Successful ovarian tissue cryopreservation with transvaginal natural orifice transluminal endoscopic surgery: A case report.

Chemotherapy and radiation therapy can cause gonadal dysfunction in women of reproductive age. Ovarian tissue cryopreservation is performed to restore fertility by allowing transplantation of the patient's frozen-thawed ovarian tissue or through future in vitro maturation and in vitro fertilization of frozen-thawed oocytes. Herein, we describe our initial experience with vaginal natural orifice transluminal endoscopic surgery for ovarian tissue preservation in a young woman with malignant tumor. A 23-year-old woman with anaplastic lymphoma kinase-positive malignant lymphoma was scheduled for hematopoietic stem cell transplantation after experiencing relapse following R-cyclophosphamide, doxorubicin, vincristine, and prednisolone therapy. Ovarian tissue cryopreservation was selected as only MII2 oocytes were collected. Vaginal natural orifice transluminal endoscopic surgery was performed to excise the left ovary. Ovarian tissues were frozen using the vitrification method. The operative time was 37 min, and blood loss was minimal. Pathological examination revealed no metastatic findings of malignant lymphoma and no thermal damage to the ovarian tissue due to bipolar disorder. The patient was discharged on the first day postoperatively, and her postoperative course was uneventful. The vaginal natural orifice transluminal endoscopic surgery technique can provide a safe and effective alternative to laparoscopy or laparotomy for the cryopreservation of ovarian tissue in young patients with cancer. We believe this method has potential application in sexually mature female cancer survivors.

Ovarian tissue cryopreservation with vaginal natural orifice transluminal endoscopic surgeryChemotherapy and radiotherapy can affect a woman's ability to have children by reducing ovarian function. This can make it hard to conceive even with fertility treatments. Freezing healthy ovaries before these treatments can help restore fertility. This can be done by freezing and later transplanting ovarian tissue or by fertilizing frozen eggs in a lab. Traditional surgery to remove ovaries can cause cosmetic issues and pain. But now, a new method called vaginal spontaneous opening transperitoneal endoscopic surgery is becoming more common. This surgery is less invasive, quicker, and causes less bleeding. We recently used this method to preserve ovarian tissue in young women with cancer. The surgery was successful with minimal complications. This new approach could offer a safer option for preserving fertility in female cancer survivors.

First Case of Nocardia wallacei From India: A Case Report and Literature Review.

Nocardia is a type of bacteria that can cause infections in both immunocompromised and immunocompetent hosts. It is an obligate aerobe and is commonly found in the environment. Pulmonary nocardiosis may present as pneumonia, endobronchial inflammatory masses, lung abscess, and cavitary disease with contiguous extension, leading to effusion and empyema. We present a case of pulmonary nocardiosis in a 75-year-old male patient with type 2 diabetes mellitus. The patient presented with bilateral pneumonia and hypoxia with an oxygen saturation of 85%. Sputum samples were sent to the microbiology laboratory for testing. Acid-fast staining with 1% H2SO4 showed acid-fast branching filamentous rods, but Nocardia could not be isolated in culture. The sample was subjected to 16S rRNA gene sequencing, which identified the pathogen as Nocardia wallacei. The culture of the sputum did not grow any pathogenic organisms, and the blood culture was sterile. Unfortunately, the patient left the hospital against medical advice as he was advised for intubation. The patient could not survive and died the next day after leaving the hospital. N. wallacei can be fatal and cause disseminated infection in both immunosuppressed and immunocompetent patients. Only eight case reports of N. wallacei have been reported in the literature from various parts of the world. Our case is the first case report of N. wallacei from India.

The First Reported Case of Elizabethkingia anophelis From Nepal.

Elizabethkingia anophelis, a gram-negative bacillus belonging to the Flavobacteriaceae family, is found in various environmental sources and has been associated with community and hospital outbreaks. Correct identification is crucial, guided by advanced genomic techniques, i.e., matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) system with an updated database. The case fatality rate, ranging from 24 to 60%, underscores the need for timely recognition and appropriate management. Additionally, Elizabethkingia presents a challenge due to its recent discovery, misidentification history, and drug resistance. Here, we present a case of fatal infection in a 30-year-old male, who presented with pneumonia. It gradually progressed and ultimately proved fatal underscoring the virulence of the pathogen involved. It was a diagnostic challenge as it likely is the first reported instance of Elizabethkingia anophelis infection from Nepal.

