Ophthalmic artery Doppler in the complementary diagnosis of preeclampsia: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the accuracy of different parameters of the ophthalmic artery Doppler (OAD) in the complementary diagnosis of preeclampsia (PE). METHODS: This meta-analysis adhered to the PRISMA guidelines. To investigate the mean difference in OAD values, peak systolic velocity (PSV), end-diastolic velocity (EDV), second systolic velocity peak (P2), resistance index (RI), pulsatility index (PI), and peak ratio (PR), between PE cases (overall and according to severity) and controls, random-effects meta-analyses were conducted for each Doppler parameter, with overall PE and mild and severe PE subgroups. Diagnostic performance and heterogeneity were evaluated with summary receiver operating characteristic (sROC) curves and 95% confidence intervals obtained with bivariate models. RESULTS: Eight studies stratified the results into mild and severe or late and early PE, involving 1,425 pregnant women. PR and P2 had better diagnostic performance than the other indexes, with the PR of AUsROC at 0.885, the sensitivity of 84%, and specificity of 92%, with a low false-positive rate of 0.08 and the P2 with AUsROC of 0.926, the sensitivity of 85% and specificity of 88%. RI, PI, and EDV showed good performance and consistency across studies but lower AUsROC values of 0.833, 0.794, and 0.772, respectively. CONCLUSION: Ophthalmic artery Doppler is a complementary tool with good performance for the diagnosis of overall and severe preeclampsia, with high and best sensitivity and specificity when using PR and P2 parameters.

Sonographic hepatorenal ratio: a noninvasive method to diagnose nonalcoholic steatosis.

PURPOSE: To evaluate the accuracy of the sonographic hepatorenal ratio (HRR) in the diagnosis and grading of nonalcoholic steatosis, using biopsy as the reference. METHODS: Ultrasound (US) and liver biopsy were performed in 42 patients with nonalcoholic fatty liver disease. Forty healthy volunteers without steatosis at US and without risk factors for nonalcoholic fatty liver disease were also studied. The HRR was obtained by dividing the mean brightness level of region-of-interest pixels in hepatic parenchyma by that in renal parenchyma. Needle biopsy samples (hematoxylin-eosin stained) were classified as mild (5-33% fatty infiltration), moderate (>33-66%), or severe (>66%) steatosis. Spearman coefficient was used to evaluate the correlation between HRR and steatosis grade, analysis of variance for differences between subgroups, and receiver operating characteristic curve analysis for sensitivity and specificity. RESULTS: Significant correlation was found between HRR and histologic steatosis (r = 0.80, p < 0.01). The HRR cutoff for predicting steatosis was ≥1.24 (sensitivity, 92.7%; specificity, 92.5%). The mean ± SD HRRs in controls and steatosis subgroups were control 1.09 ± 0.13, mild 1.46 ± 0.24, moderate 1.52 ± 0.27, severe 2.04 ± 0.3 and were significantly different from each other except between mild and moderate steatosis subgroups. CONCLUSIONS: The HRR is a noninvasive, objective, and simple method that could be used to diagnose and grade hepatic steatosis.

A sex specific approach of ophthalmic and middle cerebral arteries Doppler in smokers.

Vascular dysfunctions can progress and lead to stroke and cardiovascular disease, especially in smokers. The presence of particular vascular changes according to sex has been described and they can be identified by the Doppler method. This study evaluated Doppler velocimetry parameters of the Ophthalmic Artery (OA) and the Middle Cerebral Artery (MCA) according to sex in smokers regarding a non-smoker group. This cross-sectional observational study included 178 subjects: 93 women and 85 men. Doppler parameters were assessed in OA and MCA. Student's t-test was used, with p < 0.05. There were no significant differences in OA and MCA Doppler velocimetry data between male non-smokers and smokers. However, female smokers presented several differences compared with non-smokers: lower pulsatility index (PI) and higher peak ratio in OA, and higher PI and resistance index and lower end diastolic velocity in MCA. There were different brain vascular waveforms in the group of female smokers compared with non-smokers. Cigarette smoking also led to opposite arterial patterns in OA and MCA in the female group, with signs of falling impedance in OA and increased impedance in MCA. An individualized approach regarding arterial changes according to sex is desirable.

Ophthalmic artery Doppler velocimetry in healthy pregnancy.

OBJECTIVES: To establish normative data for ophthalmic artery Doppler parameters throughout a healthy pregnancy, to investigate the possible correlation between these Doppler measurements and gestational age, and to test intraobserver variability. METHODS: A prospective cross-sectional study was performed to assess various Doppler parameters in 276 healthy women between 20 and 39 weeks of gestation. The following measurements were obtained: pulsatility and resistance indices (PI, RI), peak systolic velocity (PSV), peak diastolic velocity (PDV), end diastolic flow velocity (EDFV), and peak ratio (PR). Quantile regression was used to estimate reference values throughout pregnancy and P<0.05 was considered significant. The intraclass correlation coefficient (Intra-CC) was used to calculate intraobserver variability. RESULTS: The 5th and 95th prediction intervals for each gestational age are presented. No significant correlation was detected between Doppler indices and gestational age. Intra-CC was excellent (0.996). CONCLUSIONS: Reference values were generated for ophthalmic artery Doppler measurements, and they did not vary significantly during healthy pregnancy.

