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Abstract Background and objectives Behçet’s disease (BD) is an ongoing systemic vasculitis with mouth and genital ulceration and eye, skin, and systemic affection. It has considerable morbidity and mortality, and a high incidence and a higher male-to-female affection characterize Egypt. We aimed to evaluate liver x receptor messenger RNA beta (LXR β) and microRNA-146a (miR-146a) gene expression in Behçet’s disease cases in Egypt to relate them with clinicopathological features. Subject and method Eighty Egyptian individuals were split into two groups for the current study: Forty Behçet’s disease cases and forty healthy controls matched by age and gender from the Rheumatology Department at Helwan University Hospital, Egypt. The transformed score, also known as the Behçet’s Disease Current Activity Form (BDCAF), was utilized to measure disease activity. To assess the amounts of LXR β and miR-146a serum expression via real-time PCR, a blood sample was obtained. Results There was a downregulation of both LXR β and miR-146a levels that significantly differed between the BD group and the control group (p = 0.0001 and 0.0001, respectively). There is a noteworthy inverse relationship between the expression level of LXR β and BDCAF Patients Index (r = − 0.79 and p = 0.0001) was found. Regarding miR-146a, it had a reverse correlation with BDCAF Patients Index (r = − 0.89 and p = 0.0001). Conclusion LXR β and miR-146a were found to be significant non-invasive predictor biomarkers for Behçet’s disease and can indicate disease activity.

Abstract Background The social distancing measures associated with the COVID-19 pandemic had far reaching effects on sexual behavior worldwide. However, it remains unclear whether sexual contact with non-steady partners was a contributor to the spread of SARS-CoV-2. The aim of this study was to (i) describe risk factors for SARS-CoV-2 seropositivity after the first pandemic wave among people using HIV Pre-Exposure Prophylaxis (PrEP) in Zurich, Switzerland, including sexual contact with non-steady partners, and (ii) assess whether the SARS-CoV-2 seropositivity among PrEP users in this time period differed from that of a demographic matched population level comparison group. Methods The study was conducted between July 2020 and October 2020 as a nested cross-sectional study within two ongoing cohort studies, SwissPrEPared (all eligible PrEP users in Switzerland ≥ 18 years old) and Corona Immunitas (a series of cross-sectional and longitudinal studies measuring the SARS-CoV-2 seroprevalence across Switzerland, beginning in April 2020). All SwissPrEPared participants were recruited from Checkpoint Zurich (the main PrEP clinic in Zurich) and were men having sex with men or transgender women. Data were collected on participants’ SARS-CoV-2 antibody status, social characteristics and behavioral data after the first wave of the pandemic in Switzerland, and seroprevalence was compared with a propensity score-matched sample from the general Zurich population. Results Of the 218 participants enrolled, 8.7% (n = 19, 95% CI: 5.5–13.5%) were seropositive for SARS-CoV-2 during the first pandemic wave, higher than that of the general male population in Zurich aged 20–65 (5.5%, 95% CI: 3.8–8.2%). Participants on average reduced their social outings, but the seronegative were more socially active before, during, and after the first lockdown period. In a logistic model, increasing mean sexual partner count was not associated with seropositivity (OR: 1.02, 95% CI: 0.95, 1.07). The estimated risk ratio for seropositivity for the participants compared to the general Zurich population after propensity score matching was 1.46 (95% CI: 0.53, 3.99). Conclusions Our study suggests that SARS-CoV-2 seropositivity was slightly elevated among people taking PrEP in Zurich during the first wave of the pandemic, but that socializing and sexual activity were less important than other factors in contributing to risk.

Abstract Personalized treatment for patients with advanced solid tumors critically depends on the deep characterization of tumor cells from patient biopsies. Here, we comprehensively characterize a pan-cancer cohort of 150 malignant serous effusion (MSE) samples at the cellular, molecular, and functional level. We find that MSE-derived cancer cells retain the genomic and transcriptomic profiles of their corresponding primary tumors, validating their use as a patient-relevant model system for solid tumor biology. Integrative analyses reveal that baseline gene expression patterns relate to global ex vivo drug sensitivity, while high-throughput drug-induced transcriptional changes in MSE samples are indicative of drug mode of action and acquired treatment resistance. A case study exemplifies the added value of multi-modal MSE profiling for patients who lack genetically stratified treatment options. In summary, our study provides a functional multi-omics view on a pan-cancer solid tumor cohort and underlines the feasibility and utility of MSE-based precision oncology.

