Wiener Klinische Wochenschrift最新文献

Introduction: Chronic hepatitis D (CHD) is a severe viral hepatitis characterized by a rapid progression towards advanced chronic liver disease (ACLD). This study aimed to characterize the Austrian CHD epidemiology with respect to disease severity, systemic inflammation and genetic markers.

Methods: Patients attending one of six participating hospitals from 2020 onwards were included and assessed regarding laboratory data, liver stiffness measurement (LSM) and biopsy, hepatic venous pressure gradient (HVPG) measurement, endoscopy and imaging. In a subset, single nucleotide polymorphisms (SNPs) in genes of interest (IL28B, PNPLA3, SERPINA1, NTCP) were assessed. Biomarkers of liver disease severity were compared to an age-matched cohort of treatment-eligible and treatment-naïve chronic hepatitis B (CHB) patients.

Results: A total of 59 CHD patients (median age: 44.0 years, 59.3% male) were included and ACLD was found in 62.7%. Decompensated patients exhibited higher levels of biomarkers of systemic inflammation, such as C‑reactive protein (p = 0.061) and interleukin 6 (p = 0.008). The SNP IL28B C/C genotype had an unfavorable effect on disease severity (higher Model for End-Stage Liver Disease [MELD] score, HVPG and ammonia levels, lower platelet counts and albumin levels, all p < 0.05). The CHD patients showed a more severe liver disease compared to CHB mono-infected patients with respect to LSM, platelets, MELD and portal hypertension (all p < 0.01).

Conclusion: This analysis of the Austrian CHD cohort before initiation of antiviral treatment showed a high burden of ACLD and portal hypertension, especially when compared to CHB patients. The IL28B C/C SNP was associated with a more severe liver disease in CHD.

Sporadic primary hyperparathyroidism is most commonly caused by a single parathyroid adenoma. Traditionally, bilateral neck exploration with assessment of all four glands was the gold standard, achieving cure rates up to 98%. This approach has largely been replaced by limited exploration (LE), in which a prelocalized hyperfunctioning gland is selectively removed using a small open, video-assisted, or endoscopic approach.Successful LE relies on accurate preoperative localization of single-gland disease. First-line imaging consists of high-resolution ultrasound combined with 99mTc-sestamibi scintigraphy with single-Photon Emission Computerized Tomograph (SPECT/CT). When results are negative or discordant, 18F-choline PET/CT is recommended, significantly improving localization and enabling targeted surgery..Because multiglandular disease cannot be definitively excluded preoperatively, intraoperative parathyroid hormone (IOPTH) monitoring has become an important adjunct. IOPTH confirms complete excision of hyperfunctioning tissue and aids detection of additional abnormal glands. Several interpretive criteria exist, including Miami, Vienna, Halle, and Rome, with Miami and Vienna most commonly used. Although routine IOPTH use in concordantly localized single-gland disease remains debated, evidence suggests it reduces persistent disease and reoperation rates, particularly when imaging is inconclusive.Endoscopic, extracervical, and robotic approaches offer superior cosmetic outcomes but involve greater dissection, higher costs, and increased technical demands, limiting widespread use. Overall, advances in imaging and intraoperative adjuncts have enabled minimally invasive parathyroidectomy to replace bilateral exploration while maintaining excellent long-term outcomes.

Interstitial lung abnormalities (ILA) are findings detected on computed tomography (CT) that potentially reflect early stages of interstitial lung disease (ILD). Their prevalence ranges between 3-10% in the general population, with higher rates observed in older individuals and smokers. ILA include bilateral and nonhypostasis-related ground-glass opacities, reticular abnormalities, traction bronchiectasis, lung architectural distortion and honeycombing, affecting more than 5% of a lung zone. The risk of progression to ILD varies between 20-80%, depending on the ILA subtype and associated risk factors. Clinical progression and risk factors include advanced age, nicotine exposure, inhaled noxious substances, thoracic surgical procedures, pneumotoxic treatment and abnormal pulmonary function parameters. Radiologically, fibrotic ILA with subpleural and basal predominance as well as larger extent of lung involvement are significantly associated with increased risk of progression. The clinical management is based on a structured evaluation including high-resolution CT, lung function diagnostics and risk stratification. In the absence of signs of advanced fibrotic changes, individualized follow-up intervals ranging from 6-36 months are recommended, depending on the patient's risk profile. This position paper provides practical recommendations for managing ILA, in line with current international guidelines, while considering new evidence on genetic risk factors, imaging features associated with progression and clinical predictors. The aim is an early identification of high-risk patients and avoidance of unnecessary diagnostic or therapeutic interventions.

