Mean Resistive Index Research Articles

Comparing the Doppler flow parameters of orbital vessels among healthy nonsmokers, diabetic nonsmokers, and diabetic smokers visiting a tertiary health-care center.

The present study aimed to assess the impact of diabetes mellitus and smoking in orbital vessels, utilizing resistive index (RI) through color Doppler imaging (CDI). The cross-sectional study consisted of 90 participants divided into three groups of 30 each. Group A consisted of normal individuals, Group B consisted of patients with diabetes, and Group C consisted of patients with a history of diabetes and smoking. The RIs were obtained for the orbital vessels for both eyes using CDI. Analysis of variance with post hoc Tukey's HSD test was conducted for pairwise comparison of the groups. Pearson's correlation test was used to correlate between RI and the amount of smoking. Significant differences were observed in the mean RI values of the ophthalmic artery, central retinal artery (CRA), and central retinal vein (CRV) in all three groups bilaterally (P < 0.001). Compared with patients in Group A, those in Group B had significantly larger RIs for all orbital vessels in both eyes (P < 0.01 for all). Patients in Group C had significantly larger RI for all three vessels (P < 0.001 for all) except for the CRV in the right eye than those in Group A. Compared with patients in Group B, those in Group C had significantly larger RI in CRA bilaterally (P = 0.05 for the right eyes and P = 0.024 for the left eyes). In Group C, a positive correlation was observed between RIs of all orbital vessels and the amount of smoking. RIs of the orbital vessels are significantly increased in patients with diabetes and higher in diabetic smokers, suggesting that diabetes affects the retinal vasculature, and smoking exacerbates this pathology.

Exploring the role of spectral Doppler in acute appendicitis

BackgroundThis study evaluated the role of spectral Doppler in acute appendicitis. The aim of the study was to find out whether spectral Doppler parameters (PSV and RI) have any useful application in diagnosing acute appendicitis as an adjunct to grayscale sonography.MethodAll clinically suspected appendicitis patients in whom the spectral Doppler signal could be obtained were enrolled in the study (N = 40). Non-angle-corrected PSV and RI were measured from the intramuscular artery. The final diagnosis of appendicitis was done either on histopathology or clinical follow-up. ROC analysis was done to find the diagnostic performance of PSV and RI and to define the cutoff values to diagnose appendicitis. The cutoff value for peak systolic velocity (PSV) and resistivity index (RI) that would help in the diagnosis of appendiceal inflammation were calculated. Its diagnostic performance was also studied in the borderline category (appendix diameter 6-8 mm).ResultsThe mean PSV in appendicitis was 19.21 cm/s, while the mean RI was 0.68. In the group without appendicitis, the mean PSV was 14.15 cm/s, while the mean RI was 0.56. The mean PSV showed a significant difference (p 0.009) in patients with and without appendicitis. These cutoff values obtained had an NPV of 87.5% (PSV) and 83.3% (RI) in the borderline category. The cutoff PSV obtained from ROC curve analysis was 11.8 cm/s with a sensitivity of 93.8%, specificity of 54.2%, PPV of 57.7%, NPV of 92.9%, and a diagnostic accuracy of 70%. The cutoff RI value obtained from ROC curve analysis was 0.56 with a sensitivity of 81.2%, specificity of 58.3%, PPV of 56.5%, NPV of 82.4%, and a diagnostic accuracy of 67.5%. On applying these cutoff values in patients with borderline appendix diameter (6–8 mm), PSV predicted appendicitis with a sensitivity of 50%, specificity of 58.3%, PPV of 16.7%, NPV of 87.5%, and a diagnostic accuracy of 57.1%. The cutoff value of RI predicted appendicitis in the borderline category with a sensitivity of 50%, specificity of 41.7%, PPV of 12.5%, and NPV of 83.3%. RI had 42.9% diagnostic accuracy.ConclusionsSpectral Doppler parameters may have a useful role in distinguishing between patients with and without appendicitis, demonstrating statistically significant differences in PSV and RI between the two groups. The cutoff PSV had high sensitivity and specificity and proved to be a better indicator than even the maximum outer diameter to exclude appendicitis. The cutoff criteria for PSV also correctly predicted the absence of appendicitis in the borderline category.

