Evaluation of Carotid Intimal Thickness in Type 2 Diabetic Individuals by Colour Doppler Ultrasonography in a Teaching Hospital in Hyderabad, Telanaga, India

BACKGROUND Diabetes mellitus is a common chronic condition in our country and is an established modifiable risk factor for cardiovascular diseases and ischemic stroke. Carotid Doppler ultrasonography is a popular tool for evaluating atherosclerosis of the carotid artery. Its two-dimensional grayscale can be used for measuring the intima-media thickness, which is a very good biomarker for atherosclerosis and can aid in plaque characterisation. We intend to evaluate carotid intimal thickness by colour Doppler ultrasonography in type 2 diabetic individuals in a teaching hospital. METHODS A prospective study was done among 70 cases of diabetes mellitus in whom ultrasonography (USG) was done in the Department of General Medicine, Maheshwara Medical College, Patancheru, Hyderabad, Telangana. RESULTS In the present study, study participants were in the age group of 20 - 70 years. Majority of the cases was in the 41 - 50 years age group with a slight male predominance and the male to female ratio was 1.8:1. In this study, intimal medial thickness (IMT) change of 0.07 mm was observed. Within the observation period of eight months, the IMT of diabetic patients increased by an average of 0.06 mm. CONCLUSIONS Colour Doppler ultrasonography of carotid is an important imaging modality for early detection of carotid artery stenosis in diabetic patients who are at risk for developing carotid atherosclerosis. It should be a routine practice to screen diabetic patients for carotid atherosclerosis. KEYWORDS Colour Doppler USG, Intima-Media Thickness, Type 2 Diabetes, Atherosclerosis

122 Colour-Doppler ultrasonography as a tool for oocyte donor selection

Colour-Doppler ultrasonography (CDU) has been applied for a more detailed examination of the ovary and uterus, mainly local blood flow in ovarian follicles and the corpus luteum (CL). The main use of CDU is for the diagnosis of early pregnancy or the selection of recipients for embryo transfer in cattle; however, this tool can also be used to select oocyte donors according to blood flow to the ovary. The concept is that more blood flow in the ovary is conducive to a healthier intraovarian environment (e.g. higher progesterone levels and removal of reactive oxygen species), yielding higher quality oocytes. The objective of this research was to evaluate invitro embryo production (IVP) after selection of oocyte donors, considering ovary irrigation before ovum pickup (OPU). The research was carried out in the reproduction laboratory at the Palominos Ranch (Jalisco, México). The oocyte donors (n=15) were synchronized before each round of OPU using an intravaginal device (1.9g of progesterone) with oestradiol benzoate (2mg) and cloprostenol sodium (500µg) on Day 0, to avoid the presence of a corpus luteum and to synchronize the follicular wave. On Day 6, the intravaginal device was removed and OPU was performed. All Angus breed donors between 3 and 5 years old with a body condition score between 5–6 (scale 1–9, where 1 is extremely thin and 9 is very obese) and were evaluated with transrectal CDU (Sonoscape S2™) with a linear-array probe (7.5MHz) before the first OPU session only. The oocyte donors were classified subjectively into three categories: low blood flow (LBF, ∼30% ovarian area), median blood flow (MBF, ∼50% ovarian area), and high blood flow (HBF, ∼70% ovarian area) and were submitted to 3 cycles of IVP each (45 total cycles). Semen from a proven bull for IVF was used during all IVP cycles. All oocytes collected from each donor were used in IVF with the same semen in all IVP cycles. The total oocytes collected, and percentages of viable oocytes, cleavage, and blastocysts on Day 7 of culture were evaluated. Statistical analysis was carried out using the GLM procedure of SAS software (version 9.3; SAS Institute Inc.) to evaluate the results of LBF, MBF, and HBF (P-value=0.05). Total oocyte recovery was 11.28±1.92, 10.06±1.31, and 15.52±1.05 for HBF, MBF, and LBF, respectively, being significantly higher for LBF (P<0.05). There were no differences in viable oocytes among groups. Cleavage rates were 53.04%±3.43 for HBF, 43.18%±2.34 for MBF, and 43.69%±1.89 for LBF, being significantly higher for HBF (P<0.05). Percentage of blastocysts on Day 7 was 38.16%±3.80 for HBF, 30.11%±2.60 for MBF, and 17.78%±2.10 for LBF. This value tended to be significantly higher for HBF than MBF, and both were significantly superior to LBF (P<0.05). In conclusion, under the conditions of this research, although LBF donors had more total recovered oocytes, blastocyst rates were increased in HBF and MBF donors. Therefore, based on the results of the present study, CDU can be a useful tool for the selection of oocyte donors.

