Cognitive Impairment and the Associated Factors Among Older People in Rural Central Tanzania.

AIM: This study examined the profile of cognitive impairment and associated factors among older people in rural central Tanzania. METHODS: We conducted a cross-sectional study involving 462 community-dwelling older adults. We performed cognitive, psychosocial, and clinical assessments and face-to-face interviews with all older adults. Descriptive, bivariate and multivariate linear regression analyses were performed to determine the participant's cognitive performance and the associated factors. RESULTS: The mean cognitive score on the Identification and Intervention for Dementia in Elderly Africans cognitive test was 11.04 (SD=2.89). Per the proposed cut-off scores to define probable and possible dementia, 13.2% of the population had probable dementia and another 13.9% had possible dementia. Increase in age was associated with poor cognitive performance (ß=-0.076, 95% CI=-0.109 to -0.043, P<0.001); whereas male sex (ß=0.989, 95% CI=0.333 to 1.645, P=0.003), higher educational attainment (ß=2.575, 95% CI=0.557 to 4.594, P=0.013) and performance in instrumental activities of daily living (ß=0.552, 95% CI=0.376 to 0.729, P<0.001) were associated with higher cognitive performance. DISCUSSION: Older people in rural settings of central Tanzania have poor cognitive functions and are at high risk of further cognitive decline. Preventive and therapeutic programs for the affected older people are warranted to prevent further decline and maintain quality of life.

High incidence of poor in-hospital outcomes of term newborns with hypoxic-ischaemic encephalopathy admitted at a regional referral hospital in Dodoma, Tanzania.

AIM: Hypoxic-ischaemic encephalopathy (HIE) is one of the leading causes of neonatal deaths and neurological impairment with the highest impact in resource-limited settings. This study aimed to determine the incidence of poor in-hospital outcomes and related factors among newborns with HIE in Tanzania. METHODS: A prospective observational study in which 170 newborns with HIE (diagnosed using the Thompson clinical score) were followed from 1 September 2020 to 28 February 2021 at the neonatal ward of Dodoma Regional Referral Hospital in Dodoma, central Tanzania, until discharge or death. Clinical parameters were recorded. Multinomial logistic regression analysis was applied to determine factors associated with adverse outcomes. RESULTS: Out of 170 newborns, 44.7% (76/170) had poor outcomes (death 27.1% (46/170); neurological deficits 17.6% (30/170)). Severe HIE (Thompson score > 14) (p < 0.0001), history of aspiration (adjusted odds ratio (AOR) = 3.06, 95% confidence interval (CI) [1.170, 8.014], p = 0.0226) and 5th-min APGAR of <7 (AOR = 2.88, 95% CI [1.133, 7.310], p = 0.0262) were associated with mortality. Severe HIE, delivery at other facilities (AOR = 3.106 CI [1.158, 8.332], p = 0.0244) and abnormal heart rate (<100 or ≥160 beats/min) on admission (AOR = 3.469 [1.200, 10.030], p = 0.0216) predicted neurological impairment at discharge. CONCLUSION: Hypoxic-ischaemic encephalopathy is associated with a high incidence of poor outcomes in resource-limited settings. To improve outcomes newborns with severe HIE, history of aspiration, referred from other facilities, 5th-min APGAR score of <7 and abnormal heart rate need improved quality of neonatal care.

The influence of major depressive disorders on neurocognitive function among adults living with HIV/AIDS in a regional referral hospital in Dodoma, Tanzania.