First cases of alveolar echinococcosis in dogs in Poland.

Alveolar echinococcosis caused by Echinococcus multilocularis is common parasitic disease among humans and animals in the northern hemisphere. Dogs, foxes, and other wild canids are definitive hosts, whereas small rodents play the role of intermediate hosts. In rare cases, after incidental ingestion of tapeworm eggs, dogs can become an intermediate host. The study describes briefly two cases of alveolar echinococcosis in dogs in Poland, including clinical management, diagnostic, treatment and molecular confirmation. Diagnostic procedures included laparotomy, cytology, histopathology and molecular analysis. Obtained sequences data were 100% homologous to E. multilocularis dehydrogenase subunit 1 gene sequences in GenBank®. To the authors' knowledge, alveolar echinococcosis has not been reported previously in a dog in Poland.

The Long-Jumping of African Swine Fever: First Genotype II Notified in Sardinia, Italy.

African swine fever (ASF) is a devastating infectious disease of domestic pigs and wild boar that is spreading quickly around the world and causing huge economic losses. Although the development of effective vaccines is currently being attempted by several labs, the absence of globally recognized licensed vaccines makes disease prevention and early detection even more crucial. ASF has spread across many countries in Europe and about two years ago affected the Italian susceptible population. In Italy, the first case of ASF genotype II in wild boar dates back to January 2022, while the first outbreak in a domestic pig farm was notified in August 2023. Currently, four clusters of infection are still ongoing in northern (Piedmont-Liguria and Lombardy), central (Lazio), and southern Italy (Calabria and Campania). In early September 2023, the first case of ASFV genotype II was detected in a domestic pig farm in Sardinia, historically affected by genotype I and in the final stage of eradication. Genomic characterization of p72, p54, and I73R/I329L genome regions revealed 100% similarity to those obtained from isolates that have been circulating in mainland Italy since January 2022 and also with international strains. The outbreak was detected and confirmed due to the passive surveillance plan on domestic pig farms put in place to provide evidence on genotype I's absence. Epidemiological investigations suggest 24 August as the most probable time of ASFV genotype II's arrival in Sardinia, likely due to human activities.

Resuscitative Endovascular Balloon Occlusion of the Aorta for Traumatic Cardiopulmonary Arrest in the Emergency Department: The First Case With Successful Return of Spontaneous Circulation in Taiwan.

Exsanguinating torso hemorrhage is a leading cause of death in trauma patients. Bleeding leads to hypothermia, acidosis, and coagulopathy, the so-called "lethal triad," and creates a vicious cycle. Therefore, bleeding control tops the priority list in the management of trauma patients. Placement of resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with traumatic non-compressible torso hemorrhage is a developing technique in the emergency departments (EDs) in Taiwan, and it is a possible solution for abdominal and pelvic trauma patients with hemodynamic instability. It not only temporarily controls bleeding below the inflation site but also increases cerebral and coronary circulation. It can create a bridge for definitive care such as an operation or an embolization, possibly preventing death. Compared to thoracotomy followed by an aortic cross clamp, REBOA is a less invasive and possibly, a more efficient way to control the hemorrhage and may lead to better overall survival. The use of REBOA has been proven to be associated with improved survival-to-discharge in severely injured trauma patients. We report a case of out-of-hospital cardiac arrest caused by penetrating injury wherein return of spontaneous circulation was successfully achieved after 39-minute cardiopulmonary resuscitation and REBOA placement in the ED. The REBOA balloon was deflated after bleeding was stopped during the laparotomy operation. The patient was then transferred to the intensive care unit for postoperative care. Unfortunately, the patient passed away approximately 12 hours after the surgery.

Acute Perimyocarditis in an Adolescent Japanese Male after a Booster Dose of the BNT162b2 COVID-19 Vaccine.