48 Timing of luteolysis and conceptus expulsion after induced pregnancy loss at three different timepoints after maternal recognition of pregnancy in cattle

Results from previous research indicate that induced pregnancy loss (IPL) on Day 36 of gestation in cattle resulted in luteolysis by gestation Day ∼45. The aim of this study was to test the hypothesis that IPL at 25, 35, or 55 days of gestation will result in luteolysis and whether the interval between IPL and luteolysis is positively associated with days of gestation at time of treatment. Pregnant non-lactating beef cows were randomly assigned to undergo IPL, consisting of an intrauterine infusion of 120mL of hypertonic saline (7.2%), at Day 25 (IPL25, n=15), Day 35 (IPL35, n=14), or Day 55 (IPL55, n=14). Corpus luteum (CL) volume and embryo/fetal viability were evaluated by transrectal B-mode ultrasonography daily for 19 days following treatment and every other day subsequently until luteolysis was identified or gestation Day 91. Blood flow through the CL was evaluated using colour-Doppler ultrasonography, and luteolysis was defined as the day when <25% of the CL was represented with colour pixels. Conceptus expulsion was defined as the absence of a conceptus and fluid accumulation in the uterus was <25%. Data were analysed using Proc Mixed in SAS (v9.4; SAS Institute Inc.). Cessation of conceptus heartbeat occurred in all animals within 24h of administration of treatment. Day of luteolysis occurred earlier (P<0.01) in IPL25 (5.3±0.4d) than IPL55 (8.9±1.4d) cows, and luteolysis tended (P=0.07) to occur earlier in IPL35 (6.6±0.6d) than IPL55 cows; however, values for this variable in IPL25 and IPL35 cows were similar (P>0.2). The variance in timing of luteolysis was greater for IPL55 than for IPL35 cows, whereas variance for IPL35 was greater than that for IPL25 (P<0.05) cows. Conceptus expulsion was detected earlier (P<0.01) in IPL25 (Day 4.2±0.4) and IPL35 (Day 5.8±0.5) than IPL55 (Day 10.4±1.4) cows; however, IPL25 and IPL35 cows had similar (P>0.1) values for this variable. Values for luteolysis and conceptus expulsion were correlated in IPL35 (r=0.84; P<0.01) and IPL55 (r=0.88; P<0.01) cows, whereas there was no correlation among values for these variables in IPL25 (r=0.31; P=0.3) cows. There were effects of treatment (P<0.01), time (P<0.01), and treatment by time interaction (P<0.01) on CL volume. Volume of the CL was less (P<0.04) in IPL25-treated cows by treatment day 5 compared with that in IPL55-treated cows. Additionally, CL volume was less (P<0.03) in IPL25 by treatment day 6 than in IPL35 cows, and IPL35 cows had a lesser (P<0.01) CL volume starting on treatment day 10 than IPL55 cows. Induction of pregnancy loss at different times of gestation resulted in luteolysis; however, the interval between treatment and luteolysis tended to increase as gestation days increased. Furthermore, the variability in the timing of luteolysis increased as gestation days increased. Results from the present study support the working hypothesis of presence of a continuous mechanism for CL maintenance during pregnancy beyond the classical maternal recognition period in cattle.

Finger blood flow after the cold challenge with primary Raynaud’s syndrome: a case report

Background Raynaud’s syndrome is a commonly encountered disorder. The relationship between the grade of Raynaud’s phenomenon and severity of vasoconstriction is unclear. Recently, various methods including colour Doppler ultrasonography have been used for assessment of vascularity of the extremities including fingers. Case summary A 53-year-old man had a 6-year history of Raynaud’s phenomenon with typical tri-coloured changes proceeding from white, blue to red and slight pain and slight paresthaesia in the fingers of both hands when his fingers were exposed to cold. He was diagnosed with primary Raynaud’s syndrome. After treatment with the calcium channel blocker amlodipine (5 mg once daily), a cold challenge did not induce Raynaud’s phenomenon on the fingers in the present patient. After the cold challenge, colour Doppler ultrasonography showed that vascularity was markedly decreased or was absent, whereas there was little difference in skin colour of the fingers. Discussion In Raynaud's phenomenon, vasospasm may occur even if the symptoms are well-controlled with a calcium channel blocker. It is unlikely that clinical symptoms in patients with Raynaud’s syndrome always reflect the severity of vasoconstriction in their fingers.

