Highest Number Of Cases Research Articles

Prevalence of paucibacillary cases of leprosy in Brazil: a 20-year systematic review and meta-analysis

IntroductionLeprosy is a chronic infectious disease caused by the agent Mycobacterium leprae, characterized by its high disabling power. Data points to Brazil being the second country with the highest number of cases in the world, behind only India, representing a major challenge for public health. This work aims to determine the prevalence of paucibacillary (PB) cases in relation to leprosy cases in Brazil, using data published in the literature.MethodsThis is a systematic review and meta-analysis carried out with studies from the last 20 years, being developed based on the Preferred Reporting Items for Systematic Review and Meta-analyzes (PRISMA).The search was carried out in the databases: PUBMED, SciELO, LILACS (via VHL)and Science Direct in October 2023, using the following descriptors (((“Brazil” [Mesh]) AND (“Leprosy, paucibacillary” [Mesh])) AND “Epidemiology” [Mesh]), in English, Portuguese and Spanish. Original studies of the analytical case–control, cohort, cross-sectional, epidemiological types were selected, as well as articles with satisfactory information for numerical extraction with separate data on the paucibacillary and multibacillary clinical forms. The methodological quality assessment followed the JBI critical appraisal checklist. Statistical analysis was performed using the Comprehensive Meta-Analyses-CMA software, version 3.0 (Biostat, Engewood, NJ, United States).ResultsThe meta-analysis of the 48 studies obtained a paucibacillary prevalence rate in Brazil of 50.5% or 0.505 (95% CI = 0.502–0.509).The differences in the analyzes were statistically significant (Q-value 4302.681;df 47; I 98.905), with a high heterogeneity value evidenced by I2 (98.905). This analysis demonstrated that the frequency in the Midwest region was the highest and the South region was the lowest (21.4%). Begg’s (Kendall Tau p = 0.35) and Egger’s tests (p = 0.20) were performed, in which no high publication bias was noted. Subgroup analysis indicated that paucibacillary cases varied from region to region, with the Midwest region having the highest prevalence and the South region having the lowest.ConclusionThe results stand out significantly for the research gaps that investigate PB cases, requiring more research aimed at investigating the paucibacillary clinical form that can contribute to the early diagnosis of leprosy.Systematic review registrationPROSPERO code: CRD42024514106.

ANÁLISE QUANTITATIVA DOS CASOS DE DENGUE NOS MUNICÍPIOS DO LITORAL NORTE DE SÃO PAULO NO PERÍODO DE JANEIRO DE 2014 A DEZEMBRO 2023

Dengue is characterized as a disease caused by a virus of the Flavivirus genus, transmitted by mosquitoes of the Aedes genus, with Aedes aegypti being the main vector. Due to its wide distribution and adaptation to urban and peri-domestic environments, dengue is predominantly found in urban areas. The ideal habitat for the mosquito is a tropical climate, which makes Brazil ideal for its proliferation. In addition to climatic factors, disorderly urbanization also contributes to the multiplication of the mosquito, increasing the places where it can reproduce. The vector's life cycle comprises the egg, four larval stages, a pupal stage and the adult, with an average lifespan of 10 to 42 days. Dengue symptoms generally include malaise, fever and weakness, and the disease tends to be self-limiting in most cases, being diagnosed through laboratory tests and clinical case. The aim of this study is to analyze the number of dengue cases in the municipalities of the north coast of São Paulo, Brazil, from January 2014 to December 2023, with the highest rate being observed in the municipality of São Sebastião with 14.95% of dengue cases in relation to the total population and the lowest rate of cases in Ilhabela with a percentage of around 7.37%. The year with the highest number of cases in the region was 2015 in the municipalities of Caraguatatuba, Ubatuba and São Sebastião and Ilhabela in 2014.

Implementation of ward's agglomerative hierarchical clustering model to detect pulmonary tuberculosis endemic areas in Aceh Utara regency

This study aims to detect pulmonary Tuberculosis (TB) endemic areas in Aceh Utara Regency based on altitude, population density, and the number of TB cases. The Agglomerative Hierarchical Clustering (AHC) algorithm was used to cluster 27 subdistricts, each measured by these three factors. The clustering results divided the subdistricts into three main clusters with distinct characteristics. Cluster 1 consists of subdistricts with low altitude, high population density, and relatively high numbers of TB cases, identifying this area as having the highest risk of TB endemicity. Cluster 2 includes areas with moderate population density and TB case numbers, while Cluster 3 consists of subdistricts at higher altitudes with fewer TB cases. The clustering results were evaluated using three key metrics: Silhouette Score, Davies-Bouldin Index, and Dunn Index, which indicated that the clustering model performed well, although some subdistricts were positioned near the cluster boundaries. This research provides valuable information for health authorities to prioritize interventions and allocate resources to areas most in need of TB management.

