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Introduction Minimally invasive gynecological surgery such as hysteroscopy has a small risk of complications. These include uterine perforation (with or without adjacent pelvic organ lesion), bleeding and infection, and are more common in the presence of risk factors such as smoking, history of pelvic inflammatory disease (PID) and endometriosis. Case Presentation A patient submitted to a diagnostic hysteroscopy with no immediate complications was admitted five days later to the emergency department in septic shock. The diagnosis of ruptured tubal abscess was made, requiring emergency laparotomy with sub-total hysterectomy and bilateral adnexectomy. Despite multiple organ failure requiring admission to the intensive care unit, the patient made a full recovery. read more Conclusion Ascending infection can be a life-threatening complication of hysteroscopy, even in the absence of previously known risk factors. © 2020 The Authors.Pneumoperitoneum seen on an X-ray or computed tomography (CT) image points to a diagnosis of ruptured viscus and immediate surgery is warranted. A case of tubo-ovarian abscess (TOA) presenting with pneumoperitoneum is unusual. Very few cases have been reported where the pneumoperitoneum is caused by an abscess involving the adnexa. We present the case of a 17-year-old patient who presented with acute abdomen and raised inflammatory markers and had laparoscopy for suspected bowel perforation based on the finding of pneumoperitoneum on CT scan. Bowel perforation was ruled out and the findings were consistent with TOA. She had drainage of the abscess, subsequently received intravenous antibiotics and postoperatively recovered well. The pneumoperitoneum could have been due to coinfection with E. coli, as the patient had had a urinary tract infection due to E. coli three weeks before presentation, or slow leakage of the TOA. In conclusion, gas under the diaphragm can be related to non-bowel-related gynaecological pathology, but it vital to rule out sinister causes. © 2020 Published by Elsevier B.V.Isolated torsion of the fallopian tube is an unusual finding in a female patient presenting with acute lower abdominal pain. Left tubal torsion is considered to be a particularly rare condition. The patient presented with lower abdominal pain due to torsion of the left hydrosalpinx with no ovarian involvement. The patient underwent laparotomy and a left salpingectomy. The follow-up was uneventful. © 2020 The Authors. Published by Elsevier B.V.Obsessive-compulsive disorder (OCD) can be successfully treated with cognitive behaviour therapy (CBT). However, as few patients have access to CBT, there is a strong push to develop and evaluate scalable and cost-effective internet-delivered interventions. BIP OCD is a therapist-guided online CBT intervention for pediatric OCD that has shown promise in trials conducted at a single site in Stockholm, Sweden. In this study, we evaluated if BIP OCD is an acceptable, feasible, and effective treatment in other countries and clinical contexts. Thirty-one patients were recruited at three different sites; a specialist OCD clinic in Gothenburg (Sweden), a specialist OCD clinic in London (United Kingdom), and a university-based clinic in Brisbane (Australia). Acceptability and feasibility measures included treatment adherence and feedback from therapists. Clinician assessments were conducted at baseline, post-treatment, and 3-month follow-up. The average module completion for the participants was 8.1/12 (SD = 3.2) and the majority of patients completed the BIP OCD treatment (100% in Gothenburg, and 55.6% in both London and Brisbane). Pooling data from the three sites, the within-group effect sizes from baseline to post-treatment on the Children's Yale-Brown Obsessive-Compulsive Scale were in the expected range (bootstrapped Cohen's d = 1.78; 95% CI 1.18-2.39), with an additional symptom reduction to the 3-month follow-up (bootstrapped Cohen's d = 0.27; 95% CI 0.02-0.51). Participating therapists identified both advantages and difficulties supporting patients in this digital format. The results of this study suggest that the treatment effects obtained in the original BIP OCD trials can be generalized to other clinical contexts nationally and internationally. Lessons learned provide important information for successful implementation of BIP OCD in regular healthcare contexts. © 2020 The Authors.Sumithion, a synthetic organophosphate, is widely used as an agricultural insecticide and for control of tiger bug (Cicindela spp.) in larval rearing for aquaculture. An experiment was conducted to examine the effects of sumithion on embryological and larval development of zebrafish Danio rerio. Fertilized egg (n = 100) and larvae (n = 100) were exposed to six concentrations of sumithion (0, 0.1, 0.2, 0.4, 0.8 and 1.6 mg L-1) in three replicates. LC50 values for embryos and larvae were calculated by probit analysis. The 24 h LC50 value of sumithion for embryo was 0.235 (0.079-0.428) mgL-1. Increasing sumithion concentrations decreased hatching success and increased embryonic mortality. In embryos, sumithion induced several malformations including immature yolk sac, dark yolk sac, yolk sac bud, broken eggshell and notochord, unhatched eggs. Larval LC50 values at 24, 48 and 72 h of various doses of sumithion exposure were 0.620 (0.436-0.963), 0.475 (0.302-0.801) and 0.341 (0.177-0.617) mgL-1, respectively. Various physical deformities, including edema, notochord deformity, yolk sac damage, body arcuation, lordosis and black pigmentation on the yolk sac were evident in response to different concentrations of sumithion. The results of the current study indicate that sumithion exerts developmental toxicity to zebrafish embryos and larvae. It is expected that current findings will increase sensitivity about the toxic effect of sumithion in early development, as well the possibility of similar actions induced by other insecticides and pesticides. © 2020 The Authors.An 81-year-old man with lung cancer with bone metastases, interstitial pneumonia, and emphysema, was hospitalized for pain control. He developed fever and chills during hospitalization. Physical examination revealed a fever of 39.1 °C, but there were no findings on history or physical examination to suggest the source of the infection. Gram-negative cocci were detected in the blood culture (Fig. 1) and in a Gram stained sputum smear (Figs. 3 and 4). Neisseria meningitis and Neisseria gonorrhoeae were ruled out based on history and an absence of suggestive symptoms. The cause of his fever was diagnosed as Moraxella catarrhalis bacteremic pneumonia based on the blood culture and the sputum smear results, and he was treated with intravenous ceftriaxone. This case illustrates the importance of Gram staining of sputum and blood culture. Moraxella catarrhalis should be considered in the differential diagnosis when gram-negative cocci are detected in the blood and the sputum. © 2020 The Authors.