Higher Resistance Index Research Articles

Thyroid hemodynamic alterations in Egyptian patients with sickle cell disease: relation to disease severity, total body iron and thyroid function.

ABSTRACTBackground: Intraparenchymal thyroid Doppler measurements might be considered a useful index of the thyroid status as well as micro-circulation elsewhere in the body among sickle cell disease (SCD) patients. The authors aim to evaluate the intra-thyroidal hemodynamic changes and thyroidal volume in SCD patients and its relation to the disease severity, and thyroid functions tests as well as iron overload state.Methods: Sixty SCD patients, randomly recruited from the regular attendants of the Pediatric Hematology Clinic, Ain Shams University, Cairo, Egypt, were studied focusing on the disease duration, the transfusion history, the recorded Hydroxyurea, and chelation therapies and the vaso-occlusive crises history. Thyroid Doppler ultrasonography [Thyroid volume, Resistance index (RI) and pulsatility index (PI)] was performed and liver & cardiac MRI were assessed.Results: Thirteen (21.7%) of the SCD patients had hypothyroidism by thyroid function tests. SCD patients had significantly higher RI and PI values and a lower thyroid volume compared to the control group. No significant correlations were found between the thyroid functions tests and the thyroid Doppler parameters; a negative correlation of the disease duration to the thyroid volume and a positive one to RI & PI values were found. The mean serum ferritin did not significantly correlate to the thyroid Doppler indices nor did Liver and cardiac MRI results.Conclusion: The authors demonstrated an increased intra-thyroidal RI & PI and a decreased thyroid volume among SCD patients which might be related to impaired thyroidal microcirculation and vasculopathy rather than iron overload.

Renal Parenchymal Thickness in Patients with Systemic Sclerosis Is Related to Intrarenal Hemodynamic Variables and Raynaud Renal Phenomenon.

Renal involvement in systemic sclerosis (SSc) ranges from urinary abnormalities, reduction of glomerular filtration rate, and high renal resistive index, to scleroderma renal crisis. Intrarenal resistance indices are considered markers of renal SSc-associated vasculopathy. The aim of this study is to evaluate renal morphological variables, such as renal length, parenchymal thickness, atrophy index, and renal sinus in patients with SSc and to correlate it with renal function and hemodynamic variables. There were 92 patients with SSc and 40 healthy controls (HC) enrolled in this study. Doppler and renal ultrasound (US) including renal length, parenchymal thickness, atrophy index, renal sinus, and intrarenal resistive index were measured in patients with SSc and HC. Renal US showed significant differences between HC and patients with SSc. The renal length (mm; 106.7 ± 5.1 vs 102.3 ± 8.4) and renal sinus (70.7 ± 7.9 vs 65.3 ± 7.7 mm) were significantly (p = 0.001) higher in HC than patients with SSc. The parenchymal thickness was significantly (p = 0.004) higher in HC than patients with SSc (18 ± 3.1 vs 16.3 ± 2.5 mm). Pulsatility index, resistive index, and systolic/diastolic ratio were significantly (p < 0.0001) lower in HC than patients with SSc. The renal length was significantly (p = 0.004) higher in diffuse cutaneous SSc (105 ± 8.4) than in limited cutaneous SSc (99.5 ± 7.5). In SSc, kidney involvement is subclinical and is related to vascular injury, Raynaud phenomenon, and chronic hypoxia that can modify renal morphology. Serum creatinine is a poor marker of renal damage, and renal US could be a useful tool - together with Doppler - to evaluate renal involvement in a systemic and chronic disease such as SSc.