Characterization of aGerman cohort with visual snow syndrome

Visual snow is adisorder of visual perception that is manifested as aconstant flickering or "TV-like" noise in the entire visual field. Visual snow syndrome (VSS) describes acombination with other additional visual symptoms, such as sensitivity to light, afterimages, night blindness and entoptic phenomena. Cases of VS have been described in the literature using awide variety of terms, often misunderstood as persistent migraine aura. Established diagnostic criteria have existed for more than 10years now; however, the pathophysiology is still incompletely understood. The exact prevalence also remains unknown and high numbers of unreported cases are suspected. This is the first detailed description of acohort of VSS patients from Germany. Patients with VSS from several studies conducted at our center were pooled and retrospectively evaluated with respect to demographic, epidemiological and clinical data. In this study 66patients with VSS were included (age 31.3 ± 8.3years, 30women). The most commonly associated visual symptoms were photophobia (67%) and afterimages (65%). Of the patients 36(54%) had comorbid migraine of whom 25(70%) had migraine with aura, 26(39%) reported depressive symptoms and 32(48%) symptoms of an anxiety disorder. Tinnitus was reported by 32(48%) patients. The characteristics of the German cohort described here are similar to other international descriptions. Due to the frequent psychological comorbidity there is still arisk of psychosomatic stigmatization.

Cutaneous leishmaniasis in British troops following jungle training in Belize: Cumulative incidence and potential risk practices

BackgroundBritish soldiers undergoing jungle training in Belize typically experience a relatively low risk of developing cutaneous leishmaniasis. However, an uncharacteristically large outbreak of cutaneous leishmaniasis occurred in 2022. This study aimed to determine the cumulative incidence of the disease and highlight potential shortcomings in personal protective measures to mitigate exposure to sand fly vector bites. MethodsA retrospective analysis was conducted on medical records of cutaneous leishmaniasis cases between 2005 and 2022, as well as on questionnaire responses regarding personal protective measures administered to cutaneous leishmaniasis cases in 2022. Data were sourced from Defence Public Health Unit, Military Environmental Health Department and British Army Training Support Unit Belize. ResultsEighty-one confirmed clinical cutaneous leishmaniasis cases were recorded between 2005 and 2022, with a substantial peak (38 cases) in 2022. Most cases occurred during the wet season. Pre-2022, the median cumulative incidence per 8-week deployment was 0.90 % (Q1–Q3: 0.34 %–1.34 %), with an annual variation of 0.2 % to 2.0 %. In 2022, the cumulative incidence spiked to 4.22 %, associated with a risk ratio of 5.3 (95 % C.I.s, 3.41, 8.16), and rising to a cumulative incidence of 7.3 % in a single unit of 450 men (33 cases) in late 2022. These values are significantly higher than the median cumulative incidence of all previous years, and to published reports for other cutaneous leishmaniasis -endemic regions. Troop responses identified limitations in the supply of optimal equipment, and in sand fly bite and leishmaniasis risk avoidance information provided by the pre-deployment health education programme. Compliance with health education advise was also suboptimal, with irregular use of insect repellents, protective clothing / head netting, and insecticide-treated hammocks. ConclusionsThe reasons behind the unusually high numbers of cutaneous leishmaniasis cases and cumulative incidence in 2022 remain unclear, emphasising the need to improve personal protective measures provision and implement a comprehensive health education programme for troops undergoing jungle training in Belize.

