Shorter Duration Of Illness Research Articles

37-Year-Old Man With Headache and Nasal Congestion

37-Year-Old Man With Headache and Nasal Congestion

HLA class I and discoveries of the HLA-K (pseudogene) related to disease severity and progression in patients with spondyloarthritis in Dr. Soetomo General Hospital, a tertiary health care center in Surabaya, Indonesia

Background: Spondyloarthritis (SpA) is a chronic inflammatory disease characterized by enthesitis, sacroiliitis, and axial joint involvement. Although the association of HLA with SpA has been widely reported, there have been no studies of HLA type in the Indonesian population within the last 20 years. This study aims to identify the HLA type in SpA patients at Dr. Soetomo General Hospital, Indonesia. Methods: This study used a cross-sectional analytical design with samples that met the criteria for SpA according to the 2009 ASAS. The clinical scores used in this study were mSASSS, BASFI, ASDAS, and Schober. Genetic identification using PCR was performed followed by sanger sequencing to determine the HLA type in the patient. DNA sequences were aligned with BLAST, and a phylogenetic tree was created using MEGA 11. Descriptive and comparative analyzes were performed using GraphPad Prism 9. Results: This study founded four types of HLA in SpA patients at Dr. Soetomo General Hospital, that is HLA-B with six alleles; -B*2704 (12.86%), -B*2705 (1.43%), -B*2706 (1.43%), -B*1802 (4.28%), -B*57v (1.43%), -B*35 (2.86%), HLA - C (21.43%), and HLA - K (52.83%). Clinical scoring of HLA-C and HLA-K indicated severe and progressive disease activity. The HLA-K had the highest mSASSS (26, 95% CI: 22–28), while HLA-C had the highest BASFI score (60, 95% CI: 55–68), the lowest Schober score (12, 95% CI: 10–14), and the shortest duration of illness (22, 95% CI: 12–36). There is no significant difference in the ASDAS score among types. Conclusions: The most common HLA types found in SpA patients at Dr. Soetomo were HLA-C and HLA-K, with the most progressive disease activity indicated by poor mSASSS, BASFI, ASDAS, and Schober scores with a short duration of illness.

Lower serum levels of IL-1β and IL-6 cytokines in adolescents with anorexia nervosa and their association with gut microbiota in a longitudinal study.

IntroductionAnorexia nervosa (AN) is an often chronic and debilitating psychiatric disease whose etiology is not completely understood. Recently, a potential role of inflammation has emerged in other psychiatric diseases, such as depression, PTSD and schizophrenia. The first results in adults with AN seemed to confirm a low-grade proinflammatory state until recent studies presented more differential findings. Studying adolescents with a shorter illness duration and fewer confounding factors might help elucidate the role of inflammation in the underlying pathophysiology of AN; however, the few available studies in adolescents remain ambiguous, and no longitudinal data are available in this age range.MethodsWe examined the proinflammatory cytokines Tumor Necrosis Factor-alpha (TNF-α), Interleukin (IL)-1β, IL-6, IL-15, and the cytokine-receptor IL-6 Receptor alpha (IL-6 Rα) in the serum of twenty-two hospitalized female adolescent patients with AN longitudinally at admission and discharge and compared their results to nineteen healthy controls (HC). We also collected clinical data and stool samples that were analyzed with 16S rRNA amplicon sequencing to explore potential influencing factors of cytokine changes.ResultsTNF-α serum levels were significantly elevated in patients with AN at admission, while IL-1β and IL-6 levels were lower at admission and discharge than in HC. After treatment, we also found significantly elevated levels of IL-6 Rα compared to HC, while IL-15 did not show significant changes. Exploratory analyses revealed positive associations of cytokine and genus-level changes between admission and discharge for IL-1β (Bacteroides) and IL-15 (Romboutsia), and negative associations for IL-15 (Anaerostipes) and TNF-α (uncultured Lachnospiraceae).ConclusionWe confirmed a previous finding of elevated levels of TNF-α also in adolescents with AN; however, the reduced IL-1β and IL-6 levels differed from the mostly increased levels found in adults. A mixed pro- and anti-inflammatory state appears to be present in adolescents, potentially due to their shorter illness duration. The gut microbiota, with its regulatory function on cytokine production, might play a role in mediating these inflammatory processes in AN and could offer targets for new therapeutic approaches.

