There is currently a lack of research focusing on pain-related functional impairment during the postpartum period. This study aimed to determine the prevalence of low back pain (LBP)-related disability among postpartum women in the Slovak Republic and to examine the relationship between LBP-related disability, pelvic girdle pain (PGP), and pelvic floor discomfort. This cross-sectional study included 791 women between 12 weeks and 1 year postpartum. Data were collected using the standardised Slovak versions of the Oswestry Disability Index (ODI), Pelvic Girdle Questionnaire (PGQ), and Pelvic Floor Impact Questionnaire–Short Form 7 (PFIQ-7), all of which demonstrated high internal consistency (Cronbach’s α > 0.9). The mean age of the participants was 31.43 years. The sample was dichotomised using the standard ODI cut-off score of 20
A 57-year-old male patient presented with the first manifestation of severe type 2 diabetes mellitus in the setting of diabetic foot syndrome complicated by osteomyelitis. The patient was treated conservatively within a multimodal interdisciplinary approach. In addition, focused extracorporeal shockwave therapy (fESWT) was performed according to International Society for Medical Shockwave Treatment (ISMST)-oriented principles. After five sessions of fESWT, local wound management resulted in extraction of a relevant bony sequestrum. Following sequestrum removal, a large wound cavity remained in the region of the right first toe (digitus I pedis), corresponding approximately to the size of an entire phalanx. Remarkably, within only 4 days, rapid and substantial granulation of the deep wound cavity was observed. The present case supports the hypothesis that focused ESWT may represent a clinically relevant adjunctive treatment option in selected patients with diabetic foot syndrome and complicated wound healing disorders. At the same time, it highlights the need for prospective randomized controlled trials.
Male factors account for around half of all cases of infertility. The prognostic relevance of abnormal semen parameters for obstetric outcomes following assisted reproductive technology (ART) is unclear. This retrospective analysis included 428 participants enrolled in the prospective Austrian registry (AROS) between January 2022 and August 2025. Male-factor infertility was defined according to the reference values of the World Health Organization (WHO) 6th edition and the criteria of the Austrian in vitro fertilization (IVF) funds. Associations between infertility factors and pregnancy complications, mode of delivery, and preterm birth were assessed using logistic and ordinal logistic regression, as appropriate. Male-factor infertility was documented in 254 cases, while female factors were documented in 206 cases, with some overlap between the two. Pregnancy complications occurred in 63.8
Endovascular aortic repair (EVAR) has become the predominant treatment for infrarenal abdominal aortic aneurysms (AAA). However, open surgical reconstruction (open aortic repair, OAR) of the infrarenal aorta has not lost its importance. While EVAR appears to be superior in the short and medium term, there is no difference between OAR and EVAR in the long term. A retrospective study comparing OAR and EVAR was performed with the aim of identifying perioperative factors influencing the choice of the specific surgical procedure. Over a defined period of time, demographic data, cohort-associated data, aneurysm-derived factors, and treatment-related parameters were analyzed in a systematic clinical, single-center observational study comparing treatment procedures for AAA (for vascular surgery quality assurance and to contribute to the research in vascular medicine and clinical care). The study population consisted of 324 consecutive patients who had undergone elective surgery for an infrarenal AAA from January 1, 2006, to August 29, 2016, using either EVAR or OAR (sex ratio 90.4
Plastic surgery is a multidimensional surgical discipline including reconstructive surgery, hand surgery, aesthetic surgery, and burn surgery, all on the fundament of plastic surgical research. In all of these disciplines, extracorporeal shockwave therapy (ESWT) has been studied both experimentally and clinically. In reconstructive surgery, experimental data clearly demonstrate better survival of flaps when either pre- and/or postconditioned with ESWT, with fewer complications. In hand surgery, ESWT has been described for bone indications like scaphoid non-unions or lunate necrosis aka Kienböck’s disease, tendon indications, nerve indications like carpal tunnel syndrome, or soft tissue indications like Dupuytren’s disease. In aesthetic surgery, cellulite has been studied extensively, with more than 15 clinical studies, some of them randomized. Both radial and focused ESWT improve cellulite after 6–8 sessions by 25–35
Avulsion injuries of the pelvic muscles cause significant time-loss injuries, especially among adolescent soccer players. I report the case of an avulsion fracture of the anterior inferior iliac spine (AIIS) with associated significant inflammation visualized by MRI and superb microvascular imaging (SMI) Doppler ultrasonography in a 15-year-old soccer player. Regenerative treatment consisted of six combined sessions of radial pressure wave with novel burst mode (Storz Masterpuls Icon), focused extracorporeal shockwave therapy (ESWT), and extracorporeal magnetotransduction therapy (EMTT). As early as 1 week after the first combined session, a 50
The incidence of necrotizing soft tissue infections is increasing, and associated mortality remains high. It is important to make an early diagnosis, but diverse atypical presentations occur. An older adult patient was admitted with sepsis syndrome without localizing clues. Necrotizing fasciitis of the right thigh and gluteus developed, and CT revealed an adjacent inflammatory cecum mass which was diagnosed during surgery as perforated adenocarcinoma. A review of the literature revealed that this rare type of necrotizing soft tissue infection is characteristic of rectosigmoid or ascending colon perforation, often being its presenting feature and the first clue to an occult underlying disease. Myriad etiologies of perforations have been reported to be associated with thigh, flank, or abdominal wall necrotizing fasciitis and peritonitis, but this syndrome remains poorly recognized. Better awareness will lead to more timely diagnosis and aggressive multifaceted treatment, which are essential for patient survival.