The value of contrast-enhanced ultrasonography to detect the sacroiliac joint for predicting relapse after discontinuation of anti-tumor necrosis factor therapy in patients with ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by high relapse. Therefore, the present study aimed to investigate the ultrasonographic features of contrast-enhanced ultrasonography (CEUS) in the sacroiliac joint (SIJ) in patients with AS in remission after discontinuation of anti-tumor necrosis factor (TNF) therapy, and also examined the role of CEUS in predicting relapse. In this prospective observational study, 130 SIJs in 65 patients with AS (according to modified New York criteria) satisfying Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease after discontinuation of anti-TNF therapy were investigated on color Doppler ultrasonography (CDUS) and CEUS. Vascularization and the resistive index (RI) of the SIJ were observed and measured. We defined no blood flow, high RI of arterial blood flow (RI ≥0.7), the reversed phase in the diastolic phase or venous blood flow in the bilateral SIJs, as negative CDUS/CEUS; meanwhile, low RI of arterial blood flow (RI <0.7) in the unilateral or bilateral SIJs was defined as positive CDUS/CEUS. All the patients were followed up for 52 weeks until relapse. Relapse was defined as an increase of two or more items in comparison with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) at the time of anti-TNF withdrawal. After 52 weeks, 46 of the 65 patients (70.8%) had relapse. The mean time to relapse was 31.4 weeks (±8.4 weeks, range 20 to 52). After discontinuation of anti-TNF therapy, positive CEUS accounted for 61.5%; this was significantly more than positive CDUS (13.8%). The vascularization detected by CEUS for patients of relapse was significantly different from that of patients with remission (P<0.05). In addition, patients with negative CEUS had a longer duration of remission than the patients with positive CEUS (P=0.005). A Cox proportional hazards regression analysis found that the disease duration could also be regarded as a factor predictive of relapse in patients with AS. The use of CEUS distinctly improved the detection of vascularization in the SIJ in patients with AS in remission after anti-TNF withdrawal. The presence of vascularization in the SIJ detected by CEUS at the time of anti-TNF withdrawal could yield a valuable predictor of relapse in patients with AS. A significant limit of this study is the lack of magnetic resonance imaging (MRI) as the standard reference.

The association between renal resistive index and premature mortality after kidney transplantation is modified by pre-transplant diabetes status: a cohort study.

Renal resistive index (RI) predicts mortality in renal transplant recipients, but we do not know whether this is true in diabetic patients. The objective of this study was to analyse the long-term predictive value of RI for death with a functioning graft (DWFG) in renal transplant recipients with or without pre-transplant diabetes. We conducted a retrospective study in 1800 renal transplant recipients between 1985 and 2017 who were followed for up to 30 years (total observation period: 14 202 patient years). Donor and recipient characteristics at time of transplantation and at 3 months were reviewed. The long-term predictive value of RI for DWFG and the age-RI and arterial pressure-RI relationships were assessed. A total of 284/1800 (15.7%) patients had diabetes mellitus before transplantation. RI was <0.75 in 1327/1800 patients (73.7%). High RI was associated with a higher risk of DWFG in non-diabetic patients [hazard ratio (HR) = 3.39, 95% confidence interval 2.50-4.61; P < 0.001], but not in patients with pre-transplant diabetes (HR = 1.25, 0.70-2.19; P = 0.39), even after multiple adjustments. There was no interaction between diabetes and age. In contrast, there was an interaction between RI and pulse pressure. Our study indicates that RI is not a predictor of DWFG in diabetic renal transplant recipients, in contrast to non-diabetic recipients. These findings could be due to a different age-RI or pulse pressure-RI relationship.

Dual Drugs Anticancer Nanoformulation using Graphene Oxide-PEG as Nanocarrier for Protocatechuic Acid and Chlorogenic Acid.

The chemotherapy of cancer has been complicated by poor bioavailability, adverse side effects, high dose requirement, drug resistance and low therapeutic indices. Cancer cells have different ways to inhibit the chemotherapeutic drugs, use of dual/multiple anticancer agents may be achieve better therapeutic effects in particular for drug resistant tumors. Designing a biocompatible delivery system, dual or multiple drugs could addressing these chemotherapy drawbacks and it is the focus of many current biomedical research. In the present study, graphene oxide-polyethylene glycol (GOPEG) nanocarrier is designed and loaded with two anticancer drugs; Protocatechuic acid (PCA) and Chlorogenic acid (CA). The designed anticancer nanocomposite was further coated with folic acid to target the cancer cells, as their surface membranes are overexpressed with folate receptors. The particle size distribution of the designed nanocomposite was found to be narrow, 9-40nm. The release profiles of the loaded drugs; PCA and CA was conducted in human body simulated PBS solutions of pH7.4 (blood pH) and pH4.8 (intracellular lysosomal pH). Anticancer properties were evaluated against cancerous cells i.e. liver cancer, HEPG2 and human colon cancer, HT-29 cells. The cytocompatbility was assessed on normal 3T3 fibroblasts cells. The size of the final designed anticancer nanocomposite formulation, GOPEG-PCACA-FA was found to be distributed at 9-40 nm with a median of 8 nm. The in vitro release of the drugs PCA and CA was found to be of sustained manner which took more than 100h for the release. Furthermore, the designed formulation was biocompatible with normal 3T3 cells and showed strong anticancer activity against liver and colon cancer cells.

