Transactions of The Royal Society of Tropical Medicine and Hygiene最新文献

{"title":"Chagas disease in Trinidad and Tobago - a call to action.","authors":"Rod Suepaul, Azad Mohammed, Nicole L Gottdenker, Christopher Oura, Adesh Ramsubhag, Vrijesh Tripathi, Raveed Khan, Jennifer K Peterson","doi":"10.1093/trstmh/traf060","DOIUrl":"https://doi.org/10.1093/trstmh/traf060","url":null,"abstract":"<p><p>Chagas disease, caused by the protozoan parasite Trypanosoma cruzi, is a vector-borne disease that can lead to serious cardiac alterations. The Caribbean nation of Trinidad and Tobago (TT) is not considered Chagas endemic by major public health organizations, but Trinidad is home to six T. cruzi vector species as well as T. cruzi-infected vertebrate hosts, including humans. Here we present the most comprehensive assessment to date of Chagas disease in TT based on information from published literature, museum specimens, hospital and veterinary records and archival documents. Panstrongylus geniculatus is the most abundant and well-studied T. cruzi vector species in TT, where it is found in and around human homes with human blood meals and with T. cruzi infection prevalences >83%. Wildlife reservoirs of T. cruzi in TT include commonly hunted species, which may pose a risk of T. cruzi transmission during preparation or consumption of infected carcasses. Blood bank data from 2020 showed a 0.5% seropositivity rate for T. cruzi, which is higher than that reported for 13 Chagas-endemic countries. By presenting the entomological, ecological, epidemiological and clinical evidence in a single report, we aim to present what is known about Chagas disease on the island, identify knowledge gaps and pinpoint areas of future research and public health focus, with the goal of sending a call to action for increased attention to Chagas disease in TT.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144544980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of malaria in Chhattisgarh, India: a surveillance data analysis, 2015-2023.","authors":"Dharmendra Kumar Gahwai, Mogan Kaviprawin, Gollapalli Pavan Kumar, Deepak Kumar Panigrahi, Jaswant Kumar Das, Kalyani Patel, Meenakshi Roy, Seema Tigga, Tripti Jain, Yogesh Patel, Amit Kumar, Aarthy Ramasamy, Manikandanesan Sakthivel, Ganeshkumar Parasuraman","doi":"10.1093/trstmh/traf072","DOIUrl":"https://doi.org/10.1093/trstmh/traf072","url":null,"abstract":"<p><strong>Background: </strong>India accounts for two-thirds of the malaria burden in Southeast Asia. We described the lab-confirmed malaria cases under the Integrated Disease Surveillance Programme in Chhattisgarh, India, from 2015 to 2023.</p><p><strong>Methods: </strong>We conducted a surveillance data analysis by abstracting the lab-confirmed malaria cases from five regions of Chhattisgarh from January 2015 to December 2023. We estimated the annual parasite incidence (API) by region and year. We estimated the incidence rate ratio (IRR) with a 95% CI over the years using a generalized estimating equation in Stata 16.0.</p><p><strong>Results: </strong>A total of 391 387 malaria cases were reported from 2015 to 2023. API ranged from 0.4-3.2 per 1000 population with an annual decline of 25% (IRR:0.75; 95% CI 0.71 to 0.79). Cases peaked in July (monsoon season) and November. Incidence was consistently higher in Chhattisgarh's Bastar (IRR:12.5; 95% CI 3.7 to 43.0) and Surguja regions (IRR:7.4; 95% CI 2.0 to 27.4) compared with the central region.</p><p><strong>Conclusions: </strong>Southern districts of Chhattisgarh consistently documented increased incidence over the years. We recommend strengthening the implementation of the vector control measures starting in May. Further research should be conducted to identify the reasons for the high malaria incidence in southern Chhattisgarh.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144544981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health literacy among the rural Bangladeshi population on first aid measures and prevention of snakebite.","authors":"Chowdhury Farheen, A K M F Rahman, Aniruddha Ghose, Md R Amin, Abu S M M Rahman, Abdullah A Sayeed, F M A Rahaman, Chinmaya Howlader, Sayra Khan, Rumana Rashid, Nusaer Chowdhury, Geeta R Debi, Md Sahidur Rahman, M A Faiz","doi":"10.1093/trstmh/trae130","DOIUrl":"10.1093/trstmh/trae130","url":null,"abstract":"<p><strong>Background: </strong>Bangladesh has a high rate of snakebite. In rural areas, there is a significant mortality and morbidity rate due to lack of awareness and inappropriate first aid practices. This study aims to determine the knowledge and practices of the rural population in two subdistricts of Bangladesh regarding snakebite prevention and first aid measures.