Forecasting environmental water availability of lakes using temporal fusion transformer: case studies of China's two largest freshwater lakes.

Preserving lacustrine ecosystems is vital for sustainable watershed development, and forecasting the environmental water availability of lakes would support policymakers in developing sound management strategies. This study proposed a methodology that merges the lake water level prediction and environmental water availability evaluation. The temporal fusion transformer (TFT) model forecasted the lake water levels for the next 7 days by inputting the streamflow and lake water level data for the past 30 days. The environmental water availability was assessed by comparing the forecasted lake water levels with the environmental water requirements, resulting in adequate, regular, scarce, and severely scarce environmental water availability. The methodology was tested in two case studies: Poyang Lake and Dongting Lake, the two largest freshwater lakes in the Yangtze River Basin, China. The TFT model performed well in forecasting the lake water levels, as shown by the high coefficient of determination and finite root mean square error. The coefficients of determination exceeded 0.98 during the model training, validation, and test for both Poyang Lake and Dongting Lake, and the root mean square errors ranged from 0.06 to 0.46 m. The accurate prediction of lake water level promoted the precise forecasting of the environmental water availability with the high Kappa coefficient exceeding 0.90. Results indicated the rationality and effectiveness of integrating the lake water level prediction and environmental water availability evaluation. Future research includes the applicability of the TFT model to other lakes worldwide to test the proposed approach and investigate strategies to cope with environmental water scarcity.

Neurodevelopmental assessment of normocephalic children born to Zika virus exposed and unexposed pregnant people.

BACKGROUND: Studies examining the association between in utero Zika virus (ZIKV) exposure and child neurodevelopmental outcomes have produced varied results. METHODS: We aimed to assess neurodevelopmental outcomes among normocephalic children born from pregnant people enrolled in the Zika in Pregnancy in Honduras (ZIPH) cohort study, July-December 2016. Enrollment occurred during the first prenatal visit. Exposure was defined as prenatal ZIKV IgM and/or ZIKV RNA result at enrollment. Normocephalic children, >6 months old, were selected for longitudinal follow-up using the Bayley Scales of Infant and Toddler Development (BSID-III) and the Ages & Stages Questionnaires: Social-Emotional (ASQ:SE-2). RESULTS: One hundred fifty-two children were assessed; after exclusion, 60 were exposed and 72 were unexposed to ZIKV during pregnancy. Twenty children in the exposed group and 21 children in the unexposed group had a composite score <85 in any of the BSID-III domains. Although exposed children had lower cognitive and language scores, differences were not statistically significant. For ASQ:SE-2 assessment, there were not statistically significant differences between groups. CONCLUSIONS: This study found no statistically significant differences in the neurodevelopment of normocephalic children between in utero ZIKV exposed and unexposed. Nevertheless, long-term monitoring of children with in utero ZIKV exposure is warranted. IMPACT: This study found no statistically significant differences in the neurodevelopment in normocephalic children with in utero Zika virus exposure compared to unexposed children, although the exposed group showed lower cognitive and language scores that persisted after adjustment by maternal age and education and after excluding children born preterm and low birth weight from the analysis. Children with prenatal Zika virus exposure, including those normocephalic and have no evidence of abnormalities at birth, should be monitored for neurodevelopmental delays. Follow-up is important to be able to detect developmental abnormalities that might not be detected earlier in life.

Differential expression of TOB/BTG family members in patients with plaque psoriasis: cross-sectional study.