Perimyocarditis is a rare and serious cardiac complication following COVID-19 vaccination. Young males are most at risk after the second dose. With the introduction of the booster (third) dose, some reports have focused on the risk of perimyocarditis after a booster dose. However, no currently available report in Japan has comprehensively described this phenomenon. A healthy 14-year-old Japanese male, who had completed a two-dose primary series of the BNT162b2 (Pfizer-BioNTech) vaccine six months prior, developed fever and chest pain within 24 hours after a homologous booster dose. He was transferred to our institute because of worsening chest pain. A multiplex PCR test showed no evidence of active viral infections, including SARS-CoV-2. Electrocardiography revealed ST-segment elevation in almost all leads, suggesting pericarditis. Echocardiography showed normal systolic function. Laboratory data demonstrated C-reactive protein levels of 8.8 mg/dL and elevated cardiac damage markers (troponin T, 1.9 ng/mL; creatine phosphokinase, 1527 U/L; MB isoenzyme, 120 U/L), suggesting myocarditis. He was diagnosed with perimyocarditis associated with the booster dose, which was confirmed by cardiac magnetic resonance imaging four days after initial symptoms. Chest pain improved spontaneously along with a resolution of electrocardiographic findings and laboratory data within several days. He was discharged eight days after admission. Perimyocarditis is less frequent after a booster dose than after primary doses. In this case, the patient with booster-dose-associated perimyocarditis showed favorable clinical course without severe sequelae. The patient's clinical course was consistent with findings on previous large-scale reports on primary-dose-associated perimyocarditis and case series on booster-dose-associated perimyocarditis.

The story behind the first few cases of monkeypox infection in non-endemic countries, 2022.

Starting May 6, 2022, a rising number of monkeypox cases started to be detected in different countries where the disease is not endemic. About 24 countries reported cases by May 28 mostly in Europe. Most of the reported cases so far were among young men particularly men who have sex with men or had a travel history to countries where cases are being registered. In this rapid review we summarized the story behind the first few cases of monkeypox virus infection in non-endemic countries and the prevention measures implemented so far by countries to contain the spread of the disease.

The first case of monkeypox virus infection detected in Taiwan: awareness and preparation.

OBJECTIVES: Monkeypox has recently been detected outside African countries. This study aimed to report and analyze the first case of monkeypox virus infection in Taiwan. METHODS: The global epidemiological information was collected from the World Health Organization (WHO) and US Centers for Disease Control and Prevention (CDC). The data from the first confirmed Taiwanese monkeypox case was obtained from Taiwan Centers for Disease Control. Monkeypox diagnosis and prevention strategies were obtained from WHO guidelines on monkeypox. Phylogenetic tree analysis and sequence alignment and comparison were used to identify the phylogeny and single nucleotide polymorphism (SNP) characterization. RESULTS: Epidemiological data indicated that since 2013, monkeypox has caused outbreaks outside African countries through contact with infected animals and international travels. Recently, two confirmed monkeypox cases were reported in Singapore and South Korea. On June 24, 2022, Taiwan CDC reported the first confirmed case of monkeypox virus infection in a 20-year-old man who returned from Germany, from January to June 2022. This is the third confirmed case of an imported monkeypox infection in Asia. Phylogenetic analysis demonstrated that this imported monkeypox virus belonged to the West African clade and is clustered with the 2022 European outbreak monkeypox isolates. Full-length sequence analysis indicates that this virus contains 51 SNPs, and has five variant SNPs compared with the recent outbreak strains. CONCLUSION: This study suggests that active surveillance, enhancing border control, and the development of vaccines and antiviral drugs are urgently required to prevent and control the burden of monkeypox disease.

Starting late does not increase the risk of post-operative complications in patients undergoing common general surgical procedures.