Spinal alignment can be assessed without radiation using three-dimensional ultrasound imaging (3DUS). Reliable measurements could inform the ideal arm position for scoliosis radiographs. This study determined the inter-evaluator reliability of axial vertebral rotation (AVR) measurements and sagittal curve angles in healthy females from 3DUS spinal images in standing with two common radiograph arm positions: Chin and abduction (Abd). Three novice evaluators (R1, R2, and R3) measured images once. The Bland-Altman bias and limits of agreement (LOA) were calculated. T5-T12 kyphosis measurements met our bias and LOA error threshold only for R1 vs R2 in the Chin position [-0.53° (-10.7,9.7)]. The distance between the bias and the LOA also met our acceptable threshold of 5° for all mean AVRTwist, and all but one AVRTwist measurements (R1-R2_Chin = 5.9°). Three lordosis measurements did not meet our acceptable threshold (R1-R2_Chin, R1-R3_Chin, and R2-R3_Abd). The inter-evaluator reliability of novice evaluators was adequate and did not differ significantly between positions.

Introduction: JC-polyomavirus-associated nephropathy (JC-PVAN) is a rare cause of allograft dysfunction with only a few cases described in the literature. Case Presentation: We present 2 cases of JC-PVAN, both of which occurred >5 years after kidney transplantation. In both cases, transplant biopsies were performed because of worsening of kidney function. We found tubulitis and interstitial inflammation; immunohistochemistry was positive for SV40, but BK virus was not detected. The presence of JC virus confirmed the diagnosis of JC-PVAN. Immunosuppressive therapy was adopted, but in both cases graft function progressively deteriorated. Conclusions: Our cases show that JC-PVAN, although much rarer than BK-PVAN, should be considered a possible cause of graft dysfunction even years after transplantation. Complete diagnostic workup, including kidney biopsy, is crucial for correct diagnosis and treatment.

We investigated whether developing an autoimmune disorder (AID) following a high-grade epithelial ovarian cancer diagnosis improves overall survival. This retrospective study included data from women treated for high-grade serous, endometrioid, or transitional cell ovarian, fallopian tube, or peritoneal cancer FIGO stage III or IV at a Swiss cantonal gynecological cancer center (2008–2023). We used Kaplan–Meier estimates and the Cox proportional hazards model using time-varying covariates for the survival function estimation. In all, 9 of 128 patients developed an AID following a cancer diagnosis. The median time from cancer diagnosis to AID was 2 years (IQR 2–5). These women survived for a median of 3031 days (IQR 1765–3963) versus 972 days (IQR 568–1819) for those who did not develop an AID (p = 0.001). The median overall survival of nine women with a pre-existing AID was 1093 days (IQR 716–1705), similar to those who never had an AID. The multivariate analyses showed older age (p = 0.003, HR 1.04, 95% CI 1.013–1.064) was associated with a poorer prognosis, and developing an AID after a cancer diagnosis was associated with longer survival (p = 0.033, HR 0.113, 95% CI 0.015–0.837). Clinical manifestations of autoimmune disorders following ovarian cancer diagnoses were associated with better overall survival (8 versus 2.7 years), indicating an overactive immune response may improve cancer control.

Abstract Monoclonal gammopathy‐associated pure red cell aplasia (MG‐PRCA) is characterized by the absence or pronounced hypoplasia of erythroid precursors in the bone marrow, causing reticulocytopenia and a normocytic, normochromic anaemia in a patient with a monoclonal plasma cell dyscrasia. We report here on the successful treatment of MG‐PRCA with isatuximab, pomalidomide, and dexamethasone after multiple lines of immunosuppressive and anti‐plasma cell‐directed treatments.