Potential application value of Doppler ultrasonography in neoadjuvant chemotherapy for breast cancer.

BACKGROUND: The aim of this study was to evaluate the efficacy of the ultrasonography with Power Doppler, by quantifying the vascular density by Vascularity Index (VI), to predict the pathologic response to neoadjuvant chemotherapy (NAC) for breast cancer (BC). METHODS: For this prospective observational study, 20 patients were recruited with a histological diagnosis of infiltrating breast carcinoma and indication for NAC. Patients were submitted to ultrasonography with Power Doppler. Tumor vascular density was evaluated by computer software SysArea©1, before treatment, after 2 or 3 cycles of chemotherapy and at the end of treatment. The pathologic response was analyzed. The sensitivity, specificity and positive and negative predictive values for the histological response were also calculated and P-values <0.05. RESULTS: VI showed a sensitivity of 88.88%, specificity of 100%, positive predictive value of 100% and negative predictive value of 91.66% for the pathologic response, as well as being strongly associated with it. The variation of VI, in terms of either an increase or decrease after 2 or 3 cycles of chemotherapy, significantly predicted the final histological response. CONCLUSIONS: The analysis of VI was predictive and showed a strong correlation with histological response to neoadjuvant chemotherapy for BC.

Abdominal Obesity and Association With Atherosclerosis Risk Factors: The Uberlândia Heart Study.

Ectopic visceral fat (VF) and subcutaneous fat (SCF) are associated with cardiovascular risk factors. Gender differences in the correlations of cardiovascular disease risk factors and ectopic fat in the Brazilian population still lacking. Cross-sectional study with 101 volunteers (50.49% men; mean age 56.5 ±â€Š18, range 19-74 years) drawn from the Uberlândia Heart Study underwent ultrasonography assessment of abdominal visceral adipose tissue with convex transducer of 3.5 MHz of frequency. The thickness of VF was ultrasonographically measured by the distance between the inner face of the abdominal muscle and the posterior face of abdominal aorta, 1 cm above the umbilicus. The SCF thickness was measured with a 7.5 MHz linear transducer transversely positioned 1 cm above the umbilical scar. The exams were always performed by the same examiner. Ectopic fat volumes were examined in relation to waist circumference, blood pressure, and metabolic risk factors. The VF was significantly associated with the levels of triglycerides (P < 0.01, r = 0.10), HDL cholesterol (P < 0.005, r = 0.15), total cholesterol (P < 0.01, r = 0.10), waist circumference (P < 0.0001, r = 0.43), systolic blood pressure (P < 0.001, r = 0.41), and diastolic blood pressure (P < 0.001, r = 0.32) in women, and with the levels of triglycerides (P < 0.002, r = 0,14), HDL cholesterol (P < 0.032, r = 0.07), glucose (P < 0.001, r = 0.15), alanine aminotransferase (ALT) (P < 0.008, r = 0.12), gamma-GT (P < 0.001, r = 0.30), waist circumference (P < 0.001, r = 0.52), systolic blood pressure (P < 0.001, r = 0.32), and diastolic blood pressure (P < 0.001, r = 0.26) in men. SCF was significantly associated with the levels of triglycerides (P < 0.01, r = 0.34), LDL cholesterol (P < 0.001, r = 0.36), total cholesterol (P < 0.05, r = 0.36), waist circumference (P < 0.0001, r = 0.62), systolic and diastolic blood pressure (P < 0.05, r = 0.34) in women, and with the waist circumference (P < 0.001, r = 0.065)), and MetS (P < 0.05, r = 0.11) in men. The VF and SCF were correlated with most cardiovascular risk factors in both genders but our findings support the idea that there are gender differences in the correlations between ectopic fat deposition and the cardiovascular risk factors.

Chronic perfusion changes and reduction in preeclampsia incidence in pregnant smokers: an ophthalmic artery Doppler study.

