Shift work has emerged as a significant health concern in recent years, and research has revealed a link to circadian rhythm dysregulation and atherosclerosis, both of which can increase the risk of cardiovascular disease (CVD). Currently, there is a lack of updated reviews regarding the impact of shiftwork on CVD. Thus, the present narrative review aims to provide a comprehensive summary of the latest research on the relationship between shift work and CVD, identify potential gaps in the current knowledge, and highlight areas for future research. Database searches for peer-reviewed articles published between January 2013 to January 2023 on shift work associated CVD revealed many studies that found shift work is linked with increased prevalence of carotid artery plaque, increased arterial stiffness, and carotid artery intima-media thickness (IMT) all suggestive of a progression of atherosclerosis attributable to shift work. Hypertension, diabetes, and a sedentary lifestyle are known risks for CVD, and the results of the present study suggest that shift work should be added to that list. The elevation of inflammatory markers and DNA damage in shift workers may be linked to their increased progression of atherosclerosis and the positive association of shift work with coronary artery disease. There are minimal studies on mitigating approaches for shift work-related CVD, such as diet modification or exercise, emphasizing the need for further directed research in this area.

A 21-year-old phenotypic male with ambiguous external genitalia and hypospadias was referred for cytogenetic studies. Exploratory laparotomy revealed presence of a small atropic uterus, unilateral gonadal dysgenesis with fallopian tubes on both sides and a cryptorchid testis on the left side. No gonad could be traced on the right side. Chromosomal analysis from peripheral whole blood culture revealed a 46, XY cell line. No mosaicism was detected. Endocrine studies showed elevated levels of serum FSH and LH with low borderline testosterone level and failure to respond to HCG stimulation. The presence of fallopian tube next to testis suggests absence of anti-Müllerian hormone secretion by Sertoli cells. The absence of Wolffian duct derivatives indicates insufficient secretion of testosterone by Leydig cells.

BACKGROUND Cardiovascular Doppler indices have long been demonstrated to have an association with the risk of perinatal death. Recent studies have investigated whether the aortic isthmus (AoI) could contribute to the prediction of mortality. 1 The isthmus, located between the origin of the left subclavian artery and the aortic end of the DA, establishes communication between the two arterial outlets that perfuse in parallel the upper and lower body of the foetus. 2 Objectives of this study were to evaluate the aortic isthmus doppler changes and its utility in management of growthrestricted foetuses. MATERIALS AND METHODSProspective observational study, recruiting 50 women with singleton pregnancy at or beyond 28 weeks of gestation presenting to the tertiary referral hospital between June 2015 to January 2016 with intra uterine growth restricted foetus based on grey scale ultrasound findings and obstetric Doppler Ultrasound showing umbilical artery pulsatility index >95 th percentile. Doppler parameters of umbilical artery, middle cerebral artery and aortic isthmus were recorded and compared to the reference values. RESULTSOut of 50 IUGR foetuses, 36(72%) showed anterograde aortic isthmus net flow whereas 14 (28%) showed retrograde aortic isthmus net blood flow. Median gestational age at inclusion and at delivery was 34.5 & 35.6 weeks in anterograde blood flow group and 30 weeks & 33 weeks in retrograde blood flow group respectively. 46% of patients had pregnancy-induced hypertension. IUGR with anaemia complicating pregnancy (sickle cell anaemia & beta thalassemia trait included) was present in 6% of cases. Bad obstetric history was seen in 4%. The postnatal complications were higher in retrograde aortic isthmus net blood flow group as compared to the anterograde net blood flow group. CONCLUSIONAbsence/reversal of diastolic flow in Aortic Isthmus carries grave prognosis and high mortality. Doppler imaging of the aortic isthmus could be used as a screening tool in clinical surveillance of foetus with IUGR. This might be of clinical relevance in improving the detection and management of intrauterine growth restriction. KEYWORDSAortic Isthmus, Doppler, IUGR.HOW TO CITE THIS ARTICLE: Bhagat B, Sheth J. Doppler assessment of the aortic isthmus and its utility in management of intrauterine growth restricted foetuses.