Prediction of pregnancy outcome by combined analysis of the fetal electrocardiogram and systolic time intervals.

A microcomputer-based system has been developed that continuously analyzes the fetal electrocardiogram (ECG) and Doppler cardiogram during labor by noninvasive means. Three systolic time intervals (preejection period [PEP], ventricular ejection time [VET], and isovolumetric contraction time), and four ECG parameters (P-R interval, QRS wave duration, T/QRS amplitude ratio, and S-T slope) are simultaneously measured and displayed. Normal values were derived from 126 uncomplicated pregnancies at term. A second group of 89 cases showing fetal heart rate patterns suggestive of fetal distress were subsequently studied: 64 had a good outcome (umbilical artery pH 7.20 or higher and a 5-minute Apgar score 7 or greater) and 25 were asphyxiated. Results were retrospectively analyzed. All asphyxiated fetuses had preejection period, PEP to VET ratio and T to QRS ratio values of more than 1 SD above the mean for the normal population. The PEP to VET ratio, which is an indicator of myocardial function independent of heart rate, proved to be the most sensitive predictor of fetal asphyxia. We conclude that analysis of systolic time intervals and ECG parameters of the fetal heart during labor improves the diagnostic accuracy of fetal heart rate monitoring.     

Neu-Laxova syndrome: Prenatal ultrasonographic diagnosis,clinical and pathological studies,and new manifestations

A diagnosis of the Neu-Laxova syndrome (NLS) was made by ultrasonography at 32 wks of gestation. Ultrasonographic examination showed intrauterine growth retardation (IUGR), Dandy-Walker anomaly, choroid plexus cysts, receding forehead and microcephaly, bilateral cataract without prominent eyes, scalp edema with no generalized edema, retrognathia, curved penis, and flexion deformities of limbs. The findings in this case are consistent with NLS; however, they did not fit any of Curry's [1982] groups. Massive swelling of hands and feet were among the main manifestations in classic NLS cases. In the case presented herein, edema was noted only in the scalp. This might shed further light on the question of variability vs. heterogeneity in the NLS. This case shows the existing possibility of an early diagnosis of NLS and adds Dandy-Walker anomaly and choroid plexus cysts as new findings to this syndrome. © 1992 Wiley-Liss, Inc.     

Paracentric inversion of Xq and ovarian dysfunction

We report on a paracentric inversion X(q13 q24) in a 20-year-old woman with ovarian dysfunction. The findings add evidence on the role of breakpoints in Xq13 and Xq24 in causing ovarian dysfunction. A review of the published data on paracentric inversion of chromosome X is included.     

Thirty-Day Post-Discharge Outcomes Following COVID-19 Infection

BackgroundThe clinical course of COVID-19 includes multiple disease phases. Data describing post-hospital discharge outcomes may provide insight into disease course. Studies describing post-hospitalization outcomes of adults following COVID-19 infection are limited to electronic medical record review, which may underestimate the incidence of outcomes.ObjectiveTo determine 30-day post-hospitalization outcomes following COVID-19 infection.DesignRetrospective cohort studySettingQuaternary referral hospital and community hospital in New York City.ParticipantsCOVID-19 infected patients discharged alive from the emergency department (ED) or hospital between March 3 and May 15, 2020.MeasurementOutcomes included return to an ED, re-hospitalization, and mortality within 30 days of hospital discharge.ResultsThirty-day follow-up data were successfully collected on 94.6% of eligible patients. Among 1344 patients, 16.5% returned to an ED, 9.8% were re-hospitalized, and 2.4% died. Among patients who returned to the ED, 50.0% (108/216) went to a different hospital from the hospital of the index presentation, and 61.1% (132/216) of those who returned were re-hospitalized. In Cox models adjusted for variables selected using the lasso method, age (HR 1.01 per year [95% CI 1.00–1.02]), diabetes (1.54 [1.06–2.23]), and the need for inpatient dialysis (3.78 [2.23–6.43]) during the index presentation were independently associated with a higher re-hospitalization rate. Older age (HR 1.08 [1.05–1.11]) and Asian race (2.89 [1.27–6.61]) were significantly associated with mortality.ConclusionsAmong patients discharged alive following their index presentation for COVID-19, risk for returning to a hospital within 30 days of discharge was substantial. These patients merit close post-discharge follow-up to optimize outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-06924-0.KEY WORDS: COVID-19, mortality, re-admission, discharge     

Reverse LISS plating for intertrochanteric Hip Fractures in elderly patients

Background  

Fractures of the intertrochanteric hip are common and the treatment of unstable fractures generally requires an operative approach. In elderly patients, osteoporosis makes internal fixation problematic and frequently contributes to failed fixation and poor clinical results. We have attempted to apply the Less Invasive Stabilization System (LISS) in reverse position for the repair of intertrochanteric hip fractures in elderly patients with osteoporotic bones. A retrospective review is presented of the cases of 28 elderly patients with stable and unstable fractures of the intertrochanteric hip treated using the reverse LISS.     