Abstract The real-world measurement of minimum foot clearance (mFC) during the swing phase of gait is critical in efforts to understand and reduce the risk of trip-and-fall incidents in populations with gait impairments. Past research has focused on measuring clearance of a single point on a person’s foot, typically the toe—however, this may overestimate mFC and may even be the wrong region of the foot in cases of gait impairments or interventions. In this work, we present a novel method to reconstruct the swing-phase trajectory of an arbitrary number of points on a person’s shoe and estimate the instantaneous height and location of whole-foot mFC. This is achieved using a single foot-mounted inertial sensor and personalized shoe geometry scan, assuming a rigid-body IMU-shoe system. This combination allows collection and analysis using out-of-lab tests, potentially including clinical environments. Validation of single marker location using the proposed method vs. motion capture showed height errors with bias less than 0.05 mm, and 95% confidence interval of − 8.18 to + 8.09 mm. The method is demonstrated in an example data set comparing different interventions for foot drop, and it shows clear differences among no intervention, functional electrical stimulation, and ankle–foot orthosis conditions. This method offers researchers and clinicians a rich understanding of a person’s gait by providing objective 3D foot kinematics and allowing a unique opportunity to view the regions of the foot where minimum clearance occurs. This information can contribute to a more informed recommendation of specific interventions or assistive technology than is currently possible in standard clinical practice.

Abstract Background A significant proportion of the global population has been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at some point since the onset of the pandemic. Although most individuals who develop coronavirus disease 2019 (COVID-19) recover without complications, about 6% have persistent symptoms, referred to as post-COVID-19 condition (PCC). Intervention studies investigating treatments that potentially alleviate PCC-related symptoms and thus aim to mitigate the global public health burden and healthcare costs linked to PCC are desperately needed. The PYCNOVID trial investigates the effects of Pycnogenol®, a French maritime pine bark extract with anti-inflammatory and antioxidative properties, versus placebo on patient-reported health status in people with PCC. Methods This is a single-center, placebo-controlled, quadruple blind, randomized trial. We aim to randomly assign 150 individuals with PCC (1:1 ratio) to receive either 200 mg Pycnogenol® or placebo daily for 12 weeks. Randomization is stratified for duration of PCC symptoms (≤ 6 months versus > 6 months) and presence of symptomatic chronic disease(s). The primary endpoint is perceived health status at 12 weeks (EuroQol—Visual Analogue Scale) adjusted for baseline values and stratification factors. Secondary endpoints include change in self-reported PCC symptoms, health-related quality of life, symptoms of depression and anxiety, cognitive function, functional exercise capacity, physical activity measured with accelerometry, and blood biomarkers for endothelial health, inflammation, coagulation, platelet function, and oxidative stress. Investigators, study participants, outcome assessors, and data analysts are blinded regarding the intervention assignment. Individuals with PCC were involved in the design of this study. Discussion This is the first trial to investigate the effects of Pycnogenol® versus placebo on patient-reported health status in people with PCC. Should the trial proof clinical effectiveness, Pycnogenol® may serve as a therapeutic approach to mitigate symptoms associated with PCC. Trial registration The study is registered at ClinicalTrials.gov. :NCT05890534, June 6, 2023.

Aim: Both teachers and learners had clear reservations in the beginning about the usefulness and benefits of supervision and feedback, which were to be implemented as a teaching method in the competency-based, post-graduate curriculum in general ambulatory pediatrics, known as PaedCompenda (www.paedcompenda.de). This paper investigates the different perceptions of the physicians undergoing specialist training () and elucidates these differences.Method: The following data were collected as part of the research on the three-year-long implementation (2019-2023):1) Four focus group discussions (N=28) with physician trainees who had no experience in primary care pediatrics or with the post-graduate curriculum;2) Problem-oriented interviews, one at the beginning and again at the end, with physician trainees (N=28) undergoing specialist training at 19 participating medical practices belonging to two post-graduate education networks;3) Videos of patient consultations with the physician trainees (N=23);4) Videos of feedback conferences regarding the videotaped patient consultations (N=7).This data was evaluated using reconstructive grounded theory.Results: A distinctly more positive perception of the benefits of supervision and feedback as a teaching and learning method was seen in the physicians who received specialist training at the practices following the PaedCompenda curriculum. In regard to method, it is crucial that the educational setting can be experienced as a learning opportunity. Playing a central role in this is constructive and conducive feedback (a. dysfunctional routines, b. underlying lack of confidence, and c. overlooked problems).Conclusions: This paper shows the opportunities of an institutionalized form of supervision and feedback as part of a competency-based, post-graduate curriculum while also making it clear that implementation is challenging. Furthermore, the medical specialists who serve as trainers need to be specifically trained to know which approaches promote learning effectively.