OBJECTIVE: Our aim was to investigate the hemodynamic profile of the ophthalmic artery in preeclamptic women, pregnant smokers and pregnant controls with no known diseases. STUDY DESIGN: A prospective cross-sectional study using the performed ophthalmic artery Doppler ultrasonography in 20 mild preeclamptic women and 20 severe preeclamptic women, 37 pregnant smokers and 51 controls. Data evaluated by using Doppler ultrasonography were as follows: resistance index, pulsatility index, peak systolic velocity, end diastolic velocity, second peak systolic velocity and peak ratio. The Doppler results, gestational age, patient age and systolic and diastolic pressure of groups were subjected to analysis of variance (p < 0.05). RESULTS: Both groups of preeclamptic women presented significant orbital hyperperfusion (resistance index: 0.64 ± 0.07 and 0.64 ± 0.13, pulsatility index:1.10 ± 0.26 and 1.02 ± 0.30, end diastolic velocity:14.13 ± 4.44 and 15.66 ± 4.17), whereas pregnant smokers showed vasospasm (0.84 ± 0.04, 2.27 ± 0.43, 4.78 ± 1.28, respectively) indicating divergent vascular pattern between these two groups (p < 0.01) and differences between each group and controls (0.78 ± 0.06, 1.89 ± 0.36, 7.43 ± 2.71), respectively, p < 0.01. Peak systolic velocity mean values for severe preeclamptic women was 40.36 ± 5.61 cm/s, significantly higher than in all groups (34.53 ± 6.82 cm/s, 31.03 ± 4.72 cm/s and 34.35 ± 6.43 cm/s). CONCLUSION: Preeclamptic women have presented hyperperfusion whereas chronic smokers have shown hypoperfusion in ophthalmic artery. Thus, chronic flow changes in pregnant smokers might reduce the number of sudden and catastrophic events in preeclampsia.

Perirenal Fat and Association With Metabolic Risk Factors: The Uberlândia Heart Study.

Perirenal fat (PRF) is associated with cardiovascular risk factors. Gender differences in the correlations of cardiovascular disease risk factors and PRF in the Brazilian population are lacking.Cross-sectional study with 101 (50.49% men; mean age 56.5 ±â€Š18, range 19-74 years) drawn from the Uberlândia Heart Study underwent ultrasonography assessment of abdominal adipose. For the PRF, a 3.5 MHz transducer was measured in the middle third of the right kidney, with the transducer positioned at the axillary midline. The examinations were always performed by the same examiner. The PRF thickness was examined in relation to waist circumference, blood pressure, and metabolic risk factors. The PRF was significantly associated with the levels of gamma-glutamyl transferase (P < 0.05, r = 0.08), fasting plasma glucose (P < 0.05, r = 0.07), waist circumference (P < 0.05, r = 0.10), and metabolic syndrome (P < 0.001, r = 0.38) in men, and with the levels of fasting plasma glucose (P < 0.05) in women.The PRF was correlated with most cardiovascular risk factors in men and only in glucose at the women.

Prevalência de bócio e nódulos tireoidianos detectados através de ultra-som em populaçäo com mais de 50 anos / Prevalence of goiter and thyroid nodules detected by of ultrasound in population over 50 years old

O objetivo deste trabalho foi estudar a prevalência de bócio e nódulos em uma populaçäo com mais de 50 anos, comparando-a com grupo controle composto pelos filhos. Para isso, foram avaliados 101 indivíduos (19M / 82F) com idades entre 51 e 85 anos e 65 filhos (18M / 47F)com idades entre 14 e 50 anos. Utilizamos o ultra-som para diagnóstico de bócio e nódulos, mas foi feita, também, avaliaçäo clínica com palpaçäo da tireóide. A prevalência de bócio e nódulos foi maior nos indivíduos com mais e 50 anos (15,8 por cento e 18,8 por cento, respectivamente), do que nos filhos (3,1 por cento e 7,7 por cento, respectivamente) Näo observamos correlaçäo entre volume tiroideano e idade. A palpaçäo da tiróide se mostrou pouco sensível para detecçäo de bócio e nódulos, mas com alta especificidade. Concluímos que a prevalência de bócio e nódulos é maior na populaçäo com mais de 50 anos, embora sem correlaçäo entre volume tiroideano e idade. O ultra-som se mostrou melhor que a palpaçäo isoladamente, na detecçäo de alteraçöes do volume e presença de nódulos tiroideanos.

Gestaçöes tópica e ectópica ovariana simultâneas / Simultaneous topic and ovarian ectopic pregnancies

A associaçao entre gestaçao tópica e ectópica é rara e ocorre aproximadamente 1 em 30.000 gestaçoes. Estamos relatando o caso de paciente primigesta, sem fatores de risco para gestaçao ectópica, com quadro inicial de dor pélvica e sangramento vaginal. Ao ultra-som transvaginal com doplerfluxometria colorida foi identificada gestaçao tópica (embriao vivo de 9 semanas) e gestaçao ectópica na topografia do ovário direito, com embriao morto. A paciente foi submetida a laparotomia com exérese do saco gestacional ectópico ovariano (ooforoplastia), o que favoreceu a evoluçao da gestaçao tópica, com nascimento de recém-nascido PIG. A ultra-sonografia, neste caso, auxiliou o diagnóstico das gestaçoes ectópica e tópica simultâneas, viabilizando a abordagem cirúrgica precoce e a manutençao da gestaçao intra-útero até o termo. O ultra-sonografista deverá sempre estar atento à possibilidade da associaçao entre gestaçao tópica e ectópica, aumentando a sensibilidade do método e reduzindo os riscos das possíveis complicaçoes graves da gestaçao ectópica rota.