Accelerating HIV epidemic control in Benue state, Nigeria, 2019-2021: the APIN program experience.

Introduction: As at 2019, Nigeria was ranked the fourth highest HIV burden in the world. There is varied geographical HIV prevalence in Nigeria. The progress made is inequitable across geographical locations and sub-populations (18). Benue state has the second highest HIV prevalence in Nigeria. In 2018, about 35,623 people living with HIV (PLHIV) were yet to commence antiretroviral treatment (ART) in the state, accounting for an estimated ART coverage gap of 11% out of the combined gap of 320,921 in the country. To close this gap, the Benue ART surge (BAS) was implemented. The aim of this study was to describe the BAS strategic approaches and demonstrate progress in expanding ART access for PLHIV in Benue State, Nigeria. Methods: BAS was implemented in 252 health facilities from May 2019 to September 2021. Data were collected and reported using an Excel-based dashboard and electronic medical records. The trend of HIV case identification, ART initiation, viral load suppression rate, and rate of interruption in treatment during the BAS period was then described and analyzed. Results: Out of 893,462 clients reached, 6.7% (n = 60,297) were diagnosed with HIV and 99.8% (n = 60,236) were initiated on ART. HIV case identification per month increased by 467% from 650 at baseline to a peak of 3685 in August 2020, and then declined by 35% to 2380 in September 2021. All new HIV-infected patients (100%) were linked to ART. Viral load testing coverage and viral load suppression rate increased from 30% (43,185/126,004) and 84% (n = 36,165/43,185) at baseline to 95% (n = 193,890/204,095) and 96% (185,785/193,890), respectively. Conclusion: Implementation of the BAS improved access to comprehensive HIV services in Benue State. The increase in HIV case identification and ART initiation significantly reduced the HIV treatment gap in the state. To fast track the attainment of UNAIDS 95-95-95 goals, lessons learnt from the BAS should be adapted and scaled up in the national HIV program in Nigeria.

'It stays with me': the experiences of second- and third-year student nurses when caring for patients with cancer.

Little is known about student nurses experiences of nursing patients with cancer in the UK. With the increasing survival of people with cancer and with cancer no longer seen as a terminal illness it is useful to understand student nurses clinical experience when nursing those with cancer. This study takes a phenomenological approach involving three focus group interviews with 20 student nurses from the second and third year of their course in one centre in the UK. All the students had experience of caring for patients with cancer. The key themes emerging from the study were: Communication, Impact on Self, Lack of Support and End-of-Life-Care. Students emphasised the need to have more knowledge and support in relation to cancer care. They describe how they lack communication skills and found it difficult to handle their emotions. A number of students found the whole experience of caring for patients with cancer emotionally distressing and draining and they describe avoiding contact with these patients by using distancing and avoidance strategies. Student nurses need additional support through demystifying cancer, using reflective practice and good mentoring in the clinical area to enable students to feel supported, and develop confidence in their capacity for care for people with cancer.

Diabetes in older adults: experience from a rural community in south-east Nigeria

Diabetes is increasing globally with low- and middleincome countries bearing the greatest burden and the older population most affected. This study sought to highlight the problem of diabetes among older adults who participated in a health programme in a rural community. Fasting blood glucose levels and blood pressure of 147 people, aged between 40 years and above, in a rural community in south-east Nigeria were measured. The mean age of participants was 62±10y (1.SD) Thirty-seven (25.2%) were diabetic, 16 (43%) of which were undiagnosed. Most (67%) were aged 50 to 69 years. Twelve (8.2%) had impaired fasting glycaemia (IFG), of which 83% were aged 60 to 79 years. Male gender was moderately associated with the risk of diabetes, while family history was strongly associated. Twenty-five (67%) of the 37 diabetic patients were hypertensive, and only one (5%) of the 21 with known diabetes had a fasting glucose <7.0 mmol/L. This report showed a high prevalence of undiagnosed diabetes and impaired fasting glycaemia among these participants in a rural health programme. There is a strong implication for robust studies to validate these findings and an urgent need to improve access to healthcare for rural dwellers

Three-dimensional (3-D) imaging in post-mortem examinations: elucidation and identification of cranial and facial fractures in victims of homicide utilizing 3-D computerized imaging reconstruction techniques.

The analysis of cranial and facial fractures in skeletal remains of homicidal victims can prove challenging for forensic anthropologists and forensic pathologists in postmortem examination. In such cases, the use of 3-D computerized imaging to elucidate the fractures and patterns of injuries can provide strong medical evidence that is very useful during litigation and at trial. The authors describe 3-D reconstructions of the skull performed as part of forensic postmortem examination in a recent victim of homicide.

