440 Assessing cardiac output by echocardiography: is contrast always better?

Abstract Aims Contrast echocardiography is very useful in clinical cardiology. It is mainly performed for the assessment of global left ventricular (LV) function, left ventricular ejection fraction (LVEF), and stroke volume (SV), thanks to improved visualization of endocardial LV borders. Contrast echocardiography, however, is not always easily available, it is more expensive than an ordinary echocardiography and it can be contraindicated in some situations (e.g. in the presence of egg allergy). This study aimed to compare the estimation of cardiac output during traditional transthoracic echocardiography and after the injection of (Sonovue) contrast. Methods and results Patients who underwent an echocardiography with and without injection of (Sonovue) contrast between April 2019 and September 2021 were enrolled in the study. A complete transthoracic echocardiography was performed and Sonovue contrast was then injected. End-diastolic and end-systolic left ventricular volume in apex 4 and 2 chamber views, biplane LVEF with Simpson's formula, end-diastolic and end-systolic left ventricular diameters in parasternal long axis were measured prior and after injecting contrast. Left ventricular outflow tract diameter (LVOTd) was measured and LV outflow tract velocity time integral was traced in order to calculate LVOT VTI SV, as the product of LVOT cross sectional area (assuming that LVOT is circular) to the LVOT VTI. LVOT VTI SV obtained during traditional echocardiography was compared to LVEF SV, calculated as the difference between end-diastolic and end-systolic volume traced after injecting Sonovue contrast. Seventy-eight patients were enrolled in the study. Forty-two had history of CAD, 22 presented dilatative cardiomyopathy, 2 hypertrophic cardiomyopathy (HMC), 1 arrhythmogenic right ventricular dysplasia; 16 had atrial fibrillation, 66 arterial hypertension, and 20 diabetes. The main indications for contrast echocardiography were measurement of EF (39 cases) and exclusion of thrombi in LV apex (18 cases). Other indications were suspect of HCM, atrial myxoma or LV non-compaction. LVOT VTI stroke volume was calculated in 64 patients (LVOT diameter was not well visualized in 8 patients and LVOT VTI could not be measured in 14 patients due to poor acoustic windows). In the same patients LVEF Stroke Volume was also calculated. A strong correlation (P-value < 0.0001) between LVOT stroke volume and LVEF Stroke Volume was found (Figure 1). Conclusions Contrast echocardiography is very useful in clinical practice, however, requires trained physicians and its use is not widespread. This study demonstrates that estimating cardiac output through LVOT VTI SV, in patients with suboptimal echo images can be equally accurate as measuring LVEF SV with contrast echocardiography. This could be particularly useful in the acute settings when contrast echocardiography isn't always feasible and knowing cardiac output can be important for therapeutic implications

Smart aging platform for evaluating cognitive functions in aging: A comparison with the MoCA in a normal population

Postprint (author's final draft

Negative Short-Term Outcome of Detoxification Therapy in Chronic Migraine With Medication Overuse Headache: Role for Early Life Traumatic Experiences and Recent Stressful Events

Background: Early traumatic experiences and Stressful episodes appear to be associated to the development and perpetuation of chronic pain disorders and to dependence-related behaviors.Objective: The present study evaluated whether these factors can be predictors, together with psychiatric conditions, of the outcome of a detoxification treatment in patients suffering from chronic migraine and medication-overuse headache in a 2-month follow-up.Methods: Consecutive patients undergoing a detoxification program as therapy for treating chronic migraine and medication overuse headache at the Pavia Headache Center were analyzed. During this program, lasting about 1 week, all patients received the standard CARE in-patient withdrawal protocol, which consisted in discontinuing abruptly the overused drug(s) and receiving daily detoxification therapy. Data on childhood traumatic events and recent stressful ones were analyzed by means of the Childhood Trauma Questionnaire and Stressful life-events Questionnaire. Psychiatric conditions were evaluated using the Structured Clinical Interview for Diagnostic and Statistical Manual of mental disorders.Results: A total of 166 (80% females; mean age 44.7) patients completed the follow-up at 2 months after the detoxification program: of these 118 (71%) (78% females; mean age 44.7) stopped overuse and reverted to an episodic pattern of headache (Group A); 19 (11%) (89% females; mean age 41.3) kept overusing and maintained a chronic pattern of headache (Group B); and 29 (18%) (79% females; mean age 46.9) stopped overuse without any benefit on headache frequency (Group C). At the multivariate analyses, a higher number of early life emotional distress (Odds Ratio 11.096; p = 0.037) arose as a prognostic factor for the outcome in Group B, while major depression during life-time (Odds Ratio 3.703; p = 0.006) and higher number of severe stressful episodes in the past 10 years (Odds Ratio 1.679; p = 0.045) were prognostic factors for the outcome of Group C.Conclusions: Data suggest that early life traumas and stressful events have a negative impact on the outcome of the detoxification program in subjects overusing acute medication for headache. The history of emotional childhood traumas is associated to the failure to cease overuse, whereas recent very serious life events are associated to the persistence of headache chronicity