Differences in Knowledge of Women of Fertilizing Age Before and After Education About Breast Self Examination Using Video in The Selabih Village Tabanan

The high number of cases of non-communicable diseases is the main cause of death in Indonesia in 2020, one of which is breast cancer. The problem of breast cancer in Indonesia can be overcome through breast self-examination. The aim of this research was to determine the difference in knowledge of women of childbearing age before and after education about breast self-examination using video in Selabih Village Tabanan. This research includes research Quasi Experimental by design One Group Pretest-Posttest. The number of samples used was 53 women of childbearing age. Data collection includes filling out a knowledge questionnaire pretest and posttest. Before being given education, the median score was 85 with score range of 65-100 and after being given education the median score increased to 90 with score range of 80-100. Analysis results used tests wilcoxon show p-value of 0.000 which can be concluded that there is a difference in knowledge of women of childbearing age before and after education about breast self-examination using video. The use of this educational video should be continued by midwives at local health centers as a medium of education for women of childbearing age so that they are able to do BSE regularly.

Urban Community Participation In Dealing With The Covid-19 Pandemic Through Environment-Based On Covid-19 Handling Policies In The City Of Mataram

The city of Mataram is an area that has a high number of Covid-19 cases in West Nusa Tenggara Province. Covid-19 has seriously impacted all aspects of life, from health, economy, society, culture, and tourism to religious rituals. This study aims to analyze the policies for handling Covid-19 in Mataram City. Second, analyze the form of community participation in efforts to deal with Covid-19 in Mataram City. This study uses the participation theory of Cohen and Uphoff as an analytical tool. This research is qualitative research with a descriptive approach. In- depth interviews, observation, and documentation employed data collection techniques. The results of this study indicate that this environment-based policy for handling Covid-19 effectively suppresses the spread of Covid-19 in Mataram City. This policy is implemented by involving the participation of all elements of government, local leaders, and the community. Community participation in handling Covid-19 starts with high public awareness of Covid-19, then implementing health protocols. Community participation is also seen in the formulation of policies for handling Covid-19, the movement to join a Task Force (Satgas), carrying out self- help movements to help each other, and being involved in evaluating the handling of Covid-19 in the City of Mataram.

Headache disorders: a persistent public health challenge for the under 50s.

Currently, neurological diseases has surpassed cardiovascular diseases as the primary cause of global disease burden. Among these, headache disorders are the most prevalent and have emerged as the main cause of disability in people under 50 years old in recent years. Since the release of GBD 2021, there has been no comprehensive systematic exposition on the burden of headache among individuals under 50 years old and a forecast for future burdens. This study aims to quantify the global, regional, and national burden of headache disorders among people under 50 from 1992 to 2021 and to predict future trends in order to provide policy makers with precise and effective epidemiological evidence. This study extracted the incidence, prevalence, and DALYs data related to headache disorders in the 5-50 age group from the GBD 2021. After age-standardizing the data, we used joinpoint regression analysis and health inequity analysis to analyze the burden and temporal trend of headache disorders and predicted the future disease burden and changes based on the age-period-cohort model. By 2021, the case number of global incidence, prevalence and DALYs have increased by 35, 39, and 41%, respectively, over the past 30 years. The incidence and prevalence of tension-type headache (TTH) are significantly higher than those of migraine, but migraine causes greater health burdens. The burden is higher for female than for male. In terms of age, youth aged 25-29 years had the highest incidence in 2021, with an age-standardized rate (ASR) of 13,454.64 (95%CI, 9,546.96-18,361.36) per 100,000 population. Nationally, the highest ASR of incidence and prevalence are found in Norway, and the most damaging to health is found in Belgium. Among the five sociodemographic index (SDI) categories, the middle SDI has the highest number of cases (190 million in 2021). It is worth noting that the forecast shows that by 2046 the three indicators will reach 680 million, 2.33 billion, and 41 million, respectively, indicating that the burden of headache disorders in this age group will continue to persist. Globally, the burden of headache disorders in people under 50 years of age remains significant and has not improved over the past 30 years, especially in regions with high SDI. Headache problems will continue to pose a serious public health challenge for this age group for some time to come. This study reveals the burden and distribution of headache disorders in this age group, providing important basis for governments and policymakers to accurately and effectively allocate health care resources, strengthen prevention and management strategies, and respond to this global health problem.

Ecuador Towards Zero Leprosy: A Twenty-Three-Year Retrospective Epidemiologic and Spatiotemporal Analysis of Leprosy in Ecuador.