Renal Resistive Index as A Early Predictor of Renal Dysfunction in Patients with Type 2 Diabetes Mellitus

Background : Type 2 diabetes develops over a long period of time, represents 85–90 per cent of all cases of diabetes . Diabetic nephropathy is a relatively common form of chronic renal disease. It is the most constant microvascular complication in diabetic patients.Conventional ultrasound and colour Doppler provide easily available, affordable and non-invasive follow up method for evaluation of kidneys in diabetic nephropathy. Aim :The purpose of this study is to assess the intrarenal resistivity index by Doppler ultrasonography in a group of diabetics with normal renal function in comparison to non diabetic controls and correlating them with biochemical parameters. Materials And Methods :The study was done over a period of 2 years from October 2020 To October 2022. The study I a case control study we evaluated the intra-renal hemodynamic changes with Doppler sonography in diabetic patients in comparison to non-diabetic controls, All the data was expressed as mean + SD. Differences between the two groups was analysed by t test and chi-square test. Categorical data expressed as frequency and percentages. Results And Observations The mean age in the diabetic group was 58.84 years SD + 15.61 years and age - non diabetic group was 56.66 years SD + 14.09 years . there was a negative correlation between age and diabetes mellitus with nephropathy , p &gt; 0.0784 r -.026 A significant the correlation of the Mean resistivity index RI of the right kidney at the hilum was 0.63 the correlation was positive that is the resistance increased in diabetes mellitus as compared to non diabetic and this was significant with a p value 0 .049 significant . All the resistive indices were higher in the diabetic than the non diabetic individuals , the highest being in the midpole and it was statistically significant at all places in both kidneys with a p value &lt;0.05. Conclusion :The renal Doppler indices are good indices to evaluate the renal dysfunction in the early stages. In this study, the blood sugar levels of all cases were at least moderately controlled, yet the renal indices showed gross anomaly even though the creatinine clearance was well above normal limits.

Kangaroo Mother Care: A Low-cost Intervention for Improving Cerebral Hemodynamics in Preterm Babies

Background Kangaroo mother care (KMC) has been utilized extensively for the care of infants with low birth weight and babies born prematurely. However, changes in cerebral blood flow (CBF) during KMC interventions are not known clearly. Hence, this study was done, in clinically stable premature babies, to study the changes in cerebral hemodynamics after KMC sessions. Methods It was a prospective study, done without a control group, with a pre-post test design. In our study, an assessment of 104 stable preterm newborns was done, before and after KMC. CBF parameters, which included mean velocity (MV), resistive index (RI) and pulsatility index (PI) were assessed using doppler ultrasonography in middle cerebral artery. Results Both PI and RI were found to be significantly decreased after KMC sessions. Their values, before and after KMC, were 2.06 ± 0.83 versus 1.67± 1.06 ( p value .04) and 0.88 ± 0.27 versus 0.75 ± 0.37 ( p value .04), respectively. On the other hand, MV of blood flow was found to be increased after KMC (33.47 ± 18.16 vs. 40.46 ± 19.49; p value .01). Thus, there is an increase in CBF parameters after KMC. Conclusion There is an increase in CBF after providing KMC, thereby having a positive influence on the structure and development of the premature infant’s brain.

Analysis of Ophthalmic Artery Doppler in Normotensive, Preeclamptic, and Eclamptic Pregnancies in Correlation With Clinical Parameters in a Tertiary Care Hospital in India.

Preeclampsia occurs in hypertensive pregnant women beyond 20 weeks of gestation and is accompanied by proteinuria. Hypertensive retinopathy is the most prevalent sign of preeclampsia, and eclampsia and it needs to be addressed at the earliest opportunity. This study was intended to gauge and assess the ophthalmic artery Doppler indices such as mean enveloped velocity, the pulsatility index (PI), and the resistivity index (RI) in normotensive, preeclamptic, and eclamptic pregnancies with their respective correlations. We also saw correlations with serum creatinine and platelets with the PI and RI. Methods A prospective case-control study was conducted among70 subjects in the Department of Radiodiagnosis of Sri Devaraj Urs Medical College, Tamaka, Karnataka, India. We carried out ultrasound and Doppler examinations of theright ophthalmic artery. Doppler indices including mean enveloped velocity, PI, and RI were assessed in normotensive as well as preeclamptic pregnancies. Results The mean ages of cases and controls were 28.26 and 26.74 years, respectively. The mean RIs in controls and cases were 0.86 and 0.69, respectively (preeclampsia and eclampsia were 0.73 and 0.65, respectively), whereas the mean PIs in controls and cases were 1.96 and 1.17, respectively (preeclampsia and eclampsia were 1.31 and 1.06, respectively). The mean enveloped velocities in preeclampsia and eclampsia were 28.82 cm/sec and 20.43 cm/sec, respectively. Conclusion We found a definite reduction in the PI, RI, and mean enveloped velocity flow levels in preeclampsia and eclampsia patients in comparison to that amongst normal subjects. Therefore, it is important to assess and manage such conditions at the earliest stage to achieve a better prognosis while providing adequate treatment to the patient.