TOB/BTG is a family of antiproliferative proteins that play an important role in the regulation of immune responses, acting as lymphocyte activators and macrophage-mediated cytotoxicity. No previous studies have explored their role in patients with psoriasis. The aim of this study was to characterize the expression of TOB/BTG family and their co-localization in skin from patients with psoriasis. This is an exploratory, observational, and cross-sectional study that included 24 plaque psoriasis patients and 15 controls. Gene expression of TOB/BTG family was determinate by RT-PCR. Protein products of TOB/BTG were evaluated by immunohistochemistry and compared with control skin tissues. Holm-Sidak's multiple comparisons test was performed. TOB/BTG family mRNA levels and protein expression were significantly decreased in psoriatic skin tissue compared to non-inflammatory control skin tissue. Double-positive cell TOB1/2, BTG1,2 and BTG4/CD16 expressions were found in normal control skin tissues through epidermis and dermis (p < 0.001) and lesser percentage in patients with mild, almost absent in moderate-severe plaque psoriasis. This is the first report of the TOB/BTG family gene and protein expression in skin tissues by a CD16 + subpopulation in plaque psoriasis. TOB/BTG family protein might represent a new therapeutic target among immune-mediated inflammatory diseases.

Prognosis factors in heart-lung transplantation: 30 years experience in a reference center.

INTRODUCTION: Heart-lung transplantation has shown a progressive decrease in the number of procedures. There is a lack of information about this field in Spain. The main goal of this study is to analyze the experience of a national reference hospital. METHODS: We performed a retrospective study of a historical cohort of heart-lung transplanted patients in a single center, during a 30 years period (from 1990 to 2021). The associations between variables were evaluated using the χ2 test or Fisher's exact test. Survival was analyzed using the Kaplan-Meier method. Differences were evaluated using the log-rank test and multivariate analysis with the Cox method. RESULTS: A decrease in the number of procedures performed in the last decade was observed [2000-2009: 19 procedures (44.2%); 2010-2021: 15 procedures (34.8%)]. Early postoperative mortality was 23.3%, falling to 13.3% from 2010. In-hospital mortality was 41%, falling to 33% from 2010. Main factors related to higher mortality: previous thoracic surgery, corticosteroid therapy, extracorporeal circulation (ECLS) greater than 200 min, ischemia time greater than 300 min, and tracheal dehiscence (p < 0.005). Overall survival at one, five, and ten years was 58%, 44.7%, and 36.1%, respectively. Factors associated with lower survival rates: previous thoracic surgery, male donor, extracorporeal circulation greater than 200 min, ischemia time greater than 300 min, tracheal dehiscence and weight difference (p < 0.005). CONCLUSIONS: There has been a progressive decrease in the number of heart-lung transplantations, being more evident in the last decade, but showing an improvement in both mortality and survival.

The burden of stillbirths in low resource settings in Latin America: Evidence from a network using an electronic surveillance system.

OBJECTIVE: To determine stillbirth ratio and its association with maternal, perinatal, and delivery characteristics, as well as geographic differences in Latin American countries (LAC). METHODS: We analysed data from the Perinatal Information System of the Latin American Center for Perinatology and Human Development (CLAP) between January 2018 and June 2021 in 8 health facilities from five LAC countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic). Maternal, pregnancy, and delivery characteristics, in addition to pregnancy outcomes were reported. Estimates of association were tested using chi-square tests, and P < 0.05 was regarded as significant. Bivariate analysis was conducted to estimate stillbirth risk. Prevalence ratios (PR) with their 95% confidence intervals (CI) for each predictor were reported. RESULTS: In total, 101,852 childbirths comprised the SIP database. For this analysis, we included 99,712 childbirths. There were 762 stillbirths during the study period; the Stillbirth ratio of 7.7/1,000 live births (ranged from 3.8 to 18.2/1,000 live births across the different maternities); 586 (76.9%) were antepartum stillbirths, 150 (19.7%) were intrapartum stillbirths and 26 (3.4%) with an ignored time of death. Stillbirth was significantly associated with women with diabetes (PRadj 2.36; 95%CI [1.25-4.46]), preeclampsia (PRadj 2.01; 95%CI [1.26-3.19]), maternal age (PRadj 1.04; 95%CI [1.02-1.05]), any medical condition (PRadj 1.48; 95%CI [1.24-1.76, and severe maternal outcome (PRadj 3.27; 95%CI [3.27-11.66]). CONCLUSIONS: Pregnancy complications and maternal morbidity were significantly associated with stillbirths. The stillbirth ratios varied across the maternity hospitals, which highlights the importance for individual surveillance. Specialized antenatal and intrapartum care remains a priority, particularly for women who are at a higher risk of stillbirth.