Ecuador has gone through a significant reduction in new cases from 2000 (106) to 2023 (12), suggesting a trend towards zero leprosy. An ecological spatiotemporal study design was used to describe the epidemiological distribution of the disease in the country during 2000-2023. Leprosy cases registered by the surveillance system of the Ecuadorian Ministry of Public Health were the data utilized for the study. From January 2000 to December 2023, 1539, incidence cases were diagnosed with leprosy in Ecuador. At the time of diagnosis, the median age was 54 years. Most of the cases were males (71.5%). The proportion of incidence cases in subjects over 50 years was 63% and 1.5% in children ≤ 15 years old. The yearly incidence rate ranged from 8.5/1,000,000 population in 2000 to 0.68/1,000,000 population in 2023, remaining within the low-endemic parameter. In total, 35 cantons reported newly detected leprosy cases in the year 2000. By the end of 2023, only eight cantons actively reported cases of leprosy. High-risk clusters for leprosy were detected in the tropical coastal region of Ecuador. The provinces with the highest number of cases during the study period were Guayas (44.8%) and Los Rios (15.7%), with zero cases being found in the Galapagos Islands. Our study is unique in that it documents a retrospective dataset over a two-decade timespan from a South American country that has effectively applied global guidelines for the control and elimination of leprosy.

Seropositivity of hepatitis A and E viruses in patients attending a tertiary care center in central India

Objectives: Hepatitis A virus (HAV) and hepatitis E virus (HEV) infections are significant global health concerns that contribute to acute viral hepatitis. This study aimed to investigate the prevalence of HAV, HEV, and co-infections in a tertiary care hospital setting in central India. Materials and Methods: This retrospective observational study analyzed 987 clinical specimens collected from suspected acute viral hepatitis cases over 5 years (2019–2023). Commercially available enzyme-linked immunosorbent assay kits were used to detect HAV and HEV immunoglobulin M antibodies. Statistical analysis: Demographic data and clinical information were collected and analyzed using Chi-square tests. P < 0.05 was considered statistically significant, indicating a significant association between the variables under investigation. Results: Overall, 32.72% of patients were seropositive for either HAV, HEV, or both. The prevalence of HAV was 22.9%, HEV was 9.83%, and co-infection was 3.24%. HAV infection was more prevalent in children (0–14 years), whereas HEV was more prevalent in adults. Both HAV and HEV infections were associated with elevated liver function markers, with the highest levels observed in co-infected cases. The monsoon season had the highest number of cases. Conclusions: This study revealed a substantial burden of HAV, HEV, and co-infections in central India. The observed sex—and age-specific prevalence patterns warrant further investigation. Effective public health strategies addressing sanitation, hygiene practices, and HAV vaccination programs are crucial to reducing the disease burden.

Emergence of mpox in the Eastern Mediterranean Region: Data assessment and implications for a public health response

IntroductionMonkeypox (mpox) is an illness caused by the MPX virus and endemic to certain African countries. Historically, sporadic outbreaks have occurred in some non-endemic areas. In 2022, a new variant emerged, clade IIb, causing a global outbreak sustained within sexual networks among men who have sex with men (MSM). To our knowledge, this is the first multi-country study examining mpox epidemiology and clinical features of the 2022–2023 outbreak caused by clade IIb across the Eastern Mediterranean Region (EMR). MethodsWe analyzed datasets of anonymous mpox case-based reports submitted to the World Health Organization (WHO) from May 2022 to December 2023 in the EMR to describe the cumulative incidence, demographics, transmission routes, and clinical outcomes. ResultsBy the end of 2022, 95 case reports were submitted to the WHO. The first case of mpox was reported in the United Arab Emirates on May 24, 2022. The highest number of cases were reported from Lebanon (27 confirmed cases). Most cases in the EMR were adult males (92 %), 60 % identifying as MSM, and 10 % living with HIV. Most reported symptoms were rash (95.4 %) and fever (69.6 %). No intensive care unit admissions or deaths were reported. ConclusionIn this study we investigated the epidemiology, clinical presentation, and outcomes of the mpox outbreak related to clade IIb in the EMR. We raise concerns about the accuracy and completeness of the data, given that the number of cases reported to the WHO from EMR countries appears to be significantly lower than the number of cases documented within the region. This discrepancy could impact the reliability of the reported figures and the region's response strategies. Despite these challenges, collaborative efforts across EMR countries have laid the groundwork for effective outbreak response, underscoring the importance of ongoing regional cooperation to enhance future preparedness strategies.

Streptococcus suis-Associated Meningitis in a Southern Region of Vietnam.

