Vienna General Hospital Research Articles

Triggerpunkt-Behandlungs-Tool zur Selbsttherapie von Myogelosen im Berufsumfeld – eine Anwendungsbeobachtung

Trigger point treatment tool for self-therapy of myogelosis in the professional environment – An observational study Aim: There is a large number of occupations where workplace-associated movement patterns and/or forced postures lead to muscle tension in the shoulders and back. These tensions have a direct detrimental impact on the quality of life and capacity for work of those affected. In the medium to long term, they also promote the development of structural degeneration of the musculoskeletal system. If employees in the healthcare sector are affected, this impairs high-quality patient care. The trigger point self-treatment tool “TensionTerminator” (ErgoPhysion, Innsbruck, Austria) was developed for the self-therapy of such tension conditions in the workplace. The use of this device was evaluated as part of an application observation in six departments at Vienna General Hospital (AKH). Methods: Six departments at Vienna General Hospital from the areas of surgery, laboratory medicine, internal medicine and radiology were each provided with a “TensionTerminator” device for independent use for 4 months between May 2023 and March 2024. A contact person in each department was trained in the use of the device and how to handle the documentation. As part of the observation, users were asked to independently enter their user ID, the duration of use and their subjective assessment of the effect (“better”/”worse”/”no change”) in a list each time they used the device. Results: During the test period, a total of 430 uses by 145 users were documented in the six departments, i.e. an average of almost 3 uses per person. The average application duration was 6.5 minutes. In 85.1% of all uses, the patient’s condition after use was described as “better”, and in 14% of all cases as “no change”. One of the 430 uses received a negative rating (“worse”). Conclusion: The trigger point self-treatment tool “TensionTerminator” has proven to be an effective device against workplace-associated muscle tension. It was received very well in the hospital setting and was used regularly. Keywords: workplace health promotion – back pain – myogelosis – myofascial trigger points

How to stay healthy in a physically demanding workplace – Die retrospektive Beurteilung einer gezielten betrieblichen Gesundheitsförderungsmaßnahme für körperlich schwer arbeitende Mitarbeiter und Mitarbeiterinnen im Allgemeinen Krankenhaus Wien

How to stay healthy in a physically demanding workplace – The retrospective assessment of a targeted occupational health promotion measure for employees doing physically demanding work at Vienna General Hospital Aim: Heavy physical work is one of the key factors in the development of spinal overload syndromes. Workplace health promotion (WHP) measures aim to minimize the harmful effects of heavy physical work as much as possible through personal measures. If generalized WHP measures are not possible, they should be carried out in a way that is tailored to specific professional groups. This paper presents such a targeted WHP measure for the patient transport services at Vienna General Hospital and its retrospective assessment by the participants. Methods: After participation in the targeted WHP measure, a validated questionnaire, the Comprehensibility of Health Education Programs (COHEP), was used. Results: The COHEP dimensions “comprehension-fostering behaviour of program trainers” (mean 16,3 ± 5,9), “transferability to everyday life” (mean 12,5 ± 4,0) and “comprehensibility of medical information” (mean 7,6 ± 2,2) were rated as very good. The COHEP dimension “amount of information” (mean 12,6 ± 6,8) was rated as average. Conclusion: The WHP project presented here was rated very highly in terms of comprehension-fostering behaviour, transferability to everyday life and comprehensibility of medical information. The amount of information, however, was rated as tending to be too extensive. Keywords: workplace health promotion – back health – manual material handling – weightlifting

Reflex testing for anti-HDV in HBsAg-positive patients offers high diagnostic yield in a large Central European tertiary care center