Prevention and treatment of COVID-19 infection by earthing

BackgroundEarthing is a body contact with earth without insulator. In previous studies, grounding revealed anti-inflammatory effect, immunity enhancement, anticoagulation, and rising blood oxygenation. AimTo investigate the role of earthing in treatment and prevention of COVID-19 infection. MethodsAn observational and interventional study included 71 cases with COVID-19 infection. Earthing was applied as preventive and treatment measures. All participants conducted earthing through direct contact with the earth or connecting apparatus for about 15 min to 6 h/day. ResultsSixty-nine patients were fully improved within 2 h–11 days after commencement of earthing (mean: 2.9 days, SD ± 2, median: 2 days), while the mean illness duration was 8.9 days (SD ± 4.6) and the median was 9 days. Two patients with many risk factors died where earthing was carried out insufficiently and too late. Nine people contracted mild or short-lived illness (mean: 6.3 days, SD ± 5.5) as a consequence of performing prophylactic earthing. There was a spectacular response in a critically ill patient who was unable to speak due to severe dyspnea with blood oxygen level 38% on continuous oxygen supply. On the second day, after two sessions of 3 h daily earthing, his oxygen level raised to 95% with oxygen supply and 77% without oxygen supply. The following symptoms were improved after implementing earthing: fever, dyspnea, cough, weakness, headache, chest pain, taste and smell sensation loss, anorexia, and body pain. ConclusionsEarthing revealed significant curing and preventive effects with a shorter illness duration.

Predicting the Risk of in-Hospital Mortality in Patients with HIV-Associated Talaromyces Marneffei Infection

Disseminated Talaromyces marneffei infection (formerly termed penicilliosis) is the third most common microbiologically confirmed opportunistic infection in Southeast Asia, with mortality of up to 30% despite antifungal therapy. There are restrictive clinical algorithms to predict treatment outcomes. A total of 513 patients with microbiology-confirmed HIV-associated talaromycosis were included in the analysis. Poor outcome was observed in 143/513 patients (27.9%). In the univariate logistic regression analysis, hepatomegaly and splenomegaly were protective factors. Shorter duration of illness, higher respiratory rates, dyspnea, AIDS-associated central nervous system syndromes, platelet counts <50,000 cells/mL, aspartate transaminase (AST) >300 U/L, alanine transaminase (ALT) >150 U/L, serum creatinine >110 µmol/L were predictors of poor outcome. In the multivariate logistic regression analysis, shorter days of illness, higher respiratory rates, platelet counts <50,000 cells/mL, AST >300 U/L and serum creatinine >110 µmol/L, active tuberculosis (TB) and/or ongoing TB induction treatment and AIDS-associated central nervous system syndromes were independent predictors of poor outcome. The prognostic scores ranged from 0 to 19, corresponding to a mortality risk of 0% to 100%. The internal validation showed acceptable discrimination (AUC=0.68) and calibration slope (0.93). The Brier score for model performance was 0.14. We developed a simple scoring system that can predict the risk of death in patients with HIV-associated talaromycosis based on routinely measured characteristics on admission. The scoring system will be further externally validated using other cohorts in the region.

Effectiveness of health education on knowledge on diabetic care among rural adult diabetic patients – a pilot analysis

Diabetic populations are anticipated to increase from 171 million to 366 million in 2030, with the greatest rates in India, China, and the United States. Diabetes is a metabolic disorder that generates high glucose levels in the blood. The World Health Organization (WHO) estimates that India has over 70 million diabetics and is on its way to become the world’s diabetes capital. Patients had a 7.20 knowledge score on the pretest and an 11.78 knowledge score on the posttest, resulting in a mean difference of 4.58 knowledge score, this is a considerable and statistically significant increase in knowledge. The relationship between the patient’s demographic characteristics and their post-test knowledge score..Patients with a high education level and longer disease duration got a higher knowledge score than those with a lower level of education and a shorter duration of illness. The chi square test and Yates corrected chi square test were used to corroborate it.

