Wiener Klinische Wochenschrift最新文献

Background: We aimed to evaluate balance control and lower extremity muscle strength in kidney transplant recipients (KTRs) including a comparison to a healthy control group and determine the predictors of static and dynamic balance control after kidney transplantation.

Methods: In this study 40 KTRs and 40 healthy controls were included. Balance control was assessed using the Biodex balance system. The static postural stability test (SPST) and clinical test of sensory integration and balance (CTSIB) were used to assess static balance control whereas the dynamic postural stability test (DPST) and limits of stability test (LOST) were used for dynamic balance control. Lower extremity muscle strength was measured with a hand-held dynamometer. Renal functions and laboratory findings of KTRs were recorded.

Results: All the stability index scores of SPST and sway index in CTSIB were significantly higher in KTRs compared to healthy controls. The right anteroposterior stability index score in DPST and the reaction time in LOST were significantly higher whereas overall score in LOST and lower extremity muscle strength were significantly lower in KTRs. The linear regression analysis revealed that hemoglobin was the predictor of static balance control accounting for 11% of the variance and body weight was the predictor of dynamic balance control accounting for 34% of the variance.

Conclusion: Balance control, both static and dynamic, are impaired in KTRs as well as lower extremity muscle strength. Hemoglobin level is a predictor of static balance control whereas body weight is a predictor of dynamic balance control after kidney transplantation.

Background: Acute tubulointerstitial nephritis (AIN) is an immune-mediated disorder that can cause acute kidney injury (AKI). We aimed to investigate the characteristics of patients with AIN and predictive factors for treatment response.

Material and methods: In this study, thirty-one patients diagnosed with AIN on kidney biopsy between 2006 and 2021 were included. Baseline clinical, histopathological, and laboratory findings, including complete blood count (CBC), creatinine, erythrocyte sedimentation rate, C‑reactive protein, C3, C4, systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and urinalysis were evaluated. Treatment response, mortality, and creatinine levels at the time of last follow-up were also noted.

Results: The median age was 46 years and 80.6% were female. Median baseline creatinine and proteinuria levels were 4.1 mg/dL and 0.84 gram/day. The median follow-up period was 14 months and 93.5% received immunosuppressives. End-stage kidney disease (ESKD) developed in five patients (16.1%). Renal recovery (creatinine < 1.4 mg/dL) was observed in 17 patients (54.8%). Higher degrees of interstitial fibrosis, tubular atrophy, granuloma formation, global glomerulosclerosis, and higher baseline hemoglobin levels, in addition to a longer interval between first symptom to initiation of immunosuppressives were associated with renal nonrecovery, statistically. Also, patients who progressed to ESKD had higher baseline hemoglobin (p = 0.033) and lymphocyte (p = 0.044) and lower PLR levels (p = 0.016), as well as higher degrees of global glomerulosclerosis (p = 0.014), interstitial fibrosis (p = 0.042), and tubular atrophy (p = 0.030).

Conclusion: Treatment response rates are low for AIN, which may lead to ESKD. Besides chronicity in histopathology specimens, higher baseline hemoglobin levels and lower platelet-to-lymphocyte ratio might be prognostic. Further studies should be conducted on new markers for AIN.

Micro- and nanoplastics are omnipresent not only in the environment, but have also been detected in human body fluids and tissue. The subsequent commentary provides a perspective about potential risks for human health as well as resulting challenges for medical science.

Objective: The potential link between malnutrition and dysphagia along with its underlying mechanisms remains unknown. This study aimed to investigate the association between malnutrition factors and dysphagia mediated by a decline in activities of daily living (ADL) among nursing home residents.

Methods: This cross-sectional study used data from 705 nursing home residents. The primary factors were risk of malnutrition and dysphagia. A body mass index (BMI) of < 18.5 and insufficient energy and protein intakes were also collected as factors related to malnutrition. The causal mediation analysis was used with malnutrition factors as the exposure, dysphagia as the outcome, and ADL as the mediation factor.