Gross morphological and ultrasonographic dimensions of normal feline kidney with reference to resistive index

Ultrasonography with color Doppler is the most quantitative analysis method for intra-renal parameters. There is a wide variation between authors in the measurement site and referencing the inter-lobar resistivity index (RI) in felines. Our objective is to morphometrically and ultrasonographically investigate the normal renal dimensions and vasculatures and draw up a normal reference value for the renal inter-lobar artery resistivity index (RI) using a Pulsed wave-Doppler ultrasonography. A total of twelve adult domestic cats were sedated and treated according to IACUC regulation guidelines to be examined using Doppler ultrasound. The same cats were used for morphometric investigation and divided into three groups regarding the used technique. The size difference between the right and left kidneys is slight, measuring 17 g (weight), 3.65 ± 0.06 cm (length), 2.54 ± 0.08 cm (width), and 2.21 ± 0.03 cm (thickness) for the right kidney, and about 15 g, 3.42 ± 0.06 cm, 2.32 ± 0.05 cm, and 2.13 ± 0.03 cm for the left one, respectively. There are three patterns of renal arteries’ point of origin. The mean RI values of both kidneys were 0.57 ± 0.08 (0.50–0.67) in the right kidney and 0.60 ± 0.08 (0.51–0.69) in the left kidney. The gross examination and ultrasonography measurements did not have a statistically different effect on the actual renal dimensions. Moreover, 0.69 is considered the standard resistivity index (RI) threshold of the feline inter-lobar artery with no correlation to the animal’s body weight.

Can the parameters of penile duplex assessment predict the success of urethroplasty?

BackgroundThis work aimed to study the role of penile duplex in predicting the outcome of anastomotic urethroplasty.MethodsBetween March 2022 and February 2023, all patients presented with posterior urethral distraction defect (PUDD) underwent anastomotic end to end urethroplasty. Preoperative evaluation of sexual function was performed using international index of erectile function (IIEF-5) and penile doppler parameters (the response E1 to E5, peak systolic velocity (PSV), end diastolic velocity (EDV) and resistivity index (RI)). Each patient was, routinely, evaluated through 12 month-follow up using IIEF-5, penile doppler parameters, uroflowmetry for Qmax and pelvic ultrasound for postvoid residual urine (PVR). The procedure was considered successful if Qmax > 15 ml/s and PVR < 50 cc at the end of follow up. The correlation between the success rate of anastomotic urethroplasty and pre-operative penile Doppler parameters was the primary outcome.ResultsThirty patients with a mean age of 29.47 ± 9.79 years were evaluated. Twenty patients (66.7%) had previous orthopedic surgery. The stricture site was membranous in 6 patients (20.0%) and bubo-membranous in 24 (80.0%). The mean stricture length was 2.52 ± 0.98 cm. There was a statistically significant increase in mean end-diastolic velocity (P < 0.001) with a subsequent significant decrease in mean resistance index (P < 0.001). 14.3% of pre-operatively potent patients developed venous leakage (P < 0.001), while there was no change of arteriogenic or venogenic erectile dysfunction. In addition, of the patients who have arteriogenic erectile dysfunction, 37.5% did not require surgery, 25% had a urethrocystoscopy, and 37.5% required a repeat end to end urethroplasty. There is a significant association between pre-operative peak systolic velocity and the need for re-operation (P = 0.005).ConclusionPenile duplex may anticipate anastomotic urethroplasty efficacy in the case of PUDD.

Role of Uterine Artery Doppler Study Between 11 and 14 Weeks as a Predictor of Preeclampsia.

Introduction Preeclampsia is a serious complication marked by antepartum hemorrhage, resulting in severe maternal and fetal complications. Predicting this condition using placental dysfunction assessments, such as uterine artery Doppler ultrasound, is challenging due to the placenta's evolving structural and biochemical characteristics throughout different stages of pregnancy. Objectives To determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the uterine artery Doppler Pulsatility Index (PI) and Resistive Index (RI) in predicting preeclampsia. To compare the Doppler ultrasound measurements between normal pregnancies and those that develop preeclampsia. To assess the diagnostic accuracy of uterine artery Doppler ultrasound in predicting gestational hypertension in addition to preeclampsia. Methodology Conducted as a prospective study, 116 antenatal mothers with computed gestational ages and scan gestational ages between 11 and 14 weeks, and a previous history of preeclampsia were included. Subjects with chronic hypertension or multiple gestations were excluded. Participants underwent uterine artery Doppler screening, during which the PI and RI were measured upon obtaining three consecutive similar waveforms, and the mean PI of the left and right arteries was calculated. The outcomes of patients with normal pregnancies and those who developed preeclampsia were compared. Data were entered into Microsoft Excel (Microsoft® Corp., Redmond, WA, USA) and analyzed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, NY, USA). Results The mean PI among participants was 1.75 (±0.38), with a range from 1 to 2.75. The mean RI was 0.58 (±0.08), ranging from 0.45 to 0.8. The cutoff for the mean PI in predicting preeclampsia was 2.27, which showed a sensitivity of 92.9%, specificity of 97.1%, PPV of 81.47%, NPV of 99.01%, and a diagnostic accuracy of 96.59% (area under the curve (AUC): 0.982). The cutoff for the mean RI for predicting preeclampsia was 0.695, with a sensitivity of 85.7%, specificity of 98%, PPV of 85.47%, NPV of 98.04%, and diagnostic accuracy of 96.52% (AUC: 0.965). In predicting gestational hypertension, the cutoff for the mean PI was 1.975, with a sensitivity of 80%, specificity of 82.9%, PPV of 17.41%, NPV of 98.92%, and diagnostic accuracy of 82.78% (AUC: 0.848). The cutoff for the mean RI in predicting gestational hypertension was 0.615, showing a sensitivity of 80%, specificity of 80.2%, PPV of 15.4%, NPV of 98.89%, and diagnostic accuracy of 80.19% (AUC: 0.767). Conclusion The research demonstrated that aberrant readings in uterine Doppler ultrasound, specifically in the PI and RI, possess strong overall validity in forecasting the occurrence of preeclampsia.