One goal of Open Science is to promote reusability, which requires understanding and documentation. Reusability spans a spectrum from the straightforward reuse of existing materials to the extraction and adaptation of specific elements, depending on the maturity of the reused research and the research context. Beyond knowledge, understanding is crucial for enabling reusability. Simply reading an article is often insufficient; thus, publishing the underlying data and software is recommended. While the FAIR principles (Findable, Accessible, Interoperable, Reusable) facilitate the discovery and legal reuse of data and software through metadata, they fall short of promoting comprehensive understanding. By applying insights from the epistemology of simulation to computational mechanics research cases, we tested our hypothesis that the simulation process involves critical components beyond software and data that are essential to understand for reuse. Our findings indicate that reusability in these cases predominantly involves adjusting existing methodologies—a combination of different process steps from an epistemological perspective. Therefore, it is imperative to document not only learned knowledge but also the decisions regarding adjustments, assumptions and applications that concern the entire simulation process. Documentation is vital for understanding and herby enabling true reusability in scientific research, aligning with philosophical considerations of transparency and the nature of scientific knowledge.

Globally, there has been an increasing call for dissemination and implementation science to improve the health equity of older adults. However, improving the health equity of older adults requires methods that allow for an in-depth understanding of the existing research. While the value of review articles is widely recognized, the value of publishing review protocols is an emerging paradigm with great potential to advance implementation science and aging research. In this article, we propose that prior to review articles, review protocols are necessary as they provide a clear and comprehensive search strategy, which greatly enhances the quality and rigor of reviews. More specifically, we argue that review protocols are indispensable because they support: (1) a clearly defined and comprehensive search methodology; (2) reviewer feedback to mitigate potential issues; and (3) registration to reduce risk of research replication. Additionally, we propose three strategies to accelerate review protocols in implementation science to support older adults’ health equity.

No abstract available.

Purpose Prospective, multicentric observational cohort study in Switzerland investigating measures to prevent mother-to-child transmission in pregnant women with HIV (WWH) and assessing health and development of their exposed children as well as of children with HIV (CWH) in general.Participants Between January 1986 and December 2022, a total of 1446 mother–child pairs were enrolled. During the same period, the study also registered 187 CWH and 521 HIV-exposed but uninfected children (HEU), for whom detailed maternal information was not available. Consequently, the cohort comprises a total of 2154 children.Findings to date During these 37 years, research by the Swiss Mother and Child HIV Cohort Study (MoCHiV) and its international collaborators has strongly influenced the prevention of vertical transmission of HIV (eg, introduction and discontinuation of elective caesarean section, neonatal postexposure prophylaxis and breastfeeding). Contributions have also been made to the management of diagnostics (eg, p24 antigen assay) and the effects of antiretroviral treatment (eg, prematurity, growth) in HEU and CWH.Future plans Most children present within the cohort are now HEU, highlighting the need to investigate other vertically transmitted pathogens such as hepatitis B and C viruses, cytomegalovirus or Treponema pallidum. In addition, analyses are planned on the longitudinal health status of CWH (eg, resistance and prolonged exposure to antiretroviral therapy), on social aspects including stigma in CWH and HEU, and on interventions to further optimise antenatal and postpartum care in WWH.