Neonatal outcomes according to different degrees of maternal morbidity: cross-sectional evidence from the Perinatal Information System (SIP) of the CLAP network.

BACKGROUND: The burden of maternal morbidity in neonatal outcomes can vary with the adequacy of healthcare provision and tool implementation to improve monitoring. Such information is lacking in Latin American countries, where the decrease in severe maternal morbidity and maternal death remains challenging. OBJECTIVES: To determine neonatal outcomes according to maternal characteristics, including different degrees of maternal morbidity in Latin American health facilities. METHODS: This is a secondary cross-sectional analysis of the Perinatal Information System (SIP) database from eight health facilities in five Latin American and Caribbean countries. Participants were all women delivering from August 2018 to June 2021, excluding cases of abortion, multiple pregnancies and missing information on perinatal outcomes. As primary and secondary outcome measures, neonatal near miss and neonatal death were measured according to maternal/pregnancy characteristics and degrees of maternal morbidity. Estimated adjusted prevalence ratios (PRadj) with their respective 95% CIs were reported. RESULTS: In total 85,863 live births were included, with 1,250 neonatal near miss (NNM) cases and 695 identified neonatal deaths. NNM and neonatal mortality ratios were 14.6 and 8.1 per 1,000 live births, respectively. Conditions independently associated with a NNM or neonatal death were the need for neonatal resuscitation (PRadj 16.73, 95% CI [13.29-21.05]), being single (PRadj 1.45, 95% CI [1.32-1.59]), maternal near miss or death (PRadj 1.64, 95% CI [1.14-2.37]), preeclampsia (PRadj 3.02, 95% CI [1.70-5.35]), eclampsia/HELPP (PRadj 1.50, 95% CI [1.16-1.94]), maternal age (years) (PRadj 1.01, 95% CI [<1.01-1.02]), major congenital anomalies (PRadj 3.21, 95% CI [1.43-7.23]), diabetes (PRadj 1.49, 95% CI [1.11-1.98]) and cardiac disease (PRadj 1.65, 95% CI [1.14-2.37]). CONCLUSION: Maternal morbidity leads to worse neonatal outcomes, especially in women suffering maternal near miss or death. Based on SIP/PAHO database all these indicators may be helpful for routine situation monitoring in Latin America with the purpose of policy changes and improvement of maternal and neonatal health.

The impact of maternal morbidity on cesarean section rates: exploring a Latin American network of sentinel facilities using the Robson's Ten Group Classification System.

BACKGROUND: Latin America has the highest Cesarean Section Rates (CSR) in the world. Robson's Ten Group Classification System (RTGCS) was developed to enable understanding the CSR in different groups of women, classified according to obstetric characteristics into one of ten groups. The size of each CS group may provide helpful data on quality of care in a determined region or setting. Data can potentially be used to compare the impact of conditions such as maternal morbidity on CSR. The objective of this study is to understand the impact of Severe Maternal Morbidity (SMM) on CSR in ten different groups of RTGCS. METHODS: Secondary analysis of childbirth information from 2018 to 2021, including 8 health facilities from 5 Latin American and Caribbean countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic), using a surveillance database (SIP-Perinatal Information System, in Spanish) implemented in different settings across Latin America. Women were classified into one of RTGCS. The frequency of each group and its respective CSR were described. Furthermore, the sample was divided into two groups, according to maternal outcomes: women without SMM and those who experienced SMM, considering Potentially Life-threatening Conditions, Maternal Near Miss and Maternal Death as the continuum of morbidity. RESULTS: Available data were obtained from 92,688 deliveries using the Robson Classification. Overall CSR was around 38%. Group 5 was responsible for almost one-third of cesarean sections. SMM occurred in 6.7% of cases. Among these cases, the overall CSR was almost 70% in this group. Group 10 had a major role (preterm deliveries). Group 5 (previous Cesarean section) had a very high CSR within the group, regardless of the occurrence of maternal morbidity (over 80%). CONCLUSION: Cesarean section rate was higher in women experiencing SMM than in those without SMM in Latin America. SMM was associated with higher Cesarean section rates, especially in groups 1 and 3. Nevertheless, group 5 was the major contributor to the overall CSR.