OBJECTIVE: To determine the influence of major depressive disorders (MDD) on the cognitive function of adults living with HIV and the prevalence of neurocognitive impairment and major depressive disorders. METHODS: The study was a cross-sectional design conducted in a referral hospital in Dodoma region central Tanzania, with a sample of 397 participants attained through systematic sampling. Neurocognitive impairment was assessed by Montreal Cognitive Assessment (MoCA), while MDD was assessed using Mini International Neuropsychiatric Interview (M.I.N.I). Two-sample independent t-tests were done to compute the significance of the mean change of MoCA score between those with or without MDD. Univariate and multivariate ordinal logistic regression models were computed to determine the association between MDD and neurocognitive impairment across all cognitive domains. RESULTS: Of 397 recruited participants, 266 (66.00%) met the criteria for neurocognitive disorder and 22 (5.51%) had major depressive disorder. Participants with MDD performed significantly poorer on cognitive testing than those without MDD (mean difference = 3.74, p-value = 0.0009). Under univariate ordinal regression, impairments in the particular domains of visuospatial-executive function, attention, language, abstraction and orientation were significantly associated with MDD and abstraction (AOR: 3.922, 95% CI: 1.546-9.947, p = 0.0004) remained significant under multivariable regression. CONCLUSION: Major depressive disorder may negatively influence neurocognitive performance in both severity and pattern of presentation. Routine screening for depressive symptoms in HIV care can be beneficial for the overall patient's outcome. Systematic and well-designed studies in the area are crucial for understanding the interaction of neuropsychiatric disorders in the HIV population.

Prevalence and factors associated with substance use among HIV positive youth attending HIV care and treatment centers in Dodoma, Tanzania.

BACKGROUND: Substance use among people living with HIV is associated with poor health, social, and psychological outcomes. This study assessed the prevalence of substance use and associated factors among youth attending HIV care and treatment centers (CTCs) in Dodoma, Tanzania. METHODS: This cross-sectional study was carried out in Dodoma, Tanzania, from February to April 2020 among youth aged 15-24 attending HIV CTCs. Data was collected using sociodemographic, WHO ASSIST Version 3.0, BDI II, and SERAD questionnaires. Data analysis was done using Stata 17. Descriptive statistics were used to summarize continuous and categorical variables. Univariable and multivariable logistic regression analyses were conducted to determine factors independently associated with substance use. RESULTS: The prevalence of substance use was relatively low (6.6%). Older youth (20 to 24 years) were 2% less likely to use substances compared to the younger ones (15 to 19 years) (AOR: 0.07; 95% CI 0.01, 0.83). There were statistically significant decreasing odds of substance use with every year increase in age at HIV diagnosis (OR: 1.66; 95% CI 1.14, 2.41). Being unemployed was statistically significantly associated with decreased odds of substance use among this population (OR: 0.03; 95% CI 0.02, 0.33). Youth who had detectable viral loads were significantly more likely to use substances compared to those with undetectable viral loads (AOR: 12.9; 95% CI 1.07, 156.05). CONCLUSIONS: Despite the low prevalence of substance use found in this study, it is important to note that late age of HIV diagnosis, employment, and detectable viral load negatively impacted HIV positive youth with regards to substance use. It is recommended that CTCs emphasize routine screening for substance use among youth who have detectable viral loads.

Factors associated with depressive symptoms and suicidal ideation and behaviours amongst sub-Saharan African adolescents aged 10-19 years: cross-sectional study.

OBJECTIVE: This study aimed to determine the burden of depression, suicidal ideation and suicidal behaviour amongst adolescents at sites in six sub-Saharan African countries and examine associated risk and protective factors. METHODS: Household-based cross-sectional study involving male and female adolescents ages 10-19 years. A total of 7,662 adolescents from eight sites in six countries participated in the survey. Three sites were urban: Dar es Salaam (Tanzania), Harar (Ethiopia) and Ibadan (Nigeria); five were rural: Dodoma (Tanzania), Iganga/Mayuge (Uganda), Kersa (Ethiopia), Ningo Prampram (Ghana) and Nouna (Burkina Faso). Log-binomials models were used to estimate relative risks and confidence intervals for factors associated with depression and suicidal behaviour. This was supplemented using log-Poisson models as needed. RESULTS: The prevalence of suicidal behaviour over the last 12 months ranged between 1.2% and 12.4% in the eight sites. Depressive symptoms and suicidal ideation/behaviours were associated with older age, female sex, food insecurity, poor access to health care and substance use. Depression was strongly associated with increased risk of suicidal behaviour at two sites where the multivariate model converged: Harar, Ethiopia (RR = 3.5, 95% CI 1.8, 7.0, P < 0.05) and Ibadan, Nigeria (RR = 3.7, 95% CI 2.2, 6.3, P < 0.0001). CONCLUSIONS: Depressive symptoms and suicidal behaviour are common amongst sub-Saharan African adolescents at these 8 sites. Most factors associated with depressive symptoms are modifiable and preventable. Routine screening for depressive symptoms in services frequented by adolescents in these and similar communities would be crucial in early detection and prompt intervention.