Results: In total, 391 residents (55.5%) were at risk of malnutrition and 451 residents (64.0%) had dysphagia. The average causal mediation effect (ACME) of risk of malnutrition on dysphagia was 0.07 (95% confidence interval, C, 0.07-0.08), and the ACME of BMI < 18.5 was 0.05 (95% CI 0.04-0.05, P < 0.001 for both). For insufficient nutritional intake, the ACME of low energy intake was 0.07 (95% CI 0.07-0.07), and the ACME of low protein intake was 0.03 (95% CI 0.02-0.04, P < 0.001 for both). The total effects of all these exposures on dysphagia were significant (P = 0.002 for low protein intake and P < 0.001 for the others).

Conclusion: Malnutrition factors were associated with dysphagia, mediated by a decline in ADL among nursing home residents. The results of this study suggest the importance of nutritional management along with approaches to ADL to prevent dysphagia.

Aspirin as a class I guideline recommended medical treatment for acute coronary syndrome has been established for decades [1]. As early intake of aspirin is crucial, self-administration of aspirin in acute chest pain might be beneficial when weighing up the potential harm including a slightly elevated bleeding risk in patients with chest pain of another origin than myocardial infarction against the benefit in patients with coronary ischemia.

Background: In order to achieve a high-quality screening colonoscopy, a high-quality bowel preparation is essential. To perform an adequate bowel cleansing patients need to understand and act on medical information, also known as health literacy. This study aimed to analyze the relationship between the patients' educational status as a proxy for health literacy and adequate bowel preparation.

Methods: A retrospective analysis of data collected within the Austrian national colorectal cancer screening program from 2012 to 2022 was conducted. The database contains information on the quality of bowel preparation as well as the academic degree of the patients. Variables were used to perform a logistic regression analysis, with bowel preparation quality (based on the Aronchick scale) as the dependent variable and completed tertiary education as independent variable, and sex and age as control variables.

Results: A total of 329,778 patients aged 30-99 years were included in the analysis. Within the group of academics, 88.46% (n = 21,883) were adequately prepared whereas in the group of non-academics, 84.79% (n = 258,641) were found to have a high bowel preparation quality. The odds ratio (OR) for academics to have an adequate bowel preparation quality was 1.37 (95% confidence interval, CI 1.32-1.43; p < 0.001).

Conclusion: Patients with a tertiary education showed better bowel preparation quality than non-academics in Austria. Therefore, it is important to improve strategies on how to inform also less educated persons to facilitate a better screening colonoscopy quality and to optimize the use of resources from a clinical as well as a public health perspective.

Background: Work satisfaction is associated with fewer employee turnover intentions, increased job engagement and interest, and has a greater impact on employee well-being than environmental factors, such as workload. In workplace learning, clinical supervisors promote student satisfaction by meeting students' supervision needs in providing safe practice opportunities, training, and guidance in the social field. To quantitatively investigate this relationship, we proposed a supervision deficit index as a measure of learner-centered supervision received and explored its correlation with satisfaction in workplace learning.

Method: In total, 1017 Austrian medical students (2015-2017) in year 6 selected the 5 most helpful supervisory activities (from 26 options) and rated their experience levels of these activities during surgery and internal medicine placement. A supervision deficit index was then created (range 0-3; 0 = no deficit).

Results: Students with no, minor or moderate supervision deficits reported higher overall satisfaction with their placements than those experiencing considerable deficits. Students' gender, clinical experience, hospital size, placement year, and clinical field did not influence the relationship. The deficit index's psychometric qualities were good. Training activities supporting competence, such as discussing patients, planning disease management, and practicing skills, were selected more often than activities supporting autonomy, such as an appropriate level of clinical duties, and social relatedness.

Discussion: Students favored competence support. Highlighting the importance of autonomy support to students and encouraging supervisors to engage in learner-centered supervision may improve the supervision experience and work satisfaction for both. The deficit index can be used to evaluate the effects of such interventions.

A 63-year-old woman with a history of acute myeloid leukemia followed by stem cell transplantation presented with acute heart failure. Transthoracic echocardiography revealed a preserved left ventricular ejection fraction with severe ventricular hypertrophy and signs of elevated filling pressures indicating infiltrative cardiomyopathy. She died from cardiac arrest due to cardiogenic shock. The autopsy revealed an enlarged heart with a fish-flesh appearance. Here, we describe a rare case of a myeloid sarcoma of the heart.