Vulnerability to snakebite envenoming and access to healthcare in the Terai region of Nepal: a geospatial analysis.

Background: Snakebite envenoming is a neglected tropical disease that mainly affects poor populations in rural areas. In hyperendemic regions, prevention could partially reduce the constant risk, but the population still needs timely access to adequate treatment. In line with WHO's snakebite roadmap, we aim to understand snakebite vulnerability through modelling of risk and access to treatment, and propose plausible solutions to optimise resource allocation. Methods: We combined snakebite-risk distribution rasters with travel-time accessibility analyses for the Terai region of Nepal, considering three vehicle types, two seasons, two snakebite syndromes, and uncertainty intervals. We proposed localised and generalised optimisation scenarios to improve snakebite treatment coverage for the population, focusing on the neurotoxic syndrome. Findings: In the Terai, the neurotoxic syndrome is the main factor leading to high snakebite vulnerability. For the most common scenario of season, syndrome, and transport, an estimated 2.07 (15.3%) million rural people fall into the high vulnerability class. This ranges between 0.3 (2.29%) and 6.8 (50.43%) million people when considering the most optimistic and most pessimistic scenarios, respectively. If all health facilities treating snakebite envenoming could optimally treat both syndromes, treatment coverage of the rural population could increase from 65.93% to 93.74%, representing a difference of >3.8 million people. Interpretation: This study is the first high-resolution analysis of snakebite vulnerability, accounting for uncertainties in both risk and travel speed. The results can help identify populations highly vulnerable to snakebite envenoming, optimise resource allocation, and support WHO's snakebite roadmap efforts. Funding: Swiss National Science Foundation.

Secondary alopecia induced by aesthetic procedures: An unrecognized potential complication.

Surgical facelifts and noninvasive techniques such as mesotherapy, hyaluronic fillers and botulinum toxin, among other procedures are widely used nowadays to reverse skin ageing and achieve rejuvenation effects. Secondary alopecia due to cosmetic procedures is a rare side effect and is poorly described in the literature. The mechanisms in which hair loss develops after an aesthetical procedure or surgical technique are not well known. The development of secondary scarring alopecia or non-scarring alopecia depends upon the interaction between different external factors, the individual host response and the extent of damage to the hair follicle anatomy. Current knowledge hints at the type of substance used, pressure to hair structures and vasculature due to the materials used, previously unknown or unaware hair disorder, and poor surgical techniques to be the main factors contributing to the development of secondary alopecia. Physicians and patients must be aware of all the substances used for the procedures and be attentive to any change in hair density or hair loss. Clinicians must have a low threshold to take biopsies if the risk of scarring alopecia may occur. Herein, we review the clinical, trichoscopic, histopathological findings and potential pathophysiological mechanisms of hair loss due to different aesthetic procedures.

"Geographical distribution of risk genotypes in pediatric patients with celiac disease in Spain".