OBJECTIF: Cette étude visait à déterminer la charge de morbidité de la dépression, des idées suicidaires et du comportement suicidaire chez les adolescents sur des sites dans six pays d'Afrique subsaharienne et examiner les facteurs de risque et de protection associés. MÉTHODES: Etude transversale réalisée auprès des ménages sur des adolescents masculins et féminins âgés de 10 à 19 ans. 7.662 adolescents de huit sites dans six pays ont participé à l'enquête. Trois sites étaient en zones urbaines: Dar es Salaam (Tanzanie), Harar (Ethiopie) et Ibadan (Nigéria); cinq étaient en zones rurales: Dodoma (Tanzanie), Iganga/Mayuge (Ouganda), Kersa (Ethiopie), Ningo Prampram (Ghana) et Nouna (Burkina Faso). Des modèles de logarithme binomial ont été utilisés pour estimer les risques relatifs et les intervalles de confiance pour les facteurs associés à la dépression et au comportement suicidaire. Cela a été complété à l'aide de modèles log-Poisson lorsque nécessaire. RÉSULTATS: La prévalence des comportements suicidaires au cours des 12 derniers mois variait entre 1,2% et 12,4% dans les huit sites. Les symptômes dépressifs et les idées/comportements suicidaires étaient associés à l'âge plus avancé, au sexe féminin, à l'insécurité alimentaire, au faible accès aux soins de santé et à la toxicomanie. La dépression était fortement associée à un risque accru de comportement suicidaire sur deux sites où il y avait une convergence dans le modèle multivarié: Harar, en Ethiopie (RR = 3,5; IC95%: 1,8-7,0; P < 0,05) et Ibadan, au Nigéria (RR = 3,7; IC95%: 2,2-6,3; P < 0,0001). CONCLUSIONS: Les symptômes dépressifs et les comportements suicidaires sont fréquents chez les adolescents africains subsahariens de ces 8 sites. La plupart des facteurs associés aux symptômes dépressifs sont modifiables et évitables. Le dépistage de routine des symptômes dépressifs dans les services fréquentés par les adolescents dans ces communautés et dans des communautés similaires serait crucial pour la détection précoce et une intervention rapide.

Incidence and predictors of post-stroke cognitive impairment among patients admitted with first stroke at tertiary hospitals in Dodoma, Tanzania: A prospective cohort study.

INTRODUCTION: Stroke survivors develop cognitive impairment, which significantly impacts their quality of life, their families, and the community as a whole but not given attention. This study aims to determine the incidence and predictors of post-stroke cognitive impairment (PSCI) among adult stroke patients admitted to a tertiary hospital in Dodoma, Tanzania. METHODOLOGY: A prospective cohort study was conducted at tertiary hospitals in the Dodoma region, central Tanzania. A sample size of 158 participants with the first stroke confirmed by CT/MRI brain aged ≥ 18 years met the criteria. At baseline, social-demographic, cardiovascular risks and stroke characteristics were acquired, and then at 30 days, participants were evaluated for cognitive functioning using Montreal Cognitive Assessment (MoCA). Key confounders for cognitive impairment, such as depression and apathy, were evaluated using the Personal Health Questionnaire (PHQ-9) and Apathy Evaluation Scale (AES), respectively. Descriptive statistics were used to summarise data; continuous data were reported as Mean (SD) or Median (IQR), and categorical data were summarised using proportions and frequencies. Univariate and multivariable logistic regression analysis was used to determine predictors of PSCI. RESULTS: The median age of the 158 participants was 58.7 years; 57.6% of them were female, and 80.4% of them met the required criteria for post-stroke cognitive impairment. After multivariable logistic regression, left hemisphere stroke (AOR: 5.798, CI: 1.030-32.623, p = 0.046), a unit cm3 increase in infarct volume (AOR: 1.064, 95% CI: 1.018-1.113, p = 0.007), and apathy symptoms (AOR: 12.259, CI: 1.112-89.173, p = 0.041) had a significant association with PSCI. CONCLUSION: The study revealed a significant prevalence of PSCI; early intervention targeting stroke survivors at risk may improve their outcomes. Future research in the field will serve to dictate policies and initiatives.

