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Introduction: Sperm banks have shifted from assisting heterosexual couples with male infertility to primarily serving single women and female couples through medical services, reflecting advances in fertility treatments and societal changes., Aims: Evaluate demographic changes among single women who have applied for sperm donation during 30 years in the State of Israel., Methods: This retrospective cohort study includes 4265 single women who received sperm donation between January 1992 and December 2021, at a tertiary medical center. We divided the follow-up period into 6 groups of 5 years each. A comparison was made of the demographic characteristics of single women applying for sperm donation in different periods according to: 1) age at the beginning of the treatment; 2) ethnic origin - 7 ethnic groups., Results: The average age of single women who received sperm donation was 38.2±4.4 years. The average age of patients decreased from 39.58 years in 1997-1992 to 38.08 years in 2017-2021 (p-value<0.05). Ashkenazic Jews (38.4%) and Sephardic Jews (37.7%) were the most common ethnic origins among single women, with Arab women comprising only 0.2%. Single Jewish women of Ashkenazi descent seek sperm donation treatment almost a year earlier than their Sephardic counterparts (Arab countries and North Africa)., Conclusions: Single Israeli women opting for early sperm donation carries significant clinical, social, and economic implications. Women from conservative social backgrounds appear to be less inclined to seek sperm donation as single individuals or tend to delay this option until a later age, in contrast to women from liberal backgrounds.

Oocyte cryopreservation is an important method in the field of infertility. This procedure can benefit the cancer patient wishing to preserve fertility before initiation of any destructive chemotherapy or radiation therapy. It is a substitute for embryo cryopreservation and thereby avoids associated ethical issues. Oocyte cryopreservation technology can lead to the establishment of "oocytes banks" and provides solutions to ovarian failure patients. Technical obstacles were the main cause for the slow progress of oocyte cryopreservation. When compared to embryos and sperm cryopreservation technologies which are in common use worldwide, the reports on oocyte cryopreservation-derived pregnancies, were sporadic and with low success rates. However, in recent years we are witnessing more and more publications and increasing success rates in this important and fascinating field. Improvement in the freezing protocols and the introduction of vitrification procedures increased the survival rates and led to the birth of more then 100 healthy newborns. In the future we believe this method will be part of daily work in the fertility world. This review describes the methods available today and the clinical reports published in this field.

In vitro maturation is a new and promising technique in the field of artificial reproductive technology. This method provides an alternative treatment to the known treatments and a solution for one of the most common and disturbing problems of infertility treatment, the hyperstimulation syndrome. The method is particularly useful in cases of patients with polycystic ovarian syndrome. The physiological process of oocyte maturation requires maturation of the nucleus and maturation of the oocyte cytoplasm. In the process of in vitro maturation of the oocyte, oocytes in their late stages of maturation are aspirated from the follicles and transferred to specific culture conditions to achieve complete maturation. The process of oocyte retrieval from small and undeveloped follicles needs proper equipment and experience. Therefore, this process requires deep understanding of the physiological process of oocyte and follicles growth and maturation, proper equipment and especially good experienced laboratory support. This review aims to describe the physiological basis for the process, the recommended protocols and to report the experience published so far on success rates and treatment safety, both maternal and fetal.

Since the 1960's, CS has become the main riot control agent in use by police and army forces throughout the world. The first post-exposure symptom is a burning sensation in the eyes, nose and throat. At a later stage, lacrimation, rhinorrhea, conjunctivitis, sore throat and salivation appear. These symptoms are followed by chest pain and dry cough, and if the substance is swallowed, it may cause nausea and vomiting. This article reviews the physical properties of CS, the main dispersing techniques, the clinical signs and symptoms of exposure, including information on mutagenicity, carcinogenesis, pregnancy safety, and will introduce guidelines for treatment after exposure.

Thalidomide was first used during the 50's-60's, especially for morning sickness in pregnant women. It was found to be a powerful teratogen only years later and was banned from use. At the same time it was found to have anti-inflammatory and anti-angiogenic properties and was approved as treatment for leprosy. As such, thalidomide might be used against pathological neovascularization, as seen in mustard gas exposure. From past experience we know that the eyes are the most vulnerable organ to mustard gas exposure. In some of the casualties there is a late sequella including pathological corneal neovascularization. So far there is no specific effective treatment against this neovascularization. The purpose of this review is to examine current research about the potential use of thalidomide as an anti-angiogenic agent, including potential role in treating mustard gas eye injury.

