The outbreak of COVID-19 — medical leadership challenge

The Corona Virus Disease 2019 (COVID-19) outbreak surprised humanity with its scale and speed. Starting in Wuhan, the capital city of Central China’s Hubei province, it rapidly spreads to East Asia, Iran, Europe and the United States of America [1]. So far, only a few countries on earth have not yet been affected by the pandemic. Dealing with an emerging new disease is particularly challenging and requires complex decision making and leadership, of both medical leaders and statesmen. Factors such as logistical and technological capabilities, medical staff training level, operational flexibility and leadership, will determine how well healthcare organizations (and nations) will cope with the challenge. In this paper, we present six major leadership dilemmas and possible solutions, in an attempt to provide tools that will assist in confronting such an extreme event

Agreement between Fetal Brain Ultrasonography and Magnetic Resonance Imaging in the Measurements of the Corpus Callosum and Transverse Cerebellar Diameter

As the use of magnetic resonance imaging of the fetal brain has evolved, the need to understand its efficiency in the biometry of the fetal brain has broadened. This study aimed to assess the level of agreement and correlation between the two cardinal imaging methods of fetal neuroimaging, ultrasonography (US) and magnetic resonance imaging (MRI), by measuring the corpus callosum (CC) and transverse cerebellar diameter (TCD) in terms of length and percentile. Measurements of CC and TCD length and percentile were documented over a 7-year span in a tertiary referral medical center. All US and MRI examinations were performed in the customary planes and subcategorized by valid reference charts. Exclusion and inclusion criteria were set before the collection and processing of the data. A total of 156 fetuses out of 483 were included in the study. A positive, strong correlation and agreement were found (r = 0.78; ICC = 0.76) between US and MRI in TCD measurements. For CC length measurement, a moderate correlation and moderate agreement (r = 0.51; ICC = 0.49) between US and MRI was observed. TCD and CC percentiles had lower levels of correlation and agreement compared with the length variables. Our study indicates good agreement between MRI and US in the assessment of TCD measurement as a part of antenatal neuroimaging. Furthermore, while the two techniques are not always compatible, they are complementary methods

Personalized charts for the fetal corpus callosum length

<p><b>Objective:</b> To personally customize the antenatal ultrasound charts for the fetal corpus callosum (CC) length.</p> <p><b>Methods:</b> 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).</p> <p><b>Results:</b> 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 (<i>R</i>² = 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% (<i>p</i> < .001). Conversely, applying these charts to the abnormal group nonsignificantly decreased the number of measurement defined as normal from 89 to 83.2% (<i>p</i> = .137)</p> <p><b>Conclusions:</b> 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.</p