Personalized charts for the fetal corpus callosum length

Abstract

Objective: To personally customize the antenatal ultrasound charts for the fetal corpus callosum (CC) length.

Methods: A retrospective analysis of fetal neuro-sonography scans. Cases were grouped as normal neuro-sonographic evaluation (normal) or as high risk and suspected brain anomaly (abnormal). The normal group was subcategorized according to Cignini’s CC length charts. Data of fetuses with a CC length between the 5th–95th percentile served for creating new charts, describing the ratio of the CC length to the major biometric parameters as a function of gestational age (GA).

Results: A total of 410 measurements were included. Of them 255 were normal and 155 abnormal. The CC length/estimated fetal weight (EFW) ratio had the strongest linear association with GA (R²?=?0.929). Applying charts using this ratio to the normal group, significantly increased the percent of CC length measurements defined as normal from 84.7 to 94.5% (p?<?.001). Conversely, applying these charts to the abnormal group nonsignificantly decreased the number of measurement defined as normal from 89 to 83.2% (p?=?.137)

Conclusions: The CC length/EFW ratio is strongly and linearly associated with GA. Using this personalized ratio may improve the diagnostic accuracy of CC evaluation by adjusting the CC length to the fetus natural proportions.     

Effect of different dress style on vitamin D level in healthy young Orthodox and ultra-Orthodox students in Israel

Summary  

Ultra-orthodox Jewish lifestyle, which encourages modest dress and indoor scholarly activity, represents a risk factor for vitamin-D deficiency. Our study in healthy young males from higher education religious institutions located in the same geographical area showed frequent and severe vitamin D deficiency, strongly correlated with the degree of sun exposure. However, PTH level was usually normal.     

Medical expertise as a critical influencing factor on the length of stay in the ED: A retrospective cohort study

Overcrowding in the emergency departments (ED) is a significant issue associated with increased morbidity and mortality rates as well as decreased patient satisfaction. Length of stay (LOS) is both a cause and a result of overcrowding. In Israel, as there are few emergency medicine (EM) physicians, the ED team is supplemented with doctors from specialties including internal medicine, general surgery, orthopedics etc. Here we compare ED length of stay (ED-LOS), treatment time and decision time between EM physicians, internists and general surgeons.A retrospective cohort study was conducted examining the Emergency Department length of stay (ED-LOS) for all adult patients attending Sheba Medical Center ED, Israel, between January 1st, and December 31st, 2014. Using electronic medical records, data was gathered on patient age, sex, primary ED physician, diagnosis, eventual disposition, treatment time and disposition decision time. The primary outcome variable was ED-LOS relative to case physician specialty and level (ED, internal medicine or surgery; specialist or resident). Secondary analysis was conducted on time to treatment/ decision as well as ED-LOS relative to patient classification variables (internal medicine vs surgical diagnosis). Specialists were compared to specialists and residents to residents for all outcomes.Residents and specialists in either EM, internal medicine or general surgery attended 57,486 (51.50%) of 111,630 visits to Sheba Hospital''s general ED. Mean ED-LOS was 4.12 ± 3.18 hours. Mean treatment time and decision time were 1.79 ± 1.82 hours, 2.84 ± 2.17 hours respectively. Amongst specialists, ED-LOS was shorter for EM physicians than for internal medicine physicians (mean difference 0.28 hours, 95% CI 0.14–0.43) and general surgeons (mean difference 0.63 hours, 95% CI 0.43–0.83). There was no statistical significance between residents when comparing outcomes.Increasing the number of EM specialists in the ED may support efforts to decrease ED-LOS, overcrowding and medical errors whilst increasing patient satisfaction and outcomes.     

Exhausting fatigue influences F-wave and peripheral conduction velocity,following lumbar radiculopathy

Purpose : The purpose of the study was to determine whether mechanical nerve root compression could indirectly contribute to early muscle fatigue because of impaired activation. Method : The patients' two legs and the control group's dominant leg were subjected to exhausting foot dorsiflexion against 2 kg weight. Electrophysiological parameters were measured under three conditions: before, upon completion of, and five minutes after the exhausting effort (i.e. causing unbearable fatigue). The study was performed in a warm room (24°C), in the EMG laboratory of a rehabilitation centre using standard equipment. Eighteen patients participated in the study (12 males and six females, mean age 47.8 &#45 12.0 years). They suffered from lumbar radiculopathy and unilateral complaints at the L4, L5 innervation territory. There were 22 matched controls (18 males and 4 females, mean age 44.4 &#45 9.9 years) that were healthy subjects. The patients' two legs and the dominant leg of the control participants were tested. The peroneal nerve was stimulated supra-maximally, behind the fibular head. Recording the activity of the anterior tibial muscle served to calculate F-wave latency, the conduction velocity of the nerve and muscle complex (NMCV), the compound muscle action potential (CMAP) amplitude and the exhaustion time. Results : Following the exhausting fatigue, the symptomatic, asymptomatic, and control legs exhibited a significant decrease in NMCV and reduced CMAP amplitude ( p < 0.05). In each condition (rest, effort, recovery), the patients' two leg types exhibited similar NMCV (symptomatic vs asymptomatic), yet each of these two types was significantly slower than the controls' NMCV. A significant prolongation of F-wave latency after an exhausting effort was found in the symptomatic legs. Conclusions : Our results suggest that a continuous exhausting effort impairs F-wave latency and NMCV, presumably by decreasing the proportion of fast conducting nerve fibres. Peroneal nerve root compression can contribute to early fatigue of the respective muscles.