The effect of endoscopic renal and ureteral stone surgeries on renal blood flow in children: a prospective trial

Aim: To assess the impact of endoscopic stone surgeries on renal perfusion and blood flow in children. Materials and methods: Children who underwent percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), ureterorenoscopy (URS), endoscopic combined intrarenal surgery (ECIRS) were included to the study. Renal Doppler ultrasonography (RDUS) was performed one day before the operation, and on the postoperative 1st day and 1st month. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured, and resistive index (RI) was calculated with the (PSV-EDV)/PSV formula. RDUS parameters were compared before and after surgery and between ipsilateral and contralateral kidneys. Results: A total of 45 children with a median age was 8 (2–17) years were included (15 (33.3%) girls, 30 (66.7%) boys). PCNL was performed in 13 children (28.9%), RIRS 11 (24.4%), URS 12 (26.7%), and ECIRS 9 (20%). There was no significant difference in renal and segmental PSV, EDV and RI values of operated kidney in the preoperative, postoperative periods. There was no significant difference between RDUS parameters of the ipsilateral and contralateral kidneys in preoperative or postoperative periods. PSV and EDV values were significantly higher in the 1st postoperative month in the group without preoperative DJ stent than in the group with DJ stent (p = 0,031, p = 0,041, respectively). However, RI values were similar. The mean RI were below the threshold value of 0.7 in each period. Conclusion: RDUS parameters didn’t show a significant difference in children. Endoscopic surgeries can be safely performed in pediatric stone disease.

Assessment of Dynamic Cerebral Autoregulation During Long-Term Exposure to High Altitude in Normal Subjects by Ultrasonography.

To evaluate changes in dynamic cerebral autoregulation (CA) during short-term and long-term exposure to high altitude with ultrasonography, and also study the sex differences in the response of CA to altitude. We assessed the differences in dynamic CA and measured with Doppler ultrasound of the bilateral internal carotid artery (ICA), vertebral artery (VA), and middle cerebral artery (MCA) and the values of basic information within 48 hours and at 2 years after arrival at Tibet in 65 healthy Han young Chinese volunteers, meanwhile, we compared the resistance index (RI) and pulsatility index (PI) of the right MCA at inhale oxygen 8 minutes when a newcomer with 2 years after arrival at Tibet. With 2 years of altitude exposure, the SaO2 of all subjects was above 90%, the mean PEF, DAP, and HR values decreased, HGB increased compared within 48 hours in same-gender groups. Comparisons of cerebral hemodynamics between before 2 years and after 2 years within male and female groups, the mean RI and PI values of bilateral MCA after 2 years were significantly higher than before 2 years, at the same time, the mean RI and PI values of bilateral ICA were significant differences (P < .05) between male groups, with regard to female groups, showed that the mean RI and PI values of bilateral VA were significant differences (P < .05). Comparisons of Right MCA hemodynamics between after oxygen uptake 8 minutes and 2 years, the mean RI and PI values were no significant difference within male and female groups (P > .05). Acute mountain sickness could result from an alteration of dynamic autoregulation of cerebral blood flow, but the impaired autoregulation may be corrected with the extension of time, furthermore, the response of CA to altitude in males and females are different.

