusted odds ratio [aOR] 2.1, 95% confidence interval [CI] 1.1–4.0), age less than 25 (aOR 3.7, 95% CI 1.6–8.9), and being active in sex work for less than 1 year (aOR 2.7, 95% CI 1.3–5.3). CONCLUSION: HIV and HCV do not appear to pose a major public health problem among FSWs in Switzerland, whereas vaccination against HBV should be promoted. FSWs showed high rates of STIs requiring treatment to reduce transmission to clients and/or steady partners. FSWs should be offered low-cost or free STI screening as a public health priority

Genotyping Performance between Saliva and Blood-Derived Genomic DNAs on the DMET Array: A Comparison

The Affymetrix Drug Metabolism Enzymes and Transporters (DMET) microarray is the first assay to offer a large representation of SNPs conferring genetic diversity across known pharmacokinetic markers. As a convenient and painless alternative to blood, saliva samples have been reported to work well for genotyping on the high density SNP arrays, but no reports to date have examined this application for saliva-derived DNA on the DMET platform. Genomic DNA extractions from saliva samples produced an ample quantity of genomic DNA for DMET arrays, however when human amplifiable DNA was measured, it was determined that a large percentage of this DNA was from bacteria or fungi. A mean of 37.3% human amplifiable DNA was determined for saliva-derived DNAs, which results in a significant decrease in the genotyping call rate (88.8%) when compared with blood-derived DNAs (99.1%). More interestingly, the percentage of human amplifiable DNA correlated with a higher genotyping call rate, and almost all samples with more than 31.3% human DNA produced a genotyping call rate of at least 96%. SNP genotyping results for saliva derived DNA (n = 39) illustrated a 98.7% concordance when compared with blood DNA. In conclusion, when compared with blood DNA and tested on the DMET array, saliva-derived DNA provided adequate genotyping quality with a significant lower number of SNP calls. Saliva-derived DNA does perform very well if it contains greater than 31.3% human amplifiable DNA

Development of a digital research assistant for the management of patients\u2019 enrollment in oncology clinical trials within a research hospital

Clinical trials in cancer treatment are imperative in enhancing patients\u2019 survival and quality of life outcomes. The lack of communication among professionals may produce a non-optimization of patients\u2019 accrual in clinical trials. We developed a specific platform, called \u201cDigital Research Assistant\u201d (DRA), to report real-time every available clinical trial and support clinician. Healthcare professionals involved in breast cancer working group agreed nine minimal fields of interest to preliminarily classify the characteristics of patients\u2019 records (including omic data, such as genomic mutations). A progressive web app (PWA) was developed to implement a cross-platform software that was scalable on several electronic devices to share the patients\u2019 records and clinical trials. A specialist is able to use and populate the platform. An AI algorithm helps in the matchmaking between patient\u2019s data and clinical trial\u2019s inclusion criteria to personalize patient enrollment. At the same time, an easy configuration allows the application of the DRA in different oncology working groups (from breast cancer to lung cancer). The DRA might represent a valid research tool supporting clinicians and scientists, in order to optimize the enrollment of patients in clinical trials. User Experience and Technology The acceptance of participants using the DRA is topic of a future analysis