Predictors of 30-day mortality following the first episode of stroke among patients admitted at referral hospitals in Dodoma, central Tanzania: A prospective longitudinal observational study.

Background and Aims: Stroke is the leading cause of disability and the second most common cause of death after ischemic heart disease worldwide. Understanding predictors of early poststroke mortality provides opportunities for interventions and favorable outcomes. This study aimed to determine the incidence and predictors of 30-day mortality among patients admitted with the first stroke at referral hospitals in Dodoma. Methods: A prospective longitudinal observational design enrolled patients with acute stroke confirmed by CT scan or MRI admitted at referral hospitals in Dodoma. The National Institute of Health Stroke Scale was used to assess stroke severity at baseline. A comparison of risk factors, clinical profiles, and mortality was done using the Chi-square test. A logistic regression model was used to determine the predictors of 30-day mortality in patients with the stroke while the 30-day probability of survival was estimated using Kaplan-Meier analysis. Results: Out of 226 patients with first-ever stroke, 121(54%) were males, and the population mean age was 63(15) years. The 140(62%) had Ischemic stroke, and 154(68%) survived at the 30th day. Patients with a history of smoking 2.4 [95% confidence interval (CI) (1.0-5.6), p = 0.048], loss of consciousness 2.7 [95% CI (1.2-6.4; p = 0.019] and unequal pupil size 13.7 [95% CI (4.1-58.1, p < 0.001 were significantly more associated with mortality within 30 days. The median survival was 7 (3-9) days, whereas alcohol drinkers and those aged above 60 years had a shorter time to mortality compared to non-alcohol drinkers and those aged <60 years. Conclusion: The study showed a high incidence of mortality within 30 days after the first stroke episode, with the highest proportion dying within 7 days of being hospitalized. Advanced age of ≥60 years, smoking, alcohol use, and severe stroke at admission warrant special attention.

Neuromyelitis optica spectrum disorder co-existing with antiphospholipid syndrome: A case report.

Key clinical message: Neuromyelitis optica spectrum disorder is an autoimmune disease, rarely presents with antiphospholipid syndrome. Diagnosis and management of NMOSD are challenging in the background of diverse presentations, especially in resource-limited settings. Abstract: Neuromyelitis optica spectrum disorder (NMOSD) is a progressive demyelinating autoimmune condition resulting from the autoantibodies produced against aquaporin-4 (AQP-4) proteins which are widely distributed in astrocytes in the nervous system. In the setting of NMOSD, it is very crucial to consider other autoimmune diseases as differential diagnoses or co-occurrences due to the diversity of symptoms. NMOSD co-exists with other autoimmune diseases such as myasthenia gravis, thyroid disease, ankylosing spondylitis, pernicious anemia, thrombotic thrombocytopenic purpura, ulcerative colitis, and systemic lupus erythematosus. Few cases of antiphospholipid syndrome co-existing with NMOSD have been reported. In resource-limited settings, the published data are scarce, and therefore, autoimmune diseases are poorly studied. Therefore, late diagnosis and delayed treatment initiation pose long-term sequelae and hence poor prognosis. Here, we present a case of an African woman in her early 40s presenting with bilateral progressive loss of vision, transverse myelitis, extensive longitudinal hyperintense T2 cervical lesion, and AQP-4 autoantibody keeping with NMOSD. The co-existence of antiphospholipid syndrome, in this case, was supported by a history of recurrent pregnancy loss and positive antiphospholipid antibodies. This case underscores the importance of individualized-based medicine, especially in resource-limited settings.

Correlates of the HIV-associated neurocognitive disorders among adults living with HIV in Dodoma region, central Tanzania: A cross-sectional study.