Botulism is caused by a neurotoxin produced from the anaerobic, spore forming bacteria--clostridium botulinum. The disease is usually caused by toxins type A, B and E. Since the disease was first recognized in the beginning of the nineteenth century as food poisoning, different forms of intoxication were described. Infantile botulism, wound botulism, infectious botulism and inadvertent botulism are all clinical syndromes caused by the same toxin. The attempt to use the botulinum toxin as biological warfare agent is well known. Recently the potential terrorist use of botulinum toxin has become a real concern. Botulism is characterized by its classic triad: 1) symmetric descending flaccid paralysis with prominent bulbar palsies 2) afebrile patient 3) clear sensorium. The paralysis usually begins in the cranial nerves where blurred vision, dysarthia and dysphagia are the initial complaints. Diagnosis is based on clinical findings, history of suspicious exposure and supportive ancillary testing to rule out other causes of neurologic dysfunction that mimic botulism such as the Guillain-Barre syndrome, Myasthenia Gravis or cerebrovascular stroke. Laboratory confirmation of suspected cases is usually delayed and treatment should begin before confirmation is completed. The treatment includes supportive care, and the administration of antitoxin which reduces mortality if given early. Since community and emergency room physicians may be the first to treat patients with any type of botulinum intoxication, they must know how to diagnose and treat this rare but potentially lethal disease.

Tularemia is a zoonosis, caused by the Gram-negative bacterium, Francisella tularensis. The organism penetrates the human body through interrupted skin or mucous membranes, via animal contact or bites from ticks, deer-flies and mosquitoes. Contaminated aerosol and water are alternative modes of transmitting the germ through the respiratory and alimentary tracks. In light of its high infectivity in aerosol and its offensive occupation in the past, tularemia may appear in a biological warfare context. After an incubation period of 3-5 days, the disease begins with systemic symptoms, which abate, leaving a clinical picture, dominated by one of the listed patterns: ulceroglandular, typhoidal, glandular, occuloglandular, pharyngeal or pneumonic. Diagnosis and identification of the bacterium is difficult and even hazardous. Most diagnoses are established by serology which is positive in 50-70% of the patients after 2 weeks of illness, and in most of them by 4-8 weeks. The treatment of choice is streptomycin intra-muscular, or gentamicin intra-venous for 10-14 days. Prophylaxis may be achieved by tetracycline treatment, beginning up to 24 hours from exposure, for 2 weeks, or by a live attenuated, investigational vaccine. Nevertheless, post-exposure, or even better so, pre-exposure intervention is the most effective way of preventing the devastating results of the attack.

Many viruses may cause encephalitis. Three such viruses of the Alpha genus (Venezuelan equine encephalitis (VEE), Western equine encephalitis (WEE) and Eastern equine encephalitis (EEE)) may be used as biological warfare agents. The clinical course of the diseases caused by these viruses is not specific, and resembles a broad range of bacterial and viral diseases. Several attenuated and inactivated vaccines were developed, but their efficacy in the biological warfare scenario is questionable. There is no effective drug therapy for the treatment of these diseases, and treatment is mainly supportive. Several VEE outbreaks were reported in humans and horses in South America and southern United States. This virus usually causes a febrile illness, which might be complicated with encephalitis, mainly in the cases of children and elderly patients. The EEE virus causes the most severe form of disease, with severe encephalitis and high proportion of sequel. It is prevalent mainly in the eastern parts of Northern America. The WEE virus, which is hybridization between the Sindbis virus and the EEE virus, causes encephalitis mainly in children. The severity of the disease caused by WEE and the sequel rate is much lower than that of EEE.