Transcranial Doppler Sonography in Acute Viral Encephalitis with Special Reference to Dengue Encephalitis

Abstract Introduction: Acute viral encephalitis syndrome including dengue encephalitis (DE) is an important tropical illness with a guarded prognosis. The cerebral blood flow may be affected in acute viral encephalitis. Transcranial Doppler (TCD) sonography can quantitatively determine intracranial vascular flow dynamics in acute viral encephalitis. Aim: We aimed to investigate the intracranial blood flow characteristics in patients with DE and compare with nondengue acute viral encephalitis patients. Materials and Methods: In this prospective study, all the cases of acute viral encephalitis including dengue were enrolled over 18 months and followed up at 3 months. TCD was performed to determine the mean velocity pulsatility index (PI) and resistive index (RI) across the middle cerebral artery, anterior cerebral artery, posterior cerebral artery (PCA), vertebral artery, and basilar artery and compared it among dengue versus nondengue group as well as outcome at 3 months. Results: Out of 39 patients, 19 were diagnosed with DE, whereas 20 patients suffered from the nondengue group. The elevated PI and RI in the left PCA were found to statistically significant (P = 0.001 and 0.008, respectively) in the DE group. There was no significant difference in any other TCD indices in any other vessel among both the groups. In addition, an initial low Glasgow Outcome Scale (GOS) and higher brain imaging abnormality were significantly associated with poor GOS of &lt;5 in both the groups. Conclusion: An elevated PI and RI of PCA could be an important initial TCD parameter in DE. TCD parameters did not affect the outcome of acute viral encephalitis.

Intracranial Pressure and Cerebral Hemodynamics in Infants Before and After Glenn Procedure.

This prospective cohort study aimed to investigate changes in intracranial pressure (ICP) and cerebral hemodynamics in infants with congenital heart disease undergoing the Glenn procedure, focusing on the relationship between superior vena cava pressure and estimated ICP. A single-center prospective cohort study. The study was conducted in a cardiac center over 4 years (2019-2022). Twenty-seven infants with congenital heart disease scheduled for the Glenn procedure were included in the study, and detailed patient demographics and primary diagnoses were recorded. Transcranial Doppler (TCD) ultrasound examinations were performed at three time points: baseline (preoperatively), postoperative while ventilated (within 24-48 hr), and at discharge. TCD parameters, blood pressure, and pulmonary artery pressure were measured. TCD parameters included systolic flow velocity, diastolic flow velocity (dFV), mean flow velocity (mFV), pulsatility index (PI), and resistance index. Estimated ICP and cerebral perfusion pressure (CPP) were calculated using established formulas. There was a significant postoperative increase in estimated ICP from 11 mm Hg (interquartile range [IQR], 10-16 mm Hg) to 15 mm Hg (IQR, 12-21 mm Hg) postoperatively (p = 0.002) with a trend toward higher CPP from 22 mm Hg (IQR, 14-30 mm Hg) to 28 mm Hg (IQR, 22-38 mm Hg) postoperatively (p = 0.1). TCD indices reflected alterations in cerebral hemodynamics, including decreased dFV and mFV and increased PI. Intracranial hemodynamics while on positive airway pressure and after extubation were similar. Glenn procedure substantially increases estimated ICP while showing a trend toward higher CPP. These findings underscore the intricate interaction between venous pressure and cerebral hemodynamics in infants undergoing the Glenn procedure. They also highlight the remarkable complexity of cerebrovascular autoregulation in maintaining stable brain perfusion under these circumstances.

A Second Trimester Prediction Algorithm for Early-Onset Hypertensive Disorders of Pregnancy Occurrence and Severity Based on Soluble fms-like Tyrosine Kinase 1 (sFlt-1)/Placental Growth Factor (PlGF) Ratio and Uterine Doppler Ultrasound in Women at Risk.

Hypertensive disorders of pregnancy (HDPs) represent a significant source of severe maternal and fetal morbidity. Screening strategies relying on traditional medical history and clinical risk factors have traditionally shown relatively modest performance, mainly in the prediction of preeclampsia, displaying a sensitivity of 37% for the early-onset form and 29% for the late-onset form. The development of more accurate predictive and diagnostic models of preeclampsia in the early stages of pregnancy represents a matter of high priority. The aim of the present paper is to create an effective second trimester prediction algorithm of early-onset HDP occurrence and severity, by combining the following two biochemical markers: a soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio and uterine artery Doppler ultrasound parameters, namely the pulsatility index (PI) and the resistivity index (RI), in a population of high-risk pregnant women, initially assessed through traditional risk factors. A prospective single-center observational longitudinal study was conducted, in which 100 women with singleton pregnancy and traditional clinical and medical history risk factors for preeclampsia were enrolled at 24 weeks of gestation. Shortly after study enrollment, all women had their sFlt-1 and PlGF levels and mean uterine artery PI and RI determined. All pregnancies were followed up until delivery. Receiver operating characteristic (ROC) analysis established algorithms based on cutoffs for the prediction of the later development of preeclampsia: PI 1.25 (96.15% sensitivity, 86.49% specificity), RI 0.62 (84.6% sensitivity, 89.2% specificity) and sFlt-1/PlGF ratio 59.55 (100% sensitivity, 89.2% specificity). The sFlt-1/PlGF ratio was the best predictor for preeclampsia, as it displayed the highest area under the curve (AUC) of 0.973. The prediction algorithm for the severe form of preeclampsia, complicated by fetal growth restriction leading to preterm birth, antepartum fetal demise or acute fetal distress with a cerebro-placental ratio of <one consisted of the following cutoffs: PI 1.44 (93.75% sensitivity, 95.24% specificity), RI 0.69 (87.5% sensitivity, 100% specificity) and sFlt-1/PlGF ratio 102.74 (93.75% sensitivity, 95.2% specificity). These algorithms may significantly enhance the prediction accuracy of preeclampsia compared to traditional risk factors. The combination of the sFlt-1/PlGF ratio with mean uterine PI and RI in particular displayed an improved performance in the prediction of severe preeclampsia with the above-mentioned complications, compared to the biochemical markers or uterine Doppler parameters used alone. Therefore, HDP screening strategies should increasingly focus on implementing such algorithms for women who are initially regarded as high risk based on traditional risk factors, in order to properly diagnose HDP and properly limit or manage the later maternal and fetal complications.