Background: Evidence on adolescents' contraceptive use and education in Austria remains limited. We aimed to describe contraceptive behavior, satisfaction with methods and sources/content of contraceptive education among pupils in Tyrol and to explore correlates of any contraceptive use among sexually active adolescents.

Methods: Cross-sectional online survey (April-July 2022) of pupils aged 14-18 years (N = 369) recruited via schools. Prespecified outcomes included current method use (stratified by sexual activity), satisfaction ratings and education sources. Analyses comprised descriptive statistics, χ²/ANOVA as appropriate, and multivariable logistic regression among sexually active participants with covariates (age, sex, school type).

Results: Overall, 91 (24.7%) pupils reported prior intercourse (median age at first intercourse 15 years); among sexually active adolescents, condoms (N = 64, 64%) and the pill (N = 37, 36%) predominated, while method non-use remained common (72%). Satisfaction varied by method; affordability scored lowest. Although > 90% reported prior education, 55% requested more information; condoms and the pill were most frequently covered. In adjusted models, any contraceptive use among sexually active adolescents was positively associated with older age and prior counselling.

Conclusion: In this exploratory sample adolescents report mixed contraceptive use and a sustained demand for tailored information. The findings highlight the need to evaluate counselling quality and affordability in the future. Causal inferences and policy projections are beyond the scope of these data.

Background: War orphans have been reported to have unfavorable psychological outcomes; however, research on the impact of an orphan's age at father loss on later mental health and resilience is scarce.

Methods: In a sample of 50 orphans (mean age 18.9 SD ± 1.5 years, age range 16-21 years, 54%, N = 27 female) who lost their father before the age of 5 years during the war in Bosnia and Herzegovina (1992-1995), the relationships between age at father loss, sociodemographic/environmental factors, and mental health characteristics including resilience in late adolescence were assessed using Pearson correlations, t‑tests, ANOVA and regression analyses.

Results: After controlling for confounders, regression analyses revealed that younger age at father loss was independently associated with lower total resilience (p = 0.001) in late adolescence and lower acceptance of self and life (p = 0.006). Education mediated the relationship between age at father loss and later self-reported depression, with higher educational levels being associated with less depressive symptoms. Furthermore, being the only child was associated with higher total resilience (p = 0.015), personal competence (p = 0.020) and acceptance of self and life (p = 0.041).

Conclusion: Our findings suggest that very early loss of a father creates a specific vulnerability, impacting war orphans' resilience in late adolescence. Resilience-focused interventions should focus on war orphans who lost their fathers at a very young age and those having siblings.

Background: Carbohydrate counting (CC) supports glycemic control. In children with type 1 diabetes mellitus (T1DM), mothers are usually the primary caregivers and parental knowledge and involvement play a key role in diabetes management.

Objective: This study aims to evaluate mothers' knowledge of CC and the impact of their knowledge level on glycemic control (glycated hemoglobin, HbA1c) in children and adolescents with T1DM.

Methods: The research was an analytical cross-sectional study conducted at the Pediatric Endocrinology Polyclinic. This study was conducted with 102 mothers of children and adolescents with T1DM. Mothers' CC knowledge was assessed using a test designed by the researchers. All participants completed demographic and clinical questionnaires. The measurement of HbA1c was used to evaluate glycemic control, where HbA1c levels < 7.5% represented good control and ≥ 7.5% indicated poor control. Multiple linear regression analysis was performed to evaluate the determinants of HbA1c (%).

