Wiener Klinische Wochenschrift最新文献

Background: Nosocomial infections have a significant impact on patients and the healthcare system. These infections lead to severe illness and mortality, prolonged hospitalization, reduced quality of life, and elevated healthcare costs.

Aim: To assess and analyze the incidence and characteristics of nosocomial infections in the intensive care unit (ICU) of Ghazi Al-Hariri Hospital, categorize the types of nosocomial infections prevalent in the ICU, and investigate temporal trends in the incidence of nosocomial infections within the ICU.

Methods: A prospective cohort study was conducted, collecting information from patients regarding their basic demographic characteristics and clinical features, including the APACHE II score, degree of organ dysfunctions, type of infection, and all procedures performed during patient care within the ICU.

Results: Of the patients 40.2% developed nosocomial infections; most were male (58%), aged under 60 years (56%), with a mean age of 54.6 ± 18.7 years. The median ICU stay was 16 days (range: 8-125 days), and the mortality rate was 60%. Medical conditions led to 68% of ICU admissions. The APACHE II scores indicated most patients were in class V (56%) and class III (24%). Ventilator-associated pneumonia (VAP) was the most common infection (64%), with Acinetobacter baumannii the most prevalent (31%). In patients with nosocomial infection, the following predictors are associated with an increased risk of death: higher APACHE 2 score, increased number of organ dysfunctions, higher SOFA (Sequential Organ Failure Assessment) score, and high CRP (C-reactive protein) levels.

Conclusion: The prevalence of nosocomial infections was high and was associated with a higher mortality rate. Furthermore, a higher APACHE 2 score, an increased number of organ dysfunctions, a higher SOFA score, and high CRP levels were the most important predictors of mortality.

Gestational diabetes mellitus (GDM) is associated with various maternal and fetal complications, including long-term cardiovascular risks for affected women. This study aimed to investigate the relationship between GDM and arterial stiffness during pregnancy and 2 months postpartum. A cross-sectional study was conducted with 100 pregnant women of 28-40 weeks of gestation and divided into 2 groups. The groups were divided based on oral glucose tolerance test (oGTT) results: 50 women with GDM and 50 controls with normal oGTT. All participants in the GDM group had a form of GDM that was successfully managed by diet only. Arterial stiffness was assessed using a non-invasive oscillometric device, the Arteriograph® (TensioMed^TM Kft, Budapest, Hungary), by measuring the right brachial artery. The results showed that during pregnancy the pulse wave velocity (PWV) was unexpectedly significantly lower in the GDM group compared to controls (8.10 m/s vs. 8.65 m/s, P T< 0.05). Central and brachial augmentation index (AIx) values showed no significant differences between the groups. No differences in PWV or AIx were observed between GDM and control groups 2 months postpartum; however, within the GDM group, central (0.50 % vs. 11.45 %) and brachial (-73.35 % vs. -51.75 %) AIx significantly increased after delivery, indicating postpartum vascular effects of GDM.These findings suggest that even diet-managed forms of GDM can induce vascular changes postpartum, underscoring the importance of early detection and management. Further research is needed to explore the mechanisms underlying these changes and their possible long-term implications for cardiovascular health in post-GDM women.

Background: Indications for reconstruction of the lower extremity range from posttraumatic defects to infections and tumors. Despite advancements in plastic surgery, flap surgery still poses a challenge. In this retrospective study local flap surgeries and microsurgical free flaps were assessed. Postoperative complications and limb preservation were analyzed.

Methods: This retrospective study included 187 patients who were treated at a university-affiliated tertiary care hospital. Defects were of traumatic (29.4%) and nontraumatic (70.6%) etiology. Limb preservation was determined during a 12-month follow-up period. Patient characteristics, flap selection and postoperative flap-associated complications were collected.

Results: The patient population included 107 men (57.2%) and 80 women (42.8%), 104 (55.6%) free flaps and 83 (44.4%) local flaps were performed. In the free flap group latissimus dorsi and gracilis flaps were most commonly performed. The most common surgeries in the local flap group were gastrocnemius, soleus and plantaris medialis muscle flaps. The overall limb preservation rate was 92.5% with no significant difference between the two groups.

Conclusion: Both methods enable reconstruction of complex lower extremity wounds and enable limb preservation in many cases. The type of flap is selected based on the anatomical location of the defect, defect size and patient factors.

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.

Various adverse reactions to elexacaftor/tezacaftor/ivacaftor (ETI) therapy have been documented in the literature. Here, we present the first reported case in Croatia of severe rash following ETI therapy in a 19-year-old female cystic fibrosis (CF) patient. There were two attempts to introduce ETI therapy, spaced two months apart, both of which resulted in diffuse maculopapular rash, in the second attempt, the rash appeared on the same day as re-initiation. Given the clinical benefits of ETI treatment, andinspired by several case reports on drug desensitization, in July 2023, we started the patient on a modified 3-day-tolerance induction protocol which was successful.

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.