Comparative sonographic assessment of renal volume and arterial Doppler velocimetric indices among women with pregnancy-induced hypertension and normotensive controls in Northern Nigeria.

Pregnancy-induced hypertension is a global public health problem, worsening maternal morbidity and mortality. Renal complications have additional devastating consequences on maternal morbidity. Renal Doppler ultrasound is a valuable tool in the management of pregnancy-induced hypertension. It helps in the assessment of renal hemodynamics with the potential to monitor renal function and predict complications. We aimed to determine the relationship between the renal volume and arterial Doppler velocimetric indices in pregnancy-induced hypertension and matched normotensive controls. Following the documentation of demographic and basic obstetric characteristics of 150 women with pregnancy-induced hypertension and an equal number of their matched controls, a 3.5-MHz convex transducer was used to measure the maternal renal volumes and renal arterial Doppler velocimetric indices (peak systolic velocity, end diastolic velocity, resistive index, pulsatility index, and systolic-diastolic radio). Student's t-test and linear regression were used to determine the differences and relationships between the quantitative variables among women with pregnancy-induced hypertension and their controls. The association chi-square test was used to determine the association between the qualitative and categorical variables. A p-value of less than 0.05 was considered significant. The mean renal volume of pregnancy-induced hypertension patients is higher bilaterally when compared to normotensive women. The mean peak systolic velocity and resistive index in pregnancy-induced hypertension patients were significantly higher compared to normotensives (59.13 ± 13.5 vs 54.19 ± 9.8 cm/s; p < 0.001) and (0.74 ± 0.2 vs 0.68 ± 0.3). The maternal renal volume and peak systolic velocity of the renal arteries are significantly higher in women with pregnancy-induced hypertension compared to normotensives.

The pattern of renal artery Doppler indices in patients with sickle cell disease.

To evaluate the pattern of renal artery Doppler indices in patients with sickle cell disease who do not have laboratory evidence of renal impairment. A case-control study was carried out after enrolling 50 patients with sickle cell disease (HbSS phenotype) (sickle cell disease group) and 50 control subjects (control group). All the participants underwent ultrasound and color Doppler examination, and the pulsatility index and resistive index values of the main renal artery, segmental artery, and interlobar artery in both kidneys were recorded and compared. The Doppler measurements of the main renal artery, segmental artery, and interlobar artery were compared between the control and sickle cell disease groups. It was found that both pulsatility index and resistive index were significantly higher in the sickle cell disease group, as compared to the control group, for the main renal artery, segmental artery, and interlobar artery (p <0.0001, p <0.0001, and p <0.0001, respectively). The optimal cut-off points for mean pulsatility index and resistive index, as measured by the Youden index, were found to be >1.08 (72% sensitivity and 88% specificity) and >0.635 (66% sensitivity and 98% specificity), respectively. Resistive index and pulsatility index values in renal Doppler sonography can serve as early radiologic predictors of renal vascular changes in sickle cell disease patients who do not have laboratory evidence of renal impairment.

A Study Assessing the Role of Renal Grayscale Ultrasonography and Flowmetry in Correlation With Renal Function Tests Across Various Renal Diseases.