Diagnostic journeys: characterization of patients and diagnostic outcomes from an academic second opinion clinic.

Diagnostic programs and second opinion clinics have grown and evolved in the recent years to help patients with rare, puzzling, and complex conditions who often suffer prolonged diagnostic journeys, but there is a paucity of literature on the clinical characteristics of these patients and the efficacy of these diagnostic programs. This study aims to characterize the diagnostic journey, case features, and diagnostic outcomes of patients referred to a team-based second opinion clinic at Stanford. Retrospective chart review was performed for 237 patients evaluated for diagnostic second opinion in the Stanford Consultative Medicine Clinic over a 5year period. Descriptive case features and diagnostic outcomes were assessed, and correlation between the two was analyzed. Sixty-three percent of our patients were women. 49% of patients had a potential precipitating event within about a month prior to the start of their illness, such as medication change, infection, or medical procedure. A single clear diagnosis was determined in 33% of cases, whereas the remaining cases were assessed to have multifactorial contributors/diagnoses (20%) or remained unclear despite extensive evaluation (47%). Shorter duration of illness, fewer prior specialties seen, and single chief symptom were associated with higher likelihood of achieving a single clear diagnosis. A single-site academic consultative service can offer additional diagnostic insights for about half of all patients evaluated for puzzling conditions. Better understanding of the clinical patterns and patient experiences gained from this study helps inform strategies to shorten their diagnostic odysseys.

The relationship between cognitive functioning, age and employment in people with severe mental illnesses in an urban area in India: A longitudinal study

Although there is substantial evidence of the association between cognitive impairment and work in people with severe mental illnesses (SMI) in developed countries, less is known about this relationship in developing countries such as India. Studies showing higher rates of employment in people with SMI in developing countries than developed ones raise the question of whether cognitive functioning is related to work status and characteristics of work (e.g., wages earned). We conducted a one-year follow-up study to investigate the relationship between employment and cognitive functioning, assessed with the Montreal Cognitive Assessment (MoCA), in 150 participants with SMI (92% schizophrenia) living in an urban area and receiving psychiatric outpatient treatment at a public hospital in India. The MoCA had good internal reliability and test-retest reliability over the one-year period. Better cognitive functioning was associated with younger age, shorter duration of illness, higher education, and male gender. Both younger and older participants with higher cognitive functioning at baseline were more likely to be employed at baseline and one year later. Work status at baseline and one year follow-up was consistently related to executive functions among younger participants, and to attention among older participants, suggesting changes over the course of illness in the importance of specific cognitive domains for achieving satisfactory work performance. The findings suggest that cognitive functioning is associated with employment in people with SMI in India. Attention to impaired cognitive functioning may be critical to improving employment outcomes in this population.

Lateral pancreatico-jejunostomy: a case series

Chronic pancreatitis and tropical pancreatitis lead to frequent abdominal pain. To reduce this pain, lateral pancreaticojejunostomy (LPJ) is the most common surgical procedure. Despite the evidence available for the effectiveness of surgical therapy, the decision for indication, type, and timing of surgical intervention is always been debated. In this case series we make an attempt to define the possible timing of the procedure and the category of patients who might benefit from it. The 14 out of 65 patients who were evaluated from July 2018 to December 2021 were included in this study. All patients were observed with pain in the abdomen, weight loss, steatorrhea, and malabsorption while none of the patients had pancreatic head mass as per cross-sectional imaging. Fourteen patients with confirmed chronic atrophic pancreatitis with severe symptoms and dilatation of the pancreatic duct were operated upon. Three of these were considered failures since they continued to have no weight gain and either pain or malabsorption. The failures were mainly due to impaired pancreas due to chronic disease and not due to failure of the procedure. Chronic pancreatitis cases, with a short duration of illness, have a better chance of success in surgery. We conclude that one can resort to LPJ in cases that do not respond to medical therapy, continue to suffer from pain, malabsorption, and weight loss. It is a relatively safe procedure that provides good pain relief with low postoperative morbidity, further preventing exacerbations and maintaining appropriate pancreatic exocrine and endocrine functions.