Cerebral toxoplasmosis is a form of encephalitis caused by Toxoplasma gondii. It typically occurs in immunocompromised individuals and is rarely observed in patients with B‑cell lymphoma. The first two patients of this case series, both previously diagnosed with peripheral B‑cell lymphoma, presented with new-onset neurological symptoms and cerebral mass lesions. Laboratory results indicated latent infection with T. gondii, but the findings in cerebrospinal fluid were unspecific One patient underwent brain biopsy, thereby confirming the diagnosis histologically, while the second patient was classified as having probable cerebral toxoplasmosis. Both patients were treated with pyrimethamine and sulfadiazine, leading to clinical and radiological improvement within weeks. To highlight the diagnostic pitfalls of cerebral toxoplasmosis, we included a third patient in the case series who presented with a cerebral metastasis of peripheral diffuse large B‑cell lymphoma. Additionally, we performed a comprehensive literature review on cerebral toxoplasmosis in patients with peripheral B‑cell lymphoma.
Cerebral toxoplasmosis is a form of encephalitis caused by Toxoplasma gondii. It typically occurs in immunocompromised individuals and is rarely observed in patients with B‑cell lymphoma. The first two patients of this case series, both previously diagnosed with peripheral B‑cell lymphoma, presented with new-onset neurological symptoms and cerebral mass lesions. Laboratory results indicated latent infection with T. gondii, but the findings in cerebrospinal fluid were unspecific One patient underwent brain biopsy, thereby confirming the diagnosis histologically, while the second patient was classified as having probable cerebral toxoplasmosis. Both patients were treated with pyrimethamine and sulfadiazine, leading to clinical and radiological improvement within weeks. To highlight the diagnostic pitfalls of cerebral toxoplasmosis, we included a third patient in the case series who presented with a cerebral metastasis of peripheral diffuse large B‑cell lymphoma. Additionally, we performed a comprehensive literature review on cerebral toxoplasmosis in patients with peripheral B‑cell lymphoma.
Regenerative therapies are increasingly integrated into modern rehabilitation medicine. Extracorporeal shock wave therapy (ESWT) represents a central modality within this framework, extending beyond symptom control toward enabling functional recovery across disciplines including occupational medicine, geriatrics, and oncology. In addition, its potential socioeconomic impact is of growing relevance. This work comprises a narrative synthesis integrating concepts of regenerative medicine, rehabilitation, prehabilitation, prevention, and health economics, with a focus on ESWT as a mechanotherapeutic intervention. Rehabilitation is based on a biopsychosocial model targeting body functions, activities, and participation. By reducing pain, modulating inflammation, and promoting tissue regeneration, ESWT acts as a biological “enabler” thereby, facilitating active rehabilitation strategies. In oncological settings, ESWT may support the management of treatment-related functional impairments. In occupational medicine and geriatrics, it contributes to maintaining ability to work and independence. From a socioeconomic perspective, ESWT may reduce healthcare utilization, prevent chronicity, shorten the duration of rehabilitation, and facilitate return to work, thereby lowering indirect costs. While evidence for primary prevention is lacking, ESWT is relevant in tertiary and quaternary prevention. Extracorporeal shock wave therapy represents a key component of regenerative rehabilitation strategies. Its function-oriented and potentially cost-effective application enhances mobility, participation, and quality of life, particularly in ageing and multimorbid populations.
This report presents a 6-year antigen-based surveillance of pediatric viral gastroenteritis in Turkey, revealing substantial epidemiological shifts during and after the coronavirus disease 2019 (COVID-19) pandemic. Adenovirus circulation was strongly affected by COVID-19-related public health restrictions, showing a marked decline during restriction periods. However, rotavirus exhibited a relative increase in 2021 despite ongoing restrictions, followed by a more pronounced rise after the relaxation of measures, aligning with the “immunity debt” hypothesis associated with altered early-life viral exposure. These findings illustrate how pandemic-related interventions reshaped the circulation of enteric viruses and underscore the value of routine rapid antigen testing for detecting post-pandemic resurgences, which is underexplored in the literature.