Current guidelines recommend reflex testing for hepatitis D virus (HDV) coinfection in hepatitis B surface antigen (HBsAg)-positive patients over risk-factor based screening. We aimed to evaluate the feasibility and diagnostic yield of reflex anti-HDV testing at a Central European tertiary care center. We retrospectively included 560 consecutive patients who had a recorded (first) positive HBsAg test result at the Vienna General Hospital between 2018 and 2022. While reflex anti-HDV testing had been implemented in our hepatitis outpatient clinic (n = 153, ‘reflex testing cohort’), HDV screening needed to be manually ordered in the remaining patients (n = 407, ‘standard testing cohort’). Overall, 98.0% and 65.1% of patients in the reflex and standard testing cohort were screened for anti-HDV, respectively, and the overall seroprevalence of anti-HDV among screened patients was 6.7% (n = 28, reflex testing cohort: 9.3%, standard testing cohort: 5.3%). Risk factors for HDV were present in 49.1% of all included and in 89.3% of anti-HDV positive patients, respectively. Anti-HDV positive patients showed higher ALT (54 [33–83] vs. 29 [19–49] U/L; p = 0.005) and a higher proportion of low-to-undetectable HBV-DNA (61.5% vs. 33.2%; p < 0.001), as compared to anti-HDV negative patients. HDV-RNA PCR was ordered in n = 21/28 (75.0%) of anti-HDV positive patients, and 76.2% had detectable HDV-RNA. Among viremic patients, 75% and 37.5% had significant fibrosis (≥ F2) or cirrhosis (F4), respectively. The prevalence of anti-HDV among HBsAg-positive patients is considerable in a large hospital located in Central Europe. Double reflex testing, i.e., anti-HDV being triggered by the presence of HBsAg and HDV-PCR bring triggered by the presence of anti-HDV, seems warranted to increase the diagnostic yield.

Monoclonal anti-amyloid antibody treatment: the epidemiological profile of the target patients in Austria and the status of treatment-eligible patients registered at an outpatient memory clinic.

The development of monoclonal anti-amyloid antibodies, adisease-modifying treatment for Alzheimer's disease (AD), has raised the necessity to identify the epidemiological profile of the possible target patients who would benefit from such therapy. These are patients in the early stages of AD with biomarker-confirmed brain amyloid positivity. In this study, the epidemiological profile of possible target patients in Austria and Vienna was estimated. The number of patients in the stage of amyloid-beta (Aβ)-positive prodromal AD in Austria and Vienna are 193,500 and 34,700 patients, respectively. The expected patient demand for the upcoming therapy in Austria and Vienna are 61,200 and 11,100 patients, respectively.In the memory clinic of the Vienna General Hospital, the number of treatment-eligible patients for an upcoming anti-amyloid antibody was on average 52.8 patients per year, which is about 10% of the total number of patients visiting the memory clinic every year. Several challenges to provide therapy to the general population include expanding the MCI screening in primary care and increasing the capacity of the healthcare system for biomarker testing, infusion delivery, and ARIA management. The study primarily addresses the status quo of identifying patients on memory clinics through cognitive screening and biomarker testing.

Systemic Metabolic and Volumetric Assessment via Whole-Body [18F]FDG-PET/CT: Pancreas Size Predicts Cachexia in Head and Neck Squamous Cell Carcinoma.

Background/Objectives: Cancer-associated cachexia in head and neck squamous cell carcinoma (HNSCC) is challenging to diagnose due to its complex pathophysiology. This study aimed to identify metabolic biomarkers linked to cachexia and survival in HNSCC patients using [18F]FDG-PET/CT imaging and machine learning (ML) techniques. Methods: We retrospectively analyzed 253 HNSCC patients from Vienna General Hospital and the MD Anderson Cancer Center. Automated organ segmentation was employed to quantify metabolic and volumetric data from [18F]FDG-PET/CT scans across 29 tissues and organs. Patients were categorized into low weight loss (LoWL; grades 0-2) and high weight loss (HiWL; grades 3-4) groups, according to the weight loss grading system (WLGS). Machine learning models, combined with Cox regression, were used to identify survival predictors. Shapley additive explanation (SHAP) analysis was conducted to determine the significance of individual features. Results: The HiWL group exhibited increased glucose metabolism in skeletal muscle and adipose tissue (p = 0.01), while the LoWL group showed higher lung metabolism. The one-year survival rate was 84.1% in the LoWL group compared to 69.2% in the HiWL group (p < 0.01). Pancreatic volume emerged as a key biomarker associated with cachexia, with the ML model achieving an AUC of 0.79 (95% CI: 0.77-0.80) and an accuracy of 0.82 (95% CI: 0.81-0.83). Multivariate Cox regression confirmed pancreatic volume as an independent prognostic factor (HR: 0.66, 95% CI: 0.46-0.95; p < 0.05). Conclusions: The integration of metabolic and volumetric data provided a strong predictive model, highlighting pancreatic volume as a key imaging biomarker in the metabolic assessment of cachexia in HNSCC. This finding enhances our understanding and may improve prognostic evaluations and therapeutic strategies.