Adipocytokines in Non-functional Adrenal Incidentalomas and Relation with Insulin Resistance Parameters.

Adrenal incidentalomas are diagnosed incidentally during radiological screenings and require endocrinological investigations for hormonal activity and malignancy. In certain studies, it has been reported that non-functional incidentalomas can be associated with high adipocytokines levels affecting the insulin resistance just like the adipose tissue with metabolic syndrome. Here, we studied serum adipocytokine levels including leptin, resistin, visfatin, omentin 1 and adiponectin in subjects with non-functional adrenal incidentaloma. Seventy-seven (77) patients (Female 57; Male 20) with non-functional adrenal incidentaloma (NFAI) were enrolled in the study. All patients' past medical history, physical examination including Body Mass Index (BMI) and waist circumference were performed. The patients' demographic, radiologic, hormonal and biochemical parameters were recorded. To compare the parameters, a control group (CG) (n=30) was formed from healthy volunteers. Both groups were matched for age, gender, waist circumference and BMI. Serum adipocytokines including leptin, resistin, visfatin, omentin 1 and adiponectin were measured quantitatively by ELISA. Fasting plasma glucose, insulin, sodium, potassium, cortisol, adrenocorticotropic hormone (ACTH), lipid profiles, and dehidroepiandrostenedion sulphate (DHEAS) were measured. Mean age of the patients was 52.2±10.4 years. BMI and waist circumference of NFAI patients were 26.2±3.28 kg/m2 and 90.2 ±7.5cm, respectively. The mean age of the control group was 48.0±8.16. BMI and waist circumference values for the control group were 25.3±3.5 kg/m2 and 88.3±9.6 cm, respectively. When both groups were compared for age, gender, BMI and waist circumference were non-significant (p>0.05). Serum fasting insulin, total cholesterol, LDL, triglyceride levels of the NFAI group were significantly higher than CG (p<0.05). The insulin resistance index (HOMAIR) values of the NFAI subjects were found to be higher than CG (2.5±1.37, 1.1±0.3 p=0.00). Resistin level of NFAI group was also found to be higher than CG [286.6 ng/L vs. 197 ng/L; (P=0,00)], respectively. Leptin levels of NFAI were significantly higher than CG [441.1 ng/mL vs. 186.5 ng/mL; (P=0.00)] respectively. Adiponectin levels were significantly reduced in the NFAI group than in the CG [10.7 mg/L vs. 30.8 mg/L; (P=0.00)]. Comparision of visfatin and omentin levels was nonsignificant. In this study on subjects with non-functional adrenal incidentaloma, we found not only significantly decreased serum adiponectin levels but also increased leptin, resistin levels as well as dyslipidemia, hypertension and high insulin resistance index. All of which could affect insulin resistance and cardiovascular risk factors. The underlying mechanisms of these findings are unknown, hence further studies are needed.

KIDNEY HISTOLOGICAL CHANGES IN HEPATORENAL SYNDROME AGAINST A BACKGROUND OF THE ALCOHOLIC LIVER CIRRHOSIS

Objective. Assessment of the significance of histological changes in the kidneys at hepatorenal syndrome and their correlation with clinical and laboratory data in this pathology.Material and methods. To achieve this goal, 152 patients were examined using clinical, laboratory and instrumental methods. We estimated glomerular filtration rate, the dopplerographic index of vascular resistance in the renal arteries, as well as the indices of histological damage at autopsy of the kidneys — glomerulosclerosis, arteiolosclerosis, and tubulo-interstitial kidney damage.Results. Evaluation of only clinical or non-invasive markers showed that high vascular resistance index, high systolic blood pressure, high urinary protein level and low glomerular filtration are the independent risk factors for the progression of renal dysfunction. The vascular resistance index grew in proportion to the increase of creatinine level. It inversely correlated with kidney function and directly correlated with histological lesion scores, among which the strongest correlation was with the tubulo-interstitial lesions. Interstitial fibrosis with tubular atrophy and capillary loss are the common manifestations of kidney damage, and tubulo-interstitial lesion is a histological parameter that correlates best of all with kidney function.Conclusions. Among the histological changes in kidneys at hepatorenal syndrome against a background of alcoholic liver cirrhosis, tubulointerstitial lesions are most often found, and closely correlate with the Doppler index of the vascular resistance in the renal arteries.