A clinico-radiological study of deep cerebral venous thrombosis.

Isolated deep cerebral venous thrombosis (DCVT) may have different presentation and outcome compared to DCVT with additional sinus thrombosis. We compare clinico-radiological findings and outcomes of patients with isolated DCVT with those having additional sinus thrombosis. Forty-one DCVT patients with or without additional sinus thrombosis were included. Deep CVT was diagnosed if there was thrombosis of straight sinus, vein of Galen, internal cerebral vein, or basal vein of Rosenthal on MR venography (MRV). Isolated DCVT patients were classified as Group A and those with additional sinus thrombosis as Group B. The clinical features, risk factors, MRI findings, and outcomes at 1, 3, and 6months were compared between Groups A and B. Median age was 28years, and 22 (54%) were females. Eight (19.5%) patients were in Group A and 33 (80.5%) in Group B. Group B patients had shorter duration of illness (7 vs 30days; p = 0.01), frequent vomiting [25 (75.7%) vs 2 (25%); p = 0.01], and papilledema [13 (39%) vs 0 (0%); p = 0.04]. Risk factors were comparable. MRI revealed bilateral thalamic [5 (62.5%) vs 6 (18.2%)] and basal ganglia [(4 (50%) vs 6 (18.2%)] lesions more frequently in Group A. At 1month, 2 (6%) patients died in Group B and none in Group A, and 24 had good outcome (50% Group A and 60.6% in Group B). At 3months, 30 had good outcome (62.5% Group A and 80.6% in Group B). Improvement after 3months was negligible. Isolated DCVT is rare, and additional sinus thrombosis is associated with more severe illness and death. However, long-term outcomes in the survivors are similar between the two groups.

Global cognitive trajectory patterns in Alzheimer's disease.

The literature on Alzheimer's disease (AD) provides little data about long-term cognitive course trajectories. We identify global cognitive outcome trajectories and associated predictor variables that may inform clinical research and care. Data derived from the National Alzheimer's Coordinating Center (NACC) Uniform Data Set were used to examine the cognitive course of persons with possible or probable AD, a Mini-Mental State Examination (MMSE) of ≥10, and complete annual assessments for 5 years. Thirty-six Alzheimer's Disease Research Centers. Four hundred and fourteen persons. We used a hybrid approach comprising qualitative analysis of MMSE trajectory graphs that were operationalized empiricallyand binary logistic regression analyses to assess 19 variables' associations with each trajectory. MMSE scores of ±3 points or greater were considered clinically meaningful. Five distinct cognitive trajectories were identified: fast decliners (32.6%), slow decliners (30.7%), zigzag stable (15.9%), stable (15.9%), and improvers (4.8%). The decliner groups had three subtypes: curvilinear, zigzag, and late decline. The fast decliners were associated with female gender, lower baseline MMSE scores, a shorter illness duration, or receiving a cognitive enhancer. An early MMSE decline of ≥3 points predicted a worse outcome. A higher rate of traumatic brain injury, the absence of an ApoE ϵ4 allele, and male gender were the strongest predictors of favorable outcomes. Our hybrid approach revealed five distinct cognitive trajectories and a variegated pattern within the decliners and stable/improvers that was more consistent with real-world clinical experience than prior statistically modeled studies. Future investigations need to determine the consistency of the distribution of these categories across settings.

Suicide risk and suicide risk factors among immigrants in Italy: A bi-center matched sample study.

