Summary In patients with sickle cell anaemia (SCA), concomitant glucose‐6‐phosphate dehydrogenase (G6PD) deficiency is usually described as having no effect and only occasionally as increasing severity. We analysed sequential clinical and biological data for the first 42 months of life in SCA patients diagnosed by neonatal screening, including 27 G6PD‐deficient patients, who were matched on sex, age and parents' geographic origin to 81 randomly selected patients with normal G6PD activity. In the G6PD‐deficient group, steady‐state haemoglobin was lower (−6·2 g/l, 95% confidence interval (CI), [−10·1; −2·3]) and reticulocyte count higher (247 × 109/l, 95%CI, [97; 397]). The acute anaemic event rate was 3 times higher in the G6PD‐deficient group (P < 10−3). A higher proportion of G6PD‐deficient patients required blood transfusion (20/27 [74%] vs. 37/81 [46%], P < 10−3), for acute anaemic events, and also vaso‐occlusive and infectious events. No significant between‐group differences were found regarding the rates of vaso‐occlusive, infectious, or cerebrovascular events. G6PD deficiency in babies with SCA worsens anaemia and increases blood transfusion requirements in the first years of life. These effects decrease after 2 years of age, presumably as the decline in fetal haemoglobin levels leads to increased sickle cell haemolysis and younger red blood cells with higher G6PD activity.

The mature Raillietina (Raillietina) baeri spermatozoon exhibits an apical cone of electron-dense material about 2.5 microm long and 0.5 microm wide and two helicoidal crest-like bodies roughly 100-125 nm thick. The latter are of different lengths, spiralized and stand in an angle of about 50 degrees with the spermatozoon axis. The axoneme is of the 9 + "1" pattern and does not reach the posterior extremity of the gamete. The nucleus is an electron-dense cord coiled in a spiral around the axoneme. The cytoplasm exhibits a posterior densification and contains few small electron-dense granules in regions I, II and V of the spermatozoon. In regions III and IV, it is divided into irregular compartments by walls of electron-dense material. The cortical microtubules are spiralized and make an angle of 40-50 degrees to the spermatozoon axis. In this work, we describe, for the first time, a spermatozoon of a davaineidaean cestode parasitic of mammals. This has enabled us to show a wide apical cone, which has never been described before in a cyclophyllidean species the spermatozoon of which has two crest-like bodies.

Despite having the largest antiretroviral treatment (ART) program in the world, only 14% of South African adolescents living with HIV (ALWH) are on ART. The purpose of this study was to identify aspects of the clinic environment that either improve or inhibit ALWH's ability to engage in HIV care. We conducted fifty-nine semi-structured, in-depth interviews with ALWH (n=20; 13-19 years of age), their caregivers (n=19), and local stakeholders (n=20) in Cape Town, South Africa. Data were coded and analyzed using inductive and deductive approaches to content analyses. Codes were grouped into positive and negative aspects of the HIV clinic environment, and into suggestions on how clinic practices could be improved to facilitate ALWH treatment retention and ART adherence. Positive clinic factors included: community co-location; familiarity with clinic staff; and adolescent only/adolescent-friendly clinic spaces. Negative clinic factors included: clinic visit frequency; overcrowding and long wait times; discrimination and stigma; lack of confidentiality; inflexible appointment-scheduling; and staff attitudes. ALWHs' clinic experiences affect their ability to remain in care and adhere to their treatment regimens. These findings support a call for innovative approaches that improve ALWH's clinic experiences and support them as they progress along the HIV treatment cascade.