Perception/production relationships in the development of the vowel duration cue to final consonant voicing

The purposes of this study were to assess: (a) the development of identification in children for the vowel duration cue to final consonant voicing and (b) the perception/production relationships in children for the vowel duration cue to final consonant voicing. Subjects were 30 children divided equally into three age groups, and 10 adults. Productions consisted of 15 repetitions of two target syllables (beet, bead) analyzed acoustically for vowel duration. From these were calculated category boundary, category separation, and variability in production for each subject. Perceptual data were collected using a synthesized speech continuum that varied vowel duration. Identification responses were used to calculate category boundary, category separation (slope/boundary width) and variability (response consistency) for each subject. Mean percentage correct discrimination was derived by using two-step and three-step two-pair same-different paradigms. The results were as follows: (a) category boundary and category separation in production were adult-like by 8 years of age, (b) variability in production was not adult-like by 10 years of age, (c) perception categorization (category boundary and category separation) was adult-like at 5 years of age, (d) perceptual consistency was not adult-like until 10 years of age, (e) percentage correct discrimination was not adult-like by 10 years of age, (f) correlations between comparable perception and production measures were nonsignificant, and (g) a pairwise comparisons analysis indicated that perception was consistently more advanced than production.     

Brainstem auditory evoked potential with increased stimulus rate in minor head trauma

Fifteen Minor Head Trauma patients were investigated by Brainstem Auditory Evoked Potentials at 10/s and 55/s stimulus rate. The results were compared with those of the same patients at a second examination, two months later, as well as with a matched normal control group. Increasing the stimulus rate in MHT patients caused a significant but reversible delay in the central conduction time. No significant difference was found regarding the interpeak latency differences at a 10/s stimulus rate. The present study suggests that the primary lesion in MHT is ischaemic, affecting synaptic efficiency, and not axonal damage. These findings may be informative on the as yet obscure pathophysiological mechanism of minor head trauma.     

Effect of irrigation or intravenous antibiotic prophylaxis on infectious morbidity at cesarean section

The efficacy of intraoperative irrigation with cefamandole nafate at cesarean section was evaluated in a prospective, randomized double-blind study. Two hundred and eight patients were treated with antibiotic irrigation and intravenous placebo or with perioperative intravenous cefamandole and irrigated with normal saline. The rate of endometritis was 10.9% in the irrigation group and 14% in the intravenous group, but the difference was not statistically significant. The rate of any infection, the number of days with fever, additional hospitalization days, and number of antibiotics used for treatment were similar in the two groups. It thus was concluded that irrigation with antibiotic is equal but not superior to perioperative intravenous antibiotics.     

Skeletal maturation during thyroxine treatment in children with congenital hypothyroidism

Heyerdahl S, Kase BF, Stake G. Skeletal maturation during thyroxine treatment in children with congenital hypothyroidism. Acta Prediatr 1994;83:618–22. Stockholm. ISSN 0803–5253
The aim of this investigation was to study if bone age development (assessed by the Greulich & Pyle atlas) was related to L-thyroxine treatment in 47 children with congenital hypothyroidism, treated early and according to general recommendations. In spite of frequent delay in skeletal maturation at diagnosis, the delay in mean bone age at a mean chronological age of 1.5 years was slight (0.5 months), and 30% of the variation in bone age SD score (SDS) at 1.5 years was accounted for by the dose of L-thyroxine and serum thyroxine during the first year. The children with a bone age within ± 1 SDS had a prescribed mean dose of L-thyroxine per kg body weight from 3 to 12 months of age of 5.4 ± 1.7 pg/kg/day, and their mean serum thyroxine concentration during the first year was 175 ± 29 nmol/l. We conclude that bone age at 1.5 years of age was positively correlated with the dose of L-thyroxine and the serum thyroxine concentration during the first year. This supports the general use of bone age assessments as a complement to other treatment variables in the follow-up of children with congenital hypothyroidism.