BACKGROUND: There is a paucity of evidence surrounding the issue of delays on the day of surgery with respect to both causes and consequences. We sought to determine whether patients whose operations started late were at increased risk of post-operative complications. METHODS: We conducted a retrospective cohort study of 1420 first-of-the-day common general surgical procedures, dividing these into "on-time start" (OTS) and "late-start" (LS) cases. Our primary outcomes were minor and major complication rate; our secondary objective was to identify factors predicting LS. Groups were compared using univariable and multivariable analysis. RESULTS: LS rate was 55.3%. On univariable analysis, LS had higher rates of major and minor complications (7.3% vs. 3.5%, p = 0.002; 3.8% vs. 1.6%, p = 0.011). On multivariable analysis, LS was not associated with increased odds of any complications. Minor complications were predicted by operative duration [OR = 1.005 (1.002-1.008)], female sex [OR = 1.78 (1.037-3.061)], and undergoing an ileostomy closure procedure [OR = 10.60 (2.791-40.246)], and were reduced in those undergoing surgery on Wednesdays [OR = 0.38 (0.166-0.876)]. Major complications were predicted by operative duration [OR = 1.007 (1.003-1.011)] and ASA class [OR = 6.73 (1.505-30.109)]. Multivariable analysis using LS as an outcome identified that anesthesia time [OR = 1.35 (1.031-1.403)], insulin-dependent diabetes [OR = 1.91 (1.128-3.246)], and dyspnea upon moderate exertion [OR = 2.52 (1.423-4.522)] were predictive of LS. CONCLUSIONS: Most cases in our study started late. While this has significant efficiency and economic costs, it is not associated with adverse patient outcomes. This topic remains incompletely described. Further research is needed to improve efficiency and patient experience by investigating the causes of operative delays.

Improving On-Time First Case Starts: An Integrative Review and Quality Improvement Project Plan.

PURPOSE: Surgeon late arrival is the major cause of delays in first case starts. The estimated cost of these delays can reach $800,000 a year. The purpose of this integrative review and proposed quality improvement (QI) project plan was to increase the first case on-time starts through surgeon behavior modification. DESIGN: An integrative literature review and creation of a QI project plan. METHODS: The literature review included an independent electronic literature search between the years of 2011 and 2020 through CINAHL PLUS, PubMed, and Medline OVID databases. The search was limited to scholarly peer-reviewed journal articles in the English language, and search terms included: "operating rooms," "delay first cases start," "first case tardiness," and "operating room efficiency." The QI project plan was a three-phase process based on surgeon behavioral modification using educational material, visual reminders, and individualized e-mail notifications of habitually late surgeons. FINDINGS: A synthesis of articles reported proper site marking and surgical consent 15 to 30 minutes before surgery increased first case on-time starts from 55.90% to 66.60% and a mean delay decrease of 9.67 minutes to 7.17 minutes. Visual cues significantly enhanced memory, 64% versus 50%, and e-mail reminders increased compliance, 77% to 86.1%. CONCLUSION: As the need for hospital revenue dependency grows, so will the need for more efficient operating rooms. The evidence shows a positive correlation between early arrival by surgeons to the preoperative area and increased on-time first case starts.

Functional paraganglioma with tumor thrombus in the inferior vena cava, first case report.

Pheochromocytoma (PHEO) is a rare neuroendocrine that tumor originated from the adrenal medulla that secrets catecholamines. Tumors from extra-adrenal chromaffin tissues are called extra-adrenal PHEO or paraganglioma (PGL). To our knowledge, adrenal PHEO and subclinical PGL with inferior vena cava (IVC) invasion had been sporadically reported, while functional PGL with IVC tumor thrombus has not been publicly reported yet. Perioperative management of those diseases is less well established because of their multidisciplinary nature and rarity. We herein present a case of primary malignant PGL with IVC invasion. A 16-year-old female patient with a history of severe paroxysmal hypertension was admitted to Peking Union Medical College Hospital on suspicion of retroperitoneal mass. In-house diagnostic work-up revealed a malignant PGL with IVC invasion, inferior mesenteric artery encasement and, aorta engagement. Multi-disciplinary discussions were held and careful preoperative preparation plans were made. After everything was ready, the functional PGL and tumor thrombus were completely resected, then a reconstruction of IVC was performed. The patient was discharged on postoperative day 14 and all her clinical symptoms disappeared afterward. No evidence of tumor residual or metastasis was found in the subsequent six months of follow-up. Gene tests were made for her and her family. Albeit its rarity, functional PGL with IVC invasion is not unresectable, a multi-disciplinary task force should be established to settle down every detail. We recommended 3-dimensional imaging reconstruction for gaining a better anatomic understanding. Literature reviews showed that complete resection is the premise of a good prognosis. In particular cases, complementary or alternative therapy like chemotherapy and 131I-metaiodobenzylguanidine might help, family hereditary genetic tests are advised as well.

