Review of adipocere formation on decomposing bodies

Decomposition is a process that occurs in a body after death involving the breakdown of organic matter. Decomposition is influenced by a range of factors that act together with the general outcome being the complete degradation of a body. Adipocere formation is a disruption of the typical decomposition process with the final result being the preservation of remains, human or animal. Adipocere arises from the decomposition of adipose tissue within the body. Adipocere is composed mostly of saturated fatty acids with hydroxy fatty acids, oxo fatty acids and fatty acid salts formed as by‐products. The mechanism of formation is not fully understood although several theories have been proposed. Adipocere is not an end product and will degrade under the right circumstances, mainly exposure to aerobic conditions and may also be consumed by macrofauna. The environments adipocere has been found in have been studied to elucidate the many factors that may influence formation. Water, soil, and dry environments are all capable of producing conditions conducive to adipocere formation. The main factors known to promote formation in all environments are an anaerobic environment, sufficient adipose tissue, warm temperatures, a mildly alkaline pH, bacteria and moisture. Adipocere may form partially within the soft tissues or they may turn completely into adipocere, preserving the internal organs and bones which may also form adipocere. Formation can occur in as little as a day or form over many years. Studying adipocere formation is important in forensic science as it may aid forensic professionals in their casework in terms of post‐mortem interval and ause/manner of death determination and comparison between similar, previously reported cases and a current case may be useful in aiding the process of the investigation. Additional research is needed in the area of adipocere degradation as there is little literature on it. The determination of the post‐mortem interval is complicated by adipocere formation and there is still not a reliable way to estimate it in bodies with adipocere formation

How have ART treatment programmes changed the patterns of excess mortality in people living with HIV? Estimates from four countries in East and Southern Africa

Background: Substantial falls in the mortality of people living with HIV (PLWH) have been observed since the introduction of antiretroviral therapy (ART) in sub-Saharan Africa. However, access and uptake of ART have been variable in many countries. We report the excess deaths observed in PLWH before and after the introduction of ART. We use data from five longitudinal studies in Malawi, South Africa, Tanzania, and Uganda, members of the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA). Methods: Individual data from five demographic surveillance sites that conduct HIV testing were used to estimate mortality attributable to HIV, calculated as the difference between the mortality rates in PLWH and HIV-negative people. Excess deaths in PLWH were standardized for age and sex differences and summarized over periods before and after ART became generally available. An exponential regression model was used to explore differences in the impact of ART over the different sites. Results: 127,585 adults across the five sites contributed a total of 487,242 person years. Before the introduction of ART, HIV-attributable mortality ranged from 45 to 88 deaths per 1,000 person years. Following ART availability, this reduced to 14–46 deaths per 1,000 person years. Exponential regression modeling showed a reduction of more than 50% (HR =0.43, 95% CI: 0.32–0.58), compared to the period before ART was available, in mortality at ages 15–54 across all five sites. Discussion: Excess mortality in adults living with HIV has reduced by over 50% in five communities in sub-Saharan Africa since the advent of ART. However, mortality rates in adults living with HIV are still 10 times higher than in HIV-negative people, indicating that substantial improvements can be made to reduce mortality further. This analysis shows differences in the impact across the sites, and contrasts with developed countries where mortality among PLWH on ART can be similar to that of the general population. Further research is urgently needed to establish why the different impacts on mortality were observed and how the care and treatment programmes in these countries can be more effective in reducing mortality further

Cryptococcal meningitis: A neglected NTD?

Although HIV/AIDS has been anything but neglected over the last decade, opportunistic infections (OIs) are increasingly overlooked as large scale donors shift their focus from acute care to prevention and earlier antiretroviral treatment (ART) initiation. Of these OIs, cryptococcal meningitis, a deadly invasive fungal infection, continues to affect hundreds of thousands of HIV patients with advanced disease each year and is responsible for an estimated 15%-20% of all AIDS-related deaths [1,2]. Yet cryptococcal meningitis ranks amongst the most poorly funded “neglected” diseases in the world, receiving 0.2% of available relevant research and development (RandD) funding according to Policy Cures’ 2016 G-Finder Report [3,4]