Gender differences in neurocognitive assessments: insights from apilot study with the International Neurocognitive Test Profile (INCP) digital battery.

The aging global population has led to an increase in the number of dementia diagnoses, with projections indicating acontinued upward trend. This demographic change presents profound challenges for patients, their families, and healthcare systems worldwide. Consequently, the demand for reliable and user-friendly screening tools that can detect dementia at early stages and monitor its progression is more critical than ever. The International Neurocognitive Test Profile (INCP), developed at the Medical University of Vienna, aims to address this need by offering adigital test battery for the early detection of dementia. This study forms apart of the INCP's ongoing development and evaluation, specifically investigating the influence of gender on test outcomes. Seventy participants, recruited through flyers at the Vienna General Hospital, completed the INCP assessment using tablets as part of the study. The effect of gender on performance across various INCP subtests was analyzed using Mann-WhitneyU tests. For further exploratory analysis, acorrelation matrix was calculated encompassing demographic variables (age and education), screening data, and all INCP subtests. The analysis revealed significant gender differences in two INCP subtests related to executive functions. Males outperformed females on the Figure Fluency Test (r = 0.30, indicating amoderate effect) and the Dice 2‑n Back Test (r = 0.29, indicating asmall effect). However, when correcting for multiple comparisons, no significant gender disparities were observed in the scores of the subtests. The identification of possible gender differences in specific subtests underscores the importance of considering gender as avariable in the further development and evaluation of the INCP. These findings offer valuable insights for the design and planning of future studies involving the INCP.

Dr. Ignaz Phillip Semmelweis: The Unrecognized Pioneer of Aseptic Practices.

Modern medicine is well-versed in aseptic and infection control practices, such as hand hygiene, proper use of disinfectants, and personal protective equipment. The early 1800s lacked any concept of effective antisepsis because they predominantly believed in the miasma theory (now abandoned), which believed that disease was caused by bad air coming out of rotting organic matter. In the era of "miasma theory," Ignaz Semmelweis dared to pave the way for germ theory disease. Vienna General Hospital supported his work, but his hypothesis remained unpublished and unheard by the rest of the world. In 1861, his major publication, "The etiology, concept, and prophylaxis of childbed fever," sparked strong opposition and rejection of his theories. His mental condition deteriorated due to the strong rejection and criticism from his peers, leading to the development of amnesia, anxiety, and severe depression. He was unfortunately admitted to an Austrian asylum, where he was confined and beaten. Eventually, the man who conquered puerperal fever succumbed to septicemia due to an infected wound from the beating.

Introduction and Validation of Low-Cost Ocular Biometry in Healthy and Cataractous Eyes Using a Thermally Tunable Swept-Source Laser

To introduce and validate a novel substantially lower-priced and rapid swept-source investigational optical biometer in healthy and cataractous eyes, using a thermally tuned laser diode used extensively in cell phones and data communication as an alternative swept source. Prospective accuracy, validity, and reliability analysis. A total of 60 eyes of 59 subjects (29 eyes of 29 healthy subjects and 31 eyes of 30 cataract patients) were enrolled in a prospective comparative study at the Vienna General Hospital between August 2021 and April 2023. Averaged intraocular distances were acquired in 2.5 seconds from datasets consisting of 5000 consecutive A-scans at a single position by a low-cost swept-source optical biometry (SSOB) system. Instrument repeatability was assessed via standard deviations (SDs) and coefficients of variation (CoVs) of parameters such as axial length (AL), anterior chamber depth (ACD), lens thickness (LT), and central corneal thickness (CCT). Healthy subjects and cataract patients were subsequently measured on the same day with the SSOB and a referential partial coherence interferometry (PCI) biometer (IOLMaster 500) to establish AL inter-device correlation (r) for instrument calibration. AL and ACD as shared parameters between both biometers were evaluated for their limits of agreements (LoA) using Bland-Altman analysis. Repeated measurements of AL, ACD, LT, and CCT revealed SDs of 18 µm, 12 µm, 12 µm, and 10 µm, respectively. All parameters except for CCT had a COV <1%. Except for 1 eye with white cataract, 59 eyes of 59 study participants with various degrees and types of cataract could be measured with both devices. The AL inter-device correlation was excellent (r > 0.99). The 95% LoAs between both biometers were -0.14 to 0.13 mm for AL and -0.28 to 0.25 mm for ACD. Optical biometry using a thermally tunable VCSEL swept-source light source has the potential to provide clinically relevant biometric parameters at an unprecedented 100-fold lower price point than currently used state-of-the-art optical biometers, paving the way for compact devices in remote care settings.