Italy has the third-largest immigrant population of European Union countries, but only a few research papers have examined suicide risk in immigrant psychiatric patients in Italy. The main aim of this paper was to compare suicidal ideation and suicide attempts in a sample of 304 psychiatric patients. We included 152 immigrant patients matched with 152 Italian patients admitted to the same wards during the same time period by age, gender, and diagnosis. We also investigated sociodemographic and clinical characteristics of the two samples including psychiatric diagnosis, age of illness onset, duration of illness, previous hospitalizations, length of hospitalization, previous suicide attempts, and substance and alcohol abuse. There were no differences between immigrant and Italian patients in either suicidal ideation (previous or current) or suicide attempts (previous or current). Immigrant patients were more likely to have a shorter duration of illness than the Italian patients and Italian patients were more likely to report substance abuse than were immigrant patients. Despite similar suicide rates between immigrants and Italian psychiatric inpatients, appropriate assessment of suicide risk in these patients is essential in implementing therapeutic suicide prevention strategies.

Diabetic Awareness Study and Factors affecting it, in Diabetic Patients in Hospital Nakfa, Rural Eritrea

Background: Diabetes mellitus is becoming the most prevailing non-communicable disease creating a burden to the health care system. The objective of this study was to assess awareness regarding diabetes mellitus and factors affecting the awareness levels. Methodology: A Hospital based cross-sectional study was conducted among all diabetic patients in follow-up of Nakfa Hospital. Interviewer administered questionnaire was used as data collection tool. Frequency distribution and tables were used and Independent sample t-tests and one way ANOVA of post hoc tests were used for data analysis. Results: A total of Ninety-two diabetic patients participated in this study. More than half (66.3%) were males with a mean age of 44.5±18.2. Nearly half (47.8%) of them were illiterate and 77.2% were unemployed. The mean scores on general knowledge, diabetic complication knowledge and self-care practice were observed to be 75.4%. Poor score was observed regarding general knowledge and self-care practice, 70.5% and 73.4% respectively. High mean score was observed in complication knowledge, 90.6%. Although being female, illiterate and short duration of illness was associated with low scores but it was not statistically significant. Conclusions: patients showed high mean score in complication knowledge and low scores on general knowledge and self-care practice. Frequent health education programs needs to be increased for better control of the disease and its complications. These results could help the policy makers to implement preventive strategies to prevent the complications and enhance the general knowledge of patients on Diabetes mellitus.

Does the Duration of the Illness Affect the Severity of Negative Symptoms of Schizophrenia?

Background:The negative symptoms of schizophrenia are less known aspects of the illness although they often mark its course and outcome. Negative symptoms refer to loss of function, and they are associated with poor outcomes. It is considered that they are more prominent with the longer duration of illness.Objective:To determine the negative symptoms in the patients with schizophrenia with regard to the duration of illness.Methods:A cross-sectional study was conducted in 60 consecutive outpatients with schizophrenia. Two groups were formed regarding the duration of illness (⩽2 years, and >3 years). The negative symptoms were established with the Brief Negative Symptom Assessment – BNSA.Results:Average score of negative symptoms in the group with the shorter duration of illness was 8.37±2.94, and in the group with longer duration was 10.73±2.86. Independent Samples Test was significant p=0.003, t-2.367, and therefore the difference between scores on BNSA within groups was significant. Moderate size effect was found (p = 0.69).Conclusion:Negative symptoms of schizophrenia are more prominent with the longer duration of illness.

Effect of lockdown due to COVID-19 on health and lifestyle of psoriasis patients: A web-based survey

Background:Chronic skin diseases like psoriasis affect a patient’s physical, psychological, and social functioning as well as well-being, and the lockdown acted as a cofactor in further worsening the quality of life in psoriasis patients.Objective:The objective of the study is to assess the effect of lockdown on the health, lifestyle, and mental well-being of psoriasis patients.Methods:A cross-sectional study was done using an online questionnaire shared through messenger applications to the patients of chronic plaque psoriasis who registered in the psoriasis clinic between August 2020 and December 2020. Data regarding demographics, psoriasis, lifestyle changes, mental status, financial loss, and problems faced during lockdown were collected.Results:Our study included 181 completed questionnaires. The mean age was 37.7 (SD 13.9) years, and 124 (68.5%) were males. Sixty-five (35.9%) patients reported worsening of their psoriasis during the lockdown. Ordinal regression analysis revealed male sex had a higher proportion of worsening of psoriasis (OR 2.56, 95% CI 1.29–5.08, P < 0.007). Duration of illness <6 months (OR 0.14, 95% CI 0.02–0.98, P < 0.04) and feeling relaxed (OR 0.14, 95% CI 0.03–0.56, P < 0.005) were negatively associated with disease worsening.Conclusion:The findings of our study reveal the impact of coronavirus disease 2019 (COVID-19) lockdown on the life of people with psoriasis. A substantial number of patients had a flare of psoriasis during the lockdown. A shorter duration of illness and relaxed mental status was negatively associated with disease worsening. Individuals with financial loss felt anxious or depressed.