Streptococcus suis is the most common and severe cause of meningitis in Vietnam, but the recent data about epidemiological characteristics and sequelae are still inadequate. We performed a retrospective study to describe the epidemiology, clinical characteristics, and outcomes of patients with S. suis-associated meningitis. A retrospective study was carried out by searching records from the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam, between January 2016 and January 2020. All data concerning epidemiological, clinical, and subclinical characteristics and treatment results were collected and analyzed. Over the study period, 153 cases were included in this study, with 95 cases occurring in the 2016-2017 period. The median age of all patients was 52 years (range, 29-90 years), and 70.6% of patients were male. Fifty-two patients (34%) were farmers, and the Mekong Delta was the region with the highest number of cases (60.1%). The most frequent manifestation of infection was fever (151/153, 98.7%), followed by hearing loss (64/153, 41.8%), and one patient (0.7%) died. All isolates remained susceptible to ceftriaxone, penicillin, vancomycin, and levofloxacin, whereas 99.2% of isolates were resistant to tetracycline. Occupational exposure to pigs and the consumption of contaminated food have been identified as primary risk factors associated with this zoonosis, and our study found no significant changes in epidemiological factors compared with past data. The Mekong Delta continues to be the most affected region for S. suis meningitis in southern Vietnam, with S. suis serotype 2 remaining the most relevant agent.

Geographic Information System for Mapping Deployment Areas Dengue Fever in Umalulu District

Dengue fever is a disease caused by the dangue virus, causing serious health problems, especially in Umalulu sub-district, East Sumba Regency which has an area of 307.90 km2 and consists of 10 villages, each of which has an impact on dengue cases. This study aims to map the area of the spread of dengue fever in real time in Umalulu sub-district using a Geographic Information System (GIS), which is currently experiencing the problem of an increase in the number of dangue hemorrhagic fever cases and assistance that has not been targeted. The research method used is Waterfall, which follows the stages of planning, data collection, system analysis and design, implementation, and maintenance. Based on black box testing, this research succeeded in producing a web-based GIS that maps the dengue fever distribution areas in showing that the Lumbukore village is the area that has the highest number of cases with 12 and the Ngarukanoru village with the lowest area with 0 cases, with an average of many cases occurring in March and April of 2024 in Umalulu District, allowing users to analyze dengue disease distribution patterns provide recommendations for prevention and control measures for dengue disease more accurately and on target.

A seroprevalence study indicates a high proportion of clinically undiagnosed MPXV infections in men who have sex with men in Berlin, Germany

IntroductionDuring the mpox outbreak in 2022, the highest number of cases in Germany were registered in Berlin, almost all of them in men who have sex with men (MSM). However, the frequency of clinically undiagnosed infections is unknown.MethodsA cross-sectional study was conducted among MSM in Berlin, Germany. Participants were recruited from private practices and community-based checkpoints specialised in HIV and STI care for MSM. They were asked to complete an online questionnaire on socio-demographic data, mpox diagnosis, vaccination history and sexual behaviour, and to provide a blood sample for serological analysis. The samples were tested for antibodies against a range of antigens to distinguish between antibodies induced by mpox infection and MVA vaccination, with pre-immune sera from childhood smallpox vaccination as a confounding factor. Associations of behavioural variables with reported and suspected mpox diagnosis as the outcome were tested using univariable and multivariable logistic regression models.ResultsBetween the 11th April and 1st July 2023, 1,119 participants were recruited in eight private practices and two community-based checkpoints in Berlin. All participants provided a blood sample for serological testing. Information for the online questionnaire was provided by 728 participants; core data on age and mpox history for participants who did not provide questionnaire data were provided by the practices for an additional 218 participants. A previous diagnosis of mpox was reported for/by 70 participants (7.4%). Using a conservative and strict case definition, we serologically identified an additional 91 individuals with suspected undiagnosed mpox infection. Individuals with reported or suspected mpox infections reported more condomless anal sex partners in the past 3 months (OR = 5.93; 95% CI 2.10-18.35 for 5–10 partners; OR = 9.53; 95% CI 2.72–37.54 for > 10 partners) and were more likely to report sexual contact with partners diagnosed with mpox (OR = 2.87; 95% CI 1.39–5.84).ConclusionA substantial proportion of mpox infections were clinically undiagnosed. The number of condomless anal sex partners was strongly associated with both confirmed and suspected undiagnosed mpox infection. Therefore, mpox control measures based on clinical diagnosis of mpox are likely to have limited effectiveness in preventing mpox transmission in outbreak situations because many infections remain unrecognised and undiagnosed.