Timely integration of palliative care. the reality check. a retrospective analysis

PurposeA large volume of literature suggests that timely integration of palliative care (PC) enhances the well-being, quality of life and satisfaction of patients and their families. It may also positively impact clinical outcomes and healthcare costs throughout the disease trajectory. Therefore, reviewing clinical practice to reflect real-life situations regarding timely PC integration is essential.MethodsThis study, conducted at the Vienna General Hospital between March 2016 and August 2022, retrospectively examined PC consultation (PCC) requests. It aimed to assess the timeliness of PC integration by analysing the duration between diagnosis and the first PCC request, as well as the interval between the first PCC request and death.ResultsThis study included 895 PCCs. The median time from diagnosis to the first PCC was 16.6 (interquartile range (IQR): 3.9–48.4) months, while the median time from the first PCC to death was 17.2 (IQR: 6.1–50.7) days. The median time from diagnosis to first PCC was 10.4 months in females (confidence interval (CI): 6.0–14.8) compared to 10.6 months in males (CI: 8.1–13.1; p = 0.675). There were no gender disparities in the time from first PCC to death, with a median of 23.3 days (CI: 15.6–31.0) for females and 22.3 days (CI: 16.2–28.4) for males (p = 0.93). Fifty percent of patients died between 5 and 47 days after the first PCC.ConclusionThese findings highlight the discrepancy between the clinical perception of PC as end-of-life care and the existing literature, thereby emphasising the importance of timely PC integration.

Complication Rates of Peripherally Inserted Central Catheters in Oncologic Versus Non-Oncologic Patients

ObjectivesPeripherally inserted central catheters are commonly used in cancer patients and provide vascular access for the administration of chemotherapy, antibiotics, or parenteral nutrition. Besides many advantages, they represent a source of possible complications such as catheter related blood stream infection, catheter occlusion, or thrombosis. In this study, the catheter-related complication rate between oncologic and non-oncologic patients was compared. MethodsThis retrospective cohort-study included 411 patients who underwent their first catheter placement at the Vienna General Hospital—Medical University of Vienna from January 2013 to June 2018. Patient demographics and catheter-related parameters were collected and statistically analyzed using a competing risk model. ResultsMean catheter dwell time was 27.75 days. The overall complication rate was 7.54% (2.72 per 1000 catheter days). Underlying malignant disease (hazard ratio: 0.351, 95% confidence interval [CI]: 0.133-0.929, P = .035) and chemotherapy administration (hazard ratio: 2.837, 95% CI: 1.088-7.394, P = .033) were significantly associated with the occurrence of any kind of complication. Catheter related blood stream infection was observed among 11 (2.68%) patients and again significantly associated with chemotherapy administration (hazard ratio: 4.545, 95% CI: 1.178-17.539; P = .028). Thrombosis was found in 7 (1.70%) patients and occlusion in 13 (3.16%) cases. Conclusions and implications for nursing practiceChoice of venous access is an interdisciplinary decision with emphasis on patient participation. In oncologic patients, our data suggests that the benefits of peripherally inserted central catheters regarding costs, invasiveness, and accessibility might be outweighed by the higher rate of complications associated with the device. This becomes even more important in a community care setting, where standardized handling procedures and patient education play a pivotal role in device safety.

Enhancing SAPS-3 Predictive Accuracy with Initial, Peak, and Last Lactate Measurements in Septic Shock.