Background Renal insufficiency, a critical concern in native and transplant kidneys, necessitates effective screening modalities for evaluation and management. Grayscale sonography has been a cornerstone in renal diagnostics, providing basic anatomical insights such as renal length, cortical thickness, and collecting system dilatation. Despite technological advancements, its impact on the differential diagnosis or management of renal disease remains limited, often showing normal findings in the presence of severe renal dysfunction. On the other hand, Doppler sonography, particularly the Doppler resistive index (RI), has shown potential in enhancing the assessment of renal dysfunction by quantifying alterations in renal blood flow and correlating with various renal pathologies and prognoses. Thus, this study aims to assess and compare the sensitivity of transabdominal and Doppler sonography as a diagnostic modality to evaluate medical renal diseases with altered renal function tests (RFTs). Methodology Participants included patients visiting the ultrasonography (USG)room at our hospital for USG of the kidneys, ureters, and bladder (USG KUB) and USG of the whole abdomen(USG W/A) with altered RFTs. Each underwent renal grayscale USG and RImeasurement, alongside standard RFTs, aiming to investigate the relationship between USG and RI findings and RFT outcomes to assess their predictive accuracy for renal function. Renal grayscale USG assessed parameters including renal dimensions, echogenicity, corticomedullary differentiation, and RI. Data management and charting were conducted with Microsoft Excel 2021 and Microsoft Word 2021. IBM SPSS Statistics for Windows, Version 24 (IBM Corp.,Armonk, NY) was utilized for data analysis. The analysis of variance (ANOVA) test examined relationships between renal parameters and RI across diagnostic groups. Furthermore, the chi-square test evaluated associations of renal ultrasound findings with RFTs and their significance. Results The study analyzed 93 patients with altered RFTs. Chronic kidney disease (CKD) affected 68 patients, primarily males in their fifth and sixth decades, showing reduced renal dimensions, increased cortical echogenicity, and elevated Doppler RI mean (RIm) with 83% sensitivity. Acute kidney injury (AKI) was found in 12 patients, mainly in their fourth decade, displaying increased renal parameters and elevated RIm with 75% sensitivity. Glomerular diseases, including nephrotic syndrome (NS) and nephritic syndrome (NeS), occurred in 9 patients, predominantly males in their fourth decade, with heightened renal cortical echogenicity and elevated RIm with 55.5% sensitivity. Lupus nephritis (LN) was detected in 4 female patients, despite normal renal parameters, showing elevated serum creatinine levels. Conclusions Doppler assessment of renal vascular waveforms effectively identifies chronic renal changes, aiding in the diagnosis of altered RFTs and guiding prognosis. While it detects typical changes like decreased size and parenchymal atrophy, it may not be as indicative of diabetic nephropathy. Key ultrasound indicators such as changes in echotexture and size, along with associated findings like ascites and effusions, help recognize altered renal function and minimize unnecessary interventions.

Comparison of Cerebral Blood Circulation of Fetuses with Congenital Heart Disease with Healthy Fetuses.

The effect of congenital cardiac malformation on fetal cerebral circulation has not been well known. This study aimed to compare the cerebral blood circulation of fetuses with congenital heart disease (CHD) with healthy fetuses. This prospective cohort study included 37 pregnant women who presented to the gynecology and obstetrics department of department of Farabi Hospital, Faculty of Medicine, Karadeniz Technical University for anomaly screening in the second trimester. The women were divided into two groups as those with fetuses having CHD and healthy fetuses. Middle cerebral artery (MCA), peak systolic velocity (PSV), pulsatility index (PI), resistivity index (RI), systole/diastole (S/D) ratio, and MCA transverse section diameter (mm) were recorded for each fetus. The most common CHDs were truncus arteriosus and hypoplastic left heart syndrome. The mean MCA PSV, resistivity index, and MDCA vessel diameter values were statistically significantly higher in the study group compared with fetuses without CHDs. The mean PI and systole/diastole ratio were statistically significantly lower in the study group than in the control group. This study reported that MCA PSV, RI, and vessel diameter were significantly higher and the S/D ratio and PI were significantly lower in fetuses with CHD compared to the healthy fetuses.

Comparative Analysis External Iliac or Internal Iliac Arteries as Graft Selection for Renal Transplantation: A Scientific Inquiry