Budd-Chiari Syndrome: Aetiologi, Diagnosis, and Management

Budd-Chiari Syndrome (BCS) is known as a disease caused by the presence of outflow obstruction of the hepatic vein and is commonly not considered as a diagnosis. Such obstruction may happen in all hepatic vein flow points, starting from small veins to the inferior vena cava opening in the right atrium, regardless of the aetiology. This syndrome occurs in approximately 0.001% population and has various aetiologies, including congenital and acquired prothrombotic conditions, myeloproliferative disease, and oral contraceptives use. Advancement in imaging enables most BCS to be diagnosed based on non-invasive imaging tests. Colour Doppler ultrasonography, which has sensitivity and specificity rate of 85-95%, is an appropriate technique for early investigation of Budd-Chiari syndrome. Colour Doppler ultrasonography and MSCT with contrast have a significancy rate of 85-91.3% with a p value 0.05 between both modalities in diagnosing BCS. Management of BCS starts with the non-invasive to highly invasive procedures, consisting of medical or recanalization therapy to prevent necrosis.

Diagnostic accuracy of Color Doppler of cerebral and umbilical pulsatality in diagnosing IUGR, taking birth weight as gold standard.

Objectives: To determine the diagnostic accuracy of colour Doppler of cerebral and umbilical pulsatality in diagnosing IUGR, taking birth weight as gold standard. Study Design: Descriptive, Cross Sectional Study. Setting: Department of Radiology, DHQ Hospital, Faisalabad. Period: 30th May 2016 to 29th November 2016. Material & Methods: Total 129 clinically suspected IUGR, 18 to 40 years of age with singleton pregnancy were included. Patients having Hb< 8.5 g/dl, chromosomal abnormality, chronic infections, severe systemic illness like uncontrolled diabetes mellitus, cardiac disease, renal or hepatic disease were excluded. Colour Doppler Ultrasonography of the cerebral and umbilical artery was performed in every patient and looked for IUGR. Colour Doppler sonography findings were compared with birth weight of baby. Results: Mean age was 30.26 ± 4.67 years. The mean gestational age was 38.60 ± 1.27 weeks. Mean parity was 2.68 ± 0.74. In Colour Doppler Ultrasonography positive patients, 64 were true positive while 09 were false positive. Among, 56 Colour Doppler Ultrasonography negative patients, 07 were false negative while 49 were true negative. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of colour Doppler of cerebral and umbilical pulsatality in diagnosing IUGR, taking birth weight as gold standard was 90.14%, 84.49%, 87.67%, 87.50% and 87.60% respectively. Conclusion: This study concluded that diagnostic accuracy of colour Doppler of cerebral and umbilical pulsatality in diagnosing IUGR is quite high.

Power and colour Doppler ultrasonography for evaluation of the ovarian and uterine haemodynamics of infertile mares

The present study was undertaken to investigate the haemodynamics of the ovary and uterus in infertile mares using power and colour Doppler ultrasonography. Forty-seven Arabian mares were handled in the current work through several examinations. Based on the breeding history complaints, physical, vaginal examination and Doppler examination, 12 mares were found to be suffering from abnormal ovarian structures (Experiment I). In addition, nine mares with normal cyclic activity were kept as control. Another 16 mares were found to suffer from abnormal uterine conditions and 10 mares with normal uterine findings served as control (Experiment II). Blood flows to the anovulatory follicle, ovarian inactivity, granulosa cell tumour were compared to those to the dominant follicle and luteal blood flow. Uterine blood flow of cysts, abnormal uterine fluids (endometritis) during estrus and diestrus were compared to normal uterine vascularisation during estrus, diestrus and post-mating. Results showed that granulosa cell tumour had the highest red colour blood flow and total colour blood flow area. Blue colour blood flow area of the corpus luteum was higher compared to the dominant follicle and inactive ovary. Uteri with uterine cyst and abnormal uterine fluids during estrus of infertile mares had high red colour blood flow, blue colour blood flow and power blood flow areas compared to normal uterus during estrus. It could be concluded that Doppler ultrasound could distinguish between normal ovaries with normal or abnormal structures. Moreover, the increased uterine blood flow area of mares with abnormal fluids in their uteri (endometritis) and uterine cysts could be distinguished by comparison to the normal uterine blood flow during estrus.