The state of the fetus circulation in congenital malformations of the fetus with placental dysfunction

Introduction. Improvement of perinatal care in Ukraine has led to a decrease in early neonatal mortality, but a decrease in antenatal losses has not occurred. In the structure of antenatal fetal death (AFD), congenital malformations (CM) account for about one fifth of reproductive losses and their percentage increases annually. A frequent complication during pregnancy with CM is placental dysfunction (PD), which occurs according to different authors in 19-69%. Primary dysfunction of the placenta with CM has a progressive nature, the consequence of which is AFD in various periods of pregnancy.The aim of the study - to reduce the frequency of antenatal fetal death in women with CM based on the determination of Doppler blood flow indicators in the feto-placental complex (FPC) and their timely delivery. Materials and Methods. The state of the feto-placental complex was monitored in 100 pregnant women with CM of the fetus in the period of 37-40 weeks of pregnancy. Studies were conducted in the uterine arteries (UA), umbilical arteries (UA), mid-cerebral artery (MCA) and fetal aorta (FA) with the definition of indicators of resistance index (RI), systolic-diastolic ratio (SDR) and pulse index (PI) . The control group (CG) consisted of 25 pregnant women, who gave birth to healthy children. The results of the study and their discussion. Examination and dynamic observation of 100 pregnant women with CM of the fetus allowed us to diagnose PD in the overwhelming number of pregnant women (41 pregnant - 41%), who manifested manifestations of fetal distress at 8.0 ± 2.71%, FGR at 29.76 ± 4.46% and FGR in combination with shallow water 3.24 ± 0.91%. For the purpose of a detailed analysis of the possible mechanisms of antenatal tanathogenesis, the patients were divided into two groups - with impaired blood flow in the FPC (OG1 - 41 pregnant) and without them (OG2 - 59 pregnant). It was pregnant OG1 that had manifestations of PD (distress, FGR and combination of FGR with low water). This separation allowed us to see the following picture of blood flow disorders.Analysis of the Doppler indices in UA showed that there is an increase in SDR in both UA, while the RI did not have a significant difference compared with CG and pregnant MG2. However, the correlation analysis did not indicate the presence of a relationship between blood flow disorders in UA and antenatal fetal death, which does not allow considering blood flow disorders in UA as stage of antenatal tanathogenesis.In pregnant MG1, a significantly higher RI index was found in UA compared with CG and MG2. PI did not have a significant difference compared with CG and pregnant women withCDF without PD. An analysis of blood flow in the MCA revealed a significant decrease in PI in pregnant MG1. A significant decrease in peripheral resistance to blood flow in the MCA can be a compensatory response to the deterioration of the fetal-placental blood circulation and is considered as indirect sign of brain congestion (the phenomenon of centralized blood flow). Analysis of the Doppler parameters in the AP testified to an increase in RI compared with the CG. An increase in RI in the aorta of the fetus may indicate a strain on the fetal heart during PD and may be a marker of the formation of congenital cardiomegaly in them.Conclusions. With CM of the fetus in combination with PD, deeper disturbances are observed in the utero-placental and placental-fetal complexes. In-time diagnosis of impaired blood flow allows in-time delivery of women with CM and reducing the risk of AFD.

