Whole-exome sequencing (WES) is an effective approach to identify the susceptibility of genetic variants of autism spectrum disorder (ASD). The Israel Ministry of Health supports WES as an adjunct tool for ASD diagnosis, despite its unclear diagnostic yield and cost effectiveness. To address this knowledge gap, we applied WES to a population-based sample of 182 Bedouin and Jewish children with ASD from southern Israel, and assessed its yield in a gene panel of 205 genes robustly associated with ASD. We then compared the incremental cost-effectiveness ratios (ICERs) for an ASD diagnosis by WES, chromosomal microarray analysis (CMA), and CMA + WES. Overall, 32 ASD candidate variants were detected in 28 children, corresponding to an overall WES diagnostic yield of 15.4%. Interestingly, the diagnostic yield was significantly higher for the Bedouin children than for the Jewish children, i.e., 27.6% vs. 11.1% (p = 0.036). The most cost-effective means for genetic testing was the CMA alone, followed closely by the CMA + WES strategy (ICER = USD 117 and USD 124.8 per child). Yet, WES alone could become more cost effective than the other two approaches if there was to be a 25% increase in its yield or a 50% decrease in its cost. These findings suggest that WES should be recommended to facilitate ASD diagnosis in Israel, especially for highly consanguineous populations, such as the Bedouin.

Accurate office blood pressure (BP) measurement remains crucial in diagnosing and managing hypertension. In this study, we aimed to compare BP measurements done over a bare arm versus a sleeved arm, while controlling all other possible sources of variance. We collected BP measurements of 100 hypertensive patients visiting a nephrology and hypertension clinic between January 2019 and December 2023. Measurements were taken by a single operator and according to the updated guidelines. BP measurements were performed first with one arm bare, and the other arm sleeved, with measurements taken simultaneously. Then, measurements were again taken simultaneously after exposing the arm which was first sleeved, and dressing the arm which was bare at first. A nonparametric Wilcoxon test was performed to compare each patient's measurements on each arm. No statistically significant differences were found between the sleeved and the bare arm measurements, with one exception of SBP measured on the left arm (slightly lower SBP on the bare arm). While looking at the absolute value of differences, the median difference was impressive with a 7-8 mmHg systolic difference and 5.5 mmHg diastolic difference. Our study revealed a robust and unpredicted effect of clothing on BP; in some patients, BP was increased while in others decreased. Therefore, we believe there is importance in measuring BP on bare skin, regardless of clothing or sleeve type.

Objective: Studies have reported intradialytic hypertension and inadequate antihypertension drugs in hemodialysis patients. Garlic and its components like Allicin have biological activities in lowering blood pressure by induction of endothelin nitric oxide synthase (eNOS) to hydrogen sulfide (H2S), which leads to calcium channel closure and relaxation, which leads to vasodilation of vessels. This study aims to analyze the effect of garlic extract supplementation on lowering blood pressure in chronic hemodialysis patients at

Objective: The question of blood pressure measuring on the bare arm was debated for many years. The updated guidelines recommend measuring on the bare arm, although former studies found no significant differences between measurements taken over a rolled-down or up sleeve compared to the bare arm. We aim to compare blood pressure measurements on the same patients over a bare and a sleeved arm. Design and method: We collected blood pressure measurements of 100 patients visiting the nephrology clinic between January 2019 and December 2022. Measurements were performed with and without sleeves on each arm for each patient (total of 400 arms) and taken simultaneously on both arms (exchanging the bare and the sleeved arm in the second measurement). Since most variables were not normally distributed, we proceeded to a non-parametric Wilcoxon test to compare each patient's measurements on each arm. Results: No statistically significant differences were found between the sleeved and the bare arm measurements, with one exception of systolic blood pressure measured on the left arm (p = 0.041). Although the actual values demonstrated no statistically significant difference, the absolute values of the differences demonstrated clinically significant higher median values on the sleeved arms, both in systolic blood pressure (7 mmHg on the right arm and 8 mmHg on the left arm) and diastolic blood pressure (5.5 mmHg for both arms). As demonstrated by the wide interquartile ranges in table 1 and seen in figure 1 for all variables, the values of all variables had high variance. Conclusions: We found no statistically significant difference in blood pressure measurements between sleeved and bare arms. However, measurement of blood pressure over sleeved arms provided unpredictable results, with up to 40-50 mmHg differences in some individuals. As clinicians, we believe that in order to standardize blood pressure measurements we should measure blood pressure on the bare arms.