</p><p><strong>Methods: </strong>This cross-sectional survey is part of an intervention study that was carried out in 250 randomly selected primary sampling units of Shibganj in the Chapainawabganj district and Kalapara in the Patuakhali district of Bangladesh. We enrolled a total of 2954 participants. The practice and knowledge were regarded adequate when the score exceeded 50%. We conducted a binomial logistic regression to identify the factors associated with inadequate knowledge and practice.</p><p><strong>Results: </strong>The community's knowledge (15.9%) and practice (14.5%) regarding snakebite prevention was insufficient. More than 77% and 45.4% of respondents believed that applying a tourniquet above the bite site and seeking a traditional healer after a snakebite were effective first aid measures. Poor knowledge was more likely to occur in farming, fishing, homemaker groups and those with lower incomes (11 000-24 000 Bangladeshi taka). Negative practices were associated with females and high family income.</p><p><strong>Conclusions: </strong>This study highlights the necessity of community intervention, with a focus on appropriate first aid and prevention measures through widespread education.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"828-838"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The neurotoxic effect of Naja nubiae (Serpentes: Elapidae) venom from Sudan.","authors":"Huda Khalid, Maowia M Mukhtar","doi":"10.1093/trstmh/trae116","DOIUrl":"10.1093/trstmh/trae116","url":null,"abstract":"<p><strong>Background: </strong>Neurotoxicity is a common feature of elapid snake envenomation. There are limited studies on the toxicity of Naja nubiae venom, the Nubian spitting cobra, from north-east Africa.</p><p><strong>Methods: </strong>We used the chick biventer cervicis nerve-muscle preparation to demonstrate the neurotoxic effect of N. nubiae venom and to compare it with the potent neurotoxic cobra Naja melanoleuca venom. Venoms were separated by successive reverse-phase high-performance liquid chromatography (RP-HPLC) runs and the molecular mass of the neurotoxins was determined by matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS).</p><p><strong>Results: </strong>Both venoms caused time-dependent inhibition of nerve-mediated twitches with a t90 value of 22.2±1.9 min and 12.9±1.2 min for N. nubiae and N. melanoleuca venoms, respectively. Prior incubation of some commercial antivenom (EchiTab-Plus-ICP [Costa Rica], CSL, Parkville, Victoria, Australia) and snake venom antisera [India]) did not prevent the neurotoxic effect of N. nubiae venom. The chromatographic separation of N. nubiae and N. melanoleuca venoms followed by MALDI-TOF MS analysis revealed that short-chain α-neurotoxin accounted for 8.4% of N. nubiae and 14.8% of N. melanoleuca whole venoms.</p><p><strong>Conclusions: </strong>N. nubiae venom, which was previously known as cytotoxic venom, exhibits considerable in vitro neurotoxic effects on chick nerve-muscle preparations that may have consequences for antivenom development in north-east Africa.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"688-696"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatio-temporal pattern and risk factors associated with cholera outbreaks in selected high-risk areas of Kenya.","authors":"Lydia M Mageto, Nyamai Mutono, Gabriel Aboge, Peter Gathura, Emmanuel Okunga, Annastacia Muange, Cecilia Kathure Mbae, Samuel M Thumbi, Samuel Kariuki","doi":"10.1093/trstmh/traf032","DOIUrl":"10.1093/trstmh/traf032","url":null,"abstract":"<p><strong>Background: </strong>Cholera is a public health challenge in Kenya. This study aimed at identifying the spatio-temporal pattern of cholera and its associated risk factors in high-risk areas to optimize resource use for targeted control.</p><p><strong>Methods: </strong>The study was conducted in Mukuru, an informal settlement, Dadaab refugee camp and counties bordering Lake Victoria. Cholera line list data from 32 subcounties (2013-2022) was sourced from Kenya's Ministry of Health. Population and water, sanitation and hygiene data came from the 2019 census. Space-time scan statistic (SaTScan) were used to carry out spatio-temporal analysis and a zero-inflated negative binomial regression model evaluated cholera risk factors.</p><p><strong>Results: </strong>A total of 7316 cholera cases were reported across 22 (69%) subcounties, the highest numbers in 2015, 2016 and 2022 affecting 21, 12 and 3 subcounties, respectively, and none in 2014. Five high-risk space-time clusters encompassing 15 subcounties were identified, with Dadaab and Fafi showing persistent outbreaks. Improved sanitation was the only variable that suggested significant protective effects to cholera control (relative risk 0.9445, p=0.001).