Assessment of Myocardial Function in Kenyan Children With Severe, Acute Malnutrition

Mortality among African children hospitalized with severe malnutrition remains high, with sudden, unexpected deaths leading to speculation about potential cardiac causes. Malnutrition is considered high risk for cardiac failure, but evidence is limited. To investigate the role of cardiovascular dysfunction in African children with severe, acute malnutrition (SAM). A prospective, matched case-control study, the Cardiac Physiology in Malnutrition (CAPMAL) study, of 88 children with SAM (exposed) vs 22 severity-matched patients without SAM (unexposed) was conducted between March 7, 2011, and February 20, 2012; data analysis was performed from October 1, 2012, to March 1, 2016. Echocardiographic and electrocardiographic (ECG) recordings (including 7-day Holter monitoring) at admission, day 7, and day 28. Findings in children with (cases) and without (controls) SAM and in marasmus and kwashiorkor phenotypes were compared. Eighty-eight children (52 with marasmus and 36 with kwashiorkor) of the 418 admitted with SAM and 22 severity-matched controls were studied. A total of 63 children (57%) were boys; median age at admission was 19 months (range, 12-39 months). On admission, abnormalities more common in cases vs controls included severe hypokalemia (potassium <2.5 mEq/L) (18 of 81 [22%] vs 0%), hypoalbuminemia (albumin level <3.4 g/dL) (66 of 88 [75%] vs 4 of 22 [18%]), and hypothyroidism (free thyroxine level <0.70 ng/dL or thyrotropin level >4.2 mU/L) (18 of 74 [24%] vs 1 of 21 [5%]) and were associated with typical electrocardiographic changes (T-wave inversion: odds ratio, 7.3; 95% CI, 1.9-28.0; P = .001), which corrected as potassium levels improved. Fourteen children with SAM (16%) but no controls died. Myocardial mass was lower in cases on admission but not by day 7. Results of the Tei Index, a measure of global cardiac function, were within the reference range and similar in cases (median, 0.37; interquartile range [IQR], 0.26-0.45) and controls (median, 0.36; IQR, 0.28-0.42). Echocardiography detected no evidence of cardiac failure among children with SAM, including those receiving intravenous fluids to correct hypovolemia. Cardiac dysfunction was generally associated with comorbidity and typical of hypovolemia, with low cardiac index (median, 4.9 L/min/m2; IQR, 3.9-6.1 L/min/m2), high systemic vascular resistance index (median, 1333 dyne seconds/cm5/m2; IQR, 1133-1752 dyne seconds/cm5/m2), and with few differences between the marasmus and kwashiorkor manifestations of malnutrition. Seven-day continuous ECG Holter monitoring during the high-risk initial refeeding period demonstrated self-limiting significant ventricular arrhythmias in 33 of 55 cases (60%) and 6 of 18 controls (33%) (P = .049); none were temporally related to adverse events, including fatalities. There is little evidence that African children with SAM are at greater risk of cardiac dysfunction or clinically significant arrhythmias than those without SAM or that marasmus and kwashiorkor differed in cardiovascular profile. These findings should prompt a review of current guidelines.

Genetic Relationship, Virulence Factors, Drug Resistance Profile and Biofilm Formation Ability of Vibrio parahaemolyticus Isolated From Mussel.

The objective of this study was to investigate the virulence factors, genetic relationship, antibiotic resistance profile and the biofilm formation ability of Vibrio parahaemolyticus isolates on shrimp and mussel surfaces at 30°C. In this study, eight (n = 8) V. parahaemolyticus isolated from mussel were examined. We used the polymerase chain reaction (PCR) to examine the distribution of different genes, and Repetitive Extragenic Palindromic-PCR (REP-PCR) to compare the genetic relationship. Disk diffusion technique was used to assess antibiotic and multiple-antibiotic resistance. The biofilm formation assay, and field emission scanning electron microscopy (FE-SEM) were used to evaluate biofilm formation ability. Transmission Electron Microscope (TEM) was used to observe the morphological structure of bacterial cell. Our results indicated that the biofilm-associated genes, 16S rRNA, toxR, and tdh, were present in all the tested V. parahaemolyticus isolates (n = 8). Approximately, 62.5% (5 isolates among 8 isolates) isolates showed strong multiple-antibiotic resistance index with an average value of 0.56. All isolates (n = 8) showed strong genetic relationship and significant biofilm formation ability on shrimp and mussel surfaces. This study demonstrated that the presence of virulence factors, high multiple antibiotic resistance index (MARI) values, and effective biofilm formation ability of V. parahaemolyticus isolates could be a great threat to human health and economic values in future. It was also suggested that a high resistance rate to antibiotic could be ineffective for treating V. parahaemolyticus infections. The continuous monitoring of V. parahaemolyticus antibiotic, molecular and biofilm characteristics is needed to increase seafood safety.