Background/Objectives: Septic shock is a severe condition with high mortality necessitating precise prognostic tools for improved patient outcomes. This study aimed to evaluate the collective predictive value of the Simplified Acute Physiology Score 3 (SAPS-3) and lactate measurements (initial, peak, last, and clearance rates within the first 24 h) in patients with septic shock. Specifically, it sought to determine how these markers enhance predictive accuracy for 28-day mortality beyond SAPS-3 alone. Methods: This retrospective cohort study analyzed data from 66 septic shock patients at two ICUs of Vienna General Hospital (2017-2019). SAPS-3 and lactate levels (initial, peak, last measurement within 24 h, and 24 h clearance) were obtained from electronic health records. Logistic regression models were constructed to identify predictors of 28-day mortality, and receiver operating characteristic (ROC) curves assessed predictive accuracy. Results: Among 66 patients, 36 (55%) died within 28 days. SAPS-3 scores significantly differed between survivors and non-survivors (76 vs. 85 points; p = 0.016). First, last, and peak lactate were significantly higher in non-survivors compared to survivors (all p < 0.001). The combination of SAPS-3 and first lactate produced the highest predictive accuracy (AUC = 80.6%). However, 24 h lactate clearance was not predictive of mortality. Conclusions: Integrating SAPS-3 with lactate measurements, particularly first lactate, improves predictive accuracy for 28-day mortality in septic shock patients. First lactate serves as an early, robust prognostic marker, providing crucial information for clinical decision-making and care prioritization. Further large-scale studies are needed to refine these predictive tools and validate their efficacy in guiding treatment strategies.

Portal hypertension and its prognostic implications in patients with Wilson's disease.

Wilson's disease may progress to cirrhosis and clinically significant portal hypertension (CSPH). We aimed to assess the prevalence and prognostic impact of CSPH-related features on hepatic decompensation and transplant-free survival in patients with Wilson's disease. About 137 patients with Wilson's disease (Leipzig score ≥4), followed for a median observation period of 9.0 (3.9-17.7) years at the Vienna General Hospital, were included in this retrospective study. Overall, 49 (35.8%) developed features of CSPH: 14 (10.2%) varices, 40 (29.2%) splenomegaly, 20 (14.6%) ascites, 18 (13.1%) hepatic encephalopathy and 3 (2.2%) experienced acute variceal bleeding. Overall, 8 (5.8%) patients died, including three deaths caused by CSPH-related complications. Within 10 years, compensated patients with features of CSPH developed more decompensation events (8.3% vs. 1.5% in patients without CSPH, p = 0.3) and had worse transplant-free-survival (91.7% vs. 98.6%), which further declined in patients with hepatic decompensation (26.7%, log-rank: p < 0.0001). Patients with liver stiffness <15 kPa and normal platelets (≥150 G/L) were less likely to decompensate within 10 years (2.6% vs. 8.4%, p = 0.002) and had a better 10-year transplant-free-survival (97.7% vs. 83.9%, p = 0.006). Patients with Wilson's disease developing features of CSPH are at an increased risk for hepatic decompensation and liver-related mortality, warranting for regular screening and timely initiation of effective CSPH-directed treatments.

Use of the CytoSorb adsorber in patients with acute-on-chronic liver failure.

CytoSorb is a hemoadsorptive column used to remove high concentrations of proinflammatory cytokines in septic shock. Data on CytoSorb application in acute-on-chronic liver failure (ACLF) is lacking. This retrospective observational study analyzed 21 ACLF patients admitted to ICUs at the Vienna General Hospital who received CytoSorb adsorber therapy between 2017 and 2023. Median ICU length of stay was 8days (IQR: 3-13), the ICU survival rate was 23.8% (n = 5). Significant decreases in bilirubin (median peak: 20.7mg/dL to median post-treatment: 10.8mg/dL; - 47.8%; p < 0.001), procalcitonin (1.34 to 0.74pg/mL; - 44.6%; p < 0.001), interleukin-6 (385 to 131ng/mL; - 66.0%; p = 0.0182)-but also of platelets (72 to 31 G/L; - 56.9%; p = 0.0014) and fibrinogen (230 to 154mg/dL; - 33.0%; p = 0.0297) were detected. ICU survivors had a trend towards a stronger relative decrease in bilirubin (- 76.1% vs. - 48.2%), procalcitonin (- 90.6% vs. - 23.5%), and IL-6 (- 54.6% vs. - 17.8%) upon CytoSorb treatment. Moreover, no serious CytoSorb-attributed complications were detected. In conclusion, use of CytoSorb adsorber in ACLF patients results in a significant decrease in bilirubin and proinflammatory cytokines, while platelets and fibrinogen were also lowered. Prospective trials are warranted to investigate the impact of CytoSorb on clinical outcomes of ACLF patients with high proinflammatory cytokine levels.

