We present the case of a woman in her late 20s who consulted our gynaecology emergency department due to dyspareunia and vaginal penetration issues. She had undergone a \'virginity reconstruction\' procedure 10 days before her wedding in Africa. Clinical examination revealed suture of the inferior part of inner labia (labia minora), narrowing of the vaginal introitus and abnormal vaginal discharge. We performed an inferior defibulation procedure and removed the sutures under general anaesthesia. Postoperative care included systemic metronidazole, counselling, vaginal dilators and topical estrogens for 1 month. There were no complications during the postoperative follow-up, and a month later, the woman confirmed a satisfactory outcome. The aim of this paper is to discuss the practice of so-called \'virginity reconstruction\', currently classified among female cosmetic genital surgeries despite being very similar to what is defined as female genital mutilation, and the care that can be provided to women in such cases.

Global migration has been increasing since before the COVID-19 pandemic. The pandemic has clearly shown a lack of preparedness for the next public health emergency when it comes to vulnerable populations including migrants. To include the issues of migration and health in the current global health agenda, it is important to establish/strengthen a network for collaboration among various stakeholders from both the migrant-sending and host countries of migrants especially in the Asian-Pacific region. As the initial step for networking in Asia, in March 2023, a hybrid style international symposium was held in Japan and agreed on a goal and five pillars: surveillance and monitoring, risk communications, community engagement, access to health and social protection services, and supportive environments. Considering the transition of context from the COVID-19 crisis to \'Build Forward Better\', through the Asian network, we will envisage the better world, where vulnerable populations including migrants will not be left behind from health security.

Echinococcosis is primarily a disease of developing nations with poor medical infrastructure, where cohabitation with domesticated animals is common. These conditions, in conjunction with the inherent chronicity of the disease, lead to low rates of diagnosis and high morbidity. Robust surveillance is not readily available in communities with the highest disease burden.WHO classifications assist in diagnostic and treatment endeavours especially in countries where this disease is not commonly encountered. However, the understanding of the pathophysiology of echinococcosis and optimal treatment are still lacking in certain patient populations.We present the case of a female from Central Asia with an isolated pulmonary hydatid cyst. She was diagnosed several months after she had an uncomplicated pregnancy and gave birth to a healthy baby girl. Due to a delay in surgical intervention, our patient received a prolonged course of treatment which resulted in a significant reduction in the size of the cyst. Given her improvement, we questioned the current guidelines set by the WHO regarding surgical resection of pulmonary hydatid cysts, compared with an extended course with albendazole in patients with an unusual and protracted course of the disease. Furthermore, we discuss the possible role of pregnancy in exacerbating symptoms of underlying pulmonary hydatid disease.

Mycetoma is a chronic infection of underlying fungal (eumycetoma) or bacterial (actinomycetoma) origin. It is characterised by a clinical triad of tumour-like swelling, actively draining sinuses and macroscopic grains of characteristic colours.We the case of a 66-year-old woman on immunosuppressive therapy presenting with eumycetoma of the foot (Madura foot). The fungal organism cultured was Acrophialophora fusisporaThis case was managed with a combination of extensive surgical debridement, and packing with calcium sulfate (Stimulan) beads impregnated with vancomycin and voriconazole. As far as the authors are aware, this is a novel adjunct to the surgical treatment of deep fungal infection in the foot.Eumycetoma treated with surgery and oral antifungal therapy leads to cure rates of 25%-35%. This novel treatment seems to bear further investigation for the potential to improve cure rates. At 8 months follow-up, our patient appears to be making good progress with no current signs of recurrence.

From July 2022, cases of imported diphtheria with toxigenic Corynebacterium diphtheriae remarkably increased among migrants arriving in Germany. Up to 30 September 2022, 44 cases have been reported to the national public health institute, all laboratory-confirmed, male, and mainly coming from Syria (n = 21) and Afghanistan (n = 17). Phylogeny and available journey information indicate that most cases (n = 19) were infected along the Balkan route. Active case finding, increased laboratory preparedness and epicentre localisation in countries along this route are important.