Chikungunya virus (CHIKV) is an arthropod-borne virus belonging to the genus Alphavirus; it has been increasingly linked to neurological complications. This study aimed to highlight the neurological manifestations of chikungunya virus infection. This retrospective case series was conducted at the Aga Khan University Hospital, Karachi, Pakistan. Adult patients (aged 18 years and above) with typical arboviral prodrome (fever, arthralgias, myalgias) who tested positive for chikungunya IgM antibodies in serum and demonstrated new-onset neurological symptoms were included in the study. The sample size consisted of 18 patients. Descriptive statistics were used to demonstrate demographics and the clinical, radiological, and electrodiagnostic details of participants. Patients with neuro-chikungunya were trichotomized based on the extent of neuroaxis involvement into those with central nervous system (CNS) involvement, those with CNS and peripheral nervous system (PNS) involvement, and those with isolated PNS involvement. This study found heterogenous nervous system involvement in chikungunya virus infection, including the brain, spinal cord, nerve roots, and peripheral nerves in variable combinations. The majority of patients in this cohort had CNS involvement (55
Scedosporium apiospermum is a ubiquitous species of ascomycete fungi. Human infections occur mostly as opportunistic infections in immunocompromised patients. Risk factors for immunocompetent patients are penetrating trauma, surgery, and near-drowning accidents. We report a complicated postsurgical infection with S. apiospermum in a 66-year-old immunocompetent adult. After microsurgical lumbar decompression, the patient developed an extensive infection in the area of the operation with sub- and epidural abscess collection, spondylodiscitis, polyradiculitis, and arachnoiditis. S. apiospermum was recovered from multiple cultures of tissue samples as well as from implant material. Despite early initiation of voriconazole therapy and surgical intervention, the progressive infection of multiple lumbar nerve roots could not be prevented and the patient developed distal sensorimotor paraparesis. Only after 10 months of continuous oral voriconazole therapy and repeated surgical procedures to replace all implant material did stabilization and clinical improvement occur. Finally, fungus was no longer detected and the patient slowly but steadily regained walking ability.
Erectile dysfunction (ED) following radical prostatectomy (RP) is a common and challenging complication that often does not respond to first- or second-line therapies. Penile prosthesis (PP) implantation offers a definitive solution, particularly in refractory cases. We present the case of a young patient with ED following RP for prostate cancer. After unsuccessful medical treatments, the patient underwent implantation of a three-piece inflatable penile prosthesis (IPP), resulting in high patient satisfaction, restoration of sexual function, and improved psychosocial well-being. The choice of prosthesis type should be individualized, considering patient factors such as manual dexterity, comorbidities, and anatomy. Both IPP and semirigidPP devices provide excellent outcomes but require careful counseling regarding expectations, device operation, and potential complications. Advances in surgical techniques have significantly reduced infection and mechanical failure rates. Despite satisfactory outcomes, penile prostheses remain underutilized due to barriers to access and delayed referral. Penile prosthesis implantation should be offered to patients with ED refractory to first- or second-line treatments. Earlier referral, comprehensive patient education, and integration into survivorship care are essential, especially for younger post-cancer patients.
Viele Betroffene von Myalgischer Enzephalomyelitis/Chronischem Fatigue-Syndrom (ME/CFS) sind hochgradig pflegebedürftig. Gleichzeitig bedingt die Post-Exertionelle Malaise (PEM), das Kernmerkmal von ME/CFS, dass bereits geringe körperliche, orthostatische, kognitive oder sensorische Belastungen eine disproportionale Zustandsverschlechterung auslösen können. Dadurch ergeben sich spezifische Anforderungen und erhebliche Herausforderungen in der häuslichen Versorgung. Die pflegerische Versorgung wird bislang überwiegend von Angehörigen getragen, die dabei nur unzureichend Hilfe und Unterstützung finden. Gleichzeitig bestehen erhebliche Defizite in Wissen, Versorgungsstrukturen und professioneller Orientierung für die an der Betreuung beteiligten Pflege- und Gesundheitsberufe sowie Ärzt:innen. Ziel dieses Leitfadens ist es, pflegerische Maßnahmen so auszurichten, dass Überlastungen vermieden und Stabilität unterstützt wird. Der Leitfaden basiert auf einer Zusammenstellung praxisorientierter Maßnahmen, die sich aus Sicht von Betroffenen und pflegenden Angehörigen bewährt haben. Diese wurden durch Expert:innen aus Pflegewissenschaft, Physiotherapie, Allgemeinmedizin und Public Health fachlich eingeordnet und inhaltlich weiterentwickelt. Der Leitfaden beschreibt Anpassungen zentraler Pflegedimensionen – von Ernährung und Körperpflege bis hin zu Kommunikation und Umgang mit emotionalen Belastungen – an krankheitsspezifische Belastungsgrenzen. Ergänzend werden Anforderungen an die Pflegebeziehung und die Planung von Hausbesuchen dargestellt sowie Möglichkeiten palliativer Pflegeprinzipien diskutiert.