Longitudinal impact of caregiver transition and family caregiving on psychiatric symptoms and psychosocial functioning among persons with schizophrenia in rural China.

This study examines the 21-year longitudinal impacts and predictive effects of family caregiver transition and the presence of family caregiving on the clinical status of persons with schizophrenia (PwSs) in a rural area of China. Using panel data derived from the Chengdu Mental Health Project (CMHP), 250 dyads of PwSs and their family caregivers were investigated in 1994 and 2015. The Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) were utilized. The generalized linear model (GLM) approach was used. The results of this study showed that more severe symptoms in PwSs were found to be significantly predicted by older age and nonmarried status at baseline. Compared with "spousal caregiving in two waves," the PANSS score was significantly higher in the "transition into sibling caregiving" group. A higher degree of psychosocial functioning was found to be significantly predicted by marital status, shorter duration of illness, and better mental status. Compared with "spousal caregiving in two waves," the GAF score was significantly lower in the "transition into parental caregiving" group. The presence of family caregiving was not a significant predictor of the severity of symptoms or psychosocial functioning in the PwSs. In conclusion, this study shows the 21-year predictive effects of family caregiver transition on the mental status of PwSs but not the presence of family caregiving. Psychosocial interventions and specific guidance should be provided to family caregivers to enhance their quality of caregiving and improve the prognosis of PwSs during long periods of home care.

Clinical Evaluation of Corridor Disease in Bos indicus (Boran) Cattle Naturally Infected With Buffalo-Derived Theileria parva.

Corridor disease (CD) is a fatal condition of cattle caused by buffalo-derived Theileria parva. Unlike the related condition, East Coast fever, which results from infection with cattle-derived T. parva, CD has not been extensively studied. We describe in detail the clinical and laboratory findings in cattle naturally infected with buffalo-derived T. parva. Forty-six cattle were exposed to buffalo-derived T. parva under field conditions at the Ol Pejeta Conservancy, Kenya, between 2013 and 2018. The first signs of disease observed in all animals were nasal discharge (mean day of onset was 9 days post-exposure), enlarged lymph nodes (10 days post-exposure), and pyrexia (13.7 days post-exposure). Coughing and labored breathing were observed in more than 50% of animals (14 days post-exposure). Less commonly observed signs, corneal edema (22%) and diarrhea (11%), were observed later in the disease progression (19 days post-exposure). All infections were considered clinically severe, and 42 animals succumbed to infection. The mean time to death across all studies was 18.4 days. The mean time from onset of clinical signs to death was 9 days and from pyrexia to death was 4.8 days, indicating a relatively short duration of clinical illness. There were significant relationships between days to death and the days to first temperature (chi2 = 4.00, p = 0.046), and days to peak temperature (chi2 = 25.81, p = 0.001), animals with earlier onset pyrexia died sooner. These clinical indicators may be useful for assessing the severity of disease in the future. All infections were confirmed by the presence of macroschizonts in lymph node biopsies (mean time to parasitosis was 11 days). Piroplasms were detected in the blood of two animals (4%) and 20 (43%) animals seroconverted. In this study, we demonstrate the successful approach to an experimental field study for CD in cattle. We also describe the clinical progression of CD in naturally infected cattle, including the onset and severity of clinical signs and pathology. Laboratory diagnoses based on examination of blood samples are unreliable, and alternatives may not be available to cattle keepers. The rapid development of CD requires recognition of the clinical signs, which may be useful for early diagnosis of the disease and effective intervention for affected animals.

