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Addiction medicine is a dynamic field that encompasses clinical practice and research in the context of societal, economic, and cultural factors at the local, national, regional, and global levels. This field has evolved profoundly during the past decades in terms of scopes and activities with the contribution of addiction medicine scientists and professionals globally. The dynamic nature of drug addiction at the global level has resulted in a crucial need for developing an international collaborative network of addiction societies, treatment programs and experts to monitor emerging concerns at national, regional, and global levels. In this protocol, methodological details of running longitudinal surveys at national, regional, and global levels through the Global Expert Network of the International Society of Addiction Medicine (ISAM-GEN) are presented. The surveys will be developed by global experts in addiction medicine on treatment services, service coverage, comorbidities, treatment standards and barriers, emerging drug addictions and/or dynamic changes in treatment needs across the world. Survey participants in categories of (1) addiction societies/associations, (2) addiction treatment programs, (3) addiction experts/clinicians and (4) related stakeholders will respond to these longitudinal global surveys. The results will be analyzed and cross-examined with available data and peer-reviewed for publication.

Sacubitril/Valsartan (S/V) carries potential anti-remodeling properties, however long-term effects and biventricular adaptive response are poorly described. 76 HFrEF patients who underwent progressive uptitration of S/V, completed the annual scheduled follow-up. After a median follow-up of 11 (8–13) months, left ventricular (LV) reverse remodeling (RR) is defined as (1) absolute increase in LV ejection fraction (EF) ≥ 10% or LVEF ≥ 50% at follow-up and (2) decrease in indexed LV end-diastolic diameter (LVEDDi) of at least 10% or indexed LVEDDi ≤ 33 mm/m2, occurred in 27.6%. Non-ischemic etiology, shorter duration of HF, and absence of a history of AF were independently associated with LVRR (p < 0.05). TAPSE and TAPSE/PASP, a non-invasive index of right ventricular (RV) coupling to the pulmonary circulation, significantly improved at follow-up (0.45 vs. 0.56, p = 0.02). 41% of patients with baseline RV dysfunction obtained favorable RV remodeling despite only a moderate correlation between RV and LV function was observed (r = 0.478, p = 0.002). Our data point to a potential long-term reverse global remodeling effect by S/V, especially in patients who start S/V at an early stage of the disease, and focus our attention on a possible direct effect of the drug in synergistic hemodynamics between RV and pulmonary circulation.

Purpose To assess the prognostic utility of quantitative 2D‐echocardiography, including strain, in patients with COVID‐19 disease. Methods COVID‐19‐infected patients admitted to the San Paolo University Hospital of Milan that underwent a clinically indicated echocardiographic examination were included in the study. To limit contamination, all measurements were performed offline. Quantitative measurements were obtained by an operator blinded to the clinical data. Results Among the 49 patients, nonsurvivors (33%) had worse respiratory parameters, index of multiorgan failure, and worse markers of lung involvement. Right ventricular (RV) dysfunction (as assessed by conventional and 2‐dimensional speckle tracking) was a common finding and a powerful independent predictor of mortality. At the ROC curve analyses, RV free wall longitudinal strain (LS) showed an AUC 0.77 ± 0.08 in predicting death, P = .008, and global RV LS (RV‐GLS) showed an AUC 0.79 ± 0.04, P = .004. This association remained significant after correction for age (OR = 1.16, 95%CI 1.01–1.34, P = .029 for RV free wall LS and OR = 1.20, 95%CI 1.01–1.42, P = .033 for RV‐GLS), for oxygen partial pressure at arterial gas analysis/fraction of inspired oxygen (OR = 1.28, 95%CI 1.04–1.57, P = .021 for RV free wall‐LS and OR = 1.30, 95%CI 1.04–1.62, P = .020 for RV‐GLS) and for the severity of pulmonary involvement measured by a computed tomography lung score (OR = 1.27, 95%CI 1.02–1.19, P = .034 for RV free wall LS and OR = 1.30, 95%CI 1.04–1.63, P = .022 for RV‐GLS). Conclusions In patients hospitalized with COVID‐19, offline quantitative 2D‐echocardiographic assessment of cardiac function is feasible. Parameters of RV function are frequently abnormal and have an independent prognostic value over markers of lung involvement.