Impact on renal resistive index of diabetes in renal transplant donors and recipients: A retrospective analysis of 1827 kidney transplant recipients.

High renal resistive index (RI) is observed in diabetes and is associated with poor patient survival, but whether it is primarily due to renal vascular resistance or systemic vascular alterations is unclear. The respective impact of kidney transplant from diabetic donors or to diabetic recipients on RI would shed some light on this issue. The objective of the study was to analyze the impact of donor and recipient diabetes on RI in order to understand the respective impact of the kidney and the vascular environment. The authors conducted a retrospective study in 1827 renal transplant recipients who received a kidney between 1985 and 2017, and had Doppler measurements at 3months after transplant. Donor and recipient characteristics at the time of transplant and at 3months were reviewed. Both donor diabetes and recipient diabetes were associated with RI in univariate analysis, but only recipient diabetes remained significantly associated in stepwise multivariate analyses (effect estimate on RI: +0.03±0.005, P<0.001). These findings were confirmed when RI was expressed as a binary variable using a cutoff of 0.75 (OR=2.50 [1.77, 3.54], P<0.001). Other determinants of RI were recipient characteristics (age, sex, systolic and diastolic blood pressure, and duration of dialysis). Donor characteristics were not associated with RI. Our results suggest that high RI observed in diabetic recipients shortly after transplant is primarily due to the new vascular environment, rather than to characteristics of the transplanted kidney. Therefore, RI reflects systemic rather than intra-renal changes.

This issue of Acta

This issue of Acta

Initial Hemodynamic Profiles of Children with Dengue Shock Syndrome in Referral Settings

Background: Fluid therapy for dengue shock syndrome (DSS) requires a dynamic approach that involves monitoring of the pathophysiological processes as well as the preload, contractility, and afterload assessment during the course dengue infection. Hemodynamically unstable DSS patients received in referral setting often complicated by fluid overload and secondary infection. Objective: This study aims to provide hemodynamic profiles and fluid responsiveness of pediatric patients admitted to the PICU with DSS. Methods: Hemodynamic profiles, laboratories, and demographic data were collected from patients aged 1 month to 18 years old with DSS who were admitted to the Pediatric Intensive Care Unit (PICU) at Dr. Sardjito General Hospital, Yogyakarta, Indonesia from January to December 2016. Hemodynamic profiles were assessed in clinically shock and not clinically shock group at PICU admission using the non-invasive Ultrasonic Cardiac Output Monitor (USCOM). Fluid responsiveness in clinically shock group was evaluated after fluid challenge with 10 ml/kgBW crystalloid or colloid. Results: Eighty six subjects were included in this study. Sixty six subjects were admitted to PICU with clinically shock condition. This group received less intravenous fluid than hemodynamically stable group (6.9 vs 7.52 ml/kgBW/hour respectively), had higher mean hematocrit level (42.09% vs 40.32% respectively), had higher hematocrit level during PICU stay (43.37% vs 42.06% respectively), significantly higher percentage to receive inotropes agent (62,1% vs 5%, p 0,000) and longer duration of inotropes usage (23,5 vs 0 hours, p 0.72). From the clinically shock patients admitted to PICU, only 19,69% were fluid responsive. Other subjects in this group with fluid non responsive state, 90,38% had low inotropic index and high systemic vascular resistance index. Among 8 patients in clinically shock group who died during PICU stay, 6 of them had low cardiac Index, fluid non responsive condition, low inotropic index and high systemic vascular resistance index. Conclusion: Only a small percentage of DSS patients with clinically shock admitted to the PICU were fluid responsive. Majority of DSS cases in children had low inotropy index and high systemic vascular resistance index.

Uterine and umbilical artery doppler in women with pre-eclampsia and their pregnancy outcomes.