Celiac disease is strongly associated with HLA DQ, specifically with haplotypes. DRB1*03-DQA1*05:01/DQB1*02:01 (DQ2.5),DRB1*07-DQA1*02:01/DQB1*02:02 (DQ2.2), DRB1*11-DQA1*05:05/DQB1*03:01 (DQ7.5), and DRB1*04-DQA1*03:01/DQB1*03:02 (DQ8). The distribution of these risk haplotypes in patients with celiac disease is different in the geographical areas investigated. A high frequency of DRB1*07- DQA1*02:01/DQB1*02:02 (DQ2.2) and DRB1*11-DQA1*05:05/DQB1*03:01 (DQ7.5), has been described in Southern Europe. We analyzed 2102 confirmed CD cases with information on both DQB1* alelles and their distribution by geographical area in Spain. According to the presence of this haplotype in one or two chromosomes, the genotype is classified in: DQ2 homozygous, DQ2 heterozygous (cis or trans), DQ8 homozygous, DQ8/DQ2.5, DQ 2.2 homozygous and genotype known as "half DQ2". Two different patterns of risks related to CD were identified. In the Basque Country and Navarre, the Mediterranean Area (Aragon, Catalonia, Valencia, Balearic Islands, and Murcia), the South of Spain (Andalucía and Extremadura), and the Canary Islands, higher frequency of DQ2.5 trans, and more than 80% of DQ2.5/DQ2.2 homozygosis were described. The Cantabrian Coast (Cantabria, Asturias, and Galicia) and Central Areas (Castilla-León and Castilla-La Mancha) showed a higher percentage of DQ2.5/DQ2.5 homozygosis and a lower DQ2.5 in trans frequency, as in Northern Europe. Madrid has an intermediate model between the two described above. 17 cases (0.8%) did not carry any CD risk haplotypes.

Willingness to participate in in-the-moment surveys triggered by online behaviors.

Surveys are a fundamental tool of empirical research, but they suffer from errors: in particular, respondents can have difficulties recalling information of interest to researchers. Recent technological developments offer new opportunities to collect data passively (i.e., without participant's intervention), avoiding recall errors. One of these opportunities is registering online behaviors (e.g., visited URLs) through tracking software ("meter") voluntarily installed by a sample of individuals on their browsing devices. Nevertheless, metered data are also affected by errors and only cover part of the objective information, while subjective information is not directly observable. Asking participants about such missing information by means of web surveys conducted in the moment an event of interest is detected by the meter has the potential to fill the gap. However, this method requires participants to be willing to participate. This paper explores the willingness to participate in in-the-moment web surveys triggered by online activities recorded by a participant-installed meter. A conjoint experiment implemented in an opt-in metered panel in Spain reveals overall high levels of willingness to participate among panelists already sharing metered data, ranging from 69% to 95%. The main aspects affecting this willingness are related to the incentive levels offered. Limited differences across participants are observed, except for household size and education. Answers to open questions also confirm that the incentive is the key driver of the decision to participate, whereas other potential problematic aspects such as the limited time to participate, privacy concerns, and discomfort caused by being interrupted play a limited role.

The impact of maternal morbidity on cesarean section rates: exploring a Latin American network of sentinel facilities using the Robson's Ten Group Classification System

Background: Latin America has the highest Cesarean Section Rates (CSR) in the world. Robson's Ten Group Classification System (RTGCS) was developed to enable understanding the CSR in different groups of women, classified according to obstetric characteristics into one of ten groups. The size of each CS group may provide helpful data on quality of care in a determined region or setting. Data can potentially be used to compare the impact of conditions such as maternal morbidity on CSR. The objective of this study is to understand the impact of Severe Maternal Morbidity (SMM) on CSR in ten different groups of RTGCS. Methods: Secondary analysis of childbirth information from 2018 to 2021, including 8 health facilities from 5 Latin American and Caribbean countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic), using a surveillance database (SIP-Perinatal Information System, in Spanish) implemented in different settings across Latin America. Women were classified into one of RTGCS. The frequency of each group and its respective CSR were described. Furthermore, the sample was divided into two groups, according to maternal outcomes: women without SMM and those who experienced SMM, considering Potentially Life-threatening Conditions, Maternal Near Miss and Maternal Death as the continuum of morbidity. Results: Available data were obtained from 92,688 deliveries using the Robson Classification. Overall CSR was around 38%. Group 5 was responsible for almost one-third of cesarean sections. SMM occurred in 6.7% of cases. Among these cases, the overall CSR was almost 70% in this group. Group 10 had a major role (preterm deliveries). Group 5 (previous Cesarean section) had a very high CSR within the group, regardless of the occurrence of maternal morbidity (over 80%). Conclusion: Cesarean section rate was higher in women experiencing SMM than in those without SMM in Latin America. SMM was associated with higher Cesarean section rates, especially in groups 1 and 3. Nevertheless, group 5 was the major contributor to the overall CSR. (AU)

Flow cytometry analysis of CD11c-positive peripheral blood mononuclear cells in horses.