BACKGROUND: HIV-associated neurocognitive disorders (HAND) continue to manifest despite advancements and improved antiretroviral therapy coverage. Neurocognitive impairment is a significant predictor of poor prognosis related to poor antiretroviral therapy adherence and retention in HIV care. METHODS: This cross-sectional study examined 397 participants attending cared for and treatment at Dodoma Regional Referral Hospital (DRRH) and selected by systematic sampling. The combination of Montreal Cognitive Assessment (MoCA), International HIV Dementia Scale (IHDS), and The Lawton Instrumental Activity of Daily Living (IADL) were used to assess HIV-associated neurocognitive disorders. Factors associated with HAND were determined using univariate and multivariable logistic regression. RESULTS: Of 397 participants, 234(59.1%) met the criteria for HAND with 231(58.2%) comprising asymptomatic neurocognitive disorder (ANI) or mild neurocognitive disorders (MND), and 3 (0.76%) HIV- associated dementia (HAD). Participants with HAND had significantly poorer performance in each cognitive domain on both MoCA and IHDS. Under multivariable regression, age of 55 years or above with Adjusted Odds Ratio (AOR): 3.5 (95%CI: 1.1, 11.6), p = 0.041 and female gender (AOR): 2.7 (95%CI: 1, 6, 4.5), p<0.001 were significantly associated with HAND. Adherence to antiretroviral therapy AOR: 0.4(95%CI: 0.2, 1.0), p = 0.044, and attaining primary education AOR: 0.3(95%CI: 0.1, 0.8), p = 0.01 or secondary education AOR: 0.1(95%CI: 0.03, 0.2), p<0.001 compared to having no formal education showed good cognitive performance. CONCLUSION: HIV-associated neurocognitive disorders are common in HIV, especially ANI and MND, are common in HIV infected Tanzanians. Both socio-demographic and clinical variables influence neurocognitive functioning in this population. Screening for mild neurocognitive disorders may be indicated if effective treatment becomes available.

Charles Bonnet syndrome in an elderly blind man with recurrent pituitary macroadenoma and optic nerve atrophy: A case report.

Key Clinical Message: Charles Bonnet syndrome presents with complex visual hallucinations in a visually impaired or blind person. The case highlights complex neuropsychiatric manifestations due to pituitary macroadenoma in geriatrics requiring multi-collaborative care. Abstract: An 81-year-old man presented with a 3-year history of vivid visual hallucinations preceded by visual impairment and recurrence of a pituitary macroadenoma. Remission of hallucination occurred within 2 weeks of 1.5 mg of haloperidol per oral once daily; this is a rare case of Charles Bonnet syndrome after recurrent pituitary macroadenoma.

Predictors of post-stroke cognitive impairment at three-month following first episode of stroke among patients attended at tertiary hospitals in Dodoma, central Tanzania: A protocol of a prospective longitudinal observational study metadata.

INTRODUCTION: Neurocognitive deficits after stroke are a common manifestation and pose a significant impact on the quality of life for patients and families; however, little attention is given to the burden and associated impact of cognitive impairment following stroke. The study aims to determine the prevalence and predictors of post-stroke cognitive impairment (PSCI) among adult stroke patients admitted to tertiary hospitals in Dodoma, Tanzania. METHODOLOGY: A prospective longitudinal study is conducted at tertiary hospitals in the Dodoma region, central Tanzania. Participants with the first stroke confirmed by CT/MRI brain aged ≥ 18 years who meet the inclusion criteria are enrolled and followed up. Baseline socio-demographic and clinical factors are identified during admission, while other clinical variables are determined during the three-month follow-up period. Descriptive statistics are used to summarize data; continuous data will be reported as Mean (SD) or Median (IQR), and categorical data will be summarized using proportions and frequencies. Univariate and multivariate logistic regression analysis will be used to determine predictors of PSCI.

Predictors and outcomes of cardiac dyssynchrony among patients with heart failure attending Benjamin Mkapa Hospital in Dodoma, central Tanzania: A protocol of prospective-longitudinal study.