The neural correlates of a central coherence task in young women with anorexia nervosa.

Heightened detail-processing and low levels of central coherence are common in individuals with anorexia nervosa (AN) and predict poorer prognosis. However, it is unclear whether these processing styles predate the disorder or, rather, emerge during later stages of AN. The current study aimed to address this question by investigating central coherence, and the neural correlates of central coherence, in a sample of young women with AN with shorter duration of illness than previous studies recruiting adult samples. We recruited 186 participants, including: 73 young women with AN, 45 young women weight-recovered from AN, and 68 age-matched controls. Participants completed the Embedded Figures Task during an fMRI scan. There were no significant differences between the participant groups in performance accuracy or reaction time. There were no other between-groups differences in neural response to the Embedded Figures Task. These findings contrast with evidence from older adults demonstrating differences in the neural underpinning of central coherence amongst participants with AN versus control participants. The current study adds to an increasing literature base demonstrating the resilience of neuropsychological traits and associated brain systems in the early stages of AN.

A molecular pathology, neurobiology, biochemical, genetic and neuroimaging study of progressive apraxia of speech

Progressive apraxia of speech is a neurodegenerative syndrome affecting spoken communication. Molecular pathology, biochemistry, genetics, and longitudinal imaging were investigated in 32 autopsy-confirmed patients with progressive apraxia of speech who were followed over 10 years. Corticobasal degeneration and progressive supranuclear palsy (4R-tauopathies) were the most common underlying pathologies. Perceptually distinct speech characteristics, combined with age-at-onset, predicted specific 4R-tauopathy; phonetic subtype and younger age predicted corticobasal degeneration, and prosodic subtype and older age predicted progressive supranuclear palsy. Phonetic and prosodic subtypes showed differing relationships within the cortico-striato-pallido-nigro-luysial network. Biochemical analysis revealed no distinct differences in aggregated 4R-tau while tau H1 haplotype frequency (69%) was lower compared to 1000+ autopsy-confirmed 4R-tauopathies. Corticobasal degeneration patients had faster rates of decline, greater cortical degeneration, and shorter illness duration than progressive supranuclear palsy. These findings help define the pathobiology of progressive apraxia of speech and may have consequences for development of 4R-tau targeting treatment.

Prevalence of Controlled Systemic Hypertension and Its Associated Risk Factors among Hypertensive Patients at Mbeya Zonal Referral Hospital, Tanzania.

Objectives: To determine the prevalence of controlled systemic hypertension and its associated risk factors among the hypertensive patients who attended the clinic at Mbeya Zonal Referral Hospital in Tanzania. Methods: A descriptive cross-sectional quantitative study was used determine the prevalence to 252 hypertensive patients were recruited during clinic visit from September to November 2020 and participant was randomly selected interviews using structured self-administered questionnaires. Data was analyzed using chi square test to find the risk factors associated with controlled hypertension. Results: Among 252 participants, 94 (39.7%) individuals with controlled hypertension giving the prevalence of controlled hypertension. The proportion of females with controlled hypertension was slightly higher than male (49 females to 45 males). The prevalence of uncontrolled hypertension was 152 (60.3%) participants. The prevalence of controlled hypertension was higher among patients who have regular clinic visit (p<0.05) and have daily adherence to their anti-hypertensive medication. A similar trend was observed among participants without financial challenges to attend clinic, short duration of illness, higher level of education and there was no association between age, sex, marital status, smoking, alcohol consumption, having health insurance and having chronic illness. Conclusion: Prevalence of controlled hypertension is higher among patients who have regular clinic visit and have daily adherence to their anti-hypertensive medication. Also, it is higher among participants without financial challenges to attend clinic so they can have regular clinic visit and checkup. Reinforcement on regular drug intake and clinic visit, good nutrition and reduced salt intake and modifying lifestyles of patient with hypertension is important.