Pre-eclampsia (PE) is an important public health menace in both developed and developing countries with high maternal and perinatal morbidity and mortality globally. A major goal towards improving antenatal management of PE is to develop accurate prediction models that identify women at high risk of this disease for appropriate interventions. In a longitudinal cohort study, high-risk singleton pregnant women enroled between April 2015 and February 2016 had uterine and umbilical artery Doppler sonography at 22-24 weeks and 32-34 weeks gestation and had their delivery outcomes documented by the obstetrician and gynaecologist. The peak systolic velocity (PSV), end-diastolic velocity (EDV), Resistivity Index (RI), Pulsatility Index (PI) and the systolic-diastolic ratio (S/D) were recorded. Among the ninety-eight high-risk pregnant women, 61 (62.2%) developed PE and 32 (32.8%) did not have PE. In the PE cases, 15 (24.5%) were mild and 46 (74.5%) were severe PE. The uterine artery PI was significantly associated with PE. A unit increase in uterine PI in high-risk pregnancies, increases the odd of PE by 37.37 times (95% confidence interval; odds ratio = 6.09, 241.9; P < 0.001). The combination of the uterine and umbilical PSV predicted 80.3% of severe PE. All three spontaneous abortions were in women who developed PE, more caesarean section (48.4%) and 69.2% of 45 pre-term deliveries occurred in women with severe PE. The findings from this study show significantly lower uterine and umbilical arteries PSV and EDV but higher RI, PI and S/D in cases that developed PE. The uterine artery PI is the best predictor of PE, whereas the combinations of uterine and umbilical arteries PSV best predict severity of PE among high-risk pregnant Nigeria women.

Bemiparin as a Prophylaxis After an Unexplained Stillbirth: Open-Label Interventional Prospective Study.

Stillbirth is a devastating event to the parents, relatives, friends, and families. The role of anticoagulants in the prevention of unexplained stillbirths is uncertain. An open-label interventional prospective cohort study was conducted on 144 women with a history of unexplained stillbirths. The intervention group had a high umbilical artery resistance index (RI) and received bemiparin. The nonintervention group had a normal RI and did not receive any intervention. We measured the adjusted odds ratio (OR) and 95% confidence interval (CI) of the main outcome for these variables using logistic regression analysis. Fresh stillbirth and early neonatal death rates were lower (P = .005, OR = 11.949 and 95% CI = 2.099-68.014) and newborn weight was higher (P = .015, OR = 0.048, 95% CI = 0.004-0.549) in the group that received bemiparin. Bemiparin is effective in decreasing the rate of stillbirth in women with a history of previous unexplained stillbirths.

A Diels–Alder reaction between cyanates and cyclopentadienone-derivatives – a new class of crosslinkable oligomers

A Diels–Alder reaction between cyclopentadienones and cyanates yields thermally crosslinkable oligomers, which combine high thermal resistance and high refractive indices.

Role of renal doppler spectral study in detecting allograft dysfunction in early post-transplant period

Doppler sonography is routinely used to assess global and segmental perfusion abnormalities in renal allograft. However, its utility in distinguishing between the causes of allograft dysfunction is unclear, and information is lacking on the outcomes of allografts with abnormal findings. In this single center study, we retrospectively reviewed the records of pediatric allograft recipients who underwent Doppler spectral study within 3 weeks of transplantation. Resistive index (RI) of >0.7 was considered abnormal. Serum creatinine at the time of Doppler and at 3-month follow-up was documented. Among 34 children transplanted over 5 years, delayed graft function (DGF) was observed in 36% of allografts. RI was significantly higher for allografts with DGF than those without DGF (0.85 ± 0.17 vs. 0.69 ± 0.10; P = 0.004). Serum creatinine was significantly higher for allografts with abnormal than normal Doppler. However, there was no significant association between RI and the underlying histopathology. RI at the level of segmental (r = 0.62) and arcuate arteries (r = 0.55) correlated well with serum creatinine. Allografts with high and normal RI had comparable serum creatinine at 3-month follow-up (median [interquartile range] 0.65 [0.6, 0.9] vs. 0.7 [0.65, 0.8]; P = 0.98).