Horses have played a prominent role in shaping our modern world, with important effects on health. Unfortunately, better characterization of the horse immune system is still needed. In this report, using flow cytometry techniques, four monoclonal antibodies against horse CD11c integrin were characterized and described for their ability to provide a positive recognition signal in peripheral blood mononuclear cells. Further immune cell phenotype experiments were performed using MHC-II, CD14, TLR4 and the specific anti-horse CD11c monoclonal antibody (1C4). With this staining panel, it was possible to detect a cell population defined by CD11c+MHC-II+TLR4+CD14low, which could be considered as putative dendritic cells. This manuscript shows that a new monoclonal antibody (1C4) can be used for the characterization of dendritic cells and their different lineages, opening the possibility of better understanding the mechanisms of immunity in horses.

Corrigendum to "What is the impact of snakebite envenoming on domestic animals? A nation-wide community-based study in Nepal and Cameroon" [Toxicon: X 9 (2021) 100068].

[This corrects the article DOI: 10.1016/j.toxcx.2021.100068.].

Effectiveness of Telemedicine Compared with Standard Care for Patients with Rheumatic Diseases: A Systematic Review.

Objective: The aim of this study was to systematically review the evidence on the effectiveness of telemedicine compared to standard care for patients with rheumatic diseases. Methods: A search was performed in MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews; for the gray literature, GREYNET databases and a snowball search were used. MeSH or Emtree terms. Three authors independently selected systematic reviews, randomized controlled trail (RCTs), or non-RCTs with patients with autoimmune or inflammatory rheumatic diseases, where telemedicine was compared with standard care. Effectiveness was measured in terms of disease activity, quality of life, and functional activity. The patients' satisfaction was also measured. The risk of bias was assessed by the Cochrane collaboration tool for RCTs and AMSTAR II for systematic reviews. Results: Four RCTs, one cross-out study, and five systematic reviews were included. The studies were conducted with rheumatoid arthritis patients, and one study involved patients with systematic lupus erythematosus. The interventions mainly involved teleconsultation and telemonitoring, with patient-reported outcomes (PROs) being compared with standard care. Four studies measured the effectiveness of telemedicine using PROs, in which three of the RCTs did not find differences in the clinical outcomes, and one found that telemedicine improved the remission of diseases, functional impairment, and radiographic joint damage progression. Two studies measured patient satisfaction with telemedicine and standard care without a significant difference between the groups. Conclusions: Despite heterogeneity between studies, the findings were remarkably consistent in demonstrating that there was no significant difference between the telemedicine group and the control group in terms of PROs and patient satisfaction. Patients should be offered the option of telemedicine to manage their diseases as part of health-care support. Further research is needed on the effectiveness of telemedicine in the long term for patients with rheumatic diseases.

Efficacy and safety of empagliflozin in glycogen storage disease type Ib: Data from an international questionnaire.

PURPOSE: This paper aims to report collective information on safety and efficacy of empagliflozin drug repurposing in individuals with glycogen storage disease type Ib (GSD Ib). METHODS: This is an international retrospective questionnaire study on the safety and efficacy of empagliflozin use for management of neutropenia/neutrophil dysfunction in patients with GSD Ib, conducted among the respective health care providers from 24 countries across the globe. RESULTS: Clinical data from 112 individuals with GSD Ib were evaluated, representing a total of 94 treatment years. The median age at start of empagliflozin treatment was 10.5 years (range = 0-38 years). Empagliflozin showed positive effects on all neutrophil dysfunction-related symptoms, including oral and urogenital mucosal lesions, recurrent infections, skin abscesses, inflammatory bowel disease, and anemia. Before initiating empagliflozin, most patients with GSD Ib were on G-CSF (94/112; 84%). At the time of the survey, 49 of 89 (55%) patients previously treated with G-CSF had completely stopped G-CSF, and another 15 (17%) were able to reduce the dose. The most common adverse event during empagliflozin treatment was hypoglycemia, occurring in 18% of individuals. CONCLUSION: Empagliflozin has a favorable effect on neutropenia/neutrophil dysfunction-related symptoms and safety profile in individuals with GSD Ib.