INTRODUCTION: Cardiac Dyssynchrony is prevalent among patients with heart failure with high cost of care and potentially poor outcomes. Nevertheless, little is known about cardiac dyssynchrony among heart failure patients, especially in developing countries. This study aims at assessing the predictors and outcomes of cardiac dyssynchrony among heart failure patients attending the cardiology department at Benjamin Mkapa Referral Hospital in Dodoma, central Tanzania. METHODS: The study will follow a prospective longitudinal design involving participants aged 18 years and above with heart failure attending the Cardiology Department at Benjamin Mkapa Hospital. Heart failure will be identified based on Framingham's score and patients will be enrolled and followed up for six months. Baseline socio-demographic and clinical characteristics will be taken during enrollment. Outcomes of interest at six months include worsening of heart failure, readmission and death. Continuous data will be summarized as Mean (SD) or Median (IQR), and categorical data will be summarized using proportions and frequencies. Binary logistic regression will be used to determine predictors and outcomes of Cardiac Dyssynchrony among patients with heart failure.

Delusional Infestation: A case of Ekbom syndrome in an elderly woman with a long history of HIV.

A 70-year-old female presented with a long history of HIV and 5 years of disturbing delusions of infestation that impaired her daily functioning. The delusions resolved with haloperidol but were followed by depressive symptoms. The case presents the complexity of managing neuropsychiatric manifestations of HIV/AIDS with comorbidities in old age.

Magnetic resonance imaging in the diagnosis of progressive supranuclear palsy: A case report and review of literature.

Key Clinical Message: Progressive supranuclear palsy (PSP) has many clinical features overlapping with other Parkinson syndromes and differentiation on clinical ground is difficult. This case highlights how a brain MRI can help diagnose PSP in settings with limited resources where histological diagnosis is difficult. Abstract: Progressive supranuclear palsy (PSP) may be challenging to diagnose due to its widely acknowledged clinical complexity and challenges with diagnosis confirmation, particularly in resource-poor settings where the ability to obtain confirmatory tests is highly complicated, leading to an inaccurate or incomplete diagnosis of PSP. This paper discusses using brain magnetic resonance imaging (MRI) to diagnose PSP, and a review of relevant literature addresses the diagnostic value of MRI in PSP.

Depressive symptoms among adolescents in six sub-Saharan African countries: A pooled analysis of associated factors.

There is a need to identify risk factors, including nutrition-related factors, for depressive disorders among sub-Saharan African (SSA) adolescents. We examined the association of multiple measures with depressive symptoms among adolescents living across six SSA countries. Building on previous analyses, we used data from a cross-sectional study conducted from 2015 to 2017 among adolescents aged 10-19 years in six SSA countries (N = 7512). Depressive symptoms were defined as highest tertile of the 6-item Kutcher Adolescent Depression Scale score. Using mixed-effects Poisson regression models, we pooled data across sites and examined the association of sociodemographic, nutrition, and other indices with depressive symptoms. We additionally assessed effect modification by sex, age, and school-going status. We observed higher risk of depressive symptoms among girls (adjusted risk ratio [RR]: 1.29, 95 % confidence interval [95 % CI]: 1.05-1.58, P = 0.016), older adolescents (RR for 18-19 years: 1.59, 95 % CI: 1.44-1.76, P < 0.001), and adolescents experiencing bullying (RR: 1.43, 95 % CI: 1.26-1.62, P < 0.001) or violence (RR: 1.34, 95 % CI: 1.24-1.45, P < 0.001). Adolescents experiencing food insecurity also had a higher risk of depressive symptoms (RR: 1.90, 95 % CI: 1.64-2.19, P < 0.001) along with those consuming ≥ 5 servings of fruit and vegetables per day (RR: 1.18, 95 % CI: 1.03-1.34, P = 0.015); conversely, those who consumed grains, roots and tubers in the past day were at decreased risk (RR: 0.73, 95 % CI: 0.69-0.77, P < 0.001). There was no strong evidence of effect modification of associations. This study reinforces the potential role of multiple sociodemographic and nutrition-related measures on risk of depressive symptoms in these populations.