ObjectivesBefore vaccines and effective treatments were available, quarantine of close contacts was important to limit the spread of SARS-CoV-2. To evaluate potential benefits and harms of quarantine, we aimed to estimate infection rates and describe experiences and mental health among persons in mandated quarantine during the early SARS-CoV-2 pandemic.MethodsWe invited adults in mandated quarantine after an exposure to SARS-CoV-2 identified through contact tracing of the Canton of Zurich, Switzerland, between August 2020 and January 2021. Participants completed two questionnaires and received up to two SARS-CoV-2 polymerase chain reaction tests, during and at the end of quarantine.ResultsAmong 395 participants, quarantine duration ranged from 2 to 20 days. By day 11 since the last contact, 11.1% [95% CI 8.4%–14.7%] were infected with SARS-CoV-2. The proportion of participants with symptoms of depression doubled from 9.3% before quarantine to 18.9% during quarantine, and 12.1% reported quarantine was very or extremely difficult.ConclusionAlthough quarantine was only moderately burdensome for most participants, some experienced significant difficulties and burden. Policymakers need to balance infection control with potential harms placed on individuals.

Understanding event-driven sediment transport in coral reef environments is essential to assessing impacts on reef species, habitats, restoration, and mitigation, yet a global knowledge gap remains due to limited quantitative studies. Hurricane Irma made landfall in the Lower Florida Keys with sustained 209 km h−1 winds and waves greater than 8 m on 10 September 2017, directly impacting the Florida Reef Tract (FRT) and providing an opportunity to perform a unique comprehensive, quantitative assessment of its impact on coral reef structure and sediment redistribution. We used lidar and multibeam derived digital elevation models (DEMs) collected before and after the passing of Hurricane Irma over a 15.98 km2 area along the lower FRT including Looe Key Reef to quantify changes in seafloor elevation, volume, and structure due to storm impacts. Elevation change was calculated at over 4 million point locations across 10 habitat types within this study area for two time periods using data collected (1) approximately 1 year before the passing of Irma and 3 to 6 months following the storm's impact as well as (2) 3 to 6 months after and up to 16.5 months after the storm. Elevation change data were then used to generate triangulated irregular network (TIN) models in ArcMap to calculate changes in seafloor volume during each time period. Our results indicate that Hurricane Irma was primarily a depositional event that increased mean seafloor elevation and volume at this study site by 0.34 m and up to 5.4 Mm3, respectively. Sediment was transported primarily west-southwest (WSW) and downslope, modifying geomorphic seafloor features including the migration of sand waves and rubble fields, formation of scour marks in shallow seagrass habitats, and burial of seagrass and coral-dominated habitats. Approximately 16.5 months after Hurricane Irma (during a 13-month period between 2017 and 2019), net erosion was observed across all habitats with mean elevation change of −0.15 m and net volume change up to −2.46 Mm3. Rates of elevation change during this post-storm period were 1 to 2 orders of magnitude greater than decadal and multi-decadal rates of change in the same location, and changes showed erosion of approximately 50 % of sediment deposited during the storm event as seafloor sediment distribution began to re-equilibrate to non-storm sea-state conditions. Our results suggest that higher-resolution elevation change data collected over seasonal and annual time periods could enhance characterization and understanding of short-term and long-term rates and processes of seafloor change.

The emergence of novel ecosystems, characterized by shifts in species composition and interactions, abiotic conditions and altered ecosystem functioning, is a major and inevitable challenge to contemporary ecosystem management. This study examines the ecological implications of Trachycarpus fortunei, a non-native evergreen palm, currently involved in a biome shift from deciduous temperate forest to evergreen laurophyllous forest in the Southern European Alps. Specifically, we investigated the effects of T. fortunei encroachment in peri-urban forests on flying and ground-dwelling arthropod communities as well as on leaf-litter decomposition. We found that the presence of T. fortunei altered arthropod community composition, mostly by reducing the number of herbivore species. This effect was likely driven by the lower quality of palm leaves as a food source compared to deciduous, dicotyledonous tree leaves and by a lower plant richness in the herb and shrub layer. Furthermore, we observed higher rates of leaf-litter decomposition associated with increasing abundance of young palm trees, which was not explained by predictors commonly associated with litter decomposition (i.e., detritivore abundance, litter depth and air temperature). Hence, the slow decay of palm leaves appears to be counterbalanced by the favourable conditions for litter decomposition within dense palm stands. Overall, our findings indicate that high densities of the non-native palm species (T. fortunei) impacts herbivore arthropod communities in the Southern European Alps, providing first evidence of possible effects on ecosystem functioning of this ongoing biome shift. These outcomes are integral components of the broader process of laurophyllisation in the study region, a phenomenon linked to climate warming and land use change, encompassing both native and non-native species.