Background: Renal transplantation is the definitive treatment for patients with end-stage renal disease (ESRD), offering improved quality of life and survival rates. The success of renal transplantation significantly depends on the surgical techniques employed, particularly the site of vascular anastomosis. While both external and internal iliac arteries are commonly used for this purpose, the impact of the choice between these two sites on transplant outcomes remains a subject of debate. Objective: This study aimed to compare the early post-operative outcomes of renal transplantation between anastomoses performed to the external iliac artery and those to the internal iliac artery, to determine if one technique offers superior results over the other. Methods: In a quasi-experimental study at the Institute of Kidney Diseases and Transplant, 50 patients with single-artery renal transplants, performed from January 2016 to July 2020, were divided into two groups based on the artery used for anastomosis: Group A (external iliac artery, n=25) and Group B (internal iliac artery, n=25). The study assessed various outcomes, including lymphocele formation, time to urine production, nadir serum creatinine levels, resistive index, hospital stay duration, and erectile function pre- and post-transplant, using the International Index of Erectile Function (IIEF) scoring system. Statistical analysis was conducted using IBM SPSS Statistics version 26. Results: The incidence of lymphocele formation was significantly higher in Group B (3 cases) compared to Group A (1 case) (P=0.045). No significant differences were found in the mean time to urine production (Group A: 22.5 minutes, Group B: 15.4 minutes), mean nadir serum creatinine (Group A: 1.17 mg/dl, Group B: 1.31 mg/dl), or mean resistive index (Group A: 0.62, Group B: 0.63). The mean hospital stay and changes in erectile function scores pre- and post-transplant were also similar between the groups. Conclusion: The choice between external and internal iliac artery anastomosis in renal transplantation does not significantly affect early post-operative outcomes, except for a higher risk of lymphocele formation with the internal iliac artery. These findings highlight the importance of surgical technique selection based on individual patient characteristics and suggest the need for further research to explore long-term outcomes.

Quantitative Analysis of Occipital Artery Bypass Donor Vessels by Ultrasonography and DSA.

Occipital artery (OA) acts as a vital donor vessel in intra-cranialand extra-cranial bypass. Ultrasonography and digital subtracted angiography (DSA) are becoming increasingly important in the assessment of vascular morphology and hemodynamically; however, quantitative analysis of occipital artery bypass donor vessels by Ultrasonography and DSA are seldom discussed. A retrospective study involving 62 cases accepted occipital artery bypass to treat posterior circulation aneurysms or artery occlusion/stenosis. The characteristics of OA are collected and analyzed. Occipital artery bypasses were performed to treat posterior circulation aneurysms in 34 patients and to treat posterior circulation artery occlusion or stenosis in 28 patients. Compared with the ultrasonography group, the DSA group had a greater diameter of OA, and Bland Altman analysis indicated that the discrepancy between the 2 groups was about 0.555 mm. Ultrasonography showed the characteristics of OA: the mean Peak Systolic Velocity (PSV) was 42.98 cm/s, the mean End Diastolic Velocity (EDV) was 8.811 cm/s, and the mean Resistance Index (RI) was 1.46. There were no statistical differences in the diameter of OA, PSV, EDV, and RI between the male group and female group, the elderly group and younger adult group or the left occipital artery group and right occipital artery group. However, compared with patients with posterior circulation aneurysms, patients with artery occlusion or stenosis were older and had higher PSV, RI, and greater diameter in occipital arteries. The mean diameter of occipital arteries was increased in the first postoperative years but reduced in 3 patients during 1 year follow-up. Both ultrasonography and DSA were effective assessment methods of occipital artery bypasses, and the DSA group had a greater diameter of OA. Age, gender, and left or right sides had little effect on the diameter of OA, PSV, EDV, and RI. Posterior circulation occlusion or stenosis had higher PSV, RI, and greater diameter of the occipital artery when compared with posterior circulation aneurysms. Occipital artery bypasses could increase the diameter of OA in most cases.

The prevalence, enterotoxigenic properties and antimicrobial susceptibility of Staphylococcus aureus isolated from various foods of animal origin

This study aimed to determine the prevalence, enterotoxigenic properties and antimicrobial resistance profile of Staphylococcus aureus isolated from 850 food samples, including bulk tank milk, Tulum cheese, chicken meat and beef carcasses, in Türkiye. S. aureus contamination rates and the mean contamination levels of 86 positive samples from bulk tank milk, Tulum cheese, chicken meat and beef carcasses were 10.8% (n:49) and 3.01±0.48 log cfu/ml, 17% (n:17) and 3.08±0.42 log cfu/g, 12% (n:12) and 2.89±0.27 log cfu/g, and 4% (n:8) and 1.28±0.54 log cfu/cm2 , respectively. 39 out of 86 isolates (45.3%) had one or more enterotoxin genes (sea-see, seg-selj, sep). sed was the most common classical enterotoxin gene, whereas sei was the most common new enterotoxin gene. Antimicrobial susceptibility testing against 16 antibiotics performed by VITEK 2 showed that 61 isolates (70.9%) were resistant to various antibiotics. 32.8% of the resistant isolates were multidrug resistant (MDR) and the mean multiple antimicrobial resistance (MAR) index was 0.301. The isolates were mostly resistant to penicillin (63.9%), followed by oxacillin (24.4%), clindamycin (19.7%) and erythromycin (12.7%). mecA was detected in 13 isolates (15.1%), but no mecC was found. It was concluded that most of the S. aureus isolates had enterotoxin genes which might cause foodborne intoxications. The high antibiotic resistance rates observed in these strains, including MRSA, may also result in some public health hazards.