Francesca Gigli Berzolari

Cardiovascular screening in low-income settings using a novel 4-lead smartphone-based electrocardiograph (D-Heart®)

BACKGROUND MHealth technologies are revolutionizing cardiovascular medicine. However, a low-cost, user-friendly smartphone-based electrocardiograph is still lacking. D-Heart® is a portable device that enables the acquisition of the ECG on multiple leads which streams via Bluetooth to any smartphone. Because of the potential impact of this technology in low-income settings, we determined the accuracy of D-Heart® tracings in the stratification of ECG morphological abnormalities, compared with 12-lead ECGs. METHODS Consecutive African patients referred to the Ziguinchor Regional Hospital (Senegal) were enrolled (n=117; 69 males, age 39±11years). D-Heart® recordings (3 peripheral leads plus V5) were obtained immediately followed by 12 lead ECGs and were assessed blindly by 2 independent observers. Global burden of ECG abnormalities was defined by a semi-quantitative score based on the sum of 9 criteria, identifying four classes of increasing severity. RESULTS D-Heart® and 12-lead ECG tracings were respectively classified as: normal: 72 (61%) vs 69 (59%); mildly abnormal: 42 (36%) vs 45 (38%); moderately abnormal: 3 (3%) vs 3 (3%). None had markedly abnormal tracings. Cohens weighted kappa (kw) test demonstrated a concordance of 0,952 (p<0,001, agreement 98,72%). Concordance was high as well for the Romhilt-Estes score (kw=0,893; p<0,001 agreement 97,35%). PR and QRS intervals comparison with Bland-Altman method showed good accuracy for D-Heart® measurements (95% limit of agreement ±20ms for PR and ±10ms for QRS). CONCLUSIONS D-Heart® proved effective and accurate stratification of ECG abnormalities comparable to the 12-lead electrocardiographs, thereby opening new perspectives for low-cost community cardiovascular screening programs in low-income settings.

Air pollution is associated to the multiple sclerosis inflammatory activity as measured by brain MRI

Background: Some environmental factors have been already associated to increased risk of multiple sclerosis (MS), but it is plausible that additional factors might play a role. Objective: To investigate in MS patients the relationship between inflammatory activity, detected by brain magnetic resonance imaging (MRI) with gadolinium (Gd), and air pollution, namely, particulate matters with diameter less than 10 μm (PM10). Methods: We analyzed from 52 remitting MS patients 226 brain MRIs, 34% with (Gd+MRI) and 66% without (Gd-MRI) T1-Gd-enhancing lesions. Daily recording of PM10 in the 30 days before MRI examination was obtained by monitors depending on the residence of subjects. Results: PM10 levels in the 5, 10, 15, 20, and 25 days before brain MRIs were higher (plus 16%, 21%, 24%, 25%, and 21%, respectively) with reference to Gd+MRI versus Gd-MRI. There was a significant association between Gd+MRI and PM10 levels (p = 0.013), independent of immune therapies, smoker status, and season. In patients who had two repeated MRIs with opposite outcomes (Gd-MRI and Gd+MRI), PM10 levels were strongly higher in concurrence with Gd+MRI (p < 0.0001). Conclusion: Our findings suggest that air pollution may be a risk factor for MS favoring inflammatory exacerbations.

A fuzzy ‘boater’ model to detect fouling and spreading risk of non-indigenous species by recreational boats

Recreational boating is an unregulated and underestimated vector of spread of non-indigenous species (NIS) in marine environments. The risk of a single boat to spread NIS depends not only on the local environmental context, but also on the type of boat and on the boat owners behaviour (hull cleaning and painting frequency, travel history). In this paper we present a model to assess the risk of fouling and spreading of NIS and its application to data derived from a questionnaire given to Italian boat owners. The model uses a two-levels fuzzy logic approach: (1) the first level assesses the risk of hull fouling and risk of spreading separately; (2) the second level combines the two separate risks in an overall index ranging from 0 (null risk) to 100 (highest risk) and measures the global risk of NIS introduction and spread through recreational boating. The questionnaire and the fuzzy model allow for a simple and rapid assessment of boats most likely to be infested. The proposed fuzzy model can be easily edited and adapted to context-specific ecological and social conditions. The results of this Italian study showed that 53.9% of the respondents were in the very-low and low risk categories, and 46.1% in the medium, high and very-high risk categories. Possible associations between some boaters habits and the fouling and spreading risk were explored using logistic regression analyses. The results indicate a high-risk profile of boat owner as an experienced sailor who visits many marinas during the summer season. Biosecurity guidelines, containment measures and awareness raising programmes should be implemented to prevent and avoid further spread of NIS in marine environments, and such management actions would benefit from the early detection of high-risk boats, and from the identification of profiles of boaters upon which these initiatives should be prioritized.