First report of spondylodiscitis caused by Bacillus circulans in an immunocompetent patient: Clinical case and review of the literature.

Bacillus circulans is mainly considered an opportunistic pathogen in immunocompromised patients. However, many different infections have been described in the literature: bacteremia, abscesses, meningitis, endophthalmitis, and wound infections. We observed a spondylodiscitis caused by Bacillus circulans in an immunocompetent patient. To date, this is the first case reported in literature. Vertebral osteomyelitis represents for clinicians a challenging infection to manage and treat, because of its insidious and indolent course. The diagnosis is frequently difficult and can often be delayed for several months and initially be misdiagnosed and mismanaged. For this reason, the clinical case was described and all published cases of infection caused by Bacillus circulans were reviewed.

Joining the club: First detection of African swine fever in wild boar in Germany.

African swine fever (ASF) has spread across many countries in Europe since the introduction into Georgia in 2007. We report here on the first cases of ASF in wild boar detected in Germany close to the border with Poland. In addition to the constant risk of ASF virus (ASFV) spread through human activities, movements of infected wild boar also represent a route of introduction. Since ASF emerged in Western Poland in November 2019, surveillance efforts, in particular examination of wild boar found dead, were intensified in the regions of Germany bordering with Poland. The first case of ASF in wild boar in Germany was therefore detected by passive surveillance and confirmed on 10 September 2020. By 24 September 2020, 32 cases were recorded. Testing of samples from tissues of carcasses in different stages of decomposition yielded cycle threshold values from 18 to 36 in the OIE-recommended PCR, which were comparable between the regional and national reference laboratory. Blood swabs yielded reliable results, indicating that the method is suitable also under outbreak conditions. Phylogenetic analysis of the ASFV whole-genome sequence generated from material of the first carcass detected in Germany, revealed that it groups with ASFV genotype II including all sequences from Eastern Europe, Asia and Belgium. However, some genetic markers including a 14 bp tandem repeat duplication in the O174L gene were confirmed that have so far been detected only in sequences from Poland (including Western Poland). Epidemiological investigations that include estimated postmortem intervals of wild boar carcasses of infected animals suggest that ASFV had been introduced into Germany in the first half of July 2020 or even earlier.

First case report of Schistosoma japonicum in Nepal.

BACKGROUND: Schistosomiasis, globally, is significant public as well as veterinary health problem as it is associated with a wide range of clinical conditions in humans and animals. Schistosomiasis is mostly caused by the following species of genus Schistosoma: Schistosoma japonicum, Schistosoma haematobium, Schistosoma mekongi, Schistosoma intercalatum Schistosoma guineensis, Schistosoma malayensis and Schistosoma mansoni. S. japonicum might be considered as the most pathogenic among these species as the clinical disease caused by this parasite ranges from mild diarrhea, nausea, Katayama fever, portal hypertension, splenomegaly and ascites to liver cirrhosis and fibrosis. S. japonicum has been commonly encountered in China, the Philippines and Indonesia. According to WHO, at least 220.8 million people required preventive treatment for schistosomiasis in 2017 but only 102.3 million people were reported to have been treated. To our knowledge, there are no cases reported from Nepal. Hence, this is the first reported case of S. japonicum in Nepal. CASE PRESENTATION: A case of acute schistosomiasis due to S. japonicum was identified in CIWEC Hospital and Travel Medicine Center, Kathmandu, Nepal. The patient arrived with gastrointestinal symptoms without any pre-existing chronic illness with no evidence of travel outside of Spain since last August, but had travelled to many other countries 2 years ago. Timely diagnosis by stool routine and microscopic examination and formal-ether concentration technique led to successful treatment of the disease. CONCLUSION: As the parasite has not been reported to date in Nepal, many people are unaware of its mode of infection and pathogenesis. Many laboratory workers are heedless with the egg of the parasite due to which this parasite might be misdiagnosed or undiagnosed. This case report might help laboratory workers to be sentient about the parasite and further diagnosis in future.