In this ten-year retrospective study we were able to show that Maltese substance-misusing mothers (SMMs) have significantly different socio-biological characteristics from mothers in the general population which seem to impact on neonatal outcomes. Significant differences from the general population were noted in the SMM's age, age at first pregnancy, marital status, educational background, number of cigarettes smoked, number of offspring and weight gained in pregnancy. SMMs booked their pregnancy in hospital later than the general population. On the other hand their infants had a lower mean birth weight and head circumference, had lower Apgar scores, were of lesser gestational age and premature. They were less breast-fed and stayed longer in hospital after their birth.

Introduction: Refractory Angina Pectoris (RAP) dramatically affects patients' life quality and medical costs. External Shockwave Myocardial Revascularization (ESMR) improves the cardiac blood flow thanks to its proangiogenetic action on ischaemic tissues. We hereby describe our experience of ESMR in RAP patients.Materials and methods: This is a retrospective study encompassing all patients referred to OSR for RAP treatment. Efficacy of ESMR was assessed considering the difference between pre and post therapy data in SAQ score and CCS, stress test performance, 24 h ECG monitoring, NT-proBNP and echocardiographic measures.Results: From a total of 97 patients with RAP, 19 patients underwent ESMR, whereas 4 were considered as control group. After the end of the treatment, ESWT group showed a significant improvement in CCS class (-1.32 +/- 0.58; p < 0.001) and in each of the five variables of the SAQ score (p < 0.05). Patients also improved their exercise duration (50,74 +/- 29.40 seconds; p < 0,001) and double product (1340,53 +/- 1321,77; p < 0,001) and reduced the number of daily ST segment depression (-1,16 +/- 1,01; p < 0,01). Ejection Fraction (2,05 +/- 1,84%; p < 0,01) and Cardiac Output (0,20 +/- 0,28 L, p < 0,01) improved too. No changes were documented in the control group.Conclusion: ESMR is an efficient therapy for refractory angina capable to improve both symptoms and instrumental tests. (C) 2017 Elsevier Inc. All rights reserved.

La comunicazione gestante-feto - The prenatal origin of the parent-child relationship was proposed in the past century by authors from a psychoanalytical domain affirming the relevance of the parent’s affective investment in the unborn baby. Extensive literature focused on psychological processes involved in transition to motherhood like adaptation to pregnancy, maternal role attainment, maternal identity forming and maternal representation of the unborn baby. During pregnancy the woman gradually becomes aware of the foetus as an individual being, increasingly recognizing the separate person. In the last twenty years literature has brought evidence to organized foetal sensory-motor behaviour, auditive competence and foetal learning capability as from the fifth month of gestation. These foetal abilities in turn contribute to the increasing maternal awareness of the foetus which seems to be crucial in establishing the mother’s attachment to her unborn baby. Mothers often report interaction with their unborn babies by talking or caressing the baby in the tummy. This early communication is supposed to have an influence on the development of the baby’s mind. In the uterus it is particularly easy for the fetus to catch the sonorous or tactile maternal stimulus and consequently the growing nervous system and the developing cortical areas may receive a specific stimulation. Moreover the emotional communication between the mother and foetus has been explored. Animal experimentation and human observational studies have pointed out a relationship between maternal depression or anxiety and the impairment of the fetal nervous system due to the exposition to maternal cortisol. Presence of anxious and depressive symptoms in pregnancy is common and is related to premature birth risk, obstetrical complications, lack in the mother’s prenatal care of herself and her baby and persists in a high number of cases in post partum depression. Based on this evidence the consideration of the foetus as a sensible, communicative and vulnerable person becomes very important as well as the promotion of pre and perinatal maternal mental health must be a priority.