Clinical Implication of Time of Ischaemic Stroke Among Post-Stroke Survivors from Eastern India: A Circadian Perspective.

The circadian variation in stroke occurrence is a well-documented phenomenon. However, the circadian effect on stroke outcome, particularly on post-stroke cognition, has not yet been fully elucidated. We aim to evaluate the influence of diurnal variation of stroke onset upon post-stroke cognition and development of post-stroke depression. Based on 4-hourly time period of stroke occurrence, 249 recruited cohorts were categorized into 6 groups. Several clinical and cognitive parameters were compared among the groups. Then, the mRNA expression of core clock genes in Peripheral Blood Mononuclear Cells were quantified and correlated with post-stroke outcomes among 24 acute phase cases with day-time or night-time stroke occurrence. Furthermore, the genetic susceptibility towards a higher number of cases in the morning was examined by genotyping CLOCK (rs1801260T/C, rs4580704G/C) and CRY2 (rs2292912C/G) genes variants in cases and 292 controls. In our study, the peak for highest incidence although observed during the early morning from 4 to 8 am, the nocturnal-onset stroke cases showed more severity (12.2 ± 5.67) at the time of admission irrespective of arterial territory involved. The night onset cases were also found to be more susceptible to develop language impairment and post-stroke depression in due course of time. Upon transcript analysis, circadian genes (BMAL1 and CRY1) were found to be downregulated in night-time cases than day-time ones during the acute phase of onset. In addition, those mRNA levels also showed a correlation with raw scores for language and depression. However, the difference in incidence frequency along a day did not reveal any genetic correlation. Therefore, we suggest night-time stroke to be positively associated with higher immediate severity and poor cognitive outcome than day-time injury and propose downregulation of circadian genes during the acute phase could be the underlying molecular mechanism for this.

Sudden cardiac death in athletes: A 20-year analysis in Portugal

Introduction and objectivesSudden cardiac death (SCD) in athletes is a tragic event, with some evidence remaining controversial. The aim of this study was to evaluate cases of SCD in athletes in Portugal within the last 20 years. MethodsAn advanced Google search using a combination of several keywords and systematic searches on websites of national newspapers/television stations was conducted. Additionally, 54 Portuguese sports federations and the Portuguese Institute of Sports and Youth were contacted by email and/or phone. All sports-related SCD cases in competitive athletes, occurring between 2003 and 2023 in Portugal, were included. The total number of athletes at risk used for the calculation of SCD incidence, was collected from official national records. ResultsA total of 42 SCD cases in athletes were identified, with a median age of 27 [18;42] years, and the great majority were male (n=39; 93%). Most events occurred in outdoor sports (n=28; 67%), especially in football (n=13; 31%), athletics (n=4; 10%) and trail running (n=4; 10%), and during competition or training sessions (n=27; 64%). The higher number of cases were reported in 2021 and 2022, while in several years no occurrences were found. The yearly average SCD incidence was 0.39 cases per 100000 athletes/year. ConclusionsThe incidence of SCD in athletes in Portugal is very low, mainly occurring in male, outdoor sports and during competitions or training sessions. Due to the limitations of passive data collection, prospective registries are needed, with standardization of the most relevant data, especially regarding their etiology and circumstances.

Problematika Batasan Usia Tindak Pidana Aborsi

Pregnancy outside of marriage is one of the factors contributing to the high number of abortion cases. Sometimes, abortion attempts fail, resulting in the birth of a living baby. It is not uncommon for these newborns to become victims of infanticide due to fear of being discovered as having given birth. This issue becomes particularly compelling when considering the condition of these children, especially infants, whose right to life is being taken away. A further discussion is needed on the age limit for abortion in relation to infanticide, as well as the fulfillment of the legal certainty principle regarding abortion age limits. The research method used is normative juridical with a statute approach and a conceptual approach. The research findings indicate ambiguity in the legal provisions regarding the age limit for abortion. Moreover, there is a need for clearer regulations concerning specific legal provisions related to abortion limits.