An analysis and report of custodial deaths in Nebraska, USA.

All medico-legal cases from the Lancaster County Coroner's Office in Lincoln, Nebraska USA, between 1991 and 1996, were reviewed for deaths which occurred in custody. The leading causes of death, in ranked order include: natural 45.1% (23/51), suicide 33.3% (17/51), homicide 11.8% (6/51), accident 7.8% (4/51), and undetermined 2% (1/51). Each cause of death was explored using the following variables: cause of death, age, sex, and race of the decedents. The findings of this investigation are compared with previous studies in other geographic regions of the country. Many similarities and differences in the frequencies of the modes of death are discussed. In addition, six unusual case studies including one accidental death, one homicide, and four suicides are presented and may serve as a reference for pathologists, forensic physicians and other forensic scientists confronted with aberrant cases.

Regulation of uveal sympathetic neurotransmission by peroxides.

PURPOSE: To investigate the effect of naturally occurring and synthetic peroxides on norepinephrine release from isolated iris-ciliary bodies of several mammalian species. METHODS: Hemiirides (bovine) and iris-ciliary bodies (human, rabbit, and rat) were incubated in Krebs solution containing [3H]-norepinephrine ([3H]NE) for 60 minutes. After incubation, tissues were set up for studies of [3H]NE release using the superfusion method. Release of [3H]NE was elicited through electrical field stimulation. RESULTS: In bovine irides, hydrogen peroxide (H2O2), cumene hydroperoxide (cuOOH), and tert-butyl hydroperoxide (buOOH) caused a concentration-dependent potentiation of field-stimulated [3H]NE release with the following rank order of potency: cuOOH > H2O2 > buOOH. Furthermore, the free radical scavenger, melatonin (2 mM), prevented the enhancement of evoked [3H]NE overflow elicited by H2O2 and cuOOH. At equimolar concentrations, H2O2 (1 mM) increased stimulated [3H]NE release from rabbit, human (mean age, 29.7; range, 15 to 48 years), and Fischer 344 rat (4 months old) iris-ciliary bodies by 98%, 50%, and 40%, respectively. However, H2O2 (1 mM) caused a 9% increase in evoked [3H]NE release in tissue from aged Fischer 344 rats (30 months old) and a 5% decrease in neurotransmitter release in tissue from old human donors (mean age, 72.3 years; range, 69 to 74 years). CONCLUSIONS: Peroxides such as H2O2 can potentiate sympathetic neurotransmission in the anterior uvea of several mammalian species. In bovine irides, H2O2-induced enhancement of neurotransmitter release can be mimicked by synthetic peroxides and may involve the generation of reactive oxygen species.

Malignant oncocytoma of the maxillary sinus--an ultrastructural study.

A unique case of a malignant oncocytoma of the maxillary sinus is reviewed in detail. The ultrastructural findings are presented. The histologic and ultrastructural criteria that characterize oncocytes and the clinicopathologic features of benign and malignant oncocytomas are discussed. This case represents the eleventh reported case that would truly qualify as a malignant oncocytoma of the paranasal sinuses.

Ultrastructural and immunohistochemical investigations of the giant cells in nodular fasciitis.

The giant cells of histologically typical cases of nodular fasciitis were studied by electron microscopy and immunohistochemistry. Ultrastructurally, these cells were found to be similar to the adjacent spindle and large fibroblast-like cells in many ways. These giant cells exhibited numerous intracytoplasmic, well-formed longitudinally oriented bundles of myofilaments and hemi-desmosome-like structures with associated basement membrane-like material, abundant endoplasmic reticulum, and numerous dense bodies. The observed myofilaments did not show beading or Z-line formation. Immunohistochemical staining by means of the indirect peroxidase-antiperoxidase technique failed to localize the proven antigenic markers of histiocytes within the giant cells. The results support the concept that the giant cells in nodular fasciitis are of myofibroblastic origin. It is thus proposed that these giant cells are neither histiocytes nor rhabdomyoblasts as previously thought, but are rather modified fibroblasts ("myofibroblasts").

Sulfuric acid poisoning.

Deliberate ingestion of a corrosive acid is an unusual manner of death. Sulfuric acid, often used in electrical industry, chemical laboratories, and agriculture, is fatal at a dosage of 3.5-7.0 ml. The mortality rate is quite high, with only 35% recovery rate. Poisoning by sulfuric acid resembles other mineral acids in that the esophagus is more commonly spared while coagulative necrosis of the stomach is often apparent. A case involving the ingestion of sulfuric acid by a patient with a history of chronic psychiatric illness is presented. The pathological, clinical, and toxicological aspects of this case are discussed.