Neurocognitive decline as a major predictor of nonadherence to antiretroviral therapy among adults living with HIV in Dodoma region, central Tanzania.

Background: The survival of people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome largely depends on good adherence to antiretroviral medications. Neuropsychiatric conditions such as major depressive disorders (MDDs) and neurocognitive disorders, in particular, are common in the HIV population and attributed to suboptimal adherence to antiretroviral treatment and overall poor clinical outcomes. This study aimed to determine the association between neurocognitive disorders and nonadherence to antiretroviral therapy (ART) in the Dodoma region's adult population living with HIV. Methods: The study was conducted in Dodoma Regional Referral Hospital using a cross-sectional design to assess 397 participants through a systematic sampling approach. Montreal Cognitive Assessment was used to determine neurocognitive function, while the Simplified Medical Adherence Questionnaire was used to assess nonadherence to ART. Logistic regression analysis was computed to determine the association between cognitive decline and nonadherence to ART while controlling for sociodemographic and clinical confounders. Results: Out of the 397 recruited participants, 266 (67.00%) and 41 (10.33%) met the criteria for neurocognitive decline and nonadherence to ART. Participants with cognitive impairment had a significantly poorer adherence rate than those without, even after controlling for confounders adjusted odds ratio (aOR): 2.183 (95% confidence interval [CI]: 1.031, 4.630, p = 0.0413). MDD was the only additional factor that remained significantly associated with ART nonadherence (aOR: 4.332, 95% CI: 1.634, 11.485, p = 0.0032). Conclusion: Neurocognitive disorders are strong predictor of suboptimal adherence to ART; a comorbid neuropsychiatric condition such as MDD may further compromise the ART adherence rate leading to poor HIV care and poor clinical outcome. Further research with systematic and more robust studies in the field will provide a baseline to design and integrate appropriate care models to maximize ART adherence in HIV care. Integration of psychiatric services in HIV care can benefit the overall patient outcome.

Visual Art Therapy and Cognition: Effects on People With Mild Cognitive Impairment and Low Education Level.

OBJECTIVES: The aim of this study was to examine the effects of visual art therapy (VAT) on cognition, psychological and functional ability of people with mild cognitive impairment (MCI), and low education. METHODS: A single-blinded randomized controlled trial was conducted among 127 older adults with MCI, mean age 73.6 years, and level of education in years, median (range) = 0 (0-9). The intervention group received 12 VAT sessions over 6 weeks. The control group received 6 health education sessions. The outcomes measures at baseline, immediately postintervention, at 3-month, and 6-month follow-up included global cognitive functions, depression, mental well-being, and instrumental activities of daily living functions. RESULTS: The intervention group demonstrated greater improvement than the control group in global cognition (ß = 2.56, 95% confidence interval [CI] = 1.16, 3.97, p < .001, standardized mean difference [SMD] = 0.75) and depression (ß = -2.01, 95% CI = -3.09, -0.93, p < .001, SMD = -0.93) immediately postintervention. The effects on cognitive functions were sustained at 3 and 6 months follow-up. The differential effect of VAT on mental well-being and functional ability compared to health education were undetectable. DISCUSSION: VAT can improve cognitive functions and mood status of older adults with MCI who have no or low education. Clinical Trials Registration Number: PACTR201901731800445. This trial was registered with Pan African Clinical Trial Registry: www.pactr.org.

Glutamatergic System in Depression and Its Role in Neuromodulatory Techniques Optimization.

Depressive disorders are among the most common psychiatric conditions and contribute to significant morbidity. Even though the use of antidepressants revolutionized the management of depression and had a tremendous positive impact on the patient's outcome, a significant proportion of patients with major depressive disorder (MDD) show no or partial or response even with adequate treatment. Given the limitations of the prevailing monoamine hypothesis-based pharmacotherapy, glutamate and glutamatergic related pathways may offer an alternative and a complementary option for designing novel intervention strategies. Over the past few decades, there has been a growing interest in understanding the neurobiological underpinnings of glutamatergic dysfunctions in the pathogenesis of depressive disorders and the development of new pharmacological and non-pharmacological treatment options. There is a growing body of evidence for the efficacy of neuromodulation techniques, including transcranial magnetic stimulation, transcutaneous direct current stimulation, transcranial alternating current stimulation, and photo-biomodulation on improving connectivity and neuroplasticity associated with depression. This review attempts to revisit the role of glutamatergic neurotransmission in the etiopathogenesis of depressive disorders and review the current neuroimaging, neurophysiological and clinical evidence of these neuromodulation techniques in the pathophysiology and treatment of depression.