Simulation and validation of the transmission error, meshing stiffness, and load sharing of planetary spur gear transmissions

Although the load sharing between planets of sequentially phased planetary gear transmissions has been studied in the past, the required solving techniques based on the Finite Element Method result in long time consuming and high computational cost. This limits the possibilities of undertaking extensive studies that take into consideration a high number of cases allowing optimal solutions to be sought or general conclusions drawn. In addition, the determination of the curves of transmission error, time-varying mesh stiffness, and load sharing among tooth pairs in simultaneous contact are also complicated. In this work an analytical model has been developed for the simulation of the time-varying mesh stiffness, quasi-static transmission error, and load sharing ratio between planets and tooth pairs of planetary spur gear transmissions. It is based on similar models for external and internal spur gears previously developed and has been validated by comparison with a hybrid model based on the Finite Element Method and theoretic-experimental correlation.

Cartridge-Based Nucleic Acid Amplification Test Compared to Fine Needle Aspiration Cytology in Suspected Cases of Tubercular Lymphadenitis (the Indian Experience)

INTRODUCTION: Diagnosis of tubercular lymphadenitis is daunting as there are varied clinical presentations and no single confirmatory gold standard test. Cartridge-based nucleic acid amplification test (CBNAAT) of the lymph node is a rapid molecular diagnostic test for simultaneously detecting tuberculosis (TB) and rifampicin resistance. AIM: To evaluate the performance of the CBNAAT test for detecting M. tuberculosis in lymph node specimens compared to fine needle aspiration cytology (FNAC). MATERIALS AND METHODS: The study was conducted in a rural tertiary care hospital in central India. A total of 180 patients clinically suspected of tubercular lymphadenitis were included. The male-to-female ratio was 1:1.3. The average age was 33.3 years. The age group 21–40 years had the highest number of cases. The most common complaints among the patients were fever (29.4%), followed by loss of appetite (9.5%), weight loss (9.5%), and cough (6.6%). However, most patients presented to the hospital with only lymphadenopathy (44.4%). The most common site involved was the anterior cervical lymph node (78.8%), followed by the axillary group (10.5%), submandibular (2.8%), inguinal (2.8%), supraclavicular (2.2%), submental (1.7%) and infraclavicular (1.1%) group of lymph nodes. The patients were subjected to both FNAC and CBNAAT testing. Results were reported as positive or negative for M. tuberculosis as CBNAAT gives a semiquantitative estimate of the concentration of bacilli. Rifampicin resistance results were reported as detected or not detected. RESULTS: Cytological examination of the lymph node aspirates revealed that most were tubercular lymphadenitis cases. Cytomorphological analysis of the cases of tubercular lymphadenitis revealed Type 6 (tubercular abscess) as the predominant pattern. CBNAAT testing detected 26 cases of M. tuberculosis and three cases of rifampicin resistance. The study reported a specificity of 92.92% and low sensitivity of 26.86% of combined FNAC and CBNAAT is much higher compared to only CBNAAT. CONCLUSION: CBNAAT, along with FNAC, is a valuable addition in first-line investigations of tubercular lymphadenitis to make a timely diagnosis.

Refinement and optimisation of Neisseria gonorrhoeae NHBA and MetQ vaccine candidates

Neisseria gonorrhoeae has a significant impact on reproductive health with an estimated 82 million new cases of infection per year worldwide. Due to the ongoing emergence of multidrug-resistant N. gonorrhoeae strains, the high number of asymptomatic cases, and the risk of disease sequelae, the development of a gonococcal vaccine is urgently needed. We have previously described two potential gonococcal vaccine antigens, cNHBA (C-terminal fragment of the Neisseria Heparin Binding Antigen) and MetQ (methionine-binding protein). This study aimed to optimise these antigens for improved immune responses and to facilitate vaccine production, by investigating cNHBA fusions with the full-length MetQ protein or N-terminal and C-terminal MetQ fragments (Met1 and Met2, respectively) adjuvanted with aluminium hydroxide. The cNHBA and MetQ fragments and fusion antigens were all immunogenic in mice, generating a predominantly IgG1 response. Antibodies mediated bacterial killing via both serum bactericidal activity (SBA) and opsonophagocytic activity (OPA), and reduced adherence to cervical and urethral epithelial cells. Among the antigen fusions tested, MetQ-cNHBA and cNHBA-Met2 generated the highest SBA, OPA and adherence blocking titres and are proposed as promising optimised antigens for N. gonorrhoeae vaccine development.