Strongyloides stercoralis is a helminth found in the soil and transmitted to humans through larval penetration of the skin. It is endemic across most of the tropical regions of the world. Infection with S. stercoralis commonly causes minimal or mild symptoms. This case report describes an interesting final diagnosis for a woman presenting with persistent nausea, vomiting and epigastric pain. Her evaluation included imaging and oesophagogastroduodenoscopy with biopsy. Her biopsy results revealed oesophageal candidiasis and disseminated strongyloidiasis. Important historical clues in this case included previous prolonged treatment with steroids, recent diagnosis of gram-negative bacteraemia, prior residence in Rwanda, and unknown predeparture treatment for S. stercoralis She was ultimately treated with fluconazole and ivermectin with marked improvement in her symptoms.

We review the case of an unstable gynaecological patient in the USA who presented with profuse vaginal bleeding after spontaneous miscarriage and was ultimately diagnosed with a uterine arteriovenous malformation managed with interventional radiology embolisation of her uterine artery. Her case was complicated by the presence of an ankle monitoring device which had been placed by US Immigration and Customs Enforcement as part of the Alternatives to Detention programme in which she was enrolled during her immigration proceedings. The device prompted important considerations regarding the potential use of cautery, MRI compatibility and device-related trauma, in addition to causing significant anxiety for the patient, who was concerned about how the team\'s actions could affect her immigration case. Discussion of her course and shared perspective highlights the unique clinical and medicolegal considerations presented by the expanded use of ankle monitoring devices for electronic surveillance (or \'e-carceration\') of non-violent immigrants and others.

We report the unusual case of a 5-year-old migrant boy from a rural area of Morocco with an almost-giant lung hydatid cyst that was an incidental finding on a chest X-ray performed during routine visa procedures. Echinococcus granulosus serology test was initially negative with subsequent positive seroconversion. Albendazole was started at 4 weeks before surgery and maintained for 4 months, with a favourable outcome. Cystic echinococcosis (CE) is considered a neglected tropical disease and affects more than one million people worldwide, mostly from a lower socioeconomic background. Preventive measures have been limited in underdeveloped regions. Children with CE are especially vulnerable, due not only to the high pathogenic potential of the disease but also to their frequent involvement in challenging socioeconomic situations, including migration. The incidence of CE is increasing in Europe because of high immigration flows from endemic countries. Nevertheless, CE is not covered by current migrant screening protocols.

A male refugee from the Middle East was diagnosed with pulmonary tuberculosis and Pott\'s disease with paravertebral abscess. After starting the standard regimen, the sputum culture converted to negative and the patient\'s general condition improved. Six weeks later, the patient presented with clinical worsening of known symptoms, new appearance of focal neurological deficits and progress of radiological features showing progression of the paravertebral abscess. Immune reconstitution inflammatory syndrome with Mycobacterium tuberculosis (TB-IRIS) was presumed, and treatment with high-dose steroids was started. Due to recurrent relapses while tapering, corticosteroids had to be given over a prolonged period. After treatment completion, the patient was in a good general condition, abscesses had decreased and neurological deficits were in complete remission. This case presents the rare manifestation of TB-IRIS in HIV-negative patients and its management in a high-income country.

A 33-year-old man presented with a 3-week history of breathlessness and cough. He disclosed that he was informed regarding a heart defect as a child in his home country but was unaware of its nature and was never followed up. Examination revealed a pansystolic murmur (loudest at the apex), a hyperdynamic, displaced apex, and pulmonary oedema. An ECG showed atrial fibrillation with a regular broad-complex ventricular rhythm. Following electrical cardioversion, the ECG revealed complete heart block, therefore explaining the regular atrial fibrillation. An urgent transthoracic echocardiography (TTE) confirmed the anatomy of congenitally corrected transposition of the great arteries (CCTGA) with torrential tricuspid regurgitation and impaired systemic right ventricle. Cardiac MRI identified a ventricular septal defect which was not visible on TTE. The patient showed a transient improvement following fluid offloading and ACE inhibition, with a more definitive improvement after cardiac resynchronisation therapy (CRT).