Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Apr 2024
ReviewPerspectives in treatment-resistant depression: esketamine and electroconvulsive therapy.
Modern electroconvulsive therapy (ECT) and the approval of nasal esketamine for clinical use have significantly improved the approach to treatment-resistant depression (TRD), which is defined as non-response to at least two different courses of antidepressants with verified adherence to treatment, adequate dosage, and duration of treatment. The goal of this literature review is to present the newest evidence regarding efficacy and safety. Furthermore, we aim to provide an overview of future perspectives in this field of research, for example, regarding structural and molecular effects. ⋯ The decision-making process between esketamine nasal spray or ECT should include the assessment of contraindications, age, severity of disease, presence of psychotic symptoms, patient preference and treatment accessibility. We conclude that both treatment options are highly effective in TRD. If both are indicated, pragmatically esketamine will be chosen before ECT; however, ECT studies in ketamine non-responders are missing.
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Wien. Klin. Wochenschr. · Apr 2024
Impact of age on the transmission of SARS-CoV-2 in healthcare workers : Influence of nonoccupational risk factors.
The incidence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV‑2) infection was highest among older adults early in the COVID-19 pandemic; however, this pattern was later reversed with young adults showing the highest incidence. The aim of this study was to identify risk factors in healthcare workers (HCWs) associated with this evolution. ⋯ The youngest HCWs had the highest incidence rate of COVID-19, which was not explained by occupational risk factors or health conditions. The increase in nonoccupational exposure since the end of the lockdowns in summer 2020 could by a key factor.
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Wien. Klin. Wochenschr. · Apr 2024
Delayed diagnosis of a transient ischemic attack caused by ChatGPT.
Techniques of artificial intelligence (AI) are increasingly used in the treatment of patients, such as providing a diagnosis in radiological imaging, improving workflow by triaging patients or providing an expert opinion based on clinical symptoms; however, such AI techniques also hold intrinsic risks as AI algorithms may point in the wrong direction and constitute a black box without explaining the reason for the decision-making process. This article outlines a case where an erroneous ChatGPT diagnosis, relied upon by the patient to evaluate symptoms, led to a significant treatment delay and a potentially life-threatening situation. With this case, we would like to point out the typical risks posed by the widespread application of AI tools not intended for medical decision-making.
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Wien. Klin. Wochenschr. · Apr 2024
Development of a highly purified tick-borne encephalitis vaccine : A personal historical account.
Before the advent of a vaccine, infections with tick-borne encephalitis (TBE) virus in Austria led to the hospitalization of several hundred and, due to underreporting, possibly more than thousand patients with severe neurological disease every year. In the late 1960s and early 1970s, this country had the highest recorded morbidity of TBE in Europe, but similar endemic risk areas exist in many other European countries as well as Central and Eastern Asia. ⋯ Low reactogenicity of the newly developed vaccine was a prerequisite for mass vaccination campaigns in Austria that started in the early 1980s. Because of its excellent immunogenicity, broad application of the highly purified vaccine paved the way for a dramatic reduction of the incidence of TBE in Austria, which is outstanding in Europe and referred to as an Austrian success story of immunoprophylaxis.