Background: Bacillus anthracis, the causative agent of anthrax, is well known in human history as a major cause of disease in domestic and wild animals and as a rare condition in humans. For the last seventy years, anthrax was developed and occasionally stored as an agent of biological weapon arsenal in numerous countries. The incubation period in humans is 1-6 days and the disease may be present as three distinct clinical syndromes: cutaneous, inhalational, and gastrointestinal disease. The major concern in regard of biological warfare is the inhalational form of anthrax, which starts as a febrile flu-like disease. The development of malaise, fatigue, cough and mild chest discomfort is followed by severe respiratory distress with dyspnea, diaphoresis, stridor, and cyanosis. Shock and death occur within 24-36 hours after onset of severe symptoms. Physical findings are non-specific, but a widened mediastinum is usually seen on chest x-ray. A positive blood culture, immunohistochemical methods and the use of the polymerase chain reaction method confirm the diagnosis. Although effectiveness may be limited after severe symptoms are present, a high dose of antibiotic treatment should be administered and aggressive supportive therapy may be necessary. In the situation of an anthrax attack, as was recently seen in the United States, penicillin is no longer recommended as an acceptable first line therapy. In this case, ciprofloxacin or doxycycline is the recommended drug of choice since penicillin-resistant strains may be used, as well as the possibility of the emergence of an inducible beta-lactamase positive bacterium. Since a high infecting dose may exacerbate the clinical course of the disease, a combination antibiotic regimen should be considered. The disease is not contagious and standard precautions are sufficient. Pre-exposure prophylaxis is based on a vaccine administration, while post-exposure prophylaxis is feasible by the initial use of oral ciprofloxacin or doxycycline. In this article we reviewed the literature with emphasis on the recent medical reports from the United States analyzing the eleven cases of inhalational anthrax as well as the new guidelines for diagnosis and treatment that resulted from the bioterrorism attack in October 2001. Although physical findings were non-specific, abnormal findings on chest x-rays were present in all the eleven cases. A positive blood culture, immunohistochemical methods and the use of the polymerase chain reaction method were highly valuable in revealing and confirming the diagnosis of anthrax. In the case of an attack with anthrax spores, the likelihood of exposure to a large infective dose of high quality spores, may require a prolonged period of treatment as well as prolonged post-exposure therapy.

Exposure to biological warfare agents may occur in several ways, the most prominent being aerosol infection, droplet infection, common component infection and via physical contact. These agents may enter the body through the respiratory tract, mucous membranes and through the skin. The mechanism of exposure and the route of entry of the specific agent will dictate the appropriate protection required. Available protective equipment include respiratory protective devices, full face protective masks and surgical masks for respiratory protection, battle dress overgarments, protective gloves and overboots for skin protection. Full protection is needed when the agent has not been identified. When the biological agent is known, the protective measures should be determined by its characteristics. Protection may include several levels of precautions: standard risk, aerosol infection, droplet infection and contact infection. This paper describes the routes of exposure to biological warfare agents, the available protective equipment and the precautions needed when treating biowarfare casualties.

The use of biological agents as weapons is a well-known and established fact in the modern world. Biological warfare can be used both in terrorist events and in war and they pose a real threat and a formidable challenge to the defender. Biological weapons, in their various forms such as germs, viruses or toxins, can harm both living creatures and their surroundings. The relative simplicity of their production and use, compared to other non-conventional weapons, renders them to be a highly accessible system that can cause numerous casualties. Therefore, it is extremely important to study the threat and learn its characteristics, so as to be appropriately prepared in order to minimize potential damage. This review summarizes the characteristics of biological weapons (physical and biological), the means of use in bioterrorism and war, the advantages and disadvantages, comparisons to other non-conventional weapons and both tactical and strategical uses.

Infection with Burkholderia mallei (formerly Pseudomonas mallei) can cause a subcutaneous infection known as "farcy" or can disseminate to condition known as Glanders. It is primarily a disease affecting horses, donkeys and mules. In humans, Glanders can produce four types of disease: localized form, pulmonary form, septicemia, and chronic form. Necrosis of the tracheobronchial tree and pustular skin lesions characterize acute infection with B. mallei. Other symptoms include febrile pneumonia, if the organism was inhaled, or signs of sepsis and multiple abscesses, if the skin was the port of entry. Glanders is endemic in Africa, Asia, the Middle East, and Central and South America. Glanders has low contiguous potential, but because of the efficacy of aerosolized dissemination and the lethal nature of the disease, B. mallei was considered a candidate for biological warfare. During World War I, Glanders was believed to have been spread to infect large numbers of Russian horses and mules on the Eastern front. The Japanese infected horses, civilians and prisoners of war during World War II. The USA and the Soviet Union have shown interest in B. mallei in their biological warfare program. The treatment is empiric and includes mono or poly-therapy with Ceftazidime, Sulfadiazine, Trimethoprim + Sulfamethoxazol, Gentamicin, Imipenem etc. Aggressive control measures essentially eliminated Glanders from the west. However, with the resurgent concern about biological warfare, B. mallei is now being studied in a few laboratories worldwide. This review provides an overview of the disease and presents the only case reported in the western world since 1949.