Primary care paediatrics is practiced throughout the countries of Europe with different structures of health care systems and identities of care providers. The best way to guarantee that paediatricians are competently trained and provide high quality care to children and adolescents in primary care is a flexible and comprehensive training program based on practice and demonstration of acquired competencies. Entrustable professional activities represent a significant step toward improving the training and assessment of future healthcare professionals. It may constitute a model that unifies the training standards in primary care and community paediatrics.

This study analyzes the self-perception of mental health of socially vulnerable elderly people during the COVID-19 crisis in Brazil. Conducted across all state capitals from February 2021 to October 2023, it included 366 participants living in various conditions such as camps, street situations, slums, and communities. The average age was 66.7 years, with a majority being male (59.0%), of Black or Brown race/color (62.3%), and earning below one minimum wage (36.6%). Findings revealed that older adults in street situations, experiencing psychological manifestations like sleep disturbances due to the pandemic, tended to assess their mental health more negatively. In contrast, older men of white race/color without such manifestations, and those practicing strategies like physical activity or relaxation, were less likely to perceive their mental health as poor. Addressing housing, implementing health strategies, and recognizing sample and regional complexities are crucial interventions for older adults in street situations.

Vector-borne diseases (VBDs) are considered as (re-)emerging, but information on the transmission cycles and wildlife reservoirs is often incomplete, particularly with regard to urban areas. The present study investigated blood samples from European hedgehogs (Erinaceus europaeus) presented at wildlife rehabilitation centres in the region of Hanover. Past exposure to B. burgdorferi sensu lato (s.l.) and tick-borne encephalitis virus (TBEV) was assessed by serological detection of antibodies, while current infections with Borrelia spp., Anaplasma phagocytophilum, Rickettsia spp., Neoehrlichia mikurensis, Bartonella spp., Babesia spp. and Spiroplasma ixodetis were investigated by (q)PCR. Of 539 hedgehogs tested for anti-Borrelia antibodies, 84.8% (457/539) were seropositive, with a higher seropositivity rate in adult than subadult animals, while anti-TBEV antibodies were detected in one animal only (0.2%; 1/526). By qPCR, 31.2% (168/539) of hedgehog blood samples were positive for Borrelia spp., 49.7% (261/525) for A. phagocytophilum, 13.0% (68/525) for Bartonella spp., 8.2% for S. ixodetis (43/525), 8.0% (42/525) for Rickettsia spp. and 1.3% (7/525) for Babesia spp., while N. mikurensis was not detected. While further differentiation of Borrelia spp. infections was not successful, 63.2% of the A. phagocytophilum infections were assigned to the zoonotic ecotype I and among Rickettsia spp. infections, 50.0% to R. helvetica by ecotype- or species-specific qPCR, respectively. Sequencing revealed the presence of a Rickettsia sp. closely related to Rickettsia felis in addition to a Bartonella sp. previously described from hedgehogs, as well as Babesia microti and Babesia venatorum. These findings show that hedgehogs from rehabilitation centres are valuable sources to identify One Health pathogens in urban areas. The hedgehogs are not only exposed to pathogens from fleas and ticks in urban areas, but they also act as potent amplifiers for these vectors and their pathogens, relevant for citizens and their pets.

Abstract Links between human milk (HM) and infant development are poorly understood and often focus on individual HM components. Here we apply multi-modal predictive machine learning to study HM and head circumference (a proxy for brain development) among 1022 mother-infant dyads of the CHILD Cohort. We integrated HM data (19 oligosaccharides, 28 fatty acids, 3 hormones, 28 chemokines) with maternal and infant demographic, health, dietary and home environment data. Head circumference was significantly predictable at 3 and 12 months. Two of the most associated features were HM n3-polyunsaturated fatty acid C22:6n3 (docosahexaenoic acid, DHA; p = 9.6e−05) and maternal intake of fish (p = 4.1e−03), a key dietary source of DHA with established relationships to brain function. Thus, using a systems biology approach, we identified meaningful relationships between HM and brain development, which validates our statistical approach, gives credence to the novel associations we observed, and sets the foundation for further research with additional cohorts and HM analytes.