Primary ovarian rhabdomyosarcoma coexisting with Pseudo-Meigs' syndrome in a young patient: a case report and brief literature review.

Primary rhabdomyosarcoma is one of the malignant soft tissue sarcomas of childhood originating from embryonic mesenchyme. The tumor can occur in the head, neck region, and limbs, and genitourinary system. Primary ovarian rhabdomyosarcoma is an extremely rare malignancy with a few documented pediatric patients in the literature. Pseudo-Meigs' syndrome is a type of Meigs' syndrome that is usually associated with other benign ovarian tumors or any other type of malignant tumors. It is a rare condition characterized by ascites, pleural effusion, benign ovarian tumors or fibroma-like tumors, and resolution of ascites and pleural effusion after the removal of the tumor. A patient of Asian origin came to our clinic with symptoms of mild dyspnea, and gradually increasing abdominal swelling. Magnetic resonance imaging scans indicated masses with solid cystic components on both ovaries with a suspicion of malignancy, showing bilateral pleural effusion and massive ascites. This is the first reported case of a pure primary ovarian rhabdomyosarcoma associated with a Pseudo-Meigs syndrome in a young girl.

The first few cases and fatalities of Corona Virus Disease 2019 (COVID-19) in the Eastern Mediterranean Region of the World Health Organization: A rapid review.

In December 2019, a cluster of atypical Pneumonia cases in Wuhan, China were reported to the World Health Organization (WHO). Later, those cases were attributed to a novel respiratory virus currently known as COVID-19. The infection is affecting every continent. It was characterized by WHO as a global pandemic on 11 March 2020. Countries worldwide are implementing various preventive measures to contain the spread of the infection such as travel and trade restrictions, closure of educational institutions and shops, and some took more strict measures such as imposing curfew. WHO is emphasizing the importance of early detection of cases, contact tracing, risk communications, implementing multisectoral approach in order to combat COVID-19 infection. Countries should provide the public with accurate, transparent information about the local and global situation of this escalating infection. Much uncertainty still surrounds this viral infection, its modes of transmission and dynamics. Epidemiological investigations particularly for the first few cases of COVID-19 infection are critical to expand our knowledge about this evolving pandemic. In this review we summarized the data available about the first few cases and fatalities of COVID-19 infection up to 18 March 2020 across Eastern Mediterranean Region of the World Health Organization. such data were only available in websites of ministries of health of the targeted countries, WHO situational reports, online newspapers, and other media channels and this gave us an idea about the amount and type of data available for the public regarding this evolving infection.

First case of Coronavirus Disease 2019 (COVID-19) pneumonia in Taiwan.

An outbreak of respiratory illness proved to be infected by a 2019 novel coronavirus, officially named Coronavirus Disease 2019 (COVID-19), was notified first in Wuhan, China, and has spread rapidly in China and to other parts of the world. Herein, we reported the first confirmed case of novel coronavirus pneumonia (NCP) imported from China in Taiwan. This case report revealed a natural course of NCP with self-recovery, which may be a good example in comparison with medical treatments.

First case of Trichinella spiralis infection in beavers (Castor fiber) in Poland and Europe.

BACKGROUND: This is the first report of the finding of Trichinella spiralis in beaver meat (Castor fiber) in Poland and Europe. In Poland, the beaver is a strictly protected animal species, except the few regions where high population density leads to economic losses. In these areas, the reduction culling of the animals was introduced. This uncommon hunting game animal is consumed and treated as a delicacy by hunters. However, currently, there is a lack of knowledge on possible risk factors for humans associated with the consumption of beaver meat. This paper presents the result of the study on the occurrence of nematodes of the genus Trichinella in beavers. METHODS: In total, 69 beavers were examined for the presence of Trichinella spp. The 50g samples were taken from each animal and digested separately, according to a procedure based on the EU reference method. The larva DNA was examined by PCR and sequencing. RESULTS: One of the 69 examined beavers was infected. Only one Trichinella larva was detected by the digestion method. The result of PCR confirms the presence of T. spiralis in beaver meat. CONCLUSIONS: This case further confirms the ability of these typical herbivores to be infected with Trichinella spp. This is the second confirmed case of Trichinella spp. infection in beavers in Europe and the first of T. spiralis.