Verrucous carcinoma is a rare, highly differentiated subtype of squamous cell carcinoma, more closely resembling a reactive process than conventional invasive squamous cell carcinoma. It is characterized by local invasion of adjacent normal tissue and low metastatic potential. Verrucous carcinoma may occasionally involve the nasal mucosa, with initial symptoms including regional discomfort, nasal obstruction, or the presence of a visible intranasal lesion that drives the patient to the initial consultation. The pathogenesis of verrucous carcinoma is not yet fully understood, and the role of infectious factors, such as human papillomavirus (HPV), remain a subject of debate. We present a 50-year-old male with verrucous carcinoma arising in the left nasal vestibule, developing following possible autoinoculation (based on anamnestic data) at the site of prior nasal trauma from a smaller, common facial wart. The patient had previously undergone partial resection of the septal cartilage, and cicatricial tissue was present in the same area as a result of earlier surgical intervention. The exophytic lesion was surgically excised and subsequently electrocauterized. No residual macroscopic tumor was observed. Koilocytosis was identified on histopathological examination. Immunohistochemical analysis demonstrated p16 overexpression. Previously histologically confirmed facial HPV-related warts support the possible HPV involvement in the pathogenesis of verrucous carcinoma and establish its role as not so controversial.
BACKGROUND:Many of those affected by myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) have significant care needs. However, post-exertional malaise, the defining feature of ME/CFS, means that even minor physical, orthostatic, cognitive, or sensory stressors can trigger a disproportionate worsening of health status, condition and symptoms. This results in specific requirements and significant challenges in home care. Nursing care is still provided predominantly by family caregivers, who frequently lack adequate assistance and support. At the same time, there are significant gaps in knowledge, care infrastructure, and professional guidance for the nursing and healthcare professionals, as well as physicians, involved in providing care. OBJECTIVE:The objective of this guide is to structure care measures in a way that prevents overexertion and promotes stability. METHODS:The guide is based on a compilation of practice-oriented measures that have proven effective from the perspective of those affected and family caregivers. These were professionally categorized and further developed by experts in nursing science, physical therapy, general practice and public health. RESULTS:The guide describes how to adjust key dimensions of care - from nutrition and personal hygiene to communication and managing emotional stress - to disease-specific exertion thresholds. Additionally, requirements for the caregiving relationship and the planning of home visits are outlined and the possibilities of palliative care principles are discussed.
To report the first documented case of actinomycosis following lingual mucosa graft (LMG) corporoplasty for Peyronie’s disease (PD) and to highlight its clinical course and successful conservative management. A 55-year-old male underwent plaque incision and LMG corporoplasty for severe PD. Eight months postoperatively, he presented with a fluid collection at the graft site. Imaging revealed a well-circumscribed lesion, and aspiration identified Actinomyces spp. without systemic symptoms. The infection was managed successfully with aspiration, compressive therapy, and oral antibiotics, thereby avoiding further surgical intervention. A recurrent curvature was later corrected with plication. Actinomycosis is a rare but treatable complication following LMG in PD surgery. Awareness of atypical graft site infections and a multidisciplinary diagnostic approach are essential for effective management.
Ureteral strictures are a potentially obstructive condition that, if left untreated, may progress to chronic kidney disease. The leading cause is iatrogenic, most commonly following endourological surgery or gynecological procedures. While reconstructive surgery—either open or robotic—remains the gold standard, endourological stents represent a viable alternative in many cases. We report the case of a 54-year-old woman who sustained an iatrogenic complete transection of the distal right ureter during myomectomy. Initial management included percutaneous nephrostomy and delayed open ureteral reconstruction using a Boari flap. Postoperative complications included stent dislocation and partial anastomotic dehiscence, necessitating revision surgery. Despite these interventions, the patient developed a recurrent distal ureteral stricture with persistent symptoms and stent intolerance. As a minimally invasive alternative, an Allium® self-expanding ureteral stent (Allium Ltd., Caesarea, Israel) was placed endoscopically. The patient experienced marked clinical improvement, stable renal function, and no major complications such as migration or encrustation. A localized inflammatory reaction at the stent contact zone was identified upon follow-up ureteroscopy, with biopsy confirming chronic inflammation. The Allium® ureteral stent represents a safe, effective, and well-tolerated option for managing complex recurrent ureteral strictures in patients who are poor candidates for, or unwilling to undergo, surgical reconstruction. This case illustrates the stent’s potential to preserve renal function and improve patient quality of life while minimizing the need for frequent interventions. Careful patient selection and regular endoscopic follow-up are critical to optimizing outcomes.