Impact of stroke volume on prognostic outcome in patients with atrial fibrillation and concomitant heart failure with preserved ejection fraction

BackgroundAtrial fibrillation (AF) can lead to a decrease in stroke volume (SV) despite a preserved left ventricular ejection fraction (LVEF). However, no previous studies have evaluated the prognostic importance of the decreased SV in patients with AF and concomitant heart failure with preserved ejection fraction (HFpEF). MethodsWe retrospectively studied the cases of 1520 consecutive patients who had undergone right heart catheterization. HFpEF (New York Heart Association functional class ≥II and LVEF ≥50%) was observed in 574 patients. We selected 47 patients with persistent AF with a heart rate of 40–110bpm and HFpEF without other underlying heart diseases. ResultsAmong a total of 47 patients, 16 (34%) had normal SV [SV index (SVI) >35ml/m2 and 31 (66%) patients had low SV (SVI≤35ml/m2)]. During the follow-up period of 1115±305 days, 14 patients (30%) met the composite endpoint defined as cardiac death and admission due to worsening heart failure. Cox proportional hazard ratio analysis showed that SVI was a predictor of the endpoint, independently of the cardiac index and other parameters. Kaplan–Meyer analysis showed that low SVI was significantly associated with a poor prognosis, with an event-free rate of 58% at the mean follow-up period of 991 days (log-rank p=0.02). In the multiple regression analysis, a high systemic vascular resistance index and a high heart rate were independent determinants of low SVI. ConclusionsOur findings suggest that low SV had a significant impact on prognosis in patients with AF despite the preserved LVEF. The SVI depended on the heart rate and SVRI.

Resistive Index in Late-Onset Neonatal Sepsis

Background and Objectives: Hemodynamics in neonatal sepsis is complex and poorly understood. Several studies have reported conflicting findings on cerebral blood flow (CBF) in sepsis from severely increased flow to severely decreased flow. The objective of our study was to study CBF by measuring the resistive index (RI) of the anterior cerebral artery in late-onset neonatal sepsis (LONS).Methods: All newborn infants admitted in our neonatal intensive care unit with suspected LONS during the period from January 2017 to December 2017 underwent point-of-care transcranial Doppler ultrasonography to measure the RI of the anterior cerebral artery within 24 h of clinical presentation before starting inotropes if at all required. Infants with congenital heart disease, perinatal asphyxia, major congenital malformations, and genetic syndromes were excluded. Neonates with positive culture were included in the final analysis.Results: Of 89 suspected LONS, 33 were culture positive and were analyzed. The mean admission weight was 2.33 ± 0.76 kg. The mean gestational age was 33.5 ± 3.4 wk. Most common organism isolated was Klebsiella pneumoniae (82%). The RI was high in 54.5% (17 of 33) and normal in 45.5% (15 of 33) cases.Conclusions: LONS is a unique and complex hemodynamic state and we found it associated with the high RI indicating decreased CBF. A larger study may help in more understanding of this unique hemodynamic association.

Doppler Ultrasonography of Foetal Middle Cerebral and Umbilical Arteries in High Risk Pregnancy

AbstractBackground: Foetal hypoxemia is associated with in-creased impedance to flow in the umbilical artery (UA) and decreased impedance in the fetal middle cerebral artery (MCA).Aim of Study: To evaluate Doppler of foetal Middle cerebral (MCA) and Umbilical (UMA) arteries in high risk pregnancies.Patients and Methods: This prospective cross-sectional study was carried on 100 patients at Menoufia university hospital in the period from March 2017 to Febraury 2018 using a 2-5MHz transabdominal probe (GE LOGIC p5 and GE LOGIC p7). The study including two groups, group (A) High risk group: Including 50 patients with pregnancy above 27 weeks presenting with high risk pregnancy, and group (B) control group: Including 50 patients with normal pregnancy above 27 weeks, Doppler examination for both MCA and UMA was done.Results: Out of the fifty pregnant women in Group A, there were 18 cases with abnormal UMA Doppler, 14 cases with abnormal MCA Doppler indices and 10 cases with abnormal cerbroplacental (CPR ). For estimating the associ-ation between high risk pregnancy and resistive index ( RI ) and pulsatility index (PI) of both UMA and MCA for predicting foetal outcome, RI of UMA showed sensitivity and specificity of 70% and 60% and accuracy of 63% and MCA RI showed sensitivity of 74%, specificity of 48% and accuracy of 61%.Conclusion: Doppler ultrasonography of foetal middle cerebral and umbilical arteries plays important role in high risk pregnancies and predicting foetal outcome.