Cholecystitis and cholelithiasis in children and adolescents.

One hundred patients aged 20 years and younger, admitted to Hurley Medical Center during a ten-year period for treatment of acute or chronic cholecystitis with or without cholelithiasis, were reviewed. Results demonstrated an increasing incidence of pediatric cases compared with previous reports, a predominance in parous teenagers, and only an 8 percent association with hemolytic diseases. The clinical presentation is very similar to that of adults. Maintaining a high index of suspicion in addition to the use of diagnostic aids such as cholecystogram, ultrasonography, and hepatobiliary imaging with technetium 99m PIPIDA (paraisopropylacetanilide iminoacetate) should lead to the diagnosis of gallbladder disease even at a very early age. Elective cholecystectomy in the stable patient is the treatment of choice, and any delays in the diagnosis and treatment will increase morbidity and mortality considerably.

Asymmetric septal hypertrophy of the heart. New findings concerning the possible etiology of sudden deaths in five males.

This report describes certain interesting postmortem findings in the hearts of five subjects who died suddenly, silently, and unexpectedly, and in whom the only significant abnormality at autopsy was asymmetric septal hypertrophy (ASH) of the heart. Deep clefts, cystic faults, and dilated vascular channels were not only seen within the septal myocardium in all the hearts, but also within the left ventricular free walls of two hearts. The septal myocardium and the left ventricular free walls of two hearts and the A-V node and His bundle of one heart demonstrated mural and luminal thrombi of several dilated vascular channels. In another heart, foci of cardiocytic myofibrillar degeneration were seen, especially close to narrowed small coronary vessels. Fetal dispersion and fibrosis of the A-V node and His bundle were evident in one heart. These abnormalities in the conducting system and the ventricular myocardium suggest that the hearts of subjects with ASH are not only excellent anatomic substrates for lethal arrhythmias, but also are bound to be hemodynamically impaired. We believe that conditions such as hypoxia, increased oxygen demand by the heart or abnormal sympathetic stimulus may easily trigger fatal arrhythmias in such individuals, thereby causing sudden death.

A fatal maprotiline intoxication.

A fatal maprotiline intoxication is presented. The postmortem anatomical and toxicologic findings are discussed, as is the mechanism of maprotiline toxicity. This report is, to the best of our knowledge, the sixth fatal maprotiline poisoning in the medical literature.

Testicular gonadal stromal (Sertoli cell) tumor.

Eighty-one cases of testicular gonadal stromal tumor have been reported in the literature. An additional case is herein reported. The pathologic, immunohistologic, and histogenetic aspects are presented.

Invasive pituitary oncocytoma.

A large invasive pituitary neoplasm, surgically resected by left frontotemporal craniotomy, and thought to represent "chromophobe" adenoma by light microscopy, exhibited ultrastructural features characteristic of oncocytoma. Electron microscopic and immunocytochemical studies showed that the tumor did not possess enhanced secretory activity. The indispensable role of electron microscopy in the identification of this rare neoplasm and especially in the classification of all pituitary tumors is emphasized.

Marked concomittant elevations in serum creatine kinase and lactic dehydrogenase in a patient with bowel necrosis.

We report what we believe to be the first proven marked concomittant elevations in serum creatine kinase (CK) and lactic dehydrogenase (LD) in a patient with bowel necrosis. The necrosis was the result of infarction secondary to bowel strangulation. The serum from this patient showed elevation of total CK activity resulting from an abnormal amount of MM, MB, and BB isoenzymes with LD2, LD3, and LD5 yielding 18 per cent, 19 per cent, and 29 per cent, respectively, of the total LD activity.

Ultrastructural features of cerebral amyloid angiopathy.

Ultrastructural studies of the brain in three cases of cerebral amyloid angiopathy demonstrated that the vascular amyloid in this disease is composed of fibrils identical to those in systemic amyloid disease, mixed with a large amount of vesicular debris. Amyloid appears to be derived from circulating protein and is depostied in areas of vascular basement membrane degeneration. The initiating degenerative change is thickening of basement membrane with accumulation of debris. Inflammation, when present, tends to accelerate amyloid deposition locally. Amyloid transport from the vascular wall into the brain parenchyma proceeds by overflow when perivascular astroglial end-feet are disarranged. Structures of perivascular amyloid plaques are similar to the neuritic (senile) plaques in Alzheimer's disease, which were used as control, except that the amyloid core of the plaques in Alzheimer's disease is not related to blood vessels.