Introduction African Americans (AA) compared to European Americans (EA) have poorer stage specific survival from colorectal cancer (CRC). Recent reports have indicated that the racial difference in survival has worsened over time, especially among younger patients. To better characterize this association, we used population-based SEER registry data to evaluate the impact of race on stage IV CRC survival in patients < 50 and ≥ 50. Patients and Methods The population was comprised of 16,782 patients diagnosed with stage IV colon and rectal adenocarcinoma between 01 January 2004 and 31 December 2011. Cox proportional hazards regression was used to evaluate the association between race and other prognostic factors and the risk of death in each age group. Results Younger AAs compared to EAs had a higher prevalence of proximal CRC at diagnosis, a factor associated with significantly higher risk of death in both races. Among patients < 50 years of age, AAs had a higher risk of death compared to EAs (HR 1.35, 95% CI 1.20 to 1.51)), which was attenuated in patients ≥ 50 years of age (HR 1.10, 95% CI 1.04 to 1.16); p for interaction 0.01. Conclusion The results revealed poor overall survival in AA compared to EA, especially in those < 50 years of age. The higher prevalence of proximal CRC at diagnosis among younger aged AA (vs. EA) may contribute to the racial difference in survival. Future studies will be needed to understand how colonic location impacts the efficacy of treatment regimens.

The mature Bothriocephalus claviceps spermatozoon is filiform and tapered at both extremities. It contains two axonemes of unequal lengths of the 9+"1" pattern of the trepaxonemata. The anterior extremity exhibits an apical cone of an electron-dense material about 6.6 microm long by 0.2 microm wide at its base and a crest-like body making an angle of about 40 degrees with the spermatozoon axis. It is spiralized around the whole extremity of the spermatozoon. The nucleus is a cord of electron-dense material that interposes itself between the two axonemes. The cortical microtubules are of two types: hollow-centred and electron-dense centred. The cytoplasm is slightly electron dense and contains numerous electron-dense granules in regions III, IV, and V of the spermatozoon. The anterior and posterior extremities of the spermatozoon contain a single axoneme. The presence of an apical cone of the electron dense material has never, to our knowledge, been reported in the Pseudophyllidea. In addition, we show for the first time the existence of a crested body in the Bothriocephalidae.

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BackgroundThe long-term benefits of antiretroviral treatment (ART) are associated with metabolic complications, especially lipodystrophy, which has been well described among HIV-infected adults and children on ART in developed settings. Specifically, stavudine, and to a lesser extent zidovudine and protease inhibitors (PI), have been consistently implicated in the development of lipodystrophy. In 2006, following advice from the WHO, Senegal began phasing out stavudine from first-line ART. The objectives of this cross-sectional analysis are to assess and identify risk factors affecting the prevalence of lipodystrophy in Senegalese children and adolescents on long-term ART participating in a cohort study.MethodsLipodystrophy was clinically assessed in two- to 18-year-old children on ART for at least six months and with no concurrent severe acute malnutrition. Risk factors for lipodystrophy were identified using stepwise multivariable logistic regression. Explanatory variables included clinical and personal data, immunovirologic status, and therapeutic history.ResultsOverall, 254 children were assessed for lipodystrophy. The median age was 10.9 years (IQR: 8.1–14.2) and the median duration on ART was 54 months (32–84). Only 18% had been previously treated with stavudine, with a median treatment duration of 8 months (5–25). Ongoing treatment included 76% of children receiving zidovudine (median duration of 48 months (26–74)) and 27% receiving PI (lopinavir/ritonavir; median duration of 49 months (23–59)). Mild signs of lipodystrophy were observed in 33 children (13%): 28 with lipoatrophy, 4 with lipohypertrophy and one with combined type. Boys were more likely to present with lipoatrophy than girls (aOR: 4.3, 95% CI: 1.6–11.7). Children previously treated with stavudine for ≥1 year had a greater risk for lipoatrophy than those never exposed (3.8, 1.0–14.0), although the association was weak. There was no association between lipodystrophy and age or current or cumulative treatment with lopinavir/ritonavir or zidovudine.ConclusionsWe report low prevalence of mild lipodystrophy in children and adolescents on long-term ART receiving a stavudine-sparing regimen. These findings are reassuring for clinicians in low-income settings where zidovudine is massively prescribed and lopinavir/ritonavir is the only widely available PI.Trial registrationClinicalTrials.gov identifier: NCT01771562 (registration date: 01/18/2013).