Use of the Free Thyroxine Index to Refine the Lower Limit of a Free Thyroxine Immunoassay for Detection of Secondary Hypothyroidism

ObjectiveTo determine the utility of measuring free T₄ index (FT₄I) in patients with low free T₄ (FT₄) levels using immunoassay and normal thyroid-stimulating hormone for the evaluation of secondary hypothyroidism.MethodsWe performed a retrospective medical chart review of patients seen at a single institution as outpatients who had a simultaneously normal thyroid-stimulating hormone level, low FT₄ level, and any FT₄I measured between June 2014 and October 2016. Demographic, laboratory, and imaging data were collected. Using FT₄I as the reference for diagnosis of hypothyroidism, the sensitivity and specificity of the FT₄ immunoassay’s lower-limit thresholds were determined. Within each threshold group, available brain imaging and biochemical evaluation were categorized according to the presence or absence of pituitary disease.ResultsA total of 155 sets of result pairs (FT₄ and FT₄I) performed on 118 subjects were analyzed. The lower limit of a normal FT₄ level by immunoassay at this institution was 0.93 ng/dL, though all pairs with FT₄ ≥0.89 ng/dL had a normal FT₄I. All pairs with FT₄ ≤0.67 ng/dL had a low FT₄I. No pituitary macroadenomas were identified in any subject, though the rates of pituitary imaging in this patient sample were low.ConclusionPatients with a borderline low FT₄ level by immunoassay often have normal FT₄I. In such patients at our center, significant structural and biochemical pituitary pathology was uncommon.     

Is the interspecific variation of body size of land snails correlated with rainfall in Israel and Palestine?

The hypothesis that body size of land snail species increases with aridity in Israel and Palestine because large snails lose relatively less water due to their lower surface to volume ratio has been investigated. Data on rainfall amplitudes of 84 land snail species in Israel and Palestine and on their body sizes were used to test for interspecific correlations between body size and rainfall. Four methods, means of body sizes in rainfall categories, the midpoint method, the across-species method, and a phylogenetically controlled analysis (CAIC) showed that there is no significant correlation between body size of land snail species and their rainfall amplitude in Israel and Palestine. The lack of an interspecific correlation between body size and rainfall amplitude may be the result of conflicting selective forces on body size.     

RECLAIMING THE PATIENT'S VOICE AND SPIRIT IN DYING: AN INSIGHT FROM ISRAEL

In the latter half of the 20th century, Western medicine moved death from the home to the hospital. As a result, the process of dying seems to have lost its spiritual dimension, and become a matter of prolonging material life by means of medical technology. The novel quandaries that arose led in turn to medico‐legal regulation. This paper describes the recent regulation of dying in Israel under its Dying Patient Law, 2005. The Law recognizes advance directives in principle, but limits their effect and form through complex medico‐legal artifices. It reflects a culture that places high value on both scientific medicine and the sanctity of life as such, and illustrates a medical culture that pitches battle against death. At the same time, the Law constructs the will of the individual in a medico‐legal language that is alien to the lay person. The paper suggests an alternative approach to advance care planning that is patient‐centred and addresses the psycho‐social needs of the individual in terms of her relational autonomy. From this perspective, advance care planning becomes an opportunity to extract the patient from the medical context and allow her to speak about her approaching death with close ones in her own terms of reference. To this end, there is a need for facilitation of an intimate encounter where patients can speak about their concerns with their loved ones. The paper also presents a methodological approach of attentive listening, which can be applied across diverse cultures and circumstances.     

Base-line susceptibility of Phlebotomus papatasi to insecticides

Susceptibility of the leishmaniasis vector sandfly Phlebotomus papatasi (Scopoli) to three insecticides was assessed on a colony originating in the Jordan Valley, Israel. Results are considered to show susceptibility to DDT and permethrin. The results for methoxychlor indicated the possibility of heterogeneity in the population and tolerance towards this compound.     

The cyclopid (Crustacea,Copepoda) fauna of the inland waters of Israel

Four species of the genusMesocyclops (Cyclopoida: Cyclopidae) are reported from Israel:Mesocyclops kieferi Van de Velde, 1984,Mesocyclops aequatorialis similis Van de Velde, 1984,Mesocyclops ogunnus Onabamiro, 1957 andMesocyclops arcanus n.sp. The new species, close toM. kieferi, is described and some remarks are given for the other species.