Body Mass Index Distributions and Obesity Prevalence in a Transgender Youth Cohort – A Retrospective Analysis

PurposeTo evaluate differences in auxological parameters between transgender and cisgender adolescents. MethodsRetrospective analysis of auxological data of 269 transgender and gender diverse patients (75% assigned female at birth or AFAB, 25% assigned male at birth or AMAB) at the outpatient clinic for Pediatric Endocrinology at the Vienna General Hospital. All were treatment naïve at initial measurement. Height and weight data were compared to current World Health Organization (WHO) standards, defining a standard deviation score (SDS) of ≥ 1 ≤ 2 as overweight and > 2 as obese. ResultsIn our untreated transgender population (mean age 15.7 years), 20% were overweight and 17% obese. Mean BMI was 0.64 SDS above the WHO average (p < .001). This result was more pronounced in the AFAB subgroup (+0.73 SDS, p < .001) than in the AMAB group (+0.37 SDS, p = .07). The AMAB group showed markedly higher BMI variance compared to WHO standards (p < .001) and to the AFAB group (p = .03), due to a higher relative number of underweight observations. When correcting for psychiatric diagnosis, transgender patients were still significantly overweight (p < .001). In patients for whom data both pregender-affirming hormone therapy and during gender-affirming hormone therapy was available (n = 133), BMI SDS did not change significantly over time (p = .22). DiscussionWe observed significantly higher rates of overweight and obesity in our adolescent transgender cohort. The reasons are likely complex and multifactorial. This makes eating and exercise behaviors central in both transgender care and future research.

Efficacy and safety of mTOR inhibition in cutaneous sarcoidosis: a single-centre trial

Sarcoidosis is an inflammatory condition that can affect various organs and tissues, causing the formation of granulomas and subsequent functional impairment. The origin of sarcoidosis remains unknown and there are few treatment options. Mechanistic target of rapamycin (mTOR) activation is commonly seen in granulomas of patients across different tissues and has been shown to induce sarcoidosis-like granulomas in a mouse model. This study aimed to examine the efficacy and safety of the mTOR inhibitor sirolimus as a treatment for cutaneous sarcoidosis. We did a single-centre, randomised study treating patients with persistent and glucocorticoid-refractory cutaneous sarcoidosis with sirolimus at the Vienna General Hospital, Medical University of Vienna (Vienna, Austria). We recruited participants who had persistent, active, and histologically proven cutaneous sarcoidosis. We used an n-of-1 crossover design in a placebo-controlled, double-blind topical treatment period and a subsequent single-arm systemic treatment phase for 4 months in the same participants. Participants initially received either 0·1% topical sirolimus in Vaseline or placebo (Vaseline alone), twice daily. After a washout period, all participants were subsequently administered a 6 mg loading dose followed by 2 mg sirolimus solution orally once daily, aiming to achieve serum concentrations of 6 ng/mL. The primary endpoint was change in the Cutaneous Sarcoidosis Activity and Morphology Index (CSAMI) after topical or systemic treatment. All participants were included in the safety analyses, and patients having completed the respective treatment period (topical treatment or systemic treatment) were included in the primary analyses. Adverse events were assessed at each study visit by clinicians and were categorised according to their correlation with the study drug, severity, seriousness, and expectedness. This study is registered with EudraCT (2017-004930-27) and is now closed. 16 participants with persistent cutaneous sarcoidosis were enrolled in the study between Sept 3, 2019, and June 15, 2021. Six (37%) of 16 participants were men, ten (63%) were women, and 15 (94%) were White. The median age of participants was 54 years (IQR 48-58). 14 participants were randomly assigned in the topical phase and 2 entered the systemic treatment phase directly. Daily topical treatment did not improve cutaneous lesions (effect estimate -1·213 [95% CI -2·505 to 0·079], p=0·066). Systemic treatment targeting trough serum concentrations of 6 ng/mL resulted in clinical and histological improvement of skin lesions in seven (70%) of ten participants (median -7·0 [95% CI -16·5 to -3·0], p=0·018). Various morphologies of cutaneous sarcoidosis, including papular, nodular, plaque, scar, and tattoo-associated sarcoidosis, responded to systemic sirolimus therapy with a long-lasting effect for more than 1 year after treatment had been stopped. There were no serious adverse events and no deaths. Short-term treatment with systemic sirolimus might be an effective and safe treatment option for patients with persistent glucocorticoid-refractory sarcoidosis with a long-lasting disease-modulating effect. The effect of sirolimus in granulomatous inflammation should be investigated further in large, multi-centre, randomised clinical trials. Vienna Science and Technology Fund, Austrian Science Fund.

