[Comment] The challenges of planetary mental health in the COVID-19 era.

As the focus of the COVID-19 crisis is gradually taken away from emergency healthcare needs, increased attention is warranted on the psychological impact of the pandemic on a global level. Existing guidance on managing the COVID-19 related distress needs to be better informed by upcoming larger-scale research. Applying e-Health can be useful in dealing with the immediate psychological needs, while developing strategies to identify vulnerable populations and shifting the provision of mental health and social care to community services need to be prioritised when looking at the future. Focusing on global mental health during this universal crisis is an opportunity for promoting a more compassionate and less discriminating society.

Metabolic syndrome and the skin: a more than superficial association. Reviewing the association between skin diseases and metabolic syndrome and a clinical decision algorithm for high risk patients.

There is ongoing scientific interest regarding comorbidities associated with the metabolic syndrome (MeTS). MeTS comprises a combination of parameters that predispose individuals to the development of type 2 diabetes and cardiovascular disease (CVD). Three or more of the following criteria are necessary: fasting glucose > 110 mg/dl (5.6 mmol/l), hypertriglyceridemia > 150 mg/dl (1.7 mmol/l), HDL levels < 40 mg/dl (men)/< 50 mg/dl (women), blood pressure > 130/85 mmHg, waist circumference (values for Mediterranean populations > 94 cm (men)/> 89 cm (women). In this review we attempted to summarize relevant data by searching dermatological literature regarding associations between various skin conditions and MeTS. A multitude of studies was retrieved and a further goal of the present article is to present plausible mechanistic connections. The severity of skin conditions like psoriasis has been linked with MeTS. Parameters of MeTS like insulin resistance are present in patients with early onset androgenic alopecia, hidradenitis suppurativa acne and rosacea. Since MeTS can lead to CVD and type 2 diabetes early detection of patients would be very important. Also therapeutic intervention on MeTS could lead to improvement on the severity of skin conditions. This reciprocal relationship between skin diseases and MeTS in our opinion holds great interest for further investigation.

The evolution of diastolic dysfunction in the hypertensive disease.

AIMS: To investigate the effects of cardiac remodelling on left ventricular (LV) diastolic function, as evaluated by tissue Doppler and blood-pool indices, with respect to loading as expressed by wall stress. Cardiac remodelling is the major pathophysiological result of increased blood pressure and manifests as changes in the size, shape, and function of the heart. METHODS AND RESULTS: We evaluated 90 hypertensive patients and 30 healthy volunteers. The hypertensive patients were divided into three groups: (i) HTN-N: normal remodelling (n= 30), (ii) HTN-CR: concentric remodelling (n= 30), and (iii) HTN-CH: concentric hypertrophy (n= 30). Mitral annular early diastolic (Ea) velocities were recorded. Filling pressures (E/Ea), relative wall thickness, LV mass index, DT, isovolumic relaxation time (IVRT), E/A ratio, and longitudinal wall stress (LWS) were also measured. Diastolic dysfunction (DD) was diagnosed based on published criteria. Progressive and increased incidence of DD with advancement of LV remodelling and an increase in LV mass was noted. Wall stress-loading was higher in the HTN-N group and lower in the HTN-CR and HTN-CH groups, despite the more deteriorated diastolic function in the latter groups. DD appeared early, even in the HTN-N group, which had a 36.6% incidence of DD compared to a 13% age-related incidence in the control group (P < 0.05). When the control group was used to define the reference values for septal Ea with the cut-off set as 2SD below the mean, the HTN-N, HTN-CR, and HTN-CH groups had abnormal diastolic function at 16.6, 26.6, and 56.6% incidence rates, respectively. Septal (Ea) was correlated with LVMI (r= -0.55), RWT (r= -0.56), Age (r= -0.52), BMI (r= -0.31), SBP (r= -0.54), PP (r= -0.55), and MAP (r= -0.39), all at P < 0.05. The correlations of blood-pool indices (DT, IVRT, and E/A) with the above parameters were less than that of tissue Doppler imaging (Septal and mean Ea). In a multivariate model, LVMI (beta= -0.25), SBP (beta = -0.26), and age (beta= -0.24) R(2)= 0.49 were found to be independent predictors of DD. CONCLUSIONS: DD appears early in hypertensive disease, before the onset of abnormal remodelling or LV hypertrophy. With progression of the remodelling process and the advance of LVH, diastolic function progressively deteriorates. Tissue Doppler indices are better correlated with clinical and echocardiographic parameters of LV remodelling compared to blood-pool indices.

Is it only diastolic dysfunction? Segmental relaxation patterns and longitudinal systolic deformation in systemic hypertension.

AIMS: To investigate changes in longitudinal systolic function estimated by strain echocardiography in relation to global diastolic dysfunction and alterations in segmental relaxation patterns. METHODS AND RESULTS: We studied 75 hypertensive patients, of whom 45 had diastolic dysfunction and normal EF, and 30 matched controls. All subjects had 2D and colour Doppler myocardial imaging. Mean longitudinal strain (S) and strain rate (SR) were averaged from the basal and mid-LV segments assessed in the longitudinal axis. Early to late diastolic SR ratio <1.1 was defined as altered segmental relaxation [segmental diastolic dysfunction (DD)]. The total number of segmental DD out of the 18 basal-mid-apical segments was calculated for all the participants. Longitudinal systolic function estimated by mean strain and SR was decreased in the hypertensive group, but was further deteriorated in the diastolic dysfunction group compared with controls. Altered Segmental Relaxation was highly correlated with longitudinal systolic dysfunction expressed by strain (r: -0.56)or SR (r: -0.57). A septal mitral annular Ea cut-off of 5.9 cm/s predicted longitudinal systolic dysfunction with a sensitivity of 81% and a specificity of 70%. A multiple linear regression model proved LVMI, systolic blood pressure (SBP) and age as independent predictors of diastolic and longitudinal systolic dysfunction and BMI to independently related to diastolic dysfunction. CONCLUSION: Longitudinal systolic dysfunction may be present in hypertensive patients with diastolic dysfunction, especially when septal Ea < 5.9 cm/s. Altered segmental relaxation pattern is highly correlated with longitudinal systolic dysfunction. LV hypertrophy, SBP and aging are important determinants of both diastolic and longitudinal systolic dysfunction, whereas obesity appears to contribute to the appearance of diastolic dysfunction.