Self-perceived normality in defecation habits

Background: Available information on normal bowel habits was mainly gathered by means of telephone interviews or mailed questionnaires. Aims: We undertook a prospective study to evaluate the defecatory habits in subjects perceiving themselves as normal concerning this function. Subjects and Methods: A questionnaire (4-week diary with "yes-no" daily answers to six questions concerning bowel habits) was distributed to 204 subjects perceiving their defecation behaviour as normal. Results: The completed questionnaire was returned by 140 subjects. No significant differences were found between sexes or age groups for any variable, even though straining at stool and feeling of incomplete and/or difficult evacuation showed a trend to increase with age. No subject had less than three bowel movements per week or more than three per day. The percentage of symptoms linked to an abnormal defecatory behaviour was well below 10%. Fifty-five percent of subjects reported at least one parameter of abnormal functioning; the most frequent was straining at stool and the rarer was the manual manoeuvres to help defecation. Conclusions: In normal subjects the prevalence of symptoms considered in Rome II criteria as part of an abnormal defecatory behaviour (in more than 25% of defecations) is well below 10%, manual manoeuvres are almost never used to help defecation, and the frequency of defecations is at least three per week. © 2005 Editrice Gastroenterologica Italiana S.r.l

Disaster risk perception knowledge base - A consolidated understanding of disaster risk perception in social media and crowdsourcing

Stato dell'arte sulla percezione del rischio in relazione all'uso dei social media e del crowdsourcing nelle diverse fasi del disaster risk managemen

Framing Disaster Risk Perception and Vulnerability in Social Media Communication: A Literature Review

The paper presents the results of a literature review on how social media can impact on disaster risk perception and vulnerability and how these two aspects are interconnected, trying to understand what factors have consequences especially on informational vulnerability. The paper answers to the increasing requests at an international level to move from a technocratic approach to disaster risk management and reduction to a holistic one, where social perspective is integrated. The paper states that this change of paradigm is relevant, especially considering the role that new technologies in communication and information systems are acquiring in disaster risk management and reduction. What emerges from the literature review is that there is a limited scientific production on the topic and further works are desired, to improve knowledge on how new communication and information technologies can impact on vulnerability and risk perception. Furthermore, the two topics are usually discussed separately. However, the role that risk perception can have in increasing or reducing vulnerability deserves to be better discussed

Framing Disaster Risk Perception and Vulnerability in Social Media Communication: A Literature Review

The paper presents the results of a literature review on how social media can impact on disaster risk perception and vulnerability and how these two aspects are interconnected, trying to understand what factors have consequences especially on informational vulnerability. The paper answers to the increasing requests at an international level to move from a technocratic approach to disaster risk management and reduction to a holistic one, where social perspective is integrated. The paper states that this change of paradigm is relevant, especially considering the role that new technologies in communication and information systems are acquiring in disaster risk management and reduction. What emerges from the literature review is that there is a limited scientific production on the topic and further works are desired, to improve knowledge on how new communication and information technologies can impact on vulnerability and risk perception. Furthermore, the two topics are usually discussed separately. However, the role that risk perception can have in increasing or reducing vulnerability deserves to be better discussed