Perception of pharmacological equivalence of generics or biosimilars in healthcare professionals in Vienna

PurposeDue to constantly rising therapy costs, biosimilars and generic drugs have gained tremendous importance through recent decades. Nevertheless, the acceptance among healthcare workers regarding biosimilars and generic drugs in previously published international studies is considerably lower than the scientific data on equivalent safety and efficacy would suggest. The aim of this questionnaire-based survey was to determine the perception and knowledge regarding generic drugs and biosimilars by medical professionals from different healthcare facilities in Vienna, Austria.MethodsThe online questionnaire was sent to public and religious hospitals in Vienna, including the university hospital “Vienna General Hospital.” In addition, doctors’ offices were reached by sending out the questionnaire in the weekly news of the Vienna Medical Association.ResultsA total of 282 physicians and 311 graduated nurses took part in the study. 63% and 62% of the participants were convinced that generic respective biosimilar drugs were clinically equivalent to the original reference drug. On average, 1.6 out of 4 knowledge questions were answered correctly about generics, while only 0.87 out of 4 questions were answered accurately about biosimilars.ConclusionThe results of this study support the outcome from previous surveys demonstrating that a large proportion of healthcare professionals is still skeptical about generics and biosimilars. According to the results of this study, better education of the medical staff might ensure greater acceptance of these types of drugs.

Characteristics and outcome of critically ill patients with systemic rheumatic diseases referred to the intensive care unit

ObjectivesPatients with systemic rheumatic diseases (SRDs) are at risk of admission to the intensive care unit (ICU). Data concerning these critically ill patients are limited to few retrospective studies.MethodsThis is...

The association between acute otitis externa-related emergency department visits and extreme weather events in a temperate continental climate

BackgroundClimate change is a global challenge that is resulting in an increased occurrence of extreme weather events. Extreme weather events have been shown to negatively impact various health conditions, leading to an overall increase in morbidity and mortality. Ear, nose, and throat (ENT) emergencies are among the most common reasons for emergency department visits (EV). Acute otitis externa (AOE), an inflammatory external auditory canal skin infection, is the second most common condition for ENT-related emergency admissions. Previously, AOE has been associated with higher temperatures during summer; However, no data exists on extreme weather events’ immediate and delayed effects on AOE-related EVs. Identifying these relationships could help predict EVs, optimize health resources, and relieve its significant burden on healthcare systems. ObjectiveThis study aimed to associate the effects of extreme weather events with the immediate and delayed risk of AOE-related EVs. MethodsA total of 1522 AOE-related EVs from the ENT outpatient clinic of the Vienna General Hospital between 2015 and 2018 were analyzed. Meteorological data for the same study period was obtained from the Austrian Central Institution for Meteorology and Geodynamics for Vienna and a distributed lag non-linear model used to associate extreme weather events with the total number of AOE-related EVs. Relative risk (RR) and cumulative RR were analyzed over a period of 14 days. ResultsAOE-related EVs showed a pronounced seasonality, with the highest occurrence in summer. The RR for AOE-related EVs was significantly increased one day after high-temperature events for seven days, to a maximum of 1.95 [1.04–3.65]. Low and high relative humidity significantly reduced the same-day occurrence of AOE-related EVs to 0.65 [0.46–0.92] and 0.74 [0.58–0.95]. Increased precipitation and wind speed significantly decreased the RR of AOE-related EVs four and seven days after occurrence. After one day, low atmospheric pressure events showed an increased RR of 1.42 [1.02–1.98] in AOE-related EVs. ConclusionsExtreme weather events significantly impact AOE-related EVs. While high mean temperatures were positively correlated with AOE-related EVs, low humidity was found to have a negative same-day effect, supporting the idea of multiple factors being involved in increasing the susceptibility for AOE. Knowledge of the pattern of events could allow the implementation of time-optimized prevention strategies to reduce the incidence of AOE, the frequency of EVs, and the burden on health care systems.