</p><p><strong>Conclusions: </strong>Dadaab and Fafi subcounties were extremely high-risk and improved sanitation significantly reduced cholera outbreaks. These data inform cholera intervention policies in vulnerable regions.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"758-766"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12212228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The incidence of snakebite in South Africa and the challenges associated with lack of reporting.","authors":"Hiral Naik, Graham J Alexander","doi":"10.1093/trstmh/trae109","DOIUrl":"10.1093/trstmh/trae109","url":null,"abstract":"<p><strong>Background: </strong>Snakebite is a public health challenge that has a substantial impact on humans and snakes. Annually, millions of people are affected by snakebite globally but there is a paucity of detailed data on snakebite incidences. The aim of this study was to assess the patterns of snakebite incidences in South Africa.</p><p><strong>Methods: </strong>We collected data from hospital records, information from the National Snakebite Database and records from the AfriTox Telelog database from 2011 to 2024.</p><p><strong>Results: </strong>The combined dataset showed that 3496 snakebite incidences have been recorded over 12.5 years. The prevalence was calculated to be 5.63 per 100 000 individuals of the population for South Africa, with the highest prevalence in KwaZulu-Natal (8.89). Males made up 65.9% of snakebite incidences and most incidences were recorded between November and March. The snake species responsible for most snakebite incidences was Bitis arietans.</p><p><strong>Conclusion: </strong>Snakebite is generally well managed in South Africa with few recorded deaths despite the relatively high number of bites. However, incidents are often not recorded or have missing information particularly regarding the circumstances of the bite. Our study provides insight on the snake species responsible for snakebite incidences in South Africa and can be used to create prevention measures.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"788-795"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12212189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment and treatment outcomes of snakebite envenoming in Uganda: a retrospective analysis.","authors":"Stella Maris Nanyonga, Scott Kaba Matafwali, Denis Kibira, Freddy Eric Kitutu","doi":"10.1093/trstmh/trae112","DOIUrl":"10.1093/trstmh/trae112","url":null,"abstract":"<p><strong>Background: </strong>Snakebite envenoming is a neglected tropical disease that causes significant morbidity and mortality in rural sub-Saharan Africa. However, there is a notable lack of data concerning the management and treatment outcomes for those affected. This study addresses this gap by examining the management and treatment outcomes of snakebite victims in Uganda.</p><p><strong>Methods: </strong>We reviewed retrospective data of 532 snakebite cases attending 16 Ugandan health facilities from January 2017 to December 2021. Demographic characteristics and clinical data were extracted from patient records and summarized using descriptive statistics.</p><p><strong>Results: </strong>The snakebite victims had a median age of 26 y, most were male (55.3%) and had bites of unidentified snake species (92.3%). Among the 465 treated patients, 71.6% received antibiotics, 66.0% hydrocortisone, 36.3% analgesics and only 6.9% antivenom. No adverse antivenom reactions were documented. The majority (89.5%) were discharged; 1.3% died and 5.5% had unknown outcomes.</p><p><strong>Conclusions: </strong>These results suggest that snakebite envenoming affects vulnerable Ugandans, particularly young males and children. Treatment is primarily supportive, with antibiotic overuse and infrequent antivenom administration. Health provider training on appropriate snakebite management is needed to optimize outcomes.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"796-803"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12212200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The One Health approach to Strongyloides stercoralis.","authors":"Jiayin Lyu, Xiaoyin Fu, Dengyu Liu","doi":"10.1093/trstmh/traf003","DOIUrl":"10.1093/trstmh/traf003","url":null,"abstract":"<p><p>The One Health concept systematically considers the health of humans, animals and the environment, emphasizing population and ecosystem health based on individual health. Strongyloides stercoralis is a soil-transmitted opportunistic pathogenic parasite that can cause strongyloidiasis in both humans and animals, potentially leading to severe disease or even death in immunocompromised hosts. This article outlines the epidemiological status, diagnosis and treatment methods of strongyloidiasis. It also discusses effective response strategies based on the One Health approach to actively cope with the zoonotic risk of S. stercoralis and promote human health development.