Management of cutaneous squamous cell carcinoma in patients with epidermolysis bullosa: best clinical practice guidelines.

This article summarizes recommendations reached following a systematic literature review and expert consensus on the diagnosis and management of cutaneous squamous cell carcinomas in people with epidermolysis bullosa. The guidelines are intended to help inform decision making by clinicians dealing with this complex complication of a devastating disease.

Loss to follow-up among infants in a study of isoniazid prophylaxis (P1041) in South Africa.

OBJECTIVE: To assess risk factors for loss to follow-up (LFU) from the IMPAACT P1041 study, an isoniazid (INH) prophylaxis study conducted in southern Africa. DESIGN: Infants in two cohorts, human immunodeficiency virus-infected (HIV+) and HIV-exposed but non-infected (HIV-), were randomized to INH or placebo for 96 weeks. LFU was evaluated at week 96. RESULTS: Of 1351 infants, 12.9% were LFU (10.4% HIV+, 14.7% HIV-); 65% of the HIV+ cohort was asymptomatic. Among HIV+ infants, large household size (>6 vs. <4 members, P = 0.035) and presence of an elder (≥55 years, P = 0.05) were associated with better retention. Although attenuated in adjusted analysis, these associations held among HIV- infants. Among HIV- infants, having a younger mother increased the risk (P = 0.008) and maternal history of TB reduced the risk of LFU, the latter by nearly 70% (P = 0.048 univariate, 0.09 adjusted). LFU was largely due to inability to contact the participant (58% HIV+, 30% HIV-), and inability to attend the clinic and withdrawal of consent (HIV-). CONCLUSIONS: Household support was an important factor in participant retention, particularly for the non-HIV-infected cohort, as young maternal age was a risk factor for LFU. Retaining study participants from this mobile population can be challenging and may warrant additional support.

Experimental infection of selected arthropods with spirurid nematodes Spirocerca lupi Railliet & Henry, 1911 and Gongylonema ingluvicola Molin, 1857.

Gongylonema ingluvicola and Spirocerca lupi are spirurid nematodes that require arthropod intermediate hosts in order to complete their life cycle. Beetles of the family Scarabaeidae are reported to serve as intermediate hosts for both these parasites. In this study selected species of beetles of the family Scarabaeidae as well as other groups of arthropods were screened for susceptibility to infection with S. lupi and G. ingluvicola. Arthropods were exposed to infective eggs of both parasites for a determined period of time and dissected/digested to determine the presence or absence of pre-infective and infective larvae. All the five species of dung beetles exposed to infection with S. lupi, namely, Pachylomerus femoralis, Scarabaeus rugosus, Gymnopleurus humanus, Kheper nigroaeneus and Anachalcos convexus were susceptible and, of the two species exposed to G. ingluvicola, only Gy. humanus was susceptible. Spirocerca lupi eggs developed in millipede species, Daratoagonus cristulatus, and remained as encysted larvae, while in Orthoporoides kyrhocephalus no development was observed. Spirocerca lupi larvae were not detected in the cricket species Gryllus assimilis, or the cockroach species Periplaneta americana, and, similarly, G. ingluvicola larvae were not detected in the millipede species O. kyrhocephalus. The difference in the susceptibility of the arthropods to the two parasite species may depend on their feeding biology.