Transversal psoas muscle thickness measurement is associated with response and survival in patients with HCC undergoing immunotherapy.

Sarcopenia is a common problem in patients with HCC. We aimed to evaluate the prognostic and predictive value of baseline transversal psoas muscle thickness (TPMT) measurement in patients with HCC undergoing immunotherapy. HCC patients treated with programmed death ligand 1-based therapies between June 2016 and October 2022 at the Vienna General Hospital (n = 80) and the Hôpital Beaujon Clichy (n = 96) were included and followed until April 2023. TPMT at the level of the third lumbar vertebra was measured independently by 2 radiologists to evaluate interreader reliability. TPMT <12mm/m in men and <8mm/m in women indicated sarcopenia. Overall, 176 patients (age: 66.3±11.7y; male: n=143, 81%, Barcelona-Clinic Liver Cancer C: n=121, 69%) were included, of which 131 (74%) exhibited cirrhosis. Interreader agreement for the diagnosis of sarcopenia based on TPMT was 92.6%, and Cohen κ showed a "strong agreement" [κ = 0.84 (95% CI: 0.75-0.92)]. Sarcopenia, present in 58 patients (33%), was associated with shorter median overall survival [7.2 (95% CI: 5.0-9.5) vs. 22.6 (95% CI: 16.4-28.8 months); p < 0.001] and median progression-free survival [3.4 (95% CI: 0.2-6.8) vs. 7.9 (95% CI: 5.8-9.9 months), p = 0.001], and an independent predictor of overall [adjusted HR: 1.63 (95% CI: 1.07-2.48)] and progression-free mortality [adjusted HR: 1.54 (95% CI: 1.06-2.23)] in multivariable analyses. The objective response rate [evaluable in 162 subjects (92.0%)] per modified Response Evaluation Criteria In Solid Tumors (mRECIST) in patients with and without sarcopenia was 22% and 39%, respectively (p = 0.029). Survival and radiological responses were worse in patients with sarcopenia and systemic inflammation [median overall survival: 6.1 (95% CI: 3.6-8.6)mo; median progression-free survival: 2.8 (95% CI: 2.1-3.4)mo; objective response rate=16%; disease control rate=39%]. Evaluation of sarcopenia using TPMT measurement is reliable and identifies HCC patients with a dismal prognosis and response to immunotherapy.

Clinical course of congestive hepatopathy pre/post heart transplantation.

Heart failure (HF) might lead to increased hepatic venous pressure, thereby impairing hepatic blood outflow and subsequently inducing congestive hepatopathy. We aimed to evaluate prevalence of congestive hepatopathy in patients undergoing heart transplantation (HTX) as well as their post-transplant course. Patients undergoing HTX from 2015-2020 at the Vienna General Hospital were included (n = 205). Congestive hepatopathy was defined by hepatic congestion on abdominal imaging and hepatic injury. Laboratory parameters, ascites severity, and clinical events were assessed and post-HTX outcomes evaluated. At listing, 104 (54%) patients showed hepatic congestion, 97 (47%) hepatic injury, and 50 (26%) had ascites. Congestive hepatopathy was diagnosed in 60 (29%) patients, who showed more often ascites, lower serum sodium and cholinesterase activity, and higher hepatic injury markers. Mean albumin-bilirubin (ALBI)-score as well as (modified)-model for end-stage liver disease (MELD)-scores were higher in patients with congestive hepatopathy. Median levels of laboratory parameters/scores normalised after HTX, and ascites resolved in most patients with congestive hepatopathy (n = 48/56, 86%). The post-HTX (median follow-up 55.1months) survival was 87% and liver-related events were rare (3%). Severe ascites, low cholinesterase, and MELD/MELD-XI were associated with ascites persistence/death 1‑year after HTX. Age, male sex, and severe ascites were the only independent predictors of post-HTX mortality. Both ALBI and MELD-scores were robust indicators of post-HTX survival when measured 4weeks after HTX (ALBI log-rank test p < 0.001; MELD log-rank test p = 0.012). Congestive hepatopathy and ascites were mostly reversible after HTX. Liver-related scores and ascites improve prognostication in patients after HTX.