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"679-687"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stigma experienced by people with drug-resistant tuberculosis in Lagos, Nigeria: a cross-sectional study.","authors":"Olusola A Adejumo, Champaklal Jinabhai, Olusoji Daniel, Firoza Haffejee","doi":"10.1093/trstmh/traf026","DOIUrl":"10.1093/trstmh/traf026","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) stigma is one of the factors responsible for low notification rates in Nigeria, especially among people with drug-resistant TB (DR-TB). This study assessed the factors associated with stigma among people with DR-TB in Lagos, Nigeria.</p><p><strong>Methods: </strong>A descriptive cross-sectional study was conducted among 203 adults on DR-TB treatment. The Redwood DR-TB stigma scale was used to assess the stigma experienced by people with DR-TB. A logistic regression model was used to evaluate the factors associated with TB stigma.</p><p><strong>Results: </strong>The prevalence of TB stigma was 65.5%. Being male (adjusted odds ratio [aOR] 2.59 [95% confidence interval {CI} 1.03 to 6.50], p=0.042), not earning an income (aOR 2.57 [95% CI 1.84 to 7.85], p=0.039), substance use (alcohol or cigarette smoking; aOR 1.61 [95% CI 1.06 to 3.88], p=0.028) and the duration of the DR-TB diagnosis (aOR 2.72 [95% CI 1.94 to 3.83], p<0.001) were associated with stigma among people with DR-TB. Human immunodeficiency virus (HIV)-negative participants experienced TB stigma 2.4 times more (crude OR 2.4 [95% CI 1.14 to 5.04], p=0.021) than HIV-positive participants, although the relationship was not sustained in the multivariate analysis.</p><p><strong>Conclusions: </strong>Having identified the factors associated with stigma in this target population, it is imperative to address and control them among DR-TB patients in Lagos, Nigeria. The urgent need for stigma reduction strategies cannot be overemphasized.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"725-732"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection and molecular characterization of dengue among patients suspected of having malaria in Timika, Central Papua, Indonesia.","authors":"Leily Trianty, Bunga Rana, Mercy Egrina Adiniko, Marsha Sinditia Santoso, Agatha Mia Puspitasari, Ristya Amalia, Pak Prayoga, Jeanne Rini Poespoprodjo, Enny Kenangalem, Dionisius Denis, Megan Angelita Salim, Edison Johar, Ida Yus Sriyani, Elisabeth Farah N Coutrier, Frilasita Aisyah Yudhaputri, Ari Winasti Satyagraha, Rintis Noviyanti, R Tedjo Sasmono","doi":"10.1093/trstmh/traf030","DOIUrl":"10.1093/trstmh/traf030","url":null,"abstract":"<p><strong>Background: </strong>Dengue and malaria are major public health problems in Indonesia. Dengue is hyperendemic nationwide, while malaria remains endemic in specific regions, especially in eastern Indonesia. Timika in Central Papua province is a highly malaria-endemic area; however, this city is historically known as a low endemic area for dengue. With the increasing incidence of dengue in Papua, this study aimed to assess dengue prevalence, possible co-infection and to molecularly characterize the dengue virus (DENV) in patients suspected of having malaria.</p><p><strong>Methods: </strong>Archived samples of patients suspected of having malaria were screened for dengue using RT-PCR. Dengue serological and antigen detection was performed and whole genome sequencing was employed to determine the genetic characteristics of viruses. Detection of other arboviruses was also performed.</p><p><strong>Results: </strong>Among 119 patients, 30 (25.2%) were positive for dengue. Most samples (n=29) were infected by DENV-3, while one was positive for DENV-2. Dengue and malaria co-infections were found in six patients. Phylogenetic analysis classified DENV-2 as the Cosmopolitan genotype that is closely related to strains from the Indonesian city of Makassar, while DENV-3 was classified as Genotype I, which is closely related to a strain from Singapore.</p><p><strong>Conclusions: </strong>Dengue significantly contributes to febrile illness among patients suspected of having malaria in Timika, Central Papua. Virus importation from surrounding regions is likely to contribute to the dispersion of DENV into eastern parts of Indonesia. Our findings reveal the underestimation of this viral disease in a highly malaria-endemic area.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"748-757"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}