A case of a 22-month-old boy with necrotizing pneumonia presenting with leukaemoid reaction misdiagnosed as leukaemia: a case report and review of the literature.

Background: Necrotizing pneumonia and hyperleukocytosis, to the extent of that seen in leukaemia, is a rarely reported presentation. The commonest trigger of such a presentation is an inflammatory process caused by an overwhelming infection which leads to bone marrow irritation. However, the misdiagnosis of this clinical entity as leukaemia should be avoided at all costs so as to avoid the anxiety associated with a diagnosis of cancer, both to the patients and their families. Case presentation: Here, we report the case of a 22-month-old boy who was referred to our Pediatric Oncology Unit (POU). Owing to a high total leukocyte count (TLC) of 98,000 cells/µl, there was a strong suspicion of leukaemia. The boy had been reviewed at another hospital where he presented with fever and cough refractory to the commencement of tuberculosis medications as a result of chest radiography findings. Laboratory investigations performed on admission in the POU were negative for leukaemia and other myeloproliferative disorders. A chest computer tomography (CT) scan was performed to delineate opacification in the right middle lobe. This revealed multiple necrotic and emphysematous foci in line with a diagnosis of necrotizing pneumonia. Subsequently, the patient responded well to a course of piperacillin- tazobactam. The TLC normalized and the cough and fever resolved over a period of 2 weeks. Conclusion: Here, we describe a particularly rare case of leukaemoid reaction with a massive leukocyte count. Such patients can be easily misdiagnosed as having leukaemia or other myeloproliferative disorders, especially in settings with limited diagnostic availability. Such misdiagnosis can cause undue stress on the patient and their families. Thus, it is important that patients presenting with these symptoms should undergo a thorough review of history, physical examination and a structured workup.

Knowledge, attitude and practice towards malaria among symptomatic patients attending Tumbi Referral Hospital: A cross-sectional study.

BACKGROUND: Despite significant improvement in prevention and control over the past decades malaria remains a significant public health concern in Tanzania with 93% of the population being at risk. To prevent malaria infection and promote malaria free zones, understanding the community's knowledge, attitudes, and practices toward malaria control are essential. This study therefore aimed at determining the levels of understanding, and attitudes, as well as socio-cultural aspects of malaria prevention and treatment-seeking behaviours among suspected malaria patients. METHODS: This study was a hospital based cross-sectional study, in which patients attending Tumbi Referral Hospital with symptoms and signs that warrant inclusion of suspicion of malaria, were recruited. We used a pre-tested semi-structured questionnaire to collect participants' demographic characteristics, as well as information on their knowledge, attitudes, and practices towards malaria infection. Data were analysed using Stata Version 12.1. RESULTS: We enrolled a total of 295 respondents of which 179 (60.68%) were females. Participants' ages ranged from 1-91 years, with a mean of 31.4 years. Seventy-nine (26.8%) patients reported having malaria in the previous 28 days, with 57 (72.2%) being laboratory confirmed. Only 52 (65.8%) individuals reported taking prescribed medications for malaria. A total of 277 (93.90%) were aware of malaria, and 264 (95.31%) knew that it is transmitted by mosquito. Nearly all participants (263, 94.95%), identified sleeping under bed nets to be protective against malaria. About half of the respondents either agreed 63 (22.74%) or strongly agreed 62 (22.38%) that malaria can be transmitted like the common cold. Self-reported mosquito net use was 88.09% (244). CONCLUSION: Despite the endemicity of malaria in our study site, patients had adequate knowledge, encouraging attitudes, and good practices related to malaria prevention and control.