Results: The mean HbA1c level of children and adolescents was 8.3% ± 1.87, with only 35.3% achieving good glycemic control. The study demonstrated that mothers possess a certain level of CC knowledge. Children and adolescents of mothers who had received a university education had lower HbA1c levels (p < 0.05). There was no significant relationship between mothers' education levels and their CC knowledge score. The HbA1c levels showed a negative correlation with mothers' CC knowledge score (r:-0.315). Mothers of children with good glycemic control had a significantly higher CC knowledge score (p < 0.05). The CC knowledge score of mothers had a negative correlation with HbA1c (%). In multiple regression analyses mothers' education levels (B:-0.318, p < 0.05) and CC knowledge score (B:-0.177, p < 0.05) were significant predictors of HbA1c, explaining 20.8% of the variance.

Conclusion: The findings suggest that there is a need to enhance mothers' CC knowledge. Mothers' CC knowledge levels were found to affect their children's glycemic control. Therefore, regular training should be provided to improve healthy eating habits and accurate carbohydrate counting knowledge, and mothers' knowledge levels should be assessed to address any gaps.

Background: Arthroscopic partial meniscectomy is one of the most commonly performed orthopedic procedures, yet many patients remain dissatisfied in the early postoperative period. Whether dissatisfaction is reflected in changes in spatiotemporal gait parameters remains unclear but such information could help the early identification of patients at risk of poor outcomes. This prospective observational cohort study aimed to assess gait parameters in patients after partial meniscectomy using foot-worn wearable sensors and to evaluate their potential as indicators of postoperative satisfaction.

Methods: In this study 27 patients scheduled for partial meniscectomy were prospectively enrolled; the final group comprised 22 patients who completed all assessments. Gait parameters were measured preoperatively and at 1 and 2 months postoperatively. At final follow-up, patients rated their satisfaction. Patients were categorized as satisfied (n = 18) or dissatisfied (n = 4).

Results: Significant improvements in stride length (p < 0.01) and walking speed (p = 0.01) were observed at 2 months postoperatively in the entire group. Among satisfied patients, both stride length and walking speed significantly improved (p < 0.01), whereas in the dissatisfied subgroup cadence and walking speed did not return to baseline values. Patient satisfaction was best predicted by an increase in cadence, with a positive predictive value of 93% (95% confidence interval, CI 72-99%).

Conclusion: Patients who reported satisfaction demonstrated improvements in gait parameters, with cadence emerging as the strongest predictor of postoperative satisfaction.

Background: Hepatorenal dysfunction is a key prognostic factor in patients with symptomatic tricuspid valve regurgitation (TR). This study evaluated the prognostic value of hepatorenal dysfunction using the Model for End-stage Liver Disease (MELD), the modified MELD-XI score, and right heart hemodynamic parameters in patients undergoing transcatheter tricuspid valve interventions (TTVI).

Methods: This prospective, single-center cohort study included patients undergoing edge-to-edge or heterotopic tricuspid valve repair. The MELD and MELD-XI scores were calculated using creatinine, bilirubin and the international normalized ratio (INR). All patients underwent right heart catheterization. The predictive value of MELD/MELD-XI scores and hemodynamic parameters, individually and combined, was assessed for a composite endpoint of 3‑month mortality or rehospitalization using receiver operating characteristics (ROC) analysis.

Results: In this study 36 patients (mean age 80.2 ± 5.9 years; 33.3% male) were analyzed. Rehospitalization occurred in 25% and the 3‑month mortality was 11%. Both MELD-XI (area under the curve, AUC 0.96, 95% confidence interval, CI 0.88-1.00, p = 0.01) and MELD score (AUC 0.91, 95% CI 0.78-1.00, p = 0.023) showed excellent predictive values for mortality. The preinterventional MELD-XI score, right ventricular (RV) pressure (AUC 0.82, 95% CI 0.61-1.00, p = 0.029), right atrial (RA) pressure (AUC 0.86, 95% CI 0.70-1.00, p = 0.015) and pulmonary artery (PA) pressure (AUC 0.82, 95% CI 0.65-0.98, p = 0.029) were predictive for the combined endpoint. The predictive value of the MELD-XI for the combined endpoint was further improved when integrating PA pressure, RA pressure, and RV pressure in the model (AUC 0.91, 95% CI 0.77-1.00, p = 0.002).

Conclusion: This pilot study identified MELD-XI score as a potential risk score for 3‑month mortality after TTVI. Its prognostic value for the combined endpoint was increased after adding invasive hemodynamic parameters.