Snakebite epidemiology in humans and domestic animals across the Terai region in Nepal: a multicluster random survey.

BACKGROUND: Each year, 2 million people worldwide are bitten by snakes, resulting in an estimated 81 000-138 000 deaths. WHO has added snakebite envenoming to the list of neglected tropical diseases, highlighting the need for stronger epidemiological evidence in endemic countries, such as Nepal. METHODS: We conducted a cross-sectional survey in villages randomly geospatially selected from aerial images from across the Nepal's Terai lowlands region (excluding towns and cities). We collected data between Nov 30, 2018 and May 7, 2019, and analysed snakebite incidence rates and outcomes in humans and domestic animals. FINDINGS: Among 63 454 human participants living in 13 879 households (249 villages), 166 were bitten by a snake over the previous 12 months; 48·8% were envenomed and 7·8% died. This corresponded to an annual crude incidence rate of 262 snakebites (adjusted incidence of 251·1 [95% CI 201·7-312·6]) and 20 deaths (22·4 [11·9-42·1]) per 100 000 people, extrapolating to 26 749-37 661 yearly bitten people and 2386-3225 deaths. Bitten people had a median age of 30 years (IQR 20-45) and with available data, 64% were female. Children younger than 15 years (n=6; 46%) and females (n=10; 77%) were disproportionately affected among the 13 people who died. The incidence was higher in the Eastern region, and mortality was higher in the Central region. Of 183 949 animals, owners reported 144 snakebites, with an annual incidence rate of 42-202 per 100 000 and mortality of 79-100%, varying by animal type. Spatial and seasonal incidence were similar in humans and in animals. INTERPRETATION: This study provides the first epidemiological estimates of snakebite envenoming in humans and domestic animals across Nepal's Terai lowlands. It was also the first to use a community-based, transdisciplinary, and One Health design. These findings call for a strengthening of preventive measures and better access to life-saving treatments. FUNDING: Swiss National Science Foundation project 315130_176271 (SNAKE-BYTE).

Assessment of the effect of snakebite on health and socioeconomic factors using a One Health perspective in the Terai region of Nepal: a cross-sectional study.

BACKGROUND: Snakebite envenoming has a substantial health and socioeconomic effect in rural communities. However, there are insufficient epidemiological and animal data, which prevents accurate assessment on the effects of snakebite. We aimed to assess the health and socioeconomic effect of snakebite using a One Health perspective. METHODS: In this cross-sectional survey-based study, we assessed the health and socioeconomic effects of snakebite data using a multicluster survey that was previously done as part of the SNAKE-BYTE project in the Terai region, Nepal. Health effect was measured in terms of disability-adjusted life years (DALYs). Livelihood losses encompassed out-of-pocket health-care expenditures, losses of productivity due to days off work, and the losses due to mortality and treatment costs in domestic animals. Mortality losses in domestic animals were also estimated as animal loss equivalents, and overall human and animal health effect expressed using modified DALYs for zoonotic disease (zDALYs). FINDINGS: We estimate an annual snakebite burden of 200 799 DALYs (95% CI 103 137-357 805), mostly due to mortality in children and women. Snakebite is estimated to lead to US$2·8 million in yearly livelihood losses associated with human and animal cases. Overall, we estimate a yearly human and animal health burden of 202 595 zDALYs (104 300-360 284). INTERPRETATION: These findings present robust evidence on the extent of snakebite's health and socioeconomic effect and emphasise the need for a One Health perspective. The results also stress how improved data collection at the community level is crucial for improved assessments of its effect. FUNDING: Swiss National Science Foundation.