Wiener Klinische Wochenschrift最新文献

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.

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.

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.

Background: Multiple sclerosis (MS) is treated with various disease-modifying therapies (DMTs) with differing efficacy and risks, yet the disease course varies markedly within and between individuals. Defining optimal treatment strategies through randomized trials is impractical because of the required sample sizes, costs and long follow-up. Large multicenter registries and prospective observational cohorts are therefore essential but demand harmonized, standardized, user-friendly data capture with rigorous quality control and data protection.

Objective: This project aims to establish standardized, nationwide MS data collection in Austria.

Methods: The project consists of five key components: (i) harmonization of data collection, (ii) creation of infrastructure for data sharing, (iii) retrospective harmonized data collection (Austrian MS Database, AMSD), (iv) prospective harmonized data collection (Austrian MS Cohort, AMSC) and (v) aggregated analyses.

Results: A comprehensive set of harmonized common data elements (CDE) comprising clinical and paraclinical data was developed and a common data collection infrastructure was generated using the web-based Research, Documentation, and Analysis platform (webRDA), an innovative data capture, processing and analysis system provided by the Medical University of Vienna offering pseudonymized storage of data supported by a robust permissions system fulfilling legal data protection and ethical requirements. The AMSC is set up as a standardized prospective collection of demographic, clinical, epidemiological, psychosocioeconomic, magnetic resonance imaging (MRI), and optical coherence tomography (OCT) data as well as body fluids.

Conclusion: The AMSD and AMSC will facilitate the evidence-based development of prognostic biomarkers, individualized therapy strategies and treatment sequences based on a high-quality, population-based dataset of more than 8000 people with MS.

Introduction: Respiratory syncytial virus (RSV) is a common pathogen of lower respiratory tract infections in infants 1 month to 1 year of age. Infections with RSV are the most common cause for hospitalization for respiratory infections and present with a high rate of complications. Different scores for severity assessment currently exist but only few of them are well validated. The "Inpatient clinical pathway for evaluation/treatment of children with bronchiolitis" from the Children's Hospital of Philadelphia (CHOP) provides clear and concise guidance for severity grading and inpatient management.

Aim: In 2019 we implemented a bronchiolitis scoring system and pathway in accordance with the CHOP pathway in our inpatient setting to assess and monitor children affected by bronchiolitis as well as to plan their discharge. This study investigated the length of stay before and after implementation of the score and the risk of readmission after regular discharge.

Methods: Data from all admitted infants 1 month to 1 year of age with a discharge diagnosis of acute bronchiolitis due to RSV (ICD 10-GM 2024 J21.0, n = 261) over a period of 9 years were evaluated, 5 winters (2014-2019, n = 140) before (group 1) and 4 winters (2020-2024, n = 121) after (group 2) implementation of the score.

Results: The study population did not differ before and after implementation of the score with respect to age (group 1: mean age = 99.9 ± 87.3 days vs. group 2: 120.2 ± 85.6 days) and sex. The groups were equally sized with a mean of 28-30 patients per season. The average length of stay was 5.5 ± 3.4 SD days. Although the length of stay before and after implementation decreased on average by 0.4 days the result was not significant (5.6 ± 3.8 SD vs. 5.3 ± 2.8 SD days, p = 0.2). The readmission rate in total was very low (5/261, 1.7%) and only 1 patient had to be readmitted after implementation of the score (4/140, 2.8% vs. 1/121, 0.8%, p = 0.38).

Conclusion: This structured clinical bronchiolitis pathway provides concise advice for outpatient as well as inpatient management. The length of stay did not differ before and after implementation. The score is a safe and useful tool for preventing readmission.

Neuropsychiatric manifestations occur in about 25% of patients with primary hyperparathyroidism (PHPT). Symptoms can range from depression, anxiety, fatigue or cognitive dysfunction which are commonly observed to more seldomly revealed states of mania, delirium or psychosis which warrant psychiatric intervention. The underlying pathophysiology is likely multifactorial, potentially explained by elevated parathormone and hypercalcemia, with subsequent direct and indirect effects on monoamine neurotransmission and neuroinflammation via monoamine oxidase, tyrosine hydroxylase, sodium-potassium adenosine triphosphatase transporter and interleukin‑6.This review aims to (1) give an overview of the hypothesized pathophysiologic understanding regarding neuropsychiatric manifestations, (2) to summarize the most common neuropsychiatric symptoms and (3) to equip clinicians with recommendations for evidence-based tools to detect neuropsychiatric symptoms effectively.Psychometric questionnaires depicting psychiatric symptom burden across PHPT research are highlighted. Cut-off values for psychiatric screening purposes and hypothesized cut-off values in PHPT research to indicate parathyroidectomy are provided. A practical approach on how screening for neuropsychiatric symptoms in PHPT might be implemented in routine clinical practice is outlined.Parathyroidectomy is recognized to alleviate neuropsychiatric symptoms in PHPT, with increasing evidence showing persistent improvements in symptoms of depression, anxiety, fatigue and cognitive dysfunction. Clinical practice guidelines still diverge on whether neuropsychiatric manifestations in PHPT warrant parathyroid surgery. A symptom-based treatment approach is recommended alongside evaluating surgical intervention.