Abstract Background Tuberculosis is one of the most significant infectious diseases for global public health. The reallocation of healthcare resources and the restrictions imposed by the COVID-19 pandemic have hindered access to TB diagnosis and treatment. Increases in unfavorable outcomes of the disease have been observed in Brazil. The objective of this study was to analyze the spatial distribution of unfavorable TB treatment outcomes in Brazil before and during the pandemic. Methods An ecological study with spatial analysis was conducted with all 5569 municipalities in Brazil. All reported cases of tuberculosis between January 2010 and December 2021, as well as reported cases of COVID-19 from February 2020 to December 2021, were included. The outcomes studied encompass loss to follow-up, drug-resistant tuberculosis, and death. The Getis Ord GI* technique was employed to assess spatial association, and the Kernel density estimator was used to identify areas with concentrated increases or decreases in outcomes. Bivariate Local Moran's I was used to examine the spatial association between outcomes and COVID-19 incidence. The study was approved by the Research Ethics Committee of Ribeirão Preto Nursing School, University of São Paulo. Results There were 134,394 cases of loss to follow-up, 10,270 cases of drug resistance, and 37,863 deaths. Clusters of high and low values were identified for all three outcomes, indicating significant changes in the spatial distribution patterns. Increases in concentrations were observed for lost to follow-up cases in the Southeast, while reductions occurred in the Northeast, South, and Midwest. Drug-resistant tuberculosis experienced an increase in the Southern and Southeastern regions and a decrease in the Northeast and South. TB-related deaths showed notable concentrations in the Midwest, Northeast, South, and Southeast. There was an increase in high occurrence clusters for deaths after 2020 and 2021 in the Northeast. Conclusions The pandemic has brought additional challenges, emphasizing the importance of enhancing efforts and disease control strategies, prioritizing early identification, treatment adherence, and follow-up. This commitment is vital for achieving the goal of tuberculosis elimination.

Abstract Background The European hedgehog (Erinaceus europaeus) is known for high levels of ectoparasitism that not only represents a health risk for the animals themselves, but also for pet animals and humans as hedgehogs are frequently taken into human care. In the present study, patterns of ectoparasite infestation were assessed in hedgehogs taken into care at northern German animal rehabilitation centres. Methods Ectoparasites (ticks, fleas and mites) of 498 hedgehogs were collected over a period of 3 years from July 2018 to May 2021. Species were identified based on morphological characteristics and also via amplification and sequencing of the partial cytochrome c oxidase subunit 2 (COX-2) gene for fleas of the family Ceratophyllidae. Seasonal changes in infestation patterns as well as correlations with animal age, body weight and health status were assessed using generalised linear models. Results Infestation with ticks, fleas and mites occurred throughout the year. Overall, 86.5% (431/498) of the examined hedgehogs were infested with ticks, 91.4% (455/498) with fleas and 17.7% (88/498) with mites. Ixodes ricinus and Ixodes hexagonus/Ixodes canisuga were the most common tick species detected, with the additional occurrence of one Ixodes frontalis. Significant seasonal changes were observed for I. ricinus, but not for I. hexagonus/I. canisuga. Additionally, I. ricinus nymph prevalence declined significantly as of 2020, probably as a consequence of the climate change-related drought as of 2018. In hedgehogs with flea infestations, Archaeopsylla erinacei, Ceratophyllus sciurorum, Nosopsyllus fasciatus and Ctenocephalides felis were identified. In all cases of mite infestation, Caparinia tripilis was detected, in addition to specimens of the family Macronyssidae and free-living mites of the family Acaridae. Statistical analyses showed correlations regarding the factors month, year, body weight and age, but no correlation was evident regarding the health status of the animals. Conclusions With a detected infestation rate of 98.6%, almost all of the examined hedgehogs were infested with at least one ectoparasite species. The seasonal activity patterns of the different ectoparasite species together with the complex annual cycle of hedgehogs lead to different seasonal patterns in ectoparasite prevalence and infestation intensities. Due to the risk of transmission of zoonotic pathogens as well as the possible negative impact on the host itself, hedgehogs should